• Journal of Hospice and Palliative Care
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• v.16 no.4
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• pp.216-222
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• 2013

Purpose: The purpose of this study was to examine nurses' emotional responses and ethical attitudes towards elderly patients' Do-Not-Resuscitate (DNR) decision. Methods: Data were collected using a questionnaire which was filled out by 153 nurses who worked in nursing homes and general hospitals. Data were analyzed using real numbers, percentages, means, standard deviations and Pearson's correlation coefficients with SPSS 19.0 program. Results: The average score for ethical attitudes towards the DNR decision was 2.68 out of 4. Under the ethical attitudes category, the highest score was found with a statement that said 'Although they will not perform cardiopulmonary resuscitate (CPR), it is right to do their best with other treatments for DNR Patients'. Items regarding emotional responses to the DNR decision, the average score was 2.36 out of 4. Among them, the highest score was achieved on 'I understand and sympathize'. No significant correlation was found between ethical attitudes and emotional responses in relation to patients' DNR decision (r=-0.12, P=0.13). Conclusion: Regarding elderly patients' DNR decision, nurses showed somewhat highly ethical attitudes and slightly positive emotional response. A follow-up study is needed to investigate variables that affect our results.

• Journal of Hospice and Palliative Care
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• v.16 no.2
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• pp.80-89
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• 2013

Purpose: We investigated how intensive care unit (ICU) nurses understand the meaning of death, death anxiety, death concern and respect for life. Methods: From November 2009 through February 2010, a survey was conducted on 230 nurses working at the ICU of 10 general hospitals located in Seoul and Gyeonggi province. Participants were asked to answer a questionnaire consisted of 67 questions under four categories of the meaning of death, death anxiety, death concern and respect for life. Results: Participants scored 4.27 points on their understanding of the meaning of death, 4.43 on death anxiety, 4.12 on death concern and 4.18 on respect for life. Participants' meaning of death was negatively correlated with death anxiety and death concern and positively with respect for life. Participants' positive meaning of death was negatively correlated with death anxiety and death concern and positively with respect for life. Participants' negative meaning of death was negatively correlated with death anxiety and death concern and positively with respect for life. Participants' death anxiety was positively correlated with death concern and negatively with respect for life. Participants' death concern was negatively correlated with respect for life. Conclusion: Compared with nurses who served at ICU for a long time, nurses with less ICU experience scored lower on the meaning of death and respect for life, while they presented high anxiety and concern about death. A training course may help nurses develop their view on the meaning of death, which in turn would enhance their performance in caring dying patients.

• Journal of Hospice and Palliative Care
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• v.20 no.1
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• pp.1-7
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• 2017

The paper describes The Narrative Communication Model of Hope Seeking Intervention developed by the authors as an approach to help clients to have individually specific hope experiences. The Model is founded upon the existential conceptualization of hope that views hope as subjective, unique experiences of meaning and processes. The Model has been developed based on the findings both in the literature and the authors' work on the nature of hope and hope experiences and integrating the concept of hope as subjective meanings and experiences, the processes of story-telling and the concept of narrative configuration as a way to engage in person-specific experiences, and person-centered communication. The results of the experiences with the application of the model in a study are used to clarify the model further. The Model incorporating story-telling and narrative construction through person-centered communication is identified in three components-the story-telling, the narrative intervention, and the communication components. These components are processed as an intervention to culminate into person-specific hope experiences in which active participation of clients as the story-teller and of interventionist as the communicative facilitator is required to produce narratives of hope with individual specific thematic plots that become the basis for hope experiences. The application of the Model has shown positive outcomes in clients with successful seeking of own hope experiences. The success of the Model application seems to depend upon interventionists' understanding of the model and the competency with the application of person-centered communication strategies.

• Journal of Hospice and Palliative Care
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• v.20 no.1
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• pp.46-57
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• 2017

Purpose: The purpose of this study is to identify the changes to nursing activities of nurses on patients with DNR (Do-Not-Resuscitate) order and factors associated to the changes. Methods: Data were collected using a structured questionnaire for 173 nurses at general hospitals. Logistic regression analysis was performed on the data using SAS 9.4. Results: With 39 nursing activities, an average of 60.4 (34.9%) nurses reported an increase in the activities, 102.4 (59.2%) no change and 10.1 (5.9%) a drop. The activity increase was the greatest in the social area, and the physical area was where the activities decreased the most. The activity increase was associated knowledge competency (9 items), attitudes (2 items), practical competency (4 items) and work load (14 items were). Conclusion: To offer systematical care for DNR patients, it is necessary to expand nurses' knowledge through end-of-life education and adjust their workload and provide a support system at the department level.

• Journal of Hospice and Palliative Care
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• v.20 no.1
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• pp.26-36
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• 2017

Purpose: To explore the meaning of prayer in Korean patients with end-stage cancer who profess Christianity or Buddhism, given the significant differences between these religions. Methods: The Colaizzi (1978) analysis method was employed. In-depth interview were performed with 13 participants (seven Christians and six Buddhists) who were admitted to a University-affiliated hospital in Korea. Results: The six categories emerged: 1) communication with God, 2) mind discipline, 3) spiritual growth, 4) mysterious experiences, 5) perception of death and after-life, and 6) various forms of prayers. Conclusion: The participants' prayer experiences were described in a religious context. Christians believed that prayer is communication with God while Buddhists regarded it as disciplining of minds. Despite some differences between the religious groups, a general meaning of prayer was a desperate desire to solve their health issues by relying on God or someone who is more powerful than themselves. They also experienced personal and spiritual growth through prayer. This study explains the phenomenon of prayer experiences and shows that prayer is an important coping mechanism.

• Journal of Hospice and Palliative Care
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• v.20 no.4
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• pp.253-263
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• 2017

Purpose: To develop end-of-life care training programs for nurses who provide in a tertiary hospital, we examined the mediating effects of empathy and resilience on the relationship between their stress and job performance. Methods: This study was conducted with 218 participants at a hospital in B city in South Korea from August 15 through August 30, 2017. Data collected from the participants were analyzed using descriptive statistics, t-test, ANOVA, Pearson's correlation coefficients, and multiple regression using the IBM SPSS/WIN 21.0 software. Results: Terminal care stress was found to be negatively correlated with empathy competence (r=-0.345, P<0.001), resilience (r=-0.223, P=0.001) and terminal care performance (r=-0.260, P<0.001), whereas empathy (r=0.467, P<0.001) and resilience (r=0.358, P<0.001) were positively correlated with terminal care performance. Empathy had a complete mediating effect (${\beta}=0.409$, P<0.001) on the relationship between terminal care stress and performance, and resilience a partial mediating effect (${\beta}=0.294$, P<0.001). Conclusion: Based on the findings of this study, development of training programs with a focus on empathy and resilience are highly recommended to improve job performance of nurses who provide terminal care in a tertiary hospital.

• Journal of Hospice and Palliative Care
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• v.19 no.4
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• pp.322-330
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• 2016

Purpose: This study investigated long-term care hospital nurses' knowledge and practice of pain management and their attitudes towards the job with an ultimate aim to provide fundamental information for development of a pain education program. Methods: A cross-sectional survey was carried out with 120 nurses from four long-term care hospitals. Nurses' knowledge of and attitudes towards pain management was measured using a tool developed by Watt-Watson. To examine their pain management practice, an instrument was developed based on the pain management guidelines used by the long-term care settings. Results: For pain management knowledge, the participants gave an average of 26.2 (${\pm}13.10$) correct answers out of 40 questions. The most frequently missed question was one about subjectivity of pain, "Patients' physiological and behavioral reactions to pain hint at the presence and intensity of pain" (89.2%), and 56.7% of the nurses believed that increasing tolerance for a narcotic analgesic means addiction. Regarding attitudes towards and practice of pain management, 80.2% of the nurses used placebos to patients who complain about pain often. Conclusion: This study revealed poor level of pain management knowledge of and attitude among long-term care hospital nurses. This might negatively affect their pain management practice. From the educational perspective, nurses should be provided with education on pain management education with emphasis on the nature of pain and misuse of placebo drugs.

• Journal of Hospice and Palliative Care
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• v.19 no.4
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• pp.331-334
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• 2016

Purpose: Advanced cancer may accompany cold sweat as paraneoplastic symptom. Few studies have been performed on the efficacy of non-steroid anti-inflammatory drug (NSAID) in advanced cancer patients who sweated without fever. Methods: To select study participants, medical records were retrospectively reviewed for patients who satisfied the following criteria: 1) incurable, advanced solid cancer; 2) Cold sweating of 4 or higher on the numeric rating scale (NRS) 4; 3) No evidence of infection or hypoglycemia; 4) No newly started opioid or anti-hormonal agents within one month; 5) NSAID prescription for the management of cold sweating and 6) Documented NRS information before and after NSAID administration. Results: A total of 13 patients were selected after excluding four patients due to lack of NRS information or fever. The mean age was 59 years old (range: 50~71), and nine patients (69%) were male. Bile duct cancer was the most common primary tumor followed by pancreatic cancer, gastric cancer and prostate cancer. The mean NRS of cold sweating dropped from baseline 6.5 (min-max: 4~10) to 1.9 at the follow-up assessment (min-max: 0~5). The mean follow-up period was 9.1 days (range: 2~30 days) from NSAID treatment to assessment. Conclusion: NSAID was effective medication for management of sweating without fever in patients with advanced cancer.

• Journal of Hospice and Palliative Care
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• v.3 no.1
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• pp.60-73
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• 2000

Purpose : The purpose of this study was to describe a total pain model in patients with terminal cancer and to identify factors relating to total pain using the Twycross Pain Management Model, which included physical, psycho-social and spiritual pain. Method : The study was a retrospective descriptive study. The first stage included 87 patients who received hospice service at Y hospital in 1997. The second stage included five model patients who suffer severe pain as selected by the four hospice nurses. Data collection was from 1) chart analysis and 2) in-depth interviews with the hospice nurses about their selected patients. Data analysis was performed using SPSS-WIN and content analysis. Result : 1) The main problems of 3 patient with terminal cancer were pain(77%), constipation (25.3%), family coping(35.6%), psycho-spiritual distress(17.2%)and other symptoms. 2. The Twycross model was a useful model. However, new items were added; loneliness, depression, and no improvement in condition as depression factors. In anger, new items were anger due to family neglect, at God and in relationships. The case studies identified the followsing; 1) Patient suffer from physical pain as well as multiple other symptoms when cancer is advanced. 2) Body concept, role change, threat to self concept, fear of pain, fear of death, anxiety, family conflict, financial burden, spiritual distress, hope for a cure, are all affected. Conclusion : 1) It is believed that the Twycross model is useful but further tests and revisions are necessary for deciding priorities in the care plan. 2) Pain management must improve culturally appropriate and family support, psychological, spiritual care are imperative for patient with terminal cancer. 3) Further study is recommended to test correlations of depression, anxiety, spiritual distress and family coping using valid instruments. A qualitative study on the spiritual journey of the patient with terminal cancer is also recommended.

• Journal of Hospice and Palliative Care
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• v.3 no.1
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• pp.28-38
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• 2000

Purpose : This study examined characteristics of, problems of and services provided to hospice recipients and their family members at a home hospice organization. Methods : The subjects were 113 people who were discharged from one free-standing home hospice organization between November, 1994 and lune, 1999. Since the opening of the organization in November of 1994, it has provided hospice services at patients' homes with no charge. Data were collected from those subjects' records. Results : The average age of the subjects was 57.1 years; those aged 60 and over were 54%. Spouse was the most frequent(50.9%) primary caregiver followed by daughter-in-law and daughter. All the subjects were diagnosed as having cancer. Of those 41 subjects who did not know their terminal stage in the beginning, 31 subjects came to know their states. Of the subjects, 72.7% were referred from their physicians. On the average, the service duration and the number of home visits were 6.8 weeks and 7.2 times, respectively. Pain was the most prevalent problem of the subjects(89.4%). Medication management was the most frequently provided service followed by psychological supports. The reasons for discharge were death(88.5%) and refusal(8%). Home was the most frequent place of death(60%). Conclusion Home hospice service providers should be trained particularly in working with elders and in managing cancer pain. People need to be referred at an appropriate time for achieving goals of hospice. Community recognition of hospice services needs to be promoted.