• Journal of Hospice and Palliative Care
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• v.19 no.2
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• pp.136-144
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• 2016

Purpose: To provide practical data for bioethics education, we identified correlations between recognition of good death, attitude towards withdrawal of meaningless life-sustaining treatment, and attitude towards euthanasia in nurses. Methods: Using convenience sampling, we recruited 218 nurses who had at least six-month work experience in one of the six general hospitals with 500 or more beds in Seoul, Busan, and Gyeongsang province. All participants understood the purpose of the study and agreed to take part in the study. The research tools used included the Concept of Good Death Measure (CoGD), the measurement tool for attitudes towards withdrawal of meaningless life-sustaining treatment (WoMLST), and the measurement tool for attitudes towards euthanasia. Data were analyzed using an Independent t-test, one-way ANOVA, and Pearson's correlation coefficient using SPSS 21 for Windows. Results: Nurses had normal levels on CoGD, WoMLST, and attitudes towards euthanasia. Nurses' CoGD, WoMLST, and euthanasia scores significantly differed depending on their education level, working period, and the importance of religion to them. A negative correlation was found between the CoGD and WoMLST scores, and WoMLST and euthanasia scores were positively correlated. Conclusion: Nurses should be trained to deal with ethical issues that may arise while caring for terminal patients. It is necessary for nurses to understand the concepts related to CoGD, WoMLST, and euthanasia, and to promote bioethics education with focus on decision-making and problem-solving ability in ethically conflicting situations.

• Journal of Hospice and Palliative Care
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• v.16 no.2
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• pp.108-117
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• 2013

Purpose: The objectives of this study were to 1) explore nurses' attitudes toward death, coping with death, understanding and performance regarding end-of-life (EOL) care, 2) describe correlations among the above factors, and 3) determine the factors affecting nurses' EOL care performance. Methods: Study participants were 187 nurses stationed at departments that post higher mortality than others such as the oncology department, intensive care unit (ICU) and emergency department (ED). Data were collected from three urban university-affiliated hospitals. Multi-dimensional measure was performed for study instruments such as "attitude toward death", "coping with death" and "understanding and performance regarding EOL care". Data were analyzed by using descriptive statistics, correlation, and multiple regressions. Results: First, nurses showed significantly different attitudes toward death by age, religion, work unit and EOL care education. Younger nurses tend to score low on the understanding of EOL care, and ED nurses' score was lower than their peers at the oncology department and ICU. Second, EOL care performance was positively correlated with attitude toward death (P<0.001), coping with death (P=0.003) and understanding of EOL care (P<0.001). Third, nurses' EOL care performance was affected by work unit (P<0.001) and understanding of EOL care (P<0.001). Conclusion: Because nurses' performance was influenced by their work unit and understanding of EOL care, they should be provided with appropriate training to improve their understanding of death and EOL care according to work unit.

• 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.15 no.3
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• pp.155-161
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• 2012

Purpose: In this study, we evaluated the effects of training for survival prediction of terminally ill patients in terms of medical professionals' confidence, accuracy and knowledge of survival prediction. Methods: Twenty-nine participants completed a self-administered questionnaire where they scored their confidence, accuracy and knowledge of survival prediction before and after the training session. The training was provided in July 2009 at a university hospital located in Gyeonggi province, Republic of Korea. The participants were instructed by a professor of family medicine specialized in hospice palliative medicine to predict survival of a case using the palliative prognostic score and objective prognostic score. The training was provided in the form of a PowerPoint presentation for 40 minutes. Results: Participants' confidence in survival prediction significantly increased from $4.00{\pm}1.73$ ($mean{\pm}SD$) (0~10, visual analogue scale) to $5.83{\pm}1.71$ after the training (P<0.001). Before training, participant's level of confidence significantly correlated with their age (P=0.04). The training significantly improved the correlation between the confidence level and the number of terminal cancer patients whom they have experienced (P=0.005 before training, P=0.017 after training). Participant's accuracy in survival prediction also significantly improved from 14 of 29 (48%) to 27 of 29 (93.1%) (P<0.001). The change in knowledge of survival prediction was too small to be statistically analyzed. Conclusion: After training, the confidence and accuracy scores significantly improved. Further study with a greater number of participants is needed to generalize this finding.

• Journal of Hospice and Palliative Care
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• v.19 no.1
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• pp.11-25
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• 2016

Purpose: The purpose of this study was to determine the factors that influence healthcare providers' attitude towards end-of-life care (EOLC) in the emergency department (ED) in hospital settings. Methods: From June 1 through June 30, 2014, a descriptive correlational study was performed with 41 doctors and 105 nurses stationed in the ED. Results: According to a regression model on the factors affecting healthcare providers' professional attitude towards EOLC, 28.1% of variance (F=15.185, P=0.000) was explained by awareness of death, gender and personal attitude towards EOLC. And 34.1% of the healthcare providers' personal attitude was related with awareness of death, experience of hospice education, occupations and professional attitude towards EOLC. Conclusion: This study demonstrated that attitude towards EOLC was influenced by awareness of death and personal characteristics. Healthcare providers in the ED should be provided with tailored training to improve their understanding of death. Also an educational program should be developed and provided to ED healthcare providers to improve their awareness of death.

• Journal of Hospice and Palliative Care
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• v.18 no.1
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• pp.25-34
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• 2015

Purpose: This study is to find relationship between cancer patient's spiritual health and the level of their anxiety and pain. Methods: From April 27 through May 11, 2012, a survey was conducted with 167 cancer patients hospitalized at a university hospital in Busan. Spiritual health was measured by the Spiritual Health Inventory developed by Highfield (1992). The instrument for anxiety measurement was the State-Trait Anxiety Inventory by Spielberger (1975) and that for pain was the Visual Analogue Scale (2009). The association between patients' characteristics and spiritual health, anxiety or pain degree were analyzed using the ANOVA test. The interrelationship between spiritual health, anxiety and pain was analyzed using Pearson's correlation coefficients. Results: The patients exhibited a moderate degree of spiritual health and anxiety and a mild level of pain. Patients' spiritual health significantly differed by their religion, education, monthly income of the family, illness conditions, physical conditions, metastasis, daily living and support. Their anxiety level was significantly different according to age, religion, education, illness conditions, physical conditions, metastasis, daily living, family/friends' support and use of analgesics. Significant differences were also found in the level of pain according to illness conditions, physical conditions, metastasis, daily living, family/friends' support and use of analgesics. We found a moderately negative correlation between spiritual health and anxiety. Anxiety and pain showed a positive correlation, and spiritual health and pain exhibited a negative correlation. Conclusion: To help cancer patients to manage their spiritual health, anxiety and pain, a program should be developed considering the primary factors discussed in this study.

• Journal of Hospice and Palliative Care
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• v.17 no.3
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• pp.161-169
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• 2014

Purpose: This study was conducted to comprehensively investigate nursing students' experience of their first encounter with death of a patient during clinical practice. Methods: This study took place from January 27 through March 6, 2012 with eight female senior nursing students enrolled at Pusan National University located in Y city who have experienced patient death. We collected their experience of their first death encounter during their clinical rotation by asking, "What is your first experience of patient's death during the clinical practice?" Husserl's phenomenological approach was applied in this study. Results: In this study, 17 themes, 15 clusters of themes and eight categories were derived. The categories included "Desire to avoid the reality of death", "Powerlessness", "Anticipation for recovery shifted to fear of death", "Various interpretations of death", "Limitations in their nursing practice", "Resentment of lack of nurses", "Longing to better understand death", and "Motivation for inner growth". Conclusion: Through their first encounter with death of a patient, nursing students experienced various emotions and viewed their role as hospice caregiver by projecting themselves as fully trained nurses in future. Participants considered terminal care as a part of nursing care. The result of this study indicates the need to include education of death in the nursing school curriculum.

• Journal of Hospice and Palliative Care
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• v.11 no.2
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• pp.91-98
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• 2008

Purpose: This study was undertaken to compare perceived stress and coping patterns, and their effects on depression between cancer patients and healthy adults. Methods: A descriptive design was used with 278 subjects, consisting of 139 cancer patients and 139 health adults, living in an urban area. All participants completed the following prerequisites; Stress Visual Analog Scale, Ways of Coping Checklist (W.C.C.L), Depression Index (CES-D), and Demography and Disease Data Questionnaire. Results: Perceived stress and depression were significantly higher, while wishful thinking was lower among cancer patients than healthy adults, after adjusting for education and family income which were not homogeneous between the groups. Among cancer patients, 20.2% of depression was mainly due to seeking support (10.7%), perceived stress and education, while 30.7% of depression in healthy adults was due to perceived stress, problem solving, and seeking support. Conclusion: These findings suggest that interventions to manage depression in cancer patients should include strategies to best foster positive coping patterns and reduce perceived stress.

• Journal of Hospice and Palliative Care
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• v.17 no.4
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• pp.270-277
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• 2014

Purpose: This is a retrospective study that investigated cancer patients' complaints of moderate or severe pain to analyze pain characteristics, pain relief interventions and their effects. Methods: The participants of this study were 363 patients who were hospitalized in the cancer ward for three to 30 days and scored 4 points or higher on the pain severity assessment. Results: The most frequent region of pain was the abdomen. The most frequent factor that exacerbated pain was movement. The most frequent pain alleviating factor was administration of analgesics. The most frequent pain type was breakthrough pain, and the most frequent non-pharmaceutical intervention for pain control was heat therapy. Among all, analgesics were routinely prescribed for 52.2% of the participants. Morphine sulfate was the most frequently used analgesic while Gabapentin was the most frequently used non-narcotic analgesic. At the time of discharge, 82.5% of the participants marked their pain intensity as 3 points or lower. Conclusion: For cancer patients complaining of moderate or severe pain, it is important to actively control pain from the beginning of admission. Thus, it is necessary to educate not only cancer patients using narcotic analgesic for pain control and their families but nurses about the effects and side-effects of drugs. Moreover, patients and their families need to learn how to assess and record pain at home to collect data that can be referred for future treatment.

• 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.