• Journal of Korean Academy of Fundamentals of Nursing
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• v.17 no.4
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• pp.450-459
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• 2010

Purpose: The purposes of this study were to identify awareness and attitudes toward advance directives (ADs) among Korean adults and to examine various opinions in the utilization of ADs among young, middle-aged, and older adults. Methods: Data were collected using a structured questionnaire from 384 adults selected by a quota sampling method on the basis of age. Results: The majority of participants preferred that they themselves would be the primary decision maker. Most of them were unaware of the option of ADs but supported the utilization of ADs. Most of the participants preferred detailed descriptions on end-of-life decisions in ADs but wanted to allow some leeway in following it. Significant differences were found among age groups in terms of the preferences regarding the utilization of ADs. Conclusion: It is suggested that nurses make efforts to educate the general public about ADs and facilitate advance care planning, which focuses on the process of communication on end-of-life preferences within the social network of relationships.

• Journal of Hospice and Palliative Care
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• v.23 no.3
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• pp.139-150
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• 2020

Purpose: The purpose of this study was to investigate the levels of end-of-life care competency; knowledge, attitudes, and experiences regarding advance directives; perceptions of good death; and end-of-life care obstacles and supportive behaviors among tertiary care nurses. Methods: The participants were 150 nurses at a tertiary hospital in Jinju, Korea. The data collected using a questionnaire were analyzed using descriptive statistics, the t-test, analysis of variance, Pearson correlation coefficients, and stepwise multiple regression in SPSS for Windows version 24.0. Results: The mean (±SD) score of end-of-life care competency was 3.63 (±0.53) on a 5-point scale. A significant difference in end-of-life care competency was found according to whether nurses had experienced the death of a family member or acquaintance (P=0.029). According to stepwise multiple regression analysis, the factors affecting end-of-life care competency were the frequency of end-of-life care supportive behaviors (β=0.38, P<0.001), experience with advance directives (β=0.29, P<0.001), and marriage (β=0.15, P=0.039). This model had an explanatory power of 27.9% (F=18.87, P<0.001). Conclusion: In order to improve nurses' end-of-life care competency, it is important to strengthen end-of-life care supportive behaviors by exposing nurses to those behaviors and providing frequent experience with advance directives.

• Journal of Korean Critical Care Nursing
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• v.3 no.2
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• pp.77-90
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• 2010

Purpose: The aim of this study is to carry out research on nurses regarding end of life decision and advance directives (ADs) and their attitude, experience and confidence towards them in order to define the role of nurses. Methods: In this research, questionnaire was distributed and data were collected and analyzed after receiving a written consent from 332 nurses. The survey was conducted from the $14^{th}$ to $30^{th}$ of September, 2009. The instrument used for conducting the study was revised version of KAESAD (The Knowledge, Attitudinal, Experiential Survey on Advance Directives). Results: We have come to a conclusion that nurses have positive attitude towards ADs. However, they hardly had any experience regarding them which leads to low confidence in assisting preparing ADs. Also, attitude towards ADs had no correlation with experience and confidence. Conclusion: In order to bring about the confidence level from positive attitude that nurses have, there needs to be a systematic change in nursing education. For that, it requires an education system that emphasizes the role of nurses which incorporates Korean culture and characteristics regarding death issue.

• Journal of Korean Academy of Rural Health Nursing
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• v.14 no.1
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• pp.1-7
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• 2019

Purpose: The purpose of this study was to describe nursing students' perception of well-dying and knowledge for Advanced Directives. Methods: Nursing students from one university were selected for the research and a survey was carried out during March and April, 2019. A total of 133 nursing students participated in this study. Data were analyzed using t-test, ANOVA, $x^2$ test with SPSS statistics 21.0. Results: According to the results, the mean score for perception of well dying was $3.00{\pm}0.31$, and knowledge for Advance Directives was $9.05{\pm}2.20$. Perception of well-dying was significantly different by grade group. Knowledge for Advance Directives was significantly different by pre-education experience. Conclusion: In order to improve the nursing students' knowledge for advanced directives, it is necessary to develop education program and provide them through the total school years.

• Journal of Korean Clinical Nursing Research
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• v.26 no.1
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• pp.86-96
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• 2020

Purpose: The purpose of study was to provide basic data for developing interventions that could help middle-aged adults prepare for dignified death in the future by examining their attitudes toward death and advance directives (AD), and knowledge of AD. Methods: Data were collected through a survey of 211 middle-aged adults from January 28 to February 28, 2019, in a city located in Gangwon Province. To analyze the data, descriptive statistics, t-test, one-way ANOVA, Scheffé test, Pearson's correlation coefficient and stepwise linear regression were utilized using SPSS/WINdows 21.0. Results: The average score of the participants' attitudes toward death and AD, and knowledge of AD was 91.82±10.89, 15.53±4.27, 46.00±9.45, respectively. There were positive correlations between attitudes toward dignified death and attitudes toward AD, and knowledge of AD. Factors that influence attitudes toward AD were shown in the order of attitudes toward dignified death, knowledge of AD, and intentions to write AD (Adjusted R²=.24). Conclusion: For the dignified death in the future, it is necessary to provide middle-aged adults with an opportunity to think about the need of AD. In addition, extensive education and promotion of AD are required to correct the misunderstanding of AD.

• Journal of Korean Academic Society of Home Health Care Nursing
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• v.25 no.3
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• pp.204-214
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• 2018

Purpose: This study aimed conducted to investigate biomedical ethics awareness and attitudes toward dignified death and advance directives among nursing students. Methods: Data were collected through structured questionnaires from 222 nursing students with clinical practice experience, from November 7 to 23, 2015. Data were analyzed by independent t-tests, one-way ANOVA, Kruskal-Wallis test, and Pearson's correlation coefficients using SPSS WIN 22.0. Results: The scores for biomedical ethics awareness and attitudes toward dignified death were 2.89 and 3.15, respectively. Regarding attitudes toward advance directives (ADs), most students agreed with writing ADs. The main reason given for writing ADs is "I want to receive my treatment of choice." As for the range and explanation method for ADs, 45.7% of participants responded, "do not know well." Regarding willingness toward life sustaining treatment, "only pain control, no life sustaining treatment" was indicated by 83.4% and, "all information about symptoms and prognosis" by 91.9% of participants. For willingness to write ADs, 70.0% of participants responded "yes." Conclusion: Curriculum for nursing ethics should be included in clinical training courses to improve related courses and provide an opportunity to deal with practical problems, such as biomedical ethics, death with dignity, and ADs.

• Journal of Hospice and Palliative Care
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• v.25 no.1
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• pp.25-41
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• 2022

Purpose: This study investigated trends of nursing research on life-sustaining treatment in South Korea. Methods: The period for data search was set from January 2018 to December 2020. The major search terms used were advance directives and life-sustaining treatment. Of the 492 records identified in the initial search, 461 articles were excluded for various reasons. A total of 31 records were included in the final qualitative analysis. Results: Sixteen studies had nursing students as study subjects, while nine studies had nurses as study subjects. The majority of the studies employed cross-sectional descriptive surveys as their research design. The major themes that emerged from the studies were as follows: attitudes toward withdrawal of life-sustaining treatment, knowledge of and attitudes toward advance directives, perceptions of a good death, and nurses' attitude toward life support care. Most of the studies reviewed concluded that attitudes toward withdrawal of life-sustaining treatment significantly impacted both knowledge of and attitudes toward advance directives and perceptions of a good death. Conclusion: To date, Korea still lacks extensive nursing research concerning life support care. Further research is needed to provide systematic education for nursing ethics and life support care, as well as the introduction of a specialist course. Furthermore, a multidisciplinary approach is necessary to provide diverse support systems and policy measures. In particular, since nurses are directly responsible for providing life support care, nurses' roles should be expanded in accordance with the Act on Decisions on Life-Sustaining Treatment.

• The Korean Society of Law and Medicine
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• v.14 no.1
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• pp.355-401
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• 2013

The first legislation for terminal health-care decision was California's Natural Death Act (NDA) of 1976 that permitted any adult person to execute a directive directing the withholding or withdrawal of life-sustaining procedures. Advance directive legislation has subsequently progressed on a state-by-state basis. By 1992, all 50 states, as well as the District of Columbia, had passed legislation to legalize some form of advance directive. This state legislation, however, has resulted in an often fragmented, incomplete, and sometimes inconsistent set of rules. Statutes enacted within a state often conflict and conflicts between statutes of different states are common. In an increasingly mobile society where an advance health-care directive given in one state must frequently be implemented in another, there is a need for greater uniformity. In 1993, the Uniform Law Commissioners approved the Uniform Health-Care Decisions Act (UHCDA) in order to bring order to the existing chaos. Unfortunately, the Commissioners waited too long to act. By the time the UHCDA was approved, nearly all states had passed legislation governing advance directives. Consequently, the UHCDA has achieved only a limited success, picking up but one or two enactments a year. The UHCDA is currently in effect in around 10 states: Alabama, Alaska, California, Delaware, Hawaii, Kansas, Maine, Mississippi, New Mexico, Tennessee, Wyoming. In these states the previous laws related to the subjects have been all repealed. The overall objective of the UHCDA is to encourage the making and enforcement of advance health care directives including living will or individual instruction, power of health-care attorney and to provide a means for making health care decisions for those who have failed to plan. The U. S. House of Representatives in 1991 enacted the Patient Self-Determination Act (PSDA). The Act stipulates that all hospitals receiving Medicaid or Medicare reimbursement must ascertain whether patients have or wish to have advance directives. The Patient Self- Determination Act does not create or legalize advance directives; rather it validates their existence in each of the states. Now in America, terminal health-care decision or advance directive for health care is common and universal system. The problem, however, is how to let more people use these good tools to make their lives more beautiful and honorable.

• The Journal of Korean Academic Society of Nursing Education
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• v.19 no.3
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• pp.330-340
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• 2013

Purpose: This study was performed to identify the level of Korean elderly's knowledge regarding concepts of end-of-life (EOL), Life-sustaining-treatment (LST), and advance directives (AD) which are critical aspects for establishing AD in Korean society. Methods: A questionnaire survey was done between October 2011 and February 2012. Knowledge of AD was evaluated with 3 aspects including EOL, LST, and AD utilizing a questionnaire that was developed by authors for the study. Data were collected from 268 community dwelling elderly from three cities and analyzed using descriptive statistics, t-tests, one-way analysis of variance, and a Scheffe post hoc test with SAS Ver. 9.1 program. Results: Overall, Korean elderly were poorly acquainted with AD related concepts. Significant differences in awareness of AD including understanding of EOL, the level of comprehension of LST, and knowledge about AD were revealed by gender, education level, economic state, and acquaintance with terms of AD or LST. Conclusion: To acknowledge autonomy and support quality of life for elderly and to meet the purpose of AD, attention should be given to target populations including elderly in terms of knowledge level related to AD, social marketing, and infra structure relevant to practice AD in our society.

• Journal of Korean Academy of Nursing
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• v.42 no.4
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• pp.486-495
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• 2012

Purpose: The purpose of this study was to explore the main prerequisite for Korean Advance Directives [KAD] to ensure their better use. Methods: Data were collected from two focus group interviews and individual email responses. Study participants were 5 doctors and 6 nurses. All interview data were transcribed and analyzed using qualitative content analysis. Results: Three main themes emerged; establishing a philosophy of KAD, protocol to practice KAD, and the KAD document itself. A philosophy is needed to ensure individual needs, consensus to practice AD and identify principle agents. The core of protocol was found to be as follows; 1) process, 2) premise, 3) procedure, 4) contextual preparation, 5) timing, 6) feasibility. Component and feasibility need to be established for the document itself. Conclusion: For a positive acceptance of KAD in Korean society, a culture sensitive, reality based, and user friendly AD needs to be developed.