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An Exploratory Study of Hospice Care to Patients with Advanced Cancer (암환자를 위한 호스피스 케어에 관한 탐색적 연구)

  • Park, Hye-Ja
    • The Korean Nurse
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    • v.28 no.3
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    • pp.52-67
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    • 1989
  • True nursing care means total nursing care which includes physical, emotional and spiritual care. The modern nursing care has tendency to focus toward physical care and needs attention toward emotional and spiritual care. The total nursing care is mandatory for patients with terminal cancer and for this purpose, hospice care became emerged. Hospice case originated from the place or shelter for the travellers to Jerusalem in medieval stage. However, the meaning of modem hospice care became changed to total nursing care for dying patients. Modern hospice care has been developed in England, and spreaded to U.S.A. and Canada for the patients with terminal cancer. Nowaday, it became a part of nursing care and the concept of hospice care extended to the palliative care of the cancer patients. Recently, it was introduced to Korea and received attention as model of total nursing care. This study was attempted to assess the efficacy of hospice care. The purpose of this study was to prove a difference in terms of physical, emotional a d spiritual aspect between the group who received hospice care and who didn't receive hospice care. The subject for this study were 113 patients with advanced cancer who were hospitalized in the S different hospitals. 67 patients received hospice care in 4 different hospitals, and 46 patients didn't receive hospice care in another 4 different hospitals. The method of this study was the questionaire which was made through the descriptive study. The descriptive study was made by individual contact with 102 patients cf advanced cancer for 9 months period. The measurement tool for questionaire was made by author through the descriptive study, and included the personal religious orientation obtained from chung(originated R. Fleck) and 5 emotional stages before dying from Kubler Ross. The content ol questionaire consisted in 67 items which included 11 for general characteristics, 10 for related condition with cancer, 13 for wishes far physical therapy, 13 for emotional reactions and 20 for personal religious orientation. Data for this study was collected from Aug. 25 to Oct. 6 by author and 4 other nurse's who received education and training by author for the collection of data. The collected data were ana lysed using descriptive statistics, $X^2-test$, t-test and pearson correlation coefficient. Results of the study were as follows: "H.C Group" means the group of patient with cancer who received hospice care. "Non H.C Group" means the group of patient with cancer who did not receive hospice care. 1. There is a difference between H.C Group and Non H.C Group in term of the number of physical symptoms, subjective degree of pain sensation and pain control, subjective beliefs in physical cure, emotional reaction, help of present emotional and spiritual care from other personal, needs of emotional and spiritual care in future, selection of treatment method by patients and personal religious orientation. 2. The comparison of H.C Group and Non H.C Group 1) There is no difference in wishes for physical therapy between two groups(p=.522). Among Non H.C Group, a group, who didn't receive traditional therapy and herb medicine was higher than a group who received these in degree of belief that the traditional therapy and herb medicine can cure their disease, and this result was higher in comparison to H.C Group(p=.025, p=.050). 2) Non H.C Group was higher than H.C Group in degree of emotional reaction(p=.050). H.C Group was higher than Non H.C Group in denial and acceptant stage among 5 different emotional stages before dying described by Kubler Ross, especially among the patient who had disease more than 13 months(p=.0069, p=.0198). 3) Non H.C Group was higher than H. C Group in demanding more emotional and spiritual care to doctor, nurse, family and pastor(p=. 010). 4) Non H.C Group was higher than H.C Group in demanding more emotional and spiritual care to each individual of doctor, nurse and family (p=.0110, p=.0029, P=. 0053). 5) H.C Group was higher th2.n Non H.C Group in degree of intrinsic behavior orientation and intrinsic belief orientation of personal religious orientation(p=.034, p=.026). 6) In H.C Group and Non H.C Group, the degree of emotional demanding of christians was significantly higher than non christians to doctor, nurse, family and pastor(p=. 000, p=.035). 7) In H.C Group there were significant positive correlations as following; (1) Between the degree of emotional demandings to doctor, nurse, family & pastor and: the degree of intrinsic behavior orientation in personal religious orientation(r=. 5512, p=.000). (2) Between the degree of emotional demandings to doctor, nurse. family & pastor and the degree of intrinsic belief orientation in personal religious orientation(r=.4795, p=.000). (3) Between the degree of intrinsic behavior orientation and the degree of intrinsic: belief orientation in personal religious orientation(r=.8986, p=.000). (4) Between the degree of extrinsic religious orientation and the degree of consensus religious orientation in personal religious orientation (r=. 2640, p=.015). In H.C. Group there were significant negative correlations as following; (1) Between the degree of intrinsic behavior orientation and extrinsic religious orientation in personal religious orientation (r=-.4218, p=.000). (2) Between the degree or intrinsic behavior orientation and consensus religious orientation in personal religious orientation(r=-. 4597, p=.000). (3) Between the degree of intrinsic belief orientations and the degree of extrinsic religious orientation in personal religious orientation(r=-.4388, p=.000). (4) Between the degree of intrinsic belief orientation and the degree of consensus religious orientation in personal religious orientation(r=-. 5424, p=.000). 8) In Non H.C Group there were significant positive correlation as following; (1) Between the degree of emotional demandings to doctor, nurse, family & pastor and the degree of intrinsic behavior orientation in personal religious orientation(r= .3566, p=.007). (2) Between the degree of emotional demandings to doctor, nurse, family & pastor and the degree of intrinsic belief orientation in personal religious orientation(r=.3430, p=.010). (3) Between the degree of intrinsic behavior orientation and the degree of intrinsic belief orientation in personal religious orientation(r=.9723, p=.000). In Non H.C Group there were significant negative correlation as following; (1) Between the degree of emotional demandings to doctor, nurse, family & pastor and the degree of extrinsic religious orientation in personal religious orientation(r= -.2862, p=.027). (2) Between the degree of intrinsic behavior orientation and the degree of extrinsic religious orientation in personal religious orientation(r=-. 5083, p=.000). (3) Between the degree of intrinsic belief orientation and the degree of extrinsic religious orientation in personal religious orientation(r=-. 5013, p=.000). In conclusion above datas suggest that hospice care provide effective total nursing care for the patients with terminal cancer, and hospice care is mandatory in all medical institutions.

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A Study on the Present Situation, Management Analysis, and Future Prospect of the Ornamental Tree Cultivation with respect to Environmental Improvement (환경개선(環境改善)을 위한 녹화수목재배(綠化樹木裁培)의 현황(現況) 및 경영분석(經營分析)과 전망(展望))

  • Park, Tai Sik;Kim, Tae Wook
    • Journal of Korean Society of Forest Science
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    • v.34 no.1
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    • pp.31-46
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    • 1977
  • The study was made to give some helpful information for policy-making on ornamental tree cultivation by doing a survey on general situations, management analysis, and future prospects of the ornamental tree growing. The study was carried out through literature studies related to the subject, questionaire surveys, and on-the-spot investigation. The questionaire surveys could be divided into two parts: pre-questionaire survey and main-questionaire survey. In the pre-questionaire survey, the researchers intended to identify the total number of ornamental tree growers, cultivation areas in size and their locations. The questionaires were sent to each town and county administration authorities, forest cooperatives, and related organizations through-out the nation. The main-questionaires were prepared for detailed study and the questionaires were sent to 200 tree growers selected by option by taking considerations of the number of tree growers and the size of cultivating areas in regions. The main findings and some information obtained in the survey were as follows: 1. The total land for ornamental tree growing was amounted to 1,873.02 hectares and the number of cultivators was totaled to 2,717. 2. The main occupations of the ornamental tree growers were found in horticulture (41.9%), agronomy (25.9%), officialdom (11.3%), animal husbandry (6.5%), business circle(4.8%), and forestry (3.2%) in sequence. 3. The ornamental trees were cultivated mostly upperland (54.8), forest land (19.4%), rice paddy (11.3%) and others. 4. The educational training of the tree growers seemed quite high. The results of the survey indicated that a large number of tree growers was occupied by college graduates (38.7%), and then high school graduates (34.7%), middle school graduates (12.9%) in order. 5. The tree farming was undertaken as a side-job (41.9%) rather than main-job (23.4%), but a few of respondents rated as subsidiary-job (18.6%). 6. The management status classified by the rate of hired labors used was likely to belong to three categories: independant enterprise management (41.9%); half independant management (31.5%); and self-management (32.4%). 7. The majority of the tree growers sold their products to the consumers through middle-man channel (48.4%), or directly to the house-holder and detailers (13.7%), but a few of the respondents answered that they disposed of their products by bidding (11.2%) or by direct selling to the contractors (4.8%). 8. The channel cf marketing seemed somewhat complicated. The results of the survey were as: (1) producers ${\rightarrow}$consumers (22.6%) (2) producers ${\rightarrow}$field middle-men${\rightarrow}$consumers (33.1%) (3) producers ${\rightarrow}$field middle-men${\rightarrow}$first stage brokers${\rightarrow}$consumers (15.3%) (4) producers ${\rightarrow}$field middle-men${\rightarrow}$second stage middle-men${\rightarrow}$brokers${\rightarrow}$consumers (5.7%) (5) producers${\rightarrow}$field middle-men${\rightarrow}$third stage middle-men${\rightarrow}$second stage middlemen${\rightarrow}$brokers${\rightarrow}$consumers (4.8%) 9. It was responded that the margin for each stage of middle-men or brokers was assumed to be 30-50%(33.1%), 20-30%(32.3%), 50-100%(9.7%), and 100-200%(2.4%) in sequence. 10. The difference between the delivery price of consumers and field selling price of the producers seemed quite large. Majority of producers responded that they received half a price compared to the consumer's prices. 11. About two thirds of the respondents opposed to the measure of "Law on Preservation and Utilization of Agricultural Land" in which says that all the ornamental trees grown on flat agricultural lands less than 8 degrees in slope must be transplanted within three years to other places more than 8 degrees in slope. 12. The tree growers said that they have paid rather high land taxes than they ought to pay (38.7%), but come responded that land tax seemed to be appropriate (15.3%), and half of the respondents answered "not known". 13. The measures for the standardization of ornamental trees by size were backed up by a large number of respondents (57.3%), but one third of the respondents showed negative answer (29.8%). 14. About half of the respondents favored the systematic marketing through organization such as forest cooperatives (54%), but quite a few respondents opposed to organizing the systematic marketing channel (36.3%). 15. The necessary measures for permission in ornamental tree cultivation was rejected by a large number of respondents (49.2%) than those of favored (43.6%).

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