• Journal of Korean Academy of Nursing Administration
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• v.7 no.3
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• pp.403-414
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• 2001

The study was intended to identify the nurses' experiences, understanding, and attitudes on DNR. Also, the study was to provide the data base for a standard of DNR decision-making and practice. The sample consisted of 347 nurses in eight general hospitals. The data were collected between August 1 and August 31, 2000. The data were analyzed using descriptive statistics and $x^2-test$. The results of the study were as follows : 1. Regarding DNR-related experience, 74.6 percent of the participants experienced DNR situations. Eleven percent of the participants received DNR education. DNR was most frequently (81.5%) requested by family members and relatives of patients. The decision-making on DNR was most frequently (76.8%) made by agreement between family members and medical staff. The DNR order was recorded at 81.9 percent on charts. Problems after DNR order were negligence in treatment and nursing care (30.6%) and guilty feelings due to doing the best (22.1%). CPR (cardiopulmonary resuscitation) was performed about 49.8 percent of DNR cases. 2. Regarding understanding and attitude on DNR, most of the participants (93.1%) thought DNR was necessary. The major reasons for the necessity of DNR were impossible recovery (44.4%) and death with dignity (41.1%). The decision-making on DNR was most frequently made by patient and family members (47.8%) and followed by agreement between family members and medical staff (25.6%), and patients themselves (16.4%). Most of the participants thought that medical staff must explain DNR to critical and end-of-life patients and their family members. Forty four percent of the participants thought that the most appropriate time for DNR explanation was when patients with critical disease were admitted to hospitals. Most of the participants (90.2%) thought a guide book for DNR is necessary to be made in hospitals. 3. There were significant differences in the participants' understanding and attitudes on DNR according to religion career education and experience of DNR. Of the participants those who have religions and education experience on DNR thought that there would be more DNR requests after DNR is explained to patients and family members (p<.05). In addition, there was higher understanding on the necessity of DNR in those who have more career and DNR experience(p<.01). The findings of the study suggest that a guide book for DNR need to be made with inclusion of legal, ethical, and cultural aspects. Also, there needs to be more education on DNR in medical ethics to health care professional and to provide more information on DNR to the general public.

• Journal of Hospice and Palliative Care
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• v.21 no.2
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• pp.51-57
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• 2018

Purpose: End-of-life (EoL) decisions are challenging and multifaceted for patients and physicians. This study was aimed to explore how EoL care is practiced for patients with a do-not-resuscitate (DNR) order. Methods: We retrospectively analyzed medical records of patients who died after agreeing to a DNR order in 2016 at a university hospital. Characteristics including cause of death, intensity of EoL care, and other factors were reviewed and statistically analyzed. Results: Of total 375 patients, 170 patients (45.3%) died with malignancies, and 205 patients (54.6%) with other causes involving the central nervous system (19.2%), pulmonary (14.7%), cardiologic (6.7%) and infectious (6.4%) conditions. Both the cancer and non-cancer patient groups showed a short duration from DNR to death (median 3 days vs 2 days, P=0.629). An intensive care group comprising patients who received one or more intensive treatments such as ventilator (n=205) showed a higher number of non-cancer patients and a shorter duration from DNR to death than a group that withheld treatment before DNR (P<0.05). Conclusion: EoL decisions were made very late by both cancer and non-cancer patients. About half of the patients did not have cancer, and two-thirds of them decided DNR during intensive treatment. To make a good EoL decision, a shared decision making with patients should be done at an earlier stage.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.16 no.1
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• pp.397-407
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• 2015

The purpose of this study was to evaluate the effect on knowledge, attitude and volition of DNR after implementing the educational program of withdrawing life sustaining treatment to elderly people. The subjects for this study were healthy elders over 65 year-old at J elderly center located at S city, Korea. Data were gathered from October 2 to November 9, 2012. Participants were randomly assigned to either experimental or control group. For the experimental group, a 50 minute educational program on withdrawing life-sustaining treatment program was delivered twice a week for 3 weeks, and the control group did not receive any education. DNR knowledge (F=4.158;p=.049), DNR attitude (F=39.60; p=.001) were higher in experimental group compare to control group. Changes in number of participants who were determined to choose DNR for themselves (p=.006), for spouse (p=.039) and for parents (p=.006) were significantly higher in experimental group compared to control group. The program was effective in changing participant's knowledge, attitude and volition toward DNR and this program can be utilized to guide the decision making process of DNR for elderly.

• Journal of Hospice and Palliative Care
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• v.19 no.1
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• pp.26-33
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• 2016

Purpose: This study was conducted to identify clinical characteristics of oncologic patients at a point when they signed their do-not-resuscitate (DNR) orders. Methods: From January through December 2014, we retrospectively analyzed the records of 197 patients who passed away after agreeing to a DNR order in the hemato-oncology department of a tertiary hospital. Results: Of all, 121 patients (61.4%) were male and 76 (38.6%) were female, and their average age was 58.7 years. Ninety-four patients (47.7%) had gastrointestinal cancer. The ECOG performance status at admission was grade 3 in 76 patients (36.5%) and grade 4 in 11 (5.6%). The patients' mean hospital stay was 20 days. The mean duration from the admission to DNR decision was 13 days, and the mean duration from DNR decision to death was seven days. Conclusion: Study results indicate that a decision on signing or refusing a DNR order was made by medical staff mostly based on the opinions of patients' guardians rather than the patients themselves. This suggests that patients' own wishes are not well respected. Thus, it is urgent to establish institutional devices to enhance cancer patients' autonomy regarding DNR and to define an adequate timing for withdrawal of treatments.

• Journal of Hospice and Palliative Care
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• v.21 no.4
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• pp.115-123
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• 2018

Purpose: The purpose of this study was to identify how nursing students' awareness of biomedical ethics and ethical values affect their attitudes towards a do-not-resuscitate (DNR) order. Methods: This cross-sectional correlation study was conducted with 275 nursing students enrolled at two universities in North Chungcheong Province and North Gyeongsang Province of South Korea. Data were collected in April 2017 using a self-reported questionnaire. Data were analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation coefficient and stepwise multiple regression with the SPSS/WIN 23.0 program. Results: The students' attitudes towards DNR were positively correlated with attitudes that seek ethical values but negatively correlated with their biomedical ethics awareness. The explained variance for attitudes towards DNR was 20%, which was significant (F=13.01, P<0.001). Conclusion: These findings suggest that nursing students' biomedical ethics awareness and ethical values were associated with their attitudes towards DNR. Curriculum organization and various educational programs should be developed and applied to help nursing students develop ethical values and awareness of biomedical ethics.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.16 no.4
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• pp.2691-2703
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• 2015

This research aims to provide basic materials for assisting DNR patient cares by understanding ICU nurses' awareness and ethical attitude regarding DNR. A total of 154 results were analyzed which were collected from Aug. 1st to Sep. 5th in 2014 by surveying nurses working in ICU (from 1 advanced general hospital in G metropolitan city and other general hospitals of more than 700 beds in Cheolla provinces). (1) For the decision attitudes of DNR, there were both consent and objection. Consent for the patient's opinion of rejecting further treatment and life extension despite of bad prognosis. And objection for no conducting DNR in the case of the patient's wish, treatment requested by the guardian, and CPR for the patient who has no chance. (2) Objection for artificial respirator and other treatment requested by the patient's family and the entrance of guardians into ICU. Consent for the passive use of artificial respirator by the doctor and the decrease of basic care to stabilize patients physically and mentally. No specific opinion for treatment not following aseptic techniques. Objection for frequent reports to primary care physician requested by the family. (3) Acknowledging less interest by the doctor, while supporting the health care team in the case of the guardian's complaint, objection for the DNR decision mede by the primary care physician. Objection for the DNR decision by the guideline. Objection or neutrality for straightforward explanation to the patient of bad prognosis. Objection for straightforward explanation of the patient's status (even near to death) to the patient him/herself or the guardian. In conclusion, the subject of DNR is the patient and the patient's opinion should be fully reflected. The conflict arising from the scope of medical practice and decision processes should be minimized. The standard and guideline for DNR decision is required for the ethical decision making for the patient along with agreements based on full explanations.

• 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.19 no.4
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• pp.292-295
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• 2016

Hospice and palliative care in Taiwan has been growing continuously. The 2015 Quality of Death index, as rated by the Economist Intelligence Unit, ranked Taiwan first among Asian countries and sixth in the world. In this review article, we highlight three particular areas that might have contributed to this success; the laws and regulations, spiritual care and research network. Finally, we discuss the future challenges and prospects for Taiwanese encounters. A systemic review was conducted with the keywords "hospice palliative care Taiwan" using PubMed. The passing of the "Natural Death Act" in 2000 set the example and established a landmark for patient autonomy in Asia; it guarantees the patient's right to request that medical staff do not resuscitate (DNR) them and to reject other futile medical treatments at the end of their life, thus reflecting the importance of palliative care from the policy perspective. In 2015, Taiwan passed another pioneering law entitled the "Patient Autonomy Act". This law states that a patient may decline medical treatment according to his/her own will. Taiwanese indigenous spiritual care was launched in 2000. It requires a Buddhist Chaplain to successfully complete a training program consisting of lectures, as well as bedside practicum before applying Buddhist practices to end-of-life care. The Japan-Korea-Taiwan research network was established for the purpose of enabling collaborative research for the East-Asian collaborative cross-cultural Study to Elucidate the Dying process (EASED) cohort. With consensus from the government and society to make it a priority, hospice and palliative medicine in Taiwan has been growing steadily.

• 한국과학기술학회:학술대회논문집
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• 2015.12a
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• pp.247-278
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• 2015

Recently, as DNR prevails more and more in Korea, discussions regarding meaningless medical life-sustaining-treatment (LST) intensified. Some of the Supreme Court decisions are even discussed in mass media, causing public debates. These cases tell us that, as life-sustaining medical technologies are highly developed, more sociological and policy-related analyses are needed on them. Firstly, this study will review 40 previous studies that analyze recent discussions in Korea about LST. Secondly, this study also shows that in bioethical and policy-related perspectives, governance about LST calls for a new implications regarding thanatoethics and thanatopolitics. In this new theoretical framework, death with dignity (DwD) can be understood as a process of giving back the thanatopower to the subject who chooses his way of ending based on his sound and free will. Thirdly, some of the new LST or resuscitation technologies such as automated external defibrillators (AED) are developed in RRI framework. However, if subjects themselves choose not to apply those technologies on them, as in the case of DNR (do not resuscitate) vows, meaning of developing such technologies are to be questioned. But currently such questions regarding the limitations of RRI are seldom asked. I argue that in order to properly apply RRI framework on existing technology, we also need to consider these points.

• Archives of Reconstructive Microsurgery
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• v.26 no.1
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• pp.18-22
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• 2017

Inevitable immobilization after surgery on lower extremities can induce chronic constipation. Elderly diabetic women usually express ambiguous gastrointestinal symptoms and signs. We present here a case of panperitonitis developed from severe fecal impaction in an elderly diabetic woman after hand reconstruction using material harvested from the lower extremities. A 68-year-old diabetic female underwent anterolateral thigh free flap and wound revision twice on the left thumb. Three weeks after surgery, she complained about mild abdominal pain though she had daily defecation. Despite encouraging ambulation, her compliance was low. Resection of the sigmoid colon and colostomy were performed after diagnosis with bowel perforation. However, the patient went into septic shock and died with multiorgan failure after the guardians issued a DNR (do not resuscitate) order. For preventing bowel perforation, increased uptake of dietary fiber and early ambulation postoperatively should be encouraged, after even hand surgeries.