• Journal of Korean Academy of Nursing
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• v.36 no.6
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• pp.1055-1064
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• 2006

Purpose: The purpose of this study was to analyze and clarify the ambiguous concept of DNR, and to distinguish between DNR and euthanasia. Method: This study used the process of Walker & Avant's concept analysis. Result: The definable attributes of DNR were care for comfort, no further treatment and no CPR. The antecedents of DNR were the autonomy of patients and families feelings about death, the uselessness of treatment and the right to die with dignity. The process of the DNR decision should be documented and the antecedents of DNR also can be a basis for objective standards of DNR decision-making. The result of DNR was the acceptance of death by patients and families. Conclusion: DNR is decided and documented by the antecedents of DNR, and the result is a natural acceptance of death, the last process of human life. Hospice care should be activated and nurses must be patient's advocates and families' supporters in the process.

• Journal of Environmental Health Sciences
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• v.34 no.6
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• pp.446-451
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• 2008

In this study, the removal characteristics of organic components and nutrients of sewage taken from the Suwon area were investigated in a lab-scale modified DNR (Daewoo Nutrient Removal) process. The modified DNR process consisted of a sludge denitrification tank, an anaerobic tank, an anoxic tank, an aerobic tank, a secondary anoxic tank and a secondary aerobic tank. The proposed process with the average C/N ratio of 3.5 was performed for the sewage treatment. The results were compared with other existing DNR processes. The organic fractions in sewage were analyzed by measuring the oxygen uptake rate. The resulting removal efficiencies of SS, BOD, COD, TN and TP were 93.1%, 95.5%, 86.1%, 67.8% and 80.6%, respectively.

• Journal of Korean Academy of Nursing
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• v.38 no.2
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• pp.298-309
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• 2008

Purpose: The purpose of the study was to describe the experiences of do-not-resuscitate (DNR) among nurses. Methods: Data were collected by in-depth interviews with 8 nurses in 8 different hospitals. Conventional qualitative content analysis was used to analyze the data. Results: Eight major themes emerged from the analysis: DNR decision-making bypassing the patient, inefficiency in the decision-making process of DNR, negative connotation of DNR, predominance of verbal DNR over written DNR, doubts and confusion about DNR, least amount of intervention in the decision for DNR change of focus in the care of the patient after a DNR order, and care burden of patients with DNR. Decision-making of DNR occurred between physicians and family members, not the patients themselves. Often high medical expenses were involved in choosing DNR, thus if choosing DNR it was implied the family members and health professionals as well did not try their best to help the patient. Verbal DNR permission was more popular in clinical settings. Most nurses felt guilty and depressed about the dying/death of patients with DNR. Conclusion: Clearer guidelines on DNR, which reflect a family-oriented culture, need to be established to reduce confusion and to promote involvement in the decision-making process of DNR among nurses.

• Journal of Korean Society of Water and Wastewater
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• v.20 no.2
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• pp.273-280
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• 2006

The sludge settleability is a key factor for operating activated sludge process as well as BNR (biological nutrient removal) process, because the poor sludge settling causes an increase of suspended solid in the effluent. In order to improving the sludge settleability, a settling agent such as iron dust can be applied. In this study, the effect of sludge settleability on the performance of DNR (Daewoo nutrient removal) process was investigated with GPS-X, which is the popular wastewater treatment process model program, and the result of modeling was verified with operating lab-scale DNR process. As a result, if the sludge blanket keeps stable in the secondary settling tank, the effluent quality is similar in spite of different SVI values. And in case of the good sludge settleability, short HRT or long SRT increased the biomass concentration in the bioreactor, and improved the pollutant removal efficiency. In spite of daily influent changing, the good sludge settleability also guaranteed the stable effluent quality. And the results of the lab-scale DNR process experiment could support the simulated results.

• Journal of the Korea Convergence Society
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• v.10 no.6
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• pp.393-399
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• 2019

This is a descriptive study on the perception and attitude toward DNR in adults. Structured questionnaires were used and 210 subjects were studied. In recognition of DNR, DNR was helpful for 'a comfortable dying(64.3%)'. The need for DNR in situation investigated 'For dignified dying (41.3%)' and 'to alleviate patient suffering(23.9%)'. Respondents who do not agree with DNR are shown 'Because legal issues can arise(61.7%)', 'Because human dignity is the life-sustaining priority(16.7%)'. In the attitude toward DNR, the most significant result was 'I want to know if I have an incurable disease (4.21).' There was no difference in attitudes toward DNR among adults. The DNR is not a method of Withdrawing in lifeprolonging treatment, It should be addressed in a comprehensive context in which human beings exercise autonomy over the process of dying and death.

• Journal of Hospice and Palliative Care
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• v.18 no.3
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• pp.179-187
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• 2015

For patients who are near the end of life, an inevitable step is discussion of a do-not-resuscitate (DNR) order, which involves patients, their family members and physicians. To discuss DNR orders, patients and family members should know the meaning of the order and cardiopulmonary resuscitation (CPR) which includes chest compression, defibrillation, medication to restart the heart, artificial ventilation, and tube insertion in the respiratory tract. And the following issues should be considered as well: patients' and their families' autonomy, futility of treatment, and the right for death with dignity. Terminal cancer patients should be informed of what futility of treatment is, such as a low survival rate of CPR, unacceptable quality of life after CPR, and an irremediable disease status. In Korea, two different law suits related to life supporting treatments had been filed, which in turn raised public interest in death with dignity. Since the 1980s, knowledge of and attitude toward DNR among physicians and the public have been improved. However, most patients are still alienated from the decision making process, and the decision is often made less than a week before death. Thus, the DNR discussion process should be improved. Early palliative care should be adopted more widely.

• Journal of Hospice and Palliative Care
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• v.20 no.2
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• pp.122-130
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• 2017

Purpose: The purpose of this study is to describe and understand the meaning and the structure of subjective experiences of intensive care nurses with death of patients with do-not-resuscitate (DNR) orders. Methods: Data were collected from eight intensive care nurses at general hospitals using individual in-depth interviews and analyzed by phenomenological research method. Results: The nurses' experiences were grouped into four theme clusters: 1) ambiguity of death without correct answer, 2) a dilemma experienced at the border between death and work, 3) the weight of death that is difficult to carry and 4) death-triggered reflection of life. Conclusion: It is necessary to develop accurate judgment criteria for DNR, detailed regulations on the DNR decision process, guidelines and education on DNR patient care for nurses. It is also needed to develop an intervention program for DNR patients' families.

• The Korean Journal of Rehabilitation Nursing
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• v.14 no.2
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• pp.118-128
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• 2011

Purpose: The purpose of this study was to explore the experiences of bereavement for main family members who had made and followed DNR decision for their family members. Method: This qualitative study was based on a grounded theory, and used in-depth interview techniques with the bereaved 10 main family members who had been treated and died under DNR order. Results: The causal condition of the family member was 'Releasing', and the main consequent phenomenon were 'Blaming self and ruminating'. The contextual condition was 'The memory of the deceased'. The action/reaction strategy was 'Purifying'. The intervening condition was 'Supporting system', and the consequence was 'Acceptance'. The experience after bereavement of the family member on DNR decision were rational processes that purified themselves and healed the guilt feeling about the decision from reflective assessment and response about DNR decision. Based on this results, the substantive theory 'Reflective self healing' was derived. Conclusion: The main family members in following DNR decision are more likely to have unhealthy emotional condition than others in normal bereavement process. But they overcame the grief of bereavement through reflective self healing process.

• 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.17 no.2
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• pp.66-74
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• 2014

Purpose: This study is aimed to investigate perceptions of caregivers and medical staff toward do not resuscitate (DNR) and advance directives (AD). Methods: Participants were 141 caregivers and 272 medical staff members from five general hospitals. A questionnaire used for the study consisted of 20 items: 14 about DNR perceptions, three about AD, one each for age, gender and employment. Results: Both medical staff and caregivers strongly recognized the need for DNR and AD, and the level of recognition was higher with medical staff than caregivers (DNR ${\chi}^2=44.56$, P=0.001; AD ${\chi}^2=16.23$, P=0.001). The main reason for the recognition was to alleviate sufferings of patients in the terminal phase. In most cases, DNR and AD were filled out when patients with terminal conditions were admitted, and patients made the decisions by consulting with their guardians. Medical staff better recognized the need and for growing demand for guidelines for the DNR and AD decision making process than caregivers (${\chi}^2=7.41$, P=0.0025). Conclusion: This study showed that patients highly rely on their caregivers when making decisions for DNR and AD. Thus, it is important that patients and caregivers are provided with objective information about the decisions. Since participants' strong support for DNR and AD was mainly aimed at alleviating patients' suffering, further study is needed in the association with hospice care. Medical staff also needs to understand the different views held by caregivers and fully consider the disparity when informing patients/caregivers to make the DNR and AD decisions.