• Journal of Hospice and Palliative Care
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• 제18권3호
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• pp.208-218
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• 2015

목적: 본 연구는 심폐소생술 비시행(DNR)에 관해 간호사와 의사의 DNR에 대한 인식 및 태도가 DNR 관련 교육 및 임상경험 여부에 따른 차이가 있는지 분석하고자 하였다. 방법: 연구대상은 단일대학병원에서 근무하는 간호사와 의사로서 총 310명이었으며, 자료수집 기간은 2013년 8월 19일부터 8월 30일까지였다. 연구도구는 DNR에 관해 간호사와 의사의 임상 경험과 윤리문제에 관한 인식 및 태도를 조사하기 위해 연구자들의 문헌고찰을 통해 30문항으로 구성된 설문지를 사용하였다. 결과: 본 연구의 참여자 중에 간호사는 238명(77%), 의사는 72명(23%)이었다. 대부분의 참가자들(99%)이 DNR의 필요성에 동의하였고 이유로는 환자의 편안하고 품위 있는 죽음(52%), 회복이 불가능한 의학적 상태(23%), 환자 본인의 죽음에 대한 선택(19%)의 순이었다. DNR 임상경험에 따른 차이는 DNR 필요성의 동의, DNR 시기 및 DNR 이후의 다른 치료의 허용에 대해서 차이를 보였다. 그러나 DNR 교육 여부에 따른 차이는 DNR 시기 이외에는 유의한 차이를 보이지 못하였다. 결론: 본 연구를 통해 DNR에 대한 교육보다는 임상에서의 경험이 실제 DNR에 대한 인식 및 태도에 유의한 영향을 미치는 것을 보여주었기에 효과적인 DNR 교육을 위하여는 실제 임상 실습을 통한 교육이 필요할 것으로 생각된다.

• 간호행정학회지
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• 제7권3호
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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.

• 간호행정학회지
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• 제9권3호
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• pp.447-458
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• 2003

Purpose: To examine the awareness and experiences of nurses and physicians on DNR. Method: The sample contained of 199 nurses and 98 physicians. The Instrument used in this study was The Nurses' Understanding and Attitude on DNR(AEDNR) developed by the Han et al and revised by the research the AEDNR included 29 items. Result: About 97.3% of them feel the necessity of DNR, Majority of subject(78.8%) have practiced DNR by the demand of 'the patient's family' and 91.8% of them made a medical record at the time they carried out DNR. There were no significant differences in their perceived necessity of DNR between nurses and physicians. Conclusion: This study can be a basis for making objective standards educational, ethical, and legal issues concerning DNR.

• 한국융합학회논문지
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• 제8권2호
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• pp.63-72
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• 2017

본 연구는 간호대학생의 DNR에 대한 융합적 인식 및 윤리적 태도를 파악하여 DNR 환자간호에 도움이 되는 기초자료로 활용하고자 시도하였다. G광역시 4년제 간호대학생 306명을 대상으로 2016년 6월 1일부터 2016년 7월 10일까지 설문조사하였고, SPSS 23.0 Program을 이용하여 최종 분석하였다. 분석결과 DNR에 대한 인식은 DNR의 필요성, 환자와 가족의 의지에 의한 DNR 결정, 문서화된 지침서의 필요성에 찬성하였다. 윤리적 태도는 환자의 의지에 의한 결정, 치료범위, 설명 여부, 지침에 따른 결정에 찬성하였고, 주치의에 의한 결정, 기본간호 제공 감소에는 반대하였다. 일반적 특성에 따른 윤리적 태도는 학년, 임상실습경험, 윤리가치관에 대한 교육경험, DNR에 대한 교육경험, 삶에 대한 만족도, 죽음에 대한 가치관에 따라 유의한 차이가 있었다. 본 연구결과를 토대로 DNR 결정에 관한 기준 및 지침을 마련하기 위한 지속적인 후속연구가 필요하다고 사료된다.

• 한국응급구조학회지
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• 제19권2호
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• pp.71-82
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• 2015

Purpose: This study aimed to investigate paramedic students' awareness and attitude toward a do not resuscitate (DNR) order and death. Methods: This research was conducted among 421 students from the Department of Emergency Medical Technology in a 4-year college located in the Chungcheong and Daejeon districts, from May 14 to 22, 2014. Data were analyzed by using IBM SPSS 21.0. Results: The mean level of attitude toward death was 2.17. The paramedic students with clinical experience showed a positive attitude toward death, of whom 72.0% answered that a DNR order is necessary. The mean level of attitude toward DNR was 2.88. The paramedic students with clinical experience showed a positive attitude toward a DNR order. They indicated that sanctity of life should be respected rather than extending ineffective treatment and that patients' decisions on DNR should be respected. The students who had more knowledge about DNR and felt the necessity of DNR had a positive attitude about death and DNR. Conclusion: Paramedic students need systematic education for proper recognition and values establishment about death and DNR.

• 대한한의정보학회지
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• 제21권2호
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• pp.25-33
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• 2015

Purpose: The purpose of this study was to examine hospital nurses' nursing activities changes after DNR(do-not-resuscitate) decision. Methods: The subjects were 120 registered nurses working in two university hospitals. The data were collected from September 1 to September 15, 2015 using self-report questionnaires. The data were analyzed using SPSS 20.0 program. Results: DNR awareness of the educational needs was very high(91.7%). But DNR educational experience was low(59.2%). Nursing activity change was classified as the physical, emotional, spiritual, and social areas. There were significant difference among religion(F=3.459, p=.010), working unit(F=3.410, p=.036), DNR awareness of the educational needs(t=5.048, p=.027), DNR educational experience(t=-2.816, p=.006) and nursing activities changes. Conclusion: Nurses are needed DNR educational programs to take care of DNR patients. And the criteria for nursing activities related to DNR is required.

• 재활간호학회지
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• 제14권2호
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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.

• 대한간호학회지
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• 제38권2호
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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.

• 간호행정학회지
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• 제11권3호
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• pp.255-264
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• 2005

This study is a descriptive research in investigating the perception of doctors and nurses with regard to DNR, and data were collected through survey questionnaires. The period of collecting data was between July 15 and October 30, 2004, distributing 128 questionnaires to 128 participants, and a total of 110 questionnaires from 55 doctors and 55 nurses were collected (86%)among 70 different hospitals. The collected data were analyzed using SAS program to get real number and percentage, and were also analyzed with $X^2$-test. The Study Results are as follows: 1. Respondents who agreed with the necessity of DNR was 97.27%, the reasons of DNR necessity were 59.20% of 'impossibility of recovery in spite of lots of efforts,' and 35.20% of 'for the purpose of choosing a comfortable and dignified death,' and 97.2% of respondents answered that it was necessary to give explanation of DNR to serious case patients, terminal patients and their family. 2. Problems derived from DNR decisions were 44.44% of 'lack of treatment and nursing,' 21.11% of 'guilty conscience about failing to do best efforts,' and 71.57% of CPR implementation right after DNR decision. 3. Reasons of implementing CRP for patients with DNR decision were 50.94% of 'for the presence of family and relatives at the point of patient's death,' 20.76% of 'guardian's change of DNR decision,' and 16.98% of 'no communication for the consent after DNR decision.' 4. With regard to who was to make DNR decision? there was a difference in the opinion between doctors' and nurses' group while the group of doctors chose 'by the consent of the family and the doctor in charge,' and the group of nurses chose 'patient's intension,' and with regard to Have you received DNR related education? and Will people who want DNR increase if there is explanation given? there was a difference between the two groups. 5. In the catholic institutions, respondents of 71.7% said that it was necessary to take DNR depending upon the situation, and 73% said that they had performed DNR before. 6. In the institutions with over 500 beds, 91.92% of respondents said that there should be an establishment of guideline book as a written format to implement DNR. From the results of this study, it was found that DNR was implemented and executed broadly in clinical fields in the absence of necessary instructions and/or guideline, and that DNR order was placed to the group of doctors who got less opportunity for proper education than did that of nurses.

• 한국산학기술학회논문지
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• 제11권12호
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• pp.4907-4921
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• 2010

본 연구의 목적은 대학생들의 DNR(Do Not Resuscitate)과 관련된 인식 및 태도를 파악하여 임상에서 사용할 수 있는 DNR에 대한 객관적인 기준을 마련하는데 도움이 되는 기초자료를 제공하고자 시도된 서술적 조사연구이다. 연구대상은 대구광역시 일개 전문대학생 1267명을 대상으로 하였다. 자료수집기간은 2010년 7월1일부터 7월31일까지였으며, 자료수집방법은 구조화된 질문지를 사용하였다. 자료 분석은 SPSS 17.0 Program을 이용하여 실수와 백분율을 구하였고, $x^2$-test로 분석하였다. DNR에 대한 간호대학생과 비 보건계열대학생 인식 및 태도를 비교한 결과, 인식에 있어서 DNR에 대한 필요성, DNR 찬성 이유, DNR 반대 이유, DNR 결정 주체자의 인식에서 유의한 차이가 있었고, 태도에서는 가족 DNR시행, 자기자신 DNR시행에서 유의한 차이가 있었다. DNR정보제공에 대한 간호 대학생과 비 보건계열대학생의 인식을 비교한 결과 DNR에 대한 정보제공 필요성, DNR 정보제공 시기, DNR 정보 제공 결과, DNR 정보제공 지침서에서 유의한 차이가 있었다. 대상자의 일반적 특성에 따른 DNR 필요성 인식차이에서 종교, 헌혈경험에서 유의한 차이가 있었고, DNR 결정 주체자에 대한 인식차이에서 종교, 형제 자매수에서 유의한 차이가 있었다. 대상자의 일반적 특성에 따른 가족 DNR시행에 대한 태도에서 성별, 연령, 경제상태, 종교, 형제 자매수, 가족중 질환 및 사망자, 헌혈경험에서 유의한 차이가 있었고 자기자신 DNR시행에 대한 태도 차이에서 성별, 경제상태, 종교, 형제 자매수, 가족중 질환 및 사망자에서 유의한 차이가 있었다. 본 연구결과를 바탕으로 DNR에 관한 기준을 마련하기 위하여 더 많은 후속 연구가 필요하다고 사료된다.