• Journal of Hospice and Palliative Care
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• 제27권1호
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• pp.11-20
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• 2024

Purpose: Advance directives (ADs) are legal documents that outline a person's preferences or decisions regarding end-of-life care ahead of time. In Korea, there is insufficient awareness and knowledge about ADs among patients undergoing hemodialysis. This study explored the relationship between perceptions of a good death, knowledge about ADs, and attitudes toward ADs in this patient population. Methods: This cross-sectional survey enrolled 119 hemodialysis patients from a secondary hospital in 2021. The participants completed a self-administered questionnaire, and the data were analyzed using the t-test, analysis of variance, Pearson correlation coefficients, Spearman rank correlation coefficients, and multiple regression analysis. Results: The average score for perceptions of a good death among hemodialysis patients was 2.80 out of 4, with clinical symptoms identified as the most critical factor. The average scores for knowledge about ADs and attitudes toward ADs were 5.69 out of 9 and 2.79 out of 4, respectively. There was a positive correlation between perceptions of a good death and attitudes toward ADs (r=0.34, P<0.001), as well as between knowledge about Ads and attitudes toward ADs (r=0.19, P=0.037). Factors influencing attitudes toward Ads included employment status (β=0.22, P=0.011), education level (β=0.22, P=0.013), and perceptions of a good death (β=0.29, P=0.001), which accounted for 24.8% of the variance in attitudes toward ADs. Conclusion: A positive perception of a good death among patients undergoing hemodialysis was associated with a positive attitude toward ADs. Educational programs are needed to improve individuals' understanding of a good death and encourage the development of end-of-life care plans.

• 한국산학기술학회논문지
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• 제19권5호
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• pp.489-498
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• 2018

본 연구는 일반인들 가운데에서 죽음을 어떻게 인식하고 있느냐에 따라 삶의 태도나 방식이 달라지기 때문에 행복에 따른 죽음인식에 차이가 있는지 알아보고, 행복지수가 높은 그룹과 행복지수가 낮은 그룹간의 호스피스 관심이 차이가 있는지 연구하고자 한다. 2017년 4월 22일 D 광역시에서 열린 걷기대회 행사에 참가한 20세 이상 성인 남녀 200명을 대상으로 설문조사를 실시하였다. 설문구성은 일반적 특성이 성별, 연령, 학력, 직업, 결혼상태, 가족 동거여부, 종교, 건강상태 8항목이었다. 행복에 관한문항은 총 29항목, 죽음 인식은 9항목으로 구성하였다. 통계 검정법으로는 설문지의 항목에 대하여 행복지수를 기준으로 카이제곱 검정, 독립표본 t-검정, 상관분석, 정준상관분석을 실시하였다. 연구결과, 임종하기 적합한 장소에 관한 문항에서 행복지수가 낮은 그룹은 "의료기관"이 46.3%로 가장 높았으며, 행복지수가 높은 그룹에서는 "살던 집"이 59.4%로 가장 높게 나타나 유의한 차이를 보였다. 병원에서 임종하는 경우가 훨씬 많은 우리나라의 현실에서 환자들이 원하는 편안하고 익숙한 장소인 집에서 임종을 맞이할 수 있는 방법인 가정형 호스피스의 이용률을 높일 수 있도록 전문 인력의 확보 및 교육 등 관리체계를 보완해야 할 것이라고 보여 진다. 그리고 대상자의 일반적 특성을 고려한 개별적이고 다양한 접근을 통하여 죽음인식을 높이고 호스피스를 효과적으로 이용할 수 있도록 하여야 할 것으로 사료된다.

• 종양간호연구
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• 제4권2호
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• pp.143-153
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• 2004

Death of spouse is the most heartbreaking stressful and inevitable tragic life event. In middle aged men who belong to the social middle class and accomplished their occupational success, experiences of spousal bereavement are great shock. The aim of this study was to find out how they overcome their mental and physical pain and to obtain the basic materials to develop suitable nursing care programs for them. The methodological approach of this study is Giorgi's phenomenological analysis meaning unit. This method also makes theme focal meaning, situated structural description and create general structural description grasped by participator's experience through situated structure description. This study performed from November 2002 to May 2004, and participators were four men. Data collected through in-depth personal interviews. which had been tapped and analysed the Giorgi's method. Finally, the five focal meaning below have been abstracted. Theme 1. Physical symptom loss of appetite, fatigue, insomnia. outbreak of illness, weight loss. Theme 2. life of spiritless lack of desire, sense of emptiness, unstableness, prosaic life. wandering. indifference of appearances, avoidance of meeting people. Theme 3. life of retrospction reflection for his wife, yearning, grief, muttering to himself, never-to-be forgotten wife, leading a lonely life. Theme 4. negative emotion reproaching, feeling hurt, marriage of daughter, feeling heavy, getting angry, sexual desire, awareness of his sinfulness. loneliness Theme 5. social support and adjustment getting his wife off his mind, curring favor with children, support and consolation by his daughter-in-law, appreciation for hospice nurse, considering remarriage, taking care of himself, good relation with his children. The result of this study showed that middle aged men bereaved of their wife by cancer need other's concern. And we have to study further to understand their experience. Until now hospice nursing is concentrated on cancer patients But from now we have to provide their families suitable nursing care programs to adjust themselves to social life before and after death of patients.

• Journal of Hospice and Palliative Care
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• 제16권4호
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• pp.264-273
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• 2013

목적: 본 연구는 암환자를 돌보는 간호사들을 대상으로 간호사의 영성, 죽음불안 및 소진 정도를 확인하고, 세 변수들간의 관계를 파악하고자 한 서술적 조사 연구이다. 방법: 대상자는 서울에 소재하는 일개 암 전문 종합병원에서 근무하는 간호사 210명을 대상으로 하였다. 자료는 2012년 4월부터 6월까지 수집하였으며, 수집한자료는 SPSS 19.0 program을 사용하여 t-test, one-way ANOVA, Scheff'e test, Pearson's correlation coefficient로 분석하였다. 결과: 영성은 6점 만점에 평균 3.51점이었으며, 하위영역별로는 삶의 의미와 목적, 관계성, 내적 자원, 초월성 순으로 높았다. 죽음불안은 5점 만점에 평균 3.22점이었으며, 하위영역별로는 죽음의 부인, 짧은 시간 지각, 죽음에 대한 두려움, 죽음 연관 문제에 대한 두려움 순으로 높았다. 소진 정도는 7점 만점에 평균 4.10점이었으며, 하위영역별로는 정서적 소모, 비 인간화, 개인적 성취감 감소 순으로 높았다. 영성은 죽음불안(r=-0.327, P=0.01)과 소진 정도(r=-0.690, P=0.01)에 역상관관계가 있었으며, 소진은 죽음불안(r=0.550, P=0.01)과 정상관 관계가 있었다. 결론: 본 연구 결과를 바탕으로 간호사들의 영성을 높이고, 그들의 죽음불안과 소진 정도를 낮출 수 있는 영적 중재를 제공하는 것을 제안한다.

• Journal of Hospice and Palliative Care
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• 제16권1호
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• pp.1-9
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• 2013

목적: 본 연구는 간호대학생의 말기환자에 대한 생명의료윤리 인식과 죽음에 대한 태도를 파악하기 위한 서술적 조사연구이다. 방법: 대상자는 D광역시에 소재한 일개 전문대학의 3년제 간호과에 재학 중인 660명이었다. 자료는 2011년 10월부터 11월까지 수집하였다. 생명의료윤리 인식은 본 연구자가 선행연구를 근거로 개발한 도구로, 죽음에 대한 태도는 Collett와 Lester(1969)의 FODS (Fear of Death Scale)로 측정하였다. 수집된 자료는 서술통계, Wilcoxon rank sum test와 Kruskall Waills test로 분석하였다. 결과: 생명의료윤리에 대한 문제로 갈등 경험이 있고, 심폐소생술 금지가 필요하다고 생각하며, 종교가 없는 학생이 그렇지 않은 학생에 비해 죽음에 대해 부정적인 태도를 가지고 있었다. 대상자 중 말기환자의 연명치료중단이 필요하다고 생각하는 경우는 81.2%였고, 말기환자의 심폐소생술 금지가 필요하다고 생각하는 경우는 76.4%로서, 심폐소생술 금지가 필요한 이유는 '평안하고 품위있는 죽음을 위해서'가 가장 많았다. 결론: 죽음에 대한 긍정적인 태도의 형성을 위해 확고한 생명의료윤리 가치관의 확립이 요구되며, 가능하면 임상실습을 시작하기 전에 교육이 실시될 필요가 있다. 교육 프로그램을 구성할 때 종교, 학년, 생명의료윤리 갈등 경험, 심폐소생술 금지 찬성 여부가 포함되어야 하며, 말기환자 간호를 미리 경험할 수 있도록 표준화 환자를 이용한 시뮬레이션 실습의 기회를 제공하는 것이 필요하다.

• 한국간호교육학회지
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• 제27권2호
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• pp.197-209
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• 2021

Purpose: The purpose of this study is to evaluate the validity and reliability of the Korean Bereavement Care Confidence Scale (K-BCCS). Methods: The Perinatal Bereavement Care Confidence Scale (PBCCS) was translated into Korean according to an algorithm of cultural adaptation process and excluded six items which were specific to perinatal bereavement. A total of 229 clinical nurses participated in the study. Construct validity, convergent validity, discriminant validity, and group comparison validity were evaluated, and Cronbach's α was calculated to estimate the reliability of the K-BCCS. Results: The K-BCCS consisted of 31 items in 7 factors, including knowledge and skills for bereavement care (12 items), organizational support (6 items), awareness of the needs (3 items), interpersonal skills (3 items), workload influence (2 items), continuous education (2 items), and understanding the grief process (3 items). The factor loading of 31 items within the 7 factors ranged from .60 to .86. For the convergent validity, the construct reliability (CR) ranged from .74 to .94, and the average variance extracted (AVE) ranged from .49 to .73, which is considered acceptable. The discriminant validity showed that the AVEs of the subscales were greater than the square of the correlation coefficient r. The nurses who had experience providing bereavement care (t=4.94, p<.001) or had received bereavement education (t=6.64, p<.001) showed higher K-BCCS values those without experience. The Cronbach's α of 31 items was .93 and ranged from .60 to .94 per subscale. Conclusion: The K-BCCS is a valid and reliable tool for evaluating nurses' confidence in bereavement care.

• Journal of Hospice and Palliative Care
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• 제14권1호
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• pp.34-41
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• 2011

목적: 말기암환자들이 보완대체요법을 선택하게된 주관적 경험을 파악하여, 대상자 입장에서의 당위성을 이해하고 이용과정에서 발생할 수 있는 현상들을 이해함으로써 좀 더 바람직하고 효율적인 이용을 위한 호스피스 완화의료 중재를 하는데 기여하고자 실시하였다. 방법: 심층면담한 내용을 Colaizzi(1976)의 방법을 이용하여 귀납적이고 서술적인 기술과 분석을 실시하였다. 결과: 말기암환자와 가족들이 보완대체요법을 선택한 4가지 범주는 첫째 현대의학의 한계 인식, 둘째 보완대체요법의 효과에 대한 신뢰, 셋째 가족의 정서적 욕구 충족 넷째, 의사의 부정적인 태도로 인한 불신이었다. 주제모음은 9가지로 '불가능한 완치에 대한 기대', '병원치료에 대한 불확실성', '항암치료의 부작용을 해결하기 위한 보조적 수단', '증상완화와 생명연장을 위함', '암치료의 부작용에 대한 두려움', '체험과 정보에 대한 신뢰', '타인의 권유', '가족으로서 도리를 다함', '의사의 부정적 태도에 불만족'이었다. 결론: 암환자의 치료 결정과정에서 대상자와 의사가 바람직한 의사소통과정을 통하여 현대의학 치료에 대한 설명이 충분히 이루어져서 대상자가 일반적인 호스피스 완화의료 서비스를 이용하고 과학적인 근거에 바탕을 둔 보완대체요법에 대한 정확한 정보 제공이 필요하다고 본다.

• Journal of Hospice and Palliative Care
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• 제24권4호
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• pp.204-213
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• 2021

Purpose: At the end of life, communication is a key factor for good care. However, in clinical practice, it is difficult to adequately discuss end-of-life care. In order to understand and analyze how decision-making related to life-sustaining treatment (LST) is performed, the shared decision-making (SDM) behaviors of physicians were investigated. Methods: A questionnaire was designed after reviewing the literature on attitudes toward SDM or decision-making related to LST. A final item was added after consulting experts. The survey was completed by internal medicine residents and hematologists/medical oncologists who treat terminal cancer patients. Results: In total, 202 respondents completed the questionnaire, and 88.6% said that the decision to continue or end LST is usually a result of SDM since they believed that sufficient explanation is provided to patients and caregivers, patients and caregivers make their own decisions according to their values, and there is sufficient time for patients and caregivers to make a decision. Expected satisfaction with the decision-making process was the highest for caregivers (57.4%), followed by physicians (49.5%) and patients (41.1%). In total, 38.1% of respondents said that SDM was adequately practiced when making decisions related to LST. The most common reason for inadequate SDM was time pressure (89.6%). Conclusion: Although most physicians answered that they practiced SDM when making decisions regarding LST, satisfactory SDM is rarely practiced in the clinical field. A model for the proper implementation of SDM is needed, and additional studies must be conducted to develop an SDM model in collaboration with other academic organizations.

• Journal of Hospice and Palliative Care
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• 제22권4호
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• pp.156-165
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• 2019

목적: 본 연구는 임상실습을 경험한 간호대학생의 말기환자에 대한 주관적 태도 유형을 확인하고, 유형별 특성을 분석하기 위해 Q 방법론을 적용한 조사연구이다. 방법: 75개의 Q 모집단 중 최종 34개의 Q표본을 선정하고 임상실습을 경험한 간호대학생 43명의 P표본을 대상으로 9점 척도의 Q-분류를 하도록 하였다. 수집된 자료는 PC QUANAL Program으로 주요인분석을 하였다. 결과: 임상실습을 경험한 간호대학생의 말기환자에 대한 주관적 태도는 모두 3개 유형으로 나타났으며, 이들의 전체변량은 49.96%였다. 제1유형인 '생명의료 희망형'은 말기환자가 자신의 상태를 정확히 알고 생명을 연장하기를 원한다고 생각하였다. 제2유형인 '서비스 제공 요구형'은 말기환자가 미리 죽음을 준비할 수 있도록 다학제적인 간호와 이에 대한 제도가 마련되어야 한다고 생각하였다. 제3유형인 '죽음 수용 인식형'은 호스피스 병동에 입원하여 품위 있게 죽기를 원한다고 생각하였다. 결론: 본 연구를 통해 임상실습을 경험한 간호대학생의 말기환자에 대한 다양한 주관적 태도를 파악했으며, 이를 토대로 유형별 맞춤형 교육 프로그램이 개발된다면 말기환자에 대한 교육이 체계적으로 이루어질 것이다.

• 한국호스피스완화의료학회:학술대회논문집
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• 한국호스피스완화의료학회 2004년도 정기총회 및 하계학술대회
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• pp.103-105
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• 2004

Every one experiences death one day, however no one can hows exactly what it is because people can not experience death until it comes, it is therefore impossible to judge correctly on the phenomenon of the death. On the whole, man experiences indirect death through the mass communications such as TV drama, fiction, magazine etc because those methods can easily access by every one. In addition to this, people usually acquire the negative awareness of death through the dramatic change of story like dying of cancer for dramatic effect by giving scare and fear to the cancers. The purpose of this study is to provide basic information on the spiritual care that enables the facing death patients to accept death as a part of life and divert hope from scare about after death by comparing and analyzing of two aspects of death meaning i.e, Korean fiction and the end stage cancer patients. Additionally, for medical staff to understand the facing death cancer patients by making to aware patients correctly and provide the better quality of care. The study was performed from September 28, 2002 to February, 28, 2003. The materials of this study were collected by direct data obtained from observation, interviews, note and diary of end stage of cancer patients and written materials acquired from Korean contemporary fiction. Participants of this study were 4 end stage cancer patients including 2 lung cancer patients, 1 liver cancer patient and 1 esophagus cancer patient. The methodology used in this study was divided into two types; Huberman & Miles methodology was used for fiction to find and categorize subject, and Colaizzi, one of phenomenological methodology was used for end stage cancer patients to find the major meaning, subject and categorization. Every one experiences death one day, however no one can knows exactly what it is because people ran not experience death until it comes, it is therefore impossible to judge correctly on the phenomenon of the death. On the whole, man experiences indirect death through the mass communications such as TV drama, fiction, magazine etc because those methods can easily access by every one. In addition to this, people usually acquire the negative awareness of death through the dramatic change of story like dying of cancer for dramatic effect by giving scare and fear to the cancers. The purpose of this study is to provide basic information on the spiritual care that enables the facing death patients to accept death as a part of life and divert hope from scare about after death by comparing and analyzing of two aspects of death meaning i.e, Korean fiction and the end stage cancer patients. Additionally, for medical staff to understand the facing death cancer patients by making to aware patients correctly and provide the better quality of care. The study was performed from September 28, 2002 to February, 28 2003. The materials of this study were collected by direct data obtained from observation, interviews, note and diary of end stage of cancer patients and written materials acquired from Korean contemporary fiction. Participants of this study were 4 end stage cancer patients including 2 lung lancer patients, 1 liver cancer patient and 1 esophagus cancer patient. The methodology used in this study was divided into two types; Huberman & Miles methodology was used for fiction to find and categorize subject, and Colaizzi, one of phenomenological methodology was used for end stage cancer patients to find the major meaning, subject and categorization.