• 대한간호
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• 제29권4호
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• pp.51-72
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• 1990

The purpose of this study was to determine whether Severance Hospice Home Care Pro gram was able to meet its objectives. This was done in order to show in detail the effects of hospice home care on the quality of life of terminally ill patients and to provide rationale for setting up more hospice home care programs in korea. The results of the study were as follows: The subjects of the study were 100 terminally ill patients who hnd died 'while in the hospice program and 64 family members who were registered with Severance Hospice Home Care Program between march 1988 and Feb. 1990. The nursing needs of these terminally ill patients were assessed by the nursing records of these patients. The need for pain control(82%) was the highest nursing need so far as the physical aspects were concerned. This was followed by poor appetite(37%), 8 dyspnea(34%), nausea and vomiting(30%) in that order of frequency. In reqard to spiritual needs, the need for religious' support was also high at 72%. Their main psychological symptoms were anxiety and fear(34% ). Burn-out was a major problem for 44% of the family members. The psychological process experiencel by the terminal ill patients was compared to the dying process, described by Kiibler Ross. In comparison of the five stages outlined by kubler Ross with the dying process of the subjects it was found that the subjects not only experienced the five stages but also experienced denial and doubt-fulness or denial with acceptance or acceptance with the expectation of a miracle. But rather than acceptance of the dying process, giving up was a frequent end point of the psychological process, of the subjects. However, when the combination of states was observed, most of the patients reached the state of acceptance in the dying process. It was difficult to identify a definite pattern of change in the psychological process of the subjects. Also it was difficult to identify the factors that influenced the psychological process. The symptoms of the terminally j]] subjects just before dying, that is, 3-4 days before dying included apparent signs of dying. These were a reduction of intake(77%), reduction of the amount of urination(63%), increase in sleeping time (64%) and acceptance of dying by patients and their families who had been unaccepting be before that time(66%). The primary care givers(family member's) degree of satisfaction with the care given to the patient by the hospice was 88.7%. The results of this study show that Severance Hospice Home Care Program had a positie effeet on the quality of life of the terminally ill patients and their family members as they faced the death of the patient. It can be seen from this study that there is an urgent need to extend hospice programs - in order to provide quality of care for terminally ill patient and their families. Based upon the reesults of this study several suggestions are presente as follows: 1) A follow up study should be carried out to identify the dying process as it is unique to Korea. 2) A comparison should be made of other hospice care programs. 3) A comparison study should- be made with subjects who do not receive any hospice care as compared to those who do by use of an experimental and control group methodology. 4) There is a need to determine a scientific method to adequeto measure the interventions carried out to meet the hospice patients nursing care needs. 5) A study should be made using quality research methodology to evaluate effects of hospiec care from the patients, their family members and the nurrse's perspective.

• 보건의료산업학회지
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• 제10권3호
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• pp.85-97
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• 2016

Objectives : In this study, the awareness of hospice and the perceptions on the need for visiting palliative care and what constitutes a good death of the citizens of Busan were investigated. The purpose of this study was to develop a hospice system based on the needs of the citizenry of Busan by seeking solutions for current hospice strategies. Methods : One thousand Busan citizens from 20 to 80 years of age were surveyed in this study. Results : Busan citizens defined a good death as spending less than one month of time in the actual process of dying at home between the ages of 80-89 years. They knew about hospice a little and were aware of its necessity. They also knew about the necessity of visiting palliative care and were interested in receiving it when appropriate but did not know much about it. Conclusions : First, there is a large difference between Busan citizens' expectations on what constitutes a good death and what a good death really is. Second, Hospice palliative care should be provided to the community. Third, the older the patient is, the more palliative care visits are necessary. Fourth, 40s and 50s must make preparations for hospice palliative care in their future.

• Journal of Hospice and Palliative Care
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• 제17권4호
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• pp.223-231
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• 2014

목적: 본 연구의 목적은 말기암환자로서 가정호스피스 돌봄을 받고 있는 대상자의 삶의 경험에서 얻어지는 현상을 이해하고 경험의 본질을 이해하고자 함이다. 방법: 가정호스피스 돌봄을 받고 있는 말기암환자 10명으로부터 심층면담을 통해 자료를 수집하였고 Colaizzi의 현상학적 방법을 사용하여 분석하였다. 결과: 의미 있는 진술에서 구성된 의미가 도출되고, 구성된 의미에서 주제 및 주제모음을 확인하여 범주화 한 결과, '삶의 질 저하', '남은 삶의 수용', '신앙으로 준비된 죽음', '고마움', '부정적 대처'의 범주가 도출되었다. 결론: 가정호스피스 돌봄을 받고 있는 말기암환자들의 삶의 경험을 이해하고, 호스피스 간호를 통해 대상자가 부정적인 삶의 경험을 극복하고, 긍정적인 삶의 경험을 할 수 있도록 체계화된 호스피스 간호의 제공이 필요하다.

• 한국산학기술학회논문지
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• 제14권3호
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• pp.1116-1122
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• 2013

본 연구는 암병동에서 실습하는 간호학생들의 통증관리 지식과 호스피스 인식에 관한 조사연구이다. 2012년 12월1일부터 14일까지 서울과 경기일대 암병동에서 실습하는 간호학생을 대상으로 총 237명이다. 조사도구는 통증관리 지식에 관한 45문항과 호스피스 인식에 관한 23문항으로 간호학생들을 평가하였다. 데이터분석은 SPSS Win17.0을 사용하였고 대상자의 빈도분석, t-test, 피어슨상관관계 계수 그리고 ANOVA를 이용하였다. 통증관리에 대한 지식과 호스피스 인식은 대상자의 학년, 종교, 실습기간에 통계적으로 유의미한 차이를 나타내었다. 통증관리 지식이 높을수록 호스피스 인식도 높아졌다. 암병동 간호학생들이 실습기간동안 암환자에 대한 고통을 효율적으로 이해하려면 사전에 공감대를 형성할 수 있는 호스피스교육이 필요하다. 또한 충분한 경험을 갖기 위해서는 실습기간을 늘릴 필요가 있다. 그러기 위해서는 호스피스 인식에 대한 확대와 홍보를 할 수 있는 방안이 필요하다.

• 호스피스학술지
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• 제5권2호
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• pp.15-21
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• 2005

Purpose: This study was designed to evaluate the perception of cancer in aspirants for hospice volunteer. Methods: Aspirants for hospice volunteer were surveyed by questionnaire before education of hospice program in September 2005 at Pyongan Hospice Center of Sam Anyang Hospital. The questionnaire was composed of total 28 items. Ten items were general characteristics and the remaining 18 items knowledge, attitude and practice of cancer and cancer pain. The data were analyzed by SPSS WIN 11.0 program using frequency, mean, percentage. Results: Eighty nine questionnaires were returned. There were 6 males and 83 females, and median age of aspirants was 46 years. Forty five aspirants(51%) had a cancer patient in th family or relatives and the others 44(49%) not. Forty eight(54%) had favorable attitude about modern clinical medicine for cancer treatment and the others 39(44%) unfavorable. Fifty eight(65%) had favorable attitude about complementary and alternative medicine for cancer treatment and the others 20(23%). In response to the question about 'How illness is a cancer', 25 aspirants(25%) responded to chronic disease, 42(47%) suffering incurable disease, the others 17(19%) death sentence, respectively. A number of aspirants had wrong knowledge and understanding of cancer, cancer pain and opioid analgesics. Seventy one percent aspirants feared cancer pain. Conclusion: The credibility to modern clinical medicine for cancer treatment was relatively low in aspirants for hospice volunteer compared with complementary and alternative medicine. They recognized a cancer as suffering incurable disease and death sentence than chronic disease. A number of aspirants had wrong knowledge of cancer, cancer pain and opioid analgesics. Therefore, further studies and trial will be warranted to evaluated the causes of these results and improve the credibility of modern clinical medicine for cancer treatment in general population.

• Journal of Hospice and Palliative Care
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• 제23권3호
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• pp.151-161
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• 2020

Purpose: This study aimed to describe the meaning of spiritual care as perceived by nursing students. Methods: This study used a descriptive research design, and the participants were 126 fourth-year nursing students from three nursing colleges. Data were collected from August to September 2019, and were analyzed using the content analysis method. Results: Four themes of spiritual care with 15 sub-themes were extracted from the content analysis: 1) "promoting spiritual well-being" (sub-themes: "providing religious help", "caring for the patient as a spiritual being", and "presupposing human dignity regardless of religion"); 2) "taking place in actual nursing practice" (representative sub-themes: "considering the perspective of the patient", "reducing suffering"); 3) "caring for the multifaceted needs of human beings" (representative sub-themes: "providing physical, mental, and spiritual care", "caring for both the mental and physical health of the patient"), and 4) "growing together" (sub-themes: "positively affecting patient well-being", "beginning with the nurse's self-transcendence"). Conclusion: These results suggest that nursing students consider spiritual care to be a highly positive and practical form of nursing care. However, because few students have been exposed to religion and spirituality, more systematic training should be provided.

• Journal of Hospice and Palliative Care
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• 제26권1호
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• pp.18-21
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• 2023

The combination of oxycodone and naloxone is useful for cancer pain management. Naloxone, as a pure opioid antagonist, cannot be used simultaneously with opioids. However, owing to its low bioavailability, it can be used in an oral composite formulation. We present the case of a 55-year-old man with gastric cancer who experienced severe opioid withdrawal syndrome (OWS) triggered by oxycodone/naloxone that was successfully managed with dexmedetomidine. He had been in a stable condition on intravenous morphine to alleviate cancer pain. Intravenous morphine was switched to oral oxycodone/naloxone for discharge from the hospital. The patient suddenly developed restlessness, heartburn, and violent behavior 30 minutes after taking oxycodone/naloxone. We attempted sedation with midazolam and propofol, but paradoxical agitation and desaturation occurred. Next, we tried dexmedetomidine and the patient showed a decreased heart rate and reduced agitation. The patient was eventually stabilized by increasing the dose of dexmedetomidine. This report informs clinicians of the possibility of OWS when switching from opioids to oxycodone/naloxone, which can be overcome with the appropriate use of sedatives and dexmedetomidine depending on the patient's condition.

• Journal of Hospice and Palliative Care
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• 제9권2호
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• pp.93-100
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• 2006

목적: 본 연구는 말기 암 환자의 호스피스 완화의료에 대한 의사들의 태도에 대하여 알아보고자 하였다. 방법: 서울과 경지지역의 종합병원에 근무하는 전문의를 대상으로 호스피스 완화의학 연구회에서 자체 개발한 설문지를 이용하여 말기 암 환자에서 호스피스 완화의료에 대한 태도를 조사하였다. 설문지는 총 17문항으로 구성되었다. 수집된 자료는 실수, 중앙값과 백분율로 분석되었다. 결과: 총 81명(남자 46명, 여자 35명)이 설문지에 응답하였으며 나이의 중앙값은 35세였다. 내과가 36명(44.4%)으로 가장 많았다. 전문의 경력의 중앙값은 4년이었다. 1주일에 진료를 하는 환자 수는 거의 환자를 보지 않는 경우가 43명(53.2%)으로 가장 많았다. 호스피스 완화의료의 정확한 정의를 알고 있는 의사수는 37명(45.6%)이었다. 호스피스 완화의료의 필요성에 대하여 80명(98.8%)이 필요하다고 응답하였고 이 중에 73명(91.2%)이 완화의학 전문의가 필요하다고 응답하였다. 말기 암 환자에 대하여 적극적으로 호스피스 완화의료에 의뢰하겠는가에 대한 질문에 55명(67.9%)이 그렇게 하겠다고 응답하였으며 이 중 17명(30.9%)은 주저한 경험이 있는데 이유로 가족의 반대가 6명(35.3%)으로 가장 많았으며 다음으로 '환자를 포기하는 것 같아서'로 응답한 의사가 4명(23.5%)이었다. 적극적으로 호스피스 완화의료에 의뢰하지 않은 22명(27.2%)에 대하여 이유로 '환자를 포기하는 느낌'과 기타 사항으로 '절차를 모른다'가 각각 6명(27.2%)으로 가장 많았다. 37명(45.7%)의 의사가 임종 전 3개월에 호스피스 완화의료를 받는 것이 가장 좋다고 응답하였으며 가장 도움을 받는 것은 정신적, 심리적 조절이라고 응답한 의사가 58명(71.6%)으로 가장 많았다. 결론: 대부분의 의사들이 호스피스 완화의료의 필요성은 인식하고 있으나 말기 암 환자에 대한 호스피스 완화의료에 의뢰하는 적극적인 자세는 부족하였다. 의사들에게 지속적인 호스피스 완화의료에 대한 교육과 정보, 홍보가 필요하리라고 생각된다.

• 대한간호학회지
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• 제21권3호
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• pp.418-435
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• 1991

The purposes of this study were to find out the effects of hospice care for the quality of life of the terminally - ill patients and to analyze the relationship between the effect of hospice care and the general characteristics of subjects. The subjects of the study were 32 terminally - ill patients hospitalized in the two general hospitals in Seoul, which have the hospice care unit. The data were collected using the questionnaire with interviews. They were done from Sept.28, 1989 to March 20, 1991. The tools used for the research were 17-item questionnaire regarding general characteristics, 42-item questionnaire about the quality of life (11- item for physical, 16 for psychosocial, and 15 for spiritual). The questionnaires were to measure the duality of life by means of the measure instruments of Betty R. Farewell(1989), Stein Kaasa(1988), Palm Pamela(1987), and Hwa-sook Choi(1987). 42 items were used after pre-test. In accordance with each purpose in this study, frequency and percentage were used on the general characteristics of subjects. ANOVA, t-test, and Pearson correlation were employed to evaluate the general characteristics of subjects and different level of quality of life before-and-after hospice care. The results of the study may be summarized as follws : 1. The effects of hospice care. Main Hypothesis : “The quality of life of the terminally - ill patients will be different from before-and-after hospice care” was supported(t＝6.82, df＝31, p＝ .000). Sub Hypothesis 1 : “The quality of life of the terminally - ill patients in the physical aspects will be different from before - and -after hospice care” was not supported(t＝0.07, df＝31, p＝ .946). Sub Hypothesis 2 : “The quality of life of the terminally - ill patients in the psychosocial aspects will be different from before-and-after hospice care” was supported (t＝4.69, df＝31, p＝ .000). Sub Hypothesis 3 : “The quality of life of the terminally - ill patients in the spiritual aspects will be different from before-and-after hospice care” was supported(t＝6.64, df＝31, p＝ .000). 2. Relationship between the general characteristics of subjects and the effects of hospice care. (1) The more the number of family, the higher the quality of life in the psychosocial aspects. (2) The higher the age of the patient, the lower the quality of life in the psychosocial aspects. (3) The high educational level of patients enjoy the high quality of life in general. (4) The high religious level of petients enjoy the higy Quality of life in the spiritual aspects. As a results of analysis above : 1. The most effective aspects of the hospice care to the terminally- ill patients was spiritual aspects. The next effective aspects was psychosocial area. 2. The least effective aspcets of the hospice care to the terminally- ill patients was physical aspects. Further study is needed to improve the quality of life in the physical aspects.

• Journal of Hospice and Palliative Care
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• 제1권1호
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• pp.65-68
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• 1998

The neuropathic pains are not well controlled by common analgesics and opioid drugs in terminal cancer patients. The types of these pains are divided within the two cages, one is due to continuous central sensitization and the other is due to paroxymal peripheral sensitization. The mechanism of continuous central sensitization is the activity of dorsal horn neurones that are activated by C-fiber input. The tricyclic antidepressants, non-tricyclic antidepressants, and oral local anaesthesia probably produce analgesic effects in neuropathic pains through suppression of this activity. The mechanism of paroxymal peripheral sensitization is the hyper-excitability of peripheral neurones. The neuropathic pains due to peripheral sensitization respond relatively the anticonvulsants and baclofen that stabilize membranes and suppress paroxymal electrical discharge. The patients was a 38-year-old female who complained of hyperthemia on upper right extremity. The symptom of this patient was improved with anticonvulsant(dilantin 600mg).