• Journal of Korean Academic Society of Home Health Care Nursing
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• v.20 no.1
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• pp.63-71
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• 2013

Purpose: This study was performed to identify nursing college students' attitudes towards death and was conducted as a pre-investigation to prepare them for coping with terminally ill patients in their clinical practice. Methods: The subjects consisted of 321 nursing students. Their attitudes towards death were measured by using the Collett-Lester Fear of Death Scale(CLFODS). The data obtained were analyzed by using the one-wayANOVA and Duncan's multiple test using the SAS 9.2 soft ware program. Results: The mean CLFODS score was 2.99. Among the 4 subscales, there were significant differences among the students with respect to grade, indirect experience of death, social isolation, daily life stress, and suicidal ideation in the past year. Conclusion: A negative attitude towards death was observed in the psychosocial characteristics, with indirect experience of death, social isolation, daily life stress, and suicidal ideation in the past year. It is necessary to educate students on how to care for dying patients before clinical practice. This education can be carried out by developing a death education program after considering the above mentioned psychosocial characteristics noted in this study.

• Journal of Hospice and Palliative Care
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• v.19 no.1
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• pp.5-10
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• 2016

Purpose: This study reviewed what the location of death (LOD) means as an outcome and how to use LOD to assess end-of-life (EOL) care. This study also examined the reason why LOD is significant for the quality of EOL care. Methods: A literature review was performed, using LODs and home deaths as outcomes in the field of EOL care, and analyzed the findings associated with key fields in regards to LOD. Results: Palliative care research used LOD, in particular, hospital death (versus home death) as a significant outcome when examining cost savings, quality of life care, and patient and family preferences. Based on substantial evidence from previous research, home hospice or continuous palliative care in non-hospital settings (i.e. homes, nursing homes) have been designed and available for dying patients in developed countries. Conclusion: The LOD delivers practical significance as an outcome for diverse reasons. In-depth examination on LOD in South Korea is needed despite limitations to interpretation of its meaning in the country.

• The Korean Society of Law and Medicine
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• v.10 no.1
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• pp.263-305
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• 2009

Is it lawful to withhold or withdraw life-sustaining treatment applied to a patient in a terminal condition or permanent unconscious condition? In Korea, there are no such laws or regulations which control affairs related to the withholding or withdrawal life-support treatment and active euthanasia as the Natural Death Act or the Death with Dignity Act in the U. S. A. And in addition there has had no precedent of Supreme Court. Recently Supreme Court has pronounced a historical judgment on a terminal care case. The court allowed the withdrawal of life-sustaining treatment from a patient in a permanent unconscious state. Fundamentally the court judged that the continuation of that medical treatment would infringe dignity and value of a patient as a human being. And the court required some legal grounds to consider such withdrawal or withholding of medical care lawful. The legal grounds are as follow. First, the patient is in a incurable and irreversible condition and already entered a stage of death. Second, the patient executed a directive, in advance, directing the withholding or withdrawal of life-support treatment in a incurable and irreversible condition or in a terminal condition. Otherwise, at least, the patient's will would be presumed through his/her character, view of value, philosophy, religious faith and career etc. I regard if a patient is in a incurable and irreversible condition or in a terminal condition, the medical contract between a patient and a doctor would be terminated because of the actual impossibility of achievement of it's purpose. So I think the discontinuation of life-sustaining care would be legally allowed without depending on the patient's own will.

• Communications for Statistical Applications and Methods
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• v.26 no.6
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• pp.557-573
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• 2019

Mortality study is an essential component of actuarial risk management for life insurance policies, annuities, and pension plans. Life expectancy has drastically increased over the last several decades; consequently, longevity risk associated with annuity products and pension systems has emerged as a crucial issue. Among the various aspects of mortality study, a consideration of the cause-of-death mortality can provide a more comprehensive understanding of the nature of mortality/longevity risk. In this case study, the cause-of-mortality data in Korea and the US were analyzed along with a multinomial logistic regression model that was constructed to quantify the impact of mortality reduction in a specific cause on actuarial values. The results of analyses imply that mortality improvement due to a specific cause should be carefully monitored and reflected in mortality/longevity risk management. It was also confirmed that multinomial logistic regression model is a useful tool for analyzing cause-of-death mortality for actuarial applications.

• Journal of Korean Critical Care Nursing
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• v.12 no.2
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• pp.39-49
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• 2019

Purpose : The purpose of this study was to identify the extent to which intensive care unit (ICU) nurses' perceptions of life-sustaining treatment decisions and "a good death" affect attitudes toward terminal care. Method : Participants included 109 ICU nurses from three university hospitals. Data were collected using structured questionnaires, and collected data were analyzed using a t-test, ANOVA, the $Scheff{\acute{e}}$ test, Pearson correlation coefficients, and a multiple regression analysis (SPSS 24.0 program). Results : Perceptions of life-sustaining treatment decisions and a sense of closeness (a constituent for the awareness of "a good death") were positively correlated with terminal care attitudes. The factors affecting terminal care attitudes were a clinical career in ICU (${\beta}=.20$, p =.035), a sense of closeness(${\beta}=.19$, p =.041), and the perception of a life-sustaining treatment decision (${\beta}=.22$, p =.017). This finding indicates that more than 10 years of experience in ICU, a greater sense of closeness, and a higher view of life-sustaining treatment decisions results in more positive attitudes toward terminal care. The explanatory power of these variables on terminal care attitudes was 14% (F=6.84, p < .001, Adj $R^2=.140$). Conclusion : A sense of closeness and the perception of life-sustaining treatment decisions were identified as the factors affecting terminal care attitudes. Thus, various programs must be developed to raise awareness among ICU nurses of "a good death" and perceptions of life-sustaining treatment decisions.

• Journal of Korean Critical Care Nursing
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• v.14 no.1
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• pp.1-13
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• 2021

Purpose : Based on Quint's theory and the relevant literature, this study constructed a structural equation model for explaining and predicting end-of-life care performance in clinical nurses. Methods : A self-administered questionnaire was used to collect data from 265 nurses between September 1 and September 30, 2016. The data were analyzed using SPSS ver. 21 and AMOS ver. 21. Results : The goodness of fit of the modified model was found to be relatively satisfactory (χ2=114.82, Nomed χ2(χ2/df)=2.44, SRMR=.06, GFI=.94, AGFI=.89, CFI=.95, TLI=.91, RMSEA=.07). End-of-life care performance was affected by the attitudes toward nursing care of the dying, working unit, and death anxiety. The attitudes toward such care had the highest effect on end-of-life care performance. Conclusion : The results suggest that end-of-life care performance is directly and indirectly affected by attitudes toward nursing care of the dying, participation in end-of-life care education, working unit, death perception, and death anxiety. To improve clinical nurses' end-of-life care performance, effective programs to promote death anxiety and attitudes toward nursing care of the dying need to be developed. In addition, hospital nursing organizations should attempt to produce concrete measures for death anxiety and terminal care attitudes in clinical nurses.

• Journal of Korean Clinical Nursing Research
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• v.28 no.3
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• pp.289-298
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• 2022

Purpose: Nursing stress on life-sustaining treatment of nurses is a significant contributing factor to nursing care performance and patient care outcomes. We need to investigate the factors associated with nursing stress on life-sustaining treatment in hospital settings. The purpose of this descriptive study was to examine the relationship of role perception of life-sustaining treatment and good death perception with nursing stress on life-sustaining treatment among nurses in hospital settings. Methods: Using a cross-sectional study design, we recruited nurses at a hospital located in a metropolitan city in Korea. The nurses completed structured questionnaire questions which were composed of well-validated questionnaires. Descriptive statistics and hierarchical multiple regression model were utilized for data analysis. Results: A total of 205 nurses participated in the study (female 93.2%; aged 20~29 years 63.0%; single status 78.5%). In the hierarchical multiple regression model, there was a significant positive relationship between role perception of life-sustaining treatment and nursing stress on life-sustaining treatment (β=.27, p<.001). Higher education level and working at a ward setting were also significantly related to nursing stress on life-sustaining treatment (β=.13, p<.046 for education level; β=.22, p=.001 for work setting). However, there was no relationship between good death perception and nursing stress on life-sustaining treatment. Conclusion: Education programs to reduce nursing stress on life-sustaining treatment are needed to develop for nurses who have higher role perception of life-sustaining treatment with higher education level working at ward settings in hospitals.

• Health Policy and Management
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• v.22 no.1
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• pp.29-48
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• 2012

The purpose of this study is to analyze medical expenses by decedents in their last year of life and compare them with those by survivors during the year 2008. This study is conducted firstly in Korea, except some studies focusing on medical cost of decedents from specific diseases. To study this, national health insurance(NHI) claims data was used with medicaid claims data. The study group(decedents) was selected from the insurance entitlement file who were dropped out from January to December of 2008. The control group(survivors) was selected from the entitlement file by stratified sampling with keeping age-sex composition of the study group. The medical expenses of decedents during one year before death were measured and compared with those of survivors by sex and age. And the medical expenses were analyzed by causes of death, and also the expenses were examined by each item of medical services. On average, the medical expense amounted to 11 million Korean Won per decedent during their last year of life in 2008. The medical expense per decedent was 9.3 higher than that of survivor. The death-related expense of under the age 35 was about 16 million Won, compared with 4 million Won in the case of over the age 95, in average. The death-related expense is higher in younger ages. This means that more medical resources are put in to save life in younger ages. Total death-related expenditure took 8.3 percent in total NHI expenditures. Of the death-related medical expenses, the largest one was injection-related cost which shares twenty five percent, and the second largest one was hospitalization charges, and then the third one was surgery cost. The results of this study suggested that we should pay attention to the medical expenses in the last of year of life when we study health care expenditure in Korea. In addition, we have to deliberate health care policy to cope with medical expenditures before death in more efficient way.

• Journal of Hospice and Palliative Care
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• v.16 no.4
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• pp.223-231
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• 2013

Purpose: This study was conducted to explore how nurses' attitude toward dignified death and moral sensitivity affect their end-of-life care performance. Methods: Study participants were 172 nurses who work at university hospitals in a metropolitan city in Korea. Data were collected from June 20 through August 13, 2012 using the Dignified Death Scale, Moral Sensitivity Scale, and End-of-Life Care Performance Scale. Data were analyzed using the SPSS/WIN 19.0 program. Results: Factors affecting nurses' end-of-life care performance included moral sensitivity, dignified death and education level. Conclusion: Moral sensitivity, dignified death and education level should be considered when developing an educational program for nurses' end-of-life care performance.

• The Journal of Korean Academic Society of Nursing Education
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• v.26 no.4
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• pp.383-392
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• 2020

Purpose: This study was a descriptive study to identify factors affecting the attitude toward life-sustaining treatment of nurses working at long-term care hospitals. Methods: Data were collected through structured questionnaires from August 2nd to 27th, 2019. Study participants consisted of 163 nurses who were working for at least 6 months from 7 long-term care hospitals in B and K city. Data were analyzed using t-test, ANOVA, Scheffe' test, Pearson's correlation coefficients, and hierarchical regression with SPSS WIN v 21.0. Results: There were significantly positive correlations between awareness of good death (r=.46, p<.001) and perception of patients' rights (r=.32, p<.001). The factors affecting participants' attitude toward life-sustaining treatment were awareness of good death (β=.35, p<.001) and their own view of death (β=.24, p=.001), which explained about 27.0% of the attitude toward life-sustaining treatment. Conclusion: Based on these results, it is necessary to develop nursing educational materials that can establish values for deaths, and cultivate legal and ethical knowledge related to attitude toward life-sustaining treatment. In addition, since the severity of a patient's condition varies and the characteristics of the institution vary depending on the type of hospital, a study is needed on the relevance of variables considering the hospital environment.