• Journal of Korean Academy of Fundamentals of Nursing
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• v.23 no.2
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• pp.172-183
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• 2016

Purpose: The purpose of this study was to explore the subjective experience of life-sustaining treatment care among nurses in intensive care units. Method: A phenomenology was used for the study. Data were collected from October to December, 2015 using open-ended questions during in-depth interviews. Participants were nurses working in intensive care units and were contacted through purposive techniques. Eight nurses participated in this study. Results: Four categories emerged from the analysis using Colaizzi's method: (a) difficulties due to life-sustaining treatment care, (b) dilemma of extension or cessation of life-sustaining treatment, (c) repressed feelings and emotional exhaustion, and (d) forming values for life-sustaining treatment from nursing experience. Conclusion: Provision of clearer guidelines on life-sustaining treatment which reflect a family-oriented culture is important for nurses in ICU and will promote nurses involvement in the decision-making process of life-sustaining treatment of patients.

• Journal of Korean Clinical Nursing Research
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• v.16 no.3
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• pp.85-98
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• 2010

Purpose: This study was aimed to investigate the awareness and attitudes towards withdrawal of the life-sustaining treatment among nurses, physicians, and the families of intensive care unit (ICU) patients in general hospitals. Methods: The data were collected using a questionnaire from 80 ICU nurses, 80 physicians, and 80 families of ICU patients in general hospitals. Data were collected from February 22nd to May 31st, 2010. Rusults: ICU nurses, physicians, and families of ICU patients felt that objective and ethical guidelines were needed in making a decision to withdraw the life-sustaining treatment. The main reason for withdrawal of the life-sustaining treatment was found that the patients could not recovered despite many efforts. The role of nurses in decision making process on withdrawal of the life-sustaining treatment was considered very positive from the view of physicians and family members. The most important role of nurses for those patients in ICU was found to try their best to care for the patients. Conclusion: ICU nurses should play a major coordinating role in communication among patients, their families, and medical teams. Also, an appropriate roles of nurses in the process of the withdrawal of the life-sustaining treatment should be established.

• Journal of Hospice and Palliative Care
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• v.23 no.2
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• pp.93-102
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• 2020

Purpose: The Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End of Life came into force in February 2018 in Korea. This study reviews the practices of end-of-life care for patients who withdrew or withheld life-sustaining treatment at a tertiary care hospital, addresses the limitations of the law, and discusses necessary steps to promote patient-centered self-determination. Methods: We retrospectively analyzed the medical records of patients who died after agreeing to withhold life-sustaining treatment in 2018 at our university hospital. The cause of death, the intensity of end-of-life care, and other characteristics were reviewed and statistically analyzed. Results: Of a total of 334 patients, 231 (69%) died from cancer. The decision to stop life-sustaining treatment was made by family members for 178 patients overall (53.3%) and for 101 (43.7%) cancer patients, regardless of the patient's wishes. When the patient decided to stop life-sustaining treatment, the time from the authorization to withhold life-sustaining treatment to death was longer than when the decision was made by family members (28.7±41.3 vs 10.5±23.2 days, P<0.001). Conclusion: In many cases, the decision to discontinue life-sustaining treatment was made by the family, not by the patient. In order to protect human dignity based on the patients' self-determination, it is necessary for patients to understand their disease based on careful explanations from physicians. Ongoing survey-based research will be necessary in the future.

• Journal of Convergence for Information Technology
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• v.10 no.12
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• pp.226-235
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• 2020

This study aimed to identify the integral factors influencing the attitudes of nursing students toward withdrawal of life-sustaining treatments. Methods: 139 nursing students were selected from the school of nursing of a single university. Questionnaires were used as measurement tools to measure their good death recognition, attitude towards death & towards withdrawal of life-sustaining treatment. The degree of good death recognition, attitude towards death & towards withdrawal of life-sustaining treatment were analyzed using descriptive statistics. Correlation between variables was analyzed using Pearson's correlation coefficient and factors influencing the attitude towards withdrawal of life-sustaining treatment using multiple linear regression. Results: Attitude towards withdrawal of life-sustaining treatment was significantly positively correlated with good death recognition(r=.312, p=.000). As a result of multiple linear regression, good death recognition significantly influenced (β=.312, p=.000), accounting for 8.5% of the variance in attitude towards withdrawal of life-sustaining treatment. Conclusions: The results from this study can be contribute to develop educational programs to foster positive attitudes towards withdrawal of life-sustaining treatment.

• Korean Journal of Adult Nursing
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• v.28 no.3
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• pp.334-342
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• 2016

Purpose: This study was conducted to identify factors that influence on self-determination for withdrawal of life-sustaining treatment in the community dwelling elderly. Methods: This study used a descriptive correlational design. A convenience sample of 201 elderly were recruited from a welfare center located in Seoul, Korea. Data collection was done from September 1 to September 18, 2015. Four survey questionnaires were used: Multidimensional Scale of Perceived Social Support (MSPSS), Life Satisfaction Index-Z (LSI-Z), Attitude on Do Not Resuscitate (DNR), and Self-determination for Withdrawing Life-sustaining Treatment. Data analysis was done by t-test, ANOVA, Pearson's correlation, and hierrarchical multiple regression. Results: Hierarchial multiple regression showed that the factors predicting the level of self-determination for withdrawing life-sustaining treatment were educational level, DNR experience in family, life satisfaction, and DNR attitude. These factors explained 44% of the self-determination for withdrawing life-sustaining treatment in community dwelling elderly. Conclusion: The results of this study suggest developing educational programs aiming at changing elderly's DNR attitude positive ways so that they can enhance self-determination for withdrawing life-sustaining treatment. Further study is needed with more elderly population in extended areas.

• Child Health Nursing Research
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• v.23 no.3
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• pp.364-374
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• 2017

Purpose: The purpose of this study was to describe feelings and actions of nurses following withdrawal of life-sustaining treatment from children being cared for by the nurses. Methods: Data were collected by in-depth interviews with 7 nurses from different hospitals where children receiving nursing care had life-sustaining treatment withdrawn. The interviews were conducted from August 2016 to February 2017 when all data were saturated. Interviews lasted 30~90 minutes and were conducted 2~3 times per participant. Data were analyzed using Giorgi's phenomenological research methodology. Results: The following factors constituted experiences of nurses working in pediatric wards when life-sustaining treatment was withdrawn from children: "agony and conflict in the aspects of care", "heavy mind and regret for exhausting care", "intentionally avoiding parents' sadness", "comforting sadness in the heart" and "orientation in the role of caring for children undergoing withdrawal of life-sustaining treatment." Conclusion: Findings indicate that support systems and intervention programs need to be developed so that nurses can understand and wisely deal with experiences of withdrawal of life-sustaining treatment from children who receive care from nurses.

• Journal of Hospice and Palliative Care
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• v.25 no.1
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• pp.25-41
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• 2022

Purpose: This study investigated trends of nursing research on life-sustaining treatment in South Korea. Methods: The period for data search was set from January 2018 to December 2020. The major search terms used were advance directives and life-sustaining treatment. Of the 492 records identified in the initial search, 461 articles were excluded for various reasons. A total of 31 records were included in the final qualitative analysis. Results: Sixteen studies had nursing students as study subjects, while nine studies had nurses as study subjects. The majority of the studies employed cross-sectional descriptive surveys as their research design. The major themes that emerged from the studies were as follows: attitudes toward withdrawal of life-sustaining treatment, knowledge of and attitudes toward advance directives, perceptions of a good death, and nurses' attitude toward life support care. Most of the studies reviewed concluded that attitudes toward withdrawal of life-sustaining treatment significantly impacted both knowledge of and attitudes toward advance directives and perceptions of a good death. Conclusion: To date, Korea still lacks extensive nursing research concerning life support care. Further research is needed to provide systematic education for nursing ethics and life support care, as well as the introduction of a specialist course. Furthermore, a multidisciplinary approach is necessary to provide diverse support systems and policy measures. In particular, since nurses are directly responsible for providing life support care, nurses' roles should be expanded in accordance with the Act on Decisions on Life-Sustaining Treatment.

• Journal of Hospice and Palliative Care
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• v.24 no.2
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• pp.97-108
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• 2021

Purpose: The purpose of this study was to examine the life-sustaining treatment decisions of terminal cancer patients. Methods: Data on 10 terminal cancer patients who decided to withhold or withdraw from treatment were collected using in-depth interviews conducted from February 8 to October 30, 2019. Data were collected until saturation was reached and then analyzed using Colaizzi's phenomenological method. Results: In this study, six thematic clusters were identified: "having complicated feelings", "making choices to protect everyone", "accepting and preparing for death", "feeling distress", "pursuing spiritual wellbeing", and "evaluating the new system". Conclusion: When facing death, terminal cancer patients often made choices to protect their family and their dignity with uneasiness of mind when deciding to withdraw from life-sustaining treatments. Though many patients had accepted and prepared for death, they experienced distress about leaving children behind after death. They also pursued spiritual well-being to find peace after deciding to withdraw from life-sustaining treatment. In addition, participants evaluated the new system of policies pertaining to decisions on life-sustaining treatment. Thus, various approaches regarding acceptance and preparation for death, communication with family, hope, and spiritual comfort should be taken in educational interventions to assist terminal cancer patients as they decide whether to withdraw from life-sustaining treatment.

• Health Policy and Management
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• v.33 no.1
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• pp.19-28
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• 2023

Background: With the enactment of the Hospice, Palliative, Care, and Life-sustaining Treatment Decision-Making Act in February 2018, legal guidelines for physician orders for life-sustaining treatment (POLST) were presented. This study was conducted to analyze the association of writing POLST on the use of health care before death. Methods: The study analyzed the electronic medical records and POLSTs of 1,003 adult patients who died at a tertiary hospital located in Seoul from February 4, 2018 to February 4, 2019. Results: Of the deaths, 80% (n=804) completed POLST. Among patients who completed POLST before death, 51% (n=412) were written 1-7 days before death, and only 31% (n=246) were completed by patients themselves. 99% (n=799) decided to withdraw or withhold cardiopulmonary resuscitation. As a result of analyzing the effect of POLST on medical use before death, it was found that POLST and inpatient cost had a significant negative correlation, and POLST completion significantly reduced death in the intensive care unit (ICU). However, both inpatient costs and death at ICU increased when the POLST was completed by surrogate decision-makers rather than patients themselves. Conclusion: The enactment of the Hospice, Palliative, Care, and Life-sustaining Treatment Decision-Making Act provided a legal basis for withdrawing and withholding meaningless life-sustaining treatment. By specifying the treatment to be received at the end of one's life through the POLST, inpatient treatment costs and death at the ICU were decreased. However, the frequent decision-making by the surrogates and completion of POLST close to death may hinder the original purpose of the law.

• Journal of Hospice and Palliative Care
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• v.13 no.2
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• pp.81-88
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• 2010

Purpose: This study was conducted to study the attitude of Korean lawyers toward withdrawal of life sustaining treatment, and compare and analyze different types of their attitudes. Methods: Research design of this project was Q methodology approach. The study population was 24 lawyers, aged from 32 to 69 years. Q sample to investigate the attitude of the lawyers toward withdrawal of life sustaining treatment included 34 statements obtained from literatures, TV debate, and depth interviews of 5 lawyers among the lawyers included. After listening to the purpose and method of the study, the 24 lawyers agreed to fill out a survey asking sociodemographic information, and the information was distributed in 9 scale Q-sample. Results: The collected data were processed through QUANL PC program and sorted into 5 types as follows: The first type was 'Choosing to withdraw life sustaining treatment', the second 'Withholding life sustaining treatment' regardless of the cost, the third is neutral type that claims that humans have the right to decide the death and life, and demands the proper legalization to protect such rights, the fourth type agrees to withdrawal of life sustaining treatment, nevertheless, admits that one has a rigt to withhold one's own life treatment, categorized as self contradiction type. The fifth type believed that 'Life and death are providential' with the faith, therefore, such authority to decide life and death belongs to God, but not human beings. Conclusion: In conclusion, the lawyer's attitudes toward withdrawal of life sustaining treatment were grouped into five different types as follows: 'Choosing to withdraw life sustaining treatment', 'Withholding life sustaining treatment', 'Demanding legalization', 'Self contradiction type', and 'Life and death are providential'.