• Title/Summary/Keyword: Life sustaining treatment

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Characteristics of End of Life Sustaining Treatment and Attitudes towards Advance Directives among Geriatric Patients (임종기 연명치료 중단관련 특성과 사전의료의향서에 대한 노인환자의 태도)

  • Jung, Seungyun;Lee, Haejung;Lee, Sunghwa
    • Journal of East-West Nursing Research
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    • v.20 no.2
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    • pp.103-111
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    • 2014
  • Purpose: The purpose of this study was to identify the characteristics of life-sustaining treatment and attitudes towards advance directives among geriatric patients. Methods: The elderly participants (N=146) were recruited from a university hospital from October 30, 2012 to March 31, 2013. A questionnaire for collecting data of participants' characteristics, their experiences related to life-sustaining treatment, and attitudes towards advance directives was used. The data were analyzed using SPSS WIN 17. Results: Most participants (84.9%) were in favor of advance directives. Although most of participants wanted to receive CPR for sudden cardiac arrest (78.8%) and pain control medication (74.0%), most preferred to refuse life-sustaining treatments such as tracheostomy (96.6%) or ventilator (87.0%). Participants who had a family or acquaintances with CPR experiences (U=852.00 p=.038), had discussed with their family and acquaintances regarding end-of-life sustaining treatment (t=2.91, p=.004), or made decisions about refusing the life sustaining treatments (t=3.19, p=.002) preferred to have advance directives than those who did not. Conclusion: The findings of this study suggested the potential benefits of educational programs about advance directives for the end-of-life for geriatric patients to make decisions for life-sustaining treatments in advance.

Comparing Perceptions, Determinants, and Needs of Patients, Family Members, Nurses, and Physicians When Making Life-Sustaining Treatment Decisions for Patients with Hematologic Malignancies

  • Kim, Semi;Ham, Eun Hye;Kim, Dong Yeon;Jang, Seung Nam;Kim, Min kyeong;Choi, Hyun Ah;Cho, Yun A;Lee, Seung A;Yun, Min Jeong
    • Journal of Hospice and Palliative Care
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    • v.25 no.1
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    • pp.12-24
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    • 2022
  • Purpose: This descriptive study compared the perceptions, determinants, and needs of patients, family members, nurses, and physicians regarding life-sustaining treatment decisions for patients with hematologic malignancies in the hematology-oncology department of a tertiary hospital in Seoul, Korea. Methods: In total, 147 subjects were recruited, gave written consent, and provided data by completing a structured questionnaire. Data were analyzed using analysis of variance, the chi-square test, and the Fisher exact test. Results: Nurses (F=3.35) and physicians (F=3.57) showed significantly greater familiarity with the Act on Decisions on Life-Sustaining Treatment than patients (F=2.69) and family members (F=2.59); (F=19.58, P<0.001). Many respondents, including 19 (51.4%) family members, 16 (43.2%) physicians, and 11 (29.7%) nurses, agreed that the patient's opinion had the greatest effect when making life-sustaining treatment decisions. Twelve (33.3%) patients answered that mental, physical, and financial burdens were the most important factors in life-sustaining treatment decisions, and there was a significant difference among the four groups (P<0.001). Twenty-four patients (66.7%), 27 (73.0%) family members, and 21(56.8%) nurses answered that physicians were the most appropriate people to provide information regarding life-sustaining treatment decisions. Unexpectedly, 19 (51.4%) physicians answered that hospice nurse practitioners were the most appropriate people to talk to about life-sustaining treatment (P<0.001). Conclusion: It is of utmost importance that the patient and physician determine when life-sustaining treatment should be withdrawn, with the patient making the ultimate decision. Doctors and nurses have the responsibility to provide detailed information. The goal of end-of-life planning is to ensure patients' dignity and respect their values.

The Relationships between Knowledge on Advance Directive, Attitudes towards the Withdrawal of Life-sustaining Treatment and Quality of Life in Hemodialysis Patients (혈액투석 환자의 사전의료의향서 지식, 연명치료중단에 대한 태도 및 삶의 질의 관계)

  • Joung, Sun-ae;Park, Kyung-Yeon
    • Research in Community and Public Health Nursing
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    • v.28 no.3
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    • pp.291-301
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    • 2017
  • Purpose: This study aims to investigate the relationships between knowledge on advance directive, attitudes towards the withdrawal of life-sustaining treatment and quality of life among hemodialysis patients. Methods: A descriptive correlational study was conducted with 103 hemodialysis patients. Data were collected using a structured questionnaire from May to September of 2016, and analysed by using descriptive statistics, t-test, ANOVA and Pearson correlation coefficient. Results: The participants' knowledge level on advance directive was $5.47{\pm}2.08$ out of 9, the attitudes towards the withdrawal of life-sustaining treatment was $3.22{\pm}0.49$ out of 5, and the quality of life was $3.35{\pm}0.92$ out of 6. The knowledge on advance directive was positively correlated with attitudes towards the withdrawal of life-sustaining treatment (r=.21, p=.037) and quality of life (r=.21, p=.036). Conclusion: According to the results of this study, the level of knowledge on advance directive is preferred to improve the quality of life of hemodialysis patients. It is needed to support and maintain ongoing education opportunities in order to improve the level of knowledge on advance directive among patients undergoing hemodialysis.

The effects of death orientation and attitude toward withdrawal of life-sustaining treatment on awareness of biomedical ethics among paramedic students

  • Park, Yunhee;Song, Hyo-Suk
    • Journal of the Korea Society of Computer and Information
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    • v.25 no.2
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    • pp.181-188
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    • 2020
  • This study was conducted to identify the effects of the degree of death orientation, attitudes toward withdrawing life-sustaining treatment, and awareness of biomedical ethics on paramedic students' own biomedical ethics. The participants of this study were 228 paramedic students from a college located in D city. Data were collected from April to June 2019 through a self-report questionnaire. There was a positive correlation between awareness of biomedical ethics and attitude toward withdrawing life-sustaining treatment (r=.63, p<.001). Multiple linear regression analysis showed that the factors affecting students' awareness of biomedical ethics were religion (β=.12, p=.018) and their attitude toward withdrawal of life-sustaining treatment (β=.61, p<.001), with an explanatory power of 41.0%. Educational programs must focus on attitudes toward withdrawing life-sustaining treatment to improve paramedic students' awareness of biomedical ethics.

Critical Care Nurses' Perception of Life-sustaining Treatment at End of Life: A Content Analysis (생애 말 연명의료에 대한 중환자실 간호사의 인식: 내용 분석 연구)

  • Koh, Chin-Kang;Ko, Chung Mee;Park, Hyeyoung
    • Journal of Korean Critical Care Nursing
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    • v.10 no.1
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    • pp.41-50
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    • 2017
  • Purpose: The purpose of this study was to describe what critical care nurses perceived about life-sustaining treatment at end of life. Methods: A qualitative content analysis method was utilized. The unit of analysis was interview text obtained from fifty critical care nurses of a general hospital. Results: Seven categories in two content areas were abstracted. In the negative perception area, the following five categories were abstracted: patients' suffering, dying with damaged dignity, patients' isolation from family members, regret about choosing life-sustaining treatment, and family members' burden. In the positive perception area, the following two categories were abstracted: willingness to sustain life and duty as family members. Conclusions: Nurses have better competencies pertaining to understanding patients' responses and suffering than any other health care professions do. Nurses should play an important role in advocating for patients and their family in the process of end-of-life care decision making.

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The Effect of Cancer Patients' Knowledge of Advanced Directives and Perception of Good Death on Attitude toward Withdrawal of Life-Sustaining Treatment (암환자의 사전연명의료의향서 지식과 좋은 죽음 인식이 연명의료중단 태도에 미치는 영향)

  • Park, Sang-Un;Kang, Yong-Sil
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.22 no.2
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    • pp.539-547
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    • 2021
  • This study was conducted to identify the effects of knowledge of Advance Directives (AD) and the patient's perception of a peaceful death on their attitude toward the withdrawal of life-sustaining treatment and to provide basic data for the development of a nursing intervention program for activating self-determination in the withdrawal of life-sustaining support of patients. The subjects were 167 adult cancer patients who received outpatient or inpatient treatment, from September 15, 2019, to March 30, 2020. The data was analyzed by mean, standard deviation, t-test, ANOVA, Pearson's correlation coefficient, and multiple regression by using SPSS 21.0. From the results, it was observed that the knowledge of AD was 8.87±2.46 out of 12, perception of a peaceful death was 2.87±0.42 out of 4, and attitude toward withdrawal of life-sustaining treatment was 3.46±0.49 out of 5. There was a positive correlation between knowledge of AD, perception of a peaceful death, and their attitude toward withdrawal of life-sustaining treatment. The influencing variables were the knowledge of AD, perception of a peaceful death, discussion with family on withdrawal of life-sustaining treatment, and explanation power was 16.0% (F=10.355, p<.001). Therefore, it is necessary to develop a program that would improve the perception of a peaceful death, increase the knowledge of AD to improve the patients' attitude toward the withdrawal of life-sustaining treatment. An intervention to assist a discussion between the patients and their families in advance would also be useful.

Legal Grounds for Withholding or Withdrawal of Life-Sustaining Treatment (연명의료의 중단 - 대법원 2009.5.21. 선고 2009다17417 판결과 관련하여 -)

  • Suk, Hee-Tae
    • 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.

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The Subjectivity of Attitudes Toward Life Support Care (성인의 생명연장술 태도에 관한 주관성 연구)

  • Choi, Ji-Eun;Jung, Yun;Kim, Boon-Han;Jeon, Hye-Won;Kim, Yoon-Sook
    • Journal of Korean Academy of Nursing
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    • v.37 no.7
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    • pp.1166-1176
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    • 2007
  • Purpose: The purpose of this study was to categorize adult's subjectivity of their attitudes towards life sustaining treatment, and thereby understand the differences among these life sustaining treatment types using Q methodology. Methods: Q-methodology, which provides a method of analyzing the subjectivity of each item, was used. Thirty selected Q-statements received from 52 adults were classified into a shape of normal distribution using a 7 point scale. The collected data was analyzed using a QUANL pc program. Result: Four types of attitudes toward life sustaining treatment were identified. Type I is called one's autonomy type. Type II is called potentiality of resuscitation type. Type III is called DNR (Do not resuscitation) type. Type IV is calledone's effort type. Conclusion: The results of the study indicate that different approaches of life support care programs are recommended based on the four types of life sustaining treatment attitudes among Korean adults.

A Study on Medical-criminal Problem of Withdrawing Life-Sustaining Treatment (치료중단행위에 대한 의료형법적 고찰 -의학적 충고에 반한 퇴원 사례를 중심으로-)

  • Cho, In-Ho
    • The Korean Society of Law and Medicine
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    • v.9 no.1
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    • pp.319-382
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    • 2008
  • As a withdrawing care's study, the purpose of this study is searching about withdrawing care's acceptance and circumstances through Bora-mae hospital case(chapter 1). Withdrawing life-sustaining treatment has various forms. Though the meaning of euthanasia, death with dignity, natural death, physician assisted suicide are duplicated, the meaning of those are different slightly. Firstly, this study looks about the difference of the those meaning and acceptance range(condition) by withdrawing care's forms(chapter 2). Bora-mae hospital case sentenced guilty about physician who discharged incompetent patient who was after surgery by patient's wife determination. This Bora-mae case that sentenced guilty about discharge against medical advise(DAMA) that is regarded to custom has brought intensive confliction of legal, social, medical aspect, Bora-mae hospital case has many legal problems. First, as to criminal law rule 250(murder), the problem is whether discharge and withdrawing life-sustaining treatment is commission or omission. this study concluded omission(district court: omission, appeal, supreme court: commission). Because legal denounce point of discharge and medical treatment withdrawing is omission that physician who is obligatory on patient to cure. If physician's act is regarded omission, it is necessary to determine whether he has guardian status and obligation. Without guardian status and obligation, omission crime can't exist. This study decided that physician had guardian status and obligation and foundation of guardian status was pre-action or acceptance of emergency patient. Physician's medical treatment duty finished when patient(or patient's guardian) demands discharge. But when patient death is foreseen and other possible treatment does not exist, his duty of life prolonging treatment does not finish. This originate from physician's social responsibility and public status that limits patient's private liberty. This study regarded physician's action as accomplice about whether physician's discharging action is accomplice or the principal offender(district court: the principal offender, appeal, supreme court: accomplice). Though the principal offender needs criminal determination and action, there is no this common determination and functional action control of physician in Bora-mae case(chapter 3). Bora-mae hospital case partly originated from deficiency of legal, institutive system including medical security system shortage, the instruction is 1. medical security system strengthening, 2. hospital ethical committee's activity strengthening, 3. institutionalization of withdrawing life-sustaining treatment, 4. acceptance of pre-decision making system, 5. sufficient persuasion of physician for patient and faithful writing of medical paper, 6. respect for patients' self-determination and rights, 7. consciousness's changing for withdrawing life-sustaining treatment and persistent education about medical ethics(chapter 4). Considering Bora-mae case, medical sector is not the dead ground of a criminal punishment. Intervention of criminal law in medical sector give rise to ill effect, that is, excess medical examination and treatment, safeguard treatment, delay of discharge from a hospital. Because sufficient guarantee of life becomes mere empty slogan under situation that impose a burden of heavy cost to family or hospital, public and systematic solution should be given(chapter 5).

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Effects of Consciousness of Biomedical Ethics and Critical Thinking Disposition on Attitude toward Withdrawal of Life-Sustaining Treatment among Nursing Students (간호대학생의 생명의료윤리의식, 비판적 사고성향이 연명치료중단에 대한 태도에 미치는 영향)

  • Kim, Eun-Young
    • Journal of Digital Convergence
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    • v.16 no.9
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    • pp.453-463
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    • 2018
  • This research was a descriptive study to investigate the effects of nursing students' biomedical ethics, and critical thinking on attitudes toward withdrawal of life-sustaining treatment. The Participant were 367 nursing students and date were collected from November until December of 2017. Data were analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation, and multiple regression with SPSS/WIN 21.0. There was a significant positive correlation between attitudes toward withdrawal of life-sustaining treatment. Also, the influencing factor on attitudes toward withdrawal of life-sustaining treatment were biomedical ethics, academic grade, subjective health status, and personality types. These factors explained 36.6% of variance. In conclusion, the higher the awareness of biomedical ethics, the more positive attitude toward the withdrawal of lifelong treatment. Based on the results above, we need to develop diverse and systematic educational programs for nursing students.