• Journal of Korean Critical Care Nursing
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• v.4 no.1
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• pp.11-24
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• 2011

Purpose: The purpose of this study was to grasp the subjectivity of the nurses toward DNR (Do not resuscitation) order. Methods: Q methodology was employed to explore the nurses' subjectivity. Q population consisted of 292 statements that were obtained through individual in-depth interviews targeting 30 employees(nurses, doctors, staff members) and literature review. Finally, 30 nurses classified 34 statements using a 9 point scale. Results: The current survey that probed into the subjectivity of the nurses relative to DNR order abstracted four categories. The first type (restrictive acceptance type) perceived the determinants of DNR as the patient's hopeless state. The second type (evidence-based type) emphasized the decision based on the guideline. The third type (medical personnel-centered type) showed the characteristic that depends passively on the professional judgement. The fourth type (rationalistic type) emphasized rational characteristic that DNR decision needs to be made by considering several situations such as economic and psychological burden of family and the quality of life. Conclusion: These types of nurse's perception need to be considered in the nurses' continuing educational program in order to confront affirmatively and positively with ethical dilemma.

• Journal of Hospice and Palliative Care
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• v.18 no.3
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• pp.179-187
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• 2015

For patients who are near the end of life, an inevitable step is discussion of a do-not-resuscitate (DNR) order, which involves patients, their family members and physicians. To discuss DNR orders, patients and family members should know the meaning of the order and cardiopulmonary resuscitation (CPR) which includes chest compression, defibrillation, medication to restart the heart, artificial ventilation, and tube insertion in the respiratory tract. And the following issues should be considered as well: patients' and their families' autonomy, futility of treatment, and the right for death with dignity. Terminal cancer patients should be informed of what futility of treatment is, such as a low survival rate of CPR, unacceptable quality of life after CPR, and an irremediable disease status. In Korea, two different law suits related to life supporting treatments had been filed, which in turn raised public interest in death with dignity. Since the 1980s, knowledge of and attitude toward DNR among physicians and the public have been improved. However, most patients are still alienated from the decision making process, and the decision is often made less than a week before death. Thus, the DNR discussion process should be improved. Early palliative care should be adopted more widely.

• 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 Korean Neurosurgical Society
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• v.42 no.2
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• pp.135-140
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• 2007

It is not the best way to treat a hopeless patient with life-sustaining medical devices until the heart beats stop. Advanced medical technology may prolong the life for a significant period without recovery from the disease. However, it would give an unbearable economic burden to the family and the society. In 2006, we decided not to operate 9 patients with traumatic intracranial hematomas. We examined those patients with special references to possible legal and ethical problems. It is reasonable to withhold a treatment after documentation that the family never wants any life sustaining treatment when the treatment does not guarantee the meaningful life.

• Journal of Hospice and Palliative Care
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• v.20 no.2
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• pp.122-130
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• 2017

Purpose: The purpose of this study is to describe and understand the meaning and the structure of subjective experiences of intensive care nurses with death of patients with do-not-resuscitate (DNR) orders. Methods: Data were collected from eight intensive care nurses at general hospitals using individual in-depth interviews and analyzed by phenomenological research method. Results: The nurses' experiences were grouped into four theme clusters: 1) ambiguity of death without correct answer, 2) a dilemma experienced at the border between death and work, 3) the weight of death that is difficult to carry and 4) death-triggered reflection of life. Conclusion: It is necessary to develop accurate judgment criteria for DNR, detailed regulations on the DNR decision process, guidelines and education on DNR patient care for nurses. It is also needed to develop an intervention program for DNR patients' families.

• Journal of Hospice and Palliative Care
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• v.26 no.1
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• pp.7-17
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• 2023

Purpose: The purpose of this study was to analyze end-of-life care practices in lung disease patients with physician orders for life-sustaining treatment (POLSTs). Methods: We retrospectively analyzed data from medical records regarding the end-of-life care practices of POLST decisions for patients with lung disease hospitalized at a tertiary hospital in Seoul, South Korea. Data were collected from January 1 to June 30, 2021. Results: Of 300 total patients, 198 had lung cancer (66.0%) and 102 had non-malignant lung diseases (34.0%). A POLST was written for 187 patients (62.3%), and an advance directive was written for 20 patients (6.7%). Subsequent treatments were hemodialysis in 13 patients (4.3%), surgery in 3 patients (1.0%), and cardiopulmonary cerebral resuscitation in 1 patient (0.3%). Among cancer patients, chemotherapy was performed in 11 patients (3.7%), targeted therapy in 11 patients (3.7%), immunotherapy in 6 patients (2.0%), and radiation therapy in 13 patients (4.3%). Depending on the type of lung disease, types of treatment differed, including hemodialysis, ventilators, bilevel positive airway pressure, high-flow nasal cannulas, nebulizers, enteral nutrition, central line, inotropic agents, and opioids. Conclusion: Although the goals of hospice care are the same whether a patient has lung cancer or a non-malignant lung disease, because the characteristics of the respective diseases differ, end-of-life care practices and hospice approaches must be considered differently.

• Korean Journal of Adult Nursing
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• v.17 no.5
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• pp.762-771
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• 2005

Purpose: The purpose of this study was to identify characteristics of patients who were recipients of decision-making DNR, to describe the situations of DNR, and to analyze the APACHE III and MOF scores. Method: Data collection was conducted through reviews of medical records of 51 patients and through interviews with families of patients who were decision-makers for DNR at C university K Hospital located in Seoul from April to September 2002. Results: The men's APACHE III and MOF scores were higher than the women's and the non cancer patients were higher than cancer patients. Some 80.4% of DNR orders was by communication, while 11.8% of consents were written. Each of APACHE III and MOF scores of patients in the intensive care unit was higher than the patients in general ward at both points of admission and decision-making of DNR. APACHE III and MOF scores positively correlated statistically with each other. Conclusions: The findings of this study suggest that APACHE III and MOF scores be useful for decision-making of DNR as a tool measuring severity.

• The Korean Journal of Rehabilitation Nursing
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• v.14 no.2
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• pp.118-128
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• 2011

Purpose: The purpose of this study was to explore the experiences of bereavement for main family members who had made and followed DNR decision for their family members. Method: This qualitative study was based on a grounded theory, and used in-depth interview techniques with the bereaved 10 main family members who had been treated and died under DNR order. Results: The causal condition of the family member was 'Releasing', and the main consequent phenomenon were 'Blaming self and ruminating'. The contextual condition was 'The memory of the deceased'. The action/reaction strategy was 'Purifying'. The intervening condition was 'Supporting system', and the consequence was 'Acceptance'. The experience after bereavement of the family member on DNR decision were rational processes that purified themselves and healed the guilt feeling about the decision from reflective assessment and response about DNR decision. Based on this results, the substantive theory 'Reflective self healing' was derived. Conclusion: The main family members in following DNR decision are more likely to have unhealthy emotional condition than others in normal bereavement process. But they overcame the grief of bereavement through reflective self healing process.

• Journal of Hospice and Palliative Care
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• v.19 no.1
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• pp.26-33
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• 2016

Purpose: This study was conducted to identify clinical characteristics of oncologic patients at a point when they signed their do-not-resuscitate (DNR) orders. Methods: From January through December 2014, we retrospectively analyzed the records of 197 patients who passed away after agreeing to a DNR order in the hemato-oncology department of a tertiary hospital. Results: Of all, 121 patients (61.4%) were male and 76 (38.6%) were female, and their average age was 58.7 years. Ninety-four patients (47.7%) had gastrointestinal cancer. The ECOG performance status at admission was grade 3 in 76 patients (36.5%) and grade 4 in 11 (5.6%). The patients' mean hospital stay was 20 days. The mean duration from the admission to DNR decision was 13 days, and the mean duration from DNR decision to death was seven days. Conclusion: Study results indicate that a decision on signing or refusing a DNR order was made by medical staff mostly based on the opinions of patients' guardians rather than the patients themselves. This suggests that patients' own wishes are not well respected. Thus, it is urgent to establish institutional devices to enhance cancer patients' autonomy regarding DNR and to define an adequate timing for withdrawal of treatments.

• Journal of Hospice and Palliative Care
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• v.20 no.1
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• pp.46-57
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• 2017

Purpose: The purpose of this study is to identify the changes to nursing activities of nurses on patients with DNR (Do-Not-Resuscitate) order and factors associated to the changes. Methods: Data were collected using a structured questionnaire for 173 nurses at general hospitals. Logistic regression analysis was performed on the data using SAS 9.4. Results: With 39 nursing activities, an average of 60.4 (34.9%) nurses reported an increase in the activities, 102.4 (59.2%) no change and 10.1 (5.9%) a drop. The activity increase was the greatest in the social area, and the physical area was where the activities decreased the most. The activity increase was associated knowledge competency (9 items), attitudes (2 items), practical competency (4 items) and work load (14 items were). Conclusion: To offer systematical care for DNR patients, it is necessary to expand nurses' knowledge through end-of-life education and adjust their workload and provide a support system at the department level.