• Journal of the Korea Academia-Industrial cooperation Society
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• v.17 no.6
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• pp.510-520
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• 2016

The purpose of this study was to understand death perception, spiritual well-being, and terminal care stress in geriatric hospital nurses and analyze related factors affecting terminal care stress. The participants were 181 nurses working in six geriatric hospitals located in Seoul and Gyonggi Province, Korea. Data were gathered from July 16 to August 1, 2015. The data were analyzed using ANOVA, t-test, Duncan test, and logistic regression. Death perception of geriatric hospital nurses had an average score of 4.30, spiritual well-being 3.40, and terminal care stress 3.84. Terminal care stress in relation to general characteristics showed a meaningful difference in religion and total clinical career. The terminal care stress level was divided into two groups using average score as a standard, and the results revealed that spiritual well-being had a significant impact on terminal care stress of geriatric hospital nurses. These factors need to be considered when developing an educational program to reduce terminal care stress of nurses working in a geriatric hospital.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.18 no.7
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• pp.290-299
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• 2017

This study was conducted to evaluate the spirituality, perceived meaning in life, hospice perception, and attitudes towards terminal care among nursing students, as well as to identify the relationships between variables and examine factors influencing their attitudes towards terminal care. Data were collected using a self-reported questionnaire completed by 308 nursing students at two universities from April 11, 2017 to April 17, 2017. Data were analyzed using descriptive analysis, a t-test, Pearson's correlation coefficients and stepwise multiple regression with the SPSS/Win 14.0 program. Attitudes toward terminal care among nursing students were significantly correlated with hospice perception(r=0.30, p<0.001) and meaning in life(r=0.30, p<0.001). Meaning in life among nursing students was significantly correlated with hospice perception(r=0.25, p<0.01) and spirituality(r=0.53, p<0.01). The significant predictors of the attitudes towards terminal care in nursing students were hospice perception(${\beta}=0.40$, p<0.001) and meaning in life(${\beta}=0.27$, p<0.001). Hospice perception explained 22.7% and meaning in life explained 5.0% of the variance. These variables explained 27.7% of the variance in attitudes toward terminal care. Overall, these findings suggest that the terminal care education program, including hospice perception and meaning in life, is necessary to enhance the positive attitude toward terminal care among nursing students.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.12
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• pp.7309-7314
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• 2013

Aim: To investigate factors that affect the place of death (POD) of terminal cancer patients. Materials and Methods: We recruited 702 consecutive patients (${\geq}18$ years) from 12 centers during July 2005 to October 2006, and 481 completed the questionnaire. In April 2011, we linked the data for 96.0% (n=462) of the deceased patients to the POD using the 2005-2009 death certificate data of Korea's National Statistical Office. The primary outcome variable was POD, and the predictive value of variables pertaining to patients and caregivers was evaluated using univariate and multivariate analyses. Results: Most patients died in a hospital (91.5%, n=441) and age, education, preference for place of terminal care, wish to use hospice/palliative care services, terminal cancer awareness, time between diagnosis and death, and global quality-of-life subscale of the EORTC QLQ-C30 of patients, and education and preference for place of terminal care of caregivers were significant predictors in univariate analyses. On multivariate analysis, patients and caregivers who preferred hospital/palliative care as the terminal care option over home care [adjusted odds ratio (aOR), 2.68; 95% confidential interval (CI), 1.18-7.04 and aOR: 2.65; 95%CI: 1.15-6.09 for patient and caregiver preferences, respectively] and caregivers who were highly educated (aOR, 3.19; 95%CI, 1.44-7.06) were predictors of POD. Conclusions: Most of the terminal cancer patients died in a hospital. Our findings indicate that major predictors of hospital deaths are preference of both the patient and caregiver for hospital/palliative care as the terminal care option and higher education of the caregiver.

• Asian Oncology Nursing
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• v.5 no.1
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• pp.40-51
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• 2005

The purpose of this study was to explore the relationship between burden and burnout of the family care-givers for caring of terminal patients with cancer. A total of 99 convenience sample was recruited form hospitals. The data were collected by a direct interview with Questionnaire about family burden and burnout. The mean score of burnout of main care-givers was 2.98, and the mean score of burden was 3.03. The care-givers' burnout was significantly different by age, sex, job, duration of treatment, level of acceptance on the stage of death, and ability of daily living activities. The family care-givers' burden was significantly different by the jobs, complication of patients, level of acceptance on the stage of death, and ability of daily living activities. In conclusions, the burnout of family care-givers was highly and positively correlated with the burden.

• The Korean Society of Law and Medicine
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• v.9 no.1
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• pp.385-411
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• 2008

The goal of medicine is to contribute to promoting national health by preventing diseases and providing treatment. The scope of modern medicine isn't merely confined to disease testing, treatment and prevention in accordance to that, and making experiments by using the human body is widespread. The advance in modern medicine has made a great contribution to valuing human dignity and actualizing a manly life, but there is a problem that has still nagged modern medicine: treatment and healing for terminal patients including cancer patients. In advanced countries, pain care and hospice medicine are already universal. Offering a helping hand for terminal patients to lead a less painful and more manly life from diverse angles instead of merely focusing on treatment is called the very hospice medicine. That is a comprehensive package of medical services to take care of death-facing terminal patients and their families with affection. That is providing physical, mental and social support for the patients to pass away in peace after living a dignified and decent life, and that is comforting their bereaved families. The National Hospice Organization of the United States provides terminal patients and their families with sustained hospital care and home care in a move to lend assistance to them. In our country, however, tertiary medical institutions simply provide medical care for terminal patients to extend their lives, and there are few institutional efforts to help them. Hospice medicine is offered mostly in our country by non- professionals including doctors, nurses, social workers, pastors or physical therapists. Terminal patients' needs cannot be satisfied in the same manner as those of other patients, and it's needed to take a different approach to their treatment as well. Nevertheless, the focus of medical care is still placed on treatment only, which should be taken seriously. Ministry for Health, Welfare & Family Affairs and Health Insurance Review & Assessment Service held a public hearing on May 21, 2008, on the cost of hospice care, quality control and demonstration project to gather extensive opinions from the academic community, experts and consumer groups to draw up plans about manpower supply, facilities and demonstration project, but the institutions are not going to work on hospice education, securement of facilities and relevant legislation. In 2002, Ministry for Health, Welfare & Family Affairs made an official announcement to introduce a hospice nurse system to nurture nurse specialists in this area. That ministry legislated for the qualifications of advanced nurse practitioner and a hospice nurse system(Article 24 and 2 in Enforcement Regulations for the Medical Law), but few specific plans are under way to carry out the regulations. It's well known that the medical law defines a nurse as a professional health care worker, and there is a move to draw a line between the responsibilities of doctors and those of nurses in association with medical errors. Specifically, the roles of professional hospice are increasingly expected to be accentuated in conjunction with treatment for terminal patients, and it seems that delving into possible problems with the job performance of nurses and coming up with workable countermeasures are what scholars of conscience should do in an effort to contribute to the development of medicine and the realization of a dignified and manly life.

• Journal of The Korea Institute of Healthcare Architecture
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• v.8 no.1
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• pp.45-52
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• 2002

Recently cancer, AIDS, chronic sickness have increased according to the elevation of socioeconomic level and fast change of lifestyle. The number of patients receiving terminal care increased fairly because the span of life is extended by development of medicinal technology. Also necessity of hospice and palliative care was risen according to the request of terminal patients that remove pain and keep calm life by interest about quality of life. However architectural plan and type specialization of facility which can correspond team's composition and supplied nursing program are not consisting. This study researches about care environment of hospice facility plan through investigation into terminal patient's special quality. The purpose of this study is to propose fundamental datas of hospice facility for architectural plan through comparative analysis of cases of domestic and outside facilities.

• The Korean Society of Law and Medicine
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• v.14 no.1
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• pp.355-401
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• 2013

The first legislation for terminal health-care decision was California's Natural Death Act (NDA) of 1976 that permitted any adult person to execute a directive directing the withholding or withdrawal of life-sustaining procedures. Advance directive legislation has subsequently progressed on a state-by-state basis. By 1992, all 50 states, as well as the District of Columbia, had passed legislation to legalize some form of advance directive. This state legislation, however, has resulted in an often fragmented, incomplete, and sometimes inconsistent set of rules. Statutes enacted within a state often conflict and conflicts between statutes of different states are common. In an increasingly mobile society where an advance health-care directive given in one state must frequently be implemented in another, there is a need for greater uniformity. In 1993, the Uniform Law Commissioners approved the Uniform Health-Care Decisions Act (UHCDA) in order to bring order to the existing chaos. Unfortunately, the Commissioners waited too long to act. By the time the UHCDA was approved, nearly all states had passed legislation governing advance directives. Consequently, the UHCDA has achieved only a limited success, picking up but one or two enactments a year. The UHCDA is currently in effect in around 10 states: Alabama, Alaska, California, Delaware, Hawaii, Kansas, Maine, Mississippi, New Mexico, Tennessee, Wyoming. In these states the previous laws related to the subjects have been all repealed. The overall objective of the UHCDA is to encourage the making and enforcement of advance health care directives including living will or individual instruction, power of health-care attorney and to provide a means for making health care decisions for those who have failed to plan. The U. S. House of Representatives in 1991 enacted the Patient Self-Determination Act (PSDA). The Act stipulates that all hospitals receiving Medicaid or Medicare reimbursement must ascertain whether patients have or wish to have advance directives. The Patient Self- Determination Act does not create or legalize advance directives; rather it validates their existence in each of the states. Now in America, terminal health-care decision or advance directive for health care is common and universal system. The problem, however, is how to let more people use these good tools to make their lives more beautiful and honorable.

• Review of Korea Contents Association
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• v.16 no.4
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• pp.41-47
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• 2018

• Journal of Korean Gerontological Nursing
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• v.20 no.3
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• pp.217-228
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• 2018

Purpose: This study was done to examine the effect on turnover intention (TI) of terminal care stress (TCS) on nurses working in long-term care hospitals (LCH). Methods: Participants were 182 nurses from 6 Seoul LCH. Data were collected from October to December, 2017. Self-report questionnaires were used to collect data on general characteristics, TCS, and TI. Results: Subjective satisfaction on the job (r=.52, p<.001), number of monthly terminal care elders (r=.16, p=.043), TCS (r=.16, p=.027), and sub-categories of TCS, 'difficulty for assigning timetable to care for terminally ill patients' (r=.17, p=.025), 'feeling a burden of caring for terminally ill patients' (r=.23, p=.002), and 'conflict with terminally patients' (r=.16, p=.034) showed statistically significant correlation with TI. Multiple regression analysis showed significant influence of subjective satisfaction with job (${\beta}=.52$, p<.001) and TCS (${\beta}=.23$, p=.001) with a 30.3% explanatory power. When sub-categories of TCS were entered, subjective satisfaction with the job (${\beta}=.50$, p<.001) and 'feeling burden of terminally ill patients' (${\beta}=.28$, p<.001) were factors significantly influencing TI with explanatory power of 32.8%. Conclusion: Findings of this study suggest that it is needed to develop standardized practice guidelines and educational programs for terminal care in LCH as well as stress healing programs for nurses.

• Journal of Korean Academic Society of Home Health Care Nursing
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• v.26 no.2
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• pp.180-188
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• 2019

Purpose: To investigate the duration of each nursing activity performed by home care nurses for non-cancer patients and the relationship between patients' palliative prognostic index (PPI) and duration of each nursing activity. Methods: Nursing activities performed for six non-cancer terminal patients were timed using a stopwatch, and 18 parameters were measured by visiting each patient thrice. The mean and standard deviations of duration for each category of nursing activities were computed. The relationship between category-specific duration of nursing activities and PPI was analyzed with Spearman's correlation and multiple regression analysis. Results: Among nursing activities, the highest greatest duration of time was spent on traffic time (11.91 min), followed by urinary catheter management (10.65 min) and insertion and management of nasogastric tube (9.03 min). In terms of nursing categories, after excluding movement time, the greatest duration of time was spent on excretion care (5.48 min), nutrition care (5.40 min), and medication (3.82 min). PPI correlated with hygiene care, excretion care, and patient and information management. Multiple regression analysis revealed that PPI increased with increasing duration of hygiene care. Conclusion: These study findings provide grounds for the increased nursing time of hygiene care for people reaching the end of life.