• 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 Hospice and Palliative Care
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• v.18 no.4
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• pp.285-293
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• 2015

Purpose: This study was conducted to explore the effects of attitude to death in hospice and palliative professionals on their terminal care stress, and to analyze relationships among variables related to the two aforementioned parameters, such as depression and coping strategies. Methods: Participants were 131 hospice and palliative professionals from the cancer units of two tertiary hospitals and two general hospitals, two hospice facilities, two geriatric hospitals, and two convalescent hospitals in J province. Data were collected from April through June 2015 and analyzed using t-test, factor analysis, ANOVA ($Scheff{\acute{e}}$ test), ANCOVA, and Pearson's correlation and a path analysis using the SPSS/WIN 21.0 and AMOS 18.0 programs. Results: The score for attitude to death was low (2.63), and that for depression was 0.45. Among all, 16.0% of the participants showed need for depression management. They scored 3.82 on terminal care stress. The subcategory with the highest mark was inner conflicts on limitation given availability of medical services (4.04). The score on coping strategy was low (3.13). They used passive coping strategies such as interpersonal avoidance (4.03), fulfilling basic needs (3.65) such as sleeping or eating. Attitudes to death had a direct negative effect on the terminal care stress level and indirectly affected through depression and fulfilling basic needs (CS2). Conclusion: It is necessary to provide hospice and palliative professionals with education on death and dying, as well as access to programs that provide emotional support and promote positive cognition of death and dying.

• 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.

• Journal of Hospice and Palliative Care
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• v.18 no.4
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• pp.306-313
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• 2015

Purpose: This study was performed to explore factors that influence attitudes toward terminal care in nursing students. Methods: Data were collected using a self-reported questionnaire filled by 175 nursing students at a university in a metropolitan city B. Data were analyzed using descriptive analysis, t-test, ANOVA, Pearson correlation coefficients and stepwise multiple regression with the SPSS/WIN 22.0 program. Results: Attitudes toward terminal care in nursing students was significantly correlated with communication competence (r=0.438, P<0.001), spirituality (r=0.374, P<0.001), and gratitude (r=0.318, P<0.001). Communication competence explained 18.7% of the variance in attitudes toward terminal care. Conclusion: The study shows communication competence is an important factor for attitudes toward terminal care in nursing students. Therefore, it is necessary to develop a communication competence enhancement program to foster nursing students with appropriate attitudes toward terminal care.

• Journal of Hospice and Palliative Care
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• v.17 no.3
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• pp.122-133
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• 2014

Purpose: We conducted a descriptive correlational study to determine a relationship between nurses' awareness of good death and attitudes toward terminal care, which in turn could be used as basic data for improvement of the quality of terminal care at geriatric hospitals. Methods: From April 3, 2013 through April 22, 2013, data were collected from 230 nurses working at geriatric hospitals. Results: Nurses' attitudes toward terminal care showed no significant correlation with awareness of good death, but it was positively correlated with a sense of closeness, a subfactor of awareness of good death. There was negative correlation between emotions regarding a deathbed, a subfactor of attitudes of nurses in charge of terminal patients, and awareness of good death. We found positive correlation between terminal care performance and awareness of good death. Conclusion: This study warrants the need for nursing education catered to characteristics of geriatric hospitals and development of diverse intervention strategies to help them to attain a positive attitude toward death by familiarizing themselves with the concept of good death and enhancing job satisfaction.

• Journal of Hospice and Palliative Care
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• v.22 no.4
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• pp.156-165
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• 2019

Purpose: This study was conducted to identify subjective attitudes towards terminal patients in nursing students who had clinical practice. The types of subjective attitude were classified by applying Q methodology. According to those types, basic reference data for the development of educational programs were provided. Methods: Thirty-four final Q samples were selected, and Q classification with a nine-point scale was performed with P samples of 43 nursing students. A key factor analysis was conducted with the collected data using the PC QUANAL program. Results: Nursing students' attitudes towards terminal patients were grouped into three types. The total variable was 49.96%. Students with Type 1 ("wish for life-sustaining medical treatment") thought that terminal patients accurately understood their medical condition and wanted to prolong their lives. Others with Type 2 ("need for service and support") believed that a multidisciplinary nursing system needs to be established to help terminal patients prepare for death. Students with Type 3 ("awareness and acceptance of death") thought that terminal patients wanted to die with dignity at a hospice unit. Conclusion: This study analyzed various types of attitude towards terminal patients, as perceived by nursing students with clinical training experience. Development of educational programs for each attitude type analyzed in this study could contribute to systematic training programs for nursing students caring for terminal patients.

• Research in Community and Public Health Nursing
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• v.16 no.3
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• pp.270-281
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• 2005

Purpose: The objective of this study was to understand the caring experience of families with terminal cancer patients. Method: This was designed to be an inductive and descriptive study. Forty-seven families with terminal cancer patients were interviewed in depth and collected data were examined through content analysis. Result: The main categories of difficulties found in this study were 'suffering of patient', 'emotional suffering of family', 'bereavement of patient', 'difficulties in coping', 'problems in treatment', 'incurable situation', 'family problems', 'relationship with other people', 'economic problems', 'spiritual problems', 'problems in the future', 'informing patients of their condition', 'preparing death', 'emotional unstability', 'meaninglessness', 'unkindness of medical teams', 'poor environment for treatment', 'difficulties in hospital environment' and 'economic burden'. Conclusion: The main point found from this result was that families taking care of terminal cancer patients are suffering emotionally from watching the patients' pains and had difficulties in coping with the patients' situation and treatment. In addition, they had negative experiences in medical teams' attitude and hospital environment. This result can be used as an important guide for nurses to assess families' needs in the terminal care setting.

• Journal of Hospice and Palliative Care
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• v.2 no.1
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• pp.23-35
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• 1999

Purpose : The hospice movement began about 30 years ago in Korea. However, basic studies have seldom been conducted about the general public's knowledge concerning hospice care and their needs for it. The purpose of this study was to investigate the general public's knowledge of and attitude toward hospice, and their needs for hospice care, and to analyze the needs for hospice care in relation to their knowledge and attitude in residents from a specific community. Methods : The survey was conducted with 924 people randomly selected from a district in Seoul. The data were collected through a self-reporting questionnaire constructed by the authors. With 30 items given in the questionnaire, the level of hospice needs showed Cronbach's alpha .89 in a pilot study and .92 in this study and the items were classified into four areas by a factor analysis. The data collected were analyzed by means of t-test and ANOVA. Results : 1) The average age of the respondents was 38. The majority of the respondents were well-educated. 2) Regarding awareness of hospice care, 54%(501 people) indicated they have heard of hospice. About 74% thought that people should be able to prepare for death in advance. About 83% wanted to be informed when they have life threatening illnesses such as terminal cancer. Also, about 63% responded that patients with terminal diseases should be provided with physical, spiritual, and psychological care for minimizing pain and peaceful death. Regarding the attitude toward hospice care, 74% responded that they would use hospice care if needed. The number of the respondents who preferred home visitation by the hospice team to care for the terminally ill ranked first with 34%. Concerning needs for hospice care : 1) By needs area, physical need showed highest mean(M=4.37), followed by social need(M=3.96), emotional need(M=3.87), and the spiritual need(M=3.79). The overall need level showed the mean value of 4.00 which reflects a considerable need for hospice care. 2) By demographic characteristics, people age over 50, the married, and the unemployed indicated higher level of needs for hospice care. Women showed higher level of needs than did men, and Catholics demonstrated higher level of needs than believers of other religion(P<0.0001). 3) As for the knowledge of and attitude toward hospice rare, the level of hospice care needs was significantly higher in the following groups: those who have heard of hospice, those who are aware of death preparation, those who want information on terminal diseases, those who want to use every method to sustain life, and those who are aware of hospice needs(P<0.001). Conclusion : It is assumed that the findings of this study on the knowledge, attitude, and needs for hospice care in the public can contribute to planning a successful hospice care program. Furthermore, the findings of this study will serve as useful data for the promotion of home hospice care to improve the quality of life of community residents, and contribute to the development of hospice care as a whole.

• Journal of Hospice and Palliative Care
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• v.23 no.4
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• pp.183-197
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• 2020

Purpose: In this study, the researchers closely investigated the psychosocial problems faced by terminal cancer patients and their family members in hospice palliative care units. Methods: The investigators conducted four sessions of art therapy intervention programs for the terminal cancer patients and their family members, carried out in-depth interviews about the influence of the cancer experience on their family function and quality of life, and analyzed their experiences using grounded theory methodology. Results: After providing autonomous written informed consent, six pairs of terminally ill cancer patients and their family members, accounting for a total of 17 participants with the inclusion of additional family members who took part sporadically, took part in the art therapy intervention and interviews. The raw data, in the form of verbatim records, were analyzed according to the procedures of grounded theory (open, axial, and selective coding). Through these processes, a total of 154 concepts, 56 subcategories, and 13 categories were identified. Families were classified into four types according to their family function, quality of life, and attitude toward death. Though the art therapy intervention, patients and their family members experienced three stages over time. Conclusion: This research focused on essential aspects of the family relationships and the art therapy experiences of terminal cancer patients and their family members through an art therapy intervention in the context of hospice palliative care. Based on these observations, the researchers constructed a theoretical rationale for art therapy interventions delivered to patients and their family members in the process of hospice palliative care.

• Journal of Hospice and Palliative Care
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• v.16 no.1
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• pp.1-9
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• 2013

Purpose: The aim of this study was to investigate nursing students' awareness of biomedical ethics and attitudes toward death of terminal patients. Methods: A structured questionnaire was developed to examine nursing students' biomedical ethics. Their attitudes toward terminal patients' death were measured by using the Collett-Lester Fear of Death Scale. Surveys were conducted with 660 nursing students enrolled at a three-year college located in Daejeon, Korea. Data were analyzed using descriptive statistics, Wilcoxon rank sum test and Kruskall Waills test. Results: Students who have experienced biomedical ethics conflicts, agreed to prohibition of cardiopulmonary resuscitation (CPR) and have no religion exhibited more negative attitudes toward death compared to students without the above characteristics. Of the participants, 81.2% answered that life sustaining treatment for terminal patients should be discontinued and 76.4% replied that CPR on terminal patients should be prohibited. The majority of the correspondents stated that the two measures above are necessary "for patients' peaceful and dignified death". Conclusion: Study results indicate the need to establish a firm biomedical ethics value to help nursing students form a positive attitude toward death. It also seems necessary to offer students related training before going into clinical practice, if possible. The training program should be developed by considering students' religion, school year, experience with biomedical ethics conflicts and opinion about CPR on terminal patients. The program should also include an opportunity for students to experience terminal patient care in advance via simulation practice on standardized patients.