• 대한간호학회지
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• 제25권3호
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• pp.510-537
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• 1995

Human health is an integral part of experience in the process of Human Becoming. Through continual interaction with the environment human beings freely choose experience and develop as responsible beings. The process of the health experience of patient with terminal cancer is a unique. he objective of this study is to understand the lived experience of patients with terminal cancer in order to provide basic information for nursing care in the clinical setting and to develop a theoretical background for clinical practice. This study is to de-scribe and define the lived experience of patients with terminal cancer in order to provide a foundation for nursing research and education. Data collection has been done between December 1993 and November 1994. The subjects included five persons -four females and one male : one who was in her sixties, one in his fifties, two in their forties, and one who was in her thirties. The researcher has met with these patients 35 times, but at eight times the patient was in a stuporous condition and not able to participate, so these were not included in the data analysis. Parse's "Human Becoming Methodology", an existential phenomenological research methodology is used for this study. Data has been collected using he dialogical engagement process of "I and You", the participant researcher and the participant subject. Dialogical engagement was discontinued when the data was theoretically saturated. Data was analyzed using the extraction - synthesis and heuristic interpretation. The criteria of Guba and Lincoln(1985). and Sandelo wski(1986) : credibility, auditability, fitness and objectivity were used to test the validity and reliability of the data. The following is a description of the structure of the lived experience of patients with terminal cancer as defined by this study : 1. Structure : 1) Suffering through the reminiscence of past experience 2) The appearance of complex emotions related to life and connectedness 3) The increasing importance of significant people and of the Absolute Being 4) The increasing realization of the importance of health and belief 5) Desire for a return to health and a peaceful life or for acceptance of dying and a comfortable death In summary the structure of the lived experience of these patients can be said to be : suffering comes through reminiscence of past experience, and there are complex emotions related to life and connectedness. Significant people and the Absolute Being become increasingly important along with a realization of the importance of health and faith. And finally there is a desire for either a return to health and a peaceful life or for the acceptance of dying and a comfortable death. 2. Heuristic Interpretation : Using Parse's Human Becoming Methodology, the structure of the lived experience of patients with terminal cancer identified in this research is interpreted as. The lived experience of patients with terminal cancer involves the solving of past conflicts, and the experience of the healing and valuing of sorrow and pain. Through the relation of life and health, and the complex emotions that arise, the lived experience of revealing - concealing is of paradoxical emotions. The increasing importance of significant others and of the Absolute Being shows Connecting and Separating an on- going process of nearness and farness. Revision of thoughts about health and faith is interpreted as transforming and desire for restoration to health and a peaceful life or acceptance of dying and a cowfortable death, as powering. In summary, it is possible to see, in the lived experience of patients with terminal cancer, the relationship of the five concepts of Parse's theory : valuing, revealing -concealing, connecting-separating, transforming, and powering. From Parse's theory, the results of this study show that meaning is related to valuing, rhythmicity to revealing-concealing and connect-ing-separating, and cotranscendence to transforming and powering.

• Journal of Hospice and Palliative Care
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• 제8권2호
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• pp.163-172
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• 2005

목적: 본 연구는 죽음교육이 간호대학생의 죽음 불안과 임종간호 태도에 미치는 영향을 알아보기 위한 비동등성 대조군 전후 설계이다. 방법: 연구대상은 J시 G대학교 간호학과 3학년 학생 중 대상자 선정기준에 맞는 자로 실험군 20명 대조군 16명이었다. 자료 수집은 실험군과 대조군 대상자 모두에게 2004년 3월 2일 일반적 특성과 죽음관련 특성, 죽음불안과 임종간호태도에 대해 사전 조사하였고, 실험군은 2004년 3월 2일부터 3월 12일까지 죽음교육을 실시한 후 사후 조사하였으며, 대조군은 실험군의 프로그램 종료일인 2004년 3월 12일에 죽음불안과 임종간호태도에 대해 사후 조사를 하였다. 연구 도구는 죽음교육 프로그램, 죽음불안과 임종간호태도 척도를 사용하였다. 본 연구에서의 죽음교육은 Alfons[14]의 '죽음 어떻게 맞이할 것인가'와 죽음교육 관련문헌[8,15-17]와 송길원[18]과 김수지 등[19]을 통해 연구자가 재구성하여 수정 보완한 것으로 죽음의 탐색, 이해, 수용, 중재 등의 내용으로 구성되어 있는 프로그램을 말하며, 실험군에게 주 3회 1회에 100분씩 총 6회기로 진행하였다. 죽음 불안은 Collette와 Lester[28]가 개발하고 서[20]가 수정 번안한 죽음불안척도(Fear of Death and Dying Scale)를 본 연구자가 수정하여 사용하였으며, 임종 간호태도는 Frommelt와 Katherine[8]이 개발한 임종간호태도척도(Attitudes toward Nursing Care of the Dying Scale)를 본 연구자가 번역한 후, 영어 전공자 2인이 역으로 번역하였고, 성인간호학 교수 2인, 정신간호학 교수 1인의 자문을 받아 사용하였다. 자료 분석은 $SPSS/pc^+$ Windows (version 10.0) 통계 프로그램을 이용하여 전산처리 하였다. 가설검증을 정규성 검증, 실험군 및 대조군의 실험 전 후 차이는 paired t-test, 실험군과 대조군의 차이는 t-test로 분석하였다. 결과: 본 연구 결과는 다음과 같았다. 1. 간호대학생의 죽음불안 정도(범위 $35{\sim}160$)는 90.89점이었고, 임종간호태도 정도(범위: $30{\sim}120$)는 86.78점이었다. 2. 제 1가설 '죽음교육을 받은 실험군의 죽음불안 정도가 죽음교육을 받지 않은 대조군보다 낮을 것이다'라는 제 1가설은 지지되었다(t=-2.11, P<.05). 3. 제 2가설 '죽음교육을 받은 실험군의 임종 간호 태도 정도는 죽음교육을 받지 않은 대조군보다 긍정적으로 높을 것이다'라는 제 2가설은 지지 되었다(t=2.99, P<.01). 결론: 죽음교육 프로그램은 간호대학생의 죽음불안 정도를 낮추고 임종간호태도를 긍정적으로 변화시키는데 효과가 있으므로 임상간호사와 호스피스 대상자 및 가족에게 적용할 필요가 있으리라 사료된다.

• 중환자간호학회지
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• 제6권1호
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• pp.11-20
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• 2013

Purpose: This study to describe experiences of nurses who work in intensive care units (ICUs) where they frequently encounter patients with attempted suicide by drug ingestion. Methods: Data were collected by 2 focus group interviews with 9 ICU nurses. The interview were recorded and transcribed, and data were analyzed using qualitative content analysis. Results: The results of data analysis, five themes were drawn: 'Confusion about for the attempted suicidal patient care', 'Helplessness for dying with attempted suicidal patients', 'Guilty for insufficient care', 'Ambivalence for the attempted suicidal patients', 'Recognition of need for professional approach'. Conclusion: The results of this study help us to understand patients who attempted suicide through the ICU nurses' experience. It would be useful to develop effective education programs for ICU nurses to preventive strategies for patients who are high risk of recurrence of suicidal crisis situation.

• Asian Pacific Journal of Cancer Prevention
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• 제13권7호
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• pp.3357-3360
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• 2012

Objective: This study was to present the survival of advanced cancer patients and explore the influence of various factors on survival time as well as survival rate. The results provide guidelines for clinical practice of cancer treatment. Methods: Follow-up of 674 advanced cancer patients was performed in a hospice. The median survival time and survival rate were calculated, and survival analysis was carried out. Results: The median survival time of all patients dying from cancer was 12.0 months and the average survival time was 25.1 months. The 1-year cumulative survival rate was $0.518{\pm}0.020$ and the 5-year cumulative survival rate was $0.088{\pm}0.012$. The following factors showed significant impacts on survival rate: gender, age, primary diagnosis, surgery and the time when pain appeared. Conclusions: The survival time of patients with advanced cancer was relatively short. Major approaches to extend the survival time include early detection, early diagnosis, effective surgical treatment, pain control, reasonable supply of nutrients and multiple interventions.

• Journal of Hospice and Palliative Care
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• 제19권3호
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• pp.240-248
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• 2016

목적: 호스피스완화의료의 목적은 환자와 가족의 고통을 줄이고 삶과 죽음의 질을 향상시키는데 있다. 편안한 임종을 맞이하는 것은 죽음의 질을 향상시키는데 역할을 한다. 이를 위해 환자와 보호자는 남은 삶 동안 임종을 준비할 수 있도록 임종과정 중 발생하는 다양한 문제와 요구에 대한 이해가 필요하다. 따라서 호스피스 환자와 가족을 위한 매뉴얼화된 임종교육 시청각 자료를 개발하고자 한다. 방법: 시청각 자료 개발을 위해서는 문헌고찰을 토대로 접근하기 쉬운 파워포인트 유인물로 초기 교육자료 개발하였고 다섯 차례에 걸친 전문의의 자문과 수정 및 보완, 평가 과정을 거쳐 완성하였다. 결과: 호스피스 환자와 가족들을 대상으로 한 시청각 교육자료는 3차시 5단계로 분류하였으며 교육 소요시간은 총 26분 34초이다. 최종 교육프로그램은 시청각 교육실 협력 하에 촬영하였으며 시청각 자료를 완성하였다. 결론: 본 연구는 완화의료병동의 구축과 전문성 증대를 위해 개발된 매뉴얼화 된 임종교육 시청각 자료로써 큰 의의가 있으며, 호스피스 환자와 가족뿐 아니라 호스피스 영역 전문 종사자들이 호스피스 환자와 가족을 대상으로 효율적인 임종교육 자료로 적극 활용되길 기대한다.

• Journal of Hospice and Palliative Care
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• 제14권2호
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• pp.101-109
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• 2011

목적: ACOVE project에서는 말기 치료의 질 평가를 위한 임상질지표를 개발하였다. 그러나 말기 치료에 대하여 의료전문가들의 의견을 반영하여 만든 임상질지표와 보호자들의 의견은 실제로 다를 수 있다. 따라서 호스피스 치료 질에 대한 보호자들의 인식 정도를 파악하기 위해 본 연구를 시행하였다. 방법: 2009년 7월부터 10월까지 총 4개월간 경북대학교 병원과 대구 보훈병원의 호스피스 병동에 입원해 있는 환자의 보호자를 대상으로 익명의 횡단면 질문지 조사(cross-sectional anonymous questionnaire)를 시행하였다. 총 120명을 선정하고 이 중 모든 질문에 성실히 답한 69명을 최종대상자로 하였다. 통계분석은 SPSS WIN ver. 14.0을 이용하여 independent t-test와 Pearson's chi-square test를 시행하였다. 결과: 좋은 임상질지표 중 가장 동의율이 높은 항목은 '완화의학 팀이나 완화의학 전문가에 의한 의학적 진찰'과 '가족들이 지켜보는 앞에서의 임종' 이었으며 이 항목들은 88.4%의 보호자가 동의하였다. 반면에 낮은 동의율을 보인 항목은 '환자와 심폐소생술에 대해 논하는 것' 으로 15.9%가 동의하였다. 나쁜 임상질지표 중 동의율이 높은 항목은 '낙상이나 욕창이 발생하는 것은 바람직하지 않다' 라는 항목이었으며 94.2%의 보호자가 동의하였고 가장 낮은 동의율을 보인 것으로는 '병원에서 임종하시는 것은 바람직하지 않다'라는 항목으로 11.6%가 동의하였다. 그리고 동의를 많이 한 그룹일수록 여자의 비율, 환자가 자신의 예후를 인지한 비율, 경제 수준이 높은 사람의 비율이 높았다. 결론: 본 연구에서는 이전 여러 연구에서 임상질지표로 권유되어진 항목들에 대한 보호자들의 동의율이 낮은 항목들이 있었으며 일부 항목들의 동의율과 보호자들의 특성이 관련이 있었다.

• 대한기계학회:학술대회논문집
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• 대한기계학회 2008년도 추계학술대회A
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• pp.1419-1426
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• 2008

Fulminant hepatic failure is a clinical syndrome associated with a high mortality rate. Orthotopic liver transplantation is the only clinically proven effective treatment for patients with end-stage liver disease who do not respond to medical management. A major limitation of this treatment modality is the scarcity of donor organs available, resulting in patients dying while waiting for a donor liver. An extracorporeal bioartificial liver (BAL) device containing viable hepatocytes has the potential to provide temporary hepatic support to liver failure patients, serving as a bridge to transplantation while awaiting a suitable donor. In some patients, providing temporary hepatic support may be sufficient to allow adequate regeneration of the host liver, thereby eliminating the need for a liver transplant. Although the BAL device is a promising technology for the treatment of liver failure, there are several technical challenges that must be overcome in order to develop systems with sufficient processing capacity and of manageable size. In this overview, the authors describe the critical issues involved in developing a BAL device. They also discuss their experiences in hepatocyte culture optimization within the context of a microchannel flat-plate BAL device.

• 중환자간호학회지
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• 제10권1호
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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.

• Perspectives in Nursing Science
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• 제5권1호
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• pp.1-15
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• 2008

Background: Recent changes in the medical environment have increased the need for the home health care nursing in Korea. Even though the number of home health care patients is increasing, the major nursing problems have not been identified due to lack of a standardized nursing diagnosis. Aim: An investigative study was conducted to determine the frequency and appropriateness of nursing problems in hospital-based home health care patients in Korea using two internationally standardized nursing diagnosis classification systems. Methods: Nursing records of 249 hospital-based home health care patients were reviewed and nursing problems were identified using the North American Nursing Diagnosis Association Nursing Diagnosis Taxonomy I (NANDA) and the Clinical Care Classification of Nursing Diagnoses (CCC). Findings: Out of 463 nursing problems. 403 nursing problems were described using the NANDA whereas 427 nursing problems were described using the CCC. Nursing diagnoses not captured by the NANDA classification include nausea/vomiting, anorexia, risk for nutrition deficit, decreased blood pressure, dying process, blood sugar impairment. infection unspecified, and disuse syndrome. Nursing diagnoses not captured by the CCC include nausea/vomiting and anorexia. Conclusions: In describing nursing problems of home health care patients, it was found that the CCC was able to represent more diagnoses than the NANDA.

• Asian Pacific Journal of Cancer Prevention
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• 제15권10호
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• pp.4251-4254
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• 2014

Background: Treatment of anemia is an important issue in the palliative care setting. Blood transfusion is generally used for this purpose in supportive care. However the place of blood transfusion in terminally ill cancer cases is less far established. Objective: We aimed to outline the use of transfusions and to find the impact of blood transfusion on survival in patients with advanced cancer and very near to death. Design: Patients dying in 2010-2011 with advanced cancer were included in the study. We retrospectively collected the data including age, type of cancer, the duration of last hospitalisation, ECOG performance status, Hb levels, transfusion history of erythrocytes and platelets, cause and the amount of transfusion. The anaemic patients who had transfusion at admission were compared with the group who were not transfused. Survival was defined as the time between the admission of last hospitalisation period and death. Results: Three hundred and ninety eight people with solid tumours died in 2010-2011 in our clinic. Ninety percent of the patients had anemia at the time of last hospitalisation. One hundred fifty three patients had erythrocyte transfusion at admission during the last hospitalisation period (38.4%). In the anaemic population the duration of last hospitalisation was longer in patients who had erythrocyte transfusion (15 days vs 8 days, p<0.001). Conclusions: Patients who had blood transfusion at the end of life lived significantly longer than the anaemic patients who were not transfused. This study remarks that blood transfusions should not be withheld from terminal cancer patients in palliative care.