1.Safety and Efficacy of Peripherally Inserted Central Catheters in Terminally Ill Cancer Patients: Single Institute Experience.
Kwonoh PARK ; Hyoung Gun LIM ; Ji Yeon HONG ; Hunho SONG
Korean Journal of Hospice and Palliative Care 2014;17(3):179-184
PURPOSE: We investigated the safety and efficacy of peripherally inserted central catheters (PICCs) in terminally ill cancer patients. METHODS: A retrospective review was conducted on patients who underwent PICC at the hospice-palliative division of KEPCO (Korea Electric Power Corporation) Medical Center between January 2013 and December 2013. All PICCs were inserted by an interventional radiologist. RESULTS: A total of 30 terminally ill cancer patients received the PICC procedure during the study period. Including one patient who had had two PICC insertions during the period, we analyzed a total of 31 episodes of catheterization and 571 PICC days. The median catheter life span was 14.0 days (range, 1~90 days). In 25 cases, catheters were maintained until the intended time (discharge, transfer, or death), while they were removed prematurely in six other cases (19%; 10.5/1000 PICC days). Thus, the catheter maintenance success rate was 81%. Of those six premature PICC removal cases, self-removal due to delirium occurred in four cases (13%; 7.0/1000 PICC days), and catheter-related blood stream infection and thrombosis were reported in one case, each (3%; 1.8/1000 PICC days). Complication cases totaled eight (26%; 14.1/1000 PICC days). The time to complication development ranged from two to 14 days and the median was seven days. There was no PICC complication-related death. CONCLUSION: Considering characteristics of terminally ill cancer patients, such as a poor general condition, vulnerability to trivial damage, and a limited period of survival, PICC could be a safe intravenous procedure.
Catheterization
;
Catheterization, Central Venous
;
Catheterization, Peripheral
;
Catheters*
;
Delirium
;
Hospice Care
;
Humans
;
Palliative Care
;
Retrospective Studies
;
Rivers
;
Terminal Care
;
Terminally Ill*
;
Thrombosis
2.Risk Factors Related to Development of Delirium in Hospice Patients.
Hae Jin KO ; Chang Ho YOUN ; Seung Eun CHUNG ; A Sol KIM ; Hyo Min KIM
Korean Journal of Hospice and Palliative Care 2014;17(3):170-178
PURPOSE: Delirium is a common and serious neuropsychiatric complication among terminally ill cancer patients. We investigated risk factors related to the development of delirium among hospice care patients. METHODS: Between May 2011 and September 2012, we included patients who were mentally alert and had no psychiatric disease or drug addiction at the hospice ward of two local hospitals. Among them, participants who had been diagnosed with delirium by two doctors according to the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders-4th edition) criteria were grouped as Delirium Group. We analyzed results of psychometric and other laboratory tests performed at the time of patient's admission - psychometric tests included cognitive function (mini-mental status examination, MMSE), depression (Beck Depression Inventory, BDI), anxiety, and insomnia (Insomnia Severity Index, ISI). Logistic regression analysis was used to compare delirium and the related factors. Cox's proportional hazard model was performed using significant factors of logistic regression analysis. RESULTS: Of the 96 patients who met the inclusion criteria, 41 (42.7%) developed delirium. According to the logistic regression analysis, primary cancer site, cognitive impairment (MMSE<24), depression (BDI> or =16), and insomnia (ISI> or =15) were significant factors related to delirium. Among the four factors, depression (OR 5.130; 95% CI, 2.009~13.097) and cognitive impairment (OR 5.130; 95% CI, 2.009~13.097) were found significant using Cox's proportional hazard model. CONCLUSION: The development of delirium was significantly related to depression and cognitive impairment among patients receiving hospice care. It is necessary to carefully monitor depression and cognitive function in hospice care.
Anxiety
;
Delirium*
;
Depression
;
Diagnostic and Statistical Manual of Mental Disorders
;
Hospice Care
;
Hospices*
;
Humans
;
Logistic Models
;
Proportional Hazards Models
;
Psychometrics
;
Risk Factors*
;
Sleep Initiation and Maintenance Disorders
;
Substance-Related Disorders
;
Terminally Ill
3.Nursing Students' First Clinical Experiences of Death.
Hyoung Sook PARK ; Youngju JEE ; Soon Hee KIM ; Yoon Ji KIM
Korean Journal of Hospice and Palliative Care 2014;17(3):161-169
PURPOSE: This study was conducted to comprehensively investigate nursing students' experience of their first encounter with death of a patient during clinical practice. METHODS: This study took place from January 27 through March 6, 2012 with eight female senior nursing students enrolled at Pusan National University located in Y city who have experienced patient death. We collected their experience of their first death encounter during their clinical rotation by asking, "What is your first experience of patient's death during the clinical practice?" Husserl's phenomenological approach was applied in this study. RESULTS: In this study, 17 themes, 15 clusters of themes and eight categories were derived. The categories included "Desire to avoid the reality of death", "Powerlessness", "Anticipation for recovery shifted to fear of death", "Various interpretations of death", "Limitations in their nursing practice", "Resentment of lack of nurses", "Longing to better understand death", and "Motivation for inner growth". CONCLUSION: Through their first encounter with death of a patient, nursing students experienced various emotions and viewed their role as hospice caregiver by projecting themselves as fully trained nurses in future. Participants considered terminal care as a part of nursing care. The result of this study indicates the need to include education of death in the nursing school curriculum.
Busan
;
Caregivers
;
Curriculum
;
Education
;
Female
;
Hospices
;
Humans
;
Nursing Care
;
Nursing*
;
Schools, Nursing
;
Students, Nursing
;
Terminal Care
4.Factors Influencing Perception of Good Death among the Community-dwelling Elderly.
Korean Journal of Hospice and Palliative Care 2014;17(3):151-160
PURPOSE: This study was conducted to investigate perception of good death among the community-dwelling elderly and identify factors related to the perception. METHODS: A questionnaire survey was carried out using a convenient sampling method (N=317). Data were analyzed by applying descriptive statistics, t-test, ANOVA, Scheffe's test, Pearson's correlation coefficient, and stepwise multiple regression. RESULTS: Participants scored an average of 3.35 on a 4-point scale for the perception level of good death. They scored higher on the factor of personal control that other factors affecting the perception. Good death was positively correlated with family support (r=0.252). Family support (beta=0.287) and gender (beta=0.197) significantly influenced the elderly's perception of good death. These variables accounted for 10.2% of the total variance. CONCLUSION: The results show that family support is an important factor for the perception of good death among the elderly. Therefore, family support should be carefully considered to ensure good death for more senior citizens. Our findings can be utilized to support programs such as death education for the elderly.
Aged*
;
Attitude to Death
;
Education
;
Humans
;
Surveys and Questionnaires
5.Intensive Care Nurses' Experiences of Death of Patients with DNR Orders.
Ji Yun LEE ; Yong Mi LEE ; Jae In JANG
Korean Journal of Hospice and Palliative Care 2017;20(2):122-130
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.
Critical Care*
;
Education
;
Hospitals, General
;
Humans
;
Intensive Care Units
;
Judgment
;
Methods
;
Patient Care
;
Qualitative Research
;
Resuscitation
;
Social Control, Formal
6.The Necessity for End-of-Life Care Education: A Preliminary Analysis with Interns at Two University Hospitals.
Do Yeun KIM ; Kyong Jee KIM ; Sung Joon SHIN ; Ivo KWON ; Eun Mi NAM ; Dae Seog HEO ; Soon Nam LEE
Korean Journal of Hospice and Palliative Care 2017;20(2):111-121
PURPOSE: This study was performed to explore the current state of end-of-life (EoL) care education provided to new interns at two university hospitals. METHODS: A questionnaire was given to incoming interns (N=64). The levels of acquired knowledge and experience of clinical observation were measured. Seven areas for self-assessment questions were identified and used to analyze the interns' attitudes towards EoL-related education and practice. RESULTS: On average, participants learned five elements (nine in total) from EoL-related classes and two (seven in total) from clinical observation. The most frequently educated element was how to deliver bad news (96.9%) in the classroom setting and how to control physical symptoms (56.5%) in clinical observation. Less than 20% received training on EoL care communication, including discussion of advanced directives. Compared with participants who had no EoL training, those who had EoL training showed positive attitudes in all seven categories regarding overall satisfaction, interest and preparedness in relation to EoL-care classes and practice. CONCLUSION: Although interns are responsible for caring of dying patients, their EoL training in classroom and clinical settings was very insufficient. Further research should be conducted to establish an education system that provides sufficient knowledge and training on EoL care.
Clinical Clerkship
;
Education*
;
Education, Medical
;
Hospitals, University*
;
Humans
;
Self-Assessment
;
Terminal Care
7.The Meaning of Dignified with Death.
Korean Journal of Hospice and Palliative Care 2017;20(2):100-110
PURPOSE: We explored Koreans' perception of the meaning of death with dignity that Korean people. METHODS: A phenomenological research methodology was applied. A total of 13 participants were sampled based on their age and gender. Participants were interviewed in depth from September 2015 through February 2016. Colaizzi's phenomenological analysis method was used for data analysis. To establish the validity of the study, we evaluated its realistic value, applicability, consistency and neutrality of the qualitative evaluation criteria of Lincoln and Guba. RESULTS: Koreans' perception of death with dignity was structured as 19 themes, nine theme clusters and four categories. The four categories were “comfortable death”, “good death”, “resolving problems before death”, and “death with good reputation”. The theme clusters were “death without pain”, “death submitting to one's fate”, “death that is not ugly”, “leaving good memories to others”, “dying in a way we want”, “death after proper settling of things”, “dealing with chronic resentment before death”, “death after living a good life”, and “death with recognition”. CONCLUSION: For Koreans, death with dignity meant not burdening others, settling things right and leaving good memories to their families and friends. Such perceptions can be applied to hospice care for terminally ill patients.
Evaluation Studies as Topic
;
Friends
;
Hospice Care
;
Hospices
;
Humans
;
Methods
;
Research Design
;
Right to Die
;
Statistics as Topic
;
Terminally Ill
8.Changes in Life-sustaining Treatment in Terminally Ill Cancer Patients after Signing a Do-Not-Resuscitate Order.
Korean Journal of Hospice and Palliative Care 2017;20(2):93-99
PURPOSE: This study investigated changes in life-sustaining treatments in terminally ill cancer patients after consenting to a do-not-resuscitate (DNR) order. METHODS: Electronic medical records were reviewed to select terminally ill cancer patients who were treated at the oncology unit of the Asan Medical Center, a tertiary hospital in South Korea and died between January 1, 2013 and December 31, 2013. RESULTS: The median (range) age of the 200 patients was 59 (22~89) years, and 62% (124 persons) were male. Among all patients, 83.5% were aware of their medical condition, and 47.0% of the patients had their DNR order signed by their spouses. The median of the patients' hospital stay was 15 days, and time from admission to DNR decision was 10 days. After signing a DNR order, 35.7~100% of the life-sustaining treatments that had been provided at the time of the DNR decision making were administered. The most commonly discontinued interventions were transfusion (13.5%), blood test (11.5%) and parenteral nutrition (8.5%). CONCLUSION: It is necessary to define the scope of life-sustaining treatments for DNR patients. Treatment guidelines should be established as well to secure terminal patients' death with dignity after their consent to a DNR order, thereby avoiding meaningless life-sustaining treatments and allowing administration of active terminal care interventions.
Chungcheongnam-do
;
Decision Making
;
Electronic Health Records
;
Hematologic Tests
;
Hospice Care
;
Humans
;
Korea
;
Length of Stay
;
Life Support Care
;
Male
;
Parenteral Nutrition
;
Resuscitation Orders*
;
Right to Die
;
Spouses
;
Terminal Care
;
Terminally Ill*
;
Tertiary Care Centers
9.Hospice and Palliative Care in Chronic Obstructive Pulmonary Disease.
Jinyoung SHIN ; Hye Yun PARK ; Jungkwon LEE
Korean Journal of Hospice and Palliative Care 2017;20(2):81-92
Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation that is usually progressive. It is a major cause of morbidity and mortality worldwide, leading to substantial and increasing economic and social burden. Palliative care for COPD patients aims to reduce symptoms and exacerbations and improve exercise tolerance and quality of life. It is difficult to make a prognosis for COPD patients due to the variable illness trajectory and advanced care of patients. However, severity of breathlessness, assessment of lung function impairment, and frequency of exacerbations can help to identify palliative care needs and determine effective methods to mitigate symptoms, which is discussed in this paper. In these patients, it is recommended to provide individualized palliative care along with curative/restorative care at the onset of COPD symptoms. Before launching a palliative care system in Korea, it is necessary to prepare pulmonary rehabilitation resources, patient-centered communication, timely palliative responsiveness, and a program for effective advanced care planning. A multidisciplinary approach involving collaboration with not only the respiratory and palliative care teams but also primary care offers a new model of care for these patients and should be considered with a priority.
Cooperative Behavior
;
Dyspnea
;
Exercise Tolerance
;
Hospice Care
;
Hospices*
;
Humans
;
Korea
;
Lung
;
Mortality
;
Palliative Care*
;
Primary Health Care
;
Prognosis
;
Pulmonary Disease, Chronic Obstructive*
;
Quality of Life
;
Rehabilitation
;
Respiratory Therapy
10.Pediatric Nurses' Perception and Knowledge about Pediatric Hospice Palliative Care.
Korean Journal of Hospice and Palliative Care 2015;18(3):235-244
PURPOSE: The aim of this study was to investigate pediatric nurses' perception and knowledge about pediatric hospice and palliative care. METHODS: A cross-sectional descriptive study was conducted with 132 nurses who are stationed in pediatric wards and intensive care units. The participants were requested to fill out a questionnaire comprising 23 items for perception and 20 items for knowledge. Data were collected after obtaining written consent. Data were analyzed using SPSS 21.0. RESULTS: Participants perceived difficulties in pediatric hospice palliative care, especially communication with patients and their families. The differences of perception among participants were observed according to pediatric hospice and palliative care experience, but not general characteristics. Participants' knowledge was 8.83+/-2.64. Nurses who work in a ward showed higher level of knowledge about pediatric hospice/palliative care. CONCLUSION: An education program should be developed and provided to pediatric nurses to improve their perception and knowledge about pediatric hospice/palliative care.
Child
;
Education
;
Hospice and Palliative Care Nursing
;
Hospices*
;
Humans
;
Intensive Care Units
;
Palliative Care*