BACKGROUND: Recently, the legal and ethical issues relative to euthanasia are becoming controversial in Korea. This study was designed to verify the differences of the attitudes on euthanasia between judicial apprentices and residents. METHODS: The questionnaire was conducted on the 35th-group of the judicial apprentices on March 24, 2004, and on the residents from April 2 to May 22, 2004. The respondents were 636 in total consisting of 460 judicial apprentices and 176 residents. RESULTS: Of the total 636 subjects, 373 (81.1%) of the judicial apprentices and 149 (84.7%) of residents agreed that allowing euthanasia is moral, without any significant difference (P>0.05). The number of residents was greater (59 people, 33.5%) than that of judicial apprentices (112 people, 24.4%) who agreed with active euthanasia (P<0.05). Among the total, 397 (86.3%) of the judicial apprentices and 160 (91.4%) of the residents answered that the law for euthanasia was necessary, without any significant difference (P>0.05). But, among these supporters, the respondents who agreed on active euthanasia were significantly different in number between judicial apprentices (n=93, 23.4%) and residents (n=54, 33.8%) (P<0.05). CONCLUSION: This study did not find any significant differences between the two groups in the necessity of the law for euthanasia, but the rate of agreement on active euthanasia was higher in residents group than in judicial apprentices group.
Surveys and Questionnaires ; Ethics ; Euthanasia* ; Euthanasia, Active ; Euthanasia, Passive ; Jurisprudence ; Korea

BACKGROUND: Medical decisions concerning the prolongation of life, the right to die and euthanasia are among the most extensively discussed issues within medicine and law today. The purpose of this study was to evaluate the attitudes of medical students and housestaff toward euthanasia. METHODS: From July 15 to September 15 of the 1998, the responses of 180 medical students and 132 housestaff to a self-administered questionnaire were analyzed to identify attitudes toward euthanasia. Over 312 respondents about attitudes toward euthanasia, the analysis of differences between proportions was made by the Chi-square test. RESULTS: About 69.9% of the respondents thought euthanasia should be legalized. The findings suggest that Buddhists (77.5%) and non-religious groups (88.1%) tend to support euthanasia more than Christians. Futhermore, medical students (74.4%) support euthanasia more than housestaffs(63.6%), male(75.1%) more often than female(57.9%). About 73.1% of the respondents said that active euthanasia is not justifiable, and 79.2% said that they do not like performing active euthanasia. In respect to passive euthanasia, 69.0% said that it is not ethically justifiable, but 63.0% would perform this as if it were legal. Housestaffs of internal medicine (76.9%) were more willing to do euthanasia than pediatrics (70.0%), surgery (63.6%), family practice (53.8%) and Ob/Gyn (33.3%). CONCLUSION: Respondents have positive attitudes toward legalization of euthanasia.. Most considered that passive euthanasia is not morally justifiable. But if it were legalized, they would be willing to do euthanasia, while they would still be disturbed by active euthanasia. The opinions of physician and medical students directly affect patient care and their attitudes must be considered if clear policies are to be developed concerning euthanasia.
Surveys and Questionnaires ; Euthanasia* ; Euthanasia, Active ; Euthanasia, Passive ; Family Practice ; Humans ; Internal Medicine ; Jurisprudence ; Life Support Care ; Patient Care ; Pediatrics ; Right to Die ; Students, Medical*

The quality of relationship between a person with dementia and a family caregiver has been identified as one of important factor in informal dementia care. Currently there is no validated questionnaire to measure the dyadic relationship in Malaysia. The aim of present study is to examine the reliability and validity of Quality of the PatientCaregiver Relationship (QCPR) questionnaire in Malay version. A total of 70 patients with mild to moderate dementia and their caregivers were recruited from the psychogeriatric clinic, Universiti Kebangsaan Malaysia Medical Centre using a cross sectional study. The QCPR questionnaire was translated into Malay following the standard guidelines for crosscultural adaptation of measure. The person with dementia and their caregiver completed the QCPR Malay version separately. Internal consistency and test-retest examined for reliability. Construct validity was tested with principal component factor analysis. The reliability of patient QCPR Malay version was good with Cronbach’s alpha coefficients of 0.86 and intraclass correlation coefficients of 0.85. Item 11 was omitted from the caregiver QCPR Malay version due to its poor correlation with the corrected item-total score. The newly formed scale, 13 items caregiver QCPR Malay version, had satisfactory reliability (Cronbach’s alpha 0.89 and intraclass correlation coefficients 0.91). Principal component factor analysis extracted 4 factors for patient version and 3 factors for caregiver version which explained 69.44% (patients’ report) and 61.20% (caregivers’ report) of the total variance of the scale. As a conclusion, both the patient (14 items) and caregiver (13 items) adapted QCPR Malay version is a reliable and valid tool to measure the quality of dyadic relationship between people with mild to moderate dementia and the caregiver.
Informal care ; dementia ; caregiver ; questionnaire ; reliability ; validity

PURPOSE: The purpose of this study was to identify the impact of practical communication strategies (PCS) on the reduction of AEs (Adverse Events) in pediatric cardiac ICU (PCICU). METHODS: Intra-operative findings and care plans were documented and shared between staff members on a daily basis from the day of operation to the day of general ward transfer. Incidence of AEs was investigated in all patients who were admitted to the PCICU and was compared with incidence of AEs one year after establishment of PCS. RESULTS: The study population consisted of 216 patients in pre-PCS group and 156 patients in post-PCS group. Incidence of readmission decreased from 6.0% (13/216) in pre-PCS group to 0.6% (1/156) in post-PCS group (chi2=7.23, p=.010). Incidence of other major complications decreased from 4.2% (9/216) to 0.6% (chi2=6.66, p=.012). Minor AEs such as intervention omission, order error, and protocol misunderstanding were reduced from 23.3 cases per 100 patient-days to 7.5 cases per 100 patient-days (chi2=20.31, p<.001). CONCLUSION: Handover protocol is an effective strategy to reduce AEs for critically ill patients after pediatric cardiac surgery. Efforts to develop effective communication strategies should be continued and outcome research about communication strategies for patient safety should be further studied.
Critical Illness ; Heart Defects, Congenital ; Humans ; Incidence ; Intensive Care Units* ; Outcome Assessment (Health Care) ; Patient Handoff ; Patient Safety ; Patients' Rooms ; Thoracic Surgery

OBJECTIVE: To explore the application and the effect of early recognition of deteriorating patient program in department of cardiac surgery. METHODS: We used the early recognition of deteriorating patient program in the cardiac surgery groups, including cardiac surgeons, nurses in ward, ICU and operation rooms of the cardiac surgery department, and compared the satisfaction of nurses and doctors, handover time, handover score of critical patients, and rate of unplanned ICU admission before and after the intervention. RESULTS: After using the early recognition of deteriorating patient program, the satisfaction of doctors and nurses was increased, the handover time was lowered 0.56 min/time (t=2.22, P<0.05), the handover score of critical patients enhanced by 19.59 points (t=30.57, P<0.001), the rate of unplanned ICU readmission after the operation reduced by 4.8% (χ2=4.14, P<0.05). CONCLUSION Early recognition of deteriorating patient program can improve the safety of cardiac patients, enhance the self-confidence of nurses and work efficiency.
Cardiology Service, Hospital ; organization & administration ; Critical Illness ; Humans ; Intensive Care Units ; Outcome and Process Assessment, Health Care ; Patient Handoff ; Surgery Department, Hospital ; organization & administration

This study was carried out to obtain basic data required to plan and develop Rehabilitation Day Care Program for the stroke survivors at home in Korea. The subjects comprised of 118 stroke survivors who discharged from 4 hospitals in Seoul during the past 2 years. The data were collected from August 3, 1998 to September 18, 1998, through interviews with questionnaires about general characteristics, activities of daily living, depression and service need of rehabilitation day care program at the outpatient clinics by trained nursing graduates. Data were analyzed with descriptive analysis, Pearson's correlation analysis, and Stepwise multiple linear regression analysis using SPSS/WIN program. The results obtained are as follows: 1. The mean score of the general need of rehabilitation day care program of stroke survivors was 2.78(range 1-4). The highest need among the service categories of the rehabilitation day care program was self-care and restorative activities category, and health services referral category, recreation category, psychosocial activities category in order. The needs of each category are as follows ; 1) In the health services referral category, the need for speech therapy was highest, followed by the need for physical therapy and occupational therapy. 2) In the psychosocial activities category, the need for self-help group was highest. 3) In the self-care and restorative activities category, the need for bathing was highest, followed by bowel training, and ambulation training. 4) The need for the recreation category was 2.62. 2. Among the need for the effect related to the utilization of day care program, the need for survivors' physical and psychological well-being was highest and was followed by the need for caregiver's physical and psychological wellbeing. Pearson's correlation analysis revealed following results; 1. The need for rehabilitation day care program service displayed a correlation with the level of education, ADL, and the level of depression, and a reverse correlation with age. 2. The need for the effect related to the utilization of rehabilitation day care program displayed a correlation with the level of education, ADL, and the level of depression. The stepwise multiple linear regression analysis revealed following results; 1. For the need for rehabilitation day care program service, 28.4% of the variance was initially explained by one variable, level of depression. The level of depression plus two variables, survivors' age and ADL, explained 34.2% of the variance in the need for rehabilitation day care program service. 2. For the need for the effect related to the utilization of rehabiJitation day care program, 12.4% of the variance was initially explained by one variable, level of depression. The level of depression plus one variable, level of education, explained 20.4% of the variance in the need for the effect related to the utilization of rehabilitation day care program. In conclusion, above characteristics should be considered when we are planning to develop stroke survivors' rehabilitation day care program.
Activities of Daily Living ; Ambulatory Care Facilities ; Baths ; Day Care, Medical* ; Depression ; Education ; Health Services ; Humans ; Korea ; Linear Models ; Nursing ; Occupational Therapy ; Surveys and Questionnaires ; Recreation ; Referral and Consultation ; Rehabilitation* ; Self Care ; Self-Help Groups ; Seoul ; Speech Therapy ; Stroke* ; Survivors* ; Walking

This study was carried out to find out the basic data required to plan and develop Rehabilitation Day Care Program for the stroke survivor's family in Korea. The subjects comprised of 92 stroke survivor's family who discharged from 4 hospitals in Seoul during the past 2 years. The data were collected from August 3. 1998 to September 18, 1998, through interviews with questionnaires about general characteristics, activities of daily living, depression and service need of rehabilitation day care program at the outpatient clinics by trained nursing graduates. Data were analyzed with descriptive analysis, Pearson's correlation analysis, and Stepwise multiple linear regression analysis using SPSS/WIN 10.0 program. The results obtained are as follows: 1. The mean score of the general need of rehabilitation day care program of stroke survivor's family was 3.10(range 1-4). The highest need among the service categories of the rehabilitation day care program was self-care and restorative activities category(3.30). and health services referral category, recreation category, psychosocial activities category in order. The needs of each category are as follows. In the health services referral category, the need for dental examination and medical examination were highest, followed by the need for physical therapy and occupational therapy. In the psychosocial activities category, the need for family counselling was highest. In the self-care and restorative activities category, the need for ROM exercise training was highest, followed by bowel training, and ambulation training. 2. The need of family for rehabilitation day care program service displayed a correlation with the level of education. ADL. and the level of depression. and a reverse correlation with age, illness intrusiveness, depression, knowledge. subject and object burden and relationship with stroke survivors. 3. The stepwise multiple linear regression analysis revealed following results. For the need for rehabilitation day care program service. 22.6% of the variance was initially explained by level of family's knowledge about caring method for stroke survivors, 8.8% was the level of subjective burden and 5.4% was relationship with stroke survivors. In conclusion, above characteristics should be considered to develop stroke survivors' rehabilitation day care program.
Activities of Daily Living ; Ambulatory Care Facilities ; Day Care, Medical* ; Depression ; Education ; Health Services ; Humans ; Korea ; Linear Models ; Nursing ; Occupational Therapy ; Surveys and Questionnaires ; Recreation ; Referral and Consultation ; Rehabilitation* ; Self Care ; Seoul ; Stroke* ; Survivors ; Walking

This study was done to develop an euthanasia attitude scale. Subjects who participated in the study were a convenience sample of 234 Korean nurses. Data were collected through a survey over a period of three months. The analysis of the data was done using SPSS PC for descriptive statistics, factor analysis and Cronbach's Coefficient Alpha. Initially 63 items were generated from interview data from eighteen nurses and from a literature review. This preliminary scale was analyzed for a reliability and validity. The results are as follow: 1. Crombach's Coefficient alpha for the 19 items was 0.8804. 2. Factor analysis was done in order to confirm construct validity and four factor were extracted from the results. These contributed 56.6% of the variance in the total score. 3. Each factor was labled 'quality of life', 'respect of life, 'client's right','medical ethics'. The author suggests that this scale could be used in assessing the attitude of Korean nurses toward euthanasia.
Euthanasia* ; Reproducibility of Results

Hospice and palliative care can help terminal patients and their family members to face the natural end of life more comfortably, by providing them with an environment to address psychosocial and spiritual problems, as well as physical symptoms. However, most patients and their caregivers have the misconception that hospice care means the withdrawal of all treatments. Many physicians also consider hospice care to be a form of terminal care after all treatments are finished. Laws regulating the withdrawal of life-prolonging treatment came into effect in Korea in 2018, and these regulations also apply to most terminal stages of benign diseases. The withdrawal of futile life-prolonging treatment is quite different from euthanasia or negligence. At the last stage of disease, treatment aimed at alleviating various symptoms can make critically ill patients more comfortable and thereby help them to die with dignity. Patients with a terminal illness should receive hospice and palliative care, instead of futile life-prolonging treatment. Therefore, education and training programs to promote a proper understanding of hospice and palliative care should be considered mandatory.
Caregivers ; Critical Illness ; Education ; Euthanasia ; Hospice Care ; Hospices ; Humans ; Jurisprudence ; Korea ; Malpractice ; Palliative Care ; Social Control, Formal ; Terminal Care ; Withholding Treatment

INTRODUCTIONThe efficiency of postoperative handover of paediatric patients to the children's intensive care unit (CICU) varies according to institutions, clinical setup and workflow. Reorganisation of handover flow based on findings from observational studies has been shown to improve the efficiency of information transfer. This study aimed to evaluate a new handover process based on recipients' perceptions, focusing on completeness and comprehensiveness of verbal communication, and the usability of a situation, background, assessment and recommendation (SBAR) form.

METHODSThis was a prospective interventional study conducted in the CICU of KK Women's and Children's Hospital, Singapore. It comprised four phases: (1) evaluation of the current handover process through an audit and opinion survey; (2) development of a new handover process based on the opinion survey and hospital personnel feedback; (3) implementation; and (4) evaluation of the new handover process. The new handover process was based on a PETS (pre-handover, equipment handover, timeout and sign out) protocol with a 'single traffic communication' flow and a new SBAR handover document. It included relevant patient information, and the options 'not applicable' and 'none', to increase compliance and reduce ambiguity.

RESULTSSignificantly more recipients indicated that the new SBAR form was the most important handover tool and provided more useful information. Recipients' perceptions indicated improvement in information sufficiency and clarity; reduction of omission errors; and fewer inconsistencies in patient descriptions in the new process.

CONCLUSIONDual customisation of the handover process, PETS protocol and SBAR form is necessary to meet the workflow and information demands of the receiving team.

Anesthesia ; Attitude of Health Personnel ; Child ; Critical Care ; methods ; Hospitals, Pediatric ; organization & administration ; Humans ; Intensive Care Units ; Medical Errors ; prevention & control ; Nurses ; Observational Studies as Topic ; Patient Handoff ; Pediatrics ; methods ; Postoperative Care ; methods ; Postoperative Period ; Prospective Studies ; Singapore ; Surveys and Questionnaires