PURPOSE: This study was conducted to examine how nurses' death anxiety and terminal care stress affect their terminal care performance in the clinical setting. METHODS: The study enrolled 180 registered nurses with experience of attending dying patients at a university hospital located in Seoul, Korea. Collected data were analyzed with descriptive statistics, one-way ANOVA and Pearson's correlation using SPSS 18.0 for Windows. RESULTS: Nurses showed significant differences in the level of death anxiety and terminal care stress as well as terminal care performance by working division, marital status, educational background and hospice training. A significant relationship was found between terminal care stress and terminal care performance. CONCLUSION: The study results showed that efforts to ease nurses' death anxiety and terminal care stress could improve their terminal care performance. Further study should be conducted to investigate other factors that affect nurses' terminal care performance from various perspectives and develop a terminal care manual which can be used as guidance for nurses in charge of terminal patient care.
Anxiety ; Fees and Charges ; Hospices ; Humans ; Korea ; Marital Status ; Nursing Services ; Patient Care ; Terminal Care

PURPOSE: The purpose of the study was to develop a feasible form of a Korean version of advance directives (K-AD). METHODS: Sixteen adults participated in this study: 10 aged 20~50 years and nine aged 65 years or older. Using a draft version of the K-AD, cognitive interview was conducted on the participants to establish a culturally acceptable form of advance directives whose directions can be understood and responded accordingly by the general population. RESULTS: Cognitive interviews revealed areas of concerns for the draft version of K-AD: lack of instructions or clarity for technical and medical terms, context complexity and inadequate response categories. The draft version was revised by rewording, offering examples and rearranging the context. Editorial style was added with appropriate uses of bold fonts, bullet-points and underlines to facilitate interviewees' cognitive responses. CONCLUSION: Study results feasibility of the revised version of the K-AD. Further study should be performed with a larger number of participants to develop a K-AD with an acceptable level of reliability and validity.
Adult ; Advance Directives ; Aged ; Cognition ; Humans ; Life Support Care ; Reproducibility of Results

PURPOSE: Home-based care providers were surveyed to assess the effect of collaborative service between Gyeongnam Regional Cancer Center (GRCC) and public health centers (PHCs) in Gyeongnam province. METHODS: Twenty home-based care providers who had previously participated in the GRCC-PHC care project were recruited from nine PHCs and were surveyed using a questionnaire developed by specialists. Questions were rated using the 5-point Likert scale ranging from "strongly disagree (-2)" to "strongly agree (+2)" and each score was multiplied by the corresponding number of respondents (n=20) with the maximum score of 40. RESULTS: Between January 2008 and December 2011, 73 patients were registered to the collaborative service: 72 by GRCC and one by PHC. Home-based care providers marked the highest score (23 points) to "The collaborative service contributed to patients and their family's psychological stability" and the lowest score (11 points) to "The collaborative service was generally helpful for home-based cancer management." For possible suggestions to improve the service, the highest score (35 points) was given to "Simplification of the hospitalization process" followed by "Substantial benefits for patients at their visit to the hospital" (34 points). CONCLUSION: The results revealed several limitations of the GRCC-PHC collaborative care service for terminal cancer patients. The service could be further improved by developing measures to address the limitations and a service model tailored to region-specific needs.
Academic Medical Centers ; Community Health Centers ; Cooperative Behavior ; Surveys and Questionnaires ; Home Care Services ; Hospitalization ; Humans ; Public Health ; Referral and Consultation ; Specialization

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.
Attitude to Death ; Bioethics ; Cardiopulmonary Resuscitation ; Humans ; Korea ; Patient Care ; Students, Nursing ; Surveys and Questionnaires

PURPOSE: The aim of this research was to explore nurses' knowledge of and attitudes toward pediatric palliative care (PPC) in Korea. METHODS: A descriptive cross-sectional design was used. A total of 196 participants were recruited from the ELNEC-PPC course held in Seoul, Korea. All participants completed a 20-item survey questionnaire which assessed knowledge of and attitudes toward PPC using a 7-point Likert scale. RESULTS: Nurses' knowledge of PPC correlated with their educational level and work experience in the pediatric unit and hospice care unit. The work experience in the pediatric unit, career length in PPC and completion of palliative education course made differences in the attitudes toward PPC. Married nurses scored significantly higher on the parental rights in determining palliative care service for their child, and nurses with master's degree or higher showed a higher level of understanding of and attitudes toward the differences between PPC and adult palliative care. CONCLUSION: The factors influencing nurses' knowledge of and attitudes toward PPC need be considered to develop a pediatric palliative training program.
Adult ; Child ; Education ; Hospice Care ; Human Rights ; Humans ; Korea ; Palliative Care* ; Parents ; Seoul ; Surveys and Questionnaires

PURPOSE: The purpose of this study is to analyze types of shared medical decision making by health professionals in a decision making position. METHODS: The Q-methodology was used. Q sample was constructed with a total of 35 Q-statements that were offered with a 9-point rating scale. The statements were structured to generate answers that would form a shape of a normal distribution. Answers to Q sample were analyzed using a QUANL PC program. RESULTS: Four types of shared medical decision making were identified. Type I is patient-centered decision making, Type II is physician-centered, Type III is health professional-centered and Type IV is patient-family-centered. CONCLUSION: Study results indicate that it is recommended to develop an education program based on the four types of shared medical decision making so that health professionals can be provided with different approaches according to their decision making style.
Decision Making* ; Education ; Health Occupations ; Humans ; Terminally Ill*

PURPOSE: This is a retrospective study that investigated cancer patients' complaints of moderate or severe pain to analyze pain characteristics, pain relief interventions and their effects. METHODS: This is a retrospective study that investigated cancer patients' complaints of moderate or severe pain to analyze pain characteristics, pain relief interventions and their effects. RESULTS: The most frequent region of pain was the abdomen. The most frequent factor that exacerbated pain was movement. The most frequent pain alleviating factor was administration of analgesics. The most frequent pain type was breakthrough pain, and the most frequent non-pharmaceutical intervention for pain control was heat therapy. Among all, analgesics were routinely prescribed for 52.2% of the participants. Morphine sulfate was the most frequently used analgesic while Gabapentin was the most frequently used non-narcotic analgesic. At the time of discharge, 82.5% of the participants marked their pain intensity as 3 points or lower. CONCLUSION: For cancer patients complaining of moderate or severe pain, it is important to actively control pain from the beginning of admission. Thus, it is necessary to educate not only cancer patients using narcotic analgesic for pain control and their families but nurses about the effects and side-effects of drugs. Moreover, patients and their families need to learn how to assess and record pain at home to collect data that can be referred for future treatment.
Abdomen ; Analgesics ; Breakthrough Pain ; Hot Temperature ; Humans ; Morphine ; Pain Management ; Retrospective Studies

PURPOSE: This preliminary study is aimed at developing standardized tools for psycho-social assessment of patients in needs for hospice/palliative care. To accomplish the purpose, investigators examined effects of perceptions of social workers on the importance of psycho-social domains of assessment in hospice/palliative care settings. Moreover, investigators paid attention to variances of perceptions of social workers' along with types of institution and credentials of those family settings. METHODS: A form of questionnaire was first explored from an initial interview assessment of 10 government-certified hospice care providers and a literature review, second constructed with eight domains and 80 items, and sent by e-mail to 55 institutions and hospitals providing hospice/palliative cares in Korea. Lastly, a total of 31 agencies returned with a completed responses and consent form (56% response rate). SPSS program (version 18.0) was used for data analysis. RESULTS: Study found that social workers perceived patients' family background (m=4.53, 5-point scale) as the most important assessment domain, whereas economic conditions (4.06 point) the least important. Social workers' perception varied by credentials (i.e., license types, training, full-time position, types of care facility). CONCLUSION: Based upon study findings, investigators can conclude strong needs for developing a assessment tool that measures multiple domains (i.e., psychological, social and ecological aspects) of patients. A standardized assessment tool should be structured with 2 axis (center/core and expanded/peripheral) and tailored for institution type. Second, professional trainings must be provided by strengthening legal institutionalization and fostering qualified social workers with full responsibilities of hospice and palliative care patients.
Axis, Cervical Vertebra ; Consent Forms ; Electronic Mail ; Foster Home Care ; Hospice Care ; Hospices* ; Humans ; Institutionalization ; Korea ; Licensure ; Palliative Care* ; Psychology ; Research Personnel ; Self-Assessment ; Social Workers* ; Statistics as Topic ; Surveys and Questionnaires

PURPOSE: This study was conducted to explore the nursing needs and satisfaction of patients who are hospitalized at hospice palliative care institutions. METHODS: This study included 80 hospice patients who were in-patients of the hospice department of two general hospitals in S city. The collected data were analyzed by descriptive statistics, t-test, one-way ANOVA, and Pearson's correlation coefficients using the IBM SPSS 20.0 program. RESULTS: The mean score of nursing needs and satisfaction were 3.58 (+/-0.31) and 3.25 (+/-0.20) respectively. Significant differences in hospice nursing needs and satisfaction were observed in terms of general characteristics including gender, education level, occupation, religion, support for medical expense and functional status. Significant positive correlation was found between the overall nursing needs and nursing satisfaction. CONCLUSION: Based on the results of this study, in order to improve the quality of hospice service, further study is necessary in a comprehensive manner to develop nursing intervention to meet physical, psychological/social, spiritual, and educational/referral nursing needs of hospice in-patients.
Education ; Hospice and Palliative Care Nursing ; Hospices* ; Hospitals, General ; Humans ; Needs Assessment ; Nursing Care ; Nursing* ; Occupations ; Palliative Care ; Personal Satisfaction

PURPOSE: Serum vitamin C is one of the indicators for antioxidant levels in the body and it is lower in cancer patients compared with the healthy population. However, there have been few studies on the levels of serum vitamin C in terminally ill cancer patients and related factors. METHODS: We followed 65 terminal cancer patients who were hospitalized in two palliative care units. We collected data of age, sex, cancer type, functional status, clinical symptoms, history of cancer therapy, and various laboratory findings including serum vitamin C level. Patients were categorized into two groups according to the quartile of serum vitamin C level (Q1-3 vs. Q4), which were compared each other. Stepwise multiple logistic regression analysis was used to identify factors related to serum vitamin C levels. RESULTS: The mean serum vitamin C level was 0.44 microg/mL, and all patients fell into the category of vitamin C deficiency. Univariate analysis showed that The serum vitamin C level was lower in non-lung cancer patients (P=0.041) and febrile patients (P=0.034). Multivariate analysis adjusted for potential confounders such as lung cancer, fever, dysphagia, dyspnea, C reactive protein, and history of chemotherapy demonstrated that odds for low serum vitamin C level was 3.7 for patients receiving chemotherapy (P=0.046) and 7.22 for febrile patients (P=0.02). CONCLUSION: Vitamin C deficiency was very severe in terminally ill cancer patients, and it was associated with history of chemotherapy and fever.
Ascorbic Acid Deficiency ; Ascorbic Acid* ; C-Reactive Protein ; Deglutition Disorders ; Drug Therapy ; Dyspnea ; Factor Analysis, Statistical ; Fever ; Humans ; Logistic Models ; Lung Neoplasms ; Multivariate Analysis ; Palliative Care ; Terminal Care ; Terminally Ill*