PURPOSE: The purpose of this paper is to identify a theoretical basis of end-of-life care by examining attributes of the concept of the nurses' acceptance of patient deaths. METHODS: Walker and Avant's approach to concept analysis was used. A literature study was performed to check the usage of the concept. To identify the attributes of the concept and come up with an operational definition, we analyzed 16 qualitative studies on nurses' experiences of death of patients, published in a national science magazine from 1999 to 2015. RESULTS: The nurses' acceptance of death of patients was identified as having four attributes: acceptance through mourning, attaining insight on life and death while ruminating life, facing with fortitude and practicing human dignity. Antecedents of the concept were experiences of patient's death, confusion and conflict, negative emotions, passive responses, denial of patients' death. The consequences of the concept were found as the holistic end-of-life care and active pursuit of life. CONCLUSION: This study on the attributes of the concept of the nurses' acceptance of death of patients and it's operational definition will likely lay the foundation for applicable end-of-life care mediations and theoretical development.
Denial (Psychology) ; Grief ; Humans ; Periodicals as Topic ; Personhood ; Walkers

The practice of medicine today is beset with unprecedented challenges which include public distrust in medical profession, increasing market force and strengthened management. Recently medical professional societies in UK & USA are overcoming these challenges in the way that medical professionalism is modernized in a changing society. They set 'a physician charter' and new definition of medical professionalism as a partnership. The principles of new medical professionalism are patient welfare, patient autonomy and social justice. It describes doctors' commitment to integrity, compassion, altruism, continuous improvement, excellence, working in partnership, just distribution of finite resources, maintaining trust by managing conflicts of interest and others. New professionalism support improvement of health care system for the welfare of society and the collective human dignity. Experience of rebuilding medical professionalism in UK and USA will give a lesson to Korean medical profession when they seek for solution to restore public confidence and take the leadership in Korean healthcare system.
Altruism ; Delivery of Health Care ; Empathy ; Humans ; Leadership ; Personhood ; Social Justice

PURPOSE: The purposes of this study was to find aesthetical-ethical paradigm of care ethics by understanding the unique moral character of care as an art and to suggest the optimal direction of nursing ethics. METHOD: This study used meaning-heuristic and -interpretive methods of hermeneutics based on philosophical aesthetic theory; Baumgarten's aesthetics, Schiller's theory of aesthetical education and Kant's theory of aesthetical judgement. RESULT: The concept of care implied aesthetical and ethical character; caring as an art was related to moral feeling based on human dignity und emotional communication in interpersonal-relationship. Caring as an art was interpreted as a moral ideal for the promotion of the humanity und the interaction in personal-relationship according to nursing theories. Philosophical aesthetics could provide the theoretical base for the interpretation of caring as an art. The proper paradigm of care ethics in nursing could be found in character-trait ethics and communication ethics according to the philosophical aesthetics. CONCLUSION: This study could show aesthetical-ethical paradigm of care ethics in nursing by the heuristic interpretation of caring as an art according to the philosophical aesthetics.
Education ; Esthetics ; Ethics* ; Ethics, Nursing ; Humans ; Nursing Theory ; Nursing* ; Personhood

PURPOSE: The concept of respect is rooted in the core value of human relations, and interpersonal relationships with others. The notion of respect in these relationships is entrenched in the broader context of the processes of relationships between professionals and clients in general, along with the philosophical and ethical foundations of respect. Although nursing principles and values, such as autonomy and dignity have built their foundation of care on the concept of respect, these concepts (ie. autonomy and dignity) are still different from respect. Respect within health professional-client relationships, indicates that respect is a fundamental concept within nursing, permeating a number of other concepts that provide purposeful nursing care within the process of nurse-client relationships and respect has been discussed as an ethical and moral concept of care that addresses the values of human dignity in the nursing discipline, however research examining the client's perspectives of respect as an ethical principle of care, especially within Canada's diverse population is non-existent. There is limited research from the client's perspective addressing challenges communicating the concept of respect in relationships between health professionals and clients, specifically research directed at immigrant or the vulnerable population.
Delivery of Health Care ; Emigrants and Immigrants ; Ethnic Groups ; Foundations ; Health Occupations ; Humans ; Nursing Care ; Personhood ; Vulnerable Populations

Despite a recent increased nation's attention given to improving end-life care, we professionals need to be more critical and reflective on our realities surrounding hospice palliative care. The aim of this paper is to suggest that palliative care models can be used for patients/families in the last phase of life and examine whether they are appropriate for caring them in congruence with philosophy of hospice. The hospice experience model (HEM) of Eagan & Labyak and the developmental model of Byock are introduced and examined for their congruence with philosophy of hospice in applying to clinical practice. The HEM as a patient/family value-directed end of life care model emphasizes three principles; unique experience of patient/family, interactions/relationships among multiple dimensions of personhood and between family, and personal growth and development in the face of suffering through a life-completion. The developmental model stipulates dying as the last stage of living, a stage of life cycle in which patients/family may have growth through life-completion in multidimensional relationships of personhood. The model includes the developmental landmarks and tasks for life-completion as the framework to guide a means of professionals' to recognize their opportunity to grow. The landmarks and tasks include worldly and social affair, individual relationships, intrapersonal, and transcendent dimension. The models could work as appropriate palliative care models for patients/families in the last stage of living. The professionals need to be encouraged to apply the models to end of life care setting.
Growth and Development ; Hospices ; Humans ; Life Cycle Stages ; Palliative Care ; Personhood ; Philosophy ; Stress, Psychological ; Terminal Care

PURPOSE: This study was done to discover the structure of the lived experiences of unresolved suffering of college students and to gather information to develop therapeutic educational interventions for nursing students. METHODS: The research question, 'What is the structure of the lived experience of unresolved suffering?' was examined based on Parse's Human becoming research method. Twelve nursing students were recruited from K University. From May, 1 to June 30, 2009, Data were gathered from writings and engagement in dialog. RESULTS: The structure found in the college students' lived experiences of suffering was as follows: negative self-concept from being discriminated and ignored by parents, feelings against people and difficulties in interpersonal relations, feelings of isolation, betrayal, guilt, and loss. Their suffering was emotional grief and social withdrawal from damaged human dignity and low self-esteem from psychological trauma. Conceptual integration found to be in process of transferring the enabling-limiting, connecting-separating values. CONCLUSION: It is necessary to develop therapeutic educational interventions for college students for further development as individuals and future health professional by developing awareness of the structure and the meaning of their suffering experience.
Grief ; Guilt ; Health Occupations ; Humans ; Interpersonal Relations ; Parents ; Personhood ; Students, Nursing

PURPOSE: Dignity therapy is a very effective intervention to improve the dignity of end-stage patients. A concept analysis by Walker and Avant (2005) was adopted to define, describe, and delimitate the concept of dignity therapy. METHODS: Nursing literature in the National Digital Science Links (NDSL) and Medline database were searched for the definitions of "dignity" and "dignity therapy". Definitions, uses, and defining attributes of dignity therapy were identified; model and contrary cases were developed; and antecedents, consequences, and empirical references were determined. RESULTS: Through dignity therapy patients and their families share their stories, and that in turn improves the quality of life and death. Five attributes were identified: higher quality of life and death, therapeutic conversation, respect of human dignity and worth, expressing thoughts about life and death and systematic process. CONCLUSION: Patients at the end of their lives feel more comfortable about death. Hospice care providers should try to protect dignity of patients in their care. The attributes of the dignity therapy clarified in this study should be applied for terminally ill patients to improve their quality of life and death.
Hospice Care ; Hospices ; Humans ; Nursing ; Personhood ; Quality of Life ; Terminally Ill ; Walkers

PURPOSE: The importance of human dignity in care is well-recognized. Care recipients' experiences with undignified care have been reported in many countries. However, few studies have measured these situations quantitatively, especially as there are no tools applicable to inpatients receiving ordinary daily care. This study aimed to develop a valid and reliable Inpatient Dignity Scale (IPDS) that can measure inpatients' expectations of and satisfaction with dignity in daily care. METHODS: We conducted a three-phase research project: item generation and a preliminary survey with 47 items related to patients' dignity in Japan, a main survey with 36 items with deliberate translation into English in Singapore, and a confirmatory survey with 35 items in England, with 442, 430, and 500 inpatients as participants in questionnaire surveys, respectively. Data from each survey were processed using factor analysis. RESULTS: Authors obtained a scale with a four-factor structure with acceptable reliability: (F1) respect as a human being, (F2) respect for personal feelings and time, (F3) respect for privacy, and (F4) respect for autonomy. CONCLUSION: The Inpatient Dignity Scale can be periodically used by hospital administrators or nurses to preserve inpatients' dignity in daily care by monitoring inpatients' views regarding their expectations of and satisfaction with dignity.
England ; Great Britain ; Hospital Administrators ; Humans ; Inpatients ; Japan ; Nursing ; Personhood ; Privacy ; Psychometrics ; Singapore

INTRODUCTIONUnderstanding personhood or "what makes you, you" is pivotal to the provision of person-centred care. Yet the manner that personhood is conceived amongst patients varies significantly. This study aims to investigate conceptions of personhood in a multiracial, multicultural, multireligious setting.

MATERIALS AND METHODSA mixed-methods study was conducted at National Cancer Centre Singapore, from January 2013 to April 2013. We used a validated questionnaire where English-speaking oncology patients rated the importance of 26 features of "personhood" on a 10-point Likert scale from 0 to 9, with 9-points being extremely important. This was followed by a semi-structured interview. Analysis of transcripts using the Grounded Theory revealed original data that inspired novel ideas about the nature of personhood, which precipitated a further study in April 2014.

RESULTSOur initial study of 100 patients revealed that personhood is conceived in a unique and novel manner. To study this, we interviewed a further 40 patients using a supplemental question to our original questionnaire. Our data affirmed our initial findings and evidenced a change in conceptions of personhood.

CONCLUSIONOur evidence supports the Ring Theory of Personhood, which suggests that personhood is defined by innate, individual, relational, societal elements. It also evidences that personhood is temporally and contextually sensitive allowing for better appreciation of the evolving goals of care that frequently occur at end-of- life. Most importantly, this study reminds healthcare professionals on the importance of "treating persons" and looking beyond familial interests in maintaining the interests and dignity of the patient.

Cultural Diversity ; Humans ; Interviews as Topic ; Language ; Neoplasms ; psychology ; therapy ; Palliative Care ; Patient-Centered Care ; Personhood ; Singapore ; Surveys and Questionnaires ; Terminal Care

Cancer is the most common cause of death in Korea. Therefore, the care of terminally ill cancer patients represents a major issue of Korean welfare. Because of lack of hospice and palliative care education and government support, most terminally ill cancer patients are not given proper care with due human dignity. The hospice and palliative care education include a change of physicians attitudes toward patients and their family members control of symptoms, such as pain, for a high quality of life, total care with a team approach, and home care. When the physicians' attitudes become changed, the patient and his or her family would feel that they still retain human dignity and experience the best quality of life with the help of team approach. For the symptom control in terminally ill cancer patients, control of pain is most important and is possible in 97% of patients with opioids. Also, the medical costs are highest in terminal stage of cancer and hospice may be a solution to reduce the cost. The hospice insurance for the terminally ill cancer patients is covered by government in many oriental countries, such as Japan, Hongkong, Singapore, and Taiwan, because it can reduce medical costs and improve the welfare of patients. The joint committee of Korean Society of Hospice·Palliative care, Korean Hospice Care, and Catholic Hospice Care have been asking for the national hospice insurance to the Korean government since 1988, to no effect. In conclusion, the hospice and palliative care should be supported by government as well as medical field.
Analgesics, Opioid ; Cause of Death ; Education ; Home Care Services ; Hong Kong ; Hospice Care ; Hospices ; Humans ; Insurance ; Japan ; Joints ; Korea ; Palliative Care ; Personhood ; Quality of Life ; Singapore ; Taiwan ; Terminally Ill