PURPOSE: This study was done to identify differences in awareness and ethical attitudes associated with Do-Not-Resuscitate (DNR) and decision about advance directives among the general populations. METHODS: Participants were 193 ordinary people from 2 provinces and data were collected from December 23, 2013 to January 30, 2014. Structured questionnaires included awareness measuring tool and ethical attitudes measuring tool. Data were analyzed with descriptive analysis using descriptive statistics, t-test, and chi2-test with SPSS/WIN 18.0 program. RESULTS: Most of the participants responded that they agreed on the necessity of DNR and needed to do it by guidelines, while 47.2% responded that patients and their families should make a decision about the DNR. After the decision about DNR, they also agreed that efforts should be made to give the best treatment even if a DNR decision had been made by the patient. In general, there was a significant difference in advance directives for CPR depending on gender and living with family or not. CONCLUSION: For a professional and systematic approach to the problem, DNR guidelines sufficient to elicit social consensus are needed.
Advance Directives* ; Cardiopulmonary Resuscitation ; Consensus ; Humans ; Surveys and Questionnaires ; Resuscitation Orders

PURPOSE: The purpose of this study was to analyze and clarify the ambiguous concept of DNR, and to distinguish between DNR and euthanasia. METHOD: This study used the process of Walker & Avant's concept analysis. RESULT: The definable attributes of DNR were care for comfort, no further treatment and no CPR. The antecedents of DNR were the autonomy of patients and families feelings about death, the uselessness of treatment and the right to die with dignity. The process of the DNR decision should be documented and the antecedents of DNR also can be a basis for objective standards of DNR decision-making. The result of DNR was the acceptance of death by patients and families. CONCLUSION: DNR is decided and documented by the antecedents of DNR, and the result is a natural acceptance of death, the last process of human life. Hospice care should be activated and nurses must be patient's advocates and families' supporters in the process.
*Attitude to Death ; Decision Making ; Family ; Hospice Care ; Humans ; *Resuscitation Orders

PURPOSE: Arguments are continuously raised with regard to life support therapy performed on dying patients who cannot be recovered through treatment. Therefore, this study surveyed doctors and nurses working in emergency departments in order to investigate their awareness on DNAR (Do-Not-Attempt-Resuscitate) and the changes in patient management provided after DNAR. METHODS: We conducted a survey of health care provider's cognition regarding DNAR in six emergency departments. RESULTS: A total of 54 doctors and 148 nurses participated in the survey; 75.7% of participants indicated that patient management was changed after DNAR. No difference in answers with regard to what should be maintained after DNAR was observed between doctors and nurses. However, in answers for what is maintained in practice, differences were observed for the following items: 'vital sign check' (87% vs. 97.3%, p=0.004), 'input/output control' (75.9% vs. 91.2%, p=0.004), 'vasopressor' (33.3% vs. 57.4%, p=0.002), and 'antibiotics or blood products' (53.7% vs. 74.3%, p=0.005). CONCLUSION: Both doctors and nurses thought that patient management was changed after DNAR. However, differences in some opinions were observed between the two groups. In order to overcome such differences, it is important for health care providers to carry out more discussions in relation to DNAR and to develop appropriate guidelines for Korean society.
Cognition ; Delivery of Health Care ; Emergencies ; Health Personnel ; Humans ; Resuscitation Orders

PURPOSE: The purpose of this study was to identify a research trend of studies related to the Do-Not-Resuscitate (DNR) decision making process in Korea. METHODS: Assessing through five computerized databases, 889 studies were reviewed and of these 32 were included. An integrative literature review and text network analysis were applied to examine the research. The keywords from each article's abstracts were extracted by using a program, KrKwic. RESULTS: The number of studies on DNR decision has been increasing, especially since 2011. A descriptive study design (59%) was most commonly used in the research. In relation to factors affecting DNR decision, 97% of the studies stated patient factors and 66% stated family factors. 'Patient', 'DNR', 'decision', 'treatment', 'life', 'family' were the major keywords, and 'patient' and 'care' were dominant keywords that ranked high in coappearance frequency. CONCLUSION: Studies related to DNR decision have been increasing, and themes of the studies have also been broader. Further research is required to investigate factors affecting DNR decision in specific populations such as cancer patients, the elderly, patients with end-stage of chronic diseases etc. Moreover, a comparative study is necessary to define differences of research trends related to DNR decision making process between Korea and other countries.
Aged ; Chronic Disease ; Decision Making ; Humans ; Korea ; Resuscitation Orders

PURPOSE: The purpose of this study was to explore the experiences of bereavement for main family members who had made and followed DNR decision for their family members. METHOD: This qualitative study was based on a grounded theory, and used in-depth interview techniques with the bereaved 10 main family members who had been treated and died under DNR order. RESULTS: The causal condition of the family member was 'Releasing', and the main consequent phenomenon were 'Blaming self and ruminating'. The contextual condition was 'The memory of the deceased'. The action/reaction strategy was 'Purifying'. The intervening condition was 'Supporting system', and the consequence was 'Acceptance'. The experience after bereavement of the family member on DNR decision were rational processes that purified themselves and healed the guilt feeling about the decision from reflective assessment and response about DNR decision. Based on this results, the substantive theory 'Reflective self healing' was derived. CONCLUSION: The main family members in following DNR decision are more likely to have unhealthy emotional condition than others in normal bereavement process. But they overcame the grief of bereavement through reflective self healing process.
Bereavement ; Grief ; Guilt ; Humans ; Memory ; Qualitative Research ; Resuscitation Orders

PURPOSE: We explored the relationship between the use of each medical intervention and the length of time between do-not-resuscitate (DNR) consent and death in Korea. MATERIALS AND METHODS: A total of 295 terminal cancer patients participated in this retrospective study. Invasive interventions (e.g., cardiopulmonary resuscitation, intubation, and hemodialysis), less invasive interventions (e.g., transfusion, antibiotic use, inotropic use, and laboratory tests), and the time interval between the DNR order and death were evaluated. The subjects were divided into three groups based on the amount of time between DNR consent and death (G1, time interval ≤ 1 day; G2, time interval > 1 day to ≤ 3 days; and G3, time interval > 3 days). RESULTS: In general, there were fewer transfusions and laboratory tests near death. Invasive interventions tended to be implemented only in the G1 group. There was also less inotrope use and fewer laboratory tests in the G3 group than G1 and G2. Moreover, the G3 group received fewer less invasive interventions than those in G1 (odds ratio [OR], 0.16; 95% confidence interval [CI], 0.03 to 0.84; 3 days before death, and OR, 0.16; 95% CI, 0.04 to 0.59; the day before death). The frequency of less invasive interventions both 1 and 3 days before death was significantly lower for the G3 group than the G1 (p ≤ 0.001) and G2 group compared to G1 (p=0.001). CONCLUSION: Earlier attainment of DNR permission was associated with reduced use of medical intervention. Thus, physicians should discuss death with terminal cancer patients at the earliest practical time to prevent unnecessary and uncomfortable procedures and reduce health care costs.
Cardiopulmonary Resuscitation ; Health Care Costs ; Humans ; Intubation ; Korea* ; Resuscitation Orders ; Retrospective Studies ; Terminal Care

BACKGROUND: A questionnaire for the primary caregivers of critically ill elderly patients on Do-Not-Resuscitate(DNR) status was developed. METHODS: The survey was administered to 132 primary caregivers of critically ill elderly patients in a veteran's hospital in Busan. RESULTS: The age range of the primary caregivers was 51-60 years. Of the primary caregivers, 58.3% of them were the patient's wife, 62.1% didn't have job, and 50.8% were not aware of the DNR status. Of the primary caregivers, 56.8% did not think about the patient's DNR, but if they heard about DNR from a physician, 68.9% of them could accept it. The most important reason for a DNR is pain relief of the dying patient. According to 72.7% of respondents, the patient should be asked about the DNR, but input from the family and physician should be included. Further, 68.2% of the respondents will consider a DNR for themselves in the future because they don't support meaningless life. The respondents were more inclined to think about DNR status, accept DNR status, and consider DNR status for themselves when they learned about the DNR from the physician and the patient is asked about the DNR. CONCLUSION: Primary caregivers are often required to think about DNR status. The findings of this study can be the basis for making objective standards concerning DNR status.
Aged ; Cardiopulmonary Resuscitation ; Caregivers ; Critical Illness ; Surveys and Questionnaires ; Humans ; Intensive Care Units ; Resuscitation Orders ; Spouses

It is not the best way to treat a hopeless patient with life-sustaining medical devices until the heart beats stop. Advanced medical technology may prolong the life for a significant period without recovery from the disease. However, it would give an unbearable economic burden to the family and the society. In 2006, we decided not to operate 9 patients with traumatic intracranial hematomas. We examined those patients with special references to possible legal and ethical problems. It is reasonable to withhold a treatment after documentation that the family never wants any life sustaining treatment when the treatment does not guarantee the meaningful life.
Craniocerebral Trauma* ; Decision Making ; Head* ; Heart ; Humans ; Intracranial Hemorrhage, Traumatic ; Medical Futility ; Resuscitation Orders ; Withholding Treatment

PURPOSE: The purpose of this study was to examine nurses' emotional responses and ethical attitudes towards elderly patients' Do-Not-Resuscitate (DNR) decision. METHODS: Data were collected using a questionnaire which was filled out by 153 nurses who worked in nursing homes and general hospitals. Data were analyzed using real numbers, percentages, means, standard deviations and Pearson's correlation coefficients with SPSS 19.0 program. RESULTS: The average score for ethical attitudes towards the DNR decision was 2.68 out of 4. Under the ethical attitudes category, the highest score was found with a statement that said 'Although they will not perform cardiopulmonary resuscitate (CPR), it is right to do their best with other treatments for DNR Patients'. Items regarding emotional responses to the DNR decision, the average score was 2.36 out of 4. Among them, the highest score was achieved on 'I understand and sympathize'. No significant correlation was found between ethical attitudes and emotional responses in relation to patients' DNR decision (r=-0.12, P=0.13). CONCLUSION: Regarding elderly patients' DNR decision, nurses showed somewhat highly ethical attitudes and slightly positive emotional response. A follow-up study is needed to investigate variables that affect our results.
Aged* ; Ethics ; Hospitals, General ; Humans ; Nursing Homes ; Resuscitation Orders ; Surveys and Questionnaires

PURPOSE: Although a Do-Not-Resuscitate (DNR) order is widely in use, it is one of the challenging issues in end-of-life care. This study was conducted to investigate attitudes toward DNR according to education and clinical experience. METHODS: Data were collected using a structured questionnaire comprising 30 items in a tertiary hospital in Seoul, Korea. RESULTS: Participants were 238 nurses and 72 physicians. Most participants (99%) agreed to the necessity of DNR for reasons such as dignified death (52%), irreversible medical condition (23%) and patients' autonomy in decision making (19%). Among all, 33% participants had received education about DNR and 87% had DNR experience. According to participants' clinical DNR experience, their attitudes toward DNR significantly differed in terms of the necessity of DNR, timing of the DNR consent and post-DNR treatments including antibiotics. However, when participants were grouped by the level of DNR education, no significant difference was observed except in the timing of the DNR consent. CONCLUSION: This study suggests that the attitudes toward DNR were more affected by clinical experience of DNR rather than education. Therefore, DNR education programs should involve clinical settings.
Anti-Bacterial Agents ; Decision Making ; Education* ; Korea ; Professional Practice ; Resuscitation Orders ; Seoul ; Tertiary Care Centers