Nurses’ Perceived Needs and Barriers Regarding Pediatric Palliative Care: A Mixed-Methods Study / 한국호스피스완화의료학회지

Purpose@#This study aimed to describe nurses’ perceived needs and barriers to pediatric palliative care (PPC). @*Methods@#Mixed methods with an embedded design were applied. An online survey was conducted for nurses who participated in the End-of-Life Nursing Education Consortium- Pediatric Palliative Care (ELNEC-PPC) train-the-trainer program, of whom 63 responded. Quantitative data were collected with a survey questionnaire developed through the Delphi method. The 47 items for needs and 15 items for barriers to PPC were analyzed with descriptive statistics. Qualitative data were collected through openended questions and analyzed with topic modeling techniques. @*Results@#The mean scores of most subdomains of the PPC needs were 3.5 or higher out of 4, and those of PPC barriers ranged from 3.22 to 3.56, indicating the items in the questionnaire developed in this study properly reflect each factor. The needs for PPC were divided into 4 categories: “children and adolescents,” “families,” “PPC management system,” and “community-based PPC.” Meanwhile, PPC barriers were divided into 3 categories: “healthcare delivery system,” “healthcare provider,” and “client.” The keywords derived from the topic modeling were perception, palliative, children, and education for necessities and lack, perception, medical care, professional care providers, service, and system for barriers to PPC. @*Conclusion@#In this study, by using mixed-methods, items of nurses’ perceived needs and barriers to PPC were identified, categorized, and weighted, and their meanings were explored. For the stable establishment of PPC, the priority should be given to improving perceptions of PPC, establishing an appropriate system, and training professional care providers.

Development of a Korean version of the Bereavement Care Confidence Scale (K-BCCS) / 한국간호교육학회지

Purpose@#The purpose of this study is to evaluate the validity and reliability of the Korean Bereavement Care Confidence Scale (K-BCCS). @*Methods@#The Perinatal Bereavement Care Confidence Scale (PBCCS) was translated into Korean according to an algorithm of cultural adaptation process and excluded six items which were specific to perinatal bereavement. A total of 229 clinical nurses participated in the study. Construct validity, convergent validity, discriminant validity, and group comparison validity were evaluated, and Cronbach’s α was calculated to estimate the reliability of the K-BCCS. @*Results@#The K-BCCS consisted of 31 items in 7 factors, including knowledge and skills for bereavement care (12 items), organizational support (6 items), awareness of the needs (3 items), interpersonal skills (3 items), workload influence (2 items), continuous education (2 items), and understanding the grief process (3 items). The factor loading of 31 items within the 7 factors ranged from .60 to .86. For the convergent validity, the construct reliability (CR) ranged from .74 to .94, and the average variance extracted (AVE) ranged from .49 to .73, which is considered acceptable. The discriminant validity showed that the AVEs of the subscales were greater than the square of the correlation coefficient r. The nurses who had experience providing bereavement care (t=4.94, p<.001) or had received bereavement education (t=6.64, p<.001) showed higher K-BCCS values those without experience. The Cronbach’s α of 31 items was .93 and ranged from .60 to .94 per subscale. @*Conclusion@#The K-BCCS is a valid and reliable tool for evaluating nurses' confidence in bereavement care.

Current Status of Complementary Therapies Provided by Hospice Palliative Care in South Korea / 한국호스피스완화의료학회지

Purpose@#The aim of this study was to investigatecomplementary therapiesprovided at hospice palliative care facilities in South Koreaas designated by the Ministry of Health and Welfare. @*Methods@#The survey was conducted via e-mail from September 2 to September 23, 2020, with responsesfrom 109 therapists and 59 managers from 55 different hospice care facilities. @*Results@#Hospices provided an average of 3.67 different types of therapies, ranging from 1 to 7 different types. The most common types of therapies were horticultural therapy (81.4%), music therapy (79.7%), art therapy (76.3%), and aromatherapy (57.6%).The average frequency of sessions was once a week, the median duration was 60 minutes.Most therapists (96.3%) had qualifications, but the certification-issuing organizations and training intensiveness varied greatly. None of the therapists were employed on a full-time basis, and their average monthly income was KRW 270,000. Therapists and managers gave average scores of 8.90 and 8.38 out of 10, respectively, regarding the positive impact of complementary therapies on patients. @*Conclusion@#In order for patients and their families to benefit from complementary therapiesat hospice care facilities, in addition tobetter terms of employment for therapists, evidence-based guidelines for different types of therapies are needed so that therapy sessions can be conducted according to the theoretical underpinnings and characteristics of the type of therapy. It is expected that the results of this study will be used for policy-making in support of therapy as an essential hospice service.

Development of a Korean version of the Bereavement Care Confidence Scale (K-BCCS) / 한국간호교육학회지

Purpose@#The purpose of this study is to evaluate the validity and reliability of the Korean Bereavement Care Confidence Scale (K-BCCS). @*Methods@#The Perinatal Bereavement Care Confidence Scale (PBCCS) was translated into Korean according to an algorithm of cultural adaptation process and excluded six items which were specific to perinatal bereavement. A total of 229 clinical nurses participated in the study. Construct validity, convergent validity, discriminant validity, and group comparison validity were evaluated, and Cronbach’s α was calculated to estimate the reliability of the K-BCCS. @*Results@#The K-BCCS consisted of 31 items in 7 factors, including knowledge and skills for bereavement care (12 items), organizational support (6 items), awareness of the needs (3 items), interpersonal skills (3 items), workload influence (2 items), continuous education (2 items), and understanding the grief process (3 items). The factor loading of 31 items within the 7 factors ranged from .60 to .86. For the convergent validity, the construct reliability (CR) ranged from .74 to .94, and the average variance extracted (AVE) ranged from .49 to .73, which is considered acceptable. The discriminant validity showed that the AVEs of the subscales were greater than the square of the correlation coefficient r. The nurses who had experience providing bereavement care (t=4.94, p<.001) or had received bereavement education (t=6.64, p<.001) showed higher K-BCCS values those without experience. The Cronbach’s α of 31 items was .93 and ranged from .60 to .94 per subscale. @*Conclusion@#The K-BCCS is a valid and reliable tool for evaluating nurses' confidence in bereavement care.

Effects of Handoff Education using Concept Mapping and PASS-BAR / 기본간호학회지

Purpose@#The purpose of this study was to identify effects of Handoff Education using Concept mapping and PASS-BAR (HECPAR) on clinical reasoning competence, self-efficacy for handoff, and handoff performance of new nurses. @*Methods@#Participants were randomly allocated into an experimental group (n=20) and control group (n=21). The experimental group received HECPAR which consisted of a one hour lecture, case based clinical practicum, and mentoring for a week. The control group received the usual informal handoffs education from senior nurses. Clinical reasoning competence, self-efficacy for handoff, and handoff performance were measured before and a week after HECPAR. Data were analyzed using Mann-Whitney U test, independent t-test, Fisher’s exact test, and chi-sqaure test. Results: The experimental group showed significant improvement in clinical reasoning competence (z=-2.29, p=.022), handoff performance (z=-2.23, p=.026), and self-efficacy of handoff (t=3.47, p=.001) compared to the control group. @*Conclusion@#The results indicate that HECPAR is effective in improving clinical reasoning competence, self-efficacy for handoff, and handoff performance by new nurses. In addition, integrating concept mapping, PASS-BAR, and mentoring proved beneficial for handoff education for new nurses.

Education, Role, and Prospects of Advanced Practice Nurses in Hospice and Palliative Care in South Korea / 한국호스피스완화의료학회지

Hospice palliative care refers to holistic care provided by an interdisciplinary team aimed at improving the quality of life of patients suffering from life-threatening diseases and their families. Among interdisciplinary team members, hospice advanced practice nurses (APNs) trained as master’s-level advanced nursing professionals are leaders who play an important role in providing patient-centered care and improving the quality of services. The Medical Service Act revised in 2018 requires the scope of practice of APNs in each field to be specified in the Ordinance of the Ministry of Health and Welfare. Accordingly, discussions on the role and scope of practice of hospice APNs are actively underway. In this review, the curriculum of hospice APNs, their work responsibilities and roles, and their current status are reviewed, and the future direction of the hospice APN system is also discussed.

Current Status of Complementary Therapies Provided by Hospice Palliative Care in South Korea / 한국호스피스완화의료학회지

Purpose@#The aim of this study was to investigatecomplementary therapiesprovided at hospice palliative care facilities in South Koreaas designated by the Ministry of Health and Welfare. @*Methods@#The survey was conducted via e-mail from September 2 to September 23, 2020, with responsesfrom 109 therapists and 59 managers from 55 different hospice care facilities. @*Results@#Hospices provided an average of 3.67 different types of therapies, ranging from 1 to 7 different types. The most common types of therapies were horticultural therapy (81.4%), music therapy (79.7%), art therapy (76.3%), and aromatherapy (57.6%).The average frequency of sessions was once a week, the median duration was 60 minutes.Most therapists (96.3%) had qualifications, but the certification-issuing organizations and training intensiveness varied greatly. None of the therapists were employed on a full-time basis, and their average monthly income was KRW 270,000. Therapists and managers gave average scores of 8.90 and 8.38 out of 10, respectively, regarding the positive impact of complementary therapies on patients. @*Conclusion@#In order for patients and their families to benefit from complementary therapiesat hospice care facilities, in addition tobetter terms of employment for therapists, evidence-based guidelines for different types of therapies are needed so that therapy sessions can be conducted according to the theoretical underpinnings and characteristics of the type of therapy. It is expected that the results of this study will be used for policy-making in support of therapy as an essential hospice service.

Current Status of End-of-Life Care Education in Undergraduate Nursing Curriculum / 한국호스피스완화의료학회지

PURPOSE: The aim of this study was to analyze the current status of end-of-life (EoL) care education of the undergraduate nursing curriculum and senior students' EoL care experience and competency.METHODS: A survey was conducted with 41 nursing schools and 622 senior nursing students on June 2018. The questionnaire consisted of 38 items on teaching regarding EoL care and 17 items on EoL care competencies based on the suggestions made by the American Nurses Association.RESULTS: Only 20% among 41 nursing schools opened an EoL care course as an elective, and the course was taken by 5.1% students. Of 622 students, 70.7% witnessed death of patients during their clinical training, but 74.8% received no or little education on EoL care from their clinical training instructors. Two of 38 education contents on EoL care were taught in class for over 80% of the students. All students scored below 3 points (2.31±0.66) for all 17 competencies, which means that they cannot perform EoL care.CONCLUSION: This study showed that there was a serious deficiency in undergraduate nursing education on EoL care. Accordingly, most nursing students who would graduate soon considered themselves incapable of performing EoL care. Nurses experience death and dying as a part of their practice and should be prepared to provide adequate EoL care. Therefore, it is urgent to improve EoL care training in the undergraduate nursing education.

Palliative Care Competencies Required of Undergraduate Nursing Students in Korea / 한국호스피스완화의료학회지

A resolution adopted by the World Health Assembly in 2014 stated that all nurses should be equipped with palliative care skills in order to integrate palliative care into a day-to-day healthcare system. This article introduces the palliative nursing competency that was developed for the Korean environment by the Korean Hospice Palliative Nursing Research Network based on its study of overseas cases where this competency and competency-based training were developed. This is the first step towards the development of competency-based palliative nursing education, and active efforts should be made to integrate this competency into the undergraduate nursing curriculum.

The Effects of the Hospice & Palliative Care Education Program for Caregivers / 한국호스피스완화의료학회지

PURPOSE: This study aimed to identify how an education program on palliative care affects nursing home caregivers' perception of hospice care and attitude towards terminally ill patient care. METHODS: This study was conducted using a nonequivalent control group with a pretest-posttest design. The participants were 101 certified care workers: 58 in the experimental group and 43 in the control. The experimental group completed the palliative care education program consisted of 20 hours of classroom training and 20 hours of clinical practicum. An ANCOVA was performed to compare the score changes to outcome variables. RESULTS: Compared with the control group, the experimental group showed significant pretest-posttest differences in both the perception of hospice care (F=21.09, P < 0.001) and attitude towards caring for terminally ill patients (F=13.28, P < 0.001). CONCLUSION: These results indicate that the palliative care education program for caregivers is effective in preparing participants to provide hospice/palliative care service. Further study is warranted to explore the effects of this program on palliative caregivers' performance.

Development of the Scope of Practice for Palliative Care Aides with Delphi Method / 한국호스피스완화의료학회지

PURPOSE: Given the emergence of a new profession called a palliative care aide, this study aims to develop the scope of its practice using the Delphi consensus method. METHODS: This study was participated by a panel of experts comprising 36 members who were involved in either hospice palliative care practice or making relevant policies. Through a four-step Delphi study, the feasibility of the duty, task and task element was examined. Among the results, items that scored over 4.0 out of 5.0 were selected. RESULTS: The analysis of the Delphi study suggested four job duties, 15 tasks and 46 task elements to be included in the practice scope for palliative care aides. CONCLUSION: This study defined the scope of practice for palliative care aides, which is expected to prevent any conflict or confusion regarding their job and to promote the quality of their service.

Pain Management Knowledge, Attitudes, and Performance of Nurses in Long-Term Care Hospitals / 한국호스피스완화의료학회지

PURPOSE: This study investigated long-term care hospital nurses' knowledge and practice of pain management and their attitudes towards the job with an ultimate aim to provide fundamental information for development of a pain education program. METHODS: A cross-sectional survey was carried out with 120 nurses from four long-term care hospitals. Nurses' knowledge of and attitudes towards pain management was measured using a tool developed by Watt-Watson. To examine their pain management practice, an instrument was developed based on the pain management guidelines used by the long-term care settings. RESULTS: For pain management knowledge, the participants gave an average of 26.2 (±13.10) correct answers out of 40 questions. The most frequently missed question was one about subjectivity of pain, “Patients' physiological and behavioral reactions to pain hint at the presence and intensity of pain” (89.2%), and 56.7% of the nurses believed that increasing tolerance for a narcotic analgesic means addiction. Regarding attitudes towards and practice of pain management, 80.2% of the nurses used placebos to patients who complain about pain often. CONCLUSION: This study revealed poor level of pain management knowledge of and attitude among long-term care hospital nurses. This might negatively affect their pain management practice. From the educational perspective, nurses should be provided with education on pain management education with emphasis on the nature of pain and misuse of placebo drugs.

Wheel of Wellness Counseling in Community Dwelling, Korean Elders: A Randomized, Controlled Trial

PURPOSE: The purpose of this study was to investigate the effects of Wheel of Wellness counseling on wellness lifestyle, depression, and health-related quality of life in community dwelling elderly people. METHODS: A parallel, randomized controlled, open label, trial was conducted. Ninety-three elderly people in a senior welfare center were randomly assigned to two groups: 1) A Wheel of Wellness counseling intervention group (n=49) and 2) a no-treatment control group (n=44). Wheel of Wellness counseling consisted of structured, individual counseling based on the Wheel of Wellness model and provided once a week for four weeks. Wellness lifestyle, depression, and health-related quality of life were assessed pre-and post-test in both groups. RESULTS: Data from 89 participants were analyzed. For participants in the experimental group, there was a significant improvement on all of the wellness-lifestyle subtasks except realistic beliefs. Perceived wellness and depression significantly improved after the in the experimental group (n=43) compared to the control group (n=46) from pre- to post-test in the areas of sense of control (p=.033), nutrition (p=.017), exercise (p=.039), self-care (p <.001), stress management (p=.017), work (p=.011), perceived wellness (p=.019), and depression (p=.031). One participant in the intervention group discontinued the intervention due to hospitalization and three in the control group discontinued the sessions. CONCLUSION: Wheel of Wellness counseling was beneficial in enhancing wellness for the community-dwelling elderly people. Research into long-term effects of the intervention and health outcomes is recommended.

Nurses' Knowledge of and Attitudes toward Pediatric Palliative Care of Korea / 한국호스피스완화의료학회지

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.

Development and Validation of the Hospice Palliative Care Performance Scale

PURPOSE: The purpose of this study was to develop and validate a hospice / palliative care performance measure which would cover more than just physical symptoms or quality of life. METHODS: Through an intensive literature review, the author chose questions that measured aspects of physical, emotional, spiritual, social, or practical domains pertinent to hospice / palliative care for inclusion in the scale. Content validation of the questions was established by 15 hospice / palliative care professionals. A preliminary Hospice Palliative Care Performance Scale (HPCPS) of 20 questions was administered to 134 pairs of terminal cancer patients from 5 hospice palliative care units and their main family caregiver. A validation study was conducted to evaluate construct validity and internal consistency. RESULTS: Factor analysis showed 14 significant questions in five subscales; Physical, Emotional, Spiritual, Social, and Patient' rights. There were no significant differences between the ratings by patients and family members except for three out of the 14 questions. The measure demonstrated construct validity, and Cronbach's alpha of the subscales ranged from .73 to .79. CONCLUSION: The HPCOS demonstrated acceptable validity and reliability. It can be used to assess effectiveness of hospice / palliative care for terminal cancer patients in practice and research.

Evaluation of a Community-Based Cancer Patient Management Program: Collaboration between a Hospice Center and Public Health Centers / 한국호스피스완화의료학회지

PURPOSE: The purpose of this study was to evaluate a community-based cancer patient management program (CBPCMP) which was collaborated between a hospice center and public health centers. METHODS: The CBPCMP proceeded on four steps; 1) Signing agreements with three public health centers, 2) Enrolling the domiciliary terminal cancer patients, 3) Providing home hospice service, and 4) Inquiring patient's level of satisfaction. From February 1 to December 31 in 2009, 43 terminal cancer patients were referred and provided with home hospice service. The hospice team made a total of 605 visits. Medical records for each visit and data from satisfaction surveys were analyzed. RESULTS: 76.7% of patients were older than 60 years, and 90.7% of the patients were alert. The level of functional status for 76.7% of patients rated as lower than ECOG grade 1. 62.8% of the patients or their caregivers signed hospice service agreements. On the initial evaluation, the most frequent reasons for referral were general weakness (86.0%), followed by anorexia (72.1%). Nurses visited the patients' most frequently (371 visits), followed by volunteers (216 visits). Nurses provided emotional support and health promotion counseling on 95.1% and 22.9% of visits, respectively. The mean satisfaction score rated by patients and their family was 4.45 out of 5. CONCLUSION: This study tested CBPCMP in collaboration with hospice centers and public health centers. CBPCMP showed a possibility to improve the quality of end of life care. To insure the quality care, however, the guidelines for home hospice service should be developed.

Depression and Quality of Life among Family Caregivers of Patients with Parkinson's Disease in South Korea / 재활간호학회지

ression and quality of life of family caregivers of patients with Parkinson's disease(PD). METHODS: A cross-sectional descriptive study was conducted in one neurology outpatient clinic in Seoul, Korea from March to June, 2006. Sixty eight family caregivers of PD patients were participated to the study, using CES-D and SF-36. RESULTS: Mean scores of depression were 16.18+/-8.39 (range: 0-48) and it was a little lower than caregiver's who took care of Dementia patients and were higher than primary caregivers of the patients with Stroke. Time for caregiving, perceived severity, duration of PD were significantly related with depression respectively. Higher ADL scores which mean greater motor disabilities were related to higher caregiver depression. Lower income and greater medical expenditure were closely related with the depression of family caregivers respectively. The mean scores of total QOL were 435.5+/-96.5 and the mean scores of PF, SF, RE and MH were lower than general population. Time for caregiving, depression, patients' ADL scores were significantly associated with QOL respectively. People who were older and had lower educational background showed lower QOL scores respectively. CONCLUSION: Healthcare professionals should pay more attention to emotional aspects of caregivers who take care of PD patients, and develop comprehensive management strategies both for patients and their caregivers.

Subjective and Objective Caregiver Burden in Parkinson's Disease / 간호학회지

PURPOSE: Parkinson's disease (PD) is a common neurodegenerative disorder characterized by motor disabilities and increasing dependence on others for daily life activities with consequent impact on patients' and caregivers' quality of life. The aim of this study was to elucidate the burden on primary caregivers of patients with PD, and identify related factors. METHODS: A cross-sectional descriptive study. Seventy-six primary caregivers of PD patients in a neurology outpatient clinic, Seoul, Korea completed structured questionnaires, of which 68 were analyzed. The structured self-report questionnaire included (1) demographic information on the caregivers, (2) information regarding the disease characteristics of the patients, and (3) the subjective and objective caregiver burdens as assessed on Montgomery, Gonyea, & Hooyman's scale. RESULTS: The mean age of the caregivers was 54.56 years, and spouses represented the largest proportion(47.0%). Caregivers of PD patients experienced high levels of burden (mean scores on the subjective and objective burdens were 45.22 and 34.90, respectively), which were comparable to the caregiver burdens in stroke, and higher than the caregiver burdens in general chronic disease. Older caregivers and spousal caregivers experienced significantly higher burdens (p=.004 and p=.019, respectively). A greater motor disability and higher modified Hoehn and Yahr grade were related to higher caregiver burden (p=.001 and p=.018, respectively). CONCLUSION: Caring for PD patients is associated with a high level of caregiver burden. Therefore, healthcare professionals should identify the burden of caregivers who look after PD patients and develop comprehensive management strategies both for patients and their caregivers.

Quality of Life and Related Factors in Patients with Chronic Hepatitis B / 기본간호학회지

PURPOSE: This study aimed to investigate LDQOL (Liver Disease Quality of Life) and its related factors of patients with Hepatitis B. METHOD: A cross-sectional descriptive study. The LDQOL was formally translated to Korean and reliability was examined. One hundred thirty eight patients following gastroenterology outpatient clinic of S. hospital in Seoul, Korea participated. RESULTS: The mean age of the patients was 45.43 years and 87.7% were men. The mean score of LDQOL was 77.34, and mean scores of subscale were followed; symptom of liver disease (SxLD) (82.12), effect of liver disease (ELD) (25.50), concentration (Conc) (84.47), memory (Mem) (83.24), health discomfort, (HD) (75.18), sexual function (SFun) (75.71), sexual problem (SProb) (84.70), Loneliness (85.50), Hopeless (67.43), and stigma of liver disease (SLD) (91.64). Women had a lower LDQOL score for Loneliness (p=.034), and over 45 year-old patients had a lower LDQOL overall score (p=.000). Patients who were HBV carriers, or who had Chronic Hepatitis B or Liver Cirrhosis reported lower QOL respectively (p=.032). CONCLUSION: Although the liver disease itself seemed to be stable, patients with HBV experienced poor QOL in ELD, SProb, SFun, and Hopeless. Therefore nursing interventions in these aspects are needed.

Survey of Perception of Complementary and Alternative Therapies (CAT) / 기본간호학회지

PURPOSE: This study was done to investigate oncology nurses' perception, attitude, knowledge and practice of CAT and to describe nurses' needs for education on CAT. METHOD: A cross-sectional descriptive study was conducted. A total of 270 oncology nurses working at four medical centers in Seoul and Kyungki participated in this study. They completed the questionnaire between December 2005 and February 2006. RESULTS: Oncology nurses perceived CAT as possible nursing interventions, but felt that there was no conclusive evidence on effectiveness/safety. Of the participants 44.4% have used CAT for themselves, and 73.9% of them were satisfied after using CAT. Two biggest reasons for CAT use were symptom control and emotional support. However, 80.8% of the participants had not had any training related to CAT. Both nurses who have used CAT and those who have been trained to practice CAT represented a more positive perception toward CAT (p=.000). The biggest perceived obstacles to the practice of CAT were concerns about side effects (71.2%) and lack of knowledge and skill (69.6%). The most favorable CAT modalities in both practice and training were mind-body medicine. CONCLUSION: Overall oncology nurses' perception toward CAT was encouraging. However a high number of the nurses reported lack of knowledge and skill in CAT. Education and training strategy for CAT need to be developed.