Development and Evaluation of an Integrative Palliative Care Scale for Cancer Patients / 한국간호교육학회지

PURPOSE: This study was done to develop and to evaluate an integrative palliative care scale for cancer patients. METHODS: The process included construction of a conceptual framework, generation of initial items, verification of content validity, selection of secondary items, preliminary study, and extraction of final items. The participants were 173 cancer patients in Daegu and Gyeongbuk. Item analysis, factor analysis, criterion related validity, and internal consistency were used to analyze the data. RESULTS: Eighteen items were selected for the final scale, and categorized into 3 factors explaining 58.3% of total variance. The factors were labeled as social/environmental palliative care (9 items), psychological palliative care (4 items), and physical palliative care (3 items), and spiritually palliative care (2 items). The scores for the scale were significantly correlated with the quality of life of cancer patients. Cronbach's alpha coefficient for the 18 items was .88. CONCLUSION: The above findings indicate that the integrative palliative care scale has good validity and reliability when used for cancer patients.

Types of Attitudes of Nursing Students in Korea Toward Bucket Lists Q-Methodological Approach / 한국간호교육학회지

PURPOSE: The purpose of this study was to analyze the types of attitudes of nursing students in Korea toward bucket lists. METHODS: The Q-methodology, which provides a method for analyzing the subjectivity of each item was used. From each of the 37 subjects, 34 selected Q-statements were classified into the shape of a normal distribution, using a 9-point scale. The collected data were analyzed using a QUANL PC program. RESULTS: Four types of attitudes toward the bucket list of subjects were identified in Korean nursing students. Typeis a pursuit of money type, Type II is a pursuit of relationship type, Type III is a pursuit of self-centered type, and Type is a pursuit of others-centered type. CONCLUSION: The results of this study indicate that different approaches toward educational programs for students in the human service area are recommended based on the four types of nursing students' attitudes toward the bucket list.

Effects of Integrated Palliative Care Intervention on Quality of Life in Terminal Cancer Patients: A Meta-analysis / 한국호스피스완화의료학회지

PURPOSE: This study was conducted to evaluate the effects of integrated palliative care intervention on quality of life in terminally ill patients. METHODS: A comprehensive literature search was performed via PubMed, Cochrane Library CENTRAL, LWW (Ovid), CINAHL and several Korean databases. The main search strategy was to combine terms indicating palliative care intervention, presence of terminal illness and study design. Methodological quality was assessed using Cochrane's Risk of Bias for randomized studies and Risk of Bias Assessment tool for non-randomized studies. Data were analyzed by the Stata 10 program. RESULTS: Eight clinical trials met the inclusion criteria with a total of 356 participants. Integrated palliative care interventions were administered for a mean of 6.5 weeks, 5.6 sessions and an average of 47.8 minutes per session. Effect sizes were heterogeneous, and subgroup analysis was done. Integrated palliative care interventions had a significant effect on quality of life (ES=1.83, P=0.018, l2=92%), spiritual well-being (ES=0.78, P=0.040, l2=0), depression (ES=0.86, P<0.001, l2=32) and anxiety (ES=0.69, P=0.041, l2=71.1). But integrated palliative care interventions had no significant effect on pain (ES=0.365, P=0.230, l2=69.8). CONCLUSION: Results support findings that integrated palliative care interventions were helpful in lessening depression and anxiety and improving quality of life and spiritual well-being, however, the interventions did not assist pain management in terminal cancer patients. These findings suggest that various integrated palliative care interventions can assist terminal cancer patients with better quality of life in the socio-psycho-spiritual dimension.

The Effect of Suffering Experience, Empathy Ability, Caring Behaviors on Terminal Care Performance of Clinical Nurses / 한국호스피스완화의료학회지

PURPOSE: This study was performed to identify factors affecting terminal care performance of clinical nurses. METHODS: The participants in this study were 175 nurses working in hospitals in Daegu and North Gyeongsang Province. Data were collected using a self-reported questionnaire and were analyzed with the IBM SPSS WIN 19.0 program. RESULTS: Nurses' terminal care performance was significantly related with suffering experience, empathy ability and caring behaviors. Significant predictors for terminal care performance were their department, empathy ability and caring behaviors. These factors explained 43.52% of the variance in terminal care performance of clinical nurses. CONCLUSION: Our study results suggest that terminal care performance of clinical nurses can be strengthened by improving empathy ability and caring behaviors.

Types of Shared Medical Decision Making for Terminally Ill Patients / 한국호스피스완화의료학회지

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.

The Impact of Nurses' Attitude toward Dignified Death and Moral Sensitivity on Their End-of-Life Care Performance / 한국호스피스완화의료학회지

PURPOSE: This study was conducted to explore how nurses' attitude toward dignified death and moral sensitivity affect their end-of-life care performance. METHODS: Study participants were 172 nurses who work at university hospitals in a metropolitan city in Korea. Data were collected from June 20 through August 13, 2012 using the Dignified Death Scale, Moral Sensitivity Scale, and End-of-Life Care Performance Scale. Data were analyzed using the SPSS/WIN 19.0 program. RESULTS: Factors affecting nurses' end-of-life care performance included moral sensitivity, dignified death and education level. CONCLUSION: Moral sensitivity, dignified death and education level should be considered when developing an educational program for nurses' end-of-life care performance.

Predictive Factors for City Dwellers' Attitudes toward Death with Dignity / 한국호스피스완화의료학회지

PURPOSE: This correlation study was performed to examine Korean adults' perceptions and attitudes towards death with dignity and the withdrawal of life sustaining treatment and to identify factors that predict their attitude towards death with dignity. METHODS: The study was conducted using convenience sampling of 291 adults from three towns of a metropolitan city in Korea. Data were collected using structured questionnaires which surveyed people's perception about and attitudes towards withdrawal of life sustaining treatment and scaled their attitude towards death with dignity. Data were analyzed by using descriptive statistics, Pearson correlation coefficients and multiple regression. RESULTS: The attitude towards the withdrawal of life sustaining treatment and death with dignity showed a significant positive correlation (r=0.49, P<0.001). For attitudes towards death with dignity, significant predictors were attitudes towards the withdrawal of life sustaining treatment, age, religion, a proper withdrawal process and advanced medical directives, which explained 49.3% of total variance. CONCLUSION: The results of this study may contribute to development of a new medical decision-making system including nurses' appropriate roles in the process of withdrawing life sustaining treatment and advanced medical directives.

Development and Evaluation of Shared Medical Decision-Making Scale for End-of-Life Patients in Korea

PURPOSE: The study was done to develop a shared decision-making scale for end-of-life patients in Korea. METHODS: The process included construction of a conceptual framework, generation of initial items, verification of content validity, selection of secondary items, preliminary study, and extraction of final items. The participants were 388 adults who lived in one of 3 Korean metropolitan cities: Seoul, Daegu, or Busan. Item analysis, factor analysis, criterion related validity, and internal consistency were used to analyze the data. Data collection was done from July to October 2011. RESULTS: Thirty-four items were selected for the final scale, and categorized into 7 factors explaining 61.9% of the total variance. The factors were labeled as sharing information (9 items), constructing system (7 items), explanation as a duty (5 items), autonomy (4 items), capturing time (3 items), participation of family (3 items), and human respect (3 items). The scores for the scale were significantly correlated among shared decision-making scale, terminating life support scale, and dignified dying scale. Cronbach's alpha coefficient for the 34 items was .94. CONCLUSION: The above findings indicate that the shared decision-making scale has a good validity and reliability when used for end-of-life patients in Korea.

Types of Perception toward End-of-Life Medical Decision-making of Clinical Nurses: Q-Methodological Approach / 한국호스피스완화의료학회지

PURPOSE: We analyzed how clinical nurses in Korea perceive terminally ill patients' medical decision-making. METHODS: The Q-methodology which analyzes the subjectivity of each item was used. We selected 34 Q-statements among those provided by each of 37 subjects and grouped them into a shape of normal distribution using a 9 point scale. The collected data were analyzed using a QUANL PC program. RESULTS: Four types of perception toward medical decision-making were identified. Type I focuses on patient participation, and Type II emphasizes the role of health professionals. Type III is characterized by an open-minded culture toward death, and Type IV values the role of family members. CONCLUSION: The results of this study indicate the need for development of a multi-disciplinary curriculum medical decision-making and death for medical and nursing students.

Effect of Family Cohesion, Subjective Happiness and other Factors on Death Anxiety in Korean Elders

PURPOSE: The purposes of this study were to explore the effects of family cohesion and subjective happiness on death anxiety of Korean elders and to identify other factors contributing to death anxiety. METHODS: The participants were 280 elders who lived in P metropolitan city. Data were collected between November 5, 2011 and January 12, 2012 using the Short Portable Mental Status Questionnaire (SPMSQ), Family Cohesion Evaluation Scale, Subjective Happiness Scale, and Fear of Death Scale (FODS). Data were analyzed using the SPSS/WIN 19.0 program. RESULTS: Family cohesion, marital status, religious activity, perceived health status, and subjective happiness were included in the factors affecting death anxiety of Korean elders. These variables explained 50.1% of death anxiety. CONCLUSION: The results of the study indicate that these variables should be considered in developing nursing intervention programs to decrease death anxiety and increase family cohesion and subjective happiness for life integration in Korean elders.

Development and Evaluation of a Dignified Dying Scale for Korean Adults

PURPOSE: The study was done to develop a dignified dying scale for Korean adults. METHODS: The process included construction of a conceptual framework, generation of initial items, verification of content validity, selection of secondary items, preliminary study, and extraction of final items. The participants were 428 adults who lived in one of 3 Korean metropolitan cities: Seoul, Daegu, and Busan. Item analysis, factor analysis, criterion related validity, and internal consistency were used to analyze the data. Data collection was done from March to June 2010. RESULTS: Thirty items were selected for the final scale, and categorized into 5 factors explaining 54.5% of the total variance. The factors were labeled as maintaining emotional comfort (10 items), arranging social relationship (9 items), avoiding suffering (3 items), maintaining autonomous decision making (4 items), and role preservation (4 items). The scores for the scale were significantly correlated with personal meanings of death scale. Cronbach's alpha coefficient for the 30 items was .92. CONCLUSION: The above findings indicate that the dignified dying scale has a good validity and reliability when used with Korean adults.

Types of Attitude toward Dignified Dying Expressed by Undergraduate Korean Students Majoring in Human Service Area: Q-Methodological Approach / 성인간호학회지

PURPOSE: The purpose of this study was to analyze attitude toward dignified dying of Korean students majoring in human service area. METHODS: The Q-methodology which provides a method of analyzing the subjectivity of each item was used. The 34 selected Q-statements from each of 38 subjects were classified into a shape of normal distribution using a 9 point scale. The collected data was analyzed using a QUANL PC program. RESULTS: Four types of attitude toward dignified dying from the subjects were identified. Type I is an expression type for happy emotion, Type II is a dislike type for life prolongation, Type III is a pursuit type for relationship improvement, and Type IV is a perception type for family presence. CONCLUSION: The results of the study indicate that integrating multi-disciplinary curriculum development related to dignified dying and death education for students majoring in human service area are needed.

Nurse's Conflict Experience toward End-of-life Medical Decision-making / 성인간호학회지

PURPOSE: The purpose of this study was to explore clinical nurse's reported conflict experience toward end-of-life medical decision making. METHODS: Data were collected by in-depth interviews with eight nurses from three different wards of university hospital in D city of Korea. Conventional qualitative analysis was used to analyze the data. RESULTS: Results were three major themes and twelve categories from the analysis. The three major themes were prioritization of treatment, non-disclosure of diagnosis, and hierarchical and power relations. CONCLUSION: The results of this study suggest that shared decision making in end of life among patient, family members, physician, and nurse may contribute to improve end-of-life care performance as well as dignified dying of patient in end of life.

Perceived Hurts and Forgiveness in Clinical Nurses: The Status and Influencing Variables / 간호행정학회지

PURPOSE: The purposes of this study were to describe events resulting in perceived hurts in nursing, and to identify factors influencing forgiveness in clinical nurses. METHODS: The study was a descriptive correlation design. From May to July, 2009, the researcher used interviews to collect data from 148 clinical nurses from five hospitals in D city. RESULTS: Clinical nurses received perceived hurt from peer-nurses, care-givers, and doctors, and the reasons for the perceived hurts were blame, neglect, and valuation. Levels of forgiveness in clinical nurses were different according to who caused the perceived hurt, the degree of the perceived hurt, and endeavors to resolve the perceived hurts. Levels of forgiveness in clinical nurses were negatively correlated with age, degree of perceived hurt, and degree of anger expression, and positively correlated with degree of self-esteem. The strongest predictors of forgiveness in clinical nurses were degree of anger expression, age, and degree of hurt. CONCLUSION: The findings of the study suggest that nursing staff should be able to identify reasons for perceived hurt in clinical nurses and provide a forgiveness program for each nursing situation.

A Meaning of Death through Emotional Expression about Death after Nursing and Medical Students' End-of-Life Care Practice / 성인간호학회지

PURPOSE: The purpose of this study was to understand the meaning of death experienced by medical and nursing students through end-of-life care practice. METHODS: Data were collected by in-depth interviews with twelve (six nursing and six medical) students. Conventional qualitative content analysis was used to analyze the data. RESULTS: This findings were analyzed in three areas: 'feeling from the word of death', 'color association of death', and 'relation between life and death'. Results were three major themes and sixteen categories from the analysis. Three major themes include 'reality of uncertain death', 'have to leave, and 'new perception about death'. Sixteen categories include 'being well', 'fear', 'unknown', 'boundless', 'being with', 'out of sight', 'new start', 'go back to', 'place going by itself', 'place to meet with', 'being transformed', 'a sense of futility', 'the same point', 'a different point', 'continuous line', and 'a crossroad'. CONCLUSION: The findings suggest a number of themes that nursing and medical students reported about the end of life experiences that could be explored as a way of improving end of life care.

Types of Survival Attitudes among First-Generation Korean Immigrants in the United States: Q-Methodological Approach / 성인간호학회지

PURPOSE: The purpose of this study was to examine the subjective opinions of first-generation Korean-Americans about survival. METHODS: The Q-methodology which provides a method of analyzing the subjectivity of each item was used. The 34 selected Q-statements from each of 38 subjects were classified into a shape of normal distribution using a 9 point scale. The collected data was analyzed using a QUANL/WIN program. RESULTS: Four types of survival attitudes from 38 first-generation Korean-Americans were identified. Type I was a satisfaction type based on belief, Type II was an effort type based on purpose, Type III was an isolation type based on ethnicity, and Type IV was a compromise type based on adaptation. Results of this study indicate that approaches to a minority's survival strategies need to be differentiated taking this typology and various subject characteristics into account. CONCLUSION: This information may provide a basic understanding for healthcare providers who work with first-generation Korean-Americans.

Factors related to Life Satisfaction in Young-Old, Old, and Oldest-Old Women

PURPOSE: The purpose of this study was to investigate the level of life satisfaction and the significant factors which impact on life satisfaction of young-old (60-69 yr), old (70-79 yr), and oldest-old (80 yr or above) women. METHODS: The participants for this study were 289 elderly Korean women living in the city of Daegu and Kyongpook province. The data were collected using structured questionnaires. ANOVA, Chi-square, and multiple regression with the SPSS program were used to analyze the data. RESULTS: There were statistically significant differences among young-old, old, and oldest-old women regarding the existence of spouse, income, educational status, and religions. The model including variables related to physical, psychological, financial, and social aspects of life, explained variance of life satisfaction of elderly women differently, such as 55% of young-old, 37% of old, and 66% of oldest-old. Finally, self-esteem was the only predictor in explaining the level of life satisfaction among old women regardless age. CONCLUSION: Based on the findings of the study, implications for practical services for elderly women and recommendations of further study are provided. Nursing interventions should be developed to improve life satisfaction of elderly women according to age differences.

Development and Application of a Multidimensional Suicide Prevention Program for Korean Elders by utilizing a Community Network / 간호학회지

PURPOSE: The purpose of this study was to develop a multidimensional suicide prevention program for Korean elders by utilizing a community network and to evaluate its effect. METHODS: A non-equivalent control group pretest-posttest design was used. The subjects were recruited from two different elderly institutions located in D city and K province, Korea. Nineteen subjects in the control group received no intervention and 20 subjects in the experimental group received a multidimensional suicide prevention program. RESULTS: There were more significant decreases in depression, suicide ideation, and increases in life satisfaction in the experimental group compared to the control group. CONCLUSION: According to the above results, the multidimensional suicide prevention program for Korean elders decreased stressful events like depression, and suicide ideation and increased life satisfaction through the community network. These findings suggest that this program can be used as an efficient intervention for elders in a critical situation.

The Effects of Holistic Education on End-of-Life Care

PURPOSE: The purpose of this study was to evaluate changes regarding knowledge, attitude and practice toward end-of-life care in nursing university students. METHOD: This study adopted nonequivalent control group pretest-posttest design. The subjects consisted of 35 in the experimental group and 35 in the control group. The education was performed for 2 hours a session, once a week for 16 weeks. Data was analyzed by the SPSS/WIN 14 computer program, and included chi2 test, independent t-test, and repeated measure ANOVA. RESULTS: There were statistically significant differences in knowledge toward end-of-life care between the experimental group and the control group. CONCLUSION: Findings suggested that holistic education on end-of-life care was effective to change students' knowledge toward end-of-life care. Therefore, holistic education is recommended as nursing education for nursing university students.

A Phenomenological Study on the Experience of Hurt and Forgiveness of Clinical Nurses in Korea after Loss of Employment / 간호학회지

PURPOSE: The purpose of this study was to understand and analyze the experience of hurt and forgiveness of clinical nurses in Korea. METHODS: A phenomenological research method guided data collection and analysis. The subjects were a total of 5 nurses who had experienced hurt and forgiveness. Data was collected through individual in-depth interviews. All interviews were audio taped and transcribed verbatim. Coding was used to establish different concepts and categories. RESULTS: The following three common constituents have been found as a retrospective focus based on the primary hurt related to the clinical situation; recognizing their personal values, obtaining their view about forgiveness, as well as their view of self. CONCLUSION: The results of this study may contribute to health professionals working in various clinical settings to understand Korean nurses with hurt and forgiveness experiences.