Unveiling nurses' end-of-life care experiences: Moral distress and impacts.

BACKGROUND: Nurses providing care to patients with end-of-life or terminal illnesses often encounter ethically challenging situations leading to moral distress. However, existing quantitative studies have examined moral distress using instruments that address general clinical situations rather than those specific to end-of-life care. Furthermore, qualitative studies have often been limited to participants from a single unit or those experiencing moral distress-induced circumstances. A comprehensive and integrated understanding of the overarching process of moral distress is vital to discern the unique circumstances surrounding end-of-life care and its consequential impacts. RESEARCH OBJECTIVES: To explore the moral distress experiences of nurses who are frequently involved in caring for patients with end-of-life or terminal illnesses and apply it to two existing theories: the model of moral distress and the ecological model. RESEARCH DESIGN: A qualitative descriptive approach was employed. PARTICIPANTS AND RESEARCH CONTEXT: Seven focus group interviews involving 30 nurses were performed. The subsequent transcriptions underwent rigorous content analysis. ETHICAL CONSIDERATIONS: We obtained Institutional Review Board approval from a university. Focus group interviews were conducted with nurses who agreed to participate and signed the consent form. FINDINGS: The moral distress-inducing factors and nurses' perceived impact of moral distress were identified and categorized based on moral distress theories and ecological models. A total of 15 categories and 30 subcategories across the following 4 domains were derived: (1) intrapersonal, (2) interpersonal, (3) organizational, and (4) structural factors. CONCLUSIONS: End-of-life-specific circumstances induced moral distress among nurses, with both negative and positive impacts identified. Effective organizational and policy support is essential to manage conflicts, form a healthy organizational culture, provide training, and prevent unnecessary expenses due to the negative consequences of moral distress.

Effects of Death Anxiety and Perceived End-of-Life Care Competencies on Fear of Terminal Care among Clinical Nurses.

Purpose: The aim of this study was to examine the effects of death anxiety and perceived end-of-life care competencies on the fear of terminal care among clinical nurses. Methods: This correlational study was conducted from June to July 2021. The study included 149 clinical nurses employed at a tertiary hospital and seven other hospitals. The measurement tools used in this study were the Thanatophobia Scale (Cronbach's α=0.87), the Death Anxiety Scale (Cronbach's α=0.80), and the Scale of End-of-life Care Competencies (Cronbach's α=0.94). These instruments were chosen to assess the levels of fear of terminal care, death-related anxiety, and competencies in end-of-life care. Results: The mean score for fear of terminal care was 3.32±1.32. Differences in fear of terminal care were observed based on the working unit, position, number of patients requiring terminal care, and experience with end-of-life care education. Fear of terminal care was significantly positively correlated with death anxiety and significantly negatively correlated with end-of-life care competencies. In multiple regression analysis, the factors influencing fear of terminal care were attitudes toward end-of-life care competencies (ß=-0.39, P<0.001), death anxiety (ß=0.24, P<0.001), knowledge of end-of-life care competencies (ß=-0.22, P=0.005), and behaviors related to end-of-life care competencies (ß=-0.16, P=0.021). These factors explained 64.6% of the total variance (F=25.54, P<0.001). Conclusion: This study suggests that developing nurses' end-of-life care competencies and reducing death anxiety are crucial for managing the fear of terminal care. Therefore, providing end-of-life care education and psychological support programs is important.

Experiences of South Korean mothers of children with medical complexity under long-term hospitalization.

AIMS: To explore the experiences of South Korean mothers of their children with medical complexity under long-term hospitalization. DESIGN: A qualitative descriptive using thematic analysis. METHODS: Seven South Korean mothers of children with medical complexity underwent semi-structured interviews between February and April 2021. Data were analysed by six phases of thematic analysis. The consolidated criteria for reporting qualitative research guidelines were applied in the conduct of the research. RESULTS: Mothers of children with medical complexity experienced a journey beginning from within their vacillating minds towards the outside world. The mother's journey during the hospitalization of their children with medical complexity began from within their vacillating minds towards achieving resilience. The mothers received various support from the family, society and hospital staff during this period of vacillation. When the mothers achieved resilience, they in turn provided support to other mothers as an act of solidarity.

Validity and reliability of the gender equity scale in nursing education.

Equity is an emerging issue across all sectors of society, and one of the frequently raised concerns in nursing education is gender inequity. An accurate assessment appears to be a key component in creating an environment of gender equity in nursing education. This study aimed to develop a scale of gender equity in nursing education and establish its validity and reliability. In total, 341 senior nursing students participated in the psychometric evaluation of the Gender Equity Scale in Nursing Education. This psychometric evaluation revealed that the 4-subdomain (personal experience of gender inequity, perceptions of gender roles, gender discrimination, and gender biases in class), 23-item measure possesses both good reliability and validity, as well as a good level of internal consistency. The Gender Equity Scale in Nursing Education was developed as a self-report questionnaire for both female and male students and considers gender role stereotypes, gender-biased educational climates, gender discrimination, and gender inequity in nursing education.

Nurses' Perceived Needs and Barriers Regarding Pediatric Palliative Care: A Mixed-Methods Study.

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 open- ended 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.

Reliability and Feasibility of the Pain Assessment in Advanced Dementia Scale-Korean Version (PAINAD-K).

BACKGROUND: There is currently no observational instrument for assessing pain in aged patients who are unable to provide self-report in long-term care hospitals in Korea. AIMS: The goal of this research was to culturally adapt and test the validity, reliability, and feasibility of the Korean version of the Pain Assessment in Advanced Dementia Scale. DESIGN: This was a methodologic study aiming to translate the Pain Assessment in Advanced Dementia Scale. PARTICIPANTS/SUBJECTS: The inpatients in a 270-bed LTC hospital in D metropolitan city were assessed pain levels. METHODS: The Pain Assessment in Advanced Dementia (PAINAD) Scale was used as an observation scale to assess 192 long-term care hospital patients, with observation durations of 1 and 5 minutes. RESULTS: The interrater reliability (1 minute) for the scale showed substantial kappa agreement of .62, and scores for the 1- and 5-minute observations showed almost perfect agreement of .95. The criterion validity of the scale (1 minute) was high relative to the Face-Legs-Activity-Cry-Consolability (FLACC) Scale, and low compared with the numeric rating scale (NRS). Discriminant validity was established between patients with and without pain. The feasibility of the Pain Assessment in Advanced Dementia Scale-Korean Version (PAINAD-K) (1 minute) indicated low sensitivity of 41.3% and high specificity of 92.6%. CONCLUSIONS: Therefore, the PAINAD-K is a valid and reliable tool to determine the absence of pain in non-verbal aged patients.

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

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.

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 Knowledge and Attitudes Survey on Pain Management for Korean Long-term Care Professionals.

PURPOSE: Inappropriate knowledge and attitude toward pain management of professionals has been pointed to be major obstacles to effective pain management in long-term care setting. The purpose of this study was to develop the knowledge and attitudes survey on pain management for Korean long-term care (LTC) professionals (KASP-K). METHODS: To develop the KASP-K, the knowledge and attitudes survey regarding pain developed by Ferrell and McCaffery in 2014 was amended after a review of broad literature and the latest pain management standards. A rigorous validation process of the KASP-K was performed by testing the content validity, item difficulty and discrimination index, construct validity, test-retest reliability, and internal consistency. RESULTS: The KASP-K consisted of 22 items and showed a content validity index of >0.7. The average difficulty of the KASP-K was 0.56 and the discrimination index was >0.2. The construct validity of the KASP-K was verified because of the differences in the sum scores depending on pain education (t = 2.30, p = .024). The test-retest reliability was r = .79 (p < .001) and the Cronbach's alpha was 0.73. CONCLUSION: This preliminary evaluation of the KASP-K demonstrated acceptable validity and reliability. The KASP-K will be able to provide scientific and empirical data regarding the knowledge of and attitude toward pain management by LTC professionals.

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.

[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.

Nurses' perceptions of medication errors and their contributing factors in South Korea.

AIM: The aim of this study was to identify Korean nurses' perceptions of medication errors. BACKGROUND: Knowing nurses' perceptions of medication errors is important in developing prevention strategies for medication errors. METHODS: A cross-sectional descriptive survey was conducted. A convenient snowballed sample of 220 nurses from seven hospitals was obtained. Participants were asked to identify contributing factors of medication errors, reporting and strategies to prevent medication errors. RESULTS: A total of 224 of 330 (67.9%) questionnaires were returned. Over half (63.6%) of the participants had been involved in medication errors once or more in the past month. For factors contributing to medication errors, 99 nurses (45.0%) answered 'advanced drug preparation and administration without rechecking'. Only 13.5% of participants informed patients and their families of medication errors and 28.3% of participants submitted an incident report. Medication errors occurred most often during the day-shift. CONCLUSIONS: Developing strategies to reduce nurses' fear of punishment and supporting nurses' attitudes in a constructive manner are needed. IMPLICATIONS FOR NURSING MANAGEMENT: Effective strategies for nursing are needed, particularly during the day-shift, and during routine medication administration. In addition, non-punitive reporting systems of medication error should be established and patients should be included in reporting.

Subjective and objective caregiver burden in Parkinson's disease.

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.

Comfort and quality of life of cancer patients.

PURPOSE: This study aimed to quantify the comfort level and quality of life (QoL) of cancer patients, to identify the variables associated with comfort level and QoL, and to identify the relationship between comfort level and QoL. METHODS: This was a cross-sectional descriptive study. The participants comprised 100 cancer patients, of which 98 were analyzed. Participants completed a self-reporting questionnaire that included the Hospice Comfort Questionnaire and the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire-C30 at outpatient clinics, inpatient units, at home, and a day-care chemotherapy unit. RESULTS: The mean age of the participants was 53.36 years, and 56.1% of them were female. The mean ± standard deviation score for total comfort was 61.50 ± 12.02, with the sociocultural comfort score being the highest (71.05 ± 16.01), followed by physical comfort (60.30 ± 16.71), psychospiritual comfort (57.65 ± 16.81), and environmental comfort (56.32 ± 16.86). There were significant subgroup differences in educational attainment, the site where they completed the questionnaire, and perceived disease status and prognosis. The QoL score for global health status was 46.34 ± 20.76, and comfort was significantly correlated with all dimensions of QoL (r = -.549 - .581). CONCLUSION: This study showed lower comfort level in psychospiritual and environmental comfort than physical and sociocultural comfort in cancer patients. Improvement in environment and psychospiritual support is suggested as strategies to enhance the comfort of cancer patients.

[Research trend of complementary and alternative medicine].

PURPOSE: This study was done to describe the research trend of Complementary and Alternative Medicine(CAM) in Korea and internationally. METHOD: A Systematic review of CAM related literature published from 2000 to 2005 was done. A comprehensive search by using 34 CAM modalities as search terms to identify all articles dealing with CAM was undertaken from 4 databases: PubMed, RICHIS, KoreaMed, and Riss4U. A Total of 588 abstracts and 223 original articles were reviewed by two independent reviewers using systematic analysis guidelines. Data regarding the types of study design, characteristics of subjects and researchers, and classification of CAM modalities was recorded. The outcome measures of CAM were identified. RESULTS: CAM research has been rapidly increasing worldwide in the last decade. In Korea, nursing(53.5%) followed by medicine(42.7%) occupied the majority of CAM research in comparison to medicine(42.9%) and disciplines in CAM(25.0%), like homeopathy, internationally. Prevailing research designs in Korea were experimental and quasi-experimental, however, randomized clinical trials were found. Internationally, survey research was dominant, with the exception of randomized clinical trials that were mostly an experimental design. CONCLUSION: The findings suggest that a robust research design in CAM research is needed to accumulate strong scientific evidence and to adopt nursing interventions from CAM modalities.

[Effects of abdominal breathing training using biofeedback on stress, immune response and quality of life in patients with a mastectomy for breast cancer].

PURPOSE: This study was to determine the effects of abdominal breathing training using biofeedback on stress, immune response, and quality of life. METHOD: The study design was a nonequivalent control group pretest- posttest, quasi-experimental design. Twenty-five breast cancer patients who had completed adjuvant chemotherapy were enrolled. The experimental group (n=12) was provided with abdominal breathing training using biofeedback once a week for 4 weeks. State anxiety, cancer physical symptoms, serum cortisol, T cell subsets (T3, T4, T8), NK cell and quality of life were measured both before and after the intervention. RESULT: Though state anxiety, cancer physical symptoms, and serum cortisol were reduced after 4 weeks of abdominal breathing training using biofeedback, there was no statistical significance. It showed, however, improvement in quality of life (p=.02), and T3 (p=.04). CONCLUSION: Abdominal breathing training using biofeedback improves quality of life in breast cancer patients after a mastectomy. However, the mechanism of this beneficial effect and stress response requires further investigation with special consideration in subject selection and frequency of measurement. Nurses should consider this strategy as a standard nursing intervention for people living with cancer.