Effects of advance care planning training on advanced practice nurse students' knowledge, confidence, and perception of end-of-life care: A mixed-method study.

AIMS: This study aimed to assess how an advance care planning training program affected advanced practice nursing students' knowledge, confidence and perception of end-of-life care in South Korea. BACKGROUND: Effective communication between healthcare providers, patients and their families is one of the most important components of quality end-of-life care. However, nurses in South Korea may feel uncomfortable helping patients and families with advance care planning because of the cultural taboo against talking about dying. DESIGN: A mixed-method design was used with data obtained from self-administered questionnaires at the onset and end of the advance care planning training program and qualitative data from participant feedback after the program. METHODS: Data collected from 65 advanced practice nursing students who participated in advance care planning training programs in June-July 2020 and 2021, conducted as part of a graduate clinical practice course, were analyzed. Data were originally collected to examine students' course outcomes. A training program was provided to advanced practice nursing students to improve their knowledge, confidence and perception in advance care planning conversations with their patients. The program comprised three sessions: online lectures, face-to-face simulations and discussions on advance care planning and ethical issues. Changes in advance care planning knowledge, confidence in supporting patients' advance directives, perceived nursing roles in end-of-life treatment decisions and perception of a good death were examined before and after the training. RESULTS: There were statistically significant increases in participants' advance care planning knowledge, confidence in supporting patients' advance directives and perception of the active role of nurses in patients' end-of-life treatment decisions after the training. CONCLUSIONS: The results indicate the effects of training programs on advanced practice nursing students' knowledge, confidence and perception of advance care planning communication. They also provide evidence about what contents and methods can be helpful in developing end-of-life care training for advanced practice nursing students.

Understanding Cultural Beliefs of a Good Death by Older People in South Korea: An Integrative Review of the Literature.

With the enforcement of the Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End-of-Life Act in 2018, interest in the quality of death in South Korea is increasing. However, few studies have provided an updated perspective on a good death. This integrative review describes the attributes of a good death from the perspective of South Korean older adults. Among the 32 studies included in this review, 16 main themes representing good death were identified. Themes of maintaining dignity, not burdening others, living a meaningful life, being pain-free, and being prepared to die were commonly reported attributes of a good death in other cultures; themes further reflected in Korean culture were filial piety and parenting. In contrast, older adult characteristics such as low income and education level, bereavement experience, disease uncertainty, and depressive symptoms were associated with high levels of fear of death or negative attitudes, such as trying to avoid suffering through death. This review provides insights into the health care provider's approach to older people at the end of their life in South Korea. Consequently, this can help determine potential unmet needs that can be improved.

Effects of the Anger Management Program for Nurses.

PURPOSE: The purpose of this study was to examine the effects of an anger management program on anger, job stress, psychological well-being, and heart rate variability in clinical nurses. METHODS: A quasi-experimental study was conducted using a nonequivalent control group, pre-post test design with repeated measures. The participants included 43 nurses assigned to the experimental and control groups. Anger, job stress, psychological well-being, and heart rate variability were evaluated before the intervention, immediately after the completion of the intervention, and four weeks after the end of the intervention. Chi-square test, t-test, Fisher's exact test, and GEE (Generalized Estimating Equations) were used to analyze the data. RESULTS: There were significant differences in the level of anger, state anger, job stress, and psychological well-being between the two groups. The rate of change in the total power (TP) and the high-frequency band (HF) of the experimental group increased immediately after the intervention completion, but that of the control group decreased at the same time. CONCLUSION: The above results demonstrate that an anger management program for nurses effectively attenuated anger and job stress, improved psychological well-being, and regulated heart rate variability.

Analysis of high-intensity care in intensive care units and its cost at the end of life among older people in South Korea between 2016 and 2019: a cross-sectional study of the health insurance review and assessment service national patient sample database.

OBJECTIVES: To provide useful information for clinicians and policy makers to prepare guidelines for adequate use of medical resources during end-of-life period by analysing the intensive care use and related costs at the end of life in South Korea. DESIGN: Cross-sectional, retrospective, observational study. SETTING: Tertiary hospitals in South Korea. PARTICIPANTS: We analysed claim data and patient information from the Health Insurance Review and Assessment Service national dataset. This dataset included 19 119 older adults aged 65 years or above who received high-intensity care at least once and died in the intensive care unit in South Korea between 2016 and 2019. High-intensity care was defined as one of the following treatments or procedures: cardiopulmonary resuscitation, mechanical ventilation, extra-corporeal membrane oxygenation, haemodialysis, transfusion, chemotherapy and vasopressors. PRIMARY AND SECONDARY OUTCOME MEASURES: Usage and cost of high-intensity care. RESULTS: The most commonly used high-intensity care was transfusion (68.9%), mechanical ventilation (50.6%) and haemodialysis (35.7%) during the study period. The annual cost of high-intensity care at the end of life increased steadily from 2016 to 2019. There existed differences by age, gender, length of hospital stays and primary cause of death in use of high-intensity care and associated costs. CONCLUSION: Findings indicate that invasive and device-dependent high-intensity care is frequently provided at the end of life among older adults, which could potentially place an economic burden on patients and their families. In Korea's ageing society, increased rates of chronic illness are expected to significantly burden those who lack the financial resources to provide end-of-life care. Therefore, guidelines for the use of high-intensity care are required to ensure affordable end-of-life care.