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Purpose: This study investigated the factors influencing attitudes toward end-of-life care among nurses at a tertiary hospital in Korea. Specifically, it examined the roles of nurses’ characteristics, death perceptions, terminal care stress, and life satisfaction. Methods: The participants included 150 nurses working at a tertiary hospital, who were recruited between August 15 and September 19, 2023. Data were collected through an online survey and analyzed using descriptive statistics, the t-test, analysis of variance, Pearson correlation coefficients, and multiple regression analysis with SPSS/WIN 28.0. Results: Nurses’ attitudes toward end-of-life care were positively correlated with death perceptions (β = .28, p < .001), 3 years or more of clinical experience (β = .25, p = .001), the experience of an acquaintance death (β = .22, p = .002) and life satisfaction (β = .20, p = .004). These variables explained 34.0% of the total variance in attitudes toward end-of-life care. Conclusion: It is essential to develop and implement individualized end-of-life nursing education programs, particularly utilizing simulations, for nurses with limited clinical experience and low levels of death perceptions. Further research should explore attitudes toward end-of-life care among various healthcare providers with a broader regional scope to improve the overall quality of end-of-life care. [ABSTRACT FROM AUTHOR]

Purpose: Globally, the issue of palliative and end-of-life care (PEOLC) in nursing homes is a common concern, and the need to measure the preparedness of nursing staff for end-of-life care is increasing. This study aimed to verify the validity and reliability of the Korean version of the self-reported scale for the Staff Preparedness for PEOLC in long-term care homes. Methods: A total of 161 staff took part in the study; among them were nine nurses, 19 nursing assistants, 133 care workers at four nursing homes located in Wonju and Seongnam cities, South Korea. The scale was translated according to the guidelines of World Health Organization guidelines and Consensus-Based Standards for the Selection of Health Measurement Instruments, and its reliability and validity were evaluated through assessing its internal consistency, stability, and construct validity (confirmatory factor analysis, CFA). Results: CFA confirmed that the measurement tool had a good fit (comparative fit index=.96, Turker-Lewis index=.95, root mean-squared error of approximation=.07). The items’ internal consistencies of the items were found to be reliable with Cronbach’s alpha=.94; the Pearson’s correlation coefficient between test and retest of the tool was .86 (p<.001); and the intraclass correlation coefficient value was .91 (95% confidence interval: .85~.96). Conclusion: The Korean version of the Staff Preparedness for PEOLC in long-term care homes was confirmed to be a useful and reliable scale for measuring the preparedness of nursing staff in Korean long-term care facilities in Korea for PEOLC. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate the effects of death anxiety and social support on the preferences for care near the end of life in older adults staying at long-term care hospitals. By understanding these relationships among the factors, we provide crucial insights for enhancing endof-life care with respect to patients’ end-of-life care preferences. Methods: This was a cross-sectional study. A total of 155 older adults staying at long-term care hospitals participated in the study. Data collection was performed from January 9, 2023 to March 9, 2023. The data were analyzed using descriptive statistics, t-tests, ANOVA, Pearson correlation coefficients, and hierarchical multiple regression analysis. Results: The results of this study show that death anxiety (β=.23, p=.002), social support (β=.22, p=.003), intensive care transfer (β=.18, p=.022), and severity of illness (β=. 16, p=.033) were significantly affecting factors to the care preferences near the end of life in older adults staying at long-term care hospitals. Conclusion: Understanding the end-of-life care preferences of older adults with death anxiety in long-term care hospitals is important. Expressing these preferences in a timely manner requires extensive support from patients, family, and health professionals. Developing an effective program for end-of-life care preferences is continuously needed for future studies. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to identify the effects of death anxiety, end-of-life nursing competency, and empathy with regard to end-of-life care stress among new nurses. Methods: Data were collected 143 new nurses who experienced end-of-life care in the university hospital located in G Province. Data were analyzed using independent t-test, one-way ANOVA, Pearson's Correlation Coefficient, and Multiple Regression Analysis with SPSS/WIN 25.0. Results: Factors influencing end-of life care stress in the participants were death anxiety (β=.66, p<.001), end-of-life competency (β=-.25, p=.003). The total explanatory power was 57.8%. Conclusion: In this study, death anxiety and end-of-life competency were found to be influential factors affecting end-of-life care stress in new nurses. A systematic intervention program to address death anxiety and end-of-life competency is needed to decrease end-of-life nursing stress among new nurses. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to evaluate the respiratory rate oxygenation (ROX) index, ROX-heart rate (ROX-HR) index, and satura- tion of percutaneous oxygen/fraction of inspired oxygen ratio (SF ratio) to predict the success for high-flow nasal cannula (HFNC) treatment applied to patients with hematologic neoplasms. Methods: A total of 167 patients who were admitted to the hematology intensive care unit were included in this study. Data were collected from electronic nursing records and were analyzed using the χ² test, independent t-test, Mann-Whitney U test, logistic regression, Receiver Operating Characteristic curve, and Area Under the Curve (AUC). Results: Eighty-nine (53.3%) patients were successfully weaned from HFNC, while 78 (46.7%) were unsuccessful. Considering specificity and sensitivity, the optimal cut-off points for predicting the success and failure of HFNC oxygen therapy were 4.50 and 14.16 (ROX index), 3.78 and 15.05 (ROX-HR index), and 119.95 and 278.06 (SF ratio), respectively. Time measurement showed that the most significant AUC was recorded before HFNC interruption occurred. Conclusion: Nurses caring for critically ill patients with hematologic neoplasms should closely observe and periodically check patients' breathing patterns. It is crucial to continuously monitor three indexes to ensure that ventilation assistance therapy is started at the right time. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to evaluate the validity and reliability of the Korean version of the Quality of Life in Life-Threatening Illness - Family Carer Version 3 (QOLLTI-F v3) among Korean family caregivers of patients with terminal cancers. Methods: A total of 198 family caregivers of terminal cancer patients were investigated using the Korean version of QOLLTI-F v3. Its psychometric properties were examined in terms of factor structure, convergent validity, discriminant validity, criterion validity and internal consistency. Results: The convergent validity of the Korean version of QOLLTI-F v3 showed that the standardized regression weights for each item were above .50 except for two out of 16 items, the average variance extracted was above .50 for four out of five factors, and the critical ratio ranged from .50 to .85. The discriminant validity of the items across all factors was confirmed. The value for Cronbach's α of 16 items was .84. Conclusion: The Korean version of the QOLLTI-F v3 is a reliable instrument with acceptable convergent and high discriminant validity for measuring the quality of life of families of people with life-threatening illnesses, including families of people with terminal cancers. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate ego integrity, readiness for death, and preferences of care near the end-of-life among hospitalized older adults in long-term care hospitals and identify factors that influence end-of-life care preference. Methods: A total of 181 older adults in long-term care hospitals participated in the study, and data collection was conducted from July 20th, 2020 to September 20th, 2020. Descriptive statistics, t-test, ANOVA, Pearson’s correlations, and multiple regression were used for data analysis. Results: The older adults in hospitalized in long-term care hospitals preferred pain management even at the risk of hastened death, while the least preferred option was autonomous decision-making, including artificially prolonging human life. Regarding end-of-life care preferences, ego-integrity (β=.18, p=.004) and death-readiness (β=.18, p=.005) were factors that only influenced the spiritual domain and in the pain domain, it was confirmed that only the ego-integrity (β=.16, p=.013) was affected. Conclusion: Although ego integrity and readiness for death did not affect all areas of end-of-life care preference among older adults in long-term care hospitals, they represent significant variables denoting positive acceptance of death and life satisfaction. As such, it is necessary to provide various opportunities for these factors to be considered in the overall process of aging. Furthermore, it has been confirmed that other variables can influence each subdomain of end-of-life care preference. Therefore, nurses should support hospitalized older adults in receiving end-of-life care according to their preferred domains. [ABSTRACT FROM AUTHOR]

This paper examines the legislative discussion of the Life-sustaining Treatment Decision Act, from the Supreme Court precedent in 2009 to the enactment of the Act in 2016. We examines what discussions were made for each issue and whether the decision was maintained or why it was suddenly omitted or changed. Considering the object of terminal stage of life and death, where different disciplines and practical fields overlap, this paper identifies how issues in the enactment discussion are interpreted, manipulated, and defined in order to reach agreement at each stage of discussion. Due to the nature of the legislative discussion in which several subjects repeatedly appear and leave, it is observed that even the concept that was agreed in the previous stage is lost in the next stage. This paper traces how discussions over the past seven years have been proceeded on these issues: people who can withhold or withdraw life-sustaining treatment; how one can decide when a patient is incompetent; the role of the institutional ethics committee; and issues of imposing and exempting responsibility for medical professionals. The authors, who tracked the short history of the published literature, concluded that the future enactment and revision of end-of-life care and death-related legislation requires a discussion structure that allows the entire society to participate in, and requires sufficient information to be generated and delivered as a prerequisite for discussion. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this descriptive survey study was to investigate the relationship between death awareness, life-sustaining nursing stress, end-of-life care competency and performance, and resilience. Additionally, the factors influencing end-of-life care performance by ICU nurses were identified. Methods: Data were collected from one tertiary and two general hospitals in J province from July 1 to July 30, 2022. Nurses working in Intensive Care Units (ICU) for more than three months who had experience in end-of-life care were selected through convenience sampling. A total of 188 responses to the survey were included in the final analysis. An IBM SPSS program was used for the data analysis. Results: Factors impacting end-of-life care performance (with an explanatory power of 31.9%) were as follows: higher knowledge and behavioral competency in end-of-life care, higher relational patterns in resilience, higher levels of death positivity in death awareness, and clinical experience of less than a year compared to that of three to five years were associated with higher end-of-life care performance. Conclusion: These findings point to the urgent need for increasing end-of-life care performance among nurses in clinical practice; therefore, practical strategies must be developed and actively implemented to strengthen relevant competencies and resilience and promote death positivity. Based on these findings, future studies are needed to develop an intervention program to improve the spiritual scope of end-of-life care and verify the effects. [ABSTRACT FROM AUTHOR]

Article 17 (1) 3 of The Act on Decisions on Life-sustaining Treatment for Patients in Hospice and Palliative Care or at the End of Life (hereinafter referred to as the ‘Life-sustaining Medical Determination Act’) was established based on the “patient’s presumptive intention” in the Supreme Court precedent for “the so-called grandmother Kim’s case or patient’s presumptive intention based on patient family statements” in the recommendation of the 3rd National Bioethics Committee. This is because it stipulates a method of confirming the patient’s intention on the premise that the patient’s prior autonomous intention exists. However, the content is quite far from guaranteeing the patient’s right to self-determination in terms of pure autonomy standards or legal principles. The above regulations stipulate that if there is a statement of agreement between two or more of the patient’s family members, it is regarded as the patient’s intention, but it does not have sufficient grounds to view it. Combining the text and clues of the above regulations, it is difficult to erase the impression that it is not just a procedure to estimate the patient’s intention, but to obtain consent from two or more family members. I am in a position that the above regulations should be improved into estimation regulations according to the pure autonomy standard. This is because the current law reflects the family’s values and positions, causing serious problems such as the risk of violating the patient’s right to self-determination and unfairly discriminating against unrelated patients. As a way to improve it, the estimated standards and methods of adult guardians under the German Civil Code are worth referring to. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate the effects of death perception and terminal care stress on terminal care performance of nurses working in long-term care hospitals. Methods: The participants included 160 nurses working in 7 long-term care hospitals with more than 150 beds in Gyeonggi Province. Data collection was conducted from July 12 to August 13, 2021. The independent t-test, Pearson correlation, and multiple linear regression were used for data analysis. Results: Of the participants, 126 (78.8%) were women, and 76 (47.5%) had a religion. The mean total clinical experience was 11.48±9.14 years; 80 (50.3%) participants had been involved in 1-18 terminal care nursing sessions, and 87 (54.4%) had been involved in terminal care nursing education. Gender (β=.17, p=.030) and positive death perception (β=.27, p=.001) affected terminal care performance. Conclusion: A professional and systematic terminal nursing care education program that can facilitate positive death perceptions of hospital nurses is needed, and it is necessary to prepare a specialized system that considers nursing hospitals’ characteristics. In addition, research on terminal care performance targeting male nurses in hospitals and the effects of the working environment and health care system of hospitals on the terminal care performance of hospital nurses is suggested. [ABSTRACT FROM AUTHOR]

The purpose of this study was to identify factors related to the end-of-life care competency of long-term-care hospital nurses. Methods: This study was conducted from June 1 to 29, 2021. Data were collected from 191 nurses working in 10 long-term hospitals using a structured self-reported questionnaire. Data were analyzed using SPSS/WIN 25.0 program by descriptive statistics, t-test, ANOVA, Pearson's correlation coefficient, and multiple linear regression. Results: As a result of multiple linear regression analysis, the factors affecting end-of-life care competency were empathy competency (β=.46, p<001), frequency of supportive behaviors for end-of-life care (β=.19, p=.005), position (β=.19, p=.002), and religion (β=.14, p=.031). This regression model was explained by 35.5% of variances in end-of-life care competency. Conclusion: To improve the quality of life and death of older adults at the end of their life, strategies are needed to identify and reinforce end-of-life care-support behavior factors and improve end-of-life care competency by improving empathy competency. [ABSTRACT FROM AUTHOR]

This study aimed to identify the relationship between death anxiety, knowledge, and attitudes toward advance directives in middle-aged patients with acute myocardial infarction. Methods: Data were collected through a survey of 142 middle-aged adults from August 27th to October 4th, 2019 in G city. Data analysis was performed using descriptive statistics, t-test, one-way ANOVA, Scheffétest, and Pearson correlation coefficient. Results: The average score of participants’ death anxiety and attitudes toward advance directives was 44.14± 6.71 and 43.61±3.53, respectively, and the average correct rate in knowledge of advance directives was 57.1%. Participants showed significant differences in death anxiety (F=3.75, p=.013), knowledge of advance directives (F=3.02, p=.033), and attitudes toward advance directives (t=2.31, p=.022) depending on the presence or absence of an object to discuss their health status. Also, there were significant differences in knowledge of advance directives (t=3.43, p=.001) and attitude toward advance directives (t=2.23, p=.027) depending on whether participants perceived the meaning of advance directives. There were positive correlations (r=.38, p<.001) between knowledge of advance directives and attitudes toward advance directives in middle-aged patients with acute myocardial infarction. Conclusion: Active information-provision and promotional strategies are needed to enhance a correct understanding of advance directives for middle-aged acute myocardial infarction patients with a high probability of sudden death to recognize the need for an advance directive and reinforce a positive attitude. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate the practical process and barriers of end-of-life nursing practice for older patients in long-term care hospitals by exploring nursing experts’ actual experiences. Methods: Qualitative data were collected through focus group interviews with 9 nurses in 3 different long-term care hospitals from April to May, 2019. All interviews were recorded and transcribed verbatim and analyzed using the content analysis method. Results: Five themes and 14 sub-themes emerged for nurses’ perception regarding end-of-life nursing practice in long-term care hospitals, whereas three themes and 10 sub-themes emerged for the barriers of end-of-life nursing practices. The results show that the end-of-life nursing practice is currently considered an additional area beyond nurses’ existing work in long-term care hospitals and the area of performance is focused almost exclusively on physical care. The care is especially lacking in psychological and spiritual areas. Moreover, aspects of practice vary by institutions, day or night shifts and individuals. Various factors that hinder nurses’ performances of end-of-life care are identified in the areas such as ignoring patients’ dignity, an underdeveloped system and lack of supportive environment. Conclusion: Findings of this study suggest the need to establish standardized protocols for end-of-life nursing care in long-term care hospitals and develop educational programs based on those protocols. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated the difficulties in end-of-life care and end-of-life care competency in nurses who take care of cancer patients. Methods: In the mixed method, a structured questionnaire on end-of-life care stress and competency was conducted on 115 nurses caring for cancer patients, and 19 were interviewed for qualitative research. For the collected quantitative data, descriptive statistics were used. For the qualitative study, the contents of the interview were summarized and systematized using the content analysis method to derive the main themes. Results: The mean end-of-life care stress was 4.08 points (out of 5) and the mean end-of-life care competency was 3.43 points (out of 5). Four themes and 11 sub-themes for the difficulties in end-of-life care were identified, and the four themes are as follows: (1) regret over limited end-of-life nursing, (2) different aspects of persistent emotional distress, (3) overloaded duty at the end-of-life (4) conflicts encountered in decision-making for life-sustaining treatment. Four themes and eight sub-themes for end-of-life care competency were identified, and the four themes are as follows: (1) empathy and listening skills, (2) communication skills, (3) clinical nursing experience and education, (4) clinical nursing competency. Conclusion: It was confirmed that nurses caring for cancer patients had a high level of end-of-life care stress, and it is necessary to develop a program to reduce difficulties in end-of-life care and increase end-of-life care competency. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to distinguish and describe the types of perceptions of do not resuscitate (DNR) proxy decisions among families of elderly patients in a long-term care facility. Methods: This exploratory study applied Q-methodology, which focuses on individual subjectivity. Thirty-four Q-statements were selected from 130 Q-populations formed based on the results of in-depth interviews and literature reviews. The P-samples were 34 families of elderly patients in a long-term care hospital in Busan, Korea. They categorized the Q-statements using a 9-point scale. Using the PC-QUANL program, factor analysis was performed with the P-samples along an axis. Results: The families' perceptions of the DNR proxy decision were categorized into three types. Type I, rational acceptance, valued consensus among family members based on comprehensive support from medical staff. Type II, psychological burden, involved hesitance in making a DNR proxy decision because of negative emotions and psychological conflict. Type III, discreet decisions, valued the patients' right to self-determination and desire for a legitimate proxy decision. Type I included 18 participants, which was the most common type, and types II and III each included eight participants. Conclusion: Families' perceptions of DNR proxy decisions vary, requiring tailored care and intervention. We suggest developing and providing interventions that may psychologically support families. [ABSTRACT FROM AUTHOR]

Purpose : Based on Quint's theory and the relevant literature, this study constructed a structural equation model for explaining and predicting end-of-life care performance in clinical nurses. Methods: A self-administered questionnaire was used to collect data from 265 nurses between September 1 and September 30, 2016. The data were analyzed using SPSS ver. 21 and AMOS ver. 21. Results: The goodness of fit of the modified model was found to be relatively satisfactory (χ²=114.82, Nomed χ²(χ²/df)=2.44, SRMR=.06, GFI=.94, AGFI=.89, CFI=.95, TLI=.91, RMSEA=.07). End-of-life care performance was affected by the attitudes toward nursing care of the dying, working unit, and death anxiety. The attitudes toward such care had the highest effect on end-of-life care performance. Conclusion : The results suggest that end-of-life care performance is directly and indirectly affected by attitudes toward nursing care of the dying, participation in end-of-life care education, working unit, death perception, and death anxiety. To improve clinical nurses' end-of-life care performance, effective programs to promote death anxiety and attitudes toward nursing care of the dying need to be developed. In addition, hospital nursing organizations should attempt to produce concrete measures for death anxiety and terminal care attitudes in clinical nurses. [ABSTRACT FROM AUTHOR]

The Act on Decisions on Life-Sustaining Treatment for Patients in Hospice and Palliative Care or at the End of Life came into effect on February 4th, 2018, in South Korea. Based on the Act, all Koreans over the age of 19 years can decide whether to refuse life-sustaining treatments at the end of life via advance directive or physician orders. Hemodialysis is one of the options designated in the Act as a life-sustaining treatment that can be withheld or withdrawn near death. However, hemodialysis has unique features. So, it is not easy to determine the best candidates for withholding/withdrawing hemodialysis at the end of life. Thus, it is necessary to investigate the meaning and implications of hemodialysis at the end of life with ethical consideration of futility and withholding or withdrawal of intervention.

With the enactment and enforcement of the Act on decisions on life-sustaining treatment for patients in hospice and palliative care or at the end of life, life-sustaining treatment decisions were institutionalized in our society. The law has a system of proxy decision-making in case the patient's intention cannot be verified, but there is no system for proxy decision-making for patients without surrogate as it is limited to consensus of all family members. Among the current systems for proxy decisionmaking for patients without surrogate are the Institutional Ethics Committee, adult guardianship, and the health care proxy that will be discussed in the future. But the above system has limitations that cannot be a practical alternative at the moment. A more important issue than who makes proxy decisions would be specific measures to ensure that they are in the best interests of the patient. Therefore, the UK's Independent Mental Capacity Advocate, which supports important decision-making on the treatment and care of the incompetent, is very useful. This system is designed to support decisions that meet the patient's best interests, and it can be said to be an independent spokesman representing the interests of the incompetent, which provides specific measures and procedures that represent the patient's interests, which can be useful in our legal system [ABSTRACT FROM AUTHOR]

Purpose : The purpose of this study was to identify the extent to which nurses' death perceptions, death anxiety, and stress associated with terminal care affects their attitudes toward terminal care. Method : A total of 214 nurses were asked questions about characteristics, death perceptions, death anxiety, stress associated with end-of-life care, and terminal care attitudes, using structured questionnaires. The data were analyzed using descriptive analysis, t-test, ANOVA, Scheffé's test, Pearson's correlation coefficients, and stepwise multiple regression. Results : Factors influencing terminal care attitudes in participants were positive meaning associated with death, respect for life, final education, end-of-life nursing education experiences, stress associated with end-of-life care, death anxiety, and position. These factors explained 38.7% of variance in participants' terminal care attitudes (F=20.18, p<.001). Conclusion : In order for nurses to have a positive attitude toward terminal care, it is necessary to raise positive awareness about death and respect for life, and it is necessary to develop various educational programs and strengthen their capacity through continuous education. [ABSTRACT FROM AUTHOR]

Purpose : This integrative review aimed to synthesize studies on intensive care unit (ICU) nurses' attitude, perceptions, and experiences toward end-of-life care decision-making. Methods : Using Whittermore and Knafl (2005)'s methods, we identified and synthesized research articles published in domestic journals between the years 2003 and 2019 and evaluated the quality of selected articles using the Mixed Methods Appraisal Tool. Results : In the 13 studies reviewed, 12 were published prior to enactment of the "The Act for Hospice and Palliative Care and Decision-Making about Life-Sustaining Treatment (2018)." All nine quantitative studies identified were based on cross-sectional descriptive survey. In four qualitative studies, content analysis (n=2) and phenomenology (n=2) were used. Overall, ICU nurses were well-aware of the necessity of communicating and limiting life-sustaining treatments. Many ICU nurses had positive attitude towards limiting life-sustaining treatments to promote patients' comfort and dignity. Although nurses were willing to take active roles, they also reported having experienced high stress in the process of decision-making and implementation. Conclusions : It is important to prepare ICU nurses with proper knowledge and attitude regarding the topic area. It is also equally important to develop systems to support nurses' emotional stress and moral distress during communication, decision-making, and implementation. [ABSTRACT FROM AUTHOR]

Chemotherapy is essential treatment in pancreatobiliary cancer patients. Knowing optimal time of chemotherapy initiation is important. Usually good performance status and general condition without jaundice is first recommendation for initiating chemotherapy. Good performance status is defined as Eastern Cooperative Oncology Group 0-1, with good biliary drainage and adequate nutritional intake. Percutaneous or endoscopic biliary drainage is recommended before chemotherapy in patient who shows high bilirubin level. The optimal timing of chemotherapy after diagnosis is not standardized but guideline recommends chemotherapy less 2 months after initial cancer diagnosis. Regard to chemotherapy response evaluation, Response Evaluation Criteria in Solid Tumors criteria is used per 2-3 months. Response Evaluation Criteria in Solid Tumors criteria evaluate the chemotherapy responsiveness. With regular tumor response, clinicians must determine whether patient can undergo chemotherapy continuously without complication. For example, Eastern Cooperative Oncology Group 3 or poor general condition make patient not to undergo chemotherapy and focus on end-of-life care. As a result, knowing about the start and stop of chemotherapy can help relieve the patient's symptoms, prolong survival and improve the quality of life. [ABSTRACT FROM AUTHOR]

This study is a descriptive research study that examines the level of terminal care nursing care and the effects on terminal nursing in the internal and external control beliefs of nurses in the nursing geriaic hospital.. The subjects consisted of 442 nurses, and data were collected through structured questionnaires.. The data were analyzed with descriptive that used SPSS WIN 22.0, and AMOS 5.0 statistical program was hypothetical model and path analysis of research hypothesis. As a result, terminal care of geriatric hospital nurses was statininificant to the terminal care stress, fatigue and locus of internal & external control. and the higher the internal control belief, the less stress of the terminal care and the higher the terminal care performance As a result, this study providers a more terminal care performance, It is considered that nursing hospital nurses who develop strategic programs and terminal care nursing will need to provide quality nursing education and work environment improvement. [ABSTRACT FROM AUTHOR]

Purpose: The Act on Hospice and Palliative Care and Decisions on Life-sustaining Treatment for Patients at the End of Life was enacted in 2016 and has taken effect since 2018 February. The content of this act was based on Physician Orders for Life-Sustaining Treatment (POLST) in the United States and we modified it for terminal cancer patients registering hospice. The object of this study is to investigate preference and implementation rate for modified Korean POLST (MMK-POLST) items in hospice ward. Methods: From February 1, 2017 to April 30, 2019, medical records regarding MMK-POLST were retrospectively analyzed for all patients hospitalized in the hospice ward of Gyeongsang National University Hospital. Results: Of the eligible 387 total cohorts, 295 patients filled out MK-POLST. MK-POLST has been completed in 133 cases (44.1%) by the patient themselves, 84 cases (28.5%) by the spouse, and 75 cases (25.4%) by their children, respectively. While only 13 (4.4%) out of 295 MKPOLST completed patients refused the parenteral nutrition and 5 patients (1.7%) for palliative sedation, the absolute majority of 288 (97.6%) patients did not want cardiopulmonary resuscitation (CPR) and ventilators and 226 people (76.9%) for pressor medications. Kappa values for the matched strength of MK-POLST implementation were poor for all items except CPR, ventilators and palliative sedation. Conclusion: Hospice patients refused to conduct cardiopulmonary resuscitation, ventilators and pressor agents. In contrast, antibiotics, parenteral nutrition and palliative sedation were favored in the majority of patients. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate the relationship between end of life care competencies and terminal care stress of nurses in long term care hospitals. Methods: For this study, 140 nurses were sampled among those that have over 6-month end of life care experience and were working at long term care hospitals located in A city and C city of Chungcheongnam-do. Using a questionnaire, data were collected from January 2018 through March 2018. Data were analyzed using the SPSS, Windows version 21.0, according to the purpose of the study and analyzed by descriptive statistics, t-test, one way ANOVA, Schéffe's test, and Pearson's correlation coefficient. Results: The mean score on terminal care stress of nurses was above the normal level. The scores on end of life care competencies significantly varied by age, total career at hospitals, death/hospice and palliative care education, and bereavement experience. The mean score of end of life care competencies was negatively correlated with the mean score of lack of knowledge and skills among the subitems of the terminal care stress category (r=-0.260, P=0.002). Conclusion: To decrease the terminal care stress of long term care hospital nurses, it is suggested to carry out end of life care education tailored to nurses' characteristics. [ABSTRACT FROM AUTHOR]

This study aims to examine eligibilities, services and delivery of services for the current end-of-life care and analyze the quality control of services for end-of-life care. We analyzed the literature and laws on end-of-life systems in Korean and the United States. Current end-of-life care, hospice and palliative care in Korea is being provided mainly in hospital setting. Quality control for the services focuses on setting the criteria for structures in hospitals (i.e. staffing, facilities and equipment). Whereas American end-of-life care system has much broader eligibility for service beneficiaries and provides care mostly at home. Also quality control for services includes process (delivering service) and outcomes, such as monitoring performance indicators and consumer’s satisfaction. This is linked to annual payment. The comparative analysis findings contributed to give the next direction of current Korean end-of-life care system. It is nessary to establish the better and extensive end-of-life care system in Korea in considering other countries’ end-of-life care systems based on more future research. [ABSTRACT FROM AUTHOR]

Purpose: This study was done to examine good death awareness, attitudes toward advance directives (ADs), and preference for care near the end-of-life (PCEOL) of hospitalized elders in long-term care hospitals. Relevant characteristics were investigated as well as correlation of the variables. Methods: This descriptive research study involved 161 hospitalized elderly patients in long-term care hospitals. A self-report questionnaire was used to measure Good Death Scale, ADs Survey, PCEOL Scale, and general characteristics. Collected data were analyzed using descriptive statistics, t-test, ANOVA, and Pearson correlation with SPSS/WIN 23.0. Results: In terms of good death awareness, a significant difference was observed; in according to age (F=3.35, p=.037), payer of treatment costs (F=3.98, p=.021), mobility (F=3.97, p=.021), heard discussion about ADs (t=-3.89, p<.001), and willing to complete ADs (t=2.12, p=.036). As far as attitudes toward ADs, the participants presented significant difference depending on religion (t=2.38, p=.018), average monthly income (F=3.91, p=.022), duration of hospital admission (F=5.33, p=.006), person to discuss ADs (t=-2.76, p=.006). On PCEOL, there was a significant difference, depending on religion (t=-3.59, p<.001) and perceived health status (F=3.93, p=.022). Finally, as for how the variables were related to each other, good death awareness and attitudes toward ADs had a weak positive correlation with PCEOL. Conclusion: To help seniors staying in nursing homes face a good death and enjoy autonomy, there should be educational and support systems that reflect each individual's sociodemographic characteristics so that the seniors can choose what kind of care they want to receive near the end-of-life. [ABSTRACT FROM AUTHOR]

It is natural for all human beings to die; hence, death is an inevitable event. However, advances in medical technology are changing the meaning of natural death. These advanced treatments provide the capability to intervene at the time of death and to reshape the circumstances around natural death, by sustaining human life. However, it is extremely difficult to judge when treatment is futile for the patient's best interests. It is therefore recommended to make time to discuss the concept of medical futility during the course of caring for a critically ill patient. Despite the expectations and efforts of the patient, the patient's family, and medical staff, the patient will eventually, have a 'hopeless' medical condition. Most discussions about decision-making in end-of-life treatment have neen ethical debates focused on the patient's self-determination and best interest in the context of concepts such as euthanasia or death with dignity. However, such discussions are insufficient for resolving the wide variety of circumstances that occur in clinical settings. Instead, the various ethical dilemmas inherent to end-of-life care should be approached by educating medical teams, patients, and their families about how to recognize medical futility. Furthermore, it is important to optimize the balance between the rights of patients and the responsibility of physicians. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to identify the difficulties with end-of-life care (EOLC) experienced by intensive care unit (ICU) nurses and to investigate their educational needs for EOLC. Methods: Mixed methods were used to survey ICU nurses at a university hospital. Quantitative data (N=106) were collected through a questionnaire and analyzed using an independent samples t-test, ANOVA, Mann-Whitney U test and Scheffé test. Qualitative data (N=19) were collected through focus group interviews and analyzed through qualitative content analysis. Results: The mean score on the difficulty of EOLC was 3.41 out of 5. The education needs derived from the qualitative analysis was categorized into four themes: 1) guidelines on professional EOLC, 2) spiritual care, 3) a program to take care of feelings of patients, families and nurses, and 4) activities to think about death. Conclusion: This study confirmed that ICU nurses were experiencing an extreme difficulty in providing EOLC. In addition, a qualitative analysis confirmed that they needed an EOL nursing program. To mitigate the difficulties experienced by nurses involved in EOLC, there is an urgent need to develop an education program for EOLC tailored to nurses' needs. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to confirm the influence of hematoonchology unit nurses' positive psychological capital and death awareness on their terminal care performance. Methods: This descriptive study data were collected from self-reported questionnaire filled by 127 oncology nurses at a tertiary hospital in Seoul, Korea. The variables were positive psychological capital, death awareness, and terminal care performance. Data were analyzed using SPSS version 22.0 software. Results: The participants scored 3.93±0.83 on positive psychological capital, 3.68±0.99 on death awareness and 2.86±0.65 on terminal care performance. The three variables were positively correlated. The factors affecting the nurses' terminal care performance were hope and resilience in the subcategory of positive psychological capital and experience of death of family members, relatives or friends within the past year; The explanatory power was 32.1%. Conclusion: It is necessary to develop educational programs to foster hope, resilience, etc. in hematooncology unit nurses to improve their quality of terminal care performance. [ABSTRACT FROM AUTHOR]

For hospice palliative care that provides comprehensive and general care, it is necessary to use assessment tools to objectively list issues and detail care plans. The initial assessment is a process of establishing an overall direction of care by identifying the patient's symptoms, social and spiritual issues and palliative care needs on the admission day or within one day of admission. This process is also used to identify the patients' and families' awareness of the illness, prognosis, treatment options and if the Physician Orders for Life-Sustaining Treatment (POLST) has been drafted. Consisting of 13 simple questions regarding the physical, mental, social, and spiritual domains, the Needs at the End-of-Life Screening Tool (NEST) is recommended as an initial assessment tool. Using specific assessment tools, a care plan is established for the issues identified in the initial assessment within three days of admission. A multidisciplinary assessment tool can be helpful in the physical domain. The psychosocial domain evaluates psychological distress, anxiety and depression. The social domain examines an ability to make decisions, understanding of the socioeconomic circumstance, family relationship, and death preparedness. A spiritual evaluation is also important, for which the Functional Assessment of Chronic Illness Therapy-Spiritual WellBeing Scale (FACIT-Sp) or the Spiritual Health Inventory (SHI) can be used. The use of an assessment tool could not only contribute to pain mitigation a better quality of life for patients, but also provide systematic training for a multidisciplinary team; And the process itself could be a stepping stone for the better care provision. [ABSTRACT FROM AUTHOR]

Purpose : The purpose of this study was to identify the extent to which intensive care unit (ICU) nurses' perceptions of life-sustaining treatment decisions and "a good death" affect attitudes toward terminal care. Method : Participants included 109 ICU nurses from three university hospitals. Data were collected using structured questionnaires, and collected data were analyzed using a t-test, ANOVA, the Scheffé test, Pearson correlation coefficients, and a multiple regression analysis (SPSS 24.0 program). Results : Perceptions of life-sustaining treatment decisions and a sense of closeness (a constituent for the awareness of "a good death") were positively correlated with terminal care attitudes. The factors affecting terminal care attitudes were a clinical career in ICU (β =.20, p=.035), a sense of closeness(β =.19, p=.041), and the perception of a lifesustaining treatment decision (β =.22, p=.017). This finding indicates that more than 10 years of experience in ICU, a greater sense of closeness, and a higher view of life-sustaining treatment decisions results in more positive attitudes toward terminal care. The explanatory power of these variables on terminal care attitudes was 14% (F=6.84, p< .001, Adj R2=.140). Conclusion : A sense of closeness and the perception of life-sustaining treatment decisions were identified as the factors affecting terminal care attitudes. Thus, various programs must be developed to raise awareness among ICU nurses of "a good death" and perceptions of life-sustaining treatment decisions. [ABSTRACT FROM AUTHOR]

Purpose: This study was performed to investigate the current status of pediatric palliative care provision and how it is perceived by the palliative care experts. Methods: A descriptive study was conducted with 61 hospice institutions. From September through October 2017, a questionnaire was completed by experts from the participating institutions. Data were analyzed using SPSS 21.0. Results: Among 61 institutions, palliative care is currently provided for pediatric cancer patients by 11 institutions (18.0%), all of which are concentrated in Seoul, Incheon and Gyeonggi and Gyengsang provinces; 85.2% of all do not plan to provide specialized pediatric palliative care in the future. According to the experts, the main barriers in providing pediatric palliative care were the insufficient number of trained specialists regardless of the delivery type. Experts said that it was appropriate to intervene when children were diagnosed with cancer that was less likely to be cured (33.7%) and to move to palliative care institutions when their conditions worsened (38.2%); and it was necessary to establish a specialized pediatric palliative care system, independent from the existing institutions for adult patients (73.8%). Conclusion: It is necessary to develop an education program to establish a nationwide pediatric palliative care centers. Pediatric palliative care intervention should be provided upon diagnosis rather than at the point of death. Patients should be transferred to palliative care institutions after intervention by their existing pediatric palliative care team at the hospital is started. [ABSTRACT FROM AUTHOR]

Purpose: This descriptive study is aimed at identifying how nursing hospital workers' performance of end-of-life care is influenced by their knowledge and awareness of hospice palliative care, attitude towards end-of-life care, performance, importance, awareness of death and the factors. Methods: A self-reported questionnaire was used to collect data from 113 workers at an accredited nursing hospital in K province. Variables were their knowledge and awareness of hospice palliative care, attitude towards end-of-life care, endof- life care performance and importance and awareness of death. An analysis was performed with the frequency, percentage, mean, standard deviation, t-test, ANOVA, Scheffe's test, Pearson's correlation coefficient and multiple regression using IBM SPSS 21.0. Results: The factors affecting the nursing hospital workers' end-of-life care performance were the importance of end-of-life care and their marital status, which showed an explanatory power of 38.2%. Conclusion: In order to improve the nursing hospital workers' end-oflife care performance, a training on the importance of end-of-life care should be provided. Therefore, we would like to propose establishing administrative measures such as 1) efficient staffing to help the caregivers better perform what they think is important, 2) development of a training program that can improve their performance of end-of-life nursing care and 3) a study to verify the effectiveness of the program. [ABSTRACT FROM AUTHOR]

Purpose: This study was done to examine the effect on turnover intention (TI) of terminal care stress (TCS) on nurses working in long-term care hospitals (LCH). Methods: Participants were 182 nurses from 6 Seoul LCH. Data were collected from October to December, 2017. Self-report questionnaires were used to collect data on general characteristics, TCS, and TI. Results: Subjective satisfaction on the job (r=.52, p<.001), number of monthly terminal care elders (r=.16, p=.043), TCS (r=.16, p=.027), and sub-categories of TCS, ‘difficulty for assigning timetable to care for terminally ill patients’ (r=.17, p=.025), ‘feeling a burden of caring for terminally ill patients’ (r=.23, p=.002), and ‘conflict with terminally patients’ (r=.16, p=.034) showed statistically significant correlation with TI. Multiple regression analysis showed significant influence of subjective satisfaction with job (β=.52, p<.001) and TCS (β=.23, p=.001) with a 30.3% explanatory power. When sub-categories of TCS were entered, subjective satisfaction with the job (β=.50, p<.001) and ‘feeling burden of terminally ill patients’ (β=.28, p<.001) were factors significantly influencing TI with explanatory power of 32.8%. Conclusion: Findings of this study suggest that it is needed to develop standardized practice guidelines and educational programs for terminal care in LCH as well as stress healing programs for nurses. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to understand the mechanisms of decision regret and stress of family surrogates' end-of-life decision making using an exploratory path model. In particular, the research identified the direct effects of perceptions of uncertainty and effective decisions on decision regret and stress, and examined the indirect effects of being informed, having clear values, and being supported for decision regret and the stress of end-of-life decision making through the mediating variables of perceptions of uncertainty and effective decisions. Methods: Data were collected from 102 family surrogates who had participated in end-of-life decision making for patients with terminal cancer in a tertiary hospital. Results: Perception of effective decisions was a significant direct predictor of decision regret, and uncertainty was a significant predictor of stress among the participants. Being informed, having clear values, and being supported had a significant indirect influence on decision regret through the perception of effective decisions among family surrogates. However, only having clear values had a significant indirect influence on stress through the perception of uncertainty. The model explained 63.0% of decision regret and 20.0% of stress among the participants and showed a good fit with the data, χ²=12.40 (df=8, p=.134), TLI=.97, and RMSEA=.07. Conclusion: Nurses can support family surrogates in end-oflife decision-making processes to decrease their decision regret by providing information about end-of-life care choices, clarifying personal values, and supporting the decision-making process, and to relieve their stress by facilitating the clarification of personal values. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to identify stress levels due to end-of-life care, coping strategies, and psychological well-being among nurses in neonatal intensive care unit, and to investigate the effect of stress levels and coping strategies on their well-being. Methods: A total of 128 nurses in the neonatal intensive care units of general hospitals in B city participated. The data were collected using a self-report questionnaire. The collected data were analyzed using descriptive statistics, the t-test, ANOVA, the Pearson correlation coefficient, and hierarchical regression with SPSS version 22.0. Results: The coping strategy that nurses most often used was seeking social support. The factors affecting the well-being of the participants were wishful thinking, problem-focused coping and seeking social support, in order. Those 3 variables explained 21 % of the total variance in psychological well-being. Problem-focused coping and seeking social support were positively associated with psychological well-being, while wishful thinking showed a negative association. Conclusion: In order to improve the psychological well-being of nurses in neonatal intensive care units, it is necessary to provide nurses with a program to build a social support system and to improve their problem-based coping skills. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate pediatric nurses' perceptions regarding in end-of-life care and turnover intention. Methods: A cross-sectional descriptive study was performed among 111 hospital nurses. Pediatric nurses' perceptions of obstacles and supportive behaviors were measured using the Pediatric Nurses' Perceptions of End of Life Care Questionnaire which was translated into Korean and turnover intention was measured using the Korean Nurse Turnover Intention Scale (K-NTIS). Results: The supportive behavior with the highest perceived magnitude was 'Physicians who are compassionate, but very clear about prognosis.' The obstacle with the highest perceived magnitude was 'Instigating painful treatments when there is no hope of recovery.' Pediatric nurses' perceptions of obstacles in end-of-life care showed statistically significant differences depending on whether nurses received end-of-life care education (t=2.02, p=.046). The perception of obstacles in end-of-life care was positively correlated with turnover intention (intensity r=.28, p=.002) (frequency r=.20, p=.027). Conclusion: These results suggest that pediatric nurses' perception of obstacles and supportive behaviors in end-of-life care need to be assessed when considering turnover intention. Furthermore, psychological counseling should be offered to nurses to prevent burnout and reduce moral distress which is correlated with the turnover rate. [ABSTRACT FROM AUTHOR]

In Korea, the Hospice, Palliative Care, and Life-sustaining Treatment Decision-making Act was enacted in February 2016 in order to ensure that the patient's self-determination in end-of-life care processes is respected. To enhance physicians' understanding of this act and to provide proper criteria for medical judgment in variety of clinical settings, consensus guidelines were published in November 2016. In this article, the characteristics of these guidelines and related issues regarding the definitions of 'the end stage of disease' and 'last days of life' and the criteria for medical judgment are presented and summarized. According to the guidelines, the term 'end stage of disease' refers to a state in which there is no possibility of a fundamental recovery and the symptoms are expected to worsen within months. The terms 'the last days of life' and 'the final days of life' refer to a state in which, despite treatment, the patient's condition is worsening and death is impending, with no possibility of recovery. The attending physician and another relevant specialist should both judge a patient's medical condition as either 'end stage of disease' for hospice/palliative care or 'the last days of life' for dying patient care according to the law. Caregivers should provide appropriate medical information to eligible patients for palliative or 'end stage of disease' care through advance care planning. Therefore, it is critically necessary that caregivers understand the legitimate process of hospice/palliative and dying patient care based on the patient's wishes and best interests. Physicians should apply these consensus guidelines to eligible patients considering their clinical course and the patients' wishes. [ABSTRACT FROM AUTHOR]

Purpose: End-of-life (EoL) decisions are challenging and multifaceted for patients and physicians. This study was aimed to explore how EoL care is practiced for patients with a do-not-resuscitate (DNR) order. Methods: We retrospectively analyzed medical records of patients who died after agreeing to a DNR order in 2016 at a university hospital. Characteristics including cause of death, intensity of EoL care, and other factors were reviewed and statistically analyzed. Results: Of total 375 patients, 170 patients (45.3%) died with malignancies, and 205 patients (54.6%) with other causes involving the central nervous system (19.2%), pulmonary (14.7%), cardiologic (6.7%) and infectious (6.4%) conditions. Both the cancer and non-cancer patient groups showed a short duration from DNR to death (median 3 days vs 2 days, P=0.629). An intensive care group comprising patients who received one or more intensive treatments such as ventilator (n=205) showed a higher number of non-cancer patients and a shorter duration from DNR to death than a group that withheld treatment before DNR (P<0.05). Conclusion: EoL decisions were made very late by both cancer and non-cancer patients. About half of the patients did not have cancer, and twothirds of them decided DNR during intensive treatment. To make a good EoL decision, a shared decision making with patients should be done at an earlier stage. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to develop an in-depth and comprehensive understanding of the experiences of critical care nurses caring for dying patients. Method: Eleven critical care nurses with experience in caring for dying patients were recruited from four tertiary hospitals. Semi-structured face-to-face interviews were conducted between November 2016 and March 2017. The transcribed data were analyzed using qualitative content analysis to identify major themes and sub-themes that represented the experiences of critical care nurses. Results: The following six themes, and twelve sub-themes, were identified: (1) the gap between expectation and reality, (2) a distorted meaning of death, (3) repeated emotional pain and stress, (4) finding a solution alone, (5) sublimation into mission and calling, and (6) integration into one's own life. Conclusion: This study found that critical care nurses experience various psychological difficulties while caring for dying patients, and they made efforts on their own to overcome them. These findings are expected to inform the development of specialized programs to support critical care nurses to tackle these challenges, create guidelines on caring for dying patients, and help promote death education. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate variables and construct paths that affect complicated grief. Methods: Participants in this cross-sectional, descriptive study were 164 bereaved spouses of cancer patients at least 12 months before the death. Data were collected from October 2016 to February 2017 using self-report structured questionnaires and were analyzed using IBM SPSS 21.0 and AMOS 20.0. Results: The variables affecting complicated grief of bereaved spouses of cancer patients were the quality of end-of-life care (g=.15, p<.001), preparedness for death (b=-.06, p=.005), and coping with bereavement (b=-.24, p<.001), whereas the quality of death and dying did not show any effects. Preparedness for death had multiple mediating effects in the relationship between the quality of end-of-life care and complicated grief (z=-2.20, p=.028), and in the relationship between the quality of end-of-life care and coping with bereavement (z=2.11, p=.035). Coping with bereavement had a mediating effect on the relationship between preparedness for death and complicated grief (z=-2.39, p=.017). Conclusion: This study revealed that preparedness for death and coping with bereavement play a prominent role in complicated grief. Therefore, it is important to help in preparing for death and enhancing coping with bereavement of spouses providing end-of-life care to cancer patients. In addition, investigating cultural differences in the relationship between the quality of end-of-life care and complicated grief is recommended. [ABSTRACT FROM AUTHOR]

Purpose: To develop end-of-life care training programs for nurses who provide in a tertiary hospital, we examined the mediating effects of empathy and resilience on the relationship between their stress and job performance. Methods: This study was conducted with 218 participants at a hospital in B city in South Korea from August 15 through August 30, 2017. Data collected from the participants were analyzed using descriptive statistics, t-test, ANOVA, Pearson's correlation coefficients, and multiple regression using the IBM SPSS/WIN 21.0 software. Results: Terminal care stress was found to be negatively correlated with empathy competence (r=-0.345, P< 0.001), resilience (r=-0.223, P=0.001) and terminal care performance (r=-0.260, P<0.001), whereas empathy (r=0.467, P<0.001) and resilience (r=0.358, P<0.001) were positively correlated with terminal care performance. Empathy had a complete mediating effect (β=0.409, P<0.001) on the relationship between terminal care stress and performance, and resilience a partial mediating effect (β=0.294, P<0.001). Conclusion: Based on the findings of this study, development of training programs with a focus on empathy and resilience are highly recommended to improve job performance of nurses who provide terminal care in a tertiary hospital. [ABSTRACT FROM AUTHOR]

Purpose: This study was conducted to identify effects of debriefing based on the clinical judgment model for nursing students on their knowledge, skill performance, clinical judgment, self-confidence and learner satisfaction during simulation based end-of-life care (ELC) education. Methods: Simulation based ELC education was developed in six steps as follows: selection of learning subjects and objects, development of learning tools, a trial run of simulation-based education, students' skill training, and evaluators' training. Forty-eight senior nursing students (25 in the experimental group and 23 in the control group) participated in the simulation-based ELC education using a high-fidelity simulator. Debriefing based on the clinical judgment was compared with the usual debriefing. Results: ANCOVA showed that there were differences in knowledge (F=4.81, p=.034), skill performance (F=68.33, p<.001), clinical judgment (F=18.33, p<.001) and self-confidence (F=4.85, p=.033), but no difference in satisfaction (t=-0.38, p=.704) between the experimental and control groups. Conclusion: This study found that debriefing based on the clinical judgement model is effective for supporting nursing students for reflecting on clinical judgment and improving their diverse competencies in complex clinical settings such as ELC. [ABSTRACT FROM AUTHOR]

BACKGROUND: Many terminally ill patients die while receiving life-sustaining treatment. Recently, the discussion of life-sustaining treatment in intensive care units (ICUs) has increased. This study is aimed to evaluate the current status of medical decision-making for dying patients. METHODS: The medical records of patients who had died in the medical ICU from March 2011 to February 2012 were reviewed retrospectively. RESULTS: Eighty-nine patients were enrolled. Their mean age was 65.8 +/- 13.3 years and 73.0% were male. The most common diagnosis was acute respiratory failure, and the most common comorbidity was hemato-oncologic malignancy. Withdrawing or withholding life-sustaining treatment including do-not-resuscitate (DNR) orders was discussed for 64 (71.9%) patients. In almost all cases, the discussion involved a physician and the patient's family. No patient wrote advance directives themselves before ICU admission. Of the patients for whom withdrawing or withholding life-sustaining treatment was discussed, the decisions were recorded in formal consent documents in 36 (56.3%) cases, while 28 (43.7%) cases involved verbal consent. In patients granting verbal consent, death within one day of the consent was more common than in those with formal document consent (85.7% vs. 61.1%, p < 0.05). The most common demand was a DNR order. Patients died 2.7 +/- 1.0 days after the decision for removal of life-sustaining treatment. CONCLUSIONS: The decision-making for life-sustaining treatment of dying patients in the ICU very often involves conflict. There is a general need to heighten our sensitivity on the objective decision-making based on patient autonomy.

According to the advance of antiretroviral regimen and the early treatment strategy, people living with human immunodeficiency virus (PLWH) are achieving the goal of virologic suppression and immune restoration. Most of them no more die of acquired immunodeficiency syndrome (AIDS) defining illnesses, and become older with chronic comorbidities such as cardiovascular, metabolic, hepatic, renal and neurological diseases. However some PLWH still visit hospitals as late presenters with very low CD4+ T cell counts, so that they suffer AIDS defining illnesses to die or experience severe neurological complications resulting in disabilities. Early palliative interventions are needed on the various symptoms of PLWH. Thus far chronic pains such as distal symmetric sensory polyneuropathies have been underevaluated. Active pain-relieving interventions are important to them. Recently we define end of life condition of human immunodeficiency virus (HIV) or eligibility to hospice care after adjusting current status of HIV treatment. Hospice teams should pay attention to the specific medical conditions, psychological needs, and social circumstances of PLWH. With just standard precautions as common infection control measures, general hospice cares can be provided to them like to other hospices subjects. For giving PLWH opportunities to have the end of life with value and dignity, hospice multidisciplinary team should intervene them early and aggressively. Now we need more clinical experiences and institutional improvements. [ABSTRACT FROM AUTHOR]

On Aug 4, 2017, the new legislation of 'Act on Hospice & Palliative Care and Patient Determination of Life Sustaining Treatments'; was enforced. Compared with articles about the hospice & palliative care of 'National Cancer Act', it should be helpful to update the change points. [ABSTRACT FROM AUTHOR]

End-stage liver disease (ESLD) is a terminal condition of cirrhosis which cannot be treated without liver transplantation. Thus, it is natural for patients to consider hospice/palliative care (HPC). Since the recent legislation of the Act on Decisions on Life-Sustaining Treatment for Patients in Hospice and Palliative Care or at the End of Life (Act No. 14013) in Korea, the practicality of this law has become an issue. The criteria for HPC should be defined with consideration to how the severity of each ESLD complication may vary by individual patients. Generally, patients qualify if they have an intractable condition despite aggressive treatment such as the hepatorenal syndrome, hepatic encephalopathy or variceal hemorrhage. However, the option of liver transplantation should be sufficiently discussed with patients and their families before making a decision on HPC. The evaluation of which ESLD patients should receive HPC should be based on a long-term doctor-patient relationship and sufficient objective data. Therefore, a multidisciplinary approach and mutual consultation among cirrhosis specialists and doctors with other expertise are essential to offer optimal and balanced treatments between liver-specific treatment and HPC. Discussed in this review are adequate criteria for HPC and special considerations for ESLD at the point of HPC. [ABSTRACT FROM AUTHOR]

Purpose: This study was performed to explore the current state of end-of-life (EoL) care education provided to new interns at two university hospitals. Methods: A questionnaire was given to incoming interns (N=64). The levels of acquired knowledge and experience of clinical observation were measured. Seven areas for self-assessment questions were identified and used to analyze the interns' attitudes towards EoL-related education and practice. Results: On average, participants learned five elements (nine in total) from EoL-related classes and two (seven in total) from clinical observation. The most frequently educated element was how to deliver bad news (96.9%) in the classroom setting and how to control physical symptoms (56.5%) in clinical observation. Less than 20% received training on EoL care communication, including discussion of advanced directives. Compared with participants who had no EoL training, those who had EoL training showed positive attitudes in all seven categories regarding overall satisfaction, interest and preparedness in relation to EoL-care classes and practice. Conclusion: Although interns are responsible for caring of dying patients, their EoL training in classroom and clinical settings was very insufficient. Further research should be conducted to establish an education system that provides sufficient knowledge and training on EoL care. [ABSTRACT FROM AUTHOR]