중환자실 간호사의 임종간호수행에 영향을 미치는 요인

고문정 ( Ko Mun Jung ),문소현 ( Moon So-hyun ) 한국간호과학회 정신간호학회(구 대한간호학회정신간호학회) 2016 정신간호학회지 Vol.25 No.4

Purpose: This study was a descriptive research to assess the level of and the relationship of related factors in the performance of end-of-life care by intensive care unit (ICU) nurses. Methods: Participants were 238 ICU nurses from university and general hospitals. Data were collected, using structured questionnaires, and collected data were analyzed using t-test, ANOVA, Scheffe test, Pearson correlation coefficients, and multiple regression analysis with SPSS/WIN 22.0. Results: There were significantly positive effects between performance of end-of-life care and end-of-life care attitudes. Performance end-of-life care was negatively associated with end-of-life care stress and obstacles. Factors that significantly influenced ICU nurses` performance of end-of-life were end-of-life care stress, medical team in obstacles related to end-of-life care, and end-of-life care attitudes, which explained about 53% of the variance in the performance of end-of-life care. Conclusion: Findings indicate that hospital organizations should carry out stress management and counseling programs in order to lower ICU nurses` end-of-life care stress, and to enhance end-of-life care attitudes. In addition, concern needs to be given to the medical team which was one of the obstacles to end-of-life care. It is also necessary to decrease the heavy workload and increase the communication with medical workers.

A Study on End-of-Life Care Supportive Behaviors, Obstacles, Empathy Competency, and End-of-Life Care Competency in Long-term Care Hospital Nurses

Son Sookyeon,Jeon Mi-Kyeong 한국간호과학회 2021 한국간호과학회 학술대회 Vol.2021 No.10

Aim(s): The rapid increase in the elderly population and end-of-life nursing at home have been transferred to medical institutions, increasing the number of elderly patients dying after spending their end-of-life in long-term care hospitals. Therefore, the purpose of this study was to examine the relationship between long-term care hospital nurses" end-of-life care supportive behaviors and obstacles, empathy competency, and end-of-life care competency. Method(s): A cross-sectional questionnaire survey was conducted. Data were collected from 191 nurses working in 10 long-term hospitals. A structured self-report questionnaire was used to assess end-of-life care supportive behaviors and obstacles, empathy competency, and end-of-life care competency. The collected data were analyzed using descriptive statistics, t-test, ANOVA, and Pearson"s correlation coefficient with the SPSS/WIN 25.0 program. Result(s): End-of-life care supportive behaviors were in the intensity 3.71±0.54, and the frequency 2.80±0.54 out of 5. Obstacles scored in the intensity 3.64±0.55, the frequency 2.92±0.53 out of 5. Empathy capacity was 3.72±0.40 out of 5. End-of-life care competency was 3.43±0.43 out of 5, and showed significant differences according to religion (F=2.79, p=.04) and job position (F=6.51, p=.002). Also, End-of-life care competency was statistically positively correlated with the intensity (r=.30, p<.001) and frequency (r=.32, p<.001) of end-of-life care supportive behaviors, and empathy competency (r=.55, p<.001). Conclusion(s): As a result of this study, it was found that the higher the frequency of end-of-life care supportive behaviors and empathy competency, the higher the end-of-life care competency. Therefore, in order to improve the quality of life and death of the elderly at the end-of-life, a strategy to enhance end-of-life care competency by strengthening frequency of end-of-life care supportive behaviors and improving empathy competency is needed.

The Professional Quality of Life on Nursing Behavior and Difficulties in Endof-Life Care : Focused on the intensive care nurses

Kim Hui-Yeon,Ahn Hye-Young 한국간호과학회 2021 한국간호과학회 학술대회 Vol.2021 No.10

Aim(s): The purpose of this study is to identify the nursing behavior and difficulties in end-of-life care to the quality of professions’ life, and to analyze factors that affect caring behavior of end-of-life patient by intensive care nurses. Method(s): For this study a descriptive design with survey method was utilized. This study recruited 193 nurses who worked at 6 kinds of intensive care unit where have 500 sickbeds located in D city, C province, for more than 6 months as the research subjects. Data were analyzed using descriptive statistics, independent t-test, one-way ANOVA, Pearson’s correlation coefficient and Multiple regression analysis. Result(s): It is found that nursing behavior showed significantly positive correlation with empathy satisfaction (r=.524, p<.001) and negative correlation with burnout (r=-. 388, p<.001). Difficulties in end-of-life care showed positive correlation with burnout (r=.461, p<.001), secondary traumatic stress (r=.488, p<.001), and negative correlation with nursing behavior (r=-. 149, p=.039). Factors affecting nursing behavior were empathy satisfaction (β= .467, p<.001), which is a sub-field of the quality of professions’ life, confidence in difficulties of end-of-life care (β=-. 168, p =.004) and nursing experience in general (β= .246, p<.001). The variables explained about nursing behavior for 36.0%. Factors affecting the difficulties of end-of-life care included burnout (β=.420, p<.001), secondary traumatic stress (β= .318, p<.001), and empathy satisfaction (β= .189, p= .049), respect as a sub-field of nursing behavior (β=-. 363, p<.001), expert knowledge and skills (β= .242, p= .002) and intensive care in general (β= .148, p= .019). The variables explained about the difficulties of end-of-life care for 42.4%. Conclusion(s): It is found that the higher the difficulty of end-of-life care in the intensive care unit, the lower the frequency of nursing care. They experience empathy fatigue, which is difficult to end-of-life care and mandatory care that they have to keep caring. Empathy Fatigue increases the difficulties of end-of-life care and empathy satisfaction can be said as an important factor in increasing nursing care. Therefore, it can be said that intervention and education programs have to be developed and applied to reduce burnout, secondary traumatic stress in order to reduce the difficulties of end-of-life care in intensive care unit. In addition, empathy satisfaction has to be improved. Then we can expect an efficient nursing care for a end-oflife patient in the intensive care unit.

호스피스 완화의료 전문기관 간호사의 임종간호수행 영향요인

전민기,권명진 대한산업경영학회 2024 산업융합연구 Vol.22 No.5

본 연구는 호스피스 완화의료 전문기관 간호사의 임종간호스트레스, 죽음인식, 사전의사결정 태도가 임종간호수행 에 미치는 영향 정도를 규명하기 위한 서술적 조사 연구이다. 본 연구의 대상자는 보건복지부로부터 호스피스 완화의료 전문 기관으로 지정된 의료기관에 근무하는 호스피스 간호사 200명이다. 본 연구의 자료수집은 서면 설문지와 인터넷 설문조사 두 가지 방법을 사용하여 2021년 8월 9일부터 9월 30일까지 이루어졌다. 자료분석방법은 대상자의 임종간호스트레스, 죽음인 식, 사전의사결정 태도, 임종간호수행 간의 관계를 분석하기 위해 Pearson’s correlation coefficient를 사용하였고 대상자 의 임종간호수행에 영향을 미치는 요인을 파악하기 위해 Hierarchical Regression을 사용하였다. 본 연구결과 임종간호수 행과 죽음인식(r=.22, p =.002), 임종간호수행과 사전의사결정 태도(r=.20, p =.004)는 유의한 상관관계를 나타냈다. 그리고 독립변수를 추가한 MODEL2에서 연령, 사전의사결정 태도, 죽음인식이 유의한 임종간호수행 영향요인이었으며 이들의 설명 력은 10.4%이었다(F=3.90, p <.001). 호스피스 간호사의 임종간호스행 능력을 향상시키기 위해서는 그 영향요인을 고려한 중재가 요구된다. This study is a descriptive research study to determine the extent to which end-of-life care stress, death awareness, and prior decision-making attitudes of nurses at a hospice and palliative nursing institution have an impact on end-of-life care performance. The subjects of this study were 200 nurses working at a hospice and palliative nursing institution. Data collection for this study was conducted from August 9 to September 30, 2021, using two methods: written questionnaire and internet survey. The data analysis method used Pearson's correlation coefficient to analyze the relationship between the subjects' end-of-life care stress, death awareness, prior decision-making attitude, and end-of-life care performance. Hierarchical Regression was used to identify factors affecting the subject's end-of-life care performance. The results of this study showed a significant correlation between end-of-life care performance and death awareness (r=.22, p =.002), and end-of-life care performance and prior decision-making attitude (r=.20, p =.004). And prior decisionmaking attitude and death awareness had a significant impact on end-of-life care performance. As death awareness and prior decision-making attitudes increased, end-of-life care performance increased, and end-of-life care stress did not appear to be a statistically significant factor influencing end-of-life care performance. In order to improve hospice nurses' ability to provide end-of-life care, intervention that takes into account the influencing factors is required.

Development of Instruments Regarding Knowledge, Practice, and Perceived Barriers for End-of-Life Care among Health Care Professionals caring for Terminal Cancer Patients

Kyungeun Son,Sanghee Kim,Sue Kim,Hei-cheul Jeung 한국간호과학회 2021 한국간호과학회 학술대회 Vol.2021 No.10

Aim(s): For the quality of care for cancer patients at the end of their lives, the healthcare professional’s competency regarding the end of life care is crucial. By measuring the competency of healthcare providers, an education program relating to a quality end-of-life care should be established. The purpose of this study was to develop instruments for identifying the knowledge, practice, and perceived barriers to end-of-life care among healthcare professionals caring for terminal cancer patients. Method(s): This study was designed to use methodological research. To measure the knowledge and practice of medical staff in end-of-life care, the first draft of the instrument was developed based on three national and international clinical practice guidelines, including “The end-of-life care clinical practice guidelines”(2020) by the Korean Society of Hospice and Palliative Medicine, the National Cancer Center, and the Ministry of Health and Welfare; “Care of dying adults in the last days of life” (2016) by the National Institute for Excellence in Health and Care; and “Palliative care Version Ⅱ” (2021) by the National Comprehensive Cancer Network. The first draft of the instrument consists of core items that were suggested for at least two of the guidelines. There were 20 initial items of knowledge, 16 items of practice, and 8 items of perceived barriers to end-of-life Care. To validate the developed instrument, 2 oncologists and 4 nurses with master"s degrees or higher and caring for cancer patients were evaluated for validity of content. In addition, the items related to perceived barriers were corrected and supplemented after receiving comments from them. Result(s): After expert validation, all items met the criteria except 1 with a CVI of less than 0.8. That item was deleted. Finally, 19 items of knowledge, 16 items of practice, and 12 items of perceived barriers regarding end-of-life care were established. The items consist of questions about imminent death, interventions in physical and psychological symptoms, and communication. Conclusion(s): This survey instrument was reported as applicable to both doctors and nurses, and as relevant to measuring health care providers’ knowledge, practice, and perceived barriers to end-of-life care. This instrument would be helpful in identifying and reducing the gap between the two groups in team nursing that require cooperation for end-of-life care. Ultimately, it provides basic data for research to provide high-quality end-of-life care to terminal cancer patients.

사회복지사의 임종케어 제공의향에 미치는 영향요인: 한국과 미국 비교연구 중심으로

권성애 ( Kwon Sung Ae ),박용순 ( Park Yong Soon ),석말숙 ( Suk Malsook ) 한국보건사회연구원 2015 保健社會硏究 Vol.35 No.3

본 연구는 임종케어 관련 요인들을 중심으로 사회복지사의 임종케어 제공의향에 미치는 영향을 문화적 측면에서 비교연구 하고자 하였다. 이를 위해 한국(서울/경기지역)과 미국(남부)에 거주하는 사회복지사 또는 예비사회복지사를 대상으로 설문하였고, 한국과 미국에서 각각 246명, 102명이 설문에 참여하였다. 통계프로그램 SPSS 20.0을 이용한 분석결과 첫째, 임종케어에 대한 일반적 요인 중에서 한국은 임종케어 훈련 참가여부와 임종케어에 대한 필요성 인지정도가 임종케어 제공의향에 영향을 미치는 것으로 나타났으며 미국의 경우 임종케어에 대한 필요성 인지정도만이 제공의향에 영향을 주는 것으로 나타났다. 둘째, 임종케어의 전문성 요인과 관련하여 한국은 임종 케어 경험이 제공의향에 영향을 보인 반면, 미국은 자기결정권에 대한 가치부여만이 제공의향에 영향이 있는 것으로 나타났다. 또한 사회인구학적 요인 중에서 한국은 종교유무가 미국은 결혼여부가 임종케어 의향에 영향을 주는 요인으로 밝혀졌다. 본 연구는 임종케어 관련요인과 제공의향에 대한 문화적 인식을 바탕으로 사회복지 측면의 실천적 접근방법을 제언하였다. The aim of this study was to evaluate and compare the intention or willingness to provide end-of-life care among social work professionals between South Korea and the United States. Factors associated with their end-of-life care intention were measured by a structured questionnaire completed by 246 social workers in a metropolitan area of South Korea and 102 social workers or social work students in the southeast of the United States. Using SPSS 20.0, the results of this study indicated that the end-of-life care intention was positively associated with the factor(s) of education or training in end-of-life care issues and the degree of recognition of the need for end-of-life care in South Korea and the degree of recognition of the need for end-of-life care in the United States. Also, experiences with end-of-life care issues in South Korea and emphasis on self-determination were identified as predictors of increased end-of-life care intention. This study underscored the societal interests for recognition of cultural preferences in end-of-life care and suggests practical approaches to increase end-of-life care intention in social work practice settings in South Korea.

노인전문사회복지사의 임종케어의향에 미치는 영향연구

권성애 ( Kwon Sung Ae ),박용순 ( Park Yong Soon ),송진영 ( Song Jin Yeong ) 한국보건사회연구원 2014 保健社會硏究 Vol.34 No.2

본 연구는 임종케어와 관련한 요인들을 중심으로 노인전문사회복지사의 임종케어를 제공할 의향에 미치는 영향을 살펴보는 것을 목적으로 하였다. 이를 위해 서울과 경기지 역에 근무하는 노인전문사회복지사 246명을 표집하였으며, SPSS 20.0을 이용하여 이를 분석하였다. 분석결과, 첫째, 임종케어에 대한 필요성 인지정도가 사회복지사의 임종케어의향에 가장 높은 영향력을 나타냈다. 둘째, 임종케어의 전문성 요인 중에서 임종케어에 대한 가치가 사회복지사의 임종케어의향에 영향이 있음을 확인하였다. 셋째, 임종케 어의 전문성 요인중에서 임종케어에 대한 경험이 사회복지사의 임종케어의향에 영향이 있음을 확인하였다. 넷째, 상관관계분석에서 높은 상관관계를 보였던 임종케어에 대한 책임성 인지정도, 임종케어 훈련참가여부, 사전의료의향서 등의 변수들은 회귀분석에서는 영향력을 보이지 않게 나타남에 따라, 이들 변수들을 대상으로 추가적인 연구의 필요성을 제시하였다. 끝으로 이와 같은 연구결과를 토대로 노인전문시설에서 근무하는 사회복지사들을 대상으로 임종케어의 제공의향을 높일 수 있는 몇 가지 제언을 하였다. This study focused on geriatric social workers in Korea, and the purpose of this study was to explore the effect of end-of-life care intention. To achieve the goal, this paper was surveyed 264 geriatric social workers in Seoul and Kyunggi-do. For analysis, SPSS 20.0 was utilized in technical statistics and the regression analysis. The results of the study were: 1) awareness of need to provide end-of-life care was represented the greatest influence on end-of-life care intention. 2) value for the end-of-life care among professional factor of end-of-life care was influenced on end-of-life care intention. 3) experience for the end-of-life care among professional factor of end-of-life care was influenced on end-of-life care intention. 4) some results of correlation analysis differed form results of regression analysis. Based on the result, some implications to increase end-of-life care intertion of geriatric social workers was discussed.

요양병원 간호사의 임종간호경험

여형남 국제문화기술진흥원 2023 The Journal of the Convergence on Culture Technolo Vol.9 No.5

Currently, the number of Long-Term Care Hospital in Korea is continuously increasing with the increase in the elderly population. Patients admitted to Long-Term Care Hospital are mainly elderly with chronic diseases, and because they are for long-term care, they often die in Long-Term Care Hospital, and the importance of end-of-life care is gradually increasing. In spite of these characteristics Studies on end-of-life care for nurses in Long-Term Care Hospital are mainly quantitative studies, and there is a limit to in-depth understanding of end-of-life care experiences. Therefore, The purpose of this study is to understand the meaning of Long-Term Care Hospital nurses' nursing experienceof end-of-life patients through a phenomenological method, and to describe and understand the meaning of the phenomenon in depth. The subjects of this study were 7 nurses who had worked for more than 6 months at a nursing hospital located in C city. The research method was in-depth interviews, and data were collected from December 2021 to March 2022. The interview date were analyzed by Giorgi's phenomenological method. As a result of the study, ‘nurses’ attitude toward end-of-life care’, ‘ambivalence toward life prolongation’, ‘reality of end-of-life care in Long-Term Care Hospital’, and ‘reflection on life and death’ were found. Therefore, it is thought that End-of-life nursing Continuing educationand interventional education programs should be developed to change Long-Term Care Hospital nurses' end-of-life care attitudes and improve coping skills.

생애말기 환자의 커뮤니티 케어에 대한 연구

김수정(Kim Soo Jung) 한국노인복지학회 2018 한국노인복지학회 학술발표논문집 Vol.2018 No.11

2018년 2월부터 연명의료결정법이 시행되면서 무의미한 연명치료가 환자나 가족 모두에게 바람직하지 않다는 인식도 정착되어가고 있고, 국가가 정책적 호스피스완화의료를 지원하며, 관련 의료기관도 늘고 있는 추세이다. 생애말기는 ‘죽음에 임박한 특정 시점’이 아니라 임종기를 향해가는 시간적 과정의 연속적 개념으로 생애말기 생활기반 안정(Well-Bing)정책과 임종기 생애마무리 지원(Well-Dying)정책이 동시에 지원되어야 한다. 국내 생애말기 지원정책을 분석한 결과에 따르면, 재택의료 서비스 미진으로 자택에 머물면서 치료하기 어려운 실정이 가장 심각한 문제로 분석되었다. 본 연구는 생애말기에 있는 환자들이 임종기 생애마무리 지원을 받을 수 있도록 생애말기 커뮤니티 케어시스템 구축을 위한 욕구 조사에 바탕을 두고 있다. 본 연구의 목적은 부산광역시 호스피스 센터의 생애말기 환자의 서비스에 대한 욕구를 확인하고 현재 받고 있는 서비스의 만족도와 삶의 질을 파악함으로써 앞으로의 생애말기 커뮤니티 케어의 개선방안을 도출하는 데 있다. 부산광역시 호스피스센터에서 재가 서비스를 받고 있는 생애말기에 놓여있는 환자 205명을 대상으로 조사원 기입식 설문조사를 실시하였다. 분석결과, 기대여명이 6개월 미만의 생애말기 환자의 경우 어떠한 서비스와 선택의 기준을 하는지와 죽음준비 혹은 교육에 대한 이해정도를 파악할 수 있었다. 서비스선택의 기준이 삶의 질에 유의한 영향을 미치는 것으로 나타나(β= -.321, p<.001), 서비스 선택의 기준이 삶의 질에 부적인 영향을 미치는 것을 알 수 있다. 서비스 선택기준이 죽음준비에 미치는 영향을 분석한 결과, 통계적으로 유의한 결과(β= -.237, p<.01)를 보여주었다. 서비스 선택기준이 죽음준비에 미치는 영향(β= -.200, p<.01)과 삶의 질에 있어서 죽음준비의 매개효과(β= .514, p<.001)를 분석한 결과, 매개효과가 있는 것으로 나타났다. With the enforcement of life extension decision Act, it is now well understood that meaningless life extension treatment is not desirable for both patients and their family. The government is, with its policy, supporting hospice palliative treatment and related medical institutions are increasing. End of life period should not be seen just as a certain point of time near death, but be seen as continuous period of time approaching toward death. In that period, governmental support is necessary especially for living condition improvement (well being) during end of life period and for ending life (well dying). According the analysis of governmental support for the domestic end of life period patients, the most serious problem was that patient could not get treatment at home due to the lack of home care services. This study is based on the research of people’s demand of establishing community end of life care system, which supports end of life patients The purpose of this study is to recognize the need of end of life period patients from Pusan area’s hospice center, and to assess satisfaction of the current service and the quality of life, and therefore to find out how to improve community care for end of life period patients. We have conducted a survey, filled in by the surveyor, on 205 end of life period patients who are provided with home care service from Pusan hospice center. From the analysis of the survey results, we could understand the criteria that patients, with life expectation less than 6 months, use to decide which service they would choose, and how well they are prepared and educated for end of life. It is found that the patients’ criteria for choosing care services affected their quality of life and their criteria have negative impact on their quality of life. We have analyzed if their care service selecting criteria effect on the preparation for death, and found that there are statistically meaningful relationship between them. Also we have analyzed the effect of service selecting criteria on death preparation and the mediating effect of death preparation on life quality, and found there exists mediating effect. the introduction of a number of new social care services for older people, the need to provide home support service for them has been criticized.

‘연명의료결정법’ 시행 이후 중환자실 간호사의 환자 연명의료결정 및 임종기 돌봄 경험 연구

안경진(Kyongjin Ahn),공병혜(Byunghye Kong),송윤진(Yoonjin Song) 한국생명윤리학회 2020 생명윤리 Vol.21 No.2

의・생명공학기술의 발달로 많은 사람들이 응급실 및 중환자실 등에서 집중연명치료를 받다가 죽음을 맞이하게 된다. 이러한 사회적 관행 속에서 ‘김할머니 사건’은 임종기 상황에서 무분별하게 적용되는 연명의료에 대한 사회적 인식 개선과 법제화의 필요성에 대해 공론화의 장을 열어주었다. 그 결과로 우리사회는 ‘호스피스·완화의료 및 임종과정에 있는 환자의 연명의료결정에 관한 법률(이하 연명의료결정법)’을 제정하였으며, 이 법을 시행한지 2년이 넘었다. 현재 시행되고 있는 ‘연명의료결정법’은 생애말기 의료적 의사결정과정에서 생명연장을 위한 연명의료 적용에 대한 환자의 자율적 의사 존중과 호스피스 및 완화의료를 통한 죽음의 질 문제를 포괄적으로 고려하기 위한 목적에서 제정되었다. 그러나 이 법은 대부분의 임종이 중환자실에서 이루어지고 있는 의료현실에 대한 성찰로 연결되지 못하고, 연명의료결정 과정에서 야기되는 다양한 딜레마 상황을 제대로 고려하지 못하고 있기 때문에 환자의 존엄한 죽음을 확보하는데 있어서 근본적 한계를 가진다. 이에 본 논문에서는 연명의료결정법 시행 이후 중환자실 간호사들의 연명의료결정 및 임종기 돌봄에서의 다양한 경험을 살펴봄으로써, 실제 의료 현장에서 법이 제정 목적에 맞게 제대로 작동하고 있는지 그 현황을 파악하고자 한다. 하지만, 본 연구는 지역 일개 종합병원의 중환자실 간호사의 경험을 중심으로 살펴보았기 때문에 다양한 지역 및 기관 간 격차 등을 비교분석하지 못한 측면이 있으며, 따라서 이들의 중환자실 임종기 돌봄 경험을 일반화하기에는 한계가 있다. 그럼에도 불구하고 본 연구는 연명의료결정법 시행 이후 발견되는 관련 제도의 유의미한 장·단점을 중환자실 간호사의 경험에 근거해 파악하고, 이를 통하여 환자의 존엄한 죽음을 위한 연명의료결정 및 임종기 돌봄환경을 위한 근본적 개선방안을 도출하고 있다는 점에서 의의가 있다. 이는 임종기 돌봄 환경의 실질적인 개선을 위한 제도적·정책적 개발을 위한 중요한 연구 자료가 될 것으로 기대된다. Despite recent developments in medical and biotechnology, most people die while undergoing intensive life-sustaining treatments in emergency rooms or intensive care units. Amid these social practices, the “Grandmother Kim case” opened a forum for public debate about the necessity to improve social awareness and about the legalization of life-sustaining treatments that are indiscriminately applied to dying patients. As a result, the “Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatments for Patients at the End of Life” was enacted and has been in effect since February of 2018. The ‘Life-sustaining Treatment Decision-making Act’, currently in effect, was enacted for the purpose of comprehensively considering the patient"s autonomy regarding the application of life-sustaining treatments and the quality of death through hospice and palliative care during the medical decision-making process at the end of life. However, because this law does not properly consider the reality of the medical setting in the intensive care unit environment and the various dilemma situations that arise during the actual intensive care unit life-sustaining treatment decision process, this law has fundamental limitations in securing a dignified death for patients. The purpose of this study is to examine the various experiences of intensive care unit nurses in life-sustaining care decisions-making and end-of-life care after the implementation of the Life-sustaining Treatment Decision-making Act ultimately to determine whether the law is properly operating in accordance with the purpose of its enactment in the actual medical field. In addition, by grasping the significant strengths and weaknesses of related systems which have arisen since the implementation of the Life-sustaining Treatment Decision-making Act, this study attempts to derive improvement measures pertaining to life-sustaining treatment decision-making for the dignified death of patients and end-of-life care environments. This study is expected to provide important research data for both institutions and those involved in policy development, leading to practical improvements of end-of-life care environments. However, since this study focused on the experiences of nurses in the intensive care unit of a local general hospital, there are limits to generalizing the results of this study.