심폐소생술금지(DNR)에 대한 간호사와 의사의 인식과 경험 = Awareness and Experience of Nurses and Physicians on DNR

다국어 초록 (Multilingual Abstract)

The present study attempts to consider the awareness and experiences of nurses and physicians on DNR (De-Not-Resuscitate Order), currently practiced in the Korean general hospitals. The purpose is to: prepare clear standards of DNR determinations that can be used commonly in the clinical setting; promote rational practice of DNR that sufficiently ensures the patient right for self-determination; activate education for medical professionals on DNR as well as medical ethics, and; make guidelines for DNR. This study also attempts to serve as a basis for making objective standards in terms of educational, ethical, and legal issues concerning DNR in consideration of the social and cultural characteristics of Korea.
The result of the study is as follows;
1) The subject consists of a total of 297 persons. 62.6% of them were 20 to 29 years old. The number persons in this age group was higher than those at 30 years old or more (37.4%). In terms of sex, the subject consists of 25.9% of males and 74.1% of females. 52.2% of them have a religion. As for their work experiences, 46.1% have worked as a medical professional for less than three years; 36.7%, for five years or more, and; 17.2%, for three years or more, but less than five years. 67.0% of the subject were nurses, while 33.0% were physicians, among whom interns were 6.7%; residents, 18.9%, and; specialists, 7.4%.
2) Subject Awareness of DNR:
97.3% of them feel the necessity of DNR, because 'recovery may be impossible in spite of many efforts after all' (60.6%). Most of them ascribe the DNR determination to the 'will of the family and the physician' .While the nurses think the determination should be based on the 'will of the patient and the family' (46.4%). most physicians think it should be based on the 'will of the family and the physician' (52.1%). Majority of the subject respond that information about DNR should be given to intensive-care patients or terminal patients as well as their family (55.9%), right after hospitalization (32.0%). 59.6% of the subject answer that the demand for DNR rises when the relevant information is given to the patients or the family. They say they will practice the DNR education to the family (75.4%) and to the patients (86.9%). 85.2%respond that written guidelines for DNR should be prepared.
3) Subject Attitudes toward DNR:
Majority of them have ever practiced DNR (78.8%), by the demand of ' the patient's family' (68.8%) and based on the determination of 'the family and the physician' (72.2%). 91.8% of them made a medical record at the time they carried out DNR. The biggest problem after the DNR determination, in their opinions, was 'the negligence of treatment and nursing care' (38.2%). 117 respondents (50.0%) have ever conducted CPR in spite of the prior determination for DNR, because 'there was nobody in the family at the deathbed' (27.0%). Majority of the respondents (92.6%) have an experience that they were asked for a counseling at the time of DNR determinations.
4) Differences among Subjects in Their Awareness of DNR:
There were no significant differences in their awareness concerning the following topics: perceived necessity of DNR, major factors requiring DNR, necessity of explaining about DNR, appropriate timing for DNR explanation, increase of patient demand for DNR after the explanation, and their own demand for DNR. However, significant differences were detected (p<.0l) in the following issues: desirable determiners for DNR, necessity of DNR guidelines, and the family demand for DNR.
5) Differences among Subjects in Their DNR Experiences:
They don't seem to have significantly different experiences in terms of the period and time they received DNR education, experience of conducting DNR, main determiner for DNR, CPR experience after DNR decision, and the demand for DNR counseling. However, significant differences were found in their experience of getting DNR education, major requester for DNR, and medical record keeping at DNR implementation (p<.05). In addition, there was also a significant difference in their experienced problems after DNR decision.
6) Differences among Subjects in Their Awareness of DNR Depending on Their DNR Experiences:
There was no significant difference between the subjects who experienced DNR and those who don't in their awareness of the following topics: major factors necessitating DNR, desirable determiner for DNR, necessity for DNR explanations, proper timing for DNR explanation, family demand for DNR, and the necessity of DNR guidelines. However, there were significant differences in their perceived necessity of DNR (p<.01) depending on their experience. In addition, significant differences were also detected in the increase of patient demand for DNR after explanations, and their own demand for DNR (p<.05).

목차 (Table of Contents)

• 목차 = ⅰ
• Ⅰ. 서론 = 1
• 1. 연구의 필요성 = 1
• 2. 연구의 목적 = 5
• 3. 용어의 정의 = 5
• 4. 연구의 제한점 = 6
• Ⅱ. 본론 = 7
• 1. 문헌고찰 = 7
• 1) 심폐소생술 금지(DNR)의 개념 = 7
• 2) DNR 대상자의 특성 = 11
• 3) DNR에 대한 간호사와 의사의 인식 및 경험 = 14
• 2. 연구내용 및 방법 = 17
• 1) 연구설계 = 17
• 2) 연구대상 = 17
• 3) 연구도구 = 17
• 4) 자료 수집방법 = 18
• 5) 자료분석방법 = 18
• Ⅲ. 결론 = 19
• 1. 연구결과 = 19
• 1) 대상자의 일반적 특성 = 19
• 2) 대상자의 DNR과 관련된 인식 = 21
• 3) 대상자의 DNR과 관련된 경험 = 25
• 4) DNR과 관련된 간호사와 의사의 인식 비교 = 30
• 5) DNR과 관련된 간호사와 의사의 경험 비교 = 32
• 6) 대상자의 DNR 시행 여부와 DNR에 대한 인식과의 관계 = 34
• 2. 논의 = 36
• 3. 결론 및 제언 = 41
• 1) 결론 = 41
• 2) 제언 = 44
• 참고문헌 = 46
• Abstract = 52
• 부록1 설문지 = 57