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한성숙,노유자,양수,유양숙,김석일,황희경,Han, Sung-Suk,Ro, You-Ja,Yang, Soo,Yoo, Yang-Sook,Kim, Sek-Il,Hwang, Hee-Hyung 한국가정간호학회 2003 가정간호학회지 Vol.10 No.1
The purpose of this study was to describe the perceived burden of the terminally III patients's caregiver and to analyze relationship between the perceived burden and the various demographics, illness characteristics, family relationships, and economic factor of the family & patients. The sample of 132 caregivers who care for the terminally III patients Kyung-Gi province, Seoul, Korea. The period of this study was from August to September, 2002. The perceived burden of the family caregiver was measured by the burden scale(20 items, 4 point scale) developed by Montgomery et al. (1985). The Data was analyzed using SAS-program by t-test and ANOVA. The results were as follows; 1. The mean of the family caregiver's burden score was 3.02. The score showed that caregivers perceive severe the level of burden. The hight items of the family caregiver's burden were' I feel it is painful to watch patient's diseases'(3.77). 'I feel afraid for what the future holds for my patients'(3.66), 'I feel it reduced to amount of privacy time'(3.64). 2. The caregiver's burden was significantly related to patient's gender(F=3.17, p= 0.0020), patient's job(F=2.49, p=0.0476), caregiver's age(F=4.29, p=0.0030), and caregiver's job(F=2.49, p=0.0476). 3. The caregiver's burden according to illness characteristics showed no significant difference. 4. The caregiver's burden was significantly associated with patient's family relationship (F=4.05, p=0.0041), patient's care mean period in a day(F=47.18, <p=.000l), patient's care period after diagnosis (F=5.18, p=<.0001), and economic status of family(F=3.58, p=0.0088). The highest caregiver's burden related to family was 'parents caregivers'(3.27), the lowest was 'patient's son & daughter caregivers'(2.88). In case of prolonged care period in a day, the caregiver's burden was significantly high. In case of prolonged care period after diagnosis, the caregiver's burden was significantly high. In case of no monthly family income. the caregiver's burden was significantly increased (3,24). The need for health care has expanded from curative therapy to health promotion and rehabilitation also. finally the need for hospice care has demanded in order to improve the quality of life of the terminally ill patients and their families. Because physical, emotional, social and spiritual approaches are required to meet their needs, the integration of various resources is very important. This study is carried out to build a community-based integrated model that is good for improving the patients and familiy's quality of life and to minimize the cost from tertiary hospitals. There were several subjects in this study such, analyses as traditional home care, utilization review of terminally ill patients, measurement of burden of family members and provided practice guidelines for the home cancer patient management. We suggest three strategies for the development of a new model. The firstly the change of the role of the healthcare center from a direct service provider to a management-oriented organization. The secondly the induction of a team-based approach by preserving the proper role of each organization. The thirdly the reenforcement of this team-based approach with the sharing of information on the patients and community-based resources. These suggests are based on the Partnership Collaboration Model and the strategies stated as in the above. In this model, the health care center could playa managerial role and all of the community's resources and the patient's information could hold in common. It is indicated that the information of the patients might be safely used by a semi-open system and an open-system for sharing of the information of the community-based resources.
회복 불가능한 환자의 심폐소생술포기(DNR)와 관련된 윤리문제
한성숙 ( Sung Suk Han ) 한국의료윤리학회 2005 한국의료윤리학회지 Vol.8 No.1
The following research has examined ethical dilemmas regarding denial of resuscitation by patients. The articlealso suggests several proposals for optimized solutions. First of all, the history and nature of CPR & DNR have been discussed. Second, mutual interactions during making decisions on DNR have been introduced. Because physicians do not exclusively conduct the decision on DNR, patients, family members, and other related siblings should be involved in the process. If necessary, the ethics committee may be applied for making appropriate decisions. Thirdly, in order to locate the nature of ethical dilemma on DNR decisions, the relationship between patients and physicians, full understanding the importance of CPR necessity, and defining the method of DNR would need to be well explained. Finally, through the ethical discussion on DNR, following conclusions have been suggested. In all situations, DNR must let physicians make decision on futility of CPR for patients` current or future conditions, and the decision must be made only after patients are fully aware of the consequences. Under the law of respecting patients` opinions, patients must have the ability to make decisions on DNR. The proper moments for deciding DNR should depend on behaviors regarding his/her conditions or diseases. Because a health care institution play an important role in making decisions as well, all opinions must be reviewed for the best outcome. It is important to remember that the main decision makers on DNR are patients. Following discussions have concluded that an agreement among people nationwide is quite essential for the appropriate DNR decisions. The research may serve as a supplement for the process of establishing the DNR guideline.
한성숙 ( Sung Suk Han ),김중호 ( Joong Ho Kim ),구인회 ( In Hoe Ku ),홍석영 ( Suk Young Hong ),이경상 ( Kyung Sang Lee ) 한국의료윤리학회 2005 한국의료윤리학회지 Vol.8 No.2
In Korea, the existence of clear guidelines on DNR(Do Not Resuscitate) has been insufficient. Generally, the procedure is done after assigned doctors and family members subjectively make decisions on DNR. Also, because patients who need DNR have been receiving the procedure inconsistently, the need for clear DNR guidelines is increasing. Through the research, the main purpose is to develop the guidelines. As the first step of the research procedure, various documentary records and DNR related database were used as references. Secondly, based on the reference, the first draft of DNR guidelines that can be applied to hospital settings was created by our researchers. On the next step, a group of professional experts was invited to review the first draft and rectify any controversial contents. To be specific, the guideline proposal was reviewed and corrected by professionals (doctors, philosophers, lawyers, etc) through 2 meetings by Delphi method. Finally, the draft was sent to Hospital Ethics Committee for a delicate examination. As a result, our guideline draft was ethically and legally acceptable according to the committee. Moreover, ethical issues were examined and discussed to provide deep understanding on the guideline draft.
간호사들이 임상에서 경험하는 도덕적 고뇌(distress)
한성숙(Sung-Suk Han) 한국생명윤리학회 2005 생명윤리 Vol.6 No.2
The sample population for this research is based on 300 employees ranging from general nurses to unit managers at the University Hospital. The survey was conducted to measure moral distress in descriptive way that nurses experience at clinical practice. Myung-Sook Yu(2003) developed the tool used for this moral distress research and there were total number of 66 questions on the survey. In terms of the reliability rate, the circumstances aspect was at .93(Cronbach's a score), cognition aspect at .90, behavior aspect at .60, and emotional aspect was at .91. The results were as follows: 1. As we look at the scores on each aspects of moral distress, the average score of circumstances was 2.89, cognition average at 3.06, behavior at 2.69, and emotion average was at 3.80. 2. In circumstances aspect, a significant difference was found only in nursing practice area(F=3.94, p=0.00). 3. There was no significant difference in cognition aspect. However, a marginal difference was found between age and nursing practice area by Duncan Test. 4. In behavior aspect, length of practice was the only difference shown(F=4.49, p=0.01) 5. Emotion aspect resulted in no sufficient difference. 6. As we looked at the circumstance aspect, depending on practice type, a significant difference was found in two categories, general ward and special ward.(t=3.94, p=0.00). 7. As we looked at the behavior aspect, depending on practice type, a significant difference was found in two categories, general ward and special ward.(t= -2.40, p=0.02). 8. There was significant positive correlation among all aspects of moral distress As a result, we can conclude that there were differences in each aspects of moral distress and the scores were above average. However, since the sample population was collected from one specific hospital setting, the reliability issue is certainly a concern. Thus, similar researches need to be conducted repeatedly, and use of larger sample population is particularly recommended to represent various regional areas.