How Should Intensive Care Unit Nurses Organize End-of-life Care? A Mixed-methods Study

정현정,김다영,장성옥 기본간호학회 2024 기본간호학회지 Vol.31 No.1

Purpose: This study aimed to explore intensive care unit nurses' perceptions of end-of-life care and to identifystrategies for improving patient comfort in the intensive care unit. Methods: This was a mixed-methods studycomprising two phases. In Phase 1, we conducted focus group interviews to investigate how intensive care unitnurses perceived end-of-life care and its specific components within an intensive care unit setting. Phase 2involved a descriptive questionnaire, utilizing items derived from the focus group interviews to assess howintensive care unit nurses evaluated the components of end-of-life care they provided in the intensive care unit. Results: The findings of the study’s two phases revealed that in end-of-life care, nurses aimed to provide comfortby connecting patients with their families, spiritual beliefs, social networks, and life experiences, while addressingchallenges within the broader scope of nursing practice in the intensive care unit. Conclusion: This study examinedintensive care unit nurses' perceptions of end-of-life care, the elements of end-of-life care, their practicalimplementation, and the associated priorities. These findings will help nurses in intensive care units determineand organize priorities in end-of-life care. For patients facing death in the intensive care unit and for the nurseswho care for them, the obstacles involved in end-of-life care must be better overcome.

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.

중환자실 인간중심 돌봄 개념 분석

전꽃비(Jeon, Kkot Bi) 가톨릭생명윤리연구소 2021 인격주의 생명윤리 Vol.11 No.1

중환자실이라는 복잡한 환경에서 환자들은 개별적인 인간이기 보다는 인간의 위엄을 잃고 단순한 치료 대상으로 느껴질 수 있다. 그러므로 중환자 치료와 간호의 방향은 현재의 질병 중심 시각에서 벗어나 인간중심의 총체적인 돌봄으로 전환될 필요가 있다. 하지만 현재 국내 중환자실의 특수한 환경을 고려한 인간중심 돌봄에 대한 개념의 정의가 명확하지 않기 때문에 인간중심 돌봄을 실현하는 데에는 어려움이 있을 것이라고 생각된다. 이에 본 연구는 중환자실 인간중심 돌봄의 개념의 속성을 파악하여 명확한 개념을 이해하고 효과적인 인간중심 돌봄을 제공하기 위해 워커와 아반트의 방법으로 개념 분석을 시행하였다. 본 연구에서 확인한 인간중심 돌봄의 주요 속성은 환자의 존엄성 존중, 치료적 관계 형성, 개별화된 돌봄, 중환자 간호에 대한 전문성이었다. 동일한 주제를 가지고 시행된 외국의 연구에서도 중환자실 인간중심 돌봄은 간호사가 환자를 인격과 존엄성을 가진 인간으로 이해하고 존중하며, 신뢰와 공감을 바탕으로 치료적 관계를 유지하여 그들의 신념과 가치를 반영한 돌봄을 제공하는 것으로 설명하여, 그 의미와 속성이 본 연구와 유사한 맥락을 갖는다는 것을 알 수 있었다. 하지만 중환자실 인간중심 돌봄의 적용에 있어서는 각 나라의 문화와 시스템을 고려한 접근이 필요하다. 우리나라는 가족 공동체의 가치를 중요하게 여긴다는 점에서, 이러한 문화적 특수성을 고려하였을 때, 가족의 참여는 중환자실 인간중심 돌봄에 있어 큰 의미를 갖는다고 볼 수 있다. 그러므로 중환자실 간호사는 환자는 물론 가족과의 상호작용 증진을 위한 노력을 해야할 것이다. 또한 우리나라는 외국에 비해 낮은 수준의 간호 인력을 확보하고 있으므로, 인력 부족으로 인한 과도한 업무량 등을 포함한 근무환경의 개선과 인간중심 돌봄이 긍정적인 협력관계에서 효과적으로 이루어진다는 점에서, 의료진 간의 관계지향적인 조직문화를 조성하기 위한 노력도 필요할 것이다. In the complex environment of intensive care units, patients can lose their dignity and feel as though they were an object being treated rather than an individual, a human with a unique personality. Therefore, the direction of critical care needs to shift from disease-centered care to person-centered care. Thus, this study was conducted to identify and understand the elements of person-centered care in the context of intensive care units using Walker and Avant’s concept analysis method. In this study, the identified attributes of person-centered care in intensive care units were: 1) to respect the patient’s dignity, 2) to form a therapeutic relationship, 3) to provide individualized care, and 4) to use professional nursing practices. The results were similar to those of foreign studies conducted on the same topic. However, the implementation of person-centered care in intensive care units requires an approach that considers the culture and systems of each country. In South Korea, family or community values are considered important. Furthermore, the participation of the family in the decision-making process for a patient may be understood as a significant part of the person-centered care in the intensive care unit. Thus, intensive care unit nurses must make efforts to enhance interaction with patients as well as their families. Additionally, it is necessary to improve the working environment for the effective implementation of person-centered care.

Attitudes towards Death, Perceptions of Hospice Care, and Hospice Care Needs among Family Members of Patients in the Intensive Care Unit

Oak, Yunha,Kim, Young-Sun Korean Society for Hospice and Palliative Care 2020 한국호스피스.완화의료학회지 Vol.23 No.4

Purpose: This study aimed to identify the relationships among attitudes towards death, perceptions of hospice care, and hospice care needs as perceived by family members of patients in the intensive care unit (ICU). Methods: This study used a descriptive correlational method. A structured questionnaire was used to collect data from 114 participating families in the ICU at Dong-A University Hospital, from October 10 to November 1, 2019. The data were analyzed in terms of frequency, percentage, and mean and standard deviation. The t-test, one-way analysis of variance, and Pearson correlation coefficients were also conducted. Results: Perceptions of hospice care showed significant differences according to age (F=3.06, P=0.031) and marital status (t=3.55, P=0.001). However, no significant differences in attitudes towards death or hospice care needs were found. A significant positive correlation was found between perceptions of hospice care and hospice care needs (r=0.49, P<0.001). Conclusion: In order for families to recognize the need for hospice care and to receive high-quality palliative care at the appropriate time, it is necessary to increase public awareness of hospice care through various educational and awareness-raising efforts, thereby providing opportunities for families of terminally ill patients to request hospice care.

발달지지간호에 대한 신생아집중치료실 간호사의 교육요구도 분석

신다애(Shin, Da-Ae),방경숙(Bang, Kyung-Sook) 한국간호교육학회 2021 한국간호교육학회지 Vol.27 No.3

Purpose: This study used a descriptive investigative design to identify educational needs for developmental supportive care for the purpose of establishing a developmental supportive care education program for nurses in neonatal intensive care units. Methods: A survey was conducted on 93 nurses working in neonatal intensive care units located in a metropolitan area, and the collected data were analyzed using descriptive statistics and a paired t-test with the SPSS 25.0 program. For the purpose of analyzing educational needs, we further analyzed data through an importance-performance analysis (IPA) and the Borich needs assessment and the locus for focus models. Results: The average importance of the developmental supportive care of nurses in neonatal intensive care units was 3.74±0.78 out of 5, and the average performance was 3.46±0.81 out of 5. A t-test on the difference between the IPA and Borich needs assessment showed the highest educational need in the categories of ‘individualized care’, and ‘I serve on the Developmental Care Committee at my institution’. In addition, according to the results of deriving the priorities of educational needs using the Borich needs assessment and the locus for focus model, the highest priority was ‘I provide appropriate pain management when noxious procedures are necessary’. Conclusion: These findings can be used as basic data to design a developmental supportive care program suitable for nurses in neonatal intensive care units to meet the educational needs for developmental supportive care.

Characteristics and Outcomes of Potentially Inappropriate Admissions to the Intensive Care Unit

Sooim Sin,Sang-Min Lee,Jinwoo Lee 대한중환자의학회 2019 Acute and Critical Care Vol.34 No.1

Background:Admission of patients perceived as potentially inappropriate for intensive care is a very sensitive and controversial issue. We aimed to evaluate the use of medical resources in the intensive care unit (ICU) and outcomes of patients according to a physician’s judgment of appropriateness. Methods:ICU physicians classified patients who were admitted to the medical ICU of a tertiary hospital as appropriate or inappropriate for intensive care within 24 hours of admission. Patient outcomes including mortality were analyzed according to appropriateness. Additionally, the usage and duration of mechanical ventilation (MV), renal replacement therapy (RRT), and extracorporeal membrane oxygenation (ECMO) were analyzed according to appropriateness. Results:In total, 105 patients (male, 55.4%; mean age, 62 years) were included. Twelve (11.4%) patients were considered inappropriate for intensive care based on guidance published by the Society of Critical Care Medicine through a questionnaire survey of physicians. There was no significant difference between patients considered inappropriate or appropriate for ICU admission regarding the use and duration of MV, RRT, and ECMO. In contrast, the ICU, in-hospital, 28-day, 90-day, and total mortality rates were significantly higher among patients with inappropriate admission than among patients with appropriate admission (ICU mortality: 50.0% vs. 25.8%, P=0.008; in-hospital mortality: 58.3% vs. 43.0%, P=0.028; 28-day mortality: 58.3% vs. 33.3%, P=0.019; 90-day mortality: 66.7% vs. 44.1%, P=0.023). Conclusions:Despite higher mortality, the amount of medical resources used for patients considered potentially inappropriate for intensive care did not differ from the resources used for patients considered suitable for ICU care.

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.

Missed nursing care and its influencing factors among neonatal intensive care unit nurses in South Korea: a descriptive study

Soohyun Kim,Sun-Mi Chae 한국아동간호학회 2022 Child Health Nursing Research Vol.28 No.2

Purpose: Preventing missed care is important in neonatal intensive care units (NICUs) due to neonates’ vulnerabilities. This study examined missed care and its influencing factors among NICU nurses. Methods: Missed care among 120 Korean NICU nurses was measured using a cross-culturally adapted online questionnaire. The frequency of missed care for 32 nursing activities and the significance of 23 reasons for missed care were collected. Results: All participants had missed at least 1 activity, missing on average 19.35 activities during a typical work-day. The most common missed item was “provide developmental care for the baby”. The most common reason for missed care was “emergency within the unit or deterioration of one of the assigned patients”. The final regression model explained 9.6% of variance in missed care. The average daily number of assigned patients receiving inotropes or sedation over the last month influenced the total number of missed care items. Conclusion: Missed care was affected by nurses’ workload related to the number of patients taking medication. Frequently missed activities, especially those related to developmental care, require patience and time, conflicting with safety prioritization and inadequate working conditions. NICU nurses’ working conditions should be improved to ensure adequate time for nursing activities.

Comparison of the Attitudes of Nurses and Physicians toward Palliative Care in Neonatal Intensive Care Units

Jung, Ha Na,Ju, Hyeon Ok Korean Society for Hospice and Palliative Care 2021 한국호스피스.완화의료학회지 Vol.24 No.3

Purpose: This study aimed to compare the attitudes of nurses and physicians toward neonatal palliative care and identify the barriers to and facilitators of neonatal palliative care, with the goal of improving palliative care for infants in neonatal intensive care units (NICUs). Methods: This cross-sectional study analyzed data from the NICUs of seven general hospitals with 112 nurses and 52 physicians participating. Data were collected using the Neonatal Palliative Care Attitude Scale questionnaire. Results: Only 12.5% of nurses and 11.5% of physicians reported that they had sufficient education in neonatal palliative care. In contrast, 89.3% of the nurses and 84.6% of the physicians reported that they needed further education. The common facilitators for both nurses and physicians were: 1) agreement by all members of the department regarding the provision of palliative care and 2) informing parents about palliative care options. The common barriers for both nurses and physicians were: 1) policies or guidelines supporting palliative care were not available, 2) counseling was not available, 3) technological imperatives, and 4) parental demands for continuing life support. Insufficient resources, staff, and time were also identified as barriers for nurses, whereas these were not identified as barriers for physicians. Conclusion: It is necessary to develop hospital or national guidelines and educational programs on neonatal palliative care, and it is equally necessary to spread social awareness of the importance of neonatal palliative care.

중환자실 임종기 돌봄

문재영,신용섭 대한중환자의학회 2013 Acute and Critical Care Vol.28 No.3

The intensive care units (ICUs) provide the best possible medical care to help critically ill patients survive acute threats to their lives. At the same time, the ICU is also the most common place to die. Thus the ICU clinicians should be competent in all aspects for end-of-life (EOL) care. The quality of EOL care in Korean ICUs do not ensure ICU patient’s autonomy and dignity at their end-of-life. For examples, several studies present that do-not-resuscitate (DNR) orders are only initiated when the patient’s death in imminent. To improve understanding EOL care of terminally ill patients, we summarize ‘Recommendations for EOL care in the ICU by the American College of Critical Care Medicine’ and ‘Consensus guidelines to withdrawing life-sustaining therapies endorsed by Korean Academy of Medical Science’. EOL care will be emerging as a comprehensive area of expertise in Korean ICUs. The ICU clinicians must strive to find the barriers for EOL care in the ICU and develop their processes to improve the care of EOL.