Journal of Korean Academy of Nursing

Original Articles

Reversals in Decisions about Life-Sustaining Treatment and Associated Factors among Older Patients with Terminal Stage of Cardiopulmonary Disease: Jung-Ja Choi, Su Hyun Kim, Shin-Woo Kim; J Korean Acad Nurs 2019;49(3):329-339. Published online January 15, 2019; DOI: https://doi.org/10.4040/jkan.2019.49.3.329

Abstract Purpose

The purpose of this study was to investigate the frequency, patterns, and factors of reversals in decisions about life-sustaining treatment (LST) among older patients with terminal-stage chronic cardiopulmonary disease.

Methods

This was a retrospective correlational descriptive study based on medical chart review. De-identified patient electronic medical record data were collected from 124 deceased older patients with terminal-stage cardiopulmonary disease who had made reversals of LST decisions in an academic tertiary hospital in 2015. Data were extracted about the reversed LST decisions, LST treatments applied before death, and patients’ demographic and clinical factors. Multivariate logistic regression analysis was used to identify the factors associated with the reversal to higher intensity of LST treatment.

Results

The use of inotropic agents was the most frequently reversed LST treatment, followed by cardiopulmonary resuscitation, intubation, ventilator therapy, and hemodialysis. Inconsistency between the last LST decisions and actual treatments occurred most often in hemodialysis. One-third of the reversals in LST decisions were made toward higher intensity of LST treatment. Patients who had lung diseases (vs. heart diseases); were single, divorced, or bereaved (vs. married); and had an acquaintance as a primary decision maker (vs. the patients themselves) were significantly more likely to reverse the LST decisions to higher intensity of LST treatment.

Conclusion

This study demonstrated the complex and turmoil situation of the LST decision-making process among older patients with terminal-stage cardiopulmonary disease and suggests the importance of support for patients and families in their LST decision-making process.

Citations

Citations to this article as recorded by

Characteristics of Life-Sustaining Treatment Decisions: National Data Analysis in South Korea
Jiyeon Choi, Heejung Jeon, Ilhak Lee
Asian Bioethics Review.2024; 16(1): 33. CrossRef
Decision and Practice of End-of-Life Care in Lung Disease Patients with Physicians Orders for Life Sustaining Treatment
Yu Mi Oh, Yoon Na Kang, Soo Jung Han, Jeong Hye Kim
The Korean Journal of Hospice and Palliative Care.2023; 26(1): 7. CrossRef
Same, same, but different? A longitudinal, mixed-methods study of stability in values and preferences for future end-of-life care among community-dwelling, older adults
Malin Eneslätt, Gert Helgesson, Carol Tishelman
BMC Palliative Care.2021;[Epub] CrossRef
Preferences for life-sustaining treatment in Korean adults: a cross-sectional study
HyunChul Youn, Suk-young Lee, Han-yong Jung, Shin-Gyeom Kim, Seung‑Hyun Kim, Hyun-Ghang Jeong
BMJ Open.2021; 11(1): e039470. CrossRef
Life-Sustaining Treatment in End-Stage Liver Disease Patients: Patients’ Decisions and Results
Hyun Jung Jung, Jeong Yun Park
The Korean Journal of Hospice and Palliative Care.2020; 23(2): 85. CrossRef

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The Effect of Patient-centered CPR Education for Family Caregivers of Patients with Cardiovascular Diseases: Hyun Sun Kim, Hyun-Jin Kim, Eunyoung E. Suh; J Korean Acad Nurs 2016;46(3):463-474. Published online June 30, 2016; DOI: https://doi.org/10.4040/jkan.2016.46.3.463

Abstract PDF

Purpose

For cardiovascular patients, family caregivers play a vital role in daily nursing and cardiac emergencies. This study aimed to evaluate the effect of patient-centered CPR education (PCE) for family caregivers of patients with cardiovascular diseases.

Methods

Fifty-four participants were randomly assigned to the PCE or control group. The PCE group received tailored counseling on overall cardiovascular disease information and CPR followed by interactive instructor-guided CPR training and re-education follow-up by telephone 2 weeks later. The control group received only video-based CPR self-education and booklets. Cardiovascular disease and CPR knowledge and self-efficacy were measured before (pre-test), immediately after (post-test 1), and 4 weeks after the PCE (post-test 2). CPR skills and performance were measured pre-test and at post-test1.

Results

The PCE group demonstrated significant improvements in knowledge (F=91.09, p<.001), self-efficacy (F=15.19, p<.001) and CPR skills and performance (F=8.10, p=.008), as well as significant differences over time (knowledge: F=364.25, p<.001; self-efficacy: F=1162.28, p<.001; CPR skills and performance: F=1798.81, p<.001). There were significant group-by-time interactions for knowledge (F=8.10, p=.001), self-efficacy (F=4.30, p=.019) and CPR skills and performance (F=4.81, p=.036) by repeated measures ANOVA.

Conclusion

This is the first study to demonstrate the effects of a patient-centered intervention with CPR education tailored for patients' and family caregivers' preferences, needs, and lifestyles. The results of this study encourage the use of tailored, patient-centered interventions in cardiovascular nursing practice.

Citations

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Mastering the Art of Caregiving: Instructional Approaches to Teaching Healthcare‐Related Procedural Skills to Informal Caregivers—An Integrative Review
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Expert opinion on evidence after the 2020 Korean Cardiopulmonary Resuscitation Guidelines: a secondary publication
Sung Phil Chung, Youdong Sohn, Jisook Lee, Youngsuk Cho, Kyoung-Chul Cha, Ju Sun Heo, Ai-Rhan Ellen Kim, Jae Guk Kim, Han-Suk Kim, Hyungoo Shin, Chiwon Ahn, Ho Geol Woo, Byung Kook Lee, Yong Soo Jang, Yu Hyeon Choi, Sung Oh Hwang
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Yu-Fei Qian, Yu-Qin Ren, Li Wang, Rong-Qian Sun, Dan-Feng Li, Samar Tharwat
International Journal of Clinical Practice.2022; 2022: 1. CrossRef
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Myra H. Wyckoff, Robert Greif, Peter T. Morley, Kee-Chong Ng, Theresa M. Olasveengen, Eunice M. Singletary, Jasmeet Soar, Adam Cheng, Ian R. Drennan, Helen G. Liley, Barnaby R. Scholefield, Michael A. Smyth, Michelle Welsford, David A. Zideman, Jason Acwo
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Kellen A. Knowles, Helen Xun, Sunyoung Jang, Sharon Pang, Charles Ng, Apurva Sharma, Erin M. Spaulding, Rohanit Singh, Alaa Diab, Ngozi Osuji, Joshua Materi, Danielle Amundsen, Shannon Wongvibulsin, Daniel Weng, Pauline Huynh, Julie Nanavati, Jennifer Wol
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Bruno Enzo Vargas-Sánchez, Miluska Madeleine Salazar-Arteaga, Aida Del Carmen Rotta-Rotta, Roy Germán Dueñas-Carbajal
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Nurses’ Cardiopulmonary Resuscitation Performance during the First 5 minutes in In-Situ Simulated Cardiac Arrest: Eun Jung Kim, Kyeong Ryong Lee, Myung Hyun Lee, Jiyoung Kim; J Korean Acad Nurs 2012;42(3):361-368. Published online June 12, 2012; DOI: https://doi.org/10.4040/jkan.2012.42.3.361

Abstract PDF

Abstract Purpose

The purpose of this study was to analyze the cardiopulmonary resuscitation skills and teamwork of nurses in simulated cardiac arrests in the hospital.

Methods

A descriptive study was conducted with 35 teams of 3 to 4 registered nurses each in a university hospital located in Seoul. A mannequin simulator was used to enact simulated cardiac arrest. Assessment included critical actions, time elapsed to initiation of critical actions, quality of cardiac compression, and teamwork which comprised leadership behavior and communication among team members.

Results

Among the 35 teams, 54% recognized apnea, 43% determined pulselessness. Eighty percent of the teams compressed at an average elapsed time of 108 ± 75 seconds with 35%, 36%, and 67% mean rates of correct compression depth, rate, and placement, respectively. Thirty- seven percent of the teams defibrillated at 224± 67 seconds. Leadership behavior and communication among team members were absent in 63% and 69% of the teams, respectively.

Conclusion

The skills of the nurses in this study cannot be considered adequate in terms of appropriate and timely actions required for resuscitation. Future resuscitation education should focus on improving the quality of cardiopulmonary resuscitation including team performance targeting the first responders of cardiac arrest.

Citations

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A Study on the Sustainable Effects of Reeducation on Cardiopulmonary Resuscitation on Nurses' Knowledge and Skills: Soo-IL Oh, Sang-Sook Han; J Korean Acad Nurs 2008;38(3):383-392. Published online June 30, 2008; DOI: https://doi.org/10.4040/jkan.2008.38.3.383

Abstract PDF

Purpose

This study was to analyze the sustainable effects of cardiopulmonary resuscitation (CPR) reeducation on nurses' knowledge and skills.

Methods

A repeated experimental design was used for a single sample group of 47 nurses working for a general hospital. The nurses were tested on their skill of CPR 3 times at an interval of 4 months. In order to test nurses' knowledge and skills, the researcher used a CPR assessment program linked to an adult practice doll (Anne).

Results

1) The amount of decrease of nurses' knowledge about CPR between points of time was wide between the first and second points of time but small between the second and third time owing to the effects of reeducation between the two points of time. 2) Nurses' skills between the first and second time dropped but they improved between the second and third time owing to the effects of reeducation.

Conclusion

As confirmed by the above findings, reeducation of CPR clearly affects nurses' knowledge and skills. Given the fact that the same period of time (4 months) elapsed between the 3 tests, it could be argued that the reeducation at the second test served to maintain nurses' knowledge and enhance their skills.

Citations

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Evaluation of a Self-efficacy-based Basic Life Support Program for High-risk Patients' Family Caregivers: Kyunghee Kang, Insook Lee; Journal of Korean Academy of Nursing 2005;35(6):1081-1090. Published online October 31, 2005; DOI: https://doi.org/10.4040/jkan.2005.35.6.1081

Abstract PDF

Purpose

The purpose of this study was to evaluate a Self-efficacy-based Basic Life Support (SEBLS) program for high-risk patients' family caregivers on cardiac arrest. The SEBLS program was constructed on the basis of Bandura's self-efficacy resources as well as the International Liaison Committee on Resuscitation's “2000 Guidelines for CPR and ECC”.

Method

The effect of the SEBLS program on emergency response self-efficacy and emergency response behavior such as BLS(Basic Life Support) knowledge and BLS skill performance was measured by a simulated control group pretest-posttest design. Study subjects were38 high-risk patients' family caregivers(20 experimental subjects and 18 control subjects) whose family patients were admitted to a general hospital in Incheon, Korea.

Result

1. Emergency response self-efficacy was significantly higher in the experimental subjects who participated in the SEBLS program than in the control subjects. (t=8.3102, p=0.0001). 2. For emergency response behavior, BLS knowledge (t=5.6941, p=0.0001) and BLS skill performance (t=27.8281, p=0.0001) was significantly higher in experimental subjects than in control subjects.

Conclusion

A SEBLS program can increase emergency response self-efficacy and emergency response behavior, and could be an effective intervention for high-risk patient's family caregivers. Long-term additional studies are needed to determine the lasting effects of the program.

Citations

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Factors Influencing for Intention to Perform Cardiopulmonary Resuscitation in Elementary and Secondary School Teachers
Kyoung Sun Song, Kyung-Yeon Park
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