Journal of Korean Academy of Nursing

Research Paper

Family’s Perception of Proxy Decision Making to Authorize Do Not Resuscitate Order of Elderly Patients in Long Term Care Facility: A Q-Methodological Study: Cho, Hyeon Jin , Kang, Jiyeon; J Korean Acad Nurs 2021;51(1):15-26. Published online February 28, 2021; DOI: https://doi.org/10.4040/jkan.20188

Purpose
This study aimed to distinguish and describe the types of perceptions of do not resuscitate (DNR) proxy decisions among families of elderly patients in a long-term care facility.
Methods
This exploratory study applied Q-methodology, which focuses on individual subjectivity. Thirty-four Q-statements were selected from 130 Q-populations formed based on the results of in-depth interviews and literature reviews. The P-samples were 34 families of elderly patients in a long-term care hospital in Busan, Korea. They categorized the Q-statements using a 9-point scale. Using the PC-QUANL program, factor analysis was performed with the P-samples along an axis.
Results
The families’ perceptions of the DNR proxy decision were categorized into three types. Type I, rational acceptance, valued consensus among family members based on comprehensive support from medical staff. Type II, psychological burden, involved hesitance in making a DNR proxy decision because of negative emotions and psychological conflict. Type III, discreet decisions, valued the patients’ right to self-determination and desire for a legitimate proxy decision. Type I included 18 participants, which was the most common type, and types II and III each included eight participants.
Conclusion
Families’ perceptions of DNR proxy decisions vary, requiring tailored care and intervention. We suggest developing and providing interventions that may psychologically support families.

Citations

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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 PDF

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.

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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.

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Development and Psychometric Evaluation of the Resuscitation Self-efficacy Scale for Nurses: Young Sook Roh, S. Barry Issenberg, Hyun Soo Chung, So Sun Kim; J Korean Acad Nurs 2012;42(7):1079-1086. Published online December 31, 2012; DOI: https://doi.org/10.4040/jkan.2012.42.7.1079

Abstract PDF

Purpose

The purpose of this study was to develop and evaluate psychometric properties of the instrument, Resuscitation Self-Efficacy Scale for nurses.

Methods

This was a methodological study for instrument development and psychometric testing. The initial item pool derived from literature review and experts resulted in 30 items linked to resuscitation self-efficacy. A convenience sample of 509 Korean nurses from eleven academic teaching hospitals participated in a survey to examine psychometric properties of the scale. To examine construct validity, exploratory factor analysis and known-group comparison were used. Cronbach's coefficient alpha was used to determine the scale's internal consistency reliability.

Results

The final scale included 17 items with four-component structure termed 'Recognition', 'Debriefing and recording', 'Responding and rescuing', and 'Reporting'. These four factors accounted for 57.5% of the variance. Each subscale and the total scale demonstrated satisfactory internal consistency: .82; .88; .87; .83; and .91 respectively. Experienced nurses reported significantly higher self-efficacy mean scores in both total and subscales compared to new graduate nurses.

Conclusion

The Resuscitation Self-Efficacy Scale for nurses yields reliable and valid results in appraising the level of resuscitation self-efficacy for Korean nurses. Further study is needed to test and refine the scale.

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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.

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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.

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Hospital Nurses' Experience of Do-Not-Resuscitate in Korea: Myungsun Yi, Sang Eun Oh, Eun Ok Choi, In Gak Kwon, Sungbok Kwon, Kyung-mi Cho, Youngah Kang, Jeonghui Ok; Journal of Korean Academy of Nursing 2008;38(2):298-309. Published online April 30, 2008; DOI: https://doi.org/10.4040/jkan.2008.38.2.298

Abstract PDF

Purpose

The purpose of the study was to describe the experiences of do-not-resuscitate (DNR) among nurses.

Methods

Data were collected by in-depth interviews with 8 nurses in 8 different hospitals. Conventional qualitative content analysis was used to analyze the data.

Results

Eight major themes emerged from the analysis: DNR decision-making bypassing the patient, inefficiency in the decision-making process of DNR, negative connotation of DNR, predominance of verbal DNR over written DNR, doubts and confusion about DNR, least amount of intervention in the decision for DNR change of focus in the care of the patient after a DNR order, and care burden of patients with DNR. Decision-making of DNR occurred between physicians and family members, not the patients themselves. Often high medical expenses were involved in choosing DNR, thus if choosing DNR it was implied the family members and health professionals as well did not try their best to help the patient. Verbal DNR permission was more popular in clinical settings. Most nurses felt guilty and depressed about the dying/death of patients with DNR.

Conclusion

Clearer guidelines on DNR, which reflect a family-oriented culture, need to be established to reduce confusion and to promote involvement in the decision-making process of DNR among nurses.

Citations

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Ji Yun Lee, Yong Mi Lee, Jae In Jang
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Attitudes and Type Analysis of Cardiopulmonary Resuscitation among Hospital Nurses in Emergency Room and Intensive Care Units
Eun-Ho Ha, Kyoung-Soon Hyun
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Ji Yun Lee, Jae In Jang
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Experience of Life-sustaining Treatment in Patient Care among Intensive Care Unit Nurses: Phenomenological Approach
Su Jeong Lee, Hye Young Kim
Journal of Korean Academy of Fundamentals of Nursing.2016; 23(2): 172. CrossRef
Comparison of attitudes towards death and perceptions of do‐not‐resuscitate orders between older Korean adults residing in a facility and at home
Soon Young Park, Ok Sun Kim, Nam Hyun Cha, Sohyune R Sok
International Journal of Nursing Practice.2015; 21(5): 660. CrossRef
Application of Animation Mobile Electronic Informed Consent in Inpatient of Long-term Care Hospital: Focused on DNR Informed Consent
Ji-Kyeong Park, Ji-On Kim
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Ethical Attitudes, Perceptions of DNR and Advance Directives of General Population
Kyung Ja Kang, Se Jin Ju
Journal of Korean Academy of Psychiatric and Mental Health Nursing.2014; 23(2): 113. CrossRef
Nurses' Experiences of Do-Not-Resuscitate (DNR) by the Narrative Inquiry
Mi Kyung Woo, Miyoung Kim
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Junghee Mun, Sumi Kim
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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

Citations to this article as recorded by

Factors Influencing for Intention to Perform Cardiopulmonary Resuscitation in Elementary and Secondary School Teachers
Kyoung Sun Song, Kyung-Yeon Park
Journal of Korean Academy of Community Health Nursing.2020; 31(3): 384. CrossRef
The Effects of Knowledge, Attitude, and Self-efficacy of CPR on Willingness to Perform CPR in Family Members of Patients with Heart Disease
Jung Min Park, Sangeun Jun
Korean Journal of Adult Nursing.2018; 30(1): 79. CrossRef

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