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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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
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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
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HyunChul Youn, Suk-young Lee, Han-yong Jung, Shin-Gyeom Kim, Seung‑Hyun Kim, Hyun-Ghang Jeong
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Family Surrogates' Decision Regret and Psychological Stress about End-of-Life Cancer Treatments: Path Analysis: Su Hyun Kim; J Korean Acad Nurs 2018;48(5):578-587. Published online October 31, 2018; DOI: https://doi.org/10.4040/jkan.2018.48.5.578

Abstract PDF

Purpose

This study aimed to understand the mechanisms of decision regret and stress of family surrogates' end-of-life decision making using an exploratory path model. In particular, the research identified the direct effects of perceptions of uncertainty and effective decisions on decision regret and stress, and examined the indirect effects of being informed, having clear values, and being supported for decision regret and the stress of end-of-life decision making through the mediating variables of perceptions of uncertainty and effective decisions.

Methods

Data were collected from 102 family surrogates who had participated in end-of-life decision making for patients with terminal cancer in a tertiary hospital.

Results

Perception of effective decisions was a significant direct predictor of decision regret, and uncertainty was a significant predictor of stress among the participants. Being informed, having clear values, and being supported had a significant indirect influence on decision regret through the perception of effective decisions among family surrogates. However, only having clear values had a significant indirect influence on stress through the perception of uncertainty. The model explained 63.0% of decision regret and 20.0% of stress among the participants and showed a good fit with the data, χ²=12.40 (df=8, p=.134), TLI=.97, and RMSEA=.07.

Conclusion

Nurses can support family surrogates in end-oflife decision-making processes to decrease their decision regret by providing information about end-of-life care choices, clarifying personal values, and supporting the decision-making process, and to relieve their stress by facilitating the clarification of personal values.

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Journal of Pain and Symptom Management.2023; 66(1): 44. CrossRef
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Mirinae Kim, Minju Kim
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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
Hyeon Jin Cho, Jiyeon Kang
Journal of Korean Academy of Nursing.2021; 51(1): 15. CrossRef
A Mixed Method Study for Exploring the Difficulties in End-of-Life Care and End-of-Life Care Competency in Nurses Who Take Care of Cancer Patients
Lae Hee Kim, Su Yeon Kim, Shin Kim, Hyun A Kim, Hwa Jeong Yang, Kyoung Min Lee, Su Yeon Lee, Kyung Hee Lee, Jeong Hye Kim
Asian Oncology Nursing.2021; 21(2): 98. CrossRef
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Hyun Jung Jung, Jeong Yun Park
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Jung-Ja Choi, Su Hyun Kim, Shin-Woo Kim
Journal of Korean Academy of Nursing.2019; 49(3): 329. CrossRef

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Influential Factors of Complicated Grief of Bereaved Spouses from Cancer Patient: So Myeong Kim, So Hi Kown; J Korean Acad Nurs 2018;48(1):59-69. Published online January 15, 2018; DOI: https://doi.org/10.4040/jkan.2018.48.1.59

Abstract PDF

Abstract Purpose

The purpose of this study was to investigate variables and construct paths that affect complicated grief.

Methods

Participants in this cross-sectional, descriptive study were 164 bereaved spouses of cancer patients at least 12 months before the death. Data were collected from October 2016 to February 2017 using self-report structured questionnaires and were analyzed using IBM SPSS 21.0 and AMOS 20.0.

Results

The variables affecting complicated grief of bereaved spouses of cancer patients were the quality of end-of-life care (g=.15, p<.001), preparedness for death (b=-.06, p=.005), and coping with bereavement (b=-.24, p<.001), whereas the quality of death and dying did not show any effects. Preparedness for death had multiple mediating effects in the relationship between the quality of end-of-life care and complicated grief (z=-2.20, p=.028), and in the relationship between the quality of end-of-life care and coping with bereavement (z=2.11, p=.035). Coping with bereavement had a mediating effect on the relationship between preparedness for death and complicated grief (z=-2.39, p=.017).

Conclusion

This study revealed that preparedness for death and coping with bereavement play a prominent role in complicated grief. Therefore, it is important to help in preparing for death and enhancing coping with bereavement of spouses providing end-of-life care to cancer patients. In addition, investigating cultural differences in the relationship between the quality of end-of-life care and complicated grief is recommended.

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Psycho-Oncologie.2020; 14(4): 195. CrossRef

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Nurses' Experience of Caring for Dying Patients in Hospitals: Myungsun Yi; Journal of Korean Academy of Nursing 2003;33(5):553-561. Published online March 28, 2017; DOI: https://doi.org/10.4040/jkan.2003.33.5.553

Abstract PDF

Purpose

To develop a substantive theory that represents hospital nurses' experience on caring for dying patients.

Method

Grounded theory method guided the data collection and analysis. A purposeful sample of 15 hospital nurses participated during the period of 2001-2002. The data were collected by semi-structured individual interviews. All interviews were audio taped and transcribed verbatim. Constant comparative analysis was employed to analyze the data.

Result

“Putting oneself into shape while being faithful to feelings and emotions” emerged as the basic social-psychological process. Three different phases were identified: being faithful to own feelings and behaviors; putting oneself into shape; and mourning death. The first phase includes the categories of “establishing trust relationships” and “sympathizing with dying patients and their family members.” The second phase consists of “controlling feelings,” “adjusting ethical conflicts,” and “providing best patient-care,” and “helping family accept the death.” And the third phase consists of “overcoming sadness” and “releasing other negative feelings.”

Conclusion

The result of this study will help health professionals develop efficient support programs that support nurses caring for dying patients in hospitals. Further study needs to be done to verify findings.

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Comparison of Cancer Nursing Interventions Recorded in Nursing Notes with Nursing Interventions Perceived by Nurses of an Oncology Unit: Patients with Terminal Cancer: Ja Yun Choi, Keum Seong Jang; Journal of Korean Academy of Nursing 2005;35(3):441-450. Published online June 30, 2005; DOI: https://doi.org/10.4040/jkan.2005.35.3.441

Abstract PDF

Purpose

The purposes of this study were to determine the core nursing interventions in nursing notes and the practice which was perceived by nurses of an oncology unit with patients with terminal cancer. Also, comparing interventions in nursing notes with interventions in perceived practice was done.

Method

Subjects were 44 nursing records of patients with terminal cancer who had died from Jan. to Dec. 2002 at C University Hospital and 83 nurses who were working on an oncology unit for more than one year. Data was collected using a Nursing Interventions Classification and analyzed by means of mean and t-test.

Results

The most frequent nursing intervention was ‘nausea management’ in the nursing note and was ‘medication administration : oral’ in perceived practice. The frequency of nursing interventions in the nursing record was lower than in perceived practice.

Conclusion

This study finds that nurses actually practice nursing care, but they may omit records. To correct for omitted nursing records, development of a systematic nursing record system, continuous education and feedback is recommended.

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