Journal of Korean Academy of Nursing

Research Paper

Development and Validation of a Dignity in Care Scale of Terminally Ill Patients for Nurses: Ahn, Yun Sil , Oh, Pok Ja; J Korean Acad Nurs 2023;53(3):340-358. Published online June 30, 2023; DOI: https://doi.org/10.4040/jkan.23039

Purpose
This study aimed to develop an instrument to showcase Dignity in Care of Terminally Ill Patients for Nurses and to examine its validity and reliability.
Methods
A total of 58 preliminary items on dignity in care of terminally ill patients for nurses were selected using content validity analysis and expert opinions on 97 candidate items derived through a literature review and qualitative focus group interviews. Questionnaires were administered to 502 nurses caring for terminally ill cancer patients at hospice and palliative care institutions. The data were analyzed using item analysis, exploratory and confirmatory factor analysis, convergent and discriminant validity, and Pearson correlation for criterion validity, reliability was tested using Cronbach’s alpha.
Results
The final instrument consisted of 25 items, with four factors identified through confirmatory factor analysis. Four factors-ethical values and moral attitudes, interaction-based communication, main-taining comfort, professional insight and competence–accounted for 61.8% of the total variance. Cronbach’s ⍺ for total items was .96, and test-retest reliability of intraclass correlation coefficient was .90.
Conclusion
Since its validity and reliability have been verified through various methods, the Dignity in Care Scale of Terminally Ill Patients for Nurses can be used for develop nursing interventions and improve dignity in care of terminally ill patients.

Citations

Citations to this article as recorded by

Development and Validation of a Dignity in Care Scale of Terminally Ill Patients for Nurses
Yun Sil Ahn, Pok Ja Oh
Journal of Korean Academy of Nursing.2023; 53(3): 340. CrossRef

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Original Articles

Factors Influencing Pain with Terminally Ill Cancer Patients in Hospice Units: You Ja Ro, Nam Cho Kim, Young Sun Hong, Jin Sun Yong; Journal of Korean Academy of Nursing 2001;31(2):206-220. Published online March 29, 2017; DOI: https://doi.org/10.4040/jkan.2001.31.2.206

Abstract PDF

The purpose of this study was to investigate the impact of depression, discomfort, spirituality, physical care, and opioid use on pain with terminally ill cancer patients residing in hospice units. The convenient sample of this study consisted of 41 terminally ill cancer patients at three hospice units in university affiliated hospitals. Patients were interviewed with structured questionnaires three times at predetermined intervals: admission to the hospice unit (Time 1), one week later (Time 2), and two weeks later (Time 3). The data was collected from January 1998 to January 1999 and was analyzed using ANOVA, Pearson correlation coefficient, and multivariate multiple regression. The results of this study were as follows: 1. The mean age of the participants was approximately 55 years old. In terms of diagnosis, lung cancer showed the highest frequency (19.5%), followed by stomach cancer and rectal cancer (17.1%). The motive of seeking hospice unit admission was control (72. 2%), followed by spiritual care (50%), and symptom relief (38.9%). 2. Regarding the type of pain felt, the highest pain frequency the participants experienced was deep pain (55%), followed by multiple pain (25%), intestinal pain (10%), then superficial (5%) and neurogenic pain (5%). For the level of pain measured by VAS, there was no significant difference among the three time points; Time 1 (5.04 +/-2.21), Time 2 (4.82+/-2.58) and Time 3(4.73+/-2.51). 3. There was significant change seen in spirituality and physical care in each time interval. Namely, the longer the length of admission at the hospice unit, the higher the importance of spirituality (p=0.0001) and the more the physical care the participants received (p=0.01). The opioid use at the three time points showed the following frequencies : Time 1 (75.6%), Time 2 (85.4%) and Time 3 (75.6%). 4. Regarding factors influencing pain, the pain level was significantly affected by the depression level (p <0.01) and the opioid use (p <0.1). These results were the most significant at the two time points (Time 1 and Time 2). At Time 3 (two weeks later), the pain level was significantly affected by the depression level (p <0.05) and the amount of physical care the participants received (p <0.1). In conclusion, the terminally ill cancer patients had moderate pain, were generally depressed, and were treated with opioid analgesics. As approaching death, the patients received more physical care due to increased physical symptoms experienced and they had a higher perception of the importance of spirituality. Thus, health care professionals need to provide continuous care for each of them to die comfortably physically, psycho- logically, and spiritually.

Citations

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Discomfort related to Peripherally Inserted Central Catheters in Cancer Patient
Misun Yi, Im-Ryung Kim, Eun-Kyung Choi, Seyoung Lee, Mikyong Kwak, Juhee Cho, Jin Seok Ahn, In Gak Kwon
Asian Oncology Nursing.2017; 17(4): 229. CrossRef
The Effects of Music Therapy by Self-Selected Music Listening on Terminal Cancer Patients’ Affect and Stress by Pain Level
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The Korean Journal of Hospice and Palliative Care.2012; 15(2): 77. CrossRef
Nursing interventions to promote dignified dying in South Korea
Kae-Hwa Jo, Ki-Wol Sung, Ardith Z Doorenbos, Elizabeth Hong, Tessa Rue, Amy Coenen
International Journal of Palliative Nursing.2011; 17(8): 392. CrossRef
Hospice and Hospice Care in Korea: Evolution, Current Status, and Challenges
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The Study on the Medical and Nursing Service Needs of the Terminal Cancer Patients and Their Caregivers: So Woo Lee, Eun Ok Lee, Dae Suk Huh, Kuck Hee Noh, Hyun Sook Kim, Sun Rae Kim, Sung Za Kim, Jung Hee Kim, Kung Ok Lee, Eun Hee Lee, Eun Za Chung, Mun Sook Cho, Myung Sook Cho, Myung Ae Whang, Young Ho Yun; Journal of Korean Academy of Nursing 1998;28(4):958-969. Published online March 29, 2017; DOI: https://doi.org/10.4040/jkan.1998.28.4.958

Abstract PDF

In this study, we attempted to investigate the needs and problems of the terminal cancer patients and their family caregivers to provide them with nursing information to improve their quality of life and prepare for a peaceful death. Data was collected from August 1, 1995 to July 31, 1996 at the internal medicine unit of S hospital in Seoul area with the two groups of participants who were family members of terminal cancer patients seventy four of them were in-patients and 34 were out-patients who were discharged from the same hospital for home care. The research tool used in this study has been developed by selecting the questionnaires from various references, modifying them for our purpose and refining then based on the results of preliminary study. While general background information about the patients was obtained by reviewing their medical records, all other information was collected by interviewing the primary family caregivers of the patients using the questionnaire. The data collected were analyzed with the SPSS PC+ program. The results of this study are summarized as follows; 1) Most frequently complained symptoms of the terminal cancer patients were in the order of pain(87%), weakness(86.1%), anorexia(83.3%) and fatigue(80.6%). 2) Main therapies for the terminal cancer patients were pain control(58.3%), hyperalimentation(47.2%) and antibiotics(21.3%). 3) Special medical devices that terminal cancer patients used most were oxygen device(11.1%), and feeding tube(5.6%). Other devices were used by less than 5% of the patents. 4) The mobility of 70.4% of the patients was worse than ECOG 3 level, they had to stay in bed more than 50% of a day. 5) Patients wanted their medical staffs to help relieve pain(45.4%), various physical symptoms(29.6%), and problems associated with their emotion(11.1%). 6) 16.7% of the family caregivers hoped for full recovery of the patients, refusing to admit the status of the patients. also, 37% wished for the extension of the patient's life at least for 6 months. 7) Only 38.9% of the family members was preparing for the patient's funeral. 8) 45.4% of family caregivers prefer hospital as the place for the patient's death, 39.8% their own home, and 14.8% undetermined. 9) caregivers of the patients were mostly close family members, i.e., spouse(62%), and sons and daughters or daughter-in-laws(21.3%). 10) 43.5% of the family caregivers were aware of hospice care. 46.8% of them learned about the hospice care from the mass media, 27.7% from health professionals, and the rest from books and other sources. 11) Caregivers were asked about the most difficult problems they encounter in home care, 41 of them pointed out the lack of health professionals they can contact, counsel and get help from in case of emergency, 17 identified the difficulty of finding appropriate transportation to hospital, and 13 stated the difficulty of admission in hospital as needed. 12) 93.6% of family caregivers demanded 24-hour hot line, 80% the visiting nurses and doctors, and 69.4% the volunteer's help. The above results indicate that terminal patients and their family caregivers demand help from qualified health professionals whenever necessary. Hospice care system led by well-trained medical and nursing staffs is one of the viable answers for such demands.

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Mun Jung Ko, So-Hyun Moon
Journal of Korean Academy of Psychiatric and Mental Health Nursing.2016; 25(4): 327. CrossRef
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Kyung Suk Heo, Eun-Jun Park
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Assessment of the Effect of a Public Health Clinics’ Home-Based Terminal Cancer Patient Management in Collaboration with a Regional Cancer Center
Haa-Na Song, Myoung Hee Kang, Gyeong Won Lee, Hoon Gu Kim, Won Sup Lee, Jung Hun Kang, Yoon Sik Kang, Young Eun
The Korean Journal of Hospice and Palliative Care.2013; 16(1): 10. CrossRef
Experiences of Family Caregivers of Patients with Terminal Cancer
Eun Sook Choi, Keum Soon Kim
Journal of Korean Academy of Nursing.2012; 42(2): 280. CrossRef
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In Sun Suh, Mi Hwa Shin, Se Hwa Hong
The Korean Journal of Hospice and Palliative Care.2010; 13(2): 89. CrossRef
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Ji Hyun Sung, Min Young Kim, Ok Hee Hwang, Han Jin Yoo, Eun Ja Lee
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Evaluation of a Community-Based Cancer Patient Management Program: Collaboration between a Hospice Center and Public Health Centers
Hae Sook Lee, Sun Hee Park, Young Soon Chung, Bookyung Lee, So-Hi Kwon
The Korean Journal of Hospice and Palliative Care.2010; 13(4): 216. CrossRef
Family Experiences in End-of-Life Care: A Literature Review
Ji-Soo Yoo, JuHee Lee, Soo Jung Chang
Asian Nursing Research.2008; 2(4): 223. CrossRef

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Review Article

Effects of Dignity Interventions on Psychosocial and Existential Distress in Terminally ill Patients: A Meta-analysis: Pok Ja Oh, Sung-Rae Shin; J Korean Acad Nurs 2014;44(5):471-483. Published online October 31, 2014; DOI: https://doi.org/10.4040/jkan.2014.44.5.471

Abstract PDF

Purpose

This study was done to evaluate the effects of dignity interventions on depression, anxiety and meaning of life in terminally ill patients.

Methods

PubMed, Cochrane Library CENTRAL, EMBASE, CINAHL and several Korean databases were searched. The main search strategy combined terms indicating dignity intervention, presence of terminal illness and study design. Methodological quality was assessed using Cochrane's Risk of Bias for randomized studies and Risk of Bias Assessment tool for non randomized studies. Data were analyzed by the RevMan 5.2.11 program of Cochrane Library.

Results

Twelve clinical trials met the inclusion criteria with a total of 878 participants. Dignity intervention was conducted for a mean of 2.2 weeks, 2.8 sessions and an average of 48.7 minutes per session. Effect sizes were heterogeneous and subgroup analysis was done. Dignity interventions had a significant effect on depression (ES=-1.05, p<.001, I²=15%) and anxiety (ES=-1.01, p<.001, I²=0). For meaning of life, dignity interventions were effective (ES=-1.64, p=.005) and effect sizes were still heterogeneous.

Conclusion

Results support findings that dignity interventions can assist terminal ill patients in reducing emotional distress and improving meaning of life. Further well-designed dignity studies will lead to better understanding of the effects of treatments on spiritual well-being.

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Effects of meaning in life and individual characteristics on dignity in patients with advanced cancer in China: a cross-sectional study
Xiaocheng Liu, Zhili Liu, Qinqin Cheng, Nuo Xu, Hui Liu, Wenjuan Ying
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Effectiveness of dignity therapy for patients with advanced cancer: A systematic review and meta‐analysis of 10 randomized controlled trials
Yanfei Li, Xiuxia Li, Liangying Hou, Liujiao Cao, Guanghua Liu, Kehu Yang
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Mechanisms Behind Religiosity and Spirituality’s Effect on Mental Health, Quality of Life and Well-Being
Mario Fernando Prieto Peres, Helder H. Kamei, Patricia R. Tobo, Giancarlo Lucchetti
Journal of Religion and Health.2018; 57(5): 1842. CrossRef

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Original Articles

Experience in Acceptance of Hospice by Patients with Terminal Cancer : A Phenomenological Research: Su Young Kwak, Byoung Sook Lee; J Korean Acad Nurs 2013;43(6):781-790. Published online December 31, 2013; DOI: https://doi.org/10.4040/jkan.2013.43.6.781

Abstract PDF

Purpose

The purpose of this study was to further understanding of the experience in acceptance of hospice by patients with terminal cancer and to explore the structure of this experience.

Methods

A phenomenological methodology was used for the study. Participants were nine patients who were admitted to the hospice unit of a university hospital. In-depth interviews were done for data collection and the data were analyzed using Colaizzi's method.

Results

Four categories, eight theme clusters and 18 themes were identified for the experience in acceptance of hospice by patients with terminal cancer. The three categories were 'Hope for a comfortable death', 'Overcoming barrier of prejudice about hospice', 'Incessant craving for life', 'The last consideration for self and family'.

Conclusion

While accepting the hospice care, participants experienced inner conflict between giving up medical treatments that prolong life and choosing a comfortable death, and also experienced an incessant craving for life. By accepting hospice care, they showed a human dignity that entails careful concerns for both self and family members.

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Human relationships in patients’ end-of-life: a qualitative study in a hospice ward
Marika Lo Monaco, Raffaella Mallaci Bocchio, Giuseppe Natoli, Salvatore Scibetta, Teresa Bongiorno, Christiano Argano, Salvatore Corrao
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Feasibility Evaluation of Korean Advance Directives (K-AD)
Shin Mi Kim, Sun Woo Hong, Jin Shil Kim, Ki Sook Kim
The Journal of Korean Academic Society of Nursing Education.2014; 20(4): 639. CrossRef

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Experiences of Family Caregivers of Patients with Terminal Cancer: Eun Sook Choi, Keum Soon Kim; J Korean Acad Nurs 2012;42(2):280-290. Published online April 30, 2012; DOI: https://doi.org/10.4040/jkan.2012.42.2.280

Abstract PDF

Purpose

This study done to identify the experiences of families caring for patients with terminal cancer. The question was, "What is the caregiving experience of a family who has a member with terminal cancer?"

Methods

Grounded Theory was applied and in-depth interviews were done with 11 family members. Interviews were recorded with the interviewees' consent and were transcribed and analyzed. Participants' relationships to patients were 6 spouses, 4 daughters, and 1 mother. The ages of the participants were between 32 and 62, with an average of 47.5.

Results

The study showed "enduring with bonds" as the main category and the main factor affecting this category was the "patients' diagnosis of terminal cancer." The caregiving experience was divided into four stages: shock, confusion, struggle, and acceptance. Mediating factors were relationship with the patient, intimacy with the patient, social support, communication, and trust. Conclusively, participants underwent internal maturity, and changes occurred in family and social and personal life.

Conclusion

The families took care of the patients with responsibility and love. The study results should help with the understanding of a family with a member with terminal cancer and should be used to develop nursing, mediating, and consulting programs for these caregivers.

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Effects of a Short-term Life Review on Spiritual Well-being, Depression, and Anxiety in Terminally Ill Cancer Patients: Sung Hee Ahn, Young Lan An, Yang Sook Yoo, Michiyo Ando, Soo Jin Yoon; J Korean Acad Nurs 2012;42(1):28-35. Published online February 29, 2012; DOI: https://doi.org/10.4040/jkan.2012.42.1.28

Abstract PDF

Purpose

This study was done to evaluate the effects of a short-term life review on spiritual well-being, depression, and anxiety in patients with terminal cancer.

Methods

The study used a pre posttest quasi experimental design with a nonequivalent control group. Measurement instruments included the Functional Assessment of Chronic Illness Therapy-Spiritual scale (FACIT-Sp12) and the Hospital Anxiety and Depression Scale (HADS). Participants were 32 patients with terminal cancer who were receiving chemotherapy or palliative care at hospitals or at home. Eighteen patients were assigned to the experimental group and 14 to the control group. A sixty minute short-term life review session was held twice a week as the intervention with the experimental group.

Results

There was a statistically significant increase in spiritual well-being in the experimental group compared to the control group. There were also significant decreases in depression and anxiety in the experimental group compared to the control group.

Conclusion

The results indicate that a short-term life review can be used as a nursing intervention for enhancing the spiritual well-being of patients with terminal cancer.

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