The Effects of Nurses' Knowledge of Withdrawal of Life-Sustaining Treatment, Death Anxiety, Perceptions of Hospice on Their Attitudes toward Withdrawal of Life-Sustaining Treatment원문보기
Lee, Young Eun
(College of Nursing, Kosin University)
,
Jung, Yu Jin
(College of Nursing, Kosin University)
,
Jang, Yoo Na
(Department of Nursing, Kyongbuk Science College)
,
Jeong, Hyo Eun
(Kosin University Research Institute of Wholistic Nursing Science)
Purpose: This descriptive study investigated the effects of nurses' knowledge of withdrawal of life-sustaining treatment, death anxiety, and perceptions of hospice care on their attitudes toward withdrawal of life-sustaining treatment. Methods: Data were collected from 262 nurses at tertiary hospita...
Purpose: This descriptive study investigated the effects of nurses' knowledge of withdrawal of life-sustaining treatment, death anxiety, and perceptions of hospice care on their attitudes toward withdrawal of life-sustaining treatment. Methods: Data were collected from 262 nurses at tertiary hospitals, general hospitals, or primary hospitals in Busan, Korea, and statistically analyzed using the t-test, analysis of variance, the Scheffé test, Pearson correlation coefficients, and hierarchical regression analysis. Results: The participants' scores were 3.68±0.45 (out of 5) for attitudes toward withdrawal of life-sustaining treatment, 0.65±0.15 (out of 1) for knowledge of withdrawal of life-sustaining treatment, 2.61±0.26 (out of 4) for death anxiety, and 4.06±0.43 (out of 5) for perceptions of hospice care. Furthermore, knowledge of withdrawal of life-sustaining treatment and perceptions of hospice care showed positive correlations with attitudes toward withdrawal of life-sustaining treatment, while death anxiety showed a negative correlation. The most significant factors influencing attitudes toward withdrawal of life-sustaining treatment were perceptions of hospice care, followed by having experienced caring for patients who withdrew life-sustaining treatment, death anxiety, having a spouse, and ethical values, and the overall explanatory power was 43.0%. Conclusion: This study showed that perceptions of hospice were an important factor influencing nurses' attitudes toward withdrawal of life-sustaining treatment. Therefore, it is necessary to develop and validate educational intervention programs that can improve perceptions of hospice care.
Purpose: This descriptive study investigated the effects of nurses' knowledge of withdrawal of life-sustaining treatment, death anxiety, and perceptions of hospice care on their attitudes toward withdrawal of life-sustaining treatment. Methods: Data were collected from 262 nurses at tertiary hospitals, general hospitals, or primary hospitals in Busan, Korea, and statistically analyzed using the t-test, analysis of variance, the Scheffé test, Pearson correlation coefficients, and hierarchical regression analysis. Results: The participants' scores were 3.68±0.45 (out of 5) for attitudes toward withdrawal of life-sustaining treatment, 0.65±0.15 (out of 1) for knowledge of withdrawal of life-sustaining treatment, 2.61±0.26 (out of 4) for death anxiety, and 4.06±0.43 (out of 5) for perceptions of hospice care. Furthermore, knowledge of withdrawal of life-sustaining treatment and perceptions of hospice care showed positive correlations with attitudes toward withdrawal of life-sustaining treatment, while death anxiety showed a negative correlation. The most significant factors influencing attitudes toward withdrawal of life-sustaining treatment were perceptions of hospice care, followed by having experienced caring for patients who withdrew life-sustaining treatment, death anxiety, having a spouse, and ethical values, and the overall explanatory power was 43.0%. Conclusion: This study showed that perceptions of hospice were an important factor influencing nurses' attitudes toward withdrawal of life-sustaining treatment. Therefore, it is necessary to develop and validate educational intervention programs that can improve perceptions of hospice care.
* AI 자동 식별 결과로 적합하지 않은 문장이 있을 수 있으니, 이용에 유의하시기 바랍니다.
문제 정의
The purpose of this study was to identify the effects of knowledge of WLST, death anxiety, and perceptions of hospice care among clinical nurses on their attitudes toward WLST. The specific objectives of the study were as follows:
제안 방법
In this study, we sought to identify the level of knowledge of WLST, death anxiety, perceptions of hospice care, and attitudes toward WLST among clinical nurses, correlations among these variables, and factors influencing participants’ attitudes toward WLST with the goal of providing a basis for facilitating positive attitudes toward WLST.
In this study, we used a structured questionnaire that consisted of a total of 101 questions, including 19 questions on knowledge of WLST, 35 questions on death anxiety, 15 questions on perceptions of hospice care, 14 questions on attitudes toward WLST, and 18 questions on general characteristics.
The purpose of this study was to determine the influence of clinical nurses’ knowledge of WLST, death anxiety, and perceptions of hospice care on their attitudes toward WLST and to provide basic data for educational programs designed to foster positive changes in their attitudes toward WLST, focusing on the identified factors.
There were 15 questions in this domain, and each question was scored using a 5-point Likert scale, with 1 being “not aware at all” and 5 being “fully aware.
This descriptive survey study was conducted to identify the effects of knowledge of WLST, death anxiety, and perceptions of hospice care on clinical nurses’ attitudes toward WLST.
To assess participants’ knowledge of WLST, we revised and supplemented the assessment tool devised by Jung [4] to reflect the Act on Decisions on Life-Sustaining Treatment revised in March 2019, as the tool is a revised and supplemented version of the assessment tool developed by Kim [18] based on the previous version of the Act on Decisions on Life-Sustaining Treatment, which was enacted in 2017.
To determine the factors affecting attitudes toward WLST, we conducted hierarchical regression analysis with the following independent variables, which were identified as possible influencing factors based on our study results and a literature review: marital status, experience of providing nursing care for patients who withdrew life-sustaining treatment, ethical values, knowledge of WLST, death anxiety, and perceptions of hospice care. Marital status, experience of providing nursing care for patients who withdrew life-sustaining treatment, and ethical values (general characteristics) were treated as dummy variables in the analysis.
대상 데이터
Data collection was performed after receiving institutional review board approval from K University (KU IRB 2019-0014) from June 4 to August 30, 2019, after obtaining permission from the head of the corresponding department of each institution. The authors explained the purpose of the study and obtained signatures from those who agreed to participate in the study before distributing the self-report questionnaires.
The participants in this study were clinical nurses working at K University Hospital, S General Hospital, K Hospital, and I Nursing Hospital, all of which are located in B metropolitan city. The participants were selected via convenience sampling as those who voluntarily agreed to participate in the study after being informed of the purpose and methods of the study.
However, considering a dropout rate of 20%, data were collected from 276 participants. With the exclusion of 14 incomplete questionnaires, 262 complete surveys were included in the final analysis.
데이터처리
2) Differences in attitudes toward WLST according to general characteristics were analyzed using the t-test, analysis of variance, and the Scheffé test.
4) The correlations between the participants’ knowledge of WLST, death anxiety, and perceptions of hospice care with their attitudes toward WLST were analyzed by Pearson correlation coefficients.
5) The factors influencing participants’ attitudes toward WLST were analyzed by hierarchical regression analysis.
이론/모형
To assess death anxiety, we used the Fear of Death and Dying Scale, which was developed by Collette and Lester [19] and translated into Korean by Suh [20].
성능/효과
3) The participants’ knowledge of WLST, death anxiety, perceptions of hospice care, and attitudes toward WLST were analyzed in terms of the minimum, maximum, and mean and standard deviation.
In this study, higher levels of knowledge of WLST in clinical nurses were associated with more positive attitudes toward WLST. In contrast, Kim et al.
The characteristics of clinical nurses that showed significant correlations with their attitudes toward WLST were age, education, religion, marital status, children, monthly household income, clinical experience, type of hospital, hospital department, experience of providing nursing care for patients with terminal illness or on their deathbed, experience with providing nursing care for patients who withdrew life-sustaining treatment, ethical values, experience of education on hospice care, and education on WLST. In other words, attitudes toward WLST were more positive among clinical nurses who were older, had a higher level of knowledge; were religious; had a spouse or child; had a higher monthly income; had more clinical experience; worked in a tertiary or general hospital (instead of a primary hospital) or in the hospice ward (instead of in other wards); had experience of providing nursing care for patients with terminal disease, end-of-life care, or those who withdrew life-sustaining medical care; had strong ethical values; or had experienced education on hospice care or WLST.
The participants’ attitudes toward WLST were positively correlated, at a statistically significant level, with their knowledge of WLST (r=0.17, P=0.005) and perceptions of hospice care (r=0.50, P＜0.001) and were negatively correlated with death anxiety (r=-0.31, P＜0.001).
The results of model I in the regression analysis, which included the general characteristics of the participants as independent variables, showed that having a spouse (B=3.63, P ＜0.001), experience of providing nursing care for patients who withdrew life-sustaining treatment, and strong ethical values were associated with positive attitudes toward WLST (F=23.671, P＜0.001), with an explanatory power of 21.6%.
후속연구
Among elderly patients with cancer, higher levels of death anxiety were associated with more negative attitudes toward WLST [13], whereas among the general population and nurses, higher death anxiety was associated with more positive attitudes toward WLST [14]. Although these studies showed that death anxiety was associated with attitudes toward WLST, they presented conflicting results depending on the study participants, and we believe that this discrepancy warrants further research.
Our findings should be further investigated in future studies. Moreover, knowledge of and attitudes toward WLST after the Act on Decisions on Life-Sustaining Treatment came into force should be investigated in large-scale survey research involving various hospitals located in various regions, and highly reliable assessment tools should be developed.
It is difficult to generalize our results beyond the respondents of this study because we included only nurses who worked at tertiary hospitals, general hospitals, or primary hospitals located in the same region. Our findings should be further investigated in future studies. Moreover, knowledge of and attitudes toward WLST after the Act on Decisions on Life-Sustaining Treatment came into force should be investigated in large-scale survey research involving various hospitals located in various regions, and highly reliable assessment tools should be developed.
참고문헌 (30)
1 National Agency for Management of Life-Sustaining Treatment c2018-2019 Monthy statistics in 2018, 2019 [Internet] KONIBP Seoul Available from: https://www.lst.go.kr/comm/monthlyStatistics.do . cited 2019 Dec 24
2 Ministry of Government legislation c1997-2019 Act on decisions on life-sustaining treatment for patients in hospice and palliative care or at the end of life in 2019 [Internet] Korea Ministry of Government Legislation Sejong Available from: http://www.law.go.kr/lsInfoP.do?lsiSeq=208166&efYd=20190328#0000 . cited 2019 Dec 24
3 Ministry of Health and Welfare c1997-2019 1st Hospice and life-sustaining treatment comprehensive plan to ensure dignity and comfort from 2019 to 2023 MOHW Sejong Available from. http://www.mohw.go.kr/react/al/sal0301vw.jsp?PAR_MENU_ID=04&MENU_ID=0403&CONT_SEQ=349863 . cited 2019 Dec. 24
4 Jung YJ 2019 The effect of nursing student's knowledge of life-sustaining treatment plan, consciousness of biomedical ethics, perception of hospice on the attitude toward withdrawal life-sustaining treatment [master's thesis] Kosin Univ. Busan
5 Coombs MA Parker R Ranse K Endacott R Bloomer MJ 2017 An integrative review of how families are prepared for, and supported during withdrawal of life sustaining treatment in intensive care J Adv Nurs 73 39 55 10.1111/jan.13097 27508938
6 Lee SJ Kim HY 2016 Experience of life-sustaining treatment in patient care among intensive care unit nurses: phenomenological approach J Korean Acad Fundam Nurs 23 172 83 10.7739/jkafn.2016.23.2.172
7 Kwon YO Ahn SH 2013 The attitude and perception on withdrawal of futile life sustaining treatment and patient self determination right among home care nurses J Korean Bioethics Assoc 14 53 66
8 Kim SG Kim SH Yun HY 2019 Factors that influence end-of-life care provided by nurses in general hospitals Korean J Med Ethics 22 53 72 10.14475/kjhpc.2019.22.2.87
9 Ostrom TM 1969 The relationship between the affective, behavioral and cognitive components of attitude J Exp Soc Psychol 5 12 30 10.1016/0022-1031(69)90003-1
10 Kim EY Seo EH Jung EY 2017 Knowledge and attitudes toward the withdrawal of life-sustaining treatment among nursing students J East-West Nurs 23 1 8 10.14370/jewnr.2017.23.1.1
11 Kim SJ Kim HS Chae Y Kim WJ Kang JS 2012 The effect of nurses's experiences with DNR orders on their knowledge and attitudes concerning the withdrawal of life-sustaining treatment Korean J Med Ethics 15 355 69 10.35301/ksme.2012.15.3.355
13 Seo YM Shin SJ 2019 The relationship among attitudes toward the withdrawal of life-sustaining treatment, death anxiety, and death acceptance among hospitalized elderly cancer patients Asian Oncol Nurs 19 142 9 10.5388/aon.2019.19.3.142
15 Korea Hospice & Palliative Nurse Association 2006 Study guides for hospice and palliative care Sumunsa Seoul
16 Je NJ Hwa JS 2018 Factors influencing withdrawal of life-sustaining treatment in tertiary general hospital workers-knowledge and attitude of organ donation and transplantation, awareness of death, knowledge and perception of hospice palliative care Korean J Hosp Palliat Care 21 92 103 10.14475/kjhpc.2018.21.3.92
17 Choi GH Kwon SH 2018 Effects of a hospice palliative education program on perception of hospice, attitude to death, and meaning of life in adults Korean J Hosp Palliat Care 21 14 22 10.14475/kjhpc.2018.21.1.14
18 Kim SB 2011 Knowledge to interruption of life-sustaining treatment and advance directives in nursing students [master's thesis] Jeonbuk Univ. Jeonju Korean
19 Collett L Lester D 1969 The fear of death and the fear of dying J Psychol 72 179 81 10.1080/00223980.1969.10543496 5811840
20 Suh HK 1987 The Relationships among life satisfaction, locus of control, and death anxiety as perceived by Korean and American older adults using selected personal demographic variables Korean J Health Edu Promot 4 95 135
21 Han JY Lee NY 2009 Nursing students' attitude toward death and perception on hospice care J Korean Oncol Nurs 9 95 103 10.14370/jewnr.2013.19.2.88
22 Byun EK Choi HR Choi AL Hong KH Kim NM Kim HS 2003 An investigative research on the attitudes of intensive care unit nurses and families on terminating life support J Korean Clin Nurs Res 9 112 24
23 Cho KH Park YK Suh SR 2017 Comparison of the death anxiety and preferences for care near the end of life between nurses and physicians Korean J Med Ethics 20 276 86 10.35301/ksme.2017.20.3.276
24 Lee YE Choi EJ Park JS Shin SH 2013 Perception and knowledge of hospice care and attitude toward death held by medical professionals from the same region in Korea Korean J Hosp Palliat Care 16 242 52 10.14475/kjhpc.2013.16.4.242
25 Lee SJ Kim HY 2017 Attitude, role perception and nursing stress on life-sustaining treatment among intensive care unit nurses Korean J Adult Nurs 29 131 42 10.7475/kjan.2017.29.2.131
26 Kim MY Mun MY 2018 Impact of biomedical ethics awareness and ethical values in nursing student on their attitudes towards DNR Korean J Hosp Palliat Care 21 115 23 10.14475/kjhpc.2018.21.4.115
27 Choi EJ Jeong HS 2018 The effect of nursing students' consciousness of biomedical ethics, good death recognition, and self-esteem on the attitude toward withdrawal of life-sustaining treatment JKAIS 19 275 84
28 Kang JH Han SJ 2013 A study of intensive care unit nurses' understanding of the meaning of death, death anxiety, death concern and respect for life Korean J Hosp Palliat Care 16 80 9 10.14475/kjhpc.2013.16.2.080
29 Kim HJ Son MS Kang IS 2019 Nurses' knowledge, attitudes, experience, and confidence toward advance directives Global Health and Nursing 9 19 27 10.35144/ghn.2019.9.1.19
30 Kim MH Kang EH Kim MY 2012 Family decision-making to withdraw life-sustaining treatment for terminally-Ill patients in an unconscious state Korean J Hosp Palliat Care 15 147 54 10.14475/kjhpc.2012.15.3.147
※ AI-Helper는 부적절한 답변을 할 수 있습니다.