중환자실 간호사의 임종간호수행에 영향을 미치는 요인

고문정 ( Ko Mun Jung ),문소현 ( Moon So-hyun ) 한국정신간호학회 2016 정신간호학회지 Vol.25 No.4

Purpose: This study was a descriptive research to assess the level of and the relationship of related factors in the performance of end-of-life care by intensive care unit (ICU) nurses. Methods: Participants were 238 ICU nurses from university and general hospitals. Data were collected, using structured questionnaires, and collected data were analyzed using t-test, ANOVA, Scheffe test, Pearson correlation coefficients, and multiple regression analysis with SPSS/WIN 22.0. Results: There were significantly positive effects between performance of end-of-life care and end-of-life care attitudes. Performance end-of-life care was negatively associated with end-of-life care stress and obstacles. Factors that significantly influenced ICU nurses` performance of end-of-life were end-of-life care stress, medical team in obstacles related to end-of-life care, and end-of-life care attitudes, which explained about 53% of the variance in the performance of end-of-life care. Conclusion: Findings indicate that hospital organizations should carry out stress management and counseling programs in order to lower ICU nurses` end-of-life care stress, and to enhance end-of-life care attitudes. In addition, concern needs to be given to the medical team which was one of the obstacles to end-of-life care. It is also necessary to decrease the heavy workload and increase the communication with medical workers.

임종 돌봄 경험에 대한 사례이해: 재독 한인 재가호스피스센터장의 경험을 중심으로

양영자 ( Yeung Ja Yang ) 경남대학교 인문과학연구소 2024 인문논총 Vol.64 No.-

The purpose of this case study is to understand in depth how end-of-life care has been provided in German and Korea, based on the experiences of a Korean hospice care at-home center director in German. Therefore, data was collected by conducting the narrative interview with the center director, which was analyzed using the qualitative interview analyse method. As a result, before and after her emigration(1999), as a nurse, she provided medicalized care in Korea that focused on the birth of life, and in Germany that focused on “curing” and prolonging life, and did not care about end-of-life care. For A, end-of-care was therefore terra incognita. However, after moving to Germany, she experienced a death of her brother in law in Germany(2006) who had been a mentor for her, which sparked her interest in end-of-care and led to a shift in her care practice that transformed end-of-care into Terra Cognita. Since then, A has been working to improve her professionalization of end-of-life-care, and has fought to change the practice from medicalized care to providing end-of-life care. She then moved to a new position as a hospice care at-home center director to focus her life more on end-of-life care, and in her role as a director, she experienced a transformation in which end-of-life care became “life itself' for her. However, unlike in Germany, where end-of-life care has become commonplace with the social and political development, end-of-life care in Korea, where she experienced her mother's dying and death online, was still perceived as lagging behind life-sustaining treatment. These findings suggest that end-of-life care is not only a matter of personal experience, but also a matter of political and practical experience at the national dimension. Based on these findings, some implications for social welfare in relation to end-of-life care were discussed.

간호대학생의 좋은죽음인식, 공감역량, 임종간호 자기효능감이 임종간호태도에 미치는 영향

류세인(Sein Rye) 학습자중심교과교육학회 2025 학습자중심교과교육연구 Vol.25 No.1

목적 본 연구는 간호대학생의 임종간호에 대한 긍정적인 태도를 형성하여 향후 간호직을 수행하는 데 필요한 자질을 높이고자 시도하였으며, 간호대학생의 좋은죽음인식, 공감역량, 임종간호 자기효능감이 임종간호태도에 미치는 영향을 파악함으로써 간호대학생의 임종간호 중재 개발을 위한 기초자료로 제공하고자 한다. 방법 G시에 소재하는 4학년 간호대학생 130명을 대상으로 하였으며, 일반적인 특성 및 변수는 기술통계, 일반적 특성에 따른 임종간호태도는 independent t-test, ANOVA, 변수 간 상관관계는 Pearson’s correlation coefficients, 이들의 임종간호태도에 미치는 영향은 다중회귀분석을 이용하여 분석하였다. 결과 간호대학생의 임종간호태도는 좋은죽음인식(r=.38, p<.001), 공감역량(r=.50, p<.001), 임종간호 자기효능감(r=.53, p<.001)와 유의미한 정적 상관관계가 있는 것으로 나타났다. 임종간호태도에 영향을 미치는 요인은 임종간호 자기효능감, 좋은죽음인식으로 나타났으며, 이들의 총 설명력은 29.9%이었다. 결론 연구 결과를 토대로, 간호대학생의 임종간호태도 향상을 위해 본 연구의 영향 요인인 임종간호 자기효능감 형성과 좋은죽음인식을 높이고자 다양한 임종 간호교육 프램그램의 개발 및 적용이 필요하다. Objectives This study aimed to develop positive attitudes toward end-of-life care among nursing students to enhance the qualities necessary for future nursing careers, and to provide a basis for developing end-of-life care interventions for nursing students by identifying the effects of good death awareness, empathy, and end-of-life care self-efficacy of end-of-life care attitudes. Methods It was targeted to 130 nursing students in G city, and the general characteristics and variables were descriptive statistics, the end-of-life care attitude according to general characteristics was Independent T-Test, ANOVA, variable correlation was Pearson's Correlation Coefficients, their the impact factor on the end-of-life care attitude was analyzed using multiple regression analysis. Results The results of the study showed that there were significant positive correlations with nursing students' good death awareness (r=.38, p<.001), empathy (r=.50, p<.001), end-of-life care self-efficacy (r=.53, p<.001) and end-of-life care attitude. The factors that affect the of end-of-life care attitude were due to self-efficacy of end-of-life care and good death awareness. Their total explanation was 29.9%. Conclusions It is necessary to develop and apply various end-of-life care education programs to increase self-efficacy of end-of-life care and good death awareness, which are the influencing factors of this study, to improve end-of-life care attitudes of nursing students.

사회복지사의 임종케어 제공의향에 미치는 영향요인: 한국과 미국 비교연구 중심으로

권성애 ( Kwon Sung Ae ),박용순 ( Park Yong Soon ),석말숙 ( Suk Malsook ) 한국보건사회연구원 2015 保健社會硏究 Vol.35 No.3

The aim of this study was to evaluate and compare the intention or willingness to provide end-of-life care among social work professionals between South Korea and the United States. Factors associated with their end-of-life care intention were measured by a structured questionnaire completed by 246 social workers in a metropolitan area of South Korea and 102 social workers or social work students in the southeast of the United States. Using SPSS 20.0, the results of this study indicated that the end-of-life care intention was positively associated with the factor(s) of education or training in end-of-life care issues and the degree of recognition of the need for end-of-life care in South Korea and the degree of recognition of the need for end-of-life care in the United States. Also, experiences with end-of-life care issues in South Korea and emphasis on self-determination were identified as predictors of increased end-of-life care intention. This study underscored the societal interests for recognition of cultural preferences in end-of-life care and suggests practical approaches to increase end-of-life care intention in social work practice settings in South Korea.

노인전문사회복지사의 임종케어의향에 미치는 영향연구

권성애 ( Kwon Sung Ae ),박용순 ( Park Yong Soon ),송진영 ( Song Jin Yeong ) 한국보건사회연구원 2014 保健社會硏究 Vol.34 No.2

This study focused on geriatric social workers in Korea, and the purpose of this study was to explore the effect of end-of-life care intention. To achieve the goal, this paper was surveyed 264 geriatric social workers in Seoul and Kyunggi-do. For analysis, SPSS 20.0 was utilized in technical statistics and the regression analysis. The results of the study were: 1) awareness of need to provide end-of-life care was represented the greatest influence on end-of-life care intention. 2) value for the end-of-life care among professional factor of end-of-life care was influenced on end-of-life care intention. 3) experience for the end-of-life care among professional factor of end-of-life care was influenced on end-of-life care intention. 4) some results of correlation analysis differed form results of regression analysis. Based on the result, some implications to increase end-of-life care intertion of geriatric social workers was discussed.

요양병원 간호사의 임종간호경험

여형남 국제문화기술진흥원 2023 문화기술의 융합 Vol.9 No.5

Currently, the number of Long-Term Care Hospital in Korea is continuously increasing with the increase in the elderly population. Patients admitted to Long-Term Care Hospital are mainly elderly with chronic diseases, and because they are for long-term care, they often die in Long-Term Care Hospital, and the importance of end-of-life care is gradually increasing. In spite of these characteristics Studies on end-of-life care for nurses in Long-Term Care Hospital are mainly quantitative studies, and there is a limit to in-depth understanding of end-of-life care experiences. Therefore, The purpose of this study is to understand the meaning of Long-Term Care Hospital nurses' nursing experienceof end-of-life patients through a phenomenological method, and to describe and understand the meaning of the phenomenon in depth. The subjects of this study were 7 nurses who had worked for more than 6 months at a nursing hospital located in C city. The research method was in-depth interviews, and data were collected from December 2021 to March 2022. The interview date were analyzed by Giorgi's phenomenological method. As a result of the study, ‘nurses’ attitude toward end-of-life care’, ‘ambivalence toward life prolongation’, ‘reality of end-of-life care in Long-Term Care Hospital’, and ‘reflection on life and death’ were found. Therefore, it is thought that End-of-life nursing Continuing educationand interventional education programs should be developed to change Long-Term Care Hospital nurses' end-of-life care attitudes and improve coping skills.

요양보호사의 돌봄노인 임종경험에 관한 질적 메타분석

강번영,오영섭 한국국제문화교류학회 2025 문화교류와 다문화교육 Vol.14 No.1

본 연구는 요양보호사의 돌봄노인 임종경험을 ‘임종 전’과 ‘임종 후’로 구분하여, 관련선행연구를 질적 메타분석 방법으로 통합적으로 분석하고 주요 결과를 도출하는 것을목적으로 하였다. 이를 위해 ‘요양보호사’, ‘임종’, ‘죽음’ 등의 핵심 키워드를 활용하여요양보호사의 임종경험을 다룬 5편의 질적연구를 분석 대상으로 선정하였다. Noblit과Hare(1988)가 제안한 7단계 질적 메타분석 절차를 적용하였으며, 각 연구에서 도출된주제를 통합하여 요양보호사의 돌봄노인 임종경험을 심층적으로 이해하고자 하였다. 분석 결과의 신뢰성과 타당성은 질적연구 및 질적 메타분석 경험이 있는 교신저자 및교수진 협의를 통해 검토하였다. 연구결과, ‘임종 전’ 단계에서는 임종 초기 반응과 애도의 한계, 가족 역할을 대신한 임종돌봄, 돌봄을 통해 배운 정서적 교감이 도출되었다. ‘임종 후’ 단계에서는 존엄한 임종돌봄을 통한 성찰, 임종을 통해 바라본 삶과 자기치유, 소명의식과 임종돌봄 교육이 나타났다. 본 연구는 요양보호사가 돌봄노인의 임종 과정에서 경험하는 신체적・심리적・정서적 어려움을 심층적으로 이해하고, 돌봄 전문성 강화를 위한 지원방안을 제시하였다. 구체적으로, 애도 상담 지원 요구, 웰다잉 프로그램과 임종 준비 교육 개선, 정책적 지원 강화, 자조모임의 활성화, ‘공존’을 기반으로 한 글쓰기 프로그램 제안 등은 요양보호사의 정서적 안정과 심리적 회복을 도모하며, 임종돌봄 역량 강화와 돌봄 서비스의 질적 향상을 위한 기초자료로 기여할 것으로 기대된다 This study aimed to categorize the end-of-life experiences of caregivers in nursing homes into the elderly people’s ‘pre-death’ and ‘post-death’ stages and to synthesize related prior research through qualitative meta-analysis, thereby deriving key findings. To achieve this, five qualitative studies on the end-of-life experiences of care workers were selected using core keywords such as “caregivers,” “end-of-life,” and “death.” Noblit and Hare's (1988) seven-step qualitative meta-analysis procedure was applied, integrating themes from each study to gain a deeper understanding of the caregivers’ end-of-life experiences with elderly patients. The reliability and validity of the analysis results were reviewed through consultations with corresponding authors and professors experienced in qualitative research and meta-analysis. The findings revealed that in the “pre-death” stage, themes such as initial responses to death and limitations in grieving, taking on family roles in end-of-life care, and emotional resonance learned through care emerged. In the “post-death” stage, themes included reflection through dignified end-of-life care, reevaluating life and self-healing through end-of-life experiences, and a sense of vocation alongside the need for end-of-life care education. This study provides an in-depth understanding of the physical, psychological, and emotional challenges experienced by care workers during the end-of-life process with elderly patients. It also proposes support measures to strengthen their professional competence. Specifically, the study suggests the need for grief counseling support, improvements in well-dying programs and end-of-life education, policy reinforcement, the activation of self-help groups, and the development of writing programs based on “coexistence.” These measures are expected to contribute to the emotional stability and psychological recovery of care workers, enhance their end-of-life care competencies, and improve the quality of caregiving services.

생애말기 환자의 커뮤니티 케어에 대한 연구

김수정(Kim Soo Jung) 한국노인복지학회 2018 한국노인복지학회 학술발표논문집 Vol.2018 No.11

2018년 2월부터 연명의료결정법이 시행되면서 무의미한 연명치료가 환자나 가족 모두에게 바람직하지 않다는 인식도 정착되어가고 있고, 국가가 정책적 호스피스완화의료를 지원하며, 관련 의료기관도 늘고 있는 추세이다. 생애말기는 ‘죽음에 임박한 특정 시점’이 아니라 임종기를 향해가는 시간적 과정의 연속적 개념으로 생애말기 생활기반 안정(Well-Bing)정책과 임종기 생애마무리 지원(Well-Dying)정책이 동시에 지원되어야 한다. 국내 생애말기 지원정책을 분석한 결과에 따르면, 재택의료 서비스 미진으로 자택에 머물면서 치료하기 어려운 실정이 가장 심각한 문제로 분석되었다. 본 연구는 생애말기에 있는 환자들이 임종기 생애마무리 지원을 받을 수 있도록 생애말기 커뮤니티 케어시스템 구축을 위한 욕구 조사에 바탕을 두고 있다. 본 연구의 목적은 부산광역시 호스피스 센터의 생애말기 환자의 서비스에 대한 욕구를 확인하고 현재 받고 있는 서비스의 만족도와 삶의 질을 파악함으로써 앞으로의 생애말기 커뮤니티 케어의 개선방안을 도출하는 데 있다. 부산광역시 호스피스센터에서 재가 서비스를 받고 있는 생애말기에 놓여있는 환자 205명을 대상으로 조사원 기입식 설문조사를 실시하였다. 분석결과, 기대여명이 6개월 미만의 생애말기 환자의 경우 어떠한 서비스와 선택의 기준을 하는지와 죽음준비 혹은 교육에 대한 이해정도를 파악할 수 있었다. 서비스선택의 기준이 삶의 질에 유의한 영향을 미치는 것으로 나타나(β= -.321, p<.001), 서비스 선택의 기준이 삶의 질에 부적인 영향을 미치는 것을 알 수 있다. 서비스 선택기준이 죽음준비에 미치는 영향을 분석한 결과, 통계적으로 유의한 결과(β= -.237, p<.01)를 보여주었다. 서비스 선택기준이 죽음준비에 미치는 영향(β= -.200, p<.01)과 삶의 질에 있어서 죽음준비의 매개효과(β= .514, p<.001)를 분석한 결과, 매개효과가 있는 것으로 나타났다. With the enforcement of life extension decision Act, it is now well understood that meaningless life extension treatment is not desirable for both patients and their family. The government is, with its policy, supporting hospice palliative treatment and related medical institutions are increasing. End of life period should not be seen just as a certain point of time near death, but be seen as continuous period of time approaching toward death. In that period, governmental support is necessary especially for living condition improvement (well being) during end of life period and for ending life (well dying). According the analysis of governmental support for the domestic end of life period patients, the most serious problem was that patient could not get treatment at home due to the lack of home care services. This study is based on the research of people’s demand of establishing community end of life care system, which supports end of life patients The purpose of this study is to recognize the need of end of life period patients from Pusan area’s hospice center, and to assess satisfaction of the current service and the quality of life, and therefore to find out how to improve community care for end of life period patients. We have conducted a survey, filled in by the surveyor, on 205 end of life period patients who are provided with home care service from Pusan hospice center. From the analysis of the survey results, we could understand the criteria that patients, with life expectation less than 6 months, use to decide which service they would choose, and how well they are prepared and educated for end of life. It is found that the patients’ criteria for choosing care services affected their quality of life and their criteria have negative impact on their quality of life. We have analyzed if their care service selecting criteria effect on the preparation for death, and found that there are statistically meaningful relationship between them. Also we have analyzed the effect of service selecting criteria on death preparation and the mediating effect of death preparation on life quality, and found there exists mediating effect. the introduction of a number of new social care services for older people, the need to provide home support service for them has been criticized.

‘연명의료결정법’ 시행 이후 중환자실 간호사의 환자 연명의료결정 및 임종기 돌봄 경험 연구

안경진(Kyongjin Ahn),공병혜(Byunghye Kong),송윤진(Yoonjin Song) 한국생명윤리학회 2020 생명윤리 Vol.21 No.2

의・생명공학기술의 발달로 많은 사람들이 응급실 및 중환자실 등에서 집중연명치료를 받다가 죽음을 맞이하게 된다. 이러한 사회적 관행 속에서 ‘김할머니 사건’은 임종기 상황에서 무분별하게 적용되는 연명의료에 대한 사회적 인식 개선과 법제화의 필요성에 대해 공론화의 장을 열어주었다. 그 결과로 우리사회는 ‘호스피스·완화의료 및 임종과정에 있는 환자의 연명의료결정에 관한 법률(이하 연명의료결정법)’을 제정하였으며, 이 법을 시행한지 2년이 넘었다. 현재 시행되고 있는 ‘연명의료결정법’은 생애말기 의료적 의사결정과정에서 생명연장을 위한 연명의료 적용에 대한 환자의 자율적 의사 존중과 호스피스 및 완화의료를 통한 죽음의 질 문제를 포괄적으로 고려하기 위한 목적에서 제정되었다. 그러나 이 법은 대부분의 임종이 중환자실에서 이루어지고 있는 의료현실에 대한 성찰로 연결되지 못하고, 연명의료결정 과정에서 야기되는 다양한 딜레마 상황을 제대로 고려하지 못하고 있기 때문에 환자의 존엄한 죽음을 확보하는데 있어서 근본적 한계를 가진다. 이에 본 논문에서는 연명의료결정법 시행 이후 중환자실 간호사들의 연명의료결정 및 임종기 돌봄에서의 다양한 경험을 살펴봄으로써, 실제 의료 현장에서 법이 제정 목적에 맞게 제대로 작동하고 있는지 그 현황을 파악하고자 한다. 하지만, 본 연구는 지역 일개 종합병원의 중환자실 간호사의 경험을 중심으로 살펴보았기 때문에 다양한 지역 및 기관 간 격차 등을 비교분석하지 못한 측면이 있으며, 따라서 이들의 중환자실 임종기 돌봄 경험을 일반화하기에는 한계가 있다. 그럼에도 불구하고 본 연구는 연명의료결정법 시행 이후 발견되는 관련 제도의 유의미한 장·단점을 중환자실 간호사의 경험에 근거해 파악하고, 이를 통하여 환자의 존엄한 죽음을 위한 연명의료결정 및 임종기 돌봄환경을 위한 근본적 개선방안을 도출하고 있다는 점에서 의의가 있다. 이는 임종기 돌봄 환경의 실질적인 개선을 위한 제도적·정책적 개발을 위한 중요한 연구 자료가 될 것으로 기대된다. Despite recent developments in medical and biotechnology, most people die while undergoing intensive life-sustaining treatments in emergency rooms or intensive care units. Amid these social practices, the “Grandmother Kim case” opened a forum for public debate about the necessity to improve social awareness and about the legalization of life-sustaining treatments that are indiscriminately applied to dying patients. As a result, the “Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatments for Patients at the End of Life” was enacted and has been in effect since February of 2018. The ‘Life-sustaining Treatment Decision-making Act’, currently in effect, was enacted for the purpose of comprehensively considering the patient"s autonomy regarding the application of life-sustaining treatments and the quality of death through hospice and palliative care during the medical decision-making process at the end of life. However, because this law does not properly consider the reality of the medical setting in the intensive care unit environment and the various dilemma situations that arise during the actual intensive care unit life-sustaining treatment decision process, this law has fundamental limitations in securing a dignified death for patients. The purpose of this study is to examine the various experiences of intensive care unit nurses in life-sustaining care decisions-making and end-of-life care after the implementation of the Life-sustaining Treatment Decision-making Act ultimately to determine whether the law is properly operating in accordance with the purpose of its enactment in the actual medical field. In addition, by grasping the significant strengths and weaknesses of related systems which have arisen since the implementation of the Life-sustaining Treatment Decision-making Act, this study attempts to derive improvement measures pertaining to life-sustaining treatment decision-making for the dignified death of patients and end-of-life care environments. This study is expected to provide important research data for both institutions and those involved in policy development, leading to practical improvements of end-of-life care environments. However, since this study focused on the experiences of nurses in the intensive care unit of a local general hospital, there are limits to generalizing the results of this study.

방문간호사의 생애말기 간호에 대한 경험: 질적 내용분석

방미성,이인숙,양주현,김소희 한국가정간호학회 2022 가정간호학회지 Vol.29 No.2

Purpose: This study aims to describe and explore the experiences of visiting nurses so as to providing high-quality end-of-life care at home. Methods: Data was collected and recorded through in-depth interviews with 11 visiting nurses and transcribed verbatim. The data were analyzed with qualitative contents analysis. Data were collected from April 8 to July 30, 2021. Results: The results revealed the following four themes and ten sub-themes: The main themes were ‘Dignified end-of-life caring practice at home’, ‘Providing integrated support of end-of-life family caregivers’, ‘Confronting the limits of visiting nursing at the end of life’ and ‘Reflection on life and feeling rewarded’. Visiting nurses have performed dignified end-of-life care at home and integrated support for family caregivers. Although the visiting nurse sometimes faced the limits of visiting nursing during end-of-life care, it was surveyed that they rewarded on their lives and felt rewarding through the end-of-life nursing experience. Conclusion: Practical and systematic training is needed to positively change the end-of-life care of visiting nurses. We propose programs, such as expert counseling, to improve coping skills in end-of-life care practice at home. Additionally, we propose various institutional supports which can support the limitations of end-of-life care provision. .