How Should Intensive Care Unit Nurses Organize End-of-life Care? A Mixed-methods Study

정현정,김다영,장성옥 기본간호학회 2024 기본간호학회지 Vol.31 No.1

Purpose: This study aimed to explore intensive care unit nurses' perceptions of end-of-life care and to identifystrategies for improving patient comfort in the intensive care unit. Methods: This was a mixed-methods studycomprising two phases. In Phase 1, we conducted focus group interviews to investigate how intensive care unitnurses perceived end-of-life care and its specific components within an intensive care unit setting. Phase 2involved a descriptive questionnaire, utilizing items derived from the focus group interviews to assess howintensive care unit nurses evaluated the components of end-of-life care they provided in the intensive care unit. Results: The findings of the study’s two phases revealed that in end-of-life care, nurses aimed to provide comfortby connecting patients with their families, spiritual beliefs, social networks, and life experiences, while addressingchallenges within the broader scope of nursing practice in the intensive care unit. Conclusion: This study examinedintensive care unit nurses' perceptions of end-of-life care, the elements of end-of-life care, their practicalimplementation, and the associated priorities. These findings will help nurses in intensive care units determineand organize priorities in end-of-life care. For patients facing death in the intensive care unit and for the nurseswho care for them, the obstacles involved in end-of-life care must be better overcome.

Post Intensive Care Syndrome in Parents of Critically Ill Pediatric Patients

Lisa Yeo,Sun-Mi Chae 한국간호과학회 2021 한국간호과학회 학술대회 Vol.2021 No.10

Aim(s): Family members can suffer from psychological symptoms and social problems when their loved one is in the intensive care unit. The symptoms experienced by families of critically ill patients are called "post-intensive care syndrome-family." The purpose of this study was to describe the symptoms of post intensive care syndrome-family in parents of critically ill pediatric patients. This study examined (1) psychological and social problems, (2) changes in symptoms over 1 month, and (3) the differences in symptoms by the participants’ characteristics. Method(s): A longitudinal descriptive study design was used for a pediatric intensive care unit in a tertiary care hospital in Korea. Parents of children admitted to the pediatric intensive care unit for at least 48hours were questioned on the day of the child’s discharge from the pediatric intensive care unit and 1 month after discharge. Anxiety, depression, post-traumatic stress symptoms and social impacts were measured as symptoms of post intensive care syndrome-family. Result(s): Among 41 participants, 36 completed the follow-up survey. Most of the parents reported all three psychological problems, anxiety, depression, and post-traumatic stress symptoms, on the day of the child’s discharge from the pediatric intensive care unit (77.8%) and more than a half (58.3%) on 1 month after discharge. Social problems significantly increased over time (p=.04). Factors associated with symptoms of post intensive care syndrome-family were emotional support from the staff of the pediatric intensive care unit. Emotional support showed a significant negative correlation with post-traumatic stress symptom(p=.003) and social problems(p=.02). Conclusion(s): This study revealed a high prevalence of psychological symptoms and increased social problems among parents of critically ill pediatric patients after discharge from the pediatric intensive care unit. Emotional support from health care professionals can help reduce symptoms of post intensive care syndrome in parents of children in pediatric intensive care units.

The Professional Quality of Life on Nursing Behavior and Difficulties in Endof-Life Care : Focused on the intensive care nurses

Kim Hui-Yeon,Ahn Hye-Young 한국간호과학회 2021 한국간호과학회 학술대회 Vol.2021 No.10

Aim(s): The purpose of this study is to identify the nursing behavior and difficulties in end-of-life care to the quality of professions’ life, and to analyze factors that affect caring behavior of end-of-life patient by intensive care nurses. Method(s): For this study a descriptive design with survey method was utilized. This study recruited 193 nurses who worked at 6 kinds of intensive care unit where have 500 sickbeds located in D city, C province, for more than 6 months as the research subjects. Data were analyzed using descriptive statistics, independent t-test, one-way ANOVA, Pearson’s correlation coefficient and Multiple regression analysis. Result(s): It is found that nursing behavior showed significantly positive correlation with empathy satisfaction (r=.524, p<.001) and negative correlation with burnout (r=-. 388, p<.001). Difficulties in end-of-life care showed positive correlation with burnout (r=.461, p<.001), secondary traumatic stress (r=.488, p<.001), and negative correlation with nursing behavior (r=-. 149, p=.039). Factors affecting nursing behavior were empathy satisfaction (β= .467, p<.001), which is a sub-field of the quality of professions’ life, confidence in difficulties of end-of-life care (β=-. 168, p =.004) and nursing experience in general (β= .246, p<.001). The variables explained about nursing behavior for 36.0%. Factors affecting the difficulties of end-of-life care included burnout (β=.420, p<.001), secondary traumatic stress (β= .318, p<.001), and empathy satisfaction (β= .189, p= .049), respect as a sub-field of nursing behavior (β=-. 363, p<.001), expert knowledge and skills (β= .242, p= .002) and intensive care in general (β= .148, p= .019). The variables explained about the difficulties of end-of-life care for 42.4%. Conclusion(s): It is found that the higher the difficulty of end-of-life care in the intensive care unit, the lower the frequency of nursing care. They experience empathy fatigue, which is difficult to end-of-life care and mandatory care that they have to keep caring. Empathy Fatigue increases the difficulties of end-of-life care and empathy satisfaction can be said as an important factor in increasing nursing care. Therefore, it can be said that intervention and education programs have to be developed and applied to reduce burnout, secondary traumatic stress in order to reduce the difficulties of end-of-life care in intensive care unit. In addition, empathy satisfaction has to be improved. Then we can expect an efficient nursing care for a end-oflife patient in the intensive care unit.

중환자 재활에서 물리치료사의 역할과 필요성

정경만,최준완,안창민 대한물리치료과학회 2023 대한물리치료과학회지 Vol.30 No.2

In the past, patients in the intensive care unit were mostly managed by the intensive care unit's own protocol through bed rest and sedation. The number of hospitalized patients in intensive care units in Korea is steadily increasing, but the mortality rate is higher than in developed countries and the perception of intensive care rehabilitation is lowered. The reality of intensive care rehabilitation in korea has many problems due to low fee structure, lack of manpower, and lack of policy establishment and will of related institutions. In addition, intensive carerehabilitation should consist of a multidisciplinary tema, and the team composition should include professionals such as dedicated doctors, dedicated nurses, and physical therapists. Although the effect of intensive care unit rehabilitation has been confirmed through previous foreign studies, the reality of intensive care unit rehabilitation in Korea is currently lagging behind due to a system of low medical fees and the will of government agencies. This study was attempted to find out the role and necessity of physical therapists in intensive care rehabilitation so that rehabilitation medical fees suitable for reality can be set when domestic intensive care rehabilitation is institutionalized and activated in the future.

중환자실 인간중심 돌봄 개념 분석

전꽃비(Jeon, Kkot Bi) 가톨릭생명윤리연구소 2021 인격주의 생명윤리 Vol.11 No.1

중환자실이라는 복잡한 환경에서 환자들은 개별적인 인간이기 보다는 인간의 위엄을 잃고 단순한 치료 대상으로 느껴질 수 있다. 그러므로 중환자 치료와 간호의 방향은 현재의 질병 중심 시각에서 벗어나 인간중심의 총체적인 돌봄으로 전환될 필요가 있다. 하지만 현재 국내 중환자실의 특수한 환경을 고려한 인간중심 돌봄에 대한 개념의 정의가 명확하지 않기 때문에 인간중심 돌봄을 실현하는 데에는 어려움이 있을 것이라고 생각된다. 이에 본 연구는 중환자실 인간중심 돌봄의 개념의 속성을 파악하여 명확한 개념을 이해하고 효과적인 인간중심 돌봄을 제공하기 위해 워커와 아반트의 방법으로 개념 분석을 시행하였다. 본 연구에서 확인한 인간중심 돌봄의 주요 속성은 환자의 존엄성 존중, 치료적 관계 형성, 개별화된 돌봄, 중환자 간호에 대한 전문성이었다. 동일한 주제를 가지고 시행된 외국의 연구에서도 중환자실 인간중심 돌봄은 간호사가 환자를 인격과 존엄성을 가진 인간으로 이해하고 존중하며, 신뢰와 공감을 바탕으로 치료적 관계를 유지하여 그들의 신념과 가치를 반영한 돌봄을 제공하는 것으로 설명하여, 그 의미와 속성이 본 연구와 유사한 맥락을 갖는다는 것을 알 수 있었다. 하지만 중환자실 인간중심 돌봄의 적용에 있어서는 각 나라의 문화와 시스템을 고려한 접근이 필요하다. 우리나라는 가족 공동체의 가치를 중요하게 여긴다는 점에서, 이러한 문화적 특수성을 고려하였을 때, 가족의 참여는 중환자실 인간중심 돌봄에 있어 큰 의미를 갖는다고 볼 수 있다. 그러므로 중환자실 간호사는 환자는 물론 가족과의 상호작용 증진을 위한 노력을 해야할 것이다. 또한 우리나라는 외국에 비해 낮은 수준의 간호 인력을 확보하고 있으므로, 인력 부족으로 인한 과도한 업무량 등을 포함한 근무환경의 개선과 인간중심 돌봄이 긍정적인 협력관계에서 효과적으로 이루어진다는 점에서, 의료진 간의 관계지향적인 조직문화를 조성하기 위한 노력도 필요할 것이다. In the complex environment of intensive care units, patients can lose their dignity and feel as though they were an object being treated rather than an individual, a human with a unique personality. Therefore, the direction of critical care needs to shift from disease-centered care to person-centered care. Thus, this study was conducted to identify and understand the elements of person-centered care in the context of intensive care units using Walker and Avant’s concept analysis method. In this study, the identified attributes of person-centered care in intensive care units were: 1) to respect the patient’s dignity, 2) to form a therapeutic relationship, 3) to provide individualized care, and 4) to use professional nursing practices. The results were similar to those of foreign studies conducted on the same topic. However, the implementation of person-centered care in intensive care units requires an approach that considers the culture and systems of each country. In South Korea, family or community values are considered important. Furthermore, the participation of the family in the decision-making process for a patient may be understood as a significant part of the person-centered care in the intensive care unit. Thus, intensive care unit nurses must make efforts to enhance interaction with patients as well as their families. Additionally, it is necessary to improve the working environment for the effective implementation of person-centered care.

신생아 집중치료 지역센터 사례를 통해 본 신생아 집중치료실(NICU) 공간 구성 및 면적 계획에 관한 연구

이기환,박서원 한국의료복지건축학회 2024 의료·복지 건축 Vol.30 No.1

Purpose: This study is to present basic data and standards for calculating the space composition and area required when planning a neonatal intensive care unit. Methods: Review domestic and foreign facility standards and regulations related to the current neonatal intensive care unit, select a regional neonatal intensive care center designated by the Ministry of Health and Welfare as a case hospital, and organize a space program for the construction plan of the neonatal intensive care unit through analysis of characteristics such as facility size and function composition. Results and Implications: The size, facility area, and detailed room composition characteristics of the neonatal intensive care unit in Korea were confirmed, and essential rooms and appropriate areas were derived when planning the construction of the neonatal intensive care unit. Korea's legal facility standards related to neonatal intensive care units are lower than the actual hospital status and overseas standards, and the facility standards of the medical law need to be improved.

‘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.

Attitudes towards Death, Perceptions of Hospice Care, and Hospice Care Needs among Family Members of Patients in the Intensive Care Unit

Oak, Yunha,Kim, Young-Sun Korean Society for Hospice and Palliative Care 2020 한국호스피스.완화의료학회지 Vol.23 No.4

Purpose: This study aimed to identify the relationships among attitudes towards death, perceptions of hospice care, and hospice care needs as perceived by family members of patients in the intensive care unit (ICU). Methods: This study used a descriptive correlational method. A structured questionnaire was used to collect data from 114 participating families in the ICU at Dong-A University Hospital, from October 10 to November 1, 2019. The data were analyzed in terms of frequency, percentage, and mean and standard deviation. The t-test, one-way analysis of variance, and Pearson correlation coefficients were also conducted. Results: Perceptions of hospice care showed significant differences according to age (F=3.06, P=0.031) and marital status (t=3.55, P=0.001). However, no significant differences in attitudes towards death or hospice care needs were found. A significant positive correlation was found between perceptions of hospice care and hospice care needs (r=0.49, P<0.001). Conclusion: In order for families to recognize the need for hospice care and to receive high-quality palliative care at the appropriate time, it is necessary to increase public awareness of hospice care through various educational and awareness-raising efforts, thereby providing opportunities for families of terminally ill patients to request hospice care.

重患者室 人院 患者의 治療 效果 評價 分析

柳吉助,尹太永,具燾書,朴良元 慶熙大學校 醫科大學 1990 慶熙 醫大 論文集 Vol.15 No.1

Challenges of the patient transition process from the intensive care unit: a qualitative study

Kobra Ghorbanzadeh,Abbas Ebadi,Mohammad Ali Hosseini,Sadat Seyed Bagher Madah,Hamidreza Khankeh 대한중환자의학회 2021 Acute and Critical Care Vol.36 No.2

Background The transition of patients from the intensive care unit (ICU) to the general ward is challenging. This study aimed to explain the challenges that patients face during the transition process. Methods In this qualitative research of conventional content analysis, data collection was conducted between February 2018 and July 2019 in educational hospitals. After obtaining informed consent, purposive sampling was performed with 22 nurses, intensive care physicians, anesthesiologists, and patients and their families using in-depth semi-structured interviews until data saturation. Results The content analysis yielded three main themes in the challenges patients face during the transition process from the ICU: mixed feelings regarding transition (happiness/hope, worry/uncertainty, abandonment); care break (different atmosphere, the difference between the program and the quality of care, assigning care to the patient and family, and care culture and beliefs); and search for support and information (ineffective communication, self-care capacity of patient and family, ineffective and disrupted training, and weak follow-up programs), which inflicts care shock in the patients. Conclusions The results showed that patients and their families were in a state of care shock during the ICU transition process and were sometimes disconcerted. It is necessary to design and implement care models according to the needs and challenges patients face during the transition period from ICU (patient-centered), based on the evidence available, and after considering the field of medicine and the accessibility of care in the country. The transition process can be improved and enhanced by obtaining knowledge about ICU care and related challenges as well as organizing a learning environment.