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Jo M, Park M, Yun K. Effects of advance care planning training on advanced practice nurse students' knowledge, confidence, and perception of end-of-life care: A mixed-method study. Nurse Educ Pract 2023; 67:103555. [PMID: 36736179 DOI: 10.1016/j.nepr.2023.103555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/12/2022] [Accepted: 01/08/2023] [Indexed: 01/24/2023]
Abstract
AIMS This study aimed to assess how an advance care planning training program affected advanced practice nursing students' knowledge, confidence and perception of end-of-life care in South Korea. BACKGROUND Effective communication between healthcare providers, patients and their families is one of the most important components of quality end-of-life care. However, nurses in South Korea may feel uncomfortable helping patients and families with advance care planning because of the cultural taboo against talking about dying. DESIGN A mixed-method design was used with data obtained from self-administered questionnaires at the onset and end of the advance care planning training program and qualitative data from participant feedback after the program. METHODS Data collected from 65 advanced practice nursing students who participated in advance care planning training programs in June-July 2020 and 2021, conducted as part of a graduate clinical practice course, were analyzed. Data were originally collected to examine students' course outcomes. A training program was provided to advanced practice nursing students to improve their knowledge, confidence and perception in advance care planning conversations with their patients. The program comprised three sessions: online lectures, face-to-face simulations and discussions on advance care planning and ethical issues. Changes in advance care planning knowledge, confidence in supporting patients' advance directives, perceived nursing roles in end-of-life treatment decisions and perception of a good death were examined before and after the training. RESULTS There were statistically significant increases in participants' advance care planning knowledge, confidence in supporting patients' advance directives and perception of the active role of nurses in patients' end-of-life treatment decisions after the training. CONCLUSIONS The results indicate the effects of training programs on advanced practice nursing students' knowledge, confidence and perception of advance care planning communication. They also provide evidence about what contents and methods can be helpful in developing end-of-life care training for advanced practice nursing students.
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Affiliation(s)
- Minjeong Jo
- College of Nursing/The Research Institute for Hospice and Palliative Care, The Catholic University of Korea, Postal No. 06591, 222 Banpo-daero, Seocho-gu, Seoul, South Korea.
| | - Mihyun Park
- College of Nursing/The Research Institute for Hospice and Palliative Care, The Catholic University of Korea, Postal No. 06591, 222 Banpo-daero, Seocho-gu, Seoul, South Korea.
| | - Kyoungsun Yun
- Department of Nursing, Suwon Women's University, Postal No.16632, 72 Onjeong-ro, Gwonseon-gu, Suwon-si, Gyeonggi-do, South Korea.
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Jung MY, Matthews A, Park C, Corte C, Gorman G, Kim S. Impact of Quality of Communication With Clinicians on Depression, Anxiety, and Quality of Life Among Korean Family Caregivers in End-of-Life Care Settings. Am J Hosp Palliat Care 2021; 39:1137-1144. [PMID: 34907792 DOI: 10.1177/10499091211060509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Min Young Jung
- Department of Population Health Nursing Science, College of Nursing, 16100The University of Illinois Chicago, Chicago, IL USA
| | - Alicia Matthews
- Department of Population Health Nursing Science, College of Nursing, 16100The University of Illinois Chicago, Chicago, IL USA
| | - Chang Park
- Department of Population Health Nursing Science, College of Nursing, 16100The University of Illinois Chicago, Chicago, IL USA
| | - Colleen Corte
- Department of Population Health Nursing Science, College of Nursing, 16100The University of Illinois Chicago, Chicago, IL USA
| | - Geraldine Gorman
- Department of Population Health Nursing Science, College of Nursing, 16100The University of Illinois Chicago, Chicago, IL USA
| | - Sujeong Kim
- Department of Family Health Nursing, College of Nursing, 26713The Catholic University of Korea,Seocho-gu, Seoul, Korea
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Lee Y, Jo M, Kim T, Yun K. Analysis of high-intensity care in intensive care units and its cost at the end of life among older people in South Korea between 2016 and 2019: a cross-sectional study of the health insurance review and assessment service national patient sample database. BMJ Open 2021; 11:e049711. [PMID: 34433604 PMCID: PMC8388299 DOI: 10.1136/bmjopen-2021-049711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To provide useful information for clinicians and policy makers to prepare guidelines for adequate use of medical resources during end-of-life period by analysing the intensive care use and related costs at the end of life in South Korea. DESIGN Cross-sectional, retrospective, observational study. SETTING Tertiary hospitals in South Korea. PARTICIPANTS We analysed claim data and patient information from the Health Insurance Review and Assessment Service national dataset. This dataset included 19 119 older adults aged 65 years or above who received high-intensity care at least once and died in the intensive care unit in South Korea between 2016 and 2019. High-intensity care was defined as one of the following treatments or procedures: cardiopulmonary resuscitation, mechanical ventilation, extra-corporeal membrane oxygenation, haemodialysis, transfusion, chemotherapy and vasopressors. PRIMARY AND SECONDARY OUTCOME MEASURES Usage and cost of high-intensity care. RESULTS The most commonly used high-intensity care was transfusion (68.9%), mechanical ventilation (50.6%) and haemodialysis (35.7%) during the study period. The annual cost of high-intensity care at the end of life increased steadily from 2016 to 2019. There existed differences by age, gender, length of hospital stays and primary cause of death in use of high-intensity care and associated costs. CONCLUSION Findings indicate that invasive and device-dependent high-intensity care is frequently provided at the end of life among older adults, which could potentially place an economic burden on patients and their families. In Korea's ageing society, increased rates of chronic illness are expected to significantly burden those who lack the financial resources to provide end-of-life care. Therefore, guidelines for the use of high-intensity care are required to ensure affordable end-of-life care.
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Affiliation(s)
- Yunji Lee
- College of Nursing, Pusan National University, Yangsan, Republic of South Korea
| | - Minjeong Jo
- College of Nursing, Catholic University of Korea, Seoul, Republic of South Korea
| | - Taehwa Kim
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, BioMedical Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of South Korea
| | - Kyoungsun Yun
- Nursing Department, Dongnam Health University, Suwon, Republic of South Korea
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Jo M, Park M, Park EJ, Choi JY. The Acceptability and Effect of a Communication-Based Advance Care Planning Program for Older Adults. J Hosp Palliat Nurs 2021; 23:375-385. [PMID: 34185729 DOI: 10.1097/njh.0000000000000762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study was a preliminary study that assessed the acceptability of a communication-based advance care planning (ACP) intervention for older adults to improve decision making for treatment at the end of life. Twenty dyads were recruited, including patients who were older than 65 years and registered in a home health care center of a teaching hospital in South Korea and their surrogates. The intervention is a patient-centered ACP program with surrogates and a structured and guided discussion by home health care nurses as the trained interventionists. The acceptability of the intervention was assessed by a mixed method including a survey and a structured interview with participants. Findings in this study indicate that recruiting older adults with chronic diseases and their surrogates in a home health care center and conducting the intervention by home health care nurses is feasible. In addition, the outcomes of this study suggest that the intervention may have a potential impact on end-of-life care decision making for older adults in South Korea. A larger-scale trial is required to determine the effects of the ACP program when implemented with various groups. This study suggests that older adults need an ACP program as part of routine care.
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Jung MY, Matthews AK. Understanding Nurses' Experiences and Perceptions of End-of-Life Care for Cancer Patients in Korea: A Scoping Review. J Palliat Care 2021; 36:255-264. [PMID: 34182840 DOI: 10.1177/08258597211027021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND Quality end-of-life care for cancer patients is a global health priority, and nurses are instrumental in providing this care. However, little is known about nurses' experiences and perceptions in end-of-life care settings in Korea. Aims: This scoping review examined Korean nurses' end-of-life care experiences and assessed the state of research in this area. METHODS Systematic searches were conducted using 7 electronic databases (PubMed, CINAHL, Scopus, Embase, WPRIM, KCI, and RISS), and 17 studies were selected for review. FINDINGS Most studies were limited to cross-sectional, descriptive designs. Outcomes regarding end-of-life care measured in the studies were categorized into cognitive variables, emotional variables, participation/performance, and educational needs. Study results suggested low nurse knowledge and self-efficacy with regard to provision of end-of-life care. Perceived barriers to quality end of life care included difficulties in meeting family members' needs. In addition, emotional outcomes associated with end-of-life care included high levels of nurse stress and burnout. Predictors of elevated stress included inability to provide adequate pain control, inability to reconcile patient requests with physician orders, and heavy workload. Although most nurses had end-of-life care experience, fewer than half reported receiving related education. The lack of knowledge and skill related to end of life care was a primary contributor to stress. CONCLUSIONS Korean nurses providing end-of-life care for cancer patients need additional education and support to help them manage high stress levels. Further study is needed to identify strategies for meeting nurses' end-of-life care education needs and of improving their overall performance in such practice.
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Affiliation(s)
- Min Young Jung
- Department of Health Systems Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Alicia K Matthews
- Department of Health Systems Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
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Jo M, Song MK, Knafl GJ, Beeber L, Yoo YS, Van Riper M. Family-clinician communication in the ICU and its relationship to psychological distress of family members: A cross-sectional study. Int J Nurs Stud 2019; 95:34-39. [PMID: 31005678 DOI: 10.1016/j.ijnurstu.2019.03.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 03/21/2019] [Accepted: 03/27/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Effective communication between family and clinicians has been identified as one of the most important factors in end-of-life care. Family members' perception of communication quality with clinicians may be associated with their psychological symptoms. OBJECTIVES To examine the association between family-clinician (physicians or nurses) communication quality and symptoms of anxiety, depression, and stress among family members of chronically critically ill patients in intensive care units (ICUs). DESIGN A cross-sectional study. SETTINGS AND PARTICIPANTS The participants were 71 adult family members of 71 patients who required prolonged mechanical ventilation in ten ICUs at three medical centres in Korea. METHODS Participants completed the Quality of Communication (QOC) questionnaire, Hospital Anxiety and Depression Scale (HADS), and Impact of Event Scale-Revised (IES-R). The data were analysed using correlation, bivariate regression, and multiple regression analysis. RESULTS The mean (SD) QOC score for physicians and nurses was 50.3 (15.2) and 42.9 (14.2), respectively. Forty-six participants (64.8%) were identified as being at risk for having anxiety symptoms; 22 (31%) had a mild risk and 24 (33.8%) had a moderate or severe risk. More family members (76.1%) were at risk for having depressive symptoms; 15 (21.1%) had a mild risk and 39 (54.9%) had a moderate or severe risk. For post-traumatic stress symptoms, 48 (67.6%) were at risk. While the QOC scores for nurses were negatively associated with participants' HADS-depression scores (β = -.01, p = .03), the QOC scores for physicians were not associated with the HADS or IES-R scores. This conclusion held after consideration of covariates. CONCLUSIONS The findings suggest that communication between family members and ICU nurses may be more influential than that with ICU physicians on psychological distress of family members in Korea. However, further research is warranted to confirm this relationship. Future interventions to reduce psychological distress in family members of chronically critically ill patients may need to target ICU nurses for improving communication skills.
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Affiliation(s)
- Minjeong Jo
- College of Nursing, Pusan National University, Republic of Korea.
| | - Mi-Kyung Song
- Center for Nursing Excellence in Palliative Care, Nell Hodgson Woodruff School of Nursing, Emory University, United States
| | - George J Knafl
- School of Nursing, University of North Carolina at Chapel Hill, United States
| | - Linda Beeber
- School of Nursing, University of North Carolina at Chapel Hill, United States
| | - Yang-Sook Yoo
- College of Nursing, The Catholic University, Republic of Korea
| | - Marcia Van Riper
- School of Nursing, University of North Carolina at Chapel Hill, United States
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Lim CY, Park JY, Kim DY, Yoo KD, Kim HJ, Kim Y, Shin SJ. Terminal lucidity in the teaching hospital setting. DEATH STUDIES 2018; 44:285-291. [PMID: 30513269 DOI: 10.1080/07481187.2018.1541943] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 09/27/2018] [Accepted: 10/02/2018] [Indexed: 06/09/2023]
Abstract
Terminal lucidity is an unpredictable end-of-life experience that has invaluable implications in preparation for death. We retrospectively evaluated terminal lucidity at a university teaching hospital. Of 338 deaths that occurred during the study period (187 in the ICU and 151 in general wards), terminal lucidity was identified in 6 cases in general wards. Periods of lucidity ranged from several hours to 4 days. After experiencing terminal lucidity, half of the patients died within a week, and the remainder died within 9 days. More attention should be directed toward understanding terminal lucidity to improve end-of-life care in a meaningful way.
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Affiliation(s)
- Chi-Yeon Lim
- Clinical Trial Center, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Seoul, Republic of Korea
| | - Jae Yoon Park
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Seoul, Republic of Korea
| | - Do Yeun Kim
- Department of Hematology and Medical Oncology, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Seoul, Republic of Korea
| | - Kyung Don Yoo
- Department of Internal Medicine Dongguk University School of Medicine, Gyeongju, Republic of Korea
| | - Hyo Jin Kim
- Department of Internal Medicine Dongguk University School of Medicine, Gyeongju, Republic of Korea
| | - Yunmi Kim
- Department of Internal Medicine Dongguk University School of Medicine, Gyeongju, Republic of Korea
| | - Sung Joon Shin
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Seoul, Republic of Korea
- W Maurice Young Center for Applied Ethics, University of British Columbia, Vancouver, Canada
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