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Factors Affecting Performance of End-of-Life Care among ICU Nurses

중환자실 간호사의 생애말 간호수행에 미치는 영향요인

  • 김미정 (경상국립대학교병원) ;
  • 장희경 (경상국립대학교 간호학과)
  • Received : 2021.06.19
  • Accepted : 2021.07.30
  • Published : 2021.08.31

Abstract

This study is a descriptive research study to identify the relationship between the performance of end-of-Life care of ICU nurses, moral distress, ethical climate, difficulties in end-of-life care, and positive psychological capital. Data were collected with structured questionnaires from 144 ICU nurses at a university hospital in J city, Gyeongnam, from October to November in 2020, and analyzed using SPSS/WIN 21.0. The subjects' performance of end-of-life care of ICU nurses is significantly different depending on marital status, experiences of end-of-life care education. The variables that had a significant effect on the performance of end-of-life care among ICU nurses were positive psychological capital and difficulties in end-of-life care. The explanatory power was 24.8%. Based on these results, it is necessary to intervention program and education to reduce difficulties in end-of-life care and increase positive psychological capital for ICU nurses.

본 연구는 중환자실 간호사의 도덕적 고뇌, 윤리적 환경, 생애말 간호 어려움 및 긍정심리자본이 생애말 간호수행에 미치는 영향을 파악하기 위한 서술적 상관관계 연구이다. 대상자는 G도의 J시와 C시에 위치한 G대학병원 중환자실에서 근무하는 간호사 144명으로, 2020년 10월부터 11월까지 설문조사를 통해 자료수집하였다. 자료분석은 SPSS/WIN 21.0 프로그램을 이용하여 통계 분석하였다. 본 연구결과 대상자의 생애말 간호수행은 결혼상태, 생애말 간호 교육경험에 따라 유의한 차이가 있는 것으로 나타났다. 중환자실 간호사의 생애말 간호수행에 유의한 영향을 미치는 변인은 긍정심리자본, 생애말 간호 어려움으로 설명력은 24.8%였다. 이러한 결과를 바탕으로 중환자실 간호사의 생애말 간호수행을 향상시키기 위해서는 생애말 간호 어려움을 감소시키고, 긍정심리자본을 향상시킬 수 있는 교육과 중재 프로그램 개발이 요구된다.

Keywords

References

  1. Statistics Korea, "Provisional outcome of death statistics", 2018. Retrieved March, 14, 2019, from http://kosis.kr/search/search.do?query=%EC%82%AC%EB%A7%9D
  2. M.J. Ko, S.H. Moon. "Factors influencing performance of end-of-life care by ICU nurses", Journal of Korean Academy of Psychiatric and Mental Health Nursing, Vol. 25, No. 4, pp. 327-337, 2017. https://doi.org/10.12934/jkpmhn.2016.25.4.327
  3. Health Insurance Review and Assessment Service, 2014..
  4. National Health Service, "End of life care", 2018. https://www.nhs.uk/
  5. K.M. Detering, A.D. Hancock, M.C. Reade, and W. Silvester, "The impact of advance care planning on end of life care in elderly patients: Randomised controlled trial", BMJ: British Medical Journal, 340, c1345, 2010. https://doi.org/10.1136/bmj.c1345
  6. L. Espinosa, A. Young, and T. Walsh, "Barriers to intensive care unit nurses providing terminal care: An integrated literature review", Critical Care Nursing Quarterly, Vol. 31, No. 1, pp. 83-93, 2008. https://doi.org/10.1097/01.CNQ.0000306402.55518.da
  7. H.S. Kim, E.K. Choi, T.H. Kim, H.Y. Yun, E.J. Kim, J.J. Hong, and S.H.. Kim, "Difficulties in end-of-life care and educational needs of intensive care unit nurses: a mixed methods study", The Korean Journal of Hospice and Palliative Care, Vol. 22 No. 2, pp. 87-99, 2019. https://doi.org/10.14475/kjhpc.2019.22.2.87
  8. E.H. Elpern, B. Covert, and R. Kleinpell, "Moral distress of staff nurses in a medical intensive care unit", American Journal of Critical Care, Vol. 14, No. 6, pp. 523-530, 2005. https://doi.org/10.4037/ajcc2005.14.6.523
  9. J.S. Lee, and S.H. Ann, "The impact of moral sensitivity and moral distress on end-of-life care performance among intensive care unit nurses", The Korean Medical Ethics Society, Vol. 22, No. 2, pp. 140-160, 2019. https://doi.org/10.35301/ksme.2019.22.2.140
  10. M.S. Yoo, "Concept analysis of moral distress in nurses", Journal of Korean Academy of Nursing Administration, Vol. 10, No. 1, pp. 49-62, 2004.
  11. B. Victor, and J.B. Cullen, "The organizational bases of ethical work climates", Administrative Science Quarterly, Vol. 33, No. 1, pp. 101-125, 1988. https://doi.org/10.2307/2392857
  12. F.M. Parker, R.B. Lazenby, and J.L. Brown, "The relationship of moral distress, ethical environment and nurse job satisfaction", Online Journal of Health Ethics, Vol. 10, No. 1, pp. 48-73, 2014.
  13. H.N. Cho, M.J. An, and H.S. So, "Differences of turnover intention by moral distress of nurses", The Journal of the Korea Contents Association, Vol. 15, No. 5, pp. 403-413, 2015. https://doi.org/10.5392/JKCA.2015.15.05.403
  14. S. Kinoshita, and M. Miyashita, "Development of a scale for difficulties felt by ICU nurses providing end-of-life care (DFINE): A survey study", Intensive & Critical Care Nursing, Vol. 27, No. 4, pp. 202-210, 2011. https://doi.org/10.1016/j.iccn.2011.04.006
  15. S.Y. Jung, and J.H. Kim, "Influence of positive psychological capital and death awareness on terminal care performance of hematooncology unit nurses", The Korean Journal of Hospice and Palliative Care, Vol. 22, No. 2, pp. 77-86, 2019. https://doi.org/10.14475/kjhpc.2019.22.2.77
  16. F. Luthans, B.J. Avolio, J.B. Avey, and S.M. Norman, "Positive psychological capital: Measurement and relationship with performance and satisfaction", Personnel Psychology, Vol. 60, Vol. 3, pp. 541-572, 2007. https://doi.org/10.1111/j.1744-6570.2007.00083.x
  17. M.E.P. Seligman, Flourish: A visionary new understanding of happiness and well-being, New York: Free Press, 2011.
  18. B.S. Lee, "The relationship of shift work nurse's positive psychological capital and the quality of life", Yonsei University, 2016.
  19. G.D. Kim, "The effects of hospice unit practice education on spiritual well-being, attitude to death, and hospice awareness of nursing students", Asian Oncology Nursing, Vol. 16, No. 4, pp. 176-184, 2016. https://doi.org/10.5388/aon.2016.16.4.176
  20. K.A. Chi, "Influence of spiritual health, mental health and death orientation on the nurse's attitude toward hospice", Master's thesis, Daejeon University, 2004.
  21. W.S. Kim, H.H. Cho, and S.H. Kwon, "The influence of terminal care performance, death anxiety and self-esteem on terminal care stress of geriatric hospital nurses", The Korean Journal of Hospice and Palliative Care, Vol. 19, No. 2, pp. 154-162, 2016. https://doi.org/10.14475/kjhpc.2016.19.2.154
  22. L.J. Lee, and H.S Park, "Death anxiety and terminal care performance of nurses at long term care hospitals", The Korean Journal of Hospice and Palliative Care, Vol. 20, No. 1, pp. 37-45, 2017. https://doi.org/10.14475/kjhpc.2017.20.1.37
  23. H.Y. Kim, K.H. Nam, and S.H. Kwon, "Mediating effects of empathy and resilience on the relationship between terminal care stress and performance for nurses in a tertiary hospital", The Korean Journal of Hospice and Palliative Care, Vol. 20, No. 4, pp. 253-263, 2017. https://doi.org/10.14475/kjhpc.2017.20.4.253
  24. H.Y. Im, M.J. Yun, and Y.C. Kwon, "Convergence effect of locus of internal & external control, stress and fatigue on the geriatric hospital nurses' terminal care performance", Journal of Digital Convergence, Vol. 17, No. 12, pp. 329-336, 2019. https://doi.org/10.14400/JDC.2019.17.12.329
  25. M.R. Park, and N.J. Je, "The impact of nursing hospital workers' hospice: Palliative care knowledge and awareness, end-of-life care attitude and death awareness on their end-of-life care performance", The Korean Journal of Hospice and Palliative Care, Vol. 21, No. 4, pp. 124-136, 2018. https://doi.org/10.14475/kjhpc.2018.21.4.124
  26. E.H. Park, and N.Y. Kim, "The influence of nursing professionalism, attitudes toward advance directive, and death anxiety on terminal care performance of nurses in long-term care hospitals", Korean Journal of Adult Nursing, Vol. 30, No. 2, pp. 183-193, 2018. https://doi.org/10.7475/kjan.2018.30.2.183
  27. G.R. Lee, "Factors influencing nurses' end-of-life care competency and performance", Master's thesis, Korea University, 2019.
  28. S.H Yoon, "A study on new graduate nurses' clinical experience of adaptation", The Journal of Korean Nursing Administration Academic Society, Vol. 8, No. 1, pp. 55-72, 2002.
  29. S.J Park, and S.H Choi, "A study on the degrees of death orientation and terminal care performance of nurses", The Korean Journal of Fundamentals of Nursing, Vol. 3, No. 2, pp. 285-297, 1996.
  30. S.Y. Chung, "A study on terminal care stress and terminal care performance of ICU nurses", Master's thesis, Hanyang University, 2013.
  31. M.C. Corley, P. Minick, R.K. Elswick, and M. Jacobs, "Nurse moral distress and ethical work environment", Nursing Ethics, Vol. 12, No. 4, pp. 381-390, 2005. https://doi.org/10.1191/0969733005ne809oa
  32. A.B. Hamric, C.T. Borchers, and E.G. Epstein, "Development and testing of an instrument to measure moral distress in healthcare professionals", AJOB Primary Research, Vol. 3, No. 2, pp. 1-9, 202. https://doi.org/10.1080/21507716.2011.652337
  33. Y.R. Chae, S.J. Yu, E.J. Lee, K.J. Kang, M.S. Park, and M. Yu, "Validity and reliability of the Korean version of the moral distress scale-revised for Korean hospital nurses", The Journal of Korean Academic Society of Nursing Education, Vol. 22, No. 2, pp. 228-239, 2016. https://doi.org/10.5977/JKASNE.2016.22.2.228
  34. B. Victor, and J.B. Cullen, "The organizational bases of ethical work climates", Administrative Science Quarterly, Vol. 33, No. 1, pp. 101-125, 1988. https://doi.org/10.2307/2392857
  35. L.L. Olson, "Hospital nurses' perceptions of the ethical climate of their work setting", Journal of Nursing Scholarship, Vol. 30, No. 4, pp. 345-349, 1998. https://doi.org/10.1111/j.1547-5069.1998.tb01331.x
  36. J.I. Hwang, and H.A. Park, "Nurses' perception of ethical climate, medical error experience and intent-to-leave", Nursing Ethics, Vol. 21, No. 1, pp. 28-42, 2014. https://doi.org/10.1177/0969733013486797
  37. F. Luthans, B.J. Avolio, J.B. Avey, and S.M. Norman, "Positive psychological capital: Measurement and relationship with performance and satisfaction", Personnel Psychology, vol. 60, No. 3, pp. 541-572, 2007. https://doi.org/10.1111/j.1744-6570.2007.00083.x
  38. F. Luthans, and C.M. Youssef, "Emerging positive organizational behavior", Journal of Management, Vol. 33, No. 3, pp. 321-349, 2007. https://doi.org/10.1177/0149206307300814
  39. D.S. Lee, and Y.D. Choi, "A study on antecedents and consequences of positive psychological capital in organizations", Korean Management Review, Vol. 39, No.1, pp. 1-28, 2010.
  40. J.Y. Shim, "Influence of Good Death Awareness, Terminal Care Attitude and Stress on Performance of Terminal Care in Nurses", Master's thesis, Dongshin University, 2019.
  41. K.H. Jo, A.R. Park, J.J. Lee, and S.J. Choi, "The effect of suffering experience, empathy ability, caring behaviors on terminal care performance of clinical nurses", The Korean Journal of Hospice and Palliative Care, Vol. 18, No. 4, pp. 276-284, 2015. https://doi.org/10.14475/kjhpc.2015.18.4.276
  42. Y.H. An, and S.R. Suh, "The effect of nurses' compassion competence on performance of terminal care in geriatric hospitals", Journal of Health Informatics and Statistics, Vol. 44, No. 3, pp. 253-261, 2019. https://doi.org/10.21032/jhis.2019.44.3.253
  43. M. McEwen, "Spiritual nursing care: State of the art", Holistic Nursing Practice, Vol. 19, No. 4, pp. 161-168, 2005. https://doi.org/10.1097/00004650-200507000-00007
  44. M.J. Seo, J.Y. Kim, S.H. Kim, and T.W. Lee, "Nurses attitudes toward death, coping with death and understanding and performance regarding EOL care: Focus on nurses at ED, ICU and oncology department", The Korean Journal of Hospice and Palliative Care, Vol. 16, No. 2, pp. 108-117, 2013. https://doi.org/10.14475/kjhpc.2013.16.2.108
  45. H.O. Kim, "The effect of work-family balance on outcomes among married nurses: Focusing on the mediating effect of emotional exhaustion", Doctoral dissertation, Kyunghee University, 2015.
  46. J.H.. Yang, "The development and evaluation of the end of life care mobile apps for nurses in intensive care unit", Master's thesis, Chung-Ang University, 2020.
  47. E.Y. Chu, "The effects of death preparation education program on the death anxiety, death attitude, and attitudes toward end-of-life care of nurses in convalescent hospitals", Master's thesis, Changshin University, 2019.
  48. R. Buckman, W.F. Baile, R. Lenzi, G. Glober, E.A. Beale, and A.P. Kudelka, "SPIKES - A six-step protocol for delivering bad news: Application to the patient with cancer", Oncologist, Vol. 5, No. 4, pp. 302, 2000. https://doi.org/10.1634/theoncologist.5-4-302
  49. S.S. Luthar, and E. Zigler, E. "Vulnerability and competence: A review of research on resilience in childhood.", American Journal of Orthopsychiatry, Vol. 61, No. 1, pp. 6-22, 1991. https://doi.org/10.1037/h0079218
  50. F. Luthans, C.M. Youssef, D.S. Sweetman, and P.D. Harms, "Meeting the leadership challenge of employee well-being through relationship PsyCap and health PsyCap", Journal of Leadership & Organizational Studies, Vol. 20, No. 1, pp. 118-133, 2013. https://doi.org/10.1177/1548051812465893
  51. C.M. Youssef-Morgan, and F. Luthans, "Psychological capital theory: Toward a positive holistic model", Advances in Positive Organizational Psychology, Vol. 1, pp. 145-166, 2013. https://doi.org/10.1108/S2046-410X(2013)0000001009
  52. J.B. Avey, R.J. Reichard, F. Luthans, and K.H. Mhatre, "Meta-analysis of the impact of positive psychological capital on employee attitudes, behaviors, and performance", Human Resource Development Quarterly, Vol. 22, No. 2, pp. 127-152, 2011. https://doi.org/10.1002/hrdq.20070
  53. A. Newman, D. Ucbasaran, F.E.I. Zhu, and G. Hirst, "Psychological capital: A review and synthesis", Journal of Organizational Behavior, Vol. 35, No. S1, pp. S120-S138, 2014. https://doi.org/10.1002/job.1916
  54. S.J. Park, "Effect of the positive psychological capital and professionalism on the nursing performance among perioperative nurses", Master's thesis, Hanyang University, 2016.
  55. M.Y. Lee, and K.H. Kim, "Influence of head nurses' transformational leadership on staff nurse's psychological well-being, stress and somatization-focused on the mediating effect of positive psychological capital", Journal of Korean Academy of Nursing Administration, Vol. 18, No. 2, pp. 166-175, 2012. https://doi.org/10.11111/jkana.2012.18.2.166
  56. B.S Lee, "The relationship of shift work nurse's positive psychological capital and the quality of life", Master's thesis, Yonsei University, 2016.
  57. M.R. Lim, "Development of positive psychological capital improvement program for long-term care hospital nurses", Doctoral dissertation, Keimyung University, 2019.
  58. F. Luthans, J.B. Avey, and J.L. Patera, "Experimental analysis of a web-based training intervention to develop positive psychological capital", Academy of Management Learning & Education, Vol. 7, No. 2, pp. 209-221, 2008. https://doi.org/10.5465/AMLE.2008.32712618
  59. H.J. Lee, "Critical care nurses' perceived end of life care competencies and supportive behaviors and barriers", Master's thesis, Seoul National University, 2015.
  60. M.E.L. Iglesias, C. Pascual, and R.B. de Bengoa Vallejo, "Obstacles and helpful behaviors in providing end-of-life care to dying patients in intensive care units", Dimensions of Critical Care Nursing, Vol. 32, No. 2, pp. 99-106, 2013. https://doi.org/10.1097/dcc.0b013e3182808429
  61. R. Lee, "Effects of a strength coaching program on positive psychological capital, coaching leadership, and organizational commitment in front-line nursing managers", Doctoral dissertation, Ewha Womans University, 2019.
  62. H.G. Jung, and H.J, Kim, "A study on the effectiveness of my friends youth group coaching program for improving resilience," Journal of the Convergence on Culture Technology, Vol. 7, No. 1, pp. 184-193, 2021. https://doi.org/10.17703/JCCT.2021.7.1.184