Sujeong Kim

In recent decades, palliative care (PC) has gained global recognition as a vital component of modern health systems, offering comprehensive support for individuals with serious and life-limiting illnesses [1]. According to the World Health Organization (WHO), palliative care extends beyond the management of physical symptoms to encompass psychological, social, and spiritual support, with the goal […]

Although there is a need to evaluate the outcomes of children's palliative care, there is no scale that reflects children and families' perspectives in South Korea. This study aimed to develop the Korean version of the Children's Palliative Care Outcome Scale (C-POS-K). The translation and cross-cultural adaptation were performed through six phases: i) conceptual definition clarification; ii) forward translation; iii) blind backward translation; iv) expert review by a panel of the C-POS team; v) cognitive interviews with 21 children with cancer and 14 parents who experienced pediatric palliative care; vi) and proofreading of the final tool with the original C-POS team in the UK. The findings of this study confirmed that the items in the original C-POS:UK fully measure the symptoms and concerns in pediatric palliative care in Korea. While most items were culturally and linguistically adapted without substantial difficulty, several terminologies posed particular challenges. After discussions of the translation team and the expert panel, culturally appropriate terms were developed and included. Although participants in cognitive interviews suggested providing examples to items, adding content beyond the original items was avoided to prevent narrowing the scope of respondents' interpretations and to maintain international comparability. The appropriateness of the translation and cultural adaptation was confirmed throughout the process. The C-POS-K preserved the original instrument's key strengths, including developmentally appropriate formats, applicability to parents, and utility for both needs assessment and quality improvement, without substantive changes in meaning. A psychometric evaluation will follow to establish validity.

Eun Sook Kim, APN, Ph.D., Mikyung Park, MSW, Saet Byeol Kim, R.N., Sunhee Choi, APN, Ph.D., Nari Yoon, MSW and Sujeong Kim, R.N, Ph.D.. J Hosp Palliat Care 2025;28:56-70. https://doi.org/10.14475/jhpc.2025.28.2.56

Background: Nurses providing care to patients with end-of-life or terminal illnesses often encounter ethically challenging situations leading to moral distress. However, existing quantitative studies have examined moral distress using instruments that address general clinical situations rather than those specific to end-of-life care. Furthermore, qualitative studies have often been limited to participants from a single unit or those experiencing moral distress-induced circumstances. A comprehensive and integrated understanding of the overarching process of moral distress is vital to discern the unique circumstances surrounding end-of-life care and its consequential impacts. Research objectives: To explore the moral distress experiences of nurses who are frequently involved in caring for patients with end-of-life or terminal illnesses and apply it to two existing theories: the model of moral distress and the ecological model. Research design: A qualitative descriptive approach was employed. Participants and research context: Seven focus group interviews involving 30 nurses were performed. The subsequent transcriptions underwent rigorous content analysis. Ethical considerations: We obtained Institutional Review Board approval from a university. Focus group interviews were conducted with nurses who agreed to participate and signed the consent form. Findings: The moral distress-inducing factors and nurses’ perceived impact of moral distress were identified and categorized based on moral distress theories and ecological models. A total of 15 categories and 30 subcategories across the following 4 domains were derived: (1) intrapersonal, (2) interpersonal, (3) organizational, and (4) structural factors. Conclusions: End-of-life-specific circumstances induced moral distress among nurses, with both negative and positive impacts identified. Effective organizational and policy support is essential to manage conflicts, form a healthy organizational culture, provide training, and prevent unnecessary expenses due to the negative consequences of moral distress.

Pediatric palliative care was introduced in South Korea in 2018, with an increased need for care of children with life-limiting conditions, such as leukemia. However, the perspective of parents, who are the primary caregivers, regarding pediatric palliative care has not been explored. This study aimed to describe the pediatric palliative care–related experiences of parents who had lost a child to leukemia to better understand their needs and care outcomes. Ten mothers of children who received pediatric palliative care were recruited. Individual in-depth interviews were conducted. Phenomenology was applied to elucidate parents' experiences during their children's illness and after bereavement. From 179 main statements and 46 meaningful units, 22 themes were derived and grouped into 11 theme clusters and 4 categories. The participants described that the pediatric palliative care team had an indispensable role in providing emotional support to them and their children; this support continued even after the child's death. In addition, the participants were satisfied with their choice to receive pediatric palliative care and hoped that more regions could benefit from the services. The study findings could contribute to advances and the popularization of pediatric palliative care in South Korea.

Background: As Korean neonatal nurses frequently experience the deaths of infants, moral distress occurs when they provide end-of-life care to the infants and their families. Although they need to care for the patients’ deaths and consequently experience burnout and turnover due to moral distress from the situation, there is a lack of a support for nurses. Moreover, not much information is available on the moral distress of neonatal nurses. There is a need to better understand Korean neonatal nurses’ moral distress to develop and implement appropriate supports. Objective: This study aimed to describe nurses’ experience of moral distress when they provide end-of-life care to infants and their families in neonatal intensive care units. Research design: This is a secondary analysis qualitative study. Content analysis was performed based on Corley’s theory of moral distress to develop a codebook and identify themes regarding moral distress among the nurses. Participants and research context: Qualitative data were collected from 20 nurses working in two NICUs in Seoul, South Korea. Ethical considerations: The original study obtained permission from a university’s institutional review board (IRB). This secondary analysis study obtained the exemption from another university’s IRB. Nurses’ participation was voluntary and confidential. Findings: The nurses’ moral distress was derived when they faced moral constraints and/or moral conflicts. Two distinct categories of moral constraints and four distinct categories of moral conflicts were identified among the neonatal nurses. In addition, impacts of moral distress on patients and nurses were identified. Conclusions: This study identified occasions neonatal nurses experience moral distress, and thus can guide in developing and implementing effective interventions to decrease their moral distress and improve their resilience in end-of-life care by providing insight into neonatal nurses’ needs for support in end-of-life care.

Background: Pediatric nurses are particularly vulnerable to moral distress and turnover due to frequent experiences with patient death combined with limited pediatric palliative resources and related support. Objective: This study examined pediatric nurses' experiences of pediatric patient death, moral distress, and turnover intention and identified the correlations between them as well as the mediating role of moral distress. Methods: This cross-sectional study conducted an online survey with 161 pediatric nurses working in a tertiary hospital in Seoul, South Korea. The survey comprised questions to assess nurses' experience of pediatric patient death and turnover intention and a validated instrument to measure their moral distress. Logistic regression was used to examine the relationships between study variables, and structural equation modeling was performed to determine the mediating effect of moral distress. Results: Pediatric nurses (N = 161) reported high levels of moral distress with a mean score of 101.06 (standard deviation = 70.528) on the pediatric version of the Moral Distress Scale. Turnover intention increased 1.01 times for every 1 U increase in moral distress. Moral distress fully mediated the relationship between the experience of pediatric patient death and turnover intention. Conclusion: Pediatric patient death had an indirect effect on turnover intention through moral distress among pediatric nurses. Reducing pediatric nurses' moral distress caused from experiencing patient death may help minimize their turnover intention.

As hospice and palliative care is a holistic service grounded in spirituality, training in spiritual care is essential. This study aimed to describe an international workforce training program for hospice and palliative care that emphasized spiritual care and evaluate the effectiveness of the training implementation. A quasi-experimental study was conducted with 28 health care professionals from 4 countries in the Western Pacific Region, who attended the international workforce trainings on hospice and palliative care. Data were collected before and after the trainings using a self-reported survey questionnaire. The participants' palliative care knowledge, spiritual well-being, perceived stress, and compassion competency were analyzed to evaluate the training program. Whereas the participants' knowledge of hospice and palliative care (P < .001) and compassion competency increased (P = .004), their perceived stress decreased post training (P = .002). This study provided an extensive description of an international workforce training program of hospice and palliative care for potential replication of the training in other regions of the world. Because training in hospice and palliative care positively influenced health care professionals' spiritual care competency, future training and studies should consider spiritual care factors, along with intellectual aspects.