Minjeong Seo

Purpose: The aim of this study was to identify the serial mediation effect of social support and health literacy in the relationship between self care capacity and health-related quality of life.Methods: Participants were 169 elderly people who lived in rural areas and were diagnosed with chronic diseases. Data collection was conducted from July 10, 2024 to August 30, 2024 through self-reported questionnaires. The data were analyzed by IBM SPSS Statistics 27 and SPSS PROCESS Macro 4.2 program.Results: The direct effect of self care capacity on health-related quality of life was significant (β = .21, p = .023). The indirect effect of self care capacity on health-related quality of life was β = .14 (95% confidence interval [CI] = =0.01~0.29). The double mediating effect of social support and health literacy in the relationship between self care capacity and health-related quality of life was β = .02 (95% CI=0.01~0.06).Conclusion: It was found that the social support and health literacy of the elderly diagnosed with chronic diseases living in rural areas were affected by self care capacity, which in turn affected health-related quality of life. It is necessary to approach successful aging by improving health-related quality of life through a system that can improve self care capacity, social support, and health literacy by efficiently utilizing community resources.

Clinical Ethics Support Services (CESS) improve health-care quality by systematically identifying and resolving ethical issues. CESS providers should be trained to understand patients’ difficulties with existential issues and advocate on their behalf. This study evaluates the effectiveness of educational programs to enhance the competencies to solve ethical issues in clinical practice for CESS providers related to life-sustaining-treatment, based on Jonsen et al.’s “the four topics approach.” This is an explanatory sequential mixed-method study conducted in quantitative and qualitative phases. Participants included 52 life-sustaining medical workers at general hospitals. The participants were categorized into 24 experimental and 28 control groups, including nurses, social workers, and legal administrations. The program encompassed bioethics, end-of-life care, critical thinking, decision-making training through clinical ethics cases, role-playing, communication skills, and discussions. In the quantitative phase, a quasi-experimental study design with pre-test, intervention, and post-test was used. The program for experimental group was provided through 8 sessions spread across 4 weeks. The participants’ experiences were explored through semi-structured interviews in the qualitative phase. After the education, the experimental and control groups differed significantly in critical thinking disposition, and hospice and palliative care knowledge. Participants acknowledged that critical thinking education improved their ability to analyze and evaluate clinical ethical dilemmas. The case-based, role-playing intervention effectively enhanced participants’ communication and critical thinking skills concerning life-sustaining treatments. Participants highlighted the importance of ongoing education and professional development to maintain core knowledge and skills, aiming to enhance the quality of care for patients, families, and colleagues. This study was retrospectively registered as a code (No: KCT0009687) in the Korean Clinical Trial Service on August 9, 2024.URL: https://cris.nih.go.kr/cris/search/detailSearch.do?seq=27805&status=5&seq_group=27805&search_page=M .

This descriptive study was designed to identify factors influencing end-of-life nursing competency among nursing students. Data were collected from 184 undergraduate students with over one year of clinical experience, all of whom were attending one of two nursing colleges located in Gyeongsangnam-do, South Korea. A self-reported structured questionnaire assessed end-of-life care competency, knowledge of hospice and palliative care, empathy competency, ethical nursing competency, and attitudes toward end-of-life care. The data were analyzed using Pearson’s correlation coefficient and multiple regression analysis with SPSS/WIN 25.0. Key predictors of end-of-life nursing competency included participation in end-of-life education, empathy competency, ethical nursing competency, and subjective health status (rated as good). The model explained 34.1% of the variance in nursing competency. These findings suggest that improving nursing students’ end-of-life competencies requires educational strategies, tailored to each university’s situation, to enhance the empathy, ethical nursing skills, and subjective health of nursing students.

This scoping review examines the “System for Decisions to Forgo Life-Sustaining Treatment” in Korea from 2018 to 2022 and is based on an analysis of 285 research studies, published in either domestic or international journals. Of the articles examined, 164 (57.5%) focused on issues related to health science, while 121 (42.5%) addressed ethical and legal aspects of the system. Articles in the former category of health science focused on advance care plans, contemplation on death, decision-making, end-of-life care, biomedical ethics, and psychosocial factors. Articles in the latter category of the ethical and legal aspects of the system focused on legal challenges, the right to self-determination, death with dignity, surrogate decision-making, contemplation of death, biomedical ethics, and legal frameworks. To ensure the system’s stable integration into society during this transitional period, it is crucial to continuously assess its operation in clinical settings. Efforts to establish a societal consensus on dignified end-of-life experiences and to conduct future multidisciplinary research should persist.

The purpose of this study was to identify the factors affecting ethical competence in nurses. This study was conducted a cross-sectional descriptive design with a convenience sample of 100 nurses from a university affiliated hospital in Seoul. The study collected data on items drawn from CENAS (The Clinical Ethics Need Assessment Survey), ethics education needs, ethical confidence, moral sensitivity, and ethical competence. The data were analyzed using descriptive statistics, a t-test, a one-way ANOVA, correlation analysis, and multiple linear regression analysis with SPSS Win 21 program. The results indicate that the main factor influencing nurses’ ethical competence is as ethical confidence (β = .53), which accounted for 42.0% of variance. These results suggest development of ethical education program for nurses for improving nurses’ ethical capabilities.

The purpose of this study was to identify the factors that influence Hemodialysis patients’ intentions to write Advanced Directives (ADs). A questionnaire was used to collect data from 165 chronic renal failure patients receiving hemodialysis treatment at two general hospitals in South Korea. The variables that were found to have a significant influence on the intention to write an AD were education level, knowledge of Ads, and attitudes toward ADs. Patients with a university degree or high school education were significantly more likely (3.35 times and 3.62 times, respectively) to write an AD than were those without a high school education. In terms of knowledge of ADs, as the score increased by 1 point out of 21, the intention to write an AD increased by 1.12 times. Regarding attitudes toward ADs, as the score increased by 1 point, the intention to write an AD increased by 1.13 times. Patients that would choose to continue dialysis treatment during the end-of-life period were less willing to write an AD than those who would stop the dialysis treatment. However, 18.5% of those willing to write an AD indicated that they would continue hemodialysis treatment during the end-of-life period. The results of this study suggest that discussions between patients, family members, and healthcare providers are required from the beginning of dialysis treatment so that these patients have the right knowledge and attitudes about ADs and can confirm their values and beliefs about end-of-life care.

More than 60% of patients with advanced cancer experience pain, and uncontrolled pain reduces the quality of life. Nurses are the closest healthcare providers to the patient and are suitable for managing cancer pain using pharmacological and non-pharmacological interventions. This study aimed to identify factors affecting the performance of cancer pain management among nurses. This study was conducted among 155 participating nurses working at a tertiary hospital who had experience with cancer pain management. Data collection was performed between October 18, 2021 and October 25, 2021. Data analysis was conducted using descriptive statistics, the independent-sample t-test, one-way analysis of variance, and hierarchical regression analysis. There were 110 subjects (71.0%) who had no experience of cancer pain management education. The results of regression analysis indicated that barriers included medical staff, patients, and the hospital system for cancer pain management (β=0.28, P<0.001). The performance of cancer pain management was also affected by experience of cancer pain management training (β=0.22, P=0.007), and cancer pain management knowledge (β=0.21, P=0.006). The explanatory power of the variable was 16.6%. It is crucial to assess system-related obstacles, as well as patients and medical staff, in order to improve nurses' cancer pain management performance. A systematic approach incorporating multidisciplinary interventions from interprofessional teams is required for effective pain management. Furthermore, pain management education is required both for cancer ward nurses and nurses in other wards.

Minhwa Kang, R.N. and Minjeong Seo, R.N., Ph.D.. J Hosp Palliat Care 2022;25:99-109. https://doi.org/10.14475/jhpc.2022.25.3.99

This study clarifies the concept of illness intrusiveness in patients with a chronic disease using the hybrid model method. To clarify the dimension, attributes, and definition of illness intrusiveness in chronic disease, three phases of analysis were conducted. In the theoretical phase, a working definition was devised through a systematic review. In the fieldwork phase, individual in-depth interviews were conducted with nine participants with chronic diseases. In the final analytic phase, the results were integrated through comparison and review. There are four domains and eleven attributes of illness intrusiveness in chronic disease. The domains include physical, psychological, social/contextual, and spiritual. The physical domain consists of four attributes: pain, fatigue, physical malfunction, and change of body image. The psychological domain consists of three attributes: psychological weakness, uncertainty, and stigma. The social/contextual domain is made up of three attributes: withdrawal of role play, limit of daily life, and burden of changing health habits. Finally, the spiritual domain had one attribute: unstable spiritual state. Thus, based on the study findings, it is necessary to develop a suitable illness intrusiveness in chronic disease assessment scale to assess chronic disease patients.