의료인이 인식하는 말기의 적절한 의료적 의사결정 저해요인 분석
A Factor Analysis of the Impediments to End-Stage Medical Decision-Making as Perceived by Nurses and Physicians in South Korea
1
조회
0
다운로드
6
인용
0
참고문헌
키워드
초록
Purpose: This study was designed to identify the impediment factors for end-stage medical decisionmaking as perceived by nurses and physicians in Korea. Method: The subjects in this descriptive exploratory study were 82 nurses and 61 physicians working in university hospitals in the Korean cities of Daegu and Busan. Principal component analysis was implemented in the exploratory factor analysis study, where the eigen value 1 was used for the basis of factor extractor and Varimax rotation was used to divide the factors. The data were analyzed by a SPSS/WIN 15.0 program. Result: The analysis of the impediment factors for end-stage medical decision-making revealed 15 statements and 5 categorized factors: legal compliance, prescriptive health professionals, interpersonal preparation, hospital systems, and ethical belief. These factors explained 66.84% of the total variance. Legal compliance was requested excessive roles and responsibilities of healthcare providers. Prescriptive health professionals were indicated reflection of paternalistic decision making type. Interpersonal preparation was claimed for readiness toward appropriate medical decision making issues among patient,families and healthcare providers. Hospital systems were showed inappropriate management of hospice palliative wards. Ethical belief was determined as an impediment factors for end stage medical decision making. Conclusion: We divided impediment factors for appropriate end stage medical decision-making into 5 separate categories. There is a need for a formation of a decision making system that includes the patient - health professional - family which is based on promoting the free choice of the patient while providing an atmosphere of open communication between health professionals which will facilitate the decision making process. The results of this study may contribute to the development of a new endstage decision-making system that is appropriate for medical care in Korea.
Abstract
Purpose: This study was designed to identify the impediment factors for end-stage medical decisionmaking as perceived by nurses and physicians in Korea. Method: The subjects in this descriptive exploratory study were 82 nurses and 61 physicians working in university hospitals in the Korean cities of Daegu and Busan. Principal component analysis was implemented in the exploratory factor analysis study, where the eigen value 1 was used for the basis of factor extractor and Varimax rotation was used to divide the factors. The data were analyzed by a SPSS/WIN 15.0 program. Result: The analysis of the impediment factors for end-stage medical decision-making revealed 15 statements and 5 categorized factors: legal compliance, prescriptive health professionals, interpersonal preparation, hospital systems, and ethical belief. These factors explained 66.84% of the total variance. Legal compliance was requested excessive roles and responsibilities of healthcare providers. Prescriptive health professionals were indicated reflection of paternalistic decision making type. Interpersonal preparation was claimed for readiness toward appropriate medical decision making issues among patient,families and healthcare providers. Hospital systems were showed inappropriate management of hospice palliative wards. Ethical belief was determined as an impediment factors for end stage medical decision making. Conclusion: We divided impediment factors for appropriate end stage medical decision-making into 5 separate categories. There is a need for a formation of a decision making system that includes the patient - health professional - family which is based on promoting the free choice of the patient while providing an atmosphere of open communication between health professionals which will facilitate the decision making process. The results of this study may contribute to the development of a new endstage decision-making system that is appropriate for medical care in Korea.
참고문헌 (29)
- Beauchamp TL, "Principle of Biomedical Ethics", pp.480~ (2001), Oxford University Press
- Briggs L, "The nurse's role in end-of-life decision-making for patients and families", Geriatr Nurs, 23(6), pp.302~310 (2002)
- Giger JN, "Multicultural and multi-ethnic considerations and advanced directives: Developing cultural competency", J Cult Divers, 13(1), pp.3~9 (2006)
- Giorgi A., "The question of validity in qualitative research", Journal of Phenomenological Psychology, 33(1), pp.1~18 (2002)
- Hair JF, "Multivariate Data Analysis with Readings" (1998), Prentice Hall
- Hilden H, "Finnish nurse's interpretations of patient autonomy in the context of end of life decision making", Nurs Ethics, 13(1), pp.41~51 (2006)
- Hinkin TR, "A review of scale development practices in the study of organizations", J Manage, 21(5), pp.967~988 (1995)
- Johnston B, "Nurses and patients perceptions of expert palliative nursing care", J Adv Nurs, 54(6), pp.700~709 (2006)
- Kim DY, "Do-not-resuscitate orders for terminal patients with cancer in teaching hospitals of Korea", J Palliat Med, 10, pp.1153~1158 (2007)
- Jia Lee, "Perspectives of Korean Patients, Families, Physicians and Nurses on Advance Directives", Asian Nursing Research, 4(4), pp.185~193 (2010), 한국간호과학회
- McLennan S, "Nurses share their views on end-of-life issues", Kai Taki Nursing New Zealand, 16(4), pp.12~14 (2010)
- Meraviglia MG, "Nurses’ needs for education on cancer and end-of-life care", J Contin Educ Nurs, 34(3), pp.122~127 (2003)
- Nordgen L, "Palliative care in a coronary care unit: A qualitative study of physicians and nurses perceptions", J Clin Nurs, 13(2), pp.185~193 (2004)
- Nunnally JC, "Psychometric Theory" (1994), McGraw-Hill
- Royak-Schaler R, "Family perspectives on communication with health care providers during end of life cancer care", Oncol Nurs Forum, 33(4)통권 : 33, pp.753~760 (2006)
- Streiner DL, "Health Measurement Scales: A Practical Guide to Their Development and Use" (2003), Oxford University Press
- Willard C, "Challenges to end of life care in the acute hospital setting", Palliat Med, 20(6), pp.611~615 (2006)
- 권복규, "국내외 뇌사, 존엄사와 안락사에 대한 인식의 변화와 윤리 - 소아를 중심으로", Korean Journal of Pediatrics, 52(8), pp.843~850 (2009), 대한소아과학회
- 박일환, "의사 환자 관계와 관계중심 진료", 가정의학회지, 30(3), pp.53~56 (2009)
- 서원식, "의사와 환자 간 공유된 진료의사결정이 환자만족도에 미치는 영향", 예방의학회지, 43(1), pp.26~34 (2010), 대한예방의학회
- 송태준, "한 대학병원 종양내과에서 사망한 환자들의 심폐소생술 금지 지시 결정 요소", 대한내과학회지, 74(4), pp.403~410 (2008), 대한내과학회
- 윤영호, "말기환자의 삶의 질 향상을 위한 호스피스 제도화", 대한의사협회지, 51(6), pp.530~535 (2008)
- 윤영호, "바람직한 임종을 위한 호스피스•완화의료 및 사회적 대책", 대한의사협회지, 52(9), pp.880~885 (2009), 대한의사협회
- 이윤성, "연명치료중지에 관한 지침제정방안", 품위 있는 죽음을 위한 사회적 합의 심포지엄, pp.4~7 (2009)
- 조계화, "간호사와 의사의 임종치료선호도 점수에 영향을 미치는 예측요인", 한국의료윤리학회지, 13(4), pp.305~320 (2010), 한국의료윤리학회
- 조계화, "말기 환자에 대한 한국형 의료적 의사결정 체계 구축을 위한 델파이연구", 한국의료윤리학회지, 14(2), pp.131~144 (2011), 한국의료윤리학회
- 조계화, "말기환자를 간호하는 간호사의 고통경험", 대한간호학회지, 31(6), pp.1055~1066 (2001)
- 조계화, "말기의 의료적 의사결정에 관한 임상간호사의 갈등경험", 성인간호학회지, 22(5), pp.488~498 (2010), 성인간호학회
- 허대석, "환자의 자기결정권과 사전의료지시서", 대한의사협회지, 52(9), pp.865~870 (2009), 대한의사협회