Search

Aims and objectives To understand hospice palliative care nurses' (HPCNs) perceptions towards spiritual care and their competence to provide spiritual care. Background Previous research has shown that many nurses lack a clear understanding of the concept of spirituality and feel inadequately prepared to assess patients' spiritual needs. Studies on competence in spiritual care are mostly descriptive, and the evidence for improving it is limited. Design A mixed-methods research design was used. Methods Quantitative data were collected from 282 nurses in forty hospice palliative care (HPC) institutions in South Korea and analysed using descriptive statistics, independent t-test, one-way ANOVA with Bonferroni test and multiple regression. Qualitative data collection involved two stages: first, an open-ended question posed to 282 nurses, and second, focus group interviews conducted with six HPC experts. Both qualitative data sets were analysed separately using content analysis. This study followed the GRAMMS guidelines. Results Of the six dimensions of spiritual care competence (SCC), the mean scores were highest in 'attitude towards the patient's spirituality' and 'communication', whereas the 'assessment and implementation of spiritual care' and 'professionalisation and improving the quality of spiritual care' had the lowest mean scores. Through content analysis, 4 themes regarding the meaning of spiritual care, 3 themes regarding requirements for spiritual care and 2 themes regarding preparedness for spiritual care were revealed. They perceived the needs of the understanding of spiritual care based on the attributes of spirituality, the education in systematic assessments and implementation for spiritual care with standardised terminology, and the opportunity to reflect on nurses' own spirituality. Conclusions Practical SCC training for HPCNs and the subsequent development of clinical practice guidelines are of vital importance. Relevance to clinical practice The results of this study provide a useful resource to develop educational programmes for strengthening the SCC of nurses and the entire HPC team.

Living with a terminal illness, whether as a patient or as the family member of a patient, often involves spiritual challenges. The ability to ascertain and meet the spiritual needs of terminally ill patients and their loved ones is an essential part of providing compassionate and competent whole person care. This study aimed to adapt the original Spiritual Interests Related to Illness Tool (SpIRIT) for use in Korea (SpIRIT-K) and to assess its reliability and validity as a tool to determine the spiritual needs of terminally ill Korean patients and their caregivers. After translation-back-translation and content validity indexing, SpIRIT-K was administered to 106 terminally ill patients and 105 family caregivers in 20 sites across South Korea. SPSS and AMOS were used for evaluating validity and reliability. The 37-item SpIRIT-K consisted of 8 factors (subscales), with each subscale consisting of between 3 and 8 items. Evidence for structural and convergent validity was observed. Internal reliability of the overall scale was 0.95. The findings showed patients and family caregivers reported no significant difference in 7 of the 8 subscales, demonstrating known-groups validity. The rigorous process of establishing cross-cultural validity for this scale provided evidence supporting its validity and reliability. The findings suggest that SpIRIT-K is suitable for research and for clinical purposes in palliative care settings in South Korea. This development also allows for comparisons between Korean and North American cultures in terms of spiritual needs among terminally ill patients and their caregivers.

This study aimed to compare perceptions of spiritual care among patients with life-threatening cancer, their primary family caregivers, and hospice/palliative care nurses.Data were collected using both structured and unstructured approaches. Structured questionnaire data were examined using statistical analysis methods, and unstructured data were examined using content analysis to compare the 3 participant groups. The questionnaire revealed that among all 3 groups, spiritual care was commonly perceived to relate to "having the opportunity for internal reflection," "finding meaning," "encouraging hope," and "listening to and being with patients." Content analysis of the unstructured data revealed 5 themes: "Caring with sincerity," "Strengthening spiritual resources," "Alleviating physical pain and discomfort" (among patients and primary family caregivers only), "Improving spiritual care service," and "Multifaceted cooperation" (among hospice/palliative care nurses only). Our findings suggest that for patients with life-threatening illnesses such as terminal cancer, spiritual care should not be limited to religious practice but should also satisfy inner existential needs, for example, by encouraging hope, providing empathy, and helping patients find meaning in their circumstances.

This study aimed to examine the reliability and validity of a scale to assess the competence of Korean nurses who provide spiritual care for patients with terminal illnesses. The reliability and validity were examined using Cronbach α, item analysis, and exploratory factor analysis. The participants were 248 hospice nurses working at 40 hospices and palliative hospitals in South Korea. The results showed that the reliability was high, as indicated by a Cronbach α of .942. The exploratory factor analysis revealed 6 dimensions (assessment and implementation of spiritual care, professionalization and improvement of the quality of spiritual care, personal support and patient counseling, referral to professionals, attitude toward the patient's spirituality, and communication) with 27 items. The 6 factors explained 68.20% of the variance in the Korean version of the Spiritual Care Competence Scale. From the results, the Korean version of the Spiritual Care Competence Scale may serve as an appropriate measure for provision of spiritual care for patients with terminal illness. In addition, it may be useful in assessing hospice and palliative nurses' ability for spiritual care.

Background Spirituality is a fundamental, intrinsic aspect of human beings and should be a core component of quality palliative care. There is an urgent need to train hospice palliative care teams (HPCTs) to enhance their ability to provide spiritual care. This study aimed to develop and evaluate a meaning-centered, spiritual care training program (McSCTP) for HPCTs (McSCTP-HPCTs). Methods The modules’ content was informed by Viktor Frankl’s meaning-centered logotherapy with its emphasis on spiritual resources, as well as the spiritual care model of the Interprofessional Spiritual Care Education Curriculum (ISPEC). Following development, we conducted a pilot test with four nurses. We used the results to inform the final program, which we tested in an intervention involving 13 members of HPCTs. We took measurements using self-administered questionnaires at three points before and after the intervention. Using descriptive statistics, the Mann-Whitney U test, and the Kruskal-Wallis test, we analyzed the participants’ demographic and career-related characteristics, as well as the degree of variance between three outcome variables: compassion fatigue (CF), spiritual care competencies (SCCs), and spiritual care therapeutics (SCT). Results We divided the McSCTP-HPCTs into five modules. Module I: The HPCTs’ SCC evaluation, understanding the major concepts of spiritual care and logotherapy; Modules II-IV: Meaning-centered interventions (MCIs) related to spiritual needs (existential, relational, and transcendental/religious); Module V: The process of meaning-centered spiritual care. The preliminary evaluation revealed significant differences in all three outcome variables at the posttest point (CF, p = 0.037; SCCs, p = 0.005; SCT, p = 0.002). At the four-week follow-up test point, we only found statistical significance with the SCCs (p = 0.006). Conclusions The McSCTP-HPCTs is suitable for use in clinical settings and provides evidence for assessing the SCCs of HPCTs.

BACKGROUND For patients with advanced or terminal cancer undergoing hospice or palliative care, spiritual care based on meaning-centered intervention (MCI) has become an essential form of support. OBJECTIVE The aim of this study was to characterize MCI systematically and the effectiveness of hospice and palliative care for patients with advanced or terminal cancer. METHODS MEDLINE via PubMed, Cochrane Library CENTRAL, EMBASE, CINAHL, and several Korean electronic databases were searched from inception to May 2017. The RevMan 5.3 program of the Cochrane Library was used for data analysis. RESULTS A meta-analysis was conducted of 10 controlled trials (6 randomized and 4 nonrandomized) featuring 623 patients with cancer. Meaning-centered interventions were compared with usual care control groups or other psychosocial interventions. The weighted average effect sizes across studies were -0.96 (P < .001, I = 7%) for meaning in life, -0.37 (P = .002, I = 0%) for spiritual well-being, -0.48 (P < .001, I = 0%) for quality of life, -0.28 (P = .02, I = 0%) for anxiety, and -0.31 (P = .02, I = 17%) for physical symptoms. CONCLUSION Spiritual care based on MCI may help to improve the physical, psychosocial, and spiritual well-being of patients with advanced or terminal cancer. IMPLICATION FOR PRACTICE Meaning-centered interventions could be a valuable way to enhance quality of life at the end stage for patients with advanced or terminal cancer.

Purpose: This study was done to analyze how a death preparation education program have the effects on awareness of hospice palliative care and withdrawing life sustaining treatment in older adults. Methods: This study employed a non-equivalent control group design among quasi-experimental designs. The experimental group was comprised with 35 adults and the control group with 40 adults. The death preparation program consisted of five two-hour sessions and was administered once a week for five straight weeks. Data were analyzed by descriptive statistics, t-test, χ 2 test, Fisher’s exact test, and ANCOVA using SPSS version 18.0. Results: The mean age of the participants was 66.2 years. A significant difference between the experimental and control groups was observed in withdrawing life sustaining treatment (F=3.380, P=0.040). However, no significant difference was found in awareness of hospice palliative care (F=0.163, P=0.850). Conclusion: The study results indicate that death preparation training could positively affect people’s awareness of withdrawing life sustaining treatment. More studies should be conducted to explore effects of death preparation edu cation for all ages and help people better understand hospice palliative care.

Purpose: The aim of this research was to explore nurses' knowledge of and attitudes toward pediatric palliative care (PPC) in Korea. Methods: A descriptive cross-sectional design was used. A total of 196 participants were recruited from the ELNEC-PPC course held in Seoul, Korea. All participants completed a 20-item survey questionnaire which assessed knowledge of and attitudes toward PPC using a 7-point Likert scale. Results: Nurses' knowledge of PPC correlated with their educational level and work experience in the pediatric unit and hospice care unit. The work experience in the pediatric unit, career length in PPC and completion of palliative education course made differences in the attitudes toward PPC. Married nurses scored significantly higher on the parental rights in determining palliative care service for their child, and nurses with master's degree or higher showed a higher level of understanding of and attitudes toward the differences between PPC and adult palliative care. Conclusion: The factors influencing nurses' knowledge of and attitudes toward PPC need be considered to develop a pediatric palliative training program.

The purpose of this paper is to suggest a direction for future studies based on the analysis of the articles published in the Korean Journal of Hospice and Palliative Care from 1998 to 2012. A total of 240 articles (51 reviews, 189 original) were examined in three five-year groups. Categories of analysis include authors' background (profession, region) and general characteristics and qualitative aspects of the original paper (participants, topic, study design, data analysis, ethical consideration, multidisciplinary approach, research funds and sample size estimation). While the journal publishes more of articles than before, it is mainly due to the increase in the number of review articles, not original articles. As for study topics, healthcare industry and physical symptoms were most frequently studied. The disparity in authors' regional background is fading, and more articles are published by nurses than before. Moreover, more studies are funded while fewer papers tend to adopt a multidisciplinary approach or focus on care givers. Also, in terms of a study design, the number of experimental and methodological studies has slightly increased. In the qualitative aspect, studies considered ethical issues and collected participation consent, and fewer studies reported an estimated sample size. In data analysis, post-adjustment comparison decreased, and new analytical methods are increasingly used. Our results indicate the need to conduct research with more extensive scientific data in various fields of hospice and palliative care.

서론호스피스ㆍ완화의료는 전 세계적으로 암 질환의 증가 및 환자와 가족들의 삶의 질 향상을 목표로 하는 치료의 방향과 더불어 빠른 발전을 하고 있다. 성인을 대상으로 한, 보다 체계적인 호스피스ㆍ완화의료 서비스를 정착시키려는 노력과 함께 지난 20년간 태아기부터 청소년기에 생명을 위협하는 질병을 가진 소아청소년들을 위한 호스피스ㆍ완화의료에 대한 관심이 증가하고 있다. 1983년 국제아동호스피스(Children’s Hospice International, CHI)가 설립된 이후 호스피스 돌봄을 제공하는 각 기관에서 소아청소년 호스피스ㆍ완화의료 서비스 제공이 확산되는 계기가 되었으나 National Hospice and Palliative Care Organization (NHPCO)의 2005년 회원통계에 의하면 20%의 호스피스 프로그램만이 아동 호스피스ㆍ완화의료 프로그램을 제공하고 있거나 개발하고 있는 중이며 나라마다 큰 차이를 보이고 있다(1). 현재 우리나라의 경우도 성인과 구별된 소아청소년을 위한 호스피스ㆍ완화의료를 제공하는 기관은 없는 실정이다. 국내의 경우 2007년 한국중앙암등록사업 보고서에 의하면 18세 미만의 아동에서 연간 1,500명이 암 진단을(10만 명 중 약 13명) 받고 있다. 미국에서는 19세 미만의 소아청소년들 중 매해 53,000명이 사망하고 있으며 20세 미만의 인구 중 연간 12,000명이 암 진단을 받고 있어(10만 명 중 약 14명) 세계적으로 생명에 위협이 되는 질병을 가진 소아청소년과 그 가족의 삶의 질 증진을 위한 체계적인 의료서비스가 조속히 정착되어야 할 시점에 있다(1,2).호스피스ㆍ완화의료를 정착하기 위해 미국에서 개발된 해당 분야 전문가를 위한 대표적인 교육 프로그램으로 EPEC (education in palliative and end-of-life care)과 ELNEC (end-of-life nursing education consortium) 프로그램이 있다. AACN (American Association of Colleges of Nur-sing)과 City of Hope에서 2000년부터 개발되기 시작한 ELNEC 프로젝트는 2012년 현재까지 8개의 교육자를 위한 교육 프로그램을 개발하였으며 그 중 소아청소년 호스피스ㆍ완화의료 분야의 전문가를 교육하기 위한 ELNEC-Pediatric Palliative Care 프로그램이 2003년 20명의 아동완화의료 영역의 전문가들에 의해 예비연구를 거쳐 개발되었고 국내에서도 2012년 7월 12∼13일 양일간 이 교육과정 교육을 실시하였다(3). 최근 주산기(perina-tal)와 신생아기(neonatal) 분야가 소아청소년 호스피스ㆍ완화의료 서비스 분야에 포함되고 있고 ELNEC에서는 2009년에 ELNEC-Pediatric Palliative Care 교육 프로그램에 주산기 및 신생아 완화의료 교육 프로그램 내용을 추가하였다. 이러한 소아청소년 호스피스ㆍ완화의료 전문인을 위한 교육프로그램의 개발과 소아청소년 호스피스ㆍ완화의료 서비스 제공을 위한 노력에도 불구하고 대부분 환아가 거의 죽음에 이르기 전까지 힘든 적극적인 치료를

Purpose: To evaluate the effects of a logotherapy program entitled ‘Finding meaning in my life’ for adolescents with terminal cancer. Methods: A nonequivalent control group, non-synchronized design was conducted with a convenience sample of 44 late adolescents with terminal cancer. The experimental group (n=22) participated in the ‘Finding meaning in my life’ program which consisted of five-day sessions for one week. The control group (n=22) received the usual nursing care. The effects were measured using adolescent meaning in life (AMIL), and quality of life (QOL) scales. The collected data were analyzed by descriptive statistics, Chi-square, and t-test using SPSS/PC 17.0 program. Results: There were significant differences in AMIL (t=3.36, p＜.05) and QOL (t=2.67, p＜.05) between the experimental and control groups. Conclusion: Logotherapy is effective in improving the meaning in life and quality of life of late adolescents with terminal cancer, and can be used to prevent existential distress.

Purpose: The purpose of this study was to test the reliability and validity of an instrument to measure suffering of family of patients with terminal cancer. Methods: This research was a methodological study processed as follows: 1) The preliminary 32 items were developed based a conceptual framework of suffering for patients with cancer. 2) The content was validated by an expert panel (n=24) and the family of patients with terminal cancers (n=33). 3) The instrument was validated by survey (n=92). Finally, 29 items were selected in developing final version of the scale. Results: Seven factors were extracted through factor analysis: ‘economical distress’, ‘loss of meaning in life’, ‘feeling of social isolation’, ‘emotional distress’, ‘burnout’, ‘guilty feeling’, and ‘physical discomfort’. These factors explained 66.94% of the total variance. Cronbach’s alpha and Guttman Split-half coefficient of the 29 items were .93 and .92. respectively. Conclusion: This scale identified as a valid and reliable tool with a high degree of reliability and validity. It can be effectively utilized to assess the degree of suffering of family in palliative care settings.

Purpose: To evaluate the effects of a logotherapy education program. Methods: A nonequivalent control group, non-synchronized design was conducted with a convenience sample of 29 children with cancer. The experimental group (n= 17) participated in the logotherapy education program which consisted of 5 daily sessions for one week. The control group (n= 12) received the usual nursing care. The effects were measured using suffering, adolescent meaning in life (AMIL), and spiritual well-being (SWBS) scales. Results: There were significant differences in suffering (W=153.00, p＜.05) and meaning in life (W=78.00, p＜.05) between the experimental and control groups. However, there was no significant difference in spiritual well-being (W=136.50, p＞.05). Conclusions: Logotherapy was effective in reducing suffering and improving the meaning in life. Logotherapy can be utilized for adolescents with terminal cancer to prevent existential distress and improve their quality of life.