Factors Associated with Quality of Dying and Death in Korean Intensive Care Units: Perceptions of Nurses
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Setting
2.3. Participants
2.4. Ethical Considerations
2.5. Data Collection
2.6. Instruments
2.6.1. The QODD Korean Language Version 3.2
2.6.2. Person-Centered Critical Care Nursing (PCCN)
2.7. Data Analysis
3. Results
3.1. QODD, PCCN, and Overall Quality of Death as Perceived by Nurses
3.2. QODD and PCCN Based on the Treatment Received during the Patient’s Hours of Death
3.3. QODD and PCCN Scores According to the General Characteristics of Nurses
3.4. The Correlations among QODD, PCCN, and Overall Quality of Death
3.5. Factors Associated with QODD
4. Discussion
4.1. QOOD and PCCN Score of ICU Nurses
4.2. QODD and PCCN According to the Patient’s Treatment at the End of Life
4.3. Improving PCCN Could Increase QOOD
4.4. Consultation with Patients on the End-of-Life Treatment Issue Could Increase QOOD
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Mean ± SD | Possible Score Range | |
---|---|---|
Total Quality of Dying and Death score | 39.12 ± 91.40 | 0–100 |
Patient’s experiences at the end of life | ||
Having pain under control | 5.23 ± 2.88 | 0–10 |
Having control over what is going on around oneself | 3.51 ± 5.98 | 0–10 |
Being able to feed oneself | 2.30 ± 3.16 | 0–10 |
Being able to breathe comfortably | 3.72 ± 7.39 | 0–10 |
Feeling at peace with dying | 3.58 ± 5.32 | 0–10 |
Feeling unafraid of dying | 4.05 ± 0.23 | 0–10 |
Being able to laugh and smile | 2.81 ± 8.14 | 0–10 |
Keeping one’s dignity and self-respect | 3.19 ± 1.39 | 0–10 |
Spending time with family, friends | 4.43 ± 4.51 | 0–10 |
Spending time alone | 3.31 ± 3.00 | 0–10 |
Being touched or hugged by loved ones | 5.58 ± 5.13 | 0–10 |
Saying goodbye to loved ones | 4.02 ± 0.59 | 0–10 |
Clearing up bad feelings | 3.22 ± 2.02 | 0–10 |
Visits from a religious advisor | 5.17 ± 1.07 | 0–10 |
Spiritual service before death | 4.86 ± 8.19 | 0–10 |
Medical care at the end of life | ||
Experience in receiving mechanical ventilation | 3.35 ± 3.51 | 0–10 |
Experience of receiving dialysis | 3.11 ± 1.45 | 0–10 |
Discussion with doctors about wishes | 3.34 ± 3.00 | 0–10 |
Experience at the moment of death | ||
Anyone present at the moment of death | 5.58 ± 5.01 | 0–10 |
State at the moment of death | 3.88 ± 8.89 | 0–10 |
PCCN | 53.27 ± 0.83 | 15–75 |
Compassion | 13.35 ± 0.84 | 4–20 |
Individuality | 13.86 ± 0.20 | 4–20 |
Respect | 14.68 ± 0.72 | 4–20 |
Comfort | 11.38 ± 0.15 | 3–15 |
Overall quality of death | 6.13 ± 1.44 | 0–10 |
QODD | PCCN | |||||
---|---|---|---|---|---|---|
N (%) | Mean ± SD | t or F (p) | Mean ± SD | t or F (p) | ||
Received CPR within 48 h of death | Yes | 139 (46.3) | 34.83 ± 0.83 | −3.282 (0.001) | 53.46 ± 0.90 | 0.398 (0.691) |
No | 161 (53.7) | 42.82 ± 1.25 | 53.10 ± 0.79 | |||
Received sedative treatment while staying in ICU | Yes | 247 (82.3) | 40.51 ± 0.92 | 2.511 (0.013) | 53.68 ± 0.85 | 2.115 (0.035) |
No | 41 (13.7) | 31.64 ± 0.98 | 50.88 ± 0.86 | |||
Suspension of life-sustaining treatments | Yes | 125 (47.2) | 40.32 ± 0.32 | 1.631 (0.104) | 52.68 ± 0.12 | 0.039 (0.969) |
No | 140 (52.8) | 36.16 ± 1.06 | 52.64 ± 0.29 | |||
Patient consulted with doctor regarding the treatment at the end of life | Yes | 97 (32.3) | 46.83 ± 0.26 a | 10.111 (<0.001) a > b * a > c * | 55.21 ± 0.78 a | 5.250 (0.006) a > b * |
No | 179 (59.7) | 35.81 ± 1.54 b | 52.10 ± 0.54 b | |||
Not sure | 24 (8.0) | 32.60 ± 6.29 c | 54.13 ± 0.81 c | |||
The reason for not suspending the life-sustaining treatments | Ethically impossible | 13 (9.3) | 26.61 ± 9.81 | 1.318 (0.267) | 49.15 ± 0.30 | 0.854 (0.493) |
Insufficient legal grounds | 37 (26.4) | 38.28 ± 3.07 | 53.65 ± 0.27 | |||
Refused by the family doctor | 10 (7.1) | 39.35 ± 3.61 | 53.70 ± 0.45 | |||
Refused by the family | 77 (55.0) | 34.99 ± 9.53 | 52.49 ± 0.89 | |||
Others | 3 (2.1) | 57.65 ± 6.84 | 55.67 ± 1.93 |
QODD | PCCN | |||||
---|---|---|---|---|---|---|
N (%) | Mean ± SD | t (p) | Mean ± SD | t (p) | ||
Gender | Male | 27 (9.0) | 41.45 ± 0.65 | 0.593 (0.554) | 54.74 ± 0.13 | 1.026 (0.306) |
Female | 273 (91.0) | 38.88 ± 1.49 | 53.12 ± 0.80 | |||
Duration of service in ICU | 6 months—less than 1 year | 13 (4.3) | 46.35 ± 8.06 | 0.892 (0.411) | 51.46 ± 0.99 | 0.468 (0.627) |
1 year—less than 3 years | 90 (30.0) | 39.69 ± 0.13 | 53.67 ± 0.63 | |||
3 years or more | 197 (65.7) | 38.37 ± 2.14 | 53.20 ± 0.04 | |||
Religion | Catholic | 47 (15.7) | 37.97 ± 9.97 | 1.047 (0.372) | 54.91 ± 0.60 | 1.573 (0.196) |
Christian | 82 (27.3) | 42.24 ± 3.34 | 53.85 ± 0.32 | |||
Buddhist | 11 (3.7) | 43.28 ± 9.82 | 54.36 ± 0.20 | |||
None | 160 (53.3) | 37.56 ± 0.84 | 52.41 ± 0.68 | |||
Education level | Bachelor’s | 251 (83.7) | 39.14 ± 1.35 | 0.365 (0.695) | 53.08 ± 0.80 | 0.731 (0.482) |
Master’s | 46 (15.3) | 38.31 ± 2.33 | 53.98 ± 0.14 | |||
Doctorate | 3 (1.0) | 49.20 ± 0.20 | 57.67 ± 0.73 | |||
Received specialized training for caring for the terminally ill after graduation | None | 164 (54.7) | 37.60 ± 1.55 | 1.302 (0.274) | 52.19 ± 0.61 | 1.417 (0.238) |
One-time training | 36 (12.0) | 38.52 ± 2.75 | 54.11 ± 0.04 | |||
Less than 6 h of training | 64 (21.3) | 45.25 ± 0.85 | 55.11 ± 0.61 | |||
More than 6 h of training (n = 36, 12.0%) | 36 (12.0) | 39.90 ± 0.35 | 51.95 ± 0.47 |
Variables | QODD | PCCN | Overall Quality of Death and Dying |
---|---|---|---|
r (p) | |||
QODD | 1 | 0.296 (<0.001) | 0.306 (<0.001) |
PCCN | 0.296 (<0.001) | 1 | 0.131 (0.023) |
Overall quality of death and dying | 0.306 (<0.001) | 0.131 (0.023) | 1 |
Variables | B | S.E | β | t | p | Adj R2 | F (p) |
---|---|---|---|---|---|---|---|
Constant | 12.036 | 10.828 | 1.112 | 0.267 | 0.16 | 9.345 (<0.001) | |
Age (years) | −0.273 | 0.215 | −0.068 | −1.265 | 0.207 | ||
Received sedative treatment (No) | −5.447 | 3.361 | −0.088 | −1.621 | 0.106 | ||
Received sedative treatment (Not sure) | −4.281 | 5.800 | −0.039 | −0.738 | 0.461 | ||
Patient consulted with a doctor regarding the treatment at the end of life (No) | −8.020 | 2.541 | −0.184 | −3.156 | 0.002 | ||
Patient consulted with a doctor regarding the treatment at the end of life (Not sure) | −12.805 | 4.480 | −0.163 | −2.859 | 0.005 | ||
Received CPR within 48 h of death (No) | 8.212 | 2.293 | 0.192 | 3.581 | <0.001 | ||
PCCN | 0.714 | 0.148 | 0.261 | 4.829 | <0.001 |
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Lee, H.; Choi, S.-H. Factors Associated with Quality of Dying and Death in Korean Intensive Care Units: Perceptions of Nurses. Healthcare 2021, 9, 40. https://doi.org/10.3390/healthcare9010040
Lee H, Choi S-H. Factors Associated with Quality of Dying and Death in Korean Intensive Care Units: Perceptions of Nurses. Healthcare. 2021; 9(1):40. https://doi.org/10.3390/healthcare9010040
Chicago/Turabian StyleLee, Haeyoung, and Seung-Hye Choi. 2021. "Factors Associated with Quality of Dying and Death in Korean Intensive Care Units: Perceptions of Nurses" Healthcare 9, no. 1: 40. https://doi.org/10.3390/healthcare9010040