14 research outputs found
Pre-service Chemistry Teachers' Awareness of Middle School Students' Misconceptions and Their Perceived Educational Needs
íìë
Œë¬ž (ìì¬)-- ììžëíêµ ëíì : 곌íêµì¡ê³Œ(ííì ê³µ), 2012. 8. ë
žíí¬.ìŽ ì°êµ¬ììë 5ê° ì¬ë²ëíì ííêµì¡ê³Œ 4íë
87ëª
ì ëììŒë¡ ì€íìë€ì ì€ê°ë
ì ëí ì§ì곌 ìžì, ê·žëŠ¬ê³ êµì¡ì구륌 ì¡°ì¬íìë€. ê²ì¬ ë구ë íìë€ì íí ì€ê°ë
ì ëí ì§ì ê²ì¬ì§ ë° ìžì ê²ì¬ì§ì íìë€ì ì€ê°ë
ì ì í 겜í곌 êŽë š êµì¡ì구ì ëí êµì¡ì구 ê²ì¬ì§ë¡ 구ì±ëìŽ ìë€. ì§ì ê²ì¬ìì ëë¶ë¶ì ìë¹ ííêµì¬ë€ì 묌ì§ì ì
ìì±ê³Œ êŽë šë íìë€ì ì€ê°ë
ì íì 충ë¶í ìžì§íì§ ëª»íìë€. ìžì ê²ì¬ììë íì ì€ê°ë
ì ëí ì§ìì íìì±ì ëìŽ ìžìíê³ ìŽë¥Œ ìì
ìì íì©íë €ë ìì§ê° 컞ë€. ê·žë¬ë 구ì±ì£Œìì êŽì ìì ì€ê°ë
íì© ë°©ìì ì ìí ìë¹ ííêµì¬ë€ì ì ìë€. íìë€ì ì€ê°ë
ì ì£Œë¡ ì¬ë²ëí íí êµê³Œêµì¡í ê°ì ë° ê°ì ìë£ë¥Œ íµíŽì ì íìŒë©°, 곌ì ìíìŽë ìì
ìì° ë° êµì¡ì€ìµìì íìë€ì ì€ê°ë
ì í곌 ëì² ë°©ìì ëí ì§ì ë° êŽë š êµì-íìµ ìë£ ë±ì ë¶ì¡±ìŒë¡ ìžíŽ ìŽë €ìì ê²ªê³ ììë€. ëí, ì€ê°ë
êŽë š ê°ì ë° ì€íì ëí êµì¡ìêµ¬ê° ëìë€. ìŽì ëí êµì¡ì íšì륌 ë
Œìíìë€.In this study, we investigated pre-service chemistry teachers' awareness and perceptions of middle school students' misconceptions and their perceived educational needs. A survey was administered to 87 seniors at the department of chemistry education of five colleges of education. The instrument was consisted of a test for their awareness and perceptions of students' misconceptions on chemistry topics and an educational need test for their experiences and needs for learning them. Analyses of the results revealed that most pre-service teachers were not thoroughly aware of students' misconceptions related to the particulate nature of matter. The perceptions of a necessity of knowing misconceptions and a willingness to deal with them were positive. However there were few pre-service teachers addressing them according to the constructivism. The pre-service teachers encountered misconceptions through chemical education courses, and had difficulties in practicing teaching strategies addressing misconceptions because of limited examples of misconceptions and insufficiencies of methods/materials in teaching. They also needed lectures and practices related to students' misconceptions. Educational implications of these findings are discussed.목 ì°š
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1.1 ì°êµ¬ì íìì± 1
1.2 ì°êµ¬ì ëŽì© ë° ì°êµ¬ 묞ì 3
1.3 ì°êµ¬ì ì íì 3
1.4 ì©ìŽì ì ì 4
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2.1.2 ì€ê°ë
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2.1.3 íì ì€ê°ë
ì í¹ì§ 8
2.2 ê°ë
ë³í륌 ìí ìì
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2.2.1 ê°ë
ë³íì 조걎 9
2.2.2 ê°ë
ë³í륌 ìí ìì
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2.3 ì€ê°ë
êŽë š ì íì°êµ¬ 14
2.3.1 íì ì€ê°ë
ì êŽí ì°êµ¬ 14
2.3.2 ìë¹ êµì¬ ë° íì§ êµì¬ì íì ì€ê°ë
ìŽíŽì êŽí ì°êµ¬ 22
2.3.3 ì€ê°ë
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3.1 ì°êµ¬ ëì ë° ì ì°š 29
3.2 ê²ì¬ ë구 29
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4.1.2 Ʞ첎ì ìšëì ë¶íŒ êŽê³ 36
4.2 ìë¹ ííêµì¬ì íì ì€ê°ë
ì ëí ìžì 38
4.3 ìë¹ ííêµì¬ë€ì íì ì€ê°ë
ì ëí êµì¡ì구 41
4.3.1 íì ì€ê°ë
ì ëí 겜í 41
4.3.2 íì ì€ê°ë
êŽë š êµì¡ì구 42
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Abstract 62Maste
Experimental of patients in the cardiovascular intensive care unit
ê°íží곌/ìì¬[íêž]
ì€íìì€ì 1943ë
ìœííê²ìì Barbiturate ì€ë
íì ì²ì¹ë¥Œ ìíŽ ì²ììŒë¡ ììë ìŽë, ì§ì€ êŽì°°, ì§ì€ ì¹ë£ê° ë³í©ë í¹ì ì¹ë£ë¥Œ íë ê³³ìŒë¡ íììê² ê³ ëì ì§ì ê°ížë¥Œ ì ê³µíê² ëë€. ìŽ ê³³ì ì§ë³ì ì¬ê°ì±ìŽë í¹ì ì²ì¹ ë± ì§ì€ ê°ížë ì¹ë£ê° íìë¡ ëë íì륌 ìì©íë ê³³ìŒë¡, íìì í¹ì±ì ì¬ë§ë¥ ë ëìì§ê³ ê°ížì ì¹ë£ì ì§ì ëìŽêž° ìíŽ ê¹šëìŽ ìë
ì í íì ë³ë±ìŒë¡ 볎ížì륌 íµì íê² ëë¯ë¡ íìë€ì ììžê°ì ëëŒê±°ë, ìì ì ì§ë³ì ì¬ê°ì±, ìíì ëí ëë €ì ë± ì¬ë¬ ê°ì§ ë¶ì ì 겜íì íê² ëë€. ìŽë° ì 첎ì , ì ìì 겜íì íìì ìíì ìí¥ì 믞ì¹ê² ëë¯ë¡ ìŽë¥Œ ìžìíì¬ íšê³Œì ìŒë¡ ê°ììíš ì ììŽìŒ íë€. í¹í ì€íìì€ììë ì§ë³ì ì¬ê°ì±ìŒë¡ ìžíŽ ì ì , ì¬ëŠ¬ì , 묞íì , ìì ìž¡ë©Žì ê°ížë¥Œ ìíí íê² ëë€. ë°ëŒì 볞 ì°êµ¬ë ìŽë¥Œ 볎ê°íêž° ìíŽ ì€íìì€ì ì
ìí íìë€ìŽ ìŽë€ 겜íì íëì§ ì¬ìžµì ìŒë¡ ìì볎Ʞ ìí
ì¬ë¡ ì°êµ¬ìŽë€.
ìë£ë 1993ë
3ìë¶í° 4ìê¹ì§ 2ë¬ì ê±žì³ ìì§íìë€. ì°êµ¬ ëììë Y ëí ë¶ì S ë³ìì ì¬íêŽê³ ì€íìì€ì ì
ì í 겜íìŽ ìë 14ëª
ìŽìë€. ìë£ë 볞 ì°êµ¬ìê° ì§ì ì¬ìžµ ë©ŽëŽê³Œ êŽì°°ì ìíŽ ìì§íìê³ , ê·ž ìž íìì ìŒë°ì ìž í¹ì±ê³Œ ì§ë³ ìíì êŽí ì 볎ë íìì ì묎 êž°ë¡ê³Œ ìê°ížì¬ì ëŽë¹ ê°ížì¬ë¡ ë¶í° ì ê³µë°ìë€. ìë£ì ëëœì ë§êž° ìíŽ ëììì ëìíì ë
¹ìì íìê³ , ë¶í¬ëª
í ë¶ë¶ì íìžíê³ ì¶ê°ëë ë¶ë¶ì ì€ëª
ì ìíŽ íìì 2ì°š ë©ŽëŽì íìë€.
ìë£ì ë¶ìì Taylorì Bogdan(1984)곌 ê¹ ê²œë곌 ìŽ ìšìŠ(1986)ì ëŽì©ë¶ì ë°©ë²(Content Analysis)ì êž°ìŽë¡ íìë€.
ìë£ì ë¶ìì ìë£ ìì§ê³Œ íšê» ìííìë€. ë¶ì 곌ì ì ì°êµ¬ìê° ì§ì ëììì ë©ŽëŽ í, êŽì°° ëŽì©ê³Œ ë
¹ìë ë©ŽëŽ ëŽì©ì êž°ë¡íê³ ìì ë ì 첎 ìë£ë¥Œ ìœìŒë©Žì ëë¬ëë 죌ì (Emerging Theme)ì êž°ë¡íìë€.
ìë£ ë¶ì 결곌ë ì€íìì€ ëŽ ì
ì 겜곌ì ë°ëŒ ëì°© ë¹ì, ìì êž°, íŽì ìêž°ë¡ ëë ì ììë€. ëì°© ë¹ììë ì€íìì€ìŽëŒë ê² ì첎ì ì§ë³ ìíì ëí ëë €ì, ìŽì ìë€ë ìëê°, ìì ì íìŒë¡ í ì ìë ê² ìê³ , ìì íì ìí©ìŽ ìê°íë ê²ë³Žë€ íšì¬ ë ëìšì ë¬Žë ¥ê°, 볎ížìë ììŽ íŒì ëšìŽì ž ìììŒë¡ ìží ê³ ëŠœê°, ë§ì·šìì 깚ìŽëë©Žì ìê°, ì¥ì륌 구ë³íì§ ëª»íë ì§ëšë ¥ ìì€ì 겜ííë ê²ìŒë¡ ëíë¬ë€. ìì êž°ì ë€ìŽìë©Ž íì ë³ì€ìì íŒì ì§ëŽë ê²ìŒë¡ ìží ì§ë£šíš, ëµëµíš, ê°í ëë ë±ìŒë¡ ê³ ëŠœê°ìŽ ëì± ì¬íŽì§ê³ , ì¡°ëª
, ìì, êž°ê²° ì¡°ììŽë 칚ë ìŽëì ë¶ëªì¹ë ì늬 ë± ìê°, ì²ê° ìê·¹ìŒë¡ ìží ìë©Ž ì¥ì, ë¶ìŸê°ì 겜ííë€. ìŽ ìêž°ìë ìŽë ì ë ì ììŽ ëë©Žì ìêµ¬ê° ë§ìì§ê³ , ê°ížì¬ì ëí êž°ëë ë§ìì§ê² ëë€. ë°ëŒì ê·žë° ê²ë€ì 충족 ì¬ë¶ì ë°ëŒ ì¹ì íš, ì 뢰ê°, ììíš, ììíšì 겜íí ê²ìŒë¡ ëíë¬ë€. ìŒë° ë³ì€ë¡ ì¬ëŒê°ë ì€íìì€ììì íŽë êž°ê° ëë©Ž ë³ì€ë¡ ê°ì 볎ížìì íšê» ìì ì ìë€ë êž°ëê°, 몞ì ìì§ììŽ ìì ë¡ìì§ê³ , ë€ë¥ž ì¬ë곌ë ìŽìŒêž°ë í ì ìë€ë ê²ìŒë¡ íŽë°©ê°ì 겜ííê³ ììë€. ë ê°ížì¬ë€íê³ ë ë¯ìŽ ìµìŽ ì¹ë°ê°ìŽ ìꞎë€ê³ íë€. í¹êž°í ë§í ê²ì ëììë€ìŽ ëì°© ë¹ìì ìì ì ì§ë³ìŽë ìì ë±ìŒë¡ ìžíŽ ì¬í íµìŠì 겜ííììë ë¶êµ¬íê³ , ë©ŽëŽì ì 첎ì ê³ íµì êŽí ìŽêž°ë³Žë€ë ì ìì , ì¬ëŠ¬ì ìž ê²œíë§ì ì€ì ì ìŒë¡ ë§íë ê²ìŽìë€. ìŽë íìì ì ìì , ì¬ëŠ¬ì 겜íìŽ ì 첎ì 겜íì ë¹íŽ íšì¬ ë í° ìí¥ì 죌ììì ìì¬íê³ ìë€ê³ íŽìí ì ìê² ë€.
ìŽì곌 ê°ì íìë€ì 겜íì ë°íìŒë¡ ëì°© ë¹ìë íìê° ìë ê³³ìŽ ìŽëì§, ì²íŽìë ìí©ìŽ ìŽë€ì§ë¥Œ ì€ëª
íŽì£ŒìŽ ëë €ììŽë ê³ ëŠœê°, ìê°. ì¥ìì íŒëì 겜ííì§ ìëë¡ íŽì£Œê³ , ìì êž°ì ë€ìŽìë©Ž, ìê°ì ì§ë£šíšìŽë ê°í ëë ë±ì ê³ ëŠœê°ìŽ ì¬íŽì§ë¯ë¡
ê°ë¥í íììê²ë ìì
ì ë£ê±°ë T.V. ë±, ì¬ê° íëì ê²ì ì ê³µíŽìŒê² ë€. ë ìê°, ì²ê°, ìŽê° ìê·¹ìŒë¡ ìží ìë©Ž ì¥ì ë ë¶ìŸê°ì 겜ííì§ ìë륵 ì¡°ëª
ì ì¡°ì íê³ , êž°ê³ì ë±ì ììì ì€ì¬ì£Œê³ , êž°ì¬ ì¡°ììŽë íì ìŽëì ì¢ ë 죌ì륌 êž°ìžì¬ ë¶ëªíë
ìëŠ¬ê° ëì§ ìë륵 íŽìŒ í ê²ìŽë€. 충ë¶ì¹ 못í ì€ëª
ìŽë, ê°ìì ìŽê³ ììì ìž ë§í¬ìì ììíš, ììíš ë±ì 겜ííë¯ë¡ íìê° ììë£ê² ììží, ë¶ëëœê² ì€ëª
ì íŽìŒê² ë€. íŽììêž°ê° ëë©Ž íìë€ì êž°ëê°, íŽë°©ê°ì ëëŒê³ ììŒë¯ë¡ ë³ì€ì ê°ì í ì ìë
ìŽë, ì§ìŒìŒí ì¬í ë±ì ëíŽ ì€ëª
ì íŽì£Œë ê²ìŽ 곌ì ìŒ ê²ìŒë¡ ì¬ë£ëë€.
ìŽìì ì°êµ¬ 결곌륌 í ëë¡ ì€íìì€ì ì
ìí íìë€ì 겜íì ëíŽ ê¹ìŽ ìê² ìŽíŽíšìŒë¡ìš íšê³Œì ìŒë¡ ì€ì¬í ì ìë ë°©ìì ë§ë š, ì 첎ì , ì ìì , ì¬ëŠ¬ì , ìì , 묞íì ê°ížë¥Œ ìí êž°ìŽê° ëëŠ¬ëŒ êž°ëíë€.
[ì묞]
The Intensive Care Unit was first established for the treatment of barbiturate addiction in Copenhagen in 1943. An intensive care unit groups critically ill patients under the care of specially trained staff members who ideally have both the eì¬cation and personality to give attent ion to minute physio1og1ic variations.
Because of the high mortality rate and isolation from significant others, many patients have negative experiences 1ike fear, isolation and powerlessness. Especially, in the intensive care unit, because of the seriousness of the patients's illness, psychologic, emotional, cultural and spiritual nursing care may
not receive appropriate attention. So this case study was done to clarify the experiences of the patients in the cardiovascular intensive care unit.
The data were collooted by the researcher during the period from March 1, 1993 to April 30, 1993. The subjects were 14 patients in the cardiovascular intensive care unit. The data were collected through in-depth interviews, as well as observations
and examination of the medical records.
According to the stave, that is admission, stability, discharge, different types of experienced can be identified. The findings are as follows.
1. Upon arrival, most patients experience fear about the prognosis of their illness. relief that they are being treated but, powerlessness, isolation and disorientation.
2. During the stable stave, they experience isolation, sleep disturbance due to tactile, visual and auditory stimuli with adaptation to the situation interaction and requests to the nurses increase, the types of response given leads to increased
feeling of unpleasantness and discontentment.
3. At the discharge stage, expectation of recovery from the illness, freedom and friendliness with nurse were the emerging theme.
From the results of this study the following recommendations can be made. Isolation and disorientation can be reduced by diversional activity. Reducing sensory stimulations such as bright lights, noise and procedures which cause disturbance of sleeping and unpleasantness will decrease these negative aspects of admission to the I. C. U. .Instead of oppressive and unilated communication, explanations in detail can he done, so the patients do not experience discontentment. During the discharge stave, teaching rehabi1itation exercise and follow up care regimen should be included in the nursing care.
This study provides a better understanding of the experiences of patients in the cardiovascular intensive case unit and may faci1itate more appropriate physica, emotional, psychological, spiritual and cultural intervention strategies to minimize the negative experiences.restrictio
(The) experience of family members on deciding to withdraw life-sustaining treatment for patients who are terminally ill
ê°íží곌/ë°ì¬[íêž]
볞 ì°êµ¬ë ë§êž°íìì ì°ëª
ì¹ë£ ì€ëšì ëí ê°ì¡±ì 겜íì ë°íêž° ìí íìì ì°êµ¬ë¡ ì€ìëìë€. 볞 ì°êµ¬ì ëììë ìì ìì¬ 1ê° ëíë³ìì ì
ìì¹ë£ë¥Œ ë°ê³ ììŒë©° 죌ì¹ìê° íìì ì¹ë£ê° ë ìŽì ìë¯žê° ìë€ê³ íëšíì¬ ì°ëª
ì¹ë£ ì€ëšì ê²°ì í íìì ê°ì¡±(죌ê°ížì ê³µì)ìŽë€. ìë£ìì§ì 2002ë
8ìë¶í° 2003ë
5ìê¹ì§ ì¬ìžµë©Žì ë°©ë²ìŒë¡ íìê³ ëŽì©ë¶ìë²ìŒë¡ ë¶ìí 결곌 6ê°ì 죌ì ì 39ê°ì 겜íëŽì©ìŽ ëì¶ëìë€.
볞 ì°êµ¬ì 결곌ë ë€ì곌 ê°ë€.
1. ì°ëª
ì¹ë£ ì€ëš ê²°ì ì ë§êž°íì ê°ì¡±ì 겜íì ì°ëª
ì¹ë£ ì€ëš ê²°ì ìêž°ì ì°ëª
ì¹ë£ ì€ëš ê²°ì íë¡ ë²ì£Œí ëìë€.
2. ì°ëª
ì¹ë£ ì€ëš ê²°ì ìêž°ì 겜íììë ì°ëª
ì¹ë£ ì€ëš ê²°ì ììž, ê²°ì 곌ì , ê²°ì ì°žì¬ìê° ì£Œì ë¡ ëì¶ëìê³ , ì°ëª
ì¹ë£ ì€ëš ê²°ì íì 겜íììë ì¹ë£ì ëŽì©, 죜ììì©, ììž¡ë ìì€ë°ìì 죌ì ê° ëíë¬ë€.
3. ì°ëª
ì¹ë£ ì€ëš ê²°ì ììžì íë³µ ê°ë¥ì±, ê³ ë ¹, ê³ íµê²œê°, ì 첎 ìì, ìììì€, ë¶ëŽê°, 죌ë³ì견, ê°ì¡±ì 곌거 겜í, íì 볞ìžì íì í¬ììŽìë€.
4. ì°ëª
ì¹ë£ ì€ëš ê²°ì 곌ì ì, 몚ë ìì¬ê° 뚌ì ê¶ì íê³ ìŽë¥Œ ê°ì¡±ìŽ í©ìíì¬ ìì©íìë€.
5. ì°ëª
ì¹ë£ ì€ëšê²°ì ì°žì¬ìë ìì¬ì ê°ì¡±, ì¹ì§ë€ë¡ ëíë¬ê³ , ê°ì¡±í©ì 곌ì ìì íìë ì ìžëìë€. ê°ížì¬ë ì°žì¬íì§ ìì ê²ìŒë¡ ëíë¬ë€.
6. ì¹ë£ì ëŽì©ììë ì¹ë£ì€ëš ì첎ì ëí ê°ë±, ê³ íµê²œê°ê³Œ ìëª
ëšì¶ ì¬ìŽììì ê°ë±, ê³ìëë ì°ëª
ì¹ë£ì ëí ë¶ë
ž, ë³ìììì Ʞ볞ê°ížì ëíŽìë ë¶ë
ž, ê³ìëë ì¹ë£ë¥Œ ê±°ë¶íì§ ëª»íšìŽë 겜íëŽì©ìŽ ëíë¬ë€.
7. ì¹ë£ì€ëš ì í ì²ì¹ ë³íë ììê³ , ì¹ë£ê²°ì ì ìì¬ ìžì ë€ë¥ž ìë£ì§ì ì°žì¬ë íì, ê°ì¡±ì ì견ì ë°ìëì§ ìë ê²ìŒë¡ ëíë¬ë€.
8. 죜ììì©ììë 죜ìì ë°ìë€ìŽêž°ê¹ì§ì ì€ë¹êž°ê° íì, íì ìì ìŽ ì£œìì ìë°íìì ìê³ ìë€ê³ ìê°, íì ìì ìŽ ì¶ì ë§ë¬ŽëŠ¬ë¥Œ ì íêž° ë°ë, íììê² ìì¢
ì€ë¹ë¥Œ ìí€ì§ 못íšì ëí ì£ì±
ê°, ê³ íµììŽ ê°êž°ë¥Œ ë°ë, 깚ëíê² ê°êž°ë¥Œ ë°ë, 몚ë ê²ì ë€ ìì§íš, ìì¢
ì ìíŽ ê°ì¡±ìŽ 몚ë 몚ì, ë³ìí겜 ë° ë©Žíì ëì ëí ë°ë, ì¥ë¡ì€ë¹, ìµì ì ë€ íë€ë ìêž°ìì, ìì¢
ì ìí ìë£ì§ì ì§ì§ íìì 겜íëŽì©ìŽ ëíë¬ë€.
9. ììž¡ë ìì€ë°ìììë ììëë ìŽë³ë¡ ìží ìŽì¡°íš, ììì ììžìŽë€ë íí, íìì ì¹ë£ ë¶ìŽí íë륌 ìë§, íìì ëí ì°ë¯Œ, ìì ì ì²ì§ íí, ì§ëìš ìíì íê³ íšì 죌ì ê° ëíë¬ë€.
ê²°ë¡ ì ìŒë¡ ë§êž°íìì ê°ì¡±ì íë³µê°ë¥ì±ìŽ ììì 죌ë ìŽì ë¡ ì°ëª
ì¹ë£ ì€ëšì ê²°ì íê³ , ìì¬ê° ê¶ì í ê²ì ê°ì¡±ìŽ ìì©íë ííìŽë íìë ë°°ì í ì± ê°ì¡±ìŽ ê²°ì íìë€. ì°ëª
ì¹ë£ ì€ëš ê²°ì ì í ì¹ë£ëŽì©ì ë³íë ììê³ ê°ì¡±ë€ì ì¹ë£ì ì§íìí©ì ìì§ ëª»í ì± ëªšë ìì¬ê²°ì ì ìë£ì§ìê² ë§¡êž°ê³ ììë€. ì°ëª
ì¹ë£ë¥Œ 묎ì믞íë€ê³ ìê°íë ìŽë¥Œ ê±°ë¶íì§ ëª»íŽ ë¶ë
žíê³ ê°ë±íê³ ìììŒë©° ì¬ì§ìŽë Ʞ볞 ê°ížë 묎ì믞í ì¹ë£ë¡ ìê°íê³ ììë€.
ê°ì¡±ë€ì íìì 죜ìì ìì©íê³ ë íì ìì ë 죜ììŽ ìë°íìì ìê³ ìë€ê³ ìê°íë©Žìë íìì íšê» 죜ìì ì€ë¹íì§ë 못íìë€. ê·žë¡ ìžíŽ ì£ì±
ê°ì ëëŒë©Žìë 죜ìŽê°ë€ë ë§ì íì§ ëª»íê³ , íì ì€ì€ë¡ 죜ìì ì€ë¹íê³ ì¡Žìì ì§í€ê³ 죜ìŽê°êž°ë¥Œ ë°ëŒê³ ììë€. ìŽë¬í ìŒë šì 곌ì ìì ê°ì¡±ë€ì ìë£ì§ì ì§ì§ì íìì ê°ì¡±ìŽ íšê» ìì ì ìë ìì¢
ì€ê³Œ ë©Žíì ë륌 ìíìë€. íìì 죜ìì ìì©í í ê°ì¡±ë€ì ìŽì¡°íš, íí, ìë§, ì£ì±
ê°, ìêž°ì°ë¯Œ, íí, íê³ ë±ì ììž¡ë ìì€ë°ìì 겜ííìë€.
ë°ëŒì ê°ížì¬ë ì°ëª
ì¹ë£ ì€ëš ê²°ì ììž, ê²°ì 곌ì , ê²°ì ì°žì¬ì, ì¹ë£ì ëŽì©ì ëíì¬ ì ìê³ ìë£íê°ì, íì ë° ê°ì¡±ê°ì ìì¬ìíµì ì£Œì²Žê° ëìŽìŒ íë€. ìŽë¥Œ ìíŽ ê°ížì¬ë€ì ê³ íµìí, ê³ ë ¹, ì 첎ììì ê·Œê±°ë¡ ì°ëª
ì¹ë£ ì€ëšì ì¡°ì¥, ë°©ì¡°íë ìŒìŽ ë°ìíì§ ìëë¡ ê°ìíë, íìê° ì¡Žìì ì§í€ê³ ì¶ì ëí ì 늬륌 íê³ ì£œìŽê° ì ìëë¡ íë ì¹ížìì ìí ì íì¬ìŒ íë€. ê°ížì¬ë ì°ëª
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ì¹ë£ ì€ëš, ë§êž°íì, ê°ì¡±ì 겜í
[ì묞]
This study was designed to identify experiences of family members regarding withdrawing life-sustaining treatment when patients are terminally ill. The exploratory method was employed for the study. The participants were family members of patients, who decided to withdraw life-sustaining treatment. The patients had been admitted to a university hospital located in Suwon and the physician had determined that further treatment was no longer meaningful. Data were collected through in-depth interviews, conducted from August 2002 to May 2003 and analyzed using content analysis. The analysis revealed 6 themes and 39 experiences.
The results of the study are as follows:
1. The experiences of family members regarding withdrawal of life-sustaining treatment were categorized in two phases. One was during the decision- making process and the other was after treatment had been withdrawn.
2. From the experiences during the decision-making process, the themes, reason for decision, process of decision and participation in the decision were derived, and after treatment was withdrawn, the themes were type of treatment, acceptance of death and reaction to anticipated loss.
3. The main factors for making a decision to withdraw treatment were related to the possibility of recovery, advanced age, alleviation of pain, wasting of the body, consciousness, burden, recommendation, past experience of family members, and desire of patients.
4. The decision-making process was initially recommended by physicians followed by agreement and acceptance of family members.
5. The participants in the decision-making process were found to be physicians, family members and relatives. Patients were excluded and nurses did not participate.
6. For treatment, themes included conflict about the withdrawal itself, conflict between alleviation of pain and shortening of life, anger against continuous life-sustaining treatment, anger against standard care in the hospital, being unable to refuse continuous treatment.
7. It was found that after treatment was withdrawn, there were no changes in treatment, no participation of other medical staff and no reflection on opinions of family members in decisions concerning treatment.
8. In acceptance of death, the following were found: need for time to admit to possibility of death, thinking that the patients themselves were aware of being close to death, hoping that the patients themselves were prepared for their rest of lives, regret for not giving the patients a chance to prepare themselves for death, desire for patient to die with no pain, desire for patient to die with dignity, thinking that all treatment had been tried, all family members being present at death, asking for better hospital environment and visiting systems, preparing for the funeral, self-consolation at having done the best, requirement of physicians'' assistance at death.
9. In reaction to anticipated loss, the following were found: impatience in the anticipated loss, grief for letting their children pass away in advance, regret for stopping medical treatment, compassion for the patient, regret for their position, and looking back over their past.
In conclusion, the pattern in decisions to withdraw life-sustaining treatment from terminally ill patients were mainly made because no possibilities of recovery were anticipated by physicians, followed by acceptance and decision by family members but with no participation by the patients themselves. Before and after withdrawing treatment, there were no changes in medical treatment and no information about phases of medical treatment. All decision-making was left to physicians. The families were angry about being unable to refuse life-sustaining treatment regarded as meaningless. Moreover they thought even standard nursing was meaningless.
After admitting that death was a possibility, family members regretted that they were unable to prepare for death together with patient even though they thought the patients themselves knew death was coming soon. Nevertheless family members hoped that the patients could prepare for death by themselves and die with dignity. After acceptance of the decision, family members experienced a reaction to the anticipated loss such as impatience, sighing, grievance, guilt, self-pity, regret, and the need for reflection. With such sentiments, family members required support from physicians and required a family room where family members could stay with their patients.
Therefore, nurses need to be aware of main reasons for withdrawing life-sustaining treatment, the decision-making process, participants in decision-making and the scope of medical care. They need to be central in assuring communication among medical team, patients and family members. Nurses need to monitor so that deciding to withdraw life-sustaining treatment may not be promoted or assisted only for the reasons such as alleviation of pain, being advanced age, and wasting of the body. And, on the other, hand nurses need to be advocates who can help dying patients settle issues in their lives and die with dignity. Nurses need to monitor nursing care, understand that a reaction to anticipated loss can show up at when the decision to withdraw life-sustaining treatment is made and also enable patients and family members to talk together about death.
Provision of a room for the family is required so that patients may face death with dignity. Regulations for hospice care are required so money is not used for meaningless medical treatment but in meeting the needs for improving quality of life. The scope of medical treatment to be continued or withdrawn should be decided after discussion with family members. Social consensus on withdrawing life-sustaining treatment needs to be developed, ethical guidelines stipulated and, under the protection of law and regulations, a regulatory system for withdrawing life-sustaining treatment.
Key words: withdrawal of life-sustaining treatment, terminally ill, experiences of family membersope