Purpose
The purpose of this descriptive survey study was to investigate the relationship between death awareness, life-sustaining nursing stress, end-of-life care competency and performance, and resilience. Additionally, the factors influencing end-of-life care performance by ICU nurses were identified. Methods: Data were collected from one tertiary and two general hospitals in J province from July 1 to July 30, 2022. Nurses working in Intensive Care Units (ICU) for more than three months who had experience in end-of-life care were selected through convenience sampling. A total of 188 responses to the survey were included in the final analysis. An IBM SPSS program was used for the data analysis. Results: Factors impacting end-of-life care performance (with an explanatory power of 31.9%) were as follows: higher knowledge and behavioral competency in end-of-life care, higher relational patterns in resilience, higher levels of death positivity in death awareness, and clinical experience of less than a year compared to that of three to five years were associated with higher end-of-life care performance. Conclusion: These findings point to the urgent need for increasing end-of-life care performance among nurses in clinical practice; therefore, practical strategies must be developed and actively implemented to strengthen relevant competencies and resilience and promote death positivity. Based on these findings, future studies are needed to develop an intervention program to improve the spiritual scope of end-of-life care and verify the effects.

PURPOSE
As advanced medical care has resulted in the unintended consequence of prolonging deaths, there is a growing interest in the decision to withhold life-sustaining treatments. The purpose of this study was to determine factors associated with the decision to withhold life-sustaining treatments in middle-aged and older adults who die in hospital in the United States.
METHODS
This cross-sectional correlational study conducted secondary analysis of 2000–2012 exit interview data from the Health and Retirement Study. Adults aged 50 and older who died in hospital and who had made a decision regarding life-sustaining treatments were included. Multivariable logistic regression was used to identify factors related to the decision to withhold life-sustaining treatments.
RESULTS
Among 1,412 adults, the prevalence of the decision to withhold life-sustaining treatments was 61.1%. Significant factors associated with the decision to withhold life-sustaining treatments were being African American (Adjusted Odds Ratio [AOR]=0.50, 95% Confidential Interval [CI]=0.30~0.86), Catholic (AOR=0.5, 95% CI=0.32~0.93), having at least one private insurance policy (AOR=1.40, 95% CI=1.02~1.92), having a living will (AOR=1.71, 95% CI=1.04~2.83), and having discussed end-of-life care with someone (AOR=1.810, 95% CI=1.25~2.62).
CONCLUSION
Differences in race and religious affiliation should be considered when older adults, family members, and health care providers make decisions regarding life-sustaining treatments at the end-of-life. Also, health insurance coverage for advance care planning makes it easier for people to discuss life-sustaining treatments with health care providers.

PURPOSE
The purpose of this study was to identify the level of terminal care performance of nurses in long-term care hospitals, and investigate how nursing professionalism, attitudes on advance directives and death anxiety affects their terminal care performance.
METHODS
Total of 294 nurses from long-term care hospitals completed the structured questionnaires including nursing professionalism scale, advance directives attitude survey, death anxiety scale and terminal care performance scale. Data were analyzed using the SPSS/WIN 24.0.
RESULTS
There were significantly correlation among terminal care performance of nurse, nursing professionalism, attitudes on advance directives, and death anxiety. The key factor that affected nurses terminal care performance was nursing professionalism(β=.26, p < .001), followed by attitudes on advance directive (β=.20, p < .001), participation of terminal care education (β=.15, p=.006), total work experience (β=.13, p=.015), and participation of Do-Not-Resuscitate education (β=.13, p=.018), which explained about 23.1% of the variance in nurses terminal care performance (F=17.05, p < .001).
CONCLUSION
The results of this research suggest that to enhance the nursing performance of nurses in long-term care hospital, it is necessary to develop an education program that can enhance a professionalism and the attitudes on advance directives, and reduce death anxiety experienced by nurses.

Citations

• The mediating effects of nurses’ professional values on the relationship between work environment and organizational commitment among long-term care hospital nurses
  Won Hee Jun
  BMC Nursing.2025;[Epub]     CrossRef
• Investigation of the effect of nurses’ professional values on their perceptions of good death: a cross-sectional study in Türkiye
  Fatma Aksoy, Sule Biyik Bayram, Aysel Özsaban
  BMC Nursing.2024;[Epub]     CrossRef
• Development and Psychometric Evaluation of the End-of-Life Nursing Competency Scale for Clinical Nurses
  Ji-yeon Kim, Hyun-sun Kim, Mi-jung Kang, Hee-young Oh, Mi-rae Jo
  Healthcare.2024; 12(16): 1580.     CrossRef
• Relationship Between Physician’s and Nurses’ Attitudes Towards Futile Treatment and Their Approach to Death and Terminally Ill Patients
  Gulay Yildirim, Meryem Türkan Işık, Sibel Oner Yalcin
  OMEGA - Journal of Death and Dying.2023;[Epub]     CrossRef
• The moderating effect of attitudes in the relationship between knowledge and self-efficacy in palliative care among nurses: A cross-sectional, correlational study
  JinShil Kim, Seongkum Heo, Jisun Yang, Miyeong Kim, SeongHu Park, KyungAh Cho, JungHee Kang, Hani Yi, Minjeong An, Jeong-Ah Ahn
  PLOS ONE.2023; 18(10): e0292135.     CrossRef
• StructuralEquation Model of End-of-Life Nursing Performance of Home Visiting Nurses
  Sukhee Kim, Soongnang Jang
  Journal of Korean Academy of psychiatric and Mental Health Nursing.2023; 32(2): 124.     CrossRef
• Factors associated with attitudes toward advance directives in nurses and comparisons of the levels between emergency nurses and palliative care nurses
  Jisun Yang, Hee Jung Kim, Seongkum Heo, Minjeong An, SeongHu Park, Songthip Ounpraseuth, JinShil Kim
  Japan Journal of Nursing Science.2023;[Epub]     CrossRef
• Education needs for clinical nursing practice using an Importance-Performance Analysis and Borich needs assessment model: Focused on nurses in the general wards of a tertiary hospital
  Mira Lee, Jiyoung Kim, Boyeon Kim, Yooyun Park, Jiyoo Han, Seunghee Lee, Hyunju Lee
  The Journal of Korean Academic Society of Nursing Education.2023; 29(2): 124.     CrossRef
• Knowledge, Experience, and Attitudes of Nurses at Long-Term Care Hospitals regarding Advance Directives
  Go Eun Park, Nae Young Lee
  The Korean Journal of Hospice and Palliative Care.2022; 25(4): 139.     CrossRef
• Trends in Nursing Research on Life-Sustaining Treatment in South Korea after the Enforcement of the Act on Decisions on Life-Sustaining Treatment
  Jun-Hwa Choi, Eun-Suk Choi
  The Korean Journal of Hospice and Palliative Care.2022; 25(1): 25.     CrossRef
• Nurses' views and applications on palliative care
  Diğdem Lafci, Ebru Yildiz, Seda Pehlivan
  Perspectives in Psychiatric Care.2021; 57(3): 1340.     CrossRef
• Effects of Awareness of Good Death and End-of-Life Care Attitudes on End-of-Life Care Performance in Long-Term Care Hospital Nurses
  Sun-Hee Kim, Eun-Young Kim
  The Korean Journal of Hospice and Palliative Care.2021; 24(1): 26.     CrossRef
• Family's Perception of Proxy Decision Making to Authorize Do Not Resuscitate Order of Elderly Patients in Long Term Care Facility: A Q-Methodological Study
  Hyeon Jin Cho, Jiyeon Kang
  Journal of Korean Academy of Nursing.2021; 51(1): 15.     CrossRef
• Nurses' Experiences of End-of-life Care for Elderly Patients in Long-term Care Hospitals
  Chun Yee Lee, Ga Eon Lee
  Journal of Korean Academy of Community Health Nursing.2020; 31(2): 199.     CrossRef
• The Relationship among Attitudes toward the Withdrawal of Life-sustaining Treatment, Death Anxiety, and Death Acceptance among Hospitalized Elderly Cancer Patients
  YeonMi Seo, Sujin Shin
  Asian Oncology Nursing.2019; 19(3): 142.     CrossRef
• The Effect of Nurses’ Compassion Competence on Performance of Terminal Care in Geriatric Hospitals
  Young Hye An, Soon Rim Suh
  Journal of Health Informatics and Statistics.2019; 44(3): 253.     CrossRef
• The Impact of Nursing Hospital Workers’ Hospice·Palliative Care Knowledge and Awareness, End-of-Life Care Attitude and Death Awareness on Their End-of-Life Care Performance
  Meera Park, Nam Joo Je
  The Korean Journal of Hospice and Palliative Care.2018; 21(4): 124.     CrossRef

PURPOSE
The purpose of this study was to understand the nurses' experiences of end of life care of older adults with dementia living in long-term care hospitals and geriatric care facilities.
METHODS
The participants were nine nurses. Open in-depth interviews were used to collect data from June, 2016 to November, 2016. Colaizzi's phenomenological approach was used to analyze the data.
RESULTS
Three categories were identified. The nurses' reported experiences of end of life care of older adults with dementia were ‘warm care with living together’, ‘care for family’, and the ‘self-reflection and responsibility as a nurse’. There were ten clusters of themes and 24 themes. The participants stated that the end of life care of older adults with dementia were individualized holistic care with dignity, being in older adults with dementia and family, and responsibility as a professional. Nurses reported the need for dementia hospice care.
CONCLUSION
These results could be considered in planning nursing intervention for hospice care. The findings support the need for educational strategies and programs to improve end of life care among older adults with dementia.

Citations

• Impact of settings and culture on nurses’ knowledge of and attitudes and perceptions towards people with dementia: An integrative literature review
  Sara Mahmoud Yaghmour
  Nursing Open.2022; 9(1): 66.     CrossRef
• Registered Nurses’ Experiences of End-of-Life Care in Nursing Homes of South Korea: A Qualitative Study
  Soo-Jung Chang
  Healthcare.2022; 10(11): 2213.     CrossRef
• Experiences of Long-term Care Hospital Nurses Caring for Elders with Dementia
  Eun Kyoung Suh, Hye Ryoung Kim
  Journal of Korean Gerontological Nursing.2019; 21(2): 99.     CrossRef
• Factors Affecting the Care Burden of Nurses Caring Elderly Patients with Dementia
  Doo Ree Kim, Eun-Kyoung Han
  Journal of Korean Academy of Community Health Nursing.2019; 30(3): 368.     CrossRef

PURPOSE
The purpose of this study was to explore the chronic patients' references for care near the end of life.
METHODS
This is a descriptive survey research, with subjects of 161 outpatients with hypertension, diabetes mellitus or chronic renal failure.
RESULTS
The majority of the subjects do not want meaningless life sustaining treatment and they report thinking positively about family or health care professional to participate in their end of life decision making process. Subjects reported preferring adequate pain management and spiritual support at the end of life. In regard to advance directives (ADs), those subjects with chronic disease report thinking positively about the necessity of ADs and its institutionalization. However, the subjects report not having the detailed information on the proper time and method of writing their ADs.
CONCLUSION
Based on these results, educational programs on end of life decision making for chronic patients need to be developed. Also, the nurse should try to reflect the opinion of chronic patients as much as possible when make an end-of-life decision.