2018년 2월 4일부터 연명의료결정법이 시행됨에도 불구하고, 중환자실에서의 연명의료결정과 관련된 임종간호 방향은 명확하지 않은 실정이며 임상 현장에서 근무하는 중환자실 간호사도 연명의료결정법과 현실 상황에서 갈등으로 경험하고 있다. 따라서 본 연구는 중환자실 간호사를 대상으로 연명의료결정에 따른 임종간호 방향과 바람직한 임종간호를 위한 실무방향을 확인하기 위해 시행되었다. 서울시 소재 상급종합 K병원 중환자실 간호사이며 중환자실 임상 경력이 1년 이상이고 연명의료중단에 동의한 환자의 임종간호를 수행한 경험이 있는 간호사로 총 12명을 선정하였다. 자료수집은 2021년 7월 5일부터 8월 16일까지 포커스 그룹 인터뷰 가이드를 따라 5년차 이하 간호사 6명과 5년차 초과 간호사 6명 두 그룹으로 나누어 그룹별로 총 두 차례에 걸쳐 인터뷰를 시행하였고, 주제분석방법으로 분석하였다. 본 연구결과 중환자실 간호사에게서 세 가지의 핵심 주제가 도출되었다. 적극적 치료 중심인 중환자실에서 ‘연명의료중단을 통한 생의 말 의미’를 찾게 되었고, 연명의료중단 결정과 관련된 환자에게 ‘죽음에 대한 극명한 접근변화- 중환자실 연명의료중단 관리’를 인식하게 되었으며, 편안한 임종을 맞이하기 위해 ‘연명의료중단: 달라지는 중환자실 간호사의 초점’을 경험하게 되었다. 본 연구결과로 연명의료결정과 관련된 중환자실 간호사의 바람직한 임종간호 실무방향을 확인할 수 있을 것이며 임상 현장의 기초자료로 도움을 줄 수 있을 것이다.
Background: A bill linked to the Life-Sustaining Treatment Decision Act of 2018 was enacted in South Korea, aimed at not prolonging medical treatment for those nearing the end of life. Intensive care unit nurses working with intensive care patients experience conflicts in patient care because the treatment plan for patients varies according to the decision on life-sustaining treatment, whereas the plan for nursing the ICU patient according to the decision on life-sustaining treatment is not clear.
Aim: This study was attempted to explore the perspectives of nurses on intensive care unit nursing according to life-sustaining treatment decisions.
Method: A focus group interview study was used to achieve the aim of this study.
Participants: Six nurses with less than 5 years of clinical experience and six nurses with more than 5 years of clinical experience working in two intensive care units at a university hospital in Seoul, Korea participated in this study.
Data collection and Analysis: Data were collected through two focus group interview studies. Two focus groups were formed based on clinical experience. A group of six nurses with less than 5 years of clinical experience and a group of six nurses with more than 5 years of clinical experience. Focus group interviews were conducted twice for each group. The analysis of the data was analyzed through thematic analysis.
Findings: As a result of this study, ICU nurses' perception of end-of-life care related to life-sustaining treatment decisions was derived from three themes. The first theme, 'meaning of life found through the discontinuation of life-sustaining treatment'; In relation to the decision to discontinue life-sustaining treatment, intensive care unit nurses suggested that nursing should be performed so that patients could reflect on the meaning of their lives at the end of their lives. In this opinion, there was a difference between the careers of nurses. Nurses with less than 5 years of clinical experience focused on pain relief for patients, while nurses with more than 5 years of experience suggested that their patients should spend the rest of their lives more valuable.
The second theme is that the patient's approach to end-of-life management is drastically changed due to the decision on life-sustaining treatment. In other words, it was the nurse's perception of end-of-life nursing for patients who decided to discontinue life-sustaining treatment and active treatment of patients who did not discontinue life-sustaining treatment. On the second theme, conflict factors related to nurses' end-of-life nursing care were also derived.
The third theme was how the patient's end-of-life care would be performed in the intensive care unit if the patient accepted the discontinuation of life-sustaining treatment. In this process, the problem that nurses must overcome is guilt. There was an emphasis according to experience. Those with less than 5 years of clinical experience emphasized the guilt experienced by nurses in this process, while nurses with more than 5 years of experience emphasized systematic end-of-life management from pre-death to the funeral process.
Conclusion: Through this study, intensive care unit nurses' perceptions related to the decision on life-sustaining treatment were unclear about nursing in the current situation in which most doctors, patients, and patients' guardians were involved, without nurses participating in the decision on life-sustaining treatment. Although the system of discontinuation of life-sustaining treatment was legally introduced into clinical practice, it was suggested through this study that clear guidelines for critical care are needed.
Key words: Life-sustaining treatment decision, End-of-life care in intensive care unit.
＊A thesis submitted in partial fulfillment of the requirements for the degree of Master of Education