말기암환자간호 (호스피스 ... - gradlms.knou.ac.kr

1 -1- ( ) , , -2- , 12345-3-1) , , , , , (holistic care)1. , -4-2) WHO .1. , .. , , .-5-3) 1. , Curative/remissive therapyPresentationDeathPalliative CareHospiceRelieving suffering -6-4) 1.

2 , 6 : , , , to alleviate(disease) withoutcuring Hospice care is end of lifeoriented Palliative care is goal oriented-10-1) (WHO) : : ( ), ( ), , : (1989) : , 2. -11-2) , (1968) 5.

3 2. (Denial) (Anger) (Bargaining) (Depression) (Acceptance) (Hope)-12-3) .2. , - ( ) . , . , , . , , , - -13-4) Pattison(1974)2. , , , , , , , , -14-1) 3. 2.

4 -15-1) 3. 6 .- ( , ) , - ( , 6 .)-16-2) ( ) 3. Medicare 6 .Medicare , . 7 , 6 .-17-2) ( ) 3.. , , .-18-3).

5 3. , ( , , , )-19-4) : .3. , , , , .. -20-5) 1 24 1 7 , . 3. , , , . , , , , 1 24 1 7.

6 1 24 1 7 ..-21-6) 1 ..3. ( ) .( ) .( ) , .( ) .-22-7) 3.. -23-7) 3.

7 2001 2002 -24-3. ( ) : . > , , : , , , . ( , Death with dignity) : ..-25-3. ( , Euthanasia).

8 (active euthanasia) (physician assisted suicide) (Advance Directive) : . , , , . : , , -26-7) 3. (Informed consent) .. (withholding) (withdrawing) , , , , . (Futile Management).

9 -27-7) 3. (Do-Not-Attempt-Resuscitation, DNAR) -28-8) 3. / : / / : / -29-9) 3.

10 -30-10) 3. , , , . , . , , , , .-31-1) 4. : (%)1 Pain67( )2 Family coping31( )3 Elimination: Bowel22( )4 Psycho-spiritual distress 15( )5 Dyspnea15( )6 Skin integrity10( ) (%)7 Nausea, vomiting9( )8 Ascites8( )9 Edema6( )10 Urinary problem5( )11 Oral mucosal integrity 3( ) : (2000).