• Journal of Gastric Cancer
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• 제5권2호
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• pp.95-100
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• 2005

목적: Critical pathway (CP)는 특정질환 표준화를 통해 적정한 진료 및 최소한의 표준진료를 행하여 진료의 질을 높이고 비용을 감소시켜 환자 및 의료진의 만족도를 높이기 위해 시도되고 있다. 본 연구는 위암수술 환자에서 CP를 개발 및 적용하고 이를 통해 치료결과의 향상을 이룰 수 있는지 알아보고자 하였다. 대상 및 방법: 2003년 10월부터 2004년 8월까지 가톨릭대학교 의과대학 강남성모병원에서 위암으로 수술 받은 185명의 환자 중 타장기 원발암이 없고, 근치적절제술을 시행 받은 환자 117예에서, CP를 적용한 26예와 동기간 동안 CP를 적용하지 않은 환자 91예의 임상적 특성, 수술 후 경과, 진료비용, 입원기간 및 환자 91예의 임상적 특성, 수술 후 경과, 진료비용, 임원기간 및 환자 만족도 등을 비교하여 위암수술에서 CP의 유용성을 알아보았다. CP를 개발하기 위하여 진료, 간호, 원무, 영양과 등이 참여하는 팀을 구성하여 외래검사 흐름도, 수술 전, 후 처방지, 경과기록 등을 표준화한 프로토콜을 작성하였다. 결과: CP환자 26명 중 1명은 십이지장 단단부 누출로, 1명은 술 후 위정체로 인한 장기 입원 및 재수술이 불가피 하여 제외되어 최종 분석된 환자는 24명이었다. 24명의 환자 중 8명에서 재원기간의 지연으로 인한 변이가 발생하였는데 6명은 환자가 자의적으로 퇴원을 거부하여 수술후 $1\∼2$일이 지연되었으며, 1명은 술 후 위정체로 2일 지연되었고, 1명은 수술 후 중환자실 입원 및 관찰기간이 필요하여 4일간 지연되어 변이율(variance rate)은 8/26 ($30.8\%$)였다. 평균 재원기간은 CPrns은 11.3일($10\∼15$일)이었고, Non-CP군은 17.5일($9\∼68$일)로 CPrns이 약 6일 짧았다(P<0.05), 술 후 평균 재원기간의 경우 CP군과 Non-CP군 각각 8.3일($7\∼12$일), 10.3일($7\~68$일)로 차이가 있으나 통계적으로 유의하지는 않았다(P>0.05). 양 군에서의 재원기간 중 총 진료비는 CP군이 평균 4,863,685원, Non-CP군이 평균 6,292,200원으로 CP군의 진료비가 낮았으나, 일당 진료비는 CP군은 430,414원, Non-CP군에서 높았음을 알 수 있었다(P<0.05). 13가지 항목의 만족도 조사에서도 CP군이 Non-CP군에 비해 높았다(P<0.05). 결론: 저자들이 개발하여 위암수술 환자에 적용한 CP 프로그램은 재원기간을 줄이고 총 진료비를 감소시킨 반면 일일 진료비의 상승과 환자 및 의료진의 만족도를 높일 수 있었다. 향후 다기관이 참여하는 전향적인 연구를 통해 보다 적절한 표준진료지침을 개발하여 그 효용성을 객관화 시켜야 할 것으로 사료된다.

• 한국응용과학기술학회지
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• 제38권3호
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• pp.891-902
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• 2021

본 연구는 자가간호프로그램이 요추간판제거술 환자의 운동이행 자기효능감, 자가간호지식, 자가간호이행에 미치는 효과를 확인하기 위한 실험연구이다. 대상자는 D광역시 소재 일개 척추전문병원 입원환자 중 미세현미경 요추간판제거술을 받은 환자로 실험군 26명, 대조군 27명이다. 수집된 자료는 SPSS 25프로그램을 이용하여 평균, 백분율, 표준편차, t-test, χ²-test, t-test, repeated measures ANOVA로 분석하였다. 연구결과 자가간호프로그램 중재를 받은 실험군은 제공받지 않은 대조군에 비해 시간이 경과함에 따라 보조기 관리지식(p=.001)과 일상생활관리지식점수(p=.005)가 더 높아 지지되었다. 또한 자가간호프로그램을 제공받은 실험군은 제공받지 않는 대조군보다 보조기 관리이행도(p=.011), 일상생활 이행도(p=.007), 유해생활 습관관리 이행도(p=.011)가 높아 지지되었다. 따라서 자가간호프로그램은 요추간판제거술 환자의 수술 전후 적용을 통해 운동이행 자기효능감, 자가간호지식 및 자가간호이행도를 향상시켜 보다 빠른 회복을 도울 수 있는 프로그램이라고 할 수 있다.

• Journal of Korean Biological Nursing Science
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• 제13권2호
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• pp.149-155
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• 2011

Purpose: The purpose of this research is to examine types of music (relax music or preferred music that patients have chosen) can effects on anxiety, blood pressure and pulse, and whether there are differences depending on the kinds of music in order to reduce anxiety of surgical patients using spinal anesthesia. Methods: This research's design is quasi-experimental design and non-equivalent control group pretest-posttest experimental design conducted on 60 surgical patients(experimental group 1=relax music therapy group, experimental group 2=preferred music therapy group, and group 3=control group) using spinal anesthesia. The Variables were trait anxiety, state anxiety, blood pressure, and pulse. Results: 1) In the state anxiety, there was a significant difference among the experimental groups 1, group 2 and the control group. 2) There was a significant difference in systolic blood pressure among the experimental group 1, group 2, and the control group. 3) In pulse, no significant difference among the experimental group 1, group 2 and the control group was detected. Conclusion: Regardless of the types of music, music therapy is thought to be effective nursing mediation to mitigate the state anxiety of surgical patients undergoing spinal anesthesia.

• Journal of Korean Biological Nursing Science
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• 제18권4호
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• pp.231-238
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• 2016

Purpose: The study aimed to evaluate the changes of body temperature and to identify the factors related to changes during surgery in burned patients. Methods: A retrospective study was conducted by reviewing the medical records of 439 adult burned patients who had a surgery under general anesthesia at the Burn Center of a university hospital. Results: After surgery, body temperature of the burned patients declined from $36.6^{\circ}C$ to $35.2^{\circ}C$; 52.2% were hypothermia. There were significant differences in the changes of body temperature according to the participants' characteristics including American society of anesthesiologists physical status, type of burn injury, total burn surface area, range of exposure, operation time, anesthesia time, amount of fluid, blood transfusion, use of tourniquet, and the method of warming therapy. Factors that influence the temperature changes were total burn surface area (${\beta}=0.26$), operation time (${\beta}=0.25$), amount of fluid (0.20), and warming therapy including 'Room temperature setting + Heated circuit + Hot line'(${\beta}=0.09$) and 'Room temperature setting+one of others'(${\beta}=0.08$). Conclusion: Burned patients experienced a decrease of their body temperature during surgery despite of warming therapy. A nursing protocol is needed to provide an appropriate warming therapy based on their characteristics in burned patients.

• 기본간호학회지
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• 제7권1호
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• pp.86-96
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• 2000

The purpose of the study was to investigate the effects of Warming Therapy used with patients consistantly before and during surgery to on changes in their body temperatures. The data were collected from patients in a university hospital in Taegu between December 1, 1998 and May 31, 1999. The subjects were selected from patients who were hospitalized for total hip replacement surgery. Thirty participants were assigned to two groups : experimental(Warming Therapy) group and control group. Each group consisted of 15 patients. The research design was a repeated measurement design, using a nonequivalent control group. The Warming Therapy, using a forced-air warming blanket, that is a, 'Bair Hugger' was applied to subjects in the experimental group. The subjects in the group were treated with the 'Bair Hugger' to warm up the whole body for 40 minutes before surgery and upper body and face during the operation. The core temperature was measured using a tympanic thermometer. The body temperature of the patients was measured 13 times every 15 minutes during the surgery. After the operation the body temperature of the patients was measured 4 times every 15 minutes, from the time of arrivial in the recovery room to the time of leaving the recovery room. The SPSS Win 9.0 program was used for data analysis. Specific methods tested were done using ${\chi}^2-test$, t-test, repeated measures ANOVA. The findings of the study are as follows. 1. The first hypothesis, 'The level of tympanic temperature for the experimental group which received Warming Therapy will be higher than that of the control group during the operation', was supported (F=32.16, p=.000). 2. The second hypothesis, 'The level of tympanic temperature for the experimental group which received Warming Therapy will be higher than that of the control group after the operation', was supported.(F=33.36, p=.000) 3. During recovery, shivering was observed one patient in the experimental group and seven patients in the control group. In summary, the findings of the study suggest that the 'Warming Therapy' applied before and during the surgery was a very effective treatment for surgical patients in maintaining the core temperature during surgery

• 종양간호연구
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• 제6권1호
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• pp.15-26
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• 2006

Purpose: This study was to assess relationships among the uncertainty, medical staff's support, and anxiety perceived by family members with cancer patients while the family members were waiting for their patients undergoing surgery. Method: The data were collected from the family members of cancer patients who were undergoing surgery in D University Hospital at B city from February 1 to April 12, 2005. The used instruments were the State Anxiety Scale of Spielberger's(1975) STAI, Mishel's Uncertainty in Illness Scale (MUIS)(1981), and Relationship Questionnaires (Lee, 1978). The collected data was analyzed by using t-test, ANOVA, Pearson's coefficients, and stepwise multiple regression. Results: As the result, the most influential variable explaining anxiety of family members was uncertainty $({\ss}=0.37)$, followed by perceived illness state $({\ss}=-0.27)$. These two variables simultaneously explained 29.3% of the variance in anxiety. Conclusion: We suggest to develop a nursing intervention program to reduce the uncertainty through the medical staff's support and o test its effects.

• 여성건강간호학회지
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• 제11권4호
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• pp.307-315
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• 2005

Purpose: A descriptive study was conducted to identify the change patterns on the level of perceived distress during the early postoperative period with regard to state anxiety in patients using patient controlled analgesia. Method: One hundred women who underwent elective hysterectomy procedures or other gynecologic surgeries completed a series of questionnaires measuring state anxiety, and subjective distress assessed by visual analog scales at 8, 24, & 48 hours postoperatively. Data were analyzed with frequencies, percentages, means, ANOVA, Repeated Measures ANCOVA, and Scheff'e post test utilizing SPSS WIN 11.0. Result: There was a gradual decrease in levels of total distress and pain over the three points in time after surgery regardless the levels of state anxiety. However, women with higher levels of anxiety their pain curve rose at 48 hours post-op. In addition, over the first two points in time, women in the higher anxiety group showed higher levels of distress than those in the lower anxiety group, but no such group differences were observed in the levels of pain, revealing higher pain levels only at 8 hours post-op in both groups. Conclusion: Irrespective of effective pain management modality, most postoperatively experienced distress in gynecological patients was derived from anxiety and pain. These findings have implications for pain management, especially in patients with emotionally charged surgeries like hysterectomy.

• Journal of Korean Biological Nursing Science
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• 제19권2호
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• pp.76-85
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• 2017

Purpose: The purpose of this study was to compare the effects of $21^{\circ}C\;CO_2$ and $37^{\circ}C\;CO_2$ pneumoperitoneum on body temperature, blood pressure, heart rate, and acid-base balance. Methods: Data were collected at a 1300-bed university hospital in Incheon, from February through September 2012. A total of 74 patients who underwent laparoscopic colectomy under general anesthesia with desflurane were randomly allocated to either a control group or an experimental group. The control group received $21^{\circ}C\;CO_2$ pneumoperitoneum; the experimental group received $37^{\circ}C\;CO_2$ pneumoperitoneum. The pneumoperitoneum of the two groups was under abdominal pressure 15 mmHg. Body temperature, systolic blood pressure, heart rate and acid-base balance were assessed at 30 minutes and 90 minutes after pneumoperitoneum, and again at 30 minutes after arriving at the Post Anesthesia Care Unit. Results: Body temperature in the $37^{\circ}C\;CO_2$ pneumoperitoneum group was significantly higher (F= 9.43, p< .001) compared to the $21^{\circ}C\;CO_2$ group. However, there were no statistically significant differences in systolic blood pressure (p= .895), heart rate (p= .340), pH (p= .231), PaCO2 (p= .490) and HCO3- (p= .768) between the two groups. Conclusion: Pneumoperitoneum of $37^{\circ}C\;CO_2$ is effective for the increase of body temperature compared to pneumoperitonium of $21^{\circ}C\;CO_2$, and it does not result in a decrease of blood pressure, heart rate or acid-base imbalance.

• 한국응용과학기술학회지
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• 제36권3호
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• pp.726-736
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• 2019

본 연구의 목적은 대학병원간호사의 자기효능감, 업무수행능력이 직무만족도에 미치는 영향을 파악하기 위함이다. 연구대상은 C시에 소재한 대학병원에 근무하는 간호사 130명을 대상으로 구조화된 설문지를 이용하여 자료 수집하였다. 수집된 자료는 spss 25.0을 이용하여 평균, 표준편차, t-test, ANOVA, Pearson's correlation, 다중회귀분석을 통해 분석하였다. 연구결과 자기효능감은 5점 만점에 평균 3.24점, 업무수행능력은 5점 만점에 평균 2.74점, 직무만족도는 5점 만점에 평균 3.10점으로 나타났다. 자기효능감, 업무수행능력, 직무만족도과의 관계는 정적상관관계가 있었다. 직무만족도에 영향을 미치는 요인으로 자기효능감(${\beta}=.39$, p<.001), 30~34세의 연령(${\beta}=-.27$, p=.001), 근무부서 중 수술실(${\beta}=-.17$, p=.029), 내과병동(${\beta}=-.17$, p=.025), 미혼(${\beta}=-.20$, p=.012)순이었고, 모형의 설명력은 30.4%이었다. 본 연구결과를 바탕으로 병원간호사의 자기효능감, 연령, 근무부서 등을 고려한 직무만족도를 증진시키기는 프로그램 개발이 필요하다.

• 동서간호학연구지
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• 제20권1호
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• pp.9-20
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• 2014

Purpose: The purpose of this research was to examine the effects of preferred music intervention on anxiety, vital signs and blood sugar of surgical patients undergoing spinal anesthesia. Methods: A quasi-experimental research with non-equivalent control group non-synchronized design was carried out. Subjects consisted of 40 patients (experimental group 20, control group 20) who were scheduled to undergo surgery with spinal anesthesia. During the operation, music individual patients preferred was provided to the experimental group. The data were collected from July 4 to November 10, 2011 and analyzed with descriptive statistics, t-test, chi-square test, ANCOVA and repeated measured ANCOVA using SAS (ver 9.2). Results: 1) Patient anxiety during the operation of the experimental group was significantly lower than the control group (F=93.77, p<.001). 2) There was no significant difference in diastolic blood pressure (F=.00, p=.979), Systolic blood pressure (F=.19, p=.668), heart rate (F=.00, p=.955), and blood sugar (F=.73, p=.399) between the experimental group and the control group. Conclusion: Letting patients hear their preferred music during surgery is an effective nursing intervention to relieve anxiety of patients undergoing surgery with spinal anesthesia.