• Title/Summary/Keyword: 수술중 간호

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Critical Pathway for Operable Gastric Cancer (위암수술 환자에서의 Critical Pathway의 개발과 적용)

  • Song, Kyo-Young;Kim, Seung-Nam;Park, Cho-Hyun
    • Journal of Gastric Cancer
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    • v.5 no.2
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    • pp.95-100
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    • 2005
  • Purpose: Critical pathways (CP), also known as clinical pathways, are management plans that display goals for patients and have led to improved outcomes for many disease entities. This study was aimed at developing a critical pathway for the surgical treatment of gastric cancer patients and evaluating its usefulness. Materials and Methods: A CP was developed and implemented by a team of surgeons, nurses, nutritionists, and administrative officials. Among the 117 patients who received curative gastrectomies for gastric cancer at Kangnam St. Mary's Hospital, The Catholic University of Korea, between October 2003 and August 2004, 26 patients were treated according to the CP. We evaluated its usefulness by comparing the clinical characterisctics, postoperative progress, hospital stays, and costs between the CP and the non-CP groups. Patient satisfaction was also surveyed with questionnaires. Results: Of the initial 26 patients in the CP group, two were excluded from the final evaluation; one patient had a duodenal stump leakage, and the other had a gastric stasis postoperatively. In 8 patients, protocol violation occurred; six patients refused to be discharged on the $7^{th}$ postoperative day, one patient who had an gastric staisis postoperatively stayed for 2 additional days, and one patient who needed ICU care stayed for 4 additional days. The drop-out rate was $7.7\%$ (2/26), and the variance rate was $30.8\%$ (8/26). The mean hospital stay was 11.3 days ($10\~15$ days) for the CP group compared with 17.5 days ($9\∼68$ days) for the non-CP group, resulting in a difference of about 6 days (P<0.05). The mean hospital stays after surgery were 10.3 days ($7\∼68$ days) and 8.3 days ($7\∼12$ days) for the non-CP and the CP groups, respectively, but the difference was statistically not significant (P>0.05). The mean charge during the hospital stay was higher in the non-CP group ( $\\$ 6,292,200) than in the CP group ( $\\$ 4,863,685). The charge per hospital day was higher in the CP group ( $\\$ 430,414) than in the non-CP group ( $\\$ 359,554). Patient satisfaction was higher in the CP group than in the non-CP group. Conclusion: By developing and applying a critical pathway in the surgical treatment of stomach cancer patients, we could reduce the length of hospital stay as well as the cost. A multi-centered prospective study to establish a standard treatment pathway and to demonstrate its effectiveness is needed in the future.

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Effects of Self-care Program on Exercise performance Self-Efficay, Self-care Knowledge, Self-care Performance in Patients with Lumbar Discectomy (자가간호프로그램이 요추간판제거술 환자의 운동이행 자기효능감, 자가간호지식, 자가간호이행에 미치는 효과)

  • Jeong, Jin-Hee;Lee, Hye-Kyung
    • Journal of the Korean Applied Science and Technology
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    • v.38 no.3
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    • pp.891-902
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    • 2021
  • This study is an experimental study to confirm the effect of self-care program on exercise performance self-efficacy, Knowledge of self-management and Performance of self-management in patients with lumbar disc removal. The subjects were 26 inpatients in the experimental group and 27 in the control group as inpatients at the D City Material Spine Hospital. The collected material was analyzed using the SPSS 25.0 program with mean, percentage, standard deviation, t-test, x2-test, Independent t-test, and repeated measures ANOVA. Hypothesis that after self-care program mediation, the experimental group had higher scores for orthosis management knowledge (p<.001) and daily life management knowledge (p=.005) as time passed compared to the unprovided control group. The hypothesis is that the experimental group provided with the self-care program has a performance of orthosis management(p=.011), higher degree of orthosis management performance (p=.011) and daily life management performance (p=.007) than the non-provided control group. Was supported. There, it was confirmed that it is an effective self-care program that can be easily applied at home to patients with lumbar disc removal from the day before surgery to after discharge.

Effects of Types of Music in Music Therapy on Anxiety and Vital signs of Surgical Patients Undergoing Operation Using Spinal Anesthesia (음악요법 유형이 척추마취 수술환자의 수술 중 불안 및 활력징후에 미치는 영향)

  • Kim, Yeoun-Ok;Kim, Joo-Hyun
    • Journal of Korean Biological Nursing Science
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    • v.13 no.2
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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.

Incidence of Hypothermia and Factors Associated with Body Temperature Changes during Surgery in Burned Patients (화상환자의 수술 중 저체온 발생 빈도와 체온변화에 영향을 미치는 요인)

  • Bae, Hye-Young;Kim, Hyunjung
    • Journal of Korean Biological Nursing Science
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    • v.18 no.4
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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.

The Effect of Pre and Intra-Operative Warming Therapy on Tympanic Temperature Changes during Perioperative Phase in Receiving Patients with Total Hip Replacement (수술전과 수술중 피부가온요법 적응이 고관절 전치환술 환자의 수술 주기 고막체온 변화에 미치는 영향)

  • Kwon Young-Sook;Kim Eun-Hee
    • Journal of Korean Academy of Fundamentals of Nursing
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    • v.7 no.1
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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

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Uncertainty, Medical Staff's Support, and Anxiety Perceived by Family Members with Patients Undergoing Surgery for Cancer (암환자가족이 지각하는 수술대기중 불안과 불확실성 및 의료인의 지지)

  • Shin, Sun-Mi;Lee, Eun-Nam;Kang, Ji-Yeon
    • Asian Oncology Nursing
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    • v.6 no.1
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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.

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Change Patterns on Subjective Distress Level in Gynecological Postoperative Patients with Different Levels of State Anxiety (불안수준에 따른 부인과 수술환자의 불편감지각의 변화 - 통증 자가 조절기 사용 중인 환자를 중심으로 -)

  • Suh, Young-Sook
    • Women's Health Nursing
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    • v.11 no.4
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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.

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Effects of 37℃ Carbon Dioxide Pneumoperitoneum on Core Body Temperature, Systolic Blood Pressure, Heart Rate and Acid-Base Balance: A Randomized Double-blind Controlled Trial (복강경 수술에서 기복제 이산화탄소의 37℃ 가온이 수술 중 체온, 수축기압 및 심박동수와 산염기 균형에 미치는 영향)

  • Park, Jin il;Yoon, Haesang
    • Journal of Korean Biological Nursing Science
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    • v.19 no.2
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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.

A Study on The Influence Factors of Self-Efficacy, Job Performance, and Job Satisfaction of University Hospital Nurses (대학병원간호사의 자기효능감, 업무수행능력이 직무만족도에 미치는 영향요인)

  • Kim, Mi-Young;Lee, Hye-Kyung
    • Journal of the Korean Applied Science and Technology
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    • v.36 no.3
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    • pp.726-736
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    • 2019
  • The purpose of this study is to investigate the effect of University hospital nurses' self-efficacy and job performance on job satisfaction. The subjects of this study were 130 nurses working at a university hospital in C city and collected data using structured questionnaires. The collected data were analyzed using mean, standard deviation, t-test, ANOVA, Pearson's correlation and multiple regression analysis using spss 25.0. The results showed that the self-efficacy was 3.24 points for the average score, 2.74 points for the job performance, and 3.10 points for the job satisfaction. Self-efficacy, job performance, and job satisfaction were statistically correlated. The factors affecting job satisfaction were self-efficacy (${\beta}=.39$, p<.001), age at 30~34 years (${\beta}=-.27$, p=.001), Operating Room(${\beta}=-.17$, p=.029), Medical ward (${\beta}=-.17$, p=.025) and unmarried (${\beta}=-.20$, p=.012) and the explanatory power of the model was 30.4%. Based on the results of this study, it is necessary to develop a program to improve the job satisfaction considering the self-efficacy, age, working department of hospital nurse.

Effects of Preferred Music Intervention on Anxiety, Vital Signs and Blood Sugar of Surgical Patients Undergoing Operation Using Spinal Anesthesia (환자 선호도를 고려한 음악중재가 척추 마취 환자의 수술 중 불안, 활력 징후 및 혈당에 미치는 영향)

  • Jung, Hyang-Mi;Park, Mal-Young;Lee, Su-Jin;Kim, Nam-Hee
    • Journal of East-West Nursing Research
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    • v.20 no.1
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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.