• Title/Summary/Keyword: 정신병동

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CLINICAL CHARACTERISTICS OF CHILD & ADOLESCENT IMPATIENT WITH SEVERE ATTENTION DEFICIT/HYPERACTIVITY DISORDER AT A CENTER (일 병원에 심한 주의력결핍/과잉운동장애로 입원한 소아청소년의 임상특성)

  • Lee, Chang-Hun;Park, Sunny;Jhin, Hea-Kyung
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.16 no.2
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    • pp.270-278
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    • 2005
  • Objectives : This study is to understand the clinical characteristics and course of inpatient severe ADHD. Methods : This study retrospectively investigated the chief complaints, history, demographics, neuropsychologic test, psychosocial status of 63 (male 58, female 5) inpatients from a single center with severe attention deficit/hyperactivity disorder(ADHD) during January 1, 1996 to October 31, 2002. Results : The patients with inpatient severe ADHD revealed a male to female ratio of 11.6 : 1 and the average age of onset was 5.3 years(63.6 months, SD 24.3 months) . Comorbidities were noted in 56/63 $(88.9\%)$ patients with the following frequencies : comorbid conduct disorder, 35$(55.6\%)$, mental retardation (MR), 24$(38.1\%)$, mood disorder, 5$(7.9\%)$, tic and Tourette's disorder, 4$(6.4\%)$, oppositional defiant disorder, 4$(5.0\%)$. Chief complaints for admission related to ADHD in 23$(36.5\%)$ patients while 37$(58.7\%)$ patients admitted due to symptoms associated to conduct disorder (CD). The mean onset age of comorbid delinquency was 9.0 years (108.2 months, SD28.8 months), and the average interval between onsets of ADHD and delinquency was 3.6 years (42.9 months, SD32.0 months). Patients who showed early delinquency tended to have an earlier onset of ADHD (p<0.05). Conclusion : The demographics, natural course, and psychosocial factors of hospitalized ADHD patients were similar to prior studies of ADHD in the general population. The onset of age was 5.3 years, and the onset of comorbid delinquency was 9.0 years. The earlier symptoms of ADHD manifested, the earlier delinquency appeared. Most patients were admitted due to chief complaints related to CD. Comorbidities, most of which were CD, were seen in $88.9\%$ of the patients.

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Nurses Attitudes toward Death, Coping with Death and Understanding and Performance Regarding EOL Care: Focus on Nurses at ED, ICU and Oncology Department (임종 다빈도 부서 간호사의 죽음에 대한 태도 및 대처정도와 생애 말기환자 간호와의 관계 - 응급실, 중환자실, 종양내과 병동 간호사를 중심으로)

  • Seo, Min-Jeong;Kim, Jung Yeon;Kim, Sanghee;Lee, Tae Wha
    • Journal of Hospice and Palliative Care
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    • v.16 no.2
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    • pp.108-117
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    • 2013
  • Purpose: The objectives of this study were to 1) explore nurses' attitudes toward death, coping with death, understanding and performance regarding end-of-life (EOL) care, 2) describe correlations among the above factors, and 3) determine the factors affecting nurses' EOL care performance. Methods: Study participants were 187 nurses stationed at departments that post higher mortality than others such as the oncology department, intensive care unit (ICU) and emergency department (ED). Data were collected from three urban university-affiliated hospitals. Multi-dimensional measure was performed for study instruments such as "attitude toward death", "coping with death" and "understanding and performance regarding EOL care". Data were analyzed by using descriptive statistics, correlation, and multiple regressions. Results: First, nurses showed significantly different attitudes toward death by age, religion, work unit and EOL care education. Younger nurses tend to score low on the understanding of EOL care, and ED nurses' score was lower than their peers at the oncology department and ICU. Second, EOL care performance was positively correlated with attitude toward death (P<0.001), coping with death (P=0.003) and understanding of EOL care (P<0.001). Third, nurses' EOL care performance was affected by work unit (P<0.001) and understanding of EOL care (P<0.001). Conclusion: Because nurses' performance was influenced by their work unit and understanding of EOL care, they should be provided with appropriate training to improve their understanding of death and EOL care according to work unit.

Comparative Study on the Stress Response of Nurses Working on Pscychiatric Wards to that of Nurses Working on General Wards (정신과 병동 간호사와 일반병동 간호사의 스트레스 반응양상에 대한 비교연구)

  • 김영자
    • Journal of Korean Academy of Nursing
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    • v.25 no.3
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    • pp.399-418
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    • 1995
  • The purpose of this study was to investigate the stress response of nurses working on psychiatric wards (psychiatric nurses) compared with that of nurses working on general wards (general nurses) in order to provide assessment data for intervention of the stress response. The Symptoms of Stress Inventory was used to measure the stress response. Data were collected by a direct survey method using a questionnaire and were collected from March first to March 30, 1995. A sample of 200 nurses working in three psychiatric hospitals and psychiatric wards in four university hospitals in Seoul and Kangwon province were selected and 200 nurses working on general wards from two general hospitals in Seoul were also selected for a total sample of 400 nurses. Nurses who had experienced more than one of the major life events in the last two years were excluded from the total number in the samples, so the final sample was 161 psychiatric nurses, and 169 general nurses. The Scores for the total stress response, scores of the SOS subscales, stress response by sociodemographic characteristics of the nurses working on the psychiatric wards were compared with those of nurses working on the general ward. The results of this investigation are as follows 1. The mean total SOS score for the psychiatric nurse was 0.81 (SD=0.48) and that of the general nurses was 0.90(SD=0.53). 2. The Mean score for peripheral manifestation, con tral-neurological symptoms, gastrointestinal symptoms, muscle tension, habitual patterns, de-pression, anxiety, anger and cognitive disorganization for the general nurses showed a tendency to be higher than those of the psychiatric nurses. Mean score for cardiopulmonary symptoms for the general nurses was significantly higher than that of the psychiatric nurses. 3. The mean scores for the sixteen SOS items for the general nurses was significantly higher than for the psychiatric nurses. The 16 items were flushing of the face, sweating excessively even in cold weather, thumping of the heart, rapid breathing, dry mouth, a choking lump in the throat, hoarseness, muscle tension in hands or arm, muscle tension in leg, working tiring one out completely, severe aches a핀 Pain make it diffi-cult to do the work, severe nervous exhaustion, worrying about health, feeling weak and faint, so upset that one wants to hit something, unable to keep thoughts from running through one's mind. The mean score of only 505 item were significantly higher for the psychiatric nurses. 4. Stress responses between psychiatric nurses and general nurses were significantly different according to the following demographic characteristics : marriage, duration of work, position, accommodation, planning to move into another working site, working ward, education in psychiatric nursing.

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THE CHARACTERISTICS OF CHILD AND ADOLESCENT INPATIENTS WITH SEVERE OBSESSIVE-COMPULSIVE DISORDER (심각한 소아 ${\cdot}$ 청소년 강박장애로 입원한 환아들의 특징)

  • Hwang, Jun-Won;You, So-Young;Chang, Jun-Hwan;Shin, Min-Sup;Cho, Soo-Churl;Hong, Kang-E;Kim, Boong-Nyun
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.15 no.2
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    • pp.143-151
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    • 2004
  • Objectives : Child and adolescent onset obsessive compulsive disorder(C-OCD) is known to be associated with poor drug response, high comorbid rate and strong genetic tendencies. Till now studies for C-OCD have been very rare in Korea. We conducted this study to investigate the informations about clinical features, familial psychiatric loading, treatment profiles and course of server C-OCD from the retrospective analysis of inpatient data of Seoul National University Children's Hospital. Method : Retrospective chart review and data analysis was performed. Twenty(male 16 : female 4) patients with final C-OCD diagnosis by DSM-IV at discharge from 1994 to 2002 were found and their medical chart, psychological data, family interview data and nursing reports were collected and analyzed. Results : 1) The sex ratio of C-OCD was male dominant(4:1). 2) Phenomenological, most common obsession was pathologic doubt, contamination fear, followed by aggressive obsession, need for symmetry, sexual obsession, most common compulsion was checking and washing, followed by breathing, movement, symmetry, repetitive asking, hoarding, mental compulsion. 3) Most common comorbid diagnosis was depression. Other axis-I diagnosis associated OCD were anxiety disorder, tic disorder, conduct and oppositional defiant disorder and psychosis. 4) Regarding psychiatric familial loadings, 17 patients(85%) had relatives with psychiatric disorders, OC-spectrum disorders(OCD or OCPD) were found in 9 patients(45%). 5) The majority of patients(75%) have received SSRI and antipsychotics treatment. The response rate above 'moderate improved" by CGI was 75%. 6) During follow-up period in outpatient clinic, five patients(25%) showed continuous complete remission, 10 patients (50%) did residual symptoms with chronic course. Conclusion : This seems to be the first systemic investigation of severe pediatric OCD patients in Korea. The children & adolescents with severe OCD in inpatient-setting showed the high comorbid rate, familial psychiatric loading, and combined pharmacotherapy with antipsychotics, As for symptoms, high rate of aggressive-sexual obsession and atypical compulsions like breathing and moving was reported in this study. Severe pediatric OCD patients, however, responded well to the combined SSRI and antipsychotics regimen.

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Review of 2016 Major Medical Decisions (2016년 주요 의료판결 분석)

  • Park, Tae Shin;Yoo, Hyun Jung;Jeong, Hye Seung;Lee, Dong Pil;Lee, Jung Sun
    • The Korean Society of Law and Medicine
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    • v.18 no.1
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    • pp.297-341
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    • 2017
  • We searched out court rulings on medical affairs through court library search sites and specialized articles on medically relevant judgments sentenced in 2016. And we selected and analyzed the judgements of the court we considered important as follows. In relation to the medical civil judgements, (1) In the case of applying surgery for female infertility during cesarean section operation but it has not been done, we expressed the regret for the lack of judgment in the process of entering the medical contract, introducing the rights infringed and the scope of compensation, (2) We pointed out that the ruling on the medical malpractice estimation goes out of limit of negligence estimation doctrine, and that the court asked very high degree duty of the traditional Korean medicine doctors to cooperate with Western medicine doctors. (3) In the case of admitting hospital's 100% responsibility, we pointed out the court overlooked the uncertainty and good intention of the medical practice. (4) Additionally, We introduced the cases admitted the hospital's responsibility in the accident related to the psychiatric patients in closed ward. Relating to a medical criminal ruling, we analyzed the supreme court decision about whether the dentist's Botox injection on the patient's face is a medical practice within the scope of the license from the viewpoint whether it is within the possible range of the word. And, concerning decisions on healthcare administration, (1) we analyzed the case about when medical personnel operate multiple medical institutions, whether it is possible to get back medical care costs under the National Health Insurance Law, (2) We commented on the ruling regarding explanation obligation in terms of object, degree, subject of explanation as a prerequisite for permissible arbitrary uninsured benefits. Finally, we reviewed the decision of the Constitutional Court about the Article 24 of the Mental Health Law, which it had allowed for a mental patient to be hospitalized forcibly by the consent of two guardians and a diagnosis of a psychiatrist. Also we indicated the problems of the revised Mental Health Law.

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Effect of Multidisciplinary Emergency Consultation System for Drug Intoxicated Patients (응급실을 내원한 약물중독 환자에 대한 다학제 응급협진체계의 효과 검증)

  • Kang, Jino;Kim, Hye Ri;Min, Kyungjoon;Kim, Na Ryoung;Heo, Yoon Kyung;Kim, Sun Mi
    • Korean Journal of Psychosomatic Medicine
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    • v.27 no.2
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    • pp.130-137
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    • 2019
  • Objectives : When a patient who attempts suicide visits the emergency room, it is important that the departments of emergency medicine, internal medicine, and psychiatry communicate with each other and prioritize treatment. This study was conducted to verify the effectiveness of the multidisciplinary emergency consultation system (ECS) for drug intoxicated patients. Methods : We retrospectively analyzed the data from medical records prior to the ECS, from July 2017 to May 2018, and after the ECS, from July 2018 to May 2019, to verify the effectiveness of the system. Results : After the ECS, admission to open wards was significantly higher than to the intensive care units (χ2=8.567, p=0.014). In addition, the proportion of consultations to the department of psychiatry among patients admitted to other departments tended to increase (χ2=4.202, p=0.053), and the time required for consultation response decreased (Z=-2.031, p=0.042). As a result of the consultation, the proportion of the patients who had been transferred to the department of psychiatry was increased (χ2=4.692, p=0.043), and the time spent to transfer tended to decrease (Z=-1.941, p=0.052). Conclusions : After implementing the ECS for drug intoxicated patients, unnecessary intensive care unit admissions, consultation response time, and the time spent to transfer were reduced, and the rate of consultation referrals and transfer rates increased. This means that the multidisciplinary consultation system rapidly provided essential medical services to patients at lower medical costs.

Exposure to Violence and Coping Behavior during the Clinical Practice of Nursing Students (임상실습 중 간호대학생의 폭력 경험과 대처 행동)

  • Oh, Jin-Hwan;Kim, Og Son;Lee, Kee-Lyong
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.16 no.8
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    • pp.5325-5335
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    • 2015
  • This study was conducted to investigate violence experiences and coping behaviors of nursing students when they were doing clinical practice. Data were collected from 250 nursing students from 10th of November to 10th of December in 2014 using questionnaires. 231 questionnaires were analyzed by descriptive statistics, t-test, and one-way ANOVA. 98.7% of the subject have experienced violence. Most frequently mentioned setting where violences were experienced was psychiatric unit, abusers were patient. Most frequent violence type was verbal abuse(97.4%) followed by physical threatening(76.2%). Most frequent coping behavior was enduring(87.8%) followed by avoiding(83.2%). In this study, most of nursing students experienced violence during the clinical practice. They need to be better protected from violence during the clinical practice. It is needed various active effort and programs to prevent violence and to help students cope more against violence in their practice.

The Role of Tc-99m HMPAO Brain Perfusion SPECT in the Psychiatric Disability Evaluation of Patients with Chronic Traumatic Brain Injury (만성 외상성 뇌 손상 환자의 정신의학적 후유 장애 평가에서 Tc-99m HMPAO 뇌혈류 SPECT의 역할)

  • So, Young;Lee, Kang-Wook;Lee, Sun-Woo;Ghi, Ick-Sung;Song, Chang-June
    • The Korean Journal of Nuclear Medicine
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    • v.36 no.4
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    • pp.232-243
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    • 2002
  • Purpose: We studied whether brain perfusion SPECT is useful in the psychiatric disability evaluation of patients with chronic traumatic brain injury (TBI). Materials and Methods: Sixty-nine patients (M:F=58:11, age $39{\pm}14$ years) who underwent Tc-99m HMPAO brain SPECT, brain MRI and neuropsychological (NP) tests during hospitalization in psychiatric wards for the psychiatric disability evaluation were included; the severity of injury was mild in 31, moderate in 17 and severe in 21. SPECT, MRI, NP tests were peformed $6{\sim}61$ months (mean 23 months) post-injury. Diagnostic accuracy of SPECT and MRI to show hypoperfusion or abnormal signal intensity in patients with cognitive impairment represented by NP test results were compared. Results: Forty-two patients were considered to have cognitive impairment on NP tests and 27 not. Brain SPECT showed 71% sensitivity and 85% specificity, while brain MRI showed 62% sensitivity and 93% specificity (p>0.05, McNemar test). SPECT found more cortical lesions and MRI was superior in detecting white matter lesions. Sensitivity and specificity of 31 mild TBI patients were 45%, 90% for SPECT and 27%, 100% for MRI (p>0.05, McNemar test). Among 41 patients with normal brain MRI, SPECT showed 63% sensitivity (50% for mild TBI) and 88% specificity (85% for malingerers). Conclusion: Brain SPECT has a supplementary role to neuropsychological tests in the psychiatric disability evaluation of chronic TBI patients by detecting more cortical lesions than MRI.

Nursing Professor's inspection and Status of Patient's Records and Informed Consent for Clinical Practice of Nursing Student in Korea and Japan (한·일 간호대학생의 임상실습 시 환자의 설명동의 및 기록관리와 지도실태)

  • Cho, Yooh-Yang;Kim, In-Hong;Yamamoto, Fujie;Yamasaki, Fujiko
    • Journal of agricultural medicine and community health
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    • v.31 no.1
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    • pp.35-46
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    • 2006
  • Objectives: In recently. the management and protection on individual information in patient's medical & nursing records have been very important, and that need a guideline. The purpose of this study was to investigate the status of using the patient's nursing records of nursing students in clinical practice, to find and discuss the patient's informed consent, and status of education and management concerned to patient's nursing records. Methods: This study used a mailing survey. data collected from September 24th to October 31th in 2002. The subject were 333 professors who are major in adult nursing, pediatric nursing, psychological nursing of 111 university of nursing department and nursing college. And then we received the survey mail from 103 professors that respondent rate was 30.9%. Results: The characteristics of study subjects showed 49.0% of university. 51.0% of college of nursing. 50.0% of the subjects practiced point the patient by oral approval in clinical practice. But when the decision of the patient was very difficult, 21.6% of the subjects take to informed consent from his or her families. During the clinical practice, 49.0% of the subjects were explain to patient about clinical practice and contents of the nursing student, only 7.8% of the subjects were explain to patient with nursing records. 52.0% of the subjects were took out records from the hospital, only 17.6% of the subjects had standard of the patient's informed consent and standard of handling practice records. 17.6%-92.2% of the subjects that educate and manage concern to patient's nursing records.

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A study on the present situation of the treatment services provided by alcohol addiction specialized hospitals (알코올중독전문병원의 서비스 제공 현황에 관한 연구)

  • Cho, Hyun;Yoo, Jin-Yeong;Lee, Ji-Hwan
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.12 no.8
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    • pp.3547-3554
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    • 2011
  • The aim of this study is to take hold of the present situation as well as the perspective of the domestic alcohol specialized hospitals. The structured questionnaire was prepared to understand the type of services, manpower and systematic programs. Among eight hospitals that stand for the alcohol addiction specialized hospitals, six hospitals agreed to participate in the survey, which was made from Jun. 17 to July 15, 2010. The average number of beds of the surveyed hospitals was 208. They were mostly private ones(66.7%), located in urban area(50%), and had experiences of alcohol treatment less than five years(50%). While all of them practiced both the inpatient and outpatient services, only 33% provided the systematic outpatient program that was at least 2 or 3 hours per week. All hospitals practiced the physical and individual psychological evaluations, but only 16.1% had the daytime programs. The beds of protective ward were 72% of all beds, and the beds of night and day occupied 7.6% and 2.6% respectively. It was found that although the average number of mental health social worker and mental health nurse was larger than that required in the regulation of mental health law there are significant deviations between hospitals. However, the manpower of psychiatrists and nurses were comparatively large. The first problem indicated by clinical experts was the patient's refusal of care, which results in an inefficiency in the treatment. The next problem was the lack of local health care institutions that can attend on the discharged patients were important issues. Also the low reimbursement and indifferences to the alcohol abuse were considered as important issues.