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An Analysis of Referrals, Nursing Diagnosis, and Nursing Interventions in Home Care - Wonju Christian Hospital Community Health Nursing Service - (가정간호 기록지 분석 - 원주기독병원 가정간호 보건활동을 중심으로 -)

  • Suh, Mi-Hae;Huh, Hae-Kyung
    • Journal of Home Health Care Nursing
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    • v.3
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    • pp.53-66
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    • 1996
  • Home Health Care is one part of the total health care system. It includes health care services that link the hospital to the community. While it is important for early discharge patients, home care is also important for people with chronic illnesses or handicapping conditions. In 1989 the Korean government passed a law that opened the way for formal development of home health care services beginning with education programs to certify nurses for home care, and then demonstration home care services. Part of the mandate of the demonstration projects was evaluation of home care services. This study was done in order to provide basic data that would contribute to the development of records that could be used for evaluation through a retrospective audit and to examine the care that had been given in Home Care at Wonju Christian Hospital over a twenty year period from 1974 to 1994. The purposes of the study were : to identify to characteristics of the clients who had received home care, to identify the reasons for client referrals, to identify the nursing problems of these clients, to identify the nursing care provided to these clients, and to identify differences in these areas over the twenty year period. The study was a descriptive study involving a retrospective audit of the client records. Demographic data on all clients were included : 4,171 clients from 2,564 families. Data on referrals, nursing diagnosis and nursing interventions were from even numbered records which had a patient problem list included in the record, 2,801 clients, Frequencies and ANOVA were used in the analysis. The results of the study showed that the majority of the clients were from Wonju city /county. There were more women than men related to the high number of postpartum clients(1,300). The high number of postparttum clients and newborns was also evident in the age distribution. An the number of maternal-child clients decreased over the 20 years, the mean age of the clients increased significantly. Other factors also contributed to this change ; as increasing number of clients with brain injuries or with cancer, and fewer children with burns, osteomyelitis and tuberculosis. There was a decrease in the mean number of visits and mean length of coverage, reflecting a movement towards a short term acute care model. The number of new clents dropped sharply after 1985. The reasons for this are : the development of other treatment alternatives for clients, the establishment of an active wellbaby clinic, many more options plus a decreasing number of new cases of Hansen's Disase, and insurance that allows people with burns to be kept in hospital until skin grafts are healed. Socioeconomic changes have resulted in an increase in the number of cases of cancer, stroke, head injuries following car accidents, and of diabetes. Of the 2,801 client records, 2,541(60.9%) contained a written referral but for 1,802 it contained only the medical diagnosis. The number of records with a referral requesting specific nursing care was 739(29.1%). Many family members who were identified as in need of nursing care had no written referral. Analysis of the patient problem list showed that 41.9% of the enteries were nursing diagnoses. Others incuded medical diagnosis, symptoms, and plans. The most frequently used diagnoses were alteration in nutrition, less than body requirements(115 entries), alteration in skin integrity(114), knowledge deficit(111), pain(78), self-care deficit(66), and alteration in pattern of urinary elimination(50). These are reflected in the NANDA categories for which the highest number of diagnosis was in the Exchanging pattern(446), followed by Moving(178), Feeling(136) and Knowing (115). Analysis of the frequency of interventions showed that exercise and teaching about exercise was the most frequent intervention, followed by teaching concering the need for follow-up care, checking vital signs, managing nutritional problems, managing catheters, giving emotional support, changing dressings, teaching about medication, teaching (subject not specified), teaching about diet, IM and IV medications or fluid, and skin care, in that order. Recommendations included: development of a record that would allow for efficient recording of frequently used nursing diagnoses and nursing interventions: expansion of the catchment area for Home Care at Wonju Christian Hospital ; expansion of the service to provide complication prevention, rehabilitation services, and support to increase the health maintenance /health promotion of the people being served as well as providing client dentered care ; and development of a clinical record that will allow efficient data collection from records, even though the recording is done by a variety of health care providers.

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Clincal Manifestations of Patients Dying of Severe Community Acquired Pneumonia (중증 원외폐렴으로 사망한 환자의 임상적 분석)

  • Choi, Won-Il;Sohn, Jeong-Ho;Kwun, Oh-Yong;Heo, Jeong-Sook;Whang, Jae-Seok;Han, Seong-Beom;Jeon, Young-June
    • Tuberculosis and Respiratory Diseases
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    • v.41 no.5
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    • pp.537-545
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    • 1994
  • Background: In 1987, the British Thoracic Society (BTS) subjected an extensive list of patient variables to statistical analysis in a prospective study of prognosis in 453 adults with community-acquired pneumonia and, subsequently published guidelines for management of severe community acquired pneumonia. It was hoped that those at risk of dying from community acquired pneumonia could be easily identified and treated appropriately, thereby reducing mortality. To date, severe community acquired pneumonia has not been well studied in Korea. Therefore, we studied retrospectively 10 patients dying of severe community acquired pneumonia in Dongsan Hospital to see clinical manifestations of dying of severe community-acquired pneumonia. Methods: Between July 1987 and july 1993, 498 patients were admitted to Keimyung University Dongsan Hospital with community acquired pneumonia, and 77 of them received intensive care. Of the 77 patients, 10 patients died. We reviewed medical records of these patients. Results: 1) The mean age of the patients was 56.2 years(range, 25 to 75 years). There were 7 men and 3 women. Seven patients(70%) were older than 60years of age. 2) The clinical features on admission were as follows: tachypnca, hypoxemia, mental change, cyanosis, leukopenia, leukocytosis, azotemia, hypotension, hypoalbuminemia in order of frequency. Three patients had one abnormal physical finding, 3 patients had 2, 2 patients had 3, and 2 patients had none of these abnormal physical findings. All patients had at least one of the abnormal laboratory findings. 3) A potential bacterial pathogen was isolated in sputum culture from 2 patients. One was E.coli, the other Enterobacter species. Sputum stain were positive in eight cases (G(+)cocci in six, G(+) cocci and G(-)bacilli in two). 4) Features of respiratory failure were the main reasons for ICU transfer, but two patients were transferred only following a cardiac or respiratory arrest in the general ward. 5) The mean of 2.7 different antibiotics were given to the patients. The aminoglycoside and first generation cephalosporin were the most frequently prescribed antibiotics, followed by the third generation cephalosporin and vancomycin. The most frequently prescribed antibiotics combination was a 1st generation cephalosporin plus an aminoglycoside. 6) Seven patients death(70%) occured after admission within the first five days, and a mean duration of hospitaliztion was 11.2 days. Conclusion: As the results show most death occured within the first five days after admission and aged patients; consequently, an aggressive intensive treatment should be provided early to the patients with severe community acquired pneumonia, and we should pay more attention to the aged patients.

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Safety and Reactogenicity of the Inactivated Poliomyelitis Vaccine (PoliorixTM) in Korea (2006-2012) (우리나라 영아에서 주사용 소아마비 백신(PoliorixTM)의 안전성 및 이상반응에 대한 연구)

  • Sin, Jong Beom;Park, Moon Sung;Ma, Sang Hyuk;Choi, Young Youn;Shin, Son Moon;Kim, Won Duck;Kuriyakose, Sherine;Ulianov, Liliana;Hardt, Karin
    • Pediatric Infection and Vaccine
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    • v.20 no.3
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    • pp.139-146
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    • 2013
  • Objective: As per the requirement of Korean Food and Drug Administration, this post-marketing surveillance was conducted in Korea to evaluate the safety and reactogenicity of Poliorix$^{TM}$ following its introduction in 2006. Methods: In this open, multicenter study, the vaccine was administered as per the current practice of Korean doctors and in reference to the guidebook by the Korean Pediatric Society and as indicated in the Korean label which was as follows - for primary vaccination three doses were given to infants at ages 2, 4 and 6 months whereas, for the booster dose a single dose was given to children aged 4-6 years. Safety data during this six year surveillance was collected using diary cards which were distributed to the parents to record adverse events. Results: A total of 639 subjects were enrolled into the study. Of these, 617 subjects and 22 subjects received the vaccine as a primary and booster dose, respectively. At least one unsolicited symptom was reported in 11.4% (73/639) of the subjects during the 7-day follow-up period; upper respiratory tract infection (2.5%;16/639) was the most frequently reported unsolicited symptom. One subject reported at least one unsolicited symptom (gastroenteritis) of grade 3 intensity within the 31-day post-vaccination period. Approximately 1.7% (11/639) of subjects reported 13 serious adverse events (SAEs). All SAEs were resolved by the end of the study. Conclusion: In Korea, primary and booster vaccination with Poliorix$^{TM}$ was well-tolerated in healthy subjects when administered according to the prescribing information as part of routine clinical practice.

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The Result of Radiotherapy for Pituitary Adenoma (뇌하수체 선종의 방사선치료 결과)

  • Lee, Hyun-Joo;Yang, Kwang-Mo;Cho, Heung-Lae;Shon, Seung-Chang;Suh, Hyun-Suk
    • Radiation Oncology Journal
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    • v.15 no.4
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    • pp.297-303
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    • 1997
  • Purpose : To evaluate the prognostic factors for disease-free survival and long-term results of radiotherapy for pituitary adenoma. Methods and Materials : The study involved a retrospective review of out-come in a series of 27 patients with pituitary adenoma, between 1984 and 1995 at Paik hospital. The study included 20 patients treated with surgery and postoperative radiotherapy and 7 with radiotherapy alone. The patients were followed for 12-146 months (median : 97 months). Seventeen were men and 10 were women. The numbers of functioning and nonfunctioning pituitary adenorna were 22 and 5 respectively and those of microadenoma and macroadenoma were 4 and 23 respectively. The radiation doses of 5040-5580cGy (median : 5040cGy) were deliverd over 5-7 weeks, using 4MV LINAC. The prognostic factors were analyzed by log-rank test. Results: For radiation therapy alone, the 5YSR was 100% and progression free survival rate was 85.8%, The tumor was controlled in 6/7 (85.8%). For surgery and postoperative radiotherapy. the 5YSR, progression free survival rate and local control rate were 95%, 84.8%, and 89.5% respectively. The parameters of tumor size, hormone secretion, radiation dose. radiotherapy field size were evaluated in a uni- and multivariate analysis and all the factors were not statisticaIty significant (P>0.05). Eleven of 12 (92%) with visual field defect experienced normalization or improvement, and 5 for 7 evaluabie patients with hyperprolactinoma achived normalization in 4 and decrement in S patients. Only 2 patients developed mild degree of Panhypopituitarism. Conclusion: The radiotherapy appears to be effective in controiling clinical symptoms and signs resulting from pituitary adenoma. Local control rate with radiotherapy alone or with surgery and postoperative radiotherauy was comparable. There was a trend toward high recurrence rate in Patients with nonfunctioning or prolactin secretion tumor and larger radiation field sizes.

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Needs and Satisfaction of Cancer Patients on the Medical Services in Jeju Special Self-Governing Province (제주지역 암환자의 의료서비스 요구도 및 만족도 분석)

  • Kim, Woo-Jeong;Kim, Min-Young;Chang, Weon-Young;Choi, Jae-Hyuck
    • Journal of Hospice and Palliative Care
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    • v.13 no.3
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    • pp.153-160
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    • 2010
  • Purpose: The purpose of the present study was to investigate needs and satisfaction on the medical services of cancer patients in Jeju Special Self-Governing Province. Methods: Total 174 cancer patients, who visited at the clinic of Jeju National University Hospital, submitted informed consent and participated in this study from July 13 to July 30, 2009. Self questionnaire was used and data were analyzed with Kolmogorov-Smirnov test, Mann-Whitney U test, ANOVA, and Kruskal-Wallis test. Results: Participants expressed the needs of most economical support (3.38 out of 4), followed by counseling of treatment plan (3.22), information of disease (3.07), and disease management except cancer (2.97). Participants were satisfied most with religious counseling (3.41), followed by nursing service support (3.39), employment counseling (3.26), and counseling for family or interpersonal relationships (3.26). The satisfaction of economical support was the lowest (1.98). Satisfaction of men was higher than women, and needs in patients who were living with children was the highest. Patients who were living alone or with children showed the lowest satisfaction about the medical services. There were no significant differences in the general characteristics, however, participants who were older than 60 years of age or had higher income showed lower needs and higher satisfaction. There were no significant differences in the medical characteristics, however, thyroid cancer patients and patients who were treated with radiation therapy or transarterial embolization showed low satisfaction. Conclusion: Cancer patients seemed to need more economical support, information of treatment or disease, and symptom management. Furthermore, there were various needs about the services, depending on family formation or economical support of patients. Therefore, it is certain that patients who were suffering from other cancers, except the 5 major cancers, needed more services. In conclusion, continuous and systemic policy to consider patient's characteristics and needs are needed in community as well as health care system.

A Study on the Well-being Related Awareness and Dietary Life Pattern in Urban Housewives (도시 주부들의 웰빙에 대한 인식과 식생활유형에 대한 연구)

  • Park, Young-Sim;Myung, Choon-Ok;Lee, Ki-Wan;Nam, Hae-Won
    • Journal of the Korean Society of Food Culture
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    • v.20 no.5
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    • pp.574-583
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    • 2005
  • To investigate the importance and practice of well-being related dietary life pattern such as purchasing food materials, food habits and eating out, a survey was conducted by questionnaire and 5-point Likert score in Seoul and Gyeonggi-Do, September, 2004 and April, 2005. The responses of 732 housewives who were over 40 years were analyzed by SPSS package program. The results were as follows. Most of them were 40-49 years(74.4%), graduated highschool (66.6%) and their family type was nuclear family type(81.4%). Almost half of them had full-time job (37.1%) and part time job (15.4%). The average importance score of 'food habits', 'purchasing food materials' and 'eating out' were $4.15{\pm}0.91,\;4.06{\pm}0.96\;and\;3.25{\pm}1.01$ respectively. But the average practice score of 'food habits' was greater($3.58{\pm}1.06$) than 'purchasing food materials ($3.19{\pm}1.19$)' and 'eating out($2.54{\pm}1.05$)'. Among 5 types of 'food habits', the type of 'cut down on eating fast food' had the greatest score of importances ($4.31{\pm}0.97$) but the difference between importance and practice was greatest(0.94). Also 'consume home-made food rather than processed or ready to food' showed great scores in importance ($4.28{\pm}0.87$) and practice($3.87{\pm}1.04$). 'Consume fruits and vegetables rather than meats' and 'avoid heavy use of oils' had the importance score of $4.04{\sim}4.19$. But the practice score of 'avoid heavy use of oils' was the lowest($3.39{\pm}0.97$). Among four types of purchasing of food materials, 'purchase domestic agricultural food' was greatest($4.37{\pm}0.78$) and 'don't purchase genetically modified food' 'purchase organic food' and 'purchase whole grain products' were also great ($3.92{\sim}3.99$). But the practice score of 'purchase organic/low chemical foods($2.77{\pm}0.98$)' and 'don't purchase genetically modified food($2.99{\pm}1.41$)' were lowest. 'Go to well being restaurant' in three types of 'eating out' showed greatest in importance($3.35{\pm}0.96$) but the practice score($2.47{\pm}0.10$) was lower than the importance score. Also 'choose menu with comparing calories' had the lower score in practice($2.45{\pm}1.06$) rather than importance score($3.22{\pm}1.03$). In regarding to 'food habits', the importance score were significantly affected by type of food expense (p<0.05) and health status (p<0.05). The importance score of 'purchase food materials' were significantly affected by the type of food expense (p<0.001), type of residence(p<0.05), and self assessment of weight(p<0.05). Monthly income, especially more 400 million won, was the commonly significant effector in practice score of 'purchase food materials' and 'eating out'.

Effects of pH and Natural Polysaccharide Gums on the Foam Stability of Soy Protein Isolate (pH와 천연 다당류 고무질이 분리대두단백질의 거품안정성에 미치는 영향)

  • Yang, Seung-Taek;Kim, Mi-Sook;Park, Chun-Og
    • Korean Journal of Food Science and Technology
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    • v.24 no.5
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    • pp.482-491
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    • 1992
  • Experiments were conducted to elucidate the effects of pH change and sodium alginate, gum karaya and gum arabic on the foaming properties of soy protein isolate (SPI). The surface tensions of SPI solution (5%) adding to gums at pH 4.0 and 5.0, near the isoelectric point (pH 4.5) were higher than those at pH 7.0 and 8.0. Specific viscosity of the solutions adding to gums (0.1, 0.2 and 0.3%) at pH 7.0 and 8.0 were $3.6{\sim}51.8$ and $4.0{\sim}51.2$, respectively. In cases of addition of sodium alginates specific viscosity were predominantly increased, while those of gum arabic did not almost increase. Addition of gums reduced the overrun, but it stabilized the foams, especially those of sodium alginates (0.2%) increased the foam stability at pH 5.0, 7.0 and 8.0 by 57, 413 and 315%, respectively. Foaming ability, foam stability and heat stability of the foam were significantly (p<0.05) affected by changing pH. There was a tendency to increase the foaming ability according to the decrease of surface tension. Specific viscosity was also important in foam stability and heat stability.

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Effects of Astringent Persimmon Paste on Quality Properties of Injeolmi (떫은감 농축액을 첨가한 인절미의 품질 특성)

  • Hong, Jin-Sook;Kim, Myoung-Ae
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.34 no.8
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    • pp.1232-1238
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    • 2005
  • The purpose of this study was to find the optimum addition amount of astringent persimmon paste to glutinous rice flour in the preparation of Gaminjeolmi (persimmon glutinous rice cake). The moisture contents of Gaminjeolmi with added astringent persimmon paste were 57$\∼$59$ \% $. With increasing addition of astringent persimmon paste, the L- and b-value were decreased. The a-value was the highest at the 8$\%$ level. In the mechanical evaluation of Gaminjeolmi, the hardness was the highest in the 0$\%$ astringent persimmon paste-lnjeolmi but the 0$\%$ level was decomposed after 2 day of storage. The adhesiveness and cohesiveness were the lowest at the 0$\%$ and 16$\%$ levels. The springiness did not differ significantly with the addition of astringent persimmon paste for 2 days of storage. The gumminess was the highest at the 0$\%$ level for 1 day of storage, significantly. In the sensory evaluation of Gaminjeolmi, the acceptance of the softness characteristics was the best at the 8$\%$ level. Addition of astringent persimmon paste improve preservation of Injeolmi and the addition of 8$\%$ of astringent persimmon paste to glutinous rice flour was found to be the best recipe in terms of the sensory qualities of softness and overall acceptability.

Comparative Study on Eating Habits, Dietary Intake Patterns, and Nutrient Intakes Between Elementary School Children With and Without Atopic Dermatitis (일부 초등학생의 아토피피부염 유무에 따른 식습관, 식품섭취양상 및 영양소섭취상태 비교 연구)

  • Park, Nam-Suk;Jeon, Eu-Sun;Kim, Young-Nam;Cho, Kyung-Dong;Baek, Ok-Hee;Lee, Bog-Hieu
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.38 no.11
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    • pp.1543-1550
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    • 2009
  • The aim of this study was to examine and compare the eating habits, dietary intake patterns and nutrient intake status of children with and without atopic dermatitis by questionnaire during July, 2008. A total 388 subjects of 5th and 6th grade elementary school children (AG: atopic group, n=65, NG: non-atopic group, n=323) in Seoul and Ulsan areas participated in this study. The questionnaire included general characteristics, dietary habits, and atopy-related food frequency. One-day 24 hour recall was collected to estimate nutrient intakes of the subjects. The data were analyzed by Chi-square test for food frequency analysis and by t-test for nutrient intakes. Atopy-related foods included milk, buckwheat, beef, pork, chicken, crab, egg, mackerel, peach, and tomato. From the findings, AG had a more irregular eating habit than NG (p<0.05). In case of food frequency, AG tended to consume more atopy-related foods than NG (p>0.05). The nutrient intakes of AG were significantly lower than those of NG (p<0.05), but only intake of animal iron in AG was higher than NG (p<0.05). NG consumed more protein than AG (p<0.05). Although milk was a noted hypersensitive allergic food, frequency and the amount of milk intake were not significantly different between two groups. In conclusion, atopic children had eaten more atopy-related foods and less nutrient intakes. Therefore, it is necessary to educate on good nutrition and guide atopic children and their parents.

Prediction of commitment and persistence in heterosexual involvements according to the styles of loving using a datamining technique (데이터마이닝을 활용한 사랑의 형태에 따른 연인관계 몰입수준 및 관계 지속여부 예측)

  • Park, Yoon-Joo
    • Journal of Intelligence and Information Systems
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    • v.22 no.4
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    • pp.69-85
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    • 2016
  • Successful relationship with loving partners is one of the most important factors in life. In psychology, there have been some previous researches studying the factors influencing romantic relationships. However, most of these researches were performed based on statistical analysis; thus they have limitations in analyzing complex non-linear relationships or rules based reasoning. This research analyzes commitment and persistence in heterosexual involvement according to styles of loving using a datamining technique as well as statistical methods. In this research, we consider six different styles of loving - 'eros', 'ludus', 'stroge', 'pragma', 'mania' and 'agape' which influence romantic relationships between lovers, besides the factors suggested by the previous researches. These six types of love are defined by Lee (1977) as follows: 'eros' is romantic, passionate love; 'ludus' is a game-playing or uncommitted love; 'storge' is a slow developing, friendship-based love; 'pragma' is a pragmatic, practical, mutually beneficial relationship; 'mania' is an obsessive or possessive love and, lastly, 'agape' is a gentle, caring, giving type of love, brotherly love, not concerned with the self. In order to do this research, data from 105 heterosexual couples were collected. Using the data, a linear regression method was first performed to find out the important factors associated with a commitment to partners. The result shows that 'satisfaction', 'eros' and 'agape' are significant factors associated with the commitment level for both male and female. Interestingly, in male cases, 'agape' has a greater effect on commitment than 'eros'. On the other hand, in female cases, 'eros' is a more significant factor than 'agape' to commitment. In addition to that, 'investment' of the male is also crucial factor for male commitment. Next, decision tree analysis was performed to find out the characteristics of high commitment couples and low commitment couples. In order to build decision tree models in this experiment, 'decision tree' operator in the datamining tool, Rapid Miner was used. The experimental result shows that males having a high satisfaction level in relationship show a high commitment level. However, even though a male may not have a high satisfaction level, if he has made a lot of financial or mental investment in relationship, and his partner shows him a certain amount of 'agape', then he also shows a high commitment level to the female. In the case of female, a women having a high 'eros' and 'satisfaction' level shows a high commitment level. Otherwise, even though a female may not have a high satisfaction level, if her partner shows a certain amount of 'mania' then the female also shows a high commitment level. Finally, this research built a prediction model to establish whether the relationship will persist or break up using a decision tree. The result shows that the most important factor influencing to the break up is a 'narcissistic tendency' of the male. In addition to that, 'satisfaction', 'investment' and 'mania' of both male and female also affect a break up. Interestingly, while the 'mania' level of a male works positively to maintain the relationship, that of a female has a negative influence. The contribution of this research is adopting a new technique of analysis using a datamining method for psychology. In addition, the results of this research can provide useful advice to couples for building a harmonious relationship with each other. This research has several limitations. First, the experimental data was sampled based on oversampling technique to balance the size of each classes. Thus, it has a limitation of evaluating performances of the predictive models objectively. Second, the result data, whether the relationship persists of not, was collected relatively in short periods - 6 months after the initial data collection. Lastly, most of the respondents of the survey is in their 20's. In order to get more general results, we would like to extend this research to general populations.