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Attitudes of Medical Students' towards End-of-life Care Decision-making (일개 의과대학생의 말기 환자 치료 결정에 대한 태도)

  • Oh, Seung-Min;Cho, Wan-Je;Kim, Jong-Koo;Lee, Hye-Ree;Lee, Duk-Chul;Shim, Jae-Yong
    • Journal of Hospice and Palliative Care
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    • v.11 no.3
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    • pp.140-146
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    • 2008
  • Purpose: Sooner of later, end-of-life care decision-making will unfold and be settled during the professional lives of medical students. However, there is prevalent ambiguity and uncertainty between the palliative treatment and euthanasia. We conducted this survey to investigate attitudes of medical students towards end-of-life making decisions, and to find out which factors primarily influenced the attitudes. Methods: A study was conducted among medical students at one university, the Republic of Korea. A written questionnaire was sent to all the 1st, 2nd, and 3rd-year medical students. It presented 5 statements on end-of-life decision-making. Students were asked whether they agreed or disagreed with each statement. Results: The response rate was 74.4%, and 267 questionnaires were analyzed. Percentages of agreement with each statements on Voluntary active euthanasia (VAE), Physician assisted suicide (PAS), Withholding life-sustaining management, Withdrawing life-sustaining management, and Terminal sedation (TS) was 37.1%, 21.7%, 58.4%, 60.3%, and 41.6%, respectively. The grade of students, religious activity, and educational experience were determinant factors. Agreement on each statements was higher in the low religious activity group than in the high religious activity group. Agreement on TS was higher among 3rd year students during their clerkship than among 1st and 2nd year students. Age of students and the experience of dying-people care had no significant influence. Conclusion: In end-of-life decision-making, religious and educational factors influenced medical students' attitudes. Especially, the experience of education during clerkship had significant influence on the attitude. Proper teaching on end-of-life decisions should further be considered during medical students' clerkship.

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A Study on the Goal-Orientation of QI Performers in the Medical Centers (의료기관 QI 담당자의 목표추구몰입에 관한 연구)

  • Kim, Mi-Sook;Park, Jae-Sung
    • The Korean Journal of Health Service Management
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    • v.2 no.1
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    • pp.105-124
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    • 2008
  • The purpose of this research is to provide the data base for the activation of Quality Improvement operation through investigating the status of Quality Improvement operation, and finding out factors influencing on the goal-orientation of QI performers in the medical centers of more than one hundred beds where are practicing Quality Improvement operation. In order to reach the purpose, document study was carried out grounded on the proceeding researches and formulated statistical data in relation with the status of Quality Improvement performers, and proof study was carried out through questionnaire survey. The subjects of the survey were the Quality Improvement performers working in seventy three medical centers in Pusan-Gyeongnam, Daegu-Gyeongbuk, and Ulsan. Among eighty three Quality Improvement performers, fifty, five were questionnaire surveyed, on the result of which Reliability Analysis, Factor Analysis, and Multiple Regression Analysis were made, using statistical program. The the results of the proof analysis on this research are as follows. First, in the factors influencing the devoting to goal pursuit of QI performers, organization-goal contribution(0.44) had significant positive effects, while organization conflict(-0.25) had significant negative effects. In other words, the higher the organization-goal contribution was, the higher the devoting to goal pursuit was, while the less the organization conflict was, the higher the devoting to goal pursuit was, which was statistically significant.(p<0.05). Second, in the aspect of goal performance types of QI performers, the process-centered type showed high level of the devoting to goal pursuit, which was statistically significant.(p<0.05). Third, in the aspect of QI performance degree, the higher the devoting to goal pursuit was, the higher the QI performance degree was, which was statistically significant.(p<0.05). In addition, the performers who perceived their workplaces organic structure showed much higher QI performance degree, which statistically significant.(p<0.05). Generalizing the results of this research, it is possible to offer a few suggestions as follows. First, as the competition among the medical centers is more severe recently owing to medical center evaluation system, medical centers are practicing various Quality Improvement operation in all of medical services such as clinical performance and management performance, to reach the purpose of both cost-cutting and medical quality improvement. Thus in order to practice Quality Improvement operation more efficiently in medical centers, it is essential to nuke use of problem-solving methods and statistical members. This as the willingness of chief executives and positive attitude and recognition of organization members. This requires the installation of divisions in charge and disposition of persons in charge, not to speak of persistent training of Quality Improvement. Second, the divisions in charge of QI carry out Quality Improvement operation at the medical center level, and take the role of generalizing and adjusting QI performances of various departments. Owing to this role, the division in charge of QI is considered indispensable organization in the QI operation of medical centers along with medical QI committee, while it contributes to the government's goal of reducing quality level gaps among medical centers. Therefore it is necessary for government and QI organizations to give institutional support and resources for the sake of QI operation of medical centers, besides to supply systematic trainning and informations to the divisions and persons in charge of QI. Third, it is certain that disposition of persons in charge should be determined in view of the scale and the scope of QI operation in medical centers.

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An Awareness of Welfare Facility for the Elderly and It's Related Factors of College Students (노인복지시설(老人福祉施設)에 대한 대학생(大學生)의 의식(意識)과 관련요인(關聯要因))

  • Jowa Yooun-Teak;Nam Chul-Hyun;Park Chun-Man
    • Journal of Society of Preventive Korean Medicine
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    • v.2 no.1
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    • pp.87-111
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    • 1998
  • For the newly approach of policy with the old aged era at hand, the result which examines the 1,200 students attending professional colleges and upward in three small-to-medium sized cities, for two months, from October 1, 1996 to November 30, in order to know the change of consciousness of the growing modern young intellectual age group is as follows. 1. The objects of survey consist of 72.1% of women, 40.4% of 20 to 21 age, 49.1% of atheists, and people from big cities and fishing and agrarian village occupy equally 40.2%. Concerning the long-termed residents, 49% of them dwell in big cities. In case of the parents' age is more than 55, 31.5% in fathers, and 10.9% in mothers. 2. The types of housing in which they desire to reside in their getting older are : 72.8% of them hope to live in individual houses, 16.6% in apartments or villas, and 3.4% in social welfare facilities. Out of respondents, compared with other groups, man rather than woman, those who are 20 to 21 age group and from fishing and agrarian villages and have over 7 family members and live with their parents have a higher preference for independent houses. 3. The districts in which they hope to live when they are old are : 41.6% of them, with the highest percent, hope to live in farming villages, the older they are, the more they hope to live in agricultural district, and women of 21 years and upward hope to live in big cities. On the other hand, the preferable degree for social welfare facilities is higher each in people who are 24 years and upward, buddhists, self-boarding students, and the more poorly they are off, the higher the percent is. 4. The types of preferable welfare facilities for the elderly are : 58.2% of them think silver towns desirable, 28.4% think the charged (or free) elderly welfare facilities. Compared with other groups, the percentage which prefer silver towns is higher in women, people from big cities, residents of main family, long-termed city residents, people with higher income, people having grandparents alive, and people who had experience of taking lectures on hygienics or social welfare. 5. 50.3% of the respondents insist that provision of living expenses against old age should be insured by social security system, and 42.8% by the elderly themselves. The percentage of the former shows higher in people of 21 years and upward, women, residents of fishing and agrarian villages, christians, people in more needy circumstances and people who have experience of using a medical institution. 6. Compared with other nations, 54.5% of the respondents have an opinion that elderly welfare and welfare work in Korea stays in insufficient level and most of them are women, people from farming village, residents of head family, people having younger parents and people being worse health condition, and they have a more positive attitude about the elderly welfare work. 7. 92.3% of the respondents answered that a national budget for the elderly welfare is scarce, and the percentage is higher in people who are older, residents of big cities, people in lower living condition and people in worse health condition. 8. 35.2% of the respondents answered that the proper cost of their old age must be over 220mi11ion. The more a family's total income is, the higher the percentage is. 9. The factors which have an effect on the preference of silver towns are sex(p<0.01, the type of the present residence(p<0.05), and a family's total income(p<0.05). 10. From the survey result of the above, we comes to the conclusion that, for the sake of welfare of the increasing elderly population, government authorities and parties concerned must exert their utmost for the elderly welfare by increasing a budget of it and establishing a number of facilities of the elderly welfare and silver towns located in fresh and comfortable villages. In addition, they have to set up a course of hygienics in all the colleges and instruct the contexts on hygienic welfare as well.

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A Study on Need Assessment in Health Promotion Programs for Developing Nursing Centers - Breast Self Examination- (간호센타 개발을 위한 건강증진 프로그램 요구사정 연구-유방자가검진 프로그램을 중심으로-)

  • Park, In-Hyae;Kang, Hae-Young;Lee, Jeong-Hee;Ryu, Hyun-Sook
    • Research in Community and Public Health Nursing
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    • v.11 no.1
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    • pp.21-36
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    • 2000
  • The purpose of this study was to assess the needs of breast self examination education (BSEE) programs for developing nursing centers. A first, we reviewed the literature of activity and management-related factors of nursing centers: and, second. we used a questionnaire to discover the degree of knowledge, attitude, and practice on breast cancer, as well as an individual's intention to participate BSEE program. 1. Reviewing the literatures of nursing center activities. Nursing centers which were administered by a professional nurse are an ideal site for faculty and student practices. With the use of nursing models of health. professional nurses in nursing centers diagnose and treat human responses to potential and actual health problems and offer holistic, client-centered health service. In nursing centers professional nursing services include health education, health promotion, and health-related research. A nursing center is comprised of the advisory and exacutive commitee; the advisory commitee serves consultants and links community needs to the nursing center, while the director of the exacutive commitee identifies the potential resources to generate funds, support, and facilitate the activities of staffs in a nursing center. Nursing centers mobilize various financal resources for reimbursement of services from college and insurance companies, collect minimum service fees from the client, and further collect fees for providing programs to community groups, this also includes membership fees, and donations. The services provided by nursing centers focus on services related to primary prevention, health maintenance & health promotion, direct nursing care for acute & chronic diseases, and holistic care for actual and potential health problems. The client satisfaction for the services was high. Students also showed positive reponses for their clinical experiences and independent working conditions. 2. The degree of knowledge, attitudes, and practices for breast cancer. and an individual's intention to participate in the BSEE program. The subjects of this study were 308 females in K-city in the Republic of Korea. Data were collected using a self-administered questionnaire. The mean age of the respondents was 35.0 years old. Those who already participated in the BSEE were 64.9%, and those who had support and encouragement to practice BSE from significant others were 25.1 %. Clients intent to participate in the BSEE were 37.0%. The mean score of knowledge(2.4 out of 5 points) and practices(1.8 out of 5 points) for breast cancer were quite low, but the mean score of attitudes was relatively positive04.5 out of 20 point) for breast cancer. Those who already had BSEE showed significantly high scores in knowledge(t=6.48, p<0.01), attitudes (t=10.54, p<0.01). and practices(t=57.07, p<0.001) for breast cancer than those who had not participated in the BSEE. In all age groups no intention to participate in the BSEE was higher than who the intention to participate. These findings suggest some strategies should be developed to increase the awareness of breast cancer's early detection.

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The Empirical Study on the Effects of the Team Empowerment caused by the Team-Based Organizational Structure in KBS (팀제가 팀 임파워먼트에 미치는 영향에 관한 연구;KBS 팀제를 중심으로)

  • Ahn, Dong-Su;Kim, Hong
    • 한국벤처창업학회:학술대회논문집
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    • 2006.04a
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    • pp.167-201
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    • 2006
  • Korean corporations are transforming their vertical operational structure to a team-based structure to compete in the rapidly changing environment and for improved performance. However, a high percentage of the respondents in KBS said that despite the appearance of the present team structure, the organization operates much like a vertically-structured organization. This result can be attributed to the lack of study and implementation toward the goal of empowerment, the key variable for the success of the team-based structure. This study aims to provide policy suggestions on how to implement the process of empowerment, by investigating the conditions that hinder the process and the attitude of the KBS employees. For the cross-sectional study, this thesis examined the domestic and international references, conducted a survey of KBS employees, personal interviews and made direct observations. Approximately 1,200 copies of the Questionnaire were distributed and 474 were completed and returned. The analysis used SPSS 12.0 software to process the data collected from 460 respondents. For the longitudinal-study, six categories that were common to this study and "The Report of the Findings of KBS Employees' View of the Team Structure" were selected. The comparative study analyzed the changes in a ten-month period. The survey findings showed a decrease of 24.2%p in the number of responses expressing negative views of the team structure and a decrease of 1.29%p in the number of positive responses. The findings indicated a positive transformation illustrating employees' improved understanding and approval of the team structure. However, KBS must address the issue on an ongoing basis. It has been proven that the employee empowerment increases the productivity of the individual and the group. In order to boost the level of empowerment, the management must exercise new, innovative leadership and build trust between the managers and the employees first. Additional workload as a result of shirking at work places was prevalent throughout all divisions and ranks, according to the survey data. This outcome leads to the conclusion that the workload is not evenly distributed or shared. And the data also showed the employees do not trust the assessment and rewards system. More attention and consideration must be paid to the team size and job allocation in order to address this matter; the present assessment and rewards system need to be complemented. The type of leadership varies depending on the characteristics of the organization's structure and employees' disposition. KBS must develop and reform its own management, leadership style to suit the characteristics of individual teams. Finally, for a soft-landing of KBS team structure, in-house training and education are necessary.

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A Study on the Emotional Labor of Sales Workers at Department Stores (백화점 판매사원의 감정노동에 관한 연구)

  • Bae, Jun-Chul;Kim, Pan-Jin
    • Journal of Distribution Science
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    • v.9 no.4
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    • pp.75-82
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    • 2011
  • Along with economic development, the service industry is growing as days go by. Therefore, companies should maximize customer satisfaction through continuous changes by providing services which are suitable for customer needs. The general service industry has a decisive effect on the rate of growth and profitability of a superior business. Therefore, many companies try to provide the best customer service to increase profitability. Because service to a customer is delivered through interactions with the employee, the employee's attitude has a strong influence on the customer's satisfaction level. For these, most service industries are required to provide new types of labor. It is often referred to 'Emotional Labor', and that is different from physical and mental labor. Service providers always provide a service for the customers with a smile, even though they conceal their emotions. The Purpose of this study is to identify theologically the fact of that Sales Workers at Department Stores emotional labor, according to the economization of service, has become to decide the predominance of competition among companies and represents the quality of service ; to confirm that their emotion management is a crucial part of the work; to identify the correlation among job stress and job satisfaction which are experienced in the process of performing display rules required by organization. To practice them, this study deals with the theological consideration of the emotional labor, job stress and job satisfaction. This study proceeded to evaluate how the emotional labor of sales workers at department stores effected on their job stress and satisfaction. The result of this study will be summarized below. First of all, the frequency of emotional display and attentiveness required to display emotions both have a similar effect on the level of job stress. In the case of the emotional dissonance, there isn't a great amount of proof that it effects the job stress. That shows us that the aspect of the latter, they express the feelings on their daily lives less than the former by the public awareness and gaze. so, once they could accept the latter, the effect on the job stress would be vanished. Second, a study was performed to figure out the effect of emotional labor on job stress. As a result, none of them make negative effects on the job satisfaction but the attentiveness to required display rules even have positive effects on it. that means the emotional labor has an indirect effect on the job satisfaction through some intermediation stuff. Third, the role conflict of job stress factors has a negative effect on job satisfaction, Although role ambiguity has a negative effect on that as well, I couldn't find appropriate proof for that. As far as I figured out, job stress can only increase job dissatisfaction. In other hands, the sales workers would have tendencies to have more motivation to work hard rather than reveal their job stress and complain about work. Finally, emotional laborers always work close to job stress. This can maximize service for the customers, but it increases stress of the laborers providing services at the same time. Then, they can not provide high quality service. It is no doubt that we need to begin managing it systematically. In conclusion, the work satisfaction of the sales workers is connected to the service quality for the customers directly.

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A Study on the Design of Case-based Reasoning Office Knowledge Recommender System for Office Professionals (사례기반추론을 이용한 사무지식 추천시스템)

  • Kim, Myong-Ok;Na, Jung-Ah
    • Journal of Intelligence and Information Systems
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    • v.17 no.3
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    • pp.131-146
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    • 2011
  • It is becoming more essential than ever for office professionals to become competent in information collection/gathering and problem solving in today's global business society. In particular, office professionals do not only assist simple chores but are also forced to make decisions as quickly and efficiently as possible in problematic situations that can end in either profit or loss to their company. Since office professionals rely heavily on their tacit knowledge to solve problems that arise in everyday business situations, it is truly helpful and efficient to refer to similar business cases from the past and share or reuse such previous business knowledge for better performance results. Case-based reasoning(CBR) is a problem-solving method which utilizes previous similar cases to solve problems. Through CBR, the closest case to the current business situation can be searched and retrieved from the case or knowledge base and can be referred to for a new solution. This reduces the time and resources needed and increase success probability. The main purpose of this study is to design a system called COKRS(Case-based reasoning Office Knowledge Recommender System) and develop a prototype for it. COKRS manages cases and their meta data, accepts key words from the user and searches the casebase for the most similar past case to the input keyword, and communicates with users to collect information about the quality of the case provided and continuously apply the information to update values on the similarity table. Core concepts like system architecture, definition of a case, meta database, similarity table have been introduced, and also an algorithm to retrieve all similar cases from past work history has also been proposed. In this research, a case is best defined as a work experience in office administration. However, defining a case in office administration was not an easy task in reality. We surveyed 10 office professionals in order to get an idea of how to define a case in office administration and found out that in most cases any type of office work is to be recorded digitally and/or non-digitally. Therefore, we have defined a record or document case as for COKRS. Similarity table was composed of items of the result of job analysis for office professionals conducted in a previous research. Values between items of the similarity table were initially set to those from researchers' experiences and literature review. The results of this study could also be utilized in other areas of business for knowledge sharing wherever it is necessary and beneficial to share and learn from past experiences. We expect this research to be a reference for researchers and developers who are in this area or interested in office knowledge recommendation system based on CBR. Focus group interview(FGI) was conducted with ten administrative assistants carefully selected from various areas of business. They were given a chance to try out COKRS in an actual work setting and make some suggestions for future improvement. FGI has identified the user-interface for saving and searching cases for keywords as the most positive aspect of COKRS, and has identified the most urgently needed improvement as transforming tacit knowledge and knowhow into recorded documents more efficiently. Also, the focus group has mentioned that it is essential to secure enough support, encouragement, and reward from the company and promote positive attitude and atmosphere for knowledge sharing for everybody's benefit in the company.

A Study on the Nurse's Response for the Clinical Application of Nursing Diagnosis (간호진단 임상적용을 위한 교육프로그램의 효과 및 간호사의 반응조사 연구)

  • Chun, C.Y.;Lim, Y.S.;Kim, Y.S.;Park, J.W.;Cho, K.S.
    • The Korean Nurse
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    • v.29 no.1
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    • pp.59-71
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    • 1990
  • Although the usefulness and importance of clinical application of nursing diagnosis are well recognized by the academic circle, it is not yet generally practiced. In order to provide data for establishing a policy for clinical nursing diagnosis; a study was made at a seminar, sponsored by the Department of nursing, Severance Hospital, with participation of 190 nurses from 33 hospitals. The objective of the study was to find out; 1) if the nurses agree with the academic community in recognizing the benefits and problems of clinical application of nursing diagnosis; 2) how the nurses evaluate their ability to carry out nursing diagnosis; and 3) if educational programs would help enhance ability of nursing diagnosis among nurses. The summary of findings by the study is as follows; 1. While all nurses responded positively on the question of benefits improving science and quality of nursing, thus elevating credibility and position of nurses, some expressed concern on the practicality of the system in setting up nursing objectiveness, confirming the nursing problems and utilizing patient information. For the 20 questions and the scale of 1~5, the lowest average score was 3.223 and the highest 4.066. 2. The study attempted to find out the opinion of the nurses on the problems that 'would make difficult to adopt the nursing diagnosis in clinics. The result of the study indicates the nurses believe the major problems are the fact that the subject of nursing diagnosis are not well defined and that the form sheets do not match with the ones that are currently being used. However, comparing it with the result of the previous study on the same question (inadequate manpower and insufficienf time allocated for the job were two major problems pointed out then.), it can be said that the opinion of the nurses studied this time was much more positive and it suggests that they believe the system can be adopted without increasing manpower and only by giving additional training and by adjusting the format of nursing record sheets. It suggests that the future for adopting a clinical nursing diagnosis is very bright. 3. As the most urgent problem to be solved for adopting clinical nursing diagnosis, 38. 5% responded that it was "education of nurses, "and 34.2% responded that it was "staffing adequate number of nurses". 4. For the 10 questions asked for self-evaluation of ability to adopt the system, with the scale of 1~5, average score was lower than 3. This indicate that they evaluate their ability to adopt the system is low. 5. The results of study taken before and after the educational programs for clinical nursing diagnosis were compared with overall score in order to determine if such program would cause changes in the response to the effect of clinical application of nursing diagnosis, and it was found that there was statistically significant changes suggesting that the education contributed to positive change in the response. 6. The results of study taken before and after the educational programs for clinical nursing diagnosis were compared with overall score in order to determine how the proble~ ms for adopting nursing system would be effected by such educational programs, and it was found that those problems be not soived with a short course of training. 7. The results of study taken before and after the educational programs for clinical nursing diagnosis were compared with overall score in order to determine if such programs would bring changes in the self-evaluation of nurses on the ability of nursing diagno sis, and it was found that program improve score of self-evaluation their ability of the nursing diagnosis. As seen in the above reports, it was found that the nu'rses are very positive about the clinical nursing diagnosis, that educational program for the clinical nursing diagnosis helps nurses for positively changing their attitude for ,the nursing diagnosis, for their self-confidence on their ability to perform nursing diagnosis. With improved know-how and self"confictence of nurses gained through educational and .training programs, the future of clinical application of nursing diagnosis is very bright.diagnosis is very bright.

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Analysis of Safety Education Contents of 『Field of home life』 in Technology·Home Economics Textbook developed by the revised curriculum in 2009 (2009 개정 기술·가정 교과서 『가정생활영역』의 안전교육 내용 분석)

  • Kim, Nam Eun
    • Journal of Korean Home Economics Education Association
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    • v.29 no.2
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    • pp.23-39
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    • 2017
  • The Purpose of this study is to present the basic data for selecting and improving the safety education contents which help practically middle school students through analysis of contents of safety education in 'field of home life' of 2009 revised middle school textbooks. The subjects of analysis are 12 types of middle school textbooks: in total 24 books written by 12 publishers in terms of the revised curriculum in 2009. The analysis criteria is developed by the researcher referring to preceding studies regarding safety education based on the seventh safety education standard presented by the Ministry of Education (2015). With such analysis criteria, all words related to the contents of the safety education of analysis criteria were extracted from each textbook, such as words directly mentioned as 'safety', words mean as 'psychological safety' and 'happy life', words related to 'attention', 'note', 'stability' etc. Under the analytic frame of safety education contents according to a home economics textbook, content analysis method was used for producing the frequency and percent of those words. The textbook analysis shows that the number of pages regarding safety education is 336.3 pages, as 9.8% in total 3,412 pages of 12 types of technology and home economics textbooks. As following the analysis of each textbook volume of the proportion in the contents related to safety education, 224.9 pages are on the first volume and 111.9 pages are on the second volume. As grades increase from year one to year three, the proportion of safety education in home economics textbooks is decreased. The highest number of safety education contents unit is 'Self-management of youth' which includes three parts of safety education. In the case of a unit for emphasizing practice, experience and practical exercise such as 'Life of youth' and 'Practice of eco-living', safety education content in the area of 'life safety' are mostly contained. Safety accidents related to the most student experienced, Household accidents (1.4%) and experiment or practice accidents (0.3%) are presented in a low figure. The contents of universal housing and school violence are duplicated on first and second volume of text. The most presented safety education content in the 12 types of textbooks are proper sexual attitude, dietary problems, family conflict and food choice. The least common contents are dangerous drugs, family welfare, internet addiction and industrial accident compensation insurance. As this study is to analyze 12 textbooks developed in 2009 revision curriculum, it is necessary to compare it with the textbook written by the revised curriculum in 2015 and to clarify the contents system of safety education and to avoid duplication of contents. In addition, it is necessary to develop and distribute a safety education program that can support textbooks.

A Comparative Case Study on the Adaptation Process of Advanced Information Technology: A Grounded Theory Approach for the Appropriation Process (신기술 사용 과정에 관한 비교 사례 연구: 기술 전유 과정의 근거이론적 접근)

  • Choi, Hee-Jae;Lee, Zoon-Ky
    • Asia pacific journal of information systems
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    • v.19 no.3
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    • pp.99-124
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    • 2009
  • Many firms in Korea have adopted and used advanced information technology in an effort to boost efficiency. The process of adapting to the new technology, at the same time, can vary from one firm to another. As such, this research focuses on several relevant factors, especially the roles of social interaction as a key variable that influences the technology adaptation process and the outcomes. Thus far, how a firm goes through the adaptation process to the new technology has not been yet fully explored. Previous studies on changes undergone by a firm or an organization due to information technology have been pursued from various theoretical points of views, evolved from technological and institutional views to an integrated social technology views. The technology adaptation process has been understood to be something that evolves over time and has been regarded as cycles between misalignments and alignments, gradually approaching the stable aligned state. The adaptation process of the new technology was defined as "appropriation" process according to Poole and DeSanctis (1994). They suggested that this process is not automatically determined by the technology design itself. Rather, people actively select how technology structures should be used; accordingly, adoption practices vary. But concepts of the appropriation process in these studies are not accurate while suggested propositions are not clear enough to apply in practice. Furthermore, these studies do not substantially suggest which factors are changed during the appropriation process and what should be done to bring about effective outcomes. Therefore, research objectives of this study lie in finding causes for the difference in ways in which advanced information technology has been used and adopted among organizations. The study also aims to explore how a firm's interaction with social as well as technological factors affects differently in resulting organizational changes. Detail objectives of this study are as follows. First, this paper primarily focuses on the appropriation process of advanced information technology in the long run, and we look into reasons for the diverse types of the usage. Second, this study is to categorize each phases in the appropriation process and make clear what changes occur and how they are evolved during each phase. Third, this study is to suggest the guidelines to determine which strategies are needed in an individual, group and organizational level. For this, a substantially grounded theory that can be applied to organizational practice has been developed from a longitudinal comparative case study. For these objectives, the technology appropriation process was explored based on Structuration Theory by Giddens (1984), Orlikoski and Robey (1991) and Adaptive Structuration Theory by Poole and DeSanctis (1994), which are examples of social technology views on organizational change by technology. Data have been obtained from interviews, observations of medical treatment task, and questionnaires administered to group members who use the technology. Data coding was executed in three steps following the grounded theory approach. First of all, concepts and categories were developed from interviews and observation data in open coding. Next, in axial coding, we related categories to subcategorize along the lines of their properties and dimensions through the paradigm model. Finally, the grounded theory about the appropriation process was developed through the conditional/consequential matrix in selective coding. In this study eight hypotheses about the adaptation process have been clearly articulated. Also, we found that the appropriation process involves through three phases, namely, "direct appropriation," "cooperate with related structures," and "interpret and make judgments." The higher phases of appropriation move, the more users represent various types of instrumental use and attitude. Moreover, the previous structures like "knowledge and experience," "belief that other members know and accept the use of technology," "horizontal communication," and "embodiment of opinion collection process" are evolved to higher degrees in their dimensions of property. Furthermore, users continuously create new spirits and structures, while removing some of the previous ones at the same time. Thus, from longitudinal view, faithful and unfaithful appropriation methods appear recursively, but gradually faithful appropriation takes over the other. In other words, the concept of spirits and structures has been changed in the adaptation process over time for the purpose of alignment between the task and other structures. These findings call for a revised or extended model of structural adaptation in IS (Information Systems) literature now that the vague adaptation process in previous studies has been clarified through the in-depth qualitative study, identifying each phrase with accuracy. In addition, based on these results some guidelines can be set up to help determine which strategies are needed in an individual, group, and organizational level for the purpose of effective technology appropriation. In practice, managers can focus on the changes of spirits and elevation of the structural dimension to achieve effective technology use.