• Title/Summary/Keyword: Clinical judgement

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Nursing Managemant, Strategies for its success (간호관리자 역할의 성공적 수행을 위한 연구)

  • Kim, So-In
    • The Korean Nurse
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    • v.29 no.5
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    • pp.46-53
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    • 1991
  • In the past, management had been done over nurses rather than nursing and this brought the existence of general manager and as a result, nurse-manager's position and role are being threatend. For the up-bringing of nursing to firm professional recognition in the 21st century, it is firmly believed that nursing managers are to be in the position to play the role of general manager with professional qualifications; personal qualities and exact understandings on the role and function of each tier group under her/his management. 124 top(3 nursing superintendents), middle-range(23 supervisors) and unit managers(98 head-nurses) from 3 university hospitals in Seoul were interviewed in order to investigate their belief in the role, professional qualifications, personal qualities as well as the strategy for the development of their leadership qualities. The frame of reference for the interview were developed by the researcher in reference to relevant literatures. It was the common belief that qualifications o[ top-managers and mid-managers require an educational background of master's preparation or higher and clinical career for at least 15 years for top-managers and 5 -10 years for mid-managers. The personal qualities required by nurse managers include; leadership, initiative, judgement, self-confidence, flexibility, open-mindedness and strong motivation. Achievment-orientedness would greatly help them become excellent managers. On the other hand, [or more effective management, managers of each teir group are to fully understand their role and perform "their job responsibilities ie. Top managers are supposed to study with emphasis on organization, function and conceptual s~ill while mid-managers concentrate their effort on the development of skills for direction, guidance and human relationship. Unit managers also supposed to have abilities to manage their function with emphasis on development of clinical performance skill, for direction on operative aspects. The strategies for the development of leadership qualities include program-planning at individual instutional level as well as local, national and international level. Nurse-managers are to be motivated and encouraged to participate in the programs in order to effectively communicate within tier groups.oups.

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Opinions and Perceptions on Allowing Nursing Students' Practice among Inpatients at a University Hospital (종합병원 입원 환자의 간호대학생 실습허용에 대한 견해 및 인식)

  • Kim, Youngjin;Kim, Jeesun;Kim, Hyerim;Park, Subi;So, Saetbyul;Jung, Bosung;Choh, Eunae;Lee, Seonyoung;Kim, Jeongeun
    • Perspectives in Nursing Science
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    • v.14 no.1
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    • pp.10-20
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    • 2017
  • Purpose: The aim of this study was to explore the patients' perspectives on nursing students' clinical practices in the wards, and to investigate their willingness for allowing students to practice on them. Methods: This was a descriptive study. 116 inpatients were recruited from the S University Hospital. A 60-item questionnaire was applied to collect the data. The participants were 19 years and older with sound judgement, and were not in special or intensive care units. Data analysis was done in SPSS/WIN 22.0 using descriptive statistics, Fishers exact test, and the ANOVA test. the participant answered to questionnaire from April 29th 2016 to May 10th. Results: 40 participants (34.5%) stated they would allow students' practice, while 72 (61.2%) said they would allow only under staff supervision. 5 participants (4.3%) stated they would not allow whatsoever. The 3 most allowed were emotional support, oral care, and vital signs measurement while the 3 least allowed were gastric feeding, intravenous catheterization, and urinary catheterization. Conclusion: Patients were more inclined to allow students to practice on them when a member of the medical team was present. A fair number of participants said they would be more inclined to allow students' practice if they felt the student was competent; hence, reinforcing simulation sessions is vital in enhancing students' competency and ultimately practice allowance.

Rapid Industrialization Induced Poor Hometeaching and Increased Juvenile Delinquents in South Korea (한국에서 급격한 산업화에 따른 가정교육 부실과 청소년범죄 증가 현상)

  • Yun, Duk-Jin
    • Clinical and Experimental Pediatrics
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    • v.46 no.10
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    • pp.958-965
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    • 2003
  • Purpose : Recently the number of juvenile delinquents have been increasing in Korea and their misdeeds were getting worse. This study was conducted to find out the basic cause of juvenile delinquency and a counterplan of overcoming this distress. Methods : The authors reviewed the statistics of the Supreme Public Prosecutors Office to know the juvenile delinquents and Korean national statistics to know the changes of family environments. The author conducted a study on the family environments between student group and juvenile delinquent group in jail, and also investigated the value judgement of middle and high school students to know the difference between the recent adolescents and the youth before 1945. Results : Nuclear families, dual-income families and divorce rates have remarkably been increased recently. All of which are considered to be the basic cause of getting worse in home teaching. It was found that the delinquent group have more defective families, poorer economic status, poorer parent's educational level than the student group, and also found that the value judgement of recent youth were quite different from that of youth before 1945. Conclusion : Industrialization have changed our home-environment rapidly which made home-teaching poorer, and the children were being insecure and melancholy, which consequently made them more abnormal youth and juvenile delinquents in Korea.

Legal issues of obtaining informed consent in pharmaceutical clinical trial as human material research : Focusing on the use of statutory form (인체유래물연구에 해당되는 의약품임상시험에서 동의 획득 기준의 법적 문제: <인체유래물연구동의서> 법정 서식의 사용을 중심으로)

  • Yoo, Sujung;Kim, Eunae
    • The Journal of KAIRB
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    • v.1 no.2
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    • pp.30-42
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    • 2019
  • In pharmaceutical clinical trials as human material research, the collection, use, storage and provision of human materials must be in accordance with the criteria stipulated in 「Bioethics and Safety Act」, except in the case that some criteria about it is in the law related to clinical trials such as 「Pharmaceutical Affairs Act」 and 「Enforcement Rule on Safety of Drugs, etc.」 so these take precedence over. Under 「Bioethics and Safety Act」, the core aspect of the legal standard for obtaining informed consent is the use of statutory form . The use of statutory form ensure that both those who obtain informed consent and those who give it can know the contents contained this form as well as recognize its importance. Thus, the person who has the right to informed consent can sign the statutory form after correct understanding of the contents. In reality, however, some researchers and IRB members determine that only the main informed consent form is to be used because most of contents on statutory from are included in the main informed consent form. Some other researchers and IRB members judge that the use of statutory form is not needed if human materials may only be used for laboratory testing and the rest will not be stored and provided for future use. Most of these determination and judgement is based on the interpretation of the Korea National Institute for Bioethics Policy(hereafter, KoNIBP) on IRB Information Portal Site. But, it is questionable whether the KoNIBP's interpretation is legally valid and the KoNIBP is the legal entity having authority to interpret existing statute. In some cased not only using the main informed consent form including enough information about the collection, use, storage and provision of human materials but also collecting necessary minimum human materials, and discarding the rest, unusing the statutory form may not cause the problem to respect and protect the research participant's rights. Therefore, the provision stipulating the criteria about the use of statutory form as the legal standard of obtaining informed consent that applies all human material research without exception should review to revise. At least, straighten out the confusion surrounding whether or not the statutory form is to be used, before the revision of related provision, considering the logical opinions of some researchers and IRB Members, the Ministry of Health and Welfare as the legal entity having authority to interpret existing statute should represent its opinion about permission of the acceptable exceptions.

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Characteristics of Patients Who Need Hypnotics on the Night before Elective Surgery (수면전일 수면제를 필요로 하는 환자들의 특성)

  • Lee, Soo-In;Yoon, Jin-Sang;Lee, Hyung-Young
    • Sleep Medicine and Psychophysiology
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    • v.4 no.2
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    • pp.172-180
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    • 1997
  • Objects : This study was carried out to investigate characteristics of patients who need hypnotics on the night before elective surgery as well as contributing variables for the necessity of hypnotics. Methods : After reviewing the clinical charts of patients who were scheduled to receive surgery by general anesthesia the following day, researchers had semi structural interviews with patients. In addition, Spielberger's State-Trait Anxiety Inventory(SSTAI), Beck Depression Inventory(BDI), Zung's Self-Rating Pain and Distress Scale(ZPDS), and Presleep and Postsleep Questionnaires were administered to patients. A total of 167 patients, who gave reliable information, were divided into two groups based on subjective judgement regarding the necessity for hypnotics on the night before surgery; 29 eligibles for hypnotics and 138 non-eligibles for hypnotics. Demographic and clinical characteristics of patients, some possible factors affecting sleep, psychological characteristics of patients and daytime status and nighttime sleep before surgery were compared between the two groups. In addition, discriminant function analysis was done to find the variables which would best discriminate among patients who differ in terms of necessity for hypnotics on the night before surgery. Results : There was no difference in demographic and clinical characteristics between the two groups; however, the satisfaction level with ward environment was significantly lower in the eligible group for hypnotics than the non-eligible group. Psychologically, the eligible group for hypnotics, compared to the non-eligible group, showed significantly more severe depression, pain, and distress; whereas anxiety level was not different between the two groups. For nighttime sleep before surgery, the eligible group for hypnotics, compared to the non-eligible group, expected poorer sleep before retiring and in fact, reported poorer sleep the following morning. In discriminant function analysis, 'expectation for sleep' and 'pain and distress' were the most potent contributors to discriminate the necessity of hypnotics. Conclusion : For the improvement of the patient's sleep on the night before elective surgery, giving hypnotics and/or analgesics should be determined by patient's opinion about the necessity of the drugs rather than by the therapist's own judgement or any other objective indices.

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Evidence-Based Practice(EBP) Among Korean Occupational Therapists : Use of Resources, Perceptions, and Barriers (한국 작업치료사들의 근거기반 치료(Evidence-Based Practice; EBP) : 인식도, 근거자원 사용과 방해요인 조사)

  • Kim, Jung-Ran;Kim, Sun-Hee;Yang, No-Yul
    • Therapeutic Science for Rehabilitation
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    • v.1 no.2
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    • pp.41-53
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    • 2012
  • Objective : The purpose of the research is to investigate Korean occupational therapists' awareness of Evidence-Based Practice(EBP), basis of clinical decision making, barrier factors of EBP execution. Methods : Form December 2009 to March 2010, 500 questionnaires were sent out to clinical occupational therapists and 160 questionnaire which are returned by the therapists were analyzed through descriptive statistics. Results : There are more female respondents than male. More than 90% of them had less than 5 years experience. Most of respondents hadn't experienced education concerning EBP(76%), and the education is not periodically conducted(55%). Moreover, treatment was being tailored based on subjective judgement. On the other hand, the degree of recognition showed that the professionalism of occupational therapists can be improved through EBP(96%), and be helpful to make clinical decision(88%). Most of the therapists answered that guaranteeing enough time to search the basis of treatment(90%) and participating in the education course(92%) is needed to make EBP applicable. This result shows that while the application rate of EBP is low, the recognition rate of EBP is high, which means it is necessary to revitalize EBP education program. Conclusions : In order to provide quality service, education course and instructor training program is needed. We should also make a great effort to offer evidence-based education to occupational therapy students. Furthermore, EBP has to be carried out to improve the professionalism of occupational therapists, and the research about education program and its effect has to be executed.

Related Factors to Visual Display Terminal Syndrome in Employees of A General Hospital in one Metropolitan City (한 광역시 종합병원 근로자의 VDT 증후군 자각증상에 대한 관련요인 연구)

  • Yoo, Se-Jong;Hong, Jee-Young;Bae, Seok-Hwan
    • Journal of radiological science and technology
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    • v.34 no.4
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    • pp.297-303
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    • 2011
  • The existing studies of VDT syndrome have been researched only about for nurse groups without radiological technologists. The target of this study was workers who perform VDT task in general hospital placed in Daejun City such as insurance judgement, patient affairs, medical record management, medical computing service, hospital administration, and radiological sections. This study was conducted at October 15, 2009 to November 2, 2009 using structured questionnaire. Results of group A (age 20-29, less than 5 years experience at clinical site, normal staff, and unmarried group) showed significant skin and psychological conditions among recognition symptoms of VDT syndrome. Group B (age 30-39, 6-10 years experience at clinical site, managing staff, and married group) tends to be similar at orbital, whole body and muscles' frame response among recognition symptoms of VDT syndrome. Results of "Multiple Linear Regression" with dependent variable that is scores of recognition symptoms of VDT syndrome are as follows. The factors which influences for orbital-related problem is gender, health cares and obstacles during daily life. The factors which influences for whole body-related is exercise, stress and recognition for health condition and the factors which influences muscles' frame-related is 6-10 years experience at clinical site, human relationship, health cares and obstacles during daily life. These are proved to be similar by statistic analysis. There is small difference at recognition symptom of VDT syndrome between the radiological technologist and other groups in general hospital. Yet, as the working circumstance of radiological technologist gradually changes to VDT environment, the recognition symptom of VDT syndrome became conscious. This can be prevented by regular job rotation, which will escape the continuous repetition of working pattern.

Estimation of nursing costs for hospitalized patients using the resource-based relative value scale (상대가치(Resource-Based Relative Value)를 이용한 간호행위별 간호원가 산정)

  • Park, Jung-Ho;Song, Mi-Sook;Sung, Young-Hee;Cho, Jung-Sook;Sim, Won-Hee
    • Journal of Korean Academy of Nursing Administration
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    • v.5 no.2
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    • pp.253-280
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    • 1999
  • A cost analysis for hospitalized patients was performed based on the RBRVS in order to determine an appropriate nursing fee schedule. The study was conducted through three phases as follows: 1) Nursing activities provided for the inpatients currently in Korea were identified and classified using a taxonomy which was developed by our research team through the Delphi process. 2) The resource-based relative points for every nursing activity according to nursing time, mental effort and judgement, technical skill, physical effort and stress were determined through a survey of 300 clinical RNs working at 5 tertiary hospitals from May 25 to July 25. 1998. 3) The nursing cost of every nursing activity for hospitalized patients was estimated based on the RBRVS. As a result, 136 nursing activities were identified and classified by nursing processes and nursing domains. However, our classification system of nursing activities should continue to be refined, and all nursing practices should be standardized. The nursing activities were given resource-based relative points ranging from 100 to 400 points, then each nursing activity was assigned a value for the RBRVS, which was determined by the exponential function of 2resource-based relative point/100. Thus, a value of 2 was calculated for 100 points, 4 for 200 points, 8 for 300 points, and 16 for 400 points. Meanwhile, the unit cost of nursing was calculated as 170 Won. The nursing cost of 136 nursing activities was estimated using the RBRVS as shown in

    . A proper nursing fee schedule for a new reimbursement system based upon the results of the above study should be prepared in the near future.

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  • An Analysis of Nursing Students Attiudes Toward Life (간호학생의 생명에 대한 태도 유형 분석 : Q-방법론적 접근)

    • 엄영란;홍여신
      • Journal of Korean Academy of Nursing
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      • v.22 no.3
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      • pp.389-406
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      • 1992
    • This study was designed to identify nursing students' attitudes toward life through a Q-methodology. A Q-sample was formed through a review of the literature and interviews(n=160)l The final Q-sample consisted of 37 statements out of an initial 100 statements after consultation with an expert panel and pilot testing. The P-sample consisted of 14 university nursing students and 27 junior college nursing students, which was selected by convenience sampling method. Data were analyzed by the Q-analysis method. The correlation between type 2 and type 3 was relatively high (r=0.539) ; that between type 1 and type 3 was lowest (r=0.014). The first type of attitude was the “rational utilitarian” type. Students in this type valued life relative to the quality of life. They agreed with euthanasia and artificial abortion if the quality of life was threatened. The criteria for their judgement were scientific knowledge and rationality. The second type of attitude was the “Christian deontologic” type. These students appreciated the sanctity of life according to Christian dogma. They disagreed with euthanasia and artficial abortion. And they disagreed strongly that life should be created by scientific development, because only God creates life. The third type of attitude was the “unconditional deontologic” type. These students agreed with the sanctity of life, not from Christian belief but from belief in the sanctity of life. The final type of attitude was the “prima facie(conditional) deonologic” type. These students appreciated the value of life and humanity. They expressed concern for others' life and suffering. They do not want to afflict others with their own miseries. This group showed a dual value system toward themselves and others. So they experience conflict between their concern for their on and others' conditions. These nursing students' values may have been influenced by their clinical experience in hospitals and other nursing fields. Through this study, we may realize the importance of education in nursing ethics for discussion of ethical conflicts and to support ethical nursing practice.

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    Antispastic Effect of Electroacupuncture on Upper Extremity in Stroke Patients by T-reflex Study : A Single-Blind, Randomized Controlled, Preliminary Study

    • Cho, Min Kyoung;Lee, In;Kwon, Jung Nam;Shin, Byung Cheul;Ko, Sung Hwa;Ko, Hyun Yoon;Shin, Yong Il;Hong, Jin Woo
      • The Journal of Korean Medicine
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      • v.36 no.4
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      • pp.8-18
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      • 2015
    • Objectives: There have been several studies evaluated effect of electroacupuncture (EA) on spasticity but most studies could not assess spasticity quantitatively because they used clinical rating scales for assessment spasticity. The objective of this study is to evaluate effect of EA on poststroke spasticity quantitatively using tendon reflex (T-reflex). Methods: 29 stroke patients with upper extremity spasticity were randomized to EA group and control group. The EA group received combined EA and rehabilitation therapy 5 times a week for 3 weeks. Acupuncture treatment was given at Jian Yu (LI 15), Qu Chi (LI 11), Shao Hai (HT 3), Wai Guan (TE 5), He Gu (LI 4), Lie Que (LU 7), Hou Xi (SI 3) of the affected side, 30 minutes of electrical stimulation with a frequency of 40/13 Hz was applied at Qu Chi (LI 11), He Gu (LI 4). The control group received only rehabilitation therapy. The efficacy of treatment was assessed using T-reflex latency and amplitude, modified Ashworth scale (MAS) of biceps brachii, brachioradialis and triceps brachii. Fugl-Meyer motor function assessment (FMA) and functional independence measure (FIM) were also measured to assess motor function and functional independence. All outcomes were measured before treatment, immediately after 3 weeks of treatment and 1 week after 3 weeks of treatment. Results: No statistically significant differences were found in outcomes including T-reflex between the study groups except for FIM values immediately after 3 weeks of treatment (p=0.037). Conclusions: These results suggest that 3 weeks of EA does not reduce poststroke upper extremity spasticity electrophysiologically and clinically. However, small sample sizes and contradictory tendency between results from T-reflex and those from MAS require cautious judgement on interpretation of the results. A larger, well-designed clinical trials for quantitative evaluation of effect of EA on poststroke spasticity will be needed.


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