• Quality Improvement in Health Care
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• v.23 no.2
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• pp.37-54
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• 2017

Objectives: The purpose of this preliminary study was to identify the nurses' perception regarding disclosure of patient safety incidents (DPSI) and to evaluate the effectiveness of education for DPSI. Methods: DPSI education was conducted for nurses majoring in clinical nurse specialist at an university. Before and after the education, the nurses made a questionnaire to evaluate the perception of DPSI. The questionnaires were divided into four categories: first, overall perception of the DPSI; second, recognition evaluation of the DPSI using hypothetical case, third, opinion on legal and nonlegal measures for facilitating the DPSI; and fourth, socio-demographic factors. The Wilcoxon signed rank test was performed on the DPSI questionnaire response to compare the perceptions before and after the education. Results: A total of 10 nurses participated in the education. DPSI education showed the possibility of improving the overall perception, necessity, effect, obstacle, and promotion method of DPSI, although there were also several responses where there was no statistical significance. In particular, DPSI education led to statistically significance change in the perception of obstacles for DPSI. For example, the number of respondents who agreed to the item "DPSI will increase the incidence of medical lawsuits." was 7 before education but decreased to 3 after education (P-value: .025) Furthermore, nurses' perception of DPSI from this study was generally positive regardless of education. Conclusion:In the future, it will be necessary to carry out DPSI education and training and to evaluate its effectiveness for more nurses.

• Journal of Korean Critical Care Nursing
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• v.17 no.1
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• pp.44-56
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• 2024

Purpose : This study sought to explore intensive care unit (ICU) nurses' perceptions regarding the disclosure of patient safety incidents (DPSI) and identify the relationship between the perception of DPSI and communication barriers. Methods : This study used a descriptive research design. A total of 110 ICU nurses from a tertiary hospital were surveyed online between September 14 and October 5, 2022. The mean DPSI score ranged between 1.0 and 4.0, with a higher score indicating a higher perception of DPSI. Results : The mean score for ICU nurses' perceptions of DPSI was 2.92 (SD=0.37). Among the characteristics of ICU nurses, differences were observed in perceptions of DPSI according to gender, age, total work experience, and ICU work experience. Communication barriers among ICU nurses were negatively correlated with negative results as a sub-factor of perceptions of DPSI. Ambiguity in the nurse's position, lack of confidence, differences in perspectives with patients, and inadequate nurse-patient relationships as sub-factors of communication barriers exhibited a negative correlation with negative results as a sub-factor of perceptions of DPSI. Conclusions : ICU nurses' perceptions of DPSI and the sub-factors related to communication barriers are negatively related to DPSI. To improve ICU nurses' perceptions, open and non-punitive circumstances, staff education, practical guidelines, and support systems are required.

• Journal of Preventive Medicine and Public Health
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• v.50 no.2
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• pp.68-82
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• 2017

Objectives: We performed a systematic review to assess and aggregate the available evidence on the frequency, expected effects, obstacles, and facilitators of disclosure of patient safety incidents (DPSI). Methods: We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for this systematic review and searched PubMed, Scopus, and the Cochrane Library for English articles published between 1990 and 2014. Two authors independently conducted the title screening and abstract review. Ninety-nine articles were selected for full-text reviews. One author extracted the data and another verified them. Results: There was considerable variation in the reported frequency of DPSI among medical professionals. The main expected effects of DPSI were decreased intention of the general public to file medical lawsuits and punish medical professionals, increased credibility of medical professionals, increased intention of patients to revisit and recommend physicians or hospitals, higher ratings of quality of care, and alleviation of feelings of guilt among medical professionals. The obstacles to DPSI were fear of medical lawsuits and punishment, fear of a damaged professional reputation among colleagues and patients, diminished patient trust, the complexity of the situation, and the absence of a patient safety culture. However, the factors facilitating DPSI included the creation of a safe environment for reporting patient safety incidents, as well as guidelines and education for DPSI. Conclusions: The reported frequency of the experience of the general public with DPSI was somewhat lower than the reported frequency of DPSI among medical professionals. Although we identified various expected effects of DPSI, more empirical evidence from real cases is required.

• Quality Improvement in Health Care
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• v.28 no.1
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• pp.34-44
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• 2022

Purpose:We investigated physicians' responses to a series of clinical vignettes consisting of patient safety incidents, with and without disclosure of patient safety incidents (DPSI). Methods: An anonymous survey was conducted to investigate physicians' responses to the DPSI via online communities of physicians, and additional participants were recruited using a snowballing sampling method. We evaluated physicians' responses to the DPSI using eight hypothetical scenarios (HS) from the following perspectives: thoughts regarding medical errors, revisiting the physician, recommendation, lawsuit, criminal prosecution, trust score, and compensation amounts. We used the chi-square test to evaluate the overall differences in response rates among the scenarios. Statistical analyses were performed using the Student's t-test to compare the trust scores and compensation amounts. Results: A total of 910 physicians participated in this survey. An overall comparison of trust scores among HS showed that HS 1 (unclear medical errors, minor harm, and DPSI) had the highest trust score. In contrast, in the opposite scenario, HS 8 (clear medical errors, major harm, and DPSI not conducted) received the lowest scores. Cases with minor harm to patients (HS 1, 2, 5, and 6) showed lower compensation amounts than the others (HS 3, 4, 7, and 8). Physicians were more likely to think of situations with DPSI as not having medical errors (53.1% vs. 55.2%). In addition, the scenarios with DPSI were evaluated favorably in terms of intention to revisit, recommend, suit, and engage in criminal proceedings. Physicians showed higher trust scores (6.2 vs 5.4) and gave lower compensation amounts ($27.7 million vs $28.1 million), although there was no significant difference in terms of compensation amounts to the physician conducting DPSI. Conclusion: Our study showed overall positive perceptions regarding DPSI among Korean physicians.

• Korean Journal of Applied Biomechanics
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• v.31 no.2
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• pp.126-132
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• 2021

Objective: The purpose of this study was to investigate how three gaze directions (bottom, normal, up) affects the coordination and stability of the lower limb during drop landing. Method: 20 female adults (age: 21.1±1.1 yrs, height: 165.7±6.2 cm, weight: 59.4±5.9 kg) participated in this study. Participants performed single-leg drop landing task on a 30 cm height and 20 cm horizontal distance away from the force plate. Kinetic and kinematic data were obtained using 8 motion capture cameras and 1 force plates and leg stiffness, loading rate, DPSI were calculated. All statistical analyses were computed by using SPSS 25.0 program. One-way repeated ANOVA was used to compared the differences between the variables in the direction of gaze. To locate the differences, Bonferroni post hoc was applied if significance was observed. Results: The hip flexion angle and ankle plantar flexion angle were significantly smaller when the gaze direction was up. In the kinetic variables, when the gaze direction was up, the loading rate and DPSI were significantly higher than those of other gaze directions. Conclusion: Our results indicated that decreased hip and ankle flexion angles, increased loading rate and DPSI when the gaze direction was up. This suggests that the difference in visual information can increase the risk of injury to the lower limb during landing.

• Korean Journal of Applied Biomechanics
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• v.26 no.2
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• pp.143-151
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• 2016

Objective: The purpose of this study was to investigate the effect of fatigue induction on ground reaction force (GRF) components, postural stability, and vertical jump performance in Taekwondo athletes. Method: Ten Taekwondo athletes (5 men, 5 women; mean age, $22.30{\pm}2.62years$; mean height, $174.21{\pm}9.20cm$; mean body weight, $67.28{\pm}12.56kg$) participated in this study. Fatigue was induced by a short period of strenuous exercise performed on a motorized treadmill. The analyzed variables included vertical jump performance, static stability (mediolateral [ML], center of pressure [COP], anteroposterior [AP] COP, ${\Delta}COPx$, ${\Delta}COPy$, and COP area), postural stability index values (ML stability index [MLSI], AP stability index [APSI], vertical stability index [VSI], dynamic postural stability index [DPSI]), and GRF components (ML force, AP force, peak vertical force [PVF], and loading rate). To analyze the variables measured in this study, PASW version 22.0 was used to calculate the mean and standard deviation, while a paired t-test was used to evaluate the pre- versus post-fatigue results. Pearson's correlation coefficients among variables were also analyzed. The statistical significance level was set at ${\alpha}$ = .05. Results: Vertical jump performance decreased significantly after the induction of fatigue, while AP COP, ${\Delta}COPx$, COP area, APSI, VSI, and DPSI increased significantly. PVF and loading rate increased significantly after the induction of fatigue, while the postural stability variables (AP COP, ${\Delta}COPy$, COP area, APSI, VSI, DPSI) were similarly correlated with GRF components (PVF, loading rate) after fatigue was achieved (r = .600, $R^2$ = 37%). Conclusion: These results suggest that the induction of fatigue can decrease postural stability and exercise performance of Taekwondo athletes during training and competition sessions.

• Korean Journal of Applied Biomechanics
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• v.25 no.1
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• pp.85-94
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• 2015

Purpose : The purpose of this study was to investigate the influence on the ground reaction force parameters according to wearing positions of backpack for during stair ascending and descending. Methods : Participants selected as subject were consisted of young female(n=10) and performed stairs walks(ascending and descending) with 2 types of wearing position(front of trunk[FT], rear of trunk[RT]). Passive(Fz 1) and active(Fz 2) forces of the vertical GRF were determined from time function and frequency domain. Also shear forces(Fx, Fy 1, Fy 2), dynamic postural stability index(MLSI, APSI, VSI, DPSI), loading rate and center of pressure (${\Delta}COPx$, ${\Delta}COPy$, COP area) were calculated from time function and frequency domain. Results : Fx, Fy 1, Fy 2, and Fz 1 in GRF didn't show significant differences statistically according to the wearing positions of backpack(p>.05), but stair descending showed higher forces than that of stair ascending. Particularly, Fz 2 of stair ascending showed higher forces than that of stair descending(p<.001), RT types showed higher than that of FT types(p<.05). MLSI, APSI, VSI, and DPSI of stair descending showed the increased stability index than that of stair ascending(p<.05), MLSI of RT types showed the decreased stability index than that of FT types(p<.05). Loading rate didn't show significant differences statistically according to the wearing positions of backpack(p>.05), but stair descending showed higher loading rate than that of stair ascending(p<.001). Also, ${\Delta}COPx$ in stair descending showed the increased movement than that of stair ascending(p<.05). Conclusions : A backpack of 10 kg(10 kg(ratio of body weights $17.61{\pm}1.17%$) showed significantly change GRF parameters according to wearing positions during stair ascending and descending. If possible, we suggest that the dynamic stability, in case of stairs walking with a smaller weights can be further improved.

• Korean Journal of Applied Biomechanics
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• v.28 no.2
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• pp.135-141
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• 2018

Objective: The purpose of this study was to investigate the effect of functional ankle instability (FAI) and surgical treatment (ST) on postural stability and leg stiffness during vertical-drop landing. Method: A total of 21 men participated in this study (normal [NOR]: 7, FAI: 7, ST: 7). We estimated dimensionless leg stiffness as the ratio of the peak vertical ground reaction force and the change in stance-phase leg length. Leg length was calculated as the distance from the center of the pelvis to the center of pressure under the foot. Furthermore, the analyzed variables included the loading rate and the dynamic postural stability index (DPSI; medial-lateral [ML], anterior-posterior [AP], and vertical [V]) in the initial contact phase. Results: The dimensionless leg stiffness in the FAI group was higher than that of the NOR group and the ST group (p = .018). This result may be due to a smaller change in stance-phase leg length (p = .001). DPSI (ML, AP, and V) and loading rate did not show differences according to the types of ankle instability during drop landing (p > .05). Conclusion: This study suggested that the dimensionless leg stiffness was within the normal range in the ST group, whereas it was increased by the stiffness of the legs rather than the peak vertical force during vertical-drop landing in the FAI group. Identifying these potential differences may enable clinicians to assess ankle instability and design rehabilitation protocols specific for the impairment.

• Korean Journal of Applied Biomechanics
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• v.24 no.2
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• pp.151-160
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• 2014

The purpose of this study was to investigate the GRF(ground reaction force) parameters according to the shoes's heel heights and ground landing distances during downward stairs on bus. Participants selected as subject were consisted of young and healthy women(n=9, mean age: $21.30{\pm}0.48$ yrs, mean height: $164.00{\pm}3.05cm$, mean body mass: $55.04{\pm}4.41kg$, mean BMI: $20.47{\pm}1.76kg/m^2$, mean foot length: $238.00{\pm}5.37mm$). They were divided into 2-types of shoe's heel heights(0 cm/bare foot, 9 cm) and also were divides into downward stairs with 3 types of landing distance(20 cm, 35 cm, 50 cm). A one force-plate was used to collect the GRF(AMTI, USA) data from the sampling rate of 1000 Hz. The GRF parameters analyzed were consisted of the medial-lateral GRF, anterior-posterior GRF, vertical GRF, loading rate, Center of Pressure(${\Delta}COPx$, ${\Delta}COPy$, COP area) and Dynamic Postural Stability Index(MLSI, APSI, VSI, DPSI) during downward stairs on bus. Medial-lateral GRF and vertical GRF didn't show significant differences statistically according to the shoe's heel heights and landing distance, but 9 cm shoes heel showed higher vertical GRF than that of 0 cm bare foot in landing distance of 50 cm. Also anterior-posterior GRF didn't show significant difference statistically according to the shoe's heel heights, but landing distance of 20 cm showed higher than that of landing distances of 35 cm and 50 cm in anterior-posterior GRF. Loading rate didn't show significant difference statistically according to the landing distance, but 9 cm shoe's heel showed higher than that of 0 cm bare foot during downward stairs. The ${\Delta}COPy$ and COP area didn't show significant differences statistically according to the shoe's heel heights and landing distance, but 0 cm bare foot showed higher than that of 9 cm shoe's heel in ${\Delta}COPx$. Dynamic Postural Stability Index(MLSI, APSI, VSI, DPSI) didn't show significant differences statistically according to the landing distance, but 9 cm shoe's heel showed decreased value than that of 0 cm bare foot in dynamics balance. Considering the above, parameters of GRF showed different characteristics according to the shoe's heel heights and ground landing distances during downward stairs on bus.

• Korean Journal of Applied Biomechanics
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• v.24 no.4
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• pp.329-338
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• 2014

The purpose of this study was to analyze of the rider postural alignments according to the fitting of stirrups lengths during walk of high level riders. Participants selected as subject were consisted of horse riders of high level (age: $47.66{\pm}3.51yrs$, height: $168.40{\pm}4.84cm$, body weight: $73.36{\pm}15.58kg$, low extremity length: $94.76{\pm}3.98cm$, career: $23.33{\pm}5.77yrs$) and walk with 3 types of stirrup lengths(ratio of low extremity 68.04%, 73.25%, 78.48%). The variables analyzed were consisted of the displacement of Y axis (center of mass, head, thigh, shank and foot), FR angle, LR angle, dynamic postural stability index (DPSI), coefficient of variation (CV%), and distance (X axis) of low extremity limb between right and left. The displacement of Y axis in COM, thigh, shank, foot limbs were not statistically significant, but movements of head showed greater distance of B type and C type than that of A type during 1 stride of walk. The FR and LR angle in trunk of horse rider, dynamic postural stability index and, coefficient of variation didn't show significant difference statistically according to the fitting of stirrup lengths. Also the distance (X axis) of low extremity in thigh and shank didn't show significant difference statistically in between right and left, but right and left foot showed greater distance in C type than that of B and A types during walk in horse back riding. The hip and ankle joint angle not statistically significant according to stirrups lengths, But knee joint angle showed more extended according to the increase of stirrups lengths during stance and swing phase in walk.