• 정보처리학회논문지C
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• 제17C권2호
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• pp.173-180
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• 2010

IT 기술의 발달에 힘입어 환자들의 위치에 상관없이 편리하게 진료가 가능한 유비쿼터스 헬스케어시스템이 개발되고 있다. 그러나 사용자의 수가 급증하고 다른 병원의 의사나 연구원 또는 환자의 가족들에게 의료 정보를 공개하도록 의료법이 개정되면서 사용자 관리와 프라이버시 침해라는 문제가 발생하였다. 이러한 문제를 해결하기 위하여 본 논문에서는 역할 기반 접근제어 모델에 기반한 사용자 접근 모델은 제안한다. RBAC 모델은 효율적인 사용자 관리 및 접근 제어를 제공하지만, 악의를 가진 사용자가 권한이 있는 역할을 가지고 정보를 유출하고자 할 경우 막을 방법이 없다. 이러한 RBAC의 취약점을 보완하기 위하여 "working status" 파라미터를 역할 속성과 연동하는 RBAC-WS 모델을 제안하였다. 역할에 working 속성을 연동함으로써 허가를 받은 사용자라 하더라도 업무 외 접근을 원천적으로 봉쇄함으로서 내부자에 의한 정보유출 문제를 해결하였다. 또한 RBAC을 위한 함수를 개발하여 도메인이 서로 다른 헬스케어 시스템에서도 유용하게 사용될 수 있도록 하였으며, RBAC-WS 모델의 기능 분석을 위하여 Healthcare 시스템 중 널리 사용되는 PACS에 적용하였다.

• 간호행정학회지
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• 제4권2호
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• pp.439-455
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• 1998

This is the descriptive investigation study intended to provide basic informations to develop concrete method of nurse arbitration which can improve the quality of nursing care on family by investigating and analyzing the perception and practice on family nursing of clinical nurse. 332 nurses working in 4 university hospitals in Seoul have been the object and the collection of data have been conducted by visiting cooperated by the department of nursing in university hospital from April 4th through April 17th 1998. The measuring instrument of the perception and the practice on family nursing which was written by the researcher was used based on the family nursing arbitration by recently amending Calgary Family Arbitration of the Model of Wright & Leahey. Cronbach's a value of this instrument was .9288 in the perception and .9168 in the practice the collected data have been analyzed by frequency percentage, averaged value. t-test, F-test(ANOVA), Duncan's Multiple Range, Pearson's Correlation Coefficient, and the results are as the follows: 1. The perception on patient's family nursing of clinical nurse showed comparatively high by 3.22 in average(maximum 3.52, minimum 2.82) on the basis of 4 point but the practice showed low by average 2.47(maximum 3.02, minimum 2.11), By providing the patients and their family with "The information about the health problem of the which is the role of giving explanation and information about the disease. the nurse presents the method of their helping patient and in case that the family lack of knowledge about the health problem and crisis of the patient which is the role of education about the method of solving the crisis and change. the nurse educates about the necessity and method of taking care of the crisis and the changes. The third question that the relation of recognizing the difficuly of family and cooperating with them in supporting the patient for mutual function is to be formed showed high in the degree of perception and practice of the necessity. 2. General characteristics of perception about patient's family nursing of the object showed no significant difference except the concerns about the family usually(F=5.472. p<.001) and general characteristics which showed significant difference in the degree of practice were educational background (F=3.177, p<.05), clinical experience (F=2.462, p<.05) and position(F=7.029. p<.001), and attention about patient's family(F=10.603, p<.001), 3. The relation between perception and practice about the nursing on patient's family showed pure correlation but the degree was very low(r=.188, p<.05). The above results showed that the clinical nurses has been high understanding about the necessity of patient's family nursing but the degree of practice has been very low due to the lack of education about the family nursing, having no ways of nurse arbitration for practical duty and lack of political administrative support. Therefore concrete and systematic family situation and arbitration method to be applied clinically are required to be developed and also the education about patient's family nursing and the development of the course for clinical practice are required and political and administrative support for clinical practice about patient's family nursing is required as well.

• Journal of Preventive Medicine and Public Health
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• 제15권1호
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• pp.17-31
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• 1982

A physician assumes toward his patient the obligation to use such reasonable care and skill as is commonly possessed and exercised by physicians in the same general line of practice in the same or similar localities and to use his best judgment at the times. Medical disputes between physicians and patients are, ever more increased in these days as human body, happens to cause a variety of changes in body unlike the function of machine. Such increased trends of medical disputes became a problem in common across the word under the influence of affluent living standard, high consciousness of life value and right by today's people. The aim of this dissertation is oriented to forming a physician's responsibilities in medicalcare accidents arising between physicians and patients. A general physician, for example, has not been negligent merely because, a specialist might have treated the patient with greater skill and knowledge. However, the fact that a physician may have acted to the best of his ability will not avoid legal problems for damages resulting from substandard treatment, that is the degree of care and skill which is to be expected of the ordinary practitioner in his field of practice. The duty of a physician who is, or holds himself out to be, a specialist is greater in the field of his specialty than one who is a general physician. A patient's consent to routine medical procedures is implied from the fact that patient comes to the physician with a medical problem and voluntarily submits to the procedures. For the more serious medical procedures and for major operations, however, it is preferable for the physician to have the patient's consent in writing, to facilitate proof of the consent in the event of a dispute or litigation. Suppose that mistakes on the part of physicians are likely to be blamed in all cases of malpractice. Then it will create a sort of shrinkage in activities of medical treatment. There should be some limitation on excessive application of 'The thing speaks for itself' on mistakes by physicians and availablity of cause and effect. It is a matter of complicity as well as a matter of importance to draw a definite boundary on responsibilities of physician. A series of further research on this particular aspect is strongly urged.

• 한국사회복지학
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• 제56권1호
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• pp.181-201
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• 2004

사회복지시설은 역사적으로 다양하고도 심각한 문제를 표출시켜 왔는데, 지역복지를 상위분야로 한 각 대안들이 국내에서 사회복지시설을 지역복지실천의 영역에서 제외시키고 있다. 그러나 사회복지시설의 본연의 역할에 비추어 볼 때, 이러한 대안들은 논리적인 문제를 안고 있다고 할 수 있다. 이러한 문제인식 하에서 본고는 일본에서의 지역복지 중 지역복지의 구성내용, 지역복지에서의 사회복지시설에 대한 규정, 지역복지 범주에서 논의되고 있는 시설사회화론을 이론적으로 제시한다는 연구목적을 제시하였다. 연구결과에 의하면, 지역복지의 중요한 요소로서, 그리고 지역복지를 발전시키는 추진력으로서 사회복지시설이 규정되고 있다는 점과 시설사회화론 또한 지역복지를 발전시키기 위한 주요한 실천이론으로서 논의되고 있으며, 지역개방 측면만이 아니라 이를 포괄한 시설의 근본적인 개혁의 논리로서 제시되고 있다는 점이 밝혀졌다.

• 항공우주정책ㆍ법학회지
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• 제25권2호
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• pp.201-230
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• 2010

자동차, 철도, 광산업이 시작되면서 등장한 새로운 위험에 대하여 사회적 유용성을 이유로 활성화된 세계를 유지하고자 출발한 허용된 법리에 대하여 우리나라의 학계에서는 다수가 인정하고 있는 분위기인데 반하여 판례에서는 아직까지 기존의 과실론 체계로 해석하고 있다. 그러나 첨단 과학기술영역의 하나인 항공 운항에 있어서 사건이나 사고의 원인이 되는 청천난류(CAT)나 요란(turbulence)을 갖고 있는 뇌우는 환자의 불안전한 예후처럼 실시간 완벽한 탐지가 곤란하고 위험 발현 여부와 크기를 확정할 수 없으며 수시로 변화하는 이상 기상 현상이다. 이러한 이유가 있음에도 청천난류(CAT)가 존재할 수 있는 jet 기류의 이용은 시간과 연료를 대폭 절감하고 치명적 위험으로 발현되지 않은 뇌우가 있는 공항으로의 접근 착륙은 승객들의 정시 출 도착을 보장하기에 사회적 유용성이 높은 운항 형태라고 할 수 있다. 위험이 예견되고 회피할 수 있는 방법이 있으나 사회적 유용성을 이유로 개연성이 낮은 청천난류(CAT)나 요란(turbulence) 위험 지역을 운항하다가 발생한 사건이나 사고에 대하여는 허용된 위험의 법리를 적용하여 조종사들의 일정한 주의의무에 대한 완화가 필요하다.

• 의료법학
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• 제23권2호
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• pp.171-209
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• 2022

2021년에도 의료와 관련된 많은 판결들이 있었는데, 그 중 본 논문에서 검토한 판결들은 다음과 같다. 먼저 진료기록 부실기재 및 변조 등과 주의의무위반 관련 판결은 의료과실 유무 등에 관한 일차적 판단자료인 진료기록이 사후에 수정된 사례에 관한 것으로 그 수정내용 및 수정시기에 비추어 사후에 수정된 진료기록 내용은 고려하지 않고 최초 작성된 진료기록을 토대로 과실 유무 판단을 하였다. 다음으로 비만치료약 처방 등에 대한 손해배상책임을 묻는 사례에 관한 판결은 처방과 관련한 과실을 인정하였으나 상당인과관계를 부정하여 재산상 손해배상책임을 부정하고, 설명의무위반에 따른 위자료만 인정하였다. 또한, 환자의 가해자에 대한 기왕치료비 손해배상채권을 대위하는 국민건강보험공단의 대위범위에 관한 전원합의체판결은 '과실상계 후 공제방식'을 취해온 기존 판례를 변경하여 '공제 후 과실상계방식'으로 대위 범위를 판단하여 피해자 보호를 도모하였다. 그리고 과실 유무에 관해 진료기록감정회신결과와 달리 판단한 판결은 과실유무 판단을 함에 있어 진료기록감정결과에 구속되는 것은 아니고 자유심증에 따라 판단한다는 입장에 따라 규범적으로 판단하였다. 마지막으로 국민건강보험공단의 요양급여비용환수처분과 관련해서는 비의료인이 개설한 의료기관에 대한 환수처분을 함에 있어서도 재량권을 행사해야 한다는 판결과 시설 및 인력을 공동이용한 의료기관에 대한 환수처분의 경우 그 환수범위를 세부적으로 판단해야 한다는 판결을 검토하였다.

• 여성건강간호학회지
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• 제1권1호
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• pp.81-96
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• 1995

This study was intended to provide women who are supposed to experience childbirth with effective nursing care exploring the childbirth experience. The purpose of this paper is to give an answer to the question of what the childbirth experience is, and phenomenological method has been used for that purpose. 17 primiparous mothers right after delivery in one university hospital of J city were served as subjects for this research. Data were collected June to October, 1993 through in depth interview with subjects using unstructured and open questions about the childbirth experience. Van Kaam's phenomenological analysis method was used for the analysis of the data. The results of the study are summarized as follows : The contents of the experience which primiparous mothers had undergone through childbirth were pain, fear, worry, relief, lightness, thankfulness, unsatisfactory, unreality, holiness for a new life, identifying the meaning of life, becoming a mother. 1. Experience before delivery Mothers experienced pain, fear, worry, unsatisfactory, relief, and thankfulness before delivery. Subjects' descriptions about the pain appeared to be various ; unbearable pain, bearable pain, anticipated pain. And their reactions were also various ours ; some endured pain, sought alternative method i.e., surgery, didn't want to reexperience it, or accepted it as women's fate. Subjects experienced fear for anticipated pain, suffering pain, and possible delayed delivery progress and were worried about delivery progress and baby wellbeing. Also, Subjects were unsatisfied with professionals' unfaithful attitude, their spouses' absence, and the ignorance of their pain. But subjects became relieved at the accustomed surroundings, good progress of delivery, support of family, care of professionals and support of other family. And they expressed their thanks to the professionals and family members for doing their best and also to their mothers who gave birth to them. 2. Experience after delivery Subjects experienced lightness, thankfulness, unsatisfactory, worry, unreality, holiness for a new life, identifying the meaning of life, becoming a mother after delivery. Mothers experienced lightness from the fact that it is over, and freshness right after delivery. They were thankful that they delivered vaginally and had an easy delivery. Subjects who delivered female baby were unsatisfied and some were worried about rearing the baby. By confessing, "I have no specific feeling, I am very confused, It is unrealistic, I feel strange", they expressed the unrealistic aspect of childbirth experience. Subjects felt holiness for a new life for novelty and birth of life. They identified the meaning of life from the fact that they felt worthy, fulfilled their duty, had their own baby, accomplished an important affair. After they experienced what it is to be a mother, they realized with it is being a mother and had a rearing expectation for the baby. The results of the study will provide basic data for caring the childbearing women.

• 한국응급구조학회지
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• 제11권1호
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• pp.27-40
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• 2007

Even now, 119 rescue services have dissatisfactory aspects in operation, system and equipments as discussed above, It is the most urgent subject to systemize rescue services so that they can be suitable for our status, for we will make 21C welfare state come true before long. So, this author suggest that the followings have to be raised to activate 119 rescue service. 1) Bring up experts and offer high-quality rescue service 2) Prepare more up-to-date equipments 3) Operate transfer joint organizations 4) Promote the ability to meet with a press at the time of rescue service activities 5) Adjust regulations related to rescue services 6) Make up for a countermeasure to traffic accidents of ambulances 7) Adjust regulations making it mandatory to establish heliport at the target on hospitals more than a defined scale 8) Install more rescue service teams 9) Educate and train officials belonging to briefing rooms, where the officials with long experiences are arranged 10) Minimize the time for rescue team to reach fields 11) Establish legal protection system for rescue the team Nowadays, our country operates the department of fire fighting and rescue services without great difficulty, even though the circumstances are bad - insufficient members and the inferior circumstances. All of the fire fighting officials are given heavy duties in bad circumstances, and so are the team of rescue service. The rescue service team, taking charge of some emergency medical system, do a fire fighting inspection as a non-duty service, though they are scanty of sleep due to prevention and protection services of the fire fighting service team. But, they can not engage in rescue services completely and have to deal with miscellaneous duties. So they can not offer professional emergency medical services. But now, almost every fire fighting organization, belonging to National Emergency Management Agency, are separating rescue services, which shows a lot of good results. People recognize rescue services to get better and better gradually and the demands for this rescue services increase. So, this is the best time when rescue service teams should offer qualitative services rather than quantitative services. The people will recognize this rescue service team to be an organization sacrificing and serving for them. However well institutes and operation systems should be established, the rescue service team can not come true their aim without strong wills that they will serve and sacrifice themselves for people from their hearts. In addition, it is essential for the officials in charge of policies about emergency medical services to have a concernment on and practice the policy without failure.

• 한국학교보건학회지
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• 제13권1호
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• pp.131-145
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• 2000

For the purpose of strengthening Dental Hygiene students' confidence and motivation in the Dental Hygiene Department and helping construct proper professionalism, survey on Dental Hygiene students' consciousness of attitude to and satisfaction of the course, career plan and occupation mind set was carried out. 530 three year students in 8 Dental Hygiene academies in Seoul and Kyonggi province were questioned. The results of the survery are as follows:. 1. Dental Hygiene students' motives consisted primarily of employment and a desire for professionalism 25% of them entered the course after one failure in the entrance examination and 17% had family members engaging in the dentistry field 84%, the largest portion, were from an academic high school. 24% had some knowledge of Dental Hygiene, which they had acquired from seniors, friends, and teachers. 2. Patient care and treatment assistance related matters were not considered important in the course. The weak points of the course turned out to be education in computers and foreign languages, but the weakest was the ability of patient care during clinical training. 53% had experiences had thought of changing their major while in the course because it didn't match their aptitude and interest. 3. As for a career after graduation, 49% worried about it Most students wanted to work at a dental hospital or general hospital, The most favored duty was coordination or reception or oral disease preventive work. They wanted to work untill they had a stable living. 68% answered they would get a job at an oral clinic and 70% said they would continue studying for self-realization. 4. Satisfaction with the major was high in students whose aptitude and interest matched the course, who had background knowledge of the major, and who. didn't think of changing the major but would continue studying resulting in statistically slight difference(p<0.001). As to satisfaction with the faculties, it was high in the students whose aptitude and interest matched the major and who didn't think about a career after graduation showing a slight difference(p<05, p<0l). As for satisfaction with clinical training, students whose aptitude and interest matched the major and who didn't consider changing the major answered positively showing a statistically slight difference(p<.001, p<.01). As to satisfaction with the course, it was high in the students who entered with aptitude and interest, who had preliminary knowledge, who didn't consider changing the major, and who didn't think about a career after graduation showing a statistically slight difference(p<.001, p<.05). 5. Occupation mind-set was positive for students who entered with interest and aptitude, who had preliminary knowledge, and who had not considered changing the major showing a statistically slight difference(P<.001). The higher the satisfaction with the major, faculty and clinical training was, the more positive the occupation mind-set was(p<.001).

• 의료법학
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• 제25권1호
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• pp.87-115
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• 2024

우리나라는 급격한 발전과 더불어 많은 성장을 이루는 과정에서 스트레스에 노출이 정신적 고통을 수반하게 되었고 다양한 사회문제로 나타나며, 응급입원의 빈도가 높아지고 있다. 정신질환자의 경우 '비자의 입원'이 문제가 되며, 경찰, 119구급대원이 정신질환자의 신체억제를 시도하며, 많은 문제점이 노출되고 있다. 이는 정신건강복지법 상 응급입원의 조항의 구성요건이 현실을 반영하지 못해 하나의 정신질환자를 두고 각 기관이 다른 입장을 내며, 응급입원이 원활하게 진행되지 않거나, 관계기관의 마찰로 이어지며 정신질환자의 안전이나, 타인의 안전이 확보되지 못하는 경우가 발생하고 있다. 응급입원은 주체가 '정신질환자로 추정되는 사람으로 자신의 건강 또는 안전이나 다른 사람에게 해를 끼칠 위험이 큰 사람을 발견한 사람'으로 정하고 있으며, 그 상황이 매우 급박하여 스스로 입원을 결정하는 입원절차를 거칠 시간적 여유가 없는 경우 의사와 경찰관의 동의를 얻어 응급입원을 의뢰할 수 있다고 규정하고, 이 경우 119구급대원이 정신의료기관까지의 호송하도록 하고 있다. 이러한 응급입원의 조항은 정신의료기관까지 이송하는 과정에 많은 문제를 내포하고 있다. 실무를 담당하는 경찰관이나 119구급대원이 응급입원과정 중 '물리력'을 사용하게 되면, 필연적으로 부작용이 발생하게 되는데, 업무상과실이 문제가 될 수 있으며, 구체적으로는 물리력을 행사할 때 법령에 근거하고 비례원칙에 따른 필요최소한도의 신체억제가 필요하게 되는데, 법령상 119구급대원이나 경찰관의 주의의무의 부재가 결국 다른 법령을 적용하여 해결하게 된다는 것이다. 이에 정신건강복지법 상 응급입원 조항의 주체를 경찰, 소방기관의 장점을 살려 주체를 변경하고, 정신보건법의 시행규칙으로 신체보호대 사용을 정의하고, 규정함으로써 119구급대원과 경찰관의 주의의무를 설정하고 정신질환자가 안전하게 치료받을 수 있도록 이송에 대한 환경을 조성함으로써 자기 또는 타인의 위험을 내포하고 있는 정신질환자 또한 안전한 환경에서 정신의료기관으로 이송될 수 있는 계기가 될 것이다.