• 한국노년학
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• 제34권2호
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• pp.369-386
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• 2014

본 연구에서는 노인장기요양보험 재가서비스 대상자의 요양문제를 체계적으로 파악하여 관리함에 있어서 수요자, 공급자, 제3지불자간의 소통을 용이하게 할 수 있는 노인장기요양보험 재가서비스 분류 틀을 개발하고 타당도를 검증하였다. 분류 틀을 구성함에 있어서 7개의 재가서비스 영역을 종축으로, 요양문제 목록화, 요양목표 설정, 서비스 제공이라는 재가서비스 과정을 횡축으로 설정하였다. 분류 틀을 고안하기 위하여 두 종류의 전문가 집단을 구성하였고, 제1전문가 집단이 재가서비스 분류 틀을 설계한 후 제2전문가 집단이 내용 타당도를 검증하여 재가서비스 분류 틀 초안을 도출하였다. 도출된 재가 서비스 분류 틀의 구성타당도와 기준타당도를 검증하기 위하여 전국에서 152명의 재가서비스 수요자를 무작위로 추출하여 분류 틀 내의 재가서비스 항목별 요구도를 조사하였다. 요인분석 결과 21개의 요양목표에 따라 114개 재가서비스 행위를 분류할 수 있었으며 행위분류 틀의 내적신뢰도 cronbach α가 0.9 이상으로 내적신뢰도가 확보되었다. 장기요양등급을 준거로 하여 기준타당도를 검증한 결과, 21개 요양목표 중 12개 요양목표의 요구도가 장기요양등급별로 통계적으로 유의한 차이를 보였다. 이상과 같은 결과를 종합하면 본 연구에서 개발한 재가서비스 분류 틀은 신뢰도와 타당도를 확보하여 노인장기요양보험 서비스의 질 향상에 기여할 것으로 판단된다.

• 의료법학
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• 제20권3호
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• pp.143-174
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• 2019

우리 헌법은, 국가로 하여금 국민의 건강을 보호할 의무를 지우고 있고, 이에 따라 구체화된 규범인 의료법은 의료기관 개설 등에 관한 사항을 상세히 규정하고 있는데, 그 내용 중 하나가 의료인의 의료기관 복수개설·운영 금지제도이다. 이에 대하여, 종래의 판례는 '다른 의사 명의로 추가 개설하는 의료기관에서 직접 의료행위 등을 하지 않는다면 여러 개의 의료기관을 개설·운영할 수 있다'라고 해석함으로써, 사실상 복수의 의료기관을 개설·운영할 수 있었다. 하지만 일부 의료인들이 다른 의료인의 면허로 의료기관을 여러 장소에 개설하고 이익을 극대화하기 위하여, 환자유인행위를 하거나 과잉진료 및 위임치료를 하는 등의 불법의료행위를 조장할 뿐만 아니라 국민의 건강권 등을 침해하는 현실적 문제가 발생하게 되었다. 이에 입법자는 의료법의 개정을 통해 의료인은 어떠한 명목으로도 둘 이상의 의료기관을 개설하거나 운영할 수 없도록 의료기관 개설제도를 정비하게 되었다. 이와 같은 개정 의료법 제33조 제8항이 위헌인지 여부에 대하여, 헌법소원과 위헌법률심판 제청이 되어 헌법재판소에서 오랜 기간 심층심리 끝에 최근 합헌결정이 선고되었다. 헌법재판소는, 보건의료는 상거래의 대상이 되어서는 아니 되고, 공공의료기관의 비중, 영리목적 환자유인, 과잉진료 등을 방지하기 위한 점을 감안하여 '목적의 정당성'을 인정하였다. 또한 의료인이 외부 자본에 종속될 우려가 있는 점, 의료기관 개설 명의인과 실제 운영자가 분리되는 것은 우려스러운 점, 인간의 신체와 생명이 수단이 되어서는 아니 된다는 점, 현재의 의료체계상 과잉진료 확인이 불가한 점 등을 고려해 볼 때 '침해의 최소성'도 인정하였다. 나아가 '법익 균형성' 등 기본권 제한의 원칙인 과잉금지원칙을 준수하여 합헌이라고 판단하였다. 이와 같이 헌법재판소가 우려하고 있는 영리추구, 과잉진료를 현실적으로 방지하기 위해서는 입법적 보완이 필요하다. 이와 관련하여 소비자단체는 입법의 필요성에 적극 찬성하고 있고, 보건의료 공급자 단체 또한 입법의 필요성에 공감하고 있다. 따라서 입법자는 헌법재판소의 이번 결정을 존중하고, 국민들의 입장을 반영하여 빠른 시일 내에 보완입법을 마련하길 기대한다.

• Child Health Nursing Research
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• 제19권2호
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• pp.120-129
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• 2013

목적 지속적인 의료기술의 발달로 미숙아의 치료, 양육 방법이 변화되어지고 있으며, 정보통신기술의 발달로 교육매체 역시 다양화 되어지는 시점에서 미숙아 부모를 위한 미숙아 돌봄 교육과 관련된 국내 연구 논문을 통합적으로 고찰하여 그 구성요소를 파악하고 각각에 대해 논의함으로써 향후 교육방법의 방향을 모색하고자 하였다. 방법 연구는 Whittemore와 Knafle (2005)이 제시한 통합적 고찰(integrative review) 방법으로 연구목적규정, 문헌검색, 데이터평가, 데이터 분석의 과정에 따라 체계적으로 탐색하고 논의하여 그 의미 있는 결과를 도출하였다. 엄격한 선정기준과 제외기준을 적용하여 4개의 국내 논문데이터베이스에서 1990년부터 2012년 10월까지 국내에서 발표된 논문 중 최종적으로 본 연구에 사용된 연구는 16편으로 확정하였다. 결과 통합적 고찰결과 미숙아 부모를 위한 미숙아 돌봄 교육의 구성요소로는 '교육자로서의 간호사와 학습자로서의 부모', '교육 내용과 교육 효과', 그리고 교육 매체, 시기, 장소를 포함한 '교육 환경'으로 분류되었다. 결론 미숙아 돌봄 교육을 위하여 부모와 가족교육을 전담하는 간호사 역할의 인정과 기관과 정부의 지속적인 관리와 지원과 함께 다학제적인 접근으로 각 양육자에 따른 맞춤형 교육이 되어야할 것이다. 향후 미숙아 돌봄 교육에서는 다양한 측면에서 교육의 효과를 측정할 수 있는 평가도구와 효율적인 교육매체의 개발과 효과적인 교육환경에서 미숙아 돌봄을 향상시킬 수 있는 프로그램의 개발을 제언한다.

• 성인간호학회지
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• 제12권2호
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• pp.278-285
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• 2000

Nausea, vomiting and retching are universal symptoms that affect individuals' state of health and self-care activities of individuals. Accurate measurements of individual symptoms are required to gather more definitive data, and enhance understanding, planning, and implementation of self-care actions. Recently the Rhodes Index of Nausea, Vomiting, and Retching(INVR), a new format of the INV-2(the Rhodes Index of Nausea and Vomiting), was developed to measure the symptoms of nausea, vomiting and retching in an English speaking population. To determine the reliability and validity of the INVR, and the possibility of using the instrument in Korea, the Korean translation of the INVR and the INV-2 were administered to a convenient sample of 105 patients at two University Hospitals in Kwangju, Korea. The Cronbach's alpha to estimate the internal consistency of reliability for INVR was 0.844. Equivalent measures of reliability were conducted to determine the percentage of agreement and the Spearman rank correlation coefficients for responses on the two instruments. The percent agreement was 83% and the correlation coefficient was 0.906 over all. A significant differences between the INVR scores of the patients with and without nausea, vomiting, or retching were seen, which indicated a construct validity. The INVR was found to be more user friendly for the patient and the healthcare providers. As a result, it is suggested that the INVR can provide a scientific base for measuring the symptoms of nausea, vomiting, and retching for nurses to improve patients' care and quality of life.

• Asian Pacific Journal of Cancer Prevention
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• 제17권4호
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• pp.2329-2336
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• 2016

Background: Despite the existence of established guidelines advocating the use and value of chemotherapy order templates, chemotherapy orders are still handwritten in many hospitals in Lebanon. This manuscript describes the implementation of standardized chemotherapy order templates (COT) in a Lebanese tertiary teaching hospital through multiple steps. Initial Assessment: An initial assessment was conducted through a retrospective appraisal of completeness of handwritten chemotherapy orders for 100 adult patients to serve as a baseline for the project and identify parameters that might afford improvement. Choice of solution: Development of over 300 standardized pre-printed COTs based on the National Comprehensive Cancer Network templates and adapted to the practice culture and patient population. Implementation: The COTs were implemented, using Kotter's 8-step model for leading change, by engaging health care providers, and identifying and removing barriers. Evaluation: Assessment of physicians' compliance with the new practice (122 orders assessed) was completed through two phases and allowed for the identification of areas of improvement. Lessons Learned: Overall, COT implementation showed an average improvement in order completion from 49.5% (handwritten orders) to 77.6% (phase 1-COT) to 87.6% (phase 2-COT) reflecting an increase of 38.1% between baseline and phase 2 and demonstrating that chemotherapy orders completeness was improved by pre-printed COT. As many of the hospitals in Lebanon are moving towards standardized COTs and computerized physician order entry (CPOE) in the next few years, this study provides a prototype for the successful implementation of COT and demonstrates their role in promoting quality improvement of cancer care.

• 한국병원경영학회지
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• 제22권4호
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• pp.1-15
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• 2017

This study was designed to analyze the effect of servicescape and human service quality on patients' internal response and their behavioral intention in dental care organizations. Self-administered survey questionnaires with structured instruments were developed, and a total of 226 responses were used for statistical analyses using SPSS Windows version 18.0 program and AMOS 18.0 program. Major findings of the study are as follows. First, among other servicescape components, air condition environment was found to have a positive effect on patients' cognitive and physiological responses, while signals and symbols had a positive effect on cognitive and emotional responses. Second, the competence, among other factors of the human service quality, had positive influence on cognitive and emotional responses, while customer understanding affected positively on emotional response. Third, none of the servicescape components showed a direct effect on patients' behavioral intention, but their influence was mediated by internal responses. However, customer understanding, among other human service quality factors, had a direct effect on patients' behavioral intention. Fourth, emotional response, among other internal response factors, proved to have positive influence on behavioral intention. Results from this study suggest that dental care service providers can increase their competitiveness and customer satisfaction by understanding and improving the most important areas of servicescape and human service quality.

• 대한소아치과학회지
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• 제42권1호
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• pp.80-86
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• 2015

진정법을 시행하는 치과의사는 반드시 발생할 수 있는 응급상황에 적절히 대처할 수 있는 능력과 환경을 갖추어야 한다. 2010년 치의학회에서 발간한 진정법 가이드라인에서 진정법을 준비하고 책임지는 치과의사는 기본생명구조술과 전문심장구조술 자격을 유지할 것을 요구하고 있다. 국내에서는 대한심폐소생협회가 2004년부터 기본생명구조술 및 전문심장구조술을 위한 Provider, Instructor 양성 과정을 진행하고 있다. 저자는2014년에 이 과정들을 이수하면서 과정에 대한 소개와 경험한 내용을 공유하고자 하였다. 기존 교육이 응급의료를 담당하는 사람들에게 초점이 맞추어 졌기에, 향후 치과의사의 특수성에 보다 적합한 교육 과정 개발이 필요하다고 사료된다.

• 한국학교ㆍ지역보건교육학회지
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• 제13권3호
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• pp.113-125
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• 2012

Objectives: This study was aimed to inspect what relation there exists between the elderly's social support, self-esteem and the suicidal thinking, and examined factors influencing their suicidal ideation. Methods: For 207 old persons above 65 residing at Seoul, questionnaire survey was performed for 4 weeks. For response data, t-test and ANOVA, Pearson's Correlation Coefficient and Multiple Regression Analysis were performed using spss 18.0 program. Results: The results of analysis are like followings. 1. As for the social support according to the general characteristics, there was statistically significant difference in sex distinction, religion, living arrangement, educational level, monthly allowance and mode to use spare time. As for self-esteem according to the general characteristics, there was statistically significant difference in sex distinction, religion, living arrangement and monthly allowance. And as for the suicidal ideation, there was statistically significant difference in the marital status. 2. As for the relation between the social support, self-esteem and the suicidal ideation, it showed statistically very significant positive correlation in the social support and self-esteem. And there existed relatively higher positive correlation in family support among sub-factors of the social support and the positive self-recognition among sub-factors of self-esteem. 3. It showed that positive and negative self-recognition as sub-factors of self-esteem, others' support as sub-factor of the social support influence on the suicidal ideation. In other words, as positive self-recognition was lower, as negative self-recognition was higher, as social support of others was lower, they had much more effect on the suicidal ideation of the elderly. And it showed about 36.1% of the explanatory capability. Conclusions: Health care providers should develop school health education for the elderly.

• 성인간호학회지
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• 제14권3호
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• pp.348-358
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• 2002

Purpose: The purpose of this study was to identify the factors influencing regular exercise of the elderly in discriminating regular exercise and non - regular exercise groups. Method: The subjects of this study were 167 elderly over the age of 60, living in a rural city in Korea. The data was collected by interview and self report questionnaire in 1999. The Cronbach 's alpha of scales used this study were .66 ~.97. Result: 1. There were significant differences in doing regular exercise between the perceived importance of the health(p=021), the perceived health status(p=.050), the perceived need of the exercise(p=000), the perceived importance of the exercise(p=.000), the intent of participation in the exercise program(p=.000), IADL score(p=.022), the perceived benefits of exercise (p=.000), the emotion of exercise(p=.000), HPLP(p=.000), the self efficacy(p=.001), the perceived benefits of health promoting behaviors(p= .011), the perceived barriers of the health promoting behaviors(p=.002), and the Internal locus of control(p=.021) of the elderly. 2. Variables which showed significance for discriminating regular exercise of the elderly in this study were the perceived need of the exercise(p=.000) and the perceived benefits of the exercise(p=.000). By using the combination of these variables, the possibility of proper prediction for predicting regular exercise group was 84.8 %, non - regular exercise group was 93.9%, and total Hit ratio was 89.4%. Conclusion: To improve exercise behavior in older adults, health care providers should focus of developing interventions to strengthen the perceived benefits, the perceived needs of the exercise.

• 대한치과기공학회지
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• 제35권4호
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• pp.395-403
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• 2013

Purpose: This article examined the affecting factors of a malocclusion status of a patient for orthodontic treatment, orthodontics medical expenses and oral health behavior on orthodontic satisfaction. Methods: This paper conducted a survey from the 15th of July to 30th of September 2012 for the patients who were under orthodontic treatment at three dental clinics where are in Deagu, and distributed a total of 210 questionnaires and analyzed 194 questionnaires, excepting for some questionnaires that were answered unfaithfully. Results: This study classified the related factors into a feeling of satisfaction with treatment and mental satisfaction for finding orthodontic satisfaction. There were the effect of the right tooth-brushing method, a periodic scaling and orthodontics medical expenses on a feeling of satisfaction with treatment, and power of explanation was 16.7%. Conclusion: There were the effect of a malocclusion status, matters that requires attention during orthodontic treatment, a periodic scaling during orthodontic treatment and orthodontics medical expenses on mental satisfaction, and power of explanation was 16.9%. Based on the result above, this paper concluded that preventive treatment and early treatment should be emphasized through developing a program for regular oral examination suited to each medical type, including the method for improving the medical treatment condition and care service for increasing orthodontic satisfaction, which the dental medical-service providers could consider the patients and secure trust.