• Title/Summary/Keyword: Hospital design

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A basic research for evaluation of a Home Care Nursing Delivery System (가정간호 서비스 질 평가를 위한 도구개발연구)

  • Kim, Mo-Im;Cho, Won-Jung;Kim, Eui-Sook;Kim, Sung-Kyu;Chang, Soon-Bok;Ryu, Ho-Sihn
    • Journal of Home Health Care Nursing
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    • v.6
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    • pp.33-45
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    • 1999
  • The purpose of this study was to develop a basic framework and criteria for evaluation of quality care provided to patients with the attributes of disease in the home care nursing field, and to provide measurement tools for home health care in the future. The study design was a developmental study for evaluation of hospital-based HCN(home care nursing) in Korea. The study process was as follows: a home care nursing study team of College of Nursing. Yonsei University reviewed the nursing records of 47 patients who were enrolled at Yonsei University Medical Center Home Care Center in March, 1995. Twenty-five patients were insured at that time, were selected from 47 patients receiving home care service for study feasibility with six disease groups; Caesarean Section (C/S), simple nephrectomy, Liver cirrhosis(LC), chronic obstructive pulmonary disease(COPD), Lung cancer or cerebrovascular accident(CVA). In this study, the following items were selected : First step : Preliminary study 1. Criteria and items were selected on the basis of related literature on each disease area. 2. Items were identified by home care nurses. 3. A physician in charge reviewed the criteria and content of selected items. 4. Items were revised through preliminary study offered to both HCN patients and discharged patients from the home care center. Second step : Pretest 1. To verify the content of the items, a pretest was conducted with 18 patients of which there were three patients in each of the six selected disease groups. Third step : Test of reliability and validity of tools 1. Using the collected data from 25 patients with either cis, Simple nephrectomy, LC, COPD, Lung cancer, or CVA. the final items were revised through a panel discussion among experts in medical care who were researchers, doctors, or nurses. 2. Reliability and validity of the completed tool were verified with both inpatients and HCN patients in each of field for researches. The study results are as follows: 1. Standard for discharge with HCN referral The referral standard for home care, which included criteria for discharge with HCN referral and criteria leaving the hospital were established. These were developed through content analysis from the results of an open-ended questionnaire to related doctors concerning characteristic for discharge with HCN referral for each of the disease groups. The final criteria was decided by discussion among the researchers. 2. Instrument for measurement of health statusPatient health status was measured pre and post home care by direct observation and interview with an open-ended questionnaire which consisted of 61 items based on Gorden's nursing diagnosis classification. These included seven items on health knowledge and health management, eight items on nutrition and metabolism, three items on elimination, five items on activity and exercise, seven items on perception and cognition, three items on sleep and rest, three items on self-perception, three items on role and interpersonal relations, five items on sexuality and reproduction, five items on coping and stress, four items on value and religion, three items on family. and three items on facilities and environment. 3. Instrument for measurement of self-care The instrument for self-care measurement was classified with scales according to the attributes of the disease. Each scale measured understanding level and practice level by a Yes or No scale. Understanding level was measured by interview but practice level was measured by both observation and interview. Items for self-care measurement included 14 for patients with a CVA, five for women who had a cis, ten for patients with lung cancer, 12 for patients with COPD, five for patients with a simple nephrectomy, and 11 for patients with LC. 4. Record for follow-up management This included (1) OPD visit sheet, (2) ER visit form, (3) complications problem form, (4) readmission sheet. and (5) visit note for others medical centers which included visit date, reason for visit, patient name, caregivers, sex, age, time and cost required for visit, and traffic expenses, that is, there were open-end items that investigated OPD visits, emergency room visits, the problem and solution of complications, readmissions and visits to other medical institution to measure health problems and expenditures during the follow up period. 5. Instrument to measure patients satisfaction The satisfaction measurement instrument by Reisseer(1975) was referred to for the development of a tool to measure patient home care satisfaction. The instrument was an open-ended questionnaire which consisted of 11 domains; treatment, nursing care, information, time consumption, accessibility, rapidity, treatment skill, service relevance, attitude, satisfaction factors, dissatisfaction factors, overall satisfaction about nursing care, and others. In conclusion, Five evaluation instruments were developed for home care nursing. These were (1)standard for discharge with HCN referral. (2)instrument for measurement of health status, (3)instrument for measurement of self-care. (4)record for follow-up management, and (5)instrument to measure patient satisfaction. Also, the five instruments can be used to evaluate the effectiveness of the service to assure quality. Further research is needed to increase the reliability and validity of instrument through a community-based HCN evaluation.

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The Effect of Positioning with Mechanically Ventilatory Acute Respitatory Failure Patients on Arterial Oxygen Partial Pressure and Alveolar-arterial Oxygen tension (인공호흡기를 부착한 급성 호흡부전 환자에서 폐병변 부위에 따른 체위적용이 동맥혈 가스분압 및 폐포동맥간 산소 분압차에 미치는 영향)

  • Hwang, Hee Joung;Park, Hye Ja
    • Korean Journal of Adult Nursing
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    • v.12 no.2
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    • pp.234-244
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    • 2000
  • It is widely recognized that manipulation of body position takes advantage of the influences of gravity for improving oxygenation. The study aims to determine the effects of positioning(supine, prone, right lateral decubitus and left lateral decubitus positions) applied to the mechanically ventilatory acute respiratory failure patients on arterial oxygen partial pressure($PaO_2$), alveolar arterial oxygen tension difference($AaDO_2$), mean aterial pressure, peak inspiratory pressure and plateau pressure. Thirty two acute respiratory failure patients admitted to the medical intensive care unit at Kangnam St. Mary's Hospital, The Catholic University of Korea from March 1997 to January 1998, were divided into three groups by radiographic evidence of unilateral or bilateral lung disease. In group 1 with dominant right lung disease were twelve subjects, group 2 with dominant left lung disease had eight subjects and group 3 had twelve subjects with bilateral lung disease. The variables were measured in 30 minutes after each position of supine, prone, good lung down lateral decubitus and sick lung down lateral decubitus position. The position order was done at random by Latin squre design. The results are as follows; 1) With group 1 patients, the $PaO_2$ in the left lateral decubitus and prone position were $126.8{\pm}30.8$ mmHg and $106.7{\pm}36.8$ mmHg, respectively(p=0.0001). 2) With group 2 patients, the $PaO_2$ in the prone and the right lateral decubitus position were $121.7{\pm}44.7$ mmHg and $118.5{\pm}31.7$ mmHg, respectively (p=0.0018). 3) With group 3 patients, the $PaO_2$ was $143.6{\pm}36.6$ mmHg in the prone position (p=0.0001). 4) With group 1 patients, the $AaDO_2$ in the left lateral decubitus and the right lateral decubitus position were $178.1{\pm}29.7$ mmHg and $233.1{\pm}24.4$ mmHg, respectively(p=0.0001). 5) With group 2 patients, the $AaDO_2$ in the prone and the left lateral decubitus postion were $184.0{\pm}39.5$ mmHg and $231.0{\pm}23.9$ mmHg, respectively(p=0.0019). 6) With group 3 patients, the $AaDO_2$ in the prone and the supine postion were $377.1{\pm}35.6$ mmHg and $435.7{\pm}13.1$ mmHg, respectively (p=0.0001). 7) There were no differences among the mean arterial pressure, peak inspiratory pressure and plateau pressure for each of the supine, prone, left lateral decubitus and right lateral decubitus position. The results suggest that oxygenation may improve in mechanically ventilatory patients with unilateral lung disease when the position is good lung dependent and prone, and patients with bilateral lung disease when the position is prone without any effects on the mean arterial pressure and airway pressure. It is suggested that body positions improve ventilation/perfusion matching and oxygenation need to be specified in patient care plans.

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A Study on the Charateristics of the Korean Adult Female Sound According to Sasang Constitution Using PSSC with a Sentence (사상체질음성분석기(四象體質音聲分析機)(PSSC)를 통한 한국인 성인여성(成人女性)의 체질별(體質別) 음향특성연구(音響特性硏究) - 단문(短文)을 중심으로 -)

  • Youn, Ji-Young;Yoon, Woo-Young;Cho, Sung-Eon;Wang, Hyang-Lan;Jeon, Jong-Weon;Kim, Dal-Rae;Yoo, Jun-Sang
    • Journal of Sasang Constitutional Medicine
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    • v.18 no.3
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    • pp.75-93
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    • 2006
  • 1. Objectives and Methods Sasang Constitutional Medicine is the original Korean Medicine. The purpose of this study was to objectify the diagnosis of Sasang Constitution. 212 Women's sentences were analyzed into 228 factors like Pitch, APQ, Shimmer, Octave and Energy, etc. Women's sentences were classified into 3 categories: total group, under 54 years old group and over 55 years old group. 2. Results 1) In Total group Soyangin's Center feq.(3) was significantly high compared with Taeyangin and Taeumin groups. Taeumin's Pitch2 was significantly high compared with Soeumin and Taeyangin groups. Taeyangin's Pitch S.D. was significantly high compared with Soyangin group. Taeyangin's Octave6 was significantly high compared with Soeumin group. There were no significant differences among constitutional groups in APQ and Shimmer segment. On the point of Energy, Taeyangin's G Tot E(1), G# Tot E(1), G dev.(1), G# dev.(1), G Tot E(2), G# Tot E(2), G dev.(4) and G# dev.(4) were significantly high compared with other groups. Soyangin's A#S.D.(2) was significantly high compared with Taeyangin group. Taeyangin's A#S.D.(3) was significantly high compared with Taeumin group. Taeyangin's F S.D.(5), F# S.D.(5) and Max Average were significantly high compared with Soeumin group. Taeumin's Peak3 and Peak4 were significantly high compared with Taeyangin group. Taeumin's PeakValue1 was significantly high compared with Soeumin group. Taeyangin's PeakValue2 was significantly high compared with Soeumin group. Taeyangin's PeakValue3 and PeakValue5 were significantly high compared with Other groups. 2) In Under 54 years old group, there were no significant differences among constitutional groups in APQ, Shimmer and Octave segment. Taeumin's Center freq.(2) was significantly high compared with Taeyangin and Soyangin groups. Taeumin's Pitch(2) and Pitch(3) were significantly high compared with Taeyangin and Soeumin groups. Taeyangin's and Taeumin's Pitch S.D. were significantly high compared with Soyangin group. Taeyangin's and Soyangin's Octave2 were significantly high compared with Taeumin group. On the point of Energy, Taeyangin's and Soyangin's A# S.D.(2) were significantly high compared with Soeumin group. Taeyangin's and Soyangin's G# dev.(1), G# dev.(2) were significantly high compared with Taeumin group. Taeyangin's and Taeumin's F# S.D.(3) were significantly high compared with Soeumin group. Taeyangin's and Soyangin's Max Average were significantly high compared with Soeumin group. Taeumin's Peak3 was significantly high compared with Taeyangin and Soeumin groups. Taeyangin's and Taeumin's PeakValue2 were significantly high compared with Soeumin group. Taeyangin's and Soeumin's PeakValue3 were significantly high compared with Taeumin group. Taeyangin's and Soyangin's PeakValue5 were significantly high compared with Soeumin group. Taeyangin's and Soyangin's PeakValue9 were significantly high compared with Taeumin group 3) In Over 55 years old group, there were no significant differences among constitutional groups in Pitch, APQ, and Peak segment. Soeumin's F Shimmer(1) and F Shimmer(2) were significantly high compared with Taeyangin and Taeumin groups. Soeumin's G# Shimmer(1) and G# Shimmer(2) were significantly high compared with Soyangin group. Taeyangin's Octave5 and Octave6 were significantly high compared with Soeumin group. On the point of Energy, Soyangin's C S.D., F# S.D.(1), F# S.D.(2) and G dev.(2) were significantly high compared with other groups. Soyangin's F# S.D.(3) was significantly high compared with Taeumin and Soeumin groups. Taeyangin's and Taeumin's G# S.D.(2) and G# S.D.(3) were significantly high compared with Soyangin group 3. Conclusions From above result, there is the possibility of efficient standard guide for constitution diagnosis by analysis of voice

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Stress and Coping for Patients with Hemiplegia during the Rehabilitation Process (편마비 환자의 재활과정에 따른 스트레스와 대처의 변화양상)

  • 강현숙
    • Journal of Korean Academy of Nursing
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    • v.24 no.1
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    • pp.18-32
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    • 1994
  • It is important to understand that patients with hemiplegia are under stress during the rehabilitation process. This study was designed to determine what changes occur in the stress perceived by these patients during the rehabilitation process. and what changes occur in the ways they coped with stress. A decriptive study with a longitudinal design was conducted. A total of 57 patients with hemiplegia who were admitted to one general hospital made up the sample for this study. A questionnaire, observations and interviews were used for the data collection which was done in three phases(within one week after admission : within one week before discharge ; within one month after discharge ). Data were analyzed using t-test, ANOVA repeated measures of ANOVA, and post hoc paired t -test, Bonferroni correction. The results of this study are : 1. Changes in the perception of stress during the rehabilitation process : There was a statistically significant differencs in the perception of stress among these patients during the rehabilitation process. On the post-hoc test. the perception of stress showed a statistically significant decrease from admission to discharge. The perception of psychological stress was high during the rehabilitation process as compared with the perception of physical and social stress. 2. Changes in the way the patients coped during the rehabilitation process : On admission passive coping was used by most of the subjects(91.2%). Passive coping showed an decrease from admission to discharge, but an increase from discharge to follow-up at one month post discharge. There was, however, no statistically significant changes in the way the patients coped during the rehabilitation process. 3. Changes in perception of stress during the rehabilitation process according to variables. Perception of stress among patients classified as So-Um was higher during the rehabilitation process, when compared with patients classified as So- Yang and Tae-Um. There was, however, no statistically significant difference in perception of stress over time. The patients with right sided paralysis perceived higher stress than those with left sided paralysis. There was, however, no statistically significant difference in perception of stress over time. Hence, stress was not influenced by which side was paralyzed th frequency of the relapse of the disease, or the time in the rehabilitation process. 4. Changes in coping during the rehabilitation process according to variables. There was a statistically significant difference in the way the patients coped at follow- up according to the three different kinds of the constitution groups. In other words, coping was not used by patients classified as Tae-Um but was used by those classified as So-Um. On the repeated measures of ANOVA, there was a statstically significant difference in stress over time, and an interaction between constitution and time. But the way of coping during the rehabilitation process was not influenced by which side was paralyzed nor by the frequency of the relapse of the disease. In conclusion, perception of psychological stress was high during the rehabilitation process, as compared to perception of physical and social stress. There was a statistcally significant difference in the perception of stress over time, Perception of stress showed a gradual decrease from over admission to follow-up period. There was. however, no statistically significant difference in the way of coping over time. Passive coping was used by most of patients. In the study, these findings suggest a need for nursing care related to the psychological support for patients with hemiplegia both in the hospital as well as at home, and the need for education and counseling on independent self-care to help the hemiplegic patients adapt to stress using active coping.

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A Need Assessment on Establishment of Oriental Health Promotion Center (한방건강증진센터 설립에 대한 인식 및 요구조사)

  • Lee, Hyang-Yeon;Kim, Kwuy-Bun;Cho, Kyoul-Ja;Shin, Hye-Sook;Kim, Kwang-Joo;Moon, Heui-Ja;Park, Shin-Ae;Kim, Yoon-Hee;Kang, Hyun-Sook
    • Journal of East-West Nursing Research
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    • v.5 no.1
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    • pp.90-101
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    • 2000
  • The study attempts to examine the degree of cognition and demand on health promotion center of oriental nursing. It puts unique nursing intervention using traditional health promotion connected with oriental medicine to practical use for residents' health promotion and prevention of disease. With the study design of cross-sectional descriptive study, 516 residents who live in 26 Dongs, Dongdaemoon-gu were selected. The tool of study consists of 30 questions which the study team made for the degree of cognition and demand on health promotion center of oriental nursing. Cronbach's $\alpha$ in the degree of cognition was .8028. Collection of research data had been done from October 1 to October 30, 1999 with help of Dongdaemoon-gu office after pretest from 20 residents. Collected data were analyzed into the number and percentage in the characteristic of a subject and connected with demand on the establishment of center, the mean and the standard deviation in the degree of cognition and F-tests in the difference of the degree of cognition by characteristics. The results were as follow; 1) The characteristic of subject of this study was male 50.6%, and average age was 38.5 years old and 30-39 years old occupied the highest percentage with 31.6%. The married were 71.8%, over high school graduates was 85.6%, monthly income from 500 thousand won to 2 million won was 86.1%. 50.8% was the type living with parents, children and sibling. 2) When they were sick, the institution which residents used at first was a pharmacy(69.2%) and hospital(27.5%), but oriental medicine hospital was just 1.4%. As for subjective health condition, 82.5% answered over average, and 28.7% answered that they had chronic illness such as arthritis, chronic digestion problem, hypertension and so on. As for information collection on health, mass communication(34.9%) and medically concerned people(28.1%) occupied relatively high rate. Free health diagnosis system(36.8%) and establishment of health promotion center(31.5%) among welfare programs that residents want to enjoy were high ranked. The rate using a special institution for health was 17.8%, and among these institutions, the rate using aerobic exercises, health center(7.0%) and steamed room(5.4%) was high. Besides, other institutions such as breathing at the abdomen, finger-pressure therapy, meridian massage, foot massage, and so on were being used. 3) As the average of the degree of cognition on health promotion center of oriental medicine was 2.92, the degree of cognition was medium. The description, "health promotion center of oriental medicine is necessary for health keeping of healthy people, including people who have a problem in health" showed the highest degree of cognition(3.04, ${\pm}0.64$). 4) As for the intention on using health promotion center of oriental nursing, 61.4% said "yes", "no" was just 1.4%. The services that people relatively high wanted to be served from the center were measures reducing stress(68.0%) (relaxation therapy, meditation, breathing at the abdomen and so on), acupuncture(66.5%), finger-pressure(61.6%), moxibustion(57.6%), meridian massage(44.2%), postpartum care(40.3%) and so on. 5) As for the degree of cognition on the establishment of health promotion center of oriental nursing by characteristics of subject, there was significant difference(F=4.03, p=.046) between male(3.01) and female(2.91). But there was no significant difference by age, marital status, level of educational achievement and monthly income. As the above result, cognition on the establishment of health promotion center of oriental nursing was relatively low because people were not familiar with about the health promotion center of oriental nursing yet. However once the center will be established, the degree of demand on the center will be relatively high. So positive advertisement will be necessary, and the management of useful programs will be also required in order to make people recognize the advantage when they actually will use the center. On the other hand, as the subject of the study consists of many young people of below 30, the health problem came to be low. And in the case of sampling, the study using random sampling that can represent population will be required.

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Analyses on Sound Effects for Soundscape Design of Healing Garden at Psychiatric Hospitals - Focused Psychological and Physiological Effects - (정신병원 치유정원의 음경관 디자인을 위한 소리효과 분석 - 심리적 및 생리적 효과를 중심으로 -)

  • Ahn, Deug-Soo
    • Journal of the Korean Institute of Landscape Architecture
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    • v.43 no.1
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    • pp.82-95
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    • 2015
  • This study is intended to obtain a guideline for creating a therapeutic garden soundscape in a psychiatric hospital by analyzing the psychological and physiological effects of auditory components on mental patients. The subjects were 27 inpatients at a psychiatric institute located in Jeollabuk-do. They were recommended by their doctors and had been diagnosed with mild cases of schizophrenia. The survey was carried out in October 2011. With regard to the study, the subjects listened to single sounds(the sound of flowing water, birdsong, wind chimes and music) and 4 sounds composed of some of these, and then Electroencephalography(EEG) and psychological effects were measured. The moving water sound was perceived as pleasing and revitalizing and the birdsong as sonorous and delightful. When designing a healing garden in a psychiatric hospital, the vitality of sound should be considered. In comparison to other single sounds, water sounds were highly preferred and had greater effects on psychological vitality. Music sounds had a significant effect on enhancing tranquility while water sounds affected on both psychological vitality and tranquillity. When comparing single sounds with combined sounds, single sounds such as running water for vitality and music for tranquility had a greater psychological effect than combined sounds. In terms of combined sound preferences, the combination of water and bird sounds had higher preference rates. Generally, combined sounds including water tended to have higher preference rates. The physiological effects of single sounds showed that music had a greater therapeutic effect than natural sounds such as water sounds and birdsong in promoting tranquility. As for combined sounds adopted to enhance physiological tranquility, it is most appropriate to combine music and birdsong or music and water sounds. However, a single music sound is more effective than combined sounds. Overall, analyses of both psychological and physiological reactions showed music and water sounds to be most calming while water sounds promoted the greatest vitality.

Needs for clinical dietitian in hospital settings: Importance of doctor's awareness regarding clinical nutrition service as mediating variable (의료기관 임상영양사 요구도에 미치는 영향 : 임상영양서비스의 중요도에 대한 의사의 인식을 매개역할 중심으로)

  • Um, Mi Hyang;Park, Yoo Kyoung;Song, Yoon Mi;Lee, Song Mi;Lyu, Eun Soon
    • Journal of Nutrition and Health
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    • v.50 no.5
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    • pp.519-529
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    • 2017
  • Purpose: The purpose of this study was to explore whether or not there is a relationship between doctor's awareness of clinical nutrition service and needs for a clinical dietitian. Methods: A cross-sectional survey design was used. The research was carried out by using questionnaires that had been specifically designed for the study. The research was conducted from September to October, 2013 for 311 doctors at 43 hospitals (with over 400 beds). Frequency analysis, factor analysis, reliability analysis, confirmatory factor analysis, and bootstrapping analysis were conducted using SPSS 21.0. Results: 'Implementation of clinical nutritional service' (p < 0.001) and 'usefulness on clinical nutrition service' (p < 0.001) were found to be correlated with 'importance of clinical nutrition service' as an independent variable. The correlation between 'importance of clinical nutrition service' as a mediating variable and 'needs for clinical dietitian' as a dependent variable was also confirmed (p < 0.001). The results of the bootstrapping test showed that the mediating effect of 'importance of clinical nutrition service' was significant. The indirect effect value between 'implementation of clinical nutrition service' and 'needs for clinical dietitian' was 0.040, indirect effect value between 'usefulness on clinical nutrition service' and 'needs for clinical dietitian' was 0.095. Conclusion: The frequency of providing clinical nutritional services, the quality of clinical nutritional services, and the degree of implementation of clinical nutritional services were found to be important for positive perception of clinical nutrition services by doctors. Therefore, proper provision of clinical nutrition services and effective therapeutic effects will be continuously highlighted, which will increase the awareness of the physician and ultimately increase the demand for clinical nutrition service.

Development of the Model for Total Quality Management and Cost of Quality using Activity Based Costing in the Hospital (병원의 활동기준원가를 이용한 총체적 질관리 모형 및 질비용 산출 모형 개발)

  • 조우현;전기홍;이해종;박은철;김병조;김보경;이상규
    • Health Policy and Management
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    • v.11 no.2
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    • pp.141-168
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    • 2001
  • Healthcare service organizations can apply the cost of quality(COQ) model as a method to evaluate a service quality improvement project such as Total Quality Management (TQM). COQ model has been used to quantify and evaluate the efficiency and effectiveness of TQM project through estimation between cost and benefit in intervention for a quality Improvement to provide satisfied services for a customer, and to identify a non value added process. For estimating cost of quality, We used activities and activity costs based on Activity Based Costing(ABC) system. These procedures let the researchers know whether the process is value-added by each activity, and identify a process to require improvement in TQM project. Through the series of procedures, health care organizations are service organizations can identify a problem in their quality improvement programs, solve the problem, and improve their quality of care for their costumers with optimized cost. The study subject was a quality improvement program of the department of radiology department in a hospital with n bed sizes in Metropolitan Statistical Area (MSA). The principal source of data for developing the COQ model was total cases of retaking shots for diagnoses during five months period from December of the 1998 to April of the 1999 in the department. First of the procedures, for estimating activity based cost of the department of diagnostic radiology, the researchers analyzed total department health insurance claims to identify activities and activity costs using one year period health insurance claims from September of the 1998 to August of the 1999. COQ model in this study applied Simpson & Multher's COQ(SM's COQ) model, and SM's COQ model divided cost of quality into failure cost with external and internal failure cost, and evaluation/prevention cost. The researchers identified contents for cost of quality, defined activities and activity costs for each content with the SM's COQ model, and finally made the formula for estimating activity costs relating to implementing service quality improvement program. The results from the formula for estimating cost of quality were following: 1. The reasons for retaking shots were largely classified into technique, appliances, patients, quality management, non-appliances, doctors, and unclassified. These classifications by reasons were allocated into each office doing re-taking shots. Therefore, total retaking shots categorized by reasons and offices, the researchers identified internal and external failure costs based on these categories. 2. The researchers have developed cost of quality (COQ) model, identified activities by content for cost of quality, assessed activity driving factors and activity contribution rate, and calculated total cost by each content for cost for quality, except for activity cost. 3. According to estimation of cost of quality for retaking shots in department of diagnostic radiology, the failure cost was ₩35,880, evaluation/preventive cost was ₩72,521, two times as much as failure cost. The proportion between internal failure cost and external failure cost in failure cost is similar. The study cannot identify trends on input cost and quality improving in cost of qualify over the time, because the study employs cross-sectional design. Even with this limitation, results of this study are much meaningful. This study shows possibility to evaluate value on the process of TQM subjects using activities and activity costs by ABC system, and this study can objectively evaluate quality improvement program through quantitative comparing input costs with marginal benefits in quality improvement.

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Effects of Wholistic Hospice Nursing Intervention Program on Pain and Anxiety for In-patient of Hospice Palliative Care Unit (전인적 호스피스간호중재 프로그램이 입원한 호스피스환자의 통증과 불안에 미치는 효과)

  • Choi, Sung-Eun;Kang, Eun-Sil;Choe, Wha-Sook
    • Korean Journal of Hospice Care
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    • v.8 no.1
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    • pp.55-67
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    • 2008
  • Purpose: This study was to test the effects of wholistic hospice nursing intervention program on pain and anxiety for in-patient of hospice palliative care unit. This study's design was one-group pre-post test quasi- experimental research. Methods: The subjects of study were 27 patients who were over 18 years old and admitted in hospice palliative care unit of S hospital in P city with agreement in hospice palliative care in their terminal disease. The experimental group subjects participated in holistic hospice nursing program took 120 minutes per session, a total of 1,200 minutes altogether for 10 sessions. The period of data collection was from April 6, 2004 to April 20, 2005. The collected data were analyzed by Paired t-test with SPSS/WIN 12.0 program. A Wholistic Hospice Nursing Intervention Program (named ‘Rainbow Program’) was used as a experimental tool in this study. This was developed by the authors. It was provided by interdisciplinary hospice team (nurses, medical doctors, social worker, pastors, art therapists, and volunteers). In addition, Korean Version of Brief Pain Inventory (BPI-K) by Young-Ho Yun(1998) was used to test degree of pain in physical aspect. And State-Anxiety Inventory was developed by Spielberger(1975) and translated by Kim, Jung-Tack & Shin, Dong-Gyun(1978) was used to test the degree of state-anxiety in emotional aspect. Results: (1) Hypothesis No. 1 "The experimental group which received Wholistic Hospice Nursing Program will have a lower degree of pain than before" was supported (t=-10.585, P= .000). (2) Hypothesis No. 2 "The experimental group which received Wholistic Hospice Nursing Program will have a lower degree of state-anxiety than before" was supported (t=-8.234, P= .000). Conclusion: Our results testified that this Wholistic Hospice Nursing Intervention Program was effective to decrease pain and state-anxiety of the in-patients of hospice palliative care unit. Therefore it can be used and applied actively in practice as a useful model of interdisciplinary team approach by hospice professionals in hospice palliative care unit.

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The Therapeutic Effect of Postganglionic Nerve Block for Symptomatic Schmorl Nodule: A Retrospective Case Series (증후성 쉬모를 결절에 대한 신경절 이후 신경차단술의 치료 효과: 후향적 증례 분석)

  • Son, In Seok;Hwang, Suk Hyun;Lee, Suk Ha;Kang, Min Seok
    • Journal of Korean Society of Spine Surgery
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    • v.25 no.4
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    • pp.147-153
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    • 2018
  • Study Design: Retrospective case series. Objectives: We retrospectively evaluated the clinical efficacy of postganglionic nerve block in symptomatic Schmorl nodules (SNs). Summary of Literature Review: SNs are common lesions that are often asymptomatic. In certain cases, SNs have been reported to cause severe axial back pain, thereby considerably impacting patients' quality of life. No consensus currently exists on the treatment of symptomatic SNs. Materials and Methods: From October 2015 to October 2017, a total of 21 patients with symptomatic SNs diagnosed by magnetic resonance imaging (MRI) that did not respond to conservative treatment after 4 weeks were included in the study. All patients received postganglionic nerve block. We evaluated effective pain relief (improvement of back pain of more than 50% compared with before the intervention) and functional improvements, assessed by visual analogue scale (VAS) and Oswestry Disability Index scores obtained at 4 hours, 4 weeks, 8 weeks, 3 months, and 6 months after the procedure. Results: Symptomatic SNs were more common at the L2-3 level, and the lower end plate was more commonly involved than the upper end plate. Eighteen of the 21 patients (85.7%) showed effective pain relief, and no deterioration was observed within the followup period. Throughout the follow-up period, the VAS remained significantly improved compared to before the procedure (p<0.05). Complications were not reported in any cases. Conclusions: Postganglionic nerve block for symptomatic SNs that do not respond to conservative treatment is a non-invasive modality for pain relief.