• 대한간호학회지
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• 제30권5호
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• pp.1156-1169
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• 2000

The study was aimed at developing an independent hospice center model that would be best suited for Korea based on a literature review and the current status of local and international hospices. For the study, five local and six international hospice organizations were surveyed. Components of the hospice center model include philosophy, purpose, resources (workers, facilities, and equipment), allocation of resources, management, financial support and hospice team service. The following is a summary of the developed model: Philosophies for the hospice center were set as follows: based on the dignity of human life and humanism, help patients spend the rest of their days in a meaningful way and accept life positively. On the staff side, to pursue a team-oriented holistic approach to improve comfort and quality of life for terminally ill persons and their families. The hospice center should have 20 beds with single, two, and four bed rooms. The center should employ, either on a part-time or full-time basis, a center director, nurses, doctors, chaplains, social workers, pharmacists, dieticians, therapists, and volunteers. In addition, it will need an administrative staff, facility managers and nurses aides. The hospice should also be equipped with facilities for patients, their families, and team members, furnished with equipment and goods at the same level of a hospital. represented by a center director who reports to a board and an advisory committee. Also, the center director administers a steering committee and five departments, namely, Administration, Nursing Service, Social Welfare, Religious Services, and Medical Service. Furthermore, the center should be able to utilize a direct and support delivery systems. The direct delivery system allows the hospice center to receive requests from, or transfer patients to, hospitals, clinics, other hospice organizations (by type), public health centers, religious organizations, social welfare organizations, patients, and their guardians. On the other hand, the support delivery system provides a link to outside facilities of various medical suppliers. In terms of management, details were made with regards to personnel management, records, infection control, safety, supplies and quality management. For financial support, some form of medical insurance coverage for hospice services, ways to promote a donation system and fund raising were examined. Hospice team service to be provided by the hospice center was categorized into assessment, physical care, emotional care, spiritual care, bereavement service, medication, education and demonstrations, medical supplies rental, request service, volunteer service, and respite service. Based on the results, the study has drawn up the following suggestions: 1. The proposed model for a hospice center as presented in the study needs to be tested with a pilot project. 2. Studies on criteria for legal approval and license for a hospice center need to be conducted to develop policies. 3. Studies on developing a hospice charge system and hospice standards that meet local conditions in Korea need to be conducted.

• 한국간호교육학회지
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• 제9권1호
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• pp.17-29
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• 2003

This study investigated the degree of self-care practice to maintain the stable respiratory function and the required respiratory nursing needs upon the elderly with chronic obstructive pulmonary diseases. The research subjects were 115 elderly people over 60 years old, who were diagnosed to have chronic obstructive pulmonary diseases (the mixed type, chronic bronchitis, bronchial asthma, emphysema) and were hospitalized in 3 university hospitals in Busan or treated as outpatient, and the data was collected over the period between June 1, 2002 and September 30, 2002. In order to measure the respiratory self-care practice degree and nursing needs of the subjects, the instrument on the self-care practice and the instrument on nursing needs were developed by the researcher. The research results are as follows: 1. The mean of respiratory self-care practice degree by the subjects was 2.41 out of 4 for each clause, and the degree of practicing general management was the highest(2.70), and nutrition control(2.66), respiratory exercise(2.65), expectoration of sputum (2.63), oxygen therapy(2.60), environment control(2.50), and medication control(2.36) succeeded. 2. The degree of self-care practice had a significant difference depending on age(F=2.82, P=0.02), frequency of hospitalization(F=3.11, P=0.01), and diagnosed disease(F=15.66, P=0.00). 3. The subjects nursing needs of respiratory system were 3.07 on the average out of 4.00, and 'I want to know how to prevent the infection of respiratory system such as cold scored the highest 3.83, while the clauses like 'want to know how to face the respiratory disorder properly'(3.77) and 'want the specific explanation of the symptoms of my disease'(3.66) also had scored high points. 4. The nursing needs of the respiratory system had a significant difference depending on diagnosed disease such as mixed type of chronic obstructive pulmonary diseases, emphysema, bronchitis, and asthma (F=6.70, P=0.00). The research showed that the subjects degree of self-care practice of respiratory system was low on the whole, while the nursing needs for managing respiratory organ were relatively high. Therefore, specific education concerning the nursing of the disease and self-care upon the elderly having chronic obstructive pulmonary disease is necessary.

• 대한간호학회지
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• 제30권6호
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• pp.1488-1502
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• 2000

This study, based on current home nursing services, aims at promoting measures for establishing a community-based home nursing system derived from the pilot home nursing demonstration project conducted by the Seoul Nurses Association. The study was based on an analysis of home nursing records from march 1993 to December 1999. The following is a summary analysis, based on individual characteristics of the patients, the organization, which recommended the service for their patients and personnel services. 1. The service has been used by many elderly people 60years of age or older(66.4%). and married people(60.9%). The average number of visits by service personnel for patients of city government was 23.5. This is 2.5 times as many visits by general patients. General patients(20.2%) had only one visit from service personnel, while 65.5% of patients of city government had 10 or more visits. Particularly, for government recommended patients, 72.7% of the patients were recommended by nurses, while only 21.9% where referred to the services by doctors. The main focus of a home nursing service was to maintain present health status (53.4%), and hospice(11.6%). Also to increase hospital-based home nursing services focused on recovery(55.9%) and maintain present health conditions (19.0%). 2. For general patients, 42.0% of patients were suffering from problems related to CVA, 11.3% from high blood pressure, and for patients referred from city, 21.2% from skeletal muscular disease. Results of home nursing services 29.4% of patients were able to recover or maintain their health status, but 48.9% of the patients died. Another main point of community-based home nursing services is medication(6.7%), other basic nursing services(6.1%), special treatment, instructions on how to use medical devices(5.9%), change of physical posture(4.6%), and training on changing physical positions(4.7%). As mentioned above there were some differences between the characteristics of patients who used the pilot home nursing service conducted by the Seoul Nurses Association and those hospital-based service users. The results are believed to be useful to support a community-based home nursing service model. Particularly, patients under medical supervision and patients recommended by government-run health clinics show a higher frequency and longer use of home nursing services compared to general patients or hospital-based home nursing service users. According to the study, nurses accounted for a large number of recommendations for home nursing services. Many patients with CVA, high blood pressure, skeletal muscular disease and bedsores used community-based home nursing services, while others used the service for minor treatments or maintaining their current health status. Based on the study, the researchers make several suggestions to establish a community- based home nursing service system. First, different ways of setting up a community-based home nursing system have to be mapped out based on the evaluation of the pilot home nursing service conducted by the Seoul Nurses Association. Secondly, a new, community-based, home health care nursing service model, and reimbursement payment system have to be developed. This is based on the outcome of the analysis, and implemented policy. Accordingly, efforts are needed to develop a community- based home nursing system with an intermediary role to promote the visiting nursing services of government-run health centers.

• 한국산학기술학회논문지
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• 제13권11호
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• pp.5238-5246
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• 2012

본 연구는 신경계 중환자에 적용한 간호행위에 따른 중환자 중증도 분류도구를 신경계 중환자에게 적용하여 그 결과를 분석하고 그에 따른 중환자 중중도 분류도구에 미치는 영향을 규명하여 신경계 중환자의 간호중재를 위한 기초자료를 파악하고자 시도되었으며 2008년 1월부터 2009년 5월, 2011년 10월부터 2011년 12월까지 서울시 소재 C 대학 병원 중환자실에 입원한 만 18세 이상의 신경계환자 203명의 의무기록지를 분석하였다. 신경계 중환자의 일반적 특성 및 임상관련 특성에 따른 중환자 중증도 분류도구 차이는 사망, 생존(p=<.001), 혈색소(p=<.001), 중탄산(p=<.001), 백혈구(p=<.001), 기관 내 삽관 유무(p=<.001), 중심 정맥관 삽입 유무(p=<.001), 중증도(p=<.001)가 통계적으로 유의한 차이를 보였다. 본 연구의 대상자 203명 중 64명이 사망하여 사망률은 31.5%였다. 중환자 중중도 분류도구로 측정된 신경계 중환자의 평균 점수는 $112.09{\pm}18.91$로 나타났고 중중도가 높아질수록 중환자 중중도 분류도구 점수도 유의하게 높아지는 경향을 보였다. 각 영역별로는 활력징후 측정 $3.74{\pm}2.15$, 감시 측정 $28.97{\pm}4.31$, 일상 활동 $34.99{\pm}3.66$, 영양 $.19{\pm}.98$, 정맥 주입 및 약물요법 $18.20{\pm}8.27$, 치료 및 시술 $16.93{\pm}4.90$, 호흡치료 $8.61{\pm}7.07$로 확인되었다. 감시 측정, 일상 활동, 정맥 주입 및 약물요법, 치료 및 시술, 호흡치료영역이 포함된 모형은 유의한 것으로 나타났으며(F=678.789, p<.001) 이들이 중환자 중증도 분류도구를 설명하는 설명력은 98.1%를 나타내어 신경계 중환자의 중중도를 예측하는데 유용한 영역이라 사료된다.

• 한국산학기술학회논문지
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• 제19권2호
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• pp.329-338
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• 2018

치과위생사의 근골격계 질환을 조사하고, 통증 조절과 자기효능감이 근골격계 질환에 미치는 영향을 분석하고자, 광주지역 치과위생사 483명을 편의 추출하여 자기기입식 설문조사를 시행하고 빈도분석, 교차분석, t-검정, 다중로지스틱 회귀분석을 실시하여 분석하였다. 연구결과 연구 대상자의 지난 1년간 근골격계 통증 유병율은 83.9%이었으며, 이중 근골격계 질환이 있는 경우는 29.8%이었다. 근골격계 질환에 영향을 주는 요인을 파악한 결과, 근골격계 통증 해결 방법이었다. 통증 해결 방법에서 병가, 작업전환이라고 응답한 군에 비해 병원, 한의원, 약국치료 라고 응답한 군의 근골격계 질환 교차비(odds ratio)는 0.22(95% 신뢰구간 0.14-0.34)로 음의 관련성을 보였다. 이것은 근골격계 장애가 있는 경우 병원, 한의원, 약국치료를 더 하지 않은 것으로 사료된다. 따라서 치과위생사의 근골격계 통증 관리를 위해서는 의학적 관리(한의학적 치료, 정맥주사나 약물 치료, 열과 냉동 치료, 스테로이드 치료, 상담 치료, 척수자극을 이용한 중재적 치료, 물리 치료, 스트레칭, 재활운동치료, 도수 치료)와 작업환경 요인을 개선할 필요가 있고 근골격계질환 예방법에 대한 적절한 접근이 필요할 것으로 생각된다.

• Journal of Hospice and Palliative Care
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• 제10권4호
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• pp.184-189
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• 2007

목적: 효과적인 통증관리의 장애요인은 크게 제도적 측면, 의료진 측면, 그리고 환자 측면으로 구분되며, 이는 모두 사회적 통념에 영향을 받는다. 따라서 본 연구는 일반인의 통증관리 장애요인을 규명하여 궁극적으로 우리 사회의 통증관리에 대한 이해를 향상시키기 위한 기초 자료를 마련하고자 시도되었다. 방법: 2007년 5월 15일부터 6월 15일까지 자원봉사자, 교사 및 지역사회 주민 163명을 대상으로 Gunnarsdottir, Donovan, Serlin, Voge와 Ward (2002)가 개발한 Barriers Questionnaire II (BQ-II)를 유양숙, 이원희, 조옥희와 이소우(2005)가 번한 보완한 통증관리 장애척도를 사용하여 자료를 수집하였다. 통증관리 장애척도의 Cronbach's $\alpha$는 .88이었다. 결과: 대상자의 평균연령은 53.36세이며, 92.6%가 통증교육을 받은 경험이 없었다. 대상자의 통증장애 정도는 평균 2.51점이었으며, 중독을 포함하는 해로운 영향 영역이 3.03점, 부작용을 포함하는 신체적 효과 영역 2.73점, 숙명론적 태도 영역 2.15점, 그리고 의사소통 영역 1.71점 순이었다. 문항별로는 '진통제를 사용하면 중독의 위험이 있다'의 장애정도가 가장 높았고, 다음은 '진통제를 사용하면 새로운 통증이 생겼을 때 알기가 어렵다', '진통제를 사용하면 몸이 익숙해져 곧 진통효과가 없을 것이다', '진통제로 인한 졸림은 조절하기 어렵다', '진통제는 면역력을 떨어뜨린다' 순이었다. 통증교육을 받은 경우의 통증관리 장애정도는 교육을 받지 않은 경우보다 유의하게 낮았다. 결론: 일반인들의 통증관리 장애요인은 환자나 가족과 유사하게 진통제 중독 및 내성에 대한 염려가 가장 높았으므로 사회적으로 확산되어 있는 통증관리 및 진통제 사용에 대한 올바른 이해를 높이기 위한 교육 및 홍보가 필요하다.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• 제25권2호
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• pp.65-72
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• 2014

Objectives : The objective of this study was to evaluate the treatment duration and adherence of osmotic-controlled release oral delivery system (OROS) methylphenidate for treatment of attention-deficit hyperactivity disorder (ADHD). Methods : A total of 843 children with ADHD were recruited : 213 children (25.3%) who had previously taken medications for ADHD and 630 drug-na$\ddot{i}$ve children (74.7%) were recruited. The dosage was adjusted according to the clinician's judgment. The primary efficacy endpoint of this study was treatment retention rate, which was estimated at Week 12 and Week 20 using the Kaplan-Meier curve. The Swanson, Nolan and Pelham-IV (SNAP-IV), Clinical Global Impression-Severity (CGI-S), Clinical Global Impression-Improvement, and the side effect rating scale were measured at every visit. Remission rates were presented based on SNAP-IV and CGI-S, respectively. Results : The treatment retention rate at 12 weeks and at 20 weeks was 76.2% and 66.8%, respectively. Divided according to 6-8, 9-11, 12-14 and 15-18 years of age, younger children tended to show a statistically higher treatment retention rate (p=.02). Based on SNAP-IV and CGI scores, children with better response to medication showed tendencies of statistically higher treatment retention rate. The most common adverse events included loss of appetite (7.1%) and insomnia (3.3%). There was no serious adverse event related to the treatment, such as death. Conclusion : The use of OROS methylphenidate for treatment of ADHD was safe and tolerable for children. In this study, lower age and better treatment response showed a statistically significant relationship with higher treatment adherence. Boys showed a trend of high treatment adherence. The treatment adherence at 20 weeks was satisfactory, however, the treatment adherence after 20 weeks showed a sharp decrease. Therefore, treatment persistence for six months after the beginning of ADHD treatment is important. In addition, the positive role of psycho-education for children and parents is necessary for increasing treatment adherence.

• Journal of Oral Medicine and Pain
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• 제34권2호
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• pp.133-141
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• 2009

평균수명의 연장으로 인한 고령인구의 증가 추세에 맞추어 65세 이상 고령환자의 구강내과 진료실태를 조사하기 위해 2007년 1월 1일부터 2008년 7월 18일까지 조선대학교 치과병원 구강내과에 내원한 만 65세 이상인 600명의 환자의 성별, 연령, 주소, 전신질환, 진단명, 치료, 타 과에서의 의뢰여부 및 의뢰한 과의 종류를 조사하였다. 연령조사에서 65세${\sim}$74세 63.7%, 75${\sim}$84세 32.2%, 85세 이상 4.2%의 비율로 나타났으며, 여성이 남성보다 더 많았다. 환자의 주소로는 구강연조직문제(44.1%)와 구강악안면통증(39.0%)이 주로 많았으며, 전신질환으로는 순환기계 질환(30.1%), 근골격계 질환(16.8%), 내분비계 질환(12.8%), 소화기계 질환(10.1%)이 많았다. 진단명은 구강 내 연조직질환(32.0%)과 측두하악관절장애의 관절장애(24.1%)와 근육장애(18.1%)가 많았으며, 내원한 환자에게 시행된 치료는 약물치료(43.9%)와 근이완요법을 포함한 물리치료(24.2%)가 주로 시행됐다. 전체 내원환자의 14.2%가 타 의료기관에서 작성한 의뢰서를 지참하여 내원하였거나, 같은 치과병원 내 타 과에서 의뢰되어 구강내과에 내원하였다. 이상의 연구를 통해 65세 이상 고령환자의 구강내과 진료실태에 대한 파악이 가능했으며, 향후 이루어질 고령환자에 대한 연구에 있어서 본 연구 결과가 도움이 되기를 기대한다.

• 가정간호학회지
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• 제3권
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• pp.53-66
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• 1996

Home Health Care is one part of the total health care system. It includes health care services that link the hospital to the community. While it is important for early discharge patients, home care is also important for people with chronic illnesses or handicapping conditions. In 1989 the Korean government passed a law that opened the way for formal development of home health care services beginning with education programs to certify nurses for home care, and then demonstration home care services. Part of the mandate of the demonstration projects was evaluation of home care services. This study was done in order to provide basic data that would contribute to the development of records that could be used for evaluation through a retrospective audit and to examine the care that had been given in Home Care at Wonju Christian Hospital over a twenty year period from 1974 to 1994. The purposes of the study were : to identify to characteristics of the clients who had received home care, to identify the reasons for client referrals, to identify the nursing problems of these clients, to identify the nursing care provided to these clients, and to identify differences in these areas over the twenty year period. The study was a descriptive study involving a retrospective audit of the client records. Demographic data on all clients were included : 4,171 clients from 2,564 families. Data on referrals, nursing diagnosis and nursing interventions were from even numbered records which had a patient problem list included in the record, 2,801 clients, Frequencies and ANOVA were used in the analysis. The results of the study showed that the majority of the clients were from Wonju city /county. There were more women than men related to the high number of postpartum clients(1,300). The high number of postparttum clients and newborns was also evident in the age distribution. An the number of maternal-child clients decreased over the 20 years, the mean age of the clients increased significantly. Other factors also contributed to this change ; as increasing number of clients with brain injuries or with cancer, and fewer children with burns, osteomyelitis and tuberculosis. There was a decrease in the mean number of visits and mean length of coverage, reflecting a movement towards a short term acute care model. The number of new clents dropped sharply after 1985. The reasons for this are : the development of other treatment alternatives for clients, the establishment of an active wellbaby clinic, many more options plus a decreasing number of new cases of Hansen's Disase, and insurance that allows people with burns to be kept in hospital until skin grafts are healed. Socioeconomic changes have resulted in an increase in the number of cases of cancer, stroke, head injuries following car accidents, and of diabetes. Of the 2,801 client records, 2,541(60.9%) contained a written referral but for 1,802 it contained only the medical diagnosis. The number of records with a referral requesting specific nursing care was 739(29.1%). Many family members who were identified as in need of nursing care had no written referral. Analysis of the patient problem list showed that 41.9% of the enteries were nursing diagnoses. Others incuded medical diagnosis, symptoms, and plans. The most frequently used diagnoses were alteration in nutrition, less than body requirements(115 entries), alteration in skin integrity(114), knowledge deficit(111), pain(78), self-care deficit(66), and alteration in pattern of urinary elimination(50). These are reflected in the NANDA categories for which the highest number of diagnosis was in the Exchanging pattern(446), followed by Moving(178), Feeling(136) and Knowing (115). Analysis of the frequency of interventions showed that exercise and teaching about exercise was the most frequent intervention, followed by teaching concering the need for follow-up care, checking vital signs, managing nutritional problems, managing catheters, giving emotional support, changing dressings, teaching about medication, teaching (subject not specified), teaching about diet, IM and IV medications or fluid, and skin care, in that order. Recommendations included: development of a record that would allow for efficient recording of frequently used nursing diagnoses and nursing interventions: expansion of the catchment area for Home Care at Wonju Christian Hospital ; expansion of the service to provide complication prevention, rehabilitation services, and support to increase the health maintenance /health promotion of the people being served as well as providing client dentered care ; and development of a clinical record that will allow efficient data collection from records, even though the recording is done by a variety of health care providers.

• Radiation Oncology Journal
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• 제21권1호
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• pp.1-9
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• 2003

목적 : 계명대학교 의과대학 치료방사선과학교실의 의료진들이 개발하여 사용하고 있는 방사선수술 시스템인 Photon Knife를 이용하여 뇌동정맥기형을 치료하고 그 효과를 보고자 하였다. 대상 및 방법 : 1993년 12월부터 2000년 10월까지 뇌동정맥기형으로 계명대학교 동산의료원 치료방사선과를 방문하여 Photon Knife로 방사선수술을 받은 환자는 30명이었다. 성별분포는 남자 20명, 여자 10명이며 연령분포는 7세부터 63세로 평균 34세이었다. 뇌동정맥기형(AVM nidus)의 위치는 전두부, 두정부, 시상부 순이었고 변소의 장경은1.2 cm에서 5.5 cm으로 평균 2.9 cm이었으며 표적용적은 0.5 cc에서 20.6 cc로 평균 6.8 cc이었다. 대부분에서 회전 중심선량의 80% 등선량곡선(Isodose line)에 1,500~2,500 cGy (중앙값 2,000 cGy)를 조사하였다. 1개의 회전중심점을 사용한 환자는 25명이었고 2개의 회전중심점을 사용한 환자는 4명이었으며 1명은 4개의 회전중심점을 사용하였다. 추적검사는 방사선수술 후 6개월에서 1년 간격으로 전산화단층촬영이나 자기공명영상을 시행하여 병소(nidus)의 완전소실이 관찰되면 뇌혈관조영술이나 자기공명영상 혈관조영촬영술로 확인하였다. 추적관찰기간은 10개월에서 103개월로 중앙추적기간은 39개월이었다 결과 : 전체환자 중 영상학적으로 20개월 이상 추적 관찰된 환자는 20명이었으며 그 중 70% (14/20)에서 완전폐색을 관찰하였다. 병소의 장경에 따라 작은 뇌동정맥기형(<2 cm) 환자 4명은 모두 완전폐색이 되었고 중간크기 뇌동정맥기형(2~3 cm은 80%, (8/10)에서 완전폐색이 되었으며 2명은 부분폐색이 되었다. 큰 뇌동정맥기형(> cm)에서는 환자 6명 중 1명만 완전폐색을 보였고 5명에서는 부분폐색은 되었으나 3년재에도 남아 있는 환자 3명은 재 방사선수술을 하였고 이 중 20개월 이상 추적검사를 받은 1명은 재 방사선수술 후 완전폐색이 되었다. 방사선 수술전 신경발작(seizure)을 주소로 내원한 환자 10명은 방사선수술과 약물투여로 신경발작의 재발은 없었다. 뇌출혈이 있었던 11명 중 1명에서 방사선수술 후 19개월, 61개월에 다시 출혈하였으나 입원 치료 후 회복되었다. 방사선수술에 의한 심각한 부작용은 관찰되지 않았다. 결론 : 이상으로 볼 때 저자들에 의해 개발된 Photon knife를 이용한 방사선수술은 뇌동정맥기형에서 수술이 불가능한 위치에 있거나 수술을 거부하는 환자 중 병소의 장경이 3 cm 이하이거나 병소의 용적이 10 cm$^{3}$ 이하인 뇌동정맥기형의 치료에 안전하고 효과적인 방법으로 사료된다. 또한 10 cm$^{3}$ 이상의 용적이 큰 뇌동정맥기형에서는 순차적(staged) 방사선수술을 처음부터 고려할 필요가 있을 것으로 사료된다.