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Analytical Psychology-Based Interpretation of a Russian Fairy Tale Entitled "Seven Stars" (러시아 민담 '일곱 개의 별'에 대한 분석심리학적 해석)

  • Myeong-Sook Hwang
    • Sim-seong Yeon-gu
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    • v.30 no.1
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    • pp.31-66
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    • 2015
  • A study on a Russian fairy tale entitled "Seven Stars" was conducted from the perspective of analytical psychology. The plot goes as follows. Once upon a time, a village in Russia was suffering from severe drought. Villagers were dying of thirst, and crops were withering day by day. One night, a little girl left their house carrying a wooden dipper to find water for her sick mother by herself. However, water was nowhere to be found. She felt tired and fell asleep. When she woke up, the moon was already over her head, and the dipper had been filled with water. On her way home to give the water to her mother, she found a dog lying on the ground. The dog was also dying of excessive thirst, so she gave the dog a handful of water. Then the wooden dipper suddenly turned into a silver dipper. When she had finally arrived home and her mother has drunk the water, the silver dipper changed into a golden dipper. At that moment, an old man showed up and asked for water. The little girl gave him water. When the old man stared at the water, she realized that there were seven diamonds twinkling like stars in the dipper. The water never ran out. Surprisingly enough, the seven diamonds suddenly soared up into the sky and eventually formed a constellation of the Big Dipper. The water was shared with the other villagers who, then, recovered their strength. The severe drought came to an end, and the villagers danced together with joy. In this fairy tale, the severe drought symbolizes devastation caused by a unidirectional stream of consciousness while the little girl represents a new function, which shows the value of women who can heal and restore from that devastation. Symbolized in a fairy tale character such as 'a daughter' or 'a little girl', the new function eventually reaches up to the value which leads and affects the group as well as individuals. To conclude, this new function represents the unconscious process whose role is to revitalize the maternity and resolve the problems posed to a group as well as individuals.

Quantitative Vertebral Bone Density Seen on Chest CT in Chronic Obstructive Pulmonary Disease Patients: Association with Mortality in the Korean Obstructive Lung Disease Cohort

  • Hye Jeon Hwang;Sang Min Lee;Joon Beom Seo;Ji-Eun Kim;Hye Young Choi;Namkug Kim;Jae Seung Lee;Sei Won Lee;Yeon-Mok Oh
    • Korean Journal of Radiology
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    • v.21 no.7
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    • pp.880-890
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    • 2020
  • Objective: Patients with chronic obstructive pulmonary disease (COPD) are known to be at risk of osteoporosis. The purpose of this study was to evaluate the association between thoracic vertebral bone density measured on chest CT (DThorax) and clinical variables, including survival, in patients with COPD. Materials and Methods: A total of 322 patients with COPD were selected from the Korean Obstructive Lung Disease (KOLD) cohort. DThorax was measured by averaging the CT values of three consecutive vertebral bodies at the level of the left main coronary artery with a round region of interest as large as possible within the anterior column of each vertebral body using an in-house software. Associations between DThorax and clinical variables, including survival, pulmonary function test (PFT) results, and CT densitometry, were evaluated. Results: The median follow-up time was 7.3 years (range: 0.1-12.4 years). Fifty-six patients (17.4%) died. DThorax differed significantly between the different Global Initiative for Chronic Obstructive Lung Disease stages. DThorax correlated positively with body mass index (BMI), some PFT results, and the six-minute walk distance, and correlated negatively with the emphysema index (EI) (all p < 0.05). In the univariate Cox analysis, older age (hazard ratio [HR], 3.617; 95% confidence interval [CI], 2.119-6.173, p < 0.001), lower BMI (HR, 3.589; 95% CI, 2.122-6.071, p < 0.001), lower forced expiratory volume in one second (FEV1) (HR, 2.975; 95% CI, 1.682-5.262, p < 0.001), lower diffusing capacity of the lung for carbon monoxide corrected with hemoglobin (DLCO) (HR, 4.595; 95% CI, 2.665-7.924, p < 0.001), higher EI (HR, 3.722; 95% CI, 2.192-6.319, p < 0.001), presence of vertebral fractures (HR, 2.062; 95% CI, 1.154-3.683, p = 0.015), and lower DThorax (HR, 2.773; 95% CI, 1.620-4.746, p < 0.001) were significantly associated with all-cause mortality and lung-related mortality. In the multivariate Cox analysis, lower DThorax (HR, 1.957; 95% CI, 1.075-3.563, p = 0.028) along with older age, lower BMI, lower FEV1, and lower DLCO were independent predictors of all-cause mortality. Conclusion: The thoracic vertebral bone density measured on chest CT demonstrated significant associations with the patients' mortality and clinical variables of disease severity in the COPD patients included in KOLD cohort.

The Interpretation of a Korean Folk Tale from the Perspective of Analytical Psychology (민담 <외쪽이>의 분석심리학적 해석)

  • Ji Youn Kim
    • Sim-seong Yeon-gu
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    • v.32 no.2
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    • pp.122-168
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    • 2017
  • I tried to understand a folk tale "The half-boy" in terms of analytical psychology. In the story, a lady without children prayed to the Buddha. The white old man came and gave three fishes, but the cat ate half of it. So, she ate two and a half. She gave birth to two perfect sons. The third son had one arm, one leg, and one eye. They grew well. Brothers went to take the civil service examinations, and the half-boy followed. But two brothers did not like the half-boy coming along. So, brothers tied the half-boy to the rocks and trees, and he picked them up with force and gave them down to the yard of the house. And the half-boy followed his brothers again, and brothers tied him with kudzu and put him in front of the tiger. The half-boy won the tiger by betting with cutting kudzu. The half-boy stripped off the tiger's skin. The host coveted the tiger skin and they played with janggi. The half-boy won the game and was permitted to take host's daughter. The half-boy went with a string, a drum, a flea, and a bedbug. He teased host's people with these. The half-boy brought a virgin and lived well. "The Half-Boy" folktale is an old story spread throughout the country. There are similar stories in India and Africa. Unilateral figures are universally distributed archetypal images. In numerous cultures gods and spirits are being portrayed as unilateral figures. In the creation mythology, half-figure beings have immortality. In Indonesian and African folk tales, the half-born boy goes to heaven and merges with its half and becomes perfect. Some of one-sided spirits are harmful to humans but some of one-sided birds, chickens, and spirits are helpful to people. Sometimes half being is a cultural hero who steals grain from heaven or gets some advice how to use bamboo. There are stories that half body becomes a whole body afterwards. But in this folktale and most of the similar folktales, half-figure does not change and maintains half-figure to the end. And as a half-figure he does various great things and marries a virgin. The half-boy symbolizes a psychic experience born in the unconscious. The unconscious contents may seem strange and weird at first and the collective consciousness does not want to accept them. But the unconscious exerts greater power and brings vitality and creativity to consciousness. This folk tale seems to have compensated for the stubborn collective consciousness of our society, which was a Confucian class society. It also allows people to change their attitude toward disabled people and recognize strengths and creativity of the handicapped.

Review on the impact of Arctic Amplification on winter cold surges over east Asia (북극 온난화 증폭이 겨울철 동아시아 한파 발생에 미치는 영향 고찰)

  • Seong-Joong Kim;Jeong-Hun Kim;Sang-Yoon Jun;Maeng-Ki Kim;Solji Lee
    • The Korean Journal of Quaternary Research
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    • v.33 no.1_2
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    • pp.1-23
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    • 2021
  • In response to the increase in atmospheric carbon dioxide and greenhouse gases, the global mean temperature is rising rapidly. In particular, the warming of the Arctic is two to three times faster than the rest. Associated with the rapid Arctic warming, the sea ice shows decreasing trends in all seasons. The faster Arctic warming is due to ice-albedo feedback by the presence of snow and ice in polar regions, which have higher reflectivity than the ocean, the bare land, or vegetation, higher long-wave heat loss to space than lower latitudes by lower surface temperature in the Arctic than lower latitudes, different stability of atmosphere between the Arctic and lower latitudes, where low stability leads to larger heat losses to atmosphere from surface by larger latent heat fluxes than the Arctic, where high stability, especially in winter, prohibits losing heat to atmosphere, increase in clouds and water vapor in the Arctic atmosphere that subsequently act as green house gases, and finally due to the increase in sensible heat fluxes from low latitudes to the Arctic via lower troposphere. In contrast to the rapid Arctic warming, in midlatitudes, especially in eastern Asia and eastern North America, cold air outbreaks occur more frequently and last longer in recent decades. Two pathways have been suggested to link the Arctic warming to cold air outbreaks over midlatitudes. The first is through troposphere in synoptic-scales by enhancing the Siberian high via a development of Rossby wave trains initiated from the Arctic, especially the Barents-Kara Seas. The second is via stratosphere by activating planetary waves to stratosphere and beyond, that leads to warming in the Arctic stratosphere and increase in geopotential height that subsequently weakens the polar vortex and results in cold air outbreaks in midlatitudes for several months. There exists lags between the Arctic warming and cold events in midlatitudes. Thus, understanding chain reactions from the Arctic warming to midlatitude cooling could help improve a predictability of seasonal winter weather in midlatitudes. This study reviews the results on the Arctic warming and its connection to midlatitudes and examines the trends in surface temperature and the Arctic sea ice.

Decentralized Composting of Garbage in a Small Composter for Dwelling House I. Laboratory Composting of the Household Garbage in a Small Bin (가정용 소형 퇴비화용기에 의한 부엌쓰레기의 분산식 퇴비화 I. 실험실 조건에서 퇴비화 연구)

  • Seo, Jeoung-Yoon;Joo, Woo-Hong
    • Korean Journal of Environmental Agriculture
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    • v.13 no.3
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    • pp.321-337
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    • 1994
  • The garbage from the dwelling houses was composted in two kinds of small composter in laboratory to investigate the possibility of garbage composting. They were general small composters. One (type 1) was insullated but the other (type 2) was not. Because it was found that type 2 was not available for composting under our meteorological conditions through winter experiment, only type 1 was tested in spring and summer. The experiment was performed for 8 weeks in each season. The seasonal variation of several compounds in compost was evaluated and discussed. The result summarized belows are those taken at the end of the experiment, if the time was not specified. 1) The maximum temperature was $58^{\circ}C$ in spring, $57^{\circ}C$ in summer and $41^{\circ}C$ in winter. This temperature was enough to destroy the pathogen except for winter. 2) The mass was reduced to average 62.5% and the volume reduction was avergae 74%. 3) The density was estimated as 0.7kg/l in spring, 0.8kg/l in summer and 1.1kg/l in winter. 4) The water content was not much changed for composting periods. It had 75.6% in spring and 76.6% in summer and winter. 5) There was a great seasonal difference in pH value. It was reached to pH 6.13 in spring, pH 8.62 in summer and pH 4.75 in winter. 6) The faster organic matter was decomposed, the greater ash content was increased. Cellulose and lignin content were increased, but hemicellulose content was reduced during composting period. 7) Nitrogen contents were in the range of 3.1-5.6% and especially high in summer. After ammonium nitrogen contents were increased at the early stage of composting period, they were decreased. The maximum ammonium nitrogen content was 3,243mg/kg after 2 weeks in winter, 6,053mg/kg after 3 weeks in spring and 30,828mg/kg after 6 weeks in summer. C/N-ratios were not much changed. Nitrification occurred actively in spring and summer. 8) The contents of volatile and higher fatty acids were increased in early stage of composting and reduced after that. The maximum content of total fatty acid was 10.1% after 2 weeks in winter, 5.8% after 2 weeks in spring and 15.7% after 4 weeks in summer. 9) The contents of inorganic compounds were not accumulated as composting was proceeded. They were in the range of 0.9-4.4% $P_2O_5$, 1.6-2.9% $K_2O$, 2.4-4.6% CaO and 0.30-0.80% MgO. 10) CN and heavy metal contents did not show any tendency. They were in the range of 0.11-28.99mg/kg CN, 24-166mg/kg Zn, 5-129mg/kg Cu, 0.8-14.3mg/kg Cd, 7-42mg/kg Pb, ND-30mg/kg Cr and $ND-132.16\;{\mu}g/kg$ Hg.

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No-tillage Agriculture of Korean-Type on Recycled Ridge I. Changes in Physical Properties : Soil Crack, Penetration Resistance, Drainage, and Capacity to Retain Water at Plastic Film Greenhouse Soil by Different Tillage System (두둑을 재활용한 한국형 무경운 농업 I. 경운방법에 따른 시설재배 토양의 물리적 특성: 균열, 관입저항, 배수, 보수력 변화)

  • Yang, Seung-Koo;Jung, Woo-Jin
    • Korean Journal of Organic Agriculture
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    • v.24 no.4
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    • pp.699-717
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    • 2016
  • This study was carried out to investigate the effect of no-tillage on sequential cropping supported from recycling of first crop ridge on the growth of pepper plant and physical properties of soil under green house condition. 1. Degree of crack on soil by tillage and no-tillage Soil cracks found in ridge and not found in row. At five months of tillage, crack number and crack length in length ridge were 3 and 37~51 cm in tillage. Maximum width and maximum depth in length ridge were 30 mm and 15.3cm in tillage. Crack number and crack length in width ridge were 7.5 and 7~28 cm in tillage. Maximum width and maximum depth in width ridge were 29 mm and 15.3 cm in tillage. At a year of no-tillage, crack number and crack length in length ridge were 1.0 and 140~200 cm in tillage. Maximum width and maximum depth in length ridge were 18 mm and 30 cm in a year of no-tillage. Crack number and crack length in width ridge were 11 and 6~22 cm in a year of no-tillage. Maximum width and maximum depth in width ridge were 22 mm and 18.5 cm in a year of no-tillage. Soil crack was not found at 2 years of no-tillage in sandy Jungdong series (jd) soil. Soil crack was found at 7 years of no-tillage in clayish Jisan series (ji) soil. 2. Penetration resistance on soil Penetration resistance was increased significantly at no-tillage in Jungdong series (jd). Depth of cultivation layer was extended at no-tillage soil compared with tillage soil. Penetration resistance of plow pan was decreased at 1 year of no-tillage compared with than tillage soil. Penetration resistance was linearly increased with increasing soil depth at tillage in Jisan series (ji). Penetration resistance on top soil was remarkably increased and then maintained continuously at no-tillage soil. 3. Drainage and moisture content of soil Moisture content of ridge in top soil was not significant difference at both tillage and no-tillage. Moisture content of ridge in 20 cm soil was 14% at no-tillage soil and 25% at tillage soil. 4. Change of capacity to retain water in soil Capacity to retain water in top soil was not significant difference at 1 bar both tillage and no-tillage. Capacity to retain water in soil was slightly higher tendency in 1 year and 2 years of no-tillage soil than tillage soil. Capacity to retain water in soil was increased at 15 bar both tillage and no-tillage. Capacity to retain water in subsoil was slightly higher tendency at 1 bar and 3 bar in 2 years of no-tillage than tillage soil and a year of no-tillage soil.

Effects of Supplementary Multiple Probiotics or Single Probiotics on the Performance, Intestinal Microflora, Immune Response of Laying Hens and Broilers (혼합 또는 단일 생균제가 산란계와 육계의 생산성, 소장내 미생물 균총 및 면역 체계에 미치는 영향)

  • Kim, Chan-Ho;Woo, Kyung-Chun;Kim, Geun-Bae;Park, Yong-Ha;Paik, In-Kee
    • Korean Journal of Poultry Science
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    • v.37 no.1
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    • pp.51-62
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    • 2010
  • This study was conducted to investigate the effects of dietary supplementation of multiple probiotics on the performance, small intestinal microflora and immune response in laying hens and broilers. In Exp.1, a total of 800, 82 wk old Hy-line Brown$^{(R)}$ laying hens were assigned to one of the following five dietary treatment; Control, Antibiotics (avilamycin 6 ppm), Probiotics; PB-M (Micro-ferm$^{(R)}$ 0.2%), PB-L (Lacto-sacc$^{(R)}$ 0.1%), PB-Y (Y University probiotics 0.2%). Each treatment was replicated eight times with 20 birds in each replicate and two birds were housed in each cage. Twenty birds units were arranged according to completely randomized block design. Feeding trial lasted 6 wk under 16 h lighting regimen. The Exp. 2, was conducted with a total of 1,000 broilers chicks (Ross$^{(R)}$). They were divided into five treatments, same as those of Exp. 1. Birds were fed starter (0~3 wk) and grower (4~5 wk) diets. Each treatment was replicated four times with 50 birds per pen comprising of deep litter. In Exp. 1, egg production parameters, such as hen-day and hen-house egg production, egg weight, broken and soft shell egg production, feed intake and feed conversion were not significantly different among treatments. However, strength and thickness of eggshell were significantly (P<0.05) different. Among the probiotics, PB-Y showed the highest strength and thickness of eggshell. Eggshell color, egg yolk color and Haugh unit were not significantly influenced. In Exp. 2, overall weight gain (0~5 wk) and mortality were not significantly different among treatments. However, weight gain of birds from PB-Y treatment during starter (0~3 wk) was significantly lower than the birds from Control and Antibiotic treatment. During the whole period (0~5 wk), birds from Antibiotics treatment had higher feed intake and Production Index (PI) and lower feed conversion than birds from Control treatment. Probiotics treatments were not significantly different from the Control on feed intake and feed conversion. In Exp.1, there were significant (P<0.05) differences in leukocytes parameters, such as white blood cell (WBC), hetrophil (HE), lymphocytes (LY), monocyte (MO), eosinophil (EO) and stress index (SI; HE/LY) in the blood of layers. Birds from Antibiotics and probiotics treatments tended to increase these parameters. In Exp. 2, however, only SI was significantly (P<0.05) decreased in Antibiotics treatments. Concentration of serum immunoglobulin (IgG) were higher (P<0.05) in PB-M and PB-Y treatments when compared with Control treatment in Exp. 1. The population of E. coli significantly (P<0.05) decreased in birds from Antibiotics, PB-L and PB-Y treatments when compared with birds from Control treatment in Exp. 1. Metalbolizability of crude fat decreased significantly (P<0.05) in birds from probiotic treatments in Exp. 2. It was concluded that the response of probiotics on the productivity of layers and broilers were different. Probiotics increased strength and thickness of eggshell in layers, and decreased feed conversion and increased PI in broilers. Leukocytes and IgG tended to increase by supplementation of antibiotics and probiotics in layers. Intestinal E. coli tended to decrease in layers. Digestibility of crude fat of diet decreased in probiotics treatments broilers. Parameters of blood and microbial were more sensitive in layers than broilers.

Electronic Roll Book using Electronic Bracelet.Child Safe-Guarding Device System (전자 팔찌를 이용한 전자 출석부.어린이 보호 장치 시스템)

  • Moon, Seung-Jin;Kim, Tae-Nam;Kim, Pan-Su
    • Journal of Intelligence and Information Systems
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    • v.17 no.4
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    • pp.143-155
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    • 2011
  • Lately electronic tagging policy for the sexual offenders was introduced in order to reduce and prevent sexual offences. However, most sexual offences against children happening these days are committed by the tagged offenders whose identities have been released. So, for the crime prevention, we need measures with which we could minimize the suffers more promptly and actively. This paper suggests a new system to relieve the sexual abuse related anxiety of the children and solve the problems that electronic bracelet has. Existing bracelets are only worn by serious criminals, and it's only for risk management and positioning, there is no way to protect the children who are the potential victims of sexual abuse and there actually happened some cases. So we suggest also letting the students(children) wear the LBS(Location Based Service) and USN(Ubiquitous Sensor Network) technology based electronic bracelets to monitor and figure out dangerous situations intelligently, so that we could prevent sexual offences against children beforehand, and while a crime is happening, we could judge the situation of the crime intelligently and take swift action to minimize the suffer. And by checking students' attendance and position, guardians could know where their children are in real time and could protect the children from not only sexual offences but also violent crimes against children like kidnapping. The overall system is like follows : RFID Tag for children monitors the approach of offenders. While an offender's RFID tag is approaching, it will transmit the situation and position as the first warning message to the control center and the guardians. When the offender is going far away, it turns to monitoring mode, and if the tag of the child or the offender is taken off or the child and offender stay at one position for 3~5 minutes or longer, then it will consider this as a dangerous situation, then transmit the emergency situations and position as the second warning message to the control center and the guardians, and ask for the dispatch of police to prevent the crime at the initial stage. The RFID module of criminals' electronic bracelets is RFID TAG, and the RFID module for the children is RFID receiver(reader), so wherever the offenders are, if an offender is at a place within 20m from a child, RFID module for children will transmit the situation every certain periods to the control center by the automatic response of the receiver. As for the positioning module, outdoors GPS or mobile communications module(CELL module)is used and UWB, WI-FI based module is used indoors. The sensor is set under the purpose of making it possible to measure the position coordinates even indoors, so that one could send his real time situation and position to the server of central control center. By using the RFID electronic roll book system of educational institutions and safety system installed at home, children's position and situation can be checked. When the child leaves for school, attendance can be checked through the electronic roll book, and when school is over the information is sent to the guardians. And using RFID access control turnstiles installed at the apartment or entrance of the house, the arrival of the children could be checked and the information is transmitted to the guardians. If the student is absent or didn't arrive at home, the information of the child is sent to the central control center from the electronic roll book or access control turnstiles, and look for the position of the child's electronic bracelet using GPS or mobile communications module, then send the information to the guardians and teacher so that they could report to the police immediately if necessary. Central management and control system is built under the purpose of monitoring dangerous situations and guardians' checking. It saves the warning and pattern data to figure out the areas with dangerous situation, and could help introduce crime prevention systems like CCTV with the highest priority. And by DB establishment personal data could be saved, the frequency of first and second warnings made, the terminal ID of the specific child and offender, warning made position, situation (like approaching, taken off of the electronic bracelet, same position for a certain time) and so on could be recorded, and the data is going to be used for preventing crimes. Even though we've already introduced electronic tagging to prevent recurrence of child sexual offences, but the crimes continuously occur. So I suggest this system to prevent crimes beforehand concerning the children's safety. If we make electronic bracelets easy to use and carry, and set the price reasonably so that many children can use, then lots of criminals could be prevented and we can protect the children easily. By preventing criminals before happening, it is going to be a helpful system for our safe life.

Fly Ash Application Effects on CH4 and CO2 Emission in an Incubation Experiment with a Paddy Soil (항온 배양 논토양 조건에서 비산재 처리에 따른 CH4와 CO2 방출 특성)

  • Lim, Sang-Sun;Choi, Woo-Jung;Kim, Han-Yong;Jung, Jae-Woon;Yoon, Kwang-Sik
    • Korean Journal of Soil Science and Fertilizer
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    • v.45 no.5
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    • pp.853-860
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    • 2012
  • To estimate potential use of fly ash in reducing $CH_4$ and $CO_2$ emission from soil, $CH_4$ and $CO_2$ fluxes from a paddy soil mixed with fly ash at different rate (w/w; 0, 5, and 10%) in the presence and absence of fertilizer N ($(NH_4)_2SO_4$) addition were investigated in a laboratory incubation for 60 days under changing water regime from wetting to drying via transition. The mean $CH_4$ flux during the entire incubation period ranged from 0.59 to $1.68mg\;CH_4\;m^{-2}day^{-1}$ with a lower rate in the soil treated with N fertilizer due to suppression of $CH_4$ production by $SO_4^{2-}$ that acts as an electron acceptor, leading to decreases in electron availability for methanogen. Fly ash application reduced $CH_4$ flux by 37.5 and 33.0% in soils without and with N addition, respectively, probably due to retardation of $CH_4$ diffusion through soil pores by addition of fine-textured fly ash. In addition, as fly ash has a potential for $CO_2$ removal via carbonation (formation of carbonate precipitates) that decreases $CO_2$ availability that is a substrate for $CO_2$ reduction reaction (one of $CH_4$ generation pathways) is likely to be another mechanisms of $CH_4$ flux reduction by fly ash. Meanwhile, the mean $CO_2$ flux during the entire incubation period was between 0.64 and $0.90g\;CO_2\;m^{-2}day^{-1}$, and that of N treated soil was lower than that without N addition. Because N addition is likely to increase soil respiration, it is not straightforward to explain the results. However, it may be possible that our experiment did not account for the substantial amount of $CO_2$ produced by heterotrophs that were activated by N addition in earlier period than the measurement was initiated. Fly ash application also lowered $CO_2$ flux by up to 20% in the soil mixed with fly ash at 10% through $CO_2$ removal by the carbonation. At the whole picture, fly ash application at 10% decreased global warming potential of emitted $CH_4$ and $CO_2$ by about 20%. Therefore, our results suggest that fly ash application can be a soil management practice to reduce green house gas emission from paddy soils. Further studies under field conditions with rice cultivation are necessary to verify our findings.

Determination of Cost and Measurement of nursing Care Hours for Hospice Patients Hospitalized in one University Hospital (일 대학병원 호스피스 병동 입원 환자의 간호활동시간 측정과 원가산정)

  • Kim, Kyeong-Uoon
    • Journal of Korean Academy of Nursing Administration
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    • v.6 no.3
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    • pp.389-404
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    • 2000
  • This study was designed to determine the cost and measurement of nursing care hours for hospice patients hostpitalized in one university hospital. 314 inpatients in the hospice unit 11 nursing manpower were enrolled. Study was taken place in C University Hospital from 8th to 28th, Nov, 1999. Researcher and investigator did pilot study for selecting compatible hospice patient classification indicators. After modifying patient classification indicators and nursing care details for general ward, approved of content validity by specialist. Using hospice patient classification indicators and per 5 min continuing observation method, researcher and investigator recorded direct nursing care hours, indirect nursing care hours, and personnel time on hospice nursing care hours, and personnel time on hospice nursing care activities sheet. All of the patients were classified into Class I(mildly ill), Class II (moderately ill), Class III (acutely ill), and Class IV (critically ill) by patient classification system (PCS) which had been carefully developed to be suitable for the Korean hospice ward. And then the elements of the nursing care cost was investigated. Based on the data from an accounting section (Riccolo, 1988), nursing care hours per patient per day in each class and nursing care cost per patient per hour were multiplied. And then the mean of the nursing care cost per patient per day in each class was calculated. Using SAS, The number of patients in class and nursing activities in duty for nursing care hours were calculated the percent, the mean, the standard deviation respectively. According to the ANOVA and the $Scheff{\'{e}$ test, direct nursing care hours per patient per day for the each class were analyzed. The results of this study were summarized as follows : 1. Distribution of patient class : class IN(33.5%) was the largest class the rest were class II(26.1%) class III(22.6%), class I(17.8%). Nursing care requirements of the inpatients in hospice ward were greater than that of the inpatients in general ward. 2. Direct nursing care activities : Measurement ${\cdot}$ observation 41.7%, medication 16.6%, exercise ${\cdot}$ safety 12.5%, education ${\cdot}$ communication 7.2% etc. The mean hours of direct nursing care per patient per day per duty were needed ; 69.3 min for day duty, 64.7 min for evening duty, 88.2 min for night duty, 38.7 min for shift duty. The mean hours of direct nursing care of night duty was longer than that of the other duty. Direct nursing care hours per patient per day in each class were needed ; 3.1 hrs for class I, 3.9 hrs for class II, 4.7 hrs for class III, and 5.2 hrs for class IV. The mean hours of direct nursing care per patient per day without the PCS was 4.1 hours. The mean hours of direct nursing care per patient per day in class was increased significantly according to increasing nursing care requirements of the inpatients(F=49.04, p=.0001). The each class was significantly different(p<0.05). The mean hours of direct nursing care of several direct nursing care activities in each class were increased according to increasing nursing care requirements of the inpatients(p<0.05) ; class III and class IV for medication and education ${\cdot}$ communication, class I, class III and class IV for measurement ${\cdot}$ observation, class I, class II and class IV for elimination ${\cdot}$ irrigation, all of class for exercise ${\cdot}$ safety. 3. Indirect nursing care activities and personnel time : Recognization 24.2%, house keeping activity 22.7%, charting 17.2%, personnel time 11.8% etc. The mean hours of indirect nursing care and personnel time per nursing manpower was 4.7 hrs. The mean hours of indirect nursing care and personnel time per duty were 294.8 min for day duty, 212.3 min for evening duty, 387.9 min for night duty, 143.3 min for shift duty. The mean of indirect nursing care hours and personnel time of night duty was longer than that of the other duty. 4. The mean hours of indirect nursing care and personnel time per patient per day was 2.5 hrs. 5. The mean hours of nursing care per patient per day in each class were class I 5.6 hrs, class II 6.4 hrs, class III 7.2 hrs, class IV 7.7 hrs. 6. The elements of the nursing care cost were composed of 2,212 won for direct nursing care cost, 267 won for direct material cost and 307 won for indirect cost. Sum of the elements of the nursing care cost was 2,786 won. 7. The mean cost of the nursing care per patient per day in each class were 15,601.6 won for class I, 17,830.4 won for class II, 20,259.2 won for class III, 21,452.2 won for class IV. As above, using modified hospice patient classification indicators and nursing care activity details, many critical ill patients were hospitalized in the hospice unit and it reflected that the more nursing care requirements of the patients, the more direct nursing care hours. Emotional ${\cdot}$ spiritual care, pain ${\cdot}$ symptom control, terminal care, education ${\cdot}$ communication, narcotics management and delivery, attending funeral ceremony, the major nursing care activities, were also the independent hospice service. But it is not compensated by the present medical insurance system. Exercise ${\cdot}$ safety, elimination ${\cdot}$ irrigation needed more nursing care hours as equal to that of intensive care units. The present nursing management fee in the medical insurance system compensated only a part of nursing car service in hospice unit, which rewarded lower cost that that of nursing care.

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