• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.13 no.1
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• pp.15-23
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• 2002

Knowledge regarding the resilience factors and risk factors of the childhood trauma on the developental trajectory is in its infancy due to the lack of prospective follow-up studies in the childhood trauma and limited understanding of the complex reciprocal interactions between childhood trauma, develop-ent and various aspects of children's environment. These difficulties in the conceptual framework and research methods in the childhood trauma are partly reflected in the inconsistencies, even controversies, of the results in the childhood trauma researches. Despite these difficulties, common aspects of the risk factors and resilience of the childhood trauma on the development can be identified from the previous studies. The resilience to the negative outcome on the development by childhood trauma includes：sex female before puberty, male after puberty or infancy), high socioeconomic status, no organic problem, easy temperament, no previous experience with early loss or separation, younger age at the trauma, better problem solving capacity, high self-esteem, internal locus of control, high coping skills, ability to identify interpersonal relationships, ability to play, sense of humor, having capable parents, having a warm relaionship with at least one of the parents, high education and participating in the organized religious activities. These commonalities of the results suggest that risk and resilient factors of the childhood trauma are interdependent, each factor has multiplicity in the impacts on the children's development according to the developmental stage of the child, family and children's other environment, trauma and stressor have diverse effects according to their intensity and risk and resilience factors could have synergistic or antagonistic effects to each other. To develop comprehensive understanding on the relationship between childhood trauma and developmental psychopathology, risk and resilience factors and to develop effective and efficient prevention and intervention, research on the effect of the stress on the neurodevelopment, on the individual differences of the response to the trauma including genetic factors and constitution, and on the brain plasticity should be accompanied in the future.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.12 no.1
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• pp.125-137
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• 2001

We investigated the self-concept, subjective depression, and state-trait anxiety of the school boys with learning disabilities(abbr. LD, n=86) and compared them with normal boys(n=52) using Piers-Harris Self-Concept Inventory, Child Depression Inventory(abbr. CDI), and State-Trait Anxiety Inventory(abbr. STAI). With regard to Piers-Harris Self-Concept Inventory total scores, there was no significant difference between two groups, but normal boys showed higher scores in intellectual and school status, physical appearance, and happiness-satisfaction subscales than patients with LD. The male patients with LD showed significantly higher ratings in CDI total scores, and CDI subscales - ineffectiveness, anhedonia, negative self-esteem than normal children. The patients with LD reported significantly higher state anxiety, but not trait anxiety. Correlation analyses revealed that self-concept decreased over time, and depression-anxiety increased across grades in the patients with LD, but not in normal children. Especially, negative mood, anhedonia, negative self-esteem subscales of CDI, and state-trait anxiety showed significant positive correlation with grades. In both groups, CDI scores were inversely correlated with Piers-Harris Self-Concept and positively with State-Trait anxiety. In conclusion, self-concept problems which were related with school achievement and self-esteem were more abundant in the patients with LD than normal children, self-image problem, depression and anxiety increased across grades. According to regression analysis, age, behavior subscale, intellectual-school status, anxiety, popularity, happiness-satisfaction, CDI-ineffectiveness, interpersonal problem, negative self-esteem, and state anxiety could explain the self-concept in the patients with LD, not in normal children. So, the self-concept of the patients with LD were found to be related to the school achievement and stress when comparing with peers. In conclusion, elementary school boys with LD showed lower self-concept, higher depression and anxiety, and these differences increased across grades. Since the patients with LD have concomitant depression and anxiety disorders, it is important that comorbidity with emotional problems should be explored and managed properly.

• Journal of Korean Academic Society 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.

• Journal of Korean Academy of Nursing Administration
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• v.1 no.1
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• pp.147-211
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• 1995

Medication is a kind of medical service and a therapeutic nursing function which takes large portion of nursing service and requires complicated procedures. So many different medical personnel should be involved and cooporate each other in order to accomplish medication. Medication is also a vital nursing service, So nurse feels heavy responsibi lity in that she gives medication to the patient finally, so she has much responsibility if medication error is happened. Therefore it seems very important to clarify the problem of medication system and method, and find the subculture of medication situation because it may promote nursing productivity. The study was conducted to 1. Describe and interpret medication situation. 2. Find out the problem of medication system and method and on alternatives. 3. Compare the medication system and method of hospitals which are located in Seoul with object hospital Ethnographic methodology was used to study medication situation by doing participant observation and interview of health care personnel. Ten nurses and three nurse aids were interviewed. Two residents and internists, two phamacists and two accountants were also interviewed. Data was obtained and analized according to Developmental Research Sequence introduced by Spradly. On the basis of this data the results were as follows. 1. The overall flow of medication system was devided into six stage : first, checking doctor's order : second writing doctor's order, : third, transfering slip into the related departments such as account department, pharmacy : fourth, distribution of medication from pharmacy to unit : fifth, identifing medication by nurses : and finally, medicating to the patient. Behaviorors have been under a lot of stress in that they have to do much works, especially paperworks, So too much time were needed. They also have been suffered interpersonal conflicts among health care personnel and role conflicts in the process of doing medication service. 2. In the process of checking order, the problem was that too much time was required for checking order and paperwork. The more the order changes the more the paperwork is. Nurses have been suffering difficulties in calling internist in order to get bill. Even if writing down slip for medication order is doctor's job, Sometimes nurse has been expected to write slip by doctors or nurse would write slip beacuse of two much complexities and efforts for calling doctors. If the slip were incorrect, much time complicated procedures were more required for correcting it. So delay of administering drug would be resulted consequently. Drugs were delivered from pharmacy to units by delivery agent and phamacist. But because drugs were delivered without arranging room number of patient. Nurse should rearrange drugs in order of the room number So it had made waste time and effort, and Even when emergency drugs were needed, Prompt delivery of drug was not easy because of many reasons. For nurses, it took too long in the identification of the right drug. Actually nurses have heavy burden when medication error happens because nurse is the final actor who gives medication to the patient, So every three shift nurse ought to check drugs as soon as every shift begins. That's why it took too much time due to repeated confirming procedure. When nurses had to go patient room in order to give medications, there were difficulties in watching patient until the patient take medicine correctly. So it was impossible to check every patient wheather he took medicine or not especially in hectic situation. 3. There were many hospitals in Seoul which have similar medication system and method as object hospital according to the results of questionaire. This means that many hospitals have been suffering srimilar problems which were identified in object hospital. 4. Recommendations for promoting simplification of medication system and method were the following : Redesigning of slip from two pieces of paper into one : early discharge announcement system, and slip confirming through computer and controlling of period of prescreption from one day to two or three days : designing personal drug storage box for each patient and using it. If nurses follow the recommendations, they will make medication short & simple, and also have enough time of direct nursing care 5. Even though there were many difficulties in medicating patients. Medication itself has been considered as a caring among nurses because it makes rapport between nurse and patient. So nurses had better accept medication as a portion of nusing service not a original portion of phamacist. There are some limits in this research in terms of confining to only one unit of one hospital, and treating it especially in view of nurses' aspects, So further researchs should be continnued from various kmds of viewpoints of doctors, phamacists and so on. ${\cdot\cdot\cdot}$. Especially esthnographic study of computerized medication system and method seems to be followed.