• Tuberculosis and Respiratory Diseases
• /
• 제66권4호
• /
• pp.300-308
• /
• 2009

연구배경: 감염성 질환 중 가장 흔한 질환인 폐렴의 질병부담을 줄이기 위해서 폐렴환자의 진료 과정 개선과 이에 영향을 미치는 요인에 대한 분석이 필요하다. 본 연구에서는 국내 폐렴환자의 진료 과정의 질적 수준을 평가하고, 질적 수준에 영향을 미치는 환자 및 병원 요인을 분석하고자 한다. 방 법: 500병상 이상 병원 21곳의 1989년 12월 31일이전 출생 입원 환자로 청구코드 주진단 기준 폐렴인 환자중 2006년 8월부터 10월 사이 퇴원 환자 중 무작위 표본추출 방식으로 1,001건을 표본으로 추출하였다. 환자 및 병원 요인과 과정 지표의 상관관계를 다중 로지스틱 회귀분석을 통하여 분석하였다. 결 과: 병원 도착 후 24시간 이내 혈중산소포화도 검사 시행률은 69.4%, 24시간 이내 혈액배양검사 시행률은 79.1%, 8시간 이내 항생제 투여율은 82.5%, 항생제 투약전 배양검사 시행률은 60.5%로 대부분의 지표가 높은 충족도를 보였다. 환자 요인 중에서는 연령이 24시간 이내혈중산소포화도 검사 시행률에 영향을 미쳤고, 병원 요인 중에는 병상수, 병상당 간호사수, 연간 응급실 내원자수, 병상가동률, 지역, 입원 시각 및 경로 등이 과정 지표 시행률에 영향을 미쳤다. 결 론: 본 연구에서 드러난 진료 과정상의 질적 수준이 취약한 부분에 대하여 질 개선 활동의 역량을 강화하여 보완할 필요가 있다. 또한, 과정 지표들의 병원 간 변이를 줄이기 위하여 지표 시행률이 낮은 의료기관에서는 진료프로토콜 개선 등의 활동을 통하여 진료 과정을 개선해 나가는 노력이 필요하다.

• 한국산학기술학회논문지
• /
• 제18권5호
• /
• pp.59-67
• /
• 2017

본 연구의 목적은 DEA(Data Envelopment Analysis)를 이용하여 한방병원의 효율성을 분석하고, 효율성 점수를 종속변수로 사후분석을 실시하여 한방병원의 비효율성 개선을 제안하는데 있다. 투입변수는 의사직수, 간호직수, 의료기사직수, 병상수이며 산출변수는 매출액을 이용하였다. EnPas와 IBM SPSS 19.0을 사용하여 104개 한방병원을 설립형태, 개원기간, 병상규모, 그리고 소재지 범주별로 효율성을 분석하고 영향을 미치는 변수를 제시하였다. 효율성 분석결과, BCC(Banker, Charnes & Cooper)모형에서 가장 높은 효율성을 보인 범주는 설립형태에서 개인병원(p<.05), 개원기간은 10년 이하(p<.05), 병상규모는 50병상 이하(p<.05), 그리고 소재지는 광역시 소재 병원이었다. 그러나 CCR(Charnes, Cooper & Rhodes)모형에서는 낮은 효율성을 보였는데, 이는 병원 규모로 인한 비효율성 때문인 것으로 나타났다. 그리고 효율성 결정요인을 파악하기 위한 이항로지스틱 분석결과에서 병상수가 1개 증가할 때마다 효율성은 0.955배씩 감소함을 알 수 있었다. 본 연구의 제한점은 자료수집의 한계로 인해 2013년 단일년도에 대한 분석을 실시하였으나, 이후 연구에서는 연구기간을 보다 확대하여 DEA/Window 기법 등을 활용한 시계열 분석을 통해 다년도의 한방병원 경영효율성 변화추이와 관련요인을 분석할 필요성이 있으며, 본 연구에 포함되지 않은 다양한 변수들이 한방병원 효율성에 영향을 미칠 수 있기 때문에 이들 변수들을 고려한 후속 연구를 기대한다.

• Journal of information and communication convergence engineering
• /
• 제9권5호
• /
• pp.577-582
• /
• 2011

EMR(Electronic Medical Record) is an emerging technology that is highly-blended between non-IT and IT area. One of methodology to link non-IT and IT area is to construct databases. Nowadays, it supports before and after-treatment for patients and should satisfy all stakeholders such as practitioners, nurses, researchers, administrators and financial department and so on. In accordance with the database maintenance, DAS (Data as Service) model is one solution for outsourcing. However, there are some scalability and strategy issues when we need to plan to use DAS model properly. We constructed three kinds of databases such as plain-text, MS built-in encryption which is in-house model and custom AES (Advanced Encryption Standard) - DAS model scaling from 5K to 2560K records. To perform custom AES-DAS better, we also devised Bucket Index using Bloom Filter. The simulation showed the response times arithmetically increased in the beginning but after a certain threshold, exponentially increased in the end. In conclusion, if the database model is close to in-house model, then vendor technology is a good way to perform and get query response times in a consistent manner. If the model is DAS model, it is easy to outsource the database, however, some technique like Bucket Index enhances its utilization. To get faster query response times, designing database such as consideration of the field type is also important. This study suggests cloud computing would be a next DAS model to satisfy the scalability and the security issues.

• 디지털융복합연구
• /
• 제16권3호
• /
• pp.353-362
• /
• 2018

본 연구는 원격간호교육 성인학습자의 성격강점, 자기효능감이 이들의 주관적 행복감에 미치는 영향을 파악하기 위한 서술적 조사연구이다. 자료는 2015년 9월부터 11월까지 일 국립원격대학교의 간호학사 특별편입과정 성인학습자 261명을 대상으로 성격강점, 자기효능감, 주관적 행복감 척도를 이용하여 수집하였다. 원격간호교육 성인학습자의 주관적 행복감의 평균 점수는 미국과 한국의 일반 성인 보다 약간 낮은 수준이었으며, 성격강점은 6개 하부영역 중에서 초월과 인간애가 가장 높았으며 정의감이 가장 낮았다. 다중회귀분석 결과, 원격간호교육 성인학습자의 주관적 행복감에 영향을 미치는 요인은 긍정적 통합성, 강인성과 지각된 건강상태이었다. 이들 변수가 주관적 행복감 총 변량의 38.0%를 설명하였으며, 긍정적 통합성이 가장 큰 영향을 미치는 요인이었다. 직업과 원격학습을 병행하는 간호사들의 주관적 행복감을 증진하기 위한 방안으로 긍정적 통합성과 강인성의 성격강점을 강화하고 건강상태를 효과적으로 관리할 수 있는 다양한 교육 및 학습 지원전략의 개발을 제언한다.

• 한국간호교육학회지
• /
• 제24권3호
• /
• pp.279-289
• /
• 2018

Purpose: The study is to confirm the influence of self-efficacy, critical thinking disposition, self-leadership, and communication competency on the core competencies of the preceptor. Methods: Data were collected from August 27 to September 7, 2017 using structured questionnaires for 127 preceptors at a general hospital located in Korea. SPSS/Win 23.0 was used to analyze the frequency, percentage, mean, standard deviation, independent t-test, one-way ANOVA, Pearson's correlation coefficients, and stepwise multiple regression. Results: The mean score of the core competencies of the preceptors was $3.94{\pm}0.35$ (range 1-5); self-efficacy was $3.88{\pm}0.49$; critical thinking disposition was $3.54{\pm}0.36$; self-leadership was $3.66{\pm}0.39$; communication competency was $3.71{\pm}0.35$. There were no statistically significant differences between the core competencies of the preceptor and general characteristics. The core competencies of the preceptors were significantly correlated with self-efficacy (r=.61, p<.001), critical thinking disposition (r=.69, p<.001), self-leadership (r=.59, p<.001), and communication competency (r=.58, p<.001). The core competencies of the preceptors were affected by critical thinking disposition (${\beta}=.54$, p<.001), followed by communication competency (${\beta}=.24$, p<.001). The explanatory power by the factors was 51% (F=63.66, p<.001). Conclusion: The results suggest that critical thinking disposition and communication competency are important predictors of the core competencies of the preceptors.

• 재활간호학회지
• /
• 제8권2호
• /
• pp.102-109
• /
• 2005

Purpose: The purpose of this study were to investigate the health status, the currency of rehabilitation therapy, and the patient learning needs on hospital with disabilities. Method: The subjects consisted of 87 disabled adults on hospital. Data was collected from February until to June 2005, where they asked structured questionnaires. A descriptive survey design was used and the SPSS 12.0 program was used for data analysis, which included t-test, ANOVA and Duncan's multiple comparison test. Result: There are a lot of patient through the transfer from the general hospital and the rehabilitation hospital. Their heath status changed good after hospital admission. Patients took exercise therapy the most, which is one of the rehabilitation therapy. But they need to enough physical therapy because patients have limited time for treatment. The education-need-level was high on hospital with disabilities, especially the need of support and care are the highest on the subscale of patient learning need. There are significant patient learning need differences in income and admission location(p<.05). Conclusion: Disabled persons on hospital needs to help and learning exercise by nurses. There should be rehabilitation programs for patients who are ready to leave the hospital. After discharging, there needs to be various rehabilitation services, support and care for the community based rehabilitation.

• 임상간호연구
• /
• 제26권2호
• /
• pp.141-153
• /
• 2020

Purpose: This study aimed to update the previously published nursing practice guideline for oral care. Methods: The guideline were updated according to the manuals developed by National Institute for Health and Care Excellence (NICE) and Scottish Intercollegiate Guidelines Network (SIGN), and a Handbook for Clinical Practice Guideline Developer Version 1.0. Results: Updated nursing practice guideline for oral care was consisted of 10 domains and 79 recommendations. The number of recommendations in each domain were: 5 general issues, 2 oral care indications, 9 oral assessment, 16 general oral care, 12 oral care for critically ill patients, 16 oral care for cancer patients, 12 oral care for cancer patients with oral complications, 5 oral care education, 1 oral care referral, and 1 documentation and report. In terms of grades for recommendations, 11.4% was grade A, 17.0% was grade B, and 68.2% was grade C. Twelve new recommendations were developed and 7 previous recommendations were deleted. Conclusion: Updated nursing practice guideline for oral care is expected to serve as an evidence-based practice guideline for oral care in South Korea. It is recommended that this guideline be spread to clinical nursing settings nationwide to improve the effectiveness of oral care practice.

• 한국정보통신학회:학술대회논문집
• /
• 한국해양정보통신학회 2010년도 춘계학술대회
• /
• pp.852-855
• /
• 2010

현재 컴퓨터 네트워크 기술의 비약적인 발전에 힘입어 USN은 시간과 장소에 구애받지 않으며 사용자가 컴퓨터나 네트워크를 인식하지 못하고 통신 환경에 접속할 수 있는 수준에 까지 이르게 되었다. 더욱이 지금은 개개인의 건강에 관심이 높아지고 있어 건강을 관리하고 예방할 수 있는 의료 분야에서도 USN의 기술 발전과 더불어 다양한 분야에서의 적용이 시도 되고 있다. 본 논문은 병원에 입원한 환자를 관리하는 의사나 간호사가 손쉽게 환자의 혈압 및 혈당에 관련된 생리학적 데이터를 측정하고 관리할 수 있게 유비쿼터스 센서 네트워크 기반의 RF 통신을 이용한 시스템을 설계하고 구현한다. 또한 MsSQL 데이터베이스를 이용하여 환자에게서 수동 및 능동적으로 측정한 혈압 및 혈당 정보를 저장하고 관리할 수 있는 데이터베이스를 설계한다. 따라서 환자의 생리학적 데이터를 실시간으로 관리하고 응급상황에 즉각적으로 대처할 수 있으므로 환자들에 대한 의료 서비스 향상에 기여할 뿐만 아니라 의료서비스 환경에 대한 패러다임 변화를 기대할 수 있다.

• 임상간호연구
• /
• 제18권1호
• /
• pp.136-148
• /
• 2012

Purpose: The purpose of this study was to develop a reliable and valid pain assessment tool suitable for critically ill patients with communication problem in Korean intensive care unit. Methods: This pain assessment tool, Critical Care Non-verbal Pain Scale (CNPS), was developed based on review of national and international researches. Data were collected from ten intensive care units at five major general hospitals in Seoul. Reliability and validity were tested during performance of position change and endotracheal suctioning. Pain was measured before, during, and 20 minutes after the two procedures. Results: Interrater reliability of the CNPS was analyzed by ICC (Intraclass correlation coefficients). ICC values were significant from .833 to .883. Significant correlation between the FPS (Face Pain Scale) scores and the CNPS scores verified concurrent validity of the CNPS. For position change, CNPS scores increased significantly between before and during (t=-23.399, p<.001) and decreased significantly between during and 20 minutes after (t=22.760, p<.001). For endotracheal suctioning, CNPS scores increased significantly between before and during (t=-29.064, p<.001) and significantly decreased between during and 20 minutes after (t=28.194, p<.001), verifying construct validity of the CNPS. Conclusion: Results indicate that the CNPS can be used to assess pain of critically ill patients who have communication problem.

• 임상간호연구
• /
• 제29권3호
• /
• pp.211-222
• /
• 2023

Purpose: This study was conducted to update the existing evidence-based nursing clinical practice guideline for indwelling urinary catheterization (IUC). Methods: The guideline have been revised in 22 steps based on international standards. The quality of the practice guidelines to be used for revision was evaluated using the Appraisal of Guidelines for Research and Evaluation II. The evaluation of the content appropriateness and applicability of the draft recommendations of the revised practice guidelines was performed using the RAND/UCLA Appropriateness Method, a decision-making method developed by the RAND Corporation. Four guidelines were used for the revision. Results: The updated nursing practice guideline for IUC consisted of 9 domains and 134 recommendations. The numbers of recommendations in each domain were: 4 Assessment, 20 Equipment, 11 Catheter insertion, 52 Catheter maintenance, 4 Catheter and drainage bag change, 9 Catheter removal, 22 Complications management, 5 Education and consult, and 7 Hospital support. The recommended grade was 8.2% for A, 38.1% for B, and 53.7% for C. Among these, the major revision was done in 11 recommendations (8.2%). A total of 29 recommendations (21.6%) were newly added. 30 (22.4%) recommendations had minor revisions such as changes or addition for some words or sentences, and 13 (9.7%) recommendations were deleted. Conclusion: Revised nursing practice guideline is expected to serve as an evidence-based practice guideline for IUC in Korea. This guideline will provide health care providers, patients, and caregivers with information to help manage IUC, leading to improved patient outcomes.