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Application and Effectiveness of a Preceptorship for the Improvement of Clinical Education (임상실습 교육개선을 위한 일 실습지도자 활용모델 (preceptorship model)의 적용 및 효과에 관한 연구 -암센타, 재활센타, 중환자실 실습을 중심으로-)

  • 이원희;김소선;한신희;이소연;김기연
    • Journal of Korean Academy of Nursing
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    • v.25 no.3
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    • pp.581-596
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    • 1995
  • Clinical practice in nursing education provides an opportunity for students, through the process of ap-plying theoretical knowledge to practice, and to learn nursing skills as well as being socialized into nursing and as such decrease the reality shock of actual nursing practice. Because of a shortage of nursing faculty, the job of achieving the objectives of the clinical practice had been turned over to the head nurses. This resulted in many problems, such as, unclear location of responsibilities and inadequate feedback from head nurses. Therefore this study was done to introduce and evaluate the use of preceptors as a way to minimize the above problems, and to maximize the achievement of the clinical practice objectives. Using an adaptation of Zerbe's (1991) three-tiered team model, clinical practice was done using a preceptor, a head nurse and a clinical instructor, each with different and well defined roles. The subjects of this study were 67 senior students of the College of Nursing of Y University in Seoul whose clinical practice in adult nursing was carried out between May 1, 1994 and December 8, 1994. There were 22 preceptors who had at least two years of clinical experience and who were recommended by their head nurses. They were given additional education on the philosophy and objectives of the College of Nursing, on communication skills, on the theory and practice of education, and on nursing diagnosis and education evaluation. The role of the preceptor was to work one-to-one with students in their practice. The role of the head nurse was to supervise and evaluate the preceptors. The role of the clinical instructor was to provide the education program for the preceptors, to provide ad-vice and suggestions to the preceptors and to maintain lines of communication with the college. With each of these roles in place, it was thought that the effectiveness and efficiency of the clinical practice could be increased significantly. To evaluate the effectiveness of the preceptorship, the three - tiered model, Lowery's Teacher Evaluation Opinion Form translated and adapted to Korea was used to measure student statisfaction. The Clinical Practice Compentency Evaluation Tool developed by Lee et ai was also used to measure student competencies. The results of this study are as follows 1. The satisfaction with clinical practice was higher with the introduction of the perceptors than it was before they were used. (t=-5.96, p=<.005) 2. The clinical practice competencies were higher with the introduction of the preceptors than it was before they were used(t=-5.l3, p<.005) 3. In order to analyze areas not measured by the quantitative tools additional analysis of the open questions was done. The results of this analysis showed that : 1) The students felt positive about their sense of security, confidence, handling of responsbility, and being systematic. They also felt positive about improvements in knowledge, opportunities for direct care, and socialization. 2) The students felt negative about the technical part of their role, lack of knowledge by the preceptor, unprofessional attitudes on the part of the preceptor, difficulty in the role of the professional nurse(student). 3) The preceptors felt positive about their responsibility, motivation, and relationship with the college. 4) The preceptors felt negative about their bur-den. Introduction of the preceptorship model will lead to change and improvement in the negative factors discussed above, solve problems in the present clinical education system, increase continuity in the education of the students, help with socialization of the students and motivation of the preceptors to up-grade their education and increase their confidence. These objectives must be obtained to further the development of professional nursing, and thus, making the preceptorship a reality is our job for the future.

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Oral Health and Related Factors for the Elderly (Structural Equation Modeling을 통한 노인(老人)의 구강건강(口腔健康) 관련요인(關聯要因) 분석(分析))

  • Seung, Jeung-Hee
    • Journal of dental hygiene science
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    • v.4 no.3
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    • pp.91-95
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    • 2004
  • This study aims to analyze realities of oral health and related factors, and establish Structural Equation Modeling. The subjects of study were 9,340 elderly over age 65 who took the health examination(the first) for the local insured which National Health Insurance Corporation carried out in the survey area mentioned below from January 2002 to December 2002. The areas surveyed were 4 big cities including Seongbuk-ku, Seoul, 5 medium cities including Wonjusi, Gangwon-do, and 5 Counties including Yeong deok County, Kyeongbuk. Considering location and the scale of population, firstly, big unit areas(metropolitan city, province) were selected according to convenience, secondly, low unit areas(city, county, district) were selected randomly. The subjects were the elderly who took all tests including an oral examination and filled in the questionnaire. Major results from analysis are as follows: 1. Review of Composition Conception Validity As a result of analyzing composition conception validity of SEM including posture test, urine test, blood test, habits of eating, drinking and smoking, oral symptoms, and oral health status, using fit index such as GFI, CFI, TLI, and RMSEA, all were within fit range and composition conception validity was recognized. 2. As a result of analyzing SEM to find the relationship between each factor and oral health status, it was confirmed that all factors except urine test affected oral health status and the synthetic SEM to explain it could be established. In result, we could verify that the elderly of rural areas who had lesser experience of visiting a clinic and oral prophylaxis had a higher rate of caries, missing teeth, and denture need, and drinking and smoking negatively affected the rate of caries, periodontal, and missing teeth. Also, periodontal diseases were observed from 43.2% of the total elderly and much from the lower age. Most of oral disease can be prevented by right oral health behavior. Therefore through oral health professionals from each district public health center of the nation, oral health education for the elderly about right eating habits and oral health care should be carried out systematically and policy change to increase access to dental service is required lest that visiting a dental clinic should be impossible or oral health behaviors such as oral prophylaxis and denture wearing should be neglected by economic, geographical barriers. Also, to establish SEM to explain the relationship between oral health status and systemic health, more accurate test methods and effective index development should be preceded. Because items developed by National Health Insurance Corporation applied to this study without alteration, structuring a model had the uppermost limit. Continual study seems to be needed.

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Understanding of the Workers in the North Area of Ulsan on the Oral Health and Hygienic Status (울산시 일부 생산직 근로자의 구강보건 인식에 대한 조사연구)

  • Lee, Ga-Ryeong
    • Journal of dental hygiene science
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    • v.4 no.3
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    • pp.117-126
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    • 2004
  • For a month of September, 2004, a questionnaire regarding dental hygiene was distributed to 165 workers of Ulsan area. A total of 125 questionnaire were analyzed: 102 collected of the distributed 165 pieces, and 23 questionnaires reported by patients of a dental clinic in Dong-gu, Woolsan. The result is as follows; (1) Labor workers of Ulsan have thought that they are in good dental health, 44.1% of respondents, following by those who they believe they are in moderate health and those who they think are in poor condition. 89.0% of total workers have experienced dental treatment. (2) Regarding the location of dental treatment, 85.0% of respondents have pointed out dental hospitals and clinics, while 3.9% have indicated that they had treatment from unlicensed dentists. Specifically, workers in their 40s over have ever experienced dental treatment by unlicensed dentists. Those who think they are in poor dental condition have tended to have more dental treatment by unlicensed dentists. (3) Regarding the reason that they put off the treatment, 59.1% of respondents have indicated that they have no time to have the treatment, following by economic burden and the lack of confidence in dentists. When they have tooth aches or the gum ache, 60% of respondents have suggested that they endure the ache or take a medicine to alleviate the pain, showing a lower understanding of early dental treatment. (4) Regarding the reason why they are unwilling to go to dentists, respondents have revealed the anxiety against pain, 50.4%, following by the difficulty of scheduling and unsatisfied services. (5) 47.2% of respondents have brushed their teeth 3 times everyday, following by those who have done it 2 times a day and those one a day. Regarding how to brush the teeth, most of respondents have brushed their teeth in the upper, lower, and the both side, 61.4%. The younger respondents and those who think they are in good dental health have tended to brush their teeth up and down. (6) Regarding the cause of the gum disease, 67.7% of respondents have thought that it is caused by poor dental hygiene, following by natural occurrence due to age, hereditary nature, and physical predisposition. (7) 67.7% of respondents have experienced dental scaling, while 32.3% of them have had no experience in it. 53.5% of workers have thought that scaling may not be recommended since they have the teeth scaled periodically once they had dental scaling, a higher rate than 46.5% who think scaling is good for the gum health.

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Tie Spatial Structure of Ch'ang-ts'ai-ts'un Village A Case Study on a Rural Village of Korean Immigrants in Yen-pien Area of China (중국(中國) 연변지구(延邊地區) 조선족(朝鮮族)마을의 구성(構成) 룡정시 지신향 장재촌을 대상으로)

  • Lee, Kyu Sung
    • Journal of architectural history
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    • v.3 no.1
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    • pp.83-99
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    • 1994
  • Ch'ang-Ts'al-Ts'un is a rural Village near Lung-jing City in Yen-pien Korean Autonomous Province of China. It was formed about 100 years ago by Korean Immigrants and has been developed maintaing the characteristics of traditional Korean architecture. Therefore investigating the spatial structure of this village is a meanigful work to confirm and explore one branch of Korean architecture. This study aims at analyzing the spatial structure of the village using direct data collected from the field work and indirect data from books and maps. The field work consists of on-the-site survey of the village layout, interviews of residents, observation notes and photography. Ch'ang-Ts'ai-Ts'un is located 360-370 m high above the sea level and at the side of a long valley. A river flows in the middle of the valley and relatively flat arable land exists at the both sides of the river. The location of the village related to the surrounding river and mountains suggests that the site of the village was chosen according to Feng-Shui, Chinese and Korean traditional architectural theory. The main direction of the house layouts is South-western. The village has been growing gradually until today. Therefore it is meaningful to make the village layout before Liberation(1946 A.D.) because the characteristics of Korean architecture prevailed more in that period. The area of the previous village is limited to the west side of the creek. New houses were later added to the east of the creek, forming a 'New Village'. Previously the village was composed of 3 small villages: Up, Middle and Down. Also the main access roads connecting the village with the neighboring villages were penetrating the village transversely. Presently the main access road comes to the village longitudinally from the main highway located in front of the village. The retrospective layout shows the existence of well-formed Territory, Places and Axes, thus suggesting a coherent Micro-cosmos. The boundary of imaginery territory perceived by present residents could be defined by linking conspicous outside places sorrounding the village such as Five-mountains, Front-mountain, Shin-dong village, Standing-rock, Rear-mountain and Myong-dong village. Inside the territory there are also the important places such as Bus-stop, Memorial tower of patriots, Road-maitenance building and the village itself. And inside it 5 transverse and 1 longitudinal axes exist in the form of river, roads and mountains. The perceived spatial structure of the village formed by Places, Axes and Territory is geometrical and well-balanced and suggests this village is fit for human settlement. The administrative area of the village is about 738 ha, 27 % of which is cultivated land and the rest is mountain area. Initially the village and surrounndings were covered with natural forest But the trees have been gradually cut down for building and warning houses, resulting in the present barren and artificial landscape with bare mountains and cultivated land. At present the area of the village occupied by houses is wedge-shaped, 600 m wide and 220 m deep in its maximum. The total area of the village is $122,175m^{2}$. The area and the rate of each sub-division arc as follow. 116 house-lots $91,465m^{2}$ (74.9 %) Land for public buildings and shops $2,980m^{2}$ (2.4 %) Roads $17,106m^{2}$ (14.0 %) Creek $1,356m^{2}$ (1.1 %) Vacant spaces and others $9,268m^{2}$ (7.6 %) TOTAL $122,175m^{2}$ (100.0 %) Each lot is fenced around with vertical wooden pannels 1.5-1.8 m high and each house is located to the backside of the lot. The open space of a lot is sub-divided into three areas using the same wooden fence: Front yard, Back yard and Access area. Front and back yards are generally used for crop-cultivation, the custom of which is rare in Korea. The number of lots is 116 and the average size of area is $694.7m^{2}$. Outdoor spaces in the village such as roads, vacant spaces, front yard of the cultural hall, front yard of shops and spacse around the creek are good 'behavioral settings' frequently used by residents for play, chatting, drinking and movie-watching. The road system of the village is net-shaped, having T-junctions in intersections. The road could be graded to 4 categories according to their functions: Access roads, Inner trunk roads, Connecting roads and Culs-de-sac. The total length of the road inside the village is 3,709 m and the average width is 4.6 m. The main direction of the road in the village is NNE-SSE and ESE-WNW, crossing with right angles. Conclusively, the spatial structure of Ch'ang-Ts'ai-Ts'un village consists of various components in different dimensions and these components form a coherent structure in each dimension. Therefore the village has a proper spatial structure meaningful and appropriate for human living.

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A Study on Pregnancy, Delivery, and Infant Rearing Knowledge and Educational Need of Marriage Immigrant Women (국제결혼 이주여성의 임신·출산 및 영유아 양육 지식과 교육요구도)

  • Jeon, Mi-Soon;Kang, Ki-Jung;Park, Sung-Hee
    • Journal of agricultural medicine and community health
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    • v.36 no.3
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    • pp.179-190
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    • 2011
  • Objectives: This study was performed to understand pregnancy, delivery, and infant rearing knowledge and educational need of marriage immigrant women to be utilized as a basic data for developing a suitable educational program. Methods: The subject of the study was composed of one hundred twenty two married immigrant women who live in South Korea. The method used in determining the population was the convenience sampling method. The data were gathered by means of personal interviews using questionnaires. Results: The mean score of pregnancy and delivery knowledge was 3.35, educational need was 3.64 out of 5, and infant rearing knowledge was 3.16, educational need was 3.66 out of 5. The pregnancy and delivery knowledge of the subject showed significant differences based on their present residential location and presence of children and their educational need varies according to their country of origin. The infant rearing knowledge on the other hand, showed notable differences according to presence of children while homeland and existence of children were the two major factors that greatly influenced the significant variation for educational need. Conclusions: The score of pregnancy, delivery and infant educational need were higher than knowledge. The score of pregnancy, delivery, and infant rearing educational need garnered similar results. Thus it is suggested that further researches should be conducted for the development, application, and verification of pregnancy, delivery, and infant rearing education programs that consider knowledge and educational need of immigrant married women in South Korea.

Clinical Characteristics of Aspergilloma (국균종의 임상적 고찰)

  • Kim, Ki-Up;Gil, Hyo-Wook;Lee, Suk-Ho;Kim, Do-Jin;Na, Moon-Jun;Uh, Soo-Taek;Kim, Yong-Hoon;Park, Choon-Sik
    • Tuberculosis and Respiratory Diseases
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    • v.52 no.1
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    • pp.46-53
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    • 2002
  • Background: Pulmonary aspergilloma is relatively common in korea. It arises from the colonization and proliferation of Aspergillus in preexisting lung parenchymal cavities, in particular tuberculosis. The most common symptom in this disorder is hemoptysis, which mayor may not be massive and life threatening. A routine chest radiography and computed tomography (CT) are the most important diagnostic procedures. A surgical resection of the aspergilloma has recently been recommended, because of the relatively low incidence of postoperative complications than in the past. A more concentrated sample of patients with aspergilloma, who either underwent a thoracotomy or tested positive for aspergillus antibodies, were reviewed. Method : The medical records of twenty-two patients with aspergilloma, who had a proven thoracotomy (9 cases), or who tested positive for the diagnostic procedure and/or aspergillus antibodies (13 cases) from January 1995 to December 2000, were reviewed retrospectively. Results : The most common underlying lung disease was a current or old healed tuberculosis, and 3 patients had cultures of mycobacterium other than tuberculosis (MOTT). The mean time until the aspergilloma was detected 5.91 years in the healed tuberculosis cases. The others cases involved a lung abscess, bronchiectasis and without lung disease. The extrapulmonary disease was alcoholism and diabetes. Hemoptysis was most common in 72.7%. A computed tomography (CT) is useful for diagnosis. The right upper lobe, especially the posterior segment, is the most common location. Bronchial artery embolization is ineffective for a long term follow-up. A lobectomy is most common in a thoracotomy, and intra-operative and post-operative complications are rare. During follow-up, the mortality rate, not from the aspergilloma but from respiratory failure, was 13.6%. Conclusion : Aspergilloma is a common cavitary lung disease, It mainly arises from tuberculosis, either current or healed, but extra-pulmonary disease including alcoholism or diabetes are other possible risk factors. Their most common problem in aspergilloma is hemoptysis. Surgery has a low risk of post-operative complications and is recommended in relatively preserved lung function or healthy patients. Medical maneuvers including embolization, and the local insertion of certain materials needs to be studied more closely.

Shape and Incidence of Rib Variations in Chest Radiographs (단순흉부촬영상 관찰되는 늑골 변이의 양상 및 빈도)

  • Joo, Ji-Seon;Bae, In-Young;Kim, Sung-Tae;Kwak, Seung-Min;Cho, Chul-Ho;Cho, Seung-Wook;Park, Chan-Sup
    • Tuberculosis and Respiratory Diseases
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    • v.48 no.1
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    • pp.45-53
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    • 2000
  • Background: The literature on variations of rib is limited. Very little has been written in the radiological journal of this country on the subject. It seemed of interest to investigate the nature and incidence of congenital variations in a series of routine chest roentgenograms. The topic of rib variations has not been covered extensively in the radiological journals in Korea. This has presented an opportunity to investigate the nature, type, shape and incidences of congenital rib variations in normal Korean adults from a series of routine roentgenograms. Methods: Chest radiographs of 5,000 adults, who visited our hospital for a routine check-up or for employment physical examinations from January 1996 to September 1998, were consecutively reviewed. The sex distribution consisted of 2,827 male males and 2,173 female females(ratio of 1.3:1) with the age range aged between 19 and 65 years(mean age: 34.6 years) were included. The chest PAs were analyzed for the presence, type, location, and shape of the rib variations. From this data the incidence of each type of variations was calculated. Results: Seventy-six of the 5,000 adults(1.52%), 63 male(2.23%) and 13 female(0.6%), showed 88 cases of rib variation(Table 1). The most common variation was the bifid rib(n=35), followed by hypoplasia of the rib(n=22), flaring of the rib(n=18), bridging of the ribs(n=7), cervical ribs(n=3), and fusion of between ribs(n=3)(Table 2). The bifid rib(Table 1) was found most frequent in the right fourth rib(12/35, 34.3%), followed by the left fifth rib(6/35, 17.1%) and right third rib(6/35, 17.1%). Hypoplasia of the rib was common in first rib(20/22, 90.9%). Flaring of the rib was common at fourth rib(8/18, 44.4%, right and left combined), and bridging between ribs was common between first and second rib(3/7, 42.9%). Conclusion : The percentage of incidence of rib variations in adults was 1.52%. Bifid rib was the most common variation, followed by hypoplasia, flaring, bridging, cervical rib, and fusion of ribs, in decreasing order.

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Smoking Status and Serum NSE Level, as Prognostic Factors in Adenocarcinoma of Lung (원발성 폐선암 환자에서 예후인자로 흡연 및 NSE 수치의 의의)

  • Kim, Hee Kyoo;Ok, Chul Ho;Jung, Mann Hong;Jang, Tae Won
    • Tuberculosis and Respiratory Diseases
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    • v.58 no.6
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    • pp.582-589
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    • 2005
  • Background : The incidence of lung adenocarcinoma, which is more prevalent in women and nonsmokers, is increasing. The aim of this study was to determine the prognostic factors of an adenocarcinoma of the lung. Material and method : The clinical information of patients diagnosed with an adenocarcinoma of the lung at the Kosin University Gospel Hospital from January 1994 to July 2004 was reviewed retrospectively. The survival time of these patients was analyzed by the patient's age, gender, performance status, weight loss, smoking history, location of the primary tumor, clinical stage, serologic tumor markers, and treatment modality. Results : For all 422 patients with an adenocarcinoma of the lung, 247 (58.5%) were male, and their mean age was 59.8 years the. The majority of patients were smokers (58.3%), and the tumors were located in the periphery (59.7%). In the smokers, the tumor was located more in the central airway compared to the non-smokers (42.8% vs. 31.9%, p=0.12). The overall median survival time was 390 days (95% CI;304-436 days). Univariate survival analysis revealed that an older age (${\geq}65$ years old), male, weight loss, smoker, central type, advanced clinical stage, elevated serum carcinoembryonic antigen (CEA, >5 ng/ml) and neuron specific enolase (NSE, >15 ng/ml), and the supportive care only were significantly poor prognostic factors. The median survival time was shorter in the smokers than nonsmokers (289 days vs. 533 days, p<0.001). In addition, it was also shorter in the elevated NSE group than in the normal range group (207 days vs. 469 days, p<0.001). Multivariate analysis showed that age, clinical stage, serum NSE, smoking status, and treatment modality were independent predictors of survival (hazard ratios: 1.68, 1.94, 1.92, 2.39 and 1.57, respectively). Conclusions : Smoking is an important prognostic factor in an adenocarcinoma of the lung, but not gender. This suggests that the better prognosis of women is more related with the lower rate of smoking. In addition, the elevated serum NSE is also an important prognostic in an adenocarcinoma of the lung.

Comparison of chewing ability and quality of life before and after the dental implantation (임플란트 시술환자의 시술 전.후의 저작능력과 삶의 질 비교)

  • Kim, Kyeong-Won;Lee, Kyeong-Soo;Kang, Pock-Soo;Kim, Woo-Shik;Lee, Hee-Kyeong
    • The Journal of Korean Academy of Prosthodontics
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    • v.47 no.2
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    • pp.215-221
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    • 2009
  • Statement of problem: Recently the populations of patients receiving implant surgery are greatly increase for maintaining oral health. Purpose: This study was conducted for implanted patients to assess the chewing ability patient satisfaction level and changes in quality of life before and after the implant surgery. Material and methods: The current study subjected 109 adult patients, older than 20 years of age, who received implant surgery from December, 2006 to October, 2007 at the 6 dental clinics located at Daegu and Ulsan metropolitan cities. Twice of surveys were conducted for the patients before and after receiving the dental implant surgery. Results: As the motivation of receiving implant surgery, 45.9% of the patients selected the surgery for the chance o "f chewing function recovery", and " failure of treatment and complications" was found to be the most worrisome at the time of surgery by recording 38.5%.The satisfaction level before the implant surgery scored 30.37, while the score was increased to 45.01 after the surgery by showing a significant difference before and after receiving the surgery(P<.001). Regard on the surgery, 91.8% of the patients responded as "Satisfy", and 89% of the study subjects responded that they have willingness to recommend the surgery to their families and friends. The chewing ability score measured by using the surveys on edible foods, the score before the surgery was 15.24, while the score was increased to 19.11 after the surgery by showing a significant difference before and after receiving the surgery(P<.001). The quality of life score was also found to be increased to 11.17 after the surgery from 9.99 before the surgery by showing a significant difference(P<.001). Conclusion: In a future, the studies on the numbers of implanted loss teeth and the location of tooth loss are necessary, more long-term follow study are needed, and it is thought to be necessary to enlarge the sample size of subjects in conducting the studies.

Evaluation of clinical status of fixed prosthesis (고정성 보철물의 임상적 상태에 대한 평가)

  • Yun, Mi-Jung;Jeon, Young-Chan;Jeong, Chang-Mo
    • The Journal of Korean Academy of Prosthodontics
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    • v.47 no.2
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    • pp.99-107
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    • 2009
  • Statement of problem: Restoring and replacing teeth with fixed prostheses commonly used in dental practice. Because of improper oral hygiene care and inaccurate laboratory procedure, complications of fixed prostheses were found in the mouth of patients. Although many efforts have been continually made to obtain the data of long term prognosis of fixed prostheses, it was difficult to do it. Purpose: The purpose of this study was to evaluate the clinical status of fixed prostheses. Material and methods: In order to assess the clinical status of fixed prostheses, a total of 161 individuals(aged 17-85, 99 women and 62 men with 1596 unit of fixed prostheses, and 1169 abutments) who first visited the Department of Prosthodontics, Pusan National University Hospital, between April to September, in 2007 were examined. Results and conclusion: The results of this study were as follows: 1. Length of service of fixed prostheses was $8.6{\pm}0.6$ years(mean), 10.0 years(median). 2. Location of fixed prostheses was found to have no statistically significant influence on longevity of fixed prostheses(P>.05). But, the success rate was high in posterior region and in mandible where the failure rate was high in combination(P<.05). 3. Longevity of fixed prostheses made of metal was longest(mean: $13.0{\pm}9.3$, median: 14.0), gold, precious ceramic, non-precious ceramic trailing behind(P<.05). 4. Number of units in fixed prostheses was found to have no statistically significant influence on longevity of fixed prostheses(P>.05). But, the success rate was high in Single-unit and the failure rate was high in over 3-unit(P<.05). 5. Condition of opposing dentition was found to have no statistically significant influence on longevity of fixed prostheses(P>.05). But, the success rate was high in natural dentition(P<.05). 6. Defective margin(28.2%), dental caries(23.0%), periodontal disease(19.3%), periapical disease(16.9%) were frequent complications. In 30.1% of the cases, abutment state after removing fixed prostheses was needed to be extracted.