• 모자간호학회지
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• 제4권1호
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• pp.3-11
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• 1994

Presently there is an increasing demand for home health care services due to changes in the demographic structure as a result of an increasing elderly population, socio-economic improvements, and changes in the family structure, as well as the growing number of people with degenerative diseases. In addition to these reasons, rising medical costs and there a shortage of patient beds space in the hospital, particularly since introduction of national medical insurance. There has been an increasing demand for health care health care services. This study was done to identify the basic data for home health care management. It focused on developing client selection criteria, assessment tools, and recording methods. This was accomplished by the researchers visiting the patients in their homes. The research process included preparation investigation, tool development, training of the project researcher, and visiting the clients in their homes. The research tools are as follows : 1. Record development : a) The selection criteria tool for home health care of postpartum women was a structured tool and consisted of four parts. b) The structured assessment tool consisted of a general items, obstetric history, past medical history, methods of feeding, medications taken before admission, laboratory test results, discharge instructions, discharge medications, family tree, economic status, environmental status, a map, health assessment of postpartum women and their newborns. c) The visit note I consisted of the frequency of visits. Visit note II consisted of the date ; nursing problems ; nursing process including the initial assessment ; nursing goal ; visit plan ; postpartum women and their neonate health status, diagnosis, goal, implementation, evaluation, summary, next plan, for visit revision. d) Problem note consisted of the date, problem numbers, nursing diagnosis, problem appearance date problem resolution date. The research results are as follows : 1. Nursing problems : The nursing problems of the postpartum women and their neonates were evaluated by the number of nursing diagnoses and the change in the pattern of nursing diagnosis related to the number of visits. a) Nursing diagnosis The nursing diagnosis was classified according to physical function, psychosocial function, family system maintained function. b) The changes of nursing diagnosis related to the number of visits. As the type of nursing diagnosis changed related to the number of visits the number of nursing diagnoses decreased. 2. Contents of home health care : The content was categorized according to assessment, direct care, counseling, education, family care, reporting to with the attending doctor. The recommendations based on the research results are as follows : 1. Tool development Replication of this study is needed to test the validity of the assessment tools used. 2. Home visit a) Home health care nurses should be licensed and qualified. A referral form from the attending doctor is needed for legal protection of nurses. b) The first home visit need to be within 24 hours of discharge from the hospital to decrease the anxiety of frightened postpartum women. c) When the changes occur in the newborn's status, home health care nurses should consult a pediatrician. Communication within the home healthcare team is essential and needs to consistent and done smoothly. 3. Home health care A Study is required to develop protocols for education of staff and for operation of all aspects of this program.

• 간호행정학회지
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• 제4권2호
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• pp.405-418
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• 1998

The purpose of this study was to describe patients satisfaction with nursing care in the emergency department and factors influencing satisfaction rates. 1. The mean score of patient satisfaction with nursing care in the emergency departments was 2.70. The mean scores of patient satisfaction with different aspects of nursing care services were 3.05 for nursing services for psychological safety: 2.67 for technical competence: 2.49 for information giving: and 1.35 for discharge teaching. 2. Patient satisfaction with nursing care services provided. according to the general characteristics of the patients. was revealed as being significantly high for the groups of patients made up of those who were male. those over 51years of age. married subjects. those with an education level of high school or below level. housewives. Buddhists. and those in the middle economic level. Patient satisfaction with nursing care according to their service utilization in the emergency departments revealed that satisfaction was significantly high for patients who were in internal medicine. neurology or psychiatry. those admitted for the first time. those for whom the distance from the department to home was less than 30 minutes. patients who visited between monday and Friday and between 8AM and 4PM. patients who did not have to wait to be seen and those who stayed in the department less than 24 hours. 3. The correlation between the patients' general characteristics. nursing service utilization of the patients in the department and their satisfaction with nursing care showed that patients with longer waiting time had lower satisfactory scores for nursing service. 4. The registered nurses working in the emergency department reported that the main reasons for low satisfaction rates included 'over worked nurses' and 'too many patients' in the emergency department. In conclusion. the results of this study suggest the necessity of developing relevant nursing interventions for discharge teaching to increase patient satisfaction with nursing care services in emergency departments: and the need for adequate support from hospital administrators to improve patients' service utilization.

• 한국의료질향상학회지
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• 제4권2호
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• pp.174-183
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• 1997

Background : Medical records thought to be reflecting the quality of medicine. By this ground, examination of medical records can be served to evaluate, and to improve the quality of medical care. To examine the medical records, we need some standards or checklists which can be used to sort out the problems. Methods: We developed checklists for medical records evaluation. We studied 1,677 medical records about its completeness using this checklists in one educational hospital. Survey was completed by 5 well trained staffs of medical record department. Results are analyzed. SPSS/PC+ program was used for statistics. Results : 13.8% of discharge summary was incomplete. Recording of the demographic information was also poor in incomplete medical records compared to complete ones. Progress note was recorded average 4.16 times during 11.9 hospital days. After 4th hospital day, recording rate of progress note dropped sharply. Rate of professor's signature on operation records was poor(27%). He or she who described the discharge summary well also wrote progress note well. Conclusions: Fill-up of demographic date should be stressed during medical record education program. Strategy to create the environment emphasizing the responsibility of professor on quality medical record should be made. We suggest new index (number of records/hospital stay) for the evaluation of completeness of progress note.

• 대한간호학회지
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• 제24권1호
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• pp.18-32
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• 1994

It is important to understand that patients with hemiplegia are under stress during the rehabilitation process. This study was designed to determine what changes occur in the stress perceived by these patients during the rehabilitation process. and what changes occur in the ways they coped with stress. A decriptive study with a longitudinal design was conducted. A total of 57 patients with hemiplegia who were admitted to one general hospital made up the sample for this study. A questionnaire, observations and interviews were used for the data collection which was done in three phases(within one week after admission : within one week before discharge ; within one month after discharge ). Data were analyzed using t-test, ANOVA repeated measures of ANOVA, and post hoc paired t -test, Bonferroni correction. The results of this study are : 1. Changes in the perception of stress during the rehabilitation process : There was a statistically significant differencs in the perception of stress among these patients during the rehabilitation process. On the post-hoc test. the perception of stress showed a statistically significant decrease from admission to discharge. The perception of psychological stress was high during the rehabilitation process as compared with the perception of physical and social stress. 2. Changes in the way the patients coped during the rehabilitation process : On admission passive coping was used by most of the subjects(91.2％). Passive coping showed an decrease from admission to discharge, but an increase from discharge to follow-up at one month post discharge. There was, however, no statistically significant changes in the way the patients coped during the rehabilitation process. 3. Changes in perception of stress during the rehabilitation process according to variables. Perception of stress among patients classified as So-Um was higher during the rehabilitation process, when compared with patients classified as So- Yang and Tae-Um. There was, however, no statistically significant difference in perception of stress over time. The patients with right sided paralysis perceived higher stress than those with left sided paralysis. There was, however, no statistically significant difference in perception of stress over time. Hence, stress was not influenced by which side was paralyzed th frequency of the relapse of the disease, or the time in the rehabilitation process. 4. Changes in coping during the rehabilitation process according to variables. There was a statistically significant difference in the way the patients coped at follow- up according to the three different kinds of the constitution groups. In other words, coping was not used by patients classified as Tae-Um but was used by those classified as So-Um. On the repeated measures of ANOVA, there was a statstically significant difference in stress over time, and an interaction between constitution and time. But the way of coping during the rehabilitation process was not influenced by which side was paralyzed nor by the frequency of the relapse of the disease. In conclusion, perception of psychological stress was high during the rehabilitation process, as compared to perception of physical and social stress. There was a statistcally significant difference in the perception of stress over time, Perception of stress showed a gradual decrease from over admission to follow-up period. There was. however, no statistically significant difference in the way of coping over time. Passive coping was used by most of patients. In the study, these findings suggest a need for nursing care related to the psychological support for patients with hemiplegia both in the hospital as well as at home, and the need for education and counseling on independent self-care to help the hemiplegic patients adapt to stress using active coping.

• Child Health Nursing Research
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• 제19권2호
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• pp.120-129
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• 2013

목적 지속적인 의료기술의 발달로 미숙아의 치료, 양육 방법이 변화되어지고 있으며, 정보통신기술의 발달로 교육매체 역시 다양화 되어지는 시점에서 미숙아 부모를 위한 미숙아 돌봄 교육과 관련된 국내 연구 논문을 통합적으로 고찰하여 그 구성요소를 파악하고 각각에 대해 논의함으로써 향후 교육방법의 방향을 모색하고자 하였다. 방법 연구는 Whittemore와 Knafle (2005)이 제시한 통합적 고찰(integrative review) 방법으로 연구목적규정, 문헌검색, 데이터평가, 데이터 분석의 과정에 따라 체계적으로 탐색하고 논의하여 그 의미 있는 결과를 도출하였다. 엄격한 선정기준과 제외기준을 적용하여 4개의 국내 논문데이터베이스에서 1990년부터 2012년 10월까지 국내에서 발표된 논문 중 최종적으로 본 연구에 사용된 연구는 16편으로 확정하였다. 결과 통합적 고찰결과 미숙아 부모를 위한 미숙아 돌봄 교육의 구성요소로는 '교육자로서의 간호사와 학습자로서의 부모', '교육 내용과 교육 효과', 그리고 교육 매체, 시기, 장소를 포함한 '교육 환경'으로 분류되었다. 결론 미숙아 돌봄 교육을 위하여 부모와 가족교육을 전담하는 간호사 역할의 인정과 기관과 정부의 지속적인 관리와 지원과 함께 다학제적인 접근으로 각 양육자에 따른 맞춤형 교육이 되어야할 것이다. 향후 미숙아 돌봄 교육에서는 다양한 측면에서 교육의 효과를 측정할 수 있는 평가도구와 효율적인 교육매체의 개발과 효과적인 교육환경에서 미숙아 돌봄을 향상시킬 수 있는 프로그램의 개발을 제언한다.

• 부모자녀건강학회지
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• 제3권2호
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• pp.67-80
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• 2000

This study was described as midwife's role and obstacle of midwife's role expansion. Midwife as primary medical personal who practices for a mother and infant health care and promotion of mother infant interaction. As the trend of increasing natural childbirth, midwifery has to provide childbearing care those who want delivery in a midwifery center. This study conducted to survey for 44 midwives who work at the midwifery center. The results of the study as fellows. 1. Most of the midwives role was care of pregnancy, delivery, postpartum women and babies. Another role was conducted educational classes childbirth, breast feeding, contraception and sexual education. 2. Some midwives role perform breech, vaccum delivery, episiotomy and suture, pitocin induction and augmentation, ultrasonogram, giving medication, anesthesia, collecting specimen from Pap smear and vaginal discharge. Midwife perform these roles without medical law support. 3. Most of the obstacles of the midwife role was the medical law limitation. Midwives want revise medical law to perform simple treatment for childbearing women and babies. 4. Half of the midwives refer cases to medical doctor in case of complication of women and newborns. 5. Current frequency of home birth rate is slightly higher than before and me cases like to have delivery under water. Finally, midwife and midwifery have to prepare to meet childbearing woman, baby and family's need. For activation and expansion of midwife's role, every midwife has to be aware of medical law accurately and they must know what practice they can do and what practice they can not do.

• 대한간호학회지
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• 제11권2호
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• pp.33-54
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• 1981

The purposes of this study were to determine the relevant nursing needs of patients following discharge; to identify the degree of their nursing needs; to identify types and status of discharge order and information given to patients; and to determine their specific nursing needs according to their diagnosis. In addition, opinions toward home care services provided by hospitals or by public health nurses and appointment plans with their physicians were also asked in order to determine the necessity of follow-up care for the patient after discharge. Nine hundred and eighty eight subjects were collected among patients being discharged from one national university hospital and four city hospitals. Data were collected from June,1979 to December,1979 using questionnaires and interviews. On the bases of these data the following findings were observed; 1) Almost 40 percents of total subjects discharged from the hospital with some or great degree of nursing needs in general. The most problematic nursing needs were needs for comfort which include needs for releaving pain, for sound sleep and rest, because these needs can only be met by professional help. More than 50% of total subjects have this problem. 2) Needs for mental health, general metabolism, general hygiene and activities and safety were observed in more than 20 percent of subjects. 3) Discharge orders on diet and oral medication were recorded in patients' charts in 70% of all cases. However, more than fifty percents of patients have not been told these information from doctors or nurses. Even though some of them might have had appointment plans with their physicians, they would not keep the appointments unless they completely understood the necessity of the follow-up care. If they have not had any appointment or would not visit the out-patient clinic, there is no method of caring them and prerenting funther discomfort or complications. Even in injection, ski care, dressing and bath, only one thirds of the subjects having recorded discharge orders understood what they need after discharge. The rest of cases have not known what to do for their further care. 4) More than 80 percents and 70 percents of total subjects agreed to a system of home care services provided by hospitals or public health nurses respectively. That is, regardless of sources of medical expenses, most of patients wanted to be taken care of at home following discharge. 5) While more than half of the patients having benefit of medical insurance or paying fully by themselves had appointment plans with their physicians, only one thirds of the patients fully or partially paid by government had appointment plans with their physicians. These results ex-plain that the appointment plan is directly associated with their economic power. This indicates that the home care services are more needed to the people with lower economical status. 6) Those who have been in the hospital more than 24 days wanted !o have home care services more than those who had less hospital days. They also had more appointment plans than other groups. 7) More than 70 percents of the subjects who had been in a university hospital and approximately 30 percents of the subjects in the city hospitals had appointment plans with their physicians. 8) Those who had the cerebrovascular disease, cancer or hypertension demanded more nursing needs such as needs for comfort, for general metabolism and for mental health. 9) Factors which were associated with the degree of patients' nursing needs were age, duration of hospitalization, opinion toward home care services given by public health nurses, hospital appointments and types of hospital. That is, the older they were and the longer the periods of hospitalization were, the higher were their nursing needs. The more they had nursing needs, the more they wanted to have nursing services and had appointment plans. It can be concluded that there is a great demand for a positive and systematic home care services to the people who have been discharged from hospitals following critical care. This program is definitely demanded for the low income groups of people with less education with the financial assistance of the government or other funding agencies.

• 동서간호학연구지
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• 제2권1호
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• pp.22-36
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• 1997

Functional recovery of cerebrovascular accident (CVA) patients were studied by examining functional independence measure (FIM) to evaluate the functional state of the patients at admission to and at discharge from the hospital and its relationship with the family support. Study subjects consisted of 129 CVA patients, who were admitted and received rehabilitation treatment at K Medical Center of Oriental Medicine from August 3 to December 18, 1997. The results were as follows: 1) Total FIM score was $72.37{\pm}25.16$ at admission and $101.67{\pm}22.13$ at discharge. The difference of average score was 29.30, which was statistically significant by paired t-test. 2) The largest difference between FIM scores at admission and at clischarge was observed in items of walking and wheel-chair riding, and the smallest clifference in items of social interaction. 3) The recovery was faster with motor function than with cognitive function, because the difference of FIM scores at admission and at discharge was much larger with motor function. 4) Recovery was better in groups under age 49 than in groups above age 70. Functional recorvery was prominent especially in groups with normal sensory state and speech functions, and groups without urinary incontinence. Recovery was less significantly in patients with paraplegic patients hospitalized longer than 2 months, patients with family all the time, and patients with CVA over 11 days. 5) We could not find any relationship between functional recovery and family support. FIM scores were lower in groups of old age(r=-0.325), long stayed in hospital (r=-0.426), and long period of time after the onset of disease(r= -0.339) with a reciprocal correlation between FIM scores and these parameters. 6) Stepwise multiple regression analysis was done to evaluate factors to affect the recovery from CVA. FIM score at admission could explain 51.2 % of the functional recovery. Important factors were periods of hospitalization, state of sensory function, age, and education (listed in decreasing order of importance). In total, they could explain 64.89% of the functional recovery. These results indicate that functional recovery of CVA patients, who were admitted to oriental medicine hospital for rehabilitation treatment, could be estimated by measuring FIM scores. Recovery was significantly better at discharge from the hospital than at admission and motor function recovery rate was much faster than that of cognitive function. 2. Recommendation Based on these results, we recommend following further studies. 1) Comparative study of recovery of motor function and of sensory function would be necessary by measuring FIM scores once a week to evaluate the recovery of CVA patients. 2) It would be interesting to see whether there is any difference of functional recovery between patients treated with either western medicine or oriental medicine. 3) Psychological factors affecting the recovery of CVA patients need to be studied.

• 대한간호학회지
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• 제24권4호
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• pp.696-705
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• 1994

This study was done to provide a basis for home health care management for women following Cesarean delivery. Furthermore it was initiated as an possible application of home health care in the future. In this study, client selection criteria was developed by the researcher and assessment tools for home health care, recording system and problem oriented recording system were revised from Jun's(1993) methods. The selection criteria tool for home health care for women who had a Cesarean delivery was structured and consisted of five areas : physical status, functional status, psychological-emetional status, educational needs status and environmental status. The structured assessment tool consisted of general items, obstetric history, past medical history, methods of feeding, medications taken before ad-mission, laboratory results, discharge instructions, discharge medications, family tree, economic status, environmental status, a map, health assessment of women and their newborns. The visit note consisted of the date : nursing problems : nursing process including initial assessment : nursing goals : visit plan : health status of the postpartum women and their newborn : nursing diagnoses : nursing implementation evaluation : summary : next visit plan and revision. The problem oriented recording system consisted of the date, problem numbers, nursing diagnoses, problem appearance date, problem resolution date. The results of the research are as follows : The seven cases having had a Cesarean delivery were discharged on an average on the 5th day after the Cesarean birth. The total number of home visits was 13. According to Cordon's functional health patterns the total possible nursing diagnoses was 34 diagnoses for the methers and their newborns. Among the 34 diagnoses, there were 13 diagnoses in the health perception /management pattern, 7 in the psychosocial health perception / management pattern, 8 in the psychosocial self-perception, 2 in the nutrition / metabolism pattern of physical function, 2 in the knowledge deficit of newborn management, anxiety related to newborn management, knowledge deficit related to disease process of new-born, anxiety related to disease process of newborn anxiety related to prognosis of baby's condition, knowledge deficit related to newborn jaundice each appeared once. The changes in the number of nursing diagnoses was related to not the number of visits but to the number of nursing diagnoses decreasing. The con-tent of the home health care was categorized ac-cording to assessment, direct care, counseling, education, family care. The recommendation based on the results of this research are Home health care nurses for Cesarean postpartum women and their neonates requires comprehensive knowledge of pregnancy, delivery, and the postpartum period and of the neonate so that they can provide appropriate care and holistic views. Most of cases terminated after the second visit, this outcome may be related to the subjects being discharged on the 5th day after delivery. Therefore, study done with earlier discharge after delivery may have different outcome. It is very hard to assess psychological aspects that need follow-up and to develop communication channels.

• 대한간호학회지
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• 제23권4호
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• pp.664-677
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• 1993

The purpose of this study was to provide basic data for the development of educational material in Korean for patient3 being discharge after open heart surgery. The subjects were 45 adult patients who were seen in the out -patient department of the thoracic surgery unit of P University hospital between February 1993 and May 1993. The data were collected through a chart review and interview. Nursing needs, and the patients status related to diet, activity, medication, physical and psychoemotional limitations were analyzed. The results are summarized as follows ; 1. Mitral valve replacement was the most frequent type of surgery(91.2%). In most cases, a mechanical valve was used (91.0%) . The duration of admission after the operation was two to four weeks for most of the patients(48.9%). The follow-up period was between one and two years for 28.9% of the patients and below 6 years for all of the patients. 2. Many Patients didn’t know the importance of a low salt diet(57.8%), and did not get any education on low salt diet (66.7%). Gimchi was included as one of the most commonly ingested foods (77.8%). All of the patients indicated nursing needs related to education about low salt diets and further they indicated a major interest in foods that are harmful (57.7%) or foods that are safe(51.1% ). 3. Most patients did not recognize the need for limitations on physical activity(84.4%). Further, 31.1％ of them could not return to work at the time of the study. All patients had nursing needs related to physical activity, with the most frequent questions being about the permissble degree of activity and special cautions dictated by their illness (60.0%). 4. Many patients were ignorant of the necessity of medication(55.6%) . Forty percent of the patients were taking additional drugs, usually herb drugs. The time and duration of medication and the side effects of drugs were common concerns (57.7%) related to nursing. needs about medication and were mentioned by all of the patients. 5. All of the patients complained of physical discomfort including the following : memory disturbance(62.2%), weight gain(60.0%), chest tightness (55.6%), hair loss(51.1%), sleep disturbance(46.7%) and other symptoms in that order of frequency. Nursing needs related to physical condition were a concern for all of them. The viability and function of the replaced valve(53.3%) and weight gain(60.0%) were mal or concerns. 6. Looking at their psychoemotional condition it was found that 36 patients(80.0%) were emotionally unstable. The causes were physical discomfort(17 patients), insufficient knowlege of open heart surgery(6 patients), fear of death(6 patients), familial over protection(2 patients ) and lack of support (5 patients).