• 한국의료질향상학회지
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• 제29권2호
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• pp.64-84
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• 2023

Purpose:Plaster splints are routinely performed in the Emergency Department (ED) and avoidable complications such as skin ulcerations and fracture instability arise mainly due to improper techniques. Despite its frequent use, there is often no formal training on the fundamental principles of plaster splint application for a medical officer rotating through ED. We aim to use Quality Improvement (QI) methodology to reduce number of incorrect plaster splint application to improve overall patient care via a bundled educational solution. Methods: We initiated a QI program implementing concepts derived from the Institute for Healthcare Improvement models, including Plan-Do-Study-Act (PDSA) cycles, to decrease the rate of incorrect plaster splint application. A bundled education solution consisting of three sequential interventions (practical teaching session, online video lecture and quick reference cards) were formulated to specifically target critical factors that had been identified as the cause of incorrect plaster splints in ED. Results: With the QI intervention, our overall rate of incorrect plaster splints was reduced from 84.1% to 68.6% over a 6-month period. Conclusion: Following the QI project implementation of the bundled educational solution, there has been a sustained reduction in incorrect plaster splints application. The continuation of the training program also ensures the sustainability of our efforts in ED.

• Journal of Information Technology Applications and Management
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• 제30권1호
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• pp.71-80
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• 2023

The purpose of this study is to promote understanding of physical activity and metabolic syndrome in middle-aged adults and to provide basic data of interventions development for the prevention and management of metabolic syndrome. Using the 2020 data for Korea National Health and Nutrition Examination Survey, 1,786 middle-aged adults between the ages of 40 and 64 with no missing data were analyzed. As a result of the study, 56.5(±2.1)% of men and 52.9(±1.81)% of women were sufficient activity group among physical activity, and the proportion of men was higher than that of women, but it was not statistically significant(t=1.27, p=.207). The prevalence of metabolic syndrome was 38.9(±2.1%) of men and 25.4(±1.5)% of women, the prevalence of men was significantly higher than that of women(t=5.12, p<.001). Compared to the insufficient activity group, the sufficient activity group had a 0.71(95% CI: 0.57~0.88) times the risk of developing low HDL(high density lipoprotein)- cholesterol(p=.002), and this pattern was maintained even after adjusting for age, education level, body mass index, smoking status, and drinking status(p=.002). Based on the results of this study, a physical activity and metabolic syndrome risk group in middle-aged adults should be selected, and physical activity promotion program to improve high density lipoprotein-cholesterol among metabolic syndrome indicators should be developed.

• 한국노년학
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• 제31권4호
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• pp.1155-1167
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• 2011

본 연구는 지역사회에 거주하는 여성 노인을 대상으로 인지기능에 따른 낙상발생빈도, 낙상 두려움, 지각된 건강상태의 차이를 비교하고 관계를 규명하는 것을 목적으로 하였다. 대상자는 S시 S구 보건소에 방문하는 대상자로 65세 이상 여성 노인으로 선정하였다. 2009년 9월부터 2010년 3월까지 사전에 교육을 받은 간호학과 대학원생 조사원들이 일대일 면접을 통해 자료를 수집하였다. 연구에 참여한 311명의 평균연령은 71.68±5.13세였고, 대상자 평균 인지기능은 22.14±4.32점으로 정상 노인 경우 25.25±1.80점, MCI 노인의 인지기능은 18.02±3.57점으로 나타났다. 지난 1년간 낙상을 경험한 대상자는 109명으로 전체 35%였고 대상자의 평균 낙상 횟수는 1회 이하가 78%에 해당되었다. 일반적 특성에 따른 인지기능 점수 차이를 비교한 결과 나이가 많을수록 인지기능 점수가 유의하게 낮게 나타났고, 배우자가 있는 경우와 교육정도가 높을수록 인지기능의 점수가 유의하게 높게 나타났다. 인지기능 정도에 따른 두 그룹(MCI그룹, 정상 인지그룹)간 낙상횟수 및 낙상두려움, 지각된 건강상태를 분석한 결과 지각된 건강상태에서 유의한 차이를 보여 인지기능이 좋은 그룹에서 스스로 지각하는 건강상태가 높은 것으로 나타났다. 또한 인지기능과 낙상횟수, 낙상두려움 및 지각된 건강상태와의 상관관계를 분석하였다. 낙상 두려움은 인지기능과 유의한 부적 상관관계를 나타내었으며, 지각된 건강상태는 인지기능과 유의한 정적인 상관성을 나타내었다. 즉 인지기능이 떨어질수록 낙상 두려움의 증가와 지각된 건강상태가 낮은 것으로 나타났다. 본 논문은 향후 인지기능 정도에 따른 노인 낙상예방 프로그램 개발에 두 가지의 정책적 함의를 제공한다고 할 수 있다. 첫째, 인지기능 상태를 고려하여 낙상 두려움과 지각된 건강상태를 통합적으로 관리할 수 있는 낙상 예방 프로그램 개발이 필요하다. 둘째, 본 연구에서 분석되지 않은 일반적으로 알려진 다른 요인들을 포함하여 병원, 노인 요양시설 등 다양한 곳에 거주하고 있는 남·여 노인을 대상으로 한 지속적인 연구의 필요성을 제시한다. 이 연구를 토대로 인지기능 향상과 낙상예방을 위한 포괄적인 교육을 통해 낙상두려움을 감소시키고 낙상 발생률을 낮추면, 궁극적으로 노인의 삶의 질이 향상될 것이다.

• 한국의료질향상학회지
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• 제7권1호
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• pp.32-45
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• 2000

Background : Critical pathway is an optional sequencing and timing of interventions by physicians, nurses, and other staff for a particular diagnosis or procedure, designed to minimize delays and resource utilization, and to maximize quality of care; abbreviated versions of case management plans that show critical outcome and key incidents that occur in a predictable and timely fashion to achieve an appropriate length of stay. This study is to develop a critical pathway for vaginal delivery and cesarean section to assess the degree of contentment of the patients and medical personnel and to implement clinical application to see how we could meet the need to guide patients to achieve continuum of care. Method : Critical pathways were developed for normal vaginal delivery and casarean section. LOS(length of stay) target for vaginal delivery was 1 day after delivery & 5 days after C-section. It was distributed to the mother at the OPD and explained thoroughly. It was applied when patients got into the Labor & Delivery Floor. We applied total of 42 patients (30 normal deliveries & 12 C-sections) from February to March, 2000. We performed patient satisfaction survey to all 42 patients, 24 nurses, and 7 residents for internal customer satisfaction. Results : Twenty six patients out of 42 responded to the survey. Twenty one patients out of 26 answered satisfactory. Eighty four percent of 21 respondents replied Critical pathway worked very well. Treatment column got the most compliance. Eleven out of 31 employees thought critical pathway is very helpful for the patient care. Eighteen people didn't see any difference. In their opinion, treatment got the least compliance, which is the contrary to patients opinion. Fifty eight percent of respondents thought that critical pathway can expedite early discharge. Conclusion : Patient satisfaction was higher than we expected but we still need to revise the form. It is recommended to analyze the cost and variance check in the future.

• 대한간호학회지
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• 제23권2호
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• pp.255-268
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• 1993

This descriptive correlational research was conducted to compare the relationship between self-esteem performance of antenatal care and health pro-motion lifestyles for unmarried and married pregnant women. The sample consisted of 94 married women attending one general hospital and residing in Seoul and 82 unmarried women from two social institutes for unmarried women. The tool used for this study was a structured questionnaire which was developed and revised by the researcher. The tool consisted of 12 items related to demographic characteristics, 10 items on self-esteem measurement, 20 items on performance of antenatal care and 37 items on health promotion lifestyle profile. The data collected from the interviews were analyzing using the SPSS, yielding frequencies, percentiles, means, standard deviations, t-test, ANOVA, Pearson’s Product Moment Correlation. The results of this study are as follows : 1) The demographic variables for the two groups were heterogenous except for religion. 2) The results of the comparison between the two groups were significantly different for self-esteem, married women(mean 20.41, standard deviation 3. 94) had higher scores on self-esteem than unmarried women(mean 24.02, standard deviation 4.11), (t=-5.91, p .001) 3) There was a stastically significant difference between the two groups on the health promotion lifestyle profile. The married women had higher scores on the health promotion lifestyle profile (t=7.22, p〈.001) 4) The score for married women on performance of antenatal care has higher than the score for unmarried women(t=8.83, p〈.001) 5) With regard to the relationship between health promotion lifestyle and performance of antenatal care and self-esteem, the correlation coefficient between self-esteem and health Promotion lifestyle for married women was .45, between per formance of antenatal care and health promotion lifestyle, .54, between self-esteem and performance of antenatal care, .32. For the unmarried women, between self-esteem and health promotion lifestyle, .39, between performance of antenatal care and health promotion lifestyle, .67, between self-esteem and performance of antenatal care, .30. 6) There was a statistically significant different between the two groups on all subconcepts of the health promotion lifestyle profile (p〈.001). 7) Comparison of the order of the scores between the two groups for the married women showed that the highest score was for nutrition, then self-actualization, interpersonal support, health responsibility, stress management and exercise in that order. For the unmarried women the highest score was for self-actualization followed by nutrition, interpersonal support, stress management, health responsibility, and exercise in that order. The score in the exercise domain was lowest in both groups. In conclusion, on the basis of the results of this study, resources and protection facilities for unmarried pregnant women could be improved through government policies and health care policies that would allow unmarried women to utilize significant social support resources and actualize health pro-motion lifestyles. Nursing should offer interventions to increase psychosocial adjustment and support tp improve the quality of life for unmarried pregnant women and further to promote improved growth and development of the infants.

• 대한간호학회지
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• 제28권2호
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• pp.303-318
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• 1998

Cutaneous stimulation and distraction are independent nursing interventions used in various painful conditions, which is explained by gate control theory. This study was aimed at identifying the effect of cutaneous stimulation, distraction and combination of cutaneous stimulation and distraction on the reduction of intravenous injection pain levels of chemotherapy patients. Repeated measurement post test research design was used for one group. Fifty-three cancer patients who received intravenous chemotherapy regulary in outpatient injection rooms of D medical center and Y medical center in Taegu were studied from June 23, 1997 to July 12, 1997. First the intravenous injection pain level of the control period was measured. Second, the intravenous injection pain level of the experimental period using cutaneous stimulation was measured. Third, the intravenous injection pain level of the experimental period using distraction was messured. Fourth, the intravenous injection pain level of the experimental period using a combination of cutaneous stimulation and distraction was measured. The instruments used for this study were a visual analogue pain scale as subjective pain measurement and an objective pain behavior checklist. Analysis of data was done by use of repeated measure ANOVA, bonferni, t-test, and F-test. The results of this study were summerized as follows : 1) The first hypothesis that the subjective pain score of intraveneous injection pain in the experimental period with cutaneous stimulation will be lower than in the control period was rejected. 2) The second hypothesis that the objective pain behavior score of intravenous injection pain in the experimental period with cutaneous stimulation will be lower than in the control period was accepted(F=24.23, p=0.0001, Bornferni p<.05). 3) The third hypothesis that the subjective pain score of intraveneous injection pain in the experimental period with distraction will be lower than in the control period was rejected. 4) The fourth hypothesis that the objective pain score of intravenous injection pain in the experimental period with distraction will be lower than in the control period was accepted(F=24.23, p=0.0001, Bornferni p<.05). 5) The fifth hypothesis that the subjective pain score of intravenous injection pain in the experimental period with combination of cutaneous stimulation and distraction will be lower than in the control period was accepted(F=3.04, p=0.031, Bonferni p<.05). 6) The sixth hypothesis that the objective pain score of intravenous injection pain in the experimental period with combination of cutaneous stimulation and distraction will be lower than in the control period was accepted(F=24.23, p=0.0001, Bonferni p<.05).

• 대한간호학회지
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• 제25권2호
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• pp.259-278
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• 1995

This study was done to investigate levels of physical fitness, self efficacy(SE), instrumental activities of daily living(IADL), and quality of life (QL), and their relationships among the elderly Data were collected from 47 noninstitutionalized elderly dwell-ing in their own homes and 43 institutionalized elderly living in homes for older people. The ages of the subjects were 65 years and over. The data were col lected from January 20th to February 20th, 1995. Physical fitness was measured with T.K. K dyna mometer, grip dynamometer, stop watch, and Purdue pegboard. Structured questionnaires developed by Kim by Lawton & Brody, and by Ro were adopted to measure SE, IADL, and QL, respectively. The data were analyzed using t-test, ANOVA, and Pearson correlation coefficients. The results were as follows : 1. The noninstitutionalized elderly had higher scores in such measures of physical fitness as body weight, skinfold thickness, flexibility and coordination as compared to the institutionalized elderly. 2. On the following measures of physical fitness, men showed higher levels than women ; in height when standing, height when sitting, body weight, and muscle strength. Women had more trunk flexibility than men. 3. Muscle strength was positively correlated with height when standing, height when sitting, and body weight. The following measures of physical fitness, muscle strength, flexibility and coordi nation, were negatively correlated with "up and go”. 4. The noninstitutionalized elderly had higher scores in SE(t=2.28, p<0.05), IADL(t=2.24, p<0.05), and QL(t=2.41, p<0.05) as compared to the institutionalized elderly. 5. SE was positively correlated with both IADL(r=0.41, p<0.001) and QL(r=0.54, p<0.001), and the latter two variables were a positively correlated (r=0.30, p<0.001). 6. SE was positively correlated with the physical fitness measures of height when standing, body weight, strength of leg muscles, strength of back muscles, grip strength, and level of touching the floor, but negatively correlated with "up and go”. 7. Positive correlations were revealed between IADL and the physical fitness measures of height, strength of leg muscles, level of trunk muscle extension, level of touching the floor, and coordination. The IADL was negatively correlated with “up and go”. 8. QL was positively correlated with body weight (r=0.28, p<0.01) and skinfold thickness (r=0.26, p<0.05). 9. Age was negatively correlated with the physical fitness measures of height when standing, height when sitting, “up and go”, strength of leg muscles, strength of back muscles, grip strength, level of trunk muscle extension, and coordination. 10. Age was also negatively correlated with SE (r=-0.24, p<0.05) and IADL(r=-0.22, p<0.05). The above results suggest that caring elderly in their own homes were more effective and that nursing interventions to enhance physical fitness, SE, IADL, and QL especially for the institutionalized elderly are stressed.

• 대한간호학회지
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• 제19권3호
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• pp.240-248
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• 1989

The increase in size and numbers of general hospitals in the process of conspicuous development of modem medicine has been accompanied by a serious increase in hospital acquired infections. Hospital aquired infections cause pain and discomfort, may threaten life, adds an economic burden, and delays recovery and return to society. Even though respiratory hospital infection rates resulting for tracheostomy and respiratory inhalation therapy, may be low, they are serious because of their bad prognosis and high mortality rates. This study was designed to assess certain aspects of respiratory infections of patients with a tracheostomy and thus provide baseline data for further research related to preventive or therapeutic nursing interventions. The specific objectives were to determine the incidence of colonization in the trachea, clinical signs, type of colonized bacteria and sensitivity to antibiotics. Data were collected from July 1 to December 10, 1989 at two university Hospital in Seoul. Subjects were 20 patients with a tracheostomy admitted to the Intensive Care Unit or Cerebral Vascular Accident Center. Clinical signs related to respiratory infection were observed using a checklist based on previous study outcomes. Bacterial culture, sensitivity test to antibiotics, WBC counts and chest X-ray were also performed. Cultures were done on the day of tracheostomy, and on the third, fifth and seventh day. Cultures were then done on seventh days after the first colonization. The results were as follows : 1. The incidence of bacteria colonization in a week was 90%(18 patients) 50% (10/20 patients) on the day of tracheostomy, 70%(7/10 patients) on the third day, and 0% on the fifth day, and 33%(1/3 patient) on the seventh day. 3 of 18 patients (16.7%) were colonies of mixed growth isolated. 2. The observed clinical signs related to respiratory infection were high fever 38.9%(7 patients), prulent secretion 16.7%(12 patients) and infiltration seen on chest X-ray 33.3%(6 patients). 3. The total number of types of bacteria isolated among the 18 subjects was 21 ; gram negative 71.4%, gram postive 28.6%. The dominant bacteria type was Staphylococcus aureus(5 cases) for gram(equation omitted) and Pseudomonas aeruginosa(3 cases), Klebsiella (4 cases), Enterobacter(3 cases) for gram (equation omitted). The results of culture on 7th day after the first colonization, 6 cases showed same type of bacteria, 3cases showed different type of bacteria and 1 cases showed no growth. 4. The sensitivity tests to antibiotics showed that Pseudomonas aeruginosa and Staphylococcus were strongly resistant to most kinds of antibiotics, but Klebsiella and the rest of gram negative bacteria were moderately sensitive to antibiotics.

• 한국융합학회논문지
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• 제11권4호
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• pp.351-357
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• 2020

본 연구는 농촌거주 노인들의 죽음불안을 파악하고 이에 영향을 주는 요인을 융합적으로 확인하기 위해 수행되었다. J시에 소재한 12개 보건진료소의 관할구역인 농촌지역 읍·면에 거주하는 노인 총 170명을 편의추출하였다. 자료분석은 SPSS/WIN 21.0 프로그램을 이용하여 t-test, pearson correlation coefficient, 회귀분석을 하였다. 전체 대상자의 평균연령은 80.0±6.42세였고, 자존감은 평균 3.3±0.58, 죽음불안은 평균 2.5±0.32였다. 자존감과 죽음불안은 유의한 부적 상관관계(r=-.173, p=.024)가 있는 것으로 나타났다. 죽음불안에 영향을 주는 요인을 확인하기 위해 성별(남성)과 자존감을 투입하여 회귀분석한 결과 성별(남성)이 죽음 불안에 가장 큰 영향을 주었으며(β =.199, p=.009), 다음으로 자존감이 죽음불안에 영향을 주었고(β =-.171, p=.023), 이들 두 변수는 죽음불안을 총 5.8%(F=6.238, p=.002) 설명하였다. 추후 보건진료소 단위의 관할구역 거주 노인을 위한 지역단위의 건강증진사업 수행시 남성노인을 우선적으로 포함하여 자존감 증진 중재를 통해 죽음불안을 낮출 수 있는 프로그램이 필요할 것으로 생각된다.

• 대한간호학회지
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• 제26권4호
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• pp.808-819
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• 1996

The purpose of this study was to examine the stressors and coping strategies of school -age children and to explore the relationship between stressful life events and health symptoms and the effects of coping and trait anxiety which is theoretically considered to mediate the relationship between stress and health symptom. The study subjects consisted of 639 elementary school children in the fourth to sixth grade living in Seoul. Of the 639 subjects, 348 were boys and 291 were girls. The mean age was 11.35 (SD=.86). The Feel Bad Scale(FBS), Schoolager's Coping Strategy Inventory(SCSI), Spielberger's Trait Anxiety Scale for Children(STAIC), and Health Symptom Questionnaire (HSQ) were adapted for this study. A pilot study was undertaken to ascertain the reliability and validity of the instruments. The Cronbach alphas of FBS, SCSI, STAIC and HSQ were from .81 to .92. The Researcher and a research assistant visited the school and data were collected in the class using the questionnaire method after an explanation of the purpose and procedures was given to the children. Data collection was done during the period between Nov.25 to Dec.19, 1995. Using the SAS statistical program, percentages, t-test, ANOVA, correlation analysis, and multiple regression were used for data analysis. The result are as follows : 1. The mean score for the FBS was 204.79(range : 48-472) and there was a significant difference according to grade. The most severe stressors perceived by children were parental divorce and death or illness of family members. The most frequently experienced stressful life events were conflict with siblings and being home alone. 2. The mean score for the SCSI was 57.36(range : 9-118) and there was a significant difference according to grade. The most frequently used, and perceived as helpful, coping strategies were distraction and cognitive activities. 3. The mean score for the HSQ were 20.7(range : 0-81) and there were significant differences according to grade and sex. The percentage of the children answering that they perceived their health state as not good was 3.9%. 4. The mean score for the STAIC was 33.76 and there were significant differences according to grade and sex. 5. There was a significant relationship between stressful life events and health symptoms ( r=.53, p<.01). Also, Stressful life events were postively related with coping strategies(r=.39, p<.01). Trait anxiety was highly correlated with health symptoms(r=.72, p<.01). 6. To examine the multivariate effects of the variables to health symptoms, multiple regression was performed. Stressful life events, coping, trait anxiety, and health concerns were identified as significant variables. Explanation of the health symptoms by these variables was 56.78%. The study revealed that stressful life events correlated with health symptoms in school-age children and coping and trait anxiety had mediating effects on this relationship. The implication for nursing is that there is a need to develop supportive interventions for high risk population to decrease health problems due to stress. Also, it is recommended that a study be conducted to explore protective factors for the prevention of health problems in children.