• Quality Improvement in Health Care
• /
• v.8 no.1
• /
• pp.10-21
• /
• 2001

Background : The Clostridium difficile is the most important identifiable cause of nosocomial infectious diarrhea and colitis, which lengthens hospital stay. Recently incidence of C. difficile has been increasing in an university hospital, and an intervention for prevention and control of C. difficile associated diarrhea (CDAD) was in prompt need. Methods : Subjects were the patients in the neurosurgical intensive care unit(NCU) where C. difficile was most frequently isolated. To increase participation of various departments, we used the CQI method, because management of CDAD requires a wholistic approach including control of antibiotics, barrier precaution and environmental cleaning and disinfection. Duration of the CQI activities was 9 months from April to December 1999. Results : The identified problems were misuse and overuse of antibiotics, lack of consciousness of medical personnels and the possibility of transmission from the contaminated environment and tube feeding. Education for proper use of antibiotics and management of C. difficile infection, use of precaution stickers, supplement of handwashing equipments, emphasis on environmental disinfection, and the change of the process of tube feeding were done. The CDAD rate in NCU was significantly decreased after the CQI program (8.6 case per 1,000 patient days from January to April 1999 vs 4.8 from May to December 1999). The distribution of neurosurgical wards including NCU among the total number of isolated C. difficile from the clinical specimens dropped from 49.4% in January to April to 33,7% in May to December. The average hospital stay of the neurosurgical department changed from 19.6 days to 15.2 days. Also, the effect of the CQI activities for C. difficile may have affected the incidence of vancomycin resistant enterococci (VRE). Duration and dosage of certain antibiotics used in the NS department were decreased. The distribution of neurosurgical department in the number of VRE isolated patients declined from 18.4% to 11.1%. Conclusion : Infection control of resistant organisms such as C. difficile is likely to be successful when management of environmental contamination an collaborative efforts of decreasing the patients' risk factors such as antibiotics management and decreasing the length of hospital stay come simultaneously. For this work, related departments need to actively participate in the entire process under a common target through discussions for identifying problems and bringing up solutions. In this respect, making use of a CQI team is an efficient method of infection control for gathering participation and cooperation of related departments.

• Journal of the Korea Academia-Industrial cooperation Society
• /
• v.17 no.11
• /
• pp.376-385
• /
• 2016

This paper aims to understand the conceptual definition and the characteristics of reality shock in new graduate nurses. We analyzed the data using the hybrid model, initially introduced by Schwartz-Barcott and Kim. The data used in this study were collected from six recently graduated nurses who work in S-si and G-si. Another part of the data was obtained from literature review regarding Reality Shock. We categorized Reality Shocks in recently graduated nurses into nine attributes within a three-dimension model. The dimensions include "cognitive", "emotional", and "situational" domains. The cognitive domain is to be aware of the factor that causes Reality Shock. The emotional domain is the negative emotional responses that appear when facing a situation causing Reality Shock. The situational domain is the sort of circumstantial situations that cause Reality Shock. Reality Shock is defined as recently graduated nurses having several negative emotions, such as powerlessness, difficulty in peer relationships, confusion, and pressure due to (i) the differences between reality of nursing and what they have learned in school, (ii) the differences between an ideal situation and the real situation, (iii) the lack of expertise of senior nurses, (iv) a situation without the respect from colleagues, and (v) the overloaded role compare with the expectations. In conclusion, we provide a guideline for establishing a strategy to reduce Reality Shock in recently graduated nurses by identifying the concept of Reality Shock.

• Journal of the Korea Academia-Industrial cooperation Society
• /
• v.17 no.12
• /
• pp.659-669
• /
• 2016

The purpose of this study was to examine, among quality improvement (QI) department employees, the effects of perception of the healthcare accreditation on job stress and to identify factors affecting turnover intention. Research data was collected between 1 June and 15 June 2016. The sample included QI department employees who had participated in a healthcare accreditation survey. The collected data were analyzed to obtain frequency, percentage, mean and standard deviation results, which were assessed by using Student's t-test, ANOVA, and multiple regression analysis. The scores for QI employees' perceptions of the healthcare accreditation, job stress, and turnover intention were 3.35, 3.66, and 3.32 of the perception by general characteristics. There were significant differences between scores according to gender, age, QI department section, position, and job satisfaction. In addition, job stress and turnover intention scores showed significant differences according to position, age, QI department section, and job satisfaction. A positive correlation was observed between healthcare perception and job stress, while turnover intention was negatively correlated with healthcare perception. The results indicate that the perception of healthcare accreditation positively affects job stress; in contrast, it decreases the number of people intending to change departments. Among the sample of lower level workers, the younger age workers who were employed for more than 10 years expressed lower satisfaction with their job, which indicates that they are affected by their notion of healthcare accreditation more than by other factors. Thus, in order to lessen work stress and employees' thoughts of leaving the department, the QI department should be encouraged to lessen job stress and provide various supports to the employees.

• Journal of Korean Public Health Nursing
• /
• v.3 no.1
• /
• pp.18-37
• /
• 1989

This study was done in order to analyze the factors which influenced the performance level of community health practitioners' task. Interview survey was done during the period from August to October, 1986. Interviewee were 166 CHPs among total of 217 CHPs in Kyonggi province area. Multiple stepwise regression and canonical correlation analysis were used to identify major factors influenced to perform community health practitioners' task. The results of this study were summarized as follows: 1. General characteristics of CHPs 1) Personal characteristics The average age of CHPs was 37.8 years and their marital status was $77.6\%$ of married, educational back-ground was $65.3\%$ of junior college graduation. Their job career was $38.6\%$ of between 1-3 years, $33.3\%$ of between 3-5 years, $22.2\%$ of less than 1 years. Most of CHPs$(62.8\%)$ were fully satisfied with their job, $33.3\%$ were moderately, and $3.8\%$ were not satisfied. 2) Working environmental condition Only $31.7%$ of CHPs were satisfied with their working condition of primary health post, $26.6\%$ were not satisfied. Half of CHPs$(52.5\%)$ replied having good cooperation with health center, $10.1\%$ replied bad. Cooperation with health subcenter was good in $32.9\%$, and bad in $21.9%$. Cooperation with private health institutions was good in $34.2\%$, bad in $21.6%$. 2. Performance level of community health practitioners' task Among a total of 52 contents of their functions medical history taking. physical examination, referral of diagnostic laboratory work-up($(86.4\%)$, health assessment of pregnant women$(82.1\%)$, development of health information system$(79.4\%)$, supervision of health workers $(78.4\%)$, follow-up of family planning acceptors$(77.3\%)$, and follow-up of family planning acceptors' side effects$(77.3\%)$ were actively performed. Diagnosis of pregnancy$(62.1\%)$, sampling of drinking water for quality test$(52.5\%)$, making list of equipment' & supplies $(51.5\%)$, evaluation of primary health post activities $(37.6\%)$, organization of village health workers$(32.4\%)$ and management of village health workers $(30.1\%)$ were poorly performed. 3. Stepwise multiple regression analysis of job function The factors which influenced the performance level of community health practitioners' function were age, marital status, educational level, job career, job satisfaction, satisfaction of working environment of primary health post, cooperation of health center, cooperation of health center, cooperation of private health instiutions in orders. These 9 variables were able to explain job function from $25.7\%$ of program planning to $6.7\%$ of management of common disease. 4. Canonical correlation analysis between the performance of function and general characteristics of CHPs. Cooperation of private health institutions was found to be the factor influencing task performance of community organization, management of primary health post, technical supervision of health personnels. Job satisfaction of CHPs was also found to be the factor influencing task performance of family planning, management of common disease and maintenance of health information system.

• Journal of Korean Academy of Nursing
• /
• v.22 no.4
• /
• pp.491-505
• /
• 1992

The purpose of this research was to understand the structure of the lived experience of parents of a child terminally ill with cancer The research question was “What is the structure of the experience of parents of a child terminally ill with cancer\ulcorner” The sample consisted of 17 parents of children admitted to the cancer units of two university hospitals in Seoul. The unstructured interviews were carried out from October 10, 1991 through January 10, 1992. They were audio-recorded and analysed using Van Kaam's method. Parents ascribed the cause of the cancer to the mother's emotional imbalance during pregnancy, the mother's stress, failure to observe religious rites, food, the parent's sin, misfortune and pollution. The theme clusters were tension, fear and depression experienced during pregnancy, stress that children suffer from abusive parents, failure to observe religious activites, bad luck, and sins committed during a previous life. When the child suffered a recurrence of cancer, the parents experienced negative emotions, nervousness, sorrow. depression and death. The theme clusters were feelings of despair, helplessness, regret, guilt, insecurity, emptyness and apathy. The long struggle with cancer resulted in the loss of economic security, loss of psychological and physical well being, and social withdrawal. The theme clusters were the economic burden of medical cost, giving up treatment, debt, limited medical insurance coverage and blood transfusion. The loss of psychological well being included stress, lack of support systems, inability to carry out responsibilities, lack of trust of the medical ten family breakdown, inappropriate expression of emotion and not disclosing the diagnosis to the child. Physically the parents suffered fatigue, insomnia, loss of appetite, loss of weight, dizzness, headache, psychosomatic symptoms, and increased consumption of liquor and cigarettes. Social withdrawal was manifested by taking time off from work to look after the child, decrease of outside social activities and feelings of isolation. Influences on family life were spousal conflicts, negative response of siblings, separation of the family members and economic hardship. The theme clusters were blaming a spouse for the cause of the illness and disagreements, maladjustment, lonliness, hostility and depression of siblings. The high price of medical care over the long period was a major factor influencing the life of the family. Positive experiences during the child's long illness were the strengthening of support systems and religious beliefs and financial help from social organizations. The support of one's spouse primarily helped to overcome the stress of the long illness. In addition, support was received from parents of other children with cancer and from nurses and religious leaders. The nurse, by providing empathetic support, should be a person with whom parents can express their feelings and share their experiences.

• Journal of Korean Academy of Nursing
• /
• v.22 no.4
• /
• pp.569-588
• /
• 1992

This study examined the relationship between the experience of stressful life events and somatic symptoms of urban women. Data were collected by interviewing 200 women from June to July 1, 1991. Vsable data work obtained from 162 of the women. Modified version of a stressful life events measurement tool developed p.5. Lee (1984) and the Somatic Discomfort Inventory by Wittenborn were used to measure the variables. Data were processed by an 5.p.5.5. program and analyzed. statistically for percentage, T-test, ANOYA and Pearson Correlation coefficient. Result of the Study are as follows : 1) The group total mean score of stressful life events was 92.66 $\pm$ 10.41. The higher scores in the $\boxDr$Test and school$\boxUl$ of the Extrapersonal factor, in the $\boxDr$Health problems$\boxUl$ of the Intrapersonal factor and $\boxDr$Conflict and differences within the family$\boxUl$ of the Interpersonal factor, factors. which a suggested by Neuman's model. 2) The group total mean score for somatic symptoms was 100.41$\pm$9.74. The higher scores were for the factors of $\boxDr$Fatigue (1.94)$\boxUl$, $\boxDr$Menopause (1.74)$\boxUl$, $\boxDr$Muscular system(1.67)$\boxUl$ and $\boxDr$Sleeping (1.67)$\boxUl$ 3) The mean scores of stressful life events were higher in the 40~60 age group, for middle school graduates(P＜.05), career women and those in nuclear families (P＞.05). 4) The mean scores of somatic symptoms were higher in the 45~60 age group, for middle school graduates, non career women and women with 5 or more children(P＜.05). 5) There was a positive correlation between the scores of stressful life events and somatic symptoms (r＝.585 P＜.05). The higher the level of stressful life events the higher the score of somatic symptoms, the results were consistent with the Extrapersonal, Intrapersonal and Interpersonal stress factors of Neuman's Health Care Systems. This research assessed the stressful life events of women, who play the most important role in the family for illness prevention and health promotion and suggested the importance of programs in the Primary Health Services to build basic coping resources.

• Journal of Korean Academy of Nursing
• /
• v.24 no.4
• /
• pp.568-583
• /
• 1994

In the changing social and economic conditions, reorientation of the health care system is a process of rearranging health care resources keeping in mind the appropriativeness, relevancy, and efficacy of health care programs. Also it has been recognized recently that the CHP program is in need of review for the same reasons, that is to say, the ease in which health care facilities are available, the high rate of coverage with insurance and the development of an effective transportation system. Therefore there is a social inclination to think that there are no remote areas and to question the roles of public health facilities, health centers, health sub centers and CHP posts. This paper was done to review problems and to propose new directions for the CHP system. The findings of this study are as follows ; 1) It is necessary that primary health care should be simplified into three parts, medical treatment, preventive care services and the organization of administration and logistics. Also each department should be supplemented with the appropriate professional personnel in order to develop a task oriented system. The reorientation of the CHP system should be managed in keeping with that of other public health care systems. Therefore it is necessary to look at the CHP system problems as one aspect of the reorientation process of public health care systems, and to work to find new ways to address these problems. 2) The location of the CHP post should be decided by the needs of the community in both the medical and preventive areas. If the people have a minimum need, the location of the CHP post should be altered and the existing roles of the CHP should be modified to allow for flexibility according to the community needs. 3) Use of the problem solving method in regular team meetings will prove to be as efficient as continuing education programs in improving job competancy. 4) The supervision of CHP's activities should be made by the same type professional personnel, that is, senior CHPs or charge nurses in the public health center at the county level. 5) The operational expensies of CHP post should be supported by the administrative department of the public health center and should create working conditions that will allow the CHP to concentrate on community health service programs. 6) The organizations for community participation, working committees, community health workers and a number of the local assembly, should be activated to provide for participation in finding solutions to health related problems in the com-munity.

• Journal of muscle and joint health
• /
• v.6 no.2
• /
• pp.226-241
• /
• 1999

This study was undertaken to find out the causal perception of rheumatoid arthritis patients, and to understand the typology. The Q-population consisted of 236 statements of causal perception were collected. Thirty eight Q-samples of causal perception were selected. The P-sample for this study were made up of 28 first visiting female rheumatoid arthritis patients from a rheumatoid arthritis specialty hospital. Each respondent responded Q-set of causal perception according to 9-point scale. The result of Q-sorting were coded and analyzed using QUANL PC program. 1) Typological Observation on Causal Perception (1) Physical Fatigue Type : Type 1 perceived that the illness occurred due to excessive work requiring physical labor or strain that had occurred from not resting after excessive physical labor, therefore, thinking the origin of the illness was from physical strain. (2) Physical origin Type : Type 2 perceived that the major cause for the illness is not only excessive physical labour but also fecundity and old age. (3) Causality to Environment Type : Type 3 perceived that rheumatoid arthritis occurred from injury to the joints or bad and humid weather. (4) Conscience of Guilty Type : Type 4 consisted of people with guilty conscience for lack of religious commitment. They perceived that the illness was a punishment from God for not praying or because of bad luck. (5) Rationally Perceiving Type : People who belong in type 5 perceived the cause of illness in light of scientific facts such as genetics, unbalanced diet or lack of exercise. (6) Psychological Stress Type : People who belong in type 6 believed that excessive stress was the cause of the illness. 2) Emotions of Rheumatoid arthritis patients Rheumatoid arthritis patients' positive emotions included determination, courage, coping, acceptance, hope, and adoption ; and their negative emotions were prostration, worry, stupor, conflicts, grievance, giving-up, resignation, depression, loss, solitariness, fear, anxiety, avoidance, anger and loneliness. Rheumatoid arthritis patients experience different level of emotions from their suffering experience from the severe pains. Rheumatoid arthritis patients also experience negative emotions when they could not perform self-care and lose their self-esteem from painful suffering ; however, they regain positive emotions when they recover from pain with the use of drugs, physical therapy or exercise. Their emotional states are closely connected to level of and presence of pain.

• Journal of the Korea Convergence Society
• /
• v.9 no.9
• /
• pp.431-440
• /
• 2018

In this study, authors predicted probability of resignation of newly employed nurses using TensorFlow, an open source software library for numerical computation and machine learning developed by Google, and suggested strategic human resources management plan. Data of 1,018 nurses who resigned between 2010 and 2017 in single university hospital were collected. After the order of data were randomly shuffled, 80% of total data were used for machine leaning and the remaining data were used for testing purpose. We utilized multiple neural network with one input layer, one output layer and 3 hidden layers. The machine-learning algorithm correctly predicted for 88.7% of resignation of nursing staff with in one year of employment and 79.8% of that within 3 years of employment. Most of resigned nurses were in their late 20s and 30s. Leading causes of resignation were marriage, childbirth, childcare and personal affairs. However, the most common cause of resignation of nursing staff with in one year of employment were maladaptation to the work and problems in interpersonal relationship.

• Journal of the Korea Academia-Industrial cooperation Society
• /
• v.20 no.12
• /
• pp.212-223
• /
• 2019

The purpose of this study was to investigate how attitude, subjective norm, and perceived behavioral control affect nurses' pressure ulcer (PU) prevention behavior among general hospital nurses based on the theory of planned behavior. A total of 111 nurses in four general hospitals in Korea participated in this study and replied to a survey on attitude, subjective norm, perceived behavioral control, and behavior regarding PU prevention. Data were analyzed with multiple regressions by all participants, education level, working department, and hospital size group. In all participants, the more positive attitude and the higher subjective norm, the more PU prevention behavior. However, in the group of 'more than bachelor degree' and 'tertiary hospital', the more clinical experience, the more behavior. In the group of 'surgical ward & intensive care unit', the higher attitude, the more behavior. In the group of 'more than bachelor degree', the higher subjective norm, the more behavior. Therefore, personalized and tailored intervention for nurses may be provided depending on nurses' education level, work department, and hospital size to enhance PU prevention behavior by means of improving nurses' attitude, subjective norm toward PU prevention.