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호스피스와 종교적 죽음이해

  • Sin, Min-Seon;Kim, Mun-Su
    • Korean Journal of Hospice Care
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    • v.6 no.1
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    • pp.1-11
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    • 2006
  • There are various understandings how to define death. In the context of medicine, death is defined as the irreversible change of the tissue according to the cessation of circulation and respiration. According to the psychologists, a person need to accept the finiteness as a human being and remain conscious that the death is not avoidable. And they say if a person doesn't regard death as unavoidable reality of life he or she will not confront the humanistic death and after all will die like animals. In philosophy, death is viewed as an unwelcome reality in the end of the journey of life. Sociologists usually understand that the society is the organization composed with living persons and human beings which construct and transmit the culture from generation to generation between the both ends of life and death. In society, the generation is changed, maintained, and developed through the phenomenon of death. Although death of human being is natural event in society, the death of a specific person brings a sense of loss, crisis, and anxiety to the communities like family, regional society, nation, and the world. In this context, death is not confined to personal dimension and it can be regarded as a social problem. It is valuable to summarize the religious perspectives on the meaning of death for the better hospice care. In shamanism, there are basic idea that although the flesh of human being disappears, soul never die. If human dies, the flesh of human being disappears but soul never disappear and come back to the origin of soul as it is called chaos. So in shamanism, it is said that shaman can solve the mortified feeling, restore the broken harmony, send the soul to comfortable space- the origin, and guarantee the blessing of descendents. Buddhists regard the death as an essential component through the cycles of life. Through this cycle, human being exits as an endlessly transmigrating being and the death is just a restoration to the original status. In Confucianism, the view on the death based on the philosophy of the "Yin and Yang" and "Five elements". In Buddhist tradition, many believers said the philosophy of "Death is the same as life". Unlike usual thoughts that a god governs "life and death" and "fortune and misfortune", Confucianists deny the governance of a god and emphasize the natural orders in which every phenomenon in the world moves according to the principle. Confucianists understand the death as a natural order with this principle. In Confucianists' belief, the essence of human being remains in their own descendent's lives after the death of ancestor, so in Confucianism there is no concept of immortality of the soul. In the history of Christianity, death has been defined generally as the separation of the immortal soul from the mortal body. In the earlier days of Old Testament, the death is regarded as a disappearance of just a flesh and human never disappear and always live in the relationship with God. Later days in Old Testament, we can find the growing concern for the life after the death because of the entrance of the theodicy. In the New Testament, the death is not regarded as the normal process of the human life and regarded as the abnormal status in which death come to human because of sin as a decisive factor and it should be conquered. In fact, the most of us afraid death because not of the fear of death itself but of the sense of the emptiness and regrets. so many people often make the monument hoping to live forever. But Christian usually regard this behavior as a sinful act because human being usually think themselves as a master of their life and attempt to become immortal in this kind of trial mortal. But if we live with God, we cannot confront such a condition because we aware limits as a mortal human being and entrust everything on Him and want to live according to His guidance. Therefore, in the Christian tradition, the death is regarded as accomplishment of life, fruits of life, invitation to the eternal life, and the last stage of human growth. For human being, the death is the great step of maturation as a human in the final stage of life.

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Development of a Critical Pathway for Patients with Coronary Artery Bypass Graft (관상동맥 우회술 환자를 위한 Critical Pathway개발)

  • 김기연
    • Journal of Korean Academy of Nursing
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    • v.28 no.1
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    • pp.117-131
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    • 1998
  • The purpose of this study was to develop a critical pathway for case management for patients who have received Coronary Artery Bypass Graft (CABG) because of Ischemic Heart Disease(IHD) which is a factor of rising medical expenses. For this study. a conceptual framework was developed through a review of the literature including six critical pathways which are currently being used in USA. In order to identify the overall service contents required by these patients and to draw up a preliminary critical pathway, 30 cases of medical records of patients who had CABG because of IHD between January, 1995 to June. 1996 at the Cardiovascular Center of Yonsei Medical Center in Seoul were analyzed. An expert validity test was done for the preliminary critical pathway and clinical validity test was also done using seven IHD patients with CABG between November 11 and 23, 1996. After these processes. the final critical pathway was developed. The results of this study are summarized as follows : 1. The vertical axis of the critical pathway includes the following eight items : tests, nutrition, medications, consultations, activity, assessments, treatments, education discharge planning and the horizontal axis includes the time from the start of hospitalization to discharge. 2. Analysis of the 30 medical records indicated that the average length of stay was 20.2days with the average length of stay from hospitalization day to operation day being 6.2 days, and the average length of stay from operation day to discharge day was 13. 9 days. Analysis of the service contents showed that the horizontal axis of the preliminary critical pathway was set from hospitalization to the 14th post operation day and the vertical axis was set to include eight items, the contents which ought to have occurred, according to the time frames of the horizontal axis. 3. As a result of the experts validity, it was found that among the total of 571 items. there was over 83% agreement for 482 items, less than 83% for 89 items, which were then deleted and a revision of the critical pathway was done. 4. A clinical validity test was done using seven IHD patients with CABG. During the process, three patients were deleted because they were out of the criteria the investigator set. Finally, four patients were used. The result of study indicated that only one patient was discharged on the tenth post operation day, which was one day later than the expected day. Three patients were discharged later than the expected day from three days to nine days. All the cases progressed on schedule until the operation day and the first post operation day, but from the second post operation days, there were differences between the critical pathway and the actual practice. The differences came from tests, assessments, and treatments. 5. On the basis of the results of the clinical validity test. the following revisions in the final critical pathway were made : the transfer from ICU to step down ward would be the second post operation day, and the transfer to a general ward, the fifth post operation day, for patients who complained of lack of sleep from the fifth post operation day to discharge, a sleeping pill would be prescribed, skin observations would be performed routinely from immediately after the operation until the third post operation day, and would continue if there was a sign of skin injury on the fourth post operation day, and assessment of chest pain would be done from the third post operation day, and the “stairs climbing” item, expected to be done on the ninth post operation day would be deleted. In conclusion, this critical pathway is partially applicable to the care of patients with CABG but there are some parts needed to be further investigated.

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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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Quality Characteristics of Jeung-Pyun Prepared with Milk (우유 첨가에 따른 증편의 품질 선택)

  • Jang, Jung-Sun;Park, Young-Sun
    • Journal of the East Asian Society of Dietary Life
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    • v.18 no.3
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    • pp.311-321
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    • 2008
  • In order to improve the insufficient protein content of Jeung-Pyun with respect to sitology, as well as its fermentation process, this study prepared Jeung-Pyun doughs containing 0, 5, 10, 15, and 20 g of milk, respectively, and examined their mechanical and functional characteristics. The internal structure of the Jeung-Pyun was observed by SEM. With regard to color, the L-value increased with increasing amounts of added milk, and the highest value (65.43) occurred in the group containing 20 g of added milk; however, there were no significant differences among groups. The group containing 20 g of added milk also presented the highest a-value, and the samples with added milk had higher b-values than the control. At 8 hours of fermentation, the 10 g- and 15 g-added milk groups had viscosities of 5726.67 and 6600 respectively; viscosity increased with increasing amounts of milk, and the added-milk groups had significantly higher values than the control group. Hardness also increased with increasing amounts of added milk. However, there were no significant differences in resilience and cohesive power among the groups. The groups containing 5 and 10 g of added milk had the lowest cohesion and break values. For appearance, the group without added milk had the whitest color. Pore size decreased and showed less uniformity as the amount of added milk increased. The unique tackju aroma of Jeung-Pyun decreased significantly as the level of added milk increased, and the 20 g addition presented the lowest value. The 10 g-added milk group had the highest level of sweetness, and sourness increased with increasing amounts of added milk. For softness, the control group was estimated as slightly softer than the added-milk groups. The stickiest sample was generally preferred when considering taste, white color, and sweetness. Among the quality characteristics, having greater stickiness, resilience, moisture, and softness was better in terms of chewing. Overall, the size of the Jeung-Pyun containing 10 g of milk was even and well-developed.

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NEW ANTIDEPRESSANTS IN CHILD AND ADOLESCENT PSYCHIATRY (소아청소년정신과영역의 새로운 항우울제)

  • Lee, Soo-Jung
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.14 no.1
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    • pp.12-25
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    • 2003
  • Objectives:As increasing number of new antidepressants have been being introduced in clinical practice, pharmacological understanding has been broadened. These changes mandate new information and theories to be incorporated into the treatment process of children with depressive disorders. In light of newly coming knowledge, this review intended to recapitulate the characteristics of new antidepressants and to consider the pivotal issues to develope guidelines for the treatment of depression in childhood and adolescence. Methods:Searching the Pub-Med online database for the articles with the key words of 'new', 'antidepressants' and 'children' ninety-seven headings of review articles were obtained. The author selected the articles of pertinent subjects in terms of either treatment guideline or psychopharmacology of new antidepressants. When required, articles about the clinical effectiveness of individual antidepressants were separatedly searched. In addition, the safety information of new antidepressants was acquired by browsing the official sites of the United States Food and Drugs Administration and Department of Health and Human Services. Results:1) For the clinical course, treatment phase, and treatment outcome, the reviews or treatment guidelines adopted the information from adult treatment guidelines. 2) Systematic and critical reviews unambiguously concluded that selective serotonin reuptake inhibitors(SSRIs) excelled tricyclic antidepressants( TCAs) for both efficacy and side effect profiles, and were recommend for the first-line choice for the treatment of children with depressive disorders. 3) New antidepressants generally lacked treatment experiences and randomized controlled clinical trials. 4) SSRIs and other new antidepressants, when used together, might result in pharmacokinetic and/or pharmacodynamic drug-to-drug interaction. 5) The difference of the clinical effectiveness of antidepressants between children and adults should be addressed from developmental aspects, which required further evidence. Conclusion:Treatment guidelines for the pharmacological treatment of childhood and adolescence depression could be constructed on the basis of clinical trial findings and practical experiences. Treatment guidelines are to best serve as the frame of reference for a clinician to make reasonable decisions for a particular therapeutic situation. In order to fulfill this role, guidelines should be updated as soon as new research data become available.

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An Analysis of the Determinants of Employment and Wage of New College Graduates (신규대졸자의 취업 및 임금수준 결정요인 분석)

  • Chai, Goo-Mook
    • Korean Journal of Social Welfare
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    • v.59 no.4
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    • pp.35-61
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    • 2007
  • This study examines the determinants of employment and wage of new college graduates by using Youth Panel Data(2003-2005) of the Work Information Center, and seeks assignments for mitigating unemployment and wage disparities of new college graduates. Results are summarized as follows. First, an analysis of the determinants of employment shows that the Kyunggi Inchon district in school locations, higher school records, and qualification certificates positively affect the employment rate, while the private college group in the non-capital area negatively affects the employment rate. Second, an analysis of determinants of standard employment demonstrates that the Kyunggi Inchon district in school locations, higher school records, qualification certificates, and the major group of medical science, pharmacy, nursing science and health science, and the major group of education positively affect the employment rate, while the private college group in the non-capital area, the junior college groups in the capital and non-capital areas negatively affect the employment rate. Third, an analysis of determinants of nonstandard employment shows that the junior college graduation in scholarly attainments, the junior college groups in the capital and non-capital areas positively affect the employment rate, while the private college group in the non-capital area negatively affects the employment rate. Fourth, an analysis of the determinants of wages demonstrates that male in sex, the older in ages, the major group of medical science, pharmacy, nursing science and health science, and the major group of education positively affect the wages, while nonstandard employment, Kyunggi Inchon and Cholla districts in school locations negatively affect the wages. These results suggest several implications. First, college education should be reformed to cultivate professional manpower who are required by industries. Second, alternative measures to mitigate sex discrimination in labor markets should be prepared. Third, the process of attaining qualification certificates should be reformed in order that it is actually connected to the abilities of work performances and the improvement of productivity. Fourth, a locally balanced development must be realized through the decentralization of industries. Fifth a systematic and comprehensive program need to be prepared to promote the employment of new college graduates.

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Various Possibilities of Dispositif Film (디스포지티프 영화의 다양한 가능성)

  • KIM, Chaehee
    • Trans-
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    • v.3
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    • pp.55-86
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    • 2017
  • This study begins with the necessity of the concept of reincarnation of film media and the inclusion of specific tendencies of contemporary films as post - cinema comes. Variable movements around recent films Challenging and experimental films show aesthetics that are difficult to approach with the analysis of classical mise en scene and montage. In this way, I review the dispositif proposed by Martin in films that are puzzling to criticize with the classical conceptual framework. This is because the concept of dispositive is a conceptual pile that extends more than a mise en scene and a montage. Dispositif films tend to be non-reproducible and non-narrative, but not all non-narrativef tendencies are dispositif films. Only the dispositif film is included in the flow. Dispositif movement has increased dramatically in the modern environment on which digital technology is based, but it is not a tendency to be found in any particular age. The movement has been detected in classical films, and the dispositif tendency has continued to exist in avant-garde films in the 1920s and some modernist films. First, for clear conceptualization of cinematic dispositif, this study examines the sources of dispositif debates that are being introduced into film theory today. In this process, the theory of Jean Louis Baudry, Michel Foucault, Agamben, Flusser, and Deleuze will help. The concept of dispositif was discussed by several scholars, including Baudry and Foucault, and today the notion of dispositif is defined across all these definitions. However, these various discussions are distinctly different from the cinematic dispositif or dispositif films that Martin advocates. Martin's proposed concept reminds us of the fundamentals of cinematic aesthetics that have distinguished between the mise-en-scene and the montage. And it will be able to reconsider those concepts and make it possible to view a thing a new light or create new films. The basic implications of dispositif are apparatus as devices, disposition and arrangement, the combination of heterogeneity. Thus, if you define a dispositif film in a word, it is a new 'constraint' consisting of rearrangement and arrangement of the heterogeneous elements that make up the conditions of the classical film. In order for something to become a new design, changes must be made in the arrangement and arrangement of the elements, forces, and forces that make up it. Naturally, the elements encompass both internal and external factors. These dispositif films have a variety of possibilities, such as reflection on the archival possibilities and the role of supervision, the reestablishment of active and creative audience, the reason for the film medium, and the ideological reflection. films can also 'network' quickly and easily with other media faster than any medium and create a new 'devised' aesthetic style. And the dispositif film that makes use of this will be a key keyword in reading the films that present the new trend of modern film. Because dispositif are so comprehensive and have a broad implication, there are certainly areas that are difficult to sophisticate. However this will have a positive effect on the future activation of dispositif studies end for end. Dispositif is difficult to elaborate the concept clearly, so it can be accessed from a wide range of dimensions and has theoretically infinite extensibility. At the beginning and end of the 21st century film, the concept of cinematic dispositif will become a decisive factor to dismantle old film aesthetics.

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A Study on the Essence and Tendency of Modern Manager (현대 경영자로서의 본질과 성향 연구)

  • Yeom, Bae-Hoon;Kim, Hyunsoo
    • Journal of Service Research and Studies
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    • v.10 no.3
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    • pp.23-42
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    • 2020
  • This study conceptualized the essence and propensity of modern management in service age, based on philosophy, and developed items to evaluate the conceptualized content. It was carried out as a new study to deepen the study of management philosophy and management theory by the new management framework. In order to establish the philosophical foundation of the modern management, the essence of the modern management was conceptualized based on the fundamental ideas of the East and West, and then an evaluation item was developed to put the essence and propensity of the modern management into practical use through analytical and empirical methods. After analyzing the representative ideas of mankind, it was derived that the Book of Change has the qualification as a philosophical model that can derive the essence of modern management. The Book of Change explains the reasoning of the world in the structure of two opposing parties, such as Taiji or Yin and Yang, and the process of acknowledging the contradictions within each opposing party and overcoming the contradictions through change is the central idea. Because you can see. After conducting a conceptual study, through empirical research, the essence and propensity of a modern manager should be conceptualized. The concept of essence and empirical study of the modern management using the leading role was conducted in two stages. First, a qualitative study using repetitive comparative analysis (CCM), focus group interview (FGI), and text mining was conducted to derive the essential and propensity conceptualization items that modern managers should possess. In addition, a quantitative study using factor analysis to develop sample items and develop measurement items through literature review and FGI was conducted to derive the essential concept of the modern management. Finally, the essence of modern management was derived: learning, preparation, challenge, inclusion, trust, morality, and sacrifice. In the future, it is necessary to conduct empirical research on the effectiveness of the essence of modern management for global and Korean representative companies.

Physicochemical properties and protease activities of microencapsulated pineapple juice powders by spray drying process (분무건조공정을 이용한 파인애플 착즙액 미세캡슐 분말의 물리화학적 특성 및 protease 활성)

  • Park, Hye-Mi;Chae, Ho-Yong;Hong, Joo-Heon
    • Food Science and Preservation
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    • v.22 no.1
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    • pp.84-90
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    • 2015
  • The physicochemical properties and protease activities of spray-dried pineapple juice powders were investigated. The pH, soluble solids, and protease activity of the pineapple juice were pH 5.43, $12.8^{\circ}Brix$, and 4.82 unit/mL, respectively. The optimum pH and temperature of the protease activity from pineapple juice were pH 7.0 and $50^{\circ}C$, respectively. The microencapsulation of pineapple juice was achieved using maltodextrin and alginic acid through spray-drying. The L value and moisture content of the spray-dried powder were higher than those of the freeze-dried powder. The particle size of the freeze-dried powder ($501.57{\mu}m$) was higher than that of the spray-dried powder ($42.58-53.32{\mu}m$). The water absorption and water solubility of the powders were 0.41-0.87, and 90.45-99.76%, respectively. When compared, the protease activities were found to be in the following order : FD (1,297.47 unit/g) > SD-MA-1 (692.08 unit/g) > SD-MA-2 (664.66 unit/g) > SD-MA-3 (642.65 unit/g) > SD-M (633.51 unit/g). In the in vitro dissolution study measurements were conducted for 4 hr in pH 1.2 simulated gastric fluid and pH 6.8 simulated intestinal fluid, using a dissolution tester at $37^{\circ}C$ in 50 rpm. The protease survival of the 3.74-15.69% microencapsulated pineapple juice powders improved with an increase in the treatment concentration of alginic acid.

Bioleaching of Mn(II) from Manganese Nodules by Bacillus sp. MR2 (Bacillus sp. MR2에 의한 망간단괴의 생물용출)

  • Choi, Sung-Chan;Lee, Ga-Hwa;Lee, Hong-Keum
    • Korean Journal of Microbiology
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    • v.45 no.4
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    • pp.411-415
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    • 2009
  • Some microorganisms are capable of leaching Mn(II) from nonsulfidic manganese ores indirectly via nonenzymatic processes. Such reductive dissolution requires organic substrates, such as glucose, sucrose, or galactose, as a source of carbon and energy for microbial growth. This study investigated characteristics of Mn(II) leaching from manganese nodules by using heterotrophic Bacillus sp. strain MR2 provided with corn starch as a less-expensive substrate. Leaching of Mn(II) at 25.6 g Mn(II) $kg^{-1}$ nodule $day^{-1}$ was accompanied with cell growth, but part of the produced Mn(II) re-adsorbed onto residual $MnO_2$ particles after 24 h. Direct contact of cells to manganese nodule was not necessary as a separation between them with a dialysis tube produced similar amount [24.6 g Mn(II) $kg^{-1}$ nodule $day^{-1}$]. These results indicated an involvement of extracellular diffusible compound(s) during Mn(II) leaching by strain MR2. In order to optimize a leaching process we tested factors that influence the reaction, and the most efficient conditions were $25\sim35^{\circ}C$, pH 5~7, inoculum density of 1.5~2.5% (v/v), pulp density of 2~3 g/L, and particle size <75 ${\mu}m$. Although Mn(II) leaching was enhanced as particle size decrease, we suggest <212 ${\mu}m$ as a proper size range since more grinding means more energy consumption The results would help for the improvement of bioleaching of manganese nodule as a less expensive, energy-efficient, and environment-friendly technology as compared to the existing physicochemical metal recovery technologies.