• Tuberculosis and Respiratory Diseases
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• v.79 no.4
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• pp.214-233
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• 2016

There is no well-stated practical guideline for mechanically ventilated patients with or without acute respiratory distress syndrome (ARDS). We generate strong (1) and weak (2) grade of recommendations based on high (A), moderate (B) and low (C) grade in the quality of evidence. In patients with ARDS, we recommend low tidal volume ventilation (1A) and prone position if it is not contraindicated (1B) to reduce their mortality. However, we did not support high-frequency oscillatory ventilation (1B) and inhaled nitric oxide (1A) as a standard treatment. We also suggest high positive end-expiratory pressure (2B), extracorporeal membrane oxygenation as a rescue therapy (2C), and neuromuscular blockage for 48 hours after starting mechanical ventilation (2B). The application of recruitment maneuver may reduce mortality (2B), however, the use of systemic steroids cannot reduce mortality (2B). In mechanically ventilated patients, we recommend light sedation (1B) and low tidal volume even without ARDS (1B) and suggest lung protective ventilation strategy during the operation to lower the incidence of lung complications including ARDS (2B). Early tracheostomy in mechanically ventilated patients can be performed only in limited patients (2A). In conclusion, of 12 recommendations, nine were in the management of ARDS, and three for mechanically ventilated patients.

• The Korean Society of Law and Medicine
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• v.9 no.1
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• pp.385-411
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• 2008

The goal of medicine is to contribute to promoting national health by preventing diseases and providing treatment. The scope of modern medicine isn't merely confined to disease testing, treatment and prevention in accordance to that, and making experiments by using the human body is widespread. The advance in modern medicine has made a great contribution to valuing human dignity and actualizing a manly life, but there is a problem that has still nagged modern medicine: treatment and healing for terminal patients including cancer patients. In advanced countries, pain care and hospice medicine are already universal. Offering a helping hand for terminal patients to lead a less painful and more manly life from diverse angles instead of merely focusing on treatment is called the very hospice medicine. That is a comprehensive package of medical services to take care of death-facing terminal patients and their families with affection. That is providing physical, mental and social support for the patients to pass away in peace after living a dignified and decent life, and that is comforting their bereaved families. The National Hospice Organization of the United States provides terminal patients and their families with sustained hospital care and home care in a move to lend assistance to them. In our country, however, tertiary medical institutions simply provide medical care for terminal patients to extend their lives, and there are few institutional efforts to help them. Hospice medicine is offered mostly in our country by non- professionals including doctors, nurses, social workers, pastors or physical therapists. Terminal patients' needs cannot be satisfied in the same manner as those of other patients, and it's needed to take a different approach to their treatment as well. Nevertheless, the focus of medical care is still placed on treatment only, which should be taken seriously. Ministry for Health, Welfare & Family Affairs and Health Insurance Review & Assessment Service held a public hearing on May 21, 2008, on the cost of hospice care, quality control and demonstration project to gather extensive opinions from the academic community, experts and consumer groups to draw up plans about manpower supply, facilities and demonstration project, but the institutions are not going to work on hospice education, securement of facilities and relevant legislation. In 2002, Ministry for Health, Welfare & Family Affairs made an official announcement to introduce a hospice nurse system to nurture nurse specialists in this area. That ministry legislated for the qualifications of advanced nurse practitioner and a hospice nurse system(Article 24 and 2 in Enforcement Regulations for the Medical Law), but few specific plans are under way to carry out the regulations. It's well known that the medical law defines a nurse as a professional health care worker, and there is a move to draw a line between the responsibilities of doctors and those of nurses in association with medical errors. Specifically, the roles of professional hospice are increasingly expected to be accentuated in conjunction with treatment for terminal patients, and it seems that delving into possible problems with the job performance of nurses and coming up with workable countermeasures are what scholars of conscience should do in an effort to contribute to the development of medicine and the realization of a dignified and manly life.

• Journal of Korean society of Dental Hygiene
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• v.11 no.4
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• pp.475-487
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• 2011

Objectives : The growing elderly population and social changes have fueled a rapid increase in demand for elderly care facilities, but health care services for the elderly, especially oral health services, have long been overlooked. The purpose of this study was to examine the oral health care of elderly residents in elderly care facilities in an effort to provide some information on the elderly's oral health care and the development of dental care programs geared toward institutionalized elderly people. Methods : The subjects in this study were 230 elderly people who were in elderly care facilities in Jeolla Province. An individual interview was held, and they got a dental checkup. As for data analysis, t-test and ANOVA were utilized, and Scheffe post-hoc test was employed. Results : 1. In relation to the subfactors of the quality of life related to oral health, the elderly people investigated got a mean of 4.58, 4.47, 4.38, 4.09, 3.94, 3.91 and 3.76 respectively in activity disorder, mental disorder, social disorder, mental inconvenience, functional disorder, physical pain and physical disorder. 2. Concerning the overall quality of life related to oral health, there were statistically significant gaps in this aspect according to gender, age, presence or absence of systemic disorder, presence or absence of eating difficulties, subjective health status, subjective oral health state and oral health concern. 3. The presence or absence of root caries had a significant relationship to physical pain and social disorder among the subfactors of the OHIP-14, but that had nothing to do with functional disorder, mental inconvenience, physical disorder, mental disorder and activity disorder. Conclusions : The oral health indexes of the institutionalized elderly people in Jeolla Province were measured, and what factors affected the subfactors of oral health was checked. As a result, there appeared a close relation ship between oral health and the quality of life. Therefore effective oral health plans that cater to the elderly should be carried out to improve elderly people's quality of life related to oral health who stay in long-term elderly care facilities. In the future, prolonged research should be implemented from diverse angles for the sake of institutionalized elderly people.

• Journal of Hospice and Palliative Care
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• v.4 no.1
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• pp.57-67
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• 2001

Purpose : The purpose of this study was to identify attitudes of hospice volunteers toward care of for terminally ill patients. Method : This was a descriptive study with a sample of 84 adults who were registered for a hospice volunteer education program at Severence Hospice Center. The Frommelt (FATCOD) scale on attitudes toward the care of the dying (Cronbach alpha=.778) and an open ended questions on "what if you only have 6 months to live" were used to collect the data. The data was analyzed using SPSS/W and content analysis. Results : 1) The hospice volunteers were mostly female, with an average age of 45 years, half of them were college graduates and their religious preference was Protestant. 2) The participants of this study demonstrated positive attitudes to care for the dying which is in coherence with hospice philosophy and principles. However they indicated difficulties in maintaining close relationships with people who are dying, and in communicating and sharing, and encouraging those who are dying to express their feelings. In the open ended questions, they identified that their most important issues would be guilt feelings toward their children, family concerns, and the burden of unfinished business in their lives. They also identified the fear of pain in the dying process and fear of the afterlife. The care they would like to receive was to have peace of mind, have a good listener, spiritual counselling, and pain relief and to be respected as a human being. The source of strength would be faith in God and they would like to overcome their of dying. The FATCOD scale has limitation in describing and identifying the need and attitude toward the care of the dying revisions were made. Conclusion : We all are the potential clients for the hospice rare. In a hospice volunteer education program, communication and interpersonal skill are essential. The fear of dying, afterlife, concerns about family with children, and human dignity are major concerns in hospice and palliative care.

• Women's Health Nursing
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• v.5 no.3
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• pp.389-409
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• 1999

This study was carried out to identify the differences between nursing needs and levels of satisfaction of postpartum women during the early postpartum period. The goal of this study was to obtain needed to develope the nursing quality for postpartum women. The subjects were 87 postpartum women who had vaginal delivery at 2 general hospital and 2 maternity hospital in the Ulsan City. The period for the data collection was from June 1 to 29, 1999. The data was gathered using an 98 items questionnaire which was a modified version of a questionnaire the developed by Y. J. Chun. Results found are as follows : 1. The general characteristics of the subjects : The majority of subjects were 25-29 yrs. (57.5%), high school and college graduates(96.5%), unemployed(75.9%), middle ranged economics(93.1%), had no religion(43.7%), male baby(52.9%), birth weight 3-3.5Kg(49.4%), wanted pregnancy(96.6%), no abortion history(50.6%), had antenatal care(89.7%), had prenatal education(32.2%), postnatal education(42.5%), intended breast feeding (46.0%), had resonable self confidence about self(20.7%), infant care(36.8%) and nuclear family pattern(82.3%). 2. The level of nursing needs of overall nursing care(3.93) and the levels of satisfaction(3.86) was relatively high. The nursing needs by category of nursing care, the highest need was in the emotional and psychological care(4.09), and the lowest need was in physical need(3.73). The satisfactions by category of nursing care, the highest satisfaction was in emotional and psychological care(4.11) and the lowest satisfaction was in education in self care(3.64). The significant differences between nursing needs and satisfactions were found on education in infant care(p=.005), and education in self care(p=.020). 3. Among items of physical care, 'accurate medication and treatment(4.21)', 'control of postpartum hemorrhage(4.13)', 'pain control and care of episiotomy wound (4.12)' and 'regular observation of postpartum conditions(4.09)' showed high nursing needs. 'Accurate medication and treatment(4.31)', 'regular observation of postpartum condition(4.24)', 'control of postpartum hemorrhage(4.22)' and 'pain control and care of episiotomy wound(4.12)' showed high satisfaction levels. 4. Among items of emotional and psychological care, 'personal treatment(4.32)', kind and faithful care(4.30)', 'detailed explanation on the treatment or nursing care(4.25)', 'adequate draping during the care and treatment(4.23)' and detailed explanation on a doubt(4.13)', showed high nursing needs, 'personal treatment(4.52)', 'kind and faithful care(4.45)', 'detailed explanation on a doubt(4.24)', 'detailed explanation on the treatment or nursing care(4.21)' and 'adequate draping during the care and treatment(4.18)' showed high satisfaction of nursing care. Difference between the level of nursing needs and satisfaction was significant except item of 'early contacts with their baby and breast feeding'. 5. Among items of environmental care, the highest level of need and satisfaction were on the items of 'neat bedding and clothes(4.05, 4.21)' and 'room cleansing or care of room(4.01, 4.28)'. Differences between the level of nursing care and satisfaction were 'room cleansing of care of room'. 6. Among items of educational needs on self care, 'sitz bath method(4.22)', 'high risk symptoms to immediate clinic visits(4.13)', 'the timing of tub bath(4.05)' and 'good secretion of breast milk(4.03)', showed high nursing needs, 'sitz bath method(4.22)' showed high satisfaction of nursing care. Differences between the level of nursing care and satisfaction were 'the timing of hair shampoo', 'the timing of tub bath', ' the method of pad change', 'postpartum exercise', 'good secretion of breast milk', 'maintenance of breast figure', 'contraindicated drugs in postpartum women', 'kegel exercise' and 'breast self examination'. 7. Among items of educational needs on infant care, 'immunization of infants(4.36)', 'symptoms of sickness to immediate clinic visits(4.28)'. 'safety and emergency care(4.28)', 'umbilical care(4.26)', 'feeding times and intervals(4.24)', 'normal growth and development of infant(4.24)' and 'infection control(4.22)', showed high level of nursing care, 'immunization of infants(4.21)', 'feeding times and intervals(4.17)', were high satisfaction items showed significant differences between the level of nursing care and satisfaction. 8. Relationship between nursing needs and levels of satisfaction among postpartum women were as follows : 1) Physical area : There were no significant differences in the level of nursing needs, but satisfaction levels were significantly different among 'working mothers', 'baby's weights', 'baby's sex', 'planning of feeding' and 'routes of receiving postpartum informations'. 2) Emotional and psychological area : The level of nursing needs were significantly different in the area of 'confidence in self care'. Satisfaction levels were significantly different among 'baby's sex', 'baby's weights', 'the confidence of infant care' and 'working mother'. 3) Environment area : There were on significant differences in the level of nursing needs, but satisfaction levels were significantly different among 'maternal age' and 'baby's weights'. 4) Education in self care : The level of nursing needs were significantly different among 'parity history' and 'type of family formation'. Satisfaction levels were significantly different among 'working mother', 'baby's sex', 'antenatal care', 'postpartum education', 'planning of feeding', 'routes of receiving postpartum informations'. 5) Education in infant care area : The level of nursing needs were significantly different among 'parity history'. Satisfaction levels were significantly different among 'baby's sex', 'receiving postpartum education or not' and 'working mother'.

• Journal of Hospice and Palliative Care
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• v.8 no.2
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• pp.224-233
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• 2005

Purpose: This study was conducted to provide basic data for developing an effective strategy for cancer pain management by comparing the levels of barriers to pain management of metastatic or advanced cancer patient and their nurses. Methods: The subject of this study were 155 patients who were treated for metastatic or advanced cancer at one of three hospitals in Seoul from January 2004 to January 2005, and 153 nurses who take care of those patients. The levels of barriers to pain management were measured using a tool developed by Gunnarsdottir et al. (2002), 27 questions on a six point scale. The levels of stresses were measured using a tool modified from a stress response measurement reported by Goh Gyung-bong et al. (2000), 27 questions on a five point scale. The levels of barriers in cancer patients were analyzed using t-test and ANOVA, while the data obtained from patients and nurses were compared by t-test. Results: Higher levels of barriers to pain management were found in three groups: 'less than middle school,' 'not treated with anti-cancer chemotherapy,' and 'ECOG of 2.' The level (2.55) of barriers to pain management in the patient group was higher than that (1.76) of the nurse group. Both of the two groups had high levels of barriers in two variables: 'There is a danger of becoming addicted to pain medicine.' and 'Using pain medicine blocks your ability to know if you have any new pain.' There was not a significant difference in the levels of stresses between the two groups. Conclusion: It was found that, for effective cancer pain management practices, it would be necessary to provide cancer patients and their nurses with education and training about pain management and related barriers.

• KSBB Journal
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• v.26 no.4
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• pp.277-282
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• 2011

The penetration of outside material into skin is not easy. It is since the skin, which is a very hard barrier, protects the body against outside chemical and physical stimulation. Microneedle system which can help improve drug penetration into skin is advancing variously in transdermal drug delivery system (TDDS) in the field of skin care. After inserting microneedle into skin by using electrical or artificial forces, it makes microhole and drug penetration easily and induces natural skin rejuvenation. Diffusion and penetration of drug by optical and electrical force of microneedle is better for fast and effective TDDS. This is more developed than the traditional method such as the manual stamp, roller, and meso gun. The drug absorbed into dermal layer by microneedle helps revive and repair damaged skin. In the future, utilization of microneedle for skin care will progress constantly because of its human-friendly biodegradable materials and the development of the no pain microneedle.

• Journal of The Korea Institute of Healthcare Architecture
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• v.8 no.1
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• pp.45-52
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• 2002

Recently cancer, AIDS, chronic sickness have increased according to the elevation of socioeconomic level and fast change of lifestyle. The number of patients receiving terminal care increased fairly because the span of life is extended by development of medicinal technology. Also necessity of hospice and palliative care was risen according to the request of terminal patients that remove pain and keep calm life by interest about quality of life. However architectural plan and type specialization of facility which can correspond team's composition and supplied nursing program are not consisting. This study researches about care environment of hospice facility plan through investigation into terminal patient's special quality. The purpose of this study is to propose fundamental datas of hospice facility for architectural plan through comparative analysis of cases of domestic and outside facilities.

• Journal of Korean Academy of Nursing Administration
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• v.13 no.4
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• pp.455-461
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• 2007

Purpose: To examine patient satisfaction with nursing care and the difference of patient satisfaction by the characteristics of emergency care service in the center for emergency medicine. Method: We surveyed 145 patients who visited Pusan-Wide Emergency Medical Center from Nov 01, 2003 to Nov 30, 2003. Patient satisfaction was assessed by asking patients and medical records reviewed to obtain the characteristics of emergency care service. Results: The mean score of patient satisfaction with nursing care was 3.12. For patient satisfaction, 'The nurse seemed earnestly concerned about my pain, fear, and anxiety' represented highest score (3.58). Patient satisfaction according to the general characteristics of patients was revealed as significantly high for the higher educated and the older. Patient satisfaction by the characteristics of emergency care service was significantly higher in no-wait group. Conclusion: Also, the fundamental of nursing, like respect for human, was maintained in emergency setting, the hospital's administration has implemented service for a high level of satisfaction with nursing care up to the expectations of the patients for with the staff and medical equipment.

• Korean Journal of Adult Nursing
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• v.23 no.5
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• pp.460-471
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• 2011

Purpose: This study was designed to investigate the levels of anxiety, depression, physical symptoms, and supportive care needs in patients with hematologic malignancy and to identify predictive factors of supportive care needs. Methods: The data were collected from 100 subjects undergoing treatments during 2010 in Korea. The questionnaires included the Hospital Anxiety-Depression Scale, the M. D. Anderson Symptom Inventory, and the Supportive Care Needs Survey-Short Form 34. The data were analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation, and stepwise multiple regression. Results: Forty percent of the subjects had anxiety and 58% had depression. Thirty-eight percent of the subjects reported to have moderate-to-severe levels of physical symptoms. The most severe physical symptom was lack of appetite, followed by fatigue and pain. In terms of supportive care needs, the health system and information domain showed the highest among all domains. Supportive care needs had a significant positive correlation with anxiety, depression, and physical symptoms. And its predictive factors were identified as anxiety, physical symptoms and marital status, with the explanatory power of 48.9%. Conclusion: These findings demonstrate that anxiety and physical symptoms should be assessed and treated to meet the supportive care needs of patients with hematologic malignancies.