• 중환자간호학회지
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• 제10권1호
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• pp.63-74
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• 2017

Purpose: The purpose of this study was to examine the effect of professional autonomy, organizational commitment, and perceived patient safety culture on patient safety management activities of nurses in medium and small-sized hospitals. Methods: A cross-sectional design was employed. Self-reported questionnaires were completed by 121 nurses with at least 3 months of working experience in medium and small-sized hospitals located in B city. Data were analyzed using descriptive statistics, a t-test, a one-way ANOVA, Pearson correlation coefficients, and a multiple regression analysis. Results: Professional autonomy (r=.22, p=.016), organizational commitment (r=.34, p<.001), and perceived patient safety culture (r=.55, p<.001) had a statistically significant positive correlation with patient safety management activities. The factors that might affect patient safety management activities were professional autonomy (${\beta}=.23$, p=.003) and perceived patient safety culture (${\beta}=.55$, p<.001). The explanatory power of these factors for patient safety management activities was 33.5% (F=21.19, p<.001). Conclusions: The development of repetitive and continuous education programs is needed to improve a nurse's professional autonomy and perceived patient safety culture.

• 의료법학
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• 제18권2호
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• pp.105-138
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• 2017

이 글은 환자의 자기결정권에 관한 몇몇 대표적인 판례들을 연혁적으로 검토한 논문이다. 대법원은 과거 음주상태에서 농약을 음독하여 자살을 시도한 환자가 치료를 거부하자 치료를 포기한 의료진에게 특정 의학적 상태(응급상황)에서 의사의 생명보호의무가 환자의 자기결정권 존중보다 우선한다고 판단하여 의료과실을 인정하였다. 이후 대법원은 가족들의 요청에 의해 지속적 식물인간 상태인 환자에게 해당 환자의 의학적 상태(회복불가능한 사망의 단계 등)를 고려하고 환자의 의사를 추정하여 연명의료를 중단하게 하였다. 최근 대법원은 종교적 신념과 관련하여 수혈과 같은 필수적인 치료를 거부한 환자에 대하여 대법원은 환자의 생명 보호에 못지않게 환자의 자기결정권을 존중하여야 할 의무가 대등한 가치를 가지는 것으로 평가할 수 있는 판단 기준을 제시하였다. 인간의 존엄성에 근거한 환자의 자기결정권과 의사의 생명보호의무가 충돌하는 상황에 대하여 연혁적 판례 검토를 통해 법원의 입장이 우리 사회에서 환자의 주체적 역할과 자율성을 존중하는 방향을 반영하여 함께 변화되어 왔음을 확인할 수 있었다. 법원이 생명권이라는 최고의 가치만을 환자의 의사보다 더욱 우선하여 판단해오다가 적어도 명시적인 환자의 의사 또는 그렇지 못할 경우에 추정적 의사까지도 고려한 치료의 유보나 중단에 대하여 고려하기 시작한 것, 종교적 신념에 근거한 자기결정권의 행사로서의 수혈거부와 같은 치료거부에 대하여 충분한 정보에 근거한 치료거부의 몇 가지 적법한 요건들을 인정하기 시작했다는 것은 이후 우리나라 의료 환경에 적잖은 영향을 줄 것이고 의료현장에서 의료행위를 하는 의사들에게도 직 간접적인 지침이 될 것이다.

• 한국융합학회논문지
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• 제12권8호
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• pp.381-391
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• 2021

본 연구의 목적은 만성질환자를 대상으로 한국어판 자율성 선호도 측정 도구(K-API)의 타당도와 신뢰도를 검증하는 것이다. 총 569명의 만성질환자가 참여하였다. 구성타당도를 검증하기 위하여 탐색적, 확인적 요인분석을 시행하고, 신뢰도는 Cronbach's α 값으로 확인하였다. 원도구를 한국어로 번역한 후 내용 타당도 검증, 예비 조사를 시행하였다. 연구결과, K-API는 두 총 10개의 문항으로 구성되며 (i) 의사결정 선호도, (ii) 정보추구 선호도의 두 영역으로 구성되었다. K-API는 자율성 선호도의 53.4%를 설명하며, 2개 요인으로 구성된 도구의 적합도 지수가 충족되었다. Cronbach's α는 의사결정 선호도는 .77, 정보추구 선호도는 .75로 나타났다. 본 연구를 통하여 K-API의 타당도가 신뢰도가 확인되었으며, 이는 아시아 지역에서의 API 도구의 적용 가능성에 대한 추가적인 근거를 제공한다.

• Tuberculosis and Respiratory Diseases
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• 제58권3호
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• pp.213-229
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• 2005

The first and the longest criminal indictment case of Korean medico-legal battle, so called BORAMAE Hospital Incident, was finally on its end by Korean Supreme Court's decision on June 24, 2004, after 7 years long legal dispute via Seoul District Court and Seoul Superior Appeal Court's decision. Boramae Hospital case was the first Korean legal case of Withdrawing Life-sustaining treatment of mechanical respirator on 58 years old Extradural Hematoma victim who was on Respirator under Coma after multi-organ failure postoperatively(APACHE II score: 34-39). Two physicians who have involved patient's care and had helped to make discharge the Near-death patient to home after repeated demand of patient's wife, due to economic reason, were sentenced as homicidal crime. This review article will discuss the following items with the review of US cases, Quinlan(1976), Nancy Cruzan(1990), Barber (1983), Helen Wanglie(1990), Baby K (1994) and Baby L cases, along with Official Statement of ATS and other Academic dignitaries of US and World.: [1] Details of Boramae Hospital incident, medical facts description and legal language of homicidal crime sentence. [2] The medical dispute about the legal misinterpretation of patient's clinical status, regarding the severity of the victim with multi-organs failure on Respirator under coma with least chance of recovery, less than 10% probability. [3] Case study of US, of similar situation. [4] Introduction of ATS official Statement on Withdrawing/ Withholding Life sustaining treatment. [5] Patient Autonomy as basic principle. [6] The procedural formality in Medical practise for keeping the legitimacy. [7] The definition of Medical Futility and its dispute. [8] Dying in Dignity and PAS(Physician Assisted Suicide)/and/or Euthanasia [9] The Korean version of "Dying in Dignity", based on the Supreme Court's decision of Boramae Hospital incident (2004.6.24.) [10] Summary and Author's Note for future prospects.

• 지역사회간호학회지
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• 제5권2호
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• pp.203-215
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• 1994

The purpose of this study was to investigate the needs for exercise of adult inpatients and ultimately to provide basic data for planning nursing intervention of patients who need exercise. The tool used for this study was a structured questionnaire which consisted of 42 items. The test items were classified into seven factors. The seven factors of the needs for exercise were need for achievement, need for activity, need for affiliation, need for autonomy, need for catharsis, need for homeostasis, and need for exhibition. Subjects of this study were 127 patients in two general hospitals in Seoul, and one general hospital in Chun Ann City. The needs of exercise were identified and the data were analyzed by gender, age, occupation, education level, monthly income, size of patient room, patient group who requires exercise and the other patient group who requires bed rest, using one-way ANOVA and Scheffe test as post-hoc. The findings of this study were as follows ; 1) Among the needs for exercise of adult patients, the highest level of the needs was the need for homeostasis. The next highest was the need for achievement, then need for activity, need for catharsis, need for autonomy, need for affiliation, and the lowest was the need for exhibition. 2) Maintaining physical fitness stood first in the need for homeostasis, relieving psychological and physical powerlessness in the need for activity, mood diversion in the need for catharsis, happiness of the family in the need for affiliation, maintaining the balanced body figure in the need for exhibition, practicing planned life in the need for achievement, and improving the ability to overcome the crisis in the need for autonomy. 3) Male patients exhibited the higher level of the needs than female patients in all factors except the need for exhibition and homeostasis. 4) There was no statistical difference in the needs between age, occupation, monthly income, and the size of patient room. 5) The need for achievement was high as the level of education goes higher. 6) The patients who performed regular exercise before admission had higher needs for activity, achievement, and autonomy, compared with the patients who did not perform the regular exercise before admission. 7) There was no statistical difference in the needs between patient group who requires exercise and the other patient group who requires bed rest. The need for homeostasis was the highest in both groups. The results from this study suggest that the need for exercise of adult inpatients should be assessed before planning exercise intervention.

• 디지털융복합연구
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• 제20권4호
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• pp.715-724
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• 2022

본 연구는 병원 간호사의 환자안전관리 중요성 인식, 전문직 자율성 및 안전분위기가 환자안전간호활동에 미치는 영향을 파악하기 위한 서술적 조사연구이다. 종합병원 간호사 211명을 대상으로, 2021년 1월 11일부터 1월 25일까지 자료수집이 이루어졌다. 자료분석은 SPSS 21.0 program을 이용하여 독립표본 t-검정, 일원분산분석, 피어슨상관계수, 단계적 회귀분석으로 하였다. 병원간호사의 환자안전간호활동 영향요인은 안전분위기(β=.297, p<.001), 환자안전관리 중요성 인식(β=.287, p<.001), 근무부서(β=.169 p=.004)이었다. 연구결과를 종합해 볼 때, 환자안전간호활동의 증진을 위해서는 간호사의 근무부서의 업무고려 및 다양한 특성을 고려한 교육프로그램 개발 및 적용, 환자안전관련 중요성 인식의 향상, 긍정적인 안전분위기의 형성이 이루어져야 한다. 본 연구는 병원 간호사의 환자안전간호활동 증진의 방안마련에 토대가 되는 자료를 제공한다는 점에서 그 의의가 있다.

• Safety and Health at Work
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• 제4권4호
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• pp.210-215
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• 2013

Background: This study aimed to identify the impacts of job stress and cognitive failure on patient safety incidents among hospital nurses in Korea. Methods: The study included 279 nurses who worked for at least 6 months in five general hospitals in Korea. Data were collected with self-administered questionnaires designed to measure job stress, cognitive failure, and patient safety incidents. Results: This study showed that 27.9% of the participants had experienced patient safety incidents in the past 6 months. Factors affecting incidents were found to be shift work [odds ratio (OR) = 6.85], cognitive failure (OR = 2.92), lacking job autonomy (OR = 0.97), and job instability (OR = 1.02). Conclusion: Patient safety incidents were affected by shift work, cognitive failure, and job stress. Many countermeasures to reduce the incidents caused by shift work, and plans to reduce job stress to reduce the workers' cognitive failure are required. In addition, there is a necessity to reduce job instability and clearly define the scope and authority for duties that are directly related to the patient's safety.

• 한국콘텐츠학회논문지
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• 제21권2호
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• pp.236-247
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• 2021

본 연구의 목적은 만성질환자의 건강 관련 의사결정에 대한 자율성 선호도에 영향을 미치는 요인을 확인하기 위함이다. 대상자는 일개 보건소에 등록된 만성질환자 522명이다. 수집된 자료는 SPSS Win 26.0 ver. 프로그램을 이용하여 기술통계, t-test, ANOVA, Scheffe-test, Pearson's correlation coefficients, multiple linear regression으로 분석하였다. 연구결과, 만성질환자의 일반적 의사결정 선호도의 영향요인은 건강에 대한 관심정도(β=-.17, p<.001)이었으며. 정보추구 선호도의 영향요인은 성별(β=-.20, p<.001)과 진료 시 질문하는 횟수(β=.09, p=.030)이었다. 본 연구는 만성질환자들이 본인의 치료 과정에서 주도적으로 역할을 할 수 있도록 환자의 특성을 고려해야 하며, 환자의 주도적이고 효율적인 의사결정을 돕기 위하여 의료인의 효과적인 의사소통 전략 수립이 필요함을 시사한다.

• 한국병원경영학회지
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• 제27권1호
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• pp.11-19
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• 2022

Purposes: This study was to investigate intention to exercise the patient's right of self-determination on adopting the non-benefit medical services and was to identify factors associated with intention to self-determined decision. Methodology: A total of 1,000 adult respondents aged 20 to 65 years were recruited using stratified random sampling and surveyed by online. Multivariate logistic regression analysis was performed to identify factors associated with intention to self-determined decision using SAS 9.4(SAS Institute Inc. Cary, NC, USA). Findings: 61.9% of total participants(n=592) had intention to exercise patient's right of self-determination on adopting the non-benefit medical services. Significant differences were observed in the exercise of self-determination in relation to prior explanation and opportunity for self-determination. Practical Implications: This study suggested that explanation duty of provider might influence on increasing intention to exercise the patient's right of self-determination. Considering appropriate use of non-benefit services, it is important to enhance explanation duty of provider.

• 대한간호학회지
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• 제47권5호
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• pp.663-675
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• 2017

Purpose: The purpose of this study was to construct and test a structural equation model of self-management of liver transplant recipients based on self-determination theory. Methods: Participants were 275 outpatients who received liver transplantation. A structured self-report questionnaire was used to assess health care providers' autonomy support, transplant-related characteristics, illness consequence perception, autonomy, competence, family relatedness, depression and self-management. Collected data were analyzed using SPSS/WIN 24.0 and AMOS 24.0 program. Results: The modified model showed a good fitness with the data: GFI=.96, RMSEA=.06, CFI=.96, NFI=.93, TLI=.93, PGFI=.43, PNFI=.49. The health care providers' autonomy support, competence, family relatedness and depression were factors with a direct influence on the self-management of liver transplant recipients. The health care providers' autonomy support and illness consequence perception had an indirect influence through competence, family relatedness and depression. However, the transplant-related characteristics and autonomy did not have a significant effect on self-management. This model explained 59.4% of the variance in self-management. Conclusion: The result suggests that continuous education must be done to promote the competence of liver transplant recipients and to encourage the patient to positively perceive their current health condition with a view that enhances one's self-management. Additionally, the liver transplant recipients should be screened for depression, which would affect self-management. Most of all, health care providers, who have the most influence on self-management, should improve therapeutic communication and try to form a therapeutic relationship with the liver transplant recipients.