• Korean Journal of Hospice Care
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• v.8 no.1
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• pp.55-67
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• 2008

Purpose: This study was to test the effects of wholistic hospice nursing intervention program on pain and anxiety for in-patient of hospice palliative care unit. This study's design was one-group pre-post test quasi- experimental research. Methods: The subjects of study were 27 patients who were over 18 years old and admitted in hospice palliative care unit of S hospital in P city with agreement in hospice palliative care in their terminal disease. The experimental group subjects participated in holistic hospice nursing program took 120 minutes per session, a total of 1,200 minutes altogether for 10 sessions. The period of data collection was from April 6, 2004 to April 20, 2005. The collected data were analyzed by Paired t-test with SPSS/WIN 12.0 program. A Wholistic Hospice Nursing Intervention Program (named ‘Rainbow Program’) was used as a experimental tool in this study. This was developed by the authors. It was provided by interdisciplinary hospice team (nurses, medical doctors, social worker, pastors, art therapists, and volunteers). In addition, Korean Version of Brief Pain Inventory (BPI-K) by Young-Ho Yun(1998) was used to test degree of pain in physical aspect. And State-Anxiety Inventory was developed by Spielberger(1975) and translated by Kim, Jung-Tack & Shin, Dong-Gyun(1978) was used to test the degree of state-anxiety in emotional aspect. Results: (1) Hypothesis No. 1 "The experimental group which received Wholistic Hospice Nursing Program will have a lower degree of pain than before" was supported (t=-10.585, P= .000). (2) Hypothesis No. 2 "The experimental group which received Wholistic Hospice Nursing Program will have a lower degree of state-anxiety than before" was supported (t=-8.234, P= .000). Conclusion: Our results testified that this Wholistic Hospice Nursing Intervention Program was effective to decrease pain and state-anxiety of the in-patients of hospice palliative care unit. Therefore it can be used and applied actively in practice as a useful model of interdisciplinary team approach by hospice professionals in hospice palliative care unit.

• Journal of Home Health Care Nursing
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• v.4
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• pp.5-22
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• 1997

The purpose of the study was to development an information delivery system for the home nursing service, to demonstrate and to evaluate the efficiency of it. The period of research conduct was from September 1996 to August 31, 1997. At the 1st stage to achieve the purpose, Firstly Assessment tool for the patients with cerebral vascular disease who have the first priority of HNS among the patients with various health problems at home was developed through literature review. Secondly, after identification of patient nursing problem by the home care nurse with the assessment tool, the patient's classification system developed by Park (1988) that was 128 nursing activities under 6 categories was used to identify the home care nurse's activities of the patient with CAV at home. The research team had several workshops with 5 clinical nurse experts to refine it. At last 110 nursing activities under 11 categories for the patients with CVA were derived. At the second stage, algorithms were developed to connect 110 nursing activities with the patient nursing problems identified by assessment tool. The computerizing process of the algorithms is as follows: These algorithms are realized with the computer program by use of the software engineering technique. The development is made by the prototyping method, which is the requirement analysis of the software specifications. The basic features of the usability, compatibility, adaptability and maintainability are taken into consideration. Particular emphasis is given to the efficient construction of the database. To enhance the database efficiency and to establish the structural cohesion, the data field is categorized with the weight of relevance to the particular disease. This approach permits the easy adaptability when numerous diseases are applied in the future. In paralleled with this, the expandability and maintainability is stressed through out the program development, which leads to the modular concept. However since the disease to be applied is increased in number as the project progress and since they are interrelated and coupled each other, the expand ability as well as maintainability should be considered with a big priority. Furthermore, since the system is to be synthesized with other medical systems in the future, these properties are very important. The prototype developed in this project is to be evaluated through the stage of system testing. There are various evaluation metrics such as cohesion, coupling and adaptability so on. But unfortunately, direct measurement of these metrics are very difficult, and accordingly, analytical and quantitative evaluations are almost impossible. Therefore, instead of the analytical evaluation, the experimental evaluation is to be applied through the test run by various users. This system testing will provide the viewpoint analysis of the user's level, and the detail and additional requirement specifications arising from user's real situation will be feedback into the system modeling. Also. the degree of freedom of the input and output will be improved, and the hardware limitation will be investigated. Upon the refining, the prototype system will be used as a design template. and will be used to develop the more extensive system. In detail. the relevant modules will be developed for the various diseases, and the module will be integrated by the macroscopic design process focusing on the inter modularity, generality of the database. and compatibility with other systems. The Home care Evaluation System is comprised of three main modules of : (1) General information on a patient, (2) General health status of a patient, and (3) Cerebrovascular disease patient. The general health status module has five sub modules of physical measurement, vitality, nursing, pharmaceutical description and emotional/cognition ability. The CVA patient module is divided into ten sub modules such as subjective sense, consciousness, memory and language pattern so on. The typical sub modules are described in appendix 3.

• KSII Transactions on Internet and Information Systems (TIIS)
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• v.16 no.7
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• pp.2209-2224
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• 2022

The Internet of Things (IoT) is being used in a wide variety of fields due to the recent 4th industrial revolution. In particular, research is being conducted that combines IoT with the medical field such as telemedicine. Among them, the field of shock detection is a big issue in the medical field because the causes of shock are diverse, treatments are very complex, and require a high level of medical knowledge and experience. The transmission of infectious diseases is common when treating critically ill patients, especially patients with shock. Thus, to effectively care for shock patients, we propose an architecture that continuously monitors the patient's condition, and automatically recommends a drug injection treatment according to the patient's shock condition. The patient's hemodynamic information is continuously monitored, and the patient's shock generation information is recorded periodically. With the recorded patient information, the patient's condition is determined and automatically injected with necessary medication. The medical team can find out whether the patient's condition has improved by checking the recorded information through web applications. The study can help relieve the shortage of medical personnel and help prevent transmission of infectious disease in medical staff. We look forward to playing a role in helping medical staff by making recommendations for the diagnosis and treatment of complex and difficult shocks.

• Quality Improvement in Health Care
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• v.28 no.1
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• pp.45-54
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• 2022

Purpose: The study aims to identify the theme list and priority criteria of patient safety theme reports in South Korea. Methods: The survey was conducted twice, and the importance of each criterion and theme was measured on a nine-point scale using the Delphi technique by a panel of 19 patient safety experts. The criteria included severity, universality, preventability, and organizational-social impact. Descriptive statistics such as frequency, percentage, mean, standard deviation, median, and interval quartile range were used to analyze the data. Results: The parameters were assigned a weighted average of 35% for severity, 20% for universality, 30% for preventability, and 15% for organizational-social impact, respectively. The final top three rankings were surgery safety, blood transfusion safety, and medication safety. In addition to expert opinion, for the theme that is selected based on the priority ranking, one to five sub-topics can be derived from the theme based on the priority ranking, societal demands, or the yearly priority list of patient safety incidents. Conclusion: It is recommended that the official patient safety center distribute the report in the form of a summary that can be utilized nationwide at medical institutions, government institutions, and other places. Updates, as well as accumulated theme reports, will serve as the baseline data for the proposal of the system and for the policy designed to implement and improve institutions' safety practices as a standard of domestic patient safety practice guidelines.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.2 no.2
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• pp.115-130
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• 1995

The incidence of oral complications among adult cancer patients undergoing chemotherapy varies from 12 to 80%. Adequate oral hygiene has been shown to be important in prevention of oral complication and an essential role is reserved for the nursing staff. These considerations prompted the decision to survey by means of a questionaire, the nurses who give care to cancer patients. The Questions were included multidisciplinary treatment, inspection skill, nursing intervention, nursing education, problem in mouth care, solution for problem solving. - Results are fellow : 1. A total of 116 of the nurses returned the questionaire 2. According to 88.2% of the respondents, the policy with regard to oral-hygine is determined by the physician and the nurse. 62.1% of nurses do not consult the dentist When oral complication is occured. 3. In only 34.5% of case was a penight used to provide the necessary extra illumination nursing Inspection of oral cavity. 4. Frequency of oral complications observed by the respondents is that they observed complications in < 25% of patients. The nature of the complication varied from ulcer, stomatitis, infection, dry mouth, candidiasis, herpes simplix, bleeding. 5. Percentages of respondents who use the intervention indicated 1) to prevent oral complication : 0.9% normal saline gargling(44%), 0.02% chlorhexidine gargling, oral dressing(38.8%), observation, nutrition, restriction of alcohol and tabaco(23.2%) 2) to deal with the early symptoms 0.9% normal saline gargling (47.4%), cryotherapy(37.9%), 0.02% chlorhexidine gargling(20.7%) 3) to help alleviate severe complications : dental consult, holding the chemotherapy(34.5%), 0.9% normal saline gargling(31.1%), cryotherapy(18.0%) 6. According to 70% of the respondents, insufficient attention is given to oral complication during nursing education classes only 8.6% said that both the theory and the practical aspects had been deal with in sufficient detail during their training. The results of the survey indicate thatoral care in cancer patients undergoing chemothrapy has a number of problem. There are not enough dentist to provide the necessary care for patients undergoing chemotherapy. The expertise of the nurses with respect to the pathogenesis of the complication is limited. In the training of nurses, additional attention to oral examinations and oral hygine is warranted. The care of patients should be the responsibility of a multidisciplinary team approach. The nurse occupies a key position with in this team, which includes the medical oncologist, a dentist.

• Journal of Home Health Care Nursing
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• v.5
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• pp.20-31
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• 1998

The purpose of this study was to develop the framework of community-based home care nursing delivery system, and to examine the validity of it. For these, home care nursing study team of College of Nursing, Seoul National University has studied home care nursing system since September, 1996, and has operated home care center since August, 1997. This study has been supported by the Korean Sience Foundation. We organized Committee of rules, and Clinical specialist consultant group for more efficient running of the home care center. In nursing station, research assistant controlled general work, and 5 home care nurses were hired for home visiting. We developed the Standards for operations, that included criteria for clients, central supply system of nursing materials, central management of nursing care cost, advertisement, patient referral system, and so forth. In our center, 108 patients enrolled, and neurologic disorders including cerebrovascular accident, and cancer were the most prevailing diseases. We tried to overcome the limitations of hopital -based home care, and to provide more accessible, efficient, safe, and stable home care nursing. Therefore, we were referred clients from patients and families, public health care center, industries, as well as from hospitals. Meanwhile, we developed home care recording system and assessment-intervention algorithm for various diseases for quality control and standardization. Also, we did continuing education, and tried to detect problems and to find solutions by regular meeting between the committee of rules and home care nurses. As the results of this study, several limitations of operation were found. First, it was difficult to manage and communicate with the doctor in the emergency situation, Second, we spent too much time for trasnsportation, because only five nurses covered all areas of Seoul and nearby cities. Third, preparation for special care of home care nurses were lacked. Forth, criteria for termination of care and frequency of home visit were ambiguous. Fifth, some difficulties were found in retrospective payment system. And finally, interconnection with home care machinery company were needed. Strategies for solving these problems were suggested.

• Quality Improvement in Health Care
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• v.18 no.1
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• pp.27-36
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• 2012

Objectives : A protocol called "critical pathway" was developed to standardize the management of hospital patients the day after they underwent gamma knife radiosurgery. The quality of improvement in patient outcomes was evaluated. Methods : Critical pathway was developed, according to the regulations of the I hospital, by analyzing the medical records of 22 inpatients who underwent gamma knife surgery within the period from January to April 2011 on the day of the surgery. The study included a group of 22 patients admitted to the hospital the day after they underwent gamma knife radiosurgery, between July and September 2011. The control group included 22 patients who had surgery employing the same method within the period from May to June 2011. To measure the effects on quality improvement, the average length of stay, the execution rate of the hospital discharge notice system, daily hospital revenue, and the satisfaction of the patients and the medical team were assessed. The patient questionnaire employed a four-point Likert scale while the medical-staff questionnaire employed a five-point Likert scale. Result : The average length of stay was significantly shorter in the study group compared to the control group (2.3 days vs. 3.8 days, P<0.05). The execution rate of the hospital discharge notice system was higher in the study group (100% vs. 72%) than in the control group. Daily hospital revenues were higher by 264,178 Korean won in the study group when compared to the control group. The study group showed greater satisfaction of patients compared to the control group based on a four-point Likert scale (P<0.05). The study group showed greater satisfaction in medical team compared to the control group based on a five-point Likert scale (P<0.05). Conclusion : The development and implementation of a critical pathway protocol for hospital admission the day after gamma knife radiosurgery is an effective care process that improves the clinical quality.

• Quality Improvement in Health Care
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• v.20 no.1
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• pp.12-24
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• 2014

Objectives: The aim of this study was to explore whether emergency bell could shorten door to electrocardiograms (ECG) time in chest pain patients presenting to emergency department (ED) by self-transport. Methods: This was a planned 6-month before-and-after interventional study design. We set up the emergency bell in walk-in patients' waiting room. Prior to the change, patients were triaged before an ECG was obtained. In new process, as soon as patient with chest pain push the emergency bell, emergency physicians examined patient and prioritized performing ECG. We analyzed door to electrocardiograms (DTE) times for patients with chest pain and ST segment elevation myocardial infarction (STEMI) patients between two periods. Results: During the enrollment period, a total of 63 patients called emergency bell. The median DTE time was 6 min (interquartile range: 3.0 - 9.0) and 82.5% received an ECG within 10 minutes, and only three patients were STEMI. DTE time in patient with chest pain was not different between two periods (p=0.980). Before intervention period, 15 walk-in patients admitted in ED for STEMI and 53.8% of STEMI patients received an ECG within 10 minutes. After intervention period, total 19 walk-in patients admitted in ED for STEMI. Of these, 89.5% met the time requirement. Conclusion: Because a small portion of patients with chest pain activated the emergency bell, new strategy for promotion of emergency bell must be needed.

• Quality Improvement in Health Care
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• v.9 no.1
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• pp.74-89
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• 2002

Background : The purpose of this study was to investigate the incidence of unplanned endotracheal extubation and to identify the influencing factor of unplanned extubation in ICUs for providing baseline data in developing prevention strategies and administrative standards. the medical records and hospital information system. In order to analyze factors related to unplanned extubation, the subjects of this study were divided by unplanned extubation group and planned extubation group and were matched by its sex, age, and disease groups in a ratio of one to two. The data were analyzed by descriptive statistics, ${\chi}^2$- test, t-test, Fisher's exact test, and logistic regression analysis with SPSSWIN 10.0 program. Result : 1) Forty-seven(4.99%) of 942 intubated patients experienced unplanned extubation 65 times during the twelve-month period. Thirtyfour( 72.34%) of 47 unplanned extubated patients required reintubation, whereas thirteen patients(27.66%) did not. 2) About half of unplanned extubation(46.8%) occurred during the night shift. 3) As for the nursing activity, respiratory nursing activity score(P=.0.06) and total nursing activity score(P=.011) showed statistically significant differences between unplanned extubation group and planned extubation group. 4) As for the patient status, unplanned extubation group showed more lower consciousness level(P=.000), more irritable or agitated behavior(P=.000), and had more applied physical restraints(P=.000) than planned extubation group. 5) As for the intubation related variables, unplanned extubation group revealed more intubated with respiratory failure(P=.000), more dependent on mechanical ventilation(P=.015) than planned extubation group. 6) Factors affecting unplanned extubations in intensive care unit patients were irritable or agitated behavior(odds ratio=13.757), night shift(odds ratio=7.166), and mechanical ventilation(odds ratio=6.257) from conditional logistic regression analysis. Conclusion : The most affecting factor of unplanned extubation was agitated or irritable behavior. Therefore the results of this study could be helpful to ICU nurses for meticulous care, decision making, timely intervention, and development of intervention strategies for preventing unplanned extubation.

• The Korean Nurse
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• v.37 no.1
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• pp.98-106
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• 1998

The purpose of this study was to investigate what effect providing the hospice care team with hospice education programs had on the death orientation. The subjects of study were 28 volunteers. 14 nurses. 30 clergies who registered on hospice education programs from Aug. 6th. 1996 to May 20th. 1997. The data were analysed by descriptive analysis. ANOVA. Duncan test. paired t-test. The results of the study can be summarized as follows ; 1. The degrees of death orientation were 85.70 in volunteers group. 84.31 in nurses group. and 73.00 in clergies group. So. clergies group has more positive death orientation than others(F=6.33. p=. 000). The degree of death orientation showed significant differences between age groups(F=5.78. p =.002). and religiosity(t=3.92. p=.000). There were no significant differences between the degree of death orientation and the others general characteristics of subjects. 2. The mean of death orientation was 80.04 before hospice education programs. but was 75.56 after hospice education programs(t= 3.92. p= .000). In conclusion. the subjects who received the hospice education programs showed the positive change in the degree of the death orientation. Therefore. it has been judged that education programs has been prerequisite in positive death orientation for hospice care. Furthermore. all of the hospice care members those who complete the hospice education program. will be performed efficient hospice care intervention for dying patients and their families.