• 의학교육논단
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• 제21권2호
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• pp.80-91
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• 2019

The tripartite mission of 'academic medicine' is education, research, and patient care. Academic medical centers (AMCs) are carrying out the mission and ultimately aiming to improve the health of people and communities. Globally, AMCs are facing a tremendous financial risk stemming from the changes in health insurance reimbursement plans and a shortage of human resources. Innovative AMCs in the United States are trying to transform their physician-centered, and siloed structure into a patient-centered, and integrated structure. They are also building integrated systems with primary healthcare groups to provide continuous patient care from primary to tertiary levels and making strategic networks based on value-based payment and the patient-centered model. These changes have been proven to improve outcomes of patient care and increase fiscal revenues, which are both crucial in supporting education and research. To address the shortage of human resources, programs are being built to develop newly appointed faculty for the future. AMCs have different approaches to bringing changes into their organizations; however, there is a common emphasis on 'a patient-centered approach,' which helps them set more explicit organizational values and make strategic decisions based on their values. Korean AMCs are facing similar challenges to AMCs in the United States in spite of many differences between the countries' healthcare systems. The innovative efforts of AMCs in the United States to address the challenges will be helpful, well-worked examples for Korean AMCs with similar challenges.

• Nuclear Engineering and Technology
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• 제40권7호
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• pp.527-532
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• 2008

As therapeutic uses of radionuclides in nuclear medicine increases, the use of patient-specific methods for calculation of radiation dose becomes more important. In this manuscript basic methods and resources for internal dose calculations are outlined, with a focus on how current changes and advances are making more accurate and detailed, patient-individualized dose calculations possible. Most current resources make use of standardized models of the human body representing median individuals, but the use of image-based and more realistic models will soon take their place, and will permit adjustments to represent individual patients and tailor therapy planning uniquely for each subject.

• 한국멀티미디어학회논문지
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• 제22권7호
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• pp.804-814
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• 2019

The patient's waiting time and length of stay have been reported as a factor decreasing their satisfaction in the hospital, especially in developing countries. This paper focuses on modeling hospital's outpatient department workflow in a developing country and optimizing the patient waiting time as well as total length of stay. By using discrete-event simulation, many alternative scenarios have raised, such as adding more working time, altering human resources, and adjusting the staff's responsibility, those scenarios will be examined to explore better settings for the hospital. The results show that possible to achieve a 9.6% reduction in patient total length of stay and it could be accomplished without adding more resources to the hospital.

• 성인간호학회지
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• 제14권1호
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• pp.125-134
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• 2002

Purpose: The objectives for this study were to identify the factors that correlate with appraisal of illness and to explore what variables are predictive of cancer patients primary caregivers' cognitive appraisal for stress. Method: The subjects were selected by convenient sampling and 130 caregivers who completed a questionnaire. Measures used in this study included the Family Inventory of Resources for Management, Social Support Index, Family Crisis Oriented Personal Evaluation Scales and Family Coping Coherence Index. Pearson correlation was used to identify the relationship among factors and multiple regression was used to determine the individual and cumulative effect of potential predictors on the caregivers' appraisal. Results: Patient's level of activity, severity of the disease, quality of relation between patient and caregiver, caregiver's subjective health status, economic status, family resources and coping were significantly correlated. Among the variables, coping, family resources, economic status and quality of relation between caregiver and patient predicted 49.2 percent of the variance in appraisal of caregivers' stress condition. Conclusion: These findings suggest that coping mechanisms and family resources are important for positive appraisal. Nurses should provide adequate nursing care for the primary caregiver about professional care information and supportive counseling.

• 대한간호학회지
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• 제36권6호
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• pp.983-991
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• 2006

Purpose: The purpose of this study was to identify the relationship among quality of life, family coherence, family hardiness, and family resources of the family care-giver caring for a cancer patient. Method: Data was collected by questionnaires from 137 families with a cancer patient at a General Hospital and Government Cancer Hospital. Data was analyzed using descriptive statistics, pearson correlation coefficients, and stepwise multiple regression. Results: The score of quality of life showed a significant positive correlation with the score of the level of family sense of coherence, family hardiness, and family resources. The most powerful predictor of quality of life was sense of coherence and the variance was 30%. A combination of sense of coherence and family resources account for 34 % of the variance in quality of life of the family care-giver caring for a cancer patient. Conclusion: The results showed that family sense of coherence, hardiness, and family resources were significant influencing factors on the quality of life of the family care-giver caring for a cancer patient.

• 대한간호학회지
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• 제45권5호
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• pp.761-772
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• 2015

Purpose: This study was done to evaluate the experience of securing patient safety in hospital operating rooms. Methods: Experiential data were collected from 15 operating room nurses through in-depth interviews. The main question was "Could you describe your experience with patient safety in the operating room?". Qualitative data from the field and transcribed notes were analyzed using Strauss and Corbin's grounded theory methodology. Results: The core category of experience with patient safety in the operating room was 'trying to maintain principles of patient safety during high-risk surgical procedures'. The participants used two interactional strategies: 'attempt continuous improvement', 'immersion in operation with sharing issues of patient safety'. Conclusion: The results indicate that the important factors for ensuring the safety of patients in the operating room are manpower, education, and a system for patient safety. Successful and safe surgery requires communication, teamwork and recognition of the importance of patient safety by the surgical team.

• 간호행정학회지
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• 제7권3호
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• pp.497-509
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• 2001

The purpose of this study was to examine frequency of job performance, level of urgency, index of importance experienced by 138 new nurses who were working at 6 hospitals that had over 400 bed in Incheon and Bucheon. The data were analyzed using a SPSS program for descriptive statistics [numbers of job performance, level of urgency, index of importance(job performance+1/4 level of urgency)]. Some of the most frequent job performance were application of aseptic technique, application of principle of infection control, and medication (IV, PO, IM, supply fluid and electrolyte). Some of the most uncommon job performance were activity as a lecturer in nursing department, activity of arrangement of community resources, and participation in multidisciplinary conference. Some of the highest level of urgency were use of aseptic technique, CPR, application of principle of infection control, defibrillation for dysrhythmia, blood transfusion, observation of patient's status in procedure (operation), v/s check, intervention for improvement of respiratory function and medication of antihypertensives. Some of the lowest level of urgency were activity as a lecturer in nursing department, preceptor's activity, supervisor and delegation of job to nurse aids, attendance at nursing conference, activity of arrangement of community resources, participation in clinical teaching practice, participation in multidisciplinary conference, and delegation of patient care. Those were indirect patient care. The order was physiologic integration(60.99%), safety and effective nursing environment, psychosocial care, and health maintenance and improvement. The most importance item in maintenance of physiologic integration was medication. Some of the highest index of importance were aseptic technique and application of principle of infection control, v/s check, observation of patient's status in operation and medication. Some of the lowest index of importance were activity as a lecturer in nursing department, preceptor's activity, activity of arrangement of community resources, participation in multidisciplinary conference, nursing conference, participation in clinical teaching, and delegation of job to nurse aids.

• 대한간호학회지
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• 제17권1호
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• pp.9-23
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• 1987

Nursing service, as the largest user of labor resources, has become concerned about appropriate allocation of staffing resources. Therefore, this project was designed to measure quantitatively the direct nursing care provided to patients and to develop a new patient classification system based on the direct nursing care activities. The initial step in the development of the classification instrument was to identify the content of direct nursing activities. The frequency with which these activities were carried out, the total time spent in carrying them out and the average time for one performance of each of the nursing activities was calculated. The next step was to select the items for the classification instrument taking into account these direct nursing activities. A list of 40 items was prepared. These items were then classified into 8 major categories: personal hygiene, moving ＆ exercise, nutrition & elimination, observation, medication, treatment, collecting specimens and other care activities for severity ill patients. Each item was assigned a value unit based on the average time required by the nursing staff to complete the specific item. The third step was to determine the practicality of the items and value units, so an attempt was made to establish content validity for these items and units by obtaing a consensus from 8 head nurses, representing eight different departments. The 4th step was to conducted a pilot study to establish the score range for the classification boundaries. For this purpose an instrument was designed using the list of items and value units and a prepared classification criteria as a guideline to validate the patient classification. A judgment group consisting of 52 supervisory nurses and head nurses were asked to select the proper patient to fit each classification criteria and to fill out the instrument for each patient. The total value unit and the frequency for each classification group was calculated. According to the frequency distribution, the score range for the classification group was determined as follows : 0~15 for groupI, 16~30 for group II, 31~50 for group III, and above 51 for group IV. Finally a patient classification form was developed.

• 한국의료질향상학회지
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• 제2권2호
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• pp.32-45
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• 1996

Background : A critical path defines an optimal sequencing and timing of interventions by physicians, nurses, and other staff for a particular diagnosis or procedure, designed to better utilize resources, maximize quality of care, and minimize delays. It can be thought of as a visualization of the patient care process. In this study, a review of appendectomy patient records was undertaken to identify a critical path for the management of this treatment. Methods: For this study, records of patients under 15 or over 65 years of age were excluded ; cases where the patient was pregnant, or where complications developed were also excluded. The remaining 21 cases were divided into two categories according to the indication for appendectomy : for acute appendicitis, and for perforated appendix or drainage of periappendical abscess. The time frame for the review was from patient examination immediately prior to operation, through discharge. The study team was composed of a surgeon, research head nurse, education head nurse, surgical part head nurse, and medical recorder. Following their review of the 21 charts, the team determined an appropriate progression and schedule for an appendectomy. Result : Through the chart and literature review, the following aspects of the care process were identified as typical and tracked : monitoring/assessment, treatment, lines/drains, medication, activity, diet, tests and patient education. Conclusion : From this study, the design team determined two separate critical paths : one for appendectomy only, and one for appendectomy plus drainage. Next, these paths must be validated and fine-tuned through clinical implementation. In addition, a comparison of our design with the critical paths determined at other hospitals would be extremely valuable for advancing research in this area. Lastly, the critical path approach to improving patient care and maximizing hospital resources should be applied to other procedures.

• 한국의료질향상학회지
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• 제18권1호
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• pp.57-70
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• 2012

Background : The purpose of this study was to understand healthcare workers' perception of patient safety culture and medical error reporting to provide basic resources for the settlement of patient safety culture in medical institutions in Korea. Methods : For this purpose, convenience sampling by self-selection was applied to healthcare workers at a university hospital in Gyeonggi-do and a total of 482 people responded. The survey used the translated version of AHRQ in Korean and distributed through the Intranet system of the hospital. Result : The ratio of positive response was low overall. Among the responses, the response for 'Nonpunitive Response to Error' was the lowest at 17.7%, followed by the responses for 'Staffing' at 21.3%, 'Handoffs & Transitions' at 32.9%, and 'Communication Openness' at 44.3%. In result of surveying whether the responders have reported patient safety incidents during the past 12 months, 68.3% responded 'not once.' Conclusion : The perception of healthcare workers' patient safety culture and medical error reporting, when compared to AHRQ, was lower overall. It is important for healthcare workers to pay greater attention to patient safety to create a safe hospital culture where they do not punish or criticize related individuals or departments.