• 의료법학
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• 제13권1호
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• pp.359-395
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• 2012

In a broad term, health and medical data means all patient information that has been generated or circulated in government health and medical policies, such as medical research and public health, and all sorts of health and medical fields as well as patients' personal data, referred as medical data (filled out as medical record forms) by medical institutions. The kinds of health and medical data in medical records are prescribed by Articles on required medical data and the terms of recordkeeping in the Enforcement Decree of the Medical Service Act. As EMR, OCS, LIS, telemedicine and u-health emerges, sharing and protecting digital health and medical data is at issue in these days. At medical institutions, health and medical data, such as medical records, is classified as "sensitive information" and thus is protected strictly. However, due to the circulative property of information, health and medical data can be public as well as being private. The legal grounds of health and medical data as such are based on the right to informational self-determination, which is one of the fundamental rights derived from the Constitution. In there, patients' rights to refuse the collection of information, to control recordkeeping (to demand access, correction or deletion) and to control using and sharing of information are rooted. In any processing of health and medical data, such as generating, recording, storing, using or disposing, privacy can be violated in many ways, including the leakage, forgery, falsification or abuse of information. That is why laws, such as the Medical Service Act and the Personal Data Protection Law, and the Guideline for Protection of Personal Data at Medical Institutions (by the Ministry of Health and Welfare) provide for technical, physical, administrative and legal safeguards on those who handle personal data (health and medical information-processing personnel and medical institutions). The Personal Data Protection Law provides for the collection, use and sharing of personal data, and the regulation thereon, the disposal of information, the means of receiving consent, and the regulation of processing of personal data. On the contrary, health and medical data can be inspected or delivered of the copies, based on the principle of restriction on fundamental rights prescribed by the Constitution. For instance, Article 21(Access to Record) of the Medical Service Act, and the Personal Data Protection Law prescribe self-disclosure, the release of information by family members or by laws, the exchange of medical data due to patient transfer, the secondary use of medical data, such as medical research, and the release of information and the release of information required by the Personal Data Protection Law.

• 의료법학
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• 제14권2호
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• pp.217-260
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• 2013

In connection to the civil liability of the medical malpractice, plaintiff and courts are solving the medical disputes with theory of the liability based on tort law. because contract law does not enact the right of claim of solatium and a plaintiff's lawyer and courts hesitate to use contract law. Medical treatment of doctor is main debt in medical contract and its in-complete performance gives rise to the violations of human's life, body and health. Consequently a breach of medical contract leads to violations of person-al rights. These violations spring from liability of contract as well as tort and damages from them are recognized based on medical contract law. A duty of explanation of doctor is a independent and appendant debt to the treatment debt. However its breach provokes violations of human's life, body and health as well as a right self-determination. Therefore consolation money claim should be recognized. In case of the violation of patient's life, body and health, patient's family al-so can demand consolation money due to the violation of their's own mental pain. However in case of the violation of only patient's self-determination without informed concent, they can not demand it by reason of the violation of patient's self-determination. But by reason of the violation of patient's life, body and health that were recognized by proximate causal relation between violation of duty of explanation and abd execution, they can do.

• 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.

• 대한간호학회지
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• 제16권3호
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• pp.108-122
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• 1986

Changing concepts of health care, are stimulating the demand for health care, thereby orienting society to health care rights to such an extent that they are deemed as fundamental ones inalienable to man. Concomitantly, qualitative as well as quantative improvement is being sought in the nursing service field. Today, efforts are being made in various areas, especially to qualitatively improve nursing services. A second issue concerns proper staffing. It is important to study staffing, in as much as it continues to be the most persistent and critical problem facing hospital nursing administrators today. It involves quantity, quality, and utilization of nursing personnel. A great deal of attention has been focused on this problem since mid 1930's when nursing services began to be felt as an important segment of hospital operation representing the largest single item of hospital budgets. Traditionally, the determination and allocation of nursing personnel resources has relied heavily on gloval approaches which make use of fixed staff-to-patient ratios. It has long been recognized that these ratios are insensitive to variations between institutions and among individual patients. Therefore, the aim of this thesis is to point to the urgent need for the development of methodology and criteria suited to the reality of Korea. The present research selected one place, the W Christian Hospital, and was conducted over a period 10 days from January, and nurses who were them on duty in their unit. The total num-her of patients surveyed was 1,426 and that of 354. The research represents many variables affecting the direct patient care time using the result from the direct observation method, then using a calculation method to estimate the relationship between the patients care time and selected variables in the hospital setting. The amount of direct patient care time varies with many factors, such 89 the patients age. diagnosis and time in hospital. Differences are also found from hospital, clinic to clinic, ward to ward, and even shift to shift. In this research, the calculation method of estimating the required member of nursing staff is obtained by dividing the time of productive patient care activity(with the time of patient care observed), by the sum of the productive time that each the staff can supply, i.e., 360 minutes, which is obtained by deducting the time for personal activities. The results indicate a substantial difference between the time of productive patient care observed directing and the time of the productive patient care estimated using calculating method. If we know accurately the time of the direct patient care on a shift, there required number of staff members calculated if the proper method can be determinded should be able the time of the direct patient care be estimated by the patient classification system, but this research has shown this system to be in accurate in Korea. There are differences in the recommended time of productive patient care and the required number of nursing staff depending upon which method is used. The calculated result is not very accurate, so more research is needed on the patient classification system.

• Journal of Hospice and Palliative Care
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• 제18권1호
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• pp.42-50
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• 2015

목적: 본 연구는 장기요양 입소시설의 사회복지사를 대상으로 임종의료결정 권리, 사회복지사의 역할 이해도를 분석하고, 이들의 상관관계를 분석하고자 한다. 방법: 본 연구는 설문지를 사용하여 수집된 자료 334부 중 분석에 포함하기 어려운 37부를 제외한 297부를 SPSS 20.0을 이용하여 T-test, 분산분석, 상관관계분석 등을 실시하였다. 결과: 사회복지사가 이해하는 노인환자와 가족의 임종의료결정 권리 이해도는 5점 만점에 $3.46{\pm}0.69$, 사회복지사 역할 이해도는 $3.48{\pm}0.84$이다. 사회복지사의 사전의료의향서 및 연명치료 결정 도움 경험, 임종의료결정 도움 업무, 근무 경력, 침상 수 등에 따라 임종의료 결정 권리 및 사회복지사 역할 이해도에 의미 있는 수준에서 집단 간 차이를 보였다. 임종의료결정 권리와 사회복지사 역할 이해도와의 상관관계는 의미 있는 수준에서 긍정적인 상관관계를 보였다(Pearson r=0.329, P<0.001). 결론: 장기요양 입소시설에서 노인환자와 가족에게 사전의료의향서 및 연명치료 결정 도움을 제공하는 사회복지사 역할의 중요성을 인식하고, 노인환자와 가족의 임종의료결정 권리를 보호하기 위하여 임종의료결정에서의 사회복지사 역할 수행을 위한 교육이나 훈련 프로그램의 개발이 필요하다.

• 한국산학기술학회논문지
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• 제14권3호
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• pp.1274-1282
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• 2013

본 연구는 상부 위장관 출혈 환자 간호에 시뮬레이션 기반 학습을 적용하여 임상수행능력에 대한 자신감 변화와 시뮬레이션 만족도를 알아보고자 간호대학생 77명을 대상으로 하였다. 본 연구방법은 단일군 전후설계방법을 이용하였으며, 임상수행능력에 대한 자신감 변화는 paired t-test를, 시뮬레이션 만족도는 기술통계로 분석하였다. 임상수행능력에 대한 자신감 점수는 시뮬레이션 전에 비해 후의 점수가 유의하게 증가하였다. 시뮬레이션 만족도 점수는 4.20점(5점 척도)로 높게 나타났으며, 학습자 만족도와 동기유발 항목에서 4.54점으로 제일 높은 점수를 보였다. 시뮬레이션 기반 학습이 임상수행능력과 학습만족도에 긍정적인 효과를 보였으므로 다양한 주제로 시뮬레이션 기반 학습을 간호학 교과과정에 적용하여 운영하는 것이 필요하다.

• 간호행정학회지
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• 제22권4호
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• pp.406-414
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• 2016

Purpose: The purpose of this study was to analyze the concept of nurses' safety within the context of the hospital environment. Methods: We used Rodgers' method of evolutionary concept analysis and reviewed the relevant literature and noted and categorized characteristics that appeared frequently. Results: Nurses' safety was defined as safe status and safe activity among nurses. Three key defining attributes were identified as: (a) the minimization of actual or perceived risk, (b) personal duties and rights, and (c) ensuring within a safe working environment. Antecedents of nurses' safety were categorized into three dimensions: (a) individual, including vigilance and knowledge gained through education and training; (b) institutional, including safety provision in the organizations; and (c) national, including legislation. The outcomes of nurses' safety included the following: (a) continued competence in nurses' work; (b) enhancement of the quality of patient care; and (c) reductions in nurses' turnover rates. Conclusion: Nurses' safety ensures that qualified nurses are able to continue to perform their duties and provide good patient care. The findings of this study could contribute to future research examining nurses' safety. In addition, appropriate tools must be developed to measure the concept.

• 의료법학
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• 제9권1호
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• pp.319-382
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• 2008

As a withdrawing care's study, the purpose of this study is searching about withdrawing care's acceptance and circumstances through Bora-mae hospital case(chapter 1). Withdrawing life-sustaining treatment has various forms. Though the meaning of euthanasia, death with dignity, natural death, physician assisted suicide are duplicated, the meaning of those are different slightly. Firstly, this study looks about the difference of the those meaning and acceptance range(condition) by withdrawing care's forms(chapter 2). Bora-mae hospital case sentenced guilty about physician who discharged incompetent patient who was after surgery by patient's wife determination. This Bora-mae case that sentenced guilty about discharge against medical advise(DAMA) that is regarded to custom has brought intensive confliction of legal, social, medical aspect, Bora-mae hospital case has many legal problems. First, as to criminal law rule 250(murder), the problem is whether discharge and withdrawing life-sustaining treatment is commission or omission. this study concluded omission(district court: omission, appeal, supreme court: commission). Because legal denounce point of discharge and medical treatment withdrawing is omission that physician who is obligatory on patient to cure. If physician's act is regarded omission, it is necessary to determine whether he has guardian status and obligation. Without guardian status and obligation, omission crime can't exist. This study decided that physician had guardian status and obligation and foundation of guardian status was pre-action or acceptance of emergency patient. Physician's medical treatment duty finished when patient(or patient's guardian) demands discharge. But when patient death is foreseen and other possible treatment does not exist, his duty of life prolonging treatment does not finish. This originate from physician's social responsibility and public status that limits patient's private liberty. This study regarded physician's action as accomplice about whether physician's discharging action is accomplice or the principal offender(district court: the principal offender, appeal, supreme court: accomplice). Though the principal offender needs criminal determination and action, there is no this common determination and functional action control of physician in Bora-mae case(chapter 3). Bora-mae hospital case partly originated from deficiency of legal, institutive system including medical security system shortage, the instruction is 1. medical security system strengthening, 2. hospital ethical committee's activity strengthening, 3. institutionalization of withdrawing life-sustaining treatment, 4. acceptance of pre-decision making system, 5. sufficient persuasion of physician for patient and faithful writing of medical paper, 6. respect for patients' self-determination and rights, 7. consciousness's changing for withdrawing life-sustaining treatment and persistent education about medical ethics(chapter 4). Considering Bora-mae case, medical sector is not the dead ground of a criminal punishment. Intervention of criminal law in medical sector give rise to ill effect, that is, excess medical examination and treatment, safeguard treatment, delay of discharge from a hospital. Because sufficient guarantee of life becomes mere empty slogan under situation that impose a burden of heavy cost to family or hospital, public and systematic solution should be given(chapter 5).

• 디지털융복합연구
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• 제13권4호
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• pp.227-233
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• 2015

최근 IT 기술의 발전과 함께 의료 기술 또한 급격하게 발전하게 되어 헬스케어 서비스를 제공받는 환자의 정보(의료정보, 질병정보 등)가 의료 서비스에서 다양하게 사용되고 있다. 그러나, 환자의 질병정보가 헬스케어 서비스에서 다양하게 사용되면서 환자 치료 방법에 대한 복잡성과 불확실성 또한 증가하여 병원은 환자 치료에 대한 의사결정이 더욱 어려워지고 있다. 본 논문에서는 헬스케어 서비스를 제공받는 환자의 치료를 효율적으로 처리하기 위해서 환자질병정보를 빅 데이터로 관리 할 수 있도록 효율성을 고려한 다기준의사결정벙법 중 하나인 퍼지 AHP를 사용한 헬스케어 환자의 효율적인 빅 데이터 관리 기법을 제안한다. 제안 기법은 환자의 질병정보들 간의 상관관계를 통해 치료기준들 간의 쌍대비교 척도를 삼각퍼지화하여 환자의 현실적 치료 방법을 찾도록 하는 것을 목적으로 한다. 제안 기법은 쌍대비교를 통해 질병 치료들간 퍼지이론의 삼각퍼지수를 적용하여 상대적인 중요도를 산출 한 후 치료 방밥에 대한 효율성을 구한다. 또한 제안 기법은 환자의 질병치료를 결정하기 위한 방법들을 계층화하여 삼각퍼지수를 이용한 쌍대비교 행렬을 구현한 후 질병치료기준별 대안에 대한 중요도를 계산하여 각 치료별 효율성을 분석하여 최종 질병치료 방법을 선택하기 때문에 기존 질병치료 방법보다 판단 및 치료의 애매함과 부정확성 상태를 5.8% 개선하고 있다.

• International Journal of Advanced Culture Technology
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• 제10권3호
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• pp.39-46
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• 2022

This study is an attempted content analysis study to analyze recent studies on clinical practice of nursing college students to identify problems with clinical practice and provide evidence for desirable clinical practice. For data collection, a total of 14 papers published in academic journals between 2017 and 2021 were selected. The analysis method was performed according to the systematic review reporting guidelines presented by Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) group. As a result of the analysis, two themes, Four sub-themes, and seventeen concepts were derived, and the clinical practice study of nursing college students showed the necessity of standardized clinical practice protocol regulations for nursing college students and respect for patient human rights. Based on the above research results, it is proposed to prepare a nursing and clinical practice protocol that can clearly present the role of nursing college students during clinical practice.