• Journal of Hospice and Palliative Care
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• 제25권1호
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• pp.1-11
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• 2022

The Act on Decisions on Life-Sustaining Treatment has been in effect since 2018 for end-of-life patients. However, only 20~25% of deaths of terminally ill patients comply with the law, while the remaining 75~80% do not. There is significant confusion in how the law distinguishes between those in the terminal stage and those in the dying process. These 2 stages can be hard to distinguish, and they should be understood as a single unified "terminal stage." The number of medical institutions eligible for life-sustaining treatment decisions should be legally expanded to properly reflect patients' wishes. To prevent unnecessary suffering resulting from futile life-sustaining treatment, life-sustaining treatment decisions for terminal patients without the needed familial relationships should be permitted and made by hospital ethics committees. Adult patients should be permitted to assign a legal representative appointed in advance to represent them. Medical records can be substituted for a patient's judgment letter (No. 9) and an implementation letter (No. 13) for the decision to suspend life-sustaining treatment. Forms 1, 10, 11, and 12 should be combined into a single form. The purpose of the Life-sustaining Medical Decisions Act is to respect patients' right to self-determination and protect their best interests. Issues related to the act that have emerged in the 3 years since its implementation must be analyzed, and a plan should be devised to improve upon its shortcomings.

• 간호행정학회지
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• 제4권1호
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• pp.247-275
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• 1998

The purpose of this study was to offer the results of content analysis and qualitative study that explored the perceptions about quality nursing care of patients and families as consumers and to identify the implications of this study for quality nursing care management and research. The data was collected from 12 adult patients and 9 families who were admmitted at medical and surgical nursing unit of one university hospital in Seoul from October, 1996 to January, 1997. Research participants were asked to response "what do you think quality nursing care?" and similar questions during the interviews was performed. Data were analyzed using open coding and content analysis with frequencies and percents of attributes of quality nursing care. Attributes of quality nursing care and meaning of quality nursing care that patients and families perceived were explored. 1. The attributes of quality nursing care that patient and families perceived were categorized into 56 attributes. The highest response rate among the attributes was 'one's heart at ease' (76.2%), and the next high response rates were ranked in order 'consideration' , 'care about' (each 61.9% 'expert skill' (57.1%), 'deal with problem promptly' , 'information offer' (42.9%), 'intimate feeling' (38.1%), 'smile' 'service spirit' , 'do one's best' (each 33.3%), 'frequent visit' (23.8%), 'observe the time' (23.8%), 'direct nursing care' , 'speaking warmly' , give a hope' , 'address kindly' , 'a sense of duty' , 'good facilities' (each 19.0%), 'inquire after a patient health' , 'patient-centered nursing care' , 'showing an example' , 'professional knowledge' , 'careless moraly patient' , 'give encourage to patients' , 'good answer a question' (each 14.3%), 'do not imprudently' , 'do not disregard' , 'broad knowledge' , 'emergency treatment skill' , 'dependability' ,'consolation' giving a sense of security' , 'a self sacrificing spirit' , 'a sense of responsibility' 'hard - working', 'enough disposition of nursing staff (each 9.5%), 'improve patient's pride' and the rest attributes exhibited 4.7%, respectively. 2. The attributes that were identified in patients' data only were 8 categories, 'service sprit' (58.3 %) 'expert knowledge' , 'good answer a question' (each 25.0%), 'hard working' (16.7%), 'a warm character', 'professional attainments', 'do without reserve', 'satisfaction' (each 8.3%), 3. The attributes were identified to families' data only were 31 categories, 'speaking warmly' , 'direct nursing care', 'adress kindly', 'patientcentered nursing care', 'showing an example' (each 33.3%). 'do not imprudently' , 'do not disregard' , 'consolation', 'giving a sense of security', 'broad knowledge' , 'emergency treatment skill', 'dependability' ,'a self - sacrificing spirit', 'a sense of responsibility' (each 22.2%), 'improve patient's pride' , 'without discrimination' , 'show kindness' , 'individual nursing care', 'being with patient' , 'helping' , 'accuracy' , 'without any mistake' , 'love' , 'self - confidence', 'self possession', 'a self - denying spirit' , 'a sense of duty' , 'tighten discipline' , 'disposed room with similar patient to diagnosis', 'compensatory relationship between me dical team' , 'role of connection' (each 11.1 %). 4. The attributes of quality nursing care were integrated into 11 categories that they were 'patientcentered nursing care' (25.1%), 'expertise' (22.1%), 'caring'(18.1%), 'kindness'(11.1%L 'nurse attainments(10.1%), 'sincerity' (7.5%), 'good environment' (2.0%), 'effective organizational management', 'coordination', 'enough nursing staff' ( each 1.0%), 'satisfaction' (0.5%) were showed in the order of the highest rate. 5. The concept of quality nursing care were defined as 'give a satisfaction to patients by patientcentered care based on professional skill and caring with kindness and sincerity'. The description of the meaning of quality nursing care provided by this research participants, patients and families can provide important information for quality nursing care management, medical marketing, education and researches of this field. On the basis of the above findings the following recommendations are made: to suggest to utilize this results for patient care in practice setting, development of quality assessment tool in nursing care, repeat study by the same subjects and method, and to a comparative study by the same method to nurse.

• 한국의료질향상학회지
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• 제29권2호
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• pp.47-63
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• 2023

Purpose:This study aims to suggest the future direction for applying service design to improve the quality of healthcare as part of hospital service innovation and present implementation plans in Korea, based on a review of quality improvement activities and the current status of service design applications. Methods: Through a literature review, we examined the status of service design introduction and application in the healthcare field, focusing on cases in the US and Europe. The possibility and limitations of service design in the healthcare field were examined through a comparison of oversea and domestic cases. Results: Recently, service design has begun to be applied to the healthcare field worldwide. Service design shows the possibility of an alternative that alleviates and complements the limitations of existing quality improvement activities. It also offers the possibility of creating new organizational improvement and innovation approaches through integration and convergence with existing quality improvement activities and management innovation. Conclusion: To effectively apply service design to hospitals, it is necessary to integrate internal organizations related to service improvement, combine methods, and objectively measure and evaluate performance. To this end, we propose the operation of a nationwide education and training center for quality improvement and service design led by academic society. Service design will provide an opportunity to change the management innovation and organizational culture of hospitals beyond the scope of the current quality improvement, which deals only with micro-subjects of individual hospitals.

• Journal of Preventive Medicine and Public Health
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• 제47권4호
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• pp.236-243
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• 2014

Objectives: Despite the recent emphasis on a patient-centered chronic care model, few studies have investigated its use in older adults in South Korea. We explored how older Korean adults perceive and cope with their chronic illness. Methods: We conducted focus group interviews in Seoul, Korea in January 2010. Focus groups were formed by disease type (hypertension and type 2 diabetes) and gender using purposive sampling. Inclusion criteria were patients aged 60 and over who had been diagnosed with diabetes or hypertension and received care at a community health center for at least six months prior to participation. Interview data were analyzed through descriptive content analysis. Results: Among personal factors, most participants felt overwhelmed when they received their diagnosis. However, with time and control of their acute symptoms using medication, their worry diminished and participants tended to denying being identified as a patient or sick person. Among socio-familial factors, participants reported experiencing stigma with their chronic illness and feeling it was a symbol of weakness. Instead of modifying their lifestyles, which might interfere with their social relationships, they resorted to only following their medicine regime prescribed by their doctor. Participants also reported feeling that their doctor only prescribed medications and acted in an authoritative and threatening manner to induce and reinforce participants' compliance with treatment. Conclusions: For successful patient-centered management of chronic illnesses, supportive environments that include family, friends, and healthcare providers should be established.

• 의학교육논단
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• 제24권2호
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• pp.79-92
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• 2022

With increasing demands for medical care by society, the medical system, and general citizens and rapid changes in doctor's awareness, the competencies required of doctors are also changing. The goal of this study was to develop a doctor's competency framework from the patient's perspective, and to make it the basis for the development of milestones and entrustable professional activities for each period of medical student education and resident training. To this end, a big data analysis using topic modeling was performed on domestic and international research papers (2011-2020), domestic newspaper articles (2016-2020), and domestic social networking service data (2016-2020) related to doctor's competencies. Delphi surveys were conducted twice with 28 medical education experts. In addition, a survey was conducted on doctor's competencies among 1,000 citizens, 407 nurses, 237 medical students, 361 majors, and 200 specialists. Through the above process, six core competencies, 16 sub-competencies, and 47 competencies were derived as subject-oriented doctor's competencies. The core competencies were: (1) competency related to disease and health as an expert; (2) competency related to patients as a communicator; (3) competency related to colleagues as a collaborator; (4) competency related to society as a health care leader (5) competency related to oneself as a professional, and (6) competency related to academics as a scholar who contributes to the development of medicine.

• 중환자간호학회지
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• 제13권3호
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• pp.51-61
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• 2020

Purpose : This study aimed to explore and describe good nursing experiences of patients with cancer. Methods : Data were collected using individual in-depth interviews with 15 males and 8 females who were hospitalized in a Korean cancer hospital. The transcribed script was analyzed using Colaizzi's phenomenological method. Results : As a result, three theme clusters and nine themes were identified. The three theme clusters were as follows: "being kind and expert in every step along the cancer care trajectory," "taking an omnipotent mediator role supporting patients' well-being," and "providing professional care touching patients' mind and body." Three themes were assigned to each cluster to illustrate the given phenomena. Conclusion : Cancer patients wanted considerate understanding and sincere care from nurses while they experienced physical and emotional suffering owing to the cancer, treatment trajectory, and hospital system. To improve the quality of nursing care for cancer patients, patient-centered care combined with nurses' expertise in oncology care must be provided based on the insights from our study's findings.

• 한국의료질향상학회지
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• 제14권1호
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• pp.49-54
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• 2008

Background : This study was to reduce incidence of falls by analyzing actual problem and drawing out improvement plan applicable to the clinical practice through operation of the staff nurses-centered fall peer review group. Method : The fall peer review group was composed of 8 nurses having patient nursing experience for over 5 years, and each of fall cases was reviewed and the root cause was analyzed. As a result, it was found that the patients and their families did not fully understandthe content of the education, and the staff nurses did not completely inspect the risk factors of falls and perform immediate intervention when patient's condition changed. Based on the above-mentioned results, improvement activity was conducted for the purposes of consolidating patients education method and supplementing computerized system to support nurses' decision making as well as devices and facilities. Result : As a result of conducting improvement activity in the aspects of education for patients, support of nurse's decision-making, and devices and facilities through operation of the staff nurses-centered fall peer review group, falls decreased by 9.5% compared to before improvement activity. Conclusion : It is concluded that operation of the clinical nurses-centered fall peer review group played a role of promoter to draw out practical and applicable improvement plan to the clinical practice and apply directions of the field-centered, and increased nurses' interest in falls and ultimately, reduced incidence of falls. Therefore the Center will continue to operate the staff nurses-centered peer review group, and recommends participation of nurses who actually take the charge of nursing patients in further analysis of patients' safety accidents.

• 한국병원경영학회지
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• 제22권3호
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• pp.133-143
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• 2017

Purpose : This study is to analyze the inpatients's experience of medical services provided by hospital including medications, treatments, and environment. Based on the results of surveys conducted as part of the inpatient experience evaluation in A hospital in Goyang, Gyeonggi province. Methodology : A sample of 300 adults aged 19 years or older who had more than one day of hospitalization was selected. The questionnaire was conducted from April 3rd to June 21st, 2017 by telephone. Findings : It is found that recommendation intention influenced by medical services, hospital environment, medication treatment process. but it turns out that there is no moderate effects of health condition between patient's experience and recommendation. Practical Implication : In order to improve the inpatient experience, there should be a way to improve experience in providing patient-centered services in the hospital s environment, medication and treatment.

• 산업공학
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• 제20권4호
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• pp.488-497
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• 2007

In order to provide appropriate decision supports in medical domain, it is required that clinical knowledge should be implemented in a computable form and integrated with hospital information systems. Healthcare organizations are increasingly adopting tools that provide decision support functions to improve patient outcomes and reduce medical errors. This paper proposes a process centric clinical decision support system based on medical knowledge. The proposed system consists of three major parts - CPG (Clinical Practice Guideline) repository, service pool, and decision support module. The decision support module interprets knowledge base generated by the CPG and service part and then generates a personalized and patient centered clinical process satisfying specific requirements of an individual patient during the entire treatment in hospitals. The proposed system helps health professionals to select appropriate clinical procedures according to the circumstances of each patient resulting in improving the quality of care and reducing medical errors.

• 한국산학기술학회논문지
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• 제13권11호
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• pp.5229-5237
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• 2012

작업치료사의 환자중심훈련(patient-centered practice)은 치료사에게 환자와 그 가족의 관점에서 능동적으로 환자의 기능부전을 찾아야 가능하다. 본 연구는 신경계 작업치료사가 검사 및 평가를 실시하기 위하여 현재 임상에서 사용하는 평가도구의 사용빈도 및 평가도구 선택시 고려사항을 알아보고, 평가에 관한 향후 방향을 제시하기 위함이었다. 연구대상자는 신경계 질환자를 대상으로 치료하는 서울 경기지역에 근무하는 작업치료사 66명이었다. 설문지는 연구대상자의 일반적인 특성, 평가관련 정보, 신경계 작업치료사가 사용하는 평가도구의 내용, 성인 평가도구 및 아동평가도구에 관한 내용으로 구성되었다. 결과분석은 설문에 응답한 66명의 자료를 대상으로 기술적 통계량을 사용하였다. 연구결과, 1일 환자 수는 10인 이상 15인 미만이 가장 많았으며, 초기평가는 20분 이상 40분 미만이 가장 많았고, 환자 재평가 주기는 1개월과 기능적 차이가 보일 때가 가장 많았다. 평가도구는 신경계 관련 도구에만 국한되지 않았으며, 평가도구 선택시 고려사항은 평가도구의 신뢰도와 타당도가 가장 높았다. 성인을 대상으로 사용한 평가도구는 '상지운동기능'은 JHFT, '인지 및 지각'은 MMSE-K, '일상생활동작'은 MBI, '작업수행'은 COPM이 가장 많았다. 또한 아동을 대상으로 한 평가도구는 '인지-지각 평가도구'는 MVPT, '일상생활동작 평가도구'는 Wee-FIM이 가장 많았다. 마지막으로 영역에 따른 평가도구 선택시 고려사항도 평가도구의 신뢰도와 타당도가 가장 높았다. 본 연구결과를 통하여 서울.경기지역에 근무하는 신경계 작업치료사의 영역별 평가도구의 사용빈도와 그 평가도구를 선택할 때 고려하는 사항을 알아볼 수 있었고, 이 결과를 바탕으로 향후 신경계 작업치료사가 평가를 수행할 때 환자수행중심 평가뿐만 아니라 환자와 보호자의 관점을 통합하여 치료계획을 수립할 필요성이 있다고 제언하는 바이다.