• Journal of Yeungnam Medical Science
• /
• 제40권2호
• /
• pp.218-222
• /
• 2023

A holistic approach to diabetes considers patient preferences, emotional health, living conditions, and other contextual factors, in addition to medication selection. Human and social factors influence treatment adherence and clinical outcomes. Social issues, cost of care, out-of-pocket expenses, pill burden (number and frequency), and injectable drugs such as insulin, can affect adherence. Clinicians can ask about these contextual factors when discussing treatment options with patients. Patients' emotional health can also affect diabetes self-care. Social stressors such as family issues may impair self-care behaviors. Diabetes can also lead to emotional stress. Diabetes distress correlates with worse glycemic control and lower overall well-being. Patient-centered communication can build the foundation of a trusting relationship with the clinician. Respect for patient preferences and fears can build trust. Relevant communication skills include asking open-ended questions, expressing empathy, active listening, and exploring the patient's perspective. Glycemic goals must be personalized based on frailty, the risk of hypoglycemia, and healthy life expectancy. Lifestyle counseling requires a nonjudgmental approach and tactfulness. The art of diabetes care rests on clinicians perceiving a patient's emotional state. Tailoring the level of advice and diabetes targets based on a patient's personal and contextual factors requires mindfulness by clinicians.

• 대한간호학회지
• /
• 제3권1호
• /
• pp.97-104
• /
• 1972

This study was designed to investigate differences in some aspects of value conceptions in fundamentals of nursing functions between nursing service personnel and nurse-educators. The purpose of the study was to identify the difference of value conceptions between the hospital nurses and school instructors, to contribute as a reference in strengthening the educational program in establishing nay hinder professional growth. The questionaries of this study were focused in the following aspects: 1) establishment of nursing service management system, 2) strengthening of the professionalization of nursing service, 3) hindrance in accomplishment of independent nursing functions, 4) communication skills in nurse-patient relationship, 5) activities directly related to nursing care planning, 6) communication skills in nurse-doctor relationship, 7) attitude towards taking responsibilities for patient- centered nursing approach, and 8) nursing educational approach towards preparation of professional competence in practicing independent nursing functions. 265 graduate nurses from 14 general hospitals and 88 nursing instructors from 18 schools, collegiate and diploma, were sampled. The main findings of the study were as follows; 1. Both groups responded highly in the lack of public recognition of nursing profession and hospital administrators support in establishment of nursing service management system. Further investigation is needed to define some relationship between the intrinsic and extrinsic factors which might give influence to the professional development. 2. while hospital nursing personnel responded on environmental pressure such as a heavy nursing load as the factor giving hindrance to independent nursing functions, the nurse educators responded highly on lack of nursing competence of individual nurses. An emphasis should be placed on the development of nursing interaction through professional education. If the professional model is not well established, nursing function will be limited to medical assistance. 3. 3. The patient-centered approach for nurse-patient communication had given positive respond for both group, tut lacks in team concept in problem solving process. There exist a social distance between nurses and other professional co-workers in the hospital hierarchy. 4. It was indicated that, as an intrinsic factor in the development of nursing service and nursing education, building up a philosophical basis is an utmost importance. This question is opened for further and extensive study to clarify whether existence of philosophical absence or philosophical stasis in nursing profession hinders the development.

• 의학교육논단
• /
• 제21권1호
• /
• pp.1-12
• /
• 2019

This study is a narrative review introducing global trends in patient safety education within medical schools and exploring the status of Korean education. Core competences for patient safety include patient centeredness, teamwork, evidence- and information-based practice, quality improvement, addressing medical errors, managing human factors and system complexity, and patient safety knowledge and responsibility. According to a Korean report addressing the role of doctors, patient safety was described as a subcategory of clinical care. Doctors' roles in patient safety included taking precautions, educating patients about the side effects of drugs, and implementing rapid treatment and appropriate follow-up when patient safety is compromised. The Korean Association of Medical Colleges suggested patient safety competence as one of eight essential human and society-centered learning outcomes. They included appropriate attitude and knowledge, human factors, a systematic approach, teamwork skills, engaging with patients and carers, and dealing with common errors. Four Korean medical schools reported integration of a patient safety course in their preclinical curriculum. Studies have shown that students experience difficulty in reporting medical errors because of hierarchical culture. It seems that patient safety is considered in a narrow sense and its education is limited in Korea. Patient safety is not a topic for dealing with only adverse events, but a science to prevent and detect early system failure. Patient safety emphasizes patient perspectives, so it has a different paradigm of medical ethics and professionalism, which have doctor-centered perspectives. Medical educators in Korea should understand patient safety concepts to implement patient safety curriculum. Further research should be done on communication in hierarchical culture and patient safety education during clerkship.

• Journal of Hospice and Palliative Care
• /
• 제24권4호
• /
• pp.199-203
• /
• 2021

This paper provides practical suggestions for how palliative care clinicians can address the expressions of spiritual struggle voiced by patients and their loved ones. In addition to practical tips for listening and responding, ethical guidance and opportunities for self-reflection related to spiritual care are briefly discussed. Principles to guide practice when the clinician is listening and responding to a patient expressing spiritual struggle include being non-directive, honoring (vs. judging) the patient's spiritual or religious experience, keeping the conversation patient-centered, focusing on the core theme of what the patient is expressing presently, using the patient's terminology and framing, and responding "heart to heart" or "head to head" to align with the patient. Ultimately, the goal of a healing response from a spiritual care generalist is to allow the patient to "hear" or "see" themselves, to gain self-awareness. To converse with patients about spirituality in an ethical manner, the clinician must first assess the patient's spiritual needs and preferences and then honor these.

• 한국치위생학회지
• /
• 제22권3호
• /
• pp.217-224
• /
• 2022

Objectives: This study aimed to establish the basic data for the performance of patient-centered care, perception of core competencies, and self-development of dental hygienists by verifying the effects of information literacy on the communication ability of dental hygienists, and the mediating effects of job crafting. Methods: Collected and analyzed data by conducting a survey targeting total 222 dental hygienists working for dental hospitals/clinics located in Seoul and Gyeonggi region. Verify the mediating effects of job crafting on the effects of information literacy on the communication ability, this study conducted the correlation analysis and simple regression analysis and multiple regression analysis. Results: In the effects of information literacy on the communication ability of dental hygienists, the cognitive crafting of job crafting (β=0.209, p<0.001) and relational crafting of job crafting (β=0.318, p<0.001) showed the partially mediating effects. Conclusions: In order to increase the educational accessibility for dental hygienists to perceive the importance of information literacy and communication ability, to improve the expertise as healthcare personnel who perform the patient-centered care by developing it, and also to develop the information literacy and job crafting, it would be necessary to develop various educational programs and contents.

• Journal of Hospice and Palliative Care
• /
• 제24권3호
• /
• pp.135-143
• /
• 2021

End-of-life patients experience physical, mental, social, and existential distress. While medical personnel provide medication and care to alleviate patients' distress, listening to and interacting with patients remains essential for understanding their psychological condition. The most important tool, though difficult to implement in practice, is end-of-life discussion (EOLD). EOLD has been shown to have positive effects on end-of-life treatment choices, achievement of patients' life goals, improvements in the quality of life of patients and their families, and the prevention of depression and complicated grief among bereaved family members. EOLD is not often undertaken in clinical practice, however, due to hesitancy among medical personnel and patients for various reasons. In order to conduct an EOLD, the patient's judgment, psychiatric illnesses such as delirium and depression, and psychological issues such as the side effects of psychotropic drugs, denial, and collusion must be evaluated. Open and honest conversation, treatment goal setting, the doctor's familiarity with the patient's background, and attentiveness when providing information are important elements for any dialogue. Meaning-centered psychotherapy was developed to alleviate the existential distress of cancer patients, and its application may promote EOLD. The future development of meaning-centered psychotherapy in practice and in research is expected to further promote EOLD.

• 서비스연구
• /
• 제2권2호
• /
• pp.45-51
• /
• 2012

U-Healthcare는 홈 네트워크, 휴대용 장치 등에 기반한 정보통신기술과 의료시스템이 서로 융합되어 개인의 생체정보 등을 실시간으로 모니터링하고, 자동으로 병원 및 의사와 연결되어 시공간의 제약을 줄임으로써 언제 어디서나 건강을 관리하고 질병을 예방하는 새로운 형태의 의료서비스이다. 본 논문에서는 진료 중심에서 예방 중심으로 변화되어가고 있는 최근의 U-Healthcare 시스템의 기술 발전 추세에 맞추어 조기 대응이 가능한 Healthcare 정보시스템 구축을 위한 요구분석 사항들에 대해 정리하고, 이를 기반으로 u-Healthcare의 실현을 위한 기존의 단위 시스템인 PACS, OCS, EMR, 응급의료시스템을 통합한 환자중심의 클라이언트 시스템을 설계한다. 특히, 온톨로지는 특정분야의 정보 모델에 이용되어 그 분야에서 공통의 어휘를 제공하고, 그 용어의 의미와 용어간의 관계를 다양한 수준의 형식성을 가지고 제공한다. 본 논문에서는 이러한 온톨로지 및 무질서한 데이터에 대한 관계를 정의하고, 보다 체계적으로 데이터를 군집화하는 클러스터링의 개념을 포함한 환자중심의 서비스를 위한 온톨로지 기반의 시스템을 제안한다.

• 중환자간호학회지
• /
• 제14권2호
• /
• pp.24-41
• /
• 2021

Purpose : The aim of this integrative review was to describe communication experiences and needs among the critically ill with an artificial airway and evaluate relevant intervention studies. Methods : Using the method employed by Whittemore and Knafl (2005), we searched for papers on PubMed, CINAHL, and Web of Science published from January 1, 2015 to September 25, 2020. A total of 26 papers (11 descriptive studies, 15 experimental ones) were identified and evaluated. Results : Communication experiences while having an artificial airway, identified either by patients' recall or direct observation, were predominantly negative. However, positive experiences were reported in patients with improvements in physical conditions and functions. Patients' communication needs were diverse, encompassing physical, psycho-emotional, social, spiritual, and medical issues. Interventions tested included alternative and augmentative communication strategies, communication intervention packages, and voice restorative devices. Physical, psychosocial, and communication-related patient outcomes were evaluated using various methods including self-report surveys, interviews, and observations. Conclusions : The findings from this review represent the state of science regarding communication of the critically ill whose vocal abilities are inhibited by the presence of an artificial airway. Future studies with rigorous experimental designs and measures are warranted to better understand and support the complex needs of this highly vulnerable patient population.

• Journal of Hospice and Palliative Care
• /
• 제20권1호
• /
• pp.1-7
• /
• 2017

이 논문은 개인적으로 경험되는 독특한 희망경험을 찾도록 도와주기 위하여 저자들이 개발한 "희망 찾기 내러티브 커뮤니케이션 모델"에 대하여 서술한다. 모델은 희망과 희망경험의 본질에 대한 문헌 및 저자들의 연구결과들과 주관적인 의미들과 경험들로서 희망 개념, 개인 특수한 희망경험에 접촉하기 위한 방법으로서 이야기하기 과정 및 내러티브 구성의 개념, 그리고 개인중심커뮤니케이션의 통합에 근거 개발되었다. 모델을 적용한 한 연구의 희망 찾기 경험은 모델을 한층 명확하게 하였다. 개인중심커뮤니케이션을 통하여 이야기하기와 내러티브 구성을 통합하는 모델은 세 요소들-이야기하기 요소, 내러티브 중재 요소, 커뮤니케이션 요소-로 구성된다. 이러한 요소들은 화자로서의 대상자가 희망경험의 근본인 개인 특수 주제적 플롯을 가진 희망 내러티브를 생산하는데 필수적으로 요구되는 커뮤니케이션 촉진자로서의 중재자의 적극적인 참여 속에서 개인-특수 희망경험을 찾는 것을 목적으로 하는 하나의 중재로서 과정화된다. 대상자에서 이 모델을 적용하여 성공적인 개인 희망경험 찾기의 긍정적인 결과가 나타났다. 이 모델의 성공은 중재자의 모델에 대한 이해와 개인중심-커뮤니케이션 전략 적용능력에 기인된 것으로 보인다.

• 한국콘텐츠학회:학술대회논문집
• /
• 한국콘텐츠학회 2013년도 춘계 종합학술대회 논문집
• /
• pp.121-122
• /
• 2013

본 연구는의사의 환자중심 커뮤니케이션이 환자만족과 치료성과에 미치는 영향을 종합병원을 진료한 339명의 환자를 대상으로 실증하였다. 연구결과 의사의 환자중심 커뮤니케이션은 환자만족과 치료성과에 유의한 영향을 미치는 것으로 나타났다. 이는 환자를 만족시키고 치료성과를 높이기 위해서는 환자 중심적인 의사소통을 해야 한다. 둘째 환자만족과 치료성과를 높이기 위해서는 진료과정에 환자를 참여시켜야 한다. 의사의 진료과정에 환자중심의 커뮤니케이션도 중요하지만 진료과정에 환자를 참여시켜야 환자만족과 치료성과를 더 높일 수 있다.