• Journal of Hospice and Palliative Care
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• 제17권4호
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• pp.278-288
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• 2014

목적: 의료가 복잡하고 전문화된 최근에는 의료학문간 소통과 융합이 강조되고 있다. 병원업무는 환자를 중심으로 여러 분야의 협동 체계를 통한 의사결정의 효율성이 요구된다. 이 논문은 말기 환자에 대한 의사와 간호사의 공유 의료적 의사결정에 대한 인식을 알아보고자 한다. 방법: Q 방법론을 적용하여 35개의 Q 진술문을 9점 척도의 정규분포로 39명에게 작성하도록 하였다. 수집된 자료는 QUANL PC 프로그램으로 분석하였다. 결과: 환자결정형, 의사결정형, 의료인 공유결정형, 환자 가족 결정형의 네 가지 유형으로 나타났다. 공통적으로 동의한 항목은 충분한 설명과 치료과정의 공유, 교육 등으로 나타났고, 부정적으로 생각한 항목은 치료에 법적 측면을 고려에 대한 내용이었다. 제1유형은 환자의 요구와 가치관을 존중하는 환자중심의 의사결정 방식을, 제2유형은 의사가 결정을 내리고 환자가 이를 따르는 방식을, 제3유형은 의료인 상호간의 협력적인 의사 공유를, 제4유형은 의료인뿐 아니라 가족 참여의 의사결정을 중요하게 생각하였다. 결론: 의료인 간의 생각이 다양하다는 것을 보여주며, 일반인과도 의견의 차이를 보여준다. 의사결정에 대한 의견의 공유와 추가적인 연구가 필요할 것으로 생각된다.

• 한국임상약학회지
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• 제27권1호
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• pp.1-8
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• 2017

The prevalence of diabetes and its related morbidity and mortality are being increased. Despite the advancement of evidence-based pharmacotherapy in the management of diabetes, many patients in our country do not achieve satisfied therapeutic outcomes. Pharmaceutical care service can be defined as a patient-centered clinical service provided by pharmacists to improve therapeutic outcomes and quality of life of patients, by identifying, and preventing or resolving drug-related problems (DRPs). Pharmaceutical care service is interdisciplinary team-based practice, and is provided through collaborative practice agreement (CPA) between one or more physicians and pharmacists. This article describes a model of pharmaceutical care service which can be adopted in our country for patients with diabetes in the ambulatory care settings. With the successful implementation of this service, clinical, economic, and humanistic outcomes of patients will be improved. Therefore, by actively implementing pharmaceutical care service, pharmacist should contribute to the promotion of patients' health and to the advancement of health care delivery system.

• 한국간호교육학회지
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• 제18권3호
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• pp.474-485
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• 2012

Purpose: The Quality and Safety Education for Nurses [QSEN] initiative group has identified six competencies (patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics) for pre-licensure nursing education along with related knowledge, skills, and attitudes for each competency. The purpose of this article is to illustrate a teaching strategy that uses films to demonstrate the QSEN competencies in undergraduate nursing students. Method: A literature review was conducted to define QSEN competencies, and six feature-length commercial movies were selected through a systematic process. We provided film titles and their synopses that can be useful in teaching the QSEN six competencies to undergraduate nursing students. Results: Patch Adams for patient-centered care, Wit for teamwork and collaboration, Lorenzo's Oil for evidence-based practice, Am$\acute{e}$lie for quality improvement, Blindness and The Island for informatics can be applied in nursing classroom practices. Conclusion: Establishing the connection between QSEN competencies and cinenurducation is novel, yet it would provide a unique opportunity for nurse educators seeking to overcome the challenge of better preparing future nurses. In future studies, additional films should be considered to enhance nursing educational strategies.

• Journal of Hospice and Palliative Care
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• 제24권1호
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• pp.1-12
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• 2021

Hospice palliative care refers to holistic care provided by an interdisciplinary team aimed at improving the quality of life of patients suffering from life-threatening diseases and their families. Among interdisciplinary team members, hospice advanced practice nurses (APNs) trained as master's-level advanced nursing professionals are leaders who play an important role in providing patient-centered care and improving the quality of services. The Medical Service Act revised in 2018 requires the scope of practice of APNs in each field to be specified in the Ordinance of the Ministry of Health and Welfare. Accordingly, discussions on the role and scope of practice of hospice APNs are actively underway. In this review, the curriculum of hospice APNs, their work responsibilities and roles, and their current status are reviewed, and the future direction of the hospice APN system is also discussed.

• Child Health Nursing Research
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• 제22권2호
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• pp.107-116
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• 2016

Purpose: Involvement of families in rounds is one strategy to implement patient- and family-centered care to help families get clear information about their child, and be actively involved in decision making. The purpose of this paper was to identify the major concepts of family-centered rounds for hospitalized children. Methods: We searched five electronic databases for relevant articles and used Whittemore and Knafl's integrative review methods to synthesize the literature. Articles published between June 2003 and January 2016 were reviewed and through full text screening 24 peer-reviewed articles were found that met the selection criteria for this review. Results: Through in-depth discussion and investigation of the relevant literature, four overarching components emerged: (a) cognition of parents and medical staff, (b) effective communication, (c) collaboration of family and medical staff, (d) coaching of medical staff. Conclusion: For successful family-centered rounds positive cognition is important. Appropriate communication skills and consideration of multi-cultural family can lead to effective communication. Offering consistent and transparent information is important for collaboration between family and medical staff. Prior education on family-centered rounds is also important. Four major components have been identified as basic standards for implementing family-centered rounds for hospitalized children.

• 의학교육논단
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• 제21권1호
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• pp.1-12
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• 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.

• Neonatal Medicine
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• 제25권2호
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• pp.53-57
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• 2018

Even with the increasing number of high risk infants, neonatal care in Korea has undergone development with improved survival rate. This rapid improvement in the outcomes brought care quality in neonatal intensive care unit (NICU) to the surface. Quality improvement (QI) involves safe, timely, effective, efficient, equitable, and patient-centered care. In this review, methods of QI are described with examples of NICU QI topics. Each NICU can voluntarily develop a QI project, but systematic supports are essential. As human and systemic resources in NICUs in Korea are insufficient, institutional and national supports are necessary to attain QI. Furthermore, collaborative neonatal network can provide a QI standard and evidence based-medicine, as well as QI research.

• 한국콘텐츠학회논문지
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• 제21권3호
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• pp.552-560
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• 2021

본 연구의 목적은 고혈압 및 당뇨병 환자의 건강 관련 의사결정에 대한 참여경험을 탐색하는 것이다. 당뇨병 또는 고혈압의 만성질환을 진단받고 1년 이상 보건소에 정기적으로 방문하였던 장년기 환자 11명이 참여하였다. 자료의 수집은 개별 인터뷰를 통해 시행되었으며, Braun과 Clark 가 제시한 주제 분석법을 적용하여 분석되었다. 연구 결과 6개의 하위주제와 3개의 주제가 도출되었다. 각각의 주제는 '짧은 면담시간을 효율적으로 활용하기 위해 노력함', '의료인에게 한정된 영역 안에서 응답함', '건강관리에 대한 지속적인 동기부여가 결여됨'이었다. 본 연구 결과는 만성질환자의 의사결정에 대한 참여를 독려하기 위해 정확하고 충분한 건강정보를 제공하고 지지적인 태도로 환자의 동기를 부여해야 할 필요성을 제시하였다.

• 한국노년학
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• 제41권2호
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• pp.197-215
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• 2021

본 연구는 요양시설거주 치매환자들의 삶의 질을 사정하기 위해 개발된 DCM(Dementai Care Mapping)을 활용, 국내 장기요양시설에서의 사람중심케어 실천 정도 및 특성을 탐색하는 것을 목적으로 한다. DCM은 훈련받은 매퍼가 시설거주 치매노인을 관찰 사정하는 도구이지만 본 연구에서는 장기요양 시설 종사자들의 자기보고식 평가척도로 변용하였다. DCM의 개념을 34개의 문항으로 조작화하였으며 브래포드치매팀의 검토를 거쳐 총화평정척도로 만들었다. 본 척도의 신뢰도는 .88로 신뢰할 만 하며, 이를 국내 시설 종사자 343명을 대상으로 설문조사를 실시한 결과 평균점수는 3.77점(5점 척도)으로 나왔다. DCM의 하위카테고리 별 평균 점수는 애착(4.02), 편안함(3.95), 포용(3.89), 정체성(3.67), 주체성(3.41)으로 나타났다. 국내 요양서비스가 대상자의 안전과 편안함에 초점을 맞춘 신체수발에 주력하며 종사자와 대상자간에 애착이 형성되고 있지만, 개별적 케어(정체성)부족이나 대상자의 삶에서 의미있는 활동이 부족한 점(주체성)에서 사람중심케어가 취약함이 드러났다. 한편, DCM척도에 의한 사람중심케어의 특성을 조직 및 개인 특성에 따라 살펴보면, 시설의 규모가 작을수록 사람중심케어 실천이 높으며 공립과 민간시설간의 차이는 없었다. 또한 시설장과 직접 서비스제공자의 사람중심케어 실천이 높으며 경력이 1~2년인 종사자들의 사람중심케어 점수가 높은 것으로 나타났다. 본 연구는 국내 요양서비스에서 사람중심케어의 실천이 필요하며 이를 위한 구체적인 방안으로 유니트케어의 적용, 시설에서 직접 서비스제공자뿐 아니라 간호, 사회복지사등 전 직원을 대상으로 한 사람중심케어 교육 실시를 제언한다. 국내 요양서비스의 질평가에서도 사람중심케어의 관점이 강화돼야 하며 이를 위해 DCM 또는 직접 관찰이 어려운 상황에서는 대안으로 본 연구에서 개발한 한국형DCM척도의 활용을 제언한다.

• 한국병원경영학회지
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• 제21권2호
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• pp.24-36
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• 2016

The aims of this study is to investigate the status of nursing care delivery systems and nurse staffing levels and to analyze differences in the quality of nursing care by the type of nursing care delivery system. This research was based on data from 723 nurses working in 55 medical and surgical units in 26 general hospitals. Descriptive statistics on nurse staffing levels and the nursing care delivery system, and multi-level logistic regression were used to estimate the determinants of quality of nursing care. The number of patients per nurse is 17.74 patients in functional nursing care and 15.56 patients in total nursing care. In comparison to hospitals adopting total nursing care, hospitals with functional nursing care had greater patients. The nurses rated units using total nursing care as significantly better quality of nursing care than the units with functional nursing care. Total nursing care or modified total nursing care, rather than functional nursing care, could lead to improvement in the quality of care(total nursing care OR=3.895, modified total nursing care OR=2.475). Patient-centered approaches under proper circumstances can be successfully implemented and the positive effects demonstrated.