• 제목/요약/키워드: Patient-focused Care

검색결과 179건 처리시간 0.028초

Workplace Violence Toward Mental Healthcare Workers Employed in Psychiatric Wards

  • d'Ettorre, Gabriele;Pellicani, Vincenza
    • Safety and Health at Work
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    • 제8권4호
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    • pp.337-342
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    • 2017
  • Background: Workplace violence (WPV) against healthcare workers (HCWs) employed in psychiatric inpatient wards is a serious occupational issue that involves both staff and patients; the consequences of WPV may include increased service costs and lower standards of care. The purpose of this review was to evaluate which topics have been focused on in the literature and which are new in approaching the concern of patient violence against HCWs employed in psychiatric inpatient wards, in the past 20 years. Methods: We searched for publications in PubMed and Web of Science using selected keywords. Each article was reviewed and categorized into one or more of the following four categories based on its subject matter: risk assessment, risk management, occurrence rates, and physical/nonphysical consequences. Results: Our search resulted in a total of 64 publications that matched our inclusion criteria. The topics discussed, in order of frequency (from highest to lowest), were as follows: "risk assessment," "risk management," "occurrence rates," and "physical/nonphysical consequences." Schizophrenia, young age, alcohol use, drug misuse, a history of violence, and hostile-dominant interpersonal styles were found to be the predictors of patients' violence. Conclusion: Risk assessment of violence by patients appeared the way to effectively minimize the occurrence of WPV and, consequently, to better protect mental HCWs. We found paucity of data regarding psychologic sequelae of WPV. According to these findings, we suggest the need to better investigate the psychologic consequences of WPV, with the aim of checking the effective interventions to assist HCW victims of violence and to prevent psychologic illness.

Genotype-phenotype correlations in pediatric patients with myotonic dystrophy type 1

  • Kim, Hyeong Jung;Na, Ji-Hoon;Lee, Young-Mock
    • Clinical and Experimental Pediatrics
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    • 제62권2호
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    • pp.55-61
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    • 2019
  • Purpose: Myotonic dystrophy, also known as dystrophia myotonica (DM), is an autosomal dominant disorder with 2 genetically distinct forms. DM type 1 (DM1) is the more common form and is caused by abnormal expansion of cytosine/thymine/guanine (CTG) repeats in the DM protein kinase (DMPK ) gene. Our study aimed to determine whether the age of onset is correlated with CTG repeat length in a population of pediatric patients with DM1. Methods: We retrospectively identified 30 pediatric patients with DM1 that underwent DMPK testing, of which the clinical data of 17 was sufficient. The cohort was divided into 2 subgroups based on the clinical phenotype (congenital-onset vs. late-onset) and number of CTG repeats (<1,000 vs. ${\geq}1,000$). Results: We found no significant difference between the age of onset and CTG repeat length in our pediatric patient population. Based on clinical subgrouping, we found that the congenital-onset subgroup was statistically different with respect to several variables, including prematurity, rate of admission to neonatal intensive care unit, need for respiratory support at birth, hypotonia, dysphagia, ventilator dependence, and functional status on last visit, compared to the late-onset subgroup. Based on genetic subgrouping, we found a single variable (poor feeding in neonate) that was significantly different in the large CTG subgroup than that in the small CTG subgroup. Conclusion: Clinical variables exhibiting statistically significant differences between the subgroups should be focused on prognosis and designing tailored management approaches for the patients; our findings will contribute to achieve this important goal for treating patients with DM1.

국내 갈락토스혈증 아동의 식생활 관리에 대한 주 보호자와 임상전문가의 인식 및 지원 요구도 조사 (Perception and Demand of Primary Caregivers and Clinical Experts for the Dietary Management of Children with Galactosemia in Korea)

  • 임서정;서혜지;김유리;오지은
    • 한국식생활문화학회지
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    • 제37권2호
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    • pp.143-152
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    • 2022
  • Galactosemia is a rare genetic metabolic disease caused by galactose and its metabolites generated during carbohydrate metabolism, which is relatively rare in Asian countries, including Korea. Patients with galactosemia should be treated with a galactose-restricted diet. However, information is lacking about the exact content of galactose in food, and dietary guidelines for patients with galactosemia in Korea. This study aims to recognize the difficulties faced by parents and clinical experts of patients with galactosemia, and understand their demands. Totally, 5 parents of children diagnosed with galactosemia and 5 clinical professionals participated in the focus group interviews. The parents' interview focused on the daily life of the patient, which included diet and social difficulties. The clinical experts mainly answered about medical care, including the number and status of patients, and their suggestions for effective treatment. Most parents were worried about social isolation due to conflicts in the family as well as in society due to a lack of understanding of the disease. The clinical experts stated the absence of a disease management system as the greatest problem. An integrated support system for patients with galactosemia, which includes appropriate dietary guidelines by considering the domestic environment, is required.

Current status of interprofessional education learning activities in wards provided by tertiary hospitals and secondary general hospitals and barriers

  • Kang, Joonsung;Sin, Hye Yeon
    • 한국임상약학회지
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    • 제32권2호
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    • pp.106-115
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    • 2022
  • Background: The World Health Organization (WHO) has focused on the need for interprofessional education (IPE) to improve interprofessional collaboration competency and patient health outcomes. Accordingly, most European and North American medical colleges have established IPE for students. However, IPE learning activity in medical wards for the clinical experience of pharmacy students has not been fully reviewed in Korea. Therefore, this study aims to examine the current status of IPE learning activities in wards at tertiary and secondary hospitals in order to identify ways to improve the program. Methods: The official document of cooperation consists of six self-administered questions regarding IPE learning activities in wards. The preceptor's response in each hospital was evaluated. Results: Of the 22 hospitals, 9 tertiary hospitals and 12 secondary general hospitals responded. For the introductory pharmacy practice experience (IPPE), participating in intensive care (IC) was provided at one secondary general hospital (8.3%) and no tertiary hospital. Ward rounds with medical staff members were provided at two tertiary hospitals (22.2%) and one (8.3%) secondary general hospital. A major barrier to executing IPE was lack of rewards and incentives for the faculty and preceptors who participated in the program. Conclusion: In both tertiary hospitals and secondary general hospitals, pharmacy students have limited exposure to IPE learning activities in wards at hospital, and IPPE at most hospitals was carried out in pharmacy settings only. This study suggests that it is necessary for the hospitals to improve and support IPE learning activities in wards in order to improve learners' competency.

지식결과에 대한 타당성 검증;간호결과분류(NOC)에 기초하여 (Validation of Nursing-sensitive Patient Outcomes;Focused on Knowledge outcomes)

  • 염영희;이규은
    • 간호행정학회지
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    • 제6권3호
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    • pp.357-374
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    • 2000
  • The purpose of this study was to validate knowledge outcomes included Nursing Outcomes Classification(NOC) developed by Johnson and Maas at the University of Iowa. A sample of 71 nurse experts working in university affiliated hospitals participated in this study. They were asked to rate indicators that examplified the outcomes on a scale of 1(indicator is not all characteristic) to 5(indicator is very characteristic). A questionnaire with an adaptation of Fehring's methodology was used to establish the content validity of outcomes. The results were as follow: 1. All indicators were considered to be 'supporting' and no indicators were considered to be 'nonsupporting'. 2. 'Knowledge: Treatment Regimen' attained and OCV score of 0.816 and was the highest OCV score among outcomes. 3. 'Knowledge: Energy Conservation' attained an OCV score of 0.748 and was the lowest OCV score among abuse outcomes. 4. 'Knowledge: Breastfeeding' attained an OCV score of 0.790 and was the highest indicator was 'description of benefits of breastfeeding'. 5. 'Knowledge: Child Safety' attained an OCV score of 0.778 and was the highest indicator was 'demonstration of first aids techniques'. 6. 'Knowledge: Diet' attained an OCV score of 0.779 and was the highest indicator was 'performance of self-monitoring activities'. 7. 'Knowledge: Disease Process' attained an OCV score of 0.815 and was the highest indicator was 'description of signs and symptoms'. 8. 'Knowledge: Health Behaviors' attained an OCV score of 0.800 and was the highest indicator was 'description of safe use of prescription drugs'. 9. 'Knowledge: Health Resources' attained an OCV score of 0.794 and was the highest indicator was 'description of need for follow-up care'. 10. 'Knowledge: Infection Control' attained an OCV score of 0.793 and was the highest indicator was 'description of signs and symptoms'. 11. 'Knowledge: Medication' attained an OCV score of 0.789 and was the highest indicator was 'description of correct administration of medication'. 12. 'Knowledge: Personal Safety' attained an OCV score of 0.804 and was the highest indicator was 'description of measures to reduce risk of accidental injury'. 13. 'Knowledge: Prescribed Activity' attained an OCV score of 0.810 and was the highest indicator was 'proper performance of exercise'. 14. 'Knowledge: Substance Use Control' attained an OCV score of 0.809 and was the highest indicator was 'description of signs of dependence during substance withdrawl'. 15. 'Knowledge: Treatment Procedure(s)' attained an OCV score of 0.795 and was the highest indicator was 'description of appropriate action for complications'. 16. 'Knowledge: Treatment Regimen' attained an OCV score of 0.816 and was the highest indicator was 'description of self-care responsibilities for emergency situations'. More outcomes need to be validated and outcomes sensitive to Korean culture need to be developed.

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국외 약사서비스 지불보상체계 현황 : 일본, 미국, 영국을 중심으로 (Current Status of the Reimbursement for Pharmacist-provided Health Care Services in Japan, the United States, and the United Kingdom)

  • 박지현
    • 한국콘텐츠학회논문지
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    • 제22권6호
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    • pp.712-728
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    • 2022
  • 세계적으로 노인인구 급증으로 병용약물이 늘어나고, 의료기술의 발달에 따라 다양한 질병 상태의 해소를 위한 약물사용이 늘어나고 있어, 약물의 효과적이고 안전한 사용을 위해 약사의 전문지식에 대한 기대 및 요구는 점차 높아지고 있다. 이에 우리나라는 지난 2009년부터 기존 4년 교육이 아닌 6년제로 약학대학의 학제를 개편하였으며, 고도화된 약료서비스의 제공을 위해 준비된 전문인력을 배출하고 있다. 그러나 현행 국민건강보험 급여체계는 여전히 전통적 약사의 역할인 조제를 중심으로 산정되어, 약사가 제공하거나 제공 가능한 서비스와, 실제로 지급되는 보상급여 간 극심한 간극이 존재하고 있다. 이에 본 연구에서는 약료서비스 지불보상제도의 국제적 동향을 비교분석하여, 현행 한국의 지불보상체계에 시사점을 주고자 하였다. 한국과 일본, 영국 및 미국의 약사서비스 지불보상정책 및 관련 문헌을 검토한 결과, 일본, 영국 및 미국의 시스템은 환자중심의 약료서비스에 대해 제도적으로 구체적이고 다양한 지불수단을 마련하여 보상하고 있으나, 한국의 약국 서비스는 상대적으로 조제관련 행위만 보상하는 정도에 그치고 있어, 국내 약료서비스의 발전을 구조적으로 저해하는 결과를 낳고 있는 것으로 나타났다. 결론적으로, 안전한 약물사용을 위한 환자중심 약료서비스의 제공을 위해서는 국내 지불보상체계가 인정하는 약료서비스의 범위를 확대하고 관련 서비스의 종류를 다양화하여 국내 약사급여제도를 개선시켜나갈 필요가 있다.

간호실무에서 신봉이론(Espoused theories)에 대한 탐색적 연구 (Investigation of Espoused Theories in Nursing Practice)

  • 서문자;김혜숙;이은희;박영숙;조경숙;강현숙;임난영;김주현;이소우;조복희;이명화;지성애;하양숙;손영희;권성복;김희진;추진아
    • 성인간호학회지
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    • 제13권1호
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    • pp.53-69
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    • 2001
  • As a nursing practice involves nurses'actions in a specific context of health care, this study has focused on exploring the espoused theories in nursing practice within the action science perspectives. Espoused theories are the belief, principles, and rationale expressed by the practitioner as guiding her/his actions in a situation of practice. The data were analysed qualitatively and 25 elements of espoused theories of nursing action were identified and clustered into 6 categories. The 25 elements of espoused theories are as follows: The clinical nurse worked in wholistic and individual nursing, focussed on the patient's needed, comfort and supportive nursing (5 theories of nursing goal); excellent skills, knowledge based, assessment and data collection, explaining, educating or a scientific basis(6 theories of nursing intervention): advocacy, value oriented, treatment, accountability and commitment(4 theories of nursing ethics); human respect, partnership, trust(3 theories of patient-nurse relationship) : knowledgable, accumulated clinical experiences and personally lived experiences, positive perspectives(4 theories of nurse), role of intervention, rewarding, peer relationship(3 theories of situations). The above mentioned espoused theories are similar to that of nursing textbooks which students learned through basic nursing education and almost the same as the Acts ofa Nurse in Korean. However, we are doubtful whether nurses actually do as they think. Therefore, it is recommended to review the theories-in-use in order to find any discrepancies between the espoused theories and the reality of nursing actions.

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아세트아미노펜 사용 편의성 증가 후 중독발생 위험의 지속적 관리 필요성 (Continuous Control of Acetaminophen Poisoning after Implementation of Regulation for Ease Access of Acetaminophen: Cohort Study from Emergency Department Based in-depth Injury Surveillance)

  • 조승직;강현영;이시진;배규현;이의중;한갑수;김수진;이성우
    • 대한임상독성학회지
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    • 제18권2호
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    • pp.57-65
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    • 2020
  • Purpose: Since 2012, acetaminophen can be accessed easily not only at pharmacies but also at convenience stores. The relationship between the easy access of acetaminophen and the risk of poisoning has been controversial. Several studies also reported different results regarding the risk of acetaminophen poisoning after access to acetaminophen was relaxed. This study examined the long-term effects on the risk of acetaminophen poisoning after easy access to acetaminophen was implemented. Methods: This was a retrospective analysis of an emergency department (ED)-based in-depth Injury Surveillance Cohort by the Korea Center for Disease Control and prevention from 2011 to 2018. Poisoning cases were selected from the Cohort, and the incidence of acetaminophen poisoning and the characteristics of the cases of acetaminophen poisoning were analyzed. The purchase path and the amount of ingestion in acetaminophen poisoning were sub-analyzed from data of six EDs. Results: Of 57,326 poisoning cases, 4.0% (2,272 cases) were acetaminophen poisoning. Of 2,272 cases of acetaminophen poisoning, 42.8% (974 cases) required in-patient care after ED management. Two hundred and sixty-four of these 964 cases required intensive care. The rates of cases that required in-patient treatment and the rates of cases that required intensive care increased from 29.4% in 2011 to 48.1% in 2018, and from 3.1% in 2011 to 15.2% in 2018, respectively (p<0.001, p<0.001). In the poisoning group with in-depth toxic surveillance (n=15,908), the incidence and proportion of acetaminophen (AAP) poisoning increased from 55 cases per year to 187 cases per year and 4.9% to 6.1%, respectively (p=0.009, p<0.001, respectively). The most common age group of acetaminophen poisoning was teenagers, which is different from the most common age group of other pharmaceutical agents: the middle age group of 40-49 years (p<0.001). Of 15,908 in-depth toxic surveillance patients, 693 patients had AAP poisoning, of whom 377 cases (54.2%) purchased acetaminophen from a non-pharmacy. The proportions of the purchase path from non-pharmacy were 41.4% at 2011-12 and 56.4% (2013-18) (p=0.004). The amount of acetaminophen ingestion was 13.5±14.3 g at 2011-12 and 13.9±15.1 g at 2013-18 (p=0.794). Conclusion: Although the incidence of acetaminophen poisoning did not increase remarkably in the short term after the implementation of the new regulation, the incidence of acetaminophen poisoning has increased slightly during the study period of 2017-18. In addition, the proportion of the purchase path from non-pharmacies has increased since the emergence of new regulations for the easy access of acetaminophen in 2012. The incidence of acetaminophen poisoning might have been affected after the increasing accessibility of acetaminophen in convenience stores. Continuous control of acetaminophen poisoning is required. Furthermore, the prevention of acetaminophen poisoning should be focused on teenagers with specialized school education programs.

새로운 간호윤리학 방법론;통합된 사례방법론 (An integrated Method of New Casuistry and Specified Principlism as Nursing Ethics Methodology)

  • 엄영란
    • 간호행정학회지
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    • 제3권1호
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    • pp.51-64
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    • 1997
  • The purpose of the study was to introduce an integrated approach of new Casuistry and specified principlism in resolving ethical problems and studying nursing ethics. In studying clinical ethics and nursing ethics, there is no systematic research method. While nurses often experience ethical dilemmas in practice, much of previous research on nursing ethics has focused merely on describing the existing problems. In addition, ethists presented theoretical analysis and critics rather than providing the specific problems solving strategies. There is a need in clinical situations for an integrated method which can provide the objective description for existing problem situations as well as specific problem solving methods. We inherit two distinct ways of discussing ethical issues. One of these frames these issues in terms of principles, rules, and other general ideas; the other focuses on the specific features of particular kinds of moral cases. In the first way general ethical rules relate to specific moral cases in a theoretical manner, with universal rules serving as "axioms" from which particular moral judgments are deduced as theorems. In the seconds, this relation is frankly practical. with general moral rules serving as "maxims", which can be fully understood only in terms of the paradigmatic cases that define their meaning and force. Theoretical arguments are structured in ways that free them from any dependence on the circumstances of their presentation and ensure them a validity of a kind that is not affected by the practical context of use. In formal arguments particular conclusions are deduced from("entailed by") the initial axioms or universal principles that are the apex of the argument. So the truth or certainty that attaches to those axioms flows downward to the specific instances to be "proved". In the language of formal logic, the axioms are major premises, the facts that specify the present instance are minor premises, and the conclusion to be "proved" is deduced (follows necessarily) from the initial presises. Practical arguments, by contrast, involve a wider range of factors than formal deductions and are read with an eye to their occasion of use. Instead of aiming at strict entailments, they draw on the outcomes of previous experience, carrying over the procedures used to resolve earlier problems and reapply them in new problmatic situations. Practical arguments depend for their power on how closely the present circumstances resemble those of the earlier precedent cases for which this particular type of argument was originally devised. So. in practical arguments, the truths and certitudes established in the precedent cases pass sideways, so as to provide "resolutions" of later problems. In the language of rational analysis, the facts of the present case define the gounds on which any resolution must be based; the general considerations that carried wight in similar situations provide warrants that help settle future cases. So the resolution of any problem holds good presumptively; its strengh depends on the similarities between the present case and the prededents; and its soundness can be challenged (or rebutted) in situations that are recognized ans exceptional. Jonsen & Toulmin (1988), and Jonsen (1991) introduce New Casuistry as a practical method. The oxford English Dictionary defines casuistry quite accurately as "that part of ethics which resolves cases of conscience, applying the general rules of religion and morality to particular instances in which circumstances alter cases or in which there appears to be a conflict of duties." They modified the casuistry of the medieval ages to use in clinical situations which is characterized by "the typology of cases and the analogy as an inference method". A case is the unit of analysis. The structure of case was made with interaction of situation and moral rules. The situation is what surrounds or stands around. The moral rule is the essence of case. The analogy can be objective because "the grounds, the warrants, the theoretical backing, the modal qualifiers" are identified in the cases. The specified principlism was the method that Degrazia (1992) integrated the principlism and the specification introduced by Richardson (1990). In this method, the principle is specified by adding information about limitations of the scope and restricting the range of the principle. This should be substantive qualifications. The integrated method is an combination of the New Casuistry and the specified principlism. For example, the study was "Ethical problems experienced by nurses in the care of terminally ill patients"(Um, 1994). A semi-structured in-depth interview was conducted for fifteen nurses who mainly took care of terminally ill patients. The first stage, twenty one cases were identified as relevant to the topic, and then were classified to four types of problems. For instance, one of these types was the patient's refusal of care. The second stage, the ethical problems in the case were defined, and then the case was analyzed. This was to analyze the reasons, the ethical values, and the related ethical principles in the cases. Then the interpretation was synthetically done by integration of the result of analysis and the situation. The third stage was the ordering phase of the cases, which was done according to the result of the interpretation and the common principles in the cases. The first two stages describe the methodology of new casuistry, and the final stage was for the methodology of the specified principlism. The common principles were the principle of autonomy and the principle of caring. The principle of autonomy was specified; when competent patients refused care, nurse should discontinue the care to respect for the patients' decision. The principle of caring was also specified; when the competent patients refused care, nurses should continue to provide the care in spite of the patients' refusal to preserve their life. These specification may lead the opposite behavior, which emphasizes the importance of nurse's will and intentions to make their decision in the clinical situations.

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대퇴경부 골절 환자의 입원 생활 (The Hospital Life of the Patient with Femoral Neck Fracture)

  • 김경자;지성애
    • 간호행정학회지
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    • 제2권1호
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    • pp.35-56
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    • 1996
  • Nowerdays, the increase of traffic accidents and old age population make the Femoral Neck Fracture(FNF) patients increase. By the improvement of education and standard of living the patients demand better medical service than before. This study is designed to give practical help for the FNF patients by observing their hospital life and establish practical nursing strategies for the FNF patients. For these purposes the Ethnographic Participant Observation was adopted. By this study is focused on the hospital life patient's view. For this end, the field study adopted orthopedic ward in the C University Hospital with 400 beds in Seoul. The object patients of the study were twelve patients. The patients experienced five stages : Embarrassment, Conflict, Stability, Independent, and Extension Stage. The findings and prepared nursing strategies are stated as follows. First, in the Embarrassment Stage they suffered embarrassment, anxiety, pain, they could not do ordinary things. The patients who accidental fractures had anxiety from unfamiliar tests and from hospitalization itself. They lamented that they could not ordinary things, and do nothing but obeying the hospital, and endure the pain. They recognized the changed environment and resigned themselves to life in the ward. In this stage, full openness by the nurses is needed. Second, the attribute of the Conflict Stage were conflict, fear, curiosity, belief, reflection. When they sign the consentment form, they experience conflicts about the possibility of complication, fear of recovery from anesthesia, curiosity about the operation procedure, post - operation state, reflection on their past life, and promise to care for their family members after discharge and keep their religious life faithfully. And they accepted the operation depending on God, believing in modern medicine, and the surgeon. Asking for their changed informations, they expected positive results from the operation. In this stage, an empathic attitude by the nurses is needed. Third, the attribute of the Stability Stage were relief, gratitude, difficulty with excretion, and pain. When they awoke from anesthesia, they felt relief because of a the end of the operation, but they experienced extreme pain, difficulty of excretion in bed. They accepted the changed environment and expected recovery. In this stage, support by the nurses is needed. Fourth, the attributes of the Independence Stage were freedom, exercise, nurturing, anxiety, and discomfort. When they ambulated and exercised, they experienced freedom. They showed exhibited weakness of the digestive organs and discomfort hospital's space, structure, and facilities, the delay of medical certificate issue the lack of prompt response by the medical agents. They ate nurturious food and felt anxiety on the end of hospital life and returning to their ordinary life. They showed the independence of overcoming their environment by increasing exercise and expected their discharges. In this stage, respect by the nurses is needed for the patients to, overcome their environment and prepare for their independence. Fifth, the attributes of the Extension Stage were pessimism, isolation, dissatisfaction, and pain. Accompanied injury and old age made their ward life extend to over seven weeks. They exhibited weariness, melancholy, skeptisis, general pessimistic feeling, and desperation caused by their isolated life. They experienced the digestive discomfort caused by the prolonged medication and psycological pain caused by long-time hospitalization. As a, result, their dissatisfaction on the human, physical, and systematic environments had been increased. They acquired critical power and sought for something to do spending their time. They expected vaguely about the returning of their ordinary life. In this stage, counseling is needed by the nurse to overcome positively their psychological, social, and physical problems. The process of the FNF patient's ward life starts from the dependent state, when they are hospitalized, and gradually progresses to self-fulfillment in order to keep independent life. As a result, the FNF patients showed "Response in Challenge" or "Adaptation in Conflict" through their experiences of social, physical, and psychological difficulties.

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