• 한국한의학연구원논문집
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• 제18권2호
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• pp.65-89
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• 2012

Objective : In order to investigate and improve public Korean medical health service satisfaction level, this study was designed. Method : A questionnaire has been conducted on 212 patients who received treatments at six public health centers in the northern part of Gyeongbuk during 15 days between Sep. 24 and Oct. 8, 2011. Result : 1. An Investigation on the usage of herbal clinics in public health centers reveals that 63.7% have received three times or more medical treatments previously and 61.8% have had their illness treated at other medical institutions. In regard to illness 32.1% have had arthritis or muscle aches. 50.9% have taken insurance medication after having had treatments at the public health centers. 66% have assessed acupuncture and moxa cautery the most satisfying. 2. To a question regarding whether herbal health treatment costs higher than that of physician's, the highest response at 31.6% is 'No'. And to a question regarding whether herbal medicines administered at public health centers have more side effects than that of physician's, the highest response at 39.6% is 'No'. 3. To a question regarding whether herbal treatment of public health centers has little effect against acute disease, 48.1% of responses are 'Fair'. To a question regarding whether herbal treatments, when compared with physician's treatments, boost better recovery of patients, 48.1% of responses are 'Fair'. To a question regarding whether herbal medicine is unscientific, when compared with that of western medicine, 38.2% of responses are 'Fair', To a question regarding whether herbal medicine has faster effect on disease than western medicine, 41.0% of responses are 'Fair'. To a question regarding whether herbal medicine is more effective on disease prevention and promotion of health than disease treatment, 38.2% of responses are 'Fair'. And to a question regarding whether the lack of various types of physical therapy devices in herbal medicine, when compared with western medicine causes inconvenience in herbal treatment, 42.0% of responses are 'Fair'. Those responses take up highest portion at each questionnaire. 4. A comparative study between herbal treatments and physician's treatments has also been conducted. To questions regarding which one of the two considering types of disease is the better, responses are the latter accounted for 43.9% against 'Cancer', the latter accounted for 45.3% against 'Endocrine disorders', the former accounted for 30.7% against 'Psychiatric disorders', the latter accounted for 38.2% gainst 'Otolaryngological(ENT) disease', the former accounted for 47.6% against 'Post traumatic stress disorder', and the former accounted for 52.4% against 'Muscle-skeletal disease'. 5. An investigation on frequency of patients' visits via (p<0.05) of subjects show a statistically significant difference. 6. First, an investigation on frequency of reasons of medical treatments reveal that age, occupation, monthly income, and insurance type (p<0.05) of subjects show a statistically significant difference. Secondly, an investigation on frequency of subjects taking insurance medicines after herbal health treatments reveal that monthly income (p<0.05) of subject shows a statistically significant difference. 7. First, an investigation on frequency of a claim that herbal treatments of public health center does not have great effect on acute disease reveals that age, education, and insurance type (p<0.05) of subjects show a statistically significant difference. Secondly, an investigation on frequency of analysis that herbal treatments has faster effect on disease compared with western treatments reveals that education level, religion, monthly income, and insurance type (p<0.05) of subjects show a statistically significant difference. 8. When herbal clinics of public health centers and general herbal medicine institutions are compared, a survey on additional treatments that herbal clinics need the most reveals that education level, monthly income, and insurance type (p<0.05) of subjects show a statistically significant difference. Secondly, an investigation on frequency of subjects who want various forms of herbal medicines reveals that occupation and insurance type (p<0.05) of subjects show a statistically significant difference. Conclusion : In order to improve efficiency of treatments and enhance patient's satisfaction level, this study suggests measures such as providing a differentiated acupuncture treatments as a whole, streamlining an reception procedure, adopting more elaborated computer system for a patient to get proper medical attention, standardizing a treatment duration in order for a maximum result, keeping regular office hours, and optimizing a consultation time for a patient.

• 농촌의학ㆍ지역보건
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• 제28권1호
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• pp.67-77
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• 2003

통합보건지소의 운영실태를 조사하고 이를 평가함으로써 지역주민에게 더욱 효율적이고 지역주민의 요구에 부합하는 서비스를 제공하는데 필요한 사업방향을 제시하는 것이 연구의 목적이다. 경상북도의 통합보건지소 3개소와 경상남도의 통합보건지소 2개소, 총 5개소의 통합보건지소를 2000년 12월 부터 2001년 1월까지 방문하여 보건지소 통합 전후의 인력, 시설, 장비, 진료 및 보건사업의 내용과 통합운영의 문제점 및 개선방안에 대한 면담을 실시하였다. 조사 대상 통합보건지소의 통합 전후 인력변화는 전체 인력은 6.8명에서 9.6명으로 2.8명 증가하였으며, 근무자 수는 통합보건지소는 6-14명으로 변이가 컸다. 통합 전후의 인력은 의사와 치과의사, 간호인력은 비슷하였고, 임상병리사와 방사선사는 한 명도 근무하지 않다가 3개 통합보건지소에 배치되었다. 보건지소 통합 후 일반진료와 치과진료는 약간 증가하였고, 방사선검사와 물리치료, 임상병리검사는 크게 증가하였다. 보건사업의 변화는 방문보건사업 건수와 이동진료 건수, 보건교육 연인원은 통합 전에 비하여 통합 후에 크게 증가하였으며, 예방접종과 자궁경부암 검진은 비슷하였다. 고혈압과 당뇨병 등록 환자수는 약간 증가하였다. 보건지소 통합 이후에 검사건수가 증가하였으나 서비스의 질은 높아졌다고 보기 어려우나, 방문보건, 이동진료, 보건교육사업은 크게 증가하여 긍정적인 현상으로 보인다. 보건지소 통합의 문제점은 인력간 업무의 내용의 불명확성, 과다하게 넓은 건물의 관리의 어려움, 보강되지 않은 장비, 운영비의 미책정, 보건교육을 위한 전문교육의 부족 등이었다. 향후 통합보건지소 기능 활성화를 위하여 의사, 간호인력 및 행정직을 배치하기 위한 최소배치 기준을 보건지소의 기준과는 별도로 설정하여야 할 것이며, 진료 및 방문서비스의 질을 향상시킬 수 있는 기본장비를 확충하는 것이 필요하다. 또한 인력간 업무의 분장을 명확히 하고, 업무관련 가이드라인을 개발하여 제공함으로써 업무의 효율성을 증대시켜야 한다.

• 수면정신생리
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• 제6권2호
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• pp.126-132
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• 1999

목 적: 저자들은 본 연구에서 혈액투석 중인 환자들을 대상으로 불면증의 빈도, 불면증 환자들의 특성, 신체적 그리고 심인적인 증상들과의 상관관계, 수면에 대한 믿음과 태도 등을 조사하여 향후 진료에 도움을 주고자 하였다. 방 법: 부산시내 소재 4개의 혈액투석실에서 혈액투석을 받고 있는 만성 신부전증 환자 153명(남 87명, 여 66명)을 대상으로 저자들이 본 연구에 알맞게 개발한 수면관련 설문지, 벡 우울증 척도, 스필버거 상태-특성 불안 척도를 이용하여 환자들의 증상을 조사하였다. 결 과: 전체 153명의 혈액투석 환자 중 65.4%인 100명이 불면증을 호소하였다. 연령, 남녀비, 교육정도, 결혼상태, 평균 혈액투석 기간, 그리고 혈청 알부민을 제외한 조사된 혈액화학검사 소견들은 불면증군과 비불면증군 사이에 차이가 없었다. 불면증군은 비불면증군에 비해 유의하게 BDI 점수와 투석전 수축기 혈압이 높았고 혈청 알부민치는 더 낮았다. 또, 시각유도척도법을 이용한 두 군간의 주관적인 고통에 대한 조사에서 불면증군은 슬픔, 불안, 걱정, 피부 소양증, 그리고 일상생활에서의 기능장애 등의 주관적인 고통을 비불면증군보다 유의하게 더 많이 호소하고 있었다. 불면증의 심한 정도가 불량한 신체적 건강상태, 피부 소양증, 그리고 골관절 통증 등의 신체적 증상, 슬픔, 불안, 걱정 등의 심인적인 증상, 그리고 낮 동안의 졸음과 일상생활에서의 기능장애와 유의한 혈액투석 중인 만성 신부전증 환자에서의 불면증 132 상관관계가 있었다. 또, 불면증군은 비불면증군에 비해 수면에 대한 비기능적인 믿음이 더 많았다. 결 론: 혈액투석을 받고 있는 말기 신부전증 환자들은 일반 인구에 비해 불면증이 흔하였고, 이들 중 불면을 호소하는 환자들은 대조군에 비해 심인적인 증상과 신체증상 그리고 일상생활에서의 기능저하를 더 호소하였고, 수면에 대한 비기능적인 믿음이 많았다. 그리고 불면증의 심한 정도는 이러한 요인들과 밀접한 관계가 있었다. 이상의 요인들을 고려하여 수면장애를 개선한다면 이들 환자들의 진료에 도움을 주어 치료 순응도와 삶의 질을 높일 수 있으리라고 생각한다.

• 한국노년학
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• 제30권1호
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• pp.21-30
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• 2010

많은 비만인들은 사회적인 편견과 차별로 인하여 신체상에 대한 불만족, 우울, 불안 및 정서장애를 경험하고 있으며, 더 나아가 건강과 관련된 삶의 질의 저하를 나타내고 있다. 이러한 비만인들의 정신적 고통을 개선하기 위하여 운동요법은 하나의 긍정적인 치료 방법으로 권장되고 있다. 본 연구는 동양의 전통 운동형태 중 기공 운동이 비만인에게 건강관련 삶의 질(SF-36), 자기효능감, 우울, 불안, 피로의 심리적 요인에 어떠한 효과를 나타내는지를 살펴봄으로써 비만인을 위한 운동처방 지침을 제공하고자 한다. 본 연구의 피검자는 S시 G구에 소재한 S대학교 골든웰빙 운동프로그램에 참가하는 50-60대의 성인으로 통제군 16명, 운동군 17명으로 분류하였다. 기공 운동은 12주 동안 주2회의 빈도로 실시하여, 운동 전 후로 건강관련 삶의 질(SF-36), 신체적 자기효능감, 우울, 불안, 피로도 변인을 측정하였다. 12주간의 기공 운동 전 후 건강관련 삶의 질(SF-36)의 8항목 중 감정역할 제한(F=0.187, p=0.668), 정신건강(F=2.043, p=0.163)은 집단 간의 유의한 차이를 나타내지 못하였으나, 신체기능(F=15.151, p<0.001), 신체역할 제한(F=18.278, p<0.001), 사회적 기능(F=4.957, p=0.033), 활력/피로(F=11.485, p=0.002), 신체통증(F=6.623, p=0.015), 일반적인 건강(F=4.498, p=0.042)의 6가지 변인은 집단 간의 유의한 차이를 나타내었다. 불안(F=0.631, p=0.433)은 집단 간의 유의한 차이를 나타내지 못하였으나, 신체적 자기효능감(F=6.124, p=0.019), 우울(F=5.109, p=0.031), 피로(F=7.998, p=0.008)의 3가지 변인은 집단 간의 유의한 차이를 나타내었다. 비만인에게 있어서 기공 운동은 비록 느린 동작으로 수행되는 낮은 강도의 운동형태일지라도 운동자체가 가져다주는 정신 심리적인 개선효과가 분명하게 나타나는 운동임을 본 연구를 통하여 확인할 수 있었다.

• 한국엔터테인먼트산업학회논문지
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• 제15권4호
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• pp.337-347
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• 2021

본 연구는 요양병원에 근무하는 치료사의 코로나19 대응 전략 및 치료실 감염관리 시스템 개선을 위한 기초자료를 제공하고 치료사의 감염관리 업무 이해를 돕고자 실시한 질적 연구이다. 연구방법은 Colaizzi의 현상학적 연구 방법을 적용하였다. 요양병원에서 근무 중인 작업치료사와 물리치료사 9명을 대상으로 전화 인터뷰를 실시하였다. 인터뷰 내용은 연구대상자의 동의하에 녹음하였으며, 추가적인 내용 확인은 이메일로 받았다. 녹음된 내용은 전사 뒤 분석하여, 코로나19에 대처한 경험의 의미와 본질을 기술하였다. 인터뷰 내용은 6개의 주제와 17개의 중심의미, 49개의 의미단위로 정리하였다. 코로나19 상황에 따라 요양병원 내 감염관리 교육 강화, 감염관리 실천, 업무시간 외 감염관리 감독으로 감염관리 시스템이 강화되었으며, 치료실 내 거리두기 실천, 업무시간 내 휴식 및 식사시간 조정, 감염관리 강화로 치료활동 제약으로 치료 환경이 변화된 것을 알 수 있었다. 또한 치료사의 역할이 확대되고 언택트 중재방법에 대한 고려하는 등 치료의 패러다임이 변화되었으며, 코호트 격리, 코로나19 사전검사, 백신접종과 부작용 경험으로 코로나19에 따른 새로운 경험을 하였음을 확인하였다. 하지만 감염업무로 인해 치료사의 업무 부담이 가중되고, 코로나19 확산에 따른 두려움과 우울감, 업무 스트레스를 겪고 있으며, 백신접종 후 휴식 보장, 감염관리 도구 및 장비 지원 등 요양병원 치료인력 지원의 필요성도 인식하고 있었다. 본 연구의 결과는 요양병원 치료실 내 감염병 대응 전략 프로그램 개발 및 요양병원 감염관리를 위한 인적, 물적 지원의 기초 자료로 활용되기를 기대한다.

• Journal of Preventive Medicine and Public Health
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• 제11권1호
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• pp.86-97
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• 1978

The mobile medical service has been operated for many years by a number of medical schools and hospitals as a most convenient means of medical service delivery to the people residing in such area where the geographical and socioeconomic conditions are not good enough to enjoy modern medical care. Despite of official appraisal showing off simply with numbers of outpatients treated and medical persons participated, however, as well recognized, the capability (in respect of budget, equipment and time) of those mobile medical teams is so limitted that it often discourages the recipients as well as medical participants themselves. In the midst of rising need to secure medical service of good quality to all parts of the country, and of developing concept of primary health care system, authors evaluated the effectiveness of and problems associated with mobile medical servies program through the community diagnosis of a village (Opo-myun, Kwangju-gun) to obtain the information which may be halpful for future improvement. 1. Owing to the nationwide Sae-Maul movement powerfully practiced during last several years, living environment of farm villages generally and remarkably improved including houses, water supply and wastes disposal etc. Neverthless, due to limitations in budget time and lack of knowledge (probably the most important), these improvements tend to keep up appearances only and are far from the goal which may being practical benefit in promoting the health of the community. 2. As a result of intensive population policy led by the government since 1962, there has been considerable advances in understanding and the rate of practicing family planning through out the villages and yet, one should see many things, especially education, to be done. Fifty eight per cent of mothers have not received prenatal check and the care for most (72%) delivery was offered by laymen at home. 3. Approximately seven per cent of the population was reported to have chronic illness but since only a few (practically none) of the people has had physical check up by doctors, the actual prevalence of chronic diseases may reach many times of the reported. The same fact was observed also in prevalence of tuberculosis; the patients registered at local health center totaled 31 comprising only 0.51% while the numbers in two neighboring villages (designated as demonstration area of tuberculosis control and mass examination was done recently) were 3.5 and 4.0% respectively. Prevalence rate of all dieseses and injuries expereinced during one month (July, 1977) was 15.8%. Only one tenth of those patients received treatment by physicians and one fifth was not treated at all. The situation was worse as for the chronic patients; 84% of all cases either have never been treated or discontinued therapy, and the main reasons were known to be financial difficulty and ignorance or indifference. 4. Among the patients treated by our mobile clinic, one third was chronic cases and 45% of all patients, by the opinion of doctors attended, were those who may be treated by specially trained nurses or other paramedics (objects of primary care). Besides, 20% of the cases required professional managements of level beyond the mobile team's capability and in this sense one may conclude that the effectiveness (performance) of present mobile medical team is quite limitted. According to above findings, the authors would like to suggest following for mobile medical service and overall medicare program for the people living in remote country side. 1. Establishment of primary health care system secured with effective communication and evacuation (between villages and local medical center) measures. 2. Nationwide enforcement of medical insurance system. 3. Simple outpatient care which now constitutes the main part of the most mobile medical services should largely be yielded up to primary health care unit of the village and the mobile team itself should be assigned on new and more urgent missions such as mass screening health examination of the villagers, health education with modern and effective audiovisual aids, professional training and consultant services for the primary health care organization.

• 성인간호학회지
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• 제12권3호
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• pp.431-451
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• 2000

In this paper, I will examine the variables influencing the Quality of Life of arthritis patients and present basic materials which help arthritis patients have positive thinking in life and ultimately lead a satisfactory life. The subjects for this study are 231 inpatients and outpatients with arthritis living in J and K city in Chonbug Province. For the analysis of collected data I employed the SAS program. The variables for characteristics and the quality of life were analysed by descriptive statistics, T-test and ANOVA, and the relations among variables were analysed through Pearson Correlation; the Regression method was employed to predict the factors affecting quality of life. For the validity of reliance on measuring equipment Cronbach Alpha was used. The results of the study are as follows : (1) The mean score of quality of life of arthritis patients is 3.09(5 in the maximum). The general characteristics which affect the quality of life are age(F=5.13, p=0.0006), standard of education(F=6.49, p=0.0003), marriage status(F=7.77, p=0.0005), monthly pay(F=4.37, p=0.0020), medical benefits (F=4.85, p=0.0087), and supports(F=4.39, p=0.0050). For the disease-related characteristics, there is a significant difference in the 6 items: pain control method(F=5.92, p= 0.0002), physical therapy(F=3.25, p=0.013), whethere or not patients exercise(F=4.62, p=0.0000), regularity of exercise(F=4.79, p=0.0000), frequency of exercise(F=6.29, p=0.0001), and amount of exercise(F=4.62, p=0.0043). Depending on the type of arthritis, there is also a significant difference in the degree of pain felt. The patients with infectious arthritis suffer from pain the most, followed by those with gout, rheumatism and degenerative arthritis, in that order. Although statistics don't show any convincing evidence, those with gout perceive that they are in best health condition, followed by those with rheumatism, degenerative arthritis, and infectious arthritis, in that order(F=2.23, p=0.0669). (2) The quality of life of arthritis patients is correlated positively with perceived health status(r=0.56, p=0.0001), health promoting behavior(r=0.53, p=0.0001), family support (r=0.46, p=0.0001), amount of exercise (r=0.36, p=0.0001), ADL(r=0.36, p=0.0001), HLOC(r=0.32, p=0.0001), frequency of exercise(r=0.32, p=0.0001)in that order, while correlated negatively with the degree of pain felt(r=-0.32, p=0.0001), the number of pain regions(r=-0.19, p= 0.0041), and the duration of pain(r=-0.14, p=0.0279). (3) Regression analysis reveals that the most powerful predictor of the quality of life is perceived health status, which account for 31.11%. The other predictors of the quality of life, which account for 60.22%, are health promoting behavior(16.51%), family support(3.81%), ADL(2.52%), gender(1.86%), the number of family members(1.36%), level of pain(1.24%), duration of pain (1.08%), and level of education(0.67%). The results of the study show that perceived health status and health promoting behavior are the two most important variables. However, considering that the perceived health condition is difficult to control by nursing intervention, it is suggested that the level of expectation for patients, must be decided first, and the health promoting behavior and the family support influencing the quality of life must be taken into account as targets for nursing intervention. As a way of controlling the quality of life, I think that a more comprehensive approach comprising the above important variables along with demographic and general characteristics is needed. I also suggest that we must continue to explore the variables affecting the quality of life and include those variables in nursing intervention.

• 대한간호
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• 제31권4호
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• pp.77-99
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• 1992

The study was carried out at W. hospital, an affiliated hospital of Y university, involved a total of 163 patients who were discharged from the hospital between May 1990 und March 199J. Data collection was twice, just prior to discharge and a minimum of three months post discharge. Thirty patients who lived within a hour travel time of the hospital received home care during the three months post discharge. Nursing diagnoses and nursing interventions For these patients were analyzed in this study. The results of the study are summarized as follows : 1. Discharge needs for the subjects of the study were analyzed using Gordon's eleven Functional categories and it was found that 48.3% of the total sample had identified nursing needs. Of these, the needs most frequently identified were in the categories of sexuality, 79.3 %, health perception, 68.2 % self concept, 62.5 %, and sleep and rest 62.5 %. Looking ut j he nursing diagnosis that were made for the 30 patients receiving home care, the following diagnoses were the most frequently given; alteration in sexual pattern 79.3%, alterations in health maintenance, 72.6%, alteration in comfort, 68.0%, depression, 64.0%, noncompliance with diet therapy, 6.3.7%, alteration in self concept, 55.6%, and alteration in sleep pattern, 53%. 2. In looking at the effects of home nursing care as demonstrated by changes in the functional categories over the three month period, it was Found that of the 11 functional categories, the need level for health perception, nutrition, activity and self concept decreased slightly over the three month period. On the average sleep patterns improved, but restfulness was slightly less and bowel elimination patterns improved but satisfaction with urinary elimination was slightly less. On the other hand, role enactment, sexuality, stress management and spirituality decreased slightly. The only results that were statistically significant at the 0.05 level were improvement. in digestion and decrease in pain. No statistically significant changes were found in ability related to ADL, the total ADL Score at discharge was $19.78{\pm}8.234, and after 3 months $19.01{\pm}8.12$. Considering that a majority of the patients were over 60 years of age and that many had brain or spinal cord injuries, the fact that their ADL ability did nor deteriorate after discharge can be interpreted as related to a positive impact by the home health care nurses. Similarly there was a slight be not statistically significant decrease in the quality of life scores between the two lest times(l47.83 at discharge and 113.02 at the three month period). Again, when the chronic nature of thee problems facing these patients is considered this maintenance of quality of life can be interpreted as a positive impact by the home health care nurses. 3. One of the home care nursing activities was diagnosis. For this activity it was found that for nine functional health categories(sexuality and spirituality excepted) there were 20 nursing diagnoses. The most frequent were noncompliance, alteration in skin integrity both actual and potential, and impaired physical mobility in that order. 4. Delivery of home health care by the home health nurses included the following nursing activities; assessment, patient education, demonstration of care activities, counselling, direct care to the patient and referrals. Direct care included changing dressings, bladder irrigations, changing Foley catheters, measurement of residual urine, perineal care, position change, back care, oral hygiene, exercise and massage of motion exercises, cleansing enemas, tracheostomy suctioning and tracheostomy care, care of dentures, applications of heat and other similar nursing activities. In conclusion almost 50% of (he sample indicated a need for continued nursing care at the time of discharge and for the patients in the sample who received home care there was a slight decrease in nursing needs but while the patients had chronic and debilitation problems there was ill decrease in ADL abilities or in quality of life. Further study needs Lo be done La increase the reliability and validity of the tool that was used to measure home health care needs. It is also recommended that study by done using a randomized sampling with a control group to compare patients who receive home care with those who do not.