• 대한간호학회지
• /
• 제1권1호
• /
• pp.27-43
• /
• 1970

This study is designed to find out proper nursing activities for the needs of the colostomy patients, i.e., mental and psychological as well as physical needs for rapid recovery, and to help them build up the follow-up care for proper social adjustment. The study is based on 268 cases out of 381 colostomy patient's records kept in Ewha Womans University Hospital, Yonsei Medical Center, and National Medical Center in between the period from Jan. 1953 to Jan. 1970. The items of study are mainly on etiology, sex, age, duration of hospitalization, mortality rate, seasonal frequency, time from the onset of illness to the admission of the hospital, signs and symptoms. 1. Frequency of onset by etiology: Neoplastic disease 112 cases (42%), Inflammatory disease 33 cases (12%), Congenital malformation 30 cases (11%), Intussusception 25 cases (9.3%), Trauma 24 cases (9%), Volvulus 17 cases (6.3%), and Crohn's disease 6 cases (2.2%). 2. By sex: male 167 cases (62.9%), and female 101 cases (37.1%). So the ratio of portion of male and female 2:1. 3. By age: under 1·year·old 27 cases (10.1%) highest, 41-50 yrs 54 cases (20.2%), 51-60 yrs 42 cases (15.5%), above 71 yrs 5 cases (1.9%). 4. Duration of hospitalization: the shortest is 2-days and the longest is 470 days. 1-20-days 52%, 40-60 days 14%. 5. Mortality rate: Under the 10-days-admission 19.5%, and the beyond 30-days-admission 3.9%. 6. Seasonal frequency: Higher in summer (32% ). 7. Signs and symptoms: abdominal pain (56%), abdominal distention (54%), vomiting (40%), bloody mucoid diarrhea (38%) , pain of anal region (18%), abdominal tenderness, anorexia, indigestion, constipation, disuria, tenesmus, high fever and chilling sensation, bile tingled vomiting. Nursing activities for the patient's physical needs are as follows: Skin care for colostomy region, Prevention of colostomy constriction and depression, Removal of an offensive odor, The use of colostomy bag-selection for, and demonstration of the use of inexpensive colostomy irrigation equipment, Personal hygiene, general skin care, care of hair, finger nails and toe-nails, Oral hygiene, sleep and rest, aquate, Daily activities, etc. Measures for regulation of bowl movement. Keeping the instruction of taking food, Preparing the meal and help for anorexia, Constipation and it's solution, Prevention of diarrhea, helping the removal of mucous, and stretch constricted steam as needed. Nursing activities for pt's socio-psychological needs are as follows; Help the patient to make decision for the operation, Remove pt's anxiety toward operation and anesthesia, To meet the pt's spiritual needs at his death bed, Help to establish family and friends cooperation, Help to reduce anxiety at the time of admission and it's solution, Help to meet religious need, Help to remove pt's anxiety for loosing his job and family maintenance, Follow-up studies for 7 cases have been done to implement the present thesis. The items of the personal interviews with the patients are as follows: Acceptability for artificial anus, The most anxious thing they had in mind at the time of discharge, The most anxious thing they hat·e in mind at present, Their friends and family's attitudes toward the patient after operation, Relations with other colostomy patients, Emotional damage from the operation, Physical problem of enema, irrigation, Control of diet, Skin care, Control of offensive odor, Patient's suggestions to nurses during hospital stay and after discharge. In conclusion, the follow-up care for colostomy patients shares equal weight or perhaps more than the post-operative care. The follow-up care should include the spiritual care for moral support of the patient, to drag him out of isolation and estrangement, and make him fully participate in social activities. It is suggested that the following measures would help to rehabilitate the colostomy patients (1) mutual acquaintance with other colostomy patients if possible form a sort of club for the colostomy patient to exchange their experiences in care (2) through the team work of doctor, nurse and rehabilitation specialists, to have a sort of concerted effort for betterment of the patient.

• 대한간호학회지
• /
• 제3권3호
• /
• pp.97-110
• /
• 1973

The goal of modern nursing is to provide comprehensive nursing care to patients. If comprehensive nursing care to children (within the hospital setting) is to be provided, consideration of the stage of growth and development of the child is especially important. From clinical observation, it appeared that nurses often disregarded individual requirements of children in giving nursing care. Therefore, the purpose of this study is to show that comprehensive nursing care which is based on an understanding of the growth and development of the child contributes to both the child and the mother's adaptability to the child's hospitalization. Method: Sixty children, three to three year of age, hospitalized at the Yonsei University Pediatric Ward ware studied. From April 1, 1973 to May 5, 1973, children admitted to the hospital were assigned to either an experimental or a compare groups. There were 30 children in each group. The sex and age of the children in each group was similar. In both groups were more male than female children. In the experimental group, each mother stayed with hot child continuously during his hospitalization. In the compare groups, the mother or some other member of the family stayed with the child. Each day on the child's admission the investigator visited the ward from 1-2 P.M. to 9-10 P.M., in order to provide comprehensive care for the experimental -group. The assistance given the nurses by the investigator was in the form of conferences regarding care and in giving direct care to the child and his mother. The compare group of children received nursing care as usually provided by the hospital. The instruments used to obtain the data for analysis were as follows: 1. The fear and anxiety reaction of the child was recorded by observation of the investigator for four areas: 1) separation from parent and relatives 2) reaction to Doctor and Nurse with white gowns 3) reaction to nursing care 4) reaction to injection and tests, etc. 2. Regression in area of eating, sleeping, and elimination were recorded by the investigator by questioning the mother and by observation. 3. Adaptability to the hospitalization was recorded by direct questioning of the children for areas of emotional and social adjustment. For children older than 3 years of age or children not seriously ill, using the simple I. Q. test this was possible for only 35 of the total 60 children. Result: 1. 55 percents of the total 60 children had been prepared by their parents for hospitalization. The children who had received prior preparation accepted hospitalization more readily than those who had received no preparation. (χ²=4.6 Ρ<0.05) 2. On admission 31.7 percent of the children expressed verbal fear of their discase or treatment. 25 percent felt that the disease was due to their mistake. 3. There was a significant difference in the reaction of the child to separation from the parent or relatives between the two groups. The experimental groups showed less anxiety due to separation than the compare group. (χ²=4.34 Ρ<0.05) In both groups there was less anxiety due to separation among school age (6-12 years) children than among preschool age (3-5 years) children. (χ²=9.22 Ρ<0.05) 4. More than half of the children in both groups reacted with fear and avoidance to doctor and/or nurses wearing white gowns. (χ²=0.06 Ρ<0.05) 5. The experimental group reacted more favorably to nursing in general than the compare group. (χ²=4.8 Ρ<0.05) 6. There was no difference in the fear and refused reaction to special tests and/or such as X-rays and injections, etc. between the groups. (χ²=3.77 Ρ<0.05) 7. More children in the compare group showed regressive tendencies in eating, sleeping, and elimination habits than in experimental groups. (χ²=2.3 Ρ<0.05 χ²=3.88 Ρ<0.05 χ²=4.9 Ρ<0.05) 8. There was a significant difference in the adaptability to hospitalization between the two groups. The experimental groups adapted more readily. (χ²=2.02 Ρ<0.05) 9. For children who had higher I.Q. s the adaptability to hospitalization was better regardless of the group. (χ²=5.03 Ρ<0.05) However, because of the small number of cases (60), this finding cannot be extrapolated without further verification. The date demonstrates that there was a greater adaptability to hospitalization by the child when comprehensive nursing care was given. By planning care and applying knowledge of growth and development to meet, nurses are in a position to prevent some of the psychological trauma associated with hospitalization.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
• /
• 제6권1호
• /
• pp.74-89
• /
• 1995

본 연구는 DSM-IV에 의해 선택적 함구증으로 진단된 23명의 아동들을 대상으로 임상적인 특성(인구학적 특성, 임상경과, 발달력, 성격특성, 가족력, 지능지수, 학업성취도), 치료방법 및 기간, 치료경과등을 조사하여 다음과 같은 결과를 얻었다. 1) 대상군의 남녀 비율은 1 : 4.8로 여아에서 높았으며 발병시 평균연령을 3세 4개월, 치료시작의 평균연령은 7세 7개월이었다. 2) 주산기의 문제를 가지고 있었던 아동은 22%였으며 언어발달이 지연되었던 아동은 26%였다. 3세 이전에 주 양육자와의 분리경험이 있던 아동은 26%, 3세 이전에 외상이나 심리적 충격을 입었던 아동은 26%였다. 유뇨증의 병력은 30%에서, 유분증의 병력은 4%에서 있었다. 3) 어머니의 공생적인(symbiotic relationship) 관계에 있는 아동은 61%였고 가정내에서 아버지보다 어머니의 영향력이 우세한 경우는 65%였다. 부모중 정신병리나 알콜/약물중독의 문제를 가지고 있는 경우는 39%였다. 과거력상 신체적인 학대를 받았던 아동은 26%였다. 4) 환아들의 성격특성중 가장 많은 것은 수줍음(100%)이었고 그 다음으로는 불안해 한다(83%), 고집이 세다(83%), 아기 같고 의존적이다(65%), 화를 잘 낸다(52%), 조종하려고 한다(39%) 순으로 많았다. 5) 지능검사를 실시한 16명 아동의 평균 지능지수는 88.3이었고 이중 정신지체의 기준은 IQ 69 이하의 아동이 7명, 70 이상인 아동아 9명이었다. 6) 치료방법중 놀이치료를 받은 아동이 65%로 가장 많았으며 약물치료를 받은 아동은 21%, 행동치료를 받은 아동은 8%, 한 가지 이상의 방법을 복합하여 치료받은 아동은 12%였다. 7) 치료종료시 최우수 평가를 받은 아동은 8.6% 였고 우수의 평가를 받은 아동은 30.4% 양호의 평가를 받은 아동은 52%, 불량의 평가를 받은 아동은 8.7%였다. 추적도사의 최우수의 평가를 받은 아동은 21.7%였고 우수는 13%, 양호는 21.7%, 불량은 34.8% 였다. 치료성과는 유의미한 상관관계를 보이는 변수는 지능지수로 나타났다. 8) 대상군을 공생형 함구증(symbiotic mutism), 언어공포성 함구증(speech phobic mutism), 반응성 함구증(reactive mutism), 수동-공격성 함구증(passive aggressive mutism)으로 분류하였을때 각각 65%, 8.6%, 12%, 30%였다. 지능지수에 따라 정신지체로 분류된 7명과 정상지능군에 속하는 9명을 비교적 언어발달 및 성격특성, 가족역동, 치료성과 등에서 차이가 있음을 알 수 있었다.

• 농촌의학ㆍ지역보건
• /
• 제4권1호
• /
• pp.41-61
• /
• 1979

Two interview surveys (1976 for 800 patients, 1978 for 200 patients) and an inventory survey through medical records(1978) for epileptic patients who have registered with the Korean Epilepsy Association (Rose Club) since 1971 were carried out by trained health workers in advance of survey. The data obtained from the analysis showed as follows: 1) 35.2% of patients were born in Seoul and 70. 6% of patients born elsewhere have lived in Seoul. 2) 50-60% of patients were 15-30 years cid. 3) 33.4%, 24,6 and 24.6 of all pupils and students went to elementary, junior and senior high schools respectively. 4) 21.2% of all pupils and students had dropped out of school and 51.4% of them were away from school because of epilepsy. 5) 3.1% of all patients had no job at all and students comprised 20.9% of patients followed by clerical work, commercial business and farming with about 6% in each group.6) Reasons given for unemployment such as dismissal (4.3%), quit (27.7%), hesitation to employ (42.5%)and discontinuance of job (25.5%) were basically due to epilepsy. 7) About half(46.2%) of all patients have become Christian since the Rose Club was a voluntary agency which has been sponsored by Christians. 8) 82. 6% of patients were diagnosed as having grand mal as the most. 9) 29.4% of patients explained aura with psychomotor disturbances and 13.8% with sensory disorders. 10) 46.3% of patients were attacked with seizures when they were tired and others(11.6% and 4.9%) after excessive eating and hunger. 11) Patients suffered more seizures in spring and summer rather than in autumn and winter and most patients had attacks 1-5 times a month. 12) For etiologic reasons of epilepsy, 35.5% of patients considered it was caused by psychological stress and 11.5% by trauma. Only 1.1% of patients considered it as having hereditary components. 13) 51% of patients were slow in caring for their own illnesses. They started to reat epilepsy after spending 5 years of time from the initial seizure. Only 5.4% of patients had received the modern anti-epileptic therapy right after the nitial seizure. 14) 62.1% of patients had no therapy or irregular or incomplete treatment before registration at the Rose Club Clinic. 15) Before registration at the Rose Club, 42.4% of patients received medical care. On the other hand, 25.6% went to herb doctors and 12.5% used to go to the drugstore in order to get anti-epileptic drugs. 16) 41. 6% of patients who took anti-epileptic drugs had more or less side-effects. Indigestion was the most common. 17) For continuation of treatment, 30.3% have received treatment for more than 5 years and the evident showed that epilepsy took a longer time to be cured. 18) Regarding the medical care received 44.2% of patients were very satisfied with effective care and 26.5% felt as good. 19) For attitudes toward epilepsy. 27.0% of patients and 68.2% of patients family were pessimistic. 20) 65.9% of patients had optimistic attitudes toward effectiveness of medical care of epilepsy. 21) 64.8% of wives and husbands had better understanding and cooperative for their spouses who had epilepsy. 22) 33.3% of patients were under-treated at the place of work. 23) 70.2% of patients wished to marry when they reach childbearing age and 63% wished to have children. Through the above results it is recommended for nation-wide epilepsy control that the sound and correct health education not only from health aspect but also from welfare aspect should be planned and implemented as soon as possible.

• 한국응급구조학회지
• /
• 제9권2호
• /
• pp.111-128
• /
• 2005

Background: Cardiac arrest is one of the most critical diseases which can likely lead to severe cerebral disability or brain death when the cases can not recover their circulation within 10 minutes. Saving out-of-hospital cardiac arrest cases is a recent concern in Korea. Resuscitation has become an important multidisciplinary branch of medicine, demanding a spectrum of skills and attracting a plethora of specialities and organizations. The best survival can be achieved if all the following links have been optimized : rapid access, and early CPR, defibrillation and ACLS, Since the "Utstein Style" was advocated in 1991, many reports about out-of-hospital cardiac arrest have been published based on this guideline. These differences prevent valid inter-hospital and international comparisons. However, it is not known how effective resuscitation has become to the patients. In other words, there are no guidelines for reviewing, reporting, and conducting research on resuscitation in Korea. This dissertation aims to provide the basic data for a unified reporting guideline of resuscitation in Korea and evaluating the out-of-hospital factors associated with survival discharge of out-of-hospital cardiac arrest. Methods: As for this study, uses the collected data about Out-of-hospital cardiac arrests at 4 area, from January, 2005 to April. 2005. With a retrospective study, 174 cases were analyzed. The data was recorded based on the Out-of-Hospital Utstein Style. Results: Resuscitation was performed on 174 out-of-hospital cardiac arrest cases at the 4 area 14 patients(8.1%) recovered their spontaneous circulation. Overall, the ROSC of the out-of-hospital cardiac arrest patients was 8.1%, which was poorer than that of western countries. Gender distribution was 50 females(28.7%) and 124 males(71.3%), approximately twice as many males as females. ROSC of witnessed arrests was found out to be 97.7%. The ratio of the witnessed arrest groups showed higher results than that of unwitnessed arrest groups in the above-examined cases. Cardiac etiology consisted of cardiac(33.5%), non-cardiac(45.7%), trauma(20.1%), and unknown(6.0%). Cardiac was the best performance. Initial rhythm showed Ventricular Tachycardia/pulseless Ventricular Fibrillation in 8 patients(6.0%), asystole in 100(75.2%) and unknown in 25(18.8%). The results of the Ventricular Tachycardia/pulseless Ventricular Fibrillation showed higher results than the others cases, The proportion of the cardiogenic cause was 33.5%, which was only half of western countries. Ventricular Tachycardia/pulseless Ventricular Fibrillation is relatively rare. These differences were due to the prevalent pattern of Out-of-hospital cardiac arrest as well as prematurity of the EMSS. Bystander CPR was practiced on 13 patients(7.52%). ROSC was shown in 46.2% cases. CPR by EMT was carried out on 167 cases(96.5%). ACLS by EMf was rare. From collapse, 4 cases(2.6%) arrived to ED within 6 minutes. 13 (8.6%) within 10 minutes, and 49(32.5%) over 31 minutes. The sooner the patients arrived, the greater the ratio of ROSC and discharged alive became, and the same with collapse time to ROSC. As the results of the logistic regression analysis, ROSC was found out to be highly influenced by the time of ED arrival from collapse and Ventricular Tachycardia/pulseless Ventricular Fibrillation. Therefore, the ratio of ROSC depends on not any single factor but various intervention factors. Conclusion: This dissertation presents the following suggestions and directions of the study hereafter. First, the first step for a chain of survival should be taken to activate EMSS early with a phone as soon as cardiac arrests are witnessed. Second, it is keenly needed that emergency medical technicians should be increased through emergency education for living. Third, it is necessary to establish the emergency transportation system. Fourth, most of the Koreans have little understanding of EMT and the present operation systems have many problems, which should be fundamentally changed. Fifth, it is required to have an active medical control over Out-of-hospital CPR, And proper psychological supports should be given not only to patients themselves and their family but also individuals who are engaged in emergency situation. Finally, through studies hereafter on nationwide, comprehensive, and standard forms, it is needed to examine into the biological figures of human body, causes and trends of cardiac arrests, and then, to enhance the survival rate of Out-of-hospital cardiac arrests. Korean guidelines for Cardiopulmonary resuscitation need to be made.

• 수면정신생리
• /
• 제29권1호
• /
• pp.15-20
• /
• 2022

배 경: 본 연구는 자살시도자와 자살사망자 간 자살방법, 스트레스 요인, 정신과적 진단에 차이가 있는지 확인하고자 하였다. 방 법: 두 가지 후향적인 자료를 분석에 사용하였다. 자살시도자의 경우 삼성서울병원의 의무기록을 확인하여 680명의 의무기록을 수집하였고 한국생명존중재단의 심리부검과정을 통해 11,722명의 자살사망자 데이터를 제공받았다. 두 가지 자료의 자살방법, 스트레스 요인, 정신과적 진단에서의 차이를 확인하였다. 결 과: 자살사망자는 자살시도자에 비해 남성이 많았고 연령대가 높은 것으로 나타났다. 자살 방법 중 목 매달기나 농약 음독과 같은 방법이 자살사망자와 관련이 있었다. 자살시도자의 경우 둔기를 이용해 손목을 긋거나 약물을 음독하는 경우와 연관이 있는 것으로 나타났다. 모든 종류의 스트레스 요인이 자살사망자에게서 높았으며, 특히 경제적인 문제와 신체적인 문제가 자살사망자에게서 높은 비율로 나타났다. 진단의 경우 연령과 성별에 따른 영향을 배제하자 자살시도자와 자살사망자 간 차이를 규명할 수 없었다. 결 론: 자살시도자와 자살사망자 사이에 자살 방법, 스트레스 요인에 차이가 있다는 것을 확인하였다. 이는 경제적인 문제와 신체적인 문제가 동반된 경우 자살 사망의 위험이 더 높을 수 있음을 시사한다.