• Journal of Preventive Medicine and Public Health
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• 제24권4호
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• pp.531-548
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• 1991

신생아의 질적 관리를 위해 신생아실 의료인력과 의료수가의 타당성을 파악하고자 영남지역내 24개 소아과 수련병원 가운데 신설병원과 모(母)병원의 수련프로그램에 의존해 있는 병원을 제외한 20개 병원의 신생아실을 대상으로 1991년 7월 29일에서 8월 14일 사이에 각 병원을 방문하여 자료를 수집하였다. 자료는 신생아실 대장에서 1991년 6월 한달동안 입.퇴원한 정상 및 환아수를 조사하고 신생아실 수간호사와 소아과 의사를 면담하여 정상신생아 관리에 소요되는 최소한의 간호시간, 인력현황, 인력의 적정성, 그리고 인력확보의 문제점을 조사하였고 자 병원 보험심사과에서 정상 질분만시와 제왕절개분만시 산모 1인당 평균 산모 및 신생아관리분의 의료비를 조사하였다. 정상신생아 1명당 하루에 필요한 최소한의 간호시간은 평균 179.5분(${\pm}58.6$)이었고 대학병원은 202.3분(${\pm}50.7$), 종합병원은 164.2분(${\pm}60.5$)이었다. 최소한의 간호 요구시간 대 제공가능한 간호시간 비는 평균 1.42였고 환아에 대한 간호 요구량을 감안했을 때는 평균 비가 2.06으로 간호인력이 매우 부족하였다. 미국 소아과학회가 권장한 신생아실 간호인력을 기준으로 할 경우 간호사는 31%, 간호조무사는 17%가 충원된 상태였다. 신생아실 수간호사의 90%와 소아과 의사의 85%가 간호사가 부족하다고 했고 간호조무사는 각각 75%가 부족하다고 했다. 간호인력 보충이 안 되는 주된 이유는 재정사정이라고 하였다. 간호조무사의 경우는 인력구하기 힘든 것이 재정사정 다음으로 중요한 이유였다. 그러나 국립대학병원의 경우는 의사와 간호사는 T.O.의 제한이 주된 이유라고 했다. 정상 질분만으로 2박 3일만에 퇴원하는 경우 총 의료비는 평균 219,430원이었고 이 중 신생아분은 20,323원(9.3%)이었으며, 제왕절개분만으로 6박 7일만에 퇴원할 경우 평균 732,578원이었고 이 중 신생아분은 76,937원(12.0%)이었다. 원가계산방식에 의한 신생아관리에 대한 최소한의 원가는 3차진료기관의 경우 1일 16,141원, 기타 종합병원은 14,576원으로 원가가 의료보험수가의 각각 5.0배, 4.9배나 되었다. 오늘날의 의료인력의 인건비 수준과 병원시설 및 관리비를 감안할 때 현행 의료수가로 양질의 신생아관리를 기대하기 어려운 것으로 생각된다.

• 한국보건간호학회지
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• 제12권1호
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• pp.55-74
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• 1998

In the past most major accidents resulted in death, but today there is a dramatic increase in the number of people who survive such accidents but who are left with permanent injury. Particularly, children who are inquisitive about their surroundings but immature in their ability to assess danger, are more vulnerable to accidents and their causes as well as to determine attitudes towards prevention. The main objective of the study was to assess the effectiveness of using an accident prevention manual for accident for accident prevention education. The study was a quasi-experimental study using a questionnaire format. The subjects of the study were 393 mothers of children attending six day care centers in Seoul. Data collection was done between May 1 and June 15, 1997. The tools used for the study were a questionnaire developed the researchers and a manual for accident prevention. The collected data were analyzed using SPSS. The results of the study are as follows: 1. Types of accidents included stabbing, bums, falls from heights, choking, falls on slippery surfaces, traffic accidents, drowning, poisoning, and electrical shock in that order of frequency. 2. The main causes of accidents in children were from cosmetics and household medications. 3. The most frequent locations of accidents in the home were the bathroom, kitchen, and stairways in that order. 4. For $90.4\%$ of children safety seats were not used when the ridding in a car. 5. In examining the parents' accident prevention practices, it was found that many parents used only . one electrical outlet for many appliances, tending to overload the electricity lines and that they were not practically concerned bout the flammability of children's pajamas, indicating a less than positive attitude towards fire prevention. 6. The parents had not provided their children with any instruction on accident prevention or on what to do after an accident had occurred. 7. After the use of pamphlet in an accident prevention education program, it was found that there was a statistically significant difference in the degree to which children carried out safety measures (t=14.96, p=.000) and in their safety habits (t=-1.67, p<.1) indicating an effectiveness in this method of education. The results of this study showed that there are many things in a child's environment that can cause accidents and that the possibility of an accident occurring is high. So nurses looking after children should be aware of the need for safety education to prevent accidents in the home and plan to provide appropriate educational material to help parents with this education.

• 한국보건간호학회지
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• 제12권2호
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• pp.172-184
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• 1998

This study was to examine the characteristics of aggressive behaviour of dementia patients. It was based on the observation of the patients in a facility for dementia patients. Observation continued for two days from 9a.m. to 5p.m .. aggressive behavior was recorded using the instrument of Ryden. The result of this study is as follows. 1. appearance rate of aggressive behaviour During two days $74\%$ of the patients did aggressive behaviour(first day-$41.8\%$. second day-$62.8\%$). The average aggressive behaviour per person was 1.65. 2. types of aggressive behaviour Aggressive behaviour was the most frequent in verbal domain(157 case; $52.5\%$). Physical domain was the second$(136case;\;45.5\%)$, and sexual domain was the last$(6 case;\;2.0\%)$. More concretely, abusive/vulgar language$(74case;\;24.7\%)$ was more than anything else. Aggressive language$(65case;\;21.7\%)$, pushing$(39case;\;13.0\%)$, intimidating posture$(21case;\;7.0\%)$. slapping $(18case;\; 6.0\%)$ followed it. 3. correlation to other factors such as sex. age etc. The average aggressive behaviour of female(2.07) was higher than that of male(1.23) (p=.05). Age also had meaningful correlation to the frequency of aggressive behaviour(p=.04). All the other factors-the period of living in facility, the seriousness of dementia. movements in daily life. CAPE, emotional state. the extent of trouble in cognition- have nothing to do with the frequency of aggressive behaviour. 4. the time, place and the target of aggressive behavior Aggressive behaviour appeared more frequently in the afternoon $(138case;\;46.4\%)$ than in the morning or at lunch time. The patient's room ranked the first in the list of places where aggressive behaviour took place $(162case;\; 54.5\%)$. Nursing personnel topped in the target of aggressive behaviour$(119case;\; 39.8\%)$. 5. the preceding causes of the aggressive behavior the most frequent preceding causes of the behavior was the stimulus of another residents $(133case, 44.4\%)$ and that of nsg personnel was few relatively$(65 cases,\; 21.7\%)$. 6. Nursing personnel used verbal reaction most frequently$(40 cases,\; 51\%)$ and in a behavioral reaction they used physical restraint $(12 cases,\; 17.1\%)$ most frequently. In the reactions of nsg personnel. the rate of undesired reaction was high$(41cases,\; 44.28\%)$. and in that of the attacked residents, the usual reaction was most frequent $(80cases,\; 65.0\%)$. In the future it is needed to investigate the characteristics of aggressive behavior of dementia patients, and based on this the method of intervention must be developed. Today the number of dementia patient increases so nurses must strive to encounter aggressive behavior more desirably.

• 대한간호학회지
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• 제4권1호
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• pp.107-120
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• 1974

Necessity and purpose of this study: In a large number of countries it has been founded that children′s domestic accidents are at great risk year by year In the United States, they publish detailed accident statistics at regular intervals. In Korea. there have been just a few studies on Accidents-At-Home of preschool children. But it can not be said that there have been any systematic statistics about this area. and any study accounting for the relations of home accidents and preschool: children in detail, Therefore, the purpose of this thesis was focused on the inquire of these relations so as to make a little contribution to Korean preschool children′s health and security measures. So, the detail-purposes are to study following questions and to testify following hypothesis. Prob. 1. What the types of accidents of Preschool children, where the place accidents occurred\ulcorner Prob. 2. What the cause of accidents and, the main factors of the cause\ulcorner Prob. 3. How about the number of their children. the disparity of age among their children and mother′s age in each case of accidents\ulcorner hypothesis 1. There will be differences in the density of protection of parents according to the number of their children. hypothesis 2, There will be differences in accident-types and first-aid methods according to parents socio-economic background. Method; This study employed the interviewing survey method, in which 130 preschool children ware random.sampled, who visit hospital to have medical care. These children (from 1 to 6 years olds) were selected at the emergency room of five hospitals in Seoul (Hosp: Severance, Woosok, Medical Center, Hanyang Medical College Hospital and Seoul Medical Col1age Hospital during study-period (from Aug. to Oct, 1973). Four head nurses in above Hospitals were employed as accident members for this study. Concerning research analysis, the method of hypothesis verifying is used. Conclusion: As two American experts on this subject. Dr, Raymond Neuter and Mr. Ross Mc Garland have drawn attention to "minor epidemics of accidents" that could be avoided by fairly simple measures. preschool children′s accidents could be avoided by parents fair attentions. In other words, one of the most common causes of preschool children′s accidents derived from their parent′s inattention. Therefore, one important task on this subject is to instruct the parents fairly about the children′s accidents. Many accidents could be avoided by the exorcist of a little self-discipline. Also, as much the prevention of accidents is important, as the first-aid Is Important and necessary at the case of the accidents. So, the methods of proper first-aid treatment must be emphasized, and must be taught in school, especially in girls school. And there could be other means available for prevention of accidents. Firstly, the public authorities can take legal measures. More stringent safety standards can be made enforceable by law. Building materials and equipment for domestic us: ought to meat minimum safety criteria at all times. Next the public itself has to understand the seriousness of the problem, and here the dissemination of information is of great importance. All mass media should be brought into play to promote greater public awareness of the question. At last, it will be needed to obtain more detailed epidemiological data through additional surveys and statistics after this study.

• 치위생과학회지
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• 제7권2호
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• pp.89-96
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• 2007

The purpose of this study was to examine the relationship between the self-expression level of dental hygiene students related to communicative competence and their stress during clinical practice and what affected their stress. The subjects in this study were 125 dental hygiene students in W college, on whom a survey was conducted from September 18 through 30, 2006. After the collected data were analyzed with SPSS WIN 10.0 program, the following findings were acquired: 1. When a factor analysis was made to evaluate the self-expression of the students, there appeared three different categories of self-expression: voice/content, facial expression/attitude and sentiment. The three made a 58.1% prediction of their self-expression. As for overall reliability, they turned out highly reliable(Cronbach'a = .881). 2. The dental hygiene students got a mean of 3.58 out of possible five points in self-expression, which indicated that they expressed themselves relatively well. Concerning connections between their general characteristics and self-expression level, those who were inactive during clinical practice got a mean of 3.28, whereas the others who were active got a mean of 3.85. It implied that those who took a more active attitude to clinical practice expressed themselves better(p < .01). The person with whom they found it hard to get along made a statistically significant difference to their self-expression(p < .05). The students who didn't fare well with dental hygienists got the best score(3.70). The second best group(3.53) didn't get along with dentists, followed by assistant nurses(3.46) and patients/caregivers(3.31). As for the impact of the field of dream job, the students who hoped to work or study overseas(4.21) excelled in self-expression those who wanted to be hired in a general hospital, to go onto a school of higher grade and to work in a public dental clinic(p < .05). Among the general characteristics, satisfaction level with major, health status and motivation of choosing dental hygiene made no statistically significant differences to their self-expression. 3. Regarding relations between self-expression level and stress about clinical practice, those who didn't express themselves properly in terms of sentiment scored higher in stress level(3.65). Their stress was statistically significantly different according to self-expression level (p < .05). 4. As for the influence of self-expression and general characteristics on stress with clinical practice, sentiment was selected from among the self-expression categories as a decisive factor to affect stress. Their stress varied statistically significantly with that(p < .05). In contrast, their demographic variables made no statistically significant difference to that, which made a 79.2% prediction of it.

• 대한소아치과학회지
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• 제27권2호
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• pp.192-201
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• 2000

전국의 123개 장애인 입소시설과 102개 특수학교를 대상으로 구강건강관리 실태를 파악하여 장애인의 구강건강관리 계획을 수립하는 데 사용할 수 있는 근거를 마련하고자 하였다. 설문지 조사법으로 연구하였다. 정기구강검진은 특수학교에서 연 2회 실시하고 있었으나, 장애인 입소시설에서는 56.8%에서 시행하였다. 우식 예방 프로그램은 장애인 입소시설의 69.1%, 특수학교의 86.3%에서 시행하였으며 프로그램의 종류는 입소시설에서 규칙적 칫솔질이 58.1%, 특수학교에서 예방교육이 65.7%로 가장 많았다. 불소를 이용한 우식예방은 입소시설과 특수학교에서 각각 8.6%, 11.8%에서 시행하고 있었으며, 열구전색은 각각 6.8%, 6.9%에서 시행하였다. 치과치료를 시행하고 있는 입소시설과 특수학교에서는 각각 84.2%, 39.2%이었고, 입소시설에서 치료를 받기 위해 이용하는 곳은 치과의원(60.2%), 보건소(16.8%), 자원봉사자(15.3%), 대학병원 (1.0%) 등이었다. 치료를 위해 치과의원에 방문하여 치료를 거부당한 경험이 있는 응답자는 17.7%이었다.

• 대한치과의사협회지
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• 제53권1호
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• pp.36-46
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• 2015

Objectives: The objective of this work was to investigate the hospital nursing care of oral and maxillofacial health in jeju province. Methods: 438 Registered nurses(RN) who were working at each of secondary hospitals in Jeju province had responded to the questionnaire. The data were analyzed via frequency analyses and one-way ANOVA to assess the state of RN on hospital nursing care of oral and maxillofacial health. Results: The class of education on density in formal density that marked '0 hour' and '1-3 hours' were 73.5% and 19.9%, respectively. The class of refresher training on density that marked '0 hours' and '1-3 hours' were 92.9% and 6.6%, aggregately 99.5%. The nursing education on appearance after tumor of maxillofacial area that marked 'formal education' and 'none' were 45.2% and 52.1%, respectively. The score of question 'function, effect and side effect of hexamedin gaggle' was $2.68{\pm}0.95$ by Likert 5-point scale. Likewise, the scores were $2.82{\pm}0.88$ on question 'management of removal denture', $2.83{\pm}0.95$ on question 'preventive dental treatment before anticancer therapy', $2.88{\pm}0.86$ on question 'function of saliva', $2.96{\pm}0.99$ on question 'oral management of tube feeding patient', $3.13{\pm}1.00$ on question 'bacterial endocarditis from oral microflora', $3.36{\pm}0.89$ on question 'dysphagia' and $3.62{\pm}1.03$ on question 'aspiration pneumonia'. RN replied that 'lack of knowledge' and 'delay of cooperation' formed 53.7% and 33.3% respectively, on question 'problem in dental consultation other diseased patient'. Conclusions: From this study, it is necessary for RN and student of nursing science to be educated on the oral and maxillofacial nursing. Authors suggest further co-study and nation-wide research.

• 보건교육건강증진학회지
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• 제20권1호
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• pp.159-172
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• 2003

Purpose : The purpose of this study was to investigated the dietary habits of students in order to identify risk groups according to their Body Mass Index (BMI), and to compare the eating behavior of students in the normal range (19${\le}$24) and those in risk groups (BMI${\le}$19, 24${\le}$27, BMI>27). Method : 1176 elementary school students, 850 middle school students and 672 high school students in Wonju City, were the participants The instrument for this study was a structured questionnaire that included demographic data as well as dietary habits, and the eating behavior instrument developed by Stunkard & Messick(1985) and revised by Kim & Kim (1997). Result : 1) As students moved up ingrade level their dietary habits became more irregular and the degree that students chewed food was reduced 2) As students moved up in grade level, a greater number of the student did not eat breakfast. The reasons given were that there were not enough time before classes started(40.4%) and a lack of appetite in the morning(10.6%) in high school students. 3) As for supper, from 67.8 to 81.9% of subjects reported having regular supper. However the rest of the subjects did not eat supper because of anorexia and fear of weight gain. 4) The results identified risk groups according to their BMI showed that for elementary school students, 55.9% were in the low weight group, 5.5% in the overweight group, and 0.9% in the obese group. For middle and high school students, 40.6% and 35.5% respectively were in the low weight group, 7.4% and 6.3% in the overweight group, and 4.1% and 2.5% the obese group. 5) Comparisons of the eating behavior of students in the normal weight group with that of those in the three risk groups showed that there significant differences in 'hunger' and cognitive restraint of eating' in elementary school students, and significant differences in 'cognitive restraint of eating' in middle and high school students. Conclusion : The results of this study show that management of diet in school health should be addressed from both the aspect of lack of nutrition and that of excess nutrition. In other words, good diet is as important for students in the low weight group as it is for those in the overweight and obese groups. The establishment of good dietary habits and eating behavior in students, by nurses and dieticians should be done by providing repeated diet education and involvement in diet counseling.

• 한국보건간호학회지
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• 제3권2호
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• pp.5-46
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• 1989

The current medical payment Insurance Rates in Korea stipulate charges for medical treatment by the doctor, pharmaceutist, medical technician and maternity nurse. But unfortunately didn't specify those charges for nursing done by the professional nurse. Only basic nursing fee is accounted insufficiently in current medical insurance fee schedule. therefore, Being face with covering entire people by medical insurance by 1991, It seems that the problems pertaining to operating the hospital and medical insurance system would be incessantly expanded in that no mention is made of medical charges rendered by major medical producer service in the current system, For that reason, this study made an attempt to clarify the importance the professional nursing puts of the current medical payment. The purpose of this study was to accounting nursing fee which diveded into the current medical fee schedule. (Method) 1. Data collection; Importance and difficulties in nursing activities was conducted in 'S' National University Hospital. Total nursing activities were selected 72 items which included direct care and indirect care. This study was conducted to evaluating the degree of importance and difficulties according to nursing activities through questionnaire to 204 RN. and so relative difficulties (acuity) were computered because the nursing cost level of each nursing service was differently established by the equivalent coefficient according to degree of relative difficulty and time required. 2. Calculation of cost according to nursing activities; After 47 nursing activities were selected in General surgery nursing units, calculation of nursing cost was as follows Cost of Nursing activity = (relative difficulty X Average hourly wage and benefits of nurse) + material cost of nursing -t- Average nursing administration cost So, Calculated cost by nursing activities was compared to current non-insured and insurance rate. 3. Calculation of nursing cost by K - DRG ; Total of 578 patients who were hospitalized in General Surgery units from January to March 1988 ware classified by K - DRG After estimation of total nursing cost based on the K-DRG, verified the appropriateness of basic nursing fee in medical insurance rate (Results) 1. Analysis of degree of importance and difficulties were 4.16 and 3.67 based on 5 point scale. This score were judged that it is worthy specifying the nursing fee 2. The nursing cost of 47 nursing service items in general surgery patients showed that the average cost of nursing activity was \1374.5 and The lowest cost was \217 of 'oral administration nursing' item, The highest cost was \11,025 of 'saline enematill clear' item 3. The result of comparison between the calculated cost by nursing activities against the current non-insured and insurance rate showed that 13 items(27.7%) involved to payment of insurance rate, 9 items(19.1%) involved to non-insured rate, remainder 25 items (53.2%) were not charged anywhere of total 47 nursing activities 4. When calculated cost by nursing activities was 100. current insurance rate was 62.3, non-insured rate was 176.6. Therefore this showed that most of non-insured rate were higher than calculated nursing cost. The insurance rate, however, were lower than it. Reim-bursement was imputed to non-insured patients. So the current rate system became estrainged from cost system. When Remainder 25 items of nursing activities compared' to \1390 of daily basic nursing fee per patient belonged to payment as a insurance fee schedule, basic nursing fee schedule was 1-2% of calculated cost of nursing activities. Therefore it showed that nursing fee was not counted adequately in it. 5. Nursing cost by K-DRG estimated in chart review based on counting number of nursing activities and length of stay The result showed that average amount of total nursing cost was \183828.1 Comparison of nursing cost calculated by K- DRG and basic nursing fee schedule showed that only 12.3% of nursing cost was charged (Conclusion) From the above research result, It is fact that nursing prime cost should be estimated more accurately and included adequately in current medical payment system. The payment system of nursing activities should be introduced not only nursing activities of drug administration and injection fee belonged to insurance fee schedule but also most nursing activities belonged not to mekical fee schedule. Even if introducing payment system of nursing activities, It should be estimated scientific method of Accounting nursing cost So nurses could offer nursing care of good quality, thereby they could make a great contribution not merely to the convalescence of the patient but to the promotion of the people's health.

• 대한간호학회지
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• 제30권6호
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• pp.1455-1466
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• 2000

The purpose of this study was to develop the framework of community-based home care nursing delivery system, and to demonstrate and evaluate the efficiency of it. The study was carned out over a period of 3years from September 1996 to August 1999. The researchers developed Standards for operations, this was all aimed toward a home care recording system, and an assessment intervention algorithm for various diseases quality control and standardization. In the center, 185 patients enrolled, and of the enrollments cerebrovascular disorder and cancer were the most prevailment diseases. Also, a home care nursing activity classification was developed in six domains. Those domains were assessment, medication, treatment, education and consultation, emotional care, and referral or follow-up care. Ten sub-domains were divided according to the systematic needs. Among these nursing activities, treatment, assessment, and education and consultation were frequently performed. In sub-domain classification, skin integrity, respiration, circulation, and immobility related care were provided most frequently. The cost of home care nursing per visit was also suggested. The cost include direct and indirect nursing care, management, and transportation cost. Also, the researchers tried to overcome the limitations of hospital-based home care to provide more accessible, efficient, safe, and stable home care nursing. Therefore, clients were referred from other patients, families, public health care centers, industries, and even hospitals. As a result of this study, several limitations of operation were found. First, it was difficult to manage and communicate with doctor in the emergency situations. Second, there was too much time spent for transportation. This was because they are only five nurses, who cover all of the areas of Seoul and nearby cities. Third, preparation for special care of home care nurses was lacking. Fourth, criteria for the termination of care and the frequency of home visits were ambiguous. Finally, interconnection with home care machinery company was so yely needed. New paragraphs' strategies for solving these problems were suggested. This study will be the basis of community-based home care nursing, and the computerized information delivery system for home care nursing in Korea.