• 간호행정학회지
• /
• 제12권2호
• /
• pp.225-232
• /
• 2006

Purpose: The purpose of this study was to analyze the services and cost of CVA patients in hospital-based home health care and compare the differences of home health care cost by hospital types. Methods: The subjects of this study were 5,756 home care patients with cerebrovascular disease. Data were collected by using home health care medical expense claims from 127 hospitals in 2004. Results: The home care service 'indewelling catheterization' was the highest(19.28%), and then 'nasogastric tube insertion and change(16.72%)', 'bladder irrigation(15.98)', 'wound management(simple dressing)(10.42%)' followed. Average home health care cost per visit was 39,943 won, and the highest 46,058 won in general hospitals and the lowest 33,922 won in tertiary hospitals, so there were statistically significant among the types of hospitals(F=1112.47, p<0.0001). Conclusions: The number of home health care patients has been rapidly growing with the increase of aged population and demand for home care services is rising. So, it could be urgent to develop a reasonable cost reimbursement system for home health services and to expend scopes of the roles of home care specialist nurses. Amid the demand of more detail understanding the present status of home care, our study can be contributed to provide fundamental information of home care in Korea.

• 디지털융복합연구
• /
• 제17권2호
• /
• pp.255-264
• /
• 2019

본 연구는 간호사의 비판적 사고 및 간호근무환경과 임상적 의사결정의 관련성을 확인하고 임상적 의사결정에 미치는 관련요인을 확인하기 위한 서술적 조사연구이다. 대상자는 서울시내 일개 상급 종합병원에서 근무하는 간호사 261명으로 자가보고식 설문지를 이용하여 자료수집 하였다. 자료분석은 SPSS 21.0 프로그램으로 기술적 통계, independent t-test, one-way ANOVA, Pearson's correlation coefficients, 위계적 회귀분석을 시행하였다. 임상적 의사결정은 연령, 학력, 직위, 교대근무, 임상경력에 따라 통계적으로 유의한 차이를 보였다. 임상적 의사결정은 비판적 사고 및 간호근무환경과 정의 상관 관계를 보였다. 임상적 의사결정에 대해 영향을 미치는 요인은 직위, 비판적 사고 중 임상적 의사결정, 간호근무환경 중 양질의 간호를 위한 기반 및 인적 물적 자원의 적절성으로 이를 통해 임상적 의사결정의 35.8%를 설명하였다. 그러므로 비판적 사고 향상과 더불어 간호의 전문성 향상을 위한 질 관리, 효과적 인적 물적 자원 관리를 위한 행정지원은 간호사의 임상적 의사결정능력을 향상시킨다.

• 한국직업건강간호학회지
• /
• 제28권4호
• /
• pp.197-207
• /
• 2019

Purpose: This study aimed to examine the relationship between organizational health (OH), safety climate (SC), the nursing working environment (NWE), and engagement in patient safety management activities (PSMA) among operating room nurses and identify the factors that predict engagement in PSMA. Methods: From August 10th to 25th, 2018, 176 operating room nurses who were working in tertiary and general hospitals responded to a structured questionnaire. Using SPSS/WIN 25.0, the collected data were subjected to independent-samples t-test, one-way analysis of variance, Scheffe?test, and Pearson's correlational and multiple stepwise regression analyses. Results: OH and SC were significantly correlated with engagement in PSMA. The factors that predicted engagement in PSMA were OH, NWE, participation in accreditation, years of work experience, and hospital size; together, they explained 17% of the variance in engagement in PSMA. Conclusion: This study revealed that OH has a significant influence on engagement in PSMA among operating room nurses. Therefore, hospitals should aim to create healthy working environments to promote engagement in PSMA among operating room nurses, actively delegate responsibilities to increase their level of participation in accreditation, and implement strategies that maintain high levels of nurse retention.

• 임상간호연구
• /
• 제28권3호
• /
• pp.270-276
• /
• 2022

Purpose: The purpose of this study was to validate the Edmonson psychiatric fall risk assessment tool (EPFRAT) for psychiatric inpatients. Methods: Data from retrospective study were collected from 670 adult inpatients in two departments of mental health medicine of a tertiary general hospital by reviewing their electronic medical records. There were 41 patients who experienced falls and 629 patients who did not experience falls during the period from January to December 2019. Data were analyzed by sensitivity, specificity, positive predictive value, negative predictive value, and a receiver-operating characteristic curve (ROC) for validity assessment using the IBM SPSS/WIN 26.0 program. Results: Factors affecting falls were the participant's age, guardian's residence, high-risk determination at the time of admission, and comorbidity. At the 85 points where the point of sum of the sensitivity and specificity was largest, the sensitivity, specificity, positive predictive value, and negative predictive value of EPFRAT were 92.7%, 79.7%, 22.9%, and 99.4%, respectively. The area under the ROC to assess the overall validity of the tool was .92 (95% CI 0.89~0.94). Conclusion: The EPFRAT was proved to be valid and reasonable for predicting falls in psychiatric inpatients. Based on the results of this study, it could be used for the assessment of high-risk patients for falls in psychiatric units.

• 대한간호학회지
• /
• 제53권1호
• /
• pp.129-143
• /
• 2023

Purpose: This study aimed to examine the mediating effects of clinical nurses' job crafting on organizational effectiveness based on the job demands-resources model proposed by Bakker and Demerouti (2017). Methods: The participants consisted of 393 nurses working in nursing units of a tertiary general hospital located in Cheongju region. The data, collected using questionnaire from August 9 to August 20, 2021, were analyzed using SPSS 23.0 and AMOS 27.0. Results: The goodness-of-fit (GoF) test results on the modified model (χ² = 2.7, GFI = .94, SRMR = .03, RMSEA = .06, NFI = .92, CFI = .94, TLI = .92, AGFI = .90), indicated that the GoF index satisfied the recommended level. Regarding the effects of each variable on organizational effectiveness, job crafting showed statistically significant direct (β = .48, p < .001), indirect (β = .23, p < .001), and total effects (β = .71, p < .001). Burnout showed statistically significant direct effect (β = - .17, p < .001). Work engagement showed statistically significant direct (β = .41, p < .001) and total effects (β = .41, p < .001). The factors explaining organizational effectiveness were job crafting, burnout, and work engagement, which had an explanatory power of 76.7%. Conclusion: Nurses' job crafting is an important mediating factor for enhancing the organizational effectiveness of nursing organizations. Hospitals should develop job-crafting success cases and related education and training programs as a strategy for enhancing the job crafting of nurses and, consequently organizational effectiveness.

• Journal of Trauma and Injury
• /
• 제36권4호
• /
• pp.385-392
• /
• 2023

Purpose: This study investigated the epidemiology, management, outcomes, and postoperative disabilities of degloving soft tissue injuries (DSTIs) treated at a tertiary care center in northern India. Methods: A prospective study of patients with DSTIs was conducted over 15 months. The type of degloving injury, the mechanism of injury, and any associated injuries were analyzed using the World Health Organization Disability Assessment Schedule (WHODAS) 2.0 along with the management, outcomes, and disabilities at a 3-month follow-up. Results: Among 75 patients with DSTIs, the average age was 27.5 years, 80.0% were male, and 76.0% had been injured in traffic accidents. The majority (93.3%) were open degloving injuries. Lower limbs were affected most often (62.7%), followed by upper limbs (32.0%). Fractures were the most commonly associated injuries (72.0%). Most patients required more than two procedures, including secondary debridement (41.3%), split skin grafting (80.0%), flap coverage (12.0%), or vacuum-assisted closure (24.0%), while five patients underwent conservative management for closed degloving injuries. Postoperative complications included surgical site infections (14.7%) and skin necrosis (10.7%). Two patients died due to septic shock and multiple organ dysfunction syndrome. The mean length of hospital stay was 11.5±8.1 days, with injuries affecting the lower limbs and perineum requiring longer hospital stays. The mean WHODAS 2.0 disability score at 3 months was 19. Most patients had mild disabilities. Time away from work depended largely upon the site and severity of the injury. Approximately 75% of patients resumed their previous job or study, 14% changed their job, and 8% stopped working completely due to residual disability. Conclusions: DSTIs are common injuries in trauma and management is challenging. Although open DSTI are clinically evident at secondary survey, closed degloving injuries may be missed in the primary survey, necessitating a high index of suspicion, thorough clinical examination, and protocol-based management. Primary preventive strategies (e.g., road safety protocols, preplacement training, and proper protective equipment in industries) are also needed to reduce the incidence of these injuries.

• 대한간호학회지
• /
• 제54권3호
• /
• pp.446-458
• /
• 2024

Purpose: This study aimed to understand the non-contact nursing experiences of clinical nurses during the COVID-19 pandemic. Methods: A qualitative research design applying thematic analysis was used. The participants were purposive sampled from three institutes: a tertiary hospital, a general hospital, and a residential treatment center in Seoul. Data were collected between December 2021 and January 2022 through individual in-depth interviews with 12 clinical nurses. The data were analyzed using Braun and Clarke's method to identify the meaning of the participants' experiences. Results: During the COVID-19 pandemic, the fields where the participants performed non-contact nursing included intensive care units and isolation wards of hospitals, a residential treatment center, and home cares. Their tasks in non-contact nursing commonly involved remote monitoring using digital devices or equipment, consultation and education. From their experiences performing tasks in these fields, the four theme clusters and nine themes were derived. The four theme clusters are as follows: (1) Confusion of nursing role; (2) Conflict due to insufficient support system; (3) Concern about the quality of nursing; (4) Reflection on the establishment of nursing professionalism. Conclusion: This study highlights the necessity for institutionalizing professional nursing areas, nursing education, and practical support by clarifying the purpose and goals of non-contact nursing and developing nursing knowledge through frameworks.

• 임상간호연구
• /
• 제30권2호
• /
• pp.94-103
• /
• 2024

Purpose: This study is descriptive research to investigate the influence of emotional intelligence and clinical competency on organizational socialization of new graduate nurses. Methods: The subjects were 202 new graduate nurses in a tertiary general hospital in Seoul. The data were collected from February 18 to April 1, 2021, using a self-reported structured questionnaire. The data were analyzed by descriptive statistics, t-test, ANOVA, Pearson's correlation coefficients, and multiple regression analysis. Results: There were significant positive correlations between emotional intelligence and clinical competency (r=.50, p<.001), emotional intelligence and organizational socialization (r=.45, p<.001), and clinical competency and organizational socialization (r=.36, p<.001) in new graduate nurses. The factors affecting the organizational socialization of new graduate nurses were emotional intelligence (β=.35, p<.001), clinical competency (β=.15, p=.034), desired department (β=.13, p=.031), and nursing value and vocational aptitude among motivation for selecting the nursing (β=.17, p=.014), and explained 25.0% of the variance in organizational socialization of new graduate nurses. Conclusion: The results of this study indicated the relationship between emotional intelligence, clinical competency, and organizational socialization, and the factors affecting organizational socialization of new graduate nurses. To improve nurses' clinical competency in the medical field, a systematic education and support system is essential for new graduate nurses entering the profession. Therefore, nursing organizations should help new graduate nurses develop their work capabilities and adapt to the organization.

• Journal of Hospice and Palliative Care
• /
• 제21권3호
• /
• pp.92-103
• /
• 2018

목적: 본 연구는 병원 근무자의 연명치료 중단에 영향을 미치는 장기기증, 장기이식, 죽음, 호스피스 완화의료의 지식, 태도 및 인식을 알아본 서술적 조사연구이다. 방법: K도 J시에 위치한 일개 상급종합병원에 근무하는 228명의 대학병원 근무자를 대상으로 자가 보고식 설문지를 이용하여 자료를 수집하였다. 자료는 SPSS WIN 21.0 프로그램으로 t-test, ANOVA, and Pearson's correlation coefficient를 이용하여 분석하였다. 결과: 대상자의 생명의료윤리 의식관련 지식은 연령, 학력, 직종, 근무부서, 생명의료윤리 교육유무에 따라 차이를 보였다. 뇌사 장기기증 장기이식에 대한 지식은 인체조직기증 및 이식에 대한 태도, 호스피스 완화의료에 대한 지식, 호스피스 완화의료의 인식에서 유의한 양의 상관관계가 있었다. 인체조직기증 및 이식에 관한 태도는 호스피스 완화의료에 대한 지식, 호스피스 완화의료의 인식, 연명치료 중단에서 유의한 상관관계가 있었고, 죽음에 대한 인식은 호스피스 완화의료에 대한 지식, 호스피스 완화의료의 인식, 연명치료 중단에서 유의한 상관관계가 있었다. 호스피스 완화의료의 인식은 연명치료 중단에서 유의한 상관관계가 있었다. 연명치료 중단 태도에 영향을 주는 요인은 호스피스 병동 근무와 인체조직기증 및 이식에 관한 태도, 호스피스 완화의료의 인식으로 연명치료 중단 태도를 32.5% 설명하였다. 결론: 연명치료 중단 태도에 호스피스 병동 근무와 인체조직기증 및 이식에 관한 태도, 호스피스 완화의료 인식이 관련이 있었으며, 생명의료윤리에 기반을 둔 다양한 교육과정의 개발 및 적용에 대한 연구가 필요함을 제언한다.

• 한국의료질향상학회지
• /
• 제10권2호
• /
• pp.176-189
• /
• 2003

Background : Gastric cancer is the most common malignant tumor in Korea. Surgical operation is one of the major treatment modalities for gastric cancer patients. Therefore, gastrectomy is one of the most common procedures in General Surgery. There were variation in length of hospital stay and medical treatment for gastrectomy between three surgeons at Asan Medical Center. Clinical pathways have received considerable attention as a tool for reducing the medical practice variation, increasing the efficiency of care process, and improving the quality of care. The aim of this study was to evaluate the effect of a clinical pathway for gastrectomy in gastric cancer patients. Methods : The clinical pathway for gastrectomy was developed and implemented by a multidisciplinary group in Asan Medical Center. A computerized clinical pathway program was developed and revised after a pilot test. A total of 145 patients underwent gastrectomy by three surgeons at Asan Medical Center. We compared the length of hospital stay, patient satisfaction, and the unplanned readmission rate between the pre-pathway group (n=67) and the post-pathway group (n=78). We also investigated the degree of satisfaction among the physicians and nurses who were main end-users of the clinical pathway. Results : The clinical pathway was applied to all target patients. The average length of hospital stay was shortened from 12.7days to 10.6days (p<0.01). The degree of patient satisfaction with the care process changed from 90.3% to 89.2% after the implementation of the clinical pathway, but the difference was not statistically significant (p=0.761). Unplanned readmission rate was 2.9% in the pre-pathway group and 0% in the post-pathway group. More than 90% of physicians and nurses answered that the clinical pathway had been a useful tool in their medical practice. Conclusions : The findings of the study demonstrated that implementation of the clinical pathway for gastrectomy produced substantial reduction in the length of hospital stay while improving the quality of patient outcomes. The computerized clinical pathway program can be used as one of the powerful patient management tools for reducing the practice variations and increasing the efficiency of care process in Korean hospital settings.