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The Relationship of Anxiety, Hopelessness, and Family Suppoort of Breast Cancer Patients Undergoing Chemotherapy (암화학요법을 받는 유방암 환자의 불안, 절망감 및 가족지지와의 관계)

  • Park Jum-Hee;Lee Hyoun-Ju;Kim Hyun-Mi;Lyu Eun-Kyung
    • Journal of Korean Academy of Fundamentals of Nursing
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    • v.4 no.1
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    • pp.147-162
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    • 1997
  • This study was attempted to provide the basic data for nursing intervention to improve the psychosociological adaptation of patients receiving chemotherapy for breast cancer by examining relationship between anxiety and hopelessness that they are experiencing and family support, in order to help them successfully cope with various psychological problems. This study was carried out with 93 breast cancer patients who are receiving chemotherapy in the injection treatment room of K University Hospital located in the downtown of Taegu after having underwent mastectomy in the hospital between December 1995 and August 1996. This study used the systematized questionnaires which contain 7 questions about general characteristics, Spielberger's trait anxiety & state anxiety scale, the tool that WON(1987) modified the hopelessness scale which was developed by Beck et al.(1967) and the family support tool made by TAE(1985). By using the SPSS/PC program, this study obtained the real number and percentage for the general characteristics of the subjects, and mean and standard variation for the degrees of trait anxiety, state anxiety, hopelessness and family support. The correlation between each variables was identified on the basis of the Pearson Correlation, and the degrees of trait anxiety, state anxiety, hopelessness and family support in the general characteristics of the subjects were analyzed by using the t-test, ANOVA, and Duncan test. The results of this study were summarized as follows. In the general characteristics of the subjects, most of each group were 51 years old or more and the middle class in income, had educational background under elementary school, no job, Buddhism in religion and spouse, and were receiving chemotherapy using MTX and 5FU. It was shown that the degree of the subjects' trait anxiety is, on an average, 50. 29, state anxiety 49. 68, hopelessness 51. 46 and family support 34. 28. Both trait anxiety and hopelessness showed normal correlation ; the higher the degree of trait anxiety is, the higher the degree of hopelessness is, while trait anxiety and family support showed reverse correlation ; the higher the degree of trait anxiety, the lower the degree of family support that the subjects perceive is. State anxiety and hopelessness also showed normal correlation ; the higher the degree of state anxiety is, the higher the degree of hopelessness is. Family support and hopelessness showed reverse correlation ; the higher the degree of family support is, the lower the degree of hopelessness that the subjects perceive is. And family support and state anxiety showed reverse correlation but there was a statistically significant difference. The degree of trait anxiety in the general characteristics of the subjects showed a significant difference by age, job and religion, the degree of state anxiety a signigicant difference by job and religion, the degree of hopelessness a signigicant difference by age, educational background and existence or not of spouse. In conclusion, the breast cancer patients receiving chemotherapy perceive anxiety and hopelessness due to several causes such as diagnosis itself or side effects of chemotherapy, so that it is required not only to develop specific nursing interventions including family support to alleviate anxiety and hopelessness but also to apply such interventions to clinical practice.

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Effect of Supportive Nursing Intervention on Hopelessness, Self-Esteem, Self-Concept of Operative Patient with Head and Neck Cancer (전인적 지지간호중재가 두경부암 수술환자의 절망감, 자아존중감 및 자아개념에 미치는 효과)

  • Seok, Jung-Hee;Kang, Eun-Sil;Choi, Hwa-Sook
    • Journal of Hospice and Palliative Care
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    • v.7 no.2
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    • pp.189-199
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    • 2004
  • Purpose: Despite the small incidence, head and neck cancer may cause a wide range of physical transformation by surgical operation, damage to active functions such as eating and speaking. It may provoke hopelessness, change self-esteem and self-concept after its operation, influencing the quality life of head and neck cancer patients. Thus nursing intervention should be developed to provide supportive nursing for head and neck cancer patients and play roles as competent supporters. Methods: This study was a nonequivalent, control group, pretest-posttest, non-synchronized quasi-experimental research designed to determine how supportive nursing intervention effects on hopelessness, self-esteem and self-concept of head and neck cancer patients. Subjects of the study included 40 adult inpatients of K University hospital in Pusan who were diagnosed as having head and neck cancer and operated. They were divided into experimental and comparison groups, each consisting of 20 members. The data were collected during the period from December 1, 1999 to April 11, 2000. Tools of the study included the protocol of supportive nursing intervention which was developed by researcher by means of reference, literal review and expert's advice. The measurement tool of hopelessness was translated by Won was the device of hopelessness self-evaluation from Beck, the tool for self-esteem measurement was developed by Rosenberg and translated by Kim, and the device of self-concept used by Lee et al, modified by Lee were used respectively. Data were analyzed using the SPSS/PC 9.0 program. The homogeneity of the subjects were tested using $x^2-test$ and t-test. 3 hypotheses were tested using t-test. Results: The results of the study can be summarized as follows. 1. The third hypothesis that the experimental group receiving supportive nursing intervention showed a little hopelessness than the control group not receiving supportive nursing intervention was supported (t=4.550, P=.000). 2. The third hypothesis that the experimental group receiving supportive nursing intervention showed more self-esteem than the control group not receiving supportive nursing intervention was supported (t=-6.40, p=.000). 3. The third hypothesis that the experimental group receiving supportive nursing intervention showed more self-concept than the control group not receiving supportive nursing intervention was supported (t=-6.065, P=.000). Conclusion: Supportive nursing intervention was effective nursing intervention strategy for reducing hopelessness and increasing self-esteem and self-concept of head and neck cancer patients. Then the quality of life of head and neck cancer patients can be enhanced by providing supportive nursing intervention in nursing practice.

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Finite Element Analysis of Bone Stress Caused by Horizontal Misfit of Implant Supported Three-Unit Fixed Prosthodontics (3차원 유한요소법에 의한 임플란트 지지 3본 고정성 가공 의치의 부적합도가 인접골 응력에 미치는 영향 분석)

  • Lee, Seung-Hwan;Jo, Kwang-Hun
    • Journal of Dental Rehabilitation and Applied Science
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    • v.28 no.2
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    • pp.147-161
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    • 2012
  • This study is to assess the effect of horizontal misfit of an implant supported 3-unit fixed prosthodontics on the stress development at the marginal cortical bone surrounding implant neck. Two finite element models consisting of a three unit fixed prosthodontics and an implant/bone complex were constructed on a three dimensional basis. The three unit fixed prosthodontics were designed either shorter (d=17.8mm model) or longer (d=18.0mm model) by 0.1mm than the span of two implants placed at the mandibular second premolar and second molar areas 17.9mm apart. Fitting of the fixed prosthodontics onto the implant abutments was simulated by a total of 6 steps, that is to say, 0.1mm displacement per each step, using DEFORM 3D (ver 6.1, SFTC, Columbus, OH, USA) program. Stresses in the fixed prosthodontics and implants were evaluated using von-Mises stress, maximum compressive stress, and radial stress as necessary. The d=17.8mm model assembled successfully on to the implant abutments while d=18.0mm model did not. Regardless if the fixed prosthodontics fitted onto the abutments or not, excessively higher stresses developed during the course of assembly trial and thereafter. On the marginal cortical bone around implants during the assembly, the peak tensile and compressive stresses were as high as 186.9MPa and 114.1MPa, respectively, even after the final sitting of the fixed prosthodontics (for d=17.8mm model). For this case, the area of marginal bone subject to compressive stresses above 55MPa, equivalent of the $4,000{\mu}{\varepsilon}$, i.e. the reported threshold strain to inhibit physiological remodeling of human cortical bone, extended up to 2mm away from implant during the assembly. Horizontal misfit of 0.1mm can produce excessively high stresses on the marginal cortical bone not only during the fixed prosthodontics assembly but also thereafter.

Contract Farming Through a Cooperative to Boost Agricultural Sector Restructuring: Evidence from a Rural Commune in Central Vietnam (베트남 농업구조개혁과 협동조합의 계약영농: 중부베트남의 농촌을 사례로)

  • Duong, Thi Thu Ha;Kim, Doo-Chul
    • Journal of the Economic Geographical Society of Korea
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    • v.25 no.1
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    • pp.109-130
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    • 2022
  • The Vietnamese government has proposed contract farming through a new type of cooperative as an institutional innovation which aims to restructure the agricultural sector. However, policy changes often impact farmers, who bear the primary effects of the transition process. Understanding households' strategies for land use and livelihood is crucial for policymaking in the agricultural development field. This study was conducted in the rural Binh Dao commune in Central Vietnam. We analyzed household members' labor force changes and their livelihood behaviors after their participation in a contract farming scheme using qualitative analysis methods combined with geographic information system (GIS) support, based on secondary data and in-depth interviews of 190 farmers. Simultaneously, we created a digital map of the cooperative's production area to investigate changes in land use and production activities. The findings show that contract farming shaped the vertical coordination of the value chain from the farmers to the cooperative and agricultural product trading companies. Subsequently, it encouraged land use and labor efficiency due to mechanical support. In addition, it also increased productivity and protected farmers from market risks. However, despite its positive effects on agricultural productivity in this case, the contract farming scheme could not achieve the restructuring of the rural labor force toward non-agricultural sectors. Ironically, farmers in the Binh Dao commune tended to increase cultivable land during the agricultural restructuring program, rather than switching their labor forces to non-agricultural sectors. The lack of stable non-farming job opportunities in rural Vietnam results in challenges to the efficiency of agricultural restructuring programs. Consequently, farmers in the Binh Dao commune are still smallholder farmers, depending on the family labor force.

Study of Patient Teaching in The Clinical Area (간호원의 환자교육 활동에 관한 연구)

  • 강규숙
    • Journal of Korean Academy of Nursing
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    • v.2 no.1
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    • pp.3-33
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    • 1971
  • Nursing of today has as one of its objectives the solving of problems related to human needs arising from the demands of a rapidly changing society. This nursing objective, I believe, can he attained by the appropriate application of scientific principles in the giving of comprehensive nursing care. Comprehensive nursing care may be defined as nursing care which meets all of the patient's needs. the needs of patients are said to fall into five broad categories: physical needs, psychological needs, environmental needs, socio-economic needs, and teaching needs. Most people who become ill have adjustment problems related to their new situation. Because patient teaching is one of the most important functions of professional nursing, the success of this teaching may be used as a gauge for evaluating comprehensive nursing care. This represents a challenge foe the future. A questionnaire consisting of 67 items was distributed to 200 professional nurses working ill direct patient care at Yonsei University Medical Center in Seoul, Korea. 160 (80,0%) nurses of the total sample returned completed questionnaires 81 (50.6%) nurses were graduates of 3 fear diploma courser 79 (49.4%) nurses were graduates of 4 year collegiate nursing schools in Korea 141 (88,1%) nurses had under 5 years of clinical experience in a medical center, while 19 (11.9%) nurses had more than 5years of clinical experience. Three hypotheses were tested: 1. “Nurses had high levels of concept and knowledge toward patient teaching”-This was demonstrated by the use of a statistical method, the mean average. 2. “Nurses graduating from collegiate programs and diploma school programs of nursing show differences in concepts and knowledge toward patient teaching”-This was demonstrated by a statistical method, the mean average, although the results showed little difference between the two groups. 3. “Nurses having different amounts of clinical experience showed differences in concepts and knowledge toward patient teaching”-This was demonstrated by the use of a statistical method, the mean average. 2. “Nurses graduating from collegiate programs and diploma school programs of nursing show differences in concepts and knowledge toward patient teaching”-This was demonstrated by a statistical method, the mean average, although the results showed little difference between the two groups. 3. “Nurses having different amounts of clinical experience showed differences in concepts and knowledge toward patient teaching”-This was demonstrated by the use of the T-test. Conclusions of this study are as follow: Before attempting the explanation, of the results, the questionnaire will he explained. The questionnaire contained 67 questions divided into 9 sections. These sections were: concept, content, time, prior preparation, method, purpose, condition, evaluation, and recommendations for patient teaching. 1. The nurse's concept of patient teaching: Most of the nurses had high levels of concepts and knowledge toward patient teaching. Though nursing service was task-centered at the turn of the century, the emphasis today is put on patient-centered nursing. But we find some of the nurses (39.4%) still are task-centered. After, patient teaching, only a few of the nurses (14.4%) checked this as “normal teaching.”It seems therefore that patient teaching is often done unconsciously. Accordingly it would he desirable to have correct concepts and knowledge of teaching taught in schools of nursing. 2. Contents of patient teaching: Most nurses (97.5%) had good information about content of patient teaching. They teach their patients during admission about their diseases, tests, treatments, and before discharge give nurses instruction about simple nursing care, personal hygiene, special diets, rest and sleep, elimination etc. 3. Time of patient teaching: Teaching can be accomplished even if there is no time set aside specifically for it. -a large part of the nurse's teaching can be done while she is giving nursing care. If she believes she has to wait for time free from other activities, she may miss many teaching opportunities. But generally proper time for patient teaching is in the midmorning or midafternoon since one and a half or two hours required. Nurses meet their patients in all stages of health: often tile patient is in a condition in which learning is impossible-pain, mental confusion, debilitation, loss of sensory perception, fear and anxiety-any of these conditions may preclude the possibility of successful teaching. 4. Prior preparation for patient teaching: The teaching aids, nurses use are charts (53.1%), periodicals (23.8%), and books (7.0%) Some of the respondents (28.1%) reported that they had had good preparation for the teaching which they were doing, others (27.5%) reported adequate preparation, and others (43.8%) reported that their preparation for teaching was inadequate. If nurses have advance preparation for normal teaching and are aware of their objectives in teaching patients, they can do effective teaching. 5. Method of patient teaching: The methods of individual patient teaching, the nurses in this study used, were conversation (55.6%) and individual discussion (19.2%) . And the methods of group patient teaching they used were demonstration (42.3%) and lecture (26.2%) They should also he prepared to use pamphlet and simple audio-visual aids for their teaching. 6. Purposes of patient teaching: The purposes of patient teaching is to help the patient recover completely, but the majority of the respondents (40.6%) don't know this. So it is necessary for them to understand correctly the purpose of patient teaching and nursing care. 7. Condition of patient teaching: The majority of respondents (75.0%) reported there were some troubles in teaching uncooperative patients. It would seem that the nurse's leaching would be improved if, in her preparation, she was given a better understanding of the patient and communication skills. The majority of respondents in the total group, felt teaching is their responsibility and they should teach their patient's family as well as the patient. The place for teaching is most often at the patient's bedside (95.6%) but the conference room (3.1%) is also used. It is important that privacy be provided in learning situations with involve personal matters. 8. Evaluation of patient teaching: The majority of respondents (76.3%,) felt leaching is a highly systematic and organized function requiring special preparation in a college or university, they have the idea that teaching is a continuous and ever-present activity of all people throughout their lives. The suggestion mentioned the most frequently for improving preparation was a course in patient teaching included in the basic nursing program. 9. Recommendations: 1) It is recommended, that in clinical nursing, patient teaching be emphasized. 2) It is recommended, that insertive education the concepts and purposes of patient teaching he renewed for all nurses. In addition to this new knowledge, methods and materials which can be applied to patient teaching should be given also. 3) It is recommended, in group patient teaching, we try to embark on team teaching.

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