• 대한간호학회지
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• 제42권4호
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• pp.453-465
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• 2012

Purpose: The study was done to develop a shared decision-making scale for end-of-life patients in Korea. Methods: The process included construction of a conceptual framework, generation of initial items, verification of content validity, selection of secondary items, preliminary study, and extraction of final items. The participants were 388 adults who lived in one of 3 Korean metropolitan cities: Seoul, Daegu, or Busan. Item analysis, factor analysis, criterion related validity, and internal consistency were used to analyze the data. Data collection was done from July to October 2011. Results: Thirty-four items were selected for the final scale, and categorized into 7 factors explaining 61.9% of the total variance. The factors were labeled as sharing information (9 items), constructing system (7 items), explanation as a duty (5 items), autonomy (4 items), capturing time (3 items), participation of family (3 items), and human respect (3 items). The scores for the scale were significantly correlated among shared decision-making scale, terminating life support scale, and dignified dying scale. Cronbach's alpha coefficient for the 34 items was .94. Conclusion: The above findings indicate that the shared decision-making scale has a good validity and reliability when used for end-of-life patients in Korea.

• 임상간호연구
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• 제14권2호
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• pp.59-70
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• 2008

Purpose: Purposes of this study were to promote understanding on mutually informed consent by comparing and analyzing the perception and experience of informed consent among physicians, nurses, and patients. Method: Participants in the study were 145 physicians, 300 nurses, and 178 patients from eight hospitals in Busan. To examine their understanding and experience with informed consent, all participants responded to a questionnaire. The collected data were analyzed using SPSS/PC 12.0 program. Results: On the necessity of informed consent, the affirmative percentages were 95.9% for physicians, 99.0% for nurses and 84.8% for patients. As to the most important reason for informed consent 47.6% of the physicians and 64.3% of the nurses answered 'because it is an occupational and ethical duty', while 46.6% of the patients answered 'because it is protection for physicians'. Regarding the legal decision maker for informed consent, 33.1% of the physicians, 27% of the nurses, and 42.1% of the patients answered that the legal decision-making right belonged to the 'patient'. The agreement rate on the necessity of providing a comprehensive explanation about informed consent was 89.0% for physicians, 98.3% for nurses, and 96.1% for patients. Conclusion: Most physicians, nurses, and even patients have inaccurate perceptions and inappropriate experience with informed consent.

• 보건의료산업학회지
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• 제7권4호
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• pp.243-257
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• 2013

This study was conducted in order to survey in healthcare worker's recognition of diagnosis related group(below; DRG) effect from July 1, 2012, to examine their recognition, expectation of the DRG system, and to provide the basic data necessary for the enforcement of the settlement. The subjects of this study were workers at clinics and hospitals sampled from hospital with DRG applying 7 diseases in Busan and Kyung-nam. A questionnaire of survey was conducted with the subjects working at clinics and hospitals from July, 25, 2012 to September 7, 2012, and the subjects were limited to doctors, officers, nurses, medical technicians and nurse assistants, and a total of 618 subjects were enrolled in this study. In the result of this study, generally, the healthcare workers recognized the DRG system. But their knowledge about that was not clear. Expanding enforcement DRG system at the present time, to provide accurate information to the healthcare consumer, workers need to know about DRG system clearly. To this end, for national health policy and medical institutions, workers should be educated constantly about providing medical service as well as the duty of enough explanation about the healthcare consumer's right to know.

• 의료법학
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• 제19권1호
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• pp.207-254
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• 2018

2017년 주요 판결 중에는, 진료계약과 함께 체결되는 틀니제작계약의 법적성질을 분리하여 후자의 경우 도급적 성질이 있다는 판결과 태아보험은 계약체결 후 1회 보험료를 받은 후부터 그 효력이 발생한다는 보험법리를 활용하여 민법에서 논의되는 전부노출설의 한계를 극복한 판결이 선고되었다. 약화사고와 관련하여 의료인의 책임을 인정하는 판결이 증가하면서 직접 약을 제조 교부하는 약사의 복약지도 등을 강화해야 한다는 의견이 있었고, 감염관리와 관련하여 법원이 과실을 부정하는 방향으로 사실관계를 해석하거나 적용한 데 대한 비판과 함께 병원감염사건의 특수성에 비추어 병원감염 관리 및 그 피해 구제를 위한 제도적 장치마련, 소송법상 증명책임 전환 등 제도의 개선이 필요하다는 의견이 있었다. 설명의무 관련 판결에서는 이미 설명이 되었던 부분이나 설명을 하지 않더라도 해당 진료행위를 수행하였을 것이기 때문에 설명의 대상이 되지 않는다는 판례 등 설명의무의 대상과 관련한 판결들이 다수 선고되었고, 손해배상의 범위와 관련하여 유방을 흉부 장기로 보아 다발성 반흔 구축 및 변형을 장해로 인정한 사건이 선고되어 많은 논의를 불러 일으켰다. 진단서와 관련한 의료법 해석에 대한 대법원 판결은 법률 규정이 가진 해석범위를 넘은 유추해석이라는 지적이 있었다.

• 한국응급구조학회지
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• 제13권1호
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• pp.19-33
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• 2009

Purpose : To check the legal relation between rescue team and patient as well as legal responsibility for patient's damage intentionally or erroneously caused by rescue member, a public official, in the performance of relevant job ; to prevent legal dispute over rescue team and to present program for fair settlement of dispute and equitable and feasible burden of damage. Method : First, the legal principle of Civil Law, Criminal Law and Administrative Law related to the theme of this research will be investigated around research by literature. Second, the case of dispute related to rescue team will be introduced. Result: 1. If 119 rescue members as a public official intentionally or erroneously cause damage to patient in the performance of job, they shall bear civil, criminal and administrative responsibility. They shall bear civil responsibility for indemnity for damage due to default or tort. The typical criminal responsibility includes accidental homicide arising out of duty, preparing falsified official document, dereliction of duty, etc. In the administrative side, the state is responsible for indemnity for peculiar status of the rescue member, public official. 2. Though raising civil petition or legal dispute over unsatisfactory rescue service may be reasonable to guarantee the right of nation, such action may cause stress to rescue member as well as may lead to mental shrinking and defensive attitude only to take the basic first aid treatment which has low possibility of mistake instead of active first aid treatment so as to avoid legal responsibility. 3. The program that may prevent legal dispute over 119 rescue team includes expansion of manpower specialized in first aid treatment, enhancement of education on legal environment, development and application of standard job guideline, formation of mutual trust with patient, detailed explanation, preparing and keeping minute record, improvement of the rescue members' ability of first aid treatment and development of medical instruction mode. Conclusion : The best policy is to prevent legal dispute. If it is impossible to basically exclude the possibility of dispute, however, we need to make effort to minimize the occurrence, settle fairly and divide damage equitably and feasibly. To improve the preventible death rate of our first aid system to the level of advanced country, 119 rescue team which is in charge of the stage before hospital needs to positively enforce special first aid by improving the qualitative level of rescue service and to strive to prevent legal dispute that may occur in the process.

• 한국의료질향상학회지
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• 제5권2호
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• pp.176-189
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• 1998

This study was conducted to evaluate the subjective ideas about the determinants of quality in ambulatory care unit among outpatients and medical staff of a university hospital, and to compare the differences of the ideas, between patients themselves and hospital staff. A self-administered questionnaire survey was conducted covering 799 outpatients and 190 hospital staff in March, 1998. The questionnaire included general characteristics and 26 determinants of ambulatory care quality. The following are summaries of the findings: 1. Both of outpatients and hospital staff perceived, "Physician's knowledge" as the most important determinant of medical care quality. 2. In respect of 7 determinants related to physician's knowledge and skill, both outpatients and hospital staff perceived "physician's knowledge and skill" as important determinants. The scores of determinants such as, "Not doing unnecessary examinations", and "Assignment of adequate number of patients and duty schedule for the physician" were significantly different between outpatients and hospital staff. 3. In respect of 4 determinants related to doctor-patient relationship, both outpatients and hospital staff perceived "attention to patient's complaints" as the most important determinant. The scores related to the determinants such as "kindness of physician" and "explanation of treatment outcome" were significantly different between outpatients and hospital staff. 4. Among the amenities related determinants, "Modern facilities and equipments" were perceived as the most important determinant in both group. 5. In respect of 8 determinants related to non-financial accommodation, outpatients perceived, "Waiting hours for treatment" as the most important determinant, and hospital staff perceived, "Kindness of hospital staff". 6. In respect of 4 determinants related to financial accommodation, outpatients perceived, "Fare account of medical cost" as the most important determinant, and hospital staff perceived, "Increasing reimbursements". Further comprehensive research should be made on the evaluation of perceptions of medical care quality, both of outpatient and inpatient care, among patients and hospital staff. So good quality in medical care will be achieved based on clients' needs.

• 여성건강간호학회지
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• 제7권4호
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• pp.499-507
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• 2001

The purpose of this study was to explore nursing needs during labor pain that had been suffered by women who have given birth. It is essential to identify the nursing needs in order to solve nursing problems and to provide better care for the parturients. The sample consisted of 20 women of primiparas and 17 women of multiparas. They underwent normal labor and delivered a healthy baby at term. The data had been collected through the unstructured interviews conducted 1-2 days after delivery in the admission room from March 1998 to March 1999. On average, the interviews lasted for about 30 minutes. Interviews were taken with the consent of the subjects. The data are categorized according to the similarities of their contents. Seventeen subordinate categories and six superordinate categories have been identified. Six superordinate categories are 1) physical nursing needs 2) nursing needs of medical behavior 3) emotional nursing needs 4) informational and teaching nursing needs 5) nursing needs of pain control 6) nursing needs of respect(personality). Seventeen subordinate categories include: comfortable posture, touch, professional knowledge and techniques, duty execution, support, company and talk, stable surroundings, reassurance, information on delivery, explanation of medical behavior, information on surroundings, instruction on the case of pain, arbitrary adjustment, artificial adjustment, respect, interest and reflection of opinions. The result of this research is the same as that of foreign research and the items of the questionnaire in Korea are the same as the foreign one. Despite the same result, however, this dissertation is significant in that the research identifies the parturients nursing needs and classified the data and thus the basis has been formed to develop the tools to assess the nursing needs of the Korean parturients. The findings can be used as the guide for nursing intervention of parturients.

• 의료법학
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• 제20권2호
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• pp.231-260
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• 2019

지난 호에 이어 2018년도 주요 의료판결을 정리하였는데, 특히 설명의무와 관련된 법원의 설시는 그 한계가 어디까지인지 알 수 없을 정도로 다기(多岐)하여 가급적 많은 판결을 소개하기 위하여 노력하였고, 손해배상의 범위와 관련하여 개호비를 다액 인정한 판결과 각서의 효력이 증가된 치료비에도 미치는 것으로 본 판결도 관심을 가져볼 필요가 있다. 진료비상계 및 공제관련 판결은 서술내용에 비하여 가장 많은 토론이 이루어졌다. 의료기관 다중 운영 사례는 중간적 판결이지만, 워낙 의료계에 관심이 많은 사건이고, 임의비급여 관련 재량권 일탈 남용이 인정된 사건도 과거에 비하여 비중이 많이 줄었지만 여전히 의미가 있다고 보았다.

• 의료법학
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• 제17권2호
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• pp.57-81
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• 2016

환자가 의사를 상대로 의료사고에 대한 민사책임을 추궁하기 위하여 소송을 제기하게 될 때, 의사의 의료과실과 환자에게 발생한 손해 사이에 인과관계가 존재하는지 여부는 소송의 승패를 좌우한다. 의료과실소송에서는 의료가 지니는 특수성으로 인하여 다른 민사사건과 달리 인과관계의 존부의 판단이 쉽지 않다. 또한 의료과실소송에서는 진료기록을 비롯한 정보가 의사에게 집중되어 있고, 환자의 의료지식은 의사에 비하여 상대적으로 부족하다. 따라서 원고인 환자가 부담하는 인과관계에 관한 증명책임의 완화가 판례를 통하여 인정되고 있다. 이에 본고에서는 우리나라에서 의료민사책임에서 인과관계를 어떻게 인정하는지에 관한 법리를 살펴보고자 한다. 그리고 우리나라 판례의 태도를 인과관계가 문제되는 유형별 - 일반적 의료행위의 경우, 설명의무의 경우, 의료과실과의 인과관계가 없는 경우 - 로 나누어 고찰하기로 한다.

• 한국안전학회지
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• 제38권1호
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• pp.55-61
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• 2023

Although corporate punishment-related systems are being implemented in several countries, such as South Korea's Serious Accidents Punishment Act (SAPA), related research has mainly focused on legal issues. This study aimed to compare and analyze the SAPA and Singapore's Workplace Safety and Health Act (WSHA) and Code of Practice on Chief Executives' and Board of Directors' Workplace Safety and Health Duties (WSHD). In addition, it was attempted to draw implications to enhance the effectiveness of the CEO's safety and health duties. For this study, a comparative analysis was conducted in 3 steps. In step 1, similar overseas systems were investigated. In step 2, the system contents were classified into four viewpoints (DUTY, RESOURCE, Other factors, and Main contents), and comparison items were derived from each viewpoint. In step 3, the viewpoints were compared, and implications were derived. The following three implications were derived through comparative analyses. 1) In WSHD, additional explanation and calibration of measures clarify the CEO's role, and 2) It is easy to use for the CEO's duties by providing the resources directly. 3) Penalties for violating the proposed duties are entrusted to the existing higher-level laws. Considering this, providing detailed content and related information for the CEO would possibly improve the SAPA to fulfill his/her duties through announcements from related organizations in the future.