• Pediatric Infection and Vaccine
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• 제26권3호
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• pp.148-160
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• 2019

목적: 본 연구에서는 신생아실과 신생아 중환자실에서 발생한 methicillin-resistant Staphylococcus aureus (MRSA) 유행에서 환자와 보균자에서 분리된 MRSA의 분자역학적 연관성을 조사하여 유행의 감염원과 전파경로를 파악하고자 하였다. 방법: MRSA 유행기간인 2017년 8월부터 9월까지 피부감염 및 패혈증 환자들과 보균자로부터 분리된 MRSA 균주를 대상으로 유전형 및 병원성 인자를 분석하고 항생제 감수성 결과를 수집하였다. 결과: 연구기간 동안 신생아실(n=27)과 신생아 중환자실(n=14)에 총 41명의 신생아들이 입원하였다. 그 중, 7명(피부감염[n=6], 패혈증[n=1])에서 MRSA 감염이 확진되었고, 보균자 4명이 발견되었다. 신생아와 접촉이 있는 의료진 32명 중 3명이 MRSA를 비강에 보균하였다. 피부감염 유행 원인 균주는 Staphylococcal chromosomal cassette mec (SCCmec) type II, sequence type (ST) 89, spa type t375였고, 뮤피로신 저농도 내성을 포함하여 항생제 다제내성을 보였다. 패혈증을 일으킨 균주는 SCCmec type IVa, ST 72, 새로운 spa type인 t17879였다. 신생아 4명에게 집락된 MRSA 균주들은 다양하였으나 SCCmec type IVa, ST 72, spa type t664가 의료진과 신생아 2명에서 공통적으로 분리되었다. Panton-Valentine leukocidin (PVL) toxin 유전자가 신생아에게 집락된 모든 균주에서 발견되었다. 결론: 피부감염 유행을 일으킨 MRSA 균주는 항생제 다제내성을 보이는 균주였다. 신생아 MRSA 보균자에게서 분리된 균주는 모두 PVL 독소 유전자를 보유하였다. 유행기간 동안 다양한 MRSA 균주가 신생아들에게서 분리되기 때문에, 효과적인 감염 관리 및 추가 환자발생의 차단을 위하여 분자역학조사를 통하여 원인균을 확인하고 전파경로를 파악하는 것이 중요하다.

• 핵의학기술
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• 제21권1호
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• pp.60-64
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• 2017

검사의 질 향상과 국제표준화의 상용화 정도관리물질을 이용한 Westgard multi-rules 적용의 유용성은 이미 알려져 있다. 그러나 핵의학 체외검사의 특성상 정도관리물질과 환자검체의 동시 계측으로 인한 측정횟수의 증가에 따라 Westgard multi-rules법을 적용함에 있어 어려움이 있다. 이에 본 연구는 핵의학 체외검사에서 상용화 정도관리물질을 이용한 Westgard multi-rules 적용의 유용성과 보완, 개선을 통해 내부정도관리의 효율성 향상을 조사하였다. 2013년 01월부터 2016년 06월까지 삼성서울병원 핵의학과 체외검사실 통합의료시스템에 기록된 총 282건의 적용된 계통오차 multi-rules (22s, 101s)과 117건의 조치사항 기록을 분석하였다. 조치사항은 multi-rules 중 계통오차의 규칙이 적용 되었을 때 기록하는 원인분석으로 정도관리물질 오류, 실험과정 오류, 검사키트 로트번호 관리 오류, 기타 등 총 4개의 대분류로 구성하였다. Westgard multi-rules 적용을 통해 조치사항을 분석한 결과 정도관리물질 오류가 62건, 실험과정 오류가 24건, 검사키트 로트번호 관리오류가 18건, 기타 13건으로 분류되었다. 정도관리물질 오류를 방지하고자 개선사항으로 기존에 각 검사자마다 사용하던 방식을 담당자 지정 방식으로 변경하여 모든 검사의 하루 소비량을 분주하여 공동사용을 하였고, 나머지 오류를 방지하고자 검사 전후 모든 과정을 표준화 하여 검사실내 어느 검사자가 시행 하더라도 일원화할 수 있게 하였다. 정도관리물질 오류를 개선한 결과 해동 후 2일 이내 신선한 물질을 사용 가능하였고 같은 물질을 사용하는 검사끼리 비교가 가능해져 물질에 의한 오류인지 명확해짐으로 계통오차 발생원인이 정도관리물질 오류로 기록하는 건수가 줄어들었다. 또한 정도관리물질의 로트번호 변경 시 교체시기가 같아 관리가 용이해졌고, 물질 사용량의 감소로 경제적 효과를 얻을 수 있었다. 그리고 검사표준화 적용 후, 계통오차의 규칙인 22s와 101s의 발생건수가 개선 전 보다 월 평균 2건 이상 줄어드는 결과를 보였다. Multi-rules의 적용을 통한 계통오차의 빠른 확인을 위해 정도관리물질의 체계적인 관리와 목표값과 표준편자의 설정 및 관리가 바탕이 되어야하며, 계통오차 발생 시 검사의 원인분석을 통한 조치사항을 기록하는 것이 중요함을 확인하였다. 본 실험의 결과로 Westgard multi-rules 적용 분석을 통해 발생 오류의 기재와 원인을 효율적으로 분석함으로써 핵의학 검사 내부정도관리의 질적 향상과 정확하고 신속한 결과보고에 기여할 것으로 사료된다.

• 보건행정학회지
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• 제14권1호
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• pp.65-88
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• 2004

In general, empowerment is defined as the motivational concept of autonomy and self-efficacy. Recently, the concept of empowerment is applied to improve organizational staff's job satisfaction and organizational commitment in many organizations. Empower-ment in service organizations, i.e., hospitals, has certainly generated more publicity than any other organizations. The objectives of this study are, first, to measure the degree of hospital employees' empowerment using Spreitzer(1995)'s empowerment theory, second, to analyze the causal relationship of organizational and job characteristics, a degree of empowerment, and organizational performance(job satisfaction and organizational commitment), and third, to offer the strategy for the improvement of job satisfaction and organizational commitment. Spreitzer insists that the empowerment is composed of 4 dimensions(meaning, competence, self-determination, and impact). And he argues that various work-related characteristics is a direct cause of empowerment and the indirect cause of job satisfaction and organizational commitment, mediated by the empowerment latent variable. In order to perform this study, data were collected by self-administered questionnaires from hospital employees working in administrative department of 3 university hospitals in Inchon and Kyunggi-Do region. The number of cases is 181(response rate; 86%). The Collected data were analyzed with SPSS Ver. 10.0 and AMOSV Ver. 4.0. First, to test validity of variables, the factor analysis was used. Second, to test reliability, Cronbach's alpha coefficients was calculated. Cronbach's alpha of empowerment variable is 0.8323 showing that there's no problem in regard to the internal consistency. Also the Cronbach's alpha of other variables are 0.8301 of the degree of perceived control, 0.6705 of job characteristics, O.8787 of compensation, 0.9254 of job satisfaction, and 0.8389 of organizational commitment, respectively. Among the questions of job characteristics, two survey questions are deleted due to lowering the reliability. Third, to test multicollinearity and correlation of variables, the correlation analysis was performed. There was no problem of multicollinearity. Finally structural equation modelling (SEM) analysis was conducted to find the causal relationship of organizational and job Characteristics, empowerment, job satisfaction and organizational commitment. The 16 variables are included for the SEM analysis. The major results of this study are as follows: First, in the case of model fitness, the condition of x$^2$ statistic(92.187) is not fully satisfied, but the indices of GFI(0.912), AGFI(0.863), NFI(0.917) and CFI(0.928) are partially satisfied, which needs to upper 0.90. Second, in the result of hypotheses testing, all hypotheses are accepted and have a positive effect in 95% or 99% confidence interval(P<0.05 or P<0.001) except the effect of compensation variable on empowerment(P=0.082). Third, in regard to the direct, indirect, and total effect of variables, the direct effect of perceived control, task characteristics, and compensation on job satisfaction are 0.728, 2.264, 0.328 and on organizational commitment are 0.094, 1.411, 0.418, respectively. Also the indirect effect of perceived control, task characteristics, and compensation on job satisfaction are 0.311, 0.196, 0.028 and on organizational commitment are 0.210, 0.132, 0.019, respectively. Thus, these findings imply that various work-related factors are direct effect of empowerment and indirect effect of result variables, job satisfaction and organizational commitment. Also These results showed that the workplace empowerment is significant mediating factor of employee's job satisfaction and organizational commitment.

• Asian Pacific Journal of Cancer Prevention
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• 제17권8호
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• pp.3769-3776
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• 2016

Background: Breast cancer is the leading cause of cancer deaths among women worldwide. High breast cancer mortality has been attributed to lack of public awareness of the disease. Little is known about the level of knowledge of breast cancer in Central African Republic. This study aimed to investigate the knowledge of health professionals on breast cancer. Materials and Methods: This cross-sectional study was conducted among 158 health professionals (27 medical; 131 paramedical) in 17 hospitals in Bangui using a self-administered questionnaire. Descriptive statistical analysis, Person's ${\chi}^2$ test and ANOVA were applied to examine associations between variables with p < 0.05 being considered significant. Results: Data analyzed using SPSS version 20 indicates that average knowledge about breast cancer perception of the entire population was 47.6%, diagnosis method 45.5%, treatment 34.3% and risk factors 23.8%. Most respondents (65.8%) agreed that breast cancer is important in Central African Republic and that family history is a risk factor (44.3%). Clinical assessments and mammography were considered most suitable diagnostic methods, and surgery as the best treatment. The knowledge level was significantly higher among medical than paramedical staff with regard to risk factors, diagnosis and treatment. However the trainee group had very high significant differences of knowledge compared with all other groups. Conclusions: There is a very urgent need to update the various training programs for these professionals, with recommendations of retraining. Health authorities must create suitable structures for the overall management of cancer observed as a serious public health problem.

• 간호행정학회지
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• 제6권2호
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• pp.281-290
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• 2000

The purpose of this study was to identify the relationship between the head nurses' leadership style the and the autonomy perceived by nurses and to provide the basic data for developing strategies of the effective nurse staff management. The subjects were 177 nurses who were working at the 3 general hospitals in Seoul. The data were collected from December 1999 to January 2000 by the structured questionnaires. For data analysis, descriptive statistics, ANOVA, Pearson correlation coefficient, and stepwise multiple regression with $SPSS-PC^+$ version 8.0 were used. The results of this study were as follows : 1. The score of 'the head nurses' transformational leadership perceived by nurses' was highier than that of 'the head nurses' transactional leadership'. Among 5 subdimensions of 'the leadership styles perceived by nurse', the scores of the 'charisma' and 'intellectual stimulation' were highest and the lowest one was that of 'extra management'. 2. Only 'the head nurses' transformational leadership perceived nurses' and 'the situatuational reward' showed a significant difference according to the married status ; nurses who were married showed higher scores than who were not. 3. 'The autonomy perceived by nurses' showed a significant difference according to the educational background ; nurses who had master degree showed higher score than who had diploma. 4. 'Charisma' was positively related to 'intellectual stimulation', 'individual consideration', and 'situational reward'. 'Intellectual stimulation' was positively related to 'individual consideration' and 'situational reward'. 'Individual consideration' was positively related to 'situational reward'. But 'extra management' was negatively related to all of variables. 'Autonomy' was significantly related to 'individual consideration' and 'the transformational leadership'. 5. The determinents of 'the autonomy perceived by nurses' were 'individual consideration' and the educational background, and they explained 15.4% of the total variance of it. The key determinent variables was 'individual consideration'. It explained 11.5% of the total variance of the autonomy. According to the results of this study, the suggestions were as follows: 1. It is necessary to develop strategies for exercising the head nurses' transformational leadership in nursing department : It should to be considered the difference in the leadership style perceived by nurses according to demographic variables. 2. The further studys on the individual consideration of head nurses' transformational leadership and the opportunity of self-development such as education for enhancing nurses' autonomy is needed.

• 치위생과학회지
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• 제10권1호
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• pp.45-54
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• 2010

본 연구는 일반치과환자의 대상으로 일반적 특성에 따른 치과 의료기관 선택요인에 관한 중요도와 치과의원과 치과병원의 선택에 중요한 영향을 미치는 정보를 제공하고자 2009년 8월부터 9월까지 조사 한 것으로 SAS(ver 9.1)분석결과 다음과 같은 결론을 얻었다. 1. 일반적 특성에 따른 치과의료기관 선택요인에 관한 중요도를 비교한 결과 연령대에 따 라서 거리, 교통, 주차편리 같은 거동이나 이동성의 편리를 중요하게 생각하고, 최종 학력에 따라서는 치과소문요인의 중요도가 높으며,(p<0.05) 직업에 따라서는 치과소문, 주차편리의 중요도에 유의한 차이가 나타났다.(p<0.05) 소득에 따라서는 전문의 수련 여부요인이 200만원 미만인 집단보다 500만원이상인 집단이 통계적으로 높게 나타났다.(p<0.05) 2. 대상 치과의원을 방문한 환자들의 방문경로는 소문이 23.7%로 가장 많았으며 다음으로 의료진 및 직원의 소개, 가족의 권유가 각각 17.7%로 나타났는데 이는 인터넷이 발달해 있는 지금도 소문이나 가족의 권유 등 구전의 효과가 크다는 것을 알 수 있다. 3. 추천도에 영향을 미치는 요인에서는 Model I에서는 의료진 실력 우수(p=0.013), 의료 정보 획득 편리(p=0.014), 예약제도 편리(p=0.029), 최신시설(p=0.001), 고가 치료비(p=0.027)은 통계적으로도 유의한 결과를 보였으며, Model II에서는 인테리어(p=0.009), 치과 이름(p=0.027)은 통계적으로도 유의한 결과를 보였다. 4. 재이용 의사에 영향을 미치는 요인에서는 Model I에서는 의료정보 획득편리(OR=0.64)와 고가의 치료비(OR=1.74)가 통계적으로 유의한 결과를 보였으며, Model 에서는 야간 및 공휴일 진료여부(OR=1.47)가 통계적으로 유의한 결과를 보였다.

• 경영과정보연구
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• 제36권1호
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• pp.309-327
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• 2017

최근 감정노동의 중요성이 커짐에 따라 본 연구는 감정노동이(표면행동, 내면행동)이 직무소진(정서적 고갈, 탈인격화, 자아성취감 저하)을 매개로 반생산적과업행동(조직일탈, 개인일탈)에 미치는 영향을 검증하고자 한다. 감정노동이 요구되는 콜센터종사자, 백화점판매원, 금융종사자, 병원접점종사자, 호텔접점종사자, 승무원, 고객센터종사자 등을 대상으로 총 350부의 설문지가 배부되었고, 불성실한 응답지를 제외한 300부의 설문지가 분석에 활용되었다. 실증연구결과는 다음과 같다. 첫째, 고객접점 종사자들이 직무수행과정에서 선택하게 되는 감정노동의 유형인 표면행동은 직무소진 중 정서적 고갈, 탈인격화, 자아성취감 저하에 모두 정(+)의 유의한 영향을 미치는 것으로 나타났다. 둘째, 내면행동은 직무소진 중 탈인격화, 자아성취감 저하에 부(-)의 유의한 영향을 미치는 것으로 나타났으나 정서적 고갈에는 유의한 영향을 미치지 않는 것으로 나타났다. 셋째, 직무소진 중 탈인격화와 자아성취감 저하는 모두 반생산적과업행동(조직일탈, 개인일탈)에 모두 정(+)의 유의한 영향을 미치는 것으로 나타났으나 정서적 고갈은 반생산적과업행동(조직일탈, 개인일탈)에 유의한 영향을 미치지 않는 것으로 나타났다. 이러한 분석결과를 토대로 본 연구의 시사점과 한계점 및 향후 연구방향에 대하여 논의하였다.

• 대한간호학회지
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• 제1권1호
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• pp.111-132
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• 1970

An analysis of nursing activities in a in-patient ward and its management was observed in order to assess necessary number of nursing hands and find out reasonable work management with them. The study was performed with two wards of St. Mary′s Hospital, Catholic Medical Center, for the period from July to December 1970. The results and conclusions were as the following 1. The role of the nurses are determined by doctor′s order in 57.7% in kind, 80.0% in amount. and by nurses decision 20.0% in amount. 2. Works related to patient care are found to be 20.6% in the internal medicine ward and 20.4% in the surgical ward while works related to treatment are 4.7% in the former and 27.2% in the letter. Medication occupies 40.0% in the internal medical ward while 26.6% in the surgery ward, and observation occupies 34.7% in the former while 25.8% in the letter. These can be said to reflect characteristic differences bet ween the two wards. 3. When nursing functions were evaluated by importance "A" level in the amount of works to be done occupied 67.6% in the surgical ward and 62.8% in the internal medical ward. In the kind of the important works, "B"level is found to be most frequent with 50% while "A"level 43%. When evaluated by difficulty, "B"level was found to be most frequent in amount in both internal medicine and surgical wards (52.6%, 38.2%). 4. Works needing professional knowledge and skills occupied 92% in the both wards while unprofessional works 2.8% and 4.2% respectively. There are indications, however, that unprofessional works have an increasing tendency. 5. When evaluated by the amount of works, the surgical ward has 11 nurses less and the internal medicine ward 3 nurses less then the necessary number of nursing staffs. There are shortage of 12 and 6 nurses respectively when evaluated by the number of patients and 18 nurses in the both wards when evaluated by the medical regulations of the Government. 6. The ratio of the nursing staff to patient was found to be 1:11.5, 1:23.0 and 1:34.5 in the morning, evening and night turn in the surgical ward. In the medical word the ratio was 1:9.4, 1:22.0 and 1:33.0. 7. The deficiency of necessary equipment and tension accompanying management of those equipment were found to lower the effective functioning of the head nurse who is a junior manager of the ward. They also consume much of the time and energy of the nurses at work who are over burdened in most of the cases. 8. The high rate of the number of nurses who leave the job impairs the functioning of team work which is considered to be most important in the effective performance of nursing activities and thus contributes to lower the efficiency of nursing functions.

• 대한간호학회지
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• 제4권3호
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• pp.93-104
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• 1974

Regardless of a patient's diagnosis, the care of his skin has been a primary concern of nurses throughout the years. Nurses has washed, dried, and rubbed the skin and have changed his position so as to keep the patient's skin in good condition and to protect him from pressure sores. However, we still find many-patients suffering from the pressure sores which may take many mothers or years of treatment and cost a lot to be repaired. In view of expensive cost for treatment of the sores and low ratios of nursing staff per patient for intensive nursing care, prophylaxis of the bed sores with sufficient aids is extremely important both for patients and for nurses. Therefore, the unique purpose of this study was to determine whether sponge is good enough to treat and prevent the pressure sore as compared with gel pad and sheepskin. Sixty patients in the age range of 15 through 45 who were in unconscious status or have difficulty of mobility were chosen between January and March of 1974 at Seoul National University Hospital. They were randomly assigned to each treatment and observed on every 4th day with regard to level of consciousness, status of mobility, moisture or dryness of the bed, general skin condition, intake of nutrition, vital signs and intervals of position change in comparison with the changes of skin over the bony prominences. The study results were reviewed in a statistical method analysis of valiance-to obtain the following findings: 1. There was no significantly different changes of skin over the sanctum or the trochanter in each group using get pad, sheepskin or sponge. It means that we may substitute sponge for expensive gel pad or sheepskin. 2. There was no significant difference among mean changes of patient's skin in relation to sheepskin, gel pad and sponge. 3. There was no significant changes of patient's akin in relation to level of consciousness, status of mobility, intake of nutrition, general skin condition, temperature, blood pressure or interval of position change. 4. There were no meaningful interactions between each treatment and level of consciousness, moisture or dryness of the bed, intake of nutrition, general skin condition, temperature or blood pressure. 5. Sheepskin and gel pad had significantly better influence on patients with limited mobility than on patients with immobility, and sponge on patients with immobility on than patients with limited mobility, 6. Sheepskin and sponge had meaningfully totter influence on patients changing position at below 2-hour interval, gel pad at 2-4-hour interval, sheepskin at 4-6-hour interval, and three of them at above 6-hour interval.

• 간호행정학회지
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• 제10권1호
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• pp.25-36
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• 2004

Purpose: Nursing puts much weight en the organization of hospital. Therefore it is necessity to improve nursing care. One of the most important things is to secure confident nurses and to develop nurse' potentiality. It directs nurse evaluation system. The concept of "performance appraisal tools" is extremely important in evaluation system. Therefore, the purpose of this study aims to define performance appraisal process. Method: In order to do this, two main study has been observed interviewing appraisers and employees in-depth and analyzing performance appraisal tools of seven hospitals and analysed validity, reliability, acceptability and practicability. Result: The result of this study can be summarized as follows; Firstly, the result of analysis of performance appraisal tools. Regard to validity, Hospitals had a typical goal, but had not put to practice use. Regard to reliability, 1) Appraisal rule had been focused on appraiser's error, how to avoid. 2) 5 hospitals accessed nurses with relative rating and 2 hospitals with absolute rating both in practice. 3) 3 hospitals informed nurses the result of performance appraisal but 4 hospitals did not. 4) All hospitals in this study had conducted superiors rating. Regard to acceptability, 1)Rating scale method had been implemented by 6 hospitals and among those conducted beth ranking method and descriptive method. 2) Most hospitals had focused on personal traits in performance appraisal factors. Regard to practicality, The term of appraisal took $10{\sim}14$ days; performance appraisal happened 1 or 2 times per year; appraisal factors were based on 10 different items. Secondly, the result of in-depth interview with head nurses and staff nurses Regard to validity, head nurses and nurses wared that the goal of performance appraisal is to develop nurse's ability. Regard to reliability, head nurses pointed out that they were doubt of the justice of performance appraisal and they should have got training. Nurses insisted that raters should have been trained due to lack of qualification of appraiser; Head nurses and nurse proposed to convert form relative rating to absolute rating; to inform the result of appraisal; to implement peers rating. Regard to acceptability, One of the critical problems of performance appraisal tools was abstract of appraisal factors ; Lack of job analysis. Regard to practicality, Head nurses used to take overtime for appraisal. There was only a little respond despite of their efforts. Nurses questioned that appraisal tools exist for only appraisal; there was less cost-effectiveness. Conclusion: Based en these findings, it could be suggested to improve the performance appraisal tools for nurses evaluation. Firstly, it is necessary to describe goal of performance appraisal clearly set up, so that nurses could improve their positive word performance and develop their potentiality. Secondly, it is necessary to obtain various training on raters, implement absolute rating and inform the result of appraisal to nurses and use peers rating. Thirdly, it is necessary to convert from rating scale method to management by objectives or behaviorally anchored rating scale and take measurable appraisal factors based en job analysis. Finally, it is necessary to reduce the appraisal cost but increase effectiveness of performance appraisal.