• 간호행정학회지
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• 제3권1호
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• pp.51-64
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• 1997

The purpose of the study was to introduce an integrated approach of new Casuistry and specified principlism in resolving ethical problems and studying nursing ethics. In studying clinical ethics and nursing ethics, there is no systematic research method. While nurses often experience ethical dilemmas in practice, much of previous research on nursing ethics has focused merely on describing the existing problems. In addition, ethists presented theoretical analysis and critics rather than providing the specific problems solving strategies. There is a need in clinical situations for an integrated method which can provide the objective description for existing problem situations as well as specific problem solving methods. We inherit two distinct ways of discussing ethical issues. One of these frames these issues in terms of principles, rules, and other general ideas; the other focuses on the specific features of particular kinds of moral cases. In the first way general ethical rules relate to specific moral cases in a theoretical manner, with universal rules serving as "axioms" from which particular moral judgments are deduced as theorems. In the seconds, this relation is frankly practical. with general moral rules serving as "maxims", which can be fully understood only in terms of the paradigmatic cases that define their meaning and force. Theoretical arguments are structured in ways that free them from any dependence on the circumstances of their presentation and ensure them a validity of a kind that is not affected by the practical context of use. In formal arguments particular conclusions are deduced from("entailed by") the initial axioms or universal principles that are the apex of the argument. So the truth or certainty that attaches to those axioms flows downward to the specific instances to be "proved". In the language of formal logic, the axioms are major premises, the facts that specify the present instance are minor premises, and the conclusion to be "proved" is deduced (follows necessarily) from the initial presises. Practical arguments, by contrast, involve a wider range of factors than formal deductions and are read with an eye to their occasion of use. Instead of aiming at strict entailments, they draw on the outcomes of previous experience, carrying over the procedures used to resolve earlier problems and reapply them in new problmatic situations. Practical arguments depend for their power on how closely the present circumstances resemble those of the earlier precedent cases for which this particular type of argument was originally devised. So. in practical arguments, the truths and certitudes established in the precedent cases pass sideways, so as to provide "resolutions" of later problems. In the language of rational analysis, the facts of the present case define the gounds on which any resolution must be based; the general considerations that carried wight in similar situations provide warrants that help settle future cases. So the resolution of any problem holds good presumptively; its strengh depends on the similarities between the present case and the prededents; and its soundness can be challenged (or rebutted) in situations that are recognized ans exceptional. Jonsen & Toulmin (1988), and Jonsen (1991) introduce New Casuistry as a practical method. The oxford English Dictionary defines casuistry quite accurately as "that part of ethics which resolves cases of conscience, applying the general rules of religion and morality to particular instances in which circumstances alter cases or in which there appears to be a conflict of duties." They modified the casuistry of the medieval ages to use in clinical situations which is characterized by "the typology of cases and the analogy as an inference method". A case is the unit of analysis. The structure of case was made with interaction of situation and moral rules. The situation is what surrounds or stands around. The moral rule is the essence of case. The analogy can be objective because "the grounds, the warrants, the theoretical backing, the modal qualifiers" are identified in the cases. The specified principlism was the method that Degrazia (1992) integrated the principlism and the specification introduced by Richardson (1990). In this method, the principle is specified by adding information about limitations of the scope and restricting the range of the principle. This should be substantive qualifications. The integrated method is an combination of the New Casuistry and the specified principlism. For example, the study was "Ethical problems experienced by nurses in the care of terminally ill patients"(Um, 1994). A semi-structured in-depth interview was conducted for fifteen nurses who mainly took care of terminally ill patients. The first stage, twenty one cases were identified as relevant to the topic, and then were classified to four types of problems. For instance, one of these types was the patient's refusal of care. The second stage, the ethical problems in the case were defined, and then the case was analyzed. This was to analyze the reasons, the ethical values, and the related ethical principles in the cases. Then the interpretation was synthetically done by integration of the result of analysis and the situation. The third stage was the ordering phase of the cases, which was done according to the result of the interpretation and the common principles in the cases. The first two stages describe the methodology of new casuistry, and the final stage was for the methodology of the specified principlism. The common principles were the principle of autonomy and the principle of caring. The principle of autonomy was specified; when competent patients refused care, nurse should discontinue the care to respect for the patients' decision. The principle of caring was also specified; when the competent patients refused care, nurses should continue to provide the care in spite of the patients' refusal to preserve their life. These specification may lead the opposite behavior, which emphasizes the importance of nurse's will and intentions to make their decision in the clinical situations.

• 여성건강간호학회지
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• 제5권1호
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• pp.111-132
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• 1999

This correlational descriptive study sought to define the relationship between the experience of Sanhujori, Korean tradition non-professional postpartal care after delivery and abortion and present physical symptom distress of arthritis female who visited to outpatient clinic of rheumatic internal medicine at three hospital located in Seoul, Pusan, Chongju, Korea. Data from a convenience sample of 98 women who orally agreed to be respondent were collected from September 1, 1998 to October 31, 1998 for two months by way of interview with semi-structured questionnaire. Data analysis consisted of frequency, percentage, mean, S. D., Pearson Correlation Coefficient, t-test, ANOVA and Scheffe test as a post hoc by SPSS. The results of the study were as follows ; Mean age of participants as 52.8 years and mean number of children 3.3. Mean frequency of child birth was 3.1 times per woman, 67.4% of respondents had menopause, 57.0% did not have Sunhujori after abortion. The health status implies the subjective health status women perceived, which came from the three points of view of the present, comparative with other of same age and changed after delivery. The respondents of 76.1% perceived them as unhealthy and the main sites of physical symptom distress were upper & lower extremities including knee and hand 34.8%, shoulder 26.5%, waist 22.4%. Women perceived the etiology of the arthritis as 'did Sanhujori wrongly' 36.7%, 'aging process' 24.5%, 'stress' 16.3%, 'overwork' 15.3%, 'Immunocompromize' & 'physical constitution' 7.1% respectively, 'character' 3.1%, 'genetic' 2.0%, 'malnutrition' 1.0%. The mean period of Sanhujori after delivery was 20.4 at the first child and 18.1 at the second child. The higher frequency of child birth, the shorter period of Sanhujori. For the subjective evaluation of whether the women did Sanhujori well or not, the rate of 'did Sanhujori well' was the highest rank in the first child and the rate of 'did not particularly Sanhujori well' was the highest rank in the last child. There was a significant positive correlation between physical function disability and rheumatoid arthritis symptom at the level of 1% of significance statistically(r=.406). And a positive correlation between physical function disability and Sanhubyung symptom at the level of 5% of significance statistically(r=.224). There was a significant positive correlation among rheumatoid arthritis symptom, Sanhubyung symptom and menopause symptom at the level of 1%-5% of significance statistically. Most of all, the correlation between Sanhubyung symptom and menopause symptom was the higher than others. There was a negative correlation between the present physical symptom distress and experience of Sanhujori(r=.-130), however it was not significant statistically. However, there was a positive correlation between subjective health status and experience of Sanhujori at the level of 1% of significance statistically(r=.328). In conclusion, this finding reconfirmed the positive relationship between the perceived health status and experience of Sanhujori after delivery among women of arthritis. It provides a challenge to the professional care givers to study further on the effects of Sanhuiori after abortion or delivery on the physical symptom distress from the variouis aspects through the cross-sectional and longitudinal research. The strategy for the development of the appropriate intervention for primary prevention of sequele after childbirth and quality of care for desirable health outcomes for postpartal women with considering deeply on the relationship between women's health and postapartal care.

• 한국학교ㆍ지역보건교육학회지
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• 제5권
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• pp.107-122
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• 2004

To correctly plant the value of sex to the juvenile, we cannot overemphasize the importance of the sexual education in schools. Therefore, the study for teachers' consciousness and view of sex is also necessary, because they are subjects of education and role-models of sex of their students. Especially, if teachers are over fifty in age, it is more important, because it is obvious, as they are in positions of managers and directors of education, that their view of sexual value and consciousness are influencing the aim of education and the course of education. Hereby this study was conducted to check their sexual consciousness, attitude, and condition and to prepare for the basic data needed for the development of a sexual education program suitable to them. The methods of the survey of this study are applied by modifying or supplementing those of precedented studies. They are used after analyzing reliance of items according to Cronbach's $\alpha$ figure calculating law, and modifying or supplementing items lower in reliance. The questionnaire survey was conducted among 1,000 randomly selected from teachers working in middle and high schools in Korea from June 14th in 2004 to June 30th. The survey analyzed 632 questionnaires suitable to it. The outcomes of the survey of this study are like the following: First, the objects of the survey consist of 64.6% men and 35.4% women. Among them, 41.1% are under fifty and the rest are over fifty. As for the periods of marriage, 15.5% are unmarried, 16.3% are under ten years, 18.0% are between ten and twenty, and 50.2% are over twenty. Second, with reagard to sex, 25.6% admit the necessity of a heterosexual friend. 32.0% say that they are conservative to sex. 54.1% are taught sexual education. 67.1% attribute sexual education to nursing teachers. Third, among those who answer that they enoughly know the concept of sex, seenig by age, 25.0% are under fifty and 58.1% are over fifty. Seening by the periods of marriage, 9.2% are unmarried, 28.2% are under ten, 49.1% are between ten and twenty, and 59.0% are over twenty. Among those who answer that they enoughly know the concepts of sexual harassment and sexual violence, seenig by age, in the turns by above-mentioned order, each 47.7% and 76.3%. Seening by the periods of marriage, each 9.2%, 28.2%, 49.1%, and 59.0%. Fourth, among those who answer that "teachers also need sexual education and sexual counsel," by age, each92.7% and 91.4%. By the periods of marriage, each 89.8%, 95.2%, 89.4%, and 92.4%. As a matter of course, we can infer the necessity of the sexual education and sexual counsel for teachers. Fifth, among those who answer that they are satisfied with their sexuality, by age, each 41.1% and 61.3%. By the period of marriage, each 4.1%, 63.1%, 64.1%, and 61.5%. As for the sexual desire like spiritual intercourse, physical intercourse containing sexuality, by age, each 71.9% and 93.5%. By the periods of marriage, each 54.0%, 81.5%, 90.3%, and 93.0%. The survey shows that those over fifty and having long marriage are feeling the stronger desire towards sexuality. Through the outcomes of this survey, a few suggestions are possible: First, it is necessary to check of the teachers' view of sexual value and to study deep about the sexual tendency of them in twenties, thirties, and forties. It is to make them teach their students on the firm basis, and also to develop suitable sexual education and counsel program.

• 대한한방소아과학회지
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• 제26권3호
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• pp.64-73
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• 2012

Objectives The purpose of this study is to see the prevalence and the patterns of the use of complementary and alternative medicine (CAM) in children and adolescent patients with allergies. Methods We analyzed data on 547 children and adolescents (age from 0-18 years old) chosen from all regions throughout the country with allergic diseases, including atopic dermatitis, allergic rhinitis, asthma and allergic urticaria. We used multiple logistic regression modeling to predict CAM use based on predictor variables. Results The previous 12-months prevalence of CAM usage in overall was 70.7% (atopic dermatitis, 78.1%; allergic rhinitis, 52.9%; asthma, 70.3%; allergic urticaria, 86.3%). Central and southern regions displayed significantly lower rate of using CAM compare to the northern region, and CAM was less likely to be used for the allergic rhinitis patients than the atopic dermatitis patients. The most commonly used CAM type was natural products (62.2%). Top five of the most frequently used CAM modalities were softener water, vitamin, red ginseng, wood bathing and aloe oil. One of the main reasons for trying CAM was from the 'hope for a more effective outcomes in additional to the conventional medicine' (43.9%). The subjective effectiveness of CAM was found to be excellent in 74.0% of the patients, and 70.3% of the parents were willing to recommend CAM therapies to the others. Conclusions CAM is used widely to treat allergic diseases in children and adolescents in Korea. Korean medical doctors should actively discuss the use of CAM with the patients and provide information on the effectiveness and safety of CAM as guide in making choice for usage of CAM.

• 보건교육건강증진학회지
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• 제32권2호
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• pp.1-13
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• 2015

Objectives: This study was conducted to investigate derived factors associated with a public service announcement on handwashing to evaluate the effect of this announcement. Methods: In early september, 1,000 persons over 19 years old was investigated by Computer Aided Telephone Interview, at last 993 persons for analysis. Outcomes were the exposure to the public service announcements on handwashing, the comprehension of this announcements, the intention of behavioral change and the practice of handwashing. Results: In particular, the proportion of exposure is more women and highly educated. The comprehension of the announcement was no statistically significant difference. The intention of behavior change showed higher in workers and understanding of the announcements. The practice of handwashing is higher in women and lower in student/unemployed. There was no difference in practice in accordance with the exposure, the comprehension and the intention of behavioral change. Conclusions: About the comprehension of the announcements and the intention of behavioral change, the effects of the public service announcements on handwashing can be very positive. But it does not affect the actual practice of hand washing. The handwashing promotion programs will have to devise a strategy and structure, operation method considering realistic and scalable platform.

• Asian Pacific Journal of Cancer Prevention
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• 제14권12호
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• pp.7143-7147
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• 2013

Background: The survival outcomes for women presenting with early breast cancer are influenced by treatment decisions. In Malaysia, survival outcome is generally poor due to late presentation. Of those who present early, many refuse treatment for complementary therapy. Objective: This study aimed to explore the decision making experiences of women with early breast cancer. Materials and Methods: A qualitative study using individual in-depth interviews was conducted to capture the decision making process of women with early breast cancer in Malaysia. We used purposive sampling to recruit women yet to undergo surgical treatment. A total of eight participants consented and were interviewed using a semi-structured interview guide. These women were recruited from a period of one week after they were informed of their diagnoses. A topic guide, based on the Ottawa decision support framework (ODSF), was used to facilitate the interviews, which were audio recorded, transcribed and analysed using a thematic approach. Results: We identified four phases in the decision-making process of women with early breast cancer: discovery (pre-diagnosis); confirmatory ('receiving bad news'); deliberation; and decision (making a decision). These phases ranged from when women first discovered abnormalities in their breasts to them making final surgical treatment decisions. Information was vital in guiding these women. Support from family members, friends, healthcare professionals as well as survivors also has an influencing role. However, the final say on treatment decision was from themselves. Conclusions: The treatment decision for women with early breast cancer in Malaysia is a result of information they gather on their decision making journey. This journey starts with diagnosis. The women's spouses, friends, family members and healthcare professionals play different roles as information providers and supporters at different stages of treatment decisions. However, the final treatment decision is influenced mainly by women's own experiences, knowledge and understanding.

• 한국콘텐츠학회논문지
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• 제16권11호
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• pp.499-509
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• 2016

본 연구는 유방암 환자의 외상 후 성장에 영향을 미치는 요인을 조사하고자 진행되었으며 자료수집은 인천광역시 내 대학병원 외래를 내원하여 유방암 진단을 받고 치료과정 중에 있는 유방암 환자 100명을 대상으로 하였다. 연구도구는 한국어판 외상 후 성장 척도(K-PTGI), 사회적지지(mMOS-SS), 유방암 자가관리에 대한 자기효능감 척도(SESSM-B)와 대처행동(CCQ) 도구를 사용하였다. 자료의 분석은 t-검정, ANOVA, Pearson 상관분석, 단계적 다중회귀분석을 하였다. 연구결과 외상 후 성장 정도는 5점만점에 평균 3.4(${\pm}0.9$)점이었다. 외상 후 성장은 사회적 지지, 유방암 자가관리에 대한 자기효능감, 대처행동과 통계적으로 유의한 양의 상관관계를 보였다. 단계적 다중회귀분석에서, 치료이행 자기효능감과 긍정적 재구조화 대처행동이 유방암환자의 외상 후 성장 영향 요인으로 나타났고, 이들 변수들의 설명력은 29%였다. 본 연구 결과를 바탕으로 유방암환자의 외상 후 성장을 향상시킬 수 있는 간호 중재 개발을 고려할 필요가 있겠다.

• Nutrition Research and Practice
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• 제14권3호
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• pp.218-229
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• 2020

BACKGROUND/OBJECTIVES: Type 2 Diabetes mellitus (T2DM) is a hereditary disease that is also strongly dependent on environmental factors, lifestyles, and dietary habits. This study explored the relationship between lifestyle habits and glycosylated hemoglobin management in T2DM patients to provide empirical outcomes to improve T2DM management and patient health literacy. SUBJECTS/METHODS: This study enrolled 349 diabetic patients with more than 5 care visits to a Diabetes Mellitus care network under the Health Management Plan led by Taiwan Department of Health (DOH). Based on relevant literature, an Outpatient Record Form of Diabetes Mellitus Care was designed and lipid profile tests were conducted for data collection and analysis. RESULTS: When modeling the data, the results showed that the odds for HbA1c > 7.5% in T2DM patients duration over 10 years was 3.785 (P = 0.002) times that in patients with disease duration of fewer than 3 years. The odds of HbA1c > 7.5% in illiterate patients was 3.128 (P = 0.039) times that in patients with senior high school education or above. The odds of HbA1c > 7.5% in patients with other chronic illness was 2.207 (P = 0.019) times that in participants without chronic illness. Among 5 beneficial lifestyle habits, the odds of HbA1c > 7.5% in patients with 2 or 3 good habits were 3.243 (P = 0.003) and 3.424 (P = 0.001) times that in patients with more than 3 good habits, respectively. CONCLUSION: This empirical outcome shows that maintaining a good lifestyle improves T2DM management and patients' knowledge, motivation, and ability to use health information. Patients with longer disease duration, education, or good lifestyle habits had optimal HbA1c management than those in patients who did not. Thus, effective selfmanagement and precaution in daily life and improved health literacy of diabetic patients are necessary to increase the quality of T2DM care.

• 한국산학기술학회논문지
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• 제17권12호
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• pp.270-284
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• 2016

본 연구는 현상학적 방법을 적용하여 유방암 생존자들의 비약물적 추후 관리 경험에 대한 본질적 구조와 의미에 대해 심도 있게 파악하는 것을 목적으로 한다. 이번 연구에서 총 참여자는 10명으로 S시 E병원 외래에 정기적으로 내원하는 유방암 생존자로 수술, 화학요법, 방사선요법을 완료한 자들이었다. 자료수집 기간은 2014년 8월부터 2015년 2월까지로 수집된 자료는 심층면담 후 Colaizzi의 방법 적용하여 분석하였다. 연구결과, 7개의 주제와 16개의 하위범주가 도출되었다. 7개의 주제는 '1. 증상을 완화하기 위해 용이한 방법을 적용함, 2. 변화된 신체 상태를 위해 움직이려 함, 3. 재발 방지를 위해 특정 식용 작물을 섭취함, 4. 건강을 유지하기 위한 식생활 양식이 있음, 5. 보완대체요법에 대해 항상 예의주시함, 6. 주치의 처방외 필요한 치료가 있음, 7. 자연친화적인 환경에서의 삶을 지향함' 이었다. 이번 연구는 유방암 생존자들이 치료 후에 일상생활에서 어떻게 추후관리를 하는지 심도있게 파악하는 데 도움을 줄 것이다. 나아가 본 결과는 향후 유방암 생존자들에게 실제 관리 양식에 근거한 실행 가능한 지침과 프로그램을 제공하는데 있어 기초자료로써 제공될 것이다.

• Journal of Gastric Cancer
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• 제9권3호
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• pp.117-127
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• 2009

목적: 의료진은 암 환자들에게 적절한 건강 관련 정보를 제공함으로써 암 환자들이 자신의 질병과 치료에 대한 불확실한 상황을 극복하여 스스로 건강을 관리하는 것을 도울 수 있다. 효과적으로 정보를 제공하기 위해서는 환자가 실제 알고자 하는 정보 내용을 파악하는 것이 필요하다. 본 연구에서는 위암 수술 후 환자의 정보 요구 경향을 확인하고자 하였다. 대상 및 방법: 위암 수술 후 환자로, 2008년 11월 18일 삼성서울병원 위암센터에서 주관한 '위암 환자의 날' 행사에 참여한 대상자에게 설문지를 배부하여 직접 작성하도록 하였고, 수집된 190명의 설문지를 분석하였다. 설문 도구는 검사, 치료, 예후, 추후 관리, 성 생활, 위암 관련 정보 영역과 7개의 단일 문항의 총 37개 문항으로 구성되었다. 결과: 정보 요구는 예후, 치료 기간 동안 스스로 할 수 있는 건강 관리 방법, 추후 관리, 위암 관련 정보, 치료, 검사 등의 순으로 높게 나타났다. 문항별로 살펴보면, 예후, 식이, 치료 중의 건강 관리와 관련한 문항에서 높은 정보 요구를 보였다. 대상자의 연령이 젊을수록 검사, 치료, 성 생활, 위암 관련 정보 영역의 정보 요구가 높았다. 결론: 기존에 축적된 병원의 치료 결과 및 예후 자료에 근거한 객관적인 예후 관련 정보를 교육 프로그램에 반영하고 암 환자 및 보호자가 이해하기 쉽도록, 그리고 치료 과정에 적극적으로 참여할 수 있도록 적절한 정보를 전달하여야 할 것이다.