• 마케팅과학연구
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• 제16권3호
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• pp.17-37
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• 2006

The present study examines the relative roles of external recommendations and internally felt satisfaction in influencing patient loyalty to a doctor. It establishes that recommendations do result in preliminary loyalty formation in the patient to the doctor, but only until the formation of own experiences; the significance of external sources of recommendation in the determination of patient loyalty becomes insignificant thenceforth. Implications for the doctors are that they should strive at fostering bonds of emotional attachment in their present patients so that they become strongly loyal and spread positive word-of-mouth which could result in the doctor getting new patients as well. Probable extensions of this research are also discussed later in the paper.

• Journal of Oral Medicine and Pain
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• 제40권1호
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• pp.3-9
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• 2015

The etiopathogenesis of burning mouth syndrome (BMS) seems to be complex and many patients probably involves interactions among local, systemic, and/or psychological factors in the pathophysiologic mechanism. Although there are controversies over whether the psychological factor is a cause or a result of BMS, several studies have supported strong relationships between psychological factors and chronic pain. It has been suggested that somatic complaints from unfavorable life experiences may influence both individual personality and mood changes; however, initiation of BMS symptoms is not necessarily correlated with stressful life events despite their elevated psychological stress. If the psychological distress is not a causal factor of BMS, it seems that BMS patients may be particularly vulnerable to psychological problems, primarily depression, anxiety, and hostility due to the characteristic entities of BMS such as chronic persistent pain itself. It seems likely that both physiological and psychological factors play a role in causing, perpetuating and/or exacerbating BMS; therefore, both two components of the patient's symptoms must be addressed. The acceptance of psychological factors by the patient is often an important element of BMS, management. The evaluation of psychological and emotional status of BMS patient enables clinicians to recognize prolonged negative and subclinical factors which can complicate the management of pain or indirectly perpetuate other physical factors. This evaluation improves the doctor-patient relationships, motivation, and compliance through a correct understanding of the clinical problem. Appropriate emotional and psychological evaluation may be required prior to developing a treatment plan in order to gain the successful treatment outcome.

• 대한간호학회지
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• 제48권5호
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• pp.601-621
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• 2018

Purpose: This study aimed to synthesize the caring experiences of Korean family members of patients with dementia through a qualitative meta-synthesis method. Methods: By searching through nine Korean and English databases, we compared 37 qualitative studies on caring experiences of family members of patients with dementia. The selected studies were synthesized through meta-synthesis, proposed by Sandelowski and Barroso (2007). Results: The meta-synthesis elicited four themes: tough life due to care for patients, changes in relationships, adaptation to caregiver's roles, and new perspectives of life through personal growth. Caregivers were shocked when a sudden diagnosis of dementia was made prior to any preparation on their part. They were tied to their patients all the time and their mind and body got exhausted. Their relationship with patients began to change and they looked at them differently. They experienced conflicts with the other non-caring family members and were alienated from them. They were also socially isolated. However, by building their own care strategies and utilizing social resources, they gradually adapted to their caregiver roles. Finally, they experienced personal growth and acquired a new perspective toward life by accepting their roles and finding meaning in their lives. Shifting the caregiver's centricity from themselves to the patient was the process of becoming human beings who actively constructed their realities while giving meaning to their painful lives and interacting with the environment. Conclusion: The results of the study can be useful for nurses in understanding the experiences of caregivers of the patients with dementia and in providing them with practical interventions.

• Asian Pacific Journal of Cancer Prevention
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• 제14권7호
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• pp.4053-4056
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• 2013

Background: Colposcopy is the gold standard procedure for evaluating cervical cytological abnormalities. Although it is essentially a minimally invasive intervention, referral for colposcopy may cause significant distress on patients. In this study, we aimed to determine if pre-procedural anxiety levels have a significant association with procedure related pain and discomfort in women undergoing colposcopy for evaluation of abnormal cervical cytology. We also assessed the impact of various clinical factors on anxiety, pain and discomfort in these patients. Materials and Methods: This prospective study was performed at the gynecologic oncology department of Zekai Tahir Burak Women's Health Education and Research Hospital in Ankara, Turkey between January and June 2013. After taking informed consent, State-Trait Anxiety Inventory (STAI) form and a 14-item questionnaire were filled for women who were admitted to our outpatient colposcopy unit for evaluation of abnormal cervical cytology. STAI scores were calculated for each participant. Immediately after the procedure, visual analog scale (VAS) scores for procedure-related pain and discomfort were obtained. Associations between STAI and VAS scores were investigated using correlation analyses. The effect of various contributing factors on anxiety, pain and discomfort were evaluated with linear regression analysis. The p values less than 0.05 were considered statistically significant. Results: A total of 222 women met the inclusion criteria within the study period. Mean patient age was $38.5{\pm}9.6$. Median state and trait anxiety scores were 47 and 46, respectively. Median VAS scores for pain and discomfort were 4 for both variables. State anxiety had a significant correlation with procedure related discomfort (p=0.02). Colposcopy related pain VAS scores were significantly affected by state anxiety level, marital status and prior gynecological examination (p<0.05). Colposcopy related discomfort VAS scores were significantly affected by state anxiety level, marital status, prior gynecological examination and educational status. Conclusions: Additional measures should be implemented in women that carry higher risk for experiencing pain and discomfort. Social, cultural and lifestyle issues may also affect women's experiences during colposcopy, therefore further studies are needed to define specific determining factors in various populations.

• Asian Pacific Journal of Cancer Prevention
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• 제15권19호
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• pp.8135-8142
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• 2014

Background: Breast cancer is the most common cancer in Iranian women and usually features delayed presentation and late diagnosis. Interpretation of symptoms, as the most important step, has a significant impact on patient delay in seeking treatment. There is a dearth of studies on symptom appraisal and the process leading to seeking help in breast cancer patients. This study explored the perceptions and experiences of Iranian women with self-detected possible breast cancer symptoms. Materials and Methods: A qualitative method was conducted involving in-depth semi-structured interviews with 27 Iranian women with self-discovered breast cancer symptoms. Participants were purposefully selected from women who attended Cancer Institute of Tehran University of Medical Sciences during June 2012 to August 2013. The audiotaped interviews were transcribed and analyzed using conventional content analysis with MAXQDA soft ware version 10. The trustworthiness of the study was verified by prolonged engagement, member validation of codes, and thick description. Results: The main concepts emerging from data analysis were categorized in four categories: symptom recognition, labeling of symptoms, interactive understanding, and confronting the fear of cancer. Symptom recognition through breast self-examination, symptom monitoring and employing prior knowledge distinguished normal from abnormal symptoms and accompanied with perception of being at risk of breast cancer led to symptom labeling. Social interaction by selective disclosure and receiving reassurance from a consultant led to confirmation or redefinition of the situation. Perceived seriousness of the situation and social meanings of breast cancer as a stigmatized and incurable illness associated with loss of femininity were reasons for patient worries and fear. Conclusions: This study emphasized that entangled cognitive, emotional and socio-cultural responses affecting understanding of symptom seriousness require further investigation. It is suggested that programs aimed at shortening patient delay in breast cancer should be focused on improving women's knowledge and self-awareness of breast cancer, in addition to correcting their social beliefs.

• 대한유전성대사질환학회지
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• 제17권1호
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• pp.1-10
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• 2017

목적: 소아기에 경험되는 미토콘드리아 질환은 희귀난치성 질환으로, 확진까지의 과정에서뿐 아니라 진단 및 진단 이후 과정에서 지속적으로 질병을 경험하는 환자와 보호자에게 모두 신체적 및 정신적인 어려움을 동반하게 된다. 본 연구에서는, 미토콘드리아 질환 소아환자의 보호자의 질환에 대한 인식을 조사하고, 확진이후 경험하게 되는 감정들에 대한 이해를 통해, 미토콘드리아 질환 환자와 보호자, 그 가족들에 대한 치료적 개입의 방향에 도움을 제시하고자 하였다. 방법: 연세의대 강남세브란스병원 소아청소년과 미토콘드리아 질환 클리닉에 내원한 83명 소아 환자의 보호자들에 대해서, 미토콘드리아 질환에 대한 인식 및 진단 이후 경험하게 되는 정서 관련 개발된 설문 조사를 시행하여 분석하였다. 환자들에 대한 미토콘드리아 질환 관련 임상 자료가 조사되었으며, 이와 관련한 분석이 이루어졌다. 결과: 총 83명의 환자들 보호자에 대한 설문 결과가 분석되었으며(남아 53명, 64%), 환자의 연령대는 6-12세가 27명(33%), 1-6세가 25명(30%) 순서였다. 미토콘드리아질환 관련 첫번째 증상 발병 연령은 0-0.5세가 전체의 43%(36명)를 차지하였고, 질병의 유병기간은 10년 이상으로 지속되는 경우가 가장 많았다(35명, 42%). 자녀가 미토콘드리아 질환으로 확진을 받기 이전에, 희귀난치성 질환에 대한 보호자의 인식정도는 '전혀 알지 못한다'가 총 83명중 44명으로 제일 높았고, 미토콘드리아 질환에 대한 보호자의 인식 정도도 '전혀 알지 못한다'가 총 83명중 68명으로 높았다. 자녀가 미토콘드리아 질환으로 확진을 받는 과정에서는 미토콘드리아 질환에 대한 보호자의 인식은 '별로알지 못한다,' '조금 안다'가 모두 높게 나타나, 확진을 받기 이전에 비해 질환에 대한 인식 정도가 높아진 것으로 나타났다. 미토콘드리아 질환 소아 환자의 보호자가 지각하는, 미토콘드리아 질환에 대한 가족들의 '인식' 정도는 대체적으로 평균 수준으로 나타난 반면, 보호자가 지각하는, 미토콘드리아 질환에 대한 가족 이외 주변 사람들의 '인식' 정도는 '전혀 알지 못한다'가 43명으로 가장 높게 선택되었다. 이와 더불어, 보호자의 인식 정도와 가족 이외 주변 사람들의 인식 정도는 대부분이 '별로 일치하지 않는다'로 보고되고 있어, 대부분의 인식이 일치하지 않는다는 의견이 보고되었다. 보호자의 자녀가 미토콘드리아 질환으로 확진 받았을 당시, 보호자가 가장 먼저 경험한 생각이나 감정으로 좌절/절망감, 막막함/무기력감, 당황스러움 등이 높게 보고되었다. 미토콘드리아 질환 진단 및 치료 과정에서 보호자의 감정으로 불안감, 치료 과정에 대한 의지, 가족 구성원으로서의 책임감이 가장 빈번하고 강하게 경험되었던 것으로 나타났고, 그 다음으로는 당황스러움과 막막함/무기력감이 보고되었다. 한편, 미토콘드리아 질환 진단 및 치료 과정에서 환자가 경험한 감정으로는 불안감이 가장 높게 보고되었으며, 치료 과정에 대한 의지, 당황스러움, 부정적인 스트레스가 보고되었다. 결론: 희귀난치성 질환인 미토콘드리아 질환은 질환에 대한 경험 이전에 보호자 및 가족들의 인식이 충분하지 못하고, 특히 가족 이외의 주변 사람들의 인식은 질환에 대한 확진 이후에도 별로 변화되지 못하여, 환자와 가족이 경험하는 정서적인 소외감이나 어려움이 높을 수 있을 것으로 여겨진다. 이와 관련하여, 질환에 대한 확진 이후 환자와 보호자가 경험하게 되는 부정적인 감정들은, 질병 자체에서 비롯되는 어려움과 더불어 질병에 대한 치료적 개입 제공에 어려운 요소로 작용할 수 있으므로 이에 대한 이해와 치료적 계획의 고려가 필요할 것으로 시사된다.

• 정신신체의학
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• 제15권1호
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• pp.29-34
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• 2007

통증은 주관적인 증상이며 이전의 경험에 의해 많이 영향을 받지만, 환자가 없는 증상을 만들어내는 것이 아니라 실재하는 것이다. 객관적인 병리가 뒷받침되는 통증은 쉽게 설명되고 치료할 수 있지만 그렇지 않은 통증은 많은 혼란과 좌절을 초래한다. 통증의 종류는 1) 해부학적인 특징과 객관적인 소견이 있는 경우 2) 해부학적인 특징이 있고 객관적인 소견이 없는 경우 3) 해부학적인 특징이 없고 스트레스, 신체화 증상과 연관된 경우 4) 해부학적인 특징이 없고 신체적인 손상과 연관이 있는 경우로 나눌 수 있다. 만성 통증의 경우 감정적, 신체적 또는 성적인 학대를 당한 병력이 있는 경우가 많다. 심리적으로 신체화 증상은 고통스런 기억을 억압하고 관심을 구하는 과정에서 나타난다. 또한 학대의 병력이 생리학적인 변화를 유발하거나 발달과정 중에서 통증에 대한 감수성을 높이고 유기적인 변화를 일으키는 것으로 생각된다. 스트레스와 연관된 통증의 치료에는 운동, 명상, 인지치료, 약물치료, 바이오피드백 치료 등의 다각적인 방법이 필요하다. 인지치료는 통증에 대한 환자의 인식과 대처방식을 바꿈으로써 통증을 경감시키는 방법으로 스트레스로 인해 발생하는 통증치료에 효과적이다. 약물치료로는 주로 항우울제 계열의 약물이 효과적인데, 항우울제는 기분증상의 호전과 무관하게 통증을 경감시키는 효과를 갖고 있다. 긴장이완 훈련과 병행하는 바이오피드백 치료 역시 통증치료에 효과적일 수 있으며, 그밖에 적절한 운동과 명상요법 같은 방법 역시 통증치료에 도움이 될 수 있다.

• Journal of Preventive Medicine and Public Health
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• 제34권1호
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• pp.1-8
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• 2001

Objectives : To gather information about the factors which influence the interest and intention of admission into charging nursing hones for the elderly(CNH), as these homes represent an important method for resolving the problems related to the rapid population aging occurring in Korea. Methods : A face-to-face interview survey was carried out with 320(men 159, women 165) patients over 60 years old who were admitted at 2 university hospitals and 5 general hospitals in the Busan area between December 1998 and March 1999. Data were analyzed through t-test, ANOVA, correlation and multiple regression analysis. Results : The mean age and years of education of the study population was 67.0 and 7.7 years, and the types of chronic degenerative disease included musculoskeletal disorders(20.1%), cerebrovascular disease(17.1%), and diabetes(14.3%). The major forms of household living arrangement prior to admission were elderly alone(22.6%), and elderly couple(33.5%), while about half of them(55.5%) didn't want to live with their children id the future. Almost half were paying medication fees by themselves(46.6%). The level of actual intention of admission$(3.07{\pm}1.39)$ into a CNH was lower than that of interest$(3.22{\pm}1.33)$(p<0.01). Multiple analysis revealed that the intention of admission increased with decreasing number of future supportive persons$(\beta=-0.107)$, lower level of activity in daily life$(\beta=-0.447)$, and longer years of education$(\beta=-0.447)$ with 32.7% of $R^2$. As for the factors which determined the admission into a CNH, the fee and facilities were considered to be most important, and professional nursing and physician's care were the most desired services. In nomenclature, they preferred 'elderly hospital' or 'elderly health center' to CNH. Conclusions : Interest in CNH is increasing recently, but existing studies about patient experiences in CHN are still limited. This study may form a basis for future examinations of the needs and uses for CNH. Active financial support and public information are considered by the authors to be important factors for the induction of welfare services for the elderly, though CNH.

• 한국호스피스완화의료학회:학술대회논문집
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• 한국호스피스완화의료학회 2004년도 정기총회 및 하계학술대회
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• pp.100-102
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• 2004

Under the current medical system, a terminal patient and his/her family who are neglected inevitably face various aspects of crises including not only physical, but also psychological, social, economic, spiritual and legal problems. Nurses often look after many terminal patents with these types of complicated problems. Therefore, educating the nurses who will take care of such patents would greatly reduce stress so the patents end could their lives in peace and without losing their dignity. This research is a quasi experimental study of nonequivalent control group. A pretest-posttest design where a basic education program is developed for nurses, who frequently treat terminal patents, to understand the importance of the role of hospice and to apply their understandings to treat terminal lancer patents. A sample of the nurses were taken from those who were working in general wards at two general hospitals in Seoul during October, 2003${\sim}$December 2003. The study was composed of 46 experimental group and 43 control group. A basic hospice education program was developed by taking emphasized and overlapping parts from advanced practice hospice nurses education course, short-term education course, an extensive literature survey and by consulting three professionals as well. With the group of 5 professors with vast experiences in oncolgy, 5 nursing administrator, 3 nursing practitioner, the tentative first version of the program was developed and reviewed. Afterwards, by utilizing person to person interviews with 2 head nurses experienced with terminal patients, 1 nurse in charge of hospice, 1 nurse on the contents of the program, and a person to person rating on the educating medium by a nurse were performed. The final version of a basic education program was developed after the second revision. The hospice basic education program consists of introduction to hospice, hospice and commucation, management of pain for terminal cancer patients, physical management for terminal cancer patients, socio-psycological caring of terminal cancer patients and management of death and separation. Total education time was four hours organized into 50 minutes of instruction and 10 minutes of break. $Powerpoint^{(R)}$ software was used as the education medium. As research tools, "Knowledge on Hospice" was developed by the author after receiving a review from one expert. "Attitude of Hospice Nursing" was revised Kim(2001)'s attitude measuring tool which was based on Wang(1998), Kwon(1989), Park and Sung(1991)'s tool. "Liability on nursing terminal patients" was used as developed by Zarits(1980) and Mongomory(1985) translated by Lee(1985). For collecting data, preliminary investigation prior to 1 week of the hospice basic education program and post-investigations after 1 week and 4 weeks of the education were carried out for the nurses at a general ward who understood and agreed on the purpose of the program. Collected data were analyzed throughout t-test, $x^2-test$, Manova test and Bonferroni correction in $SAS^{(R)}$ program. The summary of the investigation is as follows: Hypothesis 1: "Educated experimental group would possess more knowledge on hospice compared to the un-educated control group" was supported after 1 (F=12.14, p=.00) and 4 (F=5.3, p=.02) weeks of education. Hypothesis 2: "Educated experimental group would take a positive attitude toward hospice nursing compared to the un-educated control group" was supported after 1(F=3.92, p=.05) and 4(F=5.05, p=.02) weeks of education. Hypothesis 3: "Educated experimental poop would feel less liability compared to the un-educated control group in nursing terminal cancer patients' was rejected. In this study, it was found that knowledge on hospice was significantly important. By applying hospice basic education programs to nurses, the education program helped nurses to take a positive attitude toward terminal patients. It was, however, seen that the education program had no effect on alleviating liability in nursing terminal patients. Therefore, it is expected that this educational program would help hospices and nurses at general wards to understand the concept and the role of hospice so that terminal patents, now neglected under current medical system, would be able to end their lives in peace.