• Title/Summary/Keyword: quality of nursing

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A Comparative Study on the Quality of Living for Therapeutic Cancer and Hospiece Patients (치료 암환자와 호스피스 환자에 대한 삶의 질 비교)

  • Kim SeungKook;Rhee DongSoo;Rou JaeMan;Kim JongDeok
    • The Journal of Korean Society for Radiation Therapy
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    • v.16 no.1
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    • pp.79-89
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    • 2004
  • This study carried a comparative analysis of quality of living perceived by cancer and hospiece patients who received radiotheraphy, and influential factors in order to provide basic data for nursing goals and establishment of strategy. The subjects of the study were 50 cancer patients who were more than twenty years old and was receiving radiotheraphy in therapeutic radiology department of C university hospital, and fourteen hospiece patients who were in J hospital in Gwangju. They were conveniently sampled according to the selection standard, and researchers personally interviewed them using questionnaire and patient scripts to obtain necessary data. The results were presented as follows: 1. When cancer and hospiece patients were examined demographically, the number of 60 year-old patients were the most. The subjects whose marriage period was more than thirty-one years were the most. In medical expense, more than $70.0\%$ of the patients bore their expenses themselves. 2. When disease-related characteristics of the cancer and pospiece patients were exmained, more than $75\%$ of the patients had experience of being in hospital, and more than $60.0\%$ experienced operation. However, for prevalence period, $57.5\%$ of the cancer patients had less than six months, and $64.3\%$ of the hospiece patients had more than two years. 3. For physical symptoms of cancer patients, $77.5\%$ had fatigue, $60.0\%$ had loss of appetite, and $52.5\%$ had loss of weight while for the hospiece patients, $100\%$ had loss of weight, and $92.9\%$ had fatigue and loss of appetite. For the cancer patients, $0.0\%$ had swelling, and $7.5\%$ had bleeding, For the hospiece patients, $7.1\%$ had change in skin, and $14.3\%$ had diarrhea. 4. Mean score of the cancer subjects were as follows: family support, social support, emotional and spiritual support, physical symptoms, and periods were 3.87, 2.88, 3.10, 2.80, and 2.94 respectively. Those of the hospiece patients were 3.80, 1.96, 1.58, 2.64 and 3.24 respectively. 5. Mean score of family support of both patients were almost identical, but in character, a considerable difference was found: 3.10 and 1.58. In qualify of living, the mean score of hospiece patients was slightly lower.

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Comparative Research on the Health Information Manager(HIM) Duties of One Malaysian Hospital and Similar Scale Korean hospitals (말레이시아 1개 병원과 병상규모가 유사한 한국의 병원 간 보건정보관리자 직무 비교연구)

  • Kim, Hey-Kyung;Lee, Hyun-Ju
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.15 no.10
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    • pp.6158-6167
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    • 2014
  • The aim of this study was to perform comparative analysis of the duties of 7 new roles of HIMs in Malaysian and Korean hospitals of a similar scale. A Malaysian general hospital with a scale of 272 hospital beds was chosen. The researcher visited a Malaysian hospital in person and interviewed the staff in charge over a 2 week period from July 22nd 2013 to August 2nd 2013. For domestic hospitals, 13 general hospitals with 270 hospital beds, similar to the Malaysian general hospital, were chosen. Phone interviews with the department recorded the duty recording work. Regarding 7 new roles of Health Information Manager (HIM), although the role as a Health information manager and Security Officer in Malaysian general hospital was not defined, 30.8% performed their role in Korean general hospitals. The classification of disease & procedure within the role of Clinical data specialist was performed by both countries, and while the tumor registry was done in a Malaysian general hospital, only 15.4% of Korean general hospitals were operating. The statistics of the discharged patients were not measured in the Malaysian general hospital but 76.9% of Korean general hospitals recorded these statistics. Although 22.1% of Korean general hospitals operated registration work of special disease, Malaysian general hospital not only had a total legal contagious disease registration, but also took charge of information registration of hospital births and deceased ones. Other than these, the Patient Information Coordinator, Data Quality Manager, Document and Repository Manager, Research and Decision Support Analyst roles were not done by either country. The new role of HIM is operated in a low percentage in Korean middle and small hospitals. Therefore, to clearly establish the role of HIM in Korea, and have middle and small hospitals to operate such a role, it is essential for the related association to give continuous education and provide support to clarify the role within the hospital working environment. It is desirable to benchmark Malaysian general hospital's registration work on special diseases and others, and expand the work to improve overall.

Evaluation of a Community-Based Cancer Patient Management Program: Collaboration between a Hospice Center and Public Health Centers (병원 호스피스센터-보건소 연계를 통한 지역사회 재가암환자 관리 프로그램 평가)

  • Lee, Hae-Sook;Park, Sun-Hee;Chung, Young-Soon;Lee, Boo-Kyung;Kwon, So-Hi
    • Journal of Hospice and Palliative Care
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    • v.13 no.4
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    • pp.216-224
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    • 2010
  • Purpose: The purpose of this study was to evaluate a community-based cancer patient management program (CBPCMP) which was collaborated between a hospice center and public health centers. Methods: The CBPCMP proceeded on four steps; 1) Signing agreements with three public health centers, 2) Enrolling the domiciliary terminal cancer patients, 3) Providing home hospice service, and 4) Inquiring patient's level of satisfaction. From February 1 to December 31 in 2009, 43 terminal cancer patients were referred and provided with home hospice service. The hospice team made a total of 605 visits. Medical records for each visit and data from satisfaction surveys were analyzed. Results: 76.7% of patients were older than 60 years, and 90.7% of the patients were alert. The level of functional status for 76.7% of patients rated as lower than ECOG grade 1. 62.8% of the patients or their caregivers signed hospice service agreements. On the initial evaluation, the most frequent reasons for referral were general weakness (86.0%), followed by anorexia (72.1%). Nurses visited the patients' most frequently (371 visits), followed by volunteers (216 visits). Nurses provided emotional support and health promotion counseling on 95.1% and 22.9% of visits, respectively. The mean satisfaction score rated by patients and their family was 4.45 out of 5. Conclusion: This study tested CBPCMP in collaboration with hospice centers and public health centers. CBPCMP showed a possibility to improve the quality of end of life care. To insure the quality care, however, the guidelines for home hospice service should be developed.

Trends in Colorectal Cancer Incidence in Daejeon and Chungcheongnam-do, South Korea (2000-2012) (대전광역시와 충청남도의 13년간(2000-2012) 대장암 발생 추세)

  • Kim, Soon-Young;Kweon, In-Sun;Kim, Jung-A;Lee, Tae-Yong;Nam, Hae-Sung
    • Journal of agricultural medicine and community health
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    • v.40 no.3
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    • pp.115-125
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    • 2015
  • Objectives: Colorectal cancer is one of the major cancers in South Korea. We described the time trends in colorectal cancer incidence in Daejeon, a metropolitan city, and Chungcheongnam-do (Chungnam), a rural province, South Korea. Methods: Using the databases from the Daejeon Cancer Registry (DCR) and the Chungnam Cancer Registry (CCR), age-standardized (to world standard population) rates for incidence (ASRW) were calculated. Average annual percent change (AAPC) was assessed as a trend indicator. The completeness (such as the mortality/incidence ratio) and validity (such as the death certificate only %, microscopic verification %, primary site uncertain %, and age unknown %) were analyzed to examine the data quality of DCR and CCR. Results: Incidence of colorectal cancer showed increasing trend in both sexes. Over the years 2000-2012 in Daejeon, ASRW was increased significantly from 37.2 to 51.7 per 100,000 person-years (AAPC, 3.9%) among men and from 17.1 to 28.4 (AAPC, 3.9%) among women, respectively. In Chungnam, ASRW was also increased from 29.8 to 50.1 per 100,000 person-years (AAPC, 5.1%) among men and from 15.9 to 26.6 (AAPC, 3.2%) among women, respectively. The AAPC for colon cancer was greater than rectal cancer in both Daejeon and Chungnam. The trend of rectal cancer incidence was differ by sex (AAPC in men vs women, 2.7% vs 1.7% in Daejeon; 3.5% vs 0.8% in Chungnam). Indices of completeness and validity showed that the quality control of DCR and CCR was adequate to describe the trends of ASRW. Conclusions: Both Daejeon and Chungnam have had a rapid increase in colorectal cancer incidence. Monitoring and intervention are required on the risk factors which may contribute to this trend.

Factors Related to Waiting and Staying Time for Patient Care in Emergency Care Center (응급의료센터 내원환자 진료시 소요시간과 관련된 요인)

  • Han, Nam Sook;Park, Jae Yong;Lee, Sam Beom;Do, Byung Soo;Kim, Seok Beom
    • Quality Improvement in Health Care
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    • v.7 no.2
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    • pp.138-155
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    • 2000
  • Background: Factors related to waiting and staying time for patient care in emergency care center (ECC) were examined during 1 month from Apr. 1 to Apr. 30, 1997 at an ECC of Yeungnam university hospital in Taegu metropolitan city, to obtain the baseline data on the strategy of effective management of emergency patients. Method: The study subjects consisted of the 1,742 patients who visited at ECC and the data were obtained from the medical records of ECC and direct surveys. Results: The mean interval between ECC admission time and initial care time by each ECC duty residents was 83.1 minutes for male patients and 84.9 minutes for female patients, and mean ECC staying time (time interval between admission and final disposition from ECC) was 718.0 minutes in men and 670.5 minutes in women. As the results, the mean staying time in ECC was higher in older age, and especially the both of initial care time and staying time were highest in patients of medical aid, and shortest in patients of worker's accident compensation insurance. The on admission or not, previously endotracheal-intubation state of patient. The ECC staying ti initial care time was much more delayed in patients of not having previous medical records and the ECC staying time was higher in referred patients from out-patient department, in transferred patients from the other hospitals and patients having previous records, and in patients partly used the order-communicating system. The factors associated with the initial care time were the numbers of ECC patients and the existence of any true emergent patients, being cardiopulmonary resuscitation (CPR) statusme was much more longer in patients of drug intoxication, in CPR patients, in medical department patients, in transfused patients and in patients related to 3 or more departments. And according to the numbers of duty internships, the ECC staying time for four internships was more longer than for five internships and after admission ordering was done, also-more longer in status being of no available beds. As above mentioned results, the factors for the ECC staying time were thought to be statistically significant (P<0.01) according to the patient's age and the laboratory orders and the X-ray films checked. And also the factor for the ECC staying time were thought to be statistically significant (P<0.01) according to the status being of no available beds, the laboratory orders and/or the special laboratory orders, the X-ray films checked, final disposing department, transferred to other hospital or not, home medication or not, admission or not, the grades of beds, the year grades of residents, the causes of ECC visit, the being CPR status on admission or not, the surgical operation or not, being known personells in our hospital. Conclution: Authors concluded that the relieving method of long-staying time in ECC was being establishing the legally proved apparatus which could differentiate the true emergency or non-emergency patients, and that the methods of shortening ECC staying time were doing definitely necessary laboratory orders and managing beds more flexibly to admit for ECC patients and finally this methods were thought to be a method of unloading for ECC personnels and improving the quality of care in emergency patients.

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Development of Benthic Macroinvertebrates Index (BMI) for Biological Assessment on Stream Environment (하천환경의 생물학적 평가를 위한 저서동물지수(BMI)의 개발)

  • Kong, Dongsoo;Son, Se-Hwan;Hwang, Soon-Jin;Won, Doo Hee;Kim, Myoung Chul;Park, Jung Ho;Jeon, Te Su;Lee, Jong Eun;Kim, Jong Hyun;Kim, Jong Sun;Park, Jaeheung;Kwak, Inn Sil;Ham, Sun Ah;Jun, Yung-Chul;Park, Young-Seuk;Lee, Jae-Kwan;Lee, Su-Woong;Park, Chang-Hee;Moon, Jeong-Suk;Kim, Jin-Young;Park, Hae Kyung;Park, Sun Jin;Kwon, Yongju;Kim, Piljae;Kim, Ah Reum
    • Journal of Korean Society on Water Environment
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    • v.34 no.2
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    • pp.183-201
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    • 2018
  • The tolerance of Korean benthic macroinvertebrates to organic pollution has been analyzed since the early 1990s. However, considering the fact that there have been related studies carried out in some European countries since the early 20th century, the history of the research in Korea is very short and there is still much knowledge to supplement. We revised the saprobic valency, the saprobic value and the indicator weight value of 190 benthic macroinvertebrates taxa through the data of water quality and individual abundance collected from 7,086 sampling units in Korea from 2008 to 2014. The individual abundance of Uracanthella (Ephemeroptera) as a representative, one of the most common and abundant taxa in Korea, showed a typical lognormal distribution to 5-day biochemical oxygen demand (BOD5) concentration, and a normal distribution to the class interval of BOD5 concentration according to saprobic series. The value combining the mean individual abundance and the relative frequency of occurrence was a more efficient indicator value than that of each property alone. Benthic Macroinertebrates Index (BMI) was newly proposed as a modification of the saprobic index of Zelinka and Marvan (1961). BMI showed extremely significant correlation (determination coefficient $r^2$ > 0.6, n = 569 sites) with the concentration of BOD5, and the coefficient was a little higher than those of the previous indices. Until now, there has been very little research on the assessment of biological integrity of benthic macroinvertebrates community in Korea. While continuing researches into improve the reliability of BMI, it is necessary to develop multimetric indices for evaluating the integrity, including the composition of species and functional guilds, and the richness and diversity of the community.

Practice Rate of Breast Self- examination and Its Related Factors among Women in a Rural Area (일부 농촌지역 여성의 유방자가검진 실천율과 관련요인)

  • Lee, Eun-Il;Kang, Pock-Soo;Yun, Sung-Ho;Kim, Seok-Beom;Lee, Kyeong-Soo
    • Journal of agricultural medicine and community health
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    • v.26 no.2
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    • pp.147-159
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    • 2001
  • A questionnaire survey of 568 women over the age of 30 in 11 dongs of Goryeong- gun was performed to identify the practice rate of breast self- examination and its related factors. It was found that the practice rate of breast self- examination was 28.2%, with 9.7% of those surveyed performing breast self- examinations more than once a month. The practice rate of breast self- examination showed significant differences according to factors, such as age, presence of spouse, educational level, occupation, economic status, smoking, regular exercise and chronic disease. According to age, the highest practice rate of breast self-examination was between the ages of 40-49 and the lowest over the age of 60. The practice rate increased with higher the educational level and presence of spouse. According to occupation, administrative and managerial occupations presented the highest practice rate of breast self- examination. Higher economic status, regular exercise and positive family history of breast cancer each presented high practice rates of breast self- examination. The practice rate revealed higher in those who did not smoke and who had no chronic diseases than others. The greatest reason for performing breast self- examination was decided by myself for health reasons, followed by effect of mass media and promotion by health center. The most common reasons for not performing breast self- examination were don't feel the need, followed by don't know how to perform the exam and don't know about the exam itself. Multiple logistic regression analysis showed that factors, such as over the age of 60, less education, and no experience with mammography all lowered the practice rate of self-breast examination. Inconclusion, the rates of breast self- examination and regular check-ups of people in rural areas, who are characteristically older and have low educational backgrounds, were 28.2% and 9.7%. These results show the immediate need for the education of the methods for breast self- examination to be carried out by health centers in these areas. Such efforts and programs could increase the practice rate of breast self- examination and thereby improve health and enhance the quality of life of women in rural areas.

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An Analysis on the Knowledge Levels, Attitudes, and Factors Affecting the Choices of Those Who Completed the Education of Persons Conducting Clinical Trial Workers (의약품 임상시험 종사자 교육 이수자의 지식 수준, 태도, 교육 선택 요인 분석)

  • Lee, Yoon Jin;Jang, Hye Yun;Lee, Yu-Mi
    • The Journal of KAIRB
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    • v.3 no.2
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    • pp.19-27
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    • 2021
  • Purpose: This study aimed to analyze the knowledge levels, attitudes, and factors affecting the choices on the education of the participants who completed their education of persons conducting clinical trial workers, and to assess the problems of the current education system for clinical trial workers, leading to improvements. Methods: Clinical trial workers (including principal investigators/subinvestigators, members of the Institutional Review Board [IRB], clinical research coordinators) who were affiliated to one of the 4 university hospitals running their own clinical trial center and IRB in Daegu and completed their education of persons conducting clinical trial workers were the subjects of this study. One hundred seven online questionnaires were answered from 2021-04-02 to 2021-04-17. Descriptive statistics and Pearson correlation analysis were used to analyze the acquired data. Independent t-test and 1-way analysis of variance were used to analyze the differences in the knowledge levels and attitudes following the characteristics of the education participants. Results: The baseline characteristics of the 107 participants were as follows: the majority of the participants were female (72.0%), were in their 30s (36.4%), had a nursing major (29.0%), were clinical research coordinators (63.6%), had never experienced a principal investigator (79.4%), had participated 3 or more educations (58.9%), had completed their maintenance course (55.1%), had 5 or more years of clinical trial experiences (34.6%). The fields on which participants had low levels of objective knowledge were "types and preparations on audits of clinical trials," "regulations on clinical trials (Pharmaceutical Affairs Act, Korea Good Clinical Practice)." The difficulties that the participants faced were on "annual educations" and "lack of information regarding the educations." Factors that showed significant differences in objective knowledge were sex (p=0.02), number of educations (p=0.004), the curriculum of 2020 (p=0.001). Age (p=0.004), having experienced a principal investigator (p=0.006), number of educations (p<0.001), the curriculum of 2020 (p<0.001), clinical trial career (p=0.001) were factors that significantly affected subjective knowledge. Attitudes toward the education were positively correlated with objective knowledge (r=0.20, p=0.04) and subjective knowledge (r=0.32, p=0.001). Major sources through which information on educations was acquired were "institutional notices," and major factors affecting the choices on the education were "when the education took place" and "where the education took place." "Within the affiliated institution," "Online classes (recorded)" and "IRB and review processes" were each the most preferred place, mode, and content of the education. Conclusion: Knowledge levels varied largely among participants who completed their education of persons conducting clinical trial workers, depending on their characteristics such as the number of educations. Participants also complained about their lack of information on educations. The quality of education may be improved if clinical trial organizations are designated as education facilities. Education programs must be developed considering the knowledge level and demand of the participants. Furthermore, as offline classes may be impossible due to pandemics such as the coronavirus disease 2019, the development of diverse and sophisticated online classes is looked forward to.

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A Study on the School Health Education Programs Performed by School Nurses in Seoul Area (서울 시내 일부 국민학교에서 양호교사가 실시하고 있는 보건교육의 실태조사. (교실 수업을 중심으로))

  • 방에스터
    • Korean Journal of Health Education and Promotion
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    • v.5 no.2
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    • pp.26-40
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    • 1988
  • This survey was conducted to find out the present status of health education program being provided in primary schools focusing its planning, operation, contents and attitude of school nurses in September, 1988. Total 413 school nurses who are presently working in Seoul city was surveyed by mail and 167 school nurses who responded to the questionnaire were finally ana lysed. The following results were obtained. 1. The general charcteristics of the school nurses′ surveyed. As for age distribution, 30-40 age group was 60.4% the highest and the mean age was 30. 13. As for educational attainment, junior nursing college was 71.9%. 68.3% of the surveyed was married and 43.1% of them has 5-10 years of working experiences. As for schools where school nurses are presently working, 31.7% has 2,000-3,000 students, 22.8% has 50-60 classes and 5 schools have more than 80 classes. 2. Planning of a school health education School health education was planned every semester in 55.7%, which was the highest. As for utilization status of the materials for planning of a school health education as a referance, 86.8% of the total respondants utilized the guidelines published by Seoul city School nurses′ Association, and the administrative guidelines for school health, textbooks, school health statistics and articles related to school health in order. It was tried whether the number of referances being utilized was related to the working experiences. It was found that the shorter the experiances, the more materials were utilized. It was answered that teaching plan for health education was prepared by school-nurses themselves (95.2%), and was differentiated as three levels as the first and second grades, the third and fourth grades, and the fifth and sixth grades 3. The contents of the school health education 16 subjects offered to 6 grades of students were surveyed as follows. As for fifth and sixth grades, contents on growth and development was most widely provided as 54.5%, and 68.9%, respectively. And the next to this subject, dental health education was also frequently offered to the second, third and fourth grades as 50.9%, 68.9%, and 47.3%, respctively. 4. The operation of school health education Health education provided by school nurses was conducted formallu in 36.6%, and formally of informally accordin to grades in 43.9%. It was answered that 50.3% of the surveyed school had started health education from 1987, when the plan for activation of school health was ordered from. Educational Committee. Teaching hours of school nurses was 6 in 32.9%, which was the highest. The lesson was provided for class unit in 77.2%, and sex education was sometimes offered to male and female students separately. As for support of health personnels out of school for health education, 79.0% did not receive any support. If there were any aids out of school, 62.9% received them from other related agencies and 74.3% anwered that it was once in a semester. As for expenses for health education, 57.3% did not input any expenses alloted to school health program as a whole. As audio-visual materials, slides were utulized most frequently and models, and charts in order. 5. Awareness of school nurses on the operation of school health education School nurses evaluated their educational quality as a health educator subjectively, 60-70% of them answered to be average in 4 domains such as knowledge, educational skill, ability to prepare teaching plan, and cooperation. As for the awareness on the support and cooperation of the higher institutions, 46.4% -61.8% answered that "so and so" toward Ministry of Education and Ministry of Affairs, and 13-37% "not supportive" Teachers of the corresponding schools were answered to be "so and so" in 55.9%-56.7%, and "very supportive" in 33.34%. There was a significant difference in formality of the lesson according to the support of the superintendent.

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소설과 말기 암환자를 통해 본 한국인의 죽음의 의미

  • Jeon, Hye-Won;Kim, Bun-Han
    • Korean Journal of Hospice Care
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    • v.3 no.2
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    • pp.34-54
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    • 2003
  • Every one experiences death one day, however no one can knows exactly what it is because people can not experience death until it comes, it is therefore impossible to judge correctly on the phenomenon of the death. On the whole, man experiences indirect death through the mass communications such as TV drama, fiction, magazine etc because those methods can easily access by every one. In addition to this, people usually acquire the negative awareness of death through the dramatic change of story like dying of cancer for dramatic effect by giving scare and fear to the cancers. The purpose of this study is to provide basic information on the spiritual care that enables the facing death patients to accept death as a part of life and divert hope from scare about after death by comparing and analyzing of two aspects of death meaning I.e, Korean fiction and the end stage cancer patients. Additionally, for medical staff to understand the facing death cancer patients by making to aware patients correctly and provide the better quality of care. The study was performed from September 28, 2002 to February, 28 2003. The materials of this study were collected by direct data obtained from observation, interviews, note and diary of end stage of cancer patients and written materials acquired from Korean contemporary fiction. Participants of this study were 4 end stage cancer patients including 2 lung cancer patients, 1 liver cancer patient and 1 esophagus cancer patient. The methodology used in this study was divided into two types; Huberman & Miles methodology was used for fiction to find and categorize subject, and Colaizzi, one of phenomenological methodology was used for end stage cancer patients to find the major meaning, subject and categorization. 1.The death investigated in the fiction, was found as a progress of negative emotion, acceptance and sublimation, life related subjects in the negative emotion were tenacity for life, anxiety, lingering attachment, responsibility, abandonment and death related subjects were shock, isolation, fear, scare and rejection. Acceptance related subjects were acceptance, destiny, secularism, preparation and arrangement, and sublimation related subjects were sublimation through Christian and Buddhism. 2.The death showed in the participants was negative emotion, acceptance and sublimation, life related subjects were repentance, anxiety, responsibility and hopelessness, and death related subjects were dejection, solitude, anger, fear and scare. The acceptance was a type of religious acceptance that admitted instantly by reaching an understanding with the God, and death was accepted as a progress of preparation, arrangement, acceptance and hope. Sublimation related subjects were Christian sublimation and relief or destiny incurred from self-reflective sublimation through communications and thoughts. 3.The death in view of fiction and participants were positively accepted both death and negative emotion, and the study disclosed the fact that death was sublimated dependent on religion. 4.The progress of negative emotion, acceptance and sublimation was disclosed more complicated and various in the real end stage cancer patients and acceptance only found in the patients on the form of religious acceptance, according to the results compared with fiction and real end stage cancer patients. The death showed in the fiction was standardized, gradated and similar progress with psychological status of Kubler-Ross. However, death in the participants was showed complex and various feelings simultaneously, and sometimes they accepted death positively. The sublimation through religion was found in Buddhism and Christian in the fiction and mostly Christian in the participants due to a number of Hospice patients. It was found that negative emotion various types of death was more found in the participants than fiction. It is therefore necessary to study on the response of death in various types. In the participants death was incurred more systematic and variously, we knew that nursing practice focused on experience of participants is required and reality on death is much profound than we analyzed and presented, lots of situations and reactions should be premised because we can not completely rule out the negligence possibility of care mediation of participants. In caring for the facing death patients, we discovered and confirmed again through this study that the spiritual care should be needed as a mediation method.

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