• 대한간호학회지
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• 제2권1호
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• pp.3-33
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• 1971

Nursing of today has as one of its objectives the solving of problems related to human needs arising from the demands of a rapidly changing society. This nursing objective, I believe, can he attained by the appropriate application of scientific principles in the giving of comprehensive nursing care. Comprehensive nursing care may be defined as nursing care which meets all of the patient's needs. the needs of patients are said to fall into five broad categories: physical needs, psychological needs, environmental needs, socio-economic needs, and teaching needs. Most people who become ill have adjustment problems related to their new situation. Because patient teaching is one of the most important functions of professional nursing, the success of this teaching may be used as a gauge for evaluating comprehensive nursing care. This represents a challenge foe the future. A questionnaire consisting of 67 items was distributed to 200 professional nurses working ill direct patient care at Yonsei University Medical Center in Seoul, Korea. 160 (80,0%) nurses of the total sample returned completed questionnaires 81 (50.6%) nurses were graduates of 3 fear diploma courser 79 (49.4%) nurses were graduates of 4 year collegiate nursing schools in Korea 141 (88,1%) nurses had under 5 years of clinical experience in a medical center, while 19 (11.9%) nurses had more than 5years of clinical experience. Three hypotheses were tested: 1. “Nurses had high levels of concept and knowledge toward patient teaching”-This was demonstrated by the use of a statistical method, the mean average. 2. “Nurses graduating from collegiate programs and diploma school programs of nursing show differences in concepts and knowledge toward patient teaching”-This was demonstrated by a statistical method, the mean average, although the results showed little difference between the two groups. 3. “Nurses having different amounts of clinical experience showed differences in concepts and knowledge toward patient teaching”-This was demonstrated by the use of a statistical method, the mean average. 2. “Nurses graduating from collegiate programs and diploma school programs of nursing show differences in concepts and knowledge toward patient teaching”-This was demonstrated by a statistical method, the mean average, although the results showed little difference between the two groups. 3. “Nurses having different amounts of clinical experience showed differences in concepts and knowledge toward patient teaching”-This was demonstrated by the use of the T-test. Conclusions of this study are as follow: Before attempting the explanation, of the results, the questionnaire will he explained. The questionnaire contained 67 questions divided into 9 sections. These sections were: concept, content, time, prior preparation, method, purpose, condition, evaluation, and recommendations for patient teaching. 1. The nurse's concept of patient teaching: Most of the nurses had high levels of concepts and knowledge toward patient teaching. Though nursing service was task-centered at the turn of the century, the emphasis today is put on patient-centered nursing. But we find some of the nurses (39.4%) still are task-centered. After, patient teaching, only a few of the nurses (14.4%) checked this as “normal teaching.”It seems therefore that patient teaching is often done unconsciously. Accordingly it would he desirable to have correct concepts and knowledge of teaching taught in schools of nursing. 2. Contents of patient teaching: Most nurses (97.5%) had good information about content of patient teaching. They teach their patients during admission about their diseases, tests, treatments, and before discharge give nurses instruction about simple nursing care, personal hygiene, special diets, rest and sleep, elimination etc. 3. Time of patient teaching: Teaching can be accomplished even if there is no time set aside specifically for it. -a large part of the nurse's teaching can be done while she is giving nursing care. If she believes she has to wait for time free from other activities, she may miss many teaching opportunities. But generally proper time for patient teaching is in the midmorning or midafternoon since one and a half or two hours required. Nurses meet their patients in all stages of health: often tile patient is in a condition in which learning is impossible-pain, mental confusion, debilitation, loss of sensory perception, fear and anxiety-any of these conditions may preclude the possibility of successful teaching. 4. Prior preparation for patient teaching: The teaching aids, nurses use are charts (53.1%), periodicals (23.8%), and books (7.0%) Some of the respondents (28.1%) reported that they had had good preparation for the teaching which they were doing, others (27.5%) reported adequate preparation, and others (43.8%) reported that their preparation for teaching was inadequate. If nurses have advance preparation for normal teaching and are aware of their objectives in teaching patients, they can do effective teaching. 5. Method of patient teaching: The methods of individual patient teaching, the nurses in this study used, were conversation (55.6%) and individual discussion (19.2%) . And the methods of group patient teaching they used were demonstration (42.3%) and lecture (26.2%) They should also he prepared to use pamphlet and simple audio-visual aids for their teaching. 6. Purposes of patient teaching: The purposes of patient teaching is to help the patient recover completely, but the majority of the respondents (40.6%) don't know this. So it is necessary for them to understand correctly the purpose of patient teaching and nursing care. 7. Condition of patient teaching: The majority of respondents (75.0%) reported there were some troubles in teaching uncooperative patients. It would seem that the nurse's leaching would be improved if, in her preparation, she was given a better understanding of the patient and communication skills. The majority of respondents in the total group, felt teaching is their responsibility and they should teach their patient's family as well as the patient. The place for teaching is most often at the patient's bedside (95.6%) but the conference room (3.1%) is also used. It is important that privacy be provided in learning situations with involve personal matters. 8. Evaluation of patient teaching: The majority of respondents (76.3%,) felt leaching is a highly systematic and organized function requiring special preparation in a college or university, they have the idea that teaching is a continuous and ever-present activity of all people throughout their lives. The suggestion mentioned the most frequently for improving preparation was a course in patient teaching included in the basic nursing program. 9. Recommendations: 1) It is recommended, that in clinical nursing, patient teaching be emphasized. 2) It is recommended, that insertive education the concepts and purposes of patient teaching he renewed for all nurses. In addition to this new knowledge, methods and materials which can be applied to patient teaching should be given also. 3) It is recommended, in group patient teaching, we try to embark on team teaching.

• 한국유통학회지:유통연구
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• 제17권1호
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• pp.87-115
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• 2012

제휴 로열티 프로그램(coalition loyalty program; 이하 CLP라고 한다)이란 하나의 로열티 프로그램 안에 다수의 제휴 기업들이 참여하며, 이들과 독립된 (로열티 프로그램 운영)기업이 관리하는 로열티 프로그램으로 정의된다(Blattberg 등 2008). 본 연구의 목적은 고객의 브랜드에 대한 사전 선호 수준에 따라, CLP가 고객 충성도를 증가시키는 원인과 제휴 네트워크 안의 주체 간 인식의 전이에 차이가 있을 것임을 밝히는 데에 있다. 고객 충성도의 동기는 전환장벽(switching barrier) 관점(Balabanis 등 2006; Colgate와 Lang 2001; Jones 등 2000)에 따라 자발적인 이유(브랜드 매력도)와 비자발적 이유 (브랜드 전환비용)로 설명하였다. CLP안에서 브랜드(비선호)-CLP-브랜드(선호)간 전이효과(spillover effect)는 인지적 일관성(Aaker과 Keller 1990; Hamilton 등 1989)과 정보 통합 이론(Anderson 1981; Simon과 Ruth 1998)을 적용하였다. 연구 결과는 다음 세 가지로 학문적 실무적 의의를 갖는다. 첫째, 브랜드에 대한 사전 태도에 따라 정보처리 경향이 달라진다는 소비자 행동 연구의 견해를 CLP 제휴 상황에서 검증하였다. 고객은 브랜드 선호가 높을수록 자발적 동기를 강화하고, 반대의 경우 비자발적 동기를 강화한다. 둘째, 브랜드에 대한 사전 태도가 해당 브랜드와 연관된 주체 간 인식 전이에 긍정적 조절효과를 함을 검증하였다. 즉 선호 브랜드와 어떤 주체가 연관될 때(비선호 브랜드와 연관된 경우에 비해) 인식의 전이가 더 많이 발생한다. 셋째, 기업이 CLP가입에 대한 전략적 선택을 할 때 마케팅 목적에 따라 고려해야할 사항이 달라진다. 기업의 목적이 충성고객의 유지라면, 로열티 프로그램 자체의 보상 방식과 활용 방식 등이 고려되어야한다. 하지만 목적이 비충성고객의 확보라면, 유명 브랜드의 제휴 여부를 따져야 한다. 또한 기업은 CLP의 효과(브랜드 충성도)에 안주할 것이 아니라 그 원인을 알아야 하는데, 비선호 브랜드처럼 비자발적 동기 강화에 따른 충성도 증가는 장기적으로 바람직하지 못하다는 견해가 있다(Egans 2001).

• 헤리티지:역사와 과학
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• 제49권2호
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• pp.4-19
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• 2016

이순신(李舜臣)이 임진왜란 중 조정에 보고한 장계(狀啓)가 그 당시와 후대의 등록(謄錄) 형식에 따라 3자에 의해 등서되어 현재 장초(狀草), 계초(啓草), 계본(啓本) 등으로 전한다. 특히 전라좌수영의 수군절도사로 재직할 때 작성된 "임진장초(壬辰狀草)"는 대표적인 장계로 많이 알려졌다. 최근에 분실되었다가 소재가 확인된 "충민공계초"는 "임진장초"와 함께 후대의 이순신 장계류에 전범이 될 만큼 사료적인 가치가 매우 높은 국보급 유물이다. 그러나 이 책이 이순신 관련한 새로운 책인지 아니면 기존에 분실되었던 장계별책인지 불분명한 상태이다. 이에 본고에서는 이에 대한 서지적인 고찰을 통해 관련 내용을 고증하였다. "충민(忠愍)"은 이순신이 사후에 사용했던 명칭이었고, 1662년에 장계가 등서되어 "충민공계초"가 완성되었다. 여기에는 "임진장초"에 없는 12편이 더 들어있는데, 그간 분실된 것으로 알려진 장계별책에도 "임진장초"에 없는 12편이 더 들어 있었다는 점이 서로 일치하는 점이다. 특히 1928년 일본인들이 촬영한 사진 11장의 형태와 내용이 "충민공계초"에 들어있는 12편과 완전 일치한다. 조선사편수회에서 이 책을 "별도로 초사(抄寫)한 계초(啓草) 1책"이라고 한 점, 이 책의 12편으로 장계를 보충한 점, 홍기문과 이은상이 장계초본에 기존 "임진장초"에 없는 12편이 더 들어있다고 한 점, 조성도가 12편을 따로 별책본으로 분류한 점 등은 12편이 들어있는 장계별책을 "충민공계초"라고 할 수 있는 근거가 되어준다. "충무공계초"는 편수가 총 62편이므로 12편이 더 들어있는 분실된 장계별책으로 보긴 어려울 것이다. "충무공유사"의 "충무공계본"은 모두 16편이다. 본문에는 이두문이 그대로 실려 있고, 뒤의 3편은 "충민공계초"원문과 동일하다. 지금까지 이두문이 그대로 실린 것은 1935년에 간행된 조선사편수회의 "임진장초"가 유일했는데, "충무공계본"의 간행된 시기가 오히려 이를 앞서는 것으로 추정된다. "충민공계초"가 장계별책이라는 것에 대한 반론은 이은상이 "장계등본 별책의 일기 1장"이라고 한 말에 근거한다. 1953년 설의식이 "이순신수록 난중일기초"에 "무술일기" 초고 사진 1장을 도판으로 처음 소개하였다. 이은상도 "무술일기"에 장계초본 별책 속의 친필 일기초 2면을 첨가했고, 다시 "장계 등본 별책 끝에 최후 10일 동안의 일기 한 장"과 "별책부록"이라는 말을 사용하였다. 이 의견은 설의식이 정확한 출처를 모르고 소개한 "무술일기" 초고 사진 1장"에서 비롯한 것이다. 이은상은 "충무공유사"를 장계관련 책으로 잘못 파악하고 "장계등본 별책의 일기 1장"이란 말을 하였다. 이는 실제 원본상황과 다른 잘못된 견해이므로, 굳이 이를 정정한다면 "충무공유사의 일기 1장"이라고 해야 한다. 따라서 일기 1장이 딸린 장계별책은 존재하지 않는 것이므로 반박의 근거가 잘못된 것이다. 요컨대 "임진장초" 이외의 모든 장계들을 장계별책이라 할 수 있겠지만, 지금까지 통상 지칭되었던 장계별책에 유독 12편이 더 실려 있다고 한다. 이 점이 다른 장계류와 차별화된 점이다. 그러므로 여러 장계이본 중에서 유일하게 12편이 더 수록된 "충민공계초"가 기존에 알려진 장계별책이라는 견해에 더 무게가 실릴 것이다.

• 마케팅과학연구
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• 제20권1호
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• pp.59-69
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• 2010

绿色环保或者环境意识已经成为商业、政府机关, 以及消费者和世界关注的重要问题. 针对这一情况, 韩国政府宣布, 在本世纪初, "环保建设" 将被作为一种用以鼓励与环保相关的商业活动的方式. 不同层次的韩国服装业, 提出了不同的产品环保的绿色计划. 这些服装产品包括有机产品和回收的衣服. 要想使这些公司成功, 他们需要那些, 在做产品购买,使用, 处置时, 将绿色问题(如环境的可持续性发展)作为一个人判断的一个组成部分的顾客的信息. 这些消费者可以被看成是生态学的关注者. 过去的研究已经对消费者对于环保产品的购买意愿进行了检测. 此外, 还研究了影响生态保护者或绿色消费者的因素. 但是, 只是关注生态保护者在处置或者回收利用衣服上与采购绿色产品相比较是不够的. 服装处置行为有多种途径, 消费者可以用淘汰, 传承(例如: 把它送给一个年幼的弟弟), 赠与, 交换, 出售或者简单的把他扔掉等多种方式来暂时或者永久的摆脱闲置的衣服或贷款项目. 因此, 购买环保产品的行为应该结合服装处置的行为, 从而进一步了解消费者的消费行为与对环境的态度. 本项研究的目的在于提供韩国生态保护者从有利于生态学的角度出发来购买和处理衣服的生活方式的相关信息. 本研究的目标有: 1, 基于韩国对服装处置行为进行分类; 2, 调查人 们人口统计数据, 生活方式和服装消费价值观赏的差异; 3, 在环保的时尚物品的购买意愿和影响因素之间进行比较. 自填式的调查问卷是基于以往的研究设置出来的. 问卷包括10项处置衣服的条款, 22项可持续并且健康的生活方式的条款, 以及19项消费观念的条款. 根据利克特模板的五分量表设置. 此外, 购买两个时尚物品的意愿和每个物品属性的11项特征都是根据利克特模板的七分量表而来, 两种制成羊毛套衫的可以从PET识别代码的回收瓶子中创造出来的涤纶织物这两种套衫选自一个韩国和一个美国的户外运动服装的品牌. 我们对每一种产品的简介和颜色都进行了调查, 人口统计学(即性别, 年龄, 婚姻状况, 教育程度, 收入, 职业)也被包括在内. 在2009年5月份, 研究数据通过一个专业网站的调查机构进行采集, 最后有600份调查问卷可供分析, 这个调查的受访者年龄从20到49岁不等, 平均年龄为34岁. 百分之50的调查者为男性, 大约58%的受访者是已婚者, 其中62%的受访者有大学学位. 主要成分分析和因素最大方法差的方法用以识别衣服处理规模的潜在尺度. 共有三个因素生成(比如: 倒卖行为, 捐赠行为, 不回收利用行为). 基于他们处置衣服的方式对受访者进行了分类, 群类分析被使用, 最终得到了三个部分. 不同的消费者, 被分别贴上 "转售集团", "捐资团体" 以及 "不回收组织" 的标签加以分类, 其中98%是正确的分类. 从人口统计学角度来看, 这三个类别的人在性别, 婚姻状况, 职业和年龄上有显著的差异. 健康可持续的生活方式被缩减为以下5个因素: 自我满意度, 家庭定位, 健康问题, 环境问题和自愿的服务. 这是三个群体中健康可持续的生活方式的最显著的差异. 转售集团和捐赠组表现出在健康可持续的生活方式上的相同倾向, 同时, 不回收集团在生活方式方面呈现最低的平均值. 转售和捐赠团体自称享受和满意这种生活和消费方式, 并且能够利用空余的时间陪伴家人. 另外, 这两组的人关心健康和有机食品, 并试图保护能源和资源. 对服装消费的价值观产生主要影响的三个因素是: 个人价值, 社会价值和实用价值. 因素的方差测试表明转售集团和其他两组之间的因素差异最大. 转售集团相比其他价值更关注个人价值和社会价值. 相比之下, 非回收集团比捐赠集团更关注高层次的社会价值. 比较购买环保产品的意愿上, 转售集团表现出最高的购买A类产品的意愿. 另一方面, 捐赠集团则在小市场中表现出购买B类产品的最高意愿. 此外, 平均分数表明, 购买韩国的产品(B类产品)相比购买美国的产品(A类产品)更合韩国人的心意. 多元线性回归分析法确定了对环保产品的购买的意愿对制造业产品属性的影响. 产品的设计, 价格, 贡献, 对环境的保护, 价格, 兼容性是影响转售集团的显著因素, 另外, 以及对自身形象的影响是捐赠团体的重要因素. 对于非回收集团来说, 设计, 价格等因素是相同的, 自我的形象,对环保运动的贡献, 和环境保护也是很重要的. 而价格因素具有显著性的共通性. 对于B类产品来说, 设计, 合理的价格, 形象等因素是同等的重要, 但是不同的组对购买的特征和意愿有不同的倾向. 健康可持续的生活方式以及服装消费的意向对购买A类产品和B类产品的影响同样被我们所关注. 实际操作者的健康状况和个人价值都是影响购买意愿的重要因素; 然而, 在这三个群体中说服的力度都很低. 结果表明, 分类出来的每组处理服装的行为, 显示着不同服装产品的属性, 个人价值, 和实践者的特点, 这些都影响了他们的购买环保产品的意愿, 结果会使生态保护者提出并组织更合理的生态设计的战略决策.

• 항공우주정책ㆍ법학회지
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• 제9권
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• pp.85-143
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• 1997

The main purpose of the investigation of an accident caused by aircraft is to be prevented the sudden and casual accidents caused by wilful misconduct and fault from pilots, air traffic controllers, hijack, trouble of engine and machinery of aircraft, turbulence during the bad weather, collision between birds and aircraft, near miss flight by aircrafts etc. It is not the purpose of this activity to apportion blame or liability for offender of aircraft accidents. Accidents to aircraft, especially those involving the general public and their property, are a matter of great concern to the aviation community. The system of international regulation exists to improve safety and minimize, as far as possible, the risk of accidents but when they do occur there is a web of systems and procedures to investigate and respond to them. I would like to trace the general line of regulation from an international source in the Chicago Convention of 1944. Article 26 of the Convention lays down the basic principle for the investigation of the aircraft accident. Where there has been an accident to an aircraft of a contracting state which occurs in the territory of another contracting state and which involves death or serious injury or indicates serious technical defect in the aircraft or air navigation facilities, the state in which the accident occurs must institute an inquiry into the circumstances of the accident. That inquiry will be in accordance, in so far as its law permits, with the procedure which may be recommended from time to time by the International Civil Aviation Organization ICAO). There are very general provisions but they state two essential principles: first, in certain circumstances there must be an investigation, and second, who is to be responsible for undertaking that investigation. The latter is an important point to establish otherwise there could be at least two states claiming jurisdiction on the inquiry. The Chicago Convention also provides that the state where the aircraft is registered is to be given the opportunity to appoint observers to be present at the inquiry and the state holding the inquiry must communicate the report and findings in the matter to that other state. It is worth noting that the Chicago Convention (Article 25) also makes provision for assisting aircraft in distress. Each contracting state undertakes to provide such measures of assistance to aircraft in distress in its territory as it may find practicable and to permit (subject to control by its own authorities) the owner of the aircraft or authorities of the state in which the aircraft is registered, to provide such measures of assistance as may be necessitated by circumstances. Significantly, the undertaking can only be given by contracting state but the duty to provide assistance is not limited to aircraft registered in another contracting state, but presumably any aircraft in distress in the territory of the contracting state. Finally, the Convention envisages further regulations (normally to be produced under the auspices of ICAO). In this case the Convention provides that each contracting state, when undertaking a search for missing aircraft, will collaborate in co-ordinated measures which may be recommended from time to time pursuant to the Convention. Since 1944 further international regulations relating to safety and investigation of accidents have been made, both pursuant to Chicago Convention and, in particular, through the vehicle of the ICAO which has, for example, set up an accident and reporting system. By requiring the reporting of certain accidents and incidents it is building up an information service for the benefit of member states. However, Chicago Convention provides that each contracting state undertakes collaborate in securing the highest practicable degree of uniformity in regulations, standards, procedures and organization in relation to aircraft, personnel, airways and auxiliary services in all matters in which such uniformity will facilitate and improve air navigation. To this end, ICAO is to adopt and amend from time to time, as may be necessary, international standards and recommended practices and procedures dealing with, among other things, aircraft in distress and investigation of accidents. Standards and Recommended Practices for Aircraft Accident Injuries were first adopted by the ICAO Council on 11 April 1951 pursuant to Article 37 of the Chicago Convention on International Civil Aviation and were designated as Annex 13 to the Convention. The Standards Recommended Practices were based on Recommendations of the Accident Investigation Division at its first Session in February 1946 which were further developed at the Second Session of the Division in February 1947. The 2nd Edition (1966), 3rd Edition, (1973), 4th Edition (1976), 5th Edition (1979), 6th Edition (1981), 7th Edition (1988), 8th Edition (1992) of the Annex 13 (Aircraft Accident and Incident Investigation) of the Chicago Convention was amended eight times by the ICAO Council since 1966. Annex 13 sets out in detail the international standards and recommended practices to be adopted by contracting states in dealing with a serious accident to an aircraft of a contracting state occurring in the territory of another contracting state, known as the state of occurrence. It provides, principally, that the state in which the aircraft is registered is to be given the opportunity to appoint an accredited representative to be present at the inquiry conducted by the state in which the serious aircraft accident occurs. Article 26 of the Chicago Convention does not indicate what the accredited representative is to do but Annex 13 amplifies his rights and duties. In particular, the accredited representative participates in the inquiry by visiting the scene of the accident, examining the wreckage, questioning witnesses, having full access to all relevant evidence, receiving copies of all pertinent documents and making submissions in respect of the various elements of the inquiry. The main shortcomings of the present system for aircraft accident investigation are that some contracting sates are not applying Annex 13 within its express terms, although they are contracting states. Further, and much more important in practice, there are many countries which apply the letter of Annex 13 in such a way as to sterilise its spirit. This appears to be due to a number of causes often found in combination. Firstly, the requirements of the local law and of the local procedures are interpreted and applied so as preclude a more efficient investigation under Annex 13 in favour of a legalistic and sterile interpretation of its terms. Sometimes this results from a distrust of the motives of persons and bodies wishing to participate or from commercial or related to matters of liability and bodies. These may be political, commercial or related to matters of liability and insurance. Secondly, there is said to be a conscious desire to conduct the investigation in some contracting states in such a way as to absolve from any possibility of blame the authorities or nationals, whether manufacturers, operators or air traffic controllers, of the country in which the inquiry is held. The EEC has also had an input into accidents and investigations. In particular, a directive was issued in December 1980 encouraging the uniformity of standards within the EEC by means of joint co-operation of accident investigation. The sharing of and assisting with technical facilities and information was considered an important means of achieving these goals. It has since been proposed that a European accident investigation committee should be set up by the EEC (Council Directive 80/1266 of 1 December 1980). After I would like to introduce the summary of the legislation examples and system for aircraft accidents investigation of the United States, the United Kingdom, Canada, Germany, The Netherlands, Sweden, Swiss, New Zealand and Japan, and I am going to mention the present system, regulations and aviation act for the aircraft accident investigation in Korea. Furthermore I would like to point out the shortcomings of the present system and regulations and aviation act for the aircraft accident investigation and then I will suggest my personal opinion on the new and dramatic innovation on the system for aircraft accident investigation in Korea. I propose that it is necessary and desirable for us to make a new legislation or to revise the existing aviation act in order to establish the standing and independent Committee of Aircraft Accident Investigation under the Korean Government.

• Journal of Oral Medicine and Pain
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• 제32권1호
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• pp.9-33
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• 2007

치의학계에서는 의료사고를 일으킬만한 중환자나 응급환자의 빈도가 상대적으로 낮아 의료분쟁에 휘말리는 경우가 적었으나 요즈음은 의료분쟁이 증가하고 있는 추세이다. 치과진료의 특성상 항상 보조인력이 한, 두명씩 치과의사의 진료를 도와주어야 하고, 치과의사의 의료사고로 인해 의료분쟁으로 발생하는 경우도 있지만 의료법에서 정한 치과 보조인력의 진료영역에서 의료사고 및 분쟁이 발생할 수 있다. 또한 의료기관의 친절도, 서비스 불만 등 진료외적인 요인은 치과 보조인력의 역할을 무시할 수 없다. 본 연구는 2006년 현재 종합병원, 치과병원 및 의원에서 치과진료 보조업무를 하고 있는 치과위생사를 대상으로 설문조사를 하였다. 회수된 275명의 설문분석을 통하여 응답자에 관한 기본적인 자료조사 및 환자의 불평, 불만 및 의료분쟁 경험도와 함께 의료관계법의 이해도를 측정하고, 치과진료 및 의료분쟁에 대한 전반적인 의식성향을 비교분석하여 다음과 같은 결과를 얻었다. 1. 설문응답자 중에서 향후 의료사고 및 분쟁이 발생할지도 모른다는 불안감 또는 의구심을 어느 정도 가지고 있는 경우가 274명 중 251명(91.3%)이었다. 2. 치과위생사의 업무, 진료에 대한 환자의 불평, 불만 경험률은 29.5%(81명)으로 나타나 치과관련 의료분쟁의 원인이 될 수 있는 것으로 조사되었다. 3. 전체유형별 항목에 따른 환자의 문제제기 건수를 보면 직접적인 진료행위와 관련된 문제보다 불친절 및 진료비 등의 진료이외의 문제 제기가 1805건 중 349건(19.3%)으로 가장 높게 나타났다. 4. 세부유형별 항목에 따른 환자의 문제제기 건수를 보면 환자가 치료와 관련하여 충분한 사전설명이나 동의를 구하지 않았다고 문제시 한 경우가 1805건 중 129건(7.1%)으로 가장 높았다. 5. 치과위생사가 스케일링 시술 후 환자 진료기록부에 기록하는 경우는 267명 중 252명(94.4%)으로 나타났으나, 스케일링 시술 후 주의사항 설명 사실을 진료기록부에 기록하는 경우는 55명(20.8%)에 불과했다. 6. 치과진료에 있어서 환자가 언급하지 않으면 특별히 전신질환 유무를 조사하지 않는 경우가 6명(2.2%)으로 조사되었다. 7. 환자 진료와 관련되어 응급상황 발생 시 응급조치를 시행할 수 있다고 생각하는 치과위생사는 104명(38.0%)으로 조사되었다. 8. 근무지에 응급상황 발생 시 조치에 필요한 장비 및 약품을 구비해둔 경우는 115명(41.8%)으로 나타났다. 9. 의료분쟁 발생 시 문제해결에 있어 의무기록이 중요한 역할을 한다고 응답한 경우는 268명(97.81%)으로 나타났다. 10. 의료분쟁 시 문제해결에 있어서 치료 전 설명 및 동의의 의무의 이행 여부가 중요한 역할을 한다고 응답한 경우가 272명 (99.3%)으로 나타났다. 11. 의무기록의 의무보관연도가 10년이라고 옳게 응답한 경우는 160명(58.4%)에 불과했다. 12. 치과위생사의 업무를 벗어난 파노라마사진 촬영을 해도 된다고 응답한 경우가 124명(45.3%), 치경부 레진수복을 해도 된다고 응답한 경우가 71명(25.9%), 유치발치를 해도 된다고 응답한 경우가 37명(13.5%)으로 나타났다. 13. 환자의 비밀누설 금지와 관련하여 환자의 상태를 다른 사람에게 이야기하는 것은 큰 문제가 되지 않는다고 응답한 경우가 24명(8.8%)으로 나타났다. 14. 의료분쟁의 예방 및 대책에 관한 교육의 필요성에 대해서 272명(99.3%)이 필요하고, 167명(61.0%)이 시급하다고 답하였다. 15. 재학 중 의료분쟁의 예방 및 대책에 관한 관련교육을 수료한 적이 없다는 경우가 186명(64.2%), 졸업 후 의료분쟁의 예방 및 대책에 관한 보수교육을 수료한 적이 없는 경우가 212명(77.4%)으로 나타났다. 16. 향후 의료분쟁이 증가할 것으로 생각된다는 응답은 256명(93.4%)이었고, 그 원인으로는 83.3%가 인터넷, 방송 등의 매체를 통한 정보습득 기회의 확대를 꼽았다. 이상의 결과를 종합해보면 치과위생사와 관련한 환자의 불평, 불만 및 분쟁도 경험률이 응답한 치과위생사의 29.5%를 차지하고 있으며, 의료법에서 정한 의료인의 의무와 치과위생사의 직무범위에 대한 인식이 부족한 것으로 조사되어 앞으로 의료분쟁이 더욱 증가할 수 있는 가능성을 내포하고 있다. 그러므로 주의의무, 설명 및 동의의무 등의 의무를 다함은 물론, 이에 대한 인식을 제고하여야 하며, 의료법과 의료분쟁에 대한 예방 및 대책과 관련된 교육기회를 확대하여야 할 것이다.

• 미술자료
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• 제96권
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• pp.123-154
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• 2019

국립중앙박물관 소장 <인왕선영도(仁旺先塋圖)>(덕수5520)는 그림과 발문(跋文) 열 폭으로 이루어진 병풍으로, 작가는 조중묵(趙重黙)(1820~1894 이후), 주문자는 박경빈(朴景彬)(생몰년 미상), 발문을 쓴 사람은 홍선주(洪善疇)(생몰년 미상), 제작연대는 1868년이다. 국립중앙박물관은 낱장으로 보관되어 온 <인왕선영도>를 병풍으로 복원하고 특별전 '우리 강산을 그리다: 화가의 시선, 조선시대 실경산수화'에서 최초로 공개하였다. <인왕선영도>에는 오늘날 서울특별시 서대문구 홍제동과 홍은동을 아우르는 인왕산 서쪽 실경이 묘사되어있고 원경에는 북한산 연봉이 그려져 있다. 화면 속에는 인왕산(仁旺山), 추모현(追慕峴), 홍재원(弘濟院), 삼각산(三角山), 대남문(大南門), 미륵당(彌勒堂)이라는 지명이 표기되어있다. 이 지역을 나타낸 조선후기 지도와 비교해보면 지형 표현과 지명 표기에 유사성이 있다. 조중묵은 넓은 공간을 포착하기 위해 지도의 지리정보를 숙지하였을 것으로 추정된다. 실경의 현장을 답사한 결과, 조중묵은 각각의 경물을 과장하거나 생략하였고 수평의 화면에 나열식으로 조합하였음을 알 수 있었다. 조중묵은 남종화풍 정형산수에 뛰어났던 화가로, <인왕선영도>의 세부 표현에서 사왕파(四王派) 화풍의 영향을 찾을 수 있다. 19세기 도화서 화원들이 화보를 활용하여 가옥을 그리거나 토파에 호초점을 찍고 당분법(撞粉法)으로 꽃을 나타내는 등 장식적인 화풍을 구사한 경향도 부분적으로 나타난다. <인왕선영도>에는 바위를 짙은 먹으로 쓸어내리듯 붓질한 기법, 산세의 괴량감, 가로로 붓을 대어 단순하게 그린 소나무 등 18세기 정선(鄭敾)(1676~1759)의 개성적 양식도 가미되어있다. 조중묵은 인왕산 실경산수로 유명한 정선의 양식과 권위를 차용한 것으로 추정된다. 그러나 <인왕선영도>는 유기적 공간감과 현장의 인상이 잘 드러나지 않으며, 연폭 화면이라는 매체도 조중묵의 개인 양식과 잘 어울리지 않는다. <인왕선영도>는 발문의 텍스트와 화면의 이미지가 잘 조응하는 작품이다. 발문의 내용을 여섯 단락으로 나누어 보면 ①무덤의 주인공과 이장 경위, ②무덤의 입지와 풍수, ③묘제(墓祭)와 신이(神異)한 응답, ④무덤 관리에 대한 마을 사람들의 협력, ⑤병풍 제작의 동기인 박경빈의 효성과 수묘(守墓), ⑥발문을 쓴 의의로 파악된다. 이 가운데 화면에서 시각적으로 구현하기 용이한 ②의 내용은 화면에 충실하게 재현되었다. <인왕선영도> 제작의 직접적 동기인 ⑤를 보면 주문자 박경빈이 "무덤이 마치 새롭게 단장한 것 같이 눈에 완연하다."라 하여 <인왕선영도>에 만족했음을 알 수 있다. 경물 하나하나를 설명하듯 나열한 구도는 회화미는 떨어지더라도 무덤의 풍수지리를 전달하는 데는 더 적합했을 것으로 추정된다. 현존하는 상당수의 산도(山圖)는 18세기 이후 제작된 목판본 선영도로서, 족보와 문집에 수록된 경우가 많다. 16~17세기의 기록에서는 족자 선영도를 첨배(瞻拜)의 대상으로 삼은 사례를 찾을 수 있다. 선영도 첨배는 현실적으로 수묘(守墓)가 곤란할 때 이를 대신할 수 있는 의례로 인정되었다. 한효원(韓效元)(1468~1534), 조실구(曺實久)(1591~1658) 등이 선영도를 제작한 후 당대의 명사에게 서문을 요청하고 효심을 과시한 사례는 <인왕선영도>의 선구가 된 것으로 추정된다. <석정처사유거도(石亭處士幽居圖)>(개인 소장), <화개현구장도(花開縣舊莊圖)>(국립중앙박물관) 등은 선영도는 아니지만 계회도 형식의 족자이고 풍수를 도해했다는 점에서 17세기 선영도의 모습을 유추할 수 있는 자료가 된다. <인왕선영도>는 첨배라는 측면에서 초상화와도 의미가 비슷했다. 발문의 "부친의 기침소리를 직접 접하는 듯하고, 그 태도와 몸가짐을 눈으로 보는 듯하다."는 표현과 부친의 초상에 조석 문안을 올린 서효숙 고사에서 그 단초를 찾을 수 있다. 박경빈이 일반적인 선영도 형식이었던 족자나 목판화 대신 연폭 병풍의 실경산수화를 주문한 의도는 분명히 알기 어렵다. 19세기에는 민간에서도 사례(四禮) 의식에 다수의 병풍을 배설(排設)하였는데, 의례의 성격에 따라 그림의 주제를 반드시 구분하여 사용한 것은 아니었다. <인왕선영도> 또한 여러 의례에 두루 배설하거나 장식 병풍으로도 사용하기 위해서 선영 그림이라는 주제를 실경산수화 이미지 아래에 가렸을 가능성이 있다. 특히 <인왕선영도>의 핵심 소재인 무덤 봉분이 모호하게 처리된 것은 사산금표(四山禁標)의 금제 위반을 숨기기 위함일 가능성이 있다. <인왕선영도>에 묘사된 인왕산 서쪽 산기슭은 분묘 조성 금지구역이었다. 1832년에 금표 내에 몰래 쓴 묘를 적발하여 즉시 파내고 관련자를 엄히 처벌한 사례로 볼 때, 19세기 중엽까지도 사산금표 내의 분묘 금제는 효력을 발휘하고 있었던 것으로 추정된다. <인왕선영도>의 발문에는 장지를 얻기 위해 쏟은 정성이 상세하게 쓰여 있다. 장지조성에 마을사람들의 협조와 묵인이 필요했던 것은 금표 구역 내에 묘지를 조성하는 것이 부담스러운 일이었기 때문으로 볼 수 있다. <인왕선영도>와 비교 가능한 동시대 연폭 병풍의 실경산수화로 이한철(李漢喆)(1808~1880)이 그린 <석파정도(石坡亭圖)>(미국 로스앤젤레스카운티미술관)를 들 수 있다. <석파정도> 제작시기를 전후한 1861년에 이한철과 조중묵은 철종어진도사에 함께 참여하였으므로 조중묵이 이한철의 <석파정도> 제작 과정을 보았을 가능성은 상당히 높다. 조중묵이 몇 년 후 <인왕선영도>를 주문받았을 때 <석파정도>의 인상적인 연폭 실경산수를 본 경험이 반영되었을 가능성이 있다. 두 작품의 화풍 차이는 주문자의 취향과 제작 목적의 차이에서 비롯된 것으로 추정된다. <인왕선영도>는 실경산수화와 선영도의 중층적인 구조를 가지고 있어서 관람자의 지식수준과 주문자와의 친분, 관람에 들이는 시간에 따라 천차만별의 의미로 수용되었을 것이다. <인왕선영도>의 발문에는 무덤 주인의 이름과 자호, 본관이 일체 작성되지 않은 채 '박공(朴公)'이라고만 표기되어 있다. 주문자인 박경빈의 인적 사항도 파악할 수 없었으나 다만 관직에 나아가지 못한 가계를 미루어 볼 때 재력이 있음에도 지배계층으로 올라설 수 없는 신분적 한계를 지니고 있었음은 짐작할 수 있다. 발문을 쓴 홍선주 또한 사대부로 보기 어려우며, 『승정원일기』 기록에 나타나는 경아전 서리일 가능성이 있다. 박경빈은 상류 계층에 진입하고 싶은 욕망으로 보수적인 가치인 효(孝)를 강조하여 부친의 무덤을 명당으로 이전하고 <인왕선영도>를 제작하였을 것으로 추정된다. 그러나 <인왕선영도>는 금제위반 적발에 대한 우려, 병풍의 다목적성 등의 이유로 본래의 제작의도를 뚜렷하게 드러내지 못하고 모순적인 이미지가 되었다. 병풍이 제작된 지 47년 만에 각 폭이 분리된 채 미술상을 통해 이왕가미술관 소장품이 된 상황을 보더라도, 박경빈이 <인왕선영도>에서 꿈꾸었던 명당 발복과 가문의 신분상승은 이루어지지 못했던 것으로 생각된다.

• Journal of Preventive Medicine and Public Health
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• 제7권1호
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• pp.29-94
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• 1974

Today most developed countries provide modern medical care for most of the population. The rural area is the more neglected area in the medical and health field. In public health, the philosophy is that medical care for in maintenance of health is a basic right of man; it should not be discriminated against racial, environmental or financial situations. The deficiency of the medical care system, cultural bias, economic development, and ignorance of the residents about health care brought about the shortage of medical personnel and facilities on the rural areas. Moreover, medical students and physicians have been taught less about rural health care than about urban health care. Medical care, therefore, is insufficient in terms of health care personnel/and facilities in rural areas. Under such a situation, there is growing concern about the health problems among the rural population. The findings presented in this report are useful measures of the major health problems and even more important, as a guide to planning for improved medical care systems. It is hoped that findings from this study will be useful to those responsible for improving the delivery of health service for the rural population. Objectives: -to determine the health status of the residents in the rural areas. -to assess the rural population's needs in terms of health and medical care. -to make recommendations concerning improvement in the delivery of health and medical care for the rural population. Procedures: For the sampling design, the ideal would be to sample according to the proportion of the composition age-groups. As the health problems would be different by group, the sample was divided into 10 different age-groups. If the sample were allocated by proportion of composition of each age group, some age groups would be too small to estimate the health problem. The sample size of each age-group population was 100 people/age-groups. Personal interviews were conducted by specially trained medical students. The interviews dealt at length with current health status, medical care problems, utilization of medical services, medical cost paid for medical care and attitudes toward health. In addition, more information was gained from the public health field, including environmental sanitation, maternal and child health, family planning, tuberculosis control, and dental health. The sample Sample size was one fourth of total population: 1,438 The aged 10-14 years showed the largest number of 254 and the aged under one year was the smallest number of 81. Participation in examination Examination sessions usually were held in the morning every Tuesday, Wenesday, and Thursday for 3 hours at each session at the Namchun Health station. In general, the rate of participation in medical examination was low especially in ages between 10-19 years old. The highest rate of participation among are groups was the under one year age-group by 100 percent. The lowest use rate as low as 3% of those in the age-groups 10-19 years who are attending junior and senior high school in Taegu city so the time was not convenient for them to recieve examinations. Among the over 20 years old group, the rate of participation of female was higher than that of males. The results are as follows: A. Publie health problems Population: The number of pre-school age group who required child health was 724, among them infants numbered 96. Number of eligible women aged 15-44 years was 1,279, and women with husband who need maternal health numbered 700. The age-group of 65 years or older was 201 needed more health care and 65 of them had disabilities. (Table 2). Environmental sanitation: Seventy-nine percent of the residents relied upon well water as a primary source of dringking water. Ninety-three percent of the drinking water supply was rated as unfited quality for drinking. More than 90% of latrines were unhygienic, in structure design and sanitation (Table 15). Maternal and child health: Maternal health Average number of pregnancies of eligible women was 4 times. There was almost no pre- and post-natal care. Pregnancy wastage Still births was 33 per 1,000 live births. Spontaneous abortion was 156 per 1,000 live births. Induced abortion was 137 per 1,000 live births. Delivery condition More than 90 percent of deliveries were conducted at home. Attendants at last delivery were laymen by 76% and delivery without attendants was 14%. The rate of non-sterilized scissors as an instrument used to cut the umbilical cord was as high as 54% and of sickles was 14%. The rate of difficult delivery counted for 3%. Maternal death rate estimates about 35 per 10,000 live births. Child health Consultation rate for child health was almost non existant. In general, vaccination rate of children was low; vaccination rates for children aged 0-5 years with BCG and small pox were 34 and 28 percent respectively. The rate of vaccination with DPT and Polio were 23 and 25% respectively but the rate of the complete three injections were as low as 5 and 3% respectively. The number of dead children was 280 per 1,000 living children. Infants death rate was 45 per 1,000 live births (Table 16), Family planning: Approval rate of married women for family planning was as high as 86%. The rate of experiences of contraception in the past was 51%. The current rate of contraception was 37%. Willingness to use contraception in the future was as high as 86% (Table 17). Tuberculosis control: Number of registration patients at the health center currently was 25. The number indicates one eighth of estimate number of tuberculosis in the area. Number of discharged cases in the past accounted for 79 which showed 50% of active cases when discharged time. Rate of complete treatment among reasons of discharge in the past as low as 28%. There needs to be a follow up observation of the discharged cases (Table 18). Dental problems: More than 50% of the total population have at least one or more dental problems. (Table 19) B. Medical care problems Incidence rate: 1. In one month Incidence rate of medical care problems during one month was 19.6 percent. Among these health problems which required rest at home were 11.8 percent. The estimated number of patients in the total population is 1,206. The health problems reported most frequently in interviews during one month are: GI trouble, respiratory disease, neuralgia, skin disease, and communicable disease-in that order, The rate of health problems by age groups was highest in the 1-4 age group and in the 60 years or over age group, the lowest rate was the 10-14 year age group. In general, 0-29 year age group except the 1-4 year age group was low incidence rate. After 30 years old the rate of health problems increases gradually with aging. Eighty-three percent of health problems that occured during one month were solved by primary medical care procedures. Seventeen percent of health problems needed secondary care. Days rested at home because of illness during one month were 0.7 days per interviewee and 8days per patient and it accounts for 2,161 days for the total productive population in the area. (Table 20) 2. In a year The incidence rate of medical care problems during a year was 74.8%, among them health problems which required rest at home was 37 percent. Estimated number of patients in the total population during a year was 4,600. The health problems that occured most frequently among the interviewees during a year were: Cold (30%), GI trouble (18), respiratory disease (11), anemia (10), diarrhea (10), neuralgia (10), parasite disease (9), ENT (7), skin (7), headache (7), trauma (4), communicable disease (3), and circulatory disease (3) -in that order. The rate of health problems by age groups was highest in the infants group, thereafter the rate decreased gradually until the age 15-19 year age group which showed the lowest, and then the rate increased gradually with aging. Eighty-seven percent of health problems during a year were solved by primary medical care. Thirteen percent of them needed secondary medical care procedures. Days rested at home because of illness during a year were 16 days per interviewee and 44 days per patient and it accounted for 57,335 days lost among productive age group in the area (Table 21). Among those given medical examination, the conditions observed most frequently were respiratory disease, GI trouble, parasite disease, neuralgia, skin disease, trauma, tuberculosis, anemia, chronic obstructive lung disease, eye disorders-in that order (Table 22). The main health problems required secondary medical care are as fellows: (previous page). Utilization of medical care (treatment) The rate of treatment by various medical facilities for all health problems during one month was 73 percent. The rate of receiving of medical care of those who have health problems which required rest at home was 52% while the rate of those who have health problems which did not required rest was 61 percent (Table 23). The rate of receiving of medical care for all health problems during a year was 67 percent. The rate of receiving of medical care of those who have health problems which required rest at home was 82 percent while the rate of those who have health problems which did not required rest was as low as 53 percent (Table 24). Types of medical facilitied used were as follows: Hospital and clinics: 32-35% Herb clinics: 9-10% Drugstore: 53-58% Hospitalization Rate of hospitalization was 1.7% and the estimate number of hospitalizations among the total population during a year will be 107 persons (Table 25). Medical cost: Average medical cost per person during one month and a year were 171 and 2,800 won respectively. Average medical cost per patient during one month and a year were 1,109 and 3,740 won respectively. Average cost per household during a year was 15,800 won (Table 26, 27). Solution measures for health and medical care problems in rural area: A. Health problems which could be solved by paramedical workers such as nurses, midwives and aid nurses etc. are as follows: 1. Improvement of environmental sanitation 2. MCH except medical care problems 3. Family planning except surgical intervention 4. Tuberculosis control except diagnosis and prescription 5. Dental care except operational intervention 6. Health education for residents for improvement of utilization of medical facilities and early diagnosis etc. B. Medical care problems 1. Eighty-five percent of health problems could be solved by primary care procedures by general practitioners. 2. Fifteen percent of health problems need secondary medical procedures by a specialist. C. Medical cost Concidering the economic situation in rural area the amount of 2,062 won per residents during a year will be burdensome, so financial assistance is needed gorvernment to solve health and medical care problems for rural people.