• 제목/요약/키워드: treatment-seeking behavior

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간호진단중심의 퇴원계획과 가정간호적용의 효과 -만성질환자를 중심으로- (The Effects of Hospital Home Nursing Interventions based on the Nursing Diagnosis)

  • 서문자;김금순;김명애;김인자;손행미
    • 기본간호학회지
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    • 제3권1호
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    • pp.50-67
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    • 1996
  • Home nursing interventions based on nursing diagnosis were implemented to the patient who are discharged from one hospital often the treatment for chronic neuromuscular system problem, and its effects were studied. The purpose of this study was to find out the effectiveness of hospital bouned home nursing provided by hospital nurses and to categorize home nursing diagnosis and its interventions. Data from experimental group patients were collected at three different time ; at the time of discharge, two weeks after discharge and our weeks after discharge. Data from controll group patients were collected twice ; the first one at the time of discharge, and the other one four weeks after discharge. For this study nursing assessment and intervention booklet developed by the research team. There were no significant decrease of the number of nursing problems and life satis-faction. But daily activity level of patients showed the signs of significant improvement at the time of four weeks after discharge. Results of this study indicates that home nursing intervention based on nursing diagnosis provided the patients with noticeable difference in health maintanance, impairment of physical mobility, potential for infection, impaired home marntenance management, health seeking behavior, chronic pain, disuse syndrome, impaired skin integrity.

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주의력결핍 과잉행동장애 한국형 치료 권고안(II) - 진단 및 평가 - (The Korean Practice Parameter for the Treatment of Attention - Deficit Hyperactivity Disorder(II) - Diagnosis and Assessment -)

  • 천근아;김지훈;강화연;김붕년;신동원;안동현;양수진;유한익;유희정;홍현주
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • 제18권1호
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    • pp.10-15
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    • 2007
  • Probably the three most important components to a comprehensive evaluation of patients with attention-deficit hyperactivity disorder (ADHD) are the clinical interview, the medical examination, and the completion and scoring or behavior rating scales. Teachers and other school personnel are often the first to recognize that a child or adolescent might have ADHD, and often play an important role in the help-seeking/referral process. A diagnostic evaluation for ADHD should include questions about ADHD symptoms, other problems including alcohol and drug use, family history of ADHD, prior evaluation and treatment for ADHD. Screening interview or rating scales as well as interviews should be used. When it is feasible, clinicians may wish to supplement these components of the evaluation with objective assessments of the ADHD symptoms, such as psychological tests. These tests are not essential to reaching a diagnosis, however, or to treatment planning, but they may yield further information about the presence and severity of cognitive impairments that could be associated with some cases of ADHD. Screening for intellectual ability and academic achievement skills is also important in determining the presence of comorbid developmental delay or loaming disabilities. The number and type of symptoms required for a diagnosis of ADHD vary depending on the specific subtype. To receive a diagnosis of ADHD, the person must be experiencing significant distress or impairment in daily functioning, and must not meet criteria for other mental disorders which might better account for the observed symptoms such as mental retardation, autism or other pervasive developmental disorders, mood disorders, anxiety disorders. This report aims to suggest a practice guideline of assessment and diagnosis for children and adolescents with ADHD in Korea.

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신체형장애, 우울장애 및 정신신체장애 환자들간의 질병행동의 비교 (A Comparison of Illness Behavior among Patients with Somatoform Disorders, Depressive Disorders and Psychosomatic Disorders)

  • 고경봉;기선완
    • 정신신체의학
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    • 제5권2호
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    • pp.185-194
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    • 1997
  • 본 연구는 정신과외래에 내원한 52명의 신체형장애, 52명의 우울장애, 51명의 정신신체장애환자들을 대상으로 질병행동을 비교하기 위해 실시되었다 질병행동을 평가하기 위해서 질병행동평가스케줄(illness behavior assessment schedule) 및 치료추구행태에 관한 설문을 사용하였으며 면담방법은 구조적인 형태로 이루어졌다. 신체형장애환자들과 정신신체장애환자들은 각각 우울장애환자들에 비해 신체적 질병에 대한 확신, 질병에 대한 공포, 질병에 대한 집착이 더 강하고 한의원의 이용빈도가 더 높았다. 신체형장애환자들은 우울장애환자들에 비해 질병의 원인을 신체적인 것으로 더 확신하고 정동장애의 원인을 심리적인 것으로 귀착시키는 경향이 낮으며 우울 및 안절부절못하는 정도 및 정신과에 대한 수용도가 각각 더 낮았다. 한편 신체형장애환자들은 정신신체장애환자들보다 질병의 정도가 더 경한 것으로 설명되었음을 확신하였다. 신체형장애환자들은 정신적 고통이 있는 경우에 감정표현의 억제가 더 현저하였다. 신체형장애환자들 중 여자들이 남자들보다 더 심리적 장애가 있고 병의 원인을 심리적인 인자로 귀착시켜 여자에 대한 정신과적 접근이 더 용이할 수 있음을 시사하였다. 이상의 결과들은 질병 행동에 있어서 신체형장애환자들이 우울장애환자들과는 다른 반면 증상의 평가에 있어서 치료자와 환자간의 차이를 제외하고는 정신신체장애환자들과 비슷한 양상임을 시사한다. 따라서 신체형장애환자들에 대한 접근은 이런 환자들의 심리적인 것을 부정하려는 욕구를 이해하면서 처음에는 신체적인 접근으로 시작하여 점진적으로 심리적 및 생물정신사회적인 접근으로 전환해야 할 필요성이 강조된다.조절되어진다는 사실을 제시한다. 하지만 태생어류에서 이 호르몬의 실질적 작용 메카니즘 및 명확한 작용시기에 대해서는 보다 많은 연구가 요구되어 진다.을 설계하는 것이 가능하였다.적(最適) 온도(溫度)는 $30^{\circ}C$, avicelase와 ${\beta}-glucosidase$의 최적(最適) pH는 5.0, CMCase는 pH 5.5 이었으며, 균사(菌絲) 생육(生育)은 pH 5.0에서 양호(良好)하였다. 배양(培養) 기간(期間)은 avicelase가 8일(日), CMCase가 10일(日), ${\beta}-glucosidase$는 16 일간(日間) 배양(培養)하였을 때 최대치(最大値)를 보였고, 균사(菌絲) 생육(生育)은 12일(日) 배양(培養)했을 때 가장 양호(良好)하였다.가한 반면, 중국인들은 고소한 향의 강도, 고소한 향의 기호도, 전체적인 맛에서 뚜렷하게 일본참기름을 우수하게 평가하였다.s의 항체(抗體)로 반응(反應)시킨 후 protein-A gold(15 nm)로 표식(標識)시킨 바 제일 바깥 상층(上層)의 keratinocyte에 있어서 세포막표면(細胞膜表面)을 따라 표식(標識)되어 세포막항원(細胞膜抗元)을 나타내었으며, 이와 같은 소견(所見)으로 미루어 정상피부(正常皮膚) 중층편평상피세포(重層扁平上皮細胞)에서도 동일(同一)한 소견(所見)을 관찰(觀察)할 수 있다고 본다.al remnants, Resorption of fetus로 관찰된 것이다. Fetal death는 수정후 $14{\sim}18$일까지의 사망으로써 Maceration of fetus로

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만성통증 환자의 통증 조절 (Chronic pain control in patients with rheumatoid arthritis)

  • 은영
    • 근관절건강학회지
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    • 제2권1호
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    • pp.17-40
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    • 1995
  • Rheumatoid arthritis is the one of the chronic diseases, one of its major symptoms is a chronic pain. Despite developing medical treatment and surgical techniques, it is suggested that to control the pain is the goal of the treatment. But pain is an inner experience and even those closest to the patient cannot truly observe its progress or share in its suffering. The National Academy of Sciences Institute of Medicine's report on Pain and Disability concluded that there is no objective measure of pain-(exactly) no pain thermometer-nor can there ever be one, because the experience of pain is inseparable from personal perception and social influence such as culture. To explore chronic pain experience is to understand the process and property of the patient's perception of pain through the response to pain, the coping with pain, and the adaptation to pain. Therefore a qualitative study was conducted in order to gain an understanding of pain experience of patients with RA in korea. I used naturalistic inquiry as a research methodology, which had 5 axioms, the first is that realities are multiple, constructed, and holistic, the second is that knower and known are interactive, inseparable, the third is only time and context bound working hypotheses(idiographic statements) are possible, the forth is all entities are in a state of mutual simultaneous shaping, so that it is impossible to distinguish causes from effects and the last is that inquiry is value-bound. Purposive sampling was conducted as a sampling. 20 subjects who experienced pain over 10 years, lived in middle-sized city and big city in Korea, and 17 women and 3 men. The subject's age was from 32 to 62 (average 48.8), all were married, living with their spouse and children, except two-one divorced and the other widow before they became ill. I collected data using In depth structured interview. I had interviews two or three times with each subject, and the interviews were conducted at each subject's home. Each interview lasted about two hours an average. A recording was taken with the consent of the subject. I used inductive data analysis-such as unitizing and categorizing. unitizing is a process of coding, whereby raw data are systematically transformed and aggregated into units. Categorizing is a process wherby previously unitized data are organized into categories that provide descriptive or inferential information about the context or setting from which the units were derived. This process is used constant comparative method. The pain controlling process is composed of behavior of pain control. The behaviors of pain control are rearranging of ADL, hiddening role conflict, balancing treatment, and changing social relation. Rearranging of ADL includes diet management, sleep management, and the adjustment of daily life activities. The subjects try to rearrange their daily activities by modified style of motions, rearranging time span & range of activities, using auxillary facilities, and getting help in order to keep on the pace of daily life. Hiddening role conflict means to reduce conflicts between sick role and their role as a family member. In this process, the subjects use two modes, one is to control the pain complaints, and the other is to internalize the value which is to stay home is good for caring her children and being a good mother. To control pain complaints is done by 'enduring', 'understanding' the other family members, or making them undersood in order to reduce pain. Balancing treatment is composed of two aspects. One is to keep the pain within the endurable level, the other is to keep in touch with medical personnel in order to get the information of treatment and emotional support. Changing social relation is made by information seeking and sharing, formation of mutual support relation, and finally simplification of social relationships. The subjects simplify their social relationships by refraining from relations with someone who makes them physically and psychologically strained. In particular the subjects are apt to avoid contact with in-laws, and the change of relation to in-laws results in lessening the family boundary. In the course of this process, they confront the crisis of family confict result in family dissolution. This crisis is related to the threat of self-existence. Findings from this study contribute to understanding the chronic pain experience. To advance this study, we should compare this result with other cases in different cultural contexts. I think to interpret these results, korean cultural background should be considered. Especially the different family concept, more broader family members and kinship network, and the traditional medical knowledge influences patients' behavior.

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아들러의 개인심리학을 적용한 상담과정과 상담기법에 관한 연구 (A Study on Counseling Process and Counseling Techniques Applying Adler's Individual Psychology)

  • 김보기;박유미
    • 산업진흥연구
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    • 제5권3호
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    • pp.89-96
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    • 2020
  • 본 연구는 아들러의 개인심리학을 연구하여 거기에서 도출된 상담이론을 토대로 상담과정과 상담기법을 연구하고자 하였다. 아들러의 상담과정의 진행은 첫째, 관계형성단계는 상담자와 내담자 상호 간의 합의된 목표를 향해 적극적인 파트너로서 일하는 평등하고 상호 협력적인 관계를 추구하는 단계이다. 둘째, 생활양식 탐색단계는 생활양식을 이해하고 생활양식이 삶의 과업에 어떠한 영향을 미치는지를 이해하는 것을 중요한 목표로 하는 단계이다. 셋째, 통찰단계는 통찰력을 가지는 단계이다. 넷째, 재정향(행동 전환)단계로 진행된다. 아들러의 상담기법은 일반적기법과 특수기법이 있는데, 일반적 기법으로는 즉시성, 충고하기, 격려하기, 역설적 의도, 시법보이기, 역할놀이 등이 있다. 특수기법으로는 초인종 누르기, 내담자의 수프에 침 뱉기, 마이더스 기법, 타인을 즐겁게 하기, 저질의 아이 피하기, 스스로 억제하기 등이 있다. 결론적으로 개인심리상담은 의학적 모델이 아니라 성장모델에 기초하며, 치료한다는 측면보다는 건강한 개인과 사회를 재교육하고 재조명하는 데 더 많은 관심을 가지고 있다. 그러므로 아동지도센터, 부모-아동상담, 부부상담, 가족상담, 집단상담과 치료, 아동과 청소년의 개인상담, 문화적 갈등, 정신건강 운동 등 다양한 영역에 적용된다.

시대적으로 바라본 마음과 몸의 수사학 : (편)두통의 사례 (History of Rhetoric in Mind and Body Relationship : Case of Migraine and Headache)

  • 정성훈
    • 정신신체의학
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    • 제22권2호
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    • pp.55-62
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    • 2014
  • 마음과 몸의 관계는 오랜 논의에도 불구하고 설득력 있는 답을 구하지 못하고 있다. 한편, 서구 의학이 유물론적 패러다임을 받아들이면서, 기질적 이상이 없는 증상들은 "의학적으로 설명되지 않는 증상"이라 하여 변방에 머물게 된다. 이러한 증상을 이해하고자 전문가들은 마음과 몸의 관계를 바탕으로 소위 정신신체의학이라는 해석의 틀을 내놓았다. 이 해석의 틀은 의사소통 방식뿐 아니라, 환자들의 건강추구 행위 및 증상을 경험하는 양식도 변화시켰다. 시대의 필요나 새로운 과학발견에 의해 해석의 틀은 변화되어 왔으며, 어떤 때는 마음이 어떤 때는 몸이 강조되었다. 특히 치료법이 부재할 때에는 마음이 강조되면서 환자의 인격이 비난 받거나, 환자의 책임이 더 강조되었다. 반면 약물치료가 등장한 후에는 마음을 강조할 필요성이 줄어들면서 환자의 책임 역시 면제되었다. 본 논고에서는 마음과 몸의 관계를 중심으로 해석의 틀이 어떻게 시대에 따라 변화했는지를, 두통과 편두통의 사례를 통해 살펴보고자 한다. 이를 통해 해석의 틀이 어떻게 증상을 경험하는 양상을 변화시켰으며, 그때마다 책임 소재가 어떻게 달라졌는지 고찰할 것이다. 이러한 통시적 고찰은, 전문가로 하여금 그들이 만들어내는 해석의 틀이 얼마나 큰 영향력을 가지는 지, 그것이 얼마나 시대 상황과 밀접한 관계를 맺는지를 고찰할 기회를 마련할 것이다.

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기악과 학생들의 근육과 건 증상에 대한 조사연구 (A Study of Musculotendinous Problems of Students Majoring in Musical Instruments in Korea)

  • 이은남;이은옥;이인숙;박인혜;박정숙;배상철;소희영
    • 근관절건강학회지
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    • 제4권1호
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    • pp.48-60
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    • 1997
  • This study was undertaken to identify the musculotendinous problems and contributing factors to those problems In students majoring in musical instruments in Korea. The data were collected from March 2, 1996 to March 31, 1996 from 261 music students in various geographical areas. The data were analyzed for descriptive statistics, t-test, chi-square using SPSS $PC^+$ program. The results of this study were as follows : 1. In a questionnaire survey of 261 music students, one hundred twenty five(47.9%) reported having had various musculotendinous symptoms. Twenty seven students among the those who had previous symptoms(21.9%) reported the present symptoms. 2. The experience rates of musculotendinous problems in keyboard players, string players and woodwind players were 50.3%, 48.2%, 33.3% respectively. 3. Most of the students practiced most intensively during their high school years and the musculotendinous symptoms began at the same period. 4. Pain, tenderness and stiffness were the most common symptoms, while paresthesia and motor dysfunction were rare. This indicates that most players had muscle tendinous overuse, while small number had nerve entrapment and motor dysfunction. 5. In past and present symptoms, string players experienced musculotendinous symptoms mainly in both sides of shoulders, lumbar area, left finger, and left wrist, while keyboard players experienced more symptoms in the right wrist, shoulder, fingers than left side. 6. The major contributing factors to the symptoms were weight of instrument, types of instruments, types of daily activities, duration of practice, and playing technique. 7 The most frequent treatment modalities for the symptoms were acupuncture or moxibustion, other alternative therapy such as heat compress and massage. Through this study it was found that the musculotendinous problems might be increased along with their career, due to lack of knowledge about preventive measures and patterns of health behavior seeking alternative modalities rather than professional consultation. Therefore, preventive measures that focus on playing habits such as duration of practice, frequency of rest and position while playing should be developed and taught to the students, their parents, and music educators. Doctors who are interested in this area should attempt to correct the position and posture while playing of the posture. And measures for reduction of loading of instrument weight should also be developed.

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