• 제목/요약/키워드: university hospital nurses

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암 환아 가족의 아동 호스피스 요구도 (The Need for Child Hospice Care in Families of Children with Cancer)

  • 강경아;김신정;김영순
    • Journal of Hospice and Palliative Care
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    • 제7권2호
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    • pp.221-231
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    • 2004
  • 목적: 본 연구는 암환아 가족의 호스피스 요구도를 파악하여 앞으로 암 환아 간호시, 대상자의 요구에 적절한 호스피스 간호를 제공하기 위한 목적으로 시도되었다. 방법: 자료수집은 2004년 2월부터 7월까지 서울의 2개 대학병원에서 암으로 진단 받고 입원한 아동의 가족 104명을 대상으로 하였다. 대상자의 아동 호스피스 요구도를 측정하기 위해서는 아동 호스피스에 대한 국내 외 문헌고찰과 아동 호스피스 전문가와 관련자, 암 환아 가족 20명을 대상으로 면담하여 개발한 암 환아 가족의 아동 호스피스 요구 측정도구[10]를 사용하였다. 결과: 1. 대상자의 아동 호스피스 요구 정도는 4점 만점에 $2.77{\sim}4.00$점의 범위로 평균 3.41점(.38)으로 높게 나타났다. 각 요인에 따른 요구정도는 아동의 정서적 간호 말기 주요 신체적 증상의 조절, 2차적인 생리적 문제의 조절, 가족이 어려움 수용, 죽음준비를 위한 영적 돌봄의 순으로 나타났다. 2. 대상자의 일반적 특성에 따른 아동 호스피스의 요구 정도는 아동 어머니의 연령(F==4.980, P=.009), 형제나 친척 중 암 환자의 유무(t=2.423, P=.017)에 따라서만 유의한 차이가 있었다. 즉, 대상자의 아동 호스피스 요구정도는 어머니의 연령이 $36{\sim}40$세인 경우가 요구 정도가 가장 높고 35세 이하인 경우가 가장 낮았으며 형제나 친척 중 암 환자가 있는 경우가 없는 경우보다 요구 정도가 더 높았다. 결론: 아동 호스피스에 대한 암 환아 가족의 요구 정도는 정서적, 신체적, 사회적, 영적 돌봄의 순으로 나타나 가족이 자녀의 죽음을 앞두고 자녀의 신체적 증상관리와 함께 자신의 죽음에 대한 이해가 어려운 자녀의 불안과 두려움을 경감시켜주기 원하는 부모의 특성이 파악되었다. 또한 호스피스에 대한 요구도는 높았으나 자녀에 대한 호스피스 돌봄의향은 낮게 나타나 암 환아 부모들이 적극적인 치료와 호스피스에 대한 양가감정을 가지고 있음을 유추해 볼 수 있었다. 본 연구의 결과는 암 환아 가족들을 위해 간호사가 제공해야 하는 호스피스 돌봄의 방향을 제시하고 있다고 생각되며 이를 위해서는 호스피스 관련 기관뿐만 아니라 국가적 차원의 아동 호스피스에 대한 관심과 지원이 요구된다고 생각한다.

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감성활용이 오센틱리더십과 변화적 조직시민행동에 미치는 영향 (Emotional Regulation's influence on Authentic Leadership and Change Oriented Organizational Citizenship Behavior)

  • 강윤희;김종관
    • 예술인문사회 융합 멀티미디어 논문지
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    • 제8권8호
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    • pp.1-9
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    • 2018
  • 본 연구는 감성활용이 오센틱 리더십과 개인의 변화적 조직시민행동에 미치는 영향을 살펴 보았다. 감성활용은 감성지능의 네가지 하부요인으로 개인의 본인 및 타인의 감성 인지, 감성 이해 감성조절 및 감성활용 능력이며, 최근 많은 연구를 통해 개인의 감성지능이 높을수록 성과, 효율, 선제적 행동을 증가 시키며, 조직 내 부정적 행동을 감소한다는 연구들이 발표되었다. 감성활용은 감성지능의 하부요인 중 하나로써 동양의 유교적 문화는 타인을 인식하고 함께 협력해서 공존하는 관계지향적 사회적 구조이며 이런 문화에서는 감성활용이 매우 중요한 요인이라는 연구도 발표되었다. 하지만 현재 국내에서 감성활용 관련 논문은 미습한 수준이다. 오센틱 리더십 선행연구들은 학교 또는 기업체 중심으로 연구되었으며 개선과 변화가 시급한 병원, 간호사 및 의료 환경을 중심으로 실행된 연구는 미흡한 상황이다. 이런 현상은 최근 태움과 같은 안타까운 사건으로 나타났다. 본 연구에서는 간호사가 인식하는 수간호사의 오센틱 리더십이 개인의 변화적 조직시민행동에 미치는 영향을 감성 활용의 매개 효과를 통해 살펴 보았으며 SPSS 21.0을 통해 B도시의 두 개의 종합병원에서 300명의 간호사를 상대로 분석했으며 결과는 다음과 같다. 오센틱 리더십은 변화적 조직시민행동에 유의의 영향을 미친다고 나타났으며 세부적으로 네 가지 하부요인 중 자아인식, 관계적 투명성과 내재된 도덕관점 세 가지 관점 모두가 변화적 조직시민행동에 유의한 영향을 보였다. 오센틱 리더십은 감성 활용에도 유의한 영향을 미쳤으며 네 가지 하부요인 중 세 가지 요인인 자아인식, 관계적 투명성과 내재된 도덕관점 모두 유의하다고 나타났다. 오센틱 리더십의 하부 요인인 균형적 정보처리 요인만 변화적 조직시민행동과 감성 활용에 유의한 영향을 미치지 않는다는 결과가 나타났다. 감성 활용은 오센틱 리더십과 변화적 조직시민행동을 부분 매개한다는 결과가 나옴으로 향 후 감성 활용과 오센틱 리더십 훈련 및 교육을 통해 직무만족과 조직효율성을 높이고 선제적 행동요인인 변화적 조직시민행동도 높일 수 있다는 가능성을 제시하였다.

채식을 하는 스님과 비채식 일반인의 혈중 지질수준, 혈당, 혈압에 관한 연구(I) -체질량지수, 체지방 분포형태, 체지방 함량을 중심으로- (A Study of Serum Lipid Levels, Blood Sugar, Blood Pressure of Buddhist nuns in Vegetarians and Non-Vegetarians (I) - Based on BMI, WHR, %BF-)

  • 차복경
    • 한국식품영양과학회지
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    • 제31권5호
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    • pp.862-870
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    • 2002
  • 우리나라에도 심혈관질환으로 인한 사망률이 점차 증가하고 있다. 이에 본 연구에서는 채식과 혈청지질 수준 및 혈당, 혈압과의 관계를 규명하기 위한 연구의 일환으로 채식을 하는 비구니스님을 대상으로 하여 연구한 결과를 요약하면 조사대상자의 평균나이는 채식인 44.2세, 비채식인 40.5세, BMI는 각각 22.4, 21.0이었고, WHR은 0.8, 0.8이었고, %BF는 28.7,26.5였으며, 채식인의 평균채식기간은 13.1년이었다. 조사대상자의 total-cholesterol, LDL-cholesterol, HDL-chole-sterol, AI, 수축기혈압 및 혈당은 비채식인이 유의적으로 낮았으며, 심혈관질환 예견지수인 HDL-cholsterol/total-chol-esterol 비는 채식인이 유의적으로 높았다. 두군 모두 중성지방, 혈청 총 콜레스테롤, LDL-cholesterol, AI,는 BMI, WHR, %BF와는 유의적으로 높은 정의상관을 보였다. HDL-cho-lesterol은 BMI, WHR과는 유의한 부의상관을 보였다. 나이는 채식인에서는 BMI, WHR과는 높은 정의상관을 보였다. 나이는 채식인에서는 중성지방과는 정의상관, 비채식인에서는 중성지방, 혈청 총 콜레스테롤, LDL-cholesterol, AI, 수축기 혈압과는 정의 상관을 보였다. 이상의 결과에서 볼 때 두군 모두 BMI, RBW, WHR, %BF가 높을수록 총콜레스테롤, LDL-cholesterol, AI, 수축기 혈압이 유의적으로 높아졌으며 BMI, WHR이 높을수록 HDL-cholesterol은 유의적으로 낮아졌다. 그러나 채식군은 비채식군에 비해 BMI, RBW, WHR, %BF가 유의적으로 높았음에도 불구하고 심혈관 질환 관련인자인 총콜레스테롤, LDL-cholesterol, AI, 수축기 혈압 및 혈당이 비채식군에 비해 유의적으로 낮게 나타났다. 한편 나이와의 상관에서도 비채식인은 나이와 중성지방, 총 콜레스테롤, LDL-cholesterol, AI등이 모두 정의 상관을 보였으나 채식군에서는 나이와 중성지방만이 정의 상관을 보였다. 따라서 채식을 하면 비만인 사람이라도 혈중 지질수준 및 혈당, 혈압이 낮아져서 심혈관 질환 및 고혈압, 당뇨병 등의 예방 치료에 효과적일 것으로 사료된다.

채식인과 비채식인의 식습관, 식품군별 섭취빈도와 심혈과 질환관련인자와의 관련성에 관한 비교 연구 (A Comparative Study of Relationships among Eating Behavior, Intake Frequency of Food Group and Cardiovascular disease Related Factors in Vegetariand and Non-Vegetarians)

  • 차복경
    • 한국식품영양과학회지
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    • 제30권1호
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    • pp.183-192
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    • 2001
  • 우리나라도 경제성장으로 식생활 수준이 향상되고 국제교류가 활발함에 따라 식생활에 많은 변화가 있었다. 이러한 식사형태의 변화와 더불어 서구의 문제라고 여겼던 심혈관 질환을 비롯한 만성질환으로 인한 사망률이 점차 증가하고 있다. 이에 본 연구에서는 채식과 일반식을 하는 사람들을 대상으로 식습관과 식품군별 섭취빈도 등이 혈중 지질수준과 혈당, 혈압에 미치는 영향을 조사한 결과를 요약하면 다음과 같다. 조사대상자의 평균나이는 채식인 44.20세, 비채식인 40.52세, BMI는 각각 22.47, 21.08이었고, WHR은 0.85, 0.84였고, %BF는 28.79, 26.55였으며, 채식인의 평균채식기간은 13.16년이었다. 조사대상자의 total-cholesterol, LDL-cholesterol, AI, 이완기혈압 및 혈당은 비책식인이 유의적으로(p<0.01) 높았고, HDL-cholesterol도 비채식인이 유의적으로 높았으며(p<0.05) 심질환 예견지수인 HDL/total cholesterol 비는 채식인이 유의적으로(p<0.01) 높았다. 조사대상자의 식습관 점수는 채식인이 25.07, 비채식인이 23.10으로 채식인이 유의적으로 높았으며(p<0.05) 비채식군에서는 식습관 점수가 높을수록 중성지방은 유의적으로 낮아졌다. 두 군 모두 혈청 총 콜레스테롤, LDL-cholesterol 및 AI는 식습관 점수가 높을수록 유의적으로 낮아졌으며(p<0.01), 같은 식습관 접수대에서는 채식인이 혈청 총 콜레스테롤, LDL-cholesterol, AI가 유의적으로 낮았다(p<0.05). 비채식군에서는 식습관 점수가 높으면 수축기 혈압이 유의적으로 낮아졌다(p<0.05). 채식인은 육류 및 생선, 계란, 우유 및 유제품을 전혀 먹지 않는 반면 곡류, 콩 및 콩제품, 녹황색야채 및 과일, 구근류, 해조류, 유지류는 대부분이 매일 2회 이상 먹고 그 섭취빈도가 비채식군에 비하여 두드러지게 높았다. 비채식인은 채식인과는 반대로 육류, 생선, 계란, 우유 및 유제품의 섭취빈도가 높고 녹황색야채와 구근류, 콩 및 콩제품의 섭취빈도가 낮았다. 이상의 결과에서 볼 때 채식인은 비채식인에 비해 식습관 점수가 유의적으로 높았으며(p

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신생아집중간호단위 환경과 저체중출생아의 반응에 대한 연구 (A Study on the Environment for Lowbirth Weight Infants in Neonatal Intensive Care Unit in the United States)

  • 한경자
    • Child Health Nursing Research
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    • 제4권2호
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    • pp.159-176
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    • 1998
  • In effort to conduct comparative study on the caregiving environment of Neonatal Intensive Care Unit(NICU) in both U. S and Korea, this study was been conducted first in the U.S. Purpose : The purpose of this study is to identify the physical environment and direct caregiving practices to lowbirth weight infants in NICU in the US. It also aims to examine the NICU outcome status and behavioral reponses of lowbirth weight infants. Methods : A study design using descriptive and inferential statistics was been conducted through an observational, field method. A sample of 15 preform infants admitted to NICU were recruited for the study. The subjects were those with birth weight between 1,000 gm to 1,500 gm, born at the gestation period of 27 to 33 weeks, and without any chromosomal or other genetic anomalies, major congenital infections, or maternal illness. Thirty minutes observation(three times of ten minutes of continuous observation)of the infant's behavior and physiological status, and an four-hour observation of the physical environment and direct care giving procedures were been conducted on the 3rd and 10th day after birth, and on the day of discharge from the NICU or at 34weeks postconception. The data to be collected were in four areas : the demograghic characteristics of the infants, the physical environment and care giving procedures, the frequency of the infant's designated behavior and physiological response, and NICU outcome variables. A descriptive analysis and Kruskal-Wallis, Pearson r were been applied according to variable characteristics. Results : 1. Mother's mean age was 29.47. The sample consisted of 6 males and 9 females. Mean gestational ages were 29.17 weeks. Mean birth weight was 1236.33g. Mean Apgar scores at one minute were 6.6, and 7.8 at five minutes. 2. The location for the incubator was in the distance from the light, X-ray screens and nursing station, in proximity to side-lamp, telephone and faucet on the third day after birth. The location for the incubator was in the distance from the light and radio on the tenth day and in proximity to nursing station on the day of dischage from the NICU or at 34weeks postconception. 3. Nesting was the most applying aids to the infants. And foot roll, shielding and plastic frame were frequently using by nurses for facilitating well modulated restful posture. 4. There were statistically significant changes in the patterns of physical environment included locating the infant's incubator and bedding, specific aids to self regulation on the 3rd and 10th day after birth, and on the day of discharge from the NICU or at 34weeks postconception. 5. Statistically significant changes were not appeared in the patterns of direct caregiving procedure to the infants included stress inducing or reducing manipulations on the 3rd and 10th day after birth, and on the day of discharge from the NICU or at 34weeks postconception. 6. The stress response of the infants in NICU were significantly reduced as the infants grow older. 7. There were not statistically significant correlation between the physical envronment and the stress responses of the infants in NICU. 8. There were statistically significant correlation between the direct caregiving procedure to the infants and the stress response of the infants in NICU in the second and third observation on the day three. 9. Average weight gain per day from birth to discharge was 38.73g, number of days in the hospital was 42.60, number of days before bottle feeding was 3.6. Postconception age starting bottle feed ing was 31/sup +5/ weeks. Number of days on mechanical ventilator was average 7.64, 11.42 was an average number of days of oxygen need. Conclusion : It, thus, appears that to minimize the sensorymotor stimulation for the low birthweight preterm infant in NICU, manipulation of care giving practices to the babies whatever the stress inducing or reducing procedures, have to be limited in the immediate early stage after birth. And it needed to be reexamine to identify the appropriate and specific physical environment and the patterns of direct caregiving to the low birthweight preform infant as the infants grow older in NICU.

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호스피스 환자의 돌봄 요구와 가족이 인지하는 환자의 돌봄 요구 비교: Q 방법론 (Care Needs of Hospice Patients in Comparison with Those from the Family Caregivers' Perspective: Q methodology)

  • 용진선;홍현자
    • Journal of Hospice and Palliative Care
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    • 제7권2호
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    • pp.153-168
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    • 2004
  • 목적: 본 연구의 목적은 호스피스 병동에 입원한 호스피스 환자들의 돌봄 요구 유형과 가족간호자가 인지하는 환자의 돌봄 요구 유형을 파악하고, 두 군 간에 차이가 있는지 비교하여 호스피스 환자의 돌봄 요구를 만족시키기에 도움이 되는 방법을 모색하는데 필요한 기초 자료를 제공하고자 한다. 연구방법으로는 개인에 대한 내적 의미에 중심을 두고 인간의 주관성이나 태도 유형을 심층적으로 측정할 수 있는 연구 방법론인 Q방법론을 적용하였다. 방법: 본 연구를 위한 Q표본은 호스피스 환자들의 돌봄 요구에 대한 경험으로 구성된 23개의 진술문이다. 자료는 2002년 12월부터 2003년 2월까지 23개의 Q-표본을 이용하여 C 대학 K 병원 호스피스병동에 입원하고 연구에 동의한 환자 20명군과 이들을 간호하는 주 가족간호자 20명군으로 가족 20쌍의 P-표본으로부터 각각 수집하였다. 탈분포도는 정상 분포방식에 따라 9점 척도 상에 대상자의 의견과 일치하는 정도에 따라 분류하도록 하였으며, 면담시 대상자의 구술도 기록하였다. 자료 분석은 Quanl PC 프로그램을 통한 Q요인분석인 주인자 분석방법을 이용하여, 요구 유형을 파악하기 위하여 평균분석, 요인 가중치, 영역별 요인 분석, 요인 배열을 하였고, 요인수의 결정을 위해 아이겐값은 1.0 이상을 기준으로 하였다. 결과: 연구결과 호스피스 환자 군과 가족간호자 군이 인지한 호스피스 환자의 돌봄 요구 유형은 네 가지로 확인되었다. 신체적, 정서적, 영적, 그리고 사회적 돌봄 요구 유형. 돌봄 요구 유형에 대한 두 군 간의 전체 일치률은 48%이었다. 제 1유형은 '신체적 돌봄 요구형' 으로 통증조절이 안된 상태로 통증으로 인하여 심한 고통을 당하고 있어 주호소인 통증 및 신체적 안위에 대한 돌봄을 우선적으로 요구하였다. 두 군 간의 일치율은 62.5%이었다. 제 2유형은 '정서적 돌봄 요구형' 으로 가족과 친밀감과 사랑을 나누기를 원하고 죽음에 대한 두려움을 따뜻한 대화로써 정서적으로 지지 받기를 원하였다. 두 군 간의 일치율은 20%이었다. 제 3유형은 '영적 돌봄 요구형' 으로 대상자 모두 종교를 가지고 신심이 깊었으며 절대자에게 용서 받고 싶은 욕구가 많았고 기도와 사목자의 방문을 원하였다. 두 군 간의 일치율은 60%이었다. 제 4유형은 '사회적 돌봄 요구형'으로 자신이 하던 일에 대한 마무리와 봉사를 원하는 것으로 나타났다. 두 군 간의 일치율은 50%이었다. 이상으로 볼 때, 호스피스 환자와 가족간호자가 인지한 환자의 돌봄 요구는 큰 차이가 있다는 것을 알 수 있다. 따라서, 호스피스 간호사는 호스피스 환자의 돌봄 요구를 만족시키기 위해서 환자와 가족간호자간에 환자의 돌봄 요구에 대한 인지의 차이를 좁히기 위한 적절한 방법을 모색하고, 가족간호자에게 환자의 돌봄 요구를 사정하기 위한 교육을 시켜야 하겠다.

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지역사회 작업치료사의 업무 특성 및 실태 조사 : 보건소 근무 작업치료사를 중심으로 (Job Characteristics and Status of Community Occupational Therapist : Focus on OTs in Public Health Centers)

  • 민경철;김은희;우희순
    • 대한지역사회작업치료학회지
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    • 제10권3호
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    • pp.37-52
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    • 2020
  • 목적 : 본 연구는 보건소에 근무하는 작업치료사를 대상으로 지역사회 작업치료사의 업무 특성 및 실태를 파악하여, 2020년 현재 지역사회 작업치료사에 관한 기초자료로서 활용하고자 시행하였다. 연구방법 : 전국 보건소에 근무하는 작업치료사를 대상으로 이메일을 통해 설문지를 배포하여 응답을 수렴하였다. 수집된 응답지 77부를 기술통계 및 상관관계 분석을 적용하였다. 결과 : 설문응답자는 여자(77.9%), 20-30대(96.1%)가 많았고, 주로 치매 관련 팀(72.7%)에서 근무하였으며 방문, 건강, 재활 관련 다양한 팀에 소속되어 있었다. 보건소 경력은 1-2년(67.5%), 계약형태는 시간선택제 공무원(61%)이 가장 많았고, 업무 강도는 보통-매우 높음(94.8%)이, 만족도는 보통-매우 만족(85.7%)이라는 응답이 가장 많았다. 업무 고충은 예산 행정 업무(26.7%), 업무 외 고충은 계약에 따른 불평등(27.2%)이 가장 높았다. 주로 참여하는 업무는 치매 쉼터, 방문 작업치료, 그룹 작업치료이었으며, 난이도는 예산 행정, 치매 쉼터, 방문 작업치료가 높았다. 주요 치료 목표는 인지능력 향상, 가족 지지가 많았고, 빈도는 인지능력 향상, 가족 지지, 평가가 높았다. 보건소 작업치료 대상은 치매, 일반 노인, 성인 뇌병변 순이었으며, 일반인, 정신과 질환, 아동 관련 대상도 포함되어있었다. 주로 평가를 진행하는 직군은 간호사(35.7%), 작업치료사(33.7%)였으며, MMSE-DS, SGDS, SMCQ를 많이 사용하는 것으로 조사되었다. 결론 : 본 연구를 통해 지역사회 작업치료사의 업무 특성 및 실태를 확인하였다. 치매 관련 사업 등 일부분에 집중되어 있는 작업치료 업무를 넘어선 전문적인 분야 개발 및 참여가 필요하며, 추후 커뮤니티 케어로 확장되고 있는 지역사회 재활의 흐름에 발맞춘 지역사회 작업치료사의 전문적인 역할 정립을 위한 자료로 활용되기를 바란다.

대한구순구개열학회의 글로벌 자선 수술 활동 : 케냐에서의 자선 수술 활동 (Global Charity Operations of Cleft Lip and Palate by Korean Cleft Lip and Palate Association ; Charity Operations in Kenya, east Africa)

  • 정필훈;박주영;박주용;안강민;백진우;조일환;최철민;최선휴;정일혁;고은봉;홍종락;현승돈;장현석;전상호;정성욱;강나라;강영호;김병렬;김동현;김은석;김호성;김인수;김지혁;김종렬;김중민;김명진;김성민;고봉화;고성희;이부규;이의석;이종호;이의룡;이원;이원덕;민병일;남일우;팽준영;박종철;박정석;박성희;박영욱;표성운;임채홍;임재석;서병무;서제덕;윤정호;윤정주;윤형진
    • 대한구순구개열학회지
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    • 제9권2호
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    • pp.85-92
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    • 2006
  • Korean Cleft Lip and Palate Association (KCLPA) was founded in 1996. The first overseas charity operation was in Karachi, Pakistan, 2002 and our association has visited fourteen times in six countries for the free cleft surgery: Pakistan, Egypt, Kenya, Morocco, Jordan and Vietnam. The cumulated number of operated patients reaches to 280. Before our association, many Korean oral and maxillofacial surgeons have performed charity operations individually since 1964. It was started from Vietnam but the activity is now carried on in Africa, middle-east Asia, south-east Asia, China, and Korea as an official team. LG electronics, a Korean company helped to propagate our team's activity to middle-east Asia to Africa. This paper is a report concerning about the results of our association's charity activities especially in Kenya, east Africa. We provided free cleft surgery for 30 patients in 2004 and 27 patients in 2005, in Nairobi. As the blood test for HIV of the cleft patients was not allowed before and during surgery, our surgeons and nurses were cautious about every movement during the surgeries. Thus the operation time for each patient was longer than any other time. The attitude of the local hospital and the doctors seemed to be accustomed to this situation. They helped us in case of needle injuries. Safety of medical staff and patients is more important than the number of the patients operated in charity operation. This belief should be approached being parallel and multidisciplinary as an international cooperation, focusing on international funding for medical support and continuous education for local doctors who are willing to devote to their people.

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계획된 간호 정보가 수면량에 미치는 영향에 관한 연구 -개심술 환자를 중심으로- (The Effect of Structured Information on the Sleep Amount of Patients Undergoing Open Heart Surgery)

  • 이소우
    • 대한간호학회지
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    • 제12권2호
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    • pp.1-26
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    • 1982
  • The main purpose of this study was to test the effect of the structured information on the sleep amount of the patients undergoing open heart surgery. This study has specifically addressed to the Following two basic research questions: (1) Would the structed in formation influence in the reduction of sleep disturbance related to anxiety and Physical stress before and after the operation? and (2) that would be the effects of the structured information on the level of preoperative state anxiety, the hormonal change, and the degree of behavioral change in the patients undergoing an open heart surgery? A Quasi-experimental research was designed to answer these questions with one experimental group and one control group. Subjects in both groups were matched as closely as possible to avoid the effect of the differences inherent to the group characteristics, Baseline data were also. collected on both groups for 7 days prior to the experiment and found that subjects in both groups had comparable sleep patterns, trait anxiety, hormonal levels and behavioral level. A structured information as an experimental input was given to the subjects in the experimental group only. Data were collected and compared between the experimental group and the control group on the sleep amount of the consecutive pre and post operative days, on preoperative state anxiety level, and on hormonal and behavioral changes. To test the effectiveness of the structured information, two main hypotheses and three sub-hypotheses were formulated as follows; Main hypothesis 1: Experimental group which received structured information will have more sleep amount than control group without structured information in the night before the open heart surgery. Main hypothesis 2: Experimental group with structured information will have more sleep, amount than control group without structured information during the week following the open heart surgery Sub-hypothesis 1: Experimental group with structured information will be lower in the level of State anxiety than control group without structured information in the night before the open heart surgery. Sub-hypothesis 2 : Experimental group with structured information will have lower hormonal level than control group without stuctured information on the 5th day after the open heart surgery Sub-hypothesis 3: Experimental group with structured information will be lower in the behavioral change level than control group without structured information during the week after the open heart surgery. The research was conducted in a national university hospital in Seoul, Korea. The 53 Subjects who participated in the study were systematically divided into experimental group and control group which was decided by random sampling method. Among 53 subjects, 26 were placed in the experimental group and 27 in the control group. Instruments; (1) Structed information: Structured information as an independent variable was constructed by the researcher on the basis of Roy's adaptation model consisting of physiologic needs, self-concept, role function and interdependence needs as related to the sleep and of operational procedures. (2) Sleep amount measure: Sleep amount as main dependent variable was measured by trained nurses through observation on the basis of the established criteria, such as closed or open eyes, regular or irregular respiration, body movement, posture, responses to the light and question, facial expressions and self report after sleep. (3) State anxiety measure: State Anxiety as a sub-dependent variable was measured by Spi-elberger's STAI Anxiety scale, (4) Hormornal change measure: Hormone as a sub-dependent variable was measured by the cortisol level in plasma. (5) Behavior change measure: Behavior as a sub-dependent variable was measured by the Behavior and Mood Rating Scale by Wyatt. The data were collected over a period of four months, from June to October 1981, after the pretest period of two months. For the analysis of the data and test for the hypotheses, the t-test with mean differences and analysis of covariance was used. The result of the test for instruments show as follows: (1) STAI measurement for trait and state anxiety as analyzed by Cronbachs alpha coefficient analysis for item analysis and reliability showed the reliability level at r= .90 r= .91 respectively. (2) Behavior and Mood Rating Scale measurement was analyzed by means of Principal Component Analysis technique. Seven factors retained were anger, anxiety, hyperactivity, depression, bizarre behavior, suspicious behavior and emotional withdrawal. Cumulative percentage of each factor was 71.3%. The result of the test for hypotheses show as follows; (1) Main hypothesis, was not supported. The experimental group has 282 minutes of sleep as compared to the 255 minutes of sleep by the control group. Thus the sleep amount was higher in experimental group than in control group, however, the difference was not statistically significant at .05 level. (2) Main hypothesis 2 was not supported. The mean sleep amount of the experimental group and control group were 297 minutes and 278 minutes respectively Therefore, the experimental group had more sleep amount as compared to the control group, however, the difference was not statistically significant at .05 level. Thus, the main hypothesis 2 was not supported. (3) Sub-hypothesis 1 was not supported. The mean state anxiety of the experimental group and control group were 42.3, 43.9 in scores. Thus, the experimental group had slightly lower state anxiety level than control group, howe-ver, the difference was not statistically significant at .05 level. (4) Sub-hypothesis 2 was not supported. . The mean hormonal level of the experimental group and control group were 338 ㎍ and 440 ㎍ respectively. Thus, the experimental group showed decreased hormonal level than the control group, however, the difference was not statistically significant at .05 level. (5) Sub-hypothesis 3 was supported. The mean behavioral level of the experimental group and control group were 29.60 and 32.00 respectively in score. Thus, the experimental group showed lower behavioral change level than the control group. The difference was statistically significant at .05 level. In summary, the structured information did not influence the sleep amount, state anxiety or hormonal level of the subjects undergoing an open heart surgery at a statistically significant level, however, it showed a definite trends in their relationships, not least to mention its significant effect shown on behavioral change level. It can further be speculated that a great degree of individual differences in the variables such as sleep amount, state anxiety and fluctuation in hormonal level may partly be responsible for the statistical insensitivity to the experimentation.

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농촌(農村) 주민(住民)들의 의료필요도(醫療必要度)에 관(關)한 연구(硏究) (A Study Concerning Health Needs in Rural Korea)

  • 이성관;김두희;정종학;정극수;박상빈;최정헌;홍순호;라진훈
    • 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.

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