• The Korean Society of Law and Medicine
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• v.24 no.4
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• pp.103-128
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• 2023

According to the current act of Decision-Marking in Life-Sustaining Medicine, the decision to withhold or discontinue life-sustaining treatment is primarily based on the wishes of a patient in the dying process. Decision-making regarding life-sustaining treatment for these patients is made by the patient, if he or she is conscious, directly expressing his/her intention for life-sustaining treatment in writing or verbally or by writing an advance medical directive and physician orders for life-sustaining treatment. It can be exercised. On the other hand, if the patient has not written an advance medical directive or physician orders for life-sustaining treatment, the patient's intention can be confirmed with a statement from the patient's family, or a decision to discontinue life-sustaining treatment can be made with the consent of all members of the patient's family. However, in the case of an unrelated patient who has no family or whose family is unknown, if an advance medical directive or physician orders for life-sustaining treatment are not written before hospitalization and a medical condition prevents the patient from expressing his or her opinion, the patient's will cannot be known and the patient cannot be informed. A situation arises where a decision must be made as to whether to continue or discontinue life-sustaining treatment. This study reviewed discussions and measures for unbefriended patients under the current law in order to suggest policy measures for deciding on life-sustaining treatment in the case of unbefriended patients. First, we looked at the application of the adult guardian system, but although an adult guardian can replace consent for medical treatment that infringes on the body, permission from the family court is required in cases where death may occur as a direct result of medical treatment. It cannot be said to be an appropriate solution for patients in the process of dying. Second, in accordance with Article 14 of the Life-Sustaining Treatment Decision Act, we looked at the deliberation of medical institution ethics committees on decisions to discontinue life-sustaining treatment for patients without family ties.Under the current law, the medical institution ethics committee cannot make decisions on discontinuation of life-sustaining treatment for unbefriended patients, so through revision, matters regarding decisions on discontinuation of life-sustaining treatment for unbefriended patients are reflected in Article 14 of the same Act or separate provisions for unbefriended patients are made. It is necessary to establish and amend new provisions. In addition, the medical institution ethics committee must make a decision on unbefriended patients, but if the medical institution cannot make such a decision, there is a need to revise the law so that the public ethics committee can make decisions, such as discontinuing life-sustaining treatment for unbefriended patients.

• Research in Community and Public Health Nursing
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• v.2 no.1
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• pp.160-160
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• 1990

정부는 보건의료취약지역의 주민에게 보건의료를 효율적으로 제공케 함으로써 국민의 의료균형과 보건향상에 목적을 두어 보건진료원을 1981년부터 훈련 배치하였다. 본 연구는 사전 Pre-test, Post-test, Control Group Design에 의하여 이들 보건진료원이 배치되기 이전에 baseline data를 수집 분석하여 3년 후(1984년)에 보건 진료원의 활동성과를 종합적으로 평가하기 위해 실시된 것이다. 본 연구에서 농어촌 벽지에 보건진료원이 배치됨으로써 보건진료원 투입 전 후, 투입지역과 비투입지역(대조지역, control area)간 비교분석에 의하여 보건진료원이 보건의료서비스 접근성의 변화에 준 순효과가 종합적으로 평가될 수 있다. 그러나 본 보고서는 1981년에 농어촌 벽지 4,083 가구의 표본에서 수집된 자료를 이용하여 벽지의 보건의료서비스 접근성의 현상분석에 치중하고 있다. 보건의료서비스는 의료 서비스와 예방서비스로 구분되었고 예방서비스는 모성보건, 영유아보건, 가족계획으로 세 분류 되었다. 보건의료서비스와 접근성은 Aday와 Andersen의 모형에 의하여 4개 component로 나누어 분석되었고, 각 component의 특성은 지표(indicator)에 의하여 설명되고 있다.

• 대한예방의학회:학술대회논문집
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• 2001.04a
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• pp.1-26
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• 2001

국가 보건의료체계(health care system)가 올바르게 기능하기 위해서는 의료체계를 구성하는 각 요소들간의 유기적인 상호 작용이 대단히 중요하다. 정보체계는 이러한 유기적인 상호 작용을 위해 보건의료체계의 각 영역에서 꼭 필요한 시스템이다. 보건의료 서비스를 효율적으로 생산하기 위해서 투입하는 자원의 개발과 배치 체계는 물론 생산된 보건의료 서비스를 소비자가 효과적으로 이용할 수 있도록 하는 서비스 전달체계(delivery system)의 전과정에서 보건의료정보체계는 중요한 인프라가 되고 있다. 정보체계는 궁극적으로 보건의료체계가 지향하는 목적을 달성할 수 있도록 짜여져야 한다. 다시 말해, 의료체계의 각 하부영역에서 의료이용의 접근성(accessibility), 형평성(equity), 서비스의 의과학적 질(scientific technical quality), 포괄성(comprehensiveness) 등 보건의료체계가 추구하는 가치를 정보체계에서도 그대로 담아 낼 수 있어야 한다. 또한 정보체계를 구축하기 위한 요건으로 각 사업 영역별 표준화, 사업 영역간의 상호관계, 공공과 민간의 역할 분담, 정보 관련 시선과 인력, 정보기술 등의 인프라, 각 사업 영역별 정보화에서 담아야 할 정보 내용(contents, DB) 등에 대한 사전 기획이 수립되어야 한다. 그 동안 보건의료분야의 정보화사업은 1996년부터 보건소기관의 행정, 진료, 보건 업무지원을 위한 보건소정보화사업과, 1995년부터 초고속공공응용서비스 사업의 일환으로 추진해 온 전염병, 혈액유통, 장기이식, 외래진료예약, 원격진료, 응급의료, 원격치매진료 시스템 구축사업 등이 있으며, 응급의료, 혈액관리, 장기이식, 전염병정보, 외래진료예약시스템을 통합한 보건의료정보통합서비스시스템(1998년) 구축사업 등이 있었다. 이러한 사업들에 대해 현재 평가되고 있는 문제점들로는 정보화 사업에 대한 전략과 비젼이 부재한 상태에서 지나치게 정보기술 중심으로 추진되다 보니 보건의료 정보의 공유나 활용이 전혀 이루어지지 않거나 매우 제한적이었고, 시범사업의 경우는 초기 사업을 추진하기 위한 주체가 명확하지 않았고, 관련 인력의 훈련과 양성이 안 되었으며, 사업 확대를 위한 법적 기반의 취약, 정보화 사업이 부실한 데 대한 평가 기준과 대안 제시 등이 매우 취약한 것이 문제점으로 나타났다. 특히, 정보 내용과 DB 구축을 위한 표준화 등에 대한 사전 설계 부재는 개발된 정보시스템의 운영을 결정적으로 어렵게 만든 요인이 되고 있다. 전반적으로 기존의 정보화사업은 사업 추진을 위해서 꼭 필요한 비젼 수립, 비젼에 따른 목표 설정, 전략 개발, 관리체계 구축, 운영방안 수립 등 단계적인 정보화 계획이 부재한 것으로 평가되고 있어 보건의료정보체계 구축을 위한 종합 비젼 기획(ISP)이 시급한 실정이다.

• The Journal of the Korea Contents Association
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• v.21 no.8
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• pp.294-304
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• 2021

Medical institutions remodel existing hospital buildings rather than construct buildings to satisfy patient satisfaction and enhance competitiveness with other medical institutions. Medical institution remodeling is gradually increasing due to enhanced laws and systems to improve the quality of medical services and the level of patient safety. However, prior studies were discussed only within a limited range, including architectural elements, about medical institution remodeling. Therefore, this study aims to provide basic data to medical institutions planning future remodeling by examining the legal issues of medical institution remodeling in various ways. Medical institution remodeling extends the construction period due to restrictions on construction conditions, and causes damage such as noise and dust to patients. So it is necessary to prevent damage to patients in advance and to support appropriate remodeling of medical institutions. Therefore, it is necessary to prepare an Act on promotion of and support for remodeling of medical institutions. In addition, medical institutions should prepare a checklist for voluntary compliance with construction standards, preventive measures and post-improvement measures, and measures for infection and radiation exposure in hospitals.

• 건강소식
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• v.14 no.6 s.139
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• pp.2-5
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• 1990

건협 부산지부는 지난해부터 선천성대사이상질환 중 페닐케톤뇨증(PKU)에 대한 검사를 실시해, 관련 의료기관으로부터 좋은 반응을 불러 일으키고 있다. 지난해 2월부터 검사의 필요성에 대한 계몽작업을 시작해 지금까지 가검물수집, 검사, 결과통보까지 성실히 수행해 오고 있는 부산지부는, 지난해의 검사에 대한 평가를 통해 올해에는 선천성 대사이상 질환의 발견율을 증가시키기 위해 검사종목의 확대 등에 대한 계획을 수립, 진행시키고 있다. 부산지역 내 신생아 건강관리에 일익을 담당하고 있는 이 검사사업이 전국적으로 확대되어 정신박약아의 발생을 사전에 예방할 수 있게 되기를 바라면서 부산지부의 검사 실시 과정과 앞으로의 계획을 들어보기로 한다.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.26 no.3
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• pp.197-209
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• 2019

Purpose: This study was done to examine good death awareness, attitudes toward advance directives (ADs), and preference for care near the end-of-life (PCEOL) of hospitalized elders in long-term care hospitals. Relevant characteristics were investigated as well as correlation of the variables. Methods: This descriptive research study involved 161 hospitalized elderly patients in long-term care hospitals. A self-report questionnaire was used to measure Good Death Scale, ADs Survey, PCEOL Scale, and general characteristics. Collected data were analyzed using descriptive statistics, t-test, ANOVA, and Pearson correlation with SPSS/WIN 23.0. Results: In terms of good death awareness, a significant difference was observed; in according to age (F=3.35, p=.037), payer of treatment costs (F=3.98, p=.021), mobility (F=3.97, p=.021), heard discussion about ADs (t=-3.89, p<.001), and willing to complete ADs (t=2.12, p=.036). As far as attitudes toward ADs, the participants presented significant difference depending on religion (t=2.38, p=.018), average monthly income (F=3.91, p=.022), duration of hospital admission (F=5.33, p=.006), person to discuss ADs (t=-2.76, p=.006). On PCEOL, there was a significant difference, depending on religion (t=-3.59, p<.001) and perceived health status (F=3.93, p=.022). Finally, as for how the variables were related to each other, good death awareness and attitudes toward ADs had a weak positive correlation with PCEOL. Conclusion: To help seniors staying in nursing homes face a good death and enjoy autonomy, there should be educational and support systems that reflect each individual's sociodemographic characteristics so that the seniors can choose what kind of care they want to receive near the end-of-life.

• Journal of the Korea Society of Computer and Information
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• v.29 no.2
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• pp.153-168
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• 2024

The purpose of this study was to verify the correlation between variables that affect the intention to continue using medical information service applications. Then, we established a research model based on ETPB and conducted an empirical study using PLS-SEM.According to the empirical analysis results, First, intimacy, prior knowledge, and cost saving were confirmed to have a significant impact on the TPB variables such as attitude, subjective norm, and perceived behavioral control. Second, it was confirmed that TPB variables had a significant impact on behavioral intention, and behavioral intention had a significant impact on continued use intention. Third, it was confirmed that familiarity, prior knowledge, and cost saving had a significant impact on the intention to continue use through the mediation of behavioral intention based on the perception shift of medical consumers. The significance of this study is that it empirically investigated the behavior of medical consumers by deriving the impact on their intention to continue using medical information service applications through their behavioral intentions.

• Journal of the Korea Convergence Society
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• v.10 no.11
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• pp.189-198
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• 2019

In this preliminary study exploring the development of an convergent educational program, we identified the factors that affect adherence to healthcare-associated infection (HAI) control guidelines. The data were collected using a self-reported questionnaire of 183 nursing students. The collected data were analyzed using AMOS 21.0 and SPSS 21.0 program. The model fit was ${\chi}^2=52.06$ (df=9, p<.01), GFI=.93, RMSEA=.16, NFI=.85, and CFI=.90, and the explanatory power was 26.2%. As a result in this study, it was found that the theory of planned behavior(TPB) was appropriate for explaining the intention about healthcare-associated infection control guidelines. It is necessary to develop an education program that can reinforce the concepts of TPB, and iterate research to verify its effectiveness.

• The Korean Society of Law and Medicine
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• v.15 no.1
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• pp.335-373
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• 2014

According to one Medicare report, in the US, total federal spending on health care expends almost 18 percent of the nation's GDP, about double what most industrialized nations spend on health care. And in 2011, Medicare spending reached close to $554 billion, which amounted to 21 percent of the total spent on U.S. health care in that year. Of that $554 billion, Medicare spent 28 percent, or about $170 billion, on patients' last six months of life. So what are the reasons of this high cost in EOL care and its possible solutions? Much spendings of Medicare on End-of-Life care for the terminally ill/chronically ill in the US has led health economics experts to assess the characteristics of the care. Decades of study shows that EOL care is usually supply-sensitive and poor in cost-effectiveness. The volume of care is sensitively depending on the supply of resources, rather than the severity of illness or preferences of patients. This means at the End-of-Life care, the medical resources are being overused. On the other hand, opposed to the common assumption, "The more care the better utility", the study shows that the outcome is very poor. Actually the patient preference and concerns are quite the opposite from what intense EOL care would bring about. This study analyzes the reasons for the supply-sensitiveness of EOL care. It can be resulted from the common misconception about the intense care and the outcome, physicians' mission for patients, lack of End-of-Life Care Decision which helps the patients choose their own preferred treatment intensity. It also could be resulted from physicians' fear of legal liabilities, and the management strategy since the hospitals are also seeking for financial benefits. This study suggests the possible solutions for over-treatment at the End-of-Life resulting from supply-sensitiveness. Solutions can be sought in two aspects, legal implementation and management strategy. In order to implement advance directive properly, active ethics education for physicians to change their attitude toward EOL care and more conversations about end-of-life care between physicians and patients is crucial, and incentive system for the physicians who actively have the conversations with patients will also help. Also, the general education towards the public is also important in the long run, and easy and official advance directive registry system-such as online registry-has to be built and utilized more widely. Alternative strategies in management are also needed. For example, the new strategic cost management and management education, such as cutting unnecessary costs and resetting values as medical providers have to be considered. In order to effectively resolve the problem in EOL care for the terminally ill/chronically ill and provide better experience to the patients, first of all, the misconception and the wrong conventional wisdom among doctors, patients, and the government have to be overcome. And then there should be improvements in systems and cultures of the EOL care.

• Korean Journal of Adult Nursing
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• v.27 no.4
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• pp.449-458
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• 2015

Purpose: The aims of this study were to identify the reported attitudes of older patients with cancer toward advance directives (ADs) and the factors associated with their attitudes toward ADs. Methods: The design was a cross-sectional survey. The age mean of the 130 participants were 70.8, and 66.2% of the participants were male. The data were collected at one university hospital in Seoul, South Korea during the period from October $1^{st}$ to December $5^{th}$ in 2013. The data collecting instruments were the Advance Directives Attitude Survey (ADAS) and questionnaires including socio-demographic and disease-related characteristics, family function. Results: 30.0% of the participants were aware of ADs, only 9% of them had been informed by healthcare providers. Most participants (93.1%) intended to complete ADs. The mean score of ADAS was 48.29. The stepwise linear regression analysis indicated that family function, perceived health status, period of education, and age accounted for a significant percentage (52.0%, p<.001) of the variance in participants' ADAS. The variable with the greatest effect was family function. Conclusion: The findings suggest that family function and attitude of older cancer patients need to be considered for adapting ADs to Korean health care systems. Healthcare providers should include family members in advanced care planning discussions.