• Journal of Hospice and Palliative Care
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• 제2권1호
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• pp.1-6
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• 1999

배경 : 안락사는 조절되지 않는 고통을 경감시킬 목적으로 한 사람의 생명을 끝낼 의도를 가지고 가해지는 중재를 말한다. 안락사를 합법화하고 규정을 만드는데 대한 논쟁이 의학 논문들을 통하여 계속되어 왔다. 방법 : 지난 수년간 발표된 안락사에 대한 논문들을 정리하였고 안락사를 시행하는 이유들을 알아보았다. 또한 네덜란드에서 안락사를 정책적으로 허용한 이후에 빚어진 결과를 문헌 고찰을 통하여 소개하였다. 결과 : 안락사가 아닌 행위가 종종 안락사로 불리어 왔으나 그 안에 내포된 윤리적 원칙들을 조사함으로써 구분이 가능하다. 네덜란드에서 안락사를 시행하는데 사용하였던 지침들은 부적절하였고 남용된 바가 컸는데도 렘멜링크 위원회의 보고서는 네덜란드에서는 안락사가 적절히 잘 이루어 졌다고 소개하였다. 결론 : 안락사를 합법화 해야할 임상상황은 어디에도 존재하지 않는다. 총괄적이고 여러 분야의 전문가가 협동하는 완화의학은 안락사를 시행해야 할 이유라고 불리는 말기환자들의 고통의 대부분을 효과적으로 조절해 줄 수 있다.

• 한국산학기술학회논문지
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• 제21권2호
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• pp.470-478
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• 2020

본 연구에서는 단일 환산지수 체계를 유형별 외래 및 입원 환산지수로 분리하기 위한 이론 모형을 설계하였다. 그리고 가상 자료를 바탕으로 외래 및 입원 환산지수와 조정계수를 산출하였다. 본 연구에서의 중요한 결론은 다음과 같다. 첫째, 외래·입원 환산지수 개념을 도입하고 설계함으로써 의원은 외래, 병원은 중한 환자 위주의 입원 기능에 집중하도록 유도할 수 있는 최소한의 인센티브 도구를 도입할 수 있다. 둘째, 환산지수를 분리함으로써 상급종합병원을 비롯한 대형병원의 외래 진료비 수입이 목표 진료비 예산 이상으로 증가하더라도 병원수익 증대에 큰 도움이 되지 않도록 보상 체계를 설계할 수 있는 방안을 도입해 자원 배분 동기를 부여할 수 있다. 셋째, 단일 환산지수보다 다양한 요소들에 대한 명시적인 계약이 가능해져 급증하는 진료비에 대한 적절한 관리 수단으로 활용할 수 있다. 마지막으로 외래 및 입원 환산지수 분리 계약은 공급자의 행위론적인 변화를 유도해 의료전달체계를 정립하는데 기여할 수 있는 정책적인 도구로 활용될 수 있을 것이다.

• 한국유통학회지:유통연구
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• 제16권3호
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• pp.105-133
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• 2011

본 연구는 친환경농산물 구매에 있어서 소비자들이 생각하는 가격변수의 중요도를 살펴보고 가격수준에 대한 소비자의 의견에 영향을 미치는 요인들을 분석하는데 그 목적이 있다. 연구의 결과를 보면, 직접질문 결과 현재 친환경농산물 구매에 있어서 소비자들은 '제품에 대한 상세한 설명', '유통채널', '친환경식품 표기에 대한 신뢰' 등을 가격보다 더 중요하게 생각하고 있는 것으로 나타났다. 다음으로 서열로짓분석 결과가 제시하는 바는 '어린 자녀의 수'나 '가족 중 환자 유무' 등 상황적 요인이 친환경농산물의 가격수준에 대한 소비자들의 의견에 가장 큰 영향을 미치는 변수로 나타났다. 그리고 마지막으로 컨조인트분석 결과를 보면 '유통채널'이 가장 중요한 속성으로 나타났으며, 다음으로 '표기에 대한 신뢰' 그리고 가격 순으로 나타났다. 이는 첫 번째 직접질문방식의 결과가 제시하는 바와 비슷한 결과로 풀이된다. 즉 '친절한 설명'이라는 변수는 컨조인트분석에 포함하지 않았음을 감안할 때, 주어진 상품프로파일 상의 선택을 이용한 간접적인 분석 결과와 직접적으로 질문한 결과가 같은 의미를 제공하고 있음을 알 수 있다.

• 간호행정학회지
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• 제8권2호
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• pp.309-321
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• 2002

Purpose: A cost analysis for nursing services in operative nursing unit, emergency nursing unit, and ambulatory nursing unit was performed using patient classification system by nursing intensity in order to determine an appropriate nursing fee schedule. Method: The data were collected from 4 secondary hospitals and 5 tertiary hospitals from November 14th 2000 to January 15th 2001. The study was conducted through four phases as follows: 1) Nursing hours of each nursing service in special nursing units were measured using three kinds of patient classification systems by nursing intensity. 2) The nursing cost of nursing services in operative nursing unit, emergency nursing unit, and ambulatory nursing units was estimated based on patient classification system by nursing intensity. Results: As a result, nursing hours by nursing intensity of each special nursing unit were measured, and every nursing cost by nursing intensity in operation room and emergency room was estimated, meanwhile, the cost of nursing services in ambulatory care units was estimated only per visit as shown in chapter 4. Conclusion: Future research on nursing cost should be extended to other special nursing units such as various intensive nursing care units, delivery room, and so on. In addition, the patient classification system should be refined for its appropriateness to apply all levels of medical institutions.

• 대한간호학회지
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• 제47권1호
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• pp.14-24
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• 2017

Purpose: The purpose of this study was to construct and test a hypothetical model of self-management in patients with hemodialysis based on the Self-Regulation Model and resource-coping perspective. Methods: Data were collected from 215 adults receiving hemodialysis in 17 local clinics and one tertiary hospital in 2016. The Hemodialysis Self-management Instrument, the Revised Illness Perception Questionnaire, Herth Hope Index and Multidimensional Scale of Perceived Social Support were used. The exogenous variable was social context; the endogenous variables were cognitive illness representation, hope, self-management behavior, and illness outcome. For data analysis, descriptive statistics, Pearson correlation analysis, factor analysis, and structural equation modeling were performed. Results: The hypothetical model with six paths showed a good fitness to the empirical data: GFI=.96, AGFI=.90, CFI=.95, RMSEA=.08, SRMR=.04. The factors that had an influence on self-management behavior were social context (${\beta}=.84$), hope and cognitive illness representation (${\beta}=.37$ and ${\beta}=.27$) explaining 92.4% of the variance. Self-management behavior mediated the relationship between psychosocial coping resources and illness outcome. Conclusion: This research specifies a more complete spectrum of the self-management process. It is important to recognize the array of clinical resources available to support patients' self-management. Healthcare providers can facilitate self-management through collaborative care and understanding the ideas and emotions that each patient has about the illness, and ultimately improve the health outcomes. This framework can be used to guide self-management intervention development and assure effective clinical assessment.

• 한국간호교육학회지
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• 제5권1호
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• pp.39-57
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• 1999

Essential hypertension is a typical chronic disease requiring adequate and continuous management. And many studies supported that self-care was the essential factor to promote the wellbeing. The purpose of this study is to identify and understand the behavior patterns of self-care in hypertensives. As a research method, 35 Q-statements were collected through Individual interviews and review of the related literatures. 21 subjects were interviewed and the data were analyzed by the PC QUANL program with principal component analysis. There were 6 different self-care types classified as follows 1) Type 1 was the self-oriented control type, monitoring the blood pressure and taking the low salt diet. But they didn't take the anti -hypertensive drug and visit the health agency regularly. 2) Type 2 was the stress-control type. Their main activities were meditation to relieve the stress and communication with family. 3) Type 3 was called daily-life control type. This type tried to make their mind comfort and think positively. They also preferred walking and exercise regularly. 4) Type 4 was the medical-oriented control type, taking the anti-hypertensive drug, visiting the medical personnel and following the medical regimens. 5) Type 5 was the medication-oriented type. They only took the anti -hypertensive drug regularly and didn't any other self-care like as monitoring the blood pressure, taking the low salt diet and exercise. 6) Type 6 was called non-medication control type. This type had no medication, but tried to visit the health agency and health personnel. From the above results, it can be concluded that the self-care types were very various and self-care education have to provide individually according to the characteristics of self-care type. Another repeated study can be recommended to improve the nursing intervention the self-care behavior in chronic patient like as diabetics or rheumatoid arthritis.

• 대한간호학회지
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• 제47권4호
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• pp.514-525
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• 2017

Purpose: The purpose of this study was to construct and test a structural equation model for Diabetes self-management (DSM) behavior and Quality of life (QoL) in older adults with diabetes who use Citizen Health Promotion Centers. The theory used this study was a combination of the Information-Motivation-Behavioral Model (IMB) and Self-Determination Theory (SDT) to reflect autonomous characteristics of participants. Methods: Data were collected from April 20 to August 31, 2015 using a self-report questionnaire. The sample was 205 patients with type 2 Diabetes who regularly visited a Citizen Health Promotion Center. SPSS 22.0 and AMOS 22.0 programs were used to analyze the efficiency of the hypothesized model and calculate the direct and indirect effects of factor affecting the participants' DSM behavior and QoL. Results: The supported hypotheses were as follows; 1) The variable that had a direct effect on QoL was health behavior adherence (${\gamma}=.55$, p=.007). 2) The variables that had a direct effect on DSM behavior were DSM information (${\gamma}=.15$, p=.023), DSM confidence (${\gamma}=.25$, p<.001), and autonomous motivation (${\gamma}=.13$, p=.048). 3) The variable that had a direct effect on DSM confidence was autonomy support (${\gamma}=.33$, p<.001). Conclusion: The major findings of this study are that supporting patient's autonomous motivation is an influential predictor for adherence to DSM behavior, and integrative intervention strategies which include knowledge, experience and psychosocial support are essential for older adults with diabetes to continue DSM behavior and improve QoL.

• 한국간호교육학회지
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• 제20권1호
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• pp.81-92
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• 2014

Purpose: This study was to identify the effect of the experience of diabetes education on knowledge, self-care behavior and glycosylated hemoglobin (HbA1C). Further, this study was held to examine about patient's preferred methods of education and re-education frequency. Methods: 166 type 2 diabetes patients from two hospitals in Incheon participated in this study. Data were analyzed by using descriptive analysis, t-test, ANOVA, Scheffe's test and multiple regression analysis. Results: 72.3% patients needed re-education and the average interval of re-education was 8.53 months. Patients preferred education methods were lectures, practical training, and studying from pamphlet. Depending on the frequency of diabetes education, there were significant differences in the level of diabetes knowledge (F=10.88, p<.001) and self-care behaviors (F=4.59, p=.012), but there was not significant difference with HbA1C (F=1.53, p=.220). As to how much the diabetes education helped managing diabetes, there was a significant difference in the level of self-care behaviors (t=2.01, p=.049), but there were not significant differences in level of knowledge (t=1.10, p=.275) and HbA1C (t=-.33, p=.746). The experience of diabetes education was a significant factor which influenced patient's knowledge (t=3.93, p<.001) and self-care behaviors (t=2.21, p<.001). But HbA1C was not influenced by the experience of diabetes education (t=-1.68, p=.096). Conclusion: It is necessary to provide diabetes education with appropriate interval and methods and subjects that reflect the needs of patient through the study results.

• 한국간호교육학회지
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• 제15권2호
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• pp.260-273
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• 2009

Purpose: The purpose of this study was to investigate the knowledge of cardiac rehabilitation, educational needs, and self care in inpatients with coronary artery disease in China and to provide basic data for development of cardiac rehabilitation programs. Method: From Jan. 16th to Feb. 26th, 2009, 104 patients with coronary artery disease were hospitalized in general hospitals in K and H city in China. They were interviewed with a structured questionnaire. The data was analyzed using descriptive statistics, t-test, ANOVA, and Pearson's correlation analysis. Results: In inpatients with coronary artery disease in China, the score of knowledge of cardiac rehabilitation was average ($66{\pm}.18$), and the score of educational needs was high ($4.27{\pm}.49$). The score of self care was average ($3.12{\pm}.58$). The regular exercise group (p= .005) had a high knowledge of cardiac rehabilitation, the nonsmoking group (p= .022) and regular exercise group (p= .037) did well by themselves. Educational needs also affected the overall knowledge of inpatients with coronary artery disease (r= .288, p= .003). Conclusion: This study suggests that knowledge of cardiac rehabilitation and educational needs should be considered in enhancing cardiac rehabilitation programs designed for inpatients with coronary artery disease in China.

• 근관절건강학회지
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• 제11권1호
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• pp.50-60
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• 2004

Purpose: The purpose of this study was to examine the relationships among the health promoting behavior, pain, self-esteem, family support, self-efficacy in patients with chronic arthritis. Method: The data for this study were collected from February 19, 2003 to April 7, 2003. The subjects were 150 chronic arthritis patients who visited University Hospital in D City. The research instruments used in this study were HPLP II, Visual analogue scale, Self-esteem scale, Family support scale, Self-efficacy scale. In data analysis, SPSS PC ver 10.0 program was utilized and data were analyzed using descriptive statistics and t-test, ANOVA, Multiple Stepwise Regression and Pearson's correlation coefficient. Result: The average score of the pain, self-esteem, family support, self-efficacy, health promoting behavior was 5.38, 3.37, 4.29, 70.30, 2.68, respectively and the variable with the highest degree of it's subscale was interpersonal support(3.08), whereas the one with the lowest degree was exercise(1.66). There was a positive correlation(r=.327, p=.000) between the self-esteem and health promoting behavior. There was a positive correlation(r=.540, p=.000) between the family support and the self-efficacy and health promoting behavior. Family support, self-efficacy and marital status were significant factors to explain a variance of health promoting behavior in patients with chronic arthritis(51.6%). health promoting behavior. There was a positive correlation(r=.477, p= .000) between Conclusion: The health promoting behavior were positively correlated with self-esteem, family support and self-efficacy. These findings help to understand relationships among self-esteem, family support and self-efficacy in chronic arthritis patients. In addition, family support, self-efficacy and marital status were the mainly influencing factors of health promoting behavior. Among these variables family support was the most significant factor to predict a health promoting behavior. According to the results of this study, family support must be considered as a main factor in the nursing strategy for health promoting behavior of chronic arthritis patients.