• 대한간호학회지
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• 제8권1호
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• pp.163-180
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• 1978

Much of a person's energy is spent in the effort of becoming a productive member of to-day's complex society. This activity may cause tension, and chronic unrelieved tension is an influential factor in blood pressure elevation. The problem of this study was to identify manifest needs and self-actualization of patients with essential hypertension, and to analyse and compare their manifest needs and selt-actualization with the selected general characteristics of We, sex, religion, occupation and level of education with a control group of patients with normal blood pressure readings. The purpose was to contribute to the planning of nursing interventions toward reducing the impact of complex psycho-somatic factors on the anxiety of patients with essential hypertension. The instruments used included selected items from the Edwards (1959) Personal Preference Schedule (EPPS) as adapted by Hwang (1965) and from the Personal Orientation Inventory (POI) (Shostrom 1964, 1974) adapted by Kim and Lee (1977) to measure manifest needs and self-actualization. The convenience sample was chosen from 149 persons who presented themselves for general physical examinations at Ewha University Medical Centre and 41 patients diagnosed with essential hypertension at three general hospitals in Seoul during June 1 and August 31, 1977. Forty-nine persons from the Ewha group with blood-pressure readings exceeding 150/90 were added to the experimental group. Data were analysed by the S.P.S.S. computer programme using t-test and tests for statistical significance. Statistically significant findings were as follows: A. Blood Pressure and Manifest Needs. 1. with the exception of Autonomy, patients with hypertension had significantly high scores on all variables Abasement, Achievement, Affiliation, Aggression, Dominance, Emotionality, Exhibitionism and Sex. 2. When mean scores of normal persons were compared by age groups, normal persons had higher scores in the following order on Abasement (50's, 40's, 20's, 30's), Achievement (50's, 30's, 40's, 20's), Affiliation (50's, 40's, 30's, 20's), Dominance (50's, 40's, 40's, 20's) and Exhibitionism (30's, 50's, 40's, 20's). In each case, there was a significant difference between the first and last age group scores. 3. When the mean scores of normal persons were compared by sex, normal men had higher scores than women on Achievement, Affiliation, Aggression, Dominance, Exhibitionism and Sex. Male patients had higher scores than female patients on Achievement, Dominance, Exhibitionism and Sex, but female patients scored higher in Emotionality. 4. Normal persons had higher scores related to religion in the following order on Achievement (Buddhism, no religion, Christianity). Hyper tensive patients had higher scores on. Exhibitionism (no religion, Christianity, Buddhism). 5. Normal persons had higher scores related to occupation in the following order on Achievement and Exhibitionism (unemployed, office workers, teachless, businessmen), Emotionality (office workers, unemployed, businessmen, teacher) and Sex (office workers, unemployed, teachers, businessmen). Hypertensive patients had higher scores on Achievement and Aggression (teachers, businessmen, office worker, unemployed), Dominance and Exhibitionism (businessmen, teacher, of ace workers, unemployed) and Sex (teachers, office worker, businessmen, unemployed). 6. Normal persons had higher scores related to level of edification in the following order on Abasement, Emotionality and Autonomy (secondary school graduation, university). Hypertensive patients had higher scores on Abasement (no education, primary, university, secondary), Achievement (no education, secondary, university, primary) , Dominance (university, no education, secondary, primary), Exhibitionism (university, secondary, no education, primary), and Sex (university, secondary, primary, no education). B. Blood Pressure and Self_Actualization 1, Patients with hypertension had significantly lower scores on all variables. 2. Normal persons had higher scores related to age groups in the following order on Existentiality (20's, 30's, 40's, 50's). Hypertensive patients showed no significantly different scores. 3. Normal women had higher scores than men on Time Competence. Normal men had higher scores on Feeling Reactivity. Male patients had higher scores than women on Self-Actualizing Value and Self-Regard. 4. Normal persons ha 1 higher scores related to religion on spontaneity (Buddhism, no religion, Christianity). Hypertensive patients had higher scores on Time Competence and Nature of Man (Buddhism, Christianity, no religion). 5. Normal persons had higher scores related to occupation in the following order on Existentiality (teachers, office workers, businessmen, unemployed) and Self-Regard (unemployed, office workers, teachers, businessmen). Hypertensive patients showed no significantly different scores. 6. Normal persons had higher scores related to level of education in the following order on Existentiality and Self-Acceptance (university, secondary). Hypertensive patients had higher scores on inner-Director (university, secondary, no education, primary) and Existentiality (university, secondary, primary, no education). Recommendations for nursing interventions with hypertensive patients with emotional problems or low self-actualization were made. 1. The nurse should encourage the patient through her interactions with other members of the medical team to accept counselling and health education. 2. Through her therapeutic interpersonal relationships with the patient, the nurse should help him discover the causes of his emotional tension. 3. Through her health teaching with the family, the nurse should encourage them to participate with the medical team in the patient's therapeutic plan and in providing him with the minimum possible emotional support. 4. Through frequent counselling with the obsessive-thinking and inflexible patient, the nurse should reevaluate the patient's behaviour and her interventions. 5. Seriously ill patients should be given needed reeducation by members of the professional medical team.

• 대한간호학회지
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• 제28권1호
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• pp.117-131
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• 1998

The purpose of this study was to develop a critical pathway for case management for patients who have received Coronary Artery Bypass Graft (CABG) because of Ischemic Heart Disease(IHD) which is a factor of rising medical expenses. For this study. a conceptual framework was developed through a review of the literature including six critical pathways which are currently being used in USA. In order to identify the overall service contents required by these patients and to draw up a preliminary critical pathway, 30 cases of medical records of patients who had CABG because of IHD between January, 1995 to June. 1996 at the Cardiovascular Center of Yonsei Medical Center in Seoul were analyzed. An expert validity test was done for the preliminary critical pathway and clinical validity test was also done using seven IHD patients with CABG between November 11 and 23, 1996. After these processes. the final critical pathway was developed. The results of this study are summarized as follows : 1. The vertical axis of the critical pathway includes the following eight items : tests, nutrition, medications, consultations, activity, assessments, treatments, education discharge planning and the horizontal axis includes the time from the start of hospitalization to discharge. 2. Analysis of the 30 medical records indicated that the average length of stay was 20.2days with the average length of stay from hospitalization day to operation day being 6.2 days, and the average length of stay from operation day to discharge day was 13. 9 days. Analysis of the service contents showed that the horizontal axis of the preliminary critical pathway was set from hospitalization to the 14th post operation day and the vertical axis was set to include eight items, the contents which ought to have occurred, according to the time frames of the horizontal axis. 3. As a result of the experts validity, it was found that among the total of 571 items. there was over 83% agreement for 482 items, less than 83% for 89 items, which were then deleted and a revision of the critical pathway was done. 4. A clinical validity test was done using seven IHD patients with CABG. During the process, three patients were deleted because they were out of the criteria the investigator set. Finally, four patients were used. The result of study indicated that only one patient was discharged on the tenth post operation day, which was one day later than the expected day. Three patients were discharged later than the expected day from three days to nine days. All the cases progressed on schedule until the operation day and the first post operation day, but from the second post operation days, there were differences between the critical pathway and the actual practice. The differences came from tests, assessments, and treatments. 5. On the basis of the results of the clinical validity test. the following revisions in the final critical pathway were made : the transfer from ICU to step down ward would be the second post operation day, and the transfer to a general ward, the fifth post operation day, for patients who complained of lack of sleep from the fifth post operation day to discharge, a sleeping pill would be prescribed, skin observations would be performed routinely from immediately after the operation until the third post operation day, and would continue if there was a sign of skin injury on the fourth post operation day, and assessment of chest pain would be done from the third post operation day, and the “stairs climbing” item, expected to be done on the ninth post operation day would be deleted. In conclusion, this critical pathway is partially applicable to the care of patients with CABG but there are some parts needed to be further investigated.

• 한국학교ㆍ지역보건교육학회지
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• 제4권
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• pp.21-41
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• 2003

The purposes of this study were to ; first, investigate High School Teachers health promotion behavior types; second, explore the effects High School Teachers perceived benefits and perceived barriers have on their health promotion behavior ; third, suggest a desirable course that will increase teachers health. To this end, this researcher conducted a survey on health promotion behavior, perceived benefits, and perceived barriers to 329 High School teachers working in Goyang-si, Gyonggi-do. The results of the survey are as follows: Health Promotion Behavior A closer look at high school teachers health promotion behavior shows that male teachers, compared with female teachers, more actively promote their health. However, female teachers are more aware of their personal hygiene and disease risks. Older teachers, rather than younger teachers, are more willing to promote their health through better eating habits and more frequent exercise. A comparison between married and single teachers revealed that married teachers promote their health through better eating habits, and single teachers receive less stress and are better at managing their stress. Teachers working in technical high schools are better at managing their stress and personal hygiene than academic high schools teachers. Teachers working after 8 o'clock show better health promotion behavior through proper eating habits, stress management, regular exercise, disease prevention: however, teachers working before 7:30 are poor at managing their stress. Teachers not teaching supplementary lessons and not supervising night self-study are better at managing their stress, exercise schedule, and disease prevention than teachers who are. Perceived Benefits, Perceived Barriers, and Health Promotion Behavior A Comparison between male and female teachers shows that female teachers firmly believe improved eating habits and regular exercises would greatly enhance their health. However, female teachers felt more discomfort in their working environment and in utilizing medical institutes. Teachers in the 20s and 40s perceived health benefits through regular lifestyle and exercise. Teachers with less experience feel more pressure from their work environment. Teachers below their 30s feel more dissatisfaction towards using medical facilities. Teachers working in Technical High Schools are more aware of promoting their health through regular health checkups, exercise, and lifestyle ; however, teachers from Academic High Schools feel more pressure from their work environment. Teachers not performing supplementary lessons and supervising night self-study sessions are more willing to go through regular health checkups than those performing them. Also, teachers with supplementary lessons and night self-study supervisions claimed lack of leisure time, pressure from work environment, and inconvenience in using medical facilities a deterrent to promoting their health behavior. The Relationship between Health Promotion Behavior, Perceived Benefits, and Perceived Barriers The correlation ratio between Health Promotion Behavior and Perceived Benefits shows a positive relationship. The results show that High School teachers believed regular health checkups are necessary in maintaining their health. This research shows that teachers consider the following factors important in the order shown ; regular lifestyle and exercise, prevention of geriatric diseases, improving ones eating habits. In short, teachers who are more aware of the importance of regular health checkups are also more aware of the importance of promoting their health. The correlation ratio between Health Promotion Behavior and Perceived Barriers shows negative relationship. High School Teachers believe that lack of leisure activity, pressure from work environment, familys financial burden, fear of diseases, inconvenience in using medical facilities are a deterrent in promoting their health behavior. In other words, teachers with less leisure time and negative pressures from their work environment were less active in promoting their health behavior. This study shows that High School teachers will be able to promote their health behavior by maintaining regular health checkups, lifestyle, exercise, and preventing geriatric diseases. However, teachers believed that insufficient leisure time and negative pressure from their work environment acted as a deterrent to maintaining their health behavior. Most High School teachers believe they are at present healthy, and they were actively engaged in Preventative Health Promotion. The result of this study demonstrates that External factors have a large impact on teachers, which in turn acts negatively on their Health Promotion Behavior. In order to guarantee teachers health promotion behavior, systematic health checkups and increased leisure time, improvement in their work environment are necessary. Teachers also need to take a more active interest in their health.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제2권2호
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• pp.169-177
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• 1999

목 적: 소아 만성 B형 간염 환아에서 알파 인터페론의 치료 효과는 보고자마다 차이가 있으나 30~40%로 알려져 있다. 그러나 만성 지속성 B형 간염, 혈청 ALT치가 낮은 경우나 혈청 HBV DNA치가 높은 소아 만성 B형 간염 환자에서 알파 인터페론 단독 투여 시 그 치료 효과는 더 낮다고 보고되고 있다. 이에 저자들은 알파 인터페론 단독 투여 시 치료 효과가 낮다고 알려진 소아 만성 B형간염 환자에 prednisolone 이탈 요법 후 인터페론 병용 투여 시 그 치료 효과를 알아보고자 본 연구를 시행하였다. 대상 및 방법: 1996년 1월부터 1997년 12월까지 전남대학교병원 소아과에 내원하여 만성 B형 간염으로 진단받은 28명을 대상으로 하였다. 대상 환아 중 간 조직 검사 상 만성 활동성 간염을 보이고 혈청 ALT치가 100 IU/L 이상이고 혈청 HBV-DNA치가 100 pg/$300\;{\mu}L$ 미만인 14명(group 1)은 알파 인터페론을 체표면적($m^2$) 당 5백만 단위를 6개월 동안 주 3회 단독 투여하였다. 조직 검사 상 만성 지속성 간염인 경우와 만성 활동성 간염이면서 혈청ALT치가 100 IU/L 미만 또는 혈청 HBV DNA치가 100 pg/$300\;{\mu}L$ 초과한 14명(group 2)은 prednisolone을 60 mg/$m^2$, 40 mg/$m^2$, 20 mg/$m^2$으로 각각 2주씩 6주간 경구 투여하고 2주간 휴약 기간을 가진 후 알파 인터페론을 group 1과 같은 방법으로 투여하였다. 치료에 대한 반응은 인터페론 투여가 종료되는 시점에서 완전반응(항 HBe 항체의 양전화, 혈청 ALT 정상화 및 혈청 HBV-DNA 음성), 부분반응(혈청 ALT 정상화 또는 혈청 HBV-DNA 음성) 및 무반응으로 평가하였다. 결 과: 1) 대상 환아의 평균 연령은 130.6개월(21~192개월)이었고, 남아는 22례, 여아는 6례이었다. 만성 지속성 간염은 11례, 만성 활동성 간염은 17례이었고, 15명의 환아에서 모친이 B형 간염 바이러스 만성 보유자이었다. 2) Group 1에서 평균 연령은 144.1개월(97~169개월), 남아 9명, 여아 5명, 혈청 ALT $299.9{\pm}215.3$ IU/L, HBV-DNA $49.3{\pm}33.1\;pg/300\;{\mu}L$이었고, group 2에서 평균 연령은 112.1개월(21~192개월), 남아 13명, 여아 1명, 만성 지속성 간염 11명, 만성 활동성 간염 3명, 혈청 ALT $85.6{\pm}71.0$ IU/L, HBVDNA $524.3{\pm}1064\;pg/300\;{\mu}L$이었다. 3) Group 1에서 항 HBe 항체 양전은 10례(71.4%) 에서, 혈청 ALT는 9례(64.3%)에서 정상화되었고, HBV-DNA는 11례(78.6%)에서 음성화되었다. Group 2에서 항 HBe 항체 양전은 7례(50.0%)에서, 비정상 수치를 보인 9명의 환아 중 5명(55.6%)이 ALT 의 정상화를 보였고, HBV-DNA는 9례(64.3%)에서 음성화되었다. 두 군간의 항 HBe 항체의 양전율, ALT치의 정상화율, HBV DNA치의 음성화율에 있어서 통계학적으로 유의한 차이는 없었다. 4) Group 1에서 완전반응은 8례(57.1%), 부분반응은 3례(21.4%), 무반응은 3례(21.4%)이었고, group 2 에서는 완전반응 7례(50.0%), 부분반응 2례(14.3%), 무반응 5례(35.7%)으로 두 군간의 통계학적 유의한 차이는 없었다. 결 론: 소아 만성 B형 간염에 대한 치료로 인터페론 단독 요법으로 반응이 좋지 않을 것으로 예측되는 환자군에 스테로이드 이탈 요법 후 인터페론 병합 투여는 안전하고 효과적인 치료법으로 생각된다. 향후 치료 효과의 지속 여부에 대한 지속적인 관찰과 더 많은 환자를 대상으로 한 전향적인 비교 연구가 필요하리라 사료된다.