• 경영과정보연구
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• 제31권4호
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• pp.57-82
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• 2012

최근 우리나라 의료복지 분야는 인구의 고령화, 만성질환의 증가, 교통사고, 각종 산업재해, 약물 오 남용, 의학의 발달, 국가복지재정의 악화 등 다양한 환경변화에 둘러싸여 있으며, 새로운 형태의 의료복지와 관련된 새롭고 다양한 서비스 개발의 필요성이 부각되고 있다(조만복, 2010). 국가의 경제적 수준이 높아질수록 사회복지에 대한 사회적 관심은 증가하는 추세이나 복지에 대한 국가의 역할 축소와 사회복지정책에 민간참여의 확대 등 사회복지 여건의 변화는 요양시설 사회복지사들에게 시설서비스의 효과성과 효율성 제고를 위해 다양한 새로운 지식과 기술 습득, 그리고 스스로 최고의 성과를 달성하고자 노력하는 정신자세의 정립을 요구하고 있다. 요양시설에서 서비스 제공자인 사회복지사는 시설클라이언트의 삶의 질에 직접적인 영향을 미치며 서비스의 효과성에 매우 중요한 영향을 미치게 된다. 그러나 양질의 서비스 제공이라는 중요한 책무성을 지니는 장애인 및 노인요양시설은 조직 및 직무환경에 있어서 직원개발 기회의 부족, 조직보상체계의 미흡, 조직의 폐쇄성, 직원자율성의 결여, 전문성의 부족 등의 다양한 문제를 경험하고 있다(이문휘, 2007; 신현석, 2006; 박정양, 2003; 김철용, 2009). 본 연구는 실천현장에서 요양시설조직 내에서 요양시설 사회복지사의 임파워먼트 영향요인인 직무의 특성, 조직의 특성 요인에 대한 인식과 임파워먼트 수준 그리고 직무만족도에 관해서 알아보고 이러한 변인들이 사회인구학적 특성 변인별로 차이가 있는가에 대해서 살펴보고자 한다. 또한 요양시설 사회복지사의 임파워먼트에 미치는 영향력을 분석하고, 직무의 특성, 조직의 특성 그리고 임파워먼트 수준이 직무만족에 미치는 영향을 분석하는데 연구 목적이 있다.

• 의료법학
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• 제19권2호
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• pp.41-72
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• 2018

분업적 의료행위에 있어서 관여자들에 대한 의료과실을 인정함에 있어서는 그의 형사 책임을 제한하거나 또는 형사책임을 적절히 분배할 필요성이 있다. 본 논문은 분업적 의료행위에 있어서 의료인의 주의의무위반에 대한 판단기준과 이를 제한하는 규칙을 다루고 있다. 의료행위에 있어서 주의의무위반에 대한 판단기준으로 객관설이 타당함을 논증하였다. 주의의무를 판단함에 있어서 행위자 개인에게 최상의 주의의무 또는 완벽한 주의의무를 요구하는 것도 도덕적 요청으로는 의미가 있을지 모르지만, 법질서가 요구하는 수준은 사회적으로 상당한 수준 또는 '정상의' 주의의무라고 해석하는 것이 타당하다. 과실기준을 객관화함으로 개인이 책임을 지는 한계의 상한을 설정해줌으로써 개인에게 지나친 부담을 안겨주는 것을 방지하고 평등의 원칙에도 부합한다. 구체적 사례에 있어서 의료과실을 판단하는 경우에도 고려해야 할 표지를 설명하였다. 의료행위는 일반적 과실과는 다르게 전문성, 재량성과 같은 특수성, 정보의 편중성과 독점성이 있기 때문이다. 일반적 의학수준, 긴급성과 의료설비와 같은 의료환경과 조건, 의료행위의 전문성, 의료행위의 재량성에 대하여 검토하였다. 주의의무를 제한하는 규칙으로 허용된 위험의 이론과 신뢰의 원칙을 검토하였다. 수평적 분업관계에서는 신뢰의 원칙이 적용된다. 같은 병원 의사들이 각각 전문분야를 가지는 경우, 다른 병원 의사들 사이의 관계의 경우에는 원칙적으로 신뢰의 원칙이 적용된다. 그러나 예외적으로 신뢰의 원칙이 적용될 수 없는 경우도 존재한다. 수직적 분업관계에서는 신뢰의 원칙이 적용되지 않으며 상급자는 하급자를 신뢰할 수 없다. 이 경우 상급자는 하급자에 대한 위험감독의무로 전환된다. 관리의무는 임의적·간헐적 심사(stichprobenartige Überprüfungen)를 하는 것으로 충분하다고 생각한다.

• Journal of Preventive Medicine and Public Health
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• 제16권1호
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• pp.135-152
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• 1983

Emergency medical service is an important part of the health care delivery system, and the optimal allocation of resources and their efficient utilization are essentially demanded. Since these conditions are the prerequisite to prompt treatment which, in turn, will be crucial for life saving and in reducing the undesirable sequelae of the event. This study, taking the hyperbaric chamber for carbon monoxide poisoning as an example, is to develop a stochastic approach for solving the problems of optimal allocation of such emergency medical facility in Korea. The hyperbaric chamber, in Korea, is used almost exclusively for the treatment of acute carbon monoxide poisoning, most of which occur at home, since the coal briquette is used as domestic fuel by 69.6 per cent of the Korean population. The annual incidence rate of the comatous and fatal carbon monoxide poisoning is estimated at 45.5 per 10,000 of coal briquette-using population. It offers a serious public health problem and occupies a large portion of the emergency outpatients, especially in the winter season. The requirement of hyperbaric chambers can be calculated by setting the level of the annual queueing rate, which is here defined as the proportion of the annual number of the queued patients among the annual number of the total patients. The rate is determined by the size of the coal briquette-using population which generate a certain number of carbon monoxide poisoning patients in terms of the annual incidence rate, and the number of hyperbaric chambers per hospital to which the patients are sent, assuming that there is no referral of the patients among hospitals. The queueing occurs due to the conflicting events of the 'arrival' of the patients and the 'service' of the hyperbaric chambers. Here, we can assume that the length of the service time of hyperbaric chambers is fixed at sixty minutes, and the service discipline is based on 'first come, first served'. The arrival pattern of the carbon monoxide poisoning is relatively unique, because it usually occurs while the people are in bed. Diurnal variation of the carbon monoxide poisoning can hardly be formulated mathematically, so empirical cumulative distribution of the probability of the hourly arrival of the patients was used for Monte Carlo simulation to calculate the probability of queueing by the number of the patients per day, for the cases of one, two or three hyperbaric chambers assumed to be available per hospital. Incidence of the carbon monoxide poisoning also has strong seasonal variation, because of the four distinctive seasons in Korea. So the number of the patients per day could not be assumed to be distributed according to the Poisson distribution. Testing the fitness of various distributions of rare event, it turned out to be that the daily distribution of the carbon monoxide poisoning fits well to the Polya-Eggenberger distribution. With this model, we could forecast the number of the poisonings per day by the size of the coal-briquette using population. By combining the probability of queueing by the number of patients per day, and the probability of the number of patients per day in a year, we can estimate the number of the queued patients and the number of the patients in a year by the number of hyperbaric chamber per hospital and by the size of coal briquette-using population. Setting 5 per cent as the annual queueing rate, the required number of hyperbaric chambers was calculated for each province and for the whole country, in the cases of 25, 50, 75 and 100 per cent of the treatment rate which stand for the rate of the patients treated by hyperbaric chamber among the patients who are to be treated. Findings of the study were as follows. 1. Probability of the number of patients per day follows Polya-Eggenberger distribution. $$P(X=\gamma)=\frac{\Pi\limits_{k=1}^\gamma[m+(K-1)\times10.86]}{\gamma!}\times11.86^{-{(\frac{m}{10.86}+\gamma)}}$$ when$${\gamma}=1,2,...,n$$$$P(X=0)=11.86^{-(m/10.86)}$$ when $${\gamma}=0$$ Hourly arrival pattern of the patients turned out to be bimodal, the large peak was observed in $7 : 00{\sim}8 : 00$ a.m., and the small peak in $11 : 00{\sim}12 : 00$ p.m. 2. In the cases of only one or two hyperbaric chambers installed per hospital, the annual queueing rate will be at the level of more than 5 per cent. Only in case of three chambers, however, the rate will reach 5 per cent when the average number of the patients per day is 0.481. 3. According to the results above, a hospital equipped with three hyperbaric chambers will be able to serve 166,485, 83,242, 55,495 and 41,620 of population, when the treatmet rate are 25, 50, 75 and 100 per cent. 4. The required number of hyperbaric chambers are estimated at 483, 963, 1,441 and 1,923 when the treatment rate are taken as 25, 50, 75 and 100 per cent. Therefore, the shortage are respectively turned out to be 312, 791. 1,270 and 1,752. The author believes that the methodology developed in this study will also be applicable to the problems of resource allocation for the other kinds of the emergency medical facilities.

• 직업교육연구
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• 제35권4호
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• pp.19-46
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• 2016

이 연구의 목적은 사회적 수요가 증가하는 특성화고등학교 간호과 교육의 운영 현황과 교육과정 편성 운영, 교육환경 등에 대한 현황을 분석하고 간호과 교육의 개선 방향을 탐색하는데 목적이 있다. 이 연구의 방법은 관련 선행연구를 분석하고 학교알리미, 교육통계연보 등 간호관련 학과 개설 및 운영 현황 자료, 학교 교육과정, 각 기관 및 협회의 홈페이지에 소개된 공시 자료 등을 수집 분석하였다. 이 연구의 주요 결과는 다음과 같다. 첫째, 2016년 1학기 현재 특성화고등학교 중에 간호과를 개설 운영하는 학교는 총 38개교로 전체 특성화고 마이스터고의 약 6.4% 정도이다. 이들 학교는 주로 보건간호과, 치의보건간호과, 간호과, 의료간호관광과. 간호회계 및 간호경영과 등의 명칭으로 개설하였다. 간호과 졸업생은 2012년 이후 취업률과 진학률간의 격차가 좁혀지고 있으며 2015년에는 특성화고등학교 전체 평균 취업률인 46% 수준이었다. 둘째, 특성화고등학교 간호과는 인력양성 목표를 간호조무사 양성에 두고 관련 취득 자격으로 간호조무사, 요양보호사 등을 주로 제시하고 있었다. 간호과 교육과정은 자격 취득 요건, 현장 직무 수행에서 필요한 역량과 관련한 과목들을 편성하고 있었으나 간호과 교육과정의 충분성, 자격과 교육과정 편성과의 정합성 등을 검토해야 한다. 법적 요건인 780시간의 현장실습은 주로 1학년부터 2학년까지 3번의 방학을 통해 병의원 현장에서 별도의 교육과정으로 운영되고 있었다. 셋째, 간호과 교육의 물적 환경은 전공별로 2개 정도의 실습실과 학생 규모를 고려한 시도교육청의 시설설비 기준을 적용하여 비교적 기본 환경을 구축 활용하고 있었다. 인적 환경인 교사 확보는 간호 표시과목이 없음에 따라 표시과목의 개설, 지역별 배치 기준의 검토, 전문성 함양을 위한 연수 및 연구, 장학의 지원을 위한 개선이 시급한 것으로 나타났다.

• 제3의학
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• 제2권1호
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• pp.35-54
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• 1997

We tried to observe the features of ancient medical practice by analysing the records related to medicine in the book, ${\ulcorner}$the Historical Records of the Three Kingdom${\lrcorner}$ of which content includes the features of medicine in mythology, plague, delivery of twins, drugs, medical system, shamanism, constitutional medicine, psychiatry, forensic medicine, deformity, a spa, medical phrase, health and welfare work, religion, death. physiological anatomy, Taoist medicine, acupuncture, the occult af of transformation and etc. Our initial concern was about where to draw line as of medical field and we defined medicine in more broad meaning. The book ${\ulcorner}$the Historical Records of the Three Kingdoms${\lrcorner}$ describes the world of mythology by way of medicine which is not clearly a conventional one. There appears records of birth of multiple offsprings 7 times in which cases are of triplets or more. Delivering multiple offsprings were rare phenomenon though such fertility was highly admired. This shows one aspect of ancient country having more population meant more power of the nation. Of those medical records conveyed in that book includes stories of childbirth such as giving birth to a son after praying, giving birth to Kim Yoo-shin after 20 months after mother's dream of conception, and a song longing for getting a laudable child. Plagues were prevalent throughout winter to spring season and one can observe various symptoms of plagues in the record. Of these epidemic diseases, cold type might have been more common than the heat one. Appearance of epidemic diseases frequently coincided with that of natural disasters that this suggests a linkage between plague and underlying doctrine on five elements' motion and six kinds of natural factors. There exists only a few names of diseases such as epidemic disease, wind disease, and syndrome characterized by dyspnea. Otherwise there appeared only afflictions that were not specified therefore it remains cluless to keep track of certain diseases of prevalence. Since this ${\ulcorner}$Historical Records of the Three Kingdoms'${\lrcorner}$ wasn't any sort of medical book, words and terms used were not technical kind and most were the ones used generally among lay people. Therefore any mechanisms of the diseases were hardly mentioned. Some of medicinal substances such as Calculus Bovis, Radix Ginseng, Gaboderma Luciderm, magnetitum were also in use in those days. 53 kinds of dietary supplies appears in the records and some of these might have been used as medicinal purpose. Records concerning dicipline of one's body includes activities such as hunting, archery, horseback riding etc. In Shilla dynasty there were positions such as professor of medicine, Naekongbong(內供奉), Kongbong's doctor(供奉醫師), Kongbong's diviner(供奉卜師). As an educational facility, medical school was built at the first year of King Hyoso's reign and it's curricula included various subjects as ${\ulcorner}$Shin Nong's Herbal classic${\lrcorner}$, ${\ulcorner}$Kabeul classic of acupuncture and moxbustion${\lrcorner}$, ${\ulcorner}$The Plain Questions of the Yellow Emperor's Classic of Internal Medicine${\lrcorner}$, ${\ulcorner}$Classic of Acupuncturer${\lrcorner}$, ${\ulcorner}$The Pulse Classic${\lrcorner}$, ${\ulcorner}$Classic of Channels and Acupuncture Points${\lrcorner}$ and ${\ulcorner}$Difficult Classic${\lrcorner}$. There were 2 medical professors who were in charge of education. To establish pharmacopoeia, 2 Shaji(舍知), 6 Sha(史), 2 Jongshaji(從舍知) were appointed. In Baekje dynasty, Department of Herb was maintained. Doing praying for the sake of health, doing phrenology also can be extended to medical arena. Those who survived over 100 years of age appear 3 times in the record, while 98 appears once. The earliest psychiatrist Nokjin differentiated symptoms to apply either therapies using acupuncture and drug or psychotherapy. There appears a case of rape, a case of burying alive with the dead, 8 cases of suicide that can characterize a prototype of forensic medicine. Deformity-related records include phrases as follow: 'there seems protrudent bone behind the head', 'a body which has two heads, two trunks, four arms.', 'a body equipped with two heads' In those times spa can be said to be used as a place for he리ing, convalescence, and relaxation seeing the records describing a person pretended illness and went to spa to enjoy with his friends. Priest doctors and millitary surgeons were in charge of the medical sevice in the period of the Three Kingdoms by the record written by Mookhoja(墨胡子) and Hoonkyeom(訓謙). Poor diet and regimen makes people more vulnerable to diseases. So there existed charity services for those poor people who couldn't live with one's own capacity such as single parents, orphans, the aged people no one to take care and those who are ill. The cause of affliction was frequently coined with human relation. There appeared the phenomenon of releasing prisoners and allowing people to become priests at the time of king's suffering. Besides, as a healing procedure, sutra-chanting was peformed. There appears 10 cases of death related records which varies from death by drowning, or by freezing, death from animals, death from war, death from wightloss and killing oneself at the moment of spouse's death and etc. There also exist certain records which suggest the knowledge of physiology and anatomy in those times. Since the taoist books such as ${\ulcorner}$Book of the Way and Its Power(老子道德經)${\lrcorner}$ were introduced in the period of Three Kingdoms, it can be considered that medicine was also influenced by taoism. Records of higher level of acupuncture, records which links the medicine and occult art of transformation existed. Although limited, we could figure out the medical state of ancient society.