• 한국직업건강간호학회지
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• 제18권2호
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• pp.141-152
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• 2009

Purpose: The purpose of this research was to describe the decision making of nurses in a VIP ward. Method: The methodology of collecting and analyzing the data was based on the grounded theory of Strauss and Corbin (1998). The data were collected through an in-depth interview, which were audio-taped and transcribed. The data were collected from 10 nurses from July to November 2007. Results: The core category on VIP ward nurses' decision making was named as "adjusting with flexibility and deepened insight". The causal condition was established by 'the patients who wanted to be treated specially'. The contextual conditions included 'caring patients from various departments', 'differences depending on the nurses' clinical experience', and 'client-centered atmosphere in the VIP ward'. The intervening conditions included 'problem solving styles of nurses', 'attitudes of patients and family members', 'nurse-doctor relationships', and 'accessibility to information'. It was confirmed that nurses changed their action-interaction strategies depending on the intervening conditions, thus resulted in the nurses' role conflict and the need to expand their consciousness. Conclusion: The result of this study indicates that nurse's decision making depends on their experiences and the nature of social context in which nursing occurs.

• Journal of Hospice and Palliative Care
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• 제24권4호
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• pp.204-213
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• 2021

Purpose: At the end of life, communication is a key factor for good care. However, in clinical practice, it is difficult to adequately discuss end-of-life care. In order to understand and analyze how decision-making related to life-sustaining treatment (LST) is performed, the shared decision-making (SDM) behaviors of physicians were investigated. Methods: A questionnaire was designed after reviewing the literature on attitudes toward SDM or decision-making related to LST. A final item was added after consulting experts. The survey was completed by internal medicine residents and hematologists/medical oncologists who treat terminal cancer patients. Results: In total, 202 respondents completed the questionnaire, and 88.6% said that the decision to continue or end LST is usually a result of SDM since they believed that sufficient explanation is provided to patients and caregivers, patients and caregivers make their own decisions according to their values, and there is sufficient time for patients and caregivers to make a decision. Expected satisfaction with the decision-making process was the highest for caregivers (57.4%), followed by physicians (49.5%) and patients (41.1%). In total, 38.1% of respondents said that SDM was adequately practiced when making decisions related to LST. The most common reason for inadequate SDM was time pressure (89.6%). Conclusion: Although most physicians answered that they practiced SDM when making decisions regarding LST, satisfactory SDM is rarely practiced in the clinical field. A model for the proper implementation of SDM is needed, and additional studies must be conducted to develop an SDM model in collaboration with other academic organizations.

• Journal of Periodontal and Implant Science
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• 제46권3호
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• pp.166-175
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• 2016

Purpose: Decision-making by dental and medical experts can be influenced by their biases, interests, and experiences, and academic arguments about controversial issues may additionally be considered indirect experiences capable of affecting decision-making. This study reports on the use of interactive communication devices to evaluate preferences and flexibility in decision-making among dental care providers who attended two distinct academic conferences. Methods: Two debates were presented by a team of two lecturers at two academic conferences (focusing on periodontology and implant dentistry, respectively) and the audience members of each session were surveyed. Before each lecture, two case modules about the diagnosis and treatment of multirooted molar lesions were provided, and interactive communication devices were used to collect responses about decision-making preferences in treatment planning immediately before and after a debate about treatment strategies. Results: In total, 81 and 84 completed answers from both conferences were obtained for the first and second case modules, respectively. The preferred treatment plan differed significantly according to the focus of the conference, and a tendency emerged for the clinicians participating in each conference to express uniform preferences. However, attending the debates resulted in significant changes in decision-making preferences regardless of the conference focus or the characteristics of the participants. Conclusions: Our findings suggest that providing continuing education via debates on controversial issues may be effective in widening conceptual knowledge and reducing biases among experts in the dental and medical fields.

• 사상체질의학회지
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• 제29권3호
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• pp.248-261
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• 2017

Objectives The purpose of this study is to analyze the decision making process of prescribing Yeoldahanso-tang and Taeeumjowi-tang Choweseuncheng-tang using decision tree. Methods We used collected the prospective clinical data of TE type from September 2012 to July 2015. In this study, we used gender, BMI, blood pressure, pulse and clinical symptoms (digestion, sweat, defecation, urination, sleep, physical status, emotion, heat-coldness, water consumption, facial color) as variables. Decision trees were analyzed using open source R version 3.3.2. Results & Conclusions We found that the decision trees differed among institutions. However, in all institutions, it was found that stool type (ordinary symptom), urine frequency (ordinary and present symptom) and anxiety (ordinary symptom) were important in the decision of prescription. Besides, clinical informations such as sex, Body Mass Index and blood pressure affected the prescription decision.

• 임상간호연구
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• 제24권1호
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• pp.44-55
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• 2018

Purpose: This study aimed to explore and understand the experience of decision making among women undergoing or forgoing selective fetal reduction who have higher-order multiple pregnancies through assisted reproductive techniques. Methods: A qualitative study was conducted from August 1, to October 30, 2013. Eight participants were interviewed and the interviews were audio-recorded and transcribed verbatim. Six persons participated in in-depth interviews in person and two participated over the telephone. A thematic analysis was conducted. Results: Four themes were identified and carefully named: Confusion after higher-order multiple pregnancy; Obstacles to choice: Uncertain safety; Weighing between reality and ideality and; Influences of medical professionals. Conclusion: The results demonstrated a wide range of factors considered by women when making decisions about selective fetal reduction, and mothers' feelings of conflict and distress in the decision-making process. The results suggest that it is important for nurses to provide emotional support and consolation, in addition to sufficient information. These findings will help nurses improve their counseling techniques by understanding the situation of infertile couples.

• 대한간호학회지
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• 제38권2호
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• pp.298-309
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• 2008

Purpose: The purpose of the study was to describe the experiences of do-not-resuscitate (DNR) among nurses. Methods: Data were collected by in-depth interviews with 8 nurses in 8 different hospitals. Conventional qualitative content analysis was used to analyze the data. Results: Eight major themes emerged from the analysis: DNR decision-making bypassing the patient, inefficiency in the decision-making process of DNR, negative connotation of DNR, predominance of verbal DNR over written DNR, doubts and confusion about DNR, least amount of intervention in the decision for DNR change of focus in the care of the patient after a DNR order, and care burden of patients with DNR. Decision-making of DNR occurred between physicians and family members, not the patients themselves. Often high medical expenses were involved in choosing DNR, thus if choosing DNR it was implied the family members and health professionals as well did not try their best to help the patient. Verbal DNR permission was more popular in clinical settings. Most nurses felt guilty and depressed about the dying/death of patients with DNR. Conclusion: Clearer guidelines on DNR, which reflect a family-oriented culture, need to be established to reduce confusion and to promote involvement in the decision-making process of DNR among nurses.

• 한방재활의학과학회지
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• 제28권1호
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• pp.97-107
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• 2018

Objectives This is one of the manuals of East-West integrative medicine which was created by the committee on integrative medicine of Chung-Yeon Korean Medicine Hospital. The purpose of this manual is to support clinical decision-making and communication between Korean and western medical staff in a Korean medicine hospital during the rehabilitation of patients after knee surgery. Methods The draft was made by two rehabilitation specialists in Korean medicine. After a rehabilitation specialist in western medicine reviewed the draft and exchanged their ideas, a revised version that reflects the goal of consultation was made. Then the committee agreed to adopt the manuals through the process of review and feedback in addition to face-to-face discussions. Results This manual describes clinical decision-making for rehabilitation after arthroscopic partial meniscus resection, meniscus refixation, reconstruction of anterior and posterior cruciate ligaments. Therefore, it contains the schedule of rehabilitation treatment by the surgical technique, general goal of the rehabilitation by phase, guide for patients and postoperative infection management. Conclusions Despite some limitations, this manual has significance as the first example of a decision-making protocol suggestion for East-West integrative rehabilitation treatment after a knee surgery in one medical institution.

• 한방재활의학과학회지
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• 제28권1호
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• pp.109-120
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• 2018

Objectives This is one of the manuals of East-west integrative medicine which was created by the Committee on integrative medicine of Chung-Yeon Korean Medicine Hospital. The purpose of this manual is to support clinical decision making and communication during the rehabilitation of patients after shoulder surgery. Methods The drafting was done by two rehabilitation specialists in Korean medicine. After a rehabilitation specialist in western medicine reviewed the draft and exchanged their ideas, a revised version that reflects the goal of consultation was made. Then the Committee agreed to adopt the manuals through the process of review and feedback in addition to face-to-face discussions. Results This manual describes clinical decision making for rehabilitation after arthroscopic rotator cuff repair, SLAP repair, and arthrolysis. Therefore it contains the schedule of rehabilitation treatment through the surgical technique, general goal of the rehabilitation by phase, guide for patients and postoperative infection management. Conclusions The proposal of this manual has a significance for it provides information about decision making process and contents of treatment in one medical institution for East-west integrative rehabilitation treatment after shoulder surgery.

• 한방재활의학과학회지
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• 제28권4호
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• pp.59-69
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• 2018

Objectives This is one of the manuals of East-west integrative medicine which was created by the Committee on integrative medicine of Chung-Yeon Korean Medicine Hospital. The purpose of this manual is to support clinical decision making and communication during the rehabilitation of patients after lumbar spine surgery. Methods The drafting was done by two rehabilitation specialists in Korean Medicine. After a rehabilitation specialist in western medicine reviewed the draft and exchanged their ideas, a revised version that reflects the goal of consultation was made. Then the Committee agreed to adopt the manuals through the process of review and feedback in addition to face-to-face discussions. Results This manual describes clinical decision making for rehabilitation after lumbar microdiskectomy, interbody fusion, and kyphoplasty. Therefore it contains the schedule of rehabilitation treatment through the surgical technique, general goal of the rehabilitation by phase, scales for outcome measure and postoperative infection management. Conclusions The proposal of this manual has a significance for it provides information about decision making process and contents of treatment in one medical institution for East-west integrative rehabilitation treatment after lumbar spine surgery.

• 한국산학기술학회논문지
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• 제21권7호
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• pp.73-81
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• 2020

본 연구는 간호대학생들이 의료인들과 인수인계 시 명확한 정보전달에 어려움이 있는 점을 개선하기 위하여 SBAR 적용 시뮬레이션 교육을 시행하여 그들의 의사소통명확성, 의사소통자신감, 임상의사결정능력에 미치는 효과를 확인하기 위한 단일군전후설계실험연구이다. 산모와 신생아의 응급상황을 기반으로 한 시뮬레이션 실습과 SBAR교육을 접목하여 의료진에게 응급상황에 대해 명료하고 간략하게 핵심을 전달하고, 의사소통 역량을 증진시킬 수 있도록 프로그램을 적용하였다. 대상자는 B광역시 소재 1개 대학의 4학년 간호대학생 91명이며, 자료수집기간은 2019년 2월 18일부터 2019년 2월 28일까지이었다. 수집된 자료는 SPSS/WIN 21.0 program을 이용하여 paired t-test로 분석하였다. 연구결과, 시뮬레이션 실습 후에 측정한 의사소통 명확성(t=-3.99, p<.001), 의사소통 자신감(t=-8.60, p<.001), 임상의사결정능력이(t=-4.66, p<.001) 통계적으로 유의하게 증가하였다. 따라서 예비의료인으로써 간호대학생의 임상현장에서의 의사소통능력과 임상의사결정능력을 증진시키기 위해 SBAR를 적용한 시뮬레이션실습 교육프로그램을 통해 간호대학생들의 전문성을 고취시키고, 임상현장에서의 적응력을 높이고자 한 점에서 본 연구의 의의가 크다. 또한 간호교육현장에서 의료인들 간의 의사소통을 체계화하기 위해서는 시뮬레이션 실습 뿐만 아니라 일반적인 임상실습에서도 SBAR보고방법이 숙련될 수 있도록 전략을 수립하여 간호대학생의 의사소통능력 향상에 기여해야 할 것으로 생각된다.