• Women's Health Nursing
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• v.6 no.2
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• pp.234-257
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• 2000

At present in the medical care, the study and effort for producing health service to consider efficiency, effectiveness, and quality are urgently called for because of the difficulty in the keen competition according to the inter- nationalization and opening, the operation in the medical institution service testing system, the change in the medical policy of KDRGs, and the lack of the health care cost increasing rate. As an alternative, the case management for the new management system is introduced in the U.S., and the Critical Pathway that is the method designing the contents of activity and its result has been developed and applied in order to anticipate and manage the patient-outcome for the realization of the cost-effective case-management. Thus, this study intended to analyze the effectiveness to obtain by developing the Critical Pathway presented as the method to improve the quality-betterment and cost effectiveness through the continuous and consistent patient management for the hysterectomy patient and applying it to the real practice. As a study method, this author formed a conceptual framework through considering five Critical Pathway used in the current U.S. and three Critical Pathway presented in the literature to develop the Critical Pathway for the hysterectomy patient, and made out the preliminary Critical Pathway through reviewing the old chart. This author made the verified the validity of the expert group about the developed Critical Pathway, and to confirm the possibility of practice application, completed and settled the final Critical Pathway after using the Critical Pathway to the hysterectomy patient from March 1st to 15th, 1997. Finally, to analyze the application-effect of the developed Critical Pathway, this author offered health care service applying the Critical Pathway to the hysterectomy patient from April 15th to August 31th, 1997. The guide for the Critical Pathway was carried out in advance by outpatient setting nurse for outpatient setting visit before the operation, and after hospitalization the primary nurse monitored the execution degree on the every duty. After discharge this author surveyed the complication through phone visiting, and one month after discharge surveyed the patient's reaction about the offered service when outpatient setting visit and analyzed the result. The source for health care cost was obtained by the statistics about the hospital charge which was offered by the General Business Department. The results were as follows. 1. It was decided that the vertical line of the Critical Pathway was made up of eight items such as monitoring/assessment, treatment, line/drains, activity, medication, lab test, diet, patient teaching, and the horizontal line of the Critical Pathway was made up of from hospitalization to discharge. 2. After the analysis of service contents through reviewing the old chart, it was decided that the horizontal line of the preliminary Critical Pathway was made up of from hopitalization to fourth postoperative day, and the vertical line of it was divided into eight items which were the contents to occur with the time frame of the horizontal line. 3. After the verifying the validity of the expert group about the preliminary Critical Pathway, the horizontal line was amended from hopitalization to third postoperative day, and taking their consensus, some contents of the horizontal line was amended and deleted. 4. From March 1st to 15th, 1997, to confirm the clinical suitability, this author offered eight hysterectomy patients the medical service through the Critical Pathway. The result was that three of them could be discharged at the expected discharge day, and the others later than that day. Supplementing the preliminary Critical Pathway through analyzing the cause of that delay- case, this author developed the final Critical Pathway. 5. There were no significant differences between the experimental and the control group in the incidence of complication(P > 0.05). 6. The 92.4% of experimental group was satisfied with the Critical Pathway service. 7. The length of hospital stay of the experimental group offered with the Critical Pathway service was 4.6 days and there was a significant difference that it was 1.3 days shorter than that of the control group(t=-29.514, P=0.000). 8. There wsa a significant difference that the mean medical charge per one patient of the experimental group offered the Critical Pathway service was cheaper \124,150 than that of the control group(t=-9.826, P=0.000). 9. The result that the author assumed and analyzed hospital income with the rate of turning bed was assumed that the increase of hospital income was \63,245,072 for that study, and the income increase was expected with \68,704,864 for a year. The result that this author applied the Critical Pathway to the hysterectomy patient have no differences in the incidence of complication, high satisfaction with that service, and the length of hospital stay decreased in the experimental group, and the mean hospital charge per one patient decreased, but hospital income increased. Suggestions for further study and nursing practice are as follows. 1. The study to apply the Critical Pathway for a year, verify the validity, and measure the effect repeatedly is needed. 2. To apply and manage the Critical Pathway effectively, the study to computerize it is needed. 3. The study to develop hospital-based Critical Pathway about other diseases or procedure, and measure the effect is needed.

• The Journal of Korean Academic Society of Nursing Education
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• v.4 no.2
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• pp.249-263
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• 1998

The competence of newly graduated nurses is based on various clinical expriences gained when they were students. Therefore, instructors of nursing students, professors in nursing schools or directors in hospitals must play a critical role in assisting them to obtain various knowledge and experienced nursing skills. The purpose of this study was to investigate nursing care activities and nursing care hours practiced by nursing students in a general hospital. The subject students were total 214 nursing students, 2nd graders(sophomores) and 3rd graders(juniors) from 5 Junior Nursing Colleges in Seoul and they practiced at S general hospital to gain clinical experience. The data were collected for 4 days. The tools for this study were the direct nursing care activity list consisted of 15 nursing areas and the indirect nursing care activity list consisted of 9 nursing areas. The subject students were supposed to record their own score. The results of this study are ; 1. The nursing care hours per nursing student 1) The average total nursing care hours a day per each nursing student are 362.65 mins(6.04hr), the direct nursing care hours per each nursing stuent are 202.09 mins(direct nursing care rate 56.0%) and it is higher than the indirect nursing care hours, 159.75mins(indirect nursing care rate 44.0%). The direct nursing care rate of each student by a team approach in the evening shift(56.3%) is higher than that in the day shift(55.8%). 2) The hours of checking vital signs are the longest(47.35mins) among the direct nursing care activites and next is in order of counseling 8l emotional support, nurse rounds, and accompaning a patient during examination. The hours of reporting are the longest(32.39mins) among the indirect nursing care activites, and next is the activities related to education such as reviewing chart, looking up references, etc. 3) The freqency of checking vital signs practiced by nursing student is the highest(the average of 55.7 times) among the direct nursing care activities and next is in order of nurse rounds, assistance of feeding, and counseling & emotional support. The required time for nursing students to accompany their patient during examination is the longest(20.7mins) and next are in order of restriction on patient' activity, orientated by a head nurse, skin care, sitz bath, bathing & hair shampoo, and assisting with patients' exercise. 2. The nursing care hours per grader 1) The average hours of total nursing care per a nursing student are 369.2mins(6.2hrs) to 2nd graders, 355.9mins(5.9 hrs) to third graders. The direct nursing care rate per each nursing student to 3rd graders(59.3%) was higher than that to End graders(52.8%). 2) For 2nd graders, the highly marked nursing activities are teaching associated with direct nursing care activities such as drawing up papers, looking up references, reviewing charts, and being orientated by staff nurses. For 3rd graders, measurments, observations, and nurse rounds in indirect nursing care activities are taken highly 3) The most frequent practice of the nursing care activites is checking vital signs : 65 times to 3rd graders and 46.5 times to 2nd graders. Our suggestions based on the results of this study are : 1. It is recommanded to repeat the same designed study in a variety of clinical fields for further study. 2. It is recommanded to collect data not by self-record method but by observated method. 3. It is needed for nursing instructors in Nursing Schools and in hospitals to develop the guidelines and check-list of clinical practice courses.

• Women's Health Nursing
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• v.9 no.2
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• pp.189-200
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• 2003

The purpose of this comparative study is to find out women and their spouses' sexual life and the factors affecting on their sexual life after women's hysterectomy. The data were the 110 questionaires which were collected from the participants, the 55 women who had undergone a hysterectomy due to gynecologic disease or benign tumor of genital organs and their spouses from January 1, 1999 to January 30, 2002 in one general hospital located in Seoul, Korea. Questionnaires were mailed to couples, who agreed to participate on the study and self reported questionnaires returned in the pre-stamped envelopes. And personal visits were made for those couples who did not respond. Tools for Sexual life and characteristics of sexual activities were reconstituted by the author based on Kim(1996) and Chang(1988)'s tools and were reviewed by a nurse specialist. Data analysis was done by SPSS 10.0 program using frequency, percentage, mean, S.D. Pearson correlation coefficient, t-test, oneway ANOVA and multiple regression. The results of this study are as follows; 1. Of all female subjects, 80% had experienced hysterectomy below the age of 50. 2. 72.8% of female subjects and 67.3% of male subjects did not receive any sexual education & counseling before and after the surgery. More than 60% of both female and male subjects answered that it was necessary to have a sexual counseling. And 40% wanted to receive sexual counseling from a professional sexual counselor. 3. More than half of couples started their first coitus within 4 weeks after the surgery. And 88.9% of females and 85.2% of males answered that they were experiencing orgasms with their sexual relationship. 4. Influencing factors on the satisfaction level of sexual life were couple's intimacy and sexual discomfort in women and couple's intimacy and sexual knowledge in spouses. These factors explained the 33% and 24% of total variance respectively. In conclusion, the result suggests that it is necessary for couples to receive a professional sexual education and counseling to improve couples' quality of life. It is also necessary for institutions to use prepared nurses by receiving sexual counseling and education program as a professional sexual counselors or educators so as to provide individualized sexual education and counseling for their clients.

• The Korean Nurse
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• v.28 no.3
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• pp.52-67
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• 1989

True nursing care means total nursing care which includes physical, emotional and spiritual care. The modern nursing care has tendency to focus toward physical care and needs attention toward emotional and spiritual care. The total nursing care is mandatory for patients with terminal cancer and for this purpose, hospice care became emerged. Hospice case originated from the place or shelter for the travellers to Jerusalem in medieval stage. However, the meaning of modem hospice care became changed to total nursing care for dying patients. Modern hospice care has been developed in England, and spreaded to U.S.A. and Canada for the patients with terminal cancer. Nowaday, it became a part of nursing care and the concept of hospice care extended to the palliative care of the cancer patients. Recently, it was introduced to Korea and received attention as model of total nursing care. This study was attempted to assess the efficacy of hospice care. The purpose of this study was to prove a difference in terms of physical, emotional a d spiritual aspect between the group who received hospice care and who didn't receive hospice care. The subject for this study were 113 patients with advanced cancer who were hospitalized in the S different hospitals. 67 patients received hospice care in 4 different hospitals, and 46 patients didn't receive hospice care in another 4 different hospitals. The method of this study was the questionaire which was made through the descriptive study. The descriptive study was made by individual contact with 102 patients cf advanced cancer for 9 months period. The measurement tool for questionaire was made by author through the descriptive study, and included the personal religious orientation obtained from chung(originated R. Fleck) and 5 emotional stages before dying from Kubler Ross. The content ol questionaire consisted in 67 items which included 11 for general characteristics, 10 for related condition with cancer, 13 for wishes far physical therapy, 13 for emotional reactions and 20 for personal religious orientation. Data for this study was collected from Aug. 25 to Oct. 6 by author and 4 other nurse's who received education and training by author for the collection of data. The collected data were ana lysed using descriptive statistics, $X^2-test$, t-test and pearson correlation coefficient. Results of the study were as follows: "H.C Group" means the group of patient with cancer who received hospice care. "Non H.C Group" means the group of patient with cancer who did not receive hospice care. 1. There is a difference between H.C Group and Non H.C Group in term of the number of physical symptoms, subjective degree of pain sensation and pain control, subjective beliefs in physical cure, emotional reaction, help of present emotional and spiritual care from other personal, needs of emotional and spiritual care in future, selection of treatment method by patients and personal religious orientation. 2. The comparison of H.C Group and Non H.C Group 1) There is no difference in wishes for physical therapy between two groups(p=.522). Among Non H.C Group, a group, who didn't receive traditional therapy and herb medicine was higher than a group who received these in degree of belief that the traditional therapy and herb medicine can cure their disease, and this result was higher in comparison to H.C Group(p=.025, p=.050). 2) Non H.C Group was higher than H.C Group in degree of emotional reaction(p=.050). H.C Group was higher than Non H.C Group in denial and acceptant stage among 5 different emotional stages before dying described by Kubler Ross, especially among the patient who had disease more than 13 months(p=.0069, p=.0198). 3) Non H.C Group was higher than H. C Group in demanding more emotional and spiritual care to doctor, nurse, family and pastor(p=. 010). 4) Non H.C Group was higher than H.C Group in demanding more emotional and spiritual care to each individual of doctor, nurse and family (p=.0110, p=.0029, P=. 0053). 5) H.C Group was higher th2.n Non H.C Group in degree of intrinsic behavior orientation and intrinsic belief orientation of personal religious orientation(p=.034, p=.026). 6) In H.C Group and Non H.C Group, the degree of emotional demanding of christians was significantly higher than non christians to doctor, nurse, family and pastor(p=. 000, p=.035). 7) In H.C Group there were significant positive correlations as following; (1) Between the degree of emotional demandings to doctor, nurse, family & pastor and: the degree of intrinsic behavior orientation in personal religious orientation(r=. 5512, p=.000). (2) Between the degree of emotional demandings to doctor, nurse. family & pastor and the degree of intrinsic belief orientation in personal religious orientation(r=.4795, p=.000). (3) Between the degree of intrinsic behavior orientation and the degree of intrinsic: belief orientation in personal religious orientation(r=.8986, p=.000). (4) Between the degree of extrinsic religious orientation and the degree of consensus religious orientation in personal religious orientation (r=. 2640, p=.015). In H.C. Group there were significant negative correlations as following; (1) Between the degree of intrinsic behavior orientation and extrinsic religious orientation in personal religious orientation (r=-.4218, p=.000). (2) Between the degree or intrinsic behavior orientation and consensus religious orientation in personal religious orientation(r=-. 4597, p=.000). (3) Between the degree of intrinsic belief orientations and the degree of extrinsic religious orientation in personal religious orientation(r=-.4388, p=.000). (4) Between the degree of intrinsic belief orientation and the degree of consensus religious orientation in personal religious orientation(r=-. 5424, p=.000). 8) In Non H.C Group there were significant positive correlation as following; (1) Between the degree of emotional demandings to doctor, nurse, family & pastor and the degree of intrinsic behavior orientation in personal religious orientation(r= .3566, p=.007). (2) Between the degree of emotional demandings to doctor, nurse, family & pastor and the degree of intrinsic belief orientation in personal religious orientation(r=.3430, p=.010). (3) Between the degree of intrinsic behavior orientation and the degree of intrinsic belief orientation in personal religious orientation(r=.9723, p=.000). In Non H.C Group there were significant negative correlation as following; (1) Between the degree of emotional demandings to doctor, nurse, family & pastor and the degree of extrinsic religious orientation in personal religious orientation(r= -.2862, p=.027). (2) Between the degree of intrinsic behavior orientation and the degree of extrinsic religious orientation in personal religious orientation(r=-. 5083, p=.000). (3) Between the degree of intrinsic belief orientation and the degree of extrinsic religious orientation in personal religious orientation(r=-. 5013, p=.000). In conclusion above datas suggest that hospice care provide effective total nursing care for the patients with terminal cancer, and hospice care is mandatory in all medical institutions.

• Korean Parent-Child Health Journal
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• v.3 no.1
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• pp.73-94
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• 2000

This study was designed to compare the education needs in LBW infant's mother at discharge and after one month at home for development of the educational program. The subjects of this study consisted of 61 mothers of LBW infant's at discharge and 51 mothers of LBW infant's after one month at home. They were selected by convenience from 3 general hospitals and 1 pediatric hospital in Seoul, Kangreung and Inchon. The data were collected during the period from January, 5 to March, 15, 2000. The Education Needs for LBW infant Care was measured by Questionnaire that has developed by researchers. The data were analized by descriptive statistics, non-paired t-test & ANOVA using SAS. The results of this study were as follows: 1) The educational need, of the mothers of LBW infant at discharge were higher than the mothers of LBW infant after one month at home(t=8.72, p=.00). 2) There were significant associations between the educational needs of the mothers of LBW infant after one month at home and numbers of children(F=3.61, p=0.03). 3) There were significant associations of the educational needs between the mothers of LBW infant at discharge and the mothers of LBW infant after one month at home in categories and items. (1) There were significant associations by categories such as Infant care(t=8.34, p=.00), feeding(t=6.71, p=.00), unusual behavior (t=6.54, p=.00). Management disorder (t=8.67, p=.00), attachment between parents and infant(t=5.19, p=.00) and environment (t=6.14, p=.00). (2) There were two items that represented the highest educational needs in all items. That were "How about we can do when infant has a breathing disorder" and "How about we can do when infant has a seizure". These two items included Management of disorder category. In Conclusion, when the nurse teaching the method of infant care to mother, educational contents must be included about Management of disorder emphatically.

• Child Health Nursing Research
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• v.12 no.3
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• pp.386-397
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• 2006

Purpose: This study was performed to compare the difference of maternal attachment and the maternal role confidence between mother who feeds the child with mother's milk in sanitary pack by a nurse instead of her and mother who feeds the child with artificial milk. Methods: The subjects of this study consisted of mothers of premature baby who was in NICU and can not be fed with mother's milk directly. In the sample, 21 mothers were the breast feeding group and 20 were the bottle feeding group. Data were collected from April 3, 2004 to November 2, 2005, and were analyzed using SPSS WIN 10.0. Results: The degree of maternal attachment and maternal role confidence of the breast milk feeding group was higher than that of the bottle feeding group. In accordance with general characteristics, the difference was found in maternal attachment and maternal role confidence both breast feeding group and bottle feeding group. Conclusion: More systematic nursing mediation is required for the lactation of mother's milk in sanitary pack is planned to do positive interaction between mother and the child, which has an influence on the formation of maternal attachment and the of maternal role confidence after hospitalization.

• The Journal of the Korea Contents Association
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• v.17 no.3
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• pp.178-188
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• 2017

This study is a descriptive research on the subjects of hospital nurses to investigate the effect of job satisfaction and fatigue on their nursing professional attitudes. The subjects were 262 nurses working at five general hospitals in J and S cities. Data collection was conducted from December 2014 to January 2015 using structured questionnaires on job satisfaction, fatigue and nursing professional attitudes. As a result of the study, nurses' nursing profession attitude was high in 30 year old and married nurses, and in clinical experience of either less than a year or more than six years, and nurses' nursing profession attitude was higher in charge nurses and head nurses than in general nurses. The most influential factors affecting the nursing professional attitude were job satisfaction, clinical career, and fatigue in that order. These findings provide theoretical evidence to explain the importance of job satisfaction and fatigue variables in influencing factors on nursing professional attitude. Therefore, in clinical practice, it is necessary to develop and implement an education program to improve nursing professional attitudes by considering nurses' job satisfaction, clinical career and fatigue level.

• The Korean Journal of Rehabilitation Nursing
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• v.4 no.2
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• pp.137-145
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• 2001

This study examined and identified the relationship between the level of hope and self-care agency in hemodialysis patients. The purpose of the study was to reveal that hope is an essential factor to enhance self-care agency and to prepare the basic materials to help nurse the patients. The subjects for this study consisted of 108 persons who undergoing hemodialysis from 2 hospital, 2 hemodialysis center in Pusan, Korea. The degree of hope was measured by the questionnaire that has been developed by Miller. The self-care agency was measured by the questionnaire that has been developed by Kearney B.Y & Fleisher B.J. The collected data were analyzed by descriptive statistics and t-test. one-way ANOVA and Pearson's Correlation Coefficient with SPSS WIN program. Results were obtained as follows: 1) The mean scores of hope were $131.77{\pm}25.77$(range 67-195). The rate of hope classified said that the lowest hope was 2.8% and low hope was 27.8%. 2) The mean scores of self-care agency were $143.78{\pm}23.63$(range 74-187). The degree of self-care agency classified said that the rate of self-care agency deficiency was 0.9% and low self-care agency was 12.0%. 3) The hope was significantly related to self-care agency. That is, the higher the hope score was， the higher the level of self-care agency score(r=0.668，p=0.001) was. In this result, there were hemodialysis patients who have very low hope score and self-care agency score. In this cases self-care agency can be increased by encouraging the patients to be more hopeful. Conclusively nurses should access the degree of hope and self-care agency of hemodialysis patients individually and apply the hope therapy in order that the patient have higher hope than before.

• Journal of Korean Clinical Nursing Research
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• v.17 no.3
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• pp.375-387
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• 2011

Purpose: Evidence-based practice (EBP) has emerged as a marker for healthcare quality and a global issue in nursing care. This study was conducted to identify Korean registered nurses' knowledge, attitudes, and practice about EBP in Korea. Methods: With a cross-sectional design, the EBP questionnaire (EBPQ) was administered to a convenience sample of nurses (N=453) recruited from 44 general hospitals. To increase the response rate, the directors of nursing were individually contacted by the researchers. The final response rate was 95.7%. Results: The majority of participants were females (99.3%), staff nurses (57.8%), and with bachelors degree (40.6%). Most of them (314, 73.4%) had ever heard about EBP. The overall mean score for the EBPQ was $4.72{\pm}0.69$ out of maximum score of 7. The mean score for the knowledge of EBP, attitudes towards EBP, and practice/use of EBP were $4.61{\pm}0.75$, $4.85{\pm}0.94$, and $4.90{\pm}0.88$, respectively. Educational level, age, and exposure to EBP were statistically significant predictors of Korean nurses' EBP perception. Conclusion: The findings showed that nurses with higher education are more likely to use and value the best available evidence for practice. This study suggests needs not only for further exploration but also for developing educational plans provided by each institute to assist nurses with the process of EBP and the associated skills.

• Korea Journal of Hospital Management
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• v.9 no.1
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• pp.66-94
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• 2004

The objective of this study is to examine how to maximize the efficiency of hospital management by minimizing the unit cost of hospital operation. For this purpose, this paper proposes to develop a model of the profit maximization based on the cost minimization dictum using the statistical tools of arriving at the maximum likelihood values. The preliminary survey data are collected from the annual statistics and their analyses published by Korea Health Industry Development Institute and Korean Hospital Association. The maximum likelihood value statistical analyses are conducted from the information on the cost (function) of each of 36 hospitals selected by the random stratified sampling method according to the size and location (urban or rural) of hospitals. We believe that, although the size of sample is relatively small, because of the sampling method used and the high response rate, the power of estimation of the results of the statistical analyses of the sample hospitals is acceptable. The conceptual framework of analyses is adopted from the various models of the determinants of hospital costs used by the previous studies. According to this framework, the study postulates that the unit cost of hospital operation is determined by the size, scope of service, technology (production function) as measured by capacity utilization, labor capital ratio and labor input-mix variables, and by exogeneous variables. The variables to represent the above cost determinants are selected by using the step-wise regression so that only the statistically significant variables may be utilized in analyzing how these variables impact on the hospital unit cost. The results of the analyses show that the models of hospital cost determinants adopted are well chosen. The various models analyzed have the (goodness of fit) overall determination (R2) which all turned out to be significant, regardless of the variables put in to represent the cost determinants. Specifically, the size and scope of service, no matter how it is measured, i. e., number of admissions per bed, number of ambulatory visits per bed, adjusted inpatient days and adjusted outpatients, have overall effects of reducing the hospital unit costs as measured by the cost per admission, per inpatient day, or office visit implying the existence of the economy of scale in the hospital operation. Thirdly, the technology used in operating a hospital has turned out to have its ramifications on the hospital unit cost similar to those postulated in the static theory of the firm. For example, the capacity utilization as represented by the inpatient days per employee tuned out to have statistically significant negative impacts on the unit cost of hospital operation, while payroll expenses per inpatient cost has a positive effect. The input-mix of hospital operation, as represented by the ratio of the number of doctor, nurse or medical staff per general employee, supports the known thesis that the specialized manpower costs more than the general employees. The labor/capital ratio as represented by the employees per 100 beds is shown to have a positive effect on the cost as expected. As for the exogeneous variable's impacts on the cost, when this variable is represented by the percent of urban 100 population at the location where the hospital is located, the regression analysis shows that the hospitals located in the urban area have a higher cost than those in the rural area. Finally, the case study of the sample hospitals offers a specific information to hospital administrators about how they share in terms of the cost they are incurring in comparison to other hospitals. For example, if his/her hospital is of small size and located in a city, he/she can compare the various costs of his/her hospital operation with those of other similar hospitals. Therefore, he/she may be able to find the reasons why the cost of his/her hospital operation has a higher or lower cost than other similar hospitals in what factors of the hospital cost determinants.