• Title/Summary/Keyword: Health Care Program

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Patient Satisfaction with Cancer Pain Management (암성통증관리 만족도)

  • Lee, So-Woo;Kim, Si-Young;Hong, Young-Seon;Kim, Eun-Kyung;Kim, Hyun-Sook
    • Journal of Hospice and Palliative Care
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    • v.6 no.1
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    • pp.22-33
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    • 2003
  • Purpose : The purpose of this study was to evaluate the present status of patients' satisfaction and the reasons for any satisfaction or dissatisfaction in cancer pain management Methods : A cross-sectional survey was used to obtain the feedback about pain management. The results of the survey were collected from 59 in- or out-patient who had cancer treatment at two of the teaching hospitals in Seoul from July, 2002 to November, 2002. The data was obtained by a structured questionnaire based on the American Cancer Society Patient Outcome Questionnaire(APS-POQ) and other previous research. The clinical information for all patients were compiled by reviewing their medical records. Resuts : 1) The subjects' mean score of the worst pain was 6.77, the average pain score was 3.80, and the pain score after management was 2.93 for the past 24 hours. The mean score of total pain interference was $25.03{\pm}12.82$. Many of the subjects had false beliefs about pain such as 'the experience of pain is a sign that the illness has gotten worse', 'pain medicine should be 'saved' in case the pain gets worse' and 'people get addicted to pain medicine easily'. 2) 66.1% of the subjects were properly medicated with analgesics. 33.9% of the subjects reported use of various methods in controlling pain other than the prescribed medication. Only 33.9% of the subjects had a chance to be educated about pain management by doctors or nurses. 3) The mean score of patients' satisfaction with pain management was $4.19{\pm}1.14$. 72.9% of the subjects answered 'satisfied' with pain management. The reasons for dissatisfaction were 'the pain was not relieved even after the pain management', 'I was not quickly and promptly treated when I complained of pain', 'doctors and nurses didn't pay much attention to my complaints of pain.', and 'there was no appropriate information given on the methods of administration, effect duration and side effects of pain medicine.' The reasons for satisfaction were: 'the pain was relieved after the pain management.', 'doctors and nurses quickly and promptly controlled my pain.', 'doctors and nurses paid enough attention to my complaints of pain.' and 'trust in my physician'. 4) In pain severity or pain interference, no significant difference was found between the satisfied group and dissatisfied group. On the belief 'good patients avoid talking about pain', a significant difference was found between the satisfied group and dissatisfied group. Conclusions : The patients' satisfaction with cancer pain management has increased over the years but still about 30% of patients reported to be 'not satisfied' for various reasons. The results of this study suggest that patients' education should be done to improve satisfaction in the pain management program.

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Gender Differences in Pain in Cancer Patients (성별에 따른 암환자의 통증 차이)

  • Kim, Hyun-Sook;Lee, So-Woo;Yun, Young-Ho;Yu, Su-Jeong;Heo, Dae-Seog
    • Journal of Hospice and Palliative Care
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    • v.4 no.1
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    • pp.14-25
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    • 2001
  • Purpose : To determine whether there exist gender differences in pain in Korean cancer patients and whether the depression and performance that are often expressed differently between men and women with cancer interact with pain. Method : The results of survey were collected from 140 in- and out-patients (78 male and 62 female) who had cancer treatment at one of the university hospital in Seoul for four months from February of 1999. The severity and interference of pain were examined with the self-reported survey based on Korean version of Brief Pain Inventory (BPI-K). Demographic and clinical information for all patient were compiled by reviewing their medical records, and the level of depression was examined with the Korean version of Beck Depression Inventory (BDI-K). Usual statistical methods, e.g., frequences, means and SDs were used to characterize the sample. The chi-square tests for categorical data and t-test for numerical data were used for group comparison. And the correlation between variables were performed using Pearson correlation coefficient. Resuts : 1) The mean scores of the worst pain for last 24-hours measured with the pain severity of BPI-K were 5.77 in male and 6.45 in female. The pain interference of BPI-K in men was in the order of mood (5.49), enjoy (5.36), and work (5.00), and in women were work (7.48), enjoy (7.16), and mood (6.53). 2) In pain severity, significant difference was found between men and women in the average pain for last 24-hours (t=-2.130, P=.035). In pain interference, significant difference was found between men and women in activity (t=-2.450, P=.015), mood (t=-2,321, P=.022), walk (t=-2.762, P=.007), work (t=-4.946, P=.000), relate (t=-2.595, P=.010), sleep (t=-2.071, P=.040), enjoy (t=-3.198, P=.001). 3) It was found that the items of pain and depression are significantly correlated in men but not in women. Men also exhibited higher correlation in the items of pain and performance status than women. Conclusions : Women report significantly greater average pain for last 24-hours and for all items of pain interference than men. Pain and depression are significantly correlated in men. The results of this study suggest that gender differences in pain should be considered for planning effective pain management program.

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A study on oral discomfort in gynecological cancer patients undergoing chemotherapy (화학요법을 받는 부인암환자의 구강불편감에 관한 연구)

  • 정재원
    • Journal of Korean Academy of Nursing
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    • v.25 no.2
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    • pp.372-389
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    • 1995
  • The frequency with which administration of chemotherapy for gynecological cancer treatment is used has increased along with the use of surgery and radiotherapy Among the various side effects of chemotherapy, stomatitis causes a problem of function and sensation in the oral cavity. This oral discomfort can be categorized into two components ; perceived oral symptoms and observed oral symptoms. If the oral problem continues, it may cause infection, bleeding and nutritional deficiencies. As a result of this condition, compliance with the treatment process can be affected as well as the prognosis for the cancer patients. But as the oral discorrfort usually appears after chemotherapy, it is often not reported to the health care personnel as a patient problem. Without problem identification of the oral discomfort and ability to assess the problem, effective intervention cannot be planned. Therefore, this study was conducted to identify the pattern and the degree of oral discomfort due to cancer chemotherapy and thus to provide data for identification of the patient problem and for nursing assessment. The design of this study was a longitudinal de-scriptive study The subjects were in - patients who received chemotherapy under the diagnosis of gynecological cancer between Mar. 15, 1994 and May 15, 1994 at a general hospital in Seoul, Korea. The number of subjects was 64 and they were divided into two groups, one of 41 (A : 5FU & Neoplatin), the other of 23(B : Neoplatin, Cytoxan, Adriamycin), according to the treatment regimen. The data were collected for 24 days using self-re-port instruments. The instruments were the 「Perceived Oral Symptom Assessment Tool」 and 「Observed Oral Symptom Assessment Tool」 developed by this researcher. Data were analyzed using the SPSS-PC program, ANOVA, t-test, paired t-test and the Pearson Correlation Coefficient were applied. The results of this study are as follows : 1. In A regimen the peak time for perceived oral symptom scores was the fifth day after chemotherapy, and the tenth day for observed oral symptom scores. Both of the problems started on first day of chemotherapy and were not resolved completely until the 24th day after treatment. 2. In B regimen, the peak time for perceived oral symptom scores was on the seventh day after chemotherapy, and the eighth day for observed oral symptom scores. It was noted that perceived oral symptom scores were higher than observed oral symptom scores consistently for 24 days. Both also started on first day of chemotherapy, and were not resolved completely until the 24th day after chemotherapy. 3. There were no differences statistically in perceived oral symptom scores between A and B regimen. The loss of appetite and xerostomia caused the most severe discomfort in both of these two groups. 4. The were no differences statistically in observed oral symptom scores between the A and B regi moil. In the A regimen, the highest observed symptom scores were the lips, gingiva, tongue and buccal membrane in that order. But in the B regimen, the highest observed symptom scores were tongue, lips, buccal membrane and gingiva in that order. 5. In A regimen, the patients who had gingival edema and dentures had significantly higher perceived oral symptom scores. And those who had gingival edema and bleeding, foul odor and aphthous stomatitis had significantly higher observed oral symptom scores. 6. In B regimen, the patients who had the experience of stomatitis in the last course of chemotherapy had significantly higher perceived oral symptom scores. Those who had gingival edema had significantly higher observed oral symptom scores. 7. In the A regimen there was no correlation between lab values for lymphocytes and albumin with perceived oral symptom scores and observed oral symptom scores. In the B regimen, there was a significant negative correlation between lymphocytes and albumin with the observed oral symptom scores, but not between perceived oral symptom scores and lymphocytes and albumin values. In conclusion, the nurse should expect that the patient undergoing chemotherapy will complain severely about subjective discomfort and before objective physical change is observed. Also the patients who have chronic oral problems such as dentures, gingival edema and bleeding, foul odor, aphthous stomatitis will complain of severe oral discomfort due to chemotherapy.

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A study of quality of working life to dental hygienist's (치과위생사의 근로생활의 질(QWL)에 관한 연구)

  • Oh, Hye-Seung;Kim, Eun-Hee
    • Journal of Korean society of Dental Hygiene
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    • v.10 no.2
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    • pp.375-392
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    • 2010
  • Objectives : Dental hygienist's work satisfaction and stress affect the overall quality of work life(QWL). Therefore, this research is intended to suggest fundamental data to improve QWL by finding out characteristics of each work satisfaction and stress element. To this end, a total of 327 dental hygienists working at general hospitals, university hospitals, dental hospitals and dental clinics across Seoul, Gyeonggi and Incheon were surveyed. Results of survey are as follows. Methods : The collected data were analyzed by using an SPSS 12.0 statistical program, obtaining the following results. The collected data conducted a questionnaire survey for 327 dental hygienists who work at the hospitals, university hospitals, dental hospitals, and dental clinics located at Seoul, Gyeonggi-do, and Incheon district from January until March, 2009, and drew the conclusions as follows. Result : 1. Demographic characteristics, income from 1.5 to 1.99 million were the whole lot, more than 2 million to less than 1.5 million was similar. Marital status Married Unmarried higher than the atheist religion, Christianity, Catholicism, Buddhism, and other, respectively. Classification by level of education in the college graduate, university graduate, graduate diploma, respectively. 2. Are working in a job-related characteristics of dentistry, dental hospital, general and university hospital, respectively. The making in position, Mount, contractor, responsible, senior, was an intern in the order. The five-day workweek whether working at night and is not going to care whether the conduct was similar. Classification of working hours and 8 hours, 8 hours, 8 hours or less orderly, and total of less than 1-3 years of clinical experience, 5 years, less than one year, less than 3-5 years, respectively. 3. There comes out a significant difference according to age, income, position, gross clinical experience, and whether to put night shift into practice in job stability in terms of the quality subsequent to general characteristics(p<.05). 4. There comes out a significant difference according to marital status, one's place of work, position, whether to put a five-day workweek into practice in work environment and benefits package in terms of the quality subsequent to general characteristics (p<.05). 5. There comes out a significant difference according to age, marital status, income, position, and gross clinical experience in education & training and benefits packages in terms of the quality subsequent to general characteristics(p<.05). 6. There comes out a significant difference according to whether to put night medical treatment into practice in social usefulness in terms of the quality subsequent to general characteristics(p<.05). 7. There comes out a significant difference according to marital status, income, one's place of work, gross clinical experience, work hours, and whether to put a five-day workweek into practice in leisure activity in terms of the quality subsequent to general characteristics(p<.05). 8. There comes out a significant difference according to income, one's place of work, and position in wage level in terms of the quality subsequent to general characteristics(p<.05). 9. There was no significant difference in all items related to human relations and free communication in terms of the quality subsequent to general characteristics(p>.05). Conclusions : It is necessary to analyze factors related to work satisfaction and stress in order to improve dental hygienist's quality of work life. Hospitals must support them systematically and institutionally and related organizations must conduct practical research.

A Study of the Effect, Safety and Saving Expense by Reusing Hemodialyzer (재사용(再使用) 투석기(透析器)의 효과(效果) ${\cdot}$ 안정성(安定性) 및 비용절감(費用節減)에 관한 연구(硏究))

  • Jung, Ha-Chung
    • Journal of Korean Academy of Nursing Administration
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    • v.3 no.1
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    • pp.93-106
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    • 1997
  • By the increase of the rate of existence of the hemodialyzing patients, they were required the long run treatment. Regardless of medical insurance expansion, hemodialyzing cost much expenses so that hospital has been considering the reuse of hemodialyzer and flowing euqipments along with the diverse study and progress of the ways of hemodialyzing and medical instruments. This study was aimed to provide the basic materials regarding the reuse of hemodialyzer which is used for the patients of chronic renal disease. The reusing program in the artificial kidney center of K hospital has been used for this study from 50 patients aften one year result from Sep. 1995 through Aug. 1996. Automatic equipment of DRS-4 made by Seratronic Co., was used as the equipment and it was retreated with the function test simultaneously. Compliaction and confirmation of the infection were by the records of the hemodialysis of the patients. SPSS was used for the analysis of the materials by computerization. The character of the patients and the rate of removal was by mistake and percentage, function test and rate of complication by Ftest(ANOVA) and the rate of complication per items by ${\chi}^2$ and Ftest. As the post test the Duncan's test was used for the statistically significant different variables in the standard of p<.05 after Ftest. The followings are the summary of the result : 1) In the function test of the new hemodialyzer and the reused one, and in all of CA110 and CF15.11, the dialyzer ultrafiltration coeffient(KUf) was appeared to have been higher in the reusing groups than the first use ones. This has been the normal limit showing no troubles with them. 2) In the function test of the new and reused hemodialyzer, in all of CA110 and CF15.11, the total blood volume was appeared to have been the less value in the reuse groups than the new ones. This was the price within 80% of the first price that both showed possible for use. 3) The result of reuse hemodialyzer of CA110 was $29.48{\pm}7.83$ in average in the test of leak test while $17.3{\pm}7.96$ in reuse of CF15.11. The normal limit of <60 was the leak test result. So both of the hemodialyzer was normal for reuse. 4) The rate of removal of Blood Urea Nitrogen(BUN) was 72.25% in CA110 hemodialyzer by reusing 16-20 times as the highest rate showing the better result in the reuse hemodialyzer, while in CF15.11 hemodialyzer showed 71.16% by highest rate in the first use by the highest rate with no difference from the reuse. 5) The rate of removal of serum creatinine of CA110 was 64.08% by highest rate in reuse of 1-5 times by showing better result in reuse hemodialyzer. While in CF15.11 66.47% the highest by reuse of 16-20 times showing no difference from each other. 6) No patients were admitted or precribed by antibiotics in relation with reuse dialyzer and no reports were shown about hepatitis $B{\cdot}C$. AIDS in fection. 7) Of the total 248 episods of complication due to the hemodialyzing, 86 by first use, 73 by 1-5 times, 35 by 6-10 times, 35 by 11-15 times and 19 by 16-20 times have been shown which have had no significant difference between the groups. 8) In the comparison of the expense for the hemodialyzer, there was the effect of saving 11,597.6 Won between the first and reuse hemodialyzer. And by decreasing the extracted materials, they did the great role of disposing the waste matters.

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Midwives' Perceptions of the Importance of Teaching the Lamaze Method of Childbirth Preparation, Their Practice of it and Inhibiting Factors. (조산사의 라마즈 산전교육에 대한 중요성 인식과 수행정도 및 저해요인에 관한 연구)

  • Yoon, Gui-Nam;Cho, Mi-Young
    • 모자간호학회지
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    • v.2 no.1
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    • pp.21-33
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    • 1992
  • This study was done to investigate how importantly midwives thought of Lamaze Method of Childbirth, how satisfactorily they performed their Lamaze Method of Childbirth and what inhibited their activities from being performed if not done satisfactorily. The subjects of this study were 76midwives at midwifery in Pusan, Deagu, Kyungnam and Kyungbok. Data were collected by using questionaire from Sep. 1 to Sep.30, 1991. The measurement tools was maded by the researcher based on Kim's scale for prenatal nursing activities. The statistical analysis was done with based statistical values likes frequencies, means, standard deviations and advanced methods such as Pearson's correlation coefficient, 1-test, F-test, F-test by using SPSS package program. The results of this study can be summarized as follows ; 1. The results of Investigating perception according to importance degree and performance degree of Lamaze Method of Childbring showed that midwives were slightly below both perception according to importance(2.17) and performance(2.16) of Lamaze Method of Childbirth 2. Inhibiting factors of Lamaze Method of Childbirth were abscence of husband(3.08), lack of teaching room(2.71), and lack of books or literature of Lamaze Method (2.58). 3. There appears to be a positive relation between perception according to importance degree and performance degree of Lamaze Method of Childbirth (r=0.69, P<0.01). There appears to be a negative relation between perception according to importance degree and inhibit factors of performance (r=-0.38, P<0.01). There appears to be a negative relation between performance and inhibit factors of performance (r=-0.22. P<0.01). 4. The item of highest perception defree in prenatal education is 1st, Consultation about sexual life (2.53), End, illustration of the importance of a bath and perinal cleanliness and Avoidance of excessive respiration method and also its comfortable application during uterine contractility(2.45). The item of lowest perception degree is about pregnant symptom sign and predicted date of birth (E.D.C.). On the other hand, The item of highest performance degree is education about nurtrition during pregnacy. 2nd, Illustration of the Importance of a bath and perineal cleanness(2.45). The lowest one is leaching the pregnant woman and her family about the role of husband and her family and also teaching the couple to learn exercise and respiration method (1.84). Though importance perception degree and performance degree is low. Midwives who wert subject in this research shoves that they perform general items concerning prenatal education well. 5. In the relationship between perception according to importance degree of Lamaze Method of Childbirth and the general characteristics of subjects, the differences in mean number of visiting pregnacies for 1 month. 6. In the relationship between performance degree of Lamaze Method of Childbirth and the general characteristics of subjects, the differences in age, marriage, and mean number of visiting pregnancies for 1 month. With the above information we see the importance of midwife prenatal care education and high correlation between performance degree and perception degree. When Lamaze prenatal education is well performed the number of pregnant woman who have follow-up, check-ups increase. Therefore in this research we can validity that there is a relation between Lamaze prenatal education and patient follow-up. This research showes in a situation where if one does not maximally perform a prenatal education there is a possibility that the popular use of midwife activities may encounter obstacles so the education to save new knowledge and training for prenatal education is needed as a function of Lamaze prenatal education, when a special Lamaze education is well performed for the pregnant woman, who follows-up at amidwife clinic. With the above conclusion we can suggest : 1. Continued research which minimized obstacles to Lamaze prenatal education is needed. 2. The official method of midwives is necessary.

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The Clinical Usefulness Measurement of the Whole Body Percent Fat Calculated by the Part Bone Mineral Density Measurement (부분골밀도 측정을 통해 산출되는 체지방률의 임상적 유용성에 대한 평가)

  • Kang, Young-Eun;Kim, Eun-Hye;Kim, Ho-Sung;Choi, Jong-Sook;Choi, Woo-Jun
    • The Korean Journal of Nuclear Medicine Technology
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    • v.15 no.1
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    • pp.3-9
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    • 2011
  • Purpose: Generally dual energy X-ray absorptiometry has been used for the purpose of evaluation of osteoporosis and treatment. Recently the interest of obesity came to be high and body percent fat test is increasing. Existing measure of body fat have to scan the whole body can be evaluated, but only lumbar spine and hip measurements was assumed to be whole body fat as well as improving the software. It tries to check whether the part measured value not being whole body measurement has the validity or not compared with the value calculated with the method that it is different, it forgives through a correlation with a (BIA) and (BMI). Materials and Methods: In 2010, the body percent fat was measured among the examinee coming to the Asan Medical Center public health care center from March till August against 90 females more than 40 years old through (DXA) and BIA. BMI utilized the value which wrote an hight and weight measured through the body measuring instrument in the examinee information and is automatically calculated. In addition, it classified as the low weight ($13-18.5kg/m^2$), normal ($18.5-25kg/m^2$), and corpulence ($25-30kg/m^2$) based on BMI and so that it could check whether there was the difference according to the weight or not BMI and BIA and correlation between DXA were analyzed in each group. The statistical program for the analysis used SPSS 12.0. Results: The comparison of DXA at 3 which it divides into the low weight and normal and corpulence groups and BIA did not show the difference noted statistically in all groups and the between group comparison was exposed to do not have a meaning. The body percent fat measured by the correlation analysis result DXA at the state that it doesn't divide into the group showed the high correlation (r=0.908, p0.01) noted statistically compared with BMI and showed the high correlation noted statistically in a comparison with BIA (r=0.927, p0.01). Conclusion: It confirmed that the whole body percent fat presumed from the part bone density measurement showed the excel correlation compared with BIA and BMI and information is high. There is still no clear standard about the presumed whole body percent fat and it is difficult to evaluate the fat evaluation by the bone mineral density measurement. However, it is determined that the information offering which is more objective through the comparative study with the body percent fat which is very efficient and in that it can obtain till the information about a fat as well as diagnosis of the osteoporosis through the bone density checkup is measured by the afterward telegraph bone density checkup and is clinically useful is possible.

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Analyzing the Importance and Performance of Sanitation Management within Childcare Center Foodservice Facilities in Gyeongbuk Province (경북 지역 보육 시설 급식소의 위생 관리에 대한 중요도-수행도 조사)

  • Jung, Hyeon-A;Kim, An-Na;Joo, Na-Mi;Paik, Jae-Eun
    • Journal of the East Asian Society of Dietary Life
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    • v.21 no.3
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    • pp.385-391
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    • 2011
  • The purpose of this study was to analyze the importance and performance of sanitation management within childcare center foodservice facilities in Gyeongbuk province. The survey involved 248 people who participated in the food hygiene and safety education for childcare center managers in Gyeongbuk province from June to July 2010. A total of 236 survey papers were analyzed statistically by SPSS program. By the method, t-test and importance-performance analysis (IPA) was performed. Among the respondents, facility managers are 40s (41.9%) which accounted the most percentage, and for the type of facility, the largest amount was home (39.9%). The number of preschool children who are under 20 people accounted for 45.3% and food service staffs were accounted for 36.7%. No significant differences were observed for the four items on the IPA, except for the topics "the immediate deal with trash and leftover food" and "minimizing time (within 2 hours) for distribution after cooking" (p<0.001). The average score on the IPA was 4.14 points, and the average score for the importance of the evaluation was 4.49 points out of 5. Finally, childcare facility managers are aware of the importance that is lower than can be done. The results suggest that continuing education is necessary to administrators to manage the health care facility effectively.

Analysis of the Entrance Surface Dose (ESD) and Contrast Usage of Trance Femoral Cerebral Angiography (TFCA) and Cerebral Computed Tomographic Angiography (CCTA) for Cerebrovascular Disease Examining (뇌혈관 질환 검사를 위한 뇌혈관 조영술(TFCA)과 뇌혈관 전산화 단층 촬영 검사(CCTA)의 입사표면선량(ESD) 및 조영제 사용량 분석)

  • Seo, Young-Hyun;Hong, Cheon-Gi;Song, Jong-Nam
    • Journal of the Korean Society of Radiology
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    • v.13 no.4
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    • pp.495-502
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    • 2019
  • A typical cerebrovascular disease among cerebrovascular diseases is vascular diseases such as cerebral infarction, cerebral hemorrhage, cerebral aneurysm, cerebrovascular stenosis. If the disease occurs and causes cerebral damage, it may be difficult to recover completely. So that, Must continue to perform health care through examination early. In particular, Because most cerebrovascular disease examining use radiation equipment and Thus this study was to find out how to select about the optimal examining method and X-ray dose decrease method among different examining method though comparison and analysis for the entrance surface dose (ESD) on cerebrovascular examining with Trance Femoral Cerebral angiography (TFCA) and Cerebral Computed Tomographic Angiography (CCTA). Also, want to find out how to select about the optimal examining method for worried patient that contrast medium side effect though measuring and evaluating for contrast usage. Data were collected from 70 patients (43 males and 27 females) who underwent CCTA at Yeosoo region hospital from June 2018 to December 2018 and 61 patients (34 males and 27 females) who underwent TFCA at Pyeongtaek region hospital from June 2018 to November 2018. ESD analysis method collected retrospective data though M-view and PACS PLUS program, Used contrast usage measuring method did reality measuring method. In the analysis using SPSS, the ESD of TFCA was $245.74{\pm}71.91$, which was $32.05{\pm}7.74$ lower than the dose of $277.79{\pm}79.65$ of CCTA ESD, and statistically significant at t = 3.249, p = 0.017 (p<0.05). As a result of the comparison of the total amount of contrast agent, the mean contrast agent used in TFCA was $55.05{\pm}17.68ml$, which was about 14.95 smaller than the amount of contrast agent used in CCTA, and statistically significant t = -4.548, p<0.001. In conclusion, the ESD of TFCA was statistically significantly lower than that of CCTA, and also the used contrast usage was significantly tiny than that of CCTA. Therefore, Select the method to increase the utilization of TFCA for cerebral disease examining, we can consider X-ray dose decrease method at the same time as to decrease side effect of contrast medium.

A Study on Hoslital Nurses' Preferred Duty Shift and Duty Hours (병원 간호사의 선호근무시간대에 관한 연구)

  • Lee, Gyeong-Sik;Jeong, Geum-Hui
    • The Korean Nurse
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    • v.36 no.1
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    • pp.77-96
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    • 1997
  • The duty shifts of hospital nurses not only affect nurses' physical and mental health but also present various personnel management problems which often result in high turnover rates. In this context a study was carried out from October to November 1995 for a period of two months to find out the status of hospital nurses' duty shift patterns, and preferred duty hours and fixed duty shifts. The study population was 867 RNs working in five general hospitals located in Seoul and its vicinity. The questionnaire developed by the writer was used for data collection. The response rate was 85.9 percent or 745 returns. The SAS program was used for data analysis with the computation of frequencies, percentages and Chi square test. The findings of the study are as follows: 1. General characteristics of the study population: 56 percent of respondents was (25 years group and 76.5 percent were "single": the predominant proportion of respondents was junior nursing college graduates(92.2%) and have less than 5 years nursing experience in hospitals(65.5%). For their future working plan in nursing profession, nearly 50% responded as uncertain The reasons given for their career plan was predominantly 'personal growth and development' rather than financial reasons. 2. The interval for rotations of duty stations was found to be mostly irregular(56.4%) while others reported as weekly(16.1%), monthly(12.9%), and fixed terms(4.6%). 3. The main problems related to duty shifts particularly the evening and night duty nurses reported were "not enough time for the family, " "afraid of security problems after the work when returning home late at night." and "lack of leisure time". "problems in physical and physiological adjustment." "problems in family life." "lack of time for interactions with fellow nurses" etc. 4. The forty percent of respondents reported to have '1-2 times' of duty shift rotations while all others reported that '0 time'. '2-3 times'. 'more than 3 times' etc. which suggest the irregularity in duty shift rotations. 5. The majority(62.8%) of study population found to favor the rotating system of duty stations. The reasons for favoring the rotation system were: the opportunity for "learning new things and personal development." "better human relations are possible. "better understanding in various duty stations." "changes in monotonous routine job" etc. The proportion of those disfavor the rotating 'system was 34.7 percent. giving the reasons of"it impedes development of specialization." "poor job performances." "stress factors" etc. Furthermore. respondents made the following comments in relation to the rotation of duty stations: the nurses should be given the opportunity to participate in the. decision making process: personal interest and aptitudes should be considered: regular intervals for the rotations or it should be planned in advance. etc. 6. For the future career plan. the older. married group with longer nursing experiences appeared to think the nursing as their lifetime career more likely than the younger. single group with shorter nursing experiences ($x^2=61.19.{\;}p=.000;{\;}x^2=41.55.{\;}p=.000$). The reason given for their future career plan regardless of length of future service, was predominantly "personal growth and development" rather than financial reasons. For further analysis, the group those with the shorter career plan appeared to claim "financial reasons" for their future career more readily than the group who consider the nursing job as their lifetime career$(x^2$= 11.73, p=.003) did. This finding suggests the need for careful .considerations in personnel management of nursing administration particularly when dealing with the nurses' career development. The majority of respondents preferred the fixed day shift. However, further analysis of those preferred evening shift by age and civil status, "< 25 years group"(15.1%) and "single group"(13.2) were more likely to favor the fixed evening shift than > 25 years(6.4%) and married(4.8%)groups. This differences were statistically significant ($x^2=14.54, {\;}p=.000;{\;}x^2=8.75, {\;}p=.003$). 7. A great majority of respondents(86.9% or n=647) found to prefer the day shifts. When the four different types of duty shifts(Types A. B. C, D) were presented, 55.0 percent of total respondents preferred the A type or the existing one followed by D type(22.7%). B type(12.4%) and C type(8.2%). 8. When the condition of monetary incentives for the evening(20% of salary) and night shifts(40% of. salary) of the existing duty type was presented. again the day shift appeared to be the most preferred one although the rate was slightly lower(66.4% against 86.9%). In the case of evening shift, with the same incentive, the preference rates for evening and night shifts increased from 11.0 to 22.4 percent and from 0.5 to 3.0 percent respectively. When the age variable was controlled. < 25 yrs group showed higher rates(31.6%. 4.8%) than those of > 25 yrs group(15.5%. 1.3%) respectively preferring the evening and night shifts(p=.000). The civil status also seemed to operate on the preferences of the duty shifts as the single group showed lower rate(69.0%) for day duty against 83. 6% of the married group. and higher rates for evening and night duties(27.2%. 15.1%) respectively against those of the married group(3.8%. 1.8%) while a higher proportion of the married group(83. 6%) preferred the day duties than the single group(69.0%). These differences were found to be statistically all significant(p=.001). 9. The findings on preferences of three different types of fixed duty hours namely, B, C. and D(with additional monetary incentives) are as follows in order of preference: B type(12hrs a day, 3days a wk): day shift(64.1%), evening shift(26.1%). night shift(6.5%) C type(12hrs a day. 4days a wk) : evening shift(49.2%). day shift(32.8%), night shift(11.5%) D type(10hrs a day. 4days a wk): showed the similar trend as B type. The findings of higher preferences on the evening and night duties when the incentives are given. as shown above, suggest the need for the introductions of different patterns of duty hours and incentive measures in order to overcome the difficulties in rostering the nursing duties. However, the interpretation of the above data, particularly the C type, needs cautions as the total number of respondents is very small(n=61). It requires further in-depth study. In conclusion. it seemed to suggest that the patterns of nurses duty hours and shifts in the most hospitals in the country have neither been tried for different duty types nor been flexible. The stereotype rostering system of three shifts and insensitiveness for personal life aspect of nurses seemed to be prevailing. This study seems to support that irregular and frequent rotations of duty shifts may be contributing factors for most nurses' maladjustment problems in physical and mental health. personal and family life which eventually may result in high turnover rates. In order to overcome the increasing problems in personnel management of hospital nurses particularly in rostering of evening and night duty shifts, which may related to eventual high turnover rates, the findings of this study strongly suggest the need for an introduction of new rostering systems including fixed duties and appropriate incentive measures for evenings and nights which the most nurses want to avoid, In considering the nursing care of inpatients is the round-the clock business. the practice of the nursing duty shift system is inevitable. In this context, based on the findings of this study. the following are recommended: 1. The further in-depth studies on duty shifts and hours need to be undertaken for the development of appropriate and effective rostering systems for hospital nurses. 2. An introduction of appropriate incentive measures for evening and night duty shifts along with organizational considerations such as the trials for preferred duty time bands, duty hours, and fixed duty shifts should be considered if good quality of care for the patients be maintained for the round the clock. This may require an initiation of systematic research and development activities in the field of hospital nursing administration as a part of permanent system in the hospital. 3. Planned and regular intervals, orientation and training, and professional and personal growth should be considered for the rotation of different duty stations or units. 4. In considering the higher degree of preferences in the duty type of "10hours a day, 4days a week" shown in this study, it would be worthwhile to undertake the R&D type studies in large hospital settings.

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