• Title/Summary/Keyword: Medical conflict

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Connecting Value and Costs

  • Eddy David M.
    • 대한예방의학회:학술대회논문집
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    • 1994.02b
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    • pp.84-86
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    • 1994
  • AS A SOCIETY, we are in conflict with ourselves about the cost of health care. 1 On one hand, we want the best care possible, regardless of cost. On the other hand, we are not willing to pay the cost of the care we want. Our conflict parallels a flaw in the medical marketplace. An essential condition for achieving an equilibrium between cost and value is that the two must be connected through decisions. When people decide what products and services (goods) they want, they must not only see the value they will receive, but they mast also be responsible for the costs. Because of a variety of features of the medical marketplace-most notably third-party coverage, third-party advice, and uncertainty about outcomes-the required connection between value and cost is severed. The result is what we see. One side of our collective mind demands more services while the other side cries that costs are too high. Resolving our conflict will require connecting value to cost. An essential step in accomplishing this will be to incorporate costs in practice policies. 1 As controversial as that thought might seem (the great majority of practice policies currently do not take costs into account except in the most rudimentary way), arriving at the conclusion is the easy part. A more difficult issue is how to implement the goal of connecting value to cost. Suppose we agree that, in principle, costs should be considered when practice policies are designed, and that an activity should be recommended and covered only if its health outcomes (benefits minus hanns) are deemed to be worth its costs. The next questions are, Who should do the deeming? What should the deemers be asked?

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Effects of Bullying Experience on Psychological Well-Being Mediated by Conflict Management Styles and Psychological Empowerment among Nursing Students in Clinical Placement: A Structural Equation Modeling Approach

  • Ren, Liping;Kim, Hyunli
    • Journal of Korean Academy of Nursing
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    • v.47 no.5
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    • pp.700-711
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    • 2017
  • Purpose: This study aimed to test a proposed structural equation model in which bullying experience, conflict management styles and psychological empowerment predict psychological well-being among Chinese nursing students in clinical placement. Methods: Three hundred and sixty-six nursing students recruited from five hospitals in J city and Y city were assessed with self-report questionnaires on bullying experience, conflict management styles, psychological empowerment and psychological well-being including depression, self-esteem, and academic major satisfaction. Data were analyzed using SPSS version 20.0 and AMOS version 22.0. Results: The evaluation parameters included the comparative fit index at .90, the goodness of fit index at .93, the root mean square error of approximation at .07, and ${\chi}^2/df$ ratio at 2.66, indicating that the proposed structural equation model provided a good fit to the data. Experience of being bullied during clinical placement, conflict management styles and psychological empowerment explained 93.0% of the variance and had significant effects on psychological well-being, with conflict management styles and psychological empowerment mediating the association between bullying and psychological well-being. Conclusion: The findings indicated that mediation by conflict management styles and psychological empowerment alleviated the negative influence of bullying on psychological well-being. To limit bullying and its negative effects, development of effective guidelines to deal with bullying will be a critical tool for both Chinese nursing students and their instructors. Further research should incorporate conflict management styles and psychological empowerment into the specific intervention strategies for handling bullying behaviors among nursing students and staff nurses and promoting nursing students' psychological well-being.

A Study on the Relationship between Nurses Relative Power and Interpersonal Conflicts (간호사의 상대적 권력과 대인갈등)

  • 이명옥
    • Journal of Korean Academy of Nursing
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    • v.27 no.1
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    • pp.169-177
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    • 1997
  • This study aims at empirically clarifying the relationship between power and the interpersonal conflict, including nurses' understanding of their relative power, the causes of interpersonal conflicts with the nurses, and strategies to resolve conflicts, in order to understand how nurses' relative power affect their conflicts. For the empirical survey, the population was defined as all the nurses working at a medical organization in Seoul, Korea. 1083 nurses were selected as the sample for the questionnaire survey and statistical analyses. For the sampling, 32 medical organizations were selected by a stratified random method and sub-samples were arbitrarily drawn from each organization to obtain the final sample of 1083 nurses who responded to the questionnaire designed by the reseacher. According to the result of the study, most nurses experience conflict more than once a month, and 70.4% of the respondents answered that interpersonal conflicts were directly or indirectly caused by power relations. which indicates that they perceive power relations as the main cause of interpersonal conflicts. Nurses experienced the most conflicts with interns and residents(29.7%), then patients and their families(24.3%), higher-positioned nurses(12.3%), nurse colleagues(7.7%), lower-positioned nurses(6.5%), and staff doctors(5.1%). If we classify these into three groups. the frequency of the conflicts, from most frequent to least. is in the order of doctors. nurses, and patients. In terms of relative power, nurses perceive that they have greater power than patients and their families, lower-positioned nurses, and nurse colleagues. In contrast, nurses perceive that they have less power than interns and residents, higher-positioned nurses. and staff doctors. Among these groups. nurses perceive that they have the most power over patients and the least over staff doctors. These results indicate that nurses tend to experience more conflicts with members of groups that are stronger than themselves in terms of relative power, Nurses use positive strategies such as the compromise strategy(32.3%) or the collaboration strategy (20.3%) to manage conflicts, more than other strategies. However, they use avoidance or competition strategy more at the earlier stage, compromise strategy more in the mid stage, and collaboration strategy more at the later stage of the interpersonal conflict. In relation to power, nurses use the collaboration strategy or the compromise strategy more when their perceived power is greater than or equal to their counterpart's, and they use the avoidance strategy or the accommodation strategy if their power is less. In terms of source of power, nurses' perceived relative power is greater in the order of referent power. expert power, reward power, legitimate power. and coercive power. where referent power is perceived as having the greatest power and coercive power is least. Most nurses(69.3%) used their power to resolve a conflict. with positive outcomes. Expert power was used most frequently. Overall. this study strongly indicates that the enhancement of power of nurses to have equal power relations with doctors would heighten the success of conflict resolution, since power is the main cause of conflicts. Specifcally. nurses experience most conflicts with doctors against whom they perceive the greatest gap in power. and the choice of a conflict management strategy depend upon their power relations.

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Ethical considerations in publication of medical papers (의학논문 출판윤리)

  • Bae, Chong-Woo
    • Clinical and Experimental Pediatrics
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    • v.51 no.5
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    • pp.447-451
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    • 2008
  • It is fair to say that there are many ethical issues concerning the publication of medical papers. To define the best practice in the ethics of scientific publishing and a proper understanding of appropriate reporting in medical papers, this review should be useful for authors dealing with ethical issues which involve the protection of human and animal rights, the protection of confidentiality and informed consent, fabrication, falsification, plagiarism, author and authorship, copy right transfer, duplicate publication, conflict of interest, and dealing with misconduct cases.

Psychoanalytic Observations on Chest Pain (흉통(胸痛)의 정신분석적(精神分析的) 고찰(考察) -두사람의 증례(症例)를 중심으로-)

  • Lee, Moo-Suk
    • Korean Journal of Psychosomatic Medicine
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    • v.3 no.1
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    • pp.98-106
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    • 1995
  • This study presents the cases of two patients suffering from chest pain as the chief complaint and refers to related literatures to reveal the psychoanalytic meaning of chest pain. In the first case, the patient who was balked of the desire to be loved complained of her pain in the chest She had been bereaved of her husband and felt deserted by someone on whom she depended, and these experiences caused the chest pain. The drive related to this chest pain in a dependent and aggressive one. The second case, the chest pain of a 28-year-old unmarried woman, resulted from Oedipal conflict Her Oedipal conflict did not resolve successfully for the exessive sexual stimulation in her childhood such as her experiences of witnessing the primal scenes sleeping with her parents in the same room, even under a same blanket In addition, there were some other traumas which prevented her from that conflict: Her father bathed her until her puberty: She saw her father's back view as he urinated in a jerry: She heard her parents' frequent quarrels. This patient felt guilty about desire of Oedipal incest, and chest pain seemed to occur as a kind of self-inflicted punishment.

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Effects on Couples' Communication, Intimacy, Conflict and Quality of Life by Foot Massage between Immigrants (결혼 이민자 부부 간의 발마사지가 부부의 의사소통, 친밀감, 갈등 및 삶의 질에 미치는 효과)

  • Uhm, Dong-Choon
    • Journal of Korean Academy of Nursing
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    • v.40 no.4
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    • pp.493-502
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    • 2010
  • Purpose: The purpose of this study was to evaluate the effects on immigrant couples' communication, intimacy, conflict and quality of life when using foot massage. Methods: The research design consisted of pre-and-post test consecutive experimental design through a nonequivalent control group. Data were collected July 6, 2009 to February 27, 2010. The 36 couples were divided into two groups, experimental and control with 18 couples in each group. Foot massage was applied twice a week for 6 weeks by the couples in the experimental group. Results: There were statistically significant increases in communication (p=.011), intimacy (p<.001), quality of life (p=.017) between the couples in the experimental group compared to the control group. There was also a statistically significant decrease in conflict (p=.003) between the couples in the experimental group compared to the control group. Conclusion: Foot massage can be applied as a nursing intervention for improvement of marital relationship in immigrant couples.

The Effect of Authentic Leadership on Psychological Well-Being: The Mediating Effect of Relational Conflict and Job Stress (진정성 리더십이 중국의료기관에 종사하는 구성원들의 심리적 웰빙에 미치는 영향: 관계갈등과 직무스트레스의 매개효과)

  • Wang, Le;Jin, Xiu
    • Journal of Digital Convergence
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    • v.20 no.5
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    • pp.129-138
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    • 2022
  • After the spread of COVID-19 in China, Chinese medical workers bear the high-intensity work, these problems reduced psychological well-being. Psychological well-being will affect the members'behavior and job performance. Authentic leadership can improve the members'psychological well-being. This study focuses on the psychological well-being and explores how authentic leadership in the process of affecting the psychological well-being, to find out the mediating role of the leaders' relational conflict and the job stress. This study found that authentic leadership in the process of improving the members'psychological well-being, job stress will play a negative mediating effect. Under the background of COVID-19 era, this study helps to improve the psychological well-being level of medical staff.

Influence of Job Stress on Fatigue and Job Satisfaction - with Some 119 Emergency Medical Technician in Gyeonggido - (직무스트레스가 피로와 직무만족도에 미치는 영향 - 경기소방 일부 119구급대원을 중심으로 -)

  • Park, Dae-Sung;Park, Sang-Sub
    • The Korean Journal of Emergency Medical Services
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    • v.12 no.3
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    • pp.71-86
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    • 2008
  • Purpose : This study was to examine the influence of job stress of 119 Emergency Medical Technician on fatigue and job satisfaction. Methods : Subjects of this study were 228 Emergency Medical Technicians who worked at 119 Safety Center of total 92 fire stations in 12 cities of Gyeonggido including U, N, H, B, A, S, Y, G, G, G, P and I and the period of data collection was from July 11 to Sep. 10, 2007. Collected data were analyzed with SPSS 14.0 version. Results : Conclusions of this study were as follows. 1) Factor related to organization among job stress factors had the greatest influence on fatigue (B = 0.334, p < 0.01), followed by crisis situation factor (B = 0.2042, p < 0.01), inappropriate treatment factor (B = 0.174, p < 0.05), role conflict factor as special job (B = 0.109, p < 0.05) and professional knowledge and technique factor (B = 0.109, p < 0.05), and the influence of job stress factors on fatigue was explained as $R^2=0.340$. 2) Mental burden factor of job stress factors had the greatest influence on job satisfaction (B = -0.606, p < 0.01), followed by organization factor (B = -0.473, p < 0.01) and interpersonal relation and conflict factor (B = -0.339, p < 0.01), and the influence of job stress factor on fatigue was explained as $R^2=0.308$. Conclusions : Job stress of 119 rescuer is increasing continuously and such an accumulated stress lowers the job efficiency. In order to reduce, job stress, it is important to extend(${\rightarrow}$ have) proper self-development, maintain close relationships and mutual correlations among members of organization in personal dimension and to solve the role conflicts, define the organizational roles and simplify excessive job description into concrete work.

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Medical Certificate as an Evidence of Personal Injury (진단서의 증명력: 상해진단서를 중심으로)

  • Lee, Dongjin
    • The Korean Society of Law and Medicine
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    • v.18 no.2
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    • pp.47-73
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    • 2017
  • Medical certificate is a document to demonstrate a patient's health status, made up and signed by a physician, dentist, or oriental physician who attended the patient. It serves as an evidence in many official process including civil or criminal law suit, especially for one's personal injury. The Korean legal system also acknowledges and protects the evidentiary function of medical certificate by mandating physicians etc. to issue medical certificate in good faith and only when they personally attended the patient, and by criminally punishing them when they do not comply with these legal requirements. There are some reasons, however, that medical certificates often do not reflect the true health status of the patient: When physicians attend the patient and collect information regarding the health status of the patient, their priority is and should be the most cost-effective way to meet the health needs of the patient. It does not necessarily correspond to the accurate examination of the health status of the patient. Even when the patient's report on the history of the illness or the injury seems suspicious, physicians might have to avoid disproving it because that kind of attitude might harm the rapport between the physician and the patient. All these can distort the perception of the physicians and this distortion can be reproduced in the medical certificate they made up. Some of these problems might be resolved or at least enhanced by introducing new form of medical certificate which would guide physicians to reveal the nature, factual and theoretical grounds, and the limit of their findings more accurately. Others, however, would not be able to address, because it stems from the conflict between the physician's primary duty, duty to be loyal to the patient's life and health, and his secondary duty to serve as a public or neutral witness on the health status of the patient, and when both values or duties conflict with each other, they should choose the duty to the patient sacrificing the duty to the public or the court.

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A Case of Conversion Disorder Treated with Gaegyeolseogyeong-tang (전환장애 환자에 개결서경탕(開結舒經湯)을 투여한 치험례)

  • Yoon, Ji-Won;Kim, Hong-Joon;Kim, Woo-Sung;Sim, Kuk-Jin;Shim, Ha-Na;Lee, Sang-Kwan;Kang, Sei-Young
    • The Journal of Internal Korean Medicine
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    • v.25 no.3
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    • pp.590-595
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    • 2004
  • Conversion Disorder is a disorder whose predominant feature is a loss or alteration in physical functioning that suggests a physical disorder but that is actually a direct expression of a psychological conflict or need. The Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) guidelines for Conversion Disorder include these definitions: A psychosocial stressor produces a psychological conflict that is believed to help initiate or exacerbate the illness The symptoms are not under conscious control, etc. While functional disabilities are common with conversion disorders, physical and laboratory abnormalities are absent or minor in comparison with the patient's subjective complaints. Symptoms of Conversion Disorder are similar to those of stroke. But the mechanism of Conversion Disorder is similar as that of Stagnation Syndrome of Ki (氣鬱證) in Oriental medicine. Gaegyeolseogyeong-tang has been used to treat women who suffer from Conversion Disorder induced by the Stagnation Syndrome of Ki (氣鬱證). After application of the Gaegyeolseogyeong-tang for 7 days, symptoms and signs improved dramatically.

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