• 근관절건강학회지
• /
• 제2권1호
• /
• pp.17-40
• /
• 1995

Rheumatoid arthritis is the one of the chronic diseases, one of its major symptoms is a chronic pain. Despite developing medical treatment and surgical techniques, it is suggested that to control the pain is the goal of the treatment. But pain is an inner experience and even those closest to the patient cannot truly observe its progress or share in its suffering. The National Academy of Sciences Institute of Medicine's report on Pain and Disability concluded that there is no objective measure of pain-(exactly) no pain thermometer-nor can there ever be one, because the experience of pain is inseparable from personal perception and social influence such as culture. To explore chronic pain experience is to understand the process and property of the patient's perception of pain through the response to pain, the coping with pain, and the adaptation to pain. Therefore a qualitative study was conducted in order to gain an understanding of pain experience of patients with RA in korea. I used naturalistic inquiry as a research methodology, which had 5 axioms, the first is that realities are multiple, constructed, and holistic, the second is that knower and known are interactive, inseparable, the third is only time and context bound working hypotheses(idiographic statements) are possible, the forth is all entities are in a state of mutual simultaneous shaping, so that it is impossible to distinguish causes from effects and the last is that inquiry is value-bound. Purposive sampling was conducted as a sampling. 20 subjects who experienced pain over 10 years, lived in middle-sized city and big city in Korea, and 17 women and 3 men. The subject's age was from 32 to 62 (average 48.8), all were married, living with their spouse and children, except two-one divorced and the other widow before they became ill. I collected data using In depth structured interview. I had interviews two or three times with each subject, and the interviews were conducted at each subject's home. Each interview lasted about two hours an average. A recording was taken with the consent of the subject. I used inductive data analysis-such as unitizing and categorizing. unitizing is a process of coding, whereby raw data are systematically transformed and aggregated into units. Categorizing is a process wherby previously unitized data are organized into categories that provide descriptive or inferential information about the context or setting from which the units were derived. This process is used constant comparative method. The pain controlling process is composed of behavior of pain control. The behaviors of pain control are rearranging of ADL, hiddening role conflict, balancing treatment, and changing social relation. Rearranging of ADL includes diet management, sleep management, and the adjustment of daily life activities. The subjects try to rearrange their daily activities by modified style of motions, rearranging time span & range of activities, using auxillary facilities, and getting help in order to keep on the pace of daily life. Hiddening role conflict means to reduce conflicts between sick role and their role as a family member. In this process, the subjects use two modes, one is to control the pain complaints, and the other is to internalize the value which is to stay home is good for caring her children and being a good mother. To control pain complaints is done by 'enduring', 'understanding' the other family members, or making them undersood in order to reduce pain. Balancing treatment is composed of two aspects. One is to keep the pain within the endurable level, the other is to keep in touch with medical personnel in order to get the information of treatment and emotional support. Changing social relation is made by information seeking and sharing, formation of mutual support relation, and finally simplification of social relationships. The subjects simplify their social relationships by refraining from relations with someone who makes them physically and psychologically strained. In particular the subjects are apt to avoid contact with in-laws, and the change of relation to in-laws results in lessening the family boundary. In the course of this process, they confront the crisis of family confict result in family dissolution. This crisis is related to the threat of self-existence. Findings from this study contribute to understanding the chronic pain experience. To advance this study, we should compare this result with other cases in different cultural contexts. I think to interpret these results, korean cultural background should be considered. Especially the different family concept, more broader family members and kinship network, and the traditional medical knowledge influences patients' behavior.

• 인삼문화
• /
• 제3권
• /
• pp.54-73
• /
• 2021

경성제국대학의 부속기관인 생약연구소는 현재 서울대학교 약학대학 천연물 과학연구소의 전신으로, 일제강점기 인삼연구를 중점적으로 수행하였던 종합연구기관이었다. 생약연구소는 경성제국대학 의학부 약리학 제2강좌의 교수 스기하라 노리유키의 주도로 설립되게 되는데, 스기하라는 약리학 제2강좌가 설치되었던 1926년부터 고려인삼 및 한약에 관한 연구를 집중적으로 진행하였다. 약리학 제2강좌에는 의학 및 약물학 전공인 스기하라 외에도 조교수로 약학을 전공한 카쿠 텐민, 강사로 농학 및 임학을 전공한 이시도야 츠토무가 있었으며, 이들을 중심으로 1939년 생약연구소 설립 이전까지 약 36명의 연구자가 활동하였다. 이 중에서는 약 14명의 조선인 연구자들이 있었는데, 이들은 대체로 경성의전, 경성치전, 경성약전 등 전문학교 출신들로 기본적인 의약학 지식을 갖추고 한의학, 본초학 등 독자적인 의약체계를 활용하는 조선의 한약재 연구에 임하였다. 1927년부터 민병기, 김하식 등이 활동을 시작하였으며, 1930년 이후 조선인 연구자는 증가하였다. 약리학 제2강좌는 조선의 약용식물 조사 및 한약재에 대한 약리학적 작용, 성분분석 등의 분야에서 다양한 연구결과를 발표하였으며, 또한 경성의전, 경성치전, 경성마약류중독자치료소, 지방도립의원 등의 기관들과 공동연구를 진행하기도 하였다. 한편 1935년, 국내 최대의 인삼 산지인 개성에서는 "약도개성" 계획이 수립되었다. 이는 전시용 약품의 연구 및 양산화, 인삼 산업개편을 통한 수익 창출을 목적으로, 민간단체, 개성부, 관동군, 경성제국대학 등이 참여한 대규모 프로젝트였다. 1936년에 경기도립 약용식물연구소, 1938년에 경성제국대학 부속 약초원 및 병참 제약공장이 설치되었으며, 1939년, 약용식물연구소와 약초원이 결합하여 경성제국대학 부속 생약연구소가 설립되었고 스기하라는 생약연구소 소장이 되었다. 생약연구소에서는 인삼에 관한 약리학적 연구에서 더욱 나아가, 선려삼 등 인삼을 이용한 제품개발 및 판매, 그리고 인삼재배 연구가 집중적으로 진행되었다. 또한, 1941년 제주도시험장을 설립하여, 제주도산 약재를 사용한 구충제 판시를 생산하기도 하였다. 1945년 일제의 항복과 광복으로 스기하라를 포함한 일본인 연구자들은 급히 귀국하였다. 이후 생약연구소는 서울대학교에 인계되어, 경성제국대학 의학부 출신 오진섭을 소장으로 우린근, 석주명 등의 학자들이 활동하며 한국 과학계의 선도적 역할을 하였다.

• 한국의료질향상학회지
• /
• 제7권1호
• /
• pp.32-45
• /
• 2000

Background : Critical pathway is an optional sequencing and timing of interventions by physicians, nurses, and other staff for a particular diagnosis or procedure, designed to minimize delays and resource utilization, and to maximize quality of care; abbreviated versions of case management plans that show critical outcome and key incidents that occur in a predictable and timely fashion to achieve an appropriate length of stay. This study is to develop a critical pathway for vaginal delivery and cesarean section to assess the degree of contentment of the patients and medical personnel and to implement clinical application to see how we could meet the need to guide patients to achieve continuum of care. Method : Critical pathways were developed for normal vaginal delivery and casarean section. LOS(length of stay) target for vaginal delivery was 1 day after delivery & 5 days after C-section. It was distributed to the mother at the OPD and explained thoroughly. It was applied when patients got into the Labor & Delivery Floor. We applied total of 42 patients (30 normal deliveries & 12 C-sections) from February to March, 2000. We performed patient satisfaction survey to all 42 patients, 24 nurses, and 7 residents for internal customer satisfaction. Results : Twenty six patients out of 42 responded to the survey. Twenty one patients out of 26 answered satisfactory. Eighty four percent of 21 respondents replied Critical pathway worked very well. Treatment column got the most compliance. Eleven out of 31 employees thought critical pathway is very helpful for the patient care. Eighteen people didn't see any difference. In their opinion, treatment got the least compliance, which is the contrary to patients opinion. Fifty eight percent of respondents thought that critical pathway can expedite early discharge. Conclusion : Patient satisfaction was higher than we expected but we still need to revise the form. It is recommended to analyze the cost and variance check in the future.

• 한국융합학회논문지
• /
• 제7권4호
• /
• pp.107-121
• /
• 2016

본 연구는 교대근무 간호사의 직무스트레스가 간호업무성과에 미치는 영향을 융합적으로 규명하여 간호 업무수행 성과를 제고하여 교대근무 간호사의 직무스트레스를 효과적으로 관리할 수 있는 방안을 모색하고자 한다. 연구방법은 2015년 3월 2일부터 2015년 3월15일까지 B광역시에 소재하는 모대학병원에서 교대근무를 하고 있는 간호사를 대상으로 설문조사한 자료 244부를 SPSS 21.0 프로그램을 이용하여 분석하였다. 그 결과 직무스트레스 평균점수는 3.57점, 간호업무성과 평균점수는 3.69점이었다. 직무스트레스는 간호업무성과의 하위영역인 대인관계 업무에 유의한 양(+)의 영향을 미쳤다. 따라서 교대근무 간호사의 직무스트레스를 보다 정확히 파악하여 효율적인 간호인력 관리가 이루어질 수 있도록 노력해야 할 것이다. 아울러 간호업무성과의 지속적인 향상을 위하여 실제적인 직무스트레스관리 중재 프로그램이 마련되어 교대근무간호사의 직무스트레스가 효과적으로 관리된다면 질 높은 간호업무성과를 통한 양질의 의료서비스가 제공 될 것으로 기대된다.

• 한국치위생학회지
• /
• 제7권2호
• /
• pp.153-166
• /
• 2007

The job of dental hygienists is specialized, and they have to be capable of performing their primary duties including prevention of oral diseases, oral prophylaxis, and oral health education. To ensure their successful job performance, dentists should have an accurate understanding of their duties and need a change of mind-set about them. And there should be written legal and concrete regulations on the coverage of their work in order to let them boost their job performance with pride and a sense of responsibility. The purpose of this study was to examine the actual roles and job performance of dental hygienists in clinical field in an attempt to discuss the substantial job performance of dental hygienists and their job enlargement. It's basically meant to help enhance the efficiency and quality of medical services. The subjects in this study were 471 dental hygienists in dental clinics, dental hospitals, university hospitals and general hospitals across the nation, on whom a survey was conducted in person from March 2 to 25, 2005. The collected data were analyzed with SPSS Win 12.0 program, and the findings of the study were as follows: 1. The major jobs they currently performed included oral health education, hospital management, simple duties, extensive dental hygiene duties and joint treatment assistance. They hoped to continue to be responsible for oral health education, preventive treatment and extensive dental hygiene duties. 2. As for their current job by age, extensive dental hygiene duties, preventive treatment, joint treatment assistance, preserving treatment, prosthetic treatment and pediatric treatment were most conducted by the dental hygienists who were at the age of 26 to less than 31, and those who were at the age of 31 and up were most responsible for hospital management and simple duties. 3. As to job awareness by workplace, their workload was statistically significantly different according to their workplace. The hospital employees took care of more work than those in clinics. 4. Concerning job awareness by age, the younger dental hygienists suffered more role conflicts and were given a less free hand in work handling, the middle-aged group's job was uncertain. Legal regulations about the coverage of their work should be prepared in detail as a measure to stir up their responsible job performance and pride. In order to take advantage of experienced dental hygienists, their duties should be more differentiated and specialized, and their working conditions should be improved to boost their job satisfaction. That is, they should be given ample chances for promotion and serving as a middle manager and be given fair treatment according to their career. If their work is accurately darified and specialized based on career, it will boost the efficiency of dental treatment. Dental hygienists also should direct sustained efforts into self-development in order to become a skilled and professional oral health personnel.

• Journal of Preventive Medicine and Public Health
• /
• 제28권3호
• /
• pp.588-608
• /
• 1995

This study was intended to enhance the level of hospital personnel management through analysing job satisfaction of hospital employees in terms of structural, personal and environmental variables. The sample of this study consist of a total of 790 persons including doctors, residents, interns, pharmacists, nurses, medical engineers, office workers and manual workers who have worked for general hospitals with 200 beds, 300 beds and 800 beds respectively. The Likert's 5 scales were used for the measurement of satisfaction. The results can be summarized as follows: 1. Structural Variables The level of satisfaction on the job itself was generally low, 2.8 in Likert's 5 scales, with the order of role ambiguity(3.87), routinization(2.6), work overload (2.45) and autonomy(2.37). Hospital employees are aware of their responsibility and they regarded their work as heavy one. The compensatory satisfaction degree was 2.5 which was also low: There were in the order stability(3.1), distributive justice(2.57), pay(2.3) and promotion(1.9). Usually hospital employees showed high degree of stability, while, their satisfaction on promotion possibility is quite low due to specially differentiated structures of hospitals. The degree of satisfaction on the internal conditions of organizational culture was relatively higher as 2.92: They were co-worker's support(3.69), supervisory support(3.15), role conflict(2.64) and welfare(2.17) in order. The satisfaction on welfare as an economic condition was the lowest. 2. Personal Variables The level of satisfaction on personal variables was 3.27 which seemed to be quite high: Contribution to the hospital(3.38), attitude on job performance(3.28) and pride as a member of the hospital(3.07). They seem to believe that their work has been helpful to the performance of hospitals. 3. Environmental Variables The degree of satisfaction on these variables was 3.07 on the average which was derived from environmental factors such as family-role conflict and community support related to hospital employees' environment. The order of satisfaction for each variable is community support(3.2) and family-role conflict(2.94). They turned out to be fairly satisfied with their job in community and yet, they wanted more spare time to spend with their family.

• 한국의료질향상학회지
• /
• 제8권1호
• /
• pp.44-55
• /
• 2001

Background : This study aimed at identifying the effect of the standardized protocol on lowering the incidence of the ventilator associated pneumonia(VAP). Methods : The standard protocol focusing on decreasing VAP was made and applied at 5 ICUs (Medical ICU, surgical ICU, Respiratory ICU, Neonatal ICU, Pediatric ICU) in a university affiliated tertiary hospital, from April 1, 2000 to Oct 31, 2000. The protocol involved 3 parts : hand washing, the suctioning method and ventilator circuit management. All the nursing personnel received intensive education which was consisted of lecture, video film and demonstration. 176 nurses reported the performance of handwashing pre and post intervention. And randomly selected 15 nurses were observed by charge nurse and the handwashing practice was analyzed pre and post intervention. The incidence of VAP was compared with the former year incidence. Results : The self reported frequency of hand washing increased. In the direct observation of handwashing, the frequency, time, thoroughness of hand washing during 8 hours day duty was found to be improved. The frequency was increased from 1.1 time to 4.1 times; the time was improved from 1.7 seconds to 5.7 seconds and the thoroughness of the washing practice was from 0.2 times to 3.0 times respectively (p<0.001). The incidence of VAP decreased from at a rate of 15.63 number of case per 1,000 ventilator-day (April 1~August 31, 1999) to 7.23 number of case per 1,000 ventilator-days(April 1~Oct 31, 2000)(P<0.001). Conclusion : We developed the protocols which included hand washing, the suctioning method, and ventilator circuit management. Through the implementation of the protocol, the performance of hand washing improved and the VAP incidence rate in ICU was decreased.

• 간호행정학회지
• /
• 제6권3호
• /
• pp.333-345
• /
• 2000

The health care environment becomes more competitive every day. It has fallen to nurse managers - from vice presidents of patient care to nurse managers and their assistants - to recruit and develop a workforce that successfully meets the needs of both patients and the organization. This means employees who demonstrate advanced critical thinking skills, creative problem solving, and sound decision making skills combined with clinical skills and patient advocacy. The environment which nurse managers create and the way they relate to their workforce, are pivotal to organizational viability. Especially leadership of first -line nurse managers contributes to the success of their organizations. First-line nurse managers are deserved to be one of the most administrative supervisors through the middle stratum in a hospital organization as being a manager in the field service if assessed from the overall aspects of hospital, as being an interim managers in the nursing department as well as being a supreme supervisor in a unit in terms of an organizational structure in the hospital. Similarly, as a compete leader, the first-line nurse managers have not only a professional which is qualified to perform a role of appropriate coordination with medical staff and key personnel but also hold an important key position a being responsible for performing his or her given role. The first-line nurse manager is expected to manage human and fiscal resources in ways not required before. While an identified need for well-prepared first-line nurse manager continues to plague the profession, first-line nurse managers often have difficulty providing the leadership required. The need leadership training to function effectively in their positions. But we hardly find a useful leadership training program for first-line nurse managers, therefore the purpose of this study was to developed the leadership training program for them. The steps of leadership program development were below: 1st step, 2 studies were done before develop a leadership program. One was done to ask to first-line nurse managers what they want to learn through leadership training, the other one was to ask the staff nurses what their opinions are for their first-line nurse managers leadership. 2nd step was searching other leadership programs contents. The results of this study were below: The total amount of hours is 24. Leadership training program contents are : Future of nursing profession (210min), understanding basic factor's of leadership and leadership theories(310 min), self understanding as first- line nurse managers(320 min), basic principle and practice of interpersonal relationship(210 min), assertiveness training, conflict management (180min), and group study(210min). This is challenging time to be a leader, especially in nursing. As nurse managers look toward the new millennium, it seems as through the same struggles are ahead that are behind. So nurse managers need to embrace change with a positive attitude. They need to demonstrate risk taking and support it in their staffs. All these things are possible that after they participate the leadership training program.

• 간호행정학회지
• /
• 제3권1호
• /
• pp.37-50
• /
• 1997

The purpose of this study was to identify the gap between need-level and demonstration-level in nursing managerial competencies. In addition, the study proposes solutions to narrow this gap. The results of this study are as follows : 1) The mean score for need-level of each item was 4.0, and for demonstration-level, 3.5. This indicates that military hospital head nurses demonstrate a higher level of managerial competencies than the moderate level on all items. But items which were related to resource/ cost/ information managament, staff development management and professionalism management got relatively low ratings in the need-level. 2) The mean score for need-level of each category was 4.14, and for demonstration-level, 3.53. Categories on the individual dimension got a higher rating than categories on the group or organization dimension in both need-level and demonstration level. 3) The gap between need-level and demonstration-level appeared in all items(p<.05) and categories(p<.001). Although the gap was relatively low, it indicates that it is essential to plan a developmemt program for all nursing management competencies for military hospital head nurses. 4) There were significant differences in the gap between need-level and demonstration-level according to specific characteristics of the subjects. The gap did not appear in many categories on the individual dimension where the number of nursing staff was more than 10, a major grade, ICU head nurse or for head nurses having a long career. 5) Need-level and demonstration-level showed a difference according to specific characteristics of the subjects, because need-level and demonstration-level were higher where the number of nursing staff was more than 10, a major grade, and for ICU or Medical ward head nurses. The categories which showed need-level difference and demonstration-level differences according to specific characteristics of the subjects existed almostly completely in the group and organization dimension. Gap-level differences according to the number of hospital bed existed in only two categories. 6) The general causes of the gap were indicated to be 'Knowledge/ skill/ experience deficit', 'Limitation of rules and systems/ Inappropriate organizational environment' for most items, categories, and dimensions. The results of this study indicate that extensive competency developing strategies must be developed, because a gap was found in all items and categories. Specially, there is a need to concentrate attention on competencies in the group and organizational dimension which had a wider gap level. And it is important to take an individual approach according to the cause for each gap. In order to produce effective competency developing strategies, top managers must have sinsights into the importance of nursing staff development and nursing officer's efforts to develop themselves must be achieved. Further multi-dimensional(education, personnel-policy, nursing/ organizational environment) solutions to the gap must be developed and utilized.

• 한국간호교육학회지
• /
• 제5권1호
• /
• pp.97-105
• /
• 1999

Based on literature, status and role of the NP in America was reviewed. The process of developing NP program in America suggests us many things. In America, nurse practitioners have sustained a mutually beneficial status with their patients for over thirty years. Excel fence in academic education and clinical training will enable nurse practitioners to continue to provide quality health care. The magnitude changes in the health care system of the United States, the challange of providing real access of health care continues. Lack of access to adequate primary care was the driving force in the initial 1965 Federal Involvement in developing the NP role. In 1993 President Bill Clinton's health care reform initiative provided policy support for NPs as primary care providers. The Institute of Medicine explicitly recognized NPs as an integral part of the primary care team. In addition, several national reports recognized NPs as affordable, accessible, high-quality care providers. The recent passage of direct Medicare reimbursement for NPs reflected public policy statements coincided with and likely contributed to a growth spurt in the NP workforce. From 1965 to 1977 NP programs offered traditional primary care clinical tracks(adult, family, woman's health, and pediatrics) for relatively small clusters of students in a variety of institutional settings. From 1978 to 1990 these educational programs were incorporated into graduate schools of nursing. By 1990 the majority of NPs received educational preparation in master's-level nursing programs. A new emphases was placed on postmaster's NP programs designed for master's prepared clinical nurse specialists and nurse managers. he the health care system shifted hospital nursing resources toward community-based care, these master's -level nurses sought additional NP preparation. NP educational programs are defined as the educational structure in which one or more NP clinical tracks are offered. NP clinical tracks, in turn, offer curriculum and supervised clinical experiences that match standards in specific practice areas such as family(FNP), adult(AUP), geriatrics(GNP), pediatrics(PNP), women's health (WHNP), neonatal (NNP), and acute care(ACNP). There were indications that NP practice was expanding into new clinical areas as evidenced by new types of tracks, particularly in acute care and psychiatry. The increase in acute care NP students likely reflects the increased demand from hospitals and other acute care settings. In Korea, change of nurse's role into nurse practitioner's role may have many difficulties. The need of health consumer, policy support of government, approval of medical care team are all essential component. Every nursing personnel make effort to planning the new health care delivery system.