• Journal of Korean Academy of Nursing
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• v.26 no.4
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• pp.768-781
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• 1996

The problem of care of patients and families with Alzheimer's disease has become a conscious raising social policy issue in Korea. The government of the Republic of Korea has become cognizant of the situation and has begun searching for ways to remedy it. Thus, there is a need for a comprehensive under-standing of the situation in which patients and their families are struggling and the enormous problems of care. With a realization of the urgent need, this study was done to investigate the situation and the care needs of families with patients with Alzheimer's Disease, and to compare the effectiveness of services utilized by the families in terms of cost and effects on patient's conditions and on family live. The Subjects for the study were 29 families with hospitalized patients, 25 families utilizing hospital outpatient clinics, 14 families utilizing day care facilities, and 16 families with homebound patients. A total of 84 families were interviewed by four trained interviewers using structured and semistructured questionnaires. The data produced from these interviews included : the patient's stage of Alzheimer's disease, patient's bizarre behavior, hours spent on patient care per day, family burden and quality of life, direct and indirect costs encountered in the care of patients, and the families' evaluation of the effectiveness of the services received. The data were analyzed to determine the relationships between family charactersistics, patient's conditions and services utilization. The effectiveness of each of the service entities was assessed through families evaluation and hoped for service and comparisons were made between services in terms of the cost-effectiveness ratios. After initial comparison of cost-effectiveness ratios, further analysis was done to compare between groups for incremental effectiveness for each incremental unit of cost to determine the most cost-effective service entities. The findings of the study are as fellows : 1. The choice of living arrangement and the types of services are a function of the stage of Alzheimer's condition and the economic status of the family. 2. Comparision of the cost of care showed that most expenses were encountered in by families with hospitalization, families using outpatient services, and families using day care services in that order. The least expense was involved in the care of homebound patients. The economic burden felt by families was in the same order as expenses. 3. The average number of hours spent on daily patient care was 9.9 hours for the outpatient clinic users, 9.7 hours for homebound patients, and 5.4 hours for day care users. 4. There were significant differences in the patient's conditions (CDRL), bizarre behaviors and the families's burden by living arrangement and /or types of service. However, no significant difference was found between groups in the family's quality of life. 5. The families rated the services of day care center as most effective for the care of the patients and families, except for a few families who had experienced some improvement in the patient's conditions. The outpatient clinic users expressed psychological comforts mainly in that the patient was being taken care of. For those hospitalized patients, families expressed the comfort of being relieved of the burden of care and that the patient is being professionally cared for. Form the analysis of the costs, hours of patient care, patient's bizarre behaviors, family's quality of life and burdens, and family's evaluation of services, it is concluded that up to the mid stage of Alzheimer's condition, the utilization of day care center services is found to be the most cost-effective, and toward the end stage of the Alzheimer's disease, it is hoped that there will be a establishment of long term or short term in-patient facilities for the protection of patients and preservation of the integrity of families for less cost. Thus. it was concluded that the family centered system of care is the most effective for Korea with systematic support systems developed for the care of patients and their families according to the needs of families as the patient's condition deteriorates.

• Journal of Internet Computing and Services
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• v.23 no.3
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• pp.87-95
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• 2022

Recently, with the development of smart technology, in medical information platform, patient's biometric data is measured in real time and accumulated into database, and it is possible to determine the patient's emergency situations. Medical staff can easily access patient information after simple authentication using a mobile terminal. However, in accessing medical information using the mobile terminal, it is necessary to study authentication in consideration of the patient situations and mobile terminal. In this paper, we studied on medical information platforms based on big data processing and edge computing for supporting automatic authentication in emergency situations. The automatic authentication system that we had studied is an authentication system that simultaneously performs user authentication and mobile terminal authentication in emergency situations, and grants upper-level access rights to certified medical staff and mobile terminal. Big data processing and analysis techniques were applied to the proposed platform in order to determine emergency situations in consideration of patient conditions such as high blood pressure and diabetes. To quickly determine the patient's emergency situations, edge computing was placed in front of the medical information server so that the edge computing determine patient's situations instead of the medical information server. The medical information server derived emergency situation decision values using the input patient's information and accumulated biometric data, and transmit them to the edge computing to determine patient-customized emergency situation. In conclusion, the proposed medical information platform considers the patient's conditions and determine quick emergency situations through big data processing and edge computing, and enables rapid authentication in emergency situations through automatic authentication, and protects patient's information by granting access rights according to the patient situations and the role of the medical staff.

• Journal of Biomedical Engineering Research
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• v.28 no.5
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• pp.703-712
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• 2007

In this paper, we designed the RFID(Radio Frequency Identification) Emergency Medical Information System(REMIS). This REMIS offers the emergency patient's medical information using RFID and HL7(Health Level 7) to an emergency medical technician. In emergency situation as like coma, if the communication, from the patient's current location to the hospital, is possible, REMIS offer the medical information of the patient through REMIS server to an emergency medical technician. In the state of communication blocked, REMIS can offer the patient identification and the emergency information through RFID tag, which the patient wear, to an emergency medical technician. When this system was designed, the protection of the patient's medical information and their privacy was considered, and the HL7 was used to be compatible with another medical systems. Therefore, in this paper, REMIS was designed that it is always possible to offer the emergency patient's information to an emergency medical technician regardless of any communication status and to improve the emergency rescue process, effectively.

• The Korean Society of Law and Medicine
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• v.15 no.2
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• pp.3-29
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• 2014

The Supreme Court made a decision that the doctor cannot be punished for not taking a blood transfusion to the patient, depending on the patient's will to refuse the blood transfusion on June 24, 2014. The reason is that, in a special situation of conflict between the right of patients to self-determination and the duty of care, and when it was impossible to compare whether which has the superior value, if the doctor made a medical practice to respect either of those two values according to the professional sense, he cannot be punished. In principle, the doctor should make medical practices according to the patient's will. However, if the patient's life was at stake, I think, the doctor is obliged to try his best to save the life of patient. Yet to entrust the patient's life to the doctors professional sense, is to give up the obligation of the country to protect lives. In this regard, I think that the Supreme Court Decision should be reviewed, and that an ongoing research is needed.

• Child Health Nursing Research
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• v.24 no.1
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• pp.27-36
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• 2018

Purpose: The purpose of this study was to develop a model for handoff education for nursing students based on simulation using video and to identify educational effects of a simulated situation in pediatric care units. Methods: Data were collected from May 1 to 30, 2016. Participants were 84 senior nursing students in Seoul (video group: 43, simulation group: 41). Both groups were given a lecture and pre-briefing on handoff education. The simulation group had nursing practice on resolving health issues for respiratory distress using a high-fidelity baby simulator. The video group watched a video recording of a scenario based simulation, and used a summarized handoff situation to practice patient handoff to another student. Results: There was no significant difference between the two groups for handoff self-confidence, problem solving ability, handoff competence (self-assessment of students), or learning satisfaction. Self-confidence increased significantly in both groups. Handoff competency evaluated by the instructor was higher in the video group compared to the simulation group (t=2.33, p=.022). Conclusion: Nursing student education for handoff practice utilizing a video in the pediatric unit was more cost effective. Therefore, it could be a useful educational method for students in learning patient handoff practices and helpful for related research.

• Journal of Korean Academy of Rural Health Nursing
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• v.15 no.1
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• pp.30-40
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• 2020

Purpose: This study was done to describe a community health practitioner's nursing case management for a terminal cancer patient registered in the public health post. Methods: For this purpose, data were collected through the patient and family through home visits, health clinic offices, and phone calls. The nursing process was carried out from August to November 2019. Results: The patient suffered the most from anorexia and lack of energy. Also he expressed psychologically uncertainty about disease and death anxiety caused by long-term treatment. In order to reduce the death anxiety, Community Health Practitioner (CHP) asked him to express his life stories and listened to him. CHP provided information of appropriate medications and alternative foods for symptoms such as gastrointestinal disorders and anorexia to the patient and family. Observing the situation of the patient and family, CHP guided the patient and family to prepare for death and has confirmed to them that the process was not with the patient alone. Conclusion: CHP's this experience has shown the possibility for CHP to help the terminal cancer patient and family to prepare peaceful death in their communities.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.6 no.2
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• pp.320-330
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• 1999

Nursing, a behavior of caring, means a connection of patients and clients has done through the caring of clients. Nurses are always with patients. In fact, caring is very important and the core of nursing, the true meaning of caring was embedded in our custom and consciousness before the approach of academic research. As a result, the existence of caring has not seen and revealed. Therefore, there is a need to study and confirm that caring has been placed in nursing and, nurses are doing caring in practice. The purpose of this study is to present the basis of nursing theory and practice through careful analysis of presence being, an aspect of caring. The presence of nurse shows a personal and healing relationship between nurses and patients on the basis of the respect for the humanity, Also, the role of nurses is to help a patient to integrate one's physical, mental and spritual aspects. Thanks to role of nurse, the pratical nursing has the characteristic of art and becomes more aesthetic and artistic. As we have seen above, we define 'presence' as 'being there' and 'being with' a patient for the purpose of meeting the health care needs. The attributes for which presence would be most appropriate would include the following : (1) being with and being together (2) take attention (3) mutual openness (4) experience an empathy (5) have an intention (6) therapeutic interaction process A caring situation as a necessary condition must be presupposed and the factors in that situation are the nurse's intense attention to the patient and a humanistic philosophy of the institutions of the patient. In any nursing intervention skill, there is listening, touching, giving hope, reassurancing, comforting and so on ; as a result, some positive effects can be expected between nurse and patient.

• Journal of Korean Academy of Nursing Administration
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• v.1 no.1
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• pp.147-211
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• 1995

Medication is a kind of medical service and a therapeutic nursing function which takes large portion of nursing service and requires complicated procedures. So many different medical personnel should be involved and cooporate each other in order to accomplish medication. Medication is also a vital nursing service, So nurse feels heavy responsibi lity in that she gives medication to the patient finally, so she has much responsibility if medication error is happened. Therefore it seems very important to clarify the problem of medication system and method, and find the subculture of medication situation because it may promote nursing productivity. The study was conducted to 1. Describe and interpret medication situation. 2. Find out the problem of medication system and method and on alternatives. 3. Compare the medication system and method of hospitals which are located in Seoul with object hospital Ethnographic methodology was used to study medication situation by doing participant observation and interview of health care personnel. Ten nurses and three nurse aids were interviewed. Two residents and internists, two phamacists and two accountants were also interviewed. Data was obtained and analized according to Developmental Research Sequence introduced by Spradly. On the basis of this data the results were as follows. 1. The overall flow of medication system was devided into six stage : first, checking doctor's order : second writing doctor's order, : third, transfering slip into the related departments such as account department, pharmacy : fourth, distribution of medication from pharmacy to unit : fifth, identifing medication by nurses : and finally, medicating to the patient. Behaviorors have been under a lot of stress in that they have to do much works, especially paperworks, So too much time were needed. They also have been suffered interpersonal conflicts among health care personnel and role conflicts in the process of doing medication service. 2. In the process of checking order, the problem was that too much time was required for checking order and paperwork. The more the order changes the more the paperwork is. Nurses have been suffering difficulties in calling internist in order to get bill. Even if writing down slip for medication order is doctor's job, Sometimes nurse has been expected to write slip by doctors or nurse would write slip beacuse of two much complexities and efforts for calling doctors. If the slip were incorrect, much time complicated procedures were more required for correcting it. So delay of administering drug would be resulted consequently. Drugs were delivered from pharmacy to units by delivery agent and phamacist. But because drugs were delivered without arranging room number of patient. Nurse should rearrange drugs in order of the room number So it had made waste time and effort, and Even when emergency drugs were needed, Prompt delivery of drug was not easy because of many reasons. For nurses, it took too long in the identification of the right drug. Actually nurses have heavy burden when medication error happens because nurse is the final actor who gives medication to the patient, So every three shift nurse ought to check drugs as soon as every shift begins. That's why it took too much time due to repeated confirming procedure. When nurses had to go patient room in order to give medications, there were difficulties in watching patient until the patient take medicine correctly. So it was impossible to check every patient wheather he took medicine or not especially in hectic situation. 3. There were many hospitals in Seoul which have similar medication system and method as object hospital according to the results of questionaire. This means that many hospitals have been suffering srimilar problems which were identified in object hospital. 4. Recommendations for promoting simplification of medication system and method were the following : Redesigning of slip from two pieces of paper into one : early discharge announcement system, and slip confirming through computer and controlling of period of prescreption from one day to two or three days : designing personal drug storage box for each patient and using it. If nurses follow the recommendations, they will make medication short & simple, and also have enough time of direct nursing care 5. Even though there were many difficulties in medicating patients. Medication itself has been considered as a caring among nurses because it makes rapport between nurse and patient. So nurses had better accept medication as a portion of nusing service not a original portion of phamacist. There are some limits in this research in terms of confining to only one unit of one hospital, and treating it especially in view of nurses' aspects, So further researchs should be continnued from various kmds of viewpoints of doctors, phamacists and so on. ${\cdot\cdot\cdot}$. Especially esthnographic study of computerized medication system and method seems to be followed.

• The Korean Society of Law and Medicine
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• v.9 no.2
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• pp.53-75
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• 2008

The end of life problem in the United States has been evolved from the development of concept of brain death over last 50 yr. The invention of ventilator and the development of emergency medicine also played a key role to elongate the end stage of life and which caused the American people to ask a question about the patients self determination and refusing the unwarranted medical treatment in the view of the death with dignity. With regard to the patient unable to self determination, surrogate decision was also considered. To guarantee the self determination, The patient self determination act also enacted on the level of Federal regulation in 1990s. But no law has effectively dealt with the situation when medical treatment became futile. Along with the significant debates on literature and court cases. The American Medical Association's Council on Medical and Judical Affairs presented formal opinion and the Texas was the first states to regulate the medical futile situation in 1999. Even though that definition was in controversy, the concept of medical futility mainly focused on the doctors' right to refuse the treatment.

• Journal of Internet Computing and Services
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• v.19 no.6
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• pp.31-40
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• 2018

With the development of IT technology recently, medical information systems are being constructed in an integrated u-health environment through cloud services, IoT technologies, and mobile applications. These kinds of medical information systems should provide the medical staff with authorities to access patients' medical information for emergency status treatments or therapeutic purposes. Therefore, in the medical information systems, the reliable and prompt authentication processes are necessary to access the biometric information and the medical information of the patients in charge of the medical staff. However, medical information systems are accessing with simple and static user authentication mechanism using only medical ID / PWD in the present system environment. For this reason, in this paper, we suggest a dynamic situation authentication mechanism that provides transparency of medical information access including various authentication factors considering patient's emergency status condition and dynamic situation authentication system supporting it. Our dynamic Situation Authentication is a combination of user authentication and mobile device authentication, which includes various authentication factor attributes such as emergency status, role of medical staff, their working hours, and their working positions and so forth. We designed and implemented a dynamic situation authentication system including emergency status decision, dynamic situation authentication, and authentication support DB construction. Finally, in order to verify the serviceability of the suggested dynamic situation authentication system, the medical staffs download the mobile application from the medical information server to the medical staff's own mobile device together with the dynamic situation authentication process and the permission to access medical information to the patient and showed access to medical information.