• Journal of the Korean Applied Science and Technology
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• v.38 no.1
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• pp.88-98
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• 2021

This study was conducted to identify the factors affecting the self-confidence in performing patient safety management in nursing students. As a result of the analysis, 7.0 points in knowledge of patient safety management, 3.86 points in attitude of patient safety management, 3.47 points in clinical decision making ability, and 4.15 points in self-confidence in performing patient safety management. Self-confidence in performing patient safety management was positively correlated with knowledge of patient safety management(r=.216, p<.01) and attitude of patient safety management(r=.375, p<.01), clinical decision making ability(r=.467, p<.01). The self-confidence in performing patient safety management was influenced by clinical decision making ability(β=.409, p<.001) and attitude of patient safety management(β=.198, p=.011), explanatory power was 26.3%.

• Journal of Korean Academy of Nursing Administration
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• v.20 no.2
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• pp.227-236
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• 2014

Purpose: This study was designed to develop and evaluate the a web-based simulation program on patient rights education using integrated decision making model into values clarification for nurse students. Methods: The program was designed based on the Aless & Trollip model and Ford, Trygstad-Durland & Nelms's decision model. Focus groups interviews, surveys on learning needs for patient rights, and specialist interviews were used to develop for simulation scenarios and decision making modules. The simulation program was evaluated between May, 2011 and April, 2012 by 30 student nurses using an application of the web-based program evaluation tools by Chung. Results: Simulation content was composed of two scenarios on patient rights: the rights of patients with HIV and the rights of psychiatric patients. It was composed of two decision making modules which were established for value clarifications, behavioral objective formations, problems identifications, option generations, alternatives analysis, and decision evaluations. The simulation program was composed of screens for teacher and learner. The program was positively evaluated with a mean score of $3.14{\pm}0.33$. Conclusion: These study results make an important contribution to the application of educational simulation programs for nurse students' behavior and their decision making ability in protecting the patient rights.

• Journal of Digital Convergence
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• v.16 no.12
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• pp.511-521
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• 2018

The purpose of this study was to investigate the effect of critical thinking, clinical decision making ability, patient safety knowledge and attitude ability to perform patient safety activities during clinical practice on nursing student's. Data were analyzed using t-tests and one-way ANOVA using the SPSS 21.0 program. As a result, the subjects' safety nursing activities was positively correlated critical thinking disposition(r=.278, p=.001), clinical decision making ability(r=.202, p=.014), patient safety attitude(r=.421, p<.001).The significant predictors of perform safety nursing activities were gender(${\beta}=.175$, p=.031), patient safety education(${\beta}=-2.266$, p=.025), critical thinking disposition(${\beta}=3.354$, p=.001), patient safety attitude(${\beta}=.368$, p<.001). These factors explained 31.5% of the variance(R2=.561, F=4.56 p<.001). It is necessary to establish a curriculum for critical thinking disposition, clinical decision making ability, and patient safety education in order to improve patient safety performance necessary for clinical practice education of nursing college students.

• Journal of Korean Academy of Nursing
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• v.29 no.4
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• pp.880-891
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• 1999

The purpose of this study was to describe nursing decision tasks, their characteristics, and problems associated with decision making. The subjects were 32 nurses who had at least one-year nursing experience and worked on medical-surgical units or intensive care units(ICU). They were asked to describe their decision making experiences in patient care situations and to identify the characteristics of each decisions. They were also asked to describe perceived problems associated with decision making in nursing. The responses on nursing decision tasks and problems were analyzed with content analysis and the decision characteristics were identified by statistical analysis of variance. It was found that there were 16 nursing decisions which are as follows : decisions related to interpreting and selecting appropriate strategies for pain management(6.6%) ; decisions related to providing emotional support (0.7%) ; decisions related to explaining the patient's condition and rationale for procedures(1.1%) ; decisions related to assisting patients to integrate the implications of illness and recovering into their lifestyles(2.9%) ; decisions related to detecting significant changes In patients and selecting appropriate intervention strategies (17.2%) ; decisions related to anticipating problems and selecting preventive measures(4.2%) ; decisions related to identifying emergency situations(0.4%) ; decisions related to effective management of patient crisis until physician assistance becomes available(2.8%) ; decisions related to starting and maintaining intravenous therapy(2.6%) ; decisions related to administering medications(8.1%) ; decisions related to combating the hazards of immobility(7.3%) : decisions related to treating wound management strategies(5.5%) ; decisions related to relieving patient discomfort(13.9) ; decisions related to selecting appropriate strategy according to the changing situation of the patient(18.2%) ; decisions related to selecting the best strategy for patient management(5.3%) ; and decisions related to coordinating, ordering, and meeting the various needs of the patient (3.1%). The nurses reported the fellowing problems in decision making : difficulties due to lack of knowledge and experience (18.6%) ; uncertainty and complexity of decision tasks(15.2%) ; lack of time to make decisions(2.9%) ; personal values which conflict with other staff(15.7%) ; lack of selection autonomy(30.0%) ; and organizational barriers(7.6%). Continuing education programs and decision support systems for frequent nursing decision tasks can be established on the basis of these results. Then decision ability in nurses will increase through the education programs and decision support systems, and then quality of nursing service will be better.

• Journal of Convergence for Information Technology
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• v.11 no.6
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• pp.73-82
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• 2021

This study was conducted to identify factors influencinging confidence in performing patient safety management (PSM) of nursing students. The subjects of this study were 230 nursing students in four universities in two cities. Data were collected between June 22 and June 26, 2020 using by completing structured self report questionnaires. Data were analyzed using SPSS/WIN 21.0. programs. In correlation analysis, significant positive correlations were found between confidence in performing PSM, PSM knowledge(r=.321, p<.001), PSM attitude(r=.584, p<.001), and clinical decision making ability(𝛽=.460, p<.001). In multiple regression analysis, PSM attitude(𝛽=.35, p=.005) and clinical decision making ability(𝛽=.23, p<.001) were factors predicting confidence in performing PSM, which explained 34.2% of the variance in the model. Therefore, we emphasize that continuing customized convergence educational programs are required to improve nursing student's confidence in performing PSM.

• The Korean Society of Law and Medicine
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• v.23 no.1
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• pp.37-80
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• 2022

By analyzing informed consent and the refusal of emergency medical treatment (called patient dumping) under the current Emergency Medical Service Act, this study suggests that an emergency medical professional is only liable for patient dumping if their duty to protect the patient's life takes precedence over the patient's right to self-determination. In emergency medical situations, as in general medical situations, medical treatment should be performed after the emergency medical professional informs the patient about the medical treatment, including its necessity and methods, and obtains consent from the patient. Refusing or evading the performance of emergency medical services on the excuse of the informed consent not considering a waiver or alteration of informed consent requirements without reasonable reasons violates the Emergency Medical Service Act and thus makes an emergency medical professional liable to administrative disposition or criminal penalty. In other words, depending on the existence of a waiver of alteration of the informed consent, patient dumping may be established. If the patient is a minor or has no decision-making ability, and their legal representative makes a decision against the patient's medical interests, the opinion of the legal representative is not unconditionally respected. A minor also has the right to decide over their body, and the decisions of their legal representatives should be in the patient's best interests. If the patient refuses treatment, in principle, the obligation of life protection of emergency medical professionals is the top priority. However, making these decisions in the aforementioned situations in the emergency medical field is difficult because of the absence of explicit regulations regarding these exceptional problems. This study aims to organize the following precedents of the Supreme Court of Korea. The court states that, when balancing the conflicting interests between the duty to provide emergency medical service and the duty to inform is unavoidable for emergency medical professionals, they should put the duty to protect the patient's life ahead of the duty to inform if the patient's life matters. Exceptionally, when a patient has seriously considered whether they should receive treatment before the emergency medical situation, their right to self-determination can be considered equal to the obligation of emergency medical professionals to provide emergency medical treatment. This research also suggests that an amendment of the Emergency Medical Service Act should include the following. First, the criteria for determining the decision-making ability of emergency patients should consist of medical content. Second, additional consent from a medical professional is unnecessary for first-aid treatment. Finally, new provisions for emergency medical obligations for minors, new provisions for the decision standard when there are conflicting opinions about the treatment of a patient, and new penalty provisions for professionals who suspend emergency medical examinations and treatments need to be established.

• Journal of Hospice and Palliative Care
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• v.25 no.1
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• pp.42-49
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• 2022

As population aging increases the burden of cancer, the quality of death of patients with cancer is emerging as an important issue alongside their quality of life. To improve the quality of death, it is necessary to prepare for death, allowing patients to die comfortably and with dignity at the end. Considering these issues, I aim to discuss the practical aspects of notifying the patient of the terminal phase of cancer and planning for end-of-life care (i.e., advance care planning). When cancer treatment that can extend the patent's lifespan becomes difficult, the patient enters a treatment transition period. Treatment is shifted from life-prolonging care to life-enhancing care, and end-of-life care must be well planned. Medical providers often worry too much about whether the patient will be disappointed or psychologically traumatized when notified of the terminal phase of their cancer, thus delaying plans for end-of-life care. In fact, patients can accept their condition and prepare for end-of-life care better than we expect. During the treatment transition period, notification of terminal status should be given, and a well-prepared advance care plan should be established early when the patient has decision-making ability. In addition to conveying information, it is always necessary to be sensitive to whether the patient and caregiver understand the information and respond to their emotions.

• The Korean Society of Law and Medicine
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• v.11 no.2
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• pp.239-274
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• 2010

Advance directive refers to a description of the treatment method a patient wants to be provided with in case where the person is unconscious or lacks an ability to decision making in a future period or a declaration of intention that delegates and appoints another person who makes a decision regarding a treatment method on behalf of the person. Advance directive is usually a document form, but oral statement is acceptable as well. Advance directive may have a variety of forms though, it basically consists of two basic forms. That is, one is a living will, and the other is a surrogate decision making. Though the importance of advance directive has been emphasized, and the necessity of adopting the system has been strongly argued for so far, the debates on criteria, method, and procedure alike have not yet reached an agreement. It is because even the concept of advance directive is more or less ambiguous, and each specific method has its own theoretical limitations and practical constraints. Thus the inquiries on advance directive raised in the study are summarized as the meaning, practicability, and philosophical foundation of the advance directive. Firstly, the theoretical limitations of Advance directive may be categorized into conceptual and moral limitations. In case of conceptual limitations, authors of advance directives may not be well aware, in advance, of the particular situation in which he or her will experience in the future, and patients may experience the change in his or her values and lack the understanding and information about the future situation due to the changes in treatment methods. In case of moral limitations, a patient has a limited moral autonomy right and self identity that have an impact on his or her preference. Secondly, in case of practical constraints for advance directive, there exist cultural features, low ratio of documentation, as patients themselves admit, and low predictability and stability of patient's own preference regarding life-sustaining care. And the problem of validity and accuracy in proxy's decision making is also raised. Those who administer a living will, especially, may have a difficulty in understanding the directive by a patient, so that the accuracy of execution cannot be secured. In the sense, it is needed to implement a legal device in order to solve such problems. In summary, it is urgently required to understand the limitations and explore desired alternatives to overcome the relevant problems in advance, which must contribute to successfully adopting and effectively operating the advance directive system in Korea.

• The Journal of Korean Academic Society of Nursing Education
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• v.20 no.2
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• pp.212-222
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• 2014

Purpose: The purpose of this study was to evaluate the nursing students' clinical judgment skills in simulation using Tanner's Clinical Judgment Model. Method: Forty-five teams of a total 93 nursing students participated in a post-operative patient care scenario using human patient simulator. Data were collected from students' responses in scenario and guided reflective journaling according to the framework of Tanner's model which comprised noticing, interpreting, responding, and reflecting on response. Data were analyzed using descriptive statistics. Results: The students' responses of the situation were in accordance with the goals of scenario, i.e. relieving patient' pain and preventing pulmonary complications. However, most of students needed clinical cues and focused on a given clue to solve the issues. They were lack of ability to collect additional information as well as connect the relevant clues in simulated clinical situation. Conclusion: The nursing students have difficulty in what they notice, how they interpret finding, and respond appropriately to the situation. The simulation training using Tanner's model could provide faculty and nursing students with an effective teaching and learning strategy to develop the clinical judgment skills.

• PNF and Movement
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• v.14 no.3
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• pp.157-176
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• 2016

Purpose: The purpose of this study was to share an experience about processes and lessons learned to execute evidence-based practice (EBP) in neurological physical therapy. Methods: The most important thing in applying EBP to practice is to search, find, and appraise the existing evidence. Many evidence databases are available, such as CENTRAL, PEDro, PUBMED, and EMBASE. However, the knowledge represented in these databases is not always perfect. The practice model is a set of processes to resolve client problems. Therapists should make hypothesis-focused decisions through EBP. Integrating clinical reasoning and evidence is most important when it comes to the execution of EBP. Results: The process of EBP consisted of following: coming up with clinical questions, followed by searching for, appraising, evaluating, and integrating evidence. To integrate EBP into practice, it is necessary to consider clinical expertise, patient value and preferences, as well as research wth the best evidence. We provided an example of a clinical case with a stroke patient to show how this process and framework concerning clinical reasoning through evidences can be integrateds. During this process, we also utilized information technology to improve EBP ability. Conclusion: We should recognize what manner of information is needed to resolve eash patient's problem, and we should search for this information efficiently. Then, we should judge the value of the information obtained as it applies, to the clinical setting.