• Journal of Hospice and Palliative Care
• /
• v.23 no.4
• /
• pp.212-227
• /
• 2020

Purpose: This study presents the process of designing workbooks for advance care planning appropriate for the Korean cultural setting and describes actual case studies. Methods: This study focused on single inductive case studies of the utilization of an advance care planning workbook and recruited individual participants. Results: The workbook for adolescents contained six sessions and the workbook for children contained seven sessions. The workbook sessions led to four major discoveries: 1) considering the Korean cultural context, discussions on life and death must be held indirectly; 2) the role of the counselor as a supporter is crucial for the workbook to be effective; 3) the workbook must be accessible regardless of the seriousness of the illness; and 4) patients must be able to make their own choice between the workbook versions for children and adolescents. Six facilitating factors improved engagement: 1) the role of the counselor as a supporter; 2) building trust with the patient; 3) affirming freedom of expression on topics the patient wished to avoid talking about; 4) having discussions on what private information to keep secret and to whom the information can be disclosed; 5) discovering and regularly discussing relevant topics; and 6) regular communication and information-sharing with the patient's medical service providers. Conclusion: It is necessary to build on actual case studies regarding workbooks for children and adolescents in order to expand the usage of these workbooks to all relevant medical institutions in Korea.

• Tuberculosis and Respiratory Diseases
• /
• v.45 no.2
• /
• pp.437-443
• /
• 1998

Pulmonary alveolar proteinosis is characterized by the accumulation of PAS positive lipoproteinaceous or amorphous proteinaceous material in the alveolar space with spared delicate septal architecture of the lung interstitium and impaired gas exchange of alveoli. We experienced a case of secondary pulmonary alveolar proteinosis in a 41 year old male patient who have occupational history of engagement as a mason over 4year. He compalined exertional dyspnea and chest discomfort, and presented fine inspiratory crackle at both lower lung field, numerous fine nodular denisties in both lung field with peripheral sparing. Light microscopic finding of lung tissue obtained by transbronchiallung biopsy revealed homogenous eosinophilic colloid-like luminal content in the alveolar space, and electron microscopy of bronchoalveolar lavage fluid concentrate showed electron-dense multilamellated structures. To treat the disease, we tried whole lung lavage of right lung with isotonic saline under general anesthesia. After whole lung lavage of right lung, he showed markid improvement of symptom and partial improvement of chest X-ray findings. The patient has been followed for 12 month until now, with no evidence of aggravation.

• Journal of muscle and joint health
• /
• v.28 no.3
• /
• pp.252-262
• /
• 2021

Purpose: To define the concept of digital health literacy and identify its attributes. Methods: Walker and Avant's approach was employed for concept analysis. Attributes, antecedents, consequences, and the definition of digital health literacy were derived from a review of 28 studies. Results: Digital health literacy was identified to possess the following five attributes: health information seeking, health information processing, health information communication, health-related knowledge translation, and utilizing digital technology. Basic literacy skills, health concerns, motivation to use technology for health information, and access to digital technologies were all antecedents of the concept. The consequences of the concept were health behaviors, patient engagement, health status, and quality of life. Digital health literacy is the ability to seek relevant health information utilizing digital technology to solve health problems and improve quality of life. Furthermore, it refers to the translation of health-related knowledge obtained through health information processing-finding, understanding, and evaluating health information and health information communication-into the context in which individual and social factors interact. Conclusion: This study presented a new definition of digital health literacy that goes beyond existing internet-based eHealth literacy, by incorporating the context of emerging digital technologies. This proposed definition can serve as a foundation for the development of instruments and educational programs to improve individuals' digital health literacy.

• Journal of Medicine and Life Science
• /
• v.17 no.3
• /
• pp.74-79
• /
• 2020

It is necessary to expand organ donations of the deceased, as more ethical problems are emerging from the increase in organ donations from the living. As the legal and ethical discussions on donation after circulatory death (DCD) as a field with the potential to expand such domestic organ donation are being held, the need for a social consensus is increasingly highlighted. Organ DCD refers to the donation of an organ from a patient whose spontaneous blood circulation has stopped due to cardiac death. In this study, we aimed to examine whether there are legal and ethical obstacles or medical uncertainties for expanding the practice of DCD. By law, death is recognized as cardiac death, and brain death is recognized as an exception for organ transplantation. Although circulatory death precedes brain death, this paper presents a discussion to begin the process of reaching an ethical and legal agreement on whether or not circulatory death can be recognized as death. Successful implementations of DCD, including Category III DCD, in other countries are currently being reviewed to introduce Category III DCD in Korea.

• Asian Pacific Journal of Cancer Prevention
• /
• v.15 no.19
• /
• pp.8135-8142
• /
• 2014

Background: Breast cancer is the most common cancer in Iranian women and usually features delayed presentation and late diagnosis. Interpretation of symptoms, as the most important step, has a significant impact on patient delay in seeking treatment. There is a dearth of studies on symptom appraisal and the process leading to seeking help in breast cancer patients. This study explored the perceptions and experiences of Iranian women with self-detected possible breast cancer symptoms. Materials and Methods: A qualitative method was conducted involving in-depth semi-structured interviews with 27 Iranian women with self-discovered breast cancer symptoms. Participants were purposefully selected from women who attended Cancer Institute of Tehran University of Medical Sciences during June 2012 to August 2013. The audiotaped interviews were transcribed and analyzed using conventional content analysis with MAXQDA soft ware version 10. The trustworthiness of the study was verified by prolonged engagement, member validation of codes, and thick description. Results: The main concepts emerging from data analysis were categorized in four categories: symptom recognition, labeling of symptoms, interactive understanding, and confronting the fear of cancer. Symptom recognition through breast self-examination, symptom monitoring and employing prior knowledge distinguished normal from abnormal symptoms and accompanied with perception of being at risk of breast cancer led to symptom labeling. Social interaction by selective disclosure and receiving reassurance from a consultant led to confirmation or redefinition of the situation. Perceived seriousness of the situation and social meanings of breast cancer as a stigmatized and incurable illness associated with loss of femininity were reasons for patient worries and fear. Conclusions: This study emphasized that entangled cognitive, emotional and socio-cultural responses affecting understanding of symptom seriousness require further investigation. It is suggested that programs aimed at shortening patient delay in breast cancer should be focused on improving women's knowledge and self-awareness of breast cancer, in addition to correcting their social beliefs.

• Physical Therapy Korea
• /
• v.27 no.1
• /
• pp.63-69
• /
• 2020

Background: Stroke recovery is a long and complex process. Successful stroke recovery seems to be strongly associated with patients' high motivation and committed participation. Patients' motivation is a key determinant of successful rehabilitation outcomes, but it is difficult in defining and measuring. Patients' participation is defined as the degree or extent to which subjects take part in rehabilitation activities and can be measured by observable behavior. Objects: The purpose of this study was to investigate the impact of patients' level of participation in rehabilitation on functional outcomes in patients with stroke. Methods: Forty post-stroke inpatients participated in this study. The level of rehabilitation participation was measured by the Hopkins Rehabilitation Engagement Rating Scale (HRERS). Other measures used for the evaluation were the Rivermead Mobility Index (RMI) and Korean version of the Modified Barthel Index (K-MBI). Overall measurements were made at early intervention and late intervention. Spearman correlation and multiple regression were used to measure the relationships between HRERS, RMI, and K-MBI. Results: The correlation found between HRERS total scores at early intervention and RMI total scores of late intervention was above moderate (r = 0.607, p < 0.01). RMI total scores at early intervention (p < 0.000), HRERS total scores at early intervention (p < 0.001), and disease duration (p < 0.003) were significant predictors of RMI total scores at late intervention. Conclusion: The level of participation at early intervention was associated with improvement in mobility. The level of mobility at early intervention, disease duration, and patients' participation at early intervention were important determinants of functional outcome. These findings suggest that patients' participation should be encouraged in order to achieve successful stroke recovery.

• Journal of Korean Academy of Nursing
• /
• v.51 no.3
• /
• pp.363-379
• /
• 2021

Purpose: The purpose of this study was to evaluate the validity and reliability of the Korean version of Person-Centered Practice Inventory-Staff (PCPI-S) for nurses. Methods: The English PCPI-S was translated into Korean with forward and backward translation. Data were collected from 338 nurses at one general hospital in Korea. Construct validity was evaluated with confirmatory factor analysis, convergent validity, and discriminant validity. Known-group validity was also evaluated. Cronbach's α was used to assess the reliability. Results: The PCPI-S Korean version consisted of 51 items in three areas: prerequisites, the care environment, and person-centered process. The comparative fit index (CFI) and values of person-centered care process were improved after engagement and having sympathetic presence items were combined as one component. The construct validity of PCPI-S Korean version was verified using four-factor structures (.05 < RMSEA < .10, AGFI > .70, CFI > .70, and AIC). The convergent validity and discriminant validity of the entire PCPI-S question were verified using a two-factor structures (AVE > .50, construct reliability > .70). There was an acceptable known-group validity with a significant correlation between the PCPI-S level and the degree of person-centered care awareness and education. Internal consistency was reliable with Cronbach's α .95. Conclusion: The Korean version of PCPI-S is valid and reliable. It can be used as a standardized Korean version of person-centered care measurement tool. Abbreviation: RMSEA = root mean square error of approximation; AGFI = adjusted goodness of fit index; AIC = Akaike information criterion; AVE = average variance extracted.

• Journal of Preventive Medicine and Public Health
• /
• v.57 no.3
• /
• pp.252-259
• /
• 2024

Objectives: This study investigated factors associated with the retention of people living with human immunodeficiency virus (HIV) on antiretroviral therapy (ART) during the first 3 years of treatment. Methods: A retrospective study using electronic health records was conducted at a tertiary hospital in Jakarta, Indonesia. Adult HIV-positive patients who started ART from 2010 until 2020 were included. A binary logistic regression model was used to identify factors associated with ART retention in the first 3 years. Results: In total, 535 respondents were included in the analysis. The ART retention rates for the first, second, and third years were 83.7%, 79.1%, and 77.2%, respectively. The multivariate analysis revealed a negative association between CD4 count when starting ART and retention. Patients with CD4 counts >200 cells/mL were 0.65 times less likely to have good retention than those with CD4 counts ≤200 cells/mL. The year of starting ART was also significantly associated with retention. Patients who started ART in 2010-2013 or 2014-2016 were less likely to have good retention than those who started ART in 2017-2020, with adjusted odds ratios of 0.52 and 0.40, respectively. Patients who received efavirenz-based therapy were 1.69 times more likely to have good retention than those who received nevirapine (95% confidence interval, 1.05 to 2.72). Conclusions: Our study revealed a decline in ART retention in the third year. The CD4 count, year of enrollment, and an efavirenz-based regimen were significantly associated with retention. Patient engagement has long been a priority in HIV programs, with interventions being implemented to address this issue.

• Journal of Korean Academy of Nursing
• /
• v.25 no.3
• /
• pp.510-537
• /
• 1995

Human health is an integral part of experience in the process of Human Becoming. Through continual interaction with the environment human beings freely choose experience and develop as responsible beings. The process of the health experience of patient with terminal cancer is a unique. he objective of this study is to understand the lived experience of patients with terminal cancer in order to provide basic information for nursing care in the clinical setting and to develop a theoretical background for clinical practice. This study is to de-scribe and define the lived experience of patients with terminal cancer in order to provide a foundation for nursing research and education. Data collection has been done between December 1993 and November 1994. The subjects included five persons -four females and one male : one who was in her sixties, one in his fifties, two in their forties, and one who was in her thirties. The researcher has met with these patients 35 times, but at eight times the patient was in a stuporous condition and not able to participate, so these were not included in the data analysis. Parse's "Human Becoming Methodology", an existential phenomenological research methodology is used for this study. Data has been collected using he dialogical engagement process of "I and You", the participant researcher and the participant subject. Dialogical engagement was discontinued when the data was theoretically saturated. Data was analyzed using the extraction - synthesis and heuristic interpretation. The criteria of Guba and Lincoln(1985). and Sandelo wski(1986) : credibility, auditability, fitness and objectivity were used to test the validity and reliability of the data. The following is a description of the structure of the lived experience of patients with terminal cancer as defined by this study : 1. Structure : 1) Suffering through the reminiscence of past experience 2) The appearance of complex emotions related to life and connectedness 3) The increasing importance of significant people and of the Absolute Being 4) The increasing realization of the importance of health and belief 5) Desire for a return to health and a peaceful life or for acceptance of dying and a comfortable death In summary the structure of the lived experience of these patients can be said to be : suffering comes through reminiscence of past experience, and there are complex emotions related to life and connectedness. Significant people and the Absolute Being become increasingly important along with a realization of the importance of health and faith. And finally there is a desire for either a return to health and a peaceful life or for the acceptance of dying and a comfortable death. 2. Heuristic Interpretation : Using Parse's Human Becoming Methodology, the structure of the lived experience of patients with terminal cancer identified in this research is interpreted as. The lived experience of patients with terminal cancer involves the solving of past conflicts, and the experience of the healing and valuing of sorrow and pain. Through the relation of life and health, and the complex emotions that arise, the lived experience of revealing - concealing is of paradoxical emotions. The increasing importance of significant others and of the Absolute Being shows Connecting and Separating an on- going process of nearness and farness. Revision of thoughts about health and faith is interpreted as transforming and desire for restoration to health and a peaceful life or acceptance of dying and a cowfortable death, as powering. In summary, it is possible to see, in the lived experience of patients with terminal cancer, the relationship of the five concepts of Parse's theory : valuing, revealing -concealing, connecting-separating, transforming, and powering. From Parse's theory, the results of this study show that meaning is related to valuing, rhythmicity to revealing-concealing and connect-ing-separating, and cotranscendence to transforming and powering.

• Korean Journal of Psychosomatic Medicine
• /
• v.29 no.2
• /
• pp.77-85
• /
• 2021

Breast cancer is the most prevalent oncological disease among women. Various psychosocial distress is common at the diagnosis, treatment, and posttreatment phase of breast cancer. For the treatment of breast cancer, not only medical treatment but also psychosomatic integrative care will be needed. Patients with breast cancer may lead to increased vulnerability to stress, adjustment disorder, anxiety disorder, and depressive disorder, and these psychiatric diseases and conditions are associated with recurrence or exacerbation of breast cancer. Psychosocial treatment of anxiety and depression could increase the quality of life of patients and decrease the recurrence and progression of breast cancer. In this article, we reviewed 5 clinical breast cancer survivorship guidelines focused on psychosomatic integrative care including psychosocial treatment and alternative treatment for psychosocial distress. Because 5 treatment guidelines were using various definitions of evidence, we confirmed evidence of various psychosocial treatments for patients with breast cancer based on the definition of evidence by the US Preventive Service Task Force (USPSTF) guideline. We also reviewed the effect size of psychosocial treatment for anxiety, depression, mood, and quality of life in patients with breast cancer. This article discusses the barrier to the delivery of psychosomatic integrative care and suggests integrative care planning for breast cancer. Multi-disciplinary teams, patient's needs assessment, information technology support, patient and caregiver engagement, planned periodic monitoring of psychosocial distress by a psychosomatic specialist or consultation-liaison psychiatrist are recommended as key features of a psychosomatic integrated care plan.