• 제목/요약/키워드: Patient consultation

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A STUDY ON NURSING RECORD BEHAVIOR IN PATIENT′S RECORDS (간호기록 행위에 관한 조사연구)

  • 강윤희
    • Journal of Korean Academy of Nursing
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    • v.4 no.1
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    • pp.22-37
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    • 1974
  • Through the examination of hospitalized patient's records, this study purports to determine. the extent to which nursing record behaviors meet general expectations held for nursing records and the differences in nursing record behavior in relation to different nursing categories, period of recording and hospitals with different management patterns. Nursing record behaviors of 802 patient's records in four hospitals in Seoul were examined. by use of a check list, which was prepared by the author as an instrument for the study. Data obtained from this examination were processed into percentage values for percentage. test and chi-square test in order to determine their significance. Results are as follows; 1. Records pertaining to treatment ranked highest among all care categories in their extent of coverage, averaging 65.6 percent. 2. Of the treatment category records, records of medication led others at 94.3 percent. followed by records of test and collection of specimens at 59.9 percent. diet at 58.8 percent and treatment at 41.0 percent. 3. Records in the category of physical assessment and care averaged 44.1 percent, the second highest next to treatment category records, 4. Of the records in the category of physical assessment and care, records in vital signs. placed first at 98.9 percent, followed by sleep at 76.2 percent, body weight at 74.7 percent, symptoms and signs at 69.3 percent, rest at 44.5 percent, hygiene at 39.7 percent, activities and participation at 16.9 percent, positions at 10.3 percent, level of consciousness at 9.8 percent and physiological dysfunction at 1.1 percent in that order. 5. Records in the category of psychological assessment and care averaged 3.2 percent, the lowest of the -three major categories. 6. Of the records in the category of psychological assessment and care, records on emotional responses ranked top at 10.5 percent, followed by self-concern at 2.1 percent, adjustment at 2.0 percent, family, occupational and social relations at 0.7 percent and preferences. and interest at 0.5 percent in that order. 7. Records in relation to the category of specific conditions were found in 9.1 percent of the total records. 8. Of the records in the category of specific conditions, consultation and transfer records, stood first at 25.0 percent, followed by precautionary measurements at 1.4 percent and isolation at 0.9 percent 9. A great difference in nursing record behavior was observed between the first week of hospitalization and the last week, with the first week's recordings much higher than the last week in the categories of treatment and specific conditions (p<0.01). and of physical assessment and care (p <0.05). 10. A big difference was also observed among the hospitals (p<0.01). 11. A big difference was also observed between the government-run hospitals and the private hospitals in the categories of physical assessment and care and specific conditions in the first week of hospitalization (P<0.05l), and in the category of psychological assessment and care in the last week (P<0.05). 12. Between the hospitals established with foreign aid and the other hospitals, the difference in nursing record behavior was significant only in the category of physical assessment and care both in the first week and the last week (P<0.01). 13. The average nursing record behavior in all care categories stood at 45.1 percent in the extent of its coverage in relation to the general expectations.

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Giant Urethral Stone Presenting as a Scrotal Mass and Urethral Fistula (척추 손상 환자에서 고환 종물로 오인된 거대 요도 결석과 요도루)

  • Park, Seung Chol;Lee, Jea Whan;Choi, Jeong Woo;Hwang, Yong
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.18 no.12
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    • pp.208-212
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    • 2017
  • A urinary calculus in the urethra is rarely seen and usually encountered in men with a urethral stricture or diverticulum. Herein, we report a rare case of a giant calculus in the urethra of a 42-year-old male patient with paraplegia after spinal cord injury due to car accident 20 years ago. A recent urologic consultation from the emergency room was performed since the patient had multidisciplinary symptoms during the day without any urination and presented with urinary difficulties due to hematuria and pain symptoms occurring with a mass in the bottom of the testicles. Abdomen and pelvic computed tomography (CT) was performed to examine the tumor mass, which was found to be absent. In addition, urethral stones were observed in the CT. Cystostomy was performed after the first urethroplasty, and the stone was removed from the urethra. Two weeks later, the patient was subjected to urethrography to remove the Foley catheter. No specific finding in voiding was detected. Giant urethral stones sometime require differentiation from tumor status. Treatment may vary according to size and location, requiring careful examination.

Study for general characters of dental implant patients and satisfaction level of function by dental interest level (임플란트 환자의 일반적 특성 및 구강관심도에 따른 기능별 만족도 연구)

  • Yoo, Eun-Mi;Hwang, Yoon-Sook
    • Journal of Korean society of Dental Hygiene
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    • v.9 no.3
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    • pp.456-467
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    • 2009
  • For this study, self-completion survey for 149 implant patients of dental clinics and hospitals in Seoul and Kyunggi areahas been executed in order to provide basic data for increasing patient satisfaction level by effective consultation and various information for the patients who want dental implantation. The conclusion of the study is like below. 1. In terms of demographics of the study, sample size of female patients(n=85) was more than that of male patients(n=64) and patients in their 50s were major age group. When it comes to the educational level, university graduates were 85 and high school graduates were 44. And 132 were married and 6 were single. In the income level, monthly income between KRW 2~4 million was major group(n=59). 2. In the study, patients' most concern was complication or adverse events(n=41), and price(n=39) & annual dental check-up(n=49) were following it. And 80 patients responded that dental health is the most valuable(n=80) and whole body health was following(n=37). In terms of knowledge on dental implant, 100 patients responded 'know just a little', 31 and 13 answered 'generally know' and 'well know' each. 3. As a result of analyzing implant patients' satisfaction level by segment, general satisfaction rate was highest as 4.20, social satisfaction rate was 4.20, psychological function was 4.06 and masticatory function was 3.90. 4. Based on the result of comparing patient satisfaction level by general characters of dental implant patient, chewing function was the highest in the age group of 60s with score of 4.21 and in terms of social function, the group with over KRW 8 million of monthly income showed highest score with 4.54. When it comes to the psychological function, patients in their 70s showed highest satisfaction level with 4.52. In the end, patients in their 70s showed highest score with 4.81 in the overall satisfaction and it was also statistically significant. 5. In the overall satisfaction level by interest in dental health, appearance showed highest score with 4.57 and it was also significantly higher than that of whole body. In the variance by dental knowledge, 'well know' group showed highest score with 4.58, and that of 'just a little' group was 4.33. That means there are correlations between dental knowledge and satisfaction level. 6. As a result of analyzing correlations amongst variances of the study, there were strong positive correlations among them. And there were very significantly positive correlations especially between social and psychological function and between psychological and overall satisfaction level. In conclusion, higher psychological function has strong relations with both social function and overall satisfaction level(p<.001).

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A Study for Application of Standard and Performance Test According to Purpose and Subject of Respiratory Medical Device (호흡보조의료기기의 사용목적 및 대상에 따른 규격적용 방안 및 성능에 관한 연구)

  • Park, Junhyun;Ho, YeJi;Lee, Duck Hee;Choi, Jaesoon
    • Journal of Biomedical Engineering Research
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    • v.40 no.5
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    • pp.215-221
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    • 2019
  • The respiratory medical device is a medical device that delivers optimal oxygen or a certain amount of humidification to a patient by delivering artificial respiration to a patient through a machine when the patient has lost the ability to breathe spontaneously. These include respirators for use in chronic obstructive pulmonary disease and anesthesia or emergency situations, and positive airway pressure devices for treating sleep apnea, and as the population of COPD (chronic obstructive pulmonary disease) and elderly people worldwide surge, the market for the respiratory medical devices it is getting bigger. As the demand for both airway pressure devices, there is a problem that the ventilator standard is applied because the reference standard has not been established. Therefore, the boundaries between the items are blurred due to the purpose, intended use, and method of use overlapping similar items in a respiratory medical device. In addition, for both airway pressure devices, there is a problem that the ventilator standard is applied because the reference standard has not been established. Therefore, in this study, we propose clear classification criteria for the respiratory medical devices according to the purpose, intended use, and method of use and provide safety and performance evaluation guidelines for those items to help quality control of the medical devices. And to contribute to the rapid regulating and improvement of public health. This study investigated the safety and performance test methods through the principles of the respiratory medical device, national and international standards, domestic and international licensing status, and related literature surveys. The results of this study are derived from the safety and performance test items in the individual ventilator(ISO 80601-2-72), the International Standard for positive airway pressure device (ISO 80601-2-70), The safety and performance of humidifiers (ISO 80601-2-74) and the safety evaluation items related to home healthcare environment (IEC 60601-1-11), In addition, after reviewing the guidelines drawn up through expert consultation bodies including manufacturers and importers, certified test inspection institutions, academia, etc., the final guidelines were established through revision and supplementation. Therefore, in this study, we propose guidelines for evaluating the safety and performance of the respiratory medical device in accordance with growing technology development.

A Study on the Care Needs of Family-Caregivers and the Level of Self Care for Patients of Cerebral Vascular Accident(CVA) (뇌졸중환자의 자가간호 수준과 가족구성원의 간호요구)

  • Cho Young-Hee
    • Journal of Korean Academy of Fundamentals of Nursing
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    • v.7 no.2
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    • pp.239-255
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    • 2000
  • The purpose of this study was to explore the care needs of family-caregivers caring for patients with a CVA and the level of self care of the patients. The subjects for the study were 112 patients with a CVA and their caregivers. These patients were seen in a hospital or out-patient-department(OPD) at two oriental medical hospital in Jeonbuk province. The survey instruments used in this study were Kang's ADL checklist for self care of patients and Kim's Likert-style checklist for care needs of family-caregivers to patient with CVA. The survey was conducted from July 4 to August 30, 1999. Internal validity by calculation of Cronbach's alpha was 0.95, which was regarded as high. The survey results were analyzed using the SPSS program, with percentages, means, t-test, ANOVA and Pearson's correlation coefficients. The results of this study are as follows : 1. The level of self care for patients with a CVA was : 1) complete dependence(M=14.9, 13.1%), 2) complete independence(M=23.6, 20.9%), 3) incomplete independence(M=23.9, 21.0%), 4) incomplete dependence(M=26.6, 25.0%), 5) dependence and independence(M=23.0, 20.0%). The items for which there was a high level of self care were : 1) drinking(M=3.62), 2) eating (M=3.25), 3) position returning(M=3.18) : and the items for which there was a low level of self care were : 1) ascending and descending stairs(M=2.08), 2) walking(M=2.47). 3) putting on and taking off trousers(M=2.55). 2. The mean score of the sum of the care needs of the family-caregivers was : 1) need for immediate care and help: 2) need of the way to communicate with patient: 3) need for education and assistance related to physical functional level: 4) need to be informed about the disease, treatment and care: 5) need for social support and consultation: 6) need for appreciation: 7) need for management of nursing problems related to immobility. The highest meed factor was the need for immediate care and help(M=3.47): and lowest need factor was the need for management of nursing problems related to immobility(M=2.80). 3. There were significant differences between the level of care need and general characteristic of the caregivers, there were family-caregivers age(P=0.001), marital status (P=0.276), occupation (P=0.006), monthly income(P=0.000), Patient's relationship to caregivers(P=0.004) and health(P=0.000). 4. There were significant differences between the level of self care and general characteristic of the patients, there were patient paralytic condition(P=0.01), blood pressure(P=0.01), and length of suffering(P=0.03). 5 There were significant differences between the level of care need and the general characteristic factors, which were CVA patient's blood pressure (P=0.05), problem of medical fee (P=0.05). 6. There was significantly correlation with the family-caregivers care need and the level of self care in the CVA patient(r=0.300, P=0.000). As a result, need to promote the level of self care in patients and to meet the care need of family-caregivers for more efficient nursing of CVA patients, is emphasized. Therefore more study is needed on an efficient way to provide rehabilitation and quality nursing interventions for family-caregivers and patients with CVA.

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Case Report of Radiotherapy to a Breast Cancer Patient with a Pacemaker (인공심장박동기가 이식된 유방암환자의 방사선 치료에 대한 사례 보고)

  • Chae, Seung-Hoon;Park, Jang-Pil;Lee, Yang-Hoon;Yoo, Suk-Hyun;Seong, Won-Mo;Kim, Kyu-Bo
    • The Journal of Korean Society for Radiation Therapy
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    • v.24 no.2
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    • pp.197-203
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    • 2012
  • Purpose: In this study, we considerate our radiation therapy process for the breast cancer patient implanted a pacemaker applying the machine movement surgery, shielding, beam selection. Materials and Methods: We perform radiation therapy to a 54 years old, breast cancer patient implanted a pacemaker. The patient underwent a surgery to move the position of a pacemaker to right side breast after consultation with cardiology department. Prescribed dose was 5,040 cGy and daily dose 180 cGy for 28 fractions. The 10 MV photon energy, field size 0/$9.5{\times}20$ cm, half beam and opposing portal irradiation are used. To find out appropriate thickness of shielding board, we carried out an experiment using a solid water phantom ($30{\times}30{\times}7$ cm), a Farmer-type chamber (TN30013, PTW, Germany) and a shielding board (Pb $28{\times}27{\times}0.1$ cm). We calculated expected absorbed dose to te pacemaker with absorb ratio and shielding ratio. In the PTP system (Eclipse, Varian, USA), we figured out how much radiation would be absorbed to the machine with and without shielding. First day of the radiation therapy, we measured head scatter to the pacemaker with MOSFET Dose Verification System (TN-RD-70-W, Medical Canada Ltd., Canada). Results: In the phantom measurement, we found out appropriate thickness was 2 mm of shielding board. In the RTP, when using 2 mm shielding the pacemaker will be absorbed 11.5~38.2 cGy and DVH is 77.3 cGy. In the first day of the therapy, 4.3 cGy was measured so 120.4 cGy was calculated during total therapy. The patient was free from any side effects, and the machine also normally functioned. Conclusion: As the report of association which have public confidence became superannuated, there is lack of data about new machine. We believe that radiation therapy to thiese kind of patients could be done successfully with co-operation, patient-suitable planning, accurate QA, frequent in-vivo dosimetry and monitoring.

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Evaluation of the influence of a visual design of an examination guide on patient comprehension and testing accuracy (검사 안내문의 시각적 디자인화가 환자의 검사 이해도 및 정확성에 미치는 영향 평가)

  • Kang, Young-Eun;Jung, Woo-Young;Hong, Bo-Ruem
    • The Korean Journal of Nuclear Medicine Technology
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    • v.23 no.1
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    • pp.29-34
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    • 2019
  • Purpose An examination guide is a useful medium to provide the patient with an overview, pre- and post-test preparation, and precautions of nuclear testing. The design and arrangement of existing written texts and announcements were evaluated to elucidate the comprehension of patients undergoing testing. Materials and Methods Informational material describing bone scanning and $^{201}thallium$ myocardium perfusion single-photon emission computed tomography (SPECT), as a secondary examination, which accounts for the largest portion of gamma imaging at Asan Hospital (Seoul, South Korea), was selected as an improvement target in consultation with a national innovation center. Existing informational material was dispensed to patients scheduled for bone scans from November 2016 to February 2017 and the revised material was issued from March 2017 to May 2017. A survey was conducted of 200 patients who underwent $^{201}thallium$ myocardium perfusion SPECT before and after the revisions (n = 100 each time period) to assess the patients' understanding of the informational material. Results When comparing the use of the conventional vs. revised material, the number of patients who received treatment before bone scanning had decreased from 130 to 60, while the number of those who required additional imaging decreased from 53 to 14. Prior to the revision, 43% of patients underwent testing before preparation and 18% underwent additional testing. The decreased need for additional image acquisition after revision of the informational material resulted in a decrease in acquisition time of about 2 min, from 16.5 to 14.2 min. In the case of $^{201}thallium$ myocardium perfusion SPECT, patient comprehension of all five items surveyed had increased, while the number of patients who had repeatedly asked about various facets of the procedure pre- and post-testing had decreased from 36% to 16% and 31% to 14%, respectively. Conclusion Lower patient comprehension is accompanied by a decrease in image quality due to non-compliance during pre-testing and may lead to repetitive questions from the patient, which may also negatively affect the fatigue and work efficiency of the examiner. Improved readability and visibility of informational material through visualization was correlated with greater patient comprehension as well as improved image quality and acquisition time.

The Development of Exercise Therapy Protocol Applied to an Efficacy Expectation Promoting Program in Type 2 Diabetes Mellitus Patients (효능기대증진 프로그램을 적용한 운동요법 프로토콜 개발 - 제 2 형 당뇨병 환자를 중심으로 -)

  • Hwang Ae-Ran;Kim Chun-Ja
    • Journal of Korean Academy of Fundamentals of Nursing
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    • v.7 no.3
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    • pp.366-378
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    • 2000
  • Type 2 Diabetes Mellitus patients have chronic metabolic disorder and they need self care for their lifetime. But most Diabetes Mellitus patients don't know how to do a self care due to the lack of adequate support from health care professionals. It has been reported that lack of exercise therapy compliance guide is very important one. This study was conducted to develop an exercise therapy protocol applied to an efficacy expectation promoting program based on Bandura's self efficacy model for type 2 Diabetes Mellitus patients. Firstly, a conceptual framework was developed through efficacy expectation promoting Program based on Bandura's self efficacy model. In order to identify the contents of program and to design a preliminary protocol, a with the consultation experts was made. A clinical validity was tested using twenty type 2 Diabetes Mellitus patients who received follow-up care regularly through the diabetic out-patient clinic from October, 1998 to May, 2000. After this process, the final protocol was developed. The results of this study are summarized as bellows : The final exercise therapy protocol applied to an efficacy expectation promoting program for type 2 Diabetes Mellitus Patients consists of individualized exercise test and prescription, a small booklet relating personal experience with Diabetes Mellitus and a telephone coaching program for 12 weeks on performance accomplishment, vicarious experience and verbal persuasion, which are all induction modes of efficacy expectation. It is concluded that the exercise therapy protocol applied to an efficacy expectation promoting program is applicable to type 2 diabetes mellitus. And this exercise therapy protocol could show a positive effect on the exercise compliance of Diabetes Mellitus patients.

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Developing Activity Based Clinical Pathway for Patients with Total Hip Replacement (활동기준관리를 적용한 인공고관절 전치환술 Clinical Pathway 개발)

  • Hong, Yoon-Mi
    • Journal of Korean Academy of Nursing Administration
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    • v.8 no.4
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    • pp.669-689
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    • 2002
  • Purpose : The purpose of the present study is to develop a clinical pathway applied with activity-based management methodology for efficient clinical management to cope with rapid changing medical environments. Method : After making a preliminary pathway based on which a conceptual frame of reference was established to develop a clinical pathway, the final one was confirmed by verifying experts validity and clinical validity. The ultimate activity-based clinical pathway was restructured after clarifying, schematizing and analyzing the whole activities of clinical pathway in accordance with the conducting process of activity-based management. Result : A clinical pathway for total hip replacement was developed, in which the vertical axis consisted of assessment, examination, consultation, medication, treatment, diet, activity, and education, and the horizontal axis was composed of six days of hospitalization. Then, on the basis of the development, the clinical pathway including the improved contents and information was restructured after making the reform measure by analyzing each of activities in the pathway. And the list of contents related to the clinical management activity was made, which was described its main contents and the pre-activities that ought to be completed before conducting each of activities in the pathway. Conclusion : The clinical pathway applied with activity-based management may be used as a standard guidance for providing continuous and consistent patient care. It will provide the information for nursing activities to nurses and the management information about hospital and nursing activities to the hospital administrators. It will also be used as a tool for communication between medical staff. Besides, it will contribute to creating profits for the hospital by shortening the length of stay in patients.

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Management of Precancerous Cervical Lesions in Iran: A Cost Minimizing Study

  • Nahvijou, Azin;Sari, Ali Akbari;Zendehdel, Kazem;Marnani, Ahmad Barati
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.19
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    • pp.8209-8213
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    • 2014
  • Background: Cervical cancer is a common, preventable and manageable disease in women worldwide. Objectives: This study was conducted to determine the cost of follow-up for suspicious precancerous cervical lesions within a screening program using Pap smear or HPV DNA test through the decision tree. Materials and Methods: Patient follow-up processes were determined using standard guidelines and consultation with specialists to design a decision tree model. Costs of treatment in both public and private sectors were identified according to the national tariffs in 2010 and determined based on decision tree and provided services (visits to specialists, colposcopy, and conization) with two modalities: Pap smear and HPV DNA test. The number of patients and the mean cost of treatment in each sector were calculated. The prevalence of lesions and HPV were obtained from literature to estimate the cost of treatment for each woman in the population. Results: Follow-up costs were determined using seven processes for Pap smear and 11 processes for HPV DNA test. The total cost of using Pap smear and HPV DNA process for each woman in the population was 36.1$ and 174$ respectively. Conclusions: The follow-up process for patients with suspicious cervical lesions needs to be included in the existing screening program. HPV DNA test is currently more expensive than Pap smear, it is suggested that we manage precancerous cervical lesions with this latter test.