• 의료법학
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• 제15권1호
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• pp.211-237
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• 2014

Because of unpredictability and high possibility of abnormal results by clinical trials compared to general medical behaviors, a procedure for ensuring with sufficient explanations by investigators must be secured. Therefore, in a sequence of clinical trials, what kinds of scope, stage, and method of explanations provided by investigators, including doctors or researchers, to trial subjects are closely related to the compensation for damages by violation of liability for explanation. In case of application of clinical trials to patients who have critical illness such as cancer, issues of "Quality of Life" regarding trial subjects, cancer patients, should be discussed. Especially, in case of clinical trials for terminal cancer patients, the right of subjects' self-determination, which is a fundamental principle in medical behaviors, should be discussed. The right of self-determination includes participation in clinical trials for the possibility of life-sustaining even a little bit, or no participation in clinical trials in order to have a time for completing the rest of his life. Like this, if the extent and scope of explanations related to the issues of "Quality of Life" are raised as main issues, the evaluation of "Quality of Life", should be a prerequisite. In many occasions, realistically, despite bad results such as deaths or serious adverse drug reactions after clinical trials, it may not be easy for compensating to trial subjects or their survivors, who requested civil compensation for damage. Futhermore, in abnormal results after concealment of clinical trials or performance of clinical trials without permission, and in the case of trial subjects' failures of proving proximate cause between the clinical trials and abnormal results, problematic results such as no protection to the trial subjects could be occurred. In performing clinical trials, investigators should provide sufficient explanations for trial subjects and secure voluntary informed consents from the trial subjects. Therefore, clinical trials without trial subjects' permissions and the informed consent process violate trial subjects' rights of self-determination, and the investigators shall be liable for compensation for damages. Then, issues might be addressed are what are essential contents of patients' "rights of self-determination" infringed by clinical trials without subjects' permissions. Two perspectives about patients' rights of self-determination might be considered. One perspective regards physical distress of patients (subjects) from therapies without sufficient explanations as the crux of the matter. The other perspective regards infringement of human dignity caused by being subjects without permission as the crux of the matter irrespective of risks' big and small influences. This research follows perspective of the latter. Forming constant fiduciary relation between investigators (doctors) and subjects (patients) pursuant medical contracts, and in accordance with this fiduciary relation, subjects, who are patients, have expectations of explanations and treatments by the best ways. If doctors and patients set this forth as a premise, doctors should assume civil liability when doctors infringe patients' expectations.

• 대한간호학회지
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• 제33권8호
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• pp.1171-1177
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• 2003

Purpose. Despite many smoking cessation programs, many patients with CAD continue to smoke or re-smoke. The processes of change and self-change for smoking cessation is emphasized. The purpose of present study was to investigate decisional balances and processes of change according to stages of change for smoking cessation in the patients with CAD. Methods. This descriptive study was performed using the self-reported questionnaires from 157 male patients with CAD who have smoking experiences. The questionnaires consisted of decisional balances toward smoking (pros/cons) and processes of change including 7 factors. Results. 45.2% of the subjects had myocardial infarction and 54.8% for angina pectoris. Major stages of change were maintenance, contemplation, and precontemplation in 62%, 14%, and 18% respectively. The mean score of pros smoking was 31.07 and cons smoking was 32.52. The mean scores of processes of change were high in all 7 factors, especially in self determination. The pros smoking in precontemplation stage was significantly higher than those in other stages. Between contemplation and precontemplation stages, processes of change showed significant differences in stimulus control, self determination, information management, and dramatic relief. Conclusion. This study suggests that decisional balances and processes of change are stage-specific. As this study, smoking cessation program in the patients with CAD must put priority on the patients group in pre-contemplation and contemplation stages, and stress self determination and dramatic relief.

• 대한간호학회지
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• 제41권4호
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• pp.491-499
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• 2011

Purpose: The study was conducted to develop and test a hypothetical model which explains self-care behavior in patients with type 2 diabetes was established based on the Self-Determination Theory. Methods: The participants were 218 patients with type 2 diabetes mellitus enrolled in an outpatient clinic of one endocrine center in Korea. The data were collected using questionnaires from April 5 through May 7, 2010. The descriptive and correlation statistics were analyzed using the SPSS/WIN 15.0 and the structural equation modeling procedure was performed using the AMOS 7.0 program. Results: The results of this study showed that competence and autonomous motivation were the strong factors influencing self-care behavior in patients in this sample. Support from health provider for autonomy was a significant indirect factor on self-care behavior. These factors explained 64.9% of variance in the participants' self care behavior. The proposed model was concise and extensive in predicting self-care behavior of the participants. Conclusion: Findings may provide useful assistance in developing effective nursing interventions for maintaining and promoting self-care behavior in patients with type 2 diabetes.

• 동서간호학연구지
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• 제24권2호
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• pp.101-109
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• 2018

Purpose: The purpose of this study was to construct and test a structural equation model of health behavior compliance among patients with percutaneous coronary intervention based on self-determination theory. Methods: A total of 227 participants who received follow-up care after percutaneous coronary intervention were recruited. A structured questionnaire was used to assess health providers' autonomous support, basic psychological needs, autonomous motivation, controlled motivation, type D personality, and health behavior compliance. Collected data were analyzed using SPSS 21.0 and AMOS 21.0 program. Results: The final hypothetical model showed a good fitness with data: GFI=.94, RMSEA=.07, CFI=.96, NFI=.92, TLI=.94. The results revealed that autonomous support of health care providers, basic psychological needs, and autonomous motivation, and D-type personality accounted for 51.8% of health behavior compliance. Conclusion: The findings of this study indicate that enhanced autonomous support of health care providers is essential to promote patients' basic psychological needs and autonomous motivation. This leads to maximized compliance to the health behaviors among patients who underwent percutaneous coronary intervention. We recommend that health care institutions establish various measures to foster the special environments in which health care providers can actively provide and utilize autonomous support for their patients.

• 대한간호학회지
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• 제48권6호
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• pp.731-742
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• 2018

Purpose: The purpose of this study was to test a hypothesis explaining direct and indirect relationships among the factors affecting self-care behaviors of kidney transplant patients, based on self-determination theory. Methods: Data were collected from 222 outpatients with kidney transplantation. The endogenous and exogenous variables of the hypothetical model consisted of healthcare provider's autonomy support, duration after kidney transplantation, basic psychological need satisfaction, autonomous and controlled motivation, depression, and self-care behaviors. Collected data were analyzed using SPSS/WIN 24.0 and AMOS 24.0. Results: The hypothetical model demonstrated a good fit: RMSEA=.06, SRMR=.04, TLI=.94, CFI=.97. Statistically significant explanatory variables for the self-care behaviors of kidney transplant patients were duration after transplantation and basic psychological need satisfaction. Healthcare provider's autonomy support was indirectly significant, while autonomous motivation, controlled motivation and depression were not statistically significant for self-care behaviors. The variables accounted for 59.5% of the self-care behaviors of kidney transplant patients. Conclusion: It is necessary to develop an autonomy support program for healthcare providers to enhance the self-care behaviors of kidney transplant patients. Preventing the deterioration of self-care behaviors will be possible by conducting this program at one year and six years post-transplantation. In addition, the results suggest the need to developing personalized autonomy support programs for healthcare providers that can meet the basic psychological need satisfaction of kidney transplant patients.

• 의료법학
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• 제16권2호
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• pp.3-26
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• 2015

수술행위는 신체에 대한 침습을 포함하는 것이므로 의료인은 수술주체와 수술행위의 내용을 충분히 설명하여 환자가 그 수술을 받을 것인지의 여부를 선택하도록 하여야 하고, 이는 헌법 제10조에서 규정한 개인의 인격권과 행복추구권에 의하여 보호되는 환자의 자기결정권에 해당한다. 미국에서는 '대리수술'의 경우 폭행에 해당한다고 판단한 사례가 있으나, 국내에서는 아직까지 수술의사에 대한 상해죄 등을 인정한 사례가 없고, 수술행위는 환자의 신체에 대한 적대적인 손상행위가 아니므로 상해죄로 처벌하기 어려운 면이 있다. 또한 환자의 '가정적 승낙'을 폭넓게 인정하는 판례의 입장에 따르면 의사의 전단적 의료행위에 대하여 업무상과실치사상죄로 처벌하기도 어려우므로, 환자의 자기결정권 강화를 위하여 의사의 설명의무를 의료법 등에 명문화하고, 대리수술 등 전단적 의료행위에 대하여 별도의 처벌규정을 입법화할 필요가 있다.

• 의료법학
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• 제15권2호
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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.

• 성인간호학회지
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• 제13권2호
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• pp.200-208
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• 2001

The purpose of this study was to understand the nature and structure of "uncertainty of chronically ill patients" by explaining it more scientifically. This study is based on the unique experiences, which individual uncertainty experiences differ from others. In this sense, Q-methodology which includes self-psychology and abductive logics is applied to the study. The results indicate that there are six types of uncertainty of chronically ill patients : my own fault, self-esteem loss, self-care determination, cure-doubt, reality-restructure, and past-tenacity reality-absence. Thus, "uncertainty of chronically ill patients" is defined from the study as the process in which continuous transition and evaluation of possibility cause changes in human recognition, attitude, action, etc.. The significance of the study is threefold : (1) discovery of six types of uncertainty of chronically ill patients in Korean people, (2) the better understanding of "uncertainty of chronically ill patients", (3) possible developments of nursing concept and assessment and intervention technique based on the new dimension of the understanding in uncertainty for nursing of chronically ill patients from this research.

• 성인간호학회지
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• 제28권4호
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• pp.415-423
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• 2016

Purpose: This study was designed to identify the structural relationships among psychosocial variables related to sick role behavioral compliance among patients undergoing hemodialysis. Methods: The subjects were 476 patients from seven major hospitals and twelve dialysis centers located in D and P cities. Data were collected using self-report questionnaires. Data analysis was done by using SPSS/WIN 18.0 and AMOS 18.0 programs for structural equation modeling, to estimate the hypothesized model. Results: This findings support that a modified path model is efficient and appropriate to explain sick role behavioral compliance among hemodialysis patients. These factors account for 80.1% of the variance of sick-role behavioral compliance among hemodialysis patients. The variables having direct effect on sick role behavioral compliance were knowledge related to hemodialysis, social support, attitude, self-efficacy and intention. Conclusion: The modified model explains the integration process of psychosocial and behavior variables for sick-role behavioral compliance among patients undergoing hemodialysis.

• 대한가정학회지
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• 제30권3호
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• pp.193-204
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• 1992

The purpose of this article is (1) to measure the attitudes of health care consumers towards medical service, the physicians' duty to provide information and patient self-determination options, (2) to discover the their related variables. The attitude of health care consumers towards medical service reveals statistically significant corelation with age and education. Among the statistically significant independent variables it is significantly related with age in the multiple regression analysis. The attitude of health care consumers towards the physicians' duty to provide information reveals statistically significant corelation with age, education and the attitude of health care consumers towards medical service. Among these independent variables it is significantly related with the attitude of health care consumers towards medical service in the multiple regression analysis. The attitude of health care consumers towards patients' self-determination options reveals statistically significant corelation with age, the attitude of health care consumers towards medical service and the attitude of health care consumers towards the physicians' duty to provide information. Among these independent variables it is significantly related with the attitude of health care consumers towards the physicians' duty to provide information in the multiple regression analysis.