• 대한후두음성언어의학회지
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• 제26권1호
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• pp.34-39
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• 2015

후두 미세 수술을 받은 환자에서 수술 전과 후 전체적인 음성 장애 지수를 비교했을 때 모두 호전이 있는 것으로 나타났다. 영역별로는 기능적, 물리적 영역에서는 남녀간의 차이가 없었으나 감성적 영역에서는 여자보다 남자에서 수술 후 만족도가 큰 것으로 나타났다. 이번 연구를 통해 음성 장애 지수가 음성의 상태를 모두 대변할 수는 없지만 객관적인 음향, 공기역학적 검사로 평가할 수 없었던 음성 장애에 대한 환자의 인식 정도를 정량화하여 평가할 수 있는 편리한 도구임을 확인 할 수 있었다.

• 한국콘텐츠학회논문지
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• 제10권11호
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• pp.304-317
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• 2010

이 연구는 지방의료원 의료소비자의 서비스가치, 브랜드이미지 및 재이용의도 요인 간 구조적 관계를 분석하여, 이를 바탕으로 지방의료원의 효율적 운영전략을 수립하기 위하여 수행되었다. 전국의 34개 지방의료원 중 대표성이 있다고 판단되는 5개 병원을 선정하여 2개월간 조사원 기입방식으로 외래환자 387명, 입원환자 358명의 자료를 수집 분석하였다. 분석결과 지방의료원 환자가 인지한 상대적 서비스 가치는 브랜드 이미지와 정의 관계를 보였다. 구체적으로, 대학병원 및 민간병원의 진료서비스와 비교하여 환자가 인식하는 서비스 가치는 상대적으로 높은 수준이었으며, 이러한 서비스 가치는 지방의료원의 아늑함, 친절함, 전문성 등 지방의료원 브랜드 이미지와 정의 관계를 보였다. 또한, 서비스 가치와 브랜드 이미지는 재이용 의도와 정의 관계를 보였다. 민간병원 또는 대학병원 대비 상대적으로 높은 서비스 가치는 의료기술, 전문성이 높은 병원으로 인지하게 되고 재이용의도에도 긍정적인 영향을 미쳤다. 따라서, 지방의료원은 환자의 인식수준이 낮거나 측정변수의 효과나 영향이 큰 것으로 판명된 요인들에 대해 의료소비자의 인식수준을 향상시키는 방향으로 경영개선방안을 수립하여야 할 것이다.

• 수면정신생리
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• 제6권2호
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• pp.149-157
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• 1999

정신과 임상에서 편리하게 사용할 수 있는 전산화 신경심리 검사 시스템을 개발하였다. 이 시스템은 뇌의 전반적인 인지 기능과 뇌의 기능적 국재화를 평가할 수 있는 14개의 신경심리 검사로 구성되어 있다. 개발된 시스템은 멀티미디어와 객체 지향 개념에 의해 설계, 구현되었고, 마이크로 소프트 Windows에 기반을 둔 그래픽 인터페이스를 채용하여 운용이 용이하도록 하였다. 또한 마우스와 터치 스크린을 이용하여 피검사자로부터 입력을 손쉽게 받아드릴 수 있도록 하였으며, 색채 단어 검사, 범주 검사, 그리고 언어 기억 검사, 언어 지각 검사 등은 한글화하여 검사의 효율성을 향상시켰다. 개발된 시스템을 뇌손상 환자와 정신과 환자에 적용한 결과 그 인지 장애와 뇌의 기능적 국재화를 평가하는데 유용하게 사용될 수 있었다.

• 대한간호학회지
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• 제20권1호
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• pp.88-117
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• 1990

The purposes of this study are to delineate a profile of the state of a stroke patient's adaptation at 3 months after hospitalization and to explore the relationship between the level of adaptation and the variables which influence the adaptation of hemiplegic patients. To these ends, theoretical framework was derived basically from the stress adaptation model. The basic assumption underlying the level of adaptation is influenced by the presenting focal, contextual and residual stimuli. This group of stimuli is further operationalized and represented by a perception of stress. which is the perceived effect of the disability and by the mediating variables such as sociodemographic factors as an external conditioning variables and perceived social support and hardiness personality characteristics as an internal intervening variables. The dependent varibales in this study is the level of physical, psychological and social adaptation and is hypothesized to be a function of the interaction between 3 sets of variables namely, the perceived disability effect, external conditioning variables and internal intevening varibles. A total of fourty three subjects from 3 general hospitals in Seoul were observed and interviewed with the aid of 7 structured instruments. The data were collected twice on each subject : first at the pre-discharge period arid at 3 months post-discharge from hospital for the second time. The study was carried out for the period from February to August, 1988. The instruments used for the study include 4 existing scales and 3 scales developed by the researcher for this study. They are : 1) The ADL dependency scale and the scale of the clinical physical functions for the assessment of physical adaptation. 2) the SDS(self report of depression) to measure the level of psychological adaptation. 3) The scale for the amount of social activities for the measurement of the level of social adaptation. 4) The scale for the perceived effect of disability for the measurement of the focal stimuli. 5) The health related hardiness scale and the perceived interpersonal support self evaluation list(ISEL) for the measurement of the hardiness personality character and the perceived social support. The data obtained were analyzed using percentage, oneway ANOVA, Pearson coefficients correlation and stepwise multiple regression. The findings provide valuable information about the present level of physical adaptation at 3 months after discharge. The patient revealed a decreased ADL dependency and lowered limitation of physical function as compared with pre - discharge state. Psycholcgically, the average degree of depression at follow up was within normal range of depression. Socially, the amount of social activities was very low. The one way ANOVA and the correlational analysis revealed the relationship between the 3 sets of variables and the adaptation level as follows : 1) The perceived disability effect was related to the degree of the depression and the amount of social activities but was not related to the physical adaptation. 2) Among the sociodemographic variables, sex and education were related to the difference of ADL dependency and the change of physical function. These factors indicate that women more than men and educated more than the less educated were found more independent. The education was also related to the degree of depression suggesting that the higher the educational level, the more well adapted the patients were both physically and psychologically. Age, marital status and job state were not found to be related to the patient's adaptation level. 3) Among the internal intervening variables, the health related hardiness characteristic was related to the differences of ADL dependency, physical functions and the social activities, indicating that the higher the hardiness character the higher the level of physical and social adaptation. 4) The perceived social support, another internal intervening variable, was related to the degree of depression and the social activities. This data suggest that the higher the perception of social support, the better adapted the patients were psychogically and socially. In summarizing the results of the correlational analysis, the level of physical adaptation was influenced by sex, the years of education and the hardiness character. The level of psychological adaptation was influenced by the years of education, the perceived disability effect and the perceived social support. And the level of social adaptation was influenced by the perceived disability effect, the hardiness character and the perceived social support. The stepwise multiple regression analysis shows findings as follows : 1) The most important factor to explain the difference of ADL dependency was sex, indicating females were more independent than males. 2) The most important factor to explain the difference of physical function and the degree of depression was the patient's education level. 3) The strongest explaining factor for the amount of social activities was perceived self esteem(one of the subconcepts of perceived social support). Thus the most important factors influencing the level of adaptation were found to be sex, education, the hardiness character and self esteem. From the above findings, the significance of this study can be delineated as follows : 1) Corroboration of the assumed relationship between the various variables and the adaptation level as suggested in the conceptual model. 2) Support for the feasibility of the cognitive approach for nursing intervention such as hardness character training, counselling and teaching for self-care in the chronic patients.

• 한국병원경영학회지
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• 제26권2호
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• pp.56-67
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• 2021

Background: Regular doctor visits are vital for hypertension patients, especially for who have never received hypertension medication or non-pharmacologic therapy. This study purposed to study factors affecting outpatient visits for patients diagnosed with hypertension. Methods: This study included 59,009 respondents with hypertension over 30 from 2019 Community Health Survey data. Outpatient visits were defined by having hypertension treatments such as medication or non-pharmacologic therapy. Logistic regression was used to examine the factors affecting outpatient visits using SAS ver. 9.3. Results: 57,081(96.73%) patients with hypertension were identified as those having a outpatient visit for hypertension treatments, whereas 1,928(3.27%) patients did not have visits. Patient's characteristics such as gender, age, periods of hypertension, education level, perception of the blood pressure, hypertension management education, place of living, body mass index, depression and diabetes were found to have statistically significant relationship with the outpatient visits. Practical Implications: There is a need to select patients with high blood pressure who are unlikely to visit for hypertension treatments based on the study results. For those, establishing a personalized management plan such as health education and counseling programs will be helpful for the successful implementation of national chronic disease management program.

• 근관절건강학회지
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• 제2권1호
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• pp.17-40
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• 1995

Rheumatoid arthritis is the one of the chronic diseases, one of its major symptoms is a chronic pain. Despite developing medical treatment and surgical techniques, it is suggested that to control the pain is the goal of the treatment. But pain is an inner experience and even those closest to the patient cannot truly observe its progress or share in its suffering. The National Academy of Sciences Institute of Medicine's report on Pain and Disability concluded that there is no objective measure of pain-(exactly) no pain thermometer-nor can there ever be one, because the experience of pain is inseparable from personal perception and social influence such as culture. To explore chronic pain experience is to understand the process and property of the patient's perception of pain through the response to pain, the coping with pain, and the adaptation to pain. Therefore a qualitative study was conducted in order to gain an understanding of pain experience of patients with RA in korea. I used naturalistic inquiry as a research methodology, which had 5 axioms, the first is that realities are multiple, constructed, and holistic, the second is that knower and known are interactive, inseparable, the third is only time and context bound working hypotheses(idiographic statements) are possible, the forth is all entities are in a state of mutual simultaneous shaping, so that it is impossible to distinguish causes from effects and the last is that inquiry is value-bound. Purposive sampling was conducted as a sampling. 20 subjects who experienced pain over 10 years, lived in middle-sized city and big city in Korea, and 17 women and 3 men. The subject's age was from 32 to 62 (average 48.8), all were married, living with their spouse and children, except two-one divorced and the other widow before they became ill. I collected data using In depth structured interview. I had interviews two or three times with each subject, and the interviews were conducted at each subject's home. Each interview lasted about two hours an average. A recording was taken with the consent of the subject. I used inductive data analysis-such as unitizing and categorizing. unitizing is a process of coding, whereby raw data are systematically transformed and aggregated into units. Categorizing is a process wherby previously unitized data are organized into categories that provide descriptive or inferential information about the context or setting from which the units were derived. This process is used constant comparative method. The pain controlling process is composed of behavior of pain control. The behaviors of pain control are rearranging of ADL, hiddening role conflict, balancing treatment, and changing social relation. Rearranging of ADL includes diet management, sleep management, and the adjustment of daily life activities. The subjects try to rearrange their daily activities by modified style of motions, rearranging time span & range of activities, using auxillary facilities, and getting help in order to keep on the pace of daily life. Hiddening role conflict means to reduce conflicts between sick role and their role as a family member. In this process, the subjects use two modes, one is to control the pain complaints, and the other is to internalize the value which is to stay home is good for caring her children and being a good mother. To control pain complaints is done by 'enduring', 'understanding' the other family members, or making them undersood in order to reduce pain. Balancing treatment is composed of two aspects. One is to keep the pain within the endurable level, the other is to keep in touch with medical personnel in order to get the information of treatment and emotional support. Changing social relation is made by information seeking and sharing, formation of mutual support relation, and finally simplification of social relationships. The subjects simplify their social relationships by refraining from relations with someone who makes them physically and psychologically strained. In particular the subjects are apt to avoid contact with in-laws, and the change of relation to in-laws results in lessening the family boundary. In the course of this process, they confront the crisis of family confict result in family dissolution. This crisis is related to the threat of self-existence. Findings from this study contribute to understanding the chronic pain experience. To advance this study, we should compare this result with other cases in different cultural contexts. I think to interpret these results, korean cultural background should be considered. Especially the different family concept, more broader family members and kinship network, and the traditional medical knowledge influences patients' behavior.

• 대한간호
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• 제31권4호
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• pp.77-99
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• 1992

The study was carried out at W. hospital, an affiliated hospital of Y university, involved a total of 163 patients who were discharged from the hospital between May 1990 und March 199J. Data collection was twice, just prior to discharge and a minimum of three months post discharge. Thirty patients who lived within a hour travel time of the hospital received home care during the three months post discharge. Nursing diagnoses and nursing interventions For these patients were analyzed in this study. The results of the study are summarized as follows : 1. Discharge needs for the subjects of the study were analyzed using Gordon's eleven Functional categories and it was found that 48.3% of the total sample had identified nursing needs. Of these, the needs most frequently identified were in the categories of sexuality, 79.3 %, health perception, 68.2 % self concept, 62.5 %, and sleep and rest 62.5 %. Looking ut j he nursing diagnosis that were made for the 30 patients receiving home care, the following diagnoses were the most frequently given; alteration in sexual pattern 79.3%, alterations in health maintenance, 72.6%, alteration in comfort, 68.0%, depression, 64.0%, noncompliance with diet therapy, 6.3.7%, alteration in self concept, 55.6%, and alteration in sleep pattern, 53%. 2. In looking at the effects of home nursing care as demonstrated by changes in the functional categories over the three month period, it was Found that of the 11 functional categories, the need level for health perception, nutrition, activity and self concept decreased slightly over the three month period. On the average sleep patterns improved, but restfulness was slightly less and bowel elimination patterns improved but satisfaction with urinary elimination was slightly less. On the other hand, role enactment, sexuality, stress management and spirituality decreased slightly. The only results that were statistically significant at the 0.05 level were improvement. in digestion and decrease in pain. No statistically significant changes were found in ability related to ADL, the total ADL Score at discharge was $19.78{\pm}8.234, and after 3 months $19.01{\pm}8.12$. Considering that a majority of the patients were over 60 years of age and that many had brain or spinal cord injuries, the fact that their ADL ability did nor deteriorate after discharge can be interpreted as related to a positive impact by the home health care nurses. Similarly there was a slight be not statistically significant decrease in the quality of life scores between the two lest times(l47.83 at discharge and 113.02 at the three month period). Again, when the chronic nature of thee problems facing these patients is considered this maintenance of quality of life can be interpreted as a positive impact by the home health care nurses. 3. One of the home care nursing activities was diagnosis. For this activity it was found that for nine functional health categories(sexuality and spirituality excepted) there were 20 nursing diagnoses. The most frequent were noncompliance, alteration in skin integrity both actual and potential, and impaired physical mobility in that order. 4. Delivery of home health care by the home health nurses included the following nursing activities; assessment, patient education, demonstration of care activities, counselling, direct care to the patient and referrals. Direct care included changing dressings, bladder irrigations, changing Foley catheters, measurement of residual urine, perineal care, position change, back care, oral hygiene, exercise and massage of motion exercises, cleansing enemas, tracheostomy suctioning and tracheostomy care, care of dentures, applications of heat and other similar nursing activities. In conclusion almost 50% of (he sample indicated a need for continued nursing care at the time of discharge and for the patients in the sample who received home care there was a slight decrease in nursing needs but while the patients had chronic and debilitation problems there was ill decrease in ADL abilities or in quality of life. Further study needs Lo be done La increase the reliability and validity of the tool that was used to measure home health care needs. It is also recommended that study by done using a randomized sampling with a control group to compare patients who receive home care with those who do not.

• 한국방사선학회논문지
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• 제8권4호
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• pp.189-201
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• 2014

소아 방사선 검사 시 참여 여부와 방사선에 대한 인식도를 파악하여 검사의 질을 향상시키기 위해 부산 P대학병원에 내원한, 소아 아동이 있는 보호자 210명을 대상으로 2013년 8월 20일부터 2013년 9월 15일까지 설문조사하였으며 "과거에 소아 방사선 검사에 참여 해본 적이 있는가?" 라는 질문에 "그렇다"(66.2%)로 나타났고 참여한 이유는 "방사선사의 요청"(66.0%)로 가장 높게 나타났으며 "소아 방사선 검사 시 보호자의 참여가 필요하다고 생각하는가?"라는 질문에 "그렇다"(84.3%)로 나타났으며 그 이유는 "아이의 안정을 위해"(80.8%)였으며 "참여할 생각이 없다면 그 이유는 무엇인가?" 라는 질문에는 "방사선사의 업무이기 때문에"(54.8%)로 나타났다. 보호자의 심리상태 인식도 분석에서는 성별 분석을 보면 여성(3.40)이 남성(3.23)보다 평균이 높게 나타났으며, 소아 연령 분석을 보면 평균이 영아기(3.62)가 다른 소아 연령대보다 높은 것으로 나타났고 학령기(3.34), 유아기(3.25)순으로 나타났으며 통계적으로 유의한 차이가 있었다.(p<0.05) 보호자의 방사선 인식도 분석에서는 성별 분석을 보면 평균이 남성(3.09)이 여성 (2.78)보다 높게 나타났으며, 학력별 분석을 보면 평균은 대학원 (3.36)이 가장 높게 나타났고 전문대졸(2.90), 대졸(2.80), 고졸(2.77) 순서로 나타났으며 통계적으로 유의한 차이가 나타났다.(p<0.05) 보호자의 방사선 피폭 방지에 대한 인식도 분석에서는 연령별로 살펴보면 평균이 20대(3.60)가 가장 높게 나타났으며 50대(3.33), 30대(3.04)의 순으로 나타났고 40대(2.94)가 가장 낮게 나타났으며 성별 분석을 보면 평균이 남성(3.12)은 여성(2.96)보다 높게 나타났고, 소아 연령별 분석을 보면 평균이 영아기(3.27)가 가장 높게 나타났으며 유아기(2.98), 학령기(2.98)로 나타났고, 학력별 분석을 해보면 평균이 대학원(3.31)이 가장 높게 나타났으며 고졸(2.99), 대졸(2.99) 순으로 나타났고 전문대졸(2.94)이 가장 낮게 나타났으며 통계적으로 유의한 차이가 있었다.(p<0.05) 보호자들은 우선적으로 아이의 안정과 정확한 검사를 위해 방사선사와 동반검사가 필요하다고 인식하고 있었으며, 동반검사 전에 검사방법에 대해 숙지를 시키고 보호자에게 보호 장구를 필히 착용시키며 소아의 심리적 불안감을 없애기 위해 검사실의 환경 등을 개선하고 시각적, 청각적으로 편안하게 다가갈 수 있는 방안이 필요할 것으로 사료된다.

• 보건행정학회지
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• 제26권2호
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• pp.115-124
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• 2016

Background: This study aims at making a survey on health care service providers' cultural competence and making an appraisal of Chinese medical tourists on service quality, health care service providers' cultural competence, perceived value, and satisfaction. Methods: The data was collected from August until November, 2014 and 150 health care service providers and 65 Chinese medical tourists from 12 medical institutions in Daegu were enrolled in analysis. Results: The results showed that health care service provider's knowledge on Chinese culture was very low with 33.5% of correct answer. Health care service providers were found to get 3.82 point on a 5 point-scale in cultural perception, 3.53 points in cultural sensitivity, and 2.85 points in cultural skills. Chinese medical tourists were analyzed to give 4.08 points on a 5-point scale to satisfaction on health care service, followed by 4.01 points to health care service quality, 4.00 points to perceived value of health care service, and last 3.85 points to a health care service providers' cultural skills. However, there was a difference in points in cultural skills between health care service providers and Chinese medical tourists. Chinese medical tourists' satisfaction with health care service in Daegu was found to be comparatively high, but in relation to satisfaction with communication, it was found to be relatively low. Conclusion: Through this research, health care service providers' knowledge level of Chinese culture and cultural skills were low while they seemed to take a half-hearted attitude towards educational experience for building up cultural competence and foreign patient service response.

• Journal of Hospice and Palliative Care
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• 제11권1호
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• pp.42-50
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• 2008

목적: 통증은 암환자가 지각하는 가장 고통스러운 증상으로 가족간호자와의 부적절한 의사소통은 암환자의 통증관리에 영향을 미치는 중요한 요인 중 하나이다. 따라서 본 연구는 국내에서 암환자와 가족간호자의 부적절한 의사소통이 효과적인 암성통증관리에 문제가 되는 지를 살펴보기 위하여 지각하는 통증강도에 있어서 암환자와 그 가족간호자의 차이가 존재하는 지를 파악하여, 효과적인 암성통증관리를 위한 기초자료를 제공하기 위하여 실시되었다. 방법: 본 연구는 6개월 동안 서울에 소재한 1개 암 전문 병원에서 입원 또는 외래로 치료를 받고 있는 암환자와 그 환자의 가족간호자 127쌍을 대상으로 하였다. 연구도구는 간이통증척도(BPI-K)의 통증강도 항목과 선행연구를 참고하여 연구자들이 구성한 환자용 설문지 및 가족용 설문지였으며, 훈련된 연구보조원이 일대일로 자료를 수집하였다. 그리고 암환자의 임상적 자료는 의무기록 열람을 통해 수집하였다. 결과: 가족간호자들이 지각한 환자들의 '지난 24시간 동안 가장 심한' 그리고 '바로 지금' 통증강도 평균점수는 암환자들의 통증강도 평균점수에 비해 통계적으로 유의하게 높았다. 통증강도 범주별 일치도는 '지난 24시간동안 가장 심한' 통증의 경우, 암환자의 통증강도가 '심한 통증' 범주인 경우 78.7%의 가족간호자가 같은 범주로 지각하고 있었고, '통증없음'의 경우는 40%의 가족간호자가, '경미한 통증'인 경우는 27.5%의 가족간호자가, 그리고 '중등도 통증'인 경우는 22.9%의 가족간호자가 암환자와 같은 범주의 통증정도로 지각하고 있었다. 그리고 '지금 바로' 통증의 경우, 암환자의 '지금 바로' 통증강도가 '심한 통증' 범주인 경우 50.0%의 가족간호자가 같은 범주로 지각하고 있었고, '경미한 통증'인 경우는 47.2%의 가족간호자가, '통증없음'의 경우는 46.3%의 가족간호자가, 그리고 '중등도 통증'인 경우는 26.3%의 가족간호자가 암환자와 같은 범주의 통증정도로 지각하고 있었다. 결론: 본 연구결과 암환자와 가족간호자가 지각하는 환자의 통증강도 범주의 일치도는 '심한 통증' 범주를 제외하고 절반 미만으로 나타났다. 그러므로 암환자가 '심한 통증'을 경험 할 때보다 '중등도 통증' 또는 '경미한 통증'을 경험할 때 암환자와 가족간호자가 지각하는 통증강도 범주가 다를 가능성이 높으며, 암환자의 통증을 과대평가하는 가족간호자가 과소평가하는 가족간호자보다 더 많을 가능성이 높다. 이에 본 연구에서 나타난 차이를 줄이기 위해 암환자와 가족간호자를 대상으로 간단한 통증척도를 이용하여 통증을 객관적으로 사정하여 보고하도록 교육하여야할 것이다. 또한 본 연구에서 나타난 암환자와 가족간호자의 차이를 규명하는 반복연구를 통해 확인이 필요하며, 암환자와 가족간호자의 통증강도 차이에 영향을 미치는 변수들이 어떤 것인지를 밝히는 연구가 필요하다.