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유방절제술 환자의 불확실성, 불안 및 대처방식 (Uncertainty, Anxiety and Coping with Mastectomy for Breast Cancer)

  • 조옥희
    • 대한간호학회지
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    • 제30권4호
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    • pp.1006-1017
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    • 2000
  • The purpose of this study was to provide basic information for developing a nursing intervention that helps patients learn how to acquire coping to reduce post operation uncertainty and anxiety by investigating the level of uncertainty and anxiety experienced by mastectomy patients. The subjects were 134 patients selected from St. Mary's Kangnam and St. Mary's hospital, and the data collection period was from October to December of 1998. Uncertainty was measured by using Mishel Uncertainty in Illness Scale (MUIS), anxiety measured by using State-Trait Anxiety Inventory(STAI), and coping by using a questionnaire developed by Kim & Yoo (1996). Data were analyzed with SAS program by t-test, ANOVA, Duncan's multiple range test, Pearson correlation coefficients, and stepwise multiple regression. The results were as follows : 1. The mean uncertainty score was 57.6. The results of the correlation between the compliance of medical regimen and demographic characteristics were as follows ; Those who monthly income over 2,010,000 won had lower than above 1,000,000 won, and those with the experience of chemotherapy had higher than those without, and the patient who has 7∼12 months(1 yr.) post operation period had higher than the one below 6months, 25∼36 months(3 yrs.), 37∼60 months(5 yrs.), and over 61 months. 2. The mean anxiety score was 45.9. Anxiety tended to be increased slightly in subjects with low educational background, poor monthly income, experience of chemotherapy, and 7∼12 months(1 yr.) post operation period, but there was no significant difference by general characteristics 3. The mean value of the coping score was 100.7. The study revealed higher score in problem-focused coping than emotion-focused coping. In regard to coping by demographic characteristics were as follows ; those who had monthly income over 2,010,000 won had higher level of coping than those whose monthly income was between 1,010,000 and 2,000,000 won. In terms of problem- focused coping, those who had 25∼36 months of post operation period showed significantly lower level of coping than those below 6 months or 37∼60 months(5 yrs.) or over 61 months of post operation period. Regarding the emotion-focused coping, those with the christianity had significantly lower level of coping than those without it. Also, those whose monthly income over 2,010,000 won had significantly higher coping level than those with income of between 1,010,000 and 2,000,000 won. 4. A positive relationship was found between uncertainty and anxiety. Patients who experienced more uncertainty also showed more anxiety. Problem-focused coping was inversely related to uncertainty and anxiety. 5. The major variable that affected uncertainty was anxiety, explaining 63.3% of the uncertainty. In addition to this, it would explain 66.4% in total when experience of chemotherapy was added.

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한의학전문대학원 재학생들의 학업 스트레스와 학업소진에 관한 연구 (Study on Stress and Burnout in Medical Education at the School of Korean Medicine)

  • 김성혜;한승윤;김종대;최수미;이수진;임정화;채한
    • 동의신경정신과학회지
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    • 제26권2호
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    • pp.103-116
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    • 2015
  • Objectives: Medical students suffer from mental health and academic problems due to academic stress. We investigated academic stress and exhaustion along with psychological issues caused by medical education during the years in the School of Korean Medicine. Methods: Two hundred fifty-one university students from the School of Korean Medicine, Pusan National University, were asked to complete the Medical Stress Scale (MSS), Maslach Burnout Inventory-Student Survey (MBI-SS), Positive Affect and Negative Affect Schedule (PANAS), and State-Trait Anxiety Inventory (STAI) three times during each semester for two years from 2013 onwards. We analyzed the influence of school term and vacation on educational stress and negative affect with the T-test. The Pearson's correlation analysis and regression analysis were used to predict changes during the first semester or first years of study in the School of Korean Medicine. Results: Academic stress and burnout increased steadily until the first semester of third grade, which was measured with MSS and MBI-SS. The anxiety level was highest when the students started the first grade and it decreased significantly after the first semester. Negative affect repeatedly increased significantly after each school term; however, it reduced after each vacation. In the first grade, 19.5% of the last measure of MSS can be explained with the first measure of MSS. Discussion: This study extensively reviewed the trends and characteristics of four years of academic stress and its related psychological influence, and discussed its importance for developing a more efficient academic curriculum for traditional Korean Medicine.

간호학생이 임상실습시 느끼는 불안의 정도와 불안야기 상황연구 (Nursing Students Anxiety level and Perceptions of Anxiety-Producing Situations in the Clinical Setting)

  • 박춘자
    • 한국간호교육학회지
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    • 제3권
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    • pp.34-45
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    • 1997
  • Aspects of nursing student's clinical experiences are anxiety provoking. High anxiety may contribute to decreased learning. The purpose of this study was to identify the level of anxiety and potentially anxiety-producing clinical experience, the relation between the level of anxiety and their Trait-Anxiety and State-Anxiety. Finally, it is aimed at getting preparing data for guidance of students which can enhance learning effect of students for clinical experience. The samples of this study were 36 junior students(1 semester experience) and 44 senior students (3 semester experience) from Junior College of Nursing in Seoul on September 1996. The tools of this study were two kinds ; questionare of Spielberg' STAI measuring State and Trait-Anxiety, and author's for measuring the level of Anxiety producing situations and 10cm visual analogue scale was also used for measuring self stated level of anxiety on clinical setting. The collected data were analyzed by SPSS using percentage, t-test, ANOVA and Pearson correlation coefficient. The results of this study were as follows : 1. The self perception of anxiety level was 4.3/10cm and the level of anxiety in clinical setting situations was 3.5/5. 2. Among 20 questions for perception of anxiety-producing situations in the clinical setting. 'deficit of nursing knowledge' was the highest item(4.18), 'vagueness of role'(4.11), 'lack of nursing skill'(4.00), 'evaluation by faculty'(4.00) 'fear of making mistakes'(3.81) 'initial clinical experience on a unit'(3.76) 'initial application of nursing knowledge'(3.74) in turn. 3. The level of State-anxiety of senior students was higher than junior's (p=0.005)and the level of Trait-Anxiety of insufficient interpersonal relationship and unhealthy students were higher than others (p=0.015) There was no differences according to the student's grade in level of anxiety. 4. Both of self-stated anxiety and situationa anxiety of unhealthy students were high (p=0.007, p=0.000) and the level of self-stated anxiety of unsatisfied students for selection major and clinical experience were high (p=0.050, p=0.009). 5. Self-stated anxiety and situation anxiety (p=0.0000), self-stated- anxiety and Trait-anxiety(p=0.003), situation anxiety and Trait-anxiety(p=0.004), and Trait-anxiety and state-anxiety(p=0.000) of the students were interrelated. By the above conclusion, the nursing students still feel anxiety on clinical experience and on making a mistake due to the lack of their nursing knowledge and skill. And the students are afraid of the faculties' evaluation. In addition, the students who are not healthy and have not sufficiently interpersonal relationship feel more anxiety. But, since there was no difference significantly between each grade, we think it is needed that further study on the same topic in large samples. And, we have to equip the students with much nursing knowledge and philosophy apparently before the students have clinical experience. Finally, the faculty have to reduce the students' anxiety by making a climate of acceptance in clinical setting with good personality.

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수술전 환자의 정서적 상태와 수술후 통증에 관한 연구 - IV-PCA를 부착한 수술환자 대상으로 - (A Study on Emotional State of Preoperative Patients and Postoperative Pain (patients with abdominal surgery who received IV-PCA))

  • 김경희;정혜경;이현수
    • 기본간호학회지
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    • 제9권2호
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    • pp.288-299
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    • 2002
  • The patients with abdominal surgery usually have acute pain. It is important for a patient's qualify of life and for good recovery after surgery to control the postoperative pain. The purpose of this study is to identify the relationship between emotional state of preoperative patients and postoperative pain. The participants in this study were the 100 patients receiving abdominal surgery who received Intravenous Patient Controlled Analgesia (IV-PCA) at the end of the operation. The data were collected using questionnaires and the period of the data collection was from March to August, 2001. The instruments used for this study were The State-Trait Anxiety Inventory (STAI) Developed by Spielberger (1972), The Center for Epidemeologic Studies-Depression (CESD) scale and Visual Analog scale (VAS). The data were analyzed using descriptive statistics. t-test, ANOVA and Pearson Correlation coefficient with the SPSS program. The results are as follows. 1. For general characteristics there were significant differences in the degree of trait anxiety according to gender (p= 0.0010), marital status (p=0.0122), religion (p=0.0040), education (p=0.0001), occupation (p=0.0002). monthly income (p=0.0001), diagnosis (p=0.0001), and operation title (p = 0.0001). 2. For general characteristics there were significant differences in the degree of state anxiety according to gender (p= 0.0023), education (P=0.0073), monthly income (p=0.0001), diagnosis (p=0.0005), and operation title (P =0.0063). 3. For general characteristics there were significant differences in the degree of depression according to gender (p= 0.0073), occupation (p=0.0469), monthly income (p=0.0001), diagnosis (p=0.012). and operation title (p =0.0033). 4. For general characteristics there were significant differences in the degree of postoperative pain according to gender (p=0.0213), marital status (p=0.0082), education (p=0.0016), occupation (p =0.0128). monthly income (p=0.0008), diagnosis (p =0.0007), and operation title (p =0.0008). 5. The relationship between trait anxiety and postoperative pain revealed a significant positive correlation (r =0.51, p =0.0001), and the relationship between state anxiety and postoperative pain revealed a significant positive correlation (r=0.50. p=0.0001) and the relationship between Depression and pain revealed a significant positive correlation (r =0.49. p =0.0001).

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계획된 간호 정보가 수면량에 미치는 영향에 관한 연구 -개심술 환자를 중심으로- (The Effect of Structured Information on the Sleep Amount of Patients Undergoing Open Heart Surgery)

  • 이소우
    • 대한간호학회지
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    • 제12권2호
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    • pp.1-26
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    • 1982
  • The main purpose of this study was to test the effect of the structured information on the sleep amount of the patients undergoing open heart surgery. This study has specifically addressed to the Following two basic research questions: (1) Would the structed in formation influence in the reduction of sleep disturbance related to anxiety and Physical stress before and after the operation? and (2) that would be the effects of the structured information on the level of preoperative state anxiety, the hormonal change, and the degree of behavioral change in the patients undergoing an open heart surgery? A Quasi-experimental research was designed to answer these questions with one experimental group and one control group. Subjects in both groups were matched as closely as possible to avoid the effect of the differences inherent to the group characteristics, Baseline data were also. collected on both groups for 7 days prior to the experiment and found that subjects in both groups had comparable sleep patterns, trait anxiety, hormonal levels and behavioral level. A structured information as an experimental input was given to the subjects in the experimental group only. Data were collected and compared between the experimental group and the control group on the sleep amount of the consecutive pre and post operative days, on preoperative state anxiety level, and on hormonal and behavioral changes. To test the effectiveness of the structured information, two main hypotheses and three sub-hypotheses were formulated as follows; Main hypothesis 1: Experimental group which received structured information will have more sleep amount than control group without structured information in the night before the open heart surgery. Main hypothesis 2: Experimental group with structured information will have more sleep, amount than control group without structured information during the week following the open heart surgery Sub-hypothesis 1: Experimental group with structured information will be lower in the level of State anxiety than control group without structured information in the night before the open heart surgery. Sub-hypothesis 2 : Experimental group with structured information will have lower hormonal level than control group without stuctured information on the 5th day after the open heart surgery Sub-hypothesis 3: Experimental group with structured information will be lower in the behavioral change level than control group without structured information during the week after the open heart surgery. The research was conducted in a national university hospital in Seoul, Korea. The 53 Subjects who participated in the study were systematically divided into experimental group and control group which was decided by random sampling method. Among 53 subjects, 26 were placed in the experimental group and 27 in the control group. Instruments; (1) Structed information: Structured information as an independent variable was constructed by the researcher on the basis of Roy's adaptation model consisting of physiologic needs, self-concept, role function and interdependence needs as related to the sleep and of operational procedures. (2) Sleep amount measure: Sleep amount as main dependent variable was measured by trained nurses through observation on the basis of the established criteria, such as closed or open eyes, regular or irregular respiration, body movement, posture, responses to the light and question, facial expressions and self report after sleep. (3) State anxiety measure: State Anxiety as a sub-dependent variable was measured by Spi-elberger's STAI Anxiety scale, (4) Hormornal change measure: Hormone as a sub-dependent variable was measured by the cortisol level in plasma. (5) Behavior change measure: Behavior as a sub-dependent variable was measured by the Behavior and Mood Rating Scale by Wyatt. The data were collected over a period of four months, from June to October 1981, after the pretest period of two months. For the analysis of the data and test for the hypotheses, the t-test with mean differences and analysis of covariance was used. The result of the test for instruments show as follows: (1) STAI measurement for trait and state anxiety as analyzed by Cronbachs alpha coefficient analysis for item analysis and reliability showed the reliability level at r= .90 r= .91 respectively. (2) Behavior and Mood Rating Scale measurement was analyzed by means of Principal Component Analysis technique. Seven factors retained were anger, anxiety, hyperactivity, depression, bizarre behavior, suspicious behavior and emotional withdrawal. Cumulative percentage of each factor was 71.3%. The result of the test for hypotheses show as follows; (1) Main hypothesis, was not supported. The experimental group has 282 minutes of sleep as compared to the 255 minutes of sleep by the control group. Thus the sleep amount was higher in experimental group than in control group, however, the difference was not statistically significant at .05 level. (2) Main hypothesis 2 was not supported. The mean sleep amount of the experimental group and control group were 297 minutes and 278 minutes respectively Therefore, the experimental group had more sleep amount as compared to the control group, however, the difference was not statistically significant at .05 level. Thus, the main hypothesis 2 was not supported. (3) Sub-hypothesis 1 was not supported. The mean state anxiety of the experimental group and control group were 42.3, 43.9 in scores. Thus, the experimental group had slightly lower state anxiety level than control group, howe-ver, the difference was not statistically significant at .05 level. (4) Sub-hypothesis 2 was not supported. . The mean hormonal level of the experimental group and control group were 338 ㎍ and 440 ㎍ respectively. Thus, the experimental group showed decreased hormonal level than the control group, however, the difference was not statistically significant at .05 level. (5) Sub-hypothesis 3 was supported. The mean behavioral level of the experimental group and control group were 29.60 and 32.00 respectively in score. Thus, the experimental group showed lower behavioral change level than the control group. The difference was statistically significant at .05 level. In summary, the structured information did not influence the sleep amount, state anxiety or hormonal level of the subjects undergoing an open heart surgery at a statistically significant level, however, it showed a definite trends in their relationships, not least to mention its significant effect shown on behavioral change level. It can further be speculated that a great degree of individual differences in the variables such as sleep amount, state anxiety and fluctuation in hormonal level may partly be responsible for the statistical insensitivity to the experimentation.

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