• 제목/요약/키워드: day care quality

검색결과 297건 처리시간 0.023초

말기암 환자와 가족의 의료 및 간호 서비스 요구 (The Study on the Medical and Nursing Service Needs of the Terminal Cancer Patients and Their Caregivers)

  • 이소우;이은옥;허대석;노국희;김현숙;김선례;김성자;김정희;이경옥
    • 대한간호학회지
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    • 제28권4호
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    • pp.958-969
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    • 1998
  • In this study, we attempted to investigate the needs and problems of the terminal cancer patients and their family caregivers to provide them with nursing information to improve their quality of life and prepare for a peaceful death. Data was collected from August 1, 1995 to July 31, 1996 at the internal medicine unit of S hospital in Seoul area with the two groups of participants who were family members of terminal cancer patients seventy four of them were in-patients and 34 were out-patients who were discharged from the same hospital for home care. The research tool used in this study has been developed by selecting the questionnaires from various references, modifying them for our purpose and refining them based on the results of preliminary study. While general background information about the patients was obtained by reviewing their medical records, all other information was collected by interviewing the primary family caregivers of the patients using the questionnaire. The data collected were analyzed with the SPSS PC/sup +/ program. The results of this study are summarized as follows ; 1) Most frequently complained symptoms of the terminal cancer patients were in the order of pain(87%), weakness(86.1%), anorexia(83.3%) and fatigue (80.6%). 2) Main therapies for the terminal cancer patients were pain control (58.3%), hyperalimentation(47.2%) and antibiotics(21.3%). 3) Special medical devices that terminal cancer patients used most were oxygen device (11.1%), and feeding tube(5.6%). Other devices were used by less than 5% of the patients. 4) The mobility of 70.4% of the patients was worse than ECOG 3 level, they had to stay in bed more than 50% of a day. 5) Patients wanted their medical staffs to help relieve pain(45.4%), various physical symptoms(29.6%), and problems associated with their emotion(11.1%). 6) 16.7% of the family caregivers hoped for full recovery of the patients, refusing to admit the status of the patients. Also, 37% wished for the extension of the patient's life at least for 6 months. 7) Only 38.9% of the family members was preparing for the patient's funeral. 8) 45.4% of family caregivers prefer hospital as the place for the patient's death, 39.8% their own home, and 14.8% undetermined. 9) Caregivers of the patients were mostly close family members, i.e., spouse(62%), and sons and daughters or daughter-in-laws(21.3%). 10) 43.5% of the family caregivers were aware of hospice care. 46.8% of them learned about the hospice care from the mass media, 27.7% from health professionals, and the rest from books and other sources. 11) Caregivers were asked about the most difficult problems they encounter in home care, 41 of them pointed out the lack of health professionals they can contact, counsel and get help from in case of emergency, 17 identified the difficulty of finding appropriate transportation to hospital, and 13 stated the difficulty of admission in hospital as needed. 12) 93.6% of family caregivers demanded 24-hour hot line, 80% the visiting nurses and doctors, and 69.4% the volunteer's help. The above results indicate that terminal patients and their family caregivers demand help from qualified health professionals whenever necessary. Hospice care system led by well-trained medical and nursing staffs is one of the viable answers for such demands.

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신경계 작업치료사의 평가도구 사용 현황 및 향후 방향 (Current Trends and Future-Oriented View of Clinical Measurement Used by Neurological Occupational Therapist)

  • 송창순
    • 한국산학기술학회논문지
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    • 제13권11호
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    • pp.5229-5237
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    • 2012
  • 작업치료사의 환자중심훈련(patient-centered practice)은 치료사에게 환자와 그 가족의 관점에서 능동적으로 환자의 기능부전을 찾아야 가능하다. 본 연구는 신경계 작업치료사가 검사 및 평가를 실시하기 위하여 현재 임상에서 사용하는 평가도구의 사용빈도 및 평가도구 선택시 고려사항을 알아보고, 평가에 관한 향후 방향을 제시하기 위함이었다. 연구대상자는 신경계 질환자를 대상으로 치료하는 서울 경기지역에 근무하는 작업치료사 66명이었다. 설문지는 연구대상자의 일반적인 특성, 평가관련 정보, 신경계 작업치료사가 사용하는 평가도구의 내용, 성인 평가도구 및 아동평가도구에 관한 내용으로 구성되었다. 결과분석은 설문에 응답한 66명의 자료를 대상으로 기술적 통계량을 사용하였다. 연구결과, 1일 환자 수는 10인 이상 15인 미만이 가장 많았으며, 초기평가는 20분 이상 40분 미만이 가장 많았고, 환자 재평가 주기는 1개월과 기능적 차이가 보일 때가 가장 많았다. 평가도구는 신경계 관련 도구에만 국한되지 않았으며, 평가도구 선택시 고려사항은 평가도구의 신뢰도와 타당도가 가장 높았다. 성인을 대상으로 사용한 평가도구는 '상지운동기능'은 JHFT, '인지 및 지각'은 MMSE-K, '일상생활동작'은 MBI, '작업수행'은 COPM이 가장 많았다. 또한 아동을 대상으로 한 평가도구는 '인지-지각 평가도구'는 MVPT, '일상생활동작 평가도구'는 Wee-FIM이 가장 많았다. 마지막으로 영역에 따른 평가도구 선택시 고려사항도 평가도구의 신뢰도와 타당도가 가장 높았다. 본 연구결과를 통하여 서울.경기지역에 근무하는 신경계 작업치료사의 영역별 평가도구의 사용빈도와 그 평가도구를 선택할 때 고려하는 사항을 알아볼 수 있었고, 이 결과를 바탕으로 향후 신경계 작업치료사가 평가를 수행할 때 환자수행중심 평가뿐만 아니라 환자와 보호자의 관점을 통합하여 치료계획을 수립할 필요성이 있다고 제언하는 바이다.

근대 보건간호의 역사적 고찰 (Historical Review of Modern Public Health Nursing)

  • 이봉숙;한영란;양숙자
    • 농촌의학ㆍ지역보건
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    • 제43권2호
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    • pp.114-124
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    • 2018
  • 본 연구는 지역사회보건사업의 한 영역인 보건간호의 근대 역사를 6개 시기로 구분하여 고찰하고 보건간호가 나아갈 방향에 대해 제안하였다. 태동기는 1908년부터 시작되었으며 선교사에 의해 보건간호가 시작되었으나 귀국 조치되면서 위축되었다. 기반형성기는 대한민국정부 수립 후 중앙정부조직과 보건관련 법령을 체계화한 시기로 1956년 보건소법 제정으로 보건소의 법적 근거를 확보하였다. 기반조성기에 정부는 가족계획사업을 정책사업으로 수행하였고 기생충질환예방법, 결핵예방법, 모자보건법 등이 제정되면서 보건소 사업이 증가하였다. 의료법 개정으로 업무분야별 간호사 자격이 인정되어 보건간호분야 간호사가 인정되었으며 조산원이 읍면동에 배치되어 임부의 분만 출산을 돕는 등 보건간호가 활성화되었다. 분야별 정비기에는 보건소 건강증진사업이 새롭게 영입되고 정신보건센터가 전국적으로 설치되면서 국민건강의 분야별 사업이 정비되었다. 또한 지역보건의료계획을 작성하게 되어 지역주민들의 요구를 반영한 사업을 할 수 있게 되었으며 정부는 국민건강증진종합계획을 설정하여 이를 보건의료 사업의 목적으로 삼았다. 보건소 기능확대기에는 건강형평성 확보를 위해 전국 차원의 맞춤형 방문건강관리사업을 실시하였고 도시보건지소와 건강생활지원센터를 설립하여 주민들에게 접근성을 높인 일차보건의료서비스를 제공하였다. 앞으로 보건간호는 우리나라 보건의료전달체계의 특성에 알맞은 보건간호체계의 구상과 설계, 간호 인력에 대한 동기부여, 역할개발과 훈련, 새로운 보건체계와 보건간호서비스에 대한 종합적 평가 등을 통해 발전해 나가야 할 것이다.

타액-알파아밀라제를 이용한 병원간호사의 직무스트레스 측정 (Measurement of Temporal Job Stress for Hospital Nurses using Salivary Alpha-Amylase)

  • 서상혁;곽승현;김형식;심희숙;강진규;민병찬
    • 산업경영시스템학회지
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    • 제39권2호
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    • pp.82-87
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    • 2016
  • As contemporary society has become more complicated, specialized, and segmented, people are experiencing more diverse types of stress. In particular, while several factors associated with job stress have been examined among nurses, who belong to a professional group, the existing research has made no quantitative assessments of stress that reflect temporal differences in individuals. Therefore, the aim of this study is to understand the effects of job stress on alpha-amylase with regard to the working hours of nurses, to assess the variations in jobs stress over time, and provide basic data to improve the quality of nursing services. Ninety nurses working in three shifts in general, emergency, and intensive care wards of a university hospital in D City participated in this study. Salivary alpha-amylase (SAA) was extracted and analyzed at two-hour intervals from 07:00 to 15:00 from nurses on the day shift and from 23:00 to 07:00 from those working the night shift. The SAA level was highest between 23:00 and 01:00 for nurses in general wards ($mean{\pm}S.D.\;39.00{\pm}14.88$) and between 11:00 and 13:00 for those in both intensive care units and emergency wards ($mean{\pm}S.D.\;67.50{\pm}62.93$ and $mean{\pm}S.D.\;39.67{\pm}35.96$, respectively). The characteristic variation in SAA was significant between 23:00 and 01:00 (p < 0.01) and for those in their fifties or older (p < 0.01). The activation ratio of alpha-amylase, a stress reactant, showed an increase when the sympathetic nervous system was activated by mental stress; in addition, job stress was manifested with the effect of awakening at different time segments and at different ages among the nurses. With the aim of raising the level of service based on the nurses maintaining their mental health, it is necessary to focus sharply on the time segment for critical control and to conduct repetitive studies to determine the divisions of eustress critical values as well as to expand the population.

쪽방지역에 홀로 사는 남성 노인의 삶의 경험 (Study on the Lived Experience of Elderly Men Living Alone in a Single Room Occupancy(Chokbang))

  • 허소영
    • 한국노년학
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    • 제30권1호
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    • pp.241-260
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    • 2010
  • 이 연구의 목적은 쪽방지역에 홀로 사는 남성 노인의 삶의 경험이 갖는 의미와 본질을 밝힘으로서 이들의 경험에 대한 좀 더 풍부한 이해를 하는 것이다. 연구 참여자는 Y 쪽방지역에 거주하는 65세 이상 독거 남성 8명이다. 의도표집방법과 눈덩이 표집 방법을 사용하였으며, 포커스 집단 면담과 개별심층면담을 통해 자료를 수집하였다. 자료의 분석은 Giorgi의 4단계에 의거하였다. 연구결과 4개의 구성요소와 16개의 하위구성요소가 도출되었다. 쪽방에 홀로 사는 남성 노인들의 삶의 4가지 구성요소는 <마음 둘 곳 없어 외로운 신세: 아들, 남편, 아비구실 못해 가족을 지우고 살아옴, 몸은 머물지만 정들지 않는 쪽방 살이, 하루짜리 술친구에 머무는 사귐, 외로움을 안고가기>,<인색한 지원에 근근이 살아감: 쪽방처럼 사방이 막힌 인생살이에 우울함, 수급자라 휘둘리고 무시 받아 속상함>,<편견과 차별에 주눅 드는 삶: 아쉬워도 손 벌리지 못함, 가족을 꾸리지 못해 후회되고 냉대 받음, 다가가지 못하는 바깥세상 >,<사람노릇하며 살다가기: 홀로의 삶을 건사하여 독립을 유지하려함, 빚 갚는 마음으로 도움주기, 하릴없이 보내는 나날이 고역이라 일을 하고 싶음, 쪽방 사람들과 다르게 살아가기, 어른도리 하기, 마음을 다스려 현재의 삶을 수용함, 폐가 되지 않을 죽음을 준비하기>로 나타났다. 이러한 결과를 바탕으로 쪽방지역에 홀로 사는 남성 노인들의 삶의 경험에 대한 의미를 논의하고 사회복지적 함의와 후속 연구를 위한 제언을 제시하였다.

수술환자의 타지역 의료이용에 관한 연구 (A Study on Utilization of non-residential areal in Operation patient)

  • 남문희;김성수;박일수;강성홍;김원중;최순호;조혜경;김영택;홍성옥
    • 한국산학기술학회논문지
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    • 제11권6호
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    • pp.2078-2087
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    • 2010
  • 본 연구는 수술환자의 타지역 의료이용과 관련된 요인을 규명하기 위하여 2004년부터 2006년도의 퇴원손상 환자조사뿐 아니라, 인구센서스 및 보건의료자원 실태조사자료를 이용하여 교차분석, 로지스틱 회귀분석을 실시한 결과 다음과 같다. 첫째, 수술환자의 의료이용은 수도권 중심으로 집중화 현상이 뚜렷하다. 이를 개선하기 위해서 정부에서는 의료기관 및 병상수를 공급하는 일 뿐만 아니라 의료의 지역화를 위해 지방에서의 의료의 질적 수준을 올리는 정책이 필요하다. 둘째, 눈 및 부속기 질환 및 암환자의 타지역 수술률이 높으므로 질병에 따른 의료의 지역화를 위한 특정 질환의 지역화 정책추진이 요구된다. 셋째, 산재환자 수술환자의 타지역 진료율이 시간이 갈수록 증가하므로 손상환자를 위한 지역화 정책도 필요하다 할 것이다.

전천 후 생활보조 시스템을 위한 안전하고 경량화 된 인증기법 (A Secure and Lightweight Authentication Scheme for Ambient Assisted Living Systems)

  • 이명규;최현철;황보택근
    • 한국인터넷방송통신학회논문지
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    • 제19권4호
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    • pp.77-83
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    • 2019
  • 인구 증가로 인해 노인 인구가 날로 증가하고 있다. 이런 노인들에겐 다양한 보살핌이 필요하지만, 노인들을 돌볼 수 있는 의료 종사자가 부족한 상황이다. 전천후 생활보조는 고령자의 안전과 건강한 삶을 보장하고, 고령자가 자신이 선호하는 환경에서 독립적으로 살 수 있는 기간을 연장하는 것을 목표로 한다. 전천후 생활보조는 스마트 장치, 의료 센서, 무선 네트워크, 건강관리 모니터링을 위한 컴퓨터 및 소프트웨어 응용 프로그램으로 구성된 시스템을 제공한다. 전천후 생활보조는 노인들의 건강과 건강 상태를 예방, 치료 및 개선하는 등의 다양한 목적으로 사용될 수 있다. 정보 보안 및 개인 정보 보호는 전천후 생활보조 시스템 사용자가 보호받을 수 있도록 보장하는 데 중요하지만, 이러한 특성을 고려한 연구는 미미하다. 본 논문에서는 전천후 생활보조 시스템을 위하여 안전하고 경량화 된 인증기법을 제안한다. 제안된 인증기법은 전천후 생활보조 시스템에서 요구되는 중요한 보안 요구 사항들을 지원할 뿐만 아니라 다양한 유형의 공격으로부터 안전하다. 또한 제안된 인증 기법이 기존의 인증 기법들보다 더 안전하고 효율적이라는 것을 보여주기 위하여 보안 분석 결과를 제시한다.

거제도(巨濟島) 주민(住民)의 영양실태조사(營養實態調査) (Nutrition Survey in Koje Island)

  • 오승호;장수경;박명윤
    • Journal of Nutrition and Health
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    • 제10권4호
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    • pp.43-58
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    • 1977
  • Kojedo is the second largest island in Korea and a total population of 115,500 is living on the island of 394.69 sq. km. Under the direction of three nutrition professors, nutrition surveys in two villages in Kojedo, namely Siljun Ri in Hachung Myon and Soowol Ri in Shinhyun Myon, were carried by 30 college senior students majoring in nutrition from August to 20 August 1977. From a total of 176 households of the two villages, 67 households were randomly selected and 390 family members of the households were subjcets of the nutrition surveys. The precise weighing method was used in evaluating the kinds of foods and nutrient intakes of the subjects for three consecutive days. Thirty-seven pre-school children aged between 3 to 6 years and 27 fertile women were examined for biochemical findings and physical status. The main purposes of the surveys are to provide baseline data on nutrition in Kojedo Island for the Kojedo Community Development Project and to compare the nutritional status of the villages of Siljun Ri and Soowol Ri. Siljun Ri is located in the pilot project area of the Koiedo Community Health Project sponsored since December 1970 by the Christian Medical Commission of the World Council of Churches. While Soowol Ri is a control village for comparison. The results obtained are summarized as follows: Food Intake The average food intake per person per day in Siljun Ri, 1064 grams (91.7% in vegetable foods and 7.6% in animal foods) was 90 grams more than that of Soowol Ri, 974 grams (92.8% in vegetable foods and 5.9% in animal foods). However, the food intake per pre-school child in Siljun Ri, 485 grams (92.6% from vegetable foods and 6.4% from animal foods) was 21 grams lower than that of the Soowol Ri, 506 grams (88.5% from vegetable foods and 6.5% from animal foods). The average intake of beans was 16 grams(1.5% out of the total food intake) in Siljun Ri and 21 grams(2.2% of the total food intake)in Soowol Ri. The villagers should be guided for more consumption of soybeans to improve the quality of protein intake from vegetable foods. Nutrient Intake The adult intake in Siljun Ri and Soowol Ri were 2,529 kcal and 2,511 kcal respectively. The average energy intake of pre-school childen in Siljun Ri was 948 kcal and that for adult and 1,500 kcal for childen aged between 4 to 6 years-given by the Korea FAO Association, the diets in both villages were not adequate. Average daily protein intake of the subjected adult in Siljun Ri was 78.4 grams and that of Soowol Ri was 76.2 grams, while pre-school children took 30.7 grams in the former village and 31.7 grams in the latter village per child per day. The protein intake in both villages were lower than the recommended allowances, 80 grams for adult and 45 grams for $4{\sim}6$ years childen, and animal protein intake of the all subjects was very much lower than the RDA. The main charecter of the diet has been found low in quality of protein and high in carbohydrate. The calcium intakes of the pre-school children in both villages, 251.9 milligrams in Siljun Ri and 218.8 milligrams in Soowol Ri, were very much lower than the recommended allowance of 500 milligrams per day. It is apparent that the diet for children should be supplemented with calcium. Among the vitamin group, the daily average intakes of vitamin A and $B_{2}$(thiamine), $B_{2}$(riboflavin), C(ascorbic acid), and niacin were not adequate for the children in both villages. Especially the intake of riboflavin, 0.4 milligrams in both village children, was much lower than the RDA, 0.9 milligrams per day. Physical Characteristics Average height, weight, chest and head circumference of the pre-school children in both villages were similar to those of the Korean standard given by the Korean Paediatrics Association except that the average height of pre-school boys in Siljun Ri was 8 cm higher than the Korean standard of 105 cm. The mean values of upper arm circumference and skinfold thickness of pre-school boys in both villages were the same, 15.4 cm for upper arm circumference and 6.8 mm for skinfold thickness, but the mean values of those of the girls in Siljun Ri were higher than those of pre-school grils in Soowol Ri. Biochemical Findings Avera ge hemogobin value of boys and girls in both villages was the same, 11.1 grams per 100 ml of blood. The incidence of anemia (Hb value below 11g/100ml) was similar in both viltagesr 36.4% for boys and 50% for girls in Siljun Ri and 37.5% for boys and 50% for girls in Soowol Ri. Average hemoglobin values of fertile women were 10.7g% in Siljun Ri and 10.8% in Soowor Ri. The incidences of anemia(Hb valre brlow 12g/100ml) were 100% in Siljun Ri and 86.7% in Soowol Ri. The anemia of these subjects may be caused mainty low intake of good quality protein and iron intake from vegetable food. Recommendation In general, the nutritional status of a community health pilot village is not higher than that of control village due to the lack of nutrition improvement guldance services. Nutrition education should be delivered to the villagers as a main part of the health education artivities. The emphasis should be on building better health through bttter food habits and better food production as well as on preventing malnutrition and diseasrs. It can be an invaluable part of community developnent. Since nutrition is considered to be at least one-half of MCH care, no village or home visits should be made without careful provision for teaching and demoastrating something simple and practical on nutrition. The nurse, midwife, and village health worker should be the chief promoters of nutrition.

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타이치(Tai-Chi) 운동이 유방암 수술환자의 어깨관절 가동범위와 심박동수 변화에 미치는 영향 (The Effect of Tai-Chi Exercise on the Function of Shoulder Joint, Heart Rate in Breast Cancer Patients)

  • 김철우;곽이섭;김이순;김경철;김희은
    • 생명과학회지
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    • 제20권3호
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    • pp.345-349
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    • 2010
  • 본 연구는 타이치 운동이 유방암 수술 후 환자의 어깨관절 가동범위 및 심박동수에 미치는 영향을 규명하는데 그 목적이 있다. 대상자는 유방암 1~2기 진단을 받고 유방암 수술 후 2개월 이내의 B광역시에 거주하는 환자 40명을 대상으로 타이치 운동을 12주간, 주4회, 1회 60분씩 실시하여 실험 전 후 어깨관절 가동범위 및 심박동수를 측정하였다. 본 연구결과 어깨관절 가동범위의 굴곡, 선전, 내전, 외전 모두 유의하게 증가하였고(p<0.05), 심박동수도 유의하게 감소하였다(p<0.05). 이상의 결과로 타이치 운동은 유방암 수술 후 환자들에게 어깨관절 가동범위를 향상시키고 심장기능을 강화시킴으로써 심혈관질환을 예방할 수 있고 유방암 수술 후 환자들의 건강증진을 도모할 수 있는 권장할 만한 운동으로 사료된다.

고학력 기혼여성의 취업여부별 영양소 섭취로 본 식사의 질 평가 (Evaluation of Diet Quality according to Nutrient Intake between Highly Educated, Married, Unemployed and Employed Women)

  • 최지현;정영진
    • Journal of Nutrition and Health
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    • 제39권2호
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    • pp.160-170
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    • 2006
  • This study was conducted to provide foundation data for making health care policy for married women by assessing the dietary intake between highly educated married, employed and unemployed women. It is a direct interview, cross-sectional study with 24-hour recall method for one day. In selecting the subjects for this study, married, unemployed women were selected from a certain area (Daedeok Science Town) in Daejeon where there are high rates of highly educated women, and the married, employed women were selected from the teaching profession in order to avoid confounding due to including a variety of jobs. According to the Korean Standard Classification of Occupations, teaching is the representational occupation of highly educated, married women. Then, to prevent confounding due to age, we selected the subjects out of each age group at the same rate through random sampling. Women who had not graduated college, worked only part-time, or had no current spouse were excluded. As a result, 486 highly-educated, married, unemployed (250) and employed (236) women were used for analyzing data. The unemployed women consumed a higher amount of fat, cholesterol, sodium, vitamin C and folic acid while the employed women consumed a higher amount of iron, vitamin $B_l$ and vitamin $B_2$. P/M/S ratio being 1/1.18/1.05 and 1/1.05/0.87, for the unemployed women and the employed women, respectively, unemployed respondents had a higher saturated fat intake than those of employed. It is in excess of the standard ratio (1/1/1) of the Korean RDA. At the same time, in unemployed respondents the percent of energy intake from fat (24.8%, 23.2%) and animal fat (12.4%, 11.4%) were higher than those of employed respondents. The mean daily nutrient intake of calcium, zinc, and iron for both groups of respondents were lower than the Korean RDA. Both groups had phosphorus as the highest nutrient and calcium as the lowest nutrient of INQ (Index of Nutritional Quality) while nutrients with the INQ being less than 1 were calcium and iron. To sum up, the following conclusions can be made: Nutrition education and guidance for reduction of the intake of fat, especially animal fat, are necessary for unemployed women. In addition, highly educated, married, unemployed and employed women should increase the consumption of foods rich in iron and calcium to prevent anemia and osteoporosis, while decreasing the intake of phosphorus to balance proportions of calcium and phosphorus.