• 한국직업건강간호학회지
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• 제17권1호
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• pp.64-75
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• 2008

Purpose: The purpose of this study was to analyze of PCAs' activity classification system and time of PCAs who worked in Wamco. Method: The data were collected from 2 WAMCO and 308 subjects between February and August, 2007, by questionnaire and 24 time survey. The data were processed with SPSS Win 12.0. Result: In activity analysis, PCAs' activities were classified into 20 domains and 76 activities, which were hygiene, bathing, feeding & nutrition, elimination, respiration, skin care, exercise & transfer, problematic behavior control, communication, observation & measurement comfort, medication, assisting test & treatment, reporting, environment management, patient belongings care, education attendance, indirect caregiving weekly/monthly PCAs' activity. And the PCAs' time analysis showed the average of 24hrs PCAs' time were 798.8 minutes, in which 46.8% were used in day-duty, 33.6% in evening-duty, and 19.6% in night-duty. There were no statistically significant difference in total PCAs time according to the type of industrial accidents and PCAs' type and qualification. But there were statistically significant difference in total PCAs time according to the type of PCAs (day-duty/all-night vigil. Conclusion: The results of this study can be utilized usefully and reasonally in deciding of PCAs staffing and PCAs' type and grade in WAMCO.

• 한국콘텐츠학회논문지
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• 제21권3호
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• pp.761-770
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• 2021

본 연구는 초등아동을 위해 학교 정규교육시간 이외의 시간에 마을에서 제공하는 돌봄서비스가 아동이 행복한 일상생활을 보장하는 돌봄, 즉 아동권리가 실현되는 정책으로 실현되고 있는지 현황과 개선점을 살펴보고자 한다. 방과후 돌봄은 생존권과 보호권은 물론 창의적인 교육활동과 주체적인 시민성장을 지원하는 통합적 방법으로서 중요하며, 코로나 상황을 맞아 공공의 역할이 더욱 강조되고 있다. 따라서 온종일돌봄 정책 중학교밖 돌봄의 주축이 되는 다함께돌봄 정책을 아동권리 관점에서 분석하였다. 분석결과, 보호자의 역할을 대신하는 보호권에 초점이 맞추어져 아동의 4대 권리를 충분히 보장하는 포괄적 정책으로서 한계점이 있었다. 안전한 돌봄공간 마련도 중요하지만 마을의 다양한 자원을 돌봄 콘텐츠로 적극 활용하여 놀면서 배우는 아동의 선택권 확대를 위한 정책설계가 부족하다. 이를 위한 공공의 역할은 서비스의 양적확대와 더불어 내용적 공공성인 책임성, 공정성, 민주성, 공익성을 담보하기 위한 보완이 요청된다. 다함께 돌봄 정책은 아직 실행초기인 정책으로, 아동권리 관점을 반영하여 유연한 공적돌봄 체계로 발전할 수 있는 정책 개선방향을 제언하였다.

• 의료법학
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• 제20권1호
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• pp.163-201
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• 2019

의사에게는 환자와의 법률관계에서 비롯되는 여러 의무들이 존재한다. 그 중 하나가 의사 자신이 속해 있는 의료기관이 치료 및 진료를 위한 인프라나 의료기술이 부족한 것으로 판단하는 경우 환자를 적절한 진단 검사 및 진료가 가능한 의료기관으로 '전원(轉院)'하여야 하는 주의의무인 전원의무(轉院醫務)이다. 의료기관마다 환자의 응급성 정도에 따라 대응할 수 있는 능력이 다르므로 의사의 지시나 권고에 의하여든 환자 본인의 요청에 의하여든 이와 같은 환자의 전원은 불가피한 현상이다. 예를 들어 심각한 뇌손상을 입은 환자가 내원한 경우, 진단, 검사 장비 및 인력을 갖추지 못한 병원의 의사로서는 적절한 시기(이른바 '골든타임')에 진단, 검사 및 진료가 가능한 상급의료기관으로 전원을 고려하여야 한다. 이처럼 전원의무는 의사의 의무 중 하나인 것으로 의사뿐만 아니라 환자들에게도 널리 인식되고 있다. 그러므로 적절한 전원 시점을 놓치게 되어 의료사고가 발생한 상황에서는 전원의무위반 여부와 관련한 의사와 환자 간의 법적 분쟁이 있을 수밖에 없다. 본 연구에서는 이러한 상황과 관련하여 전원의무에 대한 구체적이고도 명확한 판단 기준 정립과 함께 현재 각 의료기관들에 마련되어 있는 가이드라인이 실제 적용에서의 여러 시행착오들을 반영하고 있는지에 대한 검토가 필요하다고 보고, 의사의 전원의무에 대한 판례의 동향 분석을 중심으로 전원의무 관련 판례에서 이미 제시되어 있는 판단 기준 요소들이 적절한지 그리고 현재 실무에서 적용되는 법령 및 가이드라인 등과 부합되는지 여부를 살펴봄으로써 앞으로 응급환자에 대한 의사의 전원의무 관련 분쟁조정 및 소송에서의 해석과 적용에 기여할 수 있도록 하였다.

• 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.

• 수산해양교육연구
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• 제19권2호
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• pp.168-179
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• 2007

There are many students in school. So school safety accidents are happened by accident. But, if teachers know and understand about school safety accidents exactly, the school safety accidents can be reduced. The conclusion of this study is as follow. First, generally teacher has a duty and responsibility to protect and care students in educational activities. And teacher has a responsibility to protect and care students only in the cases of predictability. Second, teacher must do his/her best about a duty of attention. If teacher do his/her best about a duty of attention, he(she) has not the responsibility about the accident. Third, teacher needs to have more concern student who has a controversial figure. And teacher needs to have an evidence that he/she did his/her best for the student ordinary times. Fourth, the criteria of teacher's legal or illegal punishment to students is (1) the motivation and details for punishment, (2) the methods and degree for punishment, (3) a part of body for punishment, (4) the degree of damage for punishment. Fifth, teacher need to learn the program about school safety accidents systematically.

• 의료법학
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• 제7권2호
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• pp.9-74
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• 2006

Due to the awareness of their rights for medical liability and the advancement of legal principles, it becomes also not hard to find those who seek damages against hospitals, doctors and nurses for the suicide committed under the protection of psychiatric institute in Korea these days. Judgements on these kinds of cases are not enough yet, so that it may be too early to try to find principles used in these cases, however it is hardly wrong to read following things from above cases. That is, to gain the case, plaintiffs should show (1) there exists an obligation of "due care"(there is a special relation between patients and hospitals), (2) the duty is violated on the basis of the applicable standard of care, (3) whatever injures or damages are sustained are proximately caused by the breach of duty and (4) the plaintiff suffers compensable damages. To specific, whether a psychiatric institute was liable for wrong death or not depends upon the patients conditions, circumstances and the extent of the danger the patients poses to himself or herself; in short, the foreseeability of self-inflicted harm(the doctor should have or could reasonably have foreseen the patient's suicide and the doctor's negligence actually caused the suicide). In this context if a patient exhibit strong suicidal tendencies, constant observation should be required. Negligence has been found not exist, however, when a patient abruptly and unexpectedly dashes from an attendant and jumps out a window or otherwise attempts to injure himself or herself. And the standard of conduct that is required to meet the obligation of "due care" is based on what the "reasonable practitioner" would do in like circumstances. The standard is not one of excellence or superior practice; it only re quires that the physician exercise that degree of skill and care that would be expected of the average qualified practitioner practicing under like circumstances. Most of these principles have been established at cases of the U.S.A and Japan. In this article you can also find the legal organizations of medical liability and medical contacts on the suicide of patients who have psychiatric diseases under Korean negligence law.

• 재활간호학회지
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• 제4권1호
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• pp.94-104
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• 2001

The purpose of this study was to analysis of nursing interventions performed by the ICU nurses to the patients with cerebrovascular disorder practically from one university hospital in Seoul. The data were collected from 15 nurses with 86 cerebrovascular disorder cases from one ICU with the questionaire to write frequency of nursing care done by the surveyee from May, 2, 2000 to July, 3, 2000 and the list of 66 nursing interventions selected out of 433 NIC(Nursing Interventions Classification) of Iowa University which were translated into Korean (44 items) and core nursing interventions by ICU nurses (22 items; KIm, Su-Jin, 1997). The data were analysed with SPSS program. The results are as follow : 1. The most frequently used nursing interventions were vital sign monitoring, fall prevention, cerebral edema management, dysreflexia management, neurologic monitoring, cardiac care, communication enhancement, technology management, bed rest care, respiratory monitoring in rank. 2. The most frequently used nursing intervention domains were 'Physiological : Complex', 'Physiological : basic', 'Behavior', 'Safty', 'Health system' in rank. In the domain of physiological : basic, the most frequently used nursing interventions were bed rest care, urinary elimination management, tube care : urinary, physical restraints in rank. In the domain of physiological : complex, the most frequently used nursing interventions were cerebral edema management, dysreflexia management, neurologic monitoring, cardiac care in rank. In the domain of behavior, the most frequently used nursing interventions were communication enhancement, touch, active listening in rank. In the domain of safty, the most frequently used nursing interventions were vital sign monitoring, fall prevention in rank. In the domain of health system, the most frequently used nursing interventions were technology management, specimen management in rank. 3. some difference of the frequency practicing the nursing interventions according to the shift of duties was found. For example, medication administration was common at day duty, touch was practiced at evening duty, temperature regulation was performed.

• 의료법학
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• 제18권1호
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• pp.61-99
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• 2017

마취는 수술 등 의료행위 시 많은 경우 필요불가결하게 동반될 수밖에 없고 마취 자체가 가진 특성 때문에 그로 인한 의료사고가 빈번하게 발생하고 있다. 마취와 관련된 의료사고가 의사의 과실로 인한 것인지를 판단하기 위해서는 마취의 전 단계를 통하여 의사 등 의료진에게 어떠한 주의의무가 요구되는지를 알아야 한다. 이 글에서는 이러한 주의의무의 기준 등을 알아보기 위하여 마취 관련된 의료사고로 판결이 선고된 1990년대부터 현재까지의 대법원 판결들과 최근의 하급심 판결사례들, 프로포폴이 사용된 사례들을 분석해보았다. 분석 결과 과거 흡입마취로 문제가 된 사례가 많았던 반면 최근에는 주로 정맥마취제나 국소마취제의 사용으로 문제가 된 사례가 많은 것을 알 수 있었고, 특히 마취제 중 프로포폴이 관련된 사고가 2007년경 이후부터 상당히 많이 발생하여 법적 분쟁이 이루어졌음을 알 수 있었다. 그런데 대법원 판례들은 대부분 과거 흡입마취로 마취한 사례여서, 흡입마취의 경우 마취 시 의료진의 주의의무의 정도와 내용에 관해 어느 정도 기준이 제시되고 있었으나, 그 외의 경우에는 그러한 기준이 제시되었다고 보기에는 미흡해 보였다. 프로포폴의 사용과 관련한 마취사고가 끊이지 않고 있는 현실 등에 비추어 볼 때 우선 의료현장에서 각각의 마취제의 사용에 관한 임상지침 등을 세우고 이를 지켜나가는 것이 중요하겠지만, 의료현실이나 의료 관행에 하나의 나침반 역할을 할 수 있도록 법원에서도 우리의 현실에 맞는 적절한 주의의무의 기준을 제시하는 것이 필요하다고 하겠다.

• 의료법학
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• 제11권1호
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• pp.331-393
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• 2010

Psychiatrists who treat violent or potentially violent patients may be sue for failure to control aggressive outpatients and for the discharge of violent inpatients. Psychiatrists may be sued for failing to protect society from the violent acts of their patients if it was reasonable for the psychiatrists to have known or should have known about the patient's violent tendencies and if the psychiatrists could have done something that could have safeguarded in public. The courts of a number of jurisdictions have imposed a duty to protect the potential victims of a third party on persons or institutions with a special relationship to that party. In the landmark case of Tarasoff v Regents of University of California, the California Supreme Court held that the special relationship between a psychotherapist and a patient imposes on the therapist a duty to act reasonably to protect the foreseeable victims of the patient. Under Tarasoff, when a therapist has determined, or under applicable professional standards should determine, that a patient poses a serious threat of violence to another, he incurs an obligation to use reasonable care to protect the intended victim against such danger. In addition to a Tarasoff type of action based on a duty to warn or protect foreseeable victims of psychiatric outpatients, courts have also imposed liability on mental health care providers based on their custody of patients known to have violent propensities. The legal duty in such a case has been stated to be that where the course of treatment of a mental patient involves an exercise of "control" over him by a physician who knows or should know that the patient is likely to cause bodily harm to others, an independent duty arises from that relationship and falls on the physician to exercise that control with such reasonable care as to prevent harm to others at the hands of the patient. After going through a period of transition, from McIntosh, Thompson and Brady case, finally, the narrow rule of requiring a specific or foreseeable threat of violence against a specific or identifiable victim is the standard threshold or trigger element in the majority of states. Judgements on these kinds of cases are not enough yet in Korea, so that it may be too early to try find principles in these cases, however it is hardly wrong to read the same reasons of Tarasoff in the judgements of Korea district courts. To specific, whether a psychiatric institute was liable for violent behavior toward others depends upon the patients conditions, circumstances and the extent of the danger the patients poses to others; in short, the foreseeability of a specific or identifiable victim. In this context if a patient exhibit strong violent behavior toward others, constant observation should be required. Negligence has been found not exist, however, when a patient abruptly and unexpectedly attack others or unidentifiable victim. And the standard of conduct that is required to meet the obligation of "due care" is based on what the "reasonable practitioner" would do in like circumstances. The standard is not one of excellence or superior practice; it only requires that the physician exercise that degree of skill and care that would be expected of the average qualified practitioner practicing under like circumstances. All these principles have been established in cases of the U.S.A and Japan. In this article you can find the reasons which you can use for psychotherapist's liability for failure to protect third person in Korea as practitioner.

• 의료법학
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• 제8권1호
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• pp.215-234
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• 2007

The mission of the doctors is to take care of human life, body and health through the medical behaviors such as diagnosis and treatment. Under this job propensity, the doctors have care duty to take the best actions required to prevent the risk according to the patients' specific disease status. Such care duty of the doctor may be evaluated based on the medical behavior level at the medical institution and clinical medical study field. Such medical level should be understood in the normative level, considering the treatment environment, condition and specialty of the behavior, because it means the medical common sense known and acknowledged to the normal doctors. While the criminal suit requires the evidence for no doubt conviction, the civil suit requires more eased different standard. The results between the criminal and civil sentence may be different, because the confirmed former case may lead to long-term imprisonment and even death penalty, while the latter case puts only monetary penalty on the defeated party.