• 간호행정학회지
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• 제3권1호
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• pp.37-50
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• 1997

The purpose of this study was to identify the gap between need-level and demonstration-level in nursing managerial competencies. In addition, the study proposes solutions to narrow this gap. The results of this study are as follows : 1) The mean score for need-level of each item was 4.0, and for demonstration-level, 3.5. This indicates that military hospital head nurses demonstrate a higher level of managerial competencies than the moderate level on all items. But items which were related to resource/ cost/ information managament, staff development management and professionalism management got relatively low ratings in the need-level. 2) The mean score for need-level of each category was 4.14, and for demonstration-level, 3.53. Categories on the individual dimension got a higher rating than categories on the group or organization dimension in both need-level and demonstration level. 3) The gap between need-level and demonstration-level appeared in all items(p<.05) and categories(p<.001). Although the gap was relatively low, it indicates that it is essential to plan a developmemt program for all nursing management competencies for military hospital head nurses. 4) There were significant differences in the gap between need-level and demonstration-level according to specific characteristics of the subjects. The gap did not appear in many categories on the individual dimension where the number of nursing staff was more than 10, a major grade, ICU head nurse or for head nurses having a long career. 5) Need-level and demonstration-level showed a difference according to specific characteristics of the subjects, because need-level and demonstration-level were higher where the number of nursing staff was more than 10, a major grade, and for ICU or Medical ward head nurses. The categories which showed need-level difference and demonstration-level differences according to specific characteristics of the subjects existed almostly completely in the group and organization dimension. Gap-level differences according to the number of hospital bed existed in only two categories. 6) The general causes of the gap were indicated to be 'Knowledge/ skill/ experience deficit', 'Limitation of rules and systems/ Inappropriate organizational environment' for most items, categories, and dimensions. The results of this study indicate that extensive competency developing strategies must be developed, because a gap was found in all items and categories. Specially, there is a need to concentrate attention on competencies in the group and organizational dimension which had a wider gap level. And it is important to take an individual approach according to the cause for each gap. In order to produce effective competency developing strategies, top managers must have sinsights into the importance of nursing staff development and nursing officer's efforts to develop themselves must be achieved. Further multi-dimensional(education, personnel-policy, nursing/ organizational environment) solutions to the gap must be developed and utilized.

• 한국간호교육학회지
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• 제5권1호
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• pp.97-105
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• 1999

Based on literature, status and role of the NP in America was reviewed. The process of developing NP program in America suggests us many things. In America, nurse practitioners have sustained a mutually beneficial status with their patients for over thirty years. Excel fence in academic education and clinical training will enable nurse practitioners to continue to provide quality health care. The magnitude changes in the health care system of the United States, the challange of providing real access of health care continues. Lack of access to adequate primary care was the driving force in the initial 1965 Federal Involvement in developing the NP role. In 1993 President Bill Clinton's health care reform initiative provided policy support for NPs as primary care providers. The Institute of Medicine explicitly recognized NPs as an integral part of the primary care team. In addition, several national reports recognized NPs as affordable, accessible, high-quality care providers. The recent passage of direct Medicare reimbursement for NPs reflected public policy statements coincided with and likely contributed to a growth spurt in the NP workforce. From 1965 to 1977 NP programs offered traditional primary care clinical tracks(adult, family, woman's health, and pediatrics) for relatively small clusters of students in a variety of institutional settings. From 1978 to 1990 these educational programs were incorporated into graduate schools of nursing. By 1990 the majority of NPs received educational preparation in master's-level nursing programs. A new emphases was placed on postmaster's NP programs designed for master's prepared clinical nurse specialists and nurse managers. he the health care system shifted hospital nursing resources toward community-based care, these master's -level nurses sought additional NP preparation. NP educational programs are defined as the educational structure in which one or more NP clinical tracks are offered. NP clinical tracks, in turn, offer curriculum and supervised clinical experiences that match standards in specific practice areas such as family(FNP), adult(AUP), geriatrics(GNP), pediatrics(PNP), women's health (WHNP), neonatal (NNP), and acute care(ACNP). There were indications that NP practice was expanding into new clinical areas as evidenced by new types of tracks, particularly in acute care and psychiatry. The increase in acute care NP students likely reflects the increased demand from hospitals and other acute care settings. In Korea, change of nurse's role into nurse practitioner's role may have many difficulties. The need of health consumer, policy support of government, approval of medical care team are all essential component. Every nursing personnel make effort to planning the new health care delivery system.

• 생물정신의학
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• 제24권2호
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• pp.59-67
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• 2017

Shift workers experience a disruption in the circadian sleep-wake rhythm, which brings upon adverse health effects such as fatigue, insomnia and decreased sleep quality. Moreover, shift work has deleterious effects on both work productivity and safety. In this review, we present a brief overview of the current literature on the consequences of shift work, especially focusing on attention-associated cognitive decline and related behavioral changes. We searched two electronic databases, PubMed and RISS, using key search terms related to cognitive domains, deleterious effects, and shift work. Twenty studies were eligible for the final review. The consequences of shift work can be classified into the following three categories extracted from the literature review : 1) work accidents ; 2) commuting accidents such as car accidents that occur on the way to and from work ; and 3) attendance management at work (i.e., absenteeism, tardiness, and unscheduled early departure). These cognitive and behavioral consequences of shift work were also found to be associated with sleep disorders in shift workers. Thus, improvements in the shift work system are necessary in order to enhance workers' health conditions, work productivity, and safety.

• Asian Pacific Journal of Cancer Prevention
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• 제16권17호
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• pp.7689-7694
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• 2015

Background: Bone tumors are neoplasias with a high overall mortality; one of the main factors that reduce survival is their high capacity to develop metastases. It has been reported that finding lung metastases at diagnosis of osteosarcoma (OS), chondrosarcoma (CS) and giant cell tumor of bone (GCTb) is quite common. In this study, we inquire the relationship of metastases caused by these tumors with different clinical and pathological aspects, in order to guide medical personnel in the diagnosis and opportune treatment of metastases or micro metastases. Materials and Methods: We collected data of 384 patients with clinical, radiological and histopathological diagnosis of OS, GCTb and CS that attended the National Rehabilitation Institute (INR) during 2006 to 2014. Chi-square and Fisher's exact tests were performed for data analysis. Results: In the three tumor types, the presence of metastases at diagnosis was variable (p=0.0001). Frequency of metastases was 36.7%, 31.7% and 13.2% for OS, CS and GCTb respectively. The average age had no significant difference (p>0.05) in relation to metastases, even so, patients with OS and GCTb and metastases, were older while patients with CS and metastases were younger, in comparison to patients without metastases. Males had a higher frequency of metastases (68.2%, p = 0.09) in contrast to CS and GCTb, in which the metastases was more frequent in women with 51.9% (p = 0.44) and 57.9% (p = 0.56) respectively. Broadly, metastasis was associated with primary tumors located in the femur (44.4%), followed by the tibia (15.6%); metastases was more frequent when primary tumor of GCTb and OS were in the same bones, but were located in the hip (26.3%) for CS. Conclusions: The frequency of metastases in OS, GCTb and CS is high in our population and is determined by different clinicopathological variables related to the kind of tumor. Further studies are needed in order to evaluate metastases subsequent to diagnosis and associations with survival and clinicopathological factors, as well as to determine the sensitivity and specificity of current methods of detection.

• 대한치과보철학회지
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• 제56권3호
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• pp.188-198
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• 2018

목적: 최근 디지털 기술의 발달과 더불어 치과영역에서도 다양한 보철물 제작을 위해 Computer aided design/computer aided manufacture (CAD/CAM) 시스템의 사용이 확대되고 있다. CAD/CAM 시스템은 전통적인 방식의 보철물 제작의 단점을 극복하여, 치과의사와 치기공사가 보철물을 제작할 때, 환자에게 한 두 번의 병원 방문으로도 정확하고 정밀도 높은 보철물의 제공이 가능하게 할 수 있다. 본 논문은 현재 국내의 CAD/CAM 시스템 현황 및 인식을 파악함으로써 새로 장비를 도입할 때 고려해야 할 항목에 대한 조언을 제공하고자 한다. 대상 및 방법: 본 설문 조사는 서울대학교 치과 병원을 포함한 전국 298 명의 치과의사, 치과위생사 및 치과기공사를 대상으로 2016년 11월부터 12월까지 2 개월간 우편을 통해 실시하였다. 결과: 치과용 CAD/CAM 밀링기 구매 시 가장 고려하는 요인은 밀링기의 성능(64.43%)이었으며 용도는 치과보철물 제작과 임플란트용 맞춤형 지대주 제작이 49.33%로 가장 높았다. 또한, 응답자의 약 60% 이상이 CAD/CAM 밀링기가 만족할 만한 성능으로 개선된다면 새로운 장비의 구매에 대해 긍정적인 답변을 보였다. 결론: 설문조사 분석결과, 성능이 개선된 CAD/CAM 밀링기 디지털화 및 4차 산업혁명을 대비하는 치과산업에서 중요한 역할을 할 것으로 여겨진다.

• Journal of Radiation Protection and Research
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• 제25권4호
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• pp.191-195
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• 2000

현재 서울대학교병원에서 진행중인 연구의 일환으로 혈관 내 방사선치료 시 시술자의 방사선피폭 정도 및 위험성에 대해 알아보고자 연구를 시행하였다. 심장혈관 폐색으로 연구에 포함되어 방사선치료른 시행 받은 42명의 환자 중 측정이 완벽한 34명의 자료를 토대로 분석을 시행하였다. 혈관내 방사선치료는 관상동맥성형술 직후 풍선도자법을 이용하여 대상 동맥의 중막에 17 Gy를 조사하였다. 사용된 동위원소는 $^{188}Re$이었으며 GM측정기로 각기 다른 8점에서 피폭선량을 측정하였다. 환자의 심장부위에서 10cm, 40cm 떨어진 지점을 시술자의 최대피폭량, 전신피폭량의 기준으로 삼았다. 치료선량의 중앙값은 111.6 mCi이었고 중앙치료시간은 576초였다. 환자 심장부위에서 l0cm, 40cm 지점의 평균 피폭 선량율은 0.43 mSv/hr, 0.30 mSv/hr 이었고, 각 지점에서의 시술 당 평균 피폭 선량은 0.07 mSv, 0.05 mSv 이었다. 이 수치는 ICRP-60나 과학기술부 고시에서 권고하고 있는 한계 피폭선량보다 훨씬 적은 값으로 현재 저울대학교병원에서 시행하고 있는 혈관내 방사선 치료법은 방사선방어 면에서 매우 안전한 방법임을 확인할 수 있었다.

• 대한간호학회지
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• 제29권4호
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• pp.743-754
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• 1999

The purpose of this descriptive study was to identify the homecare needs of patients with cancer and to provide a basis of interventions. One hundred and two patients at one general hospital in Gyeongnam responded to a questionnaire developed on the basis of care needs perceived by nurses caring for hospitalized patients with cancer. The questionnaire was a Likert type 5 point scale with 56 items on five need categories ; 1) informational 2) physical care : 3) emotional care 4) socioeconomic care and 5) special care needs. Internal consistency of this questionnaire was Cronbach's $\alpha$＝.9101 for total items. The data was collected from March 1st to May 31th, 1998, by two graduate nurses. In the data analysis, mean & standard deviation were calculated to identify the degree of care need of each item, and the t-test & ANOVA were done to determine the effects of patients' demographic background on their care needs. The findings are summarized as follows ; 1) The mean score of total of need items was 3.048. Of the four need categories the highest score was informational at 3.4, followed by emotional care, 3.063, physical care, 2.623, and socioeconomic care, 2.599. 2) In the informational need category there were four subcategories with 19 items. Medication and pain control had the highest score, 3.755 ; second was diet and exercise, 3.613 ; third was disease and treatment process, 3.337 ; and last was personal hygiene and infection prevention at 2.687. 3) In the physical care need category there was nine items, IV infusion for nutrition and management of treatment complication was above 3.2 points and the remaining items were in the 2.847-2.070 score ranges. 4) In the emotional care need category there were seven items. The highest need was in support for relationships with health personnel, 3.673. The need for support of religions beliefs and support for having a religion were low at about 2 points. 5) In the socioeconomic care need category there were six items. Support for medical insurance expansion and financial support were above 3 points. Legal support and support for caring of children were low in the care needs. 6) In the special care need category the there were 15 items. Informational need about immunization and informational need about effects of disease on growth and development were high, above 4.1 points. Need for decubitus care and prevention, sitz bath and incontinence care were low, below 2 points. 7) There were significant differences in degree of care need according to admission rate, education level, marital status, religion and caregiver's religion. In conclusion, homecare needs perceived by hospitalized patient's with cancer was moderate, but informational need was higher than direct care need, leading to the conclusion that the provision of sufficient information to patients with cancer at discharge is needed. Nursing interventions should be developed considering the patient's background.

• 인간행동과 음악연구
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• 제2권1호
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• pp.35-46
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• 2005

호스피스 환자들은 질병으로 인한 심리 정서적 문제를 동반하는데 이에 대한 적절한 치료적 개입이 이루어지지 않으면 이러한 문제가 신체화 현상으로 나타나면서 삶의 질을 방해하는 요인으로 작용한다. 본 연구는 음악이 부정적인 자기 은폐(self-concealment)를 감소시키고 언어적 비언어적 표현(self-expression)을 촉진시키는 지를 보고자하는 데에 그 목적을 두었다. 호스피스 기관에 있는 전문가들로부터 추천받은 3명의 말기 환자들을 대상으로 4개월간의 음악치료 세션을 실시하였으며, 음악치료는 각 환자들의 상태에 따라 총 9회에서 11회에 걸쳐 진행되었다. 자기은폐척도(Self-Concealment Scale: SCS)와 자기서술문(Personal Descriptive Essays)을 이용하여 음악치료프로그램 사전, 사후 검사를 실행한 후 양적 및 질적 자료를 산출하여 결과를 분석하였다. 연구 결과 다양한 음악적 개입 중에서 특히 노래를 중심으로 구성된 프로그램이 삶과 관련된 여러 가지 주제와 감정적 내용들에 대한 환자들의 반응을 이끌어 내는 데에 효과적임을 보여주었다. 사후 검사에서 환자들의 자기은폐 수준이 낮아졌으며, 자기서술문에서 보고된 자료에는 사실적인 내용 대신 감정적 내용이 증가하였음을 보여주었다. 본 연구는 여러 가지 심리 정서적 어려움을 가지고 있는 말기 환자들에게 감정표현과 의사소통 매개체로서 음악이 효과적이라는 결과를 보여주었다. 또한, 자기감정과의 만남과 이에 대한 표현은 삶의 질을 향상시킨다는 관점에서 감상과 같은 수동적 참여를 기본으로 환자의 활동 수준에 맞추어 음악프로그램을 구성한다면 환자들의 삶의 질을 향상시킬 수 있다는 점을 시사한다.

• 한국콘텐츠학회논문지
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• 제19권11호
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• pp.603-618
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• 2019

본 연구는 재가장기요양기관 방문간호사의 간호 경험의 의미와 본질을 탐구하기 위해 van Manen의 해석학적 현상학 연구방법론을 적용하였다. 연구 참여자는 방문간호 경력 1년 이상인 10명의 방문간호사들로 목적적 표집과 편의 표집, 눈덩이식 표집 방법을 통해 선정하였다. 자료 수집은 2017년 1월 7일부터 2018년 10월 12일까지 진행되었으며, 연구 참여자와의 면담은 총 23회에 걸쳐 이루어졌다. 자료 분석은 van Manen이 제시한 해석학적 현상학 방법론에 근거를 두고 전체론적(holistic) 방법과, 선택적(selective) 방법, 그리고 세분법(detailed)을 사용하였다. 연구 결과, 재가장기요양기관 방문간호사의 간호 경험은 6개 본질적 주제와 20개 하위주제로 도출되었다. 본질적 주제는 '대상자 및 보호자와 친밀한 관계를 형성함', '주도적 간호수행으로 방문간호의 기반을 다져감', '지원체계 미비로 원하는 만큼의 간호를 제공하기 어려운 현실에 직면함', '간호의 진정성이 전달되지 않을 때 속상함', '내 환자라는 책임감을 가지고 돌봄의 소명을 다함', '방문간호사로서 보람과 의미를 느끼며 오래도록 일하고자 함'이다. 본 연구는 재가장기요양기관 방문간호사들의 간호 경험을 탐색함으로써 지역사회 내에서 노인장기요양보험 방문간호사의 역할과 중요성을 이해하였다는데 의미가 있다.

• Journal of Trauma and Injury
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• 제26권3호
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• pp.111-124
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• 2013

Purpose: We should prepare proper medical service for disaster control as South Korea is not free from terrorism and war, as we experienced through the two naval battles of the Yeonpyeong, one in 1999 and the other in 2002, the sinking of Cheonan in 2010, and the attack against the border island of Yeonpyeong in 2010. Moreover, North Korea's increasingly bellicose rhetoric and mounting military threats against the world demand instant action to address the issue. The aim of this article is to describe our experience with three patients with combat-related gunshot and explosive injuries to their extremities and to establish useful methods for the management of patients with combat-related injuries. Methods: Three personnel who had been injured by gunshot or explosion during either the second naval battle of the Yeonpyeong in 2002 or the attack against the border island of Yeonpyeong in 2010 were included in our retrospective analysis. There were one case of gunshot injury and two cases of explosive injuries to the extremities, and the injured regions were the left hand, the right foot, and the right humerus. In one case, the patient had accompanying abdominal injuries, and his vital signs were unstable. He recovered after early initial management and appropriate emergency surgery. Results: All patients underwent emergent surgical debridement and temporary fixation surgery in the same military hospital immediately after their evacuations from the combat area. After that, continuous administration of antibiotics and wound care were performed, and definite reconstructions were carried out in a delayed manner. In the two cases in which flap operations for soft tissue coverage were required, one operation was performed 5 weeks after the injury, and the other operation was performed 7 weeks after the injury. Definite procedures for osteosynthesis were performed at 3 months in all cases. Complete union and adequate functional recovery were achieved in all cases. Conclusion: The patient should be stabilized and any life-threatening injuries must first be evaluated and treated with damage control surgery. Staged treatment and strict adherence to traditional principles for open fractures are recommended for combat-related gunshot and explosive injuries to the extremities.