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Critical Pathway Development for the Hysterectomy Patients and its applied Effect (자궁적출술 환자를 위한 critical pathway 개발과 적용효과)

  • Noh, Gi-Ok;Park, Kyung-Sook
    • Women's Health Nursing
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    • v.6 no.2
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    • pp.234-257
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    • 2000
  • At present in the medical care, the study and effort for producing health service to consider efficiency, effectiveness, and quality are urgently called for because of the difficulty in the keen competition according to the inter- nationalization and opening, the operation in the medical institution service testing system, the change in the medical policy of KDRGs, and the lack of the health care cost increasing rate. As an alternative, the case management for the new management system is introduced in the U.S., and the Critical Pathway that is the method designing the contents of activity and its result has been developed and applied in order to anticipate and manage the patient-outcome for the realization of the cost-effective case-management. Thus, this study intended to analyze the effectiveness to obtain by developing the Critical Pathway presented as the method to improve the quality-betterment and cost effectiveness through the continuous and consistent patient management for the hysterectomy patient and applying it to the real practice. As a study method, this author formed a conceptual framework through considering five Critical Pathway used in the current U.S. and three Critical Pathway presented in the literature to develop the Critical Pathway for the hysterectomy patient, and made out the preliminary Critical Pathway through reviewing the old chart. This author made the verified the validity of the expert group about the developed Critical Pathway, and to confirm the possibility of practice application, completed and settled the final Critical Pathway after using the Critical Pathway to the hysterectomy patient from March 1st to 15th, 1997. Finally, to analyze the application-effect of the developed Critical Pathway, this author offered health care service applying the Critical Pathway to the hysterectomy patient from April 15th to August 31th, 1997. The guide for the Critical Pathway was carried out in advance by outpatient setting nurse for outpatient setting visit before the operation, and after hospitalization the primary nurse monitored the execution degree on the every duty. After discharge this author surveyed the complication through phone visiting, and one month after discharge surveyed the patient's reaction about the offered service when outpatient setting visit and analyzed the result. The source for health care cost was obtained by the statistics about the hospital charge which was offered by the General Business Department. The results were as follows. 1. It was decided that the vertical line of the Critical Pathway was made up of eight items such as monitoring/assessment, treatment, line/drains, activity, medication, lab test, diet, patient teaching, and the horizontal line of the Critical Pathway was made up of from hospitalization to discharge. 2. After the analysis of service contents through reviewing the old chart, it was decided that the horizontal line of the preliminary Critical Pathway was made up of from hopitalization to fourth postoperative day, and the vertical line of it was divided into eight items which were the contents to occur with the time frame of the horizontal line. 3. After the verifying the validity of the expert group about the preliminary Critical Pathway, the horizontal line was amended from hopitalization to third postoperative day, and taking their consensus, some contents of the horizontal line was amended and deleted. 4. From March 1st to 15th, 1997, to confirm the clinical suitability, this author offered eight hysterectomy patients the medical service through the Critical Pathway. The result was that three of them could be discharged at the expected discharge day, and the others later than that day. Supplementing the preliminary Critical Pathway through analyzing the cause of that delay- case, this author developed the final Critical Pathway. 5. There were no significant differences between the experimental and the control group in the incidence of complication(P > 0.05). 6. The 92.4% of experimental group was satisfied with the Critical Pathway service. 7. The length of hospital stay of the experimental group offered with the Critical Pathway service was 4.6 days and there was a significant difference that it was 1.3 days shorter than that of the control group(t=-29.514, P=0.000). 8. There wsa a significant difference that the mean medical charge per one patient of the experimental group offered the Critical Pathway service was cheaper \124,150 than that of the control group(t=-9.826, P=0.000). 9. The result that the author assumed and analyzed hospital income with the rate of turning bed was assumed that the increase of hospital income was \63,245,072 for that study, and the income increase was expected with \68,704,864 for a year. The result that this author applied the Critical Pathway to the hysterectomy patient have no differences in the incidence of complication, high satisfaction with that service, and the length of hospital stay decreased in the experimental group, and the mean hospital charge per one patient decreased, but hospital income increased. Suggestions for further study and nursing practice are as follows. 1. The study to apply the Critical Pathway for a year, verify the validity, and measure the effect repeatedly is needed. 2. To apply and manage the Critical Pathway effectively, the study to computerize it is needed. 3. The study to develop hospital-based Critical Pathway about other diseases or procedure, and measure the effect is needed.

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THE RELIABILITY AND VALIDITY OF KOREAN CONNERS PARENT AND TEACHER RATING SCALE (한국어판 Conners 부모 및 교사용 평가 척도의 신뢰도와 타당도에 대한 예비적 연구)

  • Park, Eun-Hee;So, Yu-Kyoung;Choi, Nak-Kyung;Kim, Se-Joo;Noh, Joo-Sun;Ko, Yun-Joo;Kim, Young-Shin
    • Journal of the Korean Academy of Child and Adolescent Psychiatry
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    • v.14 no.2
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    • pp.183-196
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    • 2003
  • Objectives:The Purpose of this study is to investigate the reliability and validity of Korean Parent and Teacher Conners' Rating Scale. Methods:Randomly selected 1st to 6th graders of the two elementary schools(N=1044) in Anyang City participated in the study. Children diagnosed with ADHD(N=23) at the child and adolescent clinic at a university affiliated hospital were included in the study for the analysis of clinical validity of the scales. Parent and teacher completed Korean Conners' Rating Scale and Korean-ADHD Rating Scale(KARS). In addition, parents completed Korean-Children Behavior CheckList(K-CBCL). Descriptive statistics, t-test, and analysis of variance were performed. Results:Scores of Korean Conners' Parents Rating Scale were significantly correlated with those of Korean Conners Teacher Rating Scale. High internal consistency reliability were demonstrated in both parent and teacher rating scales. There were significant correlations among sub-scales of Conners' Rating Scales, K-CBCL and K-ARS. Factor analyses revealed that the K-CTRS had three-factor structure (Inattention-Passivity, Hyperactivity, Conduct Problem) and the K-CPRS had five-factor structure(Impulsive-Hyperactive, Conduct Problem I, Anxiety, Psychosomatic, Conduct Problem II). Conners' Rating Scales effectively distinguish children with ADHD from children without ADHD. Conclusion:Korean Parent and Teacher Conners' Rating Scales are valid and reliable instruments that are useful for screening and identifying childhood problem behaviors. Future studies are required with a larger number of sample sizes including adolescents from various geographic regions.

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A Study on Periodontal Disease and Tooth Loss in Metabolic Syndrome Patient (대사증후군 환자의 치주질환과 치아상실에 관한 연구)

  • Kang, Hyun-Joo
    • Journal of dental hygiene science
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    • v.15 no.4
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    • pp.445-456
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    • 2015
  • The aim of this study was to identify an effective control method of metabolic syndrome (MS) and oral diseases by investigating relationship between of MS and periodontal disease, tooth loss of the adult men and woman. We analyzed and concluded as follows, using a nationwide representative sample, in 8,225 middle senior citizens based on raw data of the 5th National Nutrition Survey in 2010, 2012. The data were analyzed by descriptive statistics, chi-squared test, and logistic regression using SAS ver. 9.2 program. The results are as follows, for correlation of metabolic component to periodontal disease, it was found that in men, the periodontal disease odds ratio of the group with abnormal fasting blood glucose increased 1.27 fold (95% confidence interval [CI], 1.04~1.54), and in woman, the odds ratios of the group with abnormal high density lipoprotein cholesterol increased 1.45 fold (95% CI, 1.22~1.72) and the odds ratio of the group with abnormal obesity increased 1.44 fold (95% CI, 1.17~1.77). For correlation of MS to periodontal disease, it was found that the odds ratio of periodontal disease in the woman at-risk group increased 1.55 fold (95% CI, 1.19~2.01) and that of the group with MS increased 2.25 fold (95% CI, 1.68~3.02). For correlation of woman's metabolic component to missing teeth, it was found that the odds ratio of group with abnormal blood pressure increased 1.41 fold (95% CI, 1.10~1.82). For correlation of woman's MS to missing teeth, it was found that the odds ratio of missing teeth in the group with MS increased 1.48 fold (95% CI, 1.07~2.04). It is considered that a public health project comprising preventive and systematic disease management is necessary for controlling MS and oral disease. The findings of the study are expected to lay the foundation for the development of oral health promotion programs.

The Knowledge and Needs of Hospice for Inpatients' Family (입원환자 가족의 호스피스 인지 및 요구도)

  • Ko, Sung-Hee;Kim, Hyun-Kyung
    • Journal of Hospice and Palliative Care
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    • v.8 no.2
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    • pp.131-142
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    • 2005
  • Purpose: The purpose of this study was to survey the knowledge and needs of hospice for inpatients' family. Methods: This study was carried out with 277 inpatients' families at J General Hospital located in J city, Korea during the period from March to May, 2004. The data were collected through a self-reporting questionnaire constructed by the authors. The data were analyzed by descriptive statistics and $x^2-test$ with SPSSWIN 10.0. Results: 83.8% of the respondents heard about hospice mostly through mass communication. 76.9% of the respondents recognized hospice to be helpful and to provide comfort during the remainder of life and to confront the moment of death. Most of the respondents responded positively to the necessity of hospice service, and would receive hospice if necessary. 76.5% of them would consider arranging preparation for death if he/she were to be diagnosed with a terminal illness. 63.9% of the respondents wanted only to be with their family members, 31.4% wanted both the family and hospice members at the moment of death. They named the best helper among the hospice members to be the nurse. 81.6% of the respondents wanted a hospice institution to be established, 23.8% of them report that the most adequate hospice management institution would be the hospice ward in hospital. Conclusion: Consequently, most respondents wanted hospice services. So Korean society is in need of developing adequate teaching and care programs for hospice according to local needs.

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The Analysis of Activities and Satisfaction of Volunteers for Hospice Care (호스피스 자원봉사자의 활동 및 만족도 분석)

  • Kim, Boon-Han;Jung, Yun;Park, Kyung-Bok
    • Journal of Hospice and Palliative Care
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    • v.5 no.2
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    • pp.163-171
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    • 2002
  • Purpose : The purpose of this study was to analyze activities and satisfaction of volunteers for hospice care. Methods : We used 271 reports of hospice care and 20 questionnaire of activities and satisfaction of volunteers for hospice care from volunteers of in a community. Window SPSS-PC was used for the data analysis and the statistical method used were the descriptive statistics, t-test, ANOVA and Pearson's correlation coefficient. Results : 1) The highest score of activity was emotional area and the next activities was physical area. 2) The degree of emotional area (t=4.94, P<.05) and spiritual area (t=3.80, P<.05) was influence by religion of volunteers. 3) The mean score of satisfaction was 3.61. 4) There was correlation between duration of activity and death experience (r=.558, P<.05), emotional care (r=.698, P<.01), spiritual care (r=.474, P<.05), satisfaction (r=.651, P<.01), and the between physical care and family care (r=.559, P<.05), and the between spiritual cue and family care (r=.512, P<.05), and between emotional care and satisfaction (r=.536, P<.05). Conclution : The above result indicated that we must develope the management and education of volunteer of hospice care for various hospice care. Also, We should to encouraged the continuous education and efficient management.

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A Study of Job Satisfaction and Related Factors of the National Hospital Nurses (국립병원 간호사의 직무만족과 관련요인 연구)

  • Suh Gil-Hee;Kim Ok-Hee
    • Journal of Korean Public Health Nursing
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    • v.7 no.2
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    • pp.53-66
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    • 1993
  • By this time, a few of previous studies of factors related to separation from their jobs and job satisfaction only have dealt with the separation rate. the cause of separation and related factors that induce job satisfaction and incentive factors, the actualities of morale some suggestions for reduction of the separation rate. This study is attempted to determine factors that have effect on job satisfaction of national hospital nurses. and to proide information and materials for the development of the administration of nursing through the appreciation of factors influencing on job satisfaction between isolated ward nurses and general ward nurses working at national hospitals. 185 nurses of national hospitals responsed th this study, and were divided into two groups. Group 1: 57 nurses working at isolated wards for tuberculosis patients and Group 2 : 128 nurses at general wards. Relevant data were collected from August, 5, 1992 through August 20, 1992. The questionnaire consisted of 8 genalized items and 4 items concerning job satisfaction. The collected data were processed with SPSS, and the relationship among vaviables was analyzed by means of $X^2-test$, Pearson Correlation, Multiple Regression. The results of this study are as follows: 1. There is no significant difference between two groups in terms of generalized items. Age distributions show $44.3\%$ under the category of less than 34. and $55.7\%$ under the category more than 35, $19.3%$ was single and $74.6\%$ was married respectively. 2. $79.4\%$ of the nurses have the desire to have in-service education under the satisfactory physical environments such as welfare system, accommodating structures and facilities, instruments or management systems of the hospital, but under the category of unsatisfactory circumstances, $60.3\%$ have the intention of having in- service education. The concern in terms of in-service education shows statistically significant difference between two groups $(X^2=8.85,\;p<0. 05)$. This result accepts the hypothesis that good physical environments could intensify interests in service education. 3. The extent of satisfaction related to psychological environments is heightend according to good physical environments. In result, the hypothesis that the extent of satisfaction in terms of physical environments could raise satisfaction about psychological environment is accepted. 4. In the light of the extent of satisfaction about physical environments, $33.3\%$ of isolated ward nurses are satisfied with physical environments, but only $11.7\%$ of general ward nurses are satisfied. $(X^2=10.88,\; p<0.01)$. This result shows that the satisfaction degree about phusicalenvironments of isolated war nurses was higher than that of general ward nurses in spite of high physical and psychological risks due to exposure to infection. Consequently. the hypothesis was rejected that the satisfaction degree about physical environments would be lower in isolated ward nurses than in general ward nurses. 5. The fact that $87.7%$ of isolated ward nurses took interest in service education and $53.19\%$ of general ward nurses took interest in service education demonstrats that isolated ward nurse have more interest in service education than gerneral ward nurses. The result shows that the hypothesis is accepted that isolated ward nurses would have mor interests in service education than general ward nurses. 6. In the extent of satisfaction about physical environments such as morale human relationship promotion, there is no significant difference between two groups in terms of statistics. The hypothesis is rejected that satisfaction about psychologic environments would be high in isolated ward nurses than in general ward nurses. In conclusion. factors influencing on job satisfaction are considered to have effect on. another, and also interdisciplinary amelioration of factors accompanied with systematic inter cooperative investigation is necessary.

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Smoking Investigation of the Sixth Year Grade-Students of Elementary School in the Rural and Small Sized Urban Area (농어촌과 중소도시 초등 학교 6년생의 흡연 실태)

  • Kim, Sang-Young;Jung, Moon-Sook
    • Journal of agricultural medicine and community health
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    • v.20 no.1
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    • pp.61-72
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    • 1995
  • To investigate the rate of smoking of 6th year grade students of elementary School by general characteristics in rural and small sized urban area, the survey was conducted during the period of Feb. 1, 1994 to Fed. 28, 1994 to 778 respondents of sixth year students of elementary school in rural area and 649 students in the small sized urban area, and also it was based on the questionnaire method. The sample consisted of 22 questions for general features of the respondents and 19 questions of smoking-ideas, totally 41 questions, which were related to the general features and the smoking oriented-factors, the real smoking fact of students, their ideas on smoking influences, and these questionnaires were statistically analysed by percentage and ${\chi}^2$-test. The results are as follows : The total respondents were 1427 students. 54.5% of respondents was of the farming, fishing area-students and 45.5% was of small, medium-sized city. Talking about the statistics of smoking, the present smoking boy-students in the farming, fishing area was marked to 14.6% ; the present smoking-boy students was marked 5.7% in the small, medium sized-city. From the viewpoint of smoking experience, 13.8% of students in farming, fishing area was shown to be experienced ; 9.7% of students in the small, medium sized-city was shown to be experienced. This indicated that there were significant difference of p<0.01 between two compared areas. From the viewpoint of family scale, in the family with many brothers, the younger brothers have a higher rate of p<0.001 of smoking-oriented than elder brother, and the students with a single parent or without parents have a higher rate of smoking on. In addition, the motivation of their smoking indicated that they had the most curiosity in smoking. From the viewpoint of academic grade, the low-level group has a higher smoking rate. Talking about the smoking knowledge of students, the present smoking students has less ideas about the smoking influences the than non-smoking students. More than 70% of the smoking-student group agreed that the education on the smoking influences was required to the elementary school students.

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Estimation of Amount and Frequency of Consumption of 50 Domestic Livestock and Processed Livestock Products (국내 50가지 축산물 및 축산가공 식품의 섭취량 및 섭취빈도 조사)

  • Park, Jin Hwa;Cho, Joon Il;Joo, In Sun;Heo, Jin Jae;Yoon, Ki Sun
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.45 no.8
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    • pp.1177-1191
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    • 2016
  • Estimation of food consumption details, such as portion size and frequency of consumption, is needed for exposure assessment step in microbiological risk assessment. This study investigated the amounts and frequencies of 50 kinds of consumed livestock products. A quantitative survey was performed by trained interviewers in face-to-face interviews with 1,500 adults aged over 19, who were randomly selected from seven major provinces in Korea. Respondents received a picture of one serving size for each of the 50 livestock products, including meats, processed meat products, milk and dairy products, and eggs and processed egg products. A t-test and general linear model were carried out using SPSS statistics. The most important factor affecting consumption of livestock products was residence area. The most frequently consumed food was milk (2.6 times/week), followed by pork (1.4 times/week), liquid yogurt (1.3 times/week), rolled omelet (1.2 times/week), semisolid yogurt (1.0 times/week), steamed egg (1.0 times/week), ice cream (0.9 times/week), chicken (0.8 times/week), low fat milk (0.7 times/week), and beef (0.6 times/week). In the case of consumption amount, people living in a city consumed meat (beef, pork, chicken, and duck) 1.5 times more than those living in a village, whereas milk and dairy products and eggs and processed egg products were consumed more frequently by people living in a town. When people eat meat, they consume twice the amount of one serving size. Students consumed livestock and processed livestock products more frequently with greater portions all at once. People living in Seoul, Incheon/Gyeonggi, and Busan/Ulsan/Gyeongnam consumed livestock products more frequently in large amounts. Data from this study can be used for risk assessment of livestock and processed livestock products as well as education for safe consumption of livestock products.

Relationship between Dyadic Adjustment and Personality Dimensions in Married Women (기혼 여성의 부부 적응도와 성격 차원간의 연관성)

  • Lee, Hyo-Geun;Joe, Sook-Haeng;Kim, Jung-Woong
    • Korean Journal of Psychosomatic Medicine
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    • v.11 no.2
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    • pp.182-195
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    • 2003
  • Background: Marriage is one of the major life events and the primary source of individual happiness and meaning of life. It is not possible to predict who will marry whom and which marriage will be successful. Marital adjustment has significant influences on an individual and relationship functioning and is associated with mental health. Good marital quality may imply good general relationship. There are several factors that correlate with or predict good marital quality. Especially individual personality factors may be a major factor in achieving and maintaining marital stability, satisfaction and happiness. The aim of the present study was to investigate the possible relationship between dyadic adjustment and personality dimensions in urban married women. Methods: Dyadic Adjustment Scale, Eysenck's Personality Questionnaire, Beck Depression Inventory and State-Trait Anxiety Inventory were administered to 215 married women. Data analysis was based on 170 women who provided reliable informations. The descriptive statistics of demographic data and 4 scales were obtained. Then the possible relationships between each data were tested by calculating Pearson's product moment correlations. To test the effects of depression and anxiety on dyadic adjustment, stepwise multiple regression analysis was done. Results: Age and length of marriage were negatively correlated with affectional expression and dyadic cohesion. Educational level was positively correlated with total dyadic adjustment score and dyadic satisfaction. Family income was positively correlated with total dyadic adjustment score, dyadic consensus, dyadic satisfaction and dyadic cohesion. Different family type showed different total dyadic adjustment score, dyadic satisfaction and dyadic cohesion. Psychoticism was negatively correlated with total dyadic adjustment score, dyadic consensus, dyadic satisfaction, affectional expression and dyadic cohesion. Neuroticism was negatively correlated with total dyadic adjustment score, dyadic consensus, dyadic satisfaction and affectional expression. Extraversion and lie were not correlated with any factors. Beck Depression Inventory and State-Trait Anxiety Inventory scores were negatively correlated with total dyadic adjustment score, dyadic consensus, dyadic satisfaction, affectional expression and dyadic cohesion. The result of multiple regression analysis indicated that psychoticism was correlated with dyadic adjustment. Conclusion: These results showed that the demographic factors such as age, length of marriage, educational level, family income and family type were significantly correlated with dyadic adjustment. Psychoticism and neuroticism measured by Eysenck Personality Inventory were significantly correlated with dyadic adjustment. But the correlations with extraversion and lie were not significant. Especially correlation between neuroticism and dyadic adjustment seemed to be mediated by emotional state such as depression and anxiety. These findings suggest that personality factors may be involved in marital relationship and that clinician must consider personality aspect in dealing with marital problems. Future study about differences between control group and psychiatric patient group will be needed.

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The Need for Child Hospice Care in Families of Children with Cancer (암 환아 가족의 아동 호스피스 요구도)

  • Kang, Kyung-Ah;Kim, Shin-Jeong;Kim, Young-Soon
    • Journal of Hospice and Palliative Care
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    • v.7 no.2
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    • pp.221-231
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    • 2004
  • Purpose: The purpose of this study was to analyze the need for child hospice care programs in families of children with cancer. Methods: The survey of 104 families who were taking care of children with cancer was conducted. This survey was conducted from February 2004 to July 2004 at two general hospitals in Seoul. The data were collected through a self-reporting questionnaire of 22 items. The items were classified into five areas by factor analysis to identify the construct validity. The reliability of the tool was established by Cronbach's alpha as .94 and the data collected were analyzed by descriptive statistics, t-test and ANOVA. Results: 1) The degree of need for hospice care of the subjects showed a high average of 3.40 (${\pm}3.8$). The need for 'emotional care of children' showed the highest mean (M=3.55), 'management of terminal physical symptoms'(M=3.49), 'control of secondary physical problems' (M=3.41), 'acceptance of the family's difficulty' (M=3.20), 'spiritual care for preparing for death'(M=3.17), respectively. 2) With respect to the demographic characteristics of the subjects, there were statistically significant differences in hospice care needs, according to the child's mother's age (F==4.980, P=.009), whether or not there were cancer patients among their siblings or relatives (t=2.423, P=.017). Conclusion: The family of children with cancer have a heavy burden of ambivalence, especially in relieving the anxiety and fear of their children, communicating about death, and managing physical symptoms. Child hospice care must be provided considering the needs of families of children with cancer. Thus popular needs as well as hospice nurses' higher concern and support for hospice care of children require further education and program development to meet the current demands.

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