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    ๊ฑฐ์‹œ์š”์ธ์„ ์ถ”๊ฐ€ํ•œ APT๋ชจํ˜•์„ ์ด์šฉํ•œ ๊ตญ๋‚ด ์ฑ„๊ถŒํฌํŠธํด๋ฆฌ์˜ค ์ˆ˜์ต๋ฅ  ๋ถ„์„

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    ํ•™์œ„๋…ผ๋ฌธ (๋ฐ•์‚ฌ)-- ์„œ์šธ๋Œ€ํ•™๊ต ๋Œ€ํ•™์› : ๊ฒฝ์ œํ•™๋ถ€(๊ฒฝ์ œํ•™์ „๊ณต), 2012. 8. ์•ˆ๋™ํ˜„.์ฑ„๊ถŒ ํฌํŠธํด๋ฆฌ์˜ค ์ˆ˜์ต๋ฅ ์— ๋Œ€ํ•œ ๊ธฐ์กด ์—ฐ๊ตฌ๋“ค์€ ๋‹จ์ผ ์ฑ„๊ถŒ์ง€์ˆ˜๋ชจํ˜• ๋‚ด์ง€๋Š” ๋‹ค์ค‘์ง€์ˆ˜๋ชจํ˜•์— ๊ตญํ•œ๋˜์–ด ๋ถ„์„์ด ์‹œํ–‰๋˜์—ˆ๋‹ค. ๋ณธ ์—ฐ๊ตฌ๋Š” ์ฑ„๊ถŒ์ž์‚ฐ์ˆ˜์ต๋ฅ  ๊ฒฐ์ •๋ชจํ˜•์œผ๋กœ ๊ธฐ์กด์˜ ์‹œ์žฅ์ง€์ˆ˜ ์š”์ธ๊ณผ ๋”๋ถˆ์–ด ๊ฑฐ์‹œ๊ฒฝ์ œ ์š”์ธ์„ ๋™์‹œ์— ๊ณ ๋ คํ•œ APT๋ชจํ˜•์˜ ์ ํ•ฉ์„ฑ์„ ๋ถ„์„ํ•˜๊ณ , ์ด๋ฅผ ๋ฐ”ํƒ•์œผ๋กœ ๊ฐœ๋ณ„ ์ฑ„๊ถŒํ˜• ํŽ€๋“œ ์„ฑ๊ณผ์— ๋Œ€ํ•œ ํ‰๊ฐ€๋ฅผ ์‹œํ–‰ํ•˜์˜€๋‹ค. ๊ฑฐ์‹œ๊ฒฝ์ œ ์š”์ธ์˜ ์„ ์ •์€ ํŠน์ • ๊ฑฐ์‹œ๋ณ€์ˆ˜๋ฅผ ์„ ํƒํ•˜์—ฌ ์‚ฌ์šฉํ•˜๋Š” ๋ฐฉ์‹์ด ์•„๋‹Œ ์ „์ฒด ๊ฑฐ์‹œ๊ฒฝ์ œ๋ณ€์ˆ˜๋กœ๋ถ€ํ„ฐ ์ฃผ์„ฑ๋ถ„๋ถ„์„์„ ํ†ตํ•ด ํ†ต๊ณ„์ ์œผ๋กœ ์œ ํšจํ•œ ์ฃผ์„ฑ๋ถ„์„ ์ถ”์ถœํ•˜๋Š” ๋ฐฉ์‹์„ ์‚ฌ์šฉํ•˜์˜€๋‹ค. ๊ตญ๋‚ด ์ฑ„๊ถŒ ํฌํŠธํด๋ฆฌ์˜ค๋ฅผ ๋Œ€์ƒ์œผ๋กœ ์‹ค์ฆ๋ถ„์„ํ•œ ๊ฒฐ๊ณผ, ์ฒซ์งธ, ๊ตญ๋‚ด ๊ฑฐ์‹œ๊ฒฝ์ œ๋ณ€์ˆ˜๋“ค์— ๋Œ€ํ•œ ์ฃผ์„ฑ๋ถ„๋ถ„์„์„ ํ†ตํ•ด ํ†ต๊ณ„์ ์œผ๋กœ ์œ ํšจํ•œ ๊ฑฐ์‹œ๊ฒฝ์ œ ์š”์ธ 2๊ฐœ๋ฅผ ์ถ”์ถœํ–ˆ๊ณ , ์ถ”์ถœํ•œ ๊ฑฐ์‹œ๊ฒฝ์ œ ์š”์ธ ๋ฐ ์‹œ์žฅ์ง€์ˆ˜ ์š”์ธ์„ ํฌํ•จํ•œ APT ๋ชจํ˜•์—์„œ ์ฑ„๊ถŒํฌํŠธํด๋ฆฌ์˜ค ๊ธฐ๋Œ€์ˆ˜์ต๋ฅ ์— ๋Œ€ํ•œ APT์˜ ๊ฐ€์„ค์„ ๊ธฐ๊ฐํ•˜์ง€ ๋ชปํ•˜์˜€๋‹ค. ๋‘˜์งธ, ์ฑ„ํƒ๋œ ๋ชจํ˜• ํ•˜์—์„œ ์ฑ„๊ถŒํ˜• ํŽ€๋“œ ์ˆ˜์ต๋ฅ ์˜ ์•ŒํŒŒ ๊ฐ’์€ ์œ ์˜ํ•œ (-)๊ฐ’์œผ๋กœ ๋‚˜ํƒ€๋‚œ ๊ฒƒ์œผ๋กœ, ์ ๊ทน์  ์šด์šฉ์ด ํŒจ์‹œ๋ธŒ ์ „๋žต์˜ ๊ธฐ๋Œ€์ˆ˜์ต๋ฅ  ๋Œ€๋น„ ์ดˆ๊ณผ์„ฑ๊ณผ๋ฅผ ๋‚ด์ง€ ๋ชปํ•˜์˜€๊ณ , ๋ณด์ˆ˜๋ฅผ ์ฐจ๊ฐํ•˜๊ธฐ ์ „์˜ ์„ฑ๊ณผ ์—ญ์‹œ ์ดˆ๊ณผ์„ฑ๊ณผ๋ฅผ ๋‚ด์ง€ ๋ชปํ•˜์˜€๋‹ค. ์…‹์งธ, ๋ณด์ˆ˜์™€ ์ดˆ๊ณผ์ˆ˜์ต๋ฅ  ์‚ฌ์ด์— ์œ ์˜ํ•œ (+) ์ƒ๊ด€์„ฑ์„ ๋ณด์˜€๊ณ , ๊ทœ๋ชจ์™€ ์ดˆ๊ณผ์ˆ˜์ต๋ฅ  ์‚ฌ์ด์—๋Š” ์œ ์˜ํ•œ ์ƒ๊ด€์„ฑ์„ ๋ณด์ด์ง€ ์•Š์•˜๋‹ค.I. ์„œ๋ก  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 II. ์—ฐ๊ตฌ๋ฐฉ๋ฒ•๋ก  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 2.1 ์ˆ˜์ต๋ฅ  ํ‰๊ฐ€๋ฅผ์œ„ํ•œ APT๋ชจํ˜• ์„ค์ • . . . . . . . . . . . . . . . . . . . . 6 2.2 ์ฃผ์„ฑ๋ถ„ ๋ถ„์„์—์„œ์œ ํšจ ์š”์ธ๊ฐฏ์ˆ˜์ธก์ •๋ฐฉ๋ฒ• . . . . . . . . . . . . . . . . 10 2.2.1 Bai-Ngs Information Criteria . . . . . . . . . . . . . . . . . . . . 11 2.2.2 ๋Œ€์•ˆ์  ํ‰๊ฐ€๋ฒ•1 : Generalized Bai-Ng Method . . . . . . . . . . . 12 2.2.3 ๋Œ€์•ˆ์  ํ‰๊ฐ€๋ฒ•2 : Onatskis Method . . . . . . . . . . . . . . . . 14 III. ํŒจ์‹œ๋ธŒ ์ฑ„๊ถŒํฌํŠธํด๋ฆฌ์˜ค๋ฅผ ์ด์šฉํ•œ๋ชจํ˜•์‹ค์ฆ๋ถ„์„ . . . . . . . . . . . . . . 16 3.1 APT๋ชจํ˜•์š”์ธ์„ ์ • . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 3.1.1 ๊ฑฐ๋ž˜ ๊ฐ€๋Šฅํ•œํฌํŠธํด๋ฆฌ์˜ค(tradable portfolio)์„ ์ • . . . . . . . . . 16 3.1.2 ๊ฑฐ์‹œ๋ณ€์ˆ˜ ์š”์ธ์„ ์ • . . . . . . . . . . . . . . . . . . . . . . . . . 20 3.2 ํŒจ์‹œ๋ธŒ์ฑ„๊ถŒํฌํŠธํด๋ฆฌ์˜ค์˜์„ ์ • . . . . . . . . . . . . . . . . . . . . . . 26 3.3 ๋ชจํ˜•specification๋ฐ์‹ค์ฆ๋ถ„์„๊ฒฐ๊ณผ . . . . . . . . . . . . . . . . . . . . 29 IV. ๊ฐœ๋ณ„์ฑ„๊ถŒํ˜• ํŽ€๋“œ์„ฑ๊ณผ ํ‰๊ฐ€ . . . . . . . . . . . . . . . . . . . . . . . . . . 41 4.1 ์ฑ„๊ถŒํ˜•ํŽ€๋“œ ๋ถ„์„์ž๋ฃŒ . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 4.2 APT๋ชจํ˜•์„ ์ด์šฉํ•œ์ฑ„๊ถŒํ˜• ํŽ€๋“œ์„ฑ๊ณผ ๋ถ„์„ . . . . . . . . . . . . . . . . 43 4.3 ๊ฑฐ์‹œ๋ณ€์ˆ˜-6๋ชจํ˜•์—์„œ์ถ”์ •ํ•œ์•ŒํŒŒ์ˆ˜์ต๋ฅ ๋ถ„์„ . . . . . . . . . . . . . . 50 4.3.1 ๋ณด์ˆ˜์ฐจ๊ฐ ์ „๋ฐ ๋ณด์ˆ˜ ์ฐจ๊ฐํ›„ ์•ŒํŒŒ์ˆ˜์ต๋ฅ ๋น„๊ต . . . . . . . . . 50 4.3.2 ์•ŒํŒŒ์ˆ˜์ต๋ฅ ์— ๋Œ€ํ•œ๋ณด์ˆ˜์™€ ๊ทœ๋ชจ์˜์˜ํ–ฅ . . . . . . . . . . . . . 54 V. ๊ฒฐ๋ก  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 ์ฐธ๊ณ ๋ฌธํ—Œ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Abstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72Docto

    Development of nursing practice standards for patients with spinal cord injury

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    ์ง€์—ญ์‚ฌํšŒ๊ฐ„ํ˜ธํ•™๊ณผ/์„์‚ฌ[ํ•œ๊ธ€] ๋ณธ ์—ฐ๊ตฌ๋Š” ์ฒ™์ˆ˜์†์ƒํ™˜์ž์—๊ฒŒ ์งˆ์ ์ธ ๊ฐ„ํ˜ธ๋ฅผ ์ œ๊ณตํ•˜๊ณ  ์งˆ ํ‰๊ฐ€์˜ ๊ทผ๊ฑฐ ์ž๋ฃŒ๊ฐ€ ๋  ์ˆ˜ ์žˆ๋Š” ์ฒ™์ˆ˜์†์ƒํ™˜์ž ๊ฐ„ํ˜ธ์‹ค๋ฌด ํ‘œ์ค€์„ ๊ฐœ๋ฐœํ•˜๋Š” ๋ฐฉ๋ฒ•๋ก ์ ์ธ ์—ฐ๊ตฌ์ด๋‹ค. ์˜ˆ๋น„ ๊ฐ„ํ˜ธ์‹ค๋ฌด ํ‘œ์ค€์€ ๋ฌธํ—Œ๊ณ ์ฐฐ ๋ฐ ๋ฏธ๊ตญ ๊ฐ„ํ˜ธํ˜‘ํšŒ์™€ ๋ฏธ๊ตญ ์‹ ๊ฒฝ๊ฐ„ํ˜ธํ˜‘ํšŒ ์‹ค๋ฌดํ‘œ์ค€์„ ํ† ๋Œ€๋กœ ํ•˜์—ฌ ๊ฐœ๋ฐœํ•˜์˜€๋‹ค. ํ‘œ์ค€์— ๋”ฐ๋ฅธ ๊ฐ„ํ˜ธํ™œ๋™์€ ๋ฌธํ—Œ๊ณ ์ฐฐ๊ณผ ์ฒ™์ˆ˜์†์ƒํ™˜์ž ๊ฐ„ํ˜ธ์™€ ๊ด€๋ จ๋œ ์ „๋ฌธ๊ฐ€๋กœ ๊ตฌ์„ฑ๋œ ์ดˆ์ ์ง‘๋‹จ์„ ์ด์šฉํ•˜์—ฌ ์šฐ๋ฆฌ๋‚˜๋ผ์˜ ์ž„์ƒ์ƒํ™ฉ์— ์•Œ๋งž์€ ํ™œ๋™๋“ค๋กœ ์„ธ๋ถ€ํ•ญ๋ชฉ์„ ์ž‘์„ฑํ•˜์˜€๋‹ค. ๊ฐœ๋ฐœ๋œ ๊ฐ„ํ˜ธ์‹ค๋ฌด ํ‘œ์ค€์— ๋Œ€ํ•œ ๋‚ด์šฉ์€ ์ฒ™์ˆ˜์†์ƒํ™˜์ž ์˜์—ญ์—์„œ ๊ฐ•์˜ ๊ฒฝํ—˜์ด ํ’๋ถ€ํ•œ ๊ฐ„ํ˜ธ๋Œ€ํ•™ ๊ต์ˆ˜ 2์ธ ๋ฐ ์ˆ˜๊ฐ„ํ˜ธ์‚ฌ 1์ธ, ์ „๊ณต์˜ 3์ธ, ์ฒ™์ˆ˜์†์ƒํ™˜์ž ๊ฐ„ํ˜ธ์—…๋ฌด์— 5๋…„ ์ด์ƒ ๊ทผ๋ฌดํ•œ ๊ฒฝํ—˜์ด ์žˆ๋Š” ๊ฐ„ํ˜ธ์‚ฌ 4์ธ์œผ๋กœ๋ถ€ํ„ฐ ๊ฒ€์ฆ ๋ฐ›์€ ํ›„ ์ตœ์ข… ์ฒ™์ˆ˜์†์ƒํ™˜์ž ๊ฐ„ํ˜ธ์‹ค๋ฌด ํ‘œ์ค€์„ ๊ฐœ๋ฐœํ•˜์˜€๋‹ค. ๋ณธ ์—ฐ๊ตฌ์— ๋Œ€ํ•œ ๊ตฌ์ฒด์ ์ธ ๊ฒฐ๊ณผ๋Š” ๋‹ค์Œ๊ณผ ๊ฐ™๋‹ค. 1. ๊ฐœ๋ฐœ๋œ ์˜ˆ๋น„ ์‹ค๋ฌดํ‘œ์ค€์€ 12๊ฐœ์˜ ํ‘œ์ค€๊ณผ 30๊ฐœ์˜ ๊ธฐ์ค€ ๋ฐ 31๊ฐœ์˜ ์ง€ํ‘œ, ์ด 259๊ฐœ์˜ ๊ฐ„ํ˜ธํ™œ๋™์œผ๋กœ ๊ตฌ์„ฑ๋˜์—ˆ๋‹ค. 2. 1์ฐจ ๋‚ด์šฉ ํƒ€๋‹น๋„ ๊ฒ€์ฆ์€ ์˜ˆ๋น„ ์‹ค๋ฌดํ‘œ์ค€์˜ ๊ฐ ํ•ญ๋ชฉ์— ๋Œ€ํ•˜์—ฌ 4์  ์ฒ™๋„ ๋ฅผ ์‚ฌ์šฉํ•˜์—ฌ 3์  โ€˜ํƒ€๋‹นํ•˜๋‹คโ€™, 4์  โ€˜๋งค์šฐ ํƒ€๋‹นํ•˜๋‹คโ€™์— ๋™์˜ํ•œ ์ „๋ฌธ๊ฐ€์ˆ˜๋กœ CVI(content validity index)๋ฅผ ๊ตฌํ•˜์˜€์œผ๋ฉฐ, ์ „์ฒด ํ•ญ๋ชฉ์— ๋Œ€ํ•œ CVI๋Š” ๋ชจ๋‘ 83%์ด์ƒ์œผ๋กœ ๋†’๊ฒŒ ๋‚˜ํƒ€๋‚ฌ๋‹ค. ๊ทธ๋Ÿฌ๋‚˜ 4๊ฐœ์˜ ํ•ญ๋ชฉ์—์„œ ์ „๋ฌธ๊ฐ€ ํƒ€๋‹น ๋„๊ฐ€ 83%์ด์ƒ์ด์ง€๋งŒ ๋ฌธํ•ญ์˜ ์ถ”๊ฐ€, ์‚ญ์ œ, ์ˆ˜์ •, ๋ณด์™„๋˜์–ด์•ผ ํ•  ๋ถ€๋ถ„์ด ์žˆ์—ˆ๋‹ค. 3. 2์ฐจ ๋‚ด์šฉ ํƒ€๋‹น๋„ ๊ฒ€์ฆ์€ 1์ฐจ ๋‚ด์šฉ ํƒ€๋‹น๋„์—์„œ ์ง€์ ๋œ 4๊ฐœ ๋ฌธํ•ญ์„ ์žฌ์ • ๋ฆฌ ํ•œ ํ›„ 1์ฐจ ๋‚ด์šฉ ํƒ€๋‹น๋„์™€ ๊ฐ™์€ ๋ฐฉ๋ฒ•์œผ๋กœ CVI๋ฅผ ๊ตฌํ•˜์˜€์œผ๋ฉฐ, 4๊ฐœ ํ•ญ ๋ชฉ ๋ชจ๋‘ ์ „๋ฌธ๊ฐ€ ํ•ฉ์˜์œจ 83%์ด์ƒ์„ ๋‚˜ํƒ€๋‚ด์–ด ๊ฐ„ํ˜ธํ™œ๋™ ํ•ญ๋ชฉ์œผ๋กœ ํฌํ•จ ์‹œ์ผฐ๋‹ค. 4. ์ตœ์ข…์ ์œผ๋กœ ๊ฐœ๋ฐœ๋œ ์ฒ™์ˆ˜์†์ƒํ™˜์ž ๊ฐ„ํ˜ธ์‹ค๋ฌด ํ‘œ์ค€์€ ์ž๋ฃŒ์ˆ˜์ง‘, ๊ฐ„ํ˜ธ์ง„๋‹จ, ๊ฐ„ํ˜ธ์„ฑ๊ณผ, ๊ฐ„ํ˜ธ๊ณ„ํš, ์ˆ˜ํ–‰, ํ‰๊ฐ€, ๊ฐ„ํ˜ธ์˜ ์งˆ, ์—…๋ฌด์ˆ˜ํ–‰ํ‰๊ฐ€, ์ „๋ฌธ์„ฑ๊ฐœ ๋ฐœ, ํ˜‘๋™, ์œค๋ฆฌ, ์—ฐ๊ตฌ ๋“ฑ 12๊ฐœ์˜ ํ‘œ์ค€๊ณผ ์ด์— ๋”ฐ๋ฅธ 30๊ฐœ์˜ ๊ธฐ์ค€๊ณผ 31๊ฐœ ์˜ ์ง€ํ‘œ์™€ 259๊ฐœ์˜ ๊ฐ„ํ˜ธํ™œ๋™์œผ๋กœ ๊ตฌ์„ฑ๋˜์—ˆ๋‹ค. ๊ฐœ๋ฐœ๋œ ์ฒ™์ˆ˜์†์ƒํ™˜์ž ๊ฐ„ํ˜ธ์‹ค๋ฌด ํ‘œ์ค€์€ ์ฒ™์ˆ˜์†์ƒํ™˜์ž์˜ ๊ฐ„ํ˜ธ์˜ ์งˆ์„ ํ–ฅ์ƒ์‹œํ‚ค๊ณ  ์ž„์ƒ์‹ค๋ฌด ์ˆ˜ํ–‰๋Šฅ๋ ฅ์˜ ๋ฐœ์ „์„ ๋„๋ชจํ•  ์ˆ˜ ์žˆ๋Š” ๊ธฐ์ดˆ ์ž๋ฃŒ๋ฅผ ์ œ๊ณตํ•  ๋ฟ๋งŒ ์•„๋‹ˆ๋ผ ์ฒ™์ˆ˜์†์ƒํ™˜์ž๋ฅผ ๊ฐ„ํ˜ธํ•˜๋Š” ๊ฐ„ํ˜ธ์‚ฌ๋“ค์˜ ์งˆ ํ‰๊ฐ€๋ฅผ ์œ„ํ•œ ์ œ๋„์  ์žฅ์น˜ ๋ฐ ๊ด€๋ฆฌํ•˜๋Š” ์ง€์นจ์„œ๋กœ์จ ํ™œ์šฉ๋  ์ˆ˜ ์žˆ์„ ๊ฒƒ์ด๋‹ค. [์˜๋ฌธ]This is a methodological research study to develop standards of nursing practice that provide the fundamental data for the qualitative care and measurement of nursing for patients with spinal cord injury. Preliminary nursing practice standards were developed on the basis of review for the related literatures and the Nursing Standards from American Nurses Association and American Neuroscience Nurses Association. To determine the fine categories of preliminary nursing practice standards, this study was done the review of related literatures and the investigation by the specialist group related the nursing practice for patient with spinal cord injury and then was modified to appropriate standards for clinical nursing environment in Korea. Specialist group has excellent active members in the field of care for patients with spinal cord injury and 10 members of this group organized 2 professors in college of nursing, 1 head nurse, 3 residents, 4 nurses in the line of this field over 5 years. The final standards for patients with spinal cord injury was invented after the validity test by the specialist group. The results of this study are summarized as follows. 1. The Preliminary nursing standards for practice was composed of 12 standards, 30 criteria, 31 indicators , and total 259 nursing practical activities. 2. The first content validity test for each category of preliminary standards for practice was applied 4-point scale. The CVI (content validity index) was decided by the number of specialists who agreed 3 points(relevant) or 4 points(very relevant). The CVI of all categories were over 83%, but 4 categories over 83% were need to add, to delete, to modify, and to revise items. 3. The second content validity test for revised 4 categories was achieved CVI as well as the first content validity test. They received more than 83% agreement by the specialists and they were added in nursing activities. 4. The final version of the nursing practice standards for patients with spinal cord injury includes 12 standards (data collection, nursing diagnosis, nursing plan, implementation, evaluation, quality of nursing, performance evaluation, development of professionalism, partnership, ethics, research), 30 criteria, 31 indicators , and 259 nursing activities. According to the above results, I think the application of the nursing practice standards for patient with spinal cord injury is possible to provide the basic data in order to improve the quality of nursing and the performance ability of clinical practice. Also, I think this standards is possible to utilize as the systematic devise for evaluate the quality of nursing and as the guideline for nurses to care patients with spinal cord injury.ope
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