코로나19 최전선에서 싸우는 간호사

Special Issu

A Study on Exercise Behavior, Exercise Environment and Social Support of Middle-Aged Women

Purpose: The purpose of this study was to identify exercise environments and social support associated with exercise behaviors in middle-aged women. Method: Subjects were 207 women aged between 41 and 59 yr in an urban community. The research instruments utilized in this study were exercise stages, exercise environments, exercise partners and social support scale. Subjects were given a self-report questionnaire. Data was analyzed using the SPSS Win program. Result: The subjects were in the stages of precontemplation (3.4%), contemplation (25.1%), preparation (40.6%), action (5.8%), and maintenance (25.1%). Subjects who engaged in regular exercise were 30.9%. The mean score of the exercise environment was 6.34. The mean score of social support was 21.28, and 65.7% of subjects had exercise partners. The score of the exercise environment was significantly associated with the exercise stage (p=.01). The number of exercise partners of regular exercise groups was significantly greater than that of non-regular exercise groups (p=.00). The score of social support of regular exercise groups was significantly greater than that of non-regular exercise groups (p=. 00). The score of social support was significantly associated with the exercise stage (p=.00). Conclusion: Exercise environments and social support need to be considered in planning exercise programs to improve exercise behavior among middle-aged women

(A) study of KDRG classification system and factors related to length of stay using data mining methodology : for the case of ce

보건정보관리학과/석사[한글] 본 연구의 목적은 제왕절개분만 산모를 대상으로 퇴원요약 정보 및 처방 데이터를 데이터마이닝 기법을 활용하여 기존 DRG 분류체계를 검증, 평가하였으며, DRG 환자군의 재원일수에 영향을 미치는 요인을 회귀분석, 의사결정나무, SPC (통계적 공정관리)기법을 활용하여 중요 결정요인을 추출해서 향후 진료지침의 개발 방안을 제시하는데 있다. 데이터마이닝 기법인 K-means clustering을 통해 DRG 분류 환자군을 분석해 본 결과 큰 차이는 아니지만 DRG 중증도 0 집단 413건 중 11건, 중증도 1집단 55건 중 37건의 분석 건수의 차이가 있었고, 선형회귀분석으로 검정했을 때 군집분석의 결정계수가 0.3375로 현 DRG 분류체계의 결정계수 0.2719보다 설명력이 더 높은 것으로 제시되었다. 군집분석 0에 속하면서 다빈도인 재원일이 7일인 환자들을 대상으로 진료행위 내역을 분석한 결과, 재원일차별로 보면 재원1∼2일차에는 주사제, 마취약제, 수혈, 수술전 Routine 검사 및 처치를 하였으며, 재원 3∼4일에는 내·외용약, 주사제(항생제), 단순 외과적 처치를 하였고, 재원 5∼6일차에는 주사제(항생제) 및 단순 외과적 처치 등으로 처방되어지는 것으로 제시되었다. 환자의 재원일수에 영향을 미치는 요인을 회귀분석으로 도출한 결과, 중증도 0일 때 처치건수, 주사건수 및 주진단명순이었고, 중증도 1 일때는 재료건수, 주사건수로 나타났다또한 의사결정나무 기법을 통해 분석시 중증도 0 일 때 주사건수가 46.5건보다 적고 처치건수가 6.5건보다 적으면 재원일수 7.2일로 짧아지며, 또한 주사건수가 22.5건보다 적을 때 재원일수가 6.4일로 더욱 감소됨을 볼 때 향후 진료행위 프로토콜 개발시 중요정보로 활용되어야겠다. SPC 기법을 통한 의료진의 진료행위 패턴을 환자의 처방내역인 투약, 처치, 검사건수를 중심으로 평균과 표준편차를 분석한 결과 중증도 0인 경우, 투약은 전체 평균 24건, 처치7.2건, 검사 7.5건으로 나타났으며, 중증도 1은 55건으로 건수가 적고 동반질환이 다양하여 의료진별로 진료형태의 변이를 단정짓기는 어려우나 향후 의료진간에 의료서비스를 모니터링하여 의료자원의 적정사용을 평가해 봄으로 의료기관의 행정 및 의사결정 지원을 위한 정보로 활용하는데 의의가 크다고 생각된다. 따라서 본 연구는 과거에 축적된 대용량의 환자데이터를 데이터마이닝이라는 새로운 기법을 사용함으로 기존의 연구에서 발견할 수 없었던 의미있는 상관관계, 의료의 질 관리,진료행위 패턴 분석, 재원일수의 변이요인 등 추세를 밝혀내고 이와 같은 유용한 정보를 체계화하여 급변하는 의료기간의 경영환경에 능동적으로 대처하며 효율적인 경영정보로 활용되어지기를 기대한다. [영문] In this study, I analyzed and evaluated the existing KDRG classification system by comparing extracted data from discharge abstract and OCS prescription data of cesarean section cases using data mining methodology .The factors affecting length of stay in KDRG cases were confirmed by regression analysis, decision tree, and SPC(Statistical Process Control).K-means clustering, a data mining methodology , was used to analyze the DRG patient data, which showed some discrepancy, though not significant; 11 cases out of 413 in the DRG severity 0 group and 37 cases out of 55 in the severity 1 group. The decision coefficient of the group analysis of DRG cases of the study hospital was 0.3375 by linear regression analysis, and it was more descriptive than that of the DRG system, 0.2719. In case of 7 day stay patients, the highest frequency in cluster 0, the results of analysis of treatments given were as follows; injection, anesthesia, transfusion, pre-operative routine examination and treatment were given on the Ist and 2nd day, internal and external medicine, injections(antibiotics), and simple dressing on the 3rd and 4th day, injections(antibiotics) and simple dressing on 5th and 6th day. By regression analysis the major factors affecting length of stay were identified as number of treatment, injections, and principal diagnosis in the group of severity 0, whereas those of the group of severity 1 were quantity of medical supplies and nwnber of injections. The results of decision tree analysis showed the length of stay in the group of severity 0 was shortened to 7.2 days when the number of injections were less than 46.5 and the number of treatments were less than 6.5, while it was shortened more to 6.4 when the number of injections were less than 22.5. These results could be used as an important reference in developing practice guideline protocols in the future. By SPC methodology, mean and standard deviations of the treatment patterns by attending physicians were analyzed in terms of the frequency of medication, treatment, and examinations. In severity 0 group the average number of medications, treatments, and examinations were 2.4, 7.2 and 7.5 respectively, but in severity 1 group, which were 55 cases, I couldn't identify the patterns of treatment by attending physicians due to the small number of cases and the variety of the diagnoses. The results of the above analysis could be used as significant data in supporting administration and decision making process in health care facilities by monitoring appropriateness of treatment patterns of physicians in terms of quality of medical care and hospital resource consumption. By using a new data processing technology , data mining methodology , I identified the significant correlations of factors, the quality of medical care, treatment patterns by physicians, and factors related to length of stay, which couldn't be identified from accumulated massive patient care data in previous studies. By systemization of analysis of patient care data as shown in this study, health care facilities could achieve an effective management and could actively meet the rapidly changing environment of health care field.ope

Perspectives on Bionursing Science

This article describes the development, evaluation and dissemination of biological nursing (bionursing) science courses established in Korea. Prior to this innovation the subject such as anatomy, physiology, biochemistry, microbiology, pharmacology and pathology were taught by non-nursing faculties, such as basic medical science faculty members. And it often did not meet and satisfy the needs of most undergraduate nursing students. To meet these needs, we have developed four bionursing courses by overhauling individual courses and integrating these by creating new titles, objectives, and contents. In this process, the Korean Society of Biological Nursing has made enormous efforts to standardize the contents of the courses and to develop standard syllabus of four bionursing subjects. This article also suggests for further development of bionursing science such as enhanced linkage of the contents of bionursing science courses with clinical practice, reinforcement of teaching competency of professors, and activation of researches using various biological measurement to provide concrete evidences for nursing practice

Quality of Chest Pain According to Causal Diseases and Description of Chest Pain in Patients with Coronary Artery Diseases in Emergency Departments

Purpose: The purpose was to identify quality of chest pain according to causal diseases and pain expression of patients with coronary artery diseases. Method: Participants were 1,964 patients with pain who visited the emergency department of A hospital from January to December 2006. Data were collected from nurses and doctors records as to causal disease, and quality and expression of chest pain. Results: Causal diseases were coronary artery diseases, non-specific chest pain, respiratory diseases, non-coronary artery heart diseases and digestive diseases in that order of frequency. Every disease except respiratory disease caused mostly dull and tract pain, but 63.7% of patients with coronary artery diseases complained of typical angina pain and 24.9% complained of atypical angina pain. Patients with coronary artery diseases mostly used word heaviness in describing their dull pain, and squeezing for tract pain. Both male and female patients who were diagnosed with coronary artery disease complained mostly frequently of dull pain and tract pain. Conclusion: The most common causal disease for patients with chest pain was coronary artery disease. atients with other diseases also frequently complained of dull and tract pain, the same as patients with coronary artery diseases. A considerable number of patients complained various types of atypical angina pain in coronary artery diseases

인터뷰 가르침에 대한 성찰

본지에서는 지난 10월호부터 '제1회 서울대학교 교육상'을 수상한 일곱 분의 교수 각인으로부터 교육상 수상 소삼과 더둘어 가르침에 대학 소신을 듣는 자리를 마련하고 있습니다. 이번 호에서는 간호대학의 최명애 교수을 만났습니다

스테로이드 유발성 근위축

Muscle atrophy is defined as a decrease in muscle mass, cross-sectional area, and myofibrillar protein content. Causes inducing muscle atrophy may be inactivity, denervation, undernutrition and steroid Inactivity may decrease protein synthesis and increase protein breakdown of skeletal muscle. The muscle atrophy due to inactivity was induced by bed rest, hindlimb suspension, cast, total hip replacement arthroplas-ty, anterior cruciate ligament reconstruction. Denervated atrophy may be induced by the loss of innervation from lower motor neuron. The atrophy was apparent in the lower limb of hemiplegic patients following ischemic stroke and in the hindlimb of ischemic stroke rats. Protein breakdown of skeletal muscle in the undernourished state results in muscle atrophy. The atrophy due to undernutrition was evident in cancer and leukemia patients and in the undernourished rats. Steroids have been used to treat allergies, inflammatory diseases, autoimmune diseases and to inhibit immune function following transplantation. Steroids may induce muscle atrophy by protein breakdown of skeletal muscle. Muscle Physiology Laboratoryat College of Nursing, Seoul National University proved that dexamethasone may induce hindlimb muscle atrophy in rats and exercise and DHEA may attenuate hindlimb muscle atrophy induced by the steroid in rats. Nurses working with patients undergoing steroid treatment to be cognizant of steroid induced muscle atrophy. They need to assess whether muscle atrophy is being occurred during and after the steroid treatment Moreover, they need to apply exercise and DHEA to the patients undergoing steroid treatment in order to attenuate the steroid induced muscle atrophy

A Study on Treatment-Seeking Behavior of Middle-aged and Old-age Saetomins in South Korea

Purpose: The purpose of this study was to explore treatment-seeking behavior of middle-aged and old-age Saetomins in South Korea. Method: The participants for this study were 11 Saetomins aged over 40 years and living in Seoul. They experienced at least one chronic disease while staying in South Korea. An in-depth interview of the 11 subjects on their experiences was conducted at their residence places. Content analysis was conducted on the qualitative data. Results: Two broad themes were identified from our content analysis; ⑴ new experience related to treatment, and ⑵ types of treatment-seeking behavior. Under the heading of major theme 1, four sub-themes were identified; ⒜ physical abnormalities that were discovered after arriving in South Korea, ⒝ an unfamiliar treatment environment, ⒞ the cost and the benefit of the medical treatment, ⒟ an increased concern about ones improving health. Under the heading of major theme 2, three sub-themes were identified; ⒜ being compliant with medical care, ⒝ managing symptoms with self-treatment, ⒞ seeking complementary and alternative treatment. Conclusion: Based on the results, we draw the conclusion that the Saetomins pursued various treatment-seeking behaviors. Therefore, the health care providers should provide systematic and specific health care services for Saetomins.본 연구는 2007년도 서울대학교 통일학 연구비 지원에 의해 수행된 논문임

Knowledge and Learning Needs of Coronary Artery Bypass Graft Patients on Cardiac Rehabilitation

Purpose : The purpose of this study was to explore the knowledge and learning needs on cardiac rehabilitation of coronary artery bypass graft(CABG) patients. Method : The subjects consisted of 100 CABG patients at A hospital in Seoul. Data were collected by the two different kind of questionnaires which measure knowledge and learning needs on cardiac rehabilitation of CABG patients. The subjects responded the questionnaire on knowledge before CABG and that on learning needs before their discharge. Result : The mean score of knowledge on cardiac rehabilitation was 68.54. Knowledge on risk factor, nature of disease, diet, daily activity, medication, post operative care were great in order. The mean score of learning needs on cardiac rehabilitation was 4.28. Learning needs on diet, medication, nature of disease, post operative care, daily activity, risk factor were great in order. There were significant differences in knowledge according to occupation, economic status and family history(p=.021, p=.017, p=.023). There was a positive correlation between knowledge and learning needs(r=.3009, p=.002). Conclusion : Level of knowledge on cardiac rehabilitation of CABG patients is low and knowledge on postoperative care is the lowest, and learning needs are great in all categories

Study on the Changes in Limb Circumferences and Muscle Areas of Critically Ill Patients using Ventilators

Purpose: The purpose of this study was to identify muscle atrophy in critically ill patients on ventilators. A comparison was made between limb circumferences and muscle areas on the day of admission to an intensive care unit (ICU) and on the 8th day after admission. Methods: The data were collected from 30 critically ill patients using ventilators at S hospital ICU in Seoul during the period from October 2005 to April 2006. Limb circumferences and skinfold thickness were measured on the day of admission and on the 8th day after admission to the ICU. Limb circumferences and skinfold thickness were measured on the right mid-arm, right mid-thigh, and right mid-calf using a measuring tape and a skinfold calipers. Limb muscle areas were calculated by an equation after measuring limb circumferences and skinfold thickness. The data were analyzed by paired t-test and independent t-test. Results: 1) Mid-arm circumference, mid-thigh circumference and mid-calf circumference on the 8th day after admission to the ICU were significantly less than those on the day of admission to the ICU, 2) Mid-arm muscle area, mid-thigh muscle area and mid-calf muscle area on the 8th day after admission to the ICU were significantly less than those on the day of admission to the ICU, 3) Steroid and vecuronium medication didnt affect changes in limb circumferences (mid-arm, mid-thigh, mid-calf) and muscle areas (mid-arm, mid-thigh, mid-calf) on the 8th day after admission to the ICU compared to the day of admission. Conclusion: Limb muscle atrophy may occur on the 8th day after admission to the ICU in critically ill patients using ventilator