지역사회 말기질환자 가족 부담감에 관한 연구

한성숙,노유자,양수,유양숙,김석일,황희경,Han, Sung-Suk,Ro, You-Ja,Yang, Soo,Yoo, Yang-Sook,Kim, Sek-Il,Hwang, Hee-Hyung 한국가정간호학회 2003 가정간호학회지 Vol.10 No.1

The purpose of this study was to describe the perceived burden of the terminally III patients's caregiver and to analyze relationship between the perceived burden and the various demographics, illness characteristics, family relationships, and economic factor of the family & patients. The sample of 132 caregivers who care for the terminally III patients Kyung-Gi province, Seoul, Korea. The period of this study was from August to September, 2002. The perceived burden of the family caregiver was measured by the burden scale(20 items, 4 point scale) developed by Montgomery et al. (1985). The Data was analyzed using SAS-program by t-test and ANOVA. The results were as follows; 1. The mean of the family caregiver's burden score was 3.02. The score showed that caregivers perceive severe the level of burden. The hight items of the family caregiver's burden were' I feel it is painful to watch patient's diseases'(3.77). 'I feel afraid for what the future holds for my patients'(3.66), 'I feel it reduced to amount of privacy time'(3.64). 2. The caregiver's burden was significantly related to patient's gender(F=3.17, p= 0.0020), patient's job(F=2.49, p=0.0476), caregiver's age(F=4.29, p=0.0030), and caregiver's job(F=2.49, p=0.0476). 3. The caregiver's burden according to illness characteristics showed no significant difference. 4. The caregiver's burden was significantly associated with patient's family relationship (F=4.05, p=0.0041), patient's care mean period in a day(F=47.18, <p=.000l), patient's care period after diagnosis (F=5.18, p=<.0001), and economic status of family(F=3.58, p=0.0088). The highest caregiver's burden related to family was 'parents caregivers'(3.27), the lowest was 'patient's son & daughter caregivers'(2.88). In case of prolonged care period in a day, the caregiver's burden was significantly high. In case of prolonged care period after diagnosis, the caregiver's burden was significantly high. In case of no monthly family income. the caregiver's burden was significantly increased (3,24). The need for health care has expanded from curative therapy to health promotion and rehabilitation also. finally the need for hospice care has demanded in order to improve the quality of life of the terminally ill patients and their families. Because physical, emotional, social and spiritual approaches are required to meet their needs, the integration of various resources is very important. This study is carried out to build a community-based integrated model that is good for improving the patients and familiy's quality of life and to minimize the cost from tertiary hospitals. There were several subjects in this study such, analyses as traditional home care, utilization review of terminally ill patients, measurement of burden of family members and provided practice guidelines for the home cancer patient management. We suggest three strategies for the development of a new model. The firstly the change of the role of the healthcare center from a direct service provider to a management-oriented organization. The secondly the induction of a team-based approach by preserving the proper role of each organization. The thirdly the reenforcement of this team-based approach with the sharing of information on the patients and community-based resources. These suggests are based on the Partnership Collaboration Model and the strategies stated as in the above. In this model, the health care center could playa managerial role and all of the community's resources and the patient's information could hold in common. It is indicated that the information of the patients might be safely used by a semi-open system and an open-system for sharing of the information of the community-based resources.

회복 불가능한 환자의 심폐소생술포기(DNR)와 관련된 윤리문제

한성숙 ( Sung Suk Han ) 한국의료윤리학회 2005 한국의료윤리학회지 Vol.8 No.1

The following research has examined ethical dilemmas regarding denial of resuscitation by patients. The articlealso suggests several proposals for optimized solutions. First of all, the history and nature of CPR & DNR have been discussed. Second, mutual interactions during making decisions on DNR have been introduced. Because physicians do not exclusively conduct the decision on DNR, patients, family members, and other related siblings should be involved in the process. If necessary, the ethics committee may be applied for making appropriate decisions. Thirdly, in order to locate the nature of ethical dilemma on DNR decisions, the relationship between patients and physicians, full understanding the importance of CPR necessity, and defining the method of DNR would need to be well explained. Finally, through the ethical discussion on DNR, following conclusions have been suggested. In all situations, DNR must let physicians make decision on futility of CPR for patients` current or future conditions, and the decision must be made only after patients are fully aware of the consequences. Under the law of respecting patients` opinions, patients must have the ability to make decisions on DNR. The proper moments for deciding DNR should depend on behaviors regarding his/her conditions or diseases. Because a health care institution play an important role in making decisions as well, all opinions must be reviewed for the best outcome. It is important to remember that the main decision makers on DNR are patients. Following discussions have concluded that an agreement among people nationwide is quite essential for the appropriate DNR decisions. The research may serve as a supplement for the process of establishing the DNR guideline.

DNR에 대한 의사들의 인식 및 태도조사

한성숙 ( Sung Suk Han ),한미현 ( Mi Hyun Han ),용진선 ( Jin Sun Yong ) 한국의료윤리학회 2003 한국의료윤리학회지 Vol.6 No.1

"실폐소생술포기(DNR)"에 대한 요청서 및 지시서 개발

한성숙(Han Sung Suk),김중호(Kim Joong Ho),문인성(Moon In Sung),용진선(Yong Jin Sun) 한국생명윤리학회 2005 생명윤리 Vol.6 No.1

The subjects of the study are First, to accumulate DNR related guideline and DNR request and order, questionnaires were sent to 70 randomly selected university hospitals and general hospitals, and the data were collected between July and September 2004. Second, after the draft of DNR request and order was developed, the first professional group (total 12 people) to seek advise regarding the draft was formed including four doctors, three head nurses, two ministers, two philosophers, and one legal professional. The second professional group (5 people) included four doctors and a legal professional who presented significant opinions in the first advisory meeting, and they discussed the revised draft during the second advice. In this study, Delphi technique was used to develop DNR requests and order. The instrument was the draft of DNR request and order form developed by researchers for our hospital based on DNR request and order collected from 9 institutions at home and materials from abroad for the development of DNR instructions and requests. For the final revision of DNR request and order form, we've decided to prepare some space to write down the diagnosis, the progress of treatment, and the prognosis of patients on the back of the form, and us e it for explaining and seeking the consent in compliance with the regulation of the hospital ethics committee. Also we've decided to call the form "DNR request and order form". Regarding the suggestion from the hospital ethics committee, the legal interpretation is needed advised; the second suggestion from a legal professional could be an alternative. This "DNR request form" will be evaluated after one year of trial in our hospital from March 1 2005. Furthermore, for the proper use of this form, we are planning to publicize to develop and use "DNR guides". I suggest developing the forms of living wills or advance directives, for they are of use in case that patient can't make his own decision due to any abrupt accident.

프리셉터의 업무수행, 자율성, 임파워먼트, 조직몰입에 대한 연구

한성숙(Sung Suk Han),양남영(Nam Young Yang),송선호(Sun Ho Song) 한국간호행정학회 2003 간호행정학회지 Vol.9 No.4

DNR(Do-Not-Resuscitate)에 대한 의사와 간호사의 경험 및 인지도

한성숙(Sung Suk Han) 한국간호행정학회 2005 간호행정학회지 Vol.11 No.3

This study is a descriptive research in investigating the perception of doctors and nurses with regard to DNR, and data were collected through survey questionnaires. The period of collecting data was between July 15 and October 30, 2004, distributing 128 questionnaires to 128 participants, and a total of 110 questionnaires from 55 doctors and 55 nurses were collected (86%) among 70 different hospitals. The collected data were analyzed using SAS program to get real number and percentage, and were also analyzed with X2-test. The Study Results are as follows: 1. Respondents who agreed with the necessity of DNR was 97.27%, the reasons of DNR necessity were 59.20% of ``impossibility of recovery in spite of lots of efforts,`` and 35.20% of ``for the purpose of choosing a comfortable and dignified death,`` and 97.2% of respondents answered that it was necessary to give explanation of DNR to serious case patients, terminal patients and their family. 2. Problems derived from DNR decisions were 44.44% of ``lack of treatment and nursing,`` 21.11% of ``guilty conscience about failing to do best efforts,`` and 71.57% of CPR implementation right after DNR decision. 3. Reasons of implementing CRP for patients with DNR decision were 50.94% of ``for the presence of family and relatives at the point of patient`s death,`` 20.76% of ``guardian`s change of DNR decision,`` and 16.98% of ``no communication for the consent after DNR decision.`` 4. With regard to who was to make DNR decision? there was a difference in the opinion between doctors`` and nurses`` group while the group of doctors chose ``by the consent of the family and the doctor in charge,`` and the group of nurses chose ``patient``s intension,`` and with regard to Have you received DNR related education? And will people who want DNR increase if there is explanation given? There was a difference between the two groups. 5. In the catholic institutions, respondents of 71.7% said that it was necessary to take DNR depending upon the situation, and 73% said that they had performed DNR before. 6. In the institutions with over 500 beds, 91.92% of respondents said that there should be an establishment of guideline book as a written format to implement DNR. From the results of this study, it was found that DNR was implemented and executed broadly in clinical fields in the absence of necessary instructions and/or guideline, and that DNR order was placed to the group of doctors who got less opportunity for proper education than did that of nurses.

DNR에 대한 간호사의 인식 및 태도조사

한성숙(Han, Sung Suk),정순아(Chung, Soon Ah),문미선(Moon, Mi Seon),한미현(Han, MI Hyun),고규희(Ko, Gyu Hee) 한국간호행정학회 2001 간호행정학회지 Vol.7 No.3

"장기등이식에관한법률"의 내용 및 시행상의 문제점 및 개선점

한성숙 ( Sung Suk Han ),홍현자 ( Hyun Ja Hong ),전희옥 ( Hee Ok Chun ) 한국의료윤리학회 2004 한국의료윤리학회지 Vol.7 No.1

간호윤리 교육이 간호학생의 도덕적 사고와 윤리적 딜레마 상화에서의 의사결정에 미치는 효과

한성숙(Sung Suk Han),안성희(Sung Hee Ahn) 한국간호행정학회 1995 간호행정학회지 Vol.1 No.2

생명과학 연구자의 연구윤리 교육과정 개발을 위한 기초연구 -연구윤리 경험, 교육현황 및 요구-

한성숙 ( Sung Suk Han ),안성희 ( Sung Hee Ahn ),구인회 ( In Hoe Ku ),이미송 ( Mi Song Lee ) 한국의료윤리학회 2007 한국의료윤리학회지 Vol.10 No.1

This study examines the experiences, current situations, and educational needs of researchers in life sciences in order to develop an educational program for research ethics. A total of 267 subjects from medical center C participated in this study. The findings were as follows: 1) 43.8% of respondents agreed with the item, "I have included the name of a person in my research who didn`t contribute to my research", while only 3.7% agreed with the statement, "I have tried to minimize risk factors which could impact on participants during the research process"; 2) on the status of ethics education, the number of discussions or lectures regarding research ethics and ethical problems was very low; 3) the highest acknowledged educational need was for "scientists` ethical responsibility and attitudes(69.7%)", while the lowest acknowledged need was for a "peer review system(27.0%)"; 4) differences in educational needs were found among the different disciplines. In medical science, research misconduct, human and animal research ethics, conflict of interest, and peer review were highlighted, while in basic biological science, animal research ethics and the relationships among research members were emphasized. In nursing science, ethics education on authorship and referencing was widely regarded as lacking. These findings indicate that research ethics education is needed in order to support responsible research conduct.