분야별 전문간호사의 전문간호업무에 대한 성과 평가: 일개 병원을 중심으로

설미이,이명선,Seol, Miee,Yi, Myoung Sun 한국중환자간호학회 2012 중환자간호학회지 Vol.5 No.2

Purpose: The purpose of the study was to evaluate how advanced practice nurses (APNs) recognized their work by analyzing nursing outcomes. The ultimate goal was to examine the utility of APNs by connecting their work to the outcomes. Methods: Cross-sectional survey was conducted to collect the data from 59 APNs in a tertiary hospital lovated in Seoul, Korea. The questionnaire with 84 outcome indicators for advanced practice nurses was used. Descriptive statistics were used to analyze the data. Results: Among 84 outcome indicators, 11 indicators were associated with the work of APNs. Majority of these findings were included in the categories of clinical results and satisfaction. Items identified to be associated with the work of APNs were different among oncology nursing area, surgical speciality area, emergency care area, and critical care area. Conclusion: The results of the study indicated that the works of APNs were relevant to education/counseling/training and interpersonal relationship with other health professionals. The results of the study could be helpful to delineate the work characteristics of APNs and increase the utility of APNs in Korea where roles of APNs are not yet clearly delineated in most clinical settings.

동종골수이식 공여자 간호를 위한 표준임상지침서 개발

설미이(Seol Miee) 대한종양간호학회 2004 Asian Oncology Nursing Vol.4 No.2

The purpose of this study was to develop a clinical pathway for the allogeneic bone marrow transplantation donor. For this study, a conceptual framework was developed through a review of the literature including six steps which are using in Jones Hopkins Hospital. USA The researcher reviewed 129 medical re-cords of donor who had bone marrow donation between January 2002 to January 2004 to identify the overall service contents required by these patients and to make a prelmunary clinical pathway. A content validity test was done for the preliminary climcal pathway, a professional group screened 51 medical re-cords and adopted with 3 hospitalization days as the climcal pathway framework In the fifth step, climcal pathway test was also done to 7 donors from April 28th to July, 2004 After these processes the final clinical pathway was developed.<br/> The results of this study are as follows<br/> 1 The vertical axis of the clinical pathway includes the following 9 items' vital signs, nursing assessment, activity, diet, intervention, medlcation, test, consultation and patient teaching The duration of the honzontal axis was 3days from admission to discharge.<br/> 2 Analysis of the 129 medical records indicated that the average length of stay was 3 4 days. The medical performance according to the vertica! axis in the prelimioary clinical pathway consisted of 51 items. After clinical validity test, It steel consisted of 51 items 10 the final form<br/> 3 Clinical Validity test was done to 7 bone marrow donors. During these process, The first patient was deleted because he was out of the criteria the investigate set and 6 patients were used, finally<br/> The result of this study indicated all of 7 donors were discharged on expected day<br/> 4 Clinical pathway enables to improve the quality of care, multidisciplinary team work It also helps nursing bone marrow donor. effective education to donor or medical member.<br/> The results of this study suggest that clinical pathway may be able to improve the quality of nursing care for bone marrow transplantation donors

한국 전문간호사제도의 현황과 활성화 전략

설미이 ( Seol Miee ),신용애 ( Shin Yong Ae ),임경춘 ( Lim Kyung Choon ),임초선 ( Leem Chosun ),최정화 ( Choi Jeong Hwa ),정재심 ( Jeong Jae Sim ) 서울대학교 간호과학연구소 2017 간호학의 지평 Vol.14 No.1

Purpose: This study aimed to provide information on the developmental process and current status of Advanced Practice Nurses (APN) and to suggest ways for activating APN roles in Korea. Methods: We reviewed literatures to explore domestic and international trends related to the roles, practice settings, scope of practice, regulatory policies, and political environment of APN. Results: Interest in the APN role has been gaining ground worldwide. While the roles of APN in the USA, Taiwan and Japan have been changed in terms of legislation and institutional regulations, the role of APN in 12 fields except for APN in home care has not been legislated since qualification was specified in Korean Medical Law. Many problems were found in vitalizing APN roles: absence of legal regulations on the scope of practice or health insurance coverage for APN, increase the number of medical support staffs who are not qualified, and a disagreement regarding the qualification field and practical field. Conclusion: This study presents snapshots and vitalizing strategies of practice, and regulation for APN to develop their unique roles in Korea. The tasks and duties of APN should be identified specifically to fulfill their roles. In terms of national health insurance policy APN`s Nursing care should be reimbursed just as nursing care of APN in home care.

서울아산병원 종양혈액내과의 암환자 교육

설미이 ( Mi Ee Seol ) 서울대학교 간호과학연구소 2003 서울대학교 간호과학연구소 학술대회 자료집 Vol.2003 No.-

500병상 이상 의료기관에서의 전문지원인력 운영실태

김민영,최수정,설미이,김정혜,김희영,변숙진 병원간호사회 2017 임상간호연구 Vol.23 No.2

목적: 본 연구는 기관(병원)에서 일하는 전문지원인력의 전국적인 운영 실태를 조사하고자 시도되었다. 방법: 자료는 2016년 5월 25일부터 7월 12일기간 동안 설문지를 통해서 수집되었다. 설문지에 응답한 1,666명의 자료가 분석에 사용되었다. 결과: 전문지원인력은 다양한 명칭으로 불리고 있었고, 크게 전문간호사, 전담간호사, PA, 코디네이터, 기타직군의 5개 그룹으로 분류하였다. 전문지원인력은 지역, 간호등급, 병상수에 따라 운영 실태가 다양하였다. 전문지원인력 배치 기준도 기관마다 차이를 보였는데, 참여기관의 절반 가까이가 배치 기준이 없다고 보고하였다. 직군별로 연령, 교육수준, 임상경력, 보상, 업무 만족도 등이 차이를 보였다. 특히 PA군은 다른 직군에 비해 낮은 급여, 열악한 근무환경과 업무 시 애로사항이 더 많고, 직무 만족도도 낮은 것으로 나타났다. 대부분의 전문지원인력(99.5%)가 위임된 처방권을 사용하고 있었지만, 표준화된 직무기술서는 68.3%, 문서화된 위임장이 있는 경우는 19.9%에 불과하였다. 결론: 전문지원인력의 법적 보호와 효과적인 의료서비스를 위해 적절한 교육, 문서화된 위임장과 업무 지침서 확립 등이 필요하다. Purpose: This study was to investigate the nationwide operational status of the professional medical support staffs (PMSS) who practice the expanded roles in the hospital setting. Methods: The data were obtained through survey from 36 hospitals with over 500 beds from 25th May to 12th July 2016. Data from 1,666 PMSS were analyzed. Results: Since the job titles varied, we classified them into 5 groups according to their roles; advanced practice nurse, clinical nurse expert, PA (physician assistant), coordinator, and others. There were differences in the operation status of PMSSs depending on the region, nurse staffing grade and number of hospital beds. Qualification criteria varied from hospital to hospital, and almost half of the hospitals didn’t have any qualification standards for them. There were differences in age, educational level, clinical careers, rewards, and job satisfaction in 5 groups. Especially PA group had low salary, poorer working conditions, more difficulties in performing their work, and lower job satisfaction than other groups. Most PMSS (99.5%) were using a delegated prescription authority, however only 68.3% had job description and 19.9% had documented delegated role. Conclusion: Adequate training curriculum, documented delegated roles, and the protocols for legal protection and efficient medical services are needed.

500병상 이상 의료기관에서의 전문지원인력의 직군별 업무 수행빈도 분석

김민영,최수정,설미이,김정혜,김희영,변숙진 한국중환자간호학회 2018 중환자간호학회지 Vol.11 No.1

This study was intended to investigate the frequency of job performance of the Korean professional medical support staffs (PMSS). Method : The data of 1,666 PMSS from 36 hospitals and over 500 beds were analyzed. The participants were divided into 5 groups: advanced practice nurses (APN), clinical nurse experts, physician assistants (PA), coordinators, and others. Results : Among the 5 main domains of job performance, advanced clinical practice has the highest frequency (111.36 d/y), followed by consultation/collaboration (75.66 d/y), education/counseling (53.54 d/y), leadership (23.90 d/y), and research (19.14 d/y). There was a significant difference in the frequency of job performance between the 5 groups of participants. The invasive activities were more frequent in the PA group. In the education and counseling domain, APNs had a higher level of job frequency than others (p ‹ .001). In the research and leadership domains, APNs and coordinators had more prominent performance frequency than other groups (p ‹ .01). However, there are some ambiguities in the job performance of the 5 groups depending on institutional characteristics. Conclusion : To establish the scope of work of PMSS, organizational and individual efforts are needed to promote and expand the leadership and research domains. To resolve the ambiguities of PMSS’ roles, it is necessary to reorganize their titles.

중증 재생불량성빈혈에서 타인 혹은 HLA 불일치 혈연간 골수이식을 위한 cyclophosphamide와 antithymocyte globulin전처치 요법

이정희,이제환,김신,설미이,이정신,김우건,김상희,지현숙,박찬정,이규형 대한조혈모세포이식학회 2001 대한조혈모세포이식학회지 Vol.6 No.1

배경: Cyclophosphamide와 ATG의 전처치 요법은 HLA가 일치하는 형제간 골수이식에서는 매우 효과적인 것으로 알려져 있으나, 타인 혹은 HLA 불일치 혈연간 골수이식에서는 전처치 요법으로서 불충분한 것으로 보고되었는데, 주요 문제는 착상 부전이었다. 우리나라를 포함하는 극동아시아 지역의 국가들에서 발표되는 보고에 의하면 타인이식을 포함하여 골수이식 후 착상 부전과 이식편대숙주질환의 발생이 서구 국가들로부터의 보고에서보다 적은 것으로 알려져 있다. 저자 등은 6예의 중증 재생불량성빈혈 환자들에서 질병 초기에 Cyclophosphamide와 ATG만을 이용하여 전처치를 한 후에 타인 혹은 HLA 불일치 혈연간 골수이식을 시행하였다. 방법: 1999년 5월부터 2000년 4월까지 서울중앙병원에서 타인 혹은 HLA 불일치 혈연간 골수이식을 시행 받은 성인 중증 재생불량성빈혈 환자들을 대상으로 하였다. 골수이식을 위한 전처치 요법으로 cyclophosphamide (50 mg/kg/d x 4)와 ATG (30 mg/kg/d x 3)를 투여하였는데, 골수이식 전에 ATG에 대하여 과민 반응을 보였던 한 예 (UPN 120)에서는 ATG 대신에 fludarabine (30 mg/m2/d x 3)을 투여하였다. 이식편대숙주질환의 예방을 위하여 cyclosporine과 methotrexate를 투여하였다. 결과: 연구 기간 중에 모두 6예가 타인 혹은 HLA 불일치 혈연간 골수이식을 시행 받았는데, 5예는 타인으로부터 골수를 공여 받았으며, 1예는 HLA의 표현형이 하나의 유전자좌에서 일치하지 않는 형제로부터 골수를 공여 받았다. 타인 골수이식을 받은 5예 중에서 3예의 공여자는 HLA의 표현형이 일치하였으며, 1예는 하나의 유전자좌가 major mismatch였고, 1예는 하나의 유전자좌가 minor mismatch였다. 추적기간의 중앙값은 406일 (범위, 328-643일)인데, 6예 모두에서 착상된 상태를 유지하면서 생존해있다. 2예에서 3도의 급성 이식편대숙주질환과 전신성 만성 이식편대숙주질환이 발생하였다. 결론: Cyclophosphamide와 ATG의 전처치 요법은 재생불량성빈혈의 초기에 타인 혹은 HLA 불일치 혈연간 골수이식을 시행 받은 한국인 환자들에서 충분히 착상을 가져올 수 있는 요법으로 생각된다. 비록 본 연구의 대상 환자 수가 적지만 결과는 매우 고무적이다. HLA가 일치하는 형제가 없는 중증 재생불량성빈혈 환자의 경우에 타인 골수 공여자에 대한 검색을 조기에 시행해야 하며, 타인 혹은 HLA 불일치 혈연간 골수이식을 질병 초기에 적극적으로 고려해야 할 것으로 생각된다. Background: Cyclophosphamide (CY) and ATG regimen was reported to be insufficient for alternative donor BMT in SAA patients due to high incidence of graft rejection. The rates of graft rejection and GVHD after allogeneic BMT including unrelated donor transplants seemed to be lower in reports from Asian countries of Far East. We applied CY/ATG regimen to six patients with early stage of SAA transplanted with marrow from alternative donors other than HLA-identical siblings. Methods: Three patients were transplanted from HLA-phenotypically identical unrelated donors, two from one-locus mismatched unrelated donors, and one from an one-locus mismatched sibling donor. Four patients received no previous therapy for SAA, and two received one course of immunosuppressive therapy with ATG. Preparative regimen was CY (200 mg/kg) plus ATG (90 mg/kg) in all patients except one who had had an anaphylactic reaction to ATG prior to BMT and received fludarabine (90 mg/m2) in place of ATG. Cyclosporine plus methotrexate were given for GVHD prophylaxis. Results: All six patients engrafted and all are alive with durable engraftment at a median follow-up of 406 days (range, 328 to 643). Two patients developed grade III acute GVHD and extensive chronic GVHD. Conclusions: CY/ATG regimen may be sufficient in Korean patients with early stage of SAA transplanted with marrow from alternative donors. Although the number of patients in present study is small, results are encouraging. Stem cell transplantation using alternative donors may be considered at early stage of aplastic anemia.

병원 간호사의 프리셉터 경험에 관한 포커스 그룹 연구

강영아 ( Young Ah Kang ),설미이 ( Mi Ee Seol ),이명선 ( Myung Sun Yi ) 서울대학교 간호과학연구소 2013 간호학의 지평 Vol.10 No.1

The purpose of this study was to describe hospital nurses` lived experience of being a preceptor in Korea. Methods: The data were collected in three focus group interviews with 15 nurses in one general hospital. The phenomenological analytic method suggested by Colaizzi was used to analyze the data. Results: Five theme clusters and 11 themes emerged from the analysis. The five themes include “inevitable rite of passage for an authentic nurse”, “facing new role and situations that were difficult to handle”, “preceptee-centered preceptorship”, “healing connection with colleague nurses”, and “enhanced status with competence”. Conclusion: The findings of the study provide deep understanding on hospital nurses` positive as well as negative experiences of being a preceptor and should inform the development of a more integrative preceptorship program to empower both preceptees and preceptors.

500병상 미만 종합병원에서의 전문지원인력 운영실태 : 간호인력을 중심으로

전미경,김정혜,김민영,설미이,최수정,김희영 병원간호사회 2018 임상간호연구 Vol.24 No.2

Purpose: This study aimed to investigate the current statistics of professional medical support staffs(PMSSs) working in general hospitals with less than 500 beds. Methods: This study was conducted on 35 general hospitals with less than 500 beds from September 11th to October 27th, 2017. Results: Four hundred fifty one PMSSs were currently providing medical support. The number of clinical nurse experts was the highest among the roles, followed by Physician Assistants(PA) and Advanced Practice Nurses. The mean job satisfaction score was 3.07 out of 5 . In the case of PA group, most of the delegated prescriptions were performed, however the delegated roles were not much documented in written format. The paucity of documentation requires a development of a committee for PMSSs, including a development of selection criteria and a scope of practice in each institution. Conclusion: The results of this study suggested the composition of a committee for PMSSs in the medical institutions and renaming the specified titles of PMSSs.

신경독성 항암제를 투여받고 있는 암환자의 말초신경병증 증상과 일상생활 방해정도

김정혜(Kim, Jeong Hye),이경민(Lee, Kyoung Min),전미진(Jeon, Mi Jin),설미이(Seol, Mi Ee),이순행(Lee, Soon Haeng),박정윤(Park, JeongYun) 대한종양간호학회 2013 Asian Oncology Nursing Vol.13 No.3

Purpose: The purpose of this study was to identify the symptoms and interference of activities of daily living (ADL) of chemotherapy induced peripheral neuropathy (CIPN) in patients receiving taxane and platinums. Methods: 141 cancer patients were recruited in the cross-sectional survey design. The instruments used in the study was the Chemotherapy-induced Peripheral Neuropathy Assessment Tool (CIPNAT) developed by Tofthagen and colleagues. Results: The patients experienced the symptom and interference of ADL of CIPN moderately. The most common symptom was nerve pain (70.2%) and the patients with high cumulative doses showed a significant of tingling sensation in the feet. Symptom severity increased substantially with cumulative dose of chemotherapeutic agents. Conclusion: The results of this study suggest that chemotherapy-induced peripheral neuropathy increase due to repeated chemotherapy and nursing intervention is necessary to reduce symptom severity and interference of ADL of CIPN.