입원환자가 인지하는 간호요구도와 간호만족도의 관계에 영향을 미치는 간호사 의사소통 매개효과

최운정(Un Jong Choi),강지숙(Ji Sook Kang) 한국산학기술학회 2018 한국산학기술학회논문지 Vol.19 No.4

본 연구는 입원환자의 간호요구도와 간호만족도의 차이를 줄이고 간호만족도에 영향을 줄 수 있는 의사소통 유형을 파악하며, 간호요구도와 간호만족도의 관계에서 의사소통에 대한 매개효과를 확인하여 간호서비스 향상을 위한 기초자료로 활용하고자 시행되었다. 본 연구는 IRB 승인 후 대학병원 입원환자 180명을 대상으로 설문지를 통해 자료가 수집되었다. 자료수집 기간은 대상으로 2017년 4월부터 6월까지 이었고, SPSS 22.0 통계 프로그램을 통해 자료분석을 수행하였다. 연구결과 대상자가 인지하는 간호사 의사소통 유형은 3.88±0.52점이었고, 대상자가 인지하는 간호요구도 3.93±0.55점으로 간호만족도 3.74±0.58점에 비해 유의하게 높았다. 대상자의 간호요구도는 입원병실에 따라 간호사 의사소통과 간호만족도의 유의한 차이를 나타내었고, 간호사 의사소통와 간호요구도(r=.286, p<.001), 간호사 의사소통과 간호만족도(r=.524, p<.001), 간호요구도와 간호만족도(r=.488, p<.001)에서 유의한 정적인 관계를 나타내었다. 입원환자가 인지하는 간호요구도와 간호만족도의 관계에서 간호사 의사소통은 부분매개효과가 있었다(Sobel test Z=2.450, p=.014). 이상의 결과를 토대로 간호사를 위한 지속적인 의사소통 강화교육 프로그램개발과 입원병실의 사생활보호를 강화하고 환자와 간호사가 의사소통을 충분히 할 수 있도록 간호인력을 충분히 확보하려는 노력이 필요하다. This study aimed to identify the mediating effect of nurse’s communication on the relationship between nursing needs and nursing satisfaction in hospital patients. After IRB approval, this study was performed by administering questionnaires to 180 university hospital patients between April and June, 2017. Collected data were analyzed with SPSS 22.0. The average score of nurse’s communication, nursing needs, and nursing satisfaction were 3.88±0.52, 3.96±0.55, and 3.74±0.59 out of 5, respectively. There were significant differences in educational and therapeutic needs versus satisfaction. As for nurse’s communication and nursing satisfaction, there were significant differences by patient’s room. There were positive correlations among nurse’s communication and nursing needs (r=.286, p<.001) as well as nurse’s communication and nursing satisfaction (r=.524, p<.001), In addition, there were positive correlations between nursing needs and satisfaction (r=.488, p<.001). Nursing communication had a partial mediating effect between nursing needs and satisfaction, which showed significance in Sobel’s test (Z=2.450, p=.014). Therefore, it is suggested that a continuous program for strengthening communication of hospital nurses is needed.

액와 림프절 전이가 없는 유방암 환자에 있어 감시 림프절의 잠재적 미세 전이

최운정(Un-Jong Choi),박원철(Won-Cheol Park),이광만(Kwang-Man Lee),윤기중(Ki-Jung Yoon) 대한외과학회 2001 Annals of Surgical Treatment and Research Vol.61 No.4

보완대체의학의 과학적 접근

최운정 ( Un Jong Choi ) 대한임상종양학회 2009 Korean Journal of Clinical Oncology Vol.5 No.2

Complementary and Alternative Medicine (CAM) is widely used in modern society and is becoming a common method to reduce the adverse effect of orthodox medicine. Recently among CAM therapies, mind-body medicine is interested in cancer patients. Scientific methods which consist of replicability and sustainability are essential factor for modern medicine. Therefore, randomized clinical trial should be considered to advance CAM. Integrated medicine means all parts of medicine included with CAM.

복강경 수술 후 반좌위가 수술회복성과 통증에 미치는 영향

최운정(Un Jong Choi),하태욱(Tae Uk Ha),강지숙(Ji Sook Kang) 한국산학기술학회 2017 한국산학기술학회논문지 Vol.18 No.5

본 연구는 본 연구는 전신마취 하에 복강경 수술을 받은 환자를 대상으로 수술 후 반좌위가 수술 회복성과 통증에 미치는 영향을 규명하고 향후 복강경 수술환자 간호에 대한 근거기반 간호중재의 기초자료로 사용되도록 시도되었다. 본 연구는 전신마취하에 복강경 수술을 받은 비뇨기과 혹은 산부인과 환자를 대상 사전동의 후 진행되었으며, 실험처치로 실험군에게는 반좌위룰 대조군에게는 기존 앙와위를 수술직후부터 24시간까지 취하게 하였다. 수술후 회복성을 확인하기 위해 회복실저류시간, 장운동 회복기간, 자가배뇨 회복기간, 수술후 병동 체류기간을 측정하였고, 통증에 대한 영향을 확인하기 위해 수술일부터 수술 2일째 까지 VAS로 통증강도를 측정하였다. 수집된 자료는 SPSS Win 20.0을 이용하여 실수, 백분율, 평균, 표준편차, Chi-square test, Independent t-test 반복측정 분산분석(Repeated Measures ANOVA)로 분석하였으며 그 결과는 다음과 같다. 첫째, 대상자의 수술회복성은 수술 후 회복실 체류시간(t=-0.284, p=.506), 수술 후 최초 가스배출시간(t=-0.837, p=.407), 수술 후 최초 대변배출시간(t=0.665, p=.509), 유치도뇨관 삽입시간(t=1.635, p=.109), 유치도뇨관 제거 후 자가배뇨시간(t=1.427, p=.165), 수술 후 병동체류시간(t=0.290, p=.773)으로 실험군과 대조군의 유의한 차이가 없었다. 둘째, 대상자의 통증은 주효과인 통증에서 실험군과 대조군간의 유의한 차이를 보였으며(F=4.851, p=.032), 세 시점간의 통증의 변화도 유의한 차이를 나타내었다(F=24.200, p=<.001). 이상과 같이 본 연구에서 복강경 수술 후 반좌위는 수술회복성에 영향을 미치지 않지만 통증에는 효과가 있었다. 따라서 복강경 수술환자에게 반좌위는 통증을 완화시키고 안위를 개선하는 데 유용한 간호중재임이 확인되었다. Purpose:This study was conducted to identify the effects of theSemi-Fowler’s position on post-operative recovery and pain for patients with laparoscopic abdominal surgery Methods: This study utilized a non-equivalent control group non-synchronized design to validate the effects of theSemi-Fowler’s position. After IRB approval, 56 patients took part in this study, 29 in the experimental group and 27 in the control group. Consent was obtained from the participants. The Semi-Folwer’s position was applied to experimental group and the supine position was applied to the control group for 24 hours after surgery. All data were reviewed retrospectively from April to June 2016. Collected data, frequency, percentage, average, standard deviation, chi-squared test, independent t-test and repeated measures ANOVA were conducted using SPSS 20.0. Results: There was no significant difference between the experimental and control group with regard to recovery outcomes; however, there was a significance differencebetween groups and among check times with regard to post operational pain. Conclusion:The results of this study provide information that will be usefulto the development of strategies for improving recovery outcomes and pain for laparoscopic operation patients.

측경부 자연 피부 주름을 이용한 원위접근 갑상선절제술의 기술적 유용성 및 미용적 탁월성

원태완,최운정,Tae Wan Won,Un Jong Choi 대한갑상선-내분비외과학회 2014 The Koreran journal of Endocrine Surgery Vol.14 No.4

Purpose: Surgery for thyroid disease requires skin incisions that can result in postsurgical problems. Therefore, several approaches in thyroid surgery have been developed to avoid large scars on the anterior neck. Since the first report of endoscopic subtotal parathyroidectomy, various endoscopic approaches have been reported. However, to be able to perform these procedures using endoscopic instruments in a skillful manner, sufficient training time and effort is required. We assessed the feasibility and cosmetic benefit of the far lateral neck approach using natural skin fold thyroidectomy. Methods: From July 2011 to February 2014, 123 patients underwent thyroidectomy via far lateral neck approach by one surgeon. An approximately 5 to 6 cm incision was created on the natural skin fold at the far lateral neck, so that the scar can be completely hidden by a V-shaped collar shirt. Thyroidectomy was performed using a Harmonic scalpelⓇ and conventional tie technique. Results: The mean operation time was 89.6±18.4 min for benign tumors and 79.1±30.1 min for malignant tumors. The number of retrieved lymph nodes (mean) was 5.4±3.5 in the central neck compartment dissection group, and 26.9±13.1 in the lateral neck lymph node dissection group. The 3, 6, and 12 month cosmetic satisfaction score (mean) after the operation was 7.47, 7.68, and 8.81. There were no hypertrophic scars or keloid on the neck. Conclusion: Far lateral approach using natural skin fold for thyroidectomy is safe and patients expressed high cosmetic satisfaction. In addition, the technique is suitable for inexperienced surgeons in endoscopic thyroidectomy. It can be a feasible alternative to conventional or endoscopic thyroidectomy.

일 대학병원 유방암 환자의 우울증상과 삶의 질

장승호,이대보,최운정,이광만,이상열,Jang, Seung-Ho,Lee, Dae-Bo,Choi, Un Jong,Lee, Kwang-Man,Lee, Sang-Yeol 한국정신신체의학회 2013 정신신체의학 Vol.21 No.1

연구목적 유방암 환자에서 우울증상의 동반 빈도는 매우 높은 것으로 알려져 있으며 우울증상은 건강과 연관된 삶의 질에 영향을 미칠 수 있다. 본 연구는 일 대학병원 유방암 환자의 우울증상의 유병율을 알아보고 우울증상이 건강과 연관된 삶의 질과, 우울증상과 삶의 질에 미치는 인구 사회학적 및 임상적 변인을 알아보고자 하였다. 방 법 원광대학교병원 외과에서 2010년 11월 1일부터 2011년 5월 31일까지 유방암으로 진단 및 수술을 받고 통원치료 중인 19세 이상 75세 미만인 여성 환자 52명에서 이전에 기분장애로 진단을 받았거나 평가 설문지 및 의학적 정보가 부족한 11명을 제외한 41명을 연구대상으로 하였다. 연구 대상자의 인구통계학적 변인 및 유방암에 대한 임상적 특성은 의무기록지를 통하여 조사하였다. 우울증상은 Beck 우울척도, 불안은 성격평가질문지의 불안 하위 척도를 이용하였으며, 건강과 관련된 삶의 질은 한국판 단축형 36항목 건강 설문지(Short Form 36 health Survey-Korean Version)를 사용하였다. Beck 우울 척도에 따른 우울증상 군과 비우울증상 군의 건강과 관련된 삶의 질을 비교하였으며, 인구사회학적 변인 및 임상적 변인을 예언 변인으로 하고 우울증상과 삶의 질을 준거 변인으로 한 중다회귀분석을 시행하였다. 결 과 유방암 환자 중 우울증상의 유병율은 36.4%였다. 우울 증상을 나타내는 유방암 환자의 건강과 연관된 삶의 질에서 신체 기능(p<.01), 신체 역할(p<.001), 전반적 건강(p<.05), 사회 기능(p<.001), 정서 역할(p<.001), 정신 건강(p<.001)의 하위 척도가 우울증상을 동반하지 않은 환자군에 비하여 유의하게 낮았다. 그러나 신체 통증 및 활력의 하위척도에서는 유의한 차이가 없었다. 유방암 환자의 우울증상은 불안과 교육 정도, 항암치료 시행 여부와 유의한 것으로 나타나 전체 우울증상의 63.6%의 설명 변량을 나타냈다. 유방암 환자의 건강과 관련한 삶의 질은 우울증상, 수술형태, 연령이 유의하였으며 55.8%의 설명 변량을 나타냈다. 결 론 유방암 환자의 우울증상은 36%에서 나타났으며 우울증상은 건강과 연관된 삶의 질을 낮추었다. 우울증상은 삶의 질에 높은 설명 변량을 가지고 있으며, 불안은 우울증상을 동반한 유방암 환자에서 높은 설명 변량을 갖고 있었다. 따라서 유방암 환자의 삶의 질을 높이기 위하여 우울증상에 대한 평가 및 치료가 필요할 것으로 여겨진다. Objectives : This study was designed to investigate the prevalence of depressive symptoms in patients with breast cancer and to identify demographic variables and clinical characteristics impact on depressive symptoms and health related quality of life in patients with breast cancer in a university hospital. Methods : Fourty-one patients with breast cancer were selected, who had visited the department of General surgery of the Wonkwang University hospital with a diagnosis of breast cancer regularly during the period November, 2010-May, 2011. All of subjects were evaluated for the depression, anxiety and the health related quality of life with Beck Depression Inventory(BDI), anxiety subscale of Personality Assessment Inventory(PAI) and Short-Form 36 Health Survey-Korean version(SF-36-K). Patients were divided into depressive symptoms and non-depressive symptoms group according to the BDI score. We compared SF-36-K between two groups, and analized multiple regression with depression and health related quality of life as criterion variables and demographic and clinical characteristics. Results : The prevalence of depression in patients with breast cancer in a University hospital was 36.4%. Compared to the non-depression, depressed patients with breast cancer appeared significantly lower mean scores on six subscales in SF-36-K : Physical function(p<.01), Role-physical(p<.001), General health(p<.05), Social function(p<.001), Role-emotional(p<.001) and Mental health(p<.001). But there was no significant difference between two groups in Vitality and Bodily pain. Anxiety, level of education and presence of enforcement of chemotherapy(63.6%) were significant explanation variables for depressive symptoms. And type of surgery and age(55.8%) were significant explanation variables for health related quality of life. Conclusions : The prevalence of depressive symptoms in patients with breast cancer in a University hospital was 36%. The depressive symptoms had not only negative impact on the health related quality of life but also important explanation variable for health related quality of life. These results suggest that depressive symptoms in patients with breast cancer should be evaluated and treated for improving patient's health related quality of life.

쇄골하 단일 절개를 통한 무기하 내시경 갑상선 절제술의 유용성

신창열,이광만,최운정,Chang-yeol Shin,M.D.,Kwang-man Lee,M.D. and Un-jong Choi,M.D. 대한갑상선-내분비외과학회 2008 The Koreran journal of Endocrine Surgery Vol.8 No.3

<B>Purpose: </B>Several approaches in endoscopic thyroid surgery have been developed to avoid large scars on the anterior neck. We assessed the feasibility and cosmetic benefit of performing gasless endoscopic thyroid surgery through a single infraclavicular approach. <P><B>Methods:</B> Thirty-one patients with a benign thyroid mass on sonography received gasless endoscopic thyroidectomy through a single infraclavicular approach. A 5-cm infraclavicular incision was created laterally, depending on the distance from the clavicle to the thyroid mass, but which would be completely hidden by a V-shaped shirt collar. In some cases, hand-assisted vessel ligation was performed through this incision. <B>Results:</B> The study included 26 female patients (out of 31), and the mean age was 38.2 years old (range, 14 to 70). All patients received a unilateral thyroid lobectomy, with or without isthmectomy, and tumors were benign (follicular adenoma in 12 and adenomatous hyperplasia in 19). A recurrent laryngeal nerve was identified in all cases. The mean operation time was 162.5 min (range, 100 to 300 min). No patients required conversion to conventional open surgery or showed postoperative bleeding, even without drainage. Hoarseness occurred in 1 patient with injury of the recurrent laryngeal nerve, which was repaired through the same incision and recovered within 6 months. Tem</B>porary hoarseness occurred in another 3 patients, but recovered within 3 months. <B>Conclusion:</B> Gasless endoscopic thyroidectomy through a single infraclavicular approach improved cosmetic outcomes and allowed for bleeding control through hand-assisted ligation of vessels. Therefore, the technique is suitable for surgeons inexperienced in endoscopic thyroidectomy. <B>(Ko</B><B>rean J Endocrine Surg 2008;8:194-199)</B>

단일 기관에서 시행한 로봇 내시경 갑상선 절제술 256예의 경험

원태완,이광만,최운정,Tae Wan Won,Kwang Man Lee,Un Jong Choi 대한갑상선-내분비외과학회 2014 The Koreran journal of Endocrine Surgery Vol.14 No.4

Purpose: Conventional thyroidectomy through a skin crease incision in the anterior neck sometimes causes a visible scar. Minimally invasive surgical techniques have been developed, and, recently, more various techniques of remote access surgery such as endoscopic and robotic thyroidectomy have been suggested and actively applied. Robotic thyroid surgery has several advantages over endoscopic thyroid surgery. These advantages include three-dimensional magnified view, tremor-filtering system, multi-articulated motion, and more comfortable surgeon position, and assistants are unnecessary for performance of the robotic thyroid surgery. Methods: From November 2008 to July 2014, 256 patients underwent robotic endoscopic thyroidectomies through a transaxillary approach. An approximately 5 cm long incision was created on the axillary natural crease, so that the scar can be completely hidden by the arm. Patients' characteristics, postoperative clinical results, complications, and pathologic details were assessed. Results: The mean age of patients was 40.9±10.1 years. For benign tumors, we performed 56 less-than total thyroidectomies. For malignant tumors, we performed 175 less-than total thyroidectomies with central compartment node dissection, 21 total thyroidectomies with central compartment node dissection, and four total thyroidectomies with lateral neck node dissection (Benign=56, Malignant=200). The mean actual operation time (console time) was 91.5±48.7 min for benign tumors and 103.0±65.8 min for malignant tumors. The number of retrieved lymph nodes was 5.1±4.1 (mean) in malignant tumors. Internal jugular vein tearing occurred in two patients. Transient hypocalcemia (four patients) and transient hoarseness (six patients) occurred, but recovered within six months. Conclusion: Robotic endoscopic thyroidectomy is technically safe and feasible and also shows excellent cosmetic outcome.

조기 유방암에서 종양의 합성기 분획 및 Ki-67 발현과 예후

이한범(Han Beom Lee),최운정(Un Jong Choi),이광만(Kwang Man Lee) 대한외과학회 2006 Annals of Surgical Treatment and Research(ASRT) Vol.71 No.5

성인에서 부분 마취하에 시행된 무긴장 탈장교정술의 비교

유지만(Jee-Man You),이광만(Kwang-Man Lee),최운정(Un-Jong Choi) 대한외과학회 2007 Annals of Surgical Treatment and Research(ASRT) Vol.72 No.1

Purpose: The aims of this study were to evaluate the feasibility of local anesthesia in tension-free herniorrhaphy, using prosthetic mesh, and to directly compare PHS<SUP>®</SUP> and Perfix<SUP>®</SUP> herniorrhaphy under local anesthesia. Methods: Patients with a groin hernia, who underwent tension-free herniorrhaphy (n=107) under local anesthesia between March 2003 and February 2006, were included. PHS<SUP>®</SUP> (n=63) and Perfix<SUP>®</SUP> (n=44) meshes were randomly used, with no difference between the PHS<SUP>®</SUP> and Perfix<SUP>®</SUP> groups in relation to mean age, gender, number of combined diseases, body mass index (BMI), recurred hernia and types of hernia. Results: Intraoperative analgesics and/or sedatives were used in 55 patients (51.4%) where local anesthesia was insufficient. In a univariate analysis, the additional use of intraoperative analgesics and/or sedatives was related to the patient’s age and BMI. The patients at an older age and with a lower BMI were more tolerant to local anesthesia. However, only the BMI was found to be a statistically significant factor from the multivariate analysis. There was no significant difference between the PHS<SUP>®</SUP> and Perfix<SUP>®</SUP> groups on the additional use of intraoperative analgesics and/or sedatives, the use of postoperative analgesics, length of hospital stay, complication and recurrence (P>0.05). Conclusion: With tension-free herniorrhaphy using the PHS<SUP>®</SUP> or Perfix<SUP>®</SUP> mesh, local anesthesia was acceptable and securable, regardless of the mesh type used. Among these patients, those at an older age and with a lower BMI were more tolerant to local anesthesia.