보완대체의학에 대한 간호학과 학생의 주관성 연구

박은영 ( Eun Young Park ),이은남 ( Eun Nam Lee ),강지연 ( Ji Yeon Kang ),주현옥 ( Hyeon Ok Ju ),김삼숙 ( Sam Sook Kim ),최은정 ( Eun Jung Choi ),김학선 ( Hack Sun Kim ) 경희대학교 동서의학연구소 2011 동서간호학연구지 Vol.17 No.1

보완대체의학은 건강증진과 질병예방을 위한 총체적인 접근법의 하나로 환자뿐 아니라 일반인들 사이에서도 이용률이 증가하고 있고, 교육에 있어서도 보완대체요법 관련 교과목을 의학이나 간호학의 정규 교과과정 내에 포함시키는 대학이 늘어남에 따라 미래의 건강관리 제공자인 간호학생들의 보완대체의학에 대한 인식이나 태도를 파악하는 것은 중요하다. 이에 본 연구는 Q방법론을 이용하여 보완대체의학에 대한 간호학생의 반응을 유형화하고 구체적인 특성을 파악하고자 시도되었다. 보완대체의학에 대한 간호학생의 반응은 4개로 유형화되었으며, 각 유형은 실용적 확신형, 견제형, 가치 인정형, 제한적 수용형으로 명명하였다. 각 유형의 명명에서 볼 수 있듯이 간호학생들은 인식에서 약간씩은 차이가 있지만 보완대 체의학에 대해 비교적 긍정적인 태도를 갖고 있는 것으로 나타났다. 이러한 결과는 간호학생들이 보완대체요법에 대해 긍정적인 태도를 보였음을 보고한 Kim (2004), Kim, Erlen, Kim 과 Sok (2006), Uzun과 Tan (2004)의 연구결과와 일치한다고 할 수 있다. 제1유형은 ‘실용적 확신형’으로 보완대체요법의 효과를 단순히 인정하기보다는 실용성에 초점을 맞춘 유형이다. 보완대체요법의 문제점으로 많이 지적되는 것 중의 하나가 사람마다 효과가 다르기 때문에 일률적으로 적용하기 어렵다는 것인데, 제1유형의 대상자들은 이를 오히려 실용적인 측면으로 인식하여, 보완대체요법의 효과는 사람마다 결과가 다르게 나타날 수 있기 때문에 어떤 치료법을 일률적으로 적용하기보다는 자신한테 맞는 보완대체요법을 찾아야 한다고 인식하는 것이다. 또한 제1유형의 대상자들은 보완대체요법에 대해 효과가 없거나 의미 없는 행위이며 의학적 치료를 방해하거나 효과를 믿을 수 없다는 데는 강하게 반대를 했다. 간호학생의 보완요법에 대한 태도를 조사한 Kim (2004)의 연구에서도 보완대체요법이 엉터리 치료법이라는 데에 대해 가장 부정적인 태도를 보임으로써 본 연구결과와 일치한다. 간호학생의 주관성을 조사한 Hwang (2004)의 연구에서는 간호학생의 인식이 세 가지로 유형화되었는데 ‘긍정적 인정형’으로 명명된 사람들은 보완대체요법이 건강의 유지와 증진에 도움이 되며, 면역력을 향상시키고 심리적 지지를 제공하고 몸을 보호하며 안위를 증진시키는 것으로 인식하고, 엉터리 치료법이고 환자의 치유에 방해가 되므로 사용을 피해야 하고 과학적인 근거를 설명할 수 없으므로 신뢰할 수 없다는 데대해서는 강한 반대의 의사를 표함으로써 본 연구에서 ‘실용적 확신형’으로 명명된 대상자들과 유사한 인식양상을 보였다. 본 연구에서의 ‘실용적 확신형’의 사람은 보완대체요법에 대해 쉽게 접근할 수 있고 여러 가지 효과를 한꺼번에 기대할 수 있다는 점에서 좀 더실용적인 면을 강조한 점이 차이라고 할 수 있다. 제2유형은 ‘견제형’으로 보완대체의학의 부작용에 대한 염려와 효과에 대한 정확한 작용기전의 뒷받침을 요구하는 유형으로, Hwang (2004)의 연구에서 보완대체요법은 체계적인 검증 후에 정통적인 치료와 병행해서 사용해야 효과가 있다고 하여 ‘객관적 수용형’으로 명명한 것과 매우 유사하다. 또한 간호사를 대상으로 한Son (2002)의 연구에서 보완대체요법을 현대의학을 보완해주는 치료법으로 고려하면서 과학적인 근거를 확립하는 일이 필요하다고 제시한 것과 일치한다. Ernst (2000)도 보완대체요법을 이용하는 대상자들은 보완대체요법의 안전성과 효율성에 대해서 알고자 하며, 보완대체요법에 대해 건강관리자와 개방적으로 의사소통할 때 안정성이 확립된다고 하여 본 연구의 ‘견제형’ 유형과 유사한 것을 볼 수 있다. ‘견제형’의 사람들은 보완대체요법에 대한 효과가 사람마다 다르게 나타나므로 보완대체요법을 무조건적으로 받아들이기 이전에 임상적인 효율성에 대한 정확한 근거와 과학적인 검증에 관한 많은 연구들이 이루어져야 할 것을 강조한 유형이다. 이러한 견해는 최근 의학이나 간호학 교육에서 근거중심의 행위를 강조하고 있는 것을 반영하는 것이라 할 수 있다. 제3유형은 ‘가치 인정형’으로 보완대체의학에 대해 과학적 신뢰를 갖고 있지는 않지만 보완대체요법의 건강증진에 대한 가치를 인정하는 유형이다. 의사를 대상으로 보완대체요법의 치료 효과에 대한 태도를 분석한 Jang 과 Park (2003)의 연구에서 62.2%는 ‘설명하기는 어렵지만 보완대체요법은 효과가 있다’고 하여 작용기전에 대한 이론적 근거는 부족하지만 치료효과에 대해서는 비교적 긍정적으로 인식하고 있는 것으로 나타나 본 연구 대상자의 ‘가치 인정형’과유사한 태도를 보였다. 또한 초등학교 보건교사를 대상으로 보완대체요법의 문제점에 대한 인식을 조사한 Kim, Kim과 Cho (2007)의 연구에서 40.5%가 ‘과학적인 검증의 부족으로 치료효과가 의심된다’고 지적하였지만 학교보건실무에서 보완대체요법의 적용가능성에 대한 질문에는 72.1%가 ‘가능하다’고 하였으며, 78%가 보완대체요법의 적용이유로 ‘증상완화, 치료보조의 효과’ 때문이라고 답하여 본 연구결과와 유사한 인식을 보였다. 또한 보완대체요법 교과목을 수강한 간호학생들에게 보완대체요법의 치료적 효과에 대해조사한 Kim (2005)의 연구에서도 ‘건강유지증진을 위해 일반 대중들도 보완대체요법을 많이 적용하고 있다’에 대해 5점 만점에 3.7점으로 응답하여 비교적 긍정적 태도를 보였다. 위의 결과들을 종합해 볼 때 보완대체요법이 체계적인 지식체로 인정하기엔 과학적 근거가 부족하지만 신체의 자연 치유력과 면역력을 증가시켜 건강증진에 영향을 미친다는 본 연구의 ‘가치 인정형’과 유사하다고 할 수있다. 제4유형은 ‘제한적 수용형’으로 보완대체의학이 건강증진에 도움이 되고 심리적 안정감을 주는 여러 가지 효과가 있는 반면 부작용이 있을 수 있고 사람마다 효과가 다르게 나타날 수 있으므로 작용기전에 대한 연구도 더 필요하다고 생각하는 유형으로 무조건적으로 수용하기보다는 제한적으로 수용하는 유형이다. 대학생을 대상으로 보완대체요법의 문제점에 대한 인식을 조사한 Gwon 등(2008)의 연구에서 ‘부작용을 예측할 수 없다’가 37.7%로 가장 높았고, 23.2%가 ‘비과학적이다’라고 응답함으로써 자신에게 맞는 보완대체요법을 찾아 효과를 볼 수는 있지만 부작용에 대한 우려, 효과에 대한 객관성 부족 및 작용기전에 대한 체계적 검증의 필요성을 언급한 본 연구에서의 ‘제한적 수용형’ 대상자와 유사한 인식을 보였다. Purpose: The purpose of this study was to grasp the subjectivity of the nursing students toward CAM and put the outcomes into use as basic facts and figures in developing and applying a curriculum associated with CAM. Methods: Q methodology was employed to explore the nursing students` subjectivity from their rank-order statements. For the Q population, individual in-depth interviews and literature research were conducted. Finally, 30 participants completed 40 Q statements. The data were analyzed using the QUANL software package. Results: The current survey that probed into the subjectivity of the nursing students relative to CAM abstracted four categories, namely, practical and convinced type, keep-under-control/wait-and-see type, merit acknowledging type and limitedly accepting type. Conclusion: It is recommended that various educational programs should be developed to shift the awareness of CAM on the part of the nursing students, based on the findings set forth in the current study.

Surgical technique for single-port laparoscopy in huge ovarian tumors: SW Kim`s technique and comparison to laparotomy

( Jeong Sook Kim ),( In Ok Lee ),( Kyung Jin Eoh ),( Young Shin Chung ),( Inha Lee ),( Jung-yun Lee ),( Eun Ji Nam ),( Sunghoon Kim ),( Young Tae Kim ),( Sang Wun Kim ) 대한산부인과학회 2017 Obstetrics & Gynecology Science Vol.60 No.2

Objective This study aimed to introduce a method to remove huge ovarian tumors (≥15 cm) intact with single-port laparoscopic surgery (SPLS) using SW Kim`s technique and to compare the surgical outcomes with those of laparotomy. Methods Medical records were retrospectively reviewed for patients who underwent either SPLS (n=21) with SW Kim`s technique using a specially designed 30×30-cm2-sized 3XL LapBag or laparotomy (n=22) for a huge ovarian tumor from December 2008 to May 2016. Perioperative surgical outcomes were compared. Results In 19/21 (90.5%) patients, SPLS was successfully performed without any tumor spillage or conversion to multi-port laparoscopy or laparotomy. There was no significant difference in patient characteristics, including tumor diameter and total operation time, between both groups. The postoperative hospital stay was significantly shorter for the SPLS group than for the laparotomy group (median, 2 [1 to 5] vs. 4 [3 to 17] days; P<0.001). The number of postoperative general diet build-up days was also significantly shorter for the SPLS group (median, 1 [1 to 4] vs. 3 [2 to 16] days; P<0.001). Immediate post-operative pain score was lower in the SPLS group (median, 2.0 [0 to 8] vs. 4.0 [0 to 8]; P=0.045). Patient-controlled anesthesia was used less in the SPLS group (61.9% vs. 100%). Conclusion SPLS was successful in removing most large ovarian tumors without rupture and showed quicker recovery and less immediate post-operative pain in comparison to laparotomy. SPLS using SW Kim`s technique could be a feasible solution to removing huge ovarian tumors.

중환자실 전문간호사의 전문간호행위 분류와 수행분석

김진현,김명애,김미원,김경숙,유정숙,이은희 대한간호학회 간호행정학회 2009 간호행정학회지 Vol.15 No.4

Purpose: The purpose of this study was to reclassify the advanced nursing practices of critical care nurse practitioners(CCNPs) in intensive care unit and measure the time and frequency of CCNP's activities. Method: Practices of ICU nurses are divided into RN's and CCNP's practices by a panel of ICU nursing experts. Each practice of CCNP is defined and CCNP's working time and service frequencies are monitored in general hospitals. Result: Practices of CCNP were classified into 4 domains and 32 practices. Fourteen practices by CCNPs were completed in 10 minutes and the other 12 practices consumed 10-30 minutes. A priority of practice in respiratory therapy was given to artificial airway management, management of tracheostomy patient, lower respiratory care, and the priority of CRRT was management of anticoagulation. Conclusions: Advanced nursing practices of CCNPs were recognized from those of RNs. A further research of CCNPs practices should be extended to other advanced practices and it is required to evaluate economic value of advanced nursing practice in the national health insurance system.

자료포락분석(DEA)를 이용한 보건의료의 효율성 측정

김남송,박홍섭,김은진,김설화,김정숙,김현아,김경숙,신지혜,최은정,양은진,유선미,유수진 圓光大學校 醫科學硏究所 2007 圓光醫科學 Vol.22 No.1

TV 요리프로그램 진행자의 전문성 여부에 따른 구성내용의 질에 대한 시청자의 평가

김운주,최은희,김기현,김정숙,송현숙,정은옥 충북대학교 교육 ·생활연구소 생활과학연구센터 2002 생활과학연구논총 Vol.6 No.1

The purpose of this study was to develop the instrument to assess the TV cooking program contents and to indentify the difference of cooking program contents according to professionalism of MC. The evaluation sheet was composed of 5 sectors(sanitary practices, cooking process, information & proceeding, table setting & tasting, applicability) with all 32 questions, 5-Likert scale was used. College students majoring in food & nutrition were very interested in cooking program and 72.4% of respondents knew the cable TV Food channel. The major source of cooking information was TV(51.5%). The comparison of four TV cooking programs with professional MC(2 program) and amateur MC(2 program) was performed. Except applicability sector, the mean evaluation scores of professional cooking program were higher than amateur cooking program. In the amateur MC program, 'hand washing', 'use of hair restraints', 'separate use of cutting board', 'dish towel cleanliness', 'separation of service table', 'taking a chair in tasting', 'use of individual dish' items rated low rating score(<2.00) so more control was needed. The findings of this research suggest that cooking professional should be participate in developing TV cooking program as MC or staff.

혈관질환 정보관리 시스템

김동익,김덕경,허세호,이병붕,김용신,김은숙,문지영,도영수,신성욱,김동수,김만태,진재욱,김용신 대한혈관외과학회 2002 Vascular Specialist International Vol.18 No.1

As medical technology progresses rapidly, there is a rise in the average age along with the Korean dietary lifestyle becoming more westernized, which leads to an increase in the number of vascular disease patients in Korea. Thus, we need to manage the medical information of a disease systematically in order to diagnose and treat constructively. However, since there has been no standardized method of man agement to date, a great deal of information could not be properly utilized nor studied. Therefore, the departments of Cardiology, Radiology and Neurology of Samsung Seoul Hospital recently got together to develop an information management system called the Vascular Data System. This program was developed to be run on win98 O/S, upper Pentium Ⅲ, and upper 128 MB Memory, and its source code is Dephi 4.0. It was configured for the user to set the configurations as well as do a variety of search and analysis. If this program were to be updated continuously, it may be used extensively as well as in various parts of clinical research activities.

한국인 알코올 의존 환자에서 알코올 대사 효소 유전자형 빈도의 남녀 차이

김성곤,김철민,이덕기,황인복,이현숙,김성연,전은숙,송영상,박제민,최병무,김명정 大韓神經精神醫學會 2005 신경정신의학 Vol.44 No.2

Objectives : There are a number of preceding epidemiological studies reporting gender differences in the genetic etiology of alcohol dependence. The author investigated gender difference in the frequencies of ADH2 and ALDH2 genoypes between the patients with alcohol dependence and normal control. Methods : The subjects were 141 alcohol dependent patients (104 males, 37 females) and 138 normal control (79 males, 59 females). The frequencies of 1/1 and 1/2+2/2 (2+ afterward) genotypes for ADH2 and ALDH2 were investigated in male and female between alcohol dependence and normal control group. DNA was extracted from WBC in peripheral venous blood and PCR-RFLP method was used out for genotyping. Results : First, the frequency of ADH2 1/1 genotype was significantly higher in alcohol dependent patients than normal control in both genders. Second, while there was no gender difference in the frequency of ADH2 1/1 genotype in normal controls, in the patient group however, the frequency was significantly higher in females than males. Third, in male subjects with alcohol dependence, the frequency of ALDH2 1/1 genotype was significantly higher than in male normal control subjects. On the other hand, in female subjects with alcohol dependence, the frequency of ALDH2 2+ genotype was significantly higher than in female normal control subjects. Conclusion : These results suggest that while the risk of alcohol dependence is predominantly affected by ALDH2 1/1 geno-type in male, the female ADH2 1/1 genotype is mainly associated with the risk of alcohol dependence. This means that there are gender differences in the genetic etiology of alcohol dependence.

數種의 弗素製材에 의해 前處置 再植 齒牙의 祖織學的 反應에 關한 硏究

金鐘秀,金殷淑,金鐘好,金容琦 大韓小兒齒科學會 1997 大韓小兒齒科學會誌 Vol.24 No.2

The effect of fluoride pretreatment upon root resorption after delayed replantation was studied in beagle dogs. Upper and lower incisors were extracted and bench dried for 45minutes. 1% Stannous Fluoride solution, 2% neutral sodium fluoride gel and 1.23% acidulated phosphate fluoride gel were used for the pre-treatment of replanted root surface in the experimental groups. Replantation was done with no treatment in control group. After of an experimental periods 3 weeks, animals were sacrificed by perfusion followed by sample preparation. A histomorphometric method was applied for evaluation of tissue reactions observed in each group under light microscope. Scanning electron microscopic observation was done to find out any different surface topography between groups. The results were as follows: 1. Fluoride-treated groups showed in general the better healing patterns than untreated control group. 2. Comparisons between three experimental groups revealed the superiority of APF-treated group over the other groups in terms of tissue healing reaction by showing the highest frequency in uncomplicated healing pattern and surface resorption and the lowest in inflammatory resorption, but with no statistical significance(p>.05) 3. Scanning elecron micrographs showed the irregular distribution of resorption cavitie s and the attached bone of variable size and shape in all groups. 4. It can be conclued that the types of fluoride did not have significant impact on the early tissue reactions after delayed replantation under the condition of the present experiment.

하루 콩단백질 25g 섭취를 위한 메뉴작성 및 영양성분 분석

한재숙,김정애,서봉순,이연정,서향순,조연숙,한경필,이신정,오옥희,우경자,조은자,구성자,김수진,李承彦,南出隆久 동아시아식생활학회 2002 동아시아식생활학회지 Vol.12 No.2

The purpose of this study was to develop menus for daily intake of 25g soybean protein and to analyse nutrients of these foods. Analytical values were compared to the theoretical one using the food composition table and recommended dietary allowances for Koreans (7th revision). The results are as follows. 1. Soybean curd residue stew, Soybean curd, Kimchi saute, and hard boiled soybean and lotus root were selected for the menu for January, of which the content of soy bean protein(SBP) was 33.1g, soybean stew, soybean curd and soybean sprout saute, and Italian deep fried soybean curd were for February, of which the content of SBP was 35.0g. The content of SBP in soybean paste soup with soybean curd, fried soybean curd and fried soybean curd roll, the menu for March, was 24.9g. That of April were soybean curd gratin with soymilk, soybean curd and ham with garlic dressing and the content of SBP was 26.3g. That of May were soybean porridge, soybean flour cake with honey (Dasik), soybean sprout soup and the content of SBP was 26.7g. That of June were soymilk, pan-fried soybean curd, steamed soybean curd with chicken and the content of SBP was 28.4g. That of July were noodle with soymilk, mapatofu, soybean curd salad and the content of SBP was 24.7g. That of August were soybean sprout with mustard dressing, Tossed green pepper with raw soybean flour, Tofu and Kimchi stew, soybean curd steak and the content of SBP was 26.2g. That of September were Chinese cabbage soup with raw soybean flour, sweet and sour tofu and the content of SBP was 23.2g. That of Oct. were Fermented soybean stew, soybean pan cake and the content of SBP was 24.3g. That of November were not-pressed soybean curd casserole, pan-fried mashed soybean curd with egg, stir frying deep-fried soybean curd with vegetables and the content of SBP was 22.4g. That of December were soybean curd and mushroom casserole, fried soybean curd and vegetables, hard boiled soybean curd and the content of SBP was 28.9g. 2. The ratio of the analytical value over theoretical value (A/B%) of one serving in kcal, carbohydrate, protein, fat, ash and dietary fiber were 57.7~107.7%, 42.9~131.9%, 79.2~118.3%, 54.5~100%, 40.7~80.8% and 42.1~113.2%, respectively. 3. The ratio of A/B% of one serving in Ca, K, Na, P and Fe were 44.1~93.6%, 59.0~153.1%, 53.1~117.7% 64.6%~138.8 and 33.8~77.3%, respectively. That in Fe was the lowest among minerals. 4. The ratio of analytical value over Korean R.D.A(A/C%) in Ca was relatively higher (22.0~85.9%) than that in kcal(18~63%). 5. The ratio of A/C% in Fe was 25.1~64.3% and lower than that in Ca and protein in general.

특집 1 : 김진균 (金晉均) / 김진균의 초기 음악활동 - 비엔나 유학 이전시기의 활동 자료 -

김은숙 (Eun Sook Kim) 민족음악학회 1996 음악과 민족 Vol.12 No.-