시스템 다이내믹스를 이용한 간호단위별 간호인력 산정에 관한 연구

김문실,성영희,권경자,김도형,김정아,신덕신,유인자,유재국,이현숙 병원간호사회 2006 임상간호연구 Vol.11 No.2

Purpose: The purpose of the study was to forecast manpower by building the nursing manpower-staffing model(surgical-medical nursing unite). Method: The system dynamics approach was adapted to build a simulation model for calculating medical-surgical nursing manpower-staffing. The model was built up on Venism 5.0b DSS. Result: The results in the basic circumstance are in following. The level of nursing service quality, patientsatisfaction, and nurse job satisfaction maintains higher at medical-surgical nursing unit of the tertiary hospitals with the ratio of bed to nurse 2.5:1-3.0:1 than at any other situations. The level of nursing service quality, patient satisfaction, and nurse job satisfaction maintains higher at madical nursing unit of the secontary hospotals with the ratio of bed to nurse 3.0:1 and at surgical nursing unit of the secondary hospitals with the ratio of bed to nurse 3.0:1-3.5:1 than at any other situations in the fundamental from. The results in the simulation circumstance are in following, As author raises the operating rate of bed into 95-100%, and cut skilled nursing staff down, the level of nursing-service quality, patient satisfaction, and nurse job satisfaction drops slightly. Conclusion: In terms of economic efficiency on tertiary hospotals, the ratio of bed to nurse for the best reasonable medical-surgical nursing manpower-staffing is 3.0:1. In terms of economic efficiency on secondary hospitals, the ratio of bed to nurse for the best reasonable medical nursing manpower-staffing is 3.0:1 and surgical nursing manpower-staffing is 3.5:1

7개 대학 병원에서 조사한 지역사회 폐렴의 원인균

정문현,김성민,강문원,최희정,정희진,이경원,한성우,송재훈,신형식,김의종,최강원,김민자,박승철,배현주,정윤섭,김준명,백경란,신완식,이규만,김양리 대한감염학회 1997 감염 Vol.29 No.5

목 적 : 폐렴은 많이 발생하면서 사망률이 크게 줄지 않는 질환이며, 이를 적절히 치료하기 위해서는 원인균의 상대적 빈도, 기저 질환에 따른 변화, 항균제 내성률, 사망에 관련된 인자들을 알아야 한다. 원인균의 빈도는 지역마다 차이가 있고 국내에서는 항균제 내성률이 높아 지역사회에서 발생한 폐렴을 치료하기 위한 경험적 항균제 선택에 도움이 되기 위해 서울 소재 6개 대학 병원과 천안의 1개 대학 병원이 참여하여 위의 사항들에 대해 조사를 하였다. 방 법 : 1995년에 내과에 입원했던 16세 이상 환자를 대상으로 했다. 퇴원 진단명이 폐렴 또는 폐결핵인 병록지을 찾았고, 이중에서 병원 감염을 제외하였다. 특이도를 높이기 위해, 이들 중에서 호흡기 증상이 있고 발열이나 저체온이 있으면서 흉부 X-선에서 이상 음영이 있는 환자만을 대상으로 했다. 폐결핵은 위의 기준에 입원 초기에 항균제 치료를 하고 입원 7일 이후에야 항결핵제가 투여된 경우만을 폐렴의 원인균으로 하였다. 혈액 배양에서 양성, 객담에서 항상균이나 M. tuberculosis가 증명된 경우, 혈청학적으로 항체가가 4배 이상 증가된 경우, 조직에서 원인균이 진단된 경우는 확정(definitive) 원인균으로 하였고, 객담에서 배양된 균이 그람 도말과 일치할때, 항결액제에 대한 반응으로 진단한 폐결핵, 단일 항체가 양성이고 이에 대해 항균제를 사용했을 때는 가능(probable) 원인균으로 정의하였다. 다세균 감염균은 각각 다 른 원인균으로 처리하였다. 임상 조사와 함께 임상병리과에서 S. pneumoniae, H. influenzae, M. catarrhalis, mycoplasma, 항상균에 대해 검사 의뢰 건수, 배양 양성수, 항균제 감수성 결과를 조사하였다. 결 과 : 폐렴의 증례 정의에 부합하지 않은 135명과 폐결핵의 정의에 해당하지 않는 230명을 제외하고 남은 246명의 평균 나이는 58.2세이고 남성이 142명(58.2%) 이었고, 71%의 환자에서 기저 질환이 있었다. 진단 방법의 시행 횟수는 혈액 배양 77.6%, 혈청 검사 18.3%, 기관지경 검사는 4.1%였고, 세균의 항원 검사를 한 예는 없었다. 원인균이 밝혀진 예는 77명(31.3%)이었다. 다세균 감염이 4명에서 있었고, 원인균의 상대적 빈도는 결핵 20명(확정 17, 가능 3: 6개 병원 자료), 폐렴구균 18(확정8 가능 10)명과 폐렴구균이 아닌 Streptococcus 3명 (모두 확정), H. influenzae 11명(모두 가능), 그람음성간균 11명(확정 7, 가능 4) (K. pneumoniae 8건), Mycoplasma 5명(확정 1, 가능 4), S. aureus 4명(확정 2, 가능 2), mucormycosis 1명(확정)이었다. 평균 입원 기간은 19일이고, 중환자실 입원률과 인공 호흡기 사용율은 각각 18%와 9.3%였다. 사망률은 13.8%였고 사망까지 평균 기간은 14.6일 이었다. 다변량 분석에서 사망을 예측할 수 있는 인자는 저체온과 빈호흡이었다. 임상병리과에서 배양되었던 모든 폐렴구균의 Penicillin 내성률은 서울 3개 병원에서 82-88%, 천안에서 72%였다. 폐렴 환자의 혈액에서 배양된 7주는 모두 Penicillin에 감수성이 있었다. K. pneumoniae 8주 모두 cefotaxime과 gentamicin에 감수성을 보였다. 결 론 : 후향적 조사이고 병원마다 원인균 진단에 차이가 있지만, 원인이 밝혀진 경우에는 결핵과 폐렴균이 흔하였고, 무균 부위에서 배양된 폐렴구균의 항균제 내성률은 낮았다. 원인이 밝혀지지 않은 경우가 많고, 혈청검사로 진단되는 원인균이 드물며, 분리균주가 적어 항균제 내성 정도를 추정하기 어려워, 이를 밝히기 위한 전향적 조사가 필요하다. Background : Community-acquired pneumonia (CAP) is one of the leading causes of mortality and morbidity, but its management is still challenging. The limitation of diagnostic methods to identify etiologic agents rapidly make it necessary to use empiric antibiotics in almost all patients, and furthermore the discovery of new respiratory pathogens and the emergence of antibiotic-resistant organisms pose difficulties to the selection of an empiric regimen. To clarify the factors necessary for the optimal choice of empirical antibiotics, such as the frequency of etiologic agents, the attributable rates to death and antimicrobial resistance rates in the community, six university hospitals in Seoul and one university hospital in Cheonan were participating in this study. Methods : medical records of adults (>15 years of age) hospitalized for CAP or pulmonary tuberculosis between April 1995 and March 1996, were reviewed. Patients who satisfied all of the following criteria were included in the study: (1) fever or hypothermia; (2) respiratory symptoms; and (3) pulmonary infiltrates on chest roentgenogram. To exclude cases of pulmonary tuberculosis whose roentgenographic features were so typical that it could be easily differentiated from conventional pneumonia, two additional criteria were required for inclusion: antibiotic treatment during the first week of hospital admission and initiation of anti-tuberculosis medications thereafter. Organisms isolated from sterile body sites, acid-fast bacilli or Mycobacterium tuberculosis isolated from sputum, pathogens diagnosed by a 4-fold rising titer of antibodies to “atypical”pathogens, or pathogens revealed by histopathology were defined as definitive cause of pneumonia; isolates from sputum withcompatible Gram stain, pathogens diagnosed by a single diagnostic titer plus use of a specific antimicrobial agent, or tuberculosis diagnosed by clinucal response to anti- tuberculosis medications were considered probable cause of pneumonia. The records of the clinical microbiology were reviewed for isolates of S. pneumoniae, H. influenzae, M. catarrhalis, Mycobacterium or acid-fast bacilli, and Mycoplasma. Then the frequency of these agents, antimicrobial resistance rates of resiratory pathogens from all body sites, and their clinical significance were evaluated. Results: After excluding 365 patients (230 with pulmonary tuberculosis and 135 with CAP) who were screened for inclusion but did not meet the inclusion criteria,246 persons were enrolled in this study. Their mean age was 58.2 years old with slight male predominance (58.2%), and 171(71%) patients had underlying illnesses. Blood cultures were performed on 191 (77.6%) patients and serologic tests on 44(18.3%) patients. The etiologic agents were identified in 31.3%, and the list of individual agents, in decreasing order, was pulmonary tuberculosis (17 definite and 3 probable: data of six hospitals), S. pneumoniae (8 definite and 10 probable), non-pneumococci (3 definite), aerobic gram-negative bacilli (7 definite and 4 probable), Haemophilus spp. (11 probable), mycoplasma (1 definite and 4 probable), polymicrobial infections (2 definite and 2 probable: E. coli and S. agalactiae, M. tuberculosis and S. aureus, S. pneumoniae and H. influenzae and A. baumannii and K. pneumonias), S. aureus (2 definite and 2 probable) , and mucormycosis (1 definite). Among gram-negative bacilli, K. pneumoniae was the most common agent (8isolates). therates of admission to the intensive care unitand of using assisted ventilation were 18% and 9.3%, respectively. The mortality was 13.8% and logistic regression analysis showed that hypothermia and tachypnea were associated with death. Hospital stay averaged 19 days. Susceptible rates of S. pneumoniae isolated from all body sites to penicillin ranged from 8% to 28% but seven isolated from blood of patients with pneumonia were susceptible to penicillin. Also all 8 isolated of k> pneumoniae from patients with pneumonia were susceptible to cefotaxime and gentamicin. Conclusion: In Korea, in addition to S. pneumoniae, M. tuberculosis is an important agent causing community-acquired pneumonia. The low incidence of etiologic diagnosis is probably related to infrequent requesting of test "atypical" pathogens and does not represent the true incidence of infections by "atypical" pathogens, which well be answered by a prospective study. The antimicrobial resistance rates of major respiratory pathogens from sterile body sites are low, however, because of a small number of the isolates this result needs confirmation by a nationwide surveillance of antimicrobial resistance.

성인간호학회지 논문(1989-2000)의 내용과 경향 분석

서문자,김소선,송미순,이명선,오의금,신경림,김옥수,이숙자,이영자,오효숙,정재심,김철규 성인간호학회 2001 성인간호학회지 Vol.13 No.4

"Journal of Korean Academy of Adult Nursing" has been published since 1989 and more than 330 articles have been published up 2000. We reviewed all the articles published in this journal to analyze the contents and trend of published articles and to find out the way of improvement both in quantity and quality of studies in this area. The results are as follows : 1) Ninety percent of articles were quantitative studies. Experimental design was used in 16.1% and quasi-experimental design was adapted in 73.6% of articles. Qualitative research were 10.3% of total articles reviewed. 2) Only 5.1% of articles described theoretical framework and 73.6% of experimentally designed articles included research hypotheses. 3) Among experimental studies, only one was true experimental studie design. Eighty nine point three persent had descriptive survey method among non-experimental studies. Amog the thirty four qualitative studies, phenomenologic(73.5%), grounded theory(14.7%), and ethnographic (11.8%) design were used. 4) Most of research subject were patients and few healthy people, healthcare worker, and patient family. 5) Psychosocial data collection method which used questionnaire were 53.7% and interview. physical measurement, observation were used in 22.8%. 8.2% 5.4% of articles respectively. 6) Total number of keywords were 692, and average number of key words per article was 2.2. Health-related keyword was the most frequently used according to four metaparadigm of nursing (human, health, nursing, and environment). Environment related keyword was rarely appeared. The number and quality of nursing research in "Journal of Korean Academy of Adult Nursing" have been improved continuously. It is difficult to find out special trend or characteristics which is unique in this journal because of relatively short history of adult nursing studies. This review study was performed to analyze adult nursing studies only in the view of quantitative aspect, but it is needed to analyse qualitatively to find philosophical or theoretical trend in nursing.

三國時代 指環에 관한 硏究

金文子 水原大學校 1994 論文集 Vol.12 No.-

he method of wearing and style of the Rings in the Period of the Three States were studied. In the Period of the Three States, they used same method of wearing in the Rings. In some cases They putted the several Rings on the five fingers in all. The styles of the Rings were divided into four groups, a plain Ring, diamond-shaped Rings, ornamented Rings, beads-limked Rings. These styles were influenced by scythe styles, and developed greatly in the Three States and transmitted to Japan.

三國時代 圓錐形 垂飾에 대한 硏究

김문자 服飾文化學會 2002 服飾文化硏究 Vol.10 No.5

The purpose of this study is to classify of the Cone shaped Pendants in old tombs of Three Kingdom States. These Cone shaped Pendants are made of bronze and coated with gold plate or Gold. Each Cone shaped Pendants consists of a Sehwhan(細環) type or Taewhan(태환) type, a median part in the form of a several joined small globe, or circular shape, and finally a cone-shaped pendant. Cone shaped Pendants is 5 part(A-a, A-b, B-1-a, B-1-b, B-2-b type) in according to the styles of the Sehwhan(細環) and Taewhan(태환) type and median ornament types. A-a, A-b, B-1-a, B-1-b type was general style that was found in most of the old tombs in Kokuryo, Pacjae, ancient Silla. B-2-b type was excavated from the only Kokuryo tombs.

渤海 服飾에 대한 硏究

金文子 水原大學校 1997 論文集 Vol.15 No.-

This thesis to study the Costume in the Palhae Dynasty. Through the tombs and frescos, men in the Palhae Dynasty weared Malack and Boktu on the head. They also weared Danryangpo and boots or Samsin. Girdles were made by attaching Square or D-shaped gold, silver, gilt-bronze plates to leather belts. Women weared YooKoon and Daesoopo, Pyo. women's hairpins and combs are made of gold, silver, copper, wood and bone. In the Ornaments Earrings consisted of a ring to hang the earrings to the ear, a middle ornament hung from it to a pendants which hung below. Necklaces were consisted of row of beads. Bracelets were shaped of circle and oval. Rings were made by gold, silver, bronze and most simple style.

高句麗 時代 裝身具에 대한 硏究

金文子 水原大學校 2000 論文集 Vol.18 No.-

The purpose of this study is to classify of the Ornaments in Kokuryo Dynasty. Trough the antique records and bequests, paintings of tombs in Kokuryo, much of ornaments has been excavated is earrings, necklaces, bracelets, rings. We can find commonness that earrings consisted of a ring to hang the earrings to the ear which was thin and thick ring. Thin ring was divided to plain ring and pendant ring. Pendant ring of thin and thick ring was a middle ornament hung from it to a pendants which hung below was made of heart shaped, cone shaped and the others. First, Heart shaped Earring is 7 part in according to heart styles. I-A, II-1-A, II-3-B type was general style that was found in most of the old tombs in Kokuryo. Cone shaped Earring is 6 part in according to the styles. Heart shaped Earring is 7 part in according to heart styles, A-a, A-b, B-1-a, B-1-b, B-2-b type was found. Plain Bracelets and engravings of abdomen on Bracelets are common in Kokuryo. The styles of the Finger rings were a plain ring and rhomb-shaped style, and engravings of abdomen on the ring in Kokuryo.

요실금이 있는 중년여성의 일상생활불편감 및 우울에 관한 연구

김금순,이윤정,서문자,박영숙 서울대학교 간호대학 간호과학연구소 1999 간호학 논문집 Vol.13 No.1

The purpose of this study was to explore the relating factors, discomfort and depression due to urinary incontinence in middle-aged women. The subjects were 215 women in the age 35-65 years old who dewelled in community. The data were collected from August to December in 1996 with interview using structured questionaire composing of items of general characteristics, obsteric characterisitcs, disease charactteristics, situation of experiencing urinary incontinence, discomfort, and terapeutic method, and Beck's depression inventory. The data were analysed using SPSS/PC+ program; Cronbach's, frequency, percentage, Spearman's or pearson's coefficient correlation. The results of this study were as follows: 1) The mean duration of experiencing the urinary incontinence was 36.16 moths and the 60.9% of the respondents experienced a few frequency of urinary incontinence and the 77.2% was somewhat small expressed as "wetting their clothes". 2) The urinary incontinence induced situations were coughing, sneezing, hasty, and ascending abdominal pressure. 3) The ost common situations of discomforts associated with hrinary incontinence were diversional activity such as exercise, long period journey, and interpersonal relations. 4) The 80.5% of ascending abdominal pressure experienced the urinary incontinence, and the most common symptom of urinary incontinence was the frequent urine(43.3%) 5) The urinary incontinence correlated with menopause, age of menopause(p<.05) and age group(p<.01) significantly. 6) The 89.7% of urinary incontinence were not treated, but they wanted to try noninvasive methods such as the herb medicine(27.4%), pelvic muscle exercise(27.0%), and biofeeback(4.2%). 7) situation of experiencing urinary incontinence, discomfort and symptoms of depression correlated with urinary incontinence significantly(p<.05). In conclusion, we need to develop and provide various nursing interventions such as the pelvic muscle exericse, biofeedback and stress & depresion management program in middle-aged women who dewells in community in view of quality of life, health maintenance and promotion.

三國時代 팔찌에 대한 연구

金文子 水原大學校 1988 論文集 Vol.6 No.-

The method of wearing and the style of the bracelet in the period of the three states were studied. In the period of the three states, men and wemen used same method of wearing in which wear several bracelets at the both wrists, and this method transfered to Japan. The styles of bracelet were devided into five groups, plain ring shaped bracelet, snake abdomen shaped bracelet, ornamental band shaped bracelet, chain shaped bracelet and strung beads bracelet. There styles were influenced by scythe style, and developed greatly in the three states and transmitted to Japan.

입원환자 낙상 발생 실태와 원인에 관한 분석 연구

김철규,서문자 한국의료QA학회 2002 한국의료질향상학회지 Vol.9 No.2

Background : The purpose of this research was to examine the fall incidence rate and its related factors of fall in inpatients. Methods : The data were collected from the 138 fall incident reports in one tertiary hospital in Seoul from April 1st 1999 to September 30th 2001. The Fall Incident Report Form was originally developed based on that of Massachusetts General Hospital revised in 1995. And this was modified for this survey by the collaborating work of QI team including researcher and department of nursing service of this particular hospital. The contents of Fall Incident Form were general characteristics of patient, factors related to fall, types and places of fall, circumstances, nursing interventions, and outcome. Results : 1)the incidence rate of fall was 0.08% of total discharged patients and 0.081 per 1000 patient-day. This incidence rate is much lower than that of general hospitals in USA. This finding might result from the different incidence report system of each hospital. 2)The characteristics of fall-prone patient were found as follows. They were mostly over 60 years old, in alert mental status, ambulatory with some assistance, and dependent on ambulatory device. The types of diseases related high incidence rate were cerebrovascular disease(3.2), hypertension(1.6), cardiovascular disease(1.4), diabetes(1.3) and liver disease(0.6). 3)The majority of fall events usually occurred in bed, beside(walking or standing)and bathroom in patient room. Usually they were up on their own when they fell. And there were more falls of elderly occurred during night time than day or evening. 4)63.8% of fall events resulted in physical injuries such as fracture and usually the patients had diagnostic procedures and some treatment(ex.suture)which caused additional cost to the patients and their families. 5)The found risk factors of fall were drugs(antihypertensive drug, diuretics)and environmental factors like too high bed height, long distance of bedside table and lamp switch, and slippery tile of bathroom floor. Conclusion : Considering these results, every medical and nursing staff should be aware of the risk factors of patients in hospital, and should intervene more actively the preventive managements, specially for the elderly patients during night. Therefore, it is recommended that the development of Fall Prevention Programs based on these results.