뇌혈관 환자에 대한 간호진단 적용 분석

김명희 대구보건대학 1996 대구보건대학 論文集 Vol.16 No.-

간호진단의 실무적용을 증진시키고 간호의 질을 높이기 위해 대구시내에 소재한 Y의료원 신경계 변동에 입원한 환자 102명에게 적용된 간호진단수 총 109개를 NANDA회의에서 채택된 간호진단명 105개에 준하여 분석한 결과 환자 1인당 평균1개를 사용하였으며 총 사용 NANDA 간호진단명은 9개로 대상자 102명중 가장 많이 사용된 간호 진단은 안위의 변화 44.0%, 불안 19.3%, 부적절한 개인적 대응 12.8%로서 높게 나타났다. 본 연구의 결과 적용된 간호진단의 종류 및 빈도가 매우 낮았으며 간호진단에 대한 사정도구개발의 연구와 간호사들에게 지속적인 보수교육이 강화되어야 한다고 생각한다. This research was done for the improvement of practical appliance of Ng. diagnosis and for the elevation of nursing guality(level). I analized the Ng. diagnosis with 109 diagnosis used by NANDA conference from 102 patients who were admitted for Neuro Surgery Ward of Y medical Center which is in Taegu. Ther general characteristics of the patients are as follows ; by sex, men were 57 cases(55.9%) and women were 45 cases(45.1%). In age, 26~29 were I case(1.0%), 30~39 were 10 cases(9.8%), 40~49 were 30 cases(29.4%), 50~59 were 32 cases(31.4%), 60~69 were 26 cases(25.5%), and over 70 were 3 cases (2.9%). In diagnosis of the patients, Cerebral Infarction were 52 cases(50.9%), Intracerebral Hemorrhage were 20 cases(19.6%), Subarachnoid Hemorrhage were 12 cases(11.8%), Epidural Hemorrhage were 7 cases(6.9%), Subdural Hemorrhage were 5 cases(4.9%), Aneurysm were 4 cases(3.9%), Cerebrovascular Accident were 2 cases(2.0%). I used all 109 Ng. diagnoses which means one person used about 1.0 of NANDA'S diagnoses. All used NANDA'S was 9 diagnoses. The most popular diagnoses were alteration in Comfort(44.0%), Anxiety(19,3%), Ineffective individual Coping(12.8%) in 102 cases. Bae showed ineffective air way clearance(48.4%), impaired Physical mobility, ineffective Breathing pattern, Knowledge deficit, All of them were 41.9% in her diagnosis analysis research of Open Heart Surgery Patients. Kang showed self care deficit(27.7%), skin integrity(23.4%), tissue perfusion, alteration in cerebral area(16.4%), and high risk for infection(0.6%), in her diagnosis analysis research of brain disease patients. Park(1987) showed the representative diagnosis of high risk for injury, altered nutrition less than body reguirements, knowledge dificit, sleep pattern disturbance, and fluid volume excess, in her evaluations, of the original and revealational research rate of five diagnosis in patients with CAAH or CAVH. When we consider the specifics of each patient we can determine how the Ng assessment reveals that patients problems differ according to their disease. Signs and symptoms are one thing, and nursing requests are another. As the specific response-formal analysis of 9 Ng. Diagnoses in which the most popular diagnoses were Emotion(33.4%), Exchanging(22.2%), Moving(12.0%), choosing(11.1%) Knowing(11.1%) but Communicating and Relating, Valuing, Perceiving were not applied.

중증외상환자의 치료경과 시간과 활력징후에 따른 응급처치 및 간호활동

김명희,박정하,김명희,구지은 기초간호학회 2014 Journal of korean biological nursing science Vol.16 No.3

Purpose: The aim of this study was to identify necessary emergency treatment and nursing activities for severe trauma patients according to elapsed time and vital signs. Methods: A survey was conducted with 121 patients over 15 points ISS on EMR from June 1, 2011 to May 31, 2012. Collected data were analyzed with descriptive statistics, applying McNemar’s test using SPSS 12.0. Results: Almost all of the subjects were men and the mean age was 46.9. Run-time for primary diagnosis, treatment decision, and leaving for the hospital room was 0.19, 4.36, and 4.21 hours, respectively, and stayover time was 9 hours. Regardless of vital signs, emergency treatments involving ambu-bagging, intubation, ventilator, and central vein catheterization insertion were offered within an hour. Central venous pressure, Foley catheter/Levin tube preparation and maintenance were performed in cases of unstable vital sign patients within an hour. Unrelated to vital signs, nursing activities for consciousness assessment, skin assesment and wound care, bed sore/fall down assesment and care, intravenous injection insertion and maintenance were conducted for all severe trauma patients within an hour. Foley catheter/Levin tube drainage care was performed for patients who had unstable vital signs within an hour. Conclusion: Emergency treatment and nursing activities for severe trauma patients were specific according to elapsed time and vital signs.

중증외상환자의 주 손상 부위별 특성과 간호활동

김명희,김명희,박정하 기초간호학회 2013 Journal of korean biological nursing science Vol.15 No.4

오늘날 산업화와 경제성장에 따라 교통사고, 재해, 산업 재해 등의 각종사고가 증가하면서(Kim, J. J. et al., 2011) 매년 12만 5천 명의 중증외상환자가 발생하고, 이 중 1만 1천 명이 사망하고 있지만, 적절하고 신속한 치료가 이루어진다면 살릴 수 있는 중증외상환자도 3천 5백 명에 달한다(Joo, 2010). 외상환자의 예방가능 사망률은 그 나라의 전체적인 외상체계를 평가할 수 있는 지표로(Mackenzie, 1999) 미국과 일본의 중증외상환자 예방가능 사망률은 10-15% (Esposito, Sanddal, Reynolds, & Sanddal, 2003; Kunihiro, 2005)인 데 비해 국내는 33%로(Kim, 2011) 2배가 넘는 실정이다. 외상진료체계를 구축하여 외상환자의 예방가능 사망률을 줄이고 있는 외국사례를 토대로(Stewart, Lane, & Stefanits, 1995) 국내에서는 2009년 중증외상 특성화 후보센터를 지정하였고, 향후 전문외상센터를 운영할 계획이다(Central Emergency Medical Center, 2009). 현재 중증외상환자들은 권역응급의료센터에서 치료를 전담하고 있으나 입원대기 환자들이 정체되고(Chun, 2008) 치료전담 의료 인력이 부족(Lee, 2011)하여 중증외상환자의 진단, 치료 및 처치가 지연되고 있다. 외상환자는 외상초기의 적절한 치료여부에 따라 예후에 많은 영향을 받으므로(Nguyen, Rivers, & Havastad, 2000), 진단 및 치료에 소요되는 시간을 단축시켜 빠른 시간 내에 처치가 이루어지는 것이 매우 중요하다(Kim et al., 2007). 외상환자의 대부분은 다발성 외상환자들로(Kim, T. Y. et al., 2011) 복합적인 문제들을 동반하는 경우가 많기 때문에 생명유지를 위한 기본적인 처치와 동시에 손상부위에 따른 사정, 처치 및 간호활동이 이루어져야 한다. 국군간호사관학교의 외상간호교육과정(Trauma Nursing Core Course, TNCC)에 신체의 해부학적 부위에 따른 간호가 있지만, 이는 사고현장에서부터 병원에 도착하기까지의 상황에 대한 것(Korean Nurses Association, 2013)이고, 응급환자 매뉴얼의 외상환자 간호처치는 이론적이므로 임상실무현장을 반영한 병원 도착 후의 중증외상환자의 간호활동에 대한 연구가 필요하다.

[기획특집] 2007년 신춘문예 당선자 특집 - 김명희

김명희 고요아침 2007 시조시학 Vol.- No.-

기서 (寄書) : 조선총림 (朝鮮叢林)에 용상대덕 (龍象大德)을 향 (向)하야 [ ㅎ.야 ] 청년도제 (靑年徒弟)의 교육장려 (敎育奬勵)를 충고함 [ ㅎ.ㅁ ] / 보수 (寶輸) 김명희 (金明熙)

김명희 조선불교월보사 1911 朝鮮佛敎月報 Vol.2 No.-

독일청소년문학에 나타난 핵문제와 문학수업모형 연구 - 파우제방의 핵폭발 뒤 최후의 아이들, 구름을 중심으로

김명희 한국독일언어문학회 2013 독일언어문학 Vol.0 No.62

Bei der vorliegenden Arbeit geht es um einen Versuch, im Unterricht die Atomproblematik in ‘Die letzten Kinder von Schewenborn’ und ‘Die Wolke’ von Gudrun Pausewang zu behandeln. Die literarischen Werke sind schonungslose Bücher. Sie zeigen die Folgen eines Atomkrieges und eines Atomunfalls in aller Härte. Die Bücher spiegeln die Angst vor einer nuklearen Verseuchung wider, die insbesondere Anfang der 1980er-Jahre und nach dem Reaktorunfall von Tschernobyl 1986 herrschte. Eine der wichtigen Punkte in diesen Roman ist der Generationskonflikt zwischen Kindern und Erwachsenen und die Anschuldigungen gegen die älteren Generationen. Sie glauben an die Macht und Autorität der Regierung und warten nur auf Hilfe von außen. Im Unterrichtsvorschlag wird der Schwerpunkt auf die Atomkatastrophe und das Leben der Menschen gelegt, und werden handlungsorientierte Methoden gleicherweise berücksichtigt wie traditionelle Verfahren der Texterschließung. Hierdurch haben die Studenten die Möglichkeiten über die Konzequenzen der atomaren Katastrophe ― Auswirkungen auf Menschen und Umwelt sowie generelle Langzeitwirkungen ― zu reflektieren. In Korea ist die Problematik der Atomkraft besonders aktuell, da es ein großes Risiko durch Atomwaffen in Nordkorea und die Atompolitik in Südkorea gibt. Dieser Unterrichtsentwurf kann nicht nur in Universitäts-, sondern auch im allgemeinen Schulunterricht angewendet werden.

위절제술 중 저체온이 수술 후 감염과 말초 백혈구 수에 미치는 영향

김명희,강영란 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.43 No.6

Background: Hypothermia occurs commonly during surgery. An increased incidence of hypothermia-induced morbidity of surgical patients has been reported. Immunosuppression has also been demonstrated after major surgery. Therefore, we investigated the rate of inflection and the changes of while blood cells depending on body temperature during a gastrectomy. Methods: Sixty patients were randomly divided into warmed intraoperatively with a circulating warm water mattress (group 1) or warm intravenous fluid/humidifier filter/circulating warm water mattress (group 2). Core temperature was recorded every 15 min during surgery and every 30 min in the recovery room. Blood samples for measurement of while blood cells were obtained preoperatively, immediately, post-op day 1 and day 2 after surgery. Results: Group 1 began to have a decrease in temperature at 30 min after surgery and a significantly lower temperature than group 2 during the surgery and 60 min in the recovery room (P<0.05). Compared with preoperative values, surgery caused an increase in neutrophils, and a decrease in lymphocytes in both groups (P<0.05). Compared with group 2, more concentrations of neutrophils and less concentration of lymphocytes and monocytes were found in group 1 on the post-operative 2^nd day (P<0.05). Fever above 37.3℃ was found in 17 of 30 patients in group 1, but in only 14 of 30 patients in group 2. Pneumonia (one patient), urinary tract infection (one) and surgical wound infection (two) were only found in group 1, but the incidence of infection was not statistically significant between the groups. Conclusions: Intraoperative hypothermia was associated with a delayed recovery of changes in white blood cells. (Korean J Anesthesiol 2002; 43: 742~748)

유엔의 재난위험 감소 추진체계 및 전략의 시사점

김명희 한국융합학회 2020 한국융합학회논문지 Vol.11 No.1

This paper examines in depth the UN's disaster risk reduction system and framework that affect a country's disaster safety strategy and focuse on identifying the global trends in disaster risk reduction that have emerged in the Hyogo and the Sendai Framework, a disaster risk reduction strategy proposed by the UN since 2000. For this aim it attempts a theoretical review based on collecting a variety of domestic and international literatures, draws meaningful implications and suggests alternatives to a national disaster risk reduction policy. According to the analysis, the UN disaster risk reduction mechanism is UNISDR, the Secretariat is UNDRR, and the SRSG represents it, and the Sendai Framework, developed from the Hyogo Code of Conduct, a global strategy which has been for disaster safety for the past decade, will lead global disaster safety for the next decade. The policy implications drawn from the analysis of both strategies are the emphasis on consistent international coordination, strengthening resilience and an integrated and comprehensive approach. In conclusion, this paper proposes the need for a disaster risk reduction strategy to establish a resilience reinforcement system to proactively identify and cope with risk factors and to minimize impacts, to promote the coordination of international coordination and cooperation at the government level. 이 논문은 한 국가의 재난전략 수립에 영향을 미치는 유엔(UN)의 재난위험 감소 추진체계와 전략을 심도 있게 고찰하고 2000년 이후 유엔이 제시한 재난위험 감소 전략인 효고 행동강령과 센다이 프레임워크에 나타난 재난위험 감소를 위한 글로벌 동향을 파악하는데 초점을 둔다. 논문의 목적은 복수의 국내ㆍ외 문헌들을 수집하여 이론적 분석을 시도하고 한 국가의 재난위험 감소 정책에 유의미한 시사점을 도출하여 대안을 제시하는데 있다. 분석의 결과에 따르면 유엔의 재난위험 감소 추진체계는 UNISDR이며 산하에 사무국으로서 UNDRR을 두고 있고 사무국장인 SRSG가 조직을 대표한다. 또한 지난 10년간 재난안전의 글로벌 전략이었던 효고 행동강령을 이은 센다이 프레임워크가 향후 10년 간 글로벌 재난안전을 주도할 것이다. 두 전략의 분석에서 도출한 정책적 시사점으로 일관된 국제공조체계의 강조, 복원력의 강화, 그리고 통합적ㆍ포괄적 접근의 강조를 제시하고 결론에서 위험요인에 미리 대처하고 충격을 최소화하는 복원력 강화 시스템의 구축과 정부차원의 일관되고 조정된 국제공조 및 협력의 활성화, 대응체계의 신속성을 강화한 재난위험 감소 전략의 수립의 필요성을 제안하였다.

전신 마취후 환자운반시 동맥혈 산소포화도에 대한 연구

김명희,박광원,길혜금,김원옥 대한마취과학회 1989 Korean Journal of Anesthesiology Vol.22 No.4

The arterial oxygen saturation (SaO2) changes during transportation of postanesthetic patients from operating room to recovery room were measured by pulse oximeter. Fourty-one ASA PS I premedicated children were studied. SaO2 was recorded on operating room under administration of 100% oxygen (T2), transportation one minute (T2), two minutes (T2), three minutes (T2), on arrival in the recovery room (R0), One minute (R1 ) and two minutes (R2) in the recovery room under administration of oxygen via nasal cannula or catheter through endotracheal tube. The significant difference between the extubated group (group 1) and the intubated group (group 2) was not found. The proportion of children with SaO2$lt;95% (PaO2$lt;75mmHg) on arrival in the recovery room with room air inhalation were 13 cases (31.7%). It is concluded that children receiving anesthesia can become hypoxemic during postanesthetic transportation with room air inhalation and in the recovery room.

요양병원 입원 노인의 우울 관련요인

김명희,김윤경,Kim, Myung-Hee,Kim, Yun-Kyung 대한예방한의학회 2012 대한예방한의학회지 Vol.16 No.3

Objective : The study was designed to identify the factors related to depression of the elderly patients in geriatric hospital. Method : The subjects consisted of 198 old people who admitted in three geriatric hospital located in Daegu City. The Data was collected through interview with questionnaire from July 16 to August 16, 2012. Results : The general characteristics which significantly affected depression was perceived health status(F=18.158, p=.000). There was a slightly negative correlation between activity daily living & depression(r=-.378,p=.000) and strongly negative correlation between life satisfaction & depression(r=-.573, p=.000). Among the factors related to depression of the subjects, life satisfaction had highest expanatory power of 32.8%. Conclusion : The finding of this study provide useful information for constructing an intervention program and care for the elderly patients in geriatric hospital with depression.