말기암환자의 섬망으로 인한 진정제 투약과 생존기간에 관한 후향적 코호트 연구

박형숙,김대숙,배은희,김정림,서정화,윤정미,Park, Hyoung Sook,Kim, Dae Sook,Bae, Eun Hee,Kim, Jung Rim,Seo, Jung Hwa,Yun, Jung Mi 한국호스피스완화의료학회 2016 한국호스피스.완화의료학회지 Vol.19 No.2

목적: 본 연구의 목적은 섬망이 있는 말기암환자에 있어 진정제의 투약 투약 관련 특성을 파악하고, 진정제 투약군과 비투약군 간의 생존기간의 차이를 확인하기 위함이다. 방법: 본 연구는 2012년 1월부터 2013년 12월까지 B 광역시 소재 P대학교병원에서 응급실과 수술실, 중환자실을 제외한 병동에서 임종한 암환자 900명 중 경과기록지, 간호기록지를 통해 섬망선별 도구인 Nu-DESC를 이용하여 섬망이 있었던 말기암환자 240명을 대상자로 선정하였다. 투약기록지를 통해 진정제인 haloperidol, diazepam, lorazepam을 정맥 또는 근육주사로 규칙적이거나 필요 시 투여한 횟수를 조사하였다. 결과: 연구 대상자의 섬망기간은 최소 1일에서 최대 61일까지 나타났고, 중앙값은 5일이었다. 연구 대상자에게서 나타난 섬망 특성은 부적절한 행동이 35.0%로 가장 많았다. 연구 대상자의 연령(F=3.96, P=0.021), 원발암의 종류(F=3.31, P=0.010), 항암치료 여부(t=-3.44, P=0.001)에 따른 섬망기간이 유의한 차이가 있었다. 연구 대상자가 진정제를 복용한 경우는 72.1%이었고, 투약된 진정제의 종류는 haloperidol이 59.6%로 가장 많았다. 진정제 투약군의 생존기간은 평균 16.85일, 비투약군은 9.37일로 나타났으나 이는 통계적으로 유의하지는 않아(t=1.766, P=0.079) 진정제 투약이 생존기간에 영향을 미치지는 않았다. 결론: 말기암환자의 섬망 발생 시 진정제 투약이 생존기간에 미치지 않았다. 이러한 결과를 바탕으로 생명단축의 윤리적 문제로 인해 진정제 사용을 꺼려하기 보다는 증상완화를 위한 진정제 치료를 적극적으로 권유할 수 있다. 또한 섬망은 가족이나 의료진과의 의사소통 장애를 유발할 뿐 아니라 환자나 가족들에게 스트레스로 작용하며 돌봄에 대한 부담감을 가중시키므로, 적절한 진정제의 투여는 말기암환자와 가족의 안위를 위해 적극적으로 추천하는 바이다. Purpose: This study analyzed the difference in survival time of patients with delirium according to sedative medication. Methods: From January 2012 through December 2013, a retrospective cohort study was performed using the electronic medical records (EMR) of Pusan National University Hospital. Among 900 patients who died from cancer, we selected 240 who suffered delirium based on the EMR. The Nu-DESC delirium screening test was used to diagnose delirium. Results: The median length of delirium period was five days. Delirium characteristics were dominated by inappropriate behaviors (35.0%). Sedatives were administered in 72.1% of the cases. The most frequently used sedative was haloperidol which was used in 59.6% of cases. The delirium period significantly differed by patients' age (F=3.96, P=0.021), cancer type (F=3.31, P=0.010), chemotherapy (t=-3.44 P=0.001). The average survival time was 16.85 days for the sedative medication group and 9.37 days for the non-medication group, which, however, was not significant (t=1.766, P=0.079). Conclusion: In this study, the use of sedatives did not affect patients' survival time. Thus, appropriate sedative medication can be positively recommended to comfort terminal cancer patients and their families.

중환자실 간호사의 직무스트레스와 건강상태에 관한 연구

박형숙,조규영,강은희,Park, Hyoung-Sook,Cho, Gyoo-Yeong,Gang, Eun-Hee 한국중환자간호학회 2010 중환자간호학회지 Vol.3 No.1

Purpose: This study was to investigate Job Stress and the Health status of ICU Nurses. Methods: Data was accumulated from 230 ICU nurses serving at least more than one year in 500 bed order hospitals during the period of three months from June 1 to August 31, 2009. Results: The average job stress was $3.14{\pm}.59$ points, which was relatively high, The average health status was $1.52{\pm}.19$ points, There was significant difference according to religion and subjective health status in Job Stress, There was significant difference according to age, religion and subjective health status in Health Status, There was significant difference according to satisfaction of work, satisfaction of personal relations, impulse to give up duty and in service education in Job Stress, There was significant difference according to satisfaction of work. satisfaction of personal relations, and expectant nursing job in Health Status, There was significantly negative relationship between job stress and health status. Conclusion: Job stress has the most important impact on health status of ICU nurses, Based on the finding, we could conclude that job stress management of ICU nurses should be required to improve health status.

입원환자의 TPN 투여전 영양상태 평가

박형숙,이수경,하미정,Park, Hyoung-Sook,Lee, Soo-Kyeong,Ha, Mi-Jeong 한국가정간호학회 2002 가정간호학회지 Vol.9 No.2

The purpose of this study was to assessment of hospitalized patients. Nutritional assessment was performed on 353 hospitalized patients before TPN support by ideal body weight. albumin, total lymphocyte count, cholesterol. The data analysis were performed on frequency, percentage, means and standard deviation. The major findings as follows: 1. Everage NPO duration was $6.77\pm5.39$day and $\geq5$days 48.9%, >5days 51.1%. NPO duration of 1M, NL, GS, Others prolonged. 2. %IBW was everge $94.86\pm17.21%$ 43.1% normal. 37.8% low weight. There were low weight IM 44.8%. TS 47.8%, Others 44.0%. 3. Albumin was everage $2.93\pm0.51$g/dl. moderate malnutrition 45.4%, mild malnutrition 30.9%. All session were malnutrition status. 4. Total lymphocyte count was ever age $960.41\pm721.32cell/mm^2$. severe malnutrition 43.9%. moderate malnutrition 29.0%, mild malnutrition 24.4%, normal 2.7%. All session were malnutrition status. 5. Cholesterol was everage $123.02\pm45.67$mg/dl 58.4% low level. 41.2% normal. 0.4% high level. 1M, GS and TS were low level. NL, NS, DR, Others were normal. It was very poor nutritional status before TPN support of patients. The malnutrition decrease immunity, slowly cure injury, cause abnormality organs, increase the complication and obstruct the recovery. Therefore, Evaluating and correcting are very important.

혈액투석환자의 자가간호 역량 및 자기효능감에 대한 연구

박형숙,조징림,Park, Hyoung-Sook,Cho, Jing-Lim 한국가정간호학회 2002 가정간호학회지 Vol.9 No.2

The purpose of this study was to identity degree on self-care agency & self efficacy of hemodialisis patients. The subjects for the study consisted of 260 hemodialisis patients and the data were collected from April 1st. 2002 to April 30. 2002. The instruments used for this study were the Self-carer As Inventory Scale(Genden & Taylor. 1998) and Concrete Self Efficacy Scale(Joo-Hyen Kim. 1995). The Self-carer As Inventory translated by So Hyang-Sook and was modified by auther of this study. The data were analysed by using SPSS/WIN program and included number. percentange. t-test, ANOV A and Pearson Correlation Coefficient. The results of the study are summarized as follows. 1. As the average score Self-care agency indicated $132.21\pm19.11$ points and Self efficacy showed $597.33\pm130.95$points. it can be said that Self-care agency and Self efficacy were high. 2. In the relationship between general and hemodialisis cure characteristics and Self care agency were significant difference in age(F=3.065. p=0.018). married(F=3.160. p= 0.029). religion(F=4.128. p=0.003). hemodialisis cure duration(F=2.615. p=0.049). 3. In the relationship between general and hemodialisis cure characteristics and Self efficacy were significant difference in age (F=2.992. p=0.019). married(F=4.427. p=0.013), job(before attack-F=1.926. p=0.044. after attack-F=1.784. p=0.048). incomes (F=2.235. p=0.041), hemodialisis cure frequency (F=1.718. p=0.042). diet practice (F=2.248. p=0.025). 4. Self efficacy was significantly related to Self-care agency(r=0.474. p<(0.001). That is the higher the self efficacy. the higher the level of Self-care agency. The result in the above showed that more concern and endeavors need to improve hope. medical support. self efficacy, self-care agency of hemodialisis patients.

OFDMA/TDD 시스템의 하향링크 빔형성 송신기 설계

박형숙,박윤옥,김철성,Park Hyeong-Sook,Park Youn-Ok,Kim Cheol-Sung 한국통신학회 2006 韓國通信學會論文誌 Vol.31 No.5a

논문은 OFDMA/TDD 시스템에서 하향링크 빔 형성 송신기의 효율적인 구조와 설계 변수의 최적화에 대하여 고찰하였다. 다수의 송신 안테나를 사용하는 하향링크 빔 형성 송신기 설계에 있어 다수의 사용자에 대한 효율적인 빔 형성 구조 설계와 송신기 블록의 word-length 는 송신기의 성능과 하드웨어 복잡도 측면에서 중요한 설계 변수가 된다. 본 논문에서는 기지국 수신에서 사용자 구분 없이 부반송파별 가중치만 메모리에 저장하고, IFFT 입력의 부반송파 단위에서 사용자에 따라 할당된 부반송파의 가중치를 고속으로 계산하여 적용하는 효율적인 빔형성기 구조를 제시하였다. 또한, 고정 소수점 시뮬레이션을 통하여 최적의 설계 변수를 분석하였다. 제시한 구조는 프레임 당 최대 사용자 수에 비례하게 메모리를 줄일 수 있으며, 또한 기지국 수신에서 사용자 제어 없이 FFT 출력을 바로 송신에 적용하여 OFDM 한 심볼의 처리 시간을 줄일 수 있고 송신기에서 빔 형성 계산은 별도의 처리 시간을 요구하지 않는 장점이 있다. This paper presents the efficient structure and parameter optimization of downlink beamforming transmitter in OFDMA/TDD system. To design downlink beamforming transmitter for multiple transmit antennas, an efficient beamforming structure for multiple users and the choice of word-length of each block are critical in the aspect of its performance and hardware complexity. We propose an efficient beamforming scheme, which stores the weights of subcarriers into memory without user identification at the receiver of base station and calculates the weights for corresponding user in a subcarrier unit of IFFT input at high speed. Also, we obtain the word-length of main data path and other design parameters by fixed-point simulation analysis. The proposed architecture could reduce the memory size proportional to the maximum number of users per frame, and the processing time of an OFDM symbol at the receiver of base station without the need of additional processing time for calculating the weights at the transmitter.

척수손상환자의 일상생활동작과 자가간호역량에 관한 상관연구

박형숙(Park Hyoung-Sook),김명희(Kim Myung-Hee),정현숙(Jeong Hyeon Suk) 기본간호학회 2005 기본간호학회지 Vol.12 No.1

간호대학생의 음주실태, 음주거부 자기효능감과 정신건강

박형숙(Park, Hyoung-Sook),조묘현(Cho, Myo Heon),조규영(Cho, Gyoo Yeong),김동희(Kim, Dong-Hee) 한국간호교육학회 2011 한국간호교육학회지 Vol.17 No.1

Purpose: This study was conducted to identify the consumption of alcohol as well as to compare drinking refusal self-efficacy and mental health between an average drinking group and a problem drinking group of Korean nursing students. Methods: A questionnaire using the Alcohol Use Disorders Identification Test (AUDIT) measuring drinking refusal self-efficacy and mental health was given to 938 students of two universities in Gyeongsangnam-do. Results: Among the respondents 381 (40.6%) were problem drinkers. The score of alcohol consumption in the AUDIT were 3.38 for the average group and 12.50 for the problem drinking group. There were significant differences between the average group and problem drinking group in age, living place, smoking, parents drinking, age of the first drink and reasons for first drink. Participants of the average group had significantly higher drinking refusal self-efficacy than the problem drinking group. Regarding mental health, there were differences between the two groups in attempted suicide. The risk factors significantly associated with problem drinking were living place, smoking and reasons for the initial drink. Conclusion: These results provide guidance for developing strategies, such as an educational program, to promote safe alcohol consumption in nursing students.

유방절제술 환자의 림프부종 자가관리 및 간호활동

박형숙(Park Hyoung Sook),오상주(Oh Sang Ju),박경연(Park Kyung Yeon) 한국성인간호학회 2006 성인간호학회지 Vol.18 No.3

수술 후 보행지지 프로그램이 노인 상복부 수술환자의 폐 환기능 회복에 미치는 효과

박형숙(Park Hyoung Sook),김남희(Kim Nam Hee),김은심(Kim Eun Sim) 기본간호학회 2009 기본간호학회지 Vol.16 No.2

Purpose: The purpose of this study was to evaluate the effects of a walking-support program on the pulmonary ventilatory functions of elderly people who had undergone upper-abdominal surgery. Method: The study was a quasi-experimental research design. There were 26 partcipants who were admitted for upper-abdominal surgery to P University Hospital in B city. Walking exercise education was provided individually to the experimental group the day before their operation and 20 minutes a day for five days after the surgery using the 'Walking Exercise Guide Document'. Pulmonary ventilatory function was with FVC (Forced Vital Capacity), PEF (Peak Expiratory Flow), FEV1 (Forced Expiratory Volume in 1 Second), FER (Forced Expiratory Ratio), Oxygen Saturation, and VAS (Visual Analog Scale). Results: The objective indexes of pulmonary ventilatory function were not significantly different between the two groups, but the subjective index was significantly different. Conclusion: With the above results, the walking support program could be an effective nursing intervention for improving pulmonary ventilatory function of surgical patients.

신규간호사의 수면 적응 경험

박형숙(Park, Hyoung-Sook),하재현(Ha, Jae-Hyun) 기본간호학회 2016 기본간호학회지 Vol.23 No.1

Purpose: This study is a qualitative research to identify new nurses’ adaptation experience to sleep changes. Method: Grounded theory methodology was utilized. Participants were 10 new nurses from one university hospital. The information was collected and analyzed using the grounded theory of Corbin and Strauss’(2008). Results: Through constant comparative analysis, central phenomenon was identified as ‘Shaky daily life due to the sleep change’. A core category emerged as ‘In the shaky daily life, go grab my position’, Causal conditions were ‘Heaviness in shift work’, ‘Not released after getting off work’, and ‘Body and mind are exhausted’. Context were ‘An environment that does not tolerate mistakes’ and ‘Clogged breathing due to worries’. Intervening factors were ‘Support of colleagues’, ‘Recovery volition in restoration of altered relationships due to sleep’. Action/Interaction Strategies were ‘To strive for a good sleep’, ‘Require a reasonable duty schedule’ and ‘Find a breakthrough’. Consequences were ‘Become the master of shaky daily life’ and ‘Accepting the life of a nurse’. Conclusion: New nurses experience sleep patterns changes from the hospital shift system. but throughout the process of adaptation, came to accept sleep disorder as part of the life of a nurse.