노인요양시설 거주 노인을 위한 한국형 근거기반 연하장애 간호 프로토콜 개발

방활란(Bang, Hwal Lan),박연환(Park, Yeon-Hwan) 대한근관절건강학회 2013 근관절건강학회지 Vol.20 No.1

Purpose: The purpose of this study was to develop an evidence-based dysphagia nursing care protocol for nursing home (NH) residents in Korea. Methods: The protocol was developed based on international guidelines and literatures. After testing content validity by experts, the protocol was applied to the intervention group (n=35) for 4 weeks at one NH in December, 2011, whereas the control group (n=34) received routine care. Results: The protocol was composed of one-page algorithm and detailed guidelines. Algorithm pathway was organized in 3 parts, including screening dysphagia risk, grouping by dysphagia risk level, and assigning nursing care into each group. The nursing care included positioning, oral care, meal time care, diet modification, providing exercise and maneuver, and checking dysphagia signs and symptoms. The experts verified the content validity. Protocol was revised to fit NH practice after the participant observation. Clinical validity was established upon evaluating usefulness, appropriateness, and convenience of the protocol by NH nurses. Dysphagia risk of the intervention group was significantly decreased. Conclusion: Developed protocol will improve the quality of dysphagia care in nursing homes as it can serve as a consistent and integrated standard for nursing care of residents with dysphagia.

노인요양시설 뇌졸중 노인을 위한 운동중심 연하훈련 프로그램의 효과

방활란(Bang, Hwal Lan),박연환(Park, Yeon-Hwan) 대한근관절건강학회 2014 근관절건강학회지 Vol.21 No.2

Purpose: The purpose of this study was to develop a training program for swallowing and to test its effect on swallowing capacity and nutritional status among nursing home residents with stroke. Methods: A swallowing training program was developed by literature review, expert validation and a pilot test. A pretest and posttest quasi-experimental study design with nonequivalent control group was used to evaluate the effectiveness of the program. Swallowing training was conducted for thirty minutes, three times a week for 8 weeks. Swallowing capacity including dysphagia screening score, swallowing symptom questionnaire and tongue pressure, and nutritional status including body mass index and mid arm muscle circumference were measured at the baseline and at 8 weeks. Results: The exercised-based swallowing training program consisted of oromotor exercise, expiratory muscle strength exercise and effortful swallow. The participants were 77.2 years old on average. At the completion of 8-week program, the experimental group showed better scores in dysphagia screening (p=.039) and swallowing symptom questionnaire (p=.004) and a significant increase in tongue pressure (p=.003). Conclusion: The exercised-based swallowing training program was safely applied to nursing home residents with stroke and showed a significant improvement of swallowing capacity. Further studies are needed to identify its effect on the nutritional status.

간호대학 시뮬레이션 교육의 이행(transition)에 대한 개념 분석

하이경,방활란,이연희,Ha, Yi Kyung,Bang, Hwal Lan,Lee, Yeon Hee 한국중환자간호학회 2019 중환자간호학회지 Vol.12 No.2

Purpose : The purpose of this study was to identify the attributes, antecedents, and consequences of the transition of simulation-based learning (SBL) in nursing schools. Methods : The study was conducted in accordance with Walker and Avant's conceptual analysis process. We searched MEDLINE, CINAHL, EMBASE, Google Scholar, and RISS (Korean Education and Research Information Service) databases, resulting in nine studies for an in-depth review. Results : The attributes of transition of SBL include (1) preparing for a professional role, (2) practicing in a real clinical setting, and (3) progressing toward expected competency. Antecedents of the concept include novice status, changing roles, clinical experience in controlled settings, and expected competency in the clinical setting. Conclusion : The transition of SBL includes the important feature of progression toward expected competency. Further research is needed to identify graduate nurses' experiences during this transition to establish a strategy for improving it and developing a measurement tool that reflects attributes of the concept.

한국판 외상 후 스트레스 장애에 대한 태도와 지식 측정도구(K-PTSD)의 타당도와 신뢰도

방경숙,방활란,홍선우,임지희 한국간호교육학회 2020 한국간호교육학회지 Vol.26 No.1

외상후 스트레스장애에 대한 관심이 높아지고 있지만 일반인이나 보건의료관련 학과생들이 PTSD에 대해 어떤 태도를 갖고 있고 얼마나 올바른 지식을 갖고 있는가에 대해 탐색한 연구는 매우 부족하며, 이를 확인할 수 있는 도구가 필요한 상황이다. 본 연구에서는 Tsai 등(2018)이 개발한 PTSD에 대한 태도와 지식 측정도구를 한국어로 번역한 후 신뢰도와 타당도를 평가하였다. 연구결과 한국어판 PTSD에 대한 태도와 지식 측정도구는 정부정책에 대한 태도에서 1개 문항이 삭제되어 4개 문항이 되었으며, PTSD 환자에 대한 태도 3개 문항은 적절한 요인분석 결과를 보였다. 정부정책에 대한 태도와 PTSD 환자에 대한 태도의 Cronbach’s α는 각각 .79, .59로 신뢰도는 중간 정도로, 사용이 가능한 수준이었다. PTSD에 대한 교육을 받은 경험이 있는 경우 PTSD에 대한 일반적인 지식과 치료에 대한 지식이 높은 것으로 나타나 집단비교법에 의한 준거기준 타당도를 만족하였다. 본 연구에서는 간호학과생과 응급구조학과생만을 대상으로 하였으므로 향후 일반인을 대상으로 하여 도구의 타당도와 신뢰도를 검증해볼 것을 제안한다. 본 연구는 일반인과 보건의료관련 학생들의 PTSD에 대한 태도와 지식 정도를 파악하고, 관련 교육프로그램을 개발하는데 기초자료로 활용될 수 있을 것이다. Purpose: The aim of this study was to examine the validity and reliability of the Korean version of the PTSD scale (K-PTSD) for measuring attitudes and knowledge of PTSD. Methods: A cross-sectional study design was used. The K-PTSD scale consisted of 8 items for attitudes, 8 items for general knowledge of PTSD, and 3 items for knowledge of PTSD treatment; 211 nursing students and paramedic students participated. Content validity, item analysis, and factor analysis were used to examine the construct validity. Criterion validity was tested by using educational experience with PTSD as a criterion. Cronbach’s α was used to identify internal consistency reliability in the attitude scale. Results: Construct validity of the K-PTSD was verified by exploratory factor analysis, with factor loadings for attitude ranging from .59 to .84. Criterion validity in comparing knowledge of PTSD (t=2.02, p=.044) and PTSD treatment (t=3.19, p=.022) showed a significant difference according to PTSD educational experience. Cronbach’s α for the attitude scale was .79 and .59. Conclusion: The findings suggest that the K-PTSD is a valid and reliable tool that can measure attitudes and knowledge of PTSD among nursing and paramedic students. However, further study is needed to retest the verification of this scale with more diverse participants.

Dysphagia Screening Measures for Use in Nursing Homes: A Systematic Review

박연환,방활란,한혜라,장희경 한국간호과학회 2015 Journal of Korean Academy of Nursing Vol.45 No.1

Purpose: The purpose of this study was to evaluate the psychometric quality and feasibility of measurements for screening dysphagia inolder adults to identify the ‘right tool’ for nurses to use in nursing homes. Methods: A systematic review was done. Electronic databaseswere searched for studies related to dysphagia screening measurements. A checklist was used to evaluate the psychometric quality andapplicability. Tools were evaluated for feasible incorporation into routine care by nurses. Results: 29 tools from 31 studies were identified. Dysphagia screening tools with an acceptable validity and reliability had sensitivity between 68% and 100% and specificity between 52%and 100%. The Gugging Swallowing Screen (GUSS) and the Standardized Swallowing Assessment (SSA) were the tools with high psychometricquality, especially with high sensitivity, that nurses could perform feasibly to identify the risk and to grade the severity of dysphagiaand aspiration of nursing home residents. Conclusion: Results show that GUSS and SSA are reliable and sensitive tools forscreening dysphagia which nurses can use in nursing homes. Further research is needed to examine feasibility of screening with identifiedtools, and also, to establish effective and standardized protocols for these tools so they can be effectively incorporated into routine care.

성인의 신체활동 실천에 영향을 미치는 지역사회환경의 주관적 인식 평가도구에 대한 체계적 고찰

현혜순,방활란,김봉정 한국웰니스학회 2018 한국웰니스학회지 Vol.13 No.1

The purpose of this study was to identify measuring elements and evaluate the quality of measurement properties of tools to assess the perceived social and physical environment for physical activity of adults. Fourteen relevant studies were found through a systematic literature review. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist was used to assess the methodological quality of studies on measurement properties. Physical domains of self-reported measurement of environmental factors included infrastructure/facilities, accessability to facilities, traffic safety, and aesthetic qualities. Social domains of self-reported measurement of environmental factors included crime safety and physical activity of neighbors. In general, the methodological quality of measures was rated 'good'. Compared with the physical environment factors affecting physical activity, the measurement of social environmental factors was very insufficient. In conclusion, to develop Korean tool with excellent methodological quality, it is necessary to consider not only the physical environmental factors, but also social environmental factors affecting physical activity of adults. 본 연구의 목적은 성인의 신체활동 실천과 관련된 지역사회환경에 대한 주관적 인식 평가 도구를 고찰하여 평가 요소를 확인하고, 질적 평가를 수행하는 것이다. 체계적 문헌고찰 절차에 근거하여 신체활동에 영향을 미치는 지역사회환경에 대해 주관적 인식을 평가한 총 14개의 도구를 분석하였고, 선정 논문의 방법론적 질 평가는 COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) checklist를 적용하였다. 환경 평가 요소로 물리적 환경은 인프라/시설, 인프라/시설의 접근성, 교통안전, 심미적 요소 등을, 사회적 환경은 범죄 안전, 지역주민의 신체적 활동성 등을 포함하고 있었다. 선정 논문의 방법론적 질 평가 결과는 대체로 ‘좋음(good)’으로 평가되었으며, 신체활동 실천과 관련된 지역사회환경 측정을 위한 도구는 물리적 환경 요소에 대한 평가에 비해 사회적 환경 요소에 대한 평가가 미흡하였다. 결론적으로 한국형 환경 평가도구 개발을 위해 물리적 환경 요소뿐만 아니라 다양한 사회적 환경 요소를 포함하고, 방법론적 질적 수준이 우수한 도구의 개발이 요구된다.

지역거점 국립대학의 의과대학 설립 타당성 : 비용-편익분석과 손익분기점분석

김진현,배현지,방활란 사단법인 인문사회과학기술융합학회 2019 예술인문사회융합멀티미디어논문지 Vol.9 No.10

Sufficient supply of medical doctor is important for the efficient health care system and the feasible access to health care services. In Korea, although, there is an urgent need for the supply expansion of physicians, governance and management for physician supply system is difficult due to the conflict of interests. Recently, in shortage of public health doctors, the National Public Medical College is about to open with 40 quota from a closed medical schools’s entrants, but it failed to lead to an increase in the number of doctors. Therefore, it is necessary to stabilize the supply system in medically vulnerable areas by expanding medical schools. The purpose of this study is to examine the feasibility and social net benefit of establishing medical school in state-run provincial universities, upon the nationwide shortage of physician manpower. The results of a cost benefit analysis showed that establishing a new medical school brings about a net present value of KRW 176.1~851.0 billion and the benefit/cost ratio was estimated to be 2.51 by human capital approach, 5.73 by risk avoidance approach, and 8.31 by willingness-to-pay. According to a break-even point analysis, it was analyzed that the profit will be generated after 20 years since the first recruitment. Therefore, the establishment of medical school in state-run provincial universities is economically feasible, and will be effective in strengthening the capacity of public healthcare workers and in stable supply of physician manpower in medically under-served regions. 보건의료체계의 효율적인 운영과 국민의 보건의료서비스에 대한 접근권을 보장하기 위해 의사인력의 충분한 확보가 중요하다. 그러나 국내는 의사인력이 부족하여 확대 양성이 시급한 상황이지만, 이해관계에 부딪혀 제도적 시행이 요원한 상황이다. 최근에는 공중보건의사가 부족하여 국립공공의료대학 개교를 앞두고 있지만 폐교된 의과대학 입학정원 40명을 보존한 것이므로 의사인력 확대로 이어지지 못하였다. 따라서 의료취약지역에 국가주도의 안정적인 의사 공급이 필요하므로 지역거점 국립대학을 중심으로 의과대학 신·증설을 위한 제도적 보완이 절실하다. 이에 본 연구에서는 지역 국립대학의 의과대학 설립의 타당성을 제시하기 위해 비용-편익 분석과 손익분기점 분석을 실시하여 경제적 타당성을 제시하고자 실시되었다. 분석 결과 입학정원 100명인 의과대학 설립의 순편익은 최소 1,761억원에서 최대 8,510억원으로 추정되었으며, 편익/비용 비(ratio)는 2.51배~8.31배로 산출되어 의과대학 설립은 경제적 타당성이 있는 것으로 평가되었다. 그리고 손익분기점 분석 결과, 의과대학 운영의 당기순이익은 의과대학 정원 모집 후 20년째부터 발생되는 것으로 추정되었다. 분석에서 제외된 간접적인 편익을 고려하면 지방 국립대학의 의과대학 설립은 사회적 편익이 훨씬 증가할 것이며, 특히 공공보건의료인력의 충원과 의료취약지역의 안정적인 의사인력 공급을 위한 효과적인 대안이 될 것으로 평가된다.

농촌지역 중노년층 주민의 주관적 건강상태와 삶의 질 관계에서 우울의 매개효과

김윤영,현혜순,방활란 한국융합학회 2020 한국융합학회논문지 Vol.11 No.5

본 연구는 농촌지역 중․노년층 주민의 주관적 건강상태와 삶의 질과의 관계를 파악하고, 주관적 건강상태와 삶의 질과의 관계에서 우울의 매개효과를 확인하여 농촌지역 중․노년층 주민의 삶의 질 향상을 위한 방안을 모색하고자 시도되었다. A군의 40세 이상 주민 235명의 주관적 건강상태, 우울, 삶의 질을 측정하여 분석하였고 매개효과의 통계적 유의성은 Sobel test로 검증하였다. 대상자의 주관적 건강상태는 삶의 질과 정적 상관관계가 있었으며 우울은 주관적 건강상태, 삶의 질의 신체적 건강지수와 정신적 건강지수 모두에서 부적 상관관계가 있었다. 주관적 건강상태와 우울은 농촌지역 중․노년층 주민의 삶의 질을 결정짓는 중요한 요인이며, 주관적 건강상태와 삶의 질의 관계에서 우울은 삶의 질에 매개효과가 있는 것으로 나타났다. 이러한 결과를 바탕으로 농촌지역 중노년층 주민의 삶의 질 향상을 위해 주관적 건강상태 개선 및 우울 경감을 위한 다양한 프로그램 개발 및 운영이 요구된다. The purpose of this study was to examine the mediating effect of depression in relation to the subjective health status and quality of life of middle-aged and elderly in rural areas. Subjective health status, depression and quality of life of 235 residents over 40 years of age in A county were collected and analyzed with t-test, ANOVA, Pearson's Correlation, and Multiple Regression, and verified with Sobel test. Depression had a mediating effect in relation to the subjective health status and quality of life of the residents. In conclusion, subjective health conditions and depression are important factors that determine the quality of life of middle-aged and elderly residents in rural areas. Various programs for improving subjective health of the residents and relieving their depression are needed to improve the quality of life of middle-aged and elderly in rural areas.

말기신부전 환자의 삶의 질 : 측정도구 개발 및 신이식과 혈액투석 환자 비교

김상준,김수태,방활란,박혜옥,한진석,김성권,이정상 대한외과학회 1991 대한외과학회 학술대회 초록집 Vol.1991 No.11

노인요양시설 건강지원서비스 현황과 장애요인

박연환(Park, Yeon-Hwan),방활란(Bang, Hwal Lan),김가혜(Kim, Ga Hye),오세은(Oh, Seieun),정영일(Jung, Young-Il),김홍수(Kim, Hongsoo) 한국성인간호학회 2015 성인간호학회지 Vol.27 No.4