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응급실에 내원한 소아발열 환자의 Clinical pathway 개발
성일순,구희경,박상희,박선영,하은화,송형곤 병원간호사회 1999 임상간호연구 Vol.5 No.1
We decided to apply clinical pathway method, one of case management for efficiency of emergency management and made an attempt to develop clinical pathway tool. Clinical pathway method is a standardized clinical map for specical diagnosis or symptom. So we were sure that the development of this tool led to achieve improvement or maintenance of quality in medical treatment, parent and patient's satisfaction improvement and efficient management in emergency department. We spent 8 months on developing clinical pathway tool. The particular procedure of tool development is as follows. formation of research team → reference study → analysis of current practical situation → search of symptom or diagnosis that is suitable to clinical pathway → reference study on selected title → taking recognition of superior committee → investigation of existing style on medical breatment → formation and verification of ideal clinical pathway tool → formation of first clinical pathway → pretest and revisement of tool → formation of second clinical pathway → staff education → clinical pathway implement. The title that we dicided to develop clinical pathway is pediatric fever, which was one of most common symptom in emergency department. We thought that this tool has an effect on improvement of patient's satisfaction, reduction of length of stay, reducation of cost, improvement or maintenance of clinical quality and efficient management of hospital resource. Finaly we made clinical pathway tool on pediatric feverile patient. But we did not apply and value the developed tool on practical situation. So it has difficulties to apply on clinical situation of other hospital setting. Here is the limitaion of our search. Therefore we recommand further studies on this tool, which are about practical use and valuation of this tool and development of assessment tool for valuation, standard and bench marking.
낙상 peer review group 운영을 통한 낙상발생률 감소
성일순,송미라,김희선,김은숙,정미아,이수미,하국희,김성화,이혜란,안경진,심미옥,김낙희,성영희 한국의료QA학회 2008 한국의료질향상학회지 Vol.14 No.1
Background : This study was to reduce incidence of falls by analyzing actual problem and drawing out improvement plan applicable to the clinical practice throughoperation of the staff nurses-centeredfall peer review group. Method: The fall peer review group was composedof 8 nurseshavingpatient nursing experience for over 5years, and each of fall cases was reviewed and the root cause was analyzed. As a result, it was found that the patients and their families did not fully understandthe content of the education, and the staff nurses did not completely inspect the risk factors of falls and performimmediate intervention whenpatient's condition changed. Based on the above-mentioned results, improvement activity was conducted for the purposes of consolidating patients education methodand supplementing computerized systemto supportnurses' decision making as wellas devicesand facilities. Result: As a resultof conducting improvement activity in the aspects of education forpatients, support of nurse's decision-making, and devicesand facilities through operation of the staff nurses-centered fall peer review group, falls decreased by 9.5% comparedto beforeimprovement activity. Conclusion : It is concluded that operation of the clinical nurses-centered fall peer review group played a roleof promoter to draw out practical and applicable improvement plan to the clinicalpractice and apply directions of the field-centered, and increased nurses' interest in falls and ultimately, reduced incidence of falls. Therefore the Center willcontinue to operate the staff nurses-centered peer review group, and recommends participation of nurseswhoactually take the charge of nursingpatients in furtheranalysis ofpatients' safety accidents.
성영희,성일순,이승자,이지향,김정하,문유정,최영미 대한간호행정학회 2006 간호행정학회지 Vol.12 No.3
Purpose: The purpose of the study was to identify critical indicators for the development of efficient patient classification system in a emergency room. Method: This study involved following five steps. Step 1. Selection of the lists direct nursing services in the ER. Step 2. Measurement of the time of direct nursing services from Aug. 31st to Nov. 30th, 2005. Step 3. Classification of the patients according to the nursing care time. Step 4. The determination the critical indicators for different patient classes. Result: Determinate indicators were as follow: 3 items in the first group (vital sign checking, Ⅳ route starting, blood sampling), 3 items in the second group (vital sign checking, fluid infusion, blood sampling), 9 items in the third group (I/O checking, O₂ inhalation, suction, fluid infusion, Ⅳ bolus, Central catheter preparation & management, blood sampling, intubation preparation & management, postmortem management), 7 items in the fourth group (EKG monitoring, BP monitoring, O₂ inhalation, fluid infusion, using the specific drugs, CPR, postmortem management). Conclusion: This study can help future studies which measure nursing services standard time or assigns value to emergency nursing services.
In-Hospital Utstein Style 에 의한 3차 의료기관 응급의료센터에서의 심폐소생술 성적
송근정,이정훈,성일순,정연권,최성욱 대한응급의학회 2001 대한응급의학회지 Vol.12 No.1
Background: To assess and report the outcomes of resuscitation, we apply the 1997 published In- Hospital Utstein Style to an actual emergency department. This study was designed to develope the data base for comparing and striding the outcomes of resuscitation. Methods: This study was carried out in a tertiary hospital from July 1998 to June 1999. The subjects were adult patients over the age of 20 years who received resuscitation at the emergency department. After making out the protocol for the In-Hospital Utstein Style, we gathered data prospectively. Results: Among 51,347 patients, 36 patients received 42 resuscitations. Forty-two(42) cases(100%) had witnessed arrest. Advance life support(ALS) intervention at the time of cardiac arrest included intravenous catheterization, 41cases(97.6%); intravenous drug injection, 20 cases(47.6%); endotracheal intubation, 20 cases(47.6%); and artificial ventilation, 12 cases(28.6%). Immediate causes of cardiac arrest were respiratory depression, 11 cases(26.2%); hypotension, 11 cases(26.2 %)·, metabolic, 9 cases(21.4%); and myocardial ischemia/infarction,5 cases(11.9%). Initial EKG ryhthms were pulseless electrical activity,31 cases(73.8%); ventricular tachycardia/flbrillation, 6 cases(14.3%); and asystole, 5 cases(11.9%). the average interval from cardiac arrest to initial defibrillation was 1.8±2.2 minutes, and the average interval from cardiac arrest to epinephrine injection was 2.6 ± 3.1 minutes. The average duration of resuscitation was 22.6± 18.4 minutes. Return of spontaneous circulation occured in 26 cases/42 case(61.9%). Of the 2 survivng patients who were discharged, 1 patient is still alive after 6 months, and the other is still alive after 1 year. Conclusion: Although the In-Hospital Uetein Style has many complementary factors, its results we very Objective thus use of the In-Hospital Utstein Style is recommend혀 for determining the outcomes of resuscitation.
뇌졸중 환자가 경험하는 외상 후 스트레스 증후, 불안 및 우울
윤희숙,남혜주,박소영,한정희,장송자,성일순,황문숙,Yoon, Hee-Sook,Nam, Hye-Joo,Park, So-Young,Han, Jung-Hee,Jang, Song-Ja,Seong, Il-Soon,Hwang, Moon-Sook 한국가정간호학회 2008 가정간호학회지 Vol.15 No.1
Purpose: The purpose of this study was to evaluate for the presence of posttraumatic stress disorder (PTSD)-related symptoms, anxiety, and depression after stroke. Eighty-four patients were enrolled between 2 and 12 months after their first ischemic or hemorrhagic stroke. Methods: PTSD symptoms were evaluated using the Impact of Event Scale (IES). The IES is a 15-item scale measuring intrusion and avoidance symptoms. The authors assessed mood alterations using the Hospital Anxiety and Depression Scale (HAD). The HAD is a brief, 14-item, self-reported questionnaire used to detect symptoms of anxiety (HADA) and depression (HADD). The survey data were analyzed using the SPSS 10.0 program. Frequency, mean, standard deviation, percentage t-test, and Pearson correlation coefficient were determined. Results: Twenty nine of the 84 (34.5%) patients scored higher than the cutoff for PTSD on the IES (IES>26). With use of the HAD scale, 44% of the patients reached the cutoff for anxiety ($HADA\;{\geq}8$). On the HSD scale, 44.1% of the patients reached the cutoff for depression ($HADD\;{\geq}8$). PTSD symptoms and anxiety were more frequent in women under age 39, without spouses, who had operations. Depression was more frequent in patients without spouses. There was a statistically significant correlation among posttraumatic stress symptoms, anxiety, and depression. Conclusion: There was statistically significant correlation among PTSD symptoms, anxiety, and depression in stroke patients. Therefore, it is necessary to develop nursing intervention for stroke patients with these clinical manifestations.