Multidisciplinary Practice Experience of Nursing Faculty and Their Collaborators for Primary Health Care in Korea

김미자,정향인,안양희 한국간호과학회 2008 Asian Nursing Research Vol.2 No.1

Purpose This study aimed to describe the range of participation of nursing faculty members and their collaborators in multidisciplinary primary health care in Korea and to analyze facilitators, benefits, barriers, and learned lessons. Methods An exploratory descriptive research design was utilized. A total of 13 nursing faculty members and 13 multidisciplinary collaborators were interviewed face to face using a brief questionnaire and semi-structured interview guide. Descriptive statistics, comparative analysis, and content analysis were used for data analysis. Results About 43% of the nursing faculty had multidisciplinary primary health care experience. Facilitators included a government-funded research/demonstration project, personal belief and expertise in primary health care, and well-delineated role boundaries. Benefits included improved quality of life, more convenient community life, meeting multifaceted needs of community residents, and enhanced research activities. Barriers were lack of teamwork; territoriality and self-protective behaviors; lack of insight into primary health care among stakeholders; nurses undervaluing their work; and the rigid bureaucratic system of public health centers. Learned lessons were the importance of teamwork and its synergistic benefits, the importance of conducting clinically relevant research, having the government’s support in the improvement of public health, developing health policies through multidisciplinary primary health care (M-D PHC) work, and respecting each other’s territory and expertise. Conclusion Teamwork should be included in all health professions’ curricula, and nursing clinical practicums should include primary health care in all specialty areas. More faculties should engage in multidisciplinary primary health care. The benefits of a multidisciplinary approach to primary health care outweigh the difficulties experienced by multidisciplinary team members. The findings of this study may be useful for future multidisciplinary primary health care work worldwide. [Asian Nursing Research 2008; 2(1):25–34] Purpose This study aimed to describe the range of participation of nursing faculty members and their collaborators in multidisciplinary primary health care in Korea and to analyze facilitators, benefits, barriers, and learned lessons. Methods An exploratory descriptive research design was utilized. A total of 13 nursing faculty members and 13 multidisciplinary collaborators were interviewed face to face using a brief questionnaire and semi-structured interview guide. Descriptive statistics, comparative analysis, and content analysis were used for data analysis. Results About 43% of the nursing faculty had multidisciplinary primary health care experience. Facilitators included a government-funded research/demonstration project, personal belief and expertise in primary health care, and well-delineated role boundaries. Benefits included improved quality of life, more convenient community life, meeting multifaceted needs of community residents, and enhanced research activities. Barriers were lack of teamwork; territoriality and self-protective behaviors; lack of insight into primary health care among stakeholders; nurses undervaluing their work; and the rigid bureaucratic system of public health centers. Learned lessons were the importance of teamwork and its synergistic benefits, the importance of conducting clinically relevant research, having the government’s support in the improvement of public health, developing health policies through multidisciplinary primary health care (M-D PHC) work, and respecting each other’s territory and expertise. Conclusion Teamwork should be included in all health professions’ curricula, and nursing clinical practicums should include primary health care in all specialty areas. More faculties should engage in multidisciplinary primary health care. The benefits of a multidisciplinary approach to primary health care outweigh the difficulties experienced by multidisciplinary team members. The findings of this study may be useful for future multidisciplinary primary health care work worldwide. [Asian Nursing Research 2008; 2(1):25–34]

중환자 팀 의료 구성원의 니즈 기반 외과계 중환자실 약료서비스 개선 연구

최지은,사은영,류수현,김민정,김귀숙,한나영,조윤숙,오정미 한국병원약사회 2019 병원약사회지 Vol.36 No.2

Background : As a member of the multidisciplinary team, the pharmacist can play an essential role in patient care in the intensive care unit (ICU). Although the number of critical care pharmacists has gradually increased and their role has expanded, there continues to be a need for improving the quality of care for critically ill patients. The aim of this study was to evaluate the status of clinical pharmacy practices in the surgical ICU (SICU) and suggest improvements in pharmaceutical care service reflecting the needs of the multidisciplinary team members. Methods : We identified the activities of pharmacists in the SICU and compared them to those previously reported in US hospitals for fundamental, desirable, and optimal activities. Based on these results, in-depth semi-structured interviews were conducted with key stakeholders to evaluate their needs for collaborative team care services improvement. The data from transcribed interviews were analyzed using thematic analysis techniques and the themes were clustered to derive the concept of service. Results : When the pharmacists’activities were compared to those of US hospitals the need for improvements in education, research, and administration were identified. Six physicians, and seven nurses were included in in-depth interviews. Most of them were satisfied with the current service of the pharmacist in the SICU and considered it necessary. However, needs for a better multidisciplinary team care service, including enhancement of pharmacists’participation, improvement of the communication system, etc., were identified. Based on the thematic analysis results, service concepts were developed, which were“ patient-centered collaborative team care”,“ persistent and longitudinal care”, and“ professional and evidence-based care”. Conclusions : An improvement service for critical care patients was derived from this qualitative analysis process. This concept can be used to guide the improvement of the overall quality of patient care in the SICU and to inform healthcare policy decisions.

커뮤니티케어 활성화 방안에 관한 다학제적 연구 -일본 지역포괄케어시스템 사례를 중심으로-

최희원 한국전시산업융합연구원 2022 한국과학예술융합학회 Vol.40 No.4

Nowadays, aging is progressing rapidly in Korea. Also, in the midst of nuclear families and low birth rate, it is no longer a matter of families but a social issue to take care of the elderly. To cope with this, the government induced ‘community care’ and has been trying to reorganize the laws and systems and promote a variety of projects. Now is the time that we need a lot of references dealing with community care. Therefore, this study is aimed to understand the characteristics of space use and operation found in the cases of ‘Community-based Integrated Care Facilities’ in Japan. The purpose of this study is to allow the findings to be utilized as references to plan community care facilities afterwards. The research method and results are as follows: First of all, literatures were reviewed to arrange the concepts of community care and Community-based Integrated Care Facilities. This researcher also selected three facilities as the cases to be investigated here as Community-based Integrated Care Facilities. Next, this study organized and analyzed the outline of each facility’s operation and the characteristics of the buildings and space use in them. This study arranged each case’s overall outline, the building’s outline, and the house-related characteristics. They differ in terms of the business entity, type of public space, and type of the house, but all three cases have public space on the first floor and houses on the second or higher floors. In Case A and Case C, general rental houses are installed, and in Case B, service-providing houses are installed for the elderly. In the public space, day services for the elderly, visiting nursing homes, clinics, day services for children, welfare services for the disabled, cafés, and stores are installed. Therefore, not only the residents corresponding to the cases but the locals can also use them. The public space is properly arranged that the locals can have easy access to it. We can also see that medical services and nursing care services corresponding to the cases investigated here are being used as public goods in the region. In addition, various sizes of external and intermediate spaces are planned to induce connection between the residents corresponding to the cases and local residents. Through research on the cases of Community-based Integrated Care Facilities in Japan, this study has attempted to derive the factors applicable when we plan or design community care-related facilities in Korea afterwards. Ultimately, this author expects that this will contribute to the activation of ‘Aging in Community’. 최근 우리나라는 고령화가 빠른 속도로 진행되고있고, 핵가족화, 저출산의 현상 속에서 노인 돌봄은더 이상 가족만의 문제가 아니라 사회문제가 되고 있다. 이에 대처하기 위해 정부에서는 ‘커뮤니티케어’를도입하여 법, 제도를 정비하고 다양한 사업을 추진하고자 노력하고 있으며, 커뮤니티케어에 관한 다양한참고자료가 필요한 시점이다. 이에 본 연구에서는 일본의 ‘지역포괄케어시설’사례에서 나타나는 공간이용 및 운영의 특성을 파악하는 것을 목적으로 진행하였다. 연구결과를 통해 향후 커뮤니티케어 시설 계획 시참고자료로 활용되는 것이 궁극적인 목적이다. 우선 문헌고찰을 통해 커뮤니티케어와 지역포괄케어시설의 개념을 정리하였고, 지역포괄케어시설 사례조사 대상 시설 3곳을 선정하여 각 시설의 운영개요, 건물 및 공간이용의 특성을 정리하고 지역포괄케어시스템의 5가지 구성요소로 제시한 ‘주거․의료․개호․ 예방․생활지원’을 분석의 틀로 삼아 분석하였다. 사례별로 전체개요(건물외관, 소재지, 개설시기, 사업주체, 운영개요), 건물개요(층수, 대지면적, 연면적, 총 건축비, 공용공간 종류), 주택 관련 특성(주호종별, 주호수, 특징)을 정리하였다. 운영주체, 공용공간의 종류, 주택 종류에는 차이가 있으나 세 사례 모두 1층에공용공간, 2층 이상에 주택을 배치하고 있다. 사례 A 와 사례 C에는 일반임대주택, 사례 B에는 서비스지원형 고령자주택이 설치되어 있다. 공용공간으로는 고령자 데이서비스, 방문개호 사업소, 진료소, 아동 데이서비스, 장애자 복지서비스, 카페, 점포 등이 설치되어있어 해당 사례의 거주자뿐 아니라 지역의 주민들도이용하고 있고, 지역주민이 접근하기 쉽도록 공용공간이 배치되어 있다. 조사대상 사례의 의료서비스 및 개호서비스를 지역의 공공재로 사용하고 있음을 알 수있다. 또한 다양한 규모의 외부공간과 매개공간을 계획하여 해당 사례 거주자들과 지역주민, 해당 사례 거주자 간의 연결을 유도하고 있다. 본 연구에서는 일본의 지역포괄케어시설 사례조사를 통해 향후 국내 커뮤니티케어 관련 시설 계획 및디자인 시 적용할 수 있는 요소를 도출하고자 하였다. 궁극적으로는 지역사회 내 계속거주(Aging in Community)의 활성화에 기여할 수 있기를 기대한다.

Multidisciplinary Approach to Breast Cancer Care

Juon, Hee-Soon The Research Institute of Nursing Science Seoul Na 2007 간호학의 지평 Vol.4 No.1

Aim: The purpose of this paper is to present the importance of multidisciplinary strategies in cancer prevention and control, especially comprehensive breast cancer care. Background: Worldwide, breast cancer is the most common cancer diagnosed among women and is the leading cause of cancer deaths. Although the incidence of breast cancer in Asian countries is still lower than in Western countries, the rate of increase for the last two decades is striking. Methods: Data on cancer mortality, incidence, and risk factors were summarized by using the most recent data available from population-based cancer registries affiliated with the International Union Against Cancer, the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program and the CDC's National Program of Cancer Registries (NPCR). Results: Global differences in breast cancer incidence and fluctuations in rates within a country still exist. The incidence of breast cancer in Asian countries was lower than in Western countries. Breast cancer incidence in the United States decreased each year during 1999-2003. On the other hand, morbidity and mortality related to breast cancer in Asia has increased significantly. Conclusion: Multidisciplinary strategies to reduce breast cancer mortality and promote breast cancer awareness are addressed. Lessons learned from multidisciplinary approaches to cancer treatment and control will be valuable in implementing future breast cancer research in the fields of basic, clinical, and population research in Asia.

미네랄 골질환 합병증을 가진 투석환자에서 다학제 팀 서비스의 임상적 성과

한나영,이상민,홍진이,노혜진,지은희,송윤경,송지윤,김인화,김연수,오정미 한국임상약학회 2016 한국임상약학회지 Vol.26 No.4

Background: Multidisciplinary team care (MTC) is a collaborative approach to treatment plan and ongoing care. We aimed to evaluate the clinical effect of MTC on the regulation of chronic kidney disease-mineral and bone disorder (CKD-MBD) complications in dialysis patients. Methods: This retrospective observational study was approved by the institutional review board. Among patients who have undergone dialysis at admission, the patients admitted to the nephrology ward were allocated to MTC group, and the others to usual care (UC) group. The MTC group had collaborative care by nephrologists, nurses, pharmacists, and nutritionists. The endpoints were the regulation of corrected calcium (cCa) and phosphate (P), the percent of patients in target level of cCa-P product (cCa×P), and the prescription rate of non-calcium based P-binders. Results: A total of 163 patients were included from January to December 2009. A significant difference was shown in the percentage of patients in target cCa×P level at admission (MTC vs. UC, 81.40% vs. 91.67%; P = 0.038), but there was no significant difference at discharge. During admission, the cCa and P levels of patients in only UC group were significantly changed. In addition, compared with UC group, patients in MTC group were more likely prescribed appropriate P-binders, when they had higher cCa×P levels than 55 mg2/dL2 (P <0.001). Conclusion: It was found that MTC had beneficial effect on improving the regulation of CKD-MBD and the appropriate phosphate binder uses. Therefore, application of the MTC is anticipated to enhance quality of clinical care in chronic diseases.

말기섬망의 실제적 지침

전진숙(Jin Sook Cheon) 대한생물치료정신의학회 2010 생물치료정신의학 Vol.16 No.2

Objectives : Delirium is the second most frequent psychiatric problems experienced in patients who are in palliative care. However, psychiatrists have not involved and have paid no attention to the care of terminal patients who are impending to death till now. The purpose of this study is to insist the importance of psychiatrists’ devotion to the care of terminal patients, in which professional training should be preceded. Methods : The English articles and e-news documents published from 1990 through 2010 are reviewed, which are obtained by internet search with words combination of terminal delirium, palliative care, end-of-life care and well-dying. Results : 1) Frequency : Delirium develops in 20% to 70% of patients who are in palliative care. Almost 90% to 95% of patients experience delirium within 48 hrs of near death. 2) Implications : Terminal delirium causes emotional suffering to the patients. The unusual behavior adds burden toward the family members and caregivers. Ultimately, the communication difficulty and uncooperation to treatment facilitates mortality as well as impairs meaningful exchange of good-bye at time of impending death. 3) Symptoms : The four hallmark symptoms of delirium are impairment of consciousness, other cognitive impairment, acute onset and symptom fluctuation and sleep-wake cycle change. In behavioral view, delirium can be classified into hypoactive, hyperactive and mixed patterns. 4) Etiologies : Delirium pathophysiology may develop by combined action of predisposing(vulnerability) factors and incident factors. 5) Management : The management of terminal delirium consists of keen assessment, identification and reverse of causes, and combination of pharmacological, environmental and spiritual interventions. Conclusion : Terminal delirium occurred in almost all patients at the end of life is difficult experience toward patients as well as family, beloved and caregivers. Terminal delirium develops by the combined action of multifatorial etiologies. In treatment, multidisciplinary care combined with pharmacological, environmental and spiritual interventions is desirable.

노인의료센터 다학제 팀의 약물 조정이 약물사용 및 약제비 절감에 미치는 효과

박세진,최나예,서예원,이정화,이은숙,김은경,김선욱,김광일 한국병원약사회 2019 병원약사회지 Vol.36 No.4

Background : Older adults tend to experience multiple chronic conditions on polypharmacy with consequent increase in adverse drug events and medication costs, requiring more medication reconciliation. To date, the effects of medication reconciliation for the inpatients by geriatric pharmacists in multidisciplinary teams have been rarely known in Korea. The purpose of this study was to assess the effects of medication reconciliation by analyzing the changes in prescription and reductions in medication costs for inpatients who received multidisciplinary team care. Methods : Records of patients age 65 and older, admitted to the geriatric center July 1, 2016-June 30, 2017, were retrospectively analyzed in this study. The list of the medications prior to the admission and upon the hospital discharge was obtained from the comprehensive geriatric assessment and electronic medical records, respectively to assess the reduction of the total number of medications, drug duplication, and potentially inappropriate medications (PIM). The cost of drugs was calculated by multiplying the daily price of medicine by the number of days of medication. Results : The mean age of 300 patients was 83.7 (SD 6.9), and 38.7% were males. The patients taking five or more medications were 87.3% before the admission, and 45.0% were mainly diagnosed with infectious disease at admission. With the medication reconciliation, the mean number of medication per patients decreased 10.5 (SD 5.0)-6.5 (SD 3.4) (p 0.001). The number of patients who received the medications listed under PIMs and duplicated was reduced 227-114, and 59-3, respectively (all p 0.001). A total of 458,573 won was saved per person through medication reconciliation. Conclusions : The multidisciplinary team care with the geriatric pharmacist led to safer and more appropriate medication therapy. As a result, it subsequently improved patient safety and medication cost-saving for geriatric patients

중환자실 임상약사의 약물처방 검토 시 필요한 필수점검 항목 개발

손유민,박효정,정지은,인용원,김정미,이영미,이숙향 한국병원약사회 2019 病院藥師會誌 Vol.36 No.1

Background and purpose : Clinical pharmacists are core members of a multidisciplinary team in critical care, playing a pivotal role in improving patient treatment. The responsibility of pharmacists for pharmacotherapeutic outcomes in South Korea has increased over the years. However, different interventional approaches or points of view in regard to patient medication exist among pharmacists, especially new team members. The purpose of this study was to set up principles of medication interventions, to develop an evidence-based checklist to minimize the difference of intervention levels, and to standardize tasks in interventions provided by pharmacists. Methods : After a comprehensive review of the literature, guidelines and protocols, the relevant items were identified. They were then structured in the form of a checklist. The consistency of the checklist was checked by a group of pharmacists involved in critical care. Cronbach’s alpha, a measure of internal consistency, was used to validate the checklist. Pharmacists’satisfaction with the checklist was assessed using Likert scales as a questionnaire survey. Results : We established an evidence-based checklist composed of seven categories for use in pharmaceutical interventions in critical care. A total of 69 pharmacists completed a questionnaire surveying satisfaction with the checklist. Consistency between two groups of pharmacists was 99.3 percent. The reliability of the checklist was Cronbach’s alpha 0.899, which validated the checklist. There was high satisfaction (4.32 on the Likert scale) with the checklist among pharmacists. Conclusions : The checklist may provide a useful tool for clinical pharmacists to conduct a highly-specialized critical care pharmaceutical intervention with evidence-based reliability.

평신도 중심의 공동체적-상황적 목회돌봄에 기초한 실천신학 방법론 연구

정보라(Chung Bo Rah) 한국오순절신학회 2010 오순절신학논단 Vol.8 No.-

How can we grasp the nature of embodied theological knowledge which is rooted in practices of pastoral care? The communal contextual approach to pastoral care has potential for helping practical theologians bridge their operative epistemology of doing pastoral care and the contributions of lay people to theological knowledge. The purpose of this article is to provide a theoretical framework of practical theology to characterize the practices of care in communities of Christian faith with regard to the “Communal Contextual Paradigm” John Patton suggests. This article first evaluates spirituality in our postmodern era and major methodologies of spirituality studies to identify operative and spiritual roots of practical theology. Second, it deals with Aristotelian concept of practical knowledge(praxis) and the clerical paradigm, suggested by Edward Farley, to look carefully at the epistemological foundations of practical theology. Finally, it identifies caring practices by communities of Christian faith as valid subject matter to facilitate a constructive understanding of practical theology integrating theory and practice, the clergy and lay people, and ministry and research. This article concludes a new ways of emphasizing the daily experiences of lay people, their spirituality, and multidisciplinary approaches to their caring practices can develop transformative practical implications of theology in ministry and research.

Treatment Strategies of Improving Quality of Care in Patients With Heart Failure

Se-Eun Kim,Byung-Su Yoo 대한심장학회 2023 Korean Circulation Journal Vol.53 No.5

Heart failure (HF) is a global health problem closely related to morbidity and mortality. As the burden of HF increases, it is necessary to manage and treat this condition well. However, there are differences between real-world practice and guidelines for the optimal treatment for HF. Patient-related, healthcare provider-related, and health system-related factors contribute to poor adherence to optimal care. This review article aims to examine HF treatment patterns and treatment adherence in real-world practice, identify clinical gaps to suggest ways to improve the quality of care for HF and clinical outcomes for patients with HF. Although it is important to optimize treatment based on evidence-based guidelines to the greatest extent, it is known that there is still poor treatment adherence, and many patients do not receive guideline-directed medical therapy, especially at the early stages. To improve medication adherence, qualitative evaluation through performance measurement, as well as education of patients, caregivers and medical staff through a multidisciplinary approach are important.