단장증후군 환자의 질병 경험

설은미,김은정,서은영 대한질적연구학회 2019 대한질적연구학회지 Vol.4 No.-

Purpose: The purpose of this study was to describe the illness experience of patients with short bowel syndrome. Methods: Six patients with short bowel syndrome were recruited from a tertiary hospital in Korea. Semi-structured and face-to-face interviews were conducted with the participants between April, 2018 and October, 2018. The transcribed data were analyzed using thematic analysis. Results: Three themes and nine sub-thems emerged as follows. The first theme is ‘suffering from bad symptoms caused by short bowel,’ including 1) difficult to suppress uncontrolled appetite, 2) fear of having abdominal pain at all time, and 3) having multiple diarrhea with non-digested food as sub-themes. The second theme is ‘enduring negative consequences of the prolonged disease,’ including 1) must adopt a skinny body to the bone, 2) have to be dependent on TPN, and 3) Suffer from complications such as infection and dehydration. The last theme was ‘having difficulties of living with hopelessness,’ including 1) being lack of information about the disease, 2) being hopeless of the fact that it is incurable, and 3) being nervous on endless medical bills to pay. Conclusion: Patients with short bowel syndrome are more likely to suffer from various physical, psychological, social, and financial problems. Based on the results of the study, health professionals could develop effective management guidelines. In addition, vigorous efforts such as multidisciplinary team approach including physicians, nurses, pharmacists and clinical dietitians are demanded to improve nutritional status and quality of life of the given population.

한 민족인 북한 어린이들에게

설은미 한국국어교육학회 1996 세계가 한동네 Vol.1996 No.-

우리가 무궁화꽃이 될 수 있다면

설은미 한국국어교육학회 1997 세계가 한동네 Vol.1997 No.-

중환자실 간호사의 임종 환자 돌봄 경험

설은미,고진강,Seol, Eun-Mi,Koh, Chin-Kang 한국중환자간호학회 2018 중환자간호학회지 Vol.11 No.2

Purpose : This study aimed to develop an in-depth and comprehensive understanding of the experiences of critical care nurses caring for dying patients. Method : Eleven critical care nurses with experience in caring for dying patients were recruited from four tertiary hospitals. Semi-structured face-to-face interviews were conducted between November 2016 and March 2017. The transcribed data were analyzed using qualitative content analysis to identify major themes and sub-themes that represented the experiences of critical care nurses. Results : The following six themes, and twelve sub-themes, were identified: (1) the gap between expectation and reality, (2) a distorted meaning of death, (3) repeated emotional pain and stress, (4) finding a solution alone, (5) sublimation into mission and calling, and (6) integration into one's own life. Conclusion : This study found that critical care nurses experience various psychological difficulties while caring for dying patients, and they made efforts on their own to overcome them. These findings are expected to inform the development of specialized programs to support critical care nurses to tackle these challenges, create guidelines on caring for dying patients, and help promote death education.

국내 대형병원에서 경장 및 정맥영양 공급을 받은 환자의 임상적 특성 및 임상경과 분석

설은미,서윤석,주달래,배혜정,이혁준 한국정맥경장영양학회 2016 한국정맥경장영양학회 학술대회집 Vol.2016 No.-

배경 및 목적: 입원 기간 중 적절한 영양지원이 환자의 임상 결과를 향상 시킨다는 많은 연구 결과에 따라 NST의 중요성은 점차 증가하고 있다. 이러한 이유로 현재 상급종합병원 및 종합병원을 포함한 전국 100여 곳에서 NST가 설치ㆍ운영되고 있다. 이에 서울대학교병원에서 3일 이상 경장 및 정맥영양 공급을 받은 환자(영양치료군)의 임상적 특성을 파악하고, 이들의 임상경과를 영양치료를 받지 않은 환자(대조군)와 비교하여 향후 NST 활동의 효율성에 대한 객관적인 지표를 마련하고자 하였다. 대상 및 방법: 2014년 6월 1일부터 2015년 5월 31일까지 1년간 검사 시행 목적으로 입원한 환자를 제외한 전체 입원 환자 중 18세 이상 성인 환자 43,954건을 대상으로 하였다. 이 중 영양치료군과 대조군의 임상적 특성 및 임상경과를 파악하기 위하여 임상적 특성으로 나이, 성별, 몸무게, 체질량지수(BMI), 서울대학교병원 영양검색도 구를 이용한 영양불량위험도, 입원 시 혈액 검사 결과(albumin, cholesterol, total lymphocyte count, Hb, CRP)를 포함하였고, 임상경과로 재원기간, 중환자실 입실여부, 중환자실 재원기간, Apache score, 경장 및 정맥영양 투여기간, 퇴원 시 혈액 검사 결과(albumin, cholesterol, Hb, CRP), 퇴원 형태를 포함하여 후향적으로 분석하였다. 또한 NST 의뢰에 따른 임상경과를 Propensity Score Matching을 통해 비교하였다. 결과: 전체 입원 환자는 총 43,954건으로 그 중 영양치료군은 4,599건(10.5%)이었다. 영양치료군과 대조군의 임상적 특성을 비교하였을 때, 영양치료군(vs. 대조군)의 평균 나이 61.5세(vs. 55.9세), 남성 58.3%(vs. 47.1%), 몸무게 57.6kg(vs. 61.9kg), BMI 21.9(vs. 23.5), 입원 시 혈중 albumin 3.4 g/dL (vs. 3.7 g/dL), cholesterol 147 mg/dL (vs. 164.9 mg/dL), TLC 1198.7mm3 (vs. 1422.6mm3), Hb 11.2 g/dL (vs. 12.0 g/dL), CRP 7.3 mg/dL (vs. 4.2 mg/dL)으로 나타났고, 모든 특성에 대하여 두 군간에 통계적으로 유의한 차이를 보였다. 임상경과는 영양치료군(vs. 대조군)의 재원기간 26.1일(vs. 9.1일), 중환자실 입실비율 31.6%(vs. 9.1%), 중환자실 재원기간 10.3일(vs. 2.1일), Apache score 24.5(vs. 16.1), 경장 및 정맥영양 투여 기간 13.6일(vs. 1.4일), 퇴원 시 혈중 albumin 3.2 g/dL (vs. 3.6 g/dL), cholesterol 140.1 mg/dL (vs. 160.9 mg/dL), Hb 10.6 g/dL (vs. 11.5 g/dL), CRP 4.2 mg/dL (vs. 3.3 mg/dL), 퇴원 형태 중 사망율 11.2%(vs. 0.8%)로 나타나 모든 특성에 대하여 두 군간에 통계적으로 유의한 차이를 보였다. 영양치료군 중 중증의 영양불량위험도를 보인 환자는 54.5%(vs. 17.9%)로 그중 NST로 의뢰된 환자는 39%(4599건 중 1794건)인 것으로 나타났고, 혈액종양내과(23.1%), 외과(15.4%), 호흡기 내과(7.9%) 순으로 높은 의뢰율을 보였다. NST 의뢰 한 군과 NST 의뢰하지 않은 군의 임상경과를 확인하기 위하여 Propensity Score Matching으로 임상 양상을 보정한 후 결과를 비교하였을 때 NST 의뢰한 군(vs. NST 의뢰하지 않은 군)의 중환자실 입실비율 31.8%(vs. 23.5%), 경장 및 정맥영양 투여 기간 14.6일(vs. 10.8일), 퇴원 시 cholesterol 137.3 mg/dL (vs. 143.3mg/dL)에서 두 군간에 통계적으로 유의한 차이를 보였고, 그 외 Apache score, 퇴원 시 혈액검사결과, 퇴원 형태에서는 NST 의뢰에 따른 임상적 차이가 없었다. 결론: 영양치료군의 임상적 특성 및 임상 경과가 대조군에 비하여 대체적으로 나쁘게 측정되었는데 이는 중증의 영양불량위험도를 가진 환자에서 영양치료가 이루어지고 있기 때문인 것으로 생각된다. 하지만, 중증의 영양불량위험도를 가진 환자 상당수에서 NST 의뢰조차 이루어지고 있지 않은 것으로 나타나 NST 의뢰를 권장하기 위한 의료 기관별 노력이 필요할 것으로 생각이 된다. 한편, 유사한 영양결핍을 보이는 환자군에서 NST 의뢰를 시행한 경우, 보다 긴 영양지원 및 중환자실 입실에도 불구하고 환자의 최종 임상경과에는 큰 차이가 없는 것으로 나타났다.

입원환자의 영양검색도구

설은미 ( Eunmi Seol ),주달래 ( Dal Lae Ju ),이혁준 ( Hyuk-joon Lee ) 한국정맥경장영양학회 2016 한국정맥경장영양학회지 Vol.8 No.1

Malnutrition is a common problem in hospital settings. A poor nutritional status has been associated with higher rates of infection, poor wound healing, longer hospital stays, and higher hospital costs. Therefore, early recognition and timely treatment of malnutrition is vital. To identify malnourished individuals or those at risk of becoming malnourished, selecting and validated a uniform screening tool is clearly an important issue. Both the Nutritional Risk Screening-2002 (NRS-2002) and Malnutrition Universal Screening Tool (MUST) are recommended by the European Society for Parenteral and Enteral Nutrition (ESPEN) for a hospital setting. For older patients, the Mini Nutritional Assessment (MNA) is the recommended tool. Short Nutrition Assessment Questionnaire (SNAQ) and Malnutrition Screening Tools (MST) are brief and simple screening tools that use self-reported queries of variables that include weight loss and poor appetite. On the other hand, many of those require considerable time and labor to administer and may not be highly applicable to a Korean population. In Korea, most hospitals use a computerized nutritional screening system with a self-developed nutrition screening index. The variables for the tools, which are based on each hospital setting, include the objective data available in the patient``s medical records and limited information collected from the nursing admission questionnaire. The application of different tools hampers any comparison of the malnutrition prevalence between different settings and patients groups. In addition, the absence of a widely accepted malnutrition screening tool hinders both effective recognition and the treatment of malnutrition. Therefore, the development of uniform and valid screening tools and effective nutritional support programs for Korean malnourished patients is needed.

중환자 간호사의 호스피스,완화의료에 대한 태도와 이에 영향을 미치는 요인

설은미 ( Eun Mi Seol ),고진강 ( Chin Kang Koh ) 서울대학교 간호과학연구소 2015 간호학의 지평 Vol.12 No.2

Purpose: The study purpose was to describe critical care nurses’ attitudes toward hospice and palliative care and their related factors. Methods: In this cross-sectional descriptive study, 175 critical care nurses who worked at a general hospital in Seoul participated via self-report survey. The Frommelt Attitude Toward Care of the Dying Scale was used to measure their attitudes, and a palliative care quiz for nursing was used to measure their knowledge about hospice and palliative care. Results: Education level, duration of nursing employment, duration of critical care nursing employment, and knowledge about hospice and palliative care were significantly associated with nurses’ attitudes. In the multiple regression analysis, education level, and duration of nursing employment were significant predictors of nurses’ attitudes. Conclusion: These findings suggest that education programs to improve nurses’ knowledge about hospice and palliative care should be developed. These will help critical care nurses obtain a positive attitude toward hospice and palliative care.

성인 입원 환자에서의 영양치료 관련 합병증: 국내 다기관 연구

설은미 ( Eun-mi Seol ),권계숙 ( Kye Sook Kwon ),김정구 ( Jeong Goo Kim ),김정태 ( Jung-tae Kim ),김지훈 ( Jihoon Kim ),문선미 ( Sun-mi Moon ),박도중 ( Do Joong Park ),박정현 ( Jung Hyun Park ),박제훈 ( Je Hoon Park ),박지영 ( Ji Y 한국정맥경장영양학회 2019 한국정맥경장영양학회지 Vol.11 No.1

Purpose: Nutritional therapy (NT), such as enteral nutrition (EN) or parenteral nutrition (PN), is essential for the malnourished patients. Although the complications related to NT has been well described, multicenter data on symptoms in the patients with receiving NT during hospitalization are still lacking. Methods: Nutrition support team (NST) consultations, on which NT-related complications were described, were collected retrospectively for one year. The inclusion criteria were patients who were (1) older than 18 years, (2) hospitalized, and (3) receiving EN or PN at the time of NST consultation. The patients’ demographics (age, sex, body mass index [BMI]), type of NT and type of complication were collected. To compare the severity of each complication, the intensive care unit (ICU) admission, hospital stay, and type of discharge were also collected. Results: A total of 14,600 NT-related complications were collected from 13,418 cases from 27 hospitals in Korea. The mean age and BMI were 65.4 years and 21.8 kg/m². The complications according to the type of NT, calorie deficiency (32.4%, n=1,229) and diarrhea (21.6%, n=820) were most common in EN. Similarly, calorie deficiency (56.8%, n=4,030) and GI problem except for diarrhea (8.6%, n=611) were most common in PN. Regarding the clinical outcomes, 18.7% (n=2,158) finally expired, 58.1% (n=7,027) were admitted to ICU, and the mean hospital days after NT-related complication were 31.3 days. Volume overload (odds ratio [OR]=3.48) and renal abnormality (OR=2.50) were closely associated with hospital death; hyperammonemia (OR=3.09) and renal abnormality (OR=2.77) were associated with ICU admission; “micronutrient and vitamin deficiency” (geometric mean [GM]=2.23) and volume overload (GM=1.61) were associated with a longer hospital stay. Conclusion: NT may induce or be associated with several complications, and some of them may seriously affect the patient’s outcome. NST personnel in each hospital should be aware of each problem during nutritional support.

국내 대형병원에서 경장 또는 정맥영양 공급을 받은 환자의 임상적 특성 및 임상 경과

설은미 ( Eunmi Seol ),서윤석 ( Yun-suhk Suh ),주달래 ( Dal Lae Ju ),배혜정 ( Hye Jung Bae ),이혁준 ( Hyuk-joon Lee ) 한국정맥경장영양학회 2016 한국정맥경장영양학회지 Vol.8 No.2

Purpose: The purposes of this study are to evaluate clinical characteristics of malnourished patients who received nutritional therapy and to compare their clinical courses according to nutritional support team (NST) consultation in tertiary referral hospital in Korea. Methods: From June 2014 to May 2015, 43,954 admitted patients who were more than 18 years old were retrospectively investigated. Characteristics of patients who received enteral nutrition (EN) or parenteral nutrition (PN) for more than 3 days (nutritional therapy group) were compared to the patients without nutritional therapy (control group). In addition, clinical courses according to NST consultation (NST group and non-NST group) were compared through propensity score matching (PSM). Results: EN or PN was applied in 4,599 patients for more than 3 days (nutritional therapy group: 10.5%). For characteristics, there were significant differences between two groups (nutritional therapy group vs. control group) with age, male proportion, body weight, body mass index. All laboratory data at admission were significantly worse in nutritional therapy group. And for clinical courses, there were significant differences in length of stay (LOS), rate of intensive care unit (ICU) admission, LOS in ICU, Acute Physiology and Chronic Health Enquiry (APACHE Ⅱ) score, days of nutritional therapy, mortality rate. NST consultation was made in 39% of nutritional therapy group. Among departments, Thoracic Surgery showed the highest rate of NST consultation (68.5%) otherwise Neurosurgery showed the lowest rate (18.7%). When PSM between NST group vs. non-NST group were made, significant differences was shown only in the rate of ICU admission, EN or PN support days, cholesterol at discharge. Conclusion: In tertiary referral hospital in Korea, more than 10% of patients still needed active nutritional therapy. NST consultation rate varies among departments. We failed to find significant differences between NST group and non-NST group.

간호사의 직장 내 폭력 경험이 우울에 미치는 영향: 사회적 지지의 매개효과를 중심으로

설은미(Eun-Mi Seol),남수현(Soohyun Nam) 대한스트레스학회 2021 스트레스硏究 Vol.29 No.1

본 연구는 간호사의 직장 내 폭력 경험과 우울의 관계에서 사회적 지지의 매개효과를 확인하는 서술적 상관관계 연구이다. 2020년 7월 10일부터 8월 28일까지 직장 내 폭력을 경험한 128명의 간호사들의 자료를 사용하여 사회적 지지의 매개효과를 검증하고, Sobel test를 통해 매개효과에 대한 통계적 유의성을 검증하였다. 분석 결과, 간호사의 직장 내 폭력 경험과 우울의 관계에서 사회적 지지가 미치는 영향이 유의하게 나타나(β=−.278, p=.032), 직장 내 폭력을 경험한 간호사에서 사회적 지지가 우울을 경감시키는 효과를 확인할 수 있었다. 따라서, 직장 내 폭력으로 인한 간호사의 우울을 경감시키기 위해 사회적 지지가 중재의 구성 요소로 활용될 수 있을 것으로 기대한다. Background: The purpose of this study was to investigate the mediating effect of social support and its relationship between workplace violence and depression in nurses. Methods: This was a cross-sectional descriptive study that included 128 registered nurses who had worked at medical institutions, except those who experienced depression without workplace violence in Korea. The data were collected between July and August 2020 using online surveys. The mediating effect was performed using multiple hierarchical regression. Results: The rate of workplace violence was 82.8% (n=106). According to the type of workplace violence, the rates of verbal violence, physical threat, and physical violence were 79.7%, 67.2%, and 33.6%, respectively. A positive correlation between workplace violence and depression was found (r=.30, p<.001), whereas social support showed negative correlations with workplace violence (r=−.18, p=.045) and depression (r=−.26, p=003). This study found a partial mediating effect between workplace violence and depression. Conclusions: It is important to develop strategies to improve the social support of nurses who experienced workplace violence and effectively prevent and manage depression.