Comparison of Nursing Activities Reflected in Nursing Notes and In-depth Interviews of Nurses in an Acute Hospital / 간호학회지

PURPOSE: The purpose of this study was to compare the nursing activities delineated by interview of nurses with those on nursing notes. METHOD: The participants of interview were 18 nurses working in medical and surgical units of a large hospital in Seoul. Each nurse was asked to choose one patient who demand most nursing care among her patients. The nurse was then interviewed to describe what her nursing activities for the patient was that day. The audio-taped interview was transcribed and the content was analyzed by researchers. Nursing notes of each nurses' patients were copied and the content analyzed by researchers. Finally, themes from the interview data and those from nursing notes were compared. RESULT: Activities related to emotional or psychological nursing, education for patient and families, and problem solving related to treatment or nursing procedure were most often omitted in nursing notes. Most of the documentation in nursing notes were related to physical condition of patients or physician's orders. Nurses described that they will do better recording if they were given less patient care responsibility, had better nursing knowledge, had better recording system, and received more training on nursing record. CONCLUSION: Nursing notes did not reflect nursing activities properly. Few independent nursing roles were documented in the nursing notes. Development of nursing education program and nursing record system is needed for improvement of nursing record.

Predictors of Intention to Quit Smoking among Patient with Coronary Heart Disease / 간호학회지

PURPOSE: The purpose of this study was to examine the level of intention to quit smoking and to identify factors influencing intention to quit among patients with coronary heart disease. Method: The subjects consisted of 80 male patients with coronary heart disease (angina pectoris, myocardial infarction) at three hospitals in Seoul. The data were collected with self reporting in a structured questionnaire. Stepwise multiple regression was used to identify predictors of intention to quit. Included variables were attitudes toward smoking cessation, subjective norms, perceived behavioral control, usefulness of smoking cessation, and previous attempts to quit. RESULT: 1. The mean score for intention to quit was 11.1(+/-6.1) which was lower than median score of the scale. 2. There were significant correlations between the all predictive variables and the intention to quit(r=.24-.48, p<.05). 3. usefulness of smoking cessation, perceived behavioral control, and previous attempts to quit explained 34.6% of the variance for intention to quit. CONCLUSION: usefulness of smoking cessation, perceived behavioral control, and previous attempts to quit were identified as important variables in explaining the intention to quit smoking among patients with coronary heart disease. Thus, it is necessary to try to enhance this factors for increasing intention to quit among patients with coronary heart disease.

Discussion on Expansion and Establishment of Home Nursing Care / 간호학회지

PURPOSE: The purpose of study is to develop a home nursing care project model suitable for Korea's heath care system and policy directions for expansion and establishment of home nursing care. METHOD: The first, status of home nursing care program in medical institution and public health center was evaluated respectively in view of structure, process and performance. And then, issues of the program were analyzed in view of accessibility, safety, and sufficient supply. The second, demand projection of home nursing care according to income level and technical level of service that is needed to the subject was tried. In addition, the level of supply for home nursing care at present was estimated. The third, home nursing care program in advanced countries (Japan and U.S.A.) was examined. RESULT AND CONCLUSION: Community-based home nursing care program is developed into public-operation model and private-operation model from above the sub-subject result. Functional network for referral system among related institutions is built up to meet various needs, regardless of accessibility to distance and economy. And prior settlements and policy directions for expansion and establishment of home nursing care are suggested.

Factors Influencing Stress Appraisal of Cancer Patients' Primary Caregivers / 성인간호학회지

PURPOSE: The objectives for this study were to identify the factors that correlate with appraisal of illness and to explore what variables are predictive of cancer patients primary caregivers' cognitive appraisal for stress. METHOD: The subjects were selected by convenient sampling and 130 caregivers who completed a questionnaire. Measures used in this study included the Family Inventory of Resources for Management, Social Support Index, Family Crisis Oriented Personal Evaluation Scales and Family Coping Coherence Index. Pearson correlation was used to identify the relationship among factors and multiple regression was used to determine the individual and cumulative effect of potential predictors on the caregivers' appraisal. RESULTS: Patient's level of activity, severity of the disease, quality of relation between patient and caregiver, caregiver's subjective health status, economic status, family resources and coping were significantly correlated. Among the variables, coping, family resources, economic status and quality of relation between caregiver and patient predicted 49.2 percent of the variance in appraisal of caregivers' stress condition. CONCLUSION: These findings suggest that coping mechanisms and family resources are important for positive appraisal. Nurses should provide adequate nursing care for the primary caregiver about professional care information and supportive counseling.

The Implementation of Homecare Nursing Network System Using Wireless Network / 대한의료정보학회지

The purpose of this project is to implement "Homecare Nursing Network System" using wireless network which was able to manage homecare service efficiently. Therefore, by completing the project of "Homecare Nursing Network System", the research team connected the headquarter and the local homecare service offices over the Internet, and built the database and application programs to operate the offices. Homecare nurses are using the PDA(personal digital assistant) in order to provide homecare nursing service, to record the patients' data, and to send and receive the data in real time. It results in improving the quality of the homecare service through the computerized knowledge-based assess and intervention algorithms. The team also has implemented the homepage to introduce the homecare office and to provide the homecare service information. "Homecare Nursing Network System" allows us to manage homecare nursing service under the computerized environment, to keep track of the homecare nursing document efficiently, to improve the quality of homecare nursing, and to expand its business territory.

Development and Analysis of Community Based Independent Home Care Nursing Service / 간호학회지

The purpose of this study was to develop the framework of community-based home care nursing delivery system, and to demonstrate and evaluate the efficiency of it. The study was carned out over a period of 3years from September 1996 to August 1999. The researchers developed Standards for operations, this was all aimed toward a home care recording system, and an assessment intervention algorithm for various diseases quality control and standardization. In the center, 185 patients enrolled, and of the enrollments cerebrovascular disorder and cancer were the most prevailment diseases. Also, a home care nursing activity classification was developed in six domains. Those domains were assessment, medication, treatment, education and consultation, emotional care, and referral or follow-up care. Ten sub-domains were divided according to the systematic needs. Among these nursing activities, treatment, assessment, and education and consultation were frequently performed. In sub-domain classification, skin integrity, respiration, circulation, and immobility related care were provided most frequently. The cost of home care nursing per visit was also suggested. The cost include direct and indirect nursing care, management, and transportation cost. Also, the researchers tried to overcome the limitations of hospital-based home care to provide more accessible, efficient, safe, and stable home care nursing. Therefore, clients were referred from other patients, families, public health care centers, industries, and even hospitals. As a result of this study, several limitations of operation were found. First, it was difficult to manage and communicate with doctor in the emergency situations. Second, there was too much time spent for transportation. This was because they are only five nurses, who cover all of the areas of Seoul and nearby cities. Third, preparation for special care of home care nurses was lacking. Fourth, criteria for the termination of care and the frequency of home visits were ambiguous. Finally, interconnection with home care machinery company was so yely needed. New paragraphs' strategies for solving these problems were suggested. This study will be the basis of community-based home care nursing, and the computerized information delivery system for home care nursing in Korea.

The Effect of Increased Dilution Volume and Prolonged Infusion Time of Vancomycin on Incidence of Adverse Reactions through Peripheral Venous Cannulae / 성인간호학회지

The purpose of the study was to explore the effect of 2 hour infusion of vancomycin(1g) in 200ml of isotonic saline every 12 hour on the frequency of "red man syndrome", phlebitis and length of peripheral catheter placement of infected patients, in order to provide safe infusion method for reducing vancomycin-induced RMS and phlebitis. The subjects of the study consisted of 16 hospitalized patients; 3 oncology and gastro-intestinal patients, 1 neurological patient, 6 thoracic surgical patients and 6 orthopedic patients, who had received vancomycin from July to October in 1999 at S-hospital. The dependent variables were the incidence of RMS, phlebitis and the length of peripheral catheter placement. The incidence of RMS was checked by an inspector at the first night whenever the infusion method of vancomycin was changed. RMS was observed every 15 minutes during an hour for symptoms of RMS such as itching, erythema, chest pain and systolic blood pressure. Incidence of phlebitis was assessed by inspector twice a day from the insertion of peripheral catheter to the removal of the catheter. The data were analyzed by percentage, mean, X2-test, t-test, repeated ANOVA, and logistic regression analysis using the SPSSWIN program. The results are summarized as follows; 1. No significant difference was identified in frequency of RMS between the experimental group and control group. 2. There was no significant difference in the change of systolic blood pressure as the time goes on between the experimental group and control group. 3. The incidence of phlebitis was significantly lower in the experimental group than in the control group. 4. The length of peripheral catheter placement was significantly longer in the experimental group than in the control group. 5. Other drugs administrated with vancomycin didn't influence the occurrence of phlebitis. However, the infusion method of vancomycin influenced the occurrence of phlebitis. The results suggest that 2 hour infusion of vancomycin(1g) in 200ml of isotonic saline every 12 hours may decrease the incidence of phlebitis and increase the length of peripheral catheter placement compared to 1 hour infusion of vancomycin(1g) in 100ml of isotonic saline every 12 hours. However, it does not reduce the incidence of RMS.

A Case of Acute Autonomic and Sensory Neuropathy Accompanied by Respiratory Failure

Acute autonomic and sensory neuropathy (AASN) is a rare neuropathy characterized by the acute onset of autonomic dysfunction and objective sensory disturbances. A 33-year-old woman experienced generalized fatigue, urinary retention, and defecation difficulty with numbness around her mouth followed by a decreased pain sensation over her face and whole body, and respiratory difficulty with aspiration pneumonia. Neurological examination revealed bilaterally dilated fixed pupils, loss of sweating and lacrimation, orthostatic hypotension, and decreased sensation of all modalities with transient mild to moderate motor weaknesses. The muscle weakness may have been responsible for her respiratory failure as her respiratory distress was resolved in conjunction with improved general muscle power. Although the pathogenetic mechanism of AASN has been generally believed to be immune-mediated, the absence of immunoglobulin responsiveness and the negative results to various autoantibody tests in our case, raises questions against its autoimmune etiology. The patient showed slow progress of overcoming her autonomic dysfunction with relatively persistent sensory deficits.

The Development of the Critical Pathway and Nursing Record for Patients received FP Chemotherapy / 성인간호학회지

The current patient management system has several limitations. To develop the critical pathway (CP) as a cost-effective method via continuous patient management, we investigated the medical records of 77 patients who underwent FP chemotherapy in Seoul National University Hospital from Feb, 1 to 28, 1999. And the pilot study was done to 12 patients admitted to undergo the FP chemotherapy. 1. The vertical contents in the CP consisted of 7 items; assessment, activity, diet, IV therapy, medication, education and evaluation. The duration of the horizontal axis was 6 days from admission to discharge. 2. The medical performance according to the vertical axis in the preliminary CP, consisted of 72 , and modified to 74 items in the final form of CP. 3. The nursing record consisted of a vertical axis of 4 items; assessment, IV therapy, medication and education. The duration of the horizontal axis was 6 days from admission to discharge of hospital days.

A Study on the Correlation between Self-efficacy and Self-care in Hemodialysis Patients / 간호학회지

The purpose of this study was to examine the correlation between self-efficacy and self-care of hemodialysis patients. The subjects consisted of 140 hemodialysis patients who underwent hemodialysis at 2 university hospital. The data were collected by used the self-efficacy tool developed by Kim Ju Hyune(1995) and the self-care tool developed by literature review and indepth open openended questions to 10 patients. Also, the questionnaire in cluded phusiologic data which collected through review of the patients' charts. The statistical analysis was used the SPSS program for frequency, mean, t-test, ANOVA and Pearson correlation. The results were as follows: 1. The mean score for general self-efficacy of hemodialysis patients was 3.103(1-4point) and there were significant differences according to perceived health. The mean score for specific self-efficacy of hemodialysis patients was 3.113 (1-4point) and there were significant differences according to perceived health, side effects and complications which related hemodialysis. 2. The mean score for self-care of hemodialysis patients was 3.822(1-5point) and there were significant differences according to marital status and economic level. 3. The relationship between general self-efficacy and self-care was a positive correlation(P=.000). The relationship between specific self-efficacy and self-care was a positive correlation(P=.000). In conclusion, this study revealed the level of self-efficacy and self-care, and the positive correlation between self-efficacy and self-care on hemodialysis patients. Therefore, intervention is needer to promote self-efficacy for self-care of hemodialysis patients. Considering the vulnerable self-care area same as checking blood pressure and weight, fluid restriction, social adjustment, exercise and rest, further studies should develop self-efficacy promoting programs for self-care of hemodialysis patients.

Effects of Cardiac Rehabilitation in Patients with Myocardial Infarction

BACKGROUND: Since the 1980s, early ambulation and cardiac rehabilitation have been emphasized in clincal practice after myocardial infarction. This is based on the belief that cardiac rehabilitation can reduce cardiovascular mortality, improve functional capacity and reduce the risk of further coronary events. In this study, we investigate the effect of aerobic exercise-based cardiac rehabilitation on functiona capacity and cardiopulmonary response in patiets with myocardial infarction. METHODS: 19 patients were divided into two group(9 patients for training group and 10 patients for control group) at 4-6 weeks after acute myocardial infarction. Training group performed aerobic exercise for 8 weeks(3 sessions per week, mean 53mins per session) at 40-60% of heart rate(HR) reserve, while control group did not. Before and after 8 weeks, all patients performed symptom-limited exercise test using modified Bruce protocol. Also, breath by breath respiratory gas analysis was carried out throughout exercise test. RESULTS: For body composition, body weight(-2.7%, p<0.001), body mass index(-2.5%, p<0.001) and %body fat(-2.6%, p<0.05) were decrease significantly in training group after 8 week cardiac rehabilitation. Resting HR(-13%, p<0.05) was reduced significantly in training group, but no significant change occured in resting blood pressure between the two groups. Maximal oxygen uptake(18%, p<0.01) and anaerobic threshold(21%, p<0.05) were increased significantly in training group after 8 week cardiac rehabilitation as compared with the control group. There was no significant change in maximal O(2)pulse between the two groups. Submaximal rate-pressure product(-17%, p<0.05) and submaximal rate of perceived exertion (-2.6, p<0.001) were decreased significantly in training group after 8 week cardiac rehabilitation as compared with the control group. CONCLUSIONS: Our findings indicate that cardiac rehabilitation results in the significant improvement of functional capacity and cardiopulmonary response in patients with myocardial infarction. Cardiac rehabilitation for patients with myocardial infarction can contribute early return and readaptation to normal life, because myocardial oxygen consumption(or rate-pressure product) is decreased at the same exercise level after exercise training.

Endocrinologic changes during short term fasting in obese postmenopausal women / 대한내분비학회지

No abstract available.