Influences of Resilience and Social Support on Postoperative Recovery among Patients with Gastrointestinal Cancer

Purpose: The purpose of this study was to investigate patients’ perceived postoperative recovery over time and to identify the influences of resilience and social support on postoperative recovery among patients with gastrointestinal cancer. Methods: 101 patients with GI cancer who underwent surgery at S tertiary hospital were recruited from October 29th, 2015 to January 19th, 2016. Data was collected 3 times at postoperative day (POD)3, and POD5 in the hospital and at POD14 at home. Statistical analyses used were descriptive statistics, t-test, ANOVA, ANCOVA, correlation, and linear mixed model. Results: The patients’ perceived postoperative recovery(reverse cording) decreased at home rather than time during hospital stay (POD3: 16.70, POD5: 15.74, POD14: 17.08). Postoperative recovery at POD5 showed negative correlation with resilience (r=-.36, p=.002). Postoperative recovery scores at POD14 were negatively correlated with resilience (r=-.60, p<.001) and social support (r=-.34, p=.019). There was a positive correlation (r=-.36, p=.002) between resilience and social support. Resilience was a significant associated factor with postoperative recovery over time (β=-0.29, p=.001). Conclusion: Since the degree of postoperative recovery after hospital discharge was perceived lower than that of during hospital stay, nursing interventions such as nurse-led telephone follow-up programs should be applied during the transition period.ope

A Methodology of Teaching KFL Writing Focused on the Travels in Homepage

The study of this paper aims to examine some new directions of teaching KFL (Korean as a Foreign Language) writirg in the era of hypermedia and search for the methods for making use of them Along with the development of information and communication and computer science, some changes have been brought into the ways of human communication. In line with this tendency, it is time that new media and modes were introduced into the education of KFL writing in a positive way so that it could cope with the contemporary changes in a versatile and flexible fashion. Therefore, this research reviews the changes in the ways of communication and in the teacher-student roles, incurred by the advent of hypermedia Meanwhile, it argues that we need a teaching method of KFL writing tailored to the recent changes. In addition, it investigates the characteristics of the new form of composition with an emphasis on homepage which is typical of hypertext compositions, By doing this, it captures the caveats and principles in homepage writing. Based on these findings, this study inquires into a new method of teaching compositions centering around the travels, a written work describing journeys. As the times change, so does the trend of education vary. We are at the age of stressing the individuality and uniqueness not only in human life and culture but in the way of thinking. Keeping pace with the needs of the times, the education of KFL writing should be done in a direction in which it can help and lead students to express their thoughts and feelings in an accurate and proper way, according to the media they use

수술 예정 환자의 마취지식과 불확실성

간호학과/석사본 연구는 수술이 예정된 환자의 마취지식 수준과 수술 전 불확실성 정도를 알아보고 연관성을 파악하여 마취교육 프로그램 개발을 위한 기초자료를 제공하기 위한 목적으로 시행된 서술적 상관관계 연구이다. 연구대상자는 수술이 예정된 성인환자로서 2014년 11월 2일부터 11월 30일까지 서울에 소재해있는 S 상급종합병원 입원 환자 중 다음날 수술이 예정된 환자 193명이었다. 연구도구로 구조화된 설문지를 사용하였으며, 마취지식 수준을 측정하기 위해 Standard Anesthesia Learning Test(SALT) 도구를 수정, 보완한 것을 사용하였고, 수술 전 불확실성 측정하기 위해 Mishel Uncertainty in Illness Scale(MUIS)을 수정, 보완한 것을 이용하였다. 수집된 자료는 SPSS 21.0 프로그램을 이용하여 기술적 통계, t-test, ANOVA, Pearson’s Correlation Coefficient로 분석하였다.연구결과는 다음과 같다. 1. 수술이 예정된 성인 환자의 마취지식 수준은 12점 만점에 평균 7.53±1.82점으로 보통이었다. 대상자의 특성에 따른 마취지식 수준은 평균 나이 48세를 기준으로(t=4.09, p< .001) 연령이 높은 집단에서, 교육수준은 고등학교 졸업을 기준으로(t= -4.98, p< .001) 교육수준이 낮은 집단에서, 그리고 ASA physical status(F=4.03, p= .019)에 따라 질병의 중증도가 높은 환자들의 마취지식 수준이 낮게 나타났으며, 통계적으로 유의한 차이를 보였다.2. 대상자들의 수술 전 불확실성 점수는 100점 만점에 38.51±10.99점으로 상대적으로 낮은 편이었다. 대상자의 특성에 따른 불확실성 정도는 진료과(F=3.43, p= .010)에 따라 차이가 있었고 외과 수술이 예정된 환자(40.69±11.16)의 불확실성 정도가 가장 높았으며, 신경외과 수술이 예정된 환자(32.38±10.71)와 유의한 차이가 있었다. 그리고 수술의 종류(t= -2.78, p= .006)에 따라 Major 수술이 예정된 환자들의 불확실성이 Moderate 수술이 예정된 환자의 불확실성보다 통계적으로 유의하게 높은 결과를 보였다.3. 연구결과, 수술이 예정된 성인 환자의 마취지식 수준이 높을수록 수술 전 불확실성은 감소하는 음의 상관관계를 보였으며, 통계학적으로 유의한 차이가 있었다(r = - .26, p< .001).결론적으로 수술이 예정된 성인환자들의 마취지식 수준은 보통이었고, 불확실성 정도는 상대적으로 낮은 편이었으며, 마취지식 수준이 높을수록 불확실성은 감소하였다. 따라서 수술 전 환자들을 대상을 마취교육이 반드시 필요하며, 대상자의 특성에 따른 맞춤형 마취교육 프로그램을 개발하여 효과적인 교육을 제공해야 할 것이다.prohibitio

A Study on Teaching Korean Writing Using Personal Homepage

The Information Age has brought many changes in many aspects of modern society. In particular, the development of computer science and the Internet has made possible the communication of a massive amount of information in the form of hypertext. Moreover, the Internet has become an effective way of communicating information in various forms such as sound, multimedia, images and some combination of these. Such method of communication using hypertext has more advantages than the linear and simplistic method of communication and the advantages include variety, openness, changeability, multi-dimentionality. Hypermedia has brought in some changes of communication style. Such advancement in the uses of Internet also means significant changes in Korean language education because it can offer learners of Korean as their first language another method to express themselves. This might indicate that Korean language educators need to be more sensitive to such changes and find ways to take the best use of the Internet This study agrees with the idea of the attempt to integrate hypertext into Korean language education, and tries to examine some characteristics of hypertext writing and general writing. In addition, the study demonstrates how a Korean learner reacts to the writing instruction using hypertext not only as a learner but also as a writer. Furthermore, this study suggests some future directions in using hypertext and personal homepage on the Internet as a useful and effective way to improve Korean writing pedagogy

남성 직장암 수술 후 환자를 위한 배변기능 향상 프로그램 개발과 효과

Background: Low anterior resection (LAR) has become a standard surgery for rectal cancer patients, to improve their health-related quality of life (HRQOL). However, rectal cancer patients with LAR experience bowel dysfunction. Objectives: The purposes of this study were to develop a bowel function improvement program for male rectal cancer patients who have undergone LAR and to examine the effectiveness of the program. Design and Setting: This study was a prospective, unblinded, randomized controlled trial. This trial was conducted at a tertiary hospital, the second-largest hospital in Seoul, South Korea. Participants: Participants of this study were adult male patients who were diagnosed with rectal cancer and had undergone LAR or ileostomy repair after LAR. The enrolled 34 patients were assigned to either the experimental or the control group in a 1:1 ratio. Methods: The bowel function improvement program for patients with rectal cancer surgery was developed based on Bandura’s self-efficacy theory and the modified Medical Research Council framework for developing a complex intervention. The bowel function improvement program was provided only for the experimental group. Self-efficacy, bowel function, HRQOL, and healthcare resources utilization were measured before discharge and at 1 and 3 months after discharge. Collected data were analyzed using IBM SPSS 25.0 and STATA 16.0. Independent t-tests, Wilcoxon rank-sum tests, and analysis of covariance were used to test the hypotheses at each time point, and generalized estimation equations were used to evaluate the effects of the program over time. Results: The bowel function improvement program was developed as a 4-week intensive program (face-to-face education, telephone coaching) and an 8-week maintenance program (text message). The bowel function improvement program was effective in improving self-efficacy over time (regression coefficient = 4.53, p = .049) and partially so in reducing unplanned healthcare resources utilization (p = .044). Bowel function and HRQOL were favored in the experimental group, but they were not statistically significant. Conclusions: Based on the research findings, it is expected that the bowel function improvement program will promote early recovery for rectal cancer surgery patients after discharge. 본 연구는 남성 직장암 수술 후 환자를 대상으로 배변기능 향상 프로그램을 개발하고 그 효과를 검증하고자 시도되었다. 배변기능 향상 프로그램은 Medical Research Council의 복합중재 프로그램 개발을 위해 수정된 기틀 (Framework) 과 Bandura (1977)의 자기효능감이론을 적용하여 개발하였다. 프로그램 개발 과정은 1) 문제확인, 2) 체계적 문헌고찰, 3) 이론 확인, 4) 요구도 결정, 5) 임상 현장 조사, 6) 프로그램 초안 개발, 7) 전문가 타당도 확인, 8) 최종 프로그램 개발 단계를 거쳤다. 개발된 프로그램의 효과를 검증하기 위하여 무작위 대조군 전후 실험설계 연구를 수행하였다. 본 연구에 참여한 대상자는 직장암 수술을 받고 퇴원이 예정된 성인 남성 환자였으며, 실험군 17명, 대조군 17명으로 실험군에게는 기존 프로그램과 배변기능 향상 프로그램을 제공하였고, 대조군에게는 기존 프로그램만을 제공하였다. 실험군과 대조군 모두 자가설문을 이용하여 퇴원 전(중재 전), 퇴원 후 1개월(집중 프로그램 종료 시점) 및 3개월(유지 프로그램 종료 시점)에 자기효능감, 배변기능, 건강관련삶의질을 측정하였고, 퇴원 후 1개월과 3개월에 의료자원이용을 조사하였다. 수집된 자료는 IBM SPSS 25.0 및 STATA 16.0을 이용하여 분석하였다. 시점별 가설 검증을 위하여 독립 표본 t 검정, 윌콕슨 순위 합 검정, 공분산분석을 이용하였고, 시간의 경과에 따른 효과 평가를 위하여 일반화추정방정식을 이용하였다. 연구결과는 다음과 같다. 1. 배변기능 향상 프로그램 개발 배변기능 향상 프로그램 개발은 Bandura의 자기효능감 이론에 따라 4가지 효능 기대 자원(성취 경험, 대리 경험, 언어적 설득, 그리고 정서적 각성)을 활용하였다. 프로그램은 운동수행 및 유지, 식이관리, 증상관리, 동기부여, 장애요인 확인 및 극복을 목표로 하여 4주간 4회기의 집중 프로그램(운동, 식이 및 증상 관리에 대한 면대면 교육 2차례, 전화코칭 2차례)과 8주간의 유지 프로그램(매주 1회 문자 메시지)으로 구성하였다. 2. 배변기능 향상 프로그램의 효과 가설 1: ‘배변기능 향상 프로그램에 참여하는 실험군은 대조군보다 (시간의 경과에 따른) 자기효능감이 높을 것이다.’는 부분적으로 지지되었다. 퇴원 후 3개월 실험군의 자기효능감 점수(65.65±12.10)는 대조군의 자기효능감 점수(62.06±12.01)보다 높았으나, 통계적으로 유의한 차이는 없었다(t=0.87, p= .392). 그러나 시간의 경과에 따른 자기효능감 점수는 통계적으로 유의한 차이가 있었다(B=4.53, p= .049). 가설 2: ‘실험군은 대조군보다 (시간의 경과에 따른) 배변기능이 향상될 것이다.’는 지지되지 않았다. 종결 시점인 퇴원 후 3개월 실험군의 배변기능장애 점수(27.76±12.94)는 대조군의 배변기능장애 점수(33.65±7.26)보다 낮았으나, 통계적으로 유의하지 않았다(t= -1.63, p= .056). 시간의 경과에 따른 실험군과 대조군의 배변기능장애 점수 또한 통계적으로 유의한 차이를 보이지 않았다(B= -9.59, p= .055). 가설 3: ‘실험군은 대조군보다 (시간의 경과에 따른) 건강관련삶의질이 높을 것이다.’는 지지되지 않았다. 퇴원 후 3개월 실험군의 모든 기능 점수와 증상 점수는 통계적으로 유의한 차이가 없었다. 또한 시간의 경과에 따른 실험군과 대조군의 기능 점수 및 증상 점수도 통계적으로 유의한 차이가 없었다. 가설 4: ‘실험군의 의료자원 이용은 대조군보다 적을 것이다.’는 부분적으로 지지되었다. 응급실 방문, 외래 방문, 약국 방문 및 의료진 연락을 포함한 계획되지 않은 의료자원 이용률과 의료비용은 실험군이 대조군에 비해 낮았다. 그러나 퇴원 후 1 개월 약국 방문만이 통계적으로 유의한 차이를 보였다(p = .044). 본 연구에서 개발된 남성 직장암 수술 후 환자를 위한 배변기능 향상 프로그램은 잠재적으로 배변기능을 향상시키고 일부의 계획되지 않은 의료자원 이용을 감소시키는데 기여하였다. 앞으로 임상 현장에서 퇴원이 예정된 직장암 수술 환자의 조기 회복을 도모하기 위해 간호사 주도 배변기능 향상 프로그램이 제공될 수 있을 것으로 기대된다.open박

Association between nurses' breaks, missed nursing care and patient safety in Korean hospitals

Aims To examine the relationship between breaks and patient safety in Korean hospitals and determine the mediating effect of missed nursing care on this relationship. Background Breaks during working hours can affect patient safety; however, few studies have examined the relationship between breaks and patient safety in hospitals and their findings were conflicting. Methods A cross-sectional online survey was conducted with 399 nurses in Korean hospitals. Multiple linear regression was used to explore the association between breaks, missed nursing care and patient safety. Model 4 of Hayes's (2018) and bootstrapping analysis were employed to identify the mediating effect of missed nursing care. Results Average break time per shift was about 15 min; most participants had breaks of less than 30 min. Missed nursing care was a complete mediator of the relationship between breaks and patient safety. Conclusion Break length has an indirect effect on patient safety, medication errors and falls with injury through missed nursing care. Implications for Nursing Management More discussion is needed to develop policy and mandatory regulations to ensure sufficient breaks and adequate nurse staffing to reduce missed nursing care and enhance patient safety.restrictio

Effects of Nurse-Led Pain Management Interventions for Patients with Total Knee/Hip Replacement

Background: A literature review was conducted to assess nurse-led nonpharmacologic pain management interventions intended for total knee/hip replacement patients. Design: This was a systematic review and meta-analysis. Data sources: The PubMed, Embase, CINAHL, and Cochrane Library databases were searched to identify relevant studies. Review methods: The systematic review was conducted based on the Cochrane Handbook for Systematic Reviews of Interventions and all Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) reporting guidelines. Two reviewers independently selected the studies and appraised their quality. Thereafter, the effects of all described nurse-led nonpharmacologic pain management interventions were estimated regarding pain, anxiety, and satisfaction through a meta-analysis. Results: In total, 219 relevant studies were found through a search. Finally, 23 studies were selected for review, with 17 included in the meta-analysis. Nurse-led nonpharmacologic pain management was effective for pain relief (effect size, -0.22; 95% confidence interval [CI], -0.42 to -0.02), and educational interventions were especially effective (effect size, -0.36; 95% CI, -0.69 to -0.03). Although interventions reduced anxiety and improved satisfaction, these results were not statistically significant based on the analysis. Conclusion: Our findings support that nurse-led nonpharmacologic pain management interventions could help reduce pain in patients with total knee/hip replacement by supplementing pharmacologic pain management. Implications for nursing: Nurse-led nonpharmacologic pain interventions should be considered to reduce patient pain with total knee/hip replacement.restrictio

Effects of a Patient Safety Course Using a Flipped Classroom Approach Among Undergraduate Nursing Students: A Quasi-Experimental Study

Background: The nursing education system has changed with the increased emphasis on patient safety in healthcare settings. Early education in patient safety is crucial to preparing nurses to be competent in patient care. Therefore, providing undergraduate patient safety education courses using an innovative approach is essential to enhancing patient safety and quality in nursing care. Objectives: This study aimed to examine the effects of a patient safety course using a flipped classroom approach on patient safety competency among undergraduate nursing students in South Korea. Design: A pre- and post-test quasi-experimental design with a non-equivalent control group was adopted. Settings: This study was conducted in the college of nursing at a university in Seoul, South Korea. Participants: A total of 75 undergraduate nursing students participated. All students enrolled in the patient safety course comprised the experimental group (n = 32); those with similar characteristics to the experimental group (age, gender, and year) but did not take the course comprised the control group (n = 43). Methods: A total of 14 sessions (28 h) addressing the topics from the World Health Organization patient safety curriculum guide were delivered using a flipped classroom approach. The teaching methods included online learning and quizzes, case studies, small and large discussions, incident report tasks, and group projects including the development of strategies for patient safety. A survey including a demographic questionnaire and the Patient Safety Competency Self-Evaluation tool was administered at the beginning and end of the fall semester. Results: Pre- and post-test results demonstrated a significant increase in students' patient safety competency including attitude, skills, and knowledge. Mean scores of patient safety competency in the experimental group were significantly higher than in the control group. Conclusions: The flipped-classroom patient safety course was shown to be effective in improving patient safety competency in terms of attitude, skills, and knowledge among undergraduate nursing students.restrictio

홈페이지 중심의 국어 작문 교육 방안 연구

The purpose of this paper is to search for some direction and method in which the teaching of Korean composition, in the era of hypermedia, can meet the further demands of the changing times and students. With an eye on the fact that individual homepages, in particular; can be epitomized as a hypertext that shows juveniles' values and personality, I delve into the necessity and methodology of homepage-oriented teaching of Korean composition. As the tines change, so does the notion of 'composition'. Thus composing is transforming into an activity where writers and readers join and rejoice together, implying that we need an education of Korean composition which suits the features of the new form of composition Another characteristic of the homepage writing is that it presupposes myriads of readers whom it is aware of and is concerned about In addition, the homepage composition is a writing activity that has to take into account legible compilation or various expressional ways as well as contents, considering that it uses computers as a mum In this light, we need to lead students to writing based on the understanding of these facts.이 연구는 한국학술진흥재단의 2000년 선정 중점 연구소 지원 사업 '하이퍼미디어 시대의 언어 문화 교육 연구'의 일환으로 서울대학교 국어교육연구소에서 수행하고 있는 연구 과제임(과제번호:KRG-2002-005-B20014)