지역응급의료센터의 격리병상 과밀화 지표분석: 코로나-19 대유행 시기의 경기도 소재 지역응급의료센터 사례를 중심으로

이이산 ( San Lee ),유진현 ( Jin Hyun Yoo ),신소미 ( So Mi Shin ),노현웅 ( Hyun Woong Noh ),김윤준 ( Yun Jun Kim ),곽동훈 ( Dong Hun Kwak ),김형수 ( Hyung Soo Kim ),최익창 ( Ik Chang Choi ),서민구 ( Min Gu Seo ) 대한응급의학회 2024 대한응급의학회지 Vol.35 No.2

Objective: Emergency department (ED) overcrowding is a global issue that negatively impacts the clinical outcome. Through the coronavirus disease 2019 (COVID-19) pandemic era, overcrowding of ED isolated territory (isolation bed) was aggravated. This study analyzed overcrowding indices of ED isolation beds during the COVID-19 pandemic. Methods: This study was a single-center, retrospective, observational study. The study analyzed 34,925 patients who visited the ED during the COVID-19 pandemic from April 2021 to August 2022. Patients who were treated in isolation beds and regular beds were compared. Among the patients using isolation beds, patients who stayed longer than 720 minutes were also classified and analyzed. Results: During the analysis period, 4,479 and 34,943 patients were treated in the ED isolation bed and ED regular bed, respectively. The overcrowding indices (general ward admission rate, intensive care unit admission rate, ED-length of stay, transfer rate, mortality rate, prolonged ED stay patient ratio) of the isolation beds were significantly higher than those of the ED regular bed (P<0.05). The prolonged ED stay-patient ratio of isolation beds and regular beds was affected by the number of COVID-19 patients (regular bed, r=0.617 and P=0.01; isolation bed, r=0.525 and P=0.03). The average ED-length of stay of isolation beds was longer than that of the ED regular beds. One hundred and forty-five patients were classified as prolonged ED stay patients. Their time from the decision point to the discharge point comprised a higher rate with an average of 76.52%. Conclusion: ED isolation beds are more vulnerable to infectious disease outbreaks. A proper medical policy and arrangement management system that can flexibly deal with disaster emergencies are required

핵의학과에서 방사선 피폭관리 실태에 대한 조사 연구

임창선(Lim, Chang-Seon),김세헌(Kim, Se-Heon) 한국산학기술학회 2009 한국산학기술학회논문지 Vol.10 No.7

의료기관 핵의학과에서는 진단과 치료를 목적으로 방사성동위원소를 사용하므로 누구나 방사선피폭에 노출 될 위험이 있다. 일반적으로 방사선 작업종사자에 대한 피폭관리는 비교적 철저히 이루어지고 있으나 환자보호자 및 일반인에 대한 피폭관리는 소홀한 경향이 있다. 특히 방사성의약품을 투여한 환자들은 잠재적 선원이 되어 작업종사 자외에 환자보호자 및 일반인에 대해 방사선피폭을 초래하므로 이로 인한 방사선피폭을 최소한으로 감소시킬 수 있 도록 관리되어야 한다. 따라서 핵의학과 방사선피폭에 대한 관리실태를 파악하기 위하여 전국에 있는 대학병원 중 7 개소에 대해 조사한 결과 환자이송요원, 환경미화원 등 수시출입자에 대해서 2 개소의 의료기관에서는 피폭선량평가 및 관리와 안전교육이 없었다. 또한 환자와 동행하는 보호자에 대한 통제와 관리는 7 개소 모두 허술하였는데 대기실 에서 검사직전 환자로부터 흡수될 수 있는 평균 방사선량률은 25.60 μSv/h로서 일반인에 대해 연간 선량한도를 초과 하지 아니하는 범위 내에서 허용되는 20 μSv/h를 초과하였다. 따라서 비록 아주 적은 피폭선량이 예상된다고 하더라 도 수시출입자에 대한 철저한 피폭선량의 관리와 교육이 요구되며, 환자보호자 등을 보호하기 위해 환자와 가까이 하 는 것을 통제하거나 환자를 격리할 필요가 있었다. After administration of a radiopharmaceutical, the patient remains radioactive for hours or even days, representing a source of potential radiation exposure. Thus, including the personnel who are occupationally exposed to ionizing radiation, radiation exposure must be managed for members of the public, in particular for people accompanying patients. In this study we investigated radiation exposure dose management in the nuclear medicine departments at seven general hospitals. Two of them had no radiation safety considerations for patient transporters, sanitation workers and the like. And they all were careless of radioprotection for people accompanying patients. The average dose rate to people accompanying patients from radioactive patients just before a bone scan was 25.60 μSv h-1. This is higher than 20 μSv h -1 which is the annual public dose limit for temporary use. Therefore radiation dose measurement and risk assessment of patient transporters, sanitation workers and the like should be performed. And the nuclear medicine technologist should provide advices on the radiation safety to patient transporters, sanitation workers, people accompanying patients and so on. To ensure the radiation safety for people accompanying patients, it is required to restrict the patient's access to his relatives, friends and other patients or isolate patients.

Patient Anxiety and Communication Experience in the Emergency Department: A Mobile, Web-Based, Mixed-Methods Study on Patient Isolation During the COVID-19 Pandemic

Kim Sumin,Chang Hansol,Kim Taerim,Cha Won Chul 대한의학회 2023 Journal of Korean medical science Vol.38 No.39

Background: Anxiety and communication difficulties in the emergency department (ED) may increase for various reasons, including isolation due to coronavirus disease 2019 (COVID-19). However, little research on anxiety and communication in EDs exists. This study explored the isolation-related anxiety and communication experiences of ED patients during the COVID-19 pandemic. Methods: A prospective mixed-methods study was conducted from May to August 2021 at the Samsung Medical Center ED, Seoul. There were two patient groups: isolation and control. Patients measured their anxiety using the State-Trait Anxiety Inventory (STAI X1) at two time points, and we surveyed patients at two time points about factors contributing to their anxiety and communication experiences. These were measured through a mobile web-based survey. Researchers interviewed patients after their discharge. Results: ED patients were not anxious regardless of isolation, and there was no statistical significance between each group at the two time points. STAI X1 was 48.4 (standard deviation [SD], 8.0) and 47.3 (SD, 10.9) for early follow-up and 46.3 (SD, 13.0) and 46.2 (SD, 13.6) for late follow-up for the isolation and control groups, respectively. The clinical process was the greatest factor contributing to anxiety as opposed to the physical environment or communication. Communication was satisfactory in 71.4% of the isolation group and 66.7% of the control group. The most important aspects of communication were information about the clinical process and patient status. Conclusion: ED patients were not anxious and were generally satisfied with medical providers’ communication regardless of their isolation status. However, patients need clinical process information for anxiety reduction and better communication.

COVID-19 Patients with Mild Symptoms or without Symptom Using Residential Treatment Center Model

Song Yi Kim,Ji Young Kim,Gyeongsil Lee,Jae Moon Yun,BeLong Cho 대한가정의학회 2022 Korean Journal of Family Medicine Vol.43 No.3

Background: The rapid rise in coronavirus disease worldwide has drastically limited the availability of hospital fa-cilities for patients. Residential treatment centers were opened in South Korea for the admission of asymptomatic or patients with mild symptoms. This study discusses the appropriateness of the admission criteria set by the cen-ters in a pandemic situation, the prioritization of patients for admission, and ways to minimize the risk of self-isola-tion.Methods: A total of 217 low-risk patients (n=217) were admitted to the Nowon Residential Treatment Center be-tween August 22 and October 14, 2020. The following criteria were met at the time of admission: patients (1) were asymptomatic or had mild symptoms, (2) had either a controlled or no underlying chronic disease, and (3) did not need oxygen treatment. Among them, 202 patients who were eligible for inclusion in the study were retrospectively investigated through periodic interviews.Results: Of the 202 patients, 153 satisfied the criteria for symptomatic isolation standards, and 25 for asymptomatic isolation standards. The clinical conditions of 24 patients were aggravated, and these patients were transferred to other hospitals, among which 12 had persistent fever and 13 were suffering dyspnea with oxygen saturation (SpO2) <95%.Conclusion: In the event of another large-scale epidemic, it would be appropriate to prioritize accommodating pa-tients who are elderly or have underlying diseases and self-isolate young patients with no underlying diseases and provide them with SpO2 meters and thermometers to self-measure SpO2 and body temperature.

Resilience and Overcoming Experiences of Coronavirus Disease 2019 Patients Hospitalized in a Single-Room Isolation Ward: A Mixed-Methods Study

Yun Ji-Su,서은영 한국간호과학회 2024 Asian Nursing Research Vol.18 No.1

Purpose The coronavirus disease 2019 (COVID-19) pandemic has caused patients to suffer from various physical and psychological symptoms and social challenges, but the impact was harder for those COVID-19 patients receiving treatment in single-room isolation wards in South Korea. This study aimed to investigate resilience, anxiety, depression, and sleep quality of those patients and the relationships between those variables, and explore the patients’ experience of resilience during the COVID-19 treatment in single-room isolation wards. Methods This study employed a mixed-methods approach, collecting quantitative data through surveys and qualitative data through semistructured interviews conducted between May and October 2022. Quantitative surveys encompassing disease-specific and demographic information, visual analog scales to assess anxiety, depression, and sleep quality, and the Connor–Davidson resilience scale were administered to patients (N = 153). Qualitative thematic analyses were conducted following interviews with a subset of patients (N = 13) belonging to the high-resilience group. Results Resilience exhibited a negative correlation with anxiety and depression, while showing a positive correlation with sleep quality. Factors affecting resilience include having a spouse, educational attainment, and depression. The qualitative thematic analysis results were categorized into: (1) facing the reality of being isolated in a room; (2) struggling to accept and adapt to isolation; and (3) seeking connections in isolation. Conclusions This research sheds light on the challenges faced by individuals in isolation and underscores the crucial role of resilience in overcoming such challenges. The resilience observed in these patients is grounded in both interpersonal and profound spiritual connections. These findings underscore the necessity for nurses to develop customized strategies to alleviate the impacts of social isolation.

조혈모세포이식을 받는 동안 무균실에 입원한 소아암 환아의 미술치료 사례연구

박주원,김태은 한국미술치료학회 2017 美術治療硏究 Vol.24 No.3

This work is the first art therapy intervention study in Korea on pediatric cancer patients undergoing hematopoietic stem cell transplantation (HSCT) in a protective isolation unit. The purpose of this study is to demonstrate the potential of the art therapy application in the protective isolation unit provided by the trained therapist trained for both patients’ psychological conditions and the specific medical environment. As part of the study, the art therapist encouraged the artistic expressions of pediatric patients by drawing images on the window located in the isolation room. The subjects of this study were four pediatric cancer patients undergoing HSCT at one of the university hospitals in Seoul, with an average age of 12 years. The data was collected from July 2014 to August 2015 with an average of 7.5 sessions per patient. The activities and the psychological, social, and spiritual changes of the patients from each session were qualitatively analyzed. The patients were able to acquire activeness through indirectly expressing their inner desires via drawing activities with the trusted art therapist. These therapeutic interventions helped the pediatric patients to alleviate psychological distress, enhance adherence to treatment, and endure stress in the isolated medical environment as well as encouraged them with hope. Therefore, this study presents the necessity and potential impact of art therapy intervention for isolated pediatric cancer patients undergoing HSCT. 본 연구는 국내 최초로 무균실에서 조혈모세포 이식을 받는 소아암 환아를 대상으로 한 미술치료 연구이다. 그동안 의료적 처치 외에는 무균실에 입원한 환아에게 적절한 심리치료적 개입이 없었던 점에 초점을 맞춰 무균실에 입원한 환아의 심리적 상황과 무균실이라는 병동의 의료 환경에서 충분히 훈련된 미술치료사가 무균실에서도 개입 가능한 미술치료를 보여주는 것이 본 연구의 목적이다. 본 연구는 미술치료사가 무균실에 입원한 환아의 신체적, 심리적 상황을 고려하여 무균실 유리창에 그림을 그려주는 것으로 미술치료를 시도하였다. 연구의 대상은 서울시의 Y대학병원에서 조혈모세포이식을 받는 소아암 환아 4명이며 평균 연령은 12세이다. 자료 수집은 2014년 7월부터 2015년 8월까지 평균 7.5회 미술치료가 개입되었다. 회기별 활동과정과 환아의 심리·사회·영적 변화는 질적으로 분석하였다. 무균실에 격리되어 있는 환아는 조혈모세포이식이라는 극도의 수동적 상황에서 신뢰로운 관계의 미술치료사가 유리창을 통해 환아의 내적 욕구를 대신 표현해주면서 능동성을 획득할 수 있었다. 이는 환아의 심리적 고통을 완화하고 치료 순응도를 높이고 고립된 의료적 상황에서 스트레스를 견디고 희망을 고취시키는데 도움을 주었다. 이에 본 연구는 무균실에 격리된 환아에 대한 미술치료 중재의 필요성과 가능성을 제시했다는 것에 의의가 있다.

COVID-19 확진자의 격리 체험

한영인(Young-In Han),배경의(Kyung-Eui Bae) 한국산학기술학회 2021 한국산학기술학회논문지 Vol.22 No.12

본 연구의 목적은 COVID-19 확진자의 격리 체험의 본질적 의미를 파악하는 것이다. COVID-19 확진자의 격리 체험의 본질적 의미를 파악하기 위해 현상학을 적용하여 분석한 질적 연구이다. 연구대상자는 COVID-19 확진을 받고 격리 경험이 있는 사람으로부터 소개를 받은 연구참여자를 통해 눈덩이 표집 방식으로 8명의 참여자로 부터 자료를 수집하였다. 자료수집은 자료가 포화 될 때까지 반복해서 진행되었다. 연구결과에서는 COVID-19 확진자의 격리 체험이 7개의 주제로 확인되었다. 도출된 주제는 ‘훅 치고 들어오는 충격에 굳어짐’, ‘생존을 위한 처절한 고립; 극야로 내던져짐’, ‘창살같이 쏟아지는 따가운 시선’, ‘소금사막 속에서 스스로 아포형성’, ‘포근하게 감싸주는 온정의 손길’, ‘초연결망 사물인터넷 세상의 도래’, ‘다양한 미래세상과 공존시대’ 으로 묶여졌다. 연구결과를 통해 확인된 COVID-19 확진자들의 격리 체험은 COVID-19 확진자만의 관점으로 공간적, 심리적, 사회적 격리상태를 극복하기 위해 자신만의 비결을 찾으려는 노력으로 확인되었다. 본 연구의 이러한 결과는 COVID-19 확진자 격리간호와 격리관리체계를 개선하기 위한 실습 또는 교육과정 개발에 기초자료로 활용할 수 있을 것이다. This study was undertaken to essentially understand the quarantine experience of COVID-19 patients. This qualitative study was analyzed by applying a phenomenological methodology. Data of study subjects was collected data from eight participants using the snowball sampling method, where the participant was introduced by an individual who had previously been diagnosed with COVID-19. Data was continuously collected till it reached saturation. The isolation experience of COVID-19 patients was confirmed in seven subjects. The varying experiences determined were "Floating due to impact", "Desperate isolation for survival; Thrown into the extreme night", "Stinging gazes pouring down like a spear", "Self-forming spores in the salt desert", "A hand of warmth that embraces and hugs you", "The advent of the hyper-connected Internet of Things world", and "Diverse future world and coexistence era". The isolation experience of participants was confirmed as an effort to discover secrets within themselves to overcome the psychosocial isolation caused by spatial isolation from the perspective of COVID-19 patients. Results of this study can be used as basic data for developing a practice or curriculum to improve the isolation care and quarantine management system for COVID-19 patients.

Isolation and Recovery Experiences of COVID-19 Patients in South Korea: A Qualitative Study

장수정,김정아,김근면,심소형 한국성인간호학회 2023 성인간호학회지 Vol.35 No.3

Purpose: COVID-19 is both a national crisis and a cause of individual trauma. This trauma is experienced during the period of acute illness and for an unpredictable duration after recovery. This study explored experiences of COVID-19 patients in hospital isolation, providing a detailed account of their experiences to furnish basic data necessary for establishing strategies to address the psychosocial problems that may arise from the hospital isolation process and recovery period. Methods: We conducted comprehensive interviews and qualitative content analysis. We held in-depth interviews with five COVID-19 patients from May 16 to August 22, 2021, and also analyzed data from interviews with five patients conducted as part of another study on COVID-19 patients' perceptions. Thus, 10 participants' interviews were analyzed in this study. Results: From the qualitative data, 34 codes, 9 subcategories, and 4 categories were identified. The categories included "Prioritization of epidemic prevention over treatment," "Victims who have been labeled as perpetrators," "Gratitude felt in difficult moments," and "Demand for respect from the system and society." After analyzing these categories, we derived the overarching theme of "It's okay, but it's not okay." Conclusion: During isolation treatment, it is crucial to uphold human rights as much as possible by prioritizing patient care, providing a comfortable environment, and offering clear guidance on their progress. Communication between patients and caregivers should be facilitated to provide psychological support. Furthermore, national policies such as economic compensation and strategies for post-traumatic growth should be implemented to address grievances and facilitate recovery.

조혈모세포이식 병동에 관한 문화기술지

강영아(Kang Young-ah),이명선(Yi Myungsun) 대한종양간호학회 2009 Asian Oncology Nursing Vol.9 No.1

Purpose: The purpose of the study was to understand how patients experience everyday life in an isolation unit for hematopoietic stem cell transplantation (HSCT). Method: The data were collected from 25 patients with HSCT at the isolation unit from January to March in 2008 in one general hospital in Korea. The data were collected by participant observations and ethnographic interviews and were analyzed using ethnographic method. Results: Four themes regarding environmental area emerged: ‘barrier pulling up the drawbridge’, ‘very strange world’, ‘small and restricted space tied by IV and other treatment lines’, and ‘loud noise in a silent space.’ Three themes regarding patients emerged: ‘facing fear and anxiety’, ‘continuation of loneliness and lethargy’, and ‘compromising with a very long, dull, and boring time’. These themes describe how patients with HSCT suffer from continuous physical and psychosocial problems in a confined space, while endeavoring to control these problems and to search for hope for a new life. Conclusion: The results of the study provide an in-depth understanding of the experience and culture of patients in an isolation unit for HSCT. They would be used in developing practical programs to decrease patient’s culture shock including fear and anxiety at isolation unit for HSCT.

격리병동 간호사의 감염 환자 돌봄 경험

허연정,김주현,정재심,이승주 대한질적연구학회 2019 대한질적연구학회지 Vol.4 No.-

Purpose: We conducted phenomenological qualitative research to provide in depth understanding on infectious disease management. Methods: Participants were 10 nurses working in an isolation ward, where only patients with infectious diseases were institutionalized in one general hospital in Seoul. Data were collected through individual interviews and analyzed according to Colaizzi data analysis method. Results: The main theme of the experience of the nurses who worked in the isolated ward was ‘Nurse's sense of duty to overcome the fear of infection’. Through 83 meaningful re-statements and 13 themes, three sub-themes including ‘Unstable isolation ward’, ‘Taking care of infected patients’ and ‘Insufficient isolation patient care system’. Conclusion: Nurses, working in the new isolation ward, work in a lonely and dangerous environment having fear of infection, being lack of supplies and overcoming various psychological difficulties. In-depth understanding of these needs require efficient infection management policies, measures, and societal recognition.