가정간호사업 기반 원격의료 서비스 모델 구축

조문숙 ( Moon Suk Cho ),이향열 ( Hyang Yuol Lee ) 대한보건협회 2017 대한보건연구 Vol.43 No.2

연구목적 : 본 연구는 일 상급종합병원에서 운영 중인 가정간호사업에 대한 만족도 및 가정간호사업기반 원격의료에 대한 요구도와 운영방식, 원격의료가 가능한 가정간호 활동서비스를 파악하여 가정간호사업 기반 원격의료 서비스모델을 구축하기 위한 서술적 조사연구이다. 연구방법 : 2016년 11월 14일부터 2016년 12월 12일까지 총 150부의 설문지를 배부, 수거하여 그중 136명의 주 돌봄 제공자와 10명의 가정전문간호사 설문지를 SPSS 23.0으로 분석하였다. 연구결과 : 가정간호서비스에 대한 만족도는 5점 척도에 평균 4.81점이었으며, 가정간호사업기반 원격의료에 대한 요구도는 5점 만점에 주돌봄제공자 평균 3.89, 가정전문간호사 평균 3.86이었고, 주로 사용하는 스마트 기기는 스마트 폰이었고, 원격의료 서비스 방법으로는 영상통화, 원격의료 제공 시 수가는 대면진료의 50%~31%로 응답하였고, 원격의료 의사는 담당 주치의, 원격의료 간호사는 가정전문간호사를 선호하였다. 원격의료 적용 가능한 가정간호 활동서비스는 4점 만점에 주 돌봄 제공자 평균 3.16, 가정전문간호사 평균 3.17으로, 기본간호영역의 건강상태 파악 및 관찰, 치료적 간호영역의 욕창간호 및 치료, 교육 및 훈련영역의 고/저 혈당 시 응급처치, 상처소독법, 감염증상 판별법, 기구소독법, 상담영역의 환자상태 상담, 재입원 상담, 그리고 기타영역의 가정간호 재의뢰, 검사처방, 처치처방, 약처방 및 용량조절이었다. 다음과 같은 연구결과를 가정간호사업 기반 원격의료 서비스 모델에 적용하였다. 주돌봄제공자는 원격의료를 통하여 병원 방문과 의료비용을 줄일 수 있어 원격의료가 유익할 것이라 판단하였으며, 가정전문간호사는 원격의료로 의료비용 절감 등의 유익성을 높게 판단하여 가정간호 사업에 원격의료 도입을 적극 검토할 필요가 있다고 하였다. 결론 : 가정간호사업기반 원격의료 시행 시 의료진과의 즉각적인 연결과 응급처치 제공을 가능하게 하여 비 계획된 재입원을 감소시키고, 가정간호 재의뢰를 위한 불필요한 내원 등을 줄일 수 있을 뿐만 아니라, 실시간으로 활력징후 및 혈당과 같은 신체계측 자료 전송을 영상통화 함으로써, 연속적이고 즉각적인 간호(primary care)가 이루어지게 하고, 모바일 교육자료 및 건강정보를 실시간 제공하여 가정간호 대상자와 주돌봄제공자의 건강관리 능력을 향상시킬 수 있다. 이러한 원격의료를 활용한 가정간호 모델은 거동이 불편하고 고령으로 치료의 어려움을 겪고 있는 만성질환이 많은 가정간호대상자의 치료과정에 중요한 역할을 할 수 있을 것이다. Objective: This study aimed to build a feasible telemedicine-service model in home healthcare by investigating customer satisfaction of current home healthcare, assessing the need and preferred operational style and identifying applicable activities of home healthcare telemedicine. Methods: This descriptive study used a standardized questionnaire. From November 14 to December 12, 2016; 136 primary caregivers and 10 advance practice nurses responded to the survey. Statistical analysis was performed using SPSS 23.0. Results: Satisfaction with current home healthcare scored 4.81 (of 5). Primary caregivers identified the need for telemedicine with a score of 3.89 (of 4) and advance practice nurses with 3.86. Smart phones were the major device preferred and video talk was the most preferred method for telemedicine. The majority of respondents thought it would be appropriate to pay between 31 and 50% of the cost of an in-person visit for telemedicine at home, and wanted their primary physician and advance practice nurse to conduct the telemedicine. Preference for activities applicable for telemedicine scored 3.16 (of 4) on average by primary caregivers and 3.17 by advance practice nurses. The average, 3.2, was the cut point for finalizing the model; health-status assessment, pressure-ulcer treatment, emergency care of high/low blood sugar level, wound dressing, identifying infections, instrument sterilization, patient condition consulting, the need for rehospitalization, re-referrals to home healthcare, adjusting prescriptions, treatment, and medication. Caregivers responded that telemedicine could be beneficial to diminish the number of hospital visits and lower costs; advance practice nurses responded that adoption of telemedicine is necessary for home healthcare to reduce medical costs. Conclusion: Telemedicine, combined with home healthcare, enables patients to easily connect with medical experts in hospitals who can provide first aid to patients, which would reduce unplanned or unnecessary rehospitalizations. Real-time physical data through video talk can help prompt care for the patient. Timely information with mobile guidance will consistently enhance self-care for home healthcare recipients. This telemedicine model would benefit most vulnerable immobilized patients with chronic diseases and provide high-quality care for home healthcare recipients.

임신기간 및 자궁저높이를 이용한 신생아 체중 예측

조문숙(Moon Suk Cho),박영숙(Young Sook Park) 여성건강간호학회 1991 모자간호학회지 Vol.1 No.1

일 병원의 환자중심 지능형 병상 지원(Smart Bedside Station) 시스템의 이용현황 및 사용 만족도

조문숙(Cho, Moon Suk),박연환(Park, Yeon-Hwan) 대한근관절건강학회 2017 근관절건강학회지 Vol.24 No.2

Streptococcus agalactiae에 의한 콩팥주위고름집

윤규현 ( Kyu Hyun Yoon ),이정현 ( Jung Hyun Lee ),한우진 ( Woo Jin Han ),조문숙 ( Moon Sook Cho ),김진용 ( Jin Yong Kim ),박윤수 ( Yoon Soo Park ),조용균 ( Yong Kyun Cho ) 대한내과학회 2009 대한내과학회지 Vol.76 No.8

증례 : 감염 ; Streptococcus agalactiae에 의한 콩팥주위고름집 1예

윤규현 ( Kyu Hyun Yoon ),이정현 ( Jung Hyun Lee ),한우진 ( Woo Jin Han ),조문숙 ( Moon Sook Cho ),김진용 ( Jin Yong Kim ),박윤수 ( Yoon Soo Park ),조용균 ( Yong Kyun Cho ) 대한내과학회 2009 대한내과학회지 Vol.76 No.1S

간호일지와 간호사의 면담자료에 나타난 간호활동 내용의 비교분석

송미순(Song, Misoon),김매자(Kim, Mae-Ja),박영숙(Park, Young Sook),이은옥(Lee, Eun-Ok),하양숙(Hah, Yang-Sook),한경자(Han, Kyung-Ja),류세앙(Ryu, Se-Ang),강혜영(Kang, Hae-Young),김경남(Kim, Kyung-Nam),조문숙(Cho, Moon-Sook) 한국간호과학회 2003 Journal of Korean Academy of Nursing Vol.33 No.6

병원 통합물류시스템(SCM)이 물류 업무성과에 미치는 영향

조문숙,염영희 한국간호과학회 간호행정학회 2011 간호행정학회지 Vol.17 No.3

Purpose: The purpose of this study was to examine the causal relationships among quality of hospital SCM (system quality, information quality, service quality), perceived usefulness, user satisfaction and logistics performance by hospital staff. Methods: A survey using a structured questionnaire was conducted with 276 hospital staff. Analysis of the data was with both SPSS Win 18.0 for descriptive statistics and AMOS 8.0 for the structural equation model. Results: The hypothetical model yielded Chi-square=8.121 (p=.087), df=4, χ2/df=2.030. GFI=.989, AGFI=.942, RMSEA=.066, NFI=.995, CFI=.997 TLI=.990 and showed good fit indices. Three dimensions of quality of SCM had significant direct effects on perceived usefulness. System and service of quality of SCM had significant direct effects on user satisfaction. Perceived usefulness had significant direct effects on user satisfaction. User satisfaction had significant direct effects on logistics performance. Conclusion: These results suggest that logistics performance can be enhanced by user satisfaction, user satisfaction can be enhanced by perceived usefulness, and perceived usefulness can be enhanced by quality of hospital SCM. Further study with various hospitals and various variables is necessary.

웹(Web)을 이용한 간호사의 투약과오 예방 프로그램 개발

박인숙,박현애,최원자,조인숙,조문숙 서울대학교 간호대학 간호과학연구소 1999 간호학 논문집 Vol.13 No.2

The purpose of this study is to develop a web-based education program for medication errors through that nurses can improve and be reminded their knowledge of medication precautions. The method used for the program development was based on the Educational Software Design and Development Guideline which was published by Korea Educational Development Institute in 1996. Research team for the program development consisted of content experts, instruction designers, a system developer, a graphic expert and user coordinators. The program development steps were as follows; 1) Related educational materials such as principles, precautions, guidelines for medication, categories and cases of medication errors as well as policy for health institution to reduce such errors were reviewed. 2) System was analyzed and designed to detail the user requirements and to deliver the learning contents more effectively and instructively. 3) The learning contents were summarized and illustrated through the instructive strategy. 4) System was implemented on the Web. Contents covered by the program were principles of medication and medication errors, guidelines to prevent medication errors, nursing care when medication errors occur, preventive strategies for the medication errors, categories of possible medication errors, care study of the medication errors. The effectiveness of the education program with the clinical nurses needs to be tested in the future.

Streptococcus anginosus 균혈증에 동반된 상완 골수염 및 주변부 연조직 농양 1예

한우진,조문숙,이정현,안홍대,윤규현,서종구,김진용,김수연,박윤수,서일혜,조용균 대한감염학회 2008 감염과 화학요법 Vol.40 No.5

Streptococcus anginosus is a normal flora found in multiple body sites and belongs to the Streptococcus milleri group, It has often been associated with pyogenic infection, such as periodontitis, endocarditis, pulmonary abscess and abdominal or cerebral abscess. Also uncommonly, it can cause osteomyelitis. A 42-year-o1d man was admitted due to gastric ulcer perforation. At 12th hospital day, left humeral osteomyelitis and soft tissue abscess developed, Streptococcus anginosus grew in blood culture, He was treated with intravenous penicillin and surgical debridement of the necrotic tissue which lead to a satisfactory result. We report a rare case of Streptococcus anginosus-induced humeral osteomyelitis and soft tissue abscess.

신증후 출혈열에서 동반된 자발성 부신 출혈 1 예

나영숙,조문숙,박원도 인제대학교 1997 仁濟醫學 Vol.18 No.4

신증후 출혈열은 바이러스에 의한 일종의 급성 전염성 출혈성 질환군으로 특징적인 3대 주증상인 발열, 출혈 증상 및 신병증을 유발한다. 출혈 증상은 모세혈관의 취약성, 각종 혈액 응고인자의 감소, 혈소판 수 및 응집능 감소 등에 의해 자발성 출혈 혹은 경미한 외상 등으로 전신의 어느 조직에서나 발생할 수 있는데 약 10-30%에서 임상적으로 문제가 되는 출혈성 합병증을 동반한다. 본 저자들은 신증 후 출혈열을 진단받은 후 자발성 부신 출혈을 동반한 경우를 치험하였기에 문헌 고찰과 함께 보고하는 바이다. Hemorrhagic fever wish renal syndrome is the designation for a group of acute infectious hemorrhagic illnesses caused by viruses, which developes three main characteristic symptoms, such as fever, hemorrhage, and renal insufficiency. Hemorrhage can be developed on any tissue of body by spontaneous bleeding or minor trauma, which is caused by fragility of capillaries, decrease of many sorts of coagulation factors, and decrease of platelet count and dysfunction, such hemorrhage brings about clinically significant hemorrhagic complication in 10-30%. We experienced one case of spontaneous adrenal hemorrhage as complication of hemorrhagic fever with renal syndrome in 23-year-old female. We report this case with reviewing literatures.