간호실무에서 신봉이론(Espoused theories)에 대한 탐색적 연구

서문자,김혜숙,이은희,박영숙,조경숙,강현숙,임난영,김주현,이소우,조복희,이명하,지성애,하양숙,손영희,권성복,김희진,추진아 성인간호학회 2001 성인간호학회지 Vol.13 No.1

As a nursing practice involves nurses' actions in a specific context of health care, this study has focused on exploring the espoused theories in nursing practice within the action science perspectives, Espoused theories are the belief, principles, and rationale expressed by the practitioner as guiding her/his actions in a situation of practice. The data were analysed qualitatively and 25 elements of espoused theories of nursing action were identified and clustered into 6 categories. The 25 elements of espoused theories are as follows: The clinical nurse worked in wholistic and individual nursing, focussed on the patient's needed, comfort and supportive nursing (5 theories of nursing goal) ; excellent skills, knowledge based, assessment and data collection, explaining, educating or a scientific basis(6 theories of nursing intervention): advocacy, value oriented, treatment, account- ability and commitment(4 theories of nursing ethics) ; human respect. partnership, trust(3 theories of patient-nurse relationship) : knowledgable, accumulated clinical experiences and personally lived experiences. positive perspectives(4 theories of nurse), role of intervention. rewarding peer relationship(3 theories of situations) The above mentioned espoused theories are similar to that of nursing textbooks which students learned through basic nursing education and almost the same as the Acts ofa Nurse in Korean. However, we are doubtful whether nurses actually do as they think. Therefore. it is recommended to review the theories-in-use in order to and any discrepancies between the espoused theories and the reality of nursing actions

간호사의 임상 실무 경험

서문자,손행미,강현숙,권성복,김주현,박영숙,이은희,임난영,조경숙,지성애 성인간호학회 2002 성인간호학회지 Vol.14 No.4

purpose: This study was conducted to describe qualitatively the entities of nurse's experiences in general hospitals and to suggest basic data guiding research on developing Standards of clinical nursing practice in Korea. Method: Fourteen nurses working at general hospitals with over 300 beds in Seoul were interviewed in-depth until saturation using tape-recorders and transcription. Result: The central theme of clinical nursing practice experienced by subjects was "being with clients" that means accepting client's personal character, solving client's needs and providing client-centered nursing. A also "being with clients" was felt to be the responsibility of nurses which was learned from their nursing schools. The nursing strategies performed in order to be with patients were proving skillful nursing techniques, accepting, educating, emotional support, advocating, and self-reflecting, the subjects experienced somewhat problematic affects such as difficulties in interpersonal relationship, work overload, negative image of nursing, deficit of self-confidence for nursing actions, poor working conditions, and unfair treatment. Nurses at the hospital practiced with pride when they felt that they were accepted by clients. Conclusion: Further research is needed to analysis problems in clinical practice and the comparison of nurses' experiences of clinical practice, with nurses' experiences in various settings.

쯔쯔가무시병에서 가피의 위치와 복장과의 관계

김백남,곽이경,문치숙,김의석,박상원,이창섭 대한감염학회 2006 감염과 화학요법 Vol.38 No.6

목적 : 쯔쯔가무시병의 예방을 위하여 위험지역에서 긴소매 윗옷을 입고 바지 끝을 양말 속에 넣는 것이 권장되고 있다. 이러한 예방조치의 효용성을 알아보기 위하여 우리는 쯔쯔가무시병에서 가피의 위치와 신발과 복장과의 관계를 살펴보았다. 재료 및 방법 : 2005년 10-12월 사이 6개 병원에서 전형적인 임상양상, 가피의 존재, 혈청검사 결과로 쯔쯔가무시병이 의심되거나 확진된 159명의 성인을 대상으로 가피의 위치, 추정 감염일, 야외활동, 당시 착용한 신발과 복장 등 을 조사하였다. 결과 : 혈청검사는 5명에서 시행되지 않았고 99명이 양성이었으며, 가피는 142명에서 발견되었다. 몸의 두 군데에서 발견된 6명을 제외한 136명 중 82명(60.3%)에서 가피는 하반신(아랫배, 엉덩이, 서혜부, 생식기, 넓적다리, 종아리)에 있었다. 감염일이 추정가능하고 가피가 1개만 있는 44명을 대상으로 하였을 때, 가피가 하반신에서 발견된 17명에서 슬리퍼를 신거나 맨발인 경우는 5명이었으나 상반신에 있는 27명 중에는 아무도 없었다(P=0.006). 바지아랫단을 양말 속에 집어 넣은 4명 중 1명은 하반신에서 3명은 상반신에서 가피가 발견되었다. 42명이 긴 소매 윗옷을 입었는데, 이중 16명은 하반신에서 26명은 상반신에서 가피가 발견되었다(P=1.00). 결론 : 쯔쯔가무시병 환자에서 신발을 신지 않거나 발이 잘 보호되지 않았을 때 가피는 하반신에 더 잘 생겼다. 바지 아랫단의 처리방법이나 긴 소매 윗옷의 착용은 가피의 위치와 통계적으로 유의한 연관관계는 발견되지는 않았다. 그러나 표본수가 적고 유충의 침범경로에 영향을 줄수 있는 다른 요인이 있기 때문에 가피의 위치와 연관관계가 없다고 이 연구에서 단정할 수는 없다. 따라서 쯔쯔가무시병의 예방을 위한 실용적인 권고를 위해서는 더 많은 연구가 필요하다. Background:Wearing a long-sleeved shirt and tucking the pants legs into the socks is recommended to prevent scrub typhus. This study investigated associations between the location of eschar and the type of clothes and shoes to evaluate the efficacy of these protective measures. Materials and Methods:One-hundred and fifty nine patients in whom scrub typhus was confirmed or suspected based on the typical clinical manifestations, presence of eschar, or positive results of serologic tests at 6 Korean hospitals from October to December 2005 were included in this study. We collected the information on the location of eschar, presumed exposure date to chiggers, and the clothes and shoes which they had worn. Results:Serologic tests were positive in 99 patients. Eschars were observed in 142 patients and 6 of them exhibited more than 2 eschars. Eighty-two (60.3%) of 136 patients with a single eschar had an eschar on the lower half of the body. Of the 44 patients whose exposure date could be estimated, and who had only a single eschar, 5 of the 17 patients with eschars in the lower half of their bodies, and none of the 27 patients with eschars in the upper half of their bodies went barefoot or wore open footware (P=0.006). Only 4 patients tucked the pants into their socks, and an eschar was found in the lower half in one patient, and in the upper half of the body in the other 3 patients. Of 42 patients who wore long-sleeved shirts, eschars were found in their lower bodies in 16, and on their upper bodies in 26 (P=1.00). Conclusion:When the feet were not protected properly with shoes, eschars were found more frequently on the lower half of the body than on the upper half. Wearing a long-sleeved shirt or tucking the pants legs into the socks was not found to be significantly correlated to the location of eschars. Further studies involving larger samples are necessary for the development of practical guidelines of protective measures to prevent scrub typhus.

국내 Epstein-Barr 바이러스 일차감염의 임상적 특성

김백남,곽이경,문치숙,김의석,박상원,이창섭 대한감염학회 2007 감염과 화학요법 Vol.39 No.6

In this study, the clinical features of 264 patients of primary Epstein-Barr virus (EBV) infection between the years of 2002-2006 were evaluated retrospectively. The median age of the patients was 6 years old (0-69), and the hospitalization rate was 78.0%. Fever (83.3%) and sore throat (50.4%) were the most common symptoms. Cervical lymphadenopathy (71.2%), tonsillitis (51.1%), splenomegaly (26.1 %), hepatomegaly (25.8%), rash (10.2%) and jaundice (1.5%) were observed. Cervical lymphadenopathy was less frequent in older age groups. The annual number of primary EBV infections according to the age group during the study period did not change significantly in this study.

2009년 인플루엔자 대유행 중 인플루엔자 진료소 방문자의 연령 분포 변화

김백남,곽이경,문치숙,김연숙,김의석,배인규,염준섭,이창섭,허지안 대한감염학회 2010 감염과 화학요법 Vol.42 No.2

The pandemic influenza (H1N1 2009) virus, after being introduced in Korea in April, 2009, spread rapidly nationwide in mid-2009. This study was conducted to characterize trend in age distribution of visitors to Flu-clinics during the pandemic. Demographic, clinical and laboratory data of visitors to flu clinic from Week 36 to 52 (August 30 to December 26) of 2009 were retrieved and collected from electronic databases at 9 hospitals. Visitors 0-6, 7-12, 13-18, 19-29, 30-64, and 65 years or more of age were classified into group I to VI, respectively. A total of 107,467 visitors were seen at Flu-clinics for a 17-week study period. Of those, 32,485 were laboratory-confirmed. Antivirals were prescribed for 62,533 visitors. Numbers of visits, prescriptions of antivirals, and laboratory-confirmed cases of the pandemic influenza (H1N1 2009) peaked at Week 44. A large number of visits by group II and III were followed by those of group I and V, especially around the peak. Numbers of visits by group VI were lowest in all hospitals. In some hospitals, higher number of visits lasted longer in children than in adults while vice versa in other hospitals depending on the location. In summary, the pandemic influenza (H1N1 2009) was presumed to peak in late October and involved majorly children and students in Korea. Unique age distribution of visitors to flu clinic was observed in some hospitals.

급성심근경색후 발생한 심실중격결손 2례

김태희,이재호,김애란,허민영,문치숙,정수룡,김대경,김두일,김동수 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.4

Ventricular septal defect remains an infrequent but devastating complication of acute MI. Approximately 1∼3% of cases of acute myocardial infarction are complicated by ventricular septal rupture in the prethrombolytic era and the incidence has decreased to 0.2% with reperfusion therapy. This mechanical complication usually occurs within the first 10 to 14 days when necrotic tissue is most abundant and the collateral coronary circulation is not well developed. This lesion is generally associated with complete coronary obstruction rather than severe stenosis. Rupture of the ventricular septum is a severe mechanical complication of acute myocardial infarction, usually resulting in death unless surgical repair is performed. The bad prognosis of this event within the first 2 weeks indicates the need for early surgical rapair. This complication is more frequent after the first acute myocardial infarction in the elderly and secondary to a transmural myocardial infarction. We report two cases of ventricular septal rupture after acute myocardial infarction.

폐렴 구균(Streptococcus pneumoniae)에 의한 척수 경막외 농양 1예

이지영,위유미,손경목,기현균,문치숙,오원섭,백경란,송재훈 대한감염학회 2004 감염과 화학요법 Vol.36 No.6

폐렴구균은 보통 폐렴이나 뇌막염을 일으키는 균으로 척수 경막외 농양을 일으키는 경우는 매우 드물다. 본 저자들은 폐렴 구균에 의한 척수 경막 외 농양을 경험하여 보고하는 바이다. 과거 건강했던 36세 남자 환자로 사다리에서 낙상한 후 요통 및 고열, 신경학적 이상으로 내원하여 자기 공명 촬영 결과 척수 경막 외 농양으로 진단받고 항균제 투여와 함께 응급 수술을 시행하였다. 농 배양 결과 페니실린 감수성인 폐렴 구균이 분리 되었고, 수술 요법과 항생제 투여 후 농양은 치유되었으나 신경학적 이상은 호전 없는 상태로 타원으로 전원되었다. Pneumonia and meningitis are the most frequent manifestations of pneumococcal infections. Pneumococcal spinal epidural abscesses have been rarely reported. Spinal epidural abscess by Streptococcus pneumoniae has been diagnosed among the patients with diabetes mellitus, alcoholism, corticosteroid therapy, intravenous drug use, chronic renal failure, AIDS, and history of spinal surgery. Recently, we experienced a case of pneumococcal spinal epidural abscess after spinal trauma. A 36-year-old male patient was admitted with back pain, fever, and paraplegia which occurred 5 days after the trauma. Spine MRI revealed spinal epidural abscess at the level from T2 to T9. He was treated with antimicrobial agents and surgical exploration for spinal epidural abscess. Pus culture grew S. pneumoniae which was susceptible to penicillin. Despite early surgical treatment, neurologic sequelae remained. Considering the high mortality and morbidity of pneumococcal spinal epidural abscess, early diagnosis and aggressive treatment including surgical intervention and antibiotics therapy should be implemented immediately.

임상간호사 역할정립에 관한 연구

지성애,이은희,조경숙,서문자,강현숙,임난영,김주현,손행미,권성복,김동옥,박영숙,손영희,한혜자,이여진,성영희,박광옥,박정원,이계숙 병원간호사회 2004 임상간호연구 Vol.9 No.2

Purpose: To identify the clinical nurses' role in hospitals in Korea to provide the basic data needed for the establishment of the policy of nursing practice. Method: Four stages of multi-dimensional survey was done inductively during 2002,7 to 2003, 7. At the first, nurse role activities were sorted with the rigorous review of the related literatures and documents and simultaneously, the data were collected by Delphi methods from professional nurses and interview with patients and their families. Secondly, research seminars were done many times to validate the contents of nurses role activities and its components with analysing the first data and classified them into nurse role and it's activities. Thirdly, massive nationwide survey on the frequency and the perceived importance of the nurse role activities from the nurses, physicians, patients and their families using the questionnaire developed by the research team. At fourth stage, research seminars were held several times to analyse the data thoughtfully. Total 1,133 composing of 652 nurses, 206 physicians and 275 patients in 40 hospitals sized over 500 beds nationwide. And there was a group of panelist composing of 17 experts. Result: Nurses' Roles and Nurses' Role Activities were identified as follows : At first step, 868 Nurses' Role Activities from literature reviews, and 981 from Nurses' Role Activities with Delphi method were sorted. At second step, 30 nurses roles and 772 nurses' role activities were sorted from the analysis of the data from the first step. Finally 40 nurses roles and 770 nurses' role activities were identified through the validation process with the research team seminar. The perceived frequency on nurses' role activities of clinical nurses was significantly different upon their ages, experiences, working places, and positions. The higher the educational level, the more perceived importantly their role activities significantly. The average score of the perceived frequency was 3.17(max. : 5) and the average scores of the perceived importance of nurse' role activities were different among nurses(4.10), doctors(3.55) and patients(3.58). Conclusion: Since these results were obtained from multi-dimensional approach nationwide, and the intensive validation process of contents were scrutinized thoughtfully, this data could be used as basic information to establish the nurse policies regarding to nurse job description and planning the nurse's man power.

Identification of the bphC Gene for meta-Cleavage of Aromatic Pollutants from a Metagenomic Library Derived from Lake Waters

Moon Mi-Sook,Lee Dong-Hun,Kim Chi-Kyung The Korean Society for Biotechnology and Bioengine 2004 Biotechnology and Bioprocess Engineering Vol.9 No.5

Useful genes can be Screened from various environments by construction of metagenomic DNA libraries. In this study, water samples were collected from several lakes in mid Korea, and analyzed by T-RFLP to examine diversities of the microbial communities. The crude DNAs r were extracted by the SDS-based freezing-thawing method, and then further purified using an $UltraClean^{TM}$ kit (MoBio, USA). The metagenomic libraries were constructed with the DNAs partially digested with EcoR I, BamH I, and Sac II in Escherichia coli DH 10B using the pBACe3.6 vector. About 44.0 Mb of metagenomic libraries were obtained with average inserts 13-15 kb in size. The bphC genes responsible for degradation of aromatic hydrocarbons via mets-cleavage were identified from the metagenomic libraries by colony hybridization using the bphC specific sequence as a probe. The 2,3-dihydroxybiphenyl (2, 3-DHBP) dioxygenase gene (bphC ), capable of degradation of 2,3-DHBP, was cloned and its nucleotide Sequences analyzed. The genes consisted of 966 and 897 base pairs with an ATG initiation codon and a TGA termination codon. The activity of the 2,3-DHBP dioxygenase was highly expressed to 2,3-DHBP and Showed a broad substrate range to 2,3-DHBP, catechol, 3-methylcatechol and 4-methylcatechol. These results in-dicated that the bphC gene identified from the metagenomes derived from lake water might be useful in the development of a potent strain for degradation of aromatic pollutants.

소화성 궤양환자의 Gastrin 및 Somatostatin에 관한 연구

지무영,김종숙 중앙대학교 의과대학 의과학연구소 1984 中央醫大誌 Vol.9 No.3

To clarify the interrelationship between the gastrointestinal hormones such as gastrin and somatostatin in gastric acid secretion and the level of gastrin and somatostatin in blood, gastric juice and antral tissues were studied using radioimmunoassay kits in the patients of peptic ulcer diseases(33gastric ulcer cases and 45 duodenal ulcer cases) and 56 normal control. The results were as follows. 1. The patients with gastric ulcer showed significantly higher gastric levels in gastric juice than the normal control group (p<0.05). Gastrin levels in gastric juice of the gastric ulcer were significantly higher than those of the duodenal ulcer group (p<0.02). 2. The patients with gastric and duodenal ulcer showed lower plasma somatostatin levels than the normal control group (p<0.01), and the patients with duodenal ulcer showed higher plasma somatostatin levels than the gastric ulcer group (p<0.01). 3. The patients with duodenal ulcer showed higher gastric juice somatostatin levels than the normal control group and the gastric ulcer group (p<0.01), and the antral tissue somatostatin levels of the normal control group were higher than those of the peptic ulcer group. 4. There was close correlation between antral tissue somatostatin and the pH of gastric juice both in the normal control (p<0.05) and gastric ulcer group (p<0.05), and correlation between antral tissue gastrin and somatostatin both in gastric ulcer group and in the normal control group (p<0.05). 5. The ratio of gastrin to somatostatin levels in the same antral tissue of the stomach in patients with gastric ulcer was lower than in the normal control (p<0.05) and in the duodenal ulcer group (p<0.05). It was suggested that the levels of gastrin and somatostatin were significantly variable according to the disease conditions because of the differences of seceretory patterns of gastrin and somatostatin.