We propose a clinical pathway of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) based on state machine. Clinical event-driven response was utilized to control workflow execution of the AECOPD clinical pathway. By comparison with the traditional clinical pathway management, clinical numerical results showed that the proposed method was better in hospitalization days, average hospitalization expense and aberration rate, and better handled the variability in the AECOPD clinical pathway execution.
Critical Pathways ; Humans ; Pulmonary Disease, Chronic Obstructive ; diagnosis ; nursing ; therapy

PURPOSE: This study was conducted to develop a simulation-based education course and to evaluate the results after the application for second year nursing students. METHODS: This study was a non-equivalent control pre-post design. Based on the clinical situation scenarios about patients with COPD and MI, a total of two simulation-based learning modules was developed. Pretest and posttest was conducted to evaluate the difference in critical thinking disposition, problem solving, and clinical competence between two groups of 102 students for the experimental group, 2007 and 90 students for the control group, 2006. The experimental group conducted a clinical performance evaluation in the final test, on December 10, 2007. RESULTS: In the experimental group, knowledge related to learning objectives was significantly increased and core intervention was performed almost exactly, but the same result was not observed in domains of analysis of laboratory test, and nursing education for patients. Self-evaluated clinical competence and problem solving level were significantly more improved in the experimental group than control group, but critical thinking disposition level wasn't. CONCLUSION: In conclusion, a simulation-based education course needs to utilize self-directed learning module like computer-based learning through web contents and MicroSim and video productions for improving nursing students' critical thinking.
Clinical Competence ; Education, Nursing ; Humans ; Learning ; Problem Solving ; Pulmonary Disease, Chronic Obstructive ; Students, Nursing ; Thinking

PURPOSE: The focus of the study was on the selection-optimization-compensation (SOC) strategy to predict successful aging mediated by dyspnea symptoms in older adults with chronic obstructive pulmonary disease. The model was constructed based on the hypotheses that coping strategy and social support of the elders predict successful aging through the SOC strategies. METHODS: Participants were 218 outpatients with chronic obstructive pulmonary disease recruited for the study. Data collection was done from March 25 to September 11, 2015, and analyzed using SPSSWIN 22.0 and AMOS 21.0. RESULTS: The hypothetical model appeared to be fit to the data. Seven of eight hypotheses selected for hypothetical model were statistically significant. The SOC strategy has only significant indirect effects through dyspnea symptoms on successful aging. Coping strategy, social support, SOC strategies and dyspnea symptoms explained 62% of variance in successful aging. CONCLUSION: The SOC strategies with social support and dyspnea symptoms significantly explained successful aging among patients with chronic obstructive pulmonary disease. Nursing strategies should be focused on social support and coping strategies to optimize SOC strategies so that older adults with chronic obstructive pulmonary disease are able to manage dyspnea symptoms and eventually achieve successful aging.
Adaptation, Psychological ; Adult ; Aging* ; Data Collection ; Dyspnea ; Humans ; Nursing ; Outpatients ; Pulmonary Disease, Chronic Obstructive*

BACKGROUND: Understanding the burden of disease is important to establish cost-effective treatment strategies and to allocate healthcare resources appropriately. However, little reliable information is available regarding the overall economic burden imposed by chronic obstructive pulmonary disease (COPD) in Korea. METHODS: This study is a multicenter observational research on the COPD burden in Korea. Total COPD costs were comprised of three categories: direct medical, direct non-medical, and indirect costs. For direct medical costs, institutional investigation was performed at 13 medical facilities mainly based on the claims data. For direct non-medical and indirect costs, site-based surveys were administered to the COPD patients during routine visits. Total costs were estimated using the COPD population defined in the recent report. RESULTS: The estimated total costs were approximately 1,245 million US dollar (1,408 billion Korean won). Direct medical costs comprised approximately 20% of the total estimated costs. Of these, formal medical costs held more than 80%. As direct non-medical costs, nursing costs made up the largest percentage (39%) of the total estimated costs. Costs for COPD-related loss of productivity formed four fifths of indirect costs, and accounted for up to 33% of the total costs. CONCLUSION: This study shows for the first time the direct and indirect costs of COPD in Korea. The total costs were enormous, and the costs of nursing and lost productivity comprised approximately 70% of total costs. The results provide insight for an effective allocation of healthcare resources and to inform establishment of strategies to reduce national burden of COPD.
Delivery of Health Care ; Efficiency ; Health Care Costs ; Humans ; Korea* ; Nursing ; Pulmonary Disease, Chronic Obstructive*

PURPOSE: This study was done to investigate the correlation among symptom experience, self-efficacy, depression, and medication adherence in patients with chronic obstructive pulmonary disease (COPD). METHODS: Participants were 100 patients with COPD recruited in one general hospital in Seoul. A structured questionnaire was used to measure the study variables. Data were analyzed using descriptive statistics, t-test, ANOVA, and Spearman correlation coefficient. RESULTS: Symptom experience and depression were positively correlated (r=.41, p < .001), symptom experience and self-efficacy were negatively correlated (r=-.21, p=.035). Depression was negatively correlated with self-efficacy (r=-.60, p < .001) and medication adherence (r=-.48, p < .001). Self-efficacy and medication adherence were positively correlated(r=.76 p < .001). CONCLUSION: Findings from this study indicate that depression and self-efficacy are important variables related to medication adherence in patients with chronic obstructive pulmonary disease. Therefore, depression and self-efficacy should be assessed, and customized nursing interventions should be provided in order to increase medication adherence.
Depression ; Hospitals, General ; Humans ; Medication Adherence ; Nursing ; Pulmonary Disease, Chronic Obstructive ; Seoul

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a major health problem resulting in significant burden for patients and families. However, family caregivers' burden has not been well recognized. The objectives of this study were to evaluate the level of caregivers' burden and to explore the related factors based on family, patient, and social support factors. METHODS: A face-to-face interview with 86 family caregivers who had been taking care of COPD patients was conducted. The participants answered a self-administered questionnaire. The questionnaire included the level of family caregivers' burden, health status and the relationship within the family, functional limitation of patients perceived by family caregivers and the social support. RESULTS: The level of caregivers' burden among participants was considerably high. Risk factors for caregivers' burden included low educational level of family caregivers, low family income, hours of caregiving, and functional limitation of the patients. Protective factors for caregivers' burden were good relationship within the family and support from other family members or friends. CONCLUSION: It is proved that family caregivers are facing significant burden in taking care of COPD patients. To reduce family caregivers' burden, it is necessary to address socioeconomic status of the family and to provide various community resources including financial support and nursing services.
Caregivers ; Cost of Illness ; Family Nursing ; Financial Support ; Humans ; Nursing Services ; Pulmonary Disease, Chronic Obstructive ; Surveys and Questionnaires ; Risk Factors ; Social Class

We present a case of Norwegian scabies in a 79-year-old male with chronic obstructive pulmonary disease, which resulted in a ward outbreak of classical scabies. A total of 23 people including nurses, nursing students, physicians, other patients in the same ward and their families were diagnosed with the infestation. Skin scales from the patient revealed numerous scabies mites (21.3/mg) at various stages from egg to adult. The patient had previously suffered from neurodermatitis and xerotic eczema for 5 years. Long-term systemic steroid therapy was considered as a possible cause of Norwegian scabies in this patient. Control of the infestation was achieved by implementing an immediate surveillance system, strict isolation and administration of scabicidal medication.
Adult ; Aged ; Eczema ; Humans ; Male ; Mites ; Neurodermatitis ; Ovum ; Pulmonary Disease, Chronic Obstructive ; Scabies* ; Skin ; Students, Nursing ; Weights and Measures

PURPOSE: This study was designed to investigate the effects of a pulmonary rehabilitation program for patients with COPD. METHOD: 37 subjects, who had a FEV1/FVC below 70%, participated. 18 were assigned to the experimental group and 19 to the control group. The program consisted of individualized education program and exercise program for 6weeks, 3times a week. Data was collected through questionnaire surveys of general characteristics, anxiety and depression, blood tests for lactic acid and cardiopulmonary exercise tests, and also using bicycle ergometer, for exercise capacity. As for data analyses, paired and unpaired t-test and x2-test were adopted using an SPSS program. RESULT: The result revealed that the increase in VT, peak O2, Emax, HRmax and Wmax, at the maximal exercise, were significantly high in the experimental group. However, the anxiety and depression scores were not significantly high in the experimental group. CONCLUSION: The pulmonary rehabilitation program was effective in increasing cardiopulmonary endurance in patients with COPD. Accordingly, we should seriously consider an individualized pulmonary rehabilitation program as a nursing intervention.
Anxiety ; Depression ; Education ; Exercise Test ; Hematologic Tests ; Humans ; Lactic Acid ; Lung Diseases ; Methods ; Nursing ; Pulmonary Disease, Chronic Obstructive* ; Rehabilitation* ; Statistics as Topic

PURPOSE: This study was designed to construct a structural model for health promoting behavior of patients with chronic disease. The hypothetical model was developed based on the literature review and Pender's health promotion model. METHOD: Data was collected by questionnaires from 1748 patients with chronic disease in General Hospital from December 1999 to July 2000 in Seoul. The disease of subject were cardiac disease included hypertension peptic ulcer, pulmonary disease included COPD and asthma, DM, and chronic kidney disease. Data analysis was done with SAS 6.12 for descriptive statistics and PC-LISREL 8.13 Program for Covariance structural analysis. RESULTS: 1. The fit of the hypothetical model to the data was moderate, it was modified by excluding 4 path and including free parameters to it. The modified model with path showed a good fitness to the empirical data (x2=591.83, p<.0001, GFI=0.97, AGFI= 0.94, NNFI=0.95, RMSR=0.01, RMSEA=0.05). 2. The perceived benefits, perceived barriers, self-efficacy, self-esteem, and the plan for action were found to have significant direct effect on health promoting behavior of chronic disease. 3. The health concept, health perception, emotional state, social support were found to have indirect effects on health promoting behavior of chronic disease. CONCLUSION: The derived model in this study is considered appropriate in explaining and predicting health promoting behavior of patients with chronic disease. Therefore, it can effectively be used as a reference model for further studies and suggested implication in nursing practice.
Asthma ; Chronic Disease* ; Health Promotion ; Heart Diseases ; Hospitals, General ; Humans ; Hypertension ; Lung Diseases ; Models, Structural* ; Nursing ; Peptic Ulcer ; Pulmonary Disease, Chronic Obstructive ; Surveys and Questionnaires ; Renal Insufficiency, Chronic ; Seoul ; Statistics as Topic

PURPOSE: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity in many countries, and it has high rate of hospital readmissions due to recurrent exacerbations of the disease. Many previous studies have suggested further examination of the factors that contribute to hospital readmissions of COPD patients. However, evidence on the effects of nurse staffing by registered nurses (RNs) on the readmission of COPD patients is lacking in Korea. The aim of our study was to evaluate the effects of nurse staffing on hospital readmissions of COPD patients. METHODS: We used National Health Insurance claim data from 2002 to 2012. A total of 1,070 hospitals and 339,379 hospitalization cases were included in the analysis. We divided the number of RNs per 100 beds and the proportion of RNs on staff to one of three groups (Q1: low; Q2: moderate; Q3: high). A generalized estimating equation model was used to evaluate the associations between readmission and nurse staffing. RESULTS: A higher number of RNs was associated with lower readmission rates of 8.9% (Q2) and 7.9% (Q3) respectively. A similar effect was observed as the proportion of RNs among the total nursing staff gradually increased, resulting in lower readmission rates of 7.7% (Q2) and 8.3% (Q3). CONCLUSIONS: Our results suggest notable positive effects of nurse staffing by RNs on patient outcomes. In addition, the magnitude of impact differed between different sizes of hospitals. Thus, human resource planning to solve staffing shortages should carefully consider the qualitative aspects of the nursing staff composition.
Aged ; Female ; Health Facility Size/statistics & numerical data ; Hospitals, General/statistics & numerical data ; Humans ; Male ; Nurses/*supply & distribution ; Nursing Staff, Hospital/*supply & distribution ; Patient Outcome Assessment ; Patient Readmission/*statistics & numerical data ; Personnel Staffing and Scheduling ; Pulmonary Disease, Chronic Obstructive/*nursing ; Quality of Health Care ; Recurrence ; Republic of Korea ; Retrospective Studies