• Journal of the Korea Academia-Industrial cooperation Society
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• v.21 no.8
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• pp.160-169
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• 2020

This study was conducted to identify the linkage and cooperation experiences in public case-management services of visiting health care practitioners. Focus group interviews were conducted with three people in charge of providing visiting healthcare services in public health centers. A semi-structured interview questionnaire was developed in advance through discussions among researchers In response to the interview questions, study participants described in detail the success and failure factors associated with linkage and cooperation that they experienced while providing visiting healthcare services. The interview data were analyzed qualitatively to identify the main themes and sub-themes reflecting visiting nurses' experiences with linkage and cooperation. The three main themes were: 'Guidelines act as positive performance factors for community-based linkage and cooperation', 'Unstable employment and lack of an integrated system act as barriers to linkage and cooperation', and 'Necessary for multidimensional approach to promoting linkage and cooperation'. Based on these results, the authors propose the development of clear linkage and cooperation standards and procedures, thereby ensuring job security for visiting nurses. Moreover, an integrated information system should be developed and implemented.

• Proceedings of the KAIS Fall Conference
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• 2009.12a
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• pp.474-478
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• 2009

본 연구는 2008년 맞춤형 방문건강관리사업에 사용되고 있는 관절통증을 중심으로 한 사례관리를 수정 보안하여 우리나라 실정에 맞는 관절통증 사례관리 프로그램을 개발, 제안하며, 맞춤형 방문건강 관리사업의 활성화와 완성도를 높이는데 있다. 연구방법으로는 2007년 전국 12주 관절통증 사례관리 결과자료 분석하고, 전국 253개 보건소의 맞춤형 방문건강관리사업 인력에 대한 자료 분석과 전국 보건소 전문가 자문회의와 토론 결과를 통해 설문지를 수정 보완하여 2008년도 충청남도 관절통증 12주 사례관리를 실시하였다. 자료분석은 SPSS 12.0 통계 프로그램을 이용하여, p-value가 0.05 미만과 0.01미만인 경우를 통계적으로 유의한 것으로 판정하였으며, 전국자료는 빈도분석, wilcoxon 부호순위 검정과 McNemar's 검정을 실시하였으며, 12주의 관절통증 사례관리의 연구기간동안 수집된 자료를 1주와 8주간, 1주와 12주간, 8주와 12주간을 paired t-test 검정과 McNemar's 검정을 실시하여 유의성 평가를 실시하였다. 연구결과는 다음과 같다. 12주 기간 동안 사전 사례관리 방문간호사의 교육을 통한 사례관리 서비스의 강도의 조절 및 매주로 서비스의 횟수를 조절하여 사례관리를 실시한 결과 총 109개 항목에서 1주와 8주간에 유의한 항목은 TG(mg/dl)를 비롯한 51개 항목, 1주와 12주간에는 콜레스테롤(mg/dl)을 비롯한 53개 항목, 8주와 12주간에는 지난 48시간동안 관절통증 점수를 비롯한 3개 항목으로 유의한 차이를 볼 수 있었으며, 1주와 8주간은 유의하나 1주와 12주간은 유의하지 않게 나타나는 항목은 TG(mg/dl)를 비롯한 3개 항목, 1주와 8주간은 유의하지 않다가 1주와 12주간은 유의하게 나타나는 항목은 콜레스테롤(mg/dl)를 비롯한 6개 항목, 1주, 8주, 12주간의 모든 기간에서 유의한 항목은 지난 48 시간동안 관절통증 점수를 비롯한 3개 항목으로 조사되었다. 결론적으로 현재 우리나라에서 추진되고 있는 맞춤형 방문건강관리 사업의 사업지침에 대한 보완을 위해 관절통증사례관리 프로그램에 있어 중재 서비스 또는 프로그램의 기간은 12주간에서 8주간으로 조정 되어야 하며, 추가가 필요한 항목으로는 교육, 자기역량 강화, 운동처방, 물리치료, 약물치료, 대체요법, 식이, 영양, 생활지도 등이며, 어골도 분석을 위한 기본 틀 및 주요 구성요소를 제시 및 기여 요인 및 결정요인을 위한 논리적 모형 제시가 필요하며, 개선목표를 위한 유지증진 및 관리능력, 지기 관리 수행도 개선과 대상자별 맞춤형 사례관리를 위한 표준화된 행동 체크리스트 제작 보급 및 사례별 운동, 물리치료 지도 방법 계획 수립에 대한 인력 충원이 필요하다.

• Journal of Korean Public Health Nursing
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• v.20 no.1
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• pp.5-15
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• 2006

Purpose: The objectives of this study was to measure the outcomes of interventions on the health and social welfare of the elderly in a rural community in Korea. The project involved integrating services of one public health center with that of one social welfare agency, which were under different administrative structures. Method: A single group pretest-posttest design was used for this research. Seventy-five elderly residents living alone in a rural community participated in the study. All of them had coverage of free basic medical care and social welfare services by the government. Major activities for the intervention included: developing partnerships among community leaders/institutes; forming committees of community residents; educating care providers and volunteers; developing 8 integrated service programs and instruments; and organizing the networks. The 20-month intervention was care-managed by a public health nurse whom collaborated with social worker, and was assisted by volunteers. The t-test was utilized to analyze the outcome variables including the elder's health, social welfare and quality of life. A major limitation of this study was the lack of a control group. Results: The outcome of the intervention was shown by improved elder's health, social welfare needs, and quality of life. Integrating the services of public health centers with those of social welfare agencies is an effective way to improve the health of the elderly in the community. Conclusion: Developing community capacity with such integrated services will pay an important role in improving the health of the elderly who live alone.

• Journal of agricultural medicine and community health
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• v.26 no.2
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• pp.15-41
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• 2001

Since medical clients and the community they live in are expected to be center of future public health and medical care system, new service programs must be developed with patients focused on in line with widening public access of information and social participation. Patients- focused service shall mean the area- oriented provision of public health service. In this study, health officers working at public health centers, public health sub- centers and medical offices in Jeonbuk- do area were taken for population in order to investigate their attitudes toward and knowledge about the service area assigning system under the public health programs. Findings from the survey to 260 health officers, divided by general category, are as follows : Government officers at public health organizations appeared to have high grade of understanding to the service area assigning system and also great appreciation for the necessity of it. Regarding the timing for the system to be introduced, they support the gradual implementation and, as for the type of service to be provided, they preferred home nursing and treatment of chronic diseases. Highly positive responses were centered on the health classes under the health promotion projects, and as far as health projects for the old are concerned, services for home nursing, for the disabled and for home- alone people are favored most. On the other hand, budgeting, manpower and reorganization are rated as prerequisite to establishment of the service area assigning system. From the viewpoint of system side, the improvement of working conditions is rendered as most urgent, while the information system for establishing the service area assigning system is conceived far from satisfactory. Proper assignment of specialists was noted as mostly important to establish the delivery system for medical service through the service area assigning system by team. As merits of the service area assigning system, it is pointed out that, through the system, health clients can better be managed and the nursing quality will be improved thank to the enhanced specialization. It is also perceived that the district health service is not well prepared to respond to the increased and diversified needs of community people and, furthermore, service programs of health centers have not been fully developed. The most serious problem standing in the way to expansion of health projects is, it is noted, uniformity (formality) of the project. Based on the results of the survey which suggest time has ripen to introduce the service area assigning system, following strategies are proposed to anchor down the system as soon as possible: First, we should introduce the system gradually, starting from the area selected, and in consideration of area specialities, refraining from the hitherto stereotyped way of providing health service. Second, we should seek to properly assign the specialists and improve the working conditions of the assigned officers by securing sufficient budget, since it is a most urgent step to lay foundation for the service area assigning system. Third, best service program should be developed to meet the satisfaction of community people by responding to their needs and solidifying the management of medical clients. Fourth, wide scope of study should further be conducted in order to help this system take roots in the central living of community residents since pilot project on the experimental base attended by specialists only can not win popularity among the masses.

• Journal of Korean Academy of Nursing Administration
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• v.17 no.1
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• pp.54-65
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• 2011

Purpose: The aim of this study was to evaluate the efficiency of community visiting health service units using DEA and to compare the results with those of traditional evaluation methods. Methods: Data were collected using 2008 annual reports of 10 districts in one city. Input variables were number of staff and operational budget per year and output variables were number of managed household per nurse, rate of controlled hypertension, and diabetes mellitus. EMS Window version 3.1 was used to measure efficiency score and bootstrapping Chi-square test was applied to identify differences between efficient and non-efficient unit by organizational factors. Results: The average efficiency score of 10 community visiting health services was about 66%. Only two of the units operated program efficiently. The career of the staff was one among other factors associated with efficiency. The evaluation results from the traditional method and DEA were totally different. Conclusion: These results indicate that, evaluation methods have very important and significant effects on the evaluation results of community visiting health service units. The DEA method is recommend as an alterative method for evaluating community visiting health service.

• Child Health Nursing Research
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• v.20 no.1
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• pp.11-19
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• 2014

Purpose: The purposes of this study were to develop a postpartum nursing intervention program for immigrant women and evaluate the effects on postpartum depression, child rearing confidence, home environment, and infant temperament. Methods: This research was a non-equivalent control group pre-test and post-test design. Participants were pregnant immigrant women from China, Vietnam, and the Philippines residing in Kyunggi province and Seoul. Twenty women were assigned to the intervention group, and 19 women to the control group. For the intervention group, the women were visited at home and provided emotional support and parenting education for three months. To analyze the intervention effects, repeated measure ANOVA and t-test were used. Results: Child rearing confidence was higher in the experimental group than the control group at interaction effect of time and group, six weeks and three months postpartum. However, there were no significant effects for maternal depression, infant temperament, and husband support. Home Observation for Measurement of the Environment (HOME) score in the experimental group was higher than that of the control group at three month postpartum. Conclusion: Results indicate that the nursing intervention program had positive effects and can be used to further the health status of immigrant mothers and children.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.12 no.8
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• pp.3563-3571
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• 2011

In this research, we analyzed the efficiency of 20 public health centers of Gyeongnam Province during 2007-2009, so weakness of input and output factor were found. We used the CCR, BCC model of Data Envelopment Analysis as a method of evaluation, made a choice human resource as the input variable, made a selection the performance of public health care center, ward as the output variable. The results of this study show that the efficiency of 20 public health centers have got better because Government and Gyeongnam have provided administrative, financial support. It is expected that this research can give good information for effective management of public health centers.

• 한국노년학
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• v.29 no.4
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• pp.1577-1589
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• 2009

The purpose of this study was to compare the health status, functional status, and home environment hazards by the fear of falling and explore the factors that contribute to the fear of falling. This was a descriptive study. Data were collected for two years with 973 older adults who enrolled in a health center at A city. Trained nurses visited subjects' home and collected data using Resident Assessment Instrument MDS-HC. The average age of the subjects was 76.8 (±7.6) and female was 74.8%. 20.7% of subjects reported fear of falling. In terms of the fear of falling, two groups were compared. There were significant differences in vision, urinary incontinence, pain that interrupts daily activity, unstable gait, comorbidities, frequency of depressive or anxious sign. The greater the age, IADL and ADL dependency, comorbidities, unstabled gait, the more fear of falling. In conclusion, this study reassured the importance of assessing the major factors related to fear of falling such as age, IADL and ADL, comorbities, gait among older adults. This study will contribute to establish strategies for preventing fall. Reducing the fear of falling through the comprehensive nursing intervention will ultimately improve the quality of life in the elderly.

• Journal of agricultural medicine and community health
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• v.28 no.1
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• pp.67-77
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• 2003

Objectives: This study is designed to suggest the health service goals necessary for providing the more efficient services relevant to the requests of the community, through the evaluation on the operating status of the unified health subcenters. Methods: We visited total 5 unified health subcenters comprising 3 ones located in Gyeongsangbuk-do and 2 ones located in Gyeongsangnam-do from December 2000 to January 2001, and interviewed about the pre- and post-unified status related to manpower, facilities, equipment, medical service and health service quality, and the problems and improvement plans of the unified management. Results: According to the evaluation on the manpower before and after the unification of the health subcenters, the total employees increased by 2.8 persons on average from 6.8 to 9.6 persons in the investigated subjects. The numbers of doctors, dentists and nurses were almost the same as before. There were no clinical pathologic technician and radiological technician before but they were appointed to duty in 3 unified health subcenters later. The unification of the health subcenters has produced slight increases in the frequency of the medical service and dental treatment and considerable increases in that of the physical therapy and laboratory tests. In relating to the changes of the health service, the cases of visiting health care and ambulatory medical service, and the total number of health education participants were greatly increased after the unification. The number of cases undergoing the vaccination and cervical cancer screening was similar to that of the pre-unification while the patient number of the registration to hypertension or diabetes showed a tendency to increase a little. Since the unification of the health subcenters, the frequency of laboratory tests has been increased, but the quality of health service has not been improved yet. Nevertheless, the unification seems to be positive according to the result of the great improvement in visiting health care, ambulatory medical service and health education service. The problems of the unification of the health subcenters were indicated in indefiniteness of the service details between the workers; excessively large building hard to be effectively managed; insufficient medical instruments, inappropriation of working expenses, lack of professional training for the health education, etc. Conclusions: For further active functions of the unified health subcenters, the minimal allocation basis to appoint doctors, nurses and administrative workers to do the duty should be differentiated from the basis for a health subcenter, and the fundamental instruments needs to be expanded to improve the quality of the medical service and visiting health care service. Moreover, the unified health subcenter needs to have definite service details between the workers, and should improve the working efficiency through the development of service-related guidelines.

• Journal of Home Health Care Nursing
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• v.10 no.1
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• pp.5-14
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• 2003

Recently, there has been an increasing need for long-term care and comprehensive health care services in community settings. The Ministry of Health and Welfare introduced the Hospital-Based Home Nursing Care Program in 2000. Before this initiative, there was a Home Nursing Demonstration Center, affiliated with the Seoul Nurse Association, had offered home nursing services with the financial support from the local government. since 1993, the Center's nursing staff has been engaged in a general hospital in an effort to provide home nursing care services within Korea's health care system. The purpose of this study was to analyze and identify characteristics of community-based home nursing care supplied by a community-based home nursing team engaged in a general hospital. Also. visit nursing care services provided by public health centers were evaluated in terms of accessibility and supply versus demand, to enhance the accessibility of low-income patients living in Seoul to home nursing care services. Data were collected from home nursing insurance reimbursement claims submitted by the community-based home nursing care team from March 1 to October 30 in 2001 and a questionnaire survey on home-visit nursing services of 25 public health centers in Seoul. The subjects consisted of 197 patients and 12 public health centers. The result were as follows. First, medical institution's community-based home nursing care program was better in technical quality than health-center-based home-visit nursing care. In addition. the pattern of the subject patients was similar to that of hospital-based home nursing care program. Second, there was a high demand for community-based home nursing care while only a small number of home-visiting nurses served at public health centers in Seoul. As a result, many patients could not receive adequate care. Finally, we suggest that community-based home nursing care program should be introduced in the national health system to meet the at-home care needs of severely ill low-income patients. Furthermore, to better utilize home nursing and visit-nursing care resources and offer continued care for patients in community settings, an efficient referral network should be built among related institutions. This would require improvement of reimbursement system and amendment of the law related to health insurance system and community-based home nursing care services.