• Journal of Preventive Medicine and Public Health
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• 제24권4호
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• pp.531-548
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• 1991

신생아의 질적 관리를 위해 신생아실 의료인력과 의료수가의 타당성을 파악하고자 영남지역내 24개 소아과 수련병원 가운데 신설병원과 모(母)병원의 수련프로그램에 의존해 있는 병원을 제외한 20개 병원의 신생아실을 대상으로 1991년 7월 29일에서 8월 14일 사이에 각 병원을 방문하여 자료를 수집하였다. 자료는 신생아실 대장에서 1991년 6월 한달동안 입.퇴원한 정상 및 환아수를 조사하고 신생아실 수간호사와 소아과 의사를 면담하여 정상신생아 관리에 소요되는 최소한의 간호시간, 인력현황, 인력의 적정성, 그리고 인력확보의 문제점을 조사하였고 자 병원 보험심사과에서 정상 질분만시와 제왕절개분만시 산모 1인당 평균 산모 및 신생아관리분의 의료비를 조사하였다. 정상신생아 1명당 하루에 필요한 최소한의 간호시간은 평균 179.5분(${\pm}58.6$)이었고 대학병원은 202.3분(${\pm}50.7$), 종합병원은 164.2분(${\pm}60.5$)이었다. 최소한의 간호 요구시간 대 제공가능한 간호시간 비는 평균 1.42였고 환아에 대한 간호 요구량을 감안했을 때는 평균 비가 2.06으로 간호인력이 매우 부족하였다. 미국 소아과학회가 권장한 신생아실 간호인력을 기준으로 할 경우 간호사는 31%, 간호조무사는 17%가 충원된 상태였다. 신생아실 수간호사의 90%와 소아과 의사의 85%가 간호사가 부족하다고 했고 간호조무사는 각각 75%가 부족하다고 했다. 간호인력 보충이 안 되는 주된 이유는 재정사정이라고 하였다. 간호조무사의 경우는 인력구하기 힘든 것이 재정사정 다음으로 중요한 이유였다. 그러나 국립대학병원의 경우는 의사와 간호사는 T.O.의 제한이 주된 이유라고 했다. 정상 질분만으로 2박 3일만에 퇴원하는 경우 총 의료비는 평균 219,430원이었고 이 중 신생아분은 20,323원(9.3%)이었으며, 제왕절개분만으로 6박 7일만에 퇴원할 경우 평균 732,578원이었고 이 중 신생아분은 76,937원(12.0%)이었다. 원가계산방식에 의한 신생아관리에 대한 최소한의 원가는 3차진료기관의 경우 1일 16,141원, 기타 종합병원은 14,576원으로 원가가 의료보험수가의 각각 5.0배, 4.9배나 되었다. 오늘날의 의료인력의 인건비 수준과 병원시설 및 관리비를 감안할 때 현행 의료수가로 양질의 신생아관리를 기대하기 어려운 것으로 생각된다.

• 대한간호
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• 제17권2호통권94호
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• pp.56-62
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• 1978

현재 우리나라 보건소사업을 Part별로 토의된 것을 대략 요약해보면, 정부에서 근래에 시도하고 있는 진료대상이 한정된 영세민이나 생보호자에게만 국한되어 있으며, 치료보다는 예방에 힘써야 하겠다는 점을 들 수 있겠고, 모자보건의 무료분만을 대폭 완화하여 최소한 보건소에 등록되어 있는 임산부만이라도 모두 혜택을 주는 방향과 적기에 예방접종을 실시하도록 하며, 결핵은 조기발견, 조기치료, 예방접종이 중요하다는 것을 결핵사업에 종사하는 모든 요원들이 주민들에게 인식시킬 것이며, 가족계획에 있어서는 모자보건향상에 목적을 두고 사업이 이루어져야 한다는 점을 아울러 강조한다. 끝으로 선진국은 인구 2,000명에 보건간호원 1인 꼴인데 우리나라는 12,000:1이므로 선진국에 비해 6:1이나 되는 보건간호원의 업무과다로 질적인 사업의 기대가 어려우므로, 인력과 경제소모를 억제할수 있도록 기구개편이 필요하며, 간호원이 가정방문시 기능별로 $4\~5$인의 중복방문으로 인한 인력낭비와 사업 우선 순위가 혼돈되어 전반 간호사업이 시급하다는 점을 들 수가 있다.

• 여성건강간호학회지
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• 제7권2호
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• pp.203-211
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• 2001

A women's meaning about labor and delivery may influence the process of childbirth and performance of the maternal role. Therefore, negative meaning about the birth experience may have a negative impact on the childrearing. The purpose of this study is to explore the meaning of labor and delivery for the strategies of nursing intervention in positive childbirth experience. The data were collected through the in-depth interviews of 10 nursing college women on Jeju Island from October 2000 to January 2001. The interviews were conducted by investigator in the class room after school hours. Each interview lasted for about 30 minutes on average. Subjects were interviewed one at a time. The interviews were recorded with the consent of the subject. The data were analyzed by means of Giorgi's phenomenological analysis methods and catagorized according to the similarities of its contents. The investigator read the data repeatedly to identify the themes and the main meanings. Eight main meanings were identified as follows : 1)pain 2) shame and disgust 3)load 4)naturality 5)unreality 6)happiness 7)anxiety 8)maturity. Under these main meanings there were seventeen themes. I. Pain : (a) It's too painful (b) I don't want to deliver II. Shame and Disgust : (a) I am shameful (b) I am hateful III. Load : (a) I don't feel free (b) I have responsibility IV. Naturality : (a) It's in order to obtain a child (b) It's natural for women (c) It's a destiny of women V. Unreality : I don't feel real VI. Happiness : (a) I am glad (b) I am happy (c) It's miraculous VII. Anxiety : (a) I am anxious (b) I am worried VIII. Maturity : (a) I understand parents (b) I feel great. The results of the study will provide basic data for positive childbirth experience.

• 임상간호연구
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• 제21권3호
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• pp.319-334
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• 2015

Purpose: The aim of this study was to analyze various nursing services of delivery room nurses by hospital level, and identify importance and frequency to provide baseline data to establish delivery room nurses' roles. Methods: Through DACUM analysis technique, service descriptions, duties, and tasks were derived from the literature. A survey was done of 242 nurses from delivery rooms of hospitals, general hospitals, superior general hospitals, and special hospitals. Importance and frequency of each service were measured using a 4point scale, and results were analyzed using SPSS. Results: Nursing services for delivery room nurses consisted of 18 duties and 86 tasks. Duties with the highest importance were 'labor support' and 'infection management', and those with lowest importance were 'collaborative care' and 'communication'. The duty with the highest frequency was 'labor support', and lowest frequency was 'communication'. There were differences between importance and frequency depending on the size of hospitals. Conclusion: Results of this first study on nursing services of delivery room nurses. delivery room nurses are performing a wide range of nursing services and the various types are clarified including importance and frequency.

• 여성건강간호학회지
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• 제2권1호
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• pp.5-24
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• 1996

The Delivery Process can be viewed as one of the developmental crisis that forces the majority of women. During the labor and delivery process the women may face a variety of problems and pain with all its subjectivity. This developmental crisis may lead a pregnant women to have a negative experience in delivery. For nurses, to help to pregnant women check with the crisis and perceived support and to positive experience. This study intended to analyze the pregnant women's delivery experience according to supporter during labor. The subjects for this study were 45 pregnant women who had normal delivery without complications, within 37 to 42 weeks of pregnancy. Data Collection was done from April 24th to May 20th 1995 by two instruments, a support measurement scale and a delivery experience measurement scale which were consisted it 18-items scale developed by researcher. The data was analyzed by SPPS program using descriptive statistic Kruskal-Wallis one way analysis and Spearman Correlation Coefficient. The result of this study are as follows. 1. Support distribution by support contents is shown is order of holding the hands (97.8%), help to urination(86.7%), bed arrangement(57.8%), massaging the arms and legs(55.6%), changes in posture(44.4%), teaching how to produce power(44.4%), while emotional support is disclosed in order of sympathy(97.8%), encouragement(82.2%), hearing the needs(60.0%), However, information support was as low as less than 33.3%. 2. The extent of delivery experience a Pregnant woman perceives is revealed in order of a sense of comfortableness(44%), satisfaction(43.2%), reduction of fear(43.2%), familiarity (42.8%), self-confidence (42.5%), decrease of laborpain(39.9%). 3. The extent of delivery support a pregnant woman perceives reveals that physical support($x^2$=22.4452, P=.000) and information support($x^2$=7.5187, P=.0233) Show a significant difference among the mothers group, the mothers-in-law group, the husbands group, but to significant difference was found in emotional support among them. 4. The extent of delivery experience a pregnant woman perceives represents a significant difference in order of the mothers group, the mothers in-law group, and the husbands group($x^2$=13.4255, P=.0012). 5. A positive correlation was manifested between the extent of support and delivery experience a pregnant woman perceives(r=.8643, P=.000). This information can be utilized as data to further the understanding delivery experience according to supporter. In Consequence, it is recommended that the range of family support limited to husband should be expended including mother and mother-in-law.

• 여성건강간호학회지
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• 제8권4호
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• pp.559-569
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• 2002

The study examined the effects of San-Yin-Jiao(SP-6) acupressure treatment on labor pain, length of delivery and anxiety for women in the labor. The effects of using SP-6 acupressure were evaluated by comparing two groups, a SP-6 acupressure group (22) and a control group (17), for a total of 39 women in labor who had a normal vaginal delivery. Data were collected using a structured questionnaire which included general characteristics, a subjective labor pain scale, measurement of duration of delivery time and a subjective anxiety scale. Data were collected before treatment (pre) and after treatment (post). The results of this study are summarized as follows : 1. The post-scores for total labor pain increased over the pre-scores but the difference between the two groups was not statistically significant(p=0.219). Wilcoxon signed rank test of the difference in pre-post labor pain scores for the SP-6 acupressure group was not statistically significant (p=0.081) but the increase for the control group was statistically significant (p=0.001). 2. The length of time for the delivery in the group which had the SP-6 acupressure was shorter (143.91${\pm}$67.77) than the control group (197.94${\pm}$89.64). The difference between the two groups was statistically significant (p=0.028). 3. The post-scores for anxiety increased over the pre-scores but the difference between the two groups was not statistically significant (p=0.426). The scores of SP-6 acupressure group did not show a significant increase by the Wilcoxon signed rank test (p=0.194) but in the control group showed a significant increase (p=0.008).This study showed that SP-6 acupressure was effective in relation to labor pain, length of time for delivery and anxiety for labor women. But it is necessary to replicate the study with a larger number of participants to generalize the results.

• 여성건강간호학회지
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• 제5권1호
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• pp.5-20
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• 1999

This study was conducted to examine primiparas' perception of delivery experience and identity as the mother("Myself as the Mother" and "My Baby") according to delivery methods such as normal delivery and cesarean section. The result of this study summarized as follows. 1. The primiparas' perception of delivery experience according to delivery methods showed that the primipars who had normally delivered perceives the delivery experience more positively than those by cesarean section(t=4.88, p=0.000). This fact supported hypothesis 1 that "the primiparas group by normal delivery should perceive the delivery experience more positively that by cesarean section." 2. The primiparas who had delivered by cesarean section were more positive in the SD-Self score than those who had normally delivered at the time when four weeks passed after delivered, and there was a significant difference(t=-4.21, p\0.000). Therefore, hypothesis 2-1 that "the primiparas group who had normally delivered should be more positive in the SD-Self 1-2 days and 4 weeks after delivery than one who delivered by cesarean section" was rejected. 3. It was shown that the primiparas who had delivered normally were more positive in the SD-Baby 1-2 days 4 weeks after delivery than those who delivered by cesarean section(after-delivery 1-2 days : t=3.10, p=0.002 and after-delivery 4 weeks : t=2.15, p=0.034). Based on this fact, hypothesis 2-2 that "the primiparas group who had delivered normally should be more positive in the SD-Baby 1-2days and 4 weeks after delivery than those who had delivered by cesarean section"was supported. 4. Primiparas who had delivered by cesarean section appeared to have a positive identity as the mother by showing a more significant difference (t=7.96, p=0.000) 4 weeks after delivery than 1-2 days after delivery. In conclusion, we see that primiparas' perception of delivery experience and identity as the mother were different according to delivery methods. Thus, it is required to devise a nursing in tervention strategy to expand support from the health care system and opportunities to provide pre. post-delivery programs so that primiparas can have a positive perception of delivery experience and a positive identity as the mother. Based on conclusion stated above, the following suggestions are made. 1. As this study compared the perception of delivery experience and identity as the mother between prmiparas who had delivered normally and ones who had delivered by cesarean section, the further study on comparison between multiparas who had delivered normally and ones who had delivered by cesarean section is needed. 2. According to the results of this study, longitudinal study is needed to examine the difference and change in the formation of maternal identity. 3. According to the result of this study, a study is also needed to determine interaction between time for maternal identity and delivery methods.

• 여성건강간호학회지
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• 제8권2호
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• pp.244-256
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• 2002

The purpose of this study was to examine the effects on labor pain and duration of delivery time for primipara women treated by San-Yin-Jiao(SP-6) and Hob-Gog(LI-4) acupressure. The design of this study was a nonequivalent control group non-synchronizedpost test only design. It was done to identify the effects of SP-6 acupressure or LI-4 acupressure on labor pain in primipara women. The benefits of using SP-6 acupressure or LI-4 acupressure were evaluated by comparing three groups, a SP-6 acupressure group, a LI-4 acupressure group and a control group, not treated with acupressure. The participants included 192 primiparas who underwent vaginal delivery, 72 primiparas in the control group, 71 in the SP-6 acupressure group and 49 in the LI-4 acupressure group. Data were collected using a structured questionnaire consisting of general characteristics, a subjective labor pain scale (Johnson, 1974), and measurement of duration of delivery time. The results of this study are summarized as follows : 1. Differences in the acupressure effect for SP-6 and LI-4 were analyzed using Scheffe's test which showed that differences in the control group vs the SP-6 group and the control group vs the LI-4 group were statistically significant (t=21.767, p<0.05; t=23.923, p<0.05), but the SP-6 group vs the LI-4 group showed no significant differences. 2. The duration of delivery time in the group which had SP-6 acupressure or LI-4 acupressure was shorter (400.77${\pm}$153.34; 379.10${\pm}$127.60) than in the control group (528.68${\pm}$239.08). Differences in the effects of acupressure with SP-6 and LI-4 were also analyzed by Scheffe's test. Control group vs SP-6 group and Control group vs LI-4 group were significantly different(t=127.91, p<0.05; t=149.58, p<0.05), but the SP-6 group vs the LI-4 group did not show any statistically significant difference (t=21.67). This study has shown that SP-6 and LI-4 acupressure were both effective in relation to labor pain and duration of delivery time for primiparas. But it is necessary to replicate the study with a larger number of participants to generalize of the results.

• 대한간호학회지
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• 제39권4호
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• pp.574-583
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• 2009

Purpose: This paper analyzed alternative methods of calculating the conversion factor for nurse-midwife's delivery services in the national health insurance and estimated the optimal reimbursement level for the services. Methods: A cost accounting model and Sustainable Growth Rate (SGR) model were developed to estimate the conversion factor of Resource-Based Relative Value Scale (RBRVS) for nurse-midwife's services, depending on the scope of revenue considered in financial analysis. The data and sources from the government and the financial statements from nurse-midwife clinics were used in analysis. Results: The cost accounting model and SGR model showed a 17.6-37.9% increase and 19.0-23.6% increase, respectively, in nurse-midwife fee for delivery services in the national health insurance. The SGR model measured an overall trend of medical expenditures rather than an individual financial status of nurse-midwife clinics, and the cost analysis properly estimated the level of reimbursement for nurse-midwife's services. Conclusion: Normal vaginal delivery in nurse-midwife clinics is considered cost-effective in terms of insurance financing. Upon a declining share of health expenditures on midwife clinics, designing a reimbursement strategy for midwife's services could be an opportunity as well as a challenge when it comes to efficient resource allocation.

• 한국보건간호학회지
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• 제32권3호
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• pp.376-387
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• 2018

Purpose: This study was conducted to assess the breast feeding rate and maternal adaptation of mothers with infants and children in early childhood in a community. Methods: This descriptive study was conducted from November to December 2015, and included a total of 283 mothers of infants and children in early childhood. The data were analyzed using descriptive analysis, the ${\chi}^2-test$, and one way ANOVA. Results: The rates of breast feeding after birth were 76.3% (1 month postpartum), 69.3% (3 months postpartum), 53.4% (6 months postpartum), 32.2% (9 months postpartum), and 22.6% (12 months postpartum). The level of maternal adaptation of subjects was $3.78{\pm}0.54$. Subjects who were breastfed until 9 months postpartum had a higher level of maternal adaptation than those who stopped breast feeding at 1 month postpartum (F=3.926, p<.002). The breast feeding rate of subjects who were educated about breast feeding after childbirth was significantly higher than that of those who did not receive breast feeding education after delivery. Conclusion: To increase the breast feeding rate and maternal adaptation, community health nurses should develop and provide breast feeding programs to mothers soon after childbirth.