• Title/Summary/Keyword: Coping

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Effect of Feeding Plum and Red Ginseng Marc on Vital Reaction in Broiler Stress (매실과 홍삼 부산물이 스트레스에 대한 육계 생체 반응에 미치는 영향)

  • Bong, Mi-Hee;Ji, Sang-Yoon;Park, Jun-Cheol;Moon, Hong-Kil;Lee, Sang-Cheul;Lee, Jun-Heon;Hong, Joon-Ki
    • Korean Journal of Poultry Science
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    • v.38 no.3
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    • pp.213-223
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    • 2011
  • This study was conducted to test the efficacy of plum (Prunus mume) and red ginseng (Panax ginseng C.A Meyer) marc as stress inhibitors under heat stress and lipopolysaccharide (LPS) challenge in broilers by investigating their effects on blood biochemical parameters, immunoglobulin concentration and splenic cytokine mRNA expressions. A total of one hundred ninety-two 1-d-old male broiler chicks (Ross 308) were divided into 2 stress conditions (heat and LPS) experiments. Each experiment was divided into 4 treatment groups with 8 replicates of 3 birds in each group. NC (negative control, no immune substances), PC (positive control, 25 ppm ${\beta}$-glucan), PM (1% plum marc) and RGM (3% red ginseng marc) treatments were administered with respective substance through water supplementation. During heat stress, The Ca/Mg ratio in PM and RGM was significantly decreased in comparison with that of NC (P<0.05). The immunoglobulin M was significantly lower in PM than in NC (P<0.05). Expression patterns of splenic cytokine mRNAs (IL-1, IL-2 and IL-6) were similar over the treatment. Expression rates of IL-1 and IL-2 in PM were significantly decreased in comparison with NC. Also, expression rates of IL-1, IL-2 and IL-6 were significantly lower in RGM than in NC (P<0.05). In conclusion, the dietary supplementation of plum and red ginseng marc improved coping ability to heat stress by preventing Ca/Mg ratio increment and by inhibiting inflammatory response in broiler chicks. However, it is necessary to determine optimal dietary level of red ginseng marc for improving growth performances in broiler chickens. These results suggest the possibility that plum and red ginseng marc could be used as the stress inhibitor under heat stress and inflammatory response in broiler chicks.

Hydrological Drought Assessment and Monitoring Based on Remote Sensing for Ungauged Areas (미계측 유역의 수문학적 가뭄 평가 및 감시를 위한 원격탐사의 활용)

  • Rhee, Jinyoung;Im, Jungho;Kim, Jongpil
    • Korean Journal of Remote Sensing
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    • v.30 no.4
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    • pp.525-536
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    • 2014
  • In this study, a method to assess and monitor hydrological drought using remote sensing was investigated for use in regions with limited observation data, and was applied to the Upper Namhangang basin in South Korea, which was seriously affected by the 2008-2009 drought. Drought information may be obtained more easily from meteorological data based on water balance than hydrological data that are hard to estimate. Air temperature data at 2 m above ground level (AGL) were estimated using remotely sensed data, evapotranspiration was estimated from the air temperature, and the correlations between precipitation minus evapotranspiration (P-PET) and streamflow percentiles were examined. Land Surface Temperature data with $1{\times}1km$ spatial resolution as well as Atmospheric Profile data with $5{\times}5km$ spatial resolution from MODIS sensor on board Aqua satellite were used to estimate monthly maximum and minimum air temperature in South Korea. Evapotranspiration was estimated from the maximum and minimum air temperature using the Hargreaves method and the estimates were compared to existing data of the University of Montana based on Penman-Monteith method showing smaller coefficient of determination values but smaller error values. Precipitation was obtained from TRMM monthly rainfall data, and the correlations of 1-, 3-, 6-, and 12-month P-PET percentiles with streamflow percentiles were analyzed for the Upper Namhan-gang basin in South Korea. The 1-month P-PET percentile during JJA (r = 0.89, tau = 0.71) and SON (r = 0.63, tau = 0.47) in the Upper Namhan-gang basin are highly correlated with the streamflow percentile with 95% confidence level. Since the effect of precipitation in the basin is especially high, the correlation between evapotranspiration percentile and streamflow percentile is positive. These results indicate that remote sensing-based P-PET estimates can be used for the assessment and monitoring of hydrological drought. The high spatial resolution estimates can be used in the decision-making process to minimize the adverse impacts of hydrological drought and to establish differentiated measures coping with drought.

Treatment Characteristics of Soil Clothing Contact Oxidation Process using Bio-media (생물담체를 충진한 토양피복 산화접촉공정의 하수처리특성)

  • Kim, Hong-Jae;Kang, Jae-Hee;Lee, Ki-Seok;Motoki, Kubo;Kang, Chang-Min;Chung, Seon-Yong
    • Journal of Korean Society of Environmental Engineers
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    • v.27 no.4
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    • pp.414-419
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    • 2005
  • This study was performed to compare the treatment efficiencies of two media, newly developed Bio-rock and conventional gravel, in soil clothing contact oxidation process. The composition of synthetic wastewater were $COD_{Cr}$ $150{\sim}370\;mg/L$, $BOD_5$ $150{\sim}270\;mg/L$, T-N $20{\sim}60\;mg/L$, T-P $5{\sim}25\;mg/L$, pH 7 and 2 mL/L of trace element solution. The experiment using two reactors was comparatively conducted for the flow rate of 40 L/d for 13 months, respectively. Initially Bio-rock reactor was increased to pH 12 due to $Ca(OH)_2$ with hydration of cement, but gravel reactor was dropped to pH 4 due to the degradation of organic material and nitrification. This significant pH variation deteriorated the growth and activity of microorganism. But the high pH of Bio-rock seems favorite to ammonia stripping and precipitation of phosphate. Such pH variation of Bio-rock and gravel reactors were finally stabilized to pH 8 and pH 6, respectively. The removal efficiencies of organic compounds from Bio-rock reactor were 96% of $COD_{Cr}$, 98% of $BOD_5$, 80% of T-N and 85% of T-P which stably coping against variation of influent concentration. But those of gravel reactor were 96% of $COD_{Cr}$, 96% of $BOD_5$, 42% of T-N and 40% of T-P, respectively. The Bio-rock was 2 times higher than T-N and T-P in treatment efficiency. And electron-microscopic examination showed that Bio-rock was more favorable to microbial adherence than gravel. The microbial populations were $5.2{\times}10^6\;CFU/mL$ of Bio-rock reactor compared to $2.6{\times}10^6\;CFU/mL$ in gravel reactor. In result Bio-rock was favor to microbial adherence and high treatment efficiency in spite of variation of influent concentration which had the advantages in saving running time and reducing site requirement.

A STUDY OF THE EFFECTIVENESS OF THE BEREAVEMENT PROGRAM OF SEVERANCE HOSPICE (세브란스 호스피스 추후관리 프로그램의 효과에 관한 연구)

  • Wang, Mae-Ryeon
    • The Korean Nurse
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    • v.31 no.2
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    • pp.51-69
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    • 1992
  • Grief that is not acknowledged and worked through may manifest itself in some emotional, mental or physical problem. In recent years much has been learned about coping with grief which the hospice program can utilize to help family members cope with their grief. This study was carried out to determine the helpfulness of the bereavement care of Severance Hospice and to learm more about the grief response of the bereaved. The tools used to collect data were an assessment form used in the bereavement program and the Grief Experience Inventory developed by Sanders and revised and translated 'by the researcher. Data was obtained from bereaved family members(54 for the final grief assessment and 39 for the grief response assessment) receiving bereavement follow-up, from July 1989 to March 1991. Results of the study were as follows: 1. Final Grief Assessment Regarding the resolution of their grief the majority of the bereaved accepted the reality of the death of their family member, while slightly more than three-quarters were able to express their feelings toward their loss. A large majority had returned to activities of daily living well or fairly well and had reinvested their energy in a person other than the deceased. In addition, the physical condition of the majority was good or fairly good. A majority of the bereaved considered the bereavement care to be helpful and almost three-quarters were not considered to be in need of more follow-up. 2. Grief Response Assessment Age was found to have a modoerately positive correlation to appetite disturbance(r=.41, P<.Ol) and loss of vigor(r=.37, P<.Ol) A moderately positive correlation was found between the number of contacts and sleep disturbance(r=2.38, P<.01) Significant differences were found between men and women in regard to guilt(t=2.38, P<.05), social isolation(t=2.44, P<.05) and depersonalization(t=2.07, P<.05) with men having the more intense grief. Significant differences were found in the grief responses of somatization(F=5.82, P<.001), physical symptoms(F=5.87, P<.OOl), appetite disturbance(F=4.40, P<.Ol), despair(3.79, P<,Ol), anger(Fp2.83, P<.05), social isolation(F=3.61, P<.05), guilt(F=3.62, P<.05) and depersonalization (F = 2.58, P <.05). In the first six of these grief responses mothers scored highest, followed by husbands and then wives, In the grief response of guilt, daughters scored highest and on the grief response of depersonalization sons scored highest. Only one grief response, that of sleep disturbance(t= -2.19, P<.05) was found to be statistically significant, with those family members who died at home having the higher scores. Based on the results of this study several suggestions are presented as follows: 1. Since unresolived grief can have a detrimental effect on the bereaved person's mental and phys. ical health it would be good for the nurse, to include questions related to death of family members and the bereaved person's response to the grief, in her nursing assessment. And in the case of unresolved grief the nurse should encourage the person to talk with a trusted friend or counselor and express their fellings of grief. 2. A study to determine the degree of resolution of the grief of those in the bereavement program could be carried out by use of the Grief Experience Inventory early in their bereavement and again 13 months after the death of their family member. 3. A comparison of the grief response of the bereaved in the bereavement program and bereaved not in the program could be carried out using the Grief Experience Inventory. 4. After bereavement programs have been started in other hospice programs it would be good to carry out a joint study of bereavement outcomes of those in the bereavement programs.

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A Study on the Effects of Meterological Factors on the Distribution of Agricultural Products: Focused on the Distribution of Chinese Cabbages (기상요인이 농산물 유통에 미치는 영향에 관한 연구: 배추 유통 사례를 중심으로)

  • Lee, Hyunjoung;Hong, Jinhwan
    • Journal of Distribution Research
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    • v.17 no.5
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    • pp.59-83
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    • 2012
  • Agriculture is a primary industry that influenced by the weather or meterological factors more than other industry. Global warming and worldwide climate changes, and unusual weather phenomena are fatal in agricultural industry and human life. Therefore, many previous studies have been made to find the relationship between weather and the productivity of agriculture. Meterological factors also influence on the distribution of agricultural product. For example, price of agricultural product is determined in the market, and also influenced by the weather of the market. However, there is only a few study was made to find this link. The objective of this study is to investigate the effects of meterological factors on the distribution of agricultural products, focusing on the distribution of chinese cabbages. Chinese cabbage is a main ingredient of Kimchi, and basic essential vegetable in Korean dinner table. However, the production of chinese cabbages is influenced by weather and very fluctuating so that the variation of its price is so unstable. Therefore, both consumers and farmers do not feel comfortable at the unstable price of chinese cabbages. In this study, we analyze the real transaction data of chinese cabbage in wholesale markets and meterological factors depending on the variety and geography. We collect and analyze data of meterological factors such as temperatures, humidity, cloudiness, rainfall, snowfall, wind speed, insolation, sunshine duration in producing and consuming region of chinese cabbages. The result of this study shows that the meterological factors such as temperature and humidity significantly influence on the volume and price of chinese cabbage transaction in wholesale market. Especially, the weather of consuming region has greater correlation effects on transaction than that of producing region in all types of chinese cabbages. Among the whole agricultural lifecycle of chinese cabbages, 'seeding - harvest - shipment - wholesale', meterological factors such as temperature and rainfall in shipment and wholesale period are significantly correlated with transaction volume and price of crops. Based on the result of correlation analysis, we make a regression analysis to verify the meterological factors' effects on the volume and price of chines cabbage transaction in wholesale market. The results of stepwise regression analysis are shown in

    and
    . The type of chinese cabbages are categorized by 5 types, i.e. alpine, gimjang for winter, spring, summer, and winter crop, and all of the regression models are shown significant relationship. In addition, meterological factors in shipment and wholesale period are entered more in regression model than those in seeding and harvest period. This result implies that weather in consuming region is also important in the distribution of chinese cabbages. Based on the result of this study, we find several implications and recommendations for policy makers of agricultural product distribution. The goal of agricultural product distribution policy is to insure proper price and production cost for farmers and provide proper price and quality, and stable supply for consumers. Therefore, coping with the uncertainty of weather is very essential to make a fruitful effect of the policy. In reality, very big part of consumer price of chinese cabbage is made up of the margin of intermediaries, because they take the risk. In addition, policy makers make efforts for farmers to utilize AWIS (Agricultural Weather Information System). In order to do that, it should integrate the relevant information including distribution and marketing as well as production. Offering a consulting service to farmers about weather management is also expected to be a good option in agriculture and weather industry. Reflecting on the result of this study, the distribution authorities can offer the guideline for the timing and volume of harvest, and it is expected to contribute to the stable equilibrium of supply and demand of agricultural products.

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  • A study on analyzing effectiveness of childbirth education (임부교실 운영효과 분석을 위한 일 연구)

    • Kim, Hea Sook;Choi, Yun Soon;Chang, Soon Bok;Jung, Jae Won
      • The Korean Nurse
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      • v.34 no.3
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      • pp.85-98
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      • 1995
    • The purpose of this study is to provide basic data regarding effective learning opportunities in childbirth education classes. Also analysis of the data indicates the optimum conditions for the welfare and improvements in the promotion of health in childbearing mothers. The results of this study are as follows; 1) The average age of the subjects in this study was 30.6 years and the total number of subjects was 58 pregnant women. The average number of children was one and 84.5% of the subjects were unemployed even though 63.8% of them held over bachelor's degrees. It was found that 22.4% of the subjects were living in an extended family. Also 61.5% of them were living with parents-in-law. The number of pregnancies were calssified as one, two, or three to nine times with the percentages of 58.7%, 22.4% and 18.9%, respectively. Further, 72.4% of the subjects had no abortion experience and 15.5% had one aborion experience. While 89.7% of the subjects planned to feed their babies with breastmilk, mixed feeding were used by only 22.4% of the sample. These data were collected at about 6 months after delivery. Thus one can see that a low rate of breastfeeding was common. 2) The length of one period of childbirth education is four weeks. It was found that 36.2% of the subjects participated in childbirth education only once, where as 13.8% participated four times and 19% of the subjects participated in this class more than four times. pregnant at least once. Further, 75.9% of the participants were participated in this education through their own will. Their motivation for participation developed through information, advertisement and posters which contained information on childbirth education. Those with unplanned pregnancies 92.9% participated after a suggestion by the nurses. The number of participants in terms of percentage according to the childbirth education contents can be classified as following. The most active participation was shown in preparation of delivery(77.6%), postpartrm management(56.9%) fetal development(37.6%) and physiology of pregnancy(17.2%). It was found that 75.9% of the subjects were willing to participate again if they were given a chance. The reason can be summarized as following: The content of the education is very helpful(47.7%). Scientific knowledge can be obtained through this program(20.5%). Participation helps in achieving psychological stability(9.1%). Participation enables one to establish a friendly relationship with other participants(6.8%) of the sample. 24.1% of the participants did not want to participate again. The reasons can be as following: They do not want another baby(42.9%). The first paricipation in childbirth education gave enough knowledge about childbirth(21.4%). Another reason for not want to participate again was because they had a cesarean birth(14.3%). Only 7.1% of them responded with a negative view. A response that they do not need childbirth education after their operation can be traced back to the general belief that childbirth education is the place where one prepares for natural birth through the Lamaze breathing technique. Of the subjects, 91.4% suggested that this program could be recommended to other childbearing mothers, because this program gave educational content along with psychological stability for childbearing women. Of the subjects 41.4% did not see any efforts towards the welfare of the baby, where as 88.2% did. Among the subjects 58.6% made some effort to eliminate the discomfort of labor by breathing and imagination and breathing and walking. Further 41.7% of the 24 subjects did not do anything toward the welfare of the baby, because they did have a cesarean section so that they didn't have a chance even though they had been educated about childbirth. Also 33.3% of the subjects did not do anything toward the welfare of the baby, because they lacked a willingness. After leaving the hospital, only 75.9% of the subjects did some exercises. The subjects who tried participate this program with their husband accounted for 20.7% of the sample. Interviewing with the subjects solved some of the uneasiness and. fear of delivery, increased self-confidence in parenting and active coping in the delivery process.

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    A Study of the TA Program and its Effects on the Development of Communication Skills for Dental Hygienist (치과위생사를 위한 TA (Transactional Analysis) 프로그램 개발)

    • Chung, Soon-Hee
      • Journal of dental hygiene science
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      • v.6 no.4
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      • pp.295-302
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      • 2006
    • This study was conducted to study the effects of the TA Theory and the TA Program, an educational testing tool developed to improve functional communication skills for dental hygienists. The results taken from the experiment using the TA program has been verified by Examination Tool for Personnel Communication developed by Chung(2001). 44 in two experimental groups and 16 in control group took part in TA Program training sessions. The experimental Group I received TA technique training session for 12 hours per day in a period of three days and Group II for 6 hours per day in a period of two days. From this experiment, the following conclusion was obtained. The results are as follows: 1) As it can be seen from the results of the examination taken prior to the experiment, the subjects of the control group and experimental groups were homogenous in all categories including self-disclosure, awareness, evaluation and acceptance of feedback, self-expression, coping with feelings, clearness, avoidance, dominance, handling of differences, and perceived acceptance. 2) After the training of TA Program was completed on Group I and II, the examination results are as follows: Control Group (1.5158), Group I (1.8260) / Control Group (1.4684), Group II (1.9985). The results of Group I and II (1.7970 and 1.9985 respectively) therefore showed a meaningful difference. 3) From the results of the experiment it is shown that dental hygienists' communication skills improved after receiving the TA Program training. Therefore TA Program may be used as an effective tool for such purpose. 4) As it can be observed from the data, Group I and II showed difference in the degree of improvements. Therefore, there needs to be a further investigation on the effects of the difference in training period. 5) This program is not only limited to the education of dental hygienists but may be widely applied to various forms of education and teaching methods.

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    A Theory Construction on the Care Experience for Spouses of Patients with Chronic Illness (만성질환자 배우자의 돌봄 경험에 대한 이론 구축)

    • Choi, Kyung-Sook;Eun, Young
      • Journal of Korean Academy of Nursing
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      • v.30 no.1
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      • pp.122-136
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      • 2000
    • Chronic illness requiring attention and management during a long period of time puts great burden onto patients, their family and society. For patients with chronic illnesses, providing social support is the most important, and the fundamental support comes from their spouses. Amount and quality of support from spouses seems to differentiated according to the sex of patients. Female patients tend to believe that their spouses are not very supportive. Therefore, the researchers assessed the burden of husbands of female arthritis patients to discover the factors that result in greater burden. Also, they developed a theoretical model of husbands′ care for their wives through a qualitative research into husbands′ experience. Method 1: The study material was 650 female arthritis patients registered in an arthritis clinic. The questionnaire about the disease experience of female arthritis patients and the burden of husbands were sent. Returned questionnaires numbered 210(32.3%) and 27 were excluded because of inadequate answers. The remaining 183 questionnaires were analyzed. The mean age of the patients was 51 years and the mean age of spouses was 55 years. The mean marital period was 28 years. The average duration since diagnosis was 9.1 years. Education level was varied from primary school to graduate school, and average income/month was 1,517,300 won. Method 2: Initial questionnaire studies on the burden of husbands were performed. Among 183 responding husbands, 23 consented to participate for a qualitative research. Data was obtained by direct and telephone interviews. The mean age of participants was 58 years, and the educational level and socioeconomic status also varied. Result: 1. Husbands′ burden: The average burden was 57.68 with a range of 6-96. 2. Burden and general characteristics: The husband′s burden correlated with the age of the patients, numbers in the family, therapy methods, patient′s level of discomfort, patient′s disease severity, patient′s level of dependence and the husband′s understanding of the level of severity. 3. Linear correlation analysis on burden: The husbands′ burden is explained in 22.5% by husband′s recognition of level of severity and husbands′ age. 4. There were four patterns of the burden on husbands: both objectve burden and subjective burden were high(pattern I), both of objectve burden and subjective burden were low(pattern II), objective burden was high but subjective burden was low(pattern III), objective burden was low but subjective burden was high(pattern IV). The pattern was correlated with the family income, educational level of the patients and their husbands, therapy methods, patient′s level of discomfort, patient′s disease severity, patient′s level of dependence and husband′s understanding of level of severity. 5. The core category of the caring experience of the husbands with arthritis patients was "companionship". The causal factor was the patients′ experience due to symptoms : physical disfigurement, pain, immobility, limitation of house chores, and limitation of social activities. Contextural factors are husbands′ identification of housework and husbands′ concern about the disease. The mediating factors are economic problems, fear of aging, feeling of limitation and family support. The strategy for interaction is mind control and how to solve emotional stress. The "companionship" resulted from caring activities, participation of household activities, helping patients′ to coping with emotional experience. 6. Companionship is established through the process of entering intervention, and caring state of mind. Entering intervention is the phase of participation of therapy and involvement of houseworks. The caring phase consists of decision on therapy, providing therapy, providing direct care, and taking over the household role of wife. Through caring phase, the changing phase set a stage in which husbands consolidate the relationship with their wives, and are reminded of the meaning of marriage. As a result, in changing phase, husbands′ companionship is enhanced. In conclusion, nursing care of chronic illnesses should include a family member especially the spouse. All information on disease shoud be provided to patients and whole family member. Strong support should also be provided to overcome difficulties in taking over role of other sex. Then the quality of life of patients and families will be much improved.

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    PRELIMINARY STUDY OF MENTAL REPRESENTATIONS OF PRESCHOOL CHILDREN EXPERIENCING SINGLE, SEVERE TRAUMA (심한 정신적 외상 경험을 한 학령 전기 아동의 정신적 표상에 대한 예비연구)

    • Eon, So-Yong;Song, Won-Woung;Oh, Kyung-Ja;Choi, Eui-Gyum;Shim, Eun-Ji;Shin, Yee-Jin
      • Journal of the Korean Academy of Child and Adolescent Psychiatry
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      • v.15 no.1
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      • pp.61-74
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      • 2004
    • Objectives:This study was performed to introduce a psychoeducational family therapy model for the families of schizophrenic patient and to investigate the effect of this model on the changes in coping style and depressive symptoms of the family members, and in perception of emotional support by families and depressive symptoms of patients. Methods:Nine preschool children, 3-5 years old, experiencing physical injuries caused by attack from a psychotic patient at kindergarten, were evaluated for psychological assessments;Intelligence test, MSSB(MacArthur Story-Stem Battery), H-T-P test(House-Tree-Person test). And their parents completed rating scale, KPI-C(Korean Personality Inventory for Children about children’s psychological conditions). Results:With respects to the contents and emotional reactions of MSSB, 9 preschool children showed generally high levels of anxiety, depression, avoidance, aggression, probably related to the traumatic experiences. Even though children couldn't verbally report directly about their traumatic experiences, in both MSSB, structured play narrative assessment tool, and HPT, free drawing and association test, they demonstrated psychiatric problems through reenactment plays, regardless of clinical diagnoses. Conclusion:Present study allowed us the chance to see beyond the outer pathological behaviors of PTSD in preschool children, through deeper evaluations of their mental representation. These preliminary data suggest deep understanding of internal representation would be of help for thorough evaluations and treatment plan for preschool children, experiencing severe trauma.

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    A basic research for evaluation of a Home Care Nursing Delivery System (가정간호 서비스 질 평가를 위한 도구개발연구)

    • Kim, Mo-Im;Cho, Won-Jung;Kim, Eui-Sook;Kim, Sung-Kyu;Chang, Soon-Bok;Ryu, Ho-Sihn
      • Journal of Home Health Care Nursing
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      • v.6
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      • pp.33-45
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      • 1999
    • The purpose of this study was to develop a basic framework and criteria for evaluation of quality care provided to patients with the attributes of disease in the home care nursing field, and to provide measurement tools for home health care in the future. The study design was a developmental study for evaluation of hospital-based HCN(home care nursing) in Korea. The study process was as follows: a home care nursing study team of College of Nursing. Yonsei University reviewed the nursing records of 47 patients who were enrolled at Yonsei University Medical Center Home Care Center in March, 1995. Twenty-five patients were insured at that time, were selected from 47 patients receiving home care service for study feasibility with six disease groups; Caesarean Section (C/S), simple nephrectomy, Liver cirrhosis(LC), chronic obstructive pulmonary disease(COPD), Lung cancer or cerebrovascular accident(CVA). In this study, the following items were selected : First step : Preliminary study 1. Criteria and items were selected on the basis of related literature on each disease area. 2. Items were identified by home care nurses. 3. A physician in charge reviewed the criteria and content of selected items. 4. Items were revised through preliminary study offered to both HCN patients and discharged patients from the home care center. Second step : Pretest 1. To verify the content of the items, a pretest was conducted with 18 patients of which there were three patients in each of the six selected disease groups. Third step : Test of reliability and validity of tools 1. Using the collected data from 25 patients with either cis, Simple nephrectomy, LC, COPD, Lung cancer, or CVA. the final items were revised through a panel discussion among experts in medical care who were researchers, doctors, or nurses. 2. Reliability and validity of the completed tool were verified with both inpatients and HCN patients in each of field for researches. The study results are as follows: 1. Standard for discharge with HCN referral The referral standard for home care, which included criteria for discharge with HCN referral and criteria leaving the hospital were established. These were developed through content analysis from the results of an open-ended questionnaire to related doctors concerning characteristic for discharge with HCN referral for each of the disease groups. The final criteria was decided by discussion among the researchers. 2. Instrument for measurement of health statusPatient health status was measured pre and post home care by direct observation and interview with an open-ended questionnaire which consisted of 61 items based on Gorden's nursing diagnosis classification. These included seven items on health knowledge and health management, eight items on nutrition and metabolism, three items on elimination, five items on activity and exercise, seven items on perception and cognition, three items on sleep and rest, three items on self-perception, three items on role and interpersonal relations, five items on sexuality and reproduction, five items on coping and stress, four items on value and religion, three items on family. and three items on facilities and environment. 3. Instrument for measurement of self-care The instrument for self-care measurement was classified with scales according to the attributes of the disease. Each scale measured understanding level and practice level by a Yes or No scale. Understanding level was measured by interview but practice level was measured by both observation and interview. Items for self-care measurement included 14 for patients with a CVA, five for women who had a cis, ten for patients with lung cancer, 12 for patients with COPD, five for patients with a simple nephrectomy, and 11 for patients with LC. 4. Record for follow-up management This included (1) OPD visit sheet, (2) ER visit form, (3) complications problem form, (4) readmission sheet. and (5) visit note for others medical centers which included visit date, reason for visit, patient name, caregivers, sex, age, time and cost required for visit, and traffic expenses, that is, there were open-end items that investigated OPD visits, emergency room visits, the problem and solution of complications, readmissions and visits to other medical institution to measure health problems and expenditures during the follow up period. 5. Instrument to measure patients satisfaction The satisfaction measurement instrument by Reisseer(1975) was referred to for the development of a tool to measure patient home care satisfaction. The instrument was an open-ended questionnaire which consisted of 11 domains; treatment, nursing care, information, time consumption, accessibility, rapidity, treatment skill, service relevance, attitude, satisfaction factors, dissatisfaction factors, overall satisfaction about nursing care, and others. In conclusion, Five evaluation instruments were developed for home care nursing. These were (1)standard for discharge with HCN referral. (2)instrument for measurement of health status, (3)instrument for measurement of self-care. (4)record for follow-up management, and (5)instrument to measure patient satisfaction. Also, the five instruments can be used to evaluate the effectiveness of the service to assure quality. Further research is needed to increase the reliability and validity of instrument through a community-based HCN evaluation.

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