• Title/Summary/Keyword: Family planning

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Comparative Analysis of Community Health Practitioner's Activities and Primary Health Post Management Before and After Officialization of Community Health practitioner (보건진료원의 정규직화 전과 후의 보건진료원 활동 및 보건진료소 관리운영체계의 비교 분석)

  • Yun, Suk-Ok;Jung, Moon-Sook
    • Journal of agricultural medicine and community health
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    • v.19 no.2
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    • pp.141-158
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    • 1994
  • To provide better health care services to the rural population, the government has made the Community Health Practitioner(CHP) a regular government official from April 1, 1992. This study was carried out to study the impact of officialization of CHP on the activities and management system of Primary Health Post(PHP). Fifty PHPs were selected by two stage sampling, cluster and simple random, from 595 PHPs in Kyungnam and Kyungpook provinces. Data were collected by a personal interview with CHPs and review of records and reports kept in the PHPs. The study was done for the periods of January 1-March 31, 1992 (before officialization) and January 1-March 31, 1993 (after officialization). Ninety-six percent of the CHPs wanted to become a regular government official in the hope of better job security and higher salary. The proportion of CHPs who were proud of their iob was increased from 24% to 46% after officialization. Those CHPs who felt insecure for their job decreased from 30% to 10%. Monthly salary was increased by 34% from 802,600 Won to 1,076,000 Won and 90% of the CHPs were satisfied with their salary, also more CHPs responded that they have autonomy in their work planning, implementation of plan, management of the post, and evaluation of their activity. There were no appreciable changes in such CHPs' activities as assessment of local health resources, drawing map for the catchment area, utilization of community organization, grasping the current population structure in the catchment area, keeping the family health records, individual and group health education, and school health service. However, the number of home visits was increased from 13.6 times on the average per month per CHP to 27.5 times. More mothers and children were referred to other medical facilities for the immunization and family planning services. Average number of patients of hypertension, cancer, and diabetes in three months period was decreased from 12.7 to 11.6, from 1.5 to 1.2, and 4.3 to 3.4, respectively. Records for the patient care, drug management, and equipment were well kept but not for other records. The level of record keeping was not changed after officialization. The proportion of PHPs which had support from the health center was increased for drug supply from 14.0% to 30.0%, for consumable commodities from 22.0% to 52.0%, for maintenance of PHP from 54.0% to 68.0%, for supply of health education materials from 34.0% to 44.0%, and supply of equipment from 54.0% to 58.0%. Total monthly revenue of a PHP was increased by about 50,000 Won; increased by 22,000 Won in patient care and 34,700 Won in the government subsidy but decreased in the membership due and donation. However, there was no remarkable changes in the expenditure. The proportion of PHPs which had received official notes from the health center for the purpose of guidance and supervision of the CHPs was increased from 20% to 38% during three months period and the average number of telephone call for supervision from the health center per PHP was increased from 1.8 to 2.1 times(p<0.01). However, the proportion of PHPs that had supervisory visit and conference was reduced from 79% to 62%, and from 88% to 74%, respectively. The proportion of CHPs who maintained a cooperative relationship with Myun Health Workers was reduced from 42% to 36%, that with the director of health center from 46% to 24%, that with the chief of public health administration section from 56% to 36%, and that with the chairman of PHP management council from 62% to 38%. Most of the CHPs (92% before and 82% after officialization) stated that the PHP management council is not helpful for the PHP. CHPs who considered the PHP management council unnecessary increased from 4% to 16%(p<0.05). Suggestions made by the CHPs for the improvement of CHP program included emphasis on health education, assurance of autonomy for PHP management, increase of the kind of drugs that can be dispensed by CHPs, and appointment of an experienced CHP in the health center as the supervisor of CHPs. The results of this study revealed that the role and function of CHPs as reflected in their activities have not been changed after officialization. However, satisfaction in job security and salary was improved as well as the autonomy. Support of health center to the PHP was improved but more official notes were sent to the PHPs which required the CHPs more paper works. Number of telephone calls for supervision was increased but there was little administrative and technical guidance for the CHP activities.

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A Survey on Activities of Community Health Practitioners in Rural Area (농촌지역 보건지료원의 업무활동 분석)

  • Kang, Pock-Soo
    • Journal of Yeungnam Medical Science
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    • v.4 no.2
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    • pp.139-148
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    • 1987
  • The community health practitioners (CHP) play an important role in primary health care services to the underserved population in rural area. Time and motion study of 26 CHPs in Kyungpook Province was conducted through work diary method for 6 consecutive days from the time they arrived until they left the primary health post(PHP) during the past 3 weeks from November 16 to December 5, 1987. The allocation of activity time by working category, service category, location of activity and CHP's function was analyzed according to the characteristics of CHPs i. e., age, marital status and experience as CHP. The major findings are as follows : The mean activity time per CHP in a week was 2,918 minutes. The length of their working hours was longer for older, married and more experienced CHPs than others. About 80% of the CHP's activities took place within the PHP and only about 20% occured outside of the PHP. Working hours for the outdoor activities were longer for younger, single and less experienced CHPs than others. The allocation of activity time by working category showed 46.3% in the technical work and 18.7% in the administrative work. Working hours for the technical activities were longer for younger, single and less experienced CHPs than others. The percentage of activity time revealed greatest as much as 63.1% for direct patient care in technical work and 61.6% for record keeping in administrative work. Of the total working hours in a week, direct patient care and public health activities accounted for 29.2% and 16.2%, respectively. Of the indoor activities, working hours for direct patient care were longer than those for public health activities. However, of the outdoor activities, working hours for public health activities were longer than those for direct patient care. The allocation of activity time by CHP's function showed 49.7% in management of common disease, 31.8% in management of PHP and technical supervision of village health workers, 9.5% in MCH and family planning, 6.6% in community health management and 2.4% in community approach. Based on these findings, it was found that CHPs were mainly working in the PHP with a majority of their time being spent for direct patient care rather than preventive and promotive health cares. To enhance the preventive and promotive health services of the CHPs and to involve the activities for community development, refresher course for CHPs should be reinforced and supervision mechanism of the CHPs should be established and operated in Gun- and province-level.

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A Study on Health of High School Students (남(男)·여(女) 고등학생(高等學生)들의 건강(健康)에 관(關)한 연구 - 일부 청소년들의 건강상태와 건강행위를 중심으로 -)

  • Kim, Hak-Soon
    • Journal of the Korean Society of School Health
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    • v.6 no.2
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    • pp.89-100
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    • 1993
  • This study intended to examine closely the reasons which influence the health status and to health behavior of teenagers and plan the development of the school health education. The subject of this study was the boys, and girls' high school students in Chonguy city. The number of them was totally 632 and the period was from July 9 to 14, 1990. 1. The Health Status of Teenagers. I have examined closely the health status of teenagers. They answered they continued to go to school. ever though the majority of teenagers had troubles in their sleeping and felt sick As for one's health, most of teenagers were in a good condition and were sometimes worrying about their health condition. 2. The Degree of Interest and Responsibilities of Teenagers for Their Own Health. In the responsibility of teenagers for their own health the answer, 'my health depends on my taking care of it', had the highest grade, 4.67. And the answer, 'I am in a good health condition because I have taken of my health very well', had the lowest average, 4.1. In the degree of interest of teenagers for their own health, the problem of studying had the highest degree, 4.48 and the use of drugs, the smoking behavior, masturbation, the drinking behavior and the birth control were the lowest degree. 3. The Health Behavior of Teenagers. In this part, teenagers performed about 64 percent's health behavior on the point of 3.37. 4. The Comparison of the Health Behavior, the Health Responsibility and the Health Interest of the Subject According to the General Characteristics. The results were as follows: 1) There are significantly different in the health behavior according to sex (t=6.23, p<.001), smoking experience (t=5.33, p<.001), living place (t=5.09, p<.001), ranking of brothers (F=4.19, p<.01), economic situation(F=6.57, p<.001). 2) There is significantly different in the health responsibility according to sex(t=2.31, p<.05), experiencd by disease(t= 1.92, p<.05). 3) There are significantly different in the health interest according to the chronic disease experience of family (t=3.29, p<.001), smoking experience(t=2.71, p<.01). 5. The Correlation of the Health Behavior, the Health Responsibility, the Health Interest and the Health Locus of Control of the Subject. The health behavior showed the positive correlation with the health responsibility (r=.2906, p<.001), and the health responsibility showed the positive correlation with the health interest (r=.0938, p<.01). Also the health behavior showed the positive correlation with powerful others health locus of control (r=.2606, p<.001), and internal health locus of control (r=.2023, p<.001), the health responsibility showed the positive correlation with internal health locus of control (r=.4541, p<.001), and chance health locus of control(r=.1352, p<.001), and the health interest showed the positive correlation with internal health locus of ccntrol (r=.0920, p<.001), powerful others health iocus of control (r=.1907, p<.001 chance health locus of control (r=.1191, p<.01). On the basis of the above result, we can find the fact that the interest of teenagers for their own health is increasing. And so, it is necessary for the school health management to establish the new curriculum which strengthens the health education for the planning of one's desirable health management. Besides we need efforts to develop the standard scale through the analysis of all reasons which influences the tenagers' health status and health behavior.

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The Perception and Emotional Experiences of Rare and Intractable Diseases in Caregivers and Pediatric Patients with Mitochondrial diseases (미토콘드리아 질환 소아 환자 보호자에서의 질환 인식 및 정서변화)

  • Eom, Soyong;Lee, Joo Young;Hyun, Jiah;Lee, Young-Mock
    • Journal of The Korean Society of Inherited Metabolic disease
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    • v.17 no.1
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    • pp.1-10
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    • 2017
  • Purpose: This study aimed to investigate the perception and emotional experiences in rare and intractable diseases for caregivers of pediatric patients with mitochondrial diseases in order to provide therapeutic interventions for patients, caregivers, and families. Methods: A total of 83 caregivers of pediatric patients with mitochondrial diseases were recruited from the pediatric mitochondrial disease clinics of the Gangnam Severance Hospital in South Korea. Participants completed the survey about their perception of mitochondrial disease and emotional experiences after the diagnosis, and these clinical data were analyzed accordingly. Results: Surveys from a total of 83 caregivers of patients were analyzed, and the patients' age ranged from 6 to 12 years (33%), followed by ages 1 to 6 years (30%). Children with mitochondrial diseases were between 0 and 0.5 years of age at the time of first symptom onset (43%), and the duration of illness lasted more than 10 years in most cases (42%). Prior to diagnosis of mitochondrial diseases, the amount of awareness the caregivers had was 'Not at all' for both rare and intractable diseases and mitochondrial diseases in 44 cases and 68 cases, respectively. For the caregivers' emotional experiences, the most common initial responses were 'Discouraged/despair', 'Helpless/lethargic', and 'Disconcerted'. 'Anxious', 'Committed to treatment', and 'Responsibility as family members' were the most common emotional responses from the caregivers, followed by 'Disconcerted' and 'Helpless/lethargic'. Conclusion: It is important to consider the level of perception and emotional experiences of caregivers and patients with rare and intractable mitochondrial diseases for planning treatment programs.

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Landscape Composition Based on Placement and Harmony in the Namgea Suhwon (치(置)와 화(和)의 개념으로 분석한 남계서원의 경관짜임)

  • Rho, Jae-Hyun;Shin, Sang-Sup
    • Journal of the Korean Institute of Landscape Architecture
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    • v.37 no.4
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    • pp.72-85
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    • 2009
  • This study attempts to examine the principles of landscape composition for a 'Suhwon(書院)' and the meaning and value of its traditional landscape architecture, in order to apply the results to the design of modern landscape architecture. A 'Suhwon' is a vital space containing the form and meaning of human activity. This study analyzes the characteristics of landscape composition in the construction of the Namgea Suhwon, located in Hamyang, by examining the form and meaning of its area and composition. The Namgea Suhwon was constructed with a suitable configuration and harmony in a good location, neither field nor mountain, and which encompasses transcendence and a return after passage through a period of birth and abundance. Its appearance means 'life existence and hidden death(生居死幽)'. Its spatial system is a reflection of the idea of Samshinoje(三神五帝: The three abilities of Providence and its five subjects) connected with Ilsangje -Samshin -Ohje. It was built based on the idea of Biryebudong(非禮不動) meaning that one should follow only good decorum and avoid discourtesy, complying with "the frame of decorum" developed by the family rites of Chu Hsi. The environmental design of the Namgea Suhwon was interrupted by the material confrontation between mountains and water and a binary code system, such as front to rear, length to breadth, and movement to stillness. The design did not adhere to stiff axes, but pursued the harmonic principles of asymmetric balance in the building and the yard, which are very naturalistic. The name 'Namgea Suhwon' is closely related with the view of placement(置) and harmony(和), which are unified with the function and meaning formed by connecting Sung Confucianism with the Pungsu-Sasinsa structure in the layout of the grounds. When examining the D/H ratio of the building and yard, it can be seen that the spaces of Ganghak, Yusang and Jehyang were built appropriately, according to the natural characteristics of each space, such as a sense of openness, enclosure, tension, relief, enhancement, and hierarchical order. The spaces also reflect human scale concepts that take advantage of auditory features. The transition process after the construction of 'Namgea Suhwon' reveals the intentions of the builder to create an ecological landscape composition based on Placement and Harmony. Placement embodies' a purposeful space in which nature and the building are connected naturally, 'incomplete open space pursuing completion', and 'potential beauty in which tension and relaxation are repeated'. Harmony embodies 'order and continuity having a sense of unity with the natural environment' and the 'sharing of daily life and memory'. 'Namgea Suhwon' contains many ideas for landscape planning, land use and the design of a campus environment.

A Study on the Mobile Medical Service Program -Based on the Community Diagnosis of a Remote Farm Area- (순회진료사업(巡回診療事業)의 문제점(問題点)과 개선방향(改善方向) (일부(一部) 무의지역에 대(對)한 지역사진단(地域社診斷)을 중심(中心)으로))

  • Park, Hung-Bae;Choi, Dong-Wook
    • Journal of Preventive Medicine and Public Health
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    • v.11 no.1
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    • pp.86-97
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    • 1978
  • The mobile medical service has been operated for many years by a number of medical schools and hospitals as a most convenient means of medical service delivery to the people residing in such area where the geographical and socioeconomic conditions are not good enough to enjoy modern medical care. Despite of official appraisal showing off simply with numbers of outpatients treated and medical persons participated, however, as well recognized, the capability (in respect of budget, equipment and time) of those mobile medical teams is so limitted that it often discourages the recipients as well as medical participants themselves. In the midst of rising need to secure medical service of good quality to all parts of the country, and of developing concept of primary health care system, authors evaluated the effectiveness of and problems associated with mobile medical servies program through the community diagnosis of a village (Opo-myun, Kwangju-gun) to obtain the information which may be halpful for future improvement. 1. Owing to the nationwide Sae-Maul movement powerfully practiced during last several years, living environment of farm villages generally and remarkably improved including houses, water supply and wastes disposal etc. Neverthless, due to limitations in budget time and lack of knowledge (probably the most important), these improvements tend to keep up appearances only and are far from the goal which may being practical benefit in promoting the health of the community. 2. As a result of intensive population policy led by the government since 1962, there has been considerable advances in understanding and the rate of practicing family planning through out the villages and yet, one should see many things, especially education, to be done. Fifty eight per cent of mothers have not received prenatal check and the care for most (72%) delivery was offered by laymen at home. 3. Approximately seven per cent of the population was reported to have chronic illness but since only a few (practically none) of the people has had physical check up by doctors, the actual prevalence of chronic diseases may reach many times of the reported. The same fact was observed also in prevalence of tuberculosis; the patients registered at local health center totaled 31 comprising only 0.51% while the numbers in two neighboring villages (designated as demonstration area of tuberculosis control and mass examination was done recently) were 3.5 and 4.0% respectively. Prevalence rate of all dieseses and injuries expereinced during one month (July, 1977) was 15.8%. Only one tenth of those patients received treatment by physicians and one fifth was not treated at all. The situation was worse as for the chronic patients; 84% of all cases either have never been treated or discontinued therapy, and the main reasons were known to be financial difficulty and ignorance or indifference. 4. Among the patients treated by our mobile clinic, one third was chronic cases and 45% of all patients, by the opinion of doctors attended, were those who may be treated by specially trained nurses or other paramedics (objects of primary care). Besides, 20% of the cases required professional managements of level beyond the mobile team's capability and in this sense one may conclude that the effectiveness (performance) of present mobile medical team is quite limitted. According to above findings, the authors would like to suggest following for mobile medical service and overall medicare program for the people living in remote country side. 1. Establishment of primary health care system secured with effective communication and evacuation (between villages and local medical center) measures. 2. Nationwide enforcement of medical insurance system. 3. Simple outpatient care which now constitutes the main part of the most mobile medical services should largely be yielded up to primary health care unit of the village and the mobile team itself should be assigned on new and more urgent missions such as mass screening health examination of the villagers, health education with modern and effective audiovisual aids, professional training and consultant services for the primary health care organization.

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STUDY OF THE EFFECT OF COMPREHENSIVE NURSING CARE ON THE ADJUSTMENT OF CHILDREN TO HOSPITALIZATION (유.소아를 위한 포괄적 간호가 그들의 병원생활 적응에 미치는 영향에 관한 연구)

  • 이자형
    • Journal of Korean Academy of Nursing
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    • v.3 no.3
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    • pp.97-110
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    • 1973
  • The goal of modern nursing is to provide comprehensive nursing care to patients. If comprehensive nursing care to children (within the hospital setting) is to be provided, consideration of the stage of growth and development of the child is especially important. From clinical observation, it appeared that nurses often disregarded individual requirements of children in giving nursing care. Therefore, the purpose of this study is to show that comprehensive nursing care which is based on an understanding of the growth and development of the child contributes to both the child and the mother's adaptability to the child's hospitalization. Method: Sixty children, three to three year of age, hospitalized at the Yonsei University Pediatric Ward ware studied. From April 1, 1973 to May 5, 1973, children admitted to the hospital were assigned to either an experimental or a compare groups. There were 30 children in each group. The sex and age of the children in each group was similar. In both groups were more male than female children. In the experimental group, each mother stayed with hot child continuously during his hospitalization. In the compare groups, the mother or some other member of the family stayed with the child. Each day on the child's admission the investigator visited the ward from 1-2 P.M. to 9-10 P.M., in order to provide comprehensive care for the experimental -group. The assistance given the nurses by the investigator was in the form of conferences regarding care and in giving direct care to the child and his mother. The compare group of children received nursing care as usually provided by the hospital. The instruments used to obtain the data for analysis were as follows: 1. The fear and anxiety reaction of the child was recorded by observation of the investigator for four areas: 1) separation from parent and relatives 2) reaction to Doctor and Nurse with white gowns 3) reaction to nursing care 4) reaction to injection and tests, etc. 2. Regression in area of eating, sleeping, and elimination were recorded by the investigator by questioning the mother and by observation. 3. Adaptability to the hospitalization was recorded by direct questioning of the children for areas of emotional and social adjustment. For children older than 3 years of age or children not seriously ill, using the simple I. Q. test this was possible for only 35 of the total 60 children. Result: 1. 55 percents of the total 60 children had been prepared by their parents for hospitalization. The children who had received prior preparation accepted hospitalization more readily than those who had received no preparation. (χ²=4.6 Ρ<0.05) 2. On admission 31.7 percent of the children expressed verbal fear of their discase or treatment. 25 percent felt that the disease was due to their mistake. 3. There was a significant difference in the reaction of the child to separation from the parent or relatives between the two groups. The experimental groups showed less anxiety due to separation than the compare group. (χ²=4.34 Ρ<0.05) In both groups there was less anxiety due to separation among school age (6-12 years) children than among preschool age (3-5 years) children. (χ²=9.22 Ρ<0.05) 4. More than half of the children in both groups reacted with fear and avoidance to doctor and/or nurses wearing white gowns. (χ²=0.06 Ρ<0.05) 5. The experimental group reacted more favorably to nursing in general than the compare group. (χ²=4.8 Ρ<0.05) 6. There was no difference in the fear and refused reaction to special tests and/or such as X-rays and injections, etc. between the groups. (χ²=3.77 Ρ<0.05) 7. More children in the compare group showed regressive tendencies in eating, sleeping, and elimination habits than in experimental groups. (χ²=2.3 Ρ<0.05 χ²=3.88 Ρ<0.05 χ²=4.9 Ρ<0.05) 8. There was a significant difference in the adaptability to hospitalization between the two groups. The experimental groups adapted more readily. (χ²=2.02 Ρ<0.05) 9. For children who had higher I.Q. s the adaptability to hospitalization was better regardless of the group. (χ²=5.03 Ρ<0.05) However, because of the small number of cases (60), this finding cannot be extrapolated without further verification. The date demonstrates that there was a greater adaptability to hospitalization by the child when comprehensive nursing care was given. By planning care and applying knowledge of growth and development to meet, nurses are in a position to prevent some of the psychological trauma associated with hospitalization.

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Identification and Measurement of Hospital-Related Fears in Hospitalized School-Aged Children (학령기 입원아동의 병원관련 공포에 관한 탐색연구)

  • 문영임
    • Journal of Korean Academy of Nursing
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    • v.25 no.1
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    • pp.61-79
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    • 1995
  • When children are admitted to hospital, they have to adapt to new and unfamiliar stimuli. Children may respond with fear to stimuli such as pain or unfamiliar experiences. One goal of nursing is to help hospitalized children to adapt effectively to their hospital experience. Accordingly, nurses need to assess childrens' fears of their hospital experience to contribute to the planning of care to alleviate these fears. The problem addressed by this study was to identify and measure hospital-related fears(hereafter called HRF) in hospitalized school-aged children. The study was conceptualized with Roy's model. A descriptive qualitative approach was used first, followed by a quantitative approach. This study was conducted from November 30, 1989 to January 12, 1991. The sample consisted of 395 hospitalized school-aged children selected through an allocated sampling technique in nine general hospitals. The HRF questionnaire (three point likert scale ) was developed by a delphi technique. The data were analyzed by an SAS program. Factor analysis was used for the examination of component factors. Differences in the HRF related to demographic variables were examined by t-test, analysis of variance and the Scheffe test. The crude scores of the HRF scale were transformed into T- scores to calculate the standard scores. The results included the following : 1. Forty-four items were derived from 188 statements identifying the childrens' hospital-re-lated fears. These items clustered into 14 factors, fear of injections, operations, bodily harm others' pain, medical rounds, physical examinations, medical staff, disease process, blood and X-rays, drugs and cockroaches, tests, harsh discipline from parents or staff, being absent from school, and separation from family. The 14 factors was classified into four categories,'pain','the unfamiliar','the un-known' and 'separation'. 2. The reliability of the HRF instruments was .92(Cronbach's alpha). In the factor analysis, Cronbach's alpha coefficients for the 14 factors ranged from .84 to .86 and Cronbach's alpha coefficients for the four categories ranged from .70 to .84. Pearson correlation coefficient scores for relationships among the 14 factors ranged from ,11 to .50, and among the four categories, from ,44 to ,63, indicating their relative independence. 3. The total group HRF score ranged from 45 to 130 in a possible range of H to 132, with a mean of 74.51. The fears identified by the children were, in order, injections, harsh discipline by parents or staff, bodily harm, operations, medical staff, disease process, and medical rounds ; the least feared was others' pain. The fear item with the highest mean score was surgery and the lowest was examination by a doctor. HRF scores were higher for girls than for boys, and for grade 1 students than for grade 6 students. HRF scores were lower for children whose fathers were over 40 than for those whose fathers were in the 30 to 39 age group, and whose mothers were over 35 than for those whose mothers were in the 20 to 34 age group. HRF scores were lower when the mother rather than any other person stayed with the child. The expressed fear of pain, the unfamiliar, the un-known and of separation directs nurses' concern to the threat felt by hospitalized children to their concept of self. This study contributes to the assessment of fears of hospitalized children and of stimuli impinging on those fears. Accordingly, nursing practice will be directed to the alleviation of pain, pre-admission orientation to the hospital setting and routines, initiation of information about procedures and experiences and arrangments for mothers to stay with their children. Recommendations were made for further research in different settings and for development and testing of the instrument.

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A RURAL HEALTH SERVICE MODEL FOR KOREA BASED OH A PRIMARY CARE NURSING SERVICE SYSTEM

  • Hong, Yeo-Shin
    • Journal of Korean Academy of Nursing
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    • v.11 no.2
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    • pp.5-8
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    • 1981
  • This study concerns itself with the development of a new model of comprehensive health service for rural communities of Korea. The study was conceived to resolve the problems of both underservice in rural communities and underutilization of valuable health manpower, namely the nurses, the disenchanted elite health personnel in Korea. On review of the current situation, the greatest deficiencies in the Korean health care system were found in the availability of primary care at the peripheries of md communities, in the dissemination of knowledge of disease prevention and health care, and in the induction of and guidance for active participation by the clientele in health maintenance at the personal, family and community level Abundant untapped health resources were identified that could be brough to bear upon the national effort to extend health services to every member of the Korean Population. Therefore, it was Postulated that the problem of underservice in rural communities of Korea can be structurcturally resolved by the effective mobilization and organization of untapped health resources, and that. a primary care Nursing Service System offers the best possibility for fulfillment of rural health service goals within the current health man-power situation. In order to identify appropriate strategies to combat the present difficulties in Korean rural health services and to utilize nurses and other health personnel in community-centered health programs, a search was made for examples of innovative service models throughout the world. An extensive literature survey and field visits to project sites both in Korea and in the United States were made. Experts in the field of world health, health service, planners, administrators, and medical and nursing practitioners in Korea, in the United States as well as visitors from other Asian countries were widely consulted. On the basis of information and inputs from these experts a new rural health service model has been constructed within the conceptual framework of community development, especially of the innovation diffusion Model. It is considered especially important that citizens in each community develop capacities for self-care with assistance and supports from available health professionals and participate in health service-related decisions that affect their own well-being. The proposed model is based upon the regionalization of health care planning utilizing a comprehensive Nursing Service System at the immediate delivery level The model features: (1) a health administration unit at each administrative level; (2) mechanisms for community participation; (3) a continuous source of primary health care at the local community level; (4) relative centralization of specialty care and provision of tertiary or super-specialty care only at major national metropolitan centers; and (5) a system for patient referral to the appropriate level of care. This model has been built around professional nurses as the key community health workers because their training is particularly suited and because large numbers of well-trained nurses are currently available and being trained. The special element in this model is a professional nurse-guided, self-care facilitating primary care Community Nursing Service System. This is supported by a Nursing Extension Service as a new training and support structure. (See attached diagrams). A broad spectrum of programs was proposed for the Community Nursing Service System. These were designed to establish a balance of activities between the clinic-centered individual care component and the field activity-centered educational and supportive component of health care services. Examples of possible program alternatives and proposed guidelines for health care in specific situations were presented, as well as the roles and functions of the key health personnel within the Community Nursing Service System. This Rural Health Service Model was proposed as a real alternative to the maldistributed, inequitable, uncoordinated solo-practice, physician-centered fee-for-service health care available to Koreans today.

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The Evaluation of Midwifery Program Through the Midwifery Leadership Training Program (조산수습과정 지도자 강습회를 통한 조산교육 평가조사연구)

  • 이경혜
    • Journal of Korean Academy of Nursing
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    • v.11 no.2
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    • pp.23-32
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    • 1981
  • The purpose of the study was to evaluate the educational content which had been given by midwifery training program. It was hoped that this result would help. It was sponsored by com-munity health worker plan effective health education. College of Nursing Ewha Womans University and The Korean Nurses Academic Society during the November 19 thru 24, 1979. It was carried out on July through on September 1980, and involved 22 community health workers. The results were as follows: 1. Most of the community health workers came from Seoul & Pusan areas and have been working at the hospitals. There were 31.82% of Head Nurses, 27.2% of Staff Nurses, 22.73% Nurse Supervisons, 13.6% of Nurse Directors and 4.5% of educational coordinator for Nurses. These participant had nurse-midwifery lincences by 63.64%. None of there had just midwifery lincences. 2, Age structures of the study population shows 31.82% of whom are.26-30 years and 22.73% of whom are 36. 40 years of age. This shown that seniority proportion is higher than the younger. There are 31.82% of 1-5 years, 27.27% of 6-10 year and 11-15 years, respectively by work career. 3. There are 54.55% of the institutions have opened their own midwifery training course for their nursing staff members. Because of lack of the facilities, shortage of instructors, and problems of administrative process. 4. According to the institution which opened for midwifery training courses, the participant was responsible for “midwifery”“Infant care”“MCH”“practice of midwifery”“Nursing adjustment”and“F. P.”5. During the midwifery couse, there were 8 institution who used the textbook and 4 institution who did not. Least of there referned to content matinals which was given by the sponsored. 6. There are 7 insititues who kept their training courses with other professional helps such as physicians., professiors and nurses. Some problems are pointed out by respondents such as“conflict with residents”“poor suportive administration”and“lake of manpower”. 8. The participant showed that they learned new knowledge as trends during this programs for there quality work so it need (one or twice times) a year. But they suggested that it needed more emphasis on the“maternal health care”and“role of the nurse-midwifery”. 9. The analysis of the results are as follows within the 6 areas which are given by the sponsored: There are highest ranks between“basic theory & family planning”“role of midwifery & nursing practice”. In the prenatal care the highest rank ware related to“health risk”on“idenify of risk symtoms”. In the health care areas which related to delivery, the responsers were related to“general conditions”or“high risk criteria”. In the health care area which related to high risk maternity care. In the neonatal health care, the highest rank was related to”health assessment of normal infant”. In the infant health care the responses was related to“abnormal symptoms”and“risk symptoms”. Actually, the participants show that they are more interested in“role of midwifery”“health assessment”and “high risk maternity care”are which emphasised on health promotion, health maintenance & disease preventive. 1) The midwifery training program need higher education for midwifery on a regular basis. 2) Within the open institution of midwifery training program, the nurses must be supported by their own institution and administry of social welfare must give systematic support. Also non-open institution must be open very soon. 3) All health workers including the residents & other workers, must cooperate for their phased common good of impovement of the maternity health. 4) Administration agonies & education institutions must provide the curriculum facilitis and administration systems which are needed for training of nurse-midwifery.

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