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A Study of Home Care Needs of Patients at Discharge and Effects of Home Care -Centered on Patients Discharged from a Rural General Hospilal- (퇴원환자의 가정간호요구와 가정간호사업의 효과 분석 - 일 종합병원을 중심으로)

  • Choi, Yun Soon;Kim, Dai Hyun;Storey, Margaret;Kim, Cho Ja;Kang, Kyu Sook
    • The Korean Nurse
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    • v.31 no.4
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    • pp.77-99
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    • 1992
  • The study was carried out at W. hospital, an affiliated hospital of Y university, involved a total of 163 patients who were discharged from the hospital between May 1990 und March 199J. Data collection was twice, just prior to discharge and a minimum of three months post discharge. Thirty patients who lived within a hour travel time of the hospital received home care during the three months post discharge. Nursing diagnoses and nursing interventions For these patients were analyzed in this study. The results of the study are summarized as follows : 1. Discharge needs for the subjects of the study were analyzed using Gordon's eleven Functional categories and it was found that 48.3% of the total sample had identified nursing needs. Of these, the needs most frequently identified were in the categories of sexuality, 79.3 %, health perception, 68.2 % self concept, 62.5 %, and sleep and rest 62.5 %. Looking ut j he nursing diagnosis that were made for the 30 patients receiving home care, the following diagnoses were the most frequently given; alteration in sexual pattern 79.3%, alterations in health maintenance, 72.6%, alteration in comfort, 68.0%, depression, 64.0%, noncompliance with diet therapy, 6.3.7%, alteration in self concept, 55.6%, and alteration in sleep pattern, 53%. 2. In looking at the effects of home nursing care as demonstrated by changes in the functional categories over the three month period, it was Found that of the 11 functional categories, the need level for health perception, nutrition, activity and self concept decreased slightly over the three month period. On the average sleep patterns improved, but restfulness was slightly less and bowel elimination patterns improved but satisfaction with urinary elimination was slightly less. On the other hand, role enactment, sexuality, stress management and spirituality decreased slightly. The only results that were statistically significant at the 0.05 level were improvement. in digestion and decrease in pain. No statistically significant changes were found in ability related to ADL, the total ADL Score at discharge was $19.78{\pm}8.234, and after 3 months $19.01{\pm}8.12$. Considering that a majority of the patients were over 60 years of age and that many had brain or spinal cord injuries, the fact that their ADL ability did nor deteriorate after discharge can be interpreted as related to a positive impact by the home health care nurses. Similarly there was a slight be not statistically significant decrease in the quality of life scores between the two lest times(l47.83 at discharge and 113.02 at the three month period). Again, when the chronic nature of thee problems facing these patients is considered this maintenance of quality of life can be interpreted as a positive impact by the home health care nurses. 3. One of the home care nursing activities was diagnosis. For this activity it was found that for nine functional health categories(sexuality and spirituality excepted) there were 20 nursing diagnoses. The most frequent were noncompliance, alteration in skin integrity both actual and potential, and impaired physical mobility in that order. 4. Delivery of home health care by the home health nurses included the following nursing activities; assessment, patient education, demonstration of care activities, counselling, direct care to the patient and referrals. Direct care included changing dressings, bladder irrigations, changing Foley catheters, measurement of residual urine, perineal care, position change, back care, oral hygiene, exercise and massage of motion exercises, cleansing enemas, tracheostomy suctioning and tracheostomy care, care of dentures, applications of heat and other similar nursing activities. In conclusion almost 50% of (he sample indicated a need for continued nursing care at the time of discharge and for the patients in the sample who received home care there was a slight decrease in nursing needs but while the patients had chronic and debilitation problems there was ill decrease in ADL abilities or in quality of life. Further study needs Lo be done La increase the reliability and validity of the tool that was used to measure home health care needs. It is also recommended that study by done using a randomized sampling with a control group to compare patients who receive home care with those who do not.

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The Empirical Study on the Effects of the Team Empowerment caused by the Team-Based Organizational Structure in KBS (팀제가 팀 임파워먼트에 미치는 영향에 관한 연구;KBS 팀제를 중심으로)

  • Ahn, Dong-Su;Kim, Hong
    • 한국벤처창업학회:학술대회논문집
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    • 2006.04a
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    • pp.167-201
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    • 2006
  • Korean corporations are transforming their vertical operational structure to a team-based structure to compete in the rapidly changing environment and for improved performance. However, a high percentage of the respondents in KBS said that despite the appearance of the present team structure, the organization operates much like a vertically-structured organization. This result can be attributed to the lack of study and implementation toward the goal of empowerment, the key variable for the success of the team-based structure. This study aims to provide policy suggestions on how to implement the process of empowerment, by investigating the conditions that hinder the process and the attitude of the KBS employees. For the cross-sectional study, this thesis examined the domestic and international references, conducted a survey of KBS employees, personal interviews and made direct observations. Approximately 1,200 copies of the Questionnaire were distributed and 474 were completed and returned. The analysis used SPSS 12.0 software to process the data collected from 460 respondents. For the longitudinal-study, six categories that were common to this study and "The Report of the Findings of KBS Employees' View of the Team Structure" were selected. The comparative study analyzed the changes in a ten-month period. The survey findings showed a decrease of 24.2%p in the number of responses expressing negative views of the team structure and a decrease of 1.29%p in the number of positive responses. The findings indicated a positive transformation illustrating employees' improved understanding and approval of the team structure. However, KBS must address the issue on an ongoing basis. It has been proven that the employee empowerment increases the productivity of the individual and the group. In order to boost the level of empowerment, the management must exercise new, innovative leadership and build trust between the managers and the employees first. Additional workload as a result of shirking at work places was prevalent throughout all divisions and ranks, according to the survey data. This outcome leads to the conclusion that the workload is not evenly distributed or shared. And the data also showed the employees do not trust the assessment and rewards system. More attention and consideration must be paid to the team size and job allocation in order to address this matter; the present assessment and rewards system need to be complemented. The type of leadership varies depending on the characteristics of the organization's structure and employees' disposition. KBS must develop and reform its own management, leadership style to suit the characteristics of individual teams. Finally, for a soft-landing of KBS team structure, in-house training and education are necessary.

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The College Students' Attitude toward Terminal Care and Euthanasia (대학생들의 임종진료에 대한 태도 - 안락사를 중심으로 -)

  • Choi, Youn-Seon;Shin, Jong-Min;Lee, Young-Mee;Lee, Tai-Ho;Hong, Myung-Ho;Kim, Jun-Suk;Yeom, Chang-Hwan
    • Journal of Hospice and Palliative Care
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    • v.2 no.1
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    • pp.16-22
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    • 1999
  • Purpose : Today, people usually die in hospitals and institution-sterile and strange, and equipped with a complex range of technology capable of supporting and prolonging life, frequently only biological one, when a return to health and vitality is no longer possible. Consequently, 'dying with dignity' has become a slogan of opposition to useless and degrading prolongation of life when a patient's organ, though still minimally functional, can no longer support or permit the exercise of self-fulfilling personal control over life's events. Dying with dignity, however, means entirely different things to different people. This study is to investigate the college students' attitude on terminal care and passive euthanasia. Methods : During June 1997, 337 college students participated in this study by responding to the pre-made questionnaire. It deft with the attitude to passive euthanasia, hospice, the most suffering fear facing the death, the preferred place and person to be with if dying. Results : 63.2% of subjects agreed to passive euthanasia. Only 14.2.% of college students can explain the concept of hospice, exactly They got the information about hospice by TV(43%), book(33.5%), religious group(12%) in order. The preferred death place was home(76.6%) and hospital(11.9%) in order. The Most suffering fear facing the death were about unknown(41.5%), loosing colleague(13.6%), pain(11%), isolation(6.5%) in order. Conclusion : About two-thirds of college students agreed to passive euthanasia. But euthanasia is dangerous and unnecessary. We should vigorously promote programmes of education in hospice and palliative medicine and care.

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지역사회 건강관리담당자의 만성질환 관리실태:전라남도를 중심으로

  • Kim, Hye-Sook;Park, Jong;Jeong, Eun
    • Journal of agricultural medicine and community health
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    • v.34 no.3
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    • pp.334-345
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    • 2009
  • Objectives: This study was performed to investigate the management status of chronic disease at community health centers. Methods: The study subjects were 450 employed persons at community health centers in Jeonlanamdo. General characteristics, status of chronic disease management and health education were collected for statistical analysis. The differences on management status among working areas were assessed with chi-square test and ANOVA. Results: The mean values of work duration were 18.7 years in rural, 14.4 years in fishing village, and 17.4 years in urban-rural, respectively. The number of management registration was highest in hypertension. The ways of disease management were medication check-up, diet stopping smoking. The contents of group health education were exercise, diet and prohibition of smoking. The place of health education was town assembling hall. The fields which officials wanted to be educated were symptom, diagnosis, treatment and complication. The most important field was early detection of chronic disease patients and health education. Finally, the field requiring support was work standardization. Conclusions: Community health workers have worked positively in chronic disease management. The barriers to work were the lack of professional and preliminary data. The support system with other health organ and health education were needed for the improvement of working ability.

A Preliminary Study for Expending of Hospital-Based Horne Health Care Coverage - Focused on Accident Inpatients Who has the Workers Compensation Insurance - (병원중심 가정간호사업 관리대상범위 확대를 위한 기초연구)

  • Lee, Sook-Ja;Lee, Jin-Kyung;Ryu, Ho-Sihn
    • Journal of Korean Academic Society of Home Health Care Nursing
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    • v.6
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    • pp.5-18
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    • 1999
  • This study was attempt to encourage for developing on rehabilitation delivery system and programs as a substitute service instead of hospitalization for accident patients at work, such as hospital based home health care nursing service. It needs vary substitutes service of hospitalization to curtail the length of stay for inpatients who were hospitalized with workers compensation insurance. It focused on developing an estimation of early discharge day of accident inpatients based on a detail statement of treatment for 115 inpatients who were hospitalized at General Hospital in 1997. This study has four specific purpose as follows. First, to find out the status of health service utilization. Second, to estimate the early discharge days and income increasing effect based on the early discharge for those patients. Third, to identify the factors to affect total medical expenditure and the length of stay for those inpatients. Forth, to figure out the need of utilizing home health care nursing service for accident patients. In order to analyze of the length of stay and medical expenditure for inpatients who were hospitalized due to the accident, the authors conducted with micro-analysis and macroanalysis from medical records and medical expenditure records. Micro-analysis was done by nominal group discussion of 4 expertise with the critical criteria. such as a decrease in the amount of treatment after surgery, treatments, tests, drugs and changes in the tests consistency, drug methods, vital signs, start of ROM exercise, doctor's order, patient's outside visiting ability, stable conditions. In addition to identify affected variables for medical expenditure. the length of stay and income effect due to early discharge day, the data was analyzed with multiple regression analysis and linear regression analysis model by SPSS-PC for windows and Excell program. Results of this study as follows. First, the mean length of stay was 37.1 days, whereas the mean length of stay due to early discharge was 28.2 days at the hospital. The estimation of early discharge days were shown that depends on the length of stay. The longer length of stay, the longer length of early discharge days, such as under 7 days length of stay patients was to estimated the mean length of stay was 4.9 days and early discharge days was 4.6. whereas the mean length of stay was 122.6 days and early discharge days was 92.0 respectively. The mean medical expenditure per day were found to be 133.409 Won. whereas the mean medical expenditure per day was shown negative linear trends according to the length of stay at the hospital. The estimation results of the income effect due to 11 early discharge days per bed was around 2,150,000 won. However, it means not the real benefits from early discharge, but the income increasing amount without considering medical prime cost in general hospital. Therefore, it needs further analysis on the cost containments and benefits under the considering as well turn over rates per bed as the medical prime costs. The length of stay was most significant and the sign was positive to the total medical expenditure, as expected. Surgery and patient's residential area also an important variable in explaining medical expenditure. The level of complications was most significant variable in explaining the length of stay. The level of the needs on horne health care nursing service which can be used for early discharge accident patients were shown very high. The needs distribution varied from 65.5% of patients and 88.9% of caregivers, to 96.4% of doctors, and 99.1% of nurses. In addition horne health nurse responded that they can be managed the accident inpatients from early discharge. From these research findings. the following suggestions has been drawn it needs to develop strategies on rehabilitation delivery system in order to focused on consumer's side which is planned for 21 century health policy in Korea. Vary intermediate facilities and horne health care would have been developed in the community based for comprehensive rehabilitation services as a substitutes of hospitalization for shortening the length of stay of hospitalizations. In hospital based horne health care nursing service, it's available immediately to utilize for the patients who wanted rehabilitation services as a substitutes of hospitalization under the cooperations with workers compensation insurance company.

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Education Need of the Visit ing Health Service Workers in Gwangju and Jeollanam-do Public Health Facilities (일부 공공보건기관 방문보건요원의 교육요구도 조사)

  • Kim, Young-Lak;Kim, Shin-Woel;Chung, Eun-Kyung;Choi, Jin-Su
    • Journal of agricultural medicine and community health
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    • v.27 no.1
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    • pp.51-64
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    • 2002
  • This study was aimed to provide the basic data for the development of effective educational program by reflecting the opinions of the visiting health service workers. The subjects were 144 visiting health service workers in Gwangju and Jeollanam-do area who responded the mail questionnaire. The data were collected from June to July, 2001 using questionnaire composed of the education need, knowledge by subjective appraisal, and experience of education. The major findings of this study were as follows: 1. The number of respondents who received at least one education within recent three years were 43(29.9%) at the central level, 57(39.6%) at the provincial level and 53(36.8%) at the district level. The satisfaction with education was higher at the central level than at the provincial and district level. 2. Knowledges by subjective appraisal on the 'chronic degenerative diseases management' and 'health promotion' was relatively high. while that of 'rehabilitation' was low. 3. The knowledge by subjective appraisal of visiting health service was related with experience of education and license status. The knowledge was higher in registered nurses than in nurse aids. The curricula related to increased level of knowledge of visting health service workers were 'elderly health care', 'rehabilitation' and 'psychiatric-mental health nursing' educations at the central level 'continuing education for the community health practioners' and 'psychiatric-mental health education' at the provincial level and 'elderly health care', 'rehabilitation' 'psychiatric-mental health' and 'acute diseases control' educations at the district level. 4. The respondents preferred elderly health management as the contents of education, officer group education as the method of education, province(30.4%) as the main body of education, exercise and practice as the form of education, 2-3 times per year as the frequency of education, and 3-5days as the period of education. The findings of this study could suggest that future education program should be planned to increae the knowledge level of visiting health service workers by reflecting their educational need.

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The Correlation of Sonographic Finding of Fatty Liver with Hematologic Examination and Body Fat Percentage (초음파상 지방간과 혈액학적 검사 및 체지방률과의 상관관계)

  • Cheon, Hae-Kyung;Lee, Tae-Yong;Kim, Young-Ran
    • Journal of radiological science and technology
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    • v.32 no.4
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    • pp.437-444
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    • 2009
  • Ultrasonography has been used as a basic examination of a medical check up for prevention and diagnostics of diseases. Even the person who has no particular subjective symptoms can have a variety of diseases. Especially fatty liver is found in many cases. In this study, we tested 3582 persons who are in between the ages of 15 to 81 and observed that 1390 persons had fatty liver while 2192 persons are normal. We classified the grade of fatty liver and compared their life styles with the results of liver function test and BMI. The results are as follows. Ratio of the subjects who had a fatty liver is 38.8%. Male and female ratio was 46.2% and 24.2%. On the correlation among the fatty liver, the body mass index and the body fat%, the average value of body mass index and body fat% were significantly higher in the group of the fatty liver than in those of the normal liver. The influence of the related factor and the correlation on the fatty liver was shown that it was more related with the order of age, body mass index, triglyceride, ALT, body fat%, sex, HDL-Cholesterol, LDL-Cholesterol, and GGT. The result of the ultrasonography carried out for the purpose of regular health check up indicates that even the 38.8% of those who was diagnosed as normal condition could have the fatty liver and have possibility of other diseases. Therefore, if there are any troubles related to liver function and lipid through hematologic examination or when practicing follow-up study with ultrasonography concerning the correlation relation between the body fat% and dietary preference, alcohol consumption and exercise, the ultrasonography is definitely useful for prevention and treatment of diseases.

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The Associations of Empowerment and Social Capital with Self-Rated Health in Communities with Poor Health (사망률이 높은 지역사회에서 임파워먼트 및 사회적 자본과 주관적 건강수준의 연관성)

  • Kim, Jang-Rak;Jeong, Baek-Geun;Park, Ki-Soo;Kang, Yune-Sik
    • Journal of agricultural medicine and community health
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    • v.37 no.3
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    • pp.131-144
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    • 2012
  • Objectives: This study was performed to identify the associations of empowerment and social capital (such as social participation and trust) with self-rated health in Korean communities with poor health. Methods: This study used the data from community health interviews conducted at 29 administrative sections (dong, eup, or myeon) with high mortality from August to October in both 2010 and 2011 as part of the Health Plus Happiness Plus Projects in Gyeongsangnam-do Province. The study subjects comprised 6,383 individuals composed of approximately 220 adults randomly sampled from each administrative section. The empowerment was measured with five-point Likert scale responses to seven perceived control questions (two at the individual level, five at the community level). The social participation was measured with 'participation in formal and/or informal group' and trust using responses to three questions about trust of others. Results: The high empowerment scores at both individual and community levels, social participation in informal groups, and high trust level had independent and significant associations with good self-rated health after adjusting for socio-demographic factors (sex, age, marital status, occupation, and food affordability) and health behaviors (smoking, alcohol drinking, and exercise) in the logistic regressions. There were weak but significant associations among empowerment, social participation, and trust levels. Conclusions: Empowerment, social participation, and trust were weakly inter-related and significantly associated with self-rated health. More studies are warranted for empowerment and other social capital indices in health promotion.

A Study on the Current Status of Health Screening and the Health Type(Physical Activity, and etc) of the Disabled by Using the Statistics of Health Insurance Corporation (건강보험공단 통계를 이용한 장애인의 건강검진 현황 및 건강형태(신체활동 등)에 대한 소고)

  • Kim, Seck-Jin;Jung, Jin-Sung
    • Journal of the Korean Applied Science and Technology
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    • v.35 no.2
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    • pp.433-444
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    • 2018
  • This study aims to examine the screening rate of health screening of the disabled by screening the data of disability and health statistics of the National Health Insurance Corporation, to suggest the problems of health examination and the future improvement measures, and also to review the type of health management of the disabled based on the results of health examination interview. As people with limited daily life or social life for a long time because of their physical/psychological disabilities in accordance with the Article2 of , out of 2,479,080 registered people with disabilities on the basis of December 31st 2015, the research subjects were limited to people with disabilities who participated in the health screening and health type for presenting the opinions about policies. In conclusion, regarding the health screening for the disabled, first, it would be necessary to collect the opinions from people with disabilities in order to prepare the health screening service suitable for them. Second, it would be needed to develop the health screening items for each type of disability and severity. Third, it would be necessary to consider the medical equipments and amenities of health examination for the disabled. Fourth, there should be the securement of manpower and education for service providers. Fifth, the mobility right of the disabled should be secured. Regarding the health type of the disabled, first, the expert consultative group in each area should be composed for the health enhancement of the disabled. Second, it would be necessary to screening the current status of health enhancement programs for the disabled and operating facilities. Third, the Central Health Medical Center for the Disabled, shown in the law on the securement of health rights & medical accessibility of the disabled should develop the standardized health enhancement programs for each disability type and severity. After examining the contents of health examination and health type of the disabled, the opinions about policies were suggested. Thus, in the future, there should be more detailed researches based on the tasks suggested by this study, and also the causal relations between health of the disabled and relevant programs should be continuously revealed.

Prevalence of Orthostatic Dysregulation in Elementary School Students and Frequency of Individual Symptoms (학동기 아동의 Orthostatic Dysregulation의 유병률과 임상증상의 빈도에 대한 연구)

  • Yang, Eun Seok;Kim, Eun-Young;Moon, Kyoung-Rae;Park, Sang Kee;Park, Young Bong;Rho, Young Il
    • Clinical and Experimental Pediatrics
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    • v.48 no.2
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    • pp.138-142
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    • 2005
  • Purpose : The purpose of the present study was to access the prevalence of orthostatic dysregulation(OD) and the frequency of each category for major and minor criteria among elementary school students using the OD questionnaire. Methods : We carried out inquiry by questionnaire as to the frequency of OD among two elementary schools with 725 students, 10 to 12 years of age, residing in Gwangju, Korea. The questionnaire was made according to criteria proposed by the Japan OD Study Group. Results : Of the 725 students(male 390; female 335) questioned, the OD was found in 338 students (53.5 percent). Prevalence of OD in males(59.2 percent) was significantly higher than in females(46.8 percent)(P<0.05). Palpitation with slight exercise(95.9 percent) was the most frequent major symptom. Headaches(85.8 percent) were the most frequent minor symptom among cases of OD. Conclusion : The prevalence of OD in elementary school students in this study(53.5 percent) was higher than in other studies. Contrary to studies from other countries, the male to female ratio was reversed. Because the diagnostic criteria seem to be dependent on subjective reporting of the symptoms, a newer diagnostic system based on more objective findings should be established.