• Title/Summary/Keyword: Home care nursing need

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Stress and Coping for Patients with Hemiplegia during the Rehabilitation Process (편마비 환자의 재활과정에 따른 스트레스와 대처의 변화양상)

  • 강현숙
    • Journal of Korean Academy of Nursing
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    • v.24 no.1
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    • pp.18-32
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    • 1994
  • It is important to understand that patients with hemiplegia are under stress during the rehabilitation process. This study was designed to determine what changes occur in the stress perceived by these patients during the rehabilitation process. and what changes occur in the ways they coped with stress. A decriptive study with a longitudinal design was conducted. A total of 57 patients with hemiplegia who were admitted to one general hospital made up the sample for this study. A questionnaire, observations and interviews were used for the data collection which was done in three phases(within one week after admission : within one week before discharge ; within one month after discharge ). Data were analyzed using t-test, ANOVA repeated measures of ANOVA, and post hoc paired t -test, Bonferroni correction. The results of this study are : 1. Changes in the perception of stress during the rehabilitation process : There was a statistically significant differencs in the perception of stress among these patients during the rehabilitation process. On the post-hoc test. the perception of stress showed a statistically significant decrease from admission to discharge. The perception of psychological stress was high during the rehabilitation process as compared with the perception of physical and social stress. 2. Changes in the way the patients coped during the rehabilitation process : On admission passive coping was used by most of the subjects(91.2%). Passive coping showed an decrease from admission to discharge, but an increase from discharge to follow-up at one month post discharge. There was, however, no statistically significant changes in the way the patients coped during the rehabilitation process. 3. Changes in perception of stress during the rehabilitation process according to variables. Perception of stress among patients classified as So-Um was higher during the rehabilitation process, when compared with patients classified as So- Yang and Tae-Um. There was, however, no statistically significant difference in perception of stress over time. The patients with right sided paralysis perceived higher stress than those with left sided paralysis. There was, however, no statistically significant difference in perception of stress over time. Hence, stress was not influenced by which side was paralyzed th frequency of the relapse of the disease, or the time in the rehabilitation process. 4. Changes in coping during the rehabilitation process according to variables. There was a statistically significant difference in the way the patients coped at follow- up according to the three different kinds of the constitution groups. In other words, coping was not used by patients classified as Tae-Um but was used by those classified as So-Um. On the repeated measures of ANOVA, there was a statstically significant difference in stress over time, and an interaction between constitution and time. But the way of coping during the rehabilitation process was not influenced by which side was paralyzed nor by the frequency of the relapse of the disease. In conclusion, perception of psychological stress was high during the rehabilitation process, as compared to perception of physical and social stress. There was a statistcally significant difference in the perception of stress over time, Perception of stress showed a gradual decrease from over admission to follow-up period. There was. however, no statistically significant difference in the way of coping over time. Passive coping was used by most of patients. In the study, these findings suggest a need for nursing care related to the psychological support for patients with hemiplegia both in the hospital as well as at home, and the need for education and counseling on independent self-care to help the hemiplegic patients adapt to stress using active coping.

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A Basic Treatise of Korean Mother′s Concern for the Artificial Feeding (인공영양에 대한 한국 어머니들의 반응에 관한 기초조사)

  • 변수자
    • Journal of Korean Academy of Nursing
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    • v.3 no.1
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    • pp.41-51
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    • 1972
  • In this article, the writer attempted to study the followings: (1) mother's knowledge of milk feeding (including method of sterilization, formula and feeding) (2) reasons of artificial feeding (3) how much mothers are concerned about their artificial feeding infants (4) condition of growth and development of artificial feeding infants. As the object of study, 96 mothers with artificial feeding infants, who had consulted dep't of pediatrics of two Hospitals in Seoul (Korea Hospital and Med. College Woo Suk Hospital, Korea Uni.) and well baby clinic of the two Health Centers (Sung Dong and Dongdaemoon), were randomly sampled. The data were treated by the statistic method of chi-square and percentage, and come to the following conclusion. 1. Knowledge of milk feeding Sterilization: 70 percentages of mothers know about the milk sterilization (including bottle, nipple and instrument), but 55 percentages of them do not know the nipple sterilization correctly. Formula: 69 percentages of mothers follow the indicator or in accordance with doctor's directions, but 31 percentages do at their option by reasons that the baby often coughs up the milk, the baby is too small, the baby often has digestive troubles, or the baby grow fleshy heavily etc, except family economic problems. Feeding: only half of mothers know the correct feeding method, especially they do not know how to determine the heat degree of milk and how to bubble up the baby correctly. They just do feeding according to the accepted usages. 2. Reasons of artificial feeding Of the reasons of artificial feeding, 18 percentages were caused by infants and 82 percentages by mothers. Most of the reasons are mainly due to the lack of breast milk and sufficient supply of nourishments rather than mother's deficiency or mother's abnormality. 3. Mother's concern for artificial feeding infants Mothers who are sharply concerned for their artificial feeding baby's growth and development: 63%, mothers who made the baby (artificial feeding infant) routine vaccinated: 81%, mothers who ear anxious about the baby's future personality forming : 68%, mothers who care about the baby's condition of nourishment; 60%, mothers who are anxious about tile selection of baby's food; 54%. 4. The growth and development of artificial feeding infants compared with Korean average infants. The artificial feeding infants are above the Korean average infants in stature by 1.21 centimeters and in weight by 0.3 kilograms. Conclusion: It has been said that there is no better food for infant than the breast milk. However, the artificial feeding has been used for the supplement of nourishments and as substitute food for the breast milk. And this artificial feeding could give the married women the chance to act in society and more opportunity to develop themselves and to work for others at home and other fields. Considering these advantages, artificial feeding should not be exclusive, but preferably should be more improved and inquired positively. And even in artificial feeding, what is most important is that mothers should recognize the requirement and need of artificial feeding clearly and correctly, and they should be accustomed to the correct knowledge and skills of artificial feeding in order to practice it appropriately. In some degree, they should be properly trained in school education process.

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A Comparative Study on the Growth & Developmental Status of Premature and Full Term Infants During the First 3Years (미숙아와 정상아의 영유아기 성장발달상태 비교연구)

  • 박영애
    • Journal of Korean Academy of Nursing
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    • v.15 no.3
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    • pp.62-73
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    • 1985
  • The problems of growth & development due to maladjustment are gradually increasing while need for the treatment of children's diseases is decreasing. The level of developmental deficiency or delay correlates with neonatal birth weight and also with gestational age, i.e. degrees of prematurity. There-fore, developmental defects and potential risk factors' are more Common in premature infants than in full term infants. The purpose of this study is to define the difference in the growth at developmental status between premature and full term infants, and to define the relation between the developmental status and the physical growth during the first 3 years' Data were collected from January 10, 1985 to April 6, 1985 at 3 hospitals including St. Mary's Hospital, and through home visiting. The subjects of this study consisted of 79 Premature infants (G.A. <37wks. & B.W. <2.5kg) and 94 full term infants (G.A.≥37 wks. & B.W.≥2.5kg). The study method used was a questionnaire, anthropometric assessment and DDST for normative data of growth & development. The collected data were analyzed using descriptive statistics, chi-square test and t-test. The results of the study were as follows: Hypothesis: 1 : That the prematures will differ from the full term infants in the physical growth status during the first 3 years was partially supported (p<0.02) : The prematures reached up the full term infants in the physical growth status in the first 6 months. And, the first hypothesis was supported (P<0.01) : There are more cases which is below‘the Korean children's physical. growth standards’in prematures than in full term infants. Hypothesis 2 : That the prematures will differ from the full term infants in the developmental status during the first 3 years was supported (P< 0.001);‘Normal’developmental status due to DDST was less in prematures than in full term infants. And, the second hypothesis was Partially supported (P<0.02) : The developmental status of the pre-matures was different from that of the full term infants within the first 3 months by analysis of passed items in DDST, Hypothesis 3 : That the prematures' developmental status will relate to their physical growth during the first 3 years was supported (P<0.001) : If the prematures' developmental status is in delayed status, then, their physical growth status is also in delayed status. This study shows that the prematures differed significantly from the full term infants in the growth at developmental status during their infancy. This means that the nurse can foster the growth & development of the prematures by supportive care during their infancy. Further longitudinal study is needed to verify these findings for the environmental factors.

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Elderly Residents' Behavior Problems as Experienced by Volunteers Working in Low-Income Welfare Facilities (자원봉사자가 경험한 저소득층 복지시설 거주노인의 문제행동)

  • Lee, In-Soo
    • Journal of Families and Better Life
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    • v.25 no.1 s.85
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    • pp.127-144
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    • 2007
  • This study was conducted for the purpose of analyzing volunteer workers' perceptions of and attitudes toward the behavior problems of the elderly residents after caring for the residents voluntarily at low-income nursing homes. Eleven male and female volunteers ranging from age 19 to 52 were asked how they felt about the elderly residents' behavior problems and what kind of behavioral problems they had experienced after doing volunteer works in the three chosen facilities. In particular, they were expected to explain what emotional changes they experienced during their volunteer service. In this study, it was observed that most of the elderly subjects experienced three categories of behavior problems: habitual, repetitious and unreasonable activities caused by the elderly residents' life span backgrounds, unexpected and/or abrupt behaviors resulting from gradual cognitive impairments, and physiological, awkward activities caused from gradual senility. The volunteers tend to believe that the elderly residents are naturally expected to act positively, since they have been provided with well- planned, regular care services such as bathing, counseling, activity programs, and religious guidances. On the other hand, some respondents stated that their experiences at the nursing homes caused them to form negative images of the elderly; they feel that the elderly are not helpful for giving advices on critical decisions, guiding and encouraging their daily lives, and offering any positive influences toward their own lives. Rather, they find themselves getting too much stressed as a result of their intimate contacts with demented or senile residents. Overall, in this study, it is proposed that education for confronting sudden abrupt behavior problems should be intensified more for female volunteers, since they tend to be more susceptible to emotional harassment resulting from the problem behaviors. It is also proposed that young volunteers who have not been systematically trained for confronting aggressive behaviors need to be separately assigned their roles in order to minimize the potential of confronting unseemly situations resulting from male residents whose mental health has deteriorated. Furthermore, it is also suggested that the combination of leisure-related activities for healthy residents and stressful intimate services for the frail residents be systematically planned and implanted for the volunteer program so that the volunteers can lessen the chances of suddenly finding themselves confronted with extremely abrupt agitations.

A Study of well-being in Caregivers Caring for Chronically Ill Family Members (만성 질환자 가족의 부담감에 관한 연구)

  • 서미혜;오가실
    • Journal of Korean Academy of Nursing
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    • v.23 no.3
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    • pp.467-486
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    • 1993
  • Today, more chronically ill and handicapped people are being cared for at home by a family member caregiver. The task of caring for a family momber may mean that the caregiver has less time and money and more work which may result in increased fatigue and symptoms of illness. This study was done to examine the well-being of family caregivers. Fifty three family caregivers were interviewed. Concepts were measured using existing tools and included : Burden(25 item 5 point scale), Social sup-port (21 item 7 point scale), Health status defined by a symptom checklist(48 item S point scale), and Well -being defined by a quality of life scale (14 item 7 point scale) and caregiving activities. Data collection was done by interview and Q-sort. Social support and well - being were positively correlated as were symptoms and burden. Symptoms and burden were negatively correlated with social support and well-being. Items on the quality of life scale had a mean score range from 3.09 to 4.96. Quality of life related to income was lowest (3.09) but the desire to use more money for the patient was rated 2.90 on the burden scale where the item means ranged from 0.73 to 3.55. The high mean of 3.55 was for obligation to give care and the low 0.73 was (or not feeling that this was helping the patient. Mean scores for symptoms ranged from 0.26 to 2.15 with the 2.15 being for “worry about all the things that have to be done.” Over half of the patients were dependent for help with some activities of daily living. The caregivers reported doing an average of 3.40 out of five patient care activities including bathing (77.4%), shampooing (67.9%), and washing face and hands (49.1%), and 3.74 out of seven home maintenance activities including laundry (98.1%), cooking (83.0%), and arranging bed-ding(75.5%). The caregivers reported their spouse as one of the main sources of social support, including in times of loneliness and anger The mean score for loneliness as burden was 2.15 and ranked fourth and 31 (58.5%) of the sample reported being lonely recently and not being satisfied with the support received. Similarly anger caused by the patient was given a mean score of 2.13, and anger was reported to have been present recently by 38 (71.7%) of the sample and satis-faction with the support given was low. Having someone to help deal with anger ranked twelfth out of 21 items on the social support scale and had a mean score of 3.98 (range 3.49 to 5.98). Spouses were reported as a major source of social support but the fact that 50% of the caregivers were caring for a spouse, may account for the quality of this source of social support having been affected. These caregivers faced the same problems as others at the same stage of life. but because of the situation, there was a strain on their resources, particularly financial and social. In conclusion it was found that burden is correlated negatively to quality of life and positively to symptoms, but in this sample, symptoms and bur-den were scored relatively low. Does this indicate that the caregivers accept caregiving as part of their destiny and accept the quality of their lives with burden and symptoms just being a part of caregiving\ulcorner Does the correlation between the bur-den and symptoms indicate they are a measure of the same phenomenon or that the sample was of a more mobile, less burdened group of caregivers\ulcorner Quality of life was the one variable that was significant in explaining the varience on burden. Further study is needed to validate the conclusions found in this study but they indicate a need for nurses to ap-proach these caregivers with a plan tailored to each individual situation and to give consideration to interventions directed at improving quality of life and expanding social support networks for those caring for spouses.

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Adolescent Health Promotion and Development of School Health Education (청소년기의 건강증진과 학교보건교육의 발전방향)

  • Yoo, Jae-Soon
    • Journal of the Korean Society of School Health
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    • v.11 no.1
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    • pp.27-50
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    • 1998
  • Adolescent health is considered to contribute to health promotion in the home and community in the near future as well as individual health. However, adolescent health has been neglected from education field because of competitive school education focused on the university entrance examination That's why I suggest in this study that we should pay much more attention to adolescent health condition and try to make It better, in terms of man-power development and life-health promotion for nation development The purposes of this study are as follows First, to look into a variety of adolescent health problems Second, to find out the situation and problems of current adolescent health promotion and school health education Third, to make an effort to find, based on the current situation, various developments of adolescent health promotion and school health education in terms of practical, political and environmental change There are used study methods as adolescent-related, school heath-related literature review and anlysis of statistical data The results and suggestions are as follows Teenagers have a great variey of health problems including most Important physical, mental and social developments Recently, chronic diseases, emotional problems, health-risk behaviors linked With adolescents are on increase The complicated disorders of physical, mental, social health rather than paricular aspects of health or health-behavior problems influence adolescent health problems adolescence is regarded as the period when most health-related behaviors are formed. Therefore, adolescent health promotion would he assured by developing the ability of controlling multi-dimensional health determinants in the early stage. Health promotion is a positive concept that each individual, family and community makes real efforts to improve their health To achive this, we need health educational, organizational, political and environmental supports. Adolescent health promotion in Korea has been systematically treated in the category of school health Current school health services have had lots of systemic, constitutional, administrative and educational flaws Accordingly, I'm concerned that we can afford to accept a variety of adolescent health needs However, I would say that if were not to make those flaws better, it's certain that Korean national competitive power and the quality of the lives of most Koreans Will he threatened someday We have to develop Comprehensive School Health Crriculum(CSHC) and set up its standards to Improve adolescent health. CSHC is an organizational and costant process. CSHC means an Important part of overall curriculums. In addition, I could say that it's an Important school health education acivity including current school health services-health care service and school health environment. In conclusion, in order to develop CSHC, we require school nurse's role changes, establishment and management of intergrated subject of health education, striking revision of school health law(or legislation of school health promotion law), reorganization of administration system, big changes in curriculum for school health educators.

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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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Primiparas만 Perceptions of Their Delivery Experience and Their Maternal-Infant Interaction : Compared According to Delivery Method (초산모의 분만유형별 분만경험에 대한 지각과 모아상호작용 과정에 관한 연구)

  • 조미영
    • Journal of Korean Academy of Nursing
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    • v.20 no.2
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    • pp.153-173
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    • 1990
  • One of the important tasks for new parents. especially mothers, is to establish warm, mutually affirming interpersonal relationships with the new baby in the family, with the purpose of promoting the healthy development of the child and the wellbeing of the whole family. Nurses assess the quality of the behavioral characteristics of the maternal-infant interaction. This study examined the relationships between primiparas pereptions of their delivery experience and their maternal infant interaction. It compared to delivery experience of mothers having a normal vaginal delivery with those having a casearean section. The purpose was to explore the relationships between the mother's perceptions of her delivery experience with her maternal infant interaction. The aim was to contribute to the development of theoretical understanding on which to base care toward promoting the quality of maternal-infant interaction. Data were collected directly by the investigator and a trained associate from Dec. 1, 1987 to March 8, 1988. Subjects were 3 random sample of 62 mothers, 32 who had a normal vaginal delivery and 30 who had a non-elective cesarean section (but without other perinatal complications) at three general hospitals in Seoul. Instruments used were the Stainton Parent -infant Interaction Scale(1981) and the Marut and Mercer Perception of Birth Scale(1979). The first observations were made in the delivery room (for vaginally delivered mothers only), followed by day 1, day 2, day 3, and 2 weeks, 4 weeks, 6 weeks and 8 weeks after birth, for a total of 7-8 contacts(Cesarean section mothers were observed on days 4 and 5 but the data not used for analysis). Observations in the hospital were made during the hour prior to scheduled feedings. The infant was placed beside the mother. Later contacts were made at home. Data analysis was done by computer using as SPSS program and indulded X² test, paired t-test, t-test, and Pearson Correlation coefficient ; the results were as follows. 1. Mothers who had a normal vaginal delivery tended to perceive the delivery experience more positively than cesarean section mothers(p=0.002). The finding supported the hypothesis I that perception of delivery would vary according to the method of delivery. Mothers' perceptions of birth were classified into three dimensions, labor, delivery and the bady. There was a significantly different and positive perception by the vaginally delivered mothers to the delivery experience(p=0.000) but no differences for labor or the bady according to the delivery method(p=0.096, p=0.389), 2. Mothers who had a normal vaginal delivery had higher average maternal-infant interaction scores(p=0.029) than mothers who had a cesarean section. There were similar higher scores for the 1st day(p=0.042), 2nd day (p=0.009), and the 3rd day(p=0.006) after delivery but not for later times. The findings supported the hypothesis Ⅱ that there would be differences in maternal-infant interaction for mothers having vaginal and cesarean section deliveries. However these differences deccreased section deliveries. However these differences decreased over time . by eight weeks the scores for vaginal delivery mothers averaged 8.1 and for cesarean section mothers, 7.9. 3. The more highly positive the pereption of the delivery experience, the higher the maternal-infant interaction score for all subjects(F=.3206, p=.006). The findings supported the hypothesis Ⅲ that there would be correlations between perceptions of delivery and maternal-infant interaction. The maternal infant interaction was highest when the perception of the bady and deliery was positive(r=.4363, p=.000, r=.2881, p=.012). No correlations between perceptions of labor and maternal-infant interaction were found(p=0.062). 4. The daily maternal-infant interaction score for the initial contact after birth to 8 weeks postpartum had the lowest average score 5.20 and the highest 7.98(in a range of 0-10). This subjects group of mothers needed nursing intervention to promote their maternal- infant interaction. The daily scores for the maternal-infant over the period of eight weeks. However, there were significantly different increases in maternal-infant interaction only from the first to second day(p=0.000) and from the fourth to sixth weeks after birth(P=0.000). 5. When the eight items of maternal-infant interaction were evaluated separately, “Expresses feelings about her role as mother” had the highest average score, 1.64(ina range of 0-3)and “Speaks to baby” the lowest, 0.9. All items, with the possible exception of “Expresses feelings about her role as mother”, suggested the subjects' need of nursing intervention to promote maternal-infant interaction. 6. There were positive correlations between certain general charateristis, namely, both a higher economic status(p=0.002) and breast feeding(p=0.202) and maternal - infant interaction. There were positive correlations between a mother's confidence in her role as a mother and the perception of the birth experience(p=0.004). For mothers who had a cesarean section, a positive perception of the birth experience was related to the duration of her marriage(p=0.010), a wanted pregnancy (P=0.030) and her confidence in her role as a mother(p=0.000). Pereptions of birth for mothers who had a normal vaginal delivery were positive than those for mothers who had a cesarean section. The level of maternalinfant interaction for mothers delivered vaginally was higher than for cesarean section mothers. The relationship between perception of birth and materanalinfant interaction was confirmed. Cesarean section has an impact on the mother's perceived experience of birth which, in turn, is positively related to maternal-infant in turn, is positively related to maternal-infant interaction. Nursing intervention to enhance maternal-infant interaction should begin in prenatal classes with an exploration of the potential impact of cesarean section on the perceptions of the birth experience and continue throughout the perinatal and post-natal periods to promote the mother's ability to control with this crisis experience and to mobilize social support. Nursing should help transform a relatively negatively perceived experience into an accepted, positively perceived and self affirming experience which enhances the maternal-infant relationship.

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A Study on Perception and Attitudes of Health Workers Towards the Organization and Activities of Urban Health Centers (도시보건소 직원의 보건소 업무에 대한 인식 및 견해)

  • Lee, Jae-Mu;Kang, Pock-Soo;Lee, Kyeong-Soo;Kim, Cheon-Tae
    • Journal of Yeungnam Medical Science
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    • v.12 no.2
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    • pp.347-365
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    • 1995
  • A survey was conducted to study perception and attitudes of health workers towards health center's activities and organization of health services, from August 15 to September 30, 1994. The study population was 310 health workers engaged in seven urban health centers in Taegu City area. A questionnaire method was used to collect data and response rate was 81.3 percent or 252 respondents. The following are summaries of findings: Profiles of study population: Health workers were predominantly female(62.3%); had college education(60.3%); and held medical and nursing positions(39.6%), technicians(30.6%) and public health/administrative positions(29.8%). Perceptions on health center's resources: Slightly more than a half(51.1%) of respondents expressed that physical facilities of the centers are inadequate; equipments needed are short(39.0%); human resource is inadequate(44.8%); and health budget allocated is insufficient(38.5%) to support the performance of health center's activities. Decentralization and health services: The majority revealed that the decentralization of government system would affect the future activities of health centers(51.9%) which may have to change. However, only one quarter of respondents(25.4%) seemed to view the decentralization positively as they expect that it would help perform health activities more effectively. The majority of the respondents(78.6%) insisted that the function and organization of the urban health centers should be changed. Target workload and job satisfaction: A large proportion (43.3%) of respondents felt that present target setting systems for various health activities are unrealistic in terms of community needs and health center's situation while only 11.1 percent responded it positively; the majority(57.5%) revealed that they need further training in professional fields to perform their job more effectively; more than one third(35.7%) expressed that they enjoy their professional autonomy in their job performance; and a considerable proportion (39.3%) said they are satisfied with their present work. Regarding the personnel management, more worker(47.3%) perceived it negatively than positive(11.5%) as most of workers seemed to think the personnel management practiced at the health centers is not fair or justly done. Health services rendered: Among health services rendered, health workers perceived the following services are most successfully delivered; they are, in order of importance, Tb control, curative services, and maternal and child health care. Such areas as health education, oral health, environmental sanitation, and integrated health services are needed to be strengthening. Regarding the community attitudes towards health workers, 41.3 percent of respondents think they are trusted by the community they serve. New areas of concern identified which must be included in future activities of health centers are, in order of priority, health care of elderly population, home health care, rehabilitation services, and such chronic diseases control programs as diabetes, hypertension, school health and mental health care. In conclusion, the study revealed that health workers seemed to have more negative perceptions and attitudes than positive ones towards organization and management of health services and activities performed by the urban health centers where they are engaged. More specifically, the majority of health workers studied revealed to have the following areas of health center's organization and management inadequate or insufficient to support effective performance of their health activities: Namely, physical facilities and equipments required are inadequate; human and financial resources are insufficient; personnel management is unsatisfactory; setting of service target system is unrealistic in terms of the community needs. However, respondents displayed a number of positive perceptions, particularly to those areas as further training needs and implementation of decentralization of government system which will bring more autonomy of local government as they perceived these change would bring the necessary changes to future activities of the health center. They also displayed positive perceptions in their job autonomy and have job satisfactions.

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