• 농촌의학ㆍ지역보건
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• 제1권1호
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• pp.29-36
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• 1976

Introduction Recently, changes in the patterns and concepts of maternity care, in both developing and developed countries have been accelerating. An outstanding development in this field is the number of deliveries taking place in hospitals or maternity centers. In Korea, however, more than 90% of deliveries are carried out at home with the help of untrained relatives or even without helpers. It is estimated that less than 10% of deliveries are assisted by professional persons such as a physician or a midwife. Taking into account the shortage of professional person i11 rural Korea, it is difficult to expect widespread prenatal, postnatal, and delivery care by professional persons in the near future, It is unrealistic, therefore, to expect rapid development of MCH care by professional persons in rural Korea due to economic and sociological reasons. Given these conditions. it is reasonable that an educated village women could used as a "maternity aid", serving simple and technically easy roles in the MCH field, if we could give such a women incentive to do so. The midwife and physician are assigned difficult problems in the MCH field which could not be solved by the village worker. However, with the application of the village worker system, we could expect to improve maternal and child hoalth through the replacement of untrained relatives as birth attendants with educated and trained maternity aides. We hope that this system will be a way of improving MCH care, which is only one part of the general health services offered at the local health centre level. Problems of MCH in rural Korea The field of MCH is not only the weakest point in the medical field in our country hut it has also dropped behind other developing countries. Regarding the knowledge about pregnancy and delivery, a large proportion of our respondents reported having only a little knowledge, while 29% reported that they had "sufficient" knowledge. The average number of pregnancies among women residing in rural areas was 4.3 while the rate of women with 5 or more pregnancies among general women and women who terminated childbearing were 43 and 80% respectively. The rate of unwanted pregnancy among general women was 19.7%. The total rate for complications during pregnancy was 15.4%, toxemia being the major complication. The rate of pregnant women with chronic disease was 7%. Regarding the interval of pregnancy, the rates of pregnancy within 12 months and within 36 months after last delivery were 9 and 49% respectively. Induced abortion has been increasing in rural areas, being as high as 30-50% in some locations. The maternal death rate was shown 10 times higher than in developed countries (35/10,000 live births). Prenatal care Most women had no consultation with a physician during the prenatal period. Of those women who did have prenatal care, the majority (63%) received such care only 1 or 2 times throughout the entire period of pregnancy. Also, in 80% of these women the first visit Game after 4 months of gestation. Delivery conditions This field is lagging behind other public health problems in our country. Namely, more than 95% of the women deliveried their baby at home, and delivery attendance by a professional person occurred only 11% of the time. Attendance rate by laymen was 78% while those receiving no care at all was 16%. For instruments used to cut the umbilical corn, sterilized scissors were used by 19%, non-sterilized scissors by 63% and 16% used sickles. Regarding delivery sheets, the rate of use of clean sheets was only 10%, unclean sheets, vinyl and papers 72%, and without sheets, 18%. The main reason for not using a hospital as a place of delivery was that the women felt they did not need it as they had previously experience easy deliveries outside hospitals. Difficult delivery composed about 5% of the total. Child health The main food for infants (95%) was breast milk. Regarding weaning time, the rates within one year, up to one and half, two, three and more than three years were 28,43,60,81 and 91% respectively, and even after the next pregnancy still continued lactation. The vaccination of children is the only service for child health in rural Korea. As shown in the Table, the rates of all kinds of vaccination were very low and insufficient. Infant death rate was 42 per 1,000 live births. Most of the deaths were caused by preventable diseases. Death of infants within the neonatal period was 83% meaning that deaths from communicable diseases decreased remarkably after that time. Infant deaths which occurred without medical care was 52%. Methods of improvement in the MCH field 1. Through the activities of village health workers (VHW) to detect pregnant women by home visiting and. after registration. visiting once a month to observe any abnormalities in pregnant women. If they find warning signs of abnormalities. they refer them to the public health nurse or midwife. Sterilized delivery kits were distributed to the expected mother 2 weeks prior to expected date of delivery by the VHW. If a delivery was expected to be difficult, then the VHW took the mother to a physician or call a physician to help after birth, the VHW visits the mother and baby to confirm health and to recommend the baby be given proper vaccination. 2. Through the midwife or public health nurse (aid nurse) Examination of pregnant women who are referred by the VHW to confirm abnormalities and to treat them. If the midwife or aid nurse could not solve the problems, they refer the pregnant women to the OB-GY specialist. The midwife and PHN will attend in the cases of normal deliveries and they help in the birth. The PHN will conduct vaccination for all infants and children under 5, years old. 3. The Physician will help only in those cases referred to him by the PHN or VHW. However, the physician should examine all pregnant women at least three times during their pregnancy. First, the physician will identify the pregnancy and conduct general physical examination to confirm any chronic disease that might disturb the continuity of the pregnancy. Second, if the pregnant woman shows any abnormalities the physician must examine and treat. Third, at 9 or 10 months of gestation (after sitting of the baby) the physician should examine the position of the fetus and measure the pelvis to recommend institutional delivery of those who are expected to have a difficult delivery. And of course. the medical care of both the mother and the infants are responsible of the physician. Overall, large areas of the field of MCH would be served by the VHW, PHN, or midwife so the physician is needed only as a parttime worker.

• Journal of Hospice and Palliative Care
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• 제13권4호
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• pp.216-224
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• 2010

목적: 본 연구는 말기 재가암환자 관리를 위한 병원호스피스센터와 보건소 간의 연계 프로그램을 평가함으로써 보다 효율적이고 효과적인 재가암환자 관리체계를 구축하고자 시도되었다. 방법: 호스피스센터-보건소 재가암관리 연계 사업은 1) 협약체결, 2) 재가 말기암환자 발굴 및 등록, 3) 가정호스피스 방문 서비스 제공, 4) 만족도 조사의 단계로 전개되었다. 일 호스피스센터와 지역의 3개 보건소가 협약을 체결하였고, 2009년 2월 1일에서 12월 31일까지 11개월 동안 43명의 환자에게 605건의 가정호스피스 방문을 실시하였다. 방문기록지 분석을 통해 서비스 대상자의 특성과 제공된 서비스의 종류와 내용을 분석하였고, 이 중 20명에게 서비스 만족도 조사를 실시하였다. 결과: 대상자의 76.7%가 60세 이상이었고, ECOG 전신 수행상태 점수는 0점과 1점이 각각 37.2%, 39.5%이었다. 환자가 병식이 있는 경우는 90.7%, 호스피스 동의서에 서명한 경우는 62.8%였다. 초기방문 시 환자의 주 호소는 전신쇠약감(86.0%)과 식욕부진(72.1%)이 가장 많았다. 평균 총 서비스 기간은 144.42일이었고, 총 605건의 방문 중 간호사 방문이 371회로 가장 많았다. 각 방문중 정서적 지지와 건강상담이 가장 빈번하게 제공되었고, 서비스 전반에 대한 만족도는 5점 척도로 측정하였을 때 평균 4.45점이었다. 결론: 본 연구는 지역사회 내에서 실제적이고 체계적인 재가 말기암환자 관리 프로그램 구축을 위한 중간평가로서의 의미가 있다. 본 연구에서 의뢰된 대상자는 입원형 호스피스보다 기능 상태가 양호하고 서비스 제공기간이 길었으며, 서비스에 대한 만족도, 특히 정서적지지와 환자상태 설명에 대한 만족도가 높았다. 그러나 방문횟수와 빈도, 임종기 관리, 병원입원 재입원하는 환자관리에 대한 기준과 서비스 표준마련은 앞으로의 과제로 제시되었다.

• Asian Pacific Journal of Cancer Prevention
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• 제17권3호
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• pp.1293-1297
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• 2016

Cholangiocarcinoma (CCA) is a serious problem in Thailand, particularly in the northeastern and northern regions. Database of population at risk are need required for monitoring, surveillance, home health care, and home visit. Therefore, this study aimed to develop a geographic information system (GIS) database and Google map of the population at risk of CCA in Mueang Yang district, Nakhon Ratchasima province, northeastern Thailand during June to October 2015. Populations at risk were screened using the Korat CCA verbal screening test (KCVST). Software included Microsoft Excel, ArcGIS, and Google Maps. The secondary data included the point of villages, sub-district boundaries, district boundaries, point of hospital in Mueang Yang district, used for created the spatial databese. The populations at risk for CCA and opisthorchiasis were used to create an arttribute database. Data were tranfered to WGS84 UTM ZONE 48. After the conversion, all of the data were imported into Google Earth using online web pages www.earthpoint.us. Some 222 from a 4,800 population at risk for CCA constituted a high risk group. Geo-visual display available at following www.google.com/maps/d/u/0/edit?mid=zPxtcHv_iDLo.kvPpxl5mAs90&hl=th. Geo-visual display 5 layers including: layer 1, village location and number of the population at risk for CCA; layer 2, sub-district health promotion hospital in Mueang Yang district and number of opisthorchiasis; layer 3, sub-district district and the number of population at risk for CCA; layer 4, district hospital and the number of population at risk for CCA and number of opisthorchiasis; and layer 5, district and the number of population at risk for CCA and number of opisthorchiasis. This GIS database and Google map production process is suitable for further monitoring, surveillance, and home health care for CCA sufferers.

• 대한물리치료과학회지
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• 제6권4호
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• pp.263-274
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• 1999

The public health service center and its branch are, as one of public institution, responsible for providing non-profitable medical service to local residents, which can't be addressed by private medical institutes. In addition, as a planning coordinator, they need to manage local medical resources effectively to make sure local residents can be offered good-quality health service fairly and impartially. The purpose of this study was to highlight the importance of physical therapy in public health service center's successful role performance, one of treatment to which local residents had a direct access. For attaining the purpose, an investigation was made into the actual facilities of public health service center and its branches in North Cholla province, the extent of use of physicaltherapy room, and the general characteristics of physical therapists. And literatures concerned were referred to. As a result, the dominant opinion was that the current physicaltherapy room shoulder be more reinforced(38.9%) or that it should he kept as it was(46.5%). Besides, the physical therapists investigated still were serving in a poor working condition. To elevate the quality and quantity of medical service, the current way to employ expert personnels temporarily or not to guarantee the position of physiotherapists should be removed immediately. Instead, physicaltherapists should be employed as regular public official. As, in home-visit project, physiotherapist are expected to play a bigger role in rehabilitation care or the management of patients with chronic disease, the physicaltherapy room should be increased and more physicaltherapists should be provided to health service institutions.

• 농촌의학ㆍ지역보건
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• 제17권1호
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• pp.34-45
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• 1992

In this county, the gap between the urban 'haves' and the rural 'have-nots' continues to be an increasing problem. WHO and UNICEF see primary health care(PHC) as the key to achieving an acceptable level of health throughout the world as a community development. PHC is essential health care made accessible to individuals and families in the community by means acceptable to them. It is the first level of contact of individual, the family, and community with the national health system. It includes at least education on health system. It includes at least education on health problems, promotion of food supply, MCH including family planning, immunization against infectious diseases, control of endemic diseases, treatment of common diseases and injuries, promotion of mental health, and provision of essential drugs. However, of the aboves, education concerning of mental health problems and the methods to identify, prevent, and control them is the principal step of establishment. In Korea, the category of PHC worker includes the physician as public doctor and nurse as primary health care practitioner and community health leader as village health worker. PHC workers of the aboves will thus function best if they are appropriately trained to respond to the health needs of the community. However in this country, since the national PHC service project launched in 1980, the government has not developed and performed appropriate and enough education and training activities. In light of above reasons, several categories of health education activities had been planned and performed being aimed at above specific target groups and the main focus was on the village health workers for about one year from July 1991 to July 1992 in Yeoju Kun of Kyonki Province. At the end of the period, evaluation of education input was carried out to measure the improvement of healthful life of people in terms of awareness, attitude, and practice. At the end of the period, evaluation of education input was carried out to measure the improvement of healthful life of people in terms of awareness, attitude, and practice. The totals of 80 village health workers, 13 public health practitioners and 9 public docters took in the course of health education for a few hours at every month and the evaluation works of educational effect were taken. The results the study were as follows. 1) Number of persons who realized the maxim "health care of the people is a duty of the government" increased after the education course, On the other hand, the rate of satisfaction on the effort of government for health promotion of the people decreased. 2) Public doctors and primary health care practitioners(nurses) liked and enjoyed the education schedule as a meeting of peer group. It provided chances of communication with staffs of Korea University Hospital. It was said that lectures covered great deal of knowledge and technic they urgently needed in the field. 3) After finishing the education course, more of village health workers(VHW) thought they adapted themselves to their roles and functions showing increased number of home visit and contact with primary health care practitioners by month. 4) In case of patient refer, VHW preferred primary health care practitioners to public doctors. 5) Capability of VHWs in most of their functions increased dramatically after when the education course finished except tuberculosis control.

• 한국체육학회지인문사회과학편
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• 제58권5호
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• pp.201-217
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• 2019

본 연구는 방문요양보호사를 활용한 치매노인을 위한 방문 맞춤형 움직임프로그램을 개발하기 위해 델파이 방법을 이용하여 전문가들이 생각하는 치매노인을 위한 움직임프로그램에 필요한 구성요소를 고찰해보는 데 그 목적이 있다. 이러한 연구 목적을 달성하기 위하여 무용치료전문가 8명, 치매전공 의사 2명, 노인운동전문가 5명, 요양보호전문가 5명 총 20명의 전문가 패널을 선정하였다. 1차 델파이 설문지는 내용분석을 하였고, 2, 3차 델파이 설문지는 5점 Likert척도로 구성하였으며 적합도를 평가하기 위해 EXCEL 프로그램으로 핵심요소 항목별 평균, 표준편차, 사분위수 범위, 수렴도, 합의도, 내용타당도 비율(CVR)를 산출하였다. 전문가 패널들이 재가 치매노인을 위한 움직임프로그램 구성 시 적합하다고 합의한 필요한 요소는 고려요소 6개, 필요 요소 7개, 빈도 주 3회 1개, 시간 30분 1개, 운영방식 1개, 리듬표현운동 5개, 유산소 운동 4개, 근력운동 4개, 스트레칭 5개, 파트너운동 3개, 마사지 4개, 소도구 5개 등 총 46개 요소가 채택되었다.

• 여성건강간호학회지
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• 제7권1호
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• pp.30-43
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• 2001

This was a pre-experimental study to confirm the breast-feeding ability and effect of follow up care on the breast-feeding rate and the breast-feeding method by the mother-infant breast-feeding assessment tool for the mothers who got the breast-feeding education. The subjects were 46 mothers who experienced normal delivery of infants at a college hospital in K-city, Kyungsangbuk-do, from July 1 to October 21, 2000. The instrument for data obtainment were The Mother-Infant Breast-Feeding Assessment Tool of Johnson et al. (1999), and The Breast- Feeding Method Measurement Tool of Jeong, Geum-hee(1997). This instrument was reliable, showing Cronbach $\alpha$.751. This study classified them into 3 groups: at high risk for breast-feeding failure, at risk for breast-feeding problems, and at low risk for breast-feeding failure by the mother-infant breast-feeding assessment tool on the day of discharge from the hospital after delivering individual breast-feeding education to the subjects. This study investigated the breast-feeding rate and the breast-feeding method through mail questionnaire at the four week after childbirth, and through the phone counselling and the home visit for follow up care at the first week and the second week after childbirth. The sixth week after childbirth, this study investigated the breast-feeding rate by phone. The data analyzed the hypothesizes by $x^2$-test, paired t-test, ANOVA, Wilcoxon signed rank test, Wilcoxon rank sum test and trend analysis using SPSS/PC+ WIN 10.0 program. The results were as follows : 1) Hypothesis 1-1, "there won't be any difference the breast-feeding rate of a group at risk for breast-feeding failure by the time elapsed" was supported through constant the breast-feeding rate, because changes in the breast-feeding rate by the time elapsed after childbirth wasn't statistically significant(t= -1.501, p=.270). Hypothesis 1-2, "there won't be any difference the breast-feeding rate of group at low risk for breast-feeding failure by the time elapsed" was supported through constant the breast-feeding rate, because changes in the breast-feeding rate by the time elapsed after childbirth wasn't statistically significant(t=-1.732, p=.225). 2) Hypothesis 2-1, "there won't be any difference between the breast-feeding method of group at risk for breast-feeding failure for four weeks after childbirth and just after childbirth” was rejected, because the mean point of post test appeared to be higher than that of pre test(t=-7.267, p=.000). Hypothesis 2-2, "there won't be any difference between the breast-feeding method of the group at low risk for breast-feeding failure for four weeks after childbirth and just after childbirth" was rejected, because the mean point of post test appeared to be higher than that of pre test(t=-2.501, p=.012). 3)The 3rd hypothesis, "there won't be any difference between breast-feeding method of groups at risk for breast-feeding problems and at low risk for breast-feeding failure at the 4th week after childbirth and just after childbirth" didn't show any difference between the breast-feeding method of groups at risk for breast-feeding problems and at low risk for breast-feeding failure in the advance test(t=-1.521, p=.130) but there was difference between them in post test (t=-2.012, p=.044). As a result, the 3rd hypothesis was supported by pre test, but it was rejected by post test. In conclusion, this study confirmed breast- feeding education and follow up care just after childbirth were effective for the breast-feeding rate and method. Accordingly, it is proposed that successful nursing intervention of breast-feeding to be necessary by continuously providing follow up care through the mother-infant breast-feeding assessment tool as well as to execute individual breast-feeding education to mothers just after childbirth.

• 대한간호학회지
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• 제30권1호
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• pp.84-97
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• 2000

The Necessity and Purpose of the Study Recently the number of patients with chronic diseases and the aged patients is increasing steadily. Furthermore, due to the expansion of health insurance system, the number of patients hospitalized in the general hospital is increasing at a surprising speed. However, hospitals urge the early discharge of the patients for the efficiencies of hospital administration, and therefore, the number of patients who must be taken care of in their home is also increasing. Homecare nursing is one of the health care service for the patients at home who require continual attention and care, and now increasing attentions are given to it as one of the professional nursing fields. However, it was almost impossible to find a study on the actual experiences of the homecare nurses written by their own language in Korea, that it also posed a great difficulty in understanding their diverse experience. Considering these situation, this study will help understanding of them, and provide the fundamental data on their experiences for making policies to develop homecare nursing. Methods of Research Phenomenological research method was employed to analyze the lived experiences of homecare nurses fundamentally. Data collection Data were collected from August 1998 to December 1998 from ten homecare nurses who worked for patients under the homecare nursing setting as model cases designated by Seoul Nurses Association and who agreed to the purpose of this study after listening to and understanding the explanation completely. The in-depth interview was carried at the time which was convenient both for the researcher and participants for one or two hours, and recovered with the approval participants. The first interview covered diverse and broad areas like the situation of homecare nursing, and their feelings and thoughts over it, and in the second and third interviews, more specific questions are asked. Data Analysis For the phenomenological analysis, contents analysis was employed. The data collected from the participants were analyzed into the following procedures according to Van Manen 's phenomenological analysis. 1) Reserve the preconception of the researcher by restricting it inside parenthesis. 2) Make a thorough observation of the lived experiences by insight process. 3) Analyze the contents (Find out the repetitive factors) 4) Interpret the essence found. 5) State the meaning of the interpretation. Results and discussion 1. Fear and expectation for the first visit. (unfamiliarity, awkwardness, anxiety, shivering) 2. Mingle with the family (feeling friendly with the family, becoming like a family member) 3. Being proud of her own know-how (learning the know-how, organizing alternatives, building up confidence) 4. Pity for the poor. (criticizing the current government, feeling ashamed, feeling anger) 5. Difficulty of constructing cooperative system with physicians (strenuousness, frustration) 6. Helplessness due to the lack of support system (difficulty to get supplies, annoyance, embarrassment by institutional restraints) 7. Anxiousness for heavy traffic and parking (annoyance, hastiness) 8. Ethical conflicts (pity for the patients and family, skepticism about lengthening life maintenance) 9. Burden for the possible accident (pressure, anxiety, conflict, physical exhaustion) 10. Establishment of identity as a professional (fulfillment, worth, joy) 11. Being distressed at other's ignorance

• 가정∙방문간호학회지
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• 제13권1호
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• pp.54-60
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• 2006

This study, a quasi-experimental study using a nonequivalent control group pretest-posttest design. conducted a survey on 30 patients test group and control group of IS patients sampling an adjacent population at random - who are operated on the breast cancer and are in the A University Hospital located in Suwon, to examine into the effects of foot reflex zone massage on their pain and sleep satisfaction through the nursing interventions. It gave them a foot reflex zone massage for the total 30 minutes-basic massage 10 minutes and reflex massage 20 minutes required to alleviate their pain day in day out covering a two-month period from the first of July to the first of September 2004. for the purpose of collecting data. It launched into a two-round foot reflex zone massage at 6 and 24 hours since mastectomy through a direct visit at the hospital room to measure pain intensity, physiological index(pulse and blood pressure) and sleep satisfaction of them. The results are as follows. First, it showed that there is all the difference between pain intensity of test group and that of control group. In result, the first hypothesis, pain of test group. which measure at 6(p=.000) and 24 hours(p=.001) since mastectomies, will be bigger than that of control group, was established. Second, it showed that there is all the difference between physiological index of test group and that of control group. In result. the second hypothesis, pulse(p= .025, p= .002), systolic blood pressure(p= .004, p=.012) and diastolic blood pressure(p=.004. p= .003) of test group, which investigate at 6 and 24 hours since mastectomies, will be bigger than that of control group, was established. Third, it showed that there is a significant difference between sleep satisfaction of test group and that of control group(p=.000). In result, the fourth hypothesis, sleep satisfaction of test group. which examine in the morning after mastectomies, will be bigger than that of control group, was established. In the result. a foot reflex zone massage is seen to be effective in the pain reduction and sleep promotion of patients who are operated on breast cancer, and in providing them with more qualitative care by improving confidence between them and nurses through a physical touch. Also, it can be applied to a clinical examination through an independent nursing intervention.

• 한국치위생학회지
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• 제7권4호
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• pp.405-418
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• 2007

The purpose of this study was to examine the interest level of mothers in oral health. The subjects in this study were 184 mothers whose children attended daycare centers in the city of K. A survey was conducted from March 15 through April 30, 2007, and SPSS WIN 11.5 program was employed to analyze their answer sheets. The findings of the study were as follows: 1. A group of mothers whose children brushed their teeth three times a day on the average made up 55.7 percent of those who were at the age of 35 and under. Among the mothers having three or more children, those mothers accounted for 59.1 percent. The daily mean toothbrushing frequency of children was higher among the better-educated mothers. 2. Concerning dietary and oral guidance, the mothers whose academic background was better curbed their children's excessive sugar intake more often, and the gap between them and the others was statistically significant(pE.05). As to the importance of oral health by the number of child and academic credential, those who had two children(36.0%) taught them the importance of oral health frequently(pE.01), and the better-educated mothers taught about it often(pE.05). The gap between the groups and the others was significant. 3. As for experience of visiting dental institutions, the working mothers visited dental institutions more often than the stay-at-home mothers, and the gap between them was statistically significant(pE.05). Regarding purpose of the visit, the largest group aimed to get treatment(64.6%), followed by having a dental checkup(14.6%) and receiving preventive treatment(13.5%). As to any inconveniences in using dental institutions, those who were working and who were in the upper income bracket found it more inconvenient to do that because of a long distance or time constraints. The gap between them and the others was significant. 4. In regard to concern for dental care, the mothers who were better educated(pE.001) and whose family income was 3 million won or more had their teeth scaled more often, and the gap between them and the others was statistically significant(pE.01). The rate of the regular visitors of dental institutions stood at 32.7 percent of the junior-college graduates, 31.0 percent of the mothers receiving college or higher education and 10.1 percent of the high-school graduates(pE.01). And those who earned larger income paid a visit to dental institutions more often and on a regular basis. The gap between them and the others was statistically significant(pE.05).