• 한국보건간호학회지
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• 제3권1호
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• pp.74-100
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• 1989

Inspite of the lots of studies on the harmfulness of cigarette smoking to the body published by many researchers since 1950, cigarette smoking people are increasing in number especially, cigarette smoking by young and women causes a serious problem. Examining the physiological motives of youth shows that, impulse which the youth want to immitate the adults, alluring curiousity, and defiant physiology of escaping from the norm of traditional groups which has been banned are cooperated well compoundly. As the period of the youth is the one which they accumulate knowledge and charactor by learning as well as the period of growth mentally, and physically they should be rightly educated about smoking before they addicted to smoking and it is desirable for us to make the youth to understand how harmfully the smoking is to effect to their growth and mental soundness simply not as a social norm which they should not smoke. The main motive of this study on the attitude of smoking by the youth is to give basic materials related on this field. For this study, 647 questionnaires were used as studying material which were able to analyze among 720 questionnaires of 2 classes of each grade of 3 high schools among the high schools of boys, girls and co-educated in Seoul from Oct. 21, 1988 through Oct. 26, 1988. Study Instrument are graded in Likert's 5 point from 40 questions which are 20 questions m affirmations and 20 questions in negations after analyzing the factors on 60 simple sentence questions which the students showed in preliminary studies. And these are systemized to be measured from 1 point which means they think smoking IS very bad to 5points which means they think smoking is really good. In these collected materials, technical statistics of frequency. percentage, average, standard deviation are used for general character and smoking attitude, $X^2-test$ for examinning Independant variables of physical. emotional, ethical and other areas pearson's coefficient of correlation for related direction and degree" and step­regression analysis for the degree of relative contribution of all variables which effect smoking attitude. The results of this study are as follows; 1. The smoking attitude of high school boys and girls showed average of 1.78 in physical area, 2.63 in emotional area, 2.61 in ethical area, 2.29 in other area respectively in a negative attitude generally also the negative attitude are expressed most strongly in physical area. I've can also say by this results that smoking is harmful to their health and further more it can be judged that this proves the youth in the period of preparation be adults have a strong curiousity in the emotional, ethical and other areas. 2. The most influential variables in each field as related factors effecting smoking attitude of the student can be explained from 13.2 in physical area the lowest experienced variables to 25.2 in emotional area the highest of degree of smoking experience. The fact that the more the smoking experienced students are increasing in number the higher tendency which accept the' smoking tells as the importance of health education about the population of latest student's smoking as important variables shown equally in each area. Those of grade, age, numbers of smoking people in house are showed meaningful in pure interrelation. Those related to the acceptance of teacher's smoking, sex, mothors education are shown meaningful in opposite interrelations. This means that the' increasing number' of smoking people in grade age, the number of smoker in family have a affirmative attitude. And people who are not interested in teacher's smoking wants to quit it, and whose mother's education is higher have a negative attitude. 3. The most negatively answered questions of the smoking attitude In physical, emotional, ethical and other areas are as belows; Firstly too much smoking is harmful to our health is 1.12 point. Secondly smoking have a ill-effect on pregnancy and embryo is 1.13 point. Thirdly smoking is harmful· to our health is 1.27 point. Fourthly smoking in crowed area with the people such as In a bus or subway should be prohibited is 1.27point. Fifthly smoking can ruin lungs is 1.31 point. And the most affirmatively answered questions are also as below; Firstly we showed smoke depending on time and place is 3.96 points. Secondly smoking is just habit is 3.83 points. Thirdly smoking people seem to be unable and deplorable is 3.69 point. Fourthly smoking should be prohibited by law is 3.56 points. Fifthly high school student's smoking is immitation of adults is 3.52 points.

• Asia pacific journal of information systems
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• 제24권1호
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• pp.31-50
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• 2014

The ubiquitous accessibility of information through mobile devices has led to an increased mobility of workers from their fixed workplaces. Market researchers estimate that by 2016, 350 million workers will be using their smartphones for business purposes, and the use of smartphones will offer new business benefits. Enterprises are now adopting mobile technologies for numerous applications to increase their operational efficiency, improve their responsiveness and competitiveness, and cultivate their innovativeness. For these reasons, various organizational aspects concerning "mobile work" have received a great deal of recent attention. Moreover, many CIOs plan to allocate a considerable amount of their budgets mobile work environments. In particular, with the consumerization of information technology, enterprise mobile applications (EMA) have played a significant role in the explosive growth of mobile computing in the workplace, and even in improving sales for firms in this field. EMA can be defined as mobile technologies and role-based applications, as companies design them for specific roles and functions in organizations. Technically, EMA can be defined as business enterprise systems, including critical business functions that enable users to access enterprise systems via wireless mobile devices, such as smartphones or tablets. Specifically, EMA enables employees to have greater access to real-time information, and provides them with simple features and functionalities that are easy for them to complete specific tasks. While the impact of EMA on organizational workers' productivity has been given considerable attention in various literatures, relatively little research effort has been made to examine how EMA actually lead to users' job performance. In particular, we have a limited understanding of what the key antecedents are of such an EMA usage outcome. In this paper, we focus on employees' perceived job performance as the outcome of EMA use, which indicates the successful role of EMA with regard to employees' tasks. Thus, to develop a deeper understanding of the relationship among EMA, its environment, and employees' perceived job performance, we develop a comprehensive model that considers the perceived-fit between EMA and employees' tasks, satisfaction on EMA, and the organizational environment. With this model, we try to examine EMA to explain how job performance through EMA is revealed from both the task-technology fit for EMA and satisfaction on EMA, while also considering the antecedent factors for these constructs. The objectives of this study are to address the following research questions: (1) How can employees successfully manage EMA in order to enhance their perceived job performance? (2) What internal and/or external factors are important antecedents in increasing EMA users' satisfaction on MES and task-technology fit for EMA? (3) What are the impacts of organizational (e.g. organizational agility), and task-related antecedents (e.g., task mobility) on task-technology fit for EMA? (4) What are the impacts of internal (e.g., self-efficacy) and external antecedents (e.g., system reputation) for the habitual use of EMA? Based on a survey from 254 actual employees who use EMA in their workplace across industries, our results indicate that task-technology fit for EMA and satisfaction on EMA are positively associated with job performance. We also identify task mobility, organizational agility, and system accessibility that are found to be positively associated with task-technology fit for EMA. Further, we find that external factor, such as the reputation of EMA, and internal factor, such as self-efficacy for EMA that are found to be positively associated with the satisfaction of EMA. The present findings enable researchers and practitioners to understand the role of EMA, which facilitates organizational workers' efficient work processes, as well as the importance of task-technology fit for EMA. Our model provides a new set of antecedents and consequence variables for a TAM involving mobile applications. The research model also provides empirical evidence that EMA are important mobile services that positively influence individuals' performance. Our findings suggest that perceived organizational agility and task mobility do have a significant influence on task-technology fit for EMA usage through positive beliefs about EMA, that self-efficacy and system reputation can also influence individuals' satisfaction on EMA, and that these factors are important contingent factors for the impact of system satisfaction and perceived job performance. Our findings can help managers gauge the impact of EMA in terms of its contribution to job performance. Our results provide an explanation as to why many firms have recently adopted EMA for efficient business processes and productivity support. Our findings additionally suggest that the cognitive fit between task and technology can be an important requirement for the productivity support of EMA. Further, our study findings can help managers in formulating their strategies and building organizational culture that can affect employees perceived job performance. Managers, thus, can tailor their dependence on EMA as high or low, depending on their task's characteristics, to maximize the job performance in the workplace. Overall, this study strengthens our knowledge regarding the impact of mobile applications in organizational contexts, technology acceptance and the role of task characteristics. To conclude, we hope that our research inspires future studies exploring digital productivity in the workplace and/or taking the role of EMA into account for employee job performance.

• 과학기술학연구
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• 제16권2호
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• pp.99-147
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• 2016

이 논문에서는 과학기술학에서 공중의 과학기술 관여가 논의되어온 방식이 갖는 유용성과 한계를 정당화와 실질적 수용의 측면에서 살펴보고자 한다. 이를 위해 우선 과학기술 전문가의 지식 체계가 포함하는 불확실성과 비전문가의 일반인 지식에 관한 STS의 통찰이 왜 그동안 참여적 거버넌스의 양적, 질적 확산으로 충분히 이어지지 못했는지의 문제를 이론적, 실질적 층위에서 논의하였다. 이어서 어떤 전문성이 참여적 거버넌스의 구성과 지속을 지지할 수 있는 것인가에 대한 답을 찾기 위한 예비적인 시도로서 한 사례-제주도 풍력 발전시설 개발과 제도 정비 과정에서 나타난 비전문가의 활동-에 주목하였다. 논문의 주장은 다음과 같이 요약된다. 첫째, 참여적 거버넌스를 정당화할 수 있는 근거는 시민/비전문가라는 사회 집단이 갖는 어떤 본질적 특성에서 도출할 수 없다. 둘째, 참여의 정당한 조건으로 수용될 수 있는 전문성의 형식과 내용은 사실 진술과 가치 판단의 경계를 재구성하는 수행의 결과로서 사후적으로 부여된다. 셋째, 제주도 풍력자원 공유화 과정에서 복잡한 사회-기술 체제의 실질적 재구성에 기여했던 것은 새롭게 유통될 수 있는 사물-사람의 관계를 만드는 '연계적 전문성'이었다. 넷째, 시민과 전문가의 전문성은 모두 대체가 아닌 보완을 필요로 한다. 궁극적으로 이 논문은 참여적 거버넌스에 대한 STS 논의가 실제로 갈등이 발생하고 결정이 이루어지고 있는 현장에 주목하여, 과거와 현재, 사실과 가치, 과학기술과 사회의 경계를 재구성하는 행위자들의 구체적 수행을 분석하는 작업으로 확장되어야 할 필요성을 강조한다.

• 한국철학논집
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• 제35호
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• pp.43-71
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• 2012

조선 시대의 재지사족은 핵심적인 지배집단이었다. 그들은 전국적으로 분포한 중소 규모의 지주였으며, 유교적 소양을 보유한 지식인 집단이었다. 17세기 이후로는 곳곳에 동성마을을 형성하고, 현조(顯祖)를 내세우면서 지역 사회에 대한 영향력을 행사했다. 그 결과 지역에서의 실질적 주도권을 재지사족이 행사하는 예가 많았다. 이런 면에서 제천 지역의 황강(黃江) 신동(新洞)에 정착한 안동 권씨 화천군파(花川君派) 문중은 대표적인 재지사족이었다. 이 집단은 1675년에 이뤄진 권상하 형제가 이주하면서 형성되었다. 노론 정파의 지도자였던 송시열의 수제자인 권상하는 과거를 외면하고 황강에서 강학에 힘썼으며, 결국은 산림(山林)으로 초빙되어 좌의정으로 제수되기까지 하였다. 권상하의 사후에 그가 가르치던 곳에는 황강서원을 비롯한 기념 시설과 제사 공간이 설치되었다. 이러한 시설들은 권상하가 중시했던 삶의 가치를 후손들이 받아들이는데 이바지했고, 지역 사회에 숭명의리(崇明義理)에 토대를 둔 척사적(斥邪的)인 정서가 자리 잡도록 하는데 이바지했다. 화천군파가 제천 지역에서 재지사족으로 성장하는 과정에 결정적인 역할을 한 인물은 또 다른 인물은 권상하의 조카인 권섭(權燮)이었다. 그는 권상하를 위한 여러 기념시설을 건립하고, 문중의 발전을 위하여 여러 규칙을 제정하였다. 아울러 황강을 넘어서 제천의 신동에 새로운 거주공간을 확보하고, 청풍 단양 문경 등지에 별서(別墅)를 장만하며 거주공간을 넓혀 나갔다. 각각의 공간에는 조상을 모시기 위한 제사 시설도 설치했다. 그 결과 권상하와 권섭의 자손들은 제천 일대에서 대표적인 성씨 집단으로 수백 년간 위세를 누릴 수 있었다. 비록 그들은 서울에 남았던 이들에 비하여 많은 엘리트 관료를 배출할 수는 없었다. 그러나 이러한 재지사족의 성장은 지역 사회의 문화적 성장, 나아가 전 조선 사회의 발전을 가능하게 했다.

• 한국과학교육학회지
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• 제41권4호
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• pp.339-358
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• 2021

본 연구에서는 초등학교 과학 모델링 수업에서 구성원들의 협력적 참여를 위해 노력했던 리더의 행위주체적 모습과 그 발현 맥락을 탐색하고, 집단적 행위주체성으로의 발전이 좌절된 맥락에 대해 분석하였다. 연구 참여자는 초등학교 5학년 1개 학급 학생 22명과 교사 1명이었으며, 학생들의 행위주체성은 수업과 인터뷰에서 나타난 발화 및 행동을 통해 분석되었다. 연구 결과, 수업 초반 리더는 권위자로서 많은 권력을 가지고 활동을 주도하였고, 이에 따라 비협력적 참여 형태가 나타났다. 그러나 수업 중반부터는 문제에 대한 해결책 파악과 개인적 경험 성찰, 연구자와의 인터뷰를 통해 소집단을 돕는 선생님으로서의 정체성을 갖고 행위주체성을 발현하게 되었다. 리더의 행위주체적인 행동은 다음과 같이 3가지 측면으로 분류할 수 있다. 첫째, 인지적 측면에서 자신의 지식을 공유하여 구성원들과의 지식 격차를 줄임으로써 구성원들이 모델링에 참여할 수 있도록 도왔다. 둘째, 규범적 측면에서 모든 학생들에게 평등한 발언권을 주기 위해 소집단의 규칙을 만들어 그들이 모두 모델링에 참여하게 했다. 셋째, 감정적 측면에서 구성원들의 기여를 인정하고 그들의 자신감을 높여 줌으로써 참여를 촉진했다. 이와 같이 리더의 행위주체성은 다양한 모습으로 나타나, 일시적으로 소집단의 권력 위계를 완화시키고 협력적인 참여 형태를 만드는 데 영향을 미쳤다. 그러나, 리더의 행위주체성이 집단적 행위주체성으로 발전되기에는 한계가 있었는데, 리더의 권력이 제한적으로 재분배되었고, 구성원들이 자신을 리더와 동등한 권위를 가진 사람으로 위치 짓지 못했기 때문이었다. 또한, 리더는 협력적 참여를 위한 구조적 지원이 부족함을 인지하고 행위주체성이 좌절되었으며, 이전의 비협력적 참여 형태로 돌아가게 되었다. 연구 결과는 리더의 행위주체성 발현을 지속시키기 위해서는 교실의 구조적 개선이 필요함을 시사하며, 리더 개인뿐만 아니라 소집단의 모든 구성원들 및 교사와의 협력을 통해 집단적 행위주체성으로 발전되어야 함을 제안한다. 이 연구는 학생들의 행위주체성 발현을 지원하는 방법에 대한 이해를 향상시키는 데 도움을 줄 수 있을 것이다.

• 치위생과학회지
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• 제18권6호
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• pp.357-366
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• 2018

본 연구는 치과위생사 직무를 다양한 각도에서 분석하고 검토하여 향후 치과 팀 내 치과진료업무를 효율적으로 분담하고 직무에 따른 교육 과정을 개발하는 데 기초 자료로 활용하기 위하여, 의료법에서 의료행위를 판단하는 기준에 따라 치과위생사 직무의 타당도를 평가하고자 하였다. 본 연구는 2017년 11월 10일부터 20일까지 강릉원주대학교 치과대학의 12명 교수를 대상으로 치과위생사 직무의 타당성을 평가하기 위해 자기기입 설문조사를 실시하였다. 치과위생사 직무가 질병예방과 치료, 환자요양지도, 보건 위생상 위해 발생 여부의 의료행위 판단기준에 해당하는지에 대한 전문가 일치율을 산출하였고, 각 행위를 의료행위 타당성 평가기준에 따라 점수화하여 level 1~4로 최종 분류하였다. 본 연구 결과에 따르면, 응답자의 50% 이상이 치위생 관리에 포함하는 치은출혈, 치주낭, 임상적 부착수준 측정 및 기록과 전문가 치면세균막 관리, 스케일링, 칫솔질 및 구강 관리용품 처방, 교육을 포함한 대상자별 구강보건교육과 치료 후 주의사항에 대한 상담이 세 가지의 의료행위 판단기준에 모두 해당된다고 응답하였다. 치과위생사가 치과임상에서 수행하는 행위는 의료행위 판단 기준에 따라 크게 4가지 범주로 분류하였고, 범주의 수준이 높을수록 수행난이도가 높고, 전문지식과 기술이 요구되는 직무로 판단할 수 있다. 치은출혈, 임상적 부착수준, 치주낭 측정 및 기록과 치면 연마, 전문가 치면세균막 관리, 스케일링, 치근활택술, 국소적 항균제 적용의 항목은 최종 점수 4.3으로 수행난이도와 전문성이 요구되는 Level 4 그룹으로 분류되었다. 우리나라 치과진료현장에서 환자의 안전과 건강권을 보장하면서 효율적으로 진료를 분담하기 위해서는 수행 행위에 따라 필요한 지식의 수준과 적절한 교육, 자격 기준 등에 대한 표준화된 지침이 개발되어 활용될 필요가 있다.

• 한국농림기상학회지
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• 제25권4호
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• pp.436-445
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• 2023

벼논에서 배출되는 메탄은 주로 폐쇄형 챔버법 또는 에디 공분산법을 이용하여 관측이 이루어진다. 본 연구에서는 기존 측정법들이 갖고 있는 장점은 활용하고 단점은 보완할 수 있는 레이저 기반의 휴대용 기체 분석기(LI-7810)와 자동 개폐식 챔버(Smart Chamber) 를 결합한 새로운 관측 기술을 소개하였다. 벼의 최대 생장 높이에 맞춰 원통 형태의 칼라를 제작하여 측정 보조 도구로 활용하였다. 시범 관측은 경기도 파주시 적성면 객현리 일대의 영농형 태양광 설비가 갖춰진 논에서 2021년 8월부터 2022년 10월까지 이루어졌다. 벼논에서의 메탄 관측을 통해 얻게 되는 가장 일반적인 그래프는 벼의 통기조직을 통한 배출로 인해 메탄의 혼합비가 일정한 기울기로 꾸준히 증가하는 특징이 나타난다. 측정되는 모든 종류의 데이터뿐만 아니라 측정과 동시에 계산되는 메탄 플럭스 값도 실시간 모니터링이 가능하며, 측정이 끝난 후에는 'SoilFluxPro' 라는 소프트웨어를 통해 관련 데이터를 확인할 수 있다. 기존의 챔버법에서는 불가능했던 포집된 온실가스 농도의 연속적인 시계열 변화를 현장에서 바로 확인할 수 있다는 점은 새 관측 기술의 가장 큰 장점이다. 동시에 좁은 지역에 다양한 처리 조건을 가지는 경우에도 적용할 수 있으며, 에디 공분산법보다 사용법이 더 간단하고 설치 및 유지보수에 들어가는 노력이 덜하다는 점에서 매력이 있다. 하지만 관측시스템이 여전히 고가이고 그 운용에 전문적인 지식이 필요하며, 다양 한 관측 구역에 여러 개의 칼라를 설치하고 이동하며 측정하는데 인력이 많이 들어간다는 단점도 존재한다. 새로운 관측 방식이 벼논에서의 메탄 배출 경로를 확인하고 그에 따른 배출량을 정량화하는데 많은 기여를 할 수 있을 것으로 기대된다.

• 마케팅과학연구
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• 제20권2호
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• pp.188-198
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• 2010

此研究旨在考察负口碑(即NWOM)对在线行销的影响, 着重分析服务失败的描述以及通信服务商的意向是如何影响消费者对企业竞争力的评估, 对企业的态度, 以及积极的口碑行销和行为意向. 对通信说服力的研究着重于 "谁说了什么; 对谁;通过何渠道;有何影响(Chiu 2007)". 在此我们研究了电子网络发布, 尤其是 "什么" 的两个方面: 通信服务失败的等级以及个人发布的知觉意向. 电子负口碑看似正在毁掉产品或企业的声誉, 这也就不难理解为什么人们总对它带有偏见, 认为其不可靠. 根据归因理论, 人们总会寻求事件的原因, 尤其是那些消极的意外的事件(Weiner 2006). Hennig-Thurau和Walsh (2003)提出 "既然读者的知识和对在线信息的作者信任度都很有限, 可以把电子口碑当做是表达-行为关系的有效调节. 此据此我们提出以下假设: 假设1. 在衡量(a)企业竞争力, (b)人们对企业的态度, (c)积极的口碑, 以及(d)行为意向时, 面临高等级服务失败电子负口碑的对象得分低于面临低等级服务失败电子负口碑的对象. 假设2. 在衡量(a)企业竞争力, (b)人们对企业的态度, (c)积极的口碑, 以及(d)行为意向时, 面临警告意向电子负口碑的对象得分低于面临报复意向电子负口碑的对象假设3. 在电子负口碑中, 服务失败的等级和知觉意向互相影响, 因此在衡量(a)企业竞争力, (b)人们对企业的态度, (c)积极的口碑, 以及(d)行为意向时, 警告意向的电子负口碑的平均反应值大于报复意向的电子负口碑. 主要研究包括一个2 (服务失败的严重性) x 2(警告意向VS报复意向的负口碑)的析因实验. 将通过模拟的在线网络发布信息刺激在线对象. 这一方案描述的服务失败是在传统的零售机构不接受礼物卡, 通过一家在线的研究公司从全国抽样. 共有113个对象参与此研究, 共分析了104份调查问卷. 研究对象认为该方案很现实, 92.3%对此反应强烈. 方案的运作相当令人满意, 所有的措施都经预先的测试验证, 各个项目也经分析证实可靠并有效. 多变量方差分析结果显示多变量间无明显的互相影响, 因此我们只研究主要影响-后倾向和服务失败的严重性. 后倾向主要影响对企业的态度, 积极的口碑和行为意向. 服务失败的严重性主要影响4个因变量: 企业的竞争力, 对企业的态度, 积极的口碑和行为意向. 需特别指出的是, 当电子负口碑描述为严重的服务失败时, 企业的竞争力低于电子负口碑描述为较轻的服务失败时. 当电子负口碑描述为严重的服务失败时, 对企业的态度差于电子负口碑描述为较轻的服务失败时. 当电子负口碑描述为严重的服务失败时, 企业的口碑差于电子负口碑描述为较轻的服务失败时. 当电子负口碑描述为严重的服务失败时, 行为意向低于电子负口碑描述为较轻的服务失败时. 因此, 假设1中的abcd都得到了支持. 另外, 衡量对企业的态度时, 警告意向的电子负口碑得分低于报复意向的电子负口碑. 衡量企业的口碑时, 警告意向的电子负口碑得分低于报复意向的电子负口碑. 衡量行为意向时, 警告意向的电子负口碑得分低于报复意向的电子负口碑. 因此与假设2中的a项不符, 尽管结果指向的是假设方向. 除此之外, 在假设的三个变量中, 后倾向对服务失败的严重性无明显的多变量或单变量影响. 因此, 假设3被推翻. 此研究有研究和管理的双重蕴涵, 如之前的研究一样, 此研究结果证实了服务失败的严重性影响消费者知觉, 态度, 积极的口碑以及行为意向(Weun et al. 2004). 关于进一步的相关性, 在线内容证实了该反应, 这意味着企业需要努力进行服务补救. 至于电子负口碑的知觉意向, 如之前的研究一样, 此研究结果意味着读者对原始资料的意向影响其对知觉, 态度, 积极口碑和行为意向的作用大小. 对管理者的蕴涵在于, 当消费者发现在线交流可靠且有影响力时, 不是所有的交流都同等重要. 电子口碑的好处在于它可以监测潜在的问题并提供纠正的可能性, 即使有潜在的危害.

• 대한간호학회지
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• 제7권2호
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• pp.43-59
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• 1977

The Community Health Service considers the family as a service unit and places the emphasis of its service on the health problems and the nursing needs of the family rather than the individual. From the conceptual point of view that tile community health service is both health maintenance and health promotion of the family, the community health nurse should have a knowledge of the growth and development of the family and be responsible for the comprehensive support of normal family development. The community health nurse often is in a position to make a real contribution to normal family development. In order to investigate the relationship between the areas of nursing need and family development, the following objectives were established 1. To discover the general characteristics of the study population by the stage of family development. 2. To discover specific nursing needs in relation to the family developmental stage, and to determine the intensity of the nursing needs and the ability of the family to cope with these needs. 3. To discover overall family health nursing problems in relation to the family developmental stage and determine the intensity of the nursing need and the problem solving ability of family. Definitions : The family developmental stages as classified by Dually were used stage 1. Married couples(without children) stage 2. Childbearing Families (oldest child birth to 30 months of age) stage 3. Families with preschool children (oldest child 2½-to 6 years) stage 4. Families with schoolchildren (oldest child 6 to 13 years). stage 5. Families with teenagers (oldest child 13 to 20 years) stage 6. Families as launching centers (first child gone to last child′s leaving home). stage 7. Middle- aged parents (empty nest to retirement) stage 8. Aging family member (retirement to death of both spouses) The areas of nursing need were defined as those used in the study, "A Comprehensive Study about Health and Nursing Need and a Social Diagram of the Community", by tile Nursing research Institute and Center for population. and Family Planning, July 1974. The study population defiled and selected were 260 nuclear families ill two myron of Kang Hwa Island. Percent, mean value and F- test were utilized in tile statistical analysis of the study result. Findings : 1. General characteristics of the study population by tile family developmental stage ; 1)The study population was distributed by the family developmental stage as follows : stage 1 : 3 families stage 2 : 13 families stage 3 : 24 families stage 4 : 41 families stage 5 : 50 families stage 6 : 106 families stage 7 : 13 families stage 8 : 10 families 2) Most families had 4 or 5 members except for those in stage, 1, 7, and 8. 3) The parents′ present age was older in the higher developmental stage and their age at marriage was also younger in the higher developmental stages. 4) The educational level of parents was primarily less than elementary school irrespective of the developmental stage. 5) More than half of parents′ occupations were listed as laborers irrespective of the developmental stage, 6) More than half of the parents were atheists irrespective of the developmental stage. 7) The higher the developmental stage(from stage 2 to stage 6 ), the wider the distribution of children′s ages. 8) More than half of the families were of middle or lower socio-economic level. 2. Problems in specific areas of nursing need by family developmental stage, the intensity of nursing need and the problem solving ability of the family : 1) As a whole, many problems, irrespective of the developmental stage, occurred in tile areas of Housing and Sanitation, Eating Patterns, Housekeeping, Preventive Measures and Dental care. Problems occurring ill particular stages included the following ; stage 1 : Prevention of Accident stage 2 : Preventive Vaccination, Family Planning. stage 3 : Preventive Vaccination, Maternal Health, Family Planning, Health of Infant and Preschooler. stage 4, 5 : Preventive Vaccination, Family Planning, Health of School Children. stage 6 : Preventive Vaccination, Health of School Children. 2) The intensity of the nursing need in the area of Acute and Chronic Diseases was generally of moderate degree or above irrespective of the developmental stages except for stage 1. Other areas of need listed as moderate or above were found in the following stages: stage 1 : Maternal Health stage 3 . Horsing and Sanitation, Prevention of Accident. stage 4 . Housing and Sanitation. stage 5 : Housing and Sanitation, Diagnostic and Medical Care. stage 6 : Diagnostic and Medical care stage 7 : Diagnostic and Medical Care, Housekeeping. stage 8 : Housing and Sanitation, Prevention of Accident, Diagnostic and Medical Care, Dental Care, Eating Patterns, Housekeeping. 3) Areas of need with moderate problem solving ability or less were as follows : stage 1 : Diagnostic and Medical Care, Maternal Health. stage 2 : Prevention of Accident, Acute and Chronic Disease, Dental Care. stage 3 : Housing and Sanitation, Acute and Chronic Disease, Diagnostic and Medical Care, Preventive Measure, Dental Care, Maternal Health, Health of Infant and preschooler, Eating Patterns. stage 4 : Housing and Sanitation, Prevention of Accident, Diagnostic and Medical Care, Preventive Measure, Dental Care, Maternal Health, Health of New Born, Health of Infant and Preschooler, Health of school Children, Eating Patterns, Housekeeping. stage 5 . Housing and Sanitation, Prevention of Accident, Acute and Chronic Disease, Diagnostic and Medical Care, Preventive Measure, Dental Care, Preventive Vaccination, Maternal Health, Eating Patterns. stage 7, 8 : Housing and Sanitation, Prevention of Accident, Acute and Chronic Disease, Diagnostic and Medical Care, Preventive Measures, Dental Care, Preventive Vaccination, Eating Patterns , Housekeeping. Problem occurrence, the degree of nursing need and the degree of problem solving ability 1 nursing need areas for the family as a whole were as follows : 1) The higher the stages(except stage 1 ), the lower the rate of problem occurrence. 2) The higher the stage becomes, the lower the intensity of the nursing need becomes. 3) The higher the stages (except stages 7 and 8), the higher. the problem solving ability. Conclusions ; 1) When the nursing care plan for the family is drawn up, depending upon the stage of family development, higher priority should be give to nursing need areas ① at which problems were shown to occur ② where the nursing need is shown to be above moderate degree and ③ where the problem solving ability was shown to be of moderate degree. 2) The priority of the nursing service should be Placed ① not on those families in the high developmental stage but on those families in the low developmental stage ② and on those areas of need shown in stages 7 and 8 where the degree nursing need was high and the ability to cope low.

• Journal of Preventive Medicine and Public Health
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• 제20권1호
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• pp.165-203
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• 1987

This project was a service-cum-research effort with a quasi-experimental study design to examine the health benefits of an integrated Family Planning (FP)/Maternal & Child health (MCH) Service approach that provides crucial factors missing in the present on-going programs. The specific objectives were: 1) To test the effectiveness of trained nurse/midwives (MW) assigned as change agents in the Health Sub-Center (HSC) to bring about the changes in the eight FP/MCH indicators, namely; (i)FP/MCH contacts between field workers and their clients (ii) the use of effective FP methods, (iii) the inter-birth interval and/or open interval, (iv) prenatal care by medically qualified personnel, (v) medically supervised deliveries, (vi) the rate of induced abortion, (vii) maternal and infant morbidity, and (viii) preinatal & infant mortality. 2) To measure the integrative linkage (contacts) between MW & HSC workers and between HSC and clients. 3) To examine the organizational or administrative factors influencing integrative linkage between health workers. Study design; The above objectives called for quasi-experimental design setting up a study and control area with and without a midwife. An active intervention program (FP/MCH minimum 'package' program) was conducted for a 2 year period from June 1982-July 1984 in Seosan County and 'before and after' surveys were conducted to measure the change. Service input; This study was undertaken by the Soonchunhyang University in collaboration with WHO. After a baseline survery in 1981, trained nurses/midwives were introduced into two health sub-centers in a rural setting (Seosan county) for a 2 year period from 1982 to 1984. A major service input was the establishment of midwifery services in the existing health delivery system with emphasis on nurse/midwife's role as the link between health workers (nurse aids) and village health workers, and the referral of risk patients to the private physician (OBGY specialist). An evaluation survey was made in August 1984 to assess the effectiveness of this alternative integrated approach in the study areas in comparison with the control area which had normal government services. Method of evaluation; a. In this study, the primary objective was first to examine to what extent the FP/MCH package program brought about changes in the pre-determined eight indicators (outcome and impact measures) and the following relationship was first analyzed; b. Nevertheless, this project did not automatically accept the assumption that if two or more activities were integrated, the results would automatically be better than a non-integrated or categorical program. There is a need to assess the 'integration process' itself within the package program. The process of integration was measured in terms of interactive linkages, or the quantity & quality of contacts between workers & clients and among workers. Intergrative linkages were hypothesized to be influenced by organizational factors at the HSC clinic level including HSC goals, sltrurture, authority, leadership style, resources, and personal characteristics of HSC staff. The extent or degree of integration, as measured by the intensity of integrative linkages, was in turn presumed to influence programme performance. Thus as indicated diagrammatically below, organizational factors constituted the independent variables, integration as the intervening variable and programme performance with respect to family planning and health services as the dependent variable: Concerning organizational factors, however, due to the limited number of HSCs (2 in the study area and 3 in the control area), they were studied by participatory observation of an anthropologist who was independent of the project. In this observation, we examined whether the assumed integration process actually occurred or not. If not, what were the constraints in producing an effective integration process. Summary of Findings; A) Program effects and impact 1. Effects on FP use: During this 2 year action period, FP acceptance increased from 58% in 1981 to 78% in 1984 in both the study and control areas. This increase in both areas was mainly due to the new family planning campaign driven by the Government for the same study period. Therefore, there was no increment of FP acceptance rate due to additional input of MW to the on-going FP program. But in the study area, quality aspects of FP were somewhat improved, having a better continuation rate of IUDs & pills and more use of effective Contraceptive methods in comparison with the control area. 2. Effects of use of MCH services: Between the study and control areas, however, there was a significant difference in maternal and child health care. For example, the coverage of prenatal care was increased from 53% for 1981 birth cohort to 75% for 1984 birth cohort in the study area. In the control area, the same increased from 41% (1981) to 65% (1984). It is noteworthy that almost two thirds of the recent birth cohort received prenatal care even in the control area, indicating that there is a growing demand of MCH care as the size of family norm becomes smaller 3. There has been a substantive increase in delivery care by medical professions in the study area, with an annual increase rate of 10% due to midwives input in the study areas. The project had about two times greater effect on postnatal care (68% vs. 33%) at delivery care(45.2% vs. 26.1%). 4. The study area had better reproductive efficiency (wanted pregancies with FP practice & healthy live births survived by one year old) than the control area, especially among women under 30 (14.1% vs. 9.6%). The proportion of women who preferred the 1st trimester for their first prenatal care rose significantly in the study area as compared to the control area (24% vs 13%). B) Effects on Interactive Linkage 1. This project made a contribution in making several useful steps in the direction of service integration, namely; i) The health workers have become familiar with procedures on how to work together with each other (especially with a midwife) in carrying out their work in FP/MCH and, ii) The health workers have gotten a feeling of the usefulness of family health records (statistical integration) in identifying targets in their own work and their usefulness in caring for family health. 2. On the other hand, because of a lack of required organizational factors, complete linkage was not obtained as the project intended. i) In regards to the government health worker's activities in terms of home visiting there was not much difference between the study & control areas though the MW did more home visiting than Government health workers. ii) In assessing the service performance of MW & health workers, the midwives balanced their workload between 40% FP, 40% MCH & 20% other activities (mainly immunization). However, $85{\sim}90%$ of the services provided by the health workers were other than FP/MCH, mainly for immunizations such as the encephalitis campaign. In the control area, a similar pattern was observed. Over 75% of their service was other than FP/MCH. Therefore, the pattern shows the health workers are a long way from becoming multipurpose workers even though the government is pushing in this direction. 3. Villagers were much more likely to visit the health sub-center clinic in the study area than in the control area (58% vs.31%) and for more combined care (45% vs.23%). C) Organization factors (admistrative integrative issues) 1. When MW (new workers with higher qualification) were introduced to HSC, it was noted that there were conflicts between the existing HSC workers (Nurse aids with less qualification than MW) and the MW for the beginning period of the project. The cause of the conflict was studied by an anthropologist and it was pointed out that these functional integration problems stemmed from the structural inadequacies of the health subcenter organization as indicated below; i) There is still no general consensus about the objectives and goals of the project between the project staff and the existing health workers. ii) There is no formal linkage between the responsibility of each member's job in the health sub-center. iii) There is still little chance for midwives to play a catalytic role or to establish communicative networks between workers in order to link various knowledge and skills to provide better FP/MCH services in the health sub-center. 2. Based on the above findings the project recommended to the County Chief (who has power to control the administrative staff and the technical staff in his county) the following ; i) In order to solve the conflicts between the individual roles and functions in performing health care activities, there must be goals agreed upon by both. ii) The health sub·center must function as an autonomous organization to undertake the integration health project. In order to do that, it is necessary to support administrative considerations, and to establish a communication system for supervision and to control of the health sub-centers. iii) The administrative organization, tentatively, must be organized to bind the health worker's midwive's and director's jobs by an organic relationship in order to achieve the integrative system under the leadership of health sub-center director. After submitting this observation report, there has been better understanding from frequent meetings & communication between HW/MW in FP/MCH work as the program developed. Lessons learned from the Seosan Project (on issues of FP/MCH integration in Korea); 1) A majority or about 80% of the couples are now practicing FP. As indicated by the study, there is a growing demand from clients for the health system to provide more MCH services than FP in order to maintain the achieved small size of family through FP practice. It is fortunate to see that the government is now formulating a MCH policy for the year 2,000 and revising MCH laws and regulations to emphasize more MCH care for achieving a small size family through family planning practice. 2) Goal consensus in FP/MCH shouBd be made among the health workers It administrators, especially to emphasize the need of care of 'wanted' child. But there is a long way to go to realize the 'real' integration of FP into MCH in Korea, unless there is a structural integration FP/MCH because a categorical FP is still first priority to reduce the rate of population growth for economic reasons but not yet for health/welfare reasons in practice. 3) There should be more financial allocation: (i) a midwife should be made available to help to promote the MCH program and coordinate services, (in) there should be a health sub·center director who can provide leadership training for managing the integrated program. There is a need for 'organizational support', if the decision of integration is made to obtain benefit from both FP & MCH. In other words, costs should be paid equally to both FP/MCH. The integration slogan itself, without the commitment of paying such costs, is powerless to advocate it. 4) Need of management training for middle level health personnel is more acute as the Government has already constructed 90 MCH centers attached to the County Health Center but without adequate manpower, facilities, and guidelines for integrating the work of both FP and MCH. 5) The local government still considers these MCH centers only as delivery centers to take care only of those visiting maternity cases. The MCH center should be a center for the managment of all pregnancies occurring in the community and the promotion of FP with a systematic and effective linkage of resources available in the county such as i.e. Village Health Worker, Community Health Practitioner, Health Sub-center Physicians & Health workers, Doctors and Midwives in MCH center, OBGY Specialists in clinics & hospitals as practiced by the Seosan project at primary health care level.