• 만화애니메이션 연구
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• 통권40호
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• pp.521-549
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• 2015

우리는 눈으로 보는 행위를 통해 모든 사물을 인지한다. 그러나 눈에 들어온 모든 사물들이 그 사물의 본질일지는 확언할 수 없다. 이에 필자는 여기서 인간이 대상을 보는 것, 그리고 그것을 인지하는 것은 과연 무엇일까라는 의문을 던져본다. 우리가 보는 대상은 '이미지'로서의 대상이며, 따라서 필자는 우리가 대상을 인지한다는 것은 우리의 시감각과 두뇌를 거친 기호작용이라고 보고 있다. 대상들의 본질보다는 우리가 인지하는 데에 '기호'로서 그 대상의 관념이 정의되고 있기 때문이다. 포스트모더니즘 시대에 이르러 예술은 더욱 일종의 정신적 가치를 창출하는 자율적 창조 활동으로서 그것을 지각하는 독자의 삶의 가치를 향유하는데 중대한 역할을 맡고 있다. 인간의 인지에 미적 가치를 부여하는 예술 분야에서 초점을 둔 본 논문은 예술 작품을 시지각적으로 규명하는데 기호작용과 연관지어 분석되었다. 예술이라는 인간의 창작 행위는 상징적이며 기호체계와 밀접하게 연결되어있으며, 나아가 파생된 시각 기호는 그것을 바라보는 주체의 시지각성과 궤도를 나란히 한다고 볼 수 있기 때문이다. 더불어 예술작품을 기호로 인식하여 해석한다면, 색(色)이나 형(形)을 통한 폭넓은 사고로 작품을 음미할 수 있으며, 따라서 필자는 예술 작품과 기호와의 관계성을 분석하는데 색채를 중점으로 둔 색채 지각 논의로 담론화 해보고자 한다. 본 논문은 특히 미술사에서 풍부한 색채를 구사하여 그려오던 인상주의 미술에서의 색채 인식 배경과 색채의 위상 및 표현방법을 바탕으로 색채가 감각 언어로서 독자에게 전달되는 그 상관성을 고찰한다. 작가와 독자 간의 소통으로 이루어지는 예술 작품을 해명하는 데 있어서 색채의 역할은, 예술가의 경험과 투과된 자신의 정서와 생각, 감정 등이 동반되어 작품 안에서 비로소 시각 기호로 사유된다. 이는 색채가 예술작품 안에서 인지 가능한 공간으로 형성될 때 기호의 의미작용을 통해 시각 언어로 해석될 수 있다. 따라서 시각예술을 연구하는데 있어서 본 색채기호 분석이 보다 새로운 텍스트로 거듭나고 향후 효과적인 커뮤니케이션으로 확대되기를 기대해본다.

• 초등상담연구
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• 제5권1호
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• pp.159-184
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• 2006

Lately, the rapid social and family system change, the entrance examination-centered circumstance in education have a negative influence not only on making up the affirmative self-esteem but also on building up the personal relationship through mutual communication with friends of the same age. Making children adapt well to school life and develop a good relationship in the class is an important subject in educational field. Thus, various school activities should offer lots of opportunities to increase their affirmative self-esteem and more specified performance-centered programs are required toform a harmonious relationship among parties of students. The purpose of this study is to improve an affirmative self-esteern and a desirable personal relationship of children through developing friend-praise program and adapting it to children. Based on the above purpose, the following subjects for this study 'are suggested. Firstly, is the friend-praise program effective in forming an affirmative self-esteem of elementary students? Secondly, is the friend-praise program successful in improving a desirable personal relationship in an elementary school? In addition, two hypotheses of study are decided on the basis of theoretical background and the former study. Hypothesis 1. The friend-praise program will have a meaningful effect on improving an affirmative self-esteem. Hypothesis 2. The friend-praise program will have a meaningful effect on improving a desirable personal relationship. In order to improve the above hypotheses, the experiment was carried out with two classes on the fourth grade in M elementary school in Wonju with being divided into one experimental group and the other comparative group. The friend-praise program which was adapted to the experimental group was composed with four steps as 'introduction', 'preparation', 'operation' and 'closing'. This program which has twelve categories was executed once or twice in a week and each class was continued for forty or sixty minutes. Contrastively, comparative group had no application of the main program. For the purpose of proving the hypotheses after adapting the program to students, I have executed both self-esteem test and personal relationship test. The tests were performed with using SPSS/Windows V10.0 and the statistic was conducted through independant sample t-test for the difference between groups and contrastive sample t-test for the individual difference in each group. The results of this study can be summarized like the followings: Firstly, from the result of previous and after tests, there was no meaningful change in the comparative group, but the experimental group showed meaningful difference in all categories of self-esteem(t=-4.496, p=.000). Especially, the general self-esteem(t=-3.216, p=.003), social self-esteem(t=-2.680, p=.012), homely self-esteem(t=-3.732, p=.001), and school self-esteem(t=-3.902, p=.000) showed a meaningful difference. At the same time, the experimental group also showed meaningful difference with the comparative group in self-esteem(t=-4.758, p=.000). Especially, the general self-esteem(t=2.581, p=.017), social self-esteem(t=3.160, p=.003), homely self-esteem(t=4.283, p=.000), and school self-esteem(t=4.110, p=.000) showed a meaningful difference. As a result of this experiment, the friend-praise program will have a meaningful effect on improving an affirmative self-esteem was proved. Secondly, there was no meaningful change in the comparative group, but the experimental group showed meaningful difference in all categories of personal relationship(t=-4.131, p=.000). Specifically, satisfaction(t=-2.113, p=.045), communication(t=-3.381, p=.002), confidence(t=-3.517, p=.001), intimacy(t=-3.958, p=.000), sensibility(t=-2.955, p=.006), openness(t=-4.318, p=.000) and interest(t=-2.941, p=.000) showed a meaningful difference. In the same instant, the experimental group also showed meaningful difference with the comparative group in all categories of personal relationship(t=3.897, p=.000). Especially, satisfaction(t=2.257, p=.003), communication(t=3.527, p=.001), confidence(t=3.704, p=.001), intimacy(t=3.904, p=.000), sensibility (t=4.382, p=.000), openness(t=2.648, p=.013) and interest(t=2.944, p=.006) showed a meaningful difference. Accordingly, the friend-praise program will have a meaningful effect on improving a desirable personal relationship was proved. Judging from all these results, we should provide primary students with various opportunities to take part in active programs which help them to set up their righteous sense of value, to solve their own problems and to develop their potentials. Consequently, many kinds of practice-centered program like the friend-praise program should be developed more systematically and teachers should apply all those programs to students according to their individual level and developmental stage.

• 한국컴퓨터정보학회논문지
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• 제20권5호
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• pp.123-131
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• 2015

정보통신의 눈부신 발전은 우리 사회에 편리함과 더불어 또 하나의 문제를 야기하고 있다. 즉 전자기기로 무제한적 감시가 가능한 사회로 변모 되고 있어, 이를 잘못 관리할 경우 또 다른 재앙으로 낳을 수 있다는 문제가 있다. 이러한 사회 속에서 살아가는 우리는 거주지의 문을 나서면서부터 곳곳에 설치되어 있는 폐쇄회로 카메라(CCTV-Closed Circuit Television)와 개인이 사용하는 스마트 폰을 통하여 감시의 덫 속에서 살아가고 있는 것이다. 한편으로는 정보통신의 발전과 함께 개인정보를 쉽게 수집, 저장하게 되면서 기업에게는 마케팅을 위한 기업의 소중한 자산가치가 되면서 이를 불법적으로 수집하고자 하는 사람들이 늘어나게 되고, 실제로 이와 관련된 사건들이 많이 발생하기도 하였다. 이러한 정보사회 속에서는 수사도 범죄행위로 인해 남게 되는 디지털 흔적을 얼마나 잘 찾아낼 수 있느냐가 그 수사의 성공도를 가늠할 수 있을 정도로 여겨지고 있으면서 수사기관은 이를 찾기 위해 노력하게 된다. 따라서 사건을 수사하면서 범죄자가 사용하였던 컴퓨터나 스마트폰의 사용흔적에 관한 압수 수색의 절차는 이제 필수적인 절차가 되었으며, 이러한 전자적인 증거를 수집할 수 있느냐는 수사의 성패를 가름하는 결정적인 요소가 되었다. 그런데 이때 수사기관들은 전자 증거자료들을 압수 또는 수색하면서 포괄적으로 이루어지는 경우가 많아 피압수자의 정보자기결정권을 침해할 우려가 높아지는 추세이다. 따라서 많은 국민들이 수사기관이 행하는 전자정보의 포괄적 압수수색에 대하여 불안감이 노출되면서 '사이버 망명'이라는 용어까지 탄생시키고 있다. 이러한 점에서 전자적 정보의 압수수색 범위를 어떻게 설정하여야 할 것인지를 검토하였다.

• 한국정보과학회논문지:정보통신
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• 제29권3호
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• pp.286-298
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• 2002

분산 컴퓨팅 환경에서 프로세스 사이의 상호 협력을 위한 통신으로 인격 프로시져 호출이 전통적으로 사용되고 있다. 분산 응용이 더욱 복잡해짐에 따라 최근 이동 에이전트 패러다임이 등장하였다. 이처럼 다양한 상호 협력을 위한 통신 패러다임이 등장함에 따라 각 패러다임의 성능에 대한 평가와 비교 연구가 이루어지고 있다. 그러나 기존의 연구에서 성능 평가를 위해 사용한 성능 모델들은 보안 서비스를 위한 평가 요소를 고려하고 있지 않기 때문에 실제 분산 환경을 제대로 반영하지 못한다. 분산 환경은 개방되어 있으므로 정보의 노출이나 도청과 같은 공격에 있어서 상당히 취약하다. 이러한 분산 환경에서 안전하게 작업을 수행하기 위해서는 여러 가지 공격으로부터 응용 프로그램이나 정보를 보호하기 위한 보안 서비스가 고려되어야 한다. 본 논문에서는 상호 협력을 위한 통신 패러다임 중 인격 프로시져 호출과 이동 에이전트의 성능을 평가하고 비교한다. 분산 응용 프로그램을 안전하게 수행하기 위해 고려해야 하는 보안 서비스에 관하여 알아보고, 이러한 보안 서비스를 적용한 새로운 성능 모델을 제시한다. N개의 데이타베이스 서버에서 사용자가 필요한 정보를 검색하는 작업을 Petri Net으로 모델링하고, 각 파라미터에 수치 값을 할당해서 수행속도를 측정하여 두 패러다임의 성능을 비교한다. 본 논문에서 안전한 통신을 위하여 보안 서비스를 적용한 두 성능 모델의 비교 결과는 다음과 같다. 원격 프로시져 호출은 연산 비용이 높은 암호화 메커니즘을 포함하는 통신 횟수와 통신량이 많기 때문에 실행 시간이 급격하게 증가하지만, 이동 에이전트 패러다임은 통신 횟수와 통신량을 줄인 수 있으므로 실행시간이 완만하게 증가하는 것을 살펴볼 수 있다.멀티미디어 제작환경을 구축하는 것이 디지털 방송 시대의 방송 사업자에게 가장 중요한 과제중의 하나가 되었다. 멀티미디어 제작환경을 구축함으로써 영상, 음성 및 다양한 부가 데이터를 포함하는 멀티미디어 프로그램을 편리하게 제작할 수 있으며, 데이터베이스로부터 필요한 영상 이미지를 자유롭게 합성, 조작하는 등, 매우 다양하고 편리한 제작기법을 활용할 수 있다. 또한 멀티미디어를 응용한 제작 분야로서 컴퓨터 그래픽스 기술은 방송의 사전제작에 커다란 기여를 하고 있으며, 이미 선거방송을 비롯한 여러가지 프로그램은 가상스튜디오와 가상캐릭터 기술을 활용하여 제작하고 있다. 방송사업자는 이러한 멀티미디어 제작시스템을 근간으로 영상검색, 영상 합성, 스크립트 편집, 가상현실 응용 등 고도의 제작 기법을 활용함으로써 사용자 친화성, 다이나믹한 표현, 실시간, 대화성을 특징으로 하는 다양한 멀티미디어 서비스를 시청자에게 제공할 수 있을 것이다.is. Using the results, we can identify dominant overestimation sources that should be analyzed more accurately to get tighter WCET estimations. To make our method independent of any existing analysis techniques, we use simulation based methodology. We have implemented a MIPS R3000 simulator equipped with several switches, each of which determines the accuracy level of the timing analysis

• 대한간호학회지
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• 제25권3호
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• pp.581-596
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• 1995

Clinical practice in nursing education provides an opportunity for students, through the process of ap-plying theoretical knowledge to practice, and to learn nursing skills as well as being socialized into nursing and as such decrease the reality shock of actual nursing practice. Because of a shortage of nursing faculty, the job of achieving the objectives of the clinical practice had been turned over to the head nurses. This resulted in many problems, such as, unclear location of responsibilities and inadequate feedback from head nurses. Therefore this study was done to introduce and evaluate the use of preceptors as a way to minimize the above problems, and to maximize the achievement of the clinical practice objectives. Using an adaptation of Zerbe's (1991) three-tiered team model, clinical practice was done using a preceptor, a head nurse and a clinical instructor, each with different and well defined roles. The subjects of this study were 67 senior students of the College of Nursing of Y University in Seoul whose clinical practice in adult nursing was carried out between May 1, 1994 and December 8, 1994. There were 22 preceptors who had at least two years of clinical experience and who were recommended by their head nurses. They were given additional education on the philosophy and objectives of the College of Nursing, on communication skills, on the theory and practice of education, and on nursing diagnosis and education evaluation. The role of the preceptor was to work one-to-one with students in their practice. The role of the head nurse was to supervise and evaluate the preceptors. The role of the clinical instructor was to provide the education program for the preceptors, to provide ad-vice and suggestions to the preceptors and to maintain lines of communication with the college. With each of these roles in place, it was thought that the effectiveness and efficiency of the clinical practice could be increased significantly. To evaluate the effectiveness of the preceptorship, the three - tiered model, Lowery's Teacher Evaluation Opinion Form translated and adapted to Korea was used to measure student statisfaction. The Clinical Practice Compentency Evaluation Tool developed by Lee et ai was also used to measure student competencies. The results of this study are as follows 1. The satisfaction with clinical practice was higher with the introduction of the perceptors than it was before they were used. (t=-5.96, p=<.005) 2. The clinical practice competencies were higher with the introduction of the preceptors than it was before they were used(t=-5.l3, p<.005) 3. In order to analyze areas not measured by the quantitative tools additional analysis of the open questions was done. The results of this analysis showed that : 1) The students felt positive about their sense of security, confidence, handling of responsbility, and being systematic. They also felt positive about improvements in knowledge, opportunities for direct care, and socialization. 2) The students felt negative about the technical part of their role, lack of knowledge by the preceptor, unprofessional attitudes on the part of the preceptor, difficulty in the role of the professional nurse(student). 3) The preceptors felt positive about their responsibility, motivation, and relationship with the college. 4) The preceptors felt negative about their bur-den. Introduction of the preceptorship model will lead to change and improvement in the negative factors discussed above, solve problems in the present clinical education system, increase continuity in the education of the students, help with socialization of the students and motivation of the preceptors to up-grade their education and increase their confidence. These objectives must be obtained to further the development of professional nursing, and thus, making the preceptorship a reality is our job for the future.

• 한국정보전자통신기술학회논문지
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• 제13권3호
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• pp.226-234
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• 2020

고령사회의 진입과 더불어 인간의 평균 수명이 연장됨에 따라 현대 사회의 남성 및 여성의 외모에 대한 관심이 증가하는 추세이다. 사람의 노화를 가장 외면적으로 판단할 수 있는 것이 바로 얼굴의 피부 주름이다. 깨끗하고 주름이 없으면서 탄력성 있는 건강한 피부를 갖기 위하여 사람들은 각종 시술을 받고 있다. 시술 중 간단하면서도 효과적인 시술을 원하는 경향이 있어 실리프팅 시술 방법이 많이 시행되고 있다. 본 연구에서는 실 리프팅 시 리프팅 효과를 개선시키기 위하여 기존의 PDO봉합사 시술에 RF고주파와 CO₂ gas를 주입하여 주름의 개선을 확인하기 위한 동물 실험을 진행하였다. 시술 전과 후의 주름 개선의 비교는 Labview를 이용한 주름 평가 프로그램으로 진행하였으며, 동물실험의 데이터는 시술 후 10주차 측정 데이터를 사용하였다. 실험그룹은 자연노화 그룹, PDO 시술 그룹, PDO에 RF고주파를 주입한 그룹, PDO에 CO₂ gas를 주입한 그룹, PDO에 CO₂ gas와 RF를 동시에 주입한 그룹으로 진행하였다. 자연노화 그룹의 개체들은 시술 전 평균 주름의 깊이는 0.408mm이었고, 10주째의 평균 주름의 깊이는 0.68mm으로 자연노화가 진행되었다. PDO 시술 그룹의 개체의 주름의 깊이는 시술 전 평균 0.384mm이었고, 시술 후 10주째에는 평균 0.348mm이었다. PDO에 RF고주파를 주입한 개체의 시술 전 평균 주름의 깊이는 0.42mm이었으며, 10주째 평균 주름의 깊이는 0.378mm이었다. PDO에 CO₂ gas를 주입한 개체는 시술 전 평균 주름의 깊이는 0.4mm이었으며, 시술 후 10주째 평균 주름의 깊이는 0.332mm로 감소하였다. PDO에 CO₂ gas와 RF고주파를 주입한 개체는 시술 전 평균 0.412mm, 시술 후 10주차 0.338mm로 감소를 볼 수 있었다. 동물 실험을 통하여 PDO봉합사에 CO₂ gas와 RF를 주입한 시술이 가장 높은 17.96%의 감소율을 보였다.

• 환경영향평가
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• 제28권5호
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• pp.440-456
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• 2019

본 연구는 미세먼지에 대한 야외활동의 위험인식의 논란에 따른 미세먼지 우려의 본질을 파악해보고자 미세먼지의 노출로 건강에 영향을 많이 받는 자전거 커뮤니티를 대상으로 카페글과 댓글을 수집하여 분석하였다. 그 결과 첫째, 정부에서 주도한 미세먼지 정책은 매 시기별로 견고해지고, 세분화되고 있었지만 자전거 커뮤니티 내에서의 미세먼지 위험인식은 시간흐름에 따라 논의가 활성화되고, 심각해지고 있었다. 둘째, 미세먼지 우려로 인한 야외활동 인식변화를 분석한 결과 자전거 커뮤니티 회원들은 날씨 변수보다 미세먼지 등급에 따라 야외활동 여부가 달라지는 양상을 보였다. 또한 국내 미세먼지 수치나 마스크 성능에 대한 불신과 맞물리면서 일상생활과 건강에 심각한 위협을 주는 공포의 대상으로 변화되고 있었다. 궁극적으로 이러한 미세먼지 위험인식은 주로 야외에서 즐겼던 자전거활동 일부를 실내공간으로 이동하게 하였다. 하지만 경관, 사람, 날씨 등 야외에서 다양한 요소들을 누리며 즐겼던 자전거활동에 비해 단조로운 실내 자전거운동은 헬스, 요가 등의 다른 실내운동 유형으로 전환되고 있었다. 종합적으로 살펴보면 미세먼지에 대한 자전거 이용객의 위험인식이나 야외 자전거활동의 인식변화는 정부나 지자체 등에서 제공하는 미세먼지 농도수치의 정확성, 중국영향, 국내 어플리케이션 신뢰성, 마스크 성능, 미세먼지 농도 제시방법(숫자제시형, 점적 데이터 제공) 등 정책 불신과 검증되지 않는 과도한 정보 오류로 인한 논란이 가장 큰 역할을 하고 있는 것으로 도출되었다. 따라서 모든 계층을 아우르는 종합적 사회방안이나 정부주도형 미세먼지 정책을 제시하기보다 자전거 이용객들의 눈높이에서 미세먼지로 인한 건강상의 위험을 인지하는 것이 필요하다. 또한 총체적 유기적으로 미세먼지를 인식하도록 돕는 체감형 위험 커뮤니케이션이나 교육 및 홍보과정이 선행되어야 하고, 단계별 토의를 통한 사회적 합의와 함께 향후 야외활동 유형별로 세분화된 체계적 연구가 추진되어야할 것으로 판단된다. 이에 따라 본 연구는 정부와 지자체, 언론, 국민들의 효과적인 커뮤니케이션 방향 모색을 위한 학술적 근거로 제공될 수 있을 것으로 기대된다.

• 한국인터넷방송통신학회논문지
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• 제23권3호
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• pp.35-43
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• 2023

본 연구의 목적은 행정서비스 활용을 위한 디지털 트윈 정책 연구이다. 본 연구는 1,000명의 대상을 기반으로한 모바일 설문조사를 통해 진행되었으며 그 연구 결과는 다음과 같다. 첫쨰, 디지털 트윈을 활용하기 위해 경기도 측면에서 적용할 수 있는 적절한 서비스 발굴이 선행되어야 한다. 경기도의 현장 업무에 적절한 디지털 트윈 서비스 발굴 시도가 우선적으로 선행되고 이를 통한 업무의 효율성 증진이 필요하다. 둘쨰, 경기도 디지털 트윈 행정서비스는 중앙정부 사업과의 중복성은 방지하고 연계 활용 가능한 모델을 구축해야 하며, 도와 시군의 현안 연관성이 높고 수요자 즉 도민이 원하는 행정서비스를 중심으로 추진되어야 한다. 셋쨰, 행정서비스 운영방식은 경기도의 디지털 트윈 행정서비스 개발을위해서 시범사업 참여를 통한 표준모델 구축 방안을 검토해야 한다. 사업 추진 방식으로 경기도가 주관기관이 되어, 협약사업 방식으로 추진하고, 경기도 디지털 트윈 자문위원단을 통해 사업 추진 전반에 대한 지원 체계를 마련하라는 것을 제언하고자 한다. 넷째, 전담부서와 행정서비스 구축, 운영, 관리 등을 위한 관련 제도 마련이 되어야 한다. 경기도에서 디지털 트윈 실현을 위해서는 사업 추진 및 운영과 법·제도적 개선을 위한 다양한 역할을 수행 할 수 있는 전담 조직이 필요하며, 전담 조직 지정을 위해서 기존 부서의 확대 개편 방안과 신설 부서 운영에 대한 검토가 필요하다. 본 연구의 한계 요인은 경기도 중심의 참여자들에 대한 조사로서 향후에는 전국을 기반으로 연구하는 것을 제언한다. 본 연구의 기대효과는 디지털 트윈 서비스를 공적인 업무를 적용시 활용할 수 있는 기초 자료로 이용할 수 있다.

• 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.

• 대한간호
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• 제35권2호
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• pp.71-91
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• 1996

The objectives of thes study were to identify the need for equipment development in nursing, and to determine the priorities for that development. The study was descriptive study done between March 2 and May 30, 1995, in which the subjects, including 421 patients, 223 family members, and 198 nurses from neurosurgery, orthopedic, rehabilitation medicine, internal medicine and intensive care units of nine general hospitals in Seoul, completed a questionnarie developed by the research team. The questionnaire consisted of 35 open and closed questions. Data was analyzed using frequencies and percentages. The results ware summarized as follows: 1) The average age of the nurses was 27.9 years, 48% of the patients were between 20 and 40 years of age, and 17% were over 60. The average lingth of experience for the nurse subjects was four years five months with 36.9%. having over five years experience. The most frequent diagnoses of patients were spinal disc(35.9%), internal medicine disease(26.0%), cerebral vascular accident(16.6%) and spinal cord injury(10%) 2) Many of the nurses(96.4%) reported deficiencies with existing equipment and 96.5% of the nurses, but only 79.8% of the patients, nurses' time. Further, 82.3% of the nurses and 75.8% of the patients felt that the development of new equipment would lead to a decrease in the cost of nursing care. 3) Nurses felt that the greatest areas of inconvenience were patient feeding(71.7%), hygiene(71.2%), caring for a patient confined to bed(70.7%), patient clothing(67.2%), mobility transfers(63.5%) and urinary elimination(52.0%). However, patients and family members listed the following as being the most inconvenient: urinary elimination(58.7%), Hygiene(50.5), feeding(48.4%), mobility transfers(47.1%) and bed care(45.2%). 4) Generally the nurses listed more inconveniences and patients and family members listed more demands for the development of equipment. These included utensils with large handles, and regulators for tube feedings; mattresses that provide for automatic position change and massage, which have patient controlled levers and a place for bed pan insertion; automatic lifts or transfer from bed to wheelchair; equipment to facilitate washing and oral hygiene as well as equipment that will allow patients with spinal cord injuries easy access to showers; a bed pan/urinal for women that is comfortable and effective from which urine can be measured and disposed of easily; disposable dressing sets and tracheostomy care sets and a convenient way of measuring changes in wound size; a safe delivery system for oxygen, a variety of mask sizes and better control of humidity, tracheal material than at present, as well as a communication system for patients with tracheostomies; clothing that will allow access to various parts of the body for treament or assessment without patients having to remove all of their clothing; and finally a system that will allow the patient to control lighting, telephones and pagers. Priority areas for equipment development reported by the nurses were, urinary elimination(58. 7%), hygiene(50.5%), feeding(48.4%), mobility transfers(47..1%), bowel elimination(40.8%). Those reported by the patients family members were feeding(71.7%), hygiene(70.0%), bedcare(70.7%), clothing(67.2%), mobility transfers(63.6%), urinary elimination(52.9%) and bowel elimination(50.5%) Altogether, nurses, patients and family members listed the following as priorities; clothing (178), bed care(144), urinary elimination(92), environment(81), hygiene(70). Further, a health professional forum listed urinary elimination, oxygen delivery, medication delivery, mobility transfers, bed care and hygiene in that order as priority areas. From this study it can be concluded that the first need is to develop equipment that will address the problems of urinary elimination. To do (l)This nurses who are interested in equipment development should organize an equipment development team to provide a forum for discussion and production of equipment for nursing.