• 제목/요약/키워드: Power System Education

검색결과 699건 처리시간 0.027초

과학영재학생의 가치 특성 및 가치유형 간 상호 관계성 분석 (A Study on Values of Scientifically Gifted Students and the Relations among Values)

  • 주영현;최호성
    • 영재교육연구
    • /
    • 제22권3호
    • /
    • pp.679-702
    • /
    • 2012
  • 본 연구는 영재의 가치관을 분석하는 데 초점을 맞추고 있다. 신념체계로서의 가치관은 개인이나 조직의 행위 선택에 직접적인 영향을 미친다. 지금까지 영재의 인지적, 사회-정서적 특성에 관한 논의는 활발하였으나 그러한 특성을 표출하게끔 작용하는 영재의 가치 혹은 신념에 관한 분석은 미흡한 실정이다. 이에 본 연구에서는 국내 2개 과학영재학교 468명을 대상으로 Schwartz의 가치조사척도를 사용하여 10개 문항 유형의 57개 가치범주에 대해 조사를 실시하였다. 그 결과 과학영재들은 '전통'이나 '권력' 등의 가치보다는 '자율', '자극', '성취' 등과 같이 영재의 일반적인 공통 특징과 일관되는 가치들을 보다 중요시하는 것으로 나타났다.

베트남 커피변경지역의 글로벌 가치사슬과 공유가치 창출 (Global Value Chains and Creating Shared Value in Vietnamese Coffee Frontier)

  • 이승철;정수열;조영국
    • 한국경제지리학회지
    • /
    • 제19권2호
    • /
    • pp.399-416
    • /
    • 2016
  • 본 연구의 목적은 베트남 커피변경지역이 글로벌 가치사슬에 통합되는 과정에서 나타나는 가치의 전유 및 실현관계를 고찰하고, 공유가치창출에 대한 지속가능한 커피 글로벌 가치사슬의 의미를 분석하고자 한다. 최근 베트남의 대표적 커피 변경지역인 닥락성은 일반 커피생산의 착취적 가치사슬에서 인증 커피 생산에 따른 공유가치사슬로의 전환을 경험하였다. 이와 같은 전환은 글로벌 가치사슬에서 지역의 교섭력과 경쟁우위를 강화시킴으로써 지속적인 가치 창출을 수반할 수 있을 것으로 기대되었다. 그러나 실질적으로 농가, 중개인, 외국 가공업체와 같은 지역 이해관계자간 이윤 분배의 위계성이 더욱 심화되는 현상이 나타났다. 이와 같은 현상의 원인은 크게 두 가지 측면에서 나타났다. 첫째, 다국적기업, 중개인, 농가 간 전속관계의 형성은 이해관계자에게 안정적인 시장을 확보해 주었지만, 다국적 기업이 전속 커피 중개인을 통해 농가를 간접적으로 통제함으로써 이해관계자 간 위계가 더욱 심화되었다. 둘째, 공유가치창출의 명목으로 농가로 전가된 사회적 및 생태적 비용이 농가의 경제적 이윤 획득을 악화시킨 반면에 다국적기업으로의 비대칭적이고 위계적인 이윤 분배를 가져왔다. 그 결과, 닥락성에 보다 위계적이고 종속적인 글로벌 가치사슬이 형성되었다.

  • PDF

쓰시마 해전의 전술적 재조명 - 배진과 기동, 손상통제를 중심으로 - (The Tactical review of the Battle of Tsushima - with focus on disposition & maneuver, and damage control -)

  • 이창현
    • Strategy21
    • /
    • 통권44호
    • /
    • pp.213-253
    • /
    • 2018
  • The Russo-Japanese War(1904-1905) in the early 20th century greatly influenced the international politics in Northeast Asia and the destiny of both countries. There are many studies on the cause of the outbreak and its effect on the Korean peninsula. The victory and defeat of the battle of Tsushima also the subject of research by renowned scholars and navy officers. Many previous studies have analyzed the process of engagement. However, There was a lack of research that analyzed at the tactical level of naval commanders. Therefore, this study tries to review the battle of Tsushima in terms of tactical level, that is formation, maneuvering, damage control. Naval operations at sea with many variables are not always done as planned. The intuitive judgement and readiness have had a decisive impact on victory and defeat. The analysis of the naval warfare on the basis of formation, maneuvering, and damage control makes the cause of the win more clearly. The conclusion of the this study can be summarized in five ways. First, victory would be achieved through the suppression of the beginning. The destiny of the Tsushima battle was determined by an 1 hour after first firing. The Japanese fleet caught fire by paralyzing the command and control capabilities of the Russian fleet. Second, the Japanese fleet's power was superior to the Russian fleet. In general, Japan and Russia had similar powers, and Admiral Togo's "T crossing tactics" decisively contributed the victory. However, when compared to the weapon system level, formation and maneuvering, Japan was much more dominant. Third, people realized that one side to be annihilated in the battle between similar powers after the Tsushima battle. The common perception before the Battle of Tsushima was that the battle ship would not sunken, and that the result of wiping out was difficult. However, there is s time for one sided victory and defeat depending on the early suppression nad the destruction of the command and control ability. Fourth, it is the importance of damage control ability. The main cause of the Russian fleet's loss of command and control ability was thick smoke from fire, and maneuverability was greatly deteriorated due to coal overload. In this way, importance is still valid after more than 100 tears. Fifth, the area of uncertainty. In the navy battles, one or two shots of clear firing in the beginning and small misconception and minor mistakes decide win or loss. Ultimately, this area of fortune can be linked to mindset of the commander. I hope this research will be help to naval researchers and naval commanders at the sea.

SVM과 meta-learning algorithm을 이용한 고지혈증 유병 예측모형 개발과 활용 (Development and application of prediction model of hyperlipidemia using SVM and meta-learning algorithm)

  • 이슬기;신택수
    • 지능정보연구
    • /
    • 제24권2호
    • /
    • pp.111-124
    • /
    • 2018
  • 본 연구는 만성질환 중의 하나인 고지혈증 유병을 예측하는 분류모형을 개발하고자 한다. 이를 위해 SVM과 meta-learning 알고리즘을 이용하여 성과를 비교하였다. 또한 각 알고리즘에서 성과를 향상시키기 위해 변수선정 방법을 통해 유의한 변수만을 선정하여 투입하여 분석하였고 이 결과 역시 각각 성과를 비교하였다. 본 연구목적을 달성하기 위해 한국의료패널 2012년 자료를 이용하였고, 변수 선정을 위해 세 가지 방법을 사용하였다. 먼저 단계적 회귀분석(stepwise regression)을 실시하였다. 둘째, 의사결정나무(decision tree) 알고리즘을 사용하였다. 마지막으로 유전자 알고리즘을 사용하여 변수를 선정하였다. 한편, 이렇게 선정된 변수를 기준으로 SVM, meta-learning 알고리즘 등을 이용하여 고지혈증 환자분류 예측모형을 비교하였고, TP rate, precision 등을 사용하여 분류 성과를 비교분석하였다. 이에 대한 분석결과는 다음과 같다. 첫째, 모든 변수를 투입하여 분류한 결과 SVM의 정확도는 88.4%, 인공신경망의 정확도는 86.7%로 SVM의 정확도가 좀 더 높았다. 둘째, stepwise를 통해 선정된 변수만을 투입하여 분류한 결과 전체 변수를 투입하였을 때보다 각각 정확도가 약간 높았다. 셋째, 의사결정나무에 의해 선정된 변수 3개만을 투입하였을 때 인공신경망의 정확도가 SVM보다 높았다. 유전자 알고리즘을 통해 선정된 변수를 투입하여 분류한 결과 SVM은 88.5%, 인공신경망은 87.9%의 분류 정확도를 보여 주었다. 마지막으로, 본 연구에서 제안하는 meta-learning 알고리즘인 스태킹(stacking)을 적용한 결과로서, SVM과 MLP의 예측결과를 메타 분류기인 SVM의 입력변수로 사용하여 예측한 결과, 고지혈증 분류 정확도가 meta-learning 알고리즘 중에서는 가장 높은 것으로 나타났다.

고해상도 재분석자료와 관측소 1시간 평균 지상 온도 비교 (Comparisons of 1-Hour-Averaged Surface Temperatures from High-Resolution Reanalysis Data and Surface Observations)

  • 송형규;윤대옥
    • 한국지구과학회지
    • /
    • 제41권2호
    • /
    • pp.95-110
    • /
    • 2020
  • 본 연구에서는 고해상도 ERA5 재분석자료 중 우리나라 지상 온도 자료의 신뢰성을 검증할 목적으로 종관기상관측소(ASOS) 관측자료와 비교를 수행하였다. 새롭게 생산되어 배포 중인 ERA5 재분석자료는 높은 시·공간적 해상도를 가져 여러 분야에 활용성이 매우 높다. 자료의 분석 기간은 ASOS 61개 관측소가 1999년 이후로 결측률이 매우 낮으며 시간평균 자료를 제공한다는 점을 고려하여 1999-2018년 기간으로 설정하였다. ERA5 격자 자료는 격자 내 90-m 수치표고모델(DEM) 분포로부터 내륙, 해안, 산악 지역에 해당하는 지형학적인 특성에 따라 분류하여 ASOS 지점 자료와 비교되었다. 분석 기간 전체에 대한 평균 지상 온도는 ASOS와 ERA5 모두 공간 분포의 패턴과 값은 큰 차이없이 유사하였다. ASOS와 ERA5의 산점도 비교를 통해 전체 기간, 특히 여름, 겨울 기간에 대해 계절 변동성을 가진다는 특성을 확인할 수 있었으며, 이는 달별 두 자료 사이의 매시간 차이 확률밀도함수(PDF)의 시계열을 통해서도 확인되었다. 두 자료 사이의 차이를 통계지수인 NMB, RMSE를 계산하여 정량화시켰을 때, 각 값에서 지역적인 특성을 보였으나 모든 지수에서 큰 차이가 없다고 판단할 수 있었으며, 상관성을 보기 위해 R과 IOA를 통해 구한 값은 모두 0.99에 근접하였다. 특히 일평균 산출에 있어 1-시간-평균 값 24개를 이용한 일평균의 경우가 최고와 최저온도의 평균을 이용하는 일평균에 비해 오차가 작게 나타났고, 두 자료 사이의 상관성도 높게 나타남을 확인하였다. 두 자료의 차이가 나타나는 원인으로 ERA5 격자 내 지형 효과가 가장 클 것으로 판단하여 수치표고모델을 활용하여 각 지역별 PDF를 이용해 첨도 및 왜도를 구하고, 이를 온도 차이 파워 스펙트럼의 1년 주기 변동 크기와 비교하였다. 그 결과, 양의 상관성을 가졌음을 확인하였다. 이는 지형 효과가 두 자료 차이의 원인이라고 설명하는 결과이다.

<춘향전>에서의 법(法)과 사랑 (Law and Love in )

  • 김종철
    • 고전문학과교육
    • /
    • 제38호
    • /
    • pp.175-200
    • /
    • 2018
  • 조선시대의 법과 관습을 기준으로 볼 때, 춘향과 이몽룡의 사랑, 춘향과 변학도의 갈등과 대결, 이몽룡의 암행어사 출도와 춘향 구출 등의 사건들은 새로운 의미를 함축하는 것으로 해석될 수 있다. 춘향과 이몽룡의 사랑은 당시의 법과 규범에 저촉되는 것이었지만 서술자는 이를 문제 삼지 않으며 오히려 지배 질서에 저항하는, 낭만적이고 새로운 사랑으로 그렸다. 그리고 춘향은 이몽룡에게 혼인을 보장한다는 증서(證書)를 요구하는데, 이는 전례 없는 법적 행위이다. 춘향과 이몽룡의 사랑이 공적인 인정을 받지 못한 상태에서 춘향과 변학도의 갈등과 대립이 전개된다. 변학도는 춘향에 대한 성적 욕구를 충족시키기 위해 수청을 요구하다 거부당하자 춘향에게 관장(官長)의 명령을 따르지 않은 혐의와 관장을 능욕한 혐의를 씌워 형추(刑推)를 가하고, 이에 맞서 춘향은 법의 부당한 적용을 항의하고, 수청 요구를 유부녀를 겁간(劫姦)하는 범죄라고 맞선다. 흥미롭게도 이 과정에서 관장이 소속 관청의 기생에게 수청을 요구하는 것은 위법 행위라는 점이 문제로 제기되지 않으며, 사욕(私慾)을 위해 법을 남용하는 변학도의 행위와 춘향의 새로운 법의식이 더 부각된다. 춘향과 결연한 이몽룡이 암행어사 출도를 하여 변학도를 봉고파직(封庫罷職)하고 춘향을 구출하는 것은 어사의 권한을 사적(私的) 목적으로 이용한 혐의를 피하기 어렵다. 그러나 서술자나 남원 민중과 국왕 등 작중 인물들은 이를 문제 삼지 않는다. 변학도와 이몽룡의 법 집행에 대한 이러한 상이한 평가는 작중 인물들과 독자들의 법감정(法感情)에 의한 것으로 이해된다. 즉 이몽룡과 춘향의 새로운 사랑과 춘향의 인권 의식에 공감하는 관점에서 변학도는 징치되어야 마땅하다고 보는 법감정이 형성되었고, 암행어사 출도는 오히려 이 법감정에 극적 쾌감을 주는 장치로 수용된 것으로 볼 수 있다. 따라서 춘향과 이몽룡의 사랑은 당시의 실정법을 넘어서는 새로운 법감정을 동반하는 것으로 해석할 수 있으며, 이 법감정은 춘향의 인권의식에 대한 공감에 기초해 있다고 볼 수 있다.

저소득층 방문간호 관리를 위한 제안 - 강북구 방문간호 대상자를 중심으로- (A Proposal on a Management Model Applicable to Visiting Nursing Program for a Low-income Group)

  • 고미자
    • 한국보건간호학회지
    • /
    • 제10권1호
    • /
    • pp.118-138
    • /
    • 1996
  • Because of accelerated urbanization public body visiting nursing project that started according as matter of health on urban class in the lower brackets of income was concentrated on Social interests has a unsatisfied points to propel project efficiently from the lack of rating materials. Therefore centering around written contents in documentary literature of citizen health by household in five years from starting year of project to now. visiting frequency by medical manpower was evaluated quantitatively and qualitatively in aspect of management hereupon. for the sake of giving a basic materials for public health project of this field. This research presents documentary literature of citizen health which become materials is that as one person's charged region of nurse in duty scale. district is Kang-Buck Gu. the object is resident in the lower brackets of income grounded livelihood protection law and who is admitted by the head of organ~chief of health care). and the number of material centering around the head of a household is 415 copy. The result of research is summarized. as follow. 1. Average visiting frequency examinated by medical manpower show difference according to valuables of supervision characteristics namely average visiting. Frequency of nurse has long term residence in case registration season is early and supervision season is the first year and is high incase a kind of house is unlicdnsed mountain town. Average visiting frequency with doctor is high incase supervision season is the first year and the medical insurance system is admitted by chief of health care. That shows that a man of discomfort behavior left alone are yet many in local society. The meaning of this result shows that the continuity of official relation about class in the lowest brackets of income of long term residence goes well between househole who is a user of visiting nursing service of the object according to midway income under management influences a given duty of nurse s and so causes quantitative decrease. 2. In case behavier and condition of health that nurse diagnoses are bad. as the type matter is a lack of health and the number of patient is large. the average visiting frequency of nurse is high. because average visiting frequency with doctor is high as the condition of health is bad and the number of patient is large. That is similar with that of nurse. CD Average visiting frequency of nurse s seen by matter of disease is very high only in apoplexy by 39.50 and is confined within limits from 7.63 to 11.36 in other disease. But average visiting frequency with doctor is double as many as that of nurse but defined in apoplexy hypertension and articulate. (1) Average visiting frequency of nurse by existence in inoculation of hepatitis is low by 6.73 in unidentified group and very high by 26.89 in group of non-inoculation and the case of the antigenic positive man of B type hepatitis or epileptic who can't be inoculated shows 13.00 and that even family nursing service is needed to them. That result shows that though one person nurse of local charge has a large scale of duty. as visting nursing service is given a class who has a large demand preferentially by respectively accurate nursing diagnosis. the number of diagnosis service is similar with it. 3. During five years. average visiting frequency of nurse is 10.84 and average visiting frequency with doctor is 76.50 seeing from the official scale of nurse. visiting by household is performed two more per year to the average. Seeing this by type of service. average visiting frequency of nurse is higher in indirectly nursing than in directly nursing and that suggests that at the time of visiting household nurse performs education of protection lively save patient but at the time of contrastedly visiting with doctor. directly nursing is more contents of service show no difference by man power and medication dressing by demand is 14.3 and 18.6 the aid of hardship term of doctor and nurse is high by 18.7 and 17.00 in the request of hospitalization when seeing by demands. 4. Action by turns exemplified 1994 is well in sequence of 2/4 turn. 3/4 turn. 1/4 turn. 4/4 turn. When seen by average visiting frequency of nurse but gradually is even. Without difference by turns. average visiting frequency of doctor is much higher in 1/4 turn than other turns. Type of service by turns is all even but directly nursing is inactive in 4/4 and indirectly nursing. Very increases in 4/4 and so. Nurse's quantity of duty is plentiful that shows that by evaluation of last turn and plan of project. Contents of service follows that medication and dressing is the highest by' 5.57 in 1/4turn. goes down gradually by turn. becomes 3.57 in 3/4 turn. and increases again by 4.83 in 4/4 turn. the rest service is higher in 2/4 turn than other turns. 5. Total visiting frequency of nurse is explained to total $37.5\%$ by six valuables of visiting frequency of doctor. nursing demand. demand of diagnosis. condition of behavior. year. Special terms and magnitude of influential power is the same as sequence of enumerated valuables. Namely. the higher the visiting frequency of doctor. the bigger nursing and demand of diagnosis is. the worse the condition of behavior is. the older the object is and the more the household of special terms is. the high total visiting frequency of nurse is.

  • PDF

로봇 인터페이스 활용을 위한 가속도 센서 기반 제스처 인식 (Accelerometer-based Gesture Recognition for Robot Interface)

  • 장민수;조용석;김재홍;손주찬
    • 지능정보연구
    • /
    • 제17권1호
    • /
    • pp.53-69
    • /
    • 2011
  • 로봇 자체 또는 로봇에 탑재된 콘텐츠와의 상호작용을 위해 일반적으로 영상 또는 음성 인식 기술이 사용된다. 그러나 영상 음성인식 기술은 아직까지 기술 및 환경 측면에서 해결해야 할 어려움이 존재하며, 실적용을 위해서는 사용자의 협조가 필요한 경우가 많다. 이로 인해 로봇과의 상호작용은 터치스크린 인터페이스를 중심으로 개발되고 있다. 향후 로봇 서비스의 확대 및 다양화를 위해서는 이들 영상 음성 중심의 기존 기술 외에 상호보완적으로 활용이 가능한 인터페이스 기술의 개발이 필요하다. 본 논문에서는 로봇 인터페이스 활용을 위한 가속도 센서 기반의 제스처 인식 기술의 개발에 대해 소개한다. 본 논문에서는 비교적 어려운 문제인 26개의 영문 알파벳 인식을 기준으로 성능을 평가하고 개발된 기술이 로봇에 적용된 사례를 제시하였다. 향후 가속도 센서가 포함된 다양한 장치들이 개발되고 이들이 로봇의 인터페이스로 사용될 때 현재 터치스크린 중심으로 된 로봇의 인터페이스 및 콘텐츠가 다양한 형태로 확장이 가능할 것으로 기대한다.

"삼국사기(三國史記)"에 기록된 의약내용(醫藥內容) 분석 (Study on Medical Records In ${\ulcorner}$the Historical Records of the Three Kingdoms${\lrcorner}$)

  • 신순식;최환수
    • 제3의학
    • /
    • 제2권1호
    • /
    • pp.35-54
    • /
    • 1997
  • We tried to observe the features of ancient medical practice by analysing the records related to medicine in the book, ${\ulcorner}$the Historical Records of the Three Kingdom${\lrcorner}$ of which content includes the features of medicine in mythology, plague, delivery of twins, drugs, medical system, shamanism, constitutional medicine, psychiatry, forensic medicine, deformity, a spa, medical phrase, health and welfare work, religion, death. physiological anatomy, Taoist medicine, acupuncture, the occult af of transformation and etc. Our initial concern was about where to draw line as of medical field and we defined medicine in more broad meaning. The book ${\ulcorner}$the Historical Records of the Three Kingdoms${\lrcorner}$ describes the world of mythology by way of medicine which is not clearly a conventional one. There appears records of birth of multiple offsprings 7 times in which cases are of triplets or more. Delivering multiple offsprings were rare phenomenon though such fertility was highly admired. This shows one aspect of ancient country having more population meant more power of the nation. Of those medical records conveyed in that book includes stories of childbirth such as giving birth to a son after praying, giving birth to Kim Yoo-shin after 20 months after mother's dream of conception, and a song longing for getting a laudable child. Plagues were prevalent throughout winter to spring season and one can observe various symptoms of plagues in the record. Of these epidemic diseases, cold type might have been more common than the heat one. Appearance of epidemic diseases frequently coincided with that of natural disasters that this suggests a linkage between plague and underlying doctrine on five elements' motion and six kinds of natural factors. There exists only a few names of diseases such as epidemic disease, wind disease, and syndrome characterized by dyspnea. Otherwise there appeared only afflictions that were not specified therefore it remains cluless to keep track of certain diseases of prevalence. Since this ${\ulcorner}$Historical Records of the Three Kingdoms'${\lrcorner}$ wasn't any sort of medical book, words and terms used were not technical kind and most were the ones used generally among lay people. Therefore any mechanisms of the diseases were hardly mentioned. Some of medicinal substances such as Calculus Bovis, Radix Ginseng, Gaboderma Luciderm, magnetitum were also in use in those days. 53 kinds of dietary supplies appears in the records and some of these might have been used as medicinal purpose. Records concerning dicipline of one's body includes activities such as hunting, archery, horseback riding etc. In Shilla dynasty there were positions such as professor of medicine, Naekongbong(內供奉), Kongbong's doctor(供奉醫師), Kongbong's diviner(供奉卜師). As an educational facility, medical school was built at the first year of King Hyoso's reign and it's curricula included various subjects as ${\ulcorner}$Shin Nong's Herbal classic${\lrcorner}$, ${\ulcorner}$Kabeul classic of acupuncture and moxbustion${\lrcorner}$, ${\ulcorner}$The Plain Questions of the Yellow Emperor's Classic of Internal Medicine${\lrcorner}$, ${\ulcorner}$Classic of Acupuncturer${\lrcorner}$, ${\ulcorner}$The Pulse Classic${\lrcorner}$, ${\ulcorner}$Classic of Channels and Acupuncture Points${\lrcorner}$ and ${\ulcorner}$Difficult Classic${\lrcorner}$. There were 2 medical professors who were in charge of education. To establish pharmacopoeia, 2 Shaji(舍知), 6 Sha(史), 2 Jongshaji(從舍知) were appointed. In Baekje dynasty, Department of Herb was maintained. Doing praying for the sake of health, doing phrenology also can be extended to medical arena. Those who survived over 100 years of age appear 3 times in the record, while 98 appears once. The earliest psychiatrist Nokjin differentiated symptoms to apply either therapies using acupuncture and drug or psychotherapy. There appears a case of rape, a case of burying alive with the dead, 8 cases of suicide that can characterize a prototype of forensic medicine. Deformity-related records include phrases as follow: 'there seems protrudent bone behind the head', 'a body which has two heads, two trunks, four arms.', 'a body equipped with two heads' In those times spa can be said to be used as a place for he리ing, convalescence, and relaxation seeing the records describing a person pretended illness and went to spa to enjoy with his friends. Priest doctors and millitary surgeons were in charge of the medical sevice in the period of the Three Kingdoms by the record written by Mookhoja(墨胡子) and Hoonkyeom(訓謙). Poor diet and regimen makes people more vulnerable to diseases. So there existed charity services for those poor people who couldn't live with one's own capacity such as single parents, orphans, the aged people no one to take care and those who are ill. The cause of affliction was frequently coined with human relation. There appeared the phenomenon of releasing prisoners and allowing people to become priests at the time of king's suffering. Besides, as a healing procedure, sutra-chanting was peformed. There appears 10 cases of death related records which varies from death by drowning, or by freezing, death from animals, death from war, death from wightloss and killing oneself at the moment of spouse's death and etc. There also exist certain records which suggest the knowledge of physiology and anatomy in those times. Since the taoist books such as ${\ulcorner}$Book of the Way and Its Power(老子道德經)${\lrcorner}$ were introduced in the period of Three Kingdoms, it can be considered that medicine was also influenced by taoism. Records of higher level of acupuncture, records which links the medicine and occult art of transformation existed. Although limited, we could figure out the medical state of ancient society.

  • PDF

추후관리가 필요한 만성질환 퇴원환자 가정간호 시범사업 운영 연구 (An Operations Study on a Home Health Nursing Demonstration Program for the Patients Discharged with Chronic Residual Health Care Problems)

  • 홍여신;이은옥;이소우;김매자;홍경자;서문자;이영자;박정호;송미순
    • 대한간호학회지
    • /
    • 제20권2호
    • /
    • pp.227-248
    • /
    • 1990
  • The study was conceived in relation to a concern over the growing gap between the needs of chronic patients and the availability of care from the current health care system in Korea. Patients with agonizing chronic pain, discomfort, despair and disability are left with helplessly unprepared families with little help from the acute care oriented health care system after discharge from hospital. There is a great need for the development of an alternative means of quality care that is economically feasible and culturally adaptible to our society. Thus, the study was designed to demonstrate the effectiveness of home heath care as an alternative to bridge the existing gap between the patients' needs and the current practice of health care. The study specifically purports to test the effects of home care on health expenditure, readmission, job retention, compliance to health care regime, general conditions, complications, and self-care knowledge and practices. The study was guided by the operations research method advocated by the Primary Health Care Operations Research Institute(PRICOR) which constitutes 3 stages of research : namely, problem analysis solution development, and solution validation. The first step in the operations research was field preparation to develop the necessary consensus and cooperation. This was done through the formation of a consulting body at the hospital and a steering committee among the researchers. For the stage of problem analysis, the Annual Report of Seoul National University Hospital and the patients records for last 5 years were reviewed and selective patient interviews were conducted to find out the magnitude of chronic health problems and areas of unmect health care needs to finally decide on the kinds of health problems to study. On the basis of problem analysis, the solution development stage was devoted to home care program development asa solution alternative. Assessment tools, teaching guidelines and care protocols were developed and tested for their validity. The final stage was the stage of experimentation and evaluation. Patients with liver diseases, hemiplegic and diabetic conditions were selected as study samples. Discharge evaluation, follow up home care, measurement and evaluation were carried out according to the protocols of care and measurement plan for each patient for the period of 6 months after discharge. The study was carried out for the period from Jan. 1987 to Dec. 1989. The following are the results of the study presented according to the hypotheses set forth for the study ; 1. Total expenditures for the period of study were not reduced for the experimental group, however, since the cost per hospital visit is about 4 times as great as the cost per home visit, the effect of cost saving by home care will become a reality as home care replaces part of the hospital visits. 2. The effect on the rate of readmission and job retention was found to be statistically nonsignificant though the number of readmission was less among the experimental group receiving home care. 3. The effect on compliance to the health care regime was found to be statistically significant at the 5% level for hepatopathic and diabetic patients. 4. Education on diet, rest and excise, and medication through home care had an effect on improved liver function test scores, prevention of complications and self - care knowledge in hepatopathic patients at a statistically significant level. 5. In hemiplegic patient, home care had an effect on increased grasping power at a significant level. However. there was no significant difference between the experimental and control groups in the level of compliane, prevention of complications or in self-care practices. 6. In diabetic patients, there was no difference between the experimental and control groups in scores of laboratory tests, appearance of complications, and self-care knowledge or self -care practices. The above findings indicate that a home care program instituted for such short term as 6 months period could not totally demonstrate its effectiveness at a statistically significant level by quantitative analysis however, what was shown in part in this analysis, and in the continuous consultation sought by those who had been in the experimental group, is that home health care has a great potential in retarding or preventing pathological progress, facilitating rehabilitative and productive life, and improving quality of life by adding comfort, confidence and strength to patients and their families. For the further studies of this kind with chronic patients it is recommended that a sample of newly diagnosed patients be followed up for a longer period of time with more frequent observations to demonstrate a more dear- cut picture of the effectiveness of home care.

  • PDF