• Journal of Internet of Things and Convergence
• /
• v.9 no.2
• /
• pp.19-31
• /
• 2023

The importance of barrier free is being highlighted worldwide. This study attempted to identify barrier-free research trends using text mining. Through this, it was intended to help with research and policies to create a barrier free environment. The analysis data is 227 papers published in domestic academic journals from 1996 when barrier free research began to 2022. The researcher converted the title, keywords, and abstract of an academic thesis into text, and then analyzed the pattern of the thesis and the meaning of the data. The summary of the research results is as follows. First, barrier-free research began to increase after 2009, with an annual average of 17.1 papers being published. This is related to the implementation guidelines for the barrier-free certification system that took effect on July 15, 2008. Second, results of barrier-free text mining i) As a result of word frequency analysis of top keywords, important keywords such as barrier free, disabled, design, universal design, access, elderly, certification, improvement, evaluation, and space, facility, and environment were searched. ii) As a result of TD-IDF analysis, the main keywords were universal design, design, certification, house, access, elderly, installation, disabled, park, evaluation, architecture, and space. iii) As a result of N-Ggam analysis, barrier free+certification, barrier free+design, barrier free+barrier free, elderly+disabled, disabled+elderly, disabled+convenience facilities, the disabled+the elderly, society+the elderly, convenience facilities+installation, certification+evaluation index, physical+environment, life+quality, etc. appeared in a related language. Third, as a result of the CONCOR analysis, cluster 1 was barrier-free issues and challenges, cluster 2 was universal design and space utilization, cluster 3 was Improving Accessibility for the Disabled, and cluster 4 was barrier free certification and evaluation. Based on the analysis results, this study presented policy implications for vitalizing barrier-free research and establishing a desirable barrier free environment.

• 한국노년학
• /
• v.29 no.2
• /
• pp.629-643
• /
• 2009

The purpose of this study is, by using the demographic variables, to identify self-efficacy, social support, and quality of life of the elderly with depression and to assess the impacts of these factors upon their quality of life. By analyzing the factors which have an impact upon the life quality of the elderly with depression, this study aims to provide important information which help understand them, and to find out what kind of care is necessary for their happy and satisfactory life. The study took purposive sampling and survey of 215 people among the elderly with depression who were under care of the outpatient clinics, day hospitals, and mental health clinics located in Seoul and Kyunggi Province, Korea. This study was conducted from November 10th to 20th, 2008 and the data were collected using the questionnaires of self-efficacy, social support, and quality of life scales. Using a SPSS/WIN 15.0 program, the analysis of the data showed the following results. First, among the demographic characteristics, the elderly with depression who were male, had spouse, higher education, no public assistance, shorter period of depression, and were healthy turned out to have higher self-efficacy. In terms of social support, the participants who had higher education, no public assistance, and were healthy turned out to have more social support. Further, in terms of quality of life, the variables of spouse, public assistance, period of depression, and health condition were statistically significant. Second, as a result of hierarchical regression, it appeared that the elderly with depression, who had higher self-efficacy, more social support, spouse, good health, no public assistance, and shorter period of depression, turned out to have higher quality of life. Based on the study findings, the implications of social work practice, policy, and future research were discussed.

• 한국노년학
• /
• v.31 no.3
• /
• pp.505-526
• /
• 2011

The purposes of this paper were to examine the level of knowledge of and attitudes toward the elderly and investigate the differences in the level of knowledge of and attitudes about the elderly by selected socio-demographic factors and aging related factors in Korea and the United States. The research subjects were 1129 college students attending 10 schools in Korea and the United States(840 Korean students in 5 schools, located in Seoul City, Gyeonggi-Do, Chungcheong-Do in Korea and 289 American students in 5 schools located in the State of New York of the United States). They were interviewed, using the structured questionnaire, and the data were analyzed by SPSS 15.0 for Windows. The research questionnaire was composed of Fact on Aging Quiz Part 1(FAQ 1) developed by Palmore(1998), Semantic Differential Scale development by Sanders et al., and several socio-demographic and aging related variables. The results indicated that, first, the level of knowledge of the elderly for Korean students was 12.51/25 and for American students was 11.57/25, resulting that the knowledge level of the elderly in Korea was higher than that of the United States. In addition, the results of students' knowledge differences between korea and the United States showed that Korean students showed high ratio of correct answer in 9 questions while American students showed high ratio of correct answer in only 4 questions, resulting that Korean students have higher knowledge than American students. Second, the level of attitudes toward the elderly for Korean students was 77.54 and for American students was 70.07 in 20-140 points, resulting that the attitude level of the elderly among American students were more positive than that of Korean students. The results of students' attitudes differences between Korea and the United States showed that Korean students responded positive tendency in only one question while American students responded positive tendencies in 14 questions, resulting that American students were more positive attitudes toward the elderly than that of Korean students. Third, there is a significant correlation between the knowledge of and attitudes toward the elderly in both Korean and American students. Based on these results, implications for policy, practice, and research were further discussed.

• Journal of Environmental Impact Assessment
• /
• v.32 no.6
• /
• pp.533-544
• /
• 2023

The Ministry of Agriculture, Food and Rural Affairs has been promoting policies to strengthen the functions of rural centers (culture, welfare, economy, education, etc.) and to ensure that services from the centers are delivered to and connected to hinterland villages. For this policy purpose, the rural center revitalization project and the basic living base creation project within the rural development projects are being promoted. However, in the process of carrying out the actual project, as the focus is on strengthening the functions of rural centers, service delivery and connection with hinterland villages are not being actively promoted. therefore, in this study, we analyze the projects previously carried out in Jeoksang-myeon, Muju-gun and the regional status, analyze the reasons why hinterland village services were not connected and activated, and propose a direction for the second phase of the basic living base creation project to be carried out in the future. As a result of analyzing the reasons for the failure of hinterland village services to be activated, problems such as disadvantages in accessing services due to dispersed residence in rural areas and limitations in topographical structure, and the lack of a service delivery system to develop demand in hinterland areas were found to be problems. Improvement measures were derived as follows. First, it is a stepping stone construction plan proposed to overcome topographical limitations. Establish a stepping base that will function as a service intermediate terminal to ensure efficient service delivery. Second, for a rational decision-making structure, we proposed a plan for deploying communication channels that could closely collect local opinions by operating various small-scale communities along with the efficient composition of a resident committee that includes residents of the central and hinterland villages and various classes. Third, it is a virtuous cycle of local manpower training plans that train local residents into professional instructors. We aim to complete a sustainable, resident-led service supply system by nurturing the most important service deliverers, that is, activists, in service delivery.

• Journal of Korean Society of Forest Science
• /
• v.20 no.1
• /
• pp.1-44
• /
• 1973

Needless to say, the management of national forest in all countries is very important in view of the national mission and management purposes. Korean national forest is also in particular significant in promoting national economy for the continuous increasing of the demand for wood, conservation of the land and social welfare. But there's no denying the fact that the leading aim of the Korean forest policy has been based upon the conservation of forest resources and recovery of land conservation function instead of improvement of the forest productive capacity. Therefore, the management of national forest should be aimed as an industry in the chain of the Korean national economy. And the increment of the forest productive capacity based on rationalized forest management is also urgently needed. Not only the increment of the timber production but also the establishment of the good forest in quality and quantity are to bring naturally many functions of conservation and other public benefits. In 1908 Korean national forest was historically established for the first time as a result of the notification for ownership, and was divided into two kinds in 1911-1924, such as indisposable national forest for land conservation, forest management, scientific research and public welfare, and the other national forest to be disposed. Indisposable forest is mostly under the jurisdiction of national forest stations (Chungbu, Tongbu, Nambu), and the tother national forests are under custody of respective cities and provinces, and under custody of the other government authorities. As of the end of 1971, national forest land is 19.5% (1,297,708 ha) of the total forest land area, but growing stock is 50.1% ($35,406,079m^3$) of the total forest growing stock, and timber production of national forest is 23.6% ($205,959m^3$) of the year production of total timber in Korea. Accordingly, it is the important fact that national forest occupies the major part of Korean forestry. The author positively affirms that success or failure of the management of national forest controls rise or fall of forestry in Korea. All functions of forest are very important, but among others the function of timber production is most important especially in Korea, that unavoidably imports a large quantity of foreign wood every year (in 1971 import of foreign wood-$3,756,000m^3$, 160,995,000 dollars). So, Korea urgently needs the improvement of forest productive capacity in national forest. But it is difficult that wood production meets the rapid increase of demand for wood to the development of economy, because production term of forestry is long, so national forest management should be rationalized by the effective investment and development of forestry techniques in the long view. Although Korean national forest business has many difficulties in the budget, techniques and the lack of labour due to outflow of rural village labour by development of national economy, and the increase of labour wages and administrative expenses etc. the development of national forest depends on adoption of the suitable forest techniques and management adapted for social and economical development. In this view point the writer has investigated and analyzed the status of the management of national forest in Korea to examine the irrational problems and suggest an improvement plan. The national forestry statistics cited in this study is based on the basic statistics and the statistics of the forest business as of the end of 1971 published by Office of Forestry, Republic of Korea, and the other depended on the data presented by the national forest stations. The writer wants to propose as follows (seemed to be helpful in improvement of Korean national forest management). 1) In the organization of national forest management, more national forest stations should be established to manage intensively, and the staff of working plan officials should be strengthened because of the importance of working plan. 2) By increasing the staff of protection officials, forest area assigned for each protection official should be decreased to 1,000-2,000 ha. 3) The frequent personnel changes of supervisor of national forest station(the responsible person on-the-spot) obstructs to accomplish the consistent management plan. 4) In the working plan drafting for national forest, basic investigations should be carefully practiced with sufficient expenditure and staff not to draft unreal working plan. 5) The area of working-unit should be decreased to less than 2,000 ha on the average for intensive management and the principle of a working-unit in a forest station should be realized as soon as possible. 6) Reforestation on open land should be completed in a short time with a debt of the special fund(a long term loan), and the land on which growing hardwood stands should be changed with conifers to increase productivity per unit area, and at the same time techical utilization method of hardwood should be developed. 7) Expenses of reforestation should be saved by mechanization and use of chemicals for reforestation and tree nursery operation providing against the lack of labour in future. 8) In forest protection, forest fire damage is enormous in comparison with foreign countries, accordingly prevention system and equipment should be improved, and also the minimum necessary budget should be counted up for establishment and manintenance of fire-lines. 9) Manufacture production should be enlarged to systematize protection, processing and circulation of forest business, and, by doing this, mich benefit is naturally given for rural people. 10) Establishment and arrangement of forest road networks and erosion control work are indispensable for the future development of national forest itself and local development. Therefore, these works should be promoted by the responsibility of general accounting instead of special accounting. 11) Mechanization of forest works should be realized for exploiting hinterlands to meet the demand for timber increased and for solving lack of labour, consequently it should promote import of forest machines, home production, training for operaters and careful adminitration. 12) Situation of labour in future will grow worse. Therefore, the countermeasure to maintain forest labourers and pay attention to public welfare facilities and works should be considered. 13) Although the condition of income and expenditure grows worse because of economical change, the regular expenditure should be fixed. So part of the surplus fund, as of the end of 1971, should be established for the fund, and used for enlarging reforestation and forest road networks(preceding investment in national forest).

• Journal of agricultural medicine and community health
• /
• v.26 no.2
• /
• pp.59-78
• /
• 2001

Data on reported cancer mortality in the Gyeongsangbuk- do province from 1991 to 1998 were collected and analyzed using the existing mortality reporting system as well as the public health network to furnish accurate data on reported cancer death and to collect data to establish a high quality district health plan. The overall crude death rate in Gyeongsangbuk province in 1991 was 74.56 deaths per 100,000-person but this rate increased to 79.22 in 1998. Among the deaths, the overall death rate of cancer was 16.7% in 1991, which increased to 19.3% in 1998; specifically the death rate of men increased from 19.4% in 1991 to 22.3% in 1998 while that of women increased from 12.4% in 1991 to 15.5% in 1998, showing a more increase among women. The types of cancer and associated death rates in 1991 were gastric cancer(41.5%), followed by liver cancer (28.8%), and lung and bronchogenic carcinoma(8.7%) and in 1998, gastric cancer (24.7%), followed by liver cancer(22.7%), lung and bronchogenic carcinoma(19.3%), showing the same order. For men and women, gastric cancer(40.2% and 44.7%, respectively) was the most common cancer death, followed by liver cancer(33.7% and 16.7%, respectively), and lung and bronchogenic carcinoma(10.2% and 5.0%, respectively) in 1991. However, in 1998, gastric cancer(27.8%) was still the most common type among both men and women, followed by liver cancer (18.5%) and lung and bronchogenic carcinoma(12.7%), showing the most decrease in gastric cancer but most increase in lung and bronchogenic carcinoma. The age- adjusted mortality rates by gastric cancer, hepatoma, laryngeal carcinoma were decreased in both male and female, and also uterine cancer was decreased in female. The age- adjusted mortality rates by lung and bronchogenic carcinoma, pancreatic cancer, rectal cancer were increased in both male and female, and also breast cancer was increased in female. The calculated overall age-adjusted death rate based on the 1995 population was 84.25 in 1991, which decreased to 77.67 in 1998. Male death rate decreased significantly from 119.81 in 1991 to 101.82 in 1998 while the female death rate increased from 48.64 in 1991 to 53.80 in 1998. A census of cancer death rate using accurate death records is important for the establishment of proper and high-quality district health and medical plan and policy. The effort to improve the accuracy of death reports using the health facility network, as had been attempted by this study, can be continued. Furthermore, there must be a way for the Health and Welfare Department to use the death reports to improve the present reporting system. Lastly, additional studies need to be conducted to investigate how much the accuracy was improved by the supplemented death reports in this study.

• Journal of the Daesoon Academy of Sciences
• /
• v.36
• /
• pp.227-266
• /
• 2020

The purpose of this paper is to review the representative Buddhist policies enforced during the reign of Gwanghaegun (光海君), the 15th king of the Joseon Dynasty, and the aspects of the Buddhist community affected by them. Through this, the influence and dynamism of Buddhism during the reign of Gwanghaegun will be revealed. Some of the findings will run contrary to what is popularly known about Joseon Buddhism and the policy of Sungyueokbul (崇儒抑佛), 'Revering Confucianism and Supressing Buddhism.' During the Joseon Dynasty, Neo-Confucianism was taken as an ideological background, and consequently, Buddhism was ostracized by the ruling class who advocated the exclusion of heretical views. This also characterized King Gwanghaegun's reign during the Mid-Joseon Dynasty. In reality though, the ruling class held mixed opinions about Buddhism, and this influenced the Buddhist community in the Gwanghaegun Period. The military might of Japan demonstrated during the Japanese Invasion of Korea in 1592, led the ruling class to recognize Buddhism, and as a result, the status of Buddhism rose to a certain extent. Based on its elevated status and the aftermath of the Japanese Invasion of Korea, the Buddhist community engaged in social welfare activities inspired by the notion of requiting favors, and the Buddhist community gained recognition for providing relief services. As a result, the number of monks increased, and the economic situation improved as land ownership was granted to temples and monks. This is the means by which the Japanese Invasion of Korea influenced the Buddhist policies of the Gwanghaegun Period and changed the religious topography of Buddhism. During the reign of King Gwanghaegun, the ruling class regarded Buddhism as heretical, but offered posthumous titles to monks who engaged in meritorious services during the Japanese invasions of 1592~1598. Favorable and/or preferential treatment was also granted to some Buddhist monks. In addition, monks began to perform labor projects that demanded organizational and physical strength, such as those which related to national defense and architecture. However, throughout the Gwanghaegun Period, the monks were paid a certain amount of compensation for their labor, and the monks' responsibility for labor increased. This can be understood as a partial reconciliation with Buddhism or an acceptance of Buddhism rather than the suppression of Buddhism often presented by historians. As for policies which affected Buddhism, the Buddhist community showed signs of cooperation with the ruling class, the creation and reconstruction of temples, and the production of Buddhist art. Through close ties with the ruling class, Buddhism during the Gwanghaegun Period saw the Buddhist community actively responded policies that impacted Buddhism, and this allowed their religious orders to be maintained. In this way, it was also confirmed that the monk, Buhyu Seonsu (浮休 善修) and his disciple Byeogam Gakseong (碧巖 覺性), took up leadership roles in their Buddhist community. The Buddhist-aimed policies of Gwanghaegun were implemented against the backdrop of the Buddhist community, wherein the ruling class held mixed opinions regarding Buddhism. As such, both improvements and set backs for Buddhism could be observed during that time period. The ruling class actively utilized the organizational power of Buddhism for national defense and civil engineering after the Japanese invasions of 1592~1598. Out of gratitude, they implemented appropriate compensation for the Buddhists involved. The Buddhist community also responded to policies that affected them through exchanges with the ruling class. They succeeded in securing funds and support to repair and produce Buddhist temples and artworks. A thoughtful inspection of the policies towards and responses to Buddhism during the Gwanghaegun Period, shows that Buddhism actually enjoyed considerable organizational power and influence. This flies in the face of the general description of Joseon Buddhism as "Sungyueokbul (revering Confucianism and supressing Buddhism)."

• Asia Marketing Journal
• /
• v.14 no.2
• /
• pp.127-156
• /
• 2012

A lot of interest in the baby-boomer generation, those who were born after World War II, has emerged since their retirement has been accelerated. The retirement of baby-boomers has caused many health, public welfare, social policy and family relationship problems. However, their increased purchasing power has made them more attractive consumers than any other generation, and they have become a fascinating niche market in the depressed economy. This research selected middle-class women of the baby-boomer generation who have had powerful effects on society and have emerged as an attractive niche market, and attempted to understand their lives intensively. Based on research activities, the purpose of this research is to identify baby-boomer generation middle-aged women's life values. Qualitative research methodology was used to achieve research objectives, and this research aimed to suggest marketing implications to connected industries based on the research results. The research objectives are as follows. 1. understanding the lives of baby-boomer middle-class women who have powerful effects on socio-economic phenomena 2. identifying the life values of baby-boomer middle-class women 3. generating marketing implications based on an understanding of baby-boomer middle-class women's lives and life values This research conducted FGIs(focus group interviews), one of the qualitative research methodologies, to figure out baby-boomer middle-class women's life values intensively and selected 10 women living in Seoul for data collection. The qualitative data of collected FGIs were analyzed with spiral data analysis methodology proposed by Creswell(2007). The most effective factors to influence these middle-class women's lives powerfully were 'time' and 'independence'. Their consciousness of the importance of using time affects their life pattern generally, and their independence also impacts greatly on the way they exploit time and on their diverse relationships. They maximized their self-realization and showed long-term partnership with their surrounding circumstances because of those effective factors. Baby-boomer middle-class women's self-realization was divided into two areas. One was their outside activities and another was perfect management of their physical appearance and home interior. Like the results of this research, their need for social entrance will be reinforced more strongly since their internal and external activities aim for the achievement of self-realization. In addition, this research suggests that baby-boomer middle-class women's activities are connected with their management of their physical appearance and home interior decorations, and that such management is caused not only by a simple interest in fashion and beauty but also a profound desire for self-realization. On account of their consciousness, which is different from other generations, Korean baby-boomer middle-class women are able to maintain positive partnerships with their surrounding circumstances; however, they also show ambivalent emotions to retain effective partnerships. To overcome those stressful situations, they make greater efforts to keep up their health and youth, and also engage in diverse activities to maintain their mental health. Finally, they generate positive attitudes toward their economic situation and extra time to develop self-realization and pursue happy, youthful and healthy lives. Based on those results, this study suggests the following implications. First, industries targeting the baby-boomer generation should develop innovative products and services which help the baby-boomer generation maximize their efficiency of time since time is one of the most important factors powerfully impacting the baby-boomer generation. They will engage in various activities to fill up their extra time and consume helpful products and services. Second, such industries should supply the baby-boomer generation with opportunities which propose new ways of self-realization since this generation shows a great desire for self-realization because of their self-efficacy. With customized strategies of satisfying their needs, the baby-boomer generation would discover opportunities to utilize their abilities, relationships and aesthetic senses, and industries would develop a niche market. Third, market segmentations which target the baby-boomer generation's desire to maintain their physical appearance and home interior should be executed since such activities are the main strategies to develop this generation's self-realization. The baby-boomer generation's desire to study those areas would be expanded, and those education systems should produce innovative products and services targeting the baby-boomer generation. This implication also offers to government officials new policies related with the baby-boomer generation. This exploratory study utilized qualitative research methodology to understand baby-boomer middle-class women's lives, and proposed propositions and limitations for further researches. As for the limitations, first, it is hard to generalize the research results so that they may apply to all areas and economic classes of the baby-boomer generation since this research selected only 10 women living in Seoul for the data collection process. To overcome this limitation, extended data collections of subjects from diverse regions and economic classes should be designed. Second, quantitative research should be conducted to supplement the findings with validities. Third, this research focused on only general ideas of the baby-boomer generation's lives since the range of this study was focused on their overall lives. Therefore, intensive research related to specific areas of their lives should be conducted.

• Journal of Korean Academy of Nursing
• /
• v.3 no.1
• /
• pp.13-40
• /
• 1972

Much has teed changed in the field of hospital administration in the It wake of the rapid development of sciences, techniques ana systematic hospital management. However, we still have a long way to go in organization, in the quality of hospital employees and hospital equipment and facilities, and in financial support in order to achieve proper hospital management. The above factors greatly effect the ability of hospitals to fulfill their obligation in patient care and nursing services. The purpose of this study is to determine the optimal methods of standardization and quality nursing so as to improve present nursing services through investigations and analyses of various problems concerning nursing administration. This study has been undertaken during the six month period from October 1971 to March 1972. The 41 comprehensive hospitals have been selected iron amongst the 139 in the whole country. These have been categorized according-to the specific purposes of their establishment, such as 7 university hospitals, 18 national or public hospitals, 12 religious hospitals and 4 enterprise ones. The following conclusions have been acquired thus far from information obtained through interviews with nursing directors who are in charge of the nursing administration in each hospital, and further investigations concerning the purposes of establishment, the organization, personnel arrangements, working conditions, practices of service, and budgets of the nursing service department. 1. The nursing administration along with its activities in this country has been uncritical1y adopted from that of the developed countries. It is necessary for us to re-establish a new medical and nursing system which is adequate for our social environments through continuous study and research. 2. The survey shows that the 7 university hospitals were chiefly concerned with education, medical care and research; the 18 national or public hospitals with medical care, public health and charity work; the 2 religious hospitals with medical care, charity and missionary works; and the 4 enterprise hospitals with public health, medical care and charity works. In general, the main purposes of the hospitals were those of charity organizations in the pursuit of medical care, education and public benefits. 3. The survey shows that in general hospital facilities rate 64 per cent and medical care 60 per-cent against a 100 per cent optimum basis in accordance with the medical treatment law and approved criteria for training hospitals. In these respects, university hospitals have achieved the highest standards, followed by religious ones, enterprise ones, and national or public ones in that order. 4. The ages of nursing directors range from 30 to 50. The level of education achieved by most of the directors is that of graduation from a nursing technical high school and a three year nursing junior college; a very few have graduated from college or have taken graduate courses. 5. As for the career tenure of nurses in the hospitals: one-third of the nurses, or 38 per cent, have worked less than one year; those in the category of one year to two represent 24 pet cent. This means that a total of 62 per cent of the career nurses have been practicing their profession for less than two years. Career nurses with over 5 years experience number only 16 per cent: therefore the efficiency of nursing services has been rated very low. 6. As for the standard of education of the nurses: 62 per cent of them have taken a three year course of nursing in junior colleges, and 22 per cent in nursing technical high schools. College graduate nurses come up to only 15 per cent; and those with graduate course only 0.4 per cent. This indicates that most of the nurses are front nursing technical high schools and three year nursing junior colleges. Accordingly, it is advisable that nursing services be divided according to their functions, such as professional, technical nurses and nurse's aides. 7. The survey also shows that the purpose of nursing service administration in the hospitals has been regulated in writing in 74 per cent of the hospitals and not regulated in writing in 26 per cent of the hospitals. The general purposes of nursing are as follows: patient care, assistance in medical care and education. The main purpose of these nursing services is to establish proper operational and personnel management which focus on in-service education. 8. The nursing service departments belong to the medical departments in almost 60 per cent of the hospitals. Even though the nursing service department is formally separated, about 24 per cent of the hospitals regard it as a functional unit in the medical department. Only 5 per cent of the hospitals keep the department as a separate one. To the contrary, approximately 12 per cent of the hospitals have not established a nursing service department at all but surbodinate it to the other department. In this respect, it is required that a new hospital organization be made to acknowledge the independent function of the nursing department. In 76 per cent of the hospitals they have advisory committees under the nursing department, such as a dormitory self·regulating committee, an in-service education committee and a nursing procedure and policy committee. 9. Personnel arrangement and working conditions of nurses 1) The ratio of nurses to patients is as follows: In university hospitals, 1 to 2.9 for hospitalized patients and 1 to 4.0 for out-patients; in religious hospitals, 1 to 2.3 for hospitalized patients and 1 to 5.4 for out-patients. Grouped together this indicates that one nurse covers 2.2 hospitalized patients and 4.3 out-patients on a daily basis. The current medical treatment law stipulates that one nurse should care for 2.5 hospitalized patients or 30.0 out-patients. Therefore the statistics indicate that nursing services are being peformed with an insufficient number of nurses to cover out-patients. The current law concerns the minimum number of nurses and disregards the required number of nurses for operation rooms, recovery rooms, delivery rooms, new-born baby rooms, central supply rooms and emergency rooms. Accordingly, tile medical treatment law has been requested to be amended. 2) The ratio of doctors to nurses: In university hospitals, the ratio is 1 to 1.1; in national of public hospitals, 1 to 0.8; in religious hospitals 1 to 0.5; and in private hospitals 1 to 0.7. The average ratio is 1 to 0.8; generally the ideal ratio is 3 to 1. Since the number of doctors working in hospitals has been recently increasing, the nursing services have consequently teen overloaded, sacrificing the services to the patients. 3) The ratio of nurses to clerical staff is 1 to 0.4. However, the ideal ratio is 5 to 1, that is, 1 to 0.2. This means that clerical personnel far outnumber the nursing staff. 4) The ratio of nurses to nurse's-aides; The average 2.5 to 1 indicates that most of the nursing service are delegated to nurse's-aides owing to the shortage of registered nurses. This is the main cause of the deterioration in the quality of nursing services. It is a real problem in the guest for better nursing services that certain hospitals employ a disproportionate number of nurse's-aides in order to meet financial requirements. 5) As for the working conditions, most of hospitals employ a three-shift day with 8 hours of duty each. However, certain hospitals still use two shifts a day. 6) As for the working environment, most of the hospitals lack welfare and hygienic facilities. 7) The salary basis is the highest in the private university hospitals, with enterprise hospitals next and religious hospitals and national or public ones lowest. 8) Method of employment is made through paper screening, and further that the appointment of nurses is conditional upon the favorable opinion of the nursing directors. 9) The unemployment ratio for one year in 1971 averaged 29 per cent. The reasons for unemployment indicate that the highest is because of marriage up to 40 per cent, and next is because of overseas employment. This high unemployment ratio further causes the deterioration of efficiency in nursing services and supplementary activities. The hospital authorities concerned should take this matter into a jeep consideration in order to reduce unemployment. 10) The importance of in-service education is well recognized and established. 1% has been noted that on the-job nurses. training has been most active, with nursing directors taking charge of the orientation programs of newly employed nurses. However, it is most necessary that a comprehensive study be made of instructors, contents and methods of education with a separate section for in-service education. 10. Nursing services'activities 1) Division of services and job descriptions are urgently required. 81 per rent of the hospitals keep written regulations of services in accordance with nursing service manuals. 19 per cent of the hospitals do not keep written regulations. Most of hospitals delegate to the nursing directors or certain supervisors the power of stipulating service regulations. In 21 per cent of the total hospitals they have policy committees, standardization committees and advisory committees to proceed with the stipulation of regulations. 2) Approximately 81 per cent of the hospitals have service channels in which directors, supervisors, head nurses and staff nurses perform their appropriate services according to the service plans and make up the service reports. In approximately 19 per cent of the hospitals the staff perform their nursing services without utilizing the above channels. 3) In the performance of nursing services, a ward manual is considered the most important one to be utilized in about 32 percent of hospitals. 25 per cent of hospitals indicate they use a kardex; 17 per cent use ward-rounding, and others take advantage of work sheets or coordination with other departments through conferences. 4) In about 78 per cent of hospitals they have records which indicate the status of personnel, and in 22 per cent they have not. 5) It has been advised that morale among nurses may be increased, ensuring more efficient services, by their being able to exchange opinions and views with each other. 6) The satisfactory performance of nursing services rely on the following factors to the degree indicated: approximately 32 per cent to the systematic nursing activities and services; 27 per cent to the head nurses ability for nursing diagnosis; 22 per cent to an effective supervisory system; 16 per cent to the hospital facilities and proper supply, and 3 per cent to effective in·service education. This means that nurses, supervisors, head nurses and directors play the most important roles in the performance of nursing services. 11. About 87 per cent of the hospitals do not have separate budgets for their nursing departments, and only 13 per cent of the hospitals have separate budgets. It is recommended that the planning and execution of the nursing administration be delegated to the pertinent administrators in order to bring about improved proved performances and activities in nursing services.

• Journal of Preventive Medicine and Public Health
• /
• v.20 no.1 s.21
• /
• pp.165-203
• /
• 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.