Research in Community and Public Health Nursing

Volume 1 (1); February 1989

Original Articles

Analysis of Nursing Personnel Distribution in Korean Local Societies and Their Jobs: Hwa Jung Kim, Hwa Jung Kim; J Korean Acad Community Health Nurs. 1989;1(1):7-23. Published online February 28, 1989

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Abstract PDF: To analyze the distribution and functions of nurses in nationwide local societies, this study was conducted from February 1986 to December 1988 by 0 researchers on 36 investigation units with four categories of nursing personnel including public health nurses, community health practitioners, school health teachers, and occupational health nurses working for industries from 9 regions. The results of this study can be summarized roughly as follows. 1. The total number of Korea's local society nurses was 10,734 including 4,311 public health nurses for public health centers, 2,038 community health practitioners for health clinics, 3,223 health teachers for schools, and 1,162 occupational health nurses for industries. 2. The region based distribution of local society nurses shows that bigger cities have more nurses but the number of their nurses per population is small. 3. As for the number of people per local society nurse, one public health nurse is in charge of 11,759 local people, one community health practitioner 1,875 people, one health teacher 1,733 students, and one occupational health nurse 1,766 workers. Thus, one local society nurse is in charge of about 1,700 persons in all the fields and one health nurse about 10,000. 4. The number of patients cared by one local society nurse is about 8~9. 5. Health problems dealt with by local society nurses include ones frequently seen among common people such as mother-child health (MCH), family planning, tuberculosis, and epidemic control in the case of public health nurses, as well as stomachache, duodenal ulcer, upper airway infection, skin symptoms, mother-child health, environmental sanitation etc. in the case of health teachers, community health practitioners, and industrial nurses. 6. As for jobs done by local society nurses, only public health nurses addressed several special duties ordered by the government including clarification of problems with public MCH services, family planning, tuberculosis treatment services, and epidemic control, as well as health education and administrative jobs, while health teachers, community health practitioners, and industrial nurses diagnosed people in their regions, schools, and industries, based on which they made plans and carried out them, and dealt with human health care, health education, environmental sanitation management, and running health organizations and centers (health clinics, school infirmaries, and medical rooms). Based on the results of this study so far, we can conclude that there are about 10,700 local society nurses in Korea, and each of them is in charge of about 1,700 people with about 10 patients cared a day by one nurse. They nurse patients on the base of their symptoms, diagnose local society residents through travelling, visiting, development and running of local society health organizations, make plans, care their populations' health, and carry out health education and environmental sanitation jobs.

A Study on the Distribution of Health Clinic Nursing Personnel and the Conditions of Health Service Delivery: Myeong Sun Kim; J Korean Acad Community Health Nurs. 1989;1(1):25-44. Published online February 28, 1989

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Abstract PDF: This study by the research team from Local Nursing Branch Association about public health centers has investigated the conditions of health service delivery carried out by public health centers nursing personnel on the quantitative side in order to provide basic data needed for a reasonable plan for providing nursing personnel for public health clinics. The results of this study are as follows. 1. The Distribution of Nursing Personnel over Public Health Centers in Each Region and in Each Service Area 1) 'As of the end of 1986, a total of 3,065 nurses were working for 225 public health centers nationwide. Of them, 481 (15.6%), the greatest number, were assigned to centers in Seoul, and 41 (1.3%), the least number, to centers in Jeju-do. As for service areas, 789 nurses (24%), the greatest number, were assigned to the area of family planning, and 103 (3%), the least number, to the area of leprosy control. The nationwide reinforcement ratio of the nursing personnel was 97% as of the end of 1986. As for the reinforcement ratio in each region, it was a 100% level in Busan, Chungbuk, and Jeonbuk while it was 91%, the lowest ratio, in Gyeongbuk. As for the ratio in each service area, it was over 100% in leprosy control and other service areas, and 93%, the lowest ratio, in the mother-child health 2) As for the distribution ratio of nursing personnel in public health centers based on their statuses, Of 3,065 workers in total, 2,99 were nurses and 866 other personnel (nursing auxiliaries + other officially recruited personnel). Thus, the ratio between nurses and other personnel was about 3:1. As for the distribution ratio between nurses and other personnel in each region, it was 79:1, the highest ratio, in Seoul, while it was 1:1, the lowest one, in Chungbuk. As for the ratio in each service area, it was 8:1, the highest ratio, in the diagnostic area, while it was 0.2:1, the lowest one, in leprosy control. 2. The numbers of populations and households to be cared by public health center nursing personnel As of October 1985, the number of nurses per population consisting of 100,000 people was 5, and that of other personnel per the same sized population was 2. The number of nurses for 10,000 households was 2, and that of other personnel for the same number of households was 1. The region that had the greatest number (7) of nurses per population of 100,000 people was Gangwon-do, while it was Incheon that had the least number (2). On the other hand, the region that had the greatest number (5) of other personnel for 100,000 people was Chungbuk, and Seoul had the least number (0.1). 3. The number of services provided by one public health nurse in each region and in each service area 1) As of the end of 1986, the nationwide average number of services per public health nurse was 235 annually, 20 monthly, and 1 daily in the tuberculosis control area. As for the region-based number of services, public health nurses provided the greatest number of services in Seoul, in that they provided 2,131 services annually in average, 178 monthly, and 7 daily. 2) As of the end of 1986, the nationwide average number of services per public health nurse was 1,129 annually, 94 monthly, and 4 daily in the family planning area. As for the region-based number of services, public health nurses provided the greatest number of services in Incheon, in that they provided 2,423 services annually, 202 monthly, and 8 daily. 3) As of the end of 1986, the nationwide average number of services per public health nurse was 1,660 annually, 138 monthly, and 6 daily in the mother-child health area. As for the region-based number of services, public health nurses provided the greatest number of services in Busan, in that they provided 8,760 services annually, 730 monthly, and 29 daily. 4. Service Delivery Ratios for Service Receivers in Service Areas 1) The number of service receivers in the tuberculosis control area as of the end of 1985 was 804,605 nationwide, and the number of services provided was 106,299. Thus the service delivery ratio was about 132 services per 1000 receivers. 2) The number of service receivers in the family planning area as of the end of 1985 was 6,749,171 nationwide, and the number of services provided was 857,511. Thus the service delivery ratio was about 127 services per 1000 receivers. 3) The number of service receivers in the mother-child health area as of the end of 1985 was 11,272,821 nationwide, and the number of services provided was 1,512,284. Thus the service delivery ratio was about 134 services per 1000 receivers. We make the following proposals based on the results so far. 1) In consideration of the various and complex requirements by receivers health medical services in future, it is necessary to yield a proper number of public nursing personnel. 2) For the sake of efficient management of public health center nursing personnel, a political measure should be provided that clearly defines limitations of jobs for such personnel based on their statuses.

A Survey on Korean Public Health Center Nurses' Job Activities in Research Health Service Areas: Yeong Im Park; J Korean Acad Community Health Nurs. 1989;1(1):45-59. Published online February 28, 1989

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Abstract PDF: As a result of the survey on performances in individual health service areas provided by 1,331 public health center nurses working for some Korean public health centers, we have got the following findings. 1. General characteristics of the subjects As for age groups, 45.3% of the nurses, the greatest proportion, belonged to the 30~39 group. As for educational levels, 72.5% graduated polytechnic schools, and 3% universities. The proportions of the subjects with respect to their job assignments turned out to be greater in the order of family plan offices (25.1%), mother-child health (MCH) centers (19.1%), and medical examination rooms (18.9%). As for their marriage statuses, 75.7% reported they were married. As for their durations of work for public health centers, those with 5 or less years of work experience accounted for the majority, 51.4%, and 21.7% appeared to have 10 or more years of experience. 65.4% of them had clinical experience, of whom in turn 39.1% had 5 or less years of experience, and 20.4% 5~9 years of experience. As for licenses owned by the public health center nurses, 37.5% had only the nurse license, 62.5% had got the license of health teacher or midwife in addition to their nurse license, and 6.1% turned out to have all the three types of licenses. 2. Performance levels in individual health service areas 1) As for the nurses' performance levels in health service areas provided by the nurses, the total average of their performances was 2.217. Their performance levels in the service planning and other administrative areas turned out to the highest, 2.767 and 2.543 respectively. The averages of the levels in the areas of other health services and practice education were 1.697 and 1.791 respectively. 2) As for their performance levels in detailed items of health service areas, the performance level of documentation and report (3.17) turned out to be high and that of grasping local societies' health requirements low (2.56) on the side of service planning. The performance level of detection and registration of gravidas (2.50) was the highest in prenatal care, that of documentation and report in delivery care (2.38), and that of health state measurement (2.42) in postnatal care. In most of these maternity areas, the performance levels of collective education and home visiting activities turned out to be the lowest. In infant/toddler care, the performance level of vaccination and health education 2.57) was the highest but that of home visiting and measurement of development turned out to be low. In family planning, the performance levels of individual family planning consult and education (2.72) and service receiver detection and registration (2.53) turned out to be high. In tuberculosis control, the performance level of patient detection and registration (2.05) was the highest while that of home visiting low, and in disease control, venereal patient consulting and education (2.34) turned out to be most actively performed. The performance levels of parasite control and hepatitis prevention instruction were high in other health services, and that of office cleaning high in other administrative jobs. 3) As a result of the survey on the nurses' performance levels in individual health service areas based on their working places, it turned out in terms of special jobs in individual offices that the performance level of tuberculosis control in tuberculosis offices was the highest (4.24), which was followed by that of family planning in family planning offices (3.72) and that of postnatal care in MCH centers (3.55). In the case of medical examination rooms and vaccination rooms, few performances were carried out except their relevant jobs, disease control (3.01) and family planning (2.33), while in maternity and infant/toddler rooms, the performance level of prenatal care (3.04) was the highest. It was vaccination rooms where service planning jobs were most frequently performed (3.78), and the performance level of delivery care was the highest in MCH centers due to the characteristics of the job. Based on the discussion so far, we make the following proposals for efficient performances of Korean public health center nurses and their performance improvement. 1) Given that health service nurses evaluated themselves as generally inactive in their jobs except those relevant to them, factors should be more practically clarified that constrict their job performances and make them passive. Also, overall conditions for activating home visiting and collective education and nurses' recognition of such activities should be enhanced as such activities most positively represent the characteristics of local society nurses' roles though their performance levels in these activities were particularly low among other activities in their relevant jobs. 2) Systematic changes should be worked on so that nurses can be adjusted to their extended role changes beyond their current mannerist, special job based nursing activities, and legal systems and re-educational courses should be provided so that they can positively carry out consequent job performances and provide improved nursing services.

A Study on Community Health Practitioners' Jobs: Seong Hyeok Kim; J Korean Acad Community Health Nurs. 1989;1(1):144-171. Published online February 28, 1989

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Abstract PDF: This study has been carried out under the supervision by the Academic Society of Community Nursing in order to provide basic data for consistent development of the community health practitioner system and effective running of job education courses by investigating the conditions of primary health care services provided by them. The survey was carried out on all community health practitioners from August 1 to November 25 1986, and the copies of the questionnaire replied by 1,438 subjects, which were useful for data processing, have been analyzed. As a result of the analysis of the data from this study, we have reached the following conclusions. 1. The average number of residents provided with health services by one community health practitioner was 1,675, and thus it is conjectured that the total number of Korean people who receive health services provided by community health practitioners nationwide is about 3.35 million. This figure accounts for about 8% of the total Korean population, and about 28% of the rural population were provided with health services by community health practitioners. 2. The adequate number of people that community health practitioners have claimed to be ideal in their services is 1,360 in average, which is less than the actual number of residents by 315. 3. The most widely distributed medical health resources in local societies in which community health clinics were established were pharmacies (48.2%), but the medical health institution type most frequently used by local residents was the community health clinic (56.2%). 4. The medical health institutions that community health practitioners most frequently referred their patients to were primary and secondary clinics and hospitals (73.4%), public health centers (17.3%), and public health center branches (5.6%) in that order. 5. The nearby medical health institutions that is most cooperative with community health practitioners were public health centers, which were followed by public health center branches and private medical institutions in that order. 6. 78.8% of the subject community health practitioners showed positive responses about the establishment of the expert nursing supervisor system in which community health practitioners could be specially guided and supervised. 7. The community health practitioners contributed themselves to their job performances in "common disease control" among other job areas. They spent about 3.5 hours in "common disease control" a day on an 8-hours-a-day base except Sunday. Given these results, the situation in Korea is that 72% of the rural population has not yet received primary health care services by community health practitioners. Some of them live in places adjacent to small cities and counties, but they receive treatment-based medical health services in the way that they are treated when they contract a disease. Thus, given the current situation in which medical health service levels are promoted, health requirements increase, and the medical insurance is extended to the whole people, preventive medical health services should be enhanced in terms of the extension of primary health care programs provided by community health practitioners. This extension of the system is expected to prevent patients from rushing to particular medical institutions (secondary and tertiary), especially to general hospitals, greatly contribute to finances of the medical insurance, and in addition, meet increasing health requirements. Thus, we can comply to the WHO slogan "Health to All Mankind until 2000 A.D." by extending primary health care services provided by community health practitioners to middle-sized and small cities and big cities as well as rural and fishing regions.

A Study on the Distribution of Industrial Nursing Personnel in Korea and the Conditions of Industrial Nursing Service Delivery: Sun Rye Kim, Ji Hyun Lee; J Korean Acad Community Health Nurs. 1989;1(1):186-237. Published online February 28, 1989

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Abstract PDF: This study tried to grasp the conditions of the distribution of industrial nurses working at businesses over the whole country, analyze their job contents based on their functions, and clarify the conditions of workers' use of medical rooms. For this purpose, the current researchers first identified industrial companies from August 1 to October 30 1986, and visited there to have interviews with industrial nurses with a questionnaire and examine medical room journals. Data were also collected from the industrial nurses' own documentation for a week period, and then we yielded the following results. 1. Conditions of the distribution of industrial nurses A total of 282 industrial nurses working for some industrial companies were our subjects, and the number of companies employing them was 272. The actual number of workers per nurse was 1,766. As for the sizes of the companies employing them, 38.6% of the companies employed 1,000 or more workers. The rate of industrial nurse distribution among the industrial companies nationwide is 0.25%. 73% of the nurses worked full-time, 12% held the job as an additional position, and 12% worked part-time. Manufacturing business accounted for the greatest proportion, 73.1%, of the companies. Their average age was 28, and 80% of them graduated polytechnic colleges. 56.8% of them had 1~5 years of experience, and were generally satisfied with their jobs. Their average monthly salary was 350 thousand won and 78.3% of medical rooms were independent. 71.9% of the health managers worked part-time, and most of the employers were positive about industrial nursing. 17.1% of the companies did not have a designated hospital. The accident rate in their companies was 23.8%. 2. Function-based analysis of job contents As a result of the investigation of performance ratios of job contents based on industrial nurses' functions, which were classified into four types, nursing service delivery jobs were most frequently performed with a score of 0.61, which was followed by nursing service running (0.53), environmental management jobs (0.37), and welfare jobs (0.33) in that order. As for nursing service delivery jobs, 100% of them participated in physical examination, health observation, and individual consulting, 97.4% in health status explanation, and 97.1% in emergency treatment and blood pressure measurement. On the other hand, As for performance rates in collective health education, the education of poisonous materials in household medicines was low (41.2%), but the establishment of provision was the lowest (34.3%). As for industrial classification, the performance level was highest in service businesses, which were followed by manufacturing companies, constructions, and financial businesses in that order. With respect to company sizes, businesses employing 300~less than 1,000 workers showed high performance levels. The average daily working time was 9.8 hours, the greatest portion of which was assigned to nursing service delivery (6.1 hours). As for week days, they worked for the longest time on Friday (10.8 hours), and it was Tuesday when they worked for the shortest time (9.6 hours) among other week days. 3. Conditions of Industrial Nursing Service Delivery The monthly frequency rate of medical room use was highest in April and December (8.7%), but lowest in February. The annual frequency of medical room use per worker was 14.9 times maximally and 3.2 times minimally. The average frequency was 4.8 times. As for medical room use frequencies based on company sizes, the tendency was that the smaller a company's size, the more reduced the annual medical room use frequency per worker was. There were no clear features observed on the base of types of businesses. As for week-day based frequencies of medical room use, the workers most frequently use medical rooms on Monday with Saturday and Sunday put aside, and similar aspects were observed among other week days. There were no clear features observed on the base of types and sizes of businesses. Of the main symptoms of workers with health problems who had used medical rooms for the week of investigation, dyspepsia accounted for 14.6%, which was followed by cold (11.4%), traumas (10%), and headache (9.2%) in that order. Even based on business sizes, most of the symptoms included dyspepsia, cold, traumas, and headache in that order. However, with respect to business types, traumas occupied the first place in construction, transportation, and warehouse businesses, and cold ranked first in financial and service businesses. The rate of referral to hospitals for the week of investigation with the patients using medical rooms was 5.5% at the highest estimate and 0.0% at the lowest estimate. The average referral rate was 1.4%. The weekly rate of referral to hospitals based on business sizes was highest in companies with 300~less than 500 workers (2.6%), and lowest in companies with 2,000 or more workers (1.2%). As for business types, the weekly rate of referral to hospitals was highest in construction (5.5%), and lowest in wholesale and retail sales (0.0%).

A Study on the Distribution of Health Teachers in Korea and the Conditions of Health Teachers' Work: Eun Hee Kim; J Korean Acad Community Health Nurs. 1989;1(1):379-411. Published online February 28, 1989

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Abstract PDF: 1. CONCLUSIONS: This study tried to grasp the conditions of Korean health teachers in individual schools, and get basic data for school nursing job performance. The subjects of the study were 1,082 health teachers who understood the purpose of this study and allowed their participation, out of a population of 2,577 health teachers who worked for elementary, middle, and high schools in cities and provinces as of 1986. The former figure accounted for 42.0% of the whole health teachers. As the research tool, a questionnaire composed on the basis of the review of the literature by professors in the research group of the Academic Society of Community Nursing was used. Data collection was done from August to October 1986. After copies of the questionnaire were distributed under the cooperation of the 13 city/province boards of education, the subjects filled them up on their own, and then sent them by mail. The results of the study are as follows. 1) Conditions of the current schools: Nationwide, health teachers were distributed 27.8% of the schools as of 1986. The distribution rate was highest in Seoul (92.9%), which was followed by Busan, Incheon, Daegu, Gyeonggi, Chungbuk, Jeonnam, Chungnam, Jeonbuk, Gangwon, Gyeongbuk, and Jeju in that order. On the other hand, each health teacher turned out to be in charge of 3.6 schools, 68.3 classes, 3404.2 students, and 95.3 teachers nationwide. In the case of elementary schools, each health teacher turned out to be in charge of 3.4 schools, 58.0 classes, 2565.4 students, and 66.6 teachers. In the case of middle schools, each health teacher was in charge of 4.1 schools, 82.3 classes, 4989.8 students, and 126.9 teachers. In the case of high schools, each health teacher was in charge of 3.9 schools, 97.4 classes, 5203.1 students, and 184.9 teachers. 2) General characteristics of the health teachers: The subjects were most greatly distributed in the 25-29 age group (37.7%), and 37.5% of the whole health teachers had work experience for 4 or less years. As many as 41.3% of the health teachers reported that they had no past clinical experience except health teacher jobs, and even 79.1% reported they had no experience in the health service area. As for their backgrounds, 73.4% graduated from a nursing college, 78.2% were married, and 65.1% had a religion. Also, 93.5% worked at national or public institutions, and 84.4% carried out their jobs independently. 3) Conditions of School Health Service Resources: Nationwide, 18.4% of the schools had 501-1000 students, 43.0% had 21-40 classes, and 34% had 41-60 teachers. Those figures represent the most common rates. Also, only 46.8% knew of school health budgets, and the ratio of health budget to whole school budget was known only to 34.1%. On the other hand, as for the total annual school health budget, 40.3% of the schools had 290 thousand won or less, and this figure represented the highest frequency. Of this amount of budget, 39.8% was used for medical tests, and 38.6% was for medication management. As for the total expenditures, schools in Seoul and Incheon turned out to spend relatively great amounts of money. Only 30.7% of the schools had a health department. As for places of school infirmaries, 45.3% of the schools had one in the center, and 72.7% had one on the ground floor. As for the conditions of school infirmary use, 79.0% adopted the exclusive use, and 68.7% had an area of 10 peyong for an infirmary. 4) Conditions of school nursing jobs: Nationwide, the average number of monthly infirmary users was 101-200 persons, which represented 33.3% of the schools and the highest frequency. 1872.4 persons used a school infirmary annually, and as for infirmary users based on their purposes, 32.3% (the figure represented the highest frequency) of them visited their school infirmary for the reason of digestive problems, which were followed by respiratory problems, skin diseases, muscular skeletal problems, consulting, oral/dental problems, otolaryngological problems, neuropsychiatric problems, circulatory problems, and urinogenital problems in that order. The frequency of annual newsletter sending was about 13.0, and of them 32.0% were about health education, which represented the highest frequency, followed by vaccination, parasite tests, notification of physical examination results, and things about physical examination in that order. On the other hand, as for the average monthly rate of time spent for school nursing jobs, 26.2% of the whole amount of time (the highest frequency) was used for school infirmary management, which was followed by health care, health education, service planning and evaluation, school environment/sanitation management, chores, class for relevant subjects, and organizational administration of school health services in that order. 5) Confidence in school nursing job performance: The subject teachers' confidence in school job performance was compared by a four point scale consisting of 4 points for 'very confident,' 3 points for 'confident,' 2 points for 'unconfident,' and one point for 'very unconfident.' As a result of the measurement of health teachers' school nursing jobs by dividing them into 6 areas, the whole score was 2.75. The score of confidence in infirmary management was highest (2.93), which was followed by confidence in health education planning and evaluation, in health care, in environmental control, and organizational administration of school health services in that order. As for the highest region-based score of confidence, the health teachers from Jeonnam received 2.98 points. In the area of service planning and evaluation, the score of confidence in performance of school health service planning turned out to be the highest (2.91), and the health teachers from Jeonnam received the highest score of confidence in performance (2.98). In the area of infirmary management, the score of confidence in performance of student consulting appeared to be the highest (3.13), and the health teacher from Jeonnam received the highest score of confidence in performance (3.04). In the area of health education, the score of confidence in performance of understanding of contents turned out to be the highest (3.00), and the health teachers from Jeju received the highest score of confidence in performance (3.05). In the area of environmental management, the score of confidence in bathroom maintenance appeared to be the highest (2.86), and the health teacher from Jeonnam received the highest score of confidence in performance (2.93). In the area of organizational administration of school health services, the score of confidence in performance of engagement in local society's health service activities turned out to be relatively high (2.48), and the health teachers from Chungbuk, Jeonnam, and Jeju received a relatively high score of confidence in performance (2.55). In the area of health care, the score of confidence in emergency treatment appeared to be the highest (3.00), and the health teacher from Jeonnam received the highest score of confidence in performance (3.01). 6) Performance levels of school nursing jobs: The subject health teachers' performance levels of school nursing jobs were compared by giving 2 points for "do" and one point for "don't do." As a result of the measurement of health teachers' school nursing jobs by dividing them into 6 areas, the whole score was 1.73. The performance level of infirmary management was the highest (1.87), which was followed by infirmary management, health service planning and evaluation, health care, in environmental control, and organizational administration of school health services in that order. As for the highest region-based performance level, the health teachers from Chungbuk received 2.98 points. In the area of service planning and evaluation, the performance level of school health service planning turned out to be the highest (1.95), and the health teachers from Jeonnam received the highest score of performance level (1.88). In the area of infirmary management, the performance level of infirmary running appeared to be the highest (1.96), and the health teacher from Chungbuk and Jeju received the highest score of performance level (1.88). In the area of health education, the performance level of understanding of contents turned out to be the highest (1.96), and the health teachers from Jeju received the highest score of performance level (1.98). In the area of environmental management, the performance level of safety control appeared to be the highest (1.89), and the health teacher from Chungbuk received the highest score of performance level (1.81). In the area of organizational administration of school health services, the performance level of engagement in local society's health service activities turned out to be relatively high (1.41), and the health teachers from Chungbuk received the highest score of performance level (1.55). In the area of health care, the performance level of stomachache treatment appeared to be the highest (2.00), and the health teacher from Chungbuk and Chungnam received the highest score of performance level (3.01). 2. SUGGESTIONS: The current researchers make the following proposals after their survey on the distribution of health teachers in Korea and the conditions of their work. 1. Health teachers themselves should be positive in improving their merits for promoting the school population's health. 2. Political supports should be sufficient that are required to keep the school population's health. 3. As this study has just investigated the conditions of a few factors working as common variables, deeper and more improved research and data should be further supported by local research reports and future investigations.

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