Research in Community and Public Health Nursing

Volume 12 (2); September 2001

Original Articles

Development of Empowerment Program for the Diabetes Patients and the Experiences of Diabetes Patient's Empowerment Process: A Grounded Theory Methodology Approach: Eun Ok Choi; J Korean Acad Community Health Nurs. 2001;12(2):317-328. Published online September 30, 2001

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Abstract PDF: The purposes of this study were to develop the empowerment education program, to describe the experiences of diabetes patient's empowerment process and to develop a theoretical model of the diabetes patient's empowerment process.
METHOD
1.: The development of the empowerment program for the diabetes patients : The strategies of the empowerment education program were enhancement of problem - solving, decision making, self-efficacy, self-control, participation and mutual support.
METHOD
2.: According to the grounded theory methodology of Strauss and Corbin, the qualitative data was collected with in depth interviews and participants observations until its saturation when the 25 consented subjects were participating and interacting with the other subjects in the empowerment education program.
RESULTS
With the analysis of the data, 29 categories were generated. The core category generated, which was a central phenomenon of the empowerment process, was named powerlessness. The intervening conditions facilitating or impeding the empowerment process were discovered as supportive systems through the participation of group meeting, problem solving dialogue, and the knowledge deficit of self-care. The action/interaction strategies were developed as the paricipating, dialoguing, questioning, supporting system, self-controlling, self efficacy, enhancing self-esteem, stress relaxing and instillation of hope.

Critical Pathway of Home Healthcare for COPD clients: Won Jung Cho, Mi Kyung Han; J Korean Acad Community Health Nurs. 2001;12(2):329-337. Published online September 30, 2001

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Abstract PDF: PURPOSE
This study was to develop a critical pathway for COPD clients in home health care.
METHOD
Review of literature, Analysis of 10 cases of home health records of COPD clients without other major chronic illness, and Contents validity test.
RESULTS
1. Vertical axis(14 activities) : physical and mental assessment, family assessment, environment assessment, rights and duties of client, oxygen use and safety, education of disease process and symptom, medication, nutrition and elimination, tests, activities, respiratory exercise, sleeping pattern, consultations and discharge planning. 2. Horizontal axis was set by the number of visits(average number of visits is 6.4) and vertical axis was set with 14 activities and the contents which should have occurred, according to the time frames of the horizontal axis. 3. According to the contents validity test, among the total of 234 items, 176 items showed over 83% agreement and 58 items showed less than 83% agreement. Those items with less than 83% agreements were either deleted or revised.
CONCLUSION
this critical pathway is applicable to the home health care of COPD clients to provide quality home nursing care services at lower cost.

Effects of Exercise Program for Workers in Small Enterprises: Hye Jin Hyun, Soon Nyoung Yoon, Eun Ok Choi; J Korean Acad Community Health Nurs. 2001;12(2):338-343. Published online September 30, 2001

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Abstract PDF: Physical activity is one of important factors of the chronic disease. It was reported that Most of Korean workers didn't take exercise regularly. The purpose of this study is testing effects of exercise program, based on the Theory of Planned Behavior. 30 subjects participating in this study are workers in small enterprises and have not taken exercise regularly. Exercise program, which includes education, support, monitoring, and counseling, was conducted for 6 weeks. Effects of this program was evaluated by the change of exercise, attitude, subjective norm, perceived control, intention of exercise, perceived health states, and fatigue. The results of this study can be summarized as follows: 1. There was the significant difference between pre and post-test in the subjective norm, perceived control, and intention of exercise, but not the significant difference in the attitude of exercise. 2. 53.3% of the subject of this study had taken exercise regulary in the post-test. 3. There was not the significant difference in the perceived health states and fatigue. From the results, it can be concluded that the exercise program is effective, leading to the change of intention and exercise rate. On the other hand, it was not effective in Physiological aspects. It seems that these result was due to short term program. Thus, it can be recommended that studies are needed with longer term program and larger sample.

The Effect of Health Promotion Program on Health of the Clients with Arthritis in Primary Health Care Center: Sun Ha Choi; J Korean Acad Community Health Nurs. 2001;12(2):344-360. Published online September 30, 2001

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Abstract PDF: A quasi-experimental study was conducted to investigate the effects of health promotion program on health of the clients with arthritis. In this study, the health promotion program consisted of self appointment and confirmation, discussion, health education, group counsel, and exercise. And the program focused on self - help group meeting. A total of 68 subjects was randomly assigned into either the control group(n=24) or the intervention group(n=44). The results of the study analyzed using a SPSS win, were as follows: 1) In physical function of physical health, there was a significant improvement in flexibility of the shoulder joint(hold the hand upward and downward behind the back), sit and reach, extension of the knee joint in the intervention group, compared to the control group, while no difference in flexibility of the shoulder joint(raising the arm), flexion of the knee joint, and grip strength. There was a significant improvement in physical functional disability in the intervention group, compared to the control group, but no difference in fatigue and pain. 2) The health promotion program resulted in improvement in psychosocial health(e.g. increase of self-efficacy and decreases of social functional disability) in the intervention group, compared to the control group. It was concluded that the health promotion program(weekly session for 6 weeks) employed in this study was appropriate for the clients with arthritis in primary health care center and had a positive effect on health in general.

Development of Community Health Nursing Service Model: Based on the Visiting Nurses Project in Seoul, Kyonggi, and Kang-won Area: Sung Sil Kim; J Korean Acad Community Health Nurs. 2001;12(2):361-374. Published online September 30, 2001

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Abstract PDF: This study was done to identify a status of home visiting project as a community health nursing system, that was the organization. personal who have age, educational background. marital status, position. experience of the home visiting in the public sectors in part of Seoul. Kyonggi. Kang-won area. It was done to provide basis data for the development of effective visiting nurses project in the health sectors, where was Health Centers in urban and rural, Branch of Health Center in rural and Health posts. The question airs were distributed 352 public health workers who working place was 118 health workers in 12 health centers in Seoul. 56 public health workers among 39 health center and other public health sectors in Kyonggi and 178 public health workers among health center and health care sectors. Data collected from October to December, 2000. The analysis by SAS system with F test, percentage and frequency. The major result were as follows. The general characteristics of the respondent show that most of them were graduates from community college and RN-BS with broadcast that they had not completed CPHN course but only two health workers have trained for the visiting nurses project. As for their grade in position, the most of health workers have seventh level and the other CHP were above sixth level in the health care post that in the government structure. This indicates that workers do not have great authority in decision making, the most period of works in the position was one and two years indicating that they change jobs frequently. On an average their clinical experience was 4.11 years which is ideal for the total service. As for preparation of staff for home visiting workers education on visiting nurses program have to receive short term or longer term training course for strong emphasis. The analysis showed that public health visiting workers responds about active job performance that based on an area, approach of acting by districts, education and position are shown statistically significant difference between acceptance of the visiting nursing job show the same as well as visiting nurses project. Special concerns for visiting Nursing care spread came to burden, many of activity carry out main solution is covered the health problem connective support system needs of quality and quantity which out health problem. As 71.1% of visiting health service held on the poor population was under the guardianship of the law, but people who health insurance wide application under law shown a tendency to increase gradually. The general characteristics of the patients showed 56.2% of female on average of age was 66.1 years old, they have health problem was the most of 47.6% of high blood pressure and stroke. the other and as a problem that economics, which is complex welfare with out health problem. Community health care service should be combined health and social work program. The form of delivery of visiting health care given the most guide and education with counselling and support.(33.6%) Among the six category of visiting care service shown statistically significant difference and next is fundamental care, remedy care with priority.

Effects on the Frequencies of Self-foot Reflex Massage Seen in the Physical Index and Anxiety Level of Hypertension Workers : The pilot study: Nam Hyun Cha, Shin Ae Park; J Korean Acad Community Health Nurs. 2001;12(2):375-389. Published online September 30, 2001

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Abstract PDF: The purpose of this study was to evaluate the effect of Self-foot Reflex Massage (SRM) programme on the physical condition and anxiety level of hypertension workers. The research was designed in the pre and post-test. Sample test was done in five workers with essential hypertension. They were divided in two groups:- Group A and Group B. The Self-foot Reflex Massage (SRM) was applied three times a week for Group A and five times a week for Group B. The SRM was given in 40 minutes each time for 4 weeks from the 1st of January to the 30th of April in 2001. In order to evaluate the effect on SRM, blood pressure, total cholesterol, triglyceride, HDL cholesterol and LDL cholesterol were measured as physical parameters and state trait anxiety inventory was used twice each time between before and after the exercise. The collected data was analysed by Mann-Whitney test with SPSS program. The results were as follows: 1. Average age for the subjects were 39.8 (ranged from thirty-two to fifty-three) and average period of hypertension history was 42 months (ranged from twenty to eighty-four). 2. There was no significant difference between two examined groups in blood pressure. But, there was a significant difference in SRM of pre and post-test for two groups. 3. There was no significant difference in blood cholesterol between two groups and between pre and post-test. 4. State trait anxiety showed significant difference between pre and post-test except the results between two groups. This result suggests that SRM is effective on the decrease of systolic and diastolic pressure and the relief of state trait anxiety except for the blood cholesterol. Therefore, blood cholesterol is needed further evaluation in large subjects and longer period. Further research is regarded as necessary to evaluate and to compare the precise effects of SRM on the foot reflex massage (FRM) in anxiety.

The Effect of a Diabetic Education Program on Self-care Behavior and Glucose Metabolism in Type 2 Diabetic Patients: Kyung Shin Paek; J Korean Acad Community Health Nurs. 2001;12(2):390-396. Published online September 30, 2001

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Abstract PDF: The purpose of this study was to test the effect of a diabetic education program using the self-efficacy theory on the self-care behavior and glucose metabolism. The subjects of the study consisted of 25 NIDDM patients who had participated with a diabetic education program from June 23 to July 14, 1999. The research design was one-group pretest-posttest design. The pretest included measuring self-care behavior and 2PPBS, the diabetic education program was conducted to the group for 4 weeks. After the diabetic education program, the posttest included remeasuring of self-care behavior and 2PPBS. Wilcoxon signed rank test was used for the significence of the differences between values before and after the diabetic education program. The results are as follows. The diabetic education program was effective in increasing the score of the self-care behavior in exercise but was not effective in increasing the score of the self-care behavior in diet, test and medication. The diabetic education program was not effective in decreasing the levels of glucose metabolism.

The Effect of Visual Health Promotion Program in Elementary School-Age Children: Jin Joo Oh, Hee Sun Shin; J Korean Acad Community Health Nurs. 2001;12(2):397-405. Published online September 30, 2001

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Abstract PDF: The vision disturbances of school- age children has been recognized as and important school health problem. As the visual disturbances of the school-age children is recognized as the nation's health problem, the importance of the development of educational program for visual health should be emphasized. Recently, eyeball movement and other visual health management method has been introduced for prevention or recovery of decrease in visual acuity. But, the effect of eyeball movement was not confirmed yet. And, the controversy around the treatment effect is continued. The decrease of visual acuity is one of the important school health problem as well as it causes discomfort in daily life of the students. So, it should be considered as an important subject for school health and there is a need to develop an effective intervention program for visual health. The purpose of this study is to develop and evaluate the program with the recognition of the need of the intervention for visual health. The visual health promotion program was developed by the researcher and the program was initiated by the school. Nonequivalent control group pretest-posttest design was applied for study which examined the effect of the visual health promotion program. The subjects were 742 children (experimental group: 398; control group: 344). The experiment was composed of health education and eyeball movement. Health education was provided 5 times to the children in the class room. Children of experimental group exercised eyeball movement in the class, watching video for 10 minutes two times a day. The exercise was continued for 10 weeks. The result of the study were as follows. 1) change of visual acuity Before the intervention, mean of the visual acuity was .86 for the experimental group and .91 for control group. After the intervention, mean of visual acuity was .95 for the experimental group and .90 for the control group. There was no significant difference in the change of visual acuity between experimental and control group. 2) change of refraction. In the experimental group, 327 eyes (41.08%) were normal vision and 469 eyes (58.98%) were eyes of refraction errors. 38.82% of the total eyes were myopia. There was no significant change in the refraction in the children with myopia after the intervention. 3) Awareness of visual acuity, change of knowledge, behavior, and attitude (1) After the intervention, there was a significant difference in the awareness of visual acuity (experimental group: 70.10%, control group: 50.97%, p<.01). (2) After the intervention, there was a significant knowledge increase in the experimental group (p<.01). (3) There was no significant difference in the visual health behavior after the intervention. (4) There was a significant positive change in the attitude related to visual health in the experimental group (p<.05). 4) There was a significant positive change in the subjective discomfort of the students. But, there was no significant change in the objective eye symptom after the intervention. Even though there was no effect in the visual acuity and the change of the refraction, subjective visual health as well as the attitude and knowledge of the children and parents toward visual health was improved significantly. Also, there was an increase in the intention of change and the awareness for the visual health management. It is suggested that various educational strategies for visual health promotion should be developed and examined for the visual health promotion of the students.

The Behavior Analysis of Home Injury Prevention based on the Model of Family Health Protection: In Sook Lee; J Korean Acad Community Health Nurs. 2001;12(2):406-416. Published online September 30, 2001

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Abstract PDF: This study is performed to confirm the influencing factors of family health protection behaviors using the variables included in Pender's Family Promotion Model. 1. The subjects are 110 families in preschooler family developmental stage, respondents are children's mother or father. These families are almost all nuclear types(95%), function of families is healthy as much as 8.0 the mean FAPGAR score. The prevalence rate of family members' illness was 14.7% these last 3 months, and 21.1% of families responded suffered from injury for last 2 years. 2. The practice rate of injury prevention behavior is below a half in supervision and modifying of their home and residential environments, especially controlling through collaborative community power. The more familiar function score is the better practicing rates of injury prevention behaviors. 3. The injury prevention behaviors correlate to family size, health status of family member, and children's congenital defects with statistical significance. Families' economic condition correlates also significantly to family health status, cognition of benefits of injury prevention, cognition of the importance of community collecting power. And the recognition of the benefits of injury prevention correlates the adaptive health concept, family norms about injury prevention, economic status. 4. Considering family health promotion model, the general influencing factor is only affected to family protective behavior, and other paths don't affect to family's behaviors. In simple regression, the family protective behavior model explains 27.8%(P=0.05), significant factors are family function status, family size, chronic illness of family members', mother's education level, father's age. 5. To define of familiar preventive behavior as a unit is very important, but it has the limitation to solve the difficulties of family studies going with the operationalized difficulties of health promotion concept.

The Influences of Visual and Hearing Impairment on Activities of Daily Living for the Community Dwelling Elderly: Eun Ok Park, Kyung Ja June, Eun Young Kim, Hee Girl Kim, Ae Young So, Ggo Me Yi; J Korean Acad Community Health Nurs. 2001;12(2):417-427. Published online September 30, 2001

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Abstract PDF: PURPOSE
The aim of this study is to identify the influence of visual and hearing impairment on the activities of daily living of community dwelling elderly.
METHODS
Data were collected by home visiting interviewers from 452 older people aged 65 years or older living in community. Resident Assessment Instrument MDS-HC(2.0version) was used for data collection. Data analysis for descriptive statistics, Chi-square test and multiple regression was made by SAS 6.2.
RESULTS
34.7% of the subject had hearing impairment and 64.3% had visual impairment Among IADL, one half of them were dependent in ordinary house work and meal preparation. In the case of ADL, 13.9% of subjects were dependent in bathing and 8.9% in personal hygiene. There was significant difference in IADL performance by visual and hearing impairment On the other hand, ADL performance showed the significant difference only in the case of hearing impairment. As the result of input of visual and hearing impairment in the process of regression, variances were increased from 3% to 11%.
CONCLUSIONS
Large proportions of older people living in the community have visual and hearing impairment. It could be confirmed that hearing and vision were significant factors influencing on IADL performance of older people. Intervention and support policy for elderly needs to focus on improvement of visual and hearing impairment.

A Comparative Study on Health-Promoting Behavior, Life Satisfaction and Self-esteem of the Young and Old Old: Yeon Hee Choi; J Korean Acad Community Health Nurs. 2001;12(2):428-436. Published online September 30, 2001

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Abstract PDF: PURPOSE
To compare the differences of health-promoting behavior, life satisfaction and self-esteem between the young old and the old old.
METHOD
The subjects were a volunteer sample of 200 elderly in K city. The instruments for this study were Health Promoting Lifestyle Profile(47 items). Life Satisfaction Scale(20 items) and Self-Esteem Scale(10 items). Frequency. percentage, t-test and Pearson's correlation coefficient with SAS program were used to analyze the data.
RESULT
1) There was a statistical significance(t=2.479. p<.05) in health-promoting behavior between the young old and the old old which showed, on an average, 3.306 points in the young old and 2.872 points in the old old. 2) There was a statistical significance(t=1.530. p<.05) in self-esteem between the young old and the old old which showed, on an average, 3.091 points in the young old and 2.981 points in the old old.
CONCLUSION
The old old is less the level of health-promoting behavior and self-esteem than the young old. It is necessary to develop comprehensive health-promoting program in order to improve a healthy lifestyle for the old old.

Nursing Education in North Korea : Past 50 Years and Future: Ggod Me Yi; J Korean Acad Community Health Nurs. 2001;12(2):437-449. Published online September 30, 2001

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Abstract PDF: PURPOSE
To understand the development of nursing education of North Korea after 1945.
METHOD
First, collecting primary sources published in NK. Second, collecting secondary sources published in South Korea. Third, interview with South Korean medical personnels who visited NK. Forth, interview with medical personnels who escaped NK.
RESULT
After 1945 NK increased health care facilities in short time and had the policy of training medical personnel in short time. Nursing education was focused on the basic practice. NK could begin free medical treatment for the laborer in 1947. Post Korean War restoration and free medical treatment system of national level in 1950s and 1960s served to the health promotion of NK population. The medical personnel training policy continued and the number of R.N. in NK had increased 13 times in 15 years. NK has tried to increase the quality of health care service and medical personnel since 1970s. Nursing education in medical colleges is three-year course but 6 month training courses in general hospitals continue. They focus on primary prevention and oriental medicine in nursing curriculum reflecting the characteristics of NK medial care. But English and high technology is very poor, and there is no computer related curriculum.
CONCLUSION
Nursing education in NK has developed reflecting the changes of NK society and health care since 1945. After 1980s NK is in deep economic depression and it is hard to recover from the state with their hands. In this state, we cannot expect the development of nursing education in NK.

A Structural Equation Modeling on Quality of Social Roles and Health for Married Working Mothers: Eun Ok Park; J Korean Acad Community Health Nurs. 2001;12(2):450-458. Published online September 30, 2001

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Abstract PDF: PURPOSE
The purpose of this study was to establish a structural equatios model on social roles and health for married working mothers. to determine the effects of social roles on Korean women's health and to explore the mediating role of self-esteem in the relationship between social roles qualities and health.
METHOD
Data were collected from 323 employed women with partner and children, lived in Seoul and near Seoul. Response rate was 62.3%. The instruments for measurements were Role Quality Scale developed by Park et al. (1999), Rosenberg's Self-Esteem Scale, and 31 items from SF-36 developed by Ware & Sherboune(1992).
RESULTS
The effect of marital role quality on self-esteem and the effect of parental role quality on health were not significant. Modification model fitted with the collected data very well, as evidenced by the small chi-square(0.58). the very high goodness-of-fit (GFI=1.00). and adjusted goodness-of-fit(AGFI=0.99). and very small root mean square residual(RMSR=0.0072). and the slope of Q-plot is over 1.41% of the variance in self-esteem and 21% of the variance in health were accounted for by these variables CONCLUSION: Further research concerned with the mediating effects of self-esteem in the role and health relationship should be covered the issue of various role combinations. And it is necessary to examine the influence of subfactor of quality of social roles on health.

Health Promotion Behaviors and Related Psychosocial variables among High School Students in Seoul: Tae Wha Lee, Sun Mi Shin; J Korean Acad Community Health Nurs. 2001;12(2):459-467. Published online September 30, 2001

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Abstract PDF: Although much has been written about the health status of adolescents, little is known about adolescents perception of their own health, family support and risk behaviors. The purpose of this study is to describe the perceived health status, family support and risk behaviors in urban high school students in Korea, and to examine the relationships between those variables. Design for the study is descriptive-correlational. The sample consisted of 600 10th-grade students who were randomly selected from 12 urban high schools located in Seoul. Data were collected on demographic characteristics, perceived health status, family support, and health risk behaviors such as tobacco use, alcohol use, eating habits, exercise, stress and coping skills. Preliminary findings of the study were as follows. In terms of perceived health status, 54.2% of the students reported that they are healthy. Students with higher socioeconomic status perceived themselves healthier than the students with lower socioeconomic status (p<.05). Overall, frequently reported health concerns were eating habits (17.2%), depression (4.8%), tobacco use(0.8%), and alcohol use (0.7%). The mean score of family support of the students was 7.67 (SD=2.43) within the range of 1-12. Gender was significantly associated with a higher level of family support among girls than boys. Data will be further analyzed in detail. The results will suggest that health promotion program should consider involving adolescents in planning, both (1) to ensure congruence of the plan of care with adolescentsconcerns and (2) to clarify the interpretation and meaning of their health risk behaviors.

A Survey of the Health Risk Behaviors of Middle School Students in Kyungju: Young Ran Han; J Korean Acad Community Health Nurs. 2001;12(2):468-481. Published online September 30, 2001

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Abstract PDF: The purpose of this study was to collect basic data to develop school health policy and health promotion program. This survey measured the levels of risk behaviors in six categories in a middle school students in Kyungju(n=490). The data was collected from November to December 2000. It was done using a 1999 version of the Youth Risk Behavior Survey of CDC, which was translated and make a partial modification. The major results were as follows. Many middle school students engaged in behaviors that will increase the likelihood of death or illness. 1) A high percentage of middle school students engaged in behaviors that contribute to unintentional injuries and school-related violence (42.1~78%) 2) Students who perceived their school life are happy experienced more depression(p=.000) and Students who perceived their school and family life are so-and-so seriously considered attempting suicide(p=.000) than other subgroup. 3) In spite of they were normal weight, 14.5% of students considered themselves overweight. 4) There was significantly difference or correlation between health risk behaviors and grade, parents educational level, perception of school life and performance, perception of family life and religion. Based on this results of study, it is necessary to develop school health program and school health policy to prevent health risk behaviors and improve health promotion especially considering characteristics of middle school students.

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