Research in Community and Public Health Nursing

Volume 6 (2); December 1995

Original Articles

Phenomenological Study of the Lived Experience of Elderly People: Bo Sun Huang, Yu Sun Shin, Suk Ok Yun, Ji Hyun Lee, Kyung Yim Jung, Jung Soon Kim, Lee Soon Kim, Bok Yong Kim, Young Mee Kang; J Korean Acad Community Health Nurs. 1995;6(2):133-160. Published online December 31, 1995

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Abstract PDF: The purpose of this study was to understand the structure of the lived experience by poor elderly people. The research question was "What is the structure of the lived experience of life of a poor elderly people." The sample consisted of 21 single poor elderly persons in Pusan. The unstructured interviews were audio-recorded and analyzed using the Van Kaam method. This study was 368 responses which yielded of descriptive expressions and priority classifications. The result generated 74 common elements, 18 syntheses of hypothetical definitions and 5 identifications of the structural definition. The structural definitions and hypothetical definitions were as follows; 1. physical discomfort ; complaints of severe pain ; dysfunction of physical organs 2. emotional cognition ; despair ; resignation ; attitude toward death 3. support system ; interaction with family ; thinking about God ; economical difficulties ; expectancy of social services ; opinions about health service ; leisure ; interaction with neighborhood ; dissatisfaction due to inadequate environment 4. past reminiscence ; negative reminiscence of one's past ; past regret ; positive reminiscence of one's past 5. desire ; desire of unrealization life ; self satisfaction The significance of this study for nursing are; Comprehension of the lived experience of client and identification' of nursing approach method concerning the lifestyle of client.

The Phenomenological Study of School health practice experience of Nursing Students: Seon Hye Woo, Young Suk Park; J Korean Acad Community Health Nurs. 1995;6(2):161-172. Published online December 31, 1995

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Abstract PDF: This study was conducted to have better understanding of the students' experience in field practice by school health practice experience. The study subjects were 40 nursing students working in department of nursing K Univ. in C city. This study was approached by phenomenological method. Collected data were analyzed by Colaizzi's method. The results were from the protocol 980 significant statements and organized into 240 formulated meanings. From formulated meaning 89 themes were identified, organized into 18 them clusters, and then into 16 categories. The nursing students took part in the practice with (expectation and readiness) different from those of the clinical practice, expressed wonder at the school which had progressed much more than their primary schools used to be. They said that they began to feel (Fatigue and stress), and that experienced tension for the lack of nursing knowledge and skill during the health education and clinical treatment activity. In addition, they experienced "ambivalence of satisfaction and something wanted", that is to say, they could have done better by means of video education and health education. The 10-day-school health practice brought about the change in( the image of teacher) and (cognition about the nursing teacher's role), made the students have(love to the client) and (desire to be nursing teacher), and then turned out experience benefical enough to be expressed "satisfaction" However, they pointed out many problems in (School Eniviroment), (Clinic), (Physical assessment), (Recording and reporting), so they had a chance to apply the school nursing process to the school. The professor should play the role of promoting the learning through the field practice and providing the stimulant of learning to help the learner get as much from the field situation as they could. Therefore, I suggest that the students always have a chance to exchange actual affairs and educational study, and that the concrete discussion and continuous cooperation be done. The professors should keep doing their best to find the way to professors should keep doing their best to find the way to promote the ability of thinking through the process the learners experienced themselves.

Community Health Practitioner's Commitment into Community : on the Aspect of Primary Health Care: Soon Nyoung Yun, Young Im Kim, Jeong Myung Choi; J Korean Acad Community Health Nurs. 1995;6(2):173-182. Published online December 31, 1995

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Abstract PDF: Primary health care(PHC) has been established since A Health Law for rural residents has been legislated in 1980 following the WHO declaration, "Health for All 2000". in 1978. PHC services are presently assumed to be provided by 2038 Community Health Practitioners(CHP) to about 28% out of rural population in Korea. Most CHPs have confronted the adaptation process to the community being practiced although a CHP's role is to evoke community participation for the improvement of their health by themselves. So the purpose of this study is to describe and explain of the commitment of CHPs into the community. Data were collected by direct interview and tape-recording under subjects' permission till theoretical saturation were occured from 6 CHPs. The subjects were 41 years old and have served in the community for 9 years in average. Main questions and concepts were explored from data according to the procedure of the grounded theory methodology. The results are as follows. 1) The number of the main concepts were twenty four that identified Motive, Desire, Personal characteristics, Unfamiliarity, Denial, Feeling of isolation, Self-sacrifice, Kindness, Patience, Assimilation, Respect for the residents, Support by the family, Support by the residents, Achievement, Acceptance of realities, Use of resources, Inducement of cooperation from the residents, Changes of the difference from time orientation between CHP and residents, Attitude as a official, Technical support, Cost management, Satisfaction level, Acknowledgement by the residents and discrepancy. 2) The twenty four concepts were categorized to seven groups such as Motivation, Feeling of Heterogeneity, Self-discipline, Social support, Induced changes in the attitudes of residents, Familarity and Persistent discrepancy. 3) The categorized groups were analyzed on the base of the Causal Conditions, Central Phenomena, Contexts, Intervening Conditions, Action / Interaction Strategies, and Consequences. Central phenomenon in this study was identified to be the feeling of heterogeneity. Community health practitioners experienced unfamiliarity and denial from the community and felt themselves isolated in the first. In time, they won the trust of residents by their efforts including self-sacrifice, kindness, patience, and assimilation. Afterward, practitioners got self-confidence and familiarity with lesser feeling of heterogeneity. Community health practitioners experienced unfamiliarity and denial from the community and felt themselves isolated in the first. In time, they won the trust of residents by their efforts including self-sacrifice, kindness, patience, and assimilation. Afterward, practitioners got self-confidence and familiarity with lesser feeling of heterogeneity. Nevertheless, practitioners could not commit themselves completely because of the persistent discrepancy between CHP and residents. 4) On the commitment process, the CHPs' feeling of heterogeneity were decresed and social support increesed and newly evolved induced change of residents through the continuous interaction between CHP and them. The contribution of this study would be concluded as follows. The contribution of this study would be concluded as follows. 1) It is expected that effective strategies for more rapid committment into the community can be developed based on this study. 2) More easy committment would be possible for the newly appointed CHP through understanding of the committment process identified on this study.

A Grounded Theory Study on Substantials of Stress of Korean Wives: Koung Hee Yang, Ju Yeon Chung, Sun Ho Choi; J Korean Acad Community Health Nurs. 1995;6(2):183-196. Published online December 31, 1995

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Abstract PDF: The purpose of this study was to construct a substantive theory about the substantials of stress of Korean Wives in the community. The subjects were 10 wives. In the process of data analysis, 'burden' was found to be the core phenomenon. And the properties of burden were 'burden of domestic economy', 'a sence of duty about the esteemed family of her husband', 'role burden in a family and her work place', and 'burden of conception'. Twenty five hypotheses were derived from the integration of categories. It is as follows : 1. The stronger the difference as perceiced by subjects, the stronger the burden will be. 2. The stronger the dissatisfaction, the stronger the burden will be. 3. The stronger the trouble, the stronger the burden will be. 4. The stronger the worry, the stronger the burden will be. 5. The stronger the forcible demand, the stronger the burden will be. 6. The stronger the regret, the stronger the burden will be. 7. The rarer the communication, the stronger the burden will be. 8. The stronger the fatigue, the stronger the burden will be. 9. The stronger the anger, the stronger the burden will be. 10. The stronger the worrisome feeling, the stronger the burden will be. 11. The stronger the unbearable feeling, the stronger the burden will be. 12. The stronger the resentment. the stronger the burden will be. 13. The stronger the sence of insufficiency, the stronger the burden will be. 14. The stronger the estrangement, the stronger the burden will be. 15. The stronger the attachment, the stronger the burden will be. 16. The stronger the personal relations, the stronger the burden will be. 17. There will be differences in the burden according to types of interpersonal relations. 18. The burden will be related to the attitude of acceptance. 19. The burden will be related to the attitude of negligence. 20. The burden will be related to independent approach method. 21. The burden will be related to interpendent approach method. 22. The stronger the independent approach method, the subject will apper the positive settlement. 23. The stronger the interdependent approach method, the subject will apper the positive settlement. 24. The Sunject experiences the burden will appear the positive settlement or negative settlement.

An Analysis of School Health Nurses' Attitude Toward Sex Education: A Q-methodological Approach: Yaung Sook Chung; J Korean Acad Community Health Nurs. 1995;6(2):197-211. Published online December 31, 1995

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Abstract PDF: This study was designed to identify school health nurses' attitudes toward sex education through a Q-methodological approach. Research was done from Apr. 3, 1995 to Oct. 15, 1995. A final Q-sample was selected to 37 statements out of initial 128 statements after consultation from counselors, educators and writers related to sex education. The P -sample was consisted with 32 school health nurses in Chonbuk province. The collected data were analyzed by Quanal program on PC. The results of the study were as follows: School health nurses are categorized into 6 types. The first type, receiving type with cognition deficiency about general learning objectives of sex education were consisted with 4 subjects. The second type, valuing type with cognition deficiency about general learning objectives of sex education were consisted with 6 subjects. The third type, adopting behavior type with cognition deficiency about specific learning objectives of sex education were consisted with 5 subjects. The fourth type, receiving type with cognition deficiency about specific learning objectives of sex education were consisted with 5 subjects. The fifth type, making sense of information type with cognition deficiency about specific learning objectives of sex education were consisted with 5 subjects. The sixth type, adopting behavior type with cognition deficiency about general learning objectives of sex education were consisted with 7 subjects. As a result of this study, we may realize necessity of prepared sex educators. Sex the educators must be fully cognitive and affective toward sex education before practicing sex education.

The Concept of Hope of Stroke Patient: A Review of the Literature for Nursing: Lee Sun Kim, Bo Sun Huang; J Korean Acad Community Health Nurs. 1995;6(2):212-233. Published online December 31, 1995

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Abstract PDF: Cerebrovascular diseases in Korea is an important health problem since mortality and mobidity have been increasing rapidly. Cerebrovascular diseases marked the 2nd rank of cause specific death rate in 1993. The ploblem of emotion after a stroke has received very little attention from the nursing profession until recently. Even the frequency of the emotional disorder after stroke is uncertain, and there has been very little research. Emotional disorder after stroke was related to limited social function, guilty conscience, helplessness, hopelessness, powerlessness, alienation, and damage of self-image. In the stroke patient, hope may be related to a rehabilitation or enhancing physical condition. Inspiring hope is necessary when stroke patients are unable to mobilize energy on their own behalf and perceive limited or no person choices available. Inspiring hope is an intervention that can be used with many nursing diagnoses, especially when feelings of helplessness, hopelessness, powerlessness, and depression are present. The nurse can inspire hope by understanding the hoping process. On the basis of this literature review, the following suggestions are prosed. 1) Qualitative studies on hope have been done to indentify variables that affect maintenance of hope in the chronically ill patients. 2) In the development of an instrument to measure hope, the validity, reliability, and cultural property of the hope have been estabilished.

A Study on the Factors Affecting Self-Regulation Program for Hypertensives: Young Im Park; J Korean Acad Community Health Nurs. 1995;6(2):234-249. Published online December 31, 1995

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Abstract PDF: Essential hypertension, one of the leading primary cause of death in Korea, is a typical chronic disease requiring adequate and continuous management. Though these hypertensives need to maintain desirable health practice by themselves for their life time, many previous studies indicated that most of the essential hypertensives have no specific symptoms and thus, reluctant to follow appropriate medical regimens causing the condition further aggravated and complicated. Thus the comprehensive self-regulation program was conducted as a nursing intervention on the promotion self-care performance and improvement in physical parameters of hypertensives. For this purpose, a one group quasi-experimental research with pre and post test design was used. And the whole program was carried out from October, 1993 to February, 1994. Self-regulation program was consisted with group education on hypertension and self-care, self-regulation including the blood pressure self-monitoring and recording, recording of daily self-care activities, and encouraging and reinforcing self-efficacy through verbal persuation and enactive attainment. The subjects were asked to measure their own blood pressure by themselves twice per day and to record blood pressure and the daily self-care performance according to the instructions provided during the whole period of 9 weeks. The data was analyzed by experimental stages: the first week, the fifth week, and the ninth week since the experimental imput began. Data were analyzed by the SPSS PC+ program with paired t -test and F-test, and multiple correlation to determine the variables affecting the effect of program. The results were as follows : 1) Subjects in J company were significantly lower diastolic blood pressure than K company after the program (t=2.39, p=.024). Level of cholesterol was significant difference according to position(t=2.23, p=.034), family history (t=-2.66, p=.013), diagnosis duration, and career(t=2.88, p=.055). Perceived self-efficacy was more significantly increased among the group with family history(t=-3.00, p=.013). 2) Before the program, there were significant positive correlation among the variables: internal-LOC and self-efficacy(r=.3952, p=.015), external-LOC and barriers (r=.6515, p=.000), chance-LOC and Barriers(r=.4133, p=.012). However there were significant negative correlation between internal-LOC and barriers (r=-.3236, p=.041, external-LOC and self -efficacy(r=-.3517, p=.028), self-efficacy and barriers(r=-.6654, p=.000). 3) There were significant relationships between changes in self - care performance and self-efficacy at 5th week (r=.5313, p=.001) and changes in self-efficacy at 9th week(r=.4586, p=.005). 4) After the program, internal health locus of control and perceived benefits showed significant correlation(r=.5673, p=.001, but perceived barriers was negative correlation with perceived self-efficacy (t=-4242, p=.01). From the above results, it can be concluded that the self-regulation program is an effective nursing strategy through the change of variables to promote self-care performance of hypertensives and to increase the self-efficacy. Thus this program can be recommended in the management of the hypertensives in workplaces and community settings.

The development of the scale for Health promotive behavior: Hee Young So, Choonsil Hong, Hyun Li Kim; J Korean Acad Community Health Nurs. 1995;6(2):250-258. Published online December 31, 1995

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Abstract PDF: The purpose of this study was to determine the level of health promotive behavior of adults and thereby to develope the health promotive behavior scale adjusting our sociocultural situation. The item for health promotive behavior was aquired from statements which was reported by Kim through deep interview with 164 Korean adults. The scale was measured with 4 points Likert type. Data was collected with questionnaire for population living in farm of Chungnam Province and Dae Jon City, from July to August 1994 by research assistant trained by researchers. Data was analysed using SPSS program with Cronbach alpha and factor analysis. The results are as follows : 1. For the reliability of the scale, Cronbach alpha was .8264 2. The factor analysis to examine the construct validity showed that health promotive behaviors included 9 factors: health management (16.0%), regular life style(7.4%), psychosomatic control(5.6%), moderation of living(4.6%), stress rnanagement(4.1%), abstain from favorite (3.9%), sanitary habit (3.8%), thought (3.2%), diet habit(3.1%). Nine factors explained 51.7% of varient.

A Field Study on Managing System of Maternity Clinic at Public Health Centers in Seoul: Yeon Kang Chung, Young Mi Kwon, Hee Young Kim; J Korean Acad Community Health Nurs. 1995;6(2):259-274. Published online December 31, 1995

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Abstract PDF: The study is to grasp the problems related to operation of Maternity clinic of public health centers in seoul and needs for public health of community in relation to consumers and providers in order to improve efficiency of community public health for mothers and children. Four pregnancy woman, who receive medical care at the maternity clinic of M public health centers in seoul and understand the purpose of this study, and one nurse who works at the were the objects of this field study. Participating observation and intensive interviews were conducted to collect data. All of them were performed as necessary from time to time since December, 1994, and not during a specific period. Through an data analysis in the order of sector analysis and classification analysis, the data were classified into specific patterns and the results are the following; 1. All of the subjects were using both private hospitals and public clinics, but managing activities prior to delivery were not carried out in accordence with theories for those activities. 2. The subjects showed two types of response to utilizing maternity clinic. they answered that the advantages of the clinic were 'short waiting time for medical treatment', 'medical treatment by female doctors' and 'economical benefit.' Meanwhile, they gave negative response to the problems of 'non-implementation of delivery' 'uncleanness and insufficient facilities', 'limited time of treatment', 'lack of expertise' and 'want of public health education for materity.' 3. Problems related to operation of maternity clinic were 'lack of experts', 'irrational facility structure' and 'absolutely lack budget'. In terms of the status of managing the subjects, 'programs only aimed at attaining the central-government-assigned objects' and 'limited management before and after delivery by non-implementing delivery' were pointed out to be problems. Regarding public health education before delivery and PR relations, 'superficial public health education for maternity' and 'absence of PR programs' were named. In planning and evaluation, 'absence of autonomous planning and evaluation by the clinic itself' was a major problem in operating the clinic. 4. 'Substantial health education and PR', 'supplementation of facilities and eqipment', 'development' and supply of demanded service by the subjects', 'implementation of autonomous programs', and 'reinforcement of supplementary education' were presented as alternatives for efficient opration of maternity clinics.

A study for quality assurance of visiting nurses service of a public health center: Soon Nyoung Yun, In Sook Lee, Hye Jin Hyun, In Ja You, Jai Nam Kim, Jung Hee Bae; J Korean Acad Community Health Nurs. 1995;6(2):275-285. Published online December 31, 1995

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Abstract PDF: The purpose of the study is to evaluate the visiting nurses service of a public health center. Data were collectd from the 36 clients who received services from a public health center. In terms of the process evaluation, the tool is composed 4 parts, 27 items such as assessment planning, implementation, and evaluation. It was measured through the health records by 2 peer review. In terms of the outcome evaluation, the level of client satisfaction was measured by self report or interview by 2 supervisor. The result were as follows: 1. 30% of 36 health records showed narsing process was not and out of them, nursing care plann including spectific activities were rarely established or unclear. 2. The lack of systematic data collection showed and nursing diagnosis was not adressed in health records review. 3. Client satisfaction score was 32, 97, out of maximum score 36. 4. The lack of sufficent objective data, care plan, record of client's health status change, and evaluation was founded therefore quality assurance for visiting nurses service and in-service education are required and the development of standardized record system need.

The Study on the Attitude about Drugs, the Actual Conditions on Drug Abuse and Drug Education of Primary School Students: Jung Soon Kim; J Korean Acad Community Health Nurs. 1995;6(2):286-298. Published online December 31, 1995

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Abstract PDF: The purposes of this study were to suggest the need for drug prevention program in primary school and to provide basic data for preventing the youth from their drug abuse. A total of 680 students of primary school in Pusan were selected to answer this questionnair. The data was collected from July 1 to July 15, 1994. The major findings of this study were as follows : 1) The attitude about drugs of primary school students was desirable. By groups, girl students showed more desirable attitude than boy students. 2) 5.9% of subjects had smoking experience, and for the motives of smoking 77.5% of them, the largest numbers, was with curiosity. 3) 39.8% of subjects had experienced alcohol use, and for the motives alcohol use 50.5% of them, the largest numbers, was with curiosity. 4) 1.8% of subjects had experienced inhalants (gas, butane gas), and for the motives of inhalants use 58.4% of them, the largest numbers, was also with curiosity. 5) The rates of smoking, alcohol use and inhalants use were higher in boy students than girl students. 6) The attitude points about drugs in case of smoking, alcohol use and inhalants use were lower than the points in case of not using them. 7) Knowledge level about .drugs of subjects was appeared poor. 8) For the need of drug education 65.9% of subjects responded "necessary", and they responded most suitable educator as school nurse. 9) The students had received drug education from school in 38.2%, from their parents in 8% and from mass media in 63.5%.

A Study on the Knowledge and Attitude about Emplyee's Health Management in the Provinces: Eun Hee Kim; J Korean Acad Community Health Nurs. 1995;6(2):299-318. Published online December 31, 1995

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Abstract PDF: This study was conducted in order to grasp the condition of the Worker's knowledge and attitude about health management. And to offer the basic materials for the health promotion in industrial field. The objects were comprised 336 of volunteered who work in E.shoemaking factory. The material of this study was the questionair (chronbach alpha=.8871) suited to the purposed of this research which has been made through studying references. All the guestionaire were collected inmediately without explanation. The data collected from 18th September to 1st Octover. Analysis of the data was done utilizing SAS program for percentage, mean, ANOVA. The result are as follows: 1. General features of the objects of study. Male was highest (58.6%), mean age was 30.07 years, graduated high school was highest(59.2%), producer in present place of employment was highest (76.2%), mean career was 7.45 years. 2. The conditions of attitude about health man agement. Correct answer of health examination was 77.8%. Having experience of health examination was 69.5%, among them have regularity was 70.9%. Think it too much trouble to do not health examination was 69.7%. Have got to do health examination was 95.6%. The reason of set up health clinic was emergency care 58.9%, health education 22.1%. Using health clinic was 70.4%, by monthly was 53.0%. The reason of think it too much trouble to use not health clinic was 65.2% The need of health clinic was 96.4% 3. The conditions of knowledge about health management. When 5 points was given to "very affirming" and 1 point was given to "very deny", the total average was 3.67, the range was 2.96-4.54. Exactly, company must given to employee put in operative health examination was highest, worked 34 hours per week on harmful worked place was lowest. And knowing about kind of harmful work was 2.86, dangerous work was 2.90. 4. Correlation between the general features and attitude variables. Female group may have more knowledge on reason of health examination. Over 50 years aged group, middle school graduated group, white colored group, less then 1 year career group may have more knowledge on health examination. White colored group may have more attitude on health examination(chi2=5.210, P<.07). High careered group may have more using on health clinic (chi2=12.08, P<.007). 5. Difference between the general features and knowledge of health management. High educated group were highest score in knowledge (F=5.214, P<.002). White colored group were highest score in knowledge (F=23.019, P<.000). 6. Difference between the attitude and knowledge of health management. Needing of health examination group were highest score in knowledge. (t=2.54, P<.011). Using of health clinic group were highest score in knowledge(t=190, P<.048). Needing of health clinic group were highest score in knowledge(t=5.13, P<.000).

Epidemiological and Lumbar x-ray Studies on the Low Back Pain of the Workers in an Automobile Industry: Soon Lae Kim; J Korean Acad Community Health Nurs. 1995;6(2):319-334. Published online December 31, 1995

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Abstract PDF: To investigate the risk factors of low back pain, an epidemiological study was carried out among male workers aged 20-55 employed in an automobile industry in Korea during the time period from February 1993 to October 1995. Workers participated to this study were divided into low back pain group(LBP) and control group, according to the self-reports by written questionnaires. General characteristics, medical history, work related factors, fatigue, and MMPI were compared between two groups. To clarify the relationship between job related low back pain and radiologic features of lumbar spine, radiographic study was carried out. The resultant data were processed for chi2-test, t-test, and stepwise logistic regression to confirm the adjusted odds ratios. The results were as follows: 1. History of back disease, lifting and carrying work, excessive physical fatigue, and weakend back strength of individual workers were directly associated with low back pain. Odd ratios of these 4 risk factors of low back pain were 5.07, 3.34, 1.49, and 1.22 respectively. 2. The frequency of low back pain history was significantly higher in LBP group. 3. Back muscle strength of lumbar spine of LBP group were significantly lower than control group. 4. The workers in LBP group revealed high fatigue symptoms. 5. In MMPI test LBP group showed higher scales in hypochondriasis, depression, hysteria, psychopathic deviate, paranoia, psychasthenia, schizophrenia, and hypomania. 6. LBP group were more frequently involved in lifting and carrying, working in awkward position, bending, twisting and using lower extremities. 7. LBP group were exposed more to vibration during working. 8. In the Analysis of radiographs of lumbar spine, Jacob's line not crossing fourth lumhar disc space, transitional vertebrae and lumbar displacement more than 4.4mm in standing lateral view were more frequently observed in LBP group than control group. Through these results, it is concluded that identification of previous history of back problem, change of work or working environment for workers with previous back problem and measures to relieve both physical and psychological fatigue of the workers are required for optimal management of work-related back problems among workers. In the present study, several results were different from the previous reports: Jacob's line not corssing fourth lumbar disc space, lumbarization, and vertebral slipping (spondylolisthesis) more than 4.4mm are related to backache. Meticulous studies are required to elucidate the difference.

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