Research in Community and Public Health Nursing

Volume 6 (1); June 1995

Original Articles

A Study on Relationships Between Environment, Organizational Structure, and Organizational Effectiveness of Public Health Centers in Korea: Soon Nyoung Yun; J Korean Acad Community Health Nurs. 1995;6(1):5-33. Published online June 30, 1995

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Abstract PDF: The objective of the study are two-fold: one is to explore the relationship between environment, organizational structure, and organizational effectiveness of public health centers in Korea, and the other is to examine the validity of contingency theory for improving the organizational structure of public health care agencies, with special emphasis on public health nursing administration. Accordingly, the conceptual model of the study consisted of three different concepts: environment, organizational structure, and organizational effectiveness, which were built up from the contingency theory. Data were collected during the period from 1st of May through 30th of June, 1990. From the total of 249 health centers in the country, one hundred and five centers were sampled non proportionally, according to the geopolitical distribution. Out of 105, 73 health centers responded to mailed questionnaire. The health centers were the unit of the study, and a various statistical analysis techniques were used: Reliability analysis(Cronbach's Alpha) for 4 measurement tools; Shapiro-Wilk statistic for normality test of measured scores of 6 variables: ANOVA, Pearson Correlaion analysis, regressional analysis, and canonical correlation analysis for the test of the relationships and differences between the variables. The results were. as follows : 1. No significant differences between forma lization, decision-making authority and environmental complexity were found(F=1.383, P=.24 ; F=.801, P=.37). 2. Negative relationships between formalization and decision-making authority for both urban and rural health centers were found(r=-.470, P=.002 ; r=-.348, P=.46). 3. No significant relationship between formalization and job satisfaction for both urban and rural health centers were found (r=-.242, P=.132, r=-.060, P=.739). 4. Significant positive relationship between decision - making authority and job satisfaction were found in urban health centers (r=.504, P=.0009), but no such relationship was observed in rural health centers. Regression coefficient between them was statistically significant(beta=1.535, P=.0002), and accuracy of regression line was accepted (W=.975, P= .420). 5. No significant relationships among formalization and family planning services, maternal health services, and tuberculosis control services for both urban and rural health centers were found. 6. Among decision-making authority and family planning services, maternal health services, and tuberculosis control services, significant positive relationship was found between de cision-making authority and family planning services(r=.286, P=.73). 7. A significant difference was found in maternal health services by the type of health centers (F=5.13, P=.026) but no difference was found in tuberculosis control services by the type of health centers, formalization, and decision-making authority. 8. A significant positive relationships were found between family planning services and maternal health services and tuberculosis control services, and between maternal health services and tuberculosis control services (r=-.499, P=.001 ; r=.457, P=.004 ; r=.495, P=.002) in case of urban health centers. In case of rural health centers, relationships between family planning services and tuberculosis control services, and between maternal health services and tuberculosis control services were statistically significant (r=.534, P=.002 ; r=.389, P=.027). No significant relationship was found between family planning and maternal health services. 9. A significant positive canonical correlation was found between the group of independent variables consisted of formalization and de cision-making authority and the group of dependent variables consisted of family planning services, maternal health services and tuberculosis control services(Rc=.455, P=.02). In case of urban health centers, no significant canonical correlation was found between them, but significant canoncial correlation was found in rural health centers(Rc=.578, P=.069). 10. Relationships between job satisfaction and health care productivity was not found significant. Through these results, the assumed relationship between environment and organizational structure was not supported in health centers. Therefore, the relationship between the organizational effectiveness and the congruence between environment and organizational structure that contingency theory proposes to exist was not able to be tested. However decision-making authority was found as an important variable of organizational structure affecting family planning services and job satisfaction in urban health centers. Thus it was suggested that decentralized decision making among health professionals would be a valuable strategy for improvement of organizational effectiveness in public health centers. It is also recommended that further studies to test contingency theory would use variability and uncertainty to define environment of public health centers instead of complexity.

Performance of Occupational Health Services by Type of Service: Tong Ran Cho; J Korean Acad Community Health Nurs. 1995;6(1):34-54. Published online June 30, 1995

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Abstract PDF: Occupational health services in Korea have been operated as dual types: one is operated by occupational health care manager and the other is health care agency without their own personnel. The performance of occupational health service should be different due to the variety of characteristics of health care manager and workplace, qualification of health care manager. This study is to analyze performance of occupational health care services with a particular consideration of job, based on comparing those two types of health care management to show on the basic data for the settlement of more qualitative. health care management system at workplace. For this study, total 391 places in Seoul and Inchon city area: 154 places (39.4%) managed by designated. health care manager and 237 places (60.6%) by the agency with their commission are selected as research samples. Tools for data collection are questionnares have been investigated during the period of 20 September 1993-20 December 1993. Those data are compared with percentiles, mean, standard deviation due to the characterstics of each variable and analyzed for impacting factors with relation to the using multiple regression analysis using SPSS PC program, especially using t -test method in order to compare each type of health care management.
Conclusions
observed from the tests and each comparison could be summerized as follows : 1. Occupational health care have been accomplished at workplaces with designated people than with agencies people, and coverage rate of the occupational health care services has differences, due to management types. The reason of these results is due to visit only one or two times monthly by the agencies, while their own health care manager obsess, at the workplaces all the times. 2. The common sickness management is the most accomplished item in health care area of occupational health care services, while the preventive care and control for the workers who have serious health problems are insufficient in workers health care area. 3. An insufficient accomplishment of overall health education has been shown because it is difficult to perform health education due to almost no chance of the direct introduction at workplaces. Therefore a strong support system for making and supplying the media is necessary in order to activate indirect health education by means of media. 4. Because health care managers and the agencies managers where take the workplaces for this study are almost nurses who have been comparatively high work site rounding rate about an environmental management at the workplaces, that non-profession can also do it, the activities about the professional area not enough. Therefore, an appropriate referral system should be established in order to complement professional area. 5. Two factors which have an effect on the coverage rate of occupational health care services are : one is those from the workplaces such as type of services, the number of workers, the number of harzadous factors and safety & health committee, the other from health care organization about whether there is its own manager or not.

An Effect of Muscle Strength Training Program on Muscle Strength, Muscle Endurance, Instrumental Activities of Daily Living and Quality of Life in the Institutionalized Elderly: Hee Ja Kim, Yeo Shin Hong; J Korean Acad Community Health Nurs. 1995;6(1):55-73. Published online June 30, 1995

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Abstract PDF: An Effect of Muscle Strength Training Program on Muscle Strength, Muscle Endurance, Instrumental Activities of Daily Living and Quality of Life in the Institutionalized Elderly Recent statistics shows that the aged are the fastest growing segment of our population by increasing life span. The age group of over 60 shows multiple health problems and the most serious handicapping problem of these. are related to the changes in muscular skeletal system. With aging, people lose. their muscle mass and muscle strength resulting from biological changes and physical inactivity. Studies documented a 30-50% loss of muscle mass in an advanced age and thus, ordinary life activities can be seriously affected due to weakened muscle strength. Preservation of muscle strength of lower limb is especially important in the aged. Since it is readily affected from reduced physical activity in old age, sometimes to the detriment of moving or walking. So muscle strength exercise program designed for the elderly to improve leg muscle strength and leg muscle endurance. The research design used was nonequivalent control group pretest - protest design. The purposes of this study were to test the effect of muscle strength exercise program utilizing Leg Press on muscle strength, muscle endurance, instrumental activities of daily living(IADL), cognitive perceptual variables and quality of life. Forty nine subjects participating in this study consisted of twenty four male and twenty five female. Twenty four experimental group subjects were selected from C-institution in Chung Buk province, and twenty five control group subjects were selected from O-institution in Chung Nam province. The mean age of subjects was 72.8 years. Muscle strength training program utilizing Leg Press for the experimental group was carried out three times a week for 9 weeks. The data was collected from August, 1993 to October, 1993. Data were analyzed with chi2-test, t-test, ANCOVA test, Kruskal Wallis 1-Way ANOVA test using SPSS PC program.
Results
were obtained as follows : 1) The experimental group showed significantly higher scores on muscle strength (leg lift strength, back lift strength and grip strength) and muscle endurance than control group after the experiment lower right quadrantF=52.35(p=.001), F=54.07(p=.001), F=6.97(p=.011), F=18.17(p=.001)upper left quadrant 2) Experimental group were significantly higher scores on IADL than control group(F=7.51, p=.009). 3) Experimental group showed significantly higher scores on economical state and self esteem aspects of the quality of life scale than control group lower right quadrantF=10.59(p=.002), F=6.97(p=.011)upper left quadrant. But there were no differences in emotional state, physical and functional state and relationship with reatives in the quality of life between groups. 4) Scores on IADL showed a significant difference with the level of muscle strength and muscle endurance lower right quadrantchi2=7.73(p=.025),;chi2=8.86;(p=.011)upper left quadrant 5) Scores on self esteem and physical and functional state aspects of the quality of life scale showed a significant difference with the level of IADL lower right quadrantchi2=11.39(p=.003),;chi2=9.02(p=.011)upper left quadrant. 6) Scores of experimental group after the experiment in cognitive perceptual variables (perceived benefit on exercise, perceived health status, self efficacy, emotion on exercise) were significantly higher than those of control group lower right quadrantF=32.09(p=.001), F=5.07(p=.029), F=20.63 (p=.001), F=30.38(p=.001)upper left quadrant. As a result of this study, the effect of strength training exercise program with Leg. Press had improved muscle strength, muscle endurance, IADL, and the perception of self esteem, physical and funtional state, and economical state. Thus strength training program could be beneficially applied for the prevention of disablity and promotion of health and wellbeing in the aged easily and safely. The subjects in the experimental group have maintained their exercises till six months after the cessation of the experiment. This seem to illustrate that changes in cognitive perceptual variables and the improvement in health status have reinforced motivation for the continuation of voluntary exercises. A further study is necessary to determine the factors affecting maintainance of muscle strength exercise and to assess the effect of weight training program on bone density.

A study on the role of the school health teacher in school vaccination: Young Im Kim; J Korean Acad Community Health Nurs. 1995;6(1):74-83. Published online June 30, 1995

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Abstract PDF: Promotion of immunization including early recognition of disease symptoms and effective control of communicable disease have been the important role of the school heath teacher in Korea. The school heath teacher as a nurse have been practiced vaccination for students as one of the major method for promotion of immunization in school. Recently it was occured difficulty for school vaccination that is practicing by school health teacher. So it is predicted for reducing of vaccination coverage rates of students. The objectives of this study are, first; to examine current guidlines of government, second, to analysis problem according to current guidline, third, to discuss further direction for school vaccination. There are used study methods as litrature review, analysis of statistical data and case study etc. Analytical framework for increased effects of vaccination in this study was safty, cost -effectiveness and coverage rates of vaccination. Major suggestions are as follows : First, It is different from the role of the public and private sectors in preventive health services. The preventive health services are characterized that the effect of health promotion is large, but the period of input effect is slow. Therefore the leading role of school vaccination should be have school and school health teacher including public sectors. Second, Health management of contemporary people can be effective with cooperative relationship between various health manpower. School health teacher as a medical manpower should be provide vaccination service continiously for health promotion of students. Third, It is necessary to maintain collective vaccination in school because have lots of advantage at safty, cost-effectiveness and coverage rates. In conclusion, school heath teacher should have central and independent role in school vaccination in according to current law. Also it will be assured lawful compensation in prepare to accident in vaccination.

Effects of Employment and Marital Status on Health Status of Women and Men: Eun Ok Park; J Korean Acad Community Health Nurs. 1995;6(1):84-97. Published online June 30, 1995

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Abstract PDF: There is a widespread concern that women's increasing involvement in dual role (job plus family role) may harm their physical health. Longevity of women is longer than that of men. By contrast, prevalence rate is higher in women than men, and No. of prevalence days, No. of days in bed and No. of days with treatment are more in women. Generally, women live longer, but women are worse in health status than men. Rate of labor participation in women is increasing gradually in Korea. This study presents an analysis of the relationships between employment. marital status and health for both Korean women and men to examine how women's increasing involvements in dual role affect their physical health. The data used in this analysis were collected by The National Statistical Office in the spring of 1992. Households, which were sampled by using a three-stage stratified cluster sampling method, were interviewed. Response rate was 99.43%. Of these, student or widowed or divorced people were excluded. 47,552 women and men aged 21-50 were available for the analysis. Health status was measured by self-assessed health status (1=excellent, 5=poor), No. of prevalent days, No. of days with treatment, and No. of days in bed in two previous weeks. And control variables are age, and education. Research findings are as follows : 1. Men have better self-rated health, fewer prevalent days, fewer days in bed, and fewer days with treatment than women. 2. The employed are more healthier than the non-employed. 3. Unmarried people are more healthier than married people. 4. Interaction effects of sex, marital status, employment are significant. This finding shows that effects of empolyment, marital status on health status is not same for women and men. 5. For male, employed people are more healthier than non-employed people. Unmarried people are more healthier than married people. This differences are significant. For female, The employed are more healthier than the non-employed. However, no differences are noticed between the married and the unmarried in health status. In conclusion, there is no evidence that women's involvements in dual role affect their physical health negatively.

An Effect of Aerobic Exercise on Blood Pressure, Pulse Rate Body Fat, Body Weight, Symptoms of Stress Response: With special reference to the adult woman: Young Hee Kim; J Korean Acad Community Health Nurs. 1995;6(1):98-113. Published online June 30, 1995

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Abstract PDF: The purpose of this study were two fold : first, to determine the effect of aerobic exercise on BP, pulse rate, body fat, body weight, symptoms of sterss response: and secondly, to apply the aerobic exercise on nursing practice in the healthy or ill subjects. In an attempt to investigate the physiological and psychological effect of exercise, a quasi -experiment, non-equivalent control group pre-test & post-test design was planned. Experiments were carried out from July 4, through August 30, 1994 with 37 subjects conveniently sampled from K & Y sports center located in Taejon. The 37 research subjects were assigned to experimental(16 subjects) and control(21 subjects) groups. Aerobic exercise was carried out for experimental group from three times to five times a week for 6 weeks in aerobic center. Data were analyzed with t-test, mean, per centage of change using SAS program.
Results
were obtained as follows: 1) Systolic blood pressure (M=123.75mmHg, % of change=1.12%) and diastolic blood pressure (M=74.38mmHg, % of change=5.79%) was increased on that of experimental group after 6 weeks experiment. But there was no significant difference between experimental group and control group. 2) Body weight was decreased on that of experimental group(M=56.54Kg, % of change=-1.60%) and that of control group(M=52.05, % of change=-0.99%) after 6 weeks. But there was no significant difference between experimental group and control group. 3) Body fat was decreased on that of experimental group(M=30.53%, % of change=-3.60%) and that of control group (M=28.75%, % of change=-3.52%) after 6 weeks. There was no significant difference between experimental group and control group. 4) Pulse rate was decreased on that of experimental group(M=69.19/min, % of change -8.43%) and that of control group(M=76.0/min, % change -0.07%) after 6weeks. There was significant difference(t=-2.621, P<0.05) between experimental group and control group. 5) Symptoms of stress response were decreased on that of experimental group(M=0.97) and that of control group(M=1.15) after 6 weeks. There was no significant difference between experimental group and control group. Therefore, adherence to aerobic exercise for 6 week seem to be affected mainly pulse rate of subjects. A futher study is necessary to determine the difference in the effect of variety exercise, programs, to study over 6 weeks, to produce professional educational program for exercise speciality nurses.

A study of the effect of health education about AIDS related knowledge and attitude in industrial workers: Tae Sung Ahn; J Korean Acad Community Health Nurs. 1995;6(1):114-124. Published online June 30, 1995

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Abstract PDF: The purpose of this study was to identify the education effect about AIDS related knowledge & attitude in industrial workers. This study examined the workers' knowledge and attitude at two times. (before education, 3days after education) This study 298 admitted workers on 3 work place who participated in health education by video material. Data were gathered from 1994. 12. 12 to 1994. 12. 22. The results were as follow: 1. The level of knowledge about AIDS; The correct answer mean score of knowledge before education was 13.7 out of 28. The correct answer mean score of knowledge after education was 17.6 out of 28. 2. The education effect about AIDS related knowledge according to 28 questions; Almost of questions were significantly increased correct answer rate about AIDS related knowledge except 2 questions. 3. The education effect about AIDS related knowledge according to workers' general characteristics: The significant general characteristics of health education effect that impact on the knowledge score were women, the teenth, the twentieth, unmarrige state, lower senior high school graduated, sexual experience had or not, over five occupational career, education time, health education experience had or not. 4. The education effect of AIDS related attitude: Significant change of attitude related AIDS were found 7 out of 9 questions.

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