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Volume 7 (1); June 1996
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Original Articles
A Comparison of Outcomes of Visiting Nursing Service by the Organizational Structure of Health Centers
Soon Nyoung Yun, Sung Ae Park
J Korean Acad Community Health Nurs. 1996;7(1):5-17.   Published online June 30, 1996
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The purpose of this study was to identify the differences of the outcomes of visiting nursing service (VNS) between the two types by the organizational structure of health centers. Type I referred to 3 health centers with departmentalization for VNS and type II of 3 health centers providing VNS under the subunit of a department. Data were collected from 38 visiting nurses at the six health centers for their perceived formalization, decision-making authority and job satisfaction, 293 clients for the satisfaction level with VNS served and their records analysis for level of quality care and frequency by the contents of VNS through the questionares during the period from June, 1 to August 30, 1993. Data were analyzed using chi2, F. t or/and Scheffe test. The result were as follows: 1) There were no significant differences in perceived formalization and decision -making authority of visiting nurses between the two types of health centers. 2) There were significant differences in the level of quality care and frequency of the VNS contents between the two types of health centers. 3) There were no significant differences in perceived clients' satisfaction and job satisfaction of the visting nurses between the two types of health centers. From this study, Not only organizational differentiation with the development of job standards and supportive system but also personnel development are suggested when new health care service in health centers begins.
Analysis of the Public Health Nurses' Job Involvement
Young Sook Chung, Young Hee Mun
J Korean Acad Community Health Nurs. 1996;7(1):18-28.   Published online June 30, 1996
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This study was carried out to explore the direction of job involvement of public health nurses and explore the way for improving services of public health center in Korea. The subjects were consisted of 164 nurses who were working at public health centers in Chonbuk. The data were collected by self-reporting questionnaire from Jan. 15 to Jan. 27, 1996. The instrument used in this study was Likert-type scale which Job Involvement Scale developed by Kanungo. The questionnaires of organizational and job characteristic were made through reviewing literatures. The data were analyzed by frequency, percentage, t-test, one-way ANOVA, Scheffe test, and Pearson's correlation coefficient with SPSS-PC+ program. Major findings were as follows : 1. Mean scores for job involvement were 3.0879 on a 5 point scale. 2. In the personal variables, professional experience(t=-2.18, p=.031), position(t=2.34, p=.021), and age(F=-1.94, p=.038) were statistically significant in job involvement. 3. The variables to job characteristic were statistically significant in job involvement: job challenge (r=.4785, p=.000), role ambiguity (r=-.3141, p=.000), task significance (r=.2714, p=.000), and role conflict(r=-.2166, p=.003). 4. The variables to organizational characteristic were statistically significant in job involvement : formalization(r=.3184, p=.000) and human centered organizational characteristic (r=.2450, p=.001).
Effects of Group Reminiscence Therapy on Depression of the Elderly Residing at Home
Young Chung, Young Ju Baik
J Korean Acad Community Health Nurs. 1996;7(1):29-37.   Published online June 30, 1996
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The purpose of this study is to exmine the effects of reminiscence therapy on deprssion of the elderly residing at home. The subjects were sampled from the members of senior citizens' centres located in Kwangju City. Total number was 73, 38 for the control group and 35 for the experimental group. The study was carried out after a non-equivalent pretest-posttest design. Data were collected from 23 Jun. to 11 Nov. 1993. Reminiscence therapy was applied only to the experimental group. once a week for 6 weeks. Depression level was measured by the questionnaire before and after treatment given. The results were as follows: 1. Religion and family-attachment among socioeconomic charactiristics were significantly different with the level of depression. 2. Religion and pocket - money provider among socioeconomic charactiristics were significantly different with the level of life-satisfaction. 3. The relationship between depression and life -satisfaction was a significant negative correlation(r=-0.777, P=0.000). 4. The depression level of the experimental group was significantly decreased after the treatment as contrasted with that of control group(P=0.004). On the basis of this study it can be concluded that reminiscence therapy reduces depression level.
A Study on Recognizing Value and Belief of Health with aged
Dong Sun Shin, Chun Sil Hong
J Korean Acad Community Health Nurs. 1996;7(1):38-51.   Published online June 30, 1996
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There is a increasingly growing emphasis on health promotion, disease prevention and optimum functioning for peaple including the chronically ill and disabled. According as the purpose of the nursing is the promotion of health, the value and belief of heal th within the nursing paradigm need to be defined in every culture. The paradigm components must be explored for meaning given by the aged in their traditional thought and philosophy. The problem addressed by this qualitative study was how the aged recognize value and belief of health, which contribute to the development of Korean nursing theory. Theoretical support for the study was from Leininger's cultural care theory and Korean philosophy and traditional oriented thought. Literature review refers to literature on the aged, health of the aged, and definition and meaning of general health concept. Grounded theory methodology guied the research methodology and analysis to build a substantive theory. The informants were 119 from a variety of social levels and family patterns; traditionally the aged are responsible for the health. The concentrated interviewing period was from may to june, 1995 ; the interviews were done by the researcher with two supporter and most were recorded on audio tape.
Result
from analysis of base datas follows; The value and belief of health that emerged from the categories and properties were the physical stability, the stability of mind, the stability of mind and body, the smoothness (harmony) of body function, the family concord, and the perfection of self. These values and beliefs of health are affected by the cosmic dual forces thought is based on the Great Absolute, family principle of confucian scholar, and Buddism. Among the values and beliefs of health, family concord is found out Korean culture peculiarities. These values and beliefs are all integrated into the idea of health. The study provided implications for nursing theory research, education, and practice change and development.
Value of Health, Multidimensonal Health Locus of Control and Level of Self-esteem in Low Income Mothers
Kwang Ok Lee, Soon Ok Yang
J Korean Acad Community Health Nurs. 1996;7(1):52-68.   Published online June 30, 1996
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As a product of poverty, health means the physical, mental and social instability caused by poverty. High mortality, high morbidity, and unsatisfied needs for medical care indicate the health condition of poor people. These indicators are related to the social and psychological property. This study is to develop an effective method of nursing in the poor family which is an essential unit in the nursing field of the community and to which a fundamental approach is need as a top priority. We can make such a study, though partially, by revealing the relationship among the Health-value, Health Locus of Contol, and the Level of Self esteem. We randomly sampled 243 women who are participating in the nursing department of the comnnity nursing centers in Seoul. We investigated by using questionaries and made an analysis on the result by SAS program. The result of this investigation can summarized as follows : 1. The average age of the subjects investigated is 43.4 and the participation rate in the economic activity is as high as 49.4%. Most of them are paid daily. The average members of the family are 4.28 persons, and 80.2% of which are nuclear families. The type of housing is as follows:51.4% are monthly-rent houses. Rent houses represent 23.5%. And 43.6% of the subjects graduate the high schools 2. The level of self-esteem possessed by the subjects is 37.17. The quality of task performance(3.46) and the morality(3.53) are low as compared with the other qualities. 3. In relation to the locus of control, internality is 22.39, the influence of powerrful others represents 20.24, and the effect of chance occurance is 16.41. 4. The orderings of value scale are the physical and mental health, comfortable life, happiness, mental peace, and pleasure. The lowest order is social recognition. 5. Considering in relation to the self-esteem and the locus of control, we found out that there is a negative relationship among the self-esteem, the influence of powerful others. The lower the level of self-esteem is, the higher the influence of powerful others is. There is also a negative relationship among the detailed items such as the qualities, and the positive attitude. 6. In a significant test in the general characters of the subjects and in the level of self-esteem, we can obtain the follwing results. The higher the economic level is, the higher the level of self-esteem is. And the higher the level of satisfaction with life is, the higher the level of self-esteem is. 7. In the locus of control, the higher the economic level is, the higher the internality is. 8. In the health-level, 75.72% represent the high health -level. And the group which has the low satisfaction with life represents the high level of health-value(81.6%). With these results, we can conclude that the level of self-esteem possessed by the poor women living in the city is high and that they have the multi-dimemsional health-value even though they are living in the poor condtions. Traditionally, the poverty has been recognized as an unfavorale factor in the health care. But this study shows that the poverty is no longer an unfavorale factor and, on the contrary, it has a potential power with which people can improve their health by possessing the high self-esteem and the high health value. The ultimate purpose which the nursing task of the community has is to make the patients keep and improve their own health. So, when the nurses approach the poor patients, the nurses should put an emphasis on the individual responsibilities of the patients, and respect their own health value.
Factors Related with the Compliance and Treatment in Patients with Pulmonary Tuberculosis in Urban and Suburb Area
Sang Soon Kim, Yoon Ock Kim
J Korean Acad Community Health Nurs. 1996;7(1):69-79.   Published online June 30, 1996
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To investigate the factors related with the compliance and the treatment of the patients with pulmonary tuberculosis in urban and suburb area, we followed up all the 755 registered patients(at urban Public Health Office 544, at suburb 210) as follow from January 1,1992 to December 31, 1993. We describe the general characteristics and the characteristics related with the disease of the patients according to the area as follow. 150 patients(27.5%) were at their age of 20 to 29 years in the urban area, whereas 45 patients (21.4%) were 60 to 69 years and another 45 patients(21.4%) were 70 to 79 years in the suburb area. According to the first chest X -ray examination, 54.5% of all cases were proved to be mild in the urban area. But in the suburb area, moderate cases (44.3%) were more than mild cases(p<0.01). Follow-up X-ray's were performed more properly(p<0.05) in the urban area(94.3%) than in the suburb area(90.0%). Most cases were found in the chest X -ray examination performed by Public Health Office (p<0.01) : payable chest X-ray in the urban area (56.7%) and free chest X-ray in the suburb area(35.2%). More patients were cured in the urban area(90.8%) than in the suburb area(87.1%). The presence of supporting family member were significantly higher(p<0.05) in the urban area(79.1%) than in the suburb area(88.1%). In the analysis of the treatment efficacy, more cure ate were found in the patients cytologically confirmed to be culture (+). In the urban area, 201 culture (+) patients (93.5%) 294 culture (-) patients (89.1%) were cured. In the suburb area, 99 culture (+) patients(91.7%) and 84 culture (-) patients(82.4%) were cured. Age, the presence of supporting family member, and the socioeconomic status of the patient had significant association with the prescription compliance related with the general characteristics of the patients. Whereas, X-ray finding and AFB culture finding were the significant factors associated with the prescription compliance related with pulmonary tuberculosis (p<0.05). The cumulative compliance in the survival analysis was 92.5% in the urban area and 88.1% in suburb area, at sixth month of follow-up. Failure rate for regular drug receipt was highest at second month in the urban area(3.75%) and at fourth month in the suburb area(4.15%). In logistic regression of the factors related with the tratment result, first X-ray examination and prescription compliance were significantly associated in the urban area(p<0.05). However, there is no factor significantly associated with the treatment result in the suburb area. It could be explained by too small size of the sample. In logistic regression of the factors related with the prescription compliance, first chest X-ray, sputum culture outcome and the presence of supporting family member were significant variables in the urban area(p<0.05). Most patients with family member were proved to be compliant with the prescription. This shows that it is important for the patients with long-lasting ilnesses to have supporting family member. Therefore, to improve prescription compliance we should strengthen the health education before the initiation of treatment and take special interest in the patients without supporting family member.
The Diagnosis for Educational Behavioral Strategies of Community Health Nurse-Community Health Worker for Control of Hypertensive Urban Young Black Men in America
Kyung Min Park
J Korean Acad Community Health Nurs. 1996;7(1):80-99.   Published online June 30, 1996
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Young black men(YBM) have the most severs levels of high blood pressure(HBP) and, in all reports but one, the lowest of HBP control of any age /sex /race group. To increase entry into care, remaining in care, and BP control for young(18-49 years) Black men, It is needed to review socio-demographic, medical characteristics, and behaviors(importance of and difficulty with HBP control behaviors, or worry about mdication) for experimental intervention study(educational- behavior strategies) of hypertensive urban young black men. The 204 participants had an average age of 38.8+7.0 years and an average educational level of 11.0{2.4 years; only 23.1% were employed full- or part-time while 26% were on disability ; and 6% were married. Only 35.3% had an MD for HBP care and 37.3% had some form of health insurance. The average BP of those men currently being in care on medication(35.3%) was 148.2/95.1{19.5/11.3 compared to those men not taking HBP care 153.7/99.1{14.0/9.8(p<.05). The average creatinine level was 1.3(excluding 3 marked elevations of 15.9, 9.6, and 7.7) for the 163 men consenting to have their blood drawn. Self-reported co-morbidity induded heart disease 7.8%, diabetes 8.9%, high cholesterol 18.2%, CVA 3.4%, alcohol and drug related problems 27.9% and 22.5% respectively. The kidney disease of those men currently being in care & on medication was 9.7 compared to those men not taking HBP care 0.8(p<.05). The problems of with sex life, physicl activity and dearly thinking of those men currently being in care & on medication was higher compared to those men not taking HBP care(p<.05). Questions of "during the past month, on how many days did you have 5 or more drinks (bottles) of any alcoholic beverag?" and smoking of those men currently being in care & on medication was 18.1% and 72.2% compared to those men not taking HBP care 27.3 and 82.6%, respectively. HBP control behaviors was assessed with 1-5 point Likert subscales(5=extreme, 1-none at all), In general, th men reportd low levels of perceived psychological barrier to HBP care and control behaviors; importance of and difficulty with HBP control behaviors, or worry about mdication. For example, on a five point scale(1=none at all, 5=extreme), average ratings for perceived important and difficulty with BP care and behaviors were 2.8(SD=1.2) and 2.5(SD=1.1). Average ratings for perceived benefit with BP care and behaviors worry about medication of those men currently being in care on medication was 4.0(SD=0.9) and 2.2(SD=1.1) compared to those men not taking HBP care 3.6(SD=0.8), 2.8 (SD=1.6) respectively(p<.05). These data support the need for educational-behavioral strategies of community health nurse to improve high blood pressure control in this high risk group through perceived barriers to treatment, health care skills and use of resources, and social support.
A Survey on Low Back Pain of General Hospital Nurses
Young Sook Kwon, Chung Nam Kim
J Korean Acad Community Health Nurs. 1996;7(1):100-117.   Published online June 30, 1996
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The purpose of the survey was to find out the prevalence rate and related factors for low back pain of nurses and to develop educational program for prevention of the low back pain. The subjects of the survey were 593 nurses of general hospitals in Tae-gu City. The survey was conducted from June 10, 1994 to October 3, 1994. The questionnaire included 34 question items concerning general characteristics, factors related to low back pain, physical nursing activities, and characteristics of low back pain. The results were as follows : 1. Among 593 of subjects, the prevalence rate of low back pain showed 62.1%. 2. In relation of health related life activities and low back pain prevalence, self-reported health state was highly significant(P=.000). 3. In relation of work environmental factors and low back pain prevalence, job satisfaction (P=.026), job stress(P=.020), and workload(P=.002) were significant. 4. In relation of physical nursing activities and low back pain prevalence, bending (P=.000), trunk twisting(P=.003), stretching(P=.006), and pulling and pushing(P=.046) were significant. 5. Physical nursing activities inducing back stress was varicant according to wards. The results of this study pointed out that the subjects' low back pain prevalence was related to the work-related physiologic and psychologic factors. Therefore, for the effective prevention of low back pain, both practicing the body mechanics and raising the morale of the nurses are needed in educational program.
Determinants of health behavior of high school and vocational highschool students
Hee Young So, Hyun Li Kim, Eun Sook Choi
J Korean Acad Community Health Nurs. 1996;7(1):118-128.   Published online June 30, 1996
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The purpose of this study was examine the determinants of highschool students' health behavior. A convenient sample of 2nd grade highschool students (N=638) responded to self-report questionnaires. The IMCHB was then tested with data using SAS program by frequency, t-test, ANOVA, regression. The results were as follows 1. Health behaviors were found to be type of school specific. 2. From the general highschool's model, student's health affected health perception and mother's health and father's education affected self esteem among a set of background variables. Health perception and self-esteem are related to health behaviors. 16.8% of the varience in regular highschool student's health behavior are explained by health perception and self-esteem. 3. From the vocational highschool's model, 20.2% of health behavior varience was explained by self-esteem. Mothers' education, health perception and self esteem explained internal motivation. Student's health, internal motivation and self-esteem explained health perception. The results indicated that there was a relatively poor fit of the IMCHB to the highschool students' data.
A critic review on the 'medical knowledge of menopausal syndrome'
Eun Ok Park
J Korean Acad Community Health Nurs. 1996;7(1):129-137.   Published online June 30, 1996
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The purpose of this study is to examine the medicalizing process of menopanse with literature review, and then is to explore the knowledge of 'menopausal syndrome' critically, focused on four critics on the biomedical model which were suggested by Mishler. Although menopause is a natural biological phenomenon, the view of many medical researchers and practitioners is that menopause is a disease. After synthetic estrogen was developel in 1938, physicians did agree on two basic assumptions : menopausal women should be managed by physicians, and medical intervention should be given. Menopouse was defined as a deficiency disease (estrogen difficiency) by Wilson in 60's and is redefined as a cause of disease(for example, osteoporosis, heart disease) at the present. But the other view of non-medical researcher is that 'menopausal syndrome' as a disease is constructed medically. It was reported that Only hot flush and sweating of physical symptoms experienced by menopausal women, were associated with menopause. Symptoms of menopausal syndrome are also related with symptons of aging. So, it cann't conclude that menopausal syndrome is resulted from menopause, and it cann't be only explained that menopausal syndrome is related causally to estrogen deficiency, and only treatment by ERT or HRT is best relevant. It cann't assume that menopausal syndrome is a common phenomenon to all menopause women, because culture affected on women's experience of menopause.
An Epidemiological Study on the Complications caused by the Sterilization Program
Myung Sun Hong
J Korean Acad Community Health Nurs. 1996;7(1):138-153.   Published online June 30, 1996
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Intending to offer basic information for a prospective health services in Korea, this study is to investigate the complication caused by sterilization in goverment family planning program from 1962 to 1995. The results are as follows: 1. Total number of sterilization performed during the period from 1962 to 1995 were 1.367,772 cases of male sterilization and 2,889,635 cases of female sterilization. 2. Incidence of the complication caused by sterilization operation from 1980 to 1995 were 1,883(0.20%) out of 925,801 cases in vasectomies and 15,866(0.70%) out of 2,256,020 cases in tubal sterilizations. 3. Major complications in vasectomy were epididymities of 658 cases (34.9%), vas recanalization of 326 cases(17.3%), hematoma of 266 cases(14.1%), scrotal abscess of 184 cases(9.8%), sperm granuloma of 76 cases(4.0%),and other of 373 cases(19.8%). On the other hand, in tubal sterilization, ectopic pregnancy was the most significant complication of 15,078 cases (95.0%) among 15,866 total complications, followed by pelvic inflammatory diseases of 155 cases(0.9%), peritonities of 96 cases(0.6%), ovarian & tubal bleeding of 31 cases(0.2%), intestinal perforation of 16 cases (0.1%), uterine bleeding of 14 cases(0.1%), uterine cervix laceration of 1 case (0.1%), and other of 271 cases(1.7%), while 161 pregnancies(0.1%) were terminated and 43 cases(0.3%) with normal delivery. 4. The occurrence rate of the complication for each period showed that most of the complication cases by vasectomy occurred in a year after the operation -the cases were 1,256 (66.7%). 254 cases(13.5%) occurred between the next year and the 2nd year, 138 cases (7.3%) between the 2nd year and the 3rd year, 73 cases(3.9%) between the 3rd year and the 4th year, 52 cases(2.8%) between the 4th year and the 5th year, 31 cases(1.6%) between the 5th year and the 6th year, 79 cases(4.2%) over the 6th year. Tubal sterilization indicated that the occurred complication cases in a year were 2,175 cases(13.7%), 2,113 cases(13.3%) occurred between the next year and the 2nd year, 2,082 cases(13.1%) between the 2nd year and the 3rd year, 2,049 cases (12. 9%) between the 3rd year and the 4th year, 1,819 cases(11.5%) between the 4th year and the 5th year, 621 cases(10.2%) between the 5th year and the 6th year, 4,007 cases(25.3%) over the 6th year. 5. For the cost of complication treatment, total 7,928,229,000 were paid as medical expenditure in which 609,438,000 for vasectomy and 7,318,791,000 for tubal sterilization. Accordingly per capita expenses were 345,000 for vasectomy and 467,000 for tubal sterilization. As the proportion of government sterilization program was decreased after 1988, that of private sterilization program would be increased. So it is recommended to set a guideline for the private sterilization program and to continue government sterilization program for the lower class.
Pastor's Expectations from Parish Nurses
Young Sook Kwon, Chung Nam Kim
J Korean Acad Community Health Nurs. 1996;7(1):154-169.   Published online June 30, 1996
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Parish nursing is a community health nursing role developed in 1983 by Lutheran chaplain Granger Westberg. An increasing emphasis on holistic care, personal reseponsibility for a healthy lifestyle, and changes in healthcare delivery systems have undoubtedly facilitated the establishment and nurturance of an innovative nursing role in the community. Parish nurses are functioning in a variety of church congregations of various denominations. The parish nurse is a educator, a personal health counselor, a coordinator of volunteers. The parish nurses helps people relate to the complexed medical care system and assists people to integrate faith and health. The autors conducted a study on pastor's expectations from parish nurses.
Results
of this study will be useful to those instrumental in planning, initiating, supporting, and evaluating a parish nurses program The research was done on 130 pastors in Taegue and Kyong Sang Buck Do, of various ages ranging from their 20's to 60's: and pastoring churches of various sizes, ranging from under 100 to over 300 members. 94.6% agreed that they needed a parish nurse on their staff; and 86.2% said they wanted to start a parish nurse program in their churches if certain basic conditions were met. The pastors responded that some would hire the nurses on a full-time basis(22.3%), a part -time basis (37.7%) or use volunteer nurses (40%). The pastors said they would expect the following from a parish nurse: health counselling (80.0%) regular health check-ups (78.5%) health care for the elderly (78.5%) health information and education (72.3%) hospice care (72.3%) visiting sick church members at home (69.2%) arranging and training volunteers to help the seek (59.2%) health care for expectant mothers (50.0%) introducing and taking people to health care facilities (46.2%) The pastors were surveyed about specific areas of health education they would want the parish nurse to teach(for example, high blood pressure and heart disease prevention and management(76.2%) ; stress management(74.6%); and diabetes prevention and management(73.8%). The pastors were surveyed about specific areas of health counselling they would expect the parish nurse to do (for example, drug abuse, (73.1), alcohol abuse(64.6%), marriage conflict(60.0%), recovery after the loss of a loved one(56.9%), and women's conflict with parents-in-law(53.8%). The pastors were surveyed about types of things they would want included in regular health check-ups, what they would want a parish nurse to do on home visits, and what they would want included in home care for the elderly. They were also surveyed on what kind of spiritual care they would like parish nurses to give. Most (90.7%) wanted their parish, parishioners to be involved in the parish nurses program as volunteers, and in a variety of ways(such as visiting sick in their homes(68.5%) and helping with housework(63.1%) and taking sick people to health facilities(60%). Parish nurses role, activities, and boundaries of practice should be continuously monitored and refined and a "case manager" should be conceptualized as an additional or all-encompassing role. An initial parish / community needs and readiness assessment should be done prior to establishing a program to detemine if the congregation is ready, willing, and able to support such a position for at least a 2 to 3 year period.

RCPHN : Research in Community and Public Health Nursing