Evaluation of Community Health Center for Vulnerable Population in Urban Areas

PURPOSE: The purpose of this study was to evaluate achievements of a community health center for vulnerable population in urban areas and to find out its strength and weakness. METHOD: This evaluative study employed system theories and analytic techniques. RESULTS: The purpose of improving vulnerable population's health-related self-care abilities adequately met the operation of programs. This center maintained close connection to a nursing college as a information resource. The subjects' satisfaction was high because team members who visited them were faithful and there were face-to-face contact, sufficient time set, closeness and resourcefulness. There were needs for regular meetings to discuss overall matters in organizing the program and to improve management skills. The mean score of health promotion lifestyle was 2.23 on a 4 point scale. This score indicates what in higher than vulnerable people in other communities. CONCLUSIONS: Community-based nursing centers for vulnerable population in urban areas should be developed as support organizations and community network.

Nutritional Risk and its Related Factors Evaluated by the Mini Nutritional Assessment for the Elderly who are Meal Service Participants

This study is designed to assess the prevalence at risk of malnutrition according to the Mini Nutritional Assessment(MNA) and evaluate the factors influencing on the nutritional risk of the elderly. Three hundred and nine elderly (110 men and 199 women: mean age = 74.1) who participated in meal service in the Chung-buk province were investigated. Mean MNA total score was 21.9 and women had significantly lower MNA scores than men (respectively, 21.5 and 22.8). In the mean time mean MNA-SF (Short Form) score was 10.7, respectively 10.6 for the women and 11.0 for the men, with the difference being statistically significant. The MNA classified 33% of the elderly as well-nourished, 61.7% as at risk of malnutrition and 5.3% as overt malnourished. However, MNA-SF categorized the examinees 40.2% as good and 59.8% at nutritional risk. Those who identified as malnourished elderly had significantly lower mean BMI, mid-arm and calf circumference, poorer functional abilities (ADL, IADL), lower MAR and food habits scores, and higher number of nutrient < or = 75% of RDA than those with at risk of malnutrition and well nourished. Also socioeconomic status such as educational level, self-rated economic status, poverty level, and marital status significantly influenced nutritional status. Similar effect was observed in self-rated nutritional status and health status, dental status, appetite change according to MNA score. Stepwise multiple regression analysis indicated that weight loss was the most predictive item in the total MNA and MNA-SF score. It was found that items such as mobility, living status (home vs institution), mode of feeding, and pressure sores were inappropriate for assessment of the elderly who are able to participate meal service program. Also, some modifications of items in MNA are needed in order to apply to Korean elderly. Even though the MNA seems to be an useful tool to screen those old people at risk of malnourished, a lot of work is still to be done with this assessment tool to secure its reliability.

Psycho-Social, Nutritional Status and Meal Service Utility Patterns by Living Arrangements of the Elderly Participated in Meal Service / 대한지역사회영양학회지

This study is designed to examine influences of living arrangements on psycho-social factors, health and nutritional status, dietary adequacy and meal service utility patterns of the elderly. Nutritional status was evaluated by Mini Nutritional Assessment (MNA). Three hundred and nine elderly (110 men and 199 women) who participated in meal service in the Chung-buk province were investigated. Proportion of the elderly living alone, couples only, living with spouse and family, living with family without spouse, and living with other than family were 30.7%, 25.9%, 14.2%, 24.3% and 4.9% respectively. The mean age of the elderly was 74.1 years and the elderly who are living couples only and living with spouse and family were younger than those with other living status. Living arrangements seem to be related to psycho-social factors, health and nutritional status, and dietary quality. Those who live alone and live with other than family were mostly women and they have lower socio-economic status, psycho-social, health and nutritional status and dietary patterns compared with those of the elderly who are living with spouse or family. It was found that the elderly who live a couple only and live with spouse and family had better emotional, health and nutritional index than those of the elderly who live with family without spouse, especially in case of females. Most of elderly perceived that participation of meal service programs had a positive effect on their daily life and satisfied with meals. The elderly living alone and living with other than family were more frequently using meal service but had a negative attitude about the charged meal service for better quality than the elderly with other living status. The most important reason for all the elderly to participate in meal service was to meet their friends and then to get other services. Particularly those who are living alone and living with other than family showed lack of moivation to prepare and set the meal, and for them the economic reason is also important. They also replied that the poor health and lack of other help were the most difficult problems for them to prepare meals. It would be effective to provide nutritional services that meet specific needs of the elderly according to their characteristics and living environment.

Developing Breakfast Menus for Most Easily Breakfast-Skipping Groups / 대한지역사회영양학회지

This study was conducted to develop the standard breakfast menu for those weak groups having insufficient breakfast intake. The following three target groups are classified as: 16 - 19 years old high school male student, 20 - 29 years old female who have job or college students, 20 - 29 years old male or female who have job (double income family). While developing menus for each target groups, we applied several basic guidelines for meal planning as follows: Nutrient intake level was set to 1/3 of RDA, while the energy level to 1/4 of RDAs. Most frequent meal pattern of Koreans was adapted; Suitabilities of appropriate serving size and cost for middle-income families were considered; Domestic foods and ingredients were used. We developed 24 menus summed by 2 menus for each season and three target groups. When evaluating the menus, most of the breakfast menus were sufficient of nutrients as a meal for the subjects. Three food groups such as grain/starch group, meat/fish/egg/bean group, vegetable/fruit group were included in all menus. Even though milk/dairy products group was not excluded for some menus, other calcium substitutes like anchovies were used. Oil/nut/sugar group was used to a minimum. The average number of foods for each menu was 12.8, which ranged from 10 to 17 depending on the menus. The average weight of the menus including soup was 822 g, 633 g and 730 g for each target group, respectively. The average price of the menu ranged from 2,000 to 3,500 won per person. The above results could be applied at home as well as foodservice institutes and furthermore could offer information for developing breakfast-substituting food products.

Nurse's Adoption on a Planned Organizational Change / 간호학회지

With the dynamically changing environment of society, managing change is the vital element of organizations's survival and growth. Health care organizations have expended enormous resources to restructure patient care delivery. Despite the growing literature describing these organizational innovations, there is a paucity of credible data that reflects systematic measurement and evaluation of such changes. This study examined the nurses' psychological response toward the work process redesign, newly introduced by the nursing department in a acute care hospital. The aim of the study was to figure out how nurses's general perception of change and perceived attributes of change affected their acceptance of change during the organizational transition. This was descriptive-correlational. The sample for the study included 50 head nurses and 135 staff nurses. Data was analyzed using SPSS PC+, version 10.0. The major findings of the study were as follows: First, the mean score of the perception of change was 71.2 (SD=13.8) with the range of 0-100, which means nurses generally perceived change positively. There were significant differences in perception of change by gender and education level. Head nurses perceived change more positively than staff nurses. The higher education level showed the more positive view of change. Second, among the perceived attributes of change, trialability had the highest mean score, which means nurses perceived the change more positively if it is testable on a limited basis. Relative advantage was perceived the most negatively. Finally, factors influencing the acceptability of the work-process redesign were perceived comparability, complexity, relative advantage, and observability, which accounted for 43.7% of the variance in the acceptability of change.This study evaluated the preliminary effects of the nursing process for reengineering, focusing on nurses' acceptability towards change. The usefulness of this research study was to determine the factors influencing acceptance of organizational members during transitional periods of change and to suggest effective strategies for increasing adoption as well as for decreasing resistance to change.

Attitudes of Food and Nutrition Majors toward Hiring Older Workers / 대한지역사회영양학회지

The purpose of this study was to identify the attitudes of nutrition majors toward hiring older workers who are over fifty-five years of age. Questionnaires were sent to 500 students who are studying food and nutrition in three colleges and three universities located in Seoul and its suburbs. Data from 490 usable responses were analyzed using the SAS package program. The study showed that although the students have a favorable perception about hiring older workers, they prefer to hire younger people under the age of 30 father than older workers(over 55 year old). Additionally, even though both the younger and older people have the same ability, they would still choose to hire younger people. Also, they think that older workers are harder to train, find it more difficult to adapt to new ways of working and are slower in their work. On the positive side, the response did show that students realize that older workers are not absent from work as frequently as younger workers and that they are more cooperative than younger workers are. The data also showed that the students who had a more positive experience with older workers also perceive those workers in a more positive way than the students who did mot have experience with older workers(p<0.0001). Finally, students who have family members who are older workers(p<0.01) and students who are planning to work past fifty-five years of ages show more positive attitudes toward older workers(p<0.01). Moreover male students showed more positive attitudes toward older workers than female students did(p<0.0001).

Characteristics of the Organizational Structures of Free Meal Service Centers and Cooperation with Community / 대한지역사회영양학회지

The purpose of this research was to observe the management system of 18 free meal service centers for the low-income homebound elderly in Chungcheongbuk-Do In order researchers interviewed staff members of the free meal service centers. Based on the results of interviews with staff members of the meal service organization. only two centers used a standard recipe. and most of the meal preparation was controlled under the experience of volunteers. Only two meal service centers employed dietitians due to the lak of budgets. The cost of a meal per day ranged from 556 won to 2,750 won and the number of attendants at meal service ranged from 35 to 350 persons. The budget for most of the meal service centers is not enough to provide meals for the elderly who want to participated in free meal service programs. Home delivery meal service was not considered due to the lake of manpower and areal dispersion in rural ares. Most meal service organizations did not cooperate with other community service organizations. Several improvement strategies are recommended for the effective running of the free meal service centers. First, a nutrition specialist should be included in the staff members of the service organization to provide nutritious meal service to the elderly Second, a joint control system might be introduced into the present system to reduced the cost and the recover the limitations of areal dispersion. Third, service, coordination should be considered to overcome the problem of lake resources.

Development of the Multimedia Education Program for Newly Employed Nurses in the Operating Room / 대한의료정보학회지

Operating Room nurses are required to have special skills and knowledge to do their job. However, because there is no systematic education program, which considers special circumstances in the OR, novice nurses have a great deal of difficulty adapting themselves to the work environment. The purpose of this study is to develope a multimedia education program, which provides the systematic learning environment, so novice nurses can adapt to the OR environment more effectively. This study has been implemented according to Computer Assisted Instruction Design Model(Il-Joo Na and In-Sung Jung, 1990), which goes through the following steps; 1). Education program analysis 2). Development, evaluation 3). CompletionLearning goals, objectives, motive strategy, and analysis of the education program are analyzed by the concepts based on basic education materials for novice surgery nurses of 6 Medical Centers in Seoul and 'Development of the job training program for newly employed nurses in operating rooms. 'written by Ji-Young Yoon(2000). We divided 9 areas of the contents in surgery education; 1. Basic orientation 2. OR nurses' roles and responsibilities 3. Asceptic technique 4. Disinfection and sterilization 5. OR safety 6. OR nursing care 7. Surgical positioning 8. OR Material management 9. Anesthetic care. We selected asceptic technique, which is the most fundamental concept in OR nursing care. The program screens consist of cover screen, screen for guide, mini menu screen, and test screen. We distributed questionnaires to fifteen experts and investigated their opinions to analyze learning contents and effects of the Courseware. The education program was modified based on respones provided by experts. This study offers an educational program, which allows the individuals to choose the areas they want to learn. The program is easy to use, which encourages the individuals to search for additional information more than one area.

Assessment of Customer Satisfaction of Service Quality in University Foodservices / 대한지역사회영양학회지

The purpose of the study was to assess customer satisfaction concerning service quality characteristics of university foodservice by using a developed DINESERV model. In particular, it was intended to develop a tool to assess the difference between customer judgements on importance and customers perceptions with actual service delivery by university foodservices. Quenstionnaires were distributed to 1,000 university students. A total at 820 university students responded with a usable response rate of 77.7%. A statistical data analysis was completed using SAS programs for descriptive analysis; a t-test, chi-square test and Dunan's multiple range test. The results of the study are as follows; 1) The mean number of students visiting university foodservices per week for males was larger than that of females. The students' first choice depended on distance when they selected foodservices. They answered their preference as the first factor when they order a particular menu items in foodservices. The first complaint factor concerning university foodservices was the price of the food. 2) Customers was not satisfied with the quality of the service of university foodservices. The important mean score of the service quality was 3.63 out of 5, but the perception mean score of the service quality was 2.87. Therefore, there was a gap(0.76) between the importance score and perception score. 3) Customers' satisfaction with the service quality by dimensions wee int he follow order: assurance>reliability>responsiveness>tangibles>empathy. Customers were more satisfied with the service quality of contracted management than that of self-operated facilities.

Standardization of Nursing Documents for Special Nursing Units / 대한의료정보학회지

The purpose of this paper is to introduce standardization activities of nursing documentation for special nursing units following standardization efforts for general nursing units last year. Modified Delphi approach with expert panel was used to identify essential nursing documents and data set for each units. Expert panel was consisted of head nurses or charge nurses of each special nursing unit from 8 tertiary hospitals with more than 500 beds in Seoul. the secretary-general of Clinical Nurses Association and a faculty of College of Nursing. The exiting nursing forms of seven special nursing units, which include Emergency room, Intensive care unit, Operating room, Respiratory intensive care unit. Delivery floor. Nursery and Dialysis room, were analyzed and prototypes of the standard nursing forms and guidelines were developed. The clinical field test was done with the help of Clinical Nurses Association. At the field test 3.744 clinical staff nurses from 20 tertiary hospitals with more than 500 beds in Korea were involved and provided feedback. Finally public hearing was held and more than 600 nurses from 116 hospitals attended and provided feedback. Through these process consensus of nursing community was attained for standard documents and data items. The result is available at http://nursing.snu.ac.kr/standard/ through internet.

A Preliminary Study for Evaluating on Demonstration Project of Community-based Home Health Care Nursing Services by the Seoul Nurses Association / 간호학회지

This study, based on current home nursing services, aims at promoting measures for establishing a community-based home nursing system derived from the pilot home nursing demonstration project conducted by the Seoul Nurses Association. The study was based on an analysis of home nursing records from march 1993 to December 1999. The following is a summary analysis, based on individual characteristics of the patients, the organization, which recommended the service for their patients and personnel services. 1. The service has been used by many elderly people 60years of age or older(66.4%). and married people(60.9%). The average number of visits by service personnel for patients of city government was 23.5. This is 2.5 times as many visits by general patients. General patients(20.2%) had only one visit from service personnel, while 65.5% of patients of city government had 10 or more visits. Particularly, for government recommended patients, 72.7% of the patients were recommended by nurses, while only 21.9% where referred to the services by doctors. The main focus of a home nursing service was to maintain present health status (53.4%), and hospice(11.6%). Also to increase hospital-based home nursing services focused on recovery(55.9%) and maintain present health conditions (19.0%). 2. For general patients, 42.0% of patients were suffering from problems related to CVA, 11.3% from high blood pressure, and for patients referred from city, 21.2% from skeletal muscular disease. Results of home nursing services 29.4% of patients were able to recover or maintain their health status, but 48.9% of the patients died. Another main point of community-based home nursing services is medication(6.7%), other basic nursing services(6.1%), special treatment, instructions on how to use medical devices(5.9%), change of physical posture(4.6%), and training on changing physical positions(4.7%). As mentioned above there were some differences between the characteristics of patients who used the pilot home nursing service conducted by the Seoul Nurses Association and those hospital-based service users. The results are believed to be useful to support a community-based home nursing service model. Particularly, patients under medical supervision and patients recommended by government-run health clinics show a higher frequency and longer use of home nursing services compared to general patients or hospital-based home nursing service users. According to the study, nurses accounted for a large number of recommendations for home nursing services. Many patients with CVA, high blood pressure, skeletal muscular disease and bedsores used community-based home nursing services, while others used the service for minor treatments or maintaining their current health status. Based on the study, the researchers make several suggestions to establish a community- based home nursing service system. First, different ways of setting up a community-based home nursing system have to be mapped out based on the evaluation of the pilot home nursing service conducted by the Seoul Nurses Association. Secondly, a new, community-based, home health care nursing service model, and reimbursement payment system have to be developed. This is based on the outcome of the analysis, and implemented policy. Accordingly, efforts are needed to develop a community- based home nursing system with an intermediary role to promote the visiting nursing services of government-run health centers.

Workload Measurement of Home Health Care Nurses' Services using Relative Value Units / 간호학회지

Home health care is moving into a set of new realities. An era of competition and cost containment has arrived. Before nurses are able to contain costs or describe the relationship between nursing activities, cost must be accurately measured based on the nurse's workload. Nurses in home health care usually desire to measure expenses for one of three reasons : reimbursement, management, or research. The purpose of the study was to investigate the work input by Registered Nurse in each of the home health care activities by relative value units and identify the factors affecting the nurses' total work input in health care services. To measure the work input by nurses, work was defined by four dimensions: time, physical effort, mental effort, and stress. This study used a descriptive-correlational design. Data collection consisted of two phases. In phase I, data on home health activities performed by nurses were collected. In phase II, data on nurses' time, physical effort, mental effort, and stress in each of home health care activities discovered phase I were collected. In this method, the respondent was asked to rate a service in relation to a reference service using a ratio scale. The sample included 39 home health care nurses. The results of the study indicated that home health care activities performed by the nurses were in 10 categories and 69 items. Measuring the relative work inputs in each of home health care activities, and foley catheterization was selected as the reference to service. In terms of time and physical effort dimensions, full bath service was rated as the most strenuous among 69 activities by the respondents, and intramuscular injection was rated as least. It was found that emergency treatment required the highest mental effort and the highest stress, while blood sugar tests required the lowest mental effort. Approximately 91.3% of the variance in total work input was accounted for by the linear combination of time, physical effort, mental effort judgement, and stress. Examining the regression coefficients of those variables, physical effort, time, and stress were found as the predictors which were significantly associated with the total work of nurses in home health care. Professional nursing's next step in the conundrum of economic volatility is to develop a tool to reflect the interaction of functional deficiency and direct professional nursing care. And this will be a more accurate predictor of nursing resource use and ultimately a great forcaeter cost.

Exploration for causality of disease condition,pain and depression in patients with rheumatoid arthritis / 성인간호학회지

No abstract available.

A clinical study of neonatal sepsis

The 35 newborns with neonatal sepsis admitted to the Neonatal Intensive Care unit of Dong-A University Hospital during 2 years and 6 months from April 1990 to October 1992, and were reviewed on the bases of incidence, clinical manifestations, underlying conditions, etiologic organisms, results or antibiotics sensitivity test and mortality rates. The results were summarized as follows; 1) The incidence of neonatal sepsis was 1.2% and male predominated. Sepsis was more prevalent in premature babies (7.5%) than in full term babies (0.8%). 2) Neonatal sepsis occured more frequently in low birth weight infant below 2500 g(6.3%) than in normal birth weight infant. 3) Underlying conditions associated with neonatal sepsis were as follows; pneumonia (25.7%), HMD (17.1%), urinary tract infection (11.4%), DIC (8.6%). 4) Common clinical manifestations observed in neonatal sepsis were jaundice (45.7%), poor feeding (22.9%), abdominal distension (20.0%), lethargy, convulsion, apnea and diarrhea in order. 5) Blood culture report revealed that gram negative organisms (57.1%) were more frequently associated with neonatal sepsis than gram positive organisms (37.1%). Klebsiella pneumoniae was the most common microorganisms in neonatal sepsis. 6) Vancomycin (100%), cephalothin (84.6%) and chloramphenicol (84.6%) were the sensitive drug to gram positive organisms. Gram negative organisms were sensitive to amikacin (100%), and cephalothin (95%). 7) Overall mortality rate was 17.1% in all patients with neonatal sepsis, 7.7% in gram positive sepsis and 25% in gram negative sepsis. We conclude that the etiologic organisms of neonatal sepsis have been altered, and have to choose appropriate antibiotics which particularly sensitive to these gram negative organisms such as Klebsiella pneumoniae, Pseudomonas aeruginosa, and also have to specify antibiotics according to the predominant organisms of the each institute.

Efficacy of ondansetron is cisplatin-induced nausea and vomiting / 대한암학회지

No abstract available.

In vitro infection of murine macrophages with salmonella typhimurium and listeria monocytogenes

No abstract available.