Effectiveness of Community-based Case Management for Patients with Hypertension

PURPOSE: The purpose of this study was to evaluate the effectiveness of case management for patients with hypertension on their health status and medical service utilization. METHODS: This study was a secondary analysis of data collected for a larger study of chronic disease management in 2008 using the National Health Insurance Corporation database. A total of 12,944 patients who received case management for hypertension were included in this analysis. The subjects of case management were classified into subgroups, namely, over-use, under-use, and non-use groups according to the amount of medical service utilization. To compare the medical service utilization, a control group was selected randomly. The data were analyzed through descriptive statistics, McNemar test, and ANOVA. RESULTS: All the subgroups displayed significant differences in blood pressure, self-management, social support, and their characteristics of medical service utilization. The total medical expense of the under-use and non-use groups increased after case management. However, there was no decrease in the medical expense of the over-use group. CONCLUSION: This finding suggests that there is a need to re-examine why patients overuse medical services and to supplement specific strategies for encouraging appropriate medical service utilization, and enhancing case management efforts for the over-use group.

Effects of Continuing Education for Healthcare Manager on Knowledge, Attitude, and Skills / 한국직업건강간호학회지

PURPOSE: This study was to examine the effects of 3 domains of continuing education (CE) for healthcare managers. METHODS: A group of 20 healthcare managers, attending 3 levels of CE, were the subjects. The data were collected by structured questionnaires before and after each education. The data were analyzed by Friedman test, Wilcoxon Signed Ranked Test, and Bonferroni correction. RESULTS: After completing CE, there was significant improvement on the scores of knowledge, attitude, and skills. CONCLUSION: This study suggests that CE for healthcare managers is an effective strategy to promote the competency of healthcare managers, who take care of the chronically ill patients.

The Relationship among Knowledge, Attitudes, Skill, Self-efficacy, and Job Satisfaction of Healthcare Managers / 산업간호학회지

PURPOSE: The purpose of this study was to identify the differences and relationships among knowledge, attitudes, skill, self-efficacy (SE), and Job satisfaction (JS) of healthcare managers (HMs) participated in the 4 kinds of continuing education. METHODS: The subjects were 152 HMs. Data were analyzed by Mann-Whitney U test, Kruskal-Wallis H test, and partial correlation. RESULTS: There were significant differences in knowledge according to the amount of healthcare management experience (HME) and the training program level (TPL); in the attitudes according to gender, age, and the TPL; in the skill according to the amount of HME and the TPL; and in SE according to gender and the TPL. There was no significant difference in JS according to general characteristics. There were significant positive correlations among knowledge, attitudes, skill, SE, and JS. CONCLUSION: The TPL was identified as a significant common variable that affects all variables apart from JS. According to these results, knowledge, attitudes, skill, and SE are considered as intrapersonal constructs, whereas JS is considered as an organizational construct. Therefore, in order to improve the quality of healthcare management, organizational strategy to enhance job satisfaction of HMs are recommended.

A Study on the Satisfaction of Web-Based Health Education Programs

PURPOSE: This study was to present the process of web-based educational program (WEP) development and to identify factors affecting satisfaction with WEP for the certificate of healthcare managers working at the National Health Insurance Corporation (NHIC). METHODS: Subjects were healthcare managers and voluntary participants of WEP. A total of 1,449 respondents were surveyed through an online questionnaire about their satisfaction with the educational contents and system. RESULTS: The mean contents satisfaction was 3.75 (SD 0.54), and system satisfaction 4.68 (SD 0.54). According to statistical analysis, the type of certification, experience and professional career of health care management affected contents satisfaction. And factors affecting system satisfaction were the type of certification and gender. CONCLUSION: WEP was utilized as a pre-requisite course for the certificate program of healthcare managers. However, the development of advanced WEP is suggested to meet the educational needs of healthcare managers who have certificate or license and their job related to healthcare management.

Factors of Physical and Psychological Symptoms in Women after Miscarriage / 여성건강간호학회지

PURPOSE: The study aimed to explore the health consequences that women experienced after miscarriage and the factors related to them. METHODS: A convenience sample consisting of 102 women who had miscarried within 2 years was used. Women were recruited from hospitals and enterprises in Seoul and Gyeong-Gi Province. Participants completed a self-administered questionnaire containing a physical and psychological symptoms checklist developed for this study. RESULTS: More than 40% of the miscarriages occurred after 9 weeks of pregnancy and 35% of women were found to have had a previous miscarriage prior to this study. Psychological symptoms were more prevalent and prolonged than the physical symptoms, furthermore, the frequencies of the symptoms experiencedwere not consistent with the duration of symptoms. Employed women and women with early miscarriages complained of more physical symptoms; however, psychological symptoms were not different according to women's characteristics. Employment was a significant factor affecting physical symptoms. CONCLUSION: Health care professionals need to inform and educate women and the family of the potential health changes during the recovery after the miscarriage. Health consequences due to miscarriages also need to be incorporated in women's reproductive health care. Nursing care should consider factors of maternal age, employment status, and obstetrical conditions upon the apparent social changes.

Analysis of the Factors Affecting to Youth Smoking Based on the Stage of Change

PURPOSE: This study was to analyse the factors affecting youth smoking, especially self-efficacy and perceived social norm, based on the stage of change. METHODS: A self-reported survey was conducted during the period from the 21st of April to the 17th of May, 2008. Data were collected from 10,707 students of 12 middle schools in Seoul, Gyeonggi-do, and Incheon. The data were analysed with SPSS/WIN 15.0. RESULT: The smoking possibility was 2.18 times higher in the male students than in female students, and 1.76 times higher in 8th-grade students and 2.48 times higher in 9th-grade students than in 7th-grade ones. Smoking possibility increased when students had more experience in alcohol, more friends who smoke, or worse relationship with their parents. Also this study showed that high-level self-efficacy and perceived social norm were acting as inhibiting factors of smoking. CONCLUSION: To reduce the youth's smoking rate, smoking prevention programs should provide educational chances to learn knowledge and skills on how to reject smoking temptation. Also, someone significant like parents should make it clear to the youth that they do not want their children to smoke.

The Processes of Habituating to Smoking among Teenagers

PURPOSE: The smoking rates among teenagers in Korea grow gradually since 1980s despite of the numerous programs for youth smoking prevention and cessation have been developed and implemented. The purpose of this study was to explore and describe the processes of habituating to smoking among teenagers using the grounded theory methodology. METHOD: Qualitative data was collected via six focus group interviews. A total of 38 people, twelve teachers and 24 middle school students participated in this study. All focus group interviews were tape-recorded, transcribed, and analyzed according to the grounded theory methodology. RESULTS: The overriding theme of the elicited grounded theory was "stepping into a quagmire by a merest chance". The student participants began smoking by a simple chance. The contingent factors to starting smoking were "discord within the family", "family member's smoking", "schoolwork stresses", or "a rebellious spirit". The conditions of smoking included accessibility, going around in group, and the lack of discipline. "Stigmatizing", "involved in mob violence", and "making a poor academic record" coexisted as the covariance of the smoking habituation. CONCLUSION: The findings of this study illustrated the comprehensive and insightful picture of the phenomena under investigation. Nursing implications and further directions for research were discussed.

Analysis of the Nursing Interventions Performed by Public Health Nurses in Health Centers Using the NIC / 간호학회지

PURPOSE: The purpose of this study was to identify nursing interventions performed by public health nurses in health centers. METHOD: Data was collected by the taxonomy of Nursing Intervention Classification (NIC 3rd: 486 nursing interventions) from 131 public health nurses in health centers and analyzed using descriptive statistics. RESULT: As its result, more than 50% of public health nurses performed 137 nursing interventions at least monthly. The most frequently used intervention class was 'activity and exercise management', followed by 'physical comfort promotion', 'community health promotion', 'life span care', 'coping assistance', 'Self care facilitation', 'information management', 'nutrition support', 'community risk management' and 'patient education'. One hundred twenty nursing interventions were rarely performed by 90% or more of the nurses. Most of them were the physical complex domain. CONCLUSION: In conclusion, 137 interventions were performed by public health nurses at least monthly. NIC is helpful to build a standardized language for public health nursing.

Development and Analysis of Community Based Independent Home Care Nursing Service / 간호학회지

The purpose of this study was to develop the framework of community-based home care nursing delivery system, and to demonstrate and evaluate the efficiency of it. The study was carned out over a period of 3years from September 1996 to August 1999. The researchers developed Standards for operations, this was all aimed toward a home care recording system, and an assessment intervention algorithm for various diseases quality control and standardization. In the center, 185 patients enrolled, and of the enrollments cerebrovascular disorder and cancer were the most prevailment diseases. Also, a home care nursing activity classification was developed in six domains. Those domains were assessment, medication, treatment, education and consultation, emotional care, and referral or follow-up care. Ten sub-domains were divided according to the systematic needs. Among these nursing activities, treatment, assessment, and education and consultation were frequently performed. In sub-domain classification, skin integrity, respiration, circulation, and immobility related care were provided most frequently. The cost of home care nursing per visit was also suggested. The cost include direct and indirect nursing care, management, and transportation cost. Also, the researchers tried to overcome the limitations of hospital-based home care to provide more accessible, efficient, safe, and stable home care nursing. Therefore, clients were referred from other patients, families, public health care centers, industries, and even hospitals. As a result of this study, several limitations of operation were found. First, it was difficult to manage and communicate with doctor in the emergency situations. Second, there was too much time spent for transportation. This was because they are only five nurses, who cover all of the areas of Seoul and nearby cities. Third, preparation for special care of home care nurses was lacking. Fourth, criteria for the termination of care and the frequency of home visits were ambiguous. Finally, interconnection with home care machinery company was so yely needed. New paragraphs' strategies for solving these problems were suggested. This study will be the basis of community-based home care nursing, and the computerized information delivery system for home care nursing in Korea.

Development of the Computerized Health Instruction System for the Registered Health Management Members / 대한의료정보학회지

The purpose of this study is to develop the computerized health instruction system to manage the Health Management Members(HMM) of the Gangbook-ku Health center in Seoul who have registered for the life-time health promotion. The HMM have been checked up and classified into 3 groups - healthy, borderline and ill group - based on their health assessment data through the computerized management system. But the computerized supporting programs for intensive management have not been sufficient enough to offer clear health instructions to the HMM and more than one user in the health center have not been able to use the system at the same time. Therefore, we have developed some new health instruction programs and upgraded the system to be used concurrently. For that purposes, we have used Delphi, Microsoft Access, ActiveX Data Objects(ADO) technology as development tools. We expect thi system to be used for health management of other public health centers, schools, and occupational settings, furthermore for evaluation of health promotion services. Additionally, this new computerized health management system supplemented with health instruction programs should be integrated to the computerized health care system at health centers in near future.

Development of a Computerized System for Intensive Care of the Health Management Members in Kangbook-gu Health Center / 대한의료정보학회지

The risk factors of chronic degenerative diseases are related to daily life style such as lack of exercise, obesity, smoking, stress, insufficient sleep, and etc. This study is conducted to develop a computerized system that check-up, guide and manage the residents' health through life-span. The morbidity of chronic degenerative diseases such as hypertension, diabetes mellitus and arthritis has been high in the survey on community health needs. These diseases are selected as the object of the study. The subjects who register as a health management member are over 40 and under 65 years old in the community. The combined approach method to individuals and groups is applied to the health management. The modeling of database for the system is constructed by entity-relationship model and relational data model. The subjects are classified into three groups of health, borderline and disease, on the basis of their clinical test result and daily life style. The intensive health care is provided to the subjects according to the result of analysis. We anticipate the community health promotion through the life style modification of the subjects by this intensive health care system.