• 보건행정학회지
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• 제29권4호
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• pp.379-381
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• 2019

Korea's healthcare is in great danger of sustainability. In 2020, the baby boomer will begin to be older, and there is no promise that the total fertility rate of 1.0 or less will rebound, and Korea's economic growth rate is predicted to be less than 2%. Together with these phenomena, Plan for Benefit Expansion in Nation Health Insurance (Moon Jae-in Care) will seriously threaten the sustainability of health insurance finance. In addition, health care in Korea has many problems: excessive medical utilization, rapidly increasing elderly medical costs, concentrating patients into big hospitals, low healthcare personnel but many healthcare facilities and equipment, bad quality of primary and mental care, and fast-growing health expenditure. For sustainability, healthcare of Korea should be reformed. The direction of the reform is people-centered and integrated healthcare in the community which is composed of empowering and engaging people, strengthening governance and accountability, reorienting the model of care, coordinating services, and creating an enabling environment.

• 한국보건간호학회지
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• 제10권2호
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• pp.146-161
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• 1996

This study was purposed to find health promotion and care needs of the elderly in rural area of Korea. As the rural elderly are limited in accessibility to health care resources and could not immediately solve their health care needs when they need. health promotion and care services are expected to bring better and more practical solutions of their health care needs. Thus, the type of health care services to be developed in Korea rural area is discussed to have emphasis on health care service component in addition to health promoting components. Methods of this study was based on survey data analysis : total 322 persons aged older than 55 living at one 'Kun' in Korea administrative unit were interviewed by health workers working at the region and also get trained for this study data collection. The data collection interview was continued from February till May in 1996. The interview questions were modified with adjustment to Korea situation. with basis of the WHO's health promotion program components. The collected data were analyzed using SAS program for frequency, correlation, regressions. The major findings were as follows : (1) $74.8\%$ of the surveyed were sick at the survey time point. and $95.9\%$ known the diagnosis name of the disease. The most frequently complained diseases were Muscular-Skeletal diseases $(43.7\%)$. $34\%$ of those sick had never treated or discontinued therapeutic procedures. so that shown the necessity of systematic and usual health care services with health promotion program development for the elderly. (2) The percent of those who make social participation was $95.3\%$. and the activities were visiting neighbors $(70.4\%)$ and lack of qualified social activity programs. (3) $78.1\%$ of the surveyed had health counseling and education from professional health workers. Those ceased smoking and drinking were $59.6\%,\; 60.3\%$. respectively. Those had no application of therapeutic drugs or nutrion supplements was $40.7\%\;and\;94.1\%$ had regular meals. Those practiced exercises was low remarking $17.7\%$. (4) Positive health behaviors were better carried out by sick groups than by the healthier. except smoking. regular meals. and exercise. $17.5\%$ of sick group smoke more than one case of cigarettes. in contrast to $9.5\%$ of the healthier. (5) Mental health status was heathier among positive health behavior earners. Health counseling and education shown better score of mental health than those never counseled. (6) Positive health behavior practice frequency did not show significant differences when crossed by social activity participation status. (7) Health behaviors of the rural elderly people were carried out better when they had positive 'continuency in therapeutic procedure' 'health status'. 'familial relationship'. 'Health Status' of the rural olderly were explained by 'exercise'. 'drinking'. 'familial relationship'. 'activities of daily living'. Thus, health behaviors practice mutually interact with health status. In conclusion. the health promotion and care program component are recommended to include ation on the necessity of positive health promotion active social acitivities. pleasant life style, adaption into changes on the elderly, safety in residential area. community acitivity and resource utilization. etc .. in addition to the elderly's disability and sickness caring services.

• 지역사회간호학회지
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• 제10권1호
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• pp.5-18
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• 1999

The aim of this study is the development of a fee - based model day care center for the elderly by inquiring into the current condition of facilities in America and in Korea, and in surveying the opinion of domestic elderly about day care facilities. A field trip to U.S. day care services was held between July 5 and July 15 in 1997, and an on-the-spot study for domestic facilities took place during March in 1998. Our research reveals that the overall supply of day care facilities can not meet future demand in terms of quality and quantity. Therefore a model must be created for day care centers of a that consists of a director from a professional group. an adequate environment, and a standardized in order to offer a qualified public health service linked to the home and community in Korea. The director of a day care center is a critical variable in determining the quality of service. Professional skills related to the needs of the elderly and the person's quality of service should be considered in appointing director for the center. This study belleves that a professional nurse should be the director of a day care center. The operating environment of a day care facility should be made up of considerable space comparable to the number of residents, should be in a comfortable and safe location, and should have equipment that provides a qualified, safe service to the elderly. Our model is designed for 20 persons and allocates 4 Peng per person. This model is comprised of a reading room. a craft room, a health room, a room for physical therapy, a dining room, a staff office, and a multi -purpose room connected to other rooms. Day care service should be a comprehensive service program meeting the multidimensional needs of the elderly. A comprehensive service program needs a team of various professionals made up of the elderly family, participants, nurses, social workers, physical therapists, nutritionists, and medical doctors. The program will also include health care service, physical therapy, speech therapy. diet, occupational therapy, transportation service, health and an education program, etc. In conclusion, a model of a day care center is developed with the following components: a professional director and an environment and program, that considers the physical, mental, and social characteristics of the elderly. A model should also motivate self-reliance self-fulfillment in the elderly in order to fulfill their health needs and to prevent isolation from society and mental depression. Furthermore, This facility will be a beneficial factor in reducing a family's burden on caring for the elderly that includes unnecessary hospital expenses. The following is a suggestion based on results this study: A service program should be developed to fit the conditions of the elderly in Korea by specifically analyzing the needs of the elderly.

• 지역사회간호학회지
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• 제12권2호
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• pp.329-337
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• 2001

Purpose: This study was to develop a critical pathway for COPD clients in home health care. Method: Review of literature. Analysis of 10 cases of home health records of COPD clients without other major chronic illness, and Contents validity test Results 1. Vertical axis(l4 activities) physical and mental assessment, family assessment. environment assessment, rights and duties of client, oxygen use and safety, education of disease process and symptom, medication, nutrition and elimination, tests, activities, respiratory exercise, sleeping pattern. consultations and discharge planning. 2. Horizontal axis was set by the number of visits(average number of visits is 6.4) and vertical axis was set with 14 activities and the contents which should have occurred, according to the time frames of the horizontal axis. 3. According to the contents validity test, among the total of 234 items, 176 items showed over 83% agreement and 58 items showed less than 83% agreement. Those items with less than 83% agreements were either deleted or revised. Conclusion this critical pathway is applicable to the home health care of COPD clients to provide quality home nursing care services at lower cost.

• 한국사회복지학
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• 제65권3호
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• pp.239-263
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• 2013

본 연구는 정신장애인과 사례관리자간의 '실천관계(Working Relationship)'를 측정하는 한국형 실천관계 척도 정신장애인 용의 개발 및 타당화를 위해 진행되었다. 척도개발을 위해 첫째, 문헌연구와 정신장애인을 대상으로 3회의 포커스면접을 통해 실천관계척도의 예비문항을 구성하였다. 둘째, 정신장애인과 정신보건사회복지전공 사회복지학과 교수 2인 및 1급 정신보건사회복지사인 실무자 2인의 검토를 통해 최종 예비문항을 선정하였다. 셋째, 최종 선정된 예비문항을 569명의 정신장애인 대상의 실증조사연구를 통해 척도의 신뢰도와 타당도를 검증하였다. 수집된 자료를 무선 분할하여 먼저 탐색적 요인분석(exploratory factor analysis)을 실시한 결과, 3개의 요인구조를 확인하였다. 요인 1은 사례관리자의 전문적 실천과 관련된 '전문가 기여', 요인 2는 '부정적인 실천관계', 요인 3은 사례관리자와 정신장애인간의 친밀감을 나타내는 '정서적 유대'로 나타났다. 나머지 표본을 가지고 확인적 요인분석(confirmatory factor analysis)을 실시한 결과 모델의 적합도는 우수한 것으로 나타났다. 이러한 연구결과를 바탕으로 최종 33문항의 한국형 실천관계 척도 정신장애인 용을 개발 제시하였으며, 본 연구의 사회복지적 함의를 논하였다.

• 한국산학기술학회논문지
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• 제22권5호
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• pp.151-161
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• 2021

본 연구는 지역보건의료계획 수립과정에서 시민들이 생각하는 건강문제와 보건 서비스 요구도를 정확히 파악하고 이를 대구광역시의 중장기 보건의료 종합계획 수립에 반영하고자 함을 목적으로 하였다. 시민참여단을 구성하여 2차례의 시민원탁회의를 실시하였으며, 시민원탁회의는 고객여정지도, DVDM (Definition, Value, Difficulty, Method) Map, 페르소나 기반 시나리오법을 통해 진행하였다. 시민들은 건강수준 향상을 위한 방안으로 보건 서비스 접근성 확대, 소생활권 중심 보건 서비스, 정신건강 서비스 확대, 건강 친화적 환경조성, 환경오염 개선, 사회적 건강개선을 제안하였으며, 건강 격차를 줄이는 방안으로는 건강 취약계층의 소통 향상 및 사회적 환경조성, 보건의료에 대한 접근성 향상, 쾌적한 물리적 공간, 사회적 역할 수행이 필요하다고 하였다. 본 연구 결과는 기존의 설문조사를 통한 주민요구도 조사와 달리 실제 주민들의 생각과 요구를 상세히 파악할 수 있었다는 점에서 의의가 있으며, 향후 지역보건사업의 기획과 수행과정에서 주민참여 수준의 단계를 평가하고, 보다 다양한 시민들의 의견을 적용할 수 있도록 주민참여 제도화 기반 수립을 위한 추가적인 연구가 필요할 것이다.

• 사회복지연구
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• 제36호
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• pp.281-299
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• 2008

지역사회 정신건강 서비스 지원을 수반하는 독립주거 (Supported Housing)는 정신장애인들에게 더 나은 삶의 질, 독립성, 지역사회 통합의 기회를 제공하는 이상적이고도 실현 가능한 주거모델로 간주되어 오고 있다. 그러나 독립주거의 긍정적 결과물 가운데 하나인 삶의 질과 관련된 요인들에 대한 선행연구는 부족하다. 본 연구는 개인 및 환경적 요인들과 독립주거에 거주하는 정신장애인들의 삶의 질과의 관계에 대하여 분석하는 것이 주목적이다. 이 목적을 위해 본 연구는 미국 펜실베니아주 필라델피아시의 독립주거 프로그램인 SIL(Supported Independent Living)에 거주하는 237명의 중증 정신장애인을 연구대상으로 하고 있다. 연구자료는 연구 참여자들과의 인터뷰, 정신건강 서비스 행정데이터 및 2000년도 미국 센서스 자료가 사용되었으며 다중 회귀분석을 이용하여 인적자원, 주거환경, 지원 프로그램, 서비스 요인과 삶의 질과의 관계를 분석하였다. 연구결과 정신건강 진단, 정신질환 수준, 신체 및 정신건강 상태, 그리고 프로그램 관리자와의 우호적 관계가 삶의 질과 관련이 있는 것으로 나타났다. 본 연구에서 파악된 삶의 질과 관련된 요인들은 중증 정신장애인들의 더 나은 삶의 질을 통한 안정된 독립생활에 대한 욕구를 충족시켜 줄 수 있는 지역사회 서비스 계획 및 정책 개발에 도움을 줄 것이다.

• 지역사회간호학회지
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• 제31권4호
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• pp.436-446
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• 2020

Purpose: This study aims to explore the association between unemployment and depression in people from different age groups ranging from 18 to 65 years old. Methods: This study used a cross-sectional design. We performed bivariate analysis and multivariable logistic regression on the 2010 Behavioral Risk Factor Surveillance System (BRFSS) data from 12 states in the United States. Results: On a sample comprised of n=53,406 individuals, of whom 2,546 (7.8%) were identified as being depressed and 3,448 (10.6%) as unemployed, we found that individuals aged 61~65 years have a lower depression risk compared to those aged 18-25 after adjusting for other variables including employment status. However, people from 61~65 have higher increased risk of depression when unemployed compared to other age groups in all three models tested (3.95 times higher in unemployed people in model 1, and 2.81 times higher in model 2 and model 3). Conclusion: Our findings indicate that there may need to be more focus on older adults who are unemployed, with associated support services for their mental health. The results of our study indicate that although older adults are less likely to be unemployed, there are more likely to experience depression if they are unemployed (once other confounding factors are taken into account) than younger adults. Policies and interventions can be developed to address not only the physical difficulties but also the mental challenges with which older adults can be at risk facing in case of unemployment.

• 한국사회복지학
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• 제61권3호
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• pp.103-127
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• 2009

사례관리의 수행요소가 지역거주 정신장애인의 삶의 질에 미치는 영향이 소비자 만족도에 의해 어떻게 매개되는지를 분석하였다. 분석대상은 지역사회정신보건서비스 기관 중 사례관리를 수행하는 18개 기관과, 이 기관의 서비스를 이용하는 381명의 정신장애인이다. 설문조사를 실시하였으며, 클라이언트 수준과 기관 수준의 자료를 동시에 고려하는 위계적 선형모형(HLM: Hierarchical Lineral Model)을 적용하여 검증하였다. 주요한 연구 결과는 실무자의 담당 사례량이 삶의 질에 직접적 영향을 주었다. 사례관리팀 접근은 소비자 만족도에 직접적 영향을 미친 반면, 소비자 만족도를 매개하여 삶의 질에 이르는 간접적 영향은 미미하였다. 적절한 사례량의 확보 및 사례관리자 확대, 팀접근의 유용성에 대한 실천적 함의를 제안하였다.

• 대한지역사회영양학회지
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• 제27권4호
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• pp.273-285
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• 2022

Objectives: This study compared the nutritional intakes of early and late preterm infants in a neonatal intensive care unit (NICU) and at home. The dietary problems and the need for community care services for premature infants were further investigated. Methods: This is a cross-sectional and descriptive study on 125 preterm infants and their parents (Early preterm n = 70, Late preterm n = 55). The data were collected by surveying the parents of preterm infants and from hospital medical records. Results: No significant differences were obtained between the early and late preterm infant groups when considering the proportion of feeding types in the NICU and at home. Early preterm infants were fed with a greater amount of additional calories at home and had more hours of tube feeding (P = 0.022). Most preterm infants had feeding problems. However, there was no significant difference between early and late preterm infants in the mental pain of parents, sleeping, feeding, and weaning problems at home. Many parents of preterm babies had no external support, and more than half the parents required community care to take care of their preterm babies. Conclusions: Regardless of the gestational age, most preterm infants have several problems with dietary intake. Our study indicates the need to establish community care services for preterm infants.