• 보건행정학회지
• /
• 제1권1호
• /
• pp.95-108
• /
• 1991

The World Health Organization and its member states, in 1978, declared that primary health care is a key to attain the goal of Health for All by the goal of Health for All by the yeas 2000. As a member state of WHO, the Republic of Korea has participated in the declaration of ALMA-ATA and committed to put national efforts for devedoping and implementing primary health care approach with the spirit and content of this Declaration. Since 1978, to translate the spirit of the Declaration into realization, Korean goverment has developed a new category of health manpower such as Community Health Practitioners serving people living in remote rural areas and Village Health Workers serving voluntarily their own village, strengthened the function of Health Centers and Health Subcenters through their reorientation and improved the infrastructure by their new construction or renovation. While primary health care is viewed as an essential health care in Korea, there are some circles who follow a narrow definition in referring to the health care at the periphey of a health system, which is erroneous. Considering the PHC is accepted as the best alternative approach to health care to solve problems that modern health systems are facing, we propose the followings as desirable health policy directions that modern health systems are facing, we propose the followings as desirable health policy directions which might translate the persopective into action at the national level after reviewing past and current PHC approach in Korea : 1. To improve the equity through the reduction of gaps between those who have access to health care and those who have not. 2. To reinforce multisectoral approach and intersectoral coordination through the re- establishment of the National Health Council or establishment of equivalent organization at the central level. 3. To stengthen community participation through lacal people's empowerment by leadership training, changing planning process from the top-down approach to bottom-up and giving the priority to human resources rater than technology, 4. To reinforce the Ministries of Health and Social Affairs through upgrading its role and function to Coordinate Ministries which involve human welfare policies, and creating a Division which is in charge of PHC in the Ministry.

• 농촌의학ㆍ지역보건
• /
• 제24권2호
• /
• pp.331-350
• /
• 1999

본 연구는 보건진료원의 성격특성과 직무만족도와의 관계를 파악하여 효율적인 업무수행에 도움을 주고 직무만족을 향상시킬수 있는 방안을 모색하기 위해 시도되었다. 연구의 대상은 광주, 전남지역 보건진료원 348명 중 200명으로 하였고, 1999년 2월 18일부터 3월 5일까지 설문지를 우편으로 대상자에게 발송하여 작성하게 한 후 응답지를 수집하였다. 연구도구로 성격특성 측정도구는 김(김기석, 1990)의 "일반성격검사"를 사용하였고 직무만족도 측정도구는 Salvitt의 도구를 석(석민현, 1992)이 수정 보완한 것을 사용하였다. 자료분석은 SPSS Program에 의해 백분율, 평균, 표준편차, Pearson's correlation coefficient, ANOVA, Logistic regression analysis 등으로 분석하였다. 본 연구의 결과는 다음과 같다. 1. 대상자의 특성 중 인구사회학적 특성과 직무만족도와의 관계에서 통계적으로 유의한 차이를 나타낸 것은 종교와 보수이다(P=.028). 2. 직업의식은 계속교육여부와 필수적 직무(P=.000), 자율성(P=.000), 보건진료원 선택동기와 필수적 직무(P=.007), 직업긍지(P=.007), 보건진료원 종사예정기간과 필수적 직무(P=.023), 직업적 긍지(P=.000), 현직에 대한 만족여부와 보수(P=.001), 필수적 직무(P=.016), 직업긍지(P=.000), 상호작용(P=.011), 자율성(P=.002), 조직요구(p=.001)가 직무만족과 통계적으로 유의한 차이를 나타냈다. 3. 근무지 여건과 직무만족도 관계를 보면 직급과 자율성(p=.038), 보건진료원 이전 분야별 경력과 상호작용(P=.059), 자율성(P.059), 진료소위치와 자율성(P=.021), 월가정방문수와 상호작용(P=.001), 월상담 교육건수와 보수(P=.044), 직업긍지(P=.021), 보건진료소 연수입과 필수적 직무(P=.013)가 통계적으로 유의한 차이를 나타냈다. 4. 보건진료원의 성격특성 중 자신감(80.1)과 책임성(82.6)이 다른 성격요인에 비해 높은 것으로 나타냈다. 5. 보건진료원의 직무만족도는 평균 3.16으로 보통수준으로 나타났으며, 직업적 긍지 점수가 4.09로 가장 높게 나타났다. 6. 성격특성과 직무만족도의 상관관계를 보면 지배성은 자율성(r=.24, P=.001)과 책임성은 직업긍지(r=.26, P=.000), 정서적 안정성은 필수적 직무(r=.25, P=.000), 사회성은 필수적 직무(r=.26, P=.000), 자신감은 필수적 직무(r=.34, P=.000)와 자율성(r=.31, P=.000)과 가장 관계가 있는 것으로 나타났다. 7. 보건진료원의 제요인과 성격특성 중 종교, 진료소위치, 환자진료, 교육기회 여부, 지배성, 자신감, 보건진료원 종사 예정기간, 현직에 대한 만족여부, 보건진료원 이전 근무 분야, 행정업무 등이 직무만족에 영향을 미치는 가장 중요한 요소로 나타났다.

• 농촌의학ㆍ지역보건
• /
• 제22권1호
• /
• pp.75-83
• /
• 1997

The medical insurance system has been adopted in 1989. Since then, the utilization of medical care services has increased rapidly. It appears that the medical institution needs more nursing manpower such as nurses and nurse aides to meet an increased demand for medical care for the residents. However, the medical care clinics run by a medical practitioners has a more shortage of nursing manpower than hospitals. The purpose of this survey was to analyze the current employment status and to obtain an opinion on the improvement of utilization such as recruitment and retention of nursing manpower. The questionnaire sent to the private physician and the response rate was 28.7% ; 87 out of 300 physicians. 82.6% of the respondents employed nurses aides rather than nurses and an average number of employees per clinic was 2.5 persons. Most physicians had difficulties in recruiting nursing manpower. It took more than one month for replacement on average, therefore, they were suffering from giving good continual care for the patient and also high resignation of nursing personnel. The low wage, long working hours, hard work and lack of incentives are the biggest reasons for the difficulty in recruiting and retaining of the nursing personnel obtained for the clinics survey. The above mentioned problems would be solved in the near future by changing those difficulties. In the meantime, the private physicians are marking an effort to retain the nursing personnel by keeping a relationship of the private physician's cooperatives.

• 지역사회간호학회지
• /
• 제7권1호
• /
• pp.129-137
• /
• 1996

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.

• 대한예방한의학회지
• /
• 제9권1호
• /
• pp.1-16
• /
• 2005

This study was conducted to identify the needs of introducing new medical specialties in oriental medicine. Three stakeholders in introducing new oriental medical specialties are oriental medical doctors, policy makers and medical consumers. Of the three, this study intended to focus on opinions of oriental medical doctors. About 1,150 self-administered questionaries were sent to the potential respondents, 320 specialists, 250 interns & residents and 580 private oriental medicine practitioners, and 480 doctors responded. The study revealed that 62% of respondents showed negative attitudes towards the introduction of new oriental medicine specialties. The private oriental medical practitioners were more likely not in favor of adding new medical boardmanship. The reasons of objection were as follows : First, it is more important to enrich the existing oriental medical boardmanship (70%). Second, the newly established specialties are most likely to be weakened(15%). The study revealed that the first and most likely specialties to be introduced was Chuna(18%), subspecialization of oriental internal medicine (15.8%), the next oriental family medicine (15.1%) and so on. And the second specialties to be desired most by the respondents were (1) cooperative medicine between the westem and oriental medicine (28%), (2) oriental preventive medicine (17.4%) and (3) oriental family medicine (16.8%). Caution must be exercised in introducing new oriental medicine specialties. The failures of western medicine in the operation of its specialist production should carefully by examined here.

• 한국농촌간호학회지
• /
• 제4권1호
• /
• pp.51-57
• /
• 2009

Purpose: This study was done to learn from the development of rural health nursing in developed countries. Method: A literature search was done using keywords such as "rural and nursing" or "rural and health" from the database CHINAL and website of institutions related to rural health and nursing. Results: In Australia, the type of rural health institution was categorized according to the population size and nursing service was done differently according to area. It is unique to Canada to have the Canadian Association of Rural and Remote Nursing, which published the survey report "the Nature of Nursing Practice in Rural and Remote Canada". In the U.S., the role of nurse practitioners in rural communities was relatively well developed and a diverse nursing care model was demonstrated. To improve health care access in rural communities, financial and political support by the governments has been part of long-term plans in the three countries. Conclusion: It is very informative to identity the difference and similarity in rural health nursing in three developed countries. For the future development of Korean rural nursing, suggestion can be made in terms of research, education and policy development.

• 대한간호학회지
• /
• 제11권2호
• /
• pp.5-8
• /
• 1981

This study concerns itself with the development of a new model of comprehensive health service for rural communities of Korea. The study was conceived to resolve the problems of both underservice in rural communities and underutilization of valuable health manpower, namely the nurses, the disenchanted elite health personnel in Korea. On review of the current situation, the greatest deficiencies in the Korean health care system were found in the availability of primary care at the peripheries of md communities, in the dissemination of knowledge of disease prevention and health care, and in the induction of and guidance for active participation by the clientele in health maintenance at the personal, family and community level Abundant untapped health resources were identified that could be brough to bear upon the national effort to extend health services to every member of the Korean Population. Therefore, it was Postulated that the problem of underservice in rural communities of Korea can be structurcturally resolved by the effective mobilization and organization of untapped health resources, and that. a primary care Nursing Service System offers the best possibility for fulfillment of rural health service goals within the current health man-power situation. In order to identify appropriate strategies to combat the present difficulties in Korean rural health services and to utilize nurses and other health personnel in community-centered health programs, a search was made for examples of innovative service models throughout the world. An extensive literature survey and field visits to project sites both in Korea and in the United States were made. Experts in the field of world health, health service, planners, administrators, and medical and nursing practitioners in Korea, in the United States as well as visitors from other Asian countries were widely consulted. On the basis of information and inputs from these experts a new rural health service model has been constructed within the conceptual framework of community development, especially of the innovation diffusion Model. It is considered especially important that citizens in each community develop capacities for self-care with assistance and supports from available health professionals and participate in health service-related decisions that affect their own well-being. The proposed model is based upon the regionalization of health care planning utilizing a comprehensive Nursing Service System at the immediate delivery level The model features: (1) a health administration unit at each administrative level; (2) mechanisms for community participation; (3) a continuous source of primary health care at the local community level; (4) relative centralization of specialty care and provision of tertiary or super-specialty care only at major national metropolitan centers; and (5) a system for patient referral to the appropriate level of care. This model has been built around professional nurses as the key community health workers because their training is particularly suited and because large numbers of well-trained nurses are currently available and being trained. The special element in this model is a professional nurse-guided, self-care facilitating primary care Community Nursing Service System. This is supported by a Nursing Extension Service as a new training and support structure. (See attached diagrams). A broad spectrum of programs was proposed for the Community Nursing Service System. These were designed to establish a balance of activities between the clinic-centered individual care component and the field activity-centered educational and supportive component of health care services. Examples of possible program alternatives and proposed guidelines for health care in specific situations were presented, as well as the roles and functions of the key health personnel within the Community Nursing Service System. This Rural Health Service Model was proposed as a real alternative to the maldistributed, inequitable, uncoordinated solo-practice, physician-centered fee-for-service health care available to Koreans today.

• 한국사회복지학
• /
• 제60권4호
• /
• pp.231-251
• /
• 2008

본 연구는 성인당뇨병 환자들을 대상으로 의료급여수급여부에 따라 건강수준 및 질병관리 장애요인에 차이가 나타나는지를 분석하고 질병관리 장애요인이 건강수준에 미치는 영향을 살펴보았다. 자료수집은 서울의 종합병원 당뇨병클리닉 및 지역사회 복지기관에서 편의표집한 55세이상 성인당뇨병 환자 144명을 대상으로 조사를 실시하였다. 분석결과, 의료급여환자가 건강보험환자에 비하여 건강수준이 더 나쁘다고 인식하고 있었으며, 질병관리 장애요인을 더 많이 경험하고 있는 것으로 나타났다. 건강보험환자와 의료급여환자간 건강수준의 차이는 인구학적 요인 및 질병관련 특성들을 통제한 이후에도 유의하였다.

• Journal of Yeungnam Medical Science
• /
• 제4권2호
• /
• pp.139-148
• /
• 1987

농촌의 일차보건의료사업의 중심적인 역할을 수행하고 있는 보건진료원의 업무활동을 분석함으로 활동내용의 개선방향과 그들의 관리에 필요한 자료를 제공하기 위하여 경상북도내의 26명의 보건진료원을 대상으로 1987년 11월 16일부터 12월 5일사이의 통상적인 활동기간을 택하여 월요일에서 토요일까지 6일간 출근에서 퇴근까지의 활동상황을 자가기록방법(work diary method)에 의해 조사한 성적을 요약하면 다음과 같다. 주당 평균 활동시간은 2,918분이었다. 연령과 보건진료원 경력이 많을수록 더 많은 시간을 활동하는 것으로 나타났고 미혼자보다는 기혼자가 더 많은 시간을 활동하였다. 총 활동시간 중 보건진료소내 근무가 79.8%였고 보건진료소외가 20.2%를 차지하였다. 보건진료소외 근무에 있어서 연령과 경력이 적을수록 그리고 미혼자가 기혼자보다 더 많이 활동한 것으로 나타났다. 활동영역별 시간 배분은 기술업무수행이 46.3%로 제일 많았고 행정업무는 18.7%를 차지하였다. 기술 업무에 있어 미혼자가 기혼자보다 연령과 경력이 적을수록 더 많이 활동하였다. slack time은 연령과 경력이 많을수록 그리고 기혼자가 미혼자보다 더 길었다. 기술업무는 보건진료소내 근무중 45.3%를 차지하였고 보건진료소외 근무중 50.2%를 차지하였다. 기타업무에 소요된 시간과 slack time은 보건진료소내 근무에서보다 보건진료소외 근무에서 현저히 적었다. 기술업무 중 환자치료활동은 63.1%이었고, 기타 서비스는 36.9%을 차지하였다. 기혼자가 미혼자보다 그리고 경력이 많을수록 환자치료활동에 소비한 시간이 많았고 지역사회 주민의 건강증진을 위한 공중보건활동에 소비한 시간이 적었다. 행정업무 중 각종 기록 및 대장정리에 61.6%를 소비하였고 마을건강원회의에 소비된 시간은 4.2%에 불과하였다. 마을건강원회의에 소요된 시간은 연령과 경력이 많을수록 기혼자가 미혼자보다 더 많았다. 총 근무시간을 활동내용별로 분석하면 환자치료활동이 29.2%로 제일 많았고, 기타활동, 각종기록 및 대장정리의 순이었다. 보건진료소내 활동은 환자치료활동이 33.9%, 공중보건활동이 11.4% 이었고, 보건진료소외 활동은 각각 10.9% 및 39.1%이었다. 보건진료원의 직무영역별 활동상황을 분석하면 통상질환관리에 소요된 시간이 49.7%로 제일 많았고 지역사회접근은 2.4%로 제일 적었다. 이상을 종합하면 보건진료원은 보건진료소내에서 주로 활동하며 예방보건활동보다는 진료활동에 더 치중하고 있다. 농촌의 일차보건의료사업의 정착을 위해서는 보건진료원 보수교육을 통하여 그리고 도, 군단위의 기술지도체계의 확립과 운영으로 건강증진업무의 강화와 지역사회개발사업에 관련된 활동에 적극 참여토록 유도해야겠다고 생각한다.

• Asian Pacific Journal of Cancer Prevention
• /
• 제15권23호
• /
• pp.10367-10374
• /
• 2015

Background: Cancer and non-communicable diseases are a major issue not only for the developed but also developing countries. Public health and primary care nursing offer great potential for primary and secondary prevention of these diseases through community and family-based approaches. Within Thailand there are related established educational curricula but less is known about how graduate practitioners enact ideas in practice and how these can influence policy at local levels. Aim: The aim of this inquiry was to develop family nursing practice in primary care settings in the Isaan region or Northeastern Thailand and to distill what worked well into a nursing model to guide practice. Materials and Methods: An appreciative inquiry approach involving analysis of written reports, focus group discussions and individual interviews was used to synthesize what worked well for fourteen family nurses involved in primary care delivery and to build the related model. Results: Three main strategies were seen to offer a basis for optimal care delivery, namely: enacting a participatory action approach mobilizing families' social capital; using family nursing process; and implementing action strategies within communities. These were distilled into a new conceptual model. Conclusions: The model has some features in common with related community partnership models and the World Health Organization Europe Family Health Nurse model, but highlights practical strategies for family nursing enactment. The model offers a basis not only for planning and implementing family care to help prevent cancer and other diseases but also for education of nurses and health care providers working in communities. This articulation of what works in this culture also offers possible transference to different contexts internationally, with related potential to inform health and social care policies, and international development of care models.