• 대한지역사회작업치료학회지
• /
• 제6권2호
• /
• pp.51-59
• /
• 2016

목적 : 본 연구에서는 규칙적인 재활체육 프로그램 참여에 따른 시설 거주 지적장애인들의 여가시간 사용과 여가활동 수행에 미치는 영향을 규명하여 시설 거주 지적장애인들의 여가시간 사용과 여가활동 수행에 대한 기초자료를 제공하는 데 그 목적이 있다. 연구방법 : 연구대상은 경기도 용인시 지적장애인 거주시설에서 거주하는 지적장애인 8명을 대상으로 하였으며, 2015년 09월 01일부터 11월 30일 까지 총 12주간 재활체육 프로그램을 실시하였다. 재활체육 프로그램으로 짐볼과 탄성밴드를 활용한 근력운동을 적용하였으며, 프로그램 참여에 따른 여가시간 사용의 변화를 조사하기 위해 매월 시간 조사표 기록에 따른 총시간, 운동 빈도를 조사하였고, 여가활동 수행에 미치는 영향을 분석하기 위해 프로그램 전, 후 캐나다작업수행측정(COPM)을 활용하여 동적 여가활동에서의 수행도와 만족도를 분석하였다. 수집된 자료는 SPSS ver.18.0으로 기술통계, 프리드만 검정(Friedman), 윌콕슨 부호순위 검정(Wilcoxon's Signed-Ranks Test)을 실시하였다. 결과 : 여가시간 사용의 분석 결과 총시간, 운동 빈도에서 프로그램 참여 후 통계적으로 유의미하게 지속적으로 증가하였으며, 여가활동 수행의 분석 결과 동적 여가활동에서의 수행도, 만족도에서 프로그램 참여 후 통계적으로 유의미하게 증가하였다. 결론 : 재활체육 프로그램의 참여가 대상자들의 여가시간 사용을 효과적으로 변화시킬 수 있는 긍정적인 요인으로 작용할 수 있어 시설에 거주하고 있는 지적장애인들에게 재활체육 프로그램의 참여는 필수적이다. 또한, 이러한 프로그램을 지속적으로 제공하고, 체계적으로 발전시키고 관리하여, 지적장애인들의 여가생활의 질을 높이고 시설 내 생활과 하루일과의 만족도를 높이는 데 기여할 수 있을 것이다.

• Journal of Preventive Medicine and Public Health
• /
• 제20권1호
• /
• pp.165-203
• /
• 1987

This project was a service-cum-research effort with a quasi-experimental study design to examine the health benefits of an integrated Family Planning (FP)/Maternal & Child health (MCH) Service approach that provides crucial factors missing in the present on-going programs. The specific objectives were: 1) To test the effectiveness of trained nurse/midwives (MW) assigned as change agents in the Health Sub-Center (HSC) to bring about the changes in the eight FP/MCH indicators, namely; (i)FP/MCH contacts between field workers and their clients (ii) the use of effective FP methods, (iii) the inter-birth interval and/or open interval, (iv) prenatal care by medically qualified personnel, (v) medically supervised deliveries, (vi) the rate of induced abortion, (vii) maternal and infant morbidity, and (viii) preinatal & infant mortality. 2) To measure the integrative linkage (contacts) between MW & HSC workers and between HSC and clients. 3) To examine the organizational or administrative factors influencing integrative linkage between health workers. Study design; The above objectives called for quasi-experimental design setting up a study and control area with and without a midwife. An active intervention program (FP/MCH minimum 'package' program) was conducted for a 2 year period from June 1982-July 1984 in Seosan County and 'before and after' surveys were conducted to measure the change. Service input; This study was undertaken by the Soonchunhyang University in collaboration with WHO. After a baseline survery in 1981, trained nurses/midwives were introduced into two health sub-centers in a rural setting (Seosan county) for a 2 year period from 1982 to 1984. A major service input was the establishment of midwifery services in the existing health delivery system with emphasis on nurse/midwife's role as the link between health workers (nurse aids) and village health workers, and the referral of risk patients to the private physician (OBGY specialist). An evaluation survey was made in August 1984 to assess the effectiveness of this alternative integrated approach in the study areas in comparison with the control area which had normal government services. Method of evaluation; a. In this study, the primary objective was first to examine to what extent the FP/MCH package program brought about changes in the pre-determined eight indicators (outcome and impact measures) and the following relationship was first analyzed; b. Nevertheless, this project did not automatically accept the assumption that if two or more activities were integrated, the results would automatically be better than a non-integrated or categorical program. There is a need to assess the 'integration process' itself within the package program. The process of integration was measured in terms of interactive linkages, or the quantity & quality of contacts between workers & clients and among workers. Intergrative linkages were hypothesized to be influenced by organizational factors at the HSC clinic level including HSC goals, sltrurture, authority, leadership style, resources, and personal characteristics of HSC staff. The extent or degree of integration, as measured by the intensity of integrative linkages, was in turn presumed to influence programme performance. Thus as indicated diagrammatically below, organizational factors constituted the independent variables, integration as the intervening variable and programme performance with respect to family planning and health services as the dependent variable: Concerning organizational factors, however, due to the limited number of HSCs (2 in the study area and 3 in the control area), they were studied by participatory observation of an anthropologist who was independent of the project. In this observation, we examined whether the assumed integration process actually occurred or not. If not, what were the constraints in producing an effective integration process. Summary of Findings; A) Program effects and impact 1. Effects on FP use: During this 2 year action period, FP acceptance increased from 58% in 1981 to 78% in 1984 in both the study and control areas. This increase in both areas was mainly due to the new family planning campaign driven by the Government for the same study period. Therefore, there was no increment of FP acceptance rate due to additional input of MW to the on-going FP program. But in the study area, quality aspects of FP were somewhat improved, having a better continuation rate of IUDs & pills and more use of effective Contraceptive methods in comparison with the control area. 2. Effects of use of MCH services: Between the study and control areas, however, there was a significant difference in maternal and child health care. For example, the coverage of prenatal care was increased from 53% for 1981 birth cohort to 75% for 1984 birth cohort in the study area. In the control area, the same increased from 41% (1981) to 65% (1984). It is noteworthy that almost two thirds of the recent birth cohort received prenatal care even in the control area, indicating that there is a growing demand of MCH care as the size of family norm becomes smaller 3. There has been a substantive increase in delivery care by medical professions in the study area, with an annual increase rate of 10% due to midwives input in the study areas. The project had about two times greater effect on postnatal care (68% vs. 33%) at delivery care(45.2% vs. 26.1%). 4. The study area had better reproductive efficiency (wanted pregancies with FP practice & healthy live births survived by one year old) than the control area, especially among women under 30 (14.1% vs. 9.6%). The proportion of women who preferred the 1st trimester for their first prenatal care rose significantly in the study area as compared to the control area (24% vs 13%). B) Effects on Interactive Linkage 1. This project made a contribution in making several useful steps in the direction of service integration, namely; i) The health workers have become familiar with procedures on how to work together with each other (especially with a midwife) in carrying out their work in FP/MCH and, ii) The health workers have gotten a feeling of the usefulness of family health records (statistical integration) in identifying targets in their own work and their usefulness in caring for family health. 2. On the other hand, because of a lack of required organizational factors, complete linkage was not obtained as the project intended. i) In regards to the government health worker's activities in terms of home visiting there was not much difference between the study & control areas though the MW did more home visiting than Government health workers. ii) In assessing the service performance of MW & health workers, the midwives balanced their workload between 40% FP, 40% MCH & 20% other activities (mainly immunization). However, $85{\sim}90%$ of the services provided by the health workers were other than FP/MCH, mainly for immunizations such as the encephalitis campaign. In the control area, a similar pattern was observed. Over 75% of their service was other than FP/MCH. Therefore, the pattern shows the health workers are a long way from becoming multipurpose workers even though the government is pushing in this direction. 3. Villagers were much more likely to visit the health sub-center clinic in the study area than in the control area (58% vs.31%) and for more combined care (45% vs.23%). C) Organization factors (admistrative integrative issues) 1. When MW (new workers with higher qualification) were introduced to HSC, it was noted that there were conflicts between the existing HSC workers (Nurse aids with less qualification than MW) and the MW for the beginning period of the project. The cause of the conflict was studied by an anthropologist and it was pointed out that these functional integration problems stemmed from the structural inadequacies of the health subcenter organization as indicated below; i) There is still no general consensus about the objectives and goals of the project between the project staff and the existing health workers. ii) There is no formal linkage between the responsibility of each member's job in the health sub-center. iii) There is still little chance for midwives to play a catalytic role or to establish communicative networks between workers in order to link various knowledge and skills to provide better FP/MCH services in the health sub-center. 2. Based on the above findings the project recommended to the County Chief (who has power to control the administrative staff and the technical staff in his county) the following ; i) In order to solve the conflicts between the individual roles and functions in performing health care activities, there must be goals agreed upon by both. ii) The health sub·center must function as an autonomous organization to undertake the integration health project. In order to do that, it is necessary to support administrative considerations, and to establish a communication system for supervision and to control of the health sub-centers. iii) The administrative organization, tentatively, must be organized to bind the health worker's midwive's and director's jobs by an organic relationship in order to achieve the integrative system under the leadership of health sub-center director. After submitting this observation report, there has been better understanding from frequent meetings & communication between HW/MW in FP/MCH work as the program developed. Lessons learned from the Seosan Project (on issues of FP/MCH integration in Korea); 1) A majority or about 80% of the couples are now practicing FP. As indicated by the study, there is a growing demand from clients for the health system to provide more MCH services than FP in order to maintain the achieved small size of family through FP practice. It is fortunate to see that the government is now formulating a MCH policy for the year 2,000 and revising MCH laws and regulations to emphasize more MCH care for achieving a small size family through family planning practice. 2) Goal consensus in FP/MCH shouBd be made among the health workers It administrators, especially to emphasize the need of care of 'wanted' child. But there is a long way to go to realize the 'real' integration of FP into MCH in Korea, unless there is a structural integration FP/MCH because a categorical FP is still first priority to reduce the rate of population growth for economic reasons but not yet for health/welfare reasons in practice. 3) There should be more financial allocation: (i) a midwife should be made available to help to promote the MCH program and coordinate services, (in) there should be a health sub·center director who can provide leadership training for managing the integrated program. There is a need for 'organizational support', if the decision of integration is made to obtain benefit from both FP & MCH. In other words, costs should be paid equally to both FP/MCH. The integration slogan itself, without the commitment of paying such costs, is powerless to advocate it. 4) Need of management training for middle level health personnel is more acute as the Government has already constructed 90 MCH centers attached to the County Health Center but without adequate manpower, facilities, and guidelines for integrating the work of both FP and MCH. 5) The local government still considers these MCH centers only as delivery centers to take care only of those visiting maternity cases. The MCH center should be a center for the managment of all pregnancies occurring in the community and the promotion of FP with a systematic and effective linkage of resources available in the county such as i.e. Village Health Worker, Community Health Practitioner, Health Sub-center Physicians & Health workers, Doctors and Midwives in MCH center, OBGY Specialists in clinics & hospitals as practiced by the Seosan project at primary health care level.

• 농촌의학ㆍ지역보건
• /
• 제20권1호
• /
• pp.1-13
• /
• 1995

본 연구는 변화되고 있는 지역사회보건사업의 요구에 따른 연도별 보건소 간호사들의 역할 변화, 역할 수행에 따른 장애요인 및 간호업무 수행과 관련하여 인지하는 직무만족도를 파악하고자 1992년 3월 19일부터 4월 11일까지 경상남도 보건간호사 270명을 대상으로 설문조사한 결과는 다음과 같다. 보건간호사들이 수행한 최우선 보건사업은 1970년 이전에는 가족계획사업, 1970 - 1979년대에는 간호업무, 1980 - 1989년대에는 모자보건사업, 1990 - 1992년대에는 간호업무이었다. 가족계획사업 내용의 우선순위는 1970년 이전에는 자궁내장치 삽입 권장과 경구피임약 또는 콘돔 배부에 역점을 두었으며 그 이후로는 가족계획 홍보를 우선으로 했다. 모자보건사업 내용의 우선순위는 1970년 이전부터 임부등록에 많이 두었으며 그 다음으로 산전진찰과 예방접종에 치중한 것으로 나타났다. 결핵관리사업 내용의 수선순위를 보면 각 년대마다 신환자 발견 등록에 치중하였으며 그 다음으로 환자관리 및 투약 주사에 비중을 두었다. 간호업무 냉용의 우선순위를 보면 1970년대 이전에는 순회진료에 역점을 두었으며 그 다음으로 주사 및 투약에 치중하였다. 전염병관리 내용의 우선순위는 1970년 이전부터 1순위였으며 그 다음으로 투약 및 주사에 치중하였다. 1990-1992년대에는 상담 및 교육이 2순위로 나타났다. 노인보건사업 내용의 수선순위가 1979년대 이전부터 순회진료가 1순위였으며 그 다음으로 검진보조가 2순위로 나타났다. 사업별 업무수행시 장애요인을 보면 가족계획 사업에서는 주민의 이해부족이 28.8%, 예산부족이 13.6%, 보건행정체계 미비가 11.9%였으며, 결핵사업에서는 주민의 이해부족이 32.5%, 업무과다(인원부족)가 15.6%, 기술이나 지식의 부족이 13.0%였다. 업무과다(인원부족)와 시설 장비의 부족이 각각 15.6%, 주님의 이해부족이 13.0%였다. 직급별 보건간호사의 직무만족도에서 경력이나 능력에 비해 승진기회여부는 불만이다가 8,9급이 64.7%로 높았으며 전문직 발전의 기회는 없다가 6,7급이 67.7%, 8,9급이 64.0%로 높았다. 보건업무에 필요한 물품과 시설의 만족여부에서 하위급으로 내려갈수록 만족도는 낮았으며 보수의 만족도에서는 적당하다가 6,7급이 64.7%, 너무 작다가 8,9급이 53.0%로 높았다. 직급별 보건간호사의 직업 긍지 만족도에서 직급이 높을수록 직업적 긍지의 직무만족도는 높았다. 직급별 현 직급에 대한 만족도는 하위급으로 내려갈수록 만족하는 사람의 비율은 높아졌다. 보건간호사의 경력(년)별 직무만족도에서 보건간호사 경력이 많을수록 직급, 승진기회, 전문직 발전의 기회에 대한 직무만족도는 낮게 나타났다. 보건간호사의 경력(년)별 직업 긍지 만족도에서 보건간호사 경력이 많을수록 직업적 긍지의 직무만족도는 높게 나타났다. 대상자의 37.6%가 이직할 의사가 있다고 하였으며, 승진기회의 부족, 근무여건의 불만이 이직 이유였다. 하력과 경력은 직무만족도 사이에 유의한 상관관계가 없었으며 직급이 낮을수록 직무만족도는 낮아 유의한 관련성을 나타내었다. 1차 보건의료사업을 수행토록 하기 위해서는 보건간호사의 인식이나 주민들의 인식을 새롭게 하기 위한 홍보활동 및 교육이 더 주어져야 할 것이며 보건간호사의 승진기회 및 직급에 대란 불만도가 높기 때문에 보건간호사의 승진제도개선 및 직무영역확대가 고려되어야 할 것이다. 그래서 간호업무에 만족할 수 있는 제도개선에 대해 고려해야 할 것으로 생각된다.