Preparation of Students for Future Challenge (미래의 요구에 부응하는 미래를 위한 간호교육)
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- The Korean Nurse
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- v.20 no.4 s.112
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- pp.50-59
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- 1981
간호학생들이 당연하고 있는 문제점 미래의 간호학생들이 교육문제를 논하기 위하여는 간호학생들이 가지고 있는 문제점을 파악하고 또 이해하는 것이 우선순위가 될 것이다. 간호학생들이 문제점에 대한 연구는 한국에서 뿐아니라 미국에서도 꽤 많이 시행되어져 왔으며 특히 간호학과정에서 중간 탈락되는 중퇴자들에 대한 연구들 중에 이러한 문제점에 대해서 언급한 것이 많다. 고등학교를 졸업하고 곧 대학과정에 진학한 학생들을 대상으로 조사 보고될 Munro의 자료에 의하면 전문대학과정에서 27
With the advent of knowledge-based society, the revitalization of technological innovation type SMEs, termed "inno-biz" hereafter, has been globally recognized as a government policymakers' primary concern in strengthening national competitiveness, and much effort is being put into establishing polices of boosting the start-ups and innovation capability of SMEs. Especially, in that the inno-biz enables national economy to get vitalized by widening world markets with its superior technology, and thus, taking the initiative of extremely competitive world markets, its growth and development has greater significance. In the case of Korea, the government has been maintaining the policies since the late 1990s of stimulating the growth of SMEs as well as building various infrastructures to foster the start-ups of the SMEs such as venture businesses with high technology. In addition, since the enactment of "Innovation Promotion Law for SMEs" in 2001, the government has been accelerating the policies of prioritizing the growth and development of inno-biz. So, for the sound growth and development of Korean inno-biz, this paper intends to offer effective management strategies for SMEs and suggest proper policies for the government, by researching into the effect of technological innovation capability and technology commercialization capability as the primary business resources on business performance in Korean SMEs in the light of market information orientation. The research is carried out on Korean companies characterized as inno-biz. On the basis of OSLO manual and prior studies, the research categorizes their status. R&D capability, technology accumulation capability and technological innovation system are categorized into technological innovation capability; product development capability, manufacturing capability and marketing capability into technology commercialization capability; and increase in product competitiveness and merits for new technology and/or product development into business performance. Then the effect of each component on business performance is substantially analyzed. In addition, the mediation effect of technological innovation and technology commercialization capability on business performance is observed by the use of the market information orientation as a parameter. The following hypotheses are proposed. H1 : Technology innovation capability will positively influence business performance. H1-1 : R&D capability will positively influence product competitiveness. H1-2 : R&D capability will positively influence merits for new technology and/or product development into business performance. H1-3 : Technology accumulation capability will positively influence product competitiveness. H1-4 : Technology accumulation capability will positively influence merits for new technology and/or product development into business performance. H1-5 : Technological innovation system will positively influence product competitiveness. H1-6 : Technological innovation system will positively influence merits for new technology and/or product development into business performance. H2 : Technology commercializing capability will positively influence business performance. H2-1 : Product development capability will positively influence product competitiveness. H2-2 : Product development capability will positively influence merits for new technology and/or product development into business performance. H2-3 : Manufacturing capability will positively influence product competitiveness. H2-4 : Manufacturing capability will positively influence merits for new technology and/or product development into business performance. H2-5 : Marketing capability will positively influence product competitiveness. H2-6 : Marketing capability will positively influence merits for new technology and/or product development into business performance. H3 : Technology innovation capability will positively influence market information orientation. H3-1 : R&D capability will positively influence information generation. H3-2 : R&D capability will positively influence information diffusion. H3-3 : R&D capability will positively influence information response. H3-4 : Technology accumulation capability will positively influence information generation. H3-5 : Technology accumulation capability will positively influence information diffusion. H3-6 : Technology accumulation capability will positively influence information response. H3-7 : Technological innovation system will positively influence information generation. H3-8 : Technological innovation system will positively influence information diffusion. H3-9 : Technological innovation system will positively influence information response. H4 : Technology commercialization capability will positively influence market information orientation. H4-1 : Product development capability will positively influence information generation. H4-2 : Product development capability will positively influence information diffusion. H4-3 : Product development capability will positively influence information response. H4-4 : Manufacturing capability will positively influence information generation. H4-5 : Manufacturing capability will positively influence information diffusion. H4-6 : Manufacturing capability will positively influence information response. H4-7 : Marketing capability will positively influence information generation. H4-8 : Marketing capability will positively influence information diffusion. H4-9 : Marketing capability will positively influence information response. H5 : Market information orientation will positively influence business performance. H5-1 : Information generation will positively influence product competitiveness. H5-2 : Information generation will positively influence merits for new technology and/or product development into business performance. H5-3 : Information diffusion will positively influence product competitiveness. H5-4 : Information diffusion will positively influence merits for new technology and/or product development into business performance. H5-5 : Information response will positively influence product competitiveness. H5-6 : Information response will positively influence merits for new technology and/or product development into business performance. H6 : Market information orientation will mediate the relationship between technology innovation capability and business performance. H7 : Market information orientation will mediate the relationship between technology commercializing capability and business performance. The followings are the research results : First, as for the effect of technological innovation on business performance, the technology accumulation capability and technological innovating system have a positive effect on increase in product competitiveness and merits for new technology and/or product development, while R&D capability has little effect on business performance. Second, as for the effect of technology commercialization capability on business performance, the effect of manufacturing capability is relatively greater than that of merits for new technology and/or product development. Third, the mediation effect of market information orientation is identified to exist partially in information generation, information diffusion and information response. Judging from these results, the following analysis can be made : On Increase in product competitiveness, directly related to successful technology commercialization of technology, management capability including technological innovation system, manufacturing capability and marketing capability has a relatively strong effect. On merits for new technology and/or product development, on the other hand, capability in technological aspect including R&D capability, technology accumulation capability and product development capability has relatively strong effect. Besides, in the cast of market information orientation, the level of information diffusion within an organization plays and important role in new technology and/or product development. Also, for commercial success like increase in product competitiveness, the level of information response is primarily required. Accordingly, the following policies are suggested : First, as the effect of technological innovation capability and technology commercialization capability on business performance differs among SMEs; in order for SMEs to secure competitiveness, the government has to establish microscopic policies for SMEs which meet their needs and characteristics. Especially, the SMEs lacking in capital and labor are required to map out management strategies of focusing their resources primarily on their strengths. And the government needs to set up policies for SMEs, not from its macro-scaled standpoint, but from the selective and concentrative one that meets the needs and characteristics of respective SMEs. Second, systematic infrastructures are urgently required which lead technological success to commercial success. Namely, as technological merits at respective SME levels do not always guarantee commercial success, the government should make and effort to build systematic infrastructures including encouragement of M&A or technology trade, systematic support for protecting intellectual property, furtherance of business incubating and industrial clusters for strengthening academic-industrial network, and revitalization of technology financing, in order to make successful commercialization from technological success. Finally, the effort to innovate technology, R&D, for example, is essential to future national competitiveness, but its result is often prolonged. So the government needs continuous concern and funding for basic science, in order to maximize technological innovation capability. Indeed the government needs to examine continuously whether technological innovation capability or technological success leads satisfactorily to commercial success in market economic system. It is because, when the transition fails, it should be left to the government.
Recently, numerous documents have been made available electronically. Internet search engines and digital libraries commonly return query results containing hundreds or even thousands of documents. In this situation, it is virtually impossible for users to examine complete documents to determine whether they might be useful for them. For this reason, some on-line documents are accompanied by a list of keywords specified by the authors in an effort to guide the users by facilitating the filtering process. In this way, a set of keywords is often considered a condensed version of the whole document and therefore plays an important role for document retrieval, Web page retrieval, document clustering, summarization, text mining, and so on. Since many academic journals ask the authors to provide a list of five or six keywords on the first page of an article, keywords are most familiar in the context of journal articles. However, many other types of documents could not benefit from the use of keywords, including Web pages, email messages, news reports, magazine articles, and business papers. Although the potential benefit is large, the implementation itself is the obstacle; manually assigning keywords to all documents is a daunting task, or even impractical in that it is extremely tedious and time-consuming requiring a certain level of domain knowledge. Therefore, it is highly desirable to automate the keyword generation process. There are mainly two approaches to achieving this aim: keyword assignment approach and keyword extraction approach. Both approaches use machine learning methods and require, for training purposes, a set of documents with keywords already attached. In the former approach, there is a given set of vocabulary, and the aim is to match them to the texts. In other words, the keywords assignment approach seeks to select the words from a controlled vocabulary that best describes a document. Although this approach is domain dependent and is not easy to transfer and expand, it can generate implicit keywords that do not appear in a document. On the other hand, in the latter approach, the aim is to extract keywords with respect to their relevance in the text without prior vocabulary. In this approach, automatic keyword generation is treated as a classification task, and keywords are commonly extracted based on supervised learning techniques. Thus, keyword extraction algorithms classify candidate keywords in a document into positive or negative examples. Several systems such as Extractor and Kea were developed using keyword extraction approach. Most indicative words in a document are selected as keywords for that document and as a result, keywords extraction is limited to terms that appear in the document. Therefore, keywords extraction cannot generate implicit keywords that are not included in a document. According to the experiment results of Turney, about 64% to 90% of keywords assigned by the authors can be found in the full text of an article. Inversely, it also means that 10% to 36% of the keywords assigned by the authors do not appear in the article, which cannot be generated through keyword extraction algorithms. Our preliminary experiment result also shows that 37% of keywords assigned by the authors are not included in the full text. This is the reason why we have decided to adopt the keyword assignment approach. In this paper, we propose a new approach for automatic keyword assignment namely IVSM(Inverse Vector Space Model). The model is based on a vector space model. which is a conventional information retrieval model that represents documents and queries by vectors in a multidimensional space. IVSM generates an appropriate keyword set for a specific document by measuring the distance between the document and the keyword sets. The keyword assignment process of IVSM is as follows: (1) calculating the vector length of each keyword set based on each keyword weight; (2) preprocessing and parsing a target document that does not have keywords; (3) calculating the vector length of the target document based on the term frequency; (4) measuring the cosine similarity between each keyword set and the target document; and (5) generating keywords that have high similarity scores. Two keyword generation systems were implemented applying IVSM: IVSM system for Web-based community service and stand-alone IVSM system. Firstly, the IVSM system is implemented in a community service for sharing knowledge and opinions on current trends such as fashion, movies, social problems, and health information. The stand-alone IVSM system is dedicated to generating keywords for academic papers, and, indeed, it has been tested through a number of academic papers including those published by the Korean Association of Shipping and Logistics, the Korea Research Academy of Distribution Information, the Korea Logistics Society, the Korea Logistics Research Association, and the Korea Port Economic Association. We measured the performance of IVSM by the number of matches between the IVSM-generated keywords and the author-assigned keywords. According to our experiment, the precisions of IVSM applied to Web-based community service and academic journals were 0.75 and 0.71, respectively. The performance of both systems is much better than that of baseline systems that generate keywords based on simple probability. Also, IVSM shows comparable performance to Extractor that is a representative system of keyword extraction approach developed by Turney. As electronic documents increase, we expect that IVSM proposed in this paper can be applied to many electronic documents in Web-based community and digital library.
Objective : This study was done to identify the status of Spiritual Well-Being in Nursing Students and to investigate the correlation between related various characteristics and Spiritual Well-Being and to provide baseline data for ride school-life and development of Spiritual-education program for nursing students. Method : The data was collected from 188 christian Nursing students by using questionary method. they are all all agreed to participate in this study. Their Spiritual Well-Being were measured using Spiritual Well-Being scale developed by Paloutzian & Ellison(1983) and translated by Choi(1990) and reversed by Kang(1996). Results : The data was analyzed by using SPSS/PC+12.0. The summary of results were as follows; 1. The mean score of Spiritual Well-Being were
The levels of health knowledge, attitude and practice of housewives considerably effect to the health of households, communities and the nation. This study was designed to grasp the levels of health knowledge, attitude and practice of houswives and analyse the various factors effecting to health in order to provide health education services as well as materials for effective formulation and implementation of health policy to improve the health of the nation. This study has been conducted through interviews by trained surveyers for 4,281 housewives selected from 4,500 households throughout the country for 40 days during July 11-August 20, 1983. The results of survey were analysed by stepwise multiple regression and path analysis are summarized as follows; 1. Based on the measurement instrument applied to this study, the levels of health knowledge, attitude and practice of housewives were extremely low with 54.5 points out of 100 points in full. Higher level with 72 points and above was approximately 21 percent and lower level with 39 points and below was approx. 24 percent. The middle level was approx. 55 percent. In order to implement health programs successively, health education should be more strengthened and to improve the level of health knowledge, attitude and practice (KAP) of the nation, political consideration as a part of spiritual reformation must be concentrated on health. 2. The level of health knowledge indicated the highest points with 57.3 the level of attitude was the second with 55.0 points and the practice level was the lowest with 50.0 point. Therefore, planning and implementation of health education program must be based on the persuasion and motivation that health knowledge turn into practice. 3. Housewives who had higher level of health knowledge, showed their practice level was relatively lower and those who had middle or low level of it practice level was the reverse. 4. Correlations among health knowledge, attitude and practice (KAP) were generally higher and statistically significant at 0.1 percent level. Correlation between total health KAP level and health knowledge was the highest with r=.8092. 5. Health KAP levels showed significant differences according to the age, number of children, marital status, self-assessed health status and concern on health of the housewives interviewed (p<0.001) 6. Health KAP levels also showed significant differences according to the education level, economic status, employment before marriage and grown-up area of the housewives interviewed. (p<0.001) 7. Heath KAP levels showed significant differences according to health insurance benificiary and the existence of patients in the family. (p<0.001). 8. Health KAP levels showed significant differences according to distance to government organizations, schools, distance to health facilities, telephone possession rate, television possession rate, newspaper reading rate and activities of Ban meeting and Women's club. (p<0.001) 9. Health KAP levels showed significant differences according to electric mass communication media such as television, radio and village broadcasting etc. and printed media such as newspaper, magazine and booklets etc., IEC variables such as individual consultation and husband-wife communication, however, there was no significance with group training. 10. Health KAP of the housewives showed close correlation with personal characteristics variables, i.e., education level (r=.5302), age (r=-.3694) grown-up area (r=.3357) and employment before marriage. In general, correlation of health knowledge level was higher than the levels of attitude or practice. In case of health concern and health insurance, correlation of practice level was higher than health knowledge level. 11. Health KAP levels showed higher correlation with community environmental characteristics, Ban meeting and activity of Women's club, however, no correlation with New-village movement. 12. Among IEC variables, husband-wife communication showed the highest correlation with health KAP levels and printed media, electric mas communication media and health consultation in order. Therefore, encouragement of husband-wife communication and development of training program for men should be included in health education program. 13. Mass media such as electric mass com. and printed media were effective for knowledge transmission and husband-wife communication and individual consultation were effective for health practice. Group training was significant for knowledge transmission, however, but not significant for attitude formation or turning to health practice. To improve health KAP levels, health knowledge should be transmitted via mass media and health consultation with health professionals and field health workers should be strengthened. 14. Correlation of health KAP levels showed that knowledge level was generally higher than that of practice and recognized that knowledge was not linked with attitude or practice. 15. The twenty-five variables effecting health KAP levels of housewives had 41 per cent explanation variances among which education level had great contribution (β=.2309) and electric mass com. media (β=.1778), husband-wife communication (β=.1482), printed media, grown-up area, and distance to government organizations in order. Variances explained (R²) of health KAP were 31%, 15%, and 30% respectively. 16. Principal variables contributed to health KAP were education level (β=.12320, β=.1465), electric mass comm. media (β=.1762, β=.1839), printed media, (β=.1383, β=.1420) husband-wife communication (β=.1004, β=.1067), grown-up area and distance to government organizations, in order. Since education level contributes greatly to health KAP of the housewives, health education including curriculum development in primary, middle and high schools must be emphasized and health science must be selected as one of the basic liberal arts subject in universities. 17. Variences explained of IEC variables to health KAP were 19% in total, 14% in knowledge, 9% in attitude, and 10% in health practice. Contributions of IEC variables to health KAP levels were printed media (β=.3882), electric mass comm media (β=.3165), husb-band wife com. (β=.2095,) and consultation on health (β=.0841) in order, however, group training showed negative effect (β=-.0402). National fund must be invested for the development of Health Program through mass media such as TV and radio etc. and for printed materials such as newspaper, magazines, phamplet etc. needed for transmission of health knowledge. 18. Variables contributed to health KAP levels through IEC variables with indirect effects were education level (Ind E=0.0410), health concern (Ind E=.0161), newspaper reading rate (Ind E=.0137), TV possession rate and activity of Ban meeting in order, however, health facility showed negative effect (Ind E=-.0232) and other variables showed direct effect but not indirect effect. 19. Among the variables effecting health KAP level, education level showed the highest in total effect (TE=.2693) then IEC (TE=.1972), grown-up city (TE=.1237), newspaper reading rate (TE=.1020), distance to government organization (TE=.095) in order. 20. Variables indicating indirect effects to health KAP levels were; at knowledge level with R²=30%, education level (Ind E=.0344), newspaper reading rate (Ind E=.0112), TV possession rate (Ind E=.0689), activity of Ban meeting (Ind E=.0079) in order and at attitude level with R²=13%, education level (Ind E=. 0338), activity of Ban meeting (Ind E=.0079), and at practice level with R²=29%. education level (Ind E=.0268), health facility (Ind E=.0830) and concern on health (Ind E=.0105). 21. Total effect to health KAP levels and IEC by variable characteristics, personal characteristics variables indicated larger than community characteristics variables. 22. Multiple Correlation Coefficient (MCC) expressed by the Personal Characteristic Variable was .5049 and explained approximately 25% of variances. MCC expressed by total Community environment variable was .4283 and explained approx. 18% of variances. MCC expressed by IEC Variables was .4380 and explained approx. 19% of variances. The most important variable effected to health KAP levels was personal characteristic and then IEC variable, Community Environment variable in order. When the IEC effected with personal characteristic or community characteristic, the MCC or the variances were relatively higher than effecting alone. Therefore it was identified that the IEC was one of the important intermediate variable.
The duty shifts of hospital nurses not only affect nurses' physical and mental health but also present various personnel management problems which often result in high turnover rates. In this context a study was carried out from October to November 1995 for a period of two months to find out the status of hospital nurses' duty shift patterns, and preferred duty hours and fixed duty shifts. The study population was 867 RNs working in five general hospitals located in Seoul and its vicinity. The questionnaire developed by the writer was used for data collection. The response rate was 85.9 percent or 745 returns. The SAS program was used for data analysis with the computation of frequencies, percentages and Chi square test. The findings of the study are as follows: 1. General characteristics of the study population: 56 percent of respondents was (25 years group and 76.5 percent were "single": the predominant proportion of respondents was junior nursing college graduates(92.2%) and have less than 5 years nursing experience in hospitals(65.5%). For their future working plan in nursing profession, nearly 50% responded as uncertain The reasons given for their career plan was predominantly 'personal growth and development' rather than financial reasons. 2. The interval for rotations of duty stations was found to be mostly irregular(56.4%) while others reported as weekly(16.1%), monthly(12.9%), and fixed terms(4.6%). 3. The main problems related to duty shifts particularly the evening and night duty nurses reported were "not enough time for the family, " "afraid of security problems after the work when returning home late at night." and "lack of leisure time". "problems in physical and physiological adjustment." "problems in family life." "lack of time for interactions with fellow nurses" etc. 4. The forty percent of respondents reported to have '1-2 times' of duty shift rotations while all others reported that '0 time'. '2-3 times'. 'more than 3 times' etc. which suggest the irregularity in duty shift rotations. 5. The majority(62.8%) of study population found to favor the rotating system of duty stations. The reasons for favoring the rotation system were: the opportunity for "learning new things and personal development." "better human relations are possible. "better understanding in various duty stations." "changes in monotonous routine job" etc. The proportion of those disfavor the rotating 'system was 34.7 percent. giving the reasons of"it impedes development of specialization." "poor job performances." "stress factors" etc. Furthermore. respondents made the following comments in relation to the rotation of duty stations: the nurses should be given the opportunity to participate in the. decision making process: personal interest and aptitudes should be considered: regular intervals for the rotations or it should be planned in advance. etc. 6. For the future career plan. the older. married group with longer nursing experiences appeared to think the nursing as their lifetime career more likely than the younger. single group with shorter nursing experiences (
This experiment was conducted, making use of the 'NONG-RIM6' arecommended variety of rice for the year of 1968. Main purposes of the experiment are to explore possibilities of; a) ways and means of saving irringation water and, b) overcoming drought at the same time so that an increased yield in rice could be resulted in. Specifically, it was tried to determine the effects of the Rotation irrigation method combined with differentiated thickness of lining upon the growth and yield of rice. Some of the major findings are summarized in the following. 1) The different thicknesses show a significant relationship with the weight of 1,000 grains. In the case of 9cm lined plot, the grain weight is 23.5grams, the heaviest. Next in order is 3cm lined plot, 6cm lined plot, control plot, and wheat straw lined-plot. 2) In rice yield, it is found that there is a considerably moderate significant relationship with both the different thickness of lining and the number of irrigation, as shown in the table. 3) There is little or no difference among different plots in terms of a) physical and chemical properties of soil, b) quality of irrigation water, c) climatic conditions, and rainfalls. 4) It is found that there is a significant relationship between differences in the method of rotation irrigation and the number of ears per hill. The plot irrigated at an interval of 7 days shows 17.4 ears and plot irrigated at an interval of 6 days, 16.3 5) In vinyl-treated plots, it is shown that both yield and component elements are greatest in the case of the plot ith whole of
The purposes of this thesis are to clarify experimentally the variation of ground water temperature in tube wells during the irrigation period of paddy rice, and the effect of ground water irrigation on the growth, grain yield and yield components of the rice plant, and, furthermore, when and why the plant is most liable to be damaged by ground water, and also to find out the effective ground water irrigation methods. The results obtained in this experiment are as follows; 1. The temperature of ground water in tube wells varies according to the location, year, and the depth of the well. The average temperatures of ground water in a tubewells, 6.3m, 8.0m deep are
This study was to investigate the drying mechanism of stratified soil by investigating 'effects of the upper soil on moisture loss of the lower soil and vice versa' and at the same time by examining how the drying progressed in the stratified soils with bare surface and with vegetated surface respectively. There were six plots of the stratified soils with bare surface(
오늘 저희에게 주어진 주제, 내일에 타당한 간호사업 및 간호교육의 향방을 어떻게 정하여야 하는가의 논의는 오늘날 간호계 주변에 일어나고 있는 변화의 실상을 이해하는 데서 비롯되어져야 한다고 생각하는 입장에서 먼저 세계적으로 건강관리사업이 당면한 딜레마가 어떠한 것이며 이러한 문제해결을 위해 어떠한 새로운 제안들이 나오고 있는가를 개관 하므로서 그 교육적 의미를 정의해 보고 장래 간호교육이 지향해야할 바를 생각해 보려 합니다. 오늘의 사회의 하나의 특징은 세계 모든 나라들이 각기 어떻게 전체 국민에게 고루 미칠 수 있는 건강관리체계를 이룩할 수 있느냐에 관심을 모으고 있는 사실이라고 봅니다. 부강한 나라에 있어서나 가장 빈궁한 나라에 있어서나 그 관심은 마찬가지로 나타나고 있읍니다. 보건진료 문제의 제기는 발달된 현대의학의 지식과 기술이 지닌 건강관리의 방대한 가능성과 건강 관리의 요구를 지닌 사람들에게 미치는 실질적인 혜택간에 점점 더 크게 벌어지는 격차에서 발생한다고 봅니다. David Rogers는 1960년대 초반까지 갖고 있던 의료지식의 축적과 민간인의 구매력 향상이 자동적으로 국민 건강의 향상을 초래할 것이라고 믿었던 순진한 꿈은 이루어지지 않았고 오히려 의료사업의 위기는 의료지식과 의료봉사간에 벌어지는 격차와 의료에 대한 막대한 투자와 그에서 얻는 건강의 혜택간의 격차에서 온다고 말하고 있읍니다. 균등 분배의 견지에서 보면 의료지식과 기술의 향상은 그 단위 투자에 대한 생산성을 낮춤으로서 오히려 장애적 요인으로 작용해온 것도 사실이고 의료의 발달에 따른 일반인의 기대 상승과 더불어 의료를 태성의 권리로 규명하는 의료보호사업의 확대로 야기되는 의료수요의 급증은 모두 기존 시설 자원에 압박을 초래하여 전래적 의료공급체제에 도전을 가해 왔으며 의료의 발달에 건 기대와는 달리 인류의 건강 문제 해결은 더욱 요원한 과제로 남게 되었읍니다. 현시점에서 세계인구의 건강문제는 기아, 영양실조, 안전한 식수 공급 및 위생적 생활환경조성의 문제에서부터 가장 정밀한 의료기술발달에 수반되는 의료사회문제에 이르는 다양한 문제를 지니고 있으며 주로 각개 국가의 경제 사회적 여건이 이 문제의 성격을 결정짓고 있다고 볼수 있읍니다. 그러나 건강 관리에 대한 요구는 영구히, 완전히 충족될 수 없는 요구에 속한다는 의미에서 경제 사회적 발달 수준에 상관없이 모든 국가가 공히 요구에 미치지 못하는 제한된 자원문제로 고심하고 있는 실정입니다. 또 하나의 공통된 관점은 각기 문제의 상황은 달라도 오늘날의 건강 문제는 주로 의료권 밖의 유전적 소인, 사회경제적, 정치문화적인 환경여건과 각기 선택하는 삶의 스타일에 깊이 관련되어 있다는 사실입니다. 따라서 오늘과 내일의 건강관리 문제는 의학적 견지에서 뿐 아니라 널리 경제, 사회, 정치, 문화적 관점에서 포괄적인 접근이 시도되어야 한다는 점과 의료의 고급화, 전문화, 일변도의 과정에서 소외되었던 기본건강관리체계 강화에 역점을 둔 다양하고 탄력성 있는 사업전개가 요구되고 있다는 점입니다. 다양한 건강관리요구에 적절히 대처할 수 있기 위한 그간 세계 각처에서 시도된 새로운 건강관리 접근과 그 제안을 살펴보면 대체로 4가지의 뚜렷한 성격들로 집약할 수 있을 것 같습니다. 그 첫째는 건강관리사업계획 및 그 수행에 있어 지역 사회의 적극적 참여를 유도하는 일, 둘째는 지역단위의 일차보건의료에서 부터 도심지 신예 종합병원, 시설 의료에 이르기까지 건강관리사업을 합리적으로 체계화하는 일. 셋째로 의료인력이용의 효율화 및 비의료인의 훈련과 협조 유발을 포함하는 효과적인 인력관리에 대한 제안과 넷째로 의료보험 및 각양 집단 의료유형을 포함하는 대체 의료재정 운영관리에 관련된 제안들을 들 수 있읍니다. 건강관리사업에 있어 지역사회 참여의 의의는 첫째로 사회 경제적인 제약이 모든 사람에게 가능한 최대한의 의료를 모두 고루 공급하기 어렵게 하고 있다는 점에서 제한된 정부재정과 지역사회가용자원을 보다 효율적으로 이용할 수 있게 하는 자조적이고 자율적인 지역사회건강관리체제의 구현에 있다고 볼 수 있으며 둘때로는 개인과 가족 및 지역민의 건강에 영향하는 많은 요인들은 실질적으로 의료권 외적 요인들로서 위생적인 생활양식, 식사습관, 의료시설이용 등 깊이 지역사회특성과 관련되어 국민보건의 실질적 향상을 위하여는 지역 주민의 자발적인 참여가 필수여건이 된다는 점 입니다. 지역 단위별 체계적인 의료사업의 전개는 제한된 의료자원의 보다 합리적이고 효율적인 이용을 가능하게 하며 요구가 있을때 언제나 가까운 거리에서 경제 사회적 제약을 받지 않고 이용할 수 있는 일차건강관리망을 통하여 건강에 관련된 정보를 얻으며 질병예방, 건강증진 및 기초적인 진료의 도움을 얻을 수 있고 의뢰에 대한 제2차, 제3차 진료에의 길은 건강관리사업의 질과 폭을 동시에 높고 넓게 해 줄 수 있는 길이 된다는 것입니다. 인력 관리에 관련된 두가지 기본 방향으로서는 첫째로 기존보건의료인력의 적정배치 유도이고 둘째는 기존인력의 역할확대, 조정 및 비의료인의 교육훈련과 부분적 업무대체를 들수 있으며 이러한 인력관리의 기본 방향은 부족되는 의료인력의 생산성을 높이고 주민들의 자조적 능력을 강화시킨다는 데에 두고 있음니다. 대체적 의료재정운영안은 대체로 의료공급과 재정관리를 이원화하여 주민의 경제능력이 의료수혜의 장애요소로 작용함을 막고 의료인의 경제적 동기에 의한 과잉치료처치에 의한 낭비를 줄임으로써 의료재정의 투자의 효과를 증대하는 데(cost-effectiveness) 그 기본방향을 두고 있다고 봅니다. 이러한 주변의료 사회적인 동향이 간호교육의 미래상에 끼치는 영향은 지대한 것이라 봅니다. 첫째로 장래 세계인구의 건강문제는 정치, 사회, 경제, 환경적인 의료권 밖의 요인들에 의해 더욱 크게 영향 받는다고 전제한다면 건강문제해결에 있어서도 전통적인 의료사업의 접근에서 더나아가 문제발생의 근원이 되는 생활개선이라는 차원에서 포괄적 접근을 생각하여야 하고 이를 위해선 정치, 경제, 사회전반에 걸친 깊이있는 이해과 주민의 생활환경에 직접 영향하는 교통수단, 통신망 mass media, 전력문제, 농업경영방법 및 조직적 사회활동 등 폭넓은 이해가 요구된다고 봅니다. 둘째로, 지역사회참여의 의의를 인정한다면 지역민의 자발적 참여를 효과적으로 유발시킬수 있고 의료집단과 각종 주민조직과 일반주민들 사이에서 협조적으로 일할수 있는 역량을 기르기위한 교육적 준비가 요구된다고 봅니다. 셋째로, 지역주민의 건강관리 자조능력 강화를 하나의 목표로 삼는다면 치료자에서 교육자로, 지도자에서 촉진자로, 제공자에서 지원자료의 역할의 변화 내지 다양화를 요구하게 될 것이므로 그에 대처할 수 있는 준비가 필요하다고 봅니다. 넷째로, 생각되어야 할 점은 지역중심건강관리사업을 지향하는 보건의료의 이념적 방향과 그에 상응하는 구체적 접근방법을 효율적으로 적용하기 위해서는 종횡으로 연결되는 의사소통체계의 정립과 민활한 정보교환이 이루어질 수 있어야 한다는 점에서 의사소통의 구심체로서 역할할 수 있는 역량을 함양해야 할 교육적 과제가 있다고 봅니다. 마지막으로 생각되어야 할 점은 지역중심으로 전개될 건강관리사업은 건강증진 및 질병예방적 측면과 질병진료 및 회복과 재활에 이르는 종합적이고 포괄적인 사업이어야 한다는 점에서 종래 공공 의료부문과 사설의료기관 사이에 나누어져 있던 예방의학과 치료의학의 통합 뿐 아니라 정부주축으로 이루어 지고 있는 지역사회개발사업 및 농촌지도사업과 종교 및 각종 민간인 집단이 벌이고있는 사업들과의 전체적인 통합적 접근이 이루어져야 한다고 생각하는 입장에서 종래 간호교육이 강조하지 않던 진료의 의무와 대외적 조직활동에 대한 보완적인 교육조치가 요구된다고 봅니다. 간호의 학문체계로서의 입장은 오랜 역사를 두고 논의의 대상이 되어왔으나 아직까지 뚜렷이 어떤 것이 간호 특유의 지식체계이며 건강문제에 관련하여 무엇이 간호특유의 결정영역이며 이 결정과 그 결과를 어떠한 방법으로 치료적 행위로 옮길 수 있는가에 대한 확실한 답을 얻지 못하고 있는 실정이라고 봅니다. 다만 근래에 제시된 여러 간호이론들 속에서 공통적으로 이야기되어지고 있는 개념들로선 우선 간호학문을 건강과 질병에 관련된 인간의 전인적이고 전체적인 상황을 다루는 학제적 과학으로서보는 입장이 있고 따라서 생물신체적인 면 외에 정신심리적, 사회경제적, 정치문화적 환경과의 상호작용 속에서 인간의 건강과 질병문제를 생각한다는 지향을 갖고 있다고 말할 수 있겠읍니다. 간호교육은 간호계 내적인 학문적, 이론적 체계화의 요구에 못지않게 대민봉사하는 전문직으로서의 사회적 책임을 감당해야하는 중요과제를 안고있어 변화하는 사회요구에 효과적으로 대처해 나가야 할 당면문제를 안고 있읍니다. 간효역할 확대, 보건진료원훈련 등 이러한 사회적 요구에 대응하려는 조치가 되겠읍니다. 이러한 시점에서 간호계가 분명히 짚고 넘어가야 할 사실은 이러한 움직임들이 종래의 의사들의 외업무공급을 연장 확대하는 입장에 서서 간호의 특수전문직 명목을 흐리게 할수있는 위험을 감수할 것인지 아니면 가능한 대체방안을 갖고 간호전문직의 독자적인 진로를 개척하면서 다각적인 도전을 받아들일 준비를 갖추든지 그 방향을 뚜렷이 해야할 일이라 생각합니다. 저로서는 이미 잘 훈련된 간호원들과 조산원들의 교육적, 경험적 배경을 기반으로 지역사회 최일선 건강관리요원으로 사회적 효능을 다 할수 있는 일차건강관리간호조직의 구현을 대체방안으로 제시하고 싶습니다. 간호원과 조산원들의 훈련된 역량과 건강관리체제의 구조적 변화를 효과적으로 조화시킨다면 대부분의 세계인구의 건강문제는 해결가능하다고 보는 입장입니다. 물론 정책과 의료와 행정적지원이 활성화되어지는 환경속에서만 그 기대하는 결과가 확대되리라는 점 부언하는 바입니다. 마지막으로 언급하고 싶은 점은 바로 오늘의 주제 ''교육의 동역자-선생과 학생''이라는 개념입니다. 특히 상회정의적 입장에서 보는 의료사업전개에 지역민 내지 의료소비자의 참여를 강조하는 현시점에 있어 교육자와 학생이 교육의 현장에서 서로 동역자로서 학습의 책임을 나누는 경험은 아주 시기적으로 적합하여 교육적으로 지대한 의미를 갖는 것이라고 생각합니다. 이에 수반되어져야 할 역할의 변화에 수용적인 자세를 갖고 적극 실제적용하려 노력하는 선생앞에서 자주적 결정을 행사해본 학생이야말로 건강관리대상자로 하여금 같은 결정권을 행사할수 있도록 촉구하여 주민의 자조적 역량을 기르고 의료사업의 민주화, 인간화를 이룩할 수 있는 길잡이가 될 수 있으리라 믿는 바입니다.