• 제목/요약/키워드: Quality of Nursing Service

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호스피스의료와 간호윤리 (Hospice Medicine and Nursing Ethics)

  • 문성제
    • 의료법학
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    • 제9권1호
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    • pp.385-411
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    • 2008
  • The goal of medicine is to contribute to promoting national health by preventing diseases and providing treatment. The scope of modern medicine isn't merely confined to disease testing, treatment and prevention in accordance to that, and making experiments by using the human body is widespread. The advance in modern medicine has made a great contribution to valuing human dignity and actualizing a manly life, but there is a problem that has still nagged modern medicine: treatment and healing for terminal patients including cancer patients. In advanced countries, pain care and hospice medicine are already universal. Offering a helping hand for terminal patients to lead a less painful and more manly life from diverse angles instead of merely focusing on treatment is called the very hospice medicine. That is a comprehensive package of medical services to take care of death-facing terminal patients and their families with affection. That is providing physical, mental and social support for the patients to pass away in peace after living a dignified and decent life, and that is comforting their bereaved families. The National Hospice Organization of the United States provides terminal patients and their families with sustained hospital care and home care in a move to lend assistance to them. In our country, however, tertiary medical institutions simply provide medical care for terminal patients to extend their lives, and there are few institutional efforts to help them. Hospice medicine is offered mostly in our country by non- professionals including doctors, nurses, social workers, pastors or physical therapists. Terminal patients' needs cannot be satisfied in the same manner as those of other patients, and it's needed to take a different approach to their treatment as well. Nevertheless, the focus of medical care is still placed on treatment only, which should be taken seriously. Ministry for Health, Welfare & Family Affairs and Health Insurance Review & Assessment Service held a public hearing on May 21, 2008, on the cost of hospice care, quality control and demonstration project to gather extensive opinions from the academic community, experts and consumer groups to draw up plans about manpower supply, facilities and demonstration project, but the institutions are not going to work on hospice education, securement of facilities and relevant legislation. In 2002, Ministry for Health, Welfare & Family Affairs made an official announcement to introduce a hospice nurse system to nurture nurse specialists in this area. That ministry legislated for the qualifications of advanced nurse practitioner and a hospice nurse system(Article 24 and 2 in Enforcement Regulations for the Medical Law), but few specific plans are under way to carry out the regulations. It's well known that the medical law defines a nurse as a professional health care worker, and there is a move to draw a line between the responsibilities of doctors and those of nurses in association with medical errors. Specifically, the roles of professional hospice are increasingly expected to be accentuated in conjunction with treatment for terminal patients, and it seems that delving into possible problems with the job performance of nurses and coming up with workable countermeasures are what scholars of conscience should do in an effort to contribute to the development of medicine and the realization of a dignified and manly life.

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보건소 방문간호사의 이직의도와 관련요인 (Factors influencing Turnover Intention of Customized Home Health Care Nurse)

  • 박정숙;오윤정
    • 농촌의학ㆍ지역보건
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    • 제39권2호
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    • pp.94-103
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    • 2014
  • 본 연구의 목적은 방문간호사의 이직의도와 직무만족도와의 관련성과 이직의도의 예측요인을 분석하여 맞춤형 방문건강관리사업의 안정적인 정착과 활성화에 도움이 되고자 시도되었다. 조사대상자는 대구시와 경상북도의 방문간호사를 대상으로 총 237명의 조사결과를 최종적으로 활용하였다. 방문간호사의 이직의도는 3.12점(5점 만점)이었고 직무만족도는 2.41점(4점 만점) 이었다. 직무만족도 하위영역에서는 운영요인의 점수가 가장 낮았고, 인간관계요인 점수가 가장 높았다. 방문간호사의 이직의도와 관련이 있는 일반적인 특성은 결혼상태, 종교, 방문건강관리업무 근무경력, 고용형태, 근무지역이었으며, 이직의도와 직무만족도간에는 부적인 상관관계를 보여주었다. 이직의도를 설명하는 주요변수로는 직무만족도, 결혼상태, 고용형태로 나타났고, 방문간호사 이직의도를 19.8% 설명하였다. 방문간호사들의 이직의도를 감소시키기 위해서는 직업 만족도 향상 방안과 각 지자체마다 방문간호사의 연속고용이 보장될 수 있도록 실효성 있는 제도적 장치 마련이 이루어져야 할 것이며, 이로 인해 방문보건사업의 정립과 함께 질적인 성과도 향상될 수 있을 것이다.

병원 호스피스센터-보건소 연계를 통한 지역사회 재가암환자 관리 프로그램 평가 (Evaluation of a Community-Based Cancer Patient Management Program: Collaboration between a Hospice Center and Public Health Centers)

  • 이해숙;박선희;정영순;이부경;권소희
    • Journal of Hospice and Palliative Care
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    • 제13권4호
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    • pp.216-224
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    • 2010
  • 목적: 본 연구는 말기 재가암환자 관리를 위한 병원호스피스센터와 보건소 간의 연계 프로그램을 평가함으로써 보다 효율적이고 효과적인 재가암환자 관리체계를 구축하고자 시도되었다. 방법: 호스피스센터-보건소 재가암관리 연계 사업은 1) 협약체결, 2) 재가 말기암환자 발굴 및 등록, 3) 가정호스피스 방문 서비스 제공, 4) 만족도 조사의 단계로 전개되었다. 일 호스피스센터와 지역의 3개 보건소가 협약을 체결하였고, 2009년 2월 1일에서 12월 31일까지 11개월 동안 43명의 환자에게 605건의 가정호스피스 방문을 실시하였다. 방문기록지 분석을 통해 서비스 대상자의 특성과 제공된 서비스의 종류와 내용을 분석하였고, 이 중 20명에게 서비스 만족도 조사를 실시하였다. 결과: 대상자의 76.7%가 60세 이상이었고, ECOG 전신 수행상태 점수는 0점과 1점이 각각 37.2%, 39.5%이었다. 환자가 병식이 있는 경우는 90.7%, 호스피스 동의서에 서명한 경우는 62.8%였다. 초기방문 시 환자의 주 호소는 전신쇠약감(86.0%)과 식욕부진(72.1%)이 가장 많았다. 평균 총 서비스 기간은 144.42일이었고, 총 605건의 방문 중 간호사 방문이 371회로 가장 많았다. 각 방문중 정서적 지지와 건강상담이 가장 빈번하게 제공되었고, 서비스 전반에 대한 만족도는 5점 척도로 측정하였을 때 평균 4.45점이었다. 결론: 본 연구는 지역사회 내에서 실제적이고 체계적인 재가 말기암환자 관리 프로그램 구축을 위한 중간평가로서의 의미가 있다. 본 연구에서 의뢰된 대상자는 입원형 호스피스보다 기능 상태가 양호하고 서비스 제공기간이 길었으며, 서비스에 대한 만족도, 특히 정서적지지와 환자상태 설명에 대한 만족도가 높았다. 그러나 방문횟수와 빈도, 임종기 관리, 병원입원 재입원하는 환자관리에 대한 기준과 서비스 표준마련은 앞으로의 과제로 제시되었다.

골다공증 유발 동물모델에서 녹용 추출물의 경구 투여 효과: 체계적 문헌고찰 및 메타분석 (The Effects of Oral Administration of Deer Antler Extracts on an Osteoporosis-induced Animal Model: A Systematic Review and Meta-analysis)

  • 이정민;김남훈;이은정
    • 한방재활의학과학회지
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    • 제32권2호
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    • pp.65-81
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    • 2022
  • Objectives This study aimed to assess the effects of oral administration of deer antler extracts on an osteoporosis-induced animal model. We analyzed the results of using deer antler single extracts on animal models with osteoporosis through a systematic review and meta-analysis. Methods We included osteoporosis studies in animal experiments that administrated deer antler extracts orally. We searched the following 13 databases without a language restriction: PubMed, EMBASE, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), China National Knowledge Infrastructure (CNKI), Wanfang, Korean Medical Database (KMbase), National Digital Science Library (NDSL), Korean Traditional Knowledge (Koreantk), Oriental Medicine Advanced Searching Integrated System (OASIS), Research Information Sharing Service (RISS), Korea Institute of Science and Technology Information (KISTI), and Koreanstudies Information Service System (KISS). We used Systematic Review Centre for Laboratory Animal Experimentation's risk of bias tool for assessing the methodological quality of the included studies. Results A total of 299 potentially relevant studies were searched and 11 were included for a systematic review. Nine studies used a single deer antler extract. A study compared the effects of single extracts of deer antler and antler glue, while another study compared the effects of three single extracts of deer antler, old antler, and antler glue. For evaluating the intervention effect, bone mineral density (BMD) was measured as the primary outcome, while the histomorphometric indicators of the bone and serum alkaline phosphatase and osteocalcin levels were used as the secondary outcome variables. On conducting a meta-analysis of studies on single deer antler extract, BMD was observed to be significantly increased compared to that in control group (standardized mean difference [SMD]=2.11; 95% confidence interval [CI]=1.58~2.65; Z=7.75; p<0.00001; I2=56%). As a result of meta-analysis, according to the concentration of deer antler, the group with high concentration showed statistically significantly higher BMD than the group with low concentration (SMD=1.28; 95% CI=0.74~1.82; Z=4.63; p<0.00001; I2=9%). Conclusions The research shows that the deer antler extracts have significant anti-osteoporotic effects on the osteoporosis-induced animal model. However the studies included in this research had a high methodological risk of bias. This indicates the requirement of considerable attention in the interpretation of the study results.

Analysis of the relationship between lifestyle habits and glycosylated hemoglobin control based on data from a Health Management Plan

  • Wang, Ya-Chun;Wang, Chi;Shih, Ping-Wen;Tang, Pei-Ling
    • Nutrition Research and Practice
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    • 제14권3호
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    • pp.218-229
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    • 2020
  • BACKGROUND/OBJECTIVES: Type 2 Diabetes mellitus (T2DM) is a hereditary disease that is also strongly dependent on environmental factors, lifestyles, and dietary habits. This study explored the relationship between lifestyle habits and glycosylated hemoglobin management in T2DM patients to provide empirical outcomes to improve T2DM management and patient health literacy. SUBJECTS/METHODS: This study enrolled 349 diabetic patients with more than 5 care visits to a Diabetes Mellitus care network under the Health Management Plan led by Taiwan Department of Health (DOH). Based on relevant literature, an Outpatient Record Form of Diabetes Mellitus Care was designed and lipid profile tests were conducted for data collection and analysis. RESULTS: When modeling the data, the results showed that the odds for HbA1c > 7.5% in T2DM patients duration over 10 years was 3.785 (P = 0.002) times that in patients with disease duration of fewer than 3 years. The odds of HbA1c > 7.5% in illiterate patients was 3.128 (P = 0.039) times that in patients with senior high school education or above. The odds of HbA1c > 7.5% in patients with other chronic illness was 2.207 (P = 0.019) times that in participants without chronic illness. Among 5 beneficial lifestyle habits, the odds of HbA1c > 7.5% in patients with 2 or 3 good habits were 3.243 (P = 0.003) and 3.424 (P = 0.001) times that in patients with more than 3 good habits, respectively. CONCLUSION: This empirical outcome shows that maintaining a good lifestyle improves T2DM management and patients' knowledge, motivation, and ability to use health information. Patients with longer disease duration, education, or good lifestyle habits had optimal HbA1c management than those in patients who did not. Thus, effective selfmanagement and precaution in daily life and improved health literacy of diabetic patients are necessary to increase the quality of T2DM care.

농촌보건의료서비스 향상을 위한 제도 개선방안 (Policy Measures for Improving Health Care Services in Rural Areas)

  • 문옥륜;이규식;박재용;고대하;이기효
    • 농촌의학ㆍ지역보건
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    • 제16권2호
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    • pp.97-119
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    • 1991
  • 본 연구는 농촌지역의 보건의료수준이 의료자원의 양적, 질적 격차와 의료이용과 의료접근도 및 건강수준의 면 등에서 도시지역보다 낙후되어 있다는 사실을 각종 통계지표를 이용하여 논증하였다. 다음으로 이러한 격차를 빚은 농촌보건사업의 문제점을 파악하여 이에 대한 대처방안을 농촌보건사업의 조직, 인력, 시설 및 장비, 재원 및 그리고 관리라는 5가지 부문으로 나누어서 모색해 보았는데 구체적으로는 첫째, 농촌보건 인력의 자질향상과 적정배치방안의 수립, 둘째, 농촌보건인력의 생산성 증대, 셋째, 보건소 및 지소의 운영개선, 넷째, 취약지 민간병원의 운영 개선, 다섯째, 사회, 경제여건의 변화에 따른 새로운 보건사업의 개발, 여섯째, 통합적인 보건의료인력관리 전담기관의 설립 등의 정책대안을 제시하고 있다.

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특수학교의 보건관리 (Health Management and Services of School-Nurse in Special Schools)

  • 이경희;박재용
    • 한국학교보건학회지
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    • 제4권2호
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    • pp.176-192
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    • 1991
  • 특수학교 보건관리의 방향 설정과 특수학교 양호교사 업무 수행에 있어 질적 향상을 위한 기초 자료를 제시하고자 전국의 102개 특수학교 양호교사를 대상으로 1991년 2월 1일부터 1991년 3월 31일까지 우편 설문 조사를 실시하여 회수된 77개 학교를 대상으로 분석한 결과를 요약하면 다음과 같다. 특수학교의 67.5%가 사립이고, 83.2%가 시 이상 지역에 위치해 있으며, 정신지체학교가 48.1%로 가장 많았다. 특수학교의 평균 학급수는 17.2학급, 평균학생수는 194명, 평균교직원 수는 28명이었다. 양호교사의 평균 연령은 32.7세였고, 97.4%가 전문대학 이상 졸업자였으며, 71.4%가 기혼자였고, 79.2%가 임상이나 보건과 관련된 분야의 과거경력이 있는 것으로 나타났다. 또한 62.3%의 양호교사가 단독 업무를 보고있었으며, 77.9%가 초등에 소속되어 있었다. 대상 특수학교 양호실은 68.9%가 l층에 위치해 있었고, 학교보건 조직은 90.9%가 구성되어 있지 않았으며, 학교보건 인력으로 교의, 치과의, 학교 약사 모두를 위촉하고 있는 곳은 18.2%에 불과했다. 학교보건에 관한 연간 예산은 양호교사의 46.8%가 모르고 있었으며, 학교당 평균 년간지출액은 317,000원으로 그 중 의약품 구입비가 제일 많았다. 학교당 월 평균양호실 이용자수는 71명이었고, 학생 1인당 연간 양호실 이용은 4.4회였으며, 외상으로 인한 이용이 26.6%로 가장 많았다. 양호실 이용자중 1.4%가 의료기관에 의뢰되었는데, 시각장애학교는 고열, 정서장애학교는 골절, 다른 영역학교는 외상으로 가장 많이 의뢰하였다. 특수학교 아동 중 간질 학생수는 956명으로 조사 대상학교 학생수의6.4%를 차지하고 있었다. 신체검사를 2회 이상 실시하고 있는 학교는 22.6% 밖에 되지 않았으며, 98.7%가 보건교육을 실시하고 있고, 성교육은 98.7%가 필요하다고 강조하였다. 보건교육은 개인 위생에 가장 비중을 두고 있었으며, 시각장애 학교는 방송교육, 청각장애 학교는 OHP나 VTR, 다른 영역의 학교는 가정통신문이나 OHP VTR을 가장 많이 사용하는 교육매체였다. 대상 양호교사의 46.8%가 학교보건관리중 보건교육이 가장 어렵다고 하였으며, 중점개선내용으로 49.4%가 특수학교 보건관리에 대한 구체적인 업무 지침이 필요하다고 강조하였다. 사업계획 및 평가, 양호실 관리, 보건교육, 환경관리, 건강관리 등의 양호교사 업무 수행은 비교적 높은 수행율과 자신감을 나타냈으나, 그 중 학교보건 사업의 평가, 체력검사, 보건교육 후 평가, 학교정화구역 관리, 상처 봉합에 대한 수행율과 자신감이 비교적 낮았다. 따라서 특수학교 보건관리의 방향설정과 양호업무의 질적수준 향상을 위하여 학교보건사업에 대한 구체적인 업무지침의 개선과 특수학교 양호교사에 대한 별도교육이 필요한 것으로 생각된다.

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간호사의 비정규직 고용실태 및 관련요인에 관한 연구 (A Study on the Nurses' Contingent Employment and Related Factors)

  • 최숙자
    • 간호행정학회지
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    • 제5권3호
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    • pp.477-500
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    • 1999
  • Korean labor market has showed remarkable change of the increase in the amount of unemployment and contingent employment since IMF bailout agreement. There is a theoretical position to explain this increase in contingent employment at hospitals with the notion of flexibility. The high flexibility of employment due to the increase of contingent employees is becoming very important part in new business strategy of hospitals. The types of contingent employment of the nurse are part-time employment temporary employment, fixed-term employment, and internship which was introduced in early 1999. Recently, Korean health care industry managers have paid attention to the customer oriented service, rationalization of business administration, service quality control so that they can adjust their business to outer environment. Especially their efforts concentrate on the wage reduction through efficient and scientific control of man power because wage shares about 40% of total cost. This dissertation aims at verifying the phenomena of the contingent employment of the nurse and analyzing the related factors and problems. To rephrase these aims in ordinal: First, verifying the phenomena of contingent employment of the nurse. Second, verifying the problems of that phenomena. Third, analyzing the related factors of the contingent employment of the nurse. To accomplish these research goals, a statistical survey was executed. in which 384 questionnaires-66 for manager nurses, 318 for contingent nurses - were given to nurses working at 66 hospitals-which have at least 100 beds-in Seoul. Among them, 187 questionnaires-38 from manager nurses, 149 from contingent nurses'- 'were returned. Then, the data coded and submitted to T-test, $X^2$ -test, variance analysis(ANOVA), correlation analysis, multiple regression analysis, Logistic Regression with SAS program. The research results of the contingent nurses are followings: 1. The average career term at the present hospital 8.4 months: duty-on days per month are 24.2 days: working time per day is 7.9 hours. These results showed little difference from regular nurses. 2. Their wage level is about 70% of regular nurses except for internship nurses whose wage level is 41% of regular nurses. To break down the wage composition, part-time nurses and internship nurses get few allowance and bonus. And contingent nurses get very low level of additional pay except for fixed-term nurses who are under similar condition of employment to regular nurses. These results show that hospital managers are trying to reduce the labor cost not only through the direct way of wage reduction but through differential treatment of bonus, retirement allowance, and other additional pay. 3. The problem of contingent employment: low level of pay; high level of turn-over rate: weakening of union; low level of working condition: heavy burden of work; inhuman treatment. The contingent nurses consider these problems more seriously than manager nurses do. What manager nurses regard problematic is the absence of feeling-belonged and responsibility of the contingent nurses. 4. The factors strongly related with the rate of the number of contingent nurses for the number of regular nurses; gross turn-over nurses; average in-patients per day; staring wage of graduate from professional college: the type of hospital ownership; the number of beds; the gap between gross newcomer nurses and gross turn-over nurses. The factors related with their gross wage per month; the number of beds; applying of health insurance; applying of industrial casualty insurance; applying of yearly-paid leave; the type of hospital ownership; average out-patients per day; gross turn-over nurses. The meaningful factors which make difference by employment type: monthly-paid leave; physiological leave. The logistic regression analysis using these two factors shows that monthly-paid leave is related with the type of hospital ownership; the number of beds; average out-patient per day, and physiological leave is related with the gross newcomer nurses; gross turn-over nurses; the number of beds.

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노인 대상 치매예방프로그램 국내 연구동향 (Domestic Research Trends of The Dementia Prevention Programs for The Elderly)

  • 양수경;고보숙;박정환
    • 한국산학기술학회논문지
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    • 제20권1호
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    • pp.131-143
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    • 2019
  • 본 연구목적은 노인 대상 치매예방프로그램 국내 연구동향 분석을 하기 위함이다. 2000년~2018년 사이에 '치매예방', '치매예방 프로그램', '치매', '노인', '노인놀이'를 키워드로 한국교육학술정보원(Riss), 구글학술검색, DBpia, 한국학술정보(Kiss)에 게재된 노인들을 위한 치매예방프로그램 연구논문을 대상으로 하였다. 총 404편의 연구논문 중 자료의 분석기준과 방법에 따라 36편의 논문을 최종 선별 하였다. 연구결과로는 첫째, 연구자료의 기본 구조와 프로그램 시행 구조를 가지고 있는 논문은 2012년~2018년 연구의 학술지 17편으로 나타났다. 그리고, 양적연구방법을 적용한 경우는 25편으로 월등히 높은 경향을 보였다. 노인 대상 치매예방프로그램 시행 구조에 대한 동향을 분석한 결과, 진행 기관은 요양원(노인복지병원)이 11편이 가장 많았고, 참여노인의 성별은 여성노인이 남성노인 보다 높은 것으로 나타났으며, 연구대상 연령은 65세 이상 연령대의 비중이 높은 것으로 나타났다. 둘째, 치매예방 중재 프로그램의 종류를 분석한 결과 통합프로그램이 11편으로 가장 높게 나타났다. 셋째, 치매예방 프로그램 측정도구 및 효과성 분석 결과, 인지기능을 측정하는 한국판 간이정신상태검사 MMSE-K 도구가 16편의 논문에서 가장 많이 사용하는 것으로 나타났으며, 통합프로그램은 인지기능에서는 10편의 연구에서 인지기능의 유의한 향상이 나타났다. 이 연구는 노인들을 위한 치매예방 교육이 단편적인 프로그램에서 벗어나 노인들의 인지기능 및 정신행동, 생활 습관 등에 영향을 주고, 건강한 노후와 삶의 질을 향상시킬 수 있도록 치매예방 프로그램이 통합적으로 이루어져야 한다는 점을 제안하였다.

청소년기의 건강증진과 학교보건교육의 발전방향 (Adolescent Health Promotion and Development of School Health Education)

  • 유재순
    • 한국학교보건학회지
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    • 제11권1호
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    • pp.27-50
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    • 1998
  • Adolescent health is considered to contribute to health promotion in the home and community in the near future as well as individual health. However, adolescent health has been neglected from education field because of competitive school education focused on the university entrance examination That's why I suggest in this study that we should pay much more attention to adolescent health condition and try to make It better, in terms of man-power development and life-health promotion for nation development The purposes of this study are as follows First, to look into a variety of adolescent health problems Second, to find out the situation and problems of current adolescent health promotion and school health education Third, to make an effort to find, based on the current situation, various developments of adolescent health promotion and school health education in terms of practical, political and environmental change There are used study methods as adolescent-related, school heath-related literature review and anlysis of statistical data The results and suggestions are as follows Teenagers have a great variey of health problems including most Important physical, mental and social developments Recently, chronic diseases, emotional problems, health-risk behaviors linked With adolescents are on increase The complicated disorders of physical, mental, social health rather than paricular aspects of health or health-behavior problems influence adolescent health problems adolescence is regarded as the period when most health-related behaviors are formed. Therefore, adolescent health promotion would he assured by developing the ability of controlling multi-dimensional health determinants in the early stage. Health promotion is a positive concept that each individual, family and community makes real efforts to improve their health To achive this, we need health educational, organizational, political and environmental supports. Adolescent health promotion in Korea has been systematically treated in the category of school health Current school health services have had lots of systemic, constitutional, administrative and educational flaws Accordingly, I'm concerned that we can afford to accept a variety of adolescent health needs However, I would say that if were not to make those flaws better, it's certain that Korean national competitive power and the quality of the lives of most Koreans Will he threatened someday We have to develop Comprehensive School Health Crriculum(CSHC) and set up its standards to Improve adolescent health. CSHC is an organizational and costant process. CSHC means an Important part of overall curriculums. In addition, I could say that it's an Important school health education acivity including current school health services-health care service and school health environment. In conclusion, in order to develop CSHC, we require school nurse's role changes, establishment and management of intergrated subject of health education, striking revision of school health law(or legislation of school health promotion law), reorganization of administration system, big changes in curriculum for school health educators.

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