• 여성건강간호학회지
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• 제5권1호
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• pp.133-145
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• 1999

The purposesof the study are to analyze the community nursing center in U.S.A and to develop the model of nursing care system based on nurse-midwifery clinic in community for women's health in Korea. 1. In America nursing center is defined as nurse-anchored system of primary care delivery or neighborhood health center. Nursing centers are identified the following four types: (1) community outreach centers, which are similar to traditional public health clinics: (2) institutional-based centers following the mission of a large institution, such as a hospital or university: (3) wellness/health promotion centers, which offer screening, education, counseling, triage, and health maintenance services: and (4) independent practice. Nursing centers are a concept of services provided by nurses in practice arrangements in a community. Nursing centers offer a variety of services, ranging from primary care provided by advanced practice nurses with medical acute management and nursing care to the more traditional education, health promotion, screening wellness and coordination services. Some services, such as the care provided by advanced practice nurses are reimbursed under various insurance plan in some instances and states, where as others, such as preventive and educational services, are not. Thus, lack of reimbursement has threatened the survival of some centers. Licensing of nursing centers varies by state and program and accreditation of nursing centers is also limited. 52% of centers are affiliated with another facility and 48% are freestanding centers. The number of registered nurse at the nursing centers ranges from just one to 115, with a mean of eight RNs peragency and a median of three. Nursing centers avail ability varies: 14% are open 24 hours, 27% have variable short hours, 23% are open 6-7 days per week, and 36% are open Monday- Friday. As the result of my visiting three health centers in Seattle and San Francisco, the women's primary care nurse practitioners focus on a systematic and comprehensive assessment of the health status of women and diagnosis and management of common physical and psychosocial health concerns of women in ambulatory settings. Therapeutic nursing strategies are directed toward self-care, risk reoduction, health surveillance, stress reduction, healthy nutrition, social support, healthy coping, psychological well-being, and pharmacological therapy. They function as primary care providers for the well ness and illness care of women from adolescence through the older adult years and pregnant families. 2. In Korea a nurse-midwife practices independently for pregnant women's health including childbearing family at her own clinic in community. Her services are reimbursed under national health insurance but they are not paid on a fee-for-service schedule covering items. Analyzing the nursing centers in America, I suggest that nurse-midwifery clinics offer primary care for women and home care for chronic ill patients. The health law and health insurance policy should be reovised in order to expand nurse-midwife's and home care nurse's roles at nurse-midwifery clinic.

• 한국해안·해양공학회논문집
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• 제34권2호
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• pp.37-45
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• 2022

경사제의 평균 잔류수명을 간편하게 추정할 수 있는 방법을 제시하였다. 누적피해의 시간 이력 자료를 기반으로 하는 추계학적 확률모형과 다르게 내구수명의 분포함수를 이용하여 평균 잔류수명을 추정하는 방법이다. 설계 내구수명과 과거 하중이력에 따라 전문가들이 판단한 내구수명의 상한치와 하한치 그리고 그 발생 가능성을 활용하여 분포함수의 모수도 쉽게 추정할 수 있다. 본 연구에서 제시된 간편법을 전면이 TTP로 피복된 경사제에 적용하였다. TTP 피복재의 시간에 따른 누적피해에 대한 모형실험 자료가 있는 동일 조건에 대하여 WP(Wiener Process) 기반의 추계학적 확률모형도 MCS(Monte-Carlo Simulation) 기법과 함께 적용하였다. 각각의 해석 방법으로부터 얻어진 결과들을 MTTF(Mean Time To Failure)와 함께 비교하여, 실제 발생 가능한 시간에 따른 모든 형태의 피해경로에 대하여 경사제의 내구수명 분포함수는 대수정규분포를 따른다는 것을 알 수 있었다. 마지막으로 본 연구에서 제시된 간편법으로 추정된 경사제의 재령에 따른 평균 잔류수명을 WP 기반 추계학적 확률모형의 결과와 비교하였다. 일정한 재령까지는 누적피해의 증가 형태와 관계없이 비교적 잘 일치하였으나, MTTF 근방의 재령에서는 선형적인 증가와 대수적인 증가 형태에서 어느 정도 차이를 보이고 있다. 따라서 불확실성을 올바로 고려하기 위해서는 추계학적 확률모형을 사용하는 것이 바람직하지만, 본 연구에서 제시한 간편법은 누적피해에 대한 시간 이력 자료를 필요로 하지 않기 때문에 항만 구조물에 대하여 평균 잔류수명 기반의 예방적 유지관리를 신속하게 계획할 필요성이 있는 경우에 유용하게 활용될 수 있다.

• 대한토목학회논문집
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• 제40권4호
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• pp.429-435
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• 2020

북한은 2017년 6차 핵실험 이후 스스로 핵 무력의 완성을 선언하였다. 한반도 비핵화를 위한 국내외의 노력에도 불구하고 그 해결전망은 밝지 않다. 북한의 WMD위협을 억제하기 위한 정치·외교적 노력과 함께 유사시 예상되는 '재앙적 상황'에 대비한 사후관리 능력의 강화가 요구된다. 이에 따라 본 연구는 CBRN 위협에 대비한 사후관리 강화방안을 제시하기 위해 수행되었다. 연구모델은 국가 차원의 재난관리 계획발전모델 중 미 국토안보부가 채택하여 활용 중인 THIRA 프로세스를 일부 보완하여 활용하였다. 한국의 사후관리 체계는 재난에 대비한 위험관리와 위기관리를 포괄한다. 이 체계는 전·평시 CBRN의 확산 또는 사용의 억제, 위협의 대응, 예상피해 최소화 등을 목적으로 민·관·군 통합방위작전의 형태로 수행된다. 예방단계에는 CBRN의 개념과 사후관리 절차를 국가관리체계 속에 반영, 통합경보체계의 보완, 대피시설의 준비 그리고 통합훈련체계의 구축 등이 요구된다. 대비단계에는 관련 법규와 매뉴얼의 정비, 정부 조직의 정비와 수행절차의 발전, 통합대응이 가능한 현장 지원체계의 구축, 그리고 주기적인 훈련 등이 필수적이다. 대응단계에는 응급처치와 구호를 위한 의료지원체계의 정상가동, 제염시설의 설치 및 운영, 그리고 피해평가 및 통제지침의 발전이 중요하다. 복구단계에서는 안정화 평가 기준 및 절차의 발전, 피해복구에 필요한 자원의 확보 및 운용, 그리고 지역방위군과 향토예비군, 민방위가 연계된 지역피해복구 역량 강화가 필요하다.

• 보건교육건강증진학회지
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• 제23권1호
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• pp.63-75
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• 2006

Objective: This study was performed to identify the related factors of change affecting the stage of change, on the assumption that there are various stages of change in the exercise behavior of workers. Method: The subjects of the study consisted of 138 workers of 10 workplaces located in Daejeon City, and data collected by using questionnaires were analyzed with SPSS/WIN 11.5 program. Results: The subjects were distributed in the stage of exercise behavior change as follows: precontemplation stage(10.9%), contemplation stage(22.5%), preparation stage(41.3%), action stage(8.7%), and maintenance stage(16.7%). Of the process of change depending on the stage of exercise behavior change, the consciousness raising(F=11.50, p=.00), dramatic relief(F=2.82, p=.02) showed significant difference in the cognitive process, and the counter conditioning(F=4.56, p=.00), reinforcement management(F=4.64, p=.00), self-liberation(F=9.46, p=.00), and stimulus control(F=13.28, p=.00) showed significant difference in the behavioral process. For decision-making depending on the stage of exercise behavior change, both the pros of decision-making(F=9.23, p=.00) and the cons of decision-making(F=2.45, p=.04) showed significant difference. Self-efficacy depending on the stage of exercise behavior change showed significant difference as F=11.50, p=.00. The related factors of change affecting the stage of exercise behavior change were the pros of decision-making, the cons of decision-making, and self-efficacy including 34.1% R-square. Conclusion: In order to change the exercise behavior of workers positively, they need to be stimulated to use the cognitive and behavioral process in the process of change properly, and to be induced to make a decision positively. And also exercise programs suitable to various characteristics of each worker as well as those of workplaces to enhance self-efficacy need to be applied after being devised. Through the further longitudinal research, it is necessary to analyze the various aspects, such as groups to select, to maintain, to stop or give up the exercise, and to avoid the change, and to study how the related factors of change affect diversity like the above.

• 한국병원경영학회지
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• 제10권1호
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• pp.93-114
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• 2005

The prenatal care is the preventive medical service to help the pregnant mother deliver the healthy baby. It's regular examines give some chances to check-up the healthy conditions. This thesis concentrates on the CRM system to support an effective prenatal care system and prove the effectiveness of it. As CRM is the adapted management related to the customer's own information, it is important to develop the CRM model classified by the patients characteristics. A general hospital in Busan operated the CRM system to carry out the effective prenatal care and there is an analysis to ensure the effectiveness of CRM system for the pregnant women in our maternity ward. The results can be summarized as follows: 1) According to the comparisons with the CRM system, we can conclude the system is desirable. (1) Maternal Age : In the age distribution, the prenatal visit frequency, triple marker freqency, oral GTT and targeted ultrasonography in the experimental group in 30 to 34 years old is higher on the whole. For over 35 years old group, the higher frequency comes out in the oral GTT and targeted ultrasonography and for 25 to 29 years old group the different figure shows just in the targeted ultrasonography. (2) Area of residence: There is a clear difference in all the items in Busan and near area but no sign of difference in prenatal visits and oral GTT in other residencial area. Especially in the targeted ultrasonography the higher figure shows in the experimental group located in the both areas. The targeted ultrasonography is known as the specific examination which should be examined by the specialists, on the contrary the other examinations can be operated in the small clinic. So the public information and seminars related with ultrasonography increases the check-up frequency. The clinic requests some ultrasonographical examinations to the specialists in general hospital. (3) Parity: The clear difference shows that the CRM system causes the prenatal visit frequency to become higher in experimental group. The figure is 9.7 times and 8.6 times each. This is opposite that the past study said multiparity reduced the average prenatal visits. But the result of CRM is considered as the method to help the multiparity understand the importance of the prenatal care. (4) Obstetrical history: In the experimental group of the spontaneous delivery group, the figure is higher in the prenatal visit frequency, triple marker, oral GTT and targeted ultrasonography but the Caesarean section delivery group has higher figure in targeted ultrasonography. (5) In the first check-up, the rate of targeted ultrasonography in under 16 week pregnancy, in the 16 week pregnancy to 32 week pregnancy and the over 32 week pregnancy in the experimental group is upper than the compared one. For the oral GTT, there is a difference in under 16 week pregnancy but no difference in prenatal visits and triple marker. 2) The analysis of characteristics of prenatal care through the decision tree resulted in the fact that the most important variable is the residential area. After the delivery frequency is following, the obstetrical history and maternal age are in order. It is the same result in the triple marker and oral GTT. Consequently it is the same order of important variables in CRM system. The effectiveness of CRM system is proved in this study. The CRM system is a marketing method to control and lead the customers through the segmentation of customer data. It increases the new customer aquisition, maintenance of loyal customers, augmentation of customers value, activation of potential customers and creation of life time customers. So eventually it can enlarge the customers value. The medical institution should make efforts to establish the data base enforced by the customer's information on the underlying ordinary data system to carry out the CRM system effectively. In addition, it should develop the a variety of marketing strategy in order to set up one to one marketing satisfying the needs of individual patients.

• 한국건설관리학회논문집
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• 제16권1호
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• pp.52-63
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• 2015

국내 건축물 중 업무시설은 국가 경제발전 및 산업구도의 변화와 더불어 급속도로 보급되기 시작하여 2012년 수도권 기준 소방대상물 현황 31개종 중 공동주택 다음으로 많은 비중을 차지하고 있는 주요 시설물이다. 그러나 2014년 현재 수도권지역 업무시설 중 70% 이상이 사용기간 15년 이상으로 주요 건축 마감재의 노후화와 기능저하가 시작되는 등 수선이 시급한 업무시설이 지속적으로 증가하고 있는 실정이다. 특히, 업무시설은 사옥 또는 임대사무실의 목적으로 활용되고 있어 시설물의 노후화와 기능 저하가 초래될 경우 건축주와 유지관리 주체에게 임대 경쟁력 저하 및 부동산 가치 하락 등의 문제점을 가져올 수 있다. 이와 같은 시설물의 노후화와 기능 저하를 예방하기 위해서는 준공 후 경과연수에 따라 수선율을 기준으로 한 예방적 차원의 계획 수선을 필요로 한다(La et al. 2001). 이러한 수선율을 기준으로 하는 국내의 수선기준들은 그 대상의 범위가 주로 공동주택과 공공기관 시설물에 국한되어 있어 업무시설에 해당 기준을 적용하기에는 한계성이 있으며, 현업에서의 수선계획 수립을 위한 수선율 기준의 적용성 제고를 위해서는 필수적으로 연간단위의 마감재별 수선율 데이터가 요구되고 있는 것으로 조사 분석되었다. 따라서 본 연구의 목적은 6개소 업무시설의 실제 수선이력데이터를 수집 및 분석하여 업무시설을 대상으로 한 건축 마감재의 수선율 산정 모형을 개발하고 사례적용을 통해 도출된 마감재별 연간단위 수선율의 적정성을 검증하는 것이다. 본 연구의 결과물은 업무시설의 건축주 및 유지관리 주체들로 하여금 발생 가능한 돌발적 보수비용과 기회비용의 낭비를 예방케 함으로써 보다 효율적인 유지보수 예산의 계획과 집행을 가능하게 할 수 있을 것으로 기대된다.

• 가정∙방문간호학회지
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• 제11권1호
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• pp.5-13
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• 2004

The home health care industry has grown rapidly and can be expected to continue to grow in the foreseeable future. Home health care refers to the practice of nursing applied to clients with a health condition in the clients place of residence. clients and their designated care givers are the focus at home health nursing practice. The goal of care is to initiate. manage and evaluate the resources needed to promote the clients optimal level of well-being and function. Nursing activities necessary to achieve this goal may warrant preventive maintenance and restorative emphases to prevent potential problems from developing. Many project program were suggested home health care model for Korea's health care system and policy direction for expansion and establishment of home health care .But the aim of this paper is to provide on overview for theoretical frame work in home health care. Theories and conceptual frameworks or models are important nursing because they define and guide the boundaries of professional practice and identify key nurse-patient-caregiver relationships that emerge with caring. Following is the research with an investigation of the literature review in the University of Arizona international medline database, In conclusion, are as followers: First, many nursing theorists have had a tremendous impact on nursing practice. the following highlights those nursing theorists that are particularly helpful in understanding home health care. 1. Florence Nightingale : Our earliest theoretical legacy. Nightingale's believes are reflected in basic infection control practice such as hand washing and infectious waste disposal and are key nursing interventions in home care. 2. Martha Roger's :Science of unitary human beings theory. Rorger's believed that the focus of shared. non invasive healing modelities is the human environmental field rather than direct physical care. These modelities continue to evolve as our awareness (reflecting greater diversity, faster rhythms, motions, and ways of knowing) transcends time and space, allowing individuals to get in touch with their integral nature of unbroken wholeness. On people as ever changing energy fields have special relevance in home care especially with hospice and palliative care applications. 3. Madeline Leininger's; Transcultural nursing theory. Home care nurses move through a variety of communities and often care for patients from different cultural back grounds. Therefore Leininger's work has a good that with home care because home care nursing practice is very culturally focused. 4. Dorothea Orem's : Self care deficit theory. Orem's theory views care as something to be performed by both nurses and patients. The role of the nurse is to provide education and support that help patients acquire the necessary activities to perform self-care. Orem's theory is foundational to have care because it begins to truly acknowledge the role of the patient in managing his or her own health. which is referred to as self-care. 5. Margaret Neuman's; Health as expending consciousness theory. Neuman believes that health compasses disease and reflects an underlying pattern of person-environment interaction. A key application of 'Neuman's work to home care is for nurses to understand that health and illness do not necessarily exist at opposite ends of a continuum. 6. Jean Watson's: Theory of human caring. Watson's theory of human caring in nursing proposes human caring as the moral ideal of nursing. Nurses participate human caring to protect, enhance and preserve humanity by assisting individuals to fing meaning in illness. pain and existence and to help others gain self knowledge. self control. and self healing such thinking lends richness to theory development. as well as clinical practice in home care. Second, Robin Rice : Dynamic self determination for self care. (A theoretical framework for home care) Dynamical self determination for self care can be useful to home care nurses in a variety of ways. As research tool it can be reflected in the interview process when the home visit. The home care nurse's role is that of facilitator of patient self-determination for self care through numerous strategies. including patient education and case management.