• Journal of Preventive Medicine and Public Health
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• v.20 no.1 s.21
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• pp.165-203
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• 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.

• Journal of Korean Neuropsychiatric Association
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• v.57 no.2
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• pp.190-208
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• 2018

Objectives To initiate and develop a treatment guideline in multidisciplinary approaches for related professions who are either working and/or living with children and adolescents with neurodevelopmental disorders who show behavioral problems. Methods To collect and reflect opinions from multiple professions who assumedly have different interventions or mediations on behavioral problems, a self-report survey and Focus Group Interview (FGI) were conducted for a group of child and adolescent psychiatrists, behavioral therapists, special education teachers, social welfare workers, and caregivers. Results According to a self-report survey and FGI results from multiple professional groups, aggressive behavior is the mostly common behavioral problem necessitating urgent interventions. However, both mainly used intervention strategies and effective treatment methods were different depending on professional backgrounds, such as pharmacological treatment, parent training, and behavior therapy, even though they shared an importance of improving communication skills. In addition, there was a common understanding of necessity to include parent training in a guideline. Lastly the data suggested lack of proper treatment facilities, qualified behavior therapists, and lack of standardized treatment guideline in the field needed to be improved for a quality of current therapeutic services. Conclusion It is supported that several subjects should be included in the guidelines, such as how to deal with aggressive behavior, parent training, and biological aspects of neurodevelopmental disorders. Also, it is expected that publishing the guideline would be helpful to above multiple professions as it is investigated that there are lack of treatment facility and qualified behavioral therapists compared to need at the moment.

• Journal of Hospice and Palliative Care
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• v.10 no.3
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• pp.128-136
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• 2007

Purpose: The purpose of this study is to investigate the current state of the home-based cancer patient management project of public health centers throughout the country. The results of the investigation is employed to identify obstacles to the execution of the program and, finally, to develop an efficient management program of home-based cancer patients. Methods: Data on the home-based cancer patient management project were collected and analyzed through visiting interviews or telephone interviews with 225 public health centers throughout the country for six months from July to December, 2006. Results: Obstacles to the present execution of the home-based cancer patient management project were identified. Some of them are : (1) patients' low trust in cancer patient management by local health centers, (2) absence of programs customized to local communities, (3) lack of personnel and vehicles for home-based cancer patient management, (4) lack of education program for personnel in charge of home-based cancer patient management, (5) problems in public health doctors, weak connection to private medical institutions, (6) absence of medical institutions and hospice facilities for cancer patients, and (7) non-standardized volunteer workers, so on. Considering all these problems, some effective management methods are proposed. The basic concept is to keep the autonomy and variety of the local helath centers. And based on this concept, three models of (1) public health center controlled model, (2) medical institutions and hospice facilities-entrusted model and (3) medical institutions and hospice facilities-cooperative model are developed. Conclusion: By adopting an adequate model among proposed three models, the public health centers are expected to achieve an efficient utilization of material resources and manpower. In addition, by inventing their own programs that are proper for the local societies, they can improve the home-based cancer patient management.

• Asia-Pacific Journal of Business Venturing and Entrepreneurship
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• v.13 no.2
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• pp.159-175
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• 2018

The purpose of this study was to identify the factors that could overcome the crisis and adversity of the nursing care provider through understanding the effect of job adaptation on the turnover intention of the nursing care provider and to contribute to the various problems of the nursing care provider in the long term. In order to confirm this as an empirical research task, risk factors and protection factors, general characteristics of the survey subjects, job adaptation and turnover intention were selected, and the risk factors and protective factors of caregivers' As a mediator. So Seoul. The results of the questionnaire survey were as follows: 291 caregivers in the elderly medical welfare facilities in Gyeonggi area. First, as the relationship between the risk factors and protective factors of occupational caregivers and occupational adaptation were more severe, the higher the maladjustment of the workplace culture, the more the job satisfaction and organizational commitment were adversely affected. The emotional support, The higher the information support, the more satisfied and satisfied the job. Second, the relationship between the risk factors of the caregiver and the protective factors and the turnover intention, the higher the conflict of caregivers, the more unstable the workplace, the more difficult it is to adapt to work culture, Respectively. Finally, as a result of verifying the mediating effect of occupational adaptation on the relationship between risk factors and protective factors and turnover intention of caregivers, job satisfaction, which is a sub-factor of job adaptation, It is shown that they play mediating roles only in the relationship between stress and turnover intention, and do not play a mediating role in the relationship between protective factor self - efficacy and social support and turnover intention. In other words, if caregivers feel satisfaction about their job, they can be less stressed on their jobs, improve their self-efficacy, and have a positive attitude toward social support. Also, it was found that the more the caregiver 's immersion into the organization, the less job stress and turnover intention decreased, but the self - efficacy and social support perception were not influenced. Based on this, the director of the facility should strive to stabilize the operation of the facility and provide high-quality services by seeking ways to improve conflict resolution and adaptation to the workplace culture so that nursing care workers can adapt to their work. And it is required to develop active management strategies and institutional support for improving job satisfaction and organizational commitment of caregivers.

• Journal of the Korean Institute of Landscape Architecture
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• v.46 no.1
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• pp.9-16
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• 2018

Landscape architecture is an indispensable professional service in building sustainable land and urban environments. The landscape architecture industry is closely related to the promotion of the health and welfare of the people, urban revitalization and residential environment improvement as well as job creation. Despite various public interest values of landscape architecture, the growth engine of the landscape architecture industry, which is supposed to improve the quality of landscape services, has stagnated. In 2015, the Landscape Architecture Promotion Act was enacted to provide a landscape architectural promotion facility and complex system to support revitalization through the integration of the landscape architecture industry. The purpose of this study is to suggest an improvement plan to enhance the effectiveness of the landscape architectural promotion facility and complex system. The results of the analysis are as follows: First, workers and experts in landscape architecture recognized the need for policies and projects to promote the landscape architecture industry. Second, the industrial types suitable for the landscape architectural promotion facility were landscape design, landscape maintenance and management, and landscape construction industry. Meanwhile the industrial types suitable for a landscape architectural promotion complex were landscape trees and landscape facilities production and distribution. Third, the expected effect of the designation of the landscape architectural facility was 'the increase of the business opportunity through the expansion of the network'. On the other hand, that of the landscape architectural promotion complex was 'the activation of various information sharing'. Fourth, 'the size of the local government landscape architecture industry and the capacity to cultivate' was the most important among the designation criteria of the landscape architectural promotion facility. As for that of the landscape architectural promotion complex, the 'feasibility of promotion plan' was the most crucial. Fifth, 'tax benefit and deductible exemption' was considered as a necessary support method for the activation of the landscape architectural promotion facility, and 'maintenance and management fee support' was recognized in the case of the landscape architectural promotion complex.

• Journal of Hospice and Palliative Care
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• v.5 no.1
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• pp.31-42
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• 2002

Purpose : The purpose of this study was to evaluate the present status of hospice palliative care programs in Korea as a basic database for standardization of hospice palliative care. Method : The data was collected from July to October, 2001. The instrument used for this study was the questionnaires which was consisted of the general characteristics of organization, recipient of service, manpower, contents of service, financial conditions and facilities. Sixty-four hospice palliative care programs answered the questionnaires, confirmed by telephone. Results : They were 40 hospital-based hospice palliative care programs and 24 nonmedical hospice palliative care programs. 11 Hospital-based hospice palliative programs have isolated unit or hospital affiliated free standing hospice. 6 Non-hospital hospice palliative programs have a free standing hospice. Major subjects of hospice palliative program were terminal cancer patients but patients with non-terminal illness were also included. Only 24 of 64 hospice palliative programs had all of the essential professionals : physicians, nurses, social workers, and clergies. Home hospice palliative care programs have a referral system in hospital based (89.7%) and nonmedical programs (73.7%). 24hr hospice are were provided in 26 hospital-based (65.0%) and 9nonmedical programs (37.5%). There were rooms for family in half of hospital-based programs. 73.9% of hospice palliative care programs have financial problems. 62.0% of Hospice palliative care programs need financial support from government. Conclusion : 64 Hospice palliative care programs provided hospice palliative services but had many problems in manpower, quality of care and facility. For improving the quality of terminal patients' life and promoting the cost effectiveness of health care resources, it is necessary to consider the standardization and institutionalization of hospice palliative care.