No abstract available.

Since patients with strokes occupy a high priority among patients for home nursing, the development of guidelines for such nursing is required and the need of these patients should be reflected in the guidelines. Therefore, this study was done to identify the content and levels of home nursing for patients with strokes and to utilize the data in developing the most effective home nursing guidelines for these patients. The level of A.D.L. and the ability to control upper extremities were measured, and through a questionnaire. the needs for home nursing and related variables were also evaluated. The subjects for the study were 121 patients, 58 inpatients and 63 home care patients who had a Stroke. Data collection was done from September 1996 to January 1997. The collected data were analyzed utilizing SPSS/PC, and the results are as follows : 1. Home nursing need of inpatients The priority order of home nursing need for inpatients was : "Training in emergency treatments and how to cope with a stroke"(2.28+1.06), next "Explanation of diets as limited or recommended", and last, "Nursing care for sleeping problems". 2. Home nursing need home of patients The priority order of home nursing needs for home patients was ; "Care for the paralyzed side"(2.89+.34), next, "Maintenance of right posture and how to change position"(2.87+.34), and last, "Counseling on sex". 3. Comparison of the levels of home nursing needs between inpatients and home patients The results of analyses of home nursing needs according to causes were grouped into seven categories ; and t-tests of the seven categories showed significant differences between the two groups in all categories, that is, the level of home nursing needs were significantly higher for home patients than inpatients in all categories of home nursing. 4. Level of home nursing needs by characteristic The variables that have affected the level of home nursing needs for these patients were sex, profession, level of education, accompanying diseases, paralyzed position, A.D.L. levels and ability levels in coordinating upper extremities. There variables, displayed a reverse correlation with the level of home nursing needs, and the degree of correlation was high. In conclusion, the above results, show there were differences in the priority order of home nursing needs between inpatients and home patients : but the content of home nursing needs wanted by these patients was similar. Meanwhile, the levels of demand for home nursing was exceptionally higher on the part of home patients than inpatients, Although it is realized that nursing guidelines for home nursing needs in all items need to be developed, there is also a necessity to guidelines in accordance with priority orders, and with consideration of the factors that affect the level of home nursing needs.

Advanced countries such as the USA and Japan are eagerly seeking ways to improve health and welfare of the elderly. One of the services is home health care service using the telephone. Various types of services using the telephone have been developed, improved and are being utilized ranging from the basic consulting to emergency response systems in the area of health care for the elderly. A demonstration project was launched to study the feasibility of a consulting system and telemedicine for the elderly using the public phone system in Korea. For this project, a gathering site for the elderly was selected and those who visited this place were interviewed to find out what kinds of services they wanted and what kind of system they needed to provide the required services. Based on the users' requests and the surrounding environment, a telephone consulting facility was established at the Research Institute of Nursing Science at Seoul National University and consulting personnel was recruited, trained and posted at the center. An Application program for home health care nurses to use when they visited the patients at their homes was developed. This system operates on a notebook Computer and allows nurses to communicate with a doctor at a local hospital through a modem and telecommunication line. These systems were implemented for three months and problems which developed during operation of the systems were identified and progressively modified. Through system evaluation, it was found that a consulting system using phone service will be an invaluable system for the welfare of the elderly in the future. But in order to meet the elderly's need, more services than mere consultation are needed. That is, communication with physicians and hospitals are needed. Thus, when there is any need for physicians' attention, physicians or hospitals should be contacted directly. Similarly for telemedicine, when the home health care nurse visits elderly patients she can assess the patient's problem and provide nursing care, access a physician or hospital to refer her patient to or consult directly using the telecommunication the system. The above mentioned system is a basic form of futuristic telemedicine for the elderly and those who have chronic disease problems. This kind of system will be of great value when it is used on the national information super-high ways in the future. In order to get to that stage, of course, this project needs great improvement in the technical, academic, and legal aspects.

PURPOSE: The purpose of study is to develop a home nursing care project model suitable for Korea's heath care system and policy directions for expansion and establishment of home nursing care. METHOD: The first, status of home nursing care program in medical institution and public health center was evaluated respectively in view of structure, process and performance. And then, issues of the program were analyzed in view of accessibility, safety, and sufficient supply. The second, demand projection of home nursing care according to income level and technical level of service that is needed to the subject was tried. In addition, the level of supply for home nursing care at present was estimated. The third, home nursing care program in advanced countries (Japan and U.S.A.) was examined. RESULT AND CONCLUSION: Community-based home nursing care program is developed into public-operation model and private-operation model from above the sub-subject result. Functional network for referral system among related institutions is built up to meet various needs, regardless of accessibility to distance and economy. And prior settlements and policy directions for expansion and establishment of home nursing care are suggested.

PURPOSE: The number of residents in elderly institution has been increasing due to the change of the family support system. This study was focused on understanding the process of adjustment of the institutionalized elderly using the Grounded Theory approach. METHOD: There were seven participants, 4 men and 3 women living in 3 different elderly facilities. The data was collected through in-depth interviews and participant observation from June 20, 1999 to January 10, 2000 and analyzed by the Strauss and Corbin's analysis method. RESULT: 125 concepts were found and grouped into 30 sub-categories and then grouped into 13 categories. These categories are <humiliation>, <fear>, <reluctance>, <difficulty of economic status>, <health problem>, <process of entrance>, <loss of family support>, <facility support>, <personality disposition>, <positive self mind-control>, <negative self mind-control>, <adjustment> and <maladjustment>, which were synthesized into the process of adjustment. <The Control of Reluctance (to live in facility)> being the core category. The adjustment process of the facility elderly consisted of: 1. expressive phase of 'reluctance' 2. control phase of 'reluctance' 3. latent phase of 'reluctance' CONCLUSION: This study offers better understandings on the adjustment process of the institutionalized elderly and provides more appropriate nursing care to the New Comers of these facilities.

The purpose of this study is to provide the directions for the further development of the home care services in Korea, through comparison of the home care system and visiting nursing activities for the elderly in Japan and with those of Korea. The results of this study were summarised as follows: The major difference between the two countries was that Japan emphasised the development of home services by visiting nurse service stations (VNSS), especially in the community. In contrast, Korea has emphasised providing hospital based home care services and assuring the quality of services through the preparation of home care nurses before beginning services. And many elderly in Korea have used a public health center when they have health problems. According to the result, the establishment of a VNSS system and activation of a public health center in the community must be considered as the direction to advance home care systems for the elderly.

PURPOSE: To evaluate the effects of planned visiting nursing services for homebound disabled persons in the community who have had a cerebrovascular accident
METHODS
One group pre-test and post-test research deign was applied to 61 disabled persons who were undergoing rehabilitation with visiting nursing services to evaluate the effects on the health status (SF-36) and activity daily living (ADL/IADL) from March to August, 2001.
RESULTS
The health status score by SF-36 of homebound disabled people was significantly improved; the average score was 28.56+/-21.24 before service, 34.29+/-22.30 at 3 months after, and 40.84+/-=27.41 at 6 months after. The activity daily living score by OASIS II was also significantly increased (z= -6.09, p=.000; z= -6.04, p= .000) at 3 months and 6 months after home visiting nursing services.
CONCLUSION
The strategy plan for developing a visiting nursing service in health centers should be prepared to develop community based rehabilitation (CBR) programs as well as to improve the level of health status and ADL/IADL for homebound disabled people in the community.

PURPOSE: The purpose of the study was to compare home care nursing intervention activities analyzed by the Nursing Intervention Classification (NIC) system for hospice and general patients.
METHOD
For the descriptive survey study, data was collected by reviewing charts of 151 hospice patients and 421 general patients who registered in the department of home health care nursing at K Hospital.
RESULTS
According to the NIC system application, there were 2380 total nursing interventions used for the hospice patients and 8725 for the general home care patients. For both sets of patients (hospice vs. general), the most frequently used nursing intervention in level 1 was the Physiological: Complex domain (40.13 vs. 31.06 percent), followed by the Safety domain; in level 2, the Risk Management class (28.4 vs. 27.70 percent), followed by Tissue Perfusion Management; and in level 3, Vital Sign Monitoring (6.18 vs. 4.84 percent), followed by Health Screening.
CONCLUSION
The study showed that there was a lack of specialized hospice nursing interventions such as emotional, family and spiritual support, and care for dying hospice patients.

PURPOSE: The purpose of this study was to analyze the differences in terms of services and cost between CVA without typical diseases (Group I), and CVA with typical diseases (Group II), in their Hospital-based home health care. METHOD: The subjects of this study were 308 CVA patients who used home care nursing during the second phase demonstration project of their hospital-based home health care. Results: The results of the study was as follows 1. Group II had more home visit (15.3/12.7) (p>0.05), and cases of death when home care (16.8/11.4) (p<0.05). 2. Group II needed more services than Group I such as bladder irrigation, skin care, bed sore care, glycerin enema, finger enema, lung care, urine sugar test, monitoring and surveillance of fluid infusion and R.O.M exercise (p<0.05). 3. The variables that showed statistical significance in the regression analysis were family style, OPD visit, level of consciousness, patient's state on termination of home care, and some extend of home health care services (R2=0.373, 0.205). CONCLUSION: Home nursing care needs to be planned by severity in Hospital-based home health care for CVA patients.

PURPOSE: This study was conducted to evaluate the effectiveness of the maternal role education program for primiparas in mother-infant interaction, childrearing environ- ment, and infant development. METHOD: A Non-equivalent control group time-series design was used. For the intervention group, programmed parenting education focusing on mother-infant interaction, home environment for infant development, and parent counseling and support was provided via home visits or telephone for twelve months.
RESULT
Significant differences were found in the mother-infant interaction feeding scale at one and three months, but no differences were found in the teaching scale at six and twelve months between the intervention and control groups. Also, the difference in childrearing environment (HOME) between the two groups was significant at three, six, twelve months. In addition, the intervention group showed higher GQ in the Griffiths mental development scale at three and six months. In multiple regression analysis, 22.6% to 43.6% of infant development was explained by HOME, mother-infant interaction, and previous development. CONCLUSION: The maternal role education program proved to be effective in promoting mother-infant interaction, organizing the childrearing environment, and fostering infant development.

The propose of this study is to give a theoretical basis for better home health service by looking at the subjective structure the collaboration between the home health nurse and doctor and at how collaboration can be improved. There are at least three types of recognition that can help the collaboration. The first type is to put more weight on the relationship between doctors and home health care nurses. This means that doctors and home health care nurses should make an effort to improve, their collaboration. The second type is to put more weight on the reward for doctors' participation. Reward will help collaboration. The third type is to put more weight on organization support. Organization support will bring about trust between doctors and home health care nurses The following conclusion were reached: 1) Trust should exist between doctors and home health care nurses. 2)Doctors should maintain an equal relationship with home health care nurses and accept them as professionals. 3) Appropriate reward should be given to doctors for their participation. 4)Home health care nurses should reinforce their skills through education, training, and professionalization. 5) Home health care nurses should cooperate with doctors by building a system that centers on patients. 6) Collaboration between doctors and home health care nurses is important because it is useful to recognize patients and their families in a broader light. 7) Doctors and home health care nurses need to be more concerned about patients. 8)More active support of hospital administrators and systems is needed to enhance collaboration between doctors and home health care nurses. 9) The present legal system for collaboration between doctors and home health care nurses can be a factor. The nine nursing strategies above will help doctors and home health care nurses build more positive relations and get closer to their patient, more effective home healthcare will get closer to people who want quality medical service.

Due to great concern about quality of care in nursing home, legislative in the US mandated development of LTC MDS. MDS, a standardized assessment database for nursing home residents, provides comprehensive, holistic assessment data for nurses and make it possible to identify nursing needs of residents. The purpose of this study is to assess the health status of nursing home residents in Missouri, America, and to stimulate international comparative research assessing the health status of the elderly. This study presented the age-specific prevalence of diseases, sex differences, and the relative prevalence of chronic diseases among nursing home residents using the Minimum Data Set in Missouri. In addition, the possibility of racial and regional differences in chronic diseases and its relationship to demographic factors were analyzed. The prevalence of diseases was, in general, higher in female elderly then males and increased with age in both sexes. The average number of diseases in the elderly, among 31 chronic diseases, was 3.43 in women and 3.25 in men. The most prevalent 5 diseases were hypertension (29.1%), congestive heart failure (26.1%), dementia (23.6%), arthritis (20.6%), and diabetes mellitus (17.7%). Sixty-eight percent of nursing home residents had at least one of the heart/circulation related diseases and 58. 4% had neurology related diseases. In conclusion, the usefulness and implication of LTC MDS to nursing can't be overemphasized. Korean nurses should prepare themselves for using it for nursing research and to answer nursing questions.

Home health care is moving into a set of new realities. An era of competition and cost containment has arrived. Before nurses are able to contain costs or describe the relationship between nursing activities, cost must be accurately measured based on the nurse's workload. Nurses in home health care usually desire to measure expenses for one of three reasons : reimbursement, management, or research. The purpose of the study was to investigate the work input by Registered Nurse in each of the home health care activities by relative value units and identify the factors affecting the nurses' total work input in health care services. To measure the work input by nurses, work was defined by four dimensions: time, physical effort, mental effort, and stress. This study used a descriptive-correlational design. Data collection consisted of two phases. In phase I, data on home health activities performed by nurses were collected. In phase II, data on nurses' time, physical effort, mental effort, and stress in each of home health care activities discovered phase I were collected. In this method, the respondent was asked to rate a service in relation to a reference service using a ratio scale. The sample included 39 home health care nurses. The results of the study indicated that home health care activities performed by the nurses were in 10 categories and 69 items. Measuring the relative work inputs in each of home health care activities, and foley catheterization was selected as the reference to service. In terms of time and physical effort dimensions, full bath service was rated as the most strenuous among 69 activities by the respondents, and intramuscular injection was rated as least. It was found that emergency treatment required the highest mental effort and the highest stress, while blood sugar tests required the lowest mental effort. Approximately 91.3% of the variance in total work input was accounted for by the linear combination of time, physical effort, mental effort judgement, and stress. Examining the regression coefficients of those variables, physical effort, time, and stress were found as the predictors which were significantly associated with the total work of nurses in home health care. Professional nursing's next step in the conundrum of economic volatility is to develop a tool to reflect the interaction of functional deficiency and direct professional nursing care. And this will be a more accurate predictor of nursing resource use and ultimately a great forcaeter cost.

This study, based on current home nursing services, aims at promoting measures for establishing a community-based home nursing system derived from the pilot home nursing demonstration project conducted by the Seoul Nurses Association. The study was based on an analysis of home nursing records from march 1993 to December 1999. The following is a summary analysis, based on individual characteristics of the patients, the organization, which recommended the service for their patients and personnel services. 1. The service has been used by many elderly people 60years of age or older(66.4%). and married people(60.9%). The average number of visits by service personnel for patients of city government was 23.5. This is 2.5 times as many visits by general patients. General patients(20.2%) had only one visit from service personnel, while 65.5% of patients of city government had 10 or more visits. Particularly, for government recommended patients, 72.7% of the patients were recommended by nurses, while only 21.9% where referred to the services by doctors. The main focus of a home nursing service was to maintain present health status (53.4%), and hospice(11.6%). Also to increase hospital-based home nursing services focused on recovery(55.9%) and maintain present health conditions (19.0%). 2. For general patients, 42.0% of patients were suffering from problems related to CVA, 11.3% from high blood pressure, and for patients referred from city, 21.2% from skeletal muscular disease. Results of home nursing services 29.4% of patients were able to recover or maintain their health status, but 48.9% of the patients died. Another main point of community-based home nursing services is medication(6.7%), other basic nursing services(6.1%), special treatment, instructions on how to use medical devices(5.9%), change of physical posture(4.6%), and training on changing physical positions(4.7%). As mentioned above there were some differences between the characteristics of patients who used the pilot home nursing service conducted by the Seoul Nurses Association and those hospital-based service users. The results are believed to be useful to support a community-based home nursing service model. Particularly, patients under medical supervision and patients recommended by government-run health clinics show a higher frequency and longer use of home nursing services compared to general patients or hospital-based home nursing service users. According to the study, nurses accounted for a large number of recommendations for home nursing services. Many patients with CVA, high blood pressure, skeletal muscular disease and bedsores used community-based home nursing services, while others used the service for minor treatments or maintaining their current health status. Based on the study, the researchers make several suggestions to establish a community- based home nursing service system. First, different ways of setting up a community-based home nursing system have to be mapped out based on the evaluation of the pilot home nursing service conducted by the Seoul Nurses Association. Secondly, a new, community-based, home health care nursing service model, and reimbursement payment system have to be developed. This is based on the outcome of the analysis, and implemented policy. Accordingly, efforts are needed to develop a community- based home nursing system with an intermediary role to promote the visiting nursing services of government-run health centers.

The purpose of this study was to develop the framework of community-based home care nursing delivery system, and to demonstrate and evaluate the efficiency of it. The study was carned out over a period of 3years from September 1996 to August 1999. The researchers developed Standards for operations, this was all aimed toward a home care recording system, and an assessment intervention algorithm for various diseases quality control and standardization. In the center, 185 patients enrolled, and of the enrollments cerebrovascular disorder and cancer were the most prevailment diseases. Also, a home care nursing activity classification was developed in six domains. Those domains were assessment, medication, treatment, education and consultation, emotional care, and referral or follow-up care. Ten sub-domains were divided according to the systematic needs. Among these nursing activities, treatment, assessment, and education and consultation were frequently performed. In sub-domain classification, skin integrity, respiration, circulation, and immobility related care were provided most frequently. The cost of home care nursing per visit was also suggested. The cost include direct and indirect nursing care, management, and transportation cost. Also, the researchers tried to overcome the limitations of hospital-based home care to provide more accessible, efficient, safe, and stable home care nursing. Therefore, clients were referred from other patients, families, public health care centers, industries, and even hospitals. As a result of this study, several limitations of operation were found. First, it was difficult to manage and communicate with doctor in the emergency situations. Second, there was too much time spent for transportation. This was because they are only five nurses, who cover all of the areas of Seoul and nearby cities. Third, preparation for special care of home care nurses was lacking. Fourth, criteria for the termination of care and the frequency of home visits were ambiguous. Finally, interconnection with home care machinery company was so yely needed. New paragraphs' strategies for solving these problems were suggested. This study will be the basis of community-based home care nursing, and the computerized information delivery system for home care nursing in Korea.

The purpose of this study was to determine the effect of walk training on leg strength, flexibility, postural stability, balance and gait in home bound elderly women. Eighteen elderly women of the experimental group aged between 70 and 90 years image who have normal vision, hearing and Romberg test. They participated in the 12 week walk training. The subjects of the experimental group practiced walk training 3 times a week for during 12 weeks. During the 40 minute workout, the subjects practiced 5 minutes of warming-up exercises, 30 minutes of conditioning exercises and 10 minutes of a cool-down exercise. The intensity for the conditioning phase was determined by subject' heart rates, which ranged from 60% to 70% of age-adjusted maximum heart rates. The body composition, leg strength, flexibility, postural stability, balance and gait were measured prior to and after the experimental treatment. The body fat, lean body mass, leg strength (ankle dorsiflexor, plantarflexor, inversor and eversir, knee flexor, extensior), flexibility (range of motion of ankle dorsiflexion, plantarflexion, inversion and eversion), and postural stability of the experimental group were significantly greater than those of the control group. Duration of standing on the right foot and that of standing on the left foot of the experimental group was greater than that of the control group. Total balance scores of the experimental group were significantly higher than those of the control group. Among 13 items for balance, the scores of experimental group in balance with eyes closes, turning balance, sternal nudge, neck turning, one leg standing balance and back extension were higher than those of the control group. Total scores of gait of the experimental group were significantly higher than those of the control group following the walking training. Scores of experimental group in step height, step length and walk stance while walking among 9 items for gait were significantly higher than those of the control group. The results suggest that walk training can improve physical fitness for prevention in home bound elderly women.

This study was carried out to assess home health care needs for welfare of solitude elderly person. The subjects of this study were 90 welfare solitude elderly person in Pusan City. Data were obtained by interview and observation using a structured questionnaire. The collected data were analyzed by t-test, ANOVA with SAS program. The results are as follows. 1. Among the home care nursing needs, environmental nursing needs topped the list, followed by spiritual, physical, psychological, communication & health knowledge and ADL nursing needs. 2. Home care nursing needs showed a significant differences by the general characteristic of the respondents. -In the age, there were significant differences in physical and communication & health knowledge nursing needs. -In the religion, there were significant differences in spiritual nursing needs. -In the marital status, there were significant differences in environmental nursing needs. -In the nursing provider, there were singificant differences in ADL, environmental and communication & health knowledge nursing needs. -In the medical benefit, there were significant differences in ADL, environmental, physical and communication & health knowledge nursing needs. -In the disease, there were significant differences in ADL nursing needs. -In the household maintenance, there were significant differences in environmental nursing needs.