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.

Cerebrovascular diseases in Korea is an important health problem since mortality and morbidity have been increased rapidly. It marked the 2nd cause of specific death rates in 1993. The stroke causes physical function disorder due to hemiparalysis and emotional disorder, and stroke patients experience helplessness, powerlessness, sense of alienation and loss of hope. These feelings make the rehabilitation difficult because they lose the will of life. The subjects of the study were seven citizens who live in Pusan, are over 50 year old and belong to low income-level. The data were collected from Jan. to Sep. 1195. The researcher as a caregiver and volunteer made confidence of them and asked for their agreement on the purpose of the study. The subjects expressed their experience as openheartedly as possible. The analysis of the data was made through the phenomenological analytic method suggested by Giorgi, which is as follows ; as an unit of description which include the subject' expressions and the researcher's observation, it is examined the theme that express the hope experience with the subject's language(underlining), and the focal meanings are identified. The focal meaning is the crystalization of the theme, which is written in the language of the researcher. After integrating the focal meaning ant make the situated structural description as the meaning of the hope experience identified on each subject's point. After integrating the situated structural description and make the general structural description as the meaning of the hope experience identified on total subject's point the systemizing of the structure of the hope experienced phenomena and the flowing of the consciousness was researched. The conclusions of this study was as follows : The ten sources of hope which the subjects experienced were sorted as under : <mutual relations to others : spouse, children, relatives, fellow believer, health professioner, associate patient group>, <spiritual dependence>, <recovery of physical function>, <rumination of the past life>, <expectation of hte future>, <economic power>, <beledf>, <ability>, <spontaneous participation>, and <recovery of roles>. Their hope was spoken out by the following two kinds of linguistics. First, the hope was expressed in the affirmative expression as follows : <to be dependable>, <to make efforts>, <to keep under control>, <to desire>, <to be pleasant>, <to be peaceful>, <to be grateful>, <to ve help>, self-confidence, Courage>, <to be happy>, <to satisfy oneself>, <to share with others>, <to understand>, and <to be affected, be impressed> Second, the hope was expressed in the negative expression as under : <to be destressed>, <to be uneasy>, <to be sorry, be unsatisfied> <despair>, <to abandon>, <to be fearful>, <to be suffer>, < to bear a burden> <to be confused>, <to be solitary>, <chest trouble>, <to feel heavy> <grief>, <to be daunted>, <to get angry>, <to be uncomfortable>, <to have something regretable> and <to feel guilty>. And their hope was expressed by the following four behavioral expressions : <physical sphere>, <psychological sphere>, <social support sphere> and <spiritual sphere>. The reaction patterns of their experience appeared in the following 4 coping method : <conquest type>, <dependence type>, <adaptation type> and <fate type>. Finally, in the hope structure the sense of certainty don't always coexict with the sense of uncertainty. When the stroke patients try to search for the best quality of life, the senses of certainty and uncertainty make a continual cyclic system in the hope structure.

This study was designed and undertaken to identify the degree of burden and depression in family caregivers of patients with stroke and to determine whether burden was directly related to depression. The data were collected from October 23th to November 20th, 1995. The subjects in this study were 80 caregivers, that is, one family member and 80 patients with stroke who were hospitalized in one oriental medicine hospital located in Taejon City. The questionnaires consisted of questions regarding burden(13 item, 6 point scale) and depression(20 item, 4 point scale). Data were analyzed using percentages, means, t-test, ANOVA and Peason-correlation coefficients, done with the SAS program. The results of this study are as follows; 1. The score for family caregiver's burden was higher than the mid level for the 13 items. 2. The score for of family caregiver's depression was relatively low. 3. The relationship between burden and depression showed a significant inverse correlation. 4. In the relationships between total burden and general characteristics of the family caregivers; there were no significant differences. But, in the relationship between objective burden and general characteristics of the family caregivers; age and education had statistically significant differences. That is, the 40's group felt more objective burden than any other age group and the high education group more than the illiterate group. 5. In the relationship between depression and general characteristics of the family caregivers; sex, education and monthly income had statistically significant differences. That is, female caregivers felt more depression than males, and the lower the level of education and the lower the monthly income, the higher the degree of depression. 6. In the relationships between burden and general charateristics of the stroke patients, only subjective burden according to the patients' sex was significantly different. That is, caregivers felt more subjective burden when caring for male patients than for female patients. 7. In the relationships between depression and general charateristics of the stroke patients, only the patients' economic status showed a statistically significant difference. That is, caregivers felt more depression in case of patients' low economic status.

Although sensory deficits caused by stroke have been occasionally reported, dysfunctions of discriminative sensation have seldom been studied in patients with strokes. With the use of specifically designed methods, discriminative sensations including texture discrimination and position sense were tested in 67 patients with acute unilateral stroke. Thirty-two age and sex-matched healthy subjects were used as controls. Impaired discriminative sensation was common in patients with unilateral stroke (detected in 57 out of the 67 patients) regardless of the lesion location except for patients with lateral medullary stroke. Proprioceptive discriminative sensation remained intact in all except for three out of 25 patients who were initially diagnosed as having pure motor stroke on the bases of conventional sensory tests. However, tactile discriminative sensation remained intact in only 17 out of 25 patients. Discriminative sensory disturbances are common in patients with unilateral stroke even in those with intact sensory function on routine examination. The subtle disturbances of this sensation may explain, at least in part, the clumsiness of the patients that is not readily explained by conventional neurological tests.

PURPOSE: The purpose of this study was to develop on east-west nursing intervention program. This study was conducted to identify the effectiveness of using facial meridian points for massage nursing intervention on the recovery of facial paralysis for 46 patients (22 for experimental group). All had suffered from strokes, and were also admitted to the division of oriental medicine in K University Hospital.
METHOD
Data was collected from February 1st to December 31st of 2000. This study used a quasi experimental, non-equivalent control group pre-test and post-test design. The recovery of facial paralysis was measured by the difference between left and right facial length, observation and self report on a seven point scale, and facial discomfort by a facial scale after 6-7 facial massages in a two week period. Data was analyzed using the SPSS package program with x2 and t test.
RESULT
The result of this study are as follows; The experimental group who received the facial meridian massage showed higher scores in recovery of facial paralysis (t=2.72, p=.009), and a smaller difference between left and right facial strength than those in control group (t=2.26, p= .29). The discomfort of the facial area in the experimental and control group showed no significant differences.
CONCLUSION
These findings indicate that a facial meridian points massage could be an effective nursing intervention to the recovery of facial paralysis. This study contributes in developing an east-west nursing intervention with the oriental meridian theory and western massage therapy.

PURPOSE: This study is used to investigate the correlation among a stroke patient family's health, burden and quality of life.
METHOD
Data was collected from one hundred twenty family care-givers registered at K and H Hospital in Seoul. Questionnaire data was drawn up by personal interviews aided by the staff nurses. The analyses of collected data are based on the rate of 100 percentage to the average, t-test, ANOVA, DMR, Pearson Correlation.
RESULT
(1) The influential factors on physical health proved to be age, sex, academic career, matrimonial status, present occupation, economic situation, the relationship with the patient, the patient-caring term, and the family-formation. The psychological health issues were age, final academic career, matrimonial status, the relation with patient and the family-formation. Burdens were shown to be age, matrimonial status, the relation with patient, and the patient-caring term. The quality of life was determined by age, final academic career, matrimonial status, and the relationship with the patient, the patient-caring term, and the family-formation. (2) The rate of the physical condition was 2.87, the psychological condition 2.43, the sense of burden 3.08, and the quality of life was 2.42. (3) The rate of correlation between the burden and the quality of life was (r=−.547), the psychological health and the burden was (r=−.531), the physical health and the burden was (r=−.263), physical health and quality of life was (r=.301), psychological health, and quality of life was (r=.413).
CONCLUSION
It follows from this study that there is a very close correlation among the stroke patient family's health, the burden, and quality of life. Therefore it is necessary that we should find various nursing intervention ways in order to mitigate the burden of family when caring for the stroke patients.

This was a descriptive study clarifying the factors affecting family caregivers' sense of well-being. This study was conducted with 131 caregivers using structured self-reporting questionnaires and directly interviewing adult patients who had been under treatment in two general hospitals. The hospitals were located in M city from Aug. 10, 2000 until Sep. 2, 2000. The collected data were analyzed using SAS PC+ program, and the data were tested using descriptive statistics, t-tests, ANOVA, Pearson's Correlation Coefficient, and Stepwise Multiple Regression. The results of this study are as follows; 1) The variables affecting the caregivers' sense of burden were age (F=3.76, p=.0063), education level (F=4.67, p=.0015), monthly income (F=2.49, p=.0466), amount of assistance provided (F=4.19, p=.0037), and the relationship with patient before disease (F=9.49, p=.0001). 2) The variables affecting caregivers' sense of well-being were age (F=9.54, p=.0001), residing with patient (t=11.38, p=.0010), the period of caregiving (F=10.52, p= .0001), education level (F= 2.79, p=.0290), monthly income (F=3.04, p=.0196), and relationship with patient before disease (F= 10.51, p=.0001). Also, all of the variables which showed statistical significance. 3) In viewing the relationship between activities of daily living (ADL) and the senses of burden and well-being, a negative relation- ship between activities of daily living (ADL) and a sense of burden was found (r=-.640, p=.000). However, the relationship between activities of daily living (ADL) and a sense of well-being had a positive correlation (r= .232, p=.008). Also the relationship between the sense of burden and the sense of well-being was revealed to have a negative correlation (r=-.614, p=.000). 4) A sense of burden was the most important indicator to the well-being of the caregivers who took care of stroke patients (R2 =.36). In addition to this, living with the patient (45%), activities of daily living (51%), relationship with patient before disease (53%), and the family's monthly income accounted for 56% of the sense of well-being of the caregivers.

In this paper, we examined the depression of stroke patient's caregivers and analyzed influencing factors of the depression. The subjects were 215 caregivers who have takencare of stroke survivors in their home. The conceptual model of this study consisted of the caregiver's depression, perceived burden, illness intrusiveness, and patient's ADL. Modified Korean CES-D, modified subjective and objective Burden Scale, Illness intrusiveness(II), and Instrumental Activity of Daily Living(IADL) were used to measure concepts. Path analysis was used to test the model of this study. The results were as follows: 1. The mean depression score was 11.6 which was below the cut-off score of the CES-D. This score indicates that the subjects were higher than normal adults' mean score but not depressive. Eighty-six out of 215 caregivers(40%) were above the cut-off score. This finding was different from previous research results, and the reason might be the patients' capability of ADL. In a group of low capability patient's activities of daily living, caregiver's depression score was 15.5. 2. Caregiver's depression was positively related to caregiver's burden and illness intrusiveness, but negatively related to patient's activities of daily living. 3. The caregiver's perceived burden and illness intrusiveness directly influenced on their depression. Furthermore, the and caregiver's illness intrusiveness led to depression indirectly through their burden. A patient's activities of daily living didn't influence directly on depression but indirectly through caregiver's illness intrusiveness and burden.

The purpose of this study was to describe the perceived burden of the stroke patient's caregiver and related factors to analyze relationships between perceived burden and social supports. A convenient sample of 225 caregivers who take care for a stroke patient at home participated in this study. Caregiver's perceived burden was measured by the objective and subjective burden scale developed by Montgomery (1985). Related factors of burden were studied in terms of the patient's instrumental activties of daily living, cognitive function, caregiver's demographic variables and caregiver's illness intrusiveness. The results were as follows: (1) The mean of objective burden score was 4.5, and subjective burden score was 3.1. These scores show that caregivers perceive moderate level of burden. (2) Caregivers' objective burden was significantly related to caregivers's illness intrusiveness (r=.62), patient's IADL (r=-.33), and patient's cognitive function (r=-.15). The subjective burden was related to the caregiver's illness intrusiveness (r=.29), the patient's IADL (r=.24), and the caregiver's age(r=.23). (3) The percentage of stroke caregivers who perceived physical support was 49.1%. The percentage of those who perceived emotional support was 61.0%, and those who perceived financial support totaled 37.6%. (4) Caregivers who received any type of social supports perceived lower subjective burden, and caregivers who received physical or psychological support perceived lower objective burden. These results emphasized the necessity of a rehabilitation programs for stroke patients and support program for family caregivers.

The purpose of this study was to identify emotional responses, of stroke patients using Q analysis. From the data analysis, five types of emotional responses in stroke patients were classified as follows. 1. Acceptance and Overcoming : They attached to life strongly and had self-confidence of recovery. They were striving against their situation through using anything else good for their recovery. 2. Anger Type : They recognized a labile feeling and were angered easily. They had a self-confident and self-esteemed personality before they had a stroke. 3. Conflict Type : They wanted interaction with others. This individual recognized that no one knows their agonies. They were thankful to god or their family, while they could not control their minds. Their family supports were low. 4. Deficiency of self-esteem Type : They had a self-confidence of recovery, but they were in fear of interaction with others. Especially, they were ashamed of themselves. They have a high sense of responsibility and nigh self-esteem for themselves before they had a stroke. 5. Despair Type. : They were sorry to trouble their family. They felt depression, anxiety, darkness, uselessness of themselves, and they wanted to die. They recognized financial burden. for their family. The characteristics of the five types of stroke patient identified in this study will be used to assess emotional nursing needs for stroke patients. The findings of this study will provide practical guidelines for developing nursing interventions for stroke patients based on the characteristics of subjectivity types.

Stroke is a major cause of death and long-term disability. Because muscle weakness is one of the most prominent consequences of stroke, it was considered important to determine whether exercise if order to improve muscle strength and range of motion could have an effect in limiting the learned disuse of the affected side. The purpose of the study was to identify the effects of an 8 week rehabilitation program on physical and cognitive ability in stroke patients. A total of 18 patients who were admitted to the oriental medicine unit of a K medical center in Seoul were recruited : Ten for the experimental group and eight for the control group. The rehabilitation program consisted of three level's of active and passive exercises for prevention of muscle contracture and at range of motion. Muscle strength, flexibility of the upper and lower extremity, perceived balance, functional independence, depression, and quality of life for the two groups were compared at the pretest and 4 and 8 weeks after the rehabilitation program. The results are as follows: 1) When measuring muscle strengths of shoulder abduction and elbow flexion, hip flexion and knee extensor, ankle dorsi-flexor and muscle strength of knee flexor. Muscle strength of knee flexor for the experimental group was significantly higher than the comparison group at the 4 weeks. 2) Muscle strength and flexibility of the ankle dorsi-flexor for the experimental group was significantly better than for the control group at 8 weeks. 3) Functional independence, perceived balance, and Tinetti balance for the experimental group as measured at 4 and 8 weeks were better than for the control group. Also, there were changes over time in physical balance and functional ability, but there was no significant differences between the groups. 4) The experimental group showed a higher quality of life and lower depression than the control group at 8 weeks. 5) Muscle strength and flexibility of ankle dorsi-flexor were significantly changer over time and an interaction between group and time. The findings suggested that the rehabilitation program would improve the physical and psychological status of the stroke patients. Thus, the gains in actual or perceived ability to perform physical activities was marked.

An explanatory design was employed to identify the relationship of physical, emotional & social readjustment and social support of post hospitalized stroke patients and their caregiver. A convenient sample of 254 patients who given follow-up care at the outpatient department after discharge and 225 caregivers were recruited. Mental Status Questionnaire(MSQ), Social Support Inventory Stroke Survivors(SSISS), Illness intrusiveness(II), Instument Activity of Daily Living(IADL), Center of Epidnmilogic Studies-Depression(CES-D), social activity and caregiver burden were used for measurement in this study. Results showed patient's physical level measured by IADL and psychological level measured by depression were high. But social activity was low. Cognitive function, depression & social activity were not significantly different by the posthospitalized period, but IADL was. The source of professional support was mostly the physician at the outpatient department. The family support was found significantly related to patient's depression & social activity and caregiver's subjective related to patient's IADL & depression. ILLness intrusiveness as a mediating variable was a significantly predicting power on patient's IADL & depression. The path analysis was used to identify the variables to predict the physical, emotional, and social status of patients, the physical, emotional, and cognitive function, illness intursiveness and professional support significantly predicted the level of siveness and family support significantly predicted the level of depression ; and patient's age and family support significantly predicted the level of social activity of posthospitalized stroke patients. Based upon these results, the rehabilitation programs to reduce the illness intrusiveness and improve cognitive function were recommended for the readjustment of the stroke patients. This model of the readjustment of the posthospitalized stroke patients is recommended as the framework for care of the stroke patients.

The purpose of this study was to examine the effect of slow stroke back massage(SSBM) on anxiety and immune response in patients undergoing open heart surgery and to compare the effect of 5-minutes with 10-minutes SSBM. Among the sixty-four patient subjects, twenty-one were one experimental group receiving massage for 10-minutes, twenty for the other experimental group receiving massage for 5-minutes and twenty-three for the control group. Subjects were admitted at Hospitals in Inchon and Puchon for open heart surgery. This study was carried out from October 10, 1997 to May 10, 1998. The levels of anxiety were measured by the Visual Analogue Scale(VAS), Trait anxiety scale, systolic and diastolic blood pressure, pulse rate, blood cortisol and the levels of immune response were measured by the blood T-lymphocyte and Natural killer cell. Study measurements were taken before and after SSBM on the 1st pst operative day. Data were analyzed using x2test, oneway ANOVA, paired t-test, t-test and Pearson product moment correlation. The results were summarized as follows: 1. After SSBM, VAS anxiety level, systolic and diastolic blood pressure and pulse rate of the experimental group were decreased significantly than those measurements before the SSBM. After SSBM, significant difference in the VAS anxiety level, systolic blood pressure and pulse rate between the experimental and control groups were found. 2. After SSBM, the blood cortisol of the experimental and control groups were increased significantly compared with before SSBM. But the significant difference in blood cortisol between the two groups was not found. 3. After SSBM, the blood T-lymphocyte percentages of the experimental and control groups were decease significantly and blood Natural killer cell percentages of the two groups were increased compared with before SSBM. But significant difference in blood T-lymphocyte and Natural killer cell percentages between the two groups was not found. 4. Significant difference in VAS anxiety level, systolic and diastolic blood pressure, pulse rate, blood cortisol, blood T-lymphocyte and Natural killer cell percentages between SSBM for 5 minutes and SSBM for 10 minutes were not found. Based upon the results, this study concludes that the slow stroke back massage for 5 minutes is a useful intervention that decreases anxiety and produces relaxation in patients undergoing open heart surgery.

PURPOSE: The purpose of this study was to develop and evaluate the effects of a support group intervention on the burden of primary family caregivers of stroke patients. METHOD: A nonequivalent control group pretest-posttest design was used. The subjects were 36 primary family caregivers of stroke patients [experimental(N=18) and control(N=18) groups] in a neurosurgery ward of a university hospital. The experimental group members participated in six sessions of a support group intervention for two weeks and the degree of their caregiving burden was evaluated. Data was analyzed by Chi-square tests, t-tests, and paired t-tests using SPSS 10.0. RESULT: The experimental group had a significantly lower total burden score (t=2.061, p= .047)and sub-scales of emotional(t=-3.319, p= .002), time-dependent(t=-2.045, p= .049) and developmental(t=-2.656, p= .012) burden scores than the control group, while no significant differences were found in physical, social or financial burden scores between the two groups. Within the experimental group, there was a significant decrease in physical(t=2.507, p= .023), emotional(t=4.754, p= .000), social(t=2.932, p= .009), time- dependent(t=5.015, p= .000) and developmental(t=7.541, p= .000) burden scores but not the financial burden score. CONCLUSION: The results suggest that a support group intervention can be utilized as an effective nursing program to reduce the burden of primary family caregivers of stroke patients.