This study concerns itself with the development of a new model of comprehensive health service for rural communities of Korea. The study was conceived to resolve the problems of both underservice in rural communities and underutilization of valuable health manpower, namely the nurses, the disenchanted elite health personnel in Korea. On review of the current situation, the greatest deficiencies in the Korean health care system were found in the availability of primary care at the peripheries of rural communities, in the dissemination of knowledge of disease prevention and health care, and in the induction of and guidance for active participation by the clientele in health maintenance at the personal, family and community level Abundant untapped health resources were identified that could be brough to bear upon the national effort to extend health services to every member of the Korean population. Therefore, it was postulated that the problem of underservice in rural communities of Korea can be structureturally resolved by the effective mobilization and organization of untapped health resources, and that a primary care Nursing Service System offers the best possibility for fulfillment of rural health service goals within the current health manpower situation. In order to identify appropriate strategies to combat the present difficulties in Korean rural health services and to utilize nurses and other health personnel in community-centered Health programs, a search was made for examples of innovative service models throughout the world. An extensive literature survey and field visits to project sites both in Korea and in the United States were made. Experts in the field of world health, health service planners, administrators, and medical and nursing practitioners in Korea, in the United States as well as visitors from other Asian countries were widely consulted. On the basis of information and inputs from these experts a new rural health service model has been constructed within the conceptual framework of community development, especially of the innovation diffusian Model. It is considered especially important that citizens in each community develop capacities for self-care with assistance and supports from available health professionals and participate in health service-related decisions that affect their own well-being. The proposed model is based upon the regionailzation of health care planning utilizing a comprehensive Nursing Service System at the immediate delivery level The model features: (1) a health administration unit at each administrative level; (2) mechanisms for community participation; (3) a continuous source of primary health care at the local community level; (4) relative centralization of specialty care and provision of tertiary or super-specialty care only at major national metropolitan centers; and (5) a system for patient referral to the appropriate level of care. This model has been built around professional nurses as the key community health workers because their training is particularly suited and because large numbers of well-trained nurses are currently available and being trained. The special element in this model is a professional nurse-guided, self-care facilitating primary care Community Nursing Service System. This is supported by a National Nursing Extension Service as a new training and support structure. (See attached diagrams) A broad spectrum of programs was proposed for the Community Nursing Service System. These were designed to establish a balance of activities between the clinic-centered individual care component and the field activity- centered educational and supportive component of health care services. Examples of possible program alternatives and proposed guidelines for health care in specific situations were presented, as well as the roles and functions of the key health personnel within the Community Nursing Service System. This Rural Health Service Model was proposed as a real alternative to the maldistributed, inequitable, uncoordinated solo-practice, physician-centered fee-for-service health care available to Koreans today.

This study was conducted to find the shortest optimum time for taking oral temperature and axillary temperature, which does not affect reliability of body temperature. For this purpose, first, the time at which all the samples are reaching maximum temperature is identified. Second, the mean maximum temperature is compared with the mean temperature of each co-nsecutive measurement by T-test, to find the time at which no significant changes in temperature occurs along time sequence. Third, optimum temperatures are set at points of - 0. 2degrees F, - 0. 4 degrees F, - 0. 6degrees F, -0. 8 degrees F, -1.0degrees F, -1.2degrees F, -1.4degrees F, from maximum temperature. A point of time at which 90% of samples reach at optimum temperature is identified and definded as opti mum time. The study sample, a total of 164 cases were devided into two groups according to their measured body temperature. The group with body temperature below 37degrees C (A group) and above 37degrees1'C (B group) were compared on the time required to reach maximum temperature and optimum temperature. The results are as follow. 1 . The time required for total sample to reach maximum temperature was 13 minutes inboth groups by oral method, 15 minutes in A group and 13 minutes in B group by axilkry method. Time required for 90 % of cases reach maximum temperature by oral method was 10 minutes in both group. By axilkry method, 12 minutes in A group. (Ref: table 2) 2. Statistical analysis by means of T-test, the time whiph does not show a significant change by oral method were 12 minutes in A group and 11 minutes in B group, and by axillary method 14 minutes in A group and 11 minutes in B group. (Ref; table 5, 6.) 3. Where optimum temperature was definded as maximum temperature minus 0.2degrees F, optimum time was found 8 minutes in both groups by oral method, and 11 minutes in A group and 9 minutes in B group by axillary method. 4 . Where optimum temperature was definded as maximum temperature minus 0.4 degrees F, optimum time was found 7 minutes in A group and 6 minutes in B group by oral method, and 9 minutes in A group and 7 minutes in B group by axilkry method. 5. Where optimum temperature was definded as maximum temperature minus 0. 8degrees F, optimum time was found 6 minutes in A group and 6 minutes in B group by axilkry method. (Ref: table 7. 8, 9, 10) 6. The commonly practiced temperature taking time, 3 minutes in oral method and 5 minutes in axfllary method con be accepted as pertinent when physiological variation of body temperature at the mean level of -1.2degrees F, is accepted. 7 . The difference in time required to resister maximum temperature was compared between the group with body temperature below 37degreesC and above 37degrees 1 C, and found no significant difference in oral method and 1- 4 minute difference in axillary method with shorter time requirement in feverish group.

In the changing social and economic conditions, reorientation of the health care system is a process of rearranging health care resources keeping in mind the appropriativeness, relevancy, and efficacy of health care programs. Also it has been recognized recently that the CHP program is in need of review for the same reasons, that is to say, the ease in which health care facilities are available, the high rate of coverage with insurance and the development of an effective transportation system. Therefore there is a social inclination to think that there are no remote areas and to question the roles of public health facilities, health centers, health sub centers and CHP posts. This paper was done to review problems and to propose new directions for the CHP system. The findings of this study are as follows; 1) It is necessary that primary health care should be simplified into three parts, medical treatment, preventive care services and the organization of administration and logistics. Also each department should be supplemented with the appropriate professional personnel in order to develop a task oriented system. The reorientation of the CHP system should be managed in keeping with that of other public health care systems. Therefore it is necessary to look at the CHP system problems as one aspect of the reorientation process of public health care systems, and to work to find new ways to address these problems. 2) The location of the CHP post should be decided by the needs of the community in both the medical and preventive areas. If the people have a minimum need, the location of the CHP post should be altered and the existing roles of the CHP should be modified to allow for flexibility according to the community needs. 3) Use of the problem solving method in regular team meetings will prove to be as efficient as continuing education programs in improving job competancy. 4) The supervision of CHP's activities should be made by the same type professional personnel, that is, senior CHPs or charge nurses in the public health center at the county level. 5) The operational expensies of CHP post should be supported by the administrative department of the public health center and should create working conditions that will allow the CHP to concentrate on community health service programs. 6) The organizations for community participation, working committees, community health workers and a number of the local assembly, should be activated to provide for participation in finding solutions to health related problems in the community.

This study was conducted to investigate risk factors for senile dementia as well as care givers' stresses and thier needs for nursing care. It was done using a retrospective survey. A convenience sample of 100 senile dementia patients and 120 normal elders in a rural area was used. The tools used in the study were the MMSE-K(Mini-Mental State Examination-Korea) for dementia screening test and a questionaire developed by the research team. Data were collected through home visits by Community Health Practitioners. Data were analyzed using descriptive statistics, T-test, and Chi-square test. The findings are as follows: 1. There were significant differences in age, marital status, and religions between the two groups. 2. There was a significant difference in smoling behavior between the two groups. 3. There was a significant difference in past history of cancer between groups. 4. There was a significant difference in past and present elderfamily relationship between the two groups. 5. There were significant differences in intellectual activities, assuming major role in famliy and seeking other's help in daily life troubles between the two groups. 6. There were significant differences in stress factors such as child problem, family conflict, health problem and illegal behavior between the two groups. 7. The major problems out by families in caring for dementia patient were catastrophic reactions, dirtiness, mood change, devouring and tremor. The most serious problems faced by families was dirtiness, with catastrophic reactions, sleep distrubance, changeableness, and a suspcio-usness following. The care givers expressed chronic fatigue, anxiety, tension, depression, disorder in daily life, shamefulness, blame from neighbours and guiltiness. 8. There is need for geriatric hospitals, nursing homes, burden sharing, and counselling or education for family care givers. A replicate study in the urban area is recommended to validate the findings of this study. To explore the impact of stress in life and 'han' on senile dementia, a qualitative study is recommended.

This study was designed to identify nursing students' attitudes toward life through a Q-methodology. A Q-sample was formed through a review of the literature and interviews(n=160). The final Q-sample consisted of 37 statements out of an initial 100 statements after consultation with an expert panel and pilot testing. The P-sample consisted of 14 university nursing students and 27 junior college nursing students, which was selected by convenience sampling method. Data were analyzed by the Q-analysis method. The correlation between type 2 and type 3 was relatively high (r=0.539) ; that between type 1 and type 3 was lowest(r=0.014). The first type of attitude was the "rational utilitarian" type. Students in this type valued life relative to the quality of life. They agreed with euthanasia and artificial abortion if the quality of life was threatened. The criteria for their judgement were scientific knowledge and rationality. The second type of attitude was the "Christian deontologic" type. These students appreciated the sanctity of life according to Christian dogma. They disagreed with euthanasia and artificial abortion. And they disagreed strongly that life should be created by scientific development, because only God creates life. The third type of attitude was the "unconditional deontologic" type. These students agreed with the sanctity of life, not from Christian belief but from belief in the sanctity of life. The final type of attitude was the "prima facie(conditional) deonologic" type. These students appreciated the value of life and humanity. They expressed concern for others' life and suffering. They do not want to afflict others with their own miseries. This group showed a dual value system toward themselves and others. So they experience conflict between their concern for their own and others' conditions. These nursing students' values may have been influenced by their clinical experience in hospitals and other nursing fields. Through this study, we may realize the importance of education in nursing ethics for discussion of ethical conflicts and to support ethical nursing practice.

The study was conceived in relation to a concern over the growing gap between the needs of chronic patients and the availability of care from the current health care system in Korea. Patients with agonizing chronic pain, discomfort, despair and disability are left with helplessly unprepared families with little help from the acute care oriented health care system after discharge from hospital. There is a great need for the development of an alternative means of quality care that is economically feasible and culturally adaptable to our society. Thus, the study was designed to demonstrate the effectiveness of home health care as an alternative to bridge the existing gap between the patients' needs and the current practice of health care. The study specifically purports to test the effects of home care on health expenditure, readmission, job retention, compliance to health care regime, general conditions, complications, and self-care knowledge and practices. The study was guided by the operations research method advocated by the Primary Health Care Operations Research Institute(PRICOR) which constitutes 3 stages of research : namely, problems analysis solution development, and solution validation. The first step in the operations research was field preparation to develop the necessary consensus and cooperation. This was done through the formation of a consulting body at the hospital and a steering committee among the researchers. For the stage of problem analysis, the Annual Report of Seoul National University Hospital and the patients records for last 5 years were reviewed and selective patient interviews were conducted to find out the magnitude of chronic health problems and areas of unmect health care needs to finally decide on the kinds of health problems to study. On the basis of problem analysis, the solution development stage was devoted to home care program development as a solution alternative. Assessment tools, teaching guidelines and care protocols were developed and tested for their validity. The final stage was the stage of experimentation and evaluation. Patients with liver diseases, hemiplegic and diabetic conditions were selected as study samples. Discharge evaluation, follow up home care, measurement and evaluation were carried out according to the protocols of care and measurement plan for each patient for the period of 6 months after discharge. The study was carried out for the period from Jan. 1987 to Dec. 1989. The following are the results of the study presented according to the hypothesis set forth for the study : 1. Total expenditures for the period of study were not reduced for the experimental group, however, since the cost per hospital visit is about 4 times as great as the cost per home visit, the effect of cost saving by home care will become a reality as home care replaces part of the hospital visits. 2. The effect on the rate of readmission and job retention was found to be statistically nonsignificant though the number of readmission was less among the experimental group receiving home care. 3. The effect on compliance to the health care regime was found to be statistically significant at the 5% level for hepatopathic and diabetic patients. 4. Education on diet, rest and exercise, and medication through home care had an effect on improved liver function test scores, prevention of complications and self-care knowledge in hepatopathic patients at a statistically significant level. 5. In hemiplegic patient, home care had an effect on increased grasping power at a significant level. However, there was no significant difference between the experimental and control groups in the level of compliance, prevention of complications or in self-care practices. 6. In diabetic patients, there was no difference between the experimental and control groups in scores of laboratory tests, appearance of complications, and self-care practices. The above findings indicate that a home care program instituted for such short term as 6 months period could not totally demonstrate its effectiveness at a statistically significant level by quantitative analysis however, what was shown in part in this analysis, and in the continuous consultation sought by those who had been in the experimental group, is that home health care has a great potential in retarding or preventing pathological progress, facilitating rehabilitative and productive life, and improving quality of life by adding comfort, confidence and strength to patients and their families. For the further studies of this kind with chronic patients it is recommended that a sample of newly diagnosed patients be followed up for a longer period of time with more frequent observations to demonstrate a more clear-cut picture of the effectiveness of home care.

The problem of care of patients and families with Alzheimer's disease has become a conscious raising social policy issue in Korea. The government of the Republic of Korea has become cognizant of the situation and has begun searching for ways to remedy it. Thus, there is a need for a comprehensive understanding of the situation in which patients and their families are struggling and the enormous problems of care. With a realization of the urgent need, this study was done to investigate the situation and the care needs of families with patients with Alzheimer's Disease, and to compare the effectiveness of services utilized by the families in terms of cost and effects on patient's conditions and on family live. The Subjects for the study were 29 families with hospitalized patients, 25 families utilizing hospital outpatient clinics, 14 families utilizing day care facilities, and 16 families with homebound patients. A total of 84 families were interviewed by four trained interviewers using structured and semistructured questionnaires. The data produced from these interviews included: the patient's stage of Alzheimer's disease, patient's bizarre behavior, hours spent on patient care per day, family burden and quality of life, direct and indirect costs encountered in the care of patients, and the families' evaluation of the effectiveness of the services received. The data were analyzed to determine the relationships between family charactersistics, patient's conditions and services utilization. The effectiveness of each of the service entities was assessed through families evaluation and hoped for service and comparisons were made between services in terms of the cost-effectiveness ratios. After initial comparison of cost-effectiveness ratios, further analysis was done to compare between groups for incremental effectiveness for each incremental unit of cost to determine the most cost-effective service entities. The findings of the study are as fellows: 1. The choice of living arrangement and the types of services are a function of the stage of Alzheimer's condition and the economic status of the family. 2. Comparision of the cost of care showed that most expenses were encountered in by families with hospitalization, families using outpatient services, and families using day care services in that order. The least expense was involved in the care of homebound patients. The economic burden felt by families was in the same order as expenses. 3. The average number of hours spent on daily patient care was 9.9 hours for the outpatient clinic users, 9.7 hours for homebound patients, and 5.4 hours for day care users. 4. There were significant differences in the patient's conditions(CDRL), bizarre behaviors and the families's burden by living arrangement and/or types of service. However, no significant difference was found between groups in the family's quality of life. 5. The families rated the services of day care center as most effective for the care of the patients and families, except for a few families who had experienced some improvement in the patient's conditions. The outpatient clinic users expressed psychological comforts mainly in that the patient was being taken care of. For those hospitalized patients, families expressed the comfort of being relieved of the burden of care and that the patient is being professionally cared for. Form the analysis of the costs, hours of patient care, patient's bizarre behaviors, family's quality of life and burdens, and family's evaluation of services, it is concluded that up to the mid stage of Alzheimer's condition, the utilization of day care center services is found to be the most cost-effective, and toward the end stage of the Alzheimer's disease, it is hoped that there will be a establishment of long term or short term in-patient facilities for the protection of patients and preservation of the integrity of families for less cost. Thus, it was concluded that the family centered system of care is the most effective for Korea with systematic support systems developed for the care of patients and their families according to the needs of families as the patient's condition deteriorates.

This study investigated the effects of education program conducted through individual home visit by CHPs, which was developed by the operational research technique for families of dementia patients. (Yeo Shin Hong et al, 1994) The study was conducted in the form of a primary experimental design with 43 people as subjects, including dementia patients and family member in several Myon areas of Chungcheong Namdo between June 10 and August 20, 1994. The data was collected by questionnaires through the home visit by the CHPs. The results of study are as follows. 1. There is no difference in the quality of life between before and after the education program. 2. Role stress 'before the education program' was significantly different than 'after the education program'. 3. There was no difference in the feeling of burden between before and after the education program. 4. There was a significant difference in the abnormal behaviors of patients between before and after the education program. 5. The knowledge of dementia by the patient's family increased significantly after the educaion program, compared to that of 'before the education program'. 6. There was a significant difference in the attitude of family members toward the education program on dementia between before and after the education program. 7. The results of analysis on the coefficient relationship of various variables showed that the age of patients and family members have a significant correlation with role stress(p=.01). 8. In the subjective evaluation of family members on changes in actual nursing actions and the improvement of knowledge and technique in terms of daily living, (including abnormal behavior of patients, adjustment of environment for patients, activity programs for patients, communication technique with patients, ensuring the safety of patients, clothing, meals and elimination, 60-65% of family members responded that their knowledge had increased. As for improvement in techniques for each item, the technique for communication with patients showed the greatest improvement while the action program method for patients showed the least change. As for the nursing service provided to patients, most respondents showed a positive change. The specific items for which more than 80% respondents answered positively were as follows: recognizing the demand of patients, getting patients to do simple house works, talking softly and gently, removing dangerous things, preparing comfortable clothes that are easy to put on and take off, and limiting water consumption at night. As a result of study, the following suggestions can be made. The purpose of the study was to examine the effect of an education program developed and applied for dementia patients and family members in the community. This needs to be compared with a similar study conducted in the urban setting. In addition, a community service program (ex: nursing horn and shelter) including the applicaion of the education program should be developed and the study done to investigate its effect.

Respect for human life and respect for human dignity are two basic values to which organized nursing has urged its members to adhere in their service to mankind. Thus it is the nurses' duty to provide health care in support of sustenance of life and to pay respect for the patient's right to dignity. In practice, however, nurses may experience dilemmas between these duties much due to the development of modern advanced techniques. These dilemmas have become more complex and difficult to resolve. Nurses are often faced with situations in which the terminally ill refuse professional care, posing serious conflicts between respect for human life and respect for human rights to self-determination. In such cases, resolution of the problem is not a simple matter, thus requires intensive study into the ethical questions related to the situation. The purpose of this study was to identify ethical problems that nurses experience in caring for terminally ill patients and explore the ways to the resolution of problems within the context of the situations. The methodology used for the study was a case study method which 'New Casuistry' proposed by Jonsen and Toulmin(1988) and the 'Specified Principlism' proposed by Degrazia(1992) as an alternative to old deductive and intuitive method. Cases were developed through semistructured indepth interviews according to the casutistry method. A total of seven nurses were interviewd who were caring for therminally ill patients. Four cases out of a total 14 cases were related to the topic. Through the case analysis it became evident that nurses appreciated other values more often than respect for the patient's right to self-determination. These other values were convenience and effiency in nursing practice in case 1, preservation of life above all other values in case 2, provision of nursing care to fulfill the nurse's professional obligation at most in case 3, and respect for the family's demand against the patient's wish in case 4. This study showed that the most important ethical problems were conflict between respect for the patient's right to self-determination and sustenance of life for the fulfillment of professional obligation. For this problem, benefit/burden analysis from the perspective of the patient and family for the promotion of patient's wellbeing may be a way to resolve the conflict. Further, through these analysis it was shown that physicians' and families' opinions dominated in the decision? making and the opinions of nurses' and patients' tended not to be reflected. Thus the patient's right to his or her care was not readily respected. To solve this problem, nurses should make efforts to communicate reciprocally with their patients, family members and physicians in an effort to respect for their patient's rights to life and diginity from the point of view and values of the patient. It is also important that nurses provide good basic nursing care up to the time of death regardless of decisions about providing or not aggressive treatment for chronically and terminally ill patients.

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.