Research in Community and Public Health Nursing

Volume 16 (4); December 2005

Original Articles

A Preliminary Study on the Classification of Visiting Nursing Service Recipients and the Development of Standardized Visiting Nursing Service Pathways Based on Public Health Center: Ho Shin Ryu, Min Hyun Suk, Rah Il Hwang, Dal Lae Chin; J Korean Acad Community Health Nurs. 2005;16(4):381-391. Published online December 31, 2005

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Abstract PDF: PURPOSE
The purpose of this research is to develop and classify district visiting nursing standards and to standardize visiting nursing service pathways.
METHOD
This research was conducted as a focus group study and analyzed visiting nursing records. We surveyed 201 recipients at urban health centers, who were selected through convenient sampling, from April 2003 to November 2003.
RESULT
First, visiting nursing service recipients were classified into four groups according to household and financial characteristics, existence of disease, ability of self-care, and existence of home care service needs. Standardized pathways of the selected items were assessment. nursing care plan, disease management and promotion of self-care ability for Level I (mean=12.2 visits). For Level II (7.3 visits) were offered assessment. disease management. health education. and health promotion services. For Level III (5.2 visits) were offered assessment. disease management. health education and health promotion services, and for Level IV (2.7 visits) were offered thorough assessment, education for self-care and health promotion.
CONCLUSION
The visiting nursing service pathways identified in this research need to be developed further as basic materials applicable to quality assurance and agency evaluation. For this, we suggest repeated research and test to apply the derived standardized visiting nursing services pathways in visiting nursing programs.

Nutritional Risk and Its Contributing Factors in the Low-income Elderly in Urban Areas: Sook Ja Yang; J Korean Acad Community Health Nurs. 2005;16(4):392-403. Published online December 31, 2005

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Abstract PDF: PURPOSE
This study was to evaluate the nutritional status of low-income elders in urban areas and factors affecting their nutritional risk.
METHODS
A cross-sectional analysis was conducted. The subjects were 300 elders selected from home visiting clients of DongJack Public Health Center. Data were collected using a questionnaire containing questions on socio-demographic characteristics. health behavior and disease. dietary pattern. Nutritional Screening Initiative. Geriatric Depression Scale and Barthel Index for ADL. Collected data were analyzed through descriptive statistics. chi2-test and multiple regression analysis using SPSS.
RESULTS
Of the subjects, 63% had high nutritional risk, 21.3% moderate nutritional risk, and 15.7% good nutritional risk. NSI score was significantly different according to economic status, subjective health condition, medication, dental health, depression. regularity of diet and meal with family. Multiple regression analysis revealed that depression, subjective health condition, dental health and regularity of diet and meal with family explain 38.1% of nutritional risk.
CONCLUSION
It is necessary to evaluate nutrition status and to control nutritional risk factors such as depression, dental health, regularity of diet and meal with family for improving the health of the low-income elderly.

A Chronic Disease Self-management Program for the Elderly in Korea: Hye Ra Yoo, Jee Won Park; J Korean Acad Community Health Nurs. 2005;16(4):404-414. Published online December 31, 2005

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Abstract PDF: OBJECTIVES
The present study proposed to evaluate 1st-month and 3rd-month health status, depression, self-efficacy and medical expenses of a community-based health promotive self-management program for old Koreans.
METHOD
Participants in the CDSMP were selected from elders in a community health center through convenient sampling. The program included a 3-hour session per week for 14 weeks. Outcomes of evaluation in the 1st month and the 3rd month included modified Self-rated Health Status Scale, Center for Epidemiologic Studies Short Depression Scale, Self-Efficacy for Managing Chronic Disease 6-item Scale, and 1-item Medical Expenses Scale.
RESULTS
Self-rate health scores increased significantly just after the intervention (16.22), in the 1st month (17.57) and in the 3rd month (19.04) (chi2=32.06, p=.000); Depression scores (reversed) also increased significantly just after the intervention (6.04), in the 1st month (7.75) and in the 3rd month (8.39) (chi2=29.92, p=.000); Self-efficacy score increased significantly just after intervention (12.87) but it decreased in the 1st month (12.73) and in the 3rd month (12.04). But all of the three scores were still higher than those before the intervention (8.65) (chi2=32.42, p=.000): Medical expense score decreased at the end of the intervention (1.57) but the cost score increased in the 1st month (2.48) and in the 3rd month (2.39) (chi2=7.81, p=.050).
CONCLUSION
CDSMP is effective in increasing self-rate health and self-efficacy and in decreasing depression in the Korean elderly. However, no significant effect of the program was observed in decreasing the medical cost of the Korean elderly.

The Relations between Self-esteem, Self-care and Life Satisfaction in the Home-dwelling Elderly: Bong Im Kim; J Korean Acad Community Health Nurs. 2005;16(4):415-423. Published online December 31, 2005

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Abstract PDF: PURPOSE
The present study was conducted to identify the relations between self-esteem. self-care and life satisfaction in the home-dwelling elderly.
METHODS
The subjects were 106 persons aged over 65 in J city. Data were collected from April to June 2005 by a questionnaire survey. The instruments used in this study are the self-esteem scale developed by Rosenberg(1965), the self-care scale by Hwang (2000) and the life-satisfaction scale by Choi (1986). Data were analyzed through t-test, ANOVA. least significant difference, Pearson's correlation coefficient and stepwise regression analysis using SPSS-Win 10.0.
RESULTS
Self-esteem and self-care were in a positive correlation with each other (r=.464, p=.000). Self-care and life-satisfaction showed a significant correlation with each other (r=.222 p=.031), and a significant correlation was found between self-esteem and life-satisfaction (r=.506, p=.000). The most significant predictors influencing life-satisfaction were self-esteem, self-care and perceived health condition, and the three factors accounted for 47.7% of variance in life satisfaction in the home-dwelling elderly.
CONCLUSION
These results suggest that self-esteem, self-care and life-satisfaction can be important factors the quality of life of the elderly in long-term care. Therefore nurses can plan nursing interventions to promote self-esteem, self-care and life satisfaction of the home-dwelling elderly.

Factors related to Disturbing Behaviors, Premorbid Personality and Depression in the Pre-demented Elderly and the Mild Demented Elderly: Kyung Mi Yang, Soon Lae Kim; J Korean Acad Community Health Nurs. 2005;16(4):424-436. Published online December 31, 2005

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Abstract PDF: PURPOSE
The purpose of this study was to identify premorbid personality, depression and disturbing behaviors to provide information for developing nursing interventions for the pre-demented and mild demented elderly living as residents of their community.
METHOD
The survey was conducted through direct interviews using a structured questionnaire in J city. Among the subjects contacted, 89 made appropriate replies to the survey.
RESULT
The subjects' disturbing behaviors were significantly related to premorbid personality and depression. The predictors to disturbing behaviors of the pre-demented elderly were sex, extroversion, neuroticism and conscientiousness. The predictors to disturbing behaviors of the mild demented elderly were agreeableness, depression, sex, conscientiousness, and extroversion.
CONCLUSION
In conclusion, disturbing behaviors of pre-demented elderly and mild demented elderly are affected not only by their premorbid personality but also by their depression. Therefore, it is necessary to encourage and respond to them with understanding their disturbing, behaviors in relation to their premorbid personality. In addition. it is important to maintain positive emotion in order to reduce their disturbing behaviors.

Experiences on Home Visiting Nursing Service among the Elderly in Community: So Young Min, Sook Kyoung Park, Jeong Mo Park, Suk Jeong Lee; J Korean Acad Community Health Nurs. 2005;16(4):437-445. Published online December 31, 2005

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Abstract PDF: PURPOSE
The purpose of this study was to understand the meaning of experiences in home visiting nursing service among the elderly in community provided by nursing students.
METHOD
This is a phenomenological study to investigate the experience of community-based patients. Data were collected through in-depth interviews from the 4th of March to the 15th of December 2003. Individual interviews were conducted with 8 patients on subjective experiences. Data were analyzed through Colaizzi's method, in which meaningful statements were extracted.
RESULT
Four categories were identified from nine theme clusters. The four categories were 'thankfulness', 'dependence', 'sorrowfulness' and 'the sense of being'.
CONCLUSION
These results show the importance of visiting nursing service for the elderly in community.

Analysis of Researches on Nursing Intervention for Elderly Health Promotion from 1994 to 2004: Tae Im Kim, Kang Yi Lee, Young Im Park, Myung Hee Jun, In Ja Kim, Eun Ju Kim, Dong Ok Kim, Yun Jung Kwon; J Korean Acad Community Health Nurs. 2005;16(4):446-457. Published online December 31, 2005

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Abstract PDF: PURPOSE
The purpose of this study was to analyse researches on nursing intervention for elderly health promotion.
METHOD
A literature review of 38 researches was carried out using guidelines developed by the present researchers.
RESULT
The research papers studied in this research were theses written for doctoral or master's degree and published between 1994 to 2004. These researches applied nursing intervention for health promotion of elders and used experimental study design. The average period of nursing intervention was about 9 weeks and the average frequency was three times per week. As for major characteristics of subject groups, most of them were over 65 years old (76.3%) and resided in community (65.8%), and each group consisted of 10 to 29 elders. The dependent variables used in these studies included physiological variables (blood pressure, blood cholesterol level, pulmonary function, fasting blood sugar, blood cortisol level, body mass etc.), psychologic variables (depression, quality of life, life satisfaction, loneliness, anxiety etc.), cognitive variables (perceived benefits, perceived barriers, self-efficacy, self-concept, subjective health status etc.), activities of daily livings, health promotion behavior, pain, risks of fall, and variables related to Trans Theoretical Model. The majority of these studies (78.9%) applied exercise programs for health promotion including exercise motivating programs (15.8%).
CONCLUSION
We suggest that more various nursing interventions must be applied to promote elders' health and to take care of their chronic diseases.

The Relation between Test Anxiety and Mental Health in Adolescents: Ji Yeong No; J Korean Acad Community Health Nurs. 2005;16(4):458-466. Published online December 31, 2005

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Abstract PDF: PURPOSE
The purpose of this study was to determine the relation between test anxiety and mental health in adolescents.
METHOD
The subjects were 450 students of two academic high schools in J City, who were selected through convenient sampling. Data were collected through a survey using a structured questionnaire from September 1st to 15th 2005. Collected data were analyzed using SPSS 10.0 for Windows through descriptive analysis, Pearson's Correlation Coefficient, t-test, ANOVA, Scheffe's test and stepwise multiple regression.
RESULT
The mean score of test anxiety was 2.40 (range:1.13-3.81) and that of mental health was 2.77 (range:0.64-5.03). A significant negative correlation was observed between test anxiety and mental health (r=-0.28, p=.000). Test anxiety was significantly different according to adolescents' general characters such as gender (t=-1.98, p=.048), grade (F=3.54, p=.030), school life satisfaction (F=10.73, p=.000) and relationship with the teacher (F=11.60, p=.000). Mental health was significantly different according to adolescents' general characters such as religion (t=2.14, p=.032) and school life satisfaction (F=4.13, p=.017). The most powerful predictor of mental health was test anxiety and it, combined with religion, accounted for 9.0% of variance in mental health in adolescents.
CONCLUSION
Test anxiety and mental health was found to be in a significant negative correlation with each other in adolescents. Therefore, nursing intervention programs for adolescents needs to reduce their test anxiety to improve their mental health.

A Study on Adolescents' Smoking Behavior and the Status and Need of Smoking Prevention Education for Adolescents: Ok Hee An, Young Mi Kwon, Mi Soon Jeon; J Korean Acad Community Health Nurs. 2005;16(4):467-477. Published online December 31, 2005

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Abstract PDF: PURPOSE
This study was to identify adolescents' smoking behavior and the status and need of smoking prevention education for adolescents.
METHOD
The subjects were 375 students selected through convenient sampling from three middle schools and three high schools in Jeonbuk. Data were collected through a questionnaire survey and analyzed using SPSS 10.1.
RESULT
The smoking rate was 20.8% and 83.7% the students experienced smoking prevention education. Students were educated by a special instructor (39.8%) or a health teacher (26.8%). Among the teaching methods, lecture was 69.4%, but some students (30.7%) wanted anti-smoking school. Among the students, 85.0% answered they want smoking prevention education and 46.7% said that it should be covered in regular curriculum.
CONCLUSION
High interest and continuity are emphasized for the success of smoking prevention education. In addition, various teaching methods need to be developed including anti-smoking school, lectures, counselling and long term education program. Moreover, smoking prevention education programs need to be covered in regular curriculum.

A Study through Individual Interaction on the Achievement Rate of Smoking Cessation Goal and Characteristics Related to Smoking Cessation in College Smokers: In Hee Choi; J Korean Acad Community Health Nurs. 2005;16(4):478-487. Published online December 31, 2005

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Abstract PDF: PURPOSE
This study was to examine the achievement rate of smoking cessation, to identify obstacles to smoking cessation, and to find means to achieve the goal of smoking cessation in college smokers.
METHOD
This study was conducted from April 26th to September 13th 2004 and used a one-shot design. The subjects selected by convenient sampling were 29 college smokers who smoked over one cigarette a day, had a positive level of urine cotinine, participated in smoking cessation education 3 times. Thereafter, individual interaction was processed between the researcher and the subject using an interaction instrument. Data were analyzed based on frequencies.,percentages and means using SPSS/Win 10.0.
RESULTS
The achievement rate of smoking cessation was 20.7% (6 students). The biggest obstacles smoking cessation were smoking stimuli (29 students) and lack of control (25 students). Among detailed obstacles, the biggest one was smoking at regular times, which was followed by withdrawal symptoms, smoking on drinking, and company with other smokers. The most effective means of smoking cessation mentioned by the subjects were in order of avoiding drinking situations, taking deep breaths, and exercising.
CONCLUSION
The results of this study, using King's theory, showed that individual interaction is effective in achieving smoking cessation. Therefore, it is suggested to make further study and broaden smoking cessation education for college smokers.

A Study on the Relation of BMI to Lipid Metabolism and Health Promoting Behavior in Middle-Aged Women: Kun Ja Lee, Chun Ja Chang, Jae Hee Yu; J Korean Acad Community Health Nurs. 2005;16(4):488-497. Published online December 31, 2005

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Abstract PDF: PURPOSE
This study examined the relation of BMI to lipid metabolism and health promoting behavior in middle-aged women.
METHODS
The subjects were 113 women between 40 to 60 years of age. The data was collected from April 2003 to July 2004. BMI was measured using body composition analyzer and lipid metabolism were measured using automatic biochemical analyzer. Health promoting behavior was collected using a structured questionnaire. The SPSSWIN(10.0 version) program was used to analyze the data and get the descriptive statistics and Pearson's correlation coefficients.
RESULTS
BMI was negatively correlated with HDL-c and positively correlated with triglyceride, but there was no significance between BMI and total cholesterol. There was no significance of correlation between BMI and total health-promoting behavior.
CONCLUSION
This study showed that BMI is meaningful in the identification of the high risk women to prevent HDL-c & triglyceride metabolism disturbance, but additional research is needed to study the correlation between BMI and health promoting behaviors in middle-aged women.

Grounded Theory Approach to Middle-aged Women's Experience in Family Health Care: Jung Hee Kim, Hyun Sook Moon, Hyun Im Kang, Mi Kyung Shin; J Korean Acad Community Health Nurs. 2005;16(4):498-507. Published online December 31, 2005

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Abstract PDF: PURPOSE
The purpose of this study is to survey health requirements of middle-aged women and their families and to provide guidelines for developing nursing interventions by describing the process of family health maintenance experienced by middle-aged women and its conceptual system.
METHODS
To get saturated data, each of four researchers conducted two or three times of in-depth interview with eight middle-aged women aged between 40-64 years old and living in Seoul and Chuncheon from the 10th to the 30th of October 2004 and each interview was continued one or two hours. The Grounded theory adopted by Strauss & Corbin (1998) is a substantive theory that can explain the experiencing process of middle-aged women.
RESULTS
We found that the casual condition of family health maintaining by middle-aged women was "confidence of health belief", and "pouring by body moving" was found to be its phenomenon. A textual condition that might respond to the phenomenon was "fatal roles acceptance", and intervening conditions that promote their family health were "retracing" and "gathering health information". These intervening conditions impacted middle-aged women's confidence in family health and led them to take actions/interactions such as "being a model of health", "adapting to circumstances", "do-it-myself", "taking-care" "harmonious mind" and "the pursuit of cleanness". These actions/interactions produced results such as "being stronger", "being unmanageable" and "being fruitful".
CONCLUSIONS
Health confidence and practical health behaviors were observed in the process that the middle-aged female participants experienced unmanageable circumstances but they accepted their roles and responsibilities and recognized that they must be get stronger. The behaviors of health-together-with were divided into enthusiastic type, adaptation type and self-sacrificing type. Therefore middle-aged woman with the understanding of family health maintaining process as well as the theoretical system and practical principals needs to implement the intervention in acceptable level of family health process of preventing psychological and physical problems.

Difference of Physical Symptoms, PWI and JCQ according to Sasang Constitutions for Industrial Workers: Nam Hyun Cha, Myung Ja Wang, Jeong Ah Kim, Ki Nam Lee; J Korean Acad Community Health Nurs. 2005;16(4):508-516. Published online December 31, 2005

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Abstract PDF: PURPOSE
This study was conducted to analyze industrial workers' stresses from physical symptoms, PWI, JCQ and tasks in classification of Sasang constitutions.
METHOD
Data were collected from industrial workers in J Province from May 2003 to June 2003. Questionnaires were distributed and collected on the day of their physical examination. Collected data were analysed through chi2-test.
RESULT
Health-related characteristics showed that most of smokers and drinkers were Taeumins and this result was statistically significant. Physical symptoms related to constitutions indicated that GI and neurologic symptoms are significantly more frequent in Soeumin. The percentage of subjects with moderate risk was high in order of Soyangin, Taeumin and Soeumin while the percentage of subjects with high risk was high in order of Soeumin, Taeumin and Soyangin.
CONCLUSION
Through this study, Lee Jae Ma's theory was be confirmed compatible with disease characteristics. However, research with more various subjects and variables needs to be made.

A Study on Taxi Drivers' Smoking Behavior, Self-efficacy and Expectation Level of Success in Smoking Cessation: Chun Mi Kim, Haeng Mi Son; J Korean Acad Community Health Nurs. 2005;16(4):517-526. Published online December 31, 2005

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Abstract PDF: PURPOSE
The purpose of this study is to find taxi drivers' smoking behavior, self-efficacy and expectation level of success in smoking cessation. It will provide useful information for developing nursing interventions in health promotion programs.
METHOD
The subjects of this study were 271 taxi drivers in Seoul and its metropolitan area. Data were collected using a self-reported questionnaire asking smoking history, smoking behaviors, health problem, stages of change for smoking cessation, self-efficacy and the expectation level of success in smoking cessation. Data were analyzed through descriptive statistics. Pearson's correlation, Mann-Whitney U test, Kruskal-Wallis test and Cronbach's a.
RESULTS
Of the taxi drivers, 83.8% were current smokers. Stages of change were as follows: 45.8% were in the precontemplation stage, 26.2% in the contemplation stage, 13.7% in the maintenance stage, 12.2% in the preparation stage and 1.5% in the action stage. In addition. 20.3% of the subjects reported health problems such as hypertension, heart disease, diabetes mellitus and respiratory disease. The expectation level of success in smoking cessation was positively related with self-efficacy. There were statistically significant differences in the expectation level of success in smoking cessation according to the number of cigarettes per day and nicotine dependency. In addition. there were statistically significant differences in self-efficacy according to the number of cigarettes per day, duration of smoking (years) and nicotine dependency.
CONCLUSION
The results of this study suggest that taxi drivers' health problems and smoking rate were serious. Therefore more systematic health promotion programs for smoking cessation should be developed and executed by health care specialists at individual taxi companies.

The Comparison of Waist Circumference, Waist to Hip Ratio and Body Mass Index in Female College Students: Seung Kyo Chaung, Kyung Shin Paek; J Korean Acad Community Health Nurs. 2005;16(4):527-533. Published online December 31, 2005

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Abstract PDF: PURPOSE
The purpose of this study was to validate waist circumference (WC) and waist to hip ratio (WHR) corresponding to body mass index (BMI) of 25kg/m2 and to survey the prevalence of hypertension according to obesity in female college students.
METHOD
Weight, height, waist and hip circumferences and blood pressure were measured for each of 286 female college students in J City, Chungbuk.
RESULTS
The subjects' mean BMI was 21.4kg/m2, and the estimated prevalence of obesity was 11.2%. The subjects, the 80th-90th percentile of whom had BMI exceeding 25kg/m2, were found to have WC of 75-78.1 cm and WHR of 0.79-0.80, respectively. Of the subjects with obesity(BMI> or =25kg/m2), 53.1% exhibited abdominal obesity (WC> or =80cm) and 40.6% had WHR over 0.80. Systolic and diastolic blood pressure were correlated with BMI, WC, and WHR. The prevalence rate of hypertension in subjects with obesity(BMI> or =25kg/m2) was 25%. Additionally, the prevalence rate of hypertension in subjects with abdominal obesity (WC> or =80cm) was 39.1%.
CONCLUSIONS
Our study indicates that WC corresponding to BMI of 25kg/m2 in female subjects in their twenties is different from that of adult women. We also found that the prevalence rate of hypertension in subjects with abdominal obesity was high. Therefore. we suggest further studies to determine the cutoff value of WC for evaluating abdominal obesity and to investigate the long-term effects of obesity on women in their twenties.

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