Global Health Project for Maternal Child Health in a Developing Country: Case Study in Tigray, Ethiopia

Purpose: The purpose of this study was to demonstrate a two-year global health project to improve maternal and child health (MCH) in Ethiopia. Methods: This is a descriptive case study. The target area is Kilte Awlaelo Woreda in Tigray Regional State, Ethiopia. A baseline survey was conducted to identify the needs of community residents and health care professionals. A MCH program was developed according to a project design matrix that included: infrastructure renovation of health centers; continuing education for midwives, nurses, and health extension workers (HEWs); and improvement of residents' MCH awareness. Project evaluation will examine the structure, process, and outcomes of the program. Results: The baseline survey showed low rates of family planning (31%) and antenatal and postnatal care use (36.1% and 69%, respectively). The institutional birth rate was 13.5%. Midwives and nurses received 2~4 educational programs about family planning and perinatal care. HEWs were also given practical education. Water and electrical infrastructure of all five health centers in the Kilte Awlaelo Woreda were renovated. Additionally, medical supplies and equipment were provided. Community health education on perinatal care, family planning, and personal hygiene was presented. Conclusion: This study highlights the role of nursing in global health and provides basic information on the development and outcomes of the global health project.본 연구는 한국국제협력단(KOICA)의 에티오피아 원조사업을 위탁 받아 수행되었

Development and evaluation of transitional care program for low birth weight infants and mothers.

간호학과/박사[한글] 본 연구는 저출생체중아 이행간호 프로그램의 개발과 평가연구로, 프로그램 개발의 준비,개발, 평가의 3단계로 구성되었다. 연구의 이론적 기틀은 이행이론(Meleis, Sawyer, Im,Messias, & Schumacher, 2000)을 근거로 하였다. 프로그램 개발 준비단계는 2000년 6월부터 8월까지 서울시내 일개 보건소에 등록된 현재교정연령 12개월 미만의 출생시 체중 2,500g미만과 출생시 재태연령 37주 이하인 저출생체중아 19명과 그 부모를 대상으로 추후간호 대한 요구도, 부모의 양육자신감, 자아존중 감, 사회적 지지, 영아의 성장발달과 건강상태, 가정의 양육환경을 조사하였다. 이 자료의 분석은 기술통계, Spearman's rho correlation coefficient, Mann-Whitney test를 이용하였고, 면접자료는 내용분석 하였다. 개발단계는 이행이론을 이론적 틀로 하면서 준비단계에서 조사한 대상자의 요구를 반영하여 전문가 집단으로부터 내용타당도를 검증받은 후 최종 프로그램을 개발하였다. 평가단계는 2000년 11월부터 2001년 5월까지 서울과 인천의 대학병원의 신생아집중치료실에서 퇴원이 결정된 출생시 체중이 2,500g 미만, 출생시 재태연령이 37주 이하인 4명의저출생체중아와 그 어머니를 대상으로 퇴원 2-3일전부터 퇴원 후 3개월까지 프로그램을 적용하였다. 프로그램의 효과는 영아의 건강상태와 성장발달, 어머니의 양육자신감과 자아존중감, 그리고 모아상호작용, 가정의 양육환경을 측정하였다. 프로그램의 운영과 프로그램 참여경험의 결과는 대상자와의 면접을 통해 자료를 수집하였다. 자료분석은 대상자 수의 제한으로 통계분석은 하지 않았고, 면접자료는 내용분석 하였다. 본 연구의 결과는 다음과 같다. 1) 프로그램 개발 준비단계에서 확인된 저출생체중아의 건강은 52.6％의 부모들이 자신의 자녀가 건강하다고 인식하고 있었으며, 퇴원 후 가장 많이 경험한 건강문제는 호흡기 감염과 열이었다. 이들의 체중과 신장은 대체로 현재의 교정연령에 적합한 정상범위를 유지하였다. 발달은 현재 교정연령 3개월 이후 저출생체중아 9명 가운데 4명에서 의심스런 발달이나 지연발달이 나타났다. 저출생체중아 부모의 양육자신감, 자아존중감, 가정의 양육환경은 모두 영아의 교정연령이 3개월 미만인 경우가 그 이상인 경우보다 낮았다. 저출생체중아 부모의 사회적 지지는 전체적으로 매우 낮은 수준으로 나타났다. 저출생체중아 부모들은 수유, 아기 다루기, 질병관리, 아기의 특성이해, 목욕 등과 관련된 양육 어려움을 보고하였고, 추후간호에 대한 요구는 교육과 정보, 자조모임, 상담통로의 확보 등이었다. 2) 최종적으로 개발된 프로그램은 4회의 가정방문, 매주 1회의 전화방문, 대상자의 필요에 따라 접근가능한 전화상담, 그리고 인터넷 자조모임으로 구성되었다. 3) 프로그램의 평가를 위해서 4명의 저출생체중아와 어머니에게 퇴원 2-3일전부터 퇴원 후 3개월까지 프로그램을 적용하였다. 프로그램 종료 시 저출생체중아의 건강상태는 대체로 양호하였고, 건강문제가 발생한 대상자의 경우는 조기발견과 적절한 치료로 연계되었다.프로그램에 참여한 저출생체중아는 모두 퇴원 3개월 후 정상발달을 나타냈다. 프로그램에 참여한 저출생체중아 부모는 본 프로그램이 양육자신감, 모아상호작용, 가정의 양육환경의 향상에 긍정적인 영향을 미쳤다고 보고하였다. 프로그램에 참여한 어머니들은 본 프로그램에 대해 높은 만족도를 보고하였고, 저출생체중아는 건강과 성장발달을 유지, 증진할 수 있었다. 특히 어머니는 지속적인 추후간호를 제공하는 간호사와 자조모임의 다른 어머니들과의 지지적인 관계형성을 통해 이행과정을 긍정적으로 경험하였다. 이상의 결과를 종합해 볼 때 부모의 요구를 반영하여 개발된 저출생체중아 이행간호 프로그램은 저출생체중아와 부모의 건강한 이행을 촉진하였다고 평가할 수 있다. 따라서 이러한 프로그램이 병원과 지역사회 공공의료기관 사이의 건강관리체계의 연계를 확립하도록 확대 적용될 것을 제안한다. [영문] The main purpose of this study was to develop and evaluate the transition nursing program for low birth weight infants and their mothers. It consisted of three phases, which were needs assessment, development, and evaluation. Needs assessment was conducted from June to August, 2000. The subjects were 19 low birth weight infants including 4 pairs of twins and their parents. The second phase was to develop the program based on the needs assessment. The conceptual framework guided the program was the theory of transition(Meleis, Im, Messias, & Schumacher, 2000). The last phase of the study was evaluation of the program. Evaluation of the tentative program was done with 4 pairs of the low birth weight infants and mothers from November, 2000 to May, 2001. Data were collected during home visits by observation, interview, and a structured questionnaire. Variables included in the evaluation were maternal confidence, self-esteem, social support, home environment, mother-infant interaction, and health status and growth and development of the infants. Data were analyzed by using Spearman's rho correlation coefficient, Mann-Whitney test and content analysis. The results were as follows: 1. The parents of low birth weight infants reported the difficulties of parenting related to feeding, bathing, infant handling, understanding of characteristics of low birth weight infants, and illness management. And education and information, support group, and easy access to consultation were identified as areas that needed follow-up service. 2. The transitional care program consists of home visits, phone visits and counselling, and support group using internet. The program begins 2-3 days before the scheduled date discharge of the infants from NICU and continued till 3 months after discharge. 3. At the end of the program, the infants maintained the health status and growth and development appropriate to their corrected age. The mothers reported that they had increased maternal confidence, more mother-infant interaction, and better home environment for the infants' development after participation in this program. The program facilitated smooth transition for both low birth weight infants and their mothers. In conclusion, it was proved that transitional care program provided accessible, and appropriate services to low birth weight infants and their mothers. According to the result of this study, it is necessary to establish more efficient referral system between hospitals and public health services in order to provide a seamless service to low birth weight infants. Also, it is imperative to develop an educational training program for home health nurses on care of low birth weight infants and their mothers during the period of transition home from NICU.ope

Stages of Change, Processes of Change, and Decisional Balance for Weight Control Associated with Body Mass Index in Female Adolescents

Purpose: The purpose of this study was to compare variables related to weight control between normal weight and overweight/obese female adolescents. Methods: This study is a supplementary analysis using a total of 293 female adolescents in Seoul. Data were collected through self-report questionnaires on the topics of stages of change, processes of change, and the decisional balance pertaining to weight control. Body weight and height were also measured. Results: There was a significant difference in the stages of change between the normal weight and overweight/obese groups. Of 12 processes of change, 9 processes were significantly higher in the overweight/obese group than in the normal weight groups. Also, female adolescents who were overweight or obese had significantly higher pros and eating efficacy scores comparing to those in the normal weight group. Conclusion: The findings of this study suggest that overweight/obese female adolescents, especially those in the action stage need supports to continue their weight control behaviors. In addition, a weight control program for female adolescents should emphasize their participation in physical activities in addition to their dietary control efforts

Needs Assenssment of Community Health Service using OMAHA SYSTHM

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Physical Activity and Fatigue among Pediatric Nurses in a Special Care Unit

Purpose: This study was designed to explore the levels of physical activity and fatigue among nurses and to identify the relationship between these variables. Methods: Participants were 89 nurses working at an intensive care unit and an operating room in a childrens hospital. Data were collected using self-reported questionnaires including the International Physical Activity Questionnaire and Brief Fatigue Inventory. Results: Most of the nurses physical activity was work related, and there was a significant difference according to the working unit. Nurses with higher work stress and lower job satisfaction showed higher levels of fatigue than their counterparts did. Work-related physical activity and the interference of fatigue with relationships were related positively, whereas transport and leisure time physical activity were negatively related to usual fatigue and the interference of fatigue with life enjoyment. Conclusion: The levels of physical activity and fatigue of nurses were higher than those observed among other populations. The appropriate level of physical activity for these nurses needs to be investigated carefully. Also, in the intervention for nurses' fatigue, their level of work-related and leisure-time physical activity should be considered separately, and their work environment and psychological satisfaction level should be included

Development of a Consecutive Clinical Nursing Practicum Module using Simulation

Purpose: This is a project report of the development of consecutive clinical nursing practicum modules using simulation encompassing the essentials of nursing over 4 years of university level education. Methods: The project was conducted from May to December in 2011 in a college of nursing in Seoul, Korea. Six nursing faculty members from different major subjects at the university participated in the project. The theoretical framework was sought in the first phase, resulting in utilizing Neuman's Systems Model. The principles of developing the contents of and the links between the modules were set up in the second phase, presented as complexity, diversity, and comprehensiveness. The details in the individual module were fleshed out in the third phase. Results: Eight clinical nursing modules using simulation were developed and presented in a table in detail. The complexity, diversity, and comprehensiveness of each module increased in depth and breadth in a consecutive order. Conclusion: It is hoped that this module is a decent curricular exemplar demonstrating comprehensive nursing practice education using a simulation technique