Analysis of Community Health Practitioners' Activities by Direct Observation

간호학과/석사[한글] 의료취약지구에서 24시간 상주하면서 활동을 하는 보건진료원이 실제로 어떤 근무시간 범위내에서 무슨 활동을 수행하고 있느냐를 파악하고 내소자 관리시의 행위를 파악하는 것은 보건진료원 활동의 올바른 평가 및 우리나라 농 어촌 현황에 적합한 보건진료원을 육성·배치하는데 있어 필요하다고 본다. 이러한 관점에서 본 연구는 보건진료원의 일일활동과 내소자관리활동의 영역별 내용 및 시간을 파악하는데 그 목적이 있다. 연구진행은 1985년 7월 16일부터 8월 14일까지 경기도, 강원도, 충청도 지역내 보건진료소중 도보건소에서부터 교통시간이 1시간 이내인 13개소의 보건진료소를 대상으로 2일간씩 직접관찰을 통해 자료를 수집하였다. 연구도구로는 간호학교수 5명으로 이루어진 연구팀이 개발한 관찰조사표와 관찰조사지침서를 이용하였고 수집된 자료는 연구자가 직접 실수 및 백분율을 산출하였다. 본 연구의 결과를 요약하면 다음과 같다. 1) 보건진료원의 업무수행시간은 지정된 시간내에 이루어지는 것이 아니라 아침 6시부터 밤 12시까지 지속적으로 이루어지고 있으며 야간에도 필요시 업무를 수행해 보건진료원은 1일 24시간동안 업무수행을 하는 것으로 관찰되었다. 2) 보건진료원의 일일활동내용은 24시간중 진료소업무수행을 위한 활동시간이 36.9%로 간호원 및 공무원등이 일일 24시간중 25%를 업무활동시간으로 소비하는 것에 비해 더 많은 시간을 업무수행에 소비하고 있는 것으로 관찰되었다. 3) 보건진료원이 진료소업무를 위해 수행하는 평균활동시간은 약 7시간 30분으로 진료 및 간호에 43.7%, 진료소 운영 및 관리에 18.5%, 기타 10.1%, 기록에 9.7%등의 순으로 시간을 소비하는 것으로 관찰되었다. 기타활동은 출장, 진료원 모임 참석, 야학지도등을 포 함하고 있다. 4) 보건진료소 내소자 특성은 남자가 54%, 여자가 46%로 관찰되었고 각 성장발달기별로는 성인기가 42.1%, 아동기가 20.9%, 영유아기가 20.4%의 순으로 내소했고 시간별 내소자수는 오전 6시부터 밤 12시까지 고른 분포를 보였다. 5) 내소자의 주소분포는 기관 및 주요보건사업별로 보면 호흡기계내 증상이 20.1%, 소화기계가 15.9%, 피부가 13.8%, 외상이 8.5% 등의 순으로 관찰되었으며 영유아기와 아동기에서는 호흡기계가, 청소년기, 성인기 및 노인기에서는 소화기계가 제 1순위로 나타났다. 6) 내소자관리시 보건진료원은 평균 10.5분간 서비스를 수행하는 것으로 것으로 관찰되었고 간호행위별로 시간을 비교해 보면 직접간호 및 치료가 4.6분으로 가장 길었고 상담 및 문제해결 4.1분, 검사 3.5분, 투약 3.4분으로 관찰되었고 행위별 건수는 문진이 267건, 투약이 244건, 기록이 228건, 검진 193건, 보건교육이 176건이며 총활동시간중 투약이 22.1%로 가장 높은 비율을 차지했다. 7) 보건진료원의 내소자관리업무중 의사의 진료범주로 볼 수 있는것은 투약중 처방행위와 봉합으로 사료되며 내소자관리활동이 진료, 간호 및 교육등의 여러 행위로 구성되어 있으므로 내소자관리업무를 단순히 진료업무로 분류, 보고하는 것은 보건진료원의 활동을 객관적으로 평가하지 못하는 것으로 사료된다. 따라서 보건진료원의 활동수행시간의 효율성을 기하기 위해 업무보조 및 가사활동보조를 위한 보조인력자원 및 보수개선 등 제도적 개선 또는 행정적 지원책이 강구되어야 할 것이다. [영문] Most of Community Health Practitioners (CHPs) in Korea reside and provide 24 hour care in medically under-served areas. It is important to identify the kinds of client services given by these CHPs, the range of working hours in the real situation as well as the CHP's over-all activities within a twenty-four hour period. This information is necessary for adequate evaluation of the CHP activities and for appropriate distribution of CHPs according to the needs of the rural area and a fishing village. The purpose of this research was to investigate the daily activities of the CHP, and the content and time spent for management activities of clients by the type of nursing care. In Kyoungki, Kangwoon and Choongcheong provinces, thirteen Community Health(CH) Posts were selected where the transportation time was less than one hour travel from the CH post to the provincial health center. The data were collected by five observers for two days for a total or 48 hours at each CH post by direct observation from 16th July to 14th August in 1985. The data collection method were structured that were observation and included check lists and guide-lines that were developed by a research team of five nursing professors at Yonsei University College of Nursing. Discriptive Statistics, frequency distribution and percentage distribution, were used to analyze the data. The summary of the research results are as follows. 1. Availability of the CHPs was not limited to specific office hours but occurred from 6 o'clock in the morning until midnight and sometimes clients came even during the night. Therefore the duty hours of the CHPs were 24 hours. 2. The percent of time spent during a twenty-four hour period in daily activities by the CHPs is as follows: privated and daily life time - 63.1% and work-related activity - 36.9%. It was observed that the CHPs spent more time carrying out their responsibilities than did the nurse and the public officials who spent 25% out of a 24 hour period in work-related activities. 3. An average time for the CHPs to carry out her job was 7 hours and 30 mins. It was observed that 43.7% of the time was spent for treatment and care, 18.5% for CH post administration and management, 10.1% for miscellaneous, and 9.7% for recording. The miscellaneous category included such things as an official trip and teaching children in a night school. 4. Fifty-four percent of the clients were male and 46% were female. According to growth and developmental stage, 42.1% of the clients were in the adult stage, 20.9% in the stage of childhood and 20.4% were in the infant stage. The number of clients were evenly distributed from 6 o'clock in the morning through midnight. 5. Client complaints of symptoms and principal health service are as follows: respiratory symptoms: 20.1%, gastro-intestinal symptoms: 15.9%, skin problems: 13.8%, wounds : 8.5%. The chief complaints were related to age groups, that is, respiratory symptoms occurred most frequently among infants and children and gastro-intestinal symptoms were among adolescents, adult and the aged. 6. Study findings related to leugth of time used for each activity and frequency of occurance are as follows : the CHP spent an average of 10.5 minutes in giving services to each client. When the average service times for nursing activities were compared: direct care and treatment took the longest tlme, 4.6 mins; counselling and problem solving, 4.1 mins; lab exam, 3.5 mins; and medication, 3.4 mins. The frequency of activity was observed as follows: history taking, 267 times; medication, 244 times; recording, 228 tims; physical examination, 193 times; and health education, 176 times. Activities related to medications occupied the highest proportion of CHP time, that is, 22.1% of total activity hours. 7. Among all services to client administered by the CHP, only the writing of prescriptions and suturing are thought of as physician's medical care. services to clients by CHPs in clude nursing care, education as well as the medical services of prescriptions and suturing. So it is the objective of this report focus upon the CHP's activity that is not medical care. The CHP is underpaid for the time of activities and the responsibilities she carries in the health care delivery system. One way of reducing the inequities would be to provide an assistant for activities that are not related directly to client care.restrictio