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서울시내 일개 여자고등학교의 학생건강평가와 사후관리에 관한 연구

Other Titles
 (A) study on health appraisal and management of girls high school students in seoul 
Issue Date
1986
Description
보건학과/석사
Abstract
[한글] 학생건강평가와 사후관리는 학교보건사업의 기본요소이다. 본 연구는 기술-사례연구로서 학생건강평가와 사후관리에 대한 실례를 분석하여 보다 효율적이고 향상된 학생건강관리에 도움이 되고자 하는데 그 목적이 있다. 연구대상은 서울시내에 소재하고 있는 E여자고등학교의 1983년 3월부터 1986년 2월까지의 학생전체(1개년간의 학생 수: 3,600명)와 학교보건인력이다. 연구도구는 연구자에 의해 고안된 check list 들을 지역사회 간호학교수의 조언을 받아 확정하여, 자료를 추출하는데 사용하였다. 수집된 자료는 백분율 및 평균값을 계산하였으며 이는 연구자가 수작업으로 산출하였다. 연구 결과는 다음과 같다. 1. 학생건강평가와 사후관리는 학생들의 질병 및 심신장애의 조기발견, 조기치료라는 보건 관리적인 의의와 학생들 스스로 건강생활을 실천할 수 있는 태도와 습관을 기르게 하며, 학생들에게 행해질 보건지식과 정보를 제공할 수 있는 교육적인 의의도 함께 가지 고 있다. 2. 보건의료 전문인력인 양호교사를 중심으로 한 학교보건 간호사업중 학생 건강평가 프로그램에 대한 소요시간은 58.2%로서 보건(설문)조사 1.4%체격검사와 시력·색각검사는 5.9% 양호실방문에 의한 평가는 29.2%, 신체검진과 구강검진 7.7% 기생충란검사 6.5%, 결핵검진(흉부 X-선 간접촬영) 1.3%, 뇨당·뇨단백검사는 1.2%이다. 학생건강평가 프로그램이 양호교사 정규업무의 많은 부분을 차지하고 있으며, 그중에서도 양호실 방문에 의한 학생건강평가 소요시간이 가장 많았다. 3. 학생건강평가 사업과정에 대한 평가에서 네트워크모델을 응용한 분석을 통해 학생건강을 위해 담임교사 및 관련교사, 양호교사, 학우, 학생보호자, 의사, 치과의사, 검사기관의 요원들이 서로 협조하고 있으며, 모든 학생건강평가 사업에 있어서 양호교사는 조정자의 역할을 하고 있었다. 4. 학생들의 건강문제로 나타난 각종 질환 및 증상은 다양하다. 건강 이상 학생 수 따른 건강문제의 빈도순위는 삭은이(17.58%), 외상(15.28%), 감기(14.94%), 두통(11,81%), 식체(10.75%), 근시(9.25%)등이었다. 흉부질환, 심장질환, 내분비대사질환, 신경질환 골격관절질환, 팔다리 운동장애, 정신신경질환, 청력장애, 언어장애등의 건강문제는 높은 빈도는 아니지만 학교에서의 특별한 보호와 세심한 배려가 필요하다. 5. 학교보건 업무 내에서 평가되어 관리되는 건강문제의 해결을 위해 의뢰되는 의료인 인력별 건강문제 분류내용과 건강이상학생분포는 다음과 같다. 총 건강이상 학생 수 7,678명 가운데, 양호교사에 의해 학교보건업무 내에서 관리 가능한 제 1단계의 건강문제별 건강이상 학생 수와 백분율은 4,188명으로 54.5%, 양호교사가 학교보건 업무 내에서 관리하면서 필요시 전문의사, 치과의사와 같은 전문인들에게 자문을 받아 관리할 수도 있는 제 2단계는 1,917명으로 25.0%, 학교보건 업무 내에서 문제로 발견되어 1회 이상의 의사의 전문적인 치료를 위해 의뢰토록 하고 학교보건 업무 내에서 관리하는 제 3단계는 2,121명으로 27.6%,학교보건 업무 내에서 문제로 발견되어 1일 이내의 의사의 즉각적인 치료를 위하여 의뢰하고 학교보건 업무 내에서 계속 관리하는 제 4단계는 22명으로 0.8%였다. 그러므로 양호교사가 학교보건 업무내에서 관리 가능한 건강이상 학생 수는 제 1단계와 제 2단계의 합 6,105명으로 79.5%였다. 6. 양호교사 인력투입을 포함한 학생건강평가 프로그램에 대한 건강 평가자별 종합경비의 총 종합경비에 대한 백분율은 양호교사에 의한 것이 48.3%, 초빙의사에 의한 것이 23.5%, 의탁 검사기관에 의한 것이 28.0%였다. 7. 학생건강평가 프로그램에 대하여 소요된 경비를 통하여 학교에서 관리되는 건강이상 학생발견을 위한 단위당 투입경비는 보건 (설문)조사가 158원, 양호실 방문에 의한 평가가 369원, 구강검진 377원, 시력 및 색각검사가 395원, 신체검진이 6,706원, 체격검사가 8,689원, 기생충란 검사가 11.476원, 결핵검진(흉부 X-선 간접촬영)이 108,510원, 뇨당·뇨단백 검사가 각각 157,946원이었다. 8. 양호교사는 학생건강평가후의 사후관리로서, 일반적인 건강이상학생에 대한 개별 또는 집단적인 건강상담 및 보건지도, 담임교사 및 관련교사와의 협조를 통한 학교생활에서의 보호조치, 일부건강이상 내용에 대한 가정에서의 적극적인 치료를 위한 가정통신문, 전화, 면담을 통해 조언하고, 그리고 조치에 대한 회답을 받았으며, 필요시에는 전문의사, 치과의사와 같은 전문인들에게 자문을 구하거나 의료기관에 의뢰하였다. 9. 학교에서 관리되는 건강이상 학생에 대한 건강평가자별 백분율은 분석결과 양호교사에 의한 것이 80.2%였고 학생건강평가 프로그램별 비용분석결과 양호교사에 의해 평가되는 프로그램에 대한 비용은 48.3%였다. 또한 학교에서 평가된 학생건강문제의 해결을 위해 양호교사가 관리 가능한 건강문제분류에 대한 건강이상학생분포가 79.5%임을 볼 때에 양호교사가 적절한 훈련 프로그램에 의해 학교건강간호사(SNP)와 같은 자격을 갖춘다면, 각 단계의 건강문제에 대해 보다 신속하고 경제적이며, 질적으로 우수한 관리를 제공할 수 있을 것이다. 학생들의 건강관리를 위하여 시행된 학생건강평가사업을 평가할 때 학교 보건법에서 규정한 학교보건의료 인력중 양호교사와 학교의(치과의)가 학생 건강평가 사업에 주로 활용되고 있고, 양호교사에 의해 많은 건강이상학생이 관리되고 있음을 파악할 수 있다. 이를 통해 볼 때 학생의 보건관리를 담당하는 네분야의 보건의료인력의 직무와 기능을 현실이 반영되어 성문화함으로써 실제에 있어서 차질이 없이 집행되도록 정책적인 배려가 있기를 바란다. A Study on Health Appraisal and Management of Girls High School Students in Seoul. Mi Lan Han Dept. of Health Science, Graduate School of Health Science and Management, Yonsei University (directed by Prof. Mo Im Kim R.N., Dr.P.H.) Aiming to contribute to better health appraisal and follow-up which are vital components of school health services, this descriptive study is carried out for students of a girls high school in Seoul with analyzing the existing data. To collect necessary data from existing records and reports, the check lists(appendix 4 and 5) are developed. Three trained assistants helped the researcher for reviewing the health appraisal records and reports of students who enrolled from March 1983 to February 1986 and daily activity records of a school health nurses at school. The main findings of this study are as follows: 1. The health appraisal appeares to be the most important activity of school health nurse a little more that a half of her time(53%) was devoted to student health appraisal. 2. Dental caries(17.5%) was found as the most prevalent health problem and followed by wound and burn(15.2%) and common cold(14.9%). 3. Among the total number of students with one health problem at least, 80% of them were found by the school nurse at the health clinic, and about 19% was identified by medical doctors while annual physical examination. Only 1% of them was detected through screening by relevant agencies. 4. Among the school personnel who were directly and indirectly related to student health appraisal and follow-up, the school health nurses was found as the core personnel in organizing and coordinating the activities. 5. The identified health problem of students follow-up could be classified into 4 different levels according to manageability of the school health nurse; Level Ⅰ: 54.5% of all health problems can be cared by school health nurse. Level Ⅱ: 25.0% can be cared by the school health nurse with advice or standing order by specialists in medical, dental and psychological field. Level Ⅲ: 20.2% has to be referred to medical doctor to diagnose at least and are followed-up by the school health nurse. Level Ⅳ: 0.3% of health problems requested immediate care by medical doctor. 6. Spending the budget of health appraisal program in school, it was discolosed that 48.3% of total expenditure including salaries of school health nurse went to school health nurses, 23.5% to medical doctor invited for physical appraisal, and 28.0% for screening by relevant agencies. compared with 80% of detection of health problems through health appraisal found by school nursing activities, only 48.3% of total health appraisal budget covered such activities. 7. In estimation of approximate cost of finding health problems of students, consultation after questionnaire survey counted the most inexpensive (158 won) and followed by consultation while students clinic visitation(369 Won). the most expensive ways of health appraisal in order are as follows; 1) In mass examination through screening, was 157,947 Won spent for urine examination of sugar, but found none of case of diabetes mellitus, and also 157,947 Won was spent for urine examination of protein, but found none of case of kidney diseases. 2) In indirect chest X-ray examination 108,510 Won was spent, but found none of tuberculosis patient. 3) In school examination for parasite, 11,476 Won was spent per case(total 82 case). 4) In growth and developmental examination for finding 22 obesity 8,689 won was spent in each cases. 5) Physical examination cost 6,706 Won oer case finding (total 95 cases). 8. Students once diagnosed and treated required thorough follow-up care as some examples presented. In conclusion, health appraisal and follow-up for students are recognized as the most important area in school health services. The effectiveness and efficiency of various method for student health appraisal needs to be further scrutinyzed.
[영문] Aiming to contribute to better health appraisal and follow-up which are vital components of school health services, this descriptive study is carried out for students of a girls high school in Seoul with analyzing the existing data. To collect necessary data from existing records and reports, the check lists(appendix 4 and 5) are developed. Three trained assistants helped the researcher for reviewing the health appraisal records and reports of students who enrolled from March 1983 to February 1986 and daily activity records of a school health nurses at school. The main findings of this study are as follows: 1. The health appraisal appeares to be the most important activity of school health nurse a little more that a half of her time(53%) was devoted to student health appraisal. 2. Dental caries(17.5%) was found as the most prevalent health problem and followed by wound and burn(15.2%) and common cold(14.9%). 3. Among the total number of students with one health problem at least, 80% of them were found by the school nurse at the health clinic, and about 19% was identified by medical doctors while annual physical examination. Only 1% of them was detected through screening by relevant agencies. 4. Among the school personnel who were directly and indirectly related to student health appraisal and follow-up, the school health nurses was found as the core personnel in organizing and coordinating the activities. 5. The identified health problem of students follow-up could be classified into 4 different levels according to manageability of the school health nurse; Level Ⅰ: 54.5% of all health problems can be cared by school health nurse. Level Ⅱ: 25.0% can be cared by the school health nurse with advice or standing order by specialists in medical, dental and psychological field. Level Ⅲ: 20.2% has to be referred to medical doctor to diagnose at least and are followed-up by the school health nurse. Level Ⅳ: 0.3% of health problems requested immediate care by medical doctor. 6. Spending the budget of health appraisal program in school, it was discolosed that 48.3% of total expenditure including salaries of school health nurse went to school health nurses, 23.5% to medical doctor invited for physical appraisal, and 28.0% for screening by relevant agencies. compared with 80% of detection of health problems through health appraisal found by school nursing activities, only 48.3% of total health appraisal budget covered such activities. 7. In estimation of approximate cost of finding health problems of students, consultation after questionnaire survey counted the most inexpensive (158 won) and followed by consultation while students clinic visitation(369 Won). the most expensive ways of health appraisal in order are as follows; 1) In mass examination through screening, was 157,947 Won spent for urine examination of sugar, but found none of case of diabetes mellitus, and also 157,947 Won was spent for urine examination of protein, but found none of case of kidney diseases. 2) In indirect chest X-ray examination 108,510 Won was spent, but found none of tuberculosis patient. 3) In school examination for parasite, 11,476 Won was spent per case(total 82 case). 4) In growth and developmental examination for finding 22 obesity 8,689 won was spent in each cases. 5) Physical examination cost 6,706 Won oer case finding (total 95 cases). 8. Students once diagnosed and treated required thorough follow-up care as some examples presented. In conclusion, health appraisal and follow-up for students are recognized as the most important area in school health services. The effectiveness and efficiency of various method for student health appraisal needs to be further scrutinyzed.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/117304
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2. 학위논문 > 4. Graduate School of Public Health (보건대학원) > 석사
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