In effort to conduct comparative study on the caregiving environment of Neonatal Intensive Care Unit(NICU) in both U. S and Korea, this study was been conducted first in the U. S. PURPOSE: The purpose of this study is to identify the physical environment and direct caregiving practices to lowbirth weight infants in NICU in the US. It also aims to examine the NICU outcome status and behavioral reponses of lowbirth weight infants.
METHODS
A study design using descriptive and inferential statistics was been conducted through an observational, field method. A sample of 15 preterm infants admitted to NICU were recruited for the study. The subjects were those with birth weight between 1,000 gm to 1,500 gm, born at the gestation period of 27 to 33 weeks, and without any chromosomal or maternal illness. Thirty minutes observation(three times of ten minutes of continuous observation) of the infant's behavior and physiological status, and an four-hour observation of the physical environment and direct care giving procedures were been conducted on the 3rd and 10th day after birth, and on the day of discharge from the NICU or at 34weeks postconception. The data to be collected were in four areas: the demographic characteristics of the infants, the physical environment and care giving procedures, the frequency of the infant's designated behavior and physiological response, and NICU outcome variables. A descriptive analysis and Kruskal-Wallis, Pearson r were been applied according to variable characteristics.
RESULTS
1. Mother's mean age was 29.47. The sample consisted of 6 males and 9 females. Mean gestational ages were 29.17 weeks. Man birth weight was 1236.33g. Mean Apgar scores at one minute were 6.6, and 7.8 at five minutes. 2. The location for the incubator was in the distance from the light, X-ray screens and nursing station, in proximity to side-lamp, telephone and faucet on the third day after birth. The location for the incubator was in the distance from the light and radio on the tenth day and in proximity to nursing station on the day of discharge from the NICU or at 34weeks postconception. 3. Nesting was the most applying aids to the infants. And foot roll, shielding and plastic frame were frequently using by nurse for facilitating well modulated restful posture. 4. There were statistically significant changes in the patterns of physical environment included locating the infant's incubator and bedding, specificaids to self regulation on the 3rd and 10th day after birth, and on the day discharge from the NICU or at 34weeks postconception. 5. Statistically significant changes were not appeared in the patterns of direct caregiving procedure to the infants included stress inducing or reducing manipulations on the 3rd and 10th day after birth, and on the day of discharge form the NICU or at 34weeks postconception. 6. The stress response of the infants in NICU were significantly reduced as the infants grow older. 7. There were not statistically significant correlation between the physical environment. and the stress responses of the infants in NICU. 8. The were statistically significant correlation between the direct caregiving procedure to the infants and the stress response of the infants in NICU in the second and third observation on the day three. 9. Average weight gain per day from birth to discharge was 38.73g, number of days in the hospital was 42.60, number of days before bottle feeding was 3.6. Postconception age starting bottle feeding was 31+5 weeks. Number of days on mechanical ventilator was average 7.64, 11.42 was an average number of days of oxygen need.
CONCLUSION
It, thus, appears that to minimize the senso-rymotor stimulation for the low birthweight preterm infant in NICU, manipulation of care giving practices to the babies whatever the stress inducing or reducing procedures, have to be limited in the immediate early stage after birth. And it needed to be reexamine to identify the appropriate and specific physical environment and the patterns of direct caregiving to the low birthweight preterm infant as the infants grow older in NICU.

The early postpartum period is crucial toward in recovery form childbirth and attainment of the maternal role. Maternal role attainment is a complex social and cognitive process of stimulus-response accomplished by learning. Helping for maternal role attainment is one of nursing goals in the early postpartum period. Based on King's conceptual framework for nursing, this study was planned as descriptive correlation study to determine the significant differences of the degree of nursery room nurses' role performance according to several variables of personal, interpersonal, and working system of nurses in nursery room, The purpose of this study was to contribute to the planning of nursing care to help maternal role attainment of the early postpartum period of mothers and to the development of relevant nursing theory, The data were collected from R3b. 3 to 28 by questionnaires with 273 nurses in nursery room. The instruments for this study were consisted of four parts: 21 questions for roll performance of nurse ; 37 questions for personal system of nurse including 31 questions for role perception of nurse ; 65 questions for interpersonal system including 63 questions for job stress of nurse ; 18 questions for working system of nurse. The toes to measure role performance and role perception, and job stress of nurse were tested for internal reliability. Cronbach's Alphas were 0.9612, 0.9058, and 0.9649. The data were analysed by using in S.A.S. computerized program and included percentage, t-test, ANOVA, Pearson Correlation Coefficient, and Duncan multiple range test. The conclusions obtained from this study are summarized as follows : 1. The mean score of the items of role performance was 2.12(SD=0.55) in Likert's 4 points scale. 2. The degree of role performance was significantly different according to role perception(p=0.0001), age(p=0.006), educational background(p=0.002), and certificate of midwife(p=0.03) among variables of personal system of subjects. 3. The degree of role performance was significantly different according to job stress(p=0.0001) and numbers of children(p=0.006) among variables of interpersonal system of subjects. 4. The degree of role performance was significantly different according to having opportunities for baby(p=0.03), the degree of flexibility to bring baby to mother's room(p=0.046), the scope of visitor for baby(p=0.016), the degree of flexibility of visiting for baby(p=0.049), the degree of participation of nurse in establishing visiting rules(p=0.017), existence and/or nonexistence of rules for breast feeding(p=0.010), existence and/or nonexistence of education for breast feeding(p=0.009), existence and/or nonexistence of breast feeding room(p=0.013), concret methods for breast feeding(p=0.003), working place(p=0.0001), and career(p=0.019) among variables of personal system of subjects.

The purpose of this study was to examine the stressors and stress coping styles of 6th grade elementary school children and to explore the relationship between stressful life events and health symptoms and the effects of coping style which is theoretically considered to mediate the relationship between stress and health symptoms. The study subjects consisted of 329 in 6th grade elementary school children in Cheong-Ju city. Of the 329 subjects, 171 were boys and 158 were girls. For this study, three kinds of questionnaires were adopted as follows ; 1) Feel Bad Scale (FBS) by Lewis et al., 2) Lazarus-Folkman's Way of coping questionnaire 3) Hee Sun Shin's Health Symptom questionnaire(HSQ) The researcher visited the school and collected data in the class using the questionnaire method after an explanation of the purpose and procedures was given to the children. Data collection was done for 10 days(from 5th to 15th of July 1997). The data were analyzed by descriptive statistics, correlation analysis, multiple regression analysis using the SAS statistical program. The results of this study were as follows; 1. The mean score for the FBS was 211.37(range : 77-427). The most severe stressors perceived by children were parental divorce and other's smash or steal of my things. The most frequently experienced stressful life events were conflict with siblings and being scolded for other's fault. 2. The most frequently used stress coping style was the active coping (M=17.85), followed by passive(M=13.64) and magical one(M=13.42). 3. The mean score for the HSQ was 23.30(range : 0-72) The most frequently complained health symptoms were headache and having much worry about everything. 4. The was a significant relationship between stressful life events and health symptoms(r=.60, p<.001). Also, stressful life events were positively related with passive coping(r=.27, p<.001) and magical coping(r=.38, p<.001). Health symptoms were positively correlated with passive coping(r=.33, p<.001) and magical coping(r=.41, p<.001). 5. Stepwise multiple regression analysis revealed that the most powerful predictor was the variable of stressful life events. Health concerns, magical coping style, passive coping style and active coping style accounted for 49.15% of the variance in health symptoms. This study revealed that stressful life events correlated with health symptoms in 6th grade elementary school children and passive coping and magical coping had mediating effects on this relationship. The implication for nursing is that there is a need to develop supportive interventions for high risk population to decrease health problems due to stress.

The purpose of this study was to build a substantive theory about the experience of the maternal uncertainty in childhood chronic illness. The qualitative research method used was grounded theory. The interviewees were 12 mothers who have cared for a child who had chronic illness. The data were collected through in-depth interviews with audiotape recording done by the investigator over a period of nine months. The data were analyzed simultaneously by a constant comparative method in which new data were continuously coded into categories and properties according to Strauss and Corbin's methodology. The 34 concepts were identified as a result of analyzing the grounded data. Ten categories were lack of clarity, unpredictability, unfamiliarity, negative change, anxiety, devotion, normalization and burn-out. Causal conditions included : lack of clarity, unpredictability, unfamiliarity and change ; central phenomena : anxiety, being perplexed ; context : seriousness of illness, support ; intervening condition : belief ; action/interaction strategies : devotion, overprotection ; consequences : normalization, burn-out. These categories were synthesized into the core concept-anxiety. The process of experiencing uncertainty was 1) Entering the world of uncertainty, 2) Struggling in the tunnel of uncertainty, 3) Reconstruction of the situation of uncertainty. Four hypotheses were derived from the analysis : (1) The higher the lack of clarity, unpredictability, unfamiliarity, change, the higher the level of uncertainty (2) The more serious the illness and the less the support, the higher the level of uncertainty. (3) The positive believes will influence the devoted care and normalization of the family life. Through this substantive theory, pediatric nurses can understand the process of experiencing maternal uncertainty in childhood chronic illness. Further research to build substantive theories to explain other uncertainties may contribute to a formal theory of how normalization is achieved in the family with chronically ill child.

This study was designed to identity the degree of burden felt by mothers of children with nephrotic syndrome. Also, relations between the subject characteristics and burden were investigated to provide basis data for their family health and nursing intervention. The study subjects were composed of 70 mothers of nephrotic syndrome patients whose children were hospitalized in 2 Pediatric wards of University Hospital in Seoul and 1 in Pusan from Mar. 2nd, 1998 to May. 30th in the same year. The questionnaires were used which dealt with burden of mothers. the questionnaires for this study designed and used by researcher placed their basis in burden Measurement Instrument developed by Montgomery et. al(1985) and the reliability of the used instrument was .78. The data analysis was done by SPSS, t-test, ANOVA and Stepwise Multiple Regression. The results of were as follows. 1. Mean score of burden of subjects was 60.82(Maximum 86, standard deviation 1.244). 2. Of the mothers characteristics, the score of burden was high in case of no religion and low income. 3. Of the patients characteristics, the score of burden ranked as high in MCNS, doing oral therapy and injection therapy at the same time, and negative perceived patients' condition. 4. The degree of burden felt by mothers of children with nephrotic syndrome was significantly predicted by the level of pt's diagnosis(11%), pt's condition(8%), economic state(6%) and pt's sex(5%), respectively. In conclusion to above study, the researcher suggests that the development of instrument for measurement of burden is in much need. Relations between burden and social support should be studied to lessen burden of mothers of children with nephrotic syndrome.

The purpose of this study was to find educational needs of toddler's mother in child-caring experience. The subject of the study was toddler's mother who visited one health care center in J city for immunization and had a child or children between twelve and thirty six months old. The subjects were 37 mothers. The instrument used for this study was a semi-structured questionnaire developed by researcher and based on Objective Content Test of Garretson(1967). The Collected data were analized by two researchers using the method of content Analysis. The results of this study are summarized as follows ; 1) Of the large categories, the need of the highest frequency was 'prevention and management of disease and injury', that of the lowest 'growth and development'. 2) In 'physical care' category, 'care of sleeping' was the highest. In 'nutrition and eating-habitual management' category, 'weaning management' was the highest. In 'prevention and management of disease and injury' category, 'disease management' was the highest. In 'discipline and teaching' category, 'discipline' was the highest. 3) In comparison with preceding references, the educational needs of child-caring which had not been shown in preceding references but had been shown in this study were hair-caring, kind of weaning diet, method of cure and nursing, management of deformity, and so on. In conclusion, educational needs of toddler's mother in child-caring experience were matter-of-fact and inclusive. Needs in management of special situation such as disease were higher than usual parenting procedure or method. In addition, there were higher needs in questions happened through child-caring experience or confirmation of procedures practicing now. Then, it is suggested that parent education program should be developed on the basis of educational needs found in this study to be more effective in preparing mothers's child-caring.

Prematurity is the main cause for respiratory disorders in neonates. The goal in respiratory management is to maintain respiration with adequate oxygenation. Chest vibration(CV) prior to endotracheal suctioning(ETS) has been arbitrarily applied to ventilated premature infants without the scientific evaluation of its safety and efficacy. A repeated measure within subjects experimental study was conducted to investigate the effects of CV prior to ETS on oxygenation and lung secretions in twenty-one ventilated premature infants. The independent variable was the type of research protocol, the control type(ETS without CV) and the intervention(ETS with CV). The dependent variables were oxygen saturation(SpO2), heart rate (HR), measured by pulse oximeter, and the amount of lung secretions measured in gram, the results showed there was no difference in SpO2 responses regardless CV employed before ETS. But there was a significant difference in HR responses between the control and the intervention, even without clinical significance. There was a significant difference in the amount of lung secretions retrieved during ETS with CV, compared to ETS without CV. This study suggested the safety of CV by demonstrating no clinically significant changes in SoO2 and HR in premature infants. The efficacy of CV could be supported by the increases in the amount of sputum during ETS with CV compared to ETS without CV in premature infants.

Disease prevention and health promotions are basically needed to be healthy, health education si the most useful mean to accomplish them, Preschool children are being developed, their health problem can effect their health status through their lives. This study was attempted to survey for status of health education of kindergarten for preshoolers and to provide the basic precious data for nursing intervention. The subjects were 51 kidergarten teachers. The data were collected by the questionnaires, which consists of 25 items concerning daily life habits of children and 1 item concerning the problems of health education for preschoolers. The data were analyzed by SAS program. The results of this study are as followed ; 1. The most frequently educated subjects were 'adequate and safe play' and 'hand washing', 'walking and running straightly', 'oral hygiene or tooth brushing', 'walking staires'. 2. The most frequently used teaching method was the explaining. 3. The most frequently used instructional media was the pictures. The slide films and OHP was seldomly used media. 4. The most effective teaching method which perceived by the kindergarten teachers was role play. Discussion and compensation/reinforcement were comparatively effective method also. 5. The most effective instructional media which perceived by the kindergarten teachers was a real object/model. 6. The problems of health education for preschoolers were 'deficiency of developed health educational programs' and 'inconsistency between parents' education and kindergarten teachers' education', 'deficiency of instructional media'. The other problems were ' the knowledge deficit of teachers themselves' and 'the difficulty of measure the effect of education', 'time deficit'.
Conclusion
ally, we have to realize the health of children is the future of our health, and reinforce the health education for preschoolers to accomplish the disease prevention and health promotion.

The purpose of this study was to identify the children's sleeping patterns, such as the sleeping hours and the nature of sleep disruptions following hospitalization and its accompanying factor. The data were collected from December, 1997 to March, 1998 using a questionnaire developed by researchers. The subjects were 76 children in a hospital. The results of this study were summarized as follows : 1. The average sleeping hours(sleep duration) at night were 10 hours and 10 minutes and 9 hours and 9 minutes before and after hospitalization respectively. There was a significant difference(P<0.01). 2. The mean bed time(sleep onset) was 10:22 pm and 10:28 pm before and after hospitalization respectively. There was no significant difference. 3. The mean hour of rising(sleep termination) was 7:54 am 7:08 am before and after hospitalization respectively. There was a significant difference(P<0.01). 4. The mean number of sleep disruption was 0.72 and 1.94 before and after hospitalization respectively. There was a significant difference(P<0.01). The sleep disruptions were influenced by crying of other children(53.9%), lights(28.9%) nursing procedures(18.4%), noise of TV(17.1%) and noise of visitors(15.8%).

Improvements in therapy have resulted in increasing numbers of children being successfully treated for cancer. However the aggressiveness of therapy & uncertainty about prognosis are associated with many adverse effects, psychological as well as physical for both the child & family. The purpose of this study were to measure the degree of perceived uncertainty, self-efficacy & coping, and then to examine the relationship between the perceived uncertainty, self-efficacy & coping in parents of children cancer patients. The subjects of this study consist of 140 parents with pediatric cancer, registered at pediatric cancer ward & Out Patient Department. Data was collected from July 1st to August 15th 1998. The tools used in this study were Mishel's the Parents' Perception of Uncertainty Scale(28item, 4 likert scale), Shere's Self-Efficacy Scale)17item, 5 likert scale) & Folkman & Lazarus Ways of Coping Checklist)34 items, 4 likert scale). Data was analyzed by t-test, Anova, Pearson Correlation co-efficient.
Results
of this study are summarized as follows : 1. Parents perceived their uncertainty to be slightly high(Mn 2.41). The degree of perceived uncertainty by the four components were followed as : lack of clarity(2.60), unpredictability(2.59), ambiguity(2.51) & lack of information(1.90). The degree of perceived uncertainty of parents with pediatric cancer revealed to be influenced significantly by the family outcome, reliability about health care provider & perceived severity of illness. 2. The range of parents' self-efficacy was measured from 35 to 85 point, so revealed slightly high. The degree of self-efficacy related to be influenced significantly by the sequency of child birth, family religion & degree of perceived support. 3. The degree of parents' coping was measured slightly high(Mn 2.78). The degree of coping related to be influenced significantly by the sequency of child birth, number of sible & degree of perceived support. 4. parents' uncertainty was related inversely to the parents' self-efficacy(r=-.38, p<.001) & coping(r=-.26, p<.001). And also parents' self-efficacy was positively related to coping(r=.56, p<.001). From the above results, it can be concluded that predicting & controlling parents' uncertainty with children cancer are necessary to improve positive coping strategies. This information may be used as a foundation for developing nursing interventions to decrease perceived uncertainty & to foster self-efficacy & coping for parents with children cancer.

The purpose of this study was to investigate the level of anxiety for the mothers of leukemic children and to provide the fundamental data for the better performance of caring to them. The subject were 292 mothers : 100 mothers whose children had a leukemia, 80 mothers whose children had taken a tonsillectomy, 112 mothers whose children with medical disease except cancer. The data were collected through the state-Trait Anxiety Inventory of Spilberger and analyzed by t-test, ANOVA, Scheffe test. The results were as follows ; 1. The state anxiety mean score of mothers with leukemic children was 54.16. 2. The state anxiety of mothers with leukemic children was higher than that of the rest (F=8.00, P=0.0004). 3. There was no significant difference in anxiety of mothers with leukemic children in relation to leukemic children's and their mother's general characteristics.

Illness is a situational crisis which affects entire family members. Children have different experiences and responses when their sibling has a cancer. There are many studies on sibling experiences to childhood cancer which have many problems in the USA. The main purpose of this study is to describe sibling experiences to childhood cancer accurately and coprehensively by collecting data from sibling to provide the data to develop nursing interventions for the families with childhood cancer. The data was collected from October 1 to November 6, 1995. A total of ten siblings with childhood cancer were interviewed. The meaningful contents were classified and categorized to four areas. Theses areas include knowledge and perception related to illness, changes in family life, changes in school life, and siblings' marturation. The results of this study were as follows : 1. Knowledge and perception related to childhood cancer : Children had limited knowledge about illness and expressed the desire to know more about sibling's illness. 2. Changes in family and school life : Children expressed loneness, emptiness, sadness, depression about separation with the mother and sibling, family mood change, leisure activities and financial difficulties. Many children reported that their school performance had suffered since sibling's illness. 3. Maturation of children : Some positive outcomes related to having a sibling with a cancer are maturation, increased affection for the sibling, empathy for their parents. The results of this study indicate that it is important to develop comprehensive nursing intervention programs for the families with a childhood cancer.

The purpose of study was to examine the effect of nonnutritive sucking(NNS) on behavioral state in preterm infants. Fourteen infants(gestational age 28-35 weeks, M=31.86 ; birth weights 1095-2275g, M=1694g) admitted to NICU, serving as their controls were randomly administered 5 min of nonnutritive sucking and a control condition. Behavioral state was measured using the Anderson Behavioral State Scale(ABSS). Heart rates were obtained for each infant before and during NNS and bottle feeding. Data collection was done by 3 experienced nurses in NICU 2 times a day for consecutive 4 days for each subject. Interrater reliability were .80-.90. The findings were as follows : 1. Preterm infants averaged active restless states 58.93% in the preintervention phase and 27.32% in the NNS phase. Inactive awake states were 3.57% in the preintervention phase and 34.64% in the NNS phase. 2. There were significantly more positive changes to inactive awake states for the NNS intervention, Z=-2.35, p=.01. 3. There was no statistically significant difference in heart rate change between NNS intervention and control condition, z=-1.15, p=.24. 4. The rates of feeding success determined by finishing prescribed amount of milk by bottle feeding within 15 minutes were 83.94% in NNS intervention and 89.29% in control condition. The findings from this study confirmed that NNS is effective for behavioral state modulation and inducing optimal state for feeding in preterm infant. The NNS intervention in nursing practice may help the transition of preterm infants for nipple feeding.