DOI QR코드

DOI QR Code

Factors Influencing Residents' Activities of Daily Living Related to Nursing Staff in Korean Nursing Homes using Path Analysis

  • Jung, Sun Ok (Dept. of College of Nursing, Ewha Womans Univ.) ;
  • Shin, Juh Hyun (Dept. of College of Nursing, Ewha Womans Univ.) ;
  • Lee, Jiyeon (Dept. of College of Nursing, Catholic Univ. of Pusan)
  • 투고 : 2022.01.23
  • 심사 : 2022.06.01
  • 발행 : 2022.06.30

초록

Purpose: The purpose of this study was to empirically test a model of associations linking locations and competition among nursing homes (NHs), mediated by facility grade and registered nurse (RN) turnover, on activities of daily living (ADLs) in Korean NHs. Methods: This study used a cross-sectional design to identify causal factors on NH residents' ADLs. Data were collected from June 2017 to August 2017. A disproportionate stratified cluster sampling method of NHs across Korea was used to gain representation. The collected data consisted of location and the Herfindahl-Hirschman Index (HHI), RN turnover rate, facility grade, and NH residents' ADLs. Results: All pathways affecting ADLs were not significant, and the effect on facility grade was significant in RN turnover (β = -.59, p < .001). RN turnover associated negatively with facility grade. In other words, the higher the RN turnover, the worse the facility grade. Conclusion: This study is the first to examine the impact of location and HHIs, mediated by RN turnover rate and facility grade, on NH residents' ADLs. To improve residents' ADLs, subsequent studies are needed to identify the factors affecting ADLs utilizing other variables because this study did not identify factors that affect ADLs.

키워드

과제정보

This work was supported by the National Research Foundation of Korea in 2021 (Grants 2021R1A2C2007104).

참고문헌

  1. P.F. Edemekong, D.L. Bomgaars, S. Sukumaran, and S.B. Levy, Activities of Daily Living, StatPearls Publishing, 2021.
  2. H. Hofmann and S. Hahn, "Characteristics of Nursing Home Residents and Physical Restraint: A Systematic Literature Review," J Clin Nurs, Vol. 23, No. 21-22, pp. 3012-3024, 2014. https://doi.org/10.1111/jocn.12384
  3. Wonju: National Health Insurance Corporation, Long-term care insurance system for the elderly. https://www.longtermcare.or.kr/npbs/indexr.jsp
  4. Wonju: National Health Insurance Corporation, 2019 Long-term care insurance statistics yearbook. https://www.nhis.or.kr/nhis/together/wbhaec07200m01.do?mode=view&articleNo=138244
  5. J.E. Gaugler, S. Duval, K.A. Anderson, and R.L. Kane, "Predicting Nursing Home Admission in the US: A Meta-Analysis," BMC Geriatrics, Vol. 7, No. 1, pp. 1-14, 2007. https://doi.org/10.1186/1471-2318-7-13
  6. Sejong: Ministry of Health and Welfare. 2017 elderly survey. https://kosis.kr/statisticsList/statisticsListIndex.do?menuId=M_01_01&vwcd=MT_ZTITLE&parmTabId=M_01_01&outLink=Y&entrType=#content-group
  7. J. Li, X. Xu, J. Sun, W. Cai, T. Qin, M. Wu, et al, "Activities of Daily Living, Life Orientation, and HealthRelated Quality of Life Among Older People in Nursing Homes: a National Cross-Sectional Study in China," Quality of Life Research, Vol. 29, No. 11, pp. 2949-2960, 2020. https://doi.org/10.1007/s11136-020-02571-w
  8. E.H. Kim and J.W. Lee, "A Study on Activity of Daily Living, Perceived Health Status, Depression of Elderly to Types of Residency (In Home and In Institution)," J Korean Data Analysis Soc. Vol. 11, No. 1, pp. 183-197, 2009.
  9. R. Wang, D. Zhang, S. Wang, T. Zhao, Y. Zang, and Y. Su, "Limitation on Activities of Daily Living, Depressive Symptoms and Suicidal Ideation Among Nursing Home Residents: The Moderating Role of Resilience," Geriatric Nursing, Vol. 41, No. 5, pp. 622-628, 2020. https://doi.org/10.1016/j.gerinurse.2020.03.018
  10. K. Sung, "Predictive Factors Associated with Death of Elderly in Nursing Homes," Asian Nursing Research, Vol. 8, No. 2, pp. 143-149, 2014. https://doi.org/10.1016/j.anr.2014.05.004
  11. J.H. Shin, E.M. Kim, and J.Y. Lee, "Factors Relating to the Quality of Care for Nursing Home Residents in Korea: Using the Delphi Method," J Korean Academy of Nurs. Vol. 49, No. 6, pp. 783-794, 2019. https://doi.org/10.4040/jkan.2019.49.6.783
  12. J.M. Lee, M.J. Park, E.J. Han, and E.E. Suh, A Study on Management of Medical Needs of the Elderly in Korean Long-Term Care Facilities 2012-19, Health Insurance Policy Institute, p. 202, 2012.
  13. C. Harrington and J.H. Swan, "Nursing Home Staffing, Turnover, and Case Mix," Medical Care Research and Review, Vol. 60, No. 3, pp. 366-392, 2003. https://doi.org/10.1177/1077558703254692
  14. J.H. Shin, G.Y. Choi, and J. Lee, "Impact of Nurse Staffing, Skill Mix and Stability on Resident Health Outcomes in Korean Nursing Homes," J Korean Gerontol Nurs. Vol. 22, No. 4, pp. 291-303, 2020. http://dx.doi.org/10.17079/jkgn.2020.22.4.291
  15. M. Henskens, I.M. Nauta, M.C. Van Eekeren, and E.J. Scherder, "Effects of Physical Activity in Nursing Home Residents with Dementia: A Randomized Controlled Trial," Dementia and Geriatric Cognitive Disorders, Vol. 46, No. 1-2, pp. 60-80, 2018. https://doi.org/10.1159/000491818
  16. J.H. Shin, I.S. Shin, and J.Y. Lee, "Factors Influencing Nursing Home Accreditation-Quality Ratings in Korea," J Korean Gerontol Nurs. Vol. 22, No. 3, pp. 226-235, 2020. http://dx.doi.org/10.17079/jkgn.2020.22.3.226
  17. R.M. Werner, R.T. Konetzka, and M.M. Kim, "Quality Improvement Under Nursing Home Compare: The Association Between Changes in Process and Outcome Measures," Medical Care, Vol. 51, No. 7, pp. 582-588, 2013. https://doi.org/10.1097/mlr.0b013e31828dbae4
  18. X. Zhao, "Competition, Information, and Quality: Evidence from Nursing Homes," J Health Econ. Vol. 49, pp. 136-152, 2016. https://doi.org/10.1016/j.jhealeco.2016.05.004
  19. Y.O. Susilo and K.W. Axhausen, "Repetitions in Individual Daily Activity-Travel-Location Patterns: A Study Using the Herfindahl-Hirschman Index," Transportation, Vol. 41, pp. 995-1011, 2014. http://dx.doi.org/10.1007/s11116-014-9519-4
  20. C. Martin and M. Ramos-Gorand, "High Turnover Among Nursing Staff in Private Nursing Homes for Dependent Elderly People in France: Impact of the Local Environment and the Wage," Economie et Statistique, Vol. 493, No. 1, pp. 49-66, 2017. http://dx.doi.org/10.24187/ecostat.2017.493s.1912
  21. J.S. Choi, S. Choi, S. Lee, E. Han, and M.I. Kim, "Does Market Competition Facilitate Resident-Centered Care Among Nursing Homes? A Comparative Analysis," Asia Pacific J Social Work and Dev. Vol. 26, No. 1, pp. 15-28, 2016. https://doi.org/10.1080/02185385.2016.1150874
  22. American Health Care Association, Staffing survey report. http://www.ahcancal.org/research_data/staffing/Documents/2011%20Staffing%20Survey%20Report.pdf
  23. Centers for Medicare & Medicaid Services, MDS 3.0 quality measures user's manual (v8.0 04-15-2013). http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Downloads/MDS-30-QMUser's-Manual-V80.pdf
  24. A. Donabedian, "Evaluating the Quality of Medical Care," Milbank Mem Fund Quarterly, Vol. 44, No. 3, pp. 166-206, 1966. https://doi.org/10.1111%2Fj.1468-0009.2005.00397.x https://doi.org/10.1111%2Fj.1468-0009.2005.00397.x
  25. P. Johnson-Carlson, C. Costanzo, and D. Kopetsky, "Predictive Staffing Simulation Model Methodology," Nurs Econ. Vol. 35, No. 4, pp. 161, 2017.
  26. J.R. Bowblis and R. Applebaum, "How Does Medicaid Reimbursement Impact Nursing Home Quality? The Effects of Small Anticipatory Changes," Health Services Res. Vol. 52, No. 5, pp. 1729-1748, 2017. https://doi.org/10.1111/1475-6773.12553
  27. L.H. Aiken, D.M. Sloane, J.P. Cimiotti, S.P. Clarke, L. Flynn, J.A. Seago, et al., "Implications of the California Nurse Staffing Mandate for Other States," Health Services Res. Vol. 45, No. 4, pp. 904-921, 2010. https://doi.org/10.1111%2Fj.1475-6773.2010.01114.x https://doi.org/10.1111%2Fj.1475-6773.2010.01114.x
  28. F. El-Jardali, R. Hammoud, L. Younan, H.S. Nuwayhid, N. Abdallah, M. Alameddine, et al., "The Making of Nursing Practice Law in Lebanon: A Policy Analysis Case Study," Health Res. Pol. and Syst. Vol. 12, No. 1, pp. 1-15, 2014. https://doi.org/10.1186/1478-4505-12-52
  29. K. Van den Heede, J. Cornelis, N. Bouckaert, L. Bruyneel, C. Van de Voorde, and W. Sermeus, "Safe Nurse Staffing Policies for Hospitals in England, Ireland, California, Victoria and Queensland: A Discussion Paper," Health Policy, Vol. 124, No. 10, pp. 1064-1073, 2020. https://doi.org/10.1016/j.healthpol.2020.08.003
  30. A.M. Trinkoff, K. Han, C.L. Storr, N. Lerner, M. Johantgen, and K. Gartrell, "Turnover, Staffing, Skill Mix, and Resident Outcomes in a National Sample of US Nursing Homes," J Nurs Admin. Vol. 43, No. 12, pp. 630-636, 2013. https://doi.org/10.1097/nna.0000000000000004
  31. J.H. Shin and I.S. Shin, "The Effect of Registered Nurses on Nursing Home Residents' Outcomes, Controlling for Organizational and Health Care Market Factors," Geriatric Nursing, Vol. 40, No. 3, pp. 296-301, 2019. https://doi.org/10.1016/j.gerinurse.2018.11.004
  32. J.Y. Lee and J.H. Shin, "Why Do They Stay? Intention to Stay Among Registered Nurses in Nursing Homes," Int. J Env. Res. and Pub. Health, Vol. 17, No. 22, pp. 8485, 2020. https://doi.org/10.3390/ijerph17228485
  33. E. Cho, H. Kim, S.J. Chang, H. Kim, and J. Kim, "Exploring Nurses' Perceptions of Nursing Home Care in South Korea: A Qualitative Study," J Korean Gerontol Nurs. Vol. 22, No. 2, pp. 85-94, 2020. https://doi.org/10.17079/jkgn.2020.22.2.85
  34. E. Cho, I.S. Kim, T.W. Lee, G.S. Kim, H. Lee, and D. Min, "Effects of Registered Nurse Staffing on Quality of Care and Resident Outcomes in Nursing Homes," Geriatric Nursing, Vol. 41, No. 6, pp. 685- 691, 2020. https://doi.org/10.1016/j.gerinurse.2020.04.001
  35. S.D. Horn, S.S. Sharkey, S. Hudak, R.J. Smout, C.C. Quinn, B. Yody, et al., "Beyond CMS Quality Measure Adjustments: Identifying Key Resident and Nursing Home Facility Factors Associated with Quality Measures," J Am. Med. Dir. Assoc. Vol. 11, No. 7, pp. 500-505, 2010. https://doi.org/10.1016/j.jamda.2009.10.008
  36. S.R. Hunt, J.C. Probst, K.S. Haddock, R. Moran, S.L. Baker, R.A. Anderson, et al., "Registered Nurse Retention Strategies in Nursing Homes: A Two-Factor Perspective," Health Care Management Rev. Vol. 37, No. 3, pp. 246-256, 2012. https://doi.org/10.1097/hmr.0b013e3182352425
  37. V.R. Comondore, P.J. Devereaux, Q. Zhou, S.B. Stone, J.W. Busse, N.C. Ravindran, et al., "Quality of Care in For-Profit and Not-For-Profit Nursing Homes: Systematic Review and Meta-Analysis," BMJ, pp. 339, 2009. https://doi.org/10.1136/bmj.b2732
  38. A. Bos, P. Boselie, and M. Trappenburg, "Financial Performance, Employee Well-Being, and Client Well-Being in For-Profit and Not-For-Profit Nursing Homes: A Systematic Review," Health Care Management Rev. Vol. 42, No. 4, pp. 352-368, 2017. https://doi.org/10.1097/hmr.0000000000000121
  39. A. Satorra and W.E. Saris, "Power of the Likelihood Ratio Test in Covariance Structure Analysis," Psychometrika, Vol. 50, No. 1, pp. 83-90, 1985. https://doi.org/10.1007/BF02294150