• 가정∙방문간호학회지
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• 제2권
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• pp.5-18
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• 1995

While the socioeonomic status of Koreas has been dramatically increasing in recent years, chronic and geriatric diseases have also been on the rise, bringing about many changes in our health care system. The basic goals of the home health care are to reduce health care costs, to increase the attrition rate in general hospitals, and to care for patients effectively and conveniontly at home. The purpose of this paper is to review and examine the current status of the home health care in Korea throughout the reports, surveys, other informations and education system of home health nurse. We identified the various types of home health care services programs, such as hospital-based home health care operated in public sector(demonstration project) and community-based home health care in health centers or in private sector, that is, Korean Nurse Association. Hospital based home heatlh care model was established as an alternative to traditional in-patiet services. Quality assurance and client satisfaction is an important measure of care received and establishment of payment and reimbursement for home health care services is important in promotng the home health care. We found out a fee-per-visit system composed of three kinds of fees : a basic service fee(16,000 Won), a travel fee(5,000 Won), and per-service fees (variables). Like fees paid for in-patient care, insureds pay 20% and insurers pay 80% of the basic and per-service fee. The travel fee is borne totally by the insured. Home health care continues to be viewed as not only the most preferred way to provide care to clients, but also the most cost effective. Home health care is that component of a continuum of comprehensive health care whereby health services are provided to individuals and families in their places of residence for the purpose of promoting, maintaining, or restoring health, or of maximizing the level of independence, while minimizing illness. Services appropriate to the needs of the individual patient and family should be planned and provided, nursing is to be a force for positive change and enhanced the nursing professionalism. Whatever type of involvement of home health care, it is essential to remember that home health care is highly service-oriented and highly touch health car deilvery system.

• 지역사회간호학회지
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• 제28권4호
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• pp.397-409
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• 2017

Purpose: Competency is a key foundation of the nursing education curriculum and a baseline element of nursing practice. The purpose of this study was to explore the competencies of community health nurses in a maternal early childhood sustained home-visiting program based on nurses' field experiences. Methods: The participants were 21 nurses who had more than 1 year of experience in this program. Reflective interviews were performed; lasting 1 hour per nurse, on August 18, 2016, and the collected data were analyzed using qualitative directed content analysis. Results: Twenty-four themes were extracted for 9 competencies. The major themes included implementing a long-term relationship-based approach, providing client-led service rather than expert-led service, helping mothers with psychosocial difficulties, and applying skills in a practical manner in the home environment. Conclusion: In order to develop a home-visiting program as part of maternal-early childhood nursing practice, nurses should develop competencies that help them make significant and positive interventions. Results indicate that the curriculum for community health nurses should be changed to improve competencies in building relationships with clients and to focus on the application of skills in specific cases and in clinical practice.

• 여성건강간호학회지
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• 제5권1호
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• pp.133-145
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• 1999

The purposesof the study are to analyze the community nursing center in U.S.A and to develop the model of nursing care system based on nurse-midwifery clinic in community for women's health in Korea. 1. In America nursing center is defined as nurse-anchored system of primary care delivery or neighborhood health center. Nursing centers are identified the following four types: (1) community outreach centers, which are similar to traditional public health clinics: (2) institutional-based centers following the mission of a large institution, such as a hospital or university: (3) wellness/health promotion centers, which offer screening, education, counseling, triage, and health maintenance services: and (4) independent practice. Nursing centers are a concept of services provided by nurses in practice arrangements in a community. Nursing centers offer a variety of services, ranging from primary care provided by advanced practice nurses with medical acute management and nursing care to the more traditional education, health promotion, screening wellness and coordination services. Some services, such as the care provided by advanced practice nurses are reimbursed under various insurance plan in some instances and states, where as others, such as preventive and educational services, are not. Thus, lack of reimbursement has threatened the survival of some centers. Licensing of nursing centers varies by state and program and accreditation of nursing centers is also limited. 52% of centers are affiliated with another facility and 48% are freestanding centers. The number of registered nurse at the nursing centers ranges from just one to 115, with a mean of eight RNs peragency and a median of three. Nursing centers avail ability varies: 14% are open 24 hours, 27% have variable short hours, 23% are open 6-7 days per week, and 36% are open Monday- Friday. As the result of my visiting three health centers in Seattle and San Francisco, the women's primary care nurse practitioners focus on a systematic and comprehensive assessment of the health status of women and diagnosis and management of common physical and psychosocial health concerns of women in ambulatory settings. Therapeutic nursing strategies are directed toward self-care, risk reoduction, health surveillance, stress reduction, healthy nutrition, social support, healthy coping, psychological well-being, and pharmacological therapy. They function as primary care providers for the well ness and illness care of women from adolescence through the older adult years and pregnant families. 2. In Korea a nurse-midwife practices independently for pregnant women's health including childbearing family at her own clinic in community. Her services are reimbursed under national health insurance but they are not paid on a fee-for-service schedule covering items. Analyzing the nursing centers in America, I suggest that nurse-midwifery clinics offer primary care for women and home care for chronic ill patients. The health law and health insurance policy should be reovised in order to expand nurse-midwife's and home care nurse's roles at nurse-midwifery clinic.

• 가정∙방문간호학회지
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• 제24권2호
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• pp.181-188
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• 2017

Purpose: The aim of this study was to compare between performance and requirements of visiting nursing care in long-term care insurance using the OMAHA system. Methods: The subjects were 72 nurses who had worked in a visiting nursing care center in long-term care insurance. Data were collected from December 5, 2016 to January 31, 2017 using self-recorded questionnaires. The collected data were analyzed using descriptive statistics and paired t-tests. Results: Four dimensions of the OMAHA system showed statistically significant differences between performance and requirements of visiting nursing care in long-term care insurance. The requirements of visiting nursing care were higher than was performance on all 40 items of the OMAHA system. The greatest difference was in environmental domain and then the psychosocial domain. Conclusion: Based on the results, we found that the environmental and psychosocial domains were the largest gap areas. Therefore, with the reality of elderly people living alone and the increase in elderly couples, active intervention connected with the community is needed in residential areas. Further, we suggest that the OMAHA system can be utilized as an integrated conceptual framework for developing and enhancing visiting nursing care in long-term care insurance.

• 가정∙방문간호학회지
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• 제5권
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• pp.20-31
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• 1998

The purpose of this study was to develop the framework of community-based home care nursing delivery system, and to examine the validity of it. For these, home care nursing study team of College of Nursing, Seoul National University has studied home care nursing system since September, 1996, and has operated home care center since August, 1997. This study has been supported by the Korean Sience Foundation. We organized Committee of rules, and Clinical specialist consultant group for more efficient running of the home care center. In nursing station, research assistant controlled general work, and 5 home care nurses were hired for home visiting. We developed the Standards for operations, that included criteria for clients, central supply system of nursing materials, central management of nursing care cost, advertisement, patient referral system, and so forth. In our center, 108 patients enrolled, and neurologic disorders including cerebrovascular accident, and cancer were the most prevailing diseases. We tried to overcome the limitations of hopital -based home care, and to provide more accessible, efficient, safe, and stable home care nursing. Therefore, we were referred clients from patients and families, public health care center, industries, as well as from hospitals. Meanwhile, we developed home care recording system and assessment-intervention algorithm for various diseases for quality control and standardization. Also, we did continuing education, and tried to detect problems and to find solutions by regular meeting between the committee of rules and home care nurses. As the results of this study, several limitations of operation were found. First, it was difficult to manage and communicate with the doctor in the emergency situation, Second, we spent too much time for trasnsportation, because only five nurses covered all areas of Seoul and nearby cities. Third, preparation for special care of home care nurses were lacked. Forth, criteria for termination of care and frequency of home visit were ambiguous. Fifth, some difficulties were found in retrospective payment system. And finally, interconnection with home care machinery company were needed. Strategies for solving these problems were suggested.

• 한국보건간호학회지
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• 제34권1호
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• pp.5-21
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• 2020

Purpose: This study compared visiting nursing services of Denmark, Sweden, Japan, and the United States to provide baseline data for the development of models for community care nursing services in South Korea. Methods: A review of the literature was performed that include journal articles, government reports, institutional reports, and national/international statistics. Site visits were performed to explore the visiting nursing services of Denmark. Results: Government centered visiting nursing services were provided in Denmark and Sweden mostly by public organizations, while private services prevailed in the United States and Japan. Nursing services included case management or care coordination services, while nurse practitioners or nurse specialists provided visiting nursing services in all of the four countries and the services were provided 24 hour a day. Conclusions: Based on the review of visiting nursing services in foreign countries, the development of models is needed to provide integrated visiting nursing services in Korea that encompass home care nursing, visiting nursing, and visiting health care services.

• 한국주거학회:학술대회논문집
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• 한국주거학회 2009년도 추계학술발표대회 논문집
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• pp.121-125
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• 2009

The nursing-care insurance system started in April, 2000 in Japan. It was a kind of business opportunities for a lot of private entrepreneurs. They came into this care service business from another type of business rapidly. They opened the pay nursing homes with 24 hour nursing. However, the expense load of the nursing-care insurance system was large, local governments started controlling on total numbers of facilities with 24 hours nursing in 2006. So the group houses besides the pay nursing home without nursing care are paid to attention. The pay nursing home has been often managed by the nursing business. Most of the group houses are managed by community based NPO. This study is a case study by the visit and the interview form for one of the group houses. The group house "Shalom Tsukimino" in Kanagawa started operations comparatively at early time among them. Through the study we recognized that a lot of people were helping the NPO as a community service. So they can manage the group house and people who live there get the services with low cost. They show that they separate residence and nursing and use the community service efficiently. We can find a new direction in this case for the life in elderly.

• 지역사회간호학회지
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• 제11권2호
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• pp.399-410
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• 2000

In this, analyzing the type of subjectivity in which people would have about home visit nursing services originating from public health care centers. I tried to research more effective ways to improve home visit nursing care services. and later. for the development of home visit nursing care. to supply basic data. The method for this study was the Q-method. created by William Stephenson. and was adequate for the study of subjectivity. For this study. through the deep interview. literature inquiry, and the discussion course. 206 Q-statement sentences were abstracted. and based on them, after Q-sample-selection. I then collected the Q-categorized-result from 32 subjects from Mar. 10. 2000 to Mar. 25. 2000. Through the statistic a analysis of PC-Qunal program. the subjectivity species were categorized and analyzed. The study results show that there are 3 sorts of recognition types. and they are analyzed in the following; The first type: the positively receiving type shows that they feel thankful and a trusting feeling about home visit nursing. The second type: the negatively mistrusting type shows that they had doubtful attitudes about the specialty of home visit nursing: they wanted medicine or nutrition remedies rather than health education and concerning the their own health care, they prefered the hospitals or clinics. The third type: the conditional receiving type shows that even though they had a positive receiving attitude about home visit nursing wanting to consult with the home visit nurses about the difficult problem which could not easily be settled, hoping that the home visit nurses could visit them more often, in their actual lives. they strongly indicated their attitudes concerning money as more important than home visits. The subjects in these 3 types commonly had a good feeling about the kindness of the home visit nurses: the first and third types also had a positive recognition about home visit nursing; however. in aspects of the evaluation and receiving attitudes, they showed a big difference. When all the above results are integrated. in the case of the first type the home visit nursing service, which satisfied the demand for health care of the medically weak people. should be continuously supplied. Additionally in case of the second type (negatively mistrust). continuous education and support should be supplied with enough interest to lead their concerns about their own health care as well as lead medical spending in a productive and effective direction in order to change their impressions. Through this study. I learned that the recognition of the objectives of home visit nursing services can be categorized in to 3 types and could be analyzed. Thus I wish that this study helps to present basic data which contributes to the development of the home visit nursing field.

• 지역사회간호학회지
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• 제31권2호
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• pp.143-155
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• 2020

Purpose: This study aimed to explore the difficulties and coping that advanced practice nurses (APNs) experience in home health nursing field. Methods: The participants were 12 APNs who had experience in home health nursing for over 5 years. Data were collected through two focus group interviews between August and September, 2017. The results were analyzed using a qualitative content analysis. Results: Out of 10 sub-categories and 29 codes, 4 categories emerged: "crushed by the responsibilities as the only healthcare professional", "worn out by family who interfere with work", "anxiety about my safety being threatened" and "using self-learned know-hows". Conclusion: APNs face difficulties due to the environmental characteristics of the homes, the characteristics of chronically critically ill (CCI) patients and their families, and legal or systematical limitations when dealing with problems based on their personal competence. In order to ensure that professional nursing care is more readily provided to CCI patients through home health nursing services in local communities, it is imperative that support systems at the organizational and institutional levels be established in a systematic way to resolve the issues faced by APNs.

• 지역사회간호학회지
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• 제12권2호
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• pp.361-374
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• 2001

This study was done to identify a status of home visiting project as a community health nursing system, that was the organization. personal who have age, educational background, marital status, position, experience of the home visiting in the public sectors in part of Seoul. Kyonggi, Kang-won area, It was done to provide basis data for the development of effective visiting nurses project in the health sectors, where was Health Centers in urban and rural. Branch of Health Center in rural and Health posts. The question airs were distributed 352 public health workers who working place was 118 health workers in 12 health centers in Seoul. 56 public health workers among 39 health center and other public health sectors in Kyonggi and 178 public health workers among health center and health care sectors. Data collected from October to December. 2000. The analysis by SAS system with F test, percentage and frequency. The major result were as follows. The general characteristics of the respondent show that most of them were graduates from community college and RN-BS with broadcast that they had not completed CPHN course but only two health workers have trained for the visiting nurses project. As for their grade in the position, the most of health workers have seventh level and the other CHP were above sixth level in the health care post that in the government structure. This indicates that workers do not have great authority in decision making, the most period of works in the position was one and two years indicating that they change jobs frequently. On an average their clinical experience was 4.11 years which is ideal for the total service. As for preparation of staff for home visiting workers education on visiting nurses program have to receive short term or longer term training course for strong emphasis. The analysis showed that public health visiting workers responds about active job performance that based on an area, approach of acting by districts, education and position are shown statistically significant difference between acceptance of the visiting nursing job show the same as well as visiting nurses project. Special concerns for visiting Nursing care spread came to burden, many of activity carry out main solution is covered the health problem connective support system needs of quality and quantity which out health problem. As 71.1% of visiting health service held on the poor population was under the guardianship of the law, but people who health insurance wide application under law shown a tendency to increase gradually. The general characteristics of the patients showed 56.2% of female on average of age was 66.1 years old, they have health problem was the most of 47.6% of high blood pressure and stroke, the other and as a problem that economics, which is complex welfare with out health problem. Community health care service should be combined health and social work program. The form of delivery of visiting health care given the most guide and education with counselling and support. (33.6%) Among the six category of visiting care service shown statistically significant difference and next is fundamental care, remedy care with priority.