• 대한간호
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• 제35권2호
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• pp.71-91
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• 1996

The objectives of thes study were to identify the need for equipment development in nursing, and to determine the priorities for that development. The study was descriptive study done between March 2 and May 30, 1995, in which the subjects, including 421 patients, 223 family members, and 198 nurses from neurosurgery, orthopedic, rehabilitation medicine, internal medicine and intensive care units of nine general hospitals in Seoul, completed a questionnarie developed by the research team. The questionnaire consisted of 35 open and closed questions. Data was analyzed using frequencies and percentages. The results ware summarized as follows: 1) The average age of the nurses was 27.9 years, 48% of the patients were between 20 and 40 years of age, and 17% were over 60. The average lingth of experience for the nurse subjects was four years five months with 36.9%. having over five years experience. The most frequent diagnoses of patients were spinal disc(35.9%), internal medicine disease(26.0%), cerebral vascular accident(16.6%) and spinal cord injury(10%) 2) Many of the nurses(96.4%) reported deficiencies with existing equipment and 96.5% of the nurses, but only 79.8% of the patients, nurses' time. Further, 82.3% of the nurses and 75.8% of the patients felt that the development of new equipment would lead to a decrease in the cost of nursing care. 3) Nurses felt that the greatest areas of inconvenience were patient feeding(71.7%), hygiene(71.2%), caring for a patient confined to bed(70.7%), patient clothing(67.2%), mobility transfers(63.5%) and urinary elimination(52.0%). However, patients and family members listed the following as being the most inconvenient: urinary elimination(58.7%), Hygiene(50.5), feeding(48.4%), mobility transfers(47.1%) and bed care(45.2%). 4) Generally the nurses listed more inconveniences and patients and family members listed more demands for the development of equipment. These included utensils with large handles, and regulators for tube feedings; mattresses that provide for automatic position change and massage, which have patient controlled levers and a place for bed pan insertion; automatic lifts or transfer from bed to wheelchair; equipment to facilitate washing and oral hygiene as well as equipment that will allow patients with spinal cord injuries easy access to showers; a bed pan/urinal for women that is comfortable and effective from which urine can be measured and disposed of easily; disposable dressing sets and tracheostomy care sets and a convenient way of measuring changes in wound size; a safe delivery system for oxygen, a variety of mask sizes and better control of humidity, tracheal material than at present, as well as a communication system for patients with tracheostomies; clothing that will allow access to various parts of the body for treament or assessment without patients having to remove all of their clothing; and finally a system that will allow the patient to control lighting, telephones and pagers. Priority areas for equipment development reported by the nurses were, urinary elimination(58. 7%), hygiene(50.5%), feeding(48.4%), mobility transfers(47..1%), bowel elimination(40.8%). Those reported by the patients family members were feeding(71.7%), hygiene(70.0%), bedcare(70.7%), clothing(67.2%), mobility transfers(63.6%), urinary elimination(52.9%) and bowel elimination(50.5%) Altogether, nurses, patients and family members listed the following as priorities; clothing (178), bed care(144), urinary elimination(92), environment(81), hygiene(70). Further, a health professional forum listed urinary elimination, oxygen delivery, medication delivery, mobility transfers, bed care and hygiene in that order as priority areas. From this study it can be concluded that the first need is to develop equipment that will address the problems of urinary elimination. To do (l)This nurses who are interested in equipment development should organize an equipment development team to provide a forum for discussion and production of equipment for nursing.

• 성인간호학회지
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• 제21권6호
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• pp.580-592
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• 2009

Purpose: The purpose of this study was to investigate the factors related to Breast cancer Screening using Mammography and CBE of Korean women over 40 years of age. Methods: The participants for this study were 183 Korean women living in 3 urban cities and aged from 40 to 75. The data were collected using structured questionnaires which included sociodemographic factors (11 items), frequency and regularity of mammography and clinical breast examination (7 items), knowledge (16 items), health belief model scale (28 items), and family support (4 items) about breast cancer and breast cancer screening. Frequencies, Chronbach's alpha for reliability, Chi-square, t-test and logistic regression with the SPSS/WIN 12 program were used to analyze the data. Results: The percentages of Korean women who had a mammography and CBE for breast cancer screening were 60.1 and 31.1, respectively. Logistic regression analyses demonstrated that regular check ups and perceived barriers were significant predictors of mammography and CBE use for breast cancer screening. Conclusion: In order to increase the frequency of breast cancer screening practices, educational support and a health care delivery system is needed to improve the chance of regular health check ups.

• 대한예방한의학회지
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• 제4권2호
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• pp.108-118
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• 2000

According to the North Korean documents , North Korean government have emphasized the development of the Koryo medicine (traditional korean medicine) and encouraged the combination of the Koryo and the modern medicine. It is regarded that this attitude arose from the ruler's will toward independency in the medical field and at the same time the lack of modern medical resources . Combinations of the Koryo medicine and the modern medicine in the clinical textbooks are classified as follows: first, mixed medication of the Koryo and the modern medicine. Second, combination of the traditional acupuncture(or moxibustion) and the medication of modern medicines. Third, injection of modern medicines at acupoints. Forth, an intramuscular or an intravenous injection of the Koryo medicine. Fifth, anesthesia using Koryo medicine. Sixth, simple surgery at the acupoints. Lastly, combination of injection and the traditional therapy(eg. acupuncture, moxibustion and cupping) Despite of many achievements in the field of combined medical treatment, recent economic failure and severe famine for several years caused collapse of the health care delivery system in North Korea, and it is hard to find combined practices actually.

• 대한치과의사협회지
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• 제21권12호통권175호
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• pp.997-1003
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• 1983

The author studied the quality and change of the effective demand for dental treatment of the cutpatients of the Wonkwang dental clinic from the March of 1982 to the August of 1983. The results were compared with the previous reports to find any changes that might come from the effect of dental insurance system. After discussing the results, the author concluded as follows: 1. The twenties were the most in the age groups, but it is desirable that age groups of mixed dentition be the most to enhance the dental health status of community. 2. The effective demand for dental treatment increased especially in the areas such as intraoral radiograph taking, amalgam filling, temporary filling, endodontic treatments, and drug application on the soft tissue, but decreased in the areas such as prosthodontic treatments, and there were no demand for the orthodontic treatment. 3. As compared with the absolute needs, the effective demand was relatively high for teeth extraction and amalgam filling, but it was generally very low. 4. So, the present extent of dental insurance system should be expanded, and the dental care delivery system should be established within the community. Finally, the economic and social status of Iri community should be enhance by political and educational plannings.

• 보건행정학회지
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• 제4권2호
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• pp.77-110
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• 1994

This study is an empiriacl analysis of effects of government intervention on the health care delivery system in Korea. The purposes of this study are to find out the effects of government intervention on the per capita national health expenditure(per capita NHE), crude mortality rate(CMR), and institutional efficiency. Here, the institutional efficiency is defined as a formula shown below: log$\frac{100-curde mortality rate }{per capita NHE}$$\times$100. The formula indicates that the instiutional efficiency increases if the CMR and/or per capita NHE goes down. In the meantime the government intervention is measured by six independent variables: I) the degree of social developments, ii) the numberr of physicians per 100, 000 population, iii) the proportion of specialists among the total physicians, iv) the proportion of public expenditure among the NHE, v) the proportion of public beds to the total number of beds, vi) the proportion of physicians working at the public sector to the total number of physicians. In the above six independent variables iv), v) and vi) are the ones that reflect the degree of government intervention. In actual calculation, the two independent variables v) and vi) are integrated into a new variable based on one to one correspondence. The materials used are the time-series data from 1970 through 1990 in Korea. A path analysis and the time-series regression analysis were adopted to estimate and examine the causal relationship between variables involved. And decomposition of the effect of causal relationship is made to find net effect, direct and indirect effect. The major findings are as follows; 1. The effect of public expenditure, number of physicians per 100, 000 population, the proportion of specialists among the total physicians and social development shows a positive relationship with per capita NHE. Only if the government intervention would be counted, the effects of the number of physicians and the proportion of specialists succeed in containing per capita NHE. 2. In additionn to the above four variables, one additional variable, per capita NHE, was also responsible for the reduction of CMR. The factor of social development found to be the most potent predictor of the CMR reduction. However, the CMR reduction due to government intervention was negligible. 3. Meanwhile, the above four variables were found to was have negative effects on the institutional efficiency. The reverse is true when the government intervention is counted. For example, the number of physicians and the proportion of specialists have played a positive role in raising institutional efficiency via goverment intervention. This comes from the factual effect that the increment of institutional efficiency via the reduction of per capita NHE is bigger than via the reduction of CMR.

• 보건행정학회지
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• 제28권1호
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• pp.48-52
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• 2018

Background: The current study evaluated the hospital utilization and characteristics of patients who received health care services for acute cerebral infarction outside their own residential area. Methods: Using the 2014 national patient survey data, information on 2,982 patients diagnosed with acute cerebral infarction through emergency department were retrieved for the analyses. Multiple logistic regression was performed to investigate the characteristics associated with using hospitals outside residential area among patients diagnosed with acute cerebral infarction. Results: Fifteen point nine percent of patients admitted for acute cerebral infarction utilized hospitals outside their residential area. Patients residing in a province were 7.7 times more likely to utilize hospitals located outside their residential areas compared to those living in Seoul metropolitan city. Patients living in Gangwon and Jeolla were 0.26 times and 0.48 times more likely to go to hospitals in different geographical areas. Also, patients within the age group of 80 years and over were 0.65 times less likely to be admitted to hospitals outside their residential area compared to those in their 40s-50s. Conclusion: The use of hospitals outside patient's residential area is shown to be substantial, given that the acute cerebral infarction requires immediate recognition and treatment. The findings on the geographical differences in the hospital utilization suggest further investigation.

• 지역사회간호학회지
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• 제7권2호
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• pp.384-399
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• 1996

The concept of parish nursing began in the late 1960s in the United States when increasing numbers of churches employed registered nurses (RNs) to provide holistic, preventive health care to the members of their congregations. Parish nursing role was developed in 1983 by Lutheran chaplain Granger Westberg, and provides care to a variety of church congregation of various denominations. The parish nurse functions as health educator, counselor, group facilitator, client advocate, and liaison to community resources. Since these activities are complementary to the population-focused practice of community health' CNSs, parish nurses either have a strong public health background or work directly with both baccalaureate-prepared public health nurses and CNSs. In a Midwest community in U.S.A., the Healthy People 2000(1991) objectives are being addressed in health ministries through a coalition between public health nurses and parish nurses. Parish nursing is in the beginning state in Korea and up untill now, there has been no research was conducted on concrete role of korean parish nurses. The main purpose of this study was to identify, classify and analyze activities of parish nurses. The other important objective of this study was to establish an effective approach and direction for parish nursing and provide a database for korean parish nursing model through analysis and' classification of the content of the nursing record which included nursing activities. This study was a descriptive survey research. The parish nurses were working in churches where the demonstration project developed on parish nursing. The study was done on all nursing records which were working in churches where the demonstration project developed on parish nursing. The study was done on all nursing records which were documented by parish nurses in three churches from March, 1995 to February, 1996. Namsan, Taegu Jeei and Nedang presbyterian churches in Taegu and Keimyung nursing college incooperated together for the parish nursing demonstration project. The data analysis procedure was as follows: First, a record analysis tool was developed and second, the data was collected, coded and analyzed, the classification for nursing activities was developed through a literature review, from which the basic analysis tool was produced and cotent validity review was also done. The classification of the activities of parish nurses showed 7 activitity categories. 7 activity categories consisted of visitation nursing, health check-ups, health education, referring, attending staff meetings, attending inservices and seminar, volunteers coordinating. The percentage of activities were as follows: Visitation nursing(A: 51.6%, B: 55%, C: 42.6%) Health check-ups(A: 13.5%, B: 12.1%, C: 22.3%) Health education(A: 13.5%, B: 13.2%, C: 18.2%) Referring(A: 1.4%, B: 4.2%, C: 2.4%) Attending staff meeting(A: 18.8%, B: 13.0%, C: 12.2%) Attending inservices and seminar(A: 1.5%, B: 2.2%, C: 2.1%) Volunteers coordinating(A: 0.3%, B: 0.4%, C: 0.0%) To establish and develope parish nursing delivery network in Korea, parish nurses role, activities and boundaries of practice should be continuously monitored and refined every 2 years. Also, It is needed to develope effective nursing recording system based on the need assessment research data of various congregation members. role, activities and boundaries of practice and arrangement of the working structure, continuing education, cooperation with community resources and structuring and organizing parish nursing delivery network. Also, It is needed to develope effective nursing recording system based on the need assessment research data of various congregation members.

• 지역사회간호학회지
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• 제10권1호
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• pp.70-79
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• 1999

This study attempts to encourage the development of a rehabilitation delivery system as a substitute service for hospitalization such as a community based intermediate facility or home health care. We need substitute services for hospitalization to curtail the length of stay for inpatients due to car accidents. It focused on developing an estimation for early discharge based on a detailed statement of treatment from medical records of 109 inpatients who were hospitalized at General Hospital in 1997. This study has three specific purposes: First, to find the mean length of stay and mean medical expenditure. Second, to estimate the mean of early discharge from the mean length of stay. Third, to analyize the income effect per bed from early discharge. In order to analyze the length of stay and medical expenditure of inpatients the author conducted a micro and macro-analysis with medical expenditure records. To estimate the early discharge we examined with a group of 4 experts decreases in the amount of treatment after surgery, in treatments, in tests, in drug methods. We also looked their vital signs, the start of ROM exercise, the time removel, a patient's visitations, and possible stable conditions. In addition to identifing the income effect due to an early discharge, the data was analyzed by an SPSS-PC for windows and Excell program with a regression analysis model. The research findings are as follows: First, the mean length of stay was 47.56 days, but the mean length of stay due to early discharge was 32.26 days. The estimation of early discharge days was shown to depend on the length of stay. The longer the length of stay, the longer the length before discharge. For example, if the patient stayed under 14 days the mean length of stay was 7.09 while an early discharge was 6.39, whereas if the mean length of stay was 155.73, the early discharge time was 107.43. The mean medical expenditure per day of car accident patients was found to be 169,085 Won, whereas the mean medical expenditure per day was shown to be in a negative linear form according to the length of stay. That is the mean expenditure for under 14 days of stay was 303,015 Won and the period of the hospitalization of 15 days to 29 days was 170,338 Won and those of 30 days to 59 days was 113,333 Won. The estimation of the income effect due to being discharged 16 days was around 2,350,000 Won with a regression analysis model. However, this does not show the real benefits from an early discharge, but only the income increasing amount without considering prime medical cost at a general hospital. Therefore, we need further analysis on cost containments and benefits incending turn over rates and medical prime costs. From these research findings, the following suggestions have been drawn, we need to develop strategies on a rehabilitation delivery system focused on consumers for the 21st century. Varions intermediate facilities and home health care should be developed in the community as a substitute for shortening the length of stay in hospitals. In home health care cases, patients who want rehabilitation services as a substitute for hospitalization in cooperation with private health insurance companies might be available immediately.

• 한국의료질향상학회지
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• 제7권2호
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• pp.190-202
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• 2000

Background : The objectives of this study were to examine patients' satisfaction with the DRG based payment method and its association with their awareness of the method, to examine patient reported changes in doctors' caring attitude, level of their out-of-pocket payments, providers' acceptance of patients' request for additional services after the program, and to examine changes in service utilization recorded in medical records. Method : One hundred-four patients who had cesarean sections before and after the demonstration program at two hospitals located in Seoul participated in the study. Patients were surveyed before discharges when their charges were finalized. Their medical records were reviewed as well to collect data for service utilization during hospital stays. The association between patients' satisfaction with the payment method and their awareness of the method was analyzed by ${\chi}^2$-test, and the significance of changes in providers' acceptance of patients' request for additional services and service utilization after the program were examined by ${\chi}^2$-test and t-test, respectively. Results : A large proportion of patients did not know of the DRG based payment method at the time of survey and a significantly larger proportion of patients who came to the hospitals with the knowledge satisfied with the method. About the same proportion of patients reported improvement and deterioration in doctors' caring attitude compare to the previous hospitalizations and a similar result was found concerning out-of-pocket payments. Providers' acceptance of patients' request for medication, PCA and painless delivery decreased significantly after the program whereas the acceptance for additional hospital days and laboratory and radiology tests did not. Length of stay, the numbers of days on antibiotics and antianemic medication, and the number of blood tests decreased significantly after the program, however, decreases in the rate of antianemic medication and the number of urine analyses were not statistically significant. Re-operation, in-hospital death, and complications were not observed before and after the program. Conclusion : The study findings indicated a need for better patient education and publicity about the newly introduced payment method to improve their satisfaction with the system. Other study findings concerning service utilization and quality of care indicators were consistent with the government funded evaluation studies.

• 간호행정학회지
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• 제1권1호
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• pp.147-211
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• 1995

Medication is a kind of medical service and a therapeutic nursing function which takes large portion of nursing service and requires complicated procedures. So many different medical personnel should be involved and cooporate each other in order to accomplish medication. Medication is also a vital nursing service, So nurse feels heavy responsibi lity in that she gives medication to the patient finally, so she has much responsibility if medication error is happened. Therefore it seems very important to clarify the problem of medication system and method, and find the subculture of medication situation because it may promote nursing productivity. The study was conducted to 1. Describe and interpret medication situation. 2. Find out the problem of medication system and method and on alternatives. 3. Compare the medication system and method of hospitals which are located in Seoul with object hospital Ethnographic methodology was used to study medication situation by doing participant observation and interview of health care personnel. Ten nurses and three nurse aids were interviewed. Two residents and internists, two phamacists and two accountants were also interviewed. Data was obtained and analized according to Developmental Research Sequence introduced by Spradly. On the basis of this data the results were as follows. 1. The overall flow of medication system was devided into six stage : first, checking doctor's order : second writing doctor's order, : third, transfering slip into the related departments such as account department, pharmacy : fourth, distribution of medication from pharmacy to unit : fifth, identifing medication by nurses : and finally, medicating to the patient. Behaviorors have been under a lot of stress in that they have to do much works, especially paperworks, So too much time were needed. They also have been suffered interpersonal conflicts among health care personnel and role conflicts in the process of doing medication service. 2. In the process of checking order, the problem was that too much time was required for checking order and paperwork. The more the order changes the more the paperwork is. Nurses have been suffering difficulties in calling internist in order to get bill. Even if writing down slip for medication order is doctor's job, Sometimes nurse has been expected to write slip by doctors or nurse would write slip beacuse of two much complexities and efforts for calling doctors. If the slip were incorrect, much time complicated procedures were more required for correcting it. So delay of administering drug would be resulted consequently. Drugs were delivered from pharmacy to units by delivery agent and phamacist. But because drugs were delivered without arranging room number of patient. Nurse should rearrange drugs in order of the room number So it had made waste time and effort, and Even when emergency drugs were needed, Prompt delivery of drug was not easy because of many reasons. For nurses, it took too long in the identification of the right drug. Actually nurses have heavy burden when medication error happens because nurse is the final actor who gives medication to the patient, So every three shift nurse ought to check drugs as soon as every shift begins. That's why it took too much time due to repeated confirming procedure. When nurses had to go patient room in order to give medications, there were difficulties in watching patient until the patient take medicine correctly. So it was impossible to check every patient wheather he took medicine or not especially in hectic situation. 3. There were many hospitals in Seoul which have similar medication system and method as object hospital according to the results of questionaire. This means that many hospitals have been suffering srimilar problems which were identified in object hospital. 4. Recommendations for promoting simplification of medication system and method were the following : Redesigning of slip from two pieces of paper into one : early discharge announcement system, and slip confirming through computer and controlling of period of prescreption from one day to two or three days : designing personal drug storage box for each patient and using it. If nurses follow the recommendations, they will make medication short & simple, and also have enough time of direct nursing care 5. Even though there were many difficulties in medicating patients. Medication itself has been considered as a caring among nurses because it makes rapport between nurse and patient. So nurses had better accept medication as a portion of nusing service not a original portion of phamacist. There are some limits in this research in terms of confining to only one unit of one hospital, and treating it especially in view of nurses' aspects, So further researchs should be continnued from various kmds of viewpoints of doctors, phamacists and so on. ${\cdot\cdot\cdot}$. Especially esthnographic study of computerized medication system and method seems to be followed.