• Child Health Nursing Research
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• v.19 no.1
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• pp.59-68
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• 2013

Purpose: This study was conducted to identify current health care management and barriers in health care management according to ecological systems, and to develop an ecological model for enhancing health care in child care centers. Methods: Focus group interviews were conducted with directors and teachers of child care centers, and with parents of children enrolled in child care. Data were analyzed by the latent content analysis method. Results: Twelve categories of health care management were identified. Barriers to child health care included knowledge deficit and lack of competence in health care by teachers, lack of useful health care manuals, non-existence of professional child health care personnel in child care centers, lack of mutual information sharing and disagreement on child health conditions between child care personnel and parents, lack of specific health related child care inspection criteria and time flexible child care centers with a lack of policy on collaboration with health care facilities. The ecological model developed included specific strategies to improve health care management in child care. Conclusion: The proposed ecological model to improve child health care management should be useful to plan future health care program considering both the immediate and indirect social environment surrounding children in child care.

• Health Policy and Management
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• v.24 no.4
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• pp.312-321
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• 2014

Background: To evaluate the quality of chronic care provided by public health centers located in a South Korean metropolitan city using a modified Assessment of Chronic Illness Care (ACIC). Methods: We conducted self-evaluation surveys and collected data using a modified ACIC from twenty five public health centers. Cultural validity of the original ACIC was examined by the public health and nursing science experts. Based on expert reviews, cognitive interviews, pre-test results, five items of the original ACIC that were not relevant were deleted. The response scale was changed from twelve-point Likert scale to Guttman scale but its scoring system was maintained. Results: Eighty eight percent of public health centers in this study reported that their overall quality of chronic care was at a limited or basic level. About 68% of the centers reported that the organization was as reasonably good or fully developed to provide chronic care. On the other hand, 96% of the public health centers reported that the clinical information system was at a very limited or basic support level. The decision support, the integration of Chronic Care Model components, the delivery system design, the community linkages, and the self-management support were evaluated as limited or basic level of support by more than half of the public health centers, respectively. Conclusion: In a metropolitan area of South Korea, quality of chronic care in public health centers was not found to reach acceptable levels of services. It is critical to enhance the quality of chronic care in public health centers.

• Journal of Korean Academy of Nursing
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• v.35 no.8
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• pp.1493-1499
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• 2005

Background. Adequate staffing is necessary to meet patient care needs and provide safe, quality nursing care. In November 1999, the Korean government implemented a new staffing policy that differentiates nursing fees for inpatients based on nurse-to-bed ratios. The purpose was to prevent hospitals from delegating nursing care to family members of patients or paid caregivers, and ultimately deteriorating the quality of nursing care services. Purpose. To examine nurse staffing levels and related factors including hospital, nursing and medical staff, and financial characteristics. Methods. A cross-sectional design was employed using two administrative databases, Medical Care Institution Database and Medical Claims Data for May 1-31, 2002. Nurse staffing was graded from 1 to 6, based on grading criteria of nurse-to-bed ratios provided by the policy. The study sample consisted of 42 tertiary and 186 general acute care hospitals. Results. None of tertiary or general hospitals gained the highest nurse staffing of Grade 1 (i.e., less than 2 beds per nurse in tertiary hospitals; less than 2.5 beds per nurse in general hospitals). Two thirds of the general hospitals had the lowest staffing of Grade 6 (i.e., 4 or more beds per nurse in tertiary hospitals; 4.5 or more beds per nurse in general hospitals). Tertiary hospitals were better staffed than general hospitals, and private hospitals had higher staffing levels compared to public hospitals. Large-sized general hospitals located in metropolitan areas had higher staffing than other general hospitals. Occupancy rate was positively related to nurse staffing. A negative relationship between nursing assistant and nurse staffing was found in general hospitals. A greater number of physician specialists were associated with better nurse staffing. Conclusions. The staffing policy needs to be evaluated and modified to make it more effective in leading hospitals to increase nurse staffing.

• Perspectives in Nursing Science
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• v.14 no.1
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• pp.37-44
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• 2017

Purpose: This study aimed to provide information on the developmental process and current status of Advanced Practice Nurses (APN) and to suggest ways for activating APN roles in Korea. Methods: We reviewed literatures to explore domestic and international trends related to the roles, practice settings, scope of practice, regulatory policies, and political environment of APN. Results: Interest in the APN role has been gaining ground worldwide. While the roles of APN in the USA, Taiwan and Japan have been changed in terms of legislation and institutional regulations, the role of APN in 12 fields except for APN in home care has not been legislated since qualification was specified in Korean Medical Law. Many problems were found in vitalizing APN roles: absence of legal regulations on the scope of practice or health insurance coverage for APN, increase the number of medical support staffs who are not qualified, and a disagreement regarding the qualification field and practical field. Conclusion: This study presents snapshots and vitalizing strategies of practice, and regulation for APN to develop their unique roles in Korea. The tasks and duties of APN should be identified specifically to fulfill their roles. In terms of national health insurance policy APN's Nursing care should be reimbursed just as nursing care of APN in home care.

• Journal of Korean Academy of Nursing
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• v.49 no.6
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• pp.783-794
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• 2019

Purpose: This study identified factors related to the quality of care in nursing homes, and elicited consensus opinions from experts on nursing homes. Methods: A Delphi questionnaire was developed based on a review of the literature using the keywords "nursing homes," "workforce," and "quality of care." A total of two Delphi surveys were conducted with 14 experts. The important and urgent factors related to the quality of care for nursing home residents emerged. Results: A consensus was achieved on the important and urgent factors relating to the quality of care. The related factors were grouped into four sections: Organizational Characteristics, Staffing Characteristics, the Long-Term Care Market and Legal and Policy Issues, and Nursing Processes. In total, 23 items were important factors and 26 items were urgent factors relating to the quality of care. In addition, the unanimous advocacy by the experts for increased hours per resident day for registered nurses (RNs, 41 minutes 59 seconds) was much higher than the current hours per resident day of RNs in Korea. Conclusion: To provide optimal care for residents in nursing homes in Korea, the mandatory and essential placement of RNs with professional knowledge and skills is paramount.

• Journal of Korean Academy of Nursing Administration
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• v.21 no.2
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• pp.174-183
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• 2015

Purpose: This study was conducted to explore the impact of nurse staffing level and oral care on pneumonia in elderly inpatients in long-term care hospitals (LTCHs). Methods: Data were obtained from the Health Insurance Review and Assessment Services (HIRA) including the profiles of LTCHs, monthly patient assessment reports and medical report survey data of pneumonia patients by HIRA in the fourth quarter of 2010. The sample consisted of 37 LTCHs and 6,593 patients. Results: Patient per nurse staff (OR=1.43, CI=1.22~1.68) and no oral care (OR=1.29, CI=1.01~1.64) were significantly related with hospital acquired pneumonia. The difference in percent of oral care by hospital was not significant between high and low group in nurse staffing level. Conclusion: In order to reduce the occurrence of pneumonia in eldery patients, effective nursing interventions are not only required but also nurse staffing levels that enable nurses to provide the intervention.

• Child Health Nursing Research
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• v.19 no.4
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• pp.247-251
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• 2013

Children from low income families are vulnerable to physical problems including obesity, asthma, hypertension and psychological problems including depression, anxiety. This study was done to identify trends in welfare policy for children from low-income families and future direction for solving health disparity problems. Dream Start is a government-sponsored project that offers services for vulnerable children, ages 0 (include pregnant woman) to 12 years and their families. The Korean Government has made an effort to alleviate health disparity through the 'Health Plan' by establishing health objectives. However, in spite of these efforts by the Korean government, health disparity has worsened in Korea. In order to strengthen family function as well as promote growth and development for vulnerable children, experts in child care need to be significantly involved in identifying neglected children in the community.

• Journal of Korean Academy of Nursing Administration
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• v.10 no.1
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• pp.1-9
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• 2004

Korean health insurance has adopted preliminary DRG payment system through 8 DRGs from 1997. But present DRG payment system gives economic incentives for hospitals to hire less nurse. This study was attempted to develope DRG adjust index to differentiate DRG price by nurse staffing level for nursing care quality. Method: We analyzed inpatient care cost by medical institute and developed DRG adjust index to differentiate DRG price by nurse staffing level. Results: Among same medical institute, inpatient care cost are very different according to hospital's nurse staffing level. In the case of casarean section, inpatient care cost of the 1st grade general hospital are more expensive 85,732won than the 6th grade hospital. The cost difference are 8.24% of total casarean section DRG price and 16.48% of DTG variable price. We developed DRG adjust index-a to apply DRG variable price and index-b to apply DRG total price for compensation cost difference of hospitals. Conclusions: DRG price adjust index will give economic incentive for hospitals to hire more nurse and improve nursing care quality.

• Research in Community and Public Health Nursing
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• v.22 no.4
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• pp.438-450
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• 2011

Purpose: This study was to investigate the effect of home visiting care service and to evaluate the effect from the cost-benefit perspective. Methods: Target participants were enrolled in 2007~2008 for home visiting care and provided with a home visiting nursing service for more than 18 months in J Ward of S City. Of 391 participants, 244 who satisfied the inclusion criteria were used in the final analysis. Cost-benefit analysis was done using the net benefit and benefit/cost ratio. Results: After providing the home care nursing service, the blood pressure control rate increased from 50.8% to 75.4%. Of the subjects, 39.8% maintained their blood pressure level within the target range. As a whole, the net benefit of home visiting care per person ranged from 434,964.86 to 447,112.43 won and the benefit/cost ratio ranged from 2.82 to 2.84. Conclusion: Home visiting care for vulnerable populations with hypertension was effective in both maintaining blood pressure and reducing blood pressure to the target range. Therefore these results are especially useful for establishing the value of home visiting services for policy makers as well as for prioritizing vulnerable populations.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.2 no.1
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• pp.55-66
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• 1995

The goals of nursing education, and the bases for evaluating them depend on the goals of nursing practice. In order to prepare for the coming twenty first century and the meet changing societal demands and health needs, it is necessary to develop a new conceptual framework for future nursing education. While hospitals will still be in significant components of the health care system, will no longer be central focus or dominant influence. Health care services will be more usually delivered at community base. The nursing education required by that new approach must provide for reconsidered about a concept of caring as nursing curriculum. The changes in health care delivery that have occured, now being proposed, for nursing education undergoing its own changes. So the philosophy and objectives of education meed to reconsidering about the caring concept and general nursing. Nurse educators must prepare students to practic in condition of constant change. At the same time nurse educators must emphasize preparation about that. The practice of science of caring in nursing draws on a basic knowledge of the behavioral knowledge, biophysical processes, pathological processes, nursing skills and procedures and various treatment regimes and problem solving to help decision making in nursing situations. The concept of care is probably one of the least understood ideas used by professional and nonprofessional people, yet it is probably one of the most improtant concepts to be understood by nursing. Human caring and human relationships are closely interrelated. Humn caring remains an essential dimension of professional work and the science of caring as essental to the discipline of nursing. It is expected that the objectives of nursing education will be accomplished when the course and content of the curriculum are based on this conceptual framework. One recurrent education goal with some consistency is that of equipping the student with the necessary skills to live effectively and productivly in the world of tomorrow. In the new vision we are developing, professional education must also include exposure to liberal arts, encouragement of critical thinking, and a moral context for advanced professional education that is based upon a contextual health policy and caring science educational model.