• 제목/요약/키워드: Health plan implementation

검색결과 139건 처리시간 0.026초

산욕부와 신생아의 가정간호 사례연구 (A Case Study of Home Health Care for Postpartum Women and their Newborns)

  • 전은미
    • 모자간호학회지
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    • 제4권1호
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    • pp.3-11
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    • 1994
  • Presently there is an increasing demand for home health care services due to changes in the demographic structure as a result of an increasing elderly population, socio-economic improvements, and changes in the family structure, as well as the growing number of people with degenerative diseases. In addition to these reasons, rising medical costs and there a shortage of patient beds space in the hospital, particularly since introduction of national medical insurance. There has been an increasing demand for health care health care services. This study was done to identify the basic data for home health care management. It focused on developing client selection criteria, assessment tools, and recording methods. This was accomplished by the researchers visiting the patients in their homes. The research process included preparation investigation, tool development, training of the project researcher, and visiting the clients in their homes. The research tools are as follows : 1. Record development : a) The selection criteria tool for home health care of postpartum women was a structured tool and consisted of four parts. b) The structured assessment tool consisted of a general items, obstetric history, past medical history, methods of feeding, medications taken before admission, laboratory test results, discharge instructions, discharge medications, family tree, economic status, environmental status, a map, health assessment of postpartum women and their newborns. c) The visit note I consisted of the frequency of visits. Visit note II consisted of the date ; nursing problems ; nursing process including the initial assessment ; nursing goal ; visit plan ; postpartum women and their neonate health status, diagnosis, goal, implementation, evaluation, summary, next plan, for visit revision. d) Problem note consisted of the date, problem numbers, nursing diagnosis, problem appearance date problem resolution date. The research results are as follows : 1. Nursing problems : The nursing problems of the postpartum women and their neonates were evaluated by the number of nursing diagnoses and the change in the pattern of nursing diagnosis related to the number of visits. a) Nursing diagnosis The nursing diagnosis was classified according to physical function, psychosocial function, family system maintained function. b) The changes of nursing diagnosis related to the number of visits. As the type of nursing diagnosis changed related to the number of visits the number of nursing diagnoses decreased. 2. Contents of home health care : The content was categorized according to assessment, direct care, counseling, education, family care, reporting to with the attending doctor. The recommendations based on the research results are as follows : 1. Tool development Replication of this study is needed to test the validity of the assessment tools used. 2. Home visit a) Home health care nurses should be licensed and qualified. A referral form from the attending doctor is needed for legal protection of nurses. b) The first home visit need to be within 24 hours of discharge from the hospital to decrease the anxiety of frightened postpartum women. c) When the changes occur in the newborn's status, home health care nurses should consult a pediatrician. Communication within the home healthcare team is essential and needs to consistent and done smoothly. 3. Home health care A Study is required to develop protocols for education of staff and for operation of all aspects of this program.

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가정간호 사업에 대한 의사, 간호사, 진료관련부서 직원 및 환자의 인식 비교 (A Study on Differences of Opinions on Home Health Care Program among Physicians, Nurses, Non-medical personnel, and Patients.)

  • 김용순;임영신;전춘영;이정자;박지원
    • 대한간호
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    • 제29권2호
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    • pp.48-65
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    • 1990
  • The government has adopted a policy to introduce Home Health Care Program, and has established a three stage plan to implement it. The three stage plan is : First, to amend Article 54 (Nurses for Different Types of Services) of the Regulations for Implementing the Law of Medical Services; Second, to tryout the new system through pilot projects established in public hospitals and clinics; and third, to implement at all hospitals and equivalent medical institutions. In accordance with the plan, the Regulation has been amend and it was promulgated on January 9,1990, thus establishing a legal ground for implementing the policy. Subsequently, however, the Medical Association raised its objection to the policy, causing a delay in moving into the second stage of the plan. Under these circumstances, a study was conducted by collecting and evaluating the opinions of physicians, nurses, non-medical personnel and patients on the need and expected result from the home health care for the purpose of help facilitating the implementation of the new system. As a result of this study, it was revealed that: 1. Except the physicians, absolute majority of all other three groups - nurses, non-medical personnel and patients -gave positive answers to all 11 items related to the need for establishing a program for Home Health Care. Among the physicians, the opinions on the need for the new services were different depending on their field of specialty, and those who have been treating long term patients were more positive in supporting the new system. 2. The respondents in all four groups held very positive view for the effectiveness and the expected result of the program. The composite total of scores for all of 17 items, however, re-veals that the physicians were least positive for the- effectiveness of the new system. The people in all four groups held high expectation on the system on the ground that: it will help continued medical care after the discharge from hospitals; that it will alleviate physical and economic burden of patient's family; that it will offer nursing services at home for the patients who are suffering from chronic disease, for those early discharge from hospital, or those who are without family members to look after the patients at home. 3. Opinions were different between patients( who will receive services) and nurses (who will provide services) on the types of services home visiting nurses should offer. The patients wanted "education on how to take care patients at home", "making arrangement to be admitted into hospital when need arises", "IV injection", "checking blood pressure", and "administering medications." On the other hand, nurses believed that they can offer all 16 types of services except "Controlling pain of patients", 4. For the question of "what types of patients are suitable for Home Health Care Program; " the physicians, the nurses and non-medical personnel all gave high score on the cases of "patients of chronic disease", "patients of old age", "terminal cases", and the "patients who require long-term stay in hospital". 5. On the question of who should control Home Health Care Program, only physicians proposed that it should be done through hospitals, while remaining three groups recommended that it should be done through public institutions such as public health center. 6. On the question of home health care fee, the respondents in all four groups believed that the most desireable way is to charge a fixed amount of visiting fee plus treatment service fee and cost of material. 7. In the case when the Home Health Care Program is to be operated through hospitals, it is recommended that a new section be created in the out-patient department for an exclusive handling of the services, instead of assigning it to an existing section. 8. For the qualification of the nurses for-home visiting, the majority of respondents recommended that they should be "registered nurses who have had clinical experiences and who have attended training courses for home health care". 9. On the question of if the program should be implemented; 74.0% of physicians, 87.5% of non-medical personnel, and 93.0% of nurses surveyed expressed positive support. 10. Among the respondents, 74.5% of -physicians, 81.3% of non-medical personnel and 90.9% of nurses said that they would refer patients' to home health care. 11. To the question addressed to patients if they would take advantage of home health care; 82.7% said they would if the fee is applicable to the Health Insurance, and 86.9% said they would follow advises of physicians in case they were decided for early discharge from hospitals. 12. While 93.5% of nurses surveyed had heard about the Home Health Care Program, only 38.6% of physicians surveyed, 50.9% of non-medical personnel, and 35.7% of patients surveyed had heard about the program. In view of above findings, the following measures are deemed prerequisite for an effective implementation of Home Health Care Program. 1. The fee for home health care to be included in the public health insurance. 2. Clearly define the types and scope of services to be offered in the Home Health Care Program. 3. Develop special programs for training nurses who will be assigned to the Home Health Care Program. 4. Train those nurses by consigning them at hospitals and educational institutions. 5. Government conducts publicity campaign toward the public and the hospitals so that the hospitals support the program and patients take advantage of them. 6. Systematic and effective publicity and educational programs for home heath care must be developed and exercises for the people of medical professions in hospitals as well as patients and their families. 7. Establish and operate pilot projects for home health care, to evaluate and refine their programs.

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학교 신종플루 확산기 동안의 초등학교 보건교사의 직무현황 (The Job Status of Health Teacher, School Nurse, during Epidemic Outbreak of Influenza H1N1 in School)

  • 신선미;김혜순;홍민순;이희우
    • 한국학교보건학회지
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    • 제23권1호
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    • pp.63-70
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    • 2010
  • Purpose: To identify the need to reform in the crisis response of Health Teacher, School Nurse, in elementary school during epidemic outbreak of influenza H1N1. Methods: 139 elementary health teachers, school nurse, in seoul elementary school responded in the questionnaire, and we analysed by using frequency and percent, t-test, and paired t-test. Results: The Job status became 121% more 'during influenza H1N1 (flu) outbreak' than Job status of 'before outbreak'. The proportion of the flu-related duty among their daily workload was up to 77.5%. The administration-related workload of the flu-related duty was 30.8%. and students' health assessment including temperature measurement 18.7%. Furthermore, an impediment of usual daily work due to an increaed flu-related workload was 95.7%, and no alternative plan such as disposition of assistant labor force was 86.1%. Especially, an impediment of health education was 61.0%, so the major concern was the loss of health education. We compared average scores (a five-point Likert scale) of health teachers' work motivation, exhaustion, work relationship and Job management of 'during' with 'before' flu-outbreak. The difference range of 'during' minus 'before' work motivation score was from -0.4 points to -0.9; work exhaustion range from 1.8 to 1.9; the difficulty of relationship between students, school personnel, parents of students, and health teachers from 1.4 points to 1.3 points; and the consideration of changing Job, taking time off from the Job and retirement from 1.4 to 1.6 points. Conclusion: The health teachers had a heavy workload due to flu-outbreak. They also experienced the impediment of usual work implementation. However, there was a shortage of alternative plan such as disposition of an assistant labor force. Under their Job status like this, the health teachers' motivation score was decreased and work exhaustion was increased. Furthermore, they had a lot of relation difficulty with students and school personnel. Therefore, we suggested that in contrast to the usual Job status, there is a need to have a prepared response during school crisis like flu-outbreak such as improved response system in seoul metropolitan education office, simplification or dispersion of administrative work, and temporary call-center for simple inquiries or advices.

선택진료 및 상급병실제도 개선정책이 건강보험 보장성에 미친 영향: 일개 상급종합병원 입원 진료비를 중심으로 (The Effect of Physician Surcharges and Private Room Charges Improvement Policy on National Health Insurance Coverage: Focusing on Analysis of a Upper Grade General Hospital's Inpatient Medical Costs)

  • 나비;은상준
    • 한국병원경영학회지
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    • 제23권1호
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    • pp.51-64
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    • 2018
  • Purposes : In February 2014, the government said that the National Health Insurance Service (NHIS) will enforce plan for reducing the financial burden from two major non-covered services including physician surcharges and private room charges, the main causes to increase uninsured, by 2017. The purpose of this study is to analyze the policy effect that performed so far by comparing out-of-pocket payment rates of policy process Methodology: This study analyzed admission medical expenses that occurred from January 2013 to March 2016 at a upper grade general hospitals in Daejeon. Number of study subjects were 134,924 and the data were analyzed with SPSS 22.0 program by using frequency, percentage, mean, standard deviation, ANOVA. The effect of two major non-payment improvement plan on out-of-pocket rates was ascertained via generalized estimating equation. Findings: Out-of-pocket payment rates was statistically significantly declined 2.7 percent than enforcement ago. Also, out-of-pocket payment, physician surcharge, the proportion of out-of-pocket payment of hospital room charge to out-of-pocket payment was statistically significantly declined. However, a further analysis of the cause of the decline in total medical costs is needed. Practical Implications: Physician surcharges and private room charges improvement policy had a positive effect on the decline of out-of-pocket payment rate. The policy of physician surcharges was very effective after the first policy enforcement but it was less effective to medical aids and near poor that was a more greater coverage than national health insurance. Since the policy has not been finalized, we have to continue a research for the successful implementation of the policy.

지역사회 통합건강증진사업 평가와 개선방안 (A Study on the Evaluation and Improvement of an Integrated Health Promotion Program in the Local Community)

  • 백종섭;홍성애
    • 한국융합학회논문지
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    • 제8권7호
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    • pp.131-139
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    • 2017
  • 본 연구는 지역주민에게 건강증진서비스를 제공하는 공무원을 대상으로 보건소 중심 통합건강증진사업의 효과성을 알아보기 위해 시행되었다. 조사는 구조화된 설문지를 이용하여 2015년 9월 10일부터 10월 5일까지 시행되었으며, 총 254개 보건소에 각 2부씩 508부를 배부하여 349부를 회수하였고, 이 중 339부를 최종 분석 자료로 활용하였다. 본 연구 결과, 대상자들은 통합건강증진사업의 효율성과 자율성, 책임성, 보건복지부지원. 유관기관지원에 대해서 전반적으로 평균 수준으로 인식하는 것으로 나타났으며, 보건소 내에 통합건강증진 전담부서가 있는 경우와 필수사업의 비중이 높을수록 모든 검정변수에서 평가가 긍정적이었다. 하지만 통합사업 전에 비해 업무량이 증가하였으며, 필수사업 시행이 지역별 건강문제나 지역 여건을 충분히 반영하지 못하는 것들이 문제점으로 조사되었다. 이러한 결과를 통합건강증진사업의 성공적 운영 전략에 반영할 필요성이 있다.

유해인자 노출감시를 통한 산업보건서비스 강화 (Strengthening Occupational Health Services through Monitoring Exposure to Health Hazards)

  • 박승현;배계완;김준범;김세동
    • 한국산업보건학회지
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    • 제31권2호
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    • pp.147-155
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    • 2021
  • Objective: The purpose of this study was to find ways for strengthening occupational health services through monitoring exposure to health hazards. Methods: About 70,000 workplaces that have conducted the work environment measurement(WEM) over the last three years(2017~2019) were classified according to the Korean Standard Industry Classification(KSIC), and the current status of WEM by industry was analyzed. The authors considered ways to monitor exposure to health hazards in order to strengthen occupational health services and protect workers' health. Results: Based on the KSIC, 934 of the 1,196 total sub-classified industries have conducted WEM in at least one workplace over the last three year(2017~2019). In the case of manufacturing, out of a total of 477 sub-classified industries, 474 have conducted WEM at more than one workplace. However, in some industries, WEM was not conducted or the implementation rate was low, so it was necessary to examine whether WEM should be expanded based on a detailed analysis of the WEM database. To this end, it is necessary to form an exposure monitoring committee in which various experts from different fields can participate. The committee needs to discuss the overall matters necessary for selecting industries that require detailed investigation or research, review the results, and prepare a final recommendation. Conclusion: In conclusion, the government needs to come up with a plan to strengthen occupational health services through surveys and research on the current status of WEM and work environment management models by industry.

A Systematic Review on Oral Health Care Programs for the Elderly in Korea (2009~2020)

  • Choi, Eun-Seo;Jung, Im-Hee;Kim, Do-Ah;Lee, Eun-Som;Lim, Hee-Jung
    • 치위생과학회지
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    • 제21권4호
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    • pp.199-212
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    • 2021
  • Background: Various oral health management programs in Korea affect the oral health improvement in the elderly Several studies have been conducted to date; however, those studies have not shown uniform results due to the differences in research methods or designs. Hence, this study aimed to review the overall research trends of the reported oral health care programs for the elderly in Korea, verify their effects, and clarify them based on the systematic literature review. Methods: The literature search selected intervention studies that applied the oral health care program for the elderly in Korea from 2001 to 2020. Following the COre, Standard, and Ideal (COSI) models presented by the US National Library of Medicine, we selected databases including Korean studies Information Service System (KISS), ScienceOn, Research Information Sharing Service (RISS), DBpia, PubMed, and Google Scholar. Of the 1,335 studies searched using keywords, titles, and abstracts, 21 were finally selected based on primary and secondary exclusion criteria. Results: The most frequent intervention period was 4 weeks, and the number of interventions varied between 2 and 90 times. As for the type of intervention, 14 studies that conducted both theory and practice were the most frequent. Significant differences in the clinical indicators, such as calculus, halitosis, salivation rate, swallowing function, and dry mouth, were found in most oral health care programs. Conclusion: Based on the results of this study, the intervention program needs further verification using multiple indicators in future studies. In addition, a study extending the intervention period and the number of samples is considered necessary for verifying continuous effectiveness of the intervention program.

중대재해처벌법의 안전보건관리체계 구축 요인과 건설업 사고지표의 연관성 분석 (Relationship Analysis of the Factors for Safety and Health Management System Stipulated in the Serious Disaster Punishment Act with Accident Statistics of Construction Industry)

  • 김판기;채희윤;김성일;정기효
    • 한국안전학회지
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    • 제37권4호
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    • pp.44-50
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    • 2022
  • This study examines the relationship between safety factors and health management systems based on accident statistics in the construction industry stipulated in the Serious Disaster Punishment Act. To determine the level of safety achieved by companies through their health management system, the top 1000 construction firms in the country were surveyed online. Four hundred sixty companies responded to the survey by providing their statistics on major accidents (mortality, accidental mortality, and injury rates). Statistical tests showed that companies with a team dedicated to the oversight of safety and health management had fewer accidents than those without one. Factor and regression analyses revealed that three factors affected the mortality and accident rates: safety and health plan, safety and health professionals, and safety and health activities. Moreover, two factors significantly influenced the injury rate: safety management supported by a cooperative company and implementation of on-site safety and health activities. The findings of this study can be used as a fundamental reference for further research and consultation on the formulation of safety and health management systems for construction companies.

제왕절개분만 산욕부와 신생아의 가정간호 사례분석 (A Case Analysis of Home Health Care for Cesarean Postpartum Women and Their Newborns)

  • 김혜숙;최연순;전은미
    • 대한간호학회지
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    • 제24권4호
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    • pp.696-705
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    • 1994
  • This study was done to provide a basis for home health care management for women following Cesarean delivery. Furthermore it was initiated as an possible application of home health care in the future. In this study, client selection criteria was developed by the researcher and assessment tools for home health care, recording system and problem oriented recording system were revised from Jun's(1993) methods. The selection criteria tool for home health care for women who had a Cesarean delivery was structured and consisted of five areas : physical status, functional status, psychological-emetional status, educational needs status and environmental status. The structured assessment tool consisted of general items, obstetric history, past medical history, methods of feeding, medications taken before ad-mission, laboratory results, discharge instructions, discharge medications, family tree, economic status, environmental status, a map, health assessment of women and their newborns. The visit note consisted of the date : nursing problems : nursing process including initial assessment : nursing goals : visit plan : health status of the postpartum women and their newborn : nursing diagnoses : nursing implementation evaluation : summary : next visit plan and revision. The problem oriented recording system consisted of the date, problem numbers, nursing diagnoses, problem appearance date, problem resolution date. The results of the research are as follows : The seven cases having had a Cesarean delivery were discharged on an average on the 5th day after the Cesarean birth. The total number of home visits was 13. According to Cordon's functional health patterns the total possible nursing diagnoses was 34 diagnoses for the methers and their newborns. Among the 34 diagnoses, there were 13 diagnoses in the health perception /management pattern, 7 in the psychosocial health perception / management pattern, 8 in the psychosocial self-perception, 2 in the nutrition / metabolism pattern of physical function, 2 in the knowledge deficit of newborn management, anxiety related to newborn management, knowledge deficit related to disease process of new-born, anxiety related to disease process of newborn anxiety related to prognosis of baby's condition, knowledge deficit related to newborn jaundice each appeared once. The changes in the number of nursing diagnoses was related to not the number of visits but to the number of nursing diagnoses decreasing. The con-tent of the home health care was categorized ac-cording to assessment, direct care, counseling, education, family care. The recommendation based on the results of this research are Home health care nurses for Cesarean postpartum women and their neonates requires comprehensive knowledge of pregnancy, delivery, and the postpartum period and of the neonate so that they can provide appropriate care and holistic views. Most of cases terminated after the second visit, this outcome may be related to the subjects being discharged on the 5th day after delivery. Therefore, study done with earlier discharge after delivery may have different outcome. It is very hard to assess psychological aspects that need follow-up and to develop communication channels.

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보건소 방문 간호 사업의 질보장을 위한 연구 (A study for quality assurance of visiting nurses service of a public health center)

  • 윤순녕;이인숙;현혜진;유인자;김재남;배정희
    • 지역사회간호학회지
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    • 제6권2호
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    • pp.275-285
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    • 1995
  • The purpose of the study is to evaluate the visiting nurses service of a public health center. Data were collectd from the 36 clients who received services from a public health center. In terms of the process evaluation, the tool is composed 4 parts, 27 items such as assessment planning, implementation, and evaluation. It was measured through the health records by 2 peer review. In terms of the outcome evaluation, the level of client satisfaction was measured by self report or interview by 2 supervisor. The result were as follows: 1. 30% of 36 health records showed narsing process was not and out of them, nursing care plann including spectific activities were rarely established or unclear. 2. The lack of systematic data collection' showed and nursing diagnosis was not adressed in health records review. 3. Client satisfaction score was 32, 97, out of maximum score 36. 4. The lack of sufficent objective data, care plan, record of client's health status change, and evaluation was founded therefore quality assurance for visiting nurses service and in-service education are required and the development of standardized record system need.

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