• 가정∙방문간호학회지
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• 제6권
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• pp.33-45
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• 1999

The purpose of this study was to develop a basic framework and criteria for evaluation of quality care provided to patients with the attributes of disease in the home care nursing field, and to provide measurement tools for home health care in the future. The study design was a developmental study for evaluation of hospital-based HCN(home care nursing) in Korea. The study process was as follows: a home care nursing study team of College of Nursing. Yonsei University reviewed the nursing records of 47 patients who were enrolled at Yonsei University Medical Center Home Care Center in March, 1995. Twenty-five patients were insured at that time, were selected from 47 patients receiving home care service for study feasibility with six disease groups; Caesarean Section (C/S), simple nephrectomy, Liver cirrhosis(LC), chronic obstructive pulmonary disease(COPD), Lung cancer or cerebrovascular accident(CVA). In this study, the following items were selected : First step : Preliminary study 1. Criteria and items were selected on the basis of related literature on each disease area. 2. Items were identified by home care nurses. 3. A physician in charge reviewed the criteria and content of selected items. 4. Items were revised through preliminary study offered to both HCN patients and discharged patients from the home care center. Second step : Pretest 1. To verify the content of the items, a pretest was conducted with 18 patients of which there were three patients in each of the six selected disease groups. Third step : Test of reliability and validity of tools 1. Using the collected data from 25 patients with either cis, Simple nephrectomy, LC, COPD, Lung cancer, or CVA. the final items were revised through a panel discussion among experts in medical care who were researchers, doctors, or nurses. 2. Reliability and validity of the completed tool were verified with both inpatients and HCN patients in each of field for researches. The study results are as follows: 1. Standard for discharge with HCN referral The referral standard for home care, which included criteria for discharge with HCN referral and criteria leaving the hospital were established. These were developed through content analysis from the results of an open-ended questionnaire to related doctors concerning characteristic for discharge with HCN referral for each of the disease groups. The final criteria was decided by discussion among the researchers. 2. Instrument for measurement of health statusPatient health status was measured pre and post home care by direct observation and interview with an open-ended questionnaire which consisted of 61 items based on Gorden's nursing diagnosis classification. These included seven items on health knowledge and health management, eight items on nutrition and metabolism, three items on elimination, five items on activity and exercise, seven items on perception and cognition, three items on sleep and rest, three items on self-perception, three items on role and interpersonal relations, five items on sexuality and reproduction, five items on coping and stress, four items on value and religion, three items on family. and three items on facilities and environment. 3. Instrument for measurement of self-care The instrument for self-care measurement was classified with scales according to the attributes of the disease. Each scale measured understanding level and practice level by a Yes or No scale. Understanding level was measured by interview but practice level was measured by both observation and interview. Items for self-care measurement included 14 for patients with a CVA, five for women who had a cis, ten for patients with lung cancer, 12 for patients with COPD, five for patients with a simple nephrectomy, and 11 for patients with LC. 4. Record for follow-up management This included (1) OPD visit sheet, (2) ER visit form, (3) complications problem form, (4) readmission sheet. and (5) visit note for others medical centers which included visit date, reason for visit, patient name, caregivers, sex, age, time and cost required for visit, and traffic expenses, that is, there were open-end items that investigated OPD visits, emergency room visits, the problem and solution of complications, readmissions and visits to other medical institution to measure health problems and expenditures during the follow up period. 5. Instrument to measure patients satisfaction The satisfaction measurement instrument by Reisseer(1975) was referred to for the development of a tool to measure patient home care satisfaction. The instrument was an open-ended questionnaire which consisted of 11 domains; treatment, nursing care, information, time consumption, accessibility, rapidity, treatment skill, service relevance, attitude, satisfaction factors, dissatisfaction factors, overall satisfaction about nursing care, and others. In conclusion, Five evaluation instruments were developed for home care nursing. These were (1)standard for discharge with HCN referral. (2)instrument for measurement of health status, (3)instrument for measurement of self-care. (4)record for follow-up management, and (5)instrument to measure patient satisfaction. Also, the five instruments can be used to evaluate the effectiveness of the service to assure quality. Further research is needed to increase the reliability and validity of instrument through a community-based HCN evaluation.

• 가정∙방문간호학회지
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• 제11권1호
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• pp.23-32
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• 2004

Purpose: The purpose of this research is to give basic data about a way of connection to individual centers and vitalization of visiting nursing program on Busan. Method: The research is done with survey for eight hospitals. sixteen public heath centers, forty-six social welfare centers to be practised visiting nursing program on Busan for actual condition of that. Results: 1. The average nursing career is below 5-10 years. But visiting nursing career is below 3 years(70%) in hospital. public, public heath center, and heath center. 2. Hospitals coverage of visiting nursing service is city as a whole. Whereas public heath center and social welfare center covered some local area. 3. Client of visiting nursing service possess in order of alone lived elderly, person in uncomplete movement, a disabled person, and a chronic disease person. 4. The main service in visiting is patient assessment, basic nursing activity, and treatment nursing activity with medication care, B.P check, dressing, bedsore care, catheter care and exchange, fluid therapy. Particularly, the hospital runs parallel to basic care and treat care in 100%. The social service center has 65.0% in a patient assessment and basic nursing activity. 5. The concern about services connecting with other center is very high. Conclusion: Actual conditions of visiting nursing program on Busan, which is presented in this study. The results of this study will become the pillar of visiting nursing program planning and application.

• 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.

• 의료ㆍ복지 건축 : 한국의료복지건축학회 논문집
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• 제15권3호
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• pp.21-29
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• 2009

Recently, the service for nursing home has been transforming in an overall way, and along with that, the supply of the recuperation facilities for the elderly has been expanding. However, the quantitative expansion of those facilities has not been accompanied by the qualitative supply. In consideration of those shortcomings of the existing facilities, it may be necessary to ensure an improvement in qualitative terms. This study investigated and analyzed the Nursing home, examined the current situation, reconsidered the state of recuperation facilities for the elderly as part of effort to prepare for the silver society, and present measures for improvement in an attempt not to repeat mistakes that have been observed in the existing facilities in planning Nursing home that will be open and built in the upcoming days, which aimed to provide basic data that can be used in the future and explore the direction of relevant design.

• 지역사회간호학회지
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• 제12권1호
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• pp.22-31
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• 2001

Purpose of this study is to compare the cost effectiveness of home care services for the cerebrovascular accident patients by the type of institution. The method is the secondary analysis using the patients' charts. 107 subjects and 1.417 visits were sampled from each type of home care institution such as one hospital based home care center. one KNA home care center, one urban health center, one rural health center and one health care post. Result: There were differences in the functional status of patients and the service contents and frequencies provided by the type of home care institution, The cost per visit for one unit of ADL by the hospital based home care was higher than by the community-based home care. Conclusion: It was suggested that the referral system among the home care institutions would be developed to improve the cost-effectiveness.

• 대한간호학회지
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• 제34권1호
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• pp.111-122
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• 2004

Purpose: This study was conducted to identify health problems and support received from the health and welfare service using MDS-HC(Minimun Data Set for Home Care) in the aged living at home. Method: Eighty-one elderly persons were selected from those listed in community-welfare service centers in Seoul and Kyunggi Province between December 2002 and January 2003. Result: Eleven health problems per elderly person on average were identified, and the frequent care needs were in order: preventive health measure, health promotion, visual function, depression & anxiety, communication disorders, social function, pain, environmental assessment, oral health, cognition and falls. The number of health problems by the level of ADL was ‘ADL 1(Independence)’ 9.87, ‘ADL 2(Partial independence)’ 12.78, ‘ADL 3(Dependence)’ 13.73. Utilization of formal health & welfare services among the elderly was ‘meals on wheels’ 40.7%, ‘home helper’ 38.2%, ‘visiting of social welfare worker’ 21.0%, ‘physical therapy’ 19.6%, ‘day care center’ 12.3%, ‘volunteer's service’ 9.9%, ‘home visiting care’ 3.7%, ‘occupational therapy’ 3.7%, and ‘speech therapy’ 2.5%. Conclusion: The results suggest that using the MDS-HC 2.0 is applicable to help decide criteria for both health and welfare service supplied to the elderly.

• 재활간호학회지
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• 제2권2호
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• pp.257-270
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• 1999

The purpose of this study is to investigate factors related to the intent of using home nursing of chronic disease patients who got out of a university hospital. For the purpose, the study selected 153 patients who were hospitalized and left K university hospital with diagnoses of cancer, hypertension, diabetes and cerebral vascular accident and ordered to be discharged and performed interviews with them and surveys on their medical records to obtain the following results. For this study a direct-interview survey and medical record review was conducted from June 28 to Aug. 30, 1998. The frequency and mean values were computed to find the characteristics of the study subjects, and $X^2$-test, t-test, factor analysis and multiple logistic regession analysis were applied for the analysis of the data. The following results were obtained. 1) When characteristics of the subjects were examined, men and women occupied for 58.8% and 41.2%, respectively. The subjects were 41.3 years old in aver age and had the monthly aver age earning of 0.99 million won or below, which was the most out of the total subjects at 34.6%. Among the total, 87.6% resided in cities and 12.4 in counties. The most left the hospital with diagnosis of cancer at 51.6%, followed by hyper tension at 24.2%, diabetes at 13.7% and cerebral vascular accident at 7.2%. 2) 93.5% of the selected patients had the intent of using home nursing and 6.5%, didn't. Among those patients having the intent, 85.6% had the intent of paying for home nursing and 14.4%, didn't. The subjects expected that the nursing would be paid 9,143 won in aver age and 47.7% of them preferred national authorities as the main servers. 86.3% of the subjects thought that home nursing business had the main advantage of making it possible to learn nursing methods at home and thereby contributing to improving the ability of patients and their facilities to solve health problems. 3) Relations between the intent of use and characteristics of the subjects such as demography-related social, home environment, disease and physical function characteristics did not show statistically significant differences among one another. Compared to those who had no intent of using home nursing, the group having the intent had more cases of male patients, the age of 39 or below, residence in cities, 5 family member s or more, no existence of home nursing servers, leaving the hospital from a non-hospitalized building, disease development for five months or below, hospitalization for ten days or more, non-hospitalization with in the recent one month, two times or over of hospitalization, leaving the hospital with no demand of special treatment, operation underwent, poor results of treatment, leaving the hospital with demand of rehabilitation services, physical disablement and high evaluation point of daily life. 4) Among those patients having the intent of using home nursing, 47.6% demanded technical nursing and 55.9%, supportive nursing. As technical nursing,' inject into a blood vessel ' and 'treat pustule and teach basic prevention methods occupied for 57.4%, respectively, topping the list. Among demands of supportive nursing, 'observe patients 'status and refer them to hospitals or community resources as available, if necessary' was the most with percent age point of 59.5. Regarding the intent of paying for home nursing, 39.2% of those patients wishing to use the nursing responded paying for technical services and 20.2, supportive services. In detail, 70.0% wanted to pay for a service stated as 'inject into a blood vessel', highest among the former services and 30.7%, a service referred to as 'teaching exercises needed to make the body of patients move', highest among the latter. When this was analyzed in terms of a relation between the need(the need for home nursing) and the demand(the intent of paying for home nursing), The rate of the need to the demand was found two or three times higher in technical nursing(0.82) than in supportive nursing(0.35). In aspects of tech ical nursing, muscle injection(1.26, the 1st rank) was highest in the rate while among aspects of supportive nursing, a service referred to as 'teach exercises needed for making patients move their bodies normally'(0.58, the 1st rank). 5) factors I(satisfaction with hospital services), II(recognition of disease state), III(economy) and IV(period of disease) occupied for 34.4, 13.8, 11.9 and 9.2 percents, respectively among factors related to the intent by the subjects of using home nursing, totaled 59.3%. In conclusion, most of chronic disease patients have the intent of using hospital-based home nursing and satisfaction with hospital services is a factor affecting the intent most. Thus a post-management system is needed to continue providing health management to those patients after they leave the hospital. Further, supportive services should be provided in order that those who are satisfied with hospital services return to their community and live their in dependent lives. Based on these results, the researcher would make the following recommendation. 1) Because home nursing becomes more and more needed due to a sharp increase in chronic disease patients and elderly people, related rules and regulations should be made and implemented. 2) Hospital nurses specializing in home nursing should be cultivated.

• 지역사회간호학회지
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• 제7권2호
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• pp.183-202
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• 1996

This study was designed out to develop a home health care service for nurses working in community care services. This study investigates actual conditions at welfare institutions related to health needs the demands of clients, and the state of home health care services we hope that this study will improve upon the current service system. In Korea home health care services are still developing and only new becoming a part of the health care supply system. The data was collected by recording the client home nursing assessments modified to the situation of UTMB home health agency. In this study 107 clients were selected for home care who needed care for physical and mental deficits. The study lasted from March to November of 1995 at one of the welfare service institutions in Chunchon city. The results show that those who most frequently needed care services were over 50 years old with a health deficit of 80.3%, followed by sex as women who needed care at 59.8%. 50.5% of the clients had very little education. 99.1% of the clients live with their family, and a medical diagnostic analysis reveals that 73.9% of the 5 year period of illnesses were the following : 38.8% - muscular -skeleton system disorder, 24.4% - hypertension and stroke, 25.7% sole disease of arthritis. For behavioral conditions 43.3% of the patients were without care services, 56.6% of the patients were taking treatment that 73.5% of those were taking medication. The most main complaint of patients were 22.4% of pain in the extremities, next were 16.8% of a limitation of body activities, 15.0% was lumbo-sacralgia. According to the investigator who was a senior student nurse, the following suggestions were made: 32.7% for curative medical services, 29.9% for physical exercise, 19.6% for emotional support. Consultation nursing services consisted of 67.2% for physical therapy, 11.2% for the maintaining healing, 9.4% for counseling. The patients at home, required assistance most frequently for muscular-skeleton problems under the category of physical systems (33.3%). But, on the other hand, 49.5% of the patients required care givers at home, 28.2% had a knowledge deficit, 21.0% had malnutrition, 18.4% had bad impaired communication. The character of health problems were devided into chronic disease(67.0%), accidents(I3.1%), and general disease(15.9%). 86% of the disabled client had an impairment of the physical system. Eating (86.9%) , Toileting(77.6%), and personal care showed much the same of ADL condition, the level and range of achievement of mobility, the most frequently self performed was 81.3% only in a room size area, and 40.2% were completely dependent when going out. Although there were a large number of home care services in th community at these welfare institutions, many clients needed a variety of curative services. As policy changes have gathered momentum, responsibility for the development of a more suitable program was demanded by the clients from the community.

• 지역사회간호학회지
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• 제29권1호
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• pp.54-64
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• 2018

Purpose: The purpose of this study is to identify factors influencing burnout in primary family caregivers of Home Health Care Patients. Methods: Data were collected from 121 primary family caregivers of home health care patients in three different hospitals in 'D' metropolitan city and the study was conducted from August 10, 2016 to January 17, 2017. The data were analyzed using descriptive statistics, t-test, ANOVA, Pearson's Correlation Coefficient, Stepwise Multiple Linear Regression. Results: Mean scores for the nursing needs of the participants were $3.54{\pm}0.79$, the family functions were $1.24{\pm}0.58$, the burnouts were $2.74{\pm}0.49$. The burnouts were positively correlated with the nursing needs but inversely correlated with the family function. The factor that had the greatest influence on the burnouts of primary family caregivers of Home Health Care was family function (${\beta}=-.245$, p=.001), followed by patients' daily activity (${\beta}=-.213$, p=.014), age (${\beta}=.208$, p=.032), monthly nursing services cost (${\beta}=-.196$, p=.044) and nursing needs (${\beta}=.129$, p=.014). The Explanatory Power of Models was 23%. Conclusion: Individually customized home care nursing intervention programs are required to be provided in accordance with patient's family function and daily activity, monthly home care nursing service cost, nursing needs and general characteristics of primary caregivers of Home Health Care Patients such as their age, the number of family members living together, sex and the name of disease.

• 가정∙방문간호학회지
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• 제22권1호
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• pp.22-37
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• 2015

Purpose: This study aimed to compare the health service delivery level and educational needs by work experiences and types of public health center among the nurses who work as visiting health services workers at public health centers. Methods: Data collected from 484 nursing staff for 2 weeks, was analyzed using the SPSS program t-test, ANOVA, and Spearman Rank-Order Correlation. Nurses with more than 2 years experience were 79.1%; and 43.6% of the subjects worked within Gun type public health centers. Results: The health service performance frequency of metropolitan city type public health centers was significantly high in the areas of education, behavior pattern, chronic disease, pregnant women & infants, and multi-cultural family. The health service performance frequency of Gun type public health centers was significantly high in the areas of type of test, fundamental nursing, and basic rehabilitation. In addition, the correlation between the performance frequency and educational needs was positively correlated, and the subjects with greater educational needs performed more. Conclusion: Educational programs should be designed according to the types of public health centers rather than work experiences, especially in systematic training for frequently performed items after reviewing the practice precisely.