• 디지털융복합연구
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• 제20권2호
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• pp.261-268
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• 2022

최근 급격한 고령화, 핵가족화 현상에 따라 외로움과 우울증으로 고통 받는 독거노인 인구도 크게 증가하고 있다. 본 논문에서는 이런 고령자에게 주거환경과 건강상태에 따라 IT의 도움으로 최적의 고령 맞춤형 서비스를 제공함으로써 삶의 만족도를 높이는 smart aging 시스템을 제안하고자 한다. 의학의 발달로 건강한 노년층이 증가함에 따라 사회 속에서 활동적으로 생활하고자 하는 고령자뿐 아니라, 시설에서의 돌봄이 필요한 고령자에 대해서도 IoT, AI(인공지능) 기술 및 메타버스 환경을 십분 활용하여 선진적인 고령자 맞춤형 지원시스템을 제공할 수 있다. 제안시스템은 병원(요양) 시설 및 재택으로 외로움으로 고통 받는 고령자에게 주거환경과 건강상태에 맞추어 현실공간과 가상공간에서 사회적 연결(social connection)을 제공하여 인간적인 만족감을 제공한다. 본 논문은 급변하는 사회 환경 변화에 AI와 메타버스 기술을 접목하고 주거환경과 건강상태에 따라 사용자 맞춤형 smart aging 시스템을 제공함으로써 미래 지향적 노인복지정책의 새로운 길을 제시할 수 있다.

• 한국융합학회논문지
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• 제12권5호
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• pp.373-383
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• 2021

우리 사회는 빠른 속도로 고령화가 진행되고 있다. 이러한 초고령화 사회에서는 의료비 증가도 늘어나고 있으며 이 상황은 사회보장제도의 지속가능성을 저하시키는 국가적인 문제로 인식되고 있다. 이를 해결하기 위해 노인 건강관리를 위한 다양한 서비스가 추진되어왔지만 대부분 취약계층, 만성질환 발병 후 건강관리에 집중해 왔으며 예방차원의 건강관리는 부족하였고 대부분 시범사업으로 그치고 있는 것이 현실이다. 이에 본 논문에서는 국내외 노인대상 건강관리 서비스의 현황을 분석하고 이를 근거로 한계점과 개선점을 분석하여 IoT 기반의 토탈실버케어센터 구축을 제안하였다. IoT 기반의 토탈실버케어센터는 다양한 센서, 의료기기, 스마트밴드 등을 통해 노인들의 건강상태를 편리하게 모니터링 할 수 있으며, 이를 바탕으로 긴급히 방문해야 하는 사용자를 구분하여 간호제공자의 시간절약 및 업무의 효율화를 통해 간호서비스의 질을 향상시킬 수 있다. 또한 사용자의 건강상태 변화가 있는 경우 건강간호 중재를 적시에 제공할 수 있을 뿐만 아니라 실시간 영상시스템을 통해 정신적인 어려움을 극복하는데 도움을 줄 수 있다.

• 지역사회간호학회지
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• 제9권2호
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• pp.280-290
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• 1998

This study was carried out to idenify the health problems and needs of crippled persons in order to develop a community based rehabilitation service program through public health center. Information on health problems and needs were obtained from 120 crippled persons staying at home by questionaire and a measuring ADL. The results were summarized as follows 1. Among 120 subjects, male crippled (70.3%) outnumbered female crippled (29.7%). Many crippled persons belonged to the 40-49 age group (33.6%) while others were over 60 years (17.4%). There were 36.8% crippled persons with an elementary education, 26.5% had completed high school, 14.5% had completed middle school. 31% of the crippled persons were employed but most of them had unskilled jobs. 80% of the respondents replied that their monthly income was under 800,000 won. 2. The major causes of their handicap were due to acquired factors(92%) such as accidents, in fectious & communicable diseases and chronic diseases rather than congenital factors(8%). Crippled persons who belong to the first grade of disabilities were 14.8%, the second grade 35.7%, the third grade 21.7%, the forth grade 12.2%, the fifth grade 12.2% and the sixth grade 3.5%. 3. This study measured the degree of the ADL of crippled persons by a modified Barthel Index including 11 items. 73.5% of them were fully independent, 8.5% required minimal help, 2.7% required moderate help, 6.0% required substantial help and 9.4% were unable to perform task. In response to the 11 items of ADL, crippled persons required more help in stair climbing, ambulation and bathing than in other items. 4. In responding to concerning health problems, 10.3% of the subjects replied with incontinence, 8.5% malnutrition, 7.6% fecal incontinence and bedsores 2.6%. Chronic diseases which needs treatment were chronic pain(61.0 %), hypertension(16.5%) and diabetes(16.5%) 5. To the question of what type of rehabilitation services subjects required, chronic diseases management(52.1%) and physical therapy (41.2%) were the highest. The most important social welfare services subjects required were economics support (51.3%) and introductions to job opportunities(42%).

• 한국의료질향상학회지
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• 제9권2호
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• pp.116-133
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• 2002

Background : It is very common in Korea to take care of non-acute patients in an acute setting, due to the lack of long-term facilities. Long term hospitalization increase medical expenses and decreases the bed utilization, which can affect the urgent and emergent admissions, and eventually jeopardize the hospital financially. In this study, strategies for effective transfers to the lower levels of care, and to decrease the length of stay were presented by surveying and analyzing the patient's knowledge of the transfer needs, and the willingness to transfer those whose hospital length of stay was more than 30days. Method : The survey is subject to a group of 251 patients who have been hospitalized over 30 days in a general hospital in Seoul. Excluding those that were in the Intensive Care Unit and psychiatric ward, 214 in-patients were used as participants. They were surveyed from April 9, 2002 to April 17, 2002. One hundred and thirty seven out of 214 were responded which made the response rate 64%. Data were analyzed by SAS and SPSS. Result : Multi-variable Logistic Regression Analysis showed a significant effect in medical expenses, knowledge of referral system and the information of the receiving hospital. The financial burden in medical expenses made the patient 10.7 times more willing to be transferred, knowledge of the referral system made them 5 times more willing to be transferred, and the information of receiving hospital makes 6.5 times more willing to be transferred. Reasons for willing to be transferred to a lower level of care were the phase of physical therapy, the distance from home, the attending physician's advice and being unable to be treated as an out patient. Reasons for refusing to be transferred were the following. The attending physician's competency, not being ready to be discharged, not trusting the receiving hospital's competency due to the lack of information, or never hearing about the referring system by the attending physician. Conclusion : Based on this, strategies for the effective transfer to the lower levels of care were suggested. It is desirable for the attending physician to be actively involved by making an effort to explain the transfer need, and referring to the Healthcare Coordinating Center, which can help the patient make the right decision. Nationwide networking for the referral system is the another key factor that may need to be suggested as an alternative to decrease the medical expenses. Collaborating with the Home Health Agency for the early discharge planning and the Social Service Department for financial aid are also needed. It is recommended that the hospital should expedite the transfer process by prioritizing the cost and the information as medical expenses, knowledge of referring system and the information of the receiving hospital, are the most important factors to the willingness to transfer to a lower level of care.

• 가정과삶의질연구
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• 제29권3호
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• pp.23-41
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• 2011

The purpose of this study is to explore social supports for elderly housing and their residential lives in small cities along rural counties of the United States and Canada, and suggest future implications for age-concentrated rural villages in Korea. In this study, five small and medium cities in non-metropolitan counties of California and Ontario province were visited and elderly residents and service experts were interviewed about their perceptions of community integrated social support networks for senior residences. The senior housing complexes were built due to influx of both metropolitan and rural residents seeking warm localities, traffic connections, business purposes in active production areas. and leisure attractions. There are five main social support networks for senior housing issues in these areas. First, the areas are claimed for senior zones and accordingly health industries are encouraged by local authorities. Second, the community is homogeneously constructed as a senior friendly environment and include features such as an RV park and mobile cottages. Third, senior-helping seniors are offered active work through golf-cluster active retirement communities. Fourth, traditional theme production camps are mobilized by the elderly workers. Lastly, an information system is maintained for screening volunteers and for senior abuse prevention. On the other hand, residential lives are occasionally negatively influenced by unbalanced concentrations of elderly facilities such as nursing stations and funeral homes. For the future of Korean rural elderly policies, suggestions are made as follows: first, an integrated urban and rural township that contains attractive places for early retiring people who seek a warm atmosphere in later life needs to be constructed. Second, an integrated model retirement village of urban and rural retirement life needs to be initiated as a measure of evaluating the adaptation process of movers in senior concentrated zones. Third, a cooperation system among governmental ministries needs to be formed with the long- term goal of establishing a traditional rural town of independent housing districts and medical facilities in rural areas. Fourth, productive and active lifestyles need to be maintained as the local community and government develop successful retirement rural villages, by limiting the expansion of nursing related facilities. Finally, generation integrated visiting welfare programs and services need to be further developed for the housing areas especially in the winter, when social integration and activity are relatively low.

• 가정∙방문간호학회지
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• 제5권
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• pp.84-99
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• 1998

The objectives of this study are to identify the actual educational contents of management for head nurse and to propose the educational subjects according to identity the needs of head, charge, and staff nurses. The subjects were investigated the actual Management Development Programs and educational needs of head nurses and prospective nurse manager(charge nurse, staff nurse with a lot of clinical experiences) in general hospitals. The tools were composed of two questionnaires: One was developed from the literature review for making items to measure actual situation. The other was revised Katz's model for measurement of educational needs. The first respondents of actual situation were 27 general hospitals with over 400 beds in Seoul and the second respondents were 89 head nurses, 67 charge nurses and 136 nurses at 3 hospitals by convenient sampling out of 27 general hospitals. Data were collected by telephone interview, mail questionnaire and visiting from 7th of October through 30th of November in 1997. In data analysis, general characteristics of the respondents and actual status of Management Development Programs were analyzed by frequency and percentage. Educational needs according to general characteristics were analyzed by ANOVA The results were as follows: 1. Actual situation of Management Development Program 1) Seven hospitals(26%) had Management Development Program for prospective managers and 14 hospitals (52%) for head nurses. 2) Education Department existed in 14 hospitals (52%). 3) One hospital(4%) had top level managers took part in the Management Development. 4) Two hospitals selected head nurse, who had finished courses of Management Development. Eight hospitals(30%) assessed educational needs. The assessment tools consisted of making a question via questionnaire(75%), determining at department meeting(12%) and interview(13%). 5) Educational programs had 3 types: 10 lecture type, 7 discussion type and 4 role play type programs. 6) One hospital evaluated the change of learner's attitude. 7) Four hospitals scored educational point, but that was measured only by attending. 8) Actual Management Development Programs were as follows. parenthesis indicates the number of hospitals. (1) Management Development Programs for Prospective manager. Role perception of Middle level Manager (1) . Role reconstruction of Nurse Manager (1). Workshop for Charge Nurse (1). Nursing Delivery System and Nursing Process (1). Communication (1). Motivation (1) (2) Management Development Programs for Head nurse.. Head nurse's Role (5). Administrative Work (7). Service Education (4). Prevention and Countermeasure of Nursing Incidence (3). Appraisal (3) 2. The results of needs on Management Development subject 1) The educational needs of all respondents on 3 skill domains showed positive agreement to strongly positive agreement. 2) High priority(more than 4.5) items were 12 of 24 Human skill items(50%), 1 of 6 Technical skill items(16%), and 2 of 13 Conceptual skill items (15%). 3) Out of high priority items, 8 items were instituted. 4) All respondents showed high needs on 3 skill domains regardless of 3 positions (head nurse, charge nurse, and nurse). Educational needs of Human skill domain, according to position were 108. S, 108.7, 106.8 (mean score = 72) , needs of Technical skill domain were 26.5, 26.6, 26.I(mean score=18), and needs of Conceptual skill domains were 56.9,56.7, 55.1(mean score=39). 5) Needs of 3 skill domains according to clinical career showed significant difference. Out of respondents, nurses with career of over 16years showed lowest degree of needs in Human skill domains(F=4.47, P=.004) and Conceptual skill domain(F=2.93, P=.034). 6) Educational needs according to educational background were not significant difference. But out of respondents, nurses educated at 3-year junior college relatively showed lowest needs in all of the 3 skill domains. With the above-mentioned findings, further study is necessary for generalization of this study at hospitals with different bed size and location. Also it is needed to study about management skill of nurse and charge nurse, and effective educational method.

• 디지털융복합연구
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• 제20권2호
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• pp.511-523
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• 2022

본 연구는 코로나19 장기화로 다양한 노인돌봄 방식의 변화가 제기되고 있어, 재가의 경증치매 및 신체허약노인을 대상으로 비대면 방식의 돌봄기술을 적용하였다. 본 연구의 목적은 AI 로봇 통합관리프로그램을 적용하여 인지기능, 일상생활활동, 우울의 정도를 비교하기 위한 비동등성 대조군 전·후 유사실험 연구이다. 자료수집은 2021년 6월 4일부터 9월 17일까지이며 실험군 17명, 대조군 18명 대상자의 설문결과를 SPSS 25.0으로 분석하였다. 연구결과, 실험군은 언어기능, 일상생활활동, 우울에서 유의하게 나타났다. 특히 중등도 이상 우울과 경증 우울이 감소되는 결과를 나타냈다. 인지기능은 장기요양등급과, 일상생활활동은 동거가족과 통계적으로 유의하게 나타났다. 따라서 '위드 코로나 시대'에 노인돌봄 현장에 비대면 방식의 돌봄기술을 도입한다면, 노인의 인지기능훈련 및 우울 감소에 기여할 것으로 사료된다.

• 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.

• 한국보건간호학회지
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• 제10권2호
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• pp.74-89
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• 1996

It hasbeen individual and social problems that mattoids, alcohols and old people alienated from their families have wandered about the streets for rapid urbanzation, industrialization and nuclear families. In our country, measures for proper guidance for the tramps under the supports of government in 1982 have been carried out. But it has been difficult that we protected without Welfare Acts for them. According to those the study has aimed to provide for the fundamental data to advance public utilities as needs of an administrative organ with focus on contents of nursing records charts, furthermore general traits of subjects perceived details related to diseases. Medical record service has been a 'D' municipal hospital. All the subjects were a total of 4,855 persons, 2.436 in 1992, 2.419 in 1994. 1. Social Traits They mainly have attended a hospital, especially Thursday and Friday from a week and winter from the seasons. They equally have attended a hospital in the beginning, middle and end of the month. They equally have attended a hospital in the months. Government and public offices such as police stations and district offices have trusted them to a hospital. After they left a hospital. their residence has been their home confirmed in the ratio of $59.2\%$. 2. Controling Characteristics of a Medical Institution The proportion of males to females was 7 to 1. In the ages, the adults at the first of adulthood from 25 years to 44 years were $52.6\%$ mostly entered a hospital. In the observations the percentage of patients should be entered total was $8.8\%$. In general. the proportion of changes by fee was about $4\%$. Then the number of patients were on an average from 30. 76 to 32, 55 persons in 1992. It was from 25. 63 to 26. 87 in 1994. But the numbers were 5 to 6. It showed that the number was decreased. 3. Medical Traits The number of days by measured and the number of days which have been entered to a hospital have not made differences. The kinds of diseases were 1.11 in 1992. but were 1. 16 in 1994. In terms of 17 kinds of international diseases divided. the diseases recorded probably have been accidents. poisoning and violence( XVII). digestive trouble(IX). endoctrin disoders. metabolism and dystrophy(III) in orders, then they have been measured $51.0\%,\; 12.7\%,\; 6.8\%$. All patients who have been entered to a hospital severly have been drinking. As the seriousness of drinking and the kinds of diseases have indicated positively correlated. It have indicated that the more serious drinking have been. the more the number of diseases have been. As we have known according to abover results. the Acts for Homeless People related to special medical problems been have revised. furthemore they need to support the basic medical adds in order to maintaim their lives.

• 디지털융복합연구
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• 제17권11호
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• pp.29-37
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• 2019

노인들은 건강상태가 다소 좋지 않더라도 지역사회에 지속적으로 거주하기 원한다. 그러나 노인의 건강 및 기능상태에 맞는 통합적인 돌봄지원 시스템의 부재로 생활시설을 선택하는 경우가 증가하고 있다. 본 연구는 2017년 노인실태조사를 활용하여 장기요양인정을 신청한 노인들을 대상으로 욕구에 맞는 서비스를 이용하고 있는지를 탐색적으로 논의하고자 한다. 분석결과 첫째, 장기요양인정을 통해 등급을 받은 노인 중에서 경증 노인은 방문요양 등 재가서비스를 주로 이용하고 있었다. 그러나 경증 노인 중에서 일부는 요양시설에 입소하고 있어서 기능 상태에 맞지 않는 서비스를 이용하고 있었다. 둘째, 방문요양서비스가 주야간보호서비스에 비해 월등히 이용이 높아서 노인 상태에 맞는 복합적인 재가서비스가 이루어지지 못하고 있었다. 셋째, 등급 외 노인의 경우 등급인정 노인에 비하여 일상생활 수행을 위한 도움을 충분히 받지 못하고 있었으며, 경로당이나 노인복지관 등 지역사회복지서비스 이용도 낮았다. 따라서 장기요양인정자의 경우 건강 및 기능상태가 경증 임에도 지역사회에 계속 거주하지 못하고 시설에 입소하는 경우가 발생하고 있고, 등급 외 노인의 경우 필요한 지역사회 돌봄 서비스를 적절이 이용하지 못해서 장기요양인정자로 상태가 악화될 가능성이 높은 것으로 판단된다.