• 가정∙방문간호학회지
• /
• 제6권
• /
• pp.5-18
• /
• 1999

This study was attempt to encourage for developing on rehabilitation delivery system and programs as a substitute service instead of hospitalization for accident patients at work, such as hospital based home health care nursing service. It needs vary substitutes service of hospitalization to curtail the length of stay for inpatients who were hospitalized with workers compensation insurance. It focused on developing an estimation of early discharge day of accident inpatients based on a detail statement of treatment for 115 inpatients who were hospitalized at General Hospital in 1997. This study has four specific purpose as follows. First, to find out the status of health service utilization. Second, to estimate the early discharge days and income increasing effect based on the early discharge for those patients. Third, to identify the factors to affect total medical expenditure and the length of stay for those inpatients. Forth, to figure out the need of utilizing home health care nursing service for accident patients. In order to analyze of the length of stay and medical expenditure for inpatients who were hospitalized due to the accident, the authors conducted with micro-analysis and macroanalysis from medical records and medical expenditure records. Micro-analysis was done by nominal group discussion of 4 expertise with the critical criteria. such as a decrease in the amount of treatment after surgery, treatments, tests, drugs and changes in the tests consistency, drug methods, vital signs, start of ROM exercise, doctor's order, patient's outside visiting ability, stable conditions. In addition to identify affected variables for medical expenditure. the length of stay and income effect due to early discharge day, the data was analyzed with multiple regression analysis and linear regression analysis model by SPSS-PC for windows and Excell program. Results of this study as follows. First, the mean length of stay was 37.1 days, whereas the mean length of stay due to early discharge was 28.2 days at the hospital. The estimation of early discharge days were shown that depends on the length of stay. The longer length of stay, the longer length of early discharge days, such as under 7 days length of stay patients was to estimated the mean length of stay was 4.9 days and early discharge days was 4.6. whereas the mean length of stay was 122.6 days and early discharge days was 92.0 respectively. The mean medical expenditure per day were found to be 133.409 Won. whereas the mean medical expenditure per day was shown negative linear trends according to the length of stay at the hospital. The estimation results of the income effect due to 11 early discharge days per bed was around 2,150,000 won. However, it means not the real benefits from early discharge, but the income increasing amount without considering medical prime cost in general hospital. Therefore, it needs further analysis on the cost containments and benefits under the considering as well turn over rates per bed as the medical prime costs. The length of stay was most significant and the sign was positive to the total medical expenditure, as expected. Surgery and patient's residential area also an important variable in explaining medical expenditure. The level of complications was most significant variable in explaining the length of stay. The level of the needs on horne health care nursing service which can be used for early discharge accident patients were shown very high. The needs distribution varied from 65.5% of patients and 88.9% of caregivers, to 96.4% of doctors, and 99.1% of nurses. In addition horne health nurse responded that they can be managed the accident inpatients from early discharge. From these research findings. the following suggestions has been drawn it needs to develop strategies on rehabilitation delivery system in order to focused on consumer's side which is planned for 21 century health policy in Korea. Vary intermediate facilities and horne health care would have been developed in the community based for comprehensive rehabilitation services as a substitutes of hospitalization for shortening the length of stay of hospitalizations. In hospital based horne health care nursing service, it's available immediately to utilize for the patients who wanted rehabilitation services as a substitutes of hospitalization under the cooperations with workers compensation insurance company.

• 대한영양사협회학술지
• /
• 제14권4호
• /
• pp.337-350
• /
• 2008

The principal objective of this study was to assess the nutritional status and dietary quality in low-income elderly individuals residing at home (LH) or in health care facilities (LHCF) with dietitian. This study was conducted via anthropometric measurements, questionnaire interviews, and dietary surveys using a 24 hr recall method with 120 low-income elderly individuals (LHCF=46, LH=74). The average ages of the LH and LHCF group were 76.3 years and 78.6 years, respectively. The LH group evidenced a significantly higher frequency of skipping meals than the LHCF group. The average energy intakes of the LHCF and LH group were 1921.0 kcal and 1443.9 kcal, with a significant difference (p<0.001). Most of the nutrient intake and intake rates for recommended intake were significantly higher among the LHCF group as compared with the LH group. The LHCF group showed significantly higher values for the nutrient adequacy ratio (NAR), the mean adequacy ratio (MAR), nutrient density (ND), and the index of nutritional quality (INQ) by dietary qualitative estimation than in the LH group. The Korean diet diversity scores (KDDS) were 3.66 for LH group and 4.93 for the LHCF group, thus were significantly higher in the LHCF group than in the LH group. The results of the present study demonstrate that the LH group appeared to experience more dietary problems than the LHCF group. It was suggested that nutritional education is needed for low-income elderly individuals living at home, in order for them to learn proper dietary management. This can be achieved via educational programs in social welfare institutions, incentives toward employment as a dietitian, and implementation of community-based support.

• Journal of Hospice and Palliative Care
• /
• 제16권1호
• /
• pp.10-19
• /
• 2013

목적: 경남지역 암센터와 경남지역 각 보건소와의 말기암환자를 대상으로 시행한 연계 사업을 담당자를 대상으로 한 설문조사를 통해서 평가하고자 하였다. 방법: 2008년 1월 1일부터 2011년 12월 31일까지 경남지역 암센터와 연계 사업 협약을 체결하고, 환자를 등록해서 진행한 보건소 실무자를 대상으로 진행하였다. 총 9개 지역 보건소의 실제 사업에 참여한 경험이 있는 재가암 담당자 20명을 대상으로 설문지를 개발하여 조사를 하였다. 각 문항의 평가는 Likert 5단계 척도를 변형하여 단계마다 -2에서 +2까지 점수를 부여하였고, 각 문항의 총점은 40점이었다. 결과: 2008년 1월부터 2011년 12월까지 73예(72예는 경남지역 암센터, 1예는 보건소에서 등록)가 연계되었다. 서비스에 대한 평가로 환자나 가족들의 심리적 안정에 도움이 된다라는 항목이 23점으로 가장 높았고, 전반적으로 재가암 사업에 도움이 된다는 점이 11점으로 가장 낮게 나왔다. 연계 서비스에 대한 개선 문항으로는 입원 절차의 간소화가 35점, 환자 병원 방문 시 실질적 혜택 제공이 34점으로 높게 나온 반면, 보건소의 인력 강화가 4점으로 가장 낮게 나타났다. 결론: 말기암환자를 대상으로 한 경남 지역 암센터-보건소 재가암 쌍방향 서비스는 몇 가지 한계점을 드러내었다. 보다 나은 연계 서비스를 위해서는 이번 연구를 통해 나타난 여러 점들을 개선하고, 또 지역 실정에 맞는 모델을 개발하는 등의 노력이 필요한 것으로 생각된다.

• 농촌의학ㆍ지역보건
• /
• 제22권2호
• /
• pp.277-293
• /
• 1997

This study was conducted to provide basic materials required to enforce and develop welfare policies, as well as the health system, for the aged, by surveying the status of health care utilized by the daily increasing old population and the importance of receiving physical therapy. Data that need in this research was gathered from over ages of 65, during the period from Jan 4, 1996 to Jan 31, using the inquiries previously made by geriatric researchers and through literatures investigator by this writer. The data were analyzed by $X^2$, Z-test, Likert scale. The findings were as follows : 1) General characteristics of subjects. People in the age group between 65 and 69 were 55.6% and the highest number, while male were 37% and female 63%. Analysis of income group disclosed 60.6% whose monthly income, including the pocket money given by children, was less than 200,000 won. 91.1% of the elderly people surveyed owned houses; only 36.4% live with spouses; while 15.6% live alone. 2) Characteristics with respect to utilization of health care institution. 56% of the total medical institutions used by the elderly people were clinics and the rates of chronic disease and musculoskeletal disease were 73.2%. 3) Characteristics with respect to approach of health care institution. 45.1% of the respondent stated it took 20 minutes to arrive at hospital, and bus accounted for 48.6% of all transportation means used to go to hospital. 4) Degree of cognition with respect to the rights of geriatric patients. (1) There is no financial support from the government for geriatric patients(71.4%). (2) Government financial support is needed for geriatric patients(95.3%). (3) Have never been regionally surveyed or called upon for interviews with respect to treatment desire and problems relating to geriatric patients(87.2%). (4) Health and medical policies for geriatric patients must be established rapidly(98.4). (5) Expansion and construction of specialized medical facilities for geriatric patients such as elderly hospital and medical center are needed(90.2%). (6) Government's welfare policies for the elderly people is insufficient(82.0%) 5) Degree of cognition on importance of physical therapy with respect to geriatric patient. (1) Physical therapy is considered most effective in treating geriatric patients(82.9%). (2) Physical therapists specializing in only elderly people must be need of separately(76.2%). (3) It is desirable for medical specialists to visit geriatric patients at home to provide physical therapy(82.9%). (4) Hospitals specializing in physical therapy for geriatric patient are required(85.6%). Based on the result for this research, the following suggestions are presented to facilitate the utilization of health care institution for the welfare of geriatric patients. Medical facilities such as elderly hospital and geriatric patient's medical center specializing in elderly people must be constructed as early as possible; and home-visiting physical therapist system must be important to treat chronic geriatric patients; our government must establish policies to provide the old ages with means for the health care and curing chronic diseases, and carry out the plans of reasonable distribution and effective untilization of medical resources.

• 농촌의학ㆍ지역보건
• /
• 제36권4호
• /
• pp.238-250
• /
• 2011

지속적인 암환자 및 암 관련 의료비용 급증은 환자 개인의 고통 및 경제적 부담으로 작용할 뿐만아니라 사회적인 부담이 되고 있다. 이에 재가암 환자에 대한 통증관리 등의 서비스 제공은 의료 비용을 절감하는데 효과가 있을 것으로 여겨지고 있다. 따라서 재가암환자에 대한 적절한 의료 및 복지 서비스 등을 제공하기 위한 자료로 활용하고자 재가암환자관리사업 수혜자의 서비스 요구도에 대하여 각 보건소의 재가암환자관리사업 담당자가 재가암환자관리사업 수혜자 방문시 면접조사방법으로 조사하였고, 불충분응답자 15명을 제외한 661명을 최종 분석대상으로 하였다. 재가암환자의 서비스 요구도에 대한 요인분석 결과 5가지 영역으로 분류할 수 있었고, 요인별 신뢰도는 0.593~0.890이었다. 요구도의 순위는 사회적 지지, 정보 및 교육제공, 심리적 문제해결, 신체증상해결, 가사도움 순으로 조사되었다. 대상자를 암 치료 및 진행 정도에 따라 말기암 환자, 치료중인 암환자, 암 완치자로 분류하였을 때, 말기암환자의 요구도가 가장 높게 나타났으며, 사회적지지, 심리적 문제 해결, 정보 및 교육 순서로 요구도가 높았다. 나머지 그룹에서는 사회적지지, 정보 및 교육, 심리적 문제 해결 순으로 말기 암환자와 차이를 보였다. 뿐만 아니라, 연령별, 거주 지역별, 종교 유무에 따른 서비스 요구도에 차이가 관찰되었고, 이를 바탕으로 현재 제공되고 있는 재가암환자관리의 효율적인 추진을 위해 대상자 분류, 연령별 및 거주 지역별 특성에 따른 서비스가 제공될 수 있도록 해야 할 것이다.

• 지역사회간호학회지
• /
• 제9권2호
• /
• pp.324-335
• /
• 1998

This study describes the extent of recognition of problems to the aged in a future society, the recognition and necessity of day care facilities, and the service contents and patterns preferred as a method of mediation for nursing the aged and increasing their quality of life. It also tries to certify the relations between those subjects. The result of the study is as follows: 1. Concerning problems of the aged of social significance the aged of the next generation consider the difficulties in nursing the aged to be the most important at 63.6%. 2. Concerning the nursing of parents, 49.4% of those answered 'children should take care of their parents and live together', while 46.7% answered that 'it is enough for children to provide an economic support, not necessarily living together. 3. Concerning information of day care facilities, 66.9% answered that they have no information. 4. Concerning the use of day care facilities, 54.6% answered that 'they would under certain circumstances', and 21.0% that 'they had better use them in the future'. 5. Concerning the feelings of the aged using day care facilities, 46.6% say 'they do not look poor', and 33.4% said that 'they look a little poor'. 6. Concerning the reasons for using day care facilities, 56.1% answered' because children do not proride care', and 48.5% answered 'because their economic ability is not sufficient'. 7. Concerning the programs potentially needed, food supply, medical services and physical therapy were ranked in that order. 8. Concerning social facilities necessary for the aged, centers that specialize in dementia, free day care facilities, home care services, and fee - based day care centers were ranked in that order. 9. Concerning institutions providing day care, welfare centers for the aged, those centers auxiliary to hospitals, asylums, and individuals were ranked in that order. 10. Concerning the responsibity running day care facilities, social workers, doctors/nursing assistants, nurses, and entrusted visitors were ranked in that order. Based on the results of this study, the study proposes that the study of applied cases of therapy in day care facilities for the aged continue.

• 한국보건간호학회지
• /
• 제5권1호
• /
• pp.70-95
• /
• 1991

The ageing problem of the population has been emerging in Korea since 1970's so that it is expecting the elderly 65 years and over among the total population from $4.5\%$ in 1988 to be $6.3\%$ in year 2000. This study was conducted to provide secure policy development in coming years for the aged on medical and health care aspects based on the examining current status of the aged problems and health care policies and systems. The study divided into four parts; The first part examined the medical insurance program and public assistance program of the health services in relation to the aged. The second part emphasized on reduction of medical care cost for the aged. The third part studied the regular health check-up program and health education for the aged. The fourth part examined the chronic disease management programs for the aged and strategies of the health care service quality improvement and specialized programs. The following recommendations made as the results of the study. 1. At present, the medical insurance program and public assistance program for the medically indigent is not appropriate to the elderly because it is a part of general medical insurance program so that Health Security Law for the Aged is proposed. 2. Medical cost will be increased due to the high occupancy rate of hospital beds and long stay of the elderly so that it is recommended to develop an early discharge program, home health care program, Health hospice and an althernative programs. 3. At present, a regular health check-ups for the elderly is not included in medical insurance program so that it is recommended to be included in the insurance program and at the same time health education program thoroughly developed for the aged. 4. To make proper medical and nursing services on chronic diseases for the elderly, it is recommended manpower development, specialized clinics or hospitals, nursing homes and an equivalent long term care facilitices should be established on the community based and a research institutions also to be related to supper the care programs.

• 한국보건간호학회지
• /
• 제35권3호
• /
• pp.430-447
• /
• 2021

Purpose: The purpose of this study was to analyze the role and tasks of nurses who were working for the elderly in the visiting health services at the public health centers. Methods: Literature reviews, two rounds of meetings with 5 experts and a two-round Delphi technique with 15 experts were performed in this study. Results: The nurses' role and job analysis revealed 5 roles, 16 duties and, 71 tasks. The nurses' roles, including discovery and registration of households/groups in visiting health service in the community, case manager, administrative management, program planning, operation and evaluation, and development of job competency. Sixteen duties included client registration and management, need assessment and plan establishment, education, consultation and support, seasonal health care, prevention and monitoring of infectious diseases, basic nursing care, chronic disease management, linkage and utilization of resources, team cooperation and coordination, home environment management, monitoring and support for intervention outcomes, evaluation, administrative management, program planning, operation and evaluation, development of professional competency and, adoption of fourth industrial revolution technology. Conclusions: Based on the results, the government should provide sufficient nursing personnel to provide universal preventive health services for the elderly and a job training program to perform these roles well.

• 대한의료기공학회지
• /
• 제11권1호
• /
• pp.117-143
• /
• 2009

The community of women into society in various fields is expanding, and married late, and accordingly, the first child birth is increasing age. Accordingly, dystocia has also increased. Listed in the literature that the traditional method of birth seemed to oriental medical interpretation of one of the ancient wisdom of the predecessors to explore. The result of this study is summarized as follows. 1. Child birth custom divide into childbirth preparation, childbirth and postpartum care. Postpartum care divide into preparation of the birthplace, food for pregnant woman and birth preparation of the necessary things. 2. Preparation of the birthplace of the court case and that qeen is three months, one month before that in the case of concubines were installed. The difference in manners, and actual number but the configuration of the same item was prepared. In the private, birthplace is installed husband's home or parent's home. 3. Rice and seaweed is food for pregnant woman. San Miguel (产 米), sangwak (山 藿) specifically called was selected by Keep elaborate. 4. 1 month before birth to baby clothing is usually prepared. For the safe of a paturient woman and a baby, magical prescription was practiced in so-guk-so(昭格署) in early chosun dynasty. After so-guk-so(昭格署) abolished magical practice was stopped. Then Wore old clothes based on dong-ui-bo-gam(東醫寶鑑) 5. Im-san-ye-zi-bub(臨产豫智法) specifically to instruct the royal birth is the birth of guidelines. Im-san-ye-zi-bub(臨产豫智法) cosist of birth place, abdominal pain Precautions, food, care after childbirth, remove the plecenta posion, method of cut navel, bath, protection. Through various court records of the situation, according to the guidelines are properly applied based on dong-ui-bo-gam(東醫寶鑑).

• Journal of Hospice and Palliative Care
• /
• 제22권3호
• /
• pp.105-116
• /
• 2019

목적: 소아청소년 호스피스 완화의료(이하 소아완화의료)는 생명을 위협하는 질환을 가진 소아청소년의 삶의 질을 향상시기 위한 총체적 돌봄 철학이자 실무의 표준이다. 국내에서는 2018년 7월 국가 지원의 소아완화의료 시범사업을 도입하였는데, 소아완화의료의 발전 방향을 제시하기 위해 국외 선진국의 소아완화의료 제공체계를 고찰하였다. 방법: 소아완화의료 제공 수준을 검토하여 영국, 미국, 일본, 싱가포르를 대상으로 선정하였다. 소아완화의료 제공체계를 다룬 국내외 학술지 등 문헌을 통합적으로 고찰하고 현지 전문가의 자문과 현지 방문조사를 수행하였다. 1990년 이후 영어, 일본어로 발간된 문헌을 중심으로 PubMed, Google, Google Scholar에서 검색하여 학술지, 정책보고서 등을 참고하였다. 각국의 소아완화의료 발전과정, 정책, 재정 모델, 대상 기준, 전달 체계, 질 관리 체계에 대해 분석하였다. 결과: 영국은 지역사회의 독립형 소아전문 완화의료기관이 일차 의료체계와 협력하며 어린이병원의 전문 소아완화의료 자문팀과 의뢰와 자문을 주고받는다. 미국은 병원기반의 전문 소아완화의료 자문팀을 중심으로 지역사회의 호스피스기관, 가정의료기관이 네트워크를 구축하고 돌봄 코디네이터를 지정하여 소아완화의료를 제공한다. 일본은 완화의료, 재택의료, 장애아동 및 만성질환아동 지원체계에서 완화의료 성격의 서비스를 제공한다. 싱가포르는 소아전문 가정 완화의료 단체가 어린이병원의 전문 자문팀과 협력하여 높은 지리적 접근성을 토대로 중추적으로 완화의료를 제공한다. 결론: 국외의 제공체계를 참고하고 국내의 현장의 요구를 반영하여 소아완화의료의 제공체계를 정비하여 미충족 요구가 발생하지 않도록 한국 소아청소년 호스피스완화의료를 최적화해 나가야 한다.