• 가정간호학회지
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• 제5권
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• pp.20-31
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• 1998

The purpose of this study was to develop the framework of community-based home care nursing delivery system, and to examine the validity of it. For these, home care nursing study team of College of Nursing, Seoul National University has studied home care nursing system since September, 1996, and has operated home care center since August, 1997. This study has been supported by the Korean Sience Foundation. We organized Committee of rules, and Clinical specialist consultant group for more efficient running of the home care center. In nursing station, research assistant controlled general work, and 5 home care nurses were hired for home visiting. We developed the Standards for operations, that included criteria for clients, central supply system of nursing materials, central management of nursing care cost, advertisement, patient referral system, and so forth. In our center, 108 patients enrolled, and neurologic disorders including cerebrovascular accident, and cancer were the most prevailing diseases. We tried to overcome the limitations of hopital -based home care, and to provide more accessible, efficient, safe, and stable home care nursing. Therefore, we were referred clients from patients and families, public health care center, industries, as well as from hospitals. Meanwhile, we developed home care recording system and assessment-intervention algorithm for various diseases for quality control and standardization. Also, we did continuing education, and tried to detect problems and to find solutions by regular meeting between the committee of rules and home care nurses. As the results of this study, several limitations of operation were found. First, it was difficult to manage and communicate with the doctor in the emergency situation, Second, we spent too much time for trasnsportation, because only five nurses covered all areas of Seoul and nearby cities. Third, preparation for special care of home care nurses were lacked. Forth, criteria for termination of care and frequency of home visit were ambiguous. Fifth, some difficulties were found in retrospective payment system. And finally, interconnection with home care machinery company were needed. Strategies for solving these problems were suggested.

• 가정간호학회지
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• 제19권2호
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• pp.119-126
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• 2012

Purpose: The purpose of this study is to identify clubhouses general characteristics, core services, funding sources and costs in Korean Clubhouse Model, and to compare with Korean and international clubhouses. We explored the annual budget, cost per member, and cost per visit for 1 year. Methods: The data were collected from 14 Korean clubhouses and analyzed using descriptive statistics and Spearman's rank correlation with the SPSS 14.0 program. Results: The average of clubhouse operating period was 8.2 years. There were an average of 40.4 active members; among them, 84.1% were schizophrenia. In addition, there were an average of 5.8 staff and 15.3 services in each clubhouse. Cost estimates were as follows: annual budget (excluding housing) $223.633, cost per member $5,704, and cost per visit $21.35. There were significant difference among the annual budget, number of staff, number of service, and active members, but hours of Work-Ordered Day and social activities hours were not statistically significant. Conclusion: Findings provide a more understanding of operations, programs, and costs of Korean clubhouses.

• 대한장애인치과학회지
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• 제13권2호
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• pp.73-79
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• 2017

The purpose of this study was to analyze the dental treatment of patients with disabilities, especially according to the frequency of general anesthesia, and to propose the improvements in oral care. The subjects of the present study were 85 patients including age, sex, medical condition, dental treatment and the number of general anesthesia. The patients were divided into regular and irregular check groups according to their follow-up patterns. These two groups were compared for the frequency of general anesthesia and the type of repeated treatment. The results showed that restorative treatment was superior in numbers under first visit of general anesthesia. And more general anesthesia was performed in the irregular recall check group compared with the regular recall check group. This survey suggest that easy access to a dental clinic and the convenience of treatment is needed. On the other hand, there is a time limit on the dental care for disabilities by the dentist. Therefore oral care training program should be simultaneously provided for parents to improve the efficiency of dental care at home. In conclusion, efforts should be made for more comprehensive and effective dental care including regular recall check and preventive home care for disabilities.

• 대한간호학회지
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• 제34권6호
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• pp.1025-1034
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• 2004

Purpose: This study defines a vulnerable group in a community that has become the main target of a national health project also, it is descriptive research to suggest an evidence-based direction to meet their deficit health-related needs, Method: This research examined 833 families and 1,835 family members of the financially vulnerable class that was registered in a home visiting program of a public health center. Among them, 892 persons who had health problems, and their family members were examined in detail to find out their characteristics of vulnerability and health needs by assessment during a nurses home visit. Frequency distribution, stepwise-regression and factor analysis were used to analyze the data. Result: The vulnerable group that was defined with social indexes set as standards, involved substantial characteristics of vulnerability. The characteristics of demand showed tendencies of being clustered in 5 factors needs of intensive nursing care, chronic nursing care problems and helplessness, maintenance of family functioning with a disability, deficient problem solving ability, and simple financial fragility. Conclusion: Categorization of needs is an evidence-based estimator of workload in nurse home visiting services, and can be used as a basic resource for direction to meet the deficit needs of a vulnerable group.

• 대한간호학회지
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• 제34권6호
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• pp.1117-1128
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• 2004

Purpose: This study was carried out to substantiate the application process of activity-based costing on the current cost of hospital home care (HHC) service. The study materials were documents, 120 client charts, health insurance demand bills, salary of 215 HHC nurses, operating expense, 6 HHC agencies, and 31 HHC nurses. Method: The research was carried out by analyzing the HHC activities and then collecting labor and operating expenses. For resource drivers, HHC activity performance time and workload were studied. For activity drivers, the number of HHC activity performances and the activity number of visits were studied. Result: The HHC activities were classified into 70 activities. In resource, the labor cost was 245￦per minute, operating cost was 9,570￦ per visit and traffic expense was an average of 12,750￦. In resource drivers, education and training had the longest time of 67 minutes. Average length of performance for activities was 13.7 minutes. The workload was applied as a relative value. The average cost of HHC was 62,741￦ and the cost ranged from 55,560￦ to 74,016￦. Conclusion: The fixed base rate for a visit in the current HHC medical fee should be increased. Exclusion from the current fee structure or flexible operation of traveling expenses should be reviewed.

• 한국치위생학회지
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• 제14권5호
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• pp.715-721
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• 2014

Objectives : The purpose of the study is to investigate the perception of elderly oral health care in the care workers in nursing homes. Methods : A self-reported questionnaire was filled out by 200 care workers in nursing homes in Daegu and Busan. Data were analyzed by SPSS 18.0 program. Results : The oral health care was maintained by innately healthy mouth(49.5%), dentists(48.5%), public health centers including institution and dentistry(46.5%), regular visit to dentistry(44.0%), and ingestion of healthy food(38.5%). Fifty eight percent of the respondents(116 persons) agreed that regular and proper toothbrushing is the most important behavior to maintain the healthy teeth. The regular visit to dental clinics(Wald=7.076, p=0.008) and an oral care by specialist (Wald=5.210, p=0.022) influenced on elderly oral health status(p<0.05). Conclusions : The oral health care education is very important for the workers in the nursing homes that the education can improve the perception toward the elderly oral health.

• 한국노년학
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• 제30권4호
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• pp.1345-1357
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• 2010

본 연구에서는 장기요양보호 서비스 중 방문목욕을 이용하는 여성노인을 대상으로 방문목욕을 받으면서 경험하게 되는 신체적, 심리적 변화는 무엇인가에 대해 심층적으로 분석코자 하였다. 이를 위해 장기요양보호서 비스를 이용중인 8명의 여성노인을 대상으로 심층면접하고 서비스 이용과정 중 경험하게 되는 신체적, 심리적 경험을 질적자료로 활용하여 자료를 분석한 탐색적 연구이다. 연구결과를 살펴보면 다음과 같다. 첫째, 여성노인의 신체적 측면에서는 방문목욕서비스를 받는 동안 변화된 여성노인의 신체적 요인을 살펴보면 서비스 이용 후 몸이 건강해지고 편해졌으며 신체적으로도 나아지고 있다고 믿고 있었다. 둘째, 심리적 측면에서는 자신의 신체적 장애로 인해 방문목욕을 받는 것에 대해 자신의 몸을 보이는 것을 추잡하고 부끄럽게 여기다가 방문목욕을 편하게 여기게 되었다. 또한 요양보호사와의 상호작용을 통해 목욕서비스 이외에 정서적측면에서 지지를 받음으로 자신에 대한 존재가치를 긍정적으로 바라보는 모습이 나타났다. 그 결과 장애로 인해 부끄럽고 불편하며 추잡스럽게 자신을 여기던 부정적 태도에서 장애를 지닌 자신의 신체적 상태를 수용하고 받아들임으로 방문목욕서비스를 편하게 받아들이게 되는 변화의 과정이 나타나 장애수용이 현실적응에 큰 영향을 미치게 되는 계기임을 알 수 있었다. 이상의 결과를 근거하여 다음과 같이 제언하였다. 첫째, 장기요양보호에서 노인에 대한 체계적인 관리 및 정서적 안정을 높이기 위해서 자신의 장애를 수용하여 현실에 적응할 수 있도록 사회복지사의 개입과정이 도입되어야 할 것이다. 둘째, 노인에게 있어 긍정적 정서에 많은 영향을 미치는 대상이 요양보호사임을 고려할 때 단지 요양보호사로써의 역할을 벗어나 노인의 강점과 긍정성을 발견하고 강화시키는 멘토의 역할을 감당할 수 있도록 요양보호사에 대한 체계적인 교육시스템의 마련이 제안되어야 할 것이다. 셋째, 지역사회를 중심으로 장기요양기관, 방문요양기관, 복지관 등과 건강보험관리공단이 통합네트워크를 구성하여 권역별로 장기요양보호를 이용하는 가정 및 긴급·위기가정에 대해 지원하는 통합사례관리체계가 마련되어야 할 것이다.

• 근관절건강학회지
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• 제27권3호
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• pp.238-246
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• 2020

Purpose: This study aimed to investigate the effect of home visiting care service and to evaluate the effect from the cost-benefit among older people. Methods: The target participants were enrolled in 2007 and they were classified into 1 year, 2 years, 3 years, and 4 years according to their service provision period. We analyzed health insurance claims data and entitlement data from the National Health Insurance Service databases between 2006 and 2010. This study examined the participants' social-economic and health status factors related to total medical expense. Cost-benefit analysis was done using the net benefit and benefit/cost ratio. Results: Based on the use of home visiting service, the effect was reduced by 223,914 won. The cost for 952,109 people aged 65 or older was 39,891,462,882 won and the benefit was 213,190,534,626 won. The net benefit was 173,299,071,744 won and the benefit/cost ratio was 5.34 times, which was very economical. Conclusion: Home visiting health care should continue to expand as a means of economically effective health care for people aged 65 and older and to ensure health equity for vulnerable groups.

• 한국사회복지학
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• 제37권
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• pp.429-448
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• 1999

본 연구는 재가복지서비스에 대한 질적 평가의 일환으로서, 사회복지관 부설 재가복지봉사센터의 서비스를 받는 재가복지 대상자를 조사대상으로 하여 재가복지대상자의 특성과 서비스 내용, 서비스 만족도, 그리고 이들 간의 상관관계를 조사함으로써 현행 재가복지사업의 문제점을 보다 심층적으로 분석하려는 것이다. 본 논문의 분석결과, 현행 재가복지서비스에 대한 대상자의 만족도 점수는 5점 척도에서 상위 $1.62{\sim}2.56$점에 위치함으로써 긍정적 평가와 부정적 평가가 모두 가능하였지만, 방문 빈도에 관한 불만이 있음을 확인할 수 있었다. 또한 현행 재가복지서비스가 대상자의 욕구 중심으로 이루어지고 있는지에 대한 의문을 갖게 하였는데, 대상자의 욕구와는 관계없이 가사서비스가 주로 제공되고 있어서 건강이 나쁜 대상자라도 의료서비스보다는 가사서비스를 더 많이 받고 있었고, 일상생활 수행능력상의 장애와 서비스간의 괴리도 심각하게 나타났다. 특히 복지 선진국과는 달리, 우리의 재가복지서비스는 건강이 나쁜 대상자, 그리고 일상생활 수행능력상의 장애를 가지는 대상자의 의료욕구를 충분히 충족시키지 못함으로써 건강이 나쁜 대상자일수록 재가 복지서비스가 도움을 주지 못한다고 생각하는 것으로 나타났다. 또한 자산조사를 자격요건으로 하는 생활보호대상자를 가장 중요한 대상자 선정기준으로 삼고 있을 뿐, 욕구조사가 거의 이루어지고 있지 못하다는 것을 보여주었다.

• 가정간호학회지
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• 제8권1호
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• pp.5-24
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• 2001

The purpose of this study was to develop a parenting intervention program and determine the efficacy of the program with low-birth weight infants and their mothers. Nine dyads for the experimental group and twelve dyads for the control group discharged from the Neonatal Intensive Care Unit of a University Hospital in Seoul were recruited for the study. For the intervention group, programmed education and support which focused on the maternal sensitivity of the infant's behavior. rearing environment. motherinfant interaction and infant care were given to each subject. Individual counseling and home visits were provided at discharge, one week after discharge. and one and three months of corrected age in every infant. Structured questionaires were administered and feeding interactions were videotaped and coded by a blinded certified observer. A Quasi-experimental design was conducted for this study. Postpartum depression, maternal self esteem. infant care burden, HOME. mother-infant interaction, and infant development were measured. Results were in favor of the intervention versus the control group. On the Beck depression inventory, intervention mothers showed decreasing trends in depressive symptom vs control mothers although, there were statistically no significant differences between the two groups at each time. The mean score of experimental group was 11.55(mild depression state) at discharge and became 8,6(normal state) at 1 month of corrected age. On the other hand, the mean score of the control group was 13.92(mild depression state) at discharge and became 14.0. Maternal self esteem in both groups improved over time. Infant care burden in both groups was also shown to increase over time. There was a significant difference between the two groups in HOME(p=.0340) at 3 months of corrected age. HOME scores of the experimental group and the control's were 31.10 and 25.58, respectively. Mothers' emotional and language responses were significantly high in the intervention group compared with the control group(p=.0155). Intervention group (53.33) showed a significantly high quality of motherinfant interaction compared with the in control group (42.80)(p =.0340). Intervention group mothers appeared have a better quality of mother-infant interaction behaviors. On the other hand, there was no statistical difference in the infant part between groups. Intervention group infants had higher trends in a general developmental quotient: although, there was no statistical difference between groups. The general developmental quotient of intervention infants was 102.56 and control's was 91.28. However, the developmental quotient of the domain of 'individuality-sociality' was higher in the intervention group infants compared with the control's(p=.0155). The concerns identified by parents revealed two domains of an infants' health management -knowledge and skills in caregiving of lowbirthweight-infants, characteristics of lowbirthweight infants, identifying a developmental milestone, coping with emergency situations and relaxation strategies of mothers from the infant care burden. Interview data with the mothers of low-birth weight infants can be used to develop intervention program contents. Limited intervention time and frequency due to time and cost limitations of this study should be modified. The intervention should be continuously implemented when low-birth weight infants become three years old. An NNNS demonstration appeared to be a very effective intervention for the mothers to improve the quality of mother-infant interactions. Therefore intervening in the mothers of low-birth weight infants as early after delivery as possible is desirable. This study has shown that home visit interventions are worthwhile for mothers only beyond the approach as an essential factor in ability of facilitating a growth fostering environment. In conclusion. the intervention program of this study was very effective in enhancing the parenting for the mothers of low-birth weight infants, resulting in health promotion of low-birth weight infants. The home-visit outreach intervention program of this study will contribute to the health delivery system in this country where there is a lack of continuous follow-up programs for low-birth weight infants after discharge from NICU, if it is activated as part of the home visit programs in community health systems.