• 대한지역사회영양학회지
• /
• 제19권4호
• /
• pp.386-400
• /
• 2014

Objectives: The purpose of this study was to provide a basic data of nutrition services in home health care by analyzing hospital-based home-visit nutrition education needs of patients at discharge. Methods: Data was collected from September 11 to October 12, 2012 by administering questionnaires to 289 chronic disease patients to be discharged from a university hospital in Pusan. The home-visit nutrition education instruments used for collecting data were developed by the researcher. Results: Regarding the demands of home-visit nutrition education, 62.3% of subjects were willing to use home-visit nutrition education and 37.7% weren't. The main reason for using the home-visit nutrition education was "the effective nutrient management in consultation with an individual's doctor", 38.9% and 31.2% of patients who did not wish to use the service gave the reason for their decision as, "Just by managing the nutritional requirements of a family's diet and, the patient will be able to fully recover", respectively. As for the demand, classified with the areas of home-visit nutrition education, the demand for the area of basic nutrition (3.75/5.00) was the highest followed by, the area of educational nutrition (3.74/5.00), therapeutic nutrition (3.67/5.00), and dietary nutrition (3.55/5.00). The demand for the area of educational nutrition was high "Considering the state of dietary management, such as disease status and drugs", 73.7%. As for the relation between the characteristics of the study subjects and analysis of demand home-visit nutrition education, the characteristic of subjects, that is, "regular home-visit nutrition education", "practice of diet therapy after discharge" had a significant difference statistically (p < 0.01). As for the relation between the needs for fundamental home-visit nutrition education and the demand of home-visit nutrition education, basic nutrition, educational nutrition, therapeutic nutrition, and dietary nutrition had a significant difference statistically (p < 0.01).

• 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.

• 호스피스학술지
• /
• 제1권1호
• /
• pp.46-69
• /
• 2001

Hospice Care is the best way to care for terminally ill patients and their family members. However most of them can not receive the appropriate hospice service because the Korean health delivery system is mainly be focussed on acutly ill patients. This study was carried out to clarify the situation of hospice in Korea and to develop a hospice care delivery system model which is appropriate in the Korean context. The theoretical framework of this study that hospice care delivery system is composed of hospice resources with personnel, facilities, etc., government and non-government hospice organization, hospice finances, hospice management and hospice delivery, was taken from the Health Delivery System of WHO(1984). Data was obtained through data analysis of litreature, interview, questionairs, visiting and Delphi Technique, from October 1998 to April 1999 involving 56 hospices, 1 hospice research center, 3 non-government hospice organizations, 20 experts who have had hospice experience for more than 3 years(mean is 9 years and 5 months) and officials or members of 3 non-government hospice organizations. There are 61 hospices in Korea. Even though hospice personnel have tried to study and to provide qualified hospice serices, there is nor any formal hospice linkage or network in Korea. This is the result of this survey made to clarify the situation of Korean hospice. Results of the study by Delphi Technique were as follows: 1.Hospice Resources: Key hospice personnel were found to be hospice coordinator, doctor, nurse, clergy, social worker, volunteers. Necessary qualifications for all personnel was that they conditions were resulted as have good health, receive hospice education and have communication skills. Education for hospice personnel is divided into (i)basic training and (ii)special education, e.g. palliative medicine course for hospice specialist or palliative care course in master degree for hospice nurse specialist. Hospice facilities could be developed by adding a living room, a space for family members, a prayer room, a church, an interview room, a kitchen, a dining room, a bath facility, a hall for music, art or work therapy, volunteers' room, garden, etc. to hospital facilities. 2.Hospice Organization: Whilst there are three non-government hospice organizations active at present, in the near future an hospice officer in the Health&Welfare Ministry plus a government Hospice body are necessary. However a non-government council to further integrate hospice development is also strongly recommended. 3.Hospice Finances: A New insurance standards, I.e. the charge for hospice care services, public information and tax reduction for donations were found suggested as methods to rise the hospice budget. 4.Hospice Management: Two divisions of hospice management/care were considered to be necessary in future. The role of the hospice officer in the Health & Welfare Ministry would be quality control of hospice teams and facilities involved/associated with hospice insurance standards. New non-government integrating councils role supporting the development of hospice care, not insurance covered. 5.Hospice delivery: Linkage&networking between hospice facilities and first, second, third level medical institutions are needed in order to provide varied and continous hospice care. Hospice Acts need to be established within the limits of medical law with regards to standards for professional staff members, educational programs, etc. The results of this study could be utilizes towards the development to two hospice care delivery system models, A and B. Model A is based on the hospital, especially the hospice unit, because in this setting is more easily available the new medical insurance for hospice care. Therefore a hospice team is organized in the hospital and may operate in the hospice unit and in the home hospice care service. After Model A is set up and operating, Model B will be the next stage, in which medical insurance cover will be extended to home hospice care service. This model(B) is also based on the hospital, but the focus of the hospital hospice unit will be moved to home hospice care which is connected by local physicians, national public health centers, community parties as like churches or volunteer groups. Model B will contribute to the care of terminally ill patients and their family members and also assist hospital administrators in cost-effectiveness.

• 지역사회간호학회지
• /
• 제10권1호
• /
• pp.5-18
• /
• 1999

The aim of this study is the development of a fee - based model day care center for the elderly by inquiring into the current condition of facilities in America and in Korea, and in surveying the opinion of domestic elderly about day care facilities. A field trip to U.S. day care services was held between July 5 and July 15 in 1997, and an on-the-spot study for domestic facilities took place during March in 1998. Our research reveals that the overall supply of day care facilities can not meet future demand in terms of quality and quantity. Therefore a model must be created for day care centers of a that consists of a director from a professional group. an adequate environment, and a standardized in order to offer a qualified public health service linked to the home and community in Korea. The director of a day care center is a critical variable in determining the quality of service. Professional skills related to the needs of the elderly and the person's quality of service should be considered in appointing director for the center. This study belleves that a professional nurse should be the director of a day care center. The operating environment of a day care facility should be made up of considerable space comparable to the number of residents, should be in a comfortable and safe location, and should have equipment that provides a qualified, safe service to the elderly. Our model is designed for 20 persons and allocates 4 Peng per person. This model is comprised of a reading room. a craft room, a health room, a room for physical therapy, a dining room, a staff office, and a multi -purpose room connected to other rooms. Day care service should be a comprehensive service program meeting the multidimensional needs of the elderly. A comprehensive service program needs a team of various professionals made up of the elderly family, participants, nurses, social workers, physical therapists, nutritionists, and medical doctors. The program will also include health care service, physical therapy, speech therapy. diet, occupational therapy, transportation service, health and an education program, etc. In conclusion, a model of a day care center is developed with the following components: a professional director and an environment and program, that considers the physical, mental, and social characteristics of the elderly. A model should also motivate self-reliance self-fulfillment in the elderly in order to fulfill their health needs and to prevent isolation from society and mental depression. Furthermore, This facility will be a beneficial factor in reducing a family's burden on caring for the elderly that includes unnecessary hospital expenses. The following is a suggestion based on results this study: A service program should be developed to fit the conditions of the elderly in Korea by specifically analyzing the needs of the elderly.

• 한국보건간호학회지
• /
• 제10권1호
• /
• pp.95-105
• /
• 1996

This study was uncertaken to find an effective management modality for patients with hypertension. Patients 60years or older were selected for this purpose from a general hospital and a welfare center in Pusan and from a public health clinic in Cheju Island. During the month of October in 1984. the management modality for hypertension. the incurred medical expenses. and knowledge about the hypertension were analyzed and compared. The following results were obtained: 1. The a erage total medical expense per year was highest at the general hospital followed by the public health clinic and the welfare center. 2. It was found that the patients chose the public health clinic for its low medical cost. the welfare center for its proximity as well as for its low medical cost. and the general hospital for its quality medical services Also. the study has shown that the prescription of drugs was the major service provided by the public health clinic whereas the blood pressure measurement. the prescription of drugs. and family planning were the primary service offered by the welfare center. Drug prescription and blood pressure measurement were two of the most important services by the general hospital. 3. It was shown that the knowledge of hypertension was highnest at the welfare center whereas the management of hypertension was highest at the public health clinic. Based on above results and considering the chronic nature. it is believed that family awareness of the illness was one of the most important aspects for effective management of the hypertension for the elderly patients. In addition. the health care clinics at every level should come forward to execition of the educational programs and home nursing schomes for the effective management of the hypertension patients.

• 여성건강간호학회지
• /
• 제21권4호
• /
• pp.308-320
• /
• 2015

Purpose: The aim of this study was to determine the predictive factors for maternal role development for mothers of premature infants. Methods: A descriptive correlational study was conducted. A total sample of 121 mothers of premature infants following discharge from the neonatal intensive care unit were recruited using two strategies; an internet-based survey and an in-person data collection in a tertiary university hospital in Korea. A self-report questionnaire was used to collect data regarding personal, birth variables, marital intimacy, maternal attachment, maternal identity and maternal role development. Results: A hierarchical multiple regression analysis indicated that parity, maternal attachment, marital intimacy and maternal identity were predictors for maternal role development for mothers of premature infants, accounting for 70% of the variance. Among these variables, maternal attachment is the most powerful predictor for maternal role development. Conclusion: Nursing interventions during hospitalization to post-discharge education that includes parents of premature babies with positive interaction between couples strengthening marital intimacy and promotes maternal attachment that leads to integrate maternal identity should be considered by priority. Community-based family services such as home visits should be focused on maximizing the predictive factors for maternal role development in transition to motherhood that can contribute to maternal health as well as optimal growth and development of premature infants.

• 한국응급구조학회지
• /
• 제15권2호
• /
• pp.27-42
• /
• 2011

Purpose: This study intended to improve quality of prehospital emergency care for trauma patients by figuring out its current situations and problems based on run-sheets and questionnaires of 119 emergency medical technicians (EMTs). Methods: This study conducted a research of 425 trauma patients transferred to the 3rd hospital in G-city by 119 ambulances from July 1, 2008 to June 30, 2009. We aslo utilized 114 copies with questionnaires of 119 EMTs working in J-province. The data were analyzed with SPSS 18.0. Results: There were 425 trauma patients including 272 men and 137 patients with traffic accident. When it comes to types of 119 EMTs who delivered cares to patients, there were 206 (48.5%) advanced EMTs, 101 (23.8%) basic EMTs, 50 (11.8%) nurses and 43 (10.2%) rescue education receivers. The most frequent measured vital sign was pulse rate (54.1%). Regarding assessment of systolic blood pressure, pulse rate and respiration rate, there were some significant differences in accordance with type of 119 EMTs. Among the 317 patients evaluated 'emergency' in field, 137 patients returned to their home. Prehospital emergency cares accounted for 861, around 2.0 treatments per a patient. In view of questionnaire, the 74.6% of 119 EMTs hoped supplement of man power for proper prehospital care to trauma patients. Conclusion: This study suggested that it is necessary to develop detailed guidelines for trauma patients so as to improve quality of trauma patient evaluation and prehospital care. Furthermore, improvement of emergency care systems will reduce mortality of trauma patients and lead to their good outcome.

• 디지털융복합연구
• /
• 제17권9호
• /
• pp.301-310
• /
• 2019

본 연구는 생애말기케어에 대한 수혜 자격, 서비스 및 전달유형, 질 관리에 대해 검토하고 생애말기케어 시스템을 위한 서비스 질 관리 방법을 분석하는 것을 목적으로 한다. 한국의 보건복지부와 미국의 Centers for Medicare and Medicaid Services에서 발간한 문헌과 법령을 수혜 대상자, 서비스 종류 및 전달유형, 질 관리에 대해 고찰하고 비교 분석하였다. 한국은 진단명을 기준으로 의료기관에서 입원 기반 서비스를 제공하고 있으며, 질 관리는 인력, 시설, 장비에 대한 기준을 만족하는 구조적 영역에서만 이루어지고 있었다. 미국은 한국보다 수혜 대상자에 대한 기준이 넓으며, 민간 독립기관에서 가정기반 서비스를 제공하고 있었다. 질 관리는 기관 지정과 성과지표 모니터링 및 소비자 만족도와 같은 결과를 포함하여 평가해 기관 보상과 연계하고 있었다. 현 연구를 통한 국가간 차이점은 향후 국내의 정책에 반영하여, 보다 발전된 시스템 구축에 방향설정에 기여를 하였다. 따라서, 향후 생애말기케어 시스템의 서비스의 질 관리와 적절한 서비스를 제공하기 위한 다양한 국가의 시스템을 지속적으로 연구할 필요가 있고, 이러한 제도 고찰을 통한 국내 시스템을 개선하고 보강하여야 한다.

• 지역사회간호학회지
• /
• 제15권2호
• /
• pp.177-186
• /
• 2004

Purpose: The purpose of this study is to analyse time taken for visiting nursing activities by visiting nurses in health centers. Method: A questionnaire was developed by a research team for the technological support of visiting nursing activities and visiting nurses. A total of 481 questionnaires were recovered by five visiting nurses from May to October 2003. Result: A visiting nurse's total length of time for visiting activities was 532.2 minutes per day and the number of households a visiting nurse visits a day was 4.5. A visiting nurse spent 133.3 minutes for actual nursing services and 119.1 minutes for travelling. Time for actual nursing activities was more than half of the total working hours. Time for travelling was 42.9 minutes on the average when using public transportation means and 25.6 minutes when using a car. Conclusion: The results of this study is expected to be used as basic data in establishing plans for the adequate supply of visiting nurses based on demands for visiting nursing services.

• 지역사회간호학회지
• /
• 제10권1호
• /
• pp.70-79
• /
• 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.