• 가정∙방문간호학회지
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• 제6권
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• pp.5-18
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• 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.

• Journal of Preventive Medicine and Public Health
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• 제11권1호
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• pp.86-97
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• 1978

The mobile medical service has been operated for many years by a number of medical schools and hospitals as a most convenient means of medical service delivery to the people residing in such area where the geographical and socioeconomic conditions are not good enough to enjoy modern medical care. Despite of official appraisal showing off simply with numbers of outpatients treated and medical persons participated, however, as well recognized, the capability (in respect of budget, equipment and time) of those mobile medical teams is so limitted that it often discourages the recipients as well as medical participants themselves. In the midst of rising need to secure medical service of good quality to all parts of the country, and of developing concept of primary health care system, authors evaluated the effectiveness of and problems associated with mobile medical servies program through the community diagnosis of a village (Opo-myun, Kwangju-gun) to obtain the information which may be halpful for future improvement. 1. Owing to the nationwide Sae-Maul movement powerfully practiced during last several years, living environment of farm villages generally and remarkably improved including houses, water supply and wastes disposal etc. Neverthless, due to limitations in budget time and lack of knowledge (probably the most important), these improvements tend to keep up appearances only and are far from the goal which may being practical benefit in promoting the health of the community. 2. As a result of intensive population policy led by the government since 1962, there has been considerable advances in understanding and the rate of practicing family planning through out the villages and yet, one should see many things, especially education, to be done. Fifty eight per cent of mothers have not received prenatal check and the care for most (72%) delivery was offered by laymen at home. 3. Approximately seven per cent of the population was reported to have chronic illness but since only a few (practically none) of the people has had physical check up by doctors, the actual prevalence of chronic diseases may reach many times of the reported. The same fact was observed also in prevalence of tuberculosis; the patients registered at local health center totaled 31 comprising only 0.51% while the numbers in two neighboring villages (designated as demonstration area of tuberculosis control and mass examination was done recently) were 3.5 and 4.0% respectively. Prevalence rate of all dieseses and injuries expereinced during one month (July, 1977) was 15.8%. Only one tenth of those patients received treatment by physicians and one fifth was not treated at all. The situation was worse as for the chronic patients; 84% of all cases either have never been treated or discontinued therapy, and the main reasons were known to be financial difficulty and ignorance or indifference. 4. Among the patients treated by our mobile clinic, one third was chronic cases and 45% of all patients, by the opinion of doctors attended, were those who may be treated by specially trained nurses or other paramedics (objects of primary care). Besides, 20% of the cases required professional managements of level beyond the mobile team's capability and in this sense one may conclude that the effectiveness (performance) of present mobile medical team is quite limitted. According to above findings, the authors would like to suggest following for mobile medical service and overall medicare program for the people living in remote country side. 1. Establishment of primary health care system secured with effective communication and evacuation (between villages and local medical center) measures. 2. Nationwide enforcement of medical insurance system. 3. Simple outpatient care which now constitutes the main part of the most mobile medical services should largely be yielded up to primary health care unit of the village and the mobile team itself should be assigned on new and more urgent missions such as mass screening health examination of the villagers, health education with modern and effective audiovisual aids, professional training and consultant services for the primary health care organization.

• Journal of Preventive Medicine and Public Health
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• 제52권5호
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• pp.323-332
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• 2019

Objectives: The aim of this study was to describe general practitioners (GPs)' opinions and practices of preventive care and patients' opinions, attitudes, and behaviors towards prevention. Methods: The data stemmed from a cross-sectional national survey on prevention conducted in Switzerland from 2015 to 2016. In total, 170 randomly drawn GPs and 1154 of their patients participated. The GPs answered an online questionnaire and the patients answered a questionnaire administrated by fieldworkers present at their practices. Results: Both patients and GPs agreed that delivering preventive care is the dedicated role of a GP. It appeared that beyond classical topics of prevention such as cardiovascular risk factors, other prevention areas (e.g., cannabis consumption, immunization, occupational risks) were scarcely covered by GPs and reported as little-known by patients. In addition, GPs seemed to use a selective approach to prevention, responding to the clinical context, rather than a systematic approach to health promotion. The results also highlight possibilities to improve prevention in family medicine through options such as more supportive tools and public advertising, more time and more delegated tasks and, finally, a more recognized role. Conclusions: Despite an unfavorable context of prevention within the healthcare system, preventive care in family medicine is reasonably good in Switzerland. However, some limitations appear regarding the topics and the circumstances of preventive care delivery. A global effort is needed to implement necessary changes, and the responsibility should be broadened to other stakeholders.

• 한국직업건강간호학회지
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• 제31권4호
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• pp.157-166
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• 2022

Purpose: The purpose of this study was to identify factors influencing fall-prevention behaviors of nurses working in long-term care hospitals. Methods: Participants included 147 nurses working in 10 long-term care hospitals in B city. Data were collected from September 20-October 12, 2016. SPSS/WIN 21.0 was used for analysis with t-test, ANOVA, Scheffé test, Pearson correlation coefficients, and multiple regression. Results: It was found that attitude toward fall (r=.29, p<.001) and patient safety culture (r=.25, p=.002) had a significant positive correlation with fall-prevention behaviors of nurses working in long-term care hospitals. The factors influencing fall-prevention behaviors in participants were clinical career and patient safety culture (β=.21, p=.012), contributing to 19% of the total variance in fall- prevention behaviors. Conclusion: The findings showed that systematic delivery of differentiated fall prevention education is preferred to nurse's clinical career as a private factor to improve fall-prevention behaviors of nurses in long term care hospital. Particularly, it is imperative to conduct periodical and practical fall-prevention education for nurses to prevent career discontinuity. An independent report system and open communication system as well as a scheme that can disseminate patient safety culture in individual departments to implement patient direct nursing are required to encourage patient safety culture in organizations.

• Clinical and Experimental Vaccine Research
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• 제12권1호
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• pp.77-79
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• 2023

The Philippines is still in a tight battle with the coronavirus disease 2019 pandemic since many cases are detected daily. With the continuous spread of another disease worldwide-monkeypox, many Filipinos are alarmed if the country's healthcare system is prepared enough, especially with the detection of its first case. Learning from the unfortunate experiences of the country during the current pandemic is essential in facing another health crisis. With this, recommendations for a robust healthcare system are proposed centered on: a massive digital information campaign about the disease; training healthcare workers to raise awareness about the virus and its transmission, management, and treatment; an intensified surveillance and detection procedure to monitor cases and execute contact tracing properly; and a persistent procurement of vaccines and drugs for treatment, with a well-designed vaccination program.

• 기본간호학회지
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• 제2권1호
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• pp.55-66
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• 1995

The goals of nursing education, and the bases for evaluating them depend on the goals of nursing practice. In order to prepare for the coming twenty first century and the meet changing societal demands and health needs, it is necessary to develop a new conceptual framework for future nursing education. While hospitals will still be in significant components of the health care system, will no longer be central focus or dominant influence. Health care services will be more usually delivered at community base. The nursing education required by that new approach must provide for reconsidered about a concept of caring as nursing curriculum. The changes in health care delivery that have occured, now being proposed, for nursing education undergoing its own changes. So the philosophy and objectives of education meed to reconsidering about the caring concept and general nursing. Nurse educators must prepare students to practic in condition of constant change. At the same time nurse educators must emphasize preparation about that. The practice of science of caring in nursing draws on a basic knowledge of the behavioral knowledge, biophysical processes, pathological processes, nursing skills and procedures and various treatment regimes and problem solving to help decision making in nursing situations. The concept of care is probably one of the least understood ideas used by professional and nonprofessional people, yet it is probably one of the most improtant concepts to be understood by nursing. Human caring and human relationships are closely interrelated. Humn caring remains an essential dimension of professional work and the science of caring as essental to the discipline of nursing. It is expected that the objectives of nursing education will be accomplished when the course and content of the curriculum are based on this conceptual framework. One recurrent education goal with some consistency is that of equipping the student with the necessary skills to live effectively and productivly in the world of tomorrow. In the new vision we are developing, professional education must also include exposure to liberal arts, encouragement of critical thinking, and a moral context for advanced professional education that is based upon a contextual health policy and caring science educational model.

• Child Health Nursing Research
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• 제2권1호
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• pp.112-126
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• 1996

The purpose of this study was to investigate the current status of the need of telephone call and to identify the status of nursing intervention through telephone. Head nurses of the pediatric nursing unit and a nurse of pediatric outpatient clinic wrote down the telephone record of calls by parents of children discharged from hospital from 7 am to 3 pm during the period of March to June, 1995. Content of 120 telephone calls but for 26 calls with incomplete record among 146 calls were analyzed into frequency of general characteristics, needs and nursing intervention. The needs of telephone call were identified and classified into 11 areas and analyzed into frequency of detailed content by 11 areas. Nursing intervention was identified and classified into 10 categories, and analyzed into frequency of detailed content by 10 categories. The findings of this study were as follows ; The need of telephone call was identified with nutritional state, medication, vital signs, language retardation, personal hygiene, vaccination, administration procedure, physical symptoms, follow up care management and others. The most frequent needs were physical symptoms and vaccination. A kind of food among nutrition dose of drugs among medication, fever among vital signs, cough among physical symptoms, and content of vaccination among vaccination was the most frequent needs. Nursing intervention through telephone was identified with instruction, knowledge offer, information offer, judgement, solicitation, referral and instruction, referral, connection, reassurance, reservation, and regulation. Instruction, knowledge offer and information offer was the most frequent nursing intervention by telephone call. Instruction was about a visit to hospital, a visit to nearby clinic, instruction about symptoms,, instruction about nursing care procedure, retelephoning and vaccination. Knowledge offer was about vaccination, knowledge related to medication, and dental care. Information offer and judgement was about vaccination and medication. Referral and instruction delivery was about instruction delivery following consultation to doctor, visit to emergency room and a visit to hospital following consultation to doctor. These results suggest that telephone call intervention program should be established as a field of extended pediatric nursing role in health care delivery system for the children.

• 대한간호학회지
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• 제30권4호
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• pp.1045-1054
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• 2000

As cost pressures have escalated, policy makers, politicians, health care providers and families have tried to devise ways to reduce health care costs. While originally developed to enhance patient control and to provide better care at the end of life, hospice care has recently received significant attention as a mean of reducing health care costs. As a program providing care for patients who are dying at their homes, hospice has expanded slowly since the opening of the first hospice in Korea in 1963. Therefore, a variety of services that responds to the needs and concerns of many dying people and their families is limited The purpose of this study was to determine the potential cost savings at the end of life among patients who used home hospice compared with the patients who received institutional care in Korea. This study used a retrospective, descriptive design. The sample for this study included 46 patients who died of lung cancer: 25 patients who received home hospice care and 21 patients who received institutional care. Data on patient characteristics, kinds and frequencies of provided treatment and nursing services, and hospice and hospital charges during the last month before death were collected. Cost of care was measured by the average cost per patient per day in the last month of life. The results of the study indicated that there were significant differences in average cost of care between home hospice sample and institutional care sample (t=9.956, p<.001; home hospice sample: M=18,102 won, institutional care sample: M=317,578 won). The cost of the home hospice sample was approximately 6% of the cost of institutional care. The majority of the home hospice nursing services were education (35.7%) and supportive counseling (25.2%), followed by medication management (13.6%), assessment (12.1%), basic nursing (7.2%), treatment (5.5%) and others. In institutional care sample, basic nursing and treatment were more emphasized than education or supportive counseling among the nursing services provided. The results of this study showed the potential for hospice to reduce costs and implications for policymakers and clinicians to incorporate hospice program into the formal health care delivery system in Korea.

• 보건행정학회지
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• 제28권3호
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• pp.222-225
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• 2018

Health policy is a historical product in the process of development, including the political and economic factors of the state as well as the social and cultural elements of the country. Bioethics began to debate the ethical questions that arise in the overall process of life's birth and death, and gradually evolved by presenting ethical directions for various social phenomena. Especially, according to the moral awakening of 'scientific medicine' which caused in some human problems in the rapidized scientific society from the late 19th century to the early 20th century, as a result of distress including the concept of various social relations, it is possible to say that it has reached the bioethics. Although health policy and bioethics are different in terms of starting and concept, they can be found in common with social, cultural, and political diversity in the times. In 2004, 'Bioethics Law' was enacted through the issue of research ethics in the life sciences. Therefore, in order to examine ethical aspects of current health policy direction and major issues, it can be divided into before and after enactment of 'Bioethics Law' in 2004. The authors would like to examine how the evolution of the ethical viewpoint on the health policy has changed in line with the enactment of the 'Bioethics Law' and how it is trying to solve it from an ethical point of view. Through the various events that took place in the 1990s and the 2000s, various discussions on bioethics were conducted in Korea. Prior to the enactment of the 'Bioethics Law,' ethical judgments of professions, distribution of healthcare resources, if the discussion focused on the ethical judgment of abortion, and the various events that appeared in the early 2000s became the beginning to inform that the ethical debate about the life, death, and dignity of human beings began in earnest in Korea with the enactment of the 'Bioethics Law.' Since then, 'Hospice and Palliative care Law' which was enacted in 2017, is based on the fact that the health policy of our country focuses on the treatment of the past diseases, health promotion, and delivery of health care services. It was an opportunity to let them know that even the quality problems were included. Therefore, considering the various circumstances, the ethical issue facing Korea's health care system in the future is the change of the demographic structure due to aging and what is to be considered as the beginning and the process of life in the overall process of life. It is the worry about how to die and when it sees as death. This has far exceeded the paradigm of traditional health care policies such as disease prevention and management and health promotion, and calls for innovative policy response at the national level that reflects the new paradigm, which in many cases creates a predictable ethical environment. And health policy should be shifted in the direction of future ethical review considering sustainability in the development process of future health care rather than coercive management.

• 한국가족복지학
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• 제61호
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• pp.59-91
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• 2018

본 연구는 노인환자 치료경험이 있는 노인 의료전문가를 대상으로, 그들이 인식하는 연령주의를 확인하는 동시에, 이러한 장벽을 없애기 위하여 연령통합적인 차원의 노력과 경험들을 어떻게 해왔는지에 초점을 둔다. 연구대상자인 9명의 의료전문가들의 연령주의와 연령통합에 대한 보다 다양한 인식과 경험을 담아내기 위해 CQR 질적연구 방법을 활용해 분석하였다. 의료전문가들은 연령주의(Ageism)에 대한 자기고백의 이중성을 보이고 있었으며, 의료현장에서는비적정진료, 노인 소외와 보호자 의존, 양극화 된 서비스와 빈곤노인에 대한 이중차별의 방식으로 연령주의가 실재(實在)하고 있었다. 이를 완화 혹은 해결하기 위한 방안으로서의 연령통합적 의료서비스 제공에 대해 어려움을 느끼고 있었으나, 소통을 위한 장벽 허물기를 추구하거나, 노인 뿐 아니라 모두에게 보편적(universal)으로 편안한 환경을 제공하거나, 제도와 서비스 기준을 확대 및 다양화하는 방식으로 연령통합적 서비스를 위한 적용노력을 하고 있는 것으로 나타났다. 급격히 증가하는 노인환자들의 건강한 삶과 적정한 의료서비스 보장을 위해첫째, 연령주의를 가속화 시키는 한국 의료체계 내 요소들에 대한 비판적 고찰, 빈곤노인에 대한 관리체계 개선, 의료전문가 제도 내 연령통합관련 커리큘럼 포함, 노인전문 의료서비스와인력양산 그리고 노인과 노인대상 의료영역에 대한 인식개선을 제안하였다.