• 보건의료산업학회지
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• 제12권1호
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• pp.81-93
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• 2018

Objectives : This cross-sectional study aims to investigate the differences in general health status (GHS) and physical care burdens (PCB) of inpatient groups in long-term care hospitals (LTCH). Methods : The data of 228 patients were analyzed by integrating the electronic medical record (EMR) data of 2016, recorded by the nurses of hospitalized patients in the hospital. Results : There was a statistically significant difference in the GHS between the high-medical demand group and the other groups, but there was no difference in the GHS among other groups. The overall PCB was higher in the high-medical demand group than in the middle-medical demand, and cognitive impairment groups, but not in the problem behavioral group. Conclusions : The current classification of patient groups has shown limitations in terms of the basis of differential benefits of the groups. In particular, the PCB of the problem behavior group was not different from that of any group; hence, it should be adjusted through further study. To control the surge of medical care costs, it is necessary to improve the irrationality of the LTCH pay system in terms of the integration and continuity for elderly care.

• 성인간호학회지
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• 제28권6호
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• pp.669-679
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• 2016

Purpose: The purpose of this study was to explore the reported good service experiences from the perspective of elderly residents of long-term care facilities. Methods: Of those residents who are 65 years old or older, 14 residents whose length of stay were one month or longer and scores of the K-Mini Mental State Examination were 15 or higher were interviewed. The interview data formed the basis for the empirical statements about the reported nature of patients' experiences as residents of long-term care facilities. These data were used in concept mapping. Results: Through multidimensional scaling analysis and hierarchical cluster analysis, 62 core statements, two dimensions, and six clusters of good service experiences were derived. The two dimensions were classified as 'care centered-participation centered services' and as 'physical-emotional services.' Six cluster themes emerged as good service experiences: 'safety of care and treatment', 'responsible and supportive staff', 'comfort of living environment', 'mental well-being', and 'respect and communication'. Conclusion: The result of the study provides information about what experiences are important to older adults with cognitive impairment. The concept map can be used to develop a patient experience index for the elderly residents of long-term care facilities.

• 한국간호교육학회지
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• 제26권4호
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• pp.383-392
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• 2020

Purpose: This study was a descriptive study to identify factors affecting the attitude toward life-sustaining treatment of nurses working at long-term care hospitals. Methods: Data were collected through structured questionnaires from August 2nd to 27th, 2019. Study participants consisted of 163 nurses who were working for at least 6 months from 7 long-term care hospitals in B and K city. Data were analyzed using t-test, ANOVA, Scheffe' test, Pearson's correlation coefficients, and hierarchical regression with SPSS WIN v 21.0. Results: There were significantly positive correlations between awareness of good death (r=.46, p<.001) and perception of patients' rights (r=.32, p<.001). The factors affecting participants' attitude toward life-sustaining treatment were awareness of good death (β=.35, p<.001) and their own view of death (β=.24, p=.001), which explained about 27.0% of the attitude toward life-sustaining treatment. Conclusion: Based on these results, it is necessary to develop nursing educational materials that can establish values for deaths, and cultivate legal and ethical knowledge related to attitude toward life-sustaining treatment. In addition, since the severity of a patient's condition varies and the characteristics of the institution vary depending on the type of hospital, a study is needed on the relevance of variables considering the hospital environment.

• 임상간호연구
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• 제29권3호
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• pp.249-260
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• 2023

Purpose: The study aimed to examine the effects of nurse staffing levels on patient outcomes in long-term care hospitals in South Korea using path analysis. Methods: We conducted a secondary analysis of national data, which included the 2021 hospital assessment results of long-term care hospitals from the Health Insurance Review and Assessment Service. Data collection was performed between June 19 and June 27, 2023. The study sample consisted of 1,215 hospitals, and we analyzed the data using SAS 9.4 and Mplus 8 software. Results: The average numbers of patients per registered nurse, certified nursing assistant, and nursing staff, including both registered nurses and certified nursing assistant, was 10.00, 7.43, and 4.00, respectively. Path analysis revealed that the number of patients per registered nurse had direct effects on improvements in activities of daily living and indirect effects on indwelling catheterization, pressure ulcer improvement, and weight loss. The number of patients per certified nursing assistant had direct effects on new pressure ulcer development and pressure ulcer improvement, with no indirect effects. The number of patients per nursing staff had direct effects on pressure ulcer improvement and no indirect effects on other patient outcomes. Conclusion: The findings suggest that establishing policies to evaluate staffing levels of registered nurse and certified nursing assistants separately is necessary in order to improve registered nurse staffing levels and patient outcomes in long-term care hospitals.

• 한국보건간호학회지
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• 제33권2호
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• pp.163-174
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• 2019

Purpose: The purpose of this study was to identify the effects of job stress, depression and fatigue on sleep quality of care workers employed in long-term care facilities. Methods: The participants were 213 care workers who worked in 11 long-term care facilities. The collected data was analyzed by descriptive statistics, t-test, ANOVA, Pearson's correlation coefficient and multiple linear regression with using the SPSS 23.0 program. Results: We found that patient-related job stress was the greatest stressor among care workers' job stresses. A significant difference in sleep quality was observed according to the self-perceived health status of the care workers. The care workers' sleep quality was negatively correlated with job stress (r=-.16, p=.018), depression (r=-.31, p<.001) and fatigue (r=-.29, p<.001). The influencing factors of sleep quality were depression (${\beta}=-0.22$, p=.001) and fatigue (${\beta}=-0.15$, p=.047). Conclusion: It is necessary to improve the health status and sleep quality of care workers by developing and applying health promotion programs to reduce the depression and fatigue of the care worker. This will ultimately improve the quality of service care for the patients.

• 보건행정학회지
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• 제26권1호
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• pp.39-50
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• 2016

Background: This study examined patient and hospital factors related to long-stay admissions in long-term care hospitals (LTCHs) among older people in Korea. Methods: We analyzed health insurance claims data, entitlement data, and institutional administrative data from the National Health Insurance Service databases between 2010 and 2012. At the patient level, we compared characteristics of patients staying in LTCHs for over 180 days (the long-stay group) with those staying in LTCHs for less than 90 days during a calendar year. At the hospital level, we examined the general characteristics and staffing levels of the top 10% of hospitals with the highest proportion of patients whose length of stay (LOS) was 180+ days (the hospitals with long-stay patients) and compared them with the top 10% of hospitals with the highest proportions of patients whose LOS was less than 90 days (hospitals with shorter-stay patients). Results: The long-stay group accounted for about 40% of all LTCH patients. People in the group were more likely to be women, aged 80+, living alone, and experiencing more than two health conditions. Compared to the hospitals with shorter-stay patients, those with long-stay patients were more likely to be occupied by patients with behavior problems and/or impaired cognition, owned by corporate or local governments, have more beds and a longer period of operation, and deliver services with lower staffing levels. Conclusion: This study found long-stay older people in LTCHs and those in LTCHs with high proportions of long-stay older patients had several distinct characteristics compared to their counterparts designated in this study. Patient and hospital characteristics need to be considered in policies aiming to resolve long-stay admissions problems in LTCHs.

• 근관절건강학회지
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• 제28권2호
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• pp.111-120
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• 2021

Purpose: This study was a descriptive research to identify the relationships among burden from behavioral psychological symptoms of dementia, dementia attitude, emotional labor and nurse's caring behavior as well as to clarify factors that affect caring behavior of nurses in long-term care hospital. Methods: For the research, this study collected data from July 8 to July 20, in 2019 with 214 nurses who worked at 10 long-term care hospitals in Chungbuk. The data were analyzed using descriptive statistics, t-tests, Mann-Whitney U test, ANOVA, Pearson's correlation coefficient, stepwise multiple regression with the SPSS 23.0 program. Results: Factors influencing caring behavior of nurses in long-term care hospital were dementia attitudes (β=.549, p<.001), burden from behavioral psychological symptoms of dementia (β=.242, p<.001) and marital status (β=.134, p=.017). These factors explained 33.9% of caring behavior (F=37.35, p<.001). Conclusion: Dementia attitudes were confirmed to be the main variable influencing nurse's caring behavior. Therefore, to improve the caring behavior of dementia patient, it is considered that the development of programs to improve dementia attitudes and in-depth understanding regarding the behavioral and psychological symptoms of dementia is necessary.

• 대한간호학회지
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• 제44권1호
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• pp.21-30
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• 2014

Purpose: This study was conducted to explore the impact of registered nurse/nurses' aid (RN/NA) staffing and turnover rate on inpatient health outcomes in long term care hospitals. Methods: A secondary analysis was done of national data from the Health Insurance Review and Assessment Services including evaluation of long term care hospitals in October-December 2010 and hospital general characteristics in July-September 2010. Final analysis of data from 610 hospitals included RN/NA staffing, turnover rate of nursing staff and 5 patient health outcome indicators. Results: Finding showed that, when variables of organization and community level were controlled, patients per RN was a significant indicator of decline in ADL for patients with dementia, and new pressure ulcer development in the high risk group and worsening of pressure ulcers. Patients per NA was a significant indicator for new pressure ulcer development in the low risk group. Turnover rate was not significant for any variable. Conclusion: To maintain and improve patient health outcomes of ADL and pressure ulcers, policies should be developed to increase the staffing level of RN. Studies are also needed to examine causal relation of NA staffing level, RN staffing level and patient health outcomes with consideration of the details of nursing practice.

• 대한간호학회지
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• 제34권2호
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• pp.278-289
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• 2004

Purpose: The purpose of this study was to classify the elderly in long-term care facilities using the Resource Utilization Group(RUG-III) and to examine the feasibility of a payment method based on the RUG-III classification system in Korea. Method: This study measured resident characteristics using a Resident Assessment Instrument-Minimum Data Set(RAI-MDS) and staff time. Data was collected from 530 elderly residents over sixty, residing in long-term care facilities. Resource use for individual patients was measured by a wage-weighted sum of staff time and the total time spent with the patient by nurses, aides, and physiotherapists. Result: The subjects were classified into 4 groups out of 7 major groups. The group of Clinically Complex was the largest (46.3%), and then Reduced Physical Function(27.2%), Behavior Problems (17.0%), and Impaired Cognition (9.4%) followed. Homogeneity of the RUG-III groups was examined by total coefficient of variation of resource use. The results showed homogeneity of resource use within RUG-III groups. Also, the difference in resource use among RUG major groups was statistically significant (p<0.001), and it also showed a hierarchy pattern as resource use increases in the same RUG group with an increase of severity levels(ADL). Conclusion: The results of this study showed that the RUG-Ill classification system differentiates resources provided to elderly in long-term care facilities in Korea.

• 보건행정학회지
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• 제17권2호
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• pp.52-67
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• 2007

Korean government is preparing the long-term care financing and delivery system in order to cope with rapid population aging. The system should be designed to provide demented patients with an appropriate services that the patients want to take, and considered to be necessary for them. In this regard, this study aims to analyse empirically a relationship between the types of long-term care services that demented patients wanted to take and they actually received during 2004. The caregivers of 609 dementia patients, who were randomly selected in a manner of proportional allocation from a nationwide claim database of the Korean National Health Insurance Corporation, were interviewed in September, 2005. Independent variables include socio-demographic characteristics, Activities of Daily Living(ADL) and Instrumental Activities of Daily Living(IADL). To explore the correspondence of the types of long-term care services that demented patients wanted to take and that they actually received, and its affecting factors, we conducted chi-square test and logistic regression analysis. Main findings are as follows. First, while only 20% of study subjects wanted home services as a long-term care services, those who wanted to use the long-term care facilities and general hospital were 37%, 43% respectively. Second, the correspondence rate was just 38% on average, and extremely low in the demented patients who wanted to use long-term care facilities. Third, the demented patients who resided in urban areas and received relatively high level of education showed high correspondence rate. Fourth, the high ADL score was closely related to low correspondence rate.