• Journal of Korean Academy of Nursing Administration
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• v.7 no.2
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• pp.265-284
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• 2001

The case management has been applied to improve the quality of care and the cost-effectiveness in the most health care institutions. In a way of case management, the critical pathway(CP) has been executed in many acute care settings, focused on the diagnoses with high cost, high volume, and high risk. This study was conducted to develop a case management program using CP as an intervention of patients with lumbar spinal stenosis for the surgery of posterolateral fusion, and to find out the effects of the critical pathway on the quality of nursing care, patient satisfaction as an outcome of care, length of stay and medical charge, and nurses' job satisfaction. At the same time, patients' functional states were checked with the Oswestry Low Back Pain Index, to show that the CP would not decrease the patients' function compared to the control group. The subjects were 25 control patients with a usual operation of lumbar fusion and 25 experimental patients with CP. They were all female, aged $50s{\sim}70s$, admitted in the Orthopedic surgery ward of a university hospital. Also nurses on the floor using CP were asked to respond to measurement tool of job satisfaction before and after the application of CP, and compared with other nurses on the different wards. Data were analyzed with t-test for continuous variables and chi-square for non-parametric variables in addition to the reliability test of the measurement tools. The results of this study were as followings: 1. Patients' functional states The differences in Oswestry scores of the experimental and control groups assessed at preoperation and at discharge were not statistically significant. The change in scores of the experimental group measured at preoperation and at discharge was larger than that of the control group, however the difference was not statistically significant. The results indicate that the CP did not decrease the patients' functional status. 2. The quality of nursing care The total of quality of nursing care given to the experimental group was better than that of the control group(P=.000). In addition, the experimental group showed better scores of quality of every item of care than the control group(P=.000 -.004). 3. Patient satisfaction Patients of the experimental group were not more satisfied with general care than the control group. But they were more satisfied with discharge care of 'explanation about medication, body posture, and brace application' and 'explanation about the adjustment of daily living and exercise during recovery'(P= .047, P=.028). 4. Nurses' job satisfaction Nurses working with the CP showed more job satisfaction than before the CP introduction(P=.048). But the control group of nurses on a different floor showed no change in job satisfaction at the same period of time. 5. Length of stay and medical charge The mean length of stay of the experimental group was shorter than that of the control group without statistical significance. The charge of medication and treatment of the experimental group were smaller than that of the control group(P=.011, P=.000). The results of the study support that the case management using critical pathway enables to improve the quality of care and job satisfaction, to reduce the medical charge, and consequently to increase satisfaction with care. However, the case management should be instituted focusing on the quality improvement of nursing and the client satisfaction, not just for the purpose of cost-effectiveness of health care facilities.

• Journal of agricultural medicine and community health
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• v.30 no.1
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• pp.101-111
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• 2005

Objectives: This study was to evaluate the compliance of hypertensive patients and its related factors registered at Community Health Practitioner Post(CHCP). Methods: 304 patients were interviewed by trained nursing students during one month(June~July 2004). The questionnaire included general charactristics, knowledge of hypertension, health education experience, constructs of Health Belief Model, self efficacy and so on. Compliance group was defined "having regularly medication and good life style". Good life style included regular exercise, non-smoking, little alcohol, low salt diet, weight control. Results: In compliance group 90.3% of man and 93.3% of woman were regularly taking hypertensive medicine, and 45.2% of man and 56.4% of woman were having good life style (compliance group). In both man and woman, the group of higher education were more compliance group, but were statistically significant were in man(p<0.05). In woman, the compliance group have significantly higher score in knowledge of hypertension(p(0.05). The compliance group have significantly higher self-efficacy score in both man and woman (p<0.05). In Health Belief Model, susceptibility and benefit were statistically significant in man, seriousness, benefit and barrier in woman(p<0.05). In multiple logistic regression analysis, education level and self efficacy in man and knowledge of hypertension, self-efficacy and benefit in woman were significant variables (p<0.05). Conclusions: It is very important to evaluate and modify life-style adding to having regularly medication in hypertensive patients registered at CHCP. To this, health education programs about benefit to compliance and the methods to improve self-efficacy should be developed for this patients.