• 대한간호학회지
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• 제42권1호
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• pp.48-55
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• 2012

Purpose: The aim of this study was to compare statistical methods to control response bias in nursing activity surveys. Methods: Data were collected at a medical unit of a general hospital. The number of nursing activities and consumed activity time were measured using self-report questionnaires. Descriptive statistics were used to identify general characteristics of the units. Average, Z-standardization, gamma regression, finite mixture model, and stochastic frontier model were adopted to estimate true activity time controlling for response bias. Results: The nursing activity time data were highly skewed and had non-normal distributions. Among the 4 different methods, only gamma regression and stochastic frontier model controlled response bias effectively and the estimated total nursing activity time did not exceeded total work time. However, in gamma regression, estimated total nursing activity time was too small to use in real clinical settings. Thus stochastic frontier model was the most appropriate method to control response bias when compared with the other methods. Conclusion: According to these results, we recommend the use of a stochastic frontier model to estimate true nursing activity time when using self-report surveys.

• 대한간호학회지
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• 제41권4호
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• pp.500-509
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• 2011

Purpose: Time-driven activity-based costing was applied to analyze the nursing activity cost and efficiency of a medical unit. Methods: Data were collected at a medical unit of a general hospital. Nursing activities were measured using a nursing activities inventory and classified as 6 domains using Easley-Storfjell Instrument. Descriptive statistics were used to identify general characteristics of the unit, nursing activities and activity time, and stochastic frontier model was adopted to estimate true activity time. Results: The average efficiency of the medical unit using theoretical resource capacity was 77%, however the efficiency using practical resource capacity was 96%. According to these results, the portion of non-added value time was estimated 23% and 4% each. The sums of total nursing activity costs were estimated 109,860,977 won in traditional activity-based costing and 84,427,126 won in time-driven activity-based costing. The difference in the two cost calculating methods was 25,433,851 won. Conclusion: These results indicate that the time-driven activity-based costing provides useful and more realistic information about the efficiency of unit operation compared to traditional activity-based costing. So time-driven activity-based costing is recommended as a performance evaluation framework for nursing departments based on cost management.

• 간호행정학회지
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• 제6권1호
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• pp.55-81
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• 2000

This study examined nursing care in a Newborn Intensive Care Unit (NICU) by reviewing nursing activities for the newborns. Through direct observation, time used for nursing care according to the nursing activity, shift, day of the week, and position of the nurses was measured. This study was done on November 15, 21, 24, 1999 at a university medical center hospital and included eight nurses and 179 newborns as the study subjects. The data were collected from the medical records, and by using a nursing activity record for the NICU, and a nursing activity time record for the NICU. The first step in the data collection process was to develop a list of nursing activities which was done through a literature review, examination of medical affairs and duty records. Content validity was measured by a panel of three professors who were experienced clinicians. In the second step two pre-training sessions were held with three sophomore student nurses who then measured the time for each nursing activity using a stopwatch. The data were analyzed using frequencies for nursing activities, averages, percentages and ANOVA for differences between shift and between days of the week, and percentages and t-test for differences according to position of the nurse. The results are as follows: 1) The total number of activities was 156, direct or indirect nursing activities. Direct nursing activity classified according to physical, educational, emotional/social/economic/spiritual needs. There were 109 direct nursing activities in 16 fields. 2) The order of nursing activities, according to time required, was record keeping, nutritional care, measurement/observation, medication, hygiene care, examination and specimen collection, and checking supplies, and according to frequency, measurement/ examination, record keeping, nutrition care, hygiene care, elimination care and medication. 3) According to shift, direct care during the night shift at 313.4 minutes was the longest time and indirect nursing care during the night shift at 252.2 minutes was the highest time. 4) For days of the week, Monday had the highest time for direct care 275.8 minutes (34.6%) and Wednessday had the highest time for indirect nursing care 269.6 minutes (36.1%). 5) For nursing time according to position of nurse, general nurses had the highest for direct care (330.7 minutes), nurse managers for indirect nursing activities (239.0 minutes) and general nurses for individual private time (63.9 minutes). The results of this study show that the major nursing time consuming activities included record keeping, nutrition care and measurement/examination. For newborns, time needs to be allowed for care to be sensitive, sophisticated and specialized rather than concentrated on indirect nursing tasks such as record keeping. Therefore, it is imperative to develop computerized systems that support a systematic approach to record keeping which is more efficient. Moreover, nursing needs according to shift, day or position of nurse can be utilized in assessing nursing resources through a computerized process.

• 간호행정학회지
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• 제12권1호
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• pp.63-75
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• 2006

Purpose: This study was aimed to specify roles of nurses from the anesthesia and recovery room by analyzing nursing activities as well as anesthesia nursing during surgery. Method: The objects were 12 RNs working in the recovery room of a university hospital located in Incheon. Self-report was performed by measuring stop-watch for five days from May 17th to May 21st in 2004. Research method was designed to record the time and frequency of the nursing activity from anesthesia and recovery room based on nurses' statement and other references for five days. The data were analyzed with descriptive statistics, ANOVA, and t-test via SPSS Win 10.0 program. Result: Nursing activities in anesthesia recovery room were classified into two different characteristics such as direct and indirect nursing activity. The activities consisted of 11 direct nursing areas and 39 nursing activities in anesthesia preparation room. The indirect nursing was classified into 8 nursing areas and 32 nursing activities. The direct nursing was classified into 12 nursing areas and 55 nursing activity. Also, the indirect nursing was classified into 7 nursing areas and 21 nursing activities in recovery room. In terms of prevalence of nursing activities in the anesthesia preparation room, observation and cooperation of anesthesia was the most prevalent activity, drug and eqipment management the second prevalent, and drug administration the third. On the other hand, in the recovery room, the most prevalent activity was vital sign checking and observation, the second most prevalent activity informative activity, and the third body temperature control. Nursing activity time was recorded according to the nursing characteristics. In the anesthesia preparation room, the direct nursing spent for 8092.20 minutes was larger than the indirect nursing spent for 7198.50 minutes. Also, in the recovery room, the direct nursing spent for 2361.16 minutes was larger than the indirect nursing spent for 1134.13 minutes. 4. Nursing activity time was compared to duty shifts. In the anesthesia preparation room, the direct nursing was more prevalent on day shift and the indirect nursing was prevalent on evening shift. However, in the recovery room, both direct and indirect nursing activities were prevalent on day shift. Conclusion: The role of anesthesia and recovery room nurses was analysed according to the time, frequency, and its characteristics.

• 한국보건간호학회지
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• 제11권1호
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• pp.93-102
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• 1997

The study aimed at investigating the living time as well as disability degree of the elderly based on daily living acting capability and living activity degree. The survey was conducted through the home-visit interview during half month at july, 1996 by the students of nursing department who were previously trained. The survey targeted the elderly aged 65 years or more living at home in rural area. The study tried to utilize Activity Inventory(AI) made for examing health and disease, disability degree, and living acting degree of the elderly. Among the AI's, there are Physical Activity of Daily Living(PADL), Instrumental Activity of Daily Living(IADL), maximum daily activity scope, and physical and mental activity level of the elderly. The daily living time is surveyed physiologic time(sleeping, eating and grooming), labor time(occupation, housekeeping and farming) and leisure time(reading, sport hobby-life). Results of the study show that social activity degree of the elderly is found to be lower than that PADL, LADL, and daily living scope. It seems that the elderly suffer from inability in daily life with lower social activity degree. But the labour time of the daily living time is the most amount time in the targeted 361 elderlys through random sampling. Therefore postponement of the disability of aging should be devised to encourage the labour activity of the elderly.

• 간호행정학회지
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• 제3권2호
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• pp.123-136
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• 1997

The purpose of this study was to confirm the classification of nursing activity and to analyze the time of nursing workload in a new open hospital. The data were collected from 20 nurses working in 6 general nursing units by 4 trained observers. The tools used for this study were an observation recording sheet and a classification sheet of nursing activity. The classification sheet was constructed to be adaptable to each hospital system based on the instrument described in the literature. The results of the study are as follows : The direct nursing activities consisted of 6 sections, 33 subsections and the indirect nursing activities consisted of 14 sections, 53 subsections. The direct nursing activities included medication, measuring and observation, care of therapies, care of physical comfort, laboratory and treatment. The indirect nursing activities included preparation of medical utensils, collection of information and assessment, recording, phone communication, professional interaction related to patients, personal time, assigning work to staff, patient eaucation and training, interaction with lab, transfer of administration of utensils, checking physician's order, dietary service, management of pollution and contagion, guide direction. Nurses spent 127.6min for direct nursing activity during day duty. It was 24.5% of total nursing activity. Within that activity medication had the highest percentage of time(40.09%), followed by communication and education with patient(24.76%), measuring and observation (16.93%), laboratory and treatment (12.85%), care of therapies(3.21%) and care of physical comfort (2.16%). The time breakdown for indirect nursing activities is as follows ; the preparation of medical utensils 22.3%, collection of information and assessment 20.29%, recording 20.27%, phone communication 8.14%, professional interaction related to patients 7.33%, personal time 7.24%, with the remaining timeshared by staffing, patient education and training, interaction with lab, transfer of administration of utensils, checking physician's order, dietary service, management of pollution and contagion, guide direction. In the analysis of the relationships between the working time and the work allocation characters of the nurses(including nurse's experiences. nurse-patients ratio, nurse-rooms ratio, and character of nursing unit) ; There were no significant differences in direct-indirect nursing times between nurse's career years. There was significant difference in direct nursing time between assigned patient numbers. The nurses assigned larger number of patients spent significantly more time in direct nursing care than that of the smaller. On the other hand, there was no significant difference in indirect nursing workload between the assigned patient numbers. There were no significant differences in direct-indirect nursing time between an allocated patient's room numbers. There was significant difference in working time between working places. The nurse in the medical unit spent more time in direct nursing care than her counterpart in the surgical unit. However there was no difference in direct nursing time between two groups. The study results indicate that nurses spent less time in the direct nursing care than in the previous studies even though the hospital system has been modernized. On the other hand they spent much more time for the coordinating role within the interdisciplinary team and for the overlapping paperwork. Therefore it is recommended that patient oriented job description and more efficient usage of modernized utilities be made.

• 간호행정학회지
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• 제9권1호
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• pp.5-18
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• 2003

Purpose : For improvement of nursing services in ambulatory unit, ambulatory nursing activity was identified and the required time by nursing activity was measured. Method : The data were collected from 4 tertiary hospitals and 2 secondary hospitals. The method of data collection was used the self-reporting method. The 123 nurse-work days and 137 nurse-aid-work days in 6 hospitals were analyzed. Results : As a result, 11 ambulatory nursing domains and 79 ambulatory nursing activities were confirmed. Above 50% of subjects performed the general outpatient affair domain. The percentage of total time spent in each domain were as follows : general outpatient affair domain, 58.3%, patient education ${\cdot}$ counseling domain, 10.8%, therapeutic care domain, 8.6% and so on. And the average hours were measured by activity and domain. Conclusion : For the improvement of ambulatory nursing care, the strategies that keep the legal standard of number of ambulatory nurse and exchange the nursing-aid for the nurse is needed. And it is also needed to standardize the ambulatory nursing services.

• 중환자간호학회지
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• 제6권2호
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• pp.65-77
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• 2013

Purpose: The purpose of the study was to analyze the nursing activities related to continuous renal replacement therapy (CRRT) in the intensive care units (ICU). Methods: We developed a list of 31 CRRT related nursing activities based on literature review and reviewed by expert group. A total of 109 direct time measurement records by 43 ICU nurses were collected and analyzed in terms of total time per shift, frequency, standard time, difficulty and performance levels of each CRRT nursing activity. Results: The mean time for CRRT nursing activity was 85.60 minutes per 8 hour shift. Nurses have spent average $9.46{\pm}6.98$ minutes in a shift for "waste fluid bag change" activity. In addition, "check catheter location" was the most time consuming single activity. The most difficult activity was "counseling-answer" and the most competent one was "dialysis solutions change". Conclusion: The CRRT nursing activities accounted for a significant portion of total nursing workload. Practical allocation of nursing staff for CRRT patient along with development of a new nursing cost system need to be considered. Continuous nursing educational and training programs on CRRT should be developed.

• Journal of Korean Biological Nursing Science
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• 제13권3호
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• pp.211-219
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• 2011

Purpose: The study compared the rest-activity rhythm and sleep pattern of elderly with young group. Methods: The subjects were 22 over than 65 years old and 23 under 65 years old. An actigraph, sleep diary, Pittsburgh Sleep Quality Index and Insomnia Severity Index scale were used as measurement tools for this study. The data were analyzed with $x^2$, Lamda test, t-test and correlation with SPSS 15.0 program. Results: The elderly had lower curve than the young group in rest-activity rhythm on each time zone. In particular, the elderly group had lower rest-activity rhythm curve of 8, 9, 14, 18, 19, 20, 21, 22 and 23 time zone than those of young group. Sleep pattern had statistical difference in the total sleep time, PSQI and insomnia. Total sleep time of elderly had lower score and PSQI and Insomnia had higher score than young group. Age had correlation with rest-activity rhythm, sleep efficiency, PSQI and insomnia. Conclusion: Rest-activity rhythm of the elderly showed an increase in activity in the early morning because of earlier get up than the young group and an decrease in activity in the afternoon because of taking a nap at this time. Elderly sleep was that total sleep time increased but sleep efficiency decreased and insomnia intensified. This sleep pattern was related to age and rest-activity rhythm.

• 대한간호
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• 제32권1호
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• pp.61-76
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• 1993

This study was done in order La provide basic data to a Fee System for hospital based Home Health Care services in Korea in the future. It was done by investigating activities provided to possible Home Health Care clients who could be discharged early from genera] hospitals and then estimating the nursing care fee according to each nursing activity based upon the time used for activity. The subjects of the study were selected by convenience sampling and consisted of 35 clients who might be clients for Home Nursing Care and were presently admitted to a medical- surgical ward of Y University Medical Center located in Seoul, Korea. The data collection period was from September 1, 1991 to September 30, 1991. The research in strum nets utilized for the study were a client selection criterial for Home Health Care developed by Choo(l991) and a check-list of nursing activity developed by researcher. The results of the study were as follows : 1. There were 44 different nursing activities provided in the seven days but the time was calculated for only 25 of the nursing activities. 2. Fees for the 25 different nursing activities were calculated by multipling the median of the average wage of a staff nurse having five years experience in an A grade general hospital to the Lime of the nursing activity. The results were compared with the insurance fee which the government recognized as an appropriate fee for that activity. The nursing activities with a lower calculated fee than the insurance fee were suction, catheterization, exercise education and dressing change. The nursing activities with a higher calculated fee than the government recognized fee were 1M injection and vital sign check. 3. There was a range of 1-15 nursing activities provided daily to the client. For the average number of nursing activities per day of 6.26 events the nursing care fee was calaulated at W 6136 per day. 4. Based upon the results of the study, a recommentdation for a Home Health Care fee per visit based on the nursing activities provided could be formulated for a Home Health Care fee system. It could be formulated as following: 1) Home health Care fee per visit $=[(direct{\;} nursing{\;}fee(direct{\;}nursing{\;}care{\;}time{\;}per{\;}activity{\;}{\times}{\;}average{\;}nursing{\;}wage)+indirect fee]{\times}average$ nursing activity per visit]+management fee+ materials fee+a travel fee In this way a nursing fee could be calculated based upon the result of the study of the nursing fees per visit. 2) Nursing activity fees per visit. = $([direct nursing{\;}care{\;}fee+indirect{\;}nursing{\;}fee]{\times}average$ number of nursing activities provided per visit] (W 6, 136) + travel fee(\ 5, 542) +management fee material $fee({\alpha})\{\;}16, 436+{\alpha}$ The nursing fee per visit as calculated in this research of $\{\;}15, 0000+{\alpha}$ could be adjusted according to the patient's condition or the use of high technology nursing care or according to the amount of time spent for travel. The nursing care fee per visit presented in this study can be validated through a Home Health Care demonstration project.