• Quality Improvement in Health Care
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• v.9 no.2
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• pp.210-228
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• 2002

Background: The purpose of this research was to examine the fall incidence rate and its related factors of fall in inpatients. Methods: The data were collected from the 138 fall incident reports in one tertiary hospital in Seoul from April 1st 1999 to September 30th 2001. The Fall Incident Report Form was originally developed based on that of Massachusetts General Hospital revised in 1995. And this was modified for this survey by the collaborating work of QI team including researcher and department of nursing service of this particular hospital. The contents of Fall Incident Form were general characteristics of patient. factors related to fall. types and places of fall. circumstances, nursing interventions. and outcome. Results: 1) The incidence rate of fall was 0.08% of total discharged patients and 0.081 per 1000 patient-day. This incidence rate is much lower than that of several hospitals in USA. This finding might result from the different incidence report system of each hospital. 2) The characteristics of fall-prone patient were found as follows. They were mostly over 60 years old, in alert mental status, ambulatory with some assistance, and dependent on ambulatory device. The types of diseases related high incidence rate were cerebrovascular disease(3.2), hypertension(1.6), cardiovascular disease(1.4), diabetes(1.3) and liver disease(0.6). 3) The majority of fall events usually occurred m bed. bedside(walking or standing) and bathroom in patient room. Usually they were up on their own when they fell. And there were more falls of elderly occurred during night time than day or evening. 4) 63.8% of fall events resulted in physical injuries such as fracture and usually the patients had diagnostic procedures and some treatment(ex. suture) which caused additional cost to the patients and their families. 5) The found risk factors of fall were drugs(antihypertensive drug, diuretics) and environmental factors like too high bed height, long distance of bedside table and lamp switch, and slippery tile of bathroom floor. Conclusion: Considering these results, every medical and nursing staff should be aware of the risk factors of patients in hospital, and should intervene more actively the preventive managements, specially for the elderly patients during night. Therefore, it is recommended that the development of Fall Prevention Programs based on these results.

• Research in Community and Public Health Nursing
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• v.6 no.2
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• pp.173-182
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• 1995

Primary health care(PHC) has been established since A Health Law for rural residents has been legislated in 1980 following the WHO declaration, 'Health for All 2000'. in 1978. PHC services are presently assumed to be provided by 2038 Community Health Practitioners(CHP) to about 28% out of rural population in Korea. Most CHPs have confronted the adaptation process to the community being practiced although a CHP's role is to evoke community participation for the improvement of their health by themselves. So the purpose of this study is to describe and explain of the commitment of CHPs into the community. Data were collected by direct interview and tape-recording under subjects' permission till theoretical saturation were occured from 6 CHPs. The subjects were 41 years old and have served in the community for 9 years in average. Main questions and concepts were explored from data according to the procedure of the grounded theory methodology. The results are as follows. 1) The number of the main concepts were twenty four that identified Motive, Desire, Personal characteristics, Unfamiliarity, Denial, Feeling of isolation, Self-sacrifice, Kindness, Patience, Assimilation, Respect for the residents, Support by the family, Support by the residents, Achievement, Acceptance of realities, Use of resources, Inducement of cooperation from the residents, Changes of the difference from time orientation between CHP and residents, Attitude as a official, Technical support, Cost management, Satisfaction level, Acknowledgement by the residents and discrepancy. 2) The twenty four concepts were categorized to seven groups such as Motivation, Feeling of Heterogeneity, Self-discipline, Social support, Induced changes in the attitudes of residents, Familarity and Persistent discrepancy. 3) The categorized groups were analyzed on the base of the Causal Conditions, Central Phenomena, Contexts, Intervening Conditions, Action / Interaction Strategies, and Consequences. Central phenomenon in this study was identified to be the feeling of heterogeneity. Community health practitioners experienced unfamiliarity and denial from the community and felt themselves isolated in the first. In time, they won the trust of residents by their efforts including self-sacrifice, kindness, patience, and assimilation. Afterward, practitioners got self-confidence and familiarity with lesser feeling of heterogeneity. Nevertheless, practitioners could not commit themselves completely because of the persistent discrepancy between CHP and residents. 4) On the commitment process, the CHPs' feeling of heterogeneity were decresed and social support increesed and newly evolved induced change of residents through the continuous interaction between CHP and them The contribution of this study would be concluded as follows. 1) It is expected that effective strategies for more rapid committment into the community can be developed based on this study. 2) More easy committment would be possible for the newly appointed CHP through understanding of the committment process identified on this study.

• Asian Oncology Nursing
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• v.3 no.1
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• pp.24-44
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• 2003

The purposes of this study was to identify and propose the expected role of the oncology nurse specialist by embodying role theory to oncology nurse specialist. The subjects of this study were 149 persons in 14 hospitals, who were classified to 4 groups, oncology nurse specialists(ONS) group, head nurses and charge nurses(HN & CN) group in hemato-oncology ward, registered nurses(RN) group in hemato-oncology ward, and hematologists & oncologists(H&O) group. The questionnaire which was consisted of 89 items for role of oncology nurse specialist, was made by researcher with a field study and literature review about role of oncology nurse specialist and verified by matrix delphi technique about content validity and construct validity. The data were collected from October 22, 2002 to November 5, 2002. All 4 groups proposed that ONS should perform an expert practitioner role first of all. But ONS group, RN group and H&O group proposed orderly expert practitioner, educator, researcher, consultant, and administrator & change agent, but HN & CN group did expert practitioner, educator, consultant, researcher, administrator & change agent. Expert practitioner had the most highest necessary degree in all groups and most highest performance degree in ONS group. That was consistent with results that all groups proposed role of expert practitioner at first. 4 items out of 20 items showed the meaningful differences between groups. For role of educator, oncology nurse specialist group proposed necessary degrees over 4.0 point out of 5.0 in all items. 4 items out of 18 items showed the meaningful differences between groups. For role of researcher, 3 nurses groups proposed a high necessary degree, but performance of ONS group was most lowest among 5 roles. 6 items out of 14 items showed the meaningful differences between groups. The role of consultant had high necessary degree in some items related to hematopoietic stem cell transplantation. 2 items out of 17 items showed the meaningful differences between groups. In nursing behaviors of administrator & change agent, those items about enacting principle, cost development and participation of professional academy had a high necessary degree. 4 items out of 18 items showed the meaningful differences between groups. Oncology nurse specialists group performed 5 roles orderly, expert practitioner, consultant, educator, administrator & change agent, researcher. This result was different from expected role of themselves as well as the other groups. There was a different necessary degree between role and embodied nursing behaviors of role. ONS group and RN group proposed orderly educator, researcher, administrator & change agent, expert practitioner, consultant, but the other groups did educator, expert practitioner, researcher, consultant, administrator & change agent. The expected standards of oncology nurse specialist in this study were usually master's degree, total career of 5-7 years, oncology career of 3-5 years and certification. But for the post, qualification and qualification institution, various opinions were suggested. In the conclusion, there was a different necessary degree between role and embodied nursing behaviors of role. All groups proposed expert practitioner at first in abstract role, but educator at first in embodied nursing behaviors of role. So we have to consider this difference carefully in the future research. ONS acted the role of expert practitioner first of all, but we should develope and expand the roles of researcher, and administrator & change agent. We should enact roles by role behaviors induced from mutual agreements in necessary degree and performance degree, and bargain the role behaviors that showed the meaningful differences between groups But, we should consider carefully which group's opinion we have to select. I suggested 36 items out of 89 items, in which ONS proposed necessary degree over 4.0 out of 5.0 and half of them performed as the nursing behaviors of oncology nurse specialist that did not induce role stress. For the future, We should role bargain the role with other groups based on these items.

• Korean Journal of Occupational Health Nursing
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• v.11 no.2
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• pp.108-120
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• 2002

This study analyzed the managerial efficiency of 11 organizations, the branch centers of a occupational health service organization in Korea, using the Data Envelopment Analysis (DEA) method. The DEA is a good method for evaluating health services since it can handle multiple inputs and outputs simultaneously, and also identify the sources and amount of inefficiency. The author approached this study using two efficient models: the monetary value model and the real value model. The DEA method based on the monetary value model included cost factors, while the real value model excluded cost factors. The input variables used were manpower of physicians, medical technicians, nurses, industrial hygienists and administrators; labor, maintenance, and material expenses. The output variables used were the number of medical examinations, workplace evaluations, group health management services and income from each service. The major results were as follows: First, in the monetary value model, 6 out of 11 organizations (54.6%) showed an efficiency score of 1.0, which means that they have been operating in very efficient ways. However, 5 organizations (46.4%) showed themselves to be relatively inefficient. Second, in the real value model, 7 out of 11 organizations (63.4%) showed an efficiency score of 1.0, which means they have been operating efficiently, while 4 organizations (46.4%) showed themselves to be relatively inefficient. Third, the reliability of DEA method were analyzed by comparing the results of the monetary value model and real value model. The results of 8 out of 11 organizations were same in terms of being efficient or not. Thus, the DEA could be a valid application method for occupational health service organizations. Fourth, the organizations that displayed common inefficiency in both the monetary value model and in the real value model 3, 9, and 10, were also considered to be managed inefficiency from expertise opinion. In summary, this study evaluated the efficiency of occupational health service organizations applying the DEA method with different variables, and found that the results of analysis could be valid in terms of both modeling and expert sense. In the future, the DEA method will be used as a useful tool to identify and evaluate the efficiency of occupational health service organizations through more applications and refinements.

• Korean Journal of Occupational Health Nursing
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• v.20 no.1
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• pp.93-103
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• 2011

Purpose: This study was conducted to assess reported industrial accidents and non-reported industrial accidents that took place in 63 small and medium sized manufacturing industries located in Daegu and Gyeongsangbuk-do in the year of 2009. Methods: During the period from January to December 2009, the number of industrial accidents that happened each month was examined according to the characteristics of industry, industrial accidents, workers with industrial accidents, treatment, as well as causes and treatment of the non-reported. Results: The total incidence rate of industrial accidents was 3.48%, of which only 0.31% reported. The incidence rate in packing and distribution among manufacturing workplace, and in the industry with 50~99 employees, was higher than the other groups. Of the non-reported, over 80% in required under 10 days of medical treatment, and 56% in required cost of less than 100,000 won. Kappa values were 0.771 concurrence in opinions for causes of non-reported, and 0.571 concurrence in opinions for management termination of non-reported between the employees and employer. Conclusion: It is suggested that more supportive policy and precise, nationwide survey on the actual state of industrial accidents, including non-reported cases, be implemented to efficiently manage industrial accidents.

• Journal of Korean Academy of Nursing
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• v.31 no.1
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• pp.139-149
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• 2001

The purpose of this study was to analyze characteristics related to the activity of Daily Living (ADL) and dementia among the elderly people who have Medicaid. The cross-sectional descriptive survey study was a nationwide randomization sampling among the population of elderly families who have Medicaid. The data were collected during the month of October, 1999 and total sample was 1,027 elderly people. There were major findings according to the studies. In the results of the ADL assessment most of elderly people were within the 24 to 45 point range. Also, 63.3% of elderly people who made 45 points do not need help when performing daily activities according to the 15 areas of activity components, and 4.9% of these people couldn't do their daily activities. The results of the Dementia assessment were 70.6% of elderly people were in the normal range, 21.7% have a mild case, and 2.8% have severe case of dementia. These were found by using instruments for mental states, which simplified to items of detection of early dementia. In the result of these tests, there was a significantly positive correlation between ADL and degree of dementia with the pearson correlation coefficients. As a result of these studies, the author recommend to strengthen function and organization of public health like a visiting nurse center for elderly people who are over 65 years old. In addition, the government should apply early detection and management system for dementia in the community continuously and cost-effectively, especially for elderly people who live alone and are vulnerable elderly as our priority.

• Journal of Environmental Health Sciences
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• v.42 no.5
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• pp.324-332
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• 2016

Objectives: The annual average of PM10 in Seoul was $45{\mu}/m^3$, which surpasses the WHO annual guidelines ($20{\mu}/m^3$). Most previous analyses of the effects of PM exposure have been retrospective studies using single hospital data, and fewer studies have attempted to address the relationship of PM10 and hospital costs. This study was conducted to investigate the effects of the concentration of PM10 on hospital visits, admissions and hospital costs in patients with respiratory and cardiovascular diseases. Methods: Medical data from the National Health Insurance Service and the monthly average of PM10 from National Institute of Environmental Research were used to identify the effects of PM10 on hospital visits, admissions and hospital costs. We applied Poisson regression and linear regression to perform the analysis. Results: The relative risks for admissions per $10{\mu}/m^3$ increase in PM10 were 23.11%, 10.2% and 6.9% increases for acute bronchiolitis, asthma and bronchitis, respectively. The relative risk for hospital visits per $10{\mu}/m^3$ increase in PM10 were 10.4%, 6.7% and 5.9% for chronic obstructive pulmonary disease, asthma and chronic sinusitis, respectively. For cardiovascular disease, the relative risk for admissions per $10{\mu}/m^3$ increase in PM10 were 2.2% and 2.1% increases in angina and acute myocardial infarction, respectively. A $10{\mu}/m^3$ increase in the monthly average of PM10 corresponded to 170,723,000 won (95% CI: 125,587,000-215,860,000 won), 123,636,000 won (95% CI: 47,784,000-199,487,000 won) and 78,571,000 won (95% CI: 29,062,000-128,081,000 won) increases in hospital costs for asthma, acute tonsillitis and chronic sinusitis, respectively. Conclusion: Hospital admissions for respiratory and cardiovascular disease were associated with PM10 levels. PM10 exposure is also associated with increased costs for respiratory diseases.

• Health Policy and Management
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• v.12 no.1
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• pp.21-53
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• 2002

The purpose of this study is to measure the resource use of the elderly in long-term care services and to examine the effects of patient and facility characteristics on their use of resources. The data were collected from 510 old people over sixty years of age, residing in five long-term care hospitals and two skilled nursing homes during the period between December 1, 2000 and February 28, 2001. For a full sample, when the first level of RUG(Resource Use Group)-III categories were employed as the proxy of patient severity, facility characteristics, such as location, size and ownership, have large effects on the resource use measured by service intensity, whereas patient characteristics such as severity have little or no effect. The resource use is significantly high if the facility: (1) is located in rural areas (gun): (2) has mare than 200 beds; (3) is a long-term care hospital; (4) is private; and (5) has a low percentage of medical aid patients. The analysis of the resource use in each RUG-III categories, for which ADL(Ability of Daily Living) were employed as the prosy of patient severity, shows a similar result. The loose relationship between the needs of residents and the resource use seems to be closely associated with the ineffective reimbursement system for providers. The current reimbursement system has no provision for quality improvement and reimburses facilities simply according to their types: fee-for-service for long-term care hospitals, and monthly-flat-rate or full-coverage-national-aid for skilled nursing facilities. It will be necessary to develop a more reasonable reimbursement system that takes patient's severity into account and gives incentives for long-term care providers to offer cost-effective services.

• Journal of Korean Biological Nursing Science
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• v.6 no.1
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• pp.33-42
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• 2004

Background : Intravenous(IV) access is becoming an increasingly important part of health care today. The current drive for clinical effectiveness and cost-effective health care serves to increase the need for reliable vascular access. Venous access devices were developed to overcome problems associated with limited peripheral access and frequent venipuncture in patients with long-term therapy. Although the peripherally inserted central catheter(PICC) have become popular during recent years in USA, its procedure is rare in Korea. Purpose : The goal of this study was to analyze the PICC inserted patient data by IV CNS intervention. Method : A Total of 62 PICCs were inserted into 51 patients by the IV CNS during a 10-month period form November, 14, 2002, to October 2, 2002. Data was obtained retrospectively through chart review. Result : The patient population included 34(54.8%) men and 28(45.2%) women, with a mean age 50.6 years. The main indication for PICC placement was to access vein in poor peripheral venous status(40.3%). The mean served interval for PICC insertions was 16.7 days(range, $2{\sim}61$ days). The reasons for removal were completed therapy in 18 cases(29.0%), patient death in 13 cases(21.0%), and mechanical or functional PICC problem in 10cases(16.1%). The three PICCs removed for presumed infection, and one had only positive tip cultures(0.2%). Conclusion : PICCs are rapidly growing popularity and required an extended course of IV therapy.

• Journal of Korean Neurosurgical Society
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• v.51 no.6
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• pp.338-342
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• 2012

Objective : The aim of this study is to implement a critical pathway (CP) for patients undergoing lumbar laminectomy or microdiscectomy and describe the results before and after the CP in terms of length of hospital stay and cost. Methods : From March 2008 to February 2009, 61 patients underwent lumbar laminectomy or microdiscectomy due to stenosis or one- or two-level disc herniation in our department and were included in the prepathway group. After development and implementation of the CP in March 2009, 58 patients were applicable for the CP, and these were classified as the postpathway group. Results : The CP, which established a 6-day hospital stay (5 bed-days), was fulfilled by 42 patients (72.4%) in the postpathway group. The mean length of stay was 5.4 days in the postpathway group compared to 6.9 days in the prepathway group, demonstrating a 20% reduction, which was a statistically significant difference ($p{\leq}0.000$). There was a statistically significant reduction in charges for bed and nursing care (p=0.002). Conclusion : Implementation of a CP for lumbar laminectomy or microdiscectomy produced significant decreases in length of hospitalization and charges for bed and nursing care. We believe that this CP reduces the unnecessary use of hospital resources without increasing risk of adverse events.