• 임상간호연구
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• 제14권1호
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• pp.161-172
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• 2008

Purpose: This study was to classify patient severity score for hemodialysis patients. Method: The subject of this study was 1,575 patients. To study the severity of the patients, we used t-test and ANOVA. The congruity was measured by Kappa coefficient and the severity in each medical facility was analyzed by ANOVA. Result: The results showed that there was a significant difference according to the levels of medical center (F=171.187, p<.0001). Categorizing the severity of the patients in each medical facility, group II and III of the secondary medical institution had higher ratio than the primary medical institution. There was not a single patient coming under group IV in both of the primary or secondary medical institutions. However, the tertiary medical institutions had more subjects in group II and III than the primary and secondary medical institutions. The group IV with the highest severity had 11 patients(1.5%), demonstrating that the tertiary medical institution had higher severity patients than the primary or secondary medical institutions. Conclusion: The results of this study appropriately reflects the repayment system of medical expenses by the government. Also, it provides the fundamental information to develop nursing fee system taken into account of the systemic differences among the primary, secondary and tertiary medical institutions.

• 지역사회간호학회지
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• 제18권3호
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• pp.480-491
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• 2007

Purpose: This study was to investigate the needs of health & community services among the disabled at home in rural areas. Methods: The subjects were 146 persons with disabilities living in J-gun. The questionnaire was based on the needs of 8 categorical services. Data were analyzed using frequency, percentage, mean, standard deviation, minimum, maximum, t-test, one-way ANOVA and Scheffe test. Results: Among the respondents, 27.4% visited the public health center in community for rehabilitation therapy. The average score of need was $2.62{\pm}.79$: education services $(2.92{\pm}1.05)$; medical services $(2.81{\pm}.82)$ nursing care services $(2.75{\pm}1.08)$; connection services $(2.62{\pm}1.20)$;, housing services $(2.60{\pm}1.09)$; emotional services $(2.41{\pm}1.03)$; other services $(2.24{\pm}1.06)$; and support of self-sustenance service $(1.92{\pm}1.15)$. The items in highest need were medical checkup (70.7%), medication (62.1%), traditional oriental therapy (60.4%) and physical therapy (58.9%), and those of lowest need were device repair (8.7%) and guidance of facility admission (7.1%). Needs were significantly different according to age (F=4.751. p=.001), employment status (t=2.108, p=.037) and medical fee payer (F=5.061, p=.002). Conclusion: The needs of education & medical services were relatively high. Demographic factors were statistically significant in determining needs. For the disabled at home in rural areas, more various services or programs should be executed based upon the needs and characteristics of based upon the needs and characteristics of the subjects.

• 여성건강간호학회지
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• 제5권1호
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• pp.133-145
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• 1999

The purposesof the study are to analyze the community nursing center in U.S.A and to develop the model of nursing care system based on nurse-midwifery clinic in community for women's health in Korea. 1. In America nursing center is defined as nurse-anchored system of primary care delivery or neighborhood health center. Nursing centers are identified the following four types: (1) community outreach centers, which are similar to traditional public health clinics: (2) institutional-based centers following the mission of a large institution, such as a hospital or university: (3) wellness/health promotion centers, which offer screening, education, counseling, triage, and health maintenance services: and (4) independent practice. Nursing centers are a concept of services provided by nurses in practice arrangements in a community. Nursing centers offer a variety of services, ranging from primary care provided by advanced practice nurses with medical acute management and nursing care to the more traditional education, health promotion, screening wellness and coordination services. Some services, such as the care provided by advanced practice nurses are reimbursed under various insurance plan in some instances and states, where as others, such as preventive and educational services, are not. Thus, lack of reimbursement has threatened the survival of some centers. Licensing of nursing centers varies by state and program and accreditation of nursing centers is also limited. 52% of centers are affiliated with another facility and 48% are freestanding centers. The number of registered nurse at the nursing centers ranges from just one to 115, with a mean of eight RNs peragency and a median of three. Nursing centers avail ability varies: 14% are open 24 hours, 27% have variable short hours, 23% are open 6-7 days per week, and 36% are open Monday- Friday. As the result of my visiting three health centers in Seattle and San Francisco, the women's primary care nurse practitioners focus on a systematic and comprehensive assessment of the health status of women and diagnosis and management of common physical and psychosocial health concerns of women in ambulatory settings. Therapeutic nursing strategies are directed toward self-care, risk reoduction, health surveillance, stress reduction, healthy nutrition, social support, healthy coping, psychological well-being, and pharmacological therapy. They function as primary care providers for the well ness and illness care of women from adolescence through the older adult years and pregnant families. 2. In Korea a nurse-midwife practices independently for pregnant women's health including childbearing family at her own clinic in community. Her services are reimbursed under national health insurance but they are not paid on a fee-for-service schedule covering items. Analyzing the nursing centers in America, I suggest that nurse-midwifery clinics offer primary care for women and home care for chronic ill patients. The health law and health insurance policy should be reovised in order to expand nurse-midwife's and home care nurse's roles at nurse-midwifery clinic.

• 한국산학기술학회논문지
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• 제18권6호
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• pp.119-128
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• 2017

본 논문은 병원에서 간호 간병통합서비스가 전국에 확대 적용되었을 경우 필요한 간호인력과 재정비용을 추계한 연구이다. 연구자료는 건강보험심사평가원으로부터 받은 2012년 기준 간호사 수, 간호조무사 수, 의료기관 수, 환자 수를 이용하였다. 간호 인력의 규모는 결정론적 방법으로 개발된 작업부하모델에 의해 추정되었다. 간호간병통합서비스 연간 총 재정비용을 계산하는데 상향식 추정방법이 사용되었다. 간호사 및 간호조무사 수는 각각 81.8%, 83.2% 더 증가되어야 간호 간병통합서비스가 전국 규모로 적용가능한 것으로 추정되었다. 전국의 모든 일반병동에 간호 간병통합서비스가 적용되기 위해 필요한 재정적 비용은 110.4% 더 증가해야 할 것으로 추정되었다. 이 새로운 시스템을 성공적으로 구현하려면, 인력공급의 양적확대 전략뿐만 아니라 숙련된 간호사와 신규간호사의 이직을 최소화해야 한다. 또한 간호사-환자 비의 타당성을 지속적으로 확인할 필요가 있다. 새로운 시스템을 모든 병원에 단계적으로 확대하여야 국민건강보험의 재정부담을 최소화할 수 있을 것이다.

• 지역사회간호학회지
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• 제18권2호
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• pp.252-265
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• 2007

Purpose: This study was attempted to provide basic data required to develop community-base rehabilitation program for disabled persons at home by investigating their characteristics. ADL, and perceived health status. Method: The subjects were 146 disabled persons at home in rural areas. Data were collected from January 22 to January 31, 2004. Data were analyzed using frequencies, percentages, means, standard deviations, minimums, maximums, $\chi^2$-test, Fisher's exact test, t-test, one-way ANOVA, Scheffe test, Contingency coefficient, Pearson's correlation, Stepwise multiple regression. Results: The average score of ADL was $5.51{\pm}1.92$: sphincter control $(5.85{\pm}2.10)$, communication $(5.66{\pm}2.02)$, transfers $(5.67{\pm}2.21)$, self care $(5.44{\pm}2.05)$, social cognition $(5.33{\pm}2.08)$, and locomotion $(4.85{\pm}2.32)$. This means that the respondents were in the state of dependence. The main items requiring others' help were 'bathing' (57.7%) and 'going up and down stairs' (51.1%) ADL was significantly different according to age, sender, occupation, medical fee payer, type, severity and duration of disability, BMI, and alcohol drinking. Among the respondents, 82.8% perceived that their health status was bad. Main factors influencing the perceived health status of disability were age and ADL$(R^2=.343)$. Conclusion: Perception of health status among the disabled is related to their characteristics and ADL, so it is necessary to develop community-base rehabilitation programs in order to improve ADL and the perception of health status.

• 한국치위생학회지
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• 제15권4호
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• pp.565-574
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• 2015

Objectives: The purpose of the study is to investigate the oral health of the elderly people receiving nursing care and home care services in Chungnam. Methods: The subjects were 350 elderly people receiving 21 nursing care and home care services in Chungnam. The direct interview with the elderly people and oral examination was carried out from July, 2012 to December, 2013 after explanation fo the purpose of the study. The subjects consisted of 178 elderly people receiving nursing care services and 172 elderly people receiving home care services. Except incomplete answers, 315 data were analyzed. The questionnaire consisted of general characteristics of the subjects, characteristics by facility, oral condition, oral care behavior, correlation by factors on oral health, influencing factor on dental caries, influencing factor on periodontal disease, and influencing factor on elasticity of gingival muscle. Data were analyzed by frequency analysis, chi-square test, and multiple regression analysis using SPSS 21.0 program. Results: Multivariate analysis of influencing factors on oral health revealed that the elderly people with low education level tended to have higher incidence rate of dental caries. The influencing factors on oral health were the elasticity of gingival muscle, periodontal disease, educational level, and economic level. (p<0.05). The explanation power was 26.2%. Conclusions: Oral Health Promotion should be obligatorily established as one of the medical system and medical fee system to promote oral health condition for the aged.

• 간호행정학회지
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• 제19권4호
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• pp.437-448
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• 2013

Purpose: This study was a retrospective survey to examine economic feasibility of home care services for patients with diabetic foot. Methods: The participants were 33 patients in the home care services (HC) group and 27 in the non-home care services (non-HC) group, all of whom were discharged early after inpatient treatment. Data were collected from medical records. Direct medical costs were calculated using medical fee payment data. Cost-effectiveness ratio was calculated using direct medical costs paid by the patient and the insurer until complete cure of the diabetic foot. Effectiveness was the time required for a complete cure. Direct medical costs included fees for hospitalization, emergency care, home care, ambulatory fees, and hospitalization or ambulatory fees at other medical institutions. Results: Mean for direct medical costs was 11,118,773 won per person in the HC group, and 16,005,883 won in the non-HC group. The difference between the groups was statistically significant (p=.042). Analysis of the results for cost-effectiveness ratio showed 91,891 won per day in the HC patients, and 109,629 won per day in the non-HC patients. Conclusion: Result shows that the cost-effectiveness ratio is lower HC patients than non-HC patients, that indicates home care services are economically feasible.

• 임상간호연구
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• 제28권1호
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• pp.1-12
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• 2022

Purpose: The purpose of this study is to investigate the association between the nurse staffing level and the patient mortality using Korean National Health Insurance data. Methods: The data of 1,068,059 patients from 913 hospitals between 2015 and 2016 were analyzed. The nurse staffing level was categorized based on the bed-to-nurse ratio in general wards, intensive care units (ICUs), and hospitals overall. The x² test and generalized estimating equations (GEE) multilevel multivariate logistic regression analyses were used to explore in-hospital mortality and 30-day mortality after admission. Results: The in-hospital mortality rate was 2.9% and 30-day mortality after admission rate was 3.0%. Odd Ratios (ORs) for in-hospital mortality were statistically lower in general wards with a bed-to-nurse ratio of less than 3.5 compared to that with 6.0 or more (OR=0.72, 95% CI=0.63~0.84) and in ICUs with a bed-to-nurse ratio of less than 0.88 compared to that with 1.25 or more (OR=0.78, 95% CI=0.66~0.92). ORs for 30-day mortality after admission were statistically lower in general wards with a bed-to-nurse ratio of less than 3.5 compared to that with 6.0 or more (OR=0.83, 95% CI=0.73~0.94) and in ICUs with a bed-to-nurse ratio of less than 0.63 compared to that with 1.25 or more (OR=0.85, 95% CI=0.72~1.00). Conclusion: To reduce the patient mortality, it is necessary to ensure a sufficient number of nurses by improving the nursing fee system according to the nurse staffing level.

• 대한간호학회지
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• 제8권1호
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• pp.131-138
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• 1978

The change of society has brought about various health problems which have become to demand comprehensive health services not only for individuals but also for families and communities as the unit. To meet the societal needs W Hospital in a rural Korea established a Department of Community Health Nursing Services and provided nursing services to patients under a early discharge program. This study is to evaluate the community health nursing services carried out the department in general, and has following specific objectives : 1. To learn attitude of the consumers and the "referees" toward early discharge program. 2. To find out attitude toward home care and cure services. 3. To find out the consumers and the "Referees" attitude toward the 15 selected home cue and cure activities by public health nurse. 4. To investigate possibility of charging fee for the 15 selected home care and cure activities by public health nurse. Three different study population were chosen: namely the consumer, the "referee" I and II. Excluding families moved out and not able to be contacted, the total families (77) referred to the department during the study period of September 1974 - December 1975 are defined as the consumer. Thirty seven nurses among 81 nurses who have been working in W Hospital since the inception of the Community Health Nursing Service Program were randomly selected. Thirty two nurses were defined as the "referee"I, because 5 questionnaires were not able to be collected. Twenty four doctors out of 37 who have been working since the Community Health Nursing Service Program started, and who were able to contact were called as the "referee" II. Data collection method employed for the consumers was direct interviewing with preposed interview schedules, and for the "referees"questionnaire method was utilized. x$^2$test and 100-percentage were employed in analyzing the data. The study findings are follows: 1. Attitude toward early discharge: Above 85% of the consumers and the "referees" approved the early discharge: Above 85% of the consumers and the "referees" approved the early discharge program. 2. Attitude toward the home care and cure services: Above 75% of the consumers and the "referees" showed positive attitude toward the home care and cure services by public health nurses. 3. Attitude toward 15 selected home care and curative activities by public health nurses: On the average more than 50% of the consumers and the "referees" expressed an affirmative attitude to perform 15 selected home care and cure services by public health nurses. 4. Attitude toward charging fee for 15 selected home care and curative activities by public health nurses: Above 85% of the consumers thought that they would pay for the services. Only 12.8% of the consumers and 5% of the "referees" what to have the services for nothing. Based upon the findings of this study; That is, the home care and cure services to be given by public health nurse were positively responded by the consumers and the pro-fissionable, one can conclude that the services provided by the Department of Community Health Nursing Service of W Hospital have been well accepted, and that early discharge program of hospital is believed to be a means to lessen the expenses of patients from hospitalization and to promote recovery from illness. It is recommended that hospital centered cure services should be reconsidered and scrutinized to meet community health needs. NOTE : "referees" are nurses and doctors who refer the early discharged Patient to the Department of Community Health Nursing Service.

• 지역사회간호학회지
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• 제10권1호
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• pp.5-18
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• 1999

The aim of this study is the development of a fee - based model day care center for the elderly by inquiring into the current condition of facilities in America and in Korea, and in surveying the opinion of domestic elderly about day care facilities. A field trip to U.S. day care services was held between July 5 and July 15 in 1997, and an on-the-spot study for domestic facilities took place during March in 1998. Our research reveals that the overall supply of day care facilities can not meet future demand in terms of quality and quantity. Therefore a model must be created for day care centers of a that consists of a director from a professional group. an adequate environment, and a standardized in order to offer a qualified public health service linked to the home and community in Korea. The director of a day care center is a critical variable in determining the quality of service. Professional skills related to the needs of the elderly and the person's quality of service should be considered in appointing director for the center. This study belleves that a professional nurse should be the director of a day care center. The operating environment of a day care facility should be made up of considerable space comparable to the number of residents, should be in a comfortable and safe location, and should have equipment that provides a qualified, safe service to the elderly. Our model is designed for 20 persons and allocates 4 Peng per person. This model is comprised of a reading room. a craft room, a health room, a room for physical therapy, a dining room, a staff office, and a multi -purpose room connected to other rooms. Day care service should be a comprehensive service program meeting the multidimensional needs of the elderly. A comprehensive service program needs a team of various professionals made up of the elderly family, participants, nurses, social workers, physical therapists, nutritionists, and medical doctors. The program will also include health care service, physical therapy, speech therapy. diet, occupational therapy, transportation service, health and an education program, etc. In conclusion, a model of a day care center is developed with the following components: a professional director and an environment and program, that considers the physical, mental, and social characteristics of the elderly. A model should also motivate self-reliance self-fulfillment in the elderly in order to fulfill their health needs and to prevent isolation from society and mental depression. Furthermore, This facility will be a beneficial factor in reducing a family's burden on caring for the elderly that includes unnecessary hospital expenses. The following is a suggestion based on results this study: A service program should be developed to fit the conditions of the elderly in Korea by specifically analyzing the needs of the elderly.