Purpose: The purpose of this manuscript is to discuss the need for use of evidence based practice (EBP) in LTC, the current use of evidence in long term care facilities and what we know about adoption of the use of EBP in LTC. Methods: Literature review and reporting of findings from the M-TRAIN study that was a quasi-experimental design to test the effectiveness of an intervention to increase the use of EBPs for urinary incontinence and pain in 48 LTC facilities. Results: Barriers to adopting EBPs include lack of available time, lack of access to current research literature, limited critical appraisal skills, excessive literature to review, non-receptive organizational culture, limited resources, and limited decision-making authority of staff to implement change. Strategies to promote adoption of EBP include the commitment of management; the culture of the home; leadership; staff knowledge, time, and reward; and facility size, complexity, the extent that members are involved outside the facility, NH chain membership, and high level of private pay residents. Findings from the M-TRAIN add, stability of nurse leader and congruency between the leaders perception of their leadership and the staff's perception of the leadership. Conclusion: There is clear evidence of the need and the benefits to residents of LTC and to the health care system yet adoption of EBP continues to be slow and sporadic. There is also evidence for the process of establishing best evidence and many resources to find the available EBPs. The urgent need now is finding ways to best get the EBPs implemented in LTC. There is growing evidence about best methods to do this but continued research is needed. Clearly, residents in LTC deserve the best care possible and EBPs represent an important vehicle by which to do this.
Journal of The Korea Institute of Healthcare Architecture
/
v.16
no.3
/
pp.49-56
/
2010
In Japan, a lot of elderly housing types have been developed in order to meet various needs of the older person and the change of social situations. Elderly housings can be divided into three categories elderly housings for healthy older persons, elderly care homes for the healthy and elderly care facilities for the unhealthy. Elderly housings include public and private rental housings. Sometimes they can be designated only for the elderly. Elderly care homes for the healthy elderly include full fee charging elderly housing, elderly homes, low fee charging elderly homes and care houses. Elderly care facilities for the unhealthy elderly consist of full fee charging elderly care homes, group homes for the dementia, elderly health facilities, nursing homes, elderly hospitals, and so on. However "elderly care facilities" have been proved not to be efficient for the delivery of elderly welfare services nor satisfactory to the frail older person. Therefore, based on the concept of the "Normalization", daily services have been provided for the elderly in order that they can live at their own home in the community for themselves. As a result, Japan aims not only to reduce elderly welfare expenses but also to increase elderly users' satisfaction. Emphasis on non-institutionalization and in-home services, regional characterization, harmony between Hard and Soft, user oriented services, substantiality, universal design and so on are sought for the sake of those goals.
Kim Byung-Jo;Koo Bong-Oh;Kim Chung-Sun;Bae Sung-Soo
The Journal of Korean Physical Therapy
/
v.14
no.4
/
pp.75-86
/
2002
The patients with a central nervous impediment and a sequela caused by a Stroke are continuously increasing, and the burden of family and society for Stroke patients are also increasing. Since Stroke patients are required to receive a long time medical treatment and care. It adds a economical burden as well as a mental and physical burden of patient's family. In addition, it is a primary factor which deepens the disparity of medical resources in social aspect. But the social concern for these patients are very insufficient and are entirely left to the patient's family The mediation of Skilled Nursing Facility for Stroke patients enable to receive more special and proper medical treatment and recuperation service in the middle of time when they return to home from hospital. It also contributes to the settlement of the charge of patient's family and the serious disparity of medical resources. Therefore, this study will summon the social understanding of the necessity of Skilled Nursing Facilities through the above debate.
Purpose: The aim of this study was to investigate the perceptions of nurses regarding their roles in social welfare facilities, including role expectation, role performance, and role conflict and its influencing factors. Methods: Data were collected by administering a structured questionnaire to 92 nurses working in 5 types of social welfare facilities. Descriptive statistics, paired t test, Pearson correlation coefficient, and multiple linear regression analyses were performed using the SPSS Win 18.0 program. Results: The mean score of role expectation ($4.44{\pm}0.41$) was significantly higher(t =17.50, p<.001) than that of role performance ($3.46{\pm}0.005$). The biggest mean difference between role expectation and role performance was found in "research activities" ($2.92{\pm}0.81$). The mean score of role conflict was $2.89{\pm}0.66$, with the highest mean score found in "conflict caused when one nurse takes up two or more roles" ($3.31{\pm}0.69$). The influencing factors on role conflict were the difference between role expectation and role performance(${\beta}=.45$, p<.001), and facility size (${\beta}=-.37$, p<.001), which accounts for 51.5% incidence of role conflict controlling nurses' age, career, position, and working periods in social welfare facilities (F=17.13, p<.001). Conclusion: The nurses working in the social welfare facilities perceived some restrictions on their role performance compared with their role expectation, this difference being a major factor influencing their role conflict. Therefore, future studies need to investigate interventions to minimize this effect.
The urgent needs to establish hospice care systems in Korea arise from the following reasons: 0) a drastic increase in chronically ill patients with the increase of aged population: (2) rapid changes in living environment from the traditional habitation (e. g., Many Koreans living in apartment complexes, which is the most popular form of modern residence in recent years, prefer to die in the hospital.): the overall increase in patients with advanced cancer: (4) recent trends in early discharge of terminally ill patients from the limited hospital facilities to accomodate other medical insurance beneficiaries; (5) easy acceptance of euthanasia owing to the recent social atmosphere that belittles the dignity of human life; (6) medical and nursing care of AIDS patient in terminal stage; (7) and the problem associated with inhumane medical care system, overtreatment, and groundless fears against narcotics. Terminally ill patients were used to be treated in the hospital in the past. In these days, however, they are forced to have home cares with little assistance from the qualified medical personnel because of insufficient hospital facilities, which are even short for the need of emergency patients and provide priority cares to medical insurance beneficiaries with other acute problems. And yet, neither are there any administrative organizations nor systematic medical studies that deal with the level of terminally ill patient's need, their family's problems and resources of hospice care systems in Korea. Thus, most patients are not able to get appropriate medical care at the terminal stage of their lives. The objective of this study is to make comprehensive database for various hospice care organization currently in operation, link them through medical information system, and develop an easily accessible hospice care model that meets the need of most Korean people. Our survey results may be summarized as follows: Nationally there are 40 organizations that provide partial or full hospice care. However, these organizations are not linked to any formal medical service network. Furthermore, the objective of hospice care, care principles, personnel with appropriate training, educational programs, standard for care, costs, consulting service to patients' family members, the extent of medical care from professional staff members, status of hospice facility, and management of those institutions are neither clearly defined nor organized compared to the international hospice care standards. The surveys on patients of terminal stage. grouped in hospice and non-hospice care patients. reveal what they want visiting nursing care to help their pain control. psychological. social and spiritual demands. While the more than 90% of hospice care patients want to reduce their pains. the non-hospice care patients. in addition to their desire for pain control. demanded more psychological. social and spiritual helps as well. The results of this research could be utilized to 0) define the standard of hospice care. (2) provide the guidance for hospice medical care costs. (3) establish the database of hospice care systems. (4) develop softwares. (5) build communication network through Medinet. and (6) provide an organized visiting home nursing care system. These information should be a valuable resource to many medical staffs who are involved in cancer therapy. nursing care. and social welfare programs.
Purpose: The purposes of this study were to identify differences of duties, tasks, and task elements of care helpers between long term care (LTC) facilities and client's home (CH), and to provide data for the development of educational programs and policies. Methods: This study was a descriptive investigation; the subjects of the study were 418 care helpers. Duties, tasks, and task elements were measured using the framework proposed by Shin et al. (2012). Data were analyzed by t-test using PASW 18.0. Results: All of the jobs were statistically significant differences between LTC and CH. Dietary assistance and Daily work assistance were more frequently in CH, and the frequency of other tasks was higher in LTC than CH. Tasks with higher-reported difficulty by those who worked in LTC were as follows: personal hygiene, position change and movement, exercise and activity assistance, safety care, communication assistance, dietary assistance, environment management, daily work assistance, emergency prevention, early detection and speedy reporting, and dementia patient care. Conclusion: These findings suggest that training for care helpers of each facility type will be differentiated. Tasks and task elements reported by care helpers were modified and added to the standard textbook.
This study was conducted to assess the morbidity and medical facilities utilization patterns of high school students in urban and rural areas, and to contribute to establishment of school health policies. A questionnaire survey was carried out for 1,979 of one boy's and one girl's high school in Pusan and 1,315 of one boy's and one girl's high school in Kyungnam province from March 27 to April 8, 1989. The summarized result is as follows. The number of students who were sick or injured in one month period was 378.0 of 1,000 students. One sick or injured student experienced 1.2 events on the average and thus the incidence rate was 453.2 per 1,000 students for a month. The morbidity rate of the urban area (550.8) was higher than that of the rural area (306.5) while the rate for girl students (561.9) was higher than that of the boy students (328.3) (P<0.01). Especially, the girl students (740.7) in the urban area showed two times higher morbidity rate than that of the girl students in the rural area. Out of all morbidity respiratory disease for 67.6 percent in urban area and 68.5 percent in rural area and it was followed by gastrointestinal disease and nervous & sensory diseases. The morbid conditions took place at school in 37.5 percent, and at home in 59.8 percent. The absence rate due to morbidity was 4.4 percent out of all morbid students. In addition, 73.5 percent of all morbid student utilized medical treatment, of which the pharmacy accounted for 53.8 percent and 57.5 percent in the urban and rural areas, respectively. The second most common facility utilized was hospital OPD. While there was no student who utilized the school nursing room in the rural area, 1.5 percent of the sick students utilized the school nursing room in the urban area. The most important in selecting medical facility was the distance. By low medical expense was more frequent cited reason for selecting medical facility in rural area (13.6 percent) than in urban area (3.2 percent). Mild illness accounted for 70.3 percent of the reasons for no treatment and 21.8 percent was due to the conflict between school hour and clinic hour. The morbid students mostly suffered from mild respiratory and gastrointestinal disease, and its incidence was the highest rate in the school. Although there was relation between the worry of absence and no-treatment, the school nursing room utilization of students was very insufficient. Therefore, it is required to activate the operation of the high school nursing room by utilizing the specialized personnel.
This study has been performed to explore main reasons for staying in paid elderly residential care facilities among the residents. In this study, five males and seven females aged 65 to 82 were asked about main reasons for staying in the facilities. The answers of the qualitative interview were drawn as follows; first, some residents had suddenly decided to move into the facility due to critical life events such as bereavement, serious illness, or supporting problems. Second, some residents had taken a long period of considerations on whether staying home or in the facilities, because their health and family supports gradually diminished over the long life span. On the other hand, a few of them voluntarily chose to stay at the facilities, because they recognized supervised group activities, nutritionally well-planned meals, and health care as major inconveniences. In this study, suggestions were made as follows: first, guiding and settlement programs should be developed for the residents of the sudden events, particularly at early stage of admission. Second, intensive nursing care units should be in separation from healthy independent groups, so that the residents are relieved from stressful contacts with extremely ill patients in the residential area.
Japan is a super-aged society where the proportion of the people aged over 65 is exceeded 20%. Therefore, there are many accidents that occur in long-term care facilities in Japan, and there are many civil litigations. The Japanese court has acknowledged in many cases that the long-term facility is responsible for the damage to the elderly who is injured in the facility. The cases can be divided into ① tumbling down, ② wandering, ③ suffocation, ④ bedsore, and ⑤ accidents among the facility-users. In most cases, the court found that the facility violated its obligation to protect their users. This is not only the case where the manager or the employee of the facility violates the obligation to watch and care for the elderly, but in some cases, the failure to maintain the human and material system itself is recognized. The basis for such judgment is whether the facility can predict the possibility of an accident and whether the facility has taken measures to prevent accidents. Also, the Japanese court recognizes the transfer of burden of proof in order to expedite the victims' rights. However, the liability of the facility for damages should not be so heavy that it would be hesitant to allow a person to enter the facility and make a contract.
Purpose: This study was conducted to investigate relationship between delirium, risk factors on delirium, and patient prognosis based on Donabedian's structure-process-outcome model. Methods: This study utilized a path analysis design. We extracted data from the electronic medical records containing delirium screening data. Each five hundred data in a delirium and a non-delirium group were randomly selected from electronic medical records of medical and surgical intensive care patients. Data were analyzed using SPSS 20 and AMOS 24. Results: In the final model, admission via emergency department (Β=.06, p=.019), age over 65 years (Β=.11, p=.001), unconsciousness (Β=.18, p=.001), dependent activities (Β=.12, p=.001), abnormal vital signs (Β=.12, p=.001), pressure ulcer risk (Β=.12, p=.001), enteral nutrition (Β=.12, p=.001), and use of restraint (Β=.30, p=.001) directly affecting delirium accounted for 56.0% of delirium cases. Delirium had a direct effect on hospital mortality (Β=.06, p=.038), hospital length of stay (Β=5.06, p=.010), and discharge to another facility (not home) (Β=.12, p=.001), also risk factors on delirium indirectly affected patient prognosis through delirium. Conclusion: The use of interventions to reduce delirium may improve patient prognosis. To improve the dependency activities and risk of pressure ulcers that directly affect delirium, early ambulation is encouraged, and treatment and nursing interventions to remove the ventilator and drainage tube quickly must be provided to minimize the application of restraint. Further, delirium can be prevented and patient prognosis improved through continuous intervention to stimulate cognitive awareness and monitoring of the onset of delirium. This study also discussed the effects of delirium intervention on the prognosis of patients with delirium and future research in this area.
본 웹사이트에 게시된 이메일 주소가 전자우편 수집 프로그램이나
그 밖의 기술적 장치를 이용하여 무단으로 수집되는 것을 거부하며,
이를 위반시 정보통신망법에 의해 형사 처벌됨을 유념하시기 바랍니다.
[게시일 2004년 10월 1일]
이용약관
제 1 장 총칙
제 1 조 (목적)
이 이용약관은 KoreaScience 홈페이지(이하 “당 사이트”)에서 제공하는 인터넷 서비스(이하 '서비스')의 가입조건 및 이용에 관한 제반 사항과 기타 필요한 사항을 구체적으로 규정함을 목적으로 합니다.
제 2 조 (용어의 정의)
① "이용자"라 함은 당 사이트에 접속하여 이 약관에 따라 당 사이트가 제공하는 서비스를 받는 회원 및 비회원을
말합니다.
② "회원"이라 함은 서비스를 이용하기 위하여 당 사이트에 개인정보를 제공하여 아이디(ID)와 비밀번호를 부여
받은 자를 말합니다.
③ "회원 아이디(ID)"라 함은 회원의 식별 및 서비스 이용을 위하여 자신이 선정한 문자 및 숫자의 조합을
말합니다.
④ "비밀번호(패스워드)"라 함은 회원이 자신의 비밀보호를 위하여 선정한 문자 및 숫자의 조합을 말합니다.
제 3 조 (이용약관의 효력 및 변경)
① 이 약관은 당 사이트에 게시하거나 기타의 방법으로 회원에게 공지함으로써 효력이 발생합니다.
② 당 사이트는 이 약관을 개정할 경우에 적용일자 및 개정사유를 명시하여 현행 약관과 함께 당 사이트의
초기화면에 그 적용일자 7일 이전부터 적용일자 전일까지 공지합니다. 다만, 회원에게 불리하게 약관내용을
변경하는 경우에는 최소한 30일 이상의 사전 유예기간을 두고 공지합니다. 이 경우 당 사이트는 개정 전
내용과 개정 후 내용을 명확하게 비교하여 이용자가 알기 쉽도록 표시합니다.
제 4 조(약관 외 준칙)
① 이 약관은 당 사이트가 제공하는 서비스에 관한 이용안내와 함께 적용됩니다.
② 이 약관에 명시되지 아니한 사항은 관계법령의 규정이 적용됩니다.
제 2 장 이용계약의 체결
제 5 조 (이용계약의 성립 등)
① 이용계약은 이용고객이 당 사이트가 정한 약관에 「동의합니다」를 선택하고, 당 사이트가 정한
온라인신청양식을 작성하여 서비스 이용을 신청한 후, 당 사이트가 이를 승낙함으로써 성립합니다.
② 제1항의 승낙은 당 사이트가 제공하는 과학기술정보검색, 맞춤정보, 서지정보 등 다른 서비스의 이용승낙을
포함합니다.
제 6 조 (회원가입)
서비스를 이용하고자 하는 고객은 당 사이트에서 정한 회원가입양식에 개인정보를 기재하여 가입을 하여야 합니다.
제 7 조 (개인정보의 보호 및 사용)
당 사이트는 관계법령이 정하는 바에 따라 회원 등록정보를 포함한 회원의 개인정보를 보호하기 위해 노력합니다. 회원 개인정보의 보호 및 사용에 대해서는 관련법령 및 당 사이트의 개인정보 보호정책이 적용됩니다.
제 8 조 (이용 신청의 승낙과 제한)
① 당 사이트는 제6조의 규정에 의한 이용신청고객에 대하여 서비스 이용을 승낙합니다.
② 당 사이트는 아래사항에 해당하는 경우에 대해서 승낙하지 아니 합니다.
- 이용계약 신청서의 내용을 허위로 기재한 경우
- 기타 규정한 제반사항을 위반하며 신청하는 경우
제 9 조 (회원 ID 부여 및 변경 등)
① 당 사이트는 이용고객에 대하여 약관에 정하는 바에 따라 자신이 선정한 회원 ID를 부여합니다.
② 회원 ID는 원칙적으로 변경이 불가하며 부득이한 사유로 인하여 변경 하고자 하는 경우에는 해당 ID를
해지하고 재가입해야 합니다.
③ 기타 회원 개인정보 관리 및 변경 등에 관한 사항은 서비스별 안내에 정하는 바에 의합니다.
제 3 장 계약 당사자의 의무
제 10 조 (KISTI의 의무)
① 당 사이트는 이용고객이 희망한 서비스 제공 개시일에 특별한 사정이 없는 한 서비스를 이용할 수 있도록
하여야 합니다.
② 당 사이트는 개인정보 보호를 위해 보안시스템을 구축하며 개인정보 보호정책을 공시하고 준수합니다.
③ 당 사이트는 회원으로부터 제기되는 의견이나 불만이 정당하다고 객관적으로 인정될 경우에는 적절한 절차를
거쳐 즉시 처리하여야 합니다. 다만, 즉시 처리가 곤란한 경우는 회원에게 그 사유와 처리일정을 통보하여야
합니다.
제 11 조 (회원의 의무)
① 이용자는 회원가입 신청 또는 회원정보 변경 시 실명으로 모든 사항을 사실에 근거하여 작성하여야 하며,
허위 또는 타인의 정보를 등록할 경우 일체의 권리를 주장할 수 없습니다.
② 당 사이트가 관계법령 및 개인정보 보호정책에 의거하여 그 책임을 지는 경우를 제외하고 회원에게 부여된
ID의 비밀번호 관리소홀, 부정사용에 의하여 발생하는 모든 결과에 대한 책임은 회원에게 있습니다.
③ 회원은 당 사이트 및 제 3자의 지적 재산권을 침해해서는 안 됩니다.
제 4 장 서비스의 이용
제 12 조 (서비스 이용 시간)
① 서비스 이용은 당 사이트의 업무상 또는 기술상 특별한 지장이 없는 한 연중무휴, 1일 24시간 운영을
원칙으로 합니다. 단, 당 사이트는 시스템 정기점검, 증설 및 교체를 위해 당 사이트가 정한 날이나 시간에
서비스를 일시 중단할 수 있으며, 예정되어 있는 작업으로 인한 서비스 일시중단은 당 사이트 홈페이지를
통해 사전에 공지합니다.
② 당 사이트는 서비스를 특정범위로 분할하여 각 범위별로 이용가능시간을 별도로 지정할 수 있습니다. 다만
이 경우 그 내용을 공지합니다.
제 13 조 (홈페이지 저작권)
① NDSL에서 제공하는 모든 저작물의 저작권은 원저작자에게 있으며, KISTI는 복제/배포/전송권을 확보하고
있습니다.
② NDSL에서 제공하는 콘텐츠를 상업적 및 기타 영리목적으로 복제/배포/전송할 경우 사전에 KISTI의 허락을
받아야 합니다.
③ NDSL에서 제공하는 콘텐츠를 보도, 비평, 교육, 연구 등을 위하여 정당한 범위 안에서 공정한 관행에
합치되게 인용할 수 있습니다.
④ NDSL에서 제공하는 콘텐츠를 무단 복제, 전송, 배포 기타 저작권법에 위반되는 방법으로 이용할 경우
저작권법 제136조에 따라 5년 이하의 징역 또는 5천만 원 이하의 벌금에 처해질 수 있습니다.
제 14 조 (유료서비스)
① 당 사이트 및 협력기관이 정한 유료서비스(원문복사 등)는 별도로 정해진 바에 따르며, 변경사항은 시행 전에
당 사이트 홈페이지를 통하여 회원에게 공지합니다.
② 유료서비스를 이용하려는 회원은 정해진 요금체계에 따라 요금을 납부해야 합니다.
제 5 장 계약 해지 및 이용 제한
제 15 조 (계약 해지)
회원이 이용계약을 해지하고자 하는 때에는 [가입해지] 메뉴를 이용해 직접 해지해야 합니다.
제 16 조 (서비스 이용제한)
① 당 사이트는 회원이 서비스 이용내용에 있어서 본 약관 제 11조 내용을 위반하거나, 다음 각 호에 해당하는
경우 서비스 이용을 제한할 수 있습니다.
- 2년 이상 서비스를 이용한 적이 없는 경우
- 기타 정상적인 서비스 운영에 방해가 될 경우
② 상기 이용제한 규정에 따라 서비스를 이용하는 회원에게 서비스 이용에 대하여 별도 공지 없이 서비스 이용의
일시정지, 이용계약 해지 할 수 있습니다.
제 17 조 (전자우편주소 수집 금지)
회원은 전자우편주소 추출기 등을 이용하여 전자우편주소를 수집 또는 제3자에게 제공할 수 없습니다.
제 6 장 손해배상 및 기타사항
제 18 조 (손해배상)
당 사이트는 무료로 제공되는 서비스와 관련하여 회원에게 어떠한 손해가 발생하더라도 당 사이트가 고의 또는 과실로 인한 손해발생을 제외하고는 이에 대하여 책임을 부담하지 아니합니다.
제 19 조 (관할 법원)
서비스 이용으로 발생한 분쟁에 대해 소송이 제기되는 경우 민사 소송법상의 관할 법원에 제기합니다.
[부 칙]
1. (시행일) 이 약관은 2016년 9월 5일부터 적용되며, 종전 약관은 본 약관으로 대체되며, 개정된 약관의 적용일 이전 가입자도 개정된 약관의 적용을 받습니다.