• 제목/요약/키워드: Patient Care Management

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질적 간호의 결과적 지표 (Outcome Indicators of Quality Nursing Care)

  • 지성애
    • 간호행정학회지
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    • 제3권1호
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    • pp.107-118
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    • 1997
  • This study was designed to obtain basic data for development of evaluation tool which would be needed to measure the outcome of general quality nursing care of individual patient. The purpose of this study was to analyze and classify the outcome indicators of quality nursing care. The 29 articles of quality nursing care and outcome measures were selected coveniently, and analyzed to classify the outcome indicators of quality nursing care using open coding method. The results of this study were as follows: 1. Quality nursing care was defined as level of excellence of nursing care to achieve good patient outcome. 2. The 6 domains of which were health status, satisfaction, self care, patient progress and prognosis, and compliance were identified in outcome indicators of quality nursing care 3. Seven indicators of health status domain which were perceived health status, quality of life, well-being, daily activities, physical-physiological status, psychoemotional status, and social role functioning were identified. 4. Two indicators of satifaction domain which were patient satisfaction and family satisfaction were identified. 5. Three indicators of self care domain which were skill, knowledge, and home management were identified. 6. Seven indicators of patient progress and prognosis domain which were change of clinical status, resolution of nursing diagnosis and problem, days of stay, dicahrge state, recovery state, survival were identified. 7. compliance with therapeutic direction compliance was identified as an indicator of compliance domain. 8. It was sugested that studies for development of evaluation tools for outcomes of quality nursing the results of this study could be executed

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가정전문간호사의 비암성 말기환자 간호행위 시간 분석 (A Time Study of Nursing Activities by Home Care Nurses for Non-Cancer Terminal Patients)

  • 이하늘;이종은
    • 가정간호학회지
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    • 제26권2호
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    • pp.180-188
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    • 2019
  • Purpose: To investigate the duration of each nursing activity performed by home care nurses for non-cancer patients and the relationship between patients' palliative prognostic index (PPI) and duration of each nursing activity. Methods: Nursing activities performed for six non-cancer terminal patients were timed using a stopwatch, and 18 parameters were measured by visiting each patient thrice. The mean and standard deviations of duration for each category of nursing activities were computed. The relationship between category-specific duration of nursing activities and PPI was analyzed with Spearman's correlation and multiple regression analysis. Results: Among nursing activities, the highest greatest duration of time was spent on traffic time (11.91 min), followed by urinary catheter management (10.65 min) and insertion and management of nasogastric tube (9.03 min). In terms of nursing categories, after excluding movement time, the greatest duration of time was spent on excretion care (5.48 min), nutrition care (5.40 min), and medication (3.82 min). PPI correlated with hygiene care, excretion care, and patient and information management. Multiple regression analysis revealed that PPI increased with increasing duration of hygiene care. Conclusion: These study findings provide grounds for the increased nursing time of hygiene care for people reaching the end of life.

모바일 병원정보시스템 사용성에 대한 실증연구 (A Case Study of a Mobile Hospital Information System Usability)

  • 안명진;양준영;류효선;박찬석
    • 한국병원경영학회지
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    • 제18권4호
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    • pp.97-112
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    • 2013
  • This study is a proposal of quality scale and measurement for the Mobile Hospital Information System Usability used to the Chungnam National University Hospital in Daejeon Korea. This study is to provide decision- making guideline for hospital managers and to provide feedback for the users' information needs in Mobile Hospital Information System. The target people of the study were medical doctors in Chungnam National University Hospital. The service contexts of usability were request of medical Care, Vital sign check of Patient, Care Agreement of Patient, Blood management, Check of care state, Sign of choice doctors, Query of doctor order and patient measurement result. The Usability factors were the efficiency, effectiveness and satisfaction of quality model ISO9241-11. This study shows that the Mobile HIS is used for the communication and education between doctor and patients. Especially, The Care Agreement of Patient is a part of the most utilized in the Mobile HIS.

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백내장 환자의 수술후 진료만족도의 다면적 평가와 결정요인 (Determinants of Multidimensional Outcomes of Patient Satisfaction in Operated Cataract Patients)

  • 최윤정;김한중;박은철;손명세;강형곤;이상규
    • 보건행정학회지
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    • 제11권2호
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    • pp.16-28
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    • 2001
  • This study was to compare multidimensional outcomes of patient's satisfaction after cataract surgery and to identify factors influencing satisfaction after operation. Patient's satisfaction was measured with three dimensions : interpersonal care, physician explanation and hospital care. Overall satisfaction was measured as means of three dimensional scores. For the study, a prospective study was performed with 389 patients who had undergone cataract surgery for either one eye or both eyes. The surgery was performed by 20 ophthalmologists who were practicing at university hospitals and general hospitals. Patients were interviewed and clinical data (the visual acuity of operated eye, visual function, symptom score and satisfaction with vision) were obtained. The doctors were questioned with self-reported questionnaire forms. Medical records were also examined to understand surgery Process. The survey was conducted before(389) and after operation(327). Alter excluding cases with incomplete data, 3n cases were enrolled In this study. Both the overall satisfaction and the satisfaction with physician explanation increased after the operation whereas the satisfaction with interpersonal care and hospital care did not change significantly. Multiple regression analysis showed that the level of education, baseline satisfaction scores and the degree of vision improvement were statistically significant variables. The preoperative lower level of education, higher level of overall satisfaction (interpersonal care, physician explanation, hospital care scores) and the more the satisfaction with vision improvement were associated with the improvement of postoperative satisfaction scores.

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병원 간호사의 안전 간호활동에 영향을 미치는 요인 (Factors Influencing Safety Care Activities of Hospital Nurses)

  • 양야기
    • 기본간호학회지
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    • 제26권3호
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    • pp.188-196
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    • 2019
  • Purpose: The purpose of this study was to investigate the relationships among fatigue, patient safety culture and safety care activities of hospital nurses, and to identify and explain factors influencing safety care activities. Methods: The research participants were 187 nurses from a urban general hospital located in Korea. Self-evaluation questionnaires were used to collect the data. Data collection was done from January 10 to 31, 2019. Data were analyzed using descriptive statistics, independent t-test, One-way ANOVA, Pearson correlation coefficients and multiple regression with the SPSS 24.0 program. Results: There were significant negative relationships between fatigue and safety care activities (r=-.22, p=.003), and significant positive relationships between patient safety culture and safety care activities (r=.22, p=.003). Factors influencing safety care activities in hospital nurses were identified as type of unit (ICU) (${\beta}=.28$), patient safety culture (${\beta}=.24$) and fatigue (${\beta}=-.19$). The explanation power of this regression model was 16% and it was statistically significant (F=8.29, p<.001). Conclusion: These results suggest the need to develop further management strategies for enhancement of safety care activities in hospital. To improve the levels of patient safety, education programs on patient safety should be developed and provided to nurses in hospitals.

일개 대학병원의 간호관리료 등급변화에 따른 간호사의 간호활동시간 비교 (Comparison of Nursing Activity Time According to the Change in Grade of Nursing Management Fee in One University Hospital)

  • 박정옥;김혜용;노경식;노영덕;박명분;소지은;박미미;방경숙
    • 임상간호연구
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    • 제16권1호
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    • pp.95-105
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    • 2010
  • Purpose: The purpose of this study was to examine the difference between direct and indirect nursing activity times according to the grade of nursing management fee. Methods: The subjects of this study were 324 working nurses at the time of 3rd grade and 319 working nurses at the 2nd grade of nursing management fee in one university hospital. Nursing activity time was measured in April and May, and in September and October of 2008 for comparison. The data were analyzed by SPSS win using frequency and t-test. Results: Direct nursing care activity time per one patient was significantly higher at 2nd grade than 3rd grade in day shift (t=-2.55, p=.012). Direct nursing care workload per one nurse was significantly lower at 2nd grade than 3rd grade in evening shift (t=2.21, p=.030), whereas indirect nursing care workload was lower at 2nd level in night shift (t=2.43 p=.016). Conclusion: The findings from this study showed that higher nurse-to-patient ratio can provide greater amount of direct nursing care activity for the patient. Also, it decreased workload of nurses. The higher nurse-to-patient ratio will be beneficial for promoting quality of nursing care as well as decreasing nurse's heavy workload.

일개 종합병원 외래환자의 진료시간 및 진료대기시간 영향요인 분석 (Factors influencing consultation time and waiting time of ambulatory patients in a tertiary teaching hospital)

  • 황지인
    • 한국의료질향상학회지
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    • 제12권1호
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    • pp.6-16
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    • 2006
  • Objectives : The purpose of this study was to identify the characteristics influencing consultation and waiting time in ambulatory patients. Methods : This study was conducted in a tertiary teaching hospital. Subjects were a total of 10,383 ambulatory patients. Consultation time was measured by time spent for meeting with his/her physician per patient. Waiting time was defined as the time difference between each patient's reserved time and time to meet with his/her physician for ambulatory care. Multiple regression analyses were performed to determine the factors influencing consultation and waiting time. Results : Consultation time was different according to patient' age, previous experience of clinic visit, recent admission history, medical department, specialist care, type of reservation, and day of the week. Significant factors influencing waiting time were patient' age, residential area, previous experience of clinic visit, recent admission history, medical department, specialist care, time spent after ambulatory care begins, and day of the week. Conclusions : The medical department was the strongest factor affecting both consultation time and waiting time. The ambulatory reservation management systems should take into account patient characteristics as well as care-related features.

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일차의료기관 혈액투석실 간호사의 간호근무환경, 환자안전문화 및 환자안전간호활동의 관계 (Relationship between Nursing Work Environment, Patient Safety Culture, and Patient Safety Nursing Activities in Hemodialysis Clinics of Primary Care Centers)

  • 홍인숙;배상현;조옥희
    • 가정간호학회지
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    • 제27권3호
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    • pp.250-258
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    • 2020
  • Purpose: This study aimed to investigate the relationship between nursing work environment, patient safety culture, and patient safety nursing activities in hemodialysis units at primary care centers. Methods: In this cross-sectional descriptive study, 116 nurses working in hemodialysis units at 22 primary care centers were enrolled as participants. They were selected them by the convenience sampling method. Data were collected using structured questionnaires that included questions on general characteristics, nursing work environment, patient safety culture, and patient safety nursing activities. Results: The nursing work environment was relatively good; however, the patient safety culture and patient safety nursing activities were poor. A positive correlation was found between nursing work environment, patient safety culture, and patient safety nursing activities. Factors that affect patient safety culture were rated high in the order of nursing work environment and patient safety nursing activities, and factors affecting patient safety nursing activities were rated high in the order of patient safety culture and age. Conclusion: This study showed that the development of tailored patient safety training for nurses in hemodialysis units working in primary care and administrative support from those institutions are needed. In particular, strategies accounting for nurses' characteristics such as age are required to strengthen patient safety nursing activities.

보험진료체계 개편의 효과에 대한 연구 (An Evaluative Analysis of the Referral System for Insurance Patients)

  • 한달선;김병익;이영조;배상수;권순호
    • Journal of Preventive Medicine and Public Health
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    • 제24권4호
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    • pp.485-495
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    • 1991
  • This study examined the effects of referral requirements for insurance patients which have been enforced since July 1, 1989 when medical insurance coverage was extended to the whole population except beneficiaries of medical assistance program. The requirements are mainly aimed at discouraging the use of tertiary care hospitals by imposing restrictions on the patient's choice of a medical service facility. The expectation is that such change in the pattern of medical care utilization would produce several desirable effects including increased efficiency in patient care and balanced development of various types of medical service facilities. In this study, these effects were assessed by the change in the number of out-patient visits and bed-days per illness episode and the share of each type of facility in the volume of services and the amount of expenditures after the implementation of the new referral system. The data for analysis were obtained from the claims to the insurance for government and school employees. The sample was drawn from the claims for the patients treated during the first six months of 1989, prior to the enforcement of referral requirements, and those of the patients treated during the first six months of 1990, after the enforcement. The 1989 sample included 299,824 claims (3.6% of total) and the 1990 sample included 332,131 (3.7% of total). The data were processed to make the unit of analysis an illness episode instead of an insurance claim. The facilities and types of care utilized for a given illness episode are defined to make up the pathway of medical care utilization. This pathway was conceived of as a Markov Chain process for further analysis. The conclusion emerged from the analysis is that the enforcement of referral requirements resulted in less use of tertiary care hospitals, and thereby decreased the volume of services and the amount of insurance expenses per illness episode. However, there are a few points that have to be taken into account in relation to the conclusion. The new referral system is likely to increase the use of medical services not covered by insurance, so that its impact on national health expenditures would be different from that on insurance expenditures. The extension of insurance coverage must have inereased patient load for all types of medical service organizations, and this increase may be partly responsible for producing the effects attributed to the new referral system. For example, excessive patient load for tertiary care hospitals may lead to the transfer of their patients to other types of facilities. Another point is that the data for this study correspond to very early phase of the new system. But both patients and medical care providers would adapt themselves to the new system to avoid or overcome its disadvantages for them, so as that its effects could change over time. Therefore, it is still necessary to closely monitor the impact of the referral requirements.

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일 대학병원 호스피스 병동 입원 환자의 간호활동시간 측정과 원가산정 (Determination of Cost and Measurement of nursing Care Hours for Hospice Patients Hospitalized in one University Hospital)

  • 김경운
    • 간호행정학회지
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    • 제6권3호
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    • pp.389-404
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    • 2000
  • This study was designed to determine the cost and measurement of nursing care hours for hospice patients hostpitalized in one university hospital. 314 inpatients in the hospice unit 11 nursing manpower were enrolled. Study was taken place in C University Hospital from 8th to 28th, Nov, 1999. Researcher and investigator did pilot study for selecting compatible hospice patient classification indicators. After modifying patient classification indicators and nursing care details for general ward, approved of content validity by specialist. Using hospice patient classification indicators and per 5 min continuing observation method, researcher and investigator recorded direct nursing care hours, indirect nursing care hours, and personnel time on hospice nursing care hours, and personnel time on hospice nursing care activities sheet. All of the patients were classified into Class I(mildly ill), Class II (moderately ill), Class III (acutely ill), and Class IV (critically ill) by patient classification system (PCS) which had been carefully developed to be suitable for the Korean hospice ward. And then the elements of the nursing care cost was investigated. Based on the data from an accounting section (Riccolo, 1988), nursing care hours per patient per day in each class and nursing care cost per patient per hour were multiplied. And then the mean of the nursing care cost per patient per day in each class was calculated. Using SAS, The number of patients in class and nursing activities in duty for nursing care hours were calculated the percent, the mean, the standard deviation respectively. According to the ANOVA and the $Scheff{\'{e}$ test, direct nursing care hours per patient per day for the each class were analyzed. The results of this study were summarized as follows : 1. Distribution of patient class : class IN(33.5%) was the largest class the rest were class II(26.1%) class III(22.6%), class I(17.8%). Nursing care requirements of the inpatients in hospice ward were greater than that of the inpatients in general ward. 2. Direct nursing care activities : Measurement ${\cdot}$ observation 41.7%, medication 16.6%, exercise ${\cdot}$ safety 12.5%, education ${\cdot}$ communication 7.2% etc. The mean hours of direct nursing care per patient per day per duty were needed ; 69.3 min for day duty, 64.7 min for evening duty, 88.2 min for night duty, 38.7 min for shift duty. The mean hours of direct nursing care of night duty was longer than that of the other duty. Direct nursing care hours per patient per day in each class were needed ; 3.1 hrs for class I, 3.9 hrs for class II, 4.7 hrs for class III, and 5.2 hrs for class IV. The mean hours of direct nursing care per patient per day without the PCS was 4.1 hours. The mean hours of direct nursing care per patient per day in class was increased significantly according to increasing nursing care requirements of the inpatients(F=49.04, p=.0001). The each class was significantly different(p<0.05). The mean hours of direct nursing care of several direct nursing care activities in each class were increased according to increasing nursing care requirements of the inpatients(p<0.05) ; class III and class IV for medication and education ${\cdot}$ communication, class I, class III and class IV for measurement ${\cdot}$ observation, class I, class II and class IV for elimination ${\cdot}$ irrigation, all of class for exercise ${\cdot}$ safety. 3. Indirect nursing care activities and personnel time : Recognization 24.2%, house keeping activity 22.7%, charting 17.2%, personnel time 11.8% etc. The mean hours of indirect nursing care and personnel time per nursing manpower was 4.7 hrs. The mean hours of indirect nursing care and personnel time per duty were 294.8 min for day duty, 212.3 min for evening duty, 387.9 min for night duty, 143.3 min for shift duty. The mean of indirect nursing care hours and personnel time of night duty was longer than that of the other duty. 4. The mean hours of indirect nursing care and personnel time per patient per day was 2.5 hrs. 5. The mean hours of nursing care per patient per day in each class were class I 5.6 hrs, class II 6.4 hrs, class III 7.2 hrs, class IV 7.7 hrs. 6. The elements of the nursing care cost were composed of 2,212 won for direct nursing care cost, 267 won for direct material cost and 307 won for indirect cost. Sum of the elements of the nursing care cost was 2,786 won. 7. The mean cost of the nursing care per patient per day in each class were 15,601.6 won for class I, 17,830.4 won for class II, 20,259.2 won for class III, 21,452.2 won for class IV. As above, using modified hospice patient classification indicators and nursing care activity details, many critical ill patients were hospitalized in the hospice unit and it reflected that the more nursing care requirements of the patients, the more direct nursing care hours. Emotional ${\cdot}$ spiritual care, pain ${\cdot}$ symptom control, terminal care, education ${\cdot}$ communication, narcotics management and delivery, attending funeral ceremony, the major nursing care activities, were also the independent hospice service. But it is not compensated by the present medical insurance system. Exercise ${\cdot}$ safety, elimination ${\cdot}$ irrigation needed more nursing care hours as equal to that of intensive care units. The present nursing management fee in the medical insurance system compensated only a part of nursing car service in hospice unit, which rewarded lower cost that that of nursing care.

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