• Korean Journal of Adult Nursing
• /
• v.13 no.1
• /
• pp.29-39
• /
• 2001

The purpose of this study was to identify factors influencing patient satisfaction and to evaluate the utility of patient satisfaction as an outcome indicator. The study was conducted by mailed questionnaire. The subjects were 900 patients discharged from adult nursing units in a tertiary teaching hospital. On the discharge date, questionnaires were distributed by two trained research assistants. The questionnaire developed by the researchers was based on Larson(1996)'s study, and consisted of 71 items with the following components: overall satisfaction, domain-specific satisfaction(administration process, hospital facility and environment, nurses, and doctors), patients' loyalty(intention to use the health care service of the hospital in the future), recommendation to others, health benefits, and demographic characteristics. Each item was rated using a five point Likert scale ranging from '1=strongly disagree' to '5= strongly agree'. The response rate was 43%(387/900). The satisfaction level with the health care service was generally high. Perceived health status was the only significant factor influencing satisfaction level. Satisfaction with doctors contributed the most to explaining overall satisfaction. Overall satisfaction was significantly correlated with patient loyalty, recommendation, to other and perceived health benefit. It was found that the score of satisfaction was positively correlated with the score of loyalty, recommendation, and health benefit. Therefore, patient satisfaction seems to be a good outcome indicator.

• Journal of Korean Academy of Nursing
• /
• v.31 no.1
• /
• pp.81-93
• /
• 2001

The purpose of this study was to develop a continuing nursing care program for cancer patients and the caregivers staying at their home and to test its effects on patients' symptom distress, caregiver burden, and satisfaction of life. The continuing nursing care program was based on the homecare needs of cancer patients, and was provided by three clinical nurses who took care of the patients while they were hospitalized. The program consisted of discharge education about selfcare using education materials(book and handout) and provisions of direct care. These were counselling and education during which visiting patients' home one week after discharge and telephone counseling two weeks after discharge. Counseling by telephone was always available during the research period. A quasi-experimental research design was used to test the effects of the program. Subjects for this study were 53 cancer patients discharged from the hospital and caregivers. These subjects were assigned to an experimental group (n=23) receiving continuous nursing care, or to a control group (n=30) not receiving continuous nursing care. Data from control group was collected first to protect from contamination. Data collection was done from October of 1998 to February of 2000. The collected data was analysed using mean, t-test, and chi-square test computed by SPSS software. The summary of results was as follows: 1) The symptom distress was a little decreased at posttest, but there were no significant differences between the experimental and the control group in symptom distress. 2) The score of caregiver burden was significantly decreased in experimental group at posttest, but no differences in control group. 3) There were no significant differences between the experimental and control group in the satisfaction of life. 4) The score of satisfaction of continuing nursing care program in experimental group at posttest was 2.321 of 3. In conclusion, even though this study did not obtain evidence of effectiveness of continuing nursing care program on patients, such as. It is still expected to be effective by a more improved program. Therefore we want to give some suggestions for further studies. 1) It is needed to make a communication channel with the patient's doctor to response promptly and appropriately to patient's conditions. 2) The research is necessary on patients in terminal stage or early stage of cancer diagnosis who have many nursing needs. 3) It is needed to readjust the roles and job assignment of clinical nurse to implement effectively as a program provider.

• Research in Community and Public Health Nursing
• /
• v.10 no.1
• /
• pp.70-79
• /
• 1999

This study attempts to encourage the development of a rehabilitation delivery system as a substitute service for hospitalization such as a community based intermediate facility or home health care. We need substitute services for hospitalization to curtail the length of stay for inpatients due to car accidents. It focused on developing an estimation for early discharge based on a detailed statement of treatment from medical records of 109 inpatients who were hospitalized at General Hospital in 1997. This study has three specific purposes: First, to find the mean length of stay and mean medical expenditure. Second, to estimate the mean of early discharge from the mean length of stay. Third, to analyize the income effect per bed from early discharge. In order to analyze the length of stay and medical expenditure of inpatients the author conducted a micro and macro-analysis with medical expenditure records. To estimate the early discharge we examined with a group of 4 experts decreases in the amount of treatment after surgery, in treatments, in tests, in drug methods. We also looked their vital signs, the start of ROM exercise, the time removel, a patient's visitations, and possible stable conditions. In addition to identifing the income effect due to an early discharge, the data was analyzed by an SPSS-PC for windows and Excell program with a regression analysis model. The research findings are as follows: First, the mean length of stay was 47.56 days, but the mean length of stay due to early discharge was 32.26 days. The estimation of early discharge days was shown to depend on the length of stay. The longer the length of stay, the longer the length before discharge. For example, if the patient stayed under 14 days the mean length of stay was 7.09 while an early discharge was 6.39, whereas if the mean length of stay was 155.73, the early discharge time was 107.43. The mean medical expenditure per day of car accident patients was found to be 169,085 Won, whereas the mean medical expenditure per day was shown to be in a negative linear form according to the length of stay. That is the mean expenditure for under 14 days of stay was 303,015 Won and the period of the hospitalization of 15 days to 29 days was 170,338 Won and those of 30 days to 59 days was 113,333 Won. The estimation of the income effect due to being discharged 16 days was around 2,350,000 Won with a regression analysis model. However, this does not show the real benefits from an early discharge, but only the income increasing amount without considering prime medical cost at a general hospital. Therefore, we need further analysis on cost containments and benefits incending turn over rates and medical prime costs. From these research findings, the following suggestions have been drawn, we need to develop strategies on a rehabilitation delivery system focused on consumers for the 21st century. Varions intermediate facilities and home health care should be developed in the community as a substitute for shortening the length of stay in hospitals. In home health care cases, patients who want rehabilitation services as a substitute for hospitalization in cooperation with private health insurance companies might be available immediately.

• Journal of Korean Academic Society of Home Health Care Nursing
• /
• v.6
• /
• pp.5-18
• /
• 1999

This study was attempt to encourage for developing on rehabilitation delivery system and programs as a substitute service instead of hospitalization for accident patients at work, such as hospital based home health care nursing service. It needs vary substitutes service of hospitalization to curtail the length of stay for inpatients who were hospitalized with workers compensation insurance. It focused on developing an estimation of early discharge day of accident inpatients based on a detail statement of treatment for 115 inpatients who were hospitalized at General Hospital in 1997. This study has four specific purpose as follows. First, to find out the status of health service utilization. Second, to estimate the early discharge days and income increasing effect based on the early discharge for those patients. Third, to identify the factors to affect total medical expenditure and the length of stay for those inpatients. Forth, to figure out the need of utilizing home health care nursing service for accident patients. In order to analyze of the length of stay and medical expenditure for inpatients who were hospitalized due to the accident, the authors conducted with micro-analysis and macroanalysis from medical records and medical expenditure records. Micro-analysis was done by nominal group discussion of 4 expertise with the critical criteria. such as a decrease in the amount of treatment after surgery, treatments, tests, drugs and changes in the tests consistency, drug methods, vital signs, start of ROM exercise, doctor's order, patient's outside visiting ability, stable conditions. In addition to identify affected variables for medical expenditure. the length of stay and income effect due to early discharge day, the data was analyzed with multiple regression analysis and linear regression analysis model by SPSS-PC for windows and Excell program. Results of this study as follows. First, the mean length of stay was 37.1 days, whereas the mean length of stay due to early discharge was 28.2 days at the hospital. The estimation of early discharge days were shown that depends on the length of stay. The longer length of stay, the longer length of early discharge days, such as under 7 days length of stay patients was to estimated the mean length of stay was 4.9 days and early discharge days was 4.6. whereas the mean length of stay was 122.6 days and early discharge days was 92.0 respectively. The mean medical expenditure per day were found to be 133.409 Won. whereas the mean medical expenditure per day was shown negative linear trends according to the length of stay at the hospital. The estimation results of the income effect due to 11 early discharge days per bed was around 2,150,000 won. However, it means not the real benefits from early discharge, but the income increasing amount without considering medical prime cost in general hospital. Therefore, it needs further analysis on the cost containments and benefits under the considering as well turn over rates per bed as the medical prime costs. The length of stay was most significant and the sign was positive to the total medical expenditure, as expected. Surgery and patient's residential area also an important variable in explaining medical expenditure. The level of complications was most significant variable in explaining the length of stay. The level of the needs on horne health care nursing service which can be used for early discharge accident patients were shown very high. The needs distribution varied from 65.5% of patients and 88.9% of caregivers, to 96.4% of doctors, and 99.1% of nurses. In addition horne health nurse responded that they can be managed the accident inpatients from early discharge. From these research findings. the following suggestions has been drawn it needs to develop strategies on rehabilitation delivery system in order to focused on consumer's side which is planned for 21 century health policy in Korea. Vary intermediate facilities and horne health care would have been developed in the community based for comprehensive rehabilitation services as a substitutes of hospitalization for shortening the length of stay of hospitalizations. In hospital based horne health care nursing service, it's available immediately to utilize for the patients who wanted rehabilitation services as a substitutes of hospitalization under the cooperations with workers compensation insurance company.

• Journal of Chest Surgery
• /
• v.11 no.3
• /
• pp.321-325
• /
• 1978

Coarctation of the aorta was rare condition among the congenital cardiovascular defects in Korea. We experienced a case of coarctatlon of the aorta [postductal type], which was successfully corrected by resection and end to end anastomosis. This patient, 21 years male patient, was admitted to the medical department for evaluation of hypertension, headache and exertional dyspnea during 4 years, and transferred to the department of chest surgery for operation. On physical examination, blood pressures were measured on both extremity, measuring 190/100mmHg on the arm and 100/80mmHg on the leg. Systolic murmur was heard on 2nd to 3rd left intercostal space and left sternal border. On simple chest x-ray, rib notching was seer/on low border of right 3rd and left 4th rib. Final preoperative diagnosis was made by the retrograde aortic catheterization and aortography, which showed the typical configuration of postductal type of coarctation with poststenotic dilatation of the aorta. On 20th, July, 1978, under the general anesthesia with endotracheal intubation, resection of coarctation of the aorta and end to end anastomosis was performed. During clamp for resection, blood pressure of upper extremity was elevated to 200/140mmHg, and controlled by Arfornad. During recovery, blood pressure over 160ramrig in systole was controlled by Reserpine for 8days postoperatively. At discharge, postoperative 8th day, brachial and femoral artery pressure was 145/85 mmHg and 135/80mmHg. After discharge, there was no evidence of specific symptoms and hypertension without antihypertensive drug.

• Proceedings of the KOSOMBE Conference
• /
• v.1992 no.05
• /
• pp.152-154
• /
• 1992

We computerized outpatient's prescription using personal computer and local area network(LAN). The information and history of patient which is stored in the HOST computer is transfered to the local file server via emulatort & LAN. Then, the computerized outpatient's prescription which is made in each examination room is transfered to the admission of discharge office and pharmacy via LAN. In the admission of discharge office, drug charge is automatically calculated, and the prescription and envelope is printed out automatically in the pharmacy. Using this system, the patient takes the drug faster than before, eventually we improve medical service. Also, this system manage hospital works and administration effectively.

• Journal of Chest Surgery
• /
• v.27 no.4
• /
• pp.328-330
• /
• 1994

Brachial plexus injury developing after axillary thoracotomy is an uncommon complication. But if it occurs, it may cause annoying events. We recently experienced 2 patients who developed brachial plexus injury after wedge resection by axillary thoracotomy . The first patient was a 22 year-old man with right spontaneous pneumothorax . After wedge resection of the right upper lung by axillary thoracotomy, he complained total paralysis of the right arm. An electromyogram was obtained at 7 days after operation, with the confirmation of brachial plexus injury. He was discharged at 22days after operation and brachial plexus injury was completely recovered 4 months after discharge. The second patient was a 17 year-old man with recurrent right pneumothorax. He underwent wedge resection of the right upper lung by axillary thoracotomy. Electromyogram confirmed the diagnosis of brachial plexus injury in the immediate postoperative period. He was discharged at 15 days after operation and brachial plexus injury was recovered 2months after discharge.Brachial plexus injury after axillary thoracotomy is caused by stretching around the clavicle and tendon of pectoralis minor by fixation of the abducted arm to the frame. Thus, when we perform wedge resection by axillary thoracotomy, we must avoid over-stretching of the brachial plexus in positioning. If brachial plexus injury develops, immediate attention and management with close rapport are important to avoid possible medicolegal problems.

• Archives of Plastic Surgery
• /
• v.36 no.5
• /
• pp.670-673
• /
• 2009

Purpose: Epidural abscesses and subdural empyemas after craniotomy are uncommon, potentially lethal, complications of neurosurgery. Patients with these complications may be difficult to manage and dural reconstruction in these patients are challenging. Methods: A 28 - year - old female patient showed recurrent intracranial infection after craniotomy for evacuation of a arachnoid cyst and subdural hematoma. Despite prolonged systemic antibiotic administration and a debridement of the subdural space, infection persisted, as evidenced by persistent fever, an elevated WBC count, CSF leakage, low CSF glucose level, and purulent wound discharge. The authors removed the previously applied lyophilized dura and transferred free omental flap to reconstruct the dura, obliterate the cyst and cover the cerebral hemisphere in the craniotomy defect. Microvascular anastomosis was between gastroepiploic and superficial temporal vessels. Results: The postoperative course was uneventful and flap survival was excellent. The infection - resistant omental tissue allowed sufficient blood circulation and dead space control. The patient was discharged 1 month after surgery and wound discharge or recurrence was absent during 13 months of follow up periods. Conclusion: The use of vascularized free omentum proved useful in cases of intractable cranial wound infection and cerebrospinal fluid leakages.

• Journal of Korean Academy of Fundamentals of Nursing
• /
• v.3 no.1
• /
• pp.50-67
• /
• 1996

Home nursing interventions based on nursing diagnosis were implemented to the patient who are discharged from one hospital often the treatment for chronic neuromuscular system problem, and its effects were studied. The purpose of this study was to find out the effectiveness of hospital bouned home nursing provided by hospital nurses and to categorize home nursing diagnosis and its interventions. Data from experimental group patients were collected at three different time ; at the time of discharge, two weeks after discharge and our weeks after discharge. Data from controll group patients were collected twice ; the first one at the time of discharge, and the other one four weeks after discharge. For this study nursing assessment and intervention booklet developed by the research team. There were no significant decrease of the number of nursing problems and life satis-faction. But daily activity level of patients showed the signs of significant improvement at the time of four weeks after discharge. Results of this study indicates that home nursing intervention based on nursing diagnosis provided the patients with noticeable difference in health maintanance, impairment of physical mobility, potential for infection, impaired home marntenance management, health seeking behavior, chronic pain, disuse syndrome, impaired skin integrity.

• Korean Journal of Adult Nursing
• /
• v.29 no.3
• /
• pp.246-255
• /
• 2017

Purpose: This study was designed to identify factors affecting depression among hospitalized older adults prior to discharge from an acute care hospital. Methods: This descriptive study included adults aged 65 or older who were hospitalized in a general hospital in Seoul, Korea. Depression was measured by the Short Form Geriatric Depression Scale and illness perception was evaluated by the Brief Illness Perception Questionnaire. Social support was examined using the Perceived Geriatric Social Support Scale. Data were collected from August 25 to October 12, 2015. Data analysis included descriptive statistics, independent t-test, Kruskal-Wallis test, Pearson's correlation coefficient, and hierarchical multiple regression. Results: Among a total of 120 participants, 57 patients (47.5%) experienced depression. Mean depression score was $7.37{\pm}3.67$. Depression was associated with illness perception (r=.53, p<.001), social support (r=-.19, p=.043), number of admission due to the recurrence (r=.31, p=.001), and time to recognize discharge plan (r=.25, p=.044). In hierarchical multiple regression, illness perception (${\beta}=.45$, p<.001) and time to recognize discharge plan (${\beta}=.21$, p=.039) were predictors of depression (F=7.68, p<.001, Adjusted $R^2=.38$). Conclusion: The findings of this study suggest that management of illness perception and timely notice of discharge are important to reduce depression in hospitalized elderly patients.