• 한국노년학
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• 제41권2호
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• pp.197-215
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• 2021

본 연구는 요양시설거주 치매환자들의 삶의 질을 사정하기 위해 개발된 DCM(Dementai Care Mapping)을 활용, 국내 장기요양시설에서의 사람중심케어 실천 정도 및 특성을 탐색하는 것을 목적으로 한다. DCM은 훈련받은 매퍼가 시설거주 치매노인을 관찰 사정하는 도구이지만 본 연구에서는 장기요양 시설 종사자들의 자기보고식 평가척도로 변용하였다. DCM의 개념을 34개의 문항으로 조작화하였으며 브래포드치매팀의 검토를 거쳐 총화평정척도로 만들었다. 본 척도의 신뢰도는 .88로 신뢰할 만 하며, 이를 국내 시설 종사자 343명을 대상으로 설문조사를 실시한 결과 평균점수는 3.77점(5점 척도)으로 나왔다. DCM의 하위카테고리 별 평균 점수는 애착(4.02), 편안함(3.95), 포용(3.89), 정체성(3.67), 주체성(3.41)으로 나타났다. 국내 요양서비스가 대상자의 안전과 편안함에 초점을 맞춘 신체수발에 주력하며 종사자와 대상자간에 애착이 형성되고 있지만, 개별적 케어(정체성)부족이나 대상자의 삶에서 의미있는 활동이 부족한 점(주체성)에서 사람중심케어가 취약함이 드러났다. 한편, DCM척도에 의한 사람중심케어의 특성을 조직 및 개인 특성에 따라 살펴보면, 시설의 규모가 작을수록 사람중심케어 실천이 높으며 공립과 민간시설간의 차이는 없었다. 또한 시설장과 직접 서비스제공자의 사람중심케어 실천이 높으며 경력이 1~2년인 종사자들의 사람중심케어 점수가 높은 것으로 나타났다. 본 연구는 국내 요양서비스에서 사람중심케어의 실천이 필요하며 이를 위한 구체적인 방안으로 유니트케어의 적용, 시설에서 직접 서비스제공자뿐 아니라 간호, 사회복지사등 전 직원을 대상으로 한 사람중심케어 교육 실시를 제언한다. 국내 요양서비스의 질평가에서도 사람중심케어의 관점이 강화돼야 하며 이를 위해 DCM 또는 직접 관찰이 어려운 상황에서는 대안으로 본 연구에서 개발한 한국형DCM척도의 활용을 제언한다.

• 한국병원경영학회지
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• 제21권2호
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• pp.24-36
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• 2016

The aims of this study is to investigate the status of nursing care delivery systems and nurse staffing levels and to analyze differences in the quality of nursing care by the type of nursing care delivery system. This research was based on data from 723 nurses working in 55 medical and surgical units in 26 general hospitals. Descriptive statistics on nurse staffing levels and the nursing care delivery system, and multi-level logistic regression were used to estimate the determinants of quality of nursing care. The number of patients per nurse is 17.74 patients in functional nursing care and 15.56 patients in total nursing care. In comparison to hospitals adopting total nursing care, hospitals with functional nursing care had greater patients. The nurses rated units using total nursing care as significantly better quality of nursing care than the units with functional nursing care. Total nursing care or modified total nursing care, rather than functional nursing care, could lead to improvement in the quality of care(total nursing care OR=3.895, modified total nursing care OR=2.475). Patient-centered approaches under proper circumstances can be successfully implemented and the positive effects demonstrated.

• 대한간호학회지
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• 제26권4호
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• pp.768-781
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• 1996

The problem of care of patients and families with Alzheimer's disease has become a conscious raising social policy issue in Korea. The government of the Republic of Korea has become cognizant of the situation and has begun searching for ways to remedy it. Thus, there is a need for a comprehensive under-standing of the situation in which patients and their families are struggling and the enormous problems of care. With a realization of the urgent need, this study was done to investigate the situation and the care needs of families with patients with Alzheimer's Disease, and to compare the effectiveness of services utilized by the families in terms of cost and effects on patient's conditions and on family live. The Subjects for the study were 29 families with hospitalized patients, 25 families utilizing hospital outpatient clinics, 14 families utilizing day care facilities, and 16 families with homebound patients. A total of 84 families were interviewed by four trained interviewers using structured and semistructured questionnaires. The data produced from these interviews included : the patient's stage of Alzheimer's disease, patient's bizarre behavior, hours spent on patient care per day, family burden and quality of life, direct and indirect costs encountered in the care of patients, and the families' evaluation of the effectiveness of the services received. The data were analyzed to determine the relationships between family charactersistics, patient's conditions and services utilization. The effectiveness of each of the service entities was assessed through families evaluation and hoped for service and comparisons were made between services in terms of the cost-effectiveness ratios. After initial comparison of cost-effectiveness ratios, further analysis was done to compare between groups for incremental effectiveness for each incremental unit of cost to determine the most cost-effective service entities. The findings of the study are as fellows : 1. The choice of living arrangement and the types of services are a function of the stage of Alzheimer's condition and the economic status of the family. 2. Comparision of the cost of care showed that most expenses were encountered in by families with hospitalization, families using outpatient services, and families using day care services in that order. The least expense was involved in the care of homebound patients. The economic burden felt by families was in the same order as expenses. 3. The average number of hours spent on daily patient care was 9.9 hours for the outpatient clinic users, 9.7 hours for homebound patients, and 5.4 hours for day care users. 4. There were significant differences in the patient's conditions (CDRL), bizarre behaviors and the families's burden by living arrangement and /or types of service. However, no significant difference was found between groups in the family's quality of life. 5. The families rated the services of day care center as most effective for the care of the patients and families, except for a few families who had experienced some improvement in the patient's conditions. The outpatient clinic users expressed psychological comforts mainly in that the patient was being taken care of. For those hospitalized patients, families expressed the comfort of being relieved of the burden of care and that the patient is being professionally cared for. Form the analysis of the costs, hours of patient care, patient's bizarre behaviors, family's quality of life and burdens, and family's evaluation of services, it is concluded that up to the mid stage of Alzheimer's condition, the utilization of day care center services is found to be the most cost-effective, and toward the end stage of the Alzheimer's disease, it is hoped that there will be a establishment of long term or short term in-patient facilities for the protection of patients and preservation of the integrity of families for less cost. Thus. it was concluded that the family centered system of care is the most effective for Korea with systematic support systems developed for the care of patients and their families according to the needs of families as the patient's condition deteriorates.

• 재활간호학회지
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• 제17권1호
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• pp.27-37
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• 2014

Purpose: The purpose of this study was to understand nurses' experience of managing diet and fluid in hemodialysis patients and to provide helpful information in improving care of hemodialysis patients. Methods: Data were collected through in-depth interviews with ten nurses who had experience of providing care to hemodialysis patients. Colazzi's phenomenological method was used to analyze data. Results: Twenty themes were identified in the first stage of data analysis and were later categorized into ten theme clusters, of which four categories were derived. The four categories were 'developing a strong feeling of responsibility for management', 'acknowledging limits in performing duties', 'providing patient-centered education' and 'becoming a guide for the long treatment process'. Conclusion: The study results will be useful for improving nursing curriculum to ensure more effective and successful diet and fluid management in hemodialysis patients.

• 대한치과의료관리학회지
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• 제8권1호
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• pp.8-14
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• 2020

To provide high-quality oral health services, the concept of measurable oral health quality must first be defined. Owing to reports of significant preventable adverse events in the healthcare service provision process, the recognition and consensus of patient safety and patient-centered health service provision was formed. Six areas that are important medical care have been identified, including the quality along with existing concepts such as timeliness, effectiveness, equity, and efficiency of medical services. While there is ongoing research on the quality of oral health, there is not yet any internationally accepted definition. The purpose of this study is to introduce the ideas of oral healthcare quality and quality indicators that have been developed and announced in the field of dentistry.

• 재활간호학회지
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• 제7권2호
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• pp.220-230
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• 2004

Purpose: The study has planned to find out the perceived social support of the families with pneumoconiosis patients. Method: The subjects of the study were the 300 family care givers of the pneumoconiosis patients who were hospitalized in Taeback, Donghae and Jeongsun Occupational Medical Center. The Social Support Survey Instrument developed by Park(1985) was adopted. Results: The Direct Perceived Supports showed statistically differences by the age(F=1.70 p=0.01) and the state of the disease(F=3.09 p=0.027) of the patients. The Health Situation Centered Support was different by the marietal situation(F=2.29 p=0.48) of the pneumoconiosis patients. The Indirect Perceived Supports were statistically different by sex(t=3.76 p=0.043) and relation with the patient (F=2.49 p=0.048), group joining(t=3.79 p=0.042) of the family care givers. The DPSs were statistically different by family income(F=2.25 p=0.025), family authority(F=2.81 p=0.031) and health insurance status(F=2.13 p=0.026). Recommendation: It is recommended to develop an active social support program at the pneumoconiosis care centers for the middle aged female family care givers of the pneumoconiosis patients with the support of Ministry of Labor, Ministry of Health and Welfare and other NGOs of pneumoconiosis.

• 근관절건강학회지
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• 제28권2호
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• pp.161-173
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• 2021

Purpose: This study examined: 1) what it meant for patients to have multimorbidity 2) how they manage their illness using health care facilities, and 3) what contextual backgrounds exist regarding the health care system. Methods: This qualitative research obtained individual in-depth interviews from 22 patients. Participants were selected by purposive sampling among those who saw physicians more often than the national average from the 2013 medical-claim data. The transcribed data were analyzed using Ground theory. Results: Multimorbidity patients suffered from "chain-like serial symptoms" and "pain without a breakthrough". They expressed themselves as "indeed patients among patients", "my body is a general hospital", and "an incompletely normal person". There was a demand to resolve the anxiety arising from the situation in which the body keeps getting sicker without showing any signs of recovery. In a state of reduced social support and a lack of trust in the doctor, their desire to be healed led them to receive a temporary relief through dependence on medical institutions. Conclusion: This research recognized the desire of multimorbidity patients to seek temporary relief through dependence on medical institutions. A more patient-centered directed care plan, specific to the needs of the patients with multimorbidity is required.

• 근관절건강학회지
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• 제24권2호
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• pp.89-100
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• 2017

Purpose: The aim of this study was to examine the utilization of and satisfaction with the smart bedside station (SBS) system among users in a hospital. Methods: A cross-sectional descriptive design was used. The participants were 190 patients, 186 family caregivers, and 154 nurses in a hospital. Results: Around 78.1% of patients or family caregivers used the SBS system at least once during their hospital stay. The commonly used items on the SBS system menu were "lab findings", "hospital cost", "today's medication", and the "alarm message". Satisfaction with the SBS system of patients and family caregivers were significantly higher than those of nurses (F=39.88, p<.001). Conclusion: A patient-centered SBS system was a useful system that could increase patient satisfaction and comfort. More specific and technical service contents reflecting the current healthcare system should be added.

• 서비스연구
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• 제2권2호
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• pp.45-51
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• 2012

U-Healthcare는 홈 네트워크, 휴대용 장치 등에 기반한 정보통신기술과 의료시스템이 서로 융합되어 개인의 생체정보 등을 실시간으로 모니터링하고, 자동으로 병원 및 의사와 연결되어 시공간의 제약을 줄임으로써 언제 어디서나 건강을 관리하고 질병을 예방하는 새로운 형태의 의료서비스이다. 본 논문에서는 진료 중심에서 예방 중심으로 변화되어가고 있는 최근의 U-Healthcare 시스템의 기술 발전 추세에 맞추어 조기 대응이 가능한 Healthcare 정보시스템 구축을 위한 요구분석 사항들에 대해 정리하고, 이를 기반으로 u-Healthcare의 실현을 위한 기존의 단위 시스템인 PACS, OCS, EMR, 응급의료시스템을 통합한 환자중심의 클라이언트 시스템을 설계한다. 특히, 온톨로지는 특정분야의 정보 모델에 이용되어 그 분야에서 공통의 어휘를 제공하고, 그 용어의 의미와 용어간의 관계를 다양한 수준의 형식성을 가지고 제공한다. 본 논문에서는 이러한 온톨로지 및 무질서한 데이터에 대한 관계를 정의하고, 보다 체계적으로 데이터를 군집화하는 클러스터링의 개념을 포함한 환자중심의 서비스를 위한 온톨로지 기반의 시스템을 제안한다.

• Journal of Hospice and Palliative Care
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• 제27권1호
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• pp.31-44
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• 2024

Purpose: The purpose of this qualitative study was to employ Colaizzi's phenomenological research method to elucidate and understand the essence of practical experiences among consultative hospice palliative care nurses working in hospice institutions. Methods: The participants in the study were 15 consultative hospice palliative care nurses with over 1 year of work experience in institutions located in S City, I City, and K Province in South Korea. Data were collected from 23 in-depth interviews and analyzed using Colaizzi's phenomenological qualitative method. Results: The practical experiences of consultative hospice palliative nurses were categorized into five categories, 10 theme clusters, and 25 themes. The five categories included "being aware of patients' situations at the time of transition to hospice palliative care," "empathizing with patients and their families by putting oneself in the other's shoes," "providing patient and family-centered end-of-life care," "experiencing difficulties in practical tasks," and "striving to improve hospice service quality." Conclusion: This study is significant in that it provides practical data for understanding the experiences of consultative hospice palliative care nurses caring for terminally ill patients. This could enhance our understanding of care solutions that effectively tackle the challenges consultative hospice palliative care nurses encounter while fulfilling their roles.