• Journal of Preventive Medicine and Public Health
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• v.29 no.4 s.55
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• pp.831-842
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• 1996

Demand for high quality medical care has recently been increasing in step with high level of income and education. Patients prefer the use of large general hospitals to small community hospitals. Large hospitals, usually located at urban area, expand their capacities to cope with the increasing demand, therefore, they easily secure revenue necessary for growth and development of hospitals. However, small community hospitals are facing with serious financial difficulties caused from the reduction of patients in one hand and the inflation of cost in another. If small rural hospitals were closed, the closure would have negative impacts on local economies in addition to the decrease in access to medical care. Community leaders should have an insight on the contribution of community hospitals to local economies. They could make a rational decision on the hospital closure only with the understanding of hospital's contribution to the community. This study is designed to develop an economic model to estimate the contribution of rural hospital to local economies, and also to apply this model with a specific hospital. The contribution of a hospital to local economies consists of two elements, direct effect and multiplier effects. The direct impacts include hospital's local purchasing power, employee's local purchasing power, and the consumption of patients coming from outside the community. The direct impact induces multiplication effect in the local economy. The seed money invested to other industries grows through economic activities in the region. This study estimated the direct effect with the data of expenditure of the case hospital. The total effect was calculated by multiplied the direct effect with a multiplier. The multiplier was drown from the ratio of marginal propensity of income and expenditure. Beside the estimation of the total impacts, the economic effect from the external resources was also analyzed by the use of the ratio of patients coming outside the region. The results are as follows. 1. The direct economic contribution of the hospital to the local economy is 1,104 million won. 2. The value of multiplier in the region is 2.976. 3. The total economic effect is 3,286 million won, and the multiplication effect is 2,182 million won. 4. The economic contribution from the external resources is 245 million won which is 7.5% of the total economic effect.

• Journal of Hospice and Palliative Care
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• v.13 no.3
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• pp.153-160
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• 2010

Purpose: The purpose of the present study was to investigate needs and satisfaction on the medical services of cancer patients in Jeju Special Self-Governing Province. Methods: Total 174 cancer patients, who visited at the clinic of Jeju National University Hospital, submitted informed consent and participated in this study from July 13 to July 30, 2009. Self questionnaire was used and data were analyzed with Kolmogorov-Smirnov test, Mann-Whitney U test, ANOVA, and Kruskal-Wallis test. Results: Participants expressed the needs of most economical support (3.38 out of 4), followed by counseling of treatment plan (3.22), information of disease (3.07), and disease management except cancer (2.97). Participants were satisfied most with religious counseling (3.41), followed by nursing service support (3.39), employment counseling (3.26), and counseling for family or interpersonal relationships (3.26). The satisfaction of economical support was the lowest (1.98). Satisfaction of men was higher than women, and needs in patients who were living with children was the highest. Patients who were living alone or with children showed the lowest satisfaction about the medical services. There were no significant differences in the general characteristics, however, participants who were older than 60 years of age or had higher income showed lower needs and higher satisfaction. There were no significant differences in the medical characteristics, however, thyroid cancer patients and patients who were treated with radiation therapy or transarterial embolization showed low satisfaction. Conclusion: Cancer patients seemed to need more economical support, information of treatment or disease, and symptom management. Furthermore, there were various needs about the services, depending on family formation or economical support of patients. Therefore, it is certain that patients who were suffering from other cancers, except the 5 major cancers, needed more services. In conclusion, continuous and systemic policy to consider patient's characteristics and needs are needed in community as well as health care system.

• Journal of Korean Academy of Nursing
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• v.54 no.2
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• pp.237-249
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• 2024

Purpose: This study aimed to examine the adequacy of current nurse staffing levels by identifying nursing activities and workload. Methods: The study used a mixed-method design. A nursing activity survey was conducted using the work sampling method over 2 working days with 119 general ward nurses. A focus group interview was conducted with 12 nurses. Quantitative and qualitative data were analyzed using SPSS 20.0 and content analysis, respectively. Results: The most amount of time was spent on medication (in direct nursing) and electronic medical record documentation (in indirect nursing). The appropriate nurse-to-patient ratio is 1:7.7 for the day shift, 1:9.0 for the evening shift, and 1:11.9 for the night shift. However, the current nurse-to-patient ratio is 1:9.4, 1:11.0, and 1:13.8 for the day, evening, and night shifts, respectively. Therefore, the current nurse staffing level is insufficient for the workload. In the focus group interview, the main reasons cited for being unable to complete tasks within working hours were communication and coordination, and the nursing electronic medical record. The essential nursing activities of basic nursing and emotional support were overlooked owing to a heavy workload. Therefore, an adequate nurse staffing level should be higher than the measured quantitative workload. Conclusion: These results suggest the general wards of tertiary hospitals should evaluate the adequacy of their current nurse staffing and allocate sufficient nurses to improve patient safety and nursing care quality.

• Quality Improvement in Health Care
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• v.5 no.1
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• pp.128-138
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• 1998

Background : There is increased recognition that rigorous approach to functional assessment will complement the assessment of clinical status. This study is to develop the appropriate visual function index in Korean patients with cataracts by the assessment of the reliability, validity of visual function indexes including VF-14. Methods : An prospective study was performed with 92 patients who had undergone either one eye or both eye cataract surgery by 3 ophthalmologists practicing at a university hospital. Patients were interviewed. and clinical data were obtained. Doctors were questioned with self-entered questionnaire forms. Medical record was examined to understand surgery process. The survey was conducted at 1-2 days before cataract surgery. Results : We used following measures : 7 visual function indexes, global measures of patients' trouble and satisfaction with vision, and best-corrected visual acuity(VA) in each eye. 7 visual function indexes showed a high internal consistency reliability (Cronbach's alpha coefficients ${\geq}$ 0.86). The better visual acuity(operated eye, better eye), the higher patient satisfaction with vision, the lower symptom score, the lower patient trouble with vision was correlated with preoperative visual function index scores. Among 7 indexes, VF-12 with the exclusion of 2 items drivings from VF-14 is a high Cronbach's alpha coefficient and correlation coefficient and the highest $R^2$. Conclusion : We conclude that VF-12 is reliable and valid in Korea. So we suggest that in Korea, all items of VF-14, the visual function index, which is in use internationally, ought to be surveyed and VF-12 which has been excluded by 2 items of drivings from VF-14 ought to be used for analysis.

• Journal of Hospice and Palliative Care
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• v.13 no.4
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• pp.216-224
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• 2010

Purpose: The purpose of this study was to evaluate a community-based cancer patient management program (CBPCMP) which was collaborated between a hospice center and public health centers. Methods: The CBPCMP proceeded on four steps; 1) Signing agreements with three public health centers, 2) Enrolling the domiciliary terminal cancer patients, 3) Providing home hospice service, and 4) Inquiring patient's level of satisfaction. From February 1 to December 31 in 2009, 43 terminal cancer patients were referred and provided with home hospice service. The hospice team made a total of 605 visits. Medical records for each visit and data from satisfaction surveys were analyzed. Results: 76.7% of patients were older than 60 years, and 90.7% of the patients were alert. The level of functional status for 76.7% of patients rated as lower than ECOG grade 1. 62.8% of the patients or their caregivers signed hospice service agreements. On the initial evaluation, the most frequent reasons for referral were general weakness (86.0%), followed by anorexia (72.1%). Nurses visited the patients' most frequently (371 visits), followed by volunteers (216 visits). Nurses provided emotional support and health promotion counseling on 95.1% and 22.9% of visits, respectively. The mean satisfaction score rated by patients and their family was 4.45 out of 5. Conclusion: This study tested CBPCMP in collaboration with hospice centers and public health centers. CBPCMP showed a possibility to improve the quality of end of life care. To insure the quality care, however, the guidelines for home hospice service should be developed.

• Quality Improvement in Health Care
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• v.5 no.1
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• pp.106-118
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• 1998

Background : This study was done to assess the relationship among multiple patient outcomes of cataract surgery perioperatively, 3-4 months and 12 months after surgery. The patient outcomes include changes in visual acuity(operated eye, better eye), visual function(VF-14), patient satisfaction, subjective satisfaction with vision, and subjective overall health status. Methods : For the assessment of relationship, prospective study was performed with 92 patients who had undergone either one or both eye cataract surgery by 3 ophthalmologists practicing at a university hospital. Patients were interviewed. and clinical data were obtained. Doctors were questioned with self-entered questionnaire forms. Medical record was examined to understand surgery process. The survey was conducted at 4 stages : preoperatively, perioperatively, postoperative 3-4 months, and postoperative 12 months. Results : The correlations within patient outcomes at 4 stages - the visual acuity of operated eye and that of better eye, patient satisfaction and VF-14, subjective overall health status and relative health status as against others - were found to be positively correlated. The change in the visual acuity of operated eye and better eye was correlated with VF-14 as well as with patient satisfaction. The change was also correlated with overall health status. However, the correlations between variables were decreased as the postoperative period got longer. Conclusion : As for the postoperative clinical patient outcomes, VF-14 is acted to linker between visual acuity - clinical outcomes and overall health status - endpoint outcomes. Therefore. VF-14 is the index of patient-sided and disease-specific outcome for cataract surgery.

• Quality Improvement in Health Care
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• v.28 no.1
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• pp.45-54
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• 2022

Purpose: The study aims to identify the theme list and priority criteria of patient safety theme reports in South Korea. Methods: The survey was conducted twice, and the importance of each criterion and theme was measured on a nine-point scale using the Delphi technique by a panel of 19 patient safety experts. The criteria included severity, universality, preventability, and organizational-social impact. Descriptive statistics such as frequency, percentage, mean, standard deviation, median, and interval quartile range were used to analyze the data. Results: The parameters were assigned a weighted average of 35% for severity, 20% for universality, 30% for preventability, and 15% for organizational-social impact, respectively. The final top three rankings were surgery safety, blood transfusion safety, and medication safety. In addition to expert opinion, for the theme that is selected based on the priority ranking, one to five sub-topics can be derived from the theme based on the priority ranking, societal demands, or the yearly priority list of patient safety incidents. Conclusion: It is recommended that the official patient safety center distribute the report in the form of a summary that can be utilized nationwide at medical institutions, government institutions, and other places. Updates, as well as accumulated theme reports, will serve as the baseline data for the proposal of the system and for the policy designed to implement and improve institutions' safety practices as a standard of domestic patient safety practice guidelines.

• Journal of Hospice and Palliative Care
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• v.9 no.1
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• pp.30-34
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• 2006

Purpose: This study is to report the operating result of the Hospice Cyber Counselling Program for improving quality of lift for terminal patients and their families. Methods: This study was performed followed by counsellor training, building strategy of public relations, management, and evaluation of the effect in order. Results: 72 subjects visited our cyber homepage and became members for approximately 9 months from Oct. 2004 to July 2005; 17 subjects in their 20s (23.6%), 12 subjects in their 30s (16.7%), 17 subjects in their 40s (23.6%), and 13 subjects above 50s (18%). Classified by diagnose related group, cancer related disease consist of 90%. As for the relationship between contents of counselling and counselling applicants, families consist of 90% and self-applicants only 10%. Only 30 members used on-line counselling and their counselling frequency was just 35 times. Although counselling frequency and the number of members who used the counselling site were not high, they tend to contact with a counsellor continuously and use the site actively after the first counselling. Conclusion: Cyber counselling program for hospice was practically managed to improve quality of life for terminal patients and their families as a basic activity for hospice business activation. Basic public relations with regard to hospice business by mass media and the press should be performed continuously and the hospice training program is required for medical personnel to be continue.

• Journal of Korean Academy of Nursing
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• v.22 no.4
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• pp.552-568
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• 1992

Recent improvements in the standard of living, national income and medical care, and a decline in the infant death rate which have occurred related to economic growth and modernization, have led to a longer average life-span and a higher ratio of elderly people in the total population, Therefore, not only in the field of nursing science, but also in the field of many other discipline, issues concerning the elderly have been given increasing interest. A great deal of effort has been spent on increasing the quality of life for elderly people. This study was conducted to analyze the correlation between social support and quality of life. The sample consisted of III subjects residing at home and 107 subjects residing in institutions all of whom were over 65 years of age. The data collection period was from October 23, 1990 to January 26, 1991. Social support was measured using the Norbeck social Support Questionnaire developed by Norbeck, translated by Oh, Ka Sil and quality of life was measured using the QOL scale developed by No, You Ja. Data were analyzed using pereentages, t-test, Pearson Correlation Coefficient and ANOVA. The results of this study are as follows : 1. There was a statistically signifivant difference in the level of social support between the two groups (t＝-8.83, p＜.001), The elderly at home reported a much higher level of social support. 2. There was a statistically significant difference in the level of QOL between the two groups (t＝-5.77, p＜.001) . The elderly at home reported a much more positive quality of life. 3. There was a positive correlation between social support and QOL for the elderly at home ard it was statistically significant (r＝.32, p＜.001). 4. There was a postitive collealtion between social support and QOL for the elderly in institutions and it was also statistically significant (r＝.19, p＜.05). 5. The relationship between the general characteristics of the elderly at home and the variables of social support and of QOL were as follows ; 1) according to sex(t＝10.57, p＜.01) and the number of offspring(F＝6.19, p＜.01), there was a statistically significant difference in social support. 2) according to amount of Pocket money, there was a statistically significant difference in QOL(F＝2.98, p＜.05). 6. The relationship between the general characteristics of the elderly in institutions and the two variables were as follows ; 1) according to sex(t＝6.24, p＜.05), the number of offspring(F＝6.16, p＜.001) and religion (F＝2.58, p＜.05), there was a statistically significant difference in social support. 2) according to religion, there was a statistically significant difference in QOL(F＝2.90, p＜.05). In conclusion, it can be said that social support is an important variable related to QOL in the elderly and that social support levels are higher for the elderly residing at home. Therefore, more specific and objective approaches and efforts are needed to effectively use resources to maintain the elderly at home and to enhance social support available to the elderly in institutions and thereby increase QOL regardless of residence.

• Journal of Families and Better Life
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• v.27 no.1
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• pp.73-88
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• 2009

The purpose of this study was to investigate the influence of the factors such as self-esteem, social supports, socio-economic status of parents, degree of disability in child, stress coping, religion, and sports.exercise on the qualities of lives in mothers with disabled children. Data were collect from 45 institutions(schools from kindergarten to senior-high, special education institutes, and social welfare institutions) by self-report questionnaire, and the subjects of the study were 386 mothers in Seoul whose children were attending the schools or institutions. Findings according to socio-demographic variables are as follows: 1. Mothers with disabled children in this study thought their quality of life as average degree. 2. The younger the mothers and children, the higher the quality of life was. 3. The higher the educational level and monthly income, the higher the quality of life was. 4. There was no statistically significant difference between the existence and nonexistence of spouse, and between the existence and nonexistence of religion as well. Findings analyzed by multiple regression are as follows: 1. Among 7 independent variables 'self-esteem'(${\beta}$=.49, p<.001), 'social supports'(${\beta}$=.15, p<.01), and 'socio-economic status'(${\beta}$=.11, p<.05) were found to be statistically significant in quality of life in mothers, while the rests were found not significant. 2. 'Self-esteem' was found to be the most influencing variable, meaning that the psychological factor such as self-esteem is more important than environmental factors in qualities of lives in mothers. 3. The total amount of explanation of the model was Adjusted R square=.301, so that it can be said about 30% can be explained among total variance of the qualities of lives in mothers with disabled children. Conclusions and recommendations based on the results above are: First, it is strongly recommended to conduct programs promoting self-esteem in mothers with disabled children, and to include 'self-esteem' hereafter in the studies related to qualities of lives in mothers with disabled children. Second, comprehensive and practical countermeasures should to be formulated to back up expenses for education and medical care, purchasing relative tools and equipments, plus helping to find jobs.