• Title/Summary/Keyword: Service Period

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A study on animal SHUNJANG in tombs 39 and 63 in Gyo-dong, Changnyeong (창녕 교동 39·63호분 동물순장 연구)

  • KWON Jooyoung;KIM Bosang
    • Korean Journal of Heritage: History & Science
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    • v.55 no.4
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    • pp.56-70
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    • 2022
  • Tombs No. 39 and No. 63 in Gyo-dong, Changnyeong, are unique in the Changnyeong area in that they do not have additional burials because they are hoenggu-style tombs with an entrance on the north side. This study tried to understand the nature and meaning of the two separate stone walls at the entrance of the tomb along with the burial process of the tomb. These two stone walls mark small tombs built independently within a large tomb, with stone wall No. 39 stone wall No. 3 (No.39-3) and No. 63 stone wall No. 3 (No. 63-3). Both units are located in the middle of the northern wall of the burial body part and share one wall with the burial body part wall stone. All animal fluids inside the stone wall were identified. In particular, it was estimated that at least three dogs were buried as a result of identification of animal fluids No. 63-3. Above all, these animals have their heads facing outward with their backs to the main occupants, and do not overlap in a limited space and are placed side by side. Changnyeong Gyo-dong No. 39-3 and 63-3 were created in the process of building the burial body, and although they are independent relics, they form a subordinate relationship in that they were built along the main burial within one tomb. In addition, it is coercive in that it is placed in an orderly manner according to a certain direction in a state that has not been dismantled after killing an animal. Therefore, It is understood to be the SHUNJANG of dogs. Studies on animal fluids excavated from tombs in the Three Kingdoms period are interpreted as animal stewardship, sacrificial collection, and animal sacrifice depending on their location, and this is known as a series of animal sacrifice rites, namely, animal stewardship and sacrifice. This recognition is based on material objectification of animals, such as food or sacrifices. However, Changnyeong Gyo-dong No. 39-3 and 63-3 are different in that they recognize animals as spiritual beings in the process of funeral rites and are closely related to the ideology that there is life after death. In addition, analysis of the location and directionality of the remains is also required from multiple angles. These two SHUNJANG correspond to the entrance to the tomb, and the location is the most open space at the entrance. The appearance of a dog looking outward, etc., can also be interpreted as the meaning of protecting the tombs and byeoksa. This appearance can be compared with the dog depicted in a mural in a Goguryeo tomb that reflects the ancient world's thought and stone figures excavated from the tomb of King Muryeong of Baekje, and it is also consistent with the meaning of the JINMYOSU protecting the ancient tombs. This suggests that a multifaceted study on animal fluid burial remains is needed in the future.

Problems in the field of maternal and child health care and its improvement in rural Korea (우리나라 농촌(農村)의 모자보건(母子保健)의 문제점(問題點)과 개선방안(改善方案))

  • Lee, Sung-Kwan
    • Journal of agricultural medicine and community health
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    • v.1 no.1
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    • pp.29-36
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    • 1976
  • Introduction Recently, changes in the patterns and concepts of maternity care, in both developing and developed countries have been accelerating. An outstanding development in this field is the number of deliveries taking place in hospitals or maternity centers. In Korea, however, more than 90% of deliveries are carried out at home with the help of untrained relatives or even without helpers. It is estimated that less than 10% of deliveries are assisted by professional persons such as a physician or a midwife. Taking into account the shortage of professional person i11 rural Korea, it is difficult to expect widespread prenatal, postnatal, and delivery care by professional persons in the near future, It is unrealistic, therefore, to expect rapid development of MCH care by professional persons in rural Korea due to economic and sociological reasons. Given these conditions. it is reasonable that an educated village women could used as a "maternity aid", serving simple and technically easy roles in the MCH field, if we could give such a women incentive to do so. The midwife and physician are assigned difficult problems in the MCH field which could not be solved by the village worker. However, with the application of the village worker system, we could expect to improve maternal and child hoalth through the replacement of untrained relatives as birth attendants with educated and trained maternity aides. We hope that this system will be a way of improving MCH care, which is only one part of the general health services offered at the local health centre level. Problems of MCH in rural Korea The field of MCH is not only the weakest point in the medical field in our country hut it has also dropped behind other developing countries. Regarding the knowledge about pregnancy and delivery, a large proportion of our respondents reported having only a little knowledge, while 29% reported that they had "sufficient" knowledge. The average number of pregnancies among women residing in rural areas was 4.3 while the rate of women with 5 or more pregnancies among general women and women who terminated childbearing were 43 and 80% respectively. The rate of unwanted pregnancy among general women was 19.7%. The total rate for complications during pregnancy was 15.4%, toxemia being the major complication. The rate of pregnant women with chronic disease was 7%. Regarding the interval of pregnancy, the rates of pregnancy within 12 months and within 36 months after last delivery were 9 and 49% respectively. Induced abortion has been increasing in rural areas, being as high as 30-50% in some locations. The maternal death rate was shown 10 times higher than in developed countries (35/10,000 live births). Prenatal care Most women had no consultation with a physician during the prenatal period. Of those women who did have prenatal care, the majority (63%) received such care only 1 or 2 times throughout the entire period of pregnancy. Also, in 80% of these women the first visit Game after 4 months of gestation. Delivery conditions This field is lagging behind other public health problems in our country. Namely, more than 95% of the women deliveried their baby at home, and delivery attendance by a professional person occurred only 11% of the time. Attendance rate by laymen was 78% while those receiving no care at all was 16%. For instruments used to cut the umbilical corn, sterilized scissors were used by 19%, non-sterilized scissors by 63% and 16% used sickles. Regarding delivery sheets, the rate of use of clean sheets was only 10%, unclean sheets, vinyl and papers 72%, and without sheets, 18%. The main reason for not using a hospital as a place of delivery was that the women felt they did not need it as they had previously experience easy deliveries outside hospitals. Difficult delivery composed about 5% of the total. Child health The main food for infants (95%) was breast milk. Regarding weaning time, the rates within one year, up to one and half, two, three and more than three years were 28,43,60,81 and 91% respectively, and even after the next pregnancy still continued lactation. The vaccination of children is the only service for child health in rural Korea. As shown in the Table, the rates of all kinds of vaccination were very low and insufficient. Infant death rate was 42 per 1,000 live births. Most of the deaths were caused by preventable diseases. Death of infants within the neonatal period was 83% meaning that deaths from communicable diseases decreased remarkably after that time. Infant deaths which occurred without medical care was 52%. Methods of improvement in the MCH field 1. Through the activities of village health workers (VHW) to detect pregnant women by home visiting and. after registration. visiting once a month to observe any abnormalities in pregnant women. If they find warning signs of abnormalities. they refer them to the public health nurse or midwife. Sterilized delivery kits were distributed to the expected mother 2 weeks prior to expected date of delivery by the VHW. If a delivery was expected to be difficult, then the VHW took the mother to a physician or call a physician to help after birth, the VHW visits the mother and baby to confirm health and to recommend the baby be given proper vaccination. 2. Through the midwife or public health nurse (aid nurse) Examination of pregnant women who are referred by the VHW to confirm abnormalities and to treat them. If the midwife or aid nurse could not solve the problems, they refer the pregnant women to the OB-GY specialist. The midwife and PHN will attend in the cases of normal deliveries and they help in the birth. The PHN will conduct vaccination for all infants and children under 5, years old. 3. The Physician will help only in those cases referred to him by the PHN or VHW. However, the physician should examine all pregnant women at least three times during their pregnancy. First, the physician will identify the pregnancy and conduct general physical examination to confirm any chronic disease that might disturb the continuity of the pregnancy. Second, if the pregnant woman shows any abnormalities the physician must examine and treat. Third, at 9 or 10 months of gestation (after sitting of the baby) the physician should examine the position of the fetus and measure the pelvis to recommend institutional delivery of those who are expected to have a difficult delivery. And of course. the medical care of both the mother and the infants are responsible of the physician. Overall, large areas of the field of MCH would be served by the VHW, PHN, or midwife so the physician is needed only as a parttime worker.

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Development of Education Program for Physicians Based on the 2004 Hospice Palliative Model Project for Terminal Cancer (의사를 위한 호스피스 교육 프로그램의 개발 - 2004 호스피스.완화의료 시범사업을 중심으로 -)

  • Kim, Su-Hyun;Shin, Sang-Won;Chong, Mi-Kyong;Lee, Soon-Nam;Lee, So-Woo;Lee, Kyung-Shik;Choi, Youn-Seon
    • Journal of Hospice and Palliative Care
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    • v.9 no.2
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    • pp.67-76
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    • 2006
  • Purpose: The purpose of this study was to develop education program for physicians who work at hospice palliative care settings in Korea, to practice abridged education program extracted from the full contents of the proposed education, and to improve the quality of hospice palliative care service. Methods: To develop the education program, questionnaire for hospice education need assessment (total 79 items) was distributed to 125 organizations practicing hospice service via mail and the data was collected from 1 Sep. to 10 Oct. 2004. Another questionnaire for hospice education importance assessment was asked to the palliative specialists from Sep. 23 to 17 Oct. 2004. Based on the analysis of the questionnaires, and reviewing various references and actual hospice palliative education programs of other countries, the education programs were developed. Results: Ore-day-Hospice education 2004 was conducted based on the suggested education program, and it was practiced four times on a national basis (2 times in Seoul, and once in Busan and Gwangju, respectively). 47 physicians attended the education program. The education program lasted about 7 hours, comprising 5 hours of common lectures for all attendants regardless of their professions and 2 hours of specific seminar for physicians only. Attendants positively responded to the contents of the education program. But they pointed out that the program should be offered on weekday and it should be more in-depth and more discussion based lesson. Conclusion: The suggested education program was not fully conducted yet. After practicing the abridged education program, more in-depth and discussion oriented rather than lecture-based education were suggested. It may be argued that the proposed education, which requires much longer period education, should also reflect the evaluation of the 1-day education program to successfully implement the proposed education program.

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The Satisfaction of Inpatient Families and Bereaved Families in the Hospice Service (호스피스 병동에 입원한 환자 가족과 사별 가족의 만족도)

  • Park, Theresia;Ra, Jeong-Ran;Seo, In-Ok;Cho, Young-Yee;Choi, Suk-Kyung;Park, Myung-Hee;Heo, Jeong-Hee;Kim, Eun-Kyung
    • Journal of Hospice and Palliative Care
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    • v.2 no.2
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    • pp.91-100
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    • 1999
  • Purpose : This study was performed to investigate the satisfaction in the hospice services provided for inpatient families and bereaved families whose members had been admitted to the hospice unit at Kangnam St. Mary's Hospital to improve the quality of care for the terminally ill patients and their families. Methods : This sample consisted of 33 families of hospice patients during the period of April to lune, 1998 and 30 bereaved families whose patients had died from March, 1993 to March, 1998. The data were collected through a self-report questionnaire and analyzed using t-test and ANOVA. Results : 1) The satisfaction level of inpatient families and bereaved families showed the mean value of 3.5 where the highest value is 5.0. 2) According to age, the level of satisfaction of inpatient families had significant differences in the fields of hospice philosophy, support for the family, medical management and nursing management(P=0.0001). The level of satisfaction of bereaved families showed significant differences in the field of support for the family, medical management, nursing management, and facilities of the hospice unit(P=0.0001). 3) By family relationship, the level of satisfaction of inpatient families had significant differences in the fields of hospice philosophy, support for the family, medical management and nursing management (P=0.0001). 4) According to religion, the level of satisfaction of inpatient families had significant differences in the fields of hospice philosophy, support for the family and nursing management (P=0.0001), but there was no significant difference for the bereaved families. Conclusions : The findings of this study showed that hospice services had positive influence on families with terminal disease such as cancer. To improve the level of satisfaction in the hospice services for families with hospice patients, we need to provide care by an interdisciplinary hospice team approach, and to assess needs of the families according to their socio-psychological characteristics. Further studies need to be conducted with large samples.

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Concerning the Constitution Court's constitutional decision and the direction of supplemental legislation concerning Article 33 paragraph 8 of the Medical Service Act - With a focus on legitimacy of a system that prohibits multiple opening of medical instituion, in the content of 2014Hun-Ba212, August 29, 2019, 2014Hun-Ga15, 2015Hun-Ma561, 2016Hun-Ba21(amalgamation), Constitutional Court of Korea - ('의료법 제33조 제8항 관련 헌법재판소의 합헌결정'에 대한 평가 및 보완 입법 방향에 대하여 -헌법재판소 2019. 8. 29. 2014헌바212, 2014헌가15, 2015헌마561, 2016헌바21(병합) 결정의 내용 중 의료기관 복수 개설금지 제도의 당위성 및 필요성을 중심으로-)

  • KIM, JOON RAE
    • The Korean Society of Law and Medicine
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    • v.20 no.3
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    • pp.143-174
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    • 2019
  • Our Constitution obliges the state to protect the health of the people, and the Medical Law, which embodied Constitution, sets out in detail the matters related to open the medical institution, and one of them is to prohibit the operation of multiple medical institutions. By the way, virtually multiple medical institutions could be opened and operated because the Supreme Court had interpreted that several medical institutions could be opened if medical activities were not performed directly at the additional medical institution which was opened under the another doctor's license. However, some health care providers opened the several medical institutions with another doctor's license for the purpose of the maximization of profit, and did illegal medical cares like the unfair luring of patients, over-treatment, and commission treatment. Also, realistic problems such as the infringed health rights have arisen. Accordingly, lawmakers had come to amend the Medical Law to readjust the system of opening for medical institution so that medical personnel could not open or operate more than one medical institution for any reason. For this reason, the Constitutional Court recently declared a constitutional decision through a long period of in-depth deliberation because the constitutional petition and the adjudication on the constitutionality of statutes had been filed on whether Article 33 paragraph 8 of the revised medical law is unconstitutional. The Constitutional Court acknowledged the "justice of purpose" in view of the importance of public medical institutions, of the prevention from seduction of for-profit patients and from over-treatment, and of the fact that health care should not be the object of commercial transactions. Given the risk that medical personnel might be subject to outside capital, the concern that the holder of the medical institution's opening certificate and the actual operator may be separated, the principle that the human body and life should not be just a means, and the current system's inability to identify over-treatment, it also acknowledged the 'minimum infringement'. Furthermore, The Constitutional Court judged it is constitutional in compliance with the principle of restricting fundamental rights, such as 'balance of legal interests'. In this regard, legislative complements are needed in order to effectively prevent the for-profit management and the over-treatment the Constitutional Court is concerned about. In this regard, consumer groups actively support the need for legislation, and health care providers groups also agree on the need for legislation. Therefore, the legislators should respect the recent Constitutional Court's decision and in the near future complete the complementary legislation to reflect the people's interests.

The Analysis of Disease Distribution of patients discharged from a general hospital in a farming and fishing village region (일개 종합병원을 이용한 농.어촌지역 퇴원환자의 질병분포에 관한 연구)

  • Yu, Eun-Yeong;Kim, Youl
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.11 no.12
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    • pp.4863-4872
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    • 2010
  • This study examined the disease conditions of patients from a farming and fishing village area. In order to analyze the medical service utilization, the necessary data were obtained from established health and medical care service plans from medical treatment related organizations. The following results were based on the analysis of data from the medical records of 2,365 discharged patients during a six months period from July to December 2009 at a general hospital in an aging farming and fishing village area. Results: The sex of the patients investigated was male 55.3%, female 44.7%, and the most frequent age category at 42.0% was 70 years of age or older. Based on type of hospital admission, 65.5% of patients who were admitted were originally outpatients. Patients were admitted according to the following departments: 49.7% for the department of internal medicine, 16.7% for the department of orthopedics, and 13.8% for the department of neurosurgery. The average number of days hospitalized was 14.8 days. The following ranks the principal diagnosis among patients in this study: S00-T98 18.4%, J00-J99 15.5%, and I00-I99 11.5%. The average number of diagnosis listed per patient was 5.6. There was a statistically significant difference for the following general characteristics according to principal diagnosis list: gender, type of insurance, admission process, and age category distribution had statistically significant differences. Monthly distribution of principal diagnoses were statistically significant difference. There was a statistically significant difference for principal diagnosis lists according to the average number of days admitted and the number of diagnosis. The results of this study showed the types of disease from typical farming and fishing village regions as disease from external injury due to the work environment of farming and fishing village regions and excessive labor throughout the year, respiratory disease, and various chronic disease from aging.

Development of Market Growth Pattern Map Based on Growth Model and Self-organizing Map Algorithm: Focusing on ICT products (자기조직화 지도를 활용한 성장모형 기반의 시장 성장패턴 지도 구축: ICT제품을 중심으로)

  • Park, Do-Hyung;Chung, Jaekwon;Chung, Yeo Jin;Lee, Dongwon
    • Journal of Intelligence and Information Systems
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    • v.20 no.4
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    • pp.1-23
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    • 2014
  • Market forecasting aims to estimate the sales volume of a product or service that is sold to consumers for a specific selling period. From the perspective of the enterprise, accurate market forecasting assists in determining the timing of new product introduction, product design, and establishing production plans and marketing strategies that enable a more efficient decision-making process. Moreover, accurate market forecasting enables governments to efficiently establish a national budget organization. This study aims to generate a market growth curve for ICT (information and communication technology) goods using past time series data; categorize products showing similar growth patterns; understand markets in the industry; and forecast the future outlook of such products. This study suggests the useful and meaningful process (or methodology) to identify the market growth pattern with quantitative growth model and data mining algorithm. The study employs the following methodology. At the first stage, past time series data are collected based on the target products or services of categorized industry. The data, such as the volume of sales and domestic consumption for a specific product or service, are collected from the relevant government ministry, the National Statistical Office, and other relevant government organizations. For collected data that may not be analyzed due to the lack of past data and the alteration of code names, data pre-processing work should be performed. At the second stage of this process, an optimal model for market forecasting should be selected. This model can be varied on the basis of the characteristics of each categorized industry. As this study is focused on the ICT industry, which has more frequent new technology appearances resulting in changes of the market structure, Logistic model, Gompertz model, and Bass model are selected. A hybrid model that combines different models can also be considered. The hybrid model considered for use in this study analyzes the size of the market potential through the Logistic and Gompertz models, and then the figures are used for the Bass model. The third stage of this process is to evaluate which model most accurately explains the data. In order to do this, the parameter should be estimated on the basis of the collected past time series data to generate the models' predictive value and calculate the root-mean squared error (RMSE). The model that shows the lowest average RMSE value for every product type is considered as the best model. At the fourth stage of this process, based on the estimated parameter value generated by the best model, a market growth pattern map is constructed with self-organizing map algorithm. A self-organizing map is learning with market pattern parameters for all products or services as input data, and the products or services are organized into an $N{\times}N$ map. The number of clusters increase from 2 to M, depending on the characteristics of the nodes on the map. The clusters are divided into zones, and the clusters with the ability to provide the most meaningful explanation are selected. Based on the final selection of clusters, the boundaries between the nodes are selected and, ultimately, the market growth pattern map is completed. The last step is to determine the final characteristics of the clusters as well as the market growth curve. The average of the market growth pattern parameters in the clusters is taken to be a representative figure. Using this figure, a growth curve is drawn for each cluster, and their characteristics are analyzed. Also, taking into consideration the product types in each cluster, their characteristics can be qualitatively generated. We expect that the process and system that this paper suggests can be used as a tool for forecasting demand in the ICT and other industries.

Changes in Yeast and Bacterial Flora during Fermentation and Storage of Gugija-Liriope tuber Makgeolli using PCR-DGGE (PCR-DGGE를 이용한 구기자-맥문동 막걸리의 발효 과정과 저장 기간 중 효모와 세균 균총의 변화)

  • Min, Jin-Hong;Nam, Yun-Gyu;Ju, Jung-Il;Jung, Jae-Hong;Lee, Jong-Soo;Kim, Ha-Kun
    • Microbiology and Biotechnology Letters
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    • v.40 no.2
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    • pp.111-116
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    • 2012
  • In this study, we investigated the microbial flora changes in Gugija-Liriope tuber Makgeolli during fermentation and storage periods. We brewed Gugija-Liriope tuber Makgeolli for a week through twostage fermentations and stored the fermentation broth for a month at $4^{\circ}C$ or $20^{\circ}C$. We collected the samples periodically and analyzed microbial flora changes using viable cell counts and PCR-denaturing gradient gel electrophoresis (DGGE). Yeast viable cells were seen to have decreased to 13% of pre-storage levels after storage for 15 days at $20^{\circ}C$; however significant changes were not observed during storage at $4^{\circ}C$. Prolongation of storage time dramatically decreased the availability of viable cells. Yeast viable cell numbers had decreased to 38% of pre-storage levels at $4^{\circ}C$ and 4.8% at $20^{\circ}C$ after storage for 30 days. The results of the DGGE profile for yeast showed that Saccharomyces cerevisiae and Saccharomyces sp. were the predominant strains at the beginning of fermentation and throughout the whole period of storage. Viable cell counts for total bacteria had decreased to 36% of pre-storage levels after storage for 15 days but did not significantly change for the full 30 days of storage at $4^{\circ}C$. Similarly, viable cell counts for bacteria had decreased to 5% while viable cell numbers did not significantly change for the full 30 days at $20^{\circ}C$. Viable cell counts for lactic acid bacteria were performed and the results were similar to those for total bacteria. The results of the DGGE profile for bacteria showed that Weissella cibaria was the predominant strain at the beginning of fermentation. However it had disappeared by the end of fermentation, and Lactobacillus fermentum and Pediococcus acidilactici became the predominant species during storage.

Development of the Information Delivery System for the Home Nursing Service (가정간호사업 운용을 위한 정보전달체계 개발 I (가정간호 데이터베이스 구축과 뇌졸중 환자의 가정간호 전산개발))

  • Park, J.H;Kim, M.J;Hong, K.J;Han, K.J;Park, S.A;Yung, S.N;Lee, I.S;Joh, H.;Bang, K.S
    • Journal of Home Health Care Nursing
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    • v.4
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    • pp.5-22
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    • 1997
  • The purpose of the study was to development an information delivery system for the home nursing service, to demonstrate and to evaluate the efficiency of it. The period of research conduct was from September 1996 to August 31, 1997. At the 1st stage to achieve the purpose, Firstly Assessment tool for the patients with cerebral vascular disease who have the first priority of HNS among the patients with various health problems at home was developed through literature review. Secondly, after identification of patient nursing problem by the home care nurse with the assessment tool, the patient's classification system developed by Park (1988) that was 128 nursing activities under 6 categories was used to identify the home care nurse's activities of the patient with CAV at home. The research team had several workshops with 5 clinical nurse experts to refine it. At last 110 nursing activities under 11 categories for the patients with CVA were derived. At the second stage, algorithms were developed to connect 110 nursing activities with the patient nursing problems identified by assessment tool. The computerizing process of the algorithms is as follows: These algorithms are realized with the computer program by use of the software engineering technique. The development is made by the prototyping method, which is the requirement analysis of the software specifications. The basic features of the usability, compatibility, adaptability and maintainability are taken into consideration. Particular emphasis is given to the efficient construction of the database. To enhance the database efficiency and to establish the structural cohesion, the data field is categorized with the weight of relevance to the particular disease. This approach permits the easy adaptability when numerous diseases are applied in the future. In paralleled with this, the expandability and maintainability is stressed through out the program development, which leads to the modular concept. However since the disease to be applied is increased in number as the project progress and since they are interrelated and coupled each other, the expand ability as well as maintainability should be considered with a big priority. Furthermore, since the system is to be synthesized with other medical systems in the future, these properties are very important. The prototype developed in this project is to be evaluated through the stage of system testing. There are various evaluation metrics such as cohesion, coupling and adaptability so on. But unfortunately, direct measurement of these metrics are very difficult, and accordingly, analytical and quantitative evaluations are almost impossible. Therefore, instead of the analytical evaluation, the experimental evaluation is to be applied through the test run by various users. This system testing will provide the viewpoint analysis of the user's level, and the detail and additional requirement specifications arising from user's real situation will be feedback into the system modeling. Also. the degree of freedom of the input and output will be improved, and the hardware limitation will be investigated. Upon the refining, the prototype system will be used as a design template. and will be used to develop the more extensive system. In detail. the relevant modules will be developed for the various diseases, and the module will be integrated by the macroscopic design process focusing on the inter modularity, generality of the database. and compatibility with other systems. The Home care Evaluation System is comprised of three main modules of : (1) General information on a patient, (2) General health status of a patient, and (3) Cerebrovascular disease patient. The general health status module has five sub modules of physical measurement, vitality, nursing, pharmaceutical description and emotional/cognition ability. The CVA patient module is divided into ten sub modules such as subjective sense, consciousness, memory and language pattern so on. The typical sub modules are described in appendix 3.

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A Study on Effectiveness of the Hospital-based Home Nursing Care of the Early Discharged Surgical Patients and its Cost Analysis (조기퇴원 수술환자의 병원중심 가정간호 효과 및 비용분석에 관한 연구)

  • 박경숙;정연강
    • Journal of Korean Academy of Nursing
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    • v.24 no.4
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    • pp.545-556
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    • 1994
  • Medical insurance and health care delivery system enabled Korean people to get the necessary medical service, but it caused increased needs for medical service, and resulted in the occurence of some problems such as a lack of manpower and medical facilities. In order to solve these problems, many countries, which already had medical insurance system had developed home care system and it has been regarded effective both in reducing costs and in increasing the rates of turnover of bed. Recently, Korea has included home nursing care in its health care delivery system, and some models of the hospital based home nursing care had been tried and its effects had been evaluated. So, author tried to run a home nursing care for the Cesarean section mothers and evaluate Its effects both in the mother's health and costs. This study was designed as a Quasi-experimental study. Subjects were thirty mothers who got Cesarean section operation in hospital in Seoul. Experimental group consisted of 15 volunteers, and control group were selected by means of matching technique. Data were gathered from February 1st to March 26th by two assistants who were trained by author. Experimental group were discharged on the 4th day after their operation, and got nursing care and assessment about their home three times on the 5th, 6th, and 7th day. Control group stayed in the hospital until 7th day as usual and were checked on the same day as above mentioned To evaluate the state of physiological recovery, vital signs, H.O.F, presence of edema in the legs, bathing, appetite, sleep, presence of pain or discomfort in the breasts, amount of lochia, color of lochia, defecation urination. To compare incidence of complication in experimental group with that in control group, specific assessment was done such variables as smell of lochia, presence of inflammation of operation wound, dizziness, and presence of immobilization in the extremities. The activities of daily living were checked Satisfaction of nursing were checked To calculate costs, author asked subjects to specify expenditure including hospital charge, traffic enpenses, and food expenses. The results were as fellows. 1. On effectiveness of home nursing careThere were n significant differences between experimental and control group in incidence of abnormal symptoms and any complication. The number of taking a bath [POD #5 P=0.001, #6 P=0.0003, #7 P=0.001] and the degree of appetite [POD #5 P=0.03, #6 P=0.02, #7 P=0.013] were significantly higher in experimental group than in control group. Contrary to author's expectation, the degree of the activities of daily living in experimental group was not higher than that of control group. All of the experimental group said they were satisfied with the home nursing care. 2. Cost analysis 1) Hospital charge of experimental group was lower than that of control group. [P=0.009] By taking home nursing care, average period of hospitalization was shortened to 3.1 days, and family members could save 22.8 hours. Total amount of money saved by early discharge was 3,443,093 Won. It is estimated that total amount of money saved by early discharge in a year will be 40,398,956 Won. 2) Home nursing care charge of 15 mothers was 1,781,633 Won. It is estimated that total amount of money Saved by it in a year Will be 20,904,493 Won. It was lower altogether than hospital charge of the three days which is 5th, 6th, 7th day of operation. The average cost of single home visit was calculated 10,940 Won. It took 87 minutes per round and it costed 1,017.3 Won. The average hour of home care was 39.0 minutes. 3) It is expected that early discharge can bring forth the increase of hospital income. On the condition that the rate of running bed is 100%, the expected increase of hospital income will be 202,374, 026 Won in a year. Suggestions for further study and nursing practice are as follows : 1. For the welfare of patients and the increased rates of running bed, home nursing care system should be included in the hospital nursing care system. 2. Studies to test effect of home nursing care on the patients with other diseases are needed. 3. Establishment of law on the practice of home nursing care is strongly recommended.

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