• 중환자간호학회지
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• 제6권2호
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• pp.65-77
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• 2013

Purpose: The purpose of the study was to analyze the nursing activities related to continuous renal replacement therapy (CRRT) in the intensive care units (ICU). Methods: We developed a list of 31 CRRT related nursing activities based on literature review and reviewed by expert group. A total of 109 direct time measurement records by 43 ICU nurses were collected and analyzed in terms of total time per shift, frequency, standard time, difficulty and performance levels of each CRRT nursing activity. Results: The mean time for CRRT nursing activity was 85.60 minutes per 8 hour shift. Nurses have spent average $9.46{\pm}6.98$ minutes in a shift for "waste fluid bag change" activity. In addition, "check catheter location" was the most time consuming single activity. The most difficult activity was "counseling-answer" and the most competent one was "dialysis solutions change". Conclusion: The CRRT nursing activities accounted for a significant portion of total nursing workload. Practical allocation of nursing staff for CRRT patient along with development of a new nursing cost system need to be considered. Continuous nursing educational and training programs on CRRT should be developed.

• 대한간호학회지
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• 제30권6호
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• pp.1543-1555
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• 2000

Home health care is moving into a set of new realities. An era of competition and cost containment has arrived. Before nurses are able to contain costs or describe the relationship between nursing activities, cost must be accurately measured based on the nurse's workload. Nurses in home health care usually desire to measure expenses for one of three reasons : reimbursement, management, or research. The purpose of the study was to investigate the work input by Registered Nurse in each of the home health care activities by relative value units and identify the factors affecting the nurses' total work input in health care services. To measure the work input by nurses, work was defined by four dimensions: time, physical effort, mental effort, and stress. This study used a descriptive-correlational design. Data collection consisted of two phases. In phase I, data on home health activities performed by nurses were collected. In phase II, data on nurses' time, physical effort, mental effort, and stress in each of home health care activities discovered phase I were collected. In this method, the respondent was asked to rate a service in relation to a reference service using a ratio scale. The sample included 39 home health care nurses. The results of the study indicated that home health care activities performed by the nurses were in 10 categories and 69 items. Measuring the relative work inputs in each of home health care activities, and foley catheterization was selected as the reference to service. In terms of time and physical effort dimensions, full bath service was rated as the most strenuous among 69 activities by the respondents, and intramuscular injection was rated as least. It was found that emergency treatment required the highest mental effort and the highest stress, while blood sugar tests required the lowest mental effort. Approximately 91.3% of the variance in total work input was accounted for by the linear combination of time, physical effort, mental effort judgement, and stress. Examining the regression coefficients of those variables, physical effort, time, and stress were found as the predictors which were significantly associated with the total work of nurses in home health care. Professional nursing's next step in the conundrum of economic volatility is to develop a tool to reflect the interaction of functional deficiency and direct professional nursing care. And this will be a more accurate predictor of nursing resource use and ultimately a great forcaeter cost.

• 대한간호학회지
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• 제24권2호
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• pp.216-225
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• 1994

The cost of hospice care should be covered by the insurance system if it is to be promoted in our country and this, in turn, requires a proper method to the estimate of this cost. The purpose of this study was to set up the method to estimate the cost of hospice care. First the cost effectiveness of hospice care were studied. By tracing the activities of hospice nurses for a given period, all the relevant data such as the scope and load of activities as well as the cost were collected. Then these were analysed and compared with the data obtained from hospice and home care. The results showed that the cost of hospice care was the most economic, and indicate its qualification as .1n in-dependent system. The main part of the cost of hospice care was found to be the labor cost which was up to 83% of the total. Therefore a method to estimate the cost should reflect the real labor cost. Several methods have been proposed in the study in terms of unit labor cost, service time, material cost, and the weight of the labor cost. All variables, including the service time surveyed in this study, can easily be translated into numerical values and it would not difficult to estmate the cost of hospice care. Hence by letting the hospice care be insured, hospice care can be expected to function as a good alternative to the present medical system.

• 한국직업건강간호학회지
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• 제25권2호
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• pp.130-140
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• 2016

Purpose: The construction worker has diverse harmful factors such as noise, dust, and dealing with chemicals. Therefore this research aimed to examine the necessity of appointing a health manager in the construction industry by examining the cost-benefit analysis when the construction industry appoints a health manager. Methods: In order to calculate the healthcare staff employment cost and the benefits from their activities in 1,425 construction companies with the staff of 300 or more people during 2011, this study analyzed existing data and existing research data, as well as national data. Results: Total annual costs were 99,920,070,900 won and total annual benefits were 324,807,182,625 won. Benefits were found to be 224,887,111,725 won exceeding costs. Benefit/cost ratio resulting from appointing a health manager in the construction industry workplaces was 3.25 times. Conclusion: The findings of this research can be used as the base data to make rational decision to positively encourage the employment of healthcare staff in construction companies pursuant to relevant laws.

• 지역사회간호학회지
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• 제10권2호
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• pp.291-306
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• 1999

Health promotion has come to the fore through new concept approach in consequence of the increase of chronic diseases. increase of medical cost and social trend of putting more emphasis on the individual responsibility for health. Studies of health promotion can be classified into two types: one is micro intervention method which is mainly focused on modifying individual life style and the other. macro intervention method in which they put another emphasis on the environment the individual is surrounded. in addition to modifying individual life style. This study belongs to the later. This study aims to develop nursing activities and program it for the purpose of community health promotion. The process of the study can be briefed as follows: to draw out nursing contents to intervene for community health promotion: to promote community health to develop nursing action indicators; to develop nursing action indicators for the development of main nursing activities. And those developed nursing activities are programmed systematically. The community health promotion program is composed of a hierarchical structure with nursing process that the nurses are supposed to apply to perform professional nursing. the level of nursing perform. the main items of nursing process. health promotion nursing indicators. health promotion nursing activities. The conclusion of this study according to objectives are as follows. First. community health promotion contents at individual and community level are remained revised and complemented and those at organizational level are developed. The developed main contents of community health promotion nursing are as follows. 1) Revised individual level nursing contents: 35 items. 2) Developed organizational level nursing contents: 24 items. 3) Revised community level nursing contents: 36 items. Second. for the development of the health promotion nursing action indicators. principles were set up and applied as follows. 1. Developed indicators should be provided with such qualities as comprehensiveness. diversity. developability, availability. practicability. 2. Developed indicators should be provided with functional abilities to measure the conditions and changes in any phenomena or state. inspect the development of the states. control the implementing program. evaluate the result of program and grasp what nurses should do. 3. Developed indicators should be provided with relevance and sequence. 4. Developed indicators should be undergo inspections from the expert. The developed community health promotion action indicators developed in this study. observing above mentioned principles. are total 330 indicators of 95 items. Third. when the main nursing activities were developed for each nursing action indicator. five priciples were set up in accordance with each nursing action indicators to decide main nursing activities. Main nursing activities developed observing those principles. are total 1273. Forth. for the programming of the developed nursing activities. three principles were set up. 1. The nursing activities are systematized in line with (nursing process) (nursing client) (key items of nursing process) (nursing action indicators for health promotion) (nursing activities). 2. The program is constructed in downward and hierarchical order. 3. The program is constructed not in relation to same level activities but in relation to high and low level activities. The process step of programming of developed main health promotion nursing activities are; Step 1. The Developed nursing action indicators are classified into nursing process. Step 2. The main nursing activities are allocated per each nursing action indicators. Step 3. The statement of main nursing activities are inspected. Step 4. The items of main nursing activities allocated by a certain nursing action indicators are sequenced. taking into consideration the elaborateness of activity. the sequency of activity. familiarity of activity. the difficulty of activity. the interest of activity. the frequency of activity. Step 5. The whole developed program should undergo comprehensive and critical inspections.

• 지역사회간호학회지
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• 제12권2호
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• pp.329-337
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• 2001

Purpose: This study was to develop a critical pathway for COPD clients in home health care. Method: Review of literature. Analysis of 10 cases of home health records of COPD clients without other major chronic illness, and Contents validity test Results 1. Vertical axis(l4 activities) physical and mental assessment, family assessment. environment assessment, rights and duties of client, oxygen use and safety, education of disease process and symptom, medication, nutrition and elimination, tests, activities, respiratory exercise, sleeping pattern. consultations and discharge planning. 2. Horizontal axis was set by the number of visits(average number of visits is 6.4) and vertical axis was set with 14 activities and the contents which should have occurred, according to the time frames of the horizontal axis. 3. According to the contents validity test, among the total of 234 items, 176 items showed over 83% agreement and 58 items showed less than 83% agreement. Those items with less than 83% agreements were either deleted or revised. Conclusion this critical pathway is applicable to the home health care of COPD clients to provide quality home nursing care services at lower cost.

• 대한간호학회지
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• 제24권4호
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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.

• 임상간호연구
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• 제23권2호
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• pp.236-247
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• 2017

Purpose: This study was to present improvement strategy and the problems of the nursing fee in national health insurance system. Methods: A total of 23 nursing activities performed by nurses were selected. Data were collected the relative value score and criteria of the Health Insurance Review & Assessment Agency. Sixty clinical nursing experts panels were composed and nursing time surveyed self-reported method. The actual fee was calculated through the nursing time, relative value score and actual labor costs. Nextly, the labor costs analyzed was compared with that in the national health insurance. Results: Although the practices were mainly performed by the nurse, other occupations have been recorded as main practitioners and the time of the nursing activity is partially improperly reflected. Additionally, although the nurse practiced mainly in glucose (semi-quantitative) test, it was confirmed that the principal practitioner was described as a clinical pathologist. The the labor cost gap was estimated that is 9.3 times (median) and 11.9 times (average) in this analysis. Conclusion: This study suggests that it is necessary to legislate a policy that can improve the quality of clinical nursing by reinforcing the appropriateness and improving nursing fee through reflection of the actual time spent for nursing care.

• 근관절건강학회지
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• 제14권1호
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• pp.77-84
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• 2007

Purpose: The purpose of the study was to compare the effects of Tai Chi exercise, Tai Chi self help program, and self help management program on arthritic pain, stiffness, fatigue and difficulties in performing daily activities in patients with osteoarthritis. Method: The pre-post experimental design was utilized with convenient sampling at Public Health Centers. Total of 38 subjects agreed to participate in the study with the inclusion criteria of being diagnosed as osteoarthritis and no previous regular exercise. The 12 subjects were assigned to Tai Chi exercise group, 13 subjects to Tai Chi exercise combined with self help management program, and the other 13 to self help management program. Tai Chi exercise group performed exercise twice a week for one hour per each session. Tai Chi self help management group came to the class twice a week, one hour for Tai Chi exercise, and another hour for self help management program. The third group came to the class once a week for one hour to participate self help management program. At the completion of 6 week programs, 10 subjects from Tai Chi exercise, 9 from Tai Chi self help, another 10 from self help management groups completed the post-test measures. The data were analyzed by SPSSWIN 11.0. The homogeneity tests for three experimental groups were conducted by $X^2-test$, Fisher's exact test, Kruskal-Wallis test. The final analysis of the post-test measures was conducted by ANCOVA with fatigue, pain, stiffness, and difficulties in daily activities of the pretest measures as covariates. Results: The results were as follows. There were no significant differences in fatigue, pain, and difficulties of daily activities among three groups for the pretest measures. The score of arthritic stiffness was significantly different among groups after controlled for covariates, but the post-hoc tests showed no group differences. Conclusion: The nursing interventions applied for osteoarthritis patients have been previously tested to show the cost effectiveness of symptoms management of this population.

• 대한간호학회지
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• 제49권2호
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• pp.113-125
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• 2019

Purpose: The purpose of this study was to examine the effects of a daily life-based physical activity enhancement program performed by middle-aged women at risk for cardiovascular disease. Methods: This study used a randomized control group pretest-posttest design. Middle-aged women aged 45 to 64 were recruited from two outpatient cardiology departments, and randomly assigned to an experimental group (n=28) and a control group (n=30). For the experimental group, after providing one-on-one counseling and education, we provided customized text messages to motivate them in daily life. To monitor the practice of physical activity, they also used an exercise diary and mobile pedometer for 12 weeks. Subjects' physical activities (MET-min/week) were measured using the International Physical Activity Questionnaire (IPAQ). Their physiological data were obtained by blood tests using a portable analyzer, and the data were analyzed using the SPSS 21.0/WIN program. Results: There were significant differences in exercise self-efficacy, health behavior, IPAQ score, body fat, body muscle, and fasting blood sugar between the two groups. However, there were no significant differences in total cholesterol, hemoglobin A1c, high-density lipoprotein cholesterol, and waist-to-hip ratio. Conclusion: Strengthening physical activity in daily life without being limited by cost burden and time and space constraints. Therefore, it is essential to motivate middle-aged women at risk for cardiovascular disease to practice activities that are easily performed in their daily lives.