• Journal of the Korea Academia-Industrial cooperation Society
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• 제17권10호
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• pp.647-654
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• 2016

The aim of this study was to investigate the effects of death education on the attitude toward DNR, fatigue, and quality of sleep for generic care worker. This study followed a nonequivalent control group and a non-synchronized design. This study was performed in a visiting generic care service institution in J city, Chung-Cheong province, Korea between February 15 to May 30, 2016. The study included 43 participants who agreed to participate in this study. They were randomly divided into two groups: 21 participants in the experimental group and 22 in the control group. Participants in the experimental group received death education 2 hours per day, once a week, for a duration of greater than 8 weeks. The effect of treatment was measured using a structured questionnaire on the attitude toward DNR, fatigue, and quality of sleep before and after 8 weeks of intervention. Data were analyzed using t-, chi-square, Fisher Exact- and paired t-tests. The experimental group showed a significantly increased attitude toward DNR (p=0.001) and quality of sleep (P<0.001), whereas significantly decreased attitude toward fatigue (p=0.030) than the control group after 8 weeks of intervention. The death education program was shown to be an effective nursing intervention for generic care workers. Therefore, we can consider the possibility of incorporating death education in the nursing program.

• The Korean Nurse
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• 제29권2호
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• pp.48-65
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• 1990

The government has adopted a policy to introduce Home Health Care Program, and has established a three stage plan to implement it. The three stage plan is : First, to amend Article 54 (Nurses for Different Types of Services) of the Regulations for Implementing the Law of Medical Services; Second, to tryout the new system through pilot projects established in public hospitals and clinics; and third, to implement at all hospitals and equivalent medical institutions. In accordance with the plan, the Regulation has been amend and it was promulgated on January 9,1990, thus establishing a legal ground for implementing the policy. Subsequently, however, the Medical Association raised its objection to the policy, causing a delay in moving into the second stage of the plan. Under these circumstances, a study was conducted by collecting and evaluating the opinions of physicians, nurses, non-medical personnel and patients on the need and expected result from the home health care for the purpose of help facilitating the implementation of the new system. As a result of this study, it was revealed that: 1. Except the physicians, absolute majority of all other three groups - nurses, non-medical personnel and patients -gave positive answers to all 11 items related to the need for establishing a program for Home Health Care. Among the physicians, the opinions on the need for the new services were different depending on their field of specialty, and those who have been treating long term patients were more positive in supporting the new system. 2. The respondents in all four groups held very positive view for the effectiveness and the expected result of the program. The composite total of scores for all of 17 items, however, re-veals that the physicians were least positive for the- effectiveness of the new system. The people in all four groups held high expectation on the system on the ground that: it will help continued medical care after the discharge from hospitals; that it will alleviate physical and economic burden of patient's family; that it will offer nursing services at home for the patients who are suffering from chronic disease, for those early discharge from hospital, or those who are without family members to look after the patients at home. 3. Opinions were different between patients( who will receive services) and nurses (who will provide services) on the types of services home visiting nurses should offer. The patients wanted "education on how to take care patients at home", "making arrangement to be admitted into hospital when need arises", "IV injection", "checking blood pressure", and "administering medications." On the other hand, nurses believed that they can offer all 16 types of services except "Controlling pain of patients", 4. For the question of "what types of patients are suitable for Home Health Care Program; " the physicians, the nurses and non-medical personnel all gave high score on the cases of "patients of chronic disease", "patients of old age", "terminal cases", and the "patients who require long-term stay in hospital". 5. On the question of who should control Home Health Care Program, only physicians proposed that it should be done through hospitals, while remaining three groups recommended that it should be done through public institutions such as public health center. 6. On the question of home health care fee, the respondents in all four groups believed that the most desireable way is to charge a fixed amount of visiting fee plus treatment service fee and cost of material. 7. In the case when the Home Health Care Program is to be operated through hospitals, it is recommended that a new section be created in the out-patient department for an exclusive handling of the services, instead of assigning it to an existing section. 8. For the qualification of the nurses for-home visiting, the majority of respondents recommended that they should be "registered nurses who have had clinical experiences and who have attended training courses for home health care". 9. On the question of if the program should be implemented; 74.0% of physicians, 87.5% of non-medical personnel, and 93.0% of nurses surveyed expressed positive support. 10. Among the respondents, 74.5% of -physicians, 81.3% of non-medical personnel and 90.9% of nurses said that they would refer patients' to home health care. 11. To the question addressed to patients if they would take advantage of home health care; 82.7% said they would if the fee is applicable to the Health Insurance, and 86.9% said they would follow advises of physicians in case they were decided for early discharge from hospitals. 12. While 93.5% of nurses surveyed had heard about the Home Health Care Program, only 38.6% of physicians surveyed, 50.9% of non-medical personnel, and 35.7% of patients surveyed had heard about the program. In view of above findings, the following measures are deemed prerequisite for an effective implementation of Home Health Care Program. 1. The fee for home health care to be included in the public health insurance. 2. Clearly define the types and scope of services to be offered in the Home Health Care Program. 3. Develop special programs for training nurses who will be assigned to the Home Health Care Program. 4. Train those nurses by consigning them at hospitals and educational institutions. 5. Government conducts publicity campaign toward the public and the hospitals so that the hospitals support the program and patients take advantage of them. 6. Systematic and effective publicity and educational programs for home heath care must be developed and exercises for the people of medical professions in hospitals as well as patients and their families. 7. Establish and operate pilot projects for home health care, to evaluate and refine their programs.

• Journal of Korean Public Health Nursing
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• 제11권1호
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• pp.138-162
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• 1997

This study was conducted to, develop the social workers role participating health and welfare services production of health centers The sharp increase rate on the elderly population in Korea lead the social issues as that health and social services are not developed enough to cope with the increase on the elderly's hearth care needs. The priority in the elderly's care service development should be put on public sectors. so that could prevent financial catastrophy of the elderly's care. The pulbic sector was concerned with health center services : as health center in Korea provide :mainly medical-oriented services. this study focused on to combine the existing health center's services into social services. The study method was based on needs survey with 322 patients aged over than 55 in rural area. "The needs survey include general health and disease care needs and daily life caring needs. The latter was applied with ADL and IADL with modificiation for the use of Korea environment. The findings were as follows : Social workers should be able to care diseases of muscular and skeletal. circulatory, digestive and general chronic disease in social service needs. aspect. Mostly the chronic pateints quit their care services because of shortage of finanical support$(18.3\%)$ and transportation problem$(19.5\%)$, but still prefer to be cured and cared from general hospitals. and at least clinic and health centers in community. The univisible dramatic effect. of health. care services also should be concerned and cared by xocial workers. The ADL and! IADL shown the most needs on transportation needs and problems caused by weaken legs. Mostly daily activities were supported by family members $(53.3\%\;spousers\;and\;35.0\%\;children)$, and the most demands were shown on helps for transportation visiting hospitals$(37\%)$ and getting similar care services for health care needs $(31.2\%)$ and daily hygeieal needs$(11.2\%)$ Social workers' role should include health care participation with social and health promotion approach as well as socio-economic supports: during health care receiving. Social workers also should provide social services for the elderly's daily needs solving for these are not in available family supporters.

• Journal of the Korea Convergence Society
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• 제12권12호
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• pp.443-451
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• 2021

This study is a qualitative research using focus group interviews with disabled people and their families to understand the unmet healthcare needs perceived themselves and to analyze the experiences of 'The 2^nd pilot project for primary care for people with disabilities', from 9 to 17 February 2021. The subjects of the study was the disabled who can express their opinions (group 1) or the guardians of the subjects who can not express their opinions (group 2). The participants were interviewed for about 100 minutes for each group once or twice. As a result of this study, the factors regarding unmet healthcare needs were extracted in subject, provider, institutional, and socio-cultural aspects. Further, the factors resolved and unresolved by the pilot project were extracted. Based on the results, we can recommend that the expanded application to the visiting service, inclusion of doctors from various departments, multidisciplinary approach including physical or occupational therapists, minimizing disconnection among the hospitals and healthcare centers, improvement of service quality by collecting opinions from people with disabilities, and more publicity activities should be applied.

• Journal of Korean Academy of Nursing
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• 제28권4호
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• pp.958-969
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• 1998

In this study, we attempted to investigate the needs and problems of the terminal cancer patients and their family caregivers to provide them with nursing information to improve their quality of life and prepare for a peaceful death. Data was collected from August 1, 1995 to July 31, 1996 at the internal medicine unit of S hospital in Seoul area with the two groups of participants who were family members of terminal cancer patients seventy four of them were in-patients and 34 were out-patients who were discharged from the same hospital for home care. The research tool used in this study has been developed by selecting the questionnaires from various references, modifying them for our purpose and refining them based on the results of preliminary study. While general background information about the patients was obtained by reviewing their medical records, all other information was collected by interviewing the primary family caregivers of the patients using the questionnaire. The data collected were analyzed with the SPSS PC/sup +/ program. The results of this study are summarized as follows ; 1) Most frequently complained symptoms of the terminal cancer patients were in the order of pain(87%), weakness(86.1%), anorexia(83.3%) and fatigue (80.6%). 2) Main therapies for the terminal cancer patients were pain control (58.3%), hyperalimentation(47.2%) and antibiotics(21.3%). 3) Special medical devices that terminal cancer patients used most were oxygen device (11.1%), and feeding tube(5.6%). Other devices were used by less than 5% of the patients. 4) The mobility of 70.4% of the patients was worse than ECOG 3 level, they had to stay in bed more than 50% of a day. 5) Patients wanted their medical staffs to help relieve pain(45.4%), various physical symptoms(29.6%), and problems associated with their emotion(11.1%). 6) 16.7% of the family caregivers hoped for full recovery of the patients, refusing to admit the status of the patients. Also, 37% wished for the extension of the patient's life at least for 6 months. 7) Only 38.9% of the family members was preparing for the patient's funeral. 8) 45.4% of family caregivers prefer hospital as the place for the patient's death, 39.8% their own home, and 14.8% undetermined. 9) Caregivers of the patients were mostly close family members, i.e., spouse(62%), and sons and daughters or daughter-in-laws(21.3%). 10) 43.5% of the family caregivers were aware of hospice care. 46.8% of them learned about the hospice care from the mass media, 27.7% from health professionals, and the rest from books and other sources. 11) Caregivers were asked about the most difficult problems they encounter in home care, 41 of them pointed out the lack of health professionals they can contact, counsel and get help from in case of emergency, 17 identified the difficulty of finding appropriate transportation to hospital, and 13 stated the difficulty of admission in hospital as needed. 12) 93.6% of family caregivers demanded 24-hour hot line, 80% the visiting nurses and doctors, and 69.4% the volunteer's help. The above results indicate that terminal patients and their family caregivers demand help from qualified health professionals whenever necessary. Hospice care system led by well-trained medical and nursing staffs is one of the viable answers for such demands.

• Health Policy and Management
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• 제19권3호
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• pp.27-44
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• 2009

The length of stay in emergency departments has been used as a quality indicator to reflect the overall efficiency of emergency care. Identifying characteristics associated with length of stay is critical to monitor overcrowding and improve efficient throughput function of emergency departments. This study examined the level of waiting time for initial assessment by physician and length of stay in emergency departments. Furthermore, we investigated the characteristics of patients' attendance associated with length of stay. An observational study was performed for a sample of 1,526 patients visiting ten nation-wide emergency departments. A structured form was designed to collect information about patients' demographics, route of admission, time and mode of arrival, triage level, cause of attendance, initial assessment time by physician, departure time, and disposition. Multiple regression analysis was performed to determine factors associated with length of stay. The average length of stay was 209.4 minutes (95% confidence interval [CI]=197.1-221.7), with a mean waiting time for initial assessment of 5.9 minutes (95% CI=5.1-6.7). After controlling for emergency department characteristics, increasing age, longer waiting times, attendance due to diseases, higher acuity, multiple diagnoses($\geq$2) and requiring admission or transfer to other health care facilities were positively associated with length of stay in emergency departments. The findings suggest that both patients' characteristics and the flow between emergency departments and parent hospitals should be taken into account in predicting length of stay in emergency departments.

• Quality Improvement in Health Care
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• 제25권2호
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• pp.16-25
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• 2019

Purpose:The healthcare system of South Korea is at the extreme of the dispersed system. Few regulations limit patients from directly visiting higher-level medical institutions for primary care sensitive conditions. As a result, similar to local clinics, general and tertiary teaching hospitals also provide diverse primary care services. Our study aimed to examine the general public's perceptions of their primary care performance. Methods: Face-to-face surveys were conducted with 1000 adults who were living in South Korea with the aid of a questionnaire that included the Korean Primary Care Assessment Tool (KPCAT). The KPCAT consists of five domains, which are the main indicators of primary care performance: first contact, comprehensiveness, coordination, personalized care, and family/community orientation. One-way analysis of variance and post hoc tests were used to compare the KPCAT scores across the three types of medical institutions. Results: Domain-wise analyses revealed two different patterns. With regard to first contact and its subdomains, the highest and lowest scores emerged for local clinics and tertiary teaching hospitals, respectively. However, the other four domain scores were significantly lower for local clinics than for the other two types of medical institutions. Conclusions: Local clinics were perceived to be medical institutions that are responsible for providing primary care. However, the general public perceived only one domain of their primary care to be superior to that of the other two types of medical institutions: first contact. National efforts should be taken to strengthen their other four domains of primary care by training their workforce and providing appropriate incentives.

• Journal of Digital Convergence
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• 제17권11호
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• pp.29-37
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• 2019

Elderly people want to live in the community even if they are in poor health. However, there is no integrated care support system suitable for the health and functional status of the elderly. So the elderly are choosing living facilities. The purpose of this study is to explore exploring whether the elderly are applying for a long-term care certification. First, mild geriatric patients were mainly using home care services such as visitation care. However, some of the milder elderly were enrolled in nursing homes. And the service that does not fit the functional status of the elderly is used. Second, it is concentrated on the use of visiting care services. Third, elderly people outside the class did not receive sufficient help for daily life, and the use of community welfare services such as the elderly welfare center was low. As a result, long-term care admitters are not able to continue to live in the community even though their health and functioning status is mild, and elderly people out of grade are unable to properly use the necessary community care services. The condition is likely to deteriorate.

• Journal of Korean Public Health Nursing
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• 제10권2호
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• pp.146-161
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• 1996

This study was purposed to find health promotion and care needs of the elderly in rural area of Korea. As the rural elderly are limited in accessibility to health care resources and could not immediately solve their health care needs when they need. health promotion and care services are expected to bring better and more practical solutions of their health care needs. Thus, the type of health care services to be developed in Korea rural area is discussed to have emphasis on health care service component in addition to health promoting components. Methods of this study was based on survey data analysis : total 322 persons aged older than 55 living at one 'Kun' in Korea administrative unit were interviewed by health workers working at the region and also get trained for this study data collection. The data collection interview was continued from February till May in 1996. The interview questions were modified with adjustment to Korea situation. with basis of the WHO's health promotion program components. The collected data were analyzed using SAS program for frequency, correlation, regressions. The major findings were as follows : (1) $74.8\%$ of the surveyed were sick at the survey time point. and $95.9\%$ known the diagnosis name of the disease. The most frequently complained diseases were Muscular-Skeletal diseases $(43.7\%)$. $34\%$ of those sick had never treated or discontinued therapeutic procedures. so that shown the necessity of systematic and usual health care services with health promotion program development for the elderly. (2) The percent of those who make social participation was $95.3\%$. and the activities were visiting neighbors $(70.4\%)$ and lack of qualified social activity programs. (3) $78.1\%$ of the surveyed had health counseling and education from professional health workers. Those ceased smoking and drinking were $59.6\%,\; 60.3\%$. respectively. Those had no application of therapeutic drugs or nutrion supplements was $40.7\%\;and\;94.1\%$ had regular meals. Those practiced exercises was low remarking $17.7\%$. (4) Positive health behaviors were better carried out by sick groups than by the healthier. except smoking. regular meals. and exercise. $17.5\%$ of sick group smoke more than one case of cigarettes. in contrast to $9.5\%$ of the healthier. (5) Mental health status was heathier among positive health behavior earners. Health counseling and education shown better score of mental health than those never counseled. (6) Positive health behavior practice frequency did not show significant differences when crossed by social activity participation status. (7) Health behaviors of the rural elderly people were carried out better when they had positive 'continuency in therapeutic procedure' 'health status'. 'familial relationship'. 'Health Status' of the rural olderly were explained by 'exercise'. 'drinking'. 'familial relationship'. 'activities of daily living'. Thus, health behaviors practice mutually interact with health status. In conclusion. the health promotion and care program component are recommended to include ation on the necessity of positive health promotion active social acitivities. pleasant life style, adaption into changes on the elderly, safety in residential area. community acitivity and resource utilization. etc .. in addition to the elderly's disability and sickness caring services.

• Journal of the Korea Academia-Industrial cooperation Society
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• 제19권1호
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• pp.355-367
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• 2018

The purpose of this study was to identify the predictors of the quality of life in community dwelling vulnerable older women with chronic joint pain. A cross-sectional study was conducted on 234 participants registered at a visiting health care service in the public health center of C-city. The structured questionnaire were used to collect data on the general characteristics, pain rating index, pain intensity, perceived health status, functional independence, sleep pattern, depression, and quality of life from February 16 to March 13, 2017. The data were analyzed using a t-test, ANOVA, Pearson's correlation coefficients, and hierarchical multiple regression analysis. The significant factors of the quality of life including general characteristics were depression (${\beta}=-.60$, p<.001), pain intensity scale (${\beta}=-.15$, p=.007), health insurance type (${\beta}=.15$, p=.001), perceived health status (${\beta}=.14$, p=.007), duration of pain (${\beta}=-.10$, p=.019), marital status (${\beta}=.10$, p=.024), and functional independence (${\beta}=.09$, p=.036). These factors accounted for 63.1% of the total variance in the quality of life. The findings suggest that a public healthcare program on managing depression is effective in improving the quality of life in community dwelling older women with chronic joint pain. Public health nurses should intervene in nursing care for economically vulnerable aged and pain management based on a precise assessment from the beginning of pain.