• Perspectives in Nursing Science
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• 제15권2호
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• pp.49-69
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• 2018

Purpose: The purpose of this study was to derive contextual indicators of medical provider quality and assess their relative importance along with the individual utilization of antenatal care (ANC) and institutional births with a skilled birth attendant (SBA) in India using a multilevel framework. Methods: The 2015~2016 Demographic and Health Survey (DHS) from India was used to assess the outcomes of neonatal, infant, and under-five child mortality. The final analytic sample included 182,980 children across 28,283 communities, 640 districts, and 36 states and union territories. The contextual indicators of medical provider quality for districts and states were derived from the individual-level number of ANC visits (<4 or ${\geq}4$) and institutional delivery with SBA. A series of random effects logistic regression models were estimated with a stepwise addition of predictor variables. Results: About half of the mothers (47.3%) had attended ${\geq}4$ ANC visits and 75.8% delivered in institutional settings with SBAs. Based on ANC visits, 276~281 districts (43.1~43.9%) and 13~16 states (36.5~44.4%) were classified as "low" quality areas, whereas 268~285 districts (41.9~44.5%) and 8~9 states (22.2~25.0%) were classified as "low" quality areas based on institutional delivery with SBAs. Conditional on a comprehensive set of covariates, the individual use of both ANC and SBA were significantly associated with all mortality outcomes (OR: 1.17, 95% CI: 1.08, 1.26, and OR: 1.10, 95% CI: 1.02, 1.19, respectively, for under-five child mortality) and remained robust even after adjusting for contextual indicators of medical provider quality. Districts and states with low quality were associated with 57~61% and 27~43% higher odds of under-five child mortality, respectively. Conclusion: When simultaneously considered, district- and state-level provider quality mattered more than individual access to care for all mortality outcomes in India. Further investigations are needed to assess the importance of improving the quality of health service delivery at higher levels to prevent unnecessary child deaths in developing countries.

• 아동학회지
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• 제21권4호
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• pp.177-196
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• 2000

A large sample (1090) of randomly selected early childhood education professionals and government officials rated each of the 133 standards of "A Model for Institutional Accreditation for Early Childhood Education and Care"(Yang, 1999) on a scale of 1 (least important) to 5 (most important). Findings were that all kindergartens and child care centers should be evaluated for accreditation every 3 years with 3-6 months for self-study and on-site validation visits by representatives of the appropritates agencies for 1-2 days. Evaluation results are should be used by institution personnel as a guide to self-supervision, by government officials as a funding standard and by parents as criteria of program quality. Essential accreditation standards included: facilities and equipment; curriculum; nutrition, health and safety; administration and management; and support systems. Safety and teacher-child interactions were most highly rated while parent involvement was not highly rated.

• 한국농촌간호학회지
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• 제4권1호
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• pp.41-50
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• 2009

By the rural area health care special law in 1980, Primary health care posts were established in rural areas as fundamental elements of the national health system. Nurses have been deployed to the posts after taking an education course mandated by the special law. However, health care posts have confronted environmental changes over the past 30 years such as an aging and decreasing rural population and advanced traffic systems, which make it necessary to reshape their form and role. Therefore, some guidelines are suggested for future role enlargement of health care posts by analyzing their current management and duties. The guidelines are as follows: 1) enlarging the portion of prevention and management of chronic degenerative diseases, 2) development and practice of diverse health promotion programs, 3) extension of primary health care for the increasing older population, 4) development of health programs for married immigrants, 5) practice of timely maternal child health programs, 6) development of adequate health care posts for low-income people in rapidly urbanizing rural areas and in poor areas in big cities, and 7) revision of laws and institutional arrangements for the role enlargement of health care posts to match social changes and customer needs.

• 예술인문사회 융합 멀티미디어 논문지
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• 제9권11호
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• pp.1015-1026
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• 2019

본 연구에서는 노인장기요양시설 평가지표개발과 관련된 선행연구의 평가현장 적용성 및 실효성이 미흡하다는 문제의식하에, 노인장기요양기관(시설급여) 평가의 품질향상을 위한 평가지표를 개발하는 데 연구의 목적이 있었다. 이를 위해 2018년도 노인장기요양기관(시설급여) 평가지표에 대한 분석적 고찰, 일본의 노인특별요양홈 평가지표에 대한 분석, 한국의 노인장기요양시설 종사자와 일본의 노인특별요양홈 종사자를 대상으로 한 평가지표 및 평가체계에 관한 FGI를 실시하였다. 연구결과를 토대로 하여 이용자가 양질의 서비스를 제공 받을 수 있도록 지원하는 측면에서 평가지표를 개발하였다. 노인의 특성, 즉 유지 및 호전되기 어려운 노인성 질환의 특성과 기관운영의 방향 및 투명성, 그리고 종말기 케어의 필요성 등을 반영하였다. 기관운영, 환경 및 안전, 수급자 권리보장, 급여제공과정, 급여제공결과를 포괄하는 43개의 평가지표를 제시하였다. 또한, 중복되고, 불필요한 평가과정을 개선하여 평가의 과정 효율성을 증가시킬 수 있는 4단계 다층평가시스템을 제안하였다.

• 한국엔터테인먼트산업학회논문지
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• 제14권1호
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• pp.179-186
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• 2020

본 연구의 목적은 독거노인의 노인돌봄서비스 만족도에 영향을 미치는 요인을 살펴보고, 노인돌봄서비스의 만족도 증진을 위한 기초 자료를 제공하고자 한다. 연구대상은 충북 J시의 노인돌봄기본서비스를 받고 있는 65세 이상 독거노인 301명을 대상으로 하였으며 영향요인을 살펴보기 위해 다중회귀분석을 실시하였다. 본 연구결과 독거노인의 노인돌봄서비스 만족도에 영향을 미치는 요인은 관리사 요인, 서비스 요인, 기관 요인, 소득수준이 유의미한 것으로 나타났다. 이는 생활관리사, 서비스 요인, 기관 요인이 높을수록, 소득수준이 낮은 독거노인 일수록 노인돌봄서비스 만족도가 높은 것으로 나타났다. 특히 생활관리사 요인이 노인돌봄서비스 만족도에 가장 큰 영향을 미치는 것으로 나타났으며, 다음은 기관요인, 서비스요인, 소득수준 순으로 나타났다. 이러한 연구결과를 근거로 정책제언을 하면 첫째, 생활관리사들의 전문성 증진과 처우개선, 둘째, 기관의 전문적이고 체계적인 서비스 지원과 사회안전망 강화, 셋째, 노인돌봄서비스의 품질향상을 위한 적절성·접근성·지속성 강화가 필요하다.

• 한국콘텐츠학회논문지
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• 제16권9호
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• pp.362-375
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• 2016

본 연구의 목적은 대학에 진학한 시설보호 청년의 결혼 태도와 결혼 태도 영향요인을 발견하는 것이다. 대학에 진학한 시설보호 청년은 발달단계상 성인이행기에 있으며, 이 발달단계에서 중요한 발달과업 중의 하나는 친밀하고 낭만적인 관계 맺기, 결혼의 선택이다. 본 연구는 이들의 결혼 이슈를 결혼 태도를 중심으로 살펴보았다. 전국의 양육시설과 자립생활관의 협조를 받아 총214명의 대학 진학 시설보호 청년에 대한 설문조사를 시행하였고 연구 결과, 이들의 결혼에 대한 태도는 대체로 호의적인 것으로 나타났다. 이들은 결혼을 외로움을 해소시켜주는 바람직하고 좋은 것으로 인식하는 경향이 있었다. 결혼 태도에 영향을 미치는 요인은 성별, 경제 수준, 자아정체감으로 나타났다. 자아정체감 하위3요소 가운데 자기 수용성, 즉 자신감과 자신을 신뢰하는 정도가 결혼 태도에 영향을 미쳤다. 이러한 연구 결과를 바탕으로 시설보호 청년의 자립 과정에서 결혼 이슈를 고려하는 것의 필요성과 의의, 결혼이 실질적인 자립 지원책으로 기능하기 위해 고려되어야 할 사항 등을 제시하였다.

• 보건행정학회지
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• 제28권4호
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• pp.392-401
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• 2018

Background: Physical activity (PA) is critical for maintaining the health and well-being of older people in community and also institutional settings. The purpose of this study was to examine the current status of PA and related individual and organizational factors among older nursing home residents with and without dementia. Methods: This is a secondary data analysis study of a nationwide survey of 92 long-term care facilities in Korea, and the study sample includes older residents with dementia (n= 753) and without dementia (n= 480). The level of PA was measured by PA time and whether or not residents had an outdoor activity over the past 3 days. Multi-variate, multi-level analyses were conducted. Results: More than half of the sample in both groups had no or less than 1 hour of PA. About one out of four older people in our sample had no outdoor activity over the past 3 days regardless of whether or not they had dementia. Among the people without dementia, several individual-level factors were associated with PA, including dependency for activities of daily living, social activity participation, and caregivers' belief in the functional improvement of residents. Unlike the non-dementia group, individual- and organizationallevel factors including staffing level and having the relevant equipment for PA were associated with PA among those with dementia. Conclusion: Study findings provide evidence on the lack of PA among older nursing home residents, and the importance of institutional capacity with regard to human resources and physical equipment for promoting PA among people with dementia, in particular. Policies and supports are needed to promote the implementation of healthy aging programs including PA for older nursing home residents. Such programs should be person-centered with consideration to the physical and cognitive status of individual residents.

• 가정∙방문간호학회지
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• 제20권1호
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• pp.44-52
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• 2013

Purpose: To identify factors that affect the job stress of visiting nurses at health centers in Seoul, Korea, who perform home care services. Methods: Data were collected in the period from November 20 to December 10, 2008, from 206 visiting nurses working at 25 health centers in Seoul metropolitan city. Self-report questionnaires of the Organization-Based Self-Esteem (OBSE) and the Korean Occupational Stress Scale (KOSS) were used. Data were analyzed by the SPSS win 15.0. Results: Several findings were obtained from the study. First, the mean of job stress was 52.4 points, which was higher than that of Korean women. Second, it was shown that by the sub-domain of job stress, the mean value belonged to the top 50% in the four sub-domains of physical environment, job demand, interpersonal conflict, and organizational system. Additionally, it belonged to the top 25% in the sub-domain of job insecurity, wherein the job stress was the highest. Third, the self-esteem of the nurses had the most significant effect on their job stress. Conclusion: Stress related to job insecurity was the highest among the visiting nurses at health centers in Seoul who perform the custom home care service thus, institutional support is urgently needed to alleviate such stress and secure their employment.

• Journal of Hospice and Palliative Care
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• 제26권2호
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• pp.95-100
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• 2023

With the implementation of Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End of Life, interests of the general public on self-determination right and dignified death of patients have increased markedly in Korea. However, "self-determination" on medical care is misunderstood as decision not to sustain life, and "dignified death" as terminating life before suffering from disease in terminal stage. This belief leads that physician-assisted suicide should be accommodated is being proliferated widely in the society even without accepting euthanasia. Artificially terminating the life of a human is an unethical act even though there is any rational or motivation by the person requesting euthanasia, and there is agreement thereof has been reached while there are overseas countries that allow euthanasia. Given the fact that the essence of medical care is to enable the human to live their lives in greater comfort by enhancing their health throughout their lives, physician-assisted suicide should be deemed as one of the means of euthanasia, not as a means of dignified death. Accordingly, institutional organization and improvement of the quality of hospice palliative care to assist the patients suffering from terminal stage or intractable diseases in putting their lives in order and to more comfortably accept the end of life physically, mentally, socially, psychologically and spiritually need to be implemented first to ensure their dignified death.

• 한국노년학
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• 제41권1호
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• pp.85-105
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• 2021

본 연구는 활동적 노화의 관점을 적용하여 장기요양시설에서의 돌봄 유형에 관한 다양한 인식유형을 분석하는 데 목적을 둔다. 이를 위해 Q방법론을 적용하였다. WHO의 활동적 노화를 위한 건강, 안전, 참여 세 영역에서 장기요양시설의 돌봄에 관한 다양한 생각을 파악하기 위해 심층면접을 진행하였다. 면접조사에는 장기요양시설 거주 노인, 거주 노인의 성인자녀, 지역사회 거주 노인, 서비스 제공자, 장기요양 전문가 등 35명이 참여하였다. 451개의 Q모집단 중 63개의 Q표본을 추출하였으며, 최종 자료분석에는 43개의 P표본 자료가 활용되었다. QUANL 프로그램을 활용하여 자료를 분석한 결과, 3개의 요인구조(4개 유형)가 적합하며 이는 전체 변량의 30.15%를 설명하는 것으로 나타났다. 현재 장기요양시설의 돌봄은 보호 중심 돌봄(1유형), 참여 중심 돌봄(2유형), 의료연계 중심 돌봄(3유형), 인간 중심 돌봄(4유형)으로 유형화할 수 있다. 본 연구결과를 바탕으로 장기요양시설에서 돌봄의 질적 변화를 위한 제도적, 실천적 함의를 제시하였다.