• 제목/요약/키워드: level of health care plan

검색결과 138건 처리시간 0.025초

대도시 보건소 동단위 방문간호 대상자의 군분류 및 표준 방문간호서비스 경로 개발을 위한 기초연구 (A Preliminary Study on the Classification of Visiting Nursing Service Recipients and the Development of Standardized Visiting Nursing Service Pathways Based on Public Health Center)

  • 황라일;유호신;석민현;진달래
    • 지역사회간호학회지
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    • 제16권4호
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    • pp.381-391
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    • 2005
  • Purpose: The purpose of this research is to develop and classify district visiting nursing standards and to standardize visiting nursing service pathways. Method: This research was conducted as a focus group study and analyzed visiting nursing records. We surveyed 201 recipients at urban health centers, who were selected through convenient sampling, from April 2003 to November 2003. Result: First, visiting nursing service recipients were classified into four groups according to household and financial characteristics, existence of disease, ability of self-care, and existence of home care service needs. Standardized pathways of the selected items were assessment. nursing care plan, disease management and promotion of self-care ability for Level I (mean=12.2 visits). For Level II (7.3 visits) were offered assessment. disease management. health education. and health promotion services. For Level III (5.2 visits) were offered assessment. disease management. health education and health promotion services, and for Level IV (2.7 visits) were offered thorough assessment, education for self-care and health promotion. Conclusion: The visiting nursing service pathways identified in this research need to be developed further as basic materials applicable to quality assurance and agency evaluation. For this, we suggest repeated research and test to apply the derived standardized visiting nursing services pathways in visiting nursing programs.

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일본의 재가간호 및 방문간호 -새로운 개호보험제도의 실시를 앞두고- (A Study on Home Care and Home Visiting Nursing in Japan)

  • 김증임
    • 지역사회간호학회지
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    • 제10권1호
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    • pp.106-120
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    • 1999
  • Japan has been prepared for aging society from 1970. In 1970, the percentage of distribution of population of 65 years old and over was 7.1%. It is similar to present percentile of the elderly in Korea. Therefore, it will be needed to study about home care and home visiting nursing in Japan at present. This study was aimed to prepare the fundamental documents for home care nursing in Korea and to know the background of new health care system of Long-term Care Insurance in Japan, by studying home care and home visiting nursing in Japan. With the continuing aging of the population, especially the increase in the number of latter stage elderly, it is predicted that there will be an increase in the number of the elderly who are bedridden and suffering senile dementia. To ensure that these people will be able to continue living in the communities and homes they are accustomed to, surrounded by their families and neighbors, Japan substantially improve and expand in-home services. There were also long-term effort to reach the level of services outlined in the Gold Plan and the New Gold Plan within the decade between FY 1991 and FY 1999 in the field of health care and welfare. Under this plan, the most noticeable change was occurred in home care, home was permitted as the field of care and visiting nursing was established in law. Through this 10- Year Strategy for Promotion of Health and Welfare Services for the Aged, many problems have been improved and solved, but some problems remained such as inadequate service supply and consumption of medical insurance for the elderly. Japan will be a society composed 25% of elderly people of total population in 2020, and it will be soon faced with a shortage of welfare and medical facilities and manpower. As for equalizing the benefits and cost burdens, and other future arrangements for health care and welfare, Long-term Care insurance system was established in 1994. This system will be enforced from April 2000 and use present facilities and services. To know home care and home visiting nursing in Japan, we need to consider present conditions well and to take notice of changes and measures to cope with an aging society continuously.

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간호업무 전산화를 위한 표준화된 간호계획의 개발에 관한 연구 (A Study on the Development of Standardized Nursing Care Plans for Computerized Nursing Service)

  • 김조자;전춘영;임영신;박지원
    • 대한간호학회지
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    • 제20권3호
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    • pp.368-380
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    • 1990
  • A central issue in the development of nursing practice is to describe the phenomenon with which nursing is concerned. To identify the health problems which can be diagnosed and managed by the nurse is the first step to organize and ensure the development of nursing science. Therefore the academic world has been discussing the application of the nursing diagnosis in nursing practice as a means of improving quality of care. The objectives of this study were to develop a standardized nursing care plan for ten selected nursing diagnoses to form a database for computerized nursing service. The research approach used in the study was (1) the selection of the ten nursing diagnoses which occur most frequently on medical-surgical wards, (2) the development of a standardized nursing care plan for the ten selected nursing diagnoses, (3) application of the plan to hospitalize patients and evaluation of the content validity by the nurses, and (4) evaluation of the clinical effects after the use of the standardized nursing care plans. The subjects were 56 nurses and 395 hospitalized patients on two medical and two surgical unit. The results of this study were as follows ; 1) The ten selected nursing diagnoses for the development of the standardized nursing care plans were “PAIN, SLEEP DISTURBANCE, ALTERED HEALTH MAINTENANCE, ALTERATION IN NUTRITION, ANXIETY, CONSTIPATION, ALTERED PATTERNS OF URINARY ELIMINATION, DISTURBANCE IN BODY IMAGE, POTENTIAL FOR ACTIVITY INTOLERANCE AND ACTIVITY INTOLERANCE”. 2. The developed standardized nursing care plans included the nursing diagnosis, definition, defining characteristics, etiologic or related factors that contribute to the condition, recording pattern, desired outcomes and nursing orders (nursing interventions). 3. The plan was used with hospitalized patients on medical - surgical wards to test for content validity. The patient's satisfaction with the nursing care and nurses' job satisfaction were investigated to evaluate the clinical effects after the use of the standardized nursing care plans. A comparison of patient satisfaction with nursing care before and after the introduction of the standardized nursing care plans showed a statistically significant higher level of satisfaction with the standardized care plans. There was no difference in the level of job satisfaction expressed by the nursing staff before and after the standardized nursing care plans were introduced. However, when opinions about the use of the standardized nursing care plans were examined it was found that there was a positive effect on clarity in defining the nursing problems, determining nursing cost, more feasible goal setting, effective and systematic nursing records and indications for nursing research. The results of this study suggest that in order to increase the use of nursing diagnoses in the clinical area, it would be effective to select some wards as a pilot project, give the nurses training in the use of nursing diagnosis and develop and use the standardized nursing care plans. In addition to the ten diagnosis used in this study it is recommended that continual development of nursing diagnoses be done using diagnoses that are appropriate to Korea and testing them for validity through standardized care plans.

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SERVQUAL을 이용한 간병서비스 질에 대한 탐색적 연구 - 대전지역 요양병원 입원환자를 대상으로 - (An Exploratory Study on Quality of Care-Giving Service with Use of SERVQUAL -Targeting Inpatients of Long-Term Care Hospitals in Daejeon Region-)

  • 김창석
    • 보건의료산업학회지
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    • 제5권1호
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    • pp.45-60
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    • 2011
  • The purpose of this study is ultimately to contribute to enhancing quality of patients' life, by grasping quality level of care-giving service that is recognized by inpatients of long-term care hospital, and by pursuing a plan for improving quality of care-giving service based on this. For this, targeting 500 patients who entered 40 long-term care hospitals in Daejeon Metropolitan City, the quality of service was multi-dimensionally grasped by using SERVQUAL scale. As a result of research, the quality of care-giving service, which is recognized by patients as survey subjects, tended to be relatively high with about 4 points as a whole out of 5-point perfection. By item, reliability was indicated to be the highest with 4.56 points. The next was surveyed to be in order of tangibility, empathy, responsiveness, and assurance.

미국의 책임의료조직(Accountable Care Organization) 운영현황 분석과 국내 의료정책에서 정책적 함의 평가 (An Evaluation of Accountable Care Organization in USA and Policy Implications for Korean Health Care System)

  • 서경화;정유민;김민지;이선희
    • 보건행정학회지
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    • 제24권4호
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    • pp.396-412
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    • 2014
  • Background: As a reform plan of health care system, Accountable Care Organization (ACO) has became an object of attention in the United States after Patient Protection and Affordable Care Act was enacted. ACO is a group of various health care providers and provide coordinated care to its assigned beneficiaries. If ACOs improve the quality level and reduce the cost of care, they can get financial incentives. Under the discussion for a quite long time and demonstration projects, ACO has been established. We aimed to analysis and discuss the history, policy mechanism, contents, status and outcomes of ACO. Also, we intended to suggest political implication Korean health care system with regard to ACO. Methods: We searched the articles related ACO in PubMed and selected several available papers about ACO. Total 56 studies were reviewed and categorized three parts; demonstration projects for formation of ACO, policy mechanism and agenda, empirical results of ACO performance. Results: As a result, establishment of ACO was successful partly in the US. It seems to be due to various project and pilot test for verification in the long time. The empirical effect of ACO was also identified in a few study but it needs more evidences to judge its positive effect. Conclusion: In Korea, there are arguments for the application of ACO. However it is difficult to implement a ACO by different political conditions between Korean and US. Nevertheless ACO proposed us the necessity of paradigm shift in our health policy and could be significant to national policy orientation in the future.

분위회귀분석법을 이용한 노인 고혈압 환자의 자가간호에 따른 분위별 영향 요인 (Predictors of Self-care Behaviors among Elderly with Hypertension using Quantile Regression Method)

  • 이은주;박은아
    • 성인간호학회지
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    • 제27권3호
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    • pp.273-282
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    • 2015
  • Purpose: The objective of this study was to identify the predictors of self-care behaviors among elderly patients with hypertension using quantile regression method. Methods: A total of 253 elderly patients diagnosed with hypertension was recruited via 3 different medical clinics for the study. The quantile regression and a liner regression was conducted using Stata 12.0 program by analyzing predictors of self-care behaviors. Results: In the ordinary least square, self-efficacy, period of disease, and education level explained 42% of the variance in self-care activities. In the quantile regression, affecting predictors of self-care behaviors were self-efficacy for all quantiles, the period of disease for from 60% quantile to 90% quantile, education level for 20%, 30%, and 50% quantiles, economic status for 10%, 50%, and 60% quantiles, age for 10%, 70% quantiles, fatigue for 10% quantile, knowledge about hypertension for 10% and 20% quantiles, and depression for 30% and 40% quantiles. Conclusion: The affecting predictors of self-care behaviors among elderly with hypertension were different from the level of self-care behaviors. These results indicated the significance in assessing predictors according to the level of self-care behaviors when clinical nurses examine the patients' health behaviors and plan any intervention strategies. Specially, education level and knowledge about hypertension were the significant predictors of self-care activities for low quantiles. Clinical nurses may promote self-care activities of the given population though health education programs.

보건의료인을 위한 금연지도자 교육용 멀티미디어 컨텐츠 개발 (Development of Multimedia Contents on Smoking Cessation Leadership Program for Health Care Professionals)

  • 신성례;서홍관
    • 성인간호학회지
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    • 제22권6호
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    • pp.582-593
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    • 2010
  • Purpose: Health care professionals represent an immediately available resource to promote smoking cessation. However, the content in smoking cessation intervention courses in most institutions is insufficiently covered due to the limited number of class hours. The purpose of this study was to develop a comprehensive tobacco cessation-web-based, multimedia, educational program for a range of medical professionals. Methods: Based on Jung's Teaching and Learning Structure Plan Model, a development process was proposed comprising four stages: (1) analysis, (2) planning, (3) production, and (4) operation/evaluation. The effectiveness of the program was tested using quasi-experimental design, and the participants in experimental group were required to complete the program. Changes in the level of knowledge and attitude were measured. Results: The educational program developed includes nine topics and 26 sub-topics. A total of 180 storyboards, 15 videos, and 27 pictures were made. After the education, the level of knowledge was significantly increased in the experimental group. Conclusion: This web-based program can be recommended as a potential medium for health care professionals to use in counseling smoking cessation. The study findings also indicated that the program may be either offered as a teaching aid or utilized concurrently with lectures for students studying health care-related topics.

2010~2011년 국민건강영양조사를 활용한 한국 노인의 치아보유상태에 따른 사회경제적 수준 분석 (Relationship between oral health status and socioeconomic status of elderly in Korea -based on 2010~2011 Korea National Health and Nutrition Examination survey data-)

  • 최용금;한선영;김철신
    • 대한치과의사협회지
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    • 제51권5호
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    • pp.265-273
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    • 2013
  • The insurance payment plan for dental implants in Korea has been criticized because the payment priority has not been properly established, and the benefits are concentrated among middle-class citizens. In the current study, the relationship between the oral health condition and socioeconomic status of the elderly was analyzed using data from the Korea National Health and Nutrition Examination Survey (KNHANES). This study aims to determine the reason underlying the criticism of the insurance payment plan. The subjects were >65-year-old individuals in the 2010 and 2011 database of KNHANES. Data from 2,812 subjects were analyzed. The socioeconomic status was determined based on edentulousness, molar tooth loss, and presence of 28 teeth. According to the analysis, the average income was 1,560,000 won for edentulous elderly, 1,811,000 won for elderly who had lost molar teeth, and 1,896,000 won for elderly with 28 teeth (p<0.05). In addition, elderly with a low education level demonstrated a poor oral health condition (p<0.001). In conclusion, the insurance plan currently under examination is not properly designed for economically impoverished elderly because the plan only covers 50% of the costs and is limited to implantation of molar teeth only. This plan will not provide practical benefits to elderly with a poor socioeconomic status; therefore, the insurance payment plan needs to be improved so that the appropriate beneficiaries can be targeted.

한국 장기요양 방문간호의 정책적 함의와 일본 방문간호의 시사점 (Policy Implications for Home-Visit Nursing(HVN) of the Korean Long Term Care Insurance through the implications of the Japanese HVN)

  • 유호신
    • 한국보건간호학회지
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    • 제29권3호
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    • pp.403-411
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    • 2015
  • Due to lack of an information system regarding the status of using home-visit nursing (HVN), it has barriers of providing improvement of the HVN for management of elderly health care in Korea. The twofold aims of the current review are to expose the existing agendas for HVN and to suggest the political implications for HVN of Korea based on the transition process and revised HVN system of Japan. This review suggests that an information evaluation system has to precede for HVN services in detail. And, the service provided per manpower should be assessed by separating the code of manpower (registered nurse, nurse aide, dental hygienist) as well as securing detailed and precise information on the HVN services. The other suggestion, development of a community-based home health care nursing model in order to provide necessary services for long-term health insurance beneficiaries. In addition, a master plan for health care for elderly should be established at the national level in order to establish an effective home health nursing delivery system.

추후관리가 필요한 만성질환 퇴원환자 가정간호 시범사업 운영 연구 (An Operations Study on a Home Health Nursing Demonstration Program for the Patients Discharged with Chronic Residual Health Care Problems)

  • 홍여신;이은옥;이소우;김매자;홍경자;서문자;이영자;박정호;송미순
    • 대한간호학회지
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    • 제20권2호
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    • pp.227-248
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    • 1990
  • The study was conceived in relation to a concern over the growing gap between the needs of chronic patients and the availability of care from the current health care system in Korea. Patients with agonizing chronic pain, discomfort, despair and disability are left with helplessly unprepared families with little help from the acute care oriented health care system after discharge from hospital. There is a great need for the development of an alternative means of quality care that is economically feasible and culturally adaptible to our society. Thus, the study was designed to demonstrate the effectiveness of home heath care as an alternative to bridge the existing gap between the patients' needs and the current practice of health care. The study specifically purports to test the effects of home care on health expenditure, readmission, job retention, compliance to health care regime, general conditions, complications, and self-care knowledge and practices. The study was guided by the operations research method advocated by the Primary Health Care Operations Research Institute(PRICOR) which constitutes 3 stages of research : namely, problem analysis solution development, and solution validation. The first step in the operations research was field preparation to develop the necessary consensus and cooperation. This was done through the formation of a consulting body at the hospital and a steering committee among the researchers. For the stage of problem analysis, the Annual Report of Seoul National University Hospital and the patients records for last 5 years were reviewed and selective patient interviews were conducted to find out the magnitude of chronic health problems and areas of unmect health care needs to finally decide on the kinds of health problems to study. On the basis of problem analysis, the solution development stage was devoted to home care program development asa solution alternative. Assessment tools, teaching guidelines and care protocols were developed and tested for their validity. The final stage was the stage of experimentation and evaluation. Patients with liver diseases, hemiplegic and diabetic conditions were selected as study samples. Discharge evaluation, follow up home care, measurement and evaluation were carried out according to the protocols of care and measurement plan for each patient for the period of 6 months after discharge. The study was carried out for the period from Jan. 1987 to Dec. 1989. The following are the results of the study presented according to the hypotheses set forth for the study ; 1. Total expenditures for the period of study were not reduced for the experimental group, however, since the cost per hospital visit is about 4 times as great as the cost per home visit, the effect of cost saving by home care will become a reality as home care replaces part of the hospital visits. 2. The effect on the rate of readmission and job retention was found to be statistically nonsignificant though the number of readmission was less among the experimental group receiving home care. 3. The effect on compliance to the health care regime was found to be statistically significant at the 5% level for hepatopathic and diabetic patients. 4. Education on diet, rest and excise, and medication through home care had an effect on improved liver function test scores, prevention of complications and self - care knowledge in hepatopathic patients at a statistically significant level. 5. In hemiplegic patient, home care had an effect on increased grasping power at a significant level. However. there was no significant difference between the experimental and control groups in the level of compliane, prevention of complications or in self-care practices. 6. In diabetic patients, there was no difference between the experimental and control groups in scores of laboratory tests, appearance of complications, and self-care knowledge or self -care practices. The above findings indicate that a home care program instituted for such short term as 6 months period could not totally demonstrate its effectiveness at a statistically significant level by quantitative analysis however, what was shown in part in this analysis, and in the continuous consultation sought by those who had been in the experimental group, is that home health care has a great potential in retarding or preventing pathological progress, facilitating rehabilitative and productive life, and improving quality of life by adding comfort, confidence and strength to patients and their families. For the further studies of this kind with chronic patients it is recommended that a sample of newly diagnosed patients be followed up for a longer period of time with more frequent observations to demonstrate a more dear- cut picture of the effectiveness of home care.

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