Therapeutic Science for Rehabilitation (재활치료과학)

Korean Society of Neurological Occupational Therapy (대한신경계작업치료학회)
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Survey on the Discharge Planning of Occupational Therapists

국내 작업치료사의 퇴원계획 개입에 대한 실태 조사연구

  • Hwang, Na-Kyoung (Dept. of Occupational Therapy, Seoul North Municipal Hospital) ;
  • Yoo, Eun-Young (Dept. of Occupational Therapy, College of Health Science, Yonsei University)
  • 황나경 (서울특별시 북부병원) ;
  • 유은영 (연세대학교 보건과학대학 작업치료학과)
  • Received : 2019.09.03
  • Accepted : 2019.11.12
  • Published : 2020.05.31
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Abstract

Objective : The purpose of this study was to investigate the necessity of occupational therapist's involvement in patient discharge planning, the areas that should be considered for discharge screening and planning, and to provide the basic data required for the development of a discharge assessment tool. Methods : We conducted an online questionnaire survey of 60 occupational therapists who were working at medical institutions and had agreed to participate in the study. The questionnaire was composed of 36 questions regarding the general characteristics of the current discharge planning process and the necessity of discharge assessment and planning. Descriptive statistics, an independent t-test, and a one-way ANOVA were conducted using SPSS 20.0. As for the post-hoc test, Scheffe's test was used. Results : The awareness of occupational therapist's role in discharge planning and the necessity of a discharge assessment tool were high, but the occupational therapist's awareness of discharge-related knowledge was low. The difficulties in discharge planning showed high response rate in the absence of adequate fee-for-service in the patient interview and assessment and the lack of team approach and appropriate assessment tools for discharge planning. The high-needs areas for evaluation during discharge were fall risk and BADL, and the low-needs areas were well-being and functional level prior to onset. Conclusion : This study is expected to provide preliminary information necessary for the development of a discharge assessment tool for effective discharge planning.

목적 : 본 연구는 환자의 퇴원계획에 대한 작업치료사 개입의 필요성과 퇴원 스크리닝과 계획을 위해 고려되어야할 영역을 조사함으로써 효과적인 퇴원계획 실행을 위한 퇴원평가도구의 개발의 기초 자료를 제공하고자 실시되었다. 연구방법 : 연구 참여에 동의한 의료기관에서 근무하는 작업치료사 60명을 대상으로 온라인 설문 조사를 실시하였다. 설문 내용은 일반적 특성, 퇴원계획 현황, 퇴원평가와 퇴원계획 필요성, 총 36문항으로 구성되었다. 수집된 자료는 SPSS 20.0 프로그램을 이용하여 기술통계, 독립표본 티 검증, 일원배치분산분석, 사후검증은 쉐페 검증으로 분석하였다. 결과 : 퇴원계획과 준비에 대한 작업치료사의 역할과 퇴원평가도구의 필요성에 대한 인식은 높게 나타났으나, 작업치료사의 퇴원 관련 지식 및 정보 보유에 대한 인식 정도는 낮은 것으로 조사되었다. 퇴원계획중재 시 겪게 되는 어려움은 면담과 평가를 위한 적절한 수가의 부재, 퇴원계획을 위한 팀 접근의 부족, 퇴원계획을 위한 적절한 평가도구의 부재에 대한 응답이 높게 나타났다. 퇴원 시 평가의 필요성이 높은 영역은 낙상위험과 BADL수행으로 나타났으며, 평가의 필요성이 낮은 영역은 안녕감과 발병 전 기능수준으로 나타났다. 결론 : 본 연구를 통해 퇴원계획에 대한 작업치료사 개입의 필요성을 파악할 수 있었으며, 향후 효과적인 퇴원계획 실행을 위한 퇴원평가도구 개발의 기초자료가 될 것으로 사료된다.

Keywords

References

  1. 김형섭, 김종문, 임현선, 홍지성, 하다솔, & 권준범 (2015). 뇌졸중 환자의 급성기 의료이용 분석을 통한 효율적 재활이용 근거 생성 연구. Retrieved from https://www.nhimc.or.kr/open-Info/management/audit/hospital_41_disc_audit05_1.do
  2. Back, J. Y., & Jun, S. E. (2012). Effects of symptom-based discharge education for stroke patients. Journal of the Korean Data Analysis Society, 14(5), 2541-2553.
  3. Blaga, L., & Robertson, L. (2008). The nature of occupational therapy practice in acute physical care settings. New Zealand Journal of Occupational Therapy, 55(2),11-18.
  4. Carroll, A., & Dowling, M. (2007). Discharge planning: Communication, education and patient participation. British Journal Nursing, 16(14), 882-886. doi:10.12968/bjon.2007.16.14.24328
  5. Chatterji, S., Byles, J., Cutler, D., Seeman, T., & Verdes, E. (2015). Health, functioning, and disability in older adults-present status and future implications. Lancet, 385(9967), 563-575. doi:10.1016/s0140-6736(14)61462-8
  6. Craig, G., Robertson, L., & Milligan, S. (2004). Occupational therapy practice in acute physical health care settings: A pilot study. New Zealand Journal of Occupational Therapy, 51(1), 5-13.
  7. Crennan, M., & MacRae, A. (2010). Occupational therapy discharge assessment of elderly patients from acute care hospitals. Physical & Occupational Therapy in Geriatrics, 28(1), 33-43. doi:10.3109/02703180903381060
  8. Eija, G., & Marja-Leena, P. (2005). Home care personnel's perspectives on successful discharge of elderly clients from hospital to home setting. Scandinavian Journal of Caring Sciences, 19(3), 288-295. doi:10.1111/j.1471-6712.2005.00343.x
  9. Fine, A. H. (1996). Leisure, living, and quality of life. In R. Rewick, I. Brown, & M. Nagler(Eds.), Quality of life in health promotion and rehabilitation(pp. 342-356). Thousand Oaks, CA: Sage Publications.
  10. Gorman, S. L., Wruble Hakim, E., Johnson, W., Bose, S., Harris, K. S., Crist, M. H., ... Coe, J. B. (2010). Nationwide acute physical therapy practice analysis identifies knowledge, skills, and behaviors that reflect acute care practice. Physical Therapy, 90(10), 1453-1467 doi:10.2522/ptj.20090385
  11. Hager, J. S. (2010). Effects of a discharge planning intervention on perceived readiness for discharge (Doctoral dissertation). Retrieved from http://sophia.stkate.edu/dnp_projects/2
  12. Hamby, J. R. (2011). Discharge planning: A consultative partnership. In H. Smith-Gabai(Ed.), Occupational therapy in acute care(pp. 687-698). Bethesda, MD: AOTA.
  13. Holm, S. E., & Mu, K. (2012). Discharge planning for the elderly in acute care: The perceptions of experienced occupational therapists. Physical & Occupational Therapy in Geriatrics, 30(3), 214-228. doi:10.3109/02703181.2012.719601
  14. Hyndman, D., & Ashburn, A. (2003). People with stroke living in the community: Attention attention deficits, balance, ADL ability and falls. Disability and Rehabilitation, 5(15), 817-822. doi:10.1080/0963828031000122221
  15. Jun, S. H. (2010). Nursing needs of the elderly inpatients at the discharge stage (Master's thesis). Ewha wamans University, Seoul.
  16. Kripalani, S., Theobald, C. N., Anctil, B., & Vasilevskis, E. E. (2014). Reducing hospital readmission rates: Current strategies and future directions. Annual Review of Medicine, 65, 471-485. doi:10.1146/annurev-med-022613-090415
  17. Kim, D. Y., Kim, Y. H., Lee, J. M., Chang, W. H., Kim, M. W., & Pyun, S. B. (2017). Clinical practice guideline for stroke rehabilitation in Korea 2016. Brain & Neurorehabilitation, 10(1), doi:10.12786/bn.2017.10.e11
  18. Matmari, L., Uyeno, J., & Heck, C. S. (2014). Physiotherapists' perceptions of and experiences with the discharge planning process in acute-care general internal medicine units in Ontario. Physiotherapy Canada, 66(3), 254-263. doi:10.3138/ptc.2013-12
  19. Masley, P. M., Havrilko, C. L., Mahnensmith, M. R., Aubert, M., & Jette, D. U. (2011). Physical therapist practice in the acute care setting: A qualitative study. Physical Therapy, 91(6), 906-919. doi:10.2522/ptj.20100296
  20. Medicare Learning Network. (2014). Discharge planning (ICN 908184). Retrieved from https://www.cms.gov/Outreach-and-Education/Medicare-LearningNetwork-MLN/MLNProducts/Downloads/Discharge-Pl-ICN908184.pdf.
  21. Ministry of Health and Welfare. (2015). A study of healthcare promotion for the disabilities in Korea. Retrieved from http://www.ndsl.kr/ndsl/search/detail/report/reportSearchResul tDetail.do?cn=TRKO201600016088
  22. Mozaffarian, D., Benjamin, E. J., Go, A. S., Arnett, D. K., Blaha, M. J., Cushman, M., & Turner, M. B. (2016). Heart disease and stroke statistics-2016 update: A report from the American Heart Association. Circulation, 133(4). doi:10.1161/CIR.0000000000000350
  23. National Quality Forum. (2009). Safe practice 15: Discharge systems. In safe practices for better healthcare -2009 update(pp. 175-181). Retrieved from http://www.qualityforum.org/Publications/2009/03/Safe_Practices_for_ Better_Healthcare%E2%80%932009_ Update.aspx.
  24. Park, E. J. (1995). Study of the reactions of discharge: For application in the discharge planning process (Master's thesis). Ewha wamans University, Seoul.
  25. Petersson, P., Springett, J., & Blomqvist, K. (2009). Telling stories from everyday practice, an opportunity to see a bigger picture: A participatory action research project about developing discharge planning. Health and Social Care in the Community, 17(6), 548-556. doi:10.1111/j.1365-2524.2009.00854.x
  26. Pethybridge, J. (2004). How team working influences discharge planning from hospital: A study of four multi-disciplinary teams in an acute hospital in England. Journal of Interprofessional Care, 18(1), 29-41. doi:10.1080/13561820410001639334
  27. Roberts, P. S., & Robinson, M. R. (2014). Occupational therapy's role in preventing acute readmissions. American Journal of Occupational Therapy, 68(3), 254-259. doi: 10.5014/ajot.2014.683001
  28. Robertson, C., & Finlay, L. (2007). Making a difference, teamwork and coping: The meaning of practice in acute physical settings. British Journal of Occupational Therapy, 70(2), 73-80. doi:10.1177/030802260707000205
  29. Robertson, L. & Blaga, L. (2013). Occupational therapy assessments used in acute physical care settings. Scandinavian Journal of Occupational Therapy, 20(2), 127-135. doi:10.3109/11038128.2012.737369
  30. Rhee, S. J., Shin, E. Y., & Jang, S. R. (2001). A study on discharge service needs for discharge planning program development to the elderly at the hospital. Korean Society of Public Health Nursing, 15(2), 376-386.
  31. Smith-Gabai, H. (2016). Occupational therapy discharge planning and recommendations in acute care: An action research study (Doctoral dissertation). Retrieved from https://nsuworks.nova.edu/hpd_ot_student_dissertations/54
  32. Teasell, R., McRae, M., Foley, N., & Bhardwaj, A. (2002). The incidence and consequences of falls in stroke patients during inpatient rehabilitation: Factors associated with high risk. Archives of Physical Medicine and Rehabilitation, 83(3), 329-333. doi:10.1053/apmr.2002.29623
  33. Umphred, D. A., Burton G. U., Lazaro, R. T., & Roller M. L. (2007). Neurological rehabilitation(5th ed., pp. 263-264). Louis: Mosby.
  34. Yoo, S. H. (2003). The educational needs of family-caregivers of stroke patient in admission and discharge (Master's thesis). Yonsei University, Seoul.