• 대한간호학회지
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• 제22권2호
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• pp.185-206
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• 1992

In this study nursing activities were examined to determine the nursing cost. A professional nursing group developed a tool for the investigation. 128 nursing activities were identified by the tool in 16 nursing care areas as referenced in the literature. Each activity was examined for four essential factors to define nursing cost ; time consumed for the care, level of professional skill, degree of independency and performer of the care. The activity was rated by a five point Likert scale. This investigation was conducted with the nursing staffing working in the 21 university hospitals in Korea and having more than four years experience especially in medical or surgical wards. The participating nursing staff were screened on the basic of the recommendation of the nursing director. The data were gathered from June 12th to August 12th, 1989. All the data were analyzed for mean, standard deviation, percent, and correlation coefficients between items. The results are summarized as follows : 1. Direct nursing care was classified into 16 large areas and 128 small activities. 2. No significant correlation was found between the study items of each activity. 3. Among 128 nursing activities, Those performed less than 50% of the time by a nurse were excluded from the nursing cost. Also excluded activities which were given less than 9 marks in all three items, time consumed, level of professional skill, and degree of independency. As a result, 83 activities in 14 nursing care areas were selected for the proposal to estimate nursing cost.

• Child Health Nursing Research
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• 제12권1호
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• pp.15-24
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• 2006

Purpose: This study was done to define nursing behavior in neonatal intensive care units so as to estimate resource-based relative value-. Method: Participating in this study were 292 nurses in neonatal intensive care units. The study surveyed physical and mental labor, stress and time involved in nursing work. Tool used in this study was a nursing labor per relative value tool. For analyzes, the relative value of each nursing behavior was calculated, where the mean value of the three components, labor intensity and component-by-component explanatory power were in percentage terms. Results: 1. Nursing behaviors in neonatal intensive care unit were classified and defined at three levels: 5 main domains, 17 mid-domains, and 42 small domains. 2. The per component explanatory power of intensity involved in nursing labor showed physical effort to be 32.45%, mental 32.86%, and stress 34.69%. 3. The reliability of nursing labor factors was very strong, Cronbach's alpha value of 0.96. Conclusion: In this research, which is a first in defining nursing behavior in neonatal intensive care units, individual nursing behavior were broken down using resource-based relative value for nursing cost, and each nursing behavior was successfully translated to a numerical value.

• 간호행정학회지
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• 제8권2호
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• pp.283-293
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• 2002

Purpose: The purpose of this study was to define cost-countable perioperative nursing activities and to analyze the cost of each nursing activities based on the Resource-Based Relative Value Scale (RBRVS). Method: Researcher and 3 research assistants observed and documented the 83 operating patients in order to measure nursing time for each of the perioperative nursing activities. And then, 35 operating room nurses with at least one year of perioperative nursing experience were observed for the RBRVS of perioperative nursing activities. Finally, the direct and indirect nursing costs were estimated. Result: Nursing costs of 25 nursing activities were estimated using the RBRVS. Most expensive nursing activities were delivery of the instrument and implement for OP team (9,780 won per hour) and behavior of wash, pack, disinfect the instrument (6,770). Conclusion: Based on the relative values of each perioperative nursing activities estimated in this study, proper medical reimbursement system should be established in a near future.

• 한국의료질향상학회지
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• 제15권1호
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• pp.101-111
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• 2009

문제: 병동 처치수가 산정 부정확 및 누락으로 인한 부적절한 재고관리로 진료차질, 불필요한 업무발생 및 수익이 감소한다. 목적: 병동 처치수가 산정 정확화를 위한 업무 표준화 도구 및 시스템을 개발하여 적정 재고관리를 통한 수익증대 및 직무만족도를 향상시킨다. 의료기관: 서울시 종로구에 소재한 대학병원 질 향상 활동: 병동중심의 처치 산정지침 개발 및 수가물품의 적정재고 관리방안을 모색하였다. 개선효과: 병동중심의 처치수가 산정 지침서를 제작하여 업무표준화를 기하였음. 응급청구 품목 및 수량이 '07년 대비 71%감소하고 타 병동 차용품목이 활동 전에 비해 61% 감소, 수량은 77% 감소함. 응급청구 총소요시간이 활동 전에 비해 '07년 대비 77% 감소하고 타 병동 차용 총 소요시간이 61% 감소함. 전년 동기간 대비 수익이 4% 증가하였으며 또한 54병동과 보험 심사팀에서 직원들의 직무만족도가 향상되었다.

• 간호행정학회지
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• 제9권2호
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• pp.205-216
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• 2003

Purpose : This study wad aimed to estimate nursing cost for hemodialysis of secondary hospitals using Resource Based Relative Value Scale(RVRBS). Method : The first, calculated nursing workload for the hemodialysis of secondary hospitals. Second, measured each spent time according to 14 nursing behaviors. Third, computed Resource Based Relative Value(RBRV) scores and nursing expenses of hemodialysis nurse. Finally, estimated nursing cost for hemodialysis of secondary hospitals, Result & Conclusion : The mean RBRV scores for each nursing behaviors were from 218.9 to 383.9 point(mean=312.7). The high RBRV socres were 383.9(Complication during hemodialysis), 353.7(Access patient vascular), 345.7 (Patient Teaching). Nursing cost for hemodialysis was estimated 23,234(won).

• 대한간호학회지
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• 제16권1호
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• pp.89-104
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• 1986

복잡한 사회문제해결에 유용한 접근방법의 하나인 계층분석과정은 수학자인 사티(Saaty)가 개발한 것으로서 이미 사회과학의 여러 분야에 적용되고 있다. 본 논문의 목적은 이 계층분석과정을 간호교육과 관련된 문제에 적용해 봄으로써 이 방법이 실제 문제해결을 위한 유용한 접근방법이 될 수 있는가를 고찰해 보는데 있다. .현대사회문제들은 다양한 관련요소, 그 요소들간이나 다른 문제들과의 복잡한 상호관계, 다수의 의사결정자의 참여, 무한한 대안, 문제의 결과에 대한 불확실성 등으로 인하여 단순한 모델이나 간단한 논리적 혹은 직관적인 판단에 준하여 일시에 해결하기 어려운 경우가 많다. 이러한 상황 하에서 문제와 관련된 요소들을 찾아내고 그 요소들을 계층적으로 분석하여 단계적으로 문제해결에 접근하는 계층분석과정을 활용함으로써 사회과학분야의 문제해결에 유용한 수단이 될 수 있다. 또한 문제와 관련된 요소를 규명하고 계층적으로 분화하는 과정에서 그 문제에 대한 보다 명확한 이해, 분석 및 현상의 흐름을 더 잘 인해하게 된다. 계층분석과정은 1) 계층구조의 설정 2) 구성요소들의 중요도 측정 3) 중요도에 따른 우선 순위의 산정 4) 우선 순위의 일관성 검토과정으로 요약된다. 본 논문에서는 이러한 과정을 통하여 미국 간호계에서 심각한 문제로 대두되어온 기본교육제도상의 쟁점(Issue of Entry into Practice）에 대한 문제 해결책이 마련되는지를 시도하였다. 즉, 기본교육 제도에 영향을 미칠 수 있는 요인들을 규명하여 계층화하고 계층내에 위치하는 구성요소들의 수평적 관계와 계층간의 수직적 관계를 체계적으로 검토하여 간호교육의 미래를 예측해 보았다. 간호교육제도에 영향을 미칠 수 있는 주요 요인들의 계층화는 거시적 환경차원(factors), 관련 이해자 집단차원(actors), 이해자 집단의 목표차원(objectives), 목표달성을 위한 정책차원(Policies), 그리고 간호교육제도의 미래를 예견한 시나리오(scenario)로 이루어졌다. 각 계층을 따라 단계적으로 중요도를 비교하여 최종적으로 각 시나리오의 우선순위 중요도(priority weight)를 구하였다. 각 시나리오의 우선순위 중요도를 간호교육과 관련된 4가지 차원들(학생, 교수, 교육기관, 직업)을 구성하고 있는 특성들에 가중하여 결과를 해석 하였다. 간호교육의 미래에 정치적(55%)과 경제적(25%) 요인이 가장 강한 영향을 미치고, 관련자중에서는 병원(38%) 의사(33%) 그리고 정부(23%)의 순으로 영향을 미친다고 분석되었다. 의외로 간호원 자신들은 큰 영향력이 없는 것으로 보여졌다. 4개의 시나리오 중에서는 그 우선순위 중요도가 현상유지(33%) 자발적4년제(32%), 강제 4년제(19%), 그리고 2~3년제의 우위(18%) 순으로 나타났다. 최종 시나리오 결과를 요약하면 1) 전체 학생수는 감소하나 양질의 간호학생수는 증가하며 2) 박사학위를 소지한 간호학 교수 및 전체 교수의 수가 증가할 것이다. 3) 전체 간호교육기여의 수는 약간 줄 것이며 그중 4년제 기관이 증가하고 반면에 2~3년제의 기관은 감소할 것이다. 4) 전문간호원이 되기 위한 입학용이도에는 별차이가 없겠으나 간호원들의 보수, 지위 및 자율성이 증가하면서 전반적인 간호의 질이 향상될 것이다. 계층분석과정의 적용으로 미국 간호교육계의 가까운 미래를 위와 같이 예견하여 보았으나 이 과정은 예견 뿐 만 아니라 일반적인 의사결정이나 문제 해결의 도구이외에도 복잡한 사회문제의 본질을 분석, 이해함으로써 보다 정화한 정책문제를 규정하는 데에도 유용할 것이다.

• 임상간호연구
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• 제20권2호
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• pp.162-176
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• 2014

Purpose: The purpose of this study was to perform an operating room nursing activities analysis and estimate nursing intensity of each nursing activity based on the Relative Value Scale (RVS). Methods: The methodology for this study of RVS was based on the work of Hsiao et al. The first stage was to identify nursing activities and the second to measure intensity of nursing activities including technical skill, mental effort, and stress. Results: Calculation of the RVS for 99 nursing practices showed a score range from 300.00 to 1337.78. CS operation assistant, OS operation assistant, and obtaining certification had high nursing intensity. Surgical hand washing, putting on surgical gowns, surgical gloves and surgical caps and mask had low nursing intensity. Conclusion: The activities of operating room are not compensated separately but reimbursement is usually included in physician fees. In the future, an estimation of nursing cost should show the nursing contribution rate to total operation revenue.

• 간호행정학회지
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• 제8권2호
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• pp.309-321
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• 2002

Purpose: A cost analysis for nursing services in operative nursing unit, emergency nursing unit, and ambulatory nursing unit was performed using patient classification system by nursing intensity in order to determine an appropriate nursing fee schedule. Method: The data were collected from 4 secondary hospitals and 5 tertiary hospitals from November 14th 2000 to January 15th 2001. The study was conducted through four phases as follows: 1) Nursing hours of each nursing service in special nursing units were measured using three kinds of patient classification systems by nursing intensity. 2) The nursing cost of nursing services in operative nursing unit, emergency nursing unit, and ambulatory nursing units was estimated based on patient classification system by nursing intensity. Results: As a result, nursing hours by nursing intensity of each special nursing unit were measured, and every nursing cost by nursing intensity in operation room and emergency room was estimated, meanwhile, the cost of nursing services in ambulatory care units was estimated only per visit as shown in chapter 4. Conclusion: Future research on nursing cost should be extended to other special nursing units such as various intensive nursing care units, delivery room, and so on. In addition, the patient classification system should be refined for its appropriateness to apply all levels of medical institutions.

• 간호행정학회지
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• 제5권3호
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• pp.547-561
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• 1999

The purpose of this study was to determine which nursing activities are performed for patients in each of the nine KDRGs and to examine common nursing activities between patients with the nine KDRGs and special nursing activities which were not common to patients with the nine KDRGs. The study will provide basic data for estimation of nursing fees. The nine KDRGs in model project are Lens procedures, tonsillectomy, &/or adenoidectomy, appendectomy &/or not complicate principal diagnosis, vaginal delivery, cesarean section, anal & stomal procedures, inguinal & femoral hernia, uterine & adneza procedure for nonmalignancy, and simple pneumonia & pleurisy. To determine the nursing activities for each of the nine KDRG, checklists of nursing activities in each nine KDRG were developed from the literature and a total of 115 records of patients 'who were diagnosed and discharged between January and April, 1999 from a tertiary medical center. Nursing activities for each of the nine KDRG were verified through two consecutive content analyses. The results of study are followed as: 1. The checklists of nursing activities developed included direct and indirect nursing activities, for a total of 241 nursing activities. Direct nursing consisted of physical, educational, emotional-socioecomomic-spiritual nursing in 17 areas. Indirect nursing had four areas. 2. Through the two consecutive content analyses, 197 nursing activities were selected, having item CVIs of .83 or more. Those included 81 nursing activities for Lens procedures, 95 for Tonsillectomy &/or Adenoidectomy. 93 in Appendectomy &/or not complicated principal diagnosis, 155 for vaginal delivery, 172 for cesarean section, 89 for anal & stomal procedures, 93 for inguinal & femoral hernia, 108 for uterine & adneza procedures for non-malignancy, and 68 for simple pneumonia & pleurisy. 3. Nursing activities for each of the nine KDRG were compared. Activities with 80% or higher commonality within the nine KDRGs consisted of 86 of 197 nursing activities for the total designated common nursing activities, 30 common nursing activities for patients in the operation group, 45 common activities for patients in the delivery Group. Special nursing activities not common within the nine KDRGs were : 3 for Lens procedures, 1 for Tonsillectomy &/or Adenoidectomy. 2 for Appendectomy &/or not complicated principal diagnosis, 27 for vaginal delivery, 21 for Cesarean section, 6 for anal & stomal procedures, 3 for inguinal & femoral hernia, 16 for uterine & adneza procedure for non-malignancy, 8 for simple pneumonia & pleurisy. In this study, nursing activities for each of the nine KDRGs verified through two consecutive content analyses are those that are performed in the hospital. And, nursing activities for each of the nine KDRGs included all nursing activities from hospital admission to discharge. So. the checklists consisted of nursing activities that allow for an estimation of nursing fees under PPS. The classification of nursing activities in the study will provide a reference for the development of a nursing activity classification.

• 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.