• 한국병원경영학회지
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• 제14권2호
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• pp.60-74
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• 2009

This study purports to verify managerial effectiveness of the integrated delivery system(IDS) of Japanese health care institutions through comparing the managerial performance between hospital groups providing with both acute and nursing care and those with acute care only. Data on the managerial performance of 697 hospitals providing with nursing care together and 819 hospitals providing with acute care only were collected from Japanese Central Social Insurance Medical Councils 2001, 2003, 2005, and were analyzed using mean comparison test(t-test) between the two groups. The results revealed that there were significant differences between the two groups in such indicators as ratio of material cost, labor cost, depreciation rate, total margin, operating margin, average number of outpatient per day, average revenue of an inpatient per day, total amount of labor cost, gross revenue per employee, and labor productivity. However, we could not find out any consistent evidence which support the effect of integrated delivery system on the hospital managerial performance. Further discussion was made on the limitation of the study and future research agenda relevant to the topic.

• 재활간호학회지
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• 제3권1호
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• pp.98-107
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• 2000

A Preliminary study for the evaluation of the Rehabilitation Nursing Program(RNP) implemented to the 25 stroke survivors at the Day Care Program Center of National Rehabilitation Hospital in Seoul was done at 1999. The purposes of this study was to assess the psychological effects as outcome-variables such as depression, powerlessness and self efficacy of the stroke survivors who were discharged from acute care hospitals. The Rehabilitation Nursing Program (RNP) integrated with the Day Care Program for rehabilitation was implemented and the psychological outcome variables were measured by 3 psychologic instruments of Zung Depression Scale, Millers's powerlessness and the Bandura's self efficacy scale. These instruments were translated into Korean and the contents validity and the reliability were tested. The subjects were 17 males and 8 females and 52% were aged over 51 years old and 24% were from 31 to 50 years old. Most of them (72%) had been educated more than high school level. The contents of RNP were 8 sessions composing of self-introduction, individualized assessment, health contract and feedback, management of depression, shaving experiences, effective communication, self efficacy teaching, health information, and daily care activities. This study found that the level of depression and the powerlessness were within average level and had not been changed the level of self efficacy after RNP were somewhat higher than before, but it was not changed significantly. According to the results, the psychological state of the subjects were not changed significantly. Only the level of self efficacy was a little improved after having the RNP. Based on theses results, the RNP should be focussed on the psychological nursing care and the psychological outcome variables were retested strictly with the enough sample size.

• 한국노년학
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• 제29권3호
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• pp.1123-1140
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• 2009

본 연구는 주간보호센터의 중풍노인이 이야기치료 집단상담을 통해 치매노인과의 갈등을 해결하는 과정을 탐색하는 연구이다. 중풍노인에 대한 이야기치료 집단상담을 7회 동안 실시한 과정을 사례연구방법을 통해 분석하였다. 분석결과 첫째, 중풍 노인들이 집단상담을 통해 치매노인을 '문제'가 아니라 '치매로 고통받는 사람'으로 보고, 치매노인을 비난하는 대신 도와줄 방법을 적극적으로 찾게 되었으며, 둘째, 자신들을 '치매노인의 피해자'가 아니라 '유능한 사람 으로 규정하게 되었고, 셋째, 중풍노인들끼리 협력적이고 친밀한 관계가 되었으며, 넷째, 중풍노인들이 주간보호센터 운영에 적극적으로 참여하게 된 것으로 나타났다. 이러한 변화에 이야기치료의 문제와 사람을 분리시키기, 클라이언트를 자기 문제의 전문가로 존중하기, 독특한 결과 찾기 등이 도움이 된 것으로 분석되었다. 이러한 결과를 바탕으로 장기요양보호대상자에게 보호를 제공할 뿐만 아니라 참여 기회를 확대하고, 이야기치료를 노인에게 적용할 것을 제안하였다.

• 대한간호학회지
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• 제24권4호
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• pp.545-556
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• 1994

Medical insurance and health care delivery system enabled Korean people to get the necessary medical service, but it caused increased needs for medical service, and resulted in the occurence of some problems such as a lack of manpower and medical facilities. In order to solve these problems, many countries, which already had medical insurance system had developed home care system and it has been regarded effective both in reducing costs and in increasing the rates of turnover of bed. Recently, Korea has included home nursing care in its health care delivery system, and some models of the hospital based home nursing care had been tried and its effects had been evaluated. So, author tried to run a home nursing care for the Cesarean section mothers and evaluate Its effects both in the mother's health and costs. This study was designed as a Quasi-experimental study. Subjects were thirty mothers who got Cesarean section operation in hospital in Seoul. Experimental group consisted of 15 volunteers, and control group were selected by means of matching technique. Data were gathered from February 1st to March 26th by two assistants who were trained by author. Experimental group were discharged on the 4th day after their operation, and got nursing care and assessment about their home three times on the 5th, 6th, and 7th day. Control group stayed in the hospital until 7th day as usual and were checked on the same day as above mentioned To evaluate the state of physiological recovery, vital signs, H.O.F, presence of edema in the legs, bathing, appetite, sleep, presence of pain or discomfort in the breasts, amount of lochia, color of lochia, defecation urination. To compare incidence of complication in experimental group with that in control group, specific assessment was done such variables as smell of lochia, presence of inflammation of operation wound, dizziness, and presence of immobilization in the extremities. The activities of daily living were checked Satisfaction of nursing were checked To calculate costs, author asked subjects to specify expenditure including hospital charge, traffic enpenses, and food expenses. The results were as fellows. 1. On effectiveness of home nursing careThere were n significant differences between experimental and control group in incidence of abnormal symptoms and any complication. The number of taking a bath [POD #5 P=0.001, #6 P=0.0003, #7 P=0.001] and the degree of appetite [POD #5 P=0.03, #6 P=0.02, #7 P=0.013] were significantly higher in experimental group than in control group. Contrary to author's expectation, the degree of the activities of daily living in experimental group was not higher than that of control group. All of the experimental group said they were satisfied with the home nursing care. 2. Cost analysis 1) Hospital charge of experimental group was lower than that of control group. ［P=0.009］ By taking home nursing care, average period of hospitalization was shortened to 3.1 days, and family members could save 22.8 hours. Total amount of money saved by early discharge was 3,443,093 Won. It is estimated that total amount of money saved by early discharge in a year will be 40,398,956 Won. 2) Home nursing care charge of 15 mothers was 1,781,633 Won. It is estimated that total amount of money Saved by it in a year Will be 20,904,493 Won. It was lower altogether than hospital charge of the three days which is 5th, 6th, 7th day of operation. The average cost of single home visit was calculated 10,940 Won. It took 87 minutes per round and it costed 1,017.3 Won. The average hour of home care was 39.0 minutes. 3) It is expected that early discharge can bring forth the increase of hospital income. On the condition that the rate of running bed is 100%, the expected increase of hospital income will be 202,374, 026 Won in a year. Suggestions for further study and nursing practice are as follows : 1. For the welfare of patients and the increased rates of running bed, home nursing care system should be included in the hospital nursing care system. 2. Studies to test effect of home nursing care on the patients with other diseases are needed. 3. Establishment of law on the practice of home nursing care is strongly recommended.

• Child Health Nursing Research
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• 제5권1호
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• pp.59-69
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• 1999

The main purpose of this study is to identify nursing needs of parents who have hospitalized child. Research design is a descriptive survey. The subjects for the study were 79 parents who have hospitalized child at a pediatric ward of one of the general hospital attached to a university in J city. The data was collected by researchers using a structured questionnaire. The questionnaire was Likert type 5 point scale, composed of 5 categories with 61 items. The data was analyzed by SPSS/PC. The results of the study were as follows ; 1) Mean score of nursing needs of subjects were 3.93 at 2nd day of admission and 3.99 at 7th day of admission. 2) Among the categories, the highest nursing need at the End day and 7th day of admission was ‘dilect nursing’, in desending order, ‘facilities and environment’, ‘education and counseling’, ‘nursing assessment’. The lowest nursing need was ‘reference’. 3) Differences between the nursing needs of subjects at 2nd day and 7th day were as follows : (1) By categories, there was a significant difference only in the ‘reference’ categoly(t=2.74, P=.008). (2) By items, there were significant differences in items of ‘to check necessary materials(t=2.31, P=.024)’, ‘to understand family function and family relationship(t=2.12, P=.041)’, ‘to set up study room(t=2.22, P=.030)’, and ‘to mediate parent's meeting group(t=3.89, P=.000)’. The above result indicated that nursing needs of parents with hospitalized child were above average, especially very high in items about disease process, and items directly associated with treatment and nursing care. So, nurses have to focus on information about the patient's state of disease, treatment, test and procedure, and in efficiently giving direct nursing care to implement mure effective care for the hospitalized children and their parents. And some future researche is needed to identify the difference of degree of nursing needs of parents with hospitalized child according to admission duration using a different sample and a longer sampling interval.

• 보건교육건강증진학회지
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• 제26권1호
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• pp.105-115
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• 2009

Objectives: This study was conducted to assess dental health states of disabled people and analyze association between perception and awareness toward dental health and dental health status. Methods: The survey was performed from June 25 through October 30, 2004. A total of 548 disabled people participated in the study with details of 419 living in eight residential care centers located in Gyeongsangbuk-do and 129 children from a special school and two day-care centers. All subjects underwent oral examination and surveyed through a questionnaire. Parents of 129 children with disabilities were also surveyed through a separate questionnaire. Results: The dental caries experience rate was 82.1% of total 548 subjects. By age, those in their 20s experienced a high rate of dental caries with 87.5%. By educational level, those with a middle school education experienced a high dental caries rate with 91.8% (p<0.05). Of total subjects who experienced dental caries, 78.9% had experience in dental caries treatment. By age, those in their 10s showed a high rate of dental caries treatment with 87.4%(p<0.05). By educational level, those with a high school education showed a high rate of dental caries treatment with 87.7%(p<0.05). Those in residential care centers had a high rate of dental caries treatment with 82.1%, which is significantly higher than 68.8% of those who used day-care centers. A tooth extraction rate was 38.0% of total subjects. Those in their 40s had a higher rate of tooth extraction(p<0.01). Those in residental care centers had a significantly higher rate of extraction with 43.4%, compared with 20.2% of those in day-care centers. Of total subjects, 61.5% had plaque. A high rate of plaque formation was observed in those in their 40s(92.0%), those with a high school education(84.0%) and those with multiple disabilities(77.8%)(p<0.01). Among total subjects, 47.6% maintained healthy periodontal tissue. Those in their 40s and those with multiple disabilities had diseased periodontal tissue(p<0.01). Of 129 disabled children, 43.8% had plaque with parents who were not oral health-conscious while 18.6% had plaque with parents who were oral health-conscious, showing a significant difference(p<0.05) Conclusion: The results of the study suggest the need for educating parents with disabled children about oral health and strengthening programs for oral health for teachers working at special schools and day-care centers.

• Tuberculosis and Respiratory Diseases
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• 제73권3호
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• pp.151-161
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• 2012

Background: Adequate assessment and control of sedation play crucial roles in the proper performance of mechanical ventilation. Methods: A total of 30 patients with various pulmonary diseases were prospectively enrolled. The study population was randomized into two groups. The sedation assessment group (SAG) received active protocol-based control of sedation, and in the empiric control group (ECG), the sedation levels were empirically adjusted. Subsequently, daily interruption of sedation (DIS) was conducted in the SAG. Results: In the SAG, the dose of midazolam was significantly reduced by control of sedation (day 1, $1.3{\pm}0.5{\mu}g/kg/min$; day 2, $0.9{\pm}0.4{\mu}g/kg/min$; p<0.01), and was significantly lower than the ECG on day 2 (p<0.01). Likewise, on day 2, sedation levels were significantly lower in the SAG than in the ECG. Significant relationship was found between Ramsay sedation scale and Richmond agitation-sedation scale (RASS; $r_s$=-0.57), Ramsay Sedation Scale and Bispectral Index (BIS; $r_s$=0.77), and RASS and BIS ($r_s$=-0.79). In 10 patients, who didn't require re-sedation after DIS, BIS showed the earliest and most significant changes among the sedation scales. Ventilatory parameters showed significant but less prominent changes, and hemodynamic parameters didn't show significant changes. No seriously adverse events ensued after the implementation of DIS. Conclusion: Active assessment and control of sedation significantly reduced the dosage of sedatives in patients receiving mechanical ventilation. DIS, conducted in limited cases, suggested its potential efficacy and tolerability.

• Tuberculosis and Respiratory Diseases
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• 제79권4호
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• pp.289-294
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• 2016

Background: The aim of our study was to evaluate the prognostic value of Charlson's weighted index of comorbidities (WIC) in patients with prolonged acute mechanical ventilation (PAMV, ventilator care ${\geq}96$ hours). Methods: We retrospectively enrolled 299 Korean PAMV patients who were admitted in a medical intensive care unit (ICU) of a university-affiliated tertiary care hospital between 2008 and 2013. Survivors were defined as patients who survived for 60 days after ICU admission. Results: The patients' mean age was $65.1{\pm}14.1$ years and 70.6% were male. The mean ICU and hospital length of stay was $21.9{\pm}19.7$ and $39.4{\pm}39.1$ days, respectively. In addition, the 60-day mortality rate after ICU admission was 35.5%. The mean WIC was $2.3{\pm}1.8$, with significant differences between nonsurvivors and survivors ($2.7{\pm}2.1$ vs. $2.1{\pm}1.7$, p<0.05). The area under the curve of receiver-operating-characteristics curve for WIC was 0.593 (95% confidence interval [CI], 0.523-0.661; p<0.05). Based on Kaplan-Meier curves of 60-day survival, WIC ${\geq}5$ had statistically lower survival than WIC <5 (logrank test, p<0.05). In a multivariate Cox proportional hazard model, WIC ${\geq}5$ was associated with poor prognosis (hazard ratio, 1.901; 95% CI, 1.140-3.171; p<0.05). The mortality rate of patients with WIC ${\geq}5$ was 54.2%. Conclusion: Our study showed a WIC score ${\geq}5$ might be helpful in predicting 60-day mortality in PAMV patients.

• 호스피스
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• 통권48호
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• pp.19-20
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• 2010

• 한국지역지리학회지
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• 제13권5호
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• pp.576-594
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• 2007

본 연구는 GIS 공간분석기법을 활용하여 서울특별시의 각 동별 노인주간보호시설의 접근성 지수를 산출, 비교 분석하여 향후 시설의 신설 또는 확장을 할 경우에 운영의 공간적 효율성과 형평성을 향상시킬 수 있는 입지 후보지는 어디인지를 파악해 보는데 목적을 두었다. 연구 결과, 전반적으로 서울시 노인주간보호시설의 분포가 시설을 이용하리라 추정되는 노인인구의 분포를 반영하고 있지 못했고, 특히 강서구와 송파구 등 서울의 외곽경계지역에 해당하는 동들의 접근성이 가장 낮은 것으로 나타났다. 이러한 연구 결과는 노인주간보호시설의 운영정책에 있어서 다음과 같은 함의를 가진다. 첫째, 시설이용 노인들의 복지시설에의 접근성 향상이라는 대전제 하에서는 현재 노인주간보호시설로 부터 상대적으로 거리가 먼 지역에서의 시설 설치가 요구된다. 둘째, 예산의 제약 등으로 추가적인 시설의 설치 없이 기존시설의 정원을 늘리는 정책을 전개할 경우 근접성이 높게 나타난 시설들의 규모를 우선적으로 확장함으로써 보다 많은 수의 노인들이 좀 더 용이하고 빈번하게 이용할 수 있도록 하는 것이 바람직하다. 마지막으로 접근성이 중시되는 다른 노인재가시설들과 사회복지시설의 설치와 확대, 평가에 있어서도 본 접근성 분석 기법을 적극 활용함으로써, 이동에 제약이 많은 복지시설 이용자들의 복지권을 보장하는 한편 사회복지 자원 투자의 당위성을 확보할 필요가 있다.