• 가정∙방문간호학회지
• /
• 제5권
• /
• pp.47-60
• /
• 1998

This study was done to identify basic information in classifying nursing diagnoses and nursing interventions needed for the further development of computerized nursing care plans. Data were collected by reviewing charts of 123 home care clients who had active disease, for whom at least one nursing diagnosis was on the chart, and who had been discharged. Data included demographics, medical orders, nursing diagnoses and nursing interventions. The results of the study, which found the most frequent medical diagnoses to be cancer (40.7%) and brain injury (26.8%), showed that 'Impaired Skin Integrity'(18.3%), 'Risk for Infection'(15.0%), 'Altered Nutrition, Less than Body Requirements'(13.8%), and 'Risk for Impaired Skin Integ rity'(9.9%) were the most frequent nursing diagnoses. 'Pressure Ulcer Care'(28.4%) was the most frequent intervention for 'Impaired Skin Integrity', 'Infection Protection'(16.0%) for 'Risk of Infection', 'Nutrition Counseling'(26.8%) for 'Altered Nutrition' and 'Positioning'(22.0%) for 'Risk for Skin Integrity Impairment', Comparison of interventions with the Nursing Intervention Classification(NIC) showed that the most frequent interventions were in the domain 'Basic Physiological' (33.94%), followed by 'Behavioral'(27.8%), and 'Complex Physiological' (22.6%). Interventions related to teaching family to give care at home could not be classified in the NIC scheme. Examination of the frequency of NIC interventions showed that for the domain 'Activity & Exercise Management', 75% of the interventions were used, but for seven domains, none were used. For the domain 'Immobility Management', 93% of the times that an intervention was used, it was 'Positioning', for the domain 'Tissue Perfusion Management', 'IV Therapy' (59.1%) and for the domain 'Elimination Management', 'Tube Care: Urinary'(54.0%). The nursing diagnoses 'Altered Urinary Elimination' and 'Im paired Physical Mobility' were both used with these clients, but neither 'Fluid Volume Deficit' nor 'Risk of Fluid Volume Deficit' were used rather 'IV Therapy' was an intervention for 'Altered Nutrition, Less than Body Requirements', A comparison of clients with cancer and those with brain injury showed that interventions for the nursing diagnosis 'Impaired Skin Integrity' were more frequent for the clients with cancer, interventions for 'Risk of Infection' were similar for the two groups but for clients with cancer there were more interventions for' Altered Nutrition'. Examination of the nursing diagnoses leading to the intervention 'Positioning' showed that for both groups, it was either 'Impaired Skin Integrity' or 'Risk for Skin Integrity Impairment'. This study identified a need for further refinement in the classification of nursing interventions to include those unique to home care and that for the purposes of computerization identification of the nursing activities to be included in each intervention needs to be done.

• 가정∙방문간호학회지
• /
• 제15권2호
• /
• pp.99-105
• /
• 2008

Purpose: We evaluated patient nutritional status in a home care setting. Method: We recruited 81 patients who received in-home care using a screening sheet. The level of nutrition-related serum marker (albumin) was checked via medical records and data analyzed using descriptive analysis, t-tests, and $X^2$-test. Results: Nutritional status varied according to the primary medical diagnosis. Poor nutritional status was significantly higher in cancer patients than in other diseases. Serum albumin levels were significantly lower in the malnutrition group than the good nutrition group. Conclusions: Nutrition screening can determine the nutritional status in home care patients. Home care nurse practitioners should consider nutritional status when assessing patient health.

• 지역사회간호학회지
• /
• 제15권2호
• /
• pp.209-217
• /
• 2004

Purpose: The purpose of this study was to construct the structure, process and outcome of community-based home care nursing service and to examine their validity. Method: There were two steps. The first step was developing the structure and process of community-based home care and the second was evaluating the outcome of community-based home care. Home care services were provided to 25 clients who had health problems. Data on these clients were analyzed. Result: According to Albrecht Model, in the developed structure and process of community-based home care, structure contained facility's philosophy, organization, delivery system, steering committee, office, equipments, medical instruments, the home care nurse and client of home care nursing. Process contained classification of client. nursing diagnosis and nursing intervention. The majority of clients were men (56%). The service was used mostly by people aged over 50 (82%). The most frequent nursing diagnoses were altered urinary elimination (23.2%). impaired skin integrity (21.8%) and risk for infection (17.6%). Nursing interventions included wound care (16.7%), tube care (15.1%) and catheter care (14.5%). Conclusion: Several strategies are suggested from this study: first, activate a referral system within the national health care system: second, increase public information on home care nursing: third, develop home care nursing services for elderly people: and fourth, construct a cooperation system between home care services and social welfare services.

• 가정∙방문간호학회지
• /
• 제8권2호
• /
• pp.121-134
• /
• 2001

The purpose of this study were to analyze the home care services and to evaluate the client's satisfaction with the home care services provided by home care service center in the C hospital. The data were collected by reviewing charts of 128 home care clients who were receiving home care services at C hospital from October 1997 to September 2000. The subjects for satisfaction of home care service were 20 clients from July 10 to September 30, 2000. The tool for measurement of present condition of home care service was developed by the researchers. The satisfactions of the home care services were measured by using the instrument developed by Im(997). The data were analyzed by using the SPSS/PC+. The results of this study were as followings : 1. Majority of the subjects was female(61.7%). The average of age was 63.5 years. The service has been used mostly by the elderly 60 years of age or older(71.1%). The economic level of most of subjects was in middle class(94.5%). 2. Majority of the subject had a cancer(55.4%), following stroke(25.0%). The average duration of disease for the subjects was 31 months. The average time of hospitalization for the subjects was 3.3 times. The duration of hospitalization was 10$\sim$30 days(26.6%), 30$\sim$60 days(23.4%) and above of the 210 days(9.4%). 3. Most of the subjects used his/her doctor (47.7%), as a consultant, following his/her nurse (28.1%), other patients or their family (21.9%). Most of reasons for a consultation were supportive management(Infusion or medication, 60.94%), following tube management(L-tube or T-tube, 25%), Foley catheter management (15.63%) etc. 4. 28 types of nursing diagnoses were used by the home care service. The nursing diagnosis altered nutrition: less than body requirement were used mostly by the home care service, following risk for infection, impaired skin integrity, impaired swallowing, ineffective airway clearance altered comfort: pain, impaired physical mobility. By the human-response pattern, exchanging(63.2%), moving(7.5%), feeling(10.4%), knowing(5.2%), communicating (2.6%), relating(0.5%) perceiving(0.4%) and choosing(0.3%). There were 42 nursing intervention types were performed by the home care service. By the NIC(nursing intervention classification. McCloskey. Bulech. 1996). physiologic: complex (30.3%) was the most, safety(28.3%), behavioral(20.0%), physiologic: basic(10.8%) and health system(1.7%). Observation or assessment was the most nursing intervention performed by the home care service. following IV infusion. vital sign observation. infusion management and fluid-electrolyte balance management. 5. The level of client's satisfaction with provided home care services showed considerably high(2.67/ 3).

• 기본간호학회지
• /
• 제3권1호
• /
• pp.50-67
• /
• 1996

Home nursing interventions based on nursing diagnosis were implemented to the patient who are discharged from one hospital often the treatment for chronic neuromuscular system problem, and its effects were studied. The purpose of this study was to find out the effectiveness of hospital bouned home nursing provided by hospital nurses and to categorize home nursing diagnosis and its interventions. Data from experimental group patients were collected at three different time ; at the time of discharge, two weeks after discharge and our weeks after discharge. Data from controll group patients were collected twice ; the first one at the time of discharge, and the other one four weeks after discharge. For this study nursing assessment and intervention booklet developed by the research team. There were no significant decrease of the number of nursing problems and life satis-faction. But daily activity level of patients showed the signs of significant improvement at the time of four weeks after discharge. Results of this study indicates that home nursing intervention based on nursing diagnosis provided the patients with noticeable difference in health maintanance, impairment of physical mobility, potential for infection, impaired home marntenance management, health seeking behavior, chronic pain, disuse syndrome, impaired skin integrity.

• 대한간호
• /
• 제34권5호
• /
• pp.52-67
• /
• 1996

As home care in developing and becoming part of the health care delivery system in Korea, it is necessary to examine the use of nursing diagnoses and related nursing interventions with a view to increasing the standardization of nursing recording. This study was done to examine the nursing diagnosis and related nursing interventions used in home care. Data were collected using a chart review of the nursing notes written for the home care given to 38 patients who had pulmonary diseases or traumatic brain or spinal cord injuries and who had received home care as part of a demonstration home care project in a college of Nursing in Seoul. Early on in the project discussions as to format and use to nursing diagnosis was done and a tool was developed based on Gordon's eleven functional catergories with the addition of categories to cover family and environment. This tool was used in the data collection. Data included nursing diagnosis, etiologies and interventions. Real numbers and percentages were used in the analysis. The results show that the most frequently used diagnoses were in the category of physical function (75.6%), followed by the category of emotional and social function (21.8%). The least frequently used category was the one for family and environment (2.6%). The order of the frequency of recorded nursing interventions was the same, 82.3% for physical function, 16.2% of emotional and social function and 1.5% for family and environment. Under the category of physical functioning the most frequently used nursing diagnoses were related to mobility (62.2%), nutrition (23.6%) and elimination (11.9%). The frequencies of nursing interventions for these three diagnostic categories were 69.8%, 16.0% and 10.8% respectively. For emotional and social functioning, the most frequently used diagnoses were for cognition-perception (37.1%), self-perception (30.6%) and perception of health (23.7%). The ordering of the frequency of nursing interventions varied slightly. The most frequently used interventions were for the category of self-perception (31.7%) followed by cognition-perception (24.1%) and perception of health (22.9%). Looking at individual diagnoses, it was found that within the categroy of physical functioning, the most frequently used diagnosis was "impaired physical mobility" (29.5%) and this diagnosis involved 43.9% of the interventions. This was followed by "ineffective breathing pattern" (19.4%) with 17.7% of interventions, and "alteration in nutrition, less than body requirements" (11.2%) with 8.1% of the interventions. For the emotional social category, noncompliance was the most frequently used nursing diagnosis (18.2%) with 19.2% of the interventions. This was followed by "anxiety" (13.4%) with 13.6% of the interventions and by "knowledge deficit" (13.4%) but with only 5.5% of the interventions. The other diagnoses and interventions did not follow this pattern of frequency. Although there were a large number of diagnostic and intervention events, the number of actual diagnoses and interventions used were relatively small ranging from six interventions for "knowledge deficit" to 40 interventions for "imparied physical mobility". From this it can be concluded that the results of this study could be used as basic data for the development of standardized charts with respect to nursing diagnosis and interventions for clients with pulmonary disease and clients with traumatic brain or spinal cord injuries. Interventions that were direct care activities (1178) were much more frequent that education (430), and assessment and observation (148). There were also few diagnoses or interventions related to the family and the environment. This suggests two areas that need to be developed in home care and that need to be considered in the development of standardized records for use in home care.

• 가정∙방문간호학회지
• /
• 제15권2호
• /
• pp.67-74
• /
• 2008

Purpose: We analyzed the need for home care services and awareness of U-healthcare in nurses of the Catholic Parish Home Care Center to link the ubiquitous health care system and the home care. Methods: We recruited 46 nurses from a home care center in the catholic parish of the C medical center from April 4th to June 8th, 2007. Results: The highest needs were 'assessment and diagnosis of the problem', 'management of hypertension & diabetes patients', 'counseling of the patient', and 'counseling of major caregiver and family problems'. Therapeutic nursing showed the highest needs in bedsore care. Nurses want hospital medical records available through the ubiquitous health care system. Conclusion: Home care services are supported from the agency, with high needs in assessing and diagnosing the problem, counseling, and managing of hypertension & diabetes patients. Education and public relations efforts on the U-healthcare system should improve system awareness.

• 대한간호학회지
• /
• 제33권2호
• /
• pp.246-255
• /
• 2003

Purpose: This study was designed to compare direct cost and indirect cost between home care and hospital care according to subject's characteristics. Method: The subjects of this study were patients with cerebrovascular disease. They were 50 patients in six university hospitals and 49 in four home care centers. Data were collected by using two type of questionnaires and reviewing medical records, home care service records and medical-fee claims from April 4th to September 13th, 2001. Result: The results were as follows; First, there was a statistically significant difference of direct cost between home care and hospital care, however, there was not a statistically significant difference of indirect cost. Second, according to subject's characteristics, six variables had statistically significant differences; sex, age, marital status, economy, job and diagnosis. Conclusion: It was found that cost-saving effect of home care was affected by subject's characteristic factors. More study needs to be done to develop a more detailed selection criteria for home care subjects.

• 가정∙방문간호학회지
• /
• 제2권
• /
• pp.35-51
• /
• 1995

This study was done to define nursing diagnose and to test the validity of the characteristics for patients with cerebrovascular accidents being seen at home by home health care nurses. This study was a descriptive study. The sample consisted of 10 experts(professors and home health care nurses) who had had a variety of experience using nursing diagnoses in clinical practice, and 336 nurse progress notes for 18 patients with cerebrovascular accidents. First, 32 nursing diagnoses were defined by the analysis of 336 nurse progress notes, and ten nursing diagnoses were selected according to a criteria of frequency and four nursing diagnoses from home health care clinical practice. Second, content validity was examined by an expert group which considered the sign / symtoms of the fourteen nursing diagnoses. The instrument used for this was a checklist for sign / symtoms based on the nurse progress notes and literature : Carpenito(1993), Kim Cho Ja et al (1994), Lee Sun Ok et al.(1994), Kim Mae Ja et al. (1992), Seoul University Hospital (1993) , Kim Mi Ja et al. (1991). The data were collected from March 1995 to April 1995. Data were analyzed using Content Validity Incidence where if 80% or more of the expert group agreed, characteristics were defined as a major sign/symtoms, if between 50% and 79% of the expert group agreed with the characteristic it was defined as a minor sign / symtoms. The results of this study are summarized as follows : 1. Thirty-two nursing diagnoses related to patients with cerebrovascular accidents were defined. There was a high frequency for the following : 'Potential for disuse syndrome (61%)', 'Impaired physical mobility(50%)', 'Impaired skin integrity (44.4%)', Potential for aspiration(33.3%)', 'Potential for infection: respiration(33.3%)', 'Self-care deficit : bathing /hygine(27.8%)', 'Ineffective family coping(22.2%)', 'Potential for trauma(22.2%)', 'Alteration in nutrition: less than body requirements(22.2%)'. The following diagnoses were also used in home health care clinical practice : 'Anxiety in family (50%)', 'Caregiver fatigue(27.8%)', 'Ineffective treatment behavior (22.2%)', 'Ineffective Levin tube management and Levin tube feeding(22.2%)'. Fourteen nursing diagnoses were selected. 2. Ten of the nursing diagnoses for patients with cerebrovascular accident were listed as nursing diagnoses by NANDA but four nursing diagnoses were new nursing diagnoses used in home health care clinical practice. 3. Characteristics of the ten Nursing Diagnoses from NANDA were developed from the sign /symtoms in the literature and in the nurse progress notes. These characteristics was verified as major or minor sign / symtoms by the expert group. 4. Characteristics of the four nursing diagnoses used in home health care were not defined by the literature but only by the nurse progress notes and verified as major or minor signs /symtoms by the expert group. On the basis of the findings of this study, the following recommendations are made : 1. Continual study is necessary to identify other signs /symtoms not verified in this study. 2. It is necessary to use verified signs /symtoms in home health care clinical practice. 3. It is necessary to define related factors which define each diagnoses in this study. 4. It is necessary to develop of standardized nursing are plans which include defined signs and symtoms. 5. It is necessary to study the outcomes of the standardized nursing care plans.

• 가정∙방문간호학회지
• /
• 제1권
• /
• pp.71-76
• /
• 1993

This study was carried out to investigate agreement, content and demand for home nursing care of hospital inpatients in brain, spain and musculoskeletal diseases. The data was collected by interviewing with 242 patients who were hospitalized in university hospital on Taegu, from September 6,60 October 9, 1993. Of 242 patients, 66.1% agreed to home nursing care system and rate of agreement was highest between 30 years to 49 years of age as 40.4% in general characteristics. The rate of agreement according to type of diagnosis was highest inpatients with spinal diseases as 75.6% according to functional status was the highest in patients who had daily living activity freely as 69.4% according to prognosis in patients at terminal stage as 80.0% and the rate of agreement to home nursing care of patients who wanted early discharge was 73.9% The first-ranking reasons of agreement to home nursing care was asking for continuous relationship with doctor as 37.3% and there was statistically significant difference in reasons of agreement to home nursing care according to functional status of patients. The first-ranking reason of early discharge among patients who wanted early discharge(74.8%) was because of long time stay in hospital. Among 23 items of nursing activity that patient wanted, the first-ranking item was recovery promotion, prevention of complication, education and counseling for health as 76.4%, drug management was 2nd-ranking item as 62.1% and the third was regular checking of vital signs as 55.9%, The lowest item of demand for home nursing care was hospice care(3.9%) and airway keep(9.1%).