요양병원 간호인력 확보수준에 따른 입원환자의 간호결과

김은희,이은주 한국데이터정보과학회 2015 한국데이터정보과학회지 Vol.26 No.3

This study was conducted to explore the impact of nursing staffing on inpatient nursing outcomes in long term care hospitals. A secondary analysis was done of national data from the Health Insurance Review and Assessment Services including evaluation of long term care hospitals. Patients per RN was a significant indicator of foley catheter ratio in high risk group and low risk group. Patients per RN&NA was a significant indicator of decline in ADL for patients with dementia, non dementia, urinary incontinence and new pressure ulcer development in the high risk group. The average nursing outcome of inpatient in high grade was higher than that low grade in long care hospital. This higher level of nursing staffing and the higher the grade shown a positive effect on the nursing outcomes of the inpatient. We therefore recommend modifying the above nurse staffing policy so as to make it more effective in improving nursing outcomes. 본 연구는 우리나라 요양병원의 간호인력 확보수준과 간호결과의 관련성을 파악하고 간호에 민감한 환자 결과를 알아봄으로써 요양병원의 적정 간호인력 확보에 대한 근거를 제공하기 위해 시행되었다. 자료는 건강보험심사평가원의 2012년 ‘요양병원 병원평가정보’를 바탕으로 분석하였다. 연구결과, 간호사 1인당 환자 수가 평균보다 많은 그룹에서 유치도뇨관 비율 (고위험군/저위험군)이 통계적으로 유의하게 높았다. 간호인력 1인당 환자 수가 평균보다 많은 그룹에서 일상생활수행능력이 감퇴한 환자비율 (치매환자군/비치매환자군), 요실금, 욕창이 새로 발생한 환자 (고위험군)비율이 통계적으로 유의하게 더 높았다. 그리고 요양병원의 등급이 향상될수록 입원환자의 간호결과가 더 좋아지는 것으로 나타났다. 이는 간호인력 확보수준이 높을수록 그리고 요양등급이 높을수록 환자의 간호결과에 긍정적인 영향이 나타난다는 결과이다. 따라서 요양병원에서 간호인력 수를 적정화시킬 수 있는보다 강력한 정책적 접근이 필요하다는 것을 제안하는 바이다.

간호등급제가 요양병원의 간호인력 확보수준에 미치는 영향

김동환(Dong Hwan Kim),이한주(Han Ju Lee) 한국간호행정학회 2014 간호행정학회지 Vol.20 No.1

본 논문의 목적은 요양병원형 간호등급제 시행 이후 간호인력과 간호인력 중 간호사 비율의 변화 경향을 살펴보기 위함이다. 간호인력과 인력구성은 병상당 간호조무사와 간호사를 포함한 간호인력의 수를 사용하여 산출하였다. 2006년부터 2010년까지 119개 요양병원의 연간자료로 구성된 자료를 사용하여 기술 분석과 패널자료회귀분석이 시행되었다. 병상당 간호인력의 수는 통계적으로 유의하게 증가하였고, 간호사 비율은 2006년과 2007년 대비, 2008년, 2009년, 2010년을 경과하면서 유의하게 감소하였다. 회귀분석 모형은 변이를 34.9% , 43.8% 설명하고 있다. 결과적으로 요양병원은 간호등급제 시행 이후에 간호인력 수를 증가시켰으나 간호사 대신에 간호조무사를 고용하는 경향을 보였다. 간호사와 간호조무사 사이의 업무 기술을 명확히 하고 적절한 병원 인센티브 정책이 수립할 것이 요구된다. The purpose of this study was to examine trends in number of nursing staff and skill mix. Methods: Nursing staff and skill mix were measured using the number of nursing staff including nurse aids and registered nurses per bed. Descriptive and panel data regression analyses were conducted using data on long-term care hospitals which included yearly series data from 2006 to 2010 for 119 hospitals. Results: The number of nursing staff per bed increased significantly but percentage of registered nurses decreased significantly from 2007 to 2010. The regression model explained this variation as much as 34.9% and 43.8%. Conclusion: The results showed that in long-term care hospitals there were more nurse aids employed instead of registered nurses after the implemention of differentiated inpatient nursing fees. Thus clarifying the job descriptions for nurses and nurse aids is needed and appropriate hospital incentive policies should be implemented.

요양병원의 간호인력 확보수준과 구강간호 실시여부가 노인 환자의 폐렴발생에 미치는 영향

채정미(Jung Mi Chae),송현종(Hyun Jong Song),강근석(Gun Seog Kang),이지윤(Ji Yun Lee) 한국간호행정학회 2015 간호행정학회지 Vol.21 No.2

This study was conducted to explore the impact of nurse staffing level and oral care on pneumonia in elderly inpatients in long-term care hospitals (LTCHs). Methods: Data were obtained from the Health Insurance Review and Assessment Services (HIRA) including the profiles of LTCHs, monthly patient assessment reports and medical report survey data of pneumonia patients by HIRA in the fourth quarter of 2010. The sample consisted of 37 LTCHs and 6,593 patients. Results: Patient per nurse staff (OR=1.43, CI=1.22~1.68) and no oral care (OR=1.29, CI=1.01~1.64) were significantly related with hospital acquired pneumonia. The difference in percent of oral care by hospital was not significant between high and low group in nurse staffing level. Conclusion: In order to reduce the occurrence of pneumonia in eldery patients, effective nursing interventions are not only required but also nurse staffing levels that enable nurses to provide the intervention.

노인요양시설의 간호인력 확보수준 및 구성과 안정성이 입소노인의 건강결과에 미치는 영향

신주현,최귀윤,이지연 한국노인간호학회 2020 노인간호학회지 Vol.22 No.4

Purpose: The purpose of this study was to investigate the impact of nurse staffing, skill mix, and stability on resident health outcomes in nursing homes. Methods: This study used a cross-sectional design with proportionate stratified sampling. A total of 53 nursing homes of all 3,261 nursing homes in Korea participated in this study. The number of residents per nursing staff, hours per resident day (HPRD), skill mix, and turnover rate of each nursing staff were used as independent variables. Residents’ health-outcome indicators, and use of the emergency room and hospital were used as dependent variables. Multiple regression was used to investigate the impact of nurse staffing, skill mix, and turnover rate on resident health outcomes. Results: The impact of residents per director of nursing (DON) was supported in fall prevention, decreased aggressive behavior, decreased antipsychotic drug use, and increased hospital use (rate and frequency). The impact of registered nurse (RN) HPRD was supported in decreased weight loss, decreased deteriorated activities of daily living, and decreased deteriorated range of motion. High RN turnover related to higher antipsychotic drug use. Conclusion: Nursing homes should increase the staffing level of DONs and RNs to maintain and improve resident health outcomes. Further research is required to confirm the impact of nurse staffing on residents’ health outcomes in nursing homes.

국내외 간호사 인력정책의 현황과 과제

이태화(Tae Wha Lee),강경화(Kyeong Hwa Kang),고유경(Yu Kyung Ko),조성현(Sung Hyun Cho),김은영(Eun Young Kim) 한국간호행정학회 2014 간호행정학회지 Vol.20 No.1

연구목적 : 본 연구는 간호인력정책과 관련된 국내외 현황과 과제를 파악하여 바람직한 간호인력정책에 대한 방향을 제시하기 위해 시도되었다. 연구결과 : 우리나라를 포함한 여러 국가에서 간호사 부족 문제에 직면하고 있다. 특히 우리나라는 활동간호사수가 OECD 회원국 평균의 절반 수준이다. 그러나 이는 단순한 수적인 부족이 아니라 일하고 하는 간호사의 부족, 잘 교육받은 간호사의 부족 및 간호사의 지역적 불균형 등 복잡한 문제를 내포하고 있다. 간호사 부족의 문제를 해결하기 위한 정책들은 간호교육기관을 늘려서 간호사 공급을 증가시키거나, 간호교육기간을 단축하거나, 보조인력을 이용하여 간호사를 대체하는 것이다. 그러나 이러한 시도들은 많은 연구에서 환자의 결과를 위협하고, 간호의 질을 떨어뜨리는 것으로 나타났다. 결론 : 간호사 부족과 관련된 요인은 매우 다양하며, 이를 해결하기 위해서는 단편적 방식이 아니라 다면적인 정책적 접근이 이루어져야 한다. In this paper issues and challenges of the workforce policy for nursing were explored and appropriate policy responses identified. Results: Many countries, including South Korea, are facing a shortage of nurses. In South Korea, the number of practicing registered nurses is about half the average for Organization for Economic Cooperation and Development (OECD) member countries. The shortage of nurses is not necessarily a shortage of individuals with nursing qualifications but also includes complex issues, such as lack of well-educated nurses, shortage of nurses willing to work, and geographical imbalances of nurses. The present nurse workforce policies are to increase number of nursing schools, to reduce the length of training, and to replace nurses with nursing assistants. However, the findings of many studies have shown that these attempts resulted in a worsening of patient outcomes and increasingly low quality of care. Conclusion: The findings in this study indicate that nurse workforce policy should have a multi-faceted approach in order to address the many factors affecting nurse shortages.

입원환자 간호관리료 차등제 도입이후 간호사 확보수준의 변화

조성현,전경자,김윤미,박보현 대한간호학회 간호행정학회 2008 간호행정학회지 Vol.14 No.2

Purpose: To examine the changes in nurse staffing in hospitals after implementing the policy of differentiating inpatient nursing fees by staffing grades. Method: The study sample included 43 tertiary hospitals, 185 general hospitals, and 282 non-general hospitals that were operating in both 1999 and 2008. Nurse staffing grade was categorized from Grade 1 (highest) to 6 (lowest) in 1999 or Grade 7 in 2008, based on the nurse-to-bed ratio. Results: Tertiary hospitals at Grade 3 and Grade 4 accounted for 49% and 35%, respectively, in 2008, whereas 63% were Grade 6 in 1999. General hospitals at Grade 6 decreased from 87% to 48%. In non-general hospitals, little change was found in the staffing distribution, in that 92% still remained in Grade 6 or 7 in 2008. Forty tertiary hospitals (93%) and 45% of general hospitals improved their staffing grades, while only 7% of non-general hospitals did. Greater likelihood of improvement in staffing grades was found in general hospitals located in metropolitan areas or having 250 or more beds. Conclusion: Elaboration of the financial incentive system is needed to increase the policy impact on staffing improvement.