보건관리자의 자격에 따른 사업장 보건관리 업무수행 행태

이재희,노재훈,김규상,안연순 大韓産業醫學會 1995 대한직업환경의학회지 Vol.7 No.1

This study was conducted to find out the characteristics, type of the duty and job satisfaction of health care managers at the worksite. The subjects of this study were 306 health care managers serving at worksite situated in Kyungin presently in 1994, concerning their job. Major dependent variables were health management, environmental management, and health planning related with health care managers job; these variables were measured by nominal scale consisted of 9 items respectively. The collected data were analysed and some major results are as follows: 1. It appeared that according to the qualification of health care managers, nurses showed high performing rate in duty of health management and health planning, industrial hygienist showed high performing rate relating to working environment managemant, and regarding their holding an additional post, the number of environmental managers held more an additionnal post than other qualified managers, thereby showing significant relatively, and however, no relation with qualification was there in decision-making. 2. The performing rate relating to health management was significantly correlate with female, youth, unmarried, higher education, general affairs in post of duty, general employee in position, only duty of health, low monthly income and nurse. But, the performing rate relating to environmental management was significantly correlate with manufacturing industries, industrial health and safety committee, male, old age, married, long work duration, additional post, high monthly income, and hygienist and environmental managers. The performing rate relating to health and environmental management, but the performing rate relating to health management was not significantly correlate with the performing rate relating to environmental management. 3. In multiple regression analysis, common major determinants of the performing duty relating to health management, environmental management and health planning were industrial health and safety committee, type of industry, education, and qualification of industry's health care managers. Additionally, age was selected as highly correlated with the performing duty relating to environmental management, and work duration and post of duty of health care managers in industry were selected as highly correlated with the performing duty relating to health planning. Based on the results indicated above, it could be understood that characteristics of the worksite - industrial health and safety committee, scale and types of industry, and characteristics of health care managers - age, education, post of duty, work duration and qualification had relations with their type of the duty. Therefore, it is required that the reference to the above-showing results such as guiding for them to precisely grasp their performing duty according to their qualification, heightening their participation in decision-making, extending the industrial health service, etc., operation and management of health care managers at the worksite should be made into being more efficient.

장애인 장기요양 매니지먼트 활성화를 위한 입법 과제

김철주,홍성대 한국의회발전연구회 2010 의정연구 Vol.16 No.3

The purpose of this paper is to consider activation plans of long-term care management system for the disabled. The main contents of this paper are diagnosis of present state and problems of long-term care management system, directional establishments in constructing new system and consideration of practical alternatives of new system. Thre are many problems in current long-term care management system for the disabled, such as duality of management function, insufficiency in advocating and representing interests of service user, poor service supervision, poor service linkage to various community social services. To overcome these problems, there need to prepare measures, such as reinforcement of management agent’s independence, integration of management function, enhancement of professionalism, introduction of service monitering and evaluation by a third party, and reinforcement service linkage to various community social services by reforming service-deliverly systems in the long term. Meanwhile, consideration of practical alternatives of new long-term care management system is deeply related to new social security system for long-term care. There are two types of new social security system for long-term care, one is to integrate with existing long-term care insurance for the elderly, the other is to expand existing personal assistant service programme. In the case of the former, it is need to change management agent to local governments and to incorporate management services into insurance fee. In the case of the latter, it is need to leave management tasks to management team composed of local governments and service providers and social workers. 이 글의 목적은 우리나라 장애인 장기요양보장제도 확충과정에서 고려돼야 할 매니지먼트체계 대안을 고찰하고 대안 도입을 위한 입법과제를 검토하는 것이다. 현행 장애인 활동보조지원 사업 중심의 장애인 장기요양보장제도 매니지먼트체계는 사례발굴 기능의 부재, 매니지먼트 기능의 이원화 및 부실, 서비스 이용자의 이해관계 대변과 옹호의 한계, 서비스 질 관리의 부실, 장애인 사회서비스 연계 부족 등의 문제를 노정하고 있다. 이러한 문제를 극복하기 위해서는 독립적 주체에 의한 매니지먼트를 통한 이용자의 이해관계 대변·옹호 강화, 매니지먼트 기능의 통합과 전문성 제고, 서비스 제공에 대한 객관적 모니터링 및 평가 강화, 지역사회 장애인 사회서비스와의 연계 강화 등을 위한 방안이 필요하다. 한편, 대안적 매니지먼트체계 구축에 대한 논의는 새로 도입될 장애인 장기요양보장제도의 도입방식과 밀접히 연관된다. 현재 유력시 되고 있는 도입방식은 기존 노인장기요양보험에의 통합 방식과 기존 장애인 활동보조지원 사업의 확대 방식 등 두 가지이다. 전자를 위해서는, 현재의 노인장기요양보험법의 부분적 개편을 통해 매니지먼트 수행 주체 및 서비스관련 내용을 규정하는 방법이 적절하다. 후자의 경우, 활동보조지원 사업관련 내용을 장애인복지법에서 분리하되 별도의 법을 제정하여 관련내용을 체계적으로 규정하는 방법이 적절하다.

지역복지계획 내의 지역 중심형 케어매니지먼트시스템 고찰 : 한일 비교

장경옥,백선아 한국통합사례관리학회 2008 한국케어매니지먼트연구 Vol.1 No.-

한국과 일본은 다양하게 지역사회주민의 삶의 질을 제고시키기 위해 접근하고 있 으나 지역 안의 재가 대상자를 위한 활동 중 케어매니지먼트기법을 통하여 접근 시도 하고 있는 것이 보편적인 활동임을 많은 연구가들이 공감하고 있다. 이와 관련하여 한국과 일본의 지역복지계획을 전체적으로 비교하기에는 체제 등 다소 무리감은 있으 나 양국의 지역복지계획 안에서의 ‘지역중심형 케어매니지먼트시스템’을 비교하여 살 펴봄으로써 개선사항을 조망해 본 후 이론적·실천적 시사점을 찾아보고자 한다. 지역 중심형 케어매니지먼트시스템의 한일 비교를 통해 나타난 연구결과를 정리하여 다음 과 같은 시사점을 얻을 수 있었다. 일본의 치노시 경우는 다음과 같다. 첫째, 치노시 소재 스와 병원 관계자와 의사회 를 중심으로 한 재가의료의 실천과 그 실현을 향한 보건·의료·복지관계자들의 스스로 힘을 합쳐 지역케어를 했다는 점이다. 둘째, 치노시 신임시장을 리더로 새로운 자치단 체를 만들기 위한 행정직원들이 힘을 합했다는 것이다. 셋째, 자원봉사와 시민활동을 전개 해 나가는 시민의 힘이라는 것이다. 이는 국가가 정책적으로 접근해야 할 이론적 과제나 방안의 접근도 있겠지만 지자체 스스로 즉, 지역주민 스스로 참여하여 활동하 고 있는 실천적 방안의 접근이 훨씬 더 내재된 역량을 이끌어 가는 데 있어 원동력을 발휘했었을 것이라는 판단이 든다. 한국의 평택시 경우는 다음과 같다. 한국의 경우 일본과 달리 지역복지계획과 노인 장기요양보험제도가 실시 전이기에 이론적 모델만 구축을 목적으로 개발되었음을 인 지하여야 하나 참고로 일본 치노시 모델을 지향하였다는 점에 주안점을 두고 이해하 여야 한다. 첫째, 서비스 전달체계 개선을 통한 효율적인 복지행정이 이루어져야 제대 로 된 케어매니지먼트시스템이 정착될 것이다. 이는 케어대상자의 욕구와 서비스 내 용에 대한 전산화된 자료를 바탕으로 서비스 제공자간의 중복, 분절된 서비스를 방지하고 이용자 중심의 욕구에 부합되는 효과적인 서비스 제공이 이루어져야 하기 때문 이다. 둘째, 주민참여 촉진을 통한 효율적인 접근이 이루어져야 할 것이다. 이는 연계 와 통합이 이루어진 보건 ․ 의료 ․ 복지의 연계서비스를 이용 후 효율과 효과를 검증 하고 정보 및 홍보자료를 동시에 만족시킬 수 사례를 기록하여 공유하기 위하여 지역 주민들에게 널리 알려야 함을 의미한다. 셋째, 치노시와 평택시의 경우 도시농촌 지역 이었기에 농촌지역일 경우 접근성의 문제점을 해결하기 위하여 역동적인 시스템을 제 공하여야 할 것이다. 이는 농촌지역의 접근이 도시지역에 편중되어 있는 지역자원의 편중을 고려하여 농촌 이용자 중심의 이동 방문 보건복지센터이 형태를 갖춘 이동 차 량을 이용하여 해당 읍면동의 사회복지위원들을 적극 연계하여 홍보하면서 노인, 장 애인 즉 주 케어대상자와 함께 저소득 층, 아동, 청소년 등 기타 가족의 자세한 정보를 취합하여 정확한 정보체계를 통해 활용한다면 최소한의 사회안전망 구축을 위하여 보 다 현실적인 보건·의료·복지서비스가 제공 될 것이다. 특히, 이동방문서비스 차량을 이용해 찾아가는 이용자 중심의 보건·의료·복지서비스를 제공할 경우 대상자가 자기 케어능력이 고취됨으로서 지역사회 내의 재가에서 최적의 건강생활을 유지 증진하는 데 기여할 것이다. 이와 관련하여 ‘지역중심형 케어매니지먼트 구축’에 있어서의 향후 한국의 과제 방 안으로 다음과 같이 제시하고자 한다. 한국과 일본의 경우 양국은 각각 시기와 형태가 달리 케어매니지먼트시스템이 구축되어 도입되는 변화의 과정을 이루어 가고 있다. 일본의 지역복지계획과 개호보험 제도, 한국의 지역복지계획과 노인 장기요양보험제 도 등 새로운 제도와 함께 기존의 케어매니지먼트시스템의 부재와 문제점이 보완되어 양국의 지역복지계획과 함께 새로운 국가제도와 맞물려 보건의료 복지서비스를 강화 하여 서비스 전달체계를 개선되어야 한다는 점에서는 누구도 부인하지 않을 것이다. 특히, 보건의료복지에 관한 연계 ‧ 통합 서비스를 제공하기 위하여 각종 국가적· 지자 체적 제도와 함께 지역주민 스스로가 참여하여 실천적으로 활용될 수 있을 때 이용자 중심 즉, 효율적인 지역중심형 케어매니지먼트시스템이 정착될 것이다. Both Korea and Japan approach to meet the quality of life for the community residents in variety aspects, it is agreed by the researchers that within a community, a care management is one of the common way to provide care for the home-based care-needy population within a community. Even though it is extensive to compare an entire plans and systems of community welfare between the two countries, to compare the local-centered care management system within the both countries community welfare plan, after further improvement would be considered, theoretical and practical consideration will be discussed. Through completion of the comparative study of the local-centered care management system in the two countries, some suggestive ideas were gathered from the result of this study. Detailed agendas of Chi-No-City in Japan are as follow: First, based on Suwa Hospital’s the parties interested in Chi-No-City and the medical association, the practice of home-based care and community care had accomplished by gathering manpower of the interested parties who are in the field of public health and welfare. Second, build up renovate self-governed organization under a newly elected mayor’s authority, all the staff of administration could gather manpower. Finally, the power of civilian was explored to volunteer activities and civil activity. To successfully perform the local-centered care management system, a politically approached theoretical task and suggestion that will be applied in nation-wide should be exist; moreover, the community residents’ self-motivation would be work as a hidden-empower to lead the local-centered care management system. It is pre-era of Korea to initiate community welfare plan and long-term care insurance for the elderly, it is important to know the purpose of this study is to develop theoretical model which is referred by Chi-No-City model in Japan. Detailed agendas of Pyung-Taek-City in Korea are as follow: First, through improvement in service deliverly system, the effective welfare administration needs to be accomplished to root care management system in Korea. Based-on computerized care needy person’s needs and contents of the service, a repetition of service provider and a segmental service need to be prevented. Therefore, an effective client-centered service which is met to client’s need should be provide. Second, having effective approach to local-centered care management system, the community residents participation need to be encouraged. After utilized accomplished liaison and integration of public health, medical, and welfare services, the effectiveness and efficiency of the services needs to be verified and the cases, which are both satisfied with information and advertising materials, need to be well recorded the purpose of sharing to community residents. Finally, both Chi-No-City and Pyung-Taek-City are urbanized-rural area, if it is applied to a rural area, a problem of accessibility needs to be resolved. In the rural area, a vehicle which is equipped with public health and welfare center would be consider as an option to maximize its accessibility to residents in rural areas. If we actively connect and advertise of the vehicle service to social workers in each district while we gathered information about primary care-needy person such as disabled and elderly to provide systematically planned service, it would be beneficial to provide sensible public health, medical and welfare service to care-required person. Especially, for providing a client-centered service to care-required person while utilizing the vehicle, the care-required person’s self-care ability would be improved as well as the person would be able to maintain his/her life at home with maintain his or her optimum health status. Especially, to establish a local-centered care management for Korea, the further assignment will be suggested as follow. Both Korea and Japan have gone through changing period of the care management system for the aspect of establishment and initiation even the two countries present different period and form. All together with a new system such as the community welfare plan and long-term care insurance system in Japan and the community welfare plan and long-term care insurance system for the elderly in Korea and the absence and problem of current care management system should be complemented to improve two countries community welfare plan. It is strongly needed to empower public health, medical and welfare service under the newly developed nation-wide system, to improve service deliverly system. Moreover, to provide a connected and integrative service for the aspect of public health, medical and welfare service, the systems of governance and nation as well as community residents’ active participation, the client-centered which is effective local-centered care management system will be settled.

영국 케어매니지먼트 시스템의 운영과 발전에 관한 연구

전용호 한국통합사례관리학회 2012 한국케어매니지먼트연구 Vol.7 No.-

영국은 지난 20여년간 케어매니지먼트를 지역사회보호의 핵심장치로서 발전시켜왔다. 본 논문의 목적은 영국케어매니지먼트 시스템과 그 운영을 분석하고 한국 노인장기요양보험에의 정책적 시사점을 모색하는 데 있다. 본 연구는 기존 문헌연구를 통해서 수행되었다. 본 연구결과에 따르면, 영국은 케어매니지먼트를 지역사회에서노인들을 위한 전문적인 욕구 사정과 서비스 제공 등의 중요한 수단으로 활용해 왔다. 특히 전문화, 예산권한의이양, 대상의 표적화, 다양한 분야의 접근의 측면에서 케어매니지먼트를 발전시켰다. 그러나, 예산의 제한과 현장에서의 전문인력들의 한계 등 때문에 당초 목표를 충분히 달성하지는 못했다. 그러나, 영국의 경험은 우리나라에 다음과 같은 정책적인 시사점을 제시한다. 무엇보다도, 한국 노인장기요양보험에 케어매니지먼트 도입의 필요성을 제시하고 있다. 중장기적으로 전문인력의 양성을 통한 케어매니지먼트의 전문화와 케어매니지먼트 서비스 대상의 표적화를 효과적으로 추진해야 할 것을 시사하고 있다. 아울러, 클라이언트의 복합적인 욕구를 충족하도록 다양한 분야의 협력적인 접근을 추진해야 할 것이다. The UK has developed care management system as a cornerstone of community care for over 20 years. The aim of this paper is to examine the care management system and its operation in the UK and to find policy suggestions for the development of Korean long-term care insurance. This research was conducted by adopting literature review methodology. The findings sugguest that care management has been used as a significant means to assess needs of elderly people and deliver services for them in the community care. In particular, the policies of care management towards specialisation, budgetary devolution, targeting, and multi-disciplinary approach have been actively sought by the government. In spite of this, the policies have not been able to successfully achieved their initial aims. The experience of developing care management in the UK suggests that there are a number of useful policy implications for the development of the Korean long-term care system. Most of all, the need for the introduction of care management in the long-term care system is suggested owing to its merits. In addition, in the medium and long-term, Korea also need to implement the policy toward the specialisation and targeting of care management. Moreover, it suggests that multi-disciplinary approach of care management should be actively sought in order to meet the complex needs of service users.

노인장기요양보험제도 실행에서의 한국형 케어매니지먼트 도입에 관한 고찰

김찬우 ( Kim Chan-woo ) 한국보건사회연구원 2013 保健社會硏究 Vol.33 No.2

본 연구의 목적은 시행 4년이 지난 노인장기요양보험제도의 실행에서 지속적으로 제기되고 있는 케어매니지먼트 도입과 서비스 관리에 대한 문제점을 파악하고 실질적인 한국형 케어매니지먼트 모델 도입 방안을 모색해 보는 것이다. 특히, 장기요양보험관련 재정의 압박을 받고 있는 OECD 국가들의 장기요양제도 하에서의 케어매니지먼트구축에 관해 종합적인 고찰을 해보고 우리나라 장기요양제도 실행에 케어매니지먼트 도입관련 정책적 제언을 제시하는 데 있다. 제도 실행 후 대상자 및 등급외자들에게 발생하는 상당한 문제점이 케어매니지먼트 도입부재에 있음에도 불구하고 도입방안에 대한 필요성, 실제 적용에서의 중앙 및 지방자치단체, 관리운영주체 및 서비스 제공자 간의 이견 들을 짚어보았다. 이를 토대로 기본 방향 설정과 도입방향 등에 대해 지난 4~5년간의 문헌들을 중심으로 적용성을 살펴보았다. 본 연구결과 케어매니지먼트의 구성요소별로 적절한 사례 수를 70~80인 정도로 하고 소속주체별 대안으로 현재 인정조사가 건강보 험공단에서 이루어진다는 제도 규정 안에서 지자체 및 서비스 공급자들 별 소속주체를 확립하여 표준이용계획서와 서비스 이용 및 모니터링 간의 실질적인 연계체계를 구축하는 케어매니지먼트 도입이 필요한 것으로 나타났다. This study explores a care management system model in National LTC Insurance(NLTCI). Current Korean NLTCI has shown several problems without the care management system for last four years, particularly regarding service quality, monitoring and utilization. In the first section, this article diagnoses the current problems without care management in the NLTCI. Those problems includes the lack of coordination among LTC services, medical services and welfare services. The fragmentation between social care and LTCI services are also derived from the lack of care management. In the second section, this study discusses five components of the care management system based on the LTC policies in some OECD countries; assessment system, case loads, employer of care managers, care management models, and the influence of care managers to the service providers. Lastly, the study discusses the model of a care management system to fit for current NLTCI. Under the NLTCI, the care management system can better play by the partnership among NHI, local governments, and key-service providers. The conclusion of this study suggests several alternatives and implications of care management to National Long-term Care Insurance in Korea.

노인장기요양보험에서의 케어매니지먼트 기능과 운영에 대한 인식연구

임정기(Jeong Gi Lim),최명민(Myung Min Choi),김욱(Wook Kim) 한국사회정책학회 2011 한국사회정책 Vol.18 No.3

본 논문은 노인장기요양보험 하에서 노인의 욕구에 적절한 서비스를 제공하고 자원을 효율적으로 관리하기 위한 케어매니지먼트의 수행체계에 대한 다양한 인식 유형을 검증하기 위한 목적을 가진다. 이를 위하여 국민건강보험공단 장기요양센터에서 등급판정 및 서비스 이용계획, 서비스 모니터링을 담당하는 요양직원을 대상으로 서비스 이용관리와 관련된 인식을 조사하였다. 우리나라 노인장기요양보험은 대상노인의 욕구에 맞는 적절한 서비스 이용과 자원의 효율적 관리를 위한 케어매니지먼트가 부재한 상황에서 보험자인 공단이 ``표준장기요양이용계획서``를 통하여 제한된 케어매니지먼트 역할을 하고 있다. 이에 케어매니지먼트를 수행하는 관련 직원은 표준장기요양이용계획서의 역할을 무엇으로 규명하고 있는지를 파악하여 향후 노인장기요양보험 하에서의 케어매니지먼트 체계 수립을 위한 기초자료를 마련하고자 한다. 분석결과 공단의 케어매니지먼트 역할에 대해 표준화를 지향하는 집단과 개별화를 지향하는 집단으로 나눌 수 있었다. 표준화를 지향하는 집단은 현재의 제도체계에 좀 더 실용적인 기준을 더하는 ``기준 보완형``과 현재의 ``표준이용계획서 중시형``으로 나뉠 수 있었으며, 개별화를 지향하는 집단은 ``전문성 지향형``과 ``노인의 욕구 중시형``로 나뉠수 있었다. 이러한 결과는 그동안 실증적으로 검증되지 못했던 케어매니지먼트에 대한 다양한 인식내용의 실체를 파악해 보았다는 데 의의가 있으며 향후 노인장기요양서비스의 케어매니지먼트 관련 정책결정과 집행과정에 있어 기초자료가 될 수 있다. This study is to find out perception types of long-term care managers who work in long term care center of National Health Insurance Corporations. Long-term care managers work for grade classification, service utilization plan and monitoring. So it is important for their perception to develop care management system in long-term care insurance. Therefor this study adopted Q methodology which is developed mainly to study on the subjective conceptualization of related people on research theme. This study found out four major types of perception on care management as role of present "standardized long-term care plan" in long-term care insurance scheme. They are the type of focusing professionalization of care manager, valuing on client- oriented needs, focusing standard criteria for care management, and insisting on more forcing present standardized care plan. Two of the former are types for care management as individualized professionalism and two of the latter are types for care management as standardized resource control. This research findings can be used to make clear understanding on diverse voices about care management. This kind of understanding would contribute to mutual understanding and clear communication to arrive positive consensus related to the matters of long-term care insurance.

연구논문 : 장애인 장기요양 매니지먼트 활성화를 위한 입법 과제

김철주 ( Cheol Joo Kim ),홍성대 ( Sung Dae Hong ) 한국의회발전연구회 2010 의정연구 Vol.16 No.3

이 글의 목적은 우리나라 장애인 장기요양보장제도 확충과정에서 고려돼야 할 매니지먼트체계 대안을 고찰하고 대안 도입을 위한 입법과제를 검토하는 것이다. 현행 장애인 활동보조지원 사업 중심의 장애인 장기요양보장제도 매니지먼트체계는 사례발굴 기능의 부재, 매니지먼트 기능의 이원화 및 부실, 서비스 이용자의 이해관계 대변과 옹호의 한계, 서비스 질 관리의 부실, 장애인 사회서비스 연계 부족 등의 문제를 노정하고 있다. 이러한 문제를 극복하기 위해서는 독립적 주체에 의한 매니지먼트를 통한 이용자의 이해관계 대변·옹호 강화, 매니지먼트 기능의 통합과 전문성 제고, 서비스 제공에 대한 객관적 모니터링 및 평가 강화, 지역사회 장애인 사회서비스와의 연계 강화 등을 위한 방안이 필요하다. 한편, 대안적 매니지먼트체계 구축에 대한 논의는 새로 도입될 장애인 장기요양보장제도의 도입방식과 밀접히 연관된다. 현재 유력시 되고 있는 도입방식은 기존 노인장기요양보험에의 통합 방식과 기존 장애인 활동보조지원 사업의 확대 방식 등 두 가지이다. 전자를 위해서는, 현재의 노인장기요양보험법의 부분적 개편을 통해 매니지먼트 수행 주체 및 서비스관련 내용을 규정하는 방법이 적절하다. 후자의 경우, 활동보조지원 사업관련 내용을 장애인복지법에서 분리하되 별도의 법을 제정하여 관련내용을 체계적으로 규정하는 방법이 적절하다. The purpose of this paper is to consider activation plans of long-term care management system for the disabled. The main contents of this paper are diagnosis of present state and problems of long-term care management system, directional establishments in constructing new system and consideration of practical alternatives of new system. Thre are many problems in current long-term care management system for the disabled, such as duality of management function, insufficiency in advocating and representing interests of service user, poor service supervision, poor service linkage to various community social services. To overcome these problems, there need to prepare measures, such as reinforcement of management agent`s independence, integration of management function, enhancement of professionalism, introduction of service monitering and evaluation by a third party, and reinforcement service linkage to various community social services by reforming service-deliverly systems in the long term. Meanwhile, consideration of practical alternatives of new long-term care management system is deeply related to new social security system for long-term care. There are two types of new social security system for long-term care, one is to integrate with existing long-term care insurance for the elderly, the other is to expand existing personal assistant service programme. In the case of the former, it is need to change management agent to local governments and to incorporate management services into insurance fee. In the case of the latter, it is need to leave management tasks to management team composed of local governments and service providers and social workers.

Relationship between the educational support needed by care managers in providing end-of-life care at home in Japan, experiences of providing end-oflife care, and acquired basic certificates

Kumiko Hayashi,Emiko Kasuya,Yuko Shiba,Shigeko Iimori,Hisako Horiguchi 한국간호과학회 2021 한국간호과학회 학술대회 Vol.2021 No.10

Aim(s): This study aims to establish details of the relationship between the educational support needed by care managers in providing end-of-life care at home in Japan, the experiences of providing end-of-life care, and the acquired basic certificates. Method(s): Data collection period: August to October of 2020. Data collection method: Anonymous self-rating questionnaire survey by using postal services. Study participants: Care managers working at in-home care management office in City A, Japan. Survey items: “Demographics”, “basic certificates that are a prerequisite for acquiring a care manager qualification”, “whether or not having experience of end-of-life care as a care manager”, and “educational support needed to provide end-of-life care as a care manager”. In the analysis, the descriptive statistics values of each item were calculated, and a chi-square test and residual analysis were performed after cross tabulation. Result(s): We distributed questionnaires to 672 establishments in City A, and collected 372 responses, and of these 342 (91.9%) were determined as valid. There were 308 (90.1%) care workers with experience of end-oflife care as a care manager. The most needed educational support for end-of-life care as a care manager was support to understand the “progress of illnesses”, 248 (72.5%) of all participants. For the basic certificates, nurses and assistant nurses were statistically significantly fewer than other basic certificates care managers (p < .05). The second most needed educational support needed was “pain control”, 186 (54.4%) of all participants. The number of participants who need “pain control” educational support was statistically significantly smaller among those with experience of end-of-life care as a care manager (p < .05). Conclusion(s): The most needed educational support for end-of-life care as a care manager was support to understand the “progress of illnesses”. For the basic certificates, nurses and assistant nurses were statistically fewer than other basic certificates care managers.

Difficulties felt by care managers in providing support for end-of-life care service clients

EMIKO KASUYA,YUKO SHIBA,KUMIKO HAYASHI,SHIGEKO IIMORI,HISAKO HORIGUCHI 한국간호과학회 2021 한국간호과학회 학술대회 Vol.2021 No.10

Aim(s): This study aims to identify difficulties faced by care managers when providing end-of-life care at home, and contribute the findings as basic data for developing educational programs for care managers. Method(s): Study participants were care managers working at 672 in home care management office in the Tokai region in Japan. An anonymous self-rating questionnaire survey was conducted using postal services between September and October of 2020. Comments provided in the open-ended question, “In what aspects do you feel it to be difficult when providing the end-of-life care” were organized into codes, and a qualitative and inductive analysis was performed. Result(s): Questionnaires were sent to 672 establishments, and 372 responses were collected. There were six categories “Problems with the long-term care insurance system” “Difficulty in improving the medical treatment environment suited to the end-of-life stage” “Anxiety due to lack of knowledge about the progress of the end-of-life care period” “Difficulty in providing support for the family” “Limitations of the role as care managers” and “Difficulty in sharing information and collaborating with medical professionals”. Conclusion(s): Care managers do not think that the present Long-term care Insurance System provide sufficient welfare services for the insured service clients at the end-of-life stage, and think that there is room for improvement. Care managers were aware of the necessity to provide end-of-life care services suited to the progress of illnesses, but they were also aware of their lack of specific knowledge of this. In addition, despite the necessity for cooperation with medical professionals, care managers felt that it is difficult to cooperate with medical professionals due to lack of information sharing, and the limitations in providing support for service clients as care managers. These issues make care managers feel it difficult to provide service clients with sufficient services.

보육시설 급식운영관리 실태 조사

이미숙,이재연,윤선화 대한지역사회영양학회 2006 대한지역사회영양학회지 Vol.11 No.2

This study was carried out to investigate foodservice management practices of 100 child care centers nationwide, and to provide background information for developing foodservice management policies at child care centers. Approximately 20% of the child care centers had a separate dining room; most of the centers were vulnerable to sanitation or safety problems. The percentage of the centers that planned menus was about 60% and 10% established standardized recipes. Fourteen percent of the centers kept records for distribution and menu evaluation and 33% kept sanitation management records. Since only 7% of the centers employed a dietitian, foodservice in most centers were not managed by professionals. The results of menu assessment revealed that 56.5% of the national/public child care centers received 19 points or higher out of 21 points, whereas 5.6% of the private child care centers received the same scores. Proper usage and storage of raw food, sanitary management of equipment and facilities, waste management/leftover food treatment, and basic facility of cooking zones were performed well by many centers. The overall scores of foodservice performance were only 31.2 out of 60 points, representing relatively poor safety management, food procurement management, and facilities and equipment management. These results indicate that the foodservice management of the child care centers are in a relatively poor state. Since nutrition management of the most centers was performed by non-professionals, it may not be possible to provide proper nutrition for health and normal growth of preschool children and to perform efficient nutrition education programs. The following suggestions are strongly recommended in order to improve foodservice performance at child care centers. First, foodservice administration should be performed by a dietitian, and second, efforts should be focused on strengthening nutrition and sanitation management. (Korean J Community Nutrition 11(2) : 229 ~ 239, 2006)