간호 인력 확보수준 및 구성이 병원 내 사망률에 미치는 영향의 병원 특성별 비교

윤경일 ( Youn Kyung-il ) 한국보건정보통계학회 2017 보건정보통계학회지 Vol.42 No.1

Objectives: The characteristics of nursing workforce is critically important in achieving quality care in a hospital. However, current hospital industry environment does not allow ample investment in human resource. Therefore, hospital management has to come up with effective ways of investment in nursing resources. This study was conducted with the purpose of providing basic information needed for effective nurse staffing decision in hospitals. The impacts of nurse staffing level in terms of quality and quantity on health outcome were analyzed. Methods: Nurse staffing level and in-hospital mortality data of 3,451 hospitals nationwide were analyzed using multiple regression models. Dependent variable of the model was in-hospital mortality and independent variables included number of patient per nurse and percentage of nurse aid in nursing staff. As the control variables, patients characteristics and hospital organizational characteristics were included in the model. Results: Number of patients per nurse and proportion of nurse aides in nursing staff showed significant positive effects on in-hospital mortality. The effects were stronger in the hospital group that had relatively lower nurse staffing level. The positive relationship between staffing level and mortality rate was stronger in the hospitals that had higher severity level. Conclusions: Health policy should focus on improving minimum standard of nurse staffing level. Also, hospitals should lay nursing staff investment priority on the nursing units that serve high severity patients.

병동 병원감염 환례수집 담당간호사에 의해 조사된 병원감염 감시기록의 정확도

조윤숙,김정순 대한감염학회 2000 감염 Vol.32 No.4

Factors Related to Nurse Staffing Levels in Tertiary and General Hospitals

Kim Yun Mi,June Kyung Ja,Cho Sung-Hyun Korean Society of Nursing Science 2005 Journal of Korean Academy of Nursing Vol.35 No.8

Background. Adequate staffing is necessary to meet patient care needs and provide safe, quality nursing care. In November 1999, the Korean government implemented a new staffing policy that differentiates nursing fees for inpatients based on nurse-to-bed ratios. The purpose was to prevent hospitals from delegating nursing care to family members of patients or paid caregivers, and ultimately deteriorating the quality of nursing care services. Purpose. To examine nurse staffing levels and related factors including hospital, nursing and medical staff, and financial characteristics. Methods. A cross-sectional design was employed using two administrative databases, Medical Care Institution Database and Medical Claims Data for May 1-31, 2002. Nurse staffing was graded from 1 to 6, based on grading criteria of nurse-to-bed ratios provided by the policy. The study sample consisted of 42 tertiary and 186 general acute care hospitals. Results. None of tertiary or general hospitals gained the highest nurse staffing of Grade 1 (i.e., less than 2 beds per nurse in tertiary hospitals; less than 2.5 beds per nurse in general hospitals). Two thirds of the general hospitals had the lowest staffing of Grade 6 (i.e., 4 or more beds per nurse in tertiary hospitals; 4.5 or more beds per nurse in general hospitals). Tertiary hospitals were better staffed than general hospitals, and private hospitals had higher staffing levels compared to public hospitals. Large-sized general hospitals located in metropolitan areas had higher staffing than other general hospitals. Occupancy rate was positively related to nurse staffing. A negative relationship between nursing assistant and nurse staffing was found in general hospitals. A greater number of physician specialists were associated with better nurse staffing. Conclusions. The staffing policy needs to be evaluated and modified to make it more effective in leading hospitals to increase nurse staffing.

시계열 자료를 이용한 병원 간호 인력의 변화 추이 및 병원 간호사 확보를 위한 정책의 효과 평가

박보현,이태진,박형근,김철웅,정백근,이상이 한국보건행정학회 2012 보건행정학회지 Vol.22 No.3

Purpose : The purpose of this study was to analyze the trend of the number of nursing staffs and skill mix and to assess the effectiveness of hospital nurse expansion policies in Korea. Methods : The trend of the number of nursing staffs and skill mix were analyzed using time series data, which composed of yearly series data from 1975 to 2009. The impact of hospital nurse expansion policies was estimated by autoregressive integrated moving average(ARIMA) intervention model. Results : The number of general hospital and hospital nurses per 100 beds was decreased in late 1980s and late 1990s due to rapid growth of beds. As a result of the number of nurse aids per 100 beds decreased, skill mix became high in general hospital but nurse ratio among hospital nursing staffs was about 50%. Expansion of new nurse and revised differentiated inpatient fee were only effective in expansion of hospital nursing staffs. But they had no effect in general hospitals. Conclusion : In Korea, a few policies related to expansion of hospital nurses have an effect on increasing the number of hospital nurse. Nevertheless, level of hospital nursing staffs is inferior to that of general hospital.

종합병원과 요양병원 간호조무사의 업무현황 및 직무만족도 비교 연구

백성희 ( Seong Hee Back ),김계하 ( Kye Ha Kim ) 경희대학교 경영연구원 2014 의료경영학연구 Vol.8 No.1

The purpose of this study is to compare job performance and job satisfaction of nurse assistants in general hospitals and long-term care hospitals. The sample consisted of 179 nursing assistants, who were working in 5 general hospitals and 5 long-term care hospitals, located in Gwangju city and the Chonnam area. Data were collected by structured questionnaires, from July to August, 2011, and analyzed using descriptive statistics, chi-square test, Fisher Exact test, independent t-test, and one-way ANOVA, using a SPSS/Win 17.0 program. There was no significant difference in job satisfaction between general hospital and long-term care hospital nurse assistants. Significant differences in job satisfaction of nurse assistants in general hospitals were observed according to age, marital status, education level, Duration of working as a nurse assistant, and turnover intention. There were significant differences in job satisfaction of nurse assistants in long-term care hospitals according to age, gender, education level, and turnover intention. Nurse assistants in long-term care hospitals seem to conduct the work of nurses. However, in order to improve the quality of nursing care, the work of nurse assistants needs to be distinguished from that of nurses. Programs need to be developed that will help to improve job satisfaction among nurse assistants.

Management of Continuing Education of Nurse Midwives by Chief Nurses in Community Hospitals in Southern Thailand

Phechnoy Singchungchai,Thitiporn Ingkathawornwong,Suriporn Kritcharoen,Thanomsri Inthanon,Sawitri Limchai-arunreung,Udom Phanthong 한국간호과학회 2009 Asian Nursing Research Vol.3 No.4

Purpose To explore the levels of continuing education management in hospitals according to their size, and to investigate problems in the management of continuing education of nurse midwives by chief nurses in community hospitals. Methods The target population was 128 chief nurses, 103 of whom (80.47%) returned the questionnaires. Data were collected using a questionnaire that had been tested for its content validity by three experts (content validity index was .80 and the Cronbach’s alpha was .83). Descriptive statistics and ANOVA were used to investigate if differences existed among groups. Results The mean score of the level of continuing education management in nurse midwives for the chief nurses was low. The levels of education management for chief nurses according to hospital size (10-bed, 30-bed, and 60-bed hospitals) were not significantly different (p > .05). The problems for chief nurses in the management of continuing education in nurse midwives in the community hospitals were: lack of manpower (70%); financial problems (45%); lack of lecturers in advanced nurse midwifery (38%); insufficient number of courses in advanced nurse midwifery (29%); length of time for study leave taken for training(21%); and safety problems in the unrest areas in the southern provinces (21%). Conclusion The levels of continuing education management by chief nurses in all the community hospitals were low, primarily due to a lack of manpower and budgetary constraints. Therefore, the Nursing Council of Thailand should provide training and funds to support advanced nurse midwifery education programs in all parts of the country. [Asian Nursing Purpose To explore the levels of continuing education management in hospitals according to their size, and to investigate problems in the management of continuing education of nurse midwives by chief nurses in community hospitals. Methods The target population was 128 chief nurses, 103 of whom (80.47%) returned the questionnaires. Data were collected using a questionnaire that had been tested for its content validity by three experts (content validity index was .80 and the Cronbach’s alpha was .83). Descriptive statistics and ANOVA were used to investigate if differences existed among groups. Results The mean score of the level of continuing education management in nurse midwives for the chief nurses was low. The levels of education management for chief nurses according to hospital size (10-bed, 30-bed, and 60-bed hospitals) were not significantly different (p > .05). The problems for chief nurses in the management of continuing education in nurse midwives in the community hospitals were: lack of manpower (70%); financial problems (45%); lack of lecturers in advanced nurse midwifery (38%); insufficient number of courses in advanced nurse midwifery (29%); length of time for study leave taken for training(21%); and safety problems in the unrest areas in the southern provinces (21%). Conclusion The levels of continuing education management by chief nurses in all the community hospitals were low, primarily due to a lack of manpower and budgetary constraints. Therefore, the Nursing Council of Thailand should provide training and funds to support advanced nurse midwifery education programs in all parts of the country. [Asian Nursing

전문직의 젠더: 도쿄제국대학 부속병원으로 본 근대 일본 의사와 간호사의 위계

최자명 대한의사학회 2022 醫史學 Vol.31 No.3

This article explores the shaping of gender hierarchy between the nurse and the doctor in modern Japan, through the lens of the Tokyo Imperial University Hospital. I understand gender hierarchy of these two medical professions not just in terms of ranks in hospital bureaucracies, salaries, or educational credentials, but also the ways their work was defined, their skill levels were evaluated, as well as the probability of their united actions as members of a single profession to advocate their shared interests. Tokyo Imperial University is Japan’s oldest university, which is the birthplace of modern medical education. The hospital of this university was a symbolic locus for the making of gender hierarchy of the doctor and the nurse, which often transpired in other institutions and articulated in state regulations such as the Nurse Regulations prepared by Home Ministry officials in 1915. In this hospital, doctors who were male, while designing nursing education and labor practices, defined nursing primarily as women’s supplementary labor for doctors. While doctors had an exclusive professional territory, such as diagnosis, surgery, and medication, what nurses’ exclusive professional territory was undefined and how their skill levels could be evaluated remained unclear. In other words, probationary nurses often worked together with trained nurses, which allowed managers of the hospital to exploit their cheap labor, as well as attenuating the professional authority of the trained nurses. But, this process did not go unchallenged. Leaders of nurses at this hospital, such as Suzuki Masa and Ōzeki Chika did not think that nurses should be subordinated to the doctor. As managers of the Tokyo Imperial University Hospital hired unmarried women to have them endure intense labor with low wages, Ōzeki publicly protested a doctor at Tokyo Imperial University to improve nurses’ working environment, and these two soon resigned. After the resignation, Suzuki organized a visiting nurse service company called The Charity Visiting Nurse Corps (jizen kangofukai), and dispatched a group of its member nurses to the clients. Unlike when they worked in the Tokyo Imperial University Hospital, they became an independent service provider, deciding their work schedules, and the fees for their service for themselves. Compared to their wages in the Tokyo Imperial University Hospital, the service fees were two to three times higher in this new company. As nurses came to claim a high pay, visiting nurse service companies of this kind blossomed in Tokyo and other big cities, However, they eventually failed to gain a clear legal definition of what nurses could exclusively do as professionals and how their skills were assessed, and private nurses lost their high demand during the Great Depression. By looking at this process, this article reconfirms the conventional wisdom that the gender hierarchy of doctors and nurses were not biologically given but socially constructed through the interplay of education, employment, state policies, and the market, and considers why nurses’ efforts alone could not challenge the entirety of this hierarchy, without institional supports from the state.

간호·간병통합서비스병동 입원환자가 지각한 간호사의 공감역량이 병원 재이용의사와 환자신뢰에 미치는 영향

양희모(Yang Hee Mo),박선희(Park Seon Hee) 사단법인 안전문화포럼 2021 안전문화연구 Vol.- No.12

본 연구는 간호·간병통합서비스 병동에 입원한 환자를 대상으로 입원기간 동안 지각한 간호사의 공감역량 정도와 병원 재이용 의사, 환자의 신뢰 정도를 알아보고 입원환자가 지각한 간호사의 공감역량이 병원 재이용 의사와 환자 신뢰에 미치는 영향을 파악하기 위해 시도되었다. 연구의 대상자는 경기도 소재 대학병원의 간호·간병통합서비스병동에 입원한 환자 195명을 대상으로 하였으며, 수집된 자료는 SPSS window 21.0 통계 프로그램을 이용하여 분석하였다. 연구의 주요 결과는 다음과 같다. 첫째, 대상자가 지각한 간호사의 공감역량은 5점 만점에 3.99점, 병원 재이용 의사는 4.13점, 환자 신뢰는 4.25점으로 나타났다. 둘째, 대상자가 지각한 간호사의 공감역량은 병원 재이용 의사, 환자 신뢰와 모두 유의한 양의 상관관계가 있는 것으로 나타났다. 셋째, 대상자가 지각한 간호사의 공감역량이 병원 재이용 의사에 미치는 영향을 확인하기 위한 회귀모형 검증결과, 통계적으로 유의하였고, 총 설명력은 38.4%였다. 또한, 대상자가 지각한 간호사의 공감역량이 환자 신뢰에 미치는 영향을 확인하기 위한 회귀모형 검증결과 통계적으로 유의하였고, 총 설명력은 59.1%였다. 이상의 연구결과로 대상자가 지각한 간호사의 공감역량은 병원 재이용 의사와 공감역량에 유의한 정(+)의 영향을 미치는 것으로 나타나, 간호사의 공감역량이 높을수록 입원환자의 병원 재이용 의사와 환자신뢰 정도도 높아지는 것으로 나타났다. 본 연구 결과는 간호·간병통합서비스 병동 간호서비스의 질 평가 향상 전략 마련을 위한 기초자료로 사용될 수 있을 것이며, 간호사의 공감역량을 더욱 향상시킬 수 있는 중재프로그램의 개발이 필요함을 시사하고 있다. This study investigated the level of empathic ability of nurses perceived, the intention to revisit the hospital, and the degree of patient trust during hospitalization by patients admitted to the integrated nursing care service hospital. An attempt was made to determine the effect of nurse s empathy ability on hospital revisit and patient trust. The subjects of this study were 195 patients admitted to the integrated nursing and care service ward at a university hospital located in Gyeonggi-do, and the collected data were analyzed using the SPSS window 21.0 statistical program. The main results of the study are as follows. First, the perceived empathic ability of the nurse was 3.99 out of 5 points, the intention to revisit the hospital was 4.13 points, and the patient s trust was 4.25 points. Second, it was found that the empathic ability of nurses perceived by the subject had a similar score with the intention to revisit the hospital and the patient s trust. Third, as a result of the regression model verification to confirm the effect of the nurse s empathic ability perceived by the subject on the intention to revisit the hospital, it was statistically significant, and the total explanatory power was 38.4%. In addition, the results of the regression model verification to confirm the effect of the empathic ability of nurses perceived by the subject on patient trust were statistically significant, and the total explanatory power was 59.1%. As a result of the above study, it was found that the nurse s empathy capacity perceived by the subject had a significant positive effect on the intention to revisit the hospital and the empathy capacity. Furthermore, it showed that higher empathy ability of nurses increased willingness to visit the hospital again and patient trust level of hospitalized patients. The results of this study can be used as basic data for developing strategies for improving the quality of nursing services in the integrated nursing care service hospital, suggesting that there is a need to develop an intervention program that can further improve the empathy capacity of nurses.

종합병원의 일반병동, 중환자실, 응급실, 수술장간호사 확보수준 관련 요인

김윤미 대한간호학회 간호행정학회 2008 간호행정학회지 Vol.14 No.4

Purpose: To analyse hospital nurse staffing level of the general nursing unit, ICU, ER and OR in general hospitals. Method: The study sample was 105 acute general hospitals which had reported the bed size and number of nurses by the nursing units. Number of bed per nurse was analysed by the hospital characteristics and the staffing levels of the doctors and the nursing assistant personnels using t-test or ANOVA and Pearson's correlation. Results: Number of bed per nurse was 3.86 in general nursing units and 0.95 in ICU. Tertiary hospitals employed more nurses in general nursing units and ICU than general hospitals. Hospitals located in Seoul and public hospitals employed more ICU nurses. OR nurse staffing level was higher in academic hospitals. Hospital size was positively correlated with nurse staffing level of the general nursing unit, ICU, ER and OR respectively. Total nurse staffing level of the hospital was positively correlated with doctor and nursing assistant personnels staffing levels. Conclusion: Differentiated nursing fee schedule was needed to implement in ER or OR. Regulation policy should be needed for the hospitals which violated hospital nurse staffing level of the law.

병원 간호등급에 따른 간호수행 정도

윤순길 ( Soon Gil Yun ),박재용 ( Jae Yong Park ),김기훈 ( Key Hoon Kim ),한창현 ( Chang Hyun Han ) 한국병원경영학회 2010 병원경영학회지 Vol.15 No.3

As a cross-sectional study, this study was aimed to investigate and compare the job efficiency and satisfaction of nurses according to the hospital grade. Survey was conducted by mail on June 2009, and the respondents were 1,016 nurses working in 15 hospitals which are 9 high-grade general hospitals and 6 general hospitals. The percent of nurses acknowledging their hospital grades is 34.5%, and that is 20.5% at high-grade general hospitals. As the result of review of studies, it is concluded that under the circumstance that differential rates are contracted to calculate fees for hospital services and copayment of patients are according to nursing grades and hospital grades, the degree of nurses` awareness of insurance fees impact on their performance like recording of care and prescription. In order to improve nurses` performance, they need to be educated about the national insurance fee system. In hospitals with higher nursing grade and more beds, the levels of nursing quality and faithfulnes and their job satisfaction were higher. Nurses` awareness of their hospital nursing grade was related to the quality of nursing but not the faithfulness. Nurses working in higher nursing-grade hospital are more self-respect and satisfied at their jobs, and their job efficiencies are not significantly different. The current nursing fees based on the proper number of nurses per beds of nursing units should be changed to be based on the amount of job per nurse by their nursing protocol, and the nurse staffing standard should be differentiated between nursing grades. As the aspect of nursing, 24-hours patient care, it is difficult to improve nurses` job satisfaction, and in the other hand, that tends to depend on their income level. In the current circumstance, comprehensive research is required to investigate the propriety of 25% of the inpatient fees as the nursing management charge.