노인요양병원으로부터 응급의료센터로 전원된 환자의 역학적 특징 분석-사례군 연구

조한진,문성우,김도현,한갑수,박종수,이성우,최성혁,홍윤식 대한응급의학회 2011 대한응급의학회지 Vol.22 No.5

Purpose: Nursing homes continue to increase in number,and more residents are being transferred to emergency departments (EDs). The objective of this study was to investigate the overall characteristics of residents who were transferred to the ED and follow-up their course of treatments. Methods: We identified nursing home residents aged 65years and older who had been transferred to the ED of a regional tertiary university medical center from January 2008 to December 2009. Further attention was paid to those who had been diagnosed with sepsis. Meantime, a separate cohort of sepsis patients was collected, made up of geriatric patients aged 65 years or older who had visited the ED voluntarily from home or through medical institutions other than nursing homes during the same period. We then compared the two cohorts of sepsis patients. Results: A total of 321 patients aged 65 years or older were transferred from nursing homes during the study period. Their mean age was 77.6±7.2 years, and 172 (54.8%)were females. Seventy six (24.2%) patients whose caregivers did not comply with the necessary procedures or refused aggressive management were discharged home or were retransferred to nursing homes. A total of 41 sepsis patients had been transferred from nursing homes, whereas 64 patients had visited the ER voluntarily or through medical institutions other than nursing homes. Even though the difference between the two groups was not significant statistically, patients transferred from nursing homes tended to be discharged or retransferred to nursing homes with inadequate treatment. Conclusion: A considerable number of patients transferred from nursing homes were found to be discharged or retransferred to nursing homes during acute care due to refusal of aggressive treatments. Likewise, the comparison of sepsis patients between the two arms showed a greater portion being retransferred with inadequate treatment as well as a greater rate of mortality among patients transferred from nursing homes.

입원환자의 의료보장형태에 따른 가정간호 이용의사에 대한 연구

김명희,조은지,박형숙,강인순,Kim, Myung-Hee,Cho, Eun-Ji,Park, Hyoung-Sook,Kang, In-Soon 한국가정간호학회 2005 가정간호학회지 Vol.12 No.2

Purpose: This study is a descriptive research which is designed to investigate hospitalized patients' intent to use home care nursing according to the types of medical security. Method: This researcher surveyed 236 patients who were hospitalized at B medical center located in Busan,. Data were collected from Sep. 1 to Nov. 30, 2005 using a questionnaire survey, medical records, face-to-face interviews and observations. Collected data were analyzed in terms of frequency, percentage, mean and standard deviation through $x^2$-test and t-test under SPSS WIN 10.0 Program. Result: Out of the total subjects, 59.3% were medical aid clients and the remaining 40.7%, health insurance ones. The hospitalized period and frequency of the former group were 38.0 days and 4.0 times, respectively, while those of the latter, 37.7 and 3.4. When home care nursing clients were examined using a given classification device, it was found that out of the total 236 subjects, 205(86.9%) were needed to receive home care nursing, 121, medical aid and the other 84, health insurance. 24.0% of medical aid clients heard about home care nursing ever before, lower than 39.3% of health insurance clients. 43.8% of the former clients said cost for home care nursing was high while, 47.6% of the latter group responded expense for the nursing intervention was low. 30.6% of medical aid clients had intent to use home care nursing, lower than 47.6% of health insurance clients. 71.7% of those patients whose monthly income was 99 million won or below had no intent to use home care nursing, higher than 62.5% of those who were 100 million or over in monthly income(p<.05). 76.4% of those clients who had no nursing provider intented to use home care nursing, higher than those who had nursing provider(p<.05). Concerning contents of home care nursing, 85.1% of medical aid clients needed education, training and counseling while, 77.4% of health insurance aids wanted medication and injection. Conclusion: In conclusion, the use of home care nursing by medical aid clients should be promoted through improving conditions for home care nursing in terms of expense, family and residence and making public relations about activities and contents of the home care nursing.

노인장기요양 방문간호 현황 및 추이

황라일 ( Hwang Rah Il ),박소영 ( Pak So Young ) 경희대학교 동서간호학연구소 2019 동서간호학연구지 Vol.25 No.2

Purpose: This study aims to provide basic data for the development of measures and promoting home health nursing by examining the current status and trends in home health nursing for long-term care (LTC) insurance beneficiaries. Methods: Secondary data, including annual LTC insurance statistics reports for 2010-2017 and LTC manpower data, were used to compute current status and trends in the provision of home health nursing. Results: Beneficiaries of home health nursing under LTC insurance, insurance-covered costs for home health nursing, home health nursing provider, and home health nursing providing institution only accounted for 3% of all insurance-covered home care services, and were on a consistent decline since 2010. In particular, vulnerable rural regions with high proportion of individuals had poor infrastructure in terms of home health nursing institutions and manpower, but had a higher home health nursing utilization rate compared to urban regions. Conclusion: In addition to measures to support home health nursing service beneficiaries, policy measures are needed to support home health nursing service personnel and institutions. Furthermore, programs to cultivate the expertise of home health nurses and improve quality of home health nursing services should be developed in order to promote home health nursing utilization in vulnerable rural regions.

Nursing Staff Characteristics on Resident Outcomes in Nursing Homes

Lippincott WilliamsWilkins 2019 The journal of nursing research Vol.27 No.1

<P><B>ABSTRACT</B></P><P><B>Background:</B></P><P>The outlook of administrative staff and registered nurses (RNs) plays a critical role in the management of nursing homes. No previous study has compared the outcomes of nursing homes with RNs on staff with those of nursing homes without RNs on staff in Korea.</P><P><B>Purpose:</B></P><P>The aim of this study was to investigate the association between nurse-led nursing homes, staff turnover, and resident outcomes in nursing homes in Korea.</P><P><B>Methods:</B></P><P>Using a cross-sectional design, 36 nursing homes with 30 or more beds participated. Primary data included 15 quality indicators.</P><P><B>Results:</B></P><P>Nursing homes with RNs had statistically significant better resident outcomes. RN turnover related positively to the prevalence of falls ( β = 1.68, <I>p</I> < .05) and tube feeding (β = 1.71, <I>p</I> < .01) and negatively to incontinence (β = −1.53, <I>p</I> < .01). Nursing homes with RNs with tenures greater than 1 year had statistically significant lower prevalence of falls (β = −0.47, <I>p</I> < .05), incontinence (β = −0.45, <I>p</I> < .05), weight loss (β = −0.53 <I>p</I> < .05), and bed rest (β = −0.54, <I>p</I> < .01) and increased range of motion (β = 0.51, <I>p</I> < .05). Interestingly, having a nurse as a director for more than 1 year related negatively to the incidence of urinary tract infection (β = −0.56, <I>p</I> < .05) in residents. The rate of RN turnover was found to impact fall prevalence (β = 1.68, <I>p</I> < .05) and tube feeding (β = 1.71, <I>p</I> < .01) positively and to impact incontinence (β = −1.53, <I>p</I> < .01) negatively.</P><P><B>Conclusions:</B></P><P>Turnover of nursing home staff and length of tenure may contribute to the more effective management of nursing homes, higher-quality long-term care insurance, and RN-staffing-related laws. Assessing staff characteristics and the tenure of employees promotes the effective management of nursing homes.</P>

Lived Experiences of Nursing Home Residents in Korea

장수정 한국간호과학회 2013 Asian Nursing Research Vol.7 No.2

Purpose: The goal of the study was to understand the experiences of life among nursing home residents. Methods: Qualitative study was conducted using Colaizzi’s phenomenological method. The participants were 11 people aged 76-96 years in two nursing homes in Korea. Results: Nine themes were identified: giving up on one self, growing apart from familiar relationships, perceiving the monotony of daily life as suffering, feeling anxious about one’s future upon observing other residents, being dissatisfied with the lack of consideration for individualized care, developing interpersonal skills for communal life, missing the daily routines of their past lives, feeling optimistic about living in a nursing home, and having a strategy for the remainder of life in the nursing home. Conclusion: The results of this study confirmed the positive and negative emotions that elderly people typically experience while in nursing homes. Nurses should educate the families of nursing home residents, so that the family can better respect elderly people’s opinions and provide them with adequate support. Furthermore, nurses must not only provide reliable support, resources and serve as advocates, but they must also pay more attention to the environment of the nursing home to make it feel like home to the elderly residents. Purpose: The goal of the study was to understand the experiences of life among nursing home residents. Methods: Qualitative study was conducted using Colaizzi’s phenomenological method. The participants were 11 people aged 76-96 years in two nursing homes in Korea. Results: Nine themes were identified: giving up on one self, growing apart from familiar relationships, perceiving the monotony of daily life as suffering, feeling anxious about one’s future upon observing other residents, being dissatisfied with the lack of consideration for individualized care, developing interpersonal skills for communal life, missing the daily routines of their past lives, feeling optimistic about living in a nursing home, and having a strategy for the remainder of life in the nursing home. Conclusion: The results of this study confirmed the positive and negative emotions that elderly people typically experience while in nursing homes. Nurses should educate the families of nursing home residents, so that the family can better respect elderly people’s opinions and provide them with adequate support. Furthermore, nurses must not only provide reliable support, resources and serve as advocates, but they must also pay more attention to the environment of the nursing home to make it feel like home to the elderly residents.

노인장기요양보험 방문간호 권고군의 방문간호 이용과 의료이용의 관계

강새봄 ( Sae Bom Kang ),김홍수 ( Hong Soo Kim ) 한국보건행정학회 2014 보건행정학회지 Vol.24 No.3

Background: This study aimed to examine the relationship between home-visit nursing services and health care utilization under the public long-term care insurance program in Korea. Methods: We analyzed the long-term care need assessment database and the long-term care and the health insurance claim databases of National Health Insurance Service between July 2011 and June 2012. The sample includes a total of 20,065 home-visit nursing recommended-older beneficiaries who use home-visit nursing and/or home-visit care, based on a standard benefit model developed by the Health Insurance Policy Institute of National Health Insurance Service. The beneficiaries were categorized into home-visit nursing use and non-use groups, and the home-visit nursing use group was again divided into high-use and low-use group of home-visit nursing, based on their total annual home-visit nursing expenditure. Two-part model and negative-binomial regression models were used for the statistical analysis. Results: The home-visit nursing use was negatively associated with the number of outpatient visit and cost, while adjusting all the covariates. The home-visit nursing use was also negatively associated with the inpatient cost among the high home-visit nursing use group. Conclusion: The findings implies home-visit nursing use prevents health care utilization. Further studies and policy strategies that can promote and strengthen home-visit nursing under the public long-term care insurance are necessary in Korea.

노인요양시설의 공간구성 관련 연구동향

오찬옥 한국실내디자인학회 2017 한국실내디자인학회논문집 Vol.26 No.2

This study was intended to grasp the research trends related to the spatial composition of nursing homes. The 43 research papers were collected and analyzed. They were analyzed to focus on the research methodology and research contents related to the spatial composition of nursing home. The researches on spatial composition of nursing home were categorized into 5 types ; 1) the researches on the overall spatial composition of nursing homes, 2) the ones on space planning of each room in nursing homes, 3) the ones on the space size of nursing home, 4) the ones on the spatial composition of nursing homes in foreign countries, 5) the ones on the usage conversion of small-sized hospital and closed school into nursing home. The size and layout of a bedroom and common space were the main issue. These studies have been consistently carried out since late 1990 and many researches used the method of the analysis of floor plan and the field study. However, the number of the subject nursing homes and the categorized space areas were different depending on studies. Therefore, it was difficult to synthesize these various results. In order to compare and synthesizing the various results of these many studies, the same criteria for dividing the spaces of nursing home needs to be applied. However, many results from these researches related to the space composition of nursing home would be the useful data for planning the nursing home. 본 연구는 노인 인구 특히 고령 노인의 증가로 노인요양시설에 대한 수요가 급증하고 있으나 이들의 특성을 배려하여 계획된 요양시설들이 부족한 우리나라의 상황에서 노인요양시설의 공간구성과 관련된 연구내용을 중심으로 2016년까지 학술지에 게재된 논문을 대상으로 연구방법과 연구내용을 중심으로 동향을 파악하고자 하였다. 노인요양시설의 공간구성과 관련하여 국내의 공간관련 학술지에 발표된 연구논문들은 총 43편이었다. 분석결과, 첫째, 이들 논문은 5개 유형으로 분류되었다. 노인요양시설 전반에 대한 공간구성모델이나 계획방향을 제시한 연구가 13편이었으며 노인요양시설의 특정 단위 및 공간의 공간구성 특성을 분석한 연구와 면적을 중심으로 분석한 연구가 각각 12편씩이었다. 일본, 미국, 핀란드, 호주 등 외국 시설들의 공간구성 특성을 살펴본 연구는 8편이었으며 병원이나 폐교를 활용한 노인요양시설의 공간구성 특성에 관한 연구가 4편이었다. 둘째, 이들 연구 중 요양시설의 전반적인 공간구성 특성 분석연구와 병원 및 폐교를 활용한 요양시설의 공간구성 특성연구 유형은 2000년부터 현재까지, 나머지 3가지 유형은 1990년대 말부터 현재까지 지속적으로 발표되어 오고 있다. 공간구성 관련 많은 연구들이 현장조사를 병행한 도면분석연구를 하였고 이 경우 조사대상 노인요양시설의 수는 연구에 따라 1개에서 62개에 이르기까지 차이가 컸다. 연구목적에 따라 다를 수 있지만 연구결과의 일반화에 주의를 할 필요가 있다. 셋째, 노인요양시설의 전반적인 공간구성 특성 분석연구들은 실태분석을 통해 침실 당 적정 사용인원수와 공용공간의 비중과 배치관계, 효율적인 복도형태유형 등을 고려한 요양시설의 계획방향을 제안하거나 공간구문론을 이용한 정량적인 분석연구결과, 사용자 행태 및 관련 기준이나 이론을 토대로 한 공간구성 분석결과에 기초한 계획방향을 제안하였다. 넷째, 노인요양시설의 단위 및 공간별 공간구성 관련 연구들 중에는 거주단위의 공간구성을 분석한 연구가 가장 많았으며 그들 연구는 간호단위당 거주단위 수와 병상수, 공용공간의 적정 규모와 배치관계, 복도형태 유형별 공간구성특성을 분석한 연구들이었으며 이외에 간호단위, 욕실과 화장실, 배회복도와 공간, 복도공간, 서비스공간 등을 대상으로 현황을 분석하고 개선안을 제안하였다. 다섯째, 노인요양시설의 면적분석연구들은 입소 노인 1인당 침실면적을 산정하여 법적 기준과 비교분석하거나 공간영역별 면적비를 산정하여 비교분석하고 사용자의 행동관찰 등을 기초로 적정 면적을 제안하였다. 여섯째, 외국 노인요양시설의 공간구성 특성분석연구들은 일본을 대상으로 한 연구가 많았으며 그 외에 미국, 핀란드, 영국, 호주 등의 요양시설들의 공간구성 특성을 계획방향과 함께 분석하였다. 일곱째, 노인장기요양보험제도의 시행으로 노인요양시설의 수요가 급증함에 따라 대도시의 소규모 병원이나 지방의 폐교를 요양시설로 용도전환하여 활용하는 방안에 대한 연구가 진행되었으며 모두 경제적이며 유용성이 있음을 보여주었다.

인천 지역 가정 거주 노인과 시설 거주 노인의 식행동 비교 연구 : The Elderly Living in Home and the Elderly Nursing Home

이강자 동아시아식생활학회 1997 동아시아식생활학회지 Vol.7 No.2

This study is investigate the eating behavior between the elderly living at home and the elderly at nursing home in Inchon City. This survey was carried out by questionaires. The result are summarized as the followings: 1. Both the elderly living at home and the elderly at nursing home are not smoking and drinking. They are in good health. 2. The elderly living at home and the elderly at nursing home have diseases like neuralgia, hypertension, diabetes etc. 3. Both the elderly living at home and the elderly at nursing home have methods of health care of a regular eating and a good sleeping. The elderly at nursing home have a regular medical examination but the elderly living at home do not. 4. Health giving drugs are depression of blood pressure, a medicine for the stomach and bowels, an anodyne. And health giving sports are walking and jogging. 5. The elderly living at home and the elderly at nursing home are significant relationship on knowledge of nutrition. 6. The elderly living at home and the elderly at nursing home prefer to taste sweet, boiling, Korean foods. 7. The elderly living at home have meats once a week and the elderly at nursing home have twice a week. Both the elderly living at home and the elderly at nursing home have fish, fruits, vegetables twice a week. The elderly at nursing home have milks twice a week. 8. The frequency of snack intake is higher the elderly at nursing home than the elderly living at home. 9. The elderly living at home and the elderly at nursing home are satisfied their dietary life.

국공립 노인장기요양시설 장기간 수요 및 적정공급량 추정

주은선(Eun-sun Joo),이미진(Mi-jin Lee) 한국사회복지교육협의회 2020 한국사회복지교육 Vol.49 No.-

본 연구는 2020~2050년 노인장기요양시설 수요 증가량과, 향후 10년 간의 국공립 노인장기요양시설의 적정 공급량을 추정한 것이다. 한국에서 국공립요양시설 증설은 공공성을 강화를 통해 시장 위주의 노인요양시설서비스의 문제를 완화시켜 서비스 질을 높이는 방안이자, 빠른 고령화로 인한 시설서비스 수요 증가에 대응하는 방안이다. 이에 국공립 노인장기요양시설 증설을 적극적인 정책 대안으로 추진하기 위해 적정공급량 추정을 시도하였다. 본 연구에서는 고령화와 함께 연령대별 입소율 차이, 대도시 및 수도권과 기타 지역의 인구분포, 지역별 적정 시설규모 등을 고려하여 요양시설서비스 수요와 국공립요양시설 적정 공급량을 추정하였다. 요양시설서비스 수요는 2020년 12월 231,175명에서 2050년 822,978명으로 증가할 것으로 예상된다. 장기요양서비스 공급에서 국공립 비중이 30% 수준이 되도록 하기 위해서는 2021~2030년에 시설요양 수요 증가분의 50%를 국공립 요양시설로 충당하도록 해야 하며, 누계로 대도시 및 수도권에 총 394개, 기타지역에 총 334개(합계 728개)가 공급될 필요가 있다. 이는 2022년까지 70인 정원 국공립시설을 약 50개 추가로 지어 총 160개소로 늘린다는 2차 장기요양기본계획의 정책 방향이 확대되어야 함을 의미한다. 본 연구는 장기간의 노인장기요양시설 수요 추정치와, 국공립 요양시설 적정 공급에 관한 상세한 수치를 제시하여 국공립요양서비스 강화정책에 시사점을 제공한다. This study estimated demands of public nursing homes for older adults between 2020 and 2050 and the adequate supply for the next 10 years. In Korea, increasing the number of public nursing homes for older adults is aimed for reinforcing publicness, enhancing the quality of care by reducing the negative effects of marketization, and directly dealing with the demands of nursing home placement primarily due to rapid aging. This study attempted to describe the detailed-estimate of demands and supply for nursing home for older adults in order to advocate for raising the number of public nursing homes, which should be the policy alternative of strengthening publicness. It is expected that Korea will exhibit the fast growth of the absolute number of older adults, the changes in the proportion of aging population, and the changes in the regional distribution of older adults for the next 30 years of rapid aging. This study estimated the demands of public nursing homes for older adults by using the nursing home placement rate of older adults by age groups, the regional distribution of older adults, and the regionally differential number of nursing home beds. The results indicated that the demands of nursing homes for older adults will be increased from 231,175 on 2020 to 822,978 in 2050. To satisfy fifty percent of the total increasing demands, 394 public nursing homes in the metropolitan cities and Gyeonggi-do (near Seoul) and 334 in other regions should be built until 2030. This findings imply that the 2nd national long-term care plan that stated the additional 50 public nursing homes (70 beds per home) should be expanded. This study provides policy implications by showing the estimate of demands of nursing homes during the extended-period, and proposing detailed-adequate supply for public nursing homes.

양로시설 거주 형태에 영향 미치는 예측변수에 관한 연구 : -무료양로원과 유료양로원 거주 노인을 대상으로-

김윤정 대한케어복지학회 2006 대한케어복지학 Vol.2 No.1

본 연구에서는 서울, 경기, 충청, 전라, 경상권의 유료양로원과 무료양로원에 거주하는 352명의 노인들을 대상으로 하여 첫째, 양로시설 거주 형태에 따른 생활실태를 비교하고, 둘째, 양로시설 거주 형태에 영향 미치는 예측변수들을 파악하는데 연구의 목적이 있다. 연구결과 첫째, 유료양로원의 경우 남자노인의 비율이 다소 높고, 65세 이하노인과 85세 이하의 노인이 다소 많은 것으로 나타났다. 그러나 학력에 따른 차이는 유의하지 않았다. 둘째, 무료양로원은 부양자가 없음이 가장 중요한 입소동기인데 유료양로원의 경우 부양자의 부담이 중요 입소동기로 작용하였다. 입소 전 동거인을 살펴보면 무료양로원 노인의 경우 독거인 경우가 절반 이상을 차지하고 있어 부양가족이 없어 입소를 하게 되었다는 입소동기와 일치하는 부분이다. 유료양로원의 경우는 자녀나 친척과 동거한 경우가 대략 절반정도이고 그 다음이 배우자와의 동거로 나타났다. 마지막으로 무료양로원 노인은 노인 스스로 시설 입소를 원했다는 비율이 높고, 유료양로원의 경우 노인 스스로는 원하지 않았다는 비율이 더 높은 것으로 나타났다. 셋째, 무료양로원 거주 노인들이 유료양로원노인에 비해 시설종사자와 노인과의 관계, 혹은 노인들 간의 관계를 우호적으로 인식하는 것으로 나타났다. 넷째, 유료양로원에 거주하는 노인의 기능장애정도가 심하고, 노인에 대한 이미지는 보다 긍정적인 것으로 나타났으나, 우울감에서 두 집단 간 차이가 유의하지 않았다. 다섯째, 노인의 시설거주 형태에 영향을 미치는 예측변인들을 판별분석을 통해 알아본 결과, 노인의 성, 연령, 입소 전 동거형태, 입소에 대한 의지, 시설입소 후의 노인들간의 관계, 가족과의 관계, 노인의 기능장애, 노인에 대한 이미지가 유의한 영향을 미치는 것으로 나타났다. Taking as objects 352 old people residing in the paid or gratuitous nursing homes in the regions of Seoul, Kyunggi, Chungcheong, Jeolla and Kyungsang, this study aims to compare the life status (variables related to moving into the facilities, interpersonal relationship after moving into the facilities) as per residential type of institution for the aged and to grasp estimate variables affecting the residential type of institution for the aged. The findings of this study is as follows. First, in the case of paid nursing home, male is more than female and the prevalent range of age is over 65 and below 85. However, the difference in academic background is not significant. Second, while the most important motive to move into gratuitous nursing home is having no supporter, important motive to move into paid nursing home is payment by supporter. Checking lodger before they move into the facilities, more than half of the aged in the gratuitous nursing home lived alone, which coincides with the above motive, i.e., non-existence of supporting family. In the case of paid nursing home, half of the aged lived with children or relatives and the next group lived with spouse. Finally, it turned out that while the aged move into the gratuitous nursing home at their own will, those in the paid nursing home mostly do not. Third, it turned out that the aged residing in gratuitous nursing home tend to recognize amicably the relation between staffs in the facilities and the aged or among the aged than those in the paid nursing home. Fourth, though the aged residing in the paid nursing home suffer severe ADL and show more positive image, the difference between two groups in mental depression is not significant. Fifth, checking estimate variables affecting the residential type of institution for the aged by discriminant analysis, it turned out that sex, age, living together before moving into the facilities, intention to move into the facilities, relation among the aged after moving into the facilities, relation with family, ADL of the aged, image of the aged have significant influence.