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REFERENCE LINKING PLATFORM OF KOREA S&T JOURNALS
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Journal of Korean Public Health Nursing
Journal Basic Information
Journal DOI :
Korean Society of public Health Nursing
Editor in Chief :
Volume & Issues
Volume 3, Issue 2 - Aug 1989
Volume 3, Issue 1 - Feb 1989
Selecting the target year
A Study on Accounting for Nursing Cost by Korean Diagnosis Related Groups (K - DRGs)
Oh, Hyo-Sook ;
Journal of Korean Public Health Nursing, volume 3, issue 2, 1989, Pages 5~46
The current medical payment Insurance Rates in Korea stipulate charges for medical treatment by the doctor, pharmaceutist, medical technician and maternity nurse. But unfortunately didn't specify those charges for nursing done by the professional nurse. Only basic nursing fee is accounted insufficiently in current medical insurance fee schedule. therefore, Being face with covering entire people by medical insurance by 1991, It seems that the problems pertaining to operating the hospital and medical insurance system would be incessantly expanded in that no mention is made of medical charges rendered by major medical producer service in the current system, For that reason, this study made an attempt to clarify the importance the professional nursing puts of the current medical payment. The purpose of this study was to accounting nursing fee which diveded into the current medical fee schedule. (Method) 1. Data collection; Importance and difficulties in nursing activities was conducted in 'S' National University Hospital. Total nursing activities were selected 72 items which included direct care and indirect care. This study was conducted to evaluating the degree of importance and difficulties according to nursing activities through questionnaire to 204 RN. and so relative difficulties (acuity) were computered because the nursing cost level of each nursing service was differently established by the equivalent coefficient according to degree of relative difficulty and time required. 2. Calculation of cost according to nursing activities; After 47 nursing activities were selected in General surgery nursing units, calculation of nursing cost was as follows Cost of Nursing activity = (relative difficulty X Average hourly wage and benefits of nurse) + material cost of nursing -t- Average nursing administration cost So, Calculated cost by nursing activities was compared to current non-insured and insurance rate. 3. Calculation of nursing cost by K - DRG ; Total of 578 patients who were hospitalized in General Surgery units from January to March 1988 ware classified by K - DRG After estimation of total nursing cost based on the K-DRG, verified the appropriateness of basic nursing fee in medical insurance rate (Results) 1. Analysis of degree of importance and difficulties were 4.16 and 3.67 based on 5 point scale. This score were judged that it is worthy specifying the nursing fee 2. The nursing cost of 47 nursing service items in general surgery patients showed that the average cost of nursing activity was \1374.5 and The lowest cost was \217 of 'oral administration nursing' item, The highest cost was \11,025 of 'saline enematill clear' item 3. The result of comparison between the calculated cost by nursing activities against the current non-insured and insurance rate showed that 13 items(27.7%) involved to payment of insurance rate, 9 items(19.1%) involved to non-insured rate, remainder 25 items (53.2%) were not charged anywhere of total 47 nursing activities 4. When calculated cost by nursing activities was 100. current insurance rate was 62.3, non-insured rate was 176.6. Therefore this showed that most of non-insured rate were higher than calculated nursing cost. The insurance rate, however, were lower than it. Reim-bursement was imputed to non-insured patients. So the current rate system became estrainged from cost system. When Remainder 25 items of nursing activities compared' to \1390 of daily basic nursing fee per patient belonged to payment as a insurance fee schedule, basic nursing fee schedule was 1-2% of calculated cost of nursing activities. Therefore it showed that nursing fee was not counted adequately in it. 5. Nursing cost by K-DRG estimated in chart review based on counting number of nursing activities and length of stay The result showed that average amount of total nursing cost was \183828.1 Comparison of nursing cost calculated by K- DRG and basic nursing fee schedule showed that only 12.3% of nursing cost was charged (Conclusion) From the above research result, It is fact that nursing prime cost should be estimated more accurately and included adequately in current medical payment system. The payment system of nursing activities should be introduced not only nursing activities of drug administration and injection fee belonged to insurance fee schedule but also most nursing activities belonged not to mekical fee schedule. Even if introducing payment system of nursing activities, It should be estimated scientific method of Accounting nursing cost So nurses could offer nursing care of good quality, thereby they could make a great contribution not merely to the convalescence of the patient but to the promotion of the people's health.
Analysis on the trends and causes of inhabitant's behavioral changes in medical institutions's utilization after enforcement of regional medical insurance. (pilot-project area of regional medical insurance; mainly Kun-wi and Kwang-hwa county)
Park, Jung-Yeon ;
Journal of Korean Public Health Nursing, volume 3, issue 2, 1989, Pages 47~76
The objectives of this study was to analyze the major causes of decreasing utilization rate of health care institutios in pilot-project area of regional medical insurance, Kwang-hwa and Kun-wi country. After the implementation of medical insurance, utilization rate of health institutions turned out' to be lower than it was estimated, when the pilot-project of regional medical insurance was planned. It might be due to changes in inhabitant's behavioral attitude toward medical insurance. So this study was made to find measures for financial stability by increasing utilization rate of health care institutions and to be available for basic demand-supply program of medical care. The hypothesis of this study was as follows; First. there is difference in understanding health care institutions between Kun-wi and Kwang-hwa. Second. respondesnts of inquiry survey have exact knowledge of their past experience of treatment taken prior to enforcement of medical insurance, Questionaire survey was made as to each 700 household among total 11, 884 households in Kun-wi and 20,919 households in Kwang-hwa. In case of Kun-wi, 70% of inquired households (491) gave their answers. In Kwang-hwa, the number was 560 households (80% of inquireds). Dollected data was processed and analyzed by way of using SPSS batch system. To evaluate facto rs distribution aspects of data and to make comparison between two area, percentage and
distribution were applied. The results were as follows; L The utilization rate of health care institutions in Kun-wi and Kwang-hwa was lower than it was estimated. when pilot-project of medical insurance was planned. 2. Prior to the implementation of medical insurance. inhabitants in two area chose the medical institutions considering such factors. First was medical care fee cheap. second in habitant's residence, Third was the institutions conveniently easy of access. 3. After the implementation of medical insurance. 26.1% of inqurieds in Kun-wi and 41.6% in Kwang-hwa, changed medical institutions. In case of Kwn-wi, from health care institution (p 0.05), and in case of Kwang-hwa, vice versa, from general medical institutions to health care institutions. 4. Evaluation by factors were made such as follows. Inquired gave high marks to following facts: In case of Kun-wi, general medical institutions were difficult of access and relation between patients: was not friendly, but burden of medical expenditure was light. Effects of treatment and facilities was good. In case of Kwang-hwa, inquired gave high evaluation marks to the follow ing facts; facilities of medical institutions was not good, but the burden of medical expenditure was light. 5. After the implementation of medical insurance, the services was evaluated as good, but inquired hopec for lessening the burden of medical expenditure. 6. In case of exact understanding of cost-sharing, the evaluation rate in Kwang-hwa was higher than that of Kun-wi (p < 0.005). And positive attitude toward necessity of medical insurance was also good in Kwang-hwa (p < 0.05). 7. In case of inquired's attitude toward medical institutions, Kwang-hwa showed positive response (p < 0.05) 8. In the case of comparison between general medical institution and health care institution, two area showed similar positive response; medical manpower, facilities of medical institutions and effest: of treatement was good. 9. In comprehensive evaluation of benefit-service; the general medical institution's positiveness was higher than that of health care institutions in Kun-wi. But in Kwang-hwa vice-versa. 10. If the medical expenditure of general medical institution and health care institutions was equal 77% of inquireds in Kun-wi and 59.1% in Kwang-hwa answered that they chose general medical insurance. Considering results above mentioned, the conclusion of this study was made as follows. 1. In Kwang-hwa county, where the understanding of health care institutions's was good, the utilization's of health care institutions was shown high. Therefore, in case of Kwang-hwa, betterment: should be made to induce increasing utilization rate for negative factors of health care institutions. 2. In case of Kun-wi, where the understanding of health care institutions was on the decrease, measures for changing such negative factors should be taken by way of strengthening public relations. And cases of Kwang-hwa should also be studied. 3. On the side of financial stabilization and establishing health care delivery system, primary health care should be available. Therefore, the major cause of inhabitant's avoiding health care institutions should be known. And measures for activating that institutions have to be taken. So, the facilities of health care institution have to be improved up to the level of clinic. And supportive measures for securing equipment and improving health care services should also be taken. It is necessary that strategy for public relations should be employed with policy considerations and supports.
A Study on the Efficiency of Clinical Practice for Nursing Education in the Junior College of Nursing in Korea
Lee, Kun-Ja ; Kim, Myung-Soon ; Yang, Young Hee ;
Journal of Korean Public Health Nursing, volume 3, issue 2, 1989, Pages 77~108
The purpose of this study was to find out the present condition of clinical practice and to develop a scheme on the efficiency of clinical practice for nursing education in junior college of nursing in korea. This study was conducted by 2 sections. Ist section was to find out the present condition of clinical practice to 42 directors of nursing collegd and data were collected July 8 to September 30, 1988. 2nd section wat to develop a scheme on the efficiency of clinical practice for nursing education and subjects were nursing professors 258: and clinical nurses 223 in 42 junior nursing colleges their clinical settings in korea. So total subjects were 481. Data were collected july 8, 1988 to June 30, 1988 and were analysed to get the mean, standand deviation, frequency, percentage, t-test, x-test used by SPSS - pc. Major findings were as follows: 1. The present condition of clinical education in junior college of nursing in Korea. 1) 32 colleges (76.2%) were managed by a-yeas system. 2) 25 colleges (59.5%) were performed by individual practice for each subject. 3) 4 weeks interval between class education and clinical education was a major type among total colleges(36.6%, J5 colleges) 4) 30 colleges (71.4%) provided clinical education for all subjects that should be practiced. Nursing administration wes not practiced in 5 colleges (41.9%) among the remainder(12 colleges). The main cause that all practice subjects were not practiced was the lack or absence of suitable clinical settings(8 colleges. 66.7%) 5) 18 colleges (42.9%) responded that a clinical educator was, subject-charged professor. 6) 12 colleges (29.3%) responded that a clinical instructor was in charge of 6~10 students. 7) The evaluation ration ratio(professor to head nurse) by each evaluator was mostly 50% to 50 % and 60% to 40%, respectively 11 colleges(27.5%) The most common evaluation methods were evaluation by head nures, report, presence, conference (11 colleges, 27.5%) 8) The field carrier of professor was mostly 2 years (79 persons, 20.7%) and mean was 3.2 years. The education carrier of a professor was mostly over than 6 years (261 persons, 66.4%) and mean was 9.2 years. The charge hours per-week of a professor were mostly 16-18 hours (16 persons, 131.8%) 9) 34 colleges (82.9%) approved that clinical practice hour was class hour and 18 colleges (43.9 %) counted that 2 hours of clinical education equaled 1 hour of class education. 2. A study 'on the efficiency of clinical practice for nursing education. L) general characteristics of subjects were as follows: kung-sang province (145 persons, 30.5%), 30-34 years (190 persons, 39.8%), graduated degree (245 persons, 51.5%), 6-10 years of carrier (199 persons, 41.4%) were the majority. 2) suitable clinical setting was responded the systematic ward with responsible clinical educator by 210 persons(43.8%) The response by working field of subjects showed a significant difference (p< 0.01) 3) 259 subjects (54.0%) responded that the desirable qualfication of clinical instructor was 3-5 years of clinical experience with master degree or higher. 4) The mean score of desirable quality degree of clinical instructor was 3.43 professors, score (3.54) was significantly higher than clinical nurses' (3.28) (p<0.01) 412 subjects (86.0%) responded that the insufficient guality of instructor was improved by continuing to seek more new information in reference. 5) 196 subjects (41.4%) responded that desirable qualification of head nurse was more than 2 years of head position among 5 years of clinical experience. The response by working' field of subjects showed a significant difference (p<0.05) 6) The mean score of desirable quality degree of head nurse was 3.18 Clinical nurses' score(3.38) was significantly higher than professors' (3.01) (p<0.01) 419 subjects (87.8%) responded that the insufficient of head nurse was improved by continuing relationship with instructor and being responsible from planing of clinical education. 7) The mean score of performance level of the desirable clinical education guide incollege was 2.91 Professors' score (2.96) was significantly higher than clinical nurses' (2.84) (p<0.01) 340 subjects (71.1%) responded that the possible resolution for poor performance was the more specified syllabus of clinical education and the satisfiable orientation for students. 8) The mean score of performance level of the desirable clinical education guide in hospital was 3.03 9) 141 subjects (29.6%) responded that the desirable clinical evaluator was the group of professor, head nurse, staff nurse. Response by working field of subjects was a significant difference (p< 0.05) 10) The mean score of performance level of the evaluation content needed in clinical education was 3.50 Clinical nurses' score (3.56) was significantly higher than professors' (3.45) (p<0.01) 11) 433 subjects (90.2%) responded that6 desirable evaluation method for clinical education was the presence. 12) The mean score of performance level about how personal difference among clinical educators was minimized was 2.89 and response by working field of subjects was not significant. The cause of poor performance was too much workload at clinical settings and too many students st colleges by 386 subjects (81.1%).
A Study of Nursing Student Teacher for School Nurse in the Field Practice
Lee, In-Kyu ;
Journal of Korean Public Health Nursing, volume 3, issue 2, 1989, Pages 109~132
I studied the problems of the field practice of nursing student teacher for school nurse from March, 1986 to April, 1989 at several primary schools of Wonju City. The Significant problems on the field practice and the results of questionnaire research were summarized as follows: 1. Suggestion of educational goal(both physical and mental aspect rather than only physical aspect as concept of health and disease changes. 2. A need of change in educational organization of school nurse: unify the two educational organization (junior college of 3yrs and college of 4yrs) by raisin g junior college to regular college status of 4yrs_ 3. Experience of questionnaire research for health problem in field practice(such as questionnaire research for detection of the problem of emotion and physical and mental status and a case report of effective training method of teeth brushing in children). 4. The improvement of school facilities for better child health education by the educational practice in primary school. 5. The educational goals for new roles of school nurse: 1) Role in exact recognizing the school health problem. 2) Role in dealing with mental problem. 3) Role in organized activity. 6. Improvement of educational act for activating teachers' role.
A Study on the Training Course for Teachers Holding Additional Job of School Health Nursing in Kyeong Nam Province
Kang, Young-Sil ; Cheong, In-Sook ;
Journal of Korean Public Health Nursing, volume 3, issue 2, 1989, Pages 133~142
The purpose of this paper is to provide the basic information concerning school health nursing activities in schools lacking in a school nurse, and the degree of satisfaction of trainess to the training course of school health nursing. The data for this study were collected by means of questionnaire from 150 teachers(100 of primary school and 50 of middle school)who attended the training course superintended by the Board of Education of Kyeong Nam Province from July 27 to August 6 in 1987. The main results of this study can be summarized as following; 1. General characteristics of the trainees: The majority of the trainees (71.3%) were in the age of twenties, 86.5% graduated from four-year teachers' college, 63.5% had less than five-year experience as a teacher. 2. 60.5% of the trainees were actually offering school health nursing services. 67.8% decided voluntarily to participate in the training course, and 62.7% attended the course for the purpose of obtaining health knowledge. 3. Only 4.2% of schools established appropriate health organization, and 34.5% were equipped with nursing clinic. But the main reason school health nursing activities were not performed very well was the insufficient supply of needed medicines and related materials. 4. School health nursing services in schools lacking in a school nurse were offered mainly by the teacher holding additional job of school health. class teacher and atheletic teacher. But the sanitary management for school meal services and community health activities were not carried out at all in many schools. 5. As a whole, trainees were satisfied with training program. But some subjects of the course did not satisfy them because those ones were so theoretical without any practice. 6. Many trainees wished the training course to be more concentrated on case studies which are helpful to solve actual problems. 7. 75% of trainees answered to have decided to perform school health nursing activities more actively than before. 8. Any significant relationship can not be found between trainees' general characteristics and their attitude to school health nursing activities after the training course. Only one factor-motivation to attend the training course-had the statistical significance of 8.7%.
A Study on the Factors which Influenced the Performance of Urban Family Planning Health Personnels' Function - Around the FP health personnels in the Seoul metropolitan city-
Lee, Myoung-Sook ; Moon, Hyung-Wha ;
Journal of Korean Public Health Nursing, volume 3, issue 2, 1989, Pages 143~156
This study was done in order to analyze the factors which influenced the performance level of urban family planning health personnels' task. Interview survey was done during the period May, 1989. Interviewee were 130 family planning health personnels among total of 140 family planning health personnels in Seoul metropolitan city area. The internal consistency reliability was tested by Cronbach’s Alpha and the construct validity of the survey tool was tested by Factor analysis. Multiple stepwise regression analysis was used to identify major factors influenced to perform family planning health personnels' task. The results of this study were summarized as follows: 1. The internal consistency reliability was high and very significant (Cronbach's Alphs=0.8445, p<0.0000). 2. The construct validity was high and very significant. This analysis was contained 5 factors; registering and keeping of eligible woman records, health educating for FP & MCH, referral for vasectomy and tubal ligation and loop, supplying contraceptive appliances, sending moved-out eligible woman records. 3. Among a total of 15 contents of their functions recording of daily report and monthly report (76.2%), classifying and keeping of records(66.2%), registering of eligible woman records(60.85ti), distribution of leaflets and pamplets(54.6%), counselling & supervision about family planning(53.8%) were actively performed. Sending moved-out eligible woman records(60.8%), health education for community people(49.2%), referring contraceptors' side-effects were poorly performed. 4. The factors which influenced the performance level of urban family planning health personnels' function were age, marital status, educational level, certification, number of residents, number of eligible women, job car-eer, work responsibility, job satisfaction knowledge, position, cooperation of community people, cooperation of Dong Office, cooperation of Health Center. These 14 variables were able to explain job function from 21.4% of follow-up care of contraceptor to 9.1% of classifying & keeping of eligible woman records.