일 대학병원 가정간호사업실의 가정간호행위 규명 및 행위별 원가 산정
(A) Study on defining nursing activities and cost analysis of hospital based home health care nursing
대학병원 가정간호사업 가정간호행위 간호학;
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The purpose of this study is to search for home health care activities for patients at home provided by G University Hospital located in a small city and to show the fundamental data for a proper estimate of home nursing cost with examples of each kind of activity. The number of the patients whom the university hospital took care of was 45. First, direct or indirect nursing activities delivered to them were investigated, and afterward necessary time for visits and for each direct or indirect care was calculated. Personnel expenses, management expenditures, and vehicle maintenance expenses were also calculated as cost items. Home nursing costs were accounted based on those calculated data. Lastly, the cost estimate of each activity was obtained. The period for collecting data was from August 4th to August 31st in 2003. The summary of the results of this study is as follows : 1) The 64 kinds of direct home nursing cares were delivered to patients at home, and the range of time for each care is from a high of 28 minutes to a low of 0.5 minute. As for the order of implementation frequencies classified by nursing domains, measurement and observation domain had the highest frequency of 418 followed by implementation improvement, 168, wound and skin care, 126, and specific care, 83in total nursing frequencies of 1,260. Considering medical domains, the number of neurological or neurosurgical patients with Cerebrovascular Disease was highest of 25 and the most nursing cares of 674 were delivered to them. As for necessary time, wound and skin care domain took the most time of 991 minutes(19.2%). The total calculated time for 159 activities was 5,193.7 minutes and average time per visit was 32.7 minutes. Speaking of nursing items, wound and skin care domain had the highest number of 10(15.6%). Lastly, vital sign measurements turned out to be the highest frequent nursing activities of 159(100%). 2) 7 domains were investigated as indirect nursing activities : phone consulting, education, preparation for nursing, conference, recording, stock management, and miscellaneous activities. Among them, stock management took the most time of 20.2 minutes. The total direct nursing time a day was 206.2 minutes and average time per visit was 57.4 minutes. 3) Traveling fee per visit was estimated at 10,396 won and management expenditure, 9,113 won. Basic visitation fee was estimated at 28,013 won, the cost of health care per visit, 38,409 won. 4) The cost of home nursing service was 849 won, the result of dividing visitation fee by average visitation time. 5) The costs of 64 kinds of direct home nursing cares ranged between the highest of 23,687 won and the lowest of 425 won. The costs of 7 domains of indirect home nursing activities ranged between 17,150 won and 340 won.