Journal of Korean Academy of Nursing

Original Articles

Factors Relating to the Quality of Care for Nursing Home Residents in Korea: Using the Delphi Method: Juh Hyun Shin, Eun Mee Kim, Ji Yeon Lee; J Korean Acad Nurs 2019;49(6):783-794. Published online December 30, 2019; DOI: https://doi.org/10.4040/jkan.2019.49.6.783

Purpose

This study identified factors related to the quality of care in nursing homes, and elicited consensus opinions from experts on nursing homes.

Methods

A Delphi questionnaire was developed based on a review of the literature using the keywords “nursing homes,” “workforce,” and “quality of care.” A total of two Delphi surveys were conducted with 14 experts. The important and urgent factors related to the quality of care for nursing home residents emerged.

Results

A consensus was achieved on the important and urgent factors relating to the quality of care. The related factors were grouped into four sections: Organizational Characteristics, Staffing Characteristics, the Long-Term Care Market and Legal and Policy Issues, and Nursing Processes. In total, 23 items were important factors and 26 items were urgent factors relating to the quality of care. In addition, the unanimous advocacy by the experts for increased hours per resident day for registered nurses (RNs, 41 minutes 59 seconds) was much higher than the current hours per resident day of RNs in Korea.

Conclusion

To provide optimal care for residents in nursing homes in Korea, the mandatory and essential placement of RNs with professional knowledge and skills is paramount.

Citations

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The effects of special nursing units in nursing homes on healthcare utilization and cost: A case-control study using propensity score matching
Eunhee Cho, Eun-Young Kim, Kyung Hee Lee, Hye-Ryoung Kim, Seonhwa Choi, Yea Seul Yoon, EunKyo Kim, Seok-Jae Heo, Se Young Jung, Jiyoon Jang
International Journal of Nursing Studies.2023; 147: 104587. CrossRef
Effects of registered nurse staffing levels, work environment, and education levels on adverse events in nursing homes
Seonhwa Choi, Eunhee Cho, Eunkyo Kim, Kyongeun Lee, Soo Jung Chang
Scientific Reports.2021;[Epub] CrossRef
Cost of Care and Pattern of Medical Care Use in the Last Year of Life among Long-Term Care Insurance Beneficiaries in South Korea: Using National Claims Data
Sunjoo Boo, Jungah Lee, Hyunjin Oh
International Journal of Environmental Research and Public Health.2020; 17(23): 9078. CrossRef
Impact of Nurse Staffing, Skill Mix and Stability on Resident Health Outcomes in Korean Nursing Homes
Juh Hyun Shin, Gui Yun Choi, Jiyeon Lee
Journal of Korean Gerontological Nursing.2020; 22(4): 291. CrossRef
The Effects of Long-term Care Hospitals' Nurse Staffing Level on Patient Outcomes: Differences according to Region
Kyung Jin Hong
Journal of Korean Academy of Nursing Administration.2020; 26(4): 354. CrossRef

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Public Reporting on the Quality Ratings of Nursing Homes in the Republic of Korea: Hyang Yuol Lee, Juh Hyun Shin; J Korean Acad Nurs 2019;49(2):161-170. Published online April 30, 2019; DOI: https://doi.org/10.4040/jkan.2019.49.2.161

Abstract PDF

Background

Quality ratings could provide vital information to help people in choosing a nursing home.

Purpose

This study investigated factors aligned with quality ratings of nursing homes.

Methods

We employed a cross-sectional descriptive design to assess publicly available data on 1,354 nursing homes with 30 or more beds in the Republic of Korea. After excluding 289 nursing homes with no reported quality-evaluation ratings, we analyzed the 2015 data of 1,065 nursing homes. To prevent multicollinearity among independent variables, we carefully selected the final set of variables based on clinical and theoretical meaningfulness to direct nursing care. Quality, the ordinal outcome, was scored from 1 to 5 with a higher score indicating higher quality of the organization. We constructed a multivariate ordered logistic regression model.

Results

Higher quality ratings of nursing homes was significantly related to the number of unoccupied beds (OR=0.99, p=.024), registered nurses (RNs) (OR=1.30, p=.003), qualified care workers (OR=1.03, p=.011), cognitive-improvement programs (OR=1.05, p=.024), and other programs for residents' activities (OR=1.09, p<.001).

Conclusion

The number of RNs had the strongest influence on the publicly reported quality rating, while the rating of qualified care workers demonstrated little effect and that of nursing assistants had no effect. The number of RNs could be used as a crucial indicator for high-quality homes; more resident-engaging programs also demonstrated better quality of nursing home care.

Citations

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Nurse staffing and adverse events in residential aged care: Retrospective multi-site analysis
Dorika Nhongo, Annie Holt, Tracy Flenady, Amanda Rebar, Kasia Bail
Collegian.2023; 30(2): 343. CrossRef
Nursing Management-Associated Factors Associated with Urinary Tract Infection in Residents from Nursing Home Based on LTCfocus Database
Wei Wang, Hui Wang
Urologia Internationalis.2022; 106(7): 744. CrossRef
Effects of registered nurse staffing levels, work environment, and education levels on adverse events in nursing homes
Seonhwa Choi, Eunhee Cho, Eunkyo Kim, Kyongeun Lee, Soo Jung Chang
Scientific Reports.2021;[Epub] CrossRef
Increasing Registered Nurse Hours Per Resident Day for Improved Nursing Home Residents’ Outcomes Using a Longitudinal Study
Juh Hyun Shin, Rosemary Anne Renaut, Mark Reiser, Ji Yeon Lee, Ty Yi Tang
International Journal of Environmental Research and Public Health.2021; 18(2): 402. CrossRef

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Family Caregivers' Experiences Utilizing a Nursing Home for Their Elderly Family Members: Sun Woo Hong, Haeng Mi Son; Journal of Korean Academy of Nursing 2007;37(5):724-735. Published online March 28, 2017; DOI: https://doi.org/10.4040/jkan.2007.37.5.724

Abstract PDF

Purpose

The purpose of this study was to explore and describe the experiences of the family caregivers using a nursing home for their elderly family members.

Method

Participants for this study were 1 man and 9 women caregivers. Data was collected through in-depth interviews from October, 2005 to April, 2006 and analyzed using Strauss and Corbin's grounded theory methodology.

Results

“Finding a way to live together” emerged as a core category and it reflected expanding consciousness allowing them to see each other in a more positive view. The basic social process of “finding a way to live together” includes 3 phases: 1) recognizing the problems, 2) finding solutions to the problems, and 3) accepting the changes in their surrounding. Lack of privacy, family troubles, extreme distress, and unavailable caregivers are reflected in the process of recognizing the problems. The process of finding solutions was making a decision, obtaining family agreement, choosing the best nursing home, and enduring the financial burden. Possible outcomes of the last phase include recovering peace of mind and continuing conflict.

Conclusion

Findings from this study offer suggestions for developing a strategy to help not only the elderly but also the family caregivers.

Citations

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Development of the Care Burden Scale for Family of Elderly in Nursing Facilities
Eun Jeong Kim, Kyung Mi Sung
Journal of Korean Academy of psychiatric and Mental Health Nursing.2024; 33(1): 80. CrossRef
Useful lessons for the provision of services in long-term care facilities in South Korea: operators’ experiences illuminate the phenomenon of working with the elderly in the field
Young Ran Tak, Hae Young Woo, Lee Han Yi, Ah Rim Kim
International Journal of Qualitative Studies on Health and Well-being.2019;[Epub] CrossRef
Hospice care education needs of nursing home staff in South Korea: a cross-sectional study
Mihyun Park, Hye-Ah Yeom, Sr Jinsun Yong
BMC Palliative Care.2019;[Epub] CrossRef
Prise en charge d’un proche âgé dépendant à domicile en Corée du Sud : recherche sur les aidantes principales de la génération du baby-boom
Yoonji Oh
Enfances, Familles, Générations.2017;[Epub] CrossRef
The Barriers and Solution of Providing Long-term Care Services at Home for the Beneficiaries with Mild Dementia: A Focus Group Interview
Mi Sook Song, Kyung Sook Lim
Journal of Korean Public Health Nursing.2016; 30(2): 259. CrossRef
Assessment of Long-Term Care Service Needs in the Baby Boom Generation
Song Yi Han
Journal of Korean Academy of Community Health Nursing.2016; 27(1): 21. CrossRef
Feelings of Guilt and Depression in Family Caregivers after Nursing Home Placement of Older Adults
Sun Young You, Young Ran Tak
Journal of Korean Gerontological Nursing.2014; 16(3): 276. CrossRef
Grounded Theory Approach on the Adaptation Process in Facility of Long-Term Care Elderly
신용석, Jung-Woo Kim, 김수정
Korean Journal of Social Welfare.2013; 65(3): 155. CrossRef
A Study on the conflict among Siblings Regarding the Long-term Care of Older Parents
Yoo,Hi-Jung
Korean Journal of Family Social Work.2013; null(40): 63. CrossRef
A Study of Determinants of Caregivers’ Attitudes towards Utilization of Residential Care in the UK: Focused on Scottish Family Caregiver in Edinburgh City
이현숙
Health and Social Welfare Review.2013; 33(1): 260. CrossRef
Knowledge regarding Advance Directives among Community-dwelling Elderly
Sun Woo Hong, Shin Mi Kim
The Journal of Korean Academic Society of Nursing Education.2013; 19(3): 330. CrossRef
Nursing Home Placement: The Process of Decision Making and Adaptation among Adult Children Caregivers of Demented Parents in Korea
Su-Hye Kwon, Young-Sook Tae
Asian Nursing Research.2012; 6(4): 143. CrossRef
The Study on commodification of filial piety through Long term care service
홍세영, 서종희
Korean Journal of Gerontological Social Welfare.2012; null(57): 51. CrossRef
Validity and Reliability of the Korean Version of the Observable Indicators of Nursing Home Care Quality Evaluation Instrument
Jia Lee
Journal of Korean Academy of Nursing.2008; 38(3): 474. CrossRef

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A Study on Aggressive Behavior Among Nursing Home Residents with Cognitive Impairment: Heeyoung Oh, Miran Eom, Yunjung Kwon; Journal of Korean Academy of Nursing 2004;34(8):1451-1459. Published online March 28, 2017; DOI: https://doi.org/10.4040/jkan.2004.34.8.1451

Abstract PDF

Purpose

With a sample of cognitively impaired nursing home residents and nursing staff, the following were examined 1) the proportion and nature of aggressive behavior, 2) the frequency and types of aggressive behavior, 3) the difference between the residents who demonstrate aggressive behavior and those who do not demonstrate aggressive behavior (age, mental status, functional status, and pain, length of nursing home stay), and 4) nursing staff responses to aggressive behavior by residents.

Methods

A cross-sectional descriptive study design was used. Data were collected from cognitively impaired nursing home residents (N=205) and nursing staff (N=60) at two nursing homes using Ryden Aggression Scale I and II, Mini-Mental State Exam, Modified Barthel Index, Verbal Descriptor Scale, and aggressive behavior management questionnaire. Data were analyzed using descriptive statistics including t-test.

Results

About 62.9% residents were found to be aggressive and 38.5% were both physically and verbally aggressive. Pushing, making threatening gestures, hitting, slapping, cursing/obscene/vulgar languages, making verbal threats were occurred frequently. Aggressive residents were significantly older, had more cognitive impairment, had more pain, and stayed longer in the nursing home when compared with non-aggressive residents. Considerable proportion of nursing staff responded to aggressive behaviors inadequately.

Conclusion

Aggressive behavior among cognitively impaired nursing home residents is prevalent thus needs to be prevented and reduced. Along with environmental modification, educational programs for nursing staff and family caregivers need to be developed and implemented so that they can have extensive knowledge and skills to manage aggressive behaviors.

Citations

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Impact of Psychological Aggression at the Workplace on Employees’ Health: A Systematic Review of Personal Outcomes and Prevention Strategies
Emelda C. R. L. Pacheco, Ana Bártolo, Fabiana Rodrigues, Anabela Pereira, João C. Duarte, Carlos F. Silva
Psychological Reports.2021; 124(3): 929. CrossRef
Care workers health in Swiss nursing homes and its association with psychosocial work environment: A cross-sectional study
Suzanne R. Dhaini, Franziska Zúñiga, Dietmar Ausserhofer, Michael Simon, Regina Kunz, Sabina De Geest, Rene Schwendimann
International Journal of Nursing Studies.2016; 53: 105. CrossRef
Do Sound Levels and Space Contribute to Agitation in Nursing Home Residents with Dementia?
Laura L. Joosse
Research in Gerontological Nursing.2012; 5(3): 174. CrossRef
Patterns of Antecedents of Catastrophic Reactions in Nursing Home Residents With Dementia in the United States
Hye-A Yeom, Nancy M. Watson
Asian Nursing Research.2009; 3(3): 99. CrossRef

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Functional Status of Stroke Patients among Different Long-Term Care Settings: Eun Young Kim; Journal of Korean Academy of Nursing 2004;34(2):372-378. Published online March 28, 2017; DOI: https://doi.org/10.4040/jkan.2004.34.2.372

Abstract PDF

Purpose

The purpose of this study was to measure the functional status of stroke patients cared for in different long-term care settings.

Method

We assessed all stroke patients in two home health care agencies, four nursing homes and one geriatric hospital in Korea (n=171) using the Resident Assessment Instrument (RAI), which comprises Activity of Daily Living (ADL), urine incontinence, bowel incontinence, a Cognitive Performance Scale (CPS),and being understood and understanding others. Data was collected by face-to-face surveys with patients.

Results

The mean ADL score, urine incontinence score, bowel incontinence score, CPS, and being understood score and understanding others score were lowest for the patients receiving home health care, and highest for the patients in nursing homes. Low scores described poor and high scores good functional status. The results showed significant differences in physical and cognitive function scores between the three groups of patients.

Conclusion

This study suggests that there may be large differences between the patients in these three types of long-term care settings. These findings can be used to help develop and implement efficient long-term care programs.

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Prevalence and potential determinants of musculoskeletal disease symptoms among care workers in long‐term care facilities in South Korea
Myung‐Sook Park, Mi Yu, Su‐Jeong Yu, Kyung‐Ja Kang, Hyun‐Mi Seo
Japan Journal of Nursing Science.2014; 11(3): 211. CrossRef
The Long-term Care Utilization of the Elderly with Dementia, Stroke, and Multimorbidity in Korea
Boyoung Jeon, Soonman Kwon, Hongsoo Kim
Health Policy and Management.2013; 23(1): 90. CrossRef

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Development of Patient Transfer Techniques based on Postural-stability Principles for the Care Helpers in Nursing Homes and Evaluation of Effectiveness: Ryewon Ma, Dukyoo Jung; J Korean Acad Nurs 2016;46(1):39-49. Published online February 29, 2016; DOI: https://doi.org/10.4040/jkan.2016.46.1.39

Abstract PDF

Purpose

This study was done to develop a postural-stability patient transfer technique for care helpers in nursing homes and to evaluate its effectiveness.

Methods

Four types of patient transfer techniques (Lifting towards the head board of the bed, turning to the lateral position, sitting upright on the bed, transferring from wheel chair to bed) were practiced in accordance with the following three methods; Care helpers habitually used transfer methods (Method 1), patient transfer methods according to care helper standard textbooks (Method 2), and a method developed by the author ensuring postural-stability (Method 3). The care helpers' muscle activity and four joint angles were measured. The collected data were analyzed using the program SPSS Statistic 21.0. To differentiate the muscle activity and joint angle, the Friedman test was executed and the post-hoc analysis was conducted using the Wilcoxon Signed Rank test.

Results

Muscle activity was significantly lower during Method 3 compared to Methods 1 and 2. In addition, the joint angle was significantly lower for the knee and shoulder joint angle while performing Method 3 compared to Methods 1 and 2.

Discussion

Findings indicate that using postural-stability patient transfer techniques can contribute to the prevention of musculoskeletal disease which care helpers suffer from due to physically demanding patient care in nursing homes.

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Low Back Pain and Its Influencing Factors among Intensive Care Unit Nurses: A Cross-sectional Study
Hyun Ju Uhm, Hye-Ja Park
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Review Article

Dysphagia Screening Measures for Use in Nursing Homes: A Systematic Review: Yeon-Hwan Park, Hwal Lan Bang, Hae-Ra Han, Hee-Kyung Chang; J Korean Acad Nurs 2015;45(1):1-13. Published online February 27, 2015; DOI: https://doi.org/10.4040/jkan.2015.45.1.1

Abstract PDF

Purpose

The purpose of this study was to evaluate the psychometric quality and feasibility of measurements for screening dysphagia in older adults to identify the 'right tool' for nurses to use in nursing homes.

Methods

A systematic review was done. Electronic databases were searched for studies related to dysphagia screening measurements. A checklist was used to evaluate the psychometric quality and applicability. Tools were evaluated for feasible incorporation into routine care by nurses.

Results

29 tools from 31 studies were identified. Dysphagia screening tools with an acceptable validity and reliability had sensitivity between 68% and 100% and specificity between 52% and 100%. The Gugging Swallowing Screen (GUSS) and the Standardized Swallowing Assessment (SSA) were the tools with high psychometric quality, especially with high sensitivity, that nurses could perform feasibly to identify the risk and to grade the severity of dysphagia and aspiration of nursing home residents.

Conclusion

Results show that GUSS and SSA are reliable and sensitive tools for screening dysphagia which nurses can use in nursing homes. Further research is needed to examine feasibility of screening with identified tools, and also, to establish effective and standardized protocols for these tools so they can be effectively incorporated into routine care.

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Original Articles

Development and Validation of the Korean Patient Safety Culture Scale for Nursing Homes: Sook Hee Yoon, Byungsoo Kim, Se Young Kim; J Korean Acad Nurs 2013;43(3):379-388. Published online June 28, 2013; DOI: https://doi.org/10.4040/jkan.2013.43.3.379

Abstract PDF

Purpose

The purpose of this study was to develop a tool to evaluate patient safety culture in nursing homes and to test its validity and reliability.

Methods

A preliminary tool was developed through interviews with focus group, content validity tests, and a pilot study. A nationwide survey was conducted from February to April, 2011, using self-report questionnaires. Participants were 982 employees in nursing homes. Data were analyzed using Cronbach's alpha, item analysis, factor analysis, and multitrait/multi-Item analysis.

Results

From the results of the analysis, 27 final items were selected from 49 items on the preliminary tool. Items with low correlation with total scale were excluded. The 4 factors sorted by factor analysis contributed 63.4% of the variance in the total scale. The factors were labeled as leadership, organizational system, working attitude, management practice. Cronbach's alpha for internal consistency was .95 and the range for the 4 factors was from .86 to .93.

Conclusion

The results of this study indicate that the Korean Patient Safety Culture Scale has reliability and validity and is suitable for evaluation of patient safety culture in Korean nursing homes.

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The Effects of Oral Care Education on Caregivers’ Knowledge, Attitude, & Behavior toward Oral Hygiene for Elderly Residents in a Nursing Home: Myung Sook Park, Smi Choi-Kwon; J Korean Acad Nurs 2011;41(5):684-693. Published online October 12, 2011; DOI: https://doi.org/10.4040/jkan.2011.41.5.684

Abstract PDF

Abstract Purpose

To investigate the effects of oral care education on knowledge, attitudes & behavior of caregivers in oral care and oral hygiene for residents in nursing homes.

Methods

In this quasi-experimental study, the intervention group (n=27) of residents received oral care from intervention group caregivers (n=28) who had received 6 weeks of oral care education. The control group (n=27) of residents received usual oral care from control group caregivers (n=26). Data on knowledge, attitude, and behavioral change in oral health care by the caregivers and plaque index & halitosis of the residents were collected. Data were analyzed using SPSS WIN 16.0.

Results

1) Scores on caregivers’ knowledge (p<.001) and behavior (p<.001) for oral care were higher in the intervention group 6 and 12 weeks. The caregivers’ attitude (p<.001) score for oral care was higher in the intervention group 12 weeks. 2) The plaque index (p=.004) and halitosis (p=.002) of the nursing home residents were lower in the intervention group than the control group at 6 and 12 weeks.

Conclusion

Oral care education programs for caregivers are effective in improving the oral hygiene of elderly residents in nursing homes through enhancement of caregiv-ers’ knowledge, attitude, and behavioral change.

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Martina Albrecht, Ramona Kupfer, Daniel R Reissmann, Ingrid Mühlhauser, Sascha Köpke
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Hung Sa Lee, Chunmi Kim
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Development of a Web-based Education Program for Nurses working in Nursing Homes on Human Rights of Older Adults: Ki-Kyong Kim; J Korean Acad Nurs 2010;40(4):463-472. Published online August 31, 2010; DOI: https://doi.org/10.4040/jkan.2010.40.4.463

Abstract PDF

Purpose

This study was done to develop a web-based education program for nurses working in nursing homes. The focus was on the rights of older adults.

Methods

The program was designed based on the Network-Based Instructional System Design (NBISD) model and was operated and evaluated between July 2007 and June 2008.

Results

Out of nursing records of 40 residents from a nursing home, the final 7 cases were deducted through classification using the Resource Utilization Group (RUG)-III. The data on needs for education was collected from 28 nurses working in 15 nursing homes located in Seoul and Gyeonggi Province, who agreed to complete a self-report questionnaire. A comprehensive review of the literature and two focus groups interviews were used to search for risk factors and guidelines for protection of human rights. The education program was developed based on Kolb's experiential learning model and composed of 5 units, which included content on types of human rights and rights to death with dignity, elder abuse, physical liberty, and self-determination. The program was positively evaluated showing a score of 3.35 (SD=0.37) out of 4.

Conclusion

The educational program developed in this study should promote nurses' sensitivity to the rights of elders and improve nurses' behaviors in protecting the rights of elders residing in nursing homes.

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Prevalence Rate and Associated Factors of Urinary Incontinence among Nursing Home Residents: Moon-Sil Kim, Seung-Hee Lee; Journal of Korean Academy of Nursing 2008;38(1):92-100. Published online February 29, 2008; DOI: https://doi.org/10.4040/jkan.2008.38.1.92

Abstract PDF

Purpose

The aim of this study was to estimate the prevalence of urinary incontinence among nursing home residents and to identify the factors associated with this condition.

Methods

The data were collected from 618 subjects (146 males and 472 females; mean age 79.9±8.4 yr; range 65-102 yr) of 30 nursing homes in Seoul, Gyeonggi-do and Gangwon-do in this cross-sectional study. The data were analyzed by chi-square test, t-test, and multiple logistic regression by using the SPSS/PC ver 12.0 program.

Results

The prevalence of UI was 64.7% (64.6% in women; 65.1% in men). After adjustment for each of the variables considered in this study, six potential factors were strongly associated with UI: activities of daily living, comorbidity, age, cognition, specialty of the facility, and a bladder training program.

Conclusion

Our finding suggests that it is necessary to develop a program for promotion of activities of daily living and to provide a bladder training program to prevent urinary incontinence among nursing home residents.

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Development and Application of Nursing Service Quality Indicators in Nursing Homes: Jane Chung; Journal of Korean Academy of Nursing 2007;37(3):401-413. Published online April 30, 2007; DOI: https://doi.org/10.4040/jkan.2007.37.3.401

Abstract PDF

Purpose

This study was designed to develop Nursing Service Quality Indicators(NSQIs) in nursing homes that would lead to an appropriate evaluation and improvement of nursing service quality.

Methods

The preliminary NSQIs were developed through literature reviews and analysis of existing quality indicators. A content validity testing was done twice by using a panel of experts who were from academia and the clinical areas. The final NSQIs were confirmed and applied in three nursing homes to test feasibility.

Results

The preliminary NSQIs had 4 domains and 31 indicators. Two content validity testings were performed. The indicators scoring over .80 CVI for each testing were selected and modified by experts' opinions. The final NSQIs consisted of7 domains and 33 indicators. They were applied in three nursing homes and it was revealed that all the indicators were applicable.

Conclusion

In this study, it is shown that this new 'Nursing Service Quality Indicators in Nursing Homes' is suitable for a holistic evaluation of nursing service quality of elderly patients in nursing homes. This NSQIs will be able to provide a basis for establishing nursing care standards and improving the nursing care quality in nursing homes.

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