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

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.

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.

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.

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

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

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.

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).

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.

The purpose of this study was to develop a scale of free nursing home adjustment for the elderly in Korea.

The developmental processes were construction of a conceptual framework, development of preliminary items, verification of content validity, twice data gathering, verification of construct validity, and reliability of final items. The first 53 preliminary items were obtained through review of literatures about nursing home adjustment and in depth interviews with 5 staffs of nursing home. These items were reviewed by five specialists for content validity and 39 items were chosen. The first data was collected from 107 elderly residing in 3 nursing homes and the second survey was from 147 residents who were living in five nursing homes. Finally this data was analyzed for construct validity and reliability.

There were 23 final items which were sorted into 5 factors. The factors were identified as ‘Relocation distress symptom’(8items), ‘Making friends’(4items), ‘Acceptance of new residence’ (6items), ‘Difficulty in group life’(3items), and ‘Having self-worth’(2items). The cumulative percent of variance was 53.466%. The reliability of the scale, Cronbach's alpha was .837.

The result of this study could be used for measuring nursing home adjustment of the elderly. However, for further validity and reliability, repeated researches are needed.

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.

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.

“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.

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

The purposes of this study were to examine the amount of daily fluid intake among nursing home residents and to explore the caregiver's perceived barriers to elderly's fluid intake.

Data was collected from 111 nursing home residents and 64 caregiver's in 4 nursing homes. A random, non-consecutive three days of 24 hour fluid intake was measured and recorded. The caregiver's perceived barriers to elderly's fluid intake was assessed using a structured questionnaire.

The average amount of daily fluid intake was 1,035(SD=359)ml with the range of 210ml to 2,050ml. About 52% (n=58) of the subjects had a less than adequate fluid intake. The amount of daily fluid intake was significantly associated with age, mental status, physical functioning, and the number of oral medications ordered. The most frequently mentioned caregiver's perceived barrier was elderly's concern about incontinence with increased fluid intake.

Inadequate fluid intake among nursing home residents is prevalent. To enhance adequate hydration of nursing home residents, an institution wide nursing intervention is necessary.

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.

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.

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.

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.

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

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.

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.

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.

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

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.

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.

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.

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.

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.

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.

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.

The purpose of the study was to explore and describe the experience of adult Korean children who are caregivers for parents institutionalized with dementia.

Participants were fourteen adult children caregivers of elders institutionalized with dementia. Data were collected through in-depth unstructured interviews with individual participants from August to November, 2012. Theoretical sampling was used to the point of theoretical saturation. Data were analyzed using Strauss and Corbin's Grounded Theory Method.

From open coding, 67 concepts, 29 sub-categories, and 14 categories were identified. Analysis revealed that the core category of the experience of adult children caring for their parents institutionalized with dementia was 'enduring the role of a prop' consisting of four phases: initial turmoil, exploration, role adjustment, and acclimation. To manage the role of a prop, participants utilized various action/interactional strategies such as overcoming the unfamiliarity, overseeing the nursing home care, and counterbalancing the caring roles. As a result, participants experienced ambivalence towards the existence of parents with dementia, changes in family relationships, altered viewpoint towards nursing homes, and restructuring of life.

In-depth understanding of the experience will guide nurses to promote effective interventions in order to better support the Korean family caregivers of parents institutionalized with dementia.

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.

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.

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.

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.

This study aimed to evaluate the effectiveness of the empowerment intervention on the levels of self-esteem, interpersonal relationships and adjustment to nursing home life of the Korean nursing home residents.

Participants (n=47) whose period of stay was less than one year were purposefully selected from 3 nursing homes in Korea. The experimental group (n=21) attended 10 weekly hour-long empowerment sessions. The empowerment program comprised two components; group education and group discussion. The control group (n=26) received a two-hour education about health management.

Compared with the control group, the experimental group showed significantly higher mean scores of self-esteem (t=5.51, p<.001), interpersonal relationships (t=2.73, p=.009) and adjustment to nursing home life (t=2.10, p=.041).

Findings of this study suggest that empowerment interventions may be effective in enhancing nursing home residents' self-esteem, interpersonal relationships and adjustment to nursing home life. Future research is needed to determine if such an empowerment program could be used with newly institutionalized elders to speed as well as enhance their adjustment to nursing home life.

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.

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.

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.

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.

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.

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.

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.

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.

The purposes of this study were to examine the relationships among activities of daily living, self-efficiency, nursing home care quality and nursing home adaptation, and to identify the influencing factors of nursing home adaptation in nursing home residents.

The study employed a descriptive correlational design. The data were collected from 148 older adults without dementia by interview from six nursing homes in three cities from February 1, 2008 to February 28, 2008.

Levels of nursing home adaptation in older adult residents were different by type of decision maker of nursing home admission, reason of nursing home admission, type of payment and length of nursing home stay. The nursing home adaptation was significantly correlated with self-efficiency and nursing home care quality. The strongest predictor of nursing home adaptation was type of decision maker of nursing home admission followed by the self-efficiency.

The study suggested that during the decision making period of nursing home admission, older adults should have enough time and careful considerations of their families to decide by themselves in positive ways. Nursing home staff should be able to identify reasons of nursing home admission and demands or expectations of older adults and their families.

The purposes of this study were; 1) to test the validity and reliability of the Korean version of Rantz's Observable Indicators of Nursing Home Care Quality Instrument (ONHQ) and 2) to evaluate the quality of Korean nursing homes.

The study employed a three-phase methodological research design. 1) The original instrument of Rantz's ONHQ was translated into Korean and modified by Korean nursing home experts. 2) A pilot study using the modified instrument was done in 20 nursing homes to examine inter-rater reliability. 3) The validity and reliability were tested in 98 nursing homes.

Seven factors were extracted through factor analysis: 'communication', 'care delivery', 'grooming', 'odor', 'environment-basics', 'environment-access', and 'environment-homelike'. These factors explained 86.07% of the total variance. Cronbach's alpha coefficient of the 30 items was .97 indicating a high internal consistency of the instrument. Inter-rater reliability according to Kappa was .82. The average score of nursing home quality was 112.07 indicating an average range of quality level.

The Korean version of the ONHQ was identified as a tool with a high degree of validity and reliability. This tool can be effectively used to assess the quality of nursing homes by professions as well as family members.

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.

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.

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.

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.

This study investigated various factors relatied to wandering behavior of Korean elders with dementia (KED).

A sample of 160 ambulatory residents with dementia from 14 long term care facilities was used to examine demographic, individual, cognitive, physical health, and environmental characteristics by comparing wanderers (N=108) to nonwanders (N=52). Subjects were evaluated by Korean versions of the Mini-mental State Exam (K-MMSE), the Physical and Instrumental Activities of Daily Living (K-PIADL), and the Revised Algase Wandering Scale Nursing Home version (KRAWS-NH) along its six dimensions. Demographic and environmental data were also obtained. Independent sample t-tests, Chi-square test, Fisher's Exact tests, and ANCOVAs were used to examine differences between wanderers and nonwanders.

Wanderers were significantly (p<.05) older and had more limitations in K-PADL and K-IADL. The degree of overall wandering and certain features of wandering were significantly different (p<.05) by total number of residents in the facility, type of bedroom (i.e., "Ondol"), and color of bedroom and living-room walls (i.e., sky blue).

Findings of this study may be useful in understanding wandering behavior of KEDs and thus developing more culturally specific management strategies.

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.

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.

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.

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.