초록 ▼

● 보호자없는 병원이란 보호자나 개인 간병인이 없이도 병원에서 필요한 서비스를 제공하는 병원으로, 적정 간호인력 확보를 통한 환자안전 및 간호간병 서비스의 질 개선 방안을 모색하기 보호자없는 병원 시범사업을 실시
● 시범사업은 병원전체가 아닌 병실단위로 실시하되, 병동단위에 간호관리료 2등급 이상으로 간호사를 배치하고, 간병기관은 다인실 1실당 간병인이 1인 이상 상주할 수 있도록 4~5인을 3교대 형식으로 배치하였으며, 환자 1일 본인부담금은 6인실 15,000원으로 설정하여 실시
● 시범사업 결과, 이용환자 등으로부터

● 보호자없는 병원이란 보호자나 개인 간병인이 없이도 병원에서 필요한 서비스를 제공하는 병원으로, 적정 간호인력 확보를 통한 환자안전 및 간호간병 서비스의 질 개선 방안을 모색하기 보호자없는 병원 시범사업을 실시
● 시범사업은 병원전체가 아닌 병실단위로 실시하되, 병동단위에 간호관리료 2등급 이상으로 간호사를 배치하고, 간병기관은 다인실 1실당 간병인이 1인 이상 상주할 수 있도록 4~5인을 3교대 형식으로 배치하였으며, 환자 1일 본인부담금은 6인실 15,000원으로 설정하여 실시
● 시범사업 결과, 이용환자 등으로부터 향후 재이용의사 및 주위에 대한 추천의사 등에 긍정적 평가를 받았으나, 향후 보호자없는 병원 활성화를 위해서는 간호관리료 차등제 수가 현실화, 보호자없는 병원 건강보험 수가 신설, 간호행위별 수가개발 등 간호수가개선, 간호 인력 근무조건 개선 및 유휴인력 활용 등과 같은 정책적 지원이 수반되어야 함

Abstract ▼

I. Purpose and necessity of research and development
● Korea, most hospitalized patients have a guardian or a person tending the sick to take care of the patients and they do most works of individual nursing.
● Hospital without a guardian means that the hospital provides necessary services for

I. Purpose and necessity of research and development
● Korea, most hospitalized patients have a guardian or a person tending the sick to take care of the patients and they do most works of individual nursing.
● Hospital without a guardian means that the hospital provides necessary services for patients so they wouldn't need a guardian or a person tending the sick. The hospital implements a test operation of a hospital without a guardian to seek ways to improve quality of patients' safety and nursing service through securing proper nurse work force.
II. Contents and methods of research and development
● Assessment on test operation of hospital without a guardian
- Defining action type of nursing and tending
- Regular monitoring and assessment on nursing and tending service
● Cost estimation for service quality assurance of hospital without a guardian
- Review on compensation range and level of nursing and tending service under current health insurance system
- Analysis on problems of compensation range and level of nursing and tending service
- Introduction method of health insurance for nursing and tending service
● Development of introduction and vitalization of hospital without a guardian
- Suggestion for operation plan of hospital without a guardian
- Policy proposal for introduction and vitalization of hospital without a guardian
III. Research result
1. Test operation status of hospital without a guardian
● Average stay days in hospital is 12.5 and average stay days on sickbed is 8.8 in the test operation
● In this test operation, stay hour of the guardian were '1 hour or less' 41.8%, '1 hour
- less than 2 hours' 21.3%, and 'less than 2 hours' 21.3% which means 'less than 2 hours' of stay hour took 63.1 % among total.
● Respondents said they would use a hospital without a guarding because 'a family member or other person cannot have a time to tend (due to work, during late at night, or due to old age)' 38.0%. Respondents said they wouldn't use a hospital without a guardian because 'a family member or other person can tend' 25.8%, and 'warm-hearted caring from a family is necessary, stability in mind, someone to talk to, relief insecurity' 22.7% that most said they should provide emotional support
2. Analysis on work type and offer hour of nursing and tending service
● Direct nursing hour for one patient per one day by a nurse was 60.4 minutes in test operation group and 60.2 minutes in control group in average which were similar as analyzed by. patient classification groups.
● Test operation group had longer hour than control group in all group 1, group 2, and group 3 of direct nursing hour for one patient per one day by a nurse, and as the patient classification group was raised as group 1, group 2, and group 3, nursing offer hour was also increased (test operation group; group 1; 59.2 minutes [group 2; 94.1 minutes [ group 3; 154.8 minutes, control group: group 1; 27.9 minutes [ group 2; 55.9 minutes [ group 3; 78.9 minutes]
● All group 1, group 2, and group 3 of direct nursing hour for by common tending system by the patient classification group was raised as group 1, group 2, and group 3, nursing offer hour was also increased (Common tending group: group 1; 66.4 minutes → group 2 109.0 minutes → group 3; 134.3minutes, control group: group 1; 12.0 minutes → group 2 73.7 minutes → group 3; 149.1 minutes)
● Operation unit of hospital without a guardian is similar to current test operation and assent for apply on partial sick rooms such as multiple patients had the highest portion as 57.7%, and the operation on ward unit (operation on a whole ward) was followed as 38.7% which had low assent rate.
● In regard to nurse disposition level (number of nurse for one patient for a day average) showed less than 2.5:1 was 58.4% and level 1 or higher of current nurse management was possible.
● 98.3% said regular nurse assistant (tending person) is needed by work shift unit in the multiple number of sick rooms (basic sick room) in operating the hospital without a guarding.
3. Improvement of nurses' work condition and utilization of idle human resources
1) Improvement of nurses' work condition
● Some medium or small sized hospitals strongly claims about low securing rate of nurse, low nurse wage, and poor work condition that caused shortage of nurse human resources. Korea Nurse Association asserts that it is urgent to improve work condition of nurse and vitalize re-employment system for idle nurse in order to solve shortage of nurse.
● According to Korea Nurse Association, initial wage of nurse in 2006 was maximum 33920000 won and minimum 11000000 won for a new in December 2006.
2) Utilization of idle human resource
● In order to solve scarce human resource of nurse in medium or small sized hospitals due to early leave and high leave rate, the nurse association has operated 'Re-employment training program for nurse' with cooperation by administrative organizations such as Ministry of Labor and Ministry of Health, Welfare, and family, and local organizations and the program is getting positive effects
● In order to solve shortage of nurse human resource, specific countermeasures are suggested such as re-employment promotion policy for potential (idle) nurses and labor environment improvement
IV. Utilization plan for results of research and development
● For operation and vitalization of ward without a guardian, economic incentive such as graduated nurse fee or addition on nurse assistant, securing proper nurse human resource, and monitoring system such as legal regulation should be established
● The results of this research are basic data for introduction of hospital by government without guardian that suggest standard of nurse arrangement, survey on recognition about hospital without a guardian, and estimated cost, and these would be used for basic data to establish policy in order for ultimate improvement of hospitalization service.

목차 Contents

• 표지...1
• 제출문...3
• 차례...4
• 표차례...6
• 그림차례...12
• 보고서요약서...13
• 요약문...14
• 한글요약문...15
• 영문요약문...18
• 제1장 연구개발과제의 개요...22
• 1. 연구배경 ...22
• 2. 연구목적 ...26
• 3. 연구내용 및 방법 ...27
• 4. 연구수행체계 ...28
• 제2장 간호간병 서비스 제공 현황 ...29
• 1. 간호간병 서비스 관련 정책 및 제도 분석 ...29
• 2. 간호간병 서비스 성과(nursing outcome) 영향요인 ...34
• 3. 외국의 간호간병 서비스 제공 현황 ...41
• 제3장 보호자없는 병원 시범사업 운영성과 ...67
• 1. 보호자없는 병원 시범사업 운영 개요 ...67
• 2. 보호자없는 병원 시범사업 운영 현황 분석 ...82
• 3. 간호간병 서비스 업무 유형 및 제공시간 분석 ...137
• 4. 공동간병제 운영 병실의 간호간병 서비스 업무 유형 및 제공시간 분석 ...158
• 5. 보호자없는 병원 시범사업군과 공동간병군 관찰조사 결과 비교 ...176
• 6. 보호자없는 병원 제도관련 간호부서장 의견조사 결과 ...186
• 제4장 간호간병 서비스 시범사업 비용추계 ...200
• 1. 간호간병 서비스 비용체계 ...200
• 2. 간호간병 서비스 비용추계 원칙 및 방법 ...207
• 3. 간호간병 서비스 비용추계 결과 ...211
• 4. 간호간병 서비스 비용의 건강보험 도입 방안 ...222
• 5. 간호간병 서비스 비용의 합리적 관리방법 ...224
• 제5장 보호자없는 병원 활성화 방안 ...230
• 1. 보호자없는 병원 시범사업 실시의 중요성 ...230
• 2. 보호자없는 병원 운영 방안 ...233
• 3. 보호자없는 병원 시범사업 실시 성과 및 제한점 ...244
• 참고문헌 ...252
• 부록 ...259
• 1. 보호자없는 병원 시범사업관련 의견 조사(환자/보호자용) ...260
• 2. 보호자없는 병원 시범사업관련 의견 조사(의료진용) ...267
• 3. 보호자없는 병원의 발전방향 모색을 위한 의견 조사(간호부서장용) ...273
• 4. 보호자 없는 병원 간병수가 개발을 위한 조사계획...279