Adoption of Evidence-Based Practice-Advance Directives in Nursing Homes

( Juh Hyun Shin ),( Dong Eun Jang ) 이화여자대학교 간호과학연구소 2016 Health & Nursing Vol.28 No.2

Purpose: Nursing homes commonly experience the death of residents, family members, and staff. The strategies to protect nursing home residents` autonomy at the end of life are very important. However, current end-of-life care procedures have been limited and too abstract. Many nursing home residents die without the opportunity to express their intentions. Residents` autonomy in the decision-making process in long-term care settings has been limited. This article explored the urgent problem of end-of-life care in nursing homes, as well as the advantages of and barriers to advance directives. Methods: By reviewing articles, this study has introduced and discussed Evidence-based practice-advance directives developed by the Gerontological Nursing Interventions Research Center, University of Iowa. Results: The benefits of advance directives are that the residents get the care that they want and need without losing the right and autonomy to make their own choices regarding future treatment. A major barrier to completing advance directives is that many NH residents are cognitively impaired. Conclusion: EBP-ADs have the advantage that we can expect an increased AD-completion rate with the use of EBP in nursing homes. Also, EBP-ADs can be purchased at a reasonable price, are systematically developed, and concise and easy to use.

Factors Relating to the Quality of Care for Nursing Home Residents in Korea: Using the Delphi Method

Shin, Juh Hyun,Kim, Eun Mee,Lee, Ji Yeon 한국간호과학회 2019 Journal of Korean Academy of Nursing Vol.49 No.6

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.

Nursing Staffing and Quality of Life in Western New York Nursing Homes

Shin, Juh Hyun,Park, Taesung,Huh, Ik-soo SAGE Publications 2014 Western journal of nursing research Vol.36 No.6

<P>This study investigated the relationship between nurse staffing and quality of life (QOL) in Western New York State nursing homes. This was a cross-sectional, correlational study. The independent variables were hours per resident day (HPRD), skill mix, and turnover rate of nursing staff. The outcomes were measured using the self-reported QOL instrument. No coefficients were statistically significant with registered nurses’ (RNs) HPRD. Certified nursing assistant (CNA) HPRD had a statistically significant positive impact on the spiritual well-being domain. There was a statistically negative relationship between the amount of licensed practical nurse (LPN) HPRD and food enjoyment; and the ratio of more RNs to fewer LPNs and CNAs had a statistically significant negative influence on the meaningful-activity, food-enjoyment, and security domains. The turnover of RNs had a statistically negative relationship with the sum of each domain. None of the coefficients was statistically significant with LPN turnover.</P>

미국거주 한국인 여성 유방암 환자를 위한 문화맞춤형 간호 중재에 관한 고찰

신주현 ( Juh Hyun Shin ) 이화여자대학교 간호과학연구소 2013 Health & Nursing Vol.25 No.2

미국에 거주하는 한국인 노인 수는 급속도로 빠르게 증가하고 있으며, 이 인구는 높은 유방암 이환율과 치사율이 보고되고 있다. 미국인들에 비해 한국계 미국인 여성들은 유방암 예방 활동(마모그램, 유방자가 검진 실천율 등)이 낮게 보고되고 있으며, 이는 언어 사용의 어려움, 무보험, 산부인과 진료에 대한 거부감, 잘못된 건강믿음으로 보고되었다. 따라서, 한국인들의 문화를 고려한 culturally responsive nursing interventions 이 시급한 시점이다. Culturally responsive nursing interventions에는 culturally sensitive interventions, culturally innovative interventions, culturally transformative interventions로 구성되어있다. 본 연구에서는 선행 연구를 기반으로, 기존 백인들을 위해 개발된 간호 중재를 한국인 문화에 맞게 수정한 culturally sensitive interventions, 한국적 문화적 요소를 의도적으로 활용한 culturally innovative intervention, 그리고, 미국 내 한국인 문화의 사회적 구성 요소를 일부 변화시키는 수준의 culturally transformative interventions 을 소개하였다. Culturally sensitive interventions은 한국문화의 특성을 고려한 Church-Based Breast-Cancer-Prevention Education Model과 Korean Grocery-Store-Based Breast-Cancer-Education Program에 대해 서술하였고, culturally innovative interventions에서는 유방암에 대한 교육중재와, 소그룹 discussion을 이용한 중재를 서술하였다. Culturally transformative interventions에서는 한국계 미국인 여성들을 위한 건강박람회와, 무료 전화 상담 등을 예로 서술하였다.

한국과 스웨덴 조산 비교 연구

신주현(Shin, Juh Hyun) 대한여성건강학회 2016 여성건강 Vol.17 No.1

Factors Influencing Nursing Home Accreditation-Quality Ratingsin Korea

신주현(Shin, Juh Hyun),신인수(Shin, In-Soo),이지연(Lee, Ji Yeon) 한국노인간호학회 2020 노인간호학회지 Vol.22 No.3

Purpose: The purpose of this study is to examine the relationship between the level of competition among nursing homes (NHs) and their geographical locations with government NH accreditation-quality ratings in Korea. We also examined the possible mediating effects of nurse turnover and NH residents’ hospitalization on the relationship.Methods: We used a cross-sectional design in this study. Data accrued using a disproportionately stratified cluster-sampling method in Korea. Independent variables included location and competition among NHs, as measured by the Herfindahl-Hirschman Index. The mediating variables included registered nurse (RN) turnover and hospital admissions from NHs. The dependent variable was the NH accreditation grade, openly published by the Korean National Health Insurance Service. Results: The high turnover of professional RNs results in deteriorated government nursing-home-quality ratings and increased hospital admissions relating to better nursing-home-quality ratings. RN turnover was statistically significant with evaluation grade and admission. Conclusion: This study identified challenges in Korea’s system of public reporting on NH quality. The accreditation system must reflect appropriate, concrete information on RN turnover and hospital admissions so NH residents are managed in a timely manner, avoiding inappropriate hospitalization.

Nursing Staff Characteristics on Resident Outcomes in Nursing Homes

Lippincott WilliamsWilkins 2019 The journal of nursing research Vol.27 No.1

<P><B>ABSTRACT</B></P><P><B>Background:</B></P><P>The outlook of administrative staff and registered nurses (RNs) plays a critical role in the management of nursing homes. No previous study has compared the outcomes of nursing homes with RNs on staff with those of nursing homes without RNs on staff in Korea.</P><P><B>Purpose:</B></P><P>The aim of this study was to investigate the association between nurse-led nursing homes, staff turnover, and resident outcomes in nursing homes in Korea.</P><P><B>Methods:</B></P><P>Using a cross-sectional design, 36 nursing homes with 30 or more beds participated. Primary data included 15 quality indicators.</P><P><B>Results:</B></P><P>Nursing homes with RNs had statistically significant better resident outcomes. RN turnover related positively to the prevalence of falls ( β = 1.68, <I>p</I> < .05) and tube feeding (β = 1.71, <I>p</I> < .01) and negatively to incontinence (β = −1.53, <I>p</I> < .01). Nursing homes with RNs with tenures greater than 1 year had statistically significant lower prevalence of falls (β = −0.47, <I>p</I> < .05), incontinence (β = −0.45, <I>p</I> < .05), weight loss (β = −0.53 <I>p</I> < .05), and bed rest (β = −0.54, <I>p</I> < .01) and increased range of motion (β = 0.51, <I>p</I> < .05). Interestingly, having a nurse as a director for more than 1 year related negatively to the incidence of urinary tract infection (β = −0.56, <I>p</I> < .05) in residents. The rate of RN turnover was found to impact fall prevalence (β = 1.68, <I>p</I> < .05) and tube feeding (β = 1.71, <I>p</I> < .01) positively and to impact incontinence (β = −1.53, <I>p</I> < .01) negatively.</P><P><B>Conclusions:</B></P><P>Turnover of nursing home staff and length of tenure may contribute to the more effective management of nursing homes, higher-quality long-term care insurance, and RN-staffing-related laws. Assessing staff characteristics and the tenure of employees promotes the effective management of nursing homes.</P>

Doll therapy: an intervention for nursing home residents with dementia.

C. B. Slack 2015 Journal of psychosocial nursing and mental health Vol.53 No.1

<P>The use of dolls as a therapeutic intervention for nursing home residents with dementia is relatively new. The current article describes a research study implemented with nursing home residents in Korea to examine the effects of doll therapy on their mood, behavior, and social interactions. A one-group, pretest-posttest design was used to measure the impact of doll therapy on 51 residents with dementia. Linear regression demonstrated statistically significant differences in aggression, obsessive behaviors, wandering, negative verbalization, negative mood, and negative physical appearance after introduction of the doll therapy intervention. Interactions with other individuals also increased over time. Findings support the benefits of doll therapy for nursing home residents with dementia; however, further research is needed to provide more empirical evidence and explore ethical considerations in the use of doll therapy in this vulnerable population.</P>

종합병원 신규간호사의 COVID-19 두려움과 직업존중감이 감염관리 수행도에 미치는 영향

정지혜 ( Jihye Jung ),신주현 ( Juh Hyun Shin ) 이화간호과학연구소 2022 Health & Nursing Vol.34 No.1

Purpose: This study aimed to investigate the effects of the factors of fear of COVID-19 and job-esteem on infection control in newly graduated registered nurses in a general hospital. Methods: This descriptive study used collected data from 159 newly graduated registered nurses working in a general hospital in Seoul; data were analyzed using t-test, ANOVA, Scheffe’s test, Pearson’s correlation coefficient, and multiple linear regression analysis. Results: Job-esteem (β = .20, p = .011) significantly influenced infection control, while fear of COVID-19 was ot related to the infection control performance. Conclusion: The study results indicate that job-esteem influences the infection control performance of new nurses. Therefore, to improve infection control performance, the reinforcing program of job esteem should be pursued to the newly graduated registered nurses.

Public Reporting on the Quality Ratings of Nursing Homes in the Republic of Korea

Lee, Hyang Yuol,Shin, Juh Hyun 한국간호과학회 2019 Journal of Korean Academy of Nursing Vol.49 No.2

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.