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Shin JH, Jung SO, Min EJ. Factors Influencing Hospitalization of Nursing Home Residents in Korea Using Regularized Negative Binomial Regression. Policy Polit Nurs Pract 2024:15271544241259427. [PMID: 38874520 DOI: 10.1177/15271544241259427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
The appropriateness of hospitalization for nursing home (NH) residents is still up for debate, with determining factors including timeliness, available treatment, healthcare staff, medication options in hospitals, and safety issues. Although the factors leading to hospitalization have been studied expansively, research on staffing is limited. Thus, this study aimed to investigate organizational predictors, nurse staffing, and government incentives and find important factors to hospitalization due to infection or disease among NH residents in Korea. A cross-sectional design was used, and data were collected via survey from a total of 51 NHs from August 27, 2021 to March 25, 2022. A total of 32 explanatory variables were included. The response variable was the count of hospitalized residents due to infection or disease. We analyzed data using least absolute shrinkage and negative binomial regression. We found that registered nurses' increased hours per resident day were related to decreased hospitalizations due to infection or disease. Appropriate retention and recruitment of nurse staffing with professional leadership should be performed to increase the quality of care for NH residents.
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Affiliation(s)
- Juh H Shin
- School of Nursing, George Washington University, USA
| | - Sun O Jung
- College of Nursing, Ewha Womans University, Korea
| | - Eun J Min
- College of Medicine, The Catholic University of Korea, Korea
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Cho E, Kim EY, Lee KH, Kim HR, Choi S, Yoon YS, Kim E, Heo SJ, Jung SY, Jang J. The effects of special nursing units in nursing homes on healthcare utilization and cost: A case-control study using propensity score matching. Int J Nurs Stud 2023; 147:104587. [PMID: 37741258 DOI: 10.1016/j.ijnurstu.2023.104587] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/09/2023] [Accepted: 08/10/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Most nursing homes in South Korea lack professional nursing services, resulting in transporting residents to hospitals for mild health problems and nursing treatment needs. While the number of nursing homes has increased, the number of registered nurses working in nursing homes has declined. In 2019, the Korean Ministry of Health and Welfare and the National Health Insurance Service launched the Special Nursing Units in Nursing Homes, a pilot nurse-led model, to resolve the lack of health and nursing services in nursing homes by mandating registered nurses' minimum staffing levels and protecting their scope of practice. OBJECTIVE This study explored the effects of the Special Nursing Units model in Nursing Homes on healthcare utilization and cost among nursing home residents. DESIGN A comparative effectiveness research design using propensity score matching. SETTING(S) Eighteen nursing homes were selected based on the region and number of beds. PARTICIPANTS There were 323 matched-pairs of residents from the case and control groups. METHODS Nursing homes with more than 30 beds were recruited nationwide, with 18 nursing homes being selected based on the region and number of beds. The case group included 323 older adults receiving professional nursing services by registered nurses under the Special Nursing Units model in Nursing Homes for more than six months consecutively in 18 nursing homes between April and December 2019. We matched control participants using propensity score matching with health insurance and long-term care data. We analyzed the differences in healthcare utilization and cost changes between the case and control groups using generalized estimating equations. RESULTS The groups were not statistically different in baseline demographic or health-related characteristics. There were 26 (8.1%) and 30 (9.3%) deaths in the case and control groups, respectively, during the six months of the model, which was not statistically different (p = .576). The case group showed statistically significant decreases in healthcare utilization and costs, including hospitalization frequency (p = .008), length of stay (p = .002), and hospitalization costs (p = .003); outpatient visit frequency (p = .003) and costs (p < .001); and home healthcare frequency (p < .001) and cost (p < .001) than the control group. CONCLUSIONS Professional nursing services by registered nurses under the Special Nursing Units model in Nursing Homes decreased healthcare utilization and costs. A nurse-led model in nursing homes, which includes mandating the minimum staffing levels of registered nurses and protecting their scope of practice, promises to improve resident health outcomes.
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Affiliation(s)
- Eunhee Cho
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, South Korea
| | - Eun-Young Kim
- Dong-A University College of Nursing, Busan, South Korea.
| | - Kyung Hee Lee
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, South Korea
| | | | - Seonhwa Choi
- Yonsei University, College of Nursing and Brain Korea 21 FOUR project, Seoul, South Korea
| | - Yea Seul Yoon
- Yonsei University, College of Nursing and Brain Korea 21 FOUR project, Seoul, South Korea
| | - EunKyo Kim
- Yonsei University, College of Nursing and Brain Korea 21 FOUR project, Seoul, South Korea
| | - Seok-Jae Heo
- Yonsei University College of Medicine Division of Biostatistics Department of Biomedical Systems Informatics, Seoul, South Korea
| | - Se Young Jung
- Dong-A University College of Nursing, Busan, South Korea
| | - Jiyoon Jang
- Yonsei University, College of Nursing and Brain Korea 21 FOUR project, Seoul, South Korea
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Min D, Cho E, Kim GS, Lee KH, Yoon JY, Kim HJ, Choi MH. Factors associated with retention intention of Registered Nurses in Korean nursing homes. Int Nurs Rev 2022; 69:459-469. [PMID: 35413132 PMCID: PMC9790496 DOI: 10.1111/inr.12754] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 03/08/2022] [Indexed: 12/30/2022]
Abstract
AIM To identify the factors associated with retention intention among Registered Nurses in South Korean nursing homes. BACKGROUND Although nurses are not mandatory personnel, Korean nursing homes employ Registered Nurses. INTRODUCTION Determining the factors related to Registered Nurses' retention intention is important for their job stability and ensure provision of quality care. METHODS This mixed-methods study employed a sequential explanatory design. A self-reported questionnaire survey was conducted between May 1 and July 3, 2019, with 155 Registered Nurses providing direct care from 37 nursing homes. In-depth qualitative interviews were conducted with 10 participants from August 1 to September 30, 2019. Data were analyzed using multilevel analysis for quantitative study and thematic analysis for qualitative study. RESULTS The participants' average age was 48.48 years. Personal factors related to retention intention were Registered Nurses' role, educational level, and job satisfaction. Institutional factors were ownership, number of beds, and working environment. The qualitative study revealed five themes: "Satisfaction with meaningful relationships," "Potential for professional growth," "Nursing service accompanied by emotional labor," "Poor working environments in nursing homes," and "Unprotected nursing expertise." DISCUSSION A nursing home's work environment is related to the Registered Nurses' retention intention. Most Registered Nurses in Korea received low wages, lacked access to career management programs, and experienced emotional labor. CONCLUSION This study highlighted the personal and institutional factors related to retention intention among Registered Nurses in South Korean nursing homes. IMPLICATIONS FOR NURSING AND NURSING POLICY A law that designates Registered Nurses as an essential nursing home workforce is required. Further, nursing homes should increase the number of Registered Nurses to improve working conditions and thereby job satisfaction. It is also necessary to foster a working environment that facilitates professional development opportunities and job clarity.
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Affiliation(s)
- Deulle Min
- Department of NursingCollege of MedicineWonkwang UniversityIksanRepublic of Korea
| | - Eunhee Cho
- Mo‐Im Kim Nursing Research InstituteYonsei University College of NursingSeoulRepublic of Korea
| | - Gwang Suk Kim
- Mo‐Im Kim Nursing Research InstituteYonsei University College of NursingSeoulRepublic of Korea
| | - Kyung Hee Lee
- Mo‐Im Kim Nursing Research InstituteYonsei University College of NursingSeoulRepublic of Korea
| | - Ju Young Yoon
- College of Nursing and Research Institute of Nursing ScienceSeoul National UniversitySeoulRepublic of Korea
| | - Hyun Joo Kim
- Yonhee Seniors Nursing HomeSeoulRepublic of Korea
| | - Moon Hee Choi
- Korea Social Science Data Archive at Asia Center Seoul National UniversitySeoulRepublic of Korea
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Park Y, Min D. Registered Nurses' perspective of systemic factors affecting nursing home care quality decline: A qualitative descriptive study. Nurs Open 2022; 10:1900-1908. [PMID: 36373815 PMCID: PMC9912408 DOI: 10.1002/nop2.1474] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/11/2022] [Accepted: 10/31/2022] [Indexed: 11/16/2022] Open
Abstract
AIM A growing number of older people are living in nursing homes worldwide, but their safety and quality of care are not guaranteed. This study explores registered nurses' (RNs) perspectives on systemic factors affecting the quality of care and safety decline of nursing home. DESIGN Qualitative descriptive study. METHODS In this study, semi-structured interviews were conducted with 10 RNs working in six nursing homes, who were chosen through purposive sampling. Data were collected from 1 August-19 September 2019, and analysed using thematic analysis. RESULTS The following five themes were derived: lack of sufficient number of RNs, poor work conditions, unclear job descriptions for RNs, no official position of nursing director and absence of transition care system. PATIENT OR PUBLIC CONTRIBUTION All reports of RNs affecting resident safety and quality of care decline were related to systemic factors. Therefore, improving quality of care in nursing homes should be supported by changes in systemic factors, such as maintaining an appropriate number of RNs and improving their working conditions.
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Affiliation(s)
- Yunhee Park
- Department of Nursing, College of MedicineWonkwang UniversityIksanKorea
| | - Deulle Min
- Department of Nursing, College of MedicineWonkwang UniversityIksanKorea
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Campagna S, Conti A, Clari M, Basso I, Sciannameo V, Di Giulio P, Dimonte V. Factors Associated With Missed Nursing Care in Nursing Homes: A Multicentre Cross-sectional Study. Int J Health Policy Manag 2022; 11:1334-1341. [PMID: 33949814 PMCID: PMC9808324 DOI: 10.34172/ijhpm.2021.23] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 03/13/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Despite its association with patient safety, few studies on missed nursing care have been conducted in nursing homes. We aimed to describe individual and environmental factors in a sample of registered nurses (RNs) reporting missed nursing care in nursing homes, and to explore the association between these factors and missed nursing care. METHODS In the present, multicentre cross-sectional study, 217 RNs from 43 nursing homes in Northern Italy reported all episodes of missed nursing care (ie, any aspect of required care that was omitted or delayed) that occurred in the 20 most dependent residents (according to RNs' judgement; 860 residents in total) over 3 consecutive days. Multilevel multivariable logistic regression models were used to test possible explanatory factors of missed nursing care (individual, work-related, organisational, and work environment factors), which were entered in a step-wise manner. RESULTS Younger RNs (P=.026), freelance RNs (P=.046), RNs with a permanent contract (P=.035), and those working in publicly-owned nursing homes reported more episodes of missed nursing care (P<.012). Public ownership (odds ratio [OR]=9.88; 95% CI 2.22-44.03; P=.003), a higher proportion of residents with severe clinical conditions (OR=2.45; 95% CI 1.12-5.37; P=.025), a lower proportion of RNs (OR=2.24; 95% CI 1.10-4.54; P=.026), and perceived lack of time to care for residents (OR=2.33; 95% CI 1.04-5.26; P=.041) were statistically significantly associated with missed nursing care. CONCLUSION Factors associated with missed nursing care are similar in hospitals and nursing homes, and include heavy workload and perceived lack of time for care. Because missed nursing care in nursing homes represents tasks performed specifically by RNs, missed nursing care in this setting should be measured in terms of these tasks. An optimal skill mix is crucial to guarantee not only comfort and basic care for nursing home residents, but also good outcomes for residents with severe clinical conditions.
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Affiliation(s)
- Sara Campagna
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy
| | - Alessio Conti
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy
| | - Marco Clari
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy
| | - Ines Basso
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy
| | - Veronica Sciannameo
- Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padua, Italy
| | - Paola Di Giulio
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy
| | - Valerio Dimonte
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy
- Città della Salute e della Scienza di Torino University Hospital, Torino, Italy
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Min D. Effects of resilience, burnout, and work-related physical pain on work-life balance of registered nurses in South Korean nursing homes: A cross-sectional study. Medicine (Baltimore) 2022; 101:e29889. [PMID: 35905217 PMCID: PMC9333544 DOI: 10.1097/md.0000000000029889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND While nursing homes increase, the number of registered nurses (RNs) working there continues to decline. This study explored the effects of resilience, burnout, and work-related physical distress on the work-life balance of RNs to improve retention rates. METHODS This cross-sectional study involved 155 RNs working in 37 nursing homes, spread across 10 South Korean cities. Data were collected from May to July 2019 using self-report questionnaires, with items relating to general and work-related characteristics, work-life balance, resilience, and burnout. Multiple regression analysis was performed to identify factors affecting participants' work-life balance, including variables that showed significant results in univariate analysis. All analyses were performed using the PASW SPSS win 26.0 program. RESULTS Participants' average age was 48.48 years, and they had been working as RNs for 17.36 years on average. Work-related physical pain was reported by 70.3% of participants. Resilience had a positive correlation with work-life balance (r = 0.38; P < .001), whereas burnout had a negative correlation with work-life balance (r = -0.45; P < .001). Work-related physical pain (β = -0.27; 95% confidence interval [CI], -25.89 to -7.48), resilience (β = 0.20; 95% CI, 0.02-0.70), and burnout (β = -0.33; 95% CI, -0.9 to -0.24) affected participants' work-life balance. CONCLUSION Interventions to facilitate work-life balance among nursing home RNs must aim to increase resilience and reduce burnout and work-related physical pain. A healthy work-life balance should improve RN retention in nursing homes, boosting the safety and quality of life of residents in turn.
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Affiliation(s)
- Deulle Min
- Department of Nursing, College of Medicine, Wonkwang University, Republic of Korea
- *Correspondence: Deulle Min, Department of Nursing, College of Medicine, Wonkwang University, 460, Iksandae-ro, Iksan, Jeonbuk 54538, Republic of Korea (e-mail: )
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End-of-life care practices in Korean nursing homes: a national survey. Int J Nurs Stud 2022; 129:104173. [DOI: 10.1016/j.ijnurstu.2022.104173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 12/10/2021] [Accepted: 01/04/2022] [Indexed: 11/24/2022]
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Kang Y, Hur Y. Nurses' Experience of Nursing Workload-Related Issues during Caring Patients with Dementia: A Qualitative Meta-Synthesis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10448. [PMID: 34639748 PMCID: PMC8508301 DOI: 10.3390/ijerph181910448] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 11/24/2022]
Abstract
The behavioral and psychological symptoms of dementia (BPSD), which appear in all dementia patients, demand sizable commitments of time and effort from nurses. This study aims to identify issues related to the workloads of nurses who provide care for dementia patients via qualitative meta-synthesis. Eleven articles were selected using a systematic review flowchart, which were then evaluated for their quality using the Critical Appraisal Skills Program checklist. Collected data were analyzed using a line-of-argument method. Theme clusters were "increased workload due to characteristics of dementia", "increased mental stress", "difficulty associated with playing a mediator role in addition to nursing duties", and "lacking systematic support for dementia patient care". To reduce the workload and mental stress of nurses in dementia care, supportive measures appropriate for their occupational characteristics should be developed, based on workload estimates that account for the attributes of dementia patients.
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Affiliation(s)
- Younhee Kang
- Division of Nursing, College of Nursing, Ewha Womans University, Seoul 03760, Korea;
- Graduate Program in System Health and Engineering, Ewha Womans University, Seoul 03760, Korea
| | - Yujin Hur
- Division of Nursing, College of Nursing, Ewha Womans University, Seoul 03760, Korea;
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Delivering, funding, and rating safe staffing levels and skills mix in aged care. Int J Nurs Stud 2021; 119:103943. [PMID: 33905991 DOI: 10.1016/j.ijnurstu.2021.103943] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/01/2021] [Accepted: 03/19/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Staffing levels and skill mix are critical issues within residential aged care. The positive impact of a sufficient number and skills mix of staff is upheld by abundant evidence within and beyond the sector. While being able to determine suitable staffing levels and skills mix to provide care to nursing home residents is vital, having an appropriate approach to funding the delivery of care is also critical. Beyond determining staffing levels and skills mix and funding care delivery, transparently rating the adequacy of staffing is also important to enable informed decision-making amongst consumers, policy makers, staff, and other stakeholders. There are existing tools for determining nursing home staffing levels and skills mix, funding care, and rating and reporting staffing, however there appears to be ongoing confusion regarding how these different tools might work together to achieve different things in order to ensure safe, quality care. OBJECTIVES In order to explain the importance of ensuring at least a minimum number (staffing level) of the right kind of staff (skills mix) to provide care to nursing home residents, in this paper we briefly explain key differences and interrelationships between three tools; one for determining staffing and skills mix, one for determining funding, and one for rating and reporting the level of staffing within a facility as a measure of quality. RESULTS Our explanation of the three existing tools has resulted in the development of a conceptual model for how minimum staffing levels and skills mix supports the delivery of safe, quality care and how this can be understood in relation to determining, funding, and rating staffing levels and skills mix. CONCLUSIONS Our conceptual model of how determining, funding, and rating staffing levels and skills mix relate to one another and fulfil different but related purposes can be used to demonstrate how minimum staffing levels and skills mix can be understood as foundational to ensuring respectful, safe, quality care.
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Shin JH, Renaut RA, Reiser M, Lee JY, Tang TY. Increasing Registered Nurse Hours Per Resident Day for Improved Nursing Home Residents' Outcomes Using a Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020402. [PMID: 33419183 PMCID: PMC7825529 DOI: 10.3390/ijerph18020402] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/18/2020] [Accepted: 01/01/2021] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to estimate how much resident outcomes can improve with an increase in hours per resident day (HPRD) of registered nurses (RNs) staffing. Nursing home (NH) staff in Korea have serious problems with inappropriate nurse staffing standards and poor working conditions, which lead to poor quality of care for NH residents. This study used a longitudinal survey design. A quota sampling was used with a total of several repeated survey measurement from 2017 to 2020 (n = 74). The independent variable was the amount of nurse staffing HPRD and the outcome variable was the compiled outcome of 15 quality-of-care indicators. Data were directly collected from all participating NHs. A longitudinal, multilevel model was used for analysis. An increase of one unit of RN HPRD (60 min) corresponded to a decrease of about 10.5% of residents with deteriorated quality of care outcomes. This study emphasized that increasing RN HPRD decreased residents’ deteriorated outcomes in NHs. This suggests that professional RNs must be secured to an appropriate level to improve the quality of care for NH residents.
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Affiliation(s)
- Juh Hyun Shin
- College of Nursing, Ewha Womans University, Seoul 03760, Korea;
- Correspondence:
| | - Rosemary Anne Renaut
- School of Mathematical and Statistical Sciences, Arizona State University, Tempe, AZ 85281, USA; (R.A.R.); (M.R.)
| | - Mark Reiser
- School of Mathematical and Statistical Sciences, Arizona State University, Tempe, AZ 85281, USA; (R.A.R.); (M.R.)
| | - Ji Yeon Lee
- College of Nursing, Ewha Womans University, Seoul 03760, Korea;
| | - Ty Yi Tang
- Department of Psychology, Arizona State University, Tempe, AZ 85281, USA;
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Cho E, Kim IS, Lee TW, Kim GS, Lee H, Min D. Effects of registered nurse staffing on quality of care and resident outcomes in nursing homes. Geriatr Nurs 2020; 41:685-691. [DOI: 10.1016/j.gerinurse.2020.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 03/29/2020] [Accepted: 04/01/2020] [Indexed: 11/30/2022]
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