A Study on the Appropriateness of Health Insurance Fee in Main Nursing Practices / 임상간호연구

PURPOSE: This study was to present improvement strategy and the problems of the nursing fee in national health insurance system. METHODS: A total of 23 nursing activities performed by nurses were selected. Data were collected the relative value score and criteria of the Health Insurance Review & Assessment Agency. Sixty clinical nursing experts panels were composed and nursing time surveyed self-reported method. The actual fee was calculated through the nursing time, relative value score and actual labor costs. Nextly, the labor costs analyzed was compared with that in the national health insurance. RESULTS: Although the practices were mainly performed by the nurse, other occupations have been recorded as main practitioners and the time of the nursing activity is partially improperly reflected. Additionally, although the nurse practiced mainly in glucose (semi-quantitative) test, it was confirmed that the principal practitioner was described as a clinical pathologist. The the labor cost gap was estimated that is 9.3 times (median) and 11.9 times (average) in this analysis. CONCLUSION: This study suggests that it is necessary to legislate a policy that can improve the quality of clinical nursing by reinforcing the appropriateness and improving nursing fee through reflection of the actual time spent for nursing care.

Influence of Decentralization, Participation in Decision Making, Job Satisfaction on Nurse Managers' Organizational Commitment / 간호행정학회지

PURPOSE: The purpose of this study was to examine the influence of decentralization, participation in decision making, job satisfaction on organizational commitment among hospital nurse managers. METHODS: The data were derived from the self-reported questionnaire responses of 198 nurse managers from January to March, 2006 at four general hospitals over 900 beds in Seoul and Gyungi province and analyzed by frequency and percentage, t-test, ANOVA and Sheffe's test and stepwise multiple regression. RESULTS: Mean of decentralization was 3.53+/-0.52, participation in decision making was 5.04+/-0.83, job satisfaction 3.54+/-0.48, and organizational commitment was 5.30+/-0.76. There were significant differences between participation in decision-making and career of manager, field of practice, span of control, especially in staffing decision. A significant correlation was found between organizational commitment and decentralization (r=.22, p<.001), participation in decision making (r=.40, p<.001), job satisfaction (r=.64, p<.001). The job satisfaction has the highest significant predictor of organizational commitment (R2=43%). CONCLUSIONS: Nursing managers' job satisfaction and organizational commitment will be promoted by granting participation in decision-making.

The Study of Serum Troponin I and CK-MB in the Acute Stage of Kawasaki Disease

PURPOSE: The pathogensis and etiologic agents are still unknown but clinical studies suggest that Kawasaki disease (KD) is an autoimmune disease caused by infectious agents associated with the early development of acute myocarditis and coronary artery abnormalities. The study investigates serum troponin I (cTnI) and creatine kinase (CK)-MB in the acute stage of KD before diagnosis the use of intravenous immunoglobulin (IVIG) treatment to confirm and find early diagnosis of acute myocarditis. METHODS: The patient group consisted of 36 cases of KD in the acute stage before IVIG treatment, and the control group consisted of 10 cases who didn't suffer from KD. The obtained sera was measured by using the Chemiluminoimmunoassay method, and compared with the results of both groups. RESULTS: The sex ratio of male to female was 1.5 : 1, and the male age was 2.6 +/- 1.6 years old. The level of cTnI increased in 14 cases (31.9%), and CK-MB increased in 9 cases (25%). Five cases (13.9%) in the patient group increased in both cTnI and CK-MB levels which correlated with each other significantly (P<0.05). But the levels of cTnI and CK-MB were negative in the control group. Acute phase reactants such as CRP, C3, ESR were positive and WBC increased in the acute stage of both groups. CONCLUSION: The level of cTnI correlates accurately to myocardial cell injury, so increasing the level of cTnI in the acute stage of KD is recommended for acute myocarditis or myocardial cell injure in the early stage before onset of clinical symptoms and signs. Therefore, the measurement of cTnI can be a more useful method for early diagnosis and confirmation of acute myocarditis than a CK-MB test, and may help in the early treatment of IVIG by reducing cardiovascular abnormalities in KD.