[Care of Korean elderly in need of care : Tendency to strengthen the role of integrated care for the elderly in communities]. / Versorgung der älteren Pflegebedürftigen in Korea : Tendenz zur Verstärkung der Rolle der integrierten Altenpflege in den Kommunen.

Since the introduction of long-term nursing care insurance in 2008, the Korean elderly in need of care are entitled to residential care or home based care services, as in the other welfare states. This article initially introduces the Korean nursing care insurance (PfV) for the elderly to give an overview of the healthcare system. Subsequently, the latest model project "Community based comprehensive care system" is introduced. The confusing care and social services should be networked and provided in a manner customized to the needs of the elderly, so that home based care before residential care can be realized.

[Transition of differences between men and women about awareness of stress during the recent two decades: data from comparison of questionnaires at two different eras].

Stress is one of the important factors on lifestyle diseases such as type 2 diabetes. Recent great changes of female roles in social activities and the introduction of Japanese public nursing care insurance in 2000 might lead to some changes in the household roles, which would have a big impact on the differences in stress between men and women. I herein investigated the two questionnaires about the awareness of stress in daily lives in 273 persons conducted in 1993 before the beginning of public nursing care insurance and in 590 persons in 2010 after the program was implemented. The understanding of the results and re-thinking of so-called 'traditional sexual roles' will provide helpful clues to the precise solution for coping with stress.

[Monitoring of nursing service context factors: first descriptive results of a cross-sectional Swiss study prior the introduction of SwissDRG]. / Monitoring von Pflegekontextfaktoren - Erste deskriptive Studienresultate einer Querschnittserhebung der schweizerischen DRG Begleitforschung Pflege vor Einführung der SwissDRG.

BACKGROUND: The adoption of DRG-based payment systems has narrowed hospitals' financial margins, necessitating streamlining and process optimization. The experience of other countries shows that this restructuring can influence context factors essential to the delivery of nursing care. As a result, nursing care quality and patient safety may be impacted. AIM: The Sinergia Project aims to develop a monitoring model and related instruments to continuously monitor the impact of DRG-based reimbursement on central nursing service context factors. METHOD: The descriptive, quantitative results were collected within the framework of a study with a mixed methods design by means of an online survey in which nurses from five hospitals participated. RESULTS: The results show that the nursing service context factors examined (nursing care complexity, quality of the work environment, management, moral distress and job satisfaction), have relevance in all practice areas as regards practice setting and nursing care delivery. Patterns can be recognized that are consistent with those found in the literature and which could be an indication of the relationships between the context factors above, as was hypothesized in the model. CONCLUSIONS: The study has provided the participating hospitals with useful data upon which to base discussions on ensuring quality of nursing care and practice development, in addition to information important to the further development of the model and the instruments employed.

Evolución de la accesibilidad a los centros sanitarios en España. Seguimiento de los últimos setenta años / Evolution of the accessibility of health centers in spain. monitoring of the last seventy years

Introducción. La accesibilidad de la población a los centros sanitarios españoles ha ido evolucionando en las últimas décadas, ligada al estado de bienestar y a los cambios en las competencias en materia de salud. El objetivo de esta revisión es describir la evolución de la accesibilidad y su impacto en la población. Metodología. Se han utilizado bases bibliográficas para buscar los artículos relacionados con el objetivo de la revisión y comprendidos entre 1940 y 2013. Se han seleccionado aquellos artículos con mayor calidad y que ayudaban a construir la revisión del tema propuesto. Resultados. La accesibilidad a los centros sanitarios españoles está ligada a la evolución de la atención pública en los últimos setenta años. Por un lado, la aparición del Seguro Obligatorio de Enfermedad (SOE) y la creación de la Seguridad Social hicieron que casi el total de la población española tuviera cobertura sanitaria. Por otro lado, la aplicación de principios como los de justicia y equidad hicieron aflorar numerosos centros hospitalarios con la finalidad de acercar al máximo la asistencia a la población. En los inicios del siglo xxi, con un crecimiento desmesurado de centros hospitalarios y una crisis económica mundial, se constata la necesidad de ubicar los centros asistenciales de acuerdo con el principio de eficiencia económico-espacial o de racionalidad económica. Conclusiones. En un entorno actual de crisis se analizan las consecuencias de la hiperaccesibilidad (sistema sanitario insostenible, polimedicación de la población, etc.) y se busca un sistema sanitario más eficiente. También es necesario plantearse la relación existente entre la hiperaccesibilidad y la hiperfrecuentación de la población a los servicios sanitarios, así como la relación entre la hiperaccesibilidad y la polimedicación (AU)

Introduction: the accessibility of the population to health centers in Spain has evolved to over the past decades, linked to the welfare state and changes in the health skills. The aim of this review is to describe the evolution of accessibility and its impact on the population. Methodology: we used bibliographic databases to search for articles related to the purpose of reviewing and between 1940 and 2013. We have selected those items with higher quality and that helped to build the review of the proposed topic. Results: the accessibility to health centers in Spain is linked to the performance of public attention in the last seventy years. On the one hand, the appearance of Compulsory Health Insurance (SOE) and the creation of Social Security made almost all of the Spanish population had health coverage. On the other hand, the application of principles such as justice and equity brought to the surface many hospitals with the aim of bringing the most assistance to the population. In the early twenty-first century, with an enormous growth of hospitals and a global economic crisis, we see the need to locate health facilities under the principle of spatial economic efficiency or economic rationality. Conclusions: in a current environment of crisis, the consequences of hyperaccessibility are analyzed (unsustainable health system, population polypharmacy, etc. ) and a more efficient healthcare system is searched. It is also necessary to consider the relationship between the hyperaccessibility and the frequent attendance of population to the health services, and the relationship between hyperaccessibility and polypharmacy

Factors associated with the use of home-visit nursing services covered by the long-term care insurance in rural Japan: a cross-sectional study.

BACKGROUND: In Japan, there is a large increase in the number of elderly persons who potentially need home-visit nursing services (VNS). However, the number of persons using the VNS has increased only little in comparison to the number of individuals who use home social services, which are also covered by the Long-Term Care Insurance (LTCI) system. This cross-sectional study investigated the predictors of the VNS used under the LTCI system in Japan. METHODS: We used 1,580 claim data from all the users of community-based services and 1,574 interview survey data collected in 2001 from the six municipal bodies in Japan. After we merged the two datasets, 1,276 users of community-based services under the LTCI were analyzed. Multiple logistic regression models stratified by care needs levels were used for analysis. RESULTS: Only 8.3% of the study subjects were VNS users. Even among study participants within the higher care-needs level, only 22.0% were VNS users. In the lower care level group, people with a higher care level (OR: 3.50, 95% CI: 1.50-8.93), those whose condition needed long term care due to respiratory or heart disease (OR: 4.31, 95% CI: 1.88-89.20), those whose period of needing care was two years or more (OR: 2.01, 95% CI: 1.14-3.48), those whose service plan was created by a medical care management agency (OR: 2.39, 95% CI: 1.31-4.33), those living with family (OR: 1.86, 95% CI: 1.00-3.42), and those who use home-help services (OR: 2.12, 95% CI: 1.17-3.83) were more likely to use the VNS. In the higher care level group, individuals with higher care level (OR: 3.63, 95% CI: 1.56-8.66), those with higher income (OR: 3.79, 95% CI: 1.01-14.25), and those who had regular hospital visits before entering the LTCI (OR: 2.36, 95% CI: 1.11-5.38) were more likely to use the VNS. CONCLUSIONS: Our results suggested that VNS use is limited due to management by non-medical care management agencies, due to no caregivers being around or a low income household. The findings of this study provide valuable insight for LTCI policy makers: the present provision of VNS should be reconsidered.

Satisfacción laboral de los profesionales de enfermería en las unidades de gestión clínica / Job stisfaction of nurses in the clinical management units

La Unidad de Gestión Clínica (UGC) se ha establecido actualmente en las instituciones sanitarias andaluzas como el modelo de gestión de referencia. Este modelo de gestión pretende instaurar en los profesionales sanitarios una idea-fuerza: el mayor rendimiento de los recursos sanitarios se realiza impulsando la práctica clínica que utilice el menor número de recursos diagnósticos y terapéuticos. La UGC no solo tiene como objetivo el ahorro económico, en el Acuerdo de Gestión Clínica [1] se valoran todas las dimensiones que la integran: la investigación, la formación, el proceso clínico, la cartera de servicios, los objetivos, la gestión económica y los indicadores de control y de seguridad. En ella se pretende transferir más responsabilidades a los profesionales sanitarios, implicándolos en la gestión de la Unidad. La UGC establece nuevos enfoques que afectan directamente a los profesionales sanitarios y plantea ventajas e inconvenientes para los facultativos y los profesionales de enfermería, implicados en la consecución de la excelencia en la labor asistencial. Estos últimos se muestran expectantes ante los cambios que se van generando en las instituciones sanitarias y aparece un debate acerca de las competencias que se derivan de la misma. Algunos profesionales de enfermería consideran que la presión asistencial a la que se ven sometidos en las instituciones públicas ha aumentado desde la aparición de la UGC y, sin embargo, otros se sienten motivados y recompensados por los resultados que obtienen con este modelo de gestión. En las instituciones sanitarias algunos profesionales se sienten más motivados que otros y esto se constata en el resultado de la actividad asistencial [2]. Ante las percepciones positivas y negativas que la UGC plantea, se considera pertinente centrar el objetivo de este trabajo en la búsqueda de los factores que influyen en la satisfacción laboral de los profesionales de enfermería de la UGC. Son escasos los estudios realizados acerca de la misma [3] pero resultan inexistentes si se vinculan con la enfermería; por tanto, la búsqueda del conocimiento científico de enfermería relacionado con el modelo de gestión clínica y fundamentado en la calidad asistencial puede llevar a establecer nuevos conceptos en torno a la profesión enfermera, profesión en la que se vislumbran importantes cambios cuando el Grado sea efectivo(AU)

Clinical Management Unit (CMU) is currently set in the Andalusian health institutions as the model reference management. This management model aims to make all healthcare professionals a powerful idea: the best performance of health resources is performed to drive clinical practice using the least number of diagnostic and therapeutic resources. The CMU not only aims at saving money, in the Clinical Management Agreement [1] are measured all the dimensions that make up the UGC: research, training, clinical process, the portfolio of services, objectives, financial management and indicators to control and security. The CMU is to transfer more responsibilities to Health Care Professionals, involving them in the management of the Unit. The CMU sets new approaches that directly affect health professionals and presents advantages and disadvantages for the Doctors and the Nurses, involved in achieving excellence in care work. Nurse Practitioners shows expectant before the changes are generated in health institutions and appears a discussion of skills derived from the CMU. Some Nurses believe that the burden of care to which they are subjected in public institutions has increased since the onset of the CMU and yet others believe that they are motivated and rewarded for the results obtained with this model of management. In health institutions, some professionals are more motivated than others and this is found in the outcome of health care activity [2]. Given the positive and negative perceptions that arise in the CMU Professional Nurses, it is considered appropriate to focus the objective of this work in the search for factors that influence job satisfaction of nurses in the CMU. There are few studies about the CMU [3] but are absent when linked with nursing, so the pursuit of scientific knowledge related to nursing management model based on Clinical and Quality Care can lead to establish new concepts around the nursing profession, a profession in which major changes are foreseen when the Grade is effective(AU)