:... (19959). (Diagnosis Related Groups ) (paym ent unit ).,,,, DRG ().. (m anaged competition )(client - centered approach )..,,,,.....,,
..,... 4. 1.,,. Joint Commission on Accreditation of Health care Organization s (JCAHO) Health Care F inancing Administration (HCF A )Medicare. Kaiser - Perm anante Medical Center (T he F amily Centered Perinat al Care Program ),,,,,,,,, APGAR,,,, Coomb s ',, (Carr,1989). William scooper (1993). ; / 36%, 19%, 16% 21%, : 10%, 9%, 9%, 7% T 24%, 15%. 21%, 10%, 15%, 14%. Carr (1989),,,,,,,,,,,.. William scooper (1993),,,,.,,,,, ( & W assenberg, 1980). Norm a (1995),,, (protocol).
Harrison (1990) (comprehen siv e assessm ent ), (hom e follow - up ), (indivisualized teaching )3.,, 4872.,. 2. 56 12.,,,,,,.. (F eedback ). 3. 2 one day. check list.. 4. W ork s h op :. 60 15T rl.,,.. 1. 12 (Jones, 1978). 24, 3, 140/ 90mmHg, 38, 38, 90/ 60-140/ 90mmHg,,. 2.74.05kg, 3842, AP GAR 1 7, 110150 /, 30-60 /, 36.137.2. T hurstondundas1985 Coomb s ' test Hem atocrit 4065%,,. 37,, 10.0g/ L, RhoGAM, 3
8,,,, 4,,. 2.5kg, Coomb s ' test (- ),,,,, 6, 48.,, w ork shop. (Jones, 1978). (Jan sson, 1985)..
Unit No - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - GPLDA (,,, ) (, ) ( )
: : 1. () : : (,, ) kg kg k g Rh / : / ( V ) : (,)/ 2., cm kg : : (, ),
3., : : (,,,,, ) :, (, ) (,,, ) : (,, ) 4., T P R B/ P ; (, ) H om an () / R L (/ ) : 5. / : 6. / 7. / / 8. / : 9. / (,,,, )
10. / : / 11. /
/ () (/ ) (/ ) (mmhg ) (S ), (F ), (E) (I), (F ), (E ), (S ), (C) (F ), (S ) 1U - 1, U - 2, U - 3, etc. () 1 U + 1, U + 2, U + 3, etc. (S ), (M ), (L) (N), (E) (R), (S ), (A) (S ), (N) (/ ) (/ ) (/ ) (S ), (I) (/ ) (/ ) (/ ) (R), (E ), (ED) (D), (A) Homan 's () /
/ : T = D=E = C= S =
: : : G P L D A ABO Rh VDRL : Breech Ex traction F orcep s V acuum : : 1 2 3 : Apg ar S core : 1 5 : cm kg cm cm cm : (,, ) (,, ) : : (, ) ( ) ( ) 1 : (, ) : : /
..,..,,,, (feedback ).... 1),, 2) 3) 4) 5) 6).. 1), 2) 3) 4) (,, ) 5),,,,, (Jan ssoin, 1985) 6).. (Brucker et al, 1985).. 1)..
2)..,,. 1.,, (1994)., 244696-705. 2. (1991)... 3. (1993)... 4. Bradley, R. Caldw ell, B.(1988). U sing th e gom e inv entory to assess th e family environm ent. P ediatric Nur sing 14, 97-102. 5. Britt on, HL. Britt on, JR.(1985). Bridgin g the gap bet w een hospit al an d hom e. Child T oday 14, 19-22. 6. Carr, K. W alt on, V.(1982). E arly postpartum discharg e. JOGNN. 11,29-30. 7. Carr, KC.(1985). Carin g for fam ilies in the hom e, chapt er 14. H om e care of th e n ew fam ily. 163-182. 8. Colburn, V (1991). T he nur se as ex pery w itn ess : A new ex pan ded role. J P erinat al and Neonat al Nur sing 5 (3), 16-24. 9. E ng elke, M K., E ng elke, S C., (1992). Predict ors of the hom e environm ent of high - risk infant s. J Com munity H ealth Nursin g, 9 (3), 171-181. 10. Garrard, J. Dow d, BE. Dor sey, B. Shapiro, J.(1987). A checklist t o as ses s th e dev elopm ent an d v alidation. P ublic H ealth Nur sin g, 4 (4), 212-218. 11. H arrison, L.(1990). P atient education in early postpartum disch arge program s. A m erican Journ al of M at ern al Child Nursin g, 15 (1), 39. 12. Hiser, PL.(1992). Con cern s of m ultiparas during the secon d postpartum w eek. JOGNN M ay/ Jun e, 195-203. 13. Jan sson, P.(1985). E arly P ostpartum discharg e. Am J Nur s 85 (5), 547-550. 14. Jon es (1978). H om e early aft er deliv ery. Am erican Journal of Nur sin g, Aug, 78-86. 15. Killeen, M.(1984). from Hospit al t o h om e : continu ou s care for new m oth er s and infant s. Nursin g M an agem ent, 15 (3), 10-13. 16. Lar son, CP.(1980). Efficacy of prenatal an d postpartum hom e visit s on child health and dev elopm ent. P ediatrics, 66 (2), 191-197. 17. Lem m er, S C.(1987). E arly discharg e : Out com es of prim iparas and their infant s. JOGNN July / Aug, 230-236. 18. Neubaur, M P (1990). Careful chartin g - Your best defen se. RN, 53, 77-82.
19. proposed out patient PP S outlined, M odern H ealth Care, V ol.25,n O.13, 1995. 20. Regan, K.(1984). E arly ob st etrical disch arge : a porgram th at w ork s. T h e Canadian Nur se, 80(9), 32-35. 21. Ry an, S.J. & W a ssenberg, C.(1980). A hospital- based hom e care porgram. Nursin g Clinics of North Am erica, 15 (2), Jun e, 323-338. 22. S am eroff, AJ.(1985). Env ironm ent al fact ors in the early screening of children at risk in W F ran - kenburg, R Em de, J Sulliv an (E ds.), E arly identification of children at risk, N ew York 21-43. 23. S am pson, SJ.(1991). M ir som g om t erv em t opm s for th e first three postpartum m onth s. JOGNN M ar/ Apr, 116-121. 24. St ew art, P., Keelan, P.(1985). U se of early postpartum caer in the h om e. Can J P ublic H ealth, 76 (6), 384-386. 25. T ribotti, S., Ly on s, N., Blackburn, S., Stein, M. & W ith er s, J.(1988). Nur sing diagn osis for the postpartum w om en. JOGNN Nov/ Dec, 410-416. 26. W illiam s, L.R., & Cooper, M.K.(1993). Nur sem an aged postpartum hom e care. Journal of Ob st etric Gynecologic & Nonn at al Nur sing, 22(1), 25-31. 27. Yan ov er, M., Jon es, D., & M iller, M (1976). P erin atal care of low risk m other s an d infant s : early discharg e w ith h om e care. N E ngl J M ed 294-705. - A b s t rac t - D ev elopm ent of a Re cordin g S y s tem for H om e H e alth Care for P o s tpartum W om en adn T h eir N e w born s H ea S ook Kim H ea S ook Kim : Colleg e of Nursin g Yon sei Univ er sity T h e Korean g ov ernm ent h as a n ew sy st em for chargin g patient care for patient s in h ospit al, on hold for the present (9 / 1995) but t o st art im plem ent ation in certain areas of patient care n ext y ear. F rom th e latter half of n ex t y ear th e M inistry of H ealth and W elfare w ould like to start dem on stration project s for hospitals w ho w ant to start u sin g DRGs for frequ ently seen m edical diagnosis an d for patient s w ith a cour se that is predict able an d for w hom non - in surance cost s are m inim al : su ch as th e patient w ho
h as a deliv ery, cesarean deliv eries, cataract surg ery, t on sillectom y or an appendect om y, and apply th e DRG sy stem of paym ent for hospital car e for th ese patient s. T h e purpose of this study w a s to est ablish a recording sy st em t o giv e effectiv e h om e h ealth care t o postpartum w om en an d th eir n ew born s. Recently the gov ernm ent announced a DRG system to apply to postpartum w omen for pilot purposes starting n ex t y ear. T his giv es im petu s t o the n eed t o dev elop hom e care records that w ill allow for sy st em atic recording an d provide continuity an d con sisten cy in care across all h ealth professionals an d w ith in - depth com m unication b etw een the profession s t o assure high qu ality care. T h ere has been a rise in m edical cost s and a short ag e of patient bed space in h ospit als, particularly since th e introduction of national m edical in surance. T he stu dy focu sed on dev eloping client selection criteria, a prim ary as sessm ent t ool, progres s n ot es and nursin g diagnoses applicable t o postpartum and new born client s. S election crit eria for hom e health care, as ses sm ent tool cont ent, nur ses progress n ot es and diagn oses w ere dev eloped through a review of the lit erature, advice from professionals w ho are ex pert in hom e health care an d actual practice in th e u se of recordin g t ools through w ork shop s. T h e recom m en dation s based on the research result s are as follow s : 1) Replication and application of these t ools is n eeded to test the v alidity of the t ools 2) In order t o hav e sy st em atic nur sing records st andardization of records ha s t o be done after nur ses have had experience u sing them. 3) R eliability an d v alidity of th e t ools has t o be est ablished through applicability t o actual care situ ation.