J Korean Acad Nurs.  2019 Dec;49(6):783-794. 10.4040/jkan.2019.49.6.783.

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

Affiliations
  • 1College of Nursing, Ewha Womans University, Seoul, Korea
  • 2Department of Nursing, Kangbuk Samsung Hospital, Seoul, Korea

Abstract

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.

Keyword

Nursing Homes; Long-Term Care; Workforce; Quality of Health Care

Reference

1. National Health Insurance Service. Long term care insurance statistical yearbook (2008–2015) [Internet]. Wonju: National Health Insurance Service;c2010–2016. cited 2019 Feb 21. Available from: https://www.nhis.or.kr/bbs7/boards/B0160/19799?boardKey=37&sort=sequence&order=desc&rows=10&messageCategoryKey=&pageNumber=1&viewType=generic&targetType=12&targetKey=37&status=&period=&startdt=&enddt=&queryField=&query=.
2. Kim JI. General characteristics of senior citizens in the care facilities and influence upon quality of life, their activities of daily living and social support affects. Korean Public Health Research. 2011; 37(1):97–108.
3. Sunwoo D. Policy issues in elderly health and long-term care policy. Health and Welfare Policy Forum. 2016; 239:34–48.
4. Shin CW, Kim SD, Cho WY. The prevalence and management of urinary incontinence in elderly patients at sanatorium in Busan area. Korean Journal of Urology. 2009; 50(5):450–456. DOI: 10.4111/kju.2009.50.5.450.
5. Ministry of Health and Welfare. Enforcement regulations of the elderly welfare act; Article 22;1 [Internet]. Sejong: Ministry of Health and Welfare;c2019. cited 2019 Feb 21. Available from: http://law.go.kr/%EB%B2%95%EB%A0%B9/%EB%85%B8%EC%9D%B8%EB%B3%B5%EC%A7%80%EB%B2%95%20%EC%8B%9C%ED%96%89%EA%B7%9C%EC%B9%99.
6. Zúñiga F, Ausserhofer D, Hamers JPH, Engberg S, Simon M, Schwendimann R. Are staffing, work environment, work stressors, and rationing of care related to care workers' perception of quality of care? A cross-sectional study. The Journal of Post-Acute and Long-Term Care Medicine. 2015; 16(10):860–866. DOI: 10.1016/j.jamda.2015.04.012.
7. Shin JH. Relationship between nursing staffing and quality of life in nursing homes. Contemporary Nurse. 2013; 44(2):133–143. DOI: 10.5172/conu.2013.44.2.133.
8. Backhaus R, Verbeek H, van Rossum E, Capezuti E, Hamers JPH. Nurse staffing impact on quality of care in nursing homes: A systematic review of longitudinal studies. The Journal of Post-Acute and Long-Term Care Medicine. 2014; 15(6):383–393. DOI: 10.1016/j.jamda.2013.12.080.
9. Spilsbury K, Hewitt C, Stirk L, Bowman C. The relationship between nurse staffing and quality of care in nursing homes: A systematic review. International Journal of Nursing Studies. 2011; 48(6):732–750. DOI: 10.1016/j.ijnurstu.2011.02.014.
10. Bowblis JR, Ghattas A. The impact of minimum quality standard regulations on nursing home staffing, quality, and exit decisions. Review of Industrial Organization. 2017; 50(1):43–68. DOI: 10.1007/s11151-016-9528-x.
11. Shin JH, Shin IS. The effect of registered nurses on nursing home residents' outcomes, controlling for organizational and health care market factors. Geriatric Nursing. 2019; 40(3):296–301. DOI: 10.1016/j.gerinurse.2018.11.004.
12. He J, Staggs VS, Bergquist-Beringer S, Dunton N. Nurse staffing and patient outcomes: A longitudinal study on trend and seasonality. BMC Nursing. 2016; 15:60. DOI: 10.1186/s12912-016-0181-3.
13. Harrington C, Choiniere J, Goldmann M, Jacobsen FF, Lloyd L, McGregor M, et al. Nursing home staffing standards and staffing levels in six countries. Journal of Nursing Scholarship. 2012; 44(1):88–98. DOI: 10.1111/j.1547-5069.2011.01430.x.
14. Lee JM, Park MJ, Han EJ, Suh EE. A study on management of medical needs of the elderly in Korean long-term care facilities. Seoul: National Health Insurance Service;2012. 11. p. 3–5. Report No.: 2012-19.
15. Ministry of Government Legislation. Regulations on certified nurse aides and medical service providers [Internet]. Sejong: Ministry of Health and Welfare;c2017. cited 2019 Feb 23. Available from: http://www.law.go.kr/%EB%B2%95%EB%A0%B9/%EA%B0%84%ED%98%B8%EC%A1%B0%EB%AC%B4%EC%82%AC+%EB%B0%8F+%EC%9D%98%EB%A3%8C%EC%9C%A0%EC%82%AC%EC%97%85%EC%9E%90%EC%97%90+%EA%B4%80%ED%95%9C+%EA%B7%9C%EC%B9%99.
16. Kim J, Lee SY. A study on care workers' job performance and competency at long-term care homes. Health and Social Welfare Review. 2013; 33(2):243–273.
17. Delbecq AL, Van de Ven AH, Gustafson DH. Group techniques for program planning: A guide to nominal group and Delphi processes. Glenview (IL): Scott, Foresman;1975. p. 5–19.
18. Rowe G, Wright G. Expert opinions in forecasting: The role of the Delphi technique. In : Armstrong JS, editor. Principles of Forecasting: A Handbook for Researchers and Practitioners. New York: Springer;2001. p. 125–144.
19. Ziglio E. The Delphi method and its contribution to decision-making. In : Adler M, Ziglio E, editors. Gazing into the Oracle: The Delphi Method and Its Application to Social Policy and Public Health. London: Jessica Kingsley;1996. p. 3–33.
20. Donabedian A. The quality of care. How can it be assessed? JAMA. 1988; 260(12):1743–1748.
21. TrackBill. An act to amend the public health law, in relation to establishing the “safe staffing for hospital care act” [Internet]. Washington, D.C.: TrackBill;c2013. cited 2019 Feb 21. Available from: https://trackbill.com/bill/new-york-senate-bill-1634-establishes-the-safe-staffing-for-hospital-care-act/399758/.
22. Kim IS. Ohm and tuberculosis warning for elderly care facilities [Internet]. Seoul: DailyMedipharm;c2012. cited 2019 Feb 21. Available from: http://www.dailymedipharm.com/news/articleView.html?idxno=6076.
23. Sunwoo D. Analysis of installation status and policy implications of long-term care facilities for the elderly. Health Welfare Issue & Focus. 2015; (299):1–8.
24. Jeong EH, Jang MK. Study on improvement of operation of long-term care facilities: Focused on the priority facilities of beneficiaries. Seoul: Seoul Welfare Foundation;2012. 12. p. 5–15. Report No.:2012-23.
25. Comondore VR, Devereaux PJ, Zhou Q, Stone SB, Busse JW, Ravindran NC, et al. Quality of care in for-profit and not-for-profit nursing homes: Systematic review and meta-analysis. British Medical Journal. 2009; 339:b2732. DOI: 10.1136/bmj.b2732.
26. National Health Insurance Service. Long-term care facility evaluation result [Internet]. Wonju: National Health Insurance Service;c2017. cited 2019 Feb 21. Available from: http://www.longtermcare.or.kr/npbs/d/m/000/moveBoardView?menuId=npe0000000770&bKey=B0009.
27. Kwon H, Hong K. The effect of publicness on the service quality in long-term care facilities. Korean Journal of Social Welfare. 2015; 67(3):253–280.
28. Hjelmar U, Bhatti Y, Petersen OH, Rostgaard T, Vrangbæk K. Public/private ownership and quality of care: Evidence from Danish nursing homes. Social Science & Medicine. 2018; 216:41–49. DOI: 10.1016/j.socscimed.2018.09.029.
29. Ma C, Olds DM, Dunton NE. Nurse work environment and quality of care by unit types: A cross-sectional study. International Journal of Nursing Studies. 2015; 52(10):1565–1572. DOI: 10.1016/j.ijnurstu.2015.05.011.
30. Kim JH, Jang CS. The effect of the working environment of elderly care facility employees on the care service quality and the mediation effect of social support. The Journal of the Korea Contents Association. 2016; 16(5):533–547. DOI: 10.5392/jkca.2016.16.05.533.
31. Park AJ, Lim NY, Kim YS, Lee YK, Song JH. Incidence and predictors of falls in institutionalized elderly. Journal of Muscle and Joint Health. 2011; 18(1):50–62. DOI: 10.5953/JMJH.2011.18.1.050.
32. National Council on Aging. National Falls Prevention Resource Center [Internet]. Arlington (VI): National Council on Aging;c2019. cited 2019 Feb 21. Available from: https://www.ncoa.org/center-for-healthy-aging/falls-resource-center/.
33. Davis JC, Robertson MC, Ashe MC, Liu-Ambrose T, Khan KM, Marra CA. International comparison of cost of falls in older adults living in the community: A systematic review. Osteoporosis International. 2010; 21(8):1295–1306. DOI: 10.1007/s00198-009-1162-0.
34. Shin JH, Hyun TK. Nurse staffing and quality of care of nursing home residents in Korea. Journal of Nursing Scholarship. 2015; 47(6):555–564. DOI: 10.1111/jnu.12166.
35. Lee HY, Blegen MA, Harrington C. The effects of RN staffing hours on nursing home quality: A two-stage model. International Journal of Nursing Studies. 2014; 51(3):409–417. DOI: 10.1016/j.ijnurstu.2013.10.007.
36. Chen MM, Grabowski DC. Intended and unintended consequences of minimum staffing standards for nursing homes. Health Economics. 2015; 24(7):822–839. DOI: 10.1002/hec.3063.
37. Kang EN. Staffing standards for long-term care facilities in selected countries. Health and Welfare Policy Forum. 2015; 225:72–79.
38. Chung KS. Promoting the realization of labor costs for nurse specialty nursing home pilot project [Internet]. Seoul: The Korean Nurses Association News;c2019. cited 2019 Feb 21. Available from: http://www.nursenews.co.kr/main/ArticleDetailView.asp?sSection=62&idx=23769.
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