This study was designed to determine the cost and measurement of nursing care hours for hospice patients hostpitalized in one university hospital.
314 inpatients in the hospice unit and 11 nursing manpower were enrolled Study was taken place in C University Hospital from 8th to 28th, Nov, 1999.
Researcher and investigator did pilot study for selecting compatible hospice patient classIDcation indicators. After modifying patient classification indicators and nursing care details for general ward, approved of content validity by specialist. Using hospice patient classification indicators and per 5 min continuing observation method, researcher and investigator recorded direct nursing care hours, indirect nursing care hours, and personnel time on hospice nursing care activities sheet. All of the patients were classified into Class I (mildly ill), Class II (moderately ill), Class III (acutely ill), and Class N (critically ill) by patient classification system (PCS) which had been carefully developed to be suitable for the Korean hospice ward, And then the elements of the nursing care cost was investigated
Based on the data from an accounting section (Riccolo, 1988), r.~ursing care hours per patient per day in each class and noising care cost per patient per hour were multiplied. And then the mean of the nursing care cost per patient per day in each class was calculated
Using; SAS, The number of patients in class and nursing activities in duty for nursing care hours were calculated the percent, the mean, the standard deviation respectively. According to the ANOVA and the Scheffe test, direct nursing care hours per patient per day for the each class were a~~ralyzed.
The results of this study were summarized as follows
1. Distribution of patient class :class N(33.5%) was the la~gest class. the rest were class II (26.1%) class ID (22.6%), class I (17.8%). Nursing care requirements of the inpatients in hospice ward were greater than that of the inpatients in general ward.
2. Direct nursing care activities ~ Measurement observation 41.7%, medication 16.6%, exercise safety 1´2.5%, education communication 7.2~ etc. The mean hours of direct nursing care per patient per day per duty were needed ~ 69.3 min for day duty, 64.7 min for evening duty, 88.2 min for night duty, 38.7 min for shift duty. The mean hours of direct nursing care of night duty was longer than that of the other duty. I)ir-ect nursing care hours per patient per day in each class were needed ; 3.1 hrs for class I , 3.9 hrs for class II, 4.7 hrs for class ID, and 5.2 hrs for class N. ´1:´he mean hours of direct nursing care per patient per day without the PCS was 4.1 hours. The mean hours of direct nursing care per patient per day in class was increased significantly according to increasing nursing czre requirements of the inpatients(F=49.04, p=.0001). ´Che each class was significantly different(p<0.05). ´[`he mean hours of direct nursing care of several direct nursing care activities in each class were increased according to increasing nursing care requirements of the inpatients(p<0.05) class ID and class N for medication and education communication, class I , class ID and class N for measurement observation, class I , class II and class N for elimination irrigation, all of class for exerase safety.
3. Indirect nursing care activities and personnel time Recognization 24.2%, house keeping activity 22.7%, charting 17.2%, personnel time 11.8% etc. The mean hours of indirect nursing care and personnel time per nursing manpower was 4.7 hrs. The mean hours of indirect nursing care and personnel time per duty were 294.8 min for day duty, 212.3 min for evening duty, 387.9 min for night duty, 143.3 min for shift duty. The mean of indirect nursing care hours and personnel time of night duty was longer than that of the other duty.
4. The mean hours of indirect nursing care and personnel time per patient per day was 2.5 hrs.
5. The mean hours of nursing care per patient per day in each class were class I 5.6 hrs, class II 6.4 hrs, class ID 7.2 hrs, class N 7.7 hrs.
6. The elements of the nursing care cost were composed of 2,212 won for direct nursing care cost, 267 won for direct material cost and 307 won for indirect cost. Sum of the elements of the nursing care cost was 2,786 won.
7. The mean cost of the nursing care per patient per day in each class were 15,601.6 won for class I , 17,830.4 won for class II, 20,259.2 won for class III, 21,452.2 won for class N.
As atrove, using modified hospice patient classification indicators and nursing care activity details, many critical ill patients were hospitalized in the hospice unit and it reflected that the more nursing care requirements of the patients, the more dv~ect nursing care hours. Emotional spiritual care, pain symptom control, terminal care, education communication, narcotics management and delivery, attending; funeral ceremony, the major nursing care activities, were also the independent hospice service. But it is not compensated by the present medical insurance system Exercise safety, elimination irrigation needed more nursing care hours as equal to that of intensive care units. The present nursing management fee in the medical insurance system compensated only a part of nursing care service in hospice unit, which rewarded lower cost than that of nursing care.
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