Cancer-oriented comprehensive nursing care service in Korea: outcomes and issues

Abstract

Introduction: Korean comprehensive nursing care service, which is covered by national insurance, has been officially initiated since 2016. Herein, we report our cancer- oriented comprehensive nursing care unit's outcomes and issues. Method and result: Our institution is a medium-sized general hospital (total of 822 beds) with 197 doctors and 634 registered nurses. We are currently running cancer-oriented comprehensive nursing care service (35 beds with 19 RN's and 8 nurse's aides) since December 2017. This special ward is caring only medical oncology patients. For 3 months, 1,619 in-patients (average 23.4 patients per day, bed turnover rate 80%) and 304 patients received chemotherapy in our unit. We evaluated our results in three categories; structure, process, and outcome. First, structural (environmental) improvements were found in more interval between beds (1.5m), fully automatic beds with fall prevention sensors, comfortable patient lounge and so on. Second, process improvements such as nursing time, quality of oncologic nursing is now on survey. Interim analysis revealed increased nursing time, decreased missing care and much improved quality of care. Finally, patient outcome and nurse outcome are also on active survey. Patient satisfaction and revisit rate have been increased. Of note, cancer patient only has to pay 8,000 won per day (almost 800 yen a day) for this nursing service. Safety indicators such as pressure ulcer, falls, and infection rate have dropped dramatically. Nurse outcomes such as satisfaction, job stress, and turnover intention or resignation rate have been stabilized. Issues during unit operation were found in still heavy workloads for nursing staff and low compensation by the government compared with other countries. Conclusion: Comprehensive care for medical oncology patients definitely improves quality of oncologic nursing. And it also enhances nurse's satisfaction and pride in work despite some limitations.