title: Nurse Staffing and Quality of Care of Nursing Home Residents in Korea.
abstract: OBJECTIVE
  To investigate the relationship between nurse staffing and quality of care in nursing homes in Korea.
  
  
  METHODS
  This study used a cross-sectional design to describe the relationship between nurse staffing and 15 quality-of-care outcomes. Independent variables were hours per resident day (HPRD), skill mix, and turnover of each nursing staff, developed with the definitions of the Centers for Medicare & Medicaid Services and the American Health Care Association. Dependent variables were prevalence of residents who experienced more than one fall in the recent 3 months, aggressive behaviors, depression, cognitive decline, pressure sores, incontinence, prescribed antibiotics because of urinary tract infection, weight loss, dehydration, tube feeding, bed rest, increased activities of daily living, decreased range of motion, use of antidepressants, and use of restraints. Outcome variables were quality indicators from the U.S. Centers for Medicare & Medicaid and 2013 nursing home evaluation manual by the Korean National Health Insurance Service.
  
  
  RESULTS
  The effects of registered nurse (RN) HPRD was supported in fall prevention, decreased tube feeding, decreased numbers of residents with deteriorated range of motion, and decreased aggressive behavior. Higher turnover of RNs related to more residents with dehydration, bed rest, and use of antipsychotic medication.
  
  
  CONCLUSIONS
  Study results supported RNs' unique contribution to resident outcomes in comparison to alternative nurse staffing in fall prevention, decreased use of tube feeding, better range of motion for residents, and decreased aggressive behaviors in nursing homes in Korea. More research is required to confirm the effects of nurse staffing on residents' outcomes in Korea.
  
  
  CONCLUSIONS
  We found consistency in the effects of RN staffing on resident outcomes acceptable. By assessing nurse staffing levels and compositions of nursing staffs, this study contributes to more effective long-term care insurance by reflecting on appropriate policies, and ultimately contributes to the stable settlement of the long-term care insurance system for elders.
authors.affiliation: Assistant Professor, Ewha Womans University, College of Health Sciences, Division of Nursing Science, Seoul, Korea.
authors.forename: Juh Hyun
authors.initials: JH
authors.lastname: Shin
authors.affiliation: Doctoral Student, Kyonggi University, Social Work, Kyonggido, Korea.
authors.forename: Ta Kyung
authors.initials: TK
authors.lastname: Hyun
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001510:Bed Rest; D003430:Cross-Sectional Studies; D003681:Dehydration; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D008134:Long-Term Care; D008297:Male; D009726:Nurses / Q000600:supply & distribution*; D009730:Nursing Assessment; D009735:Nursing Homes; D009740:Nursing Staff / Q000600:supply & distribution*; D010561:Personnel Staffing and Scheduling; D010563:Personnel Turnover; D003668:Pressure Ulcer; D015995:Prevalence; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D016059:Range of Motion, Articular; D056910:Republic of Korea; D012107:Research Design; D014481:United States; D000078329:Workforce
chemical_list: D014150:Antipsychotic Agents
keywords: Nursing home; nursing staffing; quality of care