• Journal of Korean Critical Care Nursing
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• v.16 no.1
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• pp.28-43
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• 2023

Purpose : Intensive care unit (ICU) diaries have been implemented across the international ICU community. This study aimed to comprehend the meaning and nature of the lived experience of patients' families using the ICU diary in Korea. Methods : This qualitative study adopted van Manen's hermeneutic phenomenology. The participants comprised eight women and two men who were the family members of patients in the ICU for more than three days. Data were collected using in-depth interviews and observation from July 2018 to January 2019. Results : Patients' families who experienced the ICU diary recognized it with six beings according to time: a good idea, forgotten stuff, burdensome work, touching service, my stuff, and a thing in the memory. The ICU diary had three essential meanings for the families: communication, solace and hope, and a record of life. These findings were rearranged according to van Manen's fundamental existential, and the lived things and lived others were remarkably confirmed. Conclusion : Patients' families experienced various ICU diary forms over time and recognized an ICU diary as a means of communication. Therefore, the ICU diary is expected to be used as an intervention between families and healthcare providers in the ICU to support mutual communication.

• Journal of Korean Critical Care Nursing
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• v.16 no.2
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• pp.28-41
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• 2023

Purpose : This study aimed to investigate the characteristics and risk factors associated with pressure injuries related to medical devices among patients admitted to the intensive care unit (ICU). Method : A retrospective study analyzed data from 462 ICU patients. Statistical analyses, including independent t-tests, Fisher's exact tests, and logistic regression were performed to analyze the data. Results : Among the 154 subjects, there were a total of 198 medical device-related pressure injuries (MDRPI). Stage 2 and deep tissue pressure injuries were the most frequent. MDRPI occurred most frequently on the face, with nasogastric tubes being its leading cause, followed by endotracheal tubes. The risk factors for MDRPI included male sex (odds ratio [OR]=1.78, 95% confidence interval [CI]=1.12-2.83), department at the time of ICU admission (OR=4.29, 95% CI=2.01-9.15), post-surgery ICU admission (OR=0.43, 95% CI=0.25-0.73), application of extracorporeal membrane oxygenation machines (OR=2.72, 95% CI=1.06-6.95), number of medical devices (OR=1.16, 95% CI=1.05-1.30), inotropic drug administration (OR=2.33, 95% CI=1.19-4.60), and sedative use (OR=2.53, 95% CI=1.17-5.45). Conclusion : These results enable the determination of the characteristics and risk factors associated with MDRPI. It is crucial to acknowledge the risk factors for MDRPI in ICU patients and establish a prevention strategy.

• Journal of Korean Critical Care Nursing
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• v.16 no.3
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• pp.11-23
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• 2023

Purpose : This study investigates the experiences of patients in intensive care units (ICUs), and the factors influencing these experiences. Method : We used a cross-sectional survey design to analyze previously collected cohort data from 891 patients who spent over 24 hours in 19 ICUs across four university hospitals in Busan, South Korea between June 2019 and July 2020. Within a week of ICU discharge, participants completed the Korean version of the Intensive Care Experience Questionnaire, covering four areas: "awareness of surroundings," "frightening experiences," "satisfaction with care," and "recall of experiences." We used multiple linear regression to identify factors associated with the ICU experience. Results : Low income (𝛽 = -.08, p = .016), unplanned hospitalization (𝛽 = -.09, p = .006), sedation (𝛽 = -.16, p < .001), and delirium (𝛽 = -.15, p < .001) reduce patients' awareness of their surroundings. Frightening experiences are associated with being female (𝛽 = -.07, p = .027), experiencing delirium(𝛽= -.15, p<.001), and longer stays in the ICU (𝛽= -.14, p <.001). Using sedatives decreases satisfaction with care (𝛽 = -.08, p = .048). Living alone (𝛽 = -.08, p = .013) and using painkillers (𝛽 = -.08, p = .020) reduces recall of experiences. Conclusion : Negative ICU experiences are significantly associated with being female, living alone, lower income, unplanned admission, using sedatives and painkillers, delirium, and longer stays in the ICU. Thus, improving ICU experiences requires interventions that address modifiable factors, such as delirium, medication, and length of ICU stays.

• Journal of Korean Critical Care Nursing
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• v.17 no.1
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• pp.44-56
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• 2024

Purpose : This study sought to explore intensive care unit (ICU) nurses' perceptions regarding the disclosure of patient safety incidents (DPSI) and identify the relationship between the perception of DPSI and communication barriers. Methods : This study used a descriptive research design. A total of 110 ICU nurses from a tertiary hospital were surveyed online between September 14 and October 5, 2022. The mean DPSI score ranged between 1.0 and 4.0, with a higher score indicating a higher perception of DPSI. Results : The mean score for ICU nurses' perceptions of DPSI was 2.92 (SD=0.37). Among the characteristics of ICU nurses, differences were observed in perceptions of DPSI according to gender, age, total work experience, and ICU work experience. Communication barriers among ICU nurses were negatively correlated with negative results as a sub-factor of perceptions of DPSI. Ambiguity in the nurse's position, lack of confidence, differences in perspectives with patients, and inadequate nurse-patient relationships as sub-factors of communication barriers exhibited a negative correlation with negative results as a sub-factor of perceptions of DPSI. Conclusions : ICU nurses' perceptions of DPSI and the sub-factors related to communication barriers are negatively related to DPSI. To improve ICU nurses' perceptions, open and non-punitive circumstances, staff education, practical guidelines, and support systems are required.

• Journal of Korean Critical Care Nursing
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• v.17 no.3
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• pp.14-24
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• 2024

Purpose : This study aimed to investigate the difference in compliance with the sepsis bundle and mortality rates according to the body temperature of patients with sepsis in general wards identified using a rapid response system (RRS). Methods : A retrospective observational study of 1,083 patients with sepsis in general wards identified using the RRS from July 2018 to December 2022 was performed at a tertiary care hospital in South Korea. The patients were classified into hypothermia (<36℃), normothermia (36-38℃), and hyperthermia (>38℃) groups according to their body temperature at the time of RRS activation. Results : A total of 1,083 sepsis patients were analyzed, comprising 17 cases of hypothermia, 624 cases of normothermia, and 442 cases of hyperthermia. There were statistically significant differences among the body temperature groups in the rate of compliance with the sepsis bundle within 1 h (hypothermia: 64.7% vs. normothermia: 49.5% vs. hyperthermia: 60.4%, p =.010), the rate of compliance with the overall sepsis bundle, including lactate re-measurement (64.7% vs. 49.5% vs. 60.4%, p =.001), and the rate of blood culture testing (94.1% vs. 85.9% vs. 92.8%, p =.002). The 28-day mortality rates in the hypothermia, normothermia, and hyperthermia groups were 29.4%, 32.4%, and 16.5%, respectively (p <.001). Conclusion : There were statistically significant differences in compliance with the sepsis bundle and mortality rates according to body temperature. Patients with sepsis and normothermia showed lower compliance with the sepsis bundle and higher mortality rates. Therefore, it is recommended to develop strategies for the early recognition of patients with sepsis and normothermia and to improve compliance with the sepsis bundle.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.20 no.12
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• pp.493-501
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• 2019

This paper describes nurses' perceptions toward parental participation in pediatric intensive care units (PICU). Qualitative data were collected from five nurses working at two PICUs in Seoul through individual in-depth interviews. The interviews were conducted from January to February 2016 and analyzed using traditional content analysis. Five categories were found for the parent participation in PICU: needs, attributes, benefits, barriers, and facilitating strategies for parent participation in PICU. Nurses acknowledged the necessities and benefits of parent participation, particularly in PICU, considering the parents' emotional burdens due to the critical health condition of their child as well as the limited visiting policy. The major barriers were a lack of knowledge and the skills of nurses to facilitate parent participation, nurses' heavy workloads, and lack of policies and guidelines supporting parent participation within the PICUs and hospitals. The participants indicated that organizational facilitating-strategies, such as education for nurses about meaning and skills of parent participation in PICU, raising awareness for nurses as well as parents, and ensuring professional staff dedicated to promoting parent participation, to be significant factors. Further study will be needed to develop nursing interventions to integrate parent participation in PICU care.

• Journal of Korean Clinical Nursing Research
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• v.26 no.2
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• pp.207-216
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• 2020

Purpose: The purpose of this study was to investigate the motor subtypes of delirium in patients in a Surgical Intensive Care Unit (SICU), and identify the factors related to the characteristics of patients according to the motor subtypes of delirium. Methods: Data were collected in the SICU of a tertiary hospital in ^⁎ city from October 2018 to June 2019. Delirium was detected using the Confusion Assessment Method for the ICU (CAM-ICU) and motor subtypes of delirium were measured with the Delirium Motor Subtype Scale (DMSS)-4. Patients' characteristics were obtained by using the electronic medical records. Descriptive statistics were used to analyze the data. Results: Among 1,112 patients, 172 patients showed delirium (15.5%). After excluding dementia patients and patients refusing to participate in the study, 126 patients included in the final analysis. Delirium patients were classified as hyperactive delirium (32.5%), hypoactive delirium (42.9%), mixed delirium (11.9%), and non-motor subtype delirium (12.7%). Conclusion: The study results suggest that hypoactive delirium is the most prevalent motor subtype of delirium in SICU. More application of ventilators, more administration of sedatives, more use of catheters, and higher nursing severity were reported for hypoactive delirium cases than hyperactive ones. Therefore, it is necessary to assess early the motor subtypes of delirium using structured tools and develop appropriate nursing interventions suitable for each subtype of delirium.

• Journal of Korean Critical Care Nursing
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• v.14 no.3
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• pp.26-36
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• 2021

Purpose : This study aimed to present the incidence of pressure ulcers and identify different associated factors according to the time of occurrence of pressure ulcers in intensive care unit (ICU) patients. Methods : The participants were 313 patients who reported pressure ulcers among 2,908 patients in ICUs at a large tertiary hospital in Gyeonggi-do. Among them, 220 patients (70.3%) had a pressure ulcer before admission, and 93 patients (29.7%) reported newly developed pressure ulcers after admission to the ICU. Data were collected between August 2018 and April 2019. Along with the time of occurrence and characteristics of pressure ulcers, diverse associated factors were gathered through electronic medical records. Data were analyzed using descriptive statistics, independent t-tests, and 𝑥²-tests. Results : Different risk factors associated with pressure ulcers in ICU patients according to the time of occurrence were main diagnosis, score of acute physiology and chronic health evaluation, score of Richmond agitation sedation scale, level of consciousness, administered sedatives, use of a ventilator, insertion of a feeding tube, and the duration of fasting period. Conclusion : Based on the results of this study, healthcare providers, especially ICU nurses, should try to detect early signs and symptoms of pressure ulcers, taking into account the derived factors associated with pressure ulcers in ICU patients. Practical intervention programs and strategies considering the factors associated with pressure ulcers must be developed to prevent and alleviate such ulcers in ICU patients in the future.

• Perspectives in Nursing Science
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• v.7 no.1
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• pp.43-49
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• 2010

Purpose: Rapid and accurate assessment of impaired consciousness is very important, especially for critically ill patients. Therefore, the Glasgow coma scale (GCS) has been widely adopted in the assessment of adult and pediatric comas. But the GCS should not be used for small children who show various normal responses according to their developmental stage. Therefore, the objectivity of pediatric coma measurements was verified by applying the modified GCS to patients in a pediatric intensive care unit (PICU) at a university hospital in Korea. Methods: The level of consciousness was evaluated for 200 cases who were admitted to a PICU from July 4, 2009 to September 18, 2009 and could show a verbal response, with our modified GCS for children. In addition, and we confirmed the frequency analysis and Kappa statistics with SPSS/WIN 17.0. Results: Kappa statistics which show inter-observer reliability were very good for all components (eye opening, verbal, and motor score) and was good for total GCS scores. Conclusion: It is concluded that our modified GCS is reliable. Therefore, reliable assessment for the level of consciousness is clinically practicable if enough training is supported.

• Journal of Korean Critical Care Nursing
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• v.13 no.2
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• pp.1-11
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• 2020

Purpose : The aim of this study was to compare shift satisfaction, sleep, fatigue, quality of life (QOL), and patient safety incidents between a newly implemented two-shift system and a traditional three-shift system. Methods : A total of 127 intensive care unit nurses (48 two-shift nurses and 79 three-shift nurses) working in a tertiary hospital in Seoul were recruited from January 1, 2017, to March 31, 2017. They completed a self-reported questionnaire about their work hours, shift satisfaction, sleep patterns, sleep quality, fatigue, QOL, and patient safety incidents in the past 2 weeks. Data were analyzed using SPSS version 23.0. Results : The two-shift group showed higher shift satisfaction scores compared with the three-shift group (6.93 vs. 4.37, p<.001). Sleep latency was shorter and sleep quality was better in the two-shift group compared with the three-shift group. There were no significant differences in other sleep parameters, fatigue, QOL, and patient safety incidents between the two groups. Conclusion : Although a two-shift system did not improve nurses' fatigue or QOL in this study, it may effectively serve as an alternative shift-work system that can increase sleep quality and shift satisfaction without increasing patient safety incidents.