• 대한위암학회:학술대회논문집
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• 2002.04a
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• pp.37-46
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• 2002

전통적으로 수술 전 평가는 수술 전날 밤에 시행되는 것이 일반적이었다. 그러나 외래수술을 받는 환자의 증가로 인하여 많은 환자들이 수술 당일 아침에 마취과 의사를 처음 만나게 되는 경우가 많고 심지어는 심각한 내과적 문제를 가진 환자들도 충분한 수술 전 평가가 이루어지지 않은 상태에서 수술실로 들어오게 되는 경우가 있다. 그러나 이러한 상황에서도 마취과의사는 주술기(perioperative period)의 환자 상태를 관리하는 주된 역할자로서 수술 전 환자에 대한 평가를 충실히 해야 한다. 수술 전 평가는 환자의 현재 상태를 평가하는 것이고, 수술 중 발생할 수도 있는 상황에 대비하며, 수술실을 넘어서 중환자실, 통증치료실에서의 마취의사의 역할로 이어지도록 하는 것이다. 최근 발전하고 있는 수술 전 평가 클리닉은 환자의 수술준비의 기초적인 정보를 제공한다. 이는 마취의사에게는 상당한 장점과 편리성을 제공하는 것이고, 환자 관리의 질적 향상과 급변하는 병원관리정책의 요구에 부합하는 것이다.

• Journal of Chest Surgery
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• v.30 no.6
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• pp.585-590
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• 1997

Between December 1994 and October 1996, 57 premature infants with evidence of a hemodynamically significant PDA associated with cardiopulmonary compromise underwent indomethcin therapy(Group I, n=48) or surgical ligation(Group II, n=9) because of indomethacin failure. The gestational alee(29.6$\pm$ 3.1weeks vs. 28.1 $\pm$ 1.6weeks) and birth weight(1,413 $\pm$ 580gm, ,098 $\pm$ 235gm) showed no significant differences between the two groups. Medical management included fluid restriction, diuretics, and indomethacin therapy(one or two cycles). Surgical libation was done at the neonatal intensive care unit(NICU) without moving the patient to the operation room. There was no complication associated with the operation. There were 9 deaths in Group I(19%, 9/48) and 2 deaths in Group II(22% , 219). The main causes of deaths were persistent bronchopulmonary dysplasia with sepsis(n=8) and intrapulmonary hemorrhage(n=3). The rate of medical treatment failure including death and complication in premature infants whose body weights were less than 1500gm was higher(41%, 15/38) than in premature infants whose body weights were more than 1500gm(16%, 3/19). Early surgical ligation of PDA may be applicable in the premature infant with a large size, low birth weight(<1500 gm), or associated intracardiac anomalies. Perfoming the operation in the NICU may be safe in s ead of moving the patient to the operating room.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.23 no.2
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• pp.172-183
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• 2016

Purpose: The purpose of this study was to explore the subjective experience of life-sustaining treatment care among nurses in intensive care units. Method: A phenomenology was used for the study. Data were collected from October to December, 2015 using open-ended questions during in-depth interviews. Participants were nurses working in intensive care units and were contacted through purposive techniques. Eight nurses participated in this study. Results: Four categories emerged from the analysis using Colaizzi's method: (a) difficulties due to life-sustaining treatment care, (b) dilemma of extension or cessation of life-sustaining treatment, (c) repressed feelings and emotional exhaustion, and (d) forming values for life-sustaining treatment from nursing experience. Conclusion: Provision of clearer guidelines on life-sustaining treatment which reflect a family-oriented culture is important for nurses in ICU and will promote nurses involvement in the decision-making process of life-sustaining treatment of patients.

• Korean Journal of Adult Nursing
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• v.25 no.6
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• pp.665-678
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• 2013

Purpose: The purpose of this study was to develop sleeve-type restraints and to compare the sleeve-type and conventional wrist restraints. Methods: Forty four pairs of intensive care unit (ICU) patients and their families participated in the experiment. The nurses applied sleeve-type restraints to the patients in the experimental group, and wrist restraints to the control group. The trained research assistant measured ROMs, skin temperature, edema, and skin lesions of both upper extremities (UEs) before, 24, 48, and 72 hours after the restraints applied. The emotional response of family was measured 72 hours after the restraints applied. Thirty one ICU nurses evaluated the efficiency of both types of restraints. Results: Compared to the control group, changes of ROMs, edema, and skin abrasions on both U/Es of the experimental group indicated a significant difference in physical side effects. The emotional response scores of the experimental group were significantly lower than those of the control group. The mean efficiency scores for the sleeve-type restraints were significantly higher than those for the wrist restraints. Conclusion: The results indicate that the sleeve-type restraints are better than wrist restraints with respect to physical side effects, emotional responses of family members, and application efficiency.

• Journal of Korean Biological Nursing Science
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• v.16 no.4
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• pp.259-266
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• 2014

Purpose: The purpose of this study was to analyze risk factors in predicting medical patients transferred to Intensive Care Unit (ICU) on the general ward. Methods: We reviewed retrospectively clinical data of 120 medical patients on the general ward and a Modified Early Warning Score (MEWS) between ICU group and general ward group. Data were analyzed with multivariate logistic regression and the area under the receiver operating characteristic curves using SPSS/WIN 18.0 program. Results: Fifty-two ICU patients and 68 general ward patients were included. In multivariate logistic regression, the MEWSs (Odds Ratio [OR], 1.91; 95% confidence interval [CI], 1.32-2.76), sequential organ failure assessment score (OR, 1.28; 95% CI, 1.10-1.72), $PaO_2/FiO_2$ ratio (OR, 0.98; 95% CI, 0.98-0.99), and saturation (OR, 0.93; 95% CI, 0.88-0.99) were predictive of ICU transfer. The sensitivity and the specificity of the MEWSs used with a cut-off value of six were 80.8% and 70.6% respectively for ICU transfer. Conclusion: These findings suggest that early prediction and treatment of patients with high risk of ICU transfer may improve the prognosis of patients.

• Journal of Korean Academy of Nursing
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• v.44 no.4
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• pp.437-445
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• 2014

Purpose: This study was done to identify pain perception (P-PER) by nurses and pain expression (P-EXP) by patients in critical care units (ICUs) and degree of agreement between nurses' P-PER and patients' P-EXP. Methods: Nurses' P-PER was measured with a self-administered questionnaire completed by 99 nurses working in ICUs during May, 2013. Patients' P-EXP was measured with the Critical Care Non-Verbal Pain Scale through observations of 31 ICU patients during nine nursing procedures (NPs) performed between May and July, 2013. Results: Nurses' P-PER was from 4.49 points for nasogastric tube (NGT) insertion to 0.83 for blood pressure (BP) measurement based on a 9-point scale, Patients' P-EXP was 4.48 points for NGT to 0.18 for BP measurement based on a 10-point scale. Eight NPs except oral care showed higher scores for nurses' P-PER than for patients' P-EXP. Position change (p=.019), subcutaneous injection (p<.001), blood sugar test (p<.001), and BP measurement (p<.001) showed significant differences between nurses' P-PER and patients' P-EXP. Conclusion: Nasogastric tube (NGT) insertion was scored highest by both nurses and patients. Eight NPs except 'oral care' showed nurses' P-PER was higher or similar to patients' P-EXP, which indicates that nurses may overestimate procedural pain experienced by patients.

• Journal of Korean Academy of Nursing
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• v.40 no.3
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• pp.307-316
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• 2010

Purpose: The purpose of this study was to identify the levels of relocation stress syndrome (RSS) and influencing the stress experienced by Intensive Care Unit (ICU) patients just after transfer to general wards. Methods: A cross-sectional study was conducted with 257 patients who transferred from the intensive care unit. Data were collected through self-report questionnaires from May to October, 2009. Data were analyzed using the Pearson correlation coefficient, t-test, one-way ANOVA, and stepwise multiple linear regression with SPSS/WIN 12.0. Results: The mean score for RSS was $17.80{\pm}9.16$. The factors predicting relocation stress syndrome were symptom experience, differences in scope and quality of care provided by ICU and ward nursing staffs, satisfaction with transfer process, length of stay in ICU and economic status, and these factors explained 40% of relocation stress syndrome (F=31.61, p<.001). Conclusion: By understanding the stress experienced by ICU patients, nurses are better able to provide psychological support and thus more holistic care to critically ill patients. Further research is needed to consider the impact of relocation stress syndrome on patients' health outcomes in the recovery trajectory.

• Korean Journal of Adult Nursing
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• v.16 no.3
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• pp.452-459
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• 2004

Purpose: To investigate the effect of oral care either with normal saline or with tantum solution on the oral state of the patients in intensive care unit as well as the frequency of bacteria occurrence inside their oral cavities. Method: The study was performed from March thru May of 2003 on the nonequivalent control group non-synchronized quasi-experimental design. Forty subjects were selected for each group. The data were analyzed using the SPSS 10.0 Win. The pre-experimental homogeneity and post-experimental differences between the two groups were analyzed with t-test. Result: There was a significant difference in the oral cavity state between the experimental group that had used normal saline and the control group that had used tantum solution. Conclusion: Based on the results described above, it is considered that normal saline is more effective than the tantum solution for the oral care of the patients in intensive care unit.

• Korean Journal of Adult Nursing
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• v.26 no.6
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• pp.603-613
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• 2014

Purpose: The purpose of this study was to explore and identify the role adaptation processes of family caregivers with patients transferred from intensive care unit to general ward. Methods: Using a grounded theory methodology, in-depth individual interviews were conducted. Data were collected from 11 participants. The participants were asked about their experiences of role adaptation considering situational contexts and interactional strategies. Transcribed data and field notes were analyzed using constant comparative analysis. Results: The core category was 'becoming almost a nurse with hope and fear'. The identified phenomena by the participants were the joy of being alive, having hope for a full recovery, anxiety and fear of uncertain future, feeling burdensome on a given role. The results included both role adaptation and mal-adaptation of caregivers. Conclusion: The role adaptation processes of family caregiver with patients transferred from intensive care unit to general ward can be explained as becoming almost a nurse with hope and fear. The findings of the study provided fundamental information for developing programs to support the given family caregivers for successful role adaptation.

• Korean Journal of Adult Nursing
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• v.19 no.4
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• pp.583-592
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• 2007

Purpose: The purposes of this study were to explore and describe the use of restraint on patients and to generate a grounded theory of how the use of restraint affects patients who have been restrained. Methods: Interview data from seven patients with physical restraint was analyzed using the Strauss and Corbin's grounded theory method. Data were collected and analyzed simultaneously. Unstructured and in-depth interviews were conducted retrospectively with patients recalling their memories of ICU following their transfer to general unit. Results: 'Safety belt' was emerged as a core category and it reflected that physical restraint provided a sense of security to patients. On the basis of core category, a model of the experience process of restrained patients in ICU was developed. The experience process were categorized into four stages: resistance, fear, resignation, and agreement. Stages of these proceeds appeared to have been influenced by the nurses' attitude and caring behavior such as the frequency of nurse-patient interaction, repetition of explanation, and empathetic understanding. Conclusion: These findings indicate that patients have mixed feelings towards restraint use, although negative feelings were stronger than positive ones. The result of this study will help nurses make effective nursing intervention.