• 중환자간호학회지
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• 제3권2호
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• pp.49-59
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• 2010

Purpose: The purpose of this study was to investigate in-service education needs in order to develop clinical competence of critical care nurses', and to identify contents which have to include in-service education according to nurses' characteristics. Methods: Data was collected using Critical Care Nurse Job Analysis Tool that was modified by professional team. Collected data was analyzed using the SPSS program. Results: Total 148 critical care nurses, who had worked at adult intensive care unit of one tertiary hospital in Seoul, filled out questionnaire. The results showed the participants highly needed education about cardiological nursing practices such as ECMO, pacemaker, cardiac tamponade. And there were significant correlations among in-service educational needs and ICU careers, preceptors experience, and charge nurse experience. Conclusion: It will be necessary for better nursing to develop in-service education is based on critical care nurse's need and their characteristics. Especially, it is important to develop and provide in-service education programs, which consider ICU nurse's differences for their career ladder and nursing preceptors.

• 성인간호학회지
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• 제15권2호
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• pp.287-295
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• 2003

Purpose: This descriptive study was conducted to project the number of critical care APNs needed in critical care units in an acute care hospital setting, up to the year 2020. Method: Necessary data and information were collected from various funded reports, professional literature, web-sites and personal visits to national and private institutions. The demand of critical care APNs were projected based on two critical care APNs per critical care units. Result: The projected number of critical APNs for the critical care units in acute care hospital settings as follows: 1) The total projected number of critical care APNs needed for critical care units were 1,270 in 2001. 2) By the year 2020, total number of projected critical care APNs needed in critical care units will be 1,080-1,700. Conclusion: In order to match the supply to the need, the professional organization should direct their efforts toward enacting legislation. Educational systems should identify strategies in initiation of critical care APN programs in masters level as well as standardizing curriculums across the programs.

• 중환자간호학회지
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• 제17권2호
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• pp.25-41
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• 2024

Purpose : This study aimed to investigate changes in critical nursing activities from 2009 to 2020 and explore the relationship between nurse staffing and such activities in intensive care units. Methods : A total of 446,445 adult patients admitted to intensive care units in tertiary and general hospitals from 2009 to 2020 were identified using the National Health Insurance claims database. The Critical Nursing Activities Index was calculated based on the following critical nursing activities: ventilator, extracorporeal membrane oxygenation (ECMO), and continuous renal replacement therapy (CRRT). Trend analysis was performed to analyze changes in critical nursing activities over 12 years and to assess linear trends across different staffing levels. Results : The annual utilization days for ventilators, ECMO, and CRRT, as well as the Critical Nursing Activities Index significantly increased over the study period (p-for-trend<.001) in tertiary and general hospitals, except for ventilator use in general hospitals. Ventilator, ECMO, and CRRT utilization exhibited a significant upward trend with higher nurse staffing levels (Bonferroni adjusted p-for-trend<.001). The Critical Nursing Activities Index was significantly higher in hospitals with higher staffing levels compared to those with lower staffing levels (Bonferroni adjusted p <.05). Conclusion : The findings underscore the need for improved nurse staffing levels in intensive care units. Government policies should ensure that staffing levels align with critical nursing activities among critically ill patients to uphold the quality of care.

• 중환자간호학회지
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• 제14권2호
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• pp.1-11
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• 2021

Purpose : The aim of this study was to propose appropriate nurse staffing of adult intensive care units considering patients' nursing care needs according to the Workload Management System for Critical Care Nurses (WMSCN). Methods : In a cross-sectional survey conducted in September 2017, 1,786 patients' WMSCN scores, surveys from 2,145 nurses, and administrative data from 118 units in 41 hospitals were analyzed. The means (standard deviations) of the aforementioned scores and nursing hours per patient day were presented. Nurse-to-patient ratios and nurse-to bed ratios for staffing to meet patients' nursing care needs were calculated. Results : The mean WMSCN scores were 109.50±17.17 in tertiary hospitals and 96.38±19.26 in general hospitals. Nursing hours per patient day were 12.47±2.80 in tertiary hospitals and 11.01±2.45 in general hospitals. Nursing hours per patient day correlated with WMSCN scores. Nurse-to-bed ratios required for the provision of ICU nursing care ranged from 1: 0.36 to 1: 0.48. Conclusion : Our findings provide evidence that current ICU nurse staffing is insufficient for meeting patients' nursing care needs. We suggest adjusting the legal standards for adequate nurse staffing considering these needs.

• Journal of Trauma and Injury
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• 제25권4호
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• pp.254-260
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• 2012

Purpose: Ongoing treatment and care, as well as initial stabilization, are required for trauma patients. With increasing number of sickest trauma patients and shortage of surgeons, the need for advanced practice nurse to provide and coordinate trauma care has been greater. The purpose of this study is to analyze the effect of hiring a trauma clinical nurse specialist and its influence on the treatment of trauma patients. Methods: Based on the employment of the clinical nurse specialist in December 2010, the patients were divided into two groups: patients admitted from January 1, 2010 to November 30, 2010 and patients admitted from December 1, 2010 to December 31, 2011. Retrospectively, data were collected using electronic medical records. The general characteristics, clinical courses, and ICU re-admission rates, collaboration (transfers to other departments and collaborative surgery) were compared. Results: To have a clinical nurse specialist on the trauma team resulted in a statistically significant reductions in the length of general ward hospital stay (p<0.05), the ICU re-admission rate, (p<0.03), the lead-time before transfer to other departments (p<0.05). Conclusion: The clinical nurse specialist, as a professional practitioner, improved the quality of treatment through early detection and management of problems. In addition, as a coordinator, the clinical nurse specialist maintained a cooperative relationship with multi-disciplinary medical personnel. The trauma clinical nurse specialist contributed to the treatment of trauma patients positively through a decrease in ICU re-admission rate and length of hospital stay.

• 성인간호학회지
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• 제19권5호
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• pp.56-69
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• 2007

Purpose: This study aimed to explore the discourses and the patterns of problem solving behaviors among the nurse managers. The focus of the study was the difficult situations in caring with patients and their families. Methods: Field study was performed at a for-profit hospital from March, 2004 to March, 2007. The participants of the study were 5 head nurses and 2 nurses in charge. The data were collected with iterative interviews and participant-observations. For the analysis of the data, taxonomy and critical discourse analyzing were applied. Results: The nurse mangers who showed wholistic patterns of behavior took the role of a broker among the client system, professional nursing system, medical system, and other allied health system. The nurse managers whose approach was profession-centered took the role of protector of nursing system. The nurse manager who practiced nurse-oriented pattern of behavior tried not to have harm against other members of health system. The experiences of nurse managers were effected from the discourses of patriarchal and market mechanism. Conclusion: The situation that provoke conflict between clients and nurses become more common with the changes to the health care system and to society. Nurse managers take the role of these conflict problems. The successful solving of conflict in a nursing care setting promotes the quality of care and satisfaction of clients. Programs for enhancing nurse's problem solving competency should anchored be in their practices.

• 중환자간호학회지
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• 제16권1호
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• pp.15-27
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• 2023

Purpose : The purpose of this study is to identify the factors affecting the degree of job embeddedness by examining role conflict among intensive care unit nurses, the nursing organizational culture, nurse-physician collaboration, degree of job embeddedness, to understand the relationship between these variables. Method : Participants are 148 nurses from two hospitals in the intensive care unit. Collected data are analyzed using independent t-tests, ANOVA, Scheffé test, Pearson correlations, and multiple regressions using the SPSS 25.0 program. Results : The factors that significantly influenced the participants' job embeddedness are role conflict (𝛽=-.19, p =.015), innovation-oriented culture (𝛽=.26, p =.003), and nurse-physician collaboration (𝛽=.24, p =.002). The total explanatory power of these factors for job embeddedness is 44.5% (F=15.06, p =.001). Conclusion : This study identifies role conflict among intensive care unit nurses, innovation-oriented culture, and nurse-physician collaboration as important factors affecting job embeddedness.

• 중환자간호학회지
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• 제10권1호
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• pp.1-12
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• 2017

Purpose: This study aimed to estimate the appropriate nurse staffing ratio in intensive care units (ICUs) by measuring nursing workload based on patient's severity and needs, using the Korean Patient Classification System for critical care nurses. Methods: The data were collected from January 18 to February 29, 2016 using a standardized checklist by observation or self-report. During the study period, 723 patients were included to be categorized from I to IV using the patient classification system. Measurement of total nursing workload on a shift was calculated in terms of hours based on the time and motion method by using tools for surveying nursing activities. The nursing activities were categorized as direct nursing care, indirect nursing care, and personal time. Total of 127 cases were included in measuring direct nursing time and 18 nurses participated in measuring indirect and personal time. Data were analyzed using descriptive statistics. Results: Two patients were classified into Class I (11.1%), 5 into Class II (27.8%), 9 into Class III (50%), and two into Class IV (11.1%). The amount of direct nursing care required for Class IV (513.7 min) was significantly more than that required for Class I (135.4 min). Direct and indirect nursing care was provided more often during the day shift as compared to the evening or night shifts. These findings provided the rationale for determining the appropriate ratio for nursing staff per shift based on the nursing workload in each shift. Conclusions: An appropriate ratio of nurse staffing should be ensured in ICUs to re-arrange the workload of nurses to help them provide essential direct care for patients.

• 중환자간호학회지
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• 제3권2호
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• pp.91-99
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• 2010

Purpose: The purpose of this literature review was to describe the roles of advanced practice nurses related to advance directives. Methods: A comprehensive literature review was conducted utilizing Pubmed, Ovid, and CINAHL. The key words for search were 'advance directives', 'living wills', 'durable power of attorney', 'advanced practice nursing', 'advanced practice nurse', 'nurse practitioner', and 'nurse specialist'. Research articles published between January 1990 and September 2010 and written in English were included. Review papers and expert's opinion were excluded. Results: Five articles were yielded and analyzed. Among them, two focused on the advanced practice nurses' role during the process of advance directives. The other three presented the outcomes depending on the type of nurses' involvement in each health care delivery system. Conclusion: Recently, Korea established advance directives and expanded to diverse sites. Advanced practice nurses' role in the advance directive decision-making process should be examined and developed in research and practice.

• 한국의료질향상학회지
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• 제2권2호
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• pp.32-45
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• 1996

Background : A critical path defines an optimal sequencing and timing of interventions by physicians, nurses, and other staff for a particular diagnosis or procedure, designed to better utilize resources, maximize quality of care, and minimize delays. It can be thought of as a visualization of the patient care process. In this study, a review of appendectomy patient records was undertaken to identify a critical path for the management of this treatment. Methods: For this study, records of patients under 15 or over 65 years of age were excluded ; cases where the patient was pregnant, or where complications developed were also excluded. The remaining 21 cases were divided into two categories according to the indication for appendectomy : for acute appendicitis, and for perforated appendix or drainage of periappendical abscess. The time frame for the review was from patient examination immediately prior to operation, through discharge. The study team was composed of a surgeon, research head nurse, education head nurse, surgical part head nurse, and medical recorder. Following their review of the 21 charts, the team determined an appropriate progression and schedule for an appendectomy. Result : Through the chart and literature review, the following aspects of the care process were identified as typical and tracked : monitoring/assessment, treatment, lines/drains, medication, activity, diet, tests and patient education. Conclusion : From this study, the design team determined two separate critical paths : one for appendectomy only, and one for appendectomy plus drainage. Next, these paths must be validated and fine-tuned through clinical implementation. In addition, a comparison of our design with the critical paths determined at other hospitals would be extremely valuable for advancing research in this area. Lastly, the critical path approach to improving patient care and maximizing hospital resources should be applied to other procedures.