Purpose: This study was conducted to investigate the incidence and associated factors with post-traumatic stress disorders (PTSD) in patients with intensive care units (ICU) admission experience. Methods: This study is a retrospective observational study using self-reporting questionnaire. Patients who were admitted to ICU more than 72 hours and agreed to participate were enrolled in this study. PTSD were assessed by Korean version of post-traumatic diagnosis scale, and PTSD was defined as 20 points or more. Medical records of participants were reviewed to identify influencing factors of PTSD. To analyzed the data, descriptive statistics, Mann-Whitney U test, Kruskal-Wallis test and gamma regression were utilized using SPSS/WIN 23.0 program. Results: A total of 128 patients participated in the study. Mean age of participants was 58.3±11.7 years and 50 patients (39.1%) were female. Mean duration of ICU stay was 8.43±8.09 days and PTSD was diagnosed in 12 patients (9.4%). In the results of a Gamma regression analysis, Psychiatric history (B=1.09, p=.002), APACHEII score (B=.04, p=.005), CPR experience (B=1.65, p=.017) and physical restraint (B=.68, p=.049) were independently associated with PTSD occurrence. Conclusion: The results of this study suggest that a various factors influencing PTSD should be identified to prevent PTSD in patients who requires ICU care. In addition, post-ICU care programs are required to assess and reduce PTSD.
Purpose: The purpose of this study was to examine the level of Person-centered Critical Care Nursing (PCCN) and the factors influencing PCCN for nurses in Intensive Care Units (ICU). Methods: This study was designed by cross-sectional descriptive correlational study. The participants included 147 ICU nurses in two general hospitals in Seoul, Korea. Demographic characteristics, PCCN, communication skills, professionalism, and work environment were measured. The collected data were analyzed using descriptive statistical analysis, independent t-test, One-way ANOVA, Pearson's correlation coefficient, and stepwise multiple linear regression with the SPSS/Win 25.0 program. Results: The average age of the participants was 29.6±4.7 years and the mean work experience in the ICU was 4.67±3.52 years. The level of PCCN was 3.70±0.41, which was moderate to high, and it significantly showed a positive correlation with therapeutic communication skills (r=.66, p<.001), global interpersonal communication competence (r=.42, p<.001), professionalism (r=.38, p<.001), and work environment (r=.16, p=.048). The factors influencing PCCN were identified as therapeutic communication skill and global interpersonal communication competence (Adj R2=.45, p<.001). Conclusion: The findings of this study were confirmed that the strategies to promote PCCN are necessary to enhance therapeutic communication skill and global interpersonal communication competence. In addition, they may be particularly meaningful in providing basic data for nursing education and future intervention development research to promote PCCN for the ICU nurses. For improving PCCN for healthcare providers in ICU, further studies should be conducted to develop education and intervention programs.
Background: Orthotopic organ transplantation, a treatment option for irreversible organ dysfunction according to organ failure, severe damaged organ or malignancy in situ, was usually accompanied with massive blood loss thus transfusion was required. We aimed to evaluate the adverse impact of blood transfusion on solid organ transplantation. Materials and Methods: From January, 2009 to December, 2014, patients who received orthotopic organ transplantation at Far Eastern Memorial Hospital medical center were enrolled. Clinical data regarding anemia status and red blood cell (RBC) transfusion before, during and after operation, as well as patient outcomes were collected for further univariate analysis. Results: A total of 105 patients who underwent orthotopic transplantation, including liver, kidney and small intestine were registered. The mean hemoglobin (Hb) level upon admission and before operation were $11.6{\pm}1.8g/dL$ and $11.7{\pm}1.7g/dL$, respectively; and the nadir Hb level post operation and the final Hb level before discharge were $8.3{\pm}1.6g/dL$ and $10.2{\pm}1.6g/dL$, respectively. The median units (interquartile range) of RBC transfusion in pre-operative, peri-operative and post-operative periods were 0 (0-0), 2 (0-12), and 2 (0-6) units, respectively. Furthermore, the median (interquartile range) length of hospital stay (LHS) from admission to discharge and from operation to discharge were 28 (17-44) and 24 (16-37) days, respectively. Both peri-operative and post-operative RBC transfusion were associated with longer LHS from admission to discharge and from operation to discharge. Furthermore, it increased the risk of post-operative septicemia. While peri-operative RBC transfusion elevated the risk of acute graft rejection in patients who received orthotopic transplantation. Conclusions: Worse outcome could be anticipated in those who had received massive RBC transfusion in transplantation operation. Hence, peri-operative RBC transfusion should be avoided as much as possible.
A 58-year old woman with no molar teeth on her upper left side wanted these missing teeth to be replaced with a fixed implant prosthesis. Incision, from distal to 2nd premolar to hamulus, was performed and impression of canine fossa anteriorly, zygoma buccally, pterygoid hamulus posteriorly and palatal groove lingually was taken by Optosil (Bayer Dent.). The implant frame was made of Vitallium, and was inserted the next day after the impression had been taken. 12-days later, the 4-units fixed prosthesis was constructed. The patient was extremely comfortable, had no pain, and was able to chew food more efficiently.
Purpose : The aim of this article is to describe the nurses' experiential learning mechanism on patient safety. Methods : To analyze nurses' learning experiences on patient safety cases, a focus-group interview method was used. The Kolb's experiential learning model was used as a reference model. Findings : Without deep reflective reasoning about specific experiences, there is no creative or innovative solutions to experiment actively. Nurses are likely to be reluctant learners when there is no systemic support from formal departments which is in charge of patient safety and quality of care. Conclusion : In order to build patient safety culture in hospital, there should be efforts to make nurses as active learners on patient safety as well as to build learning environments in medical units.
Journal of the Korean Institute of Rural Architecture
/
v.26
no.2
/
pp.73-84
/
2024
This study investigated the outpatient departments of Infectious Disease Hospitals by Region, which play an important role in establishing regional medical networking, to find a spatial structure that can provide a safe environment for efficient diagnosis and treatment, as well as a rational medical procedure in case of crisis. Department layout and adjacencies were derived by considering the access procedures according to patient classification, medical procedures by department, and connectivity with other departments. Based on the results derived by setting up zones according to infection control, activities, and objects, and analyzing the division of zones, the composition of areas by activities, movement flows by objects and treatment units, it can be used as basic data for the architectural plan of the Infectious Disease Hospital. Also, there are implications that can be used as basic data for planning related facilities by analyzing spatial relationships according to user behavior.
This paper included a data analysis of the unit of medical devices using mainternance recording card that had medical devices of unit failure mode, hospital of failure mode and MTBF. The results of the analysis were as follows : 1. Medical devices of unit failure mode was the highest in QC/PM such A hospital as 33.9%, B hospital 30.9%, C hospital 30.3%, second degree was the Electrical and Electronic failure such A hospital as 23.5%, B hospital 25.3%, C hospital 28%, third degree was mechanical failure such A hospital as 19.5%, B hospital 22.5%, C hospital 25.4%. 2. Hospital of failure mode was the highest in Mobile X-ray device(A hospital 62.5%, B hospital 69.5%, C hospital 37.4%), and was the lowest in Sono devices(A hospital 16.76%, B hospital 8.4%, C hospital 7%). 3. Mean time between failures(MTBT) was the highest in SONO devices and was the lowest in Mobile X-ray devices which have 200 - 400 failure hours. 4. Anverage failure ratio was the highest in Mobile X-ray devices(A hospital 31.3%, B hospital 34.8%, C hospital 18.7%), and was the lowest in Sono(Ultrasound) devices (A hospital 8.4%, B hospital 4.2%, C hospital 3.5%). 5. Failure ratio results of medical devices according to QC/PM part of unit failure mode were as follows ; A hospital was the highest part of QC/PM (50%) in Mamo X-ray device and was the lowest part of QC/PM(26.4%) in Castro X-ray. B hospital was the highest part of QC/PM(56%) in Mobile X-ray device, and the lowest part of QC/PM(12%) in Gastro X-ray. C hospital was the highest part of QC/PM(60%) in R/F X-ray device, and the lowest a part of QC/PM(21%) in Universal X-ray. It was found that the units responsible for most failure decreased by systematic management. We made the preventive maintenance schedule focusing on adjustement of operating and dust removal.
Purpose: The purpose of this study was to compare the validity of Onen's alternative grading system (AGS) with that of the APDRP and SFU grading systems in patients with isolated and complicated congenital hydronephrosis. Methods: We retrospectively reviewed the medical records of 153 patients (204 renal units) diagnosed with congenital hydronephrosis between January 2002 and December 2011. We classified patients into 2 groups; isolated or complicated hydronephrosis. All renal units were graded according to anterior-posterior diameter of renal pelvis (APDRP), Society for Fetus Urology (SFU) and Onen's grading systems. We analyzed the prognosis of hydronephrosis, according to each grading system, at 2 years of age. Results: There were 152 renal units with isolated hydronephrosis and 52 renal units with complicated hydronephrosis. The isolated hydronephrosis group had a lower grade according to Onen's AGS, and showed more frequent spontaneous remission by 2 years of age. There was more frequent obstruction (P =0.000) and surgical treatment (P =0.000) of units with high-grade hydronephrosis according to Onen's AGS. In the complicated hydronephrosis group the frequencies of spontaneous remission (P =0.015) and renal dysfunction (P =0.013) were significantly higher than those in high-grade hydronephrosis, as indicated by Onen's AGS. There were no significant differences in clinical outcomes among the highest grade groups, according to the 3 systems, in either isolated or complicated hydronephrosis. Conclusion: Onen's AGS reflects the prognosis of hydronephrosis as well as other grading systems in those with isolated hydronephrosis. It was better predictor of renal dysfunction in those with complicated hydronephrosis. However, Onen's AGS was not superior to the other grading systems in terms of predicting prognosis, especially in high-grade hydronephrosis.
Cardioplegia and myocardial protection were performed under cardiopulmonary bypass during open heart surgery with the use of St. Thomas Hospital cardioplegic solution [4 [C] for the coronary artery perfusion and normal saline solution [4[ c] for the topical cardiac cooling. To maintain the state of myocardial protection, coronary artery reperfusion was carried out using St. Thomas Hospital cardioplegic solution at the interval of 30 minutes. A total number of patients studied were 57 cases, including 37 cases of correction for congenital anomalies and 20 cases for acquired heart diseases. Cardiopulmonary bypass time during the surgery was observed to be average of 87.89*47.55 hours, aortic cross-clamping time [ACCT] to be average of 76.68*44.27 hours raging from 30 to 191 minutes. In order to evaluate the effects of myocardial protection in the surgery, serum enzyme levels were determined. To observe the relationship between ACCT and myocardial protection effects, patients studied were divided into the following 3 groups. I group: ACCT 60 minutes, II group: ACCT 90 minutes, III group: ACCT over 91 minutes [1] SGOT; The positive value [increased over 200 units] for ischemic myocardial injury during operation was observed in 11 cases [19.3% of the total] of the total patients studied, of which 4 cases [13.3%] in I group, 1 case [10.0%] in II group, and 6 cases [35.3%] in III group. [2] LDH; The positive value [increased over 900 units] for ischemic myocardial injury during operation was observed in 9 cases [15.7% of the total] of the total patients studied, of which 2 cases [6.6%] in I group, 1 case [10.0%] in II group and 6 cases [35.3%] in III group. [3] CPK; The positive value [increased over 800 units] for ischemic myocardial injury during operation was observed in 10 cases [17.5% of the total] of the total patients studied, including 4 cases [13.3%] in I group, 1 case [10.0%] in II group, and 5 cases [29.4%] in III group [4] The myocardial protection method used in the present study was demonstrated to be effective for the myocardial protection in the surgery with ACCT of up to 90 minutes. A few ischemic myocardial injury were observed in the surgery with ACCT over 91 minutes, but no significant cardiac dysfunction was noted. The surgery with ACCT of up to 191 minutes did not appear to give rise any significant interference with postoperative recovery.
Journal of Korean Academy of Fundamentals of Nursing
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v.23
no.2
/
pp.172-183
/
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.
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