• Journal of Korean Academy of Fundamentals of Nursing
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• v.18 no.2
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• pp.195-200
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• 2011

Purpose: The purpose of this study was to assess rates for handwashing adherence before and after nursing contact in intensive care units (ICU). Methods: The participants included 90 nurses working in intensive care units of an 800-bed university-affiliated hospital in Gyeonggi Province and 2000-bed university-affiliated hospital in Seoul. Time for handwashing was calculated using the average number of handwashings during an 8-hour day shift. Nursing contact was based on indications as defined by the Centers for Disease Control and Prevention (CDC, 2002). Data were analyzed using frequency, percent, t-test and ${\chi}^2$-test. Results: During an 8-hour day shift, the average number of times that hands were washed was 25.0. The rates were significantly lower before the nursing contact than after the nursing contact when it involved sectioning, observation or contact with a wound, cleaning enteric feeding bag, physical exam, use of gloves, or contact with contaminants. Conclusions: The results indicate that as handwashing rates were significantly lower before nursing contacts than after nursing contacts, there is need to develop strategies to address this deficiency in handwashing.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.5 no.1
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• pp.143-154
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• 1998

Background : There have been very few studies conducted on the number and type of microorganisms that remain on the ring finger after handwashing. This study was performed to investigate whether there were changes and differences in the type and number of microorganisms on the ring finger before and after handwashing. Method : The subjects of the study were 15 MICU and SICU staff nurses who were wearing rings. I swabbed two different fingers of the same hand with cotton balls. One finger which had a ring and the other with no ring. I swabbed the fingers of each subject three times(before handwashing, after handwashing with soap, and after handwashing with bethadine solution). After storing them for 48 hours in an incubator, I sent them to the laboratory and recorded the culture results. Results : There was no difference in the type of microorganism, but a major difference in the number of the microorganisms that existed on the finger ring. The results showed that there were much more microorganisms on the ring fingers than on the fingers that did not have rings both before and after handwashing. This tendency was consistent regardless of the handwashing agent. I therefore recommend that all nursing staff who work in general nursing units, as well as nurses who work in the ICU, remove their rings when taking care of the patients.

• Journal of Korean Clinical Nursing Research
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• v.14 no.1
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• pp.5-14
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• 2008

Purpose: To examine the current fees for nursing care and propose the strategies for improvement. Method: The number of subjects for this study was 86, including 36 chief executives of the nursing department, 14 of the health insurance department and 33 nursing managers. Data were analyzed by SPSS WIN 12.0 program. A researcher-developed questionnaire with 30 items was utilized. Results: 61% hospital had improved the nursing management fee grade after adoption of the differentiated nursing management fee schedules. After grade improvement, the time for direct nursing care increased. Also, the patient health outcome, nurse's job satisfaction were improved and more nurses were employed in general nursing units. Many subjects addressed that ICU and more nursing units were needed to adopt the differentiated nursing management fee schedules and "bed to nurse ratio" needed to be changed to "patients to nurse ratio" and specialized by the nursing units. Conclusion: The health policy in reference to fees for nursing care needs to get improved further in order to provide the quality-assured nursing care.

• Journal of Korean Clinical Nursing Research
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• v.17 no.3
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• pp.443-454
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• 2011

Purpose: The purpose of this study was to investigate the predictors of delirium in patients after orthopedic surgery. Methods: Participants were 121 orthopedic surgery patients from one university affiliated hospital located in Seoul. The instrument of Delirium Observation Screening Scale (DOS) developed by Schuurmans et al. (2003) was utilized. Data were collected from September 1st, 2010 to March 31st, 2011 and analyzed using SPSS 12.0 with descriptive statistics, t-test, chi-square test and logistic regression. Results: The delirium in patients after orthopedic surgery was occurred in 9 (7.4%) out of 121 patients. Several factors were associated with the delirium occurrence age, admission route, preadmission Activity of Daily Living (ADL), preadmission hearing aid use, preadmission walking degree, diagnosis, type of surgery, Intensive Care Unit (ICU) stay after surgery, restraint, drainage tube, time of admission to surgery, preoperative albumin and preoperative sodium. Preadmission ADL, preoperative sodium and time of admission to surgery were the significant predictors of the delirium occurrence. Conclusion: Study results may help nurses predicting and detecting delirium early and providing preventive measures to the patients with high risk of delirium after orthopedic surgery.

• Journal of Korean Clinical Nursing Research
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• v.16 no.3
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• pp.175-186
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• 2010

Purpose: Delirium can be a highly prevalent symptom in intensive care units but it may still be under-recognized despite its relation with inclined morbidity, mortality, cost, and readmission. Therefore, this study aimed to develop a protocol that covers risk factors and non-pharmacological interventions to prevent delirium in ICU patients. Methods: This study was conducted using methodological design, and it followed the Scottish Intercollegiate Guideline Network (SIGN) guideline development steps: 1) the scope of protocol was decided (population, intervention, comparison, and outcomes); 2) guidelines, systematic reviews, and protocols were reviewed and checked using methodology checklist; 3) the level of evidence and recommendation grades was assigned; 4) the appropriateness of recommendations was scored by experts; 5) the final protocol & algorithm was modified and complemented. Results: The evidence-based delirium prevention protocol was completed that includes predisposing factors, precipitating factors and recommendations with evidenced grades. Conclusion: This protocol can be used as a guide nurses in screening patients with high risk factors of delirium as well as in intervening the patients non-pharmacologically to prevent delirium.

• Quality Improvement in Health Care
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• v.21 no.1
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• pp.36-49
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• 2015

In Intensive Care Units (ICUs), where severely ill patients are treated, importance of reducing Hospital Acquired Infection (HAI) cannot be overstated. One of the simplest and most effective actions against HAI is proper hand hygiene (HH) behavior of Health Care Workers (HCWs). However, compliance varies across different cultures and different job types of HCWs (physicians, residents and nurses). This study aims to understand determinants of HH behavior by HCWs' job types in Korea. Qualitative analysis was performed based on Reasoned Action Approach style interviews with staff physicians, residents and nurses across 7 teaching hospitals. We found that all HCWs strongly believe HH is important in reducing HAI. There were, however, job type-specific HH behavior modifying factors; staff physicians stated feeling pressure to be HH behavior role model. Residents identified Quality Improvement team that measured compliance as a facilitator; a notable barrier for residents was senior physicians not washing their hands, because they were afraid of appearing impudent to their seniors. Nurses designated their chief nurse as a key referent. All participants mentioned heavy workload and lack of access to alcohol-based sanitizer as situational barriers, and sore and dry hand as deterrents to HH compliance.

• Journal of Korean Academy of Nursing Administration
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• v.7 no.3
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• pp.455-472
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• 2001

The purpose of this study was to serve as a basis for mapping out successful strategies to build the professional self-image of nurses through uniform, by examining their satisfaction with uniform and professional self-image by general characteristics, and identifying the correlational relationship between the two factors. The subjects in this study were 205 nurses who served in general departments of two university hospitals in Seoul. The departments where special uniform was required, including ICU, RR, OR and CSR, were excluded. The data were collected from September 15 through 22, 2000. For measurement of uniform satisfaction level, a uniform satisfaction scale was prepared by myself, and Arthur(1990)'s PSCNI translated and modified by Song Kyong Ae and Rho Chun Hee(1996) was employed. The Cronbach a of the uniform satisfaction scale and PSCNI was 0.90 and 0.86 respectively. The collected data were analyzed by SAS, and real number, percentage, average and standard deviation were calculated. Besides, t-test, one-way ANOVA, Pearson's r procedures were utilized, and Scheffe test was conducted as a posttest. The findings of this study were as below: 1. The uniform satisfaction of the nurses investigated was scored 2.52 on the basis of 4 points, which was on the medium level. By subarea, symbolicity satisfaction was 2.48, and aesthetic satisfaction was 2.60. The functionability satisfaction was 2.44. So the esthetic satisfaction was greatest. 2. Among general characteristics of the subjects, two factors made a significant difference to their uniform satisfaction : age(F=4.05, P=.0189), and total career(F=4.25, P=.0061). 3. Their professional self-image got 2.75 on the basis of 4 points, which was on upper middle level. The subarea score was 2.79 for professional work, 2.52 for satisfaction and 2.97 for communication. The communication area was rated highest, and the satisfaction area was scored lowest. 4. Among the general characteristics of the subjects, professional self-image was different according to five factors : age(F=17.83, P=.001), marital status(T=5.18, P=.0000), educational background(F=8.72, P=.0002), position(T=-5.29, P=.0000) and total career(F=15.23, p=.0001). Better professional self-image was possessed by the older group than the younger one, by the married group than the singles, by the better-educated group than the less-educated, by the nurses in position equal to or higher than charge nurse, or by the higher-career group. 5. The correlational relationship of uniform satisfaction to professional self-image was statistically significant, yet very weak(r=.1978, p=.0045). The satisfaction area of professional self-image was correlated to every uniform satisfaction area, including symbolicity(4=.4393, p=.0001), aesthetics(r=.2471, p=.0004), functionability(r=.3094, p=.0001) and total satisfaction(r=.4050, p=.0001). Therefore, the uniform satisfaction gave an impact on the satisfaction area of professional self-image of the nurses, and there was a significant correlational relationship between uniform symbolicity area and total professional self-image(r=.2416, p=.0005).

• Journal of Korean Public Health Nursing
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• v.18 no.1
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• pp.103-118
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• 2004

The purpose of this study was to understand the process and investigate basic theory of fatigue experience of shift work nurses. The present study adopted grounded theory methodology on fatigue of shift work nurses. The participants for this study were 15 shift work nurses who were in the age of 25 to 35, the clinical experience of 2 to 14 years and the work department of ICU. ER. ward and delivery room. The data were collected from 2000 to 2003 by using interviews and observations. The contents of the interviews were tape-recorded and were drawn through repeated method. And then were analyzed into the concept, subcategories, and categories with the open coding process and axial coding was done to identify the relationships of the concepts and categories according to the paradigm models. The core category generated, which was a central phenomena of the exhaustion process. The causal condition is change events. The central condition of exhaustion were sorted as physical discomfort, decreasing vigor, psychological instability, feeling of sleeping desire, changing face impression and being heavy body. The intervening condition were discovered as social$\cdot$ psychology$\cdot$physical resist and positive$\cdot$negative interaction strategies. The consequences of the fatigue process is the short term exhaustion relief and long term residual exhaustion. The fatigue process of this study was 'break through exhaustion' of change event-exhaustion-resist-resolve intervention-adaptation. This study offers better understanding on fatigue process of shift work nurses and may facilitate more appropriate interventive strategies to support, information and knowledges according to fatigue process.

• Journal of Korean Clinical Nursing Research
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• v.29 no.3
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• pp.312-326
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• 2023

Purpose: This study attempted to analyze the staffing level and critical care nursing fees of intensive care units at tertiary and general hospitals and to provide a professional judgment-based recommendation on staffing level and critical care nursing fee schedules. Methods: Staffing grades and critical care nursing fee schedules for the first quarter of 2017~2020 and the fourth quarter of 2020~2022 were analyzed. A survey was conducted on nursing managers and nurses about the current and appropriate staffing levels. A total of 77 nurse managers and 708 nurses working in Intensive Care Unit(ICU)s at tertiary and general hospitals participated in the study. Results: Grade 1 staffing increased from 25.6% in 2017 to 92.1% in 2022 at tertiary hospitals and from 0.8% in 2017 to 28.4% in 2022 at general hospitals. The current staffing ratios of tertiary and general hospitals were 1:2.21 and 1:2.77, respectively. The appropriate staffing ratio according to nurse managers and nurses was 1:1.00 in patients with more than a ventilator application and 1:2.00 in patients without any ventilator application in tertiary hospitals, and it was 1:1.25 in patients with more than a ventilator application and 1:2.00 in patients without any ventilator application in general hospitals, respectively. Conclusion: The appropriate staffing level was suggested from 1:1.0 to 1:2.0. The new nursing fee schedules were suggested from 1:1.0 (Grade 1) to 1:3.0 (Grade 5) and recommended to be paid based on the staffing grade, minimum number of nurses, and standard annual working days. It is expected to increase staffing levels and provide a better nursing work environment.

• Journal of Korean Academy of Nursing Administration
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• v.15 no.4
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• pp.527-538
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• 2009

Purpose: The purpose of this study was to reclassify the advanced nursing practices of critical care nurse practitioners(CCNPs) in intensive care unit and measure the time and frequency of CCNP's activities. Method: Practices of ICU nurses are divided into RN's and CCNP's practices by a panel of ICU nursing experts. Each practice of CCNP is defined and CCNP's working time and service frequencies are monitored in general hospitals. Result: Practices of CCNP were classified into 4 domains and 32 practices. Fourteen practices by CCNPs were completed in 10 minutes and the other 12 practices consumed 10-30 minutes. A priority of practice in respiratory therapy was given to artificial airway management, management of tracheostomy patient, lower respiratory care, and the priority of CRRT was management of anticoagulation. Conclusions: Advanced nursing practices of CCNPs were recognized from those of RNs. A further research of CCNPs practices should be extended to other advanced practices and it is required to evaluate economic value of advanced nursing practice in the national health insurance system.