• 보건의료산업학회지
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• 제9권3호
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• pp.69-79
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• 2015

Objectives : This study was conducted to verify the influence organizational health has on customer orientation by hospital ownership. Methods : This survey was conducted on a public hospital, private hospital, and religious hospital, respectively, during March 2014 and a total of 210 questionnaires were used in the analysis. ANOVA and regression analysis were used to analyze the collected data. Results : The management environment factor of organizational health was statistically significant in the public hospital compared to the private hospital. The reliability factor of customer organization was statistically significant in the public hospital and religious hospital respectively compared to the private hospital. For reactivity, the religious hospital was statistically significant compared to private hospital. A positive influence was shown in the vitality factor at the public hospital, and community orientation at the private hospital, while both community orientation and career showed effects at the religious hospital. ICU had a negative influence on customer orientation at the private hospital. Conclusions : The reason vitality had a relatively more important effect on customer orientation in the public hospital was due that age group of 20~29 was the dominant socio-demographic factor. Furthermore, the influence of community orientation on customer orientation in the private hospital and religious hospital may be related to the nurses' career.

• 대한간호학회지
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• 제42권1호
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• pp.116-124
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• 2012

Purpose: The study was done to compare effects of two endotracheal tube (ET tube) fixation methods (rotated fixation versus conventional) on unplanned extubation and skin integrity for orally intubated patients in intensive care units. Methods: The research design was a non-equivalent control group with repeated measures design. Participants were 80 patients; 40 participants assigned to each group. ET tube for the experimental participants fixed with rotated method every morning. Unplanned extubation was assessed by bedside nurses using the unplanned extubation report form. Oral mucosa and facial skin integrity were assessed using oral assessment guide and facial skin integrity assessment guide at day 3, 7, 10 and 14. Results: There was no difference in the unplanned extubation rate between the two groups. Oral mucosa impairment scores for the rotated fixation method were significantly lower at day 7 (p=.044), 10 (p=.048) and day 14 (p=.037). Also facial skin integrity impairment scores for the same group were significantly lower at day 7 (p=.010), 10 (p=.003), and 14 (p=.002). Conclusion: Results of the study suggest that the rotated fixation method is effective for these patients, to prevent impairment of oral mucosa and facial skin integrity. Further research is needed to prevent unplanned extubation.

• 성인간호학회지
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• 제15권3호
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• pp.463-471
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• 2003

Purpose: This study was aimed at providing scientific evidence for minimizing ventilator-associated pneumonia(VAP) by identifying appropriate timing of exchange of circuit for mechanical ventilator that is well suitable for the medical environment of intensive care units of hospitals in Korea. Method: This was a quasi-experimental study with a convenience sample of 19 adult subjects aged over 18 years who were admitted to the NS ICU of C university hospital, and placed on mechanical ventilator. The subjects were placed in two groups, compared on the incidence rate of VAP after they received exchange of circuit either at 1-week interval (N =10) or 2-week interval (N = 9). Result: 1) When considering 1000 days as the standard unit of analysis for incidence, the incidence rate of VAP was 7.19 cases at the 1-week cycle exchange group and 15.23 at the 2-week cycle exchange group, showing no statistically significant difference between the two groups. 2) There were a total of 3 types of bacteria isolated from the patients with VAP, including 2 cases with P. aeruginosa, 1 case with Streptococcus group F and A. baumannii. Conclusion: With thorough hand washing and strict management of tracheal tube of mechanical ventilator as well as use of tracheal intubation techniques, exchange cycle of circuit of mechanical ventilator by nurses may be changed from 1-week to 2-week interval.

• 임상간호연구
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• 제14권1호
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• pp.139-150
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• 2008

Purpose: The aim of this study was to develop instrument measuring the relocation stress syndrome for patients transferred from intensive care unit to general ward in Korea. Method: For item construction, components were drawn from an extensive review of the literature, existing instruments and the result of qualitative approach. A total 48 items were selected for the first draft. Ten experts evaluated this instrument for content validity and the number of items was reduced to 29. To refine and test reliability and validity of the instrument, data were collected from the 594 patients following transfer from intensive care unit. Results: Preliminarily twenty-nine items were generated through content validity and a pilot study. Using corrected items to total correlation coefficient, this instrument was further shortened to a 25 item scale. Factor analysis extracted a total of 23 items with a 5-point Likert-type scale. Relocation Stress Syndrome (RSS) included three subscales; physical factors (12 items), Patient's recognition to health care providers (8 items), and emotional factors (3 items). The RSS established content validity, construct validity, and reliability. Conclusion: This instrument demonstrates good reliability and validity, and therefore it is an appropriate measurement of assessing relocation stress syndrome in ICU to ward transition period.

• 임상간호연구
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• 제16권3호
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• pp.73-84
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• 2010

Purpose: The purpose of this study was to investigate the ethical awareness and attitude of patients' families towards Do-Not-Resuscitate(DNR), and thus provide basic information required to develop Korean appropriate DNR instructions and practice informed consent for DNR. Methods: During April 2010, 219 patient family members visiting the hospital were surveyed using a questionnaire. Results: Most of the participants preferred DNR to meaningless treatment for incurable patients. They recognized the necessity of explaining DNR to the patient with a terminal disease. They also requested DNR orders for themselves if they were in the same medical condition. In making a DNR decision, the patient's family agreed and preferred that it reflect the opinion of the patient and the doctor in charge. They also agreed that treatment should be given with the best efforts even if a DNR decision had been made for the patient. Conclusion: To make a decision on DNR for a patient who is terminally ill or for whom survival is not possible, a practice of informed consent and guidelines for executing the DNR reflecting the patient's opinion are required.

• 대한간호학회지
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• 제29권4호
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• pp.880-891
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• 1999

The purpose of this study was to describe nursing decision tasks, their characteristics, and problems associated with decision making. The subjects were 32 nurses who had at least one-year nursing experience and worked on medical-surgical units or intensive care units(ICU). They were asked to describe their decision making experiences in patient care situations and to identify the characteristics of each decisions. They were also asked to describe perceived problems associated with decision making in nursing. The responses on nursing decision tasks and problems were analyzed with content analysis and the decision characteristics were identified by statistical analysis of variance. It was found that there were 16 nursing decisions which are as follows : decisions related to interpreting and selecting appropriate strategies for pain management(6.6%) ; decisions related to providing emotional support (0.7%) ; decisions related to explaining the patient's condition and rationale for procedures(1.1%) ; decisions related to assisting patients to integrate the implications of illness and recovering into their lifestyles(2.9%) ; decisions related to detecting significant changes In patients and selecting appropriate intervention strategies (17.2%) ; decisions related to anticipating problems and selecting preventive measures(4.2%) ; decisions related to identifying emergency situations(0.4%) ; decisions related to effective management of patient crisis until physician assistance becomes available(2.8%) ; decisions related to starting and maintaining intravenous therapy(2.6%) ; decisions related to administering medications(8.1%) ; decisions related to combating the hazards of immobility(7.3%) : decisions related to treating wound management strategies(5.5%) ; decisions related to relieving patient discomfort(13.9) ; decisions related to selecting appropriate strategy according to the changing situation of the patient(18.2%) ; decisions related to selecting the best strategy for patient management(5.3%) ; and decisions related to coordinating, ordering, and meeting the various needs of the patient (3.1%). The nurses reported the fellowing problems in decision making : difficulties due to lack of knowledge and experience (18.6%) ; uncertainty and complexity of decision tasks(15.2%) ; lack of time to make decisions(2.9%) ; personal values which conflict with other staff(15.7%) ; lack of selection autonomy(30.0%) ; and organizational barriers(7.6%). Continuing education programs and decision support systems for frequent nursing decision tasks can be established on the basis of these results. Then decision ability in nurses will increase through the education programs and decision support systems, and then quality of nursing service will be better.

• 대한간호학회지
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• 제22권4호
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• pp.620-635
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• 1992

This study identified correlations between perceived family support and hopelessness in patients admitted to Neuro - surgical Intensive Care Units. The purpose was to enhance theoretical understanding of the relationships of these two variables. The subjects of this study were 51 patients admitted to N-lCU, at three general hospitals in Seoul. Data were collected by researcher in structured interviews from Aug. 12 to Oct. 13, 1992. The research tools were parts of the Moos Family Environment Scale and the Beck Hopelessness Scale. The general characteristic data were analyzed for frequency and percentage ; the hypothesis was tested by the pearson product Moment Correlation Coefficient. After normality tests by using Kolmogorov - Sminorvtest, and T- test, ANOVA and Mann-Whitney U test, Kruskal -Wallis test were used on the Family Support and the Hopelessness about general charcteristics. The results of the above analysis were as follows 1) The average family support score for the group was 63.61 (tool average 51) and item average was 3.74 (tool item average 3) : the family support score of this sample was higher than average. The average family cohesion score of family support was 35.25 (tool average 27) and item average was 3.91 (tool item average 3). The average family expression score of family support was 28.35 (tool average 24) and item average was 3.57 (tool average 3). In this sample, perceived family expression was lower than family cohesion. 2) The average hopelessness score was 45.88 (tool average 60) and item average was 2.29 (tool item average 3) : the hopelessness score of this sample was low in comparison to the average. 3) The hypothesis in this study was supported. The main hypothesis that the higher the perceived family support level, the lower the level Of the hopelessness, was Supported (r＝-.3869 p＝.003). The sub-hypothesis that the higher the perceived family cohesion level, the lower the level of hopelessness, was supported(r＝-.3688 p＝.004). The sub-hypothesis that the higher the perceived family expression level, the lower the level of hopelessness, was supported (r＝-.3068 p＝.014). 4) General characteristics of the objects related to family support were ‘economic status’(p＝.025) and ‘helping person’(P＝.044) : the higher the economic status, the greater the family support. When the patient identified the helping person as a spouse, family support was rated more highly. The only general characteristic related to family cohesion was ‘helping person’(p＝.041). No general characteristics were related to family expression. 5) The one general characteristic related to hopelessness was ‘education’(p＝.002) : the higher their education, the lower their hopelessness. For these ICU patients, were related perceived family support and hopelessness, and family expression level was low in comparison to family cohesion level. The perceived family support of these seriously ill patients in situational crisis may have influenced the patient's emotional reaction of hopelessness. This study concluded that nurses in the ICU confirm the family support of the patient, and involve the family as the most intimate support systems in the care of the patient to help reduce the patient's hopelessness.

• 대한간호학회지
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• 제30권3호
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• pp.659-669
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• 2000

Many patients of acute myocardial infarction showed delay time before seeking treatment although they needed immediate thrombolytic therapy once they perceived their symptoms. The objectives of this study were to identify the relationship between clinical symptoms and the delay, and to find the time spent before seeking the treatment. This study was a retrospective research. The delay time for the treatment consisted of the length of delay from symptom onset to patients' decision (T1), from patients' decision making to finding transportation (T2), and from taking transportation to the first hospital arrival(T3). The subjects were 89 patients who were admitted in the ICU and Cardiac Ward at Chonnam University Hospital with the first attack of acute myocardial infarction. Center, USA The data was collected for three months from March 1st to May 31st of 1998 through questionnaires and reviewing patients' charts: The chart information was suppled by two nurses working at the ICU and Cardiac Ward. The data was analyzed by using frequency, mean and ANOVA through the SAS program. The results of study summarized as follows: 1. Sixty two patients (69.7%) were male and twenty seven patients (30.3%) were female, the ratio of male to female was 2.3 : 1. 2. In daily life, the 70.8% of the patients felt chest pain and discomfort fatigue in 67.4%, dyspnea in 57.3%, and pain in arm, neck, and jaw in 52.8%. During the attack, 97.8% of the patients felt chest pain and discomfort dyspnea in 82.1%, pain in arm, neck, jaw in 67.4% and perspiration in 51.7%. 3. The length of time a patient spent seeking time for treatment (T1+T2+T3) was 94.6 minutes, in which the time for patients' decision making for treatment (T1) was 70.3 minutes, time for finding transportation (T2) was 8.2 minutes, and time for the transportation of the patient to the first hospital (T3) was 16.1 minutes. Time for patients' decision making to go to a hospital(T1) was 74.2% of the total time sought for treatment. 4. The differences of time sought for treatment between perceptions about the seriousness of the symptoms were significant (F= 6.5, p< .01). The more serious the heart symptoms they felt, the shorter the seeking time for treatment. 5. The differences of the time delay before treatment between the degree of the symptoms were significant (F= 2.9, p< .05). The patients with the typical chest pain and discomfort spent shorter the seeking time for treatment than those with the atypical symptoms of acute myocardial infarction. 6. The differences of transportation time to the first hospital between the types of cars that the patients used, were significant (F= 4.3, p< .01). When the patients used 119 or 129 they spent the least time (5.3 minutes) for transportation, and followed by way of an ambulance (15.6 minutes), private car (20.6 minutes), and taxi (24.8 minutes).

• 임상간호연구
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• 제26권2호
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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.

• 기본간호학회지
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• 제18권2호
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• pp.168-176
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• 2011

Purpose: The purpose of this study was to identify differences between intake and output balance and body weight changes and to identify factors related to differences in critically ill patients. Methods: The participants for this descriptive correlational study were 65 medical surgical ICU patients. The data were collected from patient medical records. Results: Mean age of the patients was 63.80 years (${\pm}15.21$). Body weight changes for 48 hours averaged 281.54g (${\pm}2210.48$). I&O balance for 48 hours corrected for insensible loss averaged 398.1ml. Differences ranged from 45mL to 7,535mL. In the distribution of absolute difference between body weight change and intake and output balance, only 40% of the patients were within less than 1,000 mL. Factors relating to accurate measure of intake and output were ventilation methods, respiration patterns, and edema status. Conclusion: Although mean values of weight change and I&O balance for all patients were very close, the range of differences was very wide indicating that, for many patients, intake and output is not an appropriate indicator of body fluid balance. Therefore, because of the frequency fever and/or hyperventilation, nurses need to use caution when using intake and output balance only to estimate current body fluid status for critically ill patients.