• Journal of Korean Critical Care Nursing
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• v.15 no.3
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• pp.88-100
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• 2022

Purpose : This study aimed to identify risk factors for unplanned reintubation after planned extubation and to analyze the clinical outcomes in patients admitted to the intensive care unit after cardiac surgery. Methods : The study examined patients who underwent intubation and planned extubation admitted to the intensive care unit after cardiac surgery between January 1, 2017, and December 31, 2021. The reintubation group comprised 58 patients underwent unplanned reintubation within 7 days of planned extubation. The maintenance group comprised 116 patients who did not undergo reintubation and were matched with the reintubation group using the rational for matching criteria. Data were collected retrospectively from electronic medical records. We used the independent t-test, Mann-Whitney U test, 𝑥²-test, Fisher's exact test, and logistic regression analysis with SPSS/WIN 27.0. Results : The multivariate logistic regression analysis demonstrated that albumin (odds ratio [OR]=0.38, 95% confidence interval [CI]=0.20-0.72), surgery time (OR=1.54, 95% CI=1.20-1.97), PaO₂ before extubation (OR=0.85 per 10 mmHg, 95% CI=0.75-0.97), postoperative arrhythmia (OR=2.82, 95% CI=1.22-6.51), reoperation due to bleeding (OR=4.65, 95% CI=1.27-17.07), and postoperative acute renal failure (OR=2.97, 95% CI=1.09-8.04) were risk factors for unplanned reintubation. The reintubation group had a higher in-hospital mortality rate (𝑥²=33.74, p<.001), longer intensive care unit stay (Z=-7.81, p<.001), and longer hospital stay than the maintenance group (Z=-8.29, p<.001). Conclusion : These results identified risk factors and clinical outcomes of unplanned reintubation after planned extubation after cardiac surgery. These findings should be considered when developing and managing an intervention program to prevent and reduce the incidence of unplanned reintubation.

• Quality Improvement in Health Care
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• v.4 no.1
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• pp.50-63
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• 1997

Background : A pressure sore was defined as any skin lesion caused by unrelieved pressure and resulting in damage to underlying tissue. The health care institutions in the United States were reported the incident rate of pressure sores ranging from 6 to 14 %. Intensive Care Unit needed highest quality of care has been found over 40% incidence rate of pressure sore. Also, Annual expenditures for the care of pressure sores in patients in the United States have been estimated to be $7.5 billion; furthermore, 50 percent more nursing time is required to care for patients with pressure sore in comparison to the time needed to implement preventive measures against pressure sore formation. However, In Korea, there were little reliable reports, or researches, about incidence rates of pressure sore in health care institution including intensive care unit and about the integrated approach like CQI action team for risk assessment, prevention and treatment of pressure ulcers. Therefore, this study was to develop pressure sore risk assessment tool and the protocol for prevention of pressure sore formation through CQI action team activities, to monitor incident rate of pressure sore and the length of sore formation for patients at high risk, and to approximately estimate nursing time for sore dressing during research period as the effect of CQI action team. Method : CQI action team in intensive care unit, launched since early 1996, reviewed the literature for the standardized risk assessment tool, developed the pressure sore assessment tool based on the Braden Scale, tested its validity, compared on statistics including incidence rate of pressure sore for patients at high risk. Throughout these activities, CQI action team was developed the protocol, called as St. Marys hospital Intensive Care Unit Pressure Sore Protocol, shifted the emphasis from wound treatment to wound prevention. After applied the protocol to patients at high risk, the incident rate and the period of prevention against pressure development were tested with those for patients who received care before implementation of protocol by Chi-square and Kaplan-Meier Method of Survival Analysis. Result : The CQI action team found that these was significant difference of in incidence rate of pressure sores between patients at high risk (control group) who received care before implementation of protocol and those (experimental group) who received it after implementation of protocol (p<.05). 25% possibility of pressure sore formation was shown for the patients with 6th hospital day in ICU in control group. In experimental group, the patients with 10th hospital day had 10% possibility of pressure sore. Therefore, there was significant difference(p<.05) in survival rate between two groups. Also, nursing time for dressing on pressure sore in experimental group was decreased as much as 50% of it in control group. Conclusion : The collaborative team effort led to reduced incidence, increased the length of prevention against pressure sore, and declined nursing care times for sore dressing. However, there have had several suggestions for future study. The preventive care system for pressure sore should be applied to patients at moderate, or low risk throughout continuous CQI team activities based on Bed Sore Indicator Fact Sheet. Hospital-wide supports, such as incentives, would be offered to participants for keeping strong commitment to CQI team. Also, Quality Information System monitoring incidents and estimating cost of poor quality, like workload (full time equivalence) or financial loss, regularly in a hospital has to be developed first for supporting CQI team activities as well as empowering hospital-wide QI implementation. Being several limitations, this study would be one of the report cards for the CQI team activities in intensive care unit of an acute hospital and a trial of quality improvement of health care in Korea.

• Journal of Korean society of Dental Hygiene
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• v.15 no.1
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• pp.147-152
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• 2015

Objectives: The purpose of this study was to investigate the oral health and hygiene in the neurosurgical patients in intensive care unit(ICU). Methods: The subjects were 92 neurosurgical patients in intensive care unit(ICU) from March, 2011 to December, 2012. The oral examination consisted of number of residual teeth, DMFT index, clinical attachment loss, gingival index, plague index, and Candida species colony of tongue and saliva. Plaque was inoculated from tongue and saliva and incubated in 36.5C incubator for 48 hours using $Dentocult^{(R)}$ CA(Orion Diagnostica, Espoo, Finland). Glasgow coma scale(GCS) was measured to evaluate the consciousness of the patients on the basis of medical record. Results: Oral health was poor in clinical attachment loss and gingival index. Oral hygiene in neurosurgical patients in ICU was very poor due to high plaque index and Candida colonization of tongue and saliva. Plague index was closely related to Candida colonization of tongue and saliva(p<0.05). Conclusions: Oral health and hygiene of patients in neurosurgical ICU were very poor. More careful oral hygiene care is very important and necessary to enhance the oral health improvement of the neurosurgical patients in ICU.

• Journal of Korean Clinical Nursing Research
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• v.14 no.1
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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.

• Child Health Nursing Research
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• v.28 no.2
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• pp.142-153
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• 2022

Purpose: Preventing missed care is important in neonatal intensive care units (NICUs) due to neonates' vulnerabilities. This study examined missed care and its influencing factors among NICU nurses. Methods: Missed care among 120 Korean NICU nurses was measured using a cross-culturally adapted online questionnaire. The frequency of missed care for 32 nursing activities and the significance of 23 reasons for missed care were collected. Results: All participants had missed at least 1 activity, missing on average 19.35 activities during a typical work-day. The most common missed item was "provide developmental care for the baby". The most common reason for missed care was "emergency within the unit or deterioration of one of the assigned patients". The final regression model explained 9.6% of variance in missed care. The average daily number of assigned patients receiving inotropes or sedation over the last month influenced the total number of missed care items. Conclusion: Missed care was affected by nurses' workload related to the number of patients taking medication. Frequently missed activities, especially those related to developmental care, require patience and time, conflicting with safety prioritization and inadequate working conditions. NICU nurses' working conditions should be improved to ensure adequate time for nursing activities.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.12 no.1
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• pp.121-130
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• 2005

Purpose: This study was done to determine the rate for handwashing by intensive care unit nurses according to the content of nursing tasks, to investigate the relationship between hand washing practice evaluated by nurses themselves and their actual practice observed, and finality to provide basic materials for strategy for hand washing education. Method: Data were collected by observing 27 nurses working in intensive care units of a hospital in Uijeongbu, Gyeonggi-do and by using observation and a structured self-assessment tool. Collected data were analyzed with SPSS and SAS. Results: The handwashing rate for the nurses was 4.3%. The handwashing rate was high in proportion to the risk of cross infection. In addition, the handwashing rate was highest in nurses working in the neurosurgery intensive care unit. The average score for self-assessment of handwashing was $49.42{\pm}3.78$ points and it was higher than their actual practice of handwashing. Conclusion: In order to improve handwashing by nurses, it is necessary to educate them on the importance of handwashing. In addition, there should be strategies for standardizing knowledge and attitudes to handwashing and inducing nurse:3 to practice hand washing in compliance with the policies and working conditions of the institution.

• Korean Journal of Adult Nursing
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• v.24 no.3
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• pp.232-243
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• 2012

Purpose: This study was to identify the level of knowledge and performances on evidence-based infection control and influencing factors on performance among nurses in intensive care unit. Methods: A descriptive cross-sectional survey design was used. Two hundred thirty-nine nurses at intensive care units were conveniently recruited from seven hospitals located in Seoul and Kyounggi province. Data were collected with a questionnaire survey about evidence-based infection control. Data were analyzed using SPSS/WIN 17.0 program. Results: Both level of knowledge (mean 9.15 out of 19) on preventing ventilator-associated pneumonia and central venous catheter induced bloodstream infection, and performance on evidence-based infection control (1.94 out of 4) were moderate. Performance of evidence-based practice for infection control was related to reading research articles regularly, professional satisfaction, and taken education course. Conclusion: These results indicate that systematic and organizational strategies for enhancing evidence-based infection control are needed to improve quality of intensive nursing care.

• Tuberculosis and Respiratory Diseases
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• v.77 no.4
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• pp.193-196
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• 2014

Acute airway obstruction after hemoptysis occurs due to the presence of blood clots. These conditions may result in lifethreatening ventilation impairment. We report a case of obstruction of the large airway by endobronchial blood clots which were removed using bronchoscopic cryotherapy at the bedside of intensive care unit. A 66-year-old female with endometrial cancer who had undergone chemotherapy, was admitted to the intensive care unit due to neutropenic fever. During mechanical ventilation, the minute ventilation dropped to inadequately low levels and chest radiography showed complete opacification of the left hemithorax. Flexible bronchoscopy revealed large blood clots obstructing the proximal left main bronchus. After unsuccessful attempts to remove the clots with bronchial lavage and forceps extraction, blood clots were removed using bronchoscopic cryotherapy. This report shows that cryotherapy via flexible bronchoscopy at the bedside in the intensive of intensive care unit is a simple and effective alternative for the removal of endobronchial blood clots.

• Journal of Korean Critical Care Nursing
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• v.8 no.2
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• pp.1-12
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• 2015

Purpose: The study sought to determine the state of blood glucose control, and the consequent clinical effects and variation in blood glucose level, of adult patients admitted to intensive care units following cardiothoracic surgery by comparing the blood glucose levels before and after the application of a blood glucose control protocol. Methods: The protocol was developed by modifying and supplementing the Yale protocol, and was first used in 2012. The resulting blood glucose data of an experimental group (n = 314), to which the blood glucose control protocol had been applied, and a control group (n = 347), whose blood glucose levels had been controlled according to physicians'prescriptions without the protocol, were collected through the medical records. Results: The target blood glucose ratio increased significantly in the experimental group, and the low blood glucose ratio decreased significantly in the experimental group. The two groups exhibited a significant difference (p < .001) in the degree of variation in the blood glucose levels. The duration of the use of a ventilator was significantly reduced in the experimental group (p < .001). Conclusion: It is expected that the protocol can be used for the safe and effective control of critically ill cardiothoracic surgery patients' blood glucose levels.

• Journal of Korean Critical Care Nursing
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• v.10 no.3
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• pp.31-40
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• 2017

Purpose : This study examined the prevalence of delirium-related factors in a surgical intensive care unit (SICU). Methods : This retrospective study enrolled 73 patients who were admitted to an SICU from October 1, 2016 to March 20, 2017 and who had been hospitalized for more than 72 hours. Data was collected by reviewing electronic medical records. Results : Delirium occurred in 46 (63.0%) patients. Its related factors were age, education, mechanical ventilator, sleep, narcotics, physical restraint, and central line catheters. Conclusion : The results indicate that sleep and physical restraint are significant factors related to delirium occurrence. The results of this study can help in developing guidelines for the prevention of delirium.