• Tuberculosis and Respiratory Diseases
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• 제73권2호
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• pp.100-106
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• 2012

Background: There are a plethora of literatures showing that high-intensity intensive care unit (ICU) physician staffing is associated with reduced ICU mortality. However, it is not widely used in ICUs because of limited budgets and resources. We created a critical care team (CCT) to improve outcomes in an open general ICU and evaluated its effectiveness based on patients' outcomes. Methods: We conducted this prospective, observational study in an open, general ICU setting, during a period ranging from March of 2009 to February of 2010. The CCT consisted of five teaching staffs. It provided rapid medical services within three hours after calls or consultation. Results: We analyzed the data of 830 patients (157 patients of the CCT group and 673 patients of the non-CCT one). Patients of the CCT group presented more serious conditions than those of the non-CCT group (acute physiologic and chronic health evaluation II [APACHE II] 20.2 vs. 15.8, p<0.001; sequential organ failure assessment [SOFA] 5.5 vs. 4.6, p=0.003). The CCT group also had significantly more patients on mechanical ventilation than those in the non-CCT group (45.9% vs. 23.9%, p<0.001). Success rate of weaning was significantly higher in the CCT group than that of the non-CCT group (61.1% vs. 44.7%, p=0.021). On a multivariate logistic regression analysis, the increased ICU mortality was associated with the older age, non-CCT, higher APACHE II score, higher SOFA score and mechanical ventilation (p<0.05). Conclusion: Although the CCT did not provide full-time services in an open general ICU setting, it might be associated with a reduced ICU mortality. This is particularly the case with patients on mechanical ventilation.

• 대한신경집중치료학회지
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• 제11권2호
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• pp.63-70
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• 2018

Management of mechanical ventilation is essential for patients with neuro-critical illnesses who may also have impairment of airways, lungs, respiratory muscles, and respiratory drive. However, balancing the approach to mechanical ventilation in the intensive care unit (ICU) with the need to prevent additional lung and brain injury, is challenging to intensivists. Lung protective ventilation strategies should be modified and applied to neuro-critically ill patients to maintain normocapnia and proper positive end expiratory pressure in the setting of neurological closed monitoring. Understanding the various parameters and graphic waveforms of the mechanical ventilator can provide information about the respiratory target, including appropriate tidal volume, airway pressure, and synchrony between patient and ventilator, especially in patients with neurological dysfunction due to irregularity of spontaneous respiration. Several types of asynchrony occur during mechanical ventilation, including trigger, flow, and termination asynchrony. This review aims to present the basic interpretation of mechanical ventilator waveforms and utilization of waveforms in various clinical situations in the neuro-ICU.

• 의료ㆍ복지 건축 : 한국의료복지건축학회 논문집
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• 제25권3호
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• pp.47-55
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• 2019

Purpose: This study tries to propose the dimensions and area related to patient bed and surroundings in ICU considering nurses' observation and medical care. Methods: Literature survey, 11 Case studies, some Interviews with nurses and measuring of medical equipments' dimension in ICU have been mobilized in order to deepen the ICU bed area standards. Results: 0.3m clearance between head wall and patient bed is necessary for emergency cases. The minimum distance at the foot of the bed should not be less than 0.9m for EMR cart and medical tray. The clear floor area of one bed and surroundings in open ward is $10.2m^2(3m{\times}3.4m)$. In a single-bed patient room, the minimum clear floor area is $16.0m^2(4m{\times}4m)$. Considering the control of cross infection in ICU, Single bed patient room is recommended. Implications: The result of this study can be applied to the design of ICU and legislation of ICU standard.

• 성인간호학회지
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• 제29권2호
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• pp.131-142
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• 2017

Purpose: The aims of the study were to investigate relationships among intensive care unit (ICU) nurses' attitude, role perception, and nursing stress related to life sustaining treatment (LST), and secondly, to identify factors influencing nursing stress about LST. Methods: Participants were 202 conveniently sampled ICU nurses from general hospitals in Korea with over 300 beds. From December 1, 2015 to January 31, 2016, data were collected using structured questionnaires. The questionnaire was designed to measure nursing stress related to LST. Content validity and reliability was established for the instrument. Results: Relationships were found between attitude and role perception, and between role perception and nursing stress about LST. Participants' role perception, gender, education level, and the experience of dealing with family members of patients receiving LST accounted for 13% of variance in nursing stress about LST. Conclusion: Results confirmed that ICU nurses' role perception affects nursing stress about LST. Accordingly, the nursing education programs related to LST should aim to enhance role perception of nurses, and strategies to reduce the nursing stress about LST of the nurses in ICU need to be further developed.

• 중환자간호학회지
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• 제12권2호
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• pp.39-49
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• 2019

Purpose : The purpose of this study was to identify the extent to which intensive care unit (ICU) nurses' perceptions of life-sustaining treatment decisions and "a good death" affect attitudes toward terminal care. Method : Participants included 109 ICU nurses from three university hospitals. Data were collected using structured questionnaires, and collected data were analyzed using a t-test, ANOVA, the $Scheff{\acute{e}}$ test, Pearson correlation coefficients, and a multiple regression analysis (SPSS 24.0 program). Results : Perceptions of life-sustaining treatment decisions and a sense of closeness (a constituent for the awareness of "a good death") were positively correlated with terminal care attitudes. The factors affecting terminal care attitudes were a clinical career in ICU (${\beta}=.20$, p =.035), a sense of closeness(${\beta}=.19$, p =.041), and the perception of a life-sustaining treatment decision (${\beta}=.22$, p =.017). This finding indicates that more than 10 years of experience in ICU, a greater sense of closeness, and a higher view of life-sustaining treatment decisions results in more positive attitudes toward terminal care. The explanatory power of these variables on terminal care attitudes was 14% (F=6.84, p < .001, Adj $R^2=.140$). Conclusion : A sense of closeness and the perception of life-sustaining treatment decisions were identified as the factors affecting terminal care attitudes. Thus, various programs must be developed to raise awareness among ICU nurses of "a good death" and perceptions of life-sustaining treatment decisions.

• The Korean journal of internal medicine
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• 제39권4호
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• pp.625-639
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• 2024

Background/Aims: Intensive care unit (ICU) quality is largely determined by the mortality rate. Therefore, we aimed to develop and validate a novel prognostic model for predicting mortality in Korean ICUs, using national insurance claims data. Methods: Data were obtained from the health insurance claims database maintained by the Health Insurance Review and Assessment Service of South Korea. From patients who underwent the third ICU adequacy evaluation, 42,489 cases were enrolled and randomly divided into the derivation and validation cohorts. Using the models derived from the derivation cohort, we analyzed whether they accurately predicted death in the validation cohort. The models were verified using data from one general and two tertiary hospitals. Results: Two severity correction models were created from the derivation cohort data, by applying variables selected through statistical analysis, through clinical consensus, and from performing multiple logistic regression analysis. Model 1 included six categorical variables (age, sex, Charlson comorbidity index, ventilator use, hemodialysis or continuous renal replacement therapy, and vasopressor use). Model 2 additionally included presence/absence of ICU specialists and nursing grades. In external validation, the performance of models 1 and 2 for predicting in-hospital and ICU mortality was not inferior to that of pre-existing scoring systems. Conclusions: The novel and simple models could predict in-hospital and ICU mortality and were not inferior compared to the pre-existing scoring systems.

• 중환자간호학회지
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• 제15권3호
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• pp.115-127
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• 2022

Purpose : This study aimed to investigate sleep parameters and to identify differences according to respiratory support therapy, sedation, and pain medication in intensive care unit (ICU) patients. Methods : In this observational study, sleep parameters were measured using actigraphy. We observed 45 sleep events in 30 ICU patients receiving respiratory support therapy. We measured the sleep parameters, time, efficiency, and wakefulness after sleep onset (WASO). The differences in sleep parameters according to the respiratory support therapy were analyzed using the Mann-Whitney U test. Results : The average daily sleep time of the participants was 776.66±276.71 minutes, of which more than 60% accounted for daytime sleep. During night sleep, the duration of WASO was 156.93±107.91 minutes, and the frequency of WASO was 26.02±25.82 times. The high flow nasal cannula (HFNC) group had a significantly shorter night sleep time (𝑥²=7.86, p =.049), a greater number of WASO (𝑥²=5.69, p =.128), and a longer WASO duration (𝑥²=8.75, p =.033) than groups of other respiratory therapies. Conclusion : ICU patients on respiratory support therapy experienced sleep disturbances such as disrupted circadian rhythm and sleep fragmentation. Among respiratory support regimens, HFNC was associated with poor sleep parameters, which appears to be associated with the insufficient use of analgesics. The results of this study warrant the development of interventions that can improve sleep in ICU patients receiving respiratory support, including HFNC.

• 근관절건강학회지
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• 제27권3호
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• pp.247-254
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• 2020

Purpose: This was a descriptive observational study examining the reasons for, frequency of, and factors affecting work interruption among intensive care unit (ICU) nurses. Methods: Convenience sampling was used to recruit 46 regular nurses who had been working in an ICU at D tertiary hospital in B metropolitan city for at least six months. To measure the degree of work interruption, this study revised a tool used by Brixey et al. (2007) for analyzing the type of work interruption. Results: A total of 1,787 work interruptions occurred during 368 hours of observation, i.e., at an average of 4.85 times per hour. Communication-related factors caused work interruption most frequently, followed by environmental, work-related, and personal factors. As for the work-related characteristics of nurses, participants experienced work interruption more frequently while working on weekdays, when the medical staff were stationed, than on weekends. Conclusion: ICU nurses experienced work interruption frequently. With the health care system expected to become more complicated in the future, efforts should be made to reduce unnecessary work interruptions to improve the operation efficiency of ICUs.

• 중환자간호학회지
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• 제13권2호
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• pp.36-44
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• 2020

Purpose : The person-centered care is essential for better patient outcome. This study was conducted to identify the factors affecting to the person-centered care among intensive care unit (ICU) nurses. Method : This study was cross sectional survey, and the participants included 107 ICU nurses who provided a written consent to participate in the study. Using a structured survey, nurse's compassion fatigue, compassion satisfaction, and person-centered care among ICU nurses were assessed. The collected data were analyzed using t-test, ANOVA, and Pearson correlation test with SPSS 23.0 program. The factors affecting patient-centered care were analyzed using multiple regression. Results : According to the multiple regression analysis, education level, perceived caregivers need priority and compassion satisfaction were positive affecting factors to the person-centeredness of ICU nurses. Conclusion : In conclusion, the compassion satisfaction was an affecting factor to the person-centered care, however compassion fatigue didn't affect to the person-centered care among ICU nurses. Therefore, the strategy enhancing compassion satisfaction among ICU nurses will be needed to increase person centeredness.

• Journal of Korean Biological Nursing Science
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• 제20권4호
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• pp.228-235
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• 2018

Purpose: This study aimed to investigate the clinical alarm occurrence and management of nurses toward clinical alarms in the intensive care unit (ICU). Methods: This observational study was conducted with 40 patients and nurses cases in two ICUs of a university hospital. This study divided 24 hours into the unit of an hour and conducted two times of direct observation per unit hour for 48 hours targeting the medical devices applied to 40 patients. Data were analyzed using IBM SPSS Statistics 23. Results: On average, 3.8 units of medical devices were applied for each patient and the ranges of alarm settings were wide. During 48 hours, 184 cases of clinical alarm were occurred by four types of medical devices including physiological monitors, mechanical ventilators, infusion pumps, and continuous renal replacement therapy. Among them, false alarm was 110 cases (59.8%). As for the alarm management by ICU nurses, two-minute alarm mute took up most at 38.0% (70 cases), and no response was second most at 32.6% (60 cases). When valid alarm sounded, nurses showed no response at 43.2%. Conclusion: The findings suggest that a standard protocol for alarm management should be developed for Korean ICU settings. Based on the protocol, continuous training and education should be provided to nurses for appropriate alarm management.