• Journal of Korean Critical Care Nursing
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• v.17 no.1
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• pp.30-43
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• 2024

Purpose : Post-intensive care syndrome (PICS) is characterized by a constellation of mental health, physical, and cognitive impairments, and is recognized as a long-term sequela among survivors of intensive care units (ICUs). The objective of this study was to explore the impact of intensive care experience (ICE) on the development of PICS in individuals surviving critical care. Methods : This secondary analysis utilized data derived from a prospective, multicenter cohort study of ICU survivors. The cohort comprised 143 survivors who were enrolled between July and August 2019. The original study's participants completed the Korean version of the ICE questionnaire (K-ICEQ) within one week following discharge from the ICU. Of these, 82 individuals completed the PICS questionnaire (PICSQ) three months subsequent to discharge from hospital. The influence of ICE on the manifestation of PICS was examined through Partial Least Squares-Structural Equation Modeling (PLS-SEM). Result : The R² values of the final model ranged from 0.35 to 0.51, while the Q² values were all greater than 0, indicating adequacy for prediction of PICS. Notable pathways in the relationship between the four ICE dimensions and the three PICS domains included significant associations from 'ICE-awareness of surroundings' to 'PICS-cognitive', from 'ICE-recall of experience' to 'PICS-cognitive', and from 'ICE-frightening experiences' to 'PICS-mental health'. Analysis found no significant moderating effects of age or disease severity on these relationships. Additionally, gender differences were identified in the significant pathways within the model. Conclusion : Adverse ICU experiences may detrimentally impact the cognitive and mental health domains of PICS following discharge. In order to improve long-term outcomes of individuals who survive critical care, it is imperative to develop nursing interventions aimed at enhancing the ICU experience for patients.

• Journal of Preventive Medicine and Public Health
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• v.38 no.3
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• pp.276-282
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• 2005

Objectives : To evaluate the predictive validity of three scoring systems; the acute physiology and chronic health evaluation(APACHE) III, simplified acute physiology score(SAPS) II, and mortality probability model(MPM) II systems in critically ill patients. Methods : A concurrent and retrospective study conducted by collecting data on consecutive patients admitted to the intensive care unit(ICU) including surgical, medical and coronary care unit between January 1, 2004, and March 31, 2004. Data were collected on 348 patients consecutively admitted to the ICU(aged 16 years or older, no transfer, ICU stay at least 8 hours). Three models were analyzed using logistic regression. Discrimination was assessed using receiver operating characteristic(ROC) curves, sensitivity, specificity, and correct classification rate. Calibration was assessed using the Lemeshow-Hosmer goodness of fit H-statistic. Results : For the APACHE III, SAPS II and MPM II systems, the area under the receiver operating characterist ic(ROC) curves were 0.981, 0.978, and 0.941 respectively. With a predicted risk of 0.5, the sensitivities for the APACHE III, SAPS II, and MPM II systems were 81.1, 79.2 and 71.7%, the specificities 98.3, 98.6, and 98.3%, and the correct classification rates 95.7, 95.7, and 94.3%, respectively. The SAPS II and APACHE III systems showed good calibrations(chi-squared H=2.5838 p=0.9577 for SAPS II, and chi-squared H=4.3761 p=0.8217 for APACHE III). Conclusions : The APACHE III and SAPS II systems have excellent powers of mortality prediction, and calibration, and can be useful tools for the quality assessment of intensive care units(ICUs).

• Journal of Korean Critical Care Nursing
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• v.12 no.3
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• pp.24-34
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• 2019

Purpose : The purpose of this study was to identify the moderating and mediating effects of resilience in the relationship between emotional labor and job satisfaction among nurses working in intensive care units (ICUs). Method : The participants were 144 ICU nurses from three university hospitals. Data were collected using structured questionnaires and analyzed by t-test, ANOVA, $Scheff{\acute{e}}$ test, Pearson correlation coefficients, and multiple regression analysis, using SPSS 25.0. The mediating effect of resilience in the relationship between emotional labor and job satisfaction was analyzed by multiple regression analysis according to Baron and Kenny's procedure. Results : Statistically significant negative correlations were found between emotional labor and resilience (r=-.21, p<.014) and between emotional labor and job satisfaction (r=-.34, p<.001). A significant positive correlation was found between resilience and job satisfaction (r=.31 p<.001). A partial mediating effect by resilience was found between emotional labor and job satisfaction (Z=-2.11, p=.034), but no moderating effect was found. Conclusion : To improve the job satisfaction of ICU nurses, evaluation of their emotional labor, resilience, and interventions are necessary to alleviate emotional labor and improve resilience.

• Journal of Korean Critical Care Nursing
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• v.12 no.2
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• pp.13-25
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• 2019

Purpose : The purpose of this study was to identify factors influencing the professional self-concept of nurses working in intensive care units (ICUs). Methods : Data were collected from July 1 to August 15, 2014. The subjects were 206 ICU nurses working in four university hospitals in B and U cities, Korea. Their professional self-concept was measured using Arthur's Scale revised by Yoon (2012), and professional quality of life (QOL) was measured using Pro QOL Korean Ver. 5 developed by Stamm (2010). Data were analyzed with SPSS Ver. 18, using a t-test, ANOVA, Pearson's correlation coefficient, and multiple regression analysis. Results : Professional self-concept was significantly correlated with compassion satisfaction (r=.61, p<.001), and burn out (r=-.57, p<.001). The factors influencing professional self-concept were compassion satisfaction (${\beta}=.46$, p<.001), burn out (${\beta}=-.27$, p<.001), and education level (${\beta}=.14$, p =.014). The explanatory power of this model was 46.5%. Conclusion : The results suggest that the influencing factors found in this study should be considered when planning nursing intervention programs for improving the professional self-concept of ICU nurses.

• Journal of Korean Clinical Nursing Research
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• v.19 no.1
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• pp.33-44
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• 2013

Purpose: This study was done to develop a valid and reliable Classification System for Critical Care Nursing (CSCCN) to be used in Intensive Care Units (ICUs). Methods: Head nurses and staff nurses of 17 ICUs in 6 hospitals classified 307 patients to verify interrater reliability. To verify construct validity, the staff nurses classified 404 patients according to CSCCN comparing difference in medical department and type of stay in ICU. For conversion index, 78 patients from 4 ICUs of 'S' hospital were classified and nursing time was measured by 107 nurses and 18 nurse aids using stopwatches. Results: The developed CSCCN has 11 categories, 76 nursing activities and 101 criteria. The reliability was verified as having high agreement (r=.946). The construct validity was verified comparing differences in medical department and type of stay in ICU. According to scores, four groups in the CSCCN classification were identified. According to the conversion index, one score on the CSCCN means 7.2 minutes of nursing time. Conclusion: CSCCN can be used to measure diverse and complex nursing demands including psycho-social aspects of ICU patients and convert nursing demands to numbers.

• Tuberculosis and Respiratory Diseases
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• v.83 no.1
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• pp.81-88
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• 2020

Background: Use of appropriate antibiotics for the treatment of pneumonia is integral in patients admitted to intensive care units (ICUs). Although it is recommended that empirical treatment regimens should be based on the local distribution of pathogens in patients with suspected hospital-acquired pneumonia, few studies observe patients admitted to ICUs with nursing home-acquired pneumonia (NHAP). We found factors associated with the use of inappropriate antibiotics in patients with pneumonia admitted to the ICU via the emergency room (ER). Methods: We performed a retrospective cohort study of 83 pneumonia patients with confirmed causative bacteria admitted to ICUs via ER March 2015-May 2017. We compared clinical parameters, between patients who received appropriate or inappropriate antibiotics using the Mann-Whitney U, Pearson's chi-square, and Fisher's exact tests. We investigated independent factors associated with inappropriate antibiotic use in patients using multivariate logistic regression. Results: Among 83 patients, 30 patients (36.1%) received inappropriate antibiotics. NHAP patients were more frequently treated with inappropriate antibiotics than with appropriate antibiotics (47.2% vs. 96.7%, p<0.001). Methicillin-resistant Staphylococcus aureus was more frequently isolated from individuals in the inappropriate antibiotics-treated group than in the appropriate antibiotics-treated group (7.5% vs. 70.0%, p<0.001). In multivariate analysis, NHAP was independently associated with the use of inappropriate antibiotics in patients with pneumonia admitted to the ICU via ER. Conclusion: NHAP is a risk factor associated with the use of inappropriate antibiotics in patients with pneumonia admitted to the ICU via the ER.

• Journal of Korean Clinical Nursing Research
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• v.28 no.1
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• pp.1-12
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• 2022

Purpose: The purpose of this study is to investigate the association between the nurse staffing level and the patient mortality using Korean National Health Insurance data. Methods: The data of 1,068,059 patients from 913 hospitals between 2015 and 2016 were analyzed. The nurse staffing level was categorized based on the bed-to-nurse ratio in general wards, intensive care units (ICUs), and hospitals overall. The x² test and generalized estimating equations (GEE) multilevel multivariate logistic regression analyses were used to explore in-hospital mortality and 30-day mortality after admission. Results: The in-hospital mortality rate was 2.9% and 30-day mortality after admission rate was 3.0%. Odd Ratios (ORs) for in-hospital mortality were statistically lower in general wards with a bed-to-nurse ratio of less than 3.5 compared to that with 6.0 or more (OR=0.72, 95% CI=0.63~0.84) and in ICUs with a bed-to-nurse ratio of less than 0.88 compared to that with 1.25 or more (OR=0.78, 95% CI=0.66~0.92). ORs for 30-day mortality after admission were statistically lower in general wards with a bed-to-nurse ratio of less than 3.5 compared to that with 6.0 or more (OR=0.83, 95% CI=0.73~0.94) and in ICUs with a bed-to-nurse ratio of less than 0.63 compared to that with 1.25 or more (OR=0.85, 95% CI=0.72~1.00). Conclusion: To reduce the patient mortality, it is necessary to ensure a sufficient number of nurses by improving the nursing fee system according to the nurse staffing level.

• Journal of Korean Clinical Nursing Research
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• v.20 no.3
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• pp.406-416
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• 2014

Purpose: Screening of delirium using delirium assessment tools could promote delirium detection, however, there is lack of report about regular delirium assessment in Korea. This study was intended to describe the prevalence and related risk factors of delirium in intensive care unit (ICU). Methods: The Confusion Assessment Method for the ICU (CAM-ICU) data which were evaluated by nurses in ICUs was obtained through retrospective chart review. Data were analyzed using descriptive statistics, Chi-square test, t-test, Mann-Whitney U test, and stepwise logistic regression. Results: Delirium was evaluated in 125 patients. The incidence rate of delirium was 27.2% with a high prevalence of hypoactive delirium compared to hyperactive delirium (61.8 vs. 38.2%). Those with delirium were older, had hypertension, stayed longer in hospital, receiving ventilator support, had more number of catheters, had low serum protein and albumin level. Delirium incidence also varied according to diagnosis. Age, diagnosis of gastrointestinal disease, and application of ventilator were the significant risk factors for the incidence of delirium. Conclusion: Routine delirium screening is important for early detection of delirium. Identification of high-risk group and running delirium prevention programs could improve early recognition of delirium in ICU.

• Journal of Korean Academy of Nursing
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• v.35 no.1
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• pp.47-55
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• 2005

Purpose: This study was to evaluate the validity of the Pediatric Index of Mortality Ⅱ(PIM Ⅱ). Method: The first values on PIM Ⅱ variables following ICU admission were collected from the patient's charts of 548 admissions retrospectively in three ICUs(medical, surgical, and neurosurgical) at P University Hospital and a cardiac ICU at D University Hospital in Busan from January 1, 2002 to December 31, 2003. Data was analyzed with the SPSSWIN 10.0 program for the descriptive statistics, correlation coefficient, standardized mortality ratio(SMR), validity index(sensitivity, specificity, positive predictive value, negative predictive value), and AUC of ROC curve. Result: The mortality rate was 10.9% (60 cases) and the predicted death rate was 9.5%. The correlation coefficient(r) between observed and expected death rates was .929(p<.01) and SMR was 1.15. Se, Sp, pPv, nPv, and the correct classification rate were .80, .96, .70, .98, and 94.0% respectively. In addition, areas under the curve (AUC) of the receiver operating characteristic(ROC) was 0.954 (95% CI=0.919～0.989). According to demographic characteristics, mortality was underestimated in the medical group and overestimated in the surgical group. In addition, the AUCs of ROC curve were generally high in all subgroups. Conclusion: The PIM Ⅱ showed a good, so it can be utilized for the subject hospital. better.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.21 no.4
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• pp.403-412
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• 2014

Purpose: Shift work disrupts the synchronization between the human biological clock and the environment. Sleep disturbances are common for shift work nurses, and may threaten patient safety. This study was done to investigate the sleep characteristics and medication errors (ME) of intensive care unit (ICU) nurses who work shifts, and ascertain if there is an association between these factors. Methods: Data were collected using a self-report questionnaire from 126 ICU nurses on three shifts. Collected data included their sleep characteristics including sleep patterns and sleep disturbances, and ME for the past 2 weeks. Results: There were significant differences in sleep duration and sleep latency according to shift. Day shift nurses had the shortest sleep duration, and their sleep latency was the longest (about 49 minutes) compared to nurses on evening and night shifts; 54% reported sleep disturbances, 16% experienced ME, and among these nurses 50% were on the night shift. Logistic regression analysis revealed significant associations between nurses' sleep duration and ME (adjusted OR 0.52 [95% CI 0.32-0.85]). Conclusions: The results confirmed that shift work nurses in the ICUs experience sleep disturbance, and that less sleep is associated with ME.