• Nutrition Research and Practice
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• v.15 no.6
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• pp.703-714
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• 2021

BACKGROUND/OBJECTIVES: A dietary restriction on the intake of fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) has been reported to be effective in the treatment of gastrointestinal (GI) tract complications. Enteral nutrition (EN) is widely used for patients who cannot obtain their nutritional requirements orally, but many studies have reported EN complications, especially diarrhea, in up to 50% of patients. SUBJECTS/METHODS: We performed a single-center, non-randomized, controlled trial to determine the effects of a low-FODMAP enteral formula on GI complications in patients in intensive care units (ICUs). Patients in the ICU who needed EN (n = 66) were alternately assigned to the low-FODMAP group (n = 33) or the high-FODMAP group (n = 33). RESULTS: Anthropometric and biochemical parameters were measured, and stool assessment was performed using King's Stool Chart. We excluded patients who received laxatives, GI motility agents, proton pump inhibitors, antifungal agents, and antibiotics other than β-lactams. There were no differences in GI symptoms during 7 days of intervention, including bowel sound, abdominal distension, and vomiting between the 2 groups. However, diarrhea was more frequent in the high-FODMAP group (7/33 patients) than the low-FODMAP group (1/33 patients) (P = 0.044). CONCLUSIONS: Our results suggest that a low-FODMAP enteral formula may be a practical therapeutic approach for patients who exhibit enteral formula complications. Our study warrants further randomized clinical trials and multicenter trials.

• Journal of The Korea Institute of Healthcare Architecture
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• v.22 no.4
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• pp.37-45
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• 2016

Purpose: The purpose of this paper is to analyze a sample of single corridor, pod type and composite type of ICUs in terms of patient visibility, spatial configurations and nurse walking distance focused on Korean cases. Methods: The measures of static visibility were used to quantify the patient visibility (upper third part of the patient bed) from the nurse station. The measure of space programme and area distribution (patient zone percentage, staff zone percentage, circulation zone percentage, corridor length per bed, distance from nurse station (NS) to patient bed and departmental gross square meter (DGSM) per patient bed) were calculated by using AutoCAD and MS Excel programs. In the second step of analysis the values of space distribution were compared among the three type of ICUs as well as the nurse walking distance, DGSM per bed and gross factor. in the third step of analysis regression analysis was conducted for the possible correlation between visibility and space programme and area distribution factors as well as nurse walking distance factors. Results: (1) It was found that on average composite type unit offer highest value of patient visibility followed by pod type, while single corridor type unit offers the minimum value of patient visibility among the three plan typologies. (2) Average patient visibility and DGSM per bed shows a strong positive correlation ($r^2=0.75$) and p=0.026. (3) Average patient visibility and average distance from NS has a strong negative correlation ($r^2=0.78$), and P=0.02. (4) On average composite type unit offer the minimum walking distance from NS (7.22 meter) followed by pod type unit (8.35 meter) and single corridor (9.76 meter). (5) Maximum distance from NS was noted in single corridor (18.19 meter) followed by pod type unit (15.14 meter) and Composite type unit (11.1 meter). Implications: This study may contribute to the visibility analysis of existing and future ICU design in Korea to achieve maximum patient visibility and reduced nurse walking distance.

• Journal of Korean Clinical Nursing Research
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• v.24 no.2
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• pp.255-262
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• 2018

Purpose: This study aimed to identify the view of life and death among ICU nurses and to analyze the problems related to end-of-life care in the current ICUs. Methods: A descriptive study design was used. The participants were 975 nurses working in the intensive care units of 16 general hospitals. Using a descriptive survey design, data were collected from August to December in 2016 and were analyzed using descriptive statistics, t-test, ANOVA, correlation analysis, and multiple regression analysis. Results: As a result of a correlation analysis of the data, Death perception had a significant positive correlation with EOL of nursing attitudes(r=.100, p=.002), and negative correlation with EOL stress care(r=-.221, p=<.001). The regression model explained for individual characteristics in the model, age(${\beta}=.126$, p<.001) and death perception(${\beta}=.182$, p<.001), Satisfaction of the EOL care(${\beta}=.173$, p<.001), Healing training needs on the EOL(${\beta}=-.144$, p<.001) were the most influential factors for EOL stress. Conclusion: Results reveal that ICU nurses have a moderate level of EOL stress, and that individual, age, death perception, Satisfaction of the EOL care, Healing traning needs on the EOL relevant in ICU nurses' EOL stress. Programs or interventions to reduce EOL stress and to should be developed taking into account these multidimensional factors.

• Tuberculosis and Respiratory Diseases
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• v.73 no.2
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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.

• Journal of Korean Critical Care Nursing
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• v.13 no.3
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• pp.62-74
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• 2020

Purpose : This study aimed to investigate the prevalence and risk factors of mental health problems in patients discharged from the intensive care unit (ICU). Methods : This was a secondary analysis study using data from a multicenter prospective cohort of post-ICU patients. We analyzed data of 311 patients enrolled in the primary cohort study who responded to the mental health questionnaire three months after the discharge. Anxiety and depression were measured on the Hospital Anxiety-Depression Scale, and post-traumatic stress disorder (PTSD) was measured on the Posttraumatic Diagnostic Scale. Results : The prevalence of anxiety, depression, and PTSD in patients at three months after ICU discharge were 25.7%, 17.4%, and 18.0%, respectively, and 7.7% of them experienced all three problems. Unemployment (OR=1.99, p=.033) and unplanned ICU admission (OR=2.28, p=.017) were risk factors for depression, while women gender (OR=2.34, p=.009), comorbid diseases (OR=2.88, p=.004), non-surgical ICUs (trauma ICU: OR=7.31, p=.002, medical ICU: OR=3.72, p=.007, neurological ICU: OR=2.95, p=.019) and delirium (OR=2.89, p=.009) were risk factors for PTSD. Conclusion : ICU nurses should proactively monitor risk factors for post-ICU mental health problems. In particular, guidelines on the detection and management of delirium in critically ill patients should be observed.

• Journal of Korean Critical Care Nursing
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• v.11 no.3
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• pp.12-22
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• 2018

Purpose : This methodological study develops an oral health assessment tool for critically ill patients. Method : From February 15 to April 30, 2014, this study was conducted to test the validity and reliability of the tool at two general hospitals and three medical and surgical intensive care units (ICUs) in Seoul, Korea. Results : The result of the intraclass correlation coefficient to test the between-observer reliability by analyzing the oral health assessment scores before and after oral nursing care showed that .93 of before oral care and .90 of after oral care. The correlation coefficient values of .68 (p<.001) and .71 (p<.001) before and after providing oral nursing care, respectively, indicated the presence of a statistically significant correlation between the tool and the criterion. Using the paired t-test, the differentiated validity of the tool was tested in patients who had developed pneumonia after entering the ICU. A statistically significant difference in scores was found between the time of entering the ICU and that of developing pneumonia (t=-8.73, p<.001), which provided evidence for the differentiated validity of the tool. Conclusions : Since the validity and reliability of the tool developed in this study were verified, this tool can be used to assess the oral health conditions of critically ill patients.

• Journal of Korean Academy of Nursing Administration
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• v.10 no.1
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• pp.83-96
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• 2004

Purpose: The purpose of this research is, by investigating organizational characteristics, types of nursing organizational culture and team effectiveness in ICU, to ascertain the type of nursing organizational culture and the organizational characteristic that can improve the team effectiveness. Method: The research targeted 427 nurses from 33 ICUs of 14 general hospitals which have more than 250 beds and the data were gathered by using self-report questionnaires from April 10, 2003 to April 24, 2003. For this research, the following tools were used; the tool for measuring organizational characteristics and organizational cultures and the tool for measuring team effectiveness. Result: The most significant nursing organizational characteristic in ICU is the centralization. The organizational culture in ICU is generally rank-oriented culture. There was a significant difference (p<.01) in four types of organizational cultures; relation-oriented, innovation-oriented, rank-oriented and task-oriented. Verifying influence power of organizational cultures upon team effectiveness of ICU, relation-oriented culture had 49.2% of an influence upon team effectiveness, innovation- oriented and relation-oriented culture had 60.4% of an influence, and rank-oriented, innovation-oriented and relation-oriented culture had 61.2% of an influence. The organizational culture profiles according to the types of nursing organizational cultures in 33 ICUs were found by a cluster analysis. They were classified into five culture profiles; strong balance culture profile, weak balance culture profile, innovation-oriented and task-oriened culture profile, strong relation culture profile and strong rank culture profile(p<0.5). According to me organizational culture profiles, a significant difference of team effectivenesses(coworker satisfaction, team performance perception, team satisfaction and team commitment) was found(p<.01). The strong balance culture profile had the best team effectivenesses. Conclusion: For nursing culture management, a nursing administrator should identify the relevant nursing organizational culture at first by utilizing an innovative team-leader. After identifying the organizational culture, the administrator should make strategic plans and practices that can distinguish good organizational cultures to be expanded from ones to be sublated so that a strong balance culture can be developed.

• Journal of Korean Clinical Nursing Research
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• v.17 no.3
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• pp.421-432
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• 2011

Purpose: The purpose of this study was to investigate the sleep patterns and the factors related to sleep disturbance in mechanically ventilated patients in intensive care units (ICUs). Sleep patterns in this study included both quality and quantity of sleep. Methods: Forty-four subjects were recruited in ICUs at a tertiary university hospital in D city. Data were collected using questionnaires, observation, and medical record from June, 2008 to May, 2009. Results: The total mean of sleep quality was $1.99{\pm}1.68$. The mean of total sleep time per 24-hour period was $3.75{\pm}1.94$hour (range 1-7.25) in mechanically ventilated ICU patients. The main sleep disturbance factors were listed as frequent nursing activities, attachment of medical appliances, and noise. All these factors were also significantly related to the sleep quality. Conclusion: These results indicated that mechanically ventilated patients were both qualitatively and quantitatively deprived of sleep far more than other ICU patients. In summary, a deeper understanding of sleep characteristics in mechanically ventilated ICU patients could help nurses to improve sleep derangements and patient outcome.

• Journal of Korean Academic Society of Home Health Care Nursing
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• v.24 no.3
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• pp.255-263
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• 2017

Purpose: This study was conducted to assess the incidence and characteristics of pressure ulcer in relation to the type of equipment and supplies(EnS) in intensive care unit(ICU). Method: By using secondary data analysis and descriptive investigation, 29 patients of pressure ulcers caused by EnS were examined from January 2013 to December 2015, at the advanced general hospital located in Gyeongsangnam-do. The subjects were aged 19 years and above and had been in the ICU for more than 3 days. The data were analyzed using the SPSS WIN 23.0 with frequency, percentage, and mean and standard deviation. Result: The incidence of EnS-related pressure ulcers was 3.71%. The EnS-related causes for pressure ulcers were endotracheal tube(31.03%), restraint(20.69%), and neck brace(10.34%). The longest use of EnS was oxygen tube(29 days). EnS that were possibly causing pressure ulcer for one day were restraint(upper extremities), endotracheal tube(oral and face), and oxygen mask(ear and nose). Conclusion: This study has been limited to secondary data analysis that may result in missing records of pressure ulcers related to EnS in ICU. However, the analysis of this research is expected to contribute to the development of nursing interventions to clarify the guidelines for the prevention of pressure ulcers related to EnS in ICUs.

• Journal of Korean Academy of Nursing
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• v.36 no.8
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• pp.1340-1351
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• 2006

Purpose. To determine and compare the perception among nurses and doctors of the roles and tasks of critical care advanced practice nurses (APNs) in order to establish standardized and formally agreed role criteria for such critical care APNs. Method. This study measured and analyzed the necessity of each of the roles and tasks of critical care APNs, as perceived by nurses and doctors, through a survey of 121 participants: 71 nurses in 7 intensive care units (ICUs) at a general hospital in Seoul, and 50 doctors who used ICUs. Data collection utilized a questionnaire of 128 questions in the following fields: direct practice (79), leadership and change agent (17), consultation and collaboration (15), education and counseling (11), and research (6). Results. Both the nurses' and the doctors' groups confirmed the necessity of critical care APNs, with doctors who frequently used ICUs indicating a particularly strong need. As for the priority of each role of critical care APNs, the nurses considered direct practice to be the most critical, followed by education and counseling, research, consultation and collaboration, and leadership and change agent. The doctors also considered direct practice to be the most critical, followed by education and counseling, consultation and collaboration, research, and leadership and change agent. There was a statistically significant difference between how the two groups regarded all the roles, except for the consultation and collaboration roles. As for the necessity of each role of critical care APNs, the nurses considered research to be the most necessary, followed by education and counseling, consultation and collaboration, leadership and change agent, and direct practice. The doctors, on the other hand, considered education and counseling to be the most necessary, followed by research, consultation and collaboration, leadership and change agent, and direct practice. The responses of the two groups to all the roles, except for education and counseling roles, were significantly different. Conclusion. Nurses and doctors have different perceptions of the roles and tasks of critical care APNs. Thus, it is necessary for the combined nursing and medical fields to reach an official agreement on a set of criteria to standardize for the roles and tasks of critical care APNs.