• Neonatal Medicine
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• 제18권2호
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• pp.272-279
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• 2011

목적: 최근 신생아 집중 치료실(neonatal intensive care unit, NICU)에 입원한 신생아들의 병원내 감염 중 그람 음성 간균(Gram negative bacilli, GNB)에 의한 패혈증이 증가하고 있다. NICU에서 정기적인 대변의 감시 배양을 통해 GNB에 의한 장관 집락화가 같은 균에 의한 패혈증으로 이행되는 지를 확인하고, 집락화된 GNB 병원균의 종류를 확인하며 집락화에 관여하는 위험인자를 조사하고자 하였다. 방법: 2007년 10월부터 2008년 5월까지 고신대학교 복음병원 신생아 집중치료실에 입원한 86명의 환아를 대상으로 하였다. 모든 환아에게 총 3회의 대변 채집을 계획하였는데, 출생 후 첫 대변과 2주 간격으로 2회 채집을 계획하였다. 장관의 GNB 집락화와 관련된 위험 인자들은 대상 환아들의 의무기록을 열람하거나 연관된 논문의 고찰을 통해 설정하였다. 결과: 86명의 환아 중 22명(25.6%)이 GNB에 의한 장관 집락화가 있었으나 이 환아들을 퇴원까지 추적하였을 때 GNB로 인한 패혈증은 없었다. Pseudomonas aeruginosa, Enterobcter cloacae, Citrobacter freundii가 가장 많이 분리되었다. 분리된 GNB 중 약 89% (32/36)는 amikacin에 감수성이 있었다. GNB 에 의한 장관 집락화의 가능성은 집락화 당시 수유량이 적을 때 증가한 반면, 첫 수유 시기가 지연될 때 그 가능성은 감소하였다. 결론: 저자들은 NICU에 입원한 신생아에서 장관 감시배양을 통해 장관에 집락화된 GNB를 확인하였으나 연구에 포함된 환아에서 GNB에 의한 패혈증이 발생하지 않았으므로 집락화가 패혈증으로 이행되는 지를 확인할 수는 없었다. 집락화시 적은 수유량(feeding volume at colonization day)이 집락화의 위험요인이었으므로 장관 영양의 진행이 원활하지 않을 경우 장관의 GNB 집락화 가능성을 고려해야 한다.

• 간호행정학회지
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• 제17권1호
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• pp.115-126
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• 2011

Purpose: This study was done to identify differences in work environment, work stress, turnover intention and burnout and investigate the relationship among these variables in nurses in Korean Neonatal Intensive Care Units. Method: Participants were 242 nurses working in 13 general hospitals. Burnout was measured by the Maslach Burnout Inventory (MBI), work stress with the instrument by Gu & Kim (1994), and turnover intention with the scale by Kim & Lee (2001). Size of the NICU, nurse to patient ratio, and communication satisfaction were included in work environment. Data were analyzed using Pearson correlation coefficients and multiple regression analysis with SPSS WIN program. Results: The mean score for work stress in NICU nurses was 3.43 points, for burnout, 2.72 points, and for turnover intention, 4.64 points. Burnout and turnover intention level of participants were moderate-high. Work stress, communication dissatisfaction with physician, and clinical career accounted for 33% of variance in burnout. Significant differences were found between size of NICU and staffing related to environmental characteristics in turnover intention and burnout. Conclusions: Results indicate that effective communication with coworkers and institutional support for appropriate staffing according to number of beds will help to prevent work stress, burnout, and ultimately, nurses' resignations.

• 한국병원경영학회지
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• 제24권4호
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• pp.57-69
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• 2019

Purpose: This study aimed to analyze the job performance efficiency of nurses in the Neonatal Intensive Care Unit (NICU) by using the Data Envelopment Analysis (DEA). Additionally, the study aimed to provide a detailed method to improve the currently inefficient way in which nurses perform their jobs by differentiating the reference group of more efficient nurses, and to compare the characteristics of the more efficient group of nurses to those of the less efficient group of nurses. Methodology: This study evaluated the relative job performance efficiency of nurses by applying DEA to 43 nurses in the NICU. The input variables for the efficiency analysis were working career (years), time spent in direct nursing care (hours), overtime (hours), and job-related training (hours); the output variables were the job performance scores of professional practice, research, leadership, and education. Data were analyzed using SPSS IBM 23.0 and Open Source DEA (OSDEA). Findings: The relative job performance efficiency of the 43 nurses was 0.933, and 20 nurses were evaluated as more efficient. In addition, the study confirmed the possibility of improving the overall job performance efficiency by improving leadership, while controlling the current input variables. Lastly, the more efficient nurses had significantly higher job performance scores for research (t=2.028, p=0.049), leadership (t=2.036, p=0.048), and education (t=2995, p=0.005) than those who were less efficient. Practical Implications: It is suggested that job performance be evaluated using DEA to improve the overall job performance efficiency of NICU nurses. The analysis results from DEA for nurses becomes evidence in support of establishing individualized goals for each nurse, thus resulting in a foundation for systematic human resource management of nurses, and ultimately contributing to increase in the job performance efficiency of nurses.

• 부모자녀건강학회지
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• 제3권2호
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• pp.81-93
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• 2000

The role of the neonatal nurse specialist has been well established over the past decade and now reform in 21st century. Neonatal nurse specialists responsibilities in caring for critically and long-term chronically ill infants and their families are very important. Neonatal nurse specialists have a two fold responsibility in caring for these infants. First, through acquiring advanced practice education in complex neonatal care and diagnostic skills, neonatal nurse specialists meet the physiologic needs of the infant. Second, neonatal nurse specialists provide a more holistic approach to their care through evaluating the family in treatment plans and involving the family in discharge planning for the infant. In some institutions, neonatal nurse specialists are directly involved in institutional and/or home follow-up care and case management also. It is the neonatal nurse specialists responsibility to function collaboratively with the multidisciplinary team in managing critically or chronically ill infants from admission to discharge. The role of the neonatal nurse specialist case manager can be described as one that focuses on individualized care of the infant, while providing continuity of care to both the infant and family. The neonatal nurse specialist's role will vary depending on the neonatal intensive care unit(NICU). Therefore, the multidisciplinary collaborative approach to long-term management of infants in the NICU is extremely important to provide successful transition to home or to long-term rehabilitative care facilities because care for the chronically ill infant is complex and multifaceted. I suggest the role of neonatal nurse specialist in 21st century are as follows. 1. Diagnostic/patient assessment 2. Management of patient health/illness 3. Administering/monitoring therapeutic interventions and regimens 4. Monitoring/ensuring quality of health care practices 5. Organization and work role 6. Helping role 7. Teaching/coaching role 8. Management of rapidly changing situations 9. Consulting role The advanced practice nursing model of care delivered by neonatal nurse specialist's in the NICU incorporates medical and nursing role functions and emphasizes holism, caring, and a health perspective for critically and chronically ill neonates and their families.

• Clinical and Experimental Pediatrics
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• 제62권1호
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• pp.36-41
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• 2019

Purpose: In this study, we investigated the clinical features and prognostic factors of early-onset sepsis (EOS) in neonatal intensive care unit (NICU) patients. Methods: A retrospective analysis was conducted on medical records from January 2010 to June 2017 (7.5 years) of a university hospital NICU. Results: There were 45 cases of EOS (1.2%) in 3,862 infants. The most common pathogen responsible for EOS was group B Streptococcus (GBS), implicated in 10 cases (22.2%), followed by Escherichia coli, implicated in 9 cases (20%). The frequency of gram-positive sepsis was higher in term than in preterm infants, whereas the rate of gram-negative infection was higher in preterm than in term infants (P<0.05). The overall mortality was 37.8% (17 of 45), and 47% of deaths occurred within the first 3 days of infection. There were significant differences in terms of gestational age (26.8 weeks vs. 35.1 weeks) and birth weight (957 g vs. 2,520 g) between the death and survival groups. After adjustments based on the difference in gestational age and birth weight between the 2 groups, gram-negative pathogens (odds ratio [OR], 42; 95% confidence interval [CI], 1.4-1,281.8) and some clinical findings, such as neutropenia (OR, 46; 95% CI, 1.3-1,628.7) and decreased activity (OR, 34; 95% CI, 1.8-633.4), were found to be associated with fatality. Conclusion: The common pathogens found to be responsible for EOS in NICU patients are GBS and E. coli. Gram-negative bacterial infections, decreased activity in the early phase of infection, and neutropenia were associated with poor outcomes.

• Neonatal Medicine
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• 제25권1호
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• pp.29-36
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• 2018

Purpose: The purpose of this study was to investigate the outcome after changes in the treatment strategies for very low birth weight infant (VLBWI) in a single neonatal intensive care unit (NICU) center. Methods: We performed a retrospective review of 300 VLBWI born from 1st January 2010 to 31th December 2016. We compared the outcomes including survival rate, birth weight (BW), gestational age (GA), and morbidities between period I (2010-2013, P-I) and period II (2014-2016, P-II). Results: The average survival rate was not different between P-I and P-II. However, the survival rate of ${\leq}24$ weeks' GA, 25 weeks' GA, 26 weeks' GA were 57%, 69%, 93% respectively in P-II and 31%, 59%, 87% in P-I respectively. The survival rate of infants with birth weight <500 g, 500-749 g, 750-999 g were 100%, 55%, 90% respectively in P- II and 50%, 24%, 80%, respectively in P-I. The incidence of bronchopulmonary dysplasia (BPD) was higher in P-II than in P-I (P=0.012) and moderate-to-severe BPD was also higher in P-II (P=0.004). Incidence of patent ductus arteriosus (PDA) with treatment, necrotizing enterocolitis (stage ${\geq}2$), and abnormal brain sonography were significantly lower in P-II (P=0.027, P=0.032, P=0.005). Incidences of retinopathy of prematurity (ROP) with laser treatment and early sepsis were not different. Conclusion: The survival rate and complications of VLBWI were improved in period II, especially in less than 750 g and below 26 weeks, except incidence of BPD. Changes of NICU strategies were effective to improve mortality and morbidity in VLBWI.

• Child Health Nursing Research
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• 제22권4호
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• pp.257-264
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• 2016

Purpose: The purpose of this study was to investigate the relationship among knowledge and attitude toward palliative care and perception of death for Neonatal Intensive Care Unit (NICU) nurses. Methods: A cross-sectional descriptive study was conducted with 110 nurses who work in NICUs in South Korea. The participants filled out a questionnaire regarding their knowledge, attitude towards palliative care and perception of death. The attitude scale was divided into 3 subscales: comfort level, nurses' role and nurses' involvement with family. Results: Comfort level regarding attitude towards palliative care was positively correlated with knowledge (r=.220, p=.016) and the perception of death (r=.194, p=.042). Nurses' role showed a positive correlation with perception of death (r=.395, p=.001). Conclusion: NICU nurses' knowledge of palliative care was below standard across the board, implying that there is a definite need for palliative care education for nurses. The education program for palliative care should include a section that focuses on fostering a positive perception of death as well as defining and delineating the role of nurses.

• 임상간호연구
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• 제23권2호
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• pp.211-221
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• 2017

Purpose: A National survey was conducted to assess neonatal intensive care nurses' practice, barriers, knowledge, and belief regarding Kangaroo Care (KC). Methods: A descriptive survey was conducted. Kangaroo care questionares were sent to nurses in all hospitals in Korea whose were identified as providing neonatal intensive care services(N=263). Descriptive statistics were used to summarized the data. Results: Among 67 neonatal care units, 61.1% adapted KC in their practice. About 60% of nurses in the KC providing hospital actually practiced KC. Major barrier of practicing KC were infant safety concerns, as well as work load of nurses. Respondants who had practiced KC were more knowledgable and were more positive in their belief regarding KC. Conclusion: The findings suggest that in order to overcome barriers of practicing KC, educational programs are recommended designed for nurses. In addition, development of KC practice guideline is necessary to facilicate successful and safe KC.

• Child Health Nursing Research
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• 제22권3호
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• pp.172-181
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• 2016

Purpose: This study was conducted to examine the effect of education on infection control for multidrug resistant organism (MDRO). Methods: One group pre-post time series design was used. Infection control education for MDRO infection was provided to nurses working in the Neonatal Intensive Care Unit (NICU). Knowledge and recognition were evaluated before and after education. Hand hygiene compliance, MDRO isolation rate and central line-associated bloodstream infection (CLABSI) rate were used as outcome variables. Data from 45 nurses was used for analysis. Results: General knowledge about MDRO increased (p=.011). Responses to questions about image of MDRO and MDRO management tended to change in a positive direction (p=.046). Hand hygiene compliance was 100% at pre-test, 79.5% during education period and 98.4% at post-education period. MDRO isolation rate was 6.83 per 1,000 patient days at pre-test, 10.24 during education period and 6.68 at post-education period. CLABSI rate was 3.76 per 1,000 central line days at pre-test, 6.84 during education period and 4.71 at post-education period. Conclusion: Findings indicate that the education program is effective in improving knowledge about MDRO in NICU nurses. However, more reliable indicators should be used to determine long-term effects.

• 중환자간호학회지
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• 제13권2호
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• pp.24-35
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• 2020

Purpose : This study aimed to determine whether the Korean Patient Classification System for Neonatal Care Nurses (KPCSN) properly measures neonatal intensive care needs and to compare the scale's results with those of the Workload Management System for Critical Care Nurses (WMSCN). Methods : Data were collected from the medical records of 157 patients who were admitted to the NICU of a university hospital, in D city. Two types of patient classification systems were applied to investigate the total points and distributions to investigate the total points and distributions by categories and compare relationships and classification groups between two scales. Finally, the score distribution among the classification groups was analyzed when the KPCSN was applied. Results : Scores on the KPCSN for the feeding, monitoring, and measure categories were 19.16±15.40, 16.88±3.52, and 9.13±4.78, respectively. Classification group distribution of the KPCSN was as follows : 1.9% for the first group, 24.2% for the second group, 58% for the third group, and 15.9% for the fourth group. The classification group distribution of the WMSCN was as follows: 35.7% for the third group, 61.1% for the fourth group, and 3.2% for the fifth group. Finally, the scores by categories were analyzed according to KPCSN classification group, and the characteristics of the patients' nursing needs were identified for each classification group. Conclusion : Results of this study indicate that the KPCSN effectively measures feeding needs, which account for many nursing activities in neonatal intensive care. Comparisons between the KPCSN and WMSCN classification group scores and distribution ratios verified the correlation and significance of nursing requirements.