• Child Health Nursing Research
• /
• v.27 no.1
• /
• pp.24-33
• /
• 2021

Purpose: This study aimed to evaluate the effects of a rational emotive behavior therapy (REBT)-based emotional regulation program for mothers of premature infants in the neonatal intensive care unit (NICU). Methods: The study utilized a nonequivalent control group pretest-posttest design. Seventeen mothers were recruited for the experimental group and 21 mothers for the control group. Data were collected from July 9, 2018, to Oct 12, 2018 from mothers of premature infants in the NICU regarding parental stress, state anxiety, depression, and maladaptive cognitive emotion regulation. The experimental group received eight sessions of the REBT-based emotional regulation program for 3~4 weeks, and the control group only received standard nursing care. Results: Significant differences were found between the two groups in maladaptive cognitive emotion regulation (Z=-3.88, p<.001), stress (Z=-2.76, p=.006), state anxiety (Z=-3.72, p<.001), and postpartum depression(Z=-2.62, p=.009) after the intervention in the experimental group. Conclusion: The REBT-based emotional regulation program for mothers of premature infants was effective for reducing maladaptive cognitive emotion regulation, stress, anxiety, and postpartum depression. Therefore, it may be necessary to provide an REBT-based emotional regulation program for mothers of premature infants in the NICU in clinical practice.

• Child Health Nursing Research
• /
• v.28 no.3
• /
• pp.197-207
• /
• 2022

Purpose: The purpose of this study was to investigate how pediatric intensive care unit (PICU) nurses and the mothers of hospitalized children perceived their partnership and identify the detailed differences in the common domains of partnership between them. Methods: A qualitative descriptive design with semi-structured and open-ended interviews was used. Interviews with mothers of hospitalized children and nurses in the PICU were conducted at a national university hospital in South Korea. Results: Five integrated categories were identified concerning nurses' and mothers' perceptions of partnership. Five common domains were derived by merging the partnership categories perceived by each PICU mother and nurse: expectation of trust, sharing and communication, participation in care, equality in the relationship, and coordination of opinion However, there were significant differences in the composition of the categories of these common domains. Conclusion: These results may facilitate more effective partnerships between parents and PICU nurses. Efforts should be taken to promote the formation of trust between nurses and parents and create an environment that is conductive to regular open communication in particular, steps should be taken to reduce gaps in awareness concerning this partnership and information sharing, nursing methods, and decision-making.

• Quality Improvement in Health Care
• /
• v.21 no.1
• /
• pp.36-49
• /
• 2015

In Intensive Care Units (ICUs), where severely ill patients are treated, importance of reducing Hospital Acquired Infection (HAI) cannot be overstated. One of the simplest and most effective actions against HAI is proper hand hygiene (HH) behavior of Health Care Workers (HCWs). However, compliance varies across different cultures and different job types of HCWs (physicians, residents and nurses). This study aims to understand determinants of HH behavior by HCWs' job types in Korea. Qualitative analysis was performed based on Reasoned Action Approach style interviews with staff physicians, residents and nurses across 7 teaching hospitals. We found that all HCWs strongly believe HH is important in reducing HAI. There were, however, job type-specific HH behavior modifying factors; staff physicians stated feeling pressure to be HH behavior role model. Residents identified Quality Improvement team that measured compliance as a facilitator; a notable barrier for residents was senior physicians not washing their hands, because they were afraid of appearing impudent to their seniors. Nurses designated their chief nurse as a key referent. All participants mentioned heavy workload and lack of access to alcohol-based sanitizer as situational barriers, and sore and dry hand as deterrents to HH compliance.

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

• Acute and Critical Care
• /
• v.33 no.4
• /
• pp.238-245
• /
• 2018

Background: Infection by multidrug-resistant (MDR) pathogens leads to poor patient outcomes in intensive care units (ICUs). Contact precautions are necessary to reduce the transmission of MDR pathogens. However, the importance of the surrounding environment is not well known. We studied the effects of ICU relocation on MDR respiratory pathogen detection rates and patient outcomes. Methods: Patients admitted to the ICU before and after the relocation were retrospectively analyzed. Baseline patient characteristics, types of respiratory pathogens detected, antibiotics used, and patient outcomes were measured. Results: A total of 463 adult patients admitted to the ICU, 4 months before and after the relocation, were included. Of them, 234 were admitted to the ICU before the relocation and 229 afterward. Baseline characteristics, including age, sex, and underlying comorbidities, did not differ between the two groups. After the relocation, the incidence rate of MDR respiratory pathogen detection decreased from 90.0 to 68.8 cases per 1,000 patient-days, but that difference was statistically insignificant. The use of colistin was significantly reduced from 53.5 days (95% confidence interval [CI], 20.3 to 86.7 days) to 18.7 days (95% CI, 5.6 to 31.7 days). Furthermore, the duration of hospital stay was significantly reduced from a median of 29 days (interquartile range [IQR], 14 to 50 days) to 21 days (IQR, 11 to 39 days). Conclusions: Incidence rates of MDR respiratory pathogen detection were not significantly different before and after ICU relocation. However, ICU relocation could be helpful in reducing the use of antibiotics against MDR pathogens and improving patient outcomes.

• KIEAE Journal
• /
• v.15 no.2
• /
• pp.19-26
• /
• 2015

Purpose: Maximizing human comfort in design of medical environments depends immensely on specialized architects particularly critical care design; the study proposes Evidence-Based Design as an apparent analog to Evidence-Based Medicine. Healthcare facility designs are substantially based on the findings of study in an effort to design environments that augment care by improving patient safety and being therapeutic. On SPSS (Statistical Package for Social Science) t-test is applied to simulate two independent variables of PDR (Pre Design-Research) and POE (Post- Occupancy Evaluation). PDR is conducted on relatively new hospital Hallym University Dongtan Sacred Heart Hospital to analyse visibility from researchers' point of view, here the ICU is arranged in I-Shape. POE is applied on Dongguk University Ilsan Hospital to simulate walking on LogWare where two NS are designed based on L- Shape and Seoul St. Mary's Hospital, The Catholic University of Korea where five NS are functional for ICU Intensive Care Unit, Surgical Intensive Care Unit (SICU), Medical Intensive Care Unit (MICU), Critical Care Unit (CCU), Korean Oriental Medical Care Unit which are mostly arranged in U-Shape, and walking pattern is recognized to be in a zigzag path. Method: T-Test is applied on two dependent communication variables: walkability and visibility, with confidence interval of 95%. This study systematically analyses the Nurse Station (NS) typo-morphology, and simulates nurse horizontal circulation, by computing round route visits to patient's bed, then estimating minimum round route on LogWare stop sequence software. The visual connectivity is measured on depth map graphs. Hence the aim is to reduce staff stress and fatigue for better patients care by minimizing staff horizontal travel time and to facilitate nurse walk path and support space distribution by increasing effectiveness in delivering care. Result: Applying visibility graph and isovist field on space syntax on I- Shape, L- Shape and U- Shape ICU (SICU, MICU and CCU) configuration, I-shape facilitated 20% more patients in linear view as they stir to rise from their beds from nurse station compared to U-shape. In conclusion, it was proved that U-Shape supply minimum walking and maximum visibility; and L shape provides just visibility as the nurse is at pivot. I shape provides panoramic view from the Nurse Station but very rigorous walking.

• Journal of Dental Anesthesia and Pain Medicine
• /
• v.22 no.5
• /
• pp.357-367
• /
• 2022

Background: Low-dose dexmedetomidine may be a suitable alternative to opioids for pediatric ambulatory procedures under general anesthesia (GA). However, the recovery profile remains unclear. Herein, we aimed to evaluate the effects of low-dose dexmedetomidine on the recovery profile of children. Methods: Seventy-two children undergoing ambulatory oral rehabilitation under GA were randomly and equally distributed into two groups (D and F). Group D received an infusion of dexmedetomidine 0.25 ㎍/kg for 4 min for induction, followed by maintenance of 0.4 ㎍/kg/h. Group F received an infusion of fentanyl 1 ㎍/kg over 4 min for induction, followed by maintenance at 1 ㎍/kg/h. The primary outcome was the extubation time. The secondary outcomes were awakening time, end-tidal sevoflurane (ET-Sevo) requirement, change in hemodynamic parameters, Richmond Agitation-Sedation Scale (RASS), Children's Hospital of Eastern Ontario pain scale (CHEOPS) score, length of PACU stay, and incidence of adverse events. Results: Statistically significant differences were observed in the recovery profile between the groups: the median time for extubation was 3.65 (3.44-6.2) vs. 6.25 (4.21-7) minutes in groups D vs. F (P=0.001), respectively, while the corresponding awakening times were 19 (18.75-21) and 22.5 (22-24) minutes, respectively (P < 0.001). The mean ET-Sevo was low in group D (1.1 vs. 1.2; P < 0.001). The heart rate was significantly low across all time points in group D, without resulting in bradycardia. The median RASS and CHEOPS scores were also significantly lower in group D. No significant differences were observed in the mean arterial pressure, incidence of adverse events, or length of PACU stay. Conclusion: Low-dose dexmedetomidine was more effective than fentanyl as an opioid substitute at providing a better recovery profile in pediatric ambulatory oral rehabilitation under GA. Dexmedetomidine also significantly reduced sevoflurane consumption without causing adverse events or prolonging hospital stay.

• Journal of Chest Surgery
• /
• v.55 no.4
• /
• pp.325-331
• /
• 2022

Postoperative critical care management for lung transplant recipients in the intensive care unit (ICU) has expanded in recent years due to its complexity and impact on clinical outcomes. The practical aspects of post-transplant critical care management, especially regarding ventilation and hemodynamic management during the early postoperative period in the ICU, are discussed in this brief review. Monitoring in the ICU provides information on the patient's clinical status, diagnostic assessment of complications, and future management plans since lung transplantation involves unique pathophysiological conditions and risk factors for complications. After lung transplantation, the grafts should be appropriately ventilated with lung protective strategies to prevent ventilator-induced lung injury, as well as to promote graft function and maintain adequate gas exchange. Hypotension and varying degrees of pulmonary edema are common in the immediate postoperative lung transplantation setting. Ventricular dysfunction in lung transplant recipients should also be considered. Therefore, adequate volume and hemodynamic management with vasoactive agents based on their physiological effects and patient response are critical in the early postoperative lung transplantation period. Integrated management provided by a professional multidisciplinary team is essential for the critical care management of lung transplant recipients in the ICU.

• Journal of Korean Critical Care Nursing
• /
• v.2 no.1
• /
• pp.58-68
• /
• 2009

Purpose: The treatment effects and operation status of continuous renal replacement therapy (CRRT) for acute renal failure patients have been investigated. Method: Two expert nurses reviewed the records of 731 patients undergoing CRRT in an intensive care unit of a general hospital from Jan. 2002 to Dec. 2006 with the CRRT assessment sheet and situation sheet developed for this study. Results: The number of patients received CRRT increased from 90 in 2002 to 194 in 2006. The most common indication for CRRT was azotemia (40.0%). Before CRRT treatment, patients were 78.6 ($\pm55.5$) of BUN value and 5.0 ($\pm3.2$) of Cr. value. The standard values of BUN and Cr. were lowered. Compared the survival group with the death group, there were significant differences among the medical departments and the main diagnosis group. Their BUN and creatinine value, APACHE II score, mean blood pressure, and oliguria were significantly different (p<0.05). Conclusion: This survey demonstrates a trend that patients receiving CRRT has been increased. We suggest further studies are needed in some hospitals in order to generalize the results and to find how CRRT treatment affects patient’s survival and death rate.

• Tuberculosis and Respiratory Diseases
• /
• v.73 no.2
• /
• pp.100-106
• /
• 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.