• Quality Improvement in Health Care
• /
• v.10 no.1
• /
• pp.28-41
• /
• 2003

Background : Because unplanned readmissions to intensive care unit(ICU)might be related with undesirable patient outcomes, we investigated the pattern of and reason for unplanned ICU readmission to provide baseline data for reducing unplanned returns to ICU. Methods : The subjects included all patients who readmitted to ICU during the same hospitalization at a tertiary referral hospital between January 1st and June 30th 2002. Quality improvement(QI) nurse collected the data through medical records and a medical director reviewed the data collected. Results : 1) The average unplanned ICU readmission rate was 5.6%(gastroenterology 14.6%, pediatrics 12.7%, pulmonology 11.9%, neurosurgery 6.3%, general surgery 5.3%, chest surgery 3.9%, and cardiology 3.3%). 2) Among the unplanned readmissions, more than 50% of cases were from patients older than 60 years, and the main categories of diagnose at hospital admission were neurologic disease(29.9%) and cardiovascular disease(27.6%). 3) Of unplanned ICU readmissions, 41.8% had recurrence of the initial problems, 44.8% had occurrence of new problems. And 9.7% required post-operative care after unplanned operations. 4) The most common cause responsible for unplanned ICU readmission were respiratory problem(38.3%) and cardiovascular problem(14.3%). 5) About 40% of unplanned ICU readmission occurred within 3 days after ICU discharge. 6) Average length of stay of the readmitted patients to ICUs were much longer than that of non-readmitted patients. 7) Hospital mortality rate was much higher for unplanned ICU readmitted patients(23.6%) than for non-readmitted patients(1.5%) (P<0.001). Conclusions : This study showed that the unplanned ICU readmitted patients had poor outcomes(high morality and increased length of stay). In addition study results suggest that more attention should be paid to patients in ICU with poor respiratory function or elderly patients, and careful clinical decisions are required at discharged from ICU to general ward.

• Journal of Korean Academy of Nursing
• /
• v.24 no.2
• /
• pp.190-205
• /
• 1994

Respect for human life and respect for human dignity are two basic values to which organized nursing has urged its members to adhere in their service to mankind. Thus it is the nurses’ duty to provide health care in support of sustenance of life and to pay respect for the patient’s right to dignity. In practice, however, nurses may experience dilemmas between these duties much due to the de velopment of modern advanced techniques. These dilemmas have become more complex and difficult to resolve. Nurses are often faced with situations in which the terminally ill refuse professional care, posing serious conflicts between respect for human life and respect for human rights to self-determination. In such cases, resolution of the problem is not a simple matter, thus requires intensive study into the ethical questions related to the situation. The purpose of this study was to identify ethical problems that nurses experience in caring for terminally ill patients and explore the ways to the resolution of problems within the context of the situations. The methodology used for the study was a case study method which ‘New Casuistry’ proposed by Jonsen & Toulmin(1988) and the ‘Specified Principlism’ proposed by Degrazia(1992) as an alternative to old deductive and intuitive method. Cases were developed through semistructured indepth interviews according to the casutistry method. A total of seven nurses were interviewd who were caring for therminally ill patients. Four cases out of a total 14 cases were related to the topic. Through the case analysis it became evident that nurses appreciated other values more often than respect for the patient’s right to self-determination. These other values were convenience and efficiency in nursing practice in case 1, preservation of life above all other values in case 2, provision of nursing care to fulfill the nurse’s professional obligation at most in case 3, and respect for the family’s demand against the patient’s wish in case 4. This study showed that the most important ethical problems were conflict between respect for the patient’s right to self-determination and sustenance of life for the fulfillment of professional obligation. For this problem, benefit /burden analysis from the perspective of the patient and family for the promotion of patient’s wellbeing may be a way to resolve the conflict. Further, through these analysis it was shown that physicians’ and families’ opinions dominated in the decision - making and the opinions of nurses’ and patients’ tended not to be reflected. Thus the patient's right to his or her care was not readily respected. To solve this problem. nurses should make efforts to communicate reciprocally with their patients, family members and physicians in an effort to respect for their patient’s rights to life and diginity from the point of view and values of the patient. It is also important that nurses provide good basic nursing care up to the time of death regardless of decisions about providing or not aggressive treat-ment for chronically and terminally ill patients.

• Korean Journal of Community Nutrition
• /
• v.4 no.1
• /
• pp.83-94
• /
• 1999

This study was carried out to investigate the general characteristics of public health nutritionists, the current status of nutrition services operation, the recognition about nutrition services of public health center related man power, the job satisfaction and self-assessment and the need for a retraining course of public health nutritionists. The subjects were 58 public health nutritionists who responded to the questionnaire distributed at the annual retraining program in 1998. The results of this study are summarized as follows. 1) 46.5% of the nutritionists were 26-30 years old, 62.1% were 4 year university graduates 74.1% were food and nutrition majors and 51.7% were daily workers. 2) Among the public health center-related manpower, the recognition about nutrition services was the highest for the manager of family health section, followed by the head of public health centers, and then the general nurse in public health centers. 3) The ranking of the reasons for job satisfaction of the public health nutritionists was, relationship with colleagues(3.84), inhabitants response after nutrition counselling(3.53), specialized value realization/conviction about duty(3.35), contents of the work(3.10), value achievement(3.08), self achievement/development(3.00), self discretion(2.92), participation in policy decisions(2.90), work load(2.75), chance of retraining and acquisition of new information(2.73), working environment(2.69), supervisio $n^port by superiors(2.67), salary(2.38), supply of necessary education material, technique(2.37), and budget security(2.22). 4) The satisfaction of the inhabitant's responses after nutrition counseling was the highest among the 4 year university graduates(p<0.05), the satisfaction of the specialized value realization/conviction about duty was the highest among the nutritionists 26-30 years old(p<0.05). Food and nutrition majors(p<0.05) and those having worked less than 3-5years at public health centers also showed much satisfaction(p<0.05). Satisfaction with the salary was the lowest among the food and nutrition majors(p<0.01) and daily workers(p<0.001). The satisfaction with the participation in policy decisions was the lowest among the daily workers(p<0.01). 5) The ranking for the level of self-assessment were, nutrition and dietetic practice(2.92), communication(2.80), management(2.77), public health science and practice(2.66)(p<0.01). The general characteristics such as the level of education, major, employment condition, current public health center's tenure, and charge experience of the nutrition guidance work were not significantly related to self-assessment except the management part(p<0.05). The higher the satisfaction of specialized value realization/conviction about the duty, the better the total score on the self-assessment(p<0.05)..

• Journal of the Korea Academia-Industrial cooperation Society
• /
• v.22 no.4
• /
• pp.195-205
• /
• 2021

As Coronavirus disease 2019 (COVID-19) became a pandemic, most nursing departments in Korea implemented online non-face-to-face practices rather than the existing practice method. This study was a qualitative study that analyzed the reflection diaries written by participants to understand what they experienced in the online non-face-to-face adult nursing practice process. The online non-face-to-face adult nursing practice was 90 hours for two credits and nine hours per day for a total of 10 days. This online practice consisted of computer-based simulation practice, computer-based nursing skills practice, video and educational material production, real-time online quiz, online lecture video, and discussion. As a result of analyzing the reflection diary, six categories, 13 subcategories, and 33 codes were derived. The six categories were 'Experience of various situations', 'Experience of new study', 'Fulfillment for the clinical practice', 'Building relations with professors', 'Fear of being a pre-nurse', and 'Ambivalence for the non-face-to-face practice'. These results are significant in that in the post-corona era, adult nursing practice was conducted as a non-face-to-face practice rather than a clinical practice institution, and various educational methods were operated. This study is expected to provide important basic data for the development and operation of non-face-to-face adult nursing practice.

• Journal of Internet of Things and Convergence
• /
• v.8 no.6
• /
• pp.99-113
• /
• 2022

This study is descriptive research to investigate the effects of COVID-19 stress, interpersonal (caregiver-patient) stress, and emotional labor on burnout in emergency room (ER) nurses during the COVID-19 pandemic. The data collection of this study was conducted from December 9 to 23, 2021 with ER nurses working at five tertiary general hospitals and general hospitals of Medical Center H. The data was collected with a questionnaire using tools measuring the subjects' general & job-related characteristics, COVID-19 stress, interpersonal(caregiver-patient) stress, emotional labor and burnout. The collected data was analyzed using the SPSS/WIN 25.0 statistical program for frequency analysis, descriptive statistical analysis, independent sample t-test, one-way ANOVA, Scheffé test, correlation analysis, and multiple regression analysis. The average score of COVID-19 stress in ER nurses was 3.64, interpersonal(caregiver-patient) stress 4.35, emotional labor 3.38, and burnout 3.44. As a result of analyzing differences according to general & job-related characteristics, burnout showed a significant difference according to gender, marital status, total clinical experience, and working organization. And burnout showed a significant positive correlation with COVID-19 stress, interpersonal stress and emotional labor. As a result of multiple linear regression analysis, regional emergency medical centers and local emergency medical centers among the work organization types, interpersonal stress, COVID-19 stress, and gender and the explanatory power was 28.6%. Through these results, we intend to provide basic data for the development of an intervention program to prevent burnout of emergency room nurses and improve nursing performance at the time of a new infectious disease pandemic.

• Journal of the Korea Academia-Industrial cooperation Society
• /
• v.22 no.6
• /
• pp.420-430
• /
• 2021

This was an investigative study to identify the role expectations for clinical research related tasks that ward nurses can participate in and the awareness of cooperation between ward nurses and clinical research nurses (CRNs) and the obstacles for the same. The subjects were 66 ward nurses and 65 CRNs. The data were analyzed using descriptive statistics, the two-sample t-test, and the 𝑥² test on SAS 9.3. As a result of this study, 4.56±0.41 ward nurses and 3.83±0.60 CRNs were found to have high role expectations of each other and statistically significant role expectations for ward nurses (p<.001). Significant differences were seen in the five categories of cooperation recognition between the two groups. Among the factors for cooperative disabilities, excessive work and lack of awareness of clinical research were ranked high. High role expectation becomes an element of role conflict. To organize the role of ward nurses and clinical research nurses in the new clinical research nursing work, procedures, establishing of effective practices, and the proper operation of an official system are expected to be necessary. To promote cooperation between the two groups, a culture of mutual trust and cooperation should be formed to enable each group to think of the other as partners and to recognize their expertise.

• Journal of Industrial Convergence
• /
• v.20 no.10
• /
• pp.121-129
• /
• 2022

The purpose of this study was to identify the factors affecting nursing practice of clinical nurses in the COVID-19 situation and provide basic data that could improve nursing practice in the pandemic situation. For this descriptive research, a survey was conducted to collect data from 119 clinical nurses in G City for six weeks from June 15 to July 20, 2022. Descriptive statistics, t-test, ANOVA, Pearson's correlation coefficient, and multiple regression were used. The results showed that infection control practice (r=.428, p<.001) and resilience (r=.324, p<.001) were statistically significantly correlated with nursing practice. As a factor affecting nursing practice of clinical nurses, infection control practice (B=.529, p<.001) had an explanatory power of 18.3%. This result is thought to be due to the fact that COVID-19 infection control acted as a new burden on nursing work in the COVID-19 pandemic, and recovery elasticity and job stress did not have an influence. It is however necessary to help clinical nurses relieve job stress and perform high-quality nursing through regular counseling for clinical nurses suffering severe job stress.

• Journal of Korean Neurosurgical Society
• /
• v.66 no.5
• /
• pp.573-581
• /
• 2023

Objective : Due to the implementation of vaccinations and the development of therapeutic agents, the coronavirus disease 2019 (COVID-19) pandemic that started at the end of 2019 has entered a new phase. As a result, neurosurgeons should reconsider the way they treat their patients. As the COVID-19 situation prolongs, the change in neurosurgical emergency patients according to the number of confirmed cases is no longer clear. Outpatient treatment by telephone was permitted according to government policy. In addition, visits to caregivers in the intensive care unit were limited. Methods : The electronic medical records of patients who had been treated over the phone for a month (during April 2020, while the hospital was closing) were reviewed. Meanwhile, according to the limited visits to the intensive care unit, a video meeting was held with the caregivers. After the video meeting, satisfaction was evaluated using a questionnaire. Results : During April 2020, 1021 patients received non-face-to-face care over the telephone. Among the patients, no critical medical problem occurred due to non-face-to-face care. From July 2021 to December 2021, 321 patients were admitted to the neurosurgical intensive care unit and 107 patients (33.3%) including their caregivers agreed to video visits. Twice a week, advance notice was given that access would be made through a mobile device and the nurse explained to caregivers how to use the mobile device. The time for the video meeting was approximately 20 minutes per patient. Based on the questionnaire, 81 respondents (75.7%) answered that they agreed, and 26 respondents (24.3%) answered that they strongly agreed that was easy to communicate through video meetings. Fifty-two (48.6%) agreed and 55 (51.4%) strongly agreed that they were easy to understand the doctor's explanation. For overall satisfaction with this video meeting, three respondents (2.8%) gave 4/5 points and 95 respondents (88.8%) gave 5/5 points, and nine (8.4%) gave 3/5 points. Their reason was that there was not enough time. Conclusion : In situations where patient visits are limited, video meetings through a mobile device can provide sufficient satisfaction to caregivers. Telemedicine will likely become common in the near future. Health care professionals should prepare and respond to these needs and changes. Therefore, establishing a system with institutional support is necessary.

• The Journal of the Convergence on Culture Technology
• /
• v.9 no.2
• /
• pp.133-141
• /
• 2023

This study was conducted to identify the effects of medium sized hospital nurses' nursing intention, infection prevention environment, and social psychological well-being on infection control performance of COVID-19 outbreak. The data collection period was from May 2 to May 31, 2022, and the questionnaires of 161 nurses who were working at I and B medium sized hospital in incheon and agree to participate in this study, were analyzed. Using the IBM SPSS/Win 25.0, the collected data was analyzed through the descriptive statistics, t-test, ANOVA, Pearson correlation, and multiple regreβion analysis. As a result, the infection prevention environment(β=.225, p<.001) and the experience of participating in new infectious disease education(β=.208, p=.008) had a significant effect and these variables were found to have 10.9% explanatory power for COVID-19 related infection control performance. Therefore, in the context of the outbreak of COVID-19, it is important to create an environment for infection prevention and to provide continuous and diverse education related to infectius diseases.

• Journal of Korean Academy of Nursing
• /
• v.11 no.2
• /
• pp.5-8
• /
• 1981

This study concerns itself with the development of a new model of comprehensive health service for rural communities of Korea. The study was conceived to resolve the problems of both underservice in rural communities and underutilization of valuable health manpower, namely the nurses, the disenchanted elite health personnel in Korea. On review of the current situation, the greatest deficiencies in the Korean health care system were found in the availability of primary care at the peripheries of md communities, in the dissemination of knowledge of disease prevention and health care, and in the induction of and guidance for active participation by the clientele in health maintenance at the personal, family and community level Abundant untapped health resources were identified that could be brough to bear upon the national effort to extend health services to every member of the Korean Population. Therefore, it was Postulated that the problem of underservice in rural communities of Korea can be structurcturally resolved by the effective mobilization and organization of untapped health resources, and that. a primary care Nursing Service System offers the best possibility for fulfillment of rural health service goals within the current health man-power situation. In order to identify appropriate strategies to combat the present difficulties in Korean rural health services and to utilize nurses and other health personnel in community-centered health programs, a search was made for examples of innovative service models throughout the world. An extensive literature survey and field visits to project sites both in Korea and in the United States were made. Experts in the field of world health, health service, planners, administrators, and medical and nursing practitioners in Korea, in the United States as well as visitors from other Asian countries were widely consulted. On the basis of information and inputs from these experts a new rural health service model has been constructed within the conceptual framework of community development, especially of the innovation diffusion Model. It is considered especially important that citizens in each community develop capacities for self-care with assistance and supports from available health professionals and participate in health service-related decisions that affect their own well-being. The proposed model is based upon the regionalization of health care planning utilizing a comprehensive Nursing Service System at the immediate delivery level The model features: (1) a health administration unit at each administrative level; (2) mechanisms for community participation; (3) a continuous source of primary health care at the local community level; (4) relative centralization of specialty care and provision of tertiary or super-specialty care only at major national metropolitan centers; and (5) a system for patient referral to the appropriate level of care. This model has been built around professional nurses as the key community health workers because their training is particularly suited and because large numbers of well-trained nurses are currently available and being trained. The special element in this model is a professional nurse-guided, self-care facilitating primary care Community Nursing Service System. This is supported by a Nursing Extension Service as a new training and support structure. (See attached diagrams). A broad spectrum of programs was proposed for the Community Nursing Service System. These were designed to establish a balance of activities between the clinic-centered individual care component and the field activity-centered educational and supportive component of health care services. Examples of possible program alternatives and proposed guidelines for health care in specific situations were presented, as well as the roles and functions of the key health personnel within the Community Nursing Service System. This Rural Health Service Model was proposed as a real alternative to the maldistributed, inequitable, uncoordinated solo-practice, physician-centered fee-for-service health care available to Koreans today.