• Journal of Korean Critical Care Nursing
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• v.8 no.2
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• pp.55-65
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• 2015

Purpose: The purpose of this study was to identify the attributes, antecedents, and consequences of post-intensive care syndrome. Methods: The study was conducted in accordance with Walker and Avant's conceptual analysis process. We searched the Medline, ProQuest, Google scholar, NANET (Korean National Assembly Library), and RISS (Korean Education and Research Information Service) databases resulting in 29 studies for in-depth review. Results: The attributes of post-intensive care syndrome include (1) new or worsening impairment persisting after discharge, (2) physical impairment, (3) psychological impairment, (4) cognitive impairment, and (5) symptom experience. The antecedents of the concept include a critical condition that requires intensive care, stressful events, immobility, sedation, delirium, insomnia, frailty, and invasive procedures. The consequences of post-intensive care syndrome are increased dependency in activities of daily life, decreased social interaction, delayed return to previous occupation, decreased quality of life, familial post-intensive care syndrome, and readmission/death. Conclusion: The concept of post-intensive care syndrome has multifaceted and integrative features. Further research needs to be conducted to develop a measurement tool that reflects the attributes of the concept and to develop multidisciplinary interventions to prevent post-intensive care syndrome.

• Journal of Korean Critical Care Nursing
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• v.13 no.3
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• pp.75-85
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• 2020

Purpose : This study aimed to identify the prevalence and risk factors of cognitive impairment in survivors discharged from the intensive care unit (ICU). Methods : This secondary analysis study utilized data from a multicenter prospective cohort of post-ICU patients. We analyzed the data of 175 patients enrolled in the primary cohort who completed the cognitive function evaluation three months after ICU discharge. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) scale. The cut-off points for cognitive impairment were < 23 for face-to-face evaluation and < 18 for telephone evaluation. Results : The prevalence of cognitive impairment three months after ICU discharge was 32.6%. Significant risk factors for cognitive impairment were age ≥ 60 years (OR=10.52, 95% CI=3.65~30.33, p<.001), education < high school graduation (OR=2.53, 95% CI=1.07~6.01, p=.035), unplanned ICU admission (OR=4.01, 95% CI=1.45-11.14, p=.008), and delirium in the ICU (OR=4.33, 95% CI=1.08-17.23, p=.038). Conclusion : ICU nurses should use preemptive strategies to reduce post-ICU cognitive impairment of patients with risk factors. It is necessary to frequently assess and detect early delirium in critically ill patients, while attempting various non-pharmacological interventions.

• Journal of Korean Academy of Nursing
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• v.28 no.1
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• pp.117-131
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• 1998

The purpose of this study was to develop a critical pathway for case management for patients who have received Coronary Artery Bypass Graft (CABG) because of Ischemic Heart Disease(IHD) which is a factor of rising medical expenses. For this study. a conceptual framework was developed through a review of the literature including six critical pathways which are currently being used in USA. In order to identify the overall service contents required by these patients and to draw up a preliminary critical pathway, 30 cases of medical records of patients who had CABG because of IHD between January, 1995 to June. 1996 at the Cardiovascular Center of Yonsei Medical Center in Seoul were analyzed. An expert validity test was done for the preliminary critical pathway and clinical validity test was also done using seven IHD patients with CABG between November 11 and 23, 1996. After these processes. the final critical pathway was developed. The results of this study are summarized as follows : 1. The vertical axis of the critical pathway includes the following eight items : tests, nutrition, medications, consultations, activity, assessments, treatments, education discharge planning and the horizontal axis includes the time from the start of hospitalization to discharge. 2. Analysis of the 30 medical records indicated that the average length of stay was 20.2days with the average length of stay from hospitalization day to operation day being 6.2 days, and the average length of stay from operation day to discharge day was 13. 9 days. Analysis of the service contents showed that the horizontal axis of the preliminary critical pathway was set from hospitalization to the 14th post operation day and the vertical axis was set to include eight items, the contents which ought to have occurred, according to the time frames of the horizontal axis. 3. As a result of the experts validity, it was found that among the total of 571 items. there was over 83% agreement for 482 items, less than 83% for 89 items, which were then deleted and a revision of the critical pathway was done. 4. A clinical validity test was done using seven IHD patients with CABG. During the process, three patients were deleted because they were out of the criteria the investigator set. Finally, four patients were used. The result of study indicated that only one patient was discharged on the tenth post operation day, which was one day later than the expected day. Three patients were discharged later than the expected day from three days to nine days. All the cases progressed on schedule until the operation day and the first post operation day, but from the second post operation days, there were differences between the critical pathway and the actual practice. The differences came from tests, assessments, and treatments. 5. On the basis of the results of the clinical validity test. the following revisions in the final critical pathway were made : the transfer from ICU to step down ward would be the second post operation day, and the transfer to a general ward, the fifth post operation day, for patients who complained of lack of sleep from the fifth post operation day to discharge, a sleeping pill would be prescribed, skin observations would be performed routinely from immediately after the operation until the third post operation day, and would continue if there was a sign of skin injury on the fourth post operation day, and assessment of chest pain would be done from the third post operation day, and the “stairs climbing” item, expected to be done on the ninth post operation day would be deleted. In conclusion, this critical pathway is partially applicable to the care of patients with CABG but there are some parts needed to be further investigated.

• Women's Health Nursing
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• v.16 no.4
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• pp.409-418
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• 2010

Purpose: The purpose of this study was to identify the effects of a pre-operation video assisted education program on residual urine, gas passing and state anxiety in women undergoing hysterectomy. Methods: Nonequivalent control group non-synchronized design was used for the study. In the research, video assisted education program was applied to the experimental group while a similar conventional education was done to the control group. The pre-operation state anxiety and post-operation residual urine and gas discharge of both the groups were measured. The data were analyzed using SPSS. Results: The experimental group was significantly higher than control group on gas passing (t=3.04, p=.00). However the residual urine (t=0.34, p=.73) and state anxiety (t=0.81, p=.82) did not make significant differences. Conclusion: This study is very meaningful in that it developed and provided a nursing intervention can positively affect hysterectomy patients. The pre-operation video assisted education program may be an effective nursing intervention that is clinically practical and useful to reduce time of the gas passing of hysterectomy patients after the operation.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.1 no.1
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• pp.172-177
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• 1990

The reverse of reinforcement technique was used in treating rumination of a 12-year old (estimated age) mentally retarded child in a residential setting. The subject's rumination pattern was first to vomit the food onto the floor and then to eat it back in several attempts. Consequently, the way to reverse the contingency of rumination in this child was to take away the discharge whenever rumination occurred. An ABAB single subject design was adopted to evaluate the treatment effect. In baseline 1 the frequency of his rumination for 2.5 hours after eating was an average of 46(range= 30-62), while decreased to 6.7 in treatment condition 1. However, when the discharge was not taken away in baseline 2, his rumination increased to 34 times and then decreased to zero to 1 time when the reverse of reinforcement was reinstituted in treatment condition 2. The results clearly indicate that the reverse of reinforcement which was implemented in the form of removing the discharge from the floor was successful. It was reported that the treatment effect has been maintained over 10 months post treatment.

• Journal of the Korea Convergence Society
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• v.9 no.6
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• pp.311-319
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• 2018

The purpose of this study was to identify the degree of uncertainty, uncertainty appraisal, and self-efficacy in pre-discharge arthroscopic patients and to investigate the effects of their uncertainty. This study was carried out from April to October 2016 as a descriptive research study. The subjects were presented with pre-discharge convenience sampling after arthroscopic surgery. The data of 131 patients were analyzed by t-test, ANOVA and Scheffe post-test, Pearson correlation coefficient calculation and multiple regression analysis using SPSS 18.0. As the results of this study, education level, presence of spouse, preoperative korean traditional medicine treatment experience and self-efficacy were found to have significant effects on uncertainty. The results of this study suggest that in hospital and pre-discharge education program development to reduce patient uncertainty after arthroscopic surgery.

• Journal of Gynecologic Oncology
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• v.29 no.6
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• pp.92.1-92.9
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• 2018

Objective: To evaluate the effectiveness of the pulmonary recruitment maneuver (PRM) at the end of the operation to decrease laparoscopy-induced abdominal or shoulder pain after gynecological oncologic surgery. Methods: In total, 113 women undergoing laparoscopic surgery for malignant or premalignant gynecological lesions were assigned randomly to two groups: the PRM group (the patient was placed in the Trendelenburg position ($30^{\circ}$) and the PRM, consisting of two manual pulmonary inflations to a maximum pressure of $40cmH_2O$) (n=54) and the control group (n=52). Postoperative shoulder and abdominal pain was assessed 12, 24, and 48 hours later using a visual analog scale (0-10). In addition, the incidence of post-discharge nausea and vomiting was recorded until 48 hours after discharge. Results: Postoperative shoulder pain at 12 and 24 hours was significantly less severe in the PRM group ($2.2{\pm}0.5$ and $2.0{\pm}0.4$) than in the control group ($4.0{\pm}0.5$ and $3.9{\pm}0.4$; both p<0.001). The PRM significantly reduced the severity of upper abdominal pain at 12 and 24 h compared with the control group ($3.1{\pm}0.4$ and $2.9{\pm}0.4$ vs. $2.9{\pm}0.5$ and $4.9{\pm}0.5$; both p<0.001). The analgesic requirement during the postoperative period was similar in the two groups (control group, 78.8%; PRM group, 75.9%; p=0.719). Conclusion: The PRM effectively and safely reduced postoperative shoulder and upper abdominal pain levels in patients undergoing laparoscopic gynecological oncologic surgery. Trial registry at ClinicalTrials.gov, NCT01940042.

• Journal of Korean Clinical Nursing Research
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• v.23 no.3
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• pp.376-387
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• 2017

Purpose: This study was to systematically review the contents and effects of nurse-led transitional care programs for discharged patients from hospital to home. Methods: Randomized controlled trials published between 2005 and 2015 were searched in Pubmed, Embase, Cochrane(Central Register of Controlled Trials) and CINAHL. Data were analyzed using Cochrane Review Manager(Revman) software 5.3. Results: Nine studies were selected and analyzed. Patient assessment, education and discharge planning were included in pre-discharge phase. Referring, communication and care planning were performed by nurses in transition phase. Home and phone visits, monitoring and multidisciplinary advices were included in post-discharge phase. Various outcome measures such as hospital utilization(30 days readmission and emergency department visit), quality of life, and cost were used to identify effectiveness of nurse-led transitional care programs. 30 days readmission(OR=.73, 95% CI 0.54, 0.98; p=.03) and emergency department visit(OR=.67, 95% CI 0.50, 0.88; p=.005) were statistically significant in meta-analysis. However, participant blinding was not done in seven studies which put at the risk of performance bias. Conclusion: The results indicated that nurse-led transitional care program is effective in reducing unnecessary hospital utilization. Nevertheless, small sample size and risk at performance bias are the limitation of this study. Thus, we suggest that well-designed randomized controlled trials need to be conducted.

• The Korean Nurse
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• v.32 no.5
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• pp.78-92
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• 1994

The purposes of this study were to evaluate the results of the hospital self inspection with the medical insurance and to offer basic materials to the medical insurance inspection and the education of medical insurance. The study was undertaken with 4,730 cases among the total 13,810 medical insurance in patients from Jan. 1990 to Dec. 1990 at one university hospital in Pusan. The major contents of the inspection were the omission of diagnosis and medical fee, curtailment, application mistake, the rates of inclusion, subtraction and total accumulation. The data were collected using patients charts and bills. The results of the paper analysis were as follows. 1. From the pre-discharge hospital self inspection, major omission were treatment and material fee but medication fee were moderately high and high curtailment was operation fee. 2. Decreasing order of operation fee adjustment were digestive(22.4%) muscular(22%) and neuro system operation(21.4%). Majority of the medication fee adjustments were injection form of medication(95.7%). 50% of the treatment fee adjustments were composed of injection fee(27.9%) and dressing or post-operative dressing fee(22.3%). 74.7% of material costs were composed of oxygen(30.6%), blood and the blood composed materials(44.1%). 3. Pre-discharge inspection showed 6% adjustment rate, 4.3% addition and 2.1% curtailment rate. Most of the adjustment were omission(66.1%). 4. Omission were divided by event omission(92.6%)and application mistake(7.4%). The decreasing order of omission fee were operation(21.84%), treatment(18.71 %) diagnosis(18.68%), medication (14.53%) and material costs(10.84%). So operation and treatment part were the major part of the total omission fee(40.55%). 5. The average omission of diagnosis were 1,800 per month.

• Women's Health Nursing
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• v.21 no.4
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• pp.308-320
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• 2015

Purpose: The aim of this study was to determine the predictive factors for maternal role development for mothers of premature infants. Methods: A descriptive correlational study was conducted. A total sample of 121 mothers of premature infants following discharge from the neonatal intensive care unit were recruited using two strategies; an internet-based survey and an in-person data collection in a tertiary university hospital in Korea. A self-report questionnaire was used to collect data regarding personal, birth variables, marital intimacy, maternal attachment, maternal identity and maternal role development. Results: A hierarchical multiple regression analysis indicated that parity, maternal attachment, marital intimacy and maternal identity were predictors for maternal role development for mothers of premature infants, accounting for 70% of the variance. Among these variables, maternal attachment is the most powerful predictor for maternal role development. Conclusion: Nursing interventions during hospitalization to post-discharge education that includes parents of premature babies with positive interaction between couples strengthening marital intimacy and promotes maternal attachment that leads to integrate maternal identity should be considered by priority. Community-based family services such as home visits should be focused on maximizing the predictive factors for maternal role development in transition to motherhood that can contribute to maternal health as well as optimal growth and development of premature infants.