Characteristics of Fall Events and Fall Risk Factors among Inpatients in General Hospitals in Korea / 임상간호연구

PURPOSE: The purpose of this study was to investigate the present status of falls among inpatients in general hospitals and to identify the fall risk factors that reflect the characteristics of domestic hospitals. METHODS: Data were collected between December 15, 2016 and January 15, 2017 from 32 Korean hospitals having 500 or more beds. First, 42 risk factors were extracted based on literature review and expert opinions. Then the importance of each factor was evaluated by 223 nurses from medical and surgical adult ward and intensive care units in 40 hospitals. RESULTS: The incidence rate of falls in 18 hospitals was 3.87 per 1,000 total discharged patients and 0.55 per 1,000 patient-days, and the rate of injury-related falls was 40.5%. Major risk factors for falling were identified as the following: being over 65 years of age, history of falls during admission, physical mobility disorders requiring assistance, physical factors (dizziness or vertigo, unstable gait, general weakness, walking aids, visual problems), cognitive factors (delirium, lack of understanding on limitations), neurological disease, CNS medications CONCLUSION: The findings provide information that can be in the development of a fall risk assessment tool for inpatients in general hospitals in Korea.

Development of a Resource-based Relative Value Scale and Its Conversion Factor for Advanced Nursing Practices in the National Health Insurance

PURPOSE: The purpose of this study was to develop a resource-based relative value scale (RBRVS) and its conversion factor for advanced nursing practices carried out by critical care nurse practitioners (CCNP) in intensive care units. METHODS: The methodology was developed by calculating CCNP's RBRVS for 32 advanced nursing services based on CCNP's workload and time spent in the context of national health insurance. A cost analysis was performed to estimate the conversion factor of CCNP's RBRVS. The share of CCNP's contribution to fee-for-service in intensive care units was also analyzed. RESULTS: Calculation of the RBRVS of 32 advanced nursing practices showed a range of points from 100.0 to 1,181.4 and an average of 296.1 points. The relevant conversion factor for advanced nursing practices in CCNP were estimated at 37.3-48.4 won. The contribution rate of CCNP's advanced nursing practices in the relative value scale of the national health insurance was estimated at 0.1-31.3%. CONCLUSION: Measuring the economic value of advanced nursing services will be a basis for esta-blishing a reimbursement system for CCNP's practices and thus encourage a social demand for advanced nurse practitioners.

The Effects of Artificial Dead Space on the Pulmonary Ventilation of Intubated Children with Mechanical Ventilation / 간호학회지

This study was done to evaluate the effect reducing artificial dead space on intubated children. Data were collected from July 1st, 1998 to August 31st, 1999. The subjects were selected from a pediatric intensive care unit of 'S' hospital and intubated with 3.5 mm or 4.5 mm endotracheal tube after open heart surgery. They were composed of 34 patients : 17 patients were assigned to the experimental group and the rest of them were placed in the control group. The artificial airway volume was minimized in the experimental group, and the control group maintained the artificial airway volume. ETCO2, PaCO2, SPO2 were measured as indicators of pulmonary ventilation. The tools of this study were GEM-Premier and Space-Lab patient monitors. The data were analyzed using the SPSS/PC+ program. The Chi2 -test was used to find general characteristics. The t-test was used to test the homogenety of the pulmonary ventilation status and mechanical ventilation setting before intervention between the two groups. Also, the paired t-test was used to examine the hypothesis. The results can be summerized as : 1. CO2 can be expelled effectively from the body in case artificial dead space was decreased. 2. As the artificial dead space was reduced, the difference between ETCO2 and PaCO2 was decreased, in other words pulmonary ventilation was improved. 3. If the artificial dead space occupied above 15 percent of tidal volume, the effect of CO2 was retention revealed in the body. 4. If the artificial dead space occupied below 1.5 percent of tidal volume, there was no dead space effect. Based on the results, the following is suggested to be applied practically : 1. A kind of the ventilator circuit acting artificial dead space should be removed from the intubated children with mechanical ventilaion. 2. The endotracheal tube should not be cut because extra-body space of the endotracheal tube did not have an effect on the dead space of the intubated children. Since the researcher could not cover this aspect in the study, they recommend the following. 1. The study should be extended to the other pulmonary disease patients for the effect of improving pulmonary ventilation. 2. Also, further studying with a more narrow interval in the extra-body space of the artificial airway will be able to explain the point of artificial dead space with proper ventilation.

The effects of music therapy on vital signs and pulsatile oxygen saturation of pediatric intensive care unit children / 기본간호학회지

This study was attempted to prove the effect of emotional stability and vital signs applying music therapy program to the children admitted in the PICU. Data were collected from July to September, 1997. The subjects were 30 patients admitted in the PICU of 'S' University Hospital which were divided into two groups of experimental and control. Each group had 15 subjects. Method was nonequivalent control group pretest-postteset repeated design, observing vital signs and activity of subjects prior, during, and after the music intervention. The study tools were cassette tapes of "Mother's music whose babies want to listen" and Space-lab patient monitor. Data were analyzed using the SPSS/PC+; x2 test and t-test to analyze of the general characteristics; paired t-test to prove hypo-theses. Result were as follows; 1. Infants lower than seven months showed changing into stable vital signs from applying the music therapy, however infants from eight months to three-year old showed no change in vital signs. 2. Vital signs changed to stabilized condition in infants lower than seven months were heart rate and respiration rate. 3. The stability of vital signs during music therapy turned back to the previous state while terminating music therapy. 4. The effect of music therapy in the state of activity had on both infants group of lower than seven months and from eight months to three-year old, particularly more effective in the later group. I recommend follows on the base of above results; 1. As above results shows, listening to music is effective on infants and toddler, intervention with music therapy appropriate to chidlren's age is hot recommended. 2. Comparative study with noise blocking effect and music therapy effect within the ICU environment be recommended. 3. The repeated study on when the exact time is and how many repeat the music therapy to show the above mentioned effect be recommended. 4. We recommend this music therapy to be done in the recovery room, isolating room, operating room as well as ICU.