Study for Revision of the Korean Patient Classification System / 임상간호연구

PURPOSE: The purpose of this study was to revise the KPCS-1 and to standardize the three patient classification systems for general ward, ICU and NICU. The actual utilization of the KPCS-1 score and each nursing activity was evaluated and the relationships between KPCS-1 score and nursing related variables were reviewed. METHODS: The 47,711 KPCS-1 scores of 6,931 patients who discharged from 1st to 30th April 2017 were analyzed and the statistical significance between KPCS-1 score and nursing related variables was reviewed by Generalized Estimating Equation. The revision of the KPCS-1 was carried out by Partial Least Square model. The 3 patient classification systems (KPCS-1,KPCSC and KPCSN) were standardized by professional reviews. RESULTS: KPCS-1 was a valid instrument to express nursing condition adequately and was revised as a new version which has 34 nursing activity items. The names and terminologies of pre-existing 3 patient classification systems developed by KHNA were standardized as KPCS-GW, KPCS-ICU, KPCS-NICU. CONCLUSION: KPCS-1 was a valid instrument to represent diverse nursing conditions precisely and was revised as a 34-item KPCS-GW. The terminologies of the other patient classification systems by KHNA were standardized as KPCS-ICU and KPCS-NICU.

Development of Staffing Levels for Nursing Personnel to Provide Inpatients with Integrated Nursing Care / 간호행정학회지

PURPOSE: To develop staffing levels for nursing personnel (registered nurses and nursing assistants) to provide inpatients with integrated nursing care that includes, in addition to professional nursing care, personal care previously provided by patients' families or private caregivers. METHODS: A time & motion study was conducted to observe nursing care activities and the time spent by nursing personnel, families, and private caregivers in 10 medical-surgical units. The Korean Patient Classification System-1 (KPCS-1) was used for the nurse manager survey conducted to measure staffing levels and patient needs for nursing care. RESULTS: Current nurse to patient ratios from the time-motion study and the survey study were 1:10 and 1:11, respectively. Time spent in direct patient care by nursing personnel and family/private caregivers was 51 and 130 minutes per day, respectively. Direct nursing care hours correlated with KPCS-1 scores. Nursing personnel to patient ratio required to provide integrated inpatient care ranged from 1:3.9 to 1:6.1 in tertiary hospitals and from 1:4.4 to 1:6.0 in general hospitals. The functional nursing care delivery system had been implemented in 38.5% of the nursing units. CONCLUSION: Findings indicate that appropriate nurse staffing and efficient nursing care delivery systems are required to provide integrated inpatient nursing care.

Analysis of the Nursing Practice in a Medical ICU Based on an Electronic Nursing Record / 간호학회지

PURPOSE: The purpose of this study was to identify the entity of critical care nursing practices through analyzing nursing statements described by electronic nursing records in a MICU. METHODS: 176,459 nursing statements of 188 patients during a 6 month-stay were analyzed statement by statement according to the nursing process(nursing phenomena, nursing diagnosis, & nursing activity) and 21 nursing components of Saba's Clinical Care Classification. RESULTS: Among 176,459 single statements, the statements of nursing activity ranked first in number. The contents of the statements were analyzed and categorized by main themes. Among 489 categorized themes, the number of themes of nursing phenomena statements was the highest. When analyzed by Saba's clinical Care Classification, the nursing statements mainly included a physiological component. Among 21 components, the respiratory component ranked in the first position in nursing phenomena, nursing diagnosis and nursing activity. The extra statements not included in the 21 components were 9,294(15.1%) in nursing phenomena and 21,949(22.7%) in nursing activity. Most are statements related to tests and the doctor. CONCLUSION: The entity of MICU nursing practice expressed by electronic nursing records was mainly focused on physiological components and more precisely on respiratory components.

Stages of Change in Smoking Cessation and Factors Related to Re-smoking after Coronary Artery Bypass Graft Surgery / 간호학회지

PURPOSE: The purpose of this study was to investigate the stages of change in smoking cessation after a Coronary Artery Bypass Graft(CABG) and to identify the related factors. METHODS: The subjects (n=157) were patients who underwent a CABG in a university hospital from March 1998 to October 2005 and were smokers before the CABG. Data was collected viachart review and a telephone interview, and analyzed with descriptive statistics, Chi2 test, one-way ANOVA, and Kruskal-Wallis procedure by the SPSS/PC win 12.0 program. RESULTS: The subjects smoked for an average of 34 years (21 cigarettes per day) before surgery. Eleven percent of the subjects were in pre-contemplation, 6.4% in contemplation, 13.5% in preparation, 4.5% in action, and 64.5% in the maintenance stage. Nicotine dependence and selfefficacy were different among the groups with different stages of change in smoking cessation. Nicotine dependence was the lowest (p=0.00) and self-efficacy was the highest (p=0.00) in the maintenance stage. The number of subjects in pre-contemplation and contemplation significantly increased 6 years after surgery(p=0.05). CONCLUSIONS: To implement effective smoking cessation interventions for CABG patients, the intervention should be developed to accommodate individual readiness for smoking cessation, especially so for those who had a CABG more than 6 years previously.

A Preliminary Survey of Nurses' Understanding of Delirium and Their Need for Delirium Education: In a University Hospital / 간호학회지

PURPOSE: The purpose of this survey was to investigate clinical nurses' understanding of delirium and their educational need of delirious patient care. METHOD: A survey questionnaire regarding nurses' general perception and understanding of delirium, experience with delirious patients and educational need was developed and conducted with 179 clinical nurses in a university hospital in Seoul. Data was analyzed using descriptive statistics. RESULTS: Nurses thought that delirium was one of the most important nursing problems and they considered it to be more treatable than to be preventable. However, the majority of nurses were not confident in caring for delirious patients. Nurses reported that delirium happened most often after surgery, and that possible contributing factors could be changes in physical environment and anxiety/stress, as well as medication and long-term isolation. Thirteen nursing interventions were identified but half of the nurses utilized only one or two of the thirteen. The most frequently used intervention was reorienting the patient followed by medication and emotional support, presenting family, and close observation. 99.5% of nurses addressed the importance of professional education on delirium care, especially in the area of intervention and management. CONCLUSION: The results support the strong need for development of a multi-component educational program on delirium care.

A Preliminary Report on the Differences in the Perceived Impacts of Undergraduate Bioscience Knowledge on Clinical Practice Among Korean RNs / 간호학회지

PURPOSE: Nursing has evolved as a unique and independent field over the last decades. Unfortunately, many nurses in Korea express concern that they lack appropriate background knowledge in bioscience necessary to practice nursing competently. To determine the reasons of their concerns, we examined the perceptions of RNs regarding bioscience courses in their undergraduate (Baccalaureate and 3 year diploma program) and their perceived relations to the practice of nursing. METHODS: The structured questionnaires were sent to 3 university-affiliated tertiary hospitals in Seoul, Korea. RESULTS: The responses given by the nurses in the two groups were similar. The nurses in this study reported that the bioscience courses they took as undergraduates had little relation to their professional tasks. This lack of link between bioscientific knowledge and nursing practice may be partly due to the fact that the courses are taught by non-nursing faculties who are not familiar with nursing tices. It also appears that bioscience knowledge deficit was most prominent during nursing assessment regardless of the program they attended or the unit they are currently working. CONCLUSION: Bioscience courses should be integrated into the nursing curriculum properly and taught by nursing faculty who have a strong background in biological sciences.

The Effects of Self-Efficacy Promoting Cardiac Rehabilitation Program on Self-Efficacy, Health Behavior, and Quality of Life / 간호학회지

BACKGROUND: Ischemic heart disease results from athesclerotic changes of the coronary artery. These changes are aggravated by hypercholesterolemia, smoking, obesity, lack of exercise, coronary-prone personality, and stress. Because these risk factors affect not only the prevalence of the ischemic heart disease but also recurrence of the disease, cardiac rehabilitation programs were introduced to help patients with ischemic heart disease reduce risk factors. Diverse cardiac rehabilitation programs are needed to motivate participation in cardiac rehabilitation and to enhance patients' quality of life. OBJECTIVES: To examine the effect of a self-efficacy promoting cardiac rehabiltation program on self-efficacy, health behavior and quality of life of patients with ischemic heart disease. METHODS: Data were collected from 45 hospitalized ischemic heart disease patients. Medical records were reviewed to obtain demographic and clinical characteristics. Data regarding self-efficacy, health behavior, and quality of life were obtained from interviews using structured questionnaires. The nonequivalent control group non-synchronized design was used to conduct this study. One session of conventional group education was given to patients in the control group while they were in the hospital. Patients in the experimental group participated in a newly developed cardiac rehabilitation program. It focused on strengthening selfefficacy with four self-efficacy sources - performance accomplishment, vicarious experiences, verbal persuasion and physical status using two individualized in-hospital education sessions and four weekly telephone counseling follow-up calls after discharge. RESULTS: Four weeks after discharge, the increment of total self-efficacy score was significantly higher in the experimental group than in the control group (p<.01). There was also a significant difference in the total quality of life scores increments between the two groups (p<.01). However, no significant changes were noted in the increments of total health behavior scores between the two groups. CONCLUSION: A cardiac rehabilitation program focusing on promoting self-efficacy was effective in improving self-efficacy, and quality of life of patients with ischemic heart disease.

Comparison between the Set and the Measured Tidal Volume in the Pediatric Patients Using the Adult Volume-Limited Ventilator / 대한마취과학회지

In the volume-cycled ventilator, the actual tidal volume delivered to the patient is influenced by the compression volume and elasticity of the circuit. The purpose of the present study is to compare the set tidal volume with the measured tidal volume, and calculate the compression factor of the ventilator. We studied twenty pediatric patients weighting above 10 kg. The set tidal volume ( V(r)), the exhaled volume displayed in the ventilator ( V(exh)) and the actual tidal volume measured by the Wright spirometer ( V(sp)) were compared. The results were as follows: 1) Mean tidal volume was 248+/-92 ml, mean exhaled volume was 233+/-102 ml and mean spirometer volume was 19+/-97 ml. Thus the set and the measured tidal volume were different significantly (p<0.05). but we may calculate the actual tidal volume by the relationship with the set tidal volume ( Vsp-1.03V(T) - 56 ) 2) Mean compression factor was 1.35+/-0.92 ml/cmH2O.