Development of Korean Nurse Residency Program for Tertiary Hospitals / 임상간호연구

Purpose@#The purpose of this study was to develop a Korean Nurse Residency Program (KNRP) in order to facilitate new nurses’ transition to clinical practice working at tertiary hospitals in Korea. @*Methods@#The KNRP was developed through a literature review, investigation of NRP cases in United States, two rounds of expert consultation, and appropriateness survey. For appropriateness survey of the program, a questionnaire with 118 items and 14 subcategories including overview and operation of KNRP, education programs, staffing criteria for new nurses’ education, preceptor supporting strategies, evaluation standards for new nurse’s education, infrastructure, and KNRP benefits was used. Data were collected from 369 nurses including nurse educators, nurse managers, preceptors, and new nurses working at 43 tertiary hospitals in Korea from February 16, 2021 to March 22, 2021. Data were analyzed with descriptive statistics. @*Results@#Appropriateness score of KNRP was 3.42±0.31 (out of 4) and those of 14 subcategories ranged from 3.18±0.47 to 3.58±0.46. The final version of the KNRP postulated is a one-year program, which is composed of off-job training and on-site training including preceptorship over 3 months, and competency reinforcement and adaptation supporting programs. @*Conclusion@#The application of the one-year KNRP will facilitate new graduate nurses’ transition to clinical practice. In order for effective application of the KNRP, cooperative efforts of the government, professional associations, and hospitals are needed.

Development of Korean Nurse Residency Program for Tertiary Hospitals / 임상간호연구

Purpose@#The purpose of this study was to develop a Korean Nurse Residency Program (KNRP) in order to facilitate new nurses’ transition to clinical practice working at tertiary hospitals in Korea. @*Methods@#The KNRP was developed through a literature review, investigation of NRP cases in United States, two rounds of expert consultation, and appropriateness survey. For appropriateness survey of the program, a questionnaire with 118 items and 14 subcategories including overview and operation of KNRP, education programs, staffing criteria for new nurses’ education, preceptor supporting strategies, evaluation standards for new nurse’s education, infrastructure, and KNRP benefits was used. Data were collected from 369 nurses including nurse educators, nurse managers, preceptors, and new nurses working at 43 tertiary hospitals in Korea from February 16, 2021 to March 22, 2021. Data were analyzed with descriptive statistics. @*Results@#Appropriateness score of KNRP was 3.42±0.31 (out of 4) and those of 14 subcategories ranged from 3.18±0.47 to 3.58±0.46. The final version of the KNRP postulated is a one-year program, which is composed of off-job training and on-site training including preceptorship over 3 months, and competency reinforcement and adaptation supporting programs. @*Conclusion@#The application of the one-year KNRP will facilitate new graduate nurses’ transition to clinical practice. In order for effective application of the KNRP, cooperative efforts of the government, professional associations, and hospitals are needed.

New Graduate Nurses' Satisfaction with Transition Programs and Experiences in Role Transition / 임상간호연구

PURPOSE@#The aim of this study was to investigate the satisfaction of newly graduated nurses with educational programs and their experiences in role transition.@*METHODS@#Data were collected from November 1 to December 15, 2018 and 483 new graduate nurses working at 15 tertiary hospitals and 10 general hospitals participated. For data collection, self-report questionnaires including the Casey-Fink Graduate Nurse Experience Survey tool and satisfaction with education were used. Data were analyzed using descriptive statistics, t-test, and one-way analysis of variance.@*RESULTS@#Satisfaction with education ranged from 3.09 to 3.27, and satisfaction with preceptors was 3.45(maximum 4). The skill that new nurses ranked as most difficult during the first 3 months was charting/documentation, and throughout a whole year, the top 4 difficult skills were cardiopulmonary resuscitation/emergency response, ventilator care, end-of-life care, and prioritization/time management. In comfort/confidence, new graduates felt most comfortable with support and least comfortable with patient safety. More than 50 percent of new graduates experienced stress during role transition, and the most frequently experienced stressors were related to job performance and personal life. Levels of satisfaction with education and comfort/confidence differed according to the hospital type and number of preceptors for new nurses.@*CONCLUSION@#In order to facilitate the transition of new graduate nurses to professional nurse, an extended period of education, systematic and standardized transition programs, and continuous support during the first year of practice are required.

Revised Clinical Ladder System Model Based on Nurses' Clinical Competence and Professional Activities for Nurses in General Hospitals / 임상간호연구

PURPOSE: The purpose of this study was to propose a revised Clinical Ladder System(CLS) Model for nurses based on the evaluation of clinical competence and professional activities of nurses working in general hospitals. METHODS: Data were collected between September 10 and October 30, 2017. Participants were 50 head nurses from 10 general hospitals with over 400 beds located in Seoul City and Gyeonggi Province. Each head nurse evaluated clinical competence, qualifications, and professional activities of 5 staff nurses at each of the 5 levels of CLS in her unit. The total number of the nurses evaluated was 245. Data were analyzed with descriptive statistics and t-test, one-way ANOVA, and Scheffé. RESULTS: Over 80% of the nurses were university graduates. As the CLS levels increased, clinical competence, qualifications, and professional activities also increased significantly. Education material development and quality improvement activities were carried out by nurses from level 2, research and evidence based practice activities were carried out from level 3, and nurses at level 4 or 5 participated in most of the professional activities as leaders. CONCLUSION: In order to retain excellent nurses in general hospitals, recognizing and rewarding nurses according to the revised model of the CLS are recommended.

Validity and Applicability of Clinical Ladder System Model for Nurses / 임상간호연구

PURPOSE: The purpose of this study was to verify the validity and applicability of the Clinical Ladder System(CLS) Model for nurses and to suggest a model for nurses in general hospitals as well as tertiary hospitals. METHODS: After refining questionnaires through focus group participation, a survey was carried out with 50 nurse managers and 500 staff nurses from 6 tertiary hospitals and 4 general hospitals. S-CVI and i-CVI for validity and applicability were calculated. Differences in validity and applicability by the type of hospitals and characteristics of respondents were analyzed using t-test and ANOVA. RESULTS: S-CVI for validity and applicability of the CLS model were over 0.8 in two types of hospitals and the validity and applicability of the CLS model were confirmed. No differences were found in the total score for validity between the 2 types of hospitals, but in applicability, general hospitals had significantly lower applicability than tertiary hospitals. Some items showed difference according to characteristics of the respondents. CLS models were postulated based on the study results. CONCLUSION: The CLS model refined through this study can be used for nurses. In application, modifications are needed according to the conditions of each hospital.

Risk Factors for Pediatric Inpatient Falls

PURPOSE: The purpose of this study was to identify risk factors for pediatric inpatients falls. METHODS: The study was a matched case-control design. The participants were 279 patients under the age of 6 who were admitted between January 1, 2004 and December 31, 2009. Through chart reviews, 93 pediatric patients who fell and 186 ones who did not fall were paired by gender, age, diagnosis, and length of stay. Five experts evaluated the 38 fall risk factors selected by the researchers. RESULTS: In a general hospital, pediatric patients with secondary diagnosis, tests that need the patient to be moved, intravenous lines, hyperactivity, anxiolytics, sedatives and hypnotics, and general anesthetics showed significance for falls on adjusted-odds ratios. Conditional logistic regression analysis was performed to elucidate the factors that influence pediatric inpatient falls. The probability of falls increased with hyperactivity and general weakness. Patients who didn't have tests that required them to be moved and intravenous line had a higher risk of falls. CONCLUSION: These findings provide information that is relevant in developing fall risk assessment tools and prevention programs for pediatric inpatient falls.

A Comparison of the Rates of Hemolysis and Repeated Blood Sampling using Syringe needles versus Vacuum tube needles in the Emergency Department

PURPOSE: This study was done to compare the rates of hemolysis and repeated sampling in blood samples obtained by a syringe needle versus a vacuum tube needle. METHODS: A randomized, prospective study was used to evaluate the differences between the two blood sampling methods. The study group consisted of patients seen in the emergency department (ED) for blood sampling to determine electrolyte level. ED patients were randomly assigned to either the syringe group or the vacuum tube group. All blood samples were collected by experienced ED nurses and hemolysis was determined by experienced laboratory technologists. Data were analyzed using Fisher's exact test and binary logistic regression. RESULTS: One hundred forty-five valid samples were collected (74 in the syringe group versus 71 in the vacuum tube group). 5 of 74 (6.8%) blood samples in the syringe group and 8 of 71 (11.3%) in the vacuum tube group hemolyzed. Repeated blood sampling occurred for 2 of 74 (2.7%) and 3 of 71 (4.2%) in each group respectively. There were no significant differences in rates of hemolysis and repeated sampling between two groups (B=1.97, p=.204; B=2.36, p=.345). CONCLUSION: Venipuncture with syringe needles can be recommended for ED nurses to obtain blood samples.

The Effects of Foot Reflexology on Peripheral Neuropathy, Symptom Distress, Anxiety and Depression in Cancer Patients Treated with Oxaliplatin

PURPOSE: This study was done to clarify the effects of foot reflexology on peripheral neuropathy, symptom distress, anxiety and depression in cancer patients treated with oxaliplatin. METHODS: A quasi-experimental design was employed. Changes in the variables were evaluated to test the effects of foot reflexology. Participants were cancer patients treated with oxaliplatin (experimental group 14 and control group 17). Peripheral neuropathy, symptom distress, anxiety and depression were measured before and after reflexology. Data were collected from October, 2010 to April, 2011. chi2-test, Fisher's exact test, t-test, Wilcoxon signed rank test and the Mann-Whitney U test were used to analyze the data. RESULTS: The experimental group who received foot reflexology experienced less peripheral neuropathy and symptom distress than the control group. There was no difference in anxiety and depression between the experimental and control group. CONCLUSION: The foot reflexology program adopted in this study was found to be an effective method to reduce peripheral neuropathy and symptom distress. We recommend foot reflexology for patients with chemotherapy induced peripheral neuropathy.

Evaluation of the Bar Code Medication Administration and Blood Transfusion System in a Tertiary Hospital / 간호행정학회지

PURPOSE: The purpose of this study was to assess the clinical application of a bar code medication administration and blood transfusion system and to identify its effects from the aspect of patient safety and nurse satisfaction in a tertiary hospital. METHODS: The system in this study was PDA with bar code reading capability and wireless networking function. The logs created during application of the system and administration error reports were analyzed. For nurses' satisfaction with the system, data were collected from 337 nurses using the instrument developed by Otieno et al. and analyzed using descriptive statistics. RESULTS: The system application rate was 98.8%, and the main failure cases in the system application included bar code or network related factors. When the system was applied, 0.02% of errors were prevented. The nurses were satisfied with the system from the aspect of patient safety, however relatively less satisfied with the system from the aspect of work efficiency. CONCLUSION: The results of the study indicate the usefulness for patient safety of applying the bar code medication administration and blood transfusion system to clinical practice. However technological improvements including bar code and network communication are necessary to ensure higher work efficiency in nursing practice.

Nurses' Perceptions regarding Evidence-Based Practice Facilitators in a Tertiary Hospital / 기본간호학회지

PURPOSE: The purpose of this study was to investigate facilitators of evidence-based practice (EBP) in Clinical Nurses. METHOD: The instruments used in study were the EBP facilitator scale developed by Nagy et al. and a questionnaire on EBP-related characteristics. Data were collected from 230 nurses at a tertiary hospital and analyzed by descriptive statistics. RESULTS: Compared to previous studies, this study showed that nurses had more experience related to research courses and clinical research. However, the proportion of nurses who reviewed relevant articles still remained low. The respondents had positive perceptions of organizational supports for EBP and belief in the value of EBP, whereas they had negative perceptions of skills in locating and evaluating research reports, knowledge of research terms and statistics, and time to devote to EBP. CONCLUSION: The findings of the study provide important basic data to develop and implement an EBP programs. In future, EBP programs should cover the nurses' skills to search and review research literature as well as their knowledge of research terms and statistics. Furthermore, nurses will require help to ensure that there is adequate time to devote to EBP.

Anxiety and Depression among North Korean Young Defectors in South Korea and Their Association with Health-Related Quality of Life

PURPOSE: This study examined anxiety and depression among 108 North Korean adolescent and young adult (age, 12-29 years) defectors who settled in South Korea, and evaluated the relationship between their mental health and health-related quality of life (HRQoL). MATERIALS AND METHODS: Subjects completed a questionnaire that included the Hospital Anxiety and Depression Scale (HADS), the Short Form with 36 questions (SF-36; consists of mental and physical health components) for measuring HRQoL, and items related to the period of time since defection and settlement and socio-demographic variables. RESULTS: Among the participants, 53.7% scored> or =8 on the anxiety measure questionnaire, and 22.2% scored> or =11; 36.1% of the participants scored> or =8 on the depression measure questionnaire and 14.8% scored> or =11. Both anxiety and depression subscales were associated with lower scores of total SF-36, physical component and mental component score. Depressive symptom appeared more frequently among the subjects who had lived in South Korea for <1 year than among the subjects who had lived in South Korea for 2 year or longer (odds ratio=3.77, 95% confidence intervals=1.12 to 12.70). CONCLUSION: Among North Korean adolescent and young adult defectors, anxiety and depression were associated with lower HRQoL. Therefore, it is needed to develop strategies to screen for mental health and intervene to reduce anxiety and depression during their early resettlement stage.

Importance, Satisfaction and Contribution of Advanced Practice Nurses' Role Recognized by Health Care Professionals / 간호행정학회지

PURPOSE: The purpose of this study was to identify level of recognition of the importance, satisfaction and contribution of APNs' role by physicians, nurses, and advanced practice nurses. METHOD: Perceived importance and satisfaction were measured with a 23-item questionnaire on APN role with 5 subcategories. APNs' contribution was investigated using a 13-item outcome questionnaire developed by the researchers. Between August 15 and October 31, 2009, the researchers collected data from 68 physicians, 265 nurses, and 23 APNs all working in a single tertiary hospital. Data were analyzed using descriptive statistics, Kruskal-Wallis Test with Bonferroni's Correction and scatter plot. RESULT: The importance (3.24~3.39, 4 point scale), satisfaction (3.02~3.13, 4 point scale), and contribution of APNs' role (3.39~4.12, 5 point scale) were well recognized by the health care professionals. All the three health care professional groups rated APNs' contribution high in medical service management, continuity of care, patient accessibility, improvement in patient satisfaction, and patient and family education. 'Importance-Satisfaction Analysis' showed that patient data management by APNs needed greater effort. CONCLUSIONS: The findings show that the importance, satisfaction, contribution of APNs' role are recognized, and indicate a need for further development of APNs' role through efforts to overcome the gaps identified through this research.

Medication Status and Adherence of the Elderly under Home Care Nursing

PURPOSE: This study is a descriptive research intended to clarify the medication status of community-dwelling elders and to identify factors affecting their medication adherence. METHODS: Data were collected using questionnaires and interviews from 101 subjects who had taken prescribed drugs for at least 7 days sampled among elderly people using home care nursing at a general hospital in Seoul. RESULTS: According to the results of this study, medication adherence measured by pill counting was 88.3% and that measured by self-reporting was 94.6%. There were statistically significant differences in medication adherence according to major disease (p=.006), the number of admissions (p=.032), the number of drugs (p=.051), the frequency of medication (p=.026), and depression (r=-.205). In addition, depression was found to be a significant variable explaining the medication adherence with explanatory power 3.8% (p=.035). CONCLUSION: The presence of depression affected the elderly subjects' the medication adherence. Therefore, more concern and educational approaches are required to encourage elderly people to comply correctly with medication regimens particularly for elderly patients who have a malignant or long-lasting disease or who have to take multiple drugs or maintain a daily dosing frequency.

Effects of Nei-Guan Acupressure on Nausea, Vomiting and Level of Satisfaction for Gynecological Surgery Patients Who Are Using a Patient-Controlled Analgesia

PURPOSE: This study was done to examine effects of Nei-Guan acupressure on nausea, vomiting and level of satisfaction for gynecological surgery patients who were using a patient-controlled analgesia (PCA). METHODS: For this study, 51 patients were assigned to one of three groups, a control group (17 patients), experimental group 1 (finger acupressure group) (17 patients), and experimental group 2 (relief band group) (17 patients). The data were collected for 24 hr in the recovery room of a university hospital located in Seoul. The 6 hr-intervals including the time of leaving the recovery room were taken into consideration. RESULTS: The occurrence of nausea between the experimental group with Nei-Guan acupressure treatment and the control group was different. However, there was no difference in nausea and vomiting control or level of patient satisfaction between the finger acupressure group and the relief band group. CONCLUSION: Nei-Guan acupressure is recommended for nursing practice as a way for alleviating the opioid-induced nausea and accelerating the recovery of patients who are using PCA after surgery.

Identification and Validation of Symptom Clusters in Patients with Hepatocellular Carcinoma

PURPOSE: The purpose of this study was to identify cancer-related symptom clusters and to validate the conceptual meanings of the revealed symptom clusters in patients with hepatocellular carcinoma. METHODS: This study was a cross-sectional survey and methodological study. Patients with hepatocellular carcinoma (N=194) were recruited from a medical center in Seoul. The 20-item Symptom Checklist was used to assess patients' symptom severity. Selected symptoms were factored using principal-axis factoring with varimax rotation. To validate the revealed symptom clusters, the statistical differences were analyzed by status of patients' performance status, Child-Pugh classification, and mood state among symptom clusters. RESULTS: Fatigue was the most prevalent symptom (97.4%), followed by lack of energy and stomach discomfort. Patients' symptom severity ratings fit a four-factor solution that explained 61.04% of the variance. These four factors were named pain-appetite cluster, fatigue cluster, itching-constipation cluster, and gastrointestinal cluster. The revealed symptom clusters were significantly different for patient performance status (ECOG-PSR), Child-Pugh class, anxiety, and depression. CONCLUSION: Knowing these symptom clusters may help nurses to understand reasonable mechanisms for the aggregation of symptoms. Efficient symptom management of disease-related and treatment-related symptoms is critical in promoting physical and emotional status in patients with hepatocellular carcinoma.

A Comparative Study on the Effects on Urinary Incontinence between Pelvic Floor Muscle Exercise and Magnetic Stimulation Therapy

PURPOSE: To Perform a randomized comparative study investigating the effects of Pelvic Floor Muscle Exercise(PME) and Magnetic Stimulation Therapy(MST) and to identified the problems in each of PME & MST. METHOD: Forty-nine patients with mild stress incontinence were randomly assigned to either of two treatment groups (24 patients in the PME group and 25 in the MST group). The PME group had a video exercising program for 40 times every day during 6 weeks. The MST group was treated with BioCon-2000TM, 2 times/week for six weeks. Pre-test and post-test were performed by Prineometer, 1-hour pad test. and Jackson's BFLUTS questionnaire of Jackson. Collected data were analysed using SAS 9.1 by frequency, Kolmogorov-Smirnov Z. Chi-Square-test, t-test, Fisher Exact probability test, Paired t-test, and Wilcoxon's rank sum test. RESULTS: In comparison between before and after PME and MST, statistically significant difference was observed in maximal vaginal pressure, duration of vaginal contraction, amount of urine, and symptom of urination. In the comparison of the effectiveness between PME & MST, only the maximal of vaginal pressure (Z=2.58, p=.010) was significantly different. CONCLUSION: The factor more effective in the MST group than in the PME group was high compliance.

The Perceived Importance and Performance Frequency of Nursing Interventionsin the Oncology Units in a Tertiary Hospital / 성인간호학회지

PURPOSE: This study was performed to understand the perceived importance and performance frequencies of nursing interventions and identify the core and major interventions in oncology units. METHODS: Questionnaires using 151 nursing interventions were given to 45 nurses. The performance frequency was measured through the database of the nursing process recording system for 1 year. RESULTS: The perceived importance of the nursing interventions averaged out to be 3.5 among 4 and on average 36.5 times of nursing interventions were performed on each patient. Fifteen core nursing interventions including 'pain management' were identified and they made up 82.7% of the entire performance frequency rate. And 26 interventions including 'drug administration: Amphotericin-B' were identified as major nursing interventions and occupied 10.6% of the entire performance frequency rate. CONCLUSION: Since the core and the major nursing interventions were identified and these occupied 93.3% of the all nursing interventions, these results can be utilized as baseline data for establishing the guidelines and standards of nursing interventions and providing systematic education for oncology nurses in Korea.

A Comparison of Efficiency between Computerized Nursing Records and the Paper-based Nursing Records: focus on patients with a stroke / 기본간호학회지

PURPOSE: This study was a comparative review of the computerized nursing records and paper-based nursing records to examine effects of a nursing process documentation system focusing on patients who have had stroke. METHOD: First, the researchers collected all the foci from the computerized records and the paper-based records. They selected ten nursing foci, used frequently in both groups and analyzed the number of foci per patient, appropriateness of foci, the number of nursing activities per nursing focus and whether outcomes were described or not in the nursing record. RESULTS: There was fewer errors in nursing diagnosis selection, and a larger number of activities in the records than the paper based ones. Also, there was a better description of the nursing outcomes in the computerized records. CONCLUSION: This study suggests that the computerized nursing records is significantly effective in increasing accuracy of the nursing care plan and quality of the nursing record.

User Satisfaction of Nursing Information System / 대한의료정보학회지

OBJECTIVE: User satisfaction of nursing information system and its user interface were measured in the S general hospital which new electronic medical record system had been introduced to. The new system had been developed based on nursing job's analysis. METHODS: 487 nurses who were working in the S hospital joined to survey through QUIS (Questionnaire for User Interface Satisfaction) about satisfaction of system they used. There were 4 categories-convenience, rapid response, content/configuration, accuracy of information. Those 4 categories were used analytical factors to know how the users were satisfied with its interface and function through the selected 13 system interfaces. RESULTS: With 9 scales of satisfaction score, we measured the satisfaction that the hardware provided. Terminology and system information got the highest score, and user friendly interface, easiness of learning, system performance in high score order. As like as above, we defined 5 scales of user interface satisfaction score. Content, configuration, information accuracy, convenience, rapid responses were identified as analytic categories. With interface satisfaction aspect, the pages which were reconfigured from physician order page to nurse interface got the highest score. And content and page configuration were acknowledged as the highest place. CONCLUSION: This study showed the nurses were satisfied with nursing information system. Also the trend of system development can be revealed.

The Study on the Medical and Nursing Service Needs of the Terminal Cancer Patients and Their Caregivers / 간호학회지

In this study, we attempted to investigate the needs and problems of the terminal cancer patients and their family caregivers to provide them with nursing information to improve their quality of life and prepare for a peaceful death. Data was collected from August 1, 1995 to July 31, 1996 at the internal medicine unit of S hospital in Seoul area with the two groups of participants who were family members of terminal cancer patients seventy four of them were in-patients and 34 were out-patients who were discharged from the same hospital for home care. The research tool used in this study has been developed by selecting the questionnaires from various references, modifying them for our purpose and refining then based on the results of preliminary study. While general background information about the patients was obtained by reviewing their medical records, all other information was collected by interviewing the primary family caregivers of the patients using the questionnaire. The data collected were analyzed with the SPSS PC+ program. The results of this study are summarized as follows; 1) Most frequently complained symptoms of the terminal cancer patients were in the order of pain(87%), weakness(86.1%), anorexia(83.3%) and fatigue(80.6%). 2) Main therapies for the terminal cancer patients were pain control(58.3%), hyperalimentation(47.2%) and antibiotics(21.3%). 3) Special medical devices that terminal cancer patients used most were oxygen device(11.1%), and feeding tube(5.6%). Other devices were used by less than 5% of the patents. 4) The mobility of 70.4% of the patients was worse than ECOG 3 level, they had to stay in bed more than 50% of a day. 5) Patients wanted their medical staffs to help relieve pain(45.4%), various physical symptoms(29.6%), and problems associated with their emotion(11.1%). 6) 16.7% of the family caregivers hoped for full recovery of the patients, refusing to admit the status of the patients. also, 37% wished for the extension of the patient's life at least for 6 months. 7) Only 38.9% of the family members was preparing for the patient's funeral. 8) 45.4% of family caregivers prefer hospital as the place for the patient's death, 39.8% their own home, and 14.8% undetermined. 9) caregivers of the patients were mostly close family members, i.e., spouse(62%), and sons and daughters or daughter-in-laws(21.3%). 10) 43.5% of the family caregivers were aware of hospice care. 46.8% of them learned about the hospice care from the mass media, 27.7% from health professionals, and the rest from books and other sources. 11) Caregivers were asked about the most difficult problems they encounter in home care, 41 of them pointed out the lack of health professionals they can contact, counsel and get help from in case of emergency, 17 identified the difficulty of finding appropriate transportation to hospital, and 13 stated the difficulty of admission in hospital as needed. 12) 93.6% of family caregivers demanded 24-hour hot line, 80% the visiting nurses and doctors, and 69.4% the volunteer's help. The above results indicate that terminal patients and their family caregivers demand help from qualified health professionals whenever necessary. Hospice care system led by well-trained medical and nursing staffs is one of the viable answers for such demands.