The Lived Experiences of Patient’s Families with the Intensive Care Unit Diary / 중환자간호학회지

Purpose@#: Intensive care unit (ICU) diaries have been implemented across the international ICU community. This study aimed to comprehend the meaning and nature of the lived experience of patients’ families using the ICU diary in Korea. @*Methods@#: This qualitative study adopted van Manen’s hermeneutic phenomenology. The participants comprised eight women and two men who were the family members of patients in the ICU for more than three days. Data were collected using in-depth interviews and observation from July 2018 to January 2019. @*Results@#: Patients’ families who experienced the ICU diary recognized it with six beings according to time: a good idea, forgotten stuff, burdensome work, touching service, my stuff, and a thing in the memory. The ICU diary had three essential meanings for the families: communication, solace and hope, and a record of life. These findings were rearranged according to van Manen’s fundamental existential, and the lived things and lived others were remarkably confirmed. @*Conclusion@#: Patients’ families experienced various ICU diary forms over time and recognized an ICU diary as a means of communication. Therefore, the ICU diary is expected to be used as an intervention between families and healthcare providers in the ICU to support mutual communication.

Validation of the Edmonson Psychiatric Fall Risk Assessment Tool for Psychiatric Inpatients: A Retrospective Study / 임상간호연구

Purpose@#The purpose of this study was to validate the Edmonson psychiatric fall risk assessment tool (EPFRAT) for psychiatric inpatients. @*Methods@#Data from retrospective study were collected from 670 adult inpatients in two departments of mental health medicine of a tertiary general hospital by reviewing their electronic medical records. There were 41 patients who experienced falls and 629 patients who did not experience falls during the period from January to December 2019. Data were analyzed by sensitivity, specificity, positive predictive value, negative predictive value, and a receiver-operating characteristic curve (ROC) for validity assessment using the IBM SPSS/WIN 26.0 program. @*Results@#Factors affecting falls were the participant’s age, guardian’s residence, high-risk determination at the time of admission, and comorbidity. At the 85 points where the point of sum of the sensitivity and specificity was largest, the sensitivity, specificity, positive predictive value, and negative predictive value of EPFRAT were 92.7%, 79.7%, 22.9%, and 99.4%, respectively. The area under the ROC to assess the overall validity of the tool was .92 (95% CI 0.89~0.94). @*Conclusion@#The EPFRAT was proved to be valid and reasonable for predicting falls in psychiatric inpatients. Based on the results of this study, it could be used for the assessment of high-risk patients for falls in psychiatric units.

Incidence of Peripheral Cyanosis in Patients with Therapeutic Hypothermia after Cardiac Arrest in the Acute Care Unit of a Tertiary General Hospital / 중환자간호학회지

Purpose@#: This study aimed to identify the incidence of peripheral cyanosis and the characteristics and clinical results of patients with therapeutic hypothermia after a cardiac arrest. @*Methods@#: Data were collected from April to June 2021 via the electrical medical records of 95 patients with therapeutic hypothermia for 72 hours after a cardiac arrest admitted to an acute care unit at a tertiary hospital between January 1, 2016, and December 31, 2019. The data were analyzed using descriptive statistics and a t-test, Mann–Whitney U test, Chi-squared test, Fisher’s exact test, and logistic regression using SPSS/WIN. @*Results@#: The incidence of peripheral cyanosis was 20%. In the peripheral cyanosis group, peripheral vascular disease, fibrinogen, vasopressor, infection, disseminated intravascular coagulation, acute physiology, chronic health evaluation II score on the second hospital day, nursing intervention, and mortality on the seventh hospital day were higher. The level of fibrinogen and use of vasopressors affected the occurrence of peripheral cyanosis. @*Conclusion@#: Considering the influencing variables, careful observation is necessary for patients with high fibrinogen levels and vasopressor use. These results provide basic data to recognize the need for nursing intervention for peripheral cyanosis and encourage nurses to deliver them during therapeutic hypothermia.

Middle-Aged Adults' Attitudes toward Dignified Death and Advance Directives, and Knowledge of Advance Directives / 임상간호연구

Purpose@#The purpose of study was to provide basic data for developing interventions that could help middle-aged adults prepare for dignified death in the future by examining their attitudes toward death and advance directives (AD), and knowledge of AD. @*Methods@#Data were collected through a survey of 211 middle-aged adults from January 28 to February 28, 2019, in a city located in Gangwon Province. To analyze the data, descriptive statistics, t-test, one-way ANOVA, Scheffé test, Pearson’s correlation coefficient and stepwise linear regression were utilized using SPSS/WINdows 21.0. @*Results@#The average score of the participants’ attitudes toward death and AD, and knowledge of AD was 91.82±10.89, 15.53±4.27, 46.00± 9.45, respectively. There were positive correlations between attitudes toward dignified death and attitudes toward AD, and knowledge of AD. Factors that influence attitudes toward AD were shown in the order of attitudes toward dignified death, knowledge of AD, and intentions to write AD (Adjusted R2=.24). @*Conclusion@#For the dignified death in the future, it is necessary to provide middle-aged adults with an opportunity to think about the need of AD. In addition, extensive education and promotion of AD are required to correct the misunderstanding of AD.

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.

The Effect of Appreciative Inquiry on Positive Psychological Capital and Organizational Commitment of New Nurses / 중환자간호학회지

PURPOSE: The purpose of this study was to determine whether appreciative inquiry (AI) is an effective intervention for increasing the positive psychological capital and organizational commitment of new nurses.METHOD: The study used a nonequivalent control group pretest-posttest design. The participants were 60 new nurses in a tertiary hospital in Seoul. The experimental group received 2 classes of AI education and in-unit AI activities. The control group received the existing education program.RESULTS: There was no statistically significant difference in the positive psychological capital and organizational commitment between the experimental group and the control group over time. Satisfaction with the AI education scored 3.69, which was higher than the average. The reason why the experimental group members were satisfied with the program was that AI education helped them to adapt and the in-unit AI activities made staff more cooperative and the atmosphere of the unit more positive.CONCLUSION: When applying AI activities to new nurses to promote positive psychological capital and organizational commitment, it is necessary to provide a workshop in which the participants can fully concentrate on education and to extend the period of use to one year in order to maintain the effect of AI activities.

Common Scope of Practice for Advanced Practice Nurses in Korea Derived from Expert Agreement / 중환자간호학회지

PURPOSE: This study aimed to propose a common scope of practice (SOP) for 13 specialties of Advanced Practice Nurses (APNs) in Korea.METHODS: The first draft of a common SOP was extracted from domestic and international laws with a literature review by 17 experts from the Korean Association of Advanced Practice Nurses (KAAPN). Then, the common SOP was finalized after comparing the activities of APNs in clinical settings.RESULTS: A total of 70 duties were identified and six categories were suggested for the common SOP. The SOP proposed by the KAAPN featured the following: 1) identification of and discrimination between health problems; 2) prescription and implementation of diagnostic tests; 3) treatment of injuries and diseases while implementing measures to prevent exacerbation; 4) prescription of medicinal products in line with 1) to 3); 5) referral and consultation; and 6) education and counseling. It was then confirmed that the proposed six categories in the common SOP reflected all the duties performed by APNs in clinical practice, including all 40 activities.CONCLUSION: The results of this study can be used as evidence for the legalization of a common SOP for APNs. Given the increasing multidisciplinary team approach adopted in Korean hospitals, it may be desirable to establish a broader SOP to reflect the diverse duties of APNs.

Development of a Program to Promote Maternal Role Confidence and Maternal Attachment for Mothers of Premature Infants / 임상간호연구

PURPOSE: This study was done to develop a program to promote maternal role confidence and maternal attachment for mothers of premature infants and to evaluate the effects in a neonatal intensive care unit (NICU). METHODS: This program was developed through a literature review and validation of an expert group, and tested with 60 preterm infants (experimental group 30, control group 30) in a NICU in South Korea. Data were collected from December 2017 to March 2018 and analyzed using descriptive statistics, t-test, χ²-test and Fisher's exact test with the SPSS/Win statistical program. RESULTS: Maternal role confidence for the experimental group increased significantly compared to the control group (t=3.22, p=.002). Maternal attachment in the experimental group increased significantly compared to the control group (t=2.30, p=.025). CONCLUSION: The program developed in this study should be effective in promoting maternal role confidence and maternal attachment in mothers of premature infants.

Effects of the Trunk Maintenance Repositioning Method on Keeping a 30° Side-Lying Position, Comfort, and Skin Condition / 중환자간호학회지

PURPOSE: This study was performed to evaluate the effects of a prolonged a 30°side-lying position on comfort and skin condition by applying the trunk maintenance repositioning method, which can keep the 30°side-lying position effective for preventing pressure ulcers.METHOD: Fifty-four healthy nurses working at a general hospital in Seoul were randomly assigned to an experimental group (n=27) or a control group (n=27) and assumed a position of lying on their right or left side for two hours. The trunk maintenance repositioning method was applied to the experimental group using the pillow made by the researcher, while the original repositioning method was applied to the control group using the regular pillow from the subject hospital. Participants' posture angles, comfort, and skin condition were measured at the time of the intervention, as well as at one and two hours after the intervention.RESULTS: There was no statistically significant difference in position angle, comfort, skin condition change, or sacrum and greater trochanter pressure change between the two groups over time.CONCLUSION: It is necessary to review the method and frequency of change of position in each hospital. In addition, a proper position changing pillow should be developed in consideration of patients' various body shapes.

Critical Care Nursing Courses in Bachelor of Science in Nursing Programs: Present and Future Directions / 중환자간호학회지

PURPOSE: This study examined the status of critical care nursing education in bachelor of science in nursing (BSN) to suggest future directions.METHODS: The target of the survey was 185 BSN programs that were certified by the Korean Accreditation Board of Nursing Education as of October 31, 2016. We structurally reviewed the curriculums and the course syllabi.RESULTS: Forty-eight courses of 42 BSN programs were analyzed. Only five programs offered both theoretical and practical courses in critical care nursing; 22 offered theoretical courses and 26 offered practical courses. Most courses were offered as electives with 1 or 2 credits, and were taught by faculty who were experts in adult health nursing.CONCLUSION: The results show that there is a quantitative shortage of critical care nursing education in the curriculum of BSN programs in Korea. The lack of knowledge and skills on critical care can lead to a burden of new intensive care unit nurses and is a threat to patients' health. It is necessary to develop a practical and integrative curriculum for critical care nursing education.

Experience of Patients and Families about Flexible Visiting / 중환자간호학회지

PURPOSE: This study aimed to understand the essence of experiences of patients and family members during flexible visiting in an intensive care unit (ICU).METHODS: This is a qualitative study using interviews with open ended questions. We used Colaizzi's method of phenomenological interpretation.RESULTS: Flexible visiting in the ICU impacted the patients and their families in various ways. The following categories were extracted from the patients' experiences with flexible visiting: 1) the opportunity to feel the presence of the family and 2) the burden of unrestricted visiting. The following categories were extracted from the families' experiences with flexible visiting: 1) psychological comfort by convenience 2) being aware of health care professionals and critical care nursing in the intensive care unit, and 3) double trouble.CONCLUSIONS: These results showed that flexible visiting in the ICU affected the patients and their families positively and negatively. Therefore, nursing staff need to design psychological and social interventions that address the needs of patients and their families.

Effects of Music Therapy on Pain, Anxiety and Length of Stay of Patients with Laparoscopic Hysterectomy in the Postanesthesia Care Unit

PURPOSE: This study examined the effects of music therapy on pain, anxiety and length of stay of patients undergoing laparoscopic hysterectomy in the postanesthesia care unit (PACU). METHODS: Sixty patients who received laparoscopic hysterectomy under general anesthesia from a PACU in a university hospital located in Cheonan city participated in this study. The experimental group (n=30) was offered the option to listen to their preferred music by using MP3 players and headphones for 30 minutes. The control group (n=30) received routine postoperative nursing care. Visual analogue scale was used to measure participants' pain and anxiety, length of stay in the PACU was examined by using their medical records. Data were collected from December 2013 to February 2014 and analyzed by descriptive statistics, chi2-test, Fisher's exact test, and independent t-test using SPSS version 21.0. RESULTS: The result showed that the level of post-operative pain (t=2.44, p=.018), anxiety (t=2.37, p=.021), and the length of stay in PACU (t=3.06, p=.004) significantly decreased in the experimental group as compared to the control group. CONCLUSION: This study indicated that music therapy with the patients' preferred music showed positive effects. Therefore, it can be used as a therapeutic intervention for postoperative pain management of patients with laparoscopic hysterectomy.

Association of Sleep Characteristics with Medication Errors for Shift Work Nurses in Intensive Care Units / 기본간호학회지

PURPOSE: Shift work disrupts the synchronization between the human biological clock and the environment. Sleep disturbances are common for shift work nurses, and may threaten patient safety. This study was done to investigate the sleep characteristics and medication errors (ME) of intensive care unit (ICU) nurses who work shifts, and ascertain if there is an association between these factors. METHODS: Data were collected using a self-report questionnaire from 126 ICU nurses on three shifts. Collected data included their sleep characteristics including sleep patterns and sleep disturbances, and ME for the past 2 weeks. RESULTS: There were significant differences in sleep duration and sleep latency according to shift. Day shift nurses had the shortest sleep duration, and their sleep latency was the longest (about 49 minutes) compared to nurses on evening and night shifts; 54% reported sleep disturbances, 16% experienced ME, and among these nurses 50% were on the night shift. Logistic regression analysis revealed significant associations between nurses' sleep duration and ME (adjusted OR 0.52 [95% CI 0.32-0.85]). CONCLUSIONS: The results confirmed that shift worknurses in the ICUs experience sleep disturbance, and that less sleep is associated with ME.

Effects of the Schematized Alarm-managing Manual for Continuous Renal Replacement Therapy on the Alarm Resolution Rate and Nursing Competence of Nurses in Intensive Care Units / 간호행정학회지

PURPOSE: This study was done to develop a schematized alarm-managing manual for continuous renal replacement therapy (CRRT) and to investigate its effects in maintaining continuity in the patients' treatment and promptly resolving alarms when CRRT is being carried out. METHODS: Sixtynurses from two medical intensive care units (ICUs) (one experimental and one control) at one hospital were asked to answer a questionnaire including their CRRT nursing competency and satisfaction with the manual. Data on alarm resolution rate were collected by analyzing existing data, such as the details of each alarm and the number of resolutions around the clock in the CRRT device. RESULTS: The alarm resolution rate and some of CRRT nursing competency scores in the experimental group were higher than those in the control group. The experimental group was also satisfied with the manual. CONCLUSION: The study confirmed that the schematized alarm-managing manual can be useful for ICU nurses to resolve alarms and can be used as a guideline. Application of this manual to clinical practices and its use can therefore, be encouraged through continuous educationand promotion.

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.

Oncology Advanced Nurses' Use of Outcome Indicators and Perception of Outcome Evaluation / 간호행정학회지

PURPOSE: The purpose of this study was to explore the use of outcome indicators and perception of outcome evaluation of oncology advanced practice nurses (APNs). METHOD: A total of 111 oncology APNs from hospitals which have over 400 beds were surveyed. The participants' use of outcome indicators and perception of outcome evaluation were collected using a questionnaire including 84 outcome indicators for APNs developed by Sung et al. and 13 items on APNs' contribution to the hospitals developed by Kleinpell (2005). Data were analyzed using descriptive statistics, t-test, and chi2 test. RESULT: Twelve items out of 84 outcome indicators were used over 50% of the time and 57 items could be used in the future by the participants. Seven of the 10 top-ranking outcome indicators in use were education related and were also expected to be used frequently in the future. The score for participants' perception of outcome evaluation was average-high, 3.82 out of 5. CONCLUSIONS: The results of the study show that the main outcome indicator for oncology APNs is education related, and thus the use of education related outcome indicators is recommended to make oncology APNs' activities be more visible.

ICU Nurses' Compliance with Standards for Critical Care Nursing Practice / 기본간호학회지

PURPOSE: To explore nurses' compliance with standards for critical care nursing practice in intensive care units (ICUs) and to provide basic data for high quality of critical care nursing. METHOD: A total of 616 participants from 61 ICUs which are graded from 1 to 7 throughout the nation were surveyed. Data were collected from February 9 to February 27, 2009 using a uestionnaire consisting of 58 questions including 50 nursing activities as indicators. RESULTS: The rate of ICU nurses' compliance with standards for critical care nursing practice was high. As for individual standards, compliance with the standard of assessment was the highest, followed by implementation, diagnosis, and planning in that order. There were differences in compliance according to nurses' ICU experience, work place (unit), and ICU grade. A shortage of manpower was considered as a main cause for noncompliance. CONCLUSION: The present compliance rate with standards for critical care nursing practice by ICU nurses was identified. Therefore, compliance rate can be used to promote quality of critical care nursing and development of educational programs for ICU nurses.

The Roles of Critical Care Advanced Practice Nurse / 간호학회지

PURPOSE: To determine and compare the perception among nurses and doctors of the roles and tasks of critical care advanced practice nurses (APNs) in order to establish standardized and formally agreed role criteria for such critical care APNs. METHOD: This study measured and analyzed the necessity of each of the roles and tasks of critical care APNs, as perceived by nurses and doctors, through a survey of 121 participants: 71 nurses in 7 intensive care units (ICUs) at a general hospital in Seoul, and 50 doctors who used ICUs. Data collection utilized a questionnaire of 128 questions in the following fields: direct practice (79), leadership and change agent (17), consultation and collaboration (15), education and counseling (11), and research (6). RESULTS: Both the nurses' and the doctors' groups confirmed the necessity of critical care APNs, with doctors who frequently used ICUs indicating a particularly strong need. As for the priority of each role of critical care APNs, the nurses considered direct practice to be the most critical, followed by education and counseling, research, consultation and collaboration, and leadership and change agent. The doctors also considered direct practice to be the most critical, followed by education and counseling, consultation and collaboration, research, and leadership and change agent. There was a statistically significant difference between how the two groups regarded all the roles, except for the consultation and collaboration roles. As for the necessity of each role of critical care APNs, the nurses considered research to be the most necessary, followed by education and counseling, consultation and collaboration, leadership and change agent, and direct practice. The doctors, on the other hand, considered education and counseling to be the most necessary, followed by research, consultation and collaboration, leadership and change agent, and direct practice. The responses of the two groups to all the roles, except for education and counseling roles, were significantly different. CONCLUSION: Nurses and doctors have different perceptions of the roles and tasks of critical care APNs. Thus, it is necessary for the combined nursing and medical fields to reach an official agreement on a set of criteria to standardize for the roles and tasks of critical care APNs.

Dimensions and Attributes of Quality of Life in Korean School-age Children / 아동간호학회지

PURPOSE: The purpose of this study was to describe quality of life (QOL) in Korean school-age children by identifying dimensions and attributes of QOL from the child's point of view. METHOD: In-depth interviews with focus questions were used for the study. Twelve children, aged 10 to 13 years, were recruited from Seoul and rural areas. The interviews were audio-taped and transcribed before content analysis. The data were analyzed for themes and attributes. The researchers read the data together and discussed their conclusions until a consensus was reached. RESULTS: Eight dimensions, 57 subdimensions and 101atttributes were identified for QOL in school-age children. The eight dimensions of QOL were physical, social, emotional, learning, leisure, family, self-value, and material aspects. CONCLUSION: The study results can be utilized in developing reliable instruments to measure quality of life specific to school-age children. It is proposed that a consistent and unified policy should be established by school, family, and community for the purpose of improving the QOL of school-age children.

A Study on the Hand washing of NICU nurses in a University Hospital / 기본간호학회지

Especially in NICU(Neonatal Intensive Care Unit), handwashing is an important factor in decreasing nosocomial infections due to reduced immunity, prematurity and various invasive procedures. The purpose of this study was to investigate the basic characteristics related to handwashing by NICU nurses. It was composed of three parts; questionnaire survey I (general characteristics of handwashing), questionnaire survey II(the awareness degree of handwashing importance) and actual performance. This study was performed from Oct. 8 to 14 in 1994. The results of his this study were as follows; 1. Frequency of handwashing were different by shift of working about 47.1% of the respondents. They were washing most frequently during day-shift about 75% of above. According to self evaluation to handwashing frequency, 64.7% of the respondents said their frequency of handwashing was inadequate, because of being too busy.(45.1%), bothering caused by detergent or disinfectant(17.6%), and too far from handwashing facilities(17.6%). 2. The most common handwashing agent was soap(88.2%), 52.9% of the subjects experienced adverse effects after handwashing; rough hand(44.5%), dryness(33.3%). All subjects washed their hands with running water, and 70.6% of the subjects washed upto wrist, In duration of handwashing, 52.9% of subjects washed hands 5 to 10 seconds, 29.5% of them did 11 to 15 seconds. 3. 29.4% among subjects had participated to take in the handwashing educational program. About 60% responded they would like to take the course of handwashing if possible. 4. The important nursing activities that need handwashing were changing of caring ostomy, suctioning, changing IV dressing site. On the other hand, they responded handwashing was not essential before dealing with omitus, before and after transferring machine, before changing diaper(stool). 5. Handwashing performance was 61.7%. Among seven nursing activities, suctioning(73.4%) was the highest, the next was dealing with discharge or sampling(71.1%), the lowest was bathing(34.6%). The performance was better after(70.2%) nursing activities that before(52.5%), and day(63.6%) or evening(68.3%) shift than night(56.7%).