The Nurse Staffing in Intensive Care Units based on Nursing Care Needs: A Multicenter Study / 중환자간호학회지

Purpose@#: The aim of this study was to propose appropriate nurse staffing of adult intensive care units considering patients’ nursing care needs according to the Workload Management System for Critical Care Nurses (WMSCN). @*Methods@#: In a cross-sectional survey conducted in September 2017, 1,786 patients’ WMSCN scores, surveys from 2,145 nurses, and administrative data from 118 units in 41 hospitals were analyzed. The means (standard deviations) of the aforementioned scores and nursing hours per patient day were presented. Nurse-to-patient ratios and nurse-to bed ratios for staffing to meet patients’ nursing care needs were calculated. @*Results@#: The mean WMSCN scores were 109.50±17.17 in tertiary hospitals and 96.38±19.26 in general hospitals. Nursing hours per patient day were 12.47±2.80 in tertiary hospitals and 11.01±2.45 in general hospitals. Nursing hours per patient day correlated with WMSCN scores. Nurse-to-bed ratios required for the provision of ICU nursing care ranged from 1: 0.36 to 1: 0.48. @*Conclusion@#: Our findings provide evidence that current ICU nurse staffing is insufficient for meeting patients’ nursing care needs. We suggest adjusting the legal standards for adequate nurse staffing considering these needs.

The Nurse Staffing in Intensive Care Units based on Nursing Care Needs: A Multicenter Study / 중환자간호학회지

Purpose@#: The aim of this study was to propose appropriate nurse staffing of adult intensive care units considering patients’ nursing care needs according to the Workload Management System for Critical Care Nurses (WMSCN). @*Methods@#: In a cross-sectional survey conducted in September 2017, 1,786 patients’ WMSCN scores, surveys from 2,145 nurses, and administrative data from 118 units in 41 hospitals were analyzed. The means (standard deviations) of the aforementioned scores and nursing hours per patient day were presented. Nurse-to-patient ratios and nurse-to bed ratios for staffing to meet patients’ nursing care needs were calculated. @*Results@#: The mean WMSCN scores were 109.50±17.17 in tertiary hospitals and 96.38±19.26 in general hospitals. Nursing hours per patient day were 12.47±2.80 in tertiary hospitals and 11.01±2.45 in general hospitals. Nursing hours per patient day correlated with WMSCN scores. Nurse-to-bed ratios required for the provision of ICU nursing care ranged from 1: 0.36 to 1: 0.48. @*Conclusion@#: Our findings provide evidence that current ICU nurse staffing is insufficient for meeting patients’ nursing care needs. We suggest adjusting the legal standards for adequate nurse staffing considering these needs.

Experience of Violence from the Clients and Coping Methods Among Intensive Care Unit Nurses Working in a Hospital in South Korea

PURPOSE: It is difficult to develop a good defense system that can prevent nurses from experiencing physical and verbal violence from patients and families in intensive care units, which are closed spaces. This study aimed to identify intensive care nurses' experience of violence from patients and families and investigate their coping methods, if there are any, in a tertiary hospital in South Korea. METHODS: This study used a mixed methods design using both a survey for collecting quantitative data and individual interviews for a qualitative one. A total of 200 intensive care nurses participated in the survey, with 30 of them taking part in individual interviews. Survey data were analyzed using SPSS 21.0 program, and qualitative data were analyzed by qualitative content analysis method. RESULTS: In the survey, 99.5% of the nurses reported that they had experienced violence from the patients, and 67.5% of the nurses reported that they had experienced violence from their visitors (families or relatives). Verbal violence were reported more than physical ones. They showed moderate or severe responses to violence, scoring an average of 2.98 ± 0.63 of 5. The qualitative data were analyzed to draw four themes, eight categories, and 17 subcategories. The four themes were perception of violence, coping with violence experience, coping resources, and caring mind after violence experience. CONCLUSION: While intensive care nurses experience unpredicted violence from patients and their visitors, they fail to cope well with the experience. The safe working environment of intensive care units is expected to contribute to quality care and an improvement of expertise in nursing.

Intensive Care Unit Nurses' Death Perception, End of Life Stress and End of Life Nursing Attitudes / 임상간호연구

PURPOSE: This study aimed to identify the view of life and death among ICU nurses and to analyze the problems related to end-of-life care in the current ICUs. METHODS: A descriptive study design was used. The participants were 975 nurses working in the intensive care units of 16 general hospitals. Using a descriptive survey design, data were collected from August to December in 2016 and were analyzed using descriptive statistics, t-test, ANOVA, correlation analysis, and multiple regression analysis. RESULTS: As a result of a correlation analysis of the data, Death perception had a significant positive correlation with EOL of nursing attitudes(r=.100, p=.002), and negative correlation with EOL stress care(r=−.221, p= < .001). The regression model explained for individual characteristics in the model, age(β=.126, p < .001) and death perception(β=.182, p < .001), Satisfaction of the EOL care(β=.173, p < .001), Healing training needs on the EOL(β=−.144, p < .001) were the most influential factors for EOL stress. CONCLUSION: Results reveal that ICU nurses have a moderate level of EOL stress, and that individual, age, death perception, Satisfaction of the EOL care, Healing traning needs on the EOL relevant in ICU nurses' EOL stress. Programs or interventions to reduce EOL stress and to should be developed taking into account these multidimensional factors.

Multidimensional Factors Influencing Burnout in Intensive Care Unit Nurses / 임상간호연구

PURPOSE: This study aimed to identify multidimensional factors influencing burnout in intensive care unit(ICU) nurses. METHODS: A descriptive cross-sectional design was used. Data were collected during February 2016 from a convenience sample of 222 tertiary hospital ICU nurses and analyzed using t-test, ANOVA, correlation analysis, and multiple regression analysis. RESULTS: Burnout correlated positively with compassion fatigue (CF)(r=.37, p < .001), and negatively with compassion satisfaction (CS)(r=-.66, p < .001). The regression model explained 57% of the variance in burnout. For individual characteristics in the model, perceived health status (β=-.27, p < .001) and gender (β=.14, p=.028) were the most influential factors for ICU nurses' burnout. In the model with added work-related characteristics, nursing environment (β=-.22, p=.001), perceived health status (β=-.20, p=.001), and satisfaction with department (β=-.19, p=.007) were the most influential factors. Finally, for the model with psychological characteristics added, CS (β=-.56, p < .001) and CF (β=.35, p < .001) were the most influential factors. CONCLUSION: Results reveal that most ICU nurses have a moderate level of CF and a moderate to high level of CS and burnout, and that individual, work-related and psychological factors are relevant in ICU nurses' burnout. Programs or interventions to reduce burnout should be developed taking into account these multidimensional factors.

Development of Pre-discharge Group Education Program for Liver Transplant Patients / 대한이식학회지

BACKGROUND: This study was conducted to develop a pre-discharge group education program for liver transplant patients, and to contribute to improving the knowledge and performance of self-management after discharge. METHODS: This investigation was a methodological study consisting of analysis, design, development, operation, and evaluation stages. RESULTS: The constituent items of the pre-discharge group education program for liver transplant patients include medication management, infection management, emergency management, outpatient management, complication management, nutrition management, exercise management, wound and drainage management, disability registration, and sex life. The pre-discharge group education program for liver transplant patients was conducted once a week, 30 minutes for the coordinator, 40 minutes for the clinical nurse specialist (including 10 minutes for wound and drainage management), 30 minutes for pharmacists, 20 minutes for the nutritionist, and 20 minutes for social workers. Additionally, the contents of the lecture announced by PowerPoint were made the same as the booklet. The overall knowledge level before and 3 months after the pre-discharge group education program for liver transplantation patients increased significantly from 17.32±1.53 to 19.74±0.89. At the 3-month time point, the overall compliance was 77.39±3.04 out of 80. Overall satisfaction was 9.32±0.93 on a scale of 10. Finally, the need for medication was the highest at 3 months. CONCLUSIONS: It is expected that this program can be utilized in the clinical field as an effective nursing education intervention.

Ethical Issues Recognized by Critical Care Nurses in the Intensive Care Units of a Tertiary Hospital during Two Separate Periods

This research aimed to investigate the changes in ethical issues in everyday clinical practice recognized by critical care nurses during two observation periods. We conducted a retrospective analysis of data obtained by prospective questionnaire surveys of nurses in the intensive care units (ICU) of a tertiary university-affiliated hospital in Seoul, Korea. Data were collected prospectively during two different periods, February 2002-January 2003 (Period 1) and August 2011-July 2012 (Period 2). Significantly fewer cases with ethical issues were reported in Period 2 than in Period 1 (89 cases [2.1%] of 4,291 ICU admissions vs. 51 [0.5%] of 9,302 ICU admissions, respectively; P < 0.001). The highest incidence of cases with identified ethical issues in both Periods occurred in MICU. The major source of ethical issues in Periods 1 and 2 was behavior-related. Among behavior-related issues, inappropriate healthcare professional behavior was predominant in both periods and mainly involved resident physicians. Ethical issue numbers regarding end-of-life (EOL) care significantly decreased in the proportion with respect to ethical issues during Period 2 (P = 0.044). In conclusion, the decreased incidence of cases with identified ethical issues in Period 2 might be associated with ethical enhancement related with EOL and improvements in the ICU care environment of the studied hospital. However, behavior-related issues involving resident physicians represent a considerable proportion of ethical issues encountered by critical care nurses. A systemic approach to solve behavior-related issues of resident physicians seems to be required to enhance an ethical environment in the studied ICU.

Symptom and Interference of Activities of Daily Living of Chemotherapy-Induced Peripheral Neuropathy in Patients Receiving Taxanes and Platinums

PURPOSE: The purpose of this study was to identify the symptoms and interference of activities of daily living (ADL) of chemotherapy induced peripheral neuropathy (CIPN) in patients receiving taxane and platinums. METHODS: 141 cancer patients were recruited in the cross-sectional survey design. The instruments used in the study was the Chemotherapy-induced Peripheral Neuropathy Assessment Tool (CIPNAT) developed by Tofthagen and colleagues. RESULTS: The patients experienced the symptom and interference of ADL of CIPN moderately. The most common symptom was nerve pain (70.2%) and the patients with high cumulative doses showed a significant of tingling sensation in the feet. Symptom severity increased substantially with cumulative dose of chemotherapeutic agents. CONCLUSION: The results of this study suggest that chemotherapy-induced peripheral neuropathy increase due to repeated chemotherapy and nursing intervention is necessary to reduce symptom severity and interference of ADL of CIPN.

Development and Evaluation of Learning Program for Oncology Unit-based Core Nursing Practice: Outcomes based Cancer Patients Pain Management Learning Program

PURPOSE: This study was conducted to develop a nurse-learning program for the pain management of cancer patients. METHODS: In this methodological study, a learning program was developed between January and June 2011, following the methodological procedure based on the ADDIE Instructional System Design. RESULTS: The learning program consists of 4 parts: learning goal, learning outcomes, learning method, and evaluation method. Learner-centered learning goal and learning outcomes were established, and lecture-based group learning and self-directed study were combined as the learning method. For the evaluation, we developed a written test, a nursing skill checklist, and a case report evaluation tool. After a pilot test, the learning program was assessed by an expert group for its construct validity and content-related conformance. Moreover, the effectiveness of the program was validated by the results of the learning outcomes evaluation and the achievement levels of 40 trainees who participated in the program. CONCLUSION: On the basis of the results of this study, we suggest that this unit-based core nursing practice learning program, comprising 202 nursing units developed by a research institute nursing department since 2010, be shared by all nurses in clinical nursing care settings to improve their practical performance and ensure necessary specialization.

The Effect of Laughter Therapy on Depression, Anxiety, and Stress in Patients with Breast Cancer Undergoing Radiotherapy / 종양간호학회지

PURPOSE: The purpose of this study was to investigate the of laughter therapy on depression, anxiety, and stress among patients underwent radiotherapy. METHODS: Participants in the study were comprised of 60 breast cancer outpatients who received radiotherapy. Thirty-one of the patients were assigned in the experimental group and the other 29 patients made up the control group. Laughter therapy was consisted of the delivery of information and active motion resulting in laughter. We provided laughter therapy 4 times for 2 weeks. Each session lasted 60 min. The experimental group received laughter therapy intervention as a group. An average attendance frequency per person was 2.7. To evaluate the effect of laughter therapy, the degrees of depression and anxiety were measured by Hospital Anxiety and Depression (HAD) and stress was measured by the Brief Encounter Psychosocial Instrument (BEPSI). Data analysis included a 2-test, t-test, and Fisher's exact test using SPSS 12.0 and SAS 8.0. RESULTS: There was significant decrease in the degrees of depression, anxiety, and stress in the experimental group compared to those in the control group (p<.01, p=.04, and p<.01, respectively). CONCLUSION: This study provides evidence that laughter therapy is an effective intervention in improving depression, anxiety, and stress in breast cancer patients.