A Job analysis of Hospital Midwives: A DACUM Analysis

Purpose@#This study aimed to analyze the tasks of midwives who lead natural childbirth in hospitals using the DACUM technique. @*Methods@#Data were collected from 42 hospital midwives between August 23 to October 12, 2022, and the importance, frequency, and professional difficulty of hospital midwives' tasks were assessed. The collected data were analysed using the IBM SPSS Statistics ver. 22.0 program as the average and standard deviation for the importance, difficulty, and frequency of performance the analyzed tasks. The importance, difficulty, and frequency of performance each task were indicated as high, medium, or low,; furthermore, the importance and difficulty were multiplied and analyzed using the coefficient of determination.Result: Midwives’ tasks in natural childbirth in hospitals were classified into 8 duties, 138 tasks, and 49 task elements. Duties were classified into ‘before childbirth,’ ‘during childbirth,’ ‘after childbirth,’ ‘management of high-risk pregnant women,’ ‘goods management,’ ‘administrative work,’ ‘self-development,’ and ‘newborn care.’ The most important and difficult tasks with the highest coefficient of determination were performing neonatal resuscitation if necessary (11.25), transporting and managing emergency patients (10.46), requesting hospitals to transfer patients in case of emergency (10.43), and transferring patients to a tertiary hospital in case of maternal of neonatal emergency (10.30). @*Conclusion@#In this novel study in Korea, the role of a midwife in a hospital for natural childbirth were defined, and task according to duties were analyzed.

Effects of Nurse Staffing Level on In-hospital Mortality and 30-day Mortality after Admission using Korean National Health Insurance Data / 임상간호연구

Purpose@#The purpose of this study is to investigate the association between the nurse staffing level and the patient mortality using Korean National Health Insurance data. @*Methods@#The data of 1,068,059 patients from 913 hospitals between 2015 and 2016 were analyzed. The nurse staffing level was categorized based on the bed-to-nurse ratio in general wards, intensive care units (ICUs), and hospitals overall. The x 2 test and generalized estimating equations (GEE) multilevel multivariate logistic regression analyses were used to explore in-hospital mortality and 30-day mortality after admission. @*Results@#The in-hospital mortality rate was 2.9% and 30-day mortality after admission rate was 3.0%. Odd Ratios (ORs) for in-hospital mortality were statistically lower in general wards with a bed-to-nurse ratio of less than 3.5 compared to that with 6.0 or more (OR=0.72, 95% CI=0.63~0.84) and in ICUs with a bed-to-nurse ratio of less than 0.88 compared to that with 1.25 or more (OR=0.78, 95% CI=0.66~0.92). ORs for 30-day mortality after admission were statistically lower in general wards with a bed-to-nurse ratio of less than 3.5 compared to that with 6.0 or more (OR=0.83, 95% CI=0.73~0.94) and in ICUs with a bed-to-nurse ratio of less than 0.63 compared to that with 1.25 or more (OR=0.85, 95% CI=0.72~1.00). @*Conclusion@#To reduce the patient mortality, it is necessary to ensure a sufficient number of nurses by improving the nursing fee system according to the nurse staffing level.

Different Seasonal Variations of Potassium in Hemodialysis Patients with High Longitudinal Potassium Levels: A Multicenter Cohort Study Using DialysisNet

Purpose@#To determine seasonal variations in serum potassium levels among hemodialysis patients. @*Materials and Methods@#This was a multicenter cohort study of patients whounderwent hemodialysis and were registered in DialysisNet at our four associated general hospitals between January and December 2016. Month-to-month potassium variability was quantified as SD/√{n/(n-1)}, and a non-hierarchical method was used to cluster groups according to potassium trajectories. Seasonal variations in potassium levels were analyzed using a cosinor analysis. @*Results@#The analysis was performed on 279 patients with a mean potassium level of 5.08±0.58 mmol/L. After clustering, 52.3% (n=146) of patients were included in the moderate group (K+ , 4.6±0.4 mmol/L) and 47.7% (n=133) in the high group (K+ , 5.6±0.4 mmol/L). The mean potassium level peaked in January in the moderate group (4.83±0.74 mmol/L) and in August in the high group (5.51±0.70 mmol/L). In the high potassium group, potassium levels were significantly higher in summer than in autumn (p<0.001) and spring (p=0.007). Month-to-month potassium variability was greater in the high group than in the moderate group (0.59±0.19 mmol/L vs. 0.52±0.21 mmol/L, respectively, p=0.012). Compared to patients in the first quartile of potassium variability (≤0.395 mmol/L), those with higher variability (2nd–4th quartiles) were 2.8–4.2 fold more likely to be in the high potassium group. @*Conclusion@#Different seasonal patterns of serum potassium were identified in the moderate and high potassium groups, with potassium levels being significantly higher in the summer season in the high potassium group and in winter for the moderate potassium group.

Association between Dialysis Adequacy and Cognition in Patients with Peritoneal Dialysis

Objective@#Cognition of peritoneal dialysis patients is influenced by various factors including dialysis adequacy such as fractional urea clearance (Kt/V) and relative overhydration (RelOH). This study aimed to discover the potential contribution of dialysis adequacy to cognitive function in patients undergoing peritoneal dialysis. @*Methods@#Fifty-nine patients undergoing peritoneal dialysis were recruited. Demographic information, comorbidities, and clinical lab findings were retrospectively collected, and dialysis adequacy was determined by the Kt/V and RelOH calculation. Cognition and depression were measured with Digit Symbol Substitution Test, Hopkins Verbal Learning Test, Wechsler memory scale (spatial span), Wisconsin Card Sorting Test, and Beck’s depression inventory. Partial correlation test was used to explore the correlation of dialysis adequacy with cognitive function. @*Results@#RelOH showed significant correlation with some of the Wisconsin Card Sorting test results. The categories achieved showed negative correlation (r=-0.32, p=0.02) and trials to complete first category showed positive correlation (r=0.31, p=0.02) with RelOH. Other tasks showed no significant correlation with RelOH. Kt/V. @*Conclusion@#Our study demonstrates that peritoneal dialysis adequacy, measured by RelOH, seems to be significantly correlated with the occurrence of cognitive impairment. The outcome suggests that RelOH may have the potential to clarify the role of cognitive impairment in peritoneal dialysis patients.

Emotional Labor, Job Stress and Professional Quality of Life of Public Health Nurses according to the Employment Type / 간호행정학회지

PURPOSE: This study is a descriptive survey to identify emotional labor and job stress recognized in the course of administrative work, and how these affect the professional quality of life of public health nurses according to the employment type.METHODS: Data was collected through a survey of public health nurses conducted from Dec. 2018 to Jan. 2019 (N=232).RESULTS: The emotional labor of public health nurses was 3.27 out of 5 and full-time public health nurses had the highest scores. The job stress score was moderate at 2.45 out of four. The job stress of full-time nurses was also the highest. Among the sub-divisions of professional quality of life, compassion satisfaction was 3.55 out of five, while secondary traumatic stress was moderate at 2.48 and exhaustion at 3.01. Factors affecting compassion satisfaction were shown to be employment types and exhaustion. Factors affecting secondary traumatic stress were exhaustion, job stress and emotional labor. Factors affecting exhaustion were secondary traumatic stress and compassion satisfaction.CONCLUSION: The results of this study shows that full-time public health nurses in charge of nursing organizations at public health centers have extreme difficulty with excessive role responsibilities, resulting in high emotional labor intensity and high job stress.

A Survey on the Educational Needs and Competence of Nurses in Maternal Fetal Intensive Care Unit / 여성건강간호학회지

PURPOSE: Maternal Fetal Intensive Care Unit (MFICU), which provides intensive care to high-risk mothers with increasing maternal age and high-risk newborns, has become a new field of nursing work in South Korea. The present study was conducted to identify the educational needs and self-assessing clinical competence of nurses in MFICU. METHODS: The education needs and competencies of MFICU nurses were measured through prepared questionnaires by researchers based on the previous studies on job analysis of nurses in MFICU. Data were collected from January 2019 to March 2019. The study involved 168 nurses working in MFICUs at 12 hospitals nationwide as study subjects. The data were analyzed using the SPSS WIN 23.0 program. RESULTS: The education needs of nurses in MFICU had an average of 4.21 points (±0.50) and their nursing competence was average 3.38 points (±0.60). The items reported as high education needs but low competency by nurses in MFICU were as following: ‘postpartum hemorrhage and shock,’ ‘cardiopulmonary resuscitation (CPR) for neonate,’ ‘CPR during pregnancy,’ ‘disseminated intravascular coagulation,’ ‘sepsis,’ and ‘mechanical ventilation during pregnancy.’ CONCLUSION: Based on these results, it is proposed that a comprehensive education program for nurses in MFICU should be developed by considering low capabilities among MFICU nurses as a priority factor.

Development and Evaluation of Empowering Education Program for Maternal Fetal Intensive Care Unit (MFICU) Nurses / 여성건강간호학회지

PURPOSE: This study was conducted to develop an empowering education program for Maternal-Fetal Intensive Care Unit (MFICU) nurses who provide intensive care to high-risk mother and fetus at hospitals, to test effects of the education program on nursing care confidence and nursing knowledge, and to examine program satisfaction. METHODS: This study comprised of 2 phases: program development and evaluation. First, we have followed a process of program development to develop and refine an empowering education program for MFICU nurses through collaborative works among clinical obstetrics and gynecology doctors and nurses and academic nursing professors. Second, the empowering education program was provided to 49 nurses and evaluated from July 5 to 6, 2019. Levels of MFICU nursing care confidence and knowledge were measured. RESULTS: The empowering education program included 18 hours of lectures, discussion, and Q & A, which continued for 2 days. This program significantly improved high-risk maternal-fetal nursing care confidence and knowledge of nurses. The program was well met with nurses' education need and goals, and found to be highly satisfactory. CONCLUSION: The empowering education program was observed to be effective in terms of improve nursing care confidence and knowledge of nurses in MFICU. It is proposed that this program should be open regularly for nurses to obtain and improve their clinical knowledge, confidence, and competency. Further study is needed to develop and run 2-levels of education such as basic and advanced levels based on nurses' clinical background and competency.

Disaster preparedness for earthquakes in hemodialysis units in Gyeongju and Pohang, South Korea

In 2016 and 2017, there were earthquakes greater than 5.0 in magnitude on the Korean Peninsula, which has previously been considered an earthquake-free zone. Patients with chronic kidney disease are particularly vulnerable to earthquakes, as the term “renal disaster” suggests. In the event of a major earthquake, patients on hemodialysis face the risk of losing maintenance dialysis due to infrastructure disruption. In this review, we share the experience of an earthquake in Pohang that posed a serious risk to patients on hemodialysis. We review the disaster response system in Japan and propose a disaster preparedness plan with respect to hemodialysis. Korean nephrologists and staff in dialysis facilities should be trained in emergency response to mitigate risk from natural disasters. Dialysis staff should be familiar with the action plan for natural disaster events that disrupt hemodialysis, such as outages and water treatment system failures caused by earthquakes. Patients on hemodialysis also need to be educated about disaster preparedness. In the event of a disaster situation that results in dialysis failure, patients need to know what to do. At the local and national government level, long-term preparations should be made to handle renal disaster and patient safety logistics. Moreover, Korean nephrologists should also be prepared to manage cardiovascular disease and diabetes in disaster situations. Further evaluation and management of social and national disaster preparedness of hemodialysis units to earthquakes in Korea are needed.

Association of serum mineral parameters with mortality in hemodialysis patients: Data from the Korean end-stage renal disease registry

BACKGROUND: We investigated the associations between mineral metabolism parameters and mortality to identify optimal targets in Korean hemodialysis patients. METHODS: Among hemodialysis patients registered in the end-stage renal disease registry of the Korean Society of Nephrology between March 2012 and June 2017, those with serum calcium, phosphorus, and intact parathyroid hormone (iPTH) measured at enrollment were included. Association of serum levels of calcium, phosphorus, and iPTH with all-cause mortality was analyzed. RESULTS: Among 21,433 enrolled patients, 3,135 (14.6%) died during 24.8 ± 14.5 months of follow-up. After multivariable adjustment, patients in the first quintile of corrected calcium were associated with lower mortality (hazard ratio [HR], 0.84; 95% confidence interval [95% CI], 0.71–0.99; P = 0.003), while those in the fifth quintile were associated with higher mortality (HR, 1.39; 95% CI, 1.20–1.61; P < 0.001) compared with those in the third quintile. For phosphorus, only the lowest quintile was significantly associated with increased mortality (HR, 1.24; 95% CI, 1.08–1.43; P = 0.003). The lowest (HR, 1.18; 95% CI, 1.02–1.36; P = 0.026) and highest quintiles of iPTH (HR, 1.24; 95% CI, 1.05–1.46; P = 0.013) were associated with increased mortality. For target counts achieved according to the Kidney Disease Outcomes Quality Initiative guideline, patients who did not achieve any mineral parameter targets hadhigher mortality than those who achieved all three targets (HR, 1.37; 95% CI, 1.12–1.67; P = 0.003). CONCLUSION: In Korean hemodialysis patients, high serum calcium, low phosphorus, and high and low iPTH levels were associated with increased all-cause mortality.

Job Analysis of Maternal Fetal Intensive Care Unit Nurses Using DACUM Technique / 임상간호연구

PURPOSE: This study was performed to establish the role and to analyze the job of MFICU (Maternal Fetal Intensive Care Unit) nurses using DACUM (Developing a curriculum). METHODS: A DACUM workshop was held to define MFICU nurses' role and identify their duties and tasks. A DACUM committee was consisted of 7 nurses, 2 nursing professors and 1 medical doctor and as a result, a survey was developed which contained duties and tasks of MFICU nurse. Pre-test was carried out for the validity, finally collected the data from 97 nurses who worked at 7 MFICU and 10 delivery room. RESULTS: A total of 60 duties, 115 tasks and 822 elements of tasks were defined on the DACUM chart and survey. The importance, frequency and difficulty of the tasks were presented the determinant coefficient (DC), the highest DC duty was ‘Manage maternal ventilator’ (15.09) and the lowest DC was ‘Provide nursing care for leisure to gestation extension mother’ (6.52). Twenty-eight tasks were differentiated between MFICU and delivery nurses significantly. And the most important, frequently, difficulty task perceived by MFICU nurse was ‘Check fetal heartbeat with electronic fetal heart monitor’. CONCLUSION: The organized educational program and policy was needed to develop for MFICU nurses.

The authors' reply: Hyperphosphatemia is not significantly associated with increased all-cause mortality in Korean hemodialysis patients

No abstract available.

Factors Associated with Discontinuation of Postoperative Intravenous Patient Controlled Analgesia

PURPOSE: The purpose of this study was to identify the factors associated with the discontinuation of patient controlled analgesia (PCA) after surgery. METHODS: The data of 1,092 adult patients that were over 20 years of age and underwent PCA after surgery in the Gachon University Hospital from May 1 to June 30, 2017, were collected through the patients' Electronic Medical Record (EMR). The collected data was analyzed via the use of the Chi-test, t-test and multivariate logistic regression analysis using SPSS 18.0 program. RESULTS: The postoperative PCA discontinuation rate was 26.1%. It was associated with various symptoms, such as those of nausea, dizziness, and headache. The PCA discontinuation was also related with female (odds ratio, OR=1.75; confidence interval, CI=1.09–2.82), nausea (OR=105.27; CI=61.03–181.58), total intravenous anesthesia (TIVA) of the thyroidectomy (OR=10.43; CI=5.01–21.70). CONCLUSION: It is necessary to provide additional medication and nursing interventions to reduce nausea, which is the symptom associated with PCA discontinuation, especially in the operation of female subjects and thyroidectomy under TIVA. That is, those who are at a high risk for PCA discontinuation should be able to administer additional antiemetics or reduce non medication nursing interventions.

A Study on the Appropriateness of Health Insurance Fee in Main Nursing Practices / 임상간호연구

PURPOSE: This study was to present improvement strategy and the problems of the nursing fee in national health insurance system. METHODS: A total of 23 nursing activities performed by nurses were selected. Data were collected the relative value score and criteria of the Health Insurance Review & Assessment Agency. Sixty clinical nursing experts panels were composed and nursing time surveyed self-reported method. The actual fee was calculated through the nursing time, relative value score and actual labor costs. Nextly, the labor costs analyzed was compared with that in the national health insurance. RESULTS: Although the practices were mainly performed by the nurse, other occupations have been recorded as main practitioners and the time of the nursing activity is partially improperly reflected. Additionally, although the nurse practiced mainly in glucose (semi-quantitative) test, it was confirmed that the principal practitioner was described as a clinical pathologist. The the labor cost gap was estimated that is 9.3 times (median) and 11.9 times (average) in this analysis. CONCLUSION: This study suggests that it is necessary to legislate a policy that can improve the quality of clinical nursing by reinforcing the appropriateness and improving nursing fee through reflection of the actual time spent for nursing care.

Impact of Increased Supply of Newly Licensed Nurses on Hospital Nurse Staffing and Policy Implications

PURPOSE: This study aimed to analyze the impact of increasing the supply of newly licensed nurses on improving the hospital nurse staffing grades for the period of 2009~2014. METHODS: Using public administrative data, we analyzed the effect of newly licensed nurses on staffing in 1,594 hospitals using Generalized Estimating Equation (GEE) ordered logistic regression, and of supply variation on improving staffing grades in 1,042 hospitals using GEE logistic regression. RESULTS: An increase of one newly licensed nurse per 100 beds in general units had significantly lower odds of improving staffing grades (grades 6~0 vs. 7) (odds ratio=0.95, p=.005). The supply of newly licensed nurses increased by 32% from 2009 to 2014, and proportion of hospitals whose staffing grade had improved, not changed, and worsened was 19.1%, 70.1%, and 10.8% respectively. Compared to 2009, the supply variation of newly licensed nurses in 2014 was not significantly related to the increased odds of improving staffing grades in the region (OR=1.02, p=.870). CONCLUSION: To achieve a balance in the regional supply and demand for hospital nurses, compliance with nurse staffing legislation and revisions in the nursing fee differentiation policy are needed. Rather than relying on increasing nurse supply, retention policies for new graduate nurses are required to build and sustain competent nurse workforce in the future.

Paradoxical response as a cervical lymph node enlargement after termination of anti-tuberculosis treatment in a patient with pulmonary tuberculosis / 고신대학교의과대학학술지

A paradoxical response is not uncommon in non-HIV-infected patients, particularly those with extra-pulmonary tuberculosis. It is defined as the radiological and clinical worsening of a previous lesion or the development of new lesion during anti-tuberculosis therapy. The paradoxical response has been attributed to host immunologic reactions, such as a delayed hypersensitivity or a response to mycobacterial antigens. In most reports of paradoxical response, these responses occurred in the same location as a previous lesion. In this patient with pulmonary tuberculosis, cervical lymph node enlargement occurred as a paradoxical response after the completion of anti-tuberculosis treatment. Although the new lesion developed in another location, it could be considered as a paradoxical response based on the negative culture result of acid fast bacilli from the new lesion and drug sensitivity result from initial bronchoalveolar lavage specimen. Therefore we were able to decide on the termination of unnecessary anti-tuberculous treatment. Based on our case, we can conclude that paradoxical response can occur after the termination of anti-tuberculosis therapy even in new site.

The Effects of an Intensive Education Program on Hospital Infection Control on Nursing Students' Knowledge, Attitude, and Confidence in Infection Control

PURPOSE: The purpose of this study was to develop and conduct an intensive education program on infection control and investigated how the program influenced nursing students' knowledge, attitude, and confidence in the infection control. METHODS: The program was conducted for four days between January 5 and 8, 2016, for seven hours per day. The program was conducted by the specialists in infectious diseases and the nurses specializing in infection, and the third year students enrolled in E University participated in the program. Knowledge, attitude, and confidence in infection control were measured before and after the program in the students that participated in the program and those who did not. The experimental group consisted of 33 students while the control group comprised 28 students. RESULTS: The two groups were found to be homogeneous before the education program. After four days of intensive education program, the experimental group showed statistically significant improvements in knowledge (t=2.02, p=.048), attitude (t=2.04, p=.045), and performance confidence (t=2.75, p=.008) in infection control when compared to the control group. CONCLUSION: The present study showed that our intensive education program on hospital infection control was effective for the nursing students who will be professional nurses who will carry out autonomous roles in infection control in a near future.

Nurse Staffing Levels and Proportion of Hospitals and Clinics Meeting the Legal Standard for Nurse Staffing for 1996~2013 / 간호행정학회지

PURPOSE: To analyze the proportion of medical institutions meeting the legal standard for nurse staffing. METHODS: Data collected from 29,282 institutions between 1996 and 2013 were analyzed. Nurse staffing was measured as daily patient census per registered nurse (RN). The standard for general hospitals, hospitals, and clinics is 2.5 or less, and that for long-term care hospitals is 6.0 or less of the daily patient census per RN. Clinics may substitute nursing assistants for RNs by 50% or 100% depending on their daily inpatient census; long-term care hospitals may substitute nursing assistants for RNs by two thirds of the required number of RNs. RESULTS: The proportion of general hospitals, hospitals, clinics, and long-term care hospitals meeting the standards was 63%, 19%, 63%, and 94%, respectively, in 2013. While general hospitals had an increase in the proportion during the 1996-2013 period, small changes were found in hospitals and clinics. In 2013, nurses were estimated to care for 16 (interquartile range: 12~24) patients per shift in general hospitals. Three quarters of clinics had no RNs in 2013. CONCLUSION: Many medical institutions did not meet the legally mandated minimum staffing level. The government must implement policy actions for all medical institutions to meet the legal standards.

Association of Parenting Stresses, Maternal Role Adjustment, and Types of Feeding during Hospital Stays at Birth to Breastfeeding Adaptation

PURPOSE: This study was to explore association of maternal role adjustments, parenting stresses, and demographic factors to breastfeeding adaptation. METHODS: A correlational survey design was used to recruit 183 mothers who breastfeed or breastfed their babies. Participants' visited outpatient departments and were admitted to pediatric ward at 2 hospitals in metropolitan city of Korea. Inclusion criteria for subjects were mothers whose babies were from 1 month to 24 months old. Data were collected using a self-report questionnaire for mothers' and babies' demographic variables, maternal role adjustments, parenting stresses, and maternal breastfeeding adaptations. RESULTS: Higher levels of maternal adaptations and low levels of parenting stresses were associated with greater maternal breastfeeding adaptations. Types of feeding during hospital stays and baby's health status at birth were also associated with maternal breastfeeding adaptation. CONCLUSION: Results showed that a higher level of mothers' adjustment to breastfeeding; indicated lesser parenting stresses with higher levels of maternal adaptation. Nursing interventions for breastfeeding should be applied for appropriate breastfeeding adaptation during mothers' hospital stay. As baby's poor health status at birth medical team should provide a proper breastfeeding education.

A Review of Postpartum Depression: Focused on Psychoneuroimmunological Interaction

PURPOSE: The purpose of this review was to describe a psychoneuroimmunology (PNI) framework for postpartum depression (PPD) and discuss its implications for nursing research and practice for postpartum women. METHODS: This study explored the role of hypothalamic-pituitary-adrenal (HPA) axis and inflammation as possible mediators of risk factors for PPD through literature review. RESULTS: From this PNI view, human bodies are designed to respond with the reciprocal interactions among the neuro-endocrine and immune system when they are faced with physical or psychological stressors. Chronic stress induces alterations in the function of HPA axis, and a chronic low-grade inflammatory response is associated with depression. The dysfunctions of cytokines and HPA axis have been observed during the postpartum period. Stress promotes glucocorticoid receptor resistance, which can promote inflammatory responses. This, in turn, can contribute to the pathophysiology of depression. This can especially affect populations at vulnerable time-points, such as women in the postpartum. CONCLUSION: From a PNI perspective, well-designed prospective research evaluating the role of stress and inflammation as an etiology of PPD and the effect of stress reduction is warranted to prevent PPD.

Posterior Reversible Encephalopathy Syndrome Improved by Changing Immunosuppressant from Calcineurin Inhibitor to Sirolimus in a Kidney Transplantation Recipient / 대한이식학회지

Posterior reversible encephalopathy syndrome (PRES) is neurotoxicity characterized by brain imaging findings of reversible subcortical vasogenic edema. Clinical manifestations include seizure, altered mental status, focal neurologic deficit, and headache. Tacrolimus, a potent immunosuppressant, is related to increased risk of PRES in transplantation recipients. We report on a case of PRES in a 48-year-old female kidney transplantation recipient who received immunosuppression with tacrolimus, mycophenolate mofetil, and prednisolone. On postoperative day 14, she complained of moderate to severe headache which did not respond to usual analgesics. Magnetic resonance imaging showed high signal intensity on T2-weighted images and fluid-attenuated inverse recovery imaging in both parieto-occipital areas. The condition was improved after changing immunosuppressant from tacrolimus to sirolimus.