Pressure Ulcer Management Virtual Reality Simulation (PU-VRSim) for Novice Nurses: Mixed Methods Study.

BACKGROUND: Pressure ulcers (PUs) are a common and serious complication in patients who are immobile in health care settings. Nurses play a fundamental role in the prevention of PUs; however, novice nurses lack experience in clinical situations. Virtual reality (VR) is highly conducive to clinical- and procedure-focused training because it facilitates simulations. OBJECTIVE: We aimed to explore the feasibility of a novel PU management VR simulation (PU-VRSim) program using a head-mounted display for novice nurses and to investigate how different types of learning materials (ie, VR or a video-based lecture) impact learning outcomes and experiences. METHODS: PU-VRSim was created in the Unity 3D platform. This mixed methods pilot quasi-experimental study included 35 novice nurses categorized into the experimental (n=18) and control (n=17) groups. The PU-VRSim program was applied using VR in the experimental group, whereas the control group received a video-based lecture. The PU knowledge test, critical thinking disposition measurement tool, and Korean version of the General Self-Efficacy Scale were assessed before and after the intervention in both groups. After the intervention, the experimental group was further assessed using the Clinical Judgment Rubric and interviewed to evaluate their experience with PU-VRSim. RESULTS: The results compared before and after the intervention showed significant improvements in PU knowledge in both the experimental group (P=.001) and control group (P=.005). There were no significant differences in self-efficacy and critical thinking in either group. The experimental group scored a mean of 3.23 (SD 0.44) points (accomplished) on clinical judgment, assessed using a 4-point scale. The experimental group interviews revealed that the VR simulation was realistic and helpful for learning about PU management. CONCLUSIONS: The results revealed that PU-VRSim could improve novice nurses' learning of PU management in realistic environments. Further studies using VR for clinical training are recommended for novice nurses.

Development of an infection control competency scale for clinical nurses: an instrument design study.

BACKGROUND: Nurses work in close proximity to patients, and as such, they can have a direct impact on the control of infections; thus, it is important for nurses to be competent in infection control. However, the scales used to measure infection control performance in nurses are not suitable for measuring infection control competencies that reflect nurses' expertise, clinical environment, and work. Thus, this study aimed to develop a valid and reliable measure to assess infection control competency of clinical nurses. METHODS: A concept analysis, using a hybrid model, was performed on the infection control competency of clinical nurses to confirm the components and develop 67 initial items. Ten experts evaluated the content validity of these items, and a Korean language expert and a Doctor of Nursing reviewed the questions to consolidate them into 59 items. Subsequently, 267 nurses working at a certified tertiary hospital in D City were surveyed to confirm the validity and reliability of the scale. RESULTS: As a result of the study, the final scale comprising seven factors and 33 questions was derived, and the cumulative explanatory power of these factors was 60.8%. To verify convergent and discriminant validity, confirmatory factor analysis was conducted, and the average variance extraction index, composite reliability values, and confidence interval of the correlation coefficient between factors were confirmed. Convergent and discriminant validities were verified by comparison with standard values. The Cronbach's α for the entire scale in this study was 0.93. Consequently, the validity and reliability of the clinical nurses' infection control competency measurement scale were verified. CONCLUSIONS: The validity and reliability of the infection control competency measurement scale for clinical nurses (ICCS-CN) developed in this study was verified, and the scale can be effectively used to measure the infection control competency of clinical nurses. Measuring the infection control competency of clinical nurses will help reduce the harm caused by infection and ensure patient safety by decreasing infection rates in medical institutions.

Exploring influential factors on patient safety culture in delirium nursing care within long-term care facilities: a cross-sectional survey.

BACKGROUND: Elderly residents with physical and cognitive impairments in long-term care facilities are vulnerable to safety risks. PURPOSE: This study investigated factors that influence patient safety cultures in delirium nursing care in long-term care facilities. METHODS: A cross-sectional survey was conducted among 214 nurses working in 12 long-term care facilities using a structured questionnaire from February 15, 2022, to March 14, 2022. Data analysis was performed using Pearson's correlation coefficients and hierarchical analysis with SPSS/WIN 25.0 software. RESULTS: Significant factors associated with patient safety culture were identified. Organizational factors included the availability of delirium care manuals, nursing education and experience in delirium care, and the perceived necessity of delirium education. Individual factors included nurse-to-patient ratios, and nurses marital status. CONCLUSION: To foster a strong patient safety culture, attention should be given to the availability of delirium care resources, the promotion of specialized and ongoing education and experience, and adequate staffing levels.

Web-Based Delirium Prevention Application for Long-Term Care Facilities.

OBJECTIVE: A web-based application was developed for medical staff to easily access and use a comprehensive delirium prevention management program-comprising risk prediction, assessment, and intervention-even in long-term care facilities with insufficient systems. DESIGN: A randomized control trial. SETTING AND PARTICIPANTS: A long-term care facility with 250 beds in Korea. Participants were 130 facility residents aged 18 or older who understood the purpose of this study and for whom a legal representative provided participation consent. Participants were randomly assigned to the intervention and control groups (n = 65 per group). METHODS: The participants' risk of delirium episodes was predicted using the web-based application Web_DeliPREVENT_4LCF. Delirium was assessed using the built-in Short Confusion Assessment Method (S-CAM). Among the intervention group, nonpharmacological, multicomponent delirium prevention interventions guided by the application were applied to participants who were predicted to be at risk for delirium or tested positive for delirium. The intervention was provided for 30 days. RESULTS: The intervention group had a 0.30 times lower incidence of delirium [95% confidence interval (CI) 0.12-0.79; P = .015] and 0.08 times lower 1-month hospitalization mortality (95% CI 0.01-0.79; P = .031) than the control group. There were no differences between the 2 groups in delirium severity, mortality, and 3-month hospitalization mortality, long-term care facility discharge, and length of stay. CONCLUSIONS AND IMPLICATIONS: The Web_DeliPREVENT_4LCF was effective in reducing delirium episodes and 1-month in-hospital mortality. Therefore, even in Korean long-term care facilities, which lack manpower and electronic medical record systems compared with general hospitals, the health care professional can easily access and use the app for early detection and preventive intervention for residents' delirium. REGISTRATION: KCT0005804.

Factors affecting self-care among community-dwelling hypertensive older adults: A cross-sectional study.

AIM: To examine self-care behaviours among older adults with hypertension and identify related factors, including cognitive function, religious belief and comorbidities. DESIGN: A cross-sectional study. METHODS: Self-care behaviours included diet and health. Participants completed a survey including items on demographics, disease-related characteristics and self-care behaviours and underwent cognitive function tests. Data were analysed using descriptive statistics, and multiple regression analysis was performed to analyse the factors affecting self-care. RESULTS: Regarding diet behaviour, older religious adults and those with higher scores on the Montreal Cognitive Assessment-Korean version had higher levels of self-care scores according to the HBP-SC. Regarding health behaviour, older adults with no comorbidities had higher levels of self-care scores according to the HBP-SC. CONCLUSION: Factors affecting self-care diet behaviour include religion and Montreal Cognitive Assessment-Korean version scores and those affecting health behaviour include comorbidities among older adults with hypertension. Therefore, to improve their self-care behaviours, their religious practices and comorbidities should be considered, cognitive function should be assessed, and tailored education should be provided. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: This study investigated factors affecting self-care behaviours of hypertensive older adults in South Korea. The self-care was divided into diet and health behaviours. The factors influencing diet behaviour were religion and Montreal Cognitive Assessment-Korean version scores, and the factor influencing health behaviour was comorbidities. We also investigated self-care behaviour patterns. Older adults with hypertension were good at controlling alcohol consumption and did not forget to fill prescriptions. However, they were poor at reading nutrition labels to check on sodium content and checking blood pressure at home. Therefore, nurses could develop interventions considering these influencing factors and behavioural patterns to improve self-care behaviours and enhance health for older adults with hypertension. IMPACT: Hypertension in older adults affects their health conditions and performance of self-care behaviours. Nurses could assess self-care based on diet and health behaviours. Additionally, further developing tailored programmes is recommended considering factors like religious belief, cognitive function and comorbidities. REPORTING METHOD: This study followed the STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION: This study used a convenience sample of 105 participants aged ≥ 65 years recruited from a Korean hospital.

The development of a web-based app employing machine learning for delirium prevention in long-term care facilities in South Korea.

BACKGROUND: Long-term care facilities (LCFs) in South Korea have limited knowledge of and capability to care for patients with delirium. They also often lack an electronic medical record system. These barriers hinder systematic approaches to delirium monitoring and intervention. Therefore, this study aims to develop a web-based app for delirium prevention in LCFs and analyse its feasibility and usability. METHODS: The app was developed based on the validity of the AI prediction model algorithm. A total of 173 participants were selected from LCFs to participate in a study to determine the predictive risk factors for delerium. The app was developed in five phases: (1) the identification of risk factors and preventive intervention strategies from a review of evidence-based literature, (2) the iterative design of the app and components of delirium prevention, (3) the development of a delirium prediction algorithm and cloud platform, (4) a pilot test and validation conducted with 33 patients living in a LCF, and (5) an evaluation of the usability and feasibility of the app, completed by nurses (Main users). RESULTS: A web-based app was developed to predict high risk of delirium and apply preventive interventions accordingly. Moreover, its validity, usability, and feasibility were confirmed after app development. By employing machine learning, the app can predict the degree of delirium risk and issue a warning alarm. Therefore, it can be used to support clinical decision-making, help initiate the assessment of delirium, and assist in applying preventive interventions. CONCLUSIONS: This web-based app is evidence-based and can be easily mobilised to support care for patients with delirium in LCFs. This app can improve the recognition of delirium and predict the degree of delirium risk, thereby helping develop initiatives for delirium prevention and providing interventions. Moreover, this app can be extended to predict various risk factors of LCF and apply preventive interventions. Its use can ultimately improve patient safety and quality of care.

Operationalization of an Expanded Anteroom in a COVID-19-Dedicated Hospital in South Korea.

The concentration of patients in a few facilities burdens healthcare providers and the healthcare system. This study examined the operations of an extended anteroom in a COVID-19-dedicated hospital. It presents issues to consider in the deployment and operation of an extended anteroom through discussions by expert working groups. The subjects covered included efficient space, staffing, equipment management, and education. The process involved wearing personal protective equipment (personal protective equipment; in this case, Level D), and if necessary, wearing additional powered air purification respirators (PAPR), after moving from the preparation room to the dressing room, and when entering the hospital through the entrance passage. When leaving the hospital, personnel used a mandatory exit-only passage. In the dressing room, they undressed, and then went outside. The efficient spatial composition of the anteroom facilitated entry and exit, as well as the separation of contaminated and non-contaminated areas using colors and lines. As COVID-19 spread rapidly in the community, COVID-19-dedicated hospitals were established highly quickly. Therefore, there exists a limitation because sufficient discussion with external experts has not been made. In the future, the development of an operating manual for dedicated infectious disease hospitals and continued research into the improvement of care is needed. This study indicated the need to develop educational programs and use educational simulations, to address regionally spread infectious diseases.

Machine Learning to Identify Psychomotor Behaviors of Delirium for Patients in Long-Term Care Facility.

This study aimed to develop accurate and explainable machine learning models for three psychomotor behaviors of delirium for hospitalized adult patients. A prospective pilot study was conducted with 33 participants admitted to a long-term care facility between August 10 and 25, 2020. During the pilot study, we collected 560 cases that included 33 clinical variables and the survey items from the short confusion assessment method (S-CAM), and developed a mobile-based application. Multiple machine learning algorithms, including four rule-mining algorithms (C4.5, CBA, MCAR, and LEM2) and four other statistical learning algorithms (LR, ANNs, SVMs with three kernel functions, and random forest), were validated by paired Wilcoxon signed-rank tests on both macro-averaged F1 and weighted average F1-measures during the 10-times stratified 2-fold cross-validation. The LEM2 algorithm achieved the best prediction performance (macro-averaged F1-measure of 49.35%; weighted average F1-measure of 96.55%), correctly identifying adult patients at delirium risk. In the pairwise comparison between predictive powers observed from independent models, the LEM2 model showed a medium or large effect size between 0.4925 and 0.8766 when compared with LR, ANN, SVM with RBF, and MCAR models. We have confirmed that acute consciousness in S-CAM assessment is closely associated with different predictors for screening three psychomotor behaviors of delirium: 1) education level, dementia type or its level, sleep disorder, dehydration, and infection in mixed-type delirium; 2) gender, education level, dementia type, dehydration, bedsores, and foley catheter in hyperactive delirium; and 3) pain, sleep disorder, and haloperidol use in hypoactive delirium.

Factors affecting patient safety culture in terms of compliance with preventing bloodborne pathogens among general hospital nurses.

BACKGROUND: The present study aims to investigate the relationship between patient safety culture and the prevention of transmitting bloodborne pathogens among nurses at a general hospital. METHODS: The participants were 284 nurses working at a general hospital located in a city, and the data were collected between April 26 and May 15, 2019. Questionnaires on patient safety culture and the prevention of bloodborne pathogens were used, and SPSS version 22.0 was used for descriptive and hierarchical regression analysis. RESULTS: The results showed that the following factors affected the prevention of bloodborne pathogens: experience with needle stick and sharps injuries (ß = - 0.94), teamwork (ß = 0.41), knowledge and attitude toward patient safety (ß = 0.34), leadership (ß = 0.15), and priority of patient safety (ß = 0.14). The model's explanatory power was 53% (F = 32.26, p =< 0.001). CONCLUSIONS: To increase the compliance of general hospital nurses with practices that promote the prevention of bloodborne pathogens, it is necessary to actively prevent needle sticks and sharps injuries. It is also necessary to prioritize patient safety and to develop and verify the effects of various programs that emphasize factors of patient safety culture, such as leadership, teamwork, knowledge, and attitude.

Effects of a labour and delivery simulated practice programme for elderly primigravidas.

Aim: Increasing numbers of older gravidas compel research into best practices for their labour-related outcomes. Responding to this need, this study sought to develop and evaluate a programme for older primigravidas. Design: The authors developed a simulated practice programme for older primigravidas and tested its effects. Methods: A non-equivalent control group pre- and post-test design was used with 49 community-dwelling primigravidas. The programme taught the stages of labour using a realistic scenario-based practice and a debriefing session. Data were collected between June and September 2015. Participants were divided into intervention (N = 25) and control (N = 24) groups. Postintervention group effects were analysed with independent t tests. Results: The intervention group's levels of anxiety and stress decreased and their knowledge and self-confidence increased. The intervention group's labour duration was also shorter than that of the control group.

Experience of gerotranscendence among community-dwelling older people: A cross-sectional study.

AIMS AND OBJECTIVES: To investigate the experience of gerotranscendence among older people in community in Korea and the factors that influence their experience. BACKGROUND: While the literature provides estimates of how many older people are affected by negative aspects of ageing, it is not known to what extent and why some older people experience gerotranscendence, despite the challenges they encounter throughout their lifetime. DESIGN: A cross-sectional survey. METHODS: A 55-item questionnaire was distributed to 109 older people between March and June 2017. Univariable and multivariable linear regressions were conducted on the four question group sum scores to identify factors associated with gerotranscendence. RESULTS: Older people aged 65-93 who live in a community in Korea reported the experience of gerotranscendence. Age and religion showed a statistically significant association with gerotranscendence. Religiosity showed a statistically significant association with beliefs about death and dying. Age and beliefs about death and dying have significant relationship with the experience of gerotranscendence. CONCLUSIONS: Older people who have more positive views about death and dying are more likely to experience gerotranscendence. The study results provide nurses and other healthcare professionals with new understandings and insights about the factors potentially related to positive ageing process. IMPLICATIONS FOR PRACTICE: It is essential for nurses to investigate their own beliefs about death and dying, and their understanding of gerotranscendence which will contribute to developing education programs and practice guidelines as an essential part of promoting gerotranscendence and positive ageing.

Outcomes of Patients With Delirium in Long-Term Care Facilities: A Prospective Cohort Study.

A 6-month prospective cohort study was performed in patients with or without dementia admitted to two Korean long-term care (LTC) facilities. Participants were categorized into four groups: (a) no delirium or dementia, (b) dementia only, (c) delirium only, and (d) delirium superimposed on dementia (DSD). Delirium incidence, mortality, readmission, discharge placement, length of stay, and other associated factors were evaluated. The incidence of delirium was 48%. The largest number of patients belonged to the DSD group; outcomes associated with delirium were analyzed as covariates. The delirium-only group had a significantly higher mortality rate than other groups. Length of stay was the longest for the dementia-only group. On the Kaplan-Meier survival curve, the delirium-only group had the lowest probability of survival compared to other groups. The mortality rate of patients with delirium only was significantly higher than the mortality rates of all other groups. LTC facilities should provide preventive interventions for patients with delirium. [Journal of Gerontological Nursing, 44(9), 41-50.].

Development and validation of an automated delirium risk assessment system (Auto-DelRAS) implemented in the electronic health record system.

BACKGROUND: A key component of the delirium management is prevention and early detection. OBJECTIVE: To develop an automated delirium risk assessment system (Auto-DelRAS) that automatically alerts health care providers of an intensive care unit (ICU) patient's delirium risk based only on data collected in an electronic health record (EHR) system, and to evaluate the clinical validity of this system. DESIGN: Cohort and system development designs were used. SETTING: Medical and surgical ICUs in two university hospitals in Seoul, Korea. PARTICIPANTS: A total of 3284 patients for the development of Auto-DelRAS, 325 for external validation, 694 for validation after clinical applications. METHODS: The 4211 data items were extracted from the EHR system and delirium was measured using CAM-ICU (Confusion Assessment Method for Intensive Care Unit). The potential predictors were selected and a logistic regression model was established to create a delirium risk scoring algorithm to construct the Auto-DelRAS. The Auto-DelRAS was evaluated at three months and one year after its application to clinical practice to establish the predictive validity of the system. RESULTS: Eleven predictors were finally included in the logistic regression model. The results of the Auto-DelRAS risk assessment were shown as high/moderate/low risk on a Kardex screen. The predictive validity, analyzed after the clinical application of Auto-DelRAS after one year, showed a sensitivity of 0.88, specificity of 0.72, positive predictive value of 0.53, negative predictive value of 0.94, and a Youden index of 0.59. CONCLUSIONS: A relatively high level of predictive validity was maintained with the Auto-DelRAS system, even one year after it was applied to clinical practice.

Sexual Abuse Prevention Mobile Application (SAP_MobAPP) for Primary School Children in Korea.

This study aimed to develop and evaluate the effects of a sexual abuse prevention mobile application, SAP_MobAPP, for primary school children. Forty-five subjects were trained for 40 minutes once a week. The experimental group received education that utilized the SAP_MobAPP. Control group A received Web based sexual abuse prevention education, while control group B received textbook based sexual abuse prevention education. Effectiveness was verified through a survey on child sexual abuse recognition and avoidance skills administered before and after training. The SAP_MobAPP program improved recognition (awareness) and the child's skills to avoid child sexual abuse situations, and the effects were long-lasting. However, differences between groups were not statistically significant. This study developed a sexual abuse prevention application and verified its effectiveness. Awareness and skills to avoid child sexual abuse after app education increased immediately after training and four weeks later. The SAP_MobAPP could be used for sexual abuse prevention education in schools.

The effects of a tailored intensive care unit delirium prevention protocol: A randomized controlled trial.

BACKGROUND: A decreased incidence of delirium following the application of non-pharmacologic intervention protocols to several patient populations has been previously reported. However, few studies have been conducted to examine the effects of their application to intensive care unit (ICU) patients. OBJECTIVES: To examine the effects of applying a tailored delirium preventive protocol, developed by the authors, to ICU patients by analyzing its effects on delirium incidence, in-hospital mortality, ICU readmission, and length of ICU stay in a Korean hospital. DESIGN: A single-blind randomized controlled trial. SETTINGS: A 1049-bed general hospital with a 105-bed ICU. PARTICIPANTS: Sixty and 63 ICU patients were randomly assigned to the intervention and control groups, respectively. METHODS: The researchers applied the delirium prevention protocol to the intervention group every day for the first 7 days of ICU hospitalization. Delirium incidence, mortality, and re-admission to the ICU during the same hospitalization period were analyzed by logistic regression analysis; the 7- and 30-day in-hospital mortality by Kaplan-Meier survival and Cox proportional hazard regression analysis; and length of ICU stay was assessed by linear regression analysis. RESULTS: Application of the protocol had no significant effect on delirium incidence, in-hospital mortality, re-admission to the ICU, or length of ICU stay. Whereas the risk of 30-day in-hospital mortality was not significantly lower in the intervention than in the control group (OR: 0.33; 95% CI: 0.10-1.09), we found a significantly decreased 7-day in-hospital mortality in the intervention group after protocol application (HR: 0.09; 95% CI: 0.01-0.72). CONCLUSIONS: Application of a tailored delirium prevention protocol to acute stage patients during the first 7 days of ICU hospitalization appeared to reduce the 7-day in-hospital risk of mortality only for this patient population.

Is delirium an unrecognized threat to patient safety in Korean intensive care units?

Delirium is an emerging topic in patient safety. However, in Korea, delirium is still underrecognized despite high incidence rates in Korean hospitals. We studied the impact of delirium on patient outcomes in Korean intensive care units (ICUs) and found that delirium is associated with higher in-hospital mortality, shorter survival over the course of hospitalization, longer ICU and hospital stays, more frequent readmission to the ICU for the same hospitalization event, and higher health care costs.