Identifying the nutrition support nurses' tasks using importance-performance analysis in Korea: a descriptive study.

PURPOSE: Nutrition support nurse is a member of a nutrition support team and is a health care professional who takes a significant part in all aspects of nutritional care. This study aims to investigate ways to improve the quality of tasks performed by nutrition support nurses through survey questionnaires in Korea. METHODS: An online survey was conducted between October 12 and November 31, 2018. The questionnaire consists of 36 items categorized into 5 subscales: nutrition-focused support care, education and counseling, consultation and coordination, research and quality improvement, and leadership. The importance-performance analysis method was used to confirm the relationship between the importance and performance of nutrition support nurses' tasks. RESULTS: A total of 101 nutrition support nurses participated in this survey. The importance (5.56±0.78) and performance (4.50±1.06) of nutrition support nurses' tasks showed a significant difference (t=11.27, P<0.001). Education, counseling/consultation, and participation in developing their processes and guidelines were identified as low-performance activities compared with their importance. CONCLUSION: To intervene nutrition support effectively, nutrition support nurses should have the qualification or competency through the education program based on their practice. Improved awareness of nutrition support nurses participating in research and quality improvement activity for role development is required.

Keyword Network Analysis of Infusion Nursing from Posts on the Q&A Board in the Intravenous Nurses Café.

OBJECTIVES: Portal sites have become places to share queries about performing nursing and obtain expert know-how. This study aimed to analyze topics of interest in the field of infusion nursing among nurses working in clinical settings. METHODS: In total, 169 user query data were collected from October 5, 2018 to December 25, 2021. This exploratory study analyzed the semantic structure of posts on the nurse question-and-answer board of an infusion nursing-related internet portal by extracting major keywords through text data analysis and conducting term frequency (TF) and term frequency-inverse document frequency (TF-IDF) analysis, N-gram analysis, and CONvergence of iteration CORrelation (CONCOR) analysis. Word cloud visualization was conducted utilizing the "wordcloud" package of Python to provide a visually engaging and concise summary of information about the extracted terms. RESULTS: "Infusion" was the most frequent keyword and the highest-importance word. "Infusion→line" had the strongest association, followed by "vein→catheter," "line→change," and "peripheral→vein." Three topics were identified: the replacement of catheters, maintenance of the patency of the catheters, and securement of peripheral intravenous catheters, and the subtopics were blood sampling through central venous catheter, peripherally inserted central catheter management, evidence-based infusion nursing, and pediatric infusion nursing. CONCLUSIONS: These findings indicate that nurses have various inquiries in infusion nursing. It is necessary to re-establish the duties and roles of infusion nurses, and to develop effective infusion nursing training programs.

Differences in nurses' perceptions of self-reported pain and the administered morphine dose according to the patient's facial expression in Korea

PURPOSE: This study aimed to compare nurses' perceptions of self-reported pain, the recorded pain score, and pain treatment according to the patient's facial expression. METHODS: In this descriptive cross-sectional survey, the participants were 472 nurses working at a tertiary hospital in Seoul, Korea. A self-report questionnaire presented nurses with a smiling patient complaining of acute post-surgical pain and a grimacing patient with cancer pain, both of whom reported a pain level of 8 out of 10, and asked nurses to indicate their perception of the pain intensity, the pain score that they would record, and the medication that they would provide for each patient. RESULTS: The pain intensity perceived by nurses for the grimacing patient was significantly higher than that for the smiling patient (P<0.001). The recorded pain score was likewise significantly higher for the grimacing patient than for the smiling patient (P<0.001). There was a significant difference in the amount of morphine chosen by the nurses for pain interventions between the smiling and grimacing patients (P=0.040). Higher perceived pain intensity and score were associated with higher administered doses of morphine. CONCLUSION: These findings suggest that nurses might be affected by patients' facial expressions when treating pain. A pain management program should be developed that trains nurses to accurately recognize pain hidden in patients' faces and provides them with the knowledge of how to appropriately assess and manage patients' pain.

Guidelines for the management of extravasation.

The purpose of these practice guidelines is to offer and share strategies for preventing extravasation and measures for handling drugs known to cause tissue necrosis, which may occur even with the most skilled experts at intravenous (IV) injection. Herein, general knowledge about extravasation is first described, including its definition, incidence, risk factors, diagnosis, differential diagnosis, and extravasation injuries. Management of extravasation includes nursing intervention and thermal application. At the first sign of extravasation, nursing intervention with following steps is recommended: stop administration of IV fluids immediately, disconnect the IV tube from the cannula, aspirate any remaining drug from the cannula, administer drug-specific antidote, and notify the physician. Local thermal treatments are used to decrease the site reaction and absorption of the infiltrate. Local cooling (ice packs) aids in vasoconstriction, theoretically limiting the drug dispersion. Although clear benefit has not been demonstrated with thermal applications, it remains a standard supportive care. The recommended application schedule for both warm and cold applications is 15 to 20 minutes, every 4 hours, for 24 to 48 hours. For prevention of extravasation, health professionals should be familiar with the extravasation management standard guidelines. They should regularly check the extravasation kit, assess patients' sensory changes, tingling or burning, and always pay attention to patients' words. The medical team's continuous education on extravasation is essential. With the practical use of these guidelines, it is expected to reduce the occurrence rate of extravasation and contribute to patient care improvement.

Experience and Satisfaction of Cancer Patients With a Central Venous Catheter at a Tertiary Hospital in South Korea.

As cancer chemotherapy transitions from inpatient care to outpatient care, the number of patients who receive a central venous catheter (CVC) and the interest in CVCs as a safe intravenous administration route have increased recently in South Korea. The purpose of this study was to investigate the discomforts and satisfaction that cancer patients with a CVC may experience in daily activities as an outpatient and to provide rationale for nursing interventions. Data collection was conducted between April 11, 2011, and August 31, 2011. Forty-three questionnaires were collected, and a total of 41 questionnaires were used for the final analysis. The mean age of patients was 45.1 years (SD = 11.1 years; range, 18-64 years). The average score of experience of the CVC insertion procedure, daily life experiences of patients with a CVC, the satisfaction and fear of using a CVC, and the acceptance of CVCs were 2.48 ± 0.56, 2.18 ± 0.50, 2.56 ± 0.49, and 2.35 ± 0.39, respectively. The results showed that more detailed information on CVCs, as well as sufficient emotional support, should be provided to the patient to minimize discomfort during CVC insertion. Patient-centered education helps empower patients to master CVC self-management, as well as an understanding of the cultural aspect of South Korean patients who practice the traditional Confucian ethics of "unaltering one's body" and are therefore reluctant to have CVCs inserted into their bodies.

Life-Sustaining Treatment in End-Stage Liver Disease Patients: Patients' Decisions and Results.

Purpose: In 2018, the Act on Decisions on Life-Sustaining Treatment for Patients in Hospice and Palliative Care or at the End of Life was implemented and the scope of official recognition for terminally ill patients was expanded. The purpose of this study was to investigate the decisions made by patients with end-stage liver disease about their life-sustaining treatment in a clinical setting. Methods: The subjects of this study were patients with endstage liver disease hospitalized at a tertiary hospital in Seoul, Korea who wrote physician orders for life-sustaining treatment (POLST). Data collection was done using patients' electronic medical records, and a retrospective analysis of POLST was conducted. Results: Among 101 patients, 18.8% were female and 81.2% were male, and their mean age was 61.8 (±10.61) years. Sixty-three patients (62.4%) wrote their POLST by themselves. Three patients withdrew the POLST, of whom two did so for liver transplantation, and one did so for chemotherapy. Conclusion: This study shows that sufficient consideration of liver transplantation is needed for end-stage liver disease patients before making decisions on life-sustaining treatment. The self-determination of patients must be respected and effective guidelines are urgently needed.

Analysis of data on capecitabine-related adverse drug reactions from the Korean adverse event reporting system database.

PURPOSE: The purpose of this study was to evaluate the adverse drug reactions (ADRs) and serious adverse events associated with capecitabine use in Korean patients by analyzing data from a comprehensive national database of adverse events. METHOD: Data from all reports concerning capecitabine (Anatomical Therapeutic Chemical code: L01BC06) generated between January 2011 and December 2014 were collected from the Korean Adverse Event Reporting System database (KAERS). RESULTS: A total of 676 reports and 1069 capecitabine-related ADRs were identified. Ninety-nine cases (14.6%) were classified as serious adverse events. The most commonly reported capecitabine-related ADRs involved gastrointestinal system disorders (324, 30.3%), including diarrhea, nausea, vomiting, and stomatitis, followed by skin and appendage reactions (220, 20.6%), which included symptoms such as skin discoloration/disorder/dryness, itching, and rash. CONCLUSIONS: Patients need to be educated about the common ADRs associated with capecitabine intake in a clinical setting. Patient characteristics must be considered when determining the capecitabine dosage and risk of ADRs, and nursing intervention is critical for preventing exacerbation of these ADRs.

Implementing a central venous catheter self-management education program for patients with cancer.

PURPOSE: To evaluate the effects of the central venous catheter self-management education program (CVC S-MEP) in improving knowledge, attitude, and behavior regarding CVC and in decreasing CVC-related complications in patients with cancer during homecare service. METHODS: A quasi-experimental, sequential cohort design study of patients with cancer and who have CVCs was performed to compare the effect of CVC S-MEP with usual care. RESULTS: The study group consisted of 45 participants (26 male and 19 female), and the mean age was 46.1 (SD, 10.5) years. The subjects of the CVC S-MEP had significantly high mean levels of self-management knowledge (p = 0.007), attitude (p < 0.001), and behavior (p = 0.002). Also, the participants in the CVC S-MEP had significantly lower frequency of catheter-related complications (p = 0.030). CONCLUSIONS: The CVC S-MEP helped improve patients' ability to resolve problems and adequately respond to CVC-related emergency situations by fostering greater self-care ability. Additionally, providing practical information for CVC self-management in a gradual and repetitive manner had a notable positive effect on patients.

A comprehensive review of clinical nurse specialist-led peripherally inserted central catheter placement in Korea: 4101 cases in a tertiary hospital.

Peripherally inserted central catheters (PICCs) are expected to be convenient and reliable venous access devices. The purpose of this study was to analyze clinical nurse specialist (CNS)-led PICC placement and to describe its growth in a tertiary hospital. A computerized database identified 3508 patients who had PICCs placed between November 2001 and June 2010. One thousand, eight hundred ninety-eight of the 4101 PICCs were available for complete follow-up, and 791 of 1898 PICCs were still in place. The mean dwell time of 1898 PICCs was 27.4 days (1∼422 days). Most PICCs were removed after the completion of infusion therapy; the remainder were removed following death, occlusion, suspected infection, or phlebitis, or were removed by the patient. The study found that CNS-led PICC placement for infusion therapies was effective and safe with relatively low complication rates and that CNSs played important roles in the increased use of PICCs.

Improving the quality of cancer pain management in an academic medical center emergency department.

The impact and outcomes of the implementation of a pain management guideline and pain assessment standard operating procedure (SOP) in a cancer-specific emergency department are evaluated in this article. After implementation of the SOP, the number of pain assessments conducted per patient during hospitalization increased, as did the percentage of patients who underwent a pain assessment at admission, within one hour after analgesic medication was administered, and at regular intervals.

Anorectal manometric parameters are influenced by gender and age in subjects with normal bowel function.

PURPOSE: Anorectal manometry provides objective information about anorectal function, but its results depend on the examiner's skill, the type of equipment, and subject characteristics like age or gender. This single institution, prospective study was performed to investigate the effect of gender and age on the results of anorectal manometry. METHODS: All included subjects completed a questionnaire to assess their bowel function. The survey included 13 validated questions (eight on constipation and five on incontinence) and was used to exclude subjects with pathological constipation or incontinence. Subjects with normal bowel function underwent anorectal manometry to measure anal sphincter length (ASL), maximum resting pressure (MRP), and maximum squeeze pressure (MSP), and the results were compared by gender and age. RESULTS: The mean age of the 154 participants (94 male and 60 female) was 59.1 years. ASL was greater in men (4.23 vs. 3.85 cm, p < 0.001). MRP was not significantly different according to gender (p = 0.93), but MSP was higher in men (190.18 vs. 116.49 mmHg, p < 0.001). ASL did not correlate with age (p = 0.707). MRP was inversely related to age in both men (R (2) = 0.152, p < 0.001) and women (R (2) = 0.282, p < 0.001), and MSP only in women (R (2) = 0.210, p < 0.001). CONCLUSIONS: Anorectal manometric parameters are influenced by gender and age. This should be taken into consideration when interpreting manometric readings in a clinical setting.

Chemotherapy-induced amenorrhea, menopause-specific quality of life, and endocrine profiles in premenopausal women with breast cancer who received adjuvant anthracycline-based chemotherapy: a prospective cohort study.

PURPOSE: We conducted a prospective observational study for premenopausal women receiving adjuvant adriamycin and cyclophosphamide-containing regimens to define the pattern of chemotherapy-induced amenorrhea (CIA), the menopause-specific quality of life (MENQOL), and the hormone profiles. METHODS: From October 2003 to July 2007, 387 patients with breast cancer who underwent curative surgery were prospectively included. Patient self-assessment by MENQOL questionnaires and blood samples for hormone assays were taken before chemotherapy, and 1, 6, and 12 months after chemotherapy was completed. RESULTS: Patients were categorized into three groups according to their duration and reversibility of amenorrhea, with 312 eligible patients split into long-term CIA (n = 180, 57.7 %), temporary CIA (n = 113, 36.2 %), and menstrual irregularity (n = 19, 6.1 %) groups. Risk factors for long-term CIA were identified as age ≥40 years (p < 0.001), the addition of taxane (p = 0.01), and tamoxifen use (p = 0.03). MENQOL was worst immediately after the completion of adjuvant chemotherapy, and this was not fully recovered even 12 months after chemotherapy had finished. Age ≥40 years and tamoxifen exposure were inversely associated with MENQOL. In long-term CIA patients, the level of follicle-stimulating hormone increased after chemotherapy; this level, however, was reduced in patients who received tamoxifen, but remained high and stable in those who did not (p < 0.001 at 6 months; p < 0.001 at 12 months). CONCLUSION: This study showed that most premenopausal breast cancer patients who received adjuvant chemotherapy experienced clinically significant CIA, followed by impaired MENQOL. Our findings may be relevant in the decision-making processes for premenopausal women with breast cancer.

Body fat assessment method using CT images with separation mask algorithm.

In recent years, the number of obese population in Korea has been growing up along with the economic development, environmental factors, and the change in life style. Considering the growth of obese population and the adverse effect of obesity on health, it is getting more important to prevent and diagnose the obesity with the quantitative measurement of body fat that has become an important indicator for obesity. In this study, we proposed a procedure for the automated fat assessment from computed tomography (CT) data using image processing technique. The proposed method was applied to a single-CT image as well as CT-volume data, and results were correlated to those of dual-energy X-ray absorptiometry (DEXA) that is known as the reliable method for evaluating body fat. Using single-CT images, correlation coefficients between DEXA and the automated assessment and DEXA and the manual assessment were 0.038 and 0.058, respectively (P > 0.05). Hence, there was no significant correlation between three methods using the proposed method with single-CT images. On the other hand, in case of CT-volume data, the above correlation coefficients were increased to 0.826, 0.812, and 0.805, respectively (P < 0.01). Thus, DEXA and the proposed methods with CT-volume data showed highly significant correlation with each other. The results suggest that the proposed automated assessment using CT-volume data is a reliable method for the evaluation of body fat. It is expected that the clinical application of the proposed procedure will be helpful to reduce the time for the quantitative evaluation of patient's body fat.