Purpose : As the intensive care unit (ICU) survival rate increases, interest in the lives of ICU survivors has also been increasing. The purpose of this study was to identify the sentiment of ICU survivors. Method : The author analyzed the quotations from previous qualitative studies related to ICU survivors; a total of 1,074 sentences comprising 429 quotations from 25 relevant studies were analyzed. A word cloud created in the R program was utilized to identify the most frequent adjectives used, and sentiment and emotional scores were calculated using the Artificial Intelligence (AI) program. Results : The 10 adjectives that appeared the most in the quotations were 'difficult', 'different', 'normal', 'able', 'hard', 'bad', 'ill', 'better', 'weak', and 'afraid', in order of decreasing occurrence. The mean sentiment score was negative ($-.31{\pm}.23$), and the three emotions with the highest score were 'sadness'($.52{\pm}.13$), 'joy'($.35{\pm}.22$), and 'fear'($.30{\pm}.25$). Conclusion : The natural language processing of AI used in this study is a relatively new method. As such, it is necessary to refine the methodology through repeated research in various nursing fields. In addition, further studies on nursing interventions that improve the coherency of ICU memory of survivors and familial support for the ICU survivors are needed.

Purpose : This study was intended to investigate the frequency of job performance of the Korean professional medical support staffs (PMSS). Method : The data of 1,666 PMSS from 36 hospitals and over 500 beds were analyzed. The participants were divided into 5 groups: advanced practice nurses (APN), clinical nurse experts, physician assistants (PA), coordinators, and others. Results : Among the 5 main domains of job performance, advanced clinical practice has the highest frequency (111.36 d/y), followed by consultation/collaboration (75.66 d/y), education/counseling (53.54 d/y), leadership (23.90 d/y), and research (19.14 d/y). There was a significant difference in the frequency of job performance between the 5 groups of participants. The invasive activities were more frequent in the PA group. In the education and counseling domain, APNs had a higher level of job frequency than others (p < .001). In the research and leadership domains, APNs and coordinators had more prominent performance frequency than other groups (p < .01). However, there are some ambiguities in the job performance of the 5 groups depending on institutional characteristics. Conclusion : To establish the scope of work of PMSS, organizational and individual efforts are needed to promote and expand the leadership and research domains. To resolve the ambiguities of PMSS' roles, it is necessary to reorganize their titles.

Purpose : The purpose of this study was to compare the effect of recirculation rate according to cannulation direction and interval among hemodialysis patients with arteriovenous fistula (AVF). Method : The research used repeated measures design. This study was conducted among thirty patients who received hemodialysis three times a week for longer than a year through AVF at the I University hospital. Three different types of interventions were administered to the participants each week for three weeks. Needles were placed at a different distance and in a different direction each week: 7 cm apart from each other in antegrade direction during the first week, 5 cm apart in retrograde direction in the following week, and 7 cm apart in retrograde direction in the third week. Results : No significant differences in the recirculation rate were found due to any of the three tested methods (p = 1.00). Conclusion : This finding suggests that, if the patients have well-functioned AVF, we can choose an appropriate intervention from among the three methods in consideration of the patient's diverse needs.

Purpose : Nurses' knowledge regarding advance directives may affect their administration of and confidence towards end of life care. This study aimed to describe the relationships of knowledge, confidence, and learning needs with advance directives among hospital nurses. Method : This cross-sectional study was performed at a tertiary university hospital in Seoul between September 25 and October 14, 2017. Convenience sampling was used to recruit nurses who provided bedside care and had at least 1 year of clinical experience. We used a validated self-report questionnaire. Results : The mean score of knowledge, confidence and learning needs were $5.00{\pm}1.73$, $29.81{\pm}7.52$, and $64.54{\pm}8.48$ respectively. Hospital nurses' knowledge, confidence and learning needs were significantly different according to age, job position, educational level and perceived advance directives. Knowledge regarding advance directives was significantly associated with confidence (r = .27, p < .001) and learning needs (r = .16, p = .005). Conclusion : Knowledge regarding advance directives was relatively low compared to the findings of previous studies. Therefore, nurses should be knowledgeable and encouraged to initiate advance directives. It is necessary to develop a standardized educational program regarding advance directives based on Korean cultures.

Purpose : The purpose of this study was to systematically review the instruments utilized to assess physical impairment in post-intensive care syndrome (PICS) of intensive care unit (ICU) survivors. Method : Online databases searched were MEDLINE, Cochrane, CINAHL, and Embase. Studies that met the following criteria were included: 1) the study population exclusively had experience with ICU admission; 2) the study assessed pulmonary, neuromuscular, and physical functions; and 3) the study was published in English language journals after 2007. Results : A total of 56 instruments (2 pulmonary, 25 neuromuscular, 29 physical function) from 94 studies were reviewed. They were classified into self-report, observation, and measurement according to the type of assessment. No instrument measured all 3 areas of physical impairment. Five instruments were originally developed for the ICU patients. The most frequently applied instruments were the Medical Research Council and the 36-item Short Form Survey (physical component summary), which were used in 23 studies each. Only 13.8% of reviewed studies reported the reliability or validity of the instruments. Conclusion : Our results suggest that the appropriateness of instruments assessing physical impairment in PICS cannot be guaranteed. Despite the multidimensional concept of physical disabilities, most studies measured only one area, and studies that reported psychometric properties were limited. Accordingly, we propose to develop a unique and multifaceted instrument for ICU survivors.

Purpose : A meta-analysis was conducted to identify the effectiveness of strategies designed to prevent the incidence and prevalence of pressure ulcers in intensive care units (ICUs). Method : The search strategy was designed to retrieve studies both published and unpublished between 2007 and 2017 including studies in English across PubMed and CINAHL, as well as in Korean across RISS, DBPia, NDSL, KISS, and NAL. All adult ICU participants were 18 years or over. Inclusion criteria were randomized controlled trials, quasi-experimental and comparative studies. Two independent reviewers conducted quality assessments of the included studies by Scottish Intercollegiate Guidelines Network. A Review Manager 5 was used to analyze effect sizes and to identify possible sources of heterogeneity among the studies. Results : The odds ratio (OR) effect sizes were all statistically significant. The OR of total effect size was 0.30(95% CI: 0.19, 0.47), care bundle was 0.37(95% CI: 0.24, 0.57), position change was 0.45(95% CI: 0.10, 2.08), and a silicone border foam dressing was 0.14 (95% CI: 0.07, 0.29). Conclusion : The preventive interventions for patients in the ICUs have positive impacts on reducing the incidence of pressure ulcers.

Purpose : This study was performed to evaluate the effects of a prolonged a $30^{\circ}$ side-lying position on comfort and skin condition by applying the trunk maintenance repositioning method, which can keep the $30^{\circ}$ 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.

Purpose : The purpose of this study was to analyze factors influencing the adherence to guidelines for intensive care unit (ICU) nurses to control infections due to multidrug-resistant organisms (MDRO). Method : Participants were 194 ICU nurses at 3 university hospitals. Questions for the survey inquired about attitude, subjective norms, perception of patient safety culture to carry out MDRO management guidelines, perceived behavior control (PBC), and intention, based on the theory of planned behavior. Path analysis were utilized. Results : The path analysis presented that PBC, perception of patient safety culture, and intent had a direct effect on MDRO management guidelines. Attitude towards following the manual did not have any correlation. The hypothetical model based on the theory of planned behavior was revealed as applicable; the degree of the variance in explaining adherence to the manual was 23 %, and the variance in explaining intention to fulfill the manual was 33 %. Conclusion : The results of this study suggest that we should develop a program to improve PBC to increase adherence to MDRO management guidelines. ICU nurses' perceptions of patient safety culture should also be surveyed.

Purpose : The purpose of this study was to identify the knowledge, perception and hand hygiene performance rate of hospital nurses and to identify any correlation between them. Method : Data were collected from 205 nurses working in a university hospital in Chungcheong-do. A self-report survey method was utilized. Participants completed the hand hygiene knowledge questionnaire. Results : The average knowledge of hand hygiene was 11.76 (out of 18 points), and the average perception of hand hygiene was 35.55 (out of 96). The hand hygiene performance rate was 85.62%. Knowledge of hand hygiene showed significant differences according to age (F = 75.821, p < .001), gender (t = 25.049, p < .001) and working period (F = 24.843, p < .001). The most important explanatory factor in hand hygiene performance was hand hygiene perception (${\beta}=.26$), followed by working period (${\beta}=.14$). These variables accounted for 10.0% of subjects' hand hygiene performance. Conclusion : The results of this study suggest that continuous and effective education is needed to strengthen knowledge and perception of the importance of hand hygiene practice for nurses to prevent healthcare-associated infections.