Purpose: To investigate the post-intensive care syndrome (PICS) and to analyze the factors affecting the quality of life (QoL) of survivors of critical illness. Methods: Subjects were 114 outpatients who had been discharged from intensive care units of a university hospital in B city, Korea. From July 30 through September 30, 2015, PICS was assessed using the Korean Montreal Cognitive Assessment, Hospital Anxiety-Depression Scale, Korean Instrumental/Activities of Daily Living (K-I/ADL) index, and handwriting transformation, while physical and mental health-related QoL was measured using the SF-12. Results: Of the subjects, 39.5% were screened for mild cognitive disorder and 23.7% experienced handwriting transformation after discharge. Multiple regression analysis revealed that restraint application, current job, time of ${\geq}36$ months after discharge, depression, anxiety, and handwriting transformation accounted for 40.9% of the physical health-related QoL, and depression, anxiety and experience of delirium accounted for 62.4% of the mental health-related QoL. Conclusions: It is necessary to make efforts to reduce restraint application in intensive care units and prevent the occurrence of delirium, with the objective of reducing PICS and improving the QoL of critical illness survivors.

Purpose: The aim of this study was to identify thinking strategies in the complicated decision-making process based on real patient-based data of triage nurses in the emergency department (ED). Methods: This study used the 'think aloud' method to collect data from 8 triage nurses from one general hospital ED in South Korea. The data were analyzed with protocol analysis using thinking strategies. Results: The triage process was divided into three stages. The first stage consisted of 8 thinking strategies, including searching for information. They used intuition based on directly observed concepts for identifying a crisis. The second stage consisted of 17 thinking strategies related to the decision-making process. They assessed patients and generated a hypothesis to try to understand their health problems through analytic thinking. The third stage consisted of 10 thinking strategies, including qualifying. They considered the situation of the ED and properly triaged the patients. During the triage process, they frequently used judging the value and searching for information on 17 thinking strategies. Conclusions: Triage nurses demonstrated various connected thinking strategies for each stage. Based on our results, further studies should be done to develop a triage education program.

Purpose: The purpose of this study lies in investigating nursing and medical staff perceptions on the importance of surgical patient safety protocol, teamwork, and patient safety culture, and how their grasp of the factors affects the degree of their performance of the protocol. Methods: A survey was conducted on 249 nurses and medical staff participating in the operating rooms of one higher general hospital in Seoul, using a 5-point scale self-reported questionnaire. Logistic regression analyses were used. Results: Operating room nurses yielded the highest scores on both the importance of the patient safety protocol and its performance. In patient safety culture, the operating medical staff yielded significantly higher scores than those of operating room nurses. Perception of the importance of the patient safety protocol and teamwork had a significant effect on the nurses' complete performance of the protocol. Conclusion: It is important to create a safety culture, where all the staff can actively and freely communicate with one another through team-based training programs. By enhancing teamwork and patient safety culture, it will be possible to establish the surgical patient safety protocol and to improve the performance of the protocol by health professionals.

Purpose: Continuous renal replacement therapy (CRRT) has become the preferred dialysis method to support critically ill children and neonates with acute kidney injury. Using CRRT on neonates has increased, but reports about experience are limited. The aim of this study is to describe the clinical application, outcomes, and complications of CRRT in children and neonates. Methods: A retrospective review was performed in 135 children and 36 neonates who underwent CRRT at a tertiary hospital from 2008 to 2015. Results: At the initiation of CRRT, the median age of children was 72 months and the corrected age of neonates was 37.1 weeks. Median body weight of neonates was 3.2 kg. In neonates, initial degree of fluid overload [FO%], blood flow rate [BFR] and ultrafiltration rate [UFR] rate during CRRT were higher than in children. Median real time of CRRT was 90.5 and 53.5 hours in children and neonates, respectively. Downtime of CRRT was 0.7 and 1.3 hours/day. Median mortality rates (44.4% vs.47.2%) and complication rates were similar between the groups. Conclusion: CRRT can be used for a wide range of critically ill children and neonates. Different application methods of CRRT can contribute to increased survival of neonates.

Purpose: This study aimed to estimate the pooled prevalence of workplace bullying among nurses and examine the effect of moderate factors. Methods: Studies that assessed nursing workplace bullying using the negative act questionnaire developed by Einarsen et al. were searched for in 8 databases. The pooled prevalence was calculated with overall event rate and meta-ANOVA was performed for subgroup analysis. A funnel plot and Egger's linear regression asymmetry test were performed to confirm the publication bias of meta-analyzed studies. Results: A total of 23 studies (N=11,748) were included in the systematic review, and 14 studies (N=4,585) that reported prevalence using operational criteria of victim were selected for meta-analysis. The pooled prevalence of workplace bullying was 22.2% (95% CI: 19.0~25.7). Domestic studies reported lower prevalence than international studies (18.6% vs. 27.0%, Q=8.75, p=.003). The prevalences were different according to publication year (30.6% in 2008~2010, 19.5% in 2011~2014, 21.8% in 2015, Q=11.89, p=.003). Studies that recruited only new nurses reported higher prevalence than others (28.4% vs. 20.6%, Q=3.92, p=.048). Publication bias was not found. Conclusions: Workplace bullying is prevalent in the nursing profession, and is more serious for new graduate nurses. Individual and organizational measures for preventing workplace bullying among nurses need to be sought.

Purpose: This study was conducted to examine the relationship between lateral position change and sternal complications after cardiac surgery through median sternotomy. Methods: This study was a retrospective descriptive case-control study, involving 241 patients who underwent cardiac surgery through median sternotomy. Data from October 2011 to September 2014 were collected. Results: Sternal complications (i.e. dehiscence, sternal instability, mediastinitis) developed in 33 patients (13.7%). Primary symptoms of complications were discharge and erythema, and the mean time difference from surgery to appearance of symptoms was 15 days (range, 1-138 days). The factors associated with sternal complications were cancer comorbidity (${\chi}^2=5.22$, p=.039), internal mammary artery procedure (${\chi}^2=4.16$, p=.041), and duration of extra-corporeal membrane oxygenation (p=.033). Position change was not related to incidence of sternal complications (${\chi}^2=0.14$, p=.704). Pressure ulcers appeared in 63 patients (26.1%). Mean time difference from surgery until occurrence of ulcers was 6.7 hours (range, 0-323.0 hours), but position change was started from 132.4 hours (range, 27.1-503.2 hours) after intensive care unit admission. Conclusions: These results provide baseline data to create a standard position change and activity protocol for patients after median sternotomy. Furthermore, the study could help clinical practitioners establish evidence-based nursing practices.