• Journal of Korean Critical Care Nursing
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• v.15 no.3
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• pp.1-11
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• 2022

Purpose : The purpose of this study was to not only examine the importance and performance status of patient safety nursing activities in the intensive care unit but also to understand nurses' educational needs in this respect. Methods : In this descriptive study, 196 nurses working in the intensive care units of university hospitals located at B City and G Province were enrolled. They completed the Importance-Performance Analysis (IPA) questionnaire, and the data were statistically analyzed. Results : Mean±standard deviation item scores of importance and performance of patient safety nursing activities were 4.75±0.33 and 4.48±0.38, respectively. In the IPA results, a total of 10 items were included in the second quadrant, including 1 item related to 'transfer,' 1 to 'infection,' and 1 to 'firefighting surveillance.' As the second quadrant contains the high-importance, low-performance items, these 10 items resemble the nurses' educational needs that should be prioritized. Conclusion : The results of this study can be used as a basis for the development of nursing educational programs for patient safety in the intensive care unit.

• Journal of Korean Critical Care Nursing
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• v.12 no.3
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• pp.1-12
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• 2019

Purpose : This study aims to identify the relationship between person-centered critical care nursing (PCCN) and family satisfaction for intensive care unit (ICU) nurses. Methods : This research used a cross-sectional survey. The participants were 142 nurses and 121 family members from 8 ICUs in 4 hospitals in B city. The questionnaire survey was conducted between December 2018 and March 2019. The eight ICUs were divided into those that scored high and those that scored low for person-centered care relative to the average score for PCCN, and the difference in family satisfaction between the ICUs with high and low scores was compared using t-test. Results : The mean score of PCCN was $3.68{\pm}0.40$ out of 5. In the subcategories of PCCN, "comfort"was the highest at $3.95{\pm}0.49$, followed by "respect" at $3.73{\pm}0.57$, "compassion" at $3.59{\pm}0.57$, and "individuality" at $3.47{\pm}0.54$. The average score of family satisfaction with the ICUs was $3.45{\pm}0.67$ out of 5. In its subcategories, "emotion" was the highest at $3.69{\pm}0.72$, followed by "information" at $3.61{\pm}0.75$, "participation" at $3.30{\pm}0.79$, and "resources" at $3.20{\pm}0.80$. The family satisfaction ($3.75{\pm}0.54$) with the ICU of the highest-scoring PCCN was significantly higher than the family satisfaction ($3.25{\pm}0.53$) with the ICU with the lowest-scoring PCCN (t=4.97, p<.001). Conclusion: The results suggest that the PCCN scores of ICU nurses should be promoted to improve family satisfaction. It is necessary to pursue a variety of ways to secure the provision of person-centered nursing practice in ICUs.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.26 no.2
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• pp.75-85
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• 2019

Purpose: The purpose of this study was to examine effects of music intervention on environmental stress and sleep quality in liver transplant patients who are receiving care in one-person isolation rooms of an ICU. Methods: The study was a quasi-experimental design pre-and-post nonequivalent control group. Participants were 37 patients (18 in the experimental group and 19 in the control group) who, after receiving liver transplant, were hospitalized in one-person isolation rooms of the ICU. The study covered patients admitted between August 2016 and December 2017. Earplugs and sleep shades were provided as ordinary care to both experimental and control groups, and music intervention was provided to the experimental group three times a day for 30 minutes each from the first day of hospitalization. Results: The first hypothesis, "The experimental group who received music intervention will experience a lower environmental stress level than the control group" was supported (Z=-3.212, p<.001). The second hypothesis, "The experimental group who received music intervention will experience a higher sleep quality than the control group" was also supported (t=3.715, p=.001). Conclusion: Findings show that music intervention is an effective nursing intervention to reduce environmental stress and improve sleep quality in liver transplant patients in the ICU.

• Journal of Korean Critical Care Nursing
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• v.3 no.2
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• pp.37-48
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• 2010

Purpose: The purpose of this study was to examine the frequency and the course of delirium, and identify risk factors for the development of delirium in surgical intensive care unit (SICU). Methods: Subjects older than 19 years admitted to the SICU were recruited. After informed written consent, enrolled subjects had baseline cognitive and functional assessments. Subjects were assessed daily for delirium using the Confusion Assessment Method-ICU (CAM-ICU). Results: During the study period, 110 patients were enrolled. The overall incidence of delirium was 20% (22/110). The average time to onset of delirium was 3.04(${\pm}1.25$) days. Several variables were associated with an increased risk of delirium including older age (p<.05), higher admission APACHE II score (p<.001), use of opioid and analgesics (p<.01), using physical restraints (p<.001), and intraoperative hypotension (p<.05). In a multivariate logistic regression model, using physical restraints (p<.001), intraoperative hypotension (p<.05), and older age (p<.05) remained significant predictors of the delirium development. Conclusion: Using physical restraints, intraoperative hypotension and older age was strongly associated with development of delirium in the SICU. Prevention measures need to focus on identifying patients at higher risk for delirium development.

• Tuberculosis and Respiratory Diseases
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• v.65 no.4
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• pp.292-300
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• 2008

Background: Respiratory failure is a common condition that requires intensive care, and has a high mortality rate despite the recent improvements in respiratory care. Previous reports of patients with respiratory failure focused on the specific disease or included a large proportion of surgical patients. This study evaluated the clinical characteristics, outcomes and prognostic factors of adult patients receiving mechanical ventilation in a medical intensive care unit. Methods: Retrospective chart review was performed on 479 adult patients, who received mechanical ventilation for more than 48 hours in the medical ICU of one tertiary referral hospital. Results: The mean age of the patients was $60.3{\pm}15.6$ years and 34.0% were female. The initial mean APACHE III score was $72.3{\pm}25$. The cause of MV included acute respiratory failure (71.8%), acute exacerbation of chronic pulmonary disease (20.9%), coma (5.6%), and neuromuscular disorders (1.7%). Pressure controlled ventilation was used as the initial ventilator mode in 67.8% of patients, and pressure support ventilation was used as the initial weaning mode in 83.6% of the patients. The overall mortality rate in the ICU and hospital was 49.3% and 55.4%, respectively. The main cause of death in hospital was septic shock (32.5%), respiratory failure (11.7%), and multiorgan failure (10.2%). Males, an APACHE III score >70, the cause of respiratory failure (interstitial lung disease, coma, aspiration, pneumonia, sepsis and hemoptysis), the total ventilation time, and length of stay in hospital were independently associated with mortality. Conclusion: The cause of respiratory failure, severity of the patients, and gender appears to be significantly associated with the outcome of mechanical ventilatory support in patients with respiratory failure.

• The Journal of the Korea Contents Association
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• v.14 no.11
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• pp.838-848
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• 2014

The purpose of this study was to identify the effects of bed baths with 2% chlorhexidine on the incidence of Methicillin-resistant Staphylococcus aureus (MRSA) and blood stream infection (BSI) and to suggest guidelines on the therapeutic bed baths using skin cleaner. This study was designed to compare the incidence of MRSA and BSI of the experimental group(n=188) who received the bed baths with 2% chlorhexidine with the incidence of MRSA and BSI of the control group(n=199) who received the existing bed baths with soap and skin cleaner. A research design used in the study was a randomized control group posttest-only design. The experimental group had 6.7% decrease in MRSA acquisition than the control group (7.4% vs 14.1%, p=.036). The experimental group was decreased in the incidence density of MRSA than the control group (9.32 cases per 1,000 patient-days at risk of experimental group vs 15.44 cases per 1,000 patient-days at risk of control group; p=.099). The experimental group had 4.5% decrease in the rate of BSI than the control group (0.5% vs 5.0%, p=.011). The experimental group was decreased in the incidence density of BSI than the control group (0.67 cases per 1,000 patient-days at risk of experimental group vs 5.52 cases per 1,000 patient-days at risk of control group; p=.052). These finding indicated that bed baths with 2% chlorhexidine is an effective nursing intervention to decrease the incidence of MRSA and BSI.

• The Journal of the Korea Contents Association
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• v.18 no.10
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• pp.134-144
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• 2018

The purpose of this study was to examine the effects of delirium prevention program in patients after hip joint surgey. A non equivalent control group post-test only design was utilized. Sixty four patients aged 65 and older who admitted to a surgical intensive care unit after hip joint surgery were assigned to either a experimental group (n=33) or a control group (n=31). The experimental group was provided with delirium prevention program consisting of orientation intervention, activity intervention, physiological intervention, nutritional intervention, sleep intervention, environmental intervention. Data were analyzed using ${\chi}^2-test$ and independent t-test. The experimental group showed lower incidence of delirium than the control group(${\chi}^2=7.048$, p=.008). The experimental group showed lower ICU stay and length of hospitalization than the control group although the difference was not statistically significant. Findings indicate that the dilirium prevention program is effective in reducing incidence of delirium in patients after hip joint surgery and delirium prevention program is recommended as a guide for the prevention of delirium.

• Journal of Korean Clinical Nursing Research
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• v.21 no.1
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• pp.43-52
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• 2015

Purpose: This study was aimed to develop the multicomponent intervention for preventing delirium among postoperative patients in a surgical intensive care unit (SICU). Methods: Using a quasi-experimental pre & post-test design with a non-equivalent control group, a total of 88 hospitalized patients in a SICU participated in this study. The 44 patients were allocated in each experimental and control group. The experimental group received the multicomponent intervention for delirium prevention including a delirium assessment and nursing intervention using a checklist, whereas the control group was provided with a standard care. The primary outcome of this study was the delirium incidence during the course of hospitalization. Results: There were no significant differences in the demographic and clinical characteristics between the two groups. The delirium occurred in 19.2% in the experimental group, whereas 38.6% in the control group ($x^2=4.526$, p<.05). Conclusion: The findings of the study demonstrated an effect of the multicomponent delirium prevention intervention in decreasing the delirium incidence rate over the standard care among the patients in SICU.

• Journal of Trauma and Injury
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• v.21 no.2
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• pp.85-90
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• 2008

Purpose: Supraventricular arrhythmia is a well-known complication of cardiothoracic surgery, and is common in patients wirth underlying cardiovascular disease. Also, it's treatment and prognosis are well known. However the incidence, the contributing factors, and the prognosis for supraventricular arrhythmias in noncardiothoracic surgical patients are less well known. This study was undertaken to investigate the incidence, the clinical presentation, the prognosis, and the factors comtributing to the prognosis for supraventricular arrhythmia in the surgical intensive care unit. Methods: We performed a retrospective study of 34 patients with newly developed or aggravated supraventricular arrhythmias in the surgical intensive care unit between March 2004 and February 2005. The incidence, the risk factors, and the prognosis of supraventricular arrhythmias were analyzed. Results: During a 12month period, the incidence of supraventricular arrhythmia was 1.79% (34/1896). Most patients had pre-existing cardiovascular disease and sepsis. The mortality rate was 29.4%, and the most common cause of death was multiple organ failure due to septic shock. The mean value of the APACHE II score was 20.9, and the surgical intensive care unit and the hospital lengths of stay were 9.9 days and 25.8 days, respectively. The APACHE II score measured when the arrhythmia developed was a significant factor in predicting mortality, Conclusion: Supraventricular arrhythmias result in increased mortality and increased length of stay in both the surgical intensive care unit and the hospital. The arrhythmia itself did not cause death, but a high APACHE II score incicated a poor prognosis. This may reflect the severity of the illness rather than an independent contributor to mortality.

• Journal of Chest Surgery
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• v.31 no.5
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• pp.502-508
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• 1998

Proinflammatory cytokines such as tumor necrosis factor-$\alpha$(TNF-$\alpha$) have been implicated in myocardial and organ dysfunction associated with postperfusion syndrome. We tested the hypothesis that cytokine productions are depressed by preoperative cortiosteroid injection for cardiopulmonary bypass(CPB) and the postoperative courses will be better than without steriod pretreated cases. Cardiac surgery was performed in randomized blind fashion for 20 patients from June 1996 to September 1996. In the steroid group(n=10), corticosteroid(dexamethasone 1 mg/kg) was injected 1 hour before anesthetic induction, but in the control group(n=10), nothing was injected. Each of groups were sampled 11 times as scheduled for TNF-$\alpha$ bioassays. We have checked EKG, cardiac enzymes(CPK, LDH with isoenzyme), WBC count preoperative day, one day and three days after operation. Viatal signs were continuously monitored for three postoperaive days. In the postoperative period three patients in the control group had elevated body temperature and four patients had hypotension that required considerable intravenous fluid administration. But steroid injected patients showed normal body temperture and acceptable blood pressures without supportive treatment. CPK enzymes rose in control group higher than steroid group at postoperative 1st and 3rd day(CPK; 1122$\pm$465 vs 567$\pm$271, 864$\pm$42 vs 325$\pm$87), and CPK-MB enzymes rose in control group higher than steroid group at postoperative 1st day(106.4$\pm$115.1 vs 29.5$\pm$22.4)(P=0.02). Arterial tumor necrosis factor-$\alpha$ rose during cardiopulmonary bypass, peaking at 5 minutes before the end of aortic cross clamping(ACC-5min) in steroid group(11.9$\pm$4.7 pg/ml), and 5 minutes before the end of cardiopulmonary bypass(CPB-5min) in control group(22.3$\pm$6.8 pg/ml). The steroid pretreated patients had a shorter period of time in respirator suport time, ICU stay day, hospital admission day. We conclude that corticosteroid suppress cytokine production during and after cardiopulmonary bypass, and may improve the postoperative course through inhibition of reperfusion injury such as myocardial stunning and hemodynamic instability.