• 중환자간호학회지
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• 제9권1호
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• pp.40-50
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• 2016

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.

• 중환자간호학회지
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• 제9권1호
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• pp.66-76
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• 2016

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.

• 중환자간호학회지
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• 제3권2호
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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.

• 중환자간호학회지
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• 제7권1호
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• pp.11-23
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• 2014

Purpose: As the number of cases of heart transplantation (HT) and the survival rate have increased, concerns regarding post-HT life have grown. This study was conducted to explore the relationships of perceived social support to the depression and health status of HT recipients. Methods: This descriptive study targeted all recipients who had undergone HT at S University Hospital since 1994, and 32 recipients were recruited. Results: 90.6% of the recipients were men, and the average age at the time of surgery was $47.4{\pm}13.4$ years. The ejection fraction was increased from $18.47{\pm}5.63%$ to $63.25{\pm}7.57%$, and 31 cases of New York Heart Association (NYHA) class III and IV improved to class I or II after HT. The patients reported mild depression even with high perceived social support and improved health status after HT. Among those resource persons who offered support, they reported their spouse, doctors, and nurses as most meaningful to them. Conclusion: This study confirmed the positive effects of HT on the recipients' physical improvement. It also added the discovery that the importance of recipients' subjective perception of social support might be critical for their more successful recovery and adjustment to post-HT life. Focusing on a different approach to social support and types of social resources in the recovery phase is suggested for future studies on quality of life after HT.

• 중환자간호학회지
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• 제2권2호
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• pp.5-17
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• 2009

Purpose: The purpose of this study was to investigate the current humidification state of incubator, the factors disturbing high humidification and to establish the evidence-based nursing protocol to maintain it. Methods: The subjects were 15 infants who were born with extremely low birth weight (ELBW) from May to October, 2007, and data were collected during the first 3 days and analyzed with SPSS WIN program. Results: The goal of humidity level in incubator was 95%, but mean humidity levels were 89.7%(1st day), 91.9%(2nd day), and 91.8%(3rd day)(p<0.001). The disturbing factors were opening frequency and duration of incubator door and window by caregivers. The handling of infants by nurses and doctors happened more frequently during the first day. Especially, nurses handled them more often than others, but the duration of opening during the invasive procedures by doctors was longer than others. The opening frequency had negative correlation with duration(r=-.779, p<.01). Conclusion: So the evidence-based protocol for maintaining high humidity in incubator for ELBW infants during the first 3 days and next 2 days was made. Furthermore we need to educate NICU nurses and doctors about minimal handling.

• 중환자간호학회지
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• 제2권2호
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• pp.18-27
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• 2009

Purpose: This study is to provide effective care to each individual with myocardial ischemia by finding out how the patient's knowledge related to the disease and anxiety level affect his/her compliance of patient role behavior. Methods: The subjects of study were 100 patients diagnosed as ischemic heart disease at a university hospital located in Gyeonggi Province. The data were collected from May 19, 2008 to August 30, 2008. A cross-sectional descriptive survey was done using a structured questionnaires. Results: The average score of knowledge level about myocardial ischemia was $22.24\pm5.07$(out of 31), anxiety level was $54.68\pm9.15$(out of 80), and compliance of patient role behavior was $34.28\pm6.00$(out of 50). A significant correlation between the patient's level of knowledge and his/her compliance of patient role behavior was found(r=0.239 p=0.017). The patients who are females, singles, without occupation, have a long term being diagnosed, under-educated, tend to be excellent in their compliance. Conclusion: The patient with a higher level of knowledge is better in his/her compliance of patient role behavior. Therefore, it is suggested that we need to develop nursing intervention to increase knowledge level as well as consistent educational support.

• 중환자간호학회지
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• 제3권1호
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• pp.1-13
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• 2010

Purpose: This study was designed to evaluate ICU nurses' clinical competence according to clinical ladder by job analysis tool for the evaluation tool development of clinical ladder development program, Methods: Data was collected using the ICU nurses job analysis tool from 148 ICU nurses who work for 6 ICUs of A hospital in S city, Results: The mean clinical competence score of the subjects was 3.03 on a 4 point scale, Competence score was increasing as ICU clinical ladder was higher (F=35.18, p<.001). Step_1 was the lowest and step_4 was higher than step_3 from Scheffe post hoc test, Result of multiple regression showed that ICU clinical ladder and ICU clinical nursing education explained 52.1% (F=38.83, p<.001) of ICU nurse's clinical competence. Conclusion: ICU nurses' clinical competence can be evaluated using ICU nurse's job analysis tool. Further researches is needed on job description according to clinical ladder for performance and evaluation.

• 중환자간호학회지
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• 제6권2호
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• pp.51-64
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• 2013

Purpose: This study was to analyze adherence to self-care behaviors and identify factors affecting the adherence behaviors among inpatients with heart failure. Methods: A total 94 hospitalized inpatients from three hospitals participated in a survey. Data were collected using structured self-reported questionnaire from November 28, 2011 to March 31, 2013 and analyzed using frequency, t-test, ANOVA, Pearson's correlation coefficients and stepwise multiple regression. Results: The score of adherence to self-care behaviors among inpatients with heart failure was $26.02({\pm}8.84)$. Factors related to the adherence to self-care behaviors were living with spouse (t=-2.47, p=.019), functional state (t=2.18, p=.034), heart failure knowledge (r=-.49, p<.001), social support (r=-.35, p<.001), self-control (r=-.25, p=.016), and self-care confidence (r=-.24, p=.019). The factors affecting adherence to self-care behaviors were heart failure knowledge, self-care confidence, and social support. These factors explained 32% of the variance in adherence to self-care behaviors. Conclusion: The adherence to self-care behaviors with heart failure can be improved if heart failure knowledge, self-care confidence, and social support are improved. Therefore, developing a nursing intervention program for patient with heart failure that is considered these factors leads to improve quality of life and prevent readmission.

• 중환자간호학회지
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• 제13권3호
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• pp.62-74
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• 2020

Purpose : This study aimed to investigate the prevalence and risk factors of mental health problems in patients discharged from the intensive care unit (ICU). Methods : This was a secondary analysis study using data from a multicenter prospective cohort of post-ICU patients. We analyzed data of 311 patients enrolled in the primary cohort study who responded to the mental health questionnaire three months after the discharge. Anxiety and depression were measured on the Hospital Anxiety-Depression Scale, and post-traumatic stress disorder (PTSD) was measured on the Posttraumatic Diagnostic Scale. Results : The prevalence of anxiety, depression, and PTSD in patients at three months after ICU discharge were 25.7%, 17.4%, and 18.0%, respectively, and 7.7% of them experienced all three problems. Unemployment (OR=1.99, p=.033) and unplanned ICU admission (OR=2.28, p=.017) were risk factors for depression, while women gender (OR=2.34, p=.009), comorbid diseases (OR=2.88, p=.004), non-surgical ICUs (trauma ICU: OR=7.31, p=.002, medical ICU: OR=3.72, p=.007, neurological ICU: OR=2.95, p=.019) and delirium (OR=2.89, p=.009) were risk factors for PTSD. Conclusion : ICU nurses should proactively monitor risk factors for post-ICU mental health problems. In particular, guidelines on the detection and management of delirium in critically ill patients should be observed.

• 중환자간호학회지
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• 제2권1호
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• pp.58-68
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• 2009

Purpose: The treatment effects and operation status of continuous renal replacement therapy (CRRT) for acute renal failure patients have been investigated. Method: Two expert nurses reviewed the records of 731 patients undergoing CRRT in an intensive care unit of a general hospital from Jan. 2002 to Dec. 2006 with the CRRT assessment sheet and situation sheet developed for this study. Results: The number of patients received CRRT increased from 90 in 2002 to 194 in 2006. The most common indication for CRRT was azotemia (40.0%). Before CRRT treatment, patients were 78.6 ($\pm55.5$) of BUN value and 5.0 ($\pm3.2$) of Cr. value. The standard values of BUN and Cr. were lowered. Compared the survival group with the death group, there were significant differences among the medical departments and the main diagnosis group. Their BUN and creatinine value, APACHE II score, mean blood pressure, and oliguria were significantly different (p<0.05). Conclusion: This survey demonstrates a trend that patients receiving CRRT has been increased. We suggest further studies are needed in some hospitals in order to generalize the results and to find how CRRT treatment affects patient’s survival and death rate.