• 간호행정학회지
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• 제4권1호
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• pp.229-246
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• 1998

This dissertation classifies sample patients by a measure of K-DRG to identify the most frequent group. and investigates the differences in the dependency of nursing by patient classification system in the SICU of Seoul National University Hospital in Korea. It also calculates the mean nursing care hours and costs per craniotomy patient, who is shown to be the most frequent patient group. The results of the research can be used as basic data for the development of relevant nursing cost system in the future. The results of the research are as follows: 1. Using data from 97 sample patients, as many as 26 groups are identified when the patients are classified by K-DRG. KDRG-001 (craniotomy) is found to be the most frequent group(43.30%). 2. The result from patient classification system grouping in craniotomy patients shows homogeneity in terms of dependency of nursing with 35 patients in the 4th group, 145 patients(74.36%) are in the 5th group. and 15 patients are in the 6th group among the total 195 sample patients. 3. The direct nursing care hours for the 4th, 5th, and 6th patient classification system groups are found to be 381 minuites. 483 minuites, and 519 minuites, respectively, which shows that the nursing care hours increases as the dependency of nursing is intensified. The indirect nursing care hours are found to be 454 minuites(7.57 hours). The total mean nursing care hours, which is the sum of the direct nursing care hours(467 min.: 7.78 hours) and the indirect nursing care hours (454 min.: 7.57 hours), is 921 minuites(15.35 hours) per patient a day. 4. The nursing care cost is calculated to be 123,297 won per patient a day. Considering the average duration in the ICU, we can find the total nursing care cost is 610,318 won.

• 임상간호연구
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• 제18권2호
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• pp.251-263
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• 2012

Purpose: It was necessary for developing a neonatal classification system based on nursing needs and direct care time. This study was, thus, aimed at identifying nursing activities and measuring the standard nursing practice time for developing a neonatal patient classification system in Neonatal Intensive Care Unit (NICU). Methods: The study was taken place in 8 general hospitals located in Seoul and Kyungi province, South Korea from Dec, 2009 to Jan, 2010. By using 'the modified Workload Management System for critical care Nurses' (WMSN), nursing categories, activities, standard time, and task frequencies were measured with direct observation. The data were analyzed by using descriptive statistics. Results: Neonatal nursing activities were categorized into 8 areas: vital signs (manual), monitoring, activity of daily living (ADL), feeding, medication, treatment and procedure, respiratory therapy, and education-emotional support. The most frequent and time-consuming area was an ADL, unlike that of adult patients. Conclusion: The findings of the study provide a foundation for developing a neonatal patient classification system in NICU. Further research is warranted to verify the reliability and validity of the instrument.

• 중환자간호학회지
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• 제10권3호
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• pp.41-52
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• 2017

Purpose : This concept analysis identified attributes and defined triage competency among emergency nurses. Method : Walker and Avant's approach was used to guide the concept analysis. A literature review was completed including 26 studies, 5 reports of related associations, and 5 books. Results : The concept of triage competency in emergency nurses was identified as five attributes: clinical judgment, expert assessment, management of medical resources, timely decision, and communication. Antecedents of the concept were triage education and emergency room experience. The consequences of the concept were efficiency of care, patient rating, and safety. Triage competency in emergency nurses was defined as the comprehensive ability to prioritize patients' urgency and allocate limited medical resources. Conclusion : This study is meaningful since it clarified triage competency among emergency nurses. The attributes and empirical indicators of this study will likely lay the foundation for development of triage competency metrics.

• 한국산학기술학회:학술대회논문집
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• 한국산학기술학회 2012년도 춘계학술논문집 1부
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• pp.22-24
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• 2012

The tools that classify the severity of patients based on the prediction of mortality include APACHE, SAPS, and MPM. Theses tools rely crucially on the evaluation of patients' general clinical status on the first date of their admission to ICU. Nursing activities are one of the most crucial factors influencing on the quality of treatment that patients receive and one of the contributing factors for their prognosis and safety. The purpose of this study was to identify the goodness-of-fit of CPSCS of critical patient severity classification system(CPSCS) and Glasgow coma scale(GCS) and the clinical usefulness of its death rate prediction. Data were collected from the medical records of 187 neurological patients who were admitted to the ICU of C University Hospital. The data were analyzed through $x^2$ test, t-test, Mann-Whitney, Kruskal-Wallis, goodness-of-fit test, and ROC curve. In accordance with patients' general and clinical characteristics, patient mortality turned out to be statistically different depending on ICU stay, endotracheal intubation, central venous catheter, and severity by CPSCS. Homer-Lemeshow goodness-of-fit tests were CPSCS and GCS and the results of the discrimination test using the ROC curve were $CPSCS_0$, .734, $GCS_0$,.583, $CPSCS_{24}$,.734, $GCS_{24}$, .612, $CPSCS_{48}$,.591, $GCS_{48}$,.646, $CPSCS_{72}$,.622, and $GCS_{72}$,.623. Logistic regression analysis showed that each point on the CPSCS score signifies1.034 higher likelihood of dying. Applied to neurologically ill patients, early CPSCS scores can be regarded as a useful tool.

• 대한간호학회지
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• 제28권2호
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• pp.457-467
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• 1998

The purpose of this research was to identify nursing interventions performed by MICU and SICU nurses. For data collection this study used the taxonomy of the Nursing Interventions Classification (NIC : 433 nursing interventions) which was modified by McCloskey and Bulecheck(1996). Each of the 433 interventions were identified as used by MICU and SICU nurses. More than 50% of the ICU nurses performed 280 nursing interventions at least monthly. Rarely used interventions included 26 nursing interventions in the childbearing care class. Overall, both MICU and SICU nurses used interventions in the Physiological : Complex domain most often on a daily basis and the interventions in the Family domain least often. The most frequently reported interventions as being used daily in the MICU were chest physiotherapy, airway suctioning and coughing enhancement and, in the SICU, documentation and airway suctioning. There were significant differences between MICU and SICU nurses in 17 nursing interventions childbearing care, cognitive therapy, communication enhancement, coping assistance, elimination management, lifespan care, health system mediation, immobility management, medication management, neurologic management, patient education, psychological comfort promotion, physical comfort promotion, respiratory management, risk management and information management. The SICU nurses performed there interventions more frequently than the MICU nurses. These findings will help in building of a standardized language for the MICU and SICU and enhance the quality of nursing care.

• 중환자간호학회지
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• 제9권1호
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• pp.15-26
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• 2016

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.

• 중환자간호학회지
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• 제5권2호
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• pp.61-71
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• 2012

Purpose: The aim of this study was to measure the inter-rater reliability of Emergency severity index (ESI) version 4 among triage nurse. Methods: This study was carried out from August 11, 2010 to September 7, 2010 in a regional emergency department. Data collection was done by ten triage nurses who trained ESI v.4. Two research nurses and ten triage nurses scored the ESI version 4 to the patients as references, independently. We calculated the weighted kappa between the triage nurses and research nurses to evaluate the consistency of the ESI v.4. Results: A total of 233 patients were enrolled in this study. Classification of ESI level was as follows - level 1 (0.4%), level 2 (21.0%), level 3 (67.8%), level 4 (9.4%), and level 5 (1.3%). Inter-rater reliability by weighted kappa was 0.79 (95% Confidence Interval= 0.74-0.83) and agreement rate was 87.1%. Under-triage rate by triage nurse was 6.0% and over-triage rate was 6.9%. Conclusion: For this study, inter-rater reliability was measured good level between triage nurses and research nurses in Korean single ED.

• 성인간호학회지
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• 제21권5호
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• pp.489-503
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• 2009

Purpose: This study was conducted to test criterion-related validity of the Critical Patients' Severity Classification System (CPSCS) developed by the Hospital Nurses' Association by examining relationships with brain injury severity measured by Glasgow Coma Scale (GCS), recovery state measured by Glasgow Outcome Scale (GOS), and days of stay in ICU of brain injury patients. Methods: Prospective correlational research design was adopted by including 194 brain injury patients admitted to ICU of one university hospital. Results: The score of CPSCS appeared to significantly discriminate the severity of brain injury. Among nursing activities in CPSCS, Respiratory therapy, IV Infusion and Medication, Monitoring, Activities of Daily Living (ADL), Treatment and Procedure were significant to discriminate the severity of brain injury. Respiratory therapy, Vital Signs, and Monitoring appeared to significantly discriminate the recovery states of 1- and 3-months. Nursing activities significantly contributed to predict the days of ICU stay were Respiratory therapy, ADL, and Teaching and Emotional Support. Conclusion: CPSCS developed by the Hospital Nurses Association appeared to be valid to discriminate or predict brain injury severity, recovery states, and days of stay in ICU for brain injury patients.

• 임상간호연구
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• 제18권3호
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• pp.354-367
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• 2012

Purpose: This study was done to verify validity and reliability of a neonatal patient classification system (NeoPCS-1). Methods: An expert group of 8 nurse managers and 40 nurses from 8 Neonatal Intensive Care Units in Korea, verified content validity of the measurement using item level content validity index (I-CVI). The participants were nurses caring for 469 neonates. Data were collected from November 11 to December 14, 2011 and analyzed using descriptive statistics, ANOVA, intraclass correlation coefficient, and K-cluster analysis with PASW 18.0 program. Results: Nursing domains and activities included 8 items with 91 activities. I-CVI was above .80 in all areas. Interrater reliability was significant between two raters (r=.95, p<.001). Classification scores for participants according to patient types and nurses' intuition were significantly higher for the following patients; gestational age (${\leq}29$ weeks), body weight (<1,000 gm), and transfer from hospital. Six groups were classified using cluster analysis method based on nursing needs. Patient classification scores were significantly different for the groups. Conclusion: These results show adequate validity and reliability for the NeoPCS-1 based on nursing needs. Study is needed to refine the measurement and develop index scores to estimate number of nurses needed for adequate neonatal care.

• 한국컴퓨터정보학회논문지
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• 제16권1호
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• pp.175-182
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• 2011

본 연구에서는 환자의 중증도 분류 및 인체 주요 장기의 상태 예측을 위하여 APACHE II(Acute Physiology And Chronic Health Evaluation) 기반 CDSS 도구인 CAOPI(Computer Aided Organ Prediction Index) 시스템을 제안한다. 기존 ICU 환자의 중증도 평가방법은 APACHE II를 이용하여 특정 시점의 중환자 위험도를 특정한 시점 데이터를 이용하여 산출하는 방식이었으나, 실시간으로 변화하는 환자의 상태에 맞춰 조치를 취하는데는 한계가 있다. CAOPI 시스템은 중환자실에 입실하는 환자들의 질병 중증도를 정확히 분류하고, 환자의 사망예측 뿐만 아니라장기 상태를 시각화 하여 위험도를 수치화 하였다. 또한 위험도를 특정 장기별로 구분하여 담당의 사가 환자의 상태에 맞는 맞춤형 응급조치를 취할 수 있도록 설계 및 개발 하였다.