• Journal of Korean Critical Care Nursing
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• v.12 no.3
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• pp.24-34
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• 2019

Purpose : The purpose of this study was to identify the moderating and mediating effects of resilience in the relationship between emotional labor and job satisfaction among nurses working in intensive care units (ICUs). Method : The participants were 144 ICU nurses from three university hospitals. Data were collected using structured questionnaires and analyzed by t-test, ANOVA, $Scheff{\acute{e}}$ test, Pearson correlation coefficients, and multiple regression analysis, using SPSS 25.0. The mediating effect of resilience in the relationship between emotional labor and job satisfaction was analyzed by multiple regression analysis according to Baron and Kenny's procedure. Results : Statistically significant negative correlations were found between emotional labor and resilience (r=-.21, p<.014) and between emotional labor and job satisfaction (r=-.34, p<.001). A significant positive correlation was found between resilience and job satisfaction (r=.31 p<.001). A partial mediating effect by resilience was found between emotional labor and job satisfaction (Z=-2.11, p=.034), but no moderating effect was found. Conclusion : To improve the job satisfaction of ICU nurses, evaluation of their emotional labor, resilience, and interventions are necessary to alleviate emotional labor and improve resilience.

• Journal of Korean Critical Care Nursing
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• v.13 no.2
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• pp.1-11
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• 2020

Purpose : The aim of this study was to compare shift satisfaction, sleep, fatigue, quality of life (QOL), and patient safety incidents between a newly implemented two-shift system and a traditional three-shift system. Methods : A total of 127 intensive care unit nurses (48 two-shift nurses and 79 three-shift nurses) working in a tertiary hospital in Seoul were recruited from January 1, 2017, to March 31, 2017. They completed a self-reported questionnaire about their work hours, shift satisfaction, sleep patterns, sleep quality, fatigue, QOL, and patient safety incidents in the past 2 weeks. Data were analyzed using SPSS version 23.0. Results : The two-shift group showed higher shift satisfaction scores compared with the three-shift group (6.93 vs. 4.37, p<.001). Sleep latency was shorter and sleep quality was better in the two-shift group compared with the three-shift group. There were no significant differences in other sleep parameters, fatigue, QOL, and patient safety incidents between the two groups. Conclusion : Although a two-shift system did not improve nurses' fatigue or QOL in this study, it may effectively serve as an alternative shift-work system that can increase sleep quality and shift satisfaction without increasing patient safety incidents.

• Journal of Korean Critical Care Nursing
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• v.11 no.3
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• pp.108-119
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• 2018

Purpose : This study evaluated the nutritional status and effect of nutritional support team (NST) management in critically ill patients. Methods : From January 2015 to August 2017, the study retrospectively investigated 128 patients aged above 19 years admitted to a medical intensive care unit (MICU). The patients were divided into two groups: NST (n=65) and non-NST (n=63) groups. Nutritional status, classification of bedsore risks, incidence rate of bedsore and clinical outcomes were compared. Results : The study found a higher rate of the use of enteral nutrition in the NST group (${\chi}^2=45.60$, p < .001). The prescription rate of parenteral nutrition (PN) was found to be lower in the NST group (4.6%) compared to the non-NST group (60.3%). There was a higher PN of total delivered/required caloric ratio in the NST, compared to the non-NST, group (${\chi}^2=3.33$, p=.025). There were significant differences for higher albumin levels (t=2.50, p=.014), higher total protein levels (t=2.94, p=.004), and higher proportion of discharge with survival rates (${\chi}^2=18.26$, p < .001) in the NST group. Conclusions : Providing NST management to critically ill patients showed an increase in the nutrition support. Further, to achieve effective clinical outcomes, measures such as nutrition education and continuous monitoring and management for the provision of nutritional support by the systemic administration of a nutritional support team should be considered.

• Journal of Korean Critical Care Nursing
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• v.15 no.3
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• pp.51-61
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• 2022

Purpose : This study aimed to verify the effectiveness of the clinical ladder system (CLS) by identifying the perception of the CLS, professional self-concept, self-efficacy, and organizational commitment among intensive care unit (ICU) nurses. Methods : Data were collected through a questionnaire survey of 173 nurses working in 11 ICUs at a tertiary hospital in Seoul. Results : The perception of the CLS, self-efficacy, and organizational commitment showed significant difference according to the CLS level. As a result of the partial Spearman correlation analysis after adjusting for demographic difference according to CLS (age, marital status, education, and clinical career), CLS positively correlated with the perception of the CLS (r=.16, p=.045), professional self-concept (r=.24, p=.001), and self-efficacy (r=.21, p=.007). On the contrary, organizational commitment negatively correlated with the perception of the CLS (r=-.43, p<.001) and self-efficacy (r=-.32, p<.001). Conclusion : The CLS is effective for professional self-concept and self-efficacy. However, specialists 2 nurses, who had high professional self-concept and self-efficacy, showed low level of organizational commitment. Thus, it is necessary to examine the factors of work burden and career plateau that are imposed after promotion and improve experience and planning according to the growth needs. Moreover, regular evaluation of the CLS will require hospital support to ensure that ICU nurses appreciate and actively participate in the support.

• Journal of Korean Critical Care Nursing
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• v.16 no.1
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• pp.1-14
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• 2023

Purpose : This study aimed to compare peripheral pulse oxygen saturation (SpO₂) values, measured at different monitoring sites, and arterial oxygen saturation (SaO₂) of neurocritical patients. Methods : The study included 110 patients admitted to the neurosurgical intensive care unit of a university hospital. The patients' SpO₂ values were measured in their index fingers, both second toes, both earlobes, and foreheads, using the patient monitoring system. These values were compared with the standard value of SaO₂ measured using a blood gas analyzer. Data were analyzed using descriptive values, Pearson's correlation coefficients, Lin's concordance correlation coefficients (CCC), and Bland-Altman plots. Result : Regardless of the measuring site, SpO₂ was correlated with the paired measurements of SaO₂ (r=.40~.60, p<.001, CCC range=.40~.58). No significant bias in paired measurements of SpO₂ and SaO₂ was observed at all sites (-0.06~0.19%, p>.05). SpO₂ values at the left finger and right earlobe had the narrowest range, with a 95% limits of agreement (LOA) (left finger -3.04~2.93% and right earlobe -3.18~2.79%). SpO₂ at the index finger, on the side without an arterial catheter, had a narrower range of 95% LOA than that of the opposing finger (-3.00~2.97% vs. -3.73~3.26%). Conclusion : SpO₂ at the finger without an arterial catheter had the highest level of precision. This study suggests using the index finger, on the side without an arterial catheter, for pulse oximetry in neurocritical patients.

• Tuberculosis and Respiratory Diseases
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• v.68 no.3
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• pp.162-167
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• 2010

Background: To date, there are few data on the risk factors for severe cases and deaths associated with the 2009 pandemic H1N1 influenza A. Here, we describe the clinical and epidemiologic characteristics of patients hospitalized for pneumonia and identify those factors associated with the development of major complications (MC). Methods: We reviewed the medical records of 41 cases of pneumonia admitted to a university-affiliated tertiary hospital between Aug 26 and Dec 10, 2009, and who had confirmed H1N1 influenza A based on real-time reverse transcriptase-polymerase-chain-reaction assay. There were 7,962 patients that fit these criteria. We compared the clinical features and demographic characteristics of patients who developed MC to with those who did not develop MC. Results: During the study period, 10 patients developed MC (required admission to the intensive care unit, n=10; required ventilator therapy, n=6; death, n=4). Patients with MC were significantly older than those without MC and more frequently had underlying medical conditions (90.0% vs 41.9%, p-value <0.01). In the patients with developed MC, the median $PaO_2/FiO_2$ ratio of 230.0 (145.0~347.3) at admission and pneumonia severity index (PSI) score of 141.5 (88.3~158.5) were higher than patients without MC. However, no differences were observed in laboratory findings or in viral shedding between the 2 groups. Conclusion: In hospitalized pneumonia patients of 2009 H1N1 influenza, old age, a history of malignancy, initial hypoxemia, $PaO_2/FiO_2$ ratio, and PSI score appear to be risk factor significantly related to developing MC. These findings might be the basis to influence strategies for admitting patients to an intensive or intermediate care unit and for pre-emptive antiviral therapy.

• Tuberculosis and Respiratory Diseases
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• v.85 no.1
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• pp.74-79
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• 2022

Background: The effect of underlying chronic obstructive pulmonary disease (COPD) on coronavirus disease 2019 (COVID-19) during a pandemic is controversial. The purpose of this study was to examine the prognosis of COVID-19 according to the underlying COPD. Methods: COVID-19 patients were assessed using nationwide health insurance data. Comorbidities were evaluated using the modified Charlson Comorbidity Index (mCCI) which excluded COPD from conventional CCI scores. Baseline characteristics were assessed. Univariable and multiple logistic and linear regression analyses were performed to determine effects of variables on clinical outcomes. Ages, sex, mCCI, socioeconomic status, and underlying COPD were selected as variables. Results: COPD patients showed older age (71.3±11.6 years vs. 47.7±19.1 years, p<0.001), higher mCCI (2.6±1.9 vs. 0.8±1.3, p<0.001), and higher mortality (22.9% vs. 3.2%, p<0.001) than non-COPD patients. The intensive care unit admission rate and hospital length of stay were not significantly different between the two groups. All variables were associated with mortality in univariate analysis. However, underlying COPD was not associated with mortality unlike other variables in the adjusted analysis. Older age (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.11-1.14; p<0.001), male sex (OR, 2.29; 95% CI, 1.67-3.12; p<0.001), higher mCCI (OR, 1.30; 95% CI, 1.20-1.41; p<0.001), and medical aid insurance (OR, 1.55; 95% CI, 1.03-2.32; p=0.035) were associated with mortality. Conclusion: Underlying COPD is not associated with a poor prognosis of COVID-19.

• Tuberculosis and Respiratory Diseases
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• v.50 no.5
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• pp.540-548
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• 2001

Backgrounds : Because ventilator-induced lung injury is partly dependent on the intensity of vascular flow, we hypothesized that hypothermia may attenuate the degree of such an injury through a reduced cardiac output. Methods : Twenty-seven male Sprague-Dawley rats were randomly assigned to normothermia ($37{\pm}1^{\circ}C$)-injurious ventilation (NT-V) group (n=10), hypothermia ($27{\pm}1^{\circ}C$)-injurious ventilation (HT-V) group (n=10), or nonventilated control group (n=7). The two thermal groups were subjected to injurious mechanical ventilation for 20 min with peak airway pressure 30 cm $H_2O$ at zero positive end-expiratory pressure, which was translated to tidal volume $54{\pm}6\;ml$ in the NT-V group and $53{\pm}4\;ml$ in the HT-V group (p>0.05). Results : Pressure-volume (P-V) curve after the injurious ventilation was almost identical to the baseline P-V curve in the HT-V group, whereas it was shifted rightward in the NT-V group. On gross inspection, the lungs of the HT-V group appeared smaller in size, and showed less hemorrhage especially at the dependent regions, than the lungs of the NT-V group. [Wet lung weight (g)/body weight (kg)] ($1.6{\pm}0.1$ vs $2.4{\pm}1.2$ ; p=0.014) and [wet lung weight/dry lung weight] ($5.0{\pm}0.1$ vs $6.1{\pm}0.8$ ; p=0.046) of the HT-V group were both lower than those of the NT-V group, while not different from those of the control group($1.4{\pm}0.4$, $4.8{\pm}0.4$, respectively). Protein concentration of the BAL fluid of the HT-V group was lower than that of the NT-V group($1,374{\pm}726\;ug/ml$ vs $3,471{\pm}1,985\;ug/ml$;p=0.003). Lactic dehydrogenase level of the BAL fluid of the HT-V group was lower than that of the NT-V group ($0.18{\pm}0.10\;unit/ml$ vs $0.43{\pm}0.22\;unit/ml$;p=0.046). Conclusions : Hypothermia attenuated pulmonary hemorrhage, permeability pulmonary edema, and alveolar cellular injuries associated with injurious mechanical ventilation, and preserved normal P-V characteristics of the lung in rats.

• Quality Improvement in Health Care
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• v.27 no.2
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• pp.18-29
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• 2021

Purpose: Patients with hematologic malignancy (HM) typically have a high mortality rate when their condition deteriorates. The chronic progressive course of the disease makes it difficult to assess the effect of intervention on acute events. We investigated the effectiveness of a rapid response team (RRT) on in-hospital mortality in patients with HM. Methods: We retrospectively analyzed the data of patients with HM who admitted to the medical intensive care unit between 2006 and 2015. Clinical outcomes before and after RRT implementation were evaluated. Results: A total of 228 patients in the pre-RRT period and 781 patients in the post-RRT period were included. The overall in-hospital mortality was 55.4%. Patients in the post-RRT period had improved survival; however, they required more vasopressor therapy, continuous renal replacement therapy, and extracorporeal membrane oxygenation. Multivariate analysis revealed that in-hospital mortality was associated with RRT activation (hazard ratio [HR], 0.634; 95% confidence interval [CI], 0.498-0.807; p < .001), neurological disease (HR, 2.007; 95% CI, 1.439-2.800; p < .001), sequential organ failure assessment score (HR, 1.085; 95% CI, 1.057-1.112; p < .001), need for continuous renal replacement therapy (HR, 1.608; 95% CI, 1.206-1.895; p< .001), mechanical ventilation (HR, 1.512; 95% CI, 1.206-1.895; p< .001), vasopressor (HR, 1.598; 95% CI, 1.105-2.311; p = .013), and extracorporeal membrane oxygenation (HR, 1.728; 95% CI, 1.105-2.311; p = .030). Conclusion: RRT activation may be associated with improved survival in patients with HM.

• Journal of Korean Academy of Nursing Administration
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• v.15 no.4
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• pp.527-538
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• 2009

Purpose: The purpose of this study was to reclassify the advanced nursing practices of critical care nurse practitioners(CCNPs) in intensive care unit and measure the time and frequency of CCNP's activities. Method: Practices of ICU nurses are divided into RN's and CCNP's practices by a panel of ICU nursing experts. Each practice of CCNP is defined and CCNP's working time and service frequencies are monitored in general hospitals. Result: Practices of CCNP were classified into 4 domains and 32 practices. Fourteen practices by CCNPs were completed in 10 minutes and the other 12 practices consumed 10-30 minutes. A priority of practice in respiratory therapy was given to artificial airway management, management of tracheostomy patient, lower respiratory care, and the priority of CRRT was management of anticoagulation. Conclusions: Advanced nursing practices of CCNPs were recognized from those of RNs. A further research of CCNPs practices should be extended to other advanced practices and it is required to evaluate economic value of advanced nursing practice in the national health insurance system.