• Journal of Korean Academy of Fundamentals of Nursing
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• v.7 no.2
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• pp.256-270
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• 2000

Invasive hemodynamic monitoring has become a valuable assessment parameters in critical care nursing in patients undergoing open heart surgery patients. During cardiac surgery, the Swan Ganz catheter is placed in the pulmonary artery. Critical care nurses routinely obtain cardiac output, cardiac index, and pulmonary arterial pressure in these patients. Traditionally, patients are positioned flat and supine for cardiac output measurement. Numerous studies have dealt with the effects of changing position on the hemodynamic variables. However, there are a few studies dealing with patients who undergo cardiac surgery in Korea. Thus, the purpose of this study was to determine the effects of changing position on cardiac output, PAP, CVP, BP, HR and discomfort in patients after cardiac surgery. A sample of 21 adults who had CABG and/or valve replacement with Swan Ganz catheters in place was studied. The data were collected in the cardiac ICU of a university hospital in Seoul during the period from July 28, 1999 to August 30. 1999. In this study, the independent variable is patient position in the supine, 30 degree, and 45 degree angles. Dependent variables are C.O., C.I., CVP, PAP, MAP, HR and patients' perceived discomforts. Subject discomfort was measured subjectively by visual analogue scale. Other hemodynamic data where collected by the thermodilution method and by direct measurement. The data were analyzed by percentile, t-test, ANOVA, Linear regression analysis using SPSS-/WIN program. The results are as follows : 1) Changes in cardiac output were absent in different angle positions, 0, 30. 45 degrees(F=.070, P=.932). Changes in cardiac index were absent in different angle positions, 0. 30, 45 degrees(P>.05). 2) Changes in central venous pressure were absent in different angle positions, 0, 30, 45 degree(P>.05). 3) PAP had no change in different angle 0, 30, 45 degree positions; systolic PAP(P>.05), diastolic PAP(P>.05). 4) Changes in systolic blood pressure were absent in different angle positions, 0, 30, 45 degree(P>.05). 5) Changes in heart rates were absent in different angle positions, 0, 30, 45 degree(P>.05). 6) Patients' perceived discomfort was absent in different angle positions, 0, 30, 45 degree(p<.05). In conclusion, critical care nurses can measure C.O., C.I., PAP, BP, & CVP in cardiac surgery patients at 30 degree or 45 degree positions. This can improve the patients' comfort.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.4 no.1
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• pp.147-162
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• 1997

This study was attempted to provide the basic data for nursing intervention to improve the psychosociological adaptation of patients receiving chemotherapy for breast cancer by examining relationship between anxiety and hopelessness that they are experiencing and family support, in order to help them successfully cope with various psychological problems. This study was carried out with 93 breast cancer patients who are receiving chemotherapy in the injection treatment room of K University Hospital located in the downtown of Taegu after having underwent mastectomy in the hospital between December 1995 and August 1996. This study used the systematized questionnaires which contain 7 questions about general characteristics, Spielberger's trait anxiety & state anxiety scale, the tool that WON(1987) modified the hopelessness scale which was developed by Beck et al.(1967) and the family support tool made by TAE(1985). By using the SPSS/PC program, this study obtained the real number and percentage for the general characteristics of the subjects, and mean and standard variation for the degrees of trait anxiety, state anxiety, hopelessness and family support. The correlation between each variables was identified on the basis of the Pearson Correlation, and the degrees of trait anxiety, state anxiety, hopelessness and family support in the general characteristics of the subjects were analyzed by using the t-test, ANOVA, and Duncan test. The results of this study were summarized as follows. In the general characteristics of the subjects, most of each group were 51 years old or more and the middle class in income, had educational background under elementary school, no job, Buddhism in religion and spouse, and were receiving chemotherapy using MTX and 5FU. It was shown that the degree of the subjects' trait anxiety is, on an average, 50. 29, state anxiety 49. 68, hopelessness 51. 46 and family support 34. 28. Both trait anxiety and hopelessness showed normal correlation ; the higher the degree of trait anxiety is, the higher the degree of hopelessness is, while trait anxiety and family support showed reverse correlation ; the higher the degree of trait anxiety, the lower the degree of family support that the subjects perceive is. State anxiety and hopelessness also showed normal correlation ; the higher the degree of state anxiety is, the higher the degree of hopelessness is. Family support and hopelessness showed reverse correlation ; the higher the degree of family support is, the lower the degree of hopelessness that the subjects perceive is. And family support and state anxiety showed reverse correlation but there was a statistically significant difference. The degree of trait anxiety in the general characteristics of the subjects showed a significant difference by age, job and religion, the degree of state anxiety a signigicant difference by job and religion, the degree of hopelessness a signigicant difference by age, educational background and existence or not of spouse. In conclusion, the breast cancer patients receiving chemotherapy perceive anxiety and hopelessness due to several causes such as diagnosis itself or side effects of chemotherapy, so that it is required not only to develop specific nursing interventions including family support to alleviate anxiety and hopelessness but also to apply such interventions to clinical practice.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.7 no.2
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• pp.239-255
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• 2000

The purpose of this study was to explore the care needs of family-caregivers caring for patients with a CVA and the level of self care of the patients. The subjects for the study were 112 patients with a CVA and their caregivers. These patients were seen in a hospital or out-patient-department(OPD) at two oriental medical hospital in Jeonbuk province. The survey instruments used in this study were Kang's ADL checklist for self care of patients and Kim's Likert-style checklist for care needs of family-caregivers to patient with CVA. The survey was conducted from July 4 to August 30, 1999. Internal validity by calculation of Cronbach's alpha was 0.95, which was regarded as high. The survey results were analyzed using the SPSS program, with percentages, means, t-test, ANOVA and Pearson's correlation coefficients. The results of this study are as follows : 1. The level of self care for patients with a CVA was : 1) complete dependence(M=14.9, 13.1%), 2) complete independence(M=23.6, 20.9%), 3) incomplete independence(M=23.9, 21.0%), 4) incomplete dependence(M=26.6, 25.0%), 5) dependence and independence(M=23.0, 20.0%). The items for which there was a high level of self care were : 1) drinking(M=3.62), 2) eating (M=3.25), 3) position returning(M=3.18) : and the items for which there was a low level of self care were : 1) ascending and descending stairs(M=2.08), 2) walking(M=2.47). 3) putting on and taking off trousers(M=2.55). 2. The mean score of the sum of the care needs of the family-caregivers was : 1) need for immediate care and help: 2) need of the way to communicate with patient: 3) need for education and assistance related to physical functional level: 4) need to be informed about the disease, treatment and care: 5) need for social support and consultation: 6) need for appreciation: 7) need for management of nursing problems related to immobility. The highest meed factor was the need for immediate care and help(M=3.47): and lowest need factor was the need for management of nursing problems related to immobility(M=2.80). 3. There were significant differences between the level of care need and general characteristic of the caregivers, there were family-caregivers age(P=0.001), marital status (P=0.276), occupation (P=0.006), monthly income(P=0.000), Patient's relationship to caregivers(P=0.004) and health(P=0.000). 4. There were significant differences between the level of self care and general characteristic of the patients, there were patient paralytic condition(P=0.01), blood pressure(P=0.01), and length of suffering(P=0.03). 5 There were significant differences between the level of care need and the general characteristic factors, which were CVA patient's blood pressure (P=0.05), problem of medical fee (P=0.05). 6. There was significantly correlation with the family-caregivers care need and the level of self care in the CVA patient(r=0.300, P=0.000). As a result, need to promote the level of self care in patients and to meet the care need of family-caregivers for more efficient nursing of CVA patients, is emphasized. Therefore more study is needed on an efficient way to provide rehabilitation and quality nursing interventions for family-caregivers and patients with CVA.

• Journal of Korean Academy of Nursing
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• v.6 no.1
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• pp.12-22
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• 1976

Amongst varieties of clinical nursing role, the administration of medication is often highlighted as of prime importance. In order to attain data for the improvement of teaching strategies of medication, diagnostic evaluation of the knowledge level is a necessity. This study was performed from August through December 1975. 449 registered nurses, randomly sampled from general hospitals:16 of Seoul and 7 of Taegu and Pusan, were tested through 54 test questionaries based on 4 practical dimensions of administration of medication. Results are as follows ; 1. Status of respondents: Length of clinical experiences; the average length revealed to be 2 years and 7 months, 72% revealed to have had less than 3 years of experience; 38.6%-less than 1 year, 19 .2%-over 1 year and less than 2 years, and 14, 2%-over 2 years and less than 3 years. Type of Nursing education received ; 9.4% revealed to have graduated technical high school of nursing, 67.5o/o the 3 year diploma school and 21, 7% the baccalaureate degree program. The knowledge Level; Degree of self-satisfaction on knowledge level revealed that;27, 4% responded to "more or less satisfied", 48.8% "more or less un-satisfied" and 19.8% to "not satisfied". The average level of basic knowledge revealed to be moderate by 66.95 points. The level of knowledge of 4 questionnaire categories revealed that; drug action category by average of 66.5 points, methodology category by 65.4 Points, safety measure category by 71.4 points and terminology and concepts category by 64.6 points, Questionnaire items which revealed high points are of;6 of drug action category, 4 of methodology, 4 of safety measure, and 3 of terminology. The items of low points are: 8 of drug action, 3 of methodology, 3 of safety measure and 5 of terminolology categories. 3. The type of nursing education revealed to have no significant influence on the level of knowledge on the administration of medication. 4. The length of clinical experience revealed to have no significant influence on the level of knowledge. 5. 75. l% responded that the actual practice of medication modes are "similar" to that included in the fundamentals of nursing course. 6. In-service education on medication; 54.0% revealed to have some incidental in-service education on medication while 34.0% receive programmed in- service education. 61.8% revealed to have expressed the need of systemic In-service education as one of the means for improvement of medication. 32.7% revealed to obtain information concerning medicine by reading commercial publications on drug package, while only 20.9% by reading specific information channel.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.4 no.2
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• pp.175-192
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• 1997

The purpose of this study was to identify the care needs of family-caregivers to the patients with stroke. Subjects were 115 family-caregivers caring for the patients while they were in-patients or out-patients with stroke in two general hospitals and one oriental medicine hospital located in Seoul and Kwang-Ju. The instrument used for this study was made by the researcher on the basis of results of literature review and interviews with family-caregivers, composed of 35 items. Internal validity by calculation of cronbach's alpha with data of respondents was 0.91, which was regarded as high. The Data were analyzed by SAS program, with percentage, mean, t-test, and ANOVA. Factor structures of care needs of family-caregivers were elicited by factor analysis(PCA, Varimax rotation). Datum collection had been from July 1 to August 14, 1997. The results of this study were as follows : 1. The mean score of the sum of the care needs of family-caregivers was 3.96 and the highest-mean item was 'need for immediate care(M=4.77)', and the lowest-mean item was 'need for chaplian's visit (M=2.82)'. 2. Care needs of the family-caregivers were : Need to be informed of the disease, treatment and care ; need of education and assistance related to physical functional level ; need of social support and consultation ; need of management of nursing problem related to immobility ; need of appreciation ; need of the way to communicate with patients ; need of immediate care and help. The highest mean factor was the 'need for immediate care and help(M=4.74)', and the lowest mean factor was the 'need of appreciation(M=3.58)'. 3. The variables influencing the degree of care needs perceived by family-caregivers to the patients with stroke were as follows : There were significant differences between need to be informed of the disease, treatment and care and general characteristic factors, which were family caregiver's sex (p=.0178), caring period(p=.0223) and patient's suffering period(p=.0244). There were significant differences between need of education and assistance related to physical functional level and general characteristic factors, which were patient's paralysis(p=.0177), patient's ADL dependency(p=.0032). There were significant differences between need of social support and consultation and general characteristic factors, which were family caregiver's sex(p=.0055), occupation(p=.0159), religion(p=.0093) and patient's sex(p=.0134). There was significant difference in the degree of need of management of nursing problem related to immobility, according to the patient's ADL dependency(p=.0493). There were significant differences between need of appreciation and general characteristic factors, which were family caregiver's age(p=.0107), sex(p=.0133), and patient's age(p=.0338). There were significant differences between need of the way to communicate with patient and general characteristic factors, which were patient's paralysis(p=.0002) and aphasia(p=.0001). There were significant differences between need of immediate care and help and general characteristic factors, which were family caregiver's caring period(p=.0162) and patient's suffering period(p=.0116). 4. The mean score of patient's ADL dependency was 3. 38 and the highest-mean item was 'ascending and descending stairs(M=4.12)', and the lowest-mean item was 'drinking(M=2.60)'. There was no significant difference in the degrees of care needs related to the patient's ADL dependency. 5. The highest information source of family-caregivers was from the doctors about the disease, treatment and care(26.1%). The second highest one was from mass media(20.8%), and the third one was from the nurses. The above findings may be used as the basic data to seek more efficient way of elevating nursing practice and quality for family-caregivers to the patients with stroke.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.5 no.2
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• pp.237-256
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• 1998

Death and dying of human being is a comprehensive system, and death orientation, the subjective meaning related to every component of the death system is developed throughout life. This study was designed and carried out to identify, describe and classify the orientations of Korean adult towards the death system. In an attempt to measure the subjective meaning of death and dying, unstructured Q-methodology was used. The 65 Q-statements developed by Kim(1994), used by Kim(1994) and Park(1996) were adopted as Q-population and 39 Q-statements were selected by the three researchers for Q-items for this study. Thirty-three P-samples were sampled from P-population of literate Korean men and women, 35 and 55 years of age, lived in urban Korea for the last 10 years. Sortings of the 39 Q-items according to the level of personal agreement, and a forced normal distribution into the 9 levels were carried out by the P-samples. The Z-scores of the Q-sort data were computed, and the principal components factor analysis by PC-QUANL Program were carried out. The demographic, socio-cultural and health-related attributes of the P-samples were descriptively analysed. Eight types of death orientation were identified ; Type I ; 'naturalist'. Six P-samples. Death is a natural phenomena, to be accepted as it is and to follow its natural course. Prefer to be informed of all facts and possibilities concernig the course of dying and death to occur to self. Type II ; 'life-after-life negator'. Three P-samples. Time and process of death is the destiny of each person. Death means 'darkness' and 'end to every thing, the absolute end'. Yet, wish physical integrity at the dying and after death. Type III ; 'life-after-life believer'. Six P-samples. Men are travellers passing by this life bound to the life-after-life. Priority concerns are on the activities to prepare self for the eternal life ahead. Disregard premature and sudden death. Type IV ; 'here-now believer' Five P-samples. Positive regard to the cremation of the body and donation of the organs on death. Regard religious and customary post-motem rituals meaningless. Negate life-after life. Type V; 'believer of rituals'. Five P-samples. Death being accepted as a part of, a natural end to, and destiny of human life. Concerned to ensure a dignified end to personal life and dignified post-mortem rituals. Type VI ; 'Realist'(derived from Type I). Two P-samples. Life and death as universal reality. The abrupt death at golden age at the peak of happiness is favored to avoid inevitable physical and mental distress of self and the family. Agreed to the cremation of the body. Disregard rituals. Type VII : 'Fatalist' (derived from Type II). Five P-samples. Not favored, yet, all man are destined to death, the inevitable end of all living beings. To ensure dignified end by personal consummation, information on one's dying and imminent death are to be shared. Type VIII ; 'reality avoider'(derived from Type III). One P-sample. Negative to longevity, artificial prolongation of, meaningless and distressful life. Highly positive to postmortem organ donation.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.2 no.1
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• pp.37-43
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• 1995

This study was conducted to compare the severity of cannulation pain in hemodialysis patients after topical application of EMLA cream and local injection of lidocaine and evaluated side effects and problems accompanied by the former. Twenty patients, who were on hemodialysis from September 1 to October 15, 1994 at the Kangnam St. Mary's Hospital, Catholic University Medical College, were divided into two groups of ten. To conduct a cross over study, two groups were placed on four repeated methods with lidocaine followed by four repeated methods with EMLA cream and vice versa, respectively, while the severity of cannulation pain was being measured according to a Visual Analogue Scale with each methods. The results are follows : 1) The scale of pain was recorded as $4.56{\pm}1.38$ and $2.05{\pm}1.36$ points for methods with lidocaine and EMLA cream, respectively, indicating the less severe pain with EMLA cream. 2) Local side effects such as itching(4 cases, 5.0%)and pallor (5 cases, 6.3%)were observed with methods with EMLA cream but disappeared before the completion of hemodialysis. 3) Problems associated with local lidocaine were pain at the injection of anesthetic (27cases, 16.9%)and fear for needle insertion(6 cases, 3.8%). The most frequent problems with EMLA cream application were an inconvenience in use (11 cases, 6.9%)and tedious long pretreatment time(11 cases, 6.9%), those associated with inconvenience in cream applying procedures. 4) Twelve out of twenty patients(60.0%) responded with yes to a continued use of EMLA cream in spite of problems with cream application and economical difficulties in purchasing. These results indicate that 5% EMLA cream used as a local anesthetic in hemodialysis significantly reduces cannulation pain and lacks side effects, thus serving as a suitable method for the alleviation of cannulation pain and inconvenience in hemodialysis and the relief of psychological stress of nurses.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.6 no.3
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• pp.382-396
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• 1999

This study was attempted to prove the effect of emotional stability and vital signs applying music therapy program to the children admitted in the PICU. Data were collected from July to September, 1997. The subjects were 30 patients admitted in the PICU of 'S' University Hospital which were divided into two groups of experimental and control. Each group had 15 subjects. Method was nonequivalent control group pretest-postteset repeated design, observing vital signs and activity of subjects prior, during, and after the music intervention. The study tools were cassette tapes of 'Mother's music whose babies want to listen' and Space-lab patient monitor. Data were analyzed using the $SPSS/PC+;x^2$ test and t-test to analyze of the general characteristics ; paired t-test to prove hypotheses. Result were as follows; 1. Infants lower than seven months showed changing into stable vital signs from applying the music therapy, however infants from eight months to three-year old showed no change in vital signs. 2. Vital signs changed to stabilized condition in infants lower than seven months were heart rate and respiration rate. 3. The stability of vital signs during music therapy turned back to the previous state while terminating music therapy. 4. The effect of music therapy in the state of activity had on both infants group of lower than seven months and from eight months to three-year old, particularly more effective in the later group. I recommend follows on the base of above results ; 1. As above results shows, listening to music is effective on infants and toddler, intervention with music therapy appropriate to chidlren's age is hot recommended. 2. Comparative study with noise blocking effect and music therapy effect within the ICU environment be recommended. 3. The repeated study on when the exact time is and how many repeat the music therapy to show the above mentioned effect be recommended. 4. We recommend this music therapy to be done in the recovery room, isolating room, operating room as well as ICU.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.10 no.1
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• pp.96-107
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• 2003

Objective: The purpose of this study was to identify the effects of tracheal suction and the effects of different methods of bronchodilator inhalation (Ultrasonic nebulizer: MDI puff, MDI puff with spacer) in VSD surgery patients. Material & Method: From June 2001 to March 2002, sixty consecutive patients were randomly assigned to a control group (n= 15), ultrasonic nebulizer group (n=15), metered dose inhalation (MDI) puff group (n=15) and MDI with spacer group (n=15). Vital signs (HR, BP, CVP), ABGA and pulmonary functions were measured before suction (baseline for suction), after suction, 15 minutes after suction (base of bronchodilator inhalation), 30 minutes after bronchodilator inhalation, and 2 hours after bronchodilator inhalation. Stastistical analysis was performed using SPSS software. Repeated measure ANOVA was used to examine the effects of tracheal suction. One way ANOVA with Bonferroni's correction and multiple range test (the least significant difference test) were used to examine the effects of albuterol inhalation. Result: 1. Heart .ate increased significantly immediately after suction (p<.01) and recovered 15 minutes after suction. 2. $PaO_2$ and PH decreased significantly immediately after suction (p<.05) and $PaO_2$ recovered 15 minutes after suction. $PaCO_2$ increased immediately after suction and significantly 15 minutes after suction (p<.01). But changes in vital signs and ABGA were within the normal range. 3. Tidal volume decreased significantly 15 minutes after suction (p<.05). 4. Changes of HR and tidal volume were greater in the nebuizer group compared to the other groups (p<.05) 30 minutes after bronchodilator inhalation and recovered 2 hours after bronchodilator inhalation. 5. Changes of airway deadspace was greater in the nebulizer group compared to the control group and MDI puff group 30 minutes after albuterol inhalation (p<.05) and at 2 hours (p<.01). Conclusion: Tracheal suction did not have significant effect on vital signs and pulmonary functions after OHS. Although the methods of bronchodilator inhalation did not showed any significant difference on pulmonary function, the nebulizer method increased $PaO_2$ (20%) and tidal volume transiently. If the patient needs bronchodilator inhalation with bronchospasm after OHS, the nebulizer method is the best choice. More study on the effects of bronchodilator inhalation in bronchospasm group is needed.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.22 no.3
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• pp.249-257
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• 2015

Purpose: The purpose of this pilot study was to investigate the effects of mechanical interventions for deep vein thrombosis (DVT) prophylaxis in surgical intensive care unit (SICU) patients. Methods: The participants were assigned to the intermittent pneumatic compression (IPC) and graduated compression stocking (GCS) intervention. Patients who met the criteria were selected for comparison from our previous study. Data for 140 patients were included in the final analysis. Results: The mean age was 57.5 (${\pm}15.7$) and 61.4 % were men. About forty-seven percent of the participants were 61 years or over. In the second duplex scan, 3, 2 and 1 critically ill patients developed deep vein thrombosis in the control, GCS, and IPC groups, respectively. Incidences of DVT were 6.0%, 5.0%, and 2.0% for the control, GCS, and IPC groups, respectively. This difference was not significant. Relative risks of no intervention were 3.0 and 1.2 compared with IPC and GCS application. There were no significantly different variables among the three groups before the intervention except for diagnosis on admission. Conclusion: Although it may difficult to conclude that mechanical prophylaxis effectively prevents DVT among SICU patients because there was no statistical significance in this study, but incidence rates among the three groups differed greatly. The findings reveal that further study should be conducted with larger samples and randomized controlled trial for SICU patients.