• Journal of Trauma and Injury
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• 제24권2호
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• pp.98-104
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• 2011

Purpose: The aim of this study was to evaluate the quality of the trauma care system of our hospital, in which emergency physicians care for major trauma patients in the emergency intensive care unit (ICU) in consultation with intervention radiologists and surgeons. Methods: This was a retrospective observational study conducted in an emergency ICU of a tertiary referral hospital. We enrolled consecutive patients who had been admitted to our emergency ICU with major trauma from March 2007 to September 2010. We collected data with respect to demographic findings, mechanisms of injury, the trauma and injury severity score (TRISS), emergency surgery, angiographic intervention, and 6-month mortality. Then, we compared the observed and predicted survivals of the patients. The Hosmer-Lemeshow test and calibration plots by using 10 groups, one for each decile, of predicted mortality were used to evaluate the fitness of TRISS. P-values of greater than 0.05 represent a fair calibration. Results: Among 116 patients, 12 (10.34%) were dead within 6 months after admission to the ICU, and 29 (25.00%) and 38 (32.80%) patients received emergency surgery and angiographic intervention, respectively. The mean injury severity score and revised trauma score were $36.97{\pm}17.73$ and $7.84{\pm}6.75$, respectively. The observed survival and the predicted survival of the TRISS were 89.66% (95% confidence interval [CI]: 84.03~95.28%) and 69.85% (95% CI: 63.80~75.91%), respectively. The calibration plots showed that the observed survival of our patients was consistently higher than the predicted survival of the TRISS ($p$ <0.001). Conclusion: The observed survival for the trauma care system of our hospital, in which emergency physicians care for major trauma patients in the emergency ICU in consultation with intervention radiologists and surgeons, was higher than the predicted survival of the TRISS.

• 중환자간호학회지
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• 제12권2호
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• pp.73-84
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• 2019

Purpose : The purpose of this study was to investigate the effect of the perceived nursing work environment (NWE) on person-centered critical care nursing (PCCN) practices among nurses in intensive care units (ICUs). Methods : A cross-sectional research design was adopted for this study; participants were 126 ICU nurses working in five hospitals in B city. From December 2018 to February 2019, a survey questionnaire on NWE and PCCN were conducted. The collected data were analyzed with a multiple hierarchical regression analysis. Results : The mean score for NWE was $2.98{\pm}0.39$. Among the factors, basic work system was the highest ($3.39{\pm}0.41$), followed by leadership of the head nurse ($3.31{\pm}0.55$), interpersonal relationships ($2.77{\pm}0.62$), and institutional support ($2.58{\pm}0.52$). The mean score for PCCN was $3.52{\pm}0.46$. Among the factors, comfort was the highest ($3.77{\pm}0.62$), followed by respect ($3.55{\pm}0.56$), compassion ($3.43{\pm}0.60$), and individuality ($3.38{\pm}0.56$). The interpersonal relationship (${\beta}=.31$, p=.001) and the number of patients per shift (${\beta}=-.23$, p=.005) had a significant effect on PCCN, accounting for 25.9% of the total variance. Conclusion : These results suggest that it is necessary to enhance the relationship-oriented culture and reduce the workload of nurses in order to improve the quality of nursing care in ICUs.

• 의료ㆍ복지 건축 : 한국의료복지건축학회 논문집
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• 제22권4호
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• pp.87-95
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• 2016

Purpose: Recently an experience in the MERS crisis focused on the importance of infection control in hospitals. According to Korean National healthcare-associated Infection Surveillance System (KONIS) of the KSICP, a great number of 498 people, 841 people, and 1021 people were infected by pneumonia, urinary tract infection, and bacteremia respectively from 94 hospital ICUs during the year of 2014. Therefore, the purpose of this study is to investigate the configuration and design guidelines for the ICU rooms to minimize the nosocominal infections. Methods: Based on the several infection control guidelines and revised Medical Law, consequent analyses which classified the planning and operational behavior in the ICUs of seven hospitals, were performed to reduce the cross-infection. Results: The results of this study are offering a space, configuration and design guidelines for effective infection control in the intensive care units through the unit-bed area, the bed-to-bed distance, the isolation room, etc. Implications: It is expected that this study propose the direction of architectural planning and guideline for the ICU room in order to realize the intension of revised Medical Law.

• 중환자간호학회지
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• 제15권1호
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• pp.1-12
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• 2022

Purpose : This study aimed to identify the status of intrahospital transport (IHT) of critically ill patients and provide baseline data to form recommendations for safer transport. Methods : Data were collected from 141 intensive care unit (ICU) nurses who attended national conferences between February and August, 2018. The collected data were analyzed using descriptive statistics and ANOVA, and post-hoc analysis was conducted with the Scheffé and Games-Howell tests. Results : Of the nurses surveyed, 61.7% answered that their workplace had a transport guideline. In terms of the experience of ICU nurses, 31.2% of respondents answered that they had received training on IHT. This result indicated that the degree of implementation of the guidelines for IHT was generally high, but some, including guidelines on personnel, equipment, and monitoring, were not. Guidelines of IHT were well observed when the institutes had specific guidelines for IHT of critically ill patients with specified transport grades, a scoring system to assess stability of a patient, a checklist and a protocol for action in case of problems, and when healthcare providers were provided with training. Conclusion : These results suggest that organized infrastructure, such as a transport guideline with transport grades, a checklist to improve the implementation of guidelines, and a protocol for coping with a problem, should be provided for safe transport. Additionally, effective education and evaluation to improve the competency of staff participating in the transport of patients will help reduce the occurrence of adverse events in intensive care transport in hospitals and promote patient safety.

• 간호행정학회지
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• 제11권2호
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• pp.209-218
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• 2005

Purpose: This study was to setup the basis on hospital and national nursing manpower estimation accurately according to apply patient classification system of Song's study to China hospital system. Method: This study was surveyed to 964 patients at surgical and medical ward on Yanbian University Hospital in China from 17th to 31th January, 2005. Results: There was study results to test hypotheses for estimating optimal nursing manpower as follows. First, a trimodel classification scheme was developed which suggested three categories of patients as minimal care(category 1), moderate care(category 2), intensive care(category 3). Second, there was not significant difference with nursing time by sex. Third, there was not significant difference with nursing time by medical wards. Fourth, there was not significant difference with average nursing care time for each category of patients. Category 1 was estimated to spend average 19.59minutes for patients, Category 2 was about 35.68 minutes, Category 3 was 72.07minutes respectively. Total nursing hours was 62,610 minutes. Conclusion: Patient classification system of Song's study is validity for optimal nursing manpower of hospital in China.

• 임상간호연구
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• 제22권2호
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• pp.205-216
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• 2016

Purpose: This study was performed to develop a valid and reliable Korean Patient Classification System for Neonatal care nurses (KPCSN). Methods: The study was conducted in tertiary and general hospitals with 1~2 grade according to nursing fee differentiation policy for NICU (neonatal intensive care unit) nurse staffing. The reliability was evaluated for the classification of 218 patients by 10 nurse managers and 56 staff nurses working in NICUs from 10 hospitals. To verify construct validity, 208 patients were classified and compared for the type of stay, gestational age, birth weight, and current body weight. Nursing time was measured by nurses, nurse managers, and nurse aids. For the calculation of conversion index (total nursing time divided by the KPCSN score), 426 patients were classified using the KPCSN. Data were collected from September 5 to October 28, 2015, and analyzed using t-test, ANOVA, intraclass correlation coefficient, and non-hierarchial cluster analysis. Results: The final KPCSN consisted of 11 nursing categories, 71 nursing activities and 111 criteria. The reliability of the KPCSN was r=.83 (p<.001). The construct validity was established. The KPCSN score was classified into four groups; group $1:{\leq}57points$, group 2: 58~80 points, group 3: 81~108 points, and group $4:{\geq}109points$ in the KPSCN score. The conversion index was calculated as 7.45 minutes/classification score. Conclusion: The KPCSN can be utilized to measure specific and complex nursing demands for infants receiving care in the NICUs.

• 중환자간호학회지
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• 제16권1호
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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.

• 한국컴퓨터정보학회논문지
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• 제27권12호
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• pp.69-76
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• 2022

본 논문에서는 MIMIC-IV(Medical Information Mart for Intensive Care) v2.0 데이터를 이용한 시계열 데이터의 정제 및 가공 방법을 제안한다. 더불어 해당 가공법을 기반으로 정제한 데이터셋을 활용하여 구축한 기계학습 기반의 욕창 조기 경보 시스템을 통해 해당 가공 방법의 유의성을 검증하였다. 구현된 욕창 조기 경보 시스템은 병변이 발생하기 전 12, 24시간에 미리 의료진에게 경보를 주는 시스템이다. 전자의무기록(Electronic Medical Record; EMR) 시스템과 연동하여 실시간으로 환자의 욕창 발생 위험도를 의료진에게 알려 중환자 의사결정을 지원하고, 나아가 효율적인 의료 자원 배분을 가능하게 한다. 여러 기계학습 모델 중 GRU 모델을 사용하였을 때, AUROC 평가지표를 기준으로 발생 전 12시간이 0.831, 24시간이 0.822로 가장 좋은 성능을 보였다.

• 한국의료질향상학회지
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• 제9권1호
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• pp.74-89
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• 2002

Background : The purpose of this study was to investigate the incidence of unplanned endotracheal extubation and to identify the influencing factor of unplanned extubation in ICUs for providing baseline data in developing prevention strategies and administrative standards. the medical records and hospital information system. In order to analyze factors related to unplanned extubation, the subjects of this study were divided by unplanned extubation group and planned extubation group and were matched by its sex, age, and disease groups in a ratio of one to two. The data were analyzed by descriptive statistics, ${\chi}^2$- test, t-test, Fisher's exact test, and logistic regression analysis with SPSSWIN 10.0 program. Result : 1) Forty-seven(4.99%) of 942 intubated patients experienced unplanned extubation 65 times during the twelve-month period. Thirtyfour( 72.34%) of 47 unplanned extubated patients required reintubation, whereas thirteen patients(27.66%) did not. 2) About half of unplanned extubation(46.8%) occurred during the night shift. 3) As for the nursing activity, respiratory nursing activity score(P=.0.06) and total nursing activity score(P=.011) showed statistically significant differences between unplanned extubation group and planned extubation group. 4) As for the patient status, unplanned extubation group showed more lower consciousness level(P=.000), more irritable or agitated behavior(P=.000), and had more applied physical restraints(P=.000) than planned extubation group. 5) As for the intubation related variables, unplanned extubation group revealed more intubated with respiratory failure(P=.000), more dependent on mechanical ventilation(P=.015) than planned extubation group. 6) Factors affecting unplanned extubations in intensive care unit patients were irritable or agitated behavior(odds ratio=13.757), night shift(odds ratio=7.166), and mechanical ventilation(odds ratio=6.257) from conditional logistic regression analysis. Conclusion : The most affecting factor of unplanned extubation was agitated or irritable behavior. Therefore the results of this study could be helpful to ICU nurses for meticulous care, decision making, timely intervention, and development of intervention strategies for preventing unplanned extubation.

• 대한간호학회지
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• 제34권7호
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• pp.1315-1325
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• 2004

Purpose: The purpose of this study was to examine the effects of a closed endotracheal suction system(CES) on oxygen saturation, ventilator associated pneumonia(VAP), and nursing efficacy in mechanically ventilated patients. Method: This study was conducted in the intensive care unit of a University Hospital in Gwangju City. Data was collected from July to October, 2003. Seventy mechanically ventilated patients were randomly divided into two groups; 32 for CES and 38 for open endotracheal suction system(OES) protocol. Twenty one nurses were also involved to examine the nurses' attitude of usefulness about CES. Result: $SaO_2$ was significantly different between CES and OES. The incidence of VAP in CES was lower than that of OES. Nursing efficacy was related to time, cost, and usefulness of the suction system. Time of suctioning in CES was shorter than that of OES. CES also contributed significantly to lower the cost of treatment than OES. The usefulness score of CES increased after 6 months of use. Conclusion: CES prevented VAP, was cost effective, and a safe suctioning system. CES can be used with patients with sensitivity to hypoxygenation and with a high risk of VAP.