• 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.

• Tuberculosis and Respiratory Diseases
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• 제42권4호
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• pp.535-547
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• 1995

연구배경: 균혈증은 중환자실에서 흔히 발생하는 문제로 일반 병실에서 보다 그 빈도가 더 높고 중환자의 사망률을 높이는 원인이 되며, 중환자실의 종류에 따라 감염의 선행요인, 원발부위, 원인 균주, 예후에 차이가 있다는 보고가 있다. 이에 저자 등은 본원의 내과계와 외과계 중환자들에서 발생한 균혈증의 임상적, 세균학적 양상과 예후 등에 있어서, 양 중환자 군 간에 차이가 있는지 알아보고자 본 연구를 시행하였다. 방법: 1990년 2월부터 1993년 12월까지 균혈증이 증명되었던 내과계 중환자 189예와 외과계 중환자 67예를 대상으로 병록을 후향적으로 검토하여 임상적, 세균학적 특징과 예후를 비교하였다. 결과: 1) 균혈증이 확인된 내과계 중환자는 전체 내과계 중환자에 비해 평균 연령이 높았으나, 외과계 중환자에서는 균혈증이 있었던 환자와 전체 외과계 중환자 간의 평균 연령의 차이는 없었다. 균혈증이 확인된 중환자는 전체 중환자에 비해 중환자실내 평균 재실 일수가 길었으며, 균혈증은 전체 평균 재실 기간을 초과한 상태에서 발생하였다. 2) 중환자의 균혈증 발생률은 내과계(7.9%)가 외과계(2.4%)보다 많았으나, 균혈증 환자의 평균 연령, 남녀비, 중환자실 재실 기간은 양 군 간에 차이가 없었다. 3) 외과계 균혈증 중환자는 내과계에 비해 균혈증 전 전신적 항생제나 부신피질 호르몬 사용, 감염과 연관된 경피적 장치, 침습적 조직이 선행되었던 경우가 많았다(전신적 항생제 사용: 내과계 45%, 외과계 63%, p<0.05; 부신피질 호르몬 사용: 내과계 14%, 외과계 36%, p<0.01; 기계장치: 내과계 19%, 외과계 39%, p<0.01; 침습적 조작: 내과계 19%, 외과계 61%, p<0.01). 4) 균혈증 획득 장소의 분포는 내과계의 경우 원외 균혈증 빈도(42%)가 외과계에 비해 상대적으로 높았고, 외과계는 중환자실내 획득 균혈증 빈도(78%)가 높았다(p<0.01). 5) 양 중환자실에서 균혈증의 원인 균주, 원발병소는 차이가 없었으며, 중환자실내 획득 균혈증의 경우 균혈증 발생 병일에도 차이가 없었다. 6) 균혈증의 원인 균주나 원발병소에 따른 예후의 차이는 없었다. 7) 균혈증 중환자의 사망률은 내과계(72.5%)가 외과(40.3%)보다 높았으며, 균혈증이 없었던 환자의 사망률에 비해 양 중환자군 모두 균혈증을 동반한 경우 사망률이 높았다(p<0.05). 결론: 균혈증을 가진 중환지는 일반 중환자에 비해 사망률이 더 높았으며, 평균 재실 기간을 초과한 상태에서 감염에 이환되고, 이는 다시 중환자실 재실 기간을 연장시키는 것으로 사료되었다. 내과 및 외과계 중환자에 따른 비교에서 내과계 균혈증 증환자는 선행 요인에 있어 간질환과 급성 호흡부전이 많았고 지역사회 획득 균혈증이 많았으며 사망율이 더 높았던 반면, 외과계 균혈증 중환자는 선행 요인으로 외상, 항생제나 면역억제제 시용 및 침습적 조작의 빈도가 많았으며 중환자질내 획득 균혈증의 빈도가 높았으나 사망률은 내과계보다 낮았다 양 균혈증군에서 균혈증의 원발 병소, 원인 균주 및 이에 따른 사망률에는 유의한 차이가 없었다.

• Acute and Critical Care
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• 제33권4호
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• pp.252-259
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• 2018

Background: The aim of this study was to investigate the effects of using a systematic approach to tracheostomy care by a clinical nurse specialist and surgical intensivists for patients with a tracheostomy who were transferred from the surgical intensive care unit (SICU) to the general ward. Methods: In this retrospective study, subjects were limited to SICU patients with a tracheostomy who were transferred to the general ward. The study period was divided into a preintervention period (January 1, 2007 to December 31, 2010) and a postintervention period (January 1, 2011 to December 31, 2014), and electronic medical records were used to analyze and compare patient characteristics, clinical outcomes, and readmission to the SICU. Results: The analysis included 44 patients in the preintervention group and 96 patients in the postintervention group. Decannulation time ($26.7{\pm}25.1$ vs. $12.1{\pm}16.0days$, P=0.003), length of stay in the general ward ($70.6{\pm}89.1$ vs. $40.5{\pm}42.2days$, P=0.008), length of total hospital stay ($107.5{\pm}95.6$ vs. $74.7{\pm}51.2days$, P=0.009), and readmission rate of SICU decreased due to T-cannula occlusion (58.8% vs. 5.9%, P=0.010). Conclusions: Using a systematic approach to tracheostomy care in the general ward led to reduction in decannulation time through professional management, which resulted in a shorter hospital stay. It also lowered SICU readmission by solving problems related to direct T-cannula.

• 대한간호학회지
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• 제31권2호
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• pp.304-314
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• 2001

Major purposes of this study were to investigate the administration patterns of analgesics and sedatives in SICU and to identify the factors influencing the use of prn analgesics and sedatives by ICU nurses. The sample of this descriptive study was 50 adult patients in SICU and 53 ICU nurses. Patient's medical records were reviewed to investigate names, doses, the routes of administration, the interval of administration, and the type of prescription of sedatives and analgesics administered. Study medications were narcotics, hypnotics, and antipsychotics. To identify the factors influencing the use of prn analgesics and sedatives, 53 ICU nurses checked 9 items, and rank them from first to fifth. The selection of items was based on the previous studies and the experience of the investigator. The results of the study are as follows: 1. The mean age of the subjects was 53 years, 24 patients out of 50 subjects had received mechanical ventilation therapy. Most of the patients received neurosurgeries and abdominal surgeries. 2. For 4 days, 13 total study medications and combination of these were administered to the patients. Commonly prescribed drugs were Ketoprofen and Midazolam. Twenty six to fourty two percent of the patients did not receive any drugs for at least one day during the four days. 3. On the average, the study drugs were administerd 1.4 to 2.6 times per day during 4 days. 4. More than 50 percent of the prescription was as-needed (prn) except those of the POD 3. Fourteen percent of the patients did not have any prescription for sedation and pain control after surgery. 5. Examination of the frequency of sedatives and analgesics bolus administration revealed that a greater number of doses were given during daytime (from 7 am. to 7 pm.) than nighttime (from 7 pm. to 7 am.). The difference was significant at Alpha, .05. 6. First factor that most influenced nurses to administer sedatives and analgesics for intubated patients was the evaluation of patient's vital signs (51%). For non- intubated patients, the factors that nurses considered important were the patients' complaints of pain (64%) and evaluations of patients' vital signs (23%). In conclusion, the results of this study indicate that patients in SICU might not receive enough analgesics and sedatives to feel completely free from pain during the post operational period. Future study should be focused on the evaluation of the adequacy of current practice for pain and anxiety control in terms of the SICU patient's response.

• 중환자간호학회지
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• 제10권3호
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• pp.31-40
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• 2017

Purpose : This study examined the prevalence of delirium-related factors in a surgical intensive care unit (SICU). Methods : This retrospective study enrolled 73 patients who were admitted to an SICU from October 1, 2016 to March 20, 2017 and who had been hospitalized for more than 72 hours. Data was collected by reviewing electronic medical records. Results : Delirium occurred in 46 (63.0%) patients. Its related factors were age, education, mechanical ventilator, sleep, narcotics, physical restraint, and central line catheters. Conclusion : The results indicate that sleep and physical restraint are significant factors related to delirium occurrence. The results of this study can help in developing guidelines for the prevention of delirium.

• 임상간호연구
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• 제18권1호
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• pp.126-135
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• 2012

Purpose: This study was aimed to develop a simulation training program of an advanced cardiac life support (ACLS) based on the mastery learning model (Simulation-MLM), and evaluate the effects of the program on critical care nurses. Methods: As an experimental pre-post test with a non-equivalent control group, the study employed convenience sampling of 38 critical care nurses. The experimental group received the Simulation-MLM including a theoretical lecture, formative evaluation, and simulation training, whereas only a theoretical lecture for the control group. The knowledge, self-efficacy, and performance degrees of respondents were measured to verify the effects of the Simulation-MLM. The statistical processing of the collected data utilized the SPSS WIN 17.0 program. Results: After receiving Simulation-MLM, the participants in the experimental group reported higher marks in the knowledge, self-efficacy and performance of ACLS compared with those in the control group. However, both experimental and control groups demonstrated no significant differences in knowledge, self-efficacy and performance. Conclusion: Despite of the limitation of a small sample size, this study was considered meaningful in a sense that it showed a venue for improving ACLS training efficiency. Future research with more distinct treatment differentiation and better adequate outcome variables was warranted in order to prove the effects of a theory-based simulation education.

• 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.

• 기본간호학회지
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• 제23권3호
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• pp.256-263
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• 2016

Purpose: This study was done to examine the prophylactic effect of transparent film dressing on the sacrum and coccyx sites to reduce pressure ulcers. Methods: The participants were 317 patients admitted to an SICU in Seoul, Korea. Of the patients, 175 were assigned to the experimental group and 142 to the control group. For participants in the experimental group, a prophylactic transparent film dressing was applied on the sacrum and coccyx. The control group received the usual care. The nurses checked for pressure ulcers on the sacrum and coccyx at least once every duty. When pressure ulcer occurred, it reported on the record form. The results were analyzed using Poisson and Hierarchical logistic regression. Results: The prevalence and risk of pressure ulcer was lower in the experimental group compared to the control group but the difference was not significant. The ICU length of stay was significantly associated with pressure ulcer risk. Conclusion: Findings indicate that prophylactic transparent film dressing helps to reduce pressure ulcer in SICU patients.

• 임상간호연구
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• 제21권1호
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• pp.43-52
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• 2015

Purpose: This study was aimed to develop the multicomponent intervention for preventing delirium among postoperative patients in a surgical intensive care unit (SICU). Methods: Using a quasi-experimental pre & post-test design with a non-equivalent control group, a total of 88 hospitalized patients in a SICU participated in this study. The 44 patients were allocated in each experimental and control group. The experimental group received the multicomponent intervention for delirium prevention including a delirium assessment and nursing intervention using a checklist, whereas the control group was provided with a standard care. The primary outcome of this study was the delirium incidence during the course of hospitalization. Results: There were no significant differences in the demographic and clinical characteristics between the two groups. The delirium occurred in 19.2% in the experimental group, whereas 38.6% in the control group ($x^2=4.526$, p<.05). Conclusion: The findings of the study demonstrated an effect of the multicomponent delirium prevention intervention in decreasing the delirium incidence rate over the standard care among the patients in SICU.

• 한국병원경영학회지
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• 제25권3호
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• pp.14-28
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• 2020

Purpose: The purpose of this study was to calculate the total daily nursing workload and the optimum number of nurses per intensive care unit (ICU) based on the nursing intensity and the direct nursing time per inpatient using the patient classification. Methods: Two ICUs at one general hospital were investigated. To calculate the nursing intensity, patient classification according to the nursing needs was conducted for 10 days in each unit during September 2018. We performed patient classifications for a total of 167 patient-days in the Medical Intensive Care Unit (MICU) and 86 patient-days in the Surgical Intensive Care Unit (SICU). The total number of person-days for nurses who responded to the Nursing Time survey was 151 for MICU and 85 for SICU. In each unit, direct and non-direct nursing hours, nursing intensity score, and direct nursing hours were analyzed using descriptive statistics such as frequency, percentage, and average calculated using Microsoft Excel. The amount of nursing workload and the optimum number of nurses were calculated according to the formula developed by the authors. Findings: For the MICU, the average direct nursing time per patient was 5.59 hours for Group 1, 6.98 hours for Group 2, and 9.28 hours for Group 3. For the SICU, the average direct nursing time per patient was 5.43 hours for Group 1, 7.21 hours for Group 2, 9.75 hours for Group 3, and 12.82 hours for Group 4. Practical Implications: This study confirmed that the appropriate number of nurses was not secured in the nursing unit of this study, and that leisure time such as meal time during nursing work hours was not properly guaranteed. The findings suggest that to create working environments where nurses can serve for extended periods of time without compromising their professional standards, hospitals should secure an appropriate number of nurses.