• Neonatal Medicine
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• 제18권2호
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• pp.272-279
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• 2011

목적: 최근 신생아 집중 치료실(neonatal intensive care unit, NICU)에 입원한 신생아들의 병원내 감염 중 그람 음성 간균(Gram negative bacilli, GNB)에 의한 패혈증이 증가하고 있다. NICU에서 정기적인 대변의 감시 배양을 통해 GNB에 의한 장관 집락화가 같은 균에 의한 패혈증으로 이행되는 지를 확인하고, 집락화된 GNB 병원균의 종류를 확인하며 집락화에 관여하는 위험인자를 조사하고자 하였다. 방법: 2007년 10월부터 2008년 5월까지 고신대학교 복음병원 신생아 집중치료실에 입원한 86명의 환아를 대상으로 하였다. 모든 환아에게 총 3회의 대변 채집을 계획하였는데, 출생 후 첫 대변과 2주 간격으로 2회 채집을 계획하였다. 장관의 GNB 집락화와 관련된 위험 인자들은 대상 환아들의 의무기록을 열람하거나 연관된 논문의 고찰을 통해 설정하였다. 결과: 86명의 환아 중 22명(25.6%)이 GNB에 의한 장관 집락화가 있었으나 이 환아들을 퇴원까지 추적하였을 때 GNB로 인한 패혈증은 없었다. Pseudomonas aeruginosa, Enterobcter cloacae, Citrobacter freundii가 가장 많이 분리되었다. 분리된 GNB 중 약 89% (32/36)는 amikacin에 감수성이 있었다. GNB 에 의한 장관 집락화의 가능성은 집락화 당시 수유량이 적을 때 증가한 반면, 첫 수유 시기가 지연될 때 그 가능성은 감소하였다. 결론: 저자들은 NICU에 입원한 신생아에서 장관 감시배양을 통해 장관에 집락화된 GNB를 확인하였으나 연구에 포함된 환아에서 GNB에 의한 패혈증이 발생하지 않았으므로 집락화가 패혈증으로 이행되는 지를 확인할 수는 없었다. 집락화시 적은 수유량(feeding volume at colonization day)이 집락화의 위험요인이었으므로 장관 영양의 진행이 원활하지 않을 경우 장관의 GNB 집락화 가능성을 고려해야 한다.

• 한국병원경영학회지
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• 제24권4호
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• pp.57-69
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• 2019

Purpose: This study aimed to analyze the job performance efficiency of nurses in the Neonatal Intensive Care Unit (NICU) by using the Data Envelopment Analysis (DEA). Additionally, the study aimed to provide a detailed method to improve the currently inefficient way in which nurses perform their jobs by differentiating the reference group of more efficient nurses, and to compare the characteristics of the more efficient group of nurses to those of the less efficient group of nurses. Methodology: This study evaluated the relative job performance efficiency of nurses by applying DEA to 43 nurses in the NICU. The input variables for the efficiency analysis were working career (years), time spent in direct nursing care (hours), overtime (hours), and job-related training (hours); the output variables were the job performance scores of professional practice, research, leadership, and education. Data were analyzed using SPSS IBM 23.0 and Open Source DEA (OSDEA). Findings: The relative job performance efficiency of the 43 nurses was 0.933, and 20 nurses were evaluated as more efficient. In addition, the study confirmed the possibility of improving the overall job performance efficiency by improving leadership, while controlling the current input variables. Lastly, the more efficient nurses had significantly higher job performance scores for research (t=2.028, p=0.049), leadership (t=2.036, p=0.048), and education (t=2995, p=0.005) than those who were less efficient. Practical Implications: It is suggested that job performance be evaluated using DEA to improve the overall job performance efficiency of NICU nurses. The analysis results from DEA for nurses becomes evidence in support of establishing individualized goals for each nurse, thus resulting in a foundation for systematic human resource management of nurses, and ultimately contributing to increase in the job performance efficiency of nurses.

• Clinical and Experimental Pediatrics
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• 제62권1호
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• pp.36-41
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• 2019

Purpose: In this study, we investigated the clinical features and prognostic factors of early-onset sepsis (EOS) in neonatal intensive care unit (NICU) patients. Methods: A retrospective analysis was conducted on medical records from January 2010 to June 2017 (7.5 years) of a university hospital NICU. Results: There were 45 cases of EOS (1.2%) in 3,862 infants. The most common pathogen responsible for EOS was group B Streptococcus (GBS), implicated in 10 cases (22.2%), followed by Escherichia coli, implicated in 9 cases (20%). The frequency of gram-positive sepsis was higher in term than in preterm infants, whereas the rate of gram-negative infection was higher in preterm than in term infants (P<0.05). The overall mortality was 37.8% (17 of 45), and 47% of deaths occurred within the first 3 days of infection. There were significant differences in terms of gestational age (26.8 weeks vs. 35.1 weeks) and birth weight (957 g vs. 2,520 g) between the death and survival groups. After adjustments based on the difference in gestational age and birth weight between the 2 groups, gram-negative pathogens (odds ratio [OR], 42; 95% confidence interval [CI], 1.4-1,281.8) and some clinical findings, such as neutropenia (OR, 46; 95% CI, 1.3-1,628.7) and decreased activity (OR, 34; 95% CI, 1.8-633.4), were found to be associated with fatality. Conclusion: The common pathogens found to be responsible for EOS in NICU patients are GBS and E. coli. Gram-negative bacterial infections, decreased activity in the early phase of infection, and neutropenia were associated with poor outcomes.

• 임상간호연구
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• 제23권1호
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• pp.64-72
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• 2017

Purpose: This study aimed to explore the distributions of nurse staffing grades and to report changes in staffing grades in general wards and adult and neonatal intensive care units(ICUs) by hospital type and location. Methods: Data collected from the Health Insurance Review and Assessment Service were analyzed. Nurse staffing was categorized from grades 1 to 6 or 7 for general wards, 1 to 9 for adult ICUs, and 1 to 4 for neonatal ICUs based on the nurse-to-bed ratio. Results: The staffing grade for the general wards improved during 2008-2016 in 69.8% of the tertiary hospitals, 58.5% of the general hospitals, and 31.7% of the non-general hospitals. The adult ICUs at tertiary hospitals exhibited a greater improvement in staffing grades (48.8%) than did those of general hospitals (44.2%) during 2008-2015. Tertiary hospitals in non-capital regions showed a greater improvement than those in the capital region. The majority of neonatal ICUs (67.1%) had no change in the staffing grade during 2008-2015. Conclusion: Improvements in nurse staffing differed by hospital type and location. Government policies to improve nurse staffing in non-tertiary hospitals and those in non-capital regions are required to reduce variations in nurse staffing.

• 여성건강간호학회지
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• 제11권3호
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• pp.202-208
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• 2005

Purpose: This study was conducted to discover the related factors of neonatal suckling in the initiation of breastfeeding in primiparous mothers and to provide basic data for promoting nursing intervention strategies to improve the practice of breastfeeding. Method: The subjects of this study were 71 primiparous mothers who had normal vaginal deliveries at one obstetric hospital in P metropolitan city and one delivery center in J city. The collected data was analyzed using the SPSS program. Result: The average IBFAT(Infant Breastfeeding Assessment Tool) score was 9.6$\pm$2.3. The general characteristics studied that had a significant influence on neonatal suckling in the initiation of breastfeeding were the place of delivery (ex: Hospital, Postnatal Unit), whether oxytocin was used, no usage of analgesic medication, amount of satisfaction after the first breastfeeding weight of the newborns and the Apgar score at one minute. Conclusions: A higher IBFAT score was related to primiparous mothers who had a hospital delivery, received oxytocin, received maternal labour analgesics, neonatal weight, Apgar score at one minute, and satisfaction after the first breastfeeding.

• 임상간호연구
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• 제23권2호
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• pp.211-221
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• 2017

Purpose: A National survey was conducted to assess neonatal intensive care nurses' practice, barriers, knowledge, and belief regarding Kangaroo Care (KC). Methods: A descriptive survey was conducted. Kangaroo care questionares were sent to nurses in all hospitals in Korea whose were identified as providing neonatal intensive care services(N=263). Descriptive statistics were used to summarized the data. Results: Among 67 neonatal care units, 61.1% adapted KC in their practice. About 60% of nurses in the KC providing hospital actually practiced KC. Major barrier of practicing KC were infant safety concerns, as well as work load of nurses. Respondants who had practiced KC were more knowledgable and were more positive in their belief regarding KC. Conclusion: The findings suggest that in order to overcome barriers of practicing KC, educational programs are recommended designed for nurses. In addition, development of KC practice guideline is necessary to facilicate successful and safe KC.

• 중환자간호학회지
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• 제13권2호
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• pp.24-35
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• 2020

Purpose : This study aimed to determine whether the Korean Patient Classification System for Neonatal Care Nurses (KPCSN) properly measures neonatal intensive care needs and to compare the scale's results with those of the Workload Management System for Critical Care Nurses (WMSCN). Methods : Data were collected from the medical records of 157 patients who were admitted to the NICU of a university hospital, in D city. Two types of patient classification systems were applied to investigate the total points and distributions to investigate the total points and distributions by categories and compare relationships and classification groups between two scales. Finally, the score distribution among the classification groups was analyzed when the KPCSN was applied. Results : Scores on the KPCSN for the feeding, monitoring, and measure categories were 19.16±15.40, 16.88±3.52, and 9.13±4.78, respectively. Classification group distribution of the KPCSN was as follows : 1.9% for the first group, 24.2% for the second group, 58% for the third group, and 15.9% for the fourth group. The classification group distribution of the WMSCN was as follows: 35.7% for the third group, 61.1% for the fourth group, and 3.2% for the fifth group. Finally, the scores by categories were analyzed according to KPCSN classification group, and the characteristics of the patients' nursing needs were identified for each classification group. Conclusion : Results of this study indicate that the KPCSN effectively measures feeding needs, which account for many nursing activities in neonatal intensive care. Comparisons between the KPCSN and WMSCN classification group scores and distribution ratios verified the correlation and significance of nursing requirements.

• 임상간호연구
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• 제21권2호
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• pp.207-214
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• 2015

Purpose: This study was aimed to investigate the effect of an education program on inter-rater agreement of Neonatal/Infant Braden Q Scale for clinical nurses working at a neonatal intensive care unit (NICU). Methods: This was single-arm pre and post experimental study. The participants were 12 nurses and 128 hospitalized neonates at a NICU from December, 2012 to March, 2013. Twelve nurses were divided into four different groups; for two groups were assigned nurses with 3 to 5 years of clinical experiences, and for the others with less than 1 year of clinical experience. The interventions were given by one wound ostomy specialist and two NICU nurses with over 5 years of clinical experiences for 1 hour twice. The inter-rater agreement was measured by intraclass-correlation coefficient. Results: Overall inter-rater agreement was improved from .87(95% CI: .80~.92) at the pre-test to .94(.91~.96) at post-test. Each inter-rater agreement except moisture and nutrition was also improved. Conclusion: The developed education program on scoring for Neonatal/Infant Braden Q scale was effective to improve the inter-rater agreement among clinical nurses. We suggest to privide an education for NICU nurse before using the Neonatal/Infant Braden Q scale in clinical settings.

• 한국간호교육학회지
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• 제27권3호
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• pp.261-273
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• 2021

Purpose: This study used a descriptive investigative design to identify educational needs for developmental supportive care for the purpose of establishing a developmental supportive care education program for nurses in neonatal intensive care units. Methods: A survey was conducted on 93 nurses working in neonatal intensive care units located in a metropolitan area, and the collected data were analyzed using descriptive statistics and a paired t-test with the SPSS 25.0 program. For the purpose of analyzing educational needs, we further analyzed data through an importance-performance analysis (IPA) and the Borich needs assessment and the locus for focus models. Results: The average importance of the developmental supportive care of nurses in neonatal intensive care units was 3.74±0.78 out of 5, and the average performance was 3.46±0.81 out of 5. A t-test on the difference between the IPA and Borich needs assessment showed the highest educational need in the categories of 'individualized care', and 'I serve on the Developmental Care Committee at my institution'. In addition, according to the results of deriving the priorities of educational needs using the Borich needs assessment and the locus for focus model, the highest priority was 'I provide appropriate pain management when noxious procedures are necessary'. Conclusion: These findings can be used as basic data to design a developmental supportive care program suitable for nurses in neonatal intensive care units to meet the educational needs for developmental supportive care.

• Clinical and Experimental Pediatrics
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• 제49권8호
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• pp.845-850
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• 2006

목 적 : 선천성 또는 신생아시기에 위험요인을 가진 환아에서 조기 난청의 발생율이 높으며, 지연성 또는 진행성으로 발생하는 난청의 상당 부분도 신생아시기에 위험요인이 있었던 환아에서 발생 한다. 따라서 위험군을 효과적으로 선별하고 관리하는 것은 중요하다. 본 연구는 다양한 위험인자를 발견 할 수 있는 신생아 집중 치료실 입원환자를 대상으로 청력선별검사를 시행하고 난청 발생 빈도와 위험인자들간의 관계 및 상대적인 중요성을 알아보았다. 방 법 : 2003년 5월부터 2005년 12월까지 좋은문화병원 신생아 집중치료실에 입원한 신생아 1,201명을 대상으로 하였다. 검사는 입원원인질환에서 회복되고 교정연령 36주 이상, 체중 2,200 g이상 되었을 때 자동뇌간유발반응검사(AABR. ALGO-3)를 시행하였으며 1차 청력검사에서 통과된 경우 'pass'군 통과하지 못한 경우 'refer'군으로 하였다. 첫 번째 검사에서 'refer'가 나온 경우 1개월 뒤에 재검사를 받도록 하였고 재검사에서 'refer'가 나온 경우 난청 클리닉에 의뢰하여 난청을 확진하였다. 결 과 : 총 1,201명중 1,187명(98.8%)은 청력검사를 통과 하였고 14명(1.2%)이 난청으로 진단되었다. 대상자중 293명(24.4%)이 위험인자를 가지고 있었으며, 이중 282(96.2%)이 통과 하였고, 11명(3.8%)이 난청으로 진단되었다. 위험군에서 난청의 발생빈도가 유의하게 높았다(P<0.001). 각 위험인자들 중에서 난청발생에 유의한 차이를 보인 것은 청력손상을 일으키는 약물의 사용(P<0.001), 출생체중 1,500 g 이하(P<0.001), 안면부 기형(P=0.007) 등이었다. 반면에 위험인자 중 선천성 감염, 고빌리루 빈혈증, 세균성 뇌수막염, 낮은 Apgar점수, 5일 이상의 인공호흡기 사용, 청력 이상을 나타내는 증후군 등은 'pass'군과 'refer'군 사이에 발생 빈도에 있어서 통계적으로 의미가 없었다. 결 론 : 적절한 시기에 난청을 진단하기 위해서 신생아 청력선별검사 뿐만 아니라 난청의 위험요소를 잘 파악하는 것도 중요하다.