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Research Papers
Effectiveness of the Eye Care Protocol in the Intensive Care Unit Patients: A Randomized Controlled Trial
Lim, Kyu Won , Ha, Shin Young , Kang, In Soon
J Korean Acad Nurs 2024;54(3):432-445.   Published online August 31, 2024
DOI: https://doi.org/10.4040/jkan.24017
AbstractAbstract PDF
Purpose
This study investigated the effects of an eye care protocol (ECP) on patients in the intensive care unit (ICU).
Methods
This study utilized a randomized controlled design. Participants were patients who met the inclusion criteria and were admitted to the ICU (36 in the experimental group and 38 in the control group). The experimental group received an ECP, while the control group received standard eye care, starting the day after admission, for a duration of 10 days. The ECP classifies the degree of eyelid obstruction into three stages based on the degree of exposure to the lower eyelid conjunctiva and cornea. The protocol included cleansing with normal saline gauze, administering eye drops, applying silicone and polyurethane films, and recommending consultation with an ophthalmologist if necessary. The effectiveness of ECP was assessed by analyzing tear volume, hyperemia, chemosis, and eye discharge. Data analysis was conducted using SPSS 27.0, employing the Mann-Whitney U-test and generalized estimating equations.
Results
On day 5, the experimental group demonstrated a significant increase in tear volume in both eyes compared with the control group. However, no statistically significant differences were observed in the incidence of hyperemia, chemosis, and eye discharge on days 5 and 10 of the intervention.
Conclusion
The application of the ECP in this study increased tear volume in ICU patients, thereby reducing discomfort caused by dry eyes. It has the potential to prevent complications such as damage to the surface of the eyeball resulting from decreased tear volume.
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Analysis of ROX Index, ROX-HR Index, and SpO 2 /FIO 2 Ratio in Patients Who Received HighFlow Nasal Cannula Oxygen Therapy in Pediatric Intensive Care Unit
Choi, Sun Hee , Kim, Dong Yeon , Song, Byung Yun , Yoo, Yang Sook
J Korean Acad Nurs 2023;53(4):468-479.   Published online August 31, 2023
DOI: https://doi.org/10.4040/jkan.22152
AbstractAbstract PDF
Purpose
This study aimed to evaluate the use of the respiratory rate oxygenation (ROX) index, ROX-heart rate (ROX-HR) index, and saturation of percutaneous oxygen/fraction of inspired oxygen ratio (SF ratio) to predict weaning from high-flow nasal cannula (HFNC) in patients with respiratory distress in a pediatric intensive care unit.
Methods
A total of 107 children admitted to the pediatric intensive care unit were enrolled in the study between January 1, 2017, and December 31, 2021. Data on clinical and personal information, ROX index, ROX-HR index, and SF ratio were collected from nursing records. The data were analyzed using an independent t-test, χ2 test, Mann–Whitney U test, and area under the curve (AUC).
Results
Seventy-five (70.1%) patients were successfully weaned from HFNC, while 32 (29.9%) failed. Considering specificity and sensitivity, the optimal cut off points for predicting treatment success and failure of HFNC oxygen therapy were 6.88 and 10.16 (ROX index), 5.23 and 8.61 (ROX-HR index), and 198.75 and 353.15 (SF ratio), respectively. The measurement of time showed that the most significant AUC was 1 hour before HFNC interruption.
Conclusion
The ROX index, ROX-HR index, and SF ratio appear to be promising tools for the early prediction of treatment success or failure in patients initiated on HFNC for acute hypoxemic respiratory failure. Nurses caring for critically ill pediatric patients should closely observe and periodically check their breathing patterns. It is important to continuously monitor three indexes to ensure that ventilation assistance therapy is started at the right time.

Citations

Citations to this article as recorded by  
  • Can the ROX index predict high‐flow nasal cannula failure in children under 2 with lower respiratory tract infection?
    Pablo Vasquez‐Hoyos, Alvaro L. Jacome‐Orozco, Andrea P. Rodriguez‐Mayorga, Leidy E. Sepulveda‐Forero, Diana P. Escobar‐Serna, Juan S. Barajas, Evelyn Obando‐Belalcazar, Claudia M. Salinas‐Jaimes, Juan J. Peralta‐Palmezano, Alexandra Jimenez‐Chavez, Rafael
    Pediatric Pulmonology.2024; 59(5): 1246.     CrossRef
  • Impact of Surgical Mask Placement Over High-Flow Nasal Cannula on Oxygenation Parameters in COVID-19 Patients Experiencing Hypoxemic Respiratory Failure
    Aadila Coatwala, Mayank Dhir, Sagar Sinha, Dattatray Bhusare
    Cureus.2024;[Epub]     CrossRef
  • 1,272 View
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  • 1 Web of Science
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Delirium Experience of the Intensive Care Unit Patients
Jung, Jaeyeon , Jang, Sujin , Jo, Seonmi , Lee, Sunhee
J Korean Acad Nurs 2022;52(2):134-143.   Published online April 30, 2022
DOI: https://doi.org/10.4040/jkan.21240
AbstractAbstract PDF
Purpose
The study aimed to understand the delirium experience of intensive care unit (ICU) patients.
Methods
We performed a qualitative study using Colaizzi’s phenomenological method. Eleven patients, who experienced delirium according to the Confusion Assessment Method for ICU, participated after transferring to general wards from the ICU. Individual in-depth semi-structured interviews ranging from 30 minutes to 2 hours in length were conducted between November 2018 and August 2019.
Results
Nine themes and four theme clusters emerged. The four theme clusters were: 1) “Overwhelmed by fear,” which describes the experience of a patient close to death and the feeling of difficulty in understanding disorganized thinking; 2) “Anxious about not understanding the situation,” which means that patients’ sense of time and space were disordered in the ICU; 3) “Being deserted,” which indicates the feeling of being separated from others and yourself; and 4) “Resistance to protect my dignity,” which indicates that the dignity and autonomy of an individual in the patient’s position at the ICU, are ignored.
Conclusion
Nursing interventions are needed that would enable patients to maintain orientation and self-esteem in the ICU. In addition, healthcare providers need to provide information about the unfamiliar environment in the ICU in advance.

Citations

Citations to this article as recorded by  
  • Patients' and family members' dyadic experience of post‐operative delirium in the intensive care unit: A qualitative study
    Dong Jing, Sui Weijing, Zhuang Yiyu
    Nursing in Critical Care.2025;[Epub]     CrossRef
  • Factors Influencing Intensive Care Unit Nurses’ Competency in Delirium Care in A Tertiary General Hospital
    Mi Ran Lim, Gyoo Yeong Cho
    Journal of Korean Critical Care Nursing.2024; 17(3): 37.     CrossRef
  • Exploring patients’ and families’ preferences for auditory stimulation in ICU delirium prevention: A qualitative study
    Yajun Ma, Nianqi Cui, Zhiting Guo, Yuping Zhang, Jingfen Jin
    Intensive and Critical Care Nursing.2024; 82: 103629.     CrossRef
  • The Influence of Ethical Nursing Competence and Positive Nursing Organizational Culture on Person-Centered Care in Intensive Care Unit Nurses: A Cross-Sectional Survey
    Jae Eun Lee, Hye-Young Jang
    Journal of Korean Academy of Fundamentals of Nursing.2024; 31(3): 304.     CrossRef
  • A Study on Nurses' Communication Experiences with Intubation Patients
    Ye Rim Kim, Hye Ree Park, Mee Kyung Shin
    The Korean Journal of Rehabilitation Nursing.2023; 26(1): 28.     CrossRef
  • Intensive Care Experience of Critical Care Patients and Its Related Factors : A Secondary Analysis Study
    Jiyeon Kang, Hyojeong Woo
    Journal of Korean Critical Care Nursing.2023; 16(3): 11.     CrossRef
  • Item analysis of the Korean version of the Intensive Care Experience Questionnaire: Using the Rasch Model based on Item Response Theory
    Jiyeon Kang, Minhui Kim
    Journal of Korean Critical Care Nursing.2022; 15(3): 37.     CrossRef
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Untact Visit Service Development Based on an Application Reflecting the Circumstances during COVID-19: Focusing on Utilization in the Pediatric Intensive Care Units
Woo, Dahae , Yu, Hanui , Kim, Hyo Jin , Choi, Minyoung , Kim, Dong Hee
J Korean Acad Nurs 2021;51(5):573-584.   Published online October 31, 2021
DOI: https://doi.org/10.4040/jkan.21143
AbstractAbstract PDF
Purpose
This study aimed to develop an untact visit service based on an application that can be utilized in the pediatric intensive care unit (PICU) during COVID-19.
Methods
This study adopted the double diamond process of service design comprising the discovery, defining, and development stages.
Results
We developed an untact visit service based on an application that considered the child’s status, schedule, photo, and video messages, and so on. Moreover, we derived a service flow regarding the required roles and the type of flow shown between each stakeholder.
Conclusion
Considering the ongoing pandemic, the untact visit service is designed to increase rapport and participation of parents, share the child’s information in real-time, and provide one-stop service without increasing healthcare providers’ work. It will be a useful visit service that can be applied and evaluated in various hospital settings and the PICU.

Citations

Citations to this article as recorded by  
  • Factors affecting pediatric nurses’ development of partnerships with parents of hospitalized children: An evaluation based on the stress-coping adaptation model
    In Young Cho, So Hyoung Hong, Ji Yeong Yun
    Journal of Child Health Care.2025; 29(1): 53.     CrossRef
  • Experiences of Family Members With Visitation Prohibition for Critically Ill Patients
    Sunjung Kim, Sunghee H. Tak
    Western Journal of Nursing Research.2024; 46(11): 854.     CrossRef
  • Factors influencing neonatal intensive care unit nurses' parent partnership development
    Eun Kyoung Kim, In Young Cho, Ji Yeong Yun, Bobae Park
    Journal of Pediatric Nursing.2023; 68: e27.     CrossRef
  • National Petition Analysis Related to Nursing: Text Network Analysis and Topic Modeling
    HyunJung Ko, Seok Hee Jeong, Eun Jee Lee, Hee Sun Kim
    Journal of Korean Academy of Nursing.2023; 53(6): 635.     CrossRef
  • Relationship between parental stress and post‐traumatic stress disorder: The moderating effect of visitation restrictions in paediatric intensive care units during COVID‐19
    Young Il Cho, Hyo Jin Kim, Dong Hee Kim
    Nursing in Critical Care.2023; 28(5): 808.     CrossRef
  • Need for Information and Communication Technology during COVID-19: An Exploratory Study Using Nurses’ Activity Diaries
    Hyeongsuk Lee, Dongmin Lee, Seungmin Lee
    Healthcare Informatics Research.2023; 29(3): 256.     CrossRef
  • Effects of a Noncontact Visit Program in the NICU for the Prevention of COVID-19
    Hye Young Ahn, Hee Jee Jo, Hyun Jeong Ko
    Healthcare.2023; 11(15): 2152.     CrossRef
  • The Development of Automated Personalized Self-Care (APSC) Program for Patients with Type 2 Diabetes Mellitus
    Gaeun Park, Haejung Lee, Ah Reum Khang
    Journal of Korean Academy of Nursing.2022; 52(5): 535.     CrossRef
  • 376 View
  • 7 Download
  • 8 Web of Science
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Effect of Direct Breastfeeding Program for Premature Infants in Neonatal Intensive Care Unit
Kang, Ji Hyun , Son, Hyunmi , Byun, Shin Yun , Han, Gyumin
J Korean Acad Nurs 2021;51(1):119-132.   Published online February 28, 2021
DOI: https://doi.org/10.4040/jkan.20240
AbstractAbstract PDF
Purpose
This study aimed to identify the effects of a direct breastfeeding program for premature infants in neonatal intensive care units (NICUs).
Methods
This quasi-experimental study was conducted during August 2016 to April 2017. Sixty mothers of premature infants were assigned to the experimental (n = 31) or control groups (n = 29). The program was comprised of breastfeeding education and direct breastfeeding support. The experimental and control groups were provided with education and counseling on breastfeeding at the time of admission and discharge. In the experimental group, the mothers initiated oral feeding with direct breastfeeding and engaged in breastfeeding at least seven times during the NICU stay. The collected data were analyzed by the χ2 -test and repeated measures ANOVA using an SPSS program.
Results
The experimental group showed a higher direct breastfeeding practice rate (χ2 = 19.29, p < .001), breastfeeding continuation rate (χ2 = 3.76, p < .001), and self-efficacy (F = 25.37, p < .001) than the control group except for maternal attachment.
Conclusion
The direct breastfeeding program in the NICU has significant effects on the practice and continuation rate of breastfeeding and breastfeeding self-efficacy. Therefore, this program can be applied in the NICU settings where direct breastfeeding is limited.

Citations

Citations to this article as recorded by  
  • Fresh Parent’s Own Milk for Preterm Infants: Barriers and Future Opportunities
    Carrie-Ellen Briere, Jessica Gomez
    Nutrients.2024; 16(3): 362.     CrossRef
  • Exploration of Family-Centered Care in NICUs: A Grounded Theory Methodology
    Young Ah Park, YeoJin Im
    Qualitative Health Research.2024;[Epub]     CrossRef
  • Development and Effectiveness Evaluation of Comprehensive Mobile-Based, Breastfeeding Promotion Program for Mothers with Gestational Diabetes
    Eunju Kwak, Seungmi Park
    Journal of Korean Academy of Nursing.2024; 54(2): 224.     CrossRef
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Cut-Off Values of the Post-Intensive Care Syndrome Questionnaire for the Screening of Unplanned Hospital Readmission within One Year
Kang, Jiyeon , Jeong, Yeon Jin , Hong, Jiwon
J Korean Acad Nurs 2020;50(6):787-798.   Published online December 31, 2020
DOI: https://doi.org/10.4040/jkan.20233
AbstractAbstract PDF
Purpose
This study aimed to assign weights for subscales and items of the Post-Intensive Care Syndrome questionnaire and suggest optimal cut-off values for screening unplanned hospital readmissions of critical care survivors.
Methods
Seventeen experts participated in an analytic hierarchy process for weight assignment. Participants for cut-off analysis were 240 survivors who had been admitted to intensive care units for more than 48 hours in three cities in Korea. We assessed participants using the 18-item Post-Intensive Care Syndrome questionnaire, generated receiver operating characteristic curves, and analysed cut-off values for unplanned readmission based on sensitivity, specificity, and positive likelihood ratios.
Results
Cognitive, physical, and mental subscale weights were 1.13, 0.95, and 0.92, respectively. Incidence of unplanned readmission was 25.4%. Optimal cut-off values were 23.00 for raw scores and 23.73 for weighted scores (total score 54.00), with an area of under the curve (AUC) of .933 and .929, respectively. There was no significant difference in accuracy for original and weighted scores.
Conclusion
The optimal cut-off value accuracy is excellent for screening of unplanned readmissions. We recommend that nurses use the Post-Intensive Care Syndrome Questionnaire to screen for readmission risk or evaluating relevant interventions for critical care survivors.

Citations

Citations to this article as recorded by  
  • Post intensive care syndrome: A review of clinical symptoms, evaluation, intervention
    Xiaofang He, Yuwei Song, Yuchun Cao, Liying Miao, Bin Zhu
    Heliyon.2024; 10(10): e31278.     CrossRef
  • Screening tools for post–intensive care syndrome and post-traumatic symptoms in intensive care unit survivors: A scoping review
    Usha Pant, Krooti Vyas, Shaista Meghani, Tanya Park, Colleen M. Norris, Elizabeth Papathanassoglou
    Australian Critical Care.2023; 36(5): 863.     CrossRef
  • 349 View
  • 12 Download
  • 2 Web of Science
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Original Articles
Path Analysis for Delirium on Patient Prognosis in Intensive Care Units
Sunhee Lee, Sun-Mi Lee
J Korean Acad Nurs 2019;49(6):724-735.   Published online December 30, 2019
DOI: https://doi.org/10.4040/jkan.2019.49.6.724
AbstractAbstract PDF
Purpose

This study was conducted to investigate relationship between delirium, risk factors on delirium, and patient prognosis based on Donabedian's structure-process-outcome model.

 Methods

This study utilized a path analysis design. We extracted data from the electronic medical records containing delirium screening data. Each five hundred data in a delirium and a non-delirium group were randomly selected from electronic medical records of medical and surgical intensive care patients. Data were analyzed using SPSS 20 and AMOS 24.

 Results

In the final model, admission via emergency department (B=.06, p=.019), age over 65 years (B=.11, p=.001), unconsciousness (B=.18, p=.001), dependent activities (B=.12, p=.001), abnormal vital signs (B=.12, p=.001), pressure ulcer risk (B=.12, p=.001), enteral nutrition (B=.12, p=.001), and use of restraint (B=.30, p=.001) directly affecting delirium accounted for 56.0% of delirium cases. Delirium had a direct effect on hospital mortality (B=.06, p=.038), hospital length of stay (B=5.06, p=.010), and discharge to another facility (not home) (B=.12, p=.001), also risk factors on delirium indirectly affected patient prognosis through delirium.

 Conclusion

The use of interventions to reduce delirium may improve patient prognosis. To improve the dependency activities and risk of pressure ulcers that directly affect delirium, early ambulation is encouraged, and treatment and nursing interventions to remove the ventilator and drainage tube quickly must be provided to minimize the application of restraint. Further, delirium can be prevented and patient prognosis improved through continuous intervention to stimulate cognitive awareness and monitoring of the onset of delirium. This study also discussed the effects of delirium intervention on the prognosis of patients with delirium and future research in this area.

Citations

Citations to this article as recorded by  
  • Does ICU admission dysphagia independently contribute to delirium risk in ischemic stroke patients? Results from a cohort study
    Hongtao Cheng, Simeng Song, Yonglan Tang, Shiqi Yuan, Xiaxuan Huang, Yitong Ling, Zichen Wang, Xiaoying Tian, Jun Lyu
    BMC Psychiatry.2024;[Epub]     CrossRef
  • Preoperative Anxiety and Its Postoperative Associated Factors in Patients Receiving Post Anesthetic Recovery Care at Surgical Intensive Care Unit
    Yul Ha Lee, Hye-Ja Park
    Journal of Health Informatics and Statistics.2023; 48(3): 267.     CrossRef
  • Delirium Experience of the Intensive Care Unit Patients
    Jaeyeon Jung, Sujin Jang, Seonmi Jo, Sunhee Lee
    Journal of Korean Academy of Nursing.2022; 52(2): 134.     CrossRef
  • The training needs of Korean intensive care unit nurses regarding delirium
    Young Sook Roh
    Intensive and Critical Care Nursing.2021; 62: 102954.     CrossRef
  • Effect on Quality of Care of a Delirium Prevention Campaign for Surgical Intensive Care Nurses
    Heejeong Kim, Sun-Mi Lee
    Journal of Nursing Care Quality.2021; 36(4): 361.     CrossRef
  • A Systematic Review and Meta-analysis on the Effect of Delirium Prevention Intervention in Korean Intensive Care Units
    Jiyeon Kang, Min Jeong Choi
    Journal of Korean Critical Care Nursing.2021; 14(3): 141.     CrossRef
  • 640 View
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  • 6 Crossref
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Person-Centered Relational Care Experienced by Critical Care Nurses: An Interpretative Phenomenological Analysis Study
Myoung Sun Jang, Sungjae Kim
J Korean Acad Nurs 2019;49(4):423-436.   Published online January 15, 2019
DOI: https://doi.org/10.4040/jkan.2019.49.4.423
AbstractAbstract PDF
Abstract Purpose

The aim of the study was to explore nurses’ experience of person-centered relational care in the context of critical care.

 Methods

Key interview questions were developed based on the human-to-human relationship model suggested by Travelbee. Data were collected through in-depth interviews with a purposive sample of 11 nurses having more than 2 years of working experience in intensive care units. An interpretative phenomenological analysis was conducted to analyze the data.

 Results

Four super-ordinate and nine sub-ordinate themes were identified. Emerged super-ordinate themes were as follows: (1) encountering a live person via patient monitoring systems; (2) deep empathic connection; (3) humanistic and compassionate care, and (4) accompanying the journey to the end. Study findings revealed that nurses in intensive care units experienced ‘balancing emotions’ and ‘authenticity’ in caring when entering human-to-human relationships with dying patients. The phenomenon of person-centered relational care in intensive care units was found to subsume intrinsic attributes of empathy, compassion, and trust, similar to the central concepts of Travelbee's theory.

 Conclusion

The interpretative findings in this study provide deeper understanding of Travelbee's human-to-human relationship model. The technological environment in intensive care units did not hinder experienced nurses from forming human-to-human relationships. These themes need to be emphasized in critical care nursing education as well as in nursing management. The results of this study will contribute to understanding nurse-patient caring relationships in depth, and help improve the quality of nursing care in intensive care units.

Citations

Citations to this article as recorded by  
  • Framework of humanistic care for patients in theICU: A preliminary study
    Yuchen Zhang, Li Zhao, Meng Zhang, Xiaojing Guo, Chen Xin, Yubiao Gai
    Nursing in Critical Care.2024; 29(1): 125.     CrossRef
  • Exploring Healthcare Providers’ and Women’s Perspectives of Labor Companionship during Childbirth: An Interpretative Phenomenological Analysis Study
    Anwar Nader AlKhunaizi, Areej Ghalib Al-Otaibi, Manal F. Alharbi, Ghareeb Bahari
    Healthcare.2024; 12(9): 869.     CrossRef
  • Experience of Clinical Adaptation among Nurses in Intensive Care Unit
    Jin Young Hong, Sue Kyung Sohn
    Journal of Korean Critical Care Nursing.2024; 17(1): 1.     CrossRef
  • Self-reflection of a General Ward Nurses on the Experience of End-of-Life Care for a Patient who Decided to Suspend Life-sustaining Treatment: van Manen's Hermeneutic Phenomenological Approach
    Hee Jung Hong
    Korean Journal of Adult Nursing.2023; 35(3): 273.     CrossRef
  • The impact of family care visitation programme on patients and caregivers in the intensive care unit: A mixed methods study
    Hye Jin Yoo, JaeLan Shim
    Journal of Clinical Nursing.2023; 32(13-14): 3797.     CrossRef
  • Effective Teaching Behaviors of Clinical Nursing Teachers: A Qualitative Meta-Synthesis
    Jian Zhang, Fenhua Zhou, Jinxia Jiang, Xia Duan, Xin Yang
    Frontiers in Public Health.2022;[Epub]     CrossRef
  • Nurse Spiritual Care Therapeutics Scale
    Kyung-Ah Kang, Elizabeth Johnston Taylor, Jiyoung Chun
    Journal of Hospice & Palliative Nursing.2022; 24(6): E250.     CrossRef
  • Person-centred care among intensive care unit nurses: A cross-sectional study
    Hyuna Youn, Miyoung Lee, Sun Joo Jang
    Intensive and Critical Care Nursing.2022; 73: 103293.     CrossRef
  • The Effect of a Multifaceted Family Participation Program in an Adult Cardiovascular Surgery ICU*
    Hye Jin Yoo, JaeLan Shim
    Critical Care Medicine.2021; 49(1): 38.     CrossRef
  • Conceptualization of Person-Centered Care in Korean Nursing Literature: A Scoping Review
    Ji Yea Lee, Sewon Lee, Eui Geum Oh
    Korean Journal of Adult Nursing.2020; 32(4): 354.     CrossRef
  • Critical care nurses’ communication experiences with patients and families in an intensive care unit: A qualitative study
    Hye Jin Yoo, Oak Bun Lim, Jae Lan Shim, Liza Heslop
    PLOS ONE.2020; 15(7): e0235694.     CrossRef
  • 779 View
  • 24 Download
  • 8 Web of Science
  • 11 Crossref
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Risk Factors of Medical Device-Related Pressure Ulcer in Intensive Care Units
MiJee Koo, YoungA Sim, InSoon Kang
J Korean Acad Nurs 2019;49(1):36-45.   Published online January 15, 2019
DOI: https://doi.org/10.4040/jkan.2019.49.1.36
AbstractAbstract PDF
Abstract Purpose

The purpose of this study was to identify the characteristics of and risk factors for medical-device-related pressure ulcer (MDRPU) development in intensive care units.

 Methods

A prospective cohort study design was used, and the participants were 253 adult patients who had stayed in medical and surgical intensive care units. Data were collected regarding the application of medical devices and MDRPU-related characteristics over a period of six months from June to November, 2017. Data were analyzed using independent t-test, χ 2-test, Fisher's exact test, and binary logistic regression analysis with the SPSS 21.0 program.

 Results

Among the 253 participants, MDRPUs occurred in 51 (19.8%) participants. The results of the logistic regression analysis showed that the risk factors for MDRPUs were the use of endotracheal tubes (OR=5.79, 95% CI: 1.66~20.20), having had surgery (OR=2.95, 95% CI: 1.11~7.77), being in a semi-coma/coma (OR=5.79, 95% CI: 1.04~32.05), and sedation (OR=5.54, 95% CI: 1.39~22.19).

 Conclusion

On the basis of the study results, it is effectively facilitated by nurses when they care for patients with MDRPUs in intensive care units and the results are expected to be of help in preventive education for MDRPU development as well as preparing the base data for intervention studies.

Citations

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  • Yoğun Bakım Hastalarında Tıbbi Cihazla İlişkili Basınç Yaralanması Gelişimi ve Etkileyen Faktörler: Nokta Prevalans Çalışması
    Sevil Pamuk Cebeci, Asuman Çobanoğlu, Hatice Oğuzhan
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    Handan Aydın Kahraman, Gülay İpekçoban
    Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi.2024; 13(1): 486.     CrossRef
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    Aslı Kurtgöz, Selin Keskin Kızıltepe, Hülya Keskin, Münevver Sönmez, İsmail Aşatır
    International Wound Journal.2024;[Epub]     CrossRef
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    Pei‐Ling Wu, Yi‐Jou Li, Hsiang‐Chu Pai, Chien‐Chi Liu
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    Ezgi Dirgar, Neslihan Yağmur Gider, Betül Tosun
    Advances in Skin & Wound Care.2024; 37(3): 1.     CrossRef
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    Zeynep Temiz, Aylin Aydın Sayılan, Samet Sayılan, Esra Azum
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    Lingli Jia, Yuchun Deng, Yu Xu, Xiaoli Wu, Dan Liu, Muying Li, Shijun Huang, Yaodan Zhang, Aiping Du, Huan Liu, Yongming Tian
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    Shinhye Ahn, Minjeong An, Sung-Hee Yoo, Hyunyoung Park
    Australian Critical Care.2023; 36(3): 313.     CrossRef
  • Incidência de lesões por pressão relacionadas a dispositivos médicos em unidade de terapia intensiva adulto
    Nara Reisdorfer, Eliane Regina Pereira do Nascimento, Daniele Delacanal Lazzari, Maria Elena Echevarría-Guanilo, Sabrina Guterres da Silva Galetto , Luciana Bihain Hagemann de Malfussi
    Revista de Enfermagem da UFSM.2023; 13: e32.     CrossRef
  • Characteristics and Risk Factors for Pressure Ulcers in Severe Trauma Patients Admitted to the Trauma Intensive Care Unit
    Seung-yeon Lim, Young-min Jeong, So-young Jeong
    Journal of Acute Care Surgery.2023; 13(2): 47.     CrossRef
  • The Characteristics and Risk Factors of Medical Device Related Pressure Injury in Intensive Care Unit Patients
    Mi Hyeon Jo, Hye-Ran Choi
    Journal of Korean Critical Care Nursing.2023; 16(2): 28.     CrossRef
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A Relation Study on Burden, Health promotion Behavior and Health Status of the Family Caregiver of Intensive Care Unit Patient
Eun Sil Kim, Jeong Sook Park, Chung Ja Park
Journal of Korean Academy of Nursing 2002;32(5):654-664.   Published online March 29, 2017
DOI: https://doi.org/10.4040/jkan.2002.32.5.654
AbstractAbstract PDF

PURPOSE: The purpose of this study was to identify the burden, health promotion behavior and health status and to describe the relationship of the burden, health promotion behavior and health status of the family caregivers of intensive care unit patients. METHOD: The subjects were 48 family caregivers of ICU patients in a University Hospital. Data were collected between June, 1 and July, 31, 2000 using structured questionnaires. Research tools used were Suh and Oh's Burden Scale, Revised Walker, Sechrist, and Pender's HPLP(1987) ; Revised Nam's Health State Scale(1965). RESULT: The mean score of burden of family caregiver was 3.01(full score was 5). The mean score of health promotion behavior of family caregiver was 2.52 (full score was 4). And the mean score of health status of family caregiver was 0.68(full score was 1.00). The score of psychological health state was a little higher than the physiological one. In correlational analysis, the burden and the health status of caregivers were reversely correlated . The correlation between the burden and the health promotion behavior, and the health behavior and health status were not significant. CONCLUSION: The more burden caregivers of ICU patients felt, the worse their health status. So nurses need to understand the family caregiver's burden and apply nursing care that can reduce burden, in order to improve the health status of family caregivers.

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    Sunjung Kim, Sunghee H. Tak
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  • The Lived Experiences of Patient’s Families with the Intensive Care Unit Diary
    Yu Jin Jeong, Sung Suk Ryoo, Hyun Jeong Shin, Young Hee Yi
    Journal of Korean Critical Care Nursing.2023; 16(1): 28.     CrossRef
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    JiYeon Choi, Judith A. Tate, Youn-Jung Son
    Clinical Nursing Research.2021; 30(4): 423.     CrossRef
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    Min-Jeong Park, So-Hee Park, Mi Young Chung
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    Ji-Sun Park, Kyung-Sook Bang
    Journal of East-West Nursing Research.2014; 20(2): 136.     CrossRef
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Confirmatory Analysis of Perception and Preference Scales for Work Characteristics among Korean Nurses
Yeon Ok Suh, Rha Yun Song, Daily Barbara
Journal of Korean Academy of Nursing 1999;29(2):215-224.   Published online March 29, 2017
DOI: https://doi.org/10.4040/jkan.1999.29.2.215
AbstractAbstract PDF

The study was conducted to confirm the construct of individual perception and preference for work characteristics as personal factors influencing Korean nurses' job satisfaction. The subjects of the study were 231 nurses who are currently working in intensive care units and have been for a minimum of 6 months. The study used the Staff Perception and Preference Scale(Song et al., 1997) to measure the individual's perception and preference on the technical, practice, and management components of the ideal work environment. The Korean version of the Staff Perception and Preference Scale consists of 16 items on perception and 13 on preference with each item related on a scale from 1 (not at all) to 4 (a great deal). Psychometric testing revealed that the preference and perception scale is internally consistent with Chronbach's alphas of .83 for perception scale and .80 for preference scale. The subscales of the perception and preference scale also showed acceptable reliability for the early stage of the development of the instruments with Chronbach alphas of .62-.76 and .69-.83 respectively. Criterion0related validity of the scale was tested by examining correlations with individual growth need that is conceptually close to individual preference, but not to individual perception. Individual growth need was significantly related to individual preference(r=.63, p<.05), but the correlation with the perception scale was not significant. A separate factor analysis for the each of perception and preference scales was performed with a three-factor loading solution based on a previous study. The results on the staff perception scale confirmed with varimax rotation that the items were cleanly and strongly loaded on technique, practice and management components, which together explained 50.7% of the variance. The factor analysis on the staff preference scale also yielded a three factor solution that explained 56.7% of the variance, but items on technique and management components were loaded together. This phenomena may due to the current nursing delivery system in Korea where nurses never experience either shared governance nor case management, and as a results they may not be able to consider management roles as their potential extended roles. Therefore, more efforts should be given to enhance nurses' autonomy and decision making in the technique, practice and management components of their work environment. Meanwhile, there is a need for continuously confirming and developing tools for individual perception and preferences to effectively enhance job satisfaction among Korea nurses through innovative work environments.

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The Experiences of Patients in Intensive Care Units(ICU)
Young Hae Kim, Mi Jee Koo, So Hee Kim, Young Mi Kim, Nae Young Lee, Koung Oh Chang
Journal of Korean Academy of Nursing 2007;37(6):924-931.   Published online March 28, 2017
DOI: https://doi.org/10.4040/jkan.2007.37.6.924
AbstractAbstract PDF

PURPOSE: The purpose of this study was to describe the essence of the experiences of patients in an ICU, and to understand them from the patients' point of view. METHODS: Participants in this study were six patients in P hospital. Data collection consisted of in-depth interviews and an observation method done from January to April in 2005. The method was analysis using the phenomenological method proposed by Colaizzi(1978). RESULTS: The themes were classified into eight theme clusters. The eight theme clusters were finally grouped into four categories, 'shock', 'pain', 'gratefulness' and 'pleasure of revival'. CONCLUSION: The ICU patients had negative experiences in physical.mental critical situations, but also positive experiences in consolation and nurses and families' encouragement. Therefore, ICU nurses must support patients and their families to minimize the negative experiences and maximize the positive experiences.

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  • A Study on Nurses' Communication Experiences with Intubation Patients
    Ye Rim Kim, Hye Ree Park, Mee Kyung Shin
    The Korean Journal of Rehabilitation Nursing.2023; 26(1): 28.     CrossRef
  • Item analysis of the Korean version of the Intensive Care Experience Questionnaire: Using the Rasch Model based on Item Response Theory
    Jiyeon Kang, Minhui Kim
    Journal of Korean Critical Care Nursing.2022; 15(3): 37.     CrossRef
  • Delirium Experience of the Intensive Care Unit Patients
    Jaeyeon Jung, Sujin Jang, Seonmi Jo, Sunhee Lee
    Journal of Korean Academy of Nursing.2022; 52(2): 134.     CrossRef
  • Validation of a Korean Translated Version of the Critical Care Pain Observation Tool (CPOT) for ICU Patients
    Eun-Mi Kwak, Heeyoung Oh
    Journal of Korean Academy of Nursing.2012; 42(1): 76.     CrossRef
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    Ae Ran Park, Ja Yun Choi
    Journal of Korean Academy of Nursing.2009; 39(6): 860.     CrossRef
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    Youn-Jung Son, Sung-Kyung Hong, Eun Young Jun
    Journal of Korean Academy of Nursing.2008; 38(3): 353.     CrossRef
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Analysis of the Nursing Practice in a Medical ICU Based on an Electronic Nursing Record
Kyung Ja Song
Journal of Korean Academy of Nursing 2007;37(6):883-890.   Published online March 28, 2017
DOI: https://doi.org/10.4040/jkan.2007.37.6.883
AbstractAbstract PDF

PURPOSE: The purpose of this study was to identify the entity of critical care nursing practices through analyzing nursing statements described by electronic nursing records in a MICU. METHODS: 176,459 nursing statements of 188 patients during a 6 month-stay were analyzed statement by statement according to the nursing process(nursing phenomena, nursing diagnosis, & nursing activity) and 21 nursing components of Saba's Clinical Care Classification. RESULTS: Among 176,459 single statements, the statements of nursing activity ranked first in number. The contents of the statements were analyzed and categorized by main themes. Among 489 categorized themes, the number of themes of nursing phenomena statements was the highest. When analyzed by Saba's clinical Care Classification, the nursing statements mainly included a physiological component. Among 21 components, the respiratory component ranked in the first position in nursing phenomena, nursing diagnosis and nursing activity. The extra statements not included in the 21 components were 9,294(15.1%) in nursing phenomena and 21,949(22.7%) in nursing activity. Most are statements related to tests and the doctor. CONCLUSION: The entity of MICU nursing practice expressed by electronic nursing records was mainly focused on physiological components and more precisely on respiratory components.

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    Minho Jung, Moon-Sook Kim, Joo-Yeon Lee, Kyung Yi Lee, Yeon-Hwan Park
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A Study on Job Stress and the Coping of ICU Nurses
Hyoung Sook Park, Eun Hee Gang
Journal of Korean Academy of Nursing 2007;37(5):810-821.   Published online March 28, 2017
DOI: https://doi.org/10.4040/jkan.2007.37.5.810
AbstractAbstract PDF
Purpose

This study investigated job stress and coping of ICU Nurses.

 Method

Data was accumulated from 206 ICU nurses serving at least more than one year in 500 bed order hospitals during the period of three months from June1, to August 30, 2006.

 Results

The average job stress was 2.96± .95 points, which was relatively high. The average coping was 2.55± .23 points.

 Conclusion

The extent of the job stress of ICU nurses was relatively high, and they received the heaviest stress from job circumstances. For the prevention of job stress, every effort is required to analyze the causes of stress caused by job circumstances and to pose an appropriate solution. Meanwhile, job stress, needs to be controlled using a solution for the central problem, and search for social support.

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    Yeo-Jin Kim, Keum-Sook Park, Eun-Ja Yang
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    Su Jin Jin, Ji Hyun Lee
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    Jung Ok Ko, Eun Ko
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    Hyoung-Sook Park, Jae-Hyun Ha, Mee-Hun Lee, Hyun-Ju Lee
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    Ji-Won Lee
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Patients' Anxiety in Intensive Care Units and Its Related Factors
Chin Kang Koh
Journal of Korean Academy of Nursing 2007;37(4):586-593.   Published online March 28, 2017
DOI: https://doi.org/10.4040/jkan.2007.37.4.586
AbstractAbstract PDF
Purpose

The purpose of this study was to describe patients' anxiety in the ICU and to investigate related factors on the anxiety level.

 Methods

An exploratory cross-sectional survey design was used. Forty-eight patients participated in the study. Questionnaires were asked to patients who had been cared in the ICUs.

 Results

Related to the anxiety level, the mean of the total anxiety score was 5.47, and 60% of the patients had moderate or severe level of anxiety. Patients from the coronary care unit had a significantly higher level of anxiety than those from surgical intensive care unit or pulmonary surgery care unit. Moreover, significantly different levels of anxiety were found among patients who had been stayed for 2, 3, or 4 days.

 Conclusion

Patients who were from the coronary care unit or had been stayed longer (up to 4 days) in the ICU were significantly associated with higher anxiety level.

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    Jeong-Yeong Jeon, Dong-Hee Kim, Kyoungrim Kang
    Medicine.2023; 102(8): e33001.     CrossRef
  • Effects of Prior Information About Intensive Care Unit Environment on Anxiety and Environmental Stress in Patients Undergoing Open Heart Surgery
    Kyong Mi Shin, Hye Ran Choi
    The Journal of Korean Academic Society of Nursing Education.2015; 21(1): 28.     CrossRef
  • The Effect of Back Pain Prevention Intervention Program on Back Pain Relief in Patients Following Percutaneous Coronary Intervention
    Hyea Kyung Lee, Yeon Suk Park
    The Korean Journal of Rehabilitation Nursing.2013; 16(2): 100.     CrossRef
  • Factors Influencing Relocation Stress Syndrome in Patients Following Transfer from Intensive Care Units
    Jin-Hee Park, Moon-Sook Yoo, Youn-Jung Son, Sun Hyoung Bae
    Journal of Korean Academy of Nursing.2010; 40(3): 307.     CrossRef
  • Concept Analysis of Relocation Stress - Focusing on Patients Transferred from Intensive Care Unit to General Ward -
    Youn-Jung Son, Sung-Kyung Hong, Eun Young Jun
    Journal of Korean Academy of Nursing.2008; 38(3): 353.     CrossRef
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Pain Assessment using CRIES, FLACC and PIPP in High-Risk Infants
Youngmee Ahn, Heeok Kang, Eunjin Shin
Journal of Korean Academy of Nursing 2005;35(7):1401-1409.   Published online March 28, 2017
DOI: https://doi.org/10.4040/jkan.2005.35.7.1401
AbstractAbstract PDF
Purpose

Infants at neonatal intensive care units (NICU) are invariably exposed to various procedural and environmental stimuli. The study was performed to compare the pain responses in three NICU stimulants and to examine the clinical feasibility for NICU infants using CRIES, FLACC and PIPP.

 Method

In a correlational study, a total of 94 NICU stimulants including angio-catheter insertions, trunk-rubbings and loud noises, was observed for pain responses among 64 infants using CRIES, FLACC and PIPP.

 Results

A significant difference was identified among the mean scores in CRIES(F(2, 91)=47.847, p=.000), FLACC(F(2, 91)=41.249, p=.000) and PIPP(F(2, 91)=16.272, p=.000) to three stimulants. In a Post-hoc Scheff test, an angio-catheter insertion showed the highest scores in CRIES, FLACC and PIPP compared to the other two stimulations. A strong correlation was identified between CRIES and FLACC in all three stimulations(.817 < r < .945) while inconsistent findings were identified between PIPP and CRIES or FLACC.

 Conclusions

The results of the study support that CRIES and FLACC are reliable and clinically suitable pain measurements for NICU infants. Further studies are needed in data collection time-point as well as clinical feasibility on PIPP administration to assess pain response in infants, including premature infants.

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    Hanna Popowicz, Wioletta Mędrzycka-Dąbrowska, Katarzyna Kwiecień-Jaguś
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    Jung Sook Kim, Eun Jung Lee, Eun Ha Ham, Ji Hyun Kim, Young Hee Yi
    Journal of Korean Academy of Child Health Nursing.2010; 16(4): 352.     CrossRef
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Evaluating the Validity of the Pediatric Index of Mortality II in the Intensive Care Units
Jung Soon Kim, Sun Joo Boo
Journal of Korean Academy of Nursing 2005;35(1):47-55.   Published online March 28, 2017
DOI: https://doi.org/10.4040/jkan.2005.35.1.47
AbstractAbstract PDF
Purpose

This study was to evaluate the validity of the Pediatric Index of Mortality II(PIM II).

 Method

The first values on PIM II variables following ICU admission were collected from the patient's charts of 548 admissions retrospectively in three ICUs(medical, surgical, and neurosurgical) at P University Hospital and a cardiac ICU at D University Hospital in Busan from January 1, 2002 to December 31, 2003. Data was analyzed with the SPSSWIN 10.0 program for the descriptive statistics, correlation coefficient, standardized mortality ratio(SMR), validity index(sensitivity, specificity, positive predictive value, negative predictive value), and AUC of ROC curve.

 Result

The mortality rate was 10.9%(60 cases) and the predicted death rate was 9.5%. The correlation coefficient(r) between observed and expected death rates was .929(p<.01) and SMR was 1.15. Se, Sp, pPv, nPv, and the correct classification rate were .80, .96, .70, .98, and 94.0% respectively. In addition, areas under the curve(AUC) of the receiver operating characteristic(ROC) was 0.954(95% CI=0.919~0.989). According to demographic characteristics, mortality was underestimated in the medical group and overestimated in the surgical group. In addition, the AUCs of ROC curve were generally high in all subgroups.

 Conclusion

The PIM II showed a good, so it can be utilized for the subject hospital.

Citations

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  • The Values of the Pediatric Logistic Organ Dysfunction (PELOD) Score and the Pediatric Index of Mortality (PIM) 2 Score in Emergency Department and Intensive Care Unit
    Si Kyoung Jeong, Woon Jeong Lee, Yun Joo Moon, Seon Hee Woo, Yeon Young Kyong, Se Min Choi, Won Jung Jeong, Kyu Nam Park
    The Korean Journal of Critical Care Medicine.2010; 25(3): 144.     CrossRef
  • Outcome and risk factors of pediatric hemato-oncology patients admitted in pediatric intensive care unit
    Bo Eun Kim, Eun Ju Ha, Keun Wook Bae, Seonguk Kim, Ho Joon Im, Jong Jin Seo, Seong Jong Park
    Korean Journal of Pediatrics.2009; 52(10): 1153.     CrossRef
  • Performance effectiveness of pediatric index of mortality 2 (PIM2) and pediatricrisk of mortality III (PRISM III) in pediatric patients with intensive care in single institution: Retrospective study
    Hui Seung Hwang, Na Young Lee, Seung Beom Han, Ga Young Kwak, Soo Young Lee, Seung Yun Chung, Jin Han Kang, Dae Chul Jeong
    Korean Journal of Pediatrics.2008; 51(11): 1158.     CrossRef
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Factors Predicting the Interface Pressure Related to Pressure Injury in Intensive Care Unit Patients
Ji Seon Shine, Soo Jin Kim, Ji Hyun Lee, Mi Yu
J Korean Acad Nurs 2017;47(6):794-805.   Published online January 15, 2017
DOI: https://doi.org/10.4040/jkan.2017.47.6.794
AbstractAbstract PDF
Abstract Purpose

Interface pressure is a factor that contributes to the occurrence of pressure injuries. This study aimed to investigate interface pressure at common sites of pressure injury (occipital, gluteal and peritrochanteric areas), to explore the relationships among risk factors, skin condition and interface pressure, and to identify risk factors influencing interface pressure.

 Methods

A total of 100 patients admitted to the intensive care unit were enrolled at a tertiary teaching hospital in Korea. Interface pressure was recorded by a scanning aid device (PalmQ). Patient data regarding age, pulmonary disease, Braden Scale score, body mass index, serum albumin, hemoglobin, mean blood pressure, body temperature, and oxygen saturation were included as risk factors. Data collected from July to September 2016 were analyzed using binary logistic regression.

 Results

The mean interface pressure of the occipital, gluteal, and right and left peritrochanteric areas were 37.96 (±14.90), 41.15 (±16.04), 53.44 (±24.67), and 54.33 (±22.80) mmHg, respectively. Predictive factors for pressure injuries in the occipital area were age ≥70 years (OR 3.45, 95% confidence interval [CI]: 1.19~9.98), serum albumin deficit (OR 2.88, 95% CI: 1.00~8.26) and body temperature ≥36.5oC (OR 3.12, 95% CI: 1.17~8.17); age ≥70 years (OR 2.81, 95% CI: 1.10~7.15) in the right peritrochanteric area; and body temperature ≥36.5oC (OR 2.86, 95% CI: 1.17~6.98) in the left peritrochanteric area.

 Conclusion

Our findings suggest that old age, hypoalbuminemia, and high body temperature may be contributory factors to increasing interface pressure; therefore, careful assessment and nursing care of these patients are needed to prevent pressure injury. Further studies are needed to establish cutoff values of interface pressure for patients with pressure ulcers.

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    Lili Qin, Wenjuan Yun, Cheng Hang
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    Chul-Gyu Kim, Seungmi Park, Ji Woon Ko, Sungho Jo
    Journal of Tissue Viability.2018; 27(3): 130.     CrossRef
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Development and Evaluation of a Self-Reflection Program for Intensive Care Unit Nurses Who Have Experienced the Death of Pediatric Patients
Hyun-Ju Kang, Kyung-Sook Bang
J Korean Acad Nurs 2017;47(3):392-405.   Published online January 15, 2017
DOI: https://doi.org/10.4040/jkan.2017.47.3.392
AbstractAbstract PDF
Abstract Purpose

This study aims to develop a self-reflection program for nurses who have experienced the death of pediatric patients in the intensive care unit and to evaluate its effectiveness.

 Methods

The self-reflection program was developed by means of the following four steps: establishment of the goal through investigation of an initial request, drawing up the program, preliminary research, and implementation and improvement of the program. The study employed a methodological triangulation to evaluate the effectiveness of the program. Participants were 38 nurses who had experienced the death of pediatric patients (experimental group=15, control group=23); they were recruited using convenience sampling. The self-reflection program was provided over 6 weeks (6 sessions). Data were collected from April to August, 2014 and analyzed using t-tests and content analysis.

 Results

The quantitative results showed that changes in personal growth (t=-6.33, p<.001) and burnout scores (z=-2.76, p=.005) were better in the experimental group compared to the control group. The qualitative results exhibited two themes, namely “personal growth” and “professional growth”, and ten sub-themes.

 Conclusion

The self-reflection program developed by this study was effective in helping nurses who had experienced the death of pediatric patients to achieve personal growth through self-reflection, and it was confirmed that the program can be applied in a realistic clinical nursing setting. Furthermore, it can be recommended as an intervention program for clinical nurses.

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    Hee Jung Hong
    Korean Journal of Adult Nursing.2023; 35(3): 273.     CrossRef
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    Xiaojuan Chen, Mingdi Chen, Huang Zheng, Chaoyu Wang, Huimin Chen, Qinglan Wu, Huizhao Liao, Jinru Zhu, Junyan Lin, Xudong Ou, Zhihong Zou, Zhiwei Wang, Zhenzhen Zheng, Xianrui Zhuang, Riken Chen
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    Japan Journal of Nursing Science.2021;[Epub]     CrossRef
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    Yu Mi Kim, Hyu Yong Yoon, Yong-Jun Choi, Dong-Soo Shin
    Journal of Health Informatics and Statistics.2019; 44(2): 103.     CrossRef
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Invited Article
Psychological and Physical Health in Family Caregivers of Intensive Care Unit Survivors: Current Knowledge and Future Research Strategies
JiYeon Choi, Michael P. Donahoe, Leslie A. Hoffman
J Korean Acad Nurs 2016;46(2):159-167.   Published online April 29, 2016
DOI: https://doi.org/10.4040/jkan.2016.46.2.159
AbstractAbstract PDF
Purpose

This article provides an overview of current knowledge on the impact of caregiving on the psychological and physical health of family caregivers of intensive care unit (ICU) survivors and suggestions for future research.

 Methods

Review of selected papers published in English between January 2000 and October 2015 reporting psychological and physical health outcomes in family caregivers of ICU survivors.

 Results

In family caregivers of ICU survivors followed up to five years after patients' discharge from an ICU, psychological symptoms, manifested as depression, anxiety and post-traumatic stress disorder, were highly prevalent. Poor self-care, sleep disturbances and fatigue were identified as common physical health problems in family caregivers. Studies to date are mainly descriptive; few interventions have targeted family caregivers. Further, studies that elicit unique needs of families from diverse cultures are lacking.

 Conclusion

Studies to date have described the impact of caregiving on the psychological and physical health in family caregivers of ICU survivors. Few studies have tested interventions to support unique needs in this population. Therefore, evidence for best strategies is lacking. Future research is needed to identify ICU caregivers at greatest risk for distress, time points to target interventions with maximal efficacy, needs of those from diverse cultures and test interventions to mitigate family caregivers' burden.

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Original Articles
Model for Unplanned Self Extubation of ICU Patients Using System Dynamics Approach
Yu Gil Song, Eun Kyoung Yun
J Korean Acad Nurs 2015;45(2):280-292.   Published online April 30, 2015
DOI: https://doi.org/10.4040/jkan.2015.45.2.280
AbstractAbstract PDF
Purpose

In this study a system dynamics methodology was used to identify correlation and nonlinear feedback structure among factors affecting unplanned extubation (UE) of ICU patients and to construct and verify a simulation model.

 Methods

Factors affecting UE were identified through a theoretical background established by reviewing literature and preceding studies and referencing various statistical data. Related variables were decided through verification of content validity by an expert group. A causal loop diagram (CLD) was made based on the variables. Stock & Flow modeling using Vensim PLE Plus Version 6.0b was performed to establish a model for UE.

 Results

Based on the literature review and expert verification, 18 variables associated with UE were identified and CLD was prepared. From the prepared CLD, a model was developed by converting to the Stock & Flow Diagram. Results of the simulation showed that patient stress, patient in an agitated state, restraint application, patient movability, and individual intensive nursing were variables giving the greatest effect to UE probability. To verify agreement of the UE model with real situations, simulation with 5 cases was performed. Equation check and sensitivity analysis on TIME STEP were executed to validate model integrity.

 Conclusion

Results show that identification of a proper model enables prediction of UE probability. This prediction allows for adjustment of related factors, and provides basic data do develop nursing interventions to decrease UE.

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    Fang Niu, Qinghua Liu, Xiaohui Li, Xiang Li
    Nursing Open.2023; 10(4): 2593.     CrossRef
  • Incidence of Unplanned Extubation and Related Factors of Reintubation in the Neonatal Intensive Care Unit
    Hee Moon Lim, Hyejung Lee, Mi Jung Park, Jeong Eun Shin
    Journal of The Korean Society of Maternal and Child Health.2022; 26(2): 72.     CrossRef
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    Ping Zhang, Li‐Ping Liu
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    Hye Jin Yoo, Oak Bun Lim, Jae Lan Shim, Liza Heslop
    PLOS ONE.2020; 15(7): e0235694.     CrossRef
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Risk Factors for Deliberate Self-extubation
Young Shin Cho, Jung Hee Yeo
J Korean Acad Nurs 2014;44(5):573-580.   Published online October 31, 2014
DOI: https://doi.org/10.4040/jkan.2014.44.5.573
AbstractAbstract PDF
Purpose

This study was conducted to analyze intubation survival rates according to characteristics and to identify the risk factors affecting deliberate self-extubation.

 Methods

Data were collected from patients' electronic medical reports from one hospital in B city. Participants were 450 patients with endotracheal intubation being treated in intensive care units. The collected data were analyzed using Kaplan-Meier estimation, Log rank test, and Cox's proportional hazards model.

 Results

Over 15 months thirty-two (7.1%) of the 450 intubation patients intentionally extubated themselves. The patients who had experienced high level of consciousness, agitation. use of sedative, application of restraints, and day and night shift had significantly lower intubation survival rates. Risk factors for deliberate self-extubation were age (60 years and over), unit (neurological intensive care), level of consciousness (higher), agitation, application of restraints, shift (night), and nurse-to-patient ratio (one nurse caring for two or more patients).

 Conclusion

Appropriate use of sedative drugs, effective treatment to reduce agitation, sufficient nurse-to-patient ratio, and no restraints for patients should be the focus to diminish the number of deliberate self-extubations.

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    YoungJu Eim, Su Jung Choi
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    Jaejin Kang, Yang-Sook Yoo
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    Hee Moon Lim, Hyejung Lee, Mi Jung Park, Jeong Eun Shin
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    Takeshi Unoki, Hideaki Sakuramoto, Shunsuke Taito, Yuki Kataoka
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    SaeedA Mahmood, OmaimaS Mahmood, AymanA El-Menyar, MohammadM Asim, AhmedAbdel-Aziz Abdelbari, TalatSaeed Chughtai, HassanA Al-Thani
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  • Unplanned Extubation in Patients with Mechanical Ventilation: Experience in the Medical Intensive Care Unit of a Single Tertiary Hospital
    Tae Won Lee, Jeong Woo Hong, Jung-Wan Yoo, Sunmi Ju, Seung Hun Lee, Seung Jun Lee, Yu Ji Cho, Yi Yeong Jeong, Jong Deog Lee, Ho Cheol Kim
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Pain Perception of Nurses and Pain Expression of Patients in Critical Care Units
Kyung Hee Bae, Ihn Sook Jeong
J Korean Acad Nurs 2014;44(4):437-445.   Published online August 29, 2014
DOI: https://doi.org/10.4040/jkan.2014.44.4.437
AbstractAbstract PDF
Purpose

This study was done to identify pain perception (P-PER) by nurses and pain expression (P-EXP) by patients in critical care units (ICUs) and degree of agreement between nurses' P-PER and patients' P-EXP.

 Methods

Nurses' P-PER was measured with a self-administered questionnaire completed by 99 nurses working in ICUs during May, 2013. Patients' P-EXP was measured with the Critical Care Non-Verbal Pain Scale through observations of 31 ICU patients during nine nursing procedures (NPs) performed between May and July, 2013.

 Results

Nurses' P-PER was from 4.49 points for nasogastric tube (NGT) insertion to 0.83 for blood pressure (BP) measurement based on a 9-point scale, Patients' P-EXP was 4.48 points for NGT to 0.18 for BP measurement based on a 10-point scale. Eight NPs except oral care showed higher scores for nurses' P-PER than for patients' P-EXP. Position change (p=.019), subcutaneous injection (p<.001), blood sugar test (p<.001), and BP measurement (p<.001) showed significant differences between nurses' P-PER and patients' P-EXP.

 Conclusion

Nasogastric tube (NGT) insertion was scored highest by both nurses and patients. Eight NPs except 'oral care' showed nurses' P-PER was higher or similar to patients' P-EXP, which indicates that nurses may overestimate procedural pain experienced by patients.

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    Li SuWen, Huang YuYang, Bu Wei
    Nursing in Critical Care.2025;[Epub]     CrossRef
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    Eun-Jeong Kim, Jiwon Hong, Jiyeon Kang, Na geong Kim, NaRi Kim, Su-Youn Maeng, Hye-Ryeon Park, Min Kyung Ban, Gun Young Yang, Kyung Suk Lee, Eun Hye Jang
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    John W. Devlin, Yoanna Skrobik, Céline Gélinas, Dale M. Needham, Arjen J. C. Slooter, Pratik P. Pandharipande, Paula L. Watson, Gerald L. Weinhouse, Mark E. Nunnally, Bram Rochwerg, Michele C. Balas, Mark van den Boogaard, Karen J. Bosma, Nathaniel E. Bru
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Validation of a Modified Early Warning Score to Predict ICU Transfer for Patients with Severe Sepsis or Septic Shock on General Wards
Ju Ry Lee, Hye Ran Choi
J Korean Acad Nurs 2014;44(2):219-227.   Published online April 30, 2014
DOI: https://doi.org/10.4040/jkan.2014.44.2.219
AbstractAbstract PDF
Purpose

To assess whether the Modified Early Warning Score (MEWS) predicts the need for intensive care unit (ICU) transfer for patients with severe sepsis or septic shock admitted to general wards.

 Methods

A retrospective chart review of 100 general ward patients with severe sepsis or septic shock was implemented. Clinical information and MEWS according to point of time between ICU group and general ward group were reviewed. Data were analyzed using multivariate logistic regression and the area under the receiver operating characteristic curves with SPSS/WIN 18.0 program.

 Results

Thirty-eight ICU patients and sixty-two general ward patients were included. In multivariate logistic regression, MEWS (odds ratio [OR] 2.02, 95% confidence interval [CI] 1.43-2.85), lactic acid (OR 1.83, 95% CI 1.22-2.73) and diastolic blood pressure (OR 0.89, 95% CI 0.80-1.00) were predictive of ICU transfer. The sensitivity and the specificity of MEWS used with cut-off value of six were 89.5% and 67.7% for ICU transfer.

 Conclusion

MEWS is an effective predictor of ICU transfer. A clinical algorithm could be created to respond to high MEWS and intervene with appropriate changes in clinical management.

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    Jawad Allarakia, Taher Felemban, Amer Alghamdi, Abdullah Ashi, Yousef M. Al Talhi, Ashraf Alsahafi, Abdulfatah Alamri, Mona Aldabbagh
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    Ju-Ry Lee, Youn-Kyoung Jung, Hwa Jung Kim, Younsuck Koh, Chae-Man Lim, Sang-Bum Hong, Jin Won Huh
    The Korean Journal of Internal Medicine.2020; 35(6): 1477.     CrossRef
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    Dong Hun Lee, Kyeung Mi Lee, Sung Min Lee, Byung Kook Lee, Yong Soo Cho, Goeun Choi, Seong Woo Yun
    Yonsei Medical Journal.2019; 60(4): 368.     CrossRef
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    Vikramjit Mukherjee, Laura Evans
    Current Opinion in Critical Care.2017; 23(5): 412.     CrossRef
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    C.L. Downey, W. Tahir, R. Randell, J.M. Brown, D.G. Jayne
    International Journal of Nursing Studies.2017; 76: 106.     CrossRef
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    Jin-il Kim, Doo Ree Kim, Hyo Nam Lim
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  • Temporal changes in physiological parameters of systemic inflammatory response syndrome during the three days prior to a diagnosis of sepsis: a case–control study
    HyunSoo Oh, EunKyoung Bae, SeonYoung Lim, JiHye Oh, SunYoung Han, WhaSook Seo
    Journal of Clinical Nursing.2016; 25(21-22): 3176.     CrossRef
  • Analysis of Risk Factors to Predict Intensive Care Unit Transfer in Medical in-Patients
    Ju Ry Lee, Hye Ran Choi
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Risk Factors and Clinical Outcomes for Vancomycin-Resistant Enterococcus Colonization on Intensive Care Unit Admission
Sook-Jin Byun, Jiyeon Kang
J Korean Acad Nurs 2013;43(2):287-295.   Published online April 30, 2013
DOI: https://doi.org/10.4040/jkan.2013.43.2.287
AbstractAbstract PDF
Purpose

The purpose of this study was to identify vancomycin-resistant enterococcus (VRE) colonization rate in patients admitted to the intensive care unit (ICU), associated risk factors and clinical outcomes for VRE colonization.

 Methods

Of the 7,703 patients admitted to the ICUs between January, 2008 and December, 2010, medical records of 554 VRE colonized and 503 uncolonized patients were reviewed retrospectively. To analyzed the impact of colonization on patients' clinical outcomes, 199 VRE colonized patients were matched with 199 uncolonized patients using a propensity score matching method.

 Results

During the study period, 567 (7.2%) of the 7,703 patients were colonized with VRE. Multivariate analysis identified the following independent risk factors for VRE colonization: use of antibiotics (odds ratio [OR]=3.33), having bedsores (OR=2.92), having invasive devices (OR=2.29), methicillin-resistant Staphylococcus aureus co-colonization (OR=1.84), and previous hospitalization (OR=1.74). VRE colonized patients were more likely to have infectious diseases than uncolonized patients. VRE colonization was associated with prolonged hospitalization and higher mortality.

 Conclusion

Strict infection control program including preemptive isolation for high-risk group may be helpful. Further research needs to be done to investigate the effects of active surveillance program on the incidence of colonization or infection with VRE in the ICU.

Citations

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  • Vancomycin Resistant Enterococci Prevalence, Antibiotic Susceptibility Patterns and Colonization Risk Factors Among HIV-Positive Patients in Health-Care Facilities in Debre Berhan Town, Ethiopia
    Mikiyas Zike, Abdurahaman Ahmed, Awraris Hailu, Bedru Hussien
    Infection and Drug Resistance.2024; Volume 17: 17.     CrossRef
  • Previous antibiotic therapy as independent risk factor for the presence of vancomycin-resistant enterococci in surgical inpatients. Results from a matched case-control study
    Philip MacKenzie, Jacqueline Färber, Marius Post, Torben Esser, Lukas Bechmann, Siegfried Kropf, Roland Croner, Gernot Geginat
    BMC Infectious Diseases.2023;[Epub]     CrossRef
  • Steady Inflow of Vancomycin-Resistant Enterococci from Outside a Hospital
    Hye-sun An, Sang-Won Park, Su-hui Ko, Ji Hwan Bang
    Korean Journal of Healthcare-Associated Infection Control and Prevention.2017; 22(2): 63.     CrossRef
  • Vancomycin-resistant Enterococcus colonization in the intensive care unit: Clinical outcomes and attributable costs of hospitalization
    Euihan Jung, Sookjin Byun, Hojin Lee, Sang Yi Moon, Hyuck Lee
    American Journal of Infection Control.2014; 42(10): 1062.     CrossRef
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Verification of Validity of MPM II for Neurological Patients in Intensive Care Units
Heejeong Kim, Kyunghee Kim
J Korean Acad Nurs 2011;41(1):92-100.   Published online February 28, 2011
DOI: https://doi.org/10.4040/jkan.2011.41.1.92
AbstractAbstract PDF
Purpose

Mortality Provability Model (MPM) II is a model for predicting mortality probability of patients admitted to ICU. This study was done to test the validity of MPM II for critically ill neurological patients and to determine applicability of MPM II in predicting mortality of neurological ICU patients.

 Methods

Data were collected from medical records of 187 neurological patients over 18 yr of age who were admitted to the ICU of C University Hospital during the period from January 2008 to May 2009. Collected data were analyzed through χ2 test, t-test, Mann-Whiteny test, goodness of fit test, and ROC curve.

 Results

As to mortality according to patients' general and clinically related characteristics, mortality was statistically significantly different for ICU stay, hospital stay, APACHE III score, APACHE predicted death rate, GCS, endotracheal intubation, and central venous catheter. Results of Hosmer-Lemeshow goodness-of-fit test were MPM II0 (χ2=0.02, p=.989), MPM II24 (χ2=0.99 p=.805), MPM II48 (χ2=0.91, p=.822), and MPM II72 (χ2=1.57, p=.457), and results of the discrimination test using the ROC curve were MPM II0, .726 (p<.001), MPM II24, .764 (p<.001), MPM II48, .762 (p<.001), and MPM II72, .809 (p<.001).

 Conclusion

MPM II was found to be a valid mortality prediction model for neurological ICU patients.

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  • Development of a patient classification system for critical care nursing based on nursing intensity
    Yukyung Ko, Bohyun Park, Hanju Lee, Donghwan Kim
    International Journal of Nursing Practice.2023;[Epub]     CrossRef
  • Validation Study of the Estimated Glycemic Load Model Using Commercially Available Fast Foods
    Miran Lee, Haejin Kang, Sang-Jin Chung, Kisun Nam, Yoo Kyoung Park
    Frontiers in Nutrition.2022;[Epub]     CrossRef
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    Hee-Jeonh Kim
    Journal of the Korea Academia-Industrial cooperation Society.2012; 13(11): 5238.     CrossRef
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Factors Influencing Relocation Stress Syndrome in Patients Following Transfer from Intensive Care Units
Jin-Hee Park, Moon-Sook Yoo, Youn-Jung Son, Sun Hyoung Bae
J Korean Acad Nurs 2010;40(3):307-316.   Published online June 30, 2010
DOI: https://doi.org/10.4040/jkan.2010.40.3.307
AbstractAbstract PDF
Purpose

The purpose of this study was to identify the levels of relocation stress syndrome (RSS) and influencing the stress experienced by Intensive Care Unit (ICU) patients just after transfer to general wards.

 Methods

A cross-sectional study was conducted with 257 patients who transferred from the intensive care unit. Data were collected through self-report questionnaires from May to October, 2009. Data were analyzed using the Pearson correlation coefficient, t-test, one-way ANOVA, and stepwise multiple linear regression with SPSS/WIN 12.0.

 Results

The mean score for RSS was 17.80±9.16. The factors predicting relocation stress syndrome were symptom experience, differences in scope and quality of care provided by ICU and ward nursing staffs, satisfaction with transfer process, length of stay in ICU and economic status, and these factors explained 40% of relocation stress syndrome (F=31.61, p<.001).

 Conclusion

By understanding the stress experienced by ICU patients, nurses are better able to provide psychological support and thus more holistic care to critically ill patients. Further research is needed to consider the impact of relocation stress syndrome on patients' health outcomes in the recovery trajectory.

Citations

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  • A phenomenological study on the experiences of patient transfer from the intensive care unit to general wards
    Eun-Young Lee, Jin-Hee Park, Alvisa Palese
    PLOS ONE.2021; 16(7): e0254316.     CrossRef
  • Development and psychometric evaluation of the Relocation Stress Syndrome Scale-Short Form for patients transferred from adult intensive care units to general wards
    Mi Hwa Won, Youn-Jung Son
    Intensive and Critical Care Nursing.2020; 58: 102800.     CrossRef
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    Sun Hee Yun, Eui Geum Oh, Yang Sook Yoo, So Sun Kim, Yeon Soo Jang
    Clinical Nursing Research.2017; 26(1): 27.     CrossRef
  • The Effects of Aromatherapy on Intensive Care Unit Patients’ Stress and Sleep Quality: A Nonrandomised Controlled Trial
    Eun Hee Cho, Mi-Young Lee, Myung-Haeng Hur, Nativ Dudai
    Evidence-Based Complementary and Alternative Medicine.2017;[Epub]     CrossRef
  • A tailored relocation stress intervention programme for family caregivers of patients transferred from a surgical intensive care unit to a general ward
    Seul Lee, HyunSoo Oh, YeonOk Suh, WhaSook Seo
    Journal of Clinical Nursing.2017; 26(5-6): 784.     CrossRef
  • Clinical validity of a relocation stress scale for the families of patients transferred from intensive care units
    HyunSoo Oh, Seul Lee, JiSun Kim, EunJu Lee, HyoNam Min, OkJa Cho, WhaSook Seo
    Journal of Clinical Nursing.2015; 24(13-14): 1805.     CrossRef
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Development of Nursing Key Performance Indicators for an Intensive Care Unit by using a Balanced Scorecard
Yun Jeong Choi, Ji Young Lim, Young Whee Lee, Hwa Soon Kim
J Korean Acad Nurs 2008;38(5):656-666.   Published online October 12, 2008
DOI: https://doi.org/10.4040/jkan.2008.38.5.656
AbstractAbstract PDF
Abstract Purpose

The purpose of this study was to develop visions of nursing service, nursing strategies and key performance indicators (KPIs) for an intensive care unit (ICU) based on a Balanced Scorecard (BSC).

 Methods

This study was undertaken by using methodological research. The development process consisted of four phases; the first phase was to develop the vision of nursing in ICUs. The second phase was to develop strategies according to 4 perspectives of a BSC. The third phase was to develop KPIs according to the 4 perspectives of BSC and the final phase was to combine the nursing visions, strategies and KPIs of ICUs.

 Results

Two main visions of nursing service for ICUs were established. These were ‘realization of harmonized professional nursing with human respect’ and ‘recovery of health through specialized nursing’ respectively. In order to reach the aim of developing nursing visions, thirteen practical strategies and nineteen KPIs were developed by four perspectives of the BSC.

 Conclusion

The results will be used as objective fundamental data to attain business outcomes for the achievement of nursing visions and strategies of ICUs.

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  • Development of Performance Indicators for Clinical Research Coordinators Using the Balanced Scorecard in South Korea
    Youn Sun Hwang, Tae Wha Lee
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  • Augmenting Walkability, Visibility and Arrangement for Korean ICU
    Javaria Manzoor Shaikh
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  • Development and Application of a Performance Prediction Model for Home Care Nursing Based on a Balanced Scorecard using the Bayesian Belief Network
    Wonjung Noh, GyeongAe Seomun
    Journal of Korean Academy of Nursing.2015; 45(3): 429.     CrossRef
  • Testing The Healing Environment Conditions for Nurses with two Independent Variables: Visibility Enhancement along with Shortening the Walking Distance of the Nurses to Patient - Focused on LogWare stop sequence and space syntax for U-Shape, L- Shape and
    Javaria Manzoor Shaikh, Jae Seung Park
    KIEAE Journal.2015; 15(2): 19.     CrossRef
  • Barrier free visibility for staff in ICU Focused on space syntax for circulation in Asian ICU
    Javaria Manzoor Shaikh
    Sir Syed University Research Journal of Engineering & Technology.2014; 4(1): 9.     CrossRef
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Concept Analysis of Relocation Stress - Focusing on Patients Transferred from Intensive Care Unit to General Ward -
Youn-Jung Son, Sung-Kyung Hong, Eun Young Jun
J Korean Acad Nurs 2008;38(3):353-362.   Published online June 30, 2008
DOI: https://doi.org/10.4040/jkan.2008.38.3.353
AbstractAbstract PDF
Purpose

This study was conducted to analyze and clarify the meaning of the concept for relocation stress-focusing on patients transferred from an intensive care unit to a general ward.

 Methods

This study used Walker and Avant's process of concept analysis.

 Results

Relocation stress can be defined by these attributes as follows: 1) involuntary decision about relocation, 2) moving from a familiar and safe environment to an unfamiliar one, 3) broken relationship of safety and familiarity, 4) physiological and psychosocial change after relocation. The antecedents of relocation stress consisted of these facts: 1) preparation degrees of transfer from the intensive care unit to a general ward, 2) pertinence of the information related to the transfer process, 3) change of major caregivers, 4) change in numbers of monitoring devices, 5) change in the level of self-care. There are consequences occurring as a result of relocation stress: 1) decrease in patients' quality of life, 2) decrease in coping capacity, 3) loss of control.

 Conclusion

Relocation stress is a core concept in intensive nursing care. Using this concept will contribute to continuity of intensive nursing care.

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  • Transfer anxiety in parents of children transferred from pediatric intensive care units to general wards in South Korea: a hybrid concept analysis
    Jisu Park, Eun Kyoung Choi
    Child Health Nursing Research.2022; 28(2): 154.     CrossRef
  • Development and psychometric evaluation of the Relocation Stress Syndrome Scale-Short Form for patients transferred from adult intensive care units to general wards
    Mi Hwa Won, Youn-Jung Son
    Intensive and Critical Care Nursing.2020; 58: 102800.     CrossRef
  • A tailored relocation stress intervention programme for family caregivers of patients transferred from a surgical intensive care unit to a general ward
    Seul Lee, HyunSoo Oh, YeonOk Suh, WhaSook Seo
    Journal of Clinical Nursing.2017; 26(5-6): 784.     CrossRef
  • Clinical validity of a relocation stress scale for the families of patients transferred from intensive care units
    HyunSoo Oh, Seul Lee, JiSun Kim, EunJu Lee, HyoNam Min, OkJa Cho, WhaSook Seo
    Journal of Clinical Nursing.2015; 24(13-14): 1805.     CrossRef
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Risk Factors for Nosocomial Urinary Tract Infection in the Intensive Care Unit with a Positive Urine Culture and Foley Catheterization
Seong Mi Yu, Kyung Yeon Park
Journal of Korean Academy of Nursing 2007;37(7):1149-1158.   Published online December 31, 2007
DOI: https://doi.org/10.4040/jkan.2007.37.7.1149
AbstractAbstract PDF
Purpose

The purpose of this study was to identify the risk factors for a nosocomial urinary tract infection in intensive care units with a foley catheterization which showed a positive urine culture.

 Method

Three-hundred eighty-seven patients were included in the study. A retrospective review of the electrical medical record system's databases and medical record sheets in hospitalized patients from January 2003 to December 2003 was used. The collected data was analyzed by descriptive statistics, t-test, chi-square test and logistic regression analysis.

 Result

The frequency of the participants' nosocomial urinary tract infection was 72.9%. Significant risk factors for a nosocomial urinary tract infection were ‘age’, ‘place of catheter insertion’, ‘frequency of catheter change’, and ‘duration of catheterization’. These variables explained 18.4% of variance in the experience of nosocomial urinary tract infection in intensive care units with foley catheterization.

 Conclusion

Medical personnel can decrease the incidence of a nosocomial urinary tract infection by recognizing and paying attention to the duration of catheterization, frequency of catheter change, and place of catheter insertion. As a result, specific and scrupulous strategies should be developed to reflect these factors for decreasing nosocomial urinary tract infections.

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  • Epidemiology and Resistance Patterns of Bacterial Pathogens in Urinary Tract Infections in the Northern Gyeonggi-do Area during 2007-2011
    Eunyoung Oh, Hyukmin Lee, Hwan Sub Lim, Younhee Park
    Laboratory Medicine Online.2013; 3(1): 34.     CrossRef
  • Effects of perineal care in preventing catheter associated urinary tract infections (CAUTI) in intensive care units (ICU)
    Jeong-Sil Choi, Jeong-Hwa Yeon
    Journal of Korean Academy of Fundamentals of Nursing.2012; 19(2): 223.     CrossRef
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