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

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.

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.

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.

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

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.

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.

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.

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.

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.

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).

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.

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

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.

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.

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.

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.

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.

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.

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.

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

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.

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.

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

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.

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.

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 ≥36.5^oC (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 ≥36.5^oC (OR 2.86, 95% CI: 1.17~6.98) in the left peritrochanteric area.

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.

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.

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.

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.

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.

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

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.

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).

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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).

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.