The purpose of this study was to examine the effects of a closed endotracheal suction system(CES) on oxygen saturation, ventilator associated pneumonia(VAP), and nursing efficacy in mechanically ventilated patients.

This study was conducted in the intensive care unit of a University Hospital in Gwangju City. Data was collected from July to October, 2003. Seventy mechanically ventilated patients were randomly divided into two groups; 32 for CES and 38 for open endotracheal suction system(OES) protocol. Twenty one nurses were also involved to examine the nurses' attitude of usefulness about CES.

SaO₂ was significantly different between CES and OES. The incidence of VAP in CES was lower than that of OES. Nursing efficacy was related to time, cost, and usefulness of the suction system. Time of suctioning in CES was shorter than that of OES. CES also contributed significantly to lower the cost of treatment than OES. The usefulness score of CES increased after 6 months of use.

CES prevented VAP, was cost effective, and a safe suctioning system. CES ncan be used with patients with sensitivity to hypoxygenation and with a high risk of VAP.

This study was to develop a client health status outcome evaluation instrument, and examine content validity, reliability, construct validity, and the acceptability of this instrument.

A preliminary list was made of such key information as standards, criteria, indicators and measures, by means of a broad review of literature within the field. After determining the preliminary instruments, the study sought to obtain examination, consensus, and modification of two groups of experts in the home-care field. Finally, the instrument examined content validity, reliability, construct validity, and the acceptability of this instrument.

The tool was considered of 13 criteria, 48 indicators, and 167 detail measures. The content validity index of the tool was above 0.8 according to the expert group. Regarding the reliability of the evaluators of standards 1 and 2, the degree of agreement between evaluators was high(96.4% through 98.2%). Construct validity in this study, the difference in the mean score between the baseline point and the follow up point of each of standards 1 and 2 was significant, and the mean score of the follow up point was more than that of the baseline point. After examining the acceptability of this instrument with practice managers and home care nurses in home care institutions, a positive opinion was given of this instrument, and it was indicated that to be useful and applicable in home care practice.

The results of evaluating client outcome will contribute to overall outcome-based quality improvement and service marketing in home care by providing a constant gauge of home care effectiveness.

The purpose of this study was to develop the day hospital program for Korean eating disorders patients and to examine the effect of the day hospital program on improving frequency of binging and purging, eating disorders symptoms, self-esteem, and depression.

The subjects were 24 binge eaters visited at eating disorders clinic “M”. They participated in a modified day hospital program based on the Toronto Day Hospital Program. All subjects completed the Eating Disorders Inventory(EDI)-2, Rosenberg Self-Eesteem Scale, Beck Depression Inventory(BDI) at pre and post intervention, and recorded daily food records.

In paired t-test analysis, frequency of binging and purging, self-esteem, depression, and 11 sub-scales of EDI-2(drive for thinness, bulimia, body dissatisfaction, ineffectiveness, interoceptive awareness, perfectionism, interpersonal distrust, maturity fear, asceticism, impulse regulation, social insecurity) were significantly improved after treatment.

The results of this study suggest that the day hospital program for Korean eating disorders patients may be an effective initial approach to overcoming various eating disorders symptoms. Further studies should investigate longer term outcome data using a larger sample.

The purpose of this study was to assess the importance and sensitivity to nursing interventions of four nursing sensitive nursing outcomes selected from the Nursing Outcomes Classification (NOC). Outcomes for this study were “Knowledge: Diet”, “Knowledge: Disease Process”, “Knowledge: Energy Conservation”, and “Knowledge: Health Behaviors”.

Data were collected from 183 nurses working in 2 university hospitals. Fehring method was used to estimate outcome and indicators' content and sensitivity validity. Multiple and stepwise regression were used to evaluate relationships between each outcome and its indicators.

Results confirmed the importance and nursing sensitivity of outcomes and their indicators. Key indicators of each outcomes were found by multiple regression. “Knowledge: Diet” was suggested for adding new indicators because the variance explained by indicators was relatively low. Not all of the indicators selected for stepwise regression model were rated for highly in Fehring method. The R² statistics of the stepwise regression models were between 18 and 63% in importance by selected indicators and between 34 and 68% in contribution by selected indicators.

This study refined what outcomes and indicators will be useful in clinical practice. Further research will be required for the revision of outcome and indicators of NOC. However, this study refined what outcomes and indicators will be useful in clinical practice.

The purpose of this study is to examine the difference of direct nursing activity and patient outcomes as mortality rate, complication rate, readmission rate and length of stay related to graded fee of nursing management for inpatient.

The subjects of this study were 44 general hospitals with more than 500 beds. Data totaled to 86,044 claims provided to inpatients in Jan. 2001 requested by an electronic data interchange from a Health Insurance Review Agency. The data was analyzed by SPSS win(ver.10.0) and statistical methods used were frequency, one-way ANOVA, χ²-Test and regression.

Synthetic judgment through performance index and 95% confidence interval, direct nursing activity showed to provided adequate quality of nursing care on 2nd, 3rd, 4th and 6th nursing degree. Also, patient outcomes showed difference by graded fee of nursing management for inpatient. Mortality rate of 2nd was the lowest with P.I. 67.9, 3rd, 5th, 6th, 4th in order. In case of complication rate, 2nd, 3rd and 4th were lower than other nursing degree. Readmission rate of 4th and 5th was the lowest. Length of stay of 2nd was the shortest with P.I. 88.3, 3rd, 4th, 5th, 4th, 6th in order.

The findings from this study showed that, the higher nurse-to-patient ratio, the greater amount of direct nursing care activity for the patient. Also, the more direct nursing activities influenced a lower mortality rate, complication rate and readmission rate, shorter length of stay.

In this single repeated measures study, an examination was done on the effects of dialysate flow rate on dialysis adequacy and fatigue in patients receiving hemodialysis.

This study was a prospective single center study in which repeated measures analysis of variance were used to compare Kt/V urea (Kt/V) and urea reduction ratio (URR) as dialysis adequacy measures and level of fatigue at different dialysate flow rates: twice as fast as the participant’s own blood flow, 500 mL/min, and 700 mL/min. Thirty-seven hemodialysis patients received all three dialysate flow rates using counterbalancing.

The Kt/V (M±SD) was 1.40±0.25 at twice the blood flow rate, 1.41±0.23 at 500 mL/min, and 1.46±0.24 at 700 mL/min. The URR (M±SD) was 68.20±5.90 at twice the blood flow rate, 68.67±5.22 at 500 mL/min, and 70.11±5.13 at 700 mL/min. When dialysate flow rate was increased from twice the blood flow rate to 700 mL/min and from 500 mL/min to 700 mL/min, Kt/V and URR showed relative gains. There was no difference in fatigue according to dialysate flow rate.

Increasing the dialysate flow rate to 700 mL/min is associated with a significant nicrease in dialysis adequacy. Hemodialysis with a dialysate flow rate of 700 mL/min should be considered in selected patients not achieving adequacy despite extended treatment times and optimized blood flow rate.

This study was conducted to explore the impact of registered nurse/nurses' aid (RN/NA) staffing and turnover rate on inpatient health outcomes in long term care hospitals.

A secondary analysis was done of national data from the Health Insurance Review and Assessment Services including evaluation of long term care hospitals in October-December 2010 and hospital general characteristics in July-September 2010. Final analysis of data from 610 hospitals included RN/NA staffing, turnover rate of nursing staff and 5 patient health outcome indicators.

Finding showed that, when variables of organization and community level were controlled, patients per RN was a significant indicator of decline in ADL for patients with dementia, and new pressure ulcer development in the high risk group and worsening of pressure ulcers. Patients per NA was a significant indicator for new pressure ulcer development in the low risk group. Turnover rate was not significant for any variable.

To maintain and improve patient health outcomes of ADL and pressure ulcers, policies should be developed to increase the staffing level of RN. Studies are also needed to examine causal relation of NA staffing level, RN staffing level and patient health outcomes with consideration of the details of nursing practice.

The purpose of this study was to evaluate the effectiveness of spiritual intervention studies by examining biological, psychological, and spiritual outcomes.

From electronic databases 2522 studies were retrieved, of which 21 studies met the inclusion criteria. These studies had 1411 participants. Two authors independently extracted data from the selected studies and assessed the methodological quality. The data were analyzed using the RevMan 5.1 program of the Cochrane library.

Overall effect size of spiritual intervention on spiritual and psychological (depression and anxiety) outcomes were moderate (d=-0.65 to d=-0.76, p<.001). The effects on biological outcomes (pain and functional status) ranged from -0.51 to -0.39, respectively. No publication bias was detected as evaluated by a funnel plot. Spiritual intervention had a moderate effect on psychological and spiritual outcomes and a smaller effect on biological outcomes.

The results of this study suggest that spiritual intervention can relieve depression and anxiety. Further randomized controlled trials studies are needed to evaluate the effects of spiritual intervention on biological outcomes.

This study was done to examine relationships between nurse staffing level and postsurgical patient outcomes using inpatient database from the National Health Insurance.

Records of 111,491 patients who received one of 12 types of surgery between January and December, 2009 were identified and analyzed in this study. Nurse staffing level was measured using adjusted nurse staffing grades from 0 to 7. Patient outcomes were defined as in-hospital mortality, or pneumonia, sepsis, or urinary tract infection after surgery. Logistic regression analyses estimated by Generalized Estimation Model, were used to analyze the association between nurse staffing level and patient outcomes.

An inverse relationship was found between nurse staffing and patient mortality. Compared with patients who were cared for in hospitals with the highest nurse staffing (Grades 0-1), increases in the odds of dying were found in those with Grades 6-7 [OR (odds ratio)= 2.99, 95% CI (confidence interval)= 1.94-4.60], those with Grades 4-5 (OR= 1.78, 95% CI= 1.24-2.57) and those with Grades 2-3 (OR= 1.57, 95% CI= 1.25-1.98). Lower nurse staffing level was also associated with higher number of cases in pneumonia and sepsis.

Policies for providing adequate nurse staffing is required to enhance quality of care and lead to better perioperative patient outcomes.

To compare and confirm the impact of prepregnancy body mass index on pregnancy outcome in women with a singleton conceived by assisted reproductive technology and spontaneously conceived pregnancy.

A sample of 165 and 247 pregnant women with and without assisted reproductive technology were retrospectively recruited from electronic medical charts of C hospital.

There were significant differences between the two groups for maternal age, paternal age, length of marriage, prepregnancy body mass index, parity, spontaneous abortion experience, and preterm delivery. A prepregnancy body mass index of ≥25 was associated with higher risk for maternal and neonatal complication in the assisted reproductive technology group.

The results indicate that a higher prepregnancy body mass index is associated with increased risks for adverse pregnancy outcomes for women using assisted reproductive technology. So these women need appropriate care to compensate for the risk.

The purpose of this study was to develop and validate a hospice·palliative care performance measure which would cover more than just physical symptoms or quality of life.

Through an intensive literature review, the author chose questions that measured aspects of physical, emotional, spiritual, social, or practical domains pertinent to hospice·palliative care for inclusion in the scale. Content validation of the questions was established by 15 hospice·palliative care professionals. A preliminary Hospice Palliative Care Performance Scale (HPCPS) of 20 questions was administered to 134 pairs of terminal cancer patients from 5 hospice palliative care units and their main family caregiver. A validation study was conducted to evaluate construct validity and internal consistency.

Factor analysis showed 14 significant questions in five subscales; Physical, Emotional, Spiritual, Social, and Patient' rights. There were no significant differences between the ratings by patients and family members except for three out of the 14 questions. The measure demonstrated construct validity, and Cronbach's α of the subscales ranged from .73 to .79.

The HPCOS demonstrated acceptable validity and reliability. It can be used to assess effectiveness of hospice·palliative care for terminal cancer patients in practice and research.

To evaluate the effects of case management using Resident Assessment Instrument-Home Care (RAI-HC) in home health service for older people.

All elders were assessed at baseline and 3 months later using RAI-HC. The change of function in the intervention group was compared with that of a conventional intervention group. Function was measured with Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), Cognitive Performance Scale (CPS), Depression Rating Scale (DRS), Pain and the number of Clinical Assessment Protocols (CAP).

Among ninety two elders participated in the program, 59 were allocated to the case management group and 33 to the conventional group. The intervention, home health service by a nurse over a 3 month period, consisted of comprehensive assessment, case conference for care plan, direct care, education and referral, and outcome evaluation. The percent of elders whose function improved in the intervention group was greater than the conventional group for depression (odds ratio [OR]: 10.941, confidence interval [CI]: 2.338-51.206), IADL (OR: 4.423, CI: 1.151-16.999) and the number of CAP (OR: 11.443, CI: 3.805-34.410).

Case management was effective for older people in the community. The effect might have resulted from individual, systematic intervention, however, standards of service including eligibility criteria for case management and collaboration of multi-disciplines is required for more effective home health service programs.

The purpose of this study was to analyze effects of a community-based case management program for clients with hypertension living in the community.

The research design was a one group pre and post-test design with 30 participants with hypertension who agreed to participate in the 8-12 week case management program provided by case managers from the National Health Insurance Corporation in 2002. Data were collected three times, before and after the case management services, and 6 months later. Outcomes included changes in blood pressure, knowledge of hypertension and daily life practices, including alcohol consumption, smoking, exercise, and medication adherence.

Repeated-measures ANOVA and post-hoc tests of means revealed significant differences before and after service for systolic blood pressure, daily life practices (monitoring body weight and BP, low salt and cholesterol and high vegetable diet, and stress-relief practices), and exercise. The goal for medication adherence was attained after service. Significant improvements from baseline to 6 months after service were observed in measures of salt and vegetables in diet. There were no significant differences on hypertension knowledge, alcohol consumption or smoking behavior between before service and after, and at 6 months.

The findings provide preliminary evidence that case management intervention can have positive outcomes on BP control, daily life practices, exercise, and medication adherence for clients with hypertension. However, additional interventions are needed to sustain long-term effects.

The purpose of this study was to develop and to apply the NANDA, NOC, and NIC (NNN) linkages into a computerized nursing process program using the classification systems of nursing diagnoses, nursing outcomes and nursing interventions.

The program was developed with planning, analysis, design and performance stages. The program was applied to 117 patients who were admitted to orthopedic surgery nursing units from January to February, 2004.

Thirty-five of fifty-three nursing diagnoses were identified. Five nursing diagnoses in order of frequency were: Acute pain (28.4%), Impaired physical mobility (15.6%), Impaired walking (8.7%), Chronic pain (5.5%) and Risk for disuse syndrome (5.0%). The nursing outcomes of the 'Acute pain' nursing diagnosis tended to have higher frequencies (cumulative) in order of Pain management (95.2%), Comfort level (35.5%) and Pain level (17.7%). The nursing interventions of the ‘Acute pain’ nursing diagnosis tended to have higher frequencies (cumulative) in order of Pain management (71.0%), Splinting (24.2%) and Analgesic administration (17.7%). In comparison of outcome indicator scores between before and after the intervention according to the 61 nursing outcomes, the mean scores of 52 outcome indicators after the intervention were significantly higher than before the intervention.

It is expected that this program will help nurses perform their nursing processes more efficiently.