PURPOSE: The purpose of this study was to identify the extent to which intensive care unit (ICU) nurses' perceptions of life-sustaining treatment decisions and “a good death” affect attitudes toward terminal care.METHOD: Participants included 109 ICU nurses from three university hospitals. Data were collected using structured questionnaires, and collected data were analyzed using a t-test, ANOVA, the Scheffé test, Pearson correlation coefficients, and a multiple regression analysis (SPSS 24.0 program).RESULTS: Perceptions of life-sustaining treatment decisions and a sense of closeness (a constituent for the awareness of “a good death”) were positively correlated with terminal care attitudes. The factors affecting terminal care attitudes were a clinical career in ICU (β=.20, p=.035), a sense of closeness(β=.19, p=.041), and the perception of a life-sustaining treatment decision (β=.22, p=.017). This finding indicates that more than 10 years of experience in ICU, a greater sense of closeness, and a higher view of life-sustaining treatment decisions results in more positive attitudes toward terminal care. The explanatory power of these variables on terminal care attitudes was 14% (F=6.84, p < .001, Adj R2=.140).CONCLUSION: A sense of closeness and the perception of life-sustaining treatment decisions were identified as the factors affecting terminal care attitudes. Thus, various programs must be developed to raise awareness among ICU nurses of “a good death” and perceptions of life-sustaining treatment decisions.
Critical Care ; Hospitals, University ; Intensive Care Units ; Methods ; Terminal Care

PURPOSE: To explore the person-centered care (PCC) experienced by critical patients.METHOD: This qualitative study deductively examined the attributes of the PCC model proposed by Jakimowicz and Perry. The participants were 16 patients who were recently discharged from intensive care units at a university hospital. Data were collected through in-depth interviews and were analyzed using the deductive method of content analysis.RESULTS: A total of 4 categories, 16 subcategories, and 33 codes were generated from 171 meaningful statements. The final 4 categories were “compassionate presence,” “professional interaction,” “outstanding competency,” and “patient identity.” These were consistent with the main attributes of Jakimowicz and Perry's model. However, most of the codes belonged to the “compassionate presence” and “patient identity” categories. Among the attributes of the model, “continuity of nursing,” “therapeutic relationship,” “expert knowledge,” “clinical knowledge,” “evidence-based intervention,” and “patient's rights” were not derived as codes.CONCLUSION: These findings deepen the understanding of the PCC model from the patient's point of view. The main attributes of PCC identified in the current study can be applied to the development of practical guidelines for intensive care nursing. In addition, we recommend the development of a PCC measurement tool for critical care patients.
Critical Care Nursing ; Critical Care ; Humans ; Intensive Care Units ; Methods ; Nursing ; Qualitative Research

Child ; Critical Care ; methods ; Extracorporeal Membrane Oxygenation ; Humans ; Pediatrics ; methods

PURPOSE: The purpose of this study was to explore the subjective experience of life-sustaining treatment care among nurses in intensive care units. METHODS: A phenomenology was used for the study. Data were collected from October to December, 2015 using open-ended questions during in-depth interviews. Participants were nurses working in intensive care units and were contacted through purposive techniques. Eight nurses participated in this study. RESULTS: Four categories emerged from the analysis using Colaizzi's method: (a) difficulties due to life-sustaining treatment care, (b) dilemma of extension or cessation of life-sustaining treatment, (c) repressed feelings and emotional exhaustion, and (d) forming values for life-sustaining treatment from nursing experience CONCLUSION: Provision of clearer guidelines on life-sustaining treatment which reflect a family-oriented culture is important for nurses in ICU and will promote nurses involvement in the decision-making process of life-sustaining treatment of patients.
Critical Care* ; Humans ; Intensive Care Units* ; Methods ; Nursing ; Patient Care* ; Terminal Care

Critical Illness ; Humans ; Tertiary Care Centers ; Transportation of Patients ; methods

OBJECTIVETo explore the safety and therapeutic efficacy of hemofiltration without anticoagulation in critically ill patients at high risk of bleeding.

METHODSWe retrospectively analyzed 41 patients undergoing bedside hemofiltration in the Intensive Care Unit of PUMC Hospital from December 2005 to December 2006. The hemofiltration cases with or without anticoagulation were compared.

RESULTSTotally 224 hemofiltration circuits were performed in these 41 patients, including 114 (50.89%) circuits without anticoagulation in 27 patients at high risk of bleeding and 110 (49.11%) with anticoagulation by heparin. The circuit life of hemofiltration without anticoagulation was (13.21 +/- 9.73) hours (3-55 hours), and that of hemofiltration with anticoagulation was (28. 35 +/- 26.43) hours (9-126) hours (P < 0.01). The circuit life had no correlation with prothrombin time (PT), activitated partial thromboplastin time (APTT), fibrinogen (Fbg), and platelet count (PLT) levels before the therapy (P > 0.05). The levels of blood creatinine, blood urea nitrogen, potassium, and pH value significantly improved after both therapies (P < 0.05). Urea reduction rates were (38.4 +/- 26.7)% and (24.3 +/- 13.2)% in hemofiltration with and without anticoagulation, respectively. The levels of Fbg and PLT significantly decreased after therapy in both groups (P < 0.01). PT and APTT did not change in hemofiltration without anticoagulation (P > 0.05), while APTIT was prolonged in hemofiltration with heparin (P < 0.01). Of the 21 patients who initially received hemofiltration with heparin, 7 patients turned to hemofiltration without anticoagulation for hemorrhagic complications. Seventeen (41.5%) of 41 patients died during hospital stay, but none of them died of complications of hemofiltration.

CONCLUSIONSHemofiltration without anticoagulation reduces bleeding risks and achieves an acceptable circuit life. The strategy can be applied as an alternative to critically ill patients at high risks of bleeding who need continuous blood purification.

Anticoagulants ; Critical Care ; Critical Illness ; Hemofiltration ; methods ; Hemorrhage ; prevention & control ; Heparin ; Humans ; Retrospective Studies

PURPOSE: It is difficult to develop a good defense system that can prevent nurses from experiencing physical and verbal violence from patients and families in intensive care units, which are closed spaces. This study aimed to identify intensive care nurses' experience of violence from patients and families and investigate their coping methods, if there are any, in a tertiary hospital in South Korea. METHODS: This study used a mixed methods design using both a survey for collecting quantitative data and individual interviews for a qualitative one. A total of 200 intensive care nurses participated in the survey, with 30 of them taking part in individual interviews. Survey data were analyzed using SPSS 21.0 program, and qualitative data were analyzed by qualitative content analysis method. RESULTS: In the survey, 99.5% of the nurses reported that they had experienced violence from the patients, and 67.5% of the nurses reported that they had experienced violence from their visitors (families or relatives). Verbal violence were reported more than physical ones. They showed moderate or severe responses to violence, scoring an average of 2.98 ± 0.63 of 5. The qualitative data were analyzed to draw four themes, eight categories, and 17 subcategories. The four themes were perception of violence, coping with violence experience, coping resources, and caring mind after violence experience. CONCLUSION: While intensive care nurses experience unpredicted violence from patients and their visitors, they fail to cope well with the experience. The safe working environment of intensive care units is expected to contribute to quality care and an improvement of expertise in nursing.
Critical Care* ; Humans ; Intensive Care Units* ; Korea* ; Methods* ; Nursing ; Tertiary Care Centers ; Violence*

PURPOSE: This study aimed to identify the difficulties with end-of-life care (EOLC) experienced by intensive care unit (ICU) nurses and to investigate their educational needs for EOLC. METHODS: This study aimed to identify the difficulties with end-of-life care (EOLC) experienced by intensive care unit (ICU) nurses and to investigate their educational needs for EOLC. RESULTS: The mean score on the difficulty of EOLC was 3.41 out of 5. The education needs derived from the qualitative analysis was categorized into four themes: 1) guidelines on professional EOLC, 2) spiritual care, 3) a program to take care of feelings of patients, families and nurses, and 4) activities to think about death. CONCLUSION: This study confirmed that ICU nurses were experiencing an extreme difficulty in providing EOLC. In addition, a qualitative analysis confirmed that they needed an EOL nursing program. To mitigate the difficulties experienced by nurses involved in EOLC, there is an urgent need to develop an education program for EOLC tailored to nurses' needs.
Critical Care ; Education ; Humans ; Intensive Care Units ; Methods ; Needs Assessment ; Nursing ; Terminal Care

PURPOSE: This study aimed to estimate the appropriate nurse staffing ratio in intensive care units (ICUs) by measuring nursing workload based on patient's severity and needs, using the Korean Patient Classification System for critical care nurses.METHODS: The data were collected from January 18 to February 29, 2016 using a standardized checklist by observation or self-report. During the study period, 723 patients were included to be categorized from I to IV using the patient classification system. Measurement of total nursing workload on a shift was calculated in terms of hours based on the time and motion method by using tools for surveying nursing activities. The nursing activities were categorized as direct nursing care, indirect nursing care, and personal time. Total of 127 cases were included in measuring direct nursing time and 18 nurses participated in measuring indirect and personal time. Data were analyzed using descriptive statistics.RESULTS: Two patients were classified into Class I (11.1%), 5 into Class II (27.8%), 9 into Class III (50%), and two into Class IV (11.1%). The amount of direct nursing care required for Class IV (513.7 min) was significantly more than that required for Class I (135.4 min). Direct and indirect nursing care was provided more often during the day shift as compared to the evening or night shifts. These findings provided the rationale for determining the appropriate ratio for nursing staff per shift based on the nursing workload in each shift.CONCLUSIONS: An appropriate ratio of nurse staffing should be ensured in ICUs to re-arrange the workload of nurses to help them provide essential direct care for patients.
Checklist ; Classification ; Critical Care ; Humans ; Intensive Care Units ; Methods ; Nursing Care ; Nursing Staff ; Nursing

PURPOSE: This study aimed to develop an in-depth and comprehensive understanding of the experiences of critical care nurses caring for dying patients.METHOD: Eleven critical care nurses with experience in caring for dying patients were recruited from four tertiary hospitals. Semi-structured face-to-face interviews were conducted between November 2016 and March 2017. The transcribed data were analyzed using qualitative content analysis to identify major themes and sub-themes that represented the experiences of critical care nurses.RESULTS: The following six themes, and twelve sub-themes, were identified: (1) the gap between expectation and reality, (2) a distorted meaning of death, (3) repeated emotional pain and stress, (4) finding a solution alone, (5) sublimation into mission and calling, and (6) integration into one's own life.CONCLUSION: This study found that critical care nurses experience various psychological difficulties while caring for dying patients, and they made efforts on their own to overcome them. These findings are expected to inform the development of specialized programs to support critical care nurses to tackle these challenges, create guidelines on caring for dying patients, and help promote death education.
Critical Care ; Education ; Humans ; Intensive Care Units ; Methods ; Sublimation ; Tertiary Care Centers