PURPOSE: Relocation stress is a common phenomenon in patients discharged from an intensive care unit(ICU) to a ward. Therefore, nurses need to be aware of the problems that can arise during the transfer process. The aim of this study was to identify nurses' experiences in transferring critically ill patients from the ICU to a ward. METHOD: Focus group interviews were done with 13 nurses from wards and ICU, which participated in receiving and sending of ICU patients. The debriefing notes and field notes were analyzed using the consistent comparative data analysis method. RESULT: Seven major categories were identified in the analysis of the data. These were 'mixed feeling about transfer', 'lack of transfer readiness', 'increase in family burden', 'uncertainty with unfamiliar environment', 'difficulty in decision making', 'difference of perception of the relationships between patients and health care providers', 'need for continuity of nursing care'. CONCLUSION: Transferring out of the critical care area should be presented to the patient and family as a positive step in the recovery process. However, a more universal method of passing information from nurse to nurse is needed to assist in a smooth transition.
Collodion ; Critical Care ; Critical Illness ; Delivery of Health Care ; Focus Groups ; Humans ; Critical Care ; Intensive Care Units ; Statistics as Topic

PURPOSE: This study aimed to investigate the public's perception of reimbursement for the education and counseling services provided to advanced practice nurses in intensive care units.METHOD: This was a secondary data analysis study. The original data were collected utilizing an online panel. The sample comprised 615 individuals aged between 19 and 49 years nationwide. The study variables included the public's perception of reimbursement for education and counseling services, age, gender, education level, income, and health status. Variables such as past experience of being admitted to an intensive care unit by self, family, or relatives and the recognition of advanced practice nurses were also examined.RESULTS: The mean of the perception score was 3.15 on a 4-point scale ranging from 1 (strongly disagree) to 4 (strongly agree). Among the participants, 89.2% answered “somewhat agreed” or “strongly agreed” to the question about the education and counseling services being covered by the National Health Insurance. Moreover, education level, past experience of being admitted to an intensive care unit by self, family, or relatives, and recognition of advanced practice nurses were significantly associated with the perception score.CONCLUSION: Efforts should be made to publicize the need for the education and counseling services that are provided to advanced practice nurses in intensive care units.
Counseling ; Critical Care ; Education ; Humans ; Intensive Care Units ; Methods ; National Health Programs ; Statistics as Topic

PURPOSE: The purpose of this methodological study was to examine the reliability and validity of a translated Korean version of the Critical Care Pain Observation Tool (CPOT) developed for assessment of pain in critically ill nonverbal patients. METHODS: A cross-sectional study design was used. Data were collected from a convenience sample of 202 critically ill patients admitted to a university hospital. Upon establishment of content and translation equivalence between the English and Korean version of CPOT, psychometric properties were evaluated. RESULTS: The interrater reliability was found to be acceptable with the weighted kappa coefficients of .81-.88. Significant high correlations between the CPOT and the Checklist of Nonverbal Pain Indicators were found indicating good concurrent validity (r=.72-.83, p<.001). Data showed the area under the ROC curve of 0.86 with a cut-off point of 1, which resulted in 76.9% sensitivity and 88.6% specificity. The mean score of CPOT during suctioning was significantly different from that of before (t=-14.16, p<.001) or 20 minutes after suctioning (t=16.31, p<.001). CONCLUSION: Results of this study suggest that the CPOT can be used as a reliable and valid measure to assess pain in critically ill nonverbal patients.
Adult ; *Critical Care ; Critical Illness ; Female ; Humans ; Intensive Care Units ; Intubation ; Male ; Middle Aged ; Pain Measurement/*statistics & numerical data ; Psychometrics ; ROC Curve ; Republic of Korea ; Respiration, Artificial ; Suction ; *Translating

PURPOSE: This study was attempted to provide quality improvement and revitalization of visiting nurse services by Importance-Performance Analysis of persons being provided with the services. METHODS: The subjects were 350 people being provided with visiting nurse services from a long term home care institution in the kangwon Province during the period of data collection between Aug. 16 and Sep. 15, 2011. Data analysis was conducted through t-test, ANOVA, and IPA by using the SPSS/WIN 12.0 program. RESULTS: As a result of the Importance-Performance Analysis of visiting nurse services, it turned out that the strength on reliability, assurance, and empathy should be maintained with good work and the aspects of responsiveness appeared to be intensively improved, and the tangibility proved to be subject to improvement. CONCLUSION: For the activation of visiting nurse services, methods for improving the performance in the intensive care area and management strategy establishment which highlights the advantages of strength maintenance area are needed.
Community Health Nursing* ; Data Collection ; Empathy ; Home Care Services ; Humans ; Insurance, Long-Term Care* ; Critical Care ; Long-Term Care* ; Quality Improvement ; Statistics as Topic

We investigated the clinical presentations, diagnostic and therapeutic modalities, and prognosis from follow-up of infants with apparent life-threatening events (ALTE). In addition, the relationship between the clinical characteristics of patients and significant intervention scores was analyzed. We enrolled patients younger than 12 months who were diagnosed with ALTE from January 2005 to December 2012. There were 29 ALTE infants with a peak incidence of age younger than 1 month (48.3%). The most common symptoms for ALTE diagnosis were apnea (69.0%) and color change (58.6%). Eleven patients appeared normal upon arrival at hospital but 2 patients required cardiopulmonary resuscitation during the initial ALTE. The most common ALTE cause was respiratory disease, including respiratory infection and upper airway anomalies (44.8%). There were 20 cases of repeat ALTE and 2 cases of death during hospitalization. Four patients (15.4%) experienced recurrence of ALTE after discharge and 4 patients (15.4%) showed developmental abnormalities during the follow-up period. The patients with ALTE during sleep had lower significant intervention scores (P=0.015) compared to patients with ALTE during wakefulness and patients with previous respiratory symptoms had higher significant intervention scores (P=0.013) than those without previous respiratory symptoms. Although not statistically significant, there was a weak positive correlation between the patient's total ALTE criteria and total significant intervention score (Fig. 2, r=0.330, P=0.080). We recommend that all ALTE infants undergo inpatient observation and evaluations with at least 24 hr of cardiorespiratory monitoring, and should follow up at least within a month after discharge.
Age Distribution ; Clinical Decision-Making ; Critical Care/*statistics & numerical data ; Critical Illness/*mortality/*therapy ; Female ; *Hospital Mortality ; Hospitalization/*statistics & numerical data ; Humans ; Incidence ; Infant ; Infant, Newborn ; Male ; Republic of Korea/epidemiology ; Risk Factors ; Sex Distribution ; Survival Rate ; Treatment Outcome

OBJECTIVETo develop the prediction model of acute gastrointestinal injury (AGI) classification of critically ill patients.

METHODSThe binary channel gastrointestinal sounds (GIS) monitor system was used to gather and analyze the GIS of 60 consecutive critically ill patients who were admitted in Critical Care Medicine of PLA General Hospital from April 2015 to November 2015 (patients with chronic gastrointestinal disease or history of gastrointestinal surgery were excluded). Meanwhile, the AGI grades were evaluated according to the ESICM guidelines of AGI grading system. Correlations between GIS and AGI classification were examined with Spearman rank correlation. Then principal component analysis was performed on the significantly correlated parameters after standardization. The top 3 post-normalized main components were selected for back-propagation (BP) neural network training to establish primary AGI grade model of critically ill patients based on the neural network model.

RESULTSA total of 1 132 GIS and 333 AGI were collected from 60 patients. The number (P = 0.0005), percentage of time (P = 0.0004), mean power (P = 0.0088), maximum power (P = 0.0101) and maximum time (P = 0.0025) of GIS wave from the channel located at the stomach were negatively correlated with the AGI grades, while the parameters of GIS wave from the channel located at the intestine had no significant correlation with the AGI grades(all P > 0.05). Three main components were selected after principal component analysis of these five correlated parameters. An AGI grade network model including 9 hide layers, with a fitting degree of 0.981 64 was built by BP artificial neural network based on the analysis of these three main components of GIS. The accuracy rate of the model to predict the AGI grade was 70.83%.

CONCLUSIONThe preliminary model based on GIS in classifying AGI grade is established successfully, which can help predict the classification of AGI grade of critically ill patients.

Abdominal Injuries ; classification ; diagnosis ; Auscultation ; instrumentation ; methods ; statistics & numerical data ; Computer Simulation ; Critical Care ; methods ; Critical Illness ; classification ; Diagnosis, Computer-Assisted ; instrumentation ; methods ; Diagnostic Techniques, Digestive System ; instrumentation ; statistics & numerical data ; Humans ; Models, Biological ; Neural Networks (Computer) ; Predictive Value of Tests

PURPOSE: This study aimed to investigate incidence of delirium in the pediatric intensive care unit (PICU) and to analyze associated risk factors. METHODS: The participants were 95 patients, newborn to 18 years, who were admitted to the PICU. The instruments used were the Richmond Agitation Sedation Scale (RASS), and the Cornell Assessment of Pediatric Delirium. Data analysis was performed using the descriptive, χ² test, t-test, and logistic regression analyses. RESULTS: The incidence of delirium in children admitted to the PICU was 42.1%. There were significant differences according to age (χ²=14.10, p=.007), admission type (χ²=7.40, p=.007), use of physical restraints (χ²=26.11, p<.001), RASS score (χ²=14.80, p=.001), need for oxygen (χ²=5.31, p=.021), use of a mechanical device (χ²=9.97, p=.041), feeding (χ²=7.85, p=.005), and the presence of familiar objects (χ²=29.21, p<.001). Factors associated with the diagnosis of delirium were the use of physical restraint (odds ratio [OR]=13.82, 95% confidence interval [CI]=4.16~45.95, p<.001) and the presence of familiar objects (OR=0.09, 95% CI=0.03~0.30, p=.002). CONCLUSION: Periodic delirium assessments and intervention should be actively performed. The use of restraints should be minimized if possible. The caregiver should surround the child with familiar objects and ensure a friendly hospital environment that is appropriate for the child.
Caregivers ; Child ; Critical Care ; Delirium ; Diagnosis ; Dihydroergotamine ; Humans ; Incidence ; Infant, Newborn ; Intensive Care Units ; Logistic Models ; Oxygen ; Pediatrics ; Restraint, Physical ; Risk Factors ; Statistics as Topic

PURPOSE: The objectives of this study were to determine the prevalence, incidence, duration and risk factors for delirium following liver transplantation while the patients were in the acute stage and admitted to the intensive care unit. METHOD: A retrospective chart review of 106 patients who had liver transplantation was conducted. A delirium risk factor checklist was used, to collect preoperative and postoperative data. Descriptive analysis, t-test, x2-test, and logistic regression analyses were used for data analysis. RESULTS: The post-transplantation incidence of delirium was 29.3% (n=31). Multivariate analysis revealed that risk factors were preoperative conditions in the patients including spontaneous bacterial peritonitis, hepatorenal syndrome, and postoperative laboratory test results, such as hyperbilirubinemia. CONCLUSION: Therefore, a daily delirium risk factor assessment should be conducted before liver transplantation as a way to identify risk of delirium after the liver transplantation and to effectively manage delirium when it occurs.
Checklist ; Delirium ; Hepatorenal Syndrome ; Humans ; Hyperbilirubinemia ; Incidence ; Critical Care ; Intensive Care Units ; Liver ; Liver Transplantation ; Logistic Models ; Multivariate Analysis ; Peritonitis ; Prevalence ; Retrospective Studies ; Risk Factors ; Statistics as Topic

There is a lack of information on critical care in Korea. The aim of this study was to determine the current status of Korean intensive care units (ICUs), focusing on the organization, characteristics of admitted patients, and nurse and physician staffing. Critical care specialists in charge of all 105 critical care specialty training hospitals nationwide completed a questionnaire survey. Among the ICUs, 56.4% were located in or near the capital city. Only 38 ICUs (17.3%) had intensive care specialists with a 5-day work week. The average daytime nurse-to-patient ratio was 1:2.7. Elderly people > or = 65 yr of age comprised 53% of the adult patients. The most common reasons for admission to adult ICUs were respiratory insufficiency and postoperative management. Nurse and physician staffing was insufficient for the appropriate critical care in many ICUs. Staffing was worse in areas outside the capital city. Much effort, including enhanced reimbursement of critical care costs, must be made to improve the quality of critical care at the national level.
Adult ; Aged ; Aged, 80 and over ; Critical Care/*organization & administration ; Hospitals ; Humans ; Intensive Care Units ; Middle Aged ; Nursing Staff, Hospital/*statistics & numerical data ; Outcome Assessment (Health Care) ; Physicians/*statistics & numerical data ; Questionnaires ; Republic of Korea

BACKGROUND/AIMS: Obesity is a worldwide concern, but its influence on critical care outcomes is not well understood. We tested the hypothesis that abnormal body mass index (BMI) would be an independent predictor of higher mortality rates in intensive care unit (ICU). METHODS: We retrospectively reviewed patients who had admitted to the ICU from January 2007 to December 2007. Admission BMI was analyzed as both a three categorical (underweight, < 18.5 kg/m2; normal weight, 18.5 to 24.9 kg/m2; overweight and obese, > or = 25 kg/m2) and continuous variables among all patients with an ICU lenth of stay > or = 4 days. The primary outcome was ICU mortality. RESULTS: The multivariate analysis on ICU mortality selected Mortality Prediction Model-Admission (MPM at time zero) (hazard ratio [HR], 1.024; p = 0.001; 95% confidence interval [CI], 1.010 to 1.037), failed extubation (HR, 5.092; p = 0.0001; 95% CI, 2.742 to 9.456) as significant risk factors. When controlling these variables, none of the BMI group and BMI as a continuous variable had an independent association with ICU mortality. CONCLUSIONS: BMI did not have a significant influence on ICU mortality. The ICU mortality was influenced more strongly by severity of illness and failed extubation rather than BMI.
Adult ; Aged ; *Body Mass Index ; Critical Care/*statistics & numerical data ; Critical Illness/*mortality ; Female ; Humans ; Intensive Care Units/statistics & numerical data ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Multivariate Analysis ; Obesity/*mortality ; Prognosis ; Proportional Hazards Models ; Respiration, Artificial/statistics & numerical data ; Severity of Illness Index ; Thinness/mortality