No abstract available.
Critical Illness* ; Nursing*

Authors report on the general features of the Neurosurgical Intensive Care Unit(ICU). The problems encountered in caring for critically ill neurosurgical patients are quite different from the other medical ICU paradigms. The success of the Neurosurgical ICU depends upon 1) the role of specialized nursing staff who should be aware of what the different symptoms and signs of neurological disorders are 2) monitoring data that must be able to connote changes in the neurological status 3) a concept of cooperation among the other medical departments. The materials studied are obtained from 243 patients who had been treated in the Neurosurgical ICU at SNUH during the last 6 years. Various topics are discussed and our therapeutic methods are explained and a new Neurosurgical ICU model is designed.
Critical Illness ; Humans ; Intensive Care Units* ; Critical Care* ; Nervous System Diseases ; Nursing Staff

Nurses play a crucial role in providing high-quality care in intensive care units (ICU). Previous studies have shown an association between nurse staffing levels and outcome of critically ill patients. Increasing nurse staffing levels in ICU has been recommended to improve the outcome of critically ill patients. However, nursing staff shortages associated with decreased budgets may prevent adequate nurse-to-patient ratios although there lies increasing needs for critical care. Several studies have suggested that higher nurse staffing level is associated with favorable patient outcome, including mortality, length of stay, and infections, but some of studies did not find an association between nurse staffing and patient outcome. Although there are some controversies in the associations between nurse staffing levels and patient outcome, it is difficult to apply such effect as compared with other developed countries in North American and Europe as the nurse-to-patient ratio in Korea's ICU is relatively low. By studying the nurse staffing effects for patient outcome from the Korea ICU, it is found that higher nurse staffing level is associated with improved patient mortality. This finding may suggest that a shortage of nursing staff is currently a serious issue for caring of critically ill patients in Korea.
Budgets ; Critical Care ; Critical Illness ; Developed Countries ; Europe ; Humans ; Critical Care ; Intensive Care Units ; Korea ; Length of Stay ; Nursing Staff

PURPOSE: As the intensive care unit (ICU) survival rate increases, interest in the lives of ICU survivors has also been increasing. The purpose of this study was to identify the sentiment of ICU survivors.METHOD: The author analyzed the quotations from previous qualitative studies related to ICU survivors; a total of 1,074 sentences comprising 429 quotations from 25 relevant studies were analyzed. A word cloud created in the R program was utilized to identify the most frequent adjectives used, and sentiment and emotional scores were calculated using the Artificial Intelligence (AI) program.RESULTS: The 10 adjectives that appeared the most in the quotations were ‘difficult’, ‘different’, ‘normal’, ‘able’, ‘hard’, ‘bad’, ‘ill’, ‘better’, ‘weak’, and ‘afraid’, in order of decreasing occurrence. The mean sentiment score was negative (-.31±.23), and the three emotions with the highest score were ‘sadness’(.52±.13), ‘joy’(.35±.22), and ‘fear’(.30±.25).CONCLUSION: The natural language processing of AI used in this study is a relatively new method. As such, it is necessary to refine the methodology through repeated research in various nursing fields. In addition, further studies on nursing interventions that improve the coherency of ICU memory of survivors and familial support for the ICU survivors are needed.
Artificial Intelligence ; Critical Care ; Critical Illness ; Humans ; Intensive Care Units ; Memory ; Methods ; Natural Language Processing ; Nursing ; Survival Rate ; Survivors

PURPOSE: This methodological study develops an oral health assessment tool for critically ill patients.METHOD: From February 15 to April 30, 2014, this study was conducted to test the validity and reliability of the tool at two general hospitals and three medical and surgical intensive care units (ICUs) in Seoul, Korea.RESULTS: The result of the intraclass correlation coefficient to test the between-observer reliability by analyzing the oral health assessment scores before and after oral nursing care showed that .93 of before oral care and .90 of after oral care. The correlation coefficient values of .68 (p < .001) and .71 (p < .001) before and after providing oral nursing care, respectively, indicated the presence of a statistically significant correlation between the tool and the criterion. Using the paired t-test, the differentiated validity of the tool was tested in patients who had developed pneumonia after entering the ICU. A statistically significant difference in scores was found between the time of entering the ICU and that of developing pneumonia (t=−8.73, p < .001), which provided evidence for the differentiated validity of the tool.CONCLUSION: Since the validity and reliability of the tool developed in this study were verified, this tool can be used to assess the oral health conditions of critically ill patients.
Critical Care ; Critical Illness ; Hospitals, General ; Humans ; Korea ; Methods ; Nursing Care ; Oral Health ; Pneumonia ; Reproducibility of Results ; Seoul

Problems related to agitation in the ICU patients include cardiorespiratory instability, ina bility to cooperate with nursing care, failure to maintain op timal positioning in bed, dis- ruption of life sustaining tubes and catheters, and injuries to patients and hospital person- nel. Thus, the ability to provide safe, controllable, and reversible sedation can be important in the care of critically ill patients. Midazolam is a water soluble imidazobenzodiazepine with a rapid onset of ac tion and short elimination half life compared with diazepam or lorazepam. We evaluated the use of midazolam by continuous infusion for prolonged sedation of critically ill adult patients. The results were as follows ; 1) Midazolam infusion effectively controlled severe agitation in all patients. 2) No episodes of cardiovascular depression due to midazolam occur red during the study period. 3) In one patient, tolerance was developed 6 days after infusion. 4) Mean time to alertness was 2.23 hours. 5) In a renal failure patient, there was no significant prolongation of time to alertness. These results suggest that midazolam infusion provides safe, controllable, and reversible sedation in the care of critically ill patients.
Adult ; Catheters ; Critical Illness ; Depression ; Diazepam ; Dihydroergotamine ; Half-Life ; Humans ; Lorazepam ; Midazolam* ; Nursing Care ; Renal Insufficiency

PURPOSE: This study was designed to adapt a surgical wound care algorithm that is used to provide evidence-based surgical wound care in a critical care unit. METHODS: This study used, the 'ADAPTE process', an international clinical practice guideline development method. The -'Bonnie Sue wound care algorithm' - was used as a draft for the new algorithm. A content validity index (CVI) targeting 135 critical care nurses was conducted. A 5-point Likert scale was applied to the CVI test using a statistical criterion of .75. RESULTS: A surgical wound care algorithm comprised 9 components: wound assessment, infection control, necrotic tissue management, wound classification by exudates and depths, dressing selection, consideration of systemic factors, wound expected outcome, reevaluate non-healing wounds, and special treatment for non-healing wounds. All of the CVI tests were > or =.75. Compared to existing wound care guidelines, the new wound care algorithm provides precise wound assessment, reliabilities of wound care, expands applicability of wound care to critically ill patients, and provides evidence and strength of recommendations. CONCLUSION: The new surgical wound care algorithm will contribute to the advancement of evidence-based nursing care, and its use is expected as a nursing intervention in critical care.
*Algorithms ; Critical Illness/nursing ; *Evidence-Based Nursing ; Humans ; Intensive Care Units ; Practice Guidelines as Topic ; Wounds and Injuries/*therapy

INTRODUCTIONVentilator-associated pneumonia (VAP) is a common risk among critically ill ventilated patients. This study aimed to investigate the effects of nurse-led education on: (a) knowledge of and compliance with ventilator care bundle (VCB) practices among intensive care unit (ICU) nurses; and (b) reduction in the rates of VAP post intervention.

METHODSA quasi-experimental design with pretest-posttest evaluation and observation was used to investigate nurses' knowledge of and compliance with VCB practices, and the incidence of VAP. The study was conducted among 71 nurses, and the intervention involved structured education on VAP and its prevention using VCB in an ICU setting. Data were analysed using descriptive and inferential statistics.

RESULTSNurse-led education significantly increased nurses' knowledge of (t[70] = -36.19; p < 0.001) and compliance with (t[65] = -21.41; p < 0.001) VCB practices. The incidence of VAP, which was 39 per 1,000 ventilator days during the two-month period before intervention, dropped to 15 per 1,000 ventilator days during the two-month period following intervention.

CONCLUSIONOur findings show that nurse-led education on VAP and VCB significantly increased knowledge of and compliance with VCB practices among ICU nurses, and was associated with a reduction in the incidence of VAP among intubated and mechanically ventilated ICU patients. Inclusion of recent knowledge and evidence-based VCB guidelines for VAP prevention when educating anaesthetists, nurses, physiotherapists and other healthcare providers in the critical care setting is recommended.

Adult ; Clinical Competence ; Critical Care ; methods ; standards ; Critical Illness ; Education, Nursing ; Education, Nursing, Continuing ; methods ; Female ; Humans ; Intensive Care Units ; standards ; statistics & numerical data ; Male ; Nursing ; standards ; Pneumonia, Ventilator-Associated ; prevention & control ; Respiration, Artificial ; standards ; Ventilators, Mechanical ; standards ; Young Adult

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.
Adult ; Aged ; Attitude to Health ; Critical Illness/psychology ; Female ; Humans ; Inpatients/*psychology ; *Intensive Care Units ; Interviews as Topic ; Male ; Middle Aged ; Nursing Methodology Research ; Patient Transfer ; Qualitative Research