PURPOSE: The purpose of this study was to identify the impact of practical communication strategies (PCS) on the reduction of AEs (Adverse Events) in pediatric cardiac ICU (PCICU). METHODS: Intra-operative findings and care plans were documented and shared between staff members on a daily basis from the day of operation to the day of general ward transfer. Incidence of AEs was investigated in all patients who were admitted to the PCICU and was compared with incidence of AEs one year after establishment of PCS. RESULTS: The study population consisted of 216 patients in pre-PCS group and 156 patients in post-PCS group. Incidence of readmission decreased from 6.0% (13/216) in pre-PCS group to 0.6% (1/156) in post-PCS group (chi2=7.23, p=.010). Incidence of other major complications decreased from 4.2% (9/216) to 0.6% (chi2=6.66, p=.012). Minor AEs such as intervention omission, order error, and protocol misunderstanding were reduced from 23.3 cases per 100 patient-days to 7.5 cases per 100 patient-days (chi2=20.31, p<.001). CONCLUSION: Handover protocol is an effective strategy to reduce AEs for critically ill patients after pediatric cardiac surgery. Efforts to develop effective communication strategies should be continued and outcome research about communication strategies for patient safety should be further studied.
Critical Illness ; Heart Defects, Congenital ; Humans ; Incidence ; Intensive Care Units* ; Outcome Assessment (Health Care) ; Patient Handoff ; Patient Safety ; Patients' Rooms ; Thoracic Surgery

PURPOSE: It is crucial to provide adequate enteral nutrition for postoperative recovery, wound healing and normal growth in infants in pediatric cardiac ICUs. This study was done to develop a feeding protocol using the vaso-active inotropic (VAI) score and to evaluate the impact of nutritional outcomes following the new feeding protocol for infants who underwent cardiac surgery. METHODS: This study consisted of three phases. First, a feeding protocol was developed based on a literature review. Second, ten experts rated the content validity. Third, a comparison study was conducted to evaluate the impact of the new feeding protocol. Data were analyzed using SPSS Version 20. RESULTS: Twenty-nine infants were enrolled in the pre-protocol group, and 22 infants in the post-protocol group. Patients in the 2 groups were similar. Time to reach feeding goal was significantly decreased from 56.0 (27-210) hours to 28.5 (10-496) hours in the post-protocol group (Z=-4.22, p<.001). Level of enteral feeding knowledge among nurses increased significantly after implementation of the protocol. CONCLUSION: The feeding protocol using VAI score facilitates the achievement feeding goal to decrease feeding interruptions and help nurses in their practice. Larger studies are necessary to examine clinical outcomes following the implementation of this feeding protocol.
Critical Care* ; Enteral Nutrition ; Heart Defects, Congenital ; Humans ; Infant* ; Intensive Care Units* ; Thoracic Surgery ; Wound Healing

PURPOSE: The purpose of this study was to identify the perception of role transition from a student nurse to a registered nurse among senior year nursing students and to examine factors affecting their role transition. METHODS: A descriptive survey with convenience sampling was conducted in four nursing colleges in Seoul, South Korea. Data were collected using a self-administrated questionnaire. Four instruments including role transition, self-esteem, interpersonal relationships and anxiety during clinical practicum were used and the students'demographics were also collected. A multiple logistic regression was used to identify predictors for the role transition. RESULTS: A total of 233 nursing students were surveyed and final analysis was conducted utilizing 226 participants. Mean point of perceived role transition (5 point scale) was 3.34+/-0.44. In a multiple regression model, high self-esteem, good interpersonal relationships, low anxiety during clinical practicum, and high satisfaction in college life were significant predictors of a smooth transition (Adj. R2=.32, F=22.28, p<.001). CONCLUSION: The findings suggest that role transition from a student nurse to a registered nurse is facilitated through the establishment of programs to improve self-esteem and interpersonal relationships and to reduce anxiety during clinical practicum.
Anxiety ; Humans ; Korea ; Logistic Models ; Nursing ; Surveys and Questionnaires ; Seoul ; Students, Nursing*

Purpose: To define school nurseeparent partnerships in school health care for children with type 1 diabetes (T1D) and determine its attributes using a hybrid model. Methods: This method involves a three-phase process: theoretical, fieldwork, and analytical. A literature review was conducted during the theoretical phase. A literature search of articles from January 1991 to February 2020 was conducted using relevant electronic databases. Eighty-three articles that met the inclusion criteria were completely read. Fieldwork data were collected through individual interviews from February to July 2019 in South Korea. In the fieldwork phase, interviews were conducted individually with 22 mothers of students with T1D and 20 school nurses recruited by purposeful sampling.Inductive content analysis was conducted. The findings from the theoretical phase were integrated with those from the fieldwork phase, and the final concept was derived. Results: School nurseeparent partnership in school health care for children with T1D has been defined as an interactive process of maintaining a balanced responsibility and providing tailored care to meet needs by establishing trusting relationships and communicating transparently and openly. This analysis yielded four attributes: trusting relationships, transparent and open communication, balanced responsibility, and providing tailored care to meet needsdthis entails providing nursing actions by advocating for students and performing a negotiated role together or individually for student and family. Conclusion The findings of this study add to the importance of an attribute of balancing responsibility for partnership in school health care. The results show that this partnership could contribute to the development of a scale, theory, and nursing intervention in school health care for children with T1D.

Purpose: This study aimed to verify the reliability and validity of the Pain Assessment in Advanced Dementia Scale-Korean version (PAINAD-K) for assessing pain in patients unable to communicate in the post-anesthesia care unit (PACU). Methods: The study included 205 patients, aged >65 years, admitted to the PACU following general surgery. Reliability was assessed using Cronbach’s ⍺, test-retest, intraclass correlation coefficient (ICC), and kappa coefficients. Criterion validity was evaluated with concurrent validity, and receiver operating characteristic (ROC) analysis assessed sensitivity and specificity. Convergent and discriminant validity were analyzed to verify the construct of the scale. Results: The Cronbach’s ⍺, ICC, and test-retest correlation values were .78, .95~.98, and .56~.74, respectively, indicating good reliability. At baseline, the correlation coefficient was .93 with the Algoplus scale in the non-communicative group and .82 with the numeric rating scale in the communicative group. Further establishing criterion validity in the nonverbal group, the area under the ROC curve was 0.995 (sensitivity=98.4%, specificity=97.5%) at baseline and .95 (sensitivity=96.4%, specificity=93.2%) at the 30-minute follow-up. The correlation coefficient with the Critical-Care Pain Observation Tool was .69~.96, showing convergent validity, and there was a significant interaction effect between time and group, indicating discriminant validity. Conclusion The study findings suggest that the PAINAD-K is a psychometrically valid scale for assessing pain in PACU patients aged >65 years who are unable to communicate.

Purpose: The purpose of this integrative review was to synthesize previous research on perceptions of school health care among school-aged children and adolescents with chronic diseases. Methods: This study was performed in accordance with Whittemore and Knafl's stages of an integrative review (problem identification, literature search, data evaluation, data analysis, and presentation of the results). Four databases (PubMed, CINAHL, Embase, and Web of Science) were used to retrieve relevant articles. Results: Eighteen articles were included in this review. We identified five thematic categories: peer-related issues, a safe school environment, self-perception of an existing disease, self-management, and a supportive school environment. Conclusion It is necessary to establish a school health care system with a supportive environment for children and adolescents with chronic diseases.

Purpose: The aim of this study was to identify educational priorities to ensure school health teachers’ competencies in managing students’ type 1 diabetes. Methods: A secondary analysis of the data from a cross-sectional study involving 188 health teachers was conducted. Fourteen specific competencies were identified through a literature review. Using paired t-tests, differences between knowledge levels and perceived importance were analyzed. The Borich needs assessment measured the gap between knowledge and perceived importance, and the locus for focus model presented the priorities. Results: Of the participants, 75.5% (n=142) had experience caring for students with type 1 diabetes. The discrepancy between perceived importance and knowledge level regarding the “management of the latest diabetes devices” was found to be the most significant difference (t=18.36, p<.001). High-priority competencies revealed by the Borich needs assessment and the locus for focus models included “latest guidelines,” “emergency management,” and “dietary management.” Prioritization differences were noted for the competencies “management of the latest diabetes devices,” “unique issues during the school life of children,” and “psychological issues;” the differences were dependent on the health teachers’ experience managing students with type 1 diabetes. Conclusion An educational program for health teachers is needed to enhance their competencies in managing the latest diabetes devices, handling emergencies, addressing unique issues, and staying informed about the latest insights on type 1 diabetes. Tailored education should be provided based on health teachers’ experience in managing students with type 1 diabetes.

Purpose: The aim of this study was to identify educational priorities to ensure school health teachers’ competencies in managing students’ type 1 diabetes. Methods: A secondary analysis of the data from a cross-sectional study involving 188 health teachers was conducted. Fourteen specific competencies were identified through a literature review. Using paired t-tests, differences between knowledge levels and perceived importance were analyzed. The Borich needs assessment measured the gap between knowledge and perceived importance, and the locus for focus model presented the priorities. Results: Of the participants, 75.5% (n=142) had experience caring for students with type 1 diabetes. The discrepancy between perceived importance and knowledge level regarding the “management of the latest diabetes devices” was found to be the most significant difference (t=18.36, p<.001). High-priority competencies revealed by the Borich needs assessment and the locus for focus models included “latest guidelines,” “emergency management,” and “dietary management.” Prioritization differences were noted for the competencies “management of the latest diabetes devices,” “unique issues during the school life of children,” and “psychological issues;” the differences were dependent on the health teachers’ experience managing students with type 1 diabetes. Conclusion An educational program for health teachers is needed to enhance their competencies in managing the latest diabetes devices, handling emergencies, addressing unique issues, and staying informed about the latest insights on type 1 diabetes. Tailored education should be provided based on health teachers’ experience in managing students with type 1 diabetes.

Purpose: The aim of this study was to identify educational priorities to ensure school health teachers’ competencies in managing students’ type 1 diabetes. Methods: A secondary analysis of the data from a cross-sectional study involving 188 health teachers was conducted. Fourteen specific competencies were identified through a literature review. Using paired t-tests, differences between knowledge levels and perceived importance were analyzed. The Borich needs assessment measured the gap between knowledge and perceived importance, and the locus for focus model presented the priorities. Results: Of the participants, 75.5% (n=142) had experience caring for students with type 1 diabetes. The discrepancy between perceived importance and knowledge level regarding the “management of the latest diabetes devices” was found to be the most significant difference (t=18.36, p<.001). High-priority competencies revealed by the Borich needs assessment and the locus for focus models included “latest guidelines,” “emergency management,” and “dietary management.” Prioritization differences were noted for the competencies “management of the latest diabetes devices,” “unique issues during the school life of children,” and “psychological issues;” the differences were dependent on the health teachers’ experience managing students with type 1 diabetes. Conclusion An educational program for health teachers is needed to enhance their competencies in managing the latest diabetes devices, handling emergencies, addressing unique issues, and staying informed about the latest insights on type 1 diabetes. Tailored education should be provided based on health teachers’ experience in managing students with type 1 diabetes.

PURPOSE: To determine which optic disc topographic parameters, obtained by the Heidelberg Retina Tomograph (HRT), are most useful to distinguish normal eyes from those with early to moderate glaucomatous visual field defects. METHODS: From each of 92 normal subjects and 154 patients with primary open-angle glaucoma one randomly selected eye was studied. The Humphrey perimeter, program C 30-2 visual fields, and 13 HRT parameters (software 2.01, includes rim to disc area ratio) were utilized. Because some of the optic disc parameters depend on the optic disc area, these parameters were corrected for the effect of disc area. The total glaucoma group was divided into three subgroups according to the visual field defects: early (mean deviation [MD] >-6 dB, 65 eyes), moderate (MD -6 to -12 dB, 49 eyes), and severe (MD <-12 dB, 40 eyes) glaucoma groups. RESULTS: In eyes with early glaucoma (MD = -3.43 +/- 1.60 dB), the sensitivity, specificity, accuracy, and areas under the receiver operating characteristic curve were, respectively: rim area (69%, 71%, 70%, 0.802), rim to disc area ratio (69%, 72%, 71%, 0.799), cup area (72%, 70%, 71%, 0.789) and cup to disc area ratio (69%, 70%, 69%, 0.790). In eyes with moderate glaucoma (MD = -8.75 +/- 1.88 dB), they were, respectively: rim area (78%, 86%, 83%, 0.872), rim to disc area ratio (76%, 86%, 82%, 0.869), cup area (76%, 87%, 83%, 0.864) and cup to disc area ratio (78%, 84%, 82%, 0.862). There was considerable overlap in HRT parameters between the normal and early glaucoma groups. CONCLUSIONS: The diagnostic value of single optic disc parameter had its limitations in the diagnosis of early stage glaucoma.
Diagnosis* ; Glaucoma* ; Glaucoma, Open-Angle ; Humans ; Retina* ; ROC Curve ; Sensitivity and Specificity ; Visual Fields