PURPOSE: This study was conducted to explore the impact of nurse staffing level and oral care on pneumonia in elderly inpatients in long-term care hospitals (LTCHs). METHODS: Data were obtained from the Health Insurance Review and Assessment Services (HIRA) including the profiles of LTCHs, monthly patient assessment reports and medical report survey data of pneumonia patients by HIRA in the fourth quarter of 2010. The sample consisted of 37 LTCHs and 6,593 patients. RESULTS: Patient per nurse staff (OR=1.43, CI=1.22~1.68) and no oral care (OR=1.29, CI=1.01~1.64) were significantly related with hospital acquired pneumonia. The difference in percent of oral care by hospital was not significant between high and low group in nurse staffing level. CONCLUSION: In order to reduce the occurrence of pneumonia in eldery patients, effective nursing interventions are not only required but also nurse staffing levels that enable nurses to provide the intervention.
Aged ; Humans ; Inpatients ; Insurance, Health ; Long-Term Care* ; Nursing ; Pneumonia*

PURPOSE: This study was conducted to plan and apply simulation-based practice for raising the achievement of program outcomes (POs) in nursing students. METHODS: Using convenience sampling, 95 nursing students participated in this descriptive study. A self-reported questionnaire was used to measure the achievement of POs (self-directed learning, problem-solving ability, critical thinking) and usefulness of curriculum in addition to observing tracheal suction skills using a checklist. RESULTS: A scenario with a pneumonia patient was developed to observe tracheal suction skills during simulation-based practices. Self-directed learning, problem-solving ability, and critical thinking were then scored. The mean scores of performance skill, self-directed learning, problem-solving ability, critical thinking were 37.82+/-6.03. 3.61+/-0.38, 3.61+/-0.33, and 3.73+/-0.32, respectively. All students passed the simulation-based practice in terms of performance ability and met the required achievement level for the POs at this university. Students with good suction skills showed significant differences in problem identification (p=.044) and alternative development (p=.019), which are components of problem-solving ability, compared to students with only fair skills. CONCLUSION: These findings indicate that simulation-based practice related to an adult nursing respiratory course was useful for evaluating the achievement of POs in nursing students. Further study is needed to develop a universal method of outcome measurement.
Adult ; Checklist ; Curriculum ; Humans ; Learning ; Nursing* ; Patient Simulation ; Pneumonia ; Students, Nursing* ; Suction ; Thinking

PURPOSE: This study was conducted to explore the relationship between simulation-based clinical judgment and performance ability for tracheal suction in nursing students. METHODS: With a convenience sampling, 207 nursing students participated in this descriptive study. Lasater clinical judgment rubric was used for self-reported clinical judgment in addition to observe the skill of tracheal suction using a checklist. Data were analyzed by descriptive statistics, t-test and Pearson's correlation coefficients using the SPSS/WIN 22. RESULTS: A scenario with pneumonia patient was developed to observe the skill of tracheal suction during simulation-based practices. Then self-reported clinical judgment was scored. The mean score of total sum of clinical judgment, total mean of clinical judgment, and performance skill were 36.44±4.82, 13.44±1.71, and 42.32±5.05, respectively. Statistically, students having good skills in suction showed significant differences in clinical judgment of interpreting (p=.031) compared to students having fair skills. CONCLUSION: The results of this study show that a structured debriefing method utilizing Lasater clinical judgment rubric is helpful. Also, simulation-based practice related to adult nursing in the respiratory system was useful for increasing the core basic skills among nursing students.
Adult ; Checklist ; Clinical Competence ; Humans ; Judgment* ; Methods ; Nursing* ; Patient Simulation ; Pneumonia ; Respiratory System ; Students, Nursing* ; Suction*

Coronavirus disease 2019 (COVID-19) is an acute respiratory infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Patients with COVID-19 may have respiratory dysfunction, physical dysfunction, and psychological dysfunction. Rehabilitation and long-term follow-up management are particularly important for these patients. Traditional face-to-face rehabilitation possesses high risk of infection, low coverage, time-consuming and laborious. While online rehabilitation nursing mode will be more feasible by using mobile internet technology. Based on literature review and focus group discussion, we standardize the internet-based nursing assessment, plan formulation, implementation, and effectiveness evaluation on discharged patients with COVID-19.We hope it can give guidance for nurses to provide better care for patients.
Betacoronavirus ; Coronavirus Infections ; nursing ; rehabilitation ; Humans ; Internet-Based Intervention ; Pandemics ; Pneumonia, Viral ; nursing ; rehabilitation ; Practice Guidelines as Topic

PURPOSE: 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. METHOD: 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. RESULT: 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. CONCLUSION: 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.
Adult ; Cross Infection/*etiology ; Female ; Humans ; Intubation, Intratracheal/*adverse effects/methods/nursing ; Male ; Middle Aged ; Nursing Care/standards ; Pneumonia/*etiology ; Respiration, Artificial/*adverse effects/nursing

This study was conducted to investigate the effects of a no saline, a 2 ml and a 5 ml saline instillation prior to endotracheal suctioning on oxygen saturation in patients with pneumonia. The subjects in this study were 16 pneumonic patients with a tracheotomy tube, who had been admitted to the neuro-surgical intensive care unit at a university hospital in Seoul Korea. All three (0, 2 and 5 ml) saline instillation methods were applied to the 16 patients. The methods were randomly assigned to each patient. Each of the instillation methods was applied in a four-step sequence: 1) recording the level of oxygen saturation (baseline levels), 2) instilling normal saline, 3) supplying oxygen and suctioning, and 4) recording the level of oxygen saturation. The oxygen saturation was evaluated using pulse oximetry. The recovery times for oxygen saturation to return to baseline levels following suctioning were, just after suctioning, 45seconds after suctioning and in excess of 5 minutes with 0, 2 and 5 ml saline instillations, respectively. Instillation of normal saline before suctioning could have an adverse effect on oxygen saturation, and should be used carefully as a routine intervention in patients who have pneumonia.
Adult ; Aged ; Aged, 80 and over ; Female ; Human ; Instillation, Drug ; Intubation, Intratracheal/*nursing ; Male ; Middle Age ; Oxygen/metabolism ; Pneumonia/*nursing ; Sodium Chloride/*administration & dosage ; Suction/*nursing ; Tracheotomy

STATEMENT OF PROBLEM: The introduction of "The Long-term Care Insurance System"(a public nursing care insurance scheme) is scheduled from July in 2008. Lately, the importance of oral health care had increased. Introduction and establishment of the methodology (nursing care procedure) based on professional dental knowledge is inevitable. PURPOSE: The purpose of this study was to rouse recognition of the importance of dental care in the long term elderly care in nursing homes, with implementation of the new insurance law. MATERIAL AND METHODS: Visited two institutions for the elderly, Yudang Village and Sungjiwon located in Suwon city to investigate the present conditions in terms of (1) the detailsof the institution, (2) the activities concerning with dental care in the institution, and (3) the consciousness and recognition regarding dental care of the staffs. RESULTS: In two institutions, under the present conditions, oral cleaning (including the cleaning of denture) for residents was operated with no professional advices and limited professional dental care. It was found that there was very little awareness of aspiration pneumonia. The members of staff however, did recognizethe necessity of professional maintenance and management of oral care in daily nursing care, and that many residents hold dental problems. They were very eager in introducing the methodology (nursing care procedure) in dental care in nursing homes.
Aged ; Asian Continental Ancestry Group ; Consciousness ; Dental Care ; Dentists ; Humans ; Insurance ; Insurance, Long-Term Care ; Jurisprudence ; Korea ; Long-Term Care ; Nursing Care ; Nursing Homes ; Oral Health ; Pneumonia, Aspiration

BACKGROUND: We evaluated the value of neutrophil-lymphocyte count ratio (NLCR) in patients admitted to the Emergency Department (ED) with suspected nursing home acquired pneumonia (NHAP). METHODS: From May 2011 to January 2013, 116 patients admitted to the ED with suspected NHAP were retrospectively studied. The clinical characteristics, C-reactive protein (CRP), white blood cell count, neutrophil count, lymphocyte count, and NLCR were assessed. CURB-65 score was used to calculate disease severity. General ward or intensive care unit (ICU) admissions, and 72-hour and 30-day mortality for each infection marker was assessed. RESULTS: The 116 patients had a median age of 77 years. As the CURB-65 score increased from 0-1 (low risk), to 2-3 (moderate risk), and to 4-5 (high risk), the NLCR consistently increased (mean, 6.9, 8.89, and 16.22, respectively). The difference between the moderate and high risk groups was significant (p=0.008). The NLCR (mean+/-standard deviation) was high in patients with NHAP (10.28+/-8.81) and increased even more for patients admitted to the ICU (15.69+/-14.81) or who died within 72-hour (15.63+/-9.57). NLCR showed the trend of higher value in ICU admission (p=0.072), and CRP was significantly different between ICU and general ward admission (p=0.007). CONCLUSION: NLCR at ED admission correlated with NHAP severity and was comparable to the traditional infection marker. NLCR can be assessed simply and added to the assessment tools to determine the severity of pneumonia during ED admission.
C-Reactive Protein ; Emergencies ; Humans ; Intensive Care Units ; Leukocyte Count ; Lymphocyte Count ; Mortality ; Neutrophils ; Nursing Homes* ; Nursing* ; Patients' Rooms ; Pneumonia* ; Retrospective Studies

Healthcare associated pneumonia resembles hospital acquired pneumonia in patient characteristics and in causative microorganisms. Patients from healthcare facililties are are likely to be of old age, disabilitated and have associated comorbidities. Most frequently associated organisms are enteric gram negative rods and staphylococcus aureus. However patients referred from healthcare facilities are comprised of heterogeneous risk groups, so individual risk for harboring resistant pathogens should be assessed before treatment. People residing in healthcare facilities are also at risk for atypical pneumonia and viral pneumonia. Pathogens such as legionella and chlamydia should also be taken into account, as well as viral agents like influenza and RSV which could result in seasonal, mass infection in patients residing in healthcare facilities like nursing homes. Considering the high rates of antibiotic resistance in korea, a prospective trial comparing community acquired and healthcare associated pneumonia is needed.
Chlamydia ; Comorbidity ; Delivery of Health Care ; Drug Resistance, Microbial ; Humans ; Influenza, Human ; Korea ; Legionella ; Nursing Homes ; Pneumonia ; Pneumonia, Viral ; Seasons ; Staphylococcus aureus

BACKGROUND: Little data is available regarding hospitalized patients with nursing home-acquired pneumonia (NHAP). This is unfortunate because there is an increasing number of elderly persons who are living in nursing homes in Korea. The aim of this study was to compare clinical characteristics and treatment responses of NHAP with community-acquired pneumonia (CAP). METHODS: Patients with pneumonia who were admitted from eight nursing homes or from their own homes were enrolled between May 2007 and April 2009. Their clinical characteristics and treatment responses were reviewed retrospectively, and differences between the two groups were analyzed. RESULTS: Of 110 Patients with pneumonia, 66 (60%) were from nursing homes and their median age was 84. In the NHAP group, functional performance status was significantly poorer, classical symptoms of pneumonia were less severe, and multi-lobe involvement (on chest radiographs) was more frequent than in the CAP group. Patients with NHAP more frequently showed lymphocytopenia, anemia, hypoalbuminemia, hypoxemia, and elevated blood urea nitrogen on admission. The mean CURB-65 score was 2.2 in the NHAP group, higher than 1.7 in the CAP group (p=0.004), and multi-drug resistant pathogens were also highly identified in NHAP group (39% vs. 10%, p=0.036). The mean duration of antibiotic therapy was greater for the NHAP (12.6 days) than for the CAP group (6.6 days) (p<0.001). The mortality rate was 23% in NHAP group, which was significantly higher than 5% in the CAP group (p=0.014). CONCLUSION: NHAP should be more intensively investigated because of the higher frequency of multi-drug resistant pathogens and mortality than the CAP.
Aged ; Anemia ; Anoxia ; Blood Urea Nitrogen ; Humans ; Hypoalbuminemia ; Korea ; Lymphopenia ; Nursing Homes ; Pneumonia ; Pyrenes ; Retrospective Studies ; Thorax