INTRODUCTION: Hospitalisations can pose hazards and may not be an appropriate care setting for frail nursing home (NH) residents. Few studies have quantified the extent of NH resident hospitalisations in Singapore, hence we aimed to address this knowledge gap by studying characteristics of unplanned hospitalisations over a 1-year period. METHOD: This was a retrospective cohort study of 9922 subsidised residents across 59 NHs in Singapore, with analysis using administrative healthcare data. Key measures included inpatient admission and emergency department visit rates, final discharge diagnoses and estimated costs. We examined correlates of inpatient admissions with a multivariable zero-inflated negative binomial regression model incorporating demogra-phics, institutional characteristics and Charlson Comorbidity Index. RESULTS: There were 6620 inpatient admissions in 2015, equivalent to 2.23 admissions per 1000 resident days, and the majority were repeat admissions (4504 admissions or 68.0%). Male sex (incidence rate ratio [IRR] 1.23), approaching end-of-life (IRR 2.14), hospitalisations in the past year (IRR 2.73) and recent NH admission within the last 6 months (IRR 1.31-1.99) were significantly associated with inpatient admission rate. Top 5 discharge diagnoses were lower respiratory tract infections (27.3%), urinary tract infection (9.3%), sepsis (3.1%), cellulitis (1.9%) and gastroenteritis (1.1%). We estimated the total system cost of admissions of subsidised residents to be SGD40.2 million (USD29.1 million) in 2015. CONCLUSION We anticipate that unplanned hospitali-sation rate will increase over time, especially with an increasing number of residents who will be cared for in NHs. Our findings provide a baseline to inform stakeholders and develop strategies to address this growing problem.
Humans ; Singapore ; Nursing Homes/economics* ; Retrospective Studies ; Male ; Female ; Hospitalization/statistics & numerical data* ; Aged ; Aged, 80 and over ; Emergency Service, Hospital/statistics & numerical data* ; Information Storage and Retrieval ; Homes for the Aged/economics* ; Frail Elderly/statistics & numerical data*

Objective: To understand the current situation of emergency department nurses' work engagement, and analyze the relationship between emergency department nurses' organizational climate perception, work-related acceptance actions and work engagement. Methods: In May 2021, 273 emergency department nurses from 6 class Ⅲ class a general hospitals in Tianjin were selected as the research objects by using the convenient sampling method, and the general information questionnaire, work input scale, nurses' organizational climate perception scale and work-related acceptance action questionnaire were used for questionnaire survey. The correlation between job involvement and nurses' organizational climate perception and job-related acceptance action was analyzed by pearson correlation, and the influencing factors of job involvement were analyzed by multiple linear regression. Results: The average score of job involvement was (3.57±0.45) , the average score of nurses' organizational climate perception was (3.29±0.69) , and the score of work-related acceptance action was 35.00 (29.00, 47.00) . The results of correlation analysis showed that there was a positive correlation between nurses' organizational climate perception, job acceptance action and job involvement in emergency department (r=0.435, 0.518, P<0.05) . Multiple stepwise regression analysis showed that job acceptance, nurses' perception of organizational climate, health status, specialist nurses, education and emergency work years were the influencing factors of emergency department nurses' job involvement (P<0.05) , accounting for 41.9% of the total variation. Conclusion: We should create a good organizational atmosphere, improve the acceptance of emergency department nurses to nursing work, and improve the level of nurses' work input.
Emergency Service, Hospital ; Humans ; Job Satisfaction ; Nurses ; Nursing Staff, Hospital ; Perception ; Surveys and Questionnaires ; Work Engagement

nursing home–acquired pneumonia (NHAP). We found factors associated with the use of inappropriate antibiotics in patients with pneumonia admitted to the ICU via the emergency room (ER).METHODS: We performed a retrospective cohort study of 83 pneumonia patients with confirmed causative bacteria admitted to ICUs via ER March 2015–May 2017. We compared clinical parameters, between patients who received appropriate or inappropriate antibiotics using the Mann-Whitney U, Pearson's chi-square, and Fisher's exact tests. We investigated independent factors associated with inappropriate antibiotic use in patients using multivariate logistic regression.RESULTS: Among 83 patients, 30 patients (36.1%) received inappropriate antibiotics. NHAP patients were more frequently treated with inappropriate antibiotics than with appropriate antibiotics (47.2% vs. 96.7%, p<0.001). Methicillin-resistant Staphylococcus aureus was more frequently isolated from individuals in the inappropriate antibiotics–treated group than in the appropriate antibiotics–treated group (7.5% vs. 70.0%, p<0.001). In multivariate analysis, NHAP was independently associated with the use of inappropriate antibiotics in patients with pneumonia admitted to the ICU via ER.CONCLUSION: NHAP is a risk factor associated with the use of inappropriate antibiotics in patients with pneumonia admitted to the ICU via the ER.]]>
Anti-Bacterial Agents ; Bacteria ; Cohort Studies ; Critical Care ; Emergency Service, Hospital ; Hospitals, Teaching ; Humans ; Intensive Care Units ; Logistic Models ; Methicillin-Resistant Staphylococcus aureus ; Multivariate Analysis ; Nursing ; Pneumonia ; Retrospective Studies ; Risk Factors

BACKGROUND AND OBJECTIVES: Noise levels and room acoustic parameters at a tertiary referral hospital, Seoul National University Hospital (SNUH) in Korea, are investigated. MATERIALS AND METHODS: Through a questionnaire, acoustically problematic rooms are identified. Noise levels in emergency rooms (ERs) and intensive care units (ICUs) are measured over about three days. Acoustically critical and problematic rooms in the otolaryngology department are measured including examination rooms, operating rooms, nurse stations, receptions, and patient rooms. RESULTS: The A-weighted equivalent noise level, L(Aeq), ranges from 54 to 56 dBA, which is at least 10 dB lower than the noise levels of 65 to 73 dBA measured in American ERs. In an ICU, the noise level for the first night was 66 dBA, which came down to 56 dBA for the next day. The noise levels during three different ear surgeries vary from 57 to 62 dBA, depending on the use of surgical drills and suctions. The noise levels in a patient room is found to be 47 dBA, while the nurse stations and the receptions have high noise levels up to 64 dBA. The reverberation times in an operation room, examination room, and single patient room are found to be below 0.6 s. CONCLUSIONS: At SNUH, the nurse stations and receptions were found to be quite noisy. The ERs were quieter than in the previous studies. The measured reverberation times seemed low enough but some other nurse stations and examination rooms were not satisfactory according to the questionnaire.
Acoustics ; Ear ; Emergency Service, Hospital ; Intensive Care Units ; Korea ; Noise ; Nursing Stations ; Operating Rooms ; Otolaryngology ; Patients' Rooms ; Seoul ; Suction ; Tertiary Care Centers

PURPOSE: This study was conducted to identify the effects of organizational culture for the infection control and self-efficacy on compliance with standard precautions of emergency room nurses. METHODS: This cross-sectional descriptive study was conducted from 1st July to 3rd August, 2017. The participants were 200 nurses working in emergency rooms. The data was collected using structured self-report questionnaires. RESULTS: The average scores for the organizational culture for infection control, self-efficacy and compliance with standard precautions were 5.54, 3.65, and 4.31, respectively. The organizational culture for infection control (r=.59, p<.001) and self-efficacy (r=.28, p<.001) were found to have a positive, meaningful correlation with compliance with the standard precautions. Multiple regression analysis showed that compliance with standard precautions was significantly affected by the organizational culture for infection control (β=0.55, p<.001) and self-efficacy (β=0.13, p=.033). CONCLUSION: The results for this study indicate that the organizational culture for infection control and self-efficacy were highly influential factors affecting compliance with standard precautions of emergency room nurses. Therefore, in order to improve the nurses' use of the standard precautions, it was necessary to develop and evaluate a program that considers the environmental factors and self-efficacy.
Compliance ; Emergencies ; Emergency Nursing ; Emergency Service, Hospital ; Infection Control ; Organizational Culture

PURPOSE: The purpose of this review was to evaluate the effects of emergency nursing simulation program on nursing students and nurses. METHODS: This systematic review was performed as per the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and using the R program meta package (version 4.9-2). RISS, KISS, and DBpia Library databases were searched for studies published between June 2000 and August 2018 using the following key words: (Emerge* OR nursing) AND (nurs* OR simulation). Selected studies were assessed for methodological quality using Risk of Bias for Non randomized Studies. RESULTS: 7 studies were identified and all of them met the inclusion criteria. The outcome variables were significant clinical performance, self-efficacy except knowledge, and problem-solving ability. CONCLUSION: This review provides updated evidence of the simulation-based education program in emergency nursing. Further studies are required to increase generalizability using randomized population, research design and controlled trials with sufficient sample size. Moreover, valid measurements are needed to assess the main outcomes.
Bias (Epidemiology) ; Education ; Emergencies ; Emergency Nursing ; Humans ; Korea ; Nursing Care ; Nursing ; Research Design ; Sample Size ; Simulation Training ; Students, Nursing

PURPOSE: This study focuses on investigating the effectiveness of simulation education on emergency management using a low-fidelity simulator as related to clinical skill performance, self-confidence, knowledge, learning satisfaction, and critical thinking disposition in new nurses. METHODS: A pre-post test experimental design of nonequivalent control group was applied. Fifty-five new nurses were recruited, 28 nurses for the experimental group and 27 nurses for the control group. A simulation education for emergency management comprising knowledge lecture, team learning, skill education, team simulation, and debriefing was developed and implemented from Feb. 14 to 27, 2015. Data were analyzed with percentage, average, and standard deviation, chi-square, and t-test using SPSS. RESULTS: The experimental group showed significantly higher knowledge (t=5.81, p<.001), clinical skill performance (t=10.08, p<.001), self-confidence (t=-6.24, p<.001), critical thinking disposition (t=2.42, p=.019), and learning satisfaction (t=4.21, p<.001) for emergency management compared with the control group who had traditional lecture education. CONCLUSION: The results indicate that a simulation education using a low-fidelity simulator is an efficient teaching method for new nurses to deepen their clinical skill performance, self-confidence, knowledge, learning satisfaction, and critical thinking disposition in learning emergency management.
Clinical Competence ; Education ; Emergencies ; Emergency Nursing ; Evaluation Studies as Topic ; Learning ; Patient Simulation ; Research Design ; Teaching ; Thinking

PURPOSE: The purpose of this study was to develop an informational leaflet on emergency care and to explore effects of facilitative nurse-patient interaction behavior using an informational leaflet on patient satisfaction with nurse-patient interaction behavior, patient anxiety, and patient satisfaction with use of emergency care. METHODS: This study was a quasi-experimental study that applied a nonequivalent control-group posttest-only design. The participants were 81 patients who visited the emergency department of a hospital in Korea; the experimental group (n=40) received facilitative nurse-patient interaction behavior using an informational leaflet, and the control group (n=41) received care under routine protocols without an information leaflet. The effects of the two groups were analyzed using an independent t-test with SPSS computer program. RESULTS: Patient satisfaction with nurse-patient interaction behavior and use of emergency care in the experimental group were significantly higher than in the control group. Patient anxiety related to using emergency care in the experimental group was significantly lower than the control group. CONCLUSION: Therefore, facilitative nurse-patient interaction behavior using an informational leaflet to the patient may be useful interventions that are easily implemented by nurses in emergency settings.
Anxiety ; Emergencies ; Emergency Medical Services ; Emergency Nursing ; Emergency Service, Hospital ; Humans ; Korea ; Non-Randomized Controlled Trials as Topic ; Nurse-Patient Relations ; Patient Satisfaction

PURPOSE: Although emergency care is one of the most important capabilities for novice nurses, many novice nurses have shown difficulty in emergency care in the clinical field. The purpose of this study was to provide evidence data for the future development of educational programs by analyzing the priorities in emergency care of novice nurses using the Importance-Performance Analysis. METHODS: This study was designed as a descriptive survey. The participants were 197 novice nurses who worked in general hospitals from August 1 to 31, 2018. The questionnaire consisted of ‘common emergency care’, ‘cardiovascular emergency care’, ‘nervous system emergency care’, ‘respiratory system emergency care’, ‘communication and teamwork competency’. RESULTS: As a result of this study, ‘communication and teamwork’ among emergency cares was evaluated as the most important capability in the clinical field. In the Importance-Performance Analysis, a total of 12 items were included in the quadrant A, including 5 items related to ‘cardiovascular emergency care’, 4 items to ‘respiratory system emergency care’, 2 items to ‘nervous system emergency care’ and 1 item to ‘common emergency care’. The results showed a need for intensive improvement in items included in quadrant A which are the high importance low performance items. CONCLUSION: In order to improve the emergency care of novice nurses, a variety of emergency care education programs on the nervous system and respiratory system care should be implemented as well as cardiovascular emergency care education.
Clinical Competence ; Education ; Emergencies ; Emergency Medical Services ; Emergency Nursing ; Hospitals, General ; Nervous System ; Respiratory System

PURPOSE: The purpose of this study was to examine the frequency, perceived importance and competence of pediatric emergency nursing practice (PENP) in nurses who cared for pediatric patients in the emergency department. METHODS: This cross-sectional descriptive study analyzed 175 emergency department nurses caring for pediatric patients at 7 university hospitals with more than 500 beds, located in Seoul and Gyeonggi Province. The measurement tool was modified from the Classification of Standard Nursing Activities to measure the frequency, importance of PENP, and nursing competence. It comprised 143 items in 16 domains of PENP. RESULTS: The most frequent nursing practice was the domain of ‘nursing records and environmental management’ and the least frequent practice was the ‘research and consulting’ domain. The nursing care domain perceived to be most important by nurses was ‘specialized intensive nursing care’. The nursing care domain with the highest level of nursing competence was ‘hygiene care’, and the domain with the least level of nursing competence was the ‘research and consulting’. CONCLUSION: These results will be utilized as basic data for future pediatric emergency nursing education initiatives and for establishing priorities of nursing policy to improve health care for children admitted to the emergency department.
Child ; Child Care ; Classification ; Delivery of Health Care ; Education ; Emergencies ; Emergency Nursing ; Emergency Service, Hospital ; Gyeonggi-do ; Hospitals, University ; Humans ; Mental Competency ; Nurse's Role ; Nursing Care ; Nursing ; Professional Competence ; Seoul