Purpose Over 10% of intensive care unit (ICU) patients die; however, research aimed at assessing and improving the quality of their deaths remains scarce. This study investigated the impact of communication among healthcare professionals and person-centered care provided by ICU nurses on the quality of dying and death (QODD) experienced by ICU patients.
Methods We measured general characteristics of ICU nurses, interprofessional communication, and person-centered care, and identified their impact on the quality of death for patients who died in the ICU. Participants consisted of 103 ICU nurses employed at two tertiary hospitals in South Korea. Data were collected between January and May 2023. Descriptive statistics, the t-test, analysis of variance, the Mann-Whitney U test, Pearson correlation coefficients, and multiple linear regression analyses were conducted using SPSS version 23.0.
Results The mean QODD score was 44.73±21.26. QODD was positively correlated with openness (nurse-physician), understanding (nurse-physician), satisfaction (nurse-physician), and person-centered care. Factors significantly influencing QODD included nurse-physician communication, specifically understanding (β=.35, p=.010), and person-centered care (β=.19, p=.033), explaining 20.2% of the total variance (F=7.44, p<.001).
Conclusion Improved communication among healthcare professionals and enhanced person-centered care are essential for improving the QODD for ICU patients. To achieve this, educational initiatives focusing on end-of-life care and communication training programs for healthcare professionals should be implemented.
Purpose This study aimed to determine the rates of intensive care unit readmission and to identify the factors influencing readmission among intensive care unit patients aged≥65 years with internal medicine conditions.
Methods We retrospectively reviewed electronic medical records from a tertiary care hospital in Seoul, analyzing the characteristics of patients who were and were not readmitted between December 2020 and September 2022.
Results A total of 351 patients were included. The unplanned intensive care unit readmission rate was 4.8% within 7 days and 9.1% beyond 7 days after discharge. Comorbid diabetes, higher total bilirubin levels at intensive care unit admission, lower PaO2/FiO2 ratios at discharge, and elevated Blood Urea Nitrogen (BUN) levels at discharge were associated with an increased risk of readmission within 7 days. In contrast, hypertension, prolonged intensive care unit stays, and lower hemoglobin levels at discharge were associated with readmissions occurring after 7 days.
Conclusion Intensive care unit readmission among older patients is influenced by several clinical and hematological factors. Nurses should consider a patient's history of diabetes and hypertension, length of intensive care unit stay, and laboratory values-specifically total bilirubin at admission, and PaO2/FiO2 ratio, hemoglobin, and BUN levels at discharge-when making discharge decisions. These findings can inform the development of discharge guidelines.
Purpose Patients in the Intensive Care Unit (ICU) experience a variety of symptoms. This descriptive correlational study aimed to determine the prevalence of symptoms and the physiological and situational factors associated with these symptoms in ICU patients. Methods We analyzed the Electronic Medical Records (EMRs) of 1,214 cases admitted to and discharged from the ICUs of a university hospital in Seoul over a 1-year period from June to September 2022. This analysis utilized standardized instruments embedded in EMRs and a natural language analysis framework developed by the researchers. Descriptive statistics, the x 2 test, the Fisher exact test, and multivariate logistic regression were employed to identify common symptoms and their related factors. Results In total, 85.7% of the cases had at least one symptom during their ICU stay, and 36.6% experienced 2 symptoms. Pain was the most frequently experienced symptom, affecting 69.5% of cases, followed by agitation (29.7%), dyspnea (29.7%), and delirium (4.8%). Multivariate logistic regression analysis indicated that the length of ICU stay influenced pain (odds ratio [OR]=1.04; 95% confidence interval [CI], 1.02~1.06; p<.001), delirium (OR=1.08; 95% CI, 1.06~1.11; p<.001), agitation (OR=1.07; 95% CI, 1.05~1.10; p<.001), and dyspnea (OR=1.19; 95% CI, 1.13~1.26; p<.001). Conclusion Pain, agitation, and dyspnea are common in ICU patients and are associated with the length of their ICU stay. Our study identifies factors related to these symptoms that could be targeted to manage and reduce their occurrence, providing a foundation for future research on various symptom assessment tools and natural language transcripts.
Purpose The purpose of this descriptive survey study was to investigate the relationship between death awareness, life-sustaining nursing stress, end-of-life care competency and performance, and resilience. Additionally, the factors influencing end-of-life care performance by ICU nurses were identified.
Methods: Data were collected from one tertiary and two general hospitals in J province from July 1 to July 30, 2022. Nurses working in Intensive Care Units (ICU) for more than three months who had experience in end-of-life care were selected through convenience sampling. A total of 188 responses to the survey were included in the final analysis. An IBM SPSS program was used for the data analysis.
Results: Factors impacting end-of-life care performance (with an explanatory power of 31.9%) were as follows: higher knowledge and behavioral competency in end-of-life care, higher relational patterns in resilience, higher levels of death positivity in death awareness, and clinical experience of less than a year compared to that of three to five years were associated with higher end-of-life care performance.
Conclusion: These findings point to the urgent need for increasing end-of-life care performance among nurses in clinical practice; therefore, practical strategies must be developed and actively implemented to strengthen relevant competencies and resilience and promote death positivity. Based on these findings, future studies are needed to develop an intervention program to improve the spiritual scope of end-of-life care and verify the effects.
Purpose The purpose of this study was to identify the incidence and risk factors associated with the unplanned removal of nasogastric (NG) tubes in neurocritical patients. Methods Data were collected retrospectively from the medical records of 479 patients admitted to the tertiary hospital's neuro-intensive care units (NCU). Subjects were divided into two groups depending on whether there was unplanned NG tube removal. Multivariate logistic regression analysis was used to identify risk factors. Results Unplanned removal of NG tubes occurred in 35.9% of patients. The incidence of unplanned NG tube removal was 47.2 per 1,000 patient days. Intubated time of the NG tube was 3.96 days in patients with unplanned removal. Risk factors associated with unplanned removal were men (Odds Ratio [OR]=2.19), epilepsy (OR=9.99), traumatic brain injury (OR=5.50), stroke (OR=4.42), improvement of Glasgow Coma Scale (GCS) (OR=1.08), delirium (OR=1.88), physical restraint (OR=2.44), and drainage or decompression purpose (OR=1.67). Conclusion Unplanned removal of NG tubes occurred very frequently in neurocritical patients. Care should be taken for patients with neurological diseases who show improvement in their level of consciousness but are still confused due to brain lesions or delirium to reduce it. The application of physical restraints cannot guarantee the prevention of unplanned NG tube removal. Therefore, nurses need to assess the condition of patients and NG tubes frequently.In particular, more attention should be paid to using NG tubes for decompression or drainage purposes. It is also proposed to actively review the NG tube removal plan through periodic evaluation.
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Purpose This study aimed to investigate the effects of a Multicomponent Intervention Program for Preventing Delirium (MIPPD) on the incidence of delirium, self-extubation or self-removal of the catheter, and length of stay among elderly patients in the Intensive Care Unit (ICU). Methods This study employed a nonequivalent control group pretest-posttest non-synchronized design to verify the MIPPD effects. The participants, 73 patients aged over 65 years were admitted to a university hospital's ICU in J province between December 2015 and July 2016. The MIPPD contained the following elements: family caregiver education, delirium assessment, reorientation activities, therapeutic communication, sensory intervention for vision and hearing impairments, management of immobility or limited mobility, family support, and maintenance of sleeping patterns. Under the program, nurses and family members provided immediate intervention to elderly patients with an expected length of stay of at least 48 hours. Results After the MIPPD application, the incidence of delirium in the intervention group was significantly lower (odds ratio=0.19, 95% confidence interval=0.03~0.97) than that in the control group. However, there were no significant differences between the groups in terms of self-extubation or catheter self-removal and length of stay. Conclusions This program can effectively reduce the incidence of delirium. Because prevention is optimal for delirium management, a proactive intervention must be considered; given that, in this study, there were no problems in terms of family engagement, an MIPPD involving family participation should be actively implemented in intensive care unit practice.
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Purpose This study was conducted to identify the factors affecting the performance of person-centered care among Intensive Care Unit (ICU) nurses from an ecological perspective. Methods The participants were 172 ICU nurses working in eight hospitals in B city. Data were collected from July to August, 2020. The questionnaire consisted of measuring tools for general characteristics, performance of person-centered care, compassion satisfaction, communication competence, and teamwork. The SPSS/25.0 program was used to analyze the data using hierarchical multiple regression. Results According to the hierarchical multiple regression analysis, total nursing experience, compassion satisfaction, communication competence, and team work accounted for 44.1% of the variance in performance of person-centered care among ICU nurses (p<.001). Conclusion Enhancing compassion satisfaction, communication competence, and teamwork can help increase the performance of ICU nurses’ person-centered care. In addition, in order to improve the performance of person-centered care among ICU nurses, it is necessary to investigate and explore the factors hindering the performance of person-centered care among ICU nurses with more than 5 years of experience. Therefore, multidimensional efforts are needed to develop educational programs to increase the performance of person-centered care among ICU nurses.
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Purpose This descriptive study aimed to present the incidence of delirium and identify risk factors for delirium in Trauma Intensive Care Unit (TICU) patients.
Methods: The participants were 184 patients who were hospitalized in the TICU at a Regional Trauma Center in Gyeonggi-do. Data were collected between April and November 2019. For delirium measurement, the author used the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Diverse dependent variables were collected through electronic medical records. Data were analyzed using descriptive statistics, independent t-test, x2 -test, and binomial logistic regression.
Results: Incidence of delirium in TICU patients was 34.8%. Logistic regression analysis showed that the risk factors for delirium in TICU patients were hemoglobin (Odds Ratio [OR]=0.62, 95% Confidence Interval [CI]=0.43~0.88), injury severity score (OR=1.10, 95% CI=1.01~1.20), length of TICU stay (OR=1.15, 95% CI=1.03~1.29), administered sedatives (OR=6.04, 95% CI=2.47~14.76), and use of restraints (OR=5.75, 95% CI=2.29~14.42).
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Purpose This study aimed to develop an intervention to reduce noise in the Intensive Care Unit (ICU) and evaluate the effects of applying it.
Methods: The research design was a non-equivalent control group quasi-experimental study. To develop noise reduction interventions in ICUs, preliminary intervention techniques to reduce noise were derived through a literature review, field survey, and focus group interviews. The intervention was developed by verifying the validity of the content and the clinical applicability, and the result was applied to practice. To assess the effect of the intervention, the following were evaluated: noise level in the ICU, perceived noise level, response to noise, satisfaction of patients and staff with noise management, sleep quality of patients, noise-related knowledge, and perception and performance of noise management of the staff.
Results: With the intervention developed in this study, the noise level in the ICU, perceived noise level, and response to noise of patients and staff decreased, and satisfaction with noise management increased. The sleep quality of patients, noise-related knowledge, and perception and performance of noise management of the staff increased.
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PURPOSE This study aimed to investigate the actual noise conditions in adult Intensive Care Units (ICUs) according to type, time, day of the week, and area. METHODS This study was conducted from February to March 2018. ICU noise levels were examined using a noise meter with a microphone an amplifier, auditory correction circuit, and indicator meter capable of directly reading A-weighted decibels (dBA). Noise was measured for 24 hours for seven days and the average dBA, maximum dBA, and minimum dBA were recorded. RESULTS The highest mean noise level was 58.48 dBA (range of 57.62~65.27), while lowest was 51.65 dBA (range of 51.36~52.86). Average noise levels on weekdays and weekends were over 50 dBA(the open zone was measured at 56.61 dBA, while the isolation zone was measured at 52.45 dBA. Further, daytime, evening work-times and weekdays were measured above 60 dBA, while nighttime noise levels were below 60 dBA. Finally, average noise levels during turnarounds, shift changes, and rounding times were above 60 dBA; open zone had higher average noise levels than the isolation zone. CONCLUSION This study showed that ICU noise levels exceeded those recommended by the World Health Organization regardless of type of noise, day of the week, or time. Therefore, studies are proposed to identify the need or importance of noise management by ICU personnel to reduce noise in ICUs. It also proposes studies to develop and apply noise reduction strategies that can be easily used in practice, reflecting the various characteristics of noise in ICUs.
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PURPOSE The aims of this study were to describe the incidence rate of delirium and to identify factors influencing delirium in neurological intensive care unit patients. METHODS The participants were 193 critically ill patients with neurological disorder from Chonbuk national university hospital in Jeonju. Data were collected between April 1 and November 25, 2017 using four structured questionnaires: Confusion Assessment Method for the Intensive Care Unit, Glasgow Coma Scale, Acute Physiology and Chronic Health Evaluation II, and Karnofsky Performance Scale. Data were analyzed using descriptive statistics, independent t-test, χ2 test, Mann-Whitney U test, and logistic regression using the SPSS/WIN 24.0 program. RESULTS The incidence rate of delirium was 11.9%. Delirium was related with age, length of stay in intensive care unit, Glasgow Coma Scale score, Acute Physiology and Chronic Health Evaluation II score, Karnofsky Performance Scale score, use of physical restraint, antihypertensive drugs, and anticonvulsants. Logistic regression analysis showed that age, length of stay in intensive care unit, use of physical restraint, and anticonvulsants were factors influencing delirium in neurological intensive care unit patients. CONCLUSION Delirium was related to demographic, clinical, medication-related, and environmental factors in patients in neurological intensive care units. Therefore, nurses should consider the patient's age, length of stay intensive care unit, use of physical restraint, and anticonvulsants in assessing delirium in neurological intensive care unit patients. Delirium prevention programs considering these factors may be effective for such patients.
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PURPOSE The purpose of this study was to identify the factors which contribute to the burnout of a family member providing care to a family member in the intensive care unit (ICU). METHODS Data about participants' characteristics, stress, burden, social support and burnout were collected from March 1 to September 15, 2016. Data were collected through interviews and a self-report questionnaire. One hundred and twenty-three participants who were the primary caregiver participated in the study. RESULTS The reported mean stress score was 2.13±0.78 and of reported burden was 3.24±0.27. The mean score of social support was 3.17±0.59 and of burnout was 2.61±0.58. There were significant differences in education level, financial burden, assistant, and health status in burnout of the family caregivers. Burnout had significant correlations with stress (r=.76, p < .001), burden (r=.43, p < .001), and social support (r=-.62, p < .001). The influencing factors on burnout were stress (β=0.63, p < .001), burden (β=0.14, p=.010), and social support (β=-0.32, p < .001). These variables explained 71.8% of the total variance in burnout. CONCLUSION The results suggest that stress, burden, and social support should be considered in developing the nursing interventions to improve the burnout among family caregivers of the ICU patients.
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PURPOSE The aims of the study were to investigate relationships among intensive care unit (ICU) nurses' attitude, role perception, and nursing stress related to life sustaining treatment (LST), and secondly, to identify factors influencing nursing stress about LST. METHODS Participants were 202 conveniently sampled ICU nurses from general hospitals in Korea with over 300 beds. From December 1, 2015 to January 31, 2016, data were collected using structured questionnaires. The questionnaire was designed to measure nursing stress related to LST. Content validity and reliability was established for the instrument. RESULTS Relationships were found between attitude and role perception, and between role perception and nursing stress about LST. Participants' role perception, gender, education level, and the experience of dealing with family members of patients receiving LST accounted for 13% of variance in nursing stress about LST. CONCLUSION Results confirmed that ICU nurses' role perception affects nursing stress about LST. Accordingly, the nursing education programs related to LST should aim to enhance role perception of nurses, and strategies to reduce the nursing stress about LST of the nurses in ICU need to be further developed.
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PURPOSE This study was conducted to identify factors influencing compliance of multidrug-resistant organism infection control in intensive care units (ICU) nurses. METHODS Data were collected from 254 ICU nurses who were working at 6 general and advanced general hospitals in D city and G Province. RESULTS 77.2% and 84.4% of the subjects correctly answered to questions about Methicillin-Resistant Staphylococcus Aureus (MRSA) and Vancomycin-Resistant Enterococcus (VRE), respectively. The scores of MRSA infection control compliance and VRE infection control compliance were 3.41 and 3.43, respectively. The factors influencing MRSA infection control compliance were empowerment, environmental safety recognition, and education satisfaction, which explained 30% of MRSA infection control compliance. The factors significantly related to VRE infection control compliance were empowerment, hospital types, environmental safety recognition, number of education sessions, and neonatal ICU, which explained 37% of VRE infection control compliance. CONCLUSION It is necessary to develop efficient educational programs for infection control including educational contents to improve empowerment and environmental safety recognition of nurses. Furthermore, administrative support for those infection control programs is also necessary.
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PURPOSE The purpose of this study was to investigate the emotional response of family members of physically restrained patients in the intensive care units (ICUs). METHODS The study subjects were 200 family members of ICU patients who had been on physical restraints in two university hospitals. Data were collected using the "Instrument of family's emotional response toward physically restrained patients". RESULTS The mean score of familial emotional response was 2.69 out of a possible 5. The subcategory of acceptance was the highest with 3.56 points followed by depression (3.02), helplessness (2.94), anxiety (2.87), shock (2.74), avoidance (2.64), and grudge (2.08). Multiple stepwise regression analysis indicated that the age of family members, side effects of restraints, and information provision were the variables influencing on negative emotional response of family. CONCLUSION Family members showed slightly negative emotional response toward the physical restraints. This finding could be influenced by their limited knowledge of the need for the restraints. Educational programs or fact sheets to be given to family members may be helpful.
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PURPOSE The purpose of this study was to examine if simulation training affects new graduate critical care nurses' knowledge, self-efficacy, and performance ability in emergency situations. METHODS: Forty new graduate critical care nurses were randomly assigned to either an experimental or a control group. The experimental group had didactic with simulation. The control group received only didactic without simulation about emergency situations. The data were collected before and after the training interventions. An independent t-test used for difference among variables. RESULTS: There were no significant demographic differences between the two groups or any differences on data collected knowledge, self-efficacy and performance ability. Following the training, there were significant performance ability scores (p<.001) among the nurses receiving didactic with simulation. There were no significant difference between the two groups relative to knowledge scores (p=.117), or the self-efficacy scores (p=.100). CONCLUSION: This study showed that simulation training for new graduate critical care nurses is useful to improve performance ability on emergency situations. Hence, providing simulation training to critical care nurses during an orientation period would improve quality of critical care nursing and help the new graduates nurse's adaptation.
PURPOSE This study was to examine whether VRE infection control strategies have an effect on the decrease in incidence rates for VRE acquisition and VRE nosocomial infection in ICU. METHODS All the patients were examined for VRE carriers on ICU admission. Among them, patients hospitalized for over 48 hours were investigated for VRE acquisition rates and VRE nosocomial infection rate using VRE infection control strategies in ICU for the experimental group from September 2007 to April 2008. Before that, incidence of VRE acquisition and VRE nosocomial infection for the control group without Intervention were investigated from May to August 2007 retrospectively. RESULTS VRE acquisition rate in clinical specimens was 0.6% in the experimental group, that was significantly lower when compared to the control group. VRE carrier rate at admission to ICU was 15.4%. Out of 182 VRE carriers, 180 patients were identified by the active surveillance culture. CONCLUSION These results suggested that active surveillance culture at admission was considered to be an essential measure for detection of VRE carrier. But without strict isolation and adherence rating after each intervention, hand washing and contact isolation alone did not significantly decrease VRE nosocomial infection, although it did significantly decrease incidence of VRE acquired from clinical specimen.
PURPOSE The purpose of this study was to understand the meanings and nature of ICU admission experienced among patients with critical illness. The present study adopted a hermeneutic phenomenological method which was developed by van Manen. METHODS The participants for this study were 6 men and 3 women, who were over the age of 20 with ICU admission period more than 3 days. Data were collected by using in-depth interviews and observations from March, 2007 to September, 2007. The contents of the interviews were tape-recorded with the consent of the subject. RESULTS The essential themes that fit into the context of the 4 existential grounds of body, time, space and other people were as follows: a body that cannot react the way it wants, a wave of fear and insecurity everywhere, a struggle to survive, coming out from death's door, loss of time path, a long and continued waiting until escaping, more of machinery room than a patient's room, existence of life and death, an abyss of suffering seen thru another patient, taken care of by a doctor, trust and distrust, family, the ultimate safe zone. CONCLUSION Critically ill patients in ICU experienced feelings of discomfort, unsafety, and insecurity. The result of this study can give nurses some insight into these experiences and help promote empathetic care.
PURPOSE The purpose of this research was to describe how nurses in intensive care units (ICU) work. METHOD A total of 18 ICU nurses participated in the research. The data was collected through individual in-depth interviews and analyzed by grounded theory method using NUDIST 4.0 software program. RESULTS Three different patterns regarding nursing performance among ICU nurses were identified. These are 1) nursing performance of nurses who perform excellently, 2) nursing performance of nurses who do not perform well because of their lack of experience, and 3) nursing performance of nurses who do not perform well in spite of their good years of experience. These three different nursing performances were described in terms of seven different categories; 1) assessing and monitoring nursing problems, 2) clinical decision making, 3) interpersonal relationships, 4) holistic care, 5) technical skills, 6) problem solving, 7) working independently and creatively. This study also identified two intervening factors that influenced the advancement of their expertise. CONCLUSION The results of this study might help nurse managers in developing continuing educational programs for inexperienced nurses or those nurses not performing well to become experts by a deeper understanding of the nature of nursing performance and the factors that influence nursing performance in ICU settings.
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