PURPOSE
The purpose of this study was the evaluation of a Home Nursing Care based Respiratory Management Program (HHNbRMP) on health care ability, respiratory and psychological status and quality of life (QoL) of patients with Amyotrophic Lateral Sclerosis (ALS). The management program utilizes a home mechanical ventilator (HMV) in the home.
METHODS
A non-randomized controlled experimental design was employed. HHNbRMP based on Cox's Interaction Model which includes cognitive assent (education, specialized medical care, case management), internal motivation (airway clearance, thoracic exercise, air accumulated exercise) and psychological response (meditation & active listening). These variables were measured first for a base line reading and then at four, twelve, and twenty-four weeks. The data were analyzed by t-test/ANOVA and Repeated Measures ANOVA/ANCOVA.
RESULTS
Only respiratory difficulty among the variables showed a significant difference at twelve and twenty-four weeks (F=7.52, p=.009; F=7.58, p=.009).
CONCLUSION
The Home Health Nursing Management program was effective in managing respiratory difficulty. The patients were satisfied with this program. Applying this program tailored to patients' condition, their respiratory health parameters would be improved.

Citations

• Factors associated with caring behaviors of family caregivers for patients receiving home mechanical ventilation with tracheostomy: A cross-sectional study
  Hyang Sook Kim, Chung Eun Lee, Yong Sook Yang, Tai-Heng Chen
  PLOS ONE.2021; 16(7): e0254987.     CrossRef

PURPOSE
This study examined the effects of a program designed to prevent ventilator-associated pneumonia (VAP) on VAP rate and endotracheal colonization. The program focused on aspiration prevention and oral care.
METHODS
A nonequivalent control group post-test only design was utilized. One hundred patients admitted to a medical intensive care unit (MICU) or coronary care unit (CCU) were assigned to either a experimental group (n=50) or a control group (n=50). The participants were selected 48 hours following an endotracheal intubation. VAP prevention program given to the experimental group includes keeping the head of the bed to 30°~45° high, maintaining continuous endotracheal cuff pressure at 25 cm H₂O, performing endotracheal suction before change position, and providing oral care with 0.1% chlorhexidine every four hours. The control group received usual care. Data were analyzed using t-test, x² test, Mantel-Haenszel x² and Cox proportional harzard regression model.
RESULTS
The experimental group showed a lower VAP rate than the control group although the difference was not statistically significant (x²=0.79, p=.375). The experimental group showed lower colonization in tracheal secretion than the control group (x²=14.59, p<.001).
CONCLUSION
Results showed that a VAP prevention program is effective in reducing colonization of tracheal secretion. Therefore, VAP prevention programs are recommended as an ICU nursing intervention.

Citations

• Effects of Oral Care Using Chlorhexidine Gluconate on Ventilator-associated Pneumonia and Mortality: A Systematic Review and Meta-analysis
  Nam Young Kim, Seang Ryu, Yun-Hee Kim
  Korean Journal of Adult Nursing.2019; 31(2): 109.     CrossRef

PURPOSE
This study aimed to investigate the influencing factors on self care, respiratory difficulty, sleep impediment, anxiety and depression among patients with neuromuscular disease who are dependent on Home Mechanical Ventilator (HMV).
METHODS
157 patients were recruited through hospital based home nursing care departments and HMV rental centers. Data were collected by questionnaires. The analytic methods were n (%) / M±SD, χ² / t-test or ANOVA and multiple linear regression.
RESULTS
Patients with Amyotrophic lateral sclerosis were more likely to utilize HMV, had shorter periods of morbidity and the most extended daily use of HMV. As for medical equipment, they had ambu-bag (87.2%) and oxygenator (15.4%). Reports of respiratory difficulty and sleep impediment were low. There were no significant difference. In contrast, reported anxiety and depression were high and showed significant difference between non invasive HMV and invasive HMV. Anxiety contributes to respiratory difficulty (t=3.62, p=.002), sleep impediment (t=2.06, p=.042), and depression (t=7.24, p<.001). However, home nursing care exerts a positive influence in reducing anxiety (t=-2.73, p=.008).
CONCLUSION
Anxiety contributes to respiratory difficulty, sleep impediment, and depression. However, those who use home nursing care reported less anxiety. Home nursing care positively impacts patients dependent on HMV as a practical service and available resource.

Citations

• Research Paper: Anxiety, Depression, and Their Related Factors in Patients Admitted to Intensive Care Units
  Shahrokh Yousefzadeh-Chabok, Naema Khodadadi-Hassankiadeh, Alia Saberi, Atefeh Ghanbari Khanghah, Homa Zarrabi, Mohammad Reza Yeganeh, Hamideh Hakimi, Anoush Dehnadi Moghadam
  Caspian Journal of Neurological Sciences.2018; 4(15): 159.     CrossRef

PURPOSE
This study was aimed to survey the actual caregiving conditions of family caregivers who are caring patients with rare and incurable diseases using home ventilators at home, and to clarify any factors affecting their burdens and quality of life.
METHODS
A questionnaire survey was performed by the 159 subjects, and the questionnaires contained the actual conditions of caregiving activities, and caregiver's burdens and quality of life. The collected data was analyzed by ANOVA, Pearson's correlation, and stepwise linear regressions.
RESULTS
The mean of burden scores was 3.55 out of 5, and influencing variables included the relationships with patient (spouse), respite (moderate), health status, and diagnosis (non ALS), with the explanatory power of 30.0%. The mean of the quality of life was 2.58 point, and the influencing variables included burdens, health status, and respite (enough), with the explanatory power of 39.0%.
CONCLUSION
In order to improve the quality of life among family caregivers caring for patients with using a home ventilator, it is required to develop strategies for reducing caregiving burdens as well as to introduce family respite welfare systems to family caregivers.

Citations

• Burden, social support, and coping strategies in family caregivers of individuals receiving home mechanical ventilation: a cross-sectional study
  Lucyna Płaszewska-Żywko, Izabela Fajfer-Gryz, Jakub Cichoń, Maria Kózka
  BMC Nursing.2024;[Epub]     CrossRef
• Factors Affecting Quality of Life in Family Caregivers of Patients in Intensive Care Units
  Kyeong Mi Kong, Sunjoo Boo, Youngjin Lee, Jeong-Ah Ahn
  Journal of Korean Critical Care Nursing.2024; 17(2): 12.     CrossRef
• Effects of the Discharge Education Program on Family Caregivers Caring for Patients on Mechanical Home Ventilation in Korea: A Pilot Test
  Hyang Sook Kim, Gwang Suk Kim, Hyangkyu Lee, JiYeon Choi, Young Sam Kim, Eui Geum Oh
  Home Health Care Management & Practice.2022; 34(4): 258.     CrossRef
• NADİR HASTALIĞI OLAN ÇOCUKLARIN AİLELERİNDE BAKIM YÜKÜNÜN İNCELENMESİ
  Merve Deniz PAK GÜRE, Cemre PAK
  Turkish Journal of Family Medicine and Primary Care.2021; 15(2): 269.     CrossRef
• Factors associated with caring behaviors of family caregivers for patients receiving home mechanical ventilation with tracheostomy: A cross-sectional study
  Hyang Sook Kim, Chung Eun Lee, Yong Sook Yang, Tai-Heng Chen
  PLOS ONE.2021; 16(7): e0254987.     CrossRef
• Factors Influencing Psychosocial Well-Being in Family Caregivers of People with Amyotrophic Lateral Sclerosis
  Hyeon Sik Chu, Young Ran Tak, Seung Hyun Kim
  Journal of Korean Academy of Nursing.2018; 48(4): 454.     CrossRef
• The Effect of the Activity of Daily Living of Adult People with Physical Disabilities on Spouse's Caregiving Stress and Depression
  Deok Ju Kim
  Journal of the Korea Academia-Industrial cooperation Society.2016; 17(12): 371.     CrossRef
• Influencing Factors on Stress in Caregivers of Stroke Patients Being Admitted in Rehabilitation Centers
  Nam-Hee Kim, Young-Sook Tae, Yooun-Sook Choi, Joo-Hee Bae
  Journal of the Korea Academia-Industrial cooperation Society.2016; 17(2): 188.     CrossRef

PURPOSE
This study developed and evaluated a systematic intervention among medical ICU nurses for preventing ventilator-associated pneumonia (hereafter VAP).
METHODS
A VAP prevention program was proposed based on a literature review, revised to fit the target situation, and validated. It was composed of one-time interventions including education, pamphlets, hand cultures, and a quiz event, as well as repeated interventions such as posters, reminders, posting hand culture results, and performance feedback. A simulated control group pretest-posttest design was used to verify the effectiveness of the VAP control program. The incidence of VAP among ICU patients was measured both during 3 months before (n = 80) and during 3 months after (n = 75) intervention.
RESULTS
The VAP prevention program's effectiveness, with a pre-intervention VAP rate of 17.38 and post-intervention rate of 11.04 per 1,000 ventilator days, showed a clinical tendency to decrease, but the difference was not statistically significant (p = .750).
CONCLUSION
A VAP prevention program of multiple interventions can be useful in decreasing the VAP rate. Given that the monthly decrease in the VAP rate was not considered statistically significant, long-term research needs to be done. Additionally, since this study targeted only nurses, it is suggested that future research targets other health care workers who can influence VAP rates.

PURPOSE
The purpose of this study was to identify the effect of web-based learning for ventilator practice on the knowledge and clinical competence of nursing students.
METHOD
The research design was a non-equivalent control group pre-post non-synchronized design. Twenty five nursing students were collected for the experimental group from August 23 to November 26, 2004 and nineteen nursing students for the control group from August 22 to November 25, 2005. All subjects experienced clinical practices in an intensive care unit of a hospital in G city for 2 weeks. The web-based learning for ventilator practice was conducted in the experimental group only. The data were analyzed with t-test and ANCOVA using SPSS 10.1 program.
RESULT
The 2 week web-based clinical practice learning significantly improved the knowledge scores for the experimental group, however, there was no significant differences in the score for the clinical competence between experimental and control group.
CONCLUSION
These findings suggest that a self-directed web-based learning for ventilator practice of nursing students can facilitate the knowledge of care for a ventilated patient. Therefore, faculties should develop a variety of web-based multimedia content programs for clinical instruction based on clinical situation.

PURPOSE
This study was aimed at providing scientific evidence for minimizing ventilator-associated pneumonia(VAP) by identifying appropriate timing of exchange of circuit for mechanical ventilator that is well suitable for the medical environment of intensive care units of hospitals in Korea.
METHOD
This was a quasi-experimental study with a convenience sample of 19 adult subjects aged over 18 years who were admitted to the NS ICU of C university hospital, and placed on mechanical ventilator. The subjects were placed in two groups, compared on the incidence rate of VAP after they received exchange of circuit either at 1-week interval (N =10) or 2-week interval (N = 9).
RESULT
1) When considering 1000 days as the standard unit of analysis for incidence, the incidence rate of VAP was 7.19 cases at the 1-week cycle exchange group and 15.23 at the 2-week cycle exchange group, showing no statistically significant difference between the two groups. 2) There were a total of 3 types of bacteria isolated from the patients with VAP, including 2 cases with P. aeruginosa, 1 case with Streptococcus group F and A. baumannii.
CONCLUSION
With thorough hand washing and strict management of tracheal tube of mechanical ventilator as well as use of tracheal intubation techniques, exchange cycle of circuit of mechanical ventilator by nurses may be changed from 1-week to 2-week interval.