Factors Associated with Mortality in Elderly Patients Admitted to Intensive Care Unit due to Acute Drug Intoxication from Suicide Attempts / 중환자간호학회지

Purpose@#: This study aimed to determine the mortality rate among elderly patients admitted to the intensive care unit (ICU) for acute drug intoxication resulting from suicide attempts. It also compared the characteristics of survivors and decedents to identify factors associated with mortality. @*Methods@#: This retrospective descriptive study included 150 patients aged 65 years or older who were admitted to the ICU of a tertiary university hospital in Gwangju due to acute drug intoxication, with the period spanning January 1, 2018 to December 31, 2020. The collected data were analyzed using descriptive statistics, independent t-tests, Chi-squared tests, Fisher's exact test, and multiple logistic regression analysis. @*Results@#: The mortality rate among elderly individuals admitted to the ICU for acute drug intoxication was 19.3%. The likelihood of death was significantly higher in patients with an acute physiology and chronic health examination (APACHE) Ⅲ score of 70 or above (OR=23.75, 95% CI=3.78-149.46, p＜.001) and those with metabolic acidosis on initial acid-base results (OR=3.73, 95% CI=1.12- 12.43, p =.032). @*Conclusion@#: These findings underscore the need for developing and implementing systematic education and targeted nursing interventions for ICU nurses caring for acutely drug-intoxicated elderly adults, particularly considering the APACHE Ⅲ score and the presence of metabolic acidosis.

Factors Affecting Turnover Intention of Clinical Nurses in a Tertiary Hospital: Focusing on Fatigue, Nursing Professionalism, and Compassion Satisfaction / 재활간호학회지

Purpose@#The purpose of this study was to examine the level of turnover intention and identify factors affecting turnover intention in nurses working at a tertiary hospital in Korea. @*Methods@#A descriptive study was conducted. A total of 239 clinical nurses were recruited using a convenient sampling method. The standardized questionnaires was used to assess fatigue, nursing professionalism, and compassion satisfaction. Data were analyzed using SPSS software. Descriptive statistics were computed to describe the sample and study variables. Logistic regression analyses was performed to identify factors affecting turnover intention in clinical nurses working at a tertiary hospital. @*Results@#Among the 239 clinical nurses, a mean age of participants was 28.80±5.08 years. Most of participants were female (n=228, 95.4%) and single (n=183, 76.6%) and achieved bachelor’s degree (n=186, 77.8%). Approximately 43.5% of them intended to turnover their current job. The findings showed that turnover intentions were significantly higher among clinical nurses who were younger (OR=0.93, 95% CI=0.86~0.99), worked in ICU or ER (OR=3.64, 95% CI=1.04~12.70), had higher fatigue (OR=1.02, 95% CI=1.01~1.04), and had lower professionalism (OR=0.98, 95% CI=0.96~0.99). It explained 23.7% of the variance in turnover intention. @*Conclusion@#The findings indicated that nurse administrators need to develop and provide customized intervention program to decrease fatigue and increase nursing professionalism to prevent turnover intention in clinical nurses working at a tertiary hospital.

Attitudes toward advance directives and prognosis in patients with heart failure: a pilot study

Background/Aims@#Advance directives (ADs) in Korean patients with heart failure (HF) and the associations of attitude towards ADs and HF prognosis with ADs were initially assessed using the model of the Korean-Advance Directive (K-AD). @*Methods@#Twenty-four patients with HF (age, 67.1 years; men, 58.3%; ejection fraction, 35.9%) participated. A pilot test to evaluate the feasibility of ADs and the possible associations of attitudes towards ADs and prognosis with end-of-life treatment preferences among patients with HF was conducted. @*Results@#Fifteen patients (62.5%) completed the K-ADs. The major reason for incomplete K-AD was knowledge deficit. Patients valued “comfortable death” the most (45.4%), followed by “giving no burden to the family” (13.6%). Among treatment preferences, hospice care was preferred by the majority (66.7%), while cardiopulmonary resuscitation (CPR) was preferred by the minority (31.8%). Children (50.0%) were mostly appointed as a proxy, followed by the spouse (33.3%). More patients with moderately positive attitudes completed the K-ADs than their counterparts (70.0% vs. 57.1%). The 5-year survival rate was 69.2%; the patients who preferred CPR had a higher survival rate (70.6% vs. 68.5%) whereas those who preferred hospice care had a lower survival rate than their counterparts (70.7% vs. 75.2%). @*Conclusions@#The findings support the feasibility of the K-AD model, with a high acceptance rate in two-thirds of the sample. Further studies are warranted to investigate whether treatment preferences are associated with attitude towards ADs and/or HF prognosis using larger sample size.

Validation of the Decisional Conflict Scale for Evaluating Advance Care Decision Conflict in Community-dwelling Older Adults

PURPOSE: Decisional conflict is a significant and important barrier in end-of-life care planning, and it is often encountered in health professionals' discussions with patients and their families. Little is known about the measurement of decisional conflict, and existing measures are not suitable for all contexts. In this study, psychometric properties of the Decisional Conflict Scale, which was translated for the first time into Korean [Korean version of DCS (K-DCS)], were examined. METHODS: A sample of 273 community-dwelling elders was surveyed (mean age: 77.26 years; 80.2% women). Internal consistency reliability and stability reliability were tested by calculating Cronbach α and Pearson's correlation coefficients. Exploratory factor analysis and logistic regression analyses were performed to test validity. RESULTS: Reliability of the K-DCS was acceptable with Cronbach α =.87; test-retest correlation r = .76. Factor analysis showed a two-factor structure with nine items: informed/values clarity and uncertainty. Concordance between K-DCS and the four treatment directives was significant (kappa values ≥.78). Controlling for age and gender, those with decision implementation were more likely to implement their decisions on tube feeding (odds ratio = 5.15, p = .033) and hospice care (odds ratio = 2.83, p = .017). CONCLUSION: The K-DCS appears to be a valid measure to evaluate decisional conflict about advance directives in community-dwelling Korean older adults. Further validation of the K-DCS is warranted, though caution should be exercised in using subscales because of differences in decisional contexts.

Factors Influencing Quality of Nursing Service among Clinical Nurses: Focused on Resilience and Nursing Organizational Culture / 임상간호연구

PURPOSE: The purpose of this study was to examine nursing organizational culture and resilience and their effects on quality of nursing service. METHODS: A cross-sectional study was conducted. A convenience sampling method was used to collect data from 199 participants who worked in a tertiary hospital in G city. Demographic and work related variables, quality of nursing service, resilience, and nursing organizational culture were measured using validated self-report questionnaires. RESULTS: All of the participants were women and the majority were staff nurses and single. A statistically significant difference in quality of nursing service was found for age, marital status, educational level, clinical career, position and perceived health status. Age, educational level, clinical career, position, resilience, innovation-oriented culture, relation-oriented culture, and hierarchy-oriented culture were significant predictors of quality of nursing service, explaining 47% of total variance. Among the predictors, resilience was the strongest predictor, followed by innovation-oriented culture, and hierarchy-oriented culture. CONCLUSION: Findings indicate that quality of nursing service can be improved by raising individual nurse's resilience and advancing nursing organizational culture. Considering the identified factors, researchers and administrators need to develop and provide clinical nurses with a variety of programs to improve the quality of their nursing service.

Experience of Dementia-related Anxiety in Middle-aged Female Caregivers for Family Members with Dementia: A Phenomenological Study

PURPOSE: In Korea, most elderly with dementia receive care from family members, yet little research is available on the experience of dementia-related anxiety in middle-aged female caregivers for a family member with dementia. The purpose of this study was to describe the lived experience of dementia-related anxiety in middle-aged female caregivers for family members with dementia. METHODS: A descriptive phenomenological study was conducted. A purposive sampling strategy was used to recruit participants. Twelve middle-aged women (40-59 years, mean age = 51.90 years) who were family caregivers were interviewed from February 2014 to August 2014. Data were collected through semistructured interviews and analyzed using Giorgi's method. RESULTS: The essential structure of the phenomenon was a fear of losing self-identity. The main essence was represented by six components: keenly feeling the effects of aging because of memory deficit, continuous comparison of the family member's behavior with that of the participant's, Finding it painful to see a family member with dementia as he/she does not know how this will end, not knowing the conclusion of the disease process, reducing the risk of dementia, and trying to change one's lifestyle from what it used to be in the past. CONCLUSIONS: The study provides the essential structure of the experience on dementia-related anxiety that caregivers of a family member with dementia have. The findings could help healthcare providers and researchers have better understanding of dementia-related anxiety and give more attention to the caregivers to relieve their anxiety

The Experiences of Nursing Student on Alcoholism Care / 한국간호교육학회지

PURPOSE: The aim of this study was to describe the experiences of student nurses during their clinical practice periods in an alcoholic ward. METHODS: A descriptive phenomenological study design was employed. Individual interviews were conducted and audio-taped. Colaizzi's method of data analysis was applied to inductively determine themes and formulated meanings. Data saturation was achieved and methodological rigor was established. RESULTS: Four themes were identified and these themes included anxiety of nursing practice in unfamiliar setting, sympathy with patients, learning about the inpatient alcoholics care, and self-reflection. CONCLUSION: Nursing students had positive and negative experiences in their clinical practice. The results of this study had important implications regarding clinical practice and research for nursing clinical education.