Physicians' Experience of Communication with Nurses related to Patient Safety: A Phenomenological Study Using the Colaizzi Method.

PURPOSE: This study attempted to understand the core experiences of physicians related to communicating with nurses in Korea. METHODS: Ten physicians who worked at four tertiary university hospitals were interviewed. Data were analyzed using the phenomenological method developed by Colaizzi. RESULTS: The following six categories of participants' experience of communication with nurses were extracted from the analysis: (a) "Complex situations and heavy roles that cannot afford safety," (b) "Forcing a superior position in an authoritative environment," (c) "Different perspectives on patient care and difficulties in establishing relationships," (d) "Communicating key clues and receiving feedback from each other," (e) "Apathetic agreements rather than improvements," and (f) "Gradually developing mutually complementary communication." CONCLUSION: The present findings revealed that physicians lacked an understanding about the roles and tasks of nurses. The participants engaged in mutually complementary communication with experienced nurses, obtaining desirable patient outcomes and perceived order filtering by nurses as a safety mechanism. It is important for managers to act as proactive change agents to improve communication. Furthermore, the importance and different forms of complementary communication between physicians and nurses need to be described and taught in depth with practical cases.

Nurse staffing level and overtime associated with patient safety, quality of care, and care left undone in hospitals: A cross-sectional study.

OBJECTIVE: The purpose of this study was to explore the association of nurse staffing and overtime with nurse-perceived patient safety, nurse-perceived quality of care, and care left undone. DESIGN: A cross-sectional survey. SETTING AND PARTICIPANTS: A total of 65 hospitals were selected from all of the acute hospitals (n=295) with 100 or more beds in South Korea by using a stratified random sampling method based on region and number of beds, and 60 hospitals participated in the study. All RNs working on the date of data collection in units randomly selected from the list of units in each hospital were invited to participate. The analyses in this study included only bedside RNs (n=3037) and hospitals (n=51) with responses from at least 10 bedside RNs. METHODS: We collected data on nurse staffing level, overtime, nurse-perceived patient safety, nurse-perceived quality of care, nurse-reported care left undone, and nurse characteristics through a nurse survey. Facility data from the Health Insurance Review Agency (HIRA) were used to collect hospital characteristics. Multilevel logistic regression models considering that nurses are clustered in hospitals were used to analyze the effects of hospital nurse staffing and overtime on patient safety, quality of care, and care left undone. RESULTS: A higher number of patients per RN was significantly associated with higher odds of reporting poor/failing patient safety (OR=1.02, 95% CI=1.004-1.03) and poor/fair quality of care (OR=1.02, 95% CI=1.01-1.04), and of having care left undone due to lack of time (OR=1.03, 95% CI=1.01-1.05). Compared with RNs who did not work overtime, RNs working overtime reported an 88% increase in failing or poor patient safety (OR=1.88, 95% CI=1.40-2.52), a 45% increase in fair or poor quality of nursing care (OR=1.45, 95% CI=1.17-1.80), and an 86% increase in care left undone (OR=1.86, 95% CI=1.48-2.35). CONCLUSIONS: Our findings suggest that ensuring appropriate nurse staffing and working hours is important to improve the quality and safety of care and to reduce care left undone in hospitals.

[Experience of Role Adaptation from Nurse to Member of the Nursing Faculty].

PURPOSE: The purpose of this qualitative study was to evaluate the experience of role adaptation from nurse to member of the nursing faculty. METHODS: Data were collected from 13 members of a nursing faculty through in-depth interviews. The main question asked was "Could you describe your experience from being a nurse to becoming a member of the nursing faculty?" Qualitative data from the field and transcribed notes were analyzed using Strauss and Corbin's grounded theory methodology. RESULTS: The core experiential category of role adaptation from nurse to member of the nursing faculty was 'striving for survival from culture shock'. The participants used the following three interactional strategies: 'recognizing everything and entering the school environment', 'self-reflection on being a professor and integration of experiences', and 'finding a way of adapting'. CONCLUSION: The participants tried to adapt to life as a professor and reflected on and integrated their experiences into their new life on the faculty. College faculty need to understand the impact of changes and challenges faced by new professors during role adaptation and to support this adaptation through mentorship and organized orientation programs.

[Operating Room Nurses' Experiences of Securing for Patient Safety].

PURPOSE: This study was done to evaluate the experience of securing patient safety in hospital operating rooms. METHODS: Experiential data were collected from 15 operating room nurses through in-depth interviews. The main question was "Could you describe your experience with patient safety in the operating room?". Qualitative data from the field and transcribed notes were analyzed using Strauss and Corbin's grounded theory methodology. RESULTS: The core category of experience with patient safety in the operating room was 'trying to maintain principles of patient safety during high-risk surgical procedures'. The participants used two interactional strategies: 'attempt continuous improvement', 'immersion in operation with sharing issues of patient safety'. CONCLUSION: The results indicate that the important factors for ensuring the safety of patients in the operating room are manpower, education, and a system for patient safety. Successful and safe surgery requires communication, teamwork and recognition of the importance of patient safety by the surgical team.

[Nurses' experience of incivility in general hospitals].

PURPOSE: This study was done to describe nurses' experience of incivility in hospitals and to consider nurses' work environment. METHODS: Data were collected through in-depth interviews and analyzed using Colaizzi' phenomenological analysis methodology. Participants were seven experienced clinical nurses working on a general ward (2 nurses), or in an intensive care unit (2 nurses), emergency room (2 nurses), or operating room (1 nurse). RESULTS: The incivility that nurses experienced was categorized as follows: 'being afflicted as a weak person', 'being treated as less than a professional', 'being overwhelmed by shock and anger', 'experiencing an untenable situation', 'struggling to survive', and 'pursuing professional growth'. CONCLUSION: Behavior guidelines should be developed to reduce incivility, and incivility cases should be continuously monitored by the nursing department. Also, to handle incivility problems in clinical nursing areas, a reporting and counseling system and education programs are needed.

Chemotherapy-induced amenorrhea, menopause-specific quality of life, and endocrine profiles in premenopausal women with breast cancer who received adjuvant anthracycline-based chemotherapy: a prospective cohort study.

PURPOSE: We conducted a prospective observational study for premenopausal women receiving adjuvant adriamycin and cyclophosphamide-containing regimens to define the pattern of chemotherapy-induced amenorrhea (CIA), the menopause-specific quality of life (MENQOL), and the hormone profiles. METHODS: From October 2003 to July 2007, 387 patients with breast cancer who underwent curative surgery were prospectively included. Patient self-assessment by MENQOL questionnaires and blood samples for hormone assays were taken before chemotherapy, and 1, 6, and 12 months after chemotherapy was completed. RESULTS: Patients were categorized into three groups according to their duration and reversibility of amenorrhea, with 312 eligible patients split into long-term CIA (n = 180, 57.7 %), temporary CIA (n = 113, 36.2 %), and menstrual irregularity (n = 19, 6.1 %) groups. Risk factors for long-term CIA were identified as age ≥40 years (p < 0.001), the addition of taxane (p = 0.01), and tamoxifen use (p = 0.03). MENQOL was worst immediately after the completion of adjuvant chemotherapy, and this was not fully recovered even 12 months after chemotherapy had finished. Age ≥40 years and tamoxifen exposure were inversely associated with MENQOL. In long-term CIA patients, the level of follicle-stimulating hormone increased after chemotherapy; this level, however, was reduced in patients who received tamoxifen, but remained high and stable in those who did not (p < 0.001 at 6 months; p < 0.001 at 12 months). CONCLUSION: This study showed that most premenopausal breast cancer patients who received adjuvant chemotherapy experienced clinically significant CIA, followed by impaired MENQOL. Our findings may be relevant in the decision-making processes for premenopausal women with breast cancer.

Orthostatic intolerance ambulation in patients using patient controlled analgesia.

BACKGROUND: Opioid analgesics are widely used to reduce postoperative pain and to enhance post-operative recovery. However, orthostatic intolerance (OI) induced by opioid containing intravenous patient controlled analgesia (IPCA) may hinder postoperative recovery. This study investigated factors that affect OI in patients receiving IPCA for postoperative pain control. METHODS: OI was instantly evaluated at the time of first ambulation in 175 patients taking opioid containing IPCA after open and laparoscopic subtotal gastrectomies. Patients were classified as having OI if they experienced dizziness, nausea/vomiting, blurred vision, headache, somnolence and syncope. Factors contributing to OI were assessed with logistic regression analysis. RESULTS: Out of 175 patients, 61 (52.6%) male and 44 (74.6%) female patients experienced OI at the time of first ambulation. The frequency of OI related symptoms were dizziness (97, 55.4%), nausea (46, 26.3%), headache (9, 5.1%), blurred vision (3, 1.7%) and vomiting (2, 1.1%). Significant risk factors for OI were gender (P=0.002) and total amount of opioids administered (P=0.033). CONCLUSIONS: The incidence of OI is significantly higher in male than in female patients and is influenced by the opioid dose.

[Structural equation modeling on nursing productivity of nurses in Korea].

PURPOSE: The purpose of this study was to propose and test a predictive model that could explain and predict nursing productivity. METHODS: A survey using a structured questionnaire was conducted with 360 nurses in Korea. The data were analyzed using SPSS Windows 18.0 and AMOS 19.0 program. RESULTS: Based on the constructed model, burnout and organizational commitment were found to have direct effects on nurses' turnover intention and nursing productivity. While nursing work environment was found to have indirect effects on nurses' turnover intention and nursing productivity. CONCLUSION: This structural equational model is a comprehensive theoretical model that explains the related factors and their relationship with nursing productivity. Comprehensive organizational interventions to improve nursing productivity should focus on improving the nursing work environment. Findings from this study can be used to design appropriate strategies to decrease nurse turnover in Korea. Further studies are needed to prospectively verify these causal relationships with larger samples.

Awareness of advance directives among Korean nurses.

Awareness of advance directives (AD) among 293 nurses working in acute hospitals was evaluated through a structured questionnaire. Nurses were poorly acquainted with AD. Education about AD and related concepts are required in college and field experience to improve practice and communication with patients at the end of life.

[A model on turnover intention of chief nurse officers].

PURPOSE: The purpose of this study was to test the turnover intention model for chief nurse officers in general hospitals. The variables for the study included job stress, social support, job satisfaction, and organization commitment. METHODS: A predictive, non-experimental design was used with a sample of 144 chief nurse officers from 144 general hospitals. Data were collected using self-administered questionnaires and analyzed using SPSS, AMOS program. RESULTS: The overall fitness of the hypothetical model to the data was good (χ²=16.80, p=.052, GFI=.96, AGFI=.90, NFI=.97, CFI=.99). Job stress, social support, job satisfaction, and organization commitment explained 59.0% of the variance in turnover intention by chief nurse officers. Both organization commitment and social support directly influenced turnover intention for chief nurse officers, and job stress and job satisfaction indirectly influenced turnover intention. CONCLUSION: The results imply that chief nurse officers in hospitals need social support and management of job stress to increase job satisfaction and organization commitment, and lower turnover intention.

[Nurses' experience of career ladder programs in a general hospital].

PURPOSE: The purpose of this study was to identify and describe nurses' experience of a career ladder program (CLP) in a general hospital in Korea. METHODS: The data were collected from 15 nurses who participated in the CLP. Each nurse completed individual in-depth interviews, for which the main interview question was "How do you describe your experience of CLP?". All interview data were transcribed and were analyzed using the grounded theory method. RESULTS: The core category of the experience of CLP was identified as "challenging to rebirth as an expert". The participants used five action/interaction strategies such as "taking some time for introspection", "appreciating the essence of nursing", "making use of feedback positively", "throwing away doubts about their own capabilities", "exerting themselves with confidence". The consequence of the process of adjusting to CLP was "positioning a differentiated expert." CONCLUSION: The results of this study show that participants recognized CLP as a powerful resource which leads them to professional growth and development. Thus, CLP could be utilized as a clinical career-promoting program and ultimately as a program for providing high-quality nursing services.

[The role adaptation process of the executive director of nursing department].

PURPOSE: The purpose of this study was to identify the role adaptation process experienced by executive directors of nursing department of general hospitals. METHODS: Data were collected from 9 executive nursing directors though in-depth interviews about their experiences. The main question was "How do you describe your experience of the process of role adaptation as an executive nursing director?" Qualitative data from field and transcribed notes were analyzed using Strauss & Corbin's grounded theory methodology. RESULTS: The core category of experience of the process of role adaptation as an executive nursing director was identified as "entering the center with pushing and pulling". The participants used five interactional strategies;'maintaining modest attitudes','inquiring about trends of popular feeling','making each person a faithful follower','collecting & displaying power','leading with initiative'. The consequences of role adaptation in executive nursing directors were'coexisting with others','immersing in one's new role with dedication', and'having capacity for high tolerance'. The types of role adaptations of executive directors in nursing department were friendly type, propulsive type, accommodating type. CONCLUSION: The results of this study produced useful information for executive nursing directors on designing a self-managerial program to enhance role adaptation based on interactional strategies.

A clinical-decision support system for the nursing process in the ENR.

This study was conducted to develop the clinical-decision support system for the nursing process in the Electronic nursing record system. Nursing diagnoses were linked to 4 components of the nursing process (except for diagnoses) and applied to ENR in 2007.

Development and evaluation of ICNP-based Electronic Nursing Record System.

This study was conducted to cross-map nursing statements with International Classification of Nursing Practice (ICNP) Version 1 and to develop and evaluate ICNP-based Electronic Nursing Record System. Among the 7,631 nursing statements which were cross-mapped, 5,970(78.2%) nursing statements were completely expressed and 1,520(19.9%) statements were partially expressed. ICNP-based Electronic Nursing Record System was developed for the Asan Medical Center in Korea. Most nursing statements (6,671 of 7,931, 87.0%) and Most cross-mapped ICNP terms (965 of 1,015, 94.9%) were documented by user in all the units from July, 2007 to August, 2008.

A randomised controlled trial of the effects of cryotherapy on pain, eyelid oedema and facial ecchymosis after craniotomy.

AIM: To identify the effects of cryotherapy on patient discomfort following craniotomy. BACKGROUND: Following craniotomy, many patients suffer from unexpected discomfort, including pain, eyelid oedema and ecchymosis. Cryotherapy is regarded as a safe method for managing these postcraniotomy problems. DESIGN: Randomised controlled trial. METHODS: A total of 97 Korean patients who underwent elective supratentorial craniotomy were randomly assigned to a cryotherapy or a control group. In the cryotherapy group, ice bags were applied to surgical wounds, and cold gel packs were applied to periorbital areas, for 20 minutes per hour, beginning three hours postoperatively and for three days thereafter. The level of patient pain was measured using the visual analogue scale while the eyelid oedema was measured using the Kara & Gokalan's scale. Ecchymosis was also classified according to its extent. RESULTS: The level of pain three hours after craniotomy was similar in the cryotherapy and control groups (57.9 vs. 58.7). Three days after surgery, pain had significantly decreased in the cryotherapy group (p = 0.021). After adjusting diagnosis by analysis of covariance (ANCOVA), pain score did not differ significantly between the two groups. The mean eyelid oedema scores were lower in the cryotherapy group than in the control group (0.59 vs. 2.29, p < 0.001), with ANCOVA showing that cryotherapy had a significant effect on eyelid oedema (p < 0.001). Pain (p = 0.047) and eyelid oedema (p < 0.001) in the cryotherapy group were significantly decreased over time. Ecchymosis were significantly less frequent in the cryotherapy (11/48, 22.9%) than in the control (26/49, 53.1%) group (p = 0.003). Logistic regression analysis showed that cryotherapy affected ecchymosis (p = 0.001). CONCLUSION: These results indicate that cryotherapy can control pain, eyelid oedema and facial ecchymosis after craniotomy. RELEVANCE TO CLINICAL PRACTICE: Cryotherapy, which is both convenient and cost-effective, can be used to prevent postoperative discomforts in a clinical setting.

Outbreaks of imipenem-resistant Acinetobacter baumannii producing carbapenemases in Korea.

Among 53 Acinetobacter baumannii isolates collected in 2004, nine imipenem-resistant isolates were obtained from clinical specimens taken from patients hospitalized in Busan, Korea. Nine carbapenemase-producing isolates were further investigated in order to determine the mechanisms underlying resistance. These isolates were then analyzed via antibiotic susceptibility testing, microbiological tests of carbapenemase activity, pI determination, transconjugation test, enterobacterial repetitive consensus (ERIC)-PCR, and DNA sequencing. One outbreak involved seven cases of infection by A. baumannii producing OXA-23 beta-lactamase, and was found to have been caused by a single ERIC-PCR clone. During the study period, the other outbreak involved two cases of infection by A. baumannii producing IMP-1 beta-lactamase. The two clones, one from each of the outbreaks, were characterized via a modified cloverleaf synergy test and an EDTA-disk synergy test. The isoelectric focusing of the crude bacterial extracts detected nitrocefin-positive bands with pI values of 6.65 (OXA-23) and 9.0 (IMP-1). The PCR amplification and characterization of the amplicons via direct sequencing showed that the clonal isolates harbored blaIMP-1 or blaOXA-23 determinants. The two clones were characterized by a multidrug resistance phenotype that remained unaltered throughout the outbreak. This resistance encompassed penicillins, extended-spectrum cephalosporins, carbapenems, monobactams, and aminoglycosides. These results appear to show that the imipenem resistance observed among nine Korean A. baumannii isolates could be attributed to the spread of an IMP-1- or OXA-23-producing clone. Our microbiological test of carbapenemase activity is a simple method for the screening of clinical isolates producing class D carbapenemase and/or class B metallo-beta-lactamase, in order both to determine their clinical impact and to prevent further spread.