한국에서 신생아 중환자실의 현황

신손문 대한소아청소년과학회 2008 Clinical and Experimental Pediatrics (CEP) Vol.51 No.3

Neonatal intensive care in Korea has improved remarkably since the 1990s, but there is still a shortage of facilities and equipment in NICUs. Only 71.1% of the beds needed for neonatal intensive care are available. Mechanical ventilators are not appropriately distributed to the NICUs that are equipped to handle neonatal intensive care. The number of doctors is far too small, making the number of patients per doctor very high. Nurses, too, need to take care of 7.7 patients per nurse, making it very difficult to provide adequate intensive care. All this is caused by insufficient investment by the hospitals, which, in turn, is caused by inadequate reimbursement from health insurance. Therefore, a government-sponsored effort is necessary to bring the level of neonatal intensive care up to par. (Korean J Pediatr 2008;51:243-247)

Comparison of the Attitudes of Nurses and Physicians toward Palliative Care in Neonatal Intensive Care Units

Jung, Ha Na,Ju, Hyeon Ok Korean Society for Hospice and Palliative Care 2021 한국호스피스.완화의료학회지 Vol.24 No.3

Purpose: This study aimed to compare the attitudes of nurses and physicians toward neonatal palliative care and identify the barriers to and facilitators of neonatal palliative care, with the goal of improving palliative care for infants in neonatal intensive care units (NICUs). Methods: This cross-sectional study analyzed data from the NICUs of seven general hospitals with 112 nurses and 52 physicians participating. Data were collected using the Neonatal Palliative Care Attitude Scale questionnaire. Results: Only 12.5% of nurses and 11.5% of physicians reported that they had sufficient education in neonatal palliative care. In contrast, 89.3% of the nurses and 84.6% of the physicians reported that they needed further education. The common facilitators for both nurses and physicians were: 1) agreement by all members of the department regarding the provision of palliative care and 2) informing parents about palliative care options. The common barriers for both nurses and physicians were: 1) policies or guidelines supporting palliative care were not available, 2) counseling was not available, 3) technological imperatives, and 4) parental demands for continuing life support. Insufficient resources, staff, and time were also identified as barriers for nurses, whereas these were not identified as barriers for physicians. Conclusion: It is necessary to develop hospital or national guidelines and educational programs on neonatal palliative care, and it is equally necessary to spread social awareness of the importance of neonatal palliative care.

Educational needs for practicing neonatal intensive care among Korean nursing students

Koo, Hyun Young,Lee, Bo Ryeong Korean Academy of Child Health Nursing 2021 Child Health Nursing Research Vol.27 No.4

Purpose: This study was conducted to investigate the educational needs for practicing neonatal intensive care among Korean nursing students. Methods: An explorative, sequential, mixed-methods design was used. Qualitative content analysis was conducted of in-depth interviews of six nursing students, five clinical practice faculty members, and five nurses in the neonatal intensive care unit. The results of a survey of 174 nursing students were analyzed quantitatively. Results: Nursing students, clinical practice faculty members, and nurses wanted opportunities for direct nursing practice and education in school during neonatal intensive care practice. In terms of specific educational content, nursing students expressed the highest observation-related educational needs for communication with medical team members, and they expressed the highest practice-related educational needs for operating medical equipment used for neonatal intensive care. The nursing students' needs with regard to the method of practice education were highest for orientation from the head nurses. Conclusion: Communication and operating medical equipment were found to be areas with high educational needs for practicing neonatal intensive care among Korean nursing students. Further research is needed to develop an educational framework and setting for practicing neonatal intensive care that would meet their needs.

Neonatal family-centered care: evidence and practice models

Juyoung Lee 대한소아청소년과학회 2024 Clinical and Experimental Pediatrics (CEP) Vol.67 No.4

Although advances in neonatology have reduced the mortality rate of high-risk infants, sick newborns or premature infants undergo more intensive monitoring, painful procedures, and lengthy hospitalization, leading to prolonged separation from their parents. In recent decades, the importance of parent-infant closeness early in life has become more apparent, especially in preterm infants who are prone to neurodevelopmental deficits. There isan increasing body of evidence regarding the benefits of family-centered care (FCC) in neonatal intensive careunits. Key aspects related to neonatal FCC include the parents’ presence in the ward and their participation ininfants’ daily care and decision-making processes. In addition, an environment that supports a private and comfortable space for each family member and infant, such asa single-family room, should be provided. To successfully implement FCC in neonatal intensive care units, the culture of care and hospital policies should be changed to successfully implement FCC in neonatal intensive care units, and appropriate training for medical staff is also required.

발달지지간호에 대한 신생아집중치료실 간호사의 교육요구도 분석

신다애(Shin, Da-Ae),방경숙(Bang, Kyung-Sook) 한국간호교육학회 2021 한국간호교육학회지 Vol.27 No.3

Purpose: This study used a descriptive investigative design to identify educational needs for developmental supportive care for the purpose of establishing a developmental supportive care education program for nurses in neonatal intensive care units. Methods: A survey was conducted on 93 nurses working in neonatal intensive care units located in a metropolitan area, and the collected data were analyzed using descriptive statistics and a paired t-test with the SPSS 25.0 program. For the purpose of analyzing educational needs, we further analyzed data through an importance-performance analysis (IPA) and the Borich needs assessment and the locus for focus models. Results: The average importance of the developmental supportive care of nurses in neonatal intensive care units was 3.74±0.78 out of 5, and the average performance was 3.46±0.81 out of 5. A t-test on the difference between the IPA and Borich needs assessment showed the highest educational need in the categories of ‘individualized care’, and ‘I serve on the Developmental Care Committee at my institution’. In addition, according to the results of deriving the priorities of educational needs using the Borich needs assessment and the locus for focus model, the highest priority was ‘I provide appropriate pain management when noxious procedures are necessary’. Conclusion: These findings can be used as basic data to design a developmental supportive care program suitable for nurses in neonatal intensive care units to meet the educational needs for developmental supportive care.

Deaths in the Neonatal Intensive Care Unit between 2002 and 2014

Ga Young Park,김성신 대한신생아학회 2016 Neonatal medicine Vol.23 No.1

Purpose: To report the causes and patterns of death among infants admitted to our neonatal intensive care unit (NICU) over a 13-year period. In addition, we analyzed trends regarding the type of end-of-life care provided. Methods: All of the neonates who died at the Soonchunhyang University Bucheon Hospital between January 1, 2002, and December 31, 2014, were identified. The causes and circumstances of death were extracted from individual medical records. Trends in mortality were compared between two time periods: 2002 to 2007 and 2008 to 2014. Results: Of the 5,223 admissions to our NICU, 97 neonates died. The overall mortality rate was 1.9%. The most common cause of death was sepsis (15%). At a lower gesta- tional age, infants died of extreme prematurity and complications of prematurity. Among term infants, the principal cause of death shifted to hypoxic ischemic ence- phalopathy and asphyxia. A total of 63 infants (64.9%) received maximal intensive care, and 34 infants (35%) had redirection of intensive care. During this period, the proportion of death after redirection of care increased from 30.6% to 39.6%. Infants decided to forgo life-sustaining care before death had significantly lower gestational ages and lower birth weights (30.5 vs. 27.1 weeks, P=0.005; 1,528 vs. 1,063 g, P=0.025). Conclusion: Infection remained an important cause of death for neonate, particul- arly for preterm infants. The proportion of infants who had redirectoin of care before death was increased, suggesting that quality-of-life should be considered an impor- tant factor in the decision-making process for the infant, parents, and medical staff.

Missed nursing care and its influencing factors among neonatal intensive care unit nurses in South Korea: a descriptive study

Soohyun Kim,Sun-Mi Chae 한국아동간호학회 2022 Child Health Nursing Research Vol.28 No.2

Purpose: Preventing missed care is important in neonatal intensive care units (NICUs) due to neonates’ vulnerabilities. This study examined missed care and its influencing factors among NICU nurses. Methods: Missed care among 120 Korean NICU nurses was measured using a cross-culturally adapted online questionnaire. The frequency of missed care for 32 nursing activities and the significance of 23 reasons for missed care were collected. Results: All participants had missed at least 1 activity, missing on average 19.35 activities during a typical work-day. The most common missed item was “provide developmental care for the baby”. The most common reason for missed care was “emergency within the unit or deterioration of one of the assigned patients”. The final regression model explained 9.6% of variance in missed care. The average daily number of assigned patients receiving inotropes or sedation over the last month influenced the total number of missed care items. Conclusion: Missed care was affected by nurses’ workload related to the number of patients taking medication. Frequently missed activities, especially those related to developmental care, require patience and time, conflicting with safety prioritization and inadequate working conditions. NICU nurses’ working conditions should be improved to ensure adequate time for nursing activities.

한국형 신생아중환자간호 분류도구를 이용한 간호요구도 평가

안효남,안숙희 한국중환자간호학회 2020 중환자간호학회지 Vol.13 No.2

Purpose : This study aimed to determine whether the Korean Patient Classification System for Neonatal Care Nurses (KPCSN) properly measures neonatal intensive care needs and to compare the scale’s results with those of the Workload Management System for Critical Care Nurses (WMSCN). Methods : Data were collected from the medical records of 157 patients who were admitted to the NICU of a university hospital, in D city. Two types of patient classification systems were applied to investigate the total points and distributions to investigate the total points and distributions by categories and compare relationships and classification groups between two scales. Finally, the score distribution among the classification groups was analyzed when the KPCSN was applied. Results : Scores on the KPCSN for the feeding, monitoring, and measure categories were 19.16±15.40, 16.88±3.52, and 9.13±4.78, respectively. Classification group distribution of the KPCSN was as follows : 1.9% for the first group, 24.2% for the second group, 58% for the third group, and 15.9% for the fourth group. The classification group distribution of the WMSCN was as follows: 35.7% for the third group, 61.1% for the fourth group, and 3.2% for the fifth group. Finally, the scores by categories were analyzed according to KPCSN classification group, and the characteristics of the patients’ nursing needs were identified for each classification group. Conclusion : Results of this study indicate that the KPCSN effectively measures feeding needs, which account for many nursing activities in neonatal intensive care. Comparisons between the KPCSN and WMSCN classification group scores and distribution ratios verified the correlation and significance of nursing requirements.

Perceptions of fatherhood and confidence regarding neonatal care among fathers of high-risk neonates in South Korea: a descriptive study

Jin Won Lee,Sunhee Lee 한국아동간호학회 2023 Child Health Nursing Research Vol.29 No.3

Purpose: The purpose of this study was to investigate perceptions of fatherhood among fathers of high-risk neonates and their confidence regarding neonatal care. Methods: A study was conducted of 100 fathers whose neonates had been admitted to a neonatal intensive care unit (NICU) for at least 48 hours. Perceptions of fatherhood, neonatal characteristics, and fathers' confidence regarding neonatal care were measured using a self-reported questionnaire. The survey took approximately 10 minutes to complete and was completed anonymously. The factors that affected fathers' confidence regarding neonatal care were analyzed using multiple regression. Results: The scores for positive and negative perceptions of fatherhood were relatively high at 4.27 and 3.42 out of 5 points, respectively. A positive perception of fatherhood was found to influence fathers' confidence regarding neonatal care. Conclusion: NICU nurses should encourage fathers to effectively perform their parenting roles by implementing educational programs and interventions to promote positive perceptions of fatherhood and fathers' confidence regarding neonatal care after discharge.

Current Status of Neonatologist Staffing and Workload in Korean Neonatal Intensive Care Units

이병섭,Jae Woo Lim,Yong Sung Choi,김기수 대한신생아학회 2020 Neonatal medicine Vol.27 No.2

Purpose: To identify the recent status of the neonatologist and their workload in neonatal intensive care unit (NICU) in Korea. Methods: On October 2018, a survey was conducted on the statistics of the workforce including the census of certified neonatologists, NICU beds, nursing staffing ratings, bed occupancy rate, annual admission of very low birth weight infant (VLBWI), infant acuity score of nursing, and the proportion of out-born patients. The level of neonatal care was self-rated. Results: A total of 68 centers responded to the survey. An average number of certified neonatologists and the number of NICU beds per center was 1.9 (range, 0 to 5) and 23.1 (range, 0 to 30), respectively. Thirty-eight percent (n=26) of NICUs were being operated with only one (n=24) or no (n=2) certified neonatologist and only 19% (n=13) of NICUs had ≥3 neonatologists. The average ratio of NICU beds to neonatologists rated 13.4±6.2. The higher the level of neonatal care, the higher the number of tertiary referral hospitals, neonatologists, NICU volume, infant acuity scores of nursing, and annual VLBWI admissions. However, there was no difference in the beds to neonatologist ratio between level 2 (n=9, 9.5±3.1), level 3 (n=44, 14.0± 6.9), and level 4 (n=14, 13.7±4.2). The infant acuity score was proportional to the NICU volumes, but not related to the beds to neonatologist ratio. Conclusion: Compared with the international standards, most Korean NICUs were understaffed in terms of the certified neonatologist and were unable to provide ‘continuity of care’ for high-risk newborns.