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Background: Health professionals had difficulty choosing the right time to discuss life-sustaining treatments (LSTs) since the Korean Act was passed in 2018., Objective: This study aimed to understand how patients decide to undergo LSTs in clinical practice and to compare the perceptions of these decisions among health professionals, patients, and families with suggestions to support the self-directed decisions of patients., Research Design: A retrospective observational study with electronic medical records (EMRs) and a descriptive survey was used., Methods: The data obtained from the EMRs included all adult patients who died in end-of-life care at a university hospital in 2021. We also conducted a survey of 214 health professionals and 100 patients and their families (CNUH IRB approval no. 2022-07-006)., Results: Based on the EMR data of 916 patients in end-of-life care, 78.4% signed do-not-attempt-resuscitation consents, 5.6% completed the documents for LSTs, and 10.2% completed both forms. LST decisions were mostly made by family members (81.5%). Most survey participants agreed that meaningless LSTs should be suspended, and the decision should be made by patients. Patients and family members (42-56%) and health professionals (56-58%) recommended discussing LST suspension when the patient is still conscious but with predicted deterioration of their condition. The suffering experienced by the patient was considered to be a priority by most patients (58%) and families (54%) during the decision-making process, while health professionals considered "the possibility of the patient's recovery" to be the highest priority (43-55%)., Conclusions: There is still a significant discrepancy in the perceptions of LST decisions among health professionals, patients, and their families despite high awareness of the Act. This situation makes it challenging to implement the Act to ensure respect for the rights of patients to self-determination and dignified end-of-life. Further effort is needed to improve the awareness of LSTs and to clarify the ambiguity of document preparation timing., (© 2024. The Author(s).)

Objectives: In general, fetal cfDNA is shorter than maternal cfDNA, and accuracy of noninvasive prenatal testing (NIPT) results can be improved by selecting shorter cfDNA fragments to enrich fetal-derived cfDNA. This study investigated potential improvements in the accuracy of NIPT by performing classification and analysis based on differences in cfDNA size., Methods: We performed paired-end sequencing to identify size ranges of fetal and maternal cfDNA from 62,374 pregnant women. We then developed a size-selection method to isolate and analyze both fetal and maternal cfDNA, defining fetal-derived cfDNA as less than 150 bp and maternal-derived cfDNA as greater than 180 bp., Results: By implementing size-selection method, the accuracy of NIPT was improved, resulting in an increase in the overall positive predictive value for all aneuploidies from 89.57% to 97.1%. This was achieved by enriching both fetal and maternal-derived cfDNA, which increased fetal DNA fraction while the number of false positives for all aneuploidies was reduced by more than 70%., Conclusions: We identified the differences in read length between fetal and maternal-derived cfDNA, and selectively enriched both shorter and longer cfDNA fragments for subsequent analysis. Our approach can increase the detection accuracy of NIPT for detecting fetal aneuploidies and reduce the number of false positives caused by maternal chromosomal abnormalities., (© 2023 John Wiley & Sons Ltd.)

Objective: Sleep disturbance and delirium are common problems experienced by critically ill patients in the intensive care unit (ICU). These interrelated issues increase the length of stay in the ICU but might also negatively affect long-term health outcomes. The objective of this study was to identify the nonpharmacological interventions provided to improve sleep or prevent delirium in ICU patients or both and integrate their effect sizes., Review Methods: This study was a registered systematic review and meta-analysis. We searched MEDLINE, CINAHL, EMBASE, Web of Science, and Cochrane Library from their inception until December 2021. We included randomised controlled trials and nonrandomised controlled trials-(RCT) that provided nonpharmacological interventions and reported sleep or delirium as outcome variables. Studies not published in English or whose full text was not available were excluded. The quality of the evidence was assessed with version 2 of the Cochrane risk-of-bias tool for RCTs and the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I)., Results: The systematic review included 118 studies, and the meta-analysis included 100 studies. Overall nonpharmacological interventions had significant effects on subjective sleep quality (standardised mean difference = 0.30, 95% confidence interval [CI] = 0.05 to 0.56), delirium incidence (odds ratio = 0.62, 95% CI = 0.53 to 0.73), and delirium duration (standardised mean difference = -0.68, 95% CI = -0.93 to -0.43). In individual interventions, aromatherapy, music, and massage effectively improved sleep. Exercise, family participation, information giving, cognitive stimulation, bright light therapy, architectural intervention, and bundles/protocols effectively reduced delirium. Light/noise blocking was the only intervention that ensured both sleep improvement and delirium prevention., Conclusions: Our results suggest nonpharmacological interventions improve sleep and prevent delirium in ICU patients. We recommend that ICU nurses use nonpharmacological interventions that promote person-environment compatibility in their clinical practice. The results of our review can guide nurses in adopting interventions related to sleep and delirium., Prospero Reference Number: CRD42021230815., (Copyright © 2022 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

Objectives: The aim of this study was to investigate health-related quality of life (HRQOL) and related factors in intensive care unit survivors one-12 months after discharge., Research Methodology/design: This cross-sectional survey included survivors who had been admitted to an intensive care unit for ≥48 hours., Main Outcome Measures: HRQOL was measured using the EQ-5D-5L profile, which evaluates five dimensions of health (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) on five levels (no, slight, moderate, severe, and extreme problems), EQ-VAS (score range 0-100, 100 indicating best health) and EQ values (score range -0.066-1, 1 indicating best health). The factors influencing HRQOL were analyzed by Tobit regression., Setting: Survivors treated in an intensive care unit at six institutions in Korea., Results: Only 7.9% of the 534 participants had self-reported profiles of no health problems in all five dimensions. The proportion of participants with slight problems was highest in pain/discomfort with 85.0%. The proportion with severe problems was highest in usual activities with 21.7%, followed by mobility with 21.0%. The median and interquartile range of the EQ-VAS and EQ values were 60.00 (45.00 to 75.00) and 0.72 (0.52 to 0.80), respectively. Negative impact factors on HRQOL included older age, women, residing in a long term care facility, unemployment, emergency intensive care admission, and intensive care stay ≥ 7 days., Conclusion: HRQOL among Korean intensive care survivors is low. The level of problems in physical dimensions is more severe than that in mental health dimensions. Early rehabilitation in the intensive care unit should be provided to facilitate long-term recovery., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Aim: To investigate the incidence of post-intensive care unit (ICU) depression and its risk factors among critical care survivors., Methods: The study data were extracted from the database of the National Health Insurance Service of Korea. We retrospectively analyzed data from 161,977 adult patients who were admitted to the ICU for more than 24 hr from January 1, 2012 to December 31, 2014 and survived for more than 1 year after discharge. Risk factors for newly diagnosed depression (Code F32) were analyzed using multiple logistic regression analysis., Results: The incidence of post-ICU depression was 18.5%. The major risk factors were enteral nutrition (odds ratio [OR] = 2.28, 95% confidence interval [CI] = 2.19-2.36), cerebrovascular disease (OR = 1.59, 95% CI = 1.54-1.64), and hemi/paraplegia (OR = 1.48, 95% CI = 1.41-1.56). It was observed that cardiopulmonary resuscitation (OR = 0.55, 95% CI = 0.50-0.61) and myocardial infarction (OR = 0.75, 95% CI = 0.71-0.79) lowered depression., Conclusions: The incidence of post-ICU depression was high and influenced by ICU treatment and physical impairments. Healthcare providers must pay attention to the psychological changes in survivors with major risk factors in the recovery process., (© 2019 Japan Academy of Nursing Science.)

Purpose: We aimed to classify nonpharmacological interventions used for preventing delirium in the intensive care unit (ICU), and estimate their effect size., Materials and Methods: In this systematic review and meta-analysis, the literature was searched and studies were selected based on the PRISMA flow chart. Data sources included MEDLINE, Cochrane, CINHAHL, PsyInfo, and EMBASE. We used Cochrane's Effective Practice and Organisation of Care (EPOC) criteria in study design and quality assessment of the meta-analysis., Results: This systematic review and meta-analysis included 35 and 15 studies, respectively. Studies were grouped into nine intervention types: multicomponent (16 studies), physical environment (9), daily interruption of sedation (2), exercise (2), patient education (2), automatic warning system (1), cerebral hemodynamics improving (1), family participation (1), and sedation reducing protocol (1). The effect size of preventive nonpharmacological interventions had an odds ratio (OR) of 0.66 (95% confidence interval [CI], 0.50-0.86) for delirium occurrence, and an OR of 0.31 (95% CI, 0.10-0.94) for delirium duration. Although relevant studies by interventions were lacking, a partial subgroup analysis by intervention was performed., Conclusions: Nonpharmacological interventions were effective in reducing the duration and occurrence of delirium. Consistent application and development of nonpharmacological interventions for use in the ICU are important., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Purpose: The purpose of this study was to develop a scale to measure person-centered critical care nursing and verify its reliability and validity., Methods: A total of 38 preliminary items on person-centered critical care nursing were selected using content validity analysis of and expert opinion on 72 candidate items derived through literature review and qualitative interviews. We conducted a questionnaire survey with 477 nurses who worked in intensive care units. The collected data were analyzed using exploratory factor analysis (EFA) and confirmative factor analysis (CFA) with SPSS and AMOS 24.0 program., Results: EFA was performed with principal axis factor analysis and Varimax rotation. The 15 items in 4 factors that accounted for 50.8% of the total variance were identified by deleting the items that were not meet the condition that the commonality should be .30 or more and the factor loading over .40. We named the factors as compassion, individuality, respect, and comfort, respectively. The correlation coefficient between this scale and the Caring Perception Scale was r=.57 (p<.001), which determined concurrent validity. The item-total correlation values ranged from .39 to .63, and the internal consistency for the scale was Cronbach's α=.84., Conclusion: The reliability and validity of the 15 item person-centered critical care nursing scale were verified. It is expected that the use of this scale would expand person-centered care in critical care nursing., Competing Interests: The authors declared no conflict of interest., (© 2018 Korean Society of Nursing Science.)

Purpose: The purpose of this study was to build and test a model outlining the factors related to workplace bullying among nurses. The hypothesized model included authentic leadership and a relationship-oriented organizational culture as influencing factors, symptom experience and turnover intention as consequences, and positive psychological capital as a mediator of workplace bullying among nurses., Methods: We obtained structured questionnaire data from 301 nurses working at hospitals in South Korea. Based on these data, the developed model was verified via a structural equation modeling analysis using SPSS and AMOS program., Results: The fit indices of the hypothesized model satisfied recommended levels; χ 2  = 397.58 (p < .001), normed χ 2 (χ 2 /df) = 1.82, RMR = .05, TLI = .93, CFI = .94, RMSEA = .05. A relationship-oriented organizational culture had a direct effect on workplace bullying (β = -.48, p < .001). Furthermore, workplace bullying had a direct effect on symptom experience (β = .36, p < .001), and this relationship was mediated by positive psychological capital (β = .15, p = .003). Workplace bullying also had an indirect effect on turnover intention (β = .20, p = .007). Finally, symptom experience had a direct effect on turnover intention (β = .31, p = .002)., Conclusion: These results suggest that workplace bullying among nurses may be prevented by constructing a relationship-oriented organizational culture, as long as employees have sufficient positive psychological capital. In this regard, workplace bullying among nurses should be addressed using a comprehensive strategy that considers both individual and organizational factors., (Copyright © 2018. Published by Elsevier B.V.)

Purpose: This research aimed to investigate the effects of a cognitive rehearsal program (CRP) on workplace bullying among nurses., Methods: A randomized controlled trial was performed. Participants were 40 nurses working in different university hospitals in B city, South Korea. The experimental group was provided with a 20-hour CRP comprising scenarios on bullying situations, standard communication, and role-playing. To evaluate effects of the CRP, we measured interpersonal relationships, workplace bullying, symptom experience, and turnover intention at preand post-intervention. Follow-up effect was measured in the experimental group only at 4 weeks after the intervention., Results: After the intervention, there were significant differences in interpersonal relationships (F=6.21, p=.022) and turnover intention (F=5.55, p=.024) between experimental and wait-list groups. However, there was no significant difference in workplace bullying or symptom experience between the 2 groups. The beneficial effects on interpersonal relationships and turnover intention lasted at least up to 4 weeks after CRP., Conclusion: The CRP for workplace bullying improves interpersonal relationships and decreases turnover intention. So it can be utilized as one of the personal coping strategies to reduce the the turnover among nurses. Further studies on the effects of unit- or hospital-based CRP and on the long-term effects of CRP are necessary., Competing Interests: The authors declared no conflict of interest., (© 2017 Korean Society of Nursing Science)

Purpose: The purpose of this qualitative study was to explore the workplace bullying experience of Korean nurses., Methods: Participants were twenty current or former hospital nurses who had experienced workplace bullying. Data were collected through focus group and individual in-depth interviews from February to May, 2015. Theoretical sampling method was applied to the point of theoretical saturation. Transcribed interview contents were analyzed using Corbin and Strauss's grounded theory method., Results: A total of 110 concepts, 48 sub-categories, and 17 categories were identified through the open coding process. As a result of axial coding based on the paradigm model, the central phenomenon of nurses' workplace bullying experience was revealed as 'teaching that has become bullying', and the core category was extracted as 'surviving in love-hate teaching' consisting of a four-step process: confronting reality, trial and error, relationship formation, and settlement. The relationship formation was considered to be the key phase to proceed to the positive settlement phase, and the participants utilized various strategies such as having an open mind, developing human relationships, understanding each other in this phase., Conclusion: The in-depth understanding of the workplace bullying experience has highlighted the importance of effective communication for cultivating desirable human relationships between nurses.