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체외막산소화장치 (ECMO) 적용 중환자의 영양지표 비교
신나미(Nah-Mee Shin),하숙연(Suk Yeon Ha),조윤수(Yoon Soo Cho) 한국영양학회 2021 Journal of Nutrition and Health Vol.54 No.5
본 연구는 부적절한 영양지원이 ECMO 환자의 영양상태 뿐만 아니라 사망률 등에도 부정적인 영향을 미칠 수 있음을 보여주었다. 대부분의 ECMO 환자는 중환자실 입실 초기부터 영양상태가 이미 영양불량이거나 영양불량 위험군이었고, 재원기간이 경과하면서 악화되는 것을 관찰하였다. 이는 ECMO 환자들이 가장 위중할 때에 필요로 하는 칼로리와 단백질의 영양지원이 충분하지 않았음을 시사하는 것이며, 특히 PN과 EN의 개시 시점이 영양관리지침의 권고보다 지연되지 않도록 노력하는 개선이 시급하다. 또한, ECMO 환자의 영양상태 평가만 아니라 공급한 영양지원에 대한 환자의 반응까지 고려한 영양관리가 필요한데, 이를 위해서는 영양관리가 중환자 간호에서 우선시 되어야 하며, 영양사를 포함한 다학제간 접근이 반드시 포함되어야 한다. 점차 증가하는 ECMO 적용 사례를 고려한다면, 중환자실에서의 집중치료 과정에 영양관리도 비중있게 반영되어야 할 것이다. 차후에는 전향적 무작위통제 연구로 환자의 질환 유형이나 ECMO 배치형태에 따른 영양지원방법과 효과를 비교할 것을 제안한다. 더 많은 대상자 수 확보를 위하여 여러 병원의 자료를 취합하여 분석하거나 환자 상태에 따라 영양공급의 적정량을 평가하고 비교하는 연구를 제안한다. Purpose: This study aimed at investigating the nutritional status, nutritional support, and nutritional indicators of critically ill patients on extracorporeal membrane oxygen (ECMO) in intensive care units (ICU). Methods: This descriptive study obtained data from the medical records of 37 patients who were treated using ECMO at a university hospital in Korea. The patients were admitted to the Korea University Anam Hospital ICU with acute or serious damage to vital organs from January 1, 2014 to June 30, 2016. Results: Although 32 patients (86.5%) were at a high risk of malnutrition, 26 patients (70.3%) were considered normal in terms of nutritional status by the nutritionist at the beginning of their ICU stay. However, after two weeks, nine patients had passed away and only one patient maintained normal status. Parenteral nutrition was started first but took 4.25 ± 6.95 days till initiation. Only eight patients (21.6%) were able to meet their requirement for both calories and protein. The group provided with adequate calorie and protein showed significantly longer use of the ECMO and respirator and longer ICU and total hospital stay than their counterparts. Normal levels of serum albumin and protein of the group at low-risk for malnutrition on the day of initiation of ECMO, which were significantly higher than the high-risk group, declined by the last day of ECMO leading to a lack of significant differences between the two groups. Conclusion: Considering that the nutritional indicators of patients deteriorated as the days on ECMO increased, more aggressive nutritional management to ensure adequate nutritional support should be emphasized from the beginning and throughout the ICU stay.
COVID-19 팬데믹 상황에서 간호사 간 동료연대에 대한 개념분석
신나미(Shin, Nah-Mee),공문연(Kong, Moon Yeon) 한국간호행정학회 2021 간호행정학회지 Vol.27 No.5
Purpose: This study aimed to define and clarify the concept of colleague solidarity experienced by nurses during the COVID-19 pandemic. Methods: A hybrid model method was used to investigate the dimensions, attributes, and definitions of the concept. In the theoretical phase, 20 articles selected through literature review by including nursing and related disciplines were analyzed. For the fieldwork phase, in-depth interviews were conducted with nine nurses who took care of infected patients with COVID-19 at Infectious Diseases Specialized Hospital. Results: The dimensions identified were consistently observed in the field phase, however, more attributes were found newly from the fieldwork phase. In the final phase, the concept of colleague solidarity among the nurses was found to have three dimensions with nine attributes. The interaction dimension had four attributes as voluntary support, mutual respect, open communication, and virtuous circle. The motivation dimension had two attributes of sense of communion and calling. Lastly, the relationship dimension had three attributes of unity, mutually equal relationship, and comradeship. Conclusions: This study is meaningful in observing how the concept of colleague solidarity, which is relatively unfamiliar to domestic nurses, appears in the clinical field during a national crisis and analyzing the concept.
Type D 성격 유형에 따른 교대근무 간호사의 건강증진 행위와 주관적 건강상태 및 직무 만족
신나미(Shin, Nah-Mee),김영하(Kim, Young Ha) 한국간호행정학회 2021 간호행정학회지 Vol.27 No.1
Purpose: The purpose of this study was to explore the frequency of Type D Personality Pattern (TDPP) in shift work nurses who have irregular lifestyles and based on TDPP, to compare health promotion behavior (HPB), subjective health status (SHS), and job satisfaction. Methods: A descriptive cross-sectional design was used with data collected from a convenience sample of 139 shift work nurses. The self-report questionnaires included Personality Scale, Health Promoting Lifestyle Profile II, Health Self Rating Scale, and Job Satisfaction Scale. Results: Fifty three nurses (38.1%) were found to have TDPP. Although there were no significant differences between groups with TDPP and with no TDPP, nurses with TDPP tend to be younger, live alone, and have less years of clinical experience. Also, SHS, HPB and job satisfaction were significantly lower in the nurses with TDPP than those with no TDPP. SHS was positively correlated with HPB and job satisfaction. Also, job satisfaction was positively correlated with HPB. Conclusion: TDPP in shift work nurses should be considered as TDPP is not a trait but a pattern. Therefore for shift work nurses, modifiable strategies should be effective in reducing the risk of developing TDPP and enhancing the nurses’ SHS, HPB, and job satisfaction.
박병준,신나미,Park, Byung-Jun,Shin, Nah-Mee 한국중환자간호학회 2014 중환자간호학회지 Vol.7 No.1
Purpose: As the number of cases of heart transplantation (HT) and the survival rate have increased, concerns regarding post-HT life have grown. This study was conducted to explore the relationships of perceived social support to the depression and health status of HT recipients. Methods: This descriptive study targeted all recipients who had undergone HT at S University Hospital since 1994, and 32 recipients were recruited. Results: 90.6% of the recipients were men, and the average age at the time of surgery was $47.4{\pm}13.4$ years. The ejection fraction was increased from $18.47{\pm}5.63%$ to $63.25{\pm}7.57%$, and 31 cases of New York Heart Association (NYHA) class III and IV improved to class I or II after HT. The patients reported mild depression even with high perceived social support and improved health status after HT. Among those resource persons who offered support, they reported their spouse, doctors, and nurses as most meaningful to them. Conclusion: This study confirmed the positive effects of HT on the recipients' physical improvement. It also added the discovery that the importance of recipients' subjective perception of social support might be critical for their more successful recovery and adjustment to post-HT life. Focusing on a different approach to social support and types of social resources in the recovery phase is suggested for future studies on quality of life after HT.
장성옥,신나미,김순용,Chang, Sung-Ok,Shin, Nah-Mee,Khim, Soon-Yong 기본간호학회 2009 기본간호학회지 Vol.16 No.4
Introduction: Critical thinking involves identifying problem(s), assessing resources, and generating possible solutions and allows clinical nurses to decide which solution is the most reasonable under the given circumstances, taking into consideration the "hat ifs" and how they will affect the end result. This research was conducted to further understanding and identification of subjective factors in critical thinking in clinical nurses. Methods: The research design was a Q-Methodological Approach. Q-population was formulated from a non-structured questionnaire and interviews from 17 experienced clinical nurses. Thirty selected Q-statements were sorted by 30 experienced clinical nurses. Results: Four factors for critical thinking were identified: (1) Deductive reasoning based on causal relation, (2) Construction of an effective model based on patients' responses, (3) Formulating categories based on priorities for effective interventions, and (4) Judging validity of the situational significance on clinical performances. Conclusion: Critical thinking is an attitude and reasoning process. From this study, the frame of reference for clinical nurses in formulating critical thinking within the context of clinical settings is identified and indicates the way nurses utilize thinking skills when they care for patients and areas that need further exploration as nurses and faculty develop education systems to advance clinical performance competency.