집중치료실 간호사의 진정요법 지식과 간호실무 역량요인에 대한 상관성 분석

다국어 초록 (Multilingual Abstract)

It is necessary for critical care nurses to improve clinical capacity to maintain the quality of care for patients receiving sedation therapy in intensive care unit (ICU). In 2013, the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM) proposed a new paradigm to encourage active uses of light sedation to maintain the patient’s consciousness for pain, sedation and delirium treatment at the ICU. However, there is lack of studies which investigate associations among sedation knowledge and nursing competences when Korean ICU nurses use sedation therapy. Therefore, this study is a cross-sectional correlation study aims to provide fundamental knowledge to improve the nursing practice competence for the nurse-centered sedation therapy for Korean ICU nurses.

The study participants (n = 91) were recruited from the intensive care units of two tertiary hospitals in Korea. A self-report questionnaire was used to examine the levels of knowledge on the sedation therapy and nursing practice competence. The collected data were analyzed using the IBM SPSS version 21.0 program, and descriptive statistics, independent t-test, one-way ANOVA, correlation analysis or corresponding non-parametric analyses were performed.
The results of this study are as follows:
1. The mean total knowledge score on the sedation therapy in ICU nurses was 17.97 (±1.91) out of 20 points, and the correct answer rate was 89.85%. The mean score of the basic knowledge domain was 10.74(±.77) out of 11 points, and the mean score of the latest trend was 7.23 (±1.45) out of 9 points.
2. The study results on the nursing practice competence for the sedation therapy in ICU nurses were as follows: In the ‘attitude’, using sedative drugs was positive for patients with assisted mechanical ventilation. In the ‘subjective norms’, ICU nurses reported that they were strongly influenced by others in performing the sedation therapy, specifically clinicians rather than family caregivers. In the 'orders and goal', they were independnet to manage the levels of sedation therapy, and in the 'perceived behavioral control', they were found to be influenced by other than patients’ during the sedation therapy. In the ‘sedation practices’, the use of the sedation therapy tended to increase, and in the ‘Intention to sedate all mechanically ventilated patients’, the intention to use the sedation therapy when they cared for patients with mechanical ventilation.
3. Scores of ICU nurses’ total knowledge, basic knowledge, and latest trend knowledge on the sedation therapy were statistically different by the sedation education time (p <.01).
4. The subjective norms, which is a subdomain of the nursing practice competence for the sedation therapy in ICU nurses, showed significant differences depending on their age (p = .05), education level(p = .04), clinical work experience (p = .05), and working department(p = .04). The prescription and goal had a significant difference depending on the use of the sedation therapy protocol (p < .01).
5. There were positive correlations between ICU nurses’ basic knowledge on the sedation therapy and latest trend knowledge (r = .42, p < .01). The attitude of nursing practice competence for the sedation therapy was positively correlated with the subjective norms (r = .31, p < .01), orders and goals (r = .23, p = .03), perceived behavioral control (r = .23, p = .03), Sedation practices (r = .33, p < .01), and sedation intention (r =.48, p < .01). The subjective norms was positively correlated with the orders and goal (r = .39, p < .01) and perceived behavioral control (r = .39, p < .01), and the sedation practices was positively correlated with the sedation intention (r= .35, p < .01).

This study suggests that ICU nurses should develop various competencies comprehensively in order to perform an appropriate sedation therapy. The development of nursing practice competence to perform an appropriate sedation therapy is essential, which seems to be a goal of protocol development for the nurse-centered sedation therapy at the same time.

국문 초록 (Abstract)

집중치료실 간호사는 치료중인 환자의 정신적 뿐만 아니라 물리적인 편안함을 제공하고 스트레스원의 관리를 위해 적정한 진정요법의 사용하는 역량을 갖추어야한다. 최근 세계 중환자 의학회(World Federation of Societies of Intensive and Critical Care Medicine, WFSICCM)는 집중치료실 성인 환자의 통증, 진정, 섬망 치료를 위해 환자의 의식을 유지한 얕은 진정(light sedation)의 적극 사용하는 새로운 패러다임을 도입하였다. 따라서 간호사 중심의 진정요법을 위한 간호실무 역량을 향상을 위해 국내 집중치료실 간호사 대상의 연구가 더욱 필요한 실정이다.
본 연구는 대학병원 집중치료실 간호사를 대상으로 진정요법 지식과 간호실무 역량요인을 확인하여 상관관계를 알아보기 위한 횡단적 상관관계 조사연구이다. 연구 대상은 국내 3차병원 2곳의 집중치료실에서 일하는 간호사 총 91명을 조사하였다. 선정된 대상자에게서는 자기보고식 설문조사를 통해 진정요법의 지식 및 간호실무 역량요인을 조사하였다. 수집된 자료는 IBM SPSS version 21.0 program을 이용하여 기술통계, independent t-test, one-way ANOVA, 상관관계 분석 혹은 해당되는 비모수 분석법을 시행하였다.

본 연구의 결과는 다음과 같다.

1. 집중치료실 간호사의 진정요법의 지식총점은 총 20점 중 평균 17.97(±1.91)점으로 정답률은 89.85%로 조사되었다. 기본 지식 영역은 총 11점 중 평균 10.74 (±.77)점이, 최신경향 총 9점 중 평균 7.23(±1.45)점으로 측정 되었다.
2. 집중치료실 간호사의 진정요법 간호실무 역량요인 조사 결과 ‘태도’는 기계적 보조 환기 환자에게 진정제 약물 사용이 긍정적이며 ‘주관적 신념’은 진정요법의 수행에서 타인에게 강한 영향을 받는다고 나타났다. ‘처방 및 목표’에서는 진정요법을 결정할 수 있는 독립성을 갖고 있으며 ‘조절요인’은 진정요법의 수행에서 환자가 아닌 타 영향을 받는다고 나타났다. ‘수행’은 진정요법 사용을 증가하는 성향이며 ‘기계적 환기 치료 환자의 진정 의도’ 영역에서 기계적 환기 치료 환자에게 진정요법 사용 의도는 높지 않다고 나타났다.
3. 집중치료실 간호사의 진정요법의 지식 총점, 기본지식, 최신동향 지식 모두 진정교육 시간(p < .01)에 따라 유의한 차이를 나타냈다.
4. 집중치료실 간호사의 진정요법 간호실무 역량요인의 세부영역인 주관적인 신념은 연령(p = .05), 학력(p = .04), 임상경력(p = .05), 근무부서(p = .04)에 따라 유의한 차이가 있었으며 처방 및 목표는 진정요법 프로토콜 사용 여부(p < .01)에 따라 유의한 차이가 있었다.
5. 집중치료실 간호사의 진정요법의 기본 지식과 최신동향 지식은 양의 상관관계에 있는 것으로 나타났다(r = .42, p < .01). 진정요법의 간호실무 역량요인의 태도는 주관적 신념(r = .31, p < .01), 처방 및 목표(r = .23, p = .03), 조절요인(r = .23, p = .03), 수행(r = .33, p < .01), 진정의도(r =.48, p < .01)와 양의 상관관계에 있으며 주관적인 신념은 처방 및 목표(r = .39, p < .01), 조절요인(r = .39, p < .01)과 양의 상관관계를 가지며 수행은 진정의도(r = .35, p < .01)와 양의 상관관계가 있었다.