중환자실 환자의 섬망이 중환자실 장기 체류에 미치는 영향

이야란 원광대학교 대학원 2024 국내석사

Impact of Delirium on Prolonged Intensive Care Unit Length of Stay in Patients with Critical Illness Lee, Ya Ran Directed by Professor Won, Mi Hwa R.N., Ph.D. Department of Nursing The Graduate School of Wonkwang University Purpose: This study aimed to improve understanding of delirium and provide evidence for developing nursing interventions to reduce the length of stay for patients in the intensive care unit by determining the incidence of delirium in them and the effect of delirium on prolonged intensive care unit length of stay. Methods: This prospective cohort study included 200 patients hospitalized in three intensive care units at a tertiary hospital in Jeonbuk, and data were collected from June 17 to October 7, 2023. Delirium was measured using the Korean Nursing Delirium Screening Scale. In addition, a prolonged intensive care unit length of stay was defined as eight days or longer. Study data were analyzed using descriptive statistics, χ2 test, t-test, and multiple logistic regression analyses using IBM SPSS version 26.0. Results: The results of this study are summarized as follows. First, the incidence of delirium in intensive care unit patients was 28.5%, and the prolonged intensive care unit length of stay group was 31%. Second, the mean age of intensive care unit patients was 69.07(±15.34) years, with males accounting for 117(58.5%). Of the total participants, 176(88.0%) were married, 125(62.5%) were currently non-smokers, 136(68.0%) were currently abstaining from drinking alcohol, and 135(67.5%) were unemployed. Among the departments, Internal Medicine had the largest number of patients, with 116(58.0%); the most common type of intensive care unit was the emergency intensive care unit, with 130(65.0%) patients; and 162(81.0%) participants had no history of surgery upon admission to the intensive care unit. The most frequent number of comorbidities was three or more, observed in 69 patients (34.5%); 165 patients (82.5%) did not use sedatives, and the mean Simplified Acute Physiology Score Ⅲ was 49.72±14.89. Among participants, 134(67.0%) did not use a body protector, 124(62.0%) did not use ventilators, and 89(44.5%) had three or more catheters. Among the participants’physiological indicators, the mean values of white blood cell, blood urea nitrogen, C-reactive protein, and lactate were 12.04±6.77 (x10³/uL), 26.97±20.89(mg/dL), 76.84±105.63(mg/L), and 28.38±36.03(mg/ dl), respectively. Third, the delirium and non-delirium groups significantly differed in age(χ2 =8.15, p=.005), sex(χ2=4.48, p=.039), type of intensive care unit(χ2 =16.01, p=<.001), number of comorbidities(χ2=10.05, p=<.018), sedative use(χ2 =6.17, p=<.022), Simplified Acute Physiology Score Ⅲ(χ2=5.15, p=<.001), ventilator use(χ2=35.03, p=<.001), number of catheters(χ2 =19.62, p=<.001), C-reactive protein level(χ2=3.65, p=<.001), and length of stay in the intensive care unit(χ2=67.90, p=<.001). Fourth, the length of stay in the intensive care unit significantly differed according to the type of intensive care unit(χ2=22.10, p=<.001), number of comorbidities(χ2=13.77, p=.003), sedative use(χ2=10.75, p=.002), Simplified Acute Physiology Score Ⅲ(χ2=-7.33, p=<.001), ventilator use(χ2=59.26, p=<.001), number of catheters(χ2=25.45, p=<.001), C-reactive protein level (χ2=-4.45, p=<.001), and delirium(χ2 =67.90, p=<.001). Fifth, Delirium[Odds ratio (OR)=11.92, p=<.001, 95% Confidence interval (CI)=4.16-34.20], ventilator use(OR=4.23, p=.012, 95% CI=1.38-12.99), and Simplified Acute Physiology Score Ⅲ(OR=1.05, p=.018, 95% CI=1.01-1.09) were statistically significant for patients with a prolonged intensive care unit length of stay. Conclusion: This study found that delirium, the use of a ventilator, and the severity of critical illness at admission were major factors affecting prolonged intensive care unit length of stay. Based on the study results, early assessment of delirium following admission to the intensive care unit is crucial for developing appropriate delirium-related treatment and nursing intervention strategies in order to reduce the length of stay in the intensive care unit. 중환자실 환자의 섬망이 중환자실 장기 체류에 미치는 영향 이 야 란 지도교수: 원 미 화 원광대학교 일반대학원 간호학과 목적: 본 연구는 중환자실 환자의 섬망 발생률을 확인하고, 섬망이 중환자실 장기 체류에 미치는 영향을 파악하여 섬망에 대한 이해를 높이고 중환자실 환 자의 체류 기간 감소를 위한 간호 중재 개발의 근거자료를 제공하고자 수행되 었다. 방법: 본 연구는 중환자실 환자의 섬망 발생률을 확인하고, 섬망이 중환자실 장기 체류에 미치는 영향을 규명하기 위한 전향적 코호트연구이다. 전북 소재 일개 상급종합병원의 3개 중환자실에 입원한 환자 200명을 대상으로 2023년 6 월 17일부터 10월 7일까지 자료를 수집하였다. 중환자실 환자의 섬망은 한국 판 간호 섬망 선별 도구로 측정하였으며, 중환자실 장기 체류군은 8일 이상으 로 정의하였다. 연구자료는 IBM SPSS version 26.0 프로그램을 사용하여 기술통계, χ2 test, t-test 및 다중 로지스틱 회귀분석을 이용하여 분석하였다. 결과: 본 연구의 결과를 요약하면 다음과 같다. 첫째, 중환자실 환자의 섬망 발생률은 28.5%이었고, 중환자실 장기 체류군은 31%이었다. 둘째, 중환자실 환자의 평균 연령은 69.07세(±15.34)이었고, 남성이 117명 (58.5%)을 차지하였다. 전체 대상자 중 기혼이 176명(88.0%)이었고, 현 재 금연 125명(62.5%), 현재 금주 136명(68.0%), 무직인 경우가 135명 (67.5%)으로 많았다. 진료과는 내과가 116명(58.0%)으로 가장 많았고, 중환자실 유형은 응급 중환자실이 130명(65.0%)으로 가장 많았으며, 중환자실 입실 시 수술력 이 없는 대상자는 162명(81.0%)이었다. 동반 질환 개수에서는 3개 이상 인 경우가 69명(34.5%)으로 가장 많았고, 진정제를 사용하지 않은 경우 는 165명(82.5%)이었으며, Simplified Acute Physiology Score Ⅲ 평균 점수는 49.72±14.89이었다. 신체 보호대를 적용하지 않는 대상자 134명 (67.0%), 인공호흡기를 적용하지 않는 대상자 124명(62.0%), 보유 카테터 개수는 3개 이상인 경우가 89명(44.5%)으로 가장 많았다. 대상자의 생리적 지표에서 백혈구, 혈액 요소 질소, C-반응성 단백질 및 젖산의 각 평균 수치는 12.04±6.77(x10³/uL), 26.97±20.89(mg/dL), 76.84±105.63 (mg/L) 및 28.38±36.03(mg/dl)이었다. 셋째, 중환자실 환자의 일반적 특성 및 질병 관련 특성에 따른 섬망군과 비섬 망군의 차이는 나이(χ2=8.15, p=.005), 성별(χ2=4.48, p=.039), 중환자실 유 형(χ2=16.01, p=<.001), 동반 질환 개수(χ2=10.05, p=<.018), 진정제 사용 (χ2=6.17, p=<.022), Simplified Acute Physiology Score Ⅲ(χ2=5.15, p=<.001), 인공호흡기 적용(χ2=35.03, p=<.001), 보유 카테터 개수(χ2 =19.62, p=<.001), C-반응성 단백질(χ2=3.65, p=<.001) 및 중환자실 체류 기간(χ2=67.90, p=<.001)에서 통계적으로 유의하였다. 넷째, 중환자실 환자의 일반적 특성 및 질병 관련 특성에 따른 중환자실 체류 기간의 차이는 중환자실 유형(χ2=22.10, p=<.001), 동반 질환 개수(χ2 =13.77, p=.003), 진정제 사용(χ2=10.75, p=.002), Simplified Acute Physiology Score Ⅲ(χ2=-7.33, p=<.001), 인공호흡기 적용(χ2=59.26, p=<.001), 보유 카테터 개수(χ2=25.45, p=<.001), C-반응성 단백질(χ2 =-4.45, p=<.001) 및 섬망(χ2=67.90, p=<.001)에서 통계적으로 유의하였 다. 다섯째, 중환자실 환자의 장기 체류는 섬망[Odds ratio (OR)=11.92, p=<.001, 95% Confidence interval (CI)=4.16-34.20], 인공호흡기 적용(OR=4.23, p=.012, 95% CI=1.38-12.99), 및 Simplified Acute Physiology Score Ⅲ(OR=1.05, p=.018, 95% CI=1.01-1.09)에서 통계적으로 유의하였다. 결론: 본 연구는 중환자실 환자의 섬망 발생률과 섬망, 인공호흡기 적용 및 입실 시 중환자 중증도가 중환자실 장기 체류에 주요한 영향 요인임을 확인하 였다. 본 연구 결과를 바탕으로 중환자실 체류 기간을 단축하기 위해서는 중 환자실 입실 시점부터 섬망에 대한 조기 사정과 섬망과 관련된 적절한 치료 및 간호 중재 전략을 개발하는 것이 필요하다.

소아중환자실 간호사의 영아 발달 간호에 대한 역량, 수행정도 및 중요도

남송이 연세대학교 간호대학원 2017 국내석사

This is a descriptive correlation analysis study which was conducted to provide basic data that could contribute to the preparation of guidelines for the development of education program on infant developmental care and performance of quality nursing by analyzing competency, performance, importance, and obstructive factors of the infant developmental care of nurses in the pediatric intensive care unit. The study subjects included 51 nurses in the pediatric intensive care unit and pediatric cardiac surgery intensive care unit in the S general hospital located in Seoul, and the data were collected through survey and focus group interview from March 22 to April 5, 2017. The questionnaire for infant developmental care competency was modified from the premature baby developmental support care competency tool developed by Jeong soon Kim(2015) to be suitable for our study and the validity of its contents was verified. The questionnaires for the performance and importance of infant developmental care were developed by referencing relevant literature to collect data, and the questions were modified after consulting with a professor of pediatric nursing and the validity of their contents was verified. The collected data were analyzed with descriptive statistics, t-test, ANOVA, and Pearson correlation coefficient. From the focus group interview, obstructive factors of infant developmental care were examined and analyzed with the content analysis method. The results of this study are as follows. 1. The competency of infant developmental care of the nurses in the pediatric intensive care unit was 49.00±4.37 out of a total score of 64 and 3.06±.27 based on a 4 point scale. 2. The performance of infant developmental care of the nurses in the pediatric intensive care unit was 39.39±3.70 out of a total score of 52 and 3.03±.28 based on a 4 point scale. The importance of infant developmental care was 43.90±4.36 out of a total score of 52 and 3.37±.34 based on a 4 point scale. Hence, importance showed higher scores than performance. 3. Competency of infant developmental care of the nurses in the pediatric intensive care unit according to general characteristics showed significant differences in academic degrees (t=-2.330, p=.024), total clinical experience (F=5.194, p=.004), and clinical experience in the pediatric intensive care unit (F=4.678, p=.006). Performance and importance of infant developmental care according to general characteristics did not show statistically significant variables. 4. The correlations among competency, performance, and importance of infant developmental care of the nurses in the pediatric intensive care unit showed that competency and performance (r=.362, p=.009) as well as performance and importance (r=.408, p=.003) had statistically significant difference. However, competency and importance did not show statistical significance (r=.183, p=.198). 5. The obstructive factors of infant developmental care of the nurses in the pediatric intensive care unit were personal factors (lack of knowledge, education, and experience), environmental factors (limited visit time, safety issues, lack of equipment), political factors (issues of insurance and fees, lack of manpower, lack of time caused by workload), and other factors (pressure of new nurses, lack of understanding by other medical personnel). These results indicated correlations that the nurses with high competency of infant developmental care had high performance, and the performance of infant developmental care increased as its importance increased. Therefore, to increase the performance of infant developmental care, nursing guidelines for infant developmental care that can be used during the performance of everyday nursing are required in addition to continuous and effective education programs. In addition, the work system of infant developmental care needs to be reevaluated based on the obstructive factors so that quality nursing can be performed. 본 연구는 소아중환자실 간호사들을 대상으로 영아 발달 간호에 대한 역량과 수행정도, 중요도, 장애요인을 조사하여 영아 발달 간호에 대한 교육 프로그램 개발과 질적인 간호 수행이 이루어 질 수 있도록 가이드라인 방안 마련에 도움이 될 수 있는 기초자료를 제공하기 위해 시도된 서술적 상관관계 조사 연구이다. 본 연구의 대상은 서울 소재 S 상급 종합병원 소아중환자실과 소아심장외과중환자실 간호사 51명을 대상으로 하였으며, 2017년 3월 22일부터 2017년 4월 5일까지 설문지와 포커스 그룹 인터뷰를 통해 자료수집 하였다. 본 연구에 사용한 영아 발달 간호 역량 설문지는 김정순(2015)의 미숙아 발달지지 간호역량 도구를 토대로 하여, 연구 내용에 맞게 수정한 후 내용 타당도 검증을 받고 사용하였다. 영아 발달 간호 수행정도와 중요도 설문지는 연구에 앞서 관련 문헌을 참고하여 자료 수집을 위해 사용될 설문지를 개발하였으며, 아동간호학 전공 교수의 자문을 구하여 문항을 수정한 후 내용 타당도 검증을 받고 사용하였다. 수집된 자료는 SPSS WIN 22.0을 이용하여 기술통계, t-test, ANOVA와 Pearson correlation coefficient로 분석하였다. 포커스 그룹 인터뷰를 통해 영아 발달 간호의 장애요인을 알아보았고, 내용분석방법으로 분석하였다. 본 연구의 결과는 다음과 같다. 1. 소아중환자실 간호사의 영아 발달 간호 역량은 총점 64점 만점에 49.00±4.37점, 평점 4점 만점에 3.06±.27점으로 나타났다. 2. 소아중환자실 간호사의 영아 발달 간호 수행정도는 총점 52점 만점에 39.39±3.70점, 평점 4점 만점에 3.03±.28이며, 영아 발달 간호 중요도는 총 점 52점 만점에 43.90±4.36점, 평점 4점 만점에 3.37±.34로 수행정도보다 중요도가 높게 나타났다. 3. 소아중환자실 간호사의 일반적 특성에 따른 영아 발달 간호 역량은 학력(t=-2.330, p=.024), 총 임상경력(F=5.194, p=.004), 소아중환자실 임상경력(F=4.678, p=.006)에 유의한 차이를 보였다. 일반적 특성에 따른 영아 발달 간호 수행정도와 중요도는 통계적으로 유의한 변수가 없었다. 4. 소아중환자실 간호사의 영아 발달 간호 역량, 수행정도 및 중요도 간의 상관관계에서 역량과 수행정도(r=.362, p=.009), 수행정도와 중요도(r=.408, p=.003)는 통계적으로 유의한 차이를 보였고, 역량과 중요도(r=.183, p=.198)는 통계적으로 유의하지 않았다. 5. 소아중환자실 간호사의 영아 발달 간호 장애요인은 개인적요인(지식/교육 부족, 경험부족), 환경적요인(면회시간 제한, 안전문제, 장비부족), 정책적요인(보험/수가문제, 인력부족, 업무부담으로 인한 시간부족), 기타요인(신규간호사의 눈치, 타 의료진의 인식부족)으로 나타났다. 이상의 결과를 통해 영아 발달 간호 역량이 높은 간호사일수록 수행정도가 높고, 영아 발달 간호 중요도가 높을수록 수행정도도 높아지는 상관관계를 확인하였다. 그러므로 영아 발달 간호 수행 증가를 위해 일상적인 간호 수행 시에 활용할 수 있는 영아 발달 간호 가이드라인과 지속적이고 효과적인 교육 프로그램 개발이 필요하다. 또한 장애요인을 바탕으로 영아 발달 간호의 업무 시스템을 재점검하고 개선하여 질적인 간호 수행이 이루어 질수 있도록 해야 할 것이다.

중환자의 기능 움직임 훈련이 근력, 기능수준과 삶의 질에 미치는 효과

서별 대전대학교 보건의료대학원 2019 국내석사

This study was conducted to determine the effect of functional training on strength, functional level and Quality of life patients on the Intensive care unit sixteen patients with Intensive care unit were randomly assigned to two groups of Intensive Care Unit exercise group(n=8), bedside cycle ergometer group(n=8). ICU exercise group(rolling, sitting at the edge of the bed, transfer from sitting to standing, standing balance training, ambulation) and bedside cycle ergometer group were performed 5times a week for 30 minutes during the ICU admission period. Medical Research council and functional Status Scale-Intensive Care Unit were measured before and after at the time of discharge from intensive care unit. Statistical analyses were conducted using mann-Whitney U test, Wilcoxon rank-sum test Medical Research Council and Functional Status Scale-ICU were significantly increased at intensive care unit exercise group after intensive care unit discharge compared to bedside cycle ergometer group(p<.05). Short form-36 was significantly increased at ICU exercise group compared with bedside cycle ergometer group(p<.05). ICU exercise group was more effective than bedside cycle ergometer group to improve muscle strength(MRC), functional level(FSS-ICU) and Quality of life performance(social functioning, role limitation due to a physical health problem, role limitation due to emotional problem, general health, vitality, pain) of ICU patients.

성인중환자실 간호사의 소음관리 수행도에 영향을 미치는 요인

김서정 경상국립대학교 대학원 2022 국내석사

The purpose of this study was to examine the relationships between nurses’ performance of noise management, noise experience, noise-related knowledge, response to noise, and patient safety culture and to identify factors affecting nurses’ performance of noise management in adult intensive care units. The subjects of this study were 148 nurse in adult intensive care unit with over 3 months of clinical experience working at advanced general hospitals in J and C cities. Data were collected from April 1st to 20th, 2022. The collected data were analyzed using frequency, percentage, mean, standard deviation, Independent t-test, one-way ANOVA, Scheffe's test, Pearson's correlation coefficient, and hierarchical multiple regression analysis by SPSS/WIN 25.0 program. The results of this study are summarized as follows. 1) The general characteristics of nurses in adult intensive care units were as follows. The nurses’ mean age was 28.36±4.29 years old and most of them was general nurses (96.6%). The mean years of nurses’ nursing experience was 5.52±4.34 years and the mean years of working experience in the intensive care unit was 4.23±2.30 years. Regarding noise-related characteristics, 35 nurses (23.6%) reported that the unit applied ‘quiet time’ and ‘quiet time’ was applied between midnight and 8 am. However, 113 nurses (76.4%) reported that the unit did not apply ‘quiet time.’ 147 nurses (99.3%) reported that they had no experience of receiving education on noise management. 112 nurses (75.5%) reported that the education on noise management is needed. 2) The mean score of noise experience frequency was 3.05±0.62 (range 1-4). The mean scores of its subcategories were: 3.41±0.62 of medical device factors, 2.99±0.63 of human factors, 2.96±0.84 of environmental factors. The mean score of perceived noise levels was 4.69±1.51 (range 0-10). The mean scores of its subcategories were: 5.93±1.84 of medical device factors, 4.50±1.51 of human factors, 4.05±1.90 of environmental factor. The total score of noise-related knowledge was 28.91±9.98 (range 0-54) and the percentage of correct answer was 54%, which was generally low. The mean score of response to noise was 4.89±2.32 (range 0-10). The mean scores of its subcategories were: 4.22±2.29 of physiological response and 5.42±2.55 of emotional response. The mean score of patient safety culture was 3.52±0.49 (range 1-5). The mean scores of its subcategories were: 3.86±0.66 of patient safety knowledge and attitude, 3.72±0.63 of teamwork, 3.62±0.71 of leadership, 3.53±0.72 of patient safety policy and procedure, 3.30 ±0.74 of patient safety improvement system, 3.26±0.83 of non-punitive environment, and 2.86±0.70 of patient safety priority. The mean score of performance of noise management performance was 3.45±0.64 (range 1-5). 3) There was a significant difference between the necessity of noise management education in nurses’ performance of noise management (t=2.66, p=.009). 4) There were significant positive relationships between nurses’ performance of noise management and noise experience frequency (r=.20, p=.013), noise-related knowledge (r=.21, p=.009), response to noise (r=.23, p=.005) as well as patient safety culture (r=.50, p<.001). 5) The factors affecting nurses’ performance of noise management in adult intensive care units were noise experience frequency (β=.16 p<.030), teamwork of patient safety culture (β=.33, p=.006) and patient safety policy and procedure of patient safety culture (β=.25, p=.037) explaining 37.9% of the variance. In conclusion, the factors affecting nurse’ performance of noise management in the adult intensive care unit were noise experience frequency, teamwork of patient safety culture, and patient safety policies and procedures of patient safety culture. Based on these results, we suggest that the a noise reduction intervention program should be developed using teamwork reinforcement and team approach to improve performance of noise management for nurses in adult intensive care units. Also, in addition to nurses’ personal efforts for noise management, organizational efforts and strategies are needed by establishing patient safety policies and procedures related to hospital noise at the hospital level.

DNR(Do-Not-Resuscitate)결정 후 중환자실 간호사의 간호활동의 변화

김현지 경희대학교 대학원 2014 국내석사

의료기술의 발달로 질병이 치료되는 사례도 많아졌지만 치료 불가능한 질병의 경우에는 단순한 죽음을 연장시키기만 할 뿐 잠재적으로는 환자에게 고통을 증가시키는 심폐소생술 대신에 급성 심정지 시 심폐소생술을 시행하지 않겠다는 DNR(Do-Not-Resuscitate)을 선택하는 사례가 늘어나게 되었다. DNR결정 환자를 돌보는 중환자실 간호사들은 DNR결정 후 간호활동 영역의 갈등을 느끼게 되므로, 갈등을 최소화하고 직접적인 간호를 수행하고 있는 중환자실 간호사의 효율적인 간호중재 방안을 모색하기 위해서는 DNR결정 후 간호활동 실태에 대해 조사할 필요가 있다. 본 연구는 DNR 결정 후 중환자실 간호사의 간호활동 변화의 실태를 파악하는 서술적 조사연구이다. 연구의 대상자는 대학병원 중환자실 간호사 120명을 대상으로 하였으며, 자료수집 기간은 2013년 8월 16일부터 2013년 9월 2일까지였다. 연구의 도구는 DNR결정 후 중환자실 간호사의 간호활동의 변화를 측정하기 위해 개발한 이정희 (2002)와 배영란(2000)의 측정도구를 연구자가 수정보완하여 총 39문항으로 구성된 구조화된 설문지를 사용하였으며, 본 연구에서의 신뢰도는 Cronbach’s α= .96 이었다. 자료분석은 IBM SPSS Statistics 21 프로그램을 이용하여 빈도, 백분율을 기술 통계로 분석하였고, 대상자의 DNR 관련 특성에 따른 DNR결정 후 간호활동 변화의 차이는 x2-test로 분석하였다. 본 연구 결과는 다음과 같다. 1. 전체 대상자 중 DNR과 관련된 교육을 받지 않은 대상자가 64명(53.3%)으로 교육을 받은 대상자 보다 더 많았고, DNR관련 교육이 필요하다고 생각하는 대상자가 104명(86.6%), 교육이 필요하지 않다고 생각하는 대상자가 16명(13.4%)로 나타났다. 2. DNR결정 후 중환자실 간호사의 간호활동 중 활동감소의 변화를 보인 항목은‘수면 및 휴식 상태를 사정하여 증진을 위한 중재를 시행한다’‘불안 해소를 위한 진정제나 항우울제의 사용에 대하여 의사와 상의한다’‘환자 가족이 경제적 어려움을 호소할 때 사회사업실에 의뢰한다’‘전해질 검사에 대한 감시 및 산, 염기 균형을 관리한다’‘위장관계 기능을 사정한다’‘영양 및 수분 상태를 확인하고 필요 시 보고한다’‘얼굴 세안과 부분 목욕 간호를 시행한다’‘환자의 호소를 경청한다’‘환자의 감정상태를 표현하게 한다’‘모든 치료와 간호의 결정에 환자의 의사를 반영한다’ ‘환자, 보호자와 적극적인 의사소통을 한다’‘환자가 원할 때 함께 있어준다’의 순으로 나타났으며, 정서적 영역과 신체적 영역의 항목에서 간호활동 감소가 많았다. 3. DNR결정 후 중환자실 간호사의 변화 없이 행해지고 있는 간호활동의 항목은 ‘활력징후를 정확히 측정한다’‘동공반응, GCS를 이용하여 의식 수준을 사정한다’‘객담 배출이 원활하지 않을 시 흉부 타진 및 흡인을 시행한다’ ‘배변 및 배뇨 양상과 장애유무를 사정한다’‘피부통합성 장애 예방을 위한 간호를 시행한다’‘환자의 프라이버시를 보호한다’의 순으로 나타났으며, 신체적 영역의 간호활동은 변함이 없었다. 4. DNR결정 후 중환자실 간호사의 간호활동 중 활동증가의 변화를 보인 항목은‘가족들과 같이 있기를 원하는 경우 1인실 병동에 전실을 의뢰한다’‘환자가 종교의식 참여를 원할 경우 환경을 마련해주며 영적 지도자를 원할 때 연결해 준다’‘나 자신을 치유의 도구로 사용한다’의 순으로 나타났으며, 영적 영적과 사회적 영역의 간호활동 증가가 많았다. 5. DNR관련 특성에 따른 DNR 결정 후 중환자실 간호사의 영역별 간호활동 변화의 차이는 없었다. DNR관련 교육 경험에 따라서 정서적 영역인‘환자의 감정 상태를 표현하게 한다’(x2=6.276, p=.043)와 사회적 영역인‘가족들과 같이 있기를 원하는 경우를 원하는 경우 1인실 병동에 전실을 의뢰한다’(x2=6.818, p=.033)의 항목에서 간호활동의 차이가 있었으며, DNR관련 교육 필요성 인식에 따라 신체적 영역인‘감각, 운동, 순환을 사정한다’(x2=6.204, p=.045)와 신체적 영역인‘배변 및 배뇨양상과 장애유무를 사정한다’(x2=8.589, p=.014)의 항목에서 간호활동의 차이가 있었다. 본 연구의 결과 DNR 결정 후 중환자실 간호사의 간호활동은 감소활동의 항목이 제일 많았고, 그 중 정서적 영역에서 많은 감소 활동이 있었다. DNR관련 교육 경험이 있는 집단에서 정서적, 사회적 영역의 간호활동 감소가 적었고, DNR관련 교육의 필요성 인식에 따라 무의미한 신체적 영역의 간호활동 감소가 있었다. DNR과 관련된 교육 경험과 교육의 요구도가 DNR환자를 돌보는 간호사의 활동에 영향을 미침에도 불구하고 DNR과 관련된 교육을 받을 기회는 부족한 실정이다. DNR과 관련된 간호활동에 대한 정확한 기준 마련과 함께 지속적이고 체계적인 의무화된 교육이 필요하다. After determining the DNR, nurse of the intensive care unit to care for patients in the DNR decision is made to feel the conflict of nursing area. Therefore, in order to explore ways of nursing efficient intervention of the nurse of the intensive care unit to minimize the conflict, is doing a direct care, after the decision of the DNR, we need to investigate the current status of nursing activities some. In this study, is a research descriptive to understand the reality of change in the nursing activities of nurses of intensive care after the decision of the DNR. Subjects of the study were 120 nurses of the intensive care unit of a university hospital. Data were collected through a structuralized questionnaire that is composed of all 39 questions. Reliability of the present study was Cronbach's α = .96. The data analysis were program IBM SPSS Statistics 21. General characteristics and changes of nursing activities, were analyzed by frequency and percentage. Accordance with the characteristics associated with the DNR of the subject, the difference of the change in the nursing activities, I was analyzed by Chi-square test. The results of this study were as follows: 1. 64 people(53.3%) were with no education associated with the DNR among all subjects more. 104 people(86.6%) believes the need for education associated with the DNR and subjects who believe that it is not necessary but it became 16 people(13.4%). 2. These are items that there were changes of decrease of nursing activities of the nurses of the intensive care unit after DNR decision.‘Assess the state of relaxation and sleep, to intervene’,‘Consult with your doctor about the use of sedatives for anxiolytic’,‘When the family of the patients complained of economic difficulties, I ask society to Business Office’,‘I manage the balance of acid-base and electrolyte management’,‘I assess the function of the gastrointestinal’,‘Check the status nutrients, water, and reports as needed’,‘To implement the bathing care and face-wash’,‘I listen to the patient's complaint’,‘I would like to express the emotional state of the patient’,‘I reflect the will of the patient to determine the nursing and treatment of all’,‘I make a proactive communication and patient, the guardian’,‘When the patient is required, to be with me’ Results appeared in the order, such as above. Reduction of nursing activities of physical and emotional regions in many cases. 3. Item of nursing activities that are not changes are as follows. ‘To accurately measure the vital signs’,‘Use pupil reaction, the GCS, to assess the level of consciousness’,‘I enforce the suction and chest percussion when the discharge of sputum is not smooth’,‘I assess the presence or absence of urination and excretion’,‘To implement the nursing for the prevention of skin integrity failure’,‘Protects patient privacy’ Results appeared in the order, such as above. Nursing activities of physical area did not change. 4. These are items that there were changes of increase of nursing activities of the nurses of the intensive care unit after DNR decision. ‘In order to be able to with the family, and requests the transfer in a single ward’,‘Can you prepare the environment if the patient wishes to participate in a religious ceremony and connect to when you think spiritual leaders want a patient’,‘I use as a tool to heal itself’ Results appeared in the order, such as above. Increase of nursing activities of the social area and the spiritual area there were many. 5. After determining the DNR in accordance with the characteristics that are associated with the DNR, there was no difference in the change in the nursing activity of regions of the nurse in the intensive care unit. There was a difference of nursing activities, depending on the educational experience related to DNR, Emotional area of‘I would like to express the emotional state of the patient’(x2=6.276, p=.043) and Social area of ‘In order to be able to with the family, and requests the transfer in a single ward’ (x2=6.818, p=.033), depending on the recognition of the need for education of the DNR, Physical area of ‘I assess Sensory, motor, and circulation’ (x2=6.204, p=.045) and Physical area of ‘I assess the presence or absence of urination and excretion’ (x2=8.589, p=.014). As a conclusion, after determining the DNR, changes in the activities of nursing nurse of intensive care, had more activity decrease. Among them, the emotional area in many cases. The population of educational experience related to the DNR, decrease emotional, nursing activities of social area was small. And there was a decrease in the activity of nursing meaningless physical area by recognizing the need for DNR-related education. Will affect the activities of nurses demands of education and teaching experience related to the DNR to take care of DNR patients. However, the fact is that educational opportunities associated with the DNR's poor. The exact criteria for nursing activities related to DNR is required. Education became mandatory systematic sustained is required.

Intensive Care Unit Nurses’ Experience of Watson’s Theory of Human Caring Caritas Process Three: Cultivation of One’s Own Spiritual Practice and Transpersonal Self, Going beyond Ego-Self

Leone-Sheehan, Danielle M ProQuest Dissertations & Theses Boston College 2020 해외박사(DDOD)

Purpose: The purpose of this study was to explore nurses’ experiences of Watson’s Theory of Human Caring Caritas Process Three: Cultivation of One’s Own Spiritual Practices and Transpersonal Self, Beyond Ego-Self. Background: There is currently an inadequacy of spiritual care provided to patients and families in the ICU despite a significant articulated need. Nurses report discomfort with and a lack of preparation in providing spiritual care competently. Nurses with strong personal spiritual development are more likely to report comfort with spiritual caregiving and provide spiritual care. Watson’s Theory of Human Caring Caritas Process Three; Cultivation of One’s Own Spiritual Practice and Transpersonal Self, Going Beyond Ego-Self makes explicit the primacy of relationship between nurse spiritual development and transpersonal spiritual nursing care. However, the nature of spiritual development of nurses in the ICU remains unknown. Methods: A qualitative descriptive methodology with directed content analysis applying Watson’s Caritas Process Three was used to analyze data for this study. Results: Ten ICU Nurses provided evidence of the experience of Caritas Process Three. Five themes were identified in the analysis of data: Caritas nurses vary in their ability to move beyond ego-self, Personal spiritual practices serve as a barrier and/or facilitator to nurses’ ability to provide spiritual care, Critical illness as experienced by patients and families provided the opportunity for nurses to explore spirituality with other, The care environment serves as a barrier and/or facilitator to nurses’ personal spiritual growth, and Cultivation of spiritual practice and spiritual identity is integral to a life-long process of consciousness evolution.Conclusions: The findings of this study extend and inform Caritas Process Three of Watson’s Theory of Human Caring. Nurses in this study provide evidence for the primacy of personal spiritual development for the delivery of spiritual and transpersonal care for patients in the ICU.

중환자실 간호사의 인간중심 간호수행 영향요인

이예인 부경대학교 2021 국내석사

Purpose This study was conducted to identify the factors affecting to the performance of person-centered care among intensive care unit (ICU) nurses based on ecological perspectives, and provide basic data for the development of educational programs to promote performance of person-centered care. Method This study used a cross-sectional survey. The participants were 172 ICU nurses working in 8 hospitals in B city. The questionnaire survey was conducted between July and August, 2020. The collected data was analyzed using descriptive statistics, χ-test, independent t-test, and Pearson‘s correlation coefficient with SPSS 25.0 program. The factors affecting person-centered care were analyzed using hierarchical multiple regression. Result There was a statistically significant difference in performance of person-centered care depending on the total nursing experiences among the general characteristics of the subjects(<5years)(p=.008). Person-centered care was significantly and positively correlated with compassion satisfaction(r=.478, p<.001), communication competence(r=.611, p<.001), and team work(r=.551, p<.001). In hierarchical multiple regression, all of 3 models were examined by intrapersonal, interpersonal, and organizational factors in ecological model. In the first model, including total nursing experiences and compassion satisfaction, they were significant factors explaining performance of person-centered care. In the second model adding communication competence, and it was revealed the most significant factors of them. In the final model adding team work, accounted for 44.1% of variance in performance of person-centered care among intensive care unit nurses(p<.001). Conclusion The findings of this study indicate that strategies for enhancing compassion satisfaction, communication competence, and team work are necessary to promote performance of person-centered care among intensive care unit nurses. In addition, this study can be particularly meaningful in providing basic data for nursing education and future intervention development research. Further studies should be conducted to develop nursing interventions to improve performance of person-centered care among intensive care unit nurses.

End of Life Care and Decision Making for Patients with Limited English Proficiency

Barwise, Amelia ProQuest Dissertations & Theses College of Medicin 2019 해외박사(DDOD)

Background: The population with Limited English Proficiency (LEP) in the United States (US) continues to grow and age. Previous work done by our group has demonstrated that differences exist between patients with LEP and those who speak English, in the context of decision-making and end-of-life care in the Intensive Care Unit (ICU) setting. Patients with LEP in the ICU are less likely to change their code status from full code to do-not-resuscitate (DNR), have Advance Care Directives, or receive comfort care measures only orders and tend to get more aggressive interventions at the end of life. Decisions to switch to DNR and comfort measures only orders are not only are less frequent but also take longer. Patients with LEP face multiple barriers with decision making at end of life in the ICU. There are a variety of factors contributing to this challenging problem but this issue has not been studied sufficiently to date.Objectives: To determine and understand the reasons for differences in end of life care and decision making in the ICU for patients with LEP.Methods: For our initial study we conducted secondary data analysis of the Health Information National Trends Survey (HINTS 5 cycle 2 iteration). HINTS is fielded by the National Cancer Institute and is an annual, cross-sectional, national representative survey that provides a unique and reliable data source to assess health communication, health knowledge, and use of health information technology. We used the data to assess perceived knowledge of palliative care and preferred trusted source for knowledge about palliative care among immigrants in the US. We then used qualitative research approaches, based on grounded theory methodology to conduct 40 one-on-one semi structured interviews of physicians, bedside nurses, and interpreters in the ICU. During these interviews we explored the clinicians’ perceptions of the reasons for differences in decision making and care in the ICU for patients with LEP. All transcripts were audio-recorded, transcribed, and coded independently and in duplicate to consensus. For our third study we performed a systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to describe and appraise interventions designed to improve end of life decision making for patients with LEP. We developed a search strategy using specific terms such as end of life, LEP, advance care planning, goals of care and searched a variety of traditionally used databases from 1946 to November 2018.Results: In the first study we did not find statistically significant differences in perceived knowledge of palliative care between immigrants and those born in the US following adjustments. Furthermore, in both groups, 80% of respondents declared their preferred trusted source for palliative care information was a health care provider (p=0.53). Over 70% in both native born and immigrant groups responded that they did not know what palliative care was. Low levels of education predicted poor perceived knowledge of palliative care (p<0.001). The second, a qualitative study highlighted that both poor communication as well as variations in preferences for end of life care were responsible for the differences in end of life care noted in the ICU. Following analysis of the coded transcripts, several themes were derived including specific barriers to and facilitators of communication and decision making for patients with LEP in the ICU. The third study, a systematic review revealed that only 8 interventions exist that focus on improving decision making at end of life for patients with LEP. These used trained personnel, videos, web-based modules, and written materials. Seven of eight studies were based in the US and directed towards Hispanic populations. One study was based in Australia and directed towards Greek and Italian populations. Interventions to increase advance care planning and advance directives were generally successful. Interventions aiming to influence other end of life decision making such as hospice use worked less wellConclusions: Based on our HINTS study findings, differences in end of life care among patients with LEP cannot be explained by poorer knowledge of palliative care compared to patients who speak English. However our qualitative study showed that communication is suboptimal for patients with LEP in the ICU and this negatively impacts decision making and subsequent care. Some patients with LEP also have cultural and faith-based preferences that drive some of the noted differences in decision making and care. Few scalable, feasible, and successful interventions exist to address this problem based on our systematic review findings. This research provides the groundwork for developing more effective interventions to improve end of life decision making for patients with LEP that respect and acknowledge preference variation in end of life care but prioritize improved communication.

간호중재 분류체계(NIC)에 근거한 중환자 간호단위의 간호중재 수행 분석

이영선 건국대학교 대학원 2008 국내석사

The purpose of this research is to analyze the nursing intervention, especially, for the nurses working the intensive care unit(ICU). This research uses 486 nursing intervention classification developed by McCloskey & Bulechek(2000), which is translated in Korean. The data were collected from 97 nurses laboring in ICU of hospital from April 4, 2008 to April 15. An obtained data were analyzed by SPSS (version 14.0) program. The results of this research are shown as follows: 1. The most frequently used nursing intervention domains were “Physiological: complex”, “Safety”, “Health system”, “Physiological: basic”, “Behavior”, “Family”. 2. The core nursing intervention means that 50% or more than the nurses perform it several times a day in intensive care unit. In the intensive care unit, Core nursing interventions consist of 4 domains, that is to say, “Physiological: complex”, “Physiological: basic”, “Safety”, “ Health system”, and 13 classes, 99 core nursing interventions. Most used nursing interventions are below: Positioning, Airway suctioning, Airway management, Aspiration precautions, Chest physiotherapy, Cough enhancement, Oxygen therapy, Pressure management, Pressure ulcer care, Pressure ulcer prevention, etc. 3. The nursing intervention domains are significant of Family(F=3.342, p=0.040), Health system(F=5.722, p=0.005) in MICU, SICU, Integral ICU. 4. In general characteristics, the differences of nursing intervention domains are “Safety”, “Family”, “Health system”. This research confirms the nursing intervention performing in intensive care unit and makes sense that the nursing interventions are different from 3 intensive care units.

입원 중환자가 경험하는 스트레스 해소에 관한 실증적연구

장효숙 경희대학교 행정대학원 2002 국내석사

The purpose of this study was to understand of inpatients' stress experienced at an Intensive care unit, in Nurses' and Patients'view, then to provide the qualitative nursing care that itervene therapeutic environment. This study was designed to compare intensive care unit patients and nurses'perception of the stressful items of ICU patients'experiences. The sample consists of 50 ICU patients and 79 RN employed in the ICU at one large university Hospital. The patient contacted 2days after transferred from an ICU and asked to complete the ICU stressor scale, that was a Likert type questionnaire designed to measure the stressfulness of commonly occurring items in the ICU The nurses were asked to complete the same questionnaire in the patients' place. SPSS 10.0 statistical program was used for data analysis and t-test and Duncan´s multiple range test were done to compaire the patient´s and nurse´s response. 1. In most comparison, nurses rated the items as being significantly more stressful than did the patients(p<0.05) 2. In the patients'general characteristics, patients used seperated room were less stressful than the patients' used open room.(p<0.05) 3. In nurses' general characteristics, the more experience in ICUnurses' have, the more stressful(p<0.05) 4. Item with the highest mean ratings by patients were 1) being thirsty 2) being in severe pain 3) not being relatives 4) Not knowing where, when. 5) having L-tube line Item with highest mean ratings by nurses were 1) seeing other patients'death 2) not being able to express because of trachea intubation 3) being in severe pain 4) not being able to move because of restraint 5) defication in the bed 6) frequently having IV injection 5. In the category of ICU stressor, the highest mean rating perceived by patients were isolation, disorientation, restrain of moving , sensory deprivation, sleep deprivation, disregard of personalization by nurses, the highest mean rating was restraint of moving , isolation, sensory deprivation, sleep deprivation, disregard of personalization, disorientation. There appears to be a wide variation in the perception of nurses and patients regarding the stress faced by patients in the ICU. Similiarities were noted between subject groups as to the nature of stressors, although nurses tended to rate item over. Nurses should be aware that the care they provide may not always be aimed at the needs that patients consider most important. Although nurses are unable to understand the accurate needs of patients, with thought and imagination, they can find way to reduce the stress of ICU and provide therapeutic environment. Finally nurses will try continously to find any other stress of the patients in ICU and provide individualized nursing care.