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.

한국어판 중환자실 존엄간호 측정 도구의 문화적 개작과 타당도 검증

강세진 중앙대학교 대학원 2025 국내석사

연구 배경 및 목적: 중환자실 간호사는 환자의 존엄성과 존엄간호 수행의 중요성을 인식하는 것이 중요하다. 그러나 오늘날의 중환자실은 효율적인 간호를 우선으로 여겨 환자의 존엄성은 위협받으며 이는 환자에게 심리적 고통을 가중시킨다. 따라서 중환자실 존엄간호를 측정할 수 있는 정량적 도구가 필요하므로 본 연구는 Liang 등(2022)의 중환자실 존엄간호 측정 도구(IDCQ)를 한국어로 번역하여 문화적 적합성을 확보하고, 타당도와 신뢰도를 검증하였다. 연구 방법: 한국어판 IDCQ는 문화 적합성 확보를 위해 가이드라인에 따라 번역하고 내용타당도를 확보하였으며 2024년 6월부터 8월까지 온라인 설문조사를 통해 종합병원급 이상의 중환자실 간호사 297명의 자료를 수집하여 분석하였다. IBM SPSS 29.0, AMOS 26.0을 이용하여 대상자의 일반적 특성 및 근무 환경 특성을 기술통계, 빈도를 분석하고 요인분석을 통해 구성, 집중 및 판별타당도를 검증하였으며 상관관계 분석을 이용한 준거 타당도 및 신뢰도 분석을 통한 연구 도구의 신뢰도를 확인하였다. 연구 결과: 연구 결과 한국어판 IDCQ의 내용타당도는 S-CVI/Ave=.97이었으며 탐색적 요인분석 결과 전체 변량의 43.03%를 설명하는 2개의 하위요인(상대적 존엄성, 절대적 존엄성)이 추출되었고 총 17개 문항의 요인별 적재량은 .38~.78이었다. 확인적 요인분석을 통해 모델 적합도를 확인하고, 집중 및 판별타당도를 확보하였다. 본 연구 도구의 준거인 중환자실 간호사의 인간중심간호 측정 도구(PCCN)와 통계적으로 유의한 상관관계를 보였다(r=.64, p<.001). 한국어판 IDCQ의 신뢰도는 Cronbach’s α .86이었다. 결론: 본 연구는 한국어판 IDCQ가 한국의 중환자실 간호사에게 적용하여 존엄간호를 측정할 수 있는 타당도와 신뢰도가 높은 도구임을 확인하였다. 본 연구의 결과를 바탕으로 한국어판 IDCQ를 활용하여 중환자실 간호사의 존엄간호 수행 정도를 파악하고 국내 중환자실에서 간호사로부터 제공되는 존엄간호의 질을 향상할 필요가 있다. Background: It is important for intensive care unit nurses to recognize the importance of patient dignity and performing dignified care. However, today's intensive care units prioritize efficient nursing, threatening patient dignity, which adds to the psychological distress of patients. Therefore, a quantitative tool that can measure dignified care in the intensive care unit is needed. Aims: This study aims to translate the Intensive care unit Dignified Care Questionnaire (IDCQ) by Liang et al. (2022) into Korean and verify cultural suitability, validity, and reliability. Methods: The Korean version of IDCQ was translated following the guidelines for cultural adaptation, and content validity was secured by a group of experts. From June to August 2024, data from 297 nurses working in intensive care units at the general hospital or tertiary general hospital were collected through an online survey. Using IBM SPSS 29.0 and AMOS 26.0, the general and work environment characteristics of the participants were analyzed with descriptive statistics and frequency. The construct, convergent, and discriminant validity were verified through factor analysis. The criterion validity was verified with Pearson’s correlation and the reliability was verified with Cronbach’s α. Result: The content validity of the Korean version of IDCQ was S-CVI/Ave=.97, and two sub factors (relative dignity, absolute dignity) explaining 43.03% of the total variance were extracted by exploratory factor analysis. The factor loadings of 17 items were .38~.78. Through confirmatory factor analysis, model fit, convergent validity, and discriminant validity were secured, and it showed a statistically significant correlation with Person-centered Critical Care Nursing (PCCN) which is the criterion of the Korean version of IDCQ (r=.64, p<.001). The reliability of the tool was verified with Cronbach’s α value of .86. Conclusion: The Korean version of IDCQ was confirmed to be a highly valid and reliable tool for measuring dignified care of the Korean intensive care unit nurses. Based on the results of this study, it is necessary to use the Korean version of IDCQ to determine the level of dignified care of intensive care unit nurses and improve the quality of dignified care provided by nurses in intensive care units in Korea.

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.

신생아 및 소아 중환자실 간호사의 임종간호, 지지 및 방해요인에 대한 질적 서술적 연구

이효정 중앙대학교 건강간호대학원 2024 국내석사

병원에서 사망하는 소아 환자가 증가하고 있다. 본 연구는 임종이 빈번하게 발생하는 신생아 및 소아 중환자실에서 근무하는 간호사의 관점으로 임종간호, 지지 및 방해요인에 대해 파악하는 것이다. 자료 수집은 2023년 6월부터 10월까지 서울시에 위치한 상급 종합 병원의 신생아 중환자실과 소아 중환자실 간호사 대상으로 심층 면담을 실시하였다. 17명의 참여자를 대상으로 자료 수집하였고, 면담 시간은 1시간에서 최대 2시간까지 소요되었다. 수집된 자료는 Braun과 Clarke (2006)의 주제분석을 활용하여 분석하였다. 본 연구에서는 4개의 주제(theme)와 18개의 하위주제(sub-theme)가 도출되었다. 첫 번째 주제로 환아와 가족 중심의 임종간호 제공이다. 하위주제로 신생아 및 소아 중환자실 간호사는 환아의 안위감 증진 간호, 임종기 보호자를 위한 정서적 지지 간호, 보호자를 위한 환경 조성, 임종기 보호자를 위한 상담 및 교육이 도출되었다. 두 번째 주제로 임종간호를 지지하는 부서 내 협력과 자원이다. 하위주제로 '부서 내 협력적인 분위기'와 '부서 내 프로토콜 마련'이 도출되었다. 세 번째 주제로 임종간호수행을 어렵게 하는 개인적, 조직적, 환경적 결핍과 한계이다. 하위주제로 임종간호 역량 부족, 임종간호에 집중할 수 없는 업무 부담, 임종 장소로서 중환자실의 한계가 도출되었다. 마지막 주제로 임종간호를 위한 다면적인 지원 확립이다. 하위주제로 의료진의 아동 및 가족과의 공유된 치료 계획을 위한 노력, 임종기 가족을 위한 의료인 및 의료기관, 정부의 지원 확대, 완화의료팀의 운영 및 활용을 위한 지원 확대, 임종간호를 위한 전문적인 시스템 구축, 임종간호를 제공하는 간호사에 대한 교육적, 정서적 지원 확립이 도출되었다. 본 연구의 결과를 바탕으로 신생아 및 소아 중환자실 간호사가 인지하는 임종간호 시 지지요인은 강화하고 방해요인을 개선할 필요가 있으며, 신생아 및 소아 환자 임종간호의 질 향상을 위해 의료인, 의료기관, 정부의 실용적인 지원 전략 개발을 위한 추후 연구가 필요하다. 또한, 전문적인 임종간호 교육과정 개설을 통해 통일화되고 전문적인 임종간호를 제공하기 위한 간호 실무 측면과 간호 교육적 측면에서 개선이 필요하다. The number of pediatric patients dying in hospitals is increasing. This study aimed to explore nurses’ perceptions of end-of-life care and its related facilitators and challenges in neonatal and pediatric intensive care units. Data were collected using semi-structured, individual, in-depth interviews with 17 nurses from neonatal and pediatric intensive care units of tertiary general hospitals located in Seoul from June to October 2023. The interviews took 1-2 hours. The collected data were analyzed using thematic analysis. As a result, 4 themes and 18 sub-themes emerged. The first theme was ‘providing end-of-life care centered on infants and families.’ Its sub-themes included care for child’s increased comfort, emotional support, creation of an environment, and counseling and education for family caregivers. The second theme was ‘cooperation and resources within the department supporting end-of-life care’. This theme has two sub-themes: a cooperative atmosphere within the department and the presence of protocols within the department. The third theme was ‘personal, organizational, and environmental deficiencies and limitations that make it difficult to perform end-of-life care.’ Its sub-themes were a lack of end-of-life care competencies, the difficulty focusing on end-of-life care due to too much administrative work, and limitations of the intensive care unit as a place of death. The last theme was ‘Establishment of multifaceted support for end-of-life care.’The multifaceted support included healthcare providers’efforts to have shared treatment plans with children and families, expanded support for end-of-life families from the government, healthcare institutions, and providers, support for palliative care teams, professional systems for end-of-life care, and educational and emotional support for nurses providing end-of-life care. Based on these findings, it is necessary to reinforce the facilitators to end-of-life care and address the challenges through multi-faceted strategies. There should be further research to develop and test healthcare provider-, healthcare institution-, and the government-level practical strategies to improve the quality of end-of-life care for neonatal and pediatric patients and their families. In addition, nursing education should include pediatric end-of-life care to provide systematic and professional end-of-life care.

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 도덕적 민감성, 사회적 지지, 간호근무환경이 인간중심간호에 미치는 영향

김수현 전북대학교 대학원 2024 국내석사

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.