임상간호사회에서 개발한 중환자 분류도구를 이용한 소아중환자실 환자분류와 환자관리 실태조사 = Patients Classification of Pediatric Intensive Care Unit And Management Research of Patients Through The Classification Tool Developed By Clinical Nurses Association

다국어 초록 (Multilingual Abstract)

Since Feb. 3 in 1986, Pediatric intensive care unit of Children's Hospital in Seoul National University Hospital has given intensive care in various areas to children who need respiratory therapy and concentrated treatment.
For more proper arrangement of manpower and better care for patients, classification of patients should be done. After numerous tries to classify patients, one classification system which is based on actual nursing activities in hospitals, is chosen to be pretty more proper system than any other system.
This research is based on the patient classification system developed by Clinical Nurses Association with their direct nursing activity time. This research is made to provide the fundamental data about proper manpower arrangement, costs and efficiency. This research examines the management condition of the pediatric intensive care unit and distinguishes nursing skills between infant or young patients and adults.
The subject of this research is 386 infants and children who have been hospitalized in pediatric intensive care unit of Seoul National University Hospital from Jan. 19 to June 30.
Assigned nurses check the patients daily and classifies them through the I.C.U flowsheet with the scores of nursing activity. One of Checking times is from 11:00 AM of the previous day to 11:00 AM of the next day and another is from the hospitalized time to 11:00 AM of the next day. For those who leave hospital, assigned nurses classified the patients through the flowsheet by the classification tool of severely ill patients. They are classified between those who are cared after 11:00 AM of the leaving day and those who are cared after 11:00 AM of the previous day.
General characteristics of the subject are flowed. The subject of this research is consisted of 160 female patients(41.5%) and 226 males(58.5%). By age, there are 183 of under 1-year-old patients(47.4%), which include 29 of under 1-month-old(7.5%), 103 of those who are from 1-year-olds to 5-year-olds(26.7%), 49 of those who are from 6-year-olds to 10-year-olds(12.7%), and 51 of over 10-year-olds(13.2%). And 19 patients of the subjects(4.9%) died during the research. Classified the patients through the diagnosis which they are taken, 79 of the subjects are taken cardiovascular operation(57.5%), 79 of them are taken pediatrics treatment(20.4%), and the rest 84 subjects are taken such operations as surgery of pediatrics, pediatric neuro surgery, ENT.
The result of the research is,
(1) the average hospitalization period in the pediatric intensive care unit is 7.66 days, which has been increased since 1986.
(2) the average hospitalization period of the patients is classified with 11.8 days for pediatrics group, 8.1 days for cardiovascular operation group and 2.64 days for the rest.
(3) the average hospitalization period of the patients by age is 7.45 days for under 1-month-old infants, 9.08 days for those who are from 2-month-olds to 1-year-olds, 5.37 days for those who are from 13-month-olds to 5-year-olds, and 3 days respectively for those who are from 6-year-olds to 10-year-olds, and for over 10-year-olds.
(4) by the classification of the patients, patients are concentrated in group 4(58.3%) and group 5(31.8%), which means that more than 90% of I.C.U. patients are seriously ill.
(5) the average daily direct nursing activity time is 3.9 hours for the group 2, 7 hours for the group 3, 10.2 hours for the group 4 and 14.4 hours for the group 5.
(6) the most urgent department of the direct nursing activity is ADL, followed by respiratory treatment, medication ＆ Ⅳ therapy, monitoring, treatment ＆ procedure, feeding, vital signs check, and teaching ＆ emotional support.
The research shows that the average hospitalization period has been increased and the age or the I.C.U. patients has been lowered. The average hospitalization period of under 1-month-old infant is 7.5 days, which confronts the report by Dr. Glass who says that the hospitalization days of under 1-month-old infants has lenghtened. Such different results come from the fact that the infants of this research subjects are only 7.5% of the total and focus of this research went through mostly surgery operation.
According to the classification system of I.C.U. patients, many of patients are concentrated on the group 4 and 5, which means that many patients who are hospitalized in pediatric intensive care unit are severely ill than patients in other care units. Such results go against the research of Dr. Pollack(1985), who says that 30%~60% of the patients in intensive care unit need only concentrated monitoring.
Both average time of daily nursing and patients classification system of pediatric intensive care unit show similarities between pediatric intensive care unit and adult intensive care unit. however the nursing activity of pediatric intensive care unit is different from adult intensive care unit except for ADL. That's because most subjects of this research are needed artificial ventilator.
The intensive patient classification developed by the clinical group of nurses is not quite proper to pediatric intensive care. Because this system is developed for adult patients. For example, in the case of medication, this classification system equally scores frequency of medication. But in real medication for pediatric patients needs more time than medication for adult patients. And this classification system handles only direct nursing activity time. Considering the different proficiency and careers of nurses, the nursing activity which needs more care and time for children should be given more scores and provided more proper arrangement of manpower.