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섬망 예방 간호중재가 응급중환자실 입원 환자의 섬망발생률에 미치는 효과

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Authors
이효연
Advisor
박연환
Major
간호대학 간호학과
Issue Date
2014-08
Publisher
서울대학교 대학원
Keywords
deliriumpreventionintensive care unitNu-DESC
Description
학위논문 (석사)-- 서울대학교 대학원 : 간호학과, 2014. 8. 박연환.
Abstract
Delirium is a syndrome characterized by cognitive impairment, disturbed perception with visual hallucination, delusion, mood disorder and disturbances in the sleep-wake cycle. Risk factors for delirium include predisposing factors (e.g., old age, cognitive impairment, sensory impairment, severe illness and multiple medications) and precipitating factors (e.g., infection, electrolyte imbalance, dehydration, malnutrition, indwelling catheters, light and sound). Clinical and environmental factors in the ICU setting increase the risk for delirium
thus, delirium in ICUs occurs more frequently than in general wards. Because delirium is associated with adverse outcomes
including increased mortality, a prolonged ICU-stay, deteriorated health-related quality of life etc., its prevention is important.
The aim of this study was to evaluate the effectiveness of a multicomponent intervention to prevent delirium.
This study had a non-equivalent control group non-synchronized design. Potential participants were patients admitted to the emergency intensive care unit at S city hospital, a teaching hospital from November 1, 2013, through February 28, 2014.. Among those admitted, 50 patients who had risk factors for delirium-dehydration or severe illness were enrolled. Twenty-five patients admitted from November 1, 2013 through December 15, 2013 were assigned to the control group with the usual care, and 25 patients admitted from January 5, 2014 through February 20, 2014 were assigned to the experimental group with a multicomponent intervention to prevent delirium. The multicomponent intervention, which consisted of an orientation protocol by the nurses, Orientation protocol by the family, hearing protocol, vision protocol, and use of sleep shades and ear plugs, targeted various risk factors.
Patients were examined with the Korean Nursing Delirium Screening Scale (Nu-DESC) which included disorientation, inappropriate behavior, inappropriate communication, illusion/hallucination and Psychomotor retardation.
The incidence of delirium was 20% (n=5) of the intervention group, and 48% (n=12) of the usual care group
this difference was statistically significant (χ2=4.367, p=.036). According to the Korean Nu-DESC, disorientation occurred often, and illusion/hallucination rarely occurred.
The orientation protocol by the nurses had the highest adherence rate (100%) and the use of ear plugs had the lowest adherence rate (64.5%). However, the adherence rate did not affect the incidence of delirium.
In conclusion, the multicomponent intervention reduced the incidence of delirium in the ICU patients significantly. The strengths of this study are that the intervention is cost-effective and can be implemented easily in a clinical setting.
Language
Korean
URI
https://hdl.handle.net/10371/124828
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College of Nursing (간호대학)Dept. of Nursing (간호학과)Theses (Master's Degree_간호학과)
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