입원환자의 섬망 관리를 위한
섬망의 정의
(Foreman, 1989; Lipowski, 1983; Trzepacz, Baker, & Greenhouse, 1998)
입원
입원환자의환자의24 –24 –60% 60%
(Foreman, 1989;
(Foreman, 1989; LipowskiLipowski, 1983; , 1983; TrzepaczTrzepacz, Baker, & Greenhouse, 1998), Baker, & Greenhouse, 1998)
섬망 발생율
(Inouye, 1999; Miller, 1996; Wakefield & Johnson, 2001) (Inouye, 1999; Miller, 1996; Wakefield & Johnson, 2001) (Inouye, 1999; Miller, 1996; Wakefield & Johnson, 2001)
섬망 사망율 섬망 섬망사망율사망율
섬망의 실태
섬망의 위험인자
NEECHAM
NEECHAM
NEECHAM
CAM-ICU
CAM-ICU
형식 형식B 그림B 그림
특징2 특징 특징22
CAM-ICU
조직화되지 조직화되지않은않은사고사고
다음4개의 질문 중 3개 이상의 오답을 말하거나 지시에 따르라는 것을 수행하
지 못하는 비조직적이거나 모순된 사고의 증거가 있는가?
<질문 A> <질문 B>
1) 돌은 물에 뜨는가? 1) 나뭇잎은 물에 뜨는가?
2) 물고기는 바다에 있는가? 2) 코끼리는 바다에 사는가?
3) 1파운드는 2파운드 보다 무거운가? 3) 2kg이 1kg보다 더 무거운가?
4) 손톱을 두드리는데 망치를 사용하는가? 4) 나무를 베는데 망치를 사용하는가?
특징3 특징 특징33
CAM-ICU
조직화되지 조직화되지않은않은사고사고
<요구>
1) 당신은 명확하지 않은 사고를 하는가?
2) (연구자는 환자 앞에서 2개의 손가락을 든다) 손가락이 몇 개인지 들어보세요.
3) (환자 앞에서 2개의 손가락을 들지 않고) 지금 다른 손으로 손가락을 들어보게 한다.
(만약 환자가 이미 인공호흡기를 제거했다면, 환자의 사고가 비조직적이거나 모순되었는지 결정하기 위해 산만하거나 엉뚱한 대화, 명백하지 않거나 비논 리적인 사고의 흐름이 있거나 주제에서 다른 주제로 예측할 수 없는 갑작스런 전환이 있는 것을 확인한다.)
특징3 특징특징33
없다 있다
CAM-ICU
의식
의식단계의단계의변화변화 환자의 의식수준에서 단계의 변화가 있는가?
(Alert, Drowsy, Stupor, Semi-coma, Coma 단계에서의 변화 또는 GCS의 변화)
특징4 특징특징44
없다 있다
CAM-ICU
MMSE
(Wanich, Sullivan-Marx, Gottlieb, & Johnson, 1992)
☞☞일단일단섬망인섬망인것으로것으로진단되면진단되면, 즉시, 즉시원인을원인을찾아찾아치료하치료하 는
는것뿐만것뿐만아니라아니라적절한적절한간호를간호를제공하는제공하는것이것이요구됨요구됨
(
(WanichWanich, Sullivan, Sullivan--Marx, Gottlieb, & Johnson, 1992)Marx, Gottlieb, & Johnson, 1992)
섬망에 대한 간호중재
섬망에 대한 간호중재
섬망에 대한 간호중재
Haloperidol (HaldolHaldol)) 0.5 0.5 ––5mg5mg bid/bid/tidtid PO/IMPO/IM Lorazepam
Lorazepam(Ativan(Ativan)) 0.5 0.5 ––5mg5mg bid/bid/tidtid PO/IVPO/IV Oxazepam
Oxazepam((SeraxSerax)) 10mg 10mg bid/bid/tidtid POPO Temazepam
Temazepam(Restoril(Restoril)) 10 10 ––20mg20mg q1hrq1hr POPO Thioridazine
ThioridazineHClHCl(Mellari(Mellari)) 10 10 ––20mg20mg bid/bid/tidtid PO/IMPO/IM
치료적 중재 치료적 치료적중재중재
감 사 합 니 다
감 감 사 사 합 합 니 니 다 다
ABSTRACT
The effects of delirium education program on delirium knowledge, importance of nursing intervention and nursing practice for Intensive Care Unit nurses
Park, Jin Dept. of Nursing The Graduate School Ajou University
The purpose of the study was to develop delirium education program for nurses and to analyze its effects on delirium knowledge, importance of nursing intervention and practice. Delirium is an acute medical status which is characterized by cognitive function impairment and mental change. It is caused by physical illness or drug overuse, which may affect mental status, but can be recovered at the earliest stage if the causes are removed. Once delirium occur, it may increase possibilities of obtaining side effects which bring various and serious problems such as aggravated present illness, discharge to further care centers, and increased death rate.
A total of 60 nurses in a university hospital participated in the study. The experimental group consisted of 30 nurses working at an Emergency Intensive Care Unit. Thirty nurses from a Surgical Intensive Care Unit were assigned to the control group. The experimental group participated in 3-hour delirium education program.
Delirium knowledge, importance of nursing intervention and practice were measured to examine the effect of the 3-hour delirium education program. Data collection was conducted with structured questionnaires from September 1, 2008 to October 24,
2008. Chi-Square test & t-test were used for the similarity examination of the demographic and dependent variables. Independent t-test was used for the hypothesis test.
The results of the study were as follows.
1. Delirium knowledge was 26.20(±8.31) of 48 point scale. Importance of nursing intervention scored 3.23(±0.28) of 5 point scale. The nursing practice was 3.23(±0.28) of 5 point scale.
2. Hypothesis 1 'The experimental group who participated in the delirium education program will have higher scores in delirium knowledge than the control group who did not attend the program." was accepted as the experimental group significantly showed higher score than the control group in delirium knowledge.(t=14.52, p=.000)
3. The importance of nursing intervention was also significantly higher in the experimental group(t=13.76, p=.000) so that hypothesis 2 "The experimental group will show higher score in the importance of nursing intervention." was accepted.
4. Nursing practice for delirium patients was significantly higher in the experimental group (t=13.71, p=.000) so that hypothesis 3 " the experimental group will show higher score in nursing practice " was accepted. The experimental group also significantly noticed more delirium patients than the control group.(t=7.10, p=.000).
The study indicates that delirium education is an effective tool to increase delirium knowledge, importance of nursing intervention and nursing practice. Therefore, it would be helpful to give delirium education
not only to Intensive Care Unit or experienced nurses but also to General ward and newly graduated nurses.