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중환자실 노인 환자에 대한 다면적 섬망 예방 중재 프로그램의 효과

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Alternative Title
The Effects of Multicomponent Intervention Program to Prevent Delirium for Elderly Patients in Intensive Care Unit
Abstract
The purpose of this study was to examine the effects of multicomponent intervention program to prevent delirium on the occurance of delirium, self extubation or self remove of catheter, risk of injury from a fall, and intensive care unit (ICU) length of stay of elderly patients who had been admitted to the ICU. Using a quasi-experimental pre & post-test design with a non-equivalent control group. The study participants were elderly patients aged 65 years and older, admitted to the ICU of a university hospital in J province. Data was collected of a total of 73 patients, with 35 in the experimental group and 38 in the control group, from December 26, 2015, to 3 July 3, 2016.
The multicomponent intervention program to prevent delirium for the experiment group was developed in accordance with a literature review in adherence with the recommendations for preventing delirium, as outlined by the 2010 National Institute for Health and Care Excellence (NICE) delirium clinical guidelines, as well as a validity test by experts . The multicomponent intervention program to prevent delirium consists of 27 detailed intervention items within the following 8 areas: caregiver education, delirium assessment, activities to enhance orientation, therapeutic communication, sensory mediation for deteriorated vision and hearing, management for conditions of no or reduced mobility, family support, and maintenance of sleeping patterns. The intervention program was applied for 48 hours, immediately after admission to the ICU, and a total of 6 interventions were provided with 1 intervention per working hour. Whereas the control group was provided with a standard care.
In order to verify the effects of multicomponent intervention program to prevent delirium, CAM-ICU was used to determine the presence of delirium, and the risk of injury from a fall was measured using a fall risk detection tool (MFS). A data collection table was used to keep track of self-extubation and catheter removal by the patients, and ICU length of stay was measured by calculating the total duration from admission at the ICU to discharge to the general ward after patients were stable. The collected data were analyzed with descriptive statistics, chi-square test, t-test, Fisher's exact test, and independent t-test, multivariable logistic regression, ANCOVA using the SPSS WIN 21.0 program.

The findings of this study were as follows:
1. Occurance of delirium in the experimental group was 0.169 times significantly lower than that in the control group (odds ratio(OR)=0.169, 95% CI=0.032-0.887).
2. Self extubation or self remove of catheter in the experimental group was 0.425 times lower than that in the control group (OR=0.425, 95% CI=0.040-4.507).
3. There was no significant difference in the risk of injury from a fall between the experimental and control groups (F=3.467, p=.067).
4. There was no significant difference in ICU length of stay between the experimental and control groups (F=1.413, p=.239).

In conclusion, the study showed that the multicomponent intervention program to prevent delirium for elderly patients who were admitted to the ICU did not have a significant effect on self extubation or self remove of catheter, risk of injury from a fall, and ICU length of stay. However, the program was effective in reducing the occurance of delirium; therefore, effectiveness was partially evaluated.
Author(s)
황주희
Issued Date
2017
Awarded Date
2017. 8
Type
Dissertation
URI
http://dcoll.jejunu.ac.kr/jsp/common/DcLoOrgPer.jsp?sItemId=000000008175
Alternative Author(s)
Hwang, Ju hee
Affiliation
제주대학교 일반대학원
Department
대학원 간호학과
Advisor
김민영
Table Of Contents
Ⅰ. 서론
1. 연구의 필요성 1
2. 연구의 목적 5
3. 용어의 정의 6
Ⅱ. 연구 방법
1. 연구 설계 8
2. 연구 대상 9
3. 연구 도구 11
4. 실험처치: 다면적 섬망 예방 중재 프로그램 14
5. 연구진행 및 자료 수집방법 21
6. 자료 분석 25
7. 윤리적 고려 25
Ⅲ. 연구결과
1. 집단 간의 동질성 검증 26
2. 가설 검증 32
Ⅳ. 논의 36
Ⅴ. 결론 및 제언
1. 결론 46
2. 제언 47
참고문헌 49
Abstract 57
부 록 60
부록 1. 연구 참여 설명문 및 동의서 60
부록 2. 보호자 안내문 67
부록 3. 섬망 교육용 자료(간호사 대상) 69
부록 4. 자료 수집 도구 75
부록 5. 섬망 사정도구(CAM-ICU) 평가표 78
부록 6. 낙상위험 사정도구(Morse Fall Scale, MFS) 81
부록 7. 다면적 섬망 예방 중재 프로그램 체크리스트 82
Degree
Master
Publisher
제주대학교 일반대학원
Citation
황주희. (2017). 중환자실 노인 환자에 대한 다면적 섬망 예방 중재 프로그램의 효과
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