10 research outputs found
Development of screening model on delirium occurrence in MICU patients
κ°νΈνκ³Ό/λ°μ¬λ³Έ μ°κ΅¬λ λ΄κ³Όκ³ μ€νμ μ¬λ§λ°μ μνμμΈμ κ·λͺ
νκ³ , μ λ³λͺ¨νμ κ°λ°νκ³ νλΉλ κ²μ¦μ ν¨μΌλ‘μ¨ μ€νμμ€ μ
μ€ μλΆν° μ¬λ§λ°μ κ³ μνκ΅°μ λν μ λ³μ΄ κ°λ₯νλλ‘ νμλ€. λ¬Ένκ³ μ°°μ ν΅ν΄ μ¬λ§λ°μ μνμμΈμ λμΆνμκ³ , 1μ°¨ μλΉλꡬλ₯Ό μμ±νμ¬ μ λ¬Έκ° μ§λ¨μ μ΄μ©ν νλΉλλ₯Ό κ²μ¦νμμΌλ©° κ° νλͺ©μ CVI(Index of content validity)λ₯Ό μ°μΆνμ¬ 80% μ΄μμ ν©μκ° μ΄λ£¨μ΄μ§ νλͺ©μ μ μ νμλ€. λ΄κ³Όκ³ μ€νμ μ¬λ§λ°μ μ λ³λͺ¨ν κ°λ°μ μν μλ£μμ§μ μ€νμ 166λͺ
μ λμμΌλ‘ μ€μνμ¬ 2μ°¨ μλΉλꡬλ₯Ό κ°λ°νμκ³ , μ΅μ’
κ°λ°λ μ λ³λͺ¨νμ μ ν©λμ νλ³λ ₯μ λΆμν ν νλ¨κΈ°μ€μ μ μνμλ€. μ λ³λͺ¨νμ νλΉλ κ²μ¦μ μνμ¬ μ€νμ 98λͺ
μ λμμΌλ‘ μλ£μμ§μ μ€μνκ³ , μ λ³λͺ¨νμ νλ³λ ₯κ³Ό μ νλλ₯Ό λΆμνμλ€. μλ£μμ§ κΈ°κ°μ 2012λ
1μλΆν° 9μκΉμ§ μ μμλ¬΄κΈ°λ‘ κ²ν λ₯Ό μ€μνμκ³ , μμ§λ μλ£λ SPSS/PC WIN 18.0μ μ΄μ©νμ¬ λ‘μ§μ€ν± νκ·λΆμ(logistic regression analysis)μ μ΄μ©νμ¬ λΆμνμλ€.1. λ΄κ³Όκ³ μ€νμ μ¬λ§λ°μ μνμμΈμΌλ‘ μ΄ 52κ° νλͺ©μ΄ λμΆλμκ³ , μλΉλꡬμ λν λ΄μ© νλΉλμ λν μ 체 νκ· μ CVI .92λ‘ λκ² λνλ¬λ€.2. λ΄κ³Όκ³ μ€νμ μ¬λ§ λ°μλ₯ μ 80.1%μ΄λ©°, νκ· 2.66Β±1.80μΌμ§Έ μ¬λ§μ΄ λ°μνμλ€. μ§μ μ ν μ’
λ₯λ₯Ό μ§μ μ£Όμ
ν κ²½μ°μ½λ¬Ό νκ· 2.72Β±1.8μΌμ§Έ, λ μ’
λ₯μ μ½λ¬ΌμΈ κ²½μ° 2.65Β±1.7μΌμ§Έμ μ¬λ§μ΄ λ°μν κ²μΌλ‘ λνλ¬κ³ , μ λΆμ μ§λ¨μΈ κ²½μ° νκ· 3.35Β±2.13 μΌμ§Έ, μ λΆμ μ§λ¨μ΄ μλ κ²½μ° νκ· 2.49Β±1.60μΌμ§Έλ‘ μ λΆμ μ§λ¨μΈ κ²½μ°κ° 0.89μΌμ λ λ¦κ² μ¬λ§μ΄ λ°μνλ κ²μ μ μ μμλ€.3. μ¬λ§λ°μ μ 무μ λ°λ₯Έ λ΄κ³Όκ³ μ€νμμ νΉμ±μ λΉκ΅ λΆμν κ²°κ³Ό, κΈ°κ³νκΈ° κ²½ν, κΈ°λμ½κ΄ λλ κΈ°κ΄μ κ°μ μ κ²½ν, APACHE II score β₯ 20μ , λκ΄ κ°μβ₯ 5κ°, CRPμμΉ β₯9 mg/dl, albuminμμΉ <3.3 g/dl, μμΆκΈ° νμ β₯ 140mmHg, μ΅μ λ κ²½ν, μμ°½, μλ©΄μ₯μ , μ§μ μ (midazolam, ketamine) μ§μμ£Όμ
, benzodiazepineκ³ μ κ²½μμ μ (diazepam, lorazepam)μ κ°νμ ν¬μ¬, λ§μ½μ± μ§ν΅μ (alfenil, morphine, remifentanil)μ μ§μ μ£Όμ
λ± 13κ° μμΈμμ ν΅κ³μ μΌλ‘ μ μν μ°¨μ΄λ₯Ό 보μλ€.4. λ΄κ³Όκ³ μ€νμμ μ¬λ§λ°μ μνμμΈμ λ‘μ§μ€ν± νκ·λΆμμΌλ‘ λΆμν κ²°κ³Ό, λ μ’
λ₯μ μ§μ μ λ₯Ό μ£Όμ
ν κ²½μ°κ° 2.38λ°°, ν κ°μ§ μ½λ¬Όμ μ£Όμ
ν κ²½μ°κ° 1.70λ°°, μλ©΄μ₯μ κ° μλ κ²½μ°κ° 2.21λ°°, benzodiazepineκ³ μ κ²½μμ μ λ₯Ό κ°νμ μΌλ‘ ν¬μ¬λ₯Ό ν κ²½μ°κ° 2.04λ°°, μμ°½μ΄ μλ κ²½μ°κ° 1.65λ°°, APACHE II score κ° 20μ μ΄μμΈ κ²½μ°κ° 1.15λ°° μ¬λ§λ°μμ΄ μ¦κ°νλ κ²μΌλ‘ λνλ¬λ€.5. λΆμλ λ‘μ§μ€ν± νκ·λΆμ κ²°κ³Όλ‘ λ΄κ³Όκ³ μ€νμ μ¬λ§λ°μ μ λ³λͺ¨νμ κ°λ°νμλ€.(1) λ΄κ³Όκ³ μ€νμ μ¬λ§λ°μ μ λ³λͺ¨νμ Hosmer-Lemeshowμ μ ν©λ κ²μ¬ κ²°κ³Ό λͺ¨νμ΄ μ ν©νμλ€(ΟΒ²= 3.270, p = .916).(2) λ΄κ³Όκ³ μ€νμ μ¬λ§λ°μ μ λ³λͺ¨νμ μ μλ λ‘μ§μ€ν± νκ·λΆμ κ²°κ³Όμ coefficient(B)λ₯Ό κΈ°μ€μΌλ‘ λ μ’
λ₯μ μ§μ μ μ§μ μ£Όμ
ν κ²½μ° 6μ (ν μ’
λ₯μ μ§μ μ μ§μ μ£Όμ
ν κ²½μ° 4μ ), μλ©΄μ₯μ κ° μλ κ²½μ° 6μ , benzodiazepineκ³ μ κ²½μμ μ λ₯Ό κ°νμ μΌλ‘ ν¬μ¬ν κ²½μ° 5μ , μμ°½μ΄ μλ κ²½μ° 4μ , APACHE II scoreκ° 20μ μ΄μμΈ κ²½μ° 3μ μΌλ‘ μ μννμκ³ , κ°λ°λ μ λ³λͺ¨νμ μ΄μ μ 24μ μ΄λ€.(3) λ΄κ³Όκ³ μ€νμ μ¬λ§λ°μ μ λ³λͺ¨νμ νλ³λ ₯μ AUC κ° .908(p < .001)λ‘ λ΄κ³Όκ³ μ€νμ μ¬λ§λ°μ μνμμΈμ μ λ³νκΈ°μ μ μ νλ€κ³ ν΄μν μ μλ€.(4) λ΄κ³Όκ³ μ€νμ μ¬λ§λ°μ μ λ³λͺ¨νμ νλ¨κΈ°μ€μ λ³λ³μ 10μ μμ λ―Όκ°λλ 80%, νΉμ΄λλ 89%λ‘ μΈ‘μ ν μ μκ° 10μ μ΄μμΈ κ²½μ° μ¬λ§ λ°μμ μνμ΄ λμ κ²μΌλ‘ ν΄μν μ μλ€.6. κ°λ°λ μ λ³λͺ¨νμ νλΉλλ₯Ό νλ³λ ₯κ³Ό μ νλλ‘ λΆμνμλ€. (1) λ΄κ³Όκ³ μ€νμ μ¬λ§λ°μ μ λ³λͺ¨νμ νλΉλ κ²μ¦μ μ€μν κ²°κ³Ό AUC κ°μ .935(p < .001)λ‘ λ΄κ³Όκ³ μ€νμ μ¬λ§λ°μ μνμμΈμ μ λ³νκΈ°μ μ μ νλ€κ³ ν΄μν μ μλ€.(2) λ΄κ³Όκ³ μ€νμ μ¬λ§λ°μ μ λ³λͺ¨νμ μ νλλ λ―Όκ°λλ 83%, νΉμ΄λλ 89%μ΄λ©° μ λΆλ₯μ¨μ 84%λ‘ νμΈλμλ€.μ΄μμ κ²°κ³Όμμ κ°λ°λ λ΄κ³Όκ³ μ€νμ μ¬λ§λ°μ μ λ³λͺ¨νμ μ§μ μ μ§μ μ£Όμ
, μλ©΄μ₯μ , benzodiazepineκ³ μ κ²½μμ μ λ₯Ό κ°νμ ν¬μ¬, μμ°½, APACHE II scoreμ 5κ°μ§ μμΈμΌλ‘ ꡬμ±λ μ΄μ 24μ μΌλ‘, 10μ μ΄μμΈ κ²½μ° μ¬λ§λ°μ κ³ μνκ΅°μΌλ‘ νλ¨ν μ μλ€. νλΉλ κ²μ¦μ ν΅ν΄ λ΄κ³Όκ³ μ€νμμ μ¬λ§λ°μ μνμμΈμ μ λ³μ μ μ ν¨μ μ μ μμλ€.μ΄μ μ€νμμ€ κ°νΈμ¬λ κ°νΈμ€λ¬΄μμ λ΄κ³Όκ³ μ€νμ μ¬λ§λ°μ μ λ³λͺ¨νμ μ μμ무기λ‘μ μλ£λ₯Ό μλμΌλ‘ μΆμΆνλ μμ€ν
ꡬνμ ν΅ν΄ μμ½κ² νμ©νμ¬, μ¬λ§ κ³ μνκ΅°μ νμ
νκ³ μ΄λ₯Ό κ·Όκ±°λ‘ μ¬λ§ μλ°©μ μν μ μ ν μ€μ¬νλμ μ€μνμ¬ μ€νμ κ°νΈμ μ§ ν₯μμ κΈ°μ¬ν μ μμ κ²μΌλ‘ μ¬λ£λλ€.ope
Role development of emergency nurse practitioner
μκΈκ°νΈμ 곡/μμ¬[νκΈ]
μκΈμ λ¬Έκ°νΈμ¬λ μκΈλΆμΌμμ μΌλ°κ°νΈμ¬μ μμ€μ λ₯κ°νλ μ λ¬Έμ μΈ κ΅μ‘μ λ°μ μκΈμ λ¬Έκ°λ‘μ μ°λ¦¬λλΌμμλ μκΈμ λ¬Έκ°νΈμ¬ μ λκ° λμ
λμλ€. κ·Έλ¬λ μκΈμ λ¬Έκ°νΈμ¬μ ꡬ체μ μΈ μ§λ¬΄μ λ²μμ μμ¨μ± μμ€μ΄ μ ν΄μ§μ§ μμ μ€μ μ΄λ€.
μ΄μ λ³Έ μ°κ΅¬λ μκΈμ λ¬Έκ°νΈμ¬μ μ§λ¬΄ μν μμ¨μ± μμ€μ λνμ¬ μκΈμ€μ 근무νλ μμ¬μ κ°νΈμ¬μ μ견 λΉκ΅, μκΈμ λ¬Έκ°νΈμ¬μ λν μΈμ§μ¬λΆμ λ°λ₯Έ μ견 λΉκ΅, μμ¬κ°νΈμ¬μ μκΈμ λ¬Έκ°νΈμ¬μ λν μΈμ§μ¬λΆμ λ°λ₯Έ μ견 λΉκ΅μ μ§λ¬΄ μμ¨μ± μμ€μ λν μ견 μΌμΉ μ λλ₯Ό νμΈνμ¬ μ°λ¦¬λλΌ μκΈμλ£κ΄λ¦¬μ²΄κ³μ μ ν©ν μκΈμ λ¬Έκ°νΈμ¬μ μ§λ¬΄λ₯Ό κ°λ°νμλ€.
μ°κ΅¬λꡬλ μκΈμ λ¬Έκ°νΈμ¬μ μ§λ¬΄ λ΄μ©μ΄ μ°λ¦¬λλΌμλ μμ§ νμΈλμ§ μμκΈ° λλ¬Έμ μλ 4κ°μ λ¬Ένκ³ μ°°μ κ·Όκ±°λ‘ μ°λ¦¬λλΌ μκΈμλ£ μ€μ μ λ§λλ‘ μ°κ΅¬μκ° μμ±νμκ³ λꡬμ λ΄μ©νλΉλλ κ°νΈλνμ μκΈμ λ¬Έκ°νΈ κ³Όμ μ λ΄λΉκ΅μ 2μΈ, μκΈμ§λ£μΌν° μκΈμ€μ₯ 1μΈμΌλ‘λΆν° μλ¬Έμ λ°μ λ΄μ©μ μμ , 보μνμλ€.
1. Roberts & Hedges(1998)μ Clinical Procedures in Emergency Medicineμμ 71νλͺ©μ νλκ³Ό μ μ°¨λ₯Ό λΆλ₯ν λꡬ
2. Cole & Ramirez(2000)κ° λ―Έκ΅ μκΈμ λ¬Έκ°νΈμ¬μ μν΄ μνλλ νλκ³Ό μ μ°¨λ₯Ό μ‘°μ¬ν μ°κ΅¬μμ μκΈμ€μ 근무νκ³ μλ λ―Έκ΅ μκΈμ λ¬Έκ°νΈμ¬ 72λͺ
μ λμμΌλ‘ μ°κ΅¬ν μλ£λ₯Ό λΆμνμ¬ μκΈμ λ¬Έκ°νΈμ¬μ 50% μ΄μμ΄ μννκ³ μλ 35κ° νλͺ©κ³Ό μκΈμ λ¬Έκ°νΈμ¬μ μ§λ¬΄λ‘ 50% μ΄μμ΄ μ€μνλ€κ³ μλ΅ν 56κ° νλͺ©
3. λ―Έκ΅ μκΈκ°νΈμ¬νν((ENA, 2001)μ μκΈμ λ¬Έκ°νΈμ¬μ μ€λ¬΄νμ€(Standards of Practice for the Nurse Practitioner in the Emergency Care Setting)
4. Houstonμ University of Texas Health Science Center κ΅κ³Όκ³Όμ (2004)
μ°κ΅¬λμμ μκΈμ€μ 근무νλ μμ¬μ κ°νΈμ¬ 214λͺ
μΌλ‘ μ μ£Όλλ₯Ό ν¬ν¨ν μ κ΅μ μκΈμνκ³Ό λ μ§λνΈ 36λͺ
κ³Ό μ 곡μ 52λͺ
μ ν¬ν¨ν μκΈμνκ³Ό μμ¬ 88λͺ
κ³Ό μμΈ μ§μμ 2κ° λν λ³μκ³Ό 1κ°μ μ’
ν©λ³μ, κ²½κΈ° μ§μ 1κ° λ³μμ μκΈμ€ κ°νΈμ¬ 126λͺ
μ λμμΌλ‘ νμλ€.
μλ£μμ§μ 2004λ
μκΈλΆμΌν ννκ° μνλ μμΈ LνΈν
μμ 4μ 29μΌ-30μΌ 2μΌκ°κ³Ό 5μ 10μΌ-21μΌ 12μΌκ° μ΄λ£¨μ΄μ‘λ€.
μλ£λΆμμ SPSS/WIN 12.0μ μ΄μ©νμ¬ μ μ° ν΅κ³ μ²λ¦¬νμ¬ λΆμνμλ€.
λ³Έ μ°κ΅¬κ²°κ³Όλ₯Ό μμ½νλ©΄ λ€μκ³Ό κ°λ€.
1. μκΈμ€μ 근무νλ μμ¬μ κ°νΈμ¬μ μ§μ’
κ° μ§λ¬΄μν μμ¨μ± μμ€ λΉκ΅μμ 50% μ΄μμ΄ μμ¬λ§μ μ§λ¬΄λ‘ 보λ νλͺ©μ μκΈμνκ³Ό μμ¬μ κ²½μ° Tracheostomy μν, Diagnostic peritoneal lavage μν, Lumbar puncture μν, Cricothyrotomy μν, Chest tube μ½μ
, Joint aspiration μν, Long bone(μ. femur) 골μ μ λν reduction μν, Abscessμ incision & drainage μν, μ€μ¬ μ λ§₯κ΄ μ½μ
λ° κ΄λ¦¬, μΉλ£μ 볡μμ²μλ νκ³½μ²μ μν, Nerve blocks μνμ 11κ° νλͺ©μ΄μλλ° λΉν΄ μκΈμ€μ 근무νλ κ°νΈμ¬λ Tracheostomy μν 1κ° νλͺ©λ§ μμ¬λ§μ μ§λ¬΄λ‘ λ³΄κ³ νμλ€.
2. μκΈμ λ¬Έκ°νΈμ¬μ λν΄ μκ³ μλ κ·Έλ£Ήμ μκΈκ°νΈμ¬μ μμ¨μ±μ λμ΄ νκ°νμλ€.
3. μκΈμ λ¬Έκ°νΈμ¬μ μ§λ¬΄ μνμ μμ¨μ± μμ€μ μ견 μΌμΉ μ λ
(1) μκΈμ€ μμ¬μ κ°νΈμ¬μ μ§μ’
κ° μ§λ¬΄ μνμ μμ¨μ± μ λκ° μΌμΉνλ νλͺ©μ 55κ° νλͺ© μ€ Endotracheal intubation μν, Needle thoracotomy μν, Aterial line μ½μ
λ° κ΄λ¦¬, μ§λ¨μ 볡μμ²μλ νκ³½μ²μ μν, Neck collarλ₯Ό μ΄μ©ν C-spine κ³ μ , Splint μ μ©, Nail removal / Nail trephination μν, μμ²μ λ¬΄κ· μ μλ
μ€μ, λμ μ΄λ¬Όμ§ μ κ±°λ₯Ό μν μ리μμΌμ μΈμ² μν, μ°κ΅¬ μ€μ λ° λ°ν(λ
Όλ¬Έ, νν)μ 10κ° νλͺ©μ΄μλ€.
(2) μκΈμ λ¬Έκ°νΈμ¬μ λν μΈμ§μ¬λΆμ λ°λ₯Έ μ§λ¬΄ μν μμ¨μ± μ λμ μΌμΉ νλͺ©μ 37κ° νλͺ©μ΄μλ€.
(3) μκΈμνκ³Ό μμ¬λ μκΈμ λ¬Έκ°νΈμ¬μ λν μΈμ§μ¬λΆμ μκ΄μμ΄ 55κ° νλͺ© μ€ κ°μ₯ λ§μ 50κ° νλͺ©μ λν΄ μκ²¬μ΄ μΌμΉνμκ³ μκΈμ€ κ°νΈμ¬λ μκΈμ λ¬Έκ°νΈμ¬μ λν μΈμ§μ¬λΆμ μκ΄μμ΄ 39κ° νλͺ©μ λν΄ μκ²¬μ΄ μΌμΉνμλ€.
5. μκΈμ λ¬Έκ°νΈμ¬μ μ§λ¬΄μ λλΆλΆμ μ°¨μ§νλ μ λ¬Έμ κ°νΈ μ€λ¬΄ λ΄μ©μ κΈ°μ‘΄μ μμ¬μ μν μ΄λ―λ‘ μ°λ¦¬λλΌ μκΈμ λ¬Έκ°νΈμ¬μ μ§λ¬΄λ μκΈμνκ³Ό μμ¬μ μ견μ λ°μνμ¬ μμ¬μ μ§λ¬΄λ‘ λ΅ν 11κ° νλͺ©, μ¦ Tracheostomy μν, Diagnostic peritoneal lavage μν, Lumbar puncture μν, Cricothyrotomy μν, Chest tube μ½μ
, Joint aspiration μν, Long bone(μ. femur) 골μ μ λν reduction μν, Abscessμ incision & drainage μν, μ€μ¬ μ λ§₯κ΄ μ½μ
λ° κ΄λ¦¬, μΉλ£μ 볡μμ²μλ νκ³½μ²μ μν, Nerve blocks μνμ μ μΈν 44κ° νλͺ©μΌλ‘ μ μνμλ€.
μ΄μκ³Ό κ°μ κ²°κ³Όλ₯Ό ν΅νμ¬ μκΈμ λ¬Έκ°νΈμ¬μ λμ λμ
μ΄κΈ° λ¨κ³μμ μκΈμ λ¬Έκ°νΈμ¬μ μ λ¬Έμ κ°νΈ μ€λ¬΄μ λ²μ£Όμ ν΄λΉνλ μ§λ¬΄μ λλΆλΆμ΄ κ·Έλμ μκΈμνκ³Ό μμ¬ λ§μ μν΄ μνλ μ²μΉκ° λλΆλΆμ΄λ―λ‘ μ§λ¬΄μ μ€λ³΅μ λ°©μ§νκ³ μ§μ μλ£ μλΉμ€λ₯Ό μ 곡νκΈ° μν΄μ μκΈμνκ³Ό μμ¬λ€κ³Όμ νμ‘°μ μ΄κ³ μνν μμ¬μν΅μ ν΅ν λ²μ μ λμ μ μ°©μ΄ νμμ μ΄λΌκ³ ν μ μλ€. λν, μκΈμ λ¬Έκ°νΈμ¬μ μν μ 립μ μν΄μλ μκΈμ λ¬Έκ°νΈμ¬μ μ§λ¬΄μ κ΄λ ¨λ νλ‘ν μ½ κ°λ°μ΄ μ μ€νκ² μꡬλλ©° μ§λ¬΄ λ΄μ©κ³Ό κ΄λ ¨λ 체κ³μ μΈ μ€μ΅ νλ‘κ·Έλ¨κ³Ό κ΅μ‘ νλ‘κ·Έλ¨ κ°λ°μ΄ μꡬλλ€.
[μλ¬Έ]The purpose of this study is to develop role of nurse practitioners in emergency care settings. The research design employed for the study was survey using a questionnaire, which was developed by the researcher based on following instruments: 71 activities and procedures obtained from clinical procedures in emergency medicine by Roberts and Hedges(1998); activities and procedures performed by nurse practitioners by Cole and Ramirez(2000): the standards of practice for nurse practitioner in the emergency care settings by ENA(2001); and the curriculum content of the ENP(Emergency Nurse Practitioner) at the University of Texas Health Science Center at Houston(2004).
The survey-participants were 214 nurses and 88 doctors in the emergency care setting. The data were collected from April 29 to 30, 2004 at the site of the annual conference of the Korean Society of Emergency Medicine in Seoul. And additional data from emergency nurses from May 10 to 21, 2004 at four hospitals in Seoul and Kyonggi Province.
The data was analyzed using SPSS/Win 12.0 statistical package.
The results of this study are as follows.
1. Doctors identified 11 activities for doctors only; tracheostomy, diagnostic peritoneal lavage, lumbar puncture, cricothyrotomy, insertion of chest tube, joint aspiration, reduction of fractures of long bone(e.g. femur), incision and drainage of an abscess, insertion and management of central venous catheter, therapeutic paracentesis and thoracentesis and nerve blocks, while nurses identified tracheostomy as the only activities done by doctors.
2. The subjects aware of ENP gave higher autonomy scores than the subjects who did not know much about ENP regardless of their occupation.
3. Over 50 percent of the doctors responded that 11 activities listed on the questionnaire as procedures performed by doctors only and 44 activities as nurse role with various autonomy.
Based on the result of this study, it is proposed that the curriculum for ENP education should include the contents regarding those procedures. Also, it is necessary to develop protocols and clinical pathway of 44 activities identified in this study.ope