욕창예방과 중재를 위한 알고리즘 개발

Other Titles
Development of the algorithm for the preventing and managing of pressure ulcer
Authors
김진미
Issue Date
2009-12
Awarded Date
2010
Abstract
The purpose of this study is to develop an algorithm for preventing and managing of pressure ulcer and verify the appropriateness, so this project can provide a systematic nursing frame to the nurses at hospitals and contribute to improve the hospital nursing system. The algorithm was developed through studying documentary records. This study developed four steps. The first step of this study was synthesizing the professionals’ opinions and literature. The second step of this study was an 12 expert team examined them in order to select the factors to be used in developing a decision making tree. The final factors chosen were those with an index of validity above 80% agreement. The third step of this study drew the revised algorithm after reflecting the result of appropriate contents. Next, 12 intensive care unit nurses and 13 nurses at general wards applied the revised algorithm for two weeks to their actual treatment, and the appropriateness of clinical examination was verified after that. The results of this study are summarized as follows : 1) The algorithm was concreted after studying the representative treatment guidebook of 6 countries, studying the documentary records, and synthesizing the professionals’ opinions. The general course was recorded on one page, the title of the operating guidelines for each step about the algorithm course was provided, and recorded the 7 specific guidelines were recorded on a separate page from the course. 2) As the result, preliminary algorithm for preventing and managing of pressure ulcer after 12 professionals including 1 surgeon and 1 professor from the nursing department who had professional wound treatment experience verified the appropriateness of contents, there were four algorithm courses that had more than 90 % of professionals’ agreement and 16 algorithm courses that had more than 80 %. In addition, the course that had less than 80 % of agreement needed to have re-evaluating the danger of pressure ulcer. 3) 33 items were verified by more than 90 % of professionals, and they agreed the contents were appropriate to explain how to operate each step, 48 items were verified by more than 80 % of professionals, and 9 items were verified by less than 80 % of professionals. 4) After reflecting the verified result from the professionals about the appropriateness of the contents, one course was revised that had low score, and two courses that were distinguished by two different colors. In addition, some terms were changed and the revised algorithm was drawn. Next, the operating guidelines for each step that had less than 80% of professionals' agreement were also revised and simplified th meet the situation on Korea. 5) The appropriateness of clinical examination was verified after 12 intensive care unit’s nurses and 13 general wards’ nurses used the revised algorithm for two weeks. Most courses were used by those nurses at both places, but there were some items that were used less, and they were 2 items related to re-evaluation for preventing bedsores and 2 items related to controlling infection. 6) The character of usefulness, appropriateness, and convenience among the appropriateness of clinical examination showed 2.92∼3.48 out of 4.00, so it was comparably proper. While the scientific and systematic item and the ability of recognition attained 3.48 that was comparably high, the item that asked if it helped reducing the time had 2.92 which had the lowest score. In conclusion, the algorithm for preventing and managing of pressure ulcer from this research would improve the quality of nursing as helping the decision for clinical examinations and providing consistent nursing system since it provided the course of algorithm and the guidebook for operation. In addition, nurses can have education about this algorithm that can be a tool for preventing and mediating bedsores, and this would suggest systematic nursing frame for bedsores to the hospitals in the world.
본 연구의 목적은 욕창예방과 중재를 위한 알고리즘을 개발하고 타당도를 검증하여 병원간호사에게 체계적인 간호활동의 틀을 제시하고 병원 간호실무의 수준향상에 기여하고자 함이다. 이 연구는 알고리즘을 개발하고자 시도된 방법론적 연구이다. 연구의 진행과정은 4단계로 진행되었다. 1단계로 문헌고찰과 전문가 의견을 종합하여 욕창예방과 중재를 위한 예비 알고리즘을 개발하였고, 2단계에서 12명의 전문가집단을 이용하여 내용타당도를 검증하였으며, 각 항목은 CVI (index of content validity)를 산출하여 80% 이상의 합의가 이루어진 경우 유의한 항목으로 선정하였다. 3단계에서 내용타당도 결과를 반영하여 수정 알고리즘을 도출하였으며, 4단계에서 중환자실 간호사 12명, 일반병동 간호사 13명이 수정 알고리즘을 2주간 실무에 활용하도록 한 후 임상타당도 검증을 실시하였다. 구체적인 연구 결과는 다음과 같다. 1) 6개의 국가별 대표적 실무 임상지침, 문헌고찰 및 전문가 의견을 종합하여 욕창예방과 중재를 위한 예비 알고리즘을 구성하였다. 전체 경로도는 한 장으로 구성되어 있고, 알고리즘 경로 내에서는 단계별 실행 설명문의 제목만 제시하고, 7개 실행 설명문(욕창예방 피부간호, 물리적 압력/지지면/체위변경 간호, 영양공급 간호, Stage II 처치, Stage III, IV 처치, 괴사조직/상처세척, 감염조절)의 상세한 설명은 경로도와 구분하여 따로 작성하였다. 2) 욕창예방과 중재를 위한 예비 알고리즘에 대해 외과 의사 1인, 상처전문간호사 10인, 상처전문간호사 경력이 있는 간호학 교수 1인 등 총 12명의 전문가의 내용타당도 검증을 실시한 결과, 전문가 합의가 90%이상인 알고리즘 경로는 4개였고, 80%이상인 경로는 16개였으며, 전문가 합의가 80% 미만으로 나타난 경로는 욕창위험 재평가 관련 항목 1개로 나타났다. 3) 단계별 실행 설명문에 대한 전문가 내용타당도 검증결과는 전문가 합의가 90%이상인 항목은 33개였으며, 80%이상인 항목은 48개였으며, 전문가 합의가 80% 미만으로 나타난 항목은 9개로 나타났다. 4) 전문가 내용타당도 검증 결과를 반영하여 타당도가 낮은 경로 1개를 수정하고, 욕창예방과 욕창중재 경로의 색깔을 구분하고, 용어를 수정하여 수정 알고리즘을 도출하였다. 단계별 실행 설명문도 전문가 합의 80% 미만 항목을 중심으로 국내 상황에 맞게 수정 보완, 용어 정리, 간결화하였다. 5) 중환자실 간호사 12명, 일반병동 간호사 13명에게 수정 알고리즘을 2주간 사용하게 한 후 임상타당도를 검증하였다. 대부분의 경로를 중환자실과 일반병실 간호사들이 다 사용하는 것으로 나타났으나, 사용률이 낮은 항목들은 욕창예방을 위한 재평가 관련 2개 항목과, 감염조절 관련 2개 항목이었다. 6) 임상타당도 중 유용성, 적절성, 편의성을 보면, 4점 만점에 2.92~3.48점으로 비교적 적절하다고 평가하였다. 알고리즘이 과학적이고 체계적이라는 항목과 알고리즘의 중요성에 대한 인지도 항목이 3.48점으로 높은 점수를 나타낸 반면, 시간단축에 도움이 되는 정도 항목이 2.92점으로 가장 낮게 나타났다. 결론적으로 본 연구에서 개발한 욕창예방과 중재를 위한 알고리즘은 알고리즘 경로도와 실행 설명문을 제시함으로서, 임상 의사결정을 돕고 통일된 간호를 체계적으로 제공함을 통해 간호의 질을 향상시킬 수 있을 것이다. 또한 본 알고리즘을 욕창예방과 중재를 위한 간호를 위한 교육도구로 사용하여 전 병원에 체계적인 욕창간호 틀을 제시할 수 있을 것이다.
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http://kumel.medlib.dsmc.or.kr/handle/2015.oak/11035
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3. 학위논문 > 2. College of Nursing (간호대학) > 석사
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