RCN 아동 급성통증 사정 임상실무지침의 타당도 조사

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Investigating the Validity of RCN Clinical Practice Guideline of Assessing the acute pain of children
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This study aims to investigate the validity regarding the appropriateness and applicability of clinical guideline on the assessment of children's acute pain which was developed by RCN(Royal College of Nursing Institute). To achieve the purpose of this study, RCN guideline was evaluated by a group of experts, and applied into the clinical settings to test its clinical validity. The expert group consisted of 14 persons, including 6 pediatricians, 4 nursing professors, and 4 nurses. The study was conducted from May 07, 2005 to September 10, 2005. The clinical validity was tested by 30 nurses who were working at the pediatrics ward, nursery room ward and surgical ward of a general hospital located at P city, Gyeongsangbuk-do. The tool 󰡐Pediatric nurses's knowledge and attitudes survey regarding pain󰡑 by Manworren(2001) was modified and used to evaluate nurses' knowledge regarding children's acute pain before and after application of the guideline. To evaluate nurses' pain assessment process, the nurses' performance evaluation tool developed by University of Iowa, Research Dissemination Core, was modified and used to compare nurses' performance of assessing children's acute pain. In addition, nursing records for pain assessment and nursing diagnoses for pain evaluated. SPSS/WIN 11.0 program was used with descriptive statistics, percentages, average; stand deviation, and t-test. The results of this study were follow as: 1. For the expert validity, the appropriateness of the recommendation ranged from 6.00 to 8.36 and the applicability ranged from 4.43 to 8.00. 2. Nurses's knowledge on children's acute pain increased from 11.63?2.17 to 15.63?1.63 after the application of clinical practice guideline. 3. The nursing record regarding assessment of children's acute pain using the instruments increased from 0.00?0.00 times to 4.99?1.99. The frequency of nursing diagnoses related to the pain increased from 1.69?1.99 to 2.84?1.80 after the application of clinical practice guideline. In conclusion, the appropriateness and applicability of clinical practice guideline on the assessment of children's acute pain was highly scored by experts for the most part. The clinical practice guideline was proved to be effective and valid for Korean clinical setting showing that increased nurses' knowledge about the acute pain of children, increased assessment ability and more frequent nursing recording on pain. Therefore, the clinical practice guideline on the assessment of children's acute pain is considered to be effective in improving the nurses' knowledge and practice about pain assessment and can contribute to the quality of nursing care for the management of children's pain.
본 연구는 RCN(Royal College of Nursing Institute)이 개발한 아동 급성통증 사정 임상실무지침의 적절성과 적용가능성에 대한 전문가 집단의 타당도를 조사하고, 이를 임상에 적용하여 임상타당도를 알아봄으로써 효율적인 아동 급성 통증관리에 기여하고자 실시된 연구이다. 본 임상실무지침의 전문가 타당도 조사의 연구대상은 소아과 전문의 6명, 간호학 교수 4명, 간호사 4명으로 총 14명 이었으며, 조사기간은 2005년 6월 5일부터 6월 23일까지였다. 본 임상실무지침의 임상타당도의 연구대상은 경상북도 P시 소재 1개 종합병원의 소아과, 신생아실, 외과병동에 근무하는 간호사 30명이었다. 연구도구는 간호사 지식은 Manworren(2001)의 Pediatric nurses's knowledge and attitudes survey regarding pain 설문지를 본 연구의 목적에 맞게 수정, 보완하여 사용하였고, 통증 사정 수행과정평가도구는 Dissemination Care에서 개발한 임상실무지침과 관련된 간호수행과정평가도구를 본 연구의 목적에 맞게 수정, 보완하여 사용하였다. 자료분석은 SPSS/WIN 11.0 프로그램을 이용하여 실수와 백분율, 평균, 표준편차, t-test를 실시하였다. 연구결과는 다음과 같다. 1. 권고사항의 적절성은 9점 만점 중 각 영역별로 6.00-8.36점으로, 적용가능성은 4.43-8.00으로 평가되었다. 2. 간호사의 아동 급성통증 지식은 임상실무지침 적용 전 11.63?2.17에서 적용 후 15.63?1.63으로 증가하였다. 3. 임상실무지침 적용 전과 후 통증척도를 이용한 아동 급성통증 사정 간호기록은 적용전 0.00?0.00회에서 적용 후 4.99?1.99회로, 통증 간호진단의 횟수는 적용 전 1.69?1.99회에서 적용 후 2.84?1.80회로 증가하였다. 결론적으로 RCN의 아동 급성통증 사정 임상실무지침에 대한 적절성과 적용가능성은 전문가들에 의해 대부분 높게 평가되었고, 임상에서의 적용시에도 간호사들의 아동 급성통증 지식 향상, 아동 급성통증 사정 수행과정 평가의 증진과 통증관련 간호기록 횟수의 증가 등으로 볼 때 본 임상실무지침이 효과가 있는 것으로 나타났다. 따라서, 본 연구의 결과로 아동 급성통증 사정 임상실무지침의 적용으로 효과적인 아동 통증관리를 위한 간호사의 통증관련 지식향상과 통증 사정 간호실무의 질적 향상에 효과가 있을 것으로 사료된다.
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