혈액종양 환자의 응급실 내원 예측요인 전향적 조사

Other Titles
Predictors of Hemato-oncologic patients visiting Emergency Room:a prospective study
Authors
황순영
Issue Date
2016-06
Abstract
The purpose of this descriptive study was primarily to identify the predictors of hemato-oncologic patients visiting the emergency rooms. To achieve this goal, the predictors for emergency hemato-oncologic patients were investigated, the result of which will provide basic structural information that could reduce the number of hemato-oncologic patients visiting the emergency rooms. Data from 212 hemato-oncologic patients were collected from September 1, 2015 to September 30, 2015, at K University hospital located in Daegu. Measurement scales were designed based on FACIT (Functional Assessment of Chronic Illness Therapy) categories consisting of fatigue scale, family support, BDI (Beck Depression Inventory), self-care knowledge, self-care behavior. Hemato-oncologic diseases, their related characteristics and the physiological index were reviewed by EMR (Electronic Medical Record) by using the structured paper. The analysis for this study was generated using SPSS version 21.0 to calculate frequency, percentile, average, standard deviation, t-test, chi-square test, and logistic regression. The results are as follows: 1. Of the 212 hemato-oncologic patients who visited the emergency room, 49(23.1%) patients had visited the emergency room before while 163(76.9%) patients had no previous emergency room visit experience. 2. The variables that were statistically significant for the emergency room visiting group were diagnosis(p=.009), type of treatment (p=.025), duration after diagnosis(p=.022), fatigue(p<.001), bleeding related indicators of Platelet levels(p=.022), self-care behavior(p=.042), self-care behaviors related infection(p=.010). 3. The result of running a logistics regression shows that there were seven significant predictors with 82.5% prediction probability: duration after diagnosis(CI=0.66-2.31, OR= 1.23), bleeding related indicators of Platelet levels(CI=1.70-13.06, OR=4.72), fatigue (CI=2.47-7.69, OR=4.31), self-care behaviors related infection (CI=1.93-12.19, OR=3.37). The results showed that hemato-oncologic patients are more likely to visit an emergency room under the following conditions: the longer the days are after the initial diagnosis; the lower the Platelet levels; the higher the fatigue; the lower the self-care behaviors related to infection management. Therefore, it is important that hemato-oncologic patients and health care staff be attentive, according to the results of the study. The conclusions drawn from this research could be used to develop further nursing interventional strategies for hemato-oncologic patients visiting emergency rooms. Furthermore, it is necessary to measure the effect of such nursing interventional strategies.
본 연구는 혈액종양 환자를 대상으로 응급실 내원율과 응급실 내원 예측요인을 파악하는 서술적 조사연구이다. 이를 바탕으로 혈액종양 환자의 응급실 내원 예측요인을 조사하고, 혈액종양 환자의 응급실 내원을 줄이기 위한 간호 중재 개발의 기초자료를 제공하기 위함이다. 연구대상자는 대구 소재 K대학병원에서 혈액종양으로 진단받고 치료중으로 2015년 9월 1일부터 9월 30일까지 혈액종양 내과 외래를 방문하고 본 연구의 선정기준을 만족한 212명을 대상으로 하였다. 측정도구는 FACIT (Functional Assessment of Chronic Illness Therapy)-fatigue scale, 가족지지, BDI (Beck Depression Inventory), 자가간호지식, 자가간호행위 도구를 사용하였고 혈액종양 환자의 질병 관련 특성, 생리적 지표는 구조화된 기록지로 전자의무기록을 조회하였다. 자료분석은 SPSS/WIN 21.0을 이용하여 빈도, 백분율, 표준편차, t-test, χ²-test, 로지스틱 회귀분석을 사용하였고, 본 연구의 연구결과를 요약하면 다음과 같다. 1. 혈액종양 환자 212명 중 응급실 내원군 23.1%(49명), 응급실 비내원군 76.9%(163명)으로 나타났다. 2. 응급실 내원군에서 통계적으로 유의하게 나타난 변수들은 진단명(p=.009), 치료방법(p=.025), 첫 진단 후 경과일(p=.022), 출혈관련 지표인 혈소판수(p=.022), 피로(p<.001), 자가간호 행위(p=.042), 감염관리 자가간호 행위(p=.010)이었다. 3. 로지스틱 회귀분석 결과 삽입한 7개의 예측변수 중 첫 진단 후 경과일(CI=0.66-2.31, OR=1.23), 혈소판수(CI=1.70-13.06, OR=4.72), 피로(CI=2.47-7.69, OR=4.31), 감염관리 자가간호 행위(CI=1.93-12.19, OR=3.37)가 유의한 예측요인으로 확인되었으며, 모형의 예측확률은 82.5%이었다. 결론적으로 진단 후 경과일이 길어질수록, 피로가 높을수록, 혈소판수치가 낮을수록, 감염관리 자가간호 행위가 낮을수록 혈액종양 환자의 응급실 내원 가능성이 높은 것으로 나타났다. 따라서 혈액종양 환자의 응급실 내원율을 낮추기 위해서는 혈액종양 환자의 응급실 내원 예측요인에 대한 환자와 의료인의 관심 및 관리가 중요하며, 예측요인을 포함한 응급실 내원에 대한 간호중재 개발과 그 효과 측정이 필요하다.
URI
http://kumel.medlib.dsmc.or.kr/handle/2015.oak/12954
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3. Thesis (학위논문) > 2. College of Nursing (간호대학) > 석사
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