중환자간호학회지 (Journal of Korean Critical Care Nursing)

  • 제16권1호
  • /
  • Pages.56-70
  • /
  • 2023
  • /
  • 2005-212X(pISSN)
  • /
  • 2671-8634(eISSN)
한국중환자간호학회 (Korean Society of Critical Care Nursing)
권호 표지
DOI QR코드

DOI QR Code

소아중환자실 간호사를 위한 다면적 소아 섬망 교육프로그램이 섬망 지식, 섬망 간호에 대한 자신감, 섬망 사정 정확도에 미치는 효과: 단일군 전후설계

Effects of a Multifaceted Pediatric Delirium Education Program for Pediatric Intensive Care Unit Nurses on their Delirium Knowledge, Self-confidence in Delirium Nursing, and Delirium Assessment Accuracy: A One Group Pretest-Posttest Design

  • 투고 : 2023.02.02
  • 심사 : 2023.02.21
  • 발행 : 2023.02.28
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Purpose : This study aimed to identify the effects of a multifaceted pediatric delirium education program for pediatric intensive care unit (PICU) nurses on their delirium knowledge, confidence in delirium nursing, and delirium evaluation accuracy. Methods : This study used a one-group pretest-posttest design. The participants were 50 nurses in two units of the PICU at S General Hospital in Seoul. All participants took a 1-hour lecture with case-based practice for the first two weeks, and received feedback as they applied the program to clinical practice over the next two weeks. Test measures were completed before and after the four week intervention period for all participants. The delirium evaluation accuracy was measured using the Korean version of the Cornell Assessment of Pediatric Delirium. Data were analyzed using the chi-square and paired t-tests. Results : After the Pediatric Delirium Education Program, nurses' delirium knowledge (x2=11.65, p =.001), confidence in delirium nursing (t=9.71, p<.001), and delirium evaluation accuracy (t=6.07, p<.001) improved significantly. Conclusions : Pediatric delirium education programs for PICU nurses were effective. For active application of the program in clinical practice in the future, various cases of childhood delirium and specific strategies for each subject must be developed. To achieve this, long-term intervention and research for multiple organizations are required.

키워드

과제정보

본 연구는 2019년 삼성서울병원 간호부 연구비를 지원받아 진행한 연구의 일부임

참고문헌

  1. van Eijk MM, van den Boogaard M, van Marum RJ, Benner P, Eikelenboom P, Honing ML, et al. Routine use of the confusion assessment method for the intensive care unit: A multicenter study. American Journal of Respiratory and Critical Care Medicine. 2011;184(3):340-4. http://doi.org/10.1164/rccm.201101-0065OC
  2. Salluh JI, Wang H, Schneider EB, Nagaraja N, Yenokyan G, Damluji A, et al. Outcome of delirium in critically ill patients: Systematic review and meta-analysis. British Medical Journal. 2015;350: h2538. http://doi.org/10.1136/bmj.h2538
  3. Barr J, Fraser GL, Puntillo K, Ely EW, Gelinas C, Dasta JF, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Critical Care Medicine. 2013;41(1):263-306. http://doi.org/10.1097/CCM.0b013e3182783b72
  4. Ely EW, Shintani A, Truman B, Speroff T, Gordon SM, Harrell Jr FE, et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. Journal of the American Medical Association. 2004;291(14):1753-62. http://doi.org/10.1001/jama.291.14.1753
  5. Bannon L, McGaughey J, Clarke M, McAuley DF, Blackwood B. Impact of non-pharmacological interventions on prevention and treatment of delirium in critically ill patients: Protocol for a systematic review of quantitative and qualitative research. Systematic Reviews. 2016;5:75. http://doi.org/10.1186/s13643-016-0254-0
  6. Harris J, Ramelet AS, van Dijk M, Pokorna P, Wielenga J, Tume L, et al. Clinical recommendations for pain, sedation, withdrawal and delirium assessment in critically ill infants and children: An ESPNIC position statement for healthcare professionals. Intensive Care Medicine. 2016;42(6):972-86. http://doi.org/10.1007/s00134-016-4344-1
  7. Patel AK, Bell MJ, Traube C. Delirium in pediatric critical care. Pediatric Clinics on North America. 2017;64(5):1117-32. http://doi.org/10.1016/j.pcl.2017.06.009
  8. Smith HA, Gangopadhyay M, Goben CM, Jacobowski NL, Chestnut MH, Savage S, et al. The Preschool Confusion Assessment Method for the ICU: Valid and reliable delirium monitoring for critically ill infants and children. Critical Care Medicine. 2016;44(3): 592-600. http://doi.org/10.1097/CCM.0000000000001428
  9. Staveski SL, Pickler RH, Lin L, Shaw RJ, Meinzen-Derr J, Redington A, et al. Management of pediatric delirium in pediatric cardiac intensive care patients: An international survey of current practices. Pediatric Critical Care Medicine. 2018;19(6):538-43. http://doi.org/10.1097/PCC.0000000000001558
  10. Konca C, Anil AB, Kulluoglu EP, Luleyap D, Anil M, Tekin M. Evaluation of pediatric delirium awareness and management in pediatric intensive care units in Turkey. Journal of Pediatric Intensive Care. 2022;11(2):130-7. http://doi.org/10.1055/s-0040-1721507
  11. de Castro REV, de Magalhaes-Barbosa MC, Cunha A, Cheniaux E, Prata-Barbosa A. Delirium detection based on the clinical experience of pediatric intensivists. Pediatric Critical Care Medicine. 2020;21(9):e869-e873. http://doi.org/10.1097/PCC.0000000000002482
  12. Pinzon-Casas E, Soto-Trujillo M, Camargo-Agon L, Henao-Castano A, Gualdron N, Bonilla-Gonzalez C. Preschool Confusion Assessment Method for the Intensive Care Unit-Spanish (psCAM-ICU-S): Cross-cultural adaptation and validation in Colombia. Frontier in Pediatrics. 2021;9:749522. http://doi.org/10.3389/fped.2021.749522
  13. Solberg LM, Campbell CS, Jones K, Vaughn I, Suryadevara U, Fernandez C, et al. Training hospital inpatient nursing to know (THINK) delirium: A nursing educational program. Geriatric Nursing. 2021;42(1):16-20. https://doi.org/10.1016/j.gerinurse.2020.10.018
  14. Silver G, Traube C, Kearney J, Kelly D, Yoon MJ, Moyal WN, et al. Detecting pediatric delirium: Development of a rapid observational assessment tool. Intensive Care Medicine. 2012;38(6):1025-31. http://doi.org/10.1007/s00134-012-2518-z
  15. Traube C, Silver G, Reeder RW, Doyle H, Hegel E, Wolfe HA, et al. Delirium in critically ill children: An international point prevalence study. Critical Care Medicine. 2017;45(4):584-90. https://doi.org/10.1097/CCM.0000000000002250
  16. Traube C, Silver G, Kearney J, Patel A, Atkinson TM, Yoon MJ, et al. Cornell Assessment of Pediatric Delirium: A valid, rapid, observational tool for screening delirium in the PICU. Critical Care Medicine. 2014;42(3):656-63. http://doi.org/10.1097/CCM.0b013e3182a66b76
  17. Di Nardo M, Boldrini F, Broccati F, Cancani F, Satta T, Stoppa F, et al. The LiberAction project: Implementation of a pediatric liberation bundle to screen delirium, reduce benzodiazepine sedation, and provide early mobilization in a human resource-limited pediatric intensive care unit. Frontier in Pediatrics. 2021;9:788997. https://doi.org/10.3389/fped.2021.788997
  18. Kang JS, Song HJ. Factors affecting the performace of nurses in delirium care. Journal of Korean Critical Care Nursing. 2019;12(1):13-21. https://doi.org/10.34250/jkccn.2019.12.1.13
  19. Pun BT, Gordon SM, Peterson JF, Shintani AK, Jackson JC, Foss J, et al. Large-scale implementation of sedation and delirium monitoring in the intensive care unit: A report from two medical centers. Critical Care Medicine. 2005;33(6):1199-205. https://doi.org/10.1097/01.ccm.0000166867.78320.ac
  20. Kim YN. Effects of case-centered CAM-ICU training on intensive care unit nurses' delirium knowledge and accuracy of delirium assessment [master's thesis]. Pusan: Pusan National University; 2018. p. 29-31.
  21. Gesin G, Russell BB, Lin AP, Norton HJ, Evans SL, Devlin JW. Impact of a delirium screening tool and multifaceted education on nurses' knowledge of delirium and ability to evaluate it correctly. American Journal of Critical Care. 2012;21(1):e1-e11. https://doi.org/10.4037/ajcc2012605
  22. Flaigle MC, Ascenzi J, Kudchadkar SR. Identifying barriers to delirium screening and prevention in the pediatric ICU: Evaluation of PICU staff knowledge. Journal of Pediatric Nursing. 2016;31(1):81-4. https://doi.org/10.1016/j.pedn.2015.07.009
  23. Norman SL, Taha AA. Delirium knowledge, self-confidence, and attitude in pediatric intensive care nurses. Journal of Pediatric Nursing. 2019;46:6-11. https://doi.org/10.1016/j.pedn.2019.01.013
  24. Ho MH, Yu LF, Lin PH, Chang HR, Traynor V, Huang WC, et al. Effects of a simulation-based education programme on delirium care for critical care nurses: A randomized controlled trial. Journal of Advanced Nursing. 2021;77(8):3483-93. https://doi.org/10.1111/jan.14938
  25. Park J, Park JW. Effects of a delirium education program for nurses on knowledge of delirium, importance of nursing intervention and nursing practice. Journal of Korean Academic Society of Home Care Nursing. 2013;20(2);152-9.
  26. Rohlik G, Pfeiffer AJ, Collins CE, Parrett CR, Kawai Y. Improving pediatric delirium assessment documentation and implementation of a nonpharmacologic delirium management bundle in the cardiovascular intensive care unit. Journal of Pediatric Nursing. 2021;60:168-76. https://doi.org/10.1016/j.pedn.2021.04.035
  27. Mallick N, Mize M, Patel AK. Implementation of a pediatric delirium screening program in a pediatric intensive care unit. Critical Care Nurse. 2022;42(3):37-45. https://doi.org/10.4037/ccn2022688
  28. World Health Organization (WHO). Process of translation and adaptation of instruments [Internet]. Geneva: WHO; 2015 [cited 2022 Feb 14]. Available from: https://www.mhinnovation.net/sites/default/files/files/WHO%20Guidelines%20on%20Translation%20and%20Adaptation%20of%20Instruments.docx
  29. Marino J, Bucher D, Beach M, Yegneswaran B, Cooper B. Implementation of an intensive care unit delirium protocol: An interdisciplinary quality improvement project. Dimensions of Critical Care Nursing. 2015;34(5):273-84. https://doi.org/10.1097/dcc.0000000000000130
  30. Kim HJ, Kim DH. Factors associated with pediatric delirium in the pediatric intensive care unit. Child Health Nursing Research. 2019;25(2):103-11. https://doi.org/10.4094/chnr.2019.25.2.103
  31. Nam SY, Park KY, Choi SJ. The reliability and validity of the Korean version of the Cornell Assessment of Pediatric Delirium. Journal of Korean Clincal Nursing Research. 2020;26(2):254-64. https://doi.org/10.22650/JKCNR.2020.26.2.254
  32. Seels BB, Richey RC. Instructional technology: The definition and domains of the field. Washington. DC: Association for Educational Communications and Technology; 1994. p. 1-186
  33. Schofield I, Tolson D, Fleming V. How nurses understand and care for older people with delirium in the acute hospital: A critical discourse analysis. Nursing Inquiry. 2012;19(2):165-76. https://doi.org/10.1111/j.1440-1800.2011.00554.x
  34. Smith HA, Berutti T, Brink E, Strohler B, Fuchs DC, Ely EW, et al. Pediatric critical care perceptions on analgesia, sedation, and delirium. Seminars in Respiratory and Critical Care Medicine. 2013;34(2):244-61. https://doi.org/10.1055/s-0033-1342987
  35. Oh HS. The effectiveness of clinical practice education using checklist on performance of delirium care for nursing students. Journal of Digital Convergence. 2018;16(10):289-99. https://doi.org/10.14400/JDC.2018.16.10.289
  36. Akechi T, Ishiguro C, Okuyama T, Endo C, Sagawa R, Uchida M, et al. Delirium training program for nurses. Psychosomatics. 2010;51(2):106-11. https://doi.org/10.1176/appi.psy.51.2.106
  37. Kudchadkar SR, Yaster M, Punjabi NM. Sedation, sleep promotion, and delirium screening practices in the care of mechanically ventilated children: A wake-up call for the pediatric critical care community. Critical Care Medicine. 2014;42(7):1592-1600. https://doi.org/10.1097/CCM.0000000000000326
  38. Devlin JW, Marquis F, Riker RR, Robbins T, Garpestad E, Fong JJ, et al. Combined didactic and scenario-based education improves the ability of intensive care unit staff to recognize delirium at the bedside. Critical Care. 2008;12(1):R19. https://doi.org/10.1186/cc6793
  39. Choi JI, Kim JH, Park JY. Delirium Screening, Delirium Knowledge, and Delirium Care among Hospital Nurses at a Tertiary Hospital based on Postoperative Delirium Cases. Journal of Korean Clinical Nursing Research. 2022;28(2):157-66. https://doi.org/10.22650/JKCNR.2022.28.2.157