• 임상간호연구
• /
• 제20권3호
• /
• pp.406-416
• /
• 2014

Purpose: Screening of delirium using delirium assessment tools could promote delirium detection, however, there is lack of report about regular delirium assessment in Korea. This study was intended to describe the prevalence and related risk factors of delirium in intensive care unit (ICU). Methods: The Confusion Assessment Method for the ICU (CAM-ICU) data which were evaluated by nurses in ICUs was obtained through retrospective chart review. Data were analyzed using descriptive statistics, Chi-square test, t-test, Mann-Whitney U test, and stepwise logistic regression. Results: Delirium was evaluated in 125 patients. The incidence rate of delirium was 27.2% with a high prevalence of hypoactive delirium compared to hyperactive delirium (61.8 vs. 38.2%). Those with delirium were older, had hypertension, stayed longer in hospital, receiving ventilator support, had more number of catheters, had low serum protein and albumin level. Delirium incidence also varied according to diagnosis. Age, diagnosis of gastrointestinal disease, and application of ventilator were the significant risk factors for the incidence of delirium. Conclusion: Routine delirium screening is important for early detection of delirium. Identification of high-risk group and running delirium prevention programs could improve early recognition of delirium in ICU.

• 임상간호연구
• /
• 제14권1호
• /
• pp.151-160
• /
• 2008

Purpose: The purpose of this study was to investigate factors related to delirium occurrence in the ICU patients. Method: The sample were 99 patients in the ICU in a university affiliated hospital located in Kyunggi-do. Data were collected from September $1^{st}$ to October $31^{st}$, 2006. The instrument, CAM-ICU developed by Ely et al.(2001) was utilized. Data were analyzed by SPSS 13.0 for descriptive statistics, t-test, chi-square and multiple regression. Results: The delirium in the ICU patients was occurred in 22 (22.2%) out of 99 patients. There were significant differences in factors related to delirium occurrence, such as past medical history, long hospitalization, long ICU hospitalization, restraints, intubation or tracheostomy experience, ventilator experience, high pain score, and high anxiety score. Duration of ICU hospitalization, level of anxiety and past medical history were the significant predictors of the delirium occurrence(${\ss}$=44.5%). Conclusion: This study results recommend that specific nursing strategies needed to be developed to increase the detection of delirium in the ICU patients. The ICU nurses should recognize the incidence of delirium and prevent it in ICU settings.

• 중환자간호학회지
• /
• 제8권2호
• /
• pp.33-42
• /
• 2015

Purpose: This study was conducted to identify the perception, barriers, and importance of delirium assessment of intensive care unit nurses utilizing a tool for delirium assessment. Methods: The subjects were 150 intensive care unit nurses who routinely use the CAM-ICU to screen delirium. Data were collected using self-report questionnaires and analyzed using descriptive statistics and ranking. Results: Most intensive care unit nurses had experience of education about delirium and delirium assessment, and had assessed over once in a shift. However, a small number of nurses recognized utilizing their assessment result and the effect on higher mortality and underdiagnosed and preventable problem. The first rank of barriers was being too busy to assess patients and the second was difficulty of interpreting intubated patients. The importance of delirium assessment was considered lower than assessing catheter placement and level of pain. Conclusion: The study identified intensive care unit nurses' use of a delirium assessment tool, and the perception, barriers, and importance of delirium assessment. Furthermore, it is necessary to develop education programs to improve the early recognition of delirium by intensive care unit nurses.

• 임상간호연구
• /
• 제14권2호
• /
• pp.127-138
• /
• 2008

Purpose: To examine the effects of the environmental nursing intervention using eye-shields and earplugs on the incidence of delirium, environmental stress and sleep among the patients with open-heart surgery in the post-cardiac ICU(intensive care units). Method: This study was a non-equivalent control group non-synchronized design. The subjects consisted of 93 patients who received ICU care after the cardiac surgery. Among those, 32 subjects was assigned in one experimental group with eye-shields, 31 in the other experimental group with earplugs, and 30 in the control group. ICU delirium was measured by CAM-ICU, environmental stress by ICUESS, and sleep by two sleep scales developed by Oh, et al. and Kim. The data were analyzed by the SPSS 13.0 program including frequency, percentage, t-test, $x^2$ test, ANOVA and ANCOVA. Results: There are no statistically significant differences in the incidence of delirium among three groups (p=.139). The ICU environmental stress scores from the subjects of two experimental groups demonstrated lower (F=6.731, p=.002) than the control group. Also, the degrees of sleep pattern (p=.000, p=.000) and sleep satisfaction (p=.000, p=.000) were greater than those of the control group. Conclusion: Although the environmental nursing intervention using eye-shields and earplugs did not demonstrate the effects in decreasing the incidence of ICU delirium, it has affirmative effects in decreasing environmental stress and improving the quality sleep among the patients with open-heart surgery while they stay in ICU. Further nursing implications are discussed.

• 정신신체의학
• /
• 제25권2호
• /
• pp.120-128
• /
• 2017

연구목적 섬망의 증상을 조절하기위해 일반적으로 항정신병약물이 사용되지만, 투약 기간 및 용법과 같은 처방 양상과 환자의 임상 경과 사이의 연관성에 대한 연구는 아직 부족한 상태이다. 이 연구를 통해 섬망을 경험한 환자에서 항정신병약물의 처방 양상에 따라 임상 경과에 차이가 있는지 확인하고자 하였다. 방 법 서울의 일 종합병원에서 섬망으로 자문조정이 의뢰된 입원 환자 중 2016년 7월부터 2017년 2월까지 퇴원한 212명을 대상으로 하였다. 환자의 전자의무기록을 후향적으로 검토하여 입원 기간, 사망, 인구통계학적 자료 및 임상적 요인을 조사하였고, CAM-ICU를 통해 섬망 지속 기간을 측정하였다. 항정신병약물의 처방 유형에 따라 지속투약군, 최적투약군, 필요투약군으로 나누어 임상 경과를 비교하였다. 결 과 항정신병약물을 섬망 회복 후에도 지속적으로 투약 받은 지속투약군은 섬망 증상이 있는 기간에만 투약 받은 최적투약에 비하여 입원 기간 및 섬망 이환기간에 유의한 차이가 없었으며, 퇴원시 불필요한 항정신병약물 처방을 받은 비율이 높았다. 섬망 이환기간에 비해 짧은 기간 항정신병약물을 사용한 필요투약군은 다른 두 군에 비해 섬망 이환기간이 길고 사망률이 높았다. 결 론 이 연구의 결과는 섬망 이환기간에만 항정신병약물을 투여하는 것이 적절함을 시사한다. 또한 섬망이 회복된 후에 불필요하게 항정신병약물이 처방되는 것을 최소화하기위한 정신건강의학과 자문의의 적극적인 개입이 필요하겠다.

• 중환자간호학회지
• /
• 제3권2호
• /
• pp.37-48
• /
• 2010

Purpose: The purpose of this study was to examine the frequency and the course of delirium, and identify risk factors for the development of delirium in surgical intensive care unit (SICU). Methods: Subjects older than 19 years admitted to the SICU were recruited. After informed written consent, enrolled subjects had baseline cognitive and functional assessments. Subjects were assessed daily for delirium using the Confusion Assessment Method-ICU (CAM-ICU). Results: During the study period, 110 patients were enrolled. The overall incidence of delirium was 20% (22/110). The average time to onset of delirium was 3.04(${\pm}1.25$) days. Several variables were associated with an increased risk of delirium including older age (p<.05), higher admission APACHE II score (p<.001), use of opioid and analgesics (p<.01), using physical restraints (p<.001), and intraoperative hypotension (p<.05). In a multivariate logistic regression model, using physical restraints (p<.001), intraoperative hypotension (p<.05), and older age (p<.05) remained significant predictors of the delirium development. Conclusion: Using physical restraints, intraoperative hypotension and older age was strongly associated with development of delirium in the SICU. Prevention measures need to focus on identifying patients at higher risk for delirium development.

• 임상간호연구
• /
• 제26권2호
• /
• pp.207-216
• /
• 2020

Purpose: The purpose of this study was to investigate the motor subtypes of delirium in patients in a Surgical Intensive Care Unit (SICU), and identify the factors related to the characteristics of patients according to the motor subtypes of delirium. Methods: Data were collected in the SICU of a tertiary hospital in ^⁎ city from October 2018 to June 2019. Delirium was detected using the Confusion Assessment Method for the ICU (CAM-ICU) and motor subtypes of delirium were measured with the Delirium Motor Subtype Scale (DMSS)-4. Patients' characteristics were obtained by using the electronic medical records. Descriptive statistics were used to analyze the data. Results: Among 1,112 patients, 172 patients showed delirium (15.5%). After excluding dementia patients and patients refusing to participate in the study, 126 patients included in the final analysis. Delirium patients were classified as hyperactive delirium (32.5%), hypoactive delirium (42.9%), mixed delirium (11.9%), and non-motor subtype delirium (12.7%). Conclusion: The study results suggest that hypoactive delirium is the most prevalent motor subtype of delirium in SICU. More application of ventilators, more administration of sedatives, more use of catheters, and higher nursing severity were reported for hypoactive delirium cases than hyperactive ones. Therefore, it is necessary to assess early the motor subtypes of delirium using structured tools and develop appropriate nursing interventions suitable for each subtype of delirium.