• 대한치매학회지
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• 제21권1호
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• pp.1-16
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• 2022

Background and purpose: We investigated existing nonpharmacological programs for people with dementia (PWD) to explore critical factors related to the effectiveness of these types of programs. Methods: We conducted a qualitative systematic literature review to identify nonpharmacological intervention programs developed for PWD and reviewed 36 randomized controlled trials. Among several outcomes reported in each study, we focused on the most common outcomes including quality of life (QoL), neuropsychiatric symptoms, depression, agitation, and cognition for further review. Results: Several factors were identified that might affect the outcomes of nonpharmacological interventions for PWD including study design, characteristics of the intervention, maintaining research participants, heterogeneity issues, and implementation fidelity. About half of studies in this review reported positive program effects on their targeted outcomes such as Well-being and Health for PWD on improving quality of life, neuropsychiatric symptoms and agitation; cognitive stimulation therapy on QoL, neuropsychiatric symptoms and cognition; and a stepwise multicomponent intervention on neuropsychiatric symptoms, depression and agitation. Conclusions: We found some programs even with a rigorous study design did not produce expected outcomes while other programs with poor designs reported positive outcomes, which necessitates further investigation on the validity of the assessments. Factors such as individual tailored and customized interventions, promoting social interactions, ease of administration and compatibility of interventions, and developing program theory need to be considered when developing nonpharmacological intervention programs.

• Clinical and Experimental Pediatrics
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• 제63권1호
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• pp.25-29
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• 2020

Background: Pain during the developmental period may adversely affect developing neuronal pathways and result in adverse neurodevelopmental, cognitive, and behavioral effects in later life. Immunizations, e.g., hepatitis B vaccine (HBV), administered at birth are painful experiences to which neonates are universally subjected. Purpose: Here we aimed to study and compare the effectiveness of various nonpharmacological pain management methods in newborns to enable the development of safe and effective analgesic methods for newborns. Methods: This prospective study was conducted at a tertiary care hospital in the Himalayan region. Three hundred term healthy neonates were divided into 6 groups of 50 each. Groups 1-5 were intervention groups, patients of which received a nonpharmacological intervention (breastfeeding, nonnutritive sucking, rocking, 25% sucrose, or distilled water) before the intramuscular HBV, while patients in group 6 received no intervention. The pain response in each group after the HBV injection was assessed and compared using cry duration and Douleur Aigue Nveau-ne (DAN) score, a behavioral acute pain rating scale for newborns. Results: Cry duration was decreased in all intervention groups, significantly so in the sucrose (19.90 seconds), breastfeeding (31.57 seconds), and nonnutritive sucking (36.93 seconds) groups compared with controls (52.86 seconds). DAN scores decreased significantly (P<0.05) at one or more points i.e. 30, 60, or 120 seconds in the breastfeeding and 25% sucrose intervention groups compared with controls. Conclusion: Oral sucrose and nonnutritive sucking are simple yet underutilized nonpharmacological interventions that effectively reduce pain in newborns.

• 한국노년학
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• 제37권2호
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• pp.445-459
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• 2017

본 연구는 최근 10년간 해외 학술지에 게재된 치매 환자의 일상생활 수행능력과 관련된 비약물 중재 논문의 체계적 고찰을 통해 현장에서 근무 중인 치매 전문 인력에게 비약물 중재에 대한 전반적인 정보 제공과 효과적인 중재방법을 제시하고자 하였다. 분석에 사용된 문헌은 2007년부터 2016년까지 개제된 국외 논문을 Medline Complete, PubMed Central, Scopus를 통해 검색하였다. 주요 검색 용어는"Dementia AND (ADL OR Activities of daily living) AND Nonpharmacological interventions" 을 사용하였고, 검색된 974편의 논문 중 본 연구에 적합한 9편의 연구를 분석 대상으로 선정하였다. 분석 대상 논문의 질적 수준은 I~III에 각각 3편씩 속하였다. 운동과 관련된 비약물 중재가 가장 많이 진행되었고, 연구는 재활분야(작업치료학, 물리치료학), 간호학, 심리학의 다양한 분야에서 활발히 이루어졌다. 평가도구는 기본적 일상생활 수행능력을 평가하는 Barthel Index(BI)가 가장 많이 사용되었고, 일상생활 수행능력과 동시에 가장 많이 측정된 종속변인은'인지기능'이였다. 본 연구에서 분석한 치매 환자의 일상생활 수행능력 향상을 위한 비약물 중재는 근거 기반의 중재를 제공할 수 있는 이론적 기틀을 마련하고, 비약물 중재가 지속적으로 발전할 수 있는 기초자료를 제시할 수 있을 것이며, 추후에는 본 연구 결과를 바탕으로 일상생활 수행능력 훈련을 목표로 한 중재방법에 대한 연구가 진행되기를 기대한다.

• 기본간호학회지
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• 제10권1호
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• pp.6-13
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• 2003

Purpose: A survey was done on knowledge of pain and pain interventions by clinical nurses in Deagu city and Kyoungbuk province. Method: The participants in this study were 209 nurses who worked in Daegu city, and 190 nurses who worked in Kyoungbuk province. The data were collected from August 5, to September 15, 2002. The data were analyzed with SPSS WIN 10.0 program using numbers, percentages, averages and standard deviation with t-test and ANOVA. Result: Out of a total of 30 points on general knowledge of pain, the clinical nurses had a high score of 28, and a low of 10. The average was 18.6 (SD=3.14). Of the participants, 57.9% reported not having had any pain education and 67.9% agreed that education is a necessity. Of pharmacological interventions, Tylenol had the highest score at 3.44 out of a possible 4 points. The most frequent route for giving medication was intramuscular injection (42.6%) and for 62.7%, there was a decision by the physician for routine medication or prn. On reactions after medication, moderate relief had the highest frequency (41.9%), and for side effects after the medication, feeling of nausea was most frequent (70.4%). Of the nonpharmacological approaches to pain relief, ice bag had the highest score with 2.95 out of a possible 4. Judgement to give medication was made by the nurse for 50.1% of the participants and 647% reported a little relief from pain. Conclusion: Based upon the results, continuing education and developing a better education programs (including pain mechanism, pain assessment, pharmacological interventions and nonpharmacological interventions) are needed for systematic pain management. Nurses need a high level of knowledge of pain, to be active in pharmacological interventions and nonpharmacological interventions.

• Journal of Korean Biological Nursing Science
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• 제7권1호
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• pp.69-87
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• 2005

Purpose : The purpose of this study was to identify pediatric nurses's knowledge related to children's pain and pediatric nurses' career including educational experience and to examine whether there is a difference of their knowledge according to their career. Method : Subjects of this study was 115 pediatric nurses of one university hospital who understood purpose of this study and accepted to participate in this study. Subjects responded questionnaire by self report. The data were gathered for 7 days during the period from October 20 to October '2:7, 2003. The pediatric nurses' knowledge and attitude survey regarding pain developed by Manworren(2001) was used to identify the knowledge related to children's pain of pediatric nurses. Nurses' career consisted of level of education, presently working ward, duration of experience at clinic, pediatric clinic and presently working ward and educational experience related to children's pain during undergraduate courses, ward orientation and continuing education. Educational experience regarding children's pain was measured by whether they had education related to children's pain during undergraduate courses, ward orientation and continuing education or not and their perception on the contents of education was measured by 5 point Likert type scale. SPSS Windows was used to analyze the data. Scores of the knowledge regarding children's pain and career including educational experience of pediatric nurses were presented as mean and standard deviation. Mean percentage of correct answers responded by the subjects was presented under the category of introduction, assessment, pharmacological and nonpharmacological intervention for children's pain. The difference of scores of the knowledge regarding children's pain according to nurses' career was analyzed using t-test, ANOVA and Tukey as a post hoc. Statistical significance was accepted at the level of p<.05. Result : Pediatric nurses had deficient knowledge related to children's pain on the whole and did not trust pain complaint and underestimated the pain. They were short of concrete practical knowledge about pain assessment and pharmacological and nonpharmacological intervention for children's pain. They were excessively concerned with side effect and addiction of analgesic drugs and had a negative view point on nonpharmacological pain intervention. About 50% of the subjects received education regarding children's pain while their undergraduate courses. The number of nurses who received education regarding children's pain while their undergraduate courses was found to be greater among the recently graduated nurses. In ward orientation and continuing education, only less than 10% of the nurses received education regarding children's pain. Nurses perceived their experienced educational content deficient; experienced educational content consisted of pain introduction, assessment and pharmacological and nonpharmacological intervention for children's pain while their undergraduate course, ward orientation and continuing education. There were no significant differences of the knowledge regarding children's pain of pediatric nurses according to level of education, duration of experience at clinic, pediatric clinic and presently working ward. Scores of the knowledge regarding children's pain of nurses at neonatal ward were significantly greater than those of nurses at pediatric intensive care unit. Scores of the knowledge regarding children's pain of pediatric nurses who received education during their undergraduate course were significantly greater than those who did not receive it during their undergraduate courses. Also scores of the knowledge regarding children's pain of pediatric nurses who received one kind of educational experience were significantly greater than those who had no educational experience. Conclusion : Pediatric nurses had deficient knowledge of children's pain and underestimated the pain of children. Also they were short of concrete practical knowledge on pain assessment and intervention for children's pain.

• 한국산학기술학회논문지
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• 제16권11호
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• pp.7273-7284
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• 2015

본 연구는 메타분석을 통해 불안장애에 적용된 비약물적 중재요법의 효과크기를 알아보고 대상자 중재에 근거기반한 객관적 자료를 제공하기 위해 수행되었다. 이를 위해 국내 주요 DB를 이용하여 불안장애에 대하여 비약물적 중재를 제공한 2,690편의 논문 중 불안과 우울을 종속변수로 하여, 선정기준에 적합한 최종 23편의 논문을 대상으로 분석을 실시하였다. 검색어는 '불안장애(anxiety disorder)', 중재(treatment or intervention)'를 이용하여 2015년 5월까지 출판된 논문을 검색하였다. 분석은 랜덤 효과모형을 이용하였으며, 불안과 우울의 효과크기를 각각 산출하였다. 본 연구에서 비약물적 중재의 불안에 대한 효과크기는 Hedges's g=1.693, 우울에 대한 효과크기는 Hedge's g=1.571로 큰 효과크기를 보였다. 본 연구는 국내에서 시행되고 있는 불안장애에 적용한 비약물적 중재효과에 대한 연구결과를 체계적으로 종합하고, 그 효과크기를 객관적으로 제시하여 간호중재에 적용할 수 있는 근거를 마련하였다는데 그 의의가 있다.

• 대한작업치료학회지
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• 제26권4호
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• pp.13-26
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• 2018

목적 : 본 연구에서는 체계적 고찰을 통해 치매 환자를 대상으로 사용된 비약물적 인지중재방법에 대해 알아봄으로써 임상영역에서 치매 환자 중재 시 기초자료를 삼고자 한다. 연구방법 : 2013년 1월부터 2017년 12월까지 국내 국외학회지에 게재된 논문을 KISS, PubMed와 Sciencedirect을 통하여 검색하였으며, 주요검색 용어로는 '치매 OR dementia', '인지 자극 OR cognitive stimulation', '인지재활 OR cognitive rehabilitation', '인지 훈련 OR cognitive training'을 사용하였다. 최종적으로 10개의 논문을 선정하여 분석하였다. 결과 : 선정된 10편의 논문 중 7편에서 중재 후 인지기능에 유의한 향상이 나타났으며, 3편의 연구에서는 인지기능의 향상은 나타나지 않았으나 뇌파의 활성화, 간병인과 환자와의 관계 및 간병인의 삶의 질 향상, 시각적 운동 기술 향상이 나타났다. 인지기능 개선효과를 확인을 위한 평가도구는 Mini-Mental State Examination(MMSE)가 가장 많았으며, 4편의 논문에서는 치매환자의 삶의 질을 중재 효과로 측정하였다. 인지중재의 주 대상자는 경도에서 중등도 사이의 치매환자를 대상으로 사용된 것으로 확인되었다. 결론 : 본 연구를 토대로 임상에서 치료사들이 치매환자를 대상으로 치료할 때 치매환자의 특성에 따라 중재방법, 기간, 평가도구 등을 선정하는데 필요한 근거로 활용될 수 있을 것으로 사료된다.

• Childhood Kidney Diseases
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• 제16권1호
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• pp.15-20
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• 2012

Non-neurogenic pediatric voiding dysfunction is defined as a problem during bladder filling or emptying without any neurogenic abnormality in children. The appropriate treatment of non-neurogenic pediatric voiding dysfunction is important because the disorder is frequently seen in clinical practice and might result in damages of the child's bladder or kidney. Urotherapy can be defined as nonsurgical nonpharmacological treatment for voiding dysfunction, categorized into standard urotherapy or specific intervention. Understanding of the underlying pathophysiology of non-neurogenic pediatric voiding dysfunction will lead to a change in management, from expensive and potentially harmful medications and invasive procedures to effective, noninvasive treatment of urotherapy.

• 중환자간호학회지
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• 제14권3호
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• pp.141-156
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• 2021

Purpose : This study aimed to systematically review the preventive interventions for delirium in Korean intensive care unit (ICU) patients and evaluate their efficacy. Methods : For this systematic review and meta-analysis, we searched the literature and selected studies from data sources that included the RISS, KISS, National Central Library, National Assembly Library, DBpia, Science on, MEDLINE, and Cochrane Library. We used Cochrane's revised tool for risk of bias in randomized trials and non-randomized studies of intervention tools to assess the quality of the selected studies. The effect size of the intervention was calculated as odds ratio (OR) and standardized mean difference (SMD). Results : Preventive interventions reported in 23 studies with a total of 4,799 ICU patients were effective in reducing the occurrence of delirium (OR=0.64, 95% CI : 0.49~0.91, p=.011), but not the duration (SMD=-0.22, 95% CI : -0.51~0.08, p=.148). As a result of a subgroup analysis, non-pharmacological interventions were effective in reducing the occurrence of delirium (OR=0.66, 95% CI : 0.47~0.94, p=.020), while pharmacological interventions had no effect (OR=0.68, 95% CI : 0.33~1.40, p=.295). Among the non-pharmacological interventions, multi-component intervention had the largest effect size (OR=0.38, 95% CI : 0.26~0.55, p<.001). Conclusion : Non-pharmacological interventions were effective in reducing the occurrence of delirium. We recommend the development and application of multi-component interventions to prevent delirium in the Korean ICU patients.

• 생물정신의학
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• 제23권2호
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• pp.48-56
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• 2016

Alzheimer's disease (AD) is a neurodegenerative disorder in which neuronal loss causes cognitive decline and other neuropsychiatric problems. It can be diagnosed based on history, examination, and appropriate objective assessments, using standard criteria such as the Diagnostic and Statistical Manual of Mental Disorders or the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA). Brain imaging and biomarkers are making progress in the differential diagnoses among the different disorders. The cholinesterase inhibitors, donepezil, rivastigmine and galantamine and N-methyl-D-aspartate receptors antagonist memantine are approved by the US Food and Drug Administration for AD. Recently some acetylcholinesterase inhibitors gained approval for the treatment of severe AD and became available in a higher dose formulation or a patch formulation. Optimal care in AD is multifactorial and it should include early diagnosis and multidisciplinary care with pharmacological and nonpharmacological interventions including exercise interventions, cognitive interventions and maintenance of social networks.