한국산학기술학회논문지 (Journal of the Korea Academia-Industrial cooperation Society)

  • 제20권9호
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  • Pages.167-174
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  • 2019
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  • 1975-4701(pISSN)
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  • 2288-4688(eISSN)
한국산학기술학회 (The Korea Academia-Industrial cooperation Society)
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요양병원 재원 노인의 신체적 억제대 사용과 관련 요인

Physical Restraints Use and Associated Factors Among Elderly Patients in Long-term Care Hospitals

  • 고영주 (제주한라대학교 간호학과) ;
  • 하선미 (김천대학교 간호학과)
  • Ko, Yeong Ju (Department of Nursing, Cheju Halla University) ;
  • Ha, Sun-Mi (Department of Nursing, Gimcheon University)
  • 투고 : 2019.06.18
  • 심사 : 2019.09.06
  • 발행 : 2019.09.30
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초록

본 논문은 요양병원에 재원 중인 만 65세 이상 노인들의 신체적 억제대 사용 실태와 관련된 요인을 확인하기 위해 시도된 서술적 조사연구이다. 자료수집은 2018년 3월 3일부터 3월 29일까지 4개의 요양병원에 재원 중인 만 65세 이상의 노인환자 전산 의무기록을 통해 시행되었다. 자료 분석은 기술적 통계, Pearson correlation coefficients 및 logistic regression을 사용하였다. 연구결과 요양병원 재원 노인의 신체적 억제대 사용률은 83.7%였으며, 가장 많이 사용된 신체적 억제대 유형은 침상난간으로 93.8%의 사용률을 확인하였다. 또한 신체적 억제대 사용에는 낙상 위험점수와 양의 상관관계를, MMSE와는 음의 상관관계가 있었다. 회귀분석 결과로는 낙상 위험점수, MMSE, 치료기구 개수가 신체적 억제대 사용 관련 요인으로 확인되었다. 따라서 낙상위험도가 높은 노인 환자의 경우, 인지장애가 심한 경우, 치료기구의 개수가 많아 유지하기 위해서 신체적 억제대를 사용하는 것으로 확인되었다. 본 연구결과의 신체적 억제대 사용과 관련된 요인을 통해 노인 환자들에게 신체적 억제대가 아닌 대안을 먼저 적용 할 수 있도록 임상간호실무는 변화되어야 할 것이다.

The propose od this study was to examine the extent of using physical restraint on elderly patients (over 65 years old) and who were patients in long-term care hospitals. The data was collected, from March 3 2018 to March 29 2018, from the electronic nursing records by using a recording tool, and clinical observation was also used for assessing the use of physical restraint and the related factors. Descriptive statistics, Pearson correlation coefficients and logistic regression were then performed. The usage rate for physical restraints in long-term care hospital was 83.7%, and the most common type of physical restraint was side rails. The use of physical restraints showed a positive correlation with the fall risk scores and a negative correlation with the MMSE. Logistic regression analysis showed that the Fall Risk Score (OR=1.02, 95% CI=1.01~1.03), MMSE (OR=0.94, CI=0.88~0.99) and the use of medical devices (OR=0.80, 95% CI=0.65~0.98) were related with using physical restraints. Therefore, it was confirmed that physical restraint was used in cases of a high risk of falling, severe cognitive impairment and the use of complex and fragile medical devices to treat the patient. Clinical nursing practice should be changed so that treatment alternatives can be applied for elderly patients rather than using too many physical restraints.

키워드

참고문헌

  1. Statistics Korea, The proportion of elderly population, 2019. DOI: http://kosis.kr/statHtml/statHtml.
  2. Statistics Korea, Old-age support cost, 2019. DOI: http://www.index.go.kr/potal/main/EachDtlPageDetail .do?idx_cd=1430
  3. A. R. Yoo, H. S. Kim, "Physical restraints use and a ssociated factors among older adults in nursing homes", The Korean Journal of Health Economics and Policy, Vol. 22, No. 1, pp. 39-58, 2016.
  4. Korean Institute for Healthcare Accreditation, Standard for geriatric hospital accreditation, 2013.
  5. S. M. Ha, "Factors influencing nursing practices of physical restraint use among nurses working in long-term care hospitals", Journal of the Korea Academia-Industrial, Vol. 20, No. 3, pp. 526-534, 2019. DOI: https://doi.org/10.5762/KAIS.2019.20.3.526
  6. N. A. Kandeel, A. K. Attia, 'Physical restraints practice in adult intensive care units in Egypt", Nursing and Health Sciences, Vol. 15, pp. 79-85, 2014. DOI: https://doi.org/10.1111/nhs.12000
  7. C. Heinze, T. Dassen, U. Grittner, "Use of physical restraints in nursing homes and hospitals and related factors: a cross-sectional study", Journal of Clinical Nursing, Vol. 21, pp. 1033-1040, 2011. DOI: https://doi.org/10.1111/j.1365-2702.2011.03931.x
  8. H. C. Huang, Y. T. Huang, K. C. Lin, Y. F. Kuo, "Risk factors associated with physical restraints in residential aged care facilities: a community-based epidemiological survey in Taiwan", Journal of Advanced Nursing, Vol. 70, No. 1, pp. 130-143, 2013. DOI: https://doi.org/10.1111/jan.12176
  9. M. Azizpour, M. Moosazadeh, R. Esmaeili, "Use of physical restraints in intensive care unit: a systematic review study", Acta Medica Mediterranea, Vol.33, pp. 129-136, 2017. DOI: https://doi.org/10.19193/0393-6384_2017_1_020
  10. A. F. Minnick, L. C. Mion, M. E. Johnson, C. Catrambone, R. Leipzig, "Prevalence and variation of physical restraint use in acute care settings in the US", Journal of Nursing Scholarship, Vol. 39, No.1, pp. 30-37, 2007. DOI: https://doi.org/10.1111/j.1547-5069.2007.00140.x
  11. G. Meyer, S. Kopke, B. Haastert, I. Muhlhauser, "Restraint use among nursing home residents: cross-sectional study and prospective cohort study", Journal of Clinical Nursing, Vol. 18, No. 7, pp. 981- 990, 2008. DOI: https://doi.org/10.1111/j.1365-2702.2008.02460.x
  12. S. M. Ha, G. R. Hong, "Application and predictor of physical restraint in a long-term care hospital", Hanyang Nursing Science Research, Vol. 22, No. 1, pp. 3-15, 2018.
  13. Y. A. Jo, J. S. Kim, N, L, Kim, H. J. Choi, J. K. Jo, et al., "A study on the use of physical restraints in ICUs", Korean Journal of Adult Nursing, Vol. 18, No. 4, pp. 543-552, 2006.
  14. M. Y. Kim, J. S. Park, "A study on the application of physical restraints in intensive care units", Journal of the Korean Academy of Fundamentals of Nursing, Vol. 17, No. 2, pp. 177-186, 2010.
  15. M. H. Bleijlevens, L. M. Wagner, E. Capezuti, J. P. Hamers, "Physical restraints: consensus of a research definition using a modified delphitechnique", Journal of the American Geriatrics Society, Vol. 64, No. 11, pp. 2307-2310, 2016. DOI: https://doi.org/10.1111/jgs.14435
  16. B. Reisberg, S. H. Ferris, M. J. Leon, T. Crook, "The global deterioration scale for assessment of primary degenerative dementia", American Journal of Psychiatry, Vol. 139, No. 9, 1136-1139, 1982. DOI: https://doi.org/10.1176/ajp.139.9.1136
  17. S. H. Choi, D. L. Na, B. H. Lee, D. S. Ham, J. H. Jung, et al., "The validity of the korean version of global deterioration scale", Journal of Clinical Neurology, Vol. 20, No. 6, pp. 612-617, 2002. DOI: https://doi.org/10.12779/dnd.2018.17.1.11
  18. M. F. Folstein, S. E. Folstein, P. R. McHugh, "Mini-mental state: A practical method for grading the cognitive state of patients for the clinician", Journal of Psychiatric Research. Vol. 12, No. 3, pp. 189-198, 1975. https://doi.org/10.1016/0022-3956(75)90026-6
  19. Y. C. Kwon, J. H. Park, "Modification of the mini-mental state examination for use in the elderly in a non-western society: Part I. Development of Korean version of Mini-Mental State Examination", International Journal of Getiatric Psychiatry, Vol. 5, No. 6, pp. 381-387, 1990. DOI: https://doi.org/10.1002/gps.930050606
  20. J. Morse, R. Morse, S. Tylko, "Development of a scale to identify the fall-prone patient", Canadian Journal on Aging. Vol. 8, No. 4, pp. 366-77, 1989. DOI: https://doi.org/10.1017/S0714980800008576
  21. H. S. Kim, "Care technology for long-term caregivers", 478, Hakjisa, 2008, 478.
  22. C. Kruger, H. Meyer, B. Haastert, G. Meyer, "Use of physical restraints in acute hospitals in Germany: a multi-centre cross-sectional study", International Journal of Nursing Studies. Vol. 50, No. 12, pp. 1599-1606, 2013. DOI: https://doi.org/10.1016/j.ijnurstu.2013.05.005
  23. M. H. Park, M. H. Park, "Factors influencing nurses' implementation of evidence-based restraint use in long-term care hospitals", Journal of Korean Gerontological Nursing. Vol. 18, No. 3, pp. 172-181, 2016. DOI: https://doi.org/10.17079/jkgn.2016.18.3.172
  24. H. Hofmann, E. Schorro, B. Haastert, G. Meyer, "Use of physical restraints in nursing homes: a multicentre cross-sectional study", BMC Geriatrics, Vol. 15, No. 129, pp. 1-8, 2015. DOI: https://doi.org/10.1186/s12877-015-0125-x.
  25. D. J. Estevez-Guerra, E. Farina-Lopez, E. Nunez-Gonzalez, M. Gandoy-Crego, F.Calvo-Frances, E. A. Capezuti, "The use of physical restraints in long-term care in Spain: a multi-center cross-sectional study", BMC Geriatrics, Vol. 17, No. 29, pp. 1-7, 2017. DOI: https://doi.org/10.1186/s12877-017-0421-8.
  26. E. N. Bellenger, J. E. Ibrahim, J. J. Lovell, L. Bugeja, "The nature and extent of physical restraint related death in nursing home: a systematic review", Journal of Aging and Health, Vol. 0, No. 0, pp.1-20, 2017. DOI: https://doi.org/10.1177/0898264317704541.
  27. H. C. Huang, Y. T. Huang, K. Lin, Y. F. Kuo, "Risk factors associated with physical restraints in residential aged care facilities: a community-based epidemiological survey in Taiwan", Journal of Advanced Nursing, Vol. 70, No. 1, pp. 130-14, 2013. DOI: https://doi.org/10.1111/jan.12176