• 한국학교ㆍ지역보건교육학회지
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• 제21권3호
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• pp.21-34
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• 2020

배경 및 목적: 본 연구는 학교 내 응급상황(천식 위기, 알레르기 반응, 저혈당 위기, 발작, 심폐정지, 출혈/골절, 머리/목 상해, 열성질환, 중독, 질식)에 대한 행정 차원과 물품구비 차원에서의 준비 실태, 그리고 응급처치 수행자신감을 파악하는데 목적이 있다. 방법: 단면조사연구로 274명의 보건교사를 대상으로 하였으며, 자가보고형 조사지를 이용하여 대상자와 학교의 일반적 특성, 학교 내 응급상황에 대한 행정·물품 준비 실태, 그리고, 응급처치 수행자신감 등 3개 영역의 자료를 수집하였다. 자료수집은 2018년 2월 1일부터 2018년 7월 31일까지 실시하였고, 자료분석은 기술통계, t-검정과 분산분석을 이용하였다. 결과: 대부분의 학교에서 응급상황 관리계획이 있었으나, 응급상황별로 천식 위기는 46.7%, 알레르기 반응은 58.4%에서만 관리계획을 갖추고 있었다. 산소, 혈당측정기, 자동제세동기, 경추고정장치 등은 85% 이상의 학교에서 보유하고 있었으나, 기관확장제 흡입기, 에피네프린 주사제, 흡인기 등은 거의 갖추고 있지 않았다. 응급상황 수행자신감은 5점 만점에 2.67점 (발작관리) 에서 3.55점 (심폐정지관리)이었으며, 일부 응급상황에 대해서 의료기관 근무경력이 증가함에 따라 수행자신감이 증가하였다. 결론: 대부분의 학교에서 응급관리계획을 수립하고 있었으나, 응급상황별 관리계획을 수립한 경우는 반 정도에 불과하였다. 보건교사의 학교 내 응급상황에 대한 응급처치 수행자신감은 전체적으로 낮게 나타남에 따라, 이들의 역량강화를 위한 체계적인 교육과 멘토링 프로그램이 요구된다.

• Journal of Korean Biological Nursing Science
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• 제15권4호
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• pp.247-256
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• 2013

Purpose: This study aimed to determine the effects of listening to music on pain and vital signs of critically ill patients with ventilatory support in intensive care units during nursing treatment (changes of posture and tracheal suction). Methods: The experimental treatment was to use an mp3 player and a speaker to let them listen to classical music by Mozart during nursing treatment. To determine the effects of music intervention, pain (Critical-Care Pain Observation Tool-K) was used. The data analysis was carried out by using PASW Statistics 20.0. Results: Hypothesis "The scores for pain would differ between the experimental group provided with music intervention during nursing treatment, and the control group" was supported. Conclusion: Application of music intervention during nursing treatment for critically ill patients with ventilatory support in intensive care units was found to be effective in reducing pain. Therefore, music intervention during nursing treatment for critically ill patients with ventilatory support can be used as non-pharmaceutical nursing intervention to reduce pain for the patients.

• 한국의료질향상학회지
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• 제8권1호
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• pp.44-55
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• 2001

Background : This study aimed at identifying the effect of the standardized protocol on lowering the incidence of the ventilator associated pneumonia(VAP). Methods : The standard protocol focusing on decreasing VAP was made and applied at 5 ICUs (Medical ICU, surgical ICU, Respiratory ICU, Neonatal ICU, Pediatric ICU) in a university affiliated tertiary hospital, from April 1, 2000 to Oct 31, 2000. The protocol involved 3 parts : hand washing, the suctioning method and ventilator circuit management. All the nursing personnel received intensive education which was consisted of lecture, video film and demonstration. 176 nurses reported the performance of handwashing pre and post intervention. And randomly selected 15 nurses were observed by charge nurse and the handwashing practice was analyzed pre and post intervention. The incidence of VAP was compared with the former year incidence. Results : The self reported frequency of hand washing increased. In the direct observation of handwashing, the frequency, time, thoroughness of hand washing during 8 hours day duty was found to be improved. The frequency was increased from 1.1 time to 4.1 times; the time was improved from 1.7 seconds to 5.7 seconds and the thoroughness of the washing practice was from 0.2 times to 3.0 times respectively (p<0.001). The incidence of VAP decreased from at a rate of 15.63 number of case per 1,000 ventilator-day (April 1~August 31, 1999) to 7.23 number of case per 1,000 ventilator-days(April 1~Oct 31, 2000)(P<0.001). Conclusion : We developed the protocols which included hand washing, the suctioning method, and ventilator circuit management. Through the implementation of the protocol, the performance of hand washing improved and the VAP incidence rate in ICU was decreased.

• 한국보건간호학회지
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• 제12권2호
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• pp.185-200
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• 1998

It has been contributed to public health that the hospital has multiplied in the aspect of number and has been a large size with development of modern medical science, meanwhile the problem of hospital infection is coming out seriously. Respiratory hospital infection among hospital infections develops, very commonly from patients having taken the operation of intubation or tracheostomy, which results from a big factor that the infection developed from medical appliances used for respiration aids, contamination of solution and infection of medical staff. This study is separated into four steps-the time to use normal saline and distillation water for storaging catheter which are the cause of the infection of solution to store distillation water and catheter, not to say the catheter used when the patient who should get tracheostomy operation takes suction. The purpose of this study is to offer the basic data which are needed to check contamination degree as time goes by and nurse intervention and grope for a new nursing intervention. The target of this study is hospitalized 1D an intensive care unit having 700 sickbeds which is located in IKSAN city and it targeted patients before 7 days passed after an operaion of a tracheostormy. Materials collected were analyzed by SPSS PC+ figures program. The result of this study were as follows ; 1. The gradual contamination levels of the normal saline used In suction are showing that colony increase in proportion to the length of time. 2. while colony increases in normal saline with the lapse of time. distillation water mixed with 5cc of potadine did not show any sign of the formation of colony from its preparation until it was used for 8 hours. 3. Such variables as the period of intubation insertion. the length of hospitalization in I.C.U. the age and the level of contamination of normal saline have no inter-relationship. Therefore. as the length of normal saline used In suction. the contamination level increases with the excelleration of the contamination speed. 4. Regarding the number of suction and the contamination level of the normal saline. We can observe correlation contamination level in the 3 step of suction(mean value:13.4) and the saline which was used for one hours(r=0.702. P=0.00l). four hours(r=0.694. P=0.00l). eight hours(r=0.488. P=0.029). Further we can observe contamination in the 4 step of suction (mean value: 17 .8) well as saline used for eight hours; [for one hours (r=0.64l. P=0.002). four hours (r=0.670. P=0.00l). eight hours (r=0.57 4. P=0.008)]. Thesedays clinics use normal saline by changing it. three times a day. however. the timing of saline change and the current suction methoed should be changed given the one hour used normal saline contamination number 79.850. Regarding the number of suction and the contamination lend of the normal saline.

• 대한치과보철학회지
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• 제46권1호
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• pp.83-91
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• 2008

문제제기 : 2007년 4월 '노인장기요양보험법'이 국회를 통과하였고 노인수발행위에 치과의사의 참여가 확정되어 2008년 7월부터 법이 시행되면서, 고령화가 급속이 진행되고 있는 한국사회에서 치과분야가 담당해야 할 역할은 커질 수밖에 없다. 목적 : 본 논문은 한국의 두 노인시설에 대한 설문조사를 바탕으로 일본의 노인요양보험법과 비교를 통해 앞으로 시행되는 노인장기요양법의 구강위생서비스의 역할 및 방향을 수립하는데 기여하고자 한다. 연구재료 및 방법 : 2005년 한국의 두 노인요양시설에서 책임 있는 직무자 또는 실제 간호의 내용을 파악하고 있는 분을 대상으로 15개 항목의 설문조사를 시행하였다. 결과 : 두 시설 모두 각각의 특징을 살려 매우 기능을 잘 하고 있었으나, 구강위생 및 이에 대한 직원의 인지도는 낮았으며 정기적인 진료나 관리는 소홀했다. 고찰 : 일본에서는 2000년 노인요양보험이 도입 후 체계화된 방법론을 기초로 시행되고 있다. 현재 '노인장기요양' 법안에 치과의사 참여가 보장된 것과 관련하여 앞으로 치과의사의 적극적인 참여가 필요하고, 시설 및 재택 방문 진료가 가능하도록 하는 법정비용을 통해 치과분야의 진료영역을 넓힐 수 있는 움직임이 필요하다고 볼 수 있다.

• 대한간호
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• 제33권4호
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• pp.62-85
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• 1994

The data were analyzed by using an S. P. S. S. computerized program for mean, standard deviation, percentage and paired t-test. The results of this study were as follows: 1. The increase in $PaO_2$ after hyperoxygenation and hyperinflation was highly statistically significant(p=0.041), and the increase in $PaO_2$ immediately after suctioning was not significant (p=0.752). The time of lowest $PaO_2$ was 30 seconds after the endotracheal suction. 2. The occurrance of cardiac arrhythmia after the endotracheal suction included sinus tachycardia, sinus arrhythmia, sinus bradycardia, premature atrial contraction (PAC), and premature ventricular contraction (PVC). The most frequent cardiac arrhythmia was sinus tachycardia (a subjects). Sinus arrhythmia was observed in 5 subjects and continued till 10 minutes after suctioning in two of these. Sinus bradycardia occurred in only 3 subjects and among them, 1 subjects shows sinus arrythmia till 10 minutes after suctioning along. PAC was observed in only one subject and continued till five minutes after suctining along with sinus arrhythmia. PVC was observed in three subjects: it lasted for only 30 seconds after suctioning in two subjects. but continued for 10 minutes after suctioning in the third. 6 subjects manifested two kinds of Cardiac arrhythmia Three of them showed sinus tachycardia with PVC, another 2 showed sinus bradycardia with sinus arrhythmia, and the other subject showed sinus arrhythmia with PAC. 3. The increases in heart rate during the endotracheal suction immediately after and at 30 seconds after suctioning were statistically significant (p=0.005). The increase in heart rate at one minute after suctioning was also significant (p=0.023). The increase in heart rate continued until 10 minutes after the endotracheal suction, but was not statistically significant In this study, endotracheal suctioning with hyperoxygenation and hyperinflation was effective in preventing a decrease in $PaO_2$ after suctioning, but not in preventing cardiac arrhythmias. Nurses should be aware of the complications of endotracheal suctioning and do effective hyperoxygenation and hyperinflation before and after suctioning. Further research is needed to develop a efficient endotracheal suction method which will minimize complications. This study needs to be replicated with different population of patients intubatted or having a tracheostomy, specifically, patients who cardiac or pulmonary desease. The data were analyzed by using an S. P. S. S. computerized program for mean, standard deviation, percentage and paired t-test. The results of this study were as follows: 1. The increase in $PaO_2$ after hyperoxygenation and hyperinflation was highly statistically significant(p=0.041), and the increase in $PaO_2$ immediately after suctioning was not significant (p=0.752). The time of lowest $PaO_2$ was 30 seconds after the endotracheal suction. 2. The occurrance of cardiac arrhythmia after the endotracheal suction included sinus tachycardia, sinus arrhythmia, sinus bradycardia, premature atrial contraction (PAC), and premature ventricular contraction (PVC). The most frequent cardiac arrhythmia was sinus tachycardia (a subjects). Sinus arrhythmia was observed in 5 subjects and continued till 10 minutes after suctioning in two of these. Sinus bradycardia occurred in only 3 subjects and among them, 1 subjects shows sinus arrythmia till 10 minutes after suctioning along. PAC was observed in only one subject and continued till five minutes after suctining along with sinus arrhythmia. PVC was observed in three subjects: it lasted for only 30 seconds after suctioning in two subjects. but continued for 10 minutes after suctioning in the third. 6 subjects manifested two kinds of Cardiac arrhythmia Three of them showed sinus tachycardia with PVC, another 2 showed sinus bradycardia with sinus arrhythmia, and the other subject showed sinus arrhythmia with PAC. 3. The increases in heart rate during the endotracheal suction immediately after and at 30 seconds after suctioning were statistically significant (p=0.005). The increase in heart rate at one minute after suctioning was also significant (p=0.023). The increase in heart rate continued until 10 minutes after the endotracheal suction, but was not statistically significant In this study, endotracheal suctioning with hyperoxygenation and hyperinflation was effective in preventing a decrease in $PaO_2$ after suctioning, but not in preventing cardiac arrhythmias. Nurses should be aware of the complications of endotracheal suctioning and do effective hyperoxygenation and hyperinflation before and after suctioning. Further research is needed to develop a efficient endotracheal suction method which will minimize complications. This study needs to be replicated with different population of patients intubatted or having a tracheostomy, specifically, patients who cardiac or pulmonary desease.

• 아동간호학회:학술대회논문집
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• 아동간호학회 1997년도 정기총회 및 학술대회
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• pp.61-74
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• 1997

Endotracheal suctioning is a routine procedure used for clearing secretions from the airway of the intubated infant. This procedure is not without complications. Endotracheal suctioning has been associated with decreases in $PaO_2$, decreases in systemic venous oxygenation, alterations in mean arterial Pressure, disturbances in cardiac rhythm and development of nosocomial pneumonia. So several endotracheal suctioning techniques have been developed to prevent these blown complications. Another method of Endotracheal suctioning eliminates the risk associated with disconnecting the infant from the ventilatior to perform the suctioning procedure. Studies examining closed endotracheal suctioning methods reported that the closed method results in less arterial oxygen saturation, and less systemic venous oxygen desaturation. However those studies have focused on adult patients, and there have been no published studies for newborn infants. The specific purpose of this study is to investigate the two methods and to make a comparison in terms of (1)variations in $SaO_2$, heart rate, and respiration rate appeared before and after the endotracheal suctioning; (2)difference in occurrence of nosocomial infection; (3)difference in recovery time to arrive at pre-suction baseline after suctioning and in nursing time taken for the suctioning. The present study is based on the data obtained from two groups of newborn infants : one group comprises 8 infants with closed suctioning (a total of 304 suctions) among 17 infants treated with ventilator and the other group 9 infants with open method (a total of 629 suctions). The data were analyzed using the SPSS statistical program package. As the distribution test on dependent variables with the Skewnesser Shapiro Wilk test showed an asymmetric distribution, the Wilcoxon Matched-pairs Singled- Ranks test was used for the test of variations in $SaO_2$, heart rate, and respiration rate appeared before and after the endotracheal suctioning. The difference in $SaO_2$ recovery time and nursing time was analyzed with the Mann-Whitney U-Test. The difference in physiologic consequences and occurrence of nosocomial infection between the two groups was analyzed with the Fisher's Exact Test. The results of the study are summarized as follows. For the hypothesis 1 (There would be a difference in $SaO_2$, heart rate, and respiration rate before and after suctioning between the two suctioning methods), the difference in $SaO_2$ turns out to be statistically significant (P=0.015), but heart rate and respiration rate do not procedure a notable difference (P=0.630). The hypothesis 2 (There would be a difference in rates at which a complication arises after suctioning between the two groups) does not prove to be statistically valid (P=0.246). For the hypothesis 3(There would be a difference in $SaO_2$ recovery time and nursing time between the two groups), the average $SaO_2$ recovery time after suctioning turned out to have somewhat significant difference (P=0.064), however the difference in nursing time taken for the suctioning was not statistically significant (P=0.610). The analyses indicate that the closed endotracheal suctioning is more efficient as compared with the open method, in maintaining pre-suction baseline $SaO_2$ and a rapid recovery of newborn infants. Based on these results we suggust to apply the closed method to newborn infants in the ventilation treatment. We also suggest to extend the investigation to include the comparison of suction cost taking into account the case in which a complication arises after endotracheal suctioning between the two groups.