• 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.

• 대한간호학회지
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• 제52권2호
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• pp.134-143
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• 2022

Purpose: The study aimed to understand the delirium experience of intensive care unit (ICU) patients. Methods: We performed a qualitative study using Colaizzi's phenomenological method. Eleven patients, who experienced delirium according to the Confusion Assessment Method for ICU, participated after transferring to general wards from the ICU. Individual in-depth semi-structured interviews ranging from 30 minutes to 2 hours in length were conducted between November 2018 and August 2019. Results: Nine themes and four theme clusters emerged. The four theme clusters were: 1) "Overwhelmed by fear," which describes the experience of a patient close to death and the feeling of difficulty in understanding disorganized thinking; 2) "Anxious about not understanding the situation," which means that patients' sense of time and space were disordered in the ICU; 3) "Being deserted," which indicates the feeling of being separated from others and yourself; and 4) "Resistance to protect my dignity," which indicates that the dignity and autonomy of an individual in the patient's position at the ICU, are ignored. Conclusion: Nursing interventions are needed that would enable patients to maintain orientation and self-esteem in the ICU. In addition, healthcare providers need to provide information about the unfamiliar environment in the ICU in advance.

• 임상간호연구
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• 제14권1호
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• pp.151-160
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• 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.

• 임상간호연구
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• 제16권3호
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• pp.175-186
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• 2010

Purpose: Delirium can be a highly prevalent symptom in intensive care units but it may still be under-recognized despite its relation with inclined morbidity, mortality, cost, and readmission. Therefore, this study aimed to develop a protocol that covers risk factors and non-pharmacological interventions to prevent delirium in ICU patients. Methods: This study was conducted using methodological design, and it followed the Scottish Intercollegiate Guideline Network (SIGN) guideline development steps: 1) the scope of protocol was decided (population, intervention, comparison, and outcomes); 2) guidelines, systematic reviews, and protocols were reviewed and checked using methodology checklist; 3) the level of evidence and recommendation grades was assigned; 4) the appropriateness of recommendations was scored by experts; 5) the final protocol & algorithm was modified and complemented. Results: The evidence-based delirium prevention protocol was completed that includes predisposing factors, precipitating factors and recommendations with evidenced grades. Conclusion: This protocol can be used as a guide nurses in screening patients with high risk factors of delirium as well as in intervening the patients non-pharmacologically to prevent delirium.

• Tuberculosis and Respiratory Diseases
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• 제77권1호
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• pp.6-12
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• 2014

Severe sepsis is the most common cause of death among critically ill patients in non-coronary intensive care units. In 2002, the guideline titled "Surviving Sepsis Campaign" was published by American and European Critical Care Medicine to decrease the mortality of severe sepsis and septic shock patients, which has been the basis of the treatment for those patients. After the first revised guidelines were published on 2008, the most current version was published in 2013 based on the updated literature of until fall 2012. Other important revised guidelines in critical care field such as 'Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit' were revised in 2013. This article will review the revised guidelines and several additional interesting published papers of until March 2014, including the part of ventilator-induced lung injury and the preventive strategies.

• Child Health Nursing Research
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• 제25권2호
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• pp.103-111
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• 2019

Purpose: This study aimed to investigate incidence of delirium in the pediatric intensive care unit (PICU) and to analyze associated risk factors. Methods: The participants were 95 patients, newborn to 18 years, who were admitted to the PICU. The instruments used were the Richmond Agitation Sedation Scale (RASS), and the Cornell Assessment of Pediatric Delirium. Data analysis was performed using the descriptive, $x^2$ test, t-test, and logistic regression analyses. Results: The incidence of delirium in children admitted to the PICU was 42.1%. There were significant differences according to age ($x^2=14.10$, p=.007), admission type ($x^2=7.40$, p=.007), use of physical restraints ($x^2=26.11$, p<.001), RASS score ($x^2=14.80$, p=.001), need for oxygen ($x^2=5.31$, p=.021), use of a mechanical device ($x^2=9.97$, p=.041), feeding ($x^2=7.85$, p=.005), and the presence of familiar objects ($x^2=29.21$, p<.001). Factors associated with the diagnosis of delirium were the use of physical restraint (odds ratio [OR]=13.82, 95% confidence interval [CI]=4.16~45.95, p<.001) and the presence of familiar objects (OR=0.09, 95% CI=0.03~0.30, p=.002). Conclusion: Periodic delirium assessments and intervention should be actively performed. The use of restraints should be minimized if possible. The caregiver should surround the child with familiar objects and ensure a friendly hospital environment that is appropriate for the child.

• 임상간호연구
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• 제26권2호
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• pp.207-216
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• 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.

• 중환자간호학회지
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• 제14권2호
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• pp.70-81
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• 2021

Purpose : The purpose of this study was to identify the moderating effects of emotional intelligence on the relationship between traumatic events and turnover intention among nurses working in intensive care units (ICUs). Method : In this predictive correlation study, the convenience sample included 133 ICU nurses. Data were collected using an online, structured self-report survey. The collected data were analyzed by descriptive statistics, an independent t-test, an analysis of variance, Pearson's correlation coefficient, and a hierarchical multiple regression analysis using SPSS/WIN 25.0. Results : The most frequently experienced traumatic events in ICUs were "nursing patients with abnormal behavior, including shouting and delirium," "end-of-life care," and "nursing patients with a risk of disease transmission, including AIDS and tuberculosis." The moderating effect of emotional intelligence was found to be statistically significant on the relationship between traumatic events and turnover intentions (𝛽=-0.15, p =.029). Conclusion : Intervention to improve the emotional intelligence of ICU nurses can be a salient strategy to reduce turnover intention resulting from traumatic events.

• 정신신체의학
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• 제16권2호
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• pp.81-86
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• 2008

섬망은 자연적으로 발생하는 상태는 아니며 더욱이 내인성 질환은 아니다. 그러나, 섬망은 일부 특정인구 집단에서 발생하는 데, 노인 또는 내과적 상태가 악화된 환자들에서 흔히 발생된다. 이것은 체계적인 섬망역학 연구의 제한점으로 작용한다. 일반 인구 집단에서는 그 발생이 상대적으로 적기 때문에 섬망에 대한 많은 역학 연구들은 노인에 집중되었다. 그리고, 연구에 사용된 섬망 평가도구들의 민감도와 특이도도 매우 다양하다. 노령, 남자, 불량한 인지 및 기능 상태, 그리고 알코올 남용이 잘 알려진 섬망의 위험 인자들이다. 저자는 노인, 치매 환자, 고관적 골절 환자, 중환자실 입원 환자, 말기 암 환자, 그리고 뇌졸중 환자에서의 섬마의 역학에 대하여 다루게 될 것이다.

• 중환자간호학회지
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• 제13권3호
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• pp.62-74
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• 2020

Purpose : This study aimed to investigate the prevalence and risk factors of mental health problems in patients discharged from the intensive care unit (ICU). Methods : This was a secondary analysis study using data from a multicenter prospective cohort of post-ICU patients. We analyzed data of 311 patients enrolled in the primary cohort study who responded to the mental health questionnaire three months after the discharge. Anxiety and depression were measured on the Hospital Anxiety-Depression Scale, and post-traumatic stress disorder (PTSD) was measured on the Posttraumatic Diagnostic Scale. Results : The prevalence of anxiety, depression, and PTSD in patients at three months after ICU discharge were 25.7%, 17.4%, and 18.0%, respectively, and 7.7% of them experienced all three problems. Unemployment (OR=1.99, p=.033) and unplanned ICU admission (OR=2.28, p=.017) were risk factors for depression, while women gender (OR=2.34, p=.009), comorbid diseases (OR=2.88, p=.004), non-surgical ICUs (trauma ICU: OR=7.31, p=.002, medical ICU: OR=3.72, p=.007, neurological ICU: OR=2.95, p=.019) and delirium (OR=2.89, p=.009) were risk factors for PTSD. Conclusion : ICU nurses should proactively monitor risk factors for post-ICU mental health problems. In particular, guidelines on the detection and management of delirium in critically ill patients should be observed.