중환자실 간호사의 임종 환자 돌봄 경험

설은미,고진강,Seol, Eun-Mi,Koh, Chin-Kang 한국중환자간호학회 2018 중환자간호학회지 Vol.11 No.2

Purpose : This study aimed to develop an in-depth and comprehensive understanding of the experiences of critical care nurses caring for dying patients. Method : Eleven critical care nurses with experience in caring for dying patients were recruited from four tertiary hospitals. Semi-structured face-to-face interviews were conducted between November 2016 and March 2017. The transcribed data were analyzed using qualitative content analysis to identify major themes and sub-themes that represented the experiences of critical care nurses. Results : The following six themes, and twelve sub-themes, were identified: (1) the gap between expectation and reality, (2) a distorted meaning of death, (3) repeated emotional pain and stress, (4) finding a solution alone, (5) sublimation into mission and calling, and (6) integration into one's own life. Conclusion : This study found that critical care nurses experience various psychological difficulties while caring for dying patients, and they made efforts on their own to overcome them. These findings are expected to inform the development of specialized programs to support critical care nurses to tackle these challenges, create guidelines on caring for dying patients, and help promote death education.

성인 입원 환자에서의 영양치료 관련 합병증: 국내 다기관 연구

설은미 ( Eun-mi Seol ),권계숙 ( Kye Sook Kwon ),김정구 ( Jeong Goo Kim ),김정태 ( Jung-tae Kim ),김지훈 ( Jihoon Kim ),문선미 ( Sun-mi Moon ),박도중 ( Do Joong Park ),박정현 ( Jung Hyun Park ),박제훈 ( Je Hoon Park ),박지영 ( Ji Y 한국정맥경장영양학회 2019 한국정맥경장영양학회지 Vol.11 No.1

Purpose: Nutritional therapy (NT), such as enteral nutrition (EN) or parenteral nutrition (PN), is essential for the malnourished patients. Although the complications related to NT has been well described, multicenter data on symptoms in the patients with receiving NT during hospitalization are still lacking. Methods: Nutrition support team (NST) consultations, on which NT-related complications were described, were collected retrospectively for one year. The inclusion criteria were patients who were (1) older than 18 years, (2) hospitalized, and (3) receiving EN or PN at the time of NST consultation. The patients’ demographics (age, sex, body mass index [BMI]), type of NT and type of complication were collected. To compare the severity of each complication, the intensive care unit (ICU) admission, hospital stay, and type of discharge were also collected. Results: A total of 14,600 NT-related complications were collected from 13,418 cases from 27 hospitals in Korea. The mean age and BMI were 65.4 years and 21.8 kg/m². The complications according to the type of NT, calorie deficiency (32.4%, n=1,229) and diarrhea (21.6%, n=820) were most common in EN. Similarly, calorie deficiency (56.8%, n=4,030) and GI problem except for diarrhea (8.6%, n=611) were most common in PN. Regarding the clinical outcomes, 18.7% (n=2,158) finally expired, 58.1% (n=7,027) were admitted to ICU, and the mean hospital days after NT-related complication were 31.3 days. Volume overload (odds ratio [OR]=3.48) and renal abnormality (OR=2.50) were closely associated with hospital death; hyperammonemia (OR=3.09) and renal abnormality (OR=2.77) were associated with ICU admission; “micronutrient and vitamin deficiency” (geometric mean [GM]=2.23) and volume overload (GM=1.61) were associated with a longer hospital stay. Conclusion: NT may induce or be associated with several complications, and some of them may seriously affect the patient’s outcome. NST personnel in each hospital should be aware of each problem during nutritional support.

중환자 간호사의 호스피스,완화의료에 대한 태도와 이에 영향을 미치는 요인

설은미 ( Eun Mi Seol ),고진강 ( Chin Kang Koh ) 서울대학교 간호과학연구소 2015 간호학의 지평 Vol.12 No.2

Purpose: The study purpose was to describe critical care nurses’ attitudes toward hospice and palliative care and their related factors. Methods: In this cross-sectional descriptive study, 175 critical care nurses who worked at a general hospital in Seoul participated via self-report survey. The Frommelt Attitude Toward Care of the Dying Scale was used to measure their attitudes, and a palliative care quiz for nursing was used to measure their knowledge about hospice and palliative care. Results: Education level, duration of nursing employment, duration of critical care nursing employment, and knowledge about hospice and palliative care were significantly associated with nurses’ attitudes. In the multiple regression analysis, education level, and duration of nursing employment were significant predictors of nurses’ attitudes. Conclusion: These findings suggest that education programs to improve nurses’ knowledge about hospice and palliative care should be developed. These will help critical care nurses obtain a positive attitude toward hospice and palliative care.

간호사의 직장 내 폭력 경험이 우울에 미치는 영향: 사회적 지지의 매개효과를 중심으로

설은미(Eun-Mi Seol),남수현(Soohyun Nam) 대한스트레스학회 2021 스트레스硏究 Vol.29 No.1

본 연구는 간호사의 직장 내 폭력 경험과 우울의 관계에서 사회적 지지의 매개효과를 확인하는 서술적 상관관계 연구이다. 2020년 7월 10일부터 8월 28일까지 직장 내 폭력을 경험한 128명의 간호사들의 자료를 사용하여 사회적 지지의 매개효과를 검증하고, Sobel test를 통해 매개효과에 대한 통계적 유의성을 검증하였다. 분석 결과, 간호사의 직장 내 폭력 경험과 우울의 관계에서 사회적 지지가 미치는 영향이 유의하게 나타나(β=−.278, p=.032), 직장 내 폭력을 경험한 간호사에서 사회적 지지가 우울을 경감시키는 효과를 확인할 수 있었다. 따라서, 직장 내 폭력으로 인한 간호사의 우울을 경감시키기 위해 사회적 지지가 중재의 구성 요소로 활용될 수 있을 것으로 기대한다. Background: The purpose of this study was to investigate the mediating effect of social support and its relationship between workplace violence and depression in nurses. Methods: This was a cross-sectional descriptive study that included 128 registered nurses who had worked at medical institutions, except those who experienced depression without workplace violence in Korea. The data were collected between July and August 2020 using online surveys. The mediating effect was performed using multiple hierarchical regression. Results: The rate of workplace violence was 82.8% (n=106). According to the type of workplace violence, the rates of verbal violence, physical threat, and physical violence were 79.7%, 67.2%, and 33.6%, respectively. A positive correlation between workplace violence and depression was found (r=.30, p<.001), whereas social support showed negative correlations with workplace violence (r=−.18, p=.045) and depression (r=−.26, p=003). This study found a partial mediating effect between workplace violence and depression. Conclusions: It is important to develop strategies to improve the social support of nurses who experienced workplace violence and effectively prevent and manage depression.

정맥영양 요법 시 In-line Filter의 적용

김은정 ( Eunjung Kim ),설은미 ( Eun-mi Seol ) 한국정맥경장영양학회 2019 한국정맥경장영양학회지 Vol.11 No.1

Metabolic abnormalities and catheter-related infections are common complications of parenteral nutrition (PN). Particulate contamination is a catheter-related complication can occur when administering PN: mixing the electrolytes, trace elements, vitamins into the PN, or puncturing a rubber stopper at the PN formulation. In addition, the aggregation of the components of the PN solution by a drug incompatibility reaction could be related to particulate contamination. PN contaminated with precipitates, insoluble particles, and bacteria was reported as the cause of the death of a patient. The Food and Drug Administration recommended that the filters be used during PN administration. In-line filters can retain the bacteria and insoluble particles in PN solutions, and prevent their infusion into the patient. Therefore, in-line filters are recommended to prevent catheter-related complications that can occur during PN infusion. A 0.2μ filter for lipid-free PN and a 1.2μ filter for lipid-containing PN solutions can be used. On the other hand, when a filter is applied, the infusion rate can decrease and the economic burden will increase for patients requiring long-term PN. In addition, small particles, such as viruses, polymers, and proteins cannot be filtered out completely. In conclusion, in-line filers are recommended to prevent catheter-related complications that can occur during PN administration, but there are no international standardized guidelines. Therefore, standardized guidelines will be needed based on evidence accompanied by clinical trials. In addition, in-line filter applications should be considered in the clinical field depending on the patient’s condition.