경장영양 간호실무지침 개정

조용애,구미옥,은영,유미,김정연,이현희,민자경,송정미 병원간호사회 2020 임상간호연구 Vol.26 No.1

Purpose: The purpose of this study was to update the previously developed nursing practice guideline for enteral nutrition (EN). Methods: The guideline update was done in 22 steps using standardized methodology for nursing practice guidelines. Results: The updated EN guideline consisted of 16 domains and 228 recommendations. The domains and number of recommendations in each domain were for IDSA (Infectious Diseases Society of America): 8 on general instruction, 9 on general instruction for special nutrition, 9 on general instruction for EN, 3 on assessment of EN, 10 on access to EN, 18 on EN device insertion, 16 on selection and preparation of nutritional supplements, 46 on administration and stopping EN, 22 on maintenance and management of EN, 9 on monitoring EN, 16 on prevention and management of complications of EN, 18 on medication administration, 20 on EN in various situations, 20 on prevention of errors, 1 on nursing education, and 3 on nursing documentation. For the levels of evidence, there were 9.7% for level I, 13.1% for level II, 62.5% for level III and 1.1% for GRADE (Grading of Recommendations Assessment, Development and Evaluation): 3.3% for low, 0.8% for moderate, 9.3% for very low. A total of 133 recommendations were newly developed and 10 previous recommendations were modified. Conclusion: This updated EN nursing practice guideline can be used to enhance evidence-based practice in fundamentals of nursing practice and it should be disseminated to nurses nationwide in order to improve the efficiency of EN practice.

간호분야 실무지침의 수용개작 방법론에 따른 정맥혈전색전증예방 간호실무지침의 개발

조용애,구미옥,은영,김경숙,이선희,윤지현,황정화,이경윤,박미정 병원간호사회 2016 임상간호연구 Vol.22 No.2

목적: 국내에서 사용할 수 있는 근거기반의 “정맥혈전색전 예방간호” 실무지침을 개발하기 위한 것이다. 방법: 2012년 병원간호사회에서 개발한 “간호분야 실무지침 수용개작”방법론에 따라 24단계의 수용개작 과정을 진행하였다. 결과: 정맥혈전색전 예방간호 실무지침 권고안은 16개 영역, 163개 권고안으로 구성되었다. 영역별 권고안 수는 일반적 지침 4개, VTE 위험요인 사정 4개, VTE 발생의 중재 2개, VTE 예방을 위한 기계적 중재 14개, VTE 예방을 위한 약물적 중재 30개, 내과환자의 VTE 예방 19개, 뇌졸중환자의 VTE 예방 10개, 암환자의 VTE 예방 16개, 임산부의 VTE 예방 14개, 원거리여행자의 VTE 예방 6개, 외과환자-복부수술환자 VTE 예방 5개, 흉부수술환자 VTE 예방 10개, 정형외과 환자 VTE 예방 10개, 신경외과 환자 VTE 예방 5개, 기타 외과환자 VTE 예방 4개, 비뇨기과 수술환자 VTE 예방 2개, 이비인후과 수술환자 VTE 예방 1개, 성형과 재건수술 환자 VTE 예방 1개, 통원수술환자 VTE 예방 3개, 환자를 위한 VTE 예방 교육 3개로 총 163개의 권고안이다. 권고등급은 각 권고안별로 제시되었으며, 권고등급은 총 173개이고, 권고등급은 A 등급이 24개(13.8%), B 등급이 106개(61.3%)이고, C 등급이 43개(24.9%)였다. 결론: 정맥혈전색전 예방간호 실무지침의 확산은 보다 과학적인 근거를 기반으로 수행되고, 표준화되며, 간호업무의 효율성이 개선되는데 기여할 것이다. 이에 정맥혈전색전 예방간호 실무지침을 병원간호사회를 통하여 전국의 병원에 확산하여 실무에서 활용할 것을 제언한다. Purpose: This study was conducted to develop a useful evidence-based guideline for preventing venous thromboembolism(VTE) in Korea adapting previously developed VTE guidelines. Methods: The guideline adaptation process was performed using 24 steps according to the nursing practice guideline adaptation manual developed by Hospital Nurses Association in 2012. Results: The newly developed VTE prevention guideline was consisted of 16 domains and 163 recommendations. The number of recommendations in each domain were: 4 general issues, 4 risk factors, 2 intervention at occurrence of VTE, 14 mechanical interventions, 30 pharmacological interventions, 19 VTE prevention for medical patient, 10 stroke patient, 16 cancer patient, 14 pregnancy, 6 for long distance traveller, 5 for abdominal surgery, 10 thoractic surgery, 10 orthopedic surgery, 5 neurosurgery, 4 other surgical patient, 2 urological surgery, 1 ENT surgery, 1 plastic surgery, 3 day surgery, 3 education of VTE prevention. Fourteen point three percent, 61.1%, and 24.6% of the recommendations were graded A, B, and C, respectively. Conclusion: The findings suggest that the new VTE prevention guideline can be more efficiently used to prevent VTE in hospital settings.

중환자실 간호사를 위한 자기주장훈련의 효과

조용애,김금순 병원간호사회 2013 임상간호연구 Vol.19 No.2

Purpose: This study was done to examine the effects of assertiveness training on Intensive Care Unit (ICU) nurses' assertive behavior, job stress, communication conflict, and self-esteem toward improving their communication skills and coping. Methods: The assertiveness training program was developed to a 10-hour program consisting of 3 sessions. The goals were to understand assertive behavior and learn how to practice assertive communication in general conflict situations and/or a difficult conflict situation in the ICU. Participants were 65 nurses recruited from a tertiary teaching hospital and of these, 27 nurses completed the program. Data were collected from Jan. 30th to Mar. 28th, 2009 using a questionnaire which included demographic characteristics, assertive behaviour scale, job stress scale, communication conflict inventory-specific, and self-esteem scale. Data were analyzed using SPSS v. 14.0 for x2 test and t-test. Results: ICU nurses in the experimental group had a significant increase in aspects of assertive behavior and a decrease in job stress. Conclusion: The results of the study indicate that assertiveness training is effective in increasing ICU nurses' assertive behavior and decreasing job stress through reinforcement of assertiveness behavior.

근거기반간호의 실무적용과 확산

조용애 한국근거기반간호학회 2013 근거와 간호 Vol.1 No.1

폐쇄형 기관흡인 카테터의 적절한 교환주기 설정을 위한 질향상 활동

조용애,김미순,이혜영,이민영,김대성,이주희,김은태,권우선,최문정,김정숙,이정림 한국의료QA학회 2005 가을학술대회 Vol.2005 No.2

WMSN을 이용한 중환자분류도구의 개발과 적용

조용애,신현주,조정구,정미경,이복남,송경자 병원간호사회 2005 임상간호연구 Vol.11 No.1

Purpose: The purposes of this study are to develop critical patients classification system, to establish validity and reliability and to identify the conversion index. Method: The items of WMSCN for ICU were revised at the 256 ICUs of 45 hospitals from WMSN of Walter Reed Army Hospital. Validity through the correlation between direct nursing care hours and WMSCN score and also interrater reliability was conducted at 18 of 45 hospitals. Finally, the conversion index was identified at the 5 of 18 hospitals. Result: The WMSCN consisted of 8 categories and 82 nursing indicators. The average score of WMSCN was decreased from 124.3 to 82.2 after education of guidelines. The scores by nurses were highly correlated with head nurses'(r=.94), and also scores of the WMSCN were highly correlated with the direct nursing care hour(p=.001). Finally, the conversion index was 8.36 minutes. Conclusion: WMSCN is available to classify the nursing workload for critical care patients. The education of guidelines, repeated evaluation of validity and reliability are requisite to use WMSCN effectively. And the conversion index should be adjusted to estimate the appropriate staffing in Korea.

간호사의 의료인 간 의사소통에 대한 조사연구

조용애,김미경,조명숙,남은영 병원간호사회 2013 임상간호연구 Vol.19 No.1

Purpose: To present necessary data for improvement in communications between health professionals in as characterized by nurses' communications. Methods: This study was a descriptive survey research design with a survey of 1,510 registered nurses working in general hospitals (of at least 1,900 beds) in Seoul. A questionnaire on communication in the ICU, nurse-physician and nurse-nurse, was used. Data were collected from January 9 to 20, 2012, and the response rate was 85.0%. Results: Cronbach α values ranged from.75 to .89, except for .59 for accuracy (nurse-physician), with .89 overall. The highest mean score was for perception for timeliness [3.83±.57], followed by shift communication (nurse-nurse) [3.64±.66], openness (nurse-nurse) [3.64±.65], accuracy (nurse-nurse) [3.14±.61], openness (nurse-physician) [2.90±.75], understanding (nurse-physician) [2.82±.65], and accuracy (nurse-physician) [2.70±.59]. Subscales of openness, understanding, and shift communication were strongly associated with communication satisfaction. The general characteristics of nurses with different perceptions of communications included age, clinical experience, work pattern, and department. Conclusion: Proactive activities to improve accuracy, openness and mutual understanding between physicians and nurses are required for patient safety. Further studies are also needed to reassess communications and evaluate the relationship between patient outcomes and nurses' job satisfaction after application of strategies to improve communications.

간호분야 실무지침의 수용개작 방법론에 따른 경장영양실무지침의 개발

조용애,은영,구미옥,조명숙,박명화,김경숙,김정연 병원간호사회 2014 임상간호연구 Vol.20 No.2

Purpose: This study was aimed to modify and adapt the previously developed, high-quality enteral tube feedingguidelines for the usage in clinical settings in Korea. Methods: Guideline adaptation process was undertakenaccording to the guideline adaptation manual version 2.0 developed by NECA (Kim, et al., 2011) and thestandardized methodology for nursing practice guideline adaptation (Gu, et al. 2012). Results: The modifiedand adapted enteral tube feeding guidelines were consisted of 11 domains and 95 recommendations. Thedomains and numbers of recommendations in each domain were: 4 on general issues, 2 on enteral nutritionindication and discontinue, 6 on enteral nutrition device selection, 12 on enteral tube feeding device insertions,3 on enteral nutrition formular and choices, 16 on enteral tube feeding start and progress, 20 on enteral tubefeeding maintenance and management, 15 on monitoring enteral tube feeding administration, 10 onprevention of error, 5 on medication administration, and 2 on documentation and report. There were 16.1%of the recommendations marked as A grade, 17.8% of B grade, and 66.1% of C grade. Conclusion: The adaptedenteral tube feeding nursing practice guideline is to be added to the evidence-based practice guidelines forfundamentals of nursing practice. The guideline is hoped to be disseminated to nurses nationwide in order toimprove the efficiency of enteral tube feeding practice.

중환자실 간호사의 직무스트레스와 대응방법, 이직의도에 대한 연구

조용애,김금순,김을순,박한미,유미,임은옥,현석경,김정연 병원간호사회 2009 임상간호연구 Vol.15 No.3

Purpose: This descriptive survey was aimed to investigate the ICU nurses' job stress, the way of coping, and the turnover intention and to identify the correlation among them. Methods: A 58 items-questionnaire composed of 7 sub-dimensions revised by Park, J. S. (2003) was used to measure the ICU nurses' job stress, and an questionnaire by Han, J. S. and Oh, G. S. (1990) which has 34 items from 6 sub-dimensions were used to measure the ICU nurses' way of coping. To figure out the ICU nurses' turnover intention, a 3 items-questionnaire used. A total of 456 nurses were participated in the study. Results: The participants' job stress was 2.86(4-point scale), and the way of stress coping was 2.27. Job stress had a positive correlation with the way of coping (r=.134, p=.004) and the turnover intention. The 54.1% of nurses addressed that they had some level of turnover intention. The turnover intention had a significant difference according to job stress(t=-2.041, p=.042), the type of hospital (χ2=8.052, p=.005) and the total number of hospital beds (χ2=9.232, p=.010). Conclusion: The findings of the study illustrated that the ICU nurses had at least moderate-high level of stress. The subjects' job stress showed a positive correlation with the way of coping and the turnover intention. These findings demonstrate necessity to develop an intervention for ICU nurses' stress management.

근거기반 정맥혈전색전증 예방 간호실무지침 개정

조용애,은영,이선희,전미양,정진희,한민영,김나리,허진형 병원간호사회 2023 임상간호연구 Vol.29 No.1

Purpose: This study aimed to update the previously published nursing practice guideline for prevention of venous thromboembolism (VTE). Methods: The guideline was updated according to the manuals developed by National Institute for Health and Care Excellence (NICE) and Scottish Intercollegiate Guidelines Network (SIGN), and a Handbook for Clinical Practice Guideline Developer Version 10. Results: The updated nursing practice guideline for prevention of VTE was consisted of 16 domains, 46 subdomains, and 216 recommendations. The recommendations in each domain were: 4 general issues, 8 assessment of risk and bleeding factors, 5 interventions for prevention of VTE, 18 mechanical interventions, 36 pharmacological interventions, 36 VTE prevention starategies for medical patients, 25 for cancer patients, 13 for pregnancy, 8 for surgical patients, 7 for thoractic and cardiac surgery, 16 for orthopedic surgery, 10 for cranial and spinal surgery, 5 for vascular surgery, 13 for other surgery, 3 educations and information, and 2 documentation and report. For these recommendations, the level of evidence was 32.1% for level I, 51.8% for level II, and 16.1% for level III according to the infectious diseases society of America (IDSA) rating system. A total of 112 new recommendations were developed and 49 previous recommendations were deleted. Conclusion: The updated nursing practice guideline for prevention of VTE is expected to serve as an evidence-based practice guideline for prevention of VTE in South Korea. It is recommended that this guideline will disseminate to clinical nursing settings nationwide to improve the effectiveness of prevention of VTE practice.