환경적 간호중재가 개심술 환자의 중환자실섬망증, 환경적 스트레스 및 수면에 미치는 효과 = The Effect of the Environmental Nursing Intervention on ICU Delirium, Environmental Stress and Sleep in Patients Underwent Cardiac Surgical Procedures

다국어 초록 (Multilingual Abstract)

Purpose: To examine the effects of the environmental nursing intervention using eye-shields and earplugs on the incidence of delirium, environmental stress and sleep among the patients with open-heart surgery in the post-cardiac ICU(intensive care units). Method: This study was a non-equivalent control group non-synchronized design. The subjects consisted of 93 patients who received ICU care after the cardiac surgery. Among those, 32 subjects was assigned in one experimental group with eye-shields, 31 in the other experimental group with earplugs, and 30 in the control group. ICU delirium was measured by CAM-ICU, environmental stress by ICUESS, and sleep by two sleep scales developed by Oh, et al. and Kim. The data were analyzed by the SPSS 13.0 program including frequency, percentage, t-test, χ² test, ANOVA and ANCOVA. Results: There are no statistically significant differences in the incidence of delirium among three groups (p=.139). The ICU environmental stress scores from the subjects of two experimental groups demonstrated lower (F=6.731, p=.002) than the control group. Also, the degrees of sleep pattern (p=.000, p=.000) and sleep satisfaction (p=.000, p=.000) were greater than those of the control group. Conclusion: Although the environmental nursing intervention using eye-shields and earplugs did not demonstrate the effects in decreasing the incidence of ICU delirium, it has affirmative effects in decreasing environmental stress and improving the quality sleep among the patients with open-heart surgery while they stay in ICU. Further nursing implications are discussed.

참고문헌 (Reference)

1 김명애, "중환자실 환자의 수면량과 수면량에 영향을 미치는 환경적 요인에 관한 연구" 서울대학교 1986

2 복희, "중환자실 환자와 간호사가 지각한 환경적 스트레스요인에 관한 연구" 이화여자대학교 1999

3 김경희, "중환자실 관상동맥질환자의 수면에 관한 연구" 이화여자대학교 2001

4 김영하, "중환자실 간호사의 중환자실정신증 경험" 연세대학교 2005

5 이선희, "스트레스 요인에 대한 환자와 간호사의 인식 비교연구" 대전대학교 2003

6 오진주, "수면측정도구의 개발을 위한 연구" 28 (28): 563-572, 1988

7 구윤정, "수면안대와 귀마개 적용이 중환자실 관상동맥질환자의 수면양상에 미치는 효과" 계명대학교 2005

8 손연정, "소음과 수면양상에 관한 연구(중환자실을 중심으로)" 연세대학교 1999

9 김미영, "노인환자의 입원 전․후 수면양상과 관련 요인에 관한 연구" 29 (29): 61-71, 1997

10 김묘진, "귀마개의 적용이 중환자실 입원환자의 소음으로 인한 수면장애에 미치는 효과" 계명대학교 2003

11 조남옥, "개심술환자에 있어서 수술 후 섬망에 영향을 미치는 요인에 관한 연구" 서울대학교 1985

12 신영옥, "개심술 후 섬망증 후에 관한 탐색적 연구" 연세대학교 1986

13 Sorehren,P., "Stressors perceived by cardiac surgical patients in the intensive care unit" 4 (4): 71-76, 1995

14 Pilcher,J.J., "Sleep quality versus sleep quantity: Relationships between sleep and measures of health well being and sleepiness in college students" 42 (42): 583-596, 1997

15 Simpson,T., "Relationships among sleep dimensions and factors that impair sleep after cardiac surgery" 19 : 213-223, 1996

16 Holland,C., "Patients' recollections of critical care" 16 (16): 132-141, 1997

17 Freedman,N.S., "Patient perception of sleep quality and etiology of sleep disruption in the intensive care unit" 159 : 1155-1162, 1999

18 Wesley,E.E., "Monitoring delirium in critically ill patients: Using the confusion assessment method for the intensive care unit" 23 (23): 25-38, 2003

19 McGuire,B.E., "Intensive care unit syndrome: a dangerous misnomer" 160 : 906-909, 2000

20 Geary,S.M., "Intensive care unit psychosis revisited: Under- standing and managing delirium in the critical care setting" 17 (17): 51-63, 1994

21 Granberg,A., "Intensive care syndrome : A literature review" 12 : 173-182, 1996

22 Ballard,K., "Identification of environmental stressor for patients in a surgical intensive care unit" 3 : 89-108, 1981

23 Justic,M., "Does “ICU psychosis” really exist?" 20 : 28-37, 2000

24 American Psychiatric Association, "Diagnotic and Statistical Manual of Mental Disorders(4th ed.)(DSM-Ⅳ)"

25 Margaret,C.M., "Delirium in the intensive care unit" 26 (26): 172-178, 2003

26 Bross,H.M., "Delirium in the elderly patients" 50 (50): 1325-1332, 1994

27 William,L.L., "Delirium in postacute and long-term care" 7 : 254-261, 2006

28 Wesley,E.E., "Delirium in mechanically ventilated patients validity and reliability of the confusion assessment method for the intensive Care unit(CAM-ICU)" 286 (286): 2703-2710, 2001

29 Cochran,J., "A comparison of nurses' patients' perception of intensive care unit stressors" 14 : 1038-1043, 1989