산후출혈에서 출혈량 추정의 정확성 향상을 위한 시뮬레이션 교육의 효과
Efficacy of Simulation-based Learning for Improving the Accuracy of Blood Loss Estimation in Postpartum Hemorrhage
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본 연구는 현재 일하고 있는 모자센터 간호사들과 산부인과 전공의들이 산후 출혈 상황에서 출혈량을 얼마나 정확하게 시각적으로 추정할 수 있는지, 그리고 추정에 대한 자신감 정도를 알아보고 시뮬레이션 교육을 통하여 이를 개선시킬 수 있는지 여부를 파악하고자 시도된 유사실험연구였다. 산후 출혈로 인한 모성 사망의 대부분은 예방전략과, 신속한 진단 및 치료를 통하여 막을 수 있다고 알려져 있으며, 이를 위해서는 500 mL 내외의 출혈량을 시각적으로 추정하여 산후 출혈을 신속하게 진단하는 것이 필수적이다. 본 연구는 산후 출혈 상황에서 과소평가의 경향을 재확인하였을 뿐 아니라, 단 일회의 시뮬레이션 교육을 통한 정확성 개선 효과를 입증하였다는 점에서 임상적인 중요성이 있다. 교육에 의한 정확성 향상 효과가 지속되기 위하여 반복 교육이 필요할 것이며, 추후 출혈량의 시각적 추정방법 이외에도 응급처치와 약물투여에 대한 시뮬레이션 교육이 시도된다면 응급상황에서 의료진의 판단과 처치의 정확성, 자신감 향상에 도움이 되고 나아가서는 임상적인 개선 효과도 가져올 수 있을 것으로 기대한다.
Abstract
Purpose: This study was designed to investigate an accuracy of visual estimation of blood loss and the usefulness of simulation-based educational program for postpartum hemorrhage. Methods: The participants included 12 nurses and 8 residents who were working at Mother and Baby Center of Ewha Womans University Hospital. A simulation-based education for estimation of blood loss was conducted for all of the participants. Tests were performed before and after simulation-based education. Two additional tests were performed two and four weeks after the education. Self-confidence score for blood loss estimation was also investigated by questionnaire. Results: Significant underestimation was observed in all questions of 450, 700, and 1,100 mL. Median for percent errors of each questions were -50%, -29%, and -9%, respectively. After simulation-based education, accuracy was improved with the medians of -5%, 0%, and 13%. Self- confidence score in visual estimation of blood loss was also improved significantly after the education. There were no differences by profession or work experience. Conclusion: Significant underestimation was seen before simulation-based education. This study shows that the accuracy of visual blood loss estimation was improved after education. Accurate estimation of blood loss will contribute to a timely diagnosis and resuscitation in postpartum hemorrhage. Our study suggests that periodic education for visual estimation of blood loss in obstetrical hemorrhage might improve accuracy and clinical outcome.
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