한국형 성인 환자 섬망 선별 도구 개발
Development of Korean Adult Patients Delirium Screening Tool
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목적: 본 연구의 목적은 병동에 입원한 성인 환자를 위한 한국형 성인 환자 섬망 선별 도구(K-APDS)를 개발하고, 신뢰도와 타당도를 검증하는 것이다. 방법: 도구 개발을 위해 문헌고찰 결과와 일반 병동 간호사들의 포커스그룹 인터뷰 결과를 통해 12개 문항을 도출하였고, 전문가 내용타당도를 확인하였다. 개발된 도구의 신뢰도와 타당도 검증을 위해 2022년 10월부터 11월까지 상급종합병원 3곳의 병동에 입원한 317명의 성인 환자를 대상으로 담당간호사가 평가하여 자료수집하였다. 수집된 자료를 통해 구성타당도, 대조그룹 타당도, 준거타당도, 예측타당도 및 도구의 신뢰도를 분석하였다. 결과: 구성타당도 검증을 위한 요인분석 결과 2개의 요인으로 추출되었고, 전체 변량의 60.1%를 설명하였다. 대조그룹 타당도 검증에서 섬망군과 비섬망군 간의 K-APDS의 섬망 발생 점수 차이는 매우 유의하게 나타났다(Z=-10.82, p<.001). 준거타당도 검증을 위해 K-APDS와 Delirium Observation Screening과 Pearson's correlation coefficient를 확인하였고 .94 (p<.001)로 나타났다. 예측타당도 검증 결과 민감도는 91.1%, 특이도 82.4%, 양성예측도 52.6% 및 음성예측도는 97.8%로 나타났다. K-APDS의 신뢰도는 Cronbach's α=.91로 나타났다. 결론: K-APDS는 2점 이상에서 섬망 선별이 가능하며, 우수한 타당도와 신뢰도가 검증되었다. 따라서 본 도구는 임상현장에서 환자를 간호하면서 바로 적용이 가능하고 섬망 조기 발견 및 빠른 중재 제공에 기여할 것이다.
Abstract
Purpose: The purpose of this study was to develop a Korean Adult Patients Delirium Screening Tool (K-APDS) for those admitted to general wards, and to verify its reliability and validity. Methods: For the development of the tool, 12 items were derived through the results of literature review and focus group interviews with general ward nurses, and the content validity was confirmed by experts. To verify the reliability and validity of the developed tool, 317 adult patients who were admitted to general wards of three tertiary general hospitals from October to November 2022 were evaluated by the attending nurse and data were collected. Results: After factor analysis for construct validity verification, two factors were extracted, which explained 60.1% of the total variance. After the validation of the control group, the difference in the delirium incidence scores calculated using the K-APDS between the delirium group and non-delirium group was very significant (Z=-10.82, p<.001). To verify the criterion validity, K-APDS, Delirium Observation Screening, and Pearson's correlation coefficient were checked and found to be .94 (p<.001). The predictive validity test reported that the sensitivity was 91.1%, specificity was 82.4%, positive predictive value was 52.6%, and negative predictive value was 97.8%. The reliability of K-APDS was found to be high with Cronbach’s ⍺=.91. Conclusion: K-APDS can screen for delirium with 2 or more points, excellent validity and reliability have been verified. Therefore, this tool could be applied immediately in the clinical field, and will contribute to the early detection of delirium, enabling rapid interventions.
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