경장영양 간호실무지침 개정
Updates of Nursing Practice Guideline for Enteral Nutrition
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목적: 본 연구는 경장영양간호실무지침 초판을 갱신하기 위하여 시행되었다. 방법: 갱신절차는 간호실무지침 수용개작방법론 22단계에 따라 이루어졌다. 결과: 경장영양 간호실무지침 개정판은 16개 영역의 228개 권고안으로 이루어졌다. 최종 확정된 실무지침은 일반적 지침 8개, 특수영양의 일반적 원칙 9개, 경장영양의 일반적 원칙 9개, 경장영양의 사정 3개, 접근장치의 선택 10개, 접근 장치의 삽입 18개, 경장영양액의 선택과 준비 16개, 경장영양의 주입과 중지 46, 경장영양의 유지 관리 22개, 경장영양 주입의 감시 9개, 경장영양의 합병증 예방과 관리 16개, 12. 경장영양 시 약물주입 18개, 다양한 상황에서의 경장영양 20개, 경장영양 시 오류 예방 20개, 간호교육 1개, 간호기록 3개로 구성되었다. 근거수준 및 권고등급은 IDSA 체계에서 Ⅰ 등급이 26개(9.7%)이며 Ⅱ 등급은 35개(13.1%), Ⅲ 등급은 167개(62.5%)이다. 또한 GRADE 등급으로 분류된 것은 총 36개인데 이중 2개(0.8%)가 moderate이며 9개(3.3%)가 low, 25개(9.3%)이다. 간호실무지침 초판과 개정판의 권고안 변화상태는 초판에 비해 133개의 권고안이 추가되었고 초판에 있던 95개의 권고안 중 10개는 주요개정 되었다. 결론: 본 경장영양지침 개정판이 발간되어 병원간호사회를 통해 전국으로 확산되고 실무에 반영한다면 경장영양을 하는 환자에게 도움이 되며, 간호사들에게도 최신의 지식을 제공하는 좋은 기회가 될 것이다.
Abstract
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.
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