급성기 의료기관의 일혈 발생 현황 및 임상간호사의 일혈 예방 및 관리에 대한 지식과 태도에 관한 연구
Incidence of Extravasation in Acute Care Hospitals and Nurses’ Knowledge and Attitude toward Extravasation Prevention and Management
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목적: 진단적, 치료적 약물로 인한 일혈은 정맥내 주입 약물이 주변 조직으로 유출되어 발생하게 된다. 일혈과 관련된 손상 정도는 다양한 요인과 관련이 있으며, 가벼운 정도의 피부 반응부터 심각한 피부 괴사까지 나타나게 된다. 그러나 국내의 경우 일혈 발생률이 거의 보고 되고 있지 않아 잘 알려져 있지 않은 상태이다. 따라서 본 연구는 일혈 발생률과 일혈에 대한 간호사의 지식과 태도를 확인함으로서 이와 관련된 수준 높은 간호를 제공하고자 진행하게 되었다. 방법: 일혈 발생 현황의 경우 3개의 급성기 의료기관에서 시행되었으며, 일혈에 대한 지식과 태도는 6개 병원 793명의 간호사를 대상으로 진행하였다. 결과: 일혈 발생률은 0.5%였으며, 주로 66세 이상의 노인 환자(59.9%), 내과(48.2%) 그리고 입원 후 평균 13.73±20.68일에 발생하였다. 주로 전완(52.9%)에 많이 발생했으며, 비경구영양제(33.6%)가 주된 원인이었다. 일혈에 대한 간호사의 지식과 태도는 평균 14.63±2.86점과 28.91±36.00이었으며, 일혈 예방 및 관리에 대한 지식 및 태도 간에는 유의한 음의 상관관계가(r=-.11, p=.002) 있었다. 결론: 환자 안전 관리 측면에서 정확하게 일혈 발생을 보고할 수 있는 보고 시스템이 필요로 하겠다. 또한 임상 실무에 적용할 수 있는 프로토콜 개발과 간호 교육 프로그램도 필요하겠다.
Abstract
Purpose: Extravasation of diagnostic and therapeutic materials might occur when the intravascular solution leaks into the surrounding tissues. Injury associated with extravasation depends on various factors. It may rangefrom mild skin reaction to severe necrosis. However, the incidence rate for extravasation is largely unknown because of the limited reporting in Korea. Therefore, this study was conducted to identify the incidence ofextravasation and nurses’ attitude and knowledge of extravasation for providing high-quality nursing care. Methods: Three acute care hospitals were surveyed to estimate the occurrence of extravasation. Knowledge and attitude toward extravasation were investigated from 793 nurses working in six hospitals. Results: The incidence rate of extravasation was 0.5%. Extravasation commonly occurred in elderly patients aged 66 or older (59.9%) and internal medicine (48.2%), and it happened 13.73±20.68 days after hospitalization on average. It mostly occurred in the forearm site (52.9%) and was mainly caused by parenteral nutrition (33.6%). The mean scores of nurses’ knowledge and attitude were 14.63±2.86 and 28.91±36.00, respectively. There was a significant negative correlation between the subjects' knowledge and attitude (r=-.11, p=.002). Conclusion: It is necessary to have a reporting system that can accurately monitor the occurrence of extravasation for patient safety management. In addition, it is necessary to develop a protocol that can be applied to clinical practice and a nurse education program.
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