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A Study on Sedation, Delirium and Fall in Mental Illness Taking Psychiatric Drugs

정신약물을 복용하는 정신질환자의 진정, 섬망, 낙상에 관한 연구

  • Park, Kyung-Mi (Dept. of Nursing, Daejeon Institute of Science and Technology)
  • 박경미 (대전과학기술대학교 간호학과)
  • Received : 2020.04.14
  • Accepted : 2020.08.21
  • Published : 2020.08.31

Abstract

This study is a descriptive research study to understand the relationship between sedation, delirium, and fall of people with mental illness taking psychiatric drugs. From March10, 2019 to November 10, 2019, four psychiatric nurses were evaluated on 149 people with mental illness in two psychiatric hospitals located in D city. The collected data were analyzed using descriptive statistics, t-test, ANOVA, and Pearson's correlation coefficient using SPSS 22.0. Sedation and delirium(r=.587, p=<.001), sedation and fall(r=.273, p=.001), delirium and fall(r=.390, p=<.001)were all significant positive correlation. This study identified the degree of sedation, fall, and delirium of patients taking psychiatric drugs and confirmed the relationship between sedation, fall, and delirium of people with mental illness. It is thought that it will be able to provide basic data to prevent falls and delirium that may occur when taking psychiatric drugs and to prepare a nursing intervention strategy.

본 연구는 정신약물을 복용하는 정신질환자의 진정, 섬망 및 낙상의 관계를 파악하기 위한 서술적 조사 연구이다. 2019년 3월10일부터 2019년 11월10까지 D시에 위치한 정신병원 2곳을 대상으로 정신과 간호사 4인이 정신질환자 총 149명에 대한 평가를 실시하였다. 수집된 자료는 SPSS 22.0를 이용하여 서술적 통계, t-test, ANOVA, Pearson's correlation coefficient로 분석하였다. 정신질환자의 진정과 섬망(r=.587 p=<.001), 진정과 낙상(r=.273 p=.001), 섬망과 낙상(r=.390 p=<.001)은 모두 유의한 양의 상관관계로 나타났다. 이에 본 연구는 정신약물을 복용하는 정신질환자의 진정, 낙상, 섬망의 정도를 파악하고 진정과 낙상 및 섬망간의 관계를 확인함으로써 정신약물 복용시 발생할 수 있는 낙상과 섬망을 예방하고 간호중재 전략을 마련하는 기초자료를 제공할 수 있을 것으로 생각된다.

Keywords

References

  1. Association American Psychiatric. (2013). Diagnostic and Statistical Manual of Mental Disorder: American Psychiatric Pub.
  2. Korea Statistical information service (KOSIS): http://kosis.kr/index/index.do
  3. Kim, S. Y., & Kim, S. J. (2015). Effects of Weight Reduction Program on Body Weight, Self Esteem and Self Efficacy of Chronic Mentally Ill Persons. Journal of Korean Public Health Nursing, 29(3), 594-607. DOI : 10.5932/JKPHN.2015.29.3.594
  4. Houltram, B., & Scanlan, M. (2004). Care map 6: atypical antipsychotics. Sedation...seventh in the care maps series. Nursing Standard, 18(42), 45-46. https://doi.org/10.7748/ns2004.06.18.42.45.c3637
  5. Snowdon, J., Galanos, D., & Vaswani, D. (2011). Patterns of psychotropic medication use in nursing homes: surveys in Sydney, allowing comparisons over time and between countries. International Psychogeriatrics, 23(9), 1520-1525. DOI: 10.1017/S1041610211000445
  6. Ishida, T., Katagiri, T., Uchida, H., Takeuchi, H., Sakurai, H., Watanabe, K., & Mimura, M. (2014). Incidence of Deep Vein Thrombosis in Restrained Psychiatric Patients. Psychosomatics, 55(1), 69-75. DOI: 10.1016/j.psym.2013.04.001
  7. Chang, J. G., Roh, D., An, S. K., Cho, H. S., & Kim, C. H. (2013). Antipsychotic polypharmacy in the treatment of patients with related psychoses at a university hospital. Korean J Psychopharmacol, 24(2), 69.
  8. Mäkinen, J., Miettunen, J., Isohanni, M., & Koponen, H. (2008). Negative symptoms in schizophrenia-a review. Nordic Journal of Psychiatry, 62(5), 334-341. DOI: 10.1080/08039480801959307
  9. Miller, D. D., Caroff, S. N., Davis, S. M., Rosenheck, R. A., McEvoy, J. P., Saltz, B. L., ... & Stroup, T. S. (2008). Extrapyramidal side-effects of antipsychotics in a randomised trial. The British Journal of Psychiatry, 193(4), 279-288. DOI : 10.1192/bjp.bp.108.050088
  10. National Health Services. (2007). National Patient Safety Agency. Slips, trips and falls in hospital: The third report from the Patient Safety Observatory.
  11. Rubenstein, L. Z. (2006). Falls in older people: epidemiology, risk factors and strategies for prevention. Age and ageing, 35(2), ii37-ii41. DOI : 10.1093/ageing/afl084
  12. Pandharipande, P., Shintani, A., Peterson, J., Pun, B. T., Wilkinson, G. R., Dittus, R. S., ... & Ely, E. W. (2006). Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients. Anesthesiology: The Journal of the American Society of Anesthesiologists, 104(1), 21-26. https://doi.org/10.1097/00000542-200601000-00005
  13. Maldonado, J. R. (2008). Delirium in the acute care setting: characteristics, diagnosis and treatment. Critical care clinics, 24(4), 657-722. DOI : 10.1016/j.ccc.2008.05.008
  14. Jeon, K. (2014). Management of pain, agitation and delirium in the intensive care units. The Korean Journal of Medicine, 86(5), 546-556. https://doi.org/10.3904/kjm.2014.86.5.546
  15. Bae, J. H., Kang, W. S., Paik, J. W., & Kim, J. W. (2012). Changing trends in the occurrence and management of delirium for 5 years in a university hospital. Korean J Psychosom Med, 20(2), 112.
  16. Jun, W. H., Park, J. S., & Jeong, A. S. (2011). The effect of education program by illness on perception of illness and knowledge of medication in psychiatric inpatients. Journal of East-West Nursing Research, 17(2), 110-116. DOI : 10.14370/jewnr.2011.17.2.110
  17. Seo, M., & Kim, H. R. (2009). Effectiveness of an'integrated medication adherence enhancement program for persons with schizophrenia'by using online education contents. Korean J Psychopharmacol, 20(1), 22.
  18. Kim, I., & Cho, Y. N. (2007). The effects of abdominal meridian massage on constipation in institutionalized psychiatric patients taking antipsychotic drugs. J Korean Acad Adult Nurs, 19(5), 809.
  19. Schuurmans, M. J., Shortridge-Baggett, L. M., & Duursma, S. A. (2003). The Delirium Observation Screening Scale: a screening instrument for delirium. Research and theory for nursing practice, 17(1), 31-50. DOI : 10.1891/rtnp.17.1.31.53169
  20. Poe, S. S., Cvach, M. M., Gartrell, D. G., Radzik, B. R., & Joy, T. L. (2005). An evidence-based approach to fall risk assessment, prevention, and management: lessons learned. Journal of Nursing Care Quality, 20(2), 107-116. https://doi.org/10.1097/00001786-200504000-00004
  21. Lee, Y. W., & Nam S. I. (2016). Medications as Risk Factor for Falls. Research in Vestibular Science, 15(4), 101-106. https://doi.org/10.21790/rvs.2016.15.4.101
  22. Chang, C. M., Chen, M. J., Tsai, C. Y., Ho, L. H., Hsieh, H. L., Chau, Y. L., & Liu, C. Y. (2011). Medical conditions and medications as risk factors of falls in the inpatient older people: a case-control study. International journal of geriatric psychiatry, 26(6), 602-607. DOI : 10.1002/gps.2569.
  23. Korea Institute for Healthcare Accreditation,"Healthcar e accreditation survey standard of mental hospital", Ministry of Health and Welfare, Seoul, pp.140, 2012. DOI : 10.14400/JDC.2015.13.10.445
  24. Choi, E. J., Lee, Y. S., Yang, E. J., Kim, J. H., Kim, Y. H., & Park, H. (2017). Characteristics and risk factors for falls in tertiary hospital inpatients. Journal of Korean Academy of Nursing, 47(3), 420-430. DOI : 10.4040/jkan.2017.47.3.420.
  25. Cho, Y. S., Lee, Y. O., & Youn, Y. S. (2019). Risk Factors for Falls in Tertiary Hospital Inpatients: A Survival Analysis. Journal of Korean Critical Care Nursing, 12(1), 57-70. DOI :10.34250/jkccn.2019.12.1.57.
  26. Ely, E. W., Shintani, A., Truman, B., Speroff, T., Gor don, S. M., Harrell Jr, F. E., ... & Dittus, R. S. (2004). Delirium as a predictor of mortality in mechanically v entilated patients in the intensive care unit. Jama, 291 (14), 1753-1762. DOI : 10.1001/jama.291.14.1753
  27. Hong, J. H. (2015). Delirium in the Intensive Care Unit. Journal Neurocrit Care 8(2): 46-52 https://doi.org/10.18700/jnc.2015.8.2.46
  28. Kim, N. Y., & Kim, Y. W. (2015). Diagnosis and treat ment of post-stroke delirium. Brain & Neurorehabilitation, 8(2), 59-64. DOI :10.12786/bn.2015.8.2.59
  29. Lipowski, Z. J. (1987). Delirium (acute confusional states). Jama, 258, 1789-92 https://doi.org/10.1001/jama.1987.03400130103041
  30. Kim, S. W., & Yoon, J. S. (2011). A Survey on Attitudes of Korean Psychiatrists Toward Long-Acting Injectable Antipsychotics: An Interim Analysis. Korean J Psychopharmacol, 22, S10-S17.
  31. Park, K. M. (2018). Development of sedation evaluation scale for mental disorders. Chungnam National University, Doctoral Dissertation