서 론
연구의 필요성
연구 방법
연구 설계
문항 개발 단계
●1단계 : 응급실 초진간호업무 측정도구의 개념 구성
●2단계 : 초진간호업무 예비 측정도구 항목 도출
●3단계 : 예비 측정도구의 내용 타당도 검증 및 예비도구 개발
평가단계 : 도구의 신뢰도 및 타당도 검증
●연구 대상
연구 결과
대상자의 일반적 특성
개발된 도구의 구성 타당도와 신뢰도 검정
●지식 측정도구
●수행 측정도구
<Table 1>
Domain | Item | Item content for each factor | Factor 1 | Factor 2 |
---|---|---|---|---|
Triage | 5 | Check bleeding | .854 | .141 |
6 | Check the pupil size and reflex | .774 | .357 | |
4 | Perform cardiovascular assessment (measure blood pressure and pulse) | .712 | .041 | |
2 | To measure breathing rate and observe ventilator pattern. | .641 | .273 | |
7 | To identify disorders of nervous system (disorder in sense or muscle strength, paralysis, dizziness, dysarthria and etc.) | .638 | .427 | |
3 | Check the level of consciousness. | .590 | .577 | |
12 | Depending on symptoms, take appropriate measures including oxygen inhalation, application of pulse oxymeter or EKG monitor, simple dressing, blood collection, IV line insertion, fluid drip infusion, hot cold pack, urine test, prescribed X ray or antipyretic administration, blood sugar test, and EKG. | 0.70 | .828 | |
15 | To designate an appropriate ward, nurse-in-charge and bed. | .258 | .826 | |
14 | If outpatient or primary/secondary hospital treatment is necessary rather than emergency treatment in a tertiary institution, refer the case to the night duty doctor of the emergency room | .310 | .819 | |
Eigen Value % of variance Cumulative % |
3.17 | 2.78 | ||
35.21 | 30.85 | |||
35.21 | 66.06 |
<Table 2>
Domain | Item | Item content for each factor | Factor 1 | Factor 2 | Factor 3 |
---|---|---|---|---|---|
Non-Triage | 20 | To identify name (to identify persons with same name and similar names), age and sex of patients in emergency room | .838 | .265 | .032 |
17 | To perform education to prevent fall, to ask a guardian to be present, to wash hands to prevent infection and anti-theft and record all the details | .731 | -.014 | .197 | |
18 | To ask patients with consciousness to register in administration. | .668 | .424 | .190 | |
19 | Receive an unconscious and unidentified visiting patient at my own discretion. | .613 | .440 | .333 | |
21 | To prioritize patients according to severity when multiple patients come to hospital at the same time | .599 | .207 | .490 | |
16 | To record main complaints, admissive channel (hospital name if case of an inter-hospital transfer), how to come to hospital, basic nursing treatment and test, vitality signals, consciousness, and size and response of pupils thoroughly. If it is an inter-hospital transfer case, it is required to record treated medication, attachment, treated ward and company | .521 | .305 | .385 | |
25 | To assess educational requirements of emergency nursing subjects and their guardians and provide them with proper consultation(test procedure, test time, and things related to disease). | .098 | .870 | .178 | |
28 | To keep good relationship with medical professionals and staffs in other departments. | .211 | .816 | .132 | |
30 | To contact parents or guardians of patients who came to hospital without a guardian. | .370 | .690 | .287 | |
22 | To know and use emergency apparatuses (Pulse oxymeter, Laryngoscope, Ambu-mask, Debrillator, TCP and EKG) | .044 | .285 | .859 | |
23 | To know the effects of emergency medicine and administer according to prescription | .356 | .070 | .793 | |
24 | Cope with emergency situations | .254 | .533 | .595 | |
Eigen Value % of variance Cumulative % |
3.15 | 2.83 | 2.47 | ||
26.23 | 23.56 | 20.56 | |||
26.23 | 49.79 | 70.35 |
확정된 도구의 적용 결과
●초진간호업무 지식 정답률
●초진간호업무 수행 정도
<Table 3>
Domain | Questions | Correct-answer rate | |
---|---|---|---|
n(%) | |||
Common area | 1. For emergency room patients, questions should be asked so that they answer ‘Yes’ or ‘No.’ | 40(83.3) | 79.8 |
2. The first thing to do for the patient admitted in Emergency Room is the openness of airways of the patient. | 38(79.2) | ||
3. The order of abdominal examination of the patient admitted in Emergency Room is palpation and then auscultation. When palpating, it is recommended to palpate the most painful site first. | 37(77.1) | ||
Respiratory diseases | 4. A patient with breathing difficulty came to the hospital. Oxygen saturation rate was 87%. We must provide high concentration oxygen regardless of present disease of the patient. | 44(91.7) | 81.9 |
5. Wheezing sound means the narrowed airways because of asthma, chronic obstructive pulmonary disease or bronchitis | 42(87.5) | ||
6. Unexpected sudden dyspnea that happens at rest is related to pulmonary embolism, spontaneous pneumothorax, or hypercarbia. | 32(66.7) | ||
7. If a patient complains of a pain radiating to the shoulders and neck along with an epigastric pain pressing down severely for over 30 minutes and is in a heavy cold sweat, an acute heart disease should be suspected first. | 41(85.4) | ||
Cardiovascular diseases | 8. In ventricular fibrillation, the QRS wave is completely disintegrated and appears to be very fast and irregular small waves. | 35(72.9) | 79.6 |
9. Symptoms of angina with lability are shown only when the patient over-exercises and disappear when he/she takes a rest. | 35(72.9) | ||
10. If heart rate is over 150 times/min and QRS group is narrow although rhythm is regular on EKG monitor, PSVT can be suspected. | 42(87.5) | ||
Celiopathy | 11. Among the methods of differentiating acute appendicitis, local tenderness and rebound tenderness are preferentially applicable physical examination | 40(83.3) | 94.4 |
12. Black stool is mainly resulted from bleeding in upper gastro-intestine, while bloody stool is mainly caused by bleeding in lower gastro-intestine. | 48(100) | ||
13. The first test for a female patient with childbearing age who complains pains in her abdomen after physical examination is urine pregnancy test. | 48(100) | ||
Cerebrovascular diseases | 14. To a patient in his 70s who visited through 119 for dysarthria and a deep drowsy mental state, the first test to be done after physical assessment is brain CT. | 5(10.4) | 58.3 |
15. Treatment for ischemic stroke, namely, the administration of venous thrombolytic agent(r-TPA) can be applied to a patient who has arrived within 6 hours from the onset of symptoms. | 17(35.4) | ||
16. Transient ischemic attack (TIA) does not need to be treated because it is a transient neurological deficit because of temporary disorder in blood flow to brain. | 41(85.4) | ||
17. If a patient who fell with complaining of a sudden severe headache has vomited in the 119 ambulance, cerebral infarct may be suspected first. | 31(64.6) | ||
18. The most common cause of dizziness caused by the change of posture is BPPV(Benign paroxysmal positional vertigo). | 46(95.8) | ||
Toxicopathy | 19. If there is a tonic-clonic seizure without organic encephalopathy after 30, generalized seizure because of intoxication or metabolism related problems can be suspected. | 28(58.3) | 56.2 |
20. When a drug-intoxication suspected patient arrives, it is a must to perform gastric irrigation within 3 hours. | 31(64.6) | ||
21. For a patient with blue pigmentation around the mouth and the fingertips and shallow breathing, the first emergency treatment is oxygenation. | 22(45.8) |