정신질환자의 공격행동유형에 따른 간호중재 분석

Abstract

정신과 환자들의 공격행동은 날로 증가하고 있으며 이로 인하여 입원환자 공격행동이 본인뿐만 아니라 치료진 및 타 환자들에게 위험요인이 되고 있다. 특히 정신과 간호사는 24시간 최 일선에서 환자를 간호함으로서 공격행동을 직접 경험하게 되고 공격유형에 따라 어떤 간호중재를 하느냐가 간호사의 안전과 환자의 공격행동 예방이 간호사들에게 무엇보다도 중요하다. 이에 본 연구자는 정신질환자의 공격행동유형을 알아보고 유형에 따라 간호사들이 사용하는 중재를 분석하여 중재에 영향을 미치는 요인을 알아보았다. 연구대상자는 19개 정신전문병원에서 공격행동에 대한 경험이 있는 정신과 간호사 272명을 임의 추출하였고, 자료수집기간은 2010년 4월 26일부터5월 9일까지로 2주간이다. 본 연구에서 사용된 도구는 Yudofsky(1986)가 개발한 도구를 김상원과 이귀행(1992)이 번안한 공격성 척도(Overt Aggression Scale)로 공격행동유형의 16가지와 치료적 개입 10가지를 포함하고 구성하여 사용하였다. 수집된 자료의 분석은 SPSS 17.0(ver)프로그램을 이용하여 기술 통계, x2 사용하여 통계 분석하였다. 본 연구의 결과는 다음과 같다. 1. 대상 간호사의 일반적 특성은 여자(98.2%)가 대부분이었고 평균연령은 33세로 미혼(53.3%)이 많았고 종교는 기독교(40.1%)가 많았다. 학력은 3년제 대학 출신이(65.1%), 직위는 일반 간호사가(74.6%), 정신보건간호사나 정신전문간호사의 자격증 여부는 미소지자(55.9%)가 더 많았다. 임상경력은 평균 7년 2개월, 정신과 근무경력은 평균 6년 2개월이었으며 병동의 근무조별 평균적인 간호인력은 간호사 1.7명, 보조인력(보호사)은 1.4명이었고 병동 평균 재원 환자 수는 69명으로 나타났다. 2. 간호사가 경험한 정신질환자의 공격행동은 언어적 공격행동(96.2%)을 가장 많이 경험하였고, 타해(84%), 사물에 대한 공격적 행동(79.7%), 자해(77.7%)순으로 나타났다. 3. 정신질환자의 공격행동유형별로 10%이상 사용된 간호중재는 언어적 공격행동의 간호중재는 관심주고 경청하며 의사소통(21.2%), 의사에게 보고(18.2%), 집중관찰(17.7%), 설명하기(15.5%)로 나타났다. 사물에 대한 공격적 행동은 의사에게 보고(27.3%), 강박(13.5%)이었다. 자해에서는 의사에게 보고(26.3%), 강박(14.7%)이었고 타해의 경우는 의사에게 보고(25.4%), 강박(14.3%), 집중관찰(10.2%)의 간호중재를 사용한 것으로 나타났다. 4. 대상자의 일반적인 특성과 공격유형에 따른 간호중재방법에서 언어적 공격행동의 유의한 변수로 확인 된 것은 임상 경력(p=.047)과 자격증(p=.025)이다. 임상경력이 적을수록 설명하기 중재를 많이 사용하였다. 정신전문간호사나 정신보건간호사 자격증이 있는 간호사가 없는 간호사보다 행동제한, 격리를 상대적으로 적게 간호중재로 사용하였다. 사물에 대한 공격적 행동의 유의한 변수로 확인된 것은 임상경력(p=.020)과 정신과경력(p=.001) 및 근무기관(p=.013)이다. 임상경력과 정신과경력에서는 경력이 적을수록 의사에게 보고를 많이 하였다. 근무기관에서는 전문병원이 종합병원보다 격리를 많이 하였다. 자해의 유의한 변수로 확인된 것은 연령(p=.033)과 근무기관(p=.030)이다. 30세 이하에서 집중관찰을 많이 하였고 종합병원에서 전문병원보다 강박 및 격리를 적게 사용하였다. 타해의 유의한 변수로 확인된 것은 재원환자 수(p=.032)로 재원환자수가 적을수록 집중관찰의 간호중재를 많이 하였다. 이상을 종합해 보면, 간호사가 경험한 정신질환자의 공격행동유형에서 언어적 공격행동을 많이 경험하였고 간호중재로 의사에게 보고가 기본적인 간호중재이다. 정신과에 입원하고 있는 환자들의 공격행동에 대한 간호중제는, 간호사들의 특성과 경력 및 자격증 유, 무와 재원 환자 수 등에 따라 다르게 중재된다. 그러므로 환자들에게 치료적이고 효율적인 간호중재가 적용되어야 한다. 전통적인 간호중재 뿐 아니라 공격행동 예측도구를 이용한 간호중재 및 프로그램을 통한 공격행동에 대한 환자 교육 및 간호중재 선택의 표준화도 시급하다. 또한 간호사의 독자적인 간호중재를 위한 정신전문간호사와 정신보건간호사의 중재영역의 확장을 위한 법적인 뒷받침도 필요하다.;Aggressive behavior of psychiatric patients is increasing and as a result, the aggressive behavior of the inpatients not only become a danger element for themselves but for the treatment team and the other patients as well. Especially, the psychiatric nurses are working with the patients directly for 24 hours a day so they experience the aggressive behaviors directly and depending on the attack type and what type of nursing intervention is conducted are very important to the nurses for the aggressive behavior of nursing patient safety and prevention. For this reason, this researcher studied the types of aggressive behavior in psychiatric inpatients and analyzed the intervention types used by the nurses depending on the situation. Through this, the elements affecting arbitration were evaluated. The subjects were 272 psychiatric nurses of 19 mental hospitals that had experienced aggressive movements of the inpatients and the data collection period was for 2 weeks from April 25 to May 9. The tool used in this study is the Overt Aggression Scale which was originally developed by Yudofsky (1986) and revised by Sangwon Kim and Guiheang Lee (1992). This was used by including the 16 types of aggressive behavior and 10 kinds of therapeutic intervention plans. The collected data was analyzed through the SPSS 17.(ver) program to statistically analyze them in descriptive statistics and x2. The results of this study are as follows. 1. The general characteristics of subjects demonstrated that the most were women (98.2%), and the average age was of 33 years old. The majority was unmarried (53.3 %) by marital status, and Christian (40.1%) by religion. It was noted that most of the subjects were general nurse (74.6%) in position, graduated from a 3-year college (65.1%) by education level, and there was more of non-licensed nurses (55.9%) in terms of licensure qualification of psychiatric health nurse and professional psychiatric nurse. The total clinical experience marked an average of 7 years and 2 months, and psychiatric department working experience marked an average of 6 years and 2 months. The average number of nurses by shift staff in duty of hospital wards was 1.7 nurses and auxiliary personnels (helper) were 1.4, and the average number of patients in hospital ward was 69 patients respectively. 2. The experiences of aggressive behavior of psychotic inpatients were mostly of verbal aggressive behavior (96.2%), and followed by aggressive behavior on others (84%), on certain objects (79.7%), self-injury (77.7%) respectively. 3. Aggressive behavior of psychiatric inpatients used more than 10% by the type of nursing intervention for aggressive behavior, For verbal aggressive behavior the nursing intervention was to be interested in them and listening to them through communication (21.2%), report to doctor (18.2%), closer observation (17.7%), and explaining (15.5%). In case for aggressive behavior on certain objects, the nurses reported to doctors (27.3%) and used restraint (13.5%). For self-injury, the nurses reported to doctors (26.3%) and used restraint (14.7%), and for cases of hurting others, the nurses reported to doctors (25.4%), used restraint (14.3%), and used closer observation (10.2). 4. The general characteristics of the subjects according to the type of offense nursing intervention appears to verbal aggressive behavior, it is identified as a significant variable, years of clinical experience (p =. 047) and qualifications (p =. 025) is. Clinical experience to explaining the experience fewer interventions were used. Mental professional nurse or qualified mental health nurses than a nurse and a nurse is not limited action, the seclusion was relatively low as a nursing intervention. In case for aggressive behavior on certain objects is identified as a significant variable, years of clinical experience (p =. 020) experience in psychiatric department (p =. 001), work organizations (p =. 013) respectively. Clinical experience and experience in psychiatric department a lot fewer were a lot of reported to the physician. Agencies working in the general hospital, mental hospital was much more seclusion. It's self-injury as significant variables age (p =. 033), work organizations (p =. 030) is. Much more concentrated in the age of 30 were closer observed. work organizations in the general hospital were mental hospital used less than the restraint and seclusion. Is identified as a significant variable and cases of hurting others hospital patients (p =. 032) is. closer observation that fewer patients in hospital nursing intervention was a lot . Considering the above results are summarized, among the aggressive behaviors the nurses experienced the most was the verbal aggressive attack and among the nursing interventions, reporting to the doctor was the most basic nursing intervention. The nursing intervention for the aggressive behaviors of the patients in the psychiatric ward differed depending on the characteristics, experience, qualifications, number of patients in the ward, and others. Therefore, effective and efficient nursing intervention for patients with treatment should be applied. patient education on aggressive behavior and standardized nursing intervention choice are urgently needed which are not traditional nursing intervention but which uses aggressive behavior prediction tools. Additionally, there must be legal support for the extension of intervention needed for the independent nursing intervention of nurses and of the nursing intervention areas of psychiatric specialist nurses and mental health nurses.