연명의료 결정과 환자 자기결정권에 대한 가정전문간호사의 태도와 인식

권예옥(Ye Ok Kwon),안성희(Sung Hee Ahn) 한국생명윤리학회 2013 생명윤리 Vol.14 No.2

본 연구는 연명의료 결정과 환자 자기결정권에 대한 가정전문간호사의 태도와 인식을 파악하기 위한 서술적 조사 연구이다. 연구 대상자는 2013년 2월 현재 전국의 가정간호센터에서 근무하고 있는 가정전문간호사 136명이었다. 가정전문간호사는 연명의료 중단에 대해 대체로 긍정적인 태도를 보였고, 연명의료 결정 과정에서 상담자, 지지자, 중개자로서의 가정전문간호사의 역할이 중요하다고 인식하였다. 환자의 자기결정권에 대해서는 법제화가 필요하고 결정과정에 대한 구체적인 절차확립, 병원 윤리위원회의 활성화의 필요성을 인식하였다. 연명의료 결정에 대한 태도가 긍정적일수록 환자 자기결정권에 대한 인식정도가 높았고, 연명의료 결정시 간호역할의 인식 정도가 높을수록 자기결정권에 대한 인식 정도가 높았다. 따라서, 가정전문간호사를 대상으로 연명의료 결정과 자기결정권에 대한 교육이 필요하다고 본다. 이에, 생명윤리에 기반을 둔 연명의료 결정에 대한 교육과정의 개발 및 적용에 대한 연구가 필요함을 제언한다. 또한 본 연구의 대상자가 일부 지역의 가정전문간호사로서 본 연구결과를 일반화하는데 무리가 있다고 보아 추후 반복연구를 제언한다. This study was to investigate attitude and role perception on withdrawal of futile life sustaining treatment(WFLST) and patient self-determination Right(SDR) among home care nurses. A descriptive study design were utilized. Data were collected by questionnaires for measuring an attitude and a role perception on WFLST, and a perception on SDR from 136 home care nurses. Data were analyzed with mean, standard deviation, and Pearson"s correlation coefficients. The score of the attitude and role perception on WFLST were 3.28 and 4.38 out of maximum of 5, respectively. And the perception score on SDR was 4.12. The attitude on WFLST has a positive correlation with the perception on SDR, and also there was a positive correlation between the role perception on WFLST and the perception on SDR. Comparing to such, there is no significant correlations between The attitude on WFLST and the role perception on WFLST. Additionally, Home care nurses perceived that the patient"s autonomy is important, and had contradictory attitudes on life sustaining treatment. From this results, it was shown that home care nurses in general had a positive attitude toward WFLST, also they did aware the necessity of having objective and ethical guidelines and the enactment of laws. Therefore, It is positively advisable to conduct study on the development and application of bioethics education curriculum related to WFLST and SDR for home care nurses.

가정전문간호사의 죽음 알아가기

김숙희,장숙랑 한국질적탐구학회 2019 질적탐구 Vol.5 No.2

This study was to explore the meaning of home visiting nurses’ understanding of death through the experience of home nursing. For the study, two home visiting nurses who are working at higher-level general hospitals were selected to have regular interviews, using narrative inquiry method. Study participants experienced end-of-life nursing, (traffic) accidents, and family deaths at different locations, at different times, and in different situations. The experiences of death were arranged and composed in narrative form. Ms. Park experienced death while performing home nursing. She learnt death from the-end-of life care and recognized that rainbow nursing, family anxiety from death at home, freeing up patients with customized care, how close the death is to her, difficulties of choices, giving out and leaving when one can give and thankfulness for living. To Ms. Han, death appeared, as a dignified death, the question of ‘Am I Grim Reaper?’, a remaining homework, a hard choice, a postmortal body as a tool, something that is hard to define and a life of positiveness. Summerizing the meaning of home nurses’ understanding of death, first, death is a scene of memories. Second, death causes difficult choices. Third, death is still scary. Fourth, we should prepare for death as it will becoming somedays. Fifth, we should live with gratitude for being and living in the moment. Home-visiting nurses who perform end-of-life nursing care defined the meaning of death in diverse ways, combining their personal experiences with the experience of patients death. 가정간호를 수행하면서 겪는 경험을 통하여 가정전문간호사가 죽음을 알아가는 의미를 탐구하 고자 한 연구이다. 상급 종합병원에서 의료기관 중심 가정간호를 시행 중인 가정 전문 간호사 2 인을 대상으로 정기적 만남과 심층면담을 통해 내러티브 탐구 방법으로 연구를 진행하였다. 연 구 참여자들은 다른 장소, 다른 시간, 다른 상황에서 임종간호, (교통)사고, 가족의 죽음을 경험 하였다. 죽음의 경험을 내러티브 형식으로 구성하였다. 박이산이 경험한 죽음은, 무지개 간호, 가족에게는 불안한 집에서의 임종, 맞춤형 간호로 환자를 자유롭게, 죽음은 내 곁에, 어려운 선 택, 줄 수 있을 때 주고 떠남, 살아있는 것에 감사였다. 한유미는 의연한 죽음, 내가 저승사자인 가, 남아 있는 숙제, 힘든 선택, 사후의 내 몸을 도구로, 정의하기 어려운 죽음, 긍정의 삶으로 나 타났다. 가정전문간호사가 죽음을 알아 가는 의미를 정리하면 첫째, 죽음은 추억의 한 장면이다. 둘째, 죽음은 선택장애를 만든다. 셋째, 죽음은 그래도 두렵다. 넷째, 죽음은 확실하게 오기 때문 에 준비하자. 다섯째, 지금 바로 여기에서 감사하며 사는 것이다. 임종간호를 시행하는 가정전문 간호사는 간호과정에서 겪은 환자의 죽음 경험을 개인적 경험과 병합하여 다양하게 의미화하고 있었다.

노인수발보험제도에 있어서의 간호업무

김양이 대한케어복지학회 2006 대한케어복지학 Vol.2 No.3

노인수발보험제도를 앞두고 수발 전문 인력에 대한 과열현상을 보이고 있다. 노인수발보험법상으로는 관여하게 될 인력이 수발관리사와 수발사로 명시되어 있으며 간호수발에 대한 업무는 간호사와 의사가 참여하도록 규정하고 있다. 이와 관련하여 시행지침에서 제시하고 있는 간호사와 수발사의 업무에 대해 자세히 파악하고 간호사와 수발사 간에 업무상 발생할 수 있는 중복서비스나 역할갈등에 대한 문제와 대안을 제시하고자 하였다. 연구를 통해서 몇 가지 지적할 수 있는 문제점과 개선안을 제시하자면 첫째, 전문 간호사의 서비스가 필요한 중증 대상자는 병원 중심의 가정간호기관에서 관리하고 낮은 수준의 간호서비스가 필요한 대상자가 많아서 수발사와 간호사와의 역할혼란의 문제를 초래할 수 있다. 이로 인해 중복서비스로 인한 재정낭비도 초래하게 될 것이다. 따라서 전문분야의 간호인력을 활용하여 현재 병원중심의 가정간호기관에서 관리하고 있는 대상자까지를 수발인정대상자로 흡수함으로써 노인의료비의 증가도 억제하고 수발사와 간호사의 역할도 명확히 할 수 있을 것으로 사료된다. 둘째, 수발서비스의 매뉴얼 상에는 재활관련 서비스가 상당히 많고 서비스의 수준도 수발사의 역할로 보기에는 위험부담이 크다. 특히, 우리나라 와상노인들은 골?관절계가 취약하기 때문에 기능평가 및 훈련서비스 항목에 대해서는 물리치료사의 개입이 필수적일 것으로 사료된다. 셋째, 현재 간호업무의 수행권한을 갖고 있는 의사의 전공분야에 대한 언급이 전혀 없다. 그러나 노인은 신체적, 정신적, 사회적, 심리적 노화현상이 상호 역동성을 지니고 있고 치료와도 밀접한 관련이 있다. 때문에 노인성 질병에 대한 더 많은 의학적 지식과 기술이 요구된다. 따라서 서둘러 노인병 전문의 제도가 도입되어야 할 것이며 시행 중인 노인병 인정의 제도를 강화하여 노인성 질병과 관련된 전공분야의 전문의를 간호수발 지시서 발급자로 선정하는 것이 바람직할 것으로 사료된다. 넷째, 현재의 매뉴얼이나 각 분야별 지침서상에는 서비스의 내용과 수준은 제시되어 있으나 간호사와 수발사가 제공해야 하는 서비스에 대한 명확한 역할 구분이 없다. 노인수발보험제도는 행위별 또는 시간별로 비용을 책정할 것으로 예상되므로 서비스제공자의 역할구분이 명확해야 할 것으로 사료된다. Professional care manpower is being overheated with the care insurance for the elderly ahead. According to the care insurance policy, the manpower that would be participating are indicated as the care manager and care worker. Nurses and doctors are to be participating in nursing and care service. Related to this, the service of nurses and care workers presented in the enforcement guide is closely examined to provide efficient connection service by clarifying the boundaries between duties of nurses and care workers, minimizing confusion in work, and reducing financial wasteful expenditure due to overlapped service. As for presenting several problems and improvement plans through the study, first of all, issues of confusion in roles of care workers and nurses may occur since there are many who require a low-level nursing service, and those with serious illness who needs service of a professional nurse are managed by home care agencies centered on hospitals. Financial waste will be incurred due to overlapped service. Therefore, it is considered that clarifying the duties of care workers and nurses, and including people managed by the home care agencies centered on hospitals at present in the range of care-required subjects by using the nursing manpower in professional areas is needed in order to control the increase of medical expenses. Second, there are many rehabilitation-related services in the care service manual which levels seem quite risky for a care worker. Especially, the intervention of physical therapists are considered to be essential for function valuation and training service, since recumbent elderly people in Korea have weak joints. Third, there is no comments made on the field of specialization of doctors who have the right to execute nursing service at present. However, the physical, mental, social, psychological aging phenomenons of elderly people are mutually dynamic and also closely related to treatment. So much more medical knowledge and technology on senile diseases are required. Therefore, a medical specialist of geriatrics should be induced quickly as well as strengthening the senile disease recognition policy which is being operated to have the medical specialists concerning the diseases issue guidebooks on nursing and care. Fourth, in order to increase the satisfactory rate of recipients and family of the care insurance for the elderly and improve the efficiency of the policy, a connection service with areas of the recipients' desires is absolutely required. Fifth, there are service contents and levels presented in present manuals or guidebooks in each area, but a clear classification of roles on service that nurses and care workers must provide is missing. The care insurance for the elderly is expected to arrange costs by service or time, so clear division of roles between service providers is considered to be necessary.

간호대학원의 교육운영전략 : 가정전문간호사와 호스피스전문간호사 중심으로

이원희,김조자,강규숙,오의금,김소야자,김은정,Lee, Won-Hee,Kim, Cho-Ja,Kang, Kyu-Sook,Oh, Eui-Geum,Kim, Soyaja,Kim, Eun-Jeong 한국가정간호학회 2004 가정간호학회지 Vol.11 No.1

Purpose: This study was to develop a cost-effective and efficient curriculum for advanced practice nurse (APN) programs in home health care and hospice. Method: The process was to: (1) compare and analyze the present curriculum in home health care and hospice programs, (2) identify the needs of 7 expert nurses in home health care and hospice, and (3) develop a common curriculum structure and contents between home health care and hospice specialty courses. Result: Out of the 10 credits constituting the home health care and hospice specialty courses respectively, 6 credits were identified the common courses, Common content areas included introduction to hospice, communication skills, pain control. symptom control. teaching methods, and agency management. Conclusion: These results can be utilized in the development of APN programs for home health care and hospice in terms of qualified and cost-effective aspects of education.

우리나라 가정간호 현황 분석: 2020년 가정간호 근로실태 조사를 기반으로

백희정,임지영,조영이,김인아,전은영,노준희,민자경,김희정,송종례,오승은 한국가정간호학회 2020 가정간호학회지 Vol.27 No.3

Purpose: This study was conducted to assess the working conditions of home health nurses in hospital-based home health institutions nationwide. Methods: A secondary data analysis study was conducted based on the survey data on the working conditions of home health nurses, jointly conducted by the Korean Home Health Care Nurses Association and the Academic Society of Home Health Care Nurses in September 2020. Results: Of the home health nurses respondents, 82.4% worked in tertiary hospitals and general hospitals. Most of the working hours of home health nurses were 40 hours a week. Traffic accidents accounted for a significant proportion of accidents experienced by the home health nurse while performing their duties. Most of welfare and benefits systems applicable to home health institutions were in place. The time allocated to provision of home health nursing services was usually more than 30 minutes but less than 1 hour. The type of position of the individual in charge of home health care differed according to the type of medical institution. Conclusion: It is recommended that continuous investigation and analysis be conducted in order to establish a direction for improvement of home health nurses' working conditions, based on the related accumulated data.

한국 가정전문간호사의 업무량과 직무만족도

임민영,황원주,Yim, Min-Young,Hwang, Won Ju 한국가정간호학회 2017 가정간호학회지 Vol.24 No.1

Purpose: This study aimed to identify the workload of home healthcare nurses and their job satisfaction. Methods: The research was conducted on 87 home healthcare nurses in nationwide medical institutions. Results: Number of visits was correlated with direct nursing hours. The monthly average number of visits was 108.84 ; the average number of patients was 45.66; the average daily working hours were $8.95{\pm}0.95$, of which $5.43{\pm}1.06 $ were indirect nursing hours, and $3.57{\pm}1.05$ were direct nursing hours. The average nursing time by severity condition was 22.25 minutes for group 1 patients, 28.04 minutes for group 2, 34.97 minutes for group 3, and 42.88 minutes for group 4. Of possible scores out of 5 for the job satisfaction of home healthcare nurses, their satisfaction was low for their welfare ($2.68{\pm}1.12$), workload ($2.90{\pm}0.88$), and enough time to work ($2.98{\pm}0.90$). Conclusion: The severity of patient's conditions influenced the workload of home healthcare nurses. Although workload did not correlate significantly with job satisfaction, it is necessary to devise a measure for manpower so that home healthcare nurses can secure sufficient nursing hours when they visit clients.

가정전문간호 인력과 공급의 적정성

백희정 한국가정간호학회 2020 가정간호학회지 Vol.27 No.2

Purpose: This study aimed to identify the training system and current status of home health nurses and to examine ways to retain sufficient number of advanced practice nurses (APNs) in the home health nursing field. Methods: This study analyzed the adequacy of the supply of home health nurse by reviewing the existing research literature and statistical data. Results: Discussions on how to revitalize the home care business have been ongoing since the beginning of 2001. However, despite home health nurses being oversupplied, discussions on the adequacy of supply have always been excluded from the focus of revitalization. The recent expansion of the home care business has resulted in a shortage of workforce, which can be inked not only to the continuous reduction of the designated quota of programs but also to the regional imbalance of educational institutions. The serious imbalance between supply and demand has caused fears that the home care business would drastically reduce. Conclusion: It is necessary to not only increase designated quotas for APNs programs but also integrate those programs of the similar curricula, thus lowering supply shortages in home health nurses.

가정전문간호사의 의사소통능력, 간호전문직관과 간호업무성과

정은하(Jeong, Eunha),한수정(Han, Sujeong) 한국간호행정학회 2020 간호행정학회지 Vol.26 No.4

Purpose: This study was done to identify the effects of communication competence and nursing professionalism on job performance among home healthcare nurses. Methods: The participants were 116 home healthcare nurses working at the hospitals. Data were collected from February 11 to March 22, 2019 and were analyzed with Multiple Regression Analysis. Results: The most influential factors on job performance were hospital type (β=-.21, p=.006), communication competence (β=.30, p=.001) and nursing professionalism (β=.32, p<.001) which together explained up to 40% of job performance. Conclusion: To improve nursing performance of home healthcare nurses, it is necessary to develop programs and strategies to enhance communication competence and nursing professionalism.

의료기관 가정전문간호사의 직무분석

황문숙,이승자,임난영,이미경,Hwang, Mun-Suk,Lee, Seung-Ja,Lim, Nan-Young,Lee, Mi-Kyoung 한국가정간호학회 2011 가정간호학회지 Vol.18 No.1

Purpose: The aim of this study was to develop and to analyze the task of hospital based home care nurse practitioners in Korea. Method: The definition of home care nurse practitioners and job description was developed based on developing a curriculum(DACUM) by 7 panels who have experienced in home care nursing. One hundred fifty four nurses who were working at hospital based on home care were participated. Result: Fourteen kinds of duties were identified : the selection of home care patients; basic home care nursing; advanced home care nursing; patient/family education and counseling; medical decision making and coordination of patient service; management of home care supplies and drugs for patients; management of medical records; management of home care the agency; management of home care personnel; management of the home care supplies for agency; home care public relations; improvement of home care quality; management of long-term care service; and self-improvement. Ninety-six tasks were classified. Conclusion: The abilities for quality improvement and the advanced nursing practice of home care nurses should be empowered.

가정전문간호사의 소진경험

김순화(Sun-Hwa Kim),김희정(Hee-Jeong Kim),서민숙(Min-Sook Seo) 다문화건강학회 2022 다문화건강학회지 Vol.12 No.1

Purpose: This study aimed to clarify the related phenomenon structure and meaning by an in-depth exploration of theexhaustion experience of home healthcare nurses. Methods: Six nurses belonging to a general hospital or a higher gen eral hospital with home healthcare nursing experience were interviewed in-depth, and data were collected. Colaizzi sphenomenological research method was used to analyze the results. Results: It was integrated into 13 topics, 6 topiccollections, and 3 categories ( be weary of home care, the responsibility and burden as a professional, and the drivingforce of overcoming exhaustion. ) Conclusion: This study presented the difficulties and demands faced by nurses whoparticipated in home healthcare nursing along with the adaptation process. Therefore, legal and institutional support isneeded to improve the working environment in the home healthcare nursing process.