요양보호사에 의한 노인의 신체억제 경험에 영향을 미치는 요인

홍송이(Song Iee Hong),박서영(Seo Young Park) 한국노년학회 2023 한국노년학 Vol.43 No.3

2008년 장기요양보험제도가 실시된 이래로 요양보호사는 한국 노인 돌봄의 핵심 인력으로 성장해왔으나, 요양보호사에 의한 시설학대의 가파른 증가 속도는 초고령 사회의 돌봄 위기를 초래할 만큼 요양보호사의 역량과 자질이 위태롭다는 것을 말해준다. 특히 요양보호사의 직무 중 일상생활수행능력과 인지기능이 크게 저하된 노인들에게 사용되는 신체억제는 학대와의 경계가 매우 불분명하여 지속적인 인권침해 논란이 되어왔다. 이에 본 논문은 2017년 3,000여개의 재가노인복지시설 및 재가장기요양기관으로부터 수집된 2차 자료를 활용하여 3,859명의 요양보호사를 대상으로 그들의 신체억제 행위와 이에 영향을 미치는 신체억제 인식, 신체억제 목격경험, 노인인권 침해에 대한 인식을 조사하였다. 연구결과에 따르면, 첫째, 요양보호사의 10.7%가 노인 대상자에게 신체억제를 수행한 적이 있었으며, 둘째, 요양보호사들이 해서는 안된다고 생각하는 행위의 빈도, 그들이 다른 요양보호사에 의해서 행해지는 신체억제행위의 목격빈도, 그리고 직접적으로 그들이 수행하는 신체억제 행위 사이에 개연성이 있었다. 셋째, 신체억제에 대해 부정적 인식을 갖고 있을수록 신체억제 행동이 줄어들었고, 넷째, 다른 요양보호사들의 신체억제 행위를 목격한 경험이 있는 요양보호사가 신체억제를 선택하는 것으로 분석되었다. 끝으로, 노인의 성격 때문에 인권침해가 발생한다고 응답한 요양보호사들이 신체억제 경험을 더 많이 사용하였다. 본 연구 결과는 요양보호사의 신체억제 인식 및 인권의식이 낮거나 낮을 경향이 높은 요양원 환경에서 신체억제가 더 많이 발생한다는 것을 밝히고 있다. 신체억제를 근절 또는 최소화하기 위해서 요양보호사 개인 수준의 인식 개선에서 나아가 조직문화, 다시 말해 돌봄이라는 것이 인권에 기반한 케어문화 속에서 이루어져야 함을 교육할 필요가 있다. Since the National Long-Term Care Insurance of 2008, licensed caregivers for older adults have dramatically increased in Korea. In contrast to such trends, their care capacity has been socially concerned about violation against human rights such as elder abuse including physical restraints. The distinction between physical restraints and physical abuse is ambiguous at care settings which has brought in hot debate on the violation of human rights. Therefore, we investigated the extent to which caregivers’awareness of physical restraints and reasons of elder abuse and their witness of physical restraints are associated with their physical restraints on older adults. We used the secondary data collected from 3,859 licensed caregivers working at about 3,000 day care centers across the nation in 2017. First, we found that 10.7% of caregivers performed restrictive interventions. Second, the awareness of physical restraints, witness of others’physical restraints, and their own physical restraints are related to each other. Lastly, logistic regressions confirmed that caregivers’poor awareness of physical restraints, more witness of physical restraints by other caregivers, and higher perception of victim’s personality problems mainly causing elder abuse were more likely to increase their use of physical restraints. These findings suggest that care environment insensitive to human rights might lead to elder abuse by over-utilizing physical restraints. Also, it is fundamental to develop professional care culture of licensed caregivers towards person-centered care.

임상연구 : 중환자실에서 환자 억제대 사용에 대한 간호사 교육의 효과

김윤희 ( Yoon Hee Kim ),정유순 ( Yu Soon Jeong ),박주현 ( Joo Hyun Park ),윤석화 ( Seok Hwa Yoon ) 대한마취과학회 2008 Korean Journal of Anesthesiology Vol.55 No.5

Background: Physical restraint is widely used to prevent self-harm and treatment interference in the intensive care unit (ICU)s, but it can cause adverse effects such as physical, psychological, and ethical problems. We examined the effect of nurse education on physical restraint use in the ICU. Methods: For 3 months before an ICU patient restraining program (IPRP), we investigated the application ratio of physical restraint, the incidence of complications and self-medical device breakage (self-extubation, self removal of intravenous line, etc.) Then we educated the 49 ICU nurses with an IPRP. The same data was collected again for 3 months after IPRP, and we also collected data from ICU nurses on their knowledge, attitude, and intention when applying physical restraint using questionnaires before and after IPRP education. Results: After IPRP education, the nurses` knowledge about physical restraint use improved significantly and their intension for restraint decreased. The physical restraint application ratio did not change significantly in the period before IPRP (146/475, 30.7%) compared to the period after IPRP (110/399, 27.6%). Significant decreases were shown in the incidence of physical injury and self-medical device breakage after restraint removal. There were no significant differences on the site, duration, or cause of physical restraints. Conclusions: Although the IPRP education did not decrease the restraint application ratio, there were significant decreases on patient physical injuries and medical device breakage after restraint removal. We suggest that education should be performed continuously to both nurses and doctors to decrease the application of physical restraints. (Korean J Anesthesiol 2008;55:590~5)

요양병원 간호사의 치매 환자에 대한 신체적 억제대 사용인식과 사용의도

이현주,김계하 한국노인간호학회 2016 노인간호학회지 Vol.18 No.3

Purpose: The purpose of this study was to investigate nurses' perceptions and intention to use physical restraints for geriatric hospital dementia patients. Methods: A cross-sectional study design was used with 112 nurses recruited from 6 geriatric hospitals. Data on nurses' general characteristics as well as perceptions and intention to use physical restraints for dementia patients were collected. Data were analyzed using descriptive statistics, independent t-test, one-way ANOVA, Pearson correlation coefficient and standard multiple regression with SPSS/WIN 21.0. Results: There were significant differences in perceptions of physical restraints for dementia patients according to type of restraint (wrist, lapboard with wheelchair, or alternative methods). Significant differences in intention were found for age, position, mobility decline, alternative methods, physical restraints guideline, and complaints from family. Factors affecting nurses' intention to use physical restraints included perceptions on physical restraint use, mobility decline, being a head nurse, and no alternative method available. These factors explained 51% of total variances in the regression model. Conclusion: Findings show that nurses' perception of physical restraints for geriatric hospital dementia patients is significantly correlated with intention to use physical restraints. Therefore, provision of periodic training and education on alternatives are necessary to reduce indiscriminate use of physical restraints.

한 정신병원에서의 강박 처치에 대한 입원 환자 및 병원 직원의 지각의 차이

채정호,차성조,함웅,이규항,이정균 大韓神經精神醫學會 1996 신경정신의학 Vol.35 No.5

한 정신병원에서 강박처치의 적응증, 합병증, 대체법, 감정적 영향, 적당한 처치 시간, 처치의 효능과 필요성등을 병원에 입원 중인 환자들과 직원들에게 설문조사를 하여 양 집단간에 차이가 있는 지를 알아봄으로써 환자들과 직원들간에 있는 강박처치에 대한 지각 차이를 조사하고 나아가 강박처치 시행의 규준을 확립하기 위한 기본 자를 제시하기 위하여 본 연구를 시행하였다. 강박처치의 적응증에 대해서 입원환자들은 대부분의 항목에 대해 부정적으로 보았고 단지 타환자에 대한 신체적 공격에 대해서만 다소 긍정적인 반응을 보인 반면 직원들의 경우 자해, 타환자에 대한 신체적 공격, 치료진에 대한 공격 등에 높은 응답율을 보였다. 강박처치의 부작용에 대한 지각은 입원환자의 경우 정신상태의 악화, 자해의 증가 등에 대해 보다 민감하게 반응 하였고, 실제로 경험한 부작용에 있어서는 직원들의 경우 피부박탈을 더 강조한 반면 환자군에서는 호흡곤란, 정신 상태의 악화 등을 강조하였다. 강제 처치에 대한 대체치료 방법으로는 환자군에서 면담을 중요시한 반면 직원군에서는 격리실의 이용을 강조하였다. 신체억제와 고용량의 정온화를 비교한 것은 환자군에서 신체억제가 더 효과적이라고 하였다. 신체억제 동안 느끼는 감정에 대한 지각에서 환자군은 슬픔을 가장 많이 보고하였고, 직원군은 적개심을 가장 많이 느낄 것으로 추정하였다. 신체억제의 시간에 대해서는 환자군이 긴 것으로 지각하고 있으며, 이상적인 신체억제의 시간은 환자군이 짧은 것이 좋다고 생각하고 있었다. 본 연구 결과 정신과 입원환자들과 병원직원들은 강박처치에 대하여 유의한 지각의 차이가 있다는 것을 알았으며 정신병원내에서 강제처치를 실시할 때에는 명확한 강박처치 시행에 대한 규준에 따라야 할 것임을 확인할 수 있었다. Objectives : The purpose of this study was to examine different perceptions of physical restraint and their nature between psychiatric inpatients and hospital staffs in a mental hospital and to provide baseline data for establishing the practicing standard of this therapeutic maneuver. Methods : Two hundred and two psychiatric inpatients who experienced physical restraint and 103 hospital staffs who frequently used this maneurer were surveyed with a questionnaire regarding indications, complications, alternative methods, emotional influences, duration of treatment and subjective effects of restraint. Results : Regarding indications of physical restraint, the inpatient group had negative viewpoint on the most items except "physical assault to other patients". Regarding the perception about possible complications of this treatment, the inpatient group had more concerns about "deterioration of mental status" and "increasing risk of self-injury". For experienced complications, staffs stressed "skin abrasion " while inpatients believed of "respiratory difficulties" and "deterioration of mental status" more frequently. As alternative methods of physical restraint, "increasing frequency of interview" was suggested by the inpatient group and "using seclusion room" was favored by the staff group. The inpatient group had an impression that physical restraint was more effective than high-dose neuroleptic tranquilization. For suspected emotion during this procedure, the inpatient group reported "sorrow" most frequently while the staff group presumed that "hostility" might be most frequent. Inpatients estimated that the average duration of physical restraint was longer than staffs did. Ideal duration of physical restraint was shorter in the inpatient group. Conclusion : These results suggest that there are definite differences in the perception of physical restraint between psychiatric inpatients and hospital staffs. Formal practing guideline for restraint should be set up with careful attention for these differences to maximize the therapeutic effect of this maneuver.

신체억제에 대한 요양보호사의 인식과 태도

성병주,고성희,이영희 한국디지털정책학회 2016 디지털융복합연구 Vol.14 No.9

The purpose of this study was conducted to investigate the perception and attitude toward physical restraints among elderly care workers. The subjects were 153 care workers who are working at elderly care facilities within the regions. Data were collected by structured questionnaires. Collected data were analyzed using descriptive statistics, t-test, ANOVA, Scheffé test and Pearson Correlation Coefficient. The mean score of the perception for physical restraints was 2.83 out of 5, and the mean score of the attitude for the physical restraints was 3.56 out of 5. There was a statistically significant positive correlation between the perception and attitude about physical restraints (r=.31, p<.001). This research has confirmed that it is necessary for care workers to have education about low score items of recognition and attitude about physical restraints. Therefore, we need to develop proper and efficient educational program about use method for physical restraints, and need to develop guideline for adopting physical restraints. Also, we should make efforts and attentions to reduce or abolish physical restraints in order to protect the elderly human rights. 본 연구는 신체억제에 대한 인식과 태도를 파악하기 위해 노인요양시설의 요양보호사를 대상으로 시도된 조사연구이다. 연구대상자는 노인요양시설에 근무하는 요양보호사 153명을 대상으로 하였다. 자료수집은 구조화된 설문지를 사용하였고 수집한 자료는 기술통계 및 t-test, ANOVA, Scheffé test 및 Pearson Correlation Coefficient로 분석하였다. 연구 대상자의 신체억제에 대한 인식 정도는 전체평균 2.83점(5점 만점)이었고, 대상자의 신체억제에 대한 태도 정도는 전체평균 3.56점(5점 만점)이었다. 대상자의 신체억제에 대한 인식과 태도 간에는 통계적으로 유의한 순상관관계(r=.31, p<.001)가 있는 것으로 나타났다. 본 연구결과 신체억제에 대한 인식과 태도 점수가 낮은 문항에 대한 체계적인 교육의 필요성을 확인하였다. 따라서 신체억제의 적절한 사용방법에 관한 실제적이고 효과적인 교육프로그램의 개발이 필요하며, 신체억제 적용기준과 관련된 지침개발이 필요하다. 향후 노인의 인권보호를 위해 신체억제 감소 및 폐지를 위한 노력과 관심이 요구된다.

일 정신병원에서 발생한 강박 처치에 관한 연구

안효자,김은하,정영해,안정심,조원애,박정화 병원간호사회 2013 임상간호연구 Vol.19 No.3

Purpose: The purpose of this study was to describe restraint use in care of patients with psychiatric disorders in an attempt to avoid unnecessary restraint use and provide information for developing standards regarding restraint use as a therapeutic maneuver. Methods: For this descriptive study, discharge records from N National Mental Hospital in the year 2009 were reviewed by trained nurses during Dec. 24, 2010 and Mar. 31, 2011. There were 596 restrains applied on 232 of 1,322 discharges. Data collected include general characteristic of patients, the frequency of restraint use, time since admission when restraint was applied, time of the day when restraint was applied, duration of restraint application, place of occurrence, reasons for restraint use, and degree of damage to the patent. Work experience of nurses who applied restraints, number of workforce at the time of restraint, and season of the year was also identified. Descriptive statistics, Chi-square test, t-test, ANOVA, Scheffè and Jonckheere-Terpstra were applied using SPSS 14.0 to analyze the data. Results: There were 596 restraint uses among 232 patients. Restraints were applied most frequently on males in their 40s, patients diagnosed with schizophrenia, and patients repeating admissions more than 6 times. Restraints were frequently applied within first week following admission, between 16:00 and 20:00, and the average duration of restraint was 5 hours. There were significant differences according to diagnoses of patients in the season restraint occured, time, place of occurrence, reason for restraint, and duration of restraint. Patients with alcoholism received longer restraint application. Conclusion: In order to avoid unnecessary restraint use in patients with psychiatric disorders, nurses and other health care team members need to acknowledge a group of patients such as patients with schizophrenia and alcoholism who relatively frequently restrained or receiving longer restraint. Reasonable and careful decision need to be made when applying restraint in the care of patients with alcohol problem.

노인요양시설에 근무하는 간호요원의 억제대 적용 경험

김덕희,김춘미,김은만,박명숙 노인간호학회 2011 노인간호학회지 Vol.13 No.2

Purpose: The purpose of this research was to describe experiences of nursing home health personnel in using physical restraints. Methods: Qualitative data were collected through individual interviews and focus group interviews with 17 participants from January to May, 2011. All interviews were recorded, transcribed and analyzed by the content analysis method. Results: Seven main categories were conceptualized: 'health personnel applying physical restraints in unavoidable circumstances', 'getting consent of client's family while minimizing the repulsion', 'deliberate decision making process', 'doing right but feeling sympathy and mental anguish', 'ways of coping that minimize using restraints', 'trying to use suitable restraints for elders', 'absence of standardized protocol'. Conclusion: Study results show that health personnel regard physical restraints as an undesirable method but the best way in unavoidable circumstances. Further, because there is no standardized protocol for physical restraints in nursing homes, there are differences in the decision making process and standards among facilities according to role, educational background and work experience of nursing personnel. Results suggest the necessity of quality assurance in standards and protocols for physical restraints in nursing homes, and the importance of developing protocols for restraints and including appraisal standards for restraints in nursing home quality evaluation criteria.

요양병원 재원 노인의 신체적 억제대 사용과 관련 요인

고영주(Yeong Ju Ko),하선미(Sun-Mi Ha) 한국산학기술학회 2019 한국산학기술학회논문지 Vol.20 No.9

본 논문은 요양병원에 재원 중인 만 65세 이상 노인들의 신체적 억제대 사용 실태와 관련된 요인을 확인하기 위해 시도된 서술적 조사연구이다. 자료수집은 2018년 3월 3일부터 3월 29일까지 4개의 요양병원에 재원 중인 만 65세 이상의 노인환자 전산 의무기록을 통해 시행되었다. 자료 분석은 기술적 통계, Pearson correlation coefficients 및 logistic regression을 사용하였다. 연구결과 요양병원 재원 노인의 신체적 억제대 사용률은 83.7%였으며, 가장 많이 사용된 신체적 억제대 유형은 침상난간으로 93.8%의 사용률을 확인하였다. 또한 신체적 억제대 사용에는 낙상 위험점수와 양의 상관관계를, MMSE와는 음의 상관관계가 있었다. 회귀분석 결과로는 낙상 위험점수, MMSE, 치료기구 개수가 신체적 억제대 사용 관련 요인으로 확인되었다. 따라서 낙상위험도가 높은 노인 환자의 경우, 인지장애가 심한 경우, 치료기구의 개수가 많아 유지하기 위해서 신체적 억제대를 사용하는 것으로 확인되었다. 본 연구결과의 신체적 억제대 사용과 관련된 요인을 통해 노인 환자들에게 신체적 억제대가 아닌 대안을 먼저 적용 할 수 있도록 임상간호실무는 변화되어야 할 것이다. The propose od this study was to examine the extent of using physical restraint on elderly patients (over 65 years old) and who were patients in long-term care hospitals. The data was collected, from March 3 2018 to March 29 2018, from the electronic nursing records by using a recording tool, and clinical observation was also used for assessing the use of physical restraint and the related factors. Descriptive statistics, Pearson correlation coefficients and logistic regression were then performed. The usage rate for physical restraints in long-term care hospital was 83.7%, and the most common type of physical restraint was side rails. The use of physical restraints showed a positive correlation with the fall risk scores and a negative correlation with the MMSE. Logistic regression analysis showed that the Fall Risk Score (OR=1.02, 95% CI=1.01∼1.03), MMSE (OR=0.94, CI=0.88∼0.99) and the use of medical devices (OR=0.80, 95% CI=0.65∼0.98) were related with using physical restraints. Therefore, it was confirmed that physical restraint was used in cases of a high risk of falling, severe cognitive impairment and the use of complex and fragile medical devices to treat the patient. Clinical nursing practice should be changed so that treatment alternatives can be applied for elderly patients rather than using too many physical restraints.

간호대학생의 윤리적 가치관 관련 요인: 신체보호대 사용에 대한 인식과 태도, 간호전문직관 중심으로

신성원,정선영 대한의료커뮤니케이션학회 2023 의료커뮤니케이션 Vol.18 No.2

Purpose : This Study is designed to identify factors related to ethical values that can help medical students preparing to become healthcare professionals make better ethical judgments in the face of conflicting opinions. Methods : This study is based on 114 Nursing students in University, preparing and studying to become healthcare professionals. The Data obtained from questionnaires to research perceptions of physical restraints use and attitudes regarding use of restraints, nursing professional values, and scale affect ethical values were analyzed using the SPSS/WIN 21.0. Results : To research the effects of perceptions of physical restraints use, attitudes regarding use of physical restraints and nursing professional values on ethical values, a hierarchical regression analysis is conducted with three models. In Model 3, as the last step, the perceptions of physical restraints is not a significant predictor of ethical values. However, the attitudes regarding use of restraints and the nursing professional values are related to ethical values. Conclusion : The formation of deontological ethics, which begins with the proposition that life is important, can be approached through education related to nursing professional values and education related to physical restraints.

중환자실 환자의 물리적 억제대 적용 여부에 따른 신체손상, 정서반응 우발적 치료기구 자가 제거 발생 비교

이미미,김금순 병원간호사회 2012 임상간호연구 Vol.18 No.2

Purpose: This study was done to compare the physical injury, emotional response and unplanned self-removal of medical devices in patients with physical restraints and patients not restrained. Methods: Eighty patients admitted to the intensive care unit (ICU) of a university hospital in Seoul participated in this study. Forty patients made up each group and the group not restrained was matched with the restraint group for age and history of smoking and alcohol consumption. Data on occurrence of physical injury, intensity of anxiety, stage of agitation and unplanned self-removal of medical devices were collected by observation and medical chart review using a structured instrument. Statistical processing of collected data was done with the SPSS WIN 17.0 program. Results: The physically restrained group experienced more physical injuries and recorded significantly higher levels of anxiety and agitation than the unrestrained group. However, there were no significant differences between the groups in occurrence of unplanned self-removal of medical devices. Conclusion: Results indicate a need for critical care nurses to carefully monitor physical injuries and emotional responses of physically restrained patients and to develop nursing interventions to prevent adverse effects associated with restraint use. There is also a need to develop patient safety guidelines when using physical restraints.