폐암 환자의 활동상태, 불안, 우울, 사회적 지지, 증상경험과 기능적 상태의 관계: 불쾌감이론 기반으로

김금순 ( Keum Soon Kim ),이명선 ( Myung Sun Yi ),방경숙 ( Kyung Sook Bang ),조용애 ( Young Ae Cho ),이정림 ( Jung Lim Lee ),이은 ( Eun Lee ) 서울대학교 간호과학연구소 2013 간호학의 지평 Vol.10 No.2

본 연구는 불쾌감 이론을 기반으로 생리적 요인(폐암 병기와 활동상태), 심리적 요인(불안과 우울), 상황적 요인(사회적 지지)과 증상경험 및 기능적 상태와의 관계를 파악하여 폐암 환자의 증상경험을 관리하는 간호실무에 적용하고자 시행되었다. 본 연구에서 대상자가 지각하는 증상경험은 일반 암 관련 증상과 폐암 특이 증상 점수를 합친 것으로 평균 12.62점이었다. 이는 일반 암 관련 증상을 살펴 본 Baek10)의 27.7점과 Lee와 Kim19)의 23.1점과 비교 시 낮았으며, 일반 암 관련 증상과 폐암 특이 증상 점수를 함께 측정한 Lee3)의 평균 17.15점보다 낮은 점수였다. 이러한 차이는 연령과 현재 치료에 의한 것으로 생각된다. 본 연구의 대상자는 70세 미만으로 60대가 50.5%를 차지한 반면에 Baek10)의 연구에서는 60대 이상이 66.5%인 것을 보면 연령이 증가할수록 증상이 심하다는 연구 결과7)를 지지하고 있다. 특히, 폐암은 연령이 증가할수록 발생이 높아져 70대에서의 발생이 34.5%로 가장 높은 것을 볼 때 증상관리에 대한 요구가 높음을 알 수 있다.2) 또한 본 연구에서는 현재 치료를 받고 있는 대상자가 38.6%로 Lee3)의 43.9%와 전체 대상자가 항암화학요법을 받고 있는 Baek10)의 연구와 비교 시 낮았기에 증상경험이 낮은 것으로 생각된다. 또한 대상자가 지각하는 영양상태나 건강상태가 좋을수록 증상경험은 낮은 것을 발견하였다. 그러나 본 연구대상자들의 56.4%가 암을 진단받은 지 2년이 경과하였고, 38.6%가 현재 치료를 받고 있음에도 불구하고 영양상태가 나쁘다고 인지하는 경우는 3.0%였으며 또한 지난 한달 간 4 kg 이상의 체중감소가 있었던 경우도 2.0%에 불과하였다. 또한 대상자의 80.2%가 현재 건강상태를 보통 이상으로 지각하고 있었다. 따라서 추후에 대상자의 영양과 건강상태에 대한 지각이 증상에 미치는 영향을 규명할 필요가 있다고 생각된다. 생리적 요인인 폐암 병기, 활동상태와 증상경험 간의 관계를 살펴보면, 폐암 병기와 증상경험 간에는 유의한 상관관계를 보이지 않았으나 활동상태와 증상경험 간에는 유의한 중등도의 순상관관계를 보여 활동상태가 저하될수록 증상경험이 심한 것으로 나타났다. 폐암 환자에 있어서 병기는 치료의 방향을 결정하는데 중요한 변수이나 대상자가 경험하는 증상과는 유의한 관계를 보이지 않았고, 오히려 병기와 상관없이 현재 항암화학요법과 같은 치료 중에 있는 대상자의 증상경험이 더 심각한 것으로 나타났다.3,19) 그러나 본 연구에서는 항암화학요법을 받고 있는 대상자의 증상점수가 그렇지 않은 대상자보다 높았지만 유의한 차이는 아니었기에, 질병 관련 생리적 요인에 대한 추가적인 탐색이 필요하다고 사료된다. 본 연구는 외래를 방문하는 환자를 대상으로 하여 활동상태가 ECOG PS 0에서 2단계로 활동상태가 저하될수록 증상경험은 유의하게 높았고, 이는 선행연구의 결과를 뒷받침하고 있다.3,10,11) 심리적 요인인 불안, 우울과 증상경험 간의 관계를 살펴보면, 불안과 우울 모두 증상경험과 유의한 중등도의 순상관관계를 보여 불안, 우울과 같은 심리적 디스트레스가 높을수록 증상경험이 심하게 나타난다는 선행연구의 결과와 일치한다.20,21) Lee3)의 연구에서 비소세포폐암 환자들이 지각하는 불안과 우울과 같은 디스트레스는 증상경험에 직접적인 영향을 주며, 증상경험을 통해 삶의 질에 매우 부정적인 영향을 주는 요인으로 밝혀졌다. 따라서 NCCN (National Comprehensive Cancer Network)의 권고와 같이 암의 진행단계마다 대상자의 불안과 우울을 평가하여 필요시 적절한 도움을 제공해야 하며,22) 이때 환자의 내적 능력인 극복력의 개념을 도입하는 것은 Lee3)의 연구에서 입증하였듯이 유용한 간호접근이 될 수 있다고 생각한다. 상황적 요인인 사회적 지지와 증상경험 간에는 유의한 상관 관계가 나타나지 않았으며, 이는 사회적 지지와 증상 간에 유의한 직접적인 관계가 나타나지 않았던 선행연구와 일치하였다.3,23) 그러나 Lee3)의 연구에서 사회적 지지는 극복력을 매개로 디 스트레스에 영향을 줌으로써 증상부담에 영향을 미치는 것으로 밝혀졌다. 또한 본 연구의 대상자가 지각하는 사회적 지지를 살펴보면, 20점 만점에 가족지지는 평균 17.69점, 친구지지는 13.63점, 의료인지지는 10.26점으로, 의료인 지지가 가장 낮으며, 이는 선행연구의 결과와 유사하였다.3,10) 이는 직접간호제공자일 뿐 아니라 옹호자, 지지자로서의 간호사의 역할 수행에 대한 도전적인 결과라 할 수 있다. 따라서 간호사의 지지를 증진시킬 수 있는 방법들에 대한 적극적인 모색이 필요하며, 아울러 증상경험에 영향을 미치는 상황적 요인들에 대한 추가적인 파악이 필요하다고 사료된다. 증상경험과 증상경험의 결과, 즉 기능적 상태와의 관계를 살펴보면, 유의하게 높은 역상관관계를 보여 증상경험이 심할수록 기능적 상태는 저하됨을 보여주고 있다. 이는 다발성 증상군의 경증군은 중증군에 비해 기능이 더 좋았다는 Lee와 Park4)의 연구결과와 호흡곤란 증상이 심할수록 기능상태는 저하되었다는 Mohan 등13)의 연구결과와 일치하였다. 또한 부작용 증상을 심하게 호소할수록 기능적 상태가 저하되었다는 Baek10)의 연구결과를 뒷받침하고 있다. 본 연구에서 폐암 환자가 지각하는 증상경험에 영향을 미치는 요인은 심리적 요인(불안과 우울), 생리적 요인(활동상태), 상황적 요인(사회적 지지)의 순으로 나타났으며, 이러한 요인들은 증상경험의 57.8%를 설명하는 것으로 나타났다. 구체적으로 살펴보면, 우울에 의해 증상경험이 43.4% 설명되었으며, 우울과 불안에 의해서는 50.7%설명되었다. 이는 Lee3)의 연구에서 폐암 환자를 대상으로 불안과 우울로 측정한 디 스트레스에 의해 증상부담이 62.8% 설명되었다는 결과보다는 낮았지만, 두 연구결과 모두 불안과 우울이 증상경험에 미치는 영향이 매우 큼을 보여주고 있다. 또한 활동상태가 증상경험에 미치는 영향을 고려하여 활동상태가 매우 저하된 중증의 환자에서의 반복연구가 필요하다고 생각된다. 또한 간호사는 폐암 환자의 증상에 대한 주기적인 평가를 기반으로 체계적인 관리를 제공함으로써 기능상태를 증진시키고 나아가 삶의 질 향상을 도모하는데 주도적인 역할을 담당해야 한다. 폐암 환자가 지각하는 증상경험, 영향요인들과 증상경험 간의 관계, 증상경험과 기능적 상태 간의 관계를 종합해 볼 때, 불쾌감 이론은 폐암 환자의 증상경험을 설명하는데 적합함을 알 수 있었다. 폐암 환자의 증상경험을 적절히 관리하기 위해서는 반드시 불안과 우울과 같은 심리적 요인들에 대한 평가와 환자상태에 맞는 간호접근이 선행되어야 하며, 이러한 과정에 간호사가 적극적으로 개입함으로써 환자 지지자로서의 역할을 수행해야 한다. 또한 불쾌감 이론과 같은 중범위 이론의 간호실무 적용이 더욱 활성화된다면 이론과 실무의 차이를 줄이고 간호실무가 과학적인 배경을 가지고 더욱 발전될 수 있으리라 사료된다. Purpose: The purpose of this study was to investigate the relationships of activity status, anxiety, depression, social support, symptom experience, and functional status in patients with lung cancer based on the theory of unpleasant symptoms. Methods: The participants for this study were 101 lung cancer patients who visited the outpatient department for treatment or follow-up at one hospital in Seoul. Data were collected from January 1 to February 8, 2013 using self-reported questionnaires and clinical records. To measure variables, the functional scale and symptom scale of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30, EORTC QLQ-Lung Cancer 13, Eastern Cooperative Oncology Group Performance Status, Hospital Anxiety and Depression Scale, and Multidimensional Scale of Perceived Social Support were used in this study. The data were analyzed using SPSS 19.0 software for Windows. Results: The symptom experience showed more severity in patients with lower activity status, higher anxiety and depression. With lower activity status and social support, functional status was lower. When anxiety, depression, and symptom experience were higher, functional status was also lower. The significant factors predicting symptom experience were depression, anxiety, activity status, and social support, which explained 57.8% of the variance. Conclusion: These results suggest that psychological factors such as anxiety and depression had a negative influence on the symptom experience of lung cancer patients. Therefore, providing emotional support based on the patients` needs prior to providing symptom management could be a useful strategy for improving symptom experience and functional status.

간호실무에서 신봉이론(Espoused theories)에 대한 탐색적 연구

서문자,김혜숙,이은희,박영숙,조경숙,강현숙,임난영,김주현,이소우,조복희,이명하,지성애,하양숙,손영희,권성복,김희진,추진아 성인간호학회 2001 성인간호학회지 Vol.13 No.1

As a nursing practice involves nurses' actions in a specific context of health care, this study has focused on exploring the espoused theories in nursing practice within the action science perspectives, Espoused theories are the belief, principles, and rationale expressed by the practitioner as guiding her/his actions in a situation of practice. The data were analysed qualitatively and 25 elements of espoused theories of nursing action were identified and clustered into 6 categories. The 25 elements of espoused theories are as follows: The clinical nurse worked in wholistic and individual nursing, focussed on the patient's needed, comfort and supportive nursing (5 theories of nursing goal) ; excellent skills, knowledge based, assessment and data collection, explaining, educating or a scientific basis(6 theories of nursing intervention): advocacy, value oriented, treatment, account- ability and commitment(4 theories of nursing ethics) ; human respect. partnership, trust(3 theories of patient-nurse relationship) : knowledgable, accumulated clinical experiences and personally lived experiences. positive perspectives(4 theories of nurse), role of intervention. rewarding peer relationship(3 theories of situations) The above mentioned espoused theories are similar to that of nursing textbooks which students learned through basic nursing education and almost the same as the Acts ofa Nurse in Korean. However, we are doubtful whether nurses actually do as they think. Therefore. it is recommended to review the theories-in-use in order to and any discrepancies between the espoused theories and the reality of nursing actions

알코올의 섭취가 흰쥐의 혈액과 간의 지질대사에 미치는 영향

이명숙,김영연,김효숙,김매하,전진순,서진숙,송선미,양영재,윤원손,이미라,이효영,정승현 誠信女子大學校 生活文化硏究所 2004 生活文化硏究 Vol.18 No.-

To investigate the effects of ethanol on the lipid metabolism in blood and liver, twenty one male Sprague Dawley rats had orally taken the 25% alcohol and 50% alcohol by 5g per Kg of weight during 3 weeks after the adjusting period. For the energy balance, 85% sucrose and 45% sucrose was added in control group and 25% alcohol group each. The weight was reduced by alcohol treatment according to the levels, otherwise the weight of liver and heart was little increased in alcohol groups rather than in control without significance. Moreover, RBC, WBC, hemoglobin and hematocrit were increased by alcohol treatment according to the levels without significance. Otherwise, adjusted bilirubin levels by 100g of weight was significantly increased by alcohol treatment dose dependently. Alcohol induced RBC degradation and increased circulated bilirubin because of liver damage. For blood lipid profiles, blood cholesterol was increased in 50% of alcohol group compared to that of 25% and control groups, otherwise, blood triglycerides (TG) was increased by 30% in 25% alcohol groups rather than in control but not significantly different. The hepatic lipid composition, cholesterol levels in alcohol treatment groups was lower than those in control. The hepatic TG was not influenced by alcohol treatment. The two reasons of decreasing hepatic lipids were suggested by 85% sucrose of control for energy balance more synthesized cholesterol and TG than those in 25 or 50% alcohol groups, and by cholesterol and TG could not be synthesized because of liver damage from alcohol.

박쥐혈청의 일본뇌염 Virus에 대한 중화항체

李淵台,李潤日,金慶淑,金明淑,李鍾訓 中央醫學社 1973 中央醫學 Vol.25 No.3

Bats seemed to be a susceptible animals to infection with some arboviruses but insufficient evidence precludes the determination of their relative importance in maintaining the Japanese encephalitis virus in nature. An attempt was made to evaluate the neutralizing antibody against Japanese once halitis virus on the sera of bats. The eighty-four serum samples were obtained from bats (Pipistrellus abramus Temminck) which were captured at the Mt. Song-Chu and Mt. Do-Bong in July, 1971. Neutralizing antibody against Japanese encephalitis virus was demonstrated from 5 (6.0%) out of 84 serum specimens by means of plaque inhibition method.

Purge & Trap-GC를 이용한 의약품 필름코팅 정제 중 잔류용제에 관한 연구

장준식,이명자,소유섭,문춘선,이주헌,박희라,김진숙,강경모,이선옥,방성연,유미자,유문균,금오성,이병욱 식품의약품안전청 2000 식품의약품안전청 연보 Vol.4 No.-

의약품은 약물을 생체에 적풋하기 위하여 유효성분의 효과가 언제나 일정하게 확보되고 사응에 편리하도록 만들어지는 것이므로 유효썽분 이외에 약효에 영향을 주지 않는 성분이 첨가되는 경운가 많다. 이 때 사용되는 용매들은 제피의 광택 및 건쪼시간의 단축 등을 위하여 휘발점이 낮을 용매들이 주로 사용되어진다. 본 연구는 의약품 필름코팅정제 중 잔류용매 4종(chlorofonr benzen, trichloro ethylen, 1,4-dioxane)에 대한 변형된 pirge & trap-GC 장치를 이용한 동시분석방법을 개발하였으며, 각 표준품의 RSD 값은 chloroform 3.03%, benzen 3.17%, trichloroethylen 3.69% and 1,4-dioxane 3.41%였다. 또한 시중 유통중인 의약품 50종에 대하여 잔류웅매 양을 측정하였으며, 검출되는 잔류용매는 한 건도 없었다. This study nras carried out to develope the analytical method for the mixture of chlorefonn, benzen, trichloroethylen and 1,4-dioxane simultaneously and determine the remainingorgauic solvents in coating tablets by Purge & Trap-GC. The results were as follouFs ; 1. Chloroform, benzen, trio:tloroethylen and 1,4-dioxane separated by tenax #5 trap by HP-624GC column by terrlperature programming. The peaks were separated completely at retentiontime of 6.88min for chloroform, 8.21min for benzen, 10.38miu for trichloroethylen and 11.95minfor 1,4-dioxane. 2. Standard RSD were individually chloroform 3.03%, benzen 3.17%, trichloroethylen 3.69%and 1,4-diorane 3.41%. 3. 60 samples were not detrcted chloroform, benzen, trichloroethylen and 1,4-dioxane.

암환자가 지각한 사회적지지, 희망과 삶의 질과의 관계

태영숙,강은실,이명화,박금자 고신대학교 전인간호과학연구소 2002 전인간호과학연구 학술모음집 Vol.- No.-

The Relationship among Percieved Social Support, Hope and Quality of Life of Cancer Patients Tae, Young Sook. Kong, Eun Sil. Lee, Myung Hwa. Park, Geum Ja The purpose of this study was to investigate the relationship among percieved social support, hope and Quality of life of the cancer patients and to gain the baseline data for development of nursing intervention program for promoting quality of life in cancer patients. The design of this study was a cross sectional correlational survey. The subjects were 220 out and in-cancer patients in 5 general hospitals in Pusan The data were collected from July 2 to August 1,2001. The instruments were the Percieved social support scale(16 items, 5 point scale) had developed by Tae(1986), Hope scale(12 items, 4point scale) developed by Nowotny(1989) and Quality of life scale(31 items, 10 point scale) developed by Tae et. al(2000). The data was analyzed by the SPSS/PC+ program using frequency & percentage, item mean & standard deviation, t-test, ANOVA & Scheffe test, Pearson's correlation coefficient. The results of this study was as follows : 1) The item mean score of quality of life was 6.05±1.16 (range 0-10) .The heighest score of subarea of the quality of life was the spiritual wellbeing area (7.09±1.63) and the lowest score was social wellbeing area(5.53±1.65). The mean score of perceived social support was 52.65±10.32 (최고 1, 최저 80). The mean score of family support was32.71±6.66 (range 1- 40) and the mean score of medical team support was 19.93±5.95 (range 1- 40). The mean score of Hope was 37.02±5.64 (range 1-48). 2) There were statistically significant difference in the score of quality of life according to the life effect of religion (F=3.97, p=0.00), treatment method(F=2.94, p=0.01), area of diagnosis (F=3.48, p=0.01), stage of disease (F=13.74, p= 0.00). 3) There was significant correlation between perceived social support(r=0.44, p= 0.000 ; family support: r=0.334, p=0.000, medical support; r=0.395, p=0.000), hope(r=0.563, p= 0.000) and quality of life. In conclusion, there was a significant relationship among perceived social support, hope and quality of life. Therefore perceived social support, hope intervention programs should be developed to improve the quality of life in cancer patients.

노인의 영적 간호요구

최미혜,김경희,김귀옥,김기숙,김수강,김정신,김춘숙,노흥진,박지연,성혜연,오명선,이선희,이원옥,이윤영,이현수,장명재,차혜경,채정선,홍상희 중앙대학교 의과대학 간호학과 간호과학연구소 2001 중앙간호논문집 Vol.5 No.1

This study was designed to exam the aged's needs for spiritual nursing care. The purpose was to serve as a basis for the development of spiritual nursing practice. The major findings are as follows : 1. The degree of needs for spiritual nursing care as area was that needs of love and relationship mean 22.0, needs of meaning and object mean 28.2, needs of forgiving mean 13.5. Total needs for spiritual nursing care mean 63.7, which was on the upper middle level. The needs of meaning and object was rated highest. 2. Among the general characteristics of the subjects, needs of love and relatiohship wasn't significanlty different. 3. Among the general characteristics of the subjects, needs of meaning and object was significantly different according to two factors : age(F=7.260, p=0.001), religion(F=5.275, p=0.001). Higher needs of meaning and object was possessed by the older than the younger, by the one who have religion than the other. 4. Among the general characteristics of the subjects, four factors made a significantly difference to needs of forgiving : sex(t=-2.851, p=0.006), age(F=8.201, p=0.001), religion(F=6.928, p=0.000), disease(t=2.327, p=0.024). Higher needs of forgiving was possessed by man than woman, by the older than the younger, by the one who have religion than the other, by the one who have disease than the other.

초등학교 아동의 인성발달을 위한 심리교육 프로그램의 개발 및 적용

이명숙 대구교육대학교 1999 論文集 Vol.34 No.-

Immunoblot법을 이용한 Anisakis증의 혈청학적 진단

이영주,주경환,정명숙,임한종 고려대학교 의과대학 1990 고려대 의대 잡지 Vol.27 No.1

Acute gastric anisakiasis is rather easily diagnosed by endoscopy or radiological technique. But preoperational diagnosis of acute intestinal anisakiasis is very difficult. Furthermore, the diagnosis of chronic anisakiasis is more difficult because the worm invade the stomach or intestinal wall and finally to degenerate. Serodignosis may helpful in such diagnostic difficulties. However, any of the serodiagnostic method in anisakiasis has limitations for practical use due to cross reactions. In this context, the study was performed to observe the specifically reacting antigenic bands of crude extract Anisakis larval worm antigen and their reaction to the serum antibody obtained from experimentally immunized and infected rabbit, confirmed human anisakiasis and other helminthic infection cases using SDS-PAGE and EITB. The results obtained were as follows; 1. Among 12 cases of confirmed anisakiasis, eleven showed positive reactions by ELISA. The average 0. D. value of the test was 1.035. Two from 4 D. latum infected cases and one from 4 A. lumbricoides infected cases showed positive reaction respectively. 2. Silver stained SDS-PAGE of crude Anisakis larval worm antigen revealed more than 45 antigenic protein bands. Among them, 186, 76, 72, 65, 59~62, 54, 52, 50, 49, 46, 43, 40, 33, 32, 29, 24, 23, 18, 17, and 13Kd bands were major bands. Protein bands of 12Kd relative molecular weight was observed in A. suum extract antigen, on the other hand 29 and 46Kd bands were not observed. 3. Major antigenic bands of crude Anisakis worm antigen which reacted with serum antibody of confirmed anisakiasis cases were 186, 116, 72, 52, 46, 40, 33 and 32Kd band. Most of them also reacted with the sera of D. latum, A. lumbricoides, T. trichiura infected cases except 46Kd band which showed positive resuits only with sera of anisakiasis. So, this band could be considered as diagnostic band for anisakiasis especially for the identification of cross reactions against A. lumbricoides and D. lafum infection. 4. Although, low molecular weight bands such as 33 and 32Kd were observed as species specific, the sensitivity of that fractions were obviously low. Consequently, the diagnostic use of the low molecular weight protein bands were not promising. 5. Serum of rabbit immunized with Anisakis larval worm antigen also showed positive reaction on 46Kd bands, but that of A. suum and T. canis did not. These results were in accord with the results in human cases. In conclusion, 46Kd bands of crude Anisakis larval worm antigen can be considered as a diagnostic one for the identification of cross reactions using immunoblot technique.

유아의 기질과 정서능력이 어머니와의 상호작용에 미치는 영향

이명숙,김영희 충북대학교 교육 ·생활연구소 생활과학연구센터 2003 생활과학연구논총 Vol.7 No.1

The purpose of this study was to investigate the effect of children's temperament and emotional competence on affective and controlling parent-child interaction. Subjects of this study were consisted of 219 mothers having 3 to 5-year-old children drawn from 7 preschools in Chungbuk province. The pilot study was used to examine the applicability of survey instrument. Data were analyzed by SPSSWIN with the method of frequency, percentage, t-test, correlation, and multiple regression. The results of this study were as follows: 1. There were significant differences in children's activity level and empathy according to children' sex. The level of boy's activity was higher than girls. The level of girls' empathy was higher than boys. 2. Children's adaptability, regularity, response sensitivity, and activity were significant factors for predicting affective mother-child interaction. Also, controlling mother-child interaction was only significantly influenced by children's activity. 3. The level of children's cognitive ability of self and other's emotion, emotional vocabulary expression, empathy, and emotional control were significant factors for predicting affective mother-child interaction. Also, controlling mother-child interaction was mot significantly influenced by children's emotion competence. 4. Children's temperament was more associated with affective mother-child interaction than children's emotional competence. This research indicated that children's temperament explained mothers' affective and controlling interaction with children whereas children's emotional competence only explained mothers' affective interaction with their children.