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중년기 및 노년기 류마티스 관절염 환자의 삶의 질과 자살 생각*
은영 한국노년학연구회 2022 한국 노년학연구 Vol.31 No.3
The quality of life of patients with rheumatoid arthritis (RA) is very poor due to pain or weakness. This study was to examine the relationship between quality of life and suicidal ideation based on the medical history and age of middle-aged and older RA patients, and it was conducted with the aim of exploring nursing interventions to improve the quality of life of RA patients. The research participants were 1,546 community dwellers (297 men & 1,249 women) who aged 40 years or older with RA among the Korea National Health and Nutrition Examination Survey (KNHANES) respondents from 2007 to 2020, while the research data were a part of the KNHANES’ raw data which composed of 15 questions; demographic data of the patients, disease-related characteristics, suicide-related information, and responses of the EQ-5D scale. The results showed that the RA patients who reported to have suicidal ideation were about 15.8% of them (n=244), and their data analyzed the risk of suicidal ideation depending on the patients’ medical history or age through logistic regression analyses. Regardless of the patient’s age or medical history, the more discomfort caused by RA, the greater the risk of suicidal thoughts. As for the older patients, the overall pain and discomfort were more severe than the younger patients. It means that quality of life of people who suffer from RA in old age might become poorer due to both RA itself and senility. Thus, the need for nursing intervention that can maintain and enhance physical activity-related exercise skills of RA patients was highlighted in the context of improving the quality of life for hospitalized as well as community-dwelling patients. 류마티스 관절염(Rheumatoid Arthritis, RA) 환자의 삶의 질은 통증이나 쇠약 등에 의해 매우 낮은 편이다. 본 연구는 중년 및 노년기 RA 환자의 병력이나 나이를 토대로 삶의 질과 자살 생각의 관계를 살핀 것이었는데, 이는 RA 환자의 삶의 질 제고 차원에서의 간호 중재 방안을 모색하기 위한 기초 연구였다. 연구대상자는 2007년부터 2020년까지의 국민건강영양조사(KNHANES: Korea National Health & Nutrition Examination Survey)에 참여했던 자들 가운데 RA를 앓고 있는 40세 이상 1,546명(남성 297, 여성 1,249)이었다. 연구 자료는 KNHANES의 원시자료 중에서 연구대상자의 인구통계학적 정보, 질병이나 자살 관련 정보, 그리고 삶의 질을 측정하는 EQ-5D 척도의 자료였다. 자료를 분석한 결과, RA 환자 중에서 자살을 생각했다고 응답한 비율은 약 15.8%(n=244)였는데, 그들의 자료를 병력(10년 전후)이나 나이(65세 전후)로 구분하여 자살 생각 위험성을 비교했다. 환자의 나이나 병력에 상관없이 RA로 인한 불편함이 심할수록 자살 생각의 위험이 커지는 편이었으며, 노년 집단의 경우 전반적으로 그 불편함이 더 심한 편이었다. 이와 같은 결과는 노년기에 RA를 앓게 되면 질환 및 노쇠로 인해 불편함이 더 심할 수 있음을 의미한다. 본 연구는 만성질환인 RA 환자에게 나이와 병력에 따른 맞춤형 간호중재를 제공하기 위하여 국가 자료를 분석한 것으로, 본 고의 후반부에서는 RA 환자의 삶의 질을 높여줄 수 있는 간호중재의 핵심으로 나이와 병력이 증가함에 따라 입원이나 입소 상태의 환자와 지역사회에 거주하는 환자 모두에게 신체적 활동에 관계되는 운동능력의 유지 및 증진임을 강조했다.
은영 대한류마티스 건강전문학회 1995 근관절건강학회지 Vol.2 No.1
Rheumatiod arthritis is the one of the chronic diseases, one of its major symptoms is a chronic pain. Despite developing medical treatment and surgical techniques, it is suggested that to control the pain is the goal of the treatment. But pain is an inner experience and even those closest to the patient cannot truly observe its progress or share in its suffering. The National Academy of Sciences Institute of Medicine's report on Pain and Disability concluded that these is no objective measure of pain-(exactly) no pain thermometer-nor can there ever be one, because the experience of pain is inseparable from personal perception and social influence such as culture. To explore chronic pain experience is to understand the process and property of the patient's perception of pain through the response to pain, the coping with pain, and the adaptation to pain. Therefore a qualitative study was conducted in order to gain an understanding of pain experience of patients with RA in Korea. I used naturalistic inquiry as a research methodology, which had 5 axioms, the first is that realities are multiple, constructed, and holistic, the second is that knower and known are interactive, inseparable, the third is only time and context bound working hypotheses(idiographic statements) are possible, the forth is all entities are in a state of mutual simultaneous shaping, so that it is impossible to distinguish causes from effects and the last is that inquiry is value-bound. Purposive sampling was conducted as a sampling. 20 subjects who experienced pain over 10 years, lived in middle-sized city and big city in Korea, and 17 women and 3 men. The subject's age was from 32 to 62 (average 48.8), all were married, living with their spouse and children, except two-one divorced and the other widow before they became ill. I collected data using in depth structured interview. I had interview two or three times with each subject, and the interviews were conducted at each subject's home. Each interview lasted about two hours an average. A recording was taken with the consent of the subject. I used inductive data analysis-such as unitizing and categorizing. Unitizing is a process of coding, whereby raw data are systematically transformed and aggregated into units. Categorizing is a process whereby previously unitized data are organized into categories that provide descriptive or inferential information about the context or setting from which the units were derived. This process is used constant comparative method. The pain controlling process is composed of behavior of pain control. The behaviors of pain control are rearranging of ADL, hiddening role conflict, balancing treatment, and changing social relation. Rearranging of ADL includes diet management, sleep management, and the adjustment of daily life activities. The subjects try to rearrange their daily activities by modified style of motions, rearranging time span & range of activities, using auxillary facilities, and getting help in order to keep on the pace of daily life. Hiddening role conflict means to reduce conflicts between sick role and their role as a family member. In this process, the subjects use two modes, one is to control the pain complaints, and the other is to internalize the value which is to stay home is good for caring her children and being a good mother. To control pain complaints is done by 'enduring', 'understanding' the other family members, or making them understood in order to reduce pain. Balancing treatment is composed of two aspects. One is to keep the pain within the endurable level, the other is to keep in touch with medical personnel in order to get the information of treatment and emotional support. Changing social relation is made by information seeking and sharing, formation of mutual support relation, and finally simplification of social relationships. The subjects simplify their social relationships by refraining from relations with someone who makes them physically and psychologically strained. In particular the subjects are apt to avoid contact with in-laws, and the change of relation to in-laws results in lessening the family boundary. In the course of this process, they confront the crisis of family conflict result in family dissolution. This crisis is related to the threat of self-existence. Findings from this study contribute to understanding the chronic pain experience. To advance this study, we should compare this result with other cases in different cultural contexts. I think to interpret these results, Korean cultural background should be considered. Especially the different family concept, more broader family members and kinship network, and the traditional medical knowledge influences patients' behavior.
은영 대한류마티스 건강전문학회 1996 근관절건강학회지 Vol.3 No.2
The purpose of this study is to describe the acknowledgement of the cause of the illness in the patient with RA. I used naturalistic inquiry as a research methodology. The purposive sampling was conducted. 23 subjects who experienced RA, lived in middle-sized city in Korea, and 19 women and 4 men. I collected data using indepth structured interview, "hat is the acknowledgement of the cause of the illness?" I used inductive data analysis-such as unitizing and categorizing. This process is used constant comparative method. Summerising the results of this study, the acknowledgement of the cause of the illness are composed of physical constitution, fatalism, the attribution of physical overload, the attribution of stress, the lack of nutrition. The factors which affect the acknowledgement of the cause of the illness are composed of internal factors, external factors, environmental factors. The internal factors are the weakness of the childhood, the illness experience in the family members, juvenile rheumatoid arthritis, personality, lack of nutrition. The external factors are pregnancy, delivery, role burden and conflict, economic problem. The environmental factors are humid condition, abrupt environmental change. It is needed to explaine the coping pattern according to the acknowledgement of the cause of the illness in the next research.
서예 및 운동 프로그램이 노인의 자아존중감, 스트레스, 삶의 질 및 신체적 건강에 미치는 효과
은영,우선혜,김은심,김향숙 지역사회간호학회 2008 지역사회간호학회지 Vol.19 No.1
Purpose: This study was conduct to develop a calligraphy and exercise program and examine its effects on the self-esteem, stress, quality of life and physical health of the elderly in a community health post in Korea. Method: The subjects consisted of 43 elders (experimental group: 20, control group: 23) who were attending the program of a community health post. The experimental group participated in the calligraphy and exercise program for 12 weeks (3 times a week, 120 minutes a session). Data were collected before and after the program. Results: 1) The experimental group showed significant improvement in self-esteem and quality of life and significant reduction in stress compared to the control group. 2) The experimental group and the control group were not significantly different in muscle strength and flexibility. Conclusion: These results suggest that the calligraphy and exercise progra. 우리나라에서는 농어촌 보건의료취약지역의 보건의료 서비스의 이용의 접근성을 높이고 포괄적인 일차보건의료를 제공하기 위하여 1980년 12월 농어촌 보건의료를 위한 특별조치법을 제정하고 전국의 농어촌 지역에 보건진료소를 설치하기 시작하였다. 2006년 현재 약 1900여명 가량의 보건진료원들이 활동하고 있으며, 일 보건진료소가 관할하는 인구수가 약 1000명이므로 전국으로는 약 2백만명의 농어촌 인구의 일차건강관리를 담당하고 있다. 보건진료소의 역할은 사회적 변화와 농어촌 지역의 인구변화에 따라 변화하였으며, 보건진료원의 일차적인 업무인 의료 서비스, 모성 간호, 신생아 간호, 가족계획, 결핵관리 등은 개원당시에 비하여 크게 줄었으며, 전체업무중 건강교육(31.4%), 지역사회 건강서비스(10.9%)는 크게 증가하여 보건진료소가 지역사회의 일차건강관리 기관이면서 동시에 주민들의 건강증진을 위한 센터로서 역할이 확대 개편되고 있다(Youm & Kwon, 2004).
은영 慶尙大學校 1996 論文集 Vol.35 No.2
Clinical practice in nursing education provides an oppurtunity for students, through the process of applying theoretical knowledge to practice and training nursing skills, to be an elaborated novice of nursing profession. The purpose of this study is to ecamine what is it that nursing students do in a clinical area. The perspective of activities was chosen to liiustrate, through the self-reporting of activity check list, the pattern and utilization of time during a scheduled clinical experience for nursing students. Findings are summerized in three categories of time for training the nursing skill, time for applying the nursing process, time for attending the seminar. The time for training the nursing skill constituted 46.8% of all clinical practice time. Time for applying the nursing process used 17.5% of all time. Time for attending the seminar used 23.1% of all time. Nursing students want to take active role in clinical practice, but inappropriate role model, paucity of learning material, inadequate interpersonal relationship, overload of homework were obstacles to be active learners. To improve the problem-solving , we should change the practice mode, especially to lengthen the time for applying the nursing process and to shorten the time for training the nursing skill and get rid of the obstacles to active learning.
은영,구미옥,김은심,강영실 노인간호학회 2001 노인간호학회지 Vol.3 No.1
The purposes of this study were to investigate the health status and health promoting behaviors and compare the need for health related social services for older people in the senior welfare center (SWC) and the senior citizens' clubs (SCC). The data were gathered from April to May, 2000. The subjects were registered and regularly attended the SWC and SCC. The research method was a survey using a questionnaire. The results of the study are as follows: 1. The number in the sample was 284, consisting of 145 people at SWC and 139 at SCC. The mean age of the sample was 70.75. The number of males, married status, employed status, and self-earning were greater at SWC, while the mean age was younger and the educational level was higher at SWC. 2. The health status of the elderly and the responsibility of the health was "so, so," and there was no difference between the two groups. But the health concern, the recognition of aging and the satisfaction of aging were more positive from the SWC subjects than from the SCC subjects. 3. The mean score of health promoting behavior was 9.31(range 0-17) at SWC and 8.96 at SCC. There was no difference between the two groups, but the scores on exercise, health assessment, management of stress, and maintenance of sexual relationship were higher at SWC than from those subjects at SCC. 4. The needs for health education at SWC from greatest to least, in order were: the prevention of dementia, the maintenance of memory and mental ability, and nutrition and exercise of the elderly, and finally the preparation for death of self and others. The needs for health education at SCC in order were: the prevention of dementia, nutrition, exercise of the elderly, and the health problems and self care of the elderly, with the least being emotional problems, such as loneliness, isolation, and depression, and the preparation for death of self and others. The needs for health related services at SWC were in order from greatest to least: consultation of health, diagnosis and treatment of disease, health education, and at SCC, the order was: health assessment, evaluation of health risk factors, management of chronic disease, and consultation of health status. 5. There was no difference between the two groups in health educational needs. The score of health related service needs at SWC was significantly higher than at SCC. In conclusion, the elderly at SWC were more positive and active in their pursuit of the maintenance and promotion of health than the elderly at SCC. So, for the elderly at SWC, we recommend developing a program for health education and service consisting of prevention of dementia, nutrition and exercise, health problems and self-care of the elderly, and consultation about health. For the elderly at SCC, first of all, we have to develop a program increasing interests and responsibilities for their own health and then a program promoting memory and mental ability, nutrition and exercise, and self care of health problems.