희망과 설명 요인과의 함수적 관계에 대한 메타 분석

김달숙,문원희,안성윤,오현숙,권경희,박문경,최현숙,이미옥,김영주 한국간호과학회 2004 Journal of Korean Academy of Nursing Vol.34 No.5

소생 불가능한 환자에 대한 간호 행위를 찾기 위한 탐색적 연구

김달숙,이혜경 충남대학교 의과대학 지역사회의학연구소 1984 충남의대잡지 Vol.11 No.1

This study was advanced with a view to identify the most desired nursing behaviors of patient's family for almost dying, through this, and to explorate appropriate nursing action intervend in patients almost dying. The 26 family members whose patients were cancers were interviewed at Chung-Nam national University Hospital, Dae-Jeon Eul Ji Hospital, and Dae Jeon Sun Hospital with questionaire which included 52 nursing behaviors items each having 10 grade scale and classified with psychosocial, environmental psychosocial, physical aspects and is generated through in depth literature review from April 15 to May15. he results were analyzed by basic descriptive statistics and were as follows: 1. The ten most desired nursing behaviors by family members were the nurse 'do not abandon patient', keep comfortable positon and change position frequently', `eliminate urine and feces as usual', have humorous talks to the patient frequently' `keep the patient out of suffering (cough, nausea, vomiting)', try to keep the patient to eat his favorite foods, `keep the patient rest appropriately', `ventilate the room and keep the patient inspire fresh air', try for the patient to meet the medical personnel when she or he want', keep the environment out of noise', 2. The ten least desired nursing behaviors were the nurse `act religious rituals with the patient', 'crywith the patien when the cry', `talk to the patient honestly when he keep him informed of his lab data and his condition', `administrate sedatives to the patient to keep him sleep', `try for the patient to take part in a sort of nursing action as much', 'encourage the patient I his grief', 'allow the patient to cry when he want to cry' 'keep and assist the patient his mouth cleaning', 'give the pain medications as often as possible as ordered by doctor', 3. Nursing behaviors of psychological aspects for almost dying patient showed the least quanti-

생의 마지막 단계.삶의 완결.완화간호 모델

김달숙,Kim, Dal-Sook 한국호스피스완화의료학회 2009 한국호스피스.완화의료학회지 Vol.12 No.3

근래의 호스피스 완화 서비스에 대한 국가의 관심과 지원 정책은 매우 고무적이다. 그럼에도 불구하고 호스피스 완화 의료의 정착과 발전이라는 명목을 가지고 우리는 호스피스 완화간호와 관련된 우리 주위의 현실에 비판과 반영의 눈으로 돌아볼 필요가 있다. 본 연구는 호스피스 철학에 부합되는 완화 간호 모델을 찾아내어 생의 마지막 단계에 있는 사람과 가족의 완화 간호에 적합한 모델인가를 심사하는 것은 목적으로 하였다. 소개되고 심사된 모델은 Eagan, Labyak의 호스피스 경험 모델과 Byock의 삶의 완결(life completion)을 위한 성장 모델이었다. 호스피스 경험 모델은 생의 마지막 단계에 있는 환자와 가족의 경험과 가치관에 근거한 임종 간호 모델로서 개개인의 경험의 독특성을 인정하며 환자 가족 개개인의 다 영역의 역동성과 상호작용적 관련성과 다 영역적 특성을 가진 개개인의 상호 관계성을 인정한다. 또한, 생의 마지막 단계에서도 다 영역적 상호 관계성은 긍정적인 성장과 발달을 만들 수 있음을 인정한다. 이 모델은 생의 마지막 단계에 있는 개인과 가족의 개개인 요구에 부합된 삶의 질 개선, 고통 제거, 삶의 완결, 좋은 죽음을 이끄는 완화 간호를 이끌 수 있다고 평가되었다. Byock의 성장 모델은 임종의 시기를 마지막 삶의 발달 단계로 보았다. 이 모델은 생의 마지막 단계에 있는 개인과 가족을 삶의 완결의 과정을 경험할 수 있는 존재로 보았다. 모델은 세속적인 일/사회적인 일/개인적인 관계들/개인 내재적인 영역/초월적 영역들의 세부 항목으로 이루어진 이정표와 발달 과업을 포함한다. 이 모델에서는 전문 의료인이 이정표 및 과업을 이용하여 성장의 주체의 변화를 얼마나 잘 파악하여 내고 도와주는 가가 환자 및 가족의 성장의 열쇠가 되며 한 인간이 인간 실존 안에서 삶을 마칠 수 있게 만드는 결과를 낼 수 있다.그 결과 개인은 평화와 안녕 속에서 삶을 마감할 수 있다. 이 두 모델은 호스피스 철학에 부합되는 완화 간호의 모델로 고려되었다. Despite a recent increased nation's attention given to improving end-life care, we professionals need to be more critical and reflective on our realities surrounding hospice palliative care. The aim of this paper is to suggest that palliative care models can be used for patients/families in the last phase of life and examine whether they are appropriate for caring them in congruence with philosophy of hospice. The hospice experience model (HEM) of Eagan & Labyak and the developmental model of Byock are introduced and examined for their congruence with philosophy of hospice in applying to clinical practice. The HEM as a patient/family value-directed end of life care model emphasizes three principles; unique experience of patient/family, interactions/relationships among multiple dimensions of personhood and between family, and personal growth and development in the face of suffering through a life-completion. The developmental model stipulates dying as the last stage of living, a stage of life cycle in which patients/family may have growth through life-completion in multidimensional relationships of personhood. The model includes the developmental landmarks and tasks for life-completion as the framework to guide a means of professionals' to recognize their opportunity to grow. The landmarks and tasks include worldly and social affair, individual relationships, intrapersonal, and transcendent dimension. The models could work as appropriate palliative care models for patients/families in the last stage of living. The professionals need to be encouraged to apply the models to end of life care setting.

암환자 간호를 위한 희망 측정도구 개발

김달숙,이소우 한국간호과학회 1998 Journal of Korean Academy of Nursing Vol.35 No.4

The purpose of this study was to develop a reliable and valid instrument to measure hope for cancer patients in Korea. This Hope Scale(Kim & Lee Hope Scale ; KLHS ) was developed based on not only critical universal attributes explaining both basic hope (generalized hope) and specific hope but also particular characteristics varing from culture and situation, which were revealed in a comprehensive review of the literature. Initially 60 items were generated from three sources : 36 items from the Q-sample used in the Kim's study, 1992, 21 representative items(statements) from the rest Q-population of the above study, 3 items related to the newly discovered category in the new qualitative study using 10 open ended question(death and dying) from the new qualitative study on the 20 cancer patients. At first 3 items were eliminated by the critique of the content validity experts, who were high experienced nurse, nursing professors. And then 4 items were eliminated in consideration of corrected item total correlation coefficiency, theoretical framework of this study. After that, 14 items were eliminated in comparing two or three items identified with the same meaning in each factor by this research team with factor loading and communality. This Hope Scale was finally constructed with 39 items. Psychometric evaluation was done on 492 adults(104 cancer patients, 388 adults who imagined who were cancer patients ranging from 18 to 76 years old. The results revealed high internal consistency Alpha coefficiency of .9351. Princial Component Factor Analysis with Varimax Rotation resulted in 8 factors with more than 1.0 of Eigenvalue. Referring to Eigenvalues, percent of variances(>60%), reproduced correlation matrix, and our theoretical framework, we decided the eight factors were the best1 solution to represent hope dimensions sufficiently. The eight factors were "confidence in possibility of cure", "sense of internal satisfaction", "being in communion", "meaning of life", "Korean hope perspectives", "belief in god", "self confidence", "self-worth". Among these factors, "confidence in possibility of cure", "sense of internal satisfaction", "Korean hope perspectives" were identified as different hope dimensions from those of Nowotny Hope Scale and Herth Hope Scale. There was significant negative correlation of r=-.4736 between this hope scale and Beck Hopelessness Scale (BHS), and significant positive correlation of r=.3685 between this hope scale and Life Orientation Test (LOT) which indicate convergent and discriminant validity. The range of hope scores was from 71 to 244, with a mean of 171.97(SD=28.16).

An Intervention Model to Help Clients to Seek Their Own Hope Experiences: The Narrative Communication Model of Hope Seeking Intervention

김달숙,김혜숙,Sally Thorne 한국호스피스완화의료학회 2017 한국호스피스.완화의료학회지 Vol.20 No.1

The paper describes The Narrative Communication Model of Hope Seeking Intervention developed by the authors as an approach to help clients to have individually specific hope experiences. The Model is founded upon the existential conceptualization of hope that views hope as subjective, unique experiences of meaning and processes. The Model has been developed based on the findings both in the literature and the authors’ work on the nature of hope and hope experiences and integrating the concept of hope as subjective meanings and experiences, the processes of story-telling and the concept of narrative configuration as a way to engage in person-specific experiences, and person-centered communication. The results of the experiences with the application of the model in a study are used to clarify the model further. The Model incorporating story-telling and narrative construction through person-centered communication is identified in three components–the story-telling, the narrative intervention, and the communication components. These components are processed as an intervention to culminate into personspecific hope experiences in which active participation of clients as the story-teller and of interventionist as the communicative facilitator is required to produce narratives of hope with individual specific thematic plots that become the basis for hope experiences. The application of the Model has shown positive outcomes in clients with successful seeking of own hope experiences. The success of the Model application seems to depend upon interventionists’ understanding of the model and the competency with the application of person-centered communication strategies.

진단 직후 유방암·직장암 환자의 체지방량과 자연 살 세포 활동량

김달숙,전명희 한국간호과학회 2008 Journal of Korean Academy of Nursing Vol.38 No.2

Purpose: To examine the relationship between body fat percentage (BFP) and N-K cell activity (NKCA) in Korean breast and rectal cancer patients just after diagnosis. Methods: With 35 subjects enrolled between November 2002 and May 2003, Bioelectrical Impedance Analysis was used to estimate BFP. FACS Analysis was used to measure N-K cell activity. The relationships between BFP and NKCA were identified by using curve estimation, simple regression, and multiple regression. Results: The mean BFPs of the subjects and all the sub-groups were higher than acceptable BFPs. Both the mean NKCAs of male and female subjects were lower than that of healthy women. NKCA was explained by BFP with a 14.9% variance in the total subjects (p

영적 안녕의 하부 개념인 실존적 안녕, 종교적 안녕과 희망의 함수적 관계에 대한 메타 분석

김달숙 충남대학교 간호과학연구소 2003 충남대 간호학술지 Vol.6 No.1

Purpose: The study was designed to integrate the results regarding the functional relationships of existential and religious well-being that have been defined as the sub-concepts of spiritual wellbeing to hope through quantitative meta-analysis. Method: Relevant Research studied from Jan 1980 to Feb 2003(published /not published, significant/not significant), whose subjects were adults or adults patients, were collected. It showed that each concept was measured by spiritual well-being scales with the two dimensions. Using SAS program, the number of the subjects and the correlation coefficients provided from the studies regarding existential and spiritual wellbeing as data were analyzed. Results: the data regarding relationships of existential well-being to hope were heterogeneous(p<.05). But the data regarding the relationships of religious well-being to hope was homogeneous (p>.05). All the integrated effect size (weighted d) were statistically significant (p=. 000). The value of religious well-being to hope was 1.222, and existential well-being to hope was 1.830. Conclusions: The results provide stronger evidences on which existential and religious well-being could explain hope.

소생 불가능한 환자 가족의 안락사에 대한 의식 구조

김달숙,서문자 충남대학교 의과대학 지역사회의학연구소 1983 충남의대잡지 Vol.10 No.2

The purposes of this study were to identify the attitudes of family members whose patients were confined in bed with almost dying conditions and to identify and test various factors which are closely related to attitudes of family members toward euthanasia for their almost dying patients. This study hypothesized that age, religion and education of the family members, monthly house hold income, methods of supplying medical expenses, the role of this particular patient in family, family member's awareness about the death expectation of his or her patient, hospitalization duration and frequency, the harmonic adjustment of family members would be related to the attitudes of family members toward euthanasia for the almost dying patient. The thirty-five cases were interviewed with questionaire whose patients were critically ill and considered almost dying at Chungnam National University Hospital, Chungnam Seung-Mo Hospital and Seoul National University Hospital at the period from August 17 to October 20, 1983. The findings obtained from this study were as follows: 1. Euthanasia attitude scale and family environmental scale showed high internal consistency reliability. 2. Attitudes of family members of this particular patient toward euthanasia were approximately to positive direction. 3. Monthly household income, methods of supplying medical expenses, family relation between the family member and patient, hospitalization duration and frequency and the harmonic adjustment of family members were identified as significantly related to attituds of family members toward euthanasia and the amount of variance of each variable or total variance accounts significantly. 4. The rest of the factors such as age, religion, education, awareness of death expectation and the role of the particular patient in family did not consistently influence the attitude toward euthanasia in this particular case at significant level. In the view point of the results from this study, it could be recommended for nurses to consider the above mentioned significant factors influencing the attitude toward euthanasia when they administer 'nursing process' for the almost dying patient and his or her family members.

완화돌봄에서 개인 경험에 근거한 희망 중재를 향하여

김달숙,Kim, Dal-Sook 한국호스피스완화의료학회 2012 한국호스피스.완화의료학회지 Vol.15 No.1

목적: 본 연구는 희망은 개인화된 유일하며 주관적이고 역동적인 경험이라는 가정 하에서 개인 경험에 근거한 희망 찾기 중재를 하는 데 도전해야할 문제점들을 토의하는 것을 목적으로 하였다. 방법: 연구자는 개인 경험에 근거한 희망을 향하여 가는 데 도전하여야 할 제한점과 요구되는 방안을 확인하기 위하여 비판적인 분석과 토의가 포함된 문헌 고찰을 사용하였다. 결과: 도전 과제들은 1. 개념화 문제로 대표되는 것들로서 종종 희망이 다양한 속성을 가진 표준화된 단일 구조나 현실적인 희망만이 강조되는 단일 구조로 또는 한 문헌에서 두 가지 오리엔테이션(상대주의 대 단일주의)의 혼합 속에서 기술되거나 사용되었다. 2. 완화돌봄을 받고 있는 환자들에 의하여 고유하게 경험되는 다양한 희망의 패턴이나 경험들에 대한 연구가 거의 없다. 3. 개인 경험에 근거한 희망 중재와 그 방법에 대하여 다룬 문헌이 거의 없다. 결론: 개념화 문제는 오랫동안에 걸쳐서 관련 학문 학자와 전문가에 내재되어온 고정된 오리엔테이션과 관계가 있는 것으로 보여진다. 따라서 이 문제는 우리들의 고정된 생각의 변화와 고정된 생각으로부터의 해방을 요구한다. 두 번째 도전 과제는 효과적이고 적절한 개인 경험에 근거한 희망 중재에 사용될 수 있도록 완화 간호 세팅에 있는 환자들의 다양한 희망 경험에 대한 다문화적 연구를 필요로 한다. 세 번째 도전 과제는 개인경험에 근거한 희망 중재를 위한 효과적인 방법을 찾을 것을 요구한다. Purpose: The aim of this study was to discuss challenges for hope seeking intervention based on individual experience (HSIBIE) in palliative care, assuming that hope is an individualized unique, subjective, and dynamic experience. Methods: Literature, including analysis and discussion, was reviewed to identify limitations and ways to develop HSIBIE. Results: This study identified following challenges: 1. Hope was often described and utilized as a standardized unified structure with varying attributes or mono-structure emphasizing a realistic hope, or both of them (relativism vs. monism) in one literature. This challenge is represented as a problem in conceptualization. 2. Few studies discussed various patterns of hope or individuals' unique experiences in palliative care. 3. The HSIBIE and the method for the HSIBIE have been rarely discussed. Conclusion: A problem in conceptualization is often related to fixed ideas formed over a long period and used in a closed circle of scholars and professionals. Therefore, such fixed ideas should be openly challenged with fresh perspectives. The second issue requires a cross-cultural studies of various hope experiences in palliative care, which can be used for effective and appropriate HSIBIE.

간호원의 소진 경험에 대한 기술적 연구

김달숙,박광옥 최신의학사 1986 最新醫學 Vol.29 No.8