우리나라 가정방문간호의 현황과 향후 과제

박은옥,Park, Eunok 한국농촌의학지역보건학회 2019 농촌의학·지역보건 Vol.44 No.1

본 연구에서는 우리나라 보건소 방문건강관리사업과 노인장기요양보험의 방문간호, 의료기관의 가정간호사업 등 가정방문간호사업 현황을 살펴보고, 향후 발전과정을 모색하고자 수행되었다. 본 연구를 위하여 각 가정방문간호사업의 관련 법령, 통계자료, 지침과 안내서, 연구논문과 학술대회 자료집 등을 검색하여 관련 문헌을 고찰하였다. 연구결과 보건소 방문건강관리사업은 지역보건법에 근거하여 주로 취약계층을 대상으로 간호사에게 의해 비용부담 없이 제공되고 있으며, 2017년 12월을 기준으로 1,261,208명 등록 관리되는 것으로 나타났다. 보건소 방문건강관리사업 등록 대상자는 흡연율, 걷기 실천율, 혈압조절율, 혈당조절률 등이 향상되는 것으로 나타나, 건강행위와 질병관리 측면에서 긍정적인 효과가 있고, 비용-편익이 있다고 보고되었다. 노인장기요양보험에서의 방문간호는 노인장기요양보험법에 근거하여 간호사 또는 간호조무사에 의해 재가장기요양기관에서 방문간호를 제공하고 있으며, 시간당 정해진 수가에 따라 비용을 받고 있는데, 2017년에 전체 요양급여비의 0.2%만이 방문간호로 이용하는 것으로 나타났다. 재가장기요양보험 방문간호 이용자는 비이용자에 비해 의료비도 더 적게 쓰고, 입원일도 적다고 보고되었다. 의료기관 가정간호는 의료법에 근거하여 2명 이상의 가정간호사(가정전문간호사)를 고용한 의료기관에서 의사의 처방 하에 가정간호서비스를 제공하는데, 2017년 460명의 가정간호사가 가정간호서비스를 제공하고, 전체 의료비의 0.038%가 가정간호비용으로 지불된 것으로 나타났다. 우리나라 가정방문간호 유형은 관련법이나 인력, 사업 대상이 다르지만, 서비스 이용자의 건강관리에 효과가 있고, 비용-편익이 상당히 높은 것으로 나타났다. 우리나라 가정방문간호를 발전과 활성화를 위해 세 개 유형의 가정방문간호 서비스가 통합적으로 제공될 수 있는 방안을 모색하고, 근로 조건의 개선, 가정방문간호서비스 제공인력기준이나 방문간호수가 체계의 개선과 같은 법령의 개정 등을 고려할 필요가 있다고 본다. Objectives: We searched and reviewed the literature including the laws or acts, statistics, guidelines, papers and conference proceedings related to home visit nursing care in South Korea. Method: We searched and reviewed the literature including the laws or acts, statistics, guidelines, papers and conference proceedings related to home visit nursing care in Korea. Results: There are three types of home care nursing in Korea. Public health center provides home visit nursing to vulnerable population by registered nurses for free, based on community health act in public health center. As of 2017, 1,261,208 people were enrolled in the visiting health program of public health center. Health behavior and disease management has been improved and showed having cost-benefit effect among the enrolled people in visiting health program. Visiting nursing care in long-term care services is provided by registered nurses or nurse aid, based on long-term care act. The cost is paid as the unit price according to service time. 1,095,764 older people used long-term care services in 2017, only 0.2% of total cost used for home visiting nursing. Even though the number of user of home visiting nursing, it was reported that users spent less medical cost and hospitalized shorter. Hospital-based home care nursing is provided to patients and their families under the prescription of a doctor by family nurse specialists who are employed by medical institute based on medical law. Four hundred sixty family nurse specialists worked for hospital-based home care nursing and hospital-based home care services accounted for 0.038% of total medical expenses in 2017. Conclusion: Even though home visit nursing care services are different in aspect of legal basis, personnel, running institutes, and cost basis, home visit nursing care showed cost-benefit effect and good health outcomes. In order to advance home visit nursing care, the integrated home visiting care, improvement of working condition, and revision of legal basis should be considered.

역할극을 활용한 가족간호실습교육이 간호학생의 감성지능, 의사소통능력과 가족간호수행능력에 미치는 효과

박은옥(Park, Eunok) 한국간호교육학회 2013 한국간호교육학회지 Vol.19 No.4

Purpose: This study was to investigate the effects of a family nursing practicum using role play on emotional intelligence, communication ability, and family nursing performance of nursing students. Methods: Role play training was provided to nursing students who took a community health nursing practicum (family nursing practicum). During the course for 2 weeks, participants were given role play practice for four times and a final test using role play at the end of the course. Data were collected from 52 nursing students before and after the family nurse practicum who agreed to participate in this study. Results: The scores of emotional intelligence, communication ability, and family nursing performance at post test were enhanced significantly compared to the scores at pre test. Conclusion: Nursing educators in family nursing can consider role play to improve emotional intelligence and communication ability as well as family nursing performance.

재가노인 낙상환경위험 평가도구 개발

박은옥(Eunok Park),장인순(Insun Jang) 한국콘텐츠학회 2013 한국콘텐츠학회논문지 Vol.13 No.5

본 연구는 재가노인의 낙상환경위험평가 도구를 개발하고, 신뢰도와 타당도를 검정하는 방법론적 연구이다. 예비문항은 20인의 관련 전문가에 의한 CVI(내용타당도 지수)를 사용한 내용타당도 검정을 실시하여 최종 52문항을 선정하였다. 최종도구의 타당도 및 신뢰도 검정을 위해 65세 이상 재가노인 299명에게 자료수집을 실시하여 분석하였다. 그 결과 조사자간 신뢰도는 1개 문항을 제외한 51개 문항에서 모두 kappa값이 0.80 이상으로 나타나 신뢰도가 인정되었고, 재조사방법을 통하여 나타난 일치율은 45개 문항에서 모두 80.0% 이상으로 나타났다. 구성타당도도 낙상군과 비낙상군간에 낙상환경위험평가 점수가 통계적으로 유의한 차이를 나타내 입증되었다(t=3.50, p=.001). 본 도구는 타당도와 신뢰도가 검증되었고, 낙상예방을 위한 더 안전한 환경의 개발과 관련된 추후연구에 기여할 것이다. The purpose of the study was to develop the home fall prevention checklist for community-dwelling older adults. And the validity and reliability of the checklist were tested. The preliminary questions were developed through content validity by twenty experts using the CVI(Content Validity Index). Following the establishment of content validity, 52 items of the checklist were developed. Responses of 299 community-dwelling older adults were analyzed to further establish both reliability and validity of the checklist. Reliability using cohens kappa coefficient and test-retest reliability(rate of concordance(%)), and construct validity using known-group comparison technique were tested. 51 items were over 0.80 in the cohens kappa coefficient of the checklist, 45 items were over 80.0% in test-retest reliability. Construct validity was established by known-group comparison(t=3.50, p=.001). Validity and reliability of the checklist were confirmed. This checklist will help further studies to develop more safe environment to prevent falls.

취약계층 노인의 연령별 허약정도와 관련 요인

박은옥(Park, Eunok),유미(Yu, Mi) 한국간호과학회 2016 Journal of Korean Academy of Nursing Vol.46 No.6

Purpose: This study aimed to investigate factors affecting frailty by age groups among vulnerable elders in Korea. Methods: In this secondary analysis, data were collected from records for 22,868 eldesr registered in the Visiting Health Management program of Publci Health Centers in 2012. Health behaviors, clinically diagnosed disease, frailty, depression and cognitive condition were assessed. Data were analyzed using stepwise regression to determine the associated factors of frailty by age group. Results: Alcohol consumption, physical activity, number of diseases, DM, CVA, arthritis, urinary incontinence, depression and cognitive condition were found to be factors significantly associated with frailty among the elders aged 65~74 (F=135.66, p<.001). Alcohol consumption, physical activity, CVA, arthritis, urinary incontinence, depression and cognitive condition were found to be factors associated with frailty in the elders aged 75~84 (F=245.40, p<.001). Physical activity, CVA, arthritis, depression and cognitive condition were factors associated with frailty in the elders over 85 years of age (F=96.48, p<.001). Conclusion: The findings show that frailty of elders and associated factors were different by age group, and common factors affecting frailty were physical activity, CVA, arthritis, depression and cognitive condition. Thus, these factors should be considered in the development of intervention program for care and prevention of frailty and program should be modified according to age group.

국제중재에서 중재대리인의 윤리규정에 관한 연구 – IBA 지침과 LCIA 중재규칙을 중심으로

박은옥(Eunok PARK) 한국무역상무학회 2020 貿易商務硏究 Vol.85 No.-

한 국가의 사법권을 배제하고 분쟁 당사자들이 합의한 절차에 따라 자치적으로 분쟁을 해결하는 제도인 중재에서 가장 중요한 것이 관련 당사자들의 자발적인 참여와 결과에 대한 이행이다. 이러한 분쟁당사자를 대신하여 자발적이고 적극적인 자세로 중재에 참여하게 되는 중재대리인의 경우 자신들의 역할을 이행하는데 있어 진실성과 성실성을 바탕으로 한 윤리적인 행위가 그 무엇보다도 중요하다. 중재대리인의 비윤리적인 행위는 중재절차가 진행되는 것을 방해할 뿐만 아니라 더 나아가 중재판정의 취소나 승인ㆍ집행의 거절이라는 결과까지도 초래하여 중재라는 사적분쟁해결제도의 가치를 훼손할 수도 있다. 따라서 이 논문에서는 국제중재에서 중재대리인의 윤리가 무엇을 의미하는지, 이들을 위한 통일된 윤리규정이 필요한지, 그리고 이러한 윤리규정을 어떻게 활용할 수 있는지에 대해 논의를 하고 런던국제중재법원 중재규칙과 세계변호사협회 중재대리지침서 내의 중재대리인의 윤리규정에 대해 알아보고자 한다. Arbitration is one of private dispute resolution systemswhich exclude judicial litigation and try to settle a dispute through the procedure agreed between contracting parties. As it starts fromthe agreement of parties, their voluntary participation during the arbitral proceedings and execution of decision are really crucial in arbitration.With importance of parties’ conduct and behavior in arbitration, when parties participate in arbitration through their representatives, their ethics for a good faith and integrity aremore important than anything. Representatives’ unethical behavior may obstruct arbitral proceedings and furthermore, result in setting aside of an arbitral award aswell as non-recognition or non-execution of an arbitral award. If these happen repeatedly, theywill defame the value of arbitration,which has recognized as an effective private dispute resolution system, especially in international arbitration. Therefore, this paper studies what the ethics of representatives mean,why the internationally unified code of ethics for representatives needs, and how these codes can be used in practice. Also, it analyzes relevant provisions in LCIAArbitration Rules (2014)with its Annex(General Guidelines for the Parties’ Legal Representatives) and those in IBA Guidelines on Party Representation in International Arbitration.

한국 중년 성인의 사회경제적 취약성과 대사증후군

박은옥 ( Eunok Park ) 대한보건협회 2020 대한보건연구 Vol.46 No.4

Purposes : This study was to investigate the association of socioeconomic vulnerability and metabolic syndrome(MetS). Methods : A secondary analysis using data from Korea National Health and Nutrition Examination Survey (KNHANES) were applied for this study. Participants who were 30-64 years old were included and the pooled weights for the stratified complex sampling were applied in the analysis. Socioeconomic vulnerability consisted of education, residential area, income, food living condition, house ownership, and basic livelihood recipient. Results : The prevalence of metabolic syndrome was higher in socioeconomic vulnerable group than counter group (Odds Ratio 1.77, 95% CI 1.48~2.12) after adjusting age group, gender, and marital status. The findings showed there were negative associations between education level, individual income, family household income, food living condition, basic livelihood recipients with metabolic syndrome. The prevalence of metabolic syndrome was higher among those who lived in rural area than urban area. Conclusion : Socioeconomic vulnerability increased the risks to have metabolic syndrome. Targeted intervention program for reducing and managing metabolic syndrome need to be developed and implemented for this vulnerable population. Further researches might be also needed to understand the mechanism of inequality in metabolic syndrome.

우리나라 30~64세 성인의 수면시간과 고혈압 관련 요인

박은옥(Park, Eunok) 한국성인간호학회 2014 성인간호학회지 Vol.26 No.3

청소년의 정신건강문제가 자살 관련 행위에 미치는 영향: 청소년 건강행태조사 자료를 이용하여

박은옥(Park, Eunok) 한국간호교육학회 2023 한국간호교육학회지 Vol.29 No.1

한국 성인의 사회경제적 취약성과 우울

박은옥(Park, Eunok) 한국보건사회학회 2020 보건과 사회과학 Vol.0 No.55

연구목적: 본 연구는 사회경제적 취약성과 우울과의 연관성을 탐색하기 위해 수행되었다. 연구방법: 2018년 국민건강영양조사 원시자료를 이용하여 30-64세 성인을 대상으로 이차분석을 수행하였다. 복합표본설계에 따른 가중치를 적용하여 분석하였다. 사회경제적 취약성은 교육수준, 거주지역, 소득수준, 식생활형편, 주택소유, 기초생활수급권자 여부, 1인 가구 여부 등이 포함되었다. 연구결과: 우울 유병율은 성, 연령, 결혼상태를 보정한 후에도 사회경제적으로 취약한 집단에서 더 높게 나타났다(Odds Ratio 4.32, 95% CI 2.35~7.96). 교육수준과 주택소유여부, 개인 소득 수준, 가구 소득수준, 식생활 형편, 기초생활수급권자여부, 1인 가구 여부 등에 따른 우울 유병율은 유의한 차이를 보였고, 각 변수에서 취약한 집단의 우울 유병율이 더 높았다. 결론: 사회경제적 취약성은 우울 위험을높이는 것으로 나타났다. 우울에 있어서 건강불평등을 완화하기 위해 다차원적인 사회경제적 취약집단에 초점을 맞춘 우울 중재 프로그램이 필요하며, 우울의 사회경제적 수준에 따른 불평등기전을 이해하기 위한 보다 심층적인 연구가 필요하다. Purposes: This study was to investigate the association of socioeconomic vulnerability and depression. Methods: This study is a secondary analysis using data from Korea National Health and Nutrition Examination Survey((KNHANES). Participants aged 30-64 years were included in this analysis and the sampling weights were applied. Socioeconomic vulnerability index consisted of education, income, residential area, house ownership, food living condition, and basic livelihood recipient. Results: The prevalence of depression was higher in socioeconomic vulnerable group than counter group (Odds Ratio 4.32, 95% CI 2.35~7.96) after adjusting gender and marital status. The findings showed that depression were associated with education level, individual income, family household income, housing, food living condition, basic livelihood recipients, and living alone. Conclusion: Socioeconomic vulnerability was related to the increased prevalence of depressive symptoms. Targeted intervention programs for vulnerable population to reduce depressive symptoms might need to be developed and applied for this vulnerable population. Further researches are also needed to develop and evaluate instrument to measure socioeconomic vulnerability index and to identify the mechanism of inequality in depression.

제5기 국민건강영양조사로 추정한 한국 성인의 대사증후군 유병률과 관련 요인

박은옥(Eunok Park),최수정(Su Jung Choi),이효영(Hyo Young Lee) 한국농촌의학 지역보건학회 2013 농촌의학·지역보건 Vol.38 No.1

Objectives: This study is to investigate the prevalence and related factors of metabolic syndrome among Korean adults aged 20 years and above. Methods: From the database of the 5^th Korea National Health and Nutrition Examination Survey (KNHANES V) conducted in 2010, data of 5,670 adults who responded to all the questionnaires of health interview and had metabolic syndrome in the health examination were included in this analysis. SAS 9.2 was used for statistical analysis with complex sample survey modules and commands. Results: The prevalence rate of metabolic syndrome based on the criteria proposed by International Diabetes Federation (IDF) was 18.8%. The prevalence of metabolic syndrome in each group was: 20.7% of women, 43.1% among elderly over 70 years old, 40.6% of the divorced or the separated, 27.6% of recipients of economic support from the government, 23.6% of people who had alcohol dependency problem, and 43.7% of overweight or obese adults. Independent risk factors based on the multiple logistic regression analysis revealed that prevalence of metabolic syndrome was associated with female (odds ratio 1.59 [95% confidence interval 1.20-2.11]), age (50s 3.95 [2.11-7.37], 60s 5.62 [2.98-10.61], 70s 10.56 [5.25-21.25]), high school education (0.52 [0.37-0.74]), clerk occupation (2.14 [1.27-3.60]), divorced marital status (1.72 [1.15-2.59]), alcohol dependency (1.86 [1.16-2.98]), higher BMI (14.08 [10.60-18.70]). Conclusions: The metabolic syndrome is prevalent among Korean adult population according to IDF criteria. Several demographic characteristics and potentially modifiable factors are associated with metabolic syndrome. Identification of this high-risk group and management of these modifiable factors are warranted to reduce the prevalence of metabolic syndrome.