약물 및 증상 관리교육이 정신질환자의 자가 간호활동에 미치는 효과 - 외래환자를 중심으로-

손희 ( Kyung Hee Son ),배정이 ( Jeung Iee Bai ) 한국간호과학회 정신간호학회(구 대한간호학회정신간호학회) 2000 정신간호학회지 Vol.9 No.3

자가간호란 치료자의 지시에 순응하는 차원이 아니라 건강유지, 회복, 재활을 위해 대상자가 시도하는 모든 활동을 의미하며 이러한 개념은 정신질환에서 더욱 적극적인 직접 적용이 가능하다. 그러므로 체계화된 교육프로그램인 약물 및 증상자가간호는 건강이탈과 관련된 자가 간호 요구를 지지적 교육체계를 통해 중재함으로서 궁극적으로는 정신질환자의 자가간호 능력을 향상시키는 것을 목적으로 한다. Orem(1985)는 생명과 건강 및 안녕을 유지하기 위해 개개인이 수행하는 자가간호는 건강수준향상과 직결된다 하였다. Clary 등(1992)은 정신질환자를 대상으로 자신의 질병과 치료에 대해 정보를 제공하고 교육하는 것은 이러한 과정이 치료자와 환자와의 의사소통에 관한 질과 특성의 척도가 된다고 하였다. 또한 질병과 치료에 대한 지식은 약물복용과 높은 상관이 있기 때문에, 그리고 환자의 알권리를 존중해야 하기 때문이라고 하였고, 교육의 실효를 높혀 정신질환의 재발과 재입원을 감소시키기 위해서는 환자의 참여가 더욱 적극적인 교육이 필요하다고 하였다. 스스로 자신을 돌볼 수 있는 실제적 방법으로 약물복용기술을 습득하고 나아가 자신의 질병까지도 적극적으로 대처하도록 돕는 증상관리교육은 정신질환자를 치료팀의 일원으로 받아들이는 능동적 개념으로 치료에 대한 적극성을 띄게 하고 이는 결국 자신의 건강과 안녕을 위해 스스로를 돌보는 자가간호 수행을 의미한다. 본 연구 결과에서 약물 및 증상관리교육을 받은 실험군이 교육을 받지 않은 대조군보다 자가간호활동에서 증가된 점수를 보이는 것은 약물 및 증상관리 교육내용이 정신질환의 증상, 경과, 치료에서 질병자체의 특성, 경고 증상 확인 및 대처방법, 기대되는 약물복용효과, 부작용 관리 등에 관해 완전한 정보를 제공하고 실생활에 적용함으로 질병극복에 대한 희망을 고취시켜 환자 자신이 스스로 치료 과정에 참여자가 되도록 도와 자가간호활동을 증진시킬 수 있었다고 본다. 영역별 자가간호활동을 보면 약물 복용 및 외래방문 영역에서 대조군과 유의미한 차이를 보였는데 권준수, 신성웅, 정영미, 박경호(1997)은 약물복용 예측에 가장 중요한 변수가 약물 효과를 아는 것, 부작용을 아는 것이라고 하였고, 본 교육프로그램의 구성 내용을 볼 때 이러한 결과는 당연하다고 본다. Liberman, Mueser, Wallace(1986)은 약물 및 증상관리 교육후 약물자기복용도가 현저히 증가되었다고 보고하고 Eckman, Liberman, Phipps, Karen, Blair(1990)도 약물복용도가 실험군에서는 15~20%정도가 증가되어 대조군과 유의한 차이를 보였다고 보고하였다. 본 연구에서도 비록 자가보고식이었지만 교육 후 실험군에서 대조군보다 약물복용도가 유의하게 증가되었음을 보고한 것은 이러한 연구 결과와 그 의의를 같이 한다고 생각된다. 또한 약물의 부작용으로 인해 환자들이 흔히 호소하는 변비, 배뇨 곤란 등의 문제가 교육 과정시 충분한 논의를 통해 완화될 수 있었으므로 배설과 관련된 자가간호활동에서도 실험군이 대조군에 비해 좋아졌다고 본다. 안전영역 자가간호활동 대조군보다 유의한 증가를 보인 것도 질병의 증상관리교육에서 질병의 재발로부터 자신을 보호하는 전략을 학습한 것이 도움이 되었다고 본다. 자신의 외모에 관심을 갖는 개인위생과 취미생활, 대중매체를 활용하는 여가생활에서 교육 실시 후 실험군에서 유의미한 향상된 점수를 나타낸 것은 약물복용의 효과로 증상의 안정 및 판단력 증진으로 기초적인 생활기술인 개인위생의 필요성을 알고 수행할 수 있었다고 보며 교육과정시 지속증상을 극복하는 방법으로 취미활동, 운동, TV시청, 신문 및 잡지, 영화보기 등을 권유하고 이러한 방법의 유용성을 전달한 것이 여가생활의 향상으로 연결될 수 있었다고 생각된다. 이러한 본 연구의 결과는 지역 사회 내에서 정신재활프로그램을 제공하고 개인위생활동이 증가되었음을 보고한 이숙(1996), 이경순(1998), 유숙자, 이광자, 애정희, 차진경(1998)의 보고와는 일부 일치한다. 그러나 여가생활에서도 향상되었음을 모두 보고하지는 않으며 향상된 영역별 자가간호활동 또한 상이하다. 이는 추후 정신질환자 재활을 위해 총체적 접근으로 대상자가 자신의 건강관리에 책임을 지도록 지지하고 자가간호의 실천에 목표를 두는 동시에 또한 개인별, 영역별 자가간호활동의 효율성 증진을 위해 구체적이고 전문된 프로그램이 더욱 개발되어야 할 것으로 사료된다. This study is an attempt to evaluate the effect of the medication and symptoms management education on the psychiatric patients′self-care activity. This exploratory study was designed to a quasi-experiment of pretest-posttest with a non equivalent control group. Subjects of 40 patients who were discharged from a mental hospital in Pusan were selected to be experiment and control group, with each group consisting of 20. The research period was from March, 6 to May, 29, 1999 and the pre-post test was given before and after implementing the medication and symptoms management education to the both experiment and control group. The results finding were summarized as follows ; 1. subjects who attended the medication and symptom management education scored significantly higher than control group in self-care activity(Z=-2.57, P=0.001). 2. Those who were in the experiment group reported more significant higher scores than control group in item of self-care activity, medication compliance(Z=-3.03, P=0.002), clinic visiting(Z=-4.49, P=0.000), hygiene (Z=-4.675, P=0.000), elimination(Z=-2.62, P=0.009), safety(Z=-2.31, P=0.021), leisure activity(Z=-3.11, P=0.002).

간호대학생의 정신간호학 실습 스트레스와 정신질환에 대한 인식에 관한 연구

배정이 대한간호학회정신간호학회 1999 정신간호학회지 Vol.8 No.2

Clinical experiences are stressful for nursing students. However, we ignore this problem. And the recognition for psychiatric patients of nursing students is different from that for the other patients. The prejudice or incorrect understanding of the psychiatric patients has been widely spreading even nursing student. The purpose of this study was to describe the stress and recognition for the psychiatric patients of nursing students during the clinical experience in the psychiatric unit. Data were collected through a survey over a period of 8 days. Subjects who participated in the study consisted of 80 nursing students. The author used a convenience sampling method. Two instruments were used in this study. Using Cronbach's ALPHA, instruments were assessed for validity and reliability from data. The analysis of the data was done with Window SPSS 9.0 for descriptive statistics and ANOVA test. The results of this analysis were as follows : 1. The degree of perceived stress during the clinical experience in the psychiatric unit was considerable high(2.28 out of 4.0). 2. The degree of recognized for the psychiatric patients of nursing students was general level(1.99 out of 4.00). 3. Among the stressors, insufficiency of professional clinical knowledge and skill(2.45), inadequate practical environmen(2.44) and role overlord(2.21) were identified as the stress factors with high rank of degree of stress. 4. There was significant relationship between the degree of stress and the demographic variables of nursing students such as the religion, age and practical place. And there was no significant relationship between the degree of recognition and the demographic variables of nursing students. 5. The relationship between the degree of stress and the recognition for the psychiatric patients of nursing students were significantly identified. Finally, the author suggests that this result could be adequately applied to nursing students during the clinical experience in the psychiatric unit. The faculty should be a proving the empathetic support and effective educational environment. And effective guidance program is required to improve motivation and satisfaction with nursing as a major and college life. This study will prove helpful understanding nursing student for educator and clinical nursing staff.

학부모의 초등학생에 대한 성교육 요구도 조사 연구

배정이 인제대학교 2001 仁濟論叢 Vol.16 No.1

The purpose of this study was to describe the parent's need of sexual assault preventive education for the their children. Data were collected through a survey over a period of seven months. Subjects who participated in the study consisted of 322 parents in Seoul and Busan. The author used a convenience sampling method. Tow instruments were used in this study for take a measurement of the parent's need of sexual assault preventive education for the their children. The analysis of the data was done with Window SPSS 9.0 for descriptive statistics. The results of this analysis were as follows : 1.The degree of the parent's need of sexual assault preventive education for the their children was considerably high(329 out of 332). But they had described that they didn't know how to teach(261 out of 332). 2.Among the educational contents, get along with a intersexual friend, the strategy of sexual assault prevention were identified as the objects with high rank of degree of educational need. 3.Pregnancy, birth, structure of genital organ, marriage, menstruation and menopause were identified as the objects with lower rank of degree of educational need. Finally, the author suggests that this result could be adequately applied to child education. We should be development the sexual assault preventive educational program for children. And effective guidance program is required to sexual assault prevention for children. This study will prove helpful understanding school age and prevent sexual abuse for children.

모성역할 교육 프로그램이 모성역할수행 자신감에 미치는 효과

배정이,김동원 인제대학교 1998 仁濟論叢 Vol.14 No.2

Maternal role is one of the most important roles because it affects not only the mother but also her baby. Most mother attain the maternal role. But, some primiparous mothers experience difficulties in attainment of the material role due to lack of information and knowledge. The failure of maternal role attachment disturbs maternal-infant interaction. Self-confidence is important factors in attainment and adjustment to maternal role. This study has been designed to contribute to the planning of nursing care to enhance self-confidence in maternal role performance and development of relevant nursing theory. This study evaluated the effect of the maternal role educational program on the self-confidence in maternal role performance. The design of research was one-group pretest-posttest degign. The independent variable is maternal role educational program and the dependent variable is the self-confidence in maternal role performance. Data were collected through a survey over a period of 2 months. Subjects who participated in the study consisted of 74 primiparous mothers in their postpartum periods. A total of 2 instruments were used in this study. Using Cronbach's ALPHA, instruments were assessed for validity and reliability from data obtained during the pilot study from mothers in their postpartum periods. The analysis of the data was done with SAS PC+ for descriptive statistics and Paired t- test. The results of this analysis were as follows : 1.The degree of the self-confidence in maternal role performance of total subjects measured before the expermental treatment was above average with a mean score of 3.16. 2.The degree of the self-confidence in maternal role performance of total subjects measured after the expermental treatment was above average with a mean scare of 3.81. The score of the self-confidence in material role performance of subjects measured after the expermental treatment was higher than that of the score measured before the expermental treatment(p < 0.0001). Results of this study show that maternal role educational program is effect on self-confidence in maternal role performance. Finally, the author suggests that applied for maternity nursing. As the futher study, it is necessary to reevaluate the effect of maternal educational program with more refined design and subjects.

정신질환자 가족의 경험 연구 : 근거이론적 접근 A Grounded Theory Approach

배정이 대한간호학회정신간호학회 2001 정신간호학회지 Vol.10 No.1

The Purpose of this study was to build a substantive theory about the experience of families with psychiatric patients. The qualitative research method used was grounded theory. The interviewees were seven families with psychiatric patients. The data were collected through in-depth interviews with audiotape recording done by the investigator over a period of ten months. The data were analyzed simultaneously by a constant comparative method in which new data were continuously coded into categories and properties according to Strauss and Corbin's methodology. Analysis the grounded data resulted in 152 concepts being identified. Fifteen categories emerged from the analysis. The categories were the fall in mental health illness, heavy in the chest, burden, loss, caring for the patient, hate for patient, lack of knowledge and information, lack of effort, lack of social support, lack of family support, lack of medical support, pursuit, discover of valuing, compliance and abandonment. These substantive categories are consistent with previous research results. Causal conditions included : the fall in mental health illness. Phenomena : heavy in the chest, burden, loss. Intervention condition : knowledge and information about mental health illness, effort, support. Action/ interaction strategies : desire for knowledge and information, support, effort and liberation. Consequences : discover of valuing, compliance and abandonment. These categories were synthesized into the core concept-burden. The process of discover of valuing was proceeded by caring for the psychiatric patient, hate for the psychiatric patient, knowledge and information, social support, family support, medical support, discover of valuing, heavy in the chest, loss.

간호학과 학생의 대학과정 경험 : A Phenomenological Approach

배정이 대한간호학회정신간호학회 1999 정신간호학회지 Vol.8 No.2

The purpose of this study was to explore and describe the experience of nursing student. The qualitative research method used was phenomenological approach. The participants were fourteen nursing student. The data were collected through in-depth unstructured interview with audiotape recording done by the investigator over a period of six months. The students were asked to describe about their experience as a nursing student. The data was analyzed according to the Colaizzi's method for phenomenological analysis. The interview data was organised by themes into six themes into six categores emerged from the analysis. Student experienced varies difficulty related to specific character of learning. The categories were an application for entrance to the nursing college, condition of campus life, endeavor for well adaption, clinical experiences, planning for the future, desire for nursing development. The faculty should be providing the empathetic should be a providing the empathetic support and effective educational environment. And effective guidance program is required to improve motion and satisfaction with nursing as a major and college life. This study will prove helpful understanding nursing student for educator and clinical nursing staff.

정신과 간호사의 근무 경험에 관한 연구 : 근거이론적 접근 A Grounded Theory Approach

배정이,손경희 대한간호학회정신간호학회 2000 정신간호학회지 Vol.9 No.4

The Purpose of this study was to build a substantive theory about the experience of psychiatric nurse. The qualitative research method used was grounded theory. The interviewees were twelve psychiatric nurses who had experienced. The data were collected through in-depth interviews with audiotape recording done by the investigator over a period of two years. The data were analyzed simultaneously by a constant comparative method in which new data were continuously coded into categories and properties according to Strauss and Corbin's methodology. Analysis the grounded data resulted in 120 concepts being identified. Fifteen categories emerged from the analysis. The categories were motivation of application to psychiatric ward, conflict, caring for the psychiatric patient, desire for knowledge and skill, discover of valuing. These substantive categories are consistent with previous research results. Causal conditions included : motivation of application to psychiatric ward. Phenomena : conflict. Intervention condition : professional knowledge and skill, effort, support. Action/ interaction strategies : desire for knowledge and support. Consequences : discover of valuing. These categories were synthesized into the core concept ~ The process of conflict. The process of discover of valuing was proceeded by ① professional knowledge and skill ② effort for development, ③ support from others, ④ caring for the psychiatric patient. Three hypotheses were derived form the analysis. ① Psychiatric nurses who were poorly motivated when they applied for the psychiatric ward experienced more conflict. ② Psychiatric nurses who care for the psychiatric patient to the higher extent experienced less conflict. ③ Psychiatric nurses who had professional knowledge and skill experienced more conflict. This study will prove helpful understanding psychiatric nurses.