국내 호스피스 기관의 사별 관리 실태

노유자,안영란,Ro, You-Ja,An, Young-Lan 한국호스피스완화의료학회 2000 한국호스피스.완화의료학회지 Vol.3 No.2

목적 : 본 연구는 전국 호스피스 기관의 사별관리 실태를 파악하여 효율적인 사별관리 방안의 기초자료를 제공하기 위함이다. 방법 : 1차로 1999년 9월부터 10월사이, 2차로 2000년 11월부터 12월사이에 한국 가톨릭 호스피스협회와 가톨릭대학교 간호대학 호스피스 교육연구소를 통해 확인된 전국 55개 호스피스기관을 대상으로 하였으며, 본인과 연구원이 직접 전화를 걸어 조사목적을 설명한 후 기관의 책임자와 통화하여 면접조사를 하였다. 결과 : 1) 국내 호스피스 기관의 69.1%에서 사별관리를 시행하고 있었다. 2) 사별관리의 내용으로는 전화방문 28개 기관(74.5%), 사별가족 모임 26개 기관(68.4%), 가정방문 22개 기관(57.9%), 우편물 보내기 16개 기관(42.1%), 개별상담은 7개 기관(18.4%)이었다. 3) 사별가족 모임은 26개 기관(68.4%)에서 시행하고 있었고 그 빈도는 연 1회가 42.3%로 가장 많았으며 연2회가 6개 기관(23.1%), 월 1회가 6개 기관(23.1%), 월 2회가 3개 기관(11.5%)을 차지하였다. 4) 사별관리를 위해 사별사정도구를 사용하고 있는 기관은 4개 기관(10.5%)에 불과하였다. 5) 사별관리 운영상의 문제점으로는 사별가족을 모으기가 어렵다는 점이 가장 많았고 사별관리자의 전문적인 지식의 부족, 사별관리 인력의 부족, 호스피스 기관과의 지역적 거리가 먼 경우, 사별자에 대한 사회적인 관심 부족, 재정적인 어려움 등이 있었다. 6) 효율적인 사별관리 방안으로는 사별관리 프로그램의 개발, 사별관리 교육의 필요성, 전문가 양성, 인력충원, 재정 지원 등의 요구사항이 있었다. 결론 : 국내 호스피스 기관중에서 69%가 사별관리를 시행하고는 있으나, 사별관리 전문가와 인력이 부족하고 사별관리 프로그램도 다양하지 못한 실정이다. 또한 사별자의 개별적인 욕구 측면에서 사별관리 프로그램이 다양하지 못하였다. 그러므로 효율적인 사별관리를 위해 사별관리 프로그램이 개발되어야 하며 관리운영자의 전문적인 교육과 봉사자 교육 및 훈련이 있어야 하고 사별자의 개별성과 요구에 적합한 접근방법이 모색되어야 한다. 앞으로 한국실정에 맞는 토착화된 사별관리를 위한 다각적인 연구가 시도되어야 하며 이를 실무에 적용시켜야 한다. Purpose : To evaluate the present status of bereavement care in Korean hospice service as a basic database for the effective bereavement care. Method : The data were collected two sets from September to October, 1999 and from November to December, 2000, 55 hospice institutions identified by the Hospice Education Institution, College of Nursing, Catholic University were contacted for a telephone survey. The researchers conducted telephone interviews with hospice administrators for 10 to 30 minutes. Result : 1) Among the 55 Korean Hospice institutions, 38 institutions(69.1%) provided bereavement services. 2) The contents of bereavement services consisted of telephone call 28 institutions(74.5%), bereaved family meeting 26 institutions(69.4%), home visiting 22 institutions(57.9%), mail 16 institutions(42.1%), personal counselling 7 institutions(18.4%). 3) The 26 hospice institutions(68.4%) which provided meetings for bereaved families met with the following frequency : Annually is 11 institutions(42.3%), biannually 6 institutions(23.1%), monthly 6 institutions(23.1%) and bimonthly 3 institutions(11.5%). 4) Only 4 hospice institutions(10.5%) used the assessment tool to screen for high risk of bereaved. 5) The major difficulties of current bereavement services were low attendance for the bereaved family meeting, shortage of professional managers and volunteers, limited accessibility to hospice institutions, little social awareness for the bereaved, and financial difficulties. 6) The hospice administrators expressed the need for the development of bereavement program, the education program for the bereavement services, trained professionals, the sufficient provision of human resource and financial support for more effective bereavement services. Conclusion : Although many hospice institutions(69.1%) provided bereavement services, they generally lacked capable bereavement professionals and various individualized bereavement services. In conclusion, it is required to develop the specified bereavement program and the training program for the staff and volunteers, so as to provide customized bereavement services based on individual needs. Further research will be necessary to evaluate the effects of customized bereavement services in Korea before applying to practice.

일부 지역주민들의 호스피스에 대한 인지와 태도 및 간호요구 조사

노유자,한성숙,안성희,용진선,Ro, You-Ja,Han, Sung-Suk,Ahn, Sung-Hee,Yong, Jin-Sun 한국호스피스완화의료학회 1999 한국호스피스.완화의료학회지 Vol.2 No.1

목적 : 본 연구는 일부 지역 주민들의 호스피스에 대한 인지와 태도 및 호스피스 간호 요구를 조사하고, 호스피스에 대한 인지와 태도에 따른 호스피스 간호요구를 파악하기 위함이다. 방법 : 1998년 9월부터 10월까지 서초구에 거주하는 $20{\sim}60$세의 성인 남녀 924명을 대상으로 하였으며, 자료는 자기보고식 설문지를 통하여 수집되었고, t-test와 ANOVA를 사용하여 분석하였고 Scheffe test로 다중비교를 하였다. 결과 : 1) 연구대상자의 평균연령은 38세였고, 대부분이 고학력자였다. 2) 호스피스에 대한 인지에서, 호스피스에 대해 들어 본 경험이 있다고 한 경우가 54.1%(501명)였으며, 그 중에서 64%가 여성이었고, 고졸 이상 학력자가 90.7%이었다. 죽음을 미리 준비해야 한다고 생각하는가에 대하여는 약 74%가 긍정적 대답을 하였다. 암과 같은 불치병에 걸린다면 의료인이 그 사실을 말해주기를 원하는가에 대해서는 약 83%가 원한다고 답하였다. 불치병에 걸린 사람에 대한 간호에 대해서는 63.1%가 고통을 최소로 줄이고 편안한 죽음을 맞이할 수 있도록 신체적, 정신적, 영적인 간호를 제공해야한다고 응답하였다. 3) 호스피스에 대한 태도에서, 필요시 호스피스 간호를 받겠다고 한 경우가 약 73.8% 이었고, 말기환자를 돌보는 방법으로는 기정에서 호스피스 팀의 방문을 받으며 돌보는 것이 33.5%로 가장 높았다. 4) 호스피스 간호요구를 영역별로 보면, 신체적 요구(M=4.37)가 가장 높았고 사회적 요구(M=3.96), 정서적 요구(M=3.87), 영적 요구(M=3.79)순이었으며, 전체 요구도는 평균 약 4.00점으로 호스피스에 대한 높은 요구를 보였다. 인구학적 특성별로는, 50세 이상의 연령층과 기혼자들에서 요구도가 가장 높았고, 남성보다 여성이 높았으며, 종교별로는 가톨릭의 경우 요구도가 가장 높았다. 호스피스 간호 요구도는 호스피스에 대해 들어본 경험, 죽음에 대한 준비, 불치병에 대한 통고 및 호스피스의 필요성 인식에 따라 유의한 차이를 보였다. 즉, 호스피스에 대해 들어본 군, 죽음을 미리 준비해야 된다고 전적으로 긍정한 군, 불치병에 대한 통고를 원하는 군, 그리고 필요시에 호스피스 간호를 받겠다는 군에서 호스피스 간호 요구도가 유의하게 높았다. 결론 : 본 연구의 결과는 호스피스에 대한 인지정도를 높일 수 있는 홍보와 교육이 필요함을 시사하며, 지역사회 주민들의 요구를 충족시켜 삶의 질을 향상시키기 위한 가정 호스피스를 발전시키고 나아가서는 전반적인 호스피스 발전을 위한 유용한 자료가 될 것으로 기대된다. Purpose : The hospice movement began about 30 years ago in Korea. However, basic studies have seldom been conducted about the general public's knowledge concerning hospice care and their needs for it. The purpose of this study was to investigate the general public's knowledge of and attitude toward hospice, and their needs for hospice care, and to analyze the needs for hospice care in relation to their knowledge and attitude in residents from a specific community. Methods : The survey was conducted with 924 people randomly selected from a district in Seoul. The data were collected through a self-reporting questionnaire constructed by the authors. With 30 items given in the questionnaire, the level of hospice needs showed Cronbach's alpha .89 in a pilot study and .92 in this study and the items were classified into four areas by a factor analysis. The data collected were analyzed by means of t-test and ANOVA. Results : 1) The average age of the respondents was 38. The majority of the respondents were well-educated. 2) Regarding awareness of hospice care, 54%(501 people) indicated they have heard of hospice. About 74% thought that people should be able to prepare for death in advance. About 83% wanted to be informed when they have life threatening illnesses such as terminal cancer. Also, about 63% responded that patients with terminal diseases should be provided with physical, spiritual, and psychological care for minimizing pain and peaceful death. Regarding the attitude toward hospice care, 74% responded that they would use hospice care if needed. The number of the respondents who preferred home visitation by the hospice team to care for the terminally ill ranked first with 34%. Concerning needs for hospice care : 1) By needs area, physical need showed highest mean(M=4.37), followed by social need(M=3.96), emotional need(M=3.87), and the spiritual need(M=3.79). The overall need level showed the mean value of 4.00 which reflects a considerable need for hospice care. 2) By demographic characteristics, people age over 50, the married, and the unemployed indicated higher level of needs for hospice care. Women showed higher level of needs than did men, and Catholics demonstrated higher level of needs than believers of other religion(P<0.0001). 3) As for the knowledge of and attitude toward hospice rare, the level of hospice care needs was significantly higher in the following groups: those who have heard of hospice, those who are aware of death preparation, those who want information on terminal diseases, those who want to use every method to sustain life, and those who are aware of hospice needs(P<0.001). Conclusion : It is assumed that the findings of this study on the knowledge, attitude, and needs for hospice care in the public can contribute to planning a successful hospice care program. Furthermore, the findings of this study will serve as useful data for the promotion of home hospice care to improve the quality of life of community residents, and contribute to the development of hospice care as a whole.

호스피스 팀 구성원의 직무지침 개발

노유자,한성숙,유양숙,용진선,Ro, You-Ja,Han, Sung-Suk,Yoo, Yang-Sook,Yong, Jin-Sun 한국호스피스완화의료학회 2001 한국호스피스.완화의료학회지 Vol.4 No.1

목적 : 본 연구는 우리나라 호스피스 팀 구성원의 직무지침을 개발하여 앞으로 호스피스 제도화 방안에 기초자료를 제공하기 위하여 수행되었다. 방법 : 관련 국내외 문헌고찰을 토대로 호스피스팀 구성원의 직무 지침안을 설정하여 직무지침에 대한 도구를 개발하였다. 개발된 도구의 내용 타당도를 2차에 걸쳐 전문가에게 우편 설문조사하였다. 1차 조사는 1999년 12월부터 2000년 1월까지 국내 호스피스 기관에 종사하고 있는 실무자 및 호스피스 전문가 126인을 대상으로 하였으며, 2차 조사는 2000년 8월부터 10월까지 35인을 대상으로 하였다. 자료는 조사자가 직접 기관을 방문하여 설문지를 통해 수집하였다. 결과 : 1차 조사에서 호스피스 조정자, 간호사, 사목자, 사회복지사, 약사, 영양사, 치료사, 자원봉사자, 그리고 간호 조무사의 역할과 자격은 CVI가 80.0점 이상인 문항으로 선정하였다. 의사의 자격 중 '마취제 관리 자격증을 소지한 자' 문항은 78.6점 이었고, 자원봉사자 팀장의 자격에서 '대학 이상의 학력소지자' 문항은 74.7점 이었으므로 제외시켰다. 2차 조사에서 호스피스 간호사, 사목자, 사회복지사, 약사, 영양사, 치료사, 자원봉사자, 그리고 간호 조무사의 역할과 자격은 CVI가 80.0점 이상인 문항을 선정하였다. 그러나 호스피스 조정자의 역할 중 '신체적, 사회적, 심리적, 영적 상태를 진단하고 계획한다' 문항이 77.9점이었고, 자원봉사자 팀장의 역할 중 주 1회 팀회의에 참여하고 대상자를 위한 공식적인 간호계획에 참여한다'가 78.6점이었으나 1차에서 80점 이상이었기 때문에 포함시켰다. 결론 : 개발된 직무지침을 적용한 후 수정, 보완하는 과정과 한국 실정에 적합한 호스피스 팀 구성원의 직무지침 표준을 위한 연구가 필요하다. Purpose : The purpose of this study was to develop task guidelines for hospice team members. The task range of all personnel who work for hospice institutions was identified, and a tool describing roles and tasks of the hospice team members was developed based on review of related literature, both domestic and international. Methods : The content validity of the tool was assured by an expert panel through two phases of discussion. The first phase of the study included a survey conducted from December 1999 to January 2000 for a total of 126 hospice experts and practitioners affiliated with domestic hospice institutions. The second phase of the study included 35 subjects. The data were collected using a survey when the investigators visited each hospice institution. The data were analyzed using descriptive statistics. Results : 1) In the first phase of the study, all items scored over 80 points in CVI were selected as the roles and tasks of hospice coordinator, nurse, pastor, social worker, pharmacist, nutritionist, therapist, volunteer, and nurse aide. However, two items were excluded because they scored below 80 points: an item describing eligibility of a physician, a person who has a license for managing anesthetic agents was scored as 78.6 points, and an item describing the eligibility of the team leader of volunteers, a person educated at the graduate level was scored as 74.7 points. 2) In the second phase of the study, all items scored over 80 points in CVI were selected as the roles and tasks of hospice nurse, pastor, social worker, pharmacist, nutritionist, therapist, volunteer, and nurse aide. Of the roles of the hospice coordinator, however, the item scored as 77.9 points, assess and plan a patients physical, social, emotional, and spiritual status, and, of the roles of the team leaders of volunteers, the item scored as 78.6, attend a team meeting once a week and participate in building an standard nursing plan for patients were included in the tool since they scored over 80 points in the first phase of the study. Conclusion : The developed task guideline should be further modified and revised based on the findings of a preliminary application in the actual field. There is also a need of continuous research for developing more culturally-appropriate task guidelines for hospice team members.

지역사회 말기질환자 가족 부담감에 관한 연구

한성숙,노유자,양수,유양숙,김석일,황희경,Han, Sung-Suk,Ro, You-Ja,Yang, Soo,Yoo, Yang-Sook,Kim, Sek-Il,Hwang, Hee-Hyung 한국가정간호학회 2003 가정간호학회지 Vol.10 No.1

The purpose of this study was to describe the perceived burden of the terminally III patients's caregiver and to analyze relationship between the perceived burden and the various demographics, illness characteristics, family relationships, and economic factor of the family & patients. The sample of 132 caregivers who care for the terminally III patients Kyung-Gi province, Seoul, Korea. The period of this study was from August to September, 2002. The perceived burden of the family caregiver was measured by the burden scale(20 items, 4 point scale) developed by Montgomery et al. (1985). The Data was analyzed using SAS-program by t-test and ANOVA. The results were as follows; 1. The mean of the family caregiver's burden score was 3.02. The score showed that caregivers perceive severe the level of burden. The hight items of the family caregiver's burden were' I feel it is painful to watch patient's diseases'(3.77). 'I feel afraid for what the future holds for my patients'(3.66), 'I feel it reduced to amount of privacy time'(3.64). 2. The caregiver's burden was significantly related to patient's gender(F=3.17, p= 0.0020), patient's job(F=2.49, p=0.0476), caregiver's age(F=4.29, p=0.0030), and caregiver's job(F=2.49, p=0.0476). 3. The caregiver's burden according to illness characteristics showed no significant difference. 4. The caregiver's burden was significantly associated with patient's family relationship (F=4.05, p=0.0041), patient's care mean period in a day(F=47.18, <p=.000l), patient's care period after diagnosis (F=5.18, p=<.0001), and economic status of family(F=3.58, p=0.0088). The highest caregiver's burden related to family was 'parents caregivers'(3.27), the lowest was 'patient's son & daughter caregivers'(2.88). In case of prolonged care period in a day, the caregiver's burden was significantly high. In case of prolonged care period after diagnosis, the caregiver's burden was significantly high. In case of no monthly family income. the caregiver's burden was significantly increased (3,24). The need for health care has expanded from curative therapy to health promotion and rehabilitation also. finally the need for hospice care has demanded in order to improve the quality of life of the terminally ill patients and their families. Because physical, emotional, social and spiritual approaches are required to meet their needs, the integration of various resources is very important. This study is carried out to build a community-based integrated model that is good for improving the patients and familiy's quality of life and to minimize the cost from tertiary hospitals. There were several subjects in this study such, analyses as traditional home care, utilization review of terminally ill patients, measurement of burden of family members and provided practice guidelines for the home cancer patient management. We suggest three strategies for the development of a new model. The firstly the change of the role of the healthcare center from a direct service provider to a management-oriented organization. The secondly the induction of a team-based approach by preserving the proper role of each organization. The thirdly the reenforcement of this team-based approach with the sharing of information on the patients and community-based resources. These suggests are based on the Partnership Collaboration Model and the strategies stated as in the above. In this model, the health care center could playa managerial role and all of the community's resources and the patient's information could hold in common. It is indicated that the information of the patients might be safely used by a semi-open system and an open-system for sharing of the information of the community-based resources.

호스피스 병동에 입원한 말기 암환자의 통증 예측요인

용진선,한성숙,노유자,홍현자,Yong, Jin-Sun,Han, Sung-Suk,Ro, You-Ja,Hong, Hyun-Ja 한국호스피스완화의료학회 2002 한국호스피스.완화의료학회지 Vol.5 No.2

목적 : 본 연구는 호스피스 병동에 입원한 말기 암 환자의 통증과 통증에 영향을 미치는 요인인 우울, 불편감, 신체적 간호 시행 횟수, 진통제 사용, 및 영적상태를 평가하기 위한 서술적 조사 연구이다. 대상 : C 대학 3개 부속병원의 호스피스 병동에 새로 입원한 말기 암환자 58명을 대상으로 하였다. 자료수집은 1998년 1월부터 1999년 1월까지 1년간 연구원들의 직접 면접으로 실시하였다. 수집된 자료는 ANOVA, Pearson correlation oefficient, 및 Multivatiate mulitiple regression으로 통계 처리하였다. 결과 : 1) 인구학적 특성:대상자의 나이는 평균 57세 이었고, 60세 이상이 28명(48.3%)으로 가장 많았다. 교육정도는 고등학교 이상 졸업자가 약 53%를 차지하였고, 종교는 가톨릭이 62.1%로 가장 많았다. 결혼 상태는 대부분이 기혼(89.7%)이었고, 가족 수는 2명인 경우가 25.9%, 4명이 19.0%, 없는 경우가 17.2%, 3명이 15.5 % 순이다. 임상적 특성으로 진단명은 위암이 24.1%, 폐암이 17.2%, 직장암이 13.8% 순 이었다. 호스피스 병동에 입원하게된 동기는 통증완화가 67.2%, 영적 간호가 39.7%, 증상완화가 27.6%였다. 수술을 받은 경우는 44.8%, 받지 않은 경우가 55.2%였다. 가족력에 암이 있었던 경우는 27.6%이었고, 일상 수행 정도는 부분적으로 가능한 경우가 65.5%로 가장 많았으며, 전혀 불가능이 22.4%, 그리고 12.1%는 가능하였다. 돌봄과 관련된 특성에서 주 돌봄 제공자가 주로 가족(72.4%)이었으며, 간호 장소는 84.5%가 병원을 선호하였고 그 이유는 통증 조절(51.7%), 언제나 치료가 가능한 점(15.5%), 정서적 안정(15.5%), 그리고 영적 간호(12.1 %) 순으로 나타났다. 대상자 모두는 가정에서의 간호를 염려하고 있었는데 그 이유는 통증 조절이 어렵다는 것(77.6%), 영적 간호 제공자 부재(15.5%), 돌봐줄 사람의 부재(13.8%), 및 가족의 부담감(6.9%)이었다. 통증의 종류를 보면, 대상자의 53.4%가 심부 통증, 20.7%가 복합적인 통증, 17.3%가 내장 통증, 5.2%가 신경성 통증, 3.4%가 표재성 통증을 호소하였다. 마약성 진통제를 사용한 경우는 77.6%였다. 통증 정도는 평균 4.69점이었고, 우울감은 6.13점, 불편감은 4.13점, 그리고 신체간호 시행은 2.59점이였다. 2) 통증과 통증 관련요인과의 상관 관계 :통증과 우울(P<.05), 통증과 신체적 간호(P<.05), 통증과 불편감(P<.05), 우울과 불편감(P<.05)사이에 순 상관 관계를 보여, 우울하고 불편감이 심할 수록 통증이 더 심했으며, 신체 간호 횟수가 많은 경우일수록 통증을 더 느꼈고, 우울할 수록 불편감도 더 심했다. 3) 통증예측 요인 분석: 우울 정도(${\beta}=0.41$, P=0.0049) 와 마약성 진통제 사용 여부(${\beta}=2.11$, P=0.0132)가 환자의 통증 정도($R^2=.46$)에 유의하게 영향을 미쳤다. 결론 : 본 연구의 결과 말기 암환자들 대부분이 입원 당시 중등도 이상의 통증이 있었으며, 통증정도는 우울과 불편감 그리고 신체간호 횟수와 상관관계가 있었고, 우울과 마약성 진통제 사용이 통증 예측인자로 나타났다. 그러므로 말기 암환자의 통증을 완화하기 위해서는 약물요법은 물론 신체적, 심리적, 및 영적 측면과 관련된 총체적인 접근에 의한 다학제간의 중재프로그램이 마련되어야 한다고 본다. Purpose : The purpose of this study was to investigate the impact of depression, discomfort, spirituality, physical care, and opioid use on pain with terminally ill cancer patients in the hospice units. Method : The convenient sample of this study consisted of 58 terminally ill cancer patients at three hospice units in university-affiliated hospitals. Patients were interviewed with structured questionnaires. The data was analyzed using ANOVA, Pearson correlation coefficient, and multivariate multiple regression. Result : The results of this study were as follows : 1) The mean age of the participants was approximately 57 years. Regarding diagnosis, stomach cancer showed the highest frequency (24.1%), followed by lung cancer (17.2%) and rectal cancer (13.8%). Regarding motivation for admission to the hospice unit, the majority of the participants indicated pain control (67.2%), followed by spiritual care (39.7%), and symptom relief (27.6%). 2) The mean pain level measured by VAS was 5.13 (${\pm}2.61$). Regarding pain type, the highest pain frequency the participants experienced was deep pain (53.4%), followed by multiple pain (20.7%), intestinal pain (17.3%), and neurogenic (5.2%) and superficial pain (3.4%). 3) Regarding the factors influencing pain, the pain level was significantly affected by the depression level (P<0.01) and the opioid use (P<0.01). Conclusion, In summary, the higher the level of pain the terminally ill cancer patents had the higher the depression level as well as the opioid use. Thus, health care professionals need to continuously provide holistic care for them to die comfortably.

Emotional Stress and Cancer among Female Patients

Kyum Koo Chon(전겸구),Young Sook Tae(태영숙),You-Ja Ro(노유자) 대한스트레스학회 1999 스트레스硏究 Vol.7 No.2

호스피스 병동과 일반병동의 말기암환자의 간호중재 비교

노유자,한성숙,용진선,송민선,홍진의 가톨릭대학교 간호대학 호스피스 교육연구소 2002 호스피스논집 Vol.6 No.-

The purpose of the study was to compare symptoms, medical therapies, and nursing interventions with terminal cancer patients during the last four weeks of their lives in a hospice unit and general units. For the descriptive survey study, data were collected by reviewing the charts of 243 patients who died of terminal cancer at K hospital in Seoul. The data was analyzed using Chi-square test and t-test. The study findings are summarized as follows: There were higher frequencies in physical symptoms of constipation, itching sensation, pain, sleeping disturbance, sore, and urinary difficulty for those patients in the hospice unit than those patient in general units. All emotional symptoms were recorded significantly higher for those patients in the hospice unit than those in general units. Regarding the major medical treatments, pain control was used significantly more for those patients in the hospice unit but antibiotic therapy and resuscitation were used significantly more for those patients in general units. The hospice unit provided more comprehensive nursing interventions including psychological, spiritual, and family cares as well as physiological care for terminal cancer patients. The facts showed that those patients who need hospice care in general units should be referred to the hospice unite at an appropriate time.

한국 호스피스의 현황과 전망에 관한 연구

노유자,김남초,이선미 가톨릭대학교 가톨릭대학교 간호대학 호스피스 교육연구소 1996 호스피스논집 Vol.1 No.-

There has been a growing interest and concern to Hospice in Korea since 1965, which was started by Catholic sisters for the first in Korea, however, hospice is still infant stage, also there has been no report summarizing about the present status of hospice. The authors interviewed people in charge of thirty-nine hospice centers, and also reviewed thirty-four papers published between 1984 and 1995. This study was carried out from March 4th to April 27th, 1996. The results of the interviews revealed 1. Hospice services were spread nationwidly and at least one hospice center is active in each province of Korea. 2. Most of hospice services were established in the 1987s and 1990s. 3. Type of hospices are : 7 Hospice Units are hospital based. There are scattering hospices in 16 hospitals. There are 5 hospital based home hospices and 7 independent home hospices. Occupation of people in charge of hospice services were: nurses 15, priest. ministers, catholic brothers & sisters 12, doctors 9. Religious background of hospice were : catholic 25, protestant 8. 4. Hospice services were supported by personal funds in 12, personal and administration funds in 11 and administration funds in 9 hospices. 5. Hospices have been running by a team approach all but 9 of the 39 centers. Twenty one centers had education /intervention programs, but only eight of these centers had a bereavement programs. Thirteen centers published an introductory brochure for public relations. The results of the review of the papers revealed 1. Among thirty four papers, twenty papers were published between 1991-1995, showing a gradual increase in the study of hospice in recent years. 2. The content of the papers were : research 19, article 13, case report 2. 3. The subject of these studies were : cancer patients who were in the terminal stage and their families in 9, hospice care in 14. Problems suggested by people in charge of hospice were : lack of concern about hospices among doctors, patients and their families and administration officials, poor facilities, financial deficit and a lack of man power. It has been proposed that governmental financial support as well as regulatory is necessary. Enhancement of public relations is also proposed for the development of hospices in Korea. Problems that was found in papers were lack of Public Relations, financial deficits, meagerness of research and of personnel. Financial and regulatory support from the government was strongly suggested. Other proposals were similar to the results from interviews with person in chrage of hospice service. Above results showed that there has been a consensus about the problems and proposals among the members of hospice services in Korea. And also improvement in understanding of hospice services as well as financial and regulatory support from the government is necessary for the development of hospice in Korea.

삶의 질과 관련된 국내 간호논문 분석

노유자,김춘길,이영숙 성인간호학회 1999 성인간호학회지 Vol.11 No.4

This study was done to analyze research trends and to suggest future directions for nursing research on the quality of life (QL) in Korea. The purposes of this study were to describe systematically 10 years of QL nursing, and to identify patterns of tools and significant variables on studies of QL. This article reviewed 71 nursing researches on QL between 1987 and 1996, by examining them according to the period of publication, research for a degree or not, research design, type of subjects, dat collection methods, measurement instruments and range of reliabilities, type of nursing intervention and association of QL and related variables. The findings of the analysis can be summarized as follows: 1. The number of studies related to QL increased from 1987 to 1994. But they have decreased since 1995. 48 of them(67.6%) identified surveys and correlational studies. 2. In all the titles of the studies, there were 7 types of concepts, including QL, quality satisfaction, life satisfaction, and well-being. Among them, QL was the most often used. 3. The subjects of 21 studies were healthy people. In 49 studies, patients had various illnesses. The majority of the patients were hemodialysis patients and cancer patients. Questionnaires were used for data collection in 58 studies. 56 studies were done for the thesis of a degree. while those in the remaining studies were not for degrees. 4. The research designs were various, except in the thesis for a doctorate. There were many more experimental studies(57.1%) done in the thesis for a doctorate. 5. The types of intervention were categorized as exercise(6), supportive care(3), reminiscence(2), relaxation(1), music(1), and hospice care(1). 6. As measurement tools, 14 types of tools relating to QL were used. 11 of them were composed of multiple dimensions. Among them, the QL Scale by You-Ja Ro(1988) was the most widely used in the studies. In the following, the Life Satisfaction Index by Jin Yun(1982), the Quality of life Scale of National Conference of Cancer nursing(1983), and the Life Satisfaction Index by Wood, Wylie & Sheafor(1969) were used. The reliabilities of the QL Scale were reported in 63 studies, and the Cronbach's alpha coefficients were over 0.7 in 60 cases. The quality of life scales included five dimensions ; such as physical, psychological, social, economical, and spiritual dimensions. 7. There were two categories of factors influencing the quality of life: First, factors that cannot be changed by nursing intervention were : age, educational level, gender, marital status, income, employment status, occupation, number of family members, religion, and illness history. Second, factors that can be changed by nursing intervention were : physical activity, health status, the presence of complications, support, self-esteem, stress, self-efficacy, activities of daily life, physical strength, satisfaction with life, and anxiety. Types of nursing intervention used to improve quality of life were : therapies in relaxation, exercise, reminiscence, and family support, social support, and hospice care. On the basis of the above findings, the following recommendations were made : 1. Further studies on the quality of life instruments of analysis are needed to provide an understanding of dimensions of life in detail. 2. A Meta-analysis needs to be conducted to identify intervention effects on the quality of life. 3. A tool development study is needed to measure the quality of life appropriately in different illnesses. 4. More replicated analysis studies of QL are needed to prove the effect of variables on the QL.

삶의질

노유자 성인간호학회 1993 성인간호학회지 Vol.5 No.2

Renal transplantation is increasingly used to deal with end-stage renal failure. There should be adequate nursing interventions to take care of renal transplantation recipients. The ultimate goal of nursing care for renal transplantation would be to raise quality of life of its recipients. In addressing this issue, this study examined the level of quality of life, and sociodemographic and health factors influencing quality of life among 100 renal transplantation recipients. These recipients were aged between 30 and 59 years, who were chosen by a convenience sampling technique from the renal transplantation recipients at two university hospital in Seoul. Data were obtained through personal interviews, self-report questionnaires, and medical records during the period of August to November of 1993. Quality of life(QL) was measured by using the Quality of Life scale developed by Ro(1988). As to statistical tests, ANOVA, t-test, Scheffe test, Pearson Correlation Coefficients, and Stepwise multiple regression were used through the software package SAS.Renal transplantation is increasingly used to deal with end-stage renal failure. There should be adequate nursing interventions to take care of renal transplantation recipients. The ultimate goal of nursing care for renal transplantation would be to raise quality of life of its recipients. In addressing this issue, this study examined the level of quality of life, and sociodemographic and health factors influencing quality of life among 100 renal transplantation recipients. These recipients were aged between 30 and 59 years, who were chosen by a convenience sampling technique from the renal transplantation recipients at two university hospitals in Seoul. Data were obtained through personal interviews, self-report questionnaires, and medical records during the period of August to November of 1993. Quality of life(QL) was measured by using the Quality of Life scale developed by Ro(1988). As to statistical tests, ANOVA, t-test, Scheffe test, Pearson Correlation Coefficients, and Stepwise multiple regression were used through the software package SAS. The results are summarized as follows : 1. The mean of the QL was 155.95 with arrange between 94 to 207 on the scale ranged from 47 to 235. Of the 6 dimensions of the QL, the score for family relationship was highest(3.52), which is followed by self-esteem(3.41), relationship with neighbors(3.37), emotional state(3.34), physical state and function(3.26), and economic life(3.18). 2. The QL score was positively associated with higher educational level (F=5.50, P=.00) and with having no complication(F=5.35, P=.00). The association between the dimension of the QL and sociodemographic factors are following. 1) Higher score for emotional state was found among the married(t=2.16, P=.04), college graduated(F=3.81, P=.03), and those experiencing no complication(F=5.51, P=.01). 2) Those having religion(t=2.18, P=.03), college graduates(F=4.81, P=.01), and those earning a higher income(F=3.14, P=.05) tended to have better economic life. 3) College graduates revealed higher self-esteem than high school graduates(F=6.06, P=.00). 4) Those experiencing no complications showed better physical state and function(F=15.77, P=.00). 5) Better relationship with neighbors was correlated with being a woman(t=2.10, P=.03), having a religion(t=2.83, P=.01), and earning a higher income(F=3.41, P=.04). 6) Those earning a higher income showed better family relationship than their counterparts(F=3.31, P=.04). 3. With regard to overall QL score, those with grater score tended to perceive their health better than those with lower score(r=.5123, P=.0001). 4. As to hematologic laboratory findings, the mean score of Hb was 12,86g/dl, of Hct 37.82%, of BUN 27.59mg/dl, of Creatinine 1.06mg/dl, and of Cyclosporine 226.36ng/ml. 5. Of the sociodemographic and health factor studied here, perceived health state explained the largest amount of the variance of the QL(26.31%). Educational level accounted for 12.65% of the remaining variance of the QL to be explained. 6. When compared to those healthy adult examined by Ro(1988), each dimensional score of the QL was similar between the two groups. By contrast, the subjects of the present study perceived their health state as poorer than those health adults did.