폐암 환자의 활동상태, 불안, 우울, 사회적 지지, 증상경험과 기능적 상태의 관계: 불쾌감이론 기반으로

김금순 ( Keum Soon Kim ),이명선 ( Myung Sun Yi ),방경숙 ( Kyung Sook Bang ),조용애 ( Young Ae Cho ),이정림 ( Jung Lim Lee ),이은 ( Eun Lee ) 서울대학교 간호과학연구소 2013 간호학의 지평 Vol.10 No.2

본 연구는 불쾌감 이론을 기반으로 생리적 요인(폐암 병기와 활동상태), 심리적 요인(불안과 우울), 상황적 요인(사회적 지지)과 증상경험 및 기능적 상태와의 관계를 파악하여 폐암 환자의 증상경험을 관리하는 간호실무에 적용하고자 시행되었다. 본 연구에서 대상자가 지각하는 증상경험은 일반 암 관련 증상과 폐암 특이 증상 점수를 합친 것으로 평균 12.62점이었다. 이는 일반 암 관련 증상을 살펴 본 Baek10)의 27.7점과 Lee와 Kim19)의 23.1점과 비교 시 낮았으며, 일반 암 관련 증상과 폐암 특이 증상 점수를 함께 측정한 Lee3)의 평균 17.15점보다 낮은 점수였다. 이러한 차이는 연령과 현재 치료에 의한 것으로 생각된다. 본 연구의 대상자는 70세 미만으로 60대가 50.5%를 차지한 반면에 Baek10)의 연구에서는 60대 이상이 66.5%인 것을 보면 연령이 증가할수록 증상이 심하다는 연구 결과7)를 지지하고 있다. 특히, 폐암은 연령이 증가할수록 발생이 높아져 70대에서의 발생이 34.5%로 가장 높은 것을 볼 때 증상관리에 대한 요구가 높음을 알 수 있다.2) 또한 본 연구에서는 현재 치료를 받고 있는 대상자가 38.6%로 Lee3)의 43.9%와 전체 대상자가 항암화학요법을 받고 있는 Baek10)의 연구와 비교 시 낮았기에 증상경험이 낮은 것으로 생각된다. 또한 대상자가 지각하는 영양상태나 건강상태가 좋을수록 증상경험은 낮은 것을 발견하였다. 그러나 본 연구대상자들의 56.4%가 암을 진단받은 지 2년이 경과하였고, 38.6%가 현재 치료를 받고 있음에도 불구하고 영양상태가 나쁘다고 인지하는 경우는 3.0%였으며 또한 지난 한달 간 4 kg 이상의 체중감소가 있었던 경우도 2.0%에 불과하였다. 또한 대상자의 80.2%가 현재 건강상태를 보통 이상으로 지각하고 있었다. 따라서 추후에 대상자의 영양과 건강상태에 대한 지각이 증상에 미치는 영향을 규명할 필요가 있다고 생각된다. 생리적 요인인 폐암 병기, 활동상태와 증상경험 간의 관계를 살펴보면, 폐암 병기와 증상경험 간에는 유의한 상관관계를 보이지 않았으나 활동상태와 증상경험 간에는 유의한 중등도의 순상관관계를 보여 활동상태가 저하될수록 증상경험이 심한 것으로 나타났다. 폐암 환자에 있어서 병기는 치료의 방향을 결정하는데 중요한 변수이나 대상자가 경험하는 증상과는 유의한 관계를 보이지 않았고, 오히려 병기와 상관없이 현재 항암화학요법과 같은 치료 중에 있는 대상자의 증상경험이 더 심각한 것으로 나타났다.3,19) 그러나 본 연구에서는 항암화학요법을 받고 있는 대상자의 증상점수가 그렇지 않은 대상자보다 높았지만 유의한 차이는 아니었기에, 질병 관련 생리적 요인에 대한 추가적인 탐색이 필요하다고 사료된다. 본 연구는 외래를 방문하는 환자를 대상으로 하여 활동상태가 ECOG PS 0에서 2단계로 활동상태가 저하될수록 증상경험은 유의하게 높았고, 이는 선행연구의 결과를 뒷받침하고 있다.3,10,11) 심리적 요인인 불안, 우울과 증상경험 간의 관계를 살펴보면, 불안과 우울 모두 증상경험과 유의한 중등도의 순상관관계를 보여 불안, 우울과 같은 심리적 디스트레스가 높을수록 증상경험이 심하게 나타난다는 선행연구의 결과와 일치한다.20,21) Lee3)의 연구에서 비소세포폐암 환자들이 지각하는 불안과 우울과 같은 디스트레스는 증상경험에 직접적인 영향을 주며, 증상경험을 통해 삶의 질에 매우 부정적인 영향을 주는 요인으로 밝혀졌다. 따라서 NCCN (National Comprehensive Cancer Network)의 권고와 같이 암의 진행단계마다 대상자의 불안과 우울을 평가하여 필요시 적절한 도움을 제공해야 하며,22) 이때 환자의 내적 능력인 극복력의 개념을 도입하는 것은 Lee3)의 연구에서 입증하였듯이 유용한 간호접근이 될 수 있다고 생각한다. 상황적 요인인 사회적 지지와 증상경험 간에는 유의한 상관 관계가 나타나지 않았으며, 이는 사회적 지지와 증상 간에 유의한 직접적인 관계가 나타나지 않았던 선행연구와 일치하였다.3,23) 그러나 Lee3)의 연구에서 사회적 지지는 극복력을 매개로 디 스트레스에 영향을 줌으로써 증상부담에 영향을 미치는 것으로 밝혀졌다. 또한 본 연구의 대상자가 지각하는 사회적 지지를 살펴보면, 20점 만점에 가족지지는 평균 17.69점, 친구지지는 13.63점, 의료인지지는 10.26점으로, 의료인 지지가 가장 낮으며, 이는 선행연구의 결과와 유사하였다.3,10) 이는 직접간호제공자일 뿐 아니라 옹호자, 지지자로서의 간호사의 역할 수행에 대한 도전적인 결과라 할 수 있다. 따라서 간호사의 지지를 증진시킬 수 있는 방법들에 대한 적극적인 모색이 필요하며, 아울러 증상경험에 영향을 미치는 상황적 요인들에 대한 추가적인 파악이 필요하다고 사료된다. 증상경험과 증상경험의 결과, 즉 기능적 상태와의 관계를 살펴보면, 유의하게 높은 역상관관계를 보여 증상경험이 심할수록 기능적 상태는 저하됨을 보여주고 있다. 이는 다발성 증상군의 경증군은 중증군에 비해 기능이 더 좋았다는 Lee와 Park4)의 연구결과와 호흡곤란 증상이 심할수록 기능상태는 저하되었다는 Mohan 등13)의 연구결과와 일치하였다. 또한 부작용 증상을 심하게 호소할수록 기능적 상태가 저하되었다는 Baek10)의 연구결과를 뒷받침하고 있다. 본 연구에서 폐암 환자가 지각하는 증상경험에 영향을 미치는 요인은 심리적 요인(불안과 우울), 생리적 요인(활동상태), 상황적 요인(사회적 지지)의 순으로 나타났으며, 이러한 요인들은 증상경험의 57.8%를 설명하는 것으로 나타났다. 구체적으로 살펴보면, 우울에 의해 증상경험이 43.4% 설명되었으며, 우울과 불안에 의해서는 50.7%설명되었다. 이는 Lee3)의 연구에서 폐암 환자를 대상으로 불안과 우울로 측정한 디 스트레스에 의해 증상부담이 62.8% 설명되었다는 결과보다는 낮았지만, 두 연구결과 모두 불안과 우울이 증상경험에 미치는 영향이 매우 큼을 보여주고 있다. 또한 활동상태가 증상경험에 미치는 영향을 고려하여 활동상태가 매우 저하된 중증의 환자에서의 반복연구가 필요하다고 생각된다. 또한 간호사는 폐암 환자의 증상에 대한 주기적인 평가를 기반으로 체계적인 관리를 제공함으로써 기능상태를 증진시키고 나아가 삶의 질 향상을 도모하는데 주도적인 역할을 담당해야 한다. 폐암 환자가 지각하는 증상경험, 영향요인들과 증상경험 간의 관계, 증상경험과 기능적 상태 간의 관계를 종합해 볼 때, 불쾌감 이론은 폐암 환자의 증상경험을 설명하는데 적합함을 알 수 있었다. 폐암 환자의 증상경험을 적절히 관리하기 위해서는 반드시 불안과 우울과 같은 심리적 요인들에 대한 평가와 환자상태에 맞는 간호접근이 선행되어야 하며, 이러한 과정에 간호사가 적극적으로 개입함으로써 환자 지지자로서의 역할을 수행해야 한다. 또한 불쾌감 이론과 같은 중범위 이론의 간호실무 적용이 더욱 활성화된다면 이론과 실무의 차이를 줄이고 간호실무가 과학적인 배경을 가지고 더욱 발전될 수 있으리라 사료된다. Purpose: The purpose of this study was to investigate the relationships of activity status, anxiety, depression, social support, symptom experience, and functional status in patients with lung cancer based on the theory of unpleasant symptoms. Methods: The participants for this study were 101 lung cancer patients who visited the outpatient department for treatment or follow-up at one hospital in Seoul. Data were collected from January 1 to February 8, 2013 using self-reported questionnaires and clinical records. To measure variables, the functional scale and symptom scale of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30, EORTC QLQ-Lung Cancer 13, Eastern Cooperative Oncology Group Performance Status, Hospital Anxiety and Depression Scale, and Multidimensional Scale of Perceived Social Support were used in this study. The data were analyzed using SPSS 19.0 software for Windows. Results: The symptom experience showed more severity in patients with lower activity status, higher anxiety and depression. With lower activity status and social support, functional status was lower. When anxiety, depression, and symptom experience were higher, functional status was also lower. The significant factors predicting symptom experience were depression, anxiety, activity status, and social support, which explained 57.8% of the variance. Conclusion: These results suggest that psychological factors such as anxiety and depression had a negative influence on the symptom experience of lung cancer patients. Therefore, providing emotional support based on the patients` needs prior to providing symptom management could be a useful strategy for improving symptom experience and functional status.

보건교사의 비만관리실태 조사연구

김이순,주현옥,송미경 韓國學校保健學會 2002 韓國學校保健學會誌 Vol.15 No.2

This study was a research study to find out the real picture and practice of student obesity control by primary, middle and high school nurses. The study sampled 196 school nurses working in the Busan City and Northern Gyungsang Province, who agreed on the purpose of the study. When it comes to the study process, at the meeting of the whole school nurse, the researcher explained the purpose of the study and asked them to complete questionnaires and return on the spot. The study is designed to provide basic data for school nurses in field to systematically and efficiently control student obesity by examining perception of school obesity control and the real picture of practice of obesity control as well as its problems. The study used SPSS 10.0 to analyze data. The results are as follows: Annual plans about obesity control appeared significant at the primary school, 89.3%, higher than 77.3% of the middle and high school(p<0.05). Annual project evaluation showed a significant difference by regions, 56.0% of metro cities vs. small cities(p<0.01). The number of measuring weight of obese students was higher at the primary school than at the middle and high school(p<0.05). Also small cities conducted the weight measurement more often than metro cities(p<0.001). Among the health education methods for obesity, counseling appeared statistically significant(p<.01). The health education showed a significant difference in more experienced school nurses. Among the educational media, environment postings were used at the primary school, 24.0%, higher than 5.3% of the middle and high school. It showed a significant difference(p<.001). OHP or epidiascopes were used at the primary school, 36.4%, significantly higher than the middle and high school(p<.001). In addition, computer was used at the primary school, 21.5%, higher than the middle and high school(<.05). Problems of obesity education data included a lack of textbooks and programs and a short of educational media. However it didnt show a significant difference in schools or in regions. Counseling activities for obesity showed a significant difference in schools(p<.01) and in regions(p<.001). When parents with obese students were in counseling, those in their 20s used home correspondence and those in their 30s and 40s used phone call(p<.01). The rate of equipment to measure obesity was higher at the middle and high school than the primary school, showing a significant difference(p<.001). therefore, regular health education curriculums for school nurses should be systematically created to promote student health. Furthermore, it needs to make standard textbooks for health education by grades as well as by levels and to develop various educational programs and educational media.

방사선사진에서의 골질과 임상적으로 평가한 골질 분류의 상관관계

김현우,허경회,박관수,김정화,이원진,허민석,이삼선,최순철 대한구강악안면방사선학회 2006 Imaging Science in Dentistry Vol.37 No.1

Purpose : To investigate the validity of digital image processing on panoramic radiographs in estimating bone quality before endosseous dental implant installation by correlating bone quality in radiographic images with clinical bone quality classification. Materials and Methods : An experienced surgeon assessed and classified bone quality for implant sites with tactile sensation at the time of implant placement. Including fractal dimension eighteen morphologic features of trabecular pattern were examined in each anatomical sites on panoramic radiographs. Finally bone quality of 67 implant sites were evaluated in 42 patients. Results : Pearson correlation analysis showed that three morphologic parameters had weak linear negative correlation with clinical bone quality classification showing correlation coefficients of -0.276, -0.280, and -0.289, respectively (p<0.05). And other three morphologic parameters had obvious linear negative correlation with clinical bone quality classification showing correlation coefficients of -0.346, -0.488, and -0.343 respectively (p<0.05). Fractal dimension also had a linear correlation with clinical bone quality classification with correlation coefficients -0.506 significantly (p<0.05). Conclusion : This study suggests that fractal and morphometric analysis using digital panoramic radiographs can be used to evaluate bone quality for implant recipient sites. (Korean J Oral Maxillofac Radiol 2006; 36 : 25-32)

노인의 자기초월 체험에 관한 연구

김순이 성인간호학회 2000 성인간호학회지 Vol.12 No.4

This Qualitative nursing research used a helmeneutic phenomenological approach to discover meaning in an self-transcendence experience. The ultimate aim of the inquiry was to discover the essence of self-transcendence experience and to promote understanding. The study used van Manen's Methodology of phenmonological research. Multiple strategies for data collecting were utilized : in depth face-to-face interview and analysis of elders' literature. The following themes of experience emerged : Accepting becoming older as a natural phenomenon, transferring to one's own sons and daughters' oriented life. Maintaining harmonious relationship with neighbors and peer, observing real situations with silence, forming internal integrity with perseverance, compromising own's real situation, actualizing one's death, giving up roots of life, depending on God and conforming to human limitation. From this study essential themes for understanding self-transcendence experience and needs for continuing inquiry were identified.

의원성 사고로 발생한 타액선염 : 증례보고

김현우,허경회,이원진,허민석,이삼선,최순철 대한구강악안면방사선학회 2004 Imaging Science in Dentistry Vol.34 No.2

A case of sialadenitis is presented in a patient with painful swelling of the right mouth floor. The condition was caused by trauma on the right mouth floor during dental treatment, which had happened 15 days before admission. On aspiration, mucous secretion was found and ultrasonography showed obstruction of duct. Histopathological studies and surgical investigation established a definite diagnosis of obstructive sialadenitis caused by ductal laceration. As surgical treatment sialodochoplasty was selected. The case and relevant considerations are discussed.

革新(工場 새마을 運動) 受容에 영향을 주는 集團의 構适的 變因에 關한 硏究

金言住,權純明,李東仁 충남대학교 인문과학연구소 1980 인문학연구 Vol.7 No.1

디지털 측방두부규격방사선사진과 MDCT의 3차원 재구성 영상을 이용한 합성측방두부규격방사선사진의 계측치 비교 및 머리 위치가 미치는 효과

김미자,최보람,허경회,이원진,허민석,이삼선,최순철 대한구강악안면방사선학회 2009 Imaging Science in Dentistry Vol.39 No.3

Purpose : To investigate the reproducibilities and compare the measurements in digital and MDCT-synthesized cephalometric radiograph, and to investigate the effect of head position on the measurement during imaging with MDCT. Materials and Methods : Twenty-two dry skulls (combined with mandible) were used in this study. Conventional digital cephalometric radiograph was taken in standard position, and MDCT was taken in standard position and two rotated position (10°left rotation and 10°right tilting). MDCT data were imported in OnDemand?? and lateral cephalometric radiograph were synthesized from 3D virtual models. Two types of rotated MDCT data were synthesized with default mode and with corrected mode using both ear rods. For all six images, sixteen angular and eleven linear measurements were made in V-Ceph?? three times. Reproducibility of measurements was assessed using repeated measures ANOVA and ICC. Linear and angular measurements were compared between digital and five MDCTsynthesized images by Student t-test. Results : All measurements in six types of cephalometric radiograph were not statistically different under ICC examination. Measurements were not different between digital and MDCT-synthesized images (P> .05). Measurements in MDCT-synthesized image in 10°left rotation or 10°right tilting position showed possibility of difference from digital image in some measurements, and possibility of improvement via realignment of head position using both ear rods. Conclusion : MDCT-synthesized cephalometric radiograph can substitute conventional cephalometric radiograph. The error on head position during imaging with MDCT have possibility that can produce measurement errors with MDCT-synthesized image, and these position error can be corrected by realignment of the head position using both ear rods. (Korean J Oral Maxillofac Radiol 2009; 39 : 133-47)

디지털 및 일반 측방두부규격방사선사진에서 측정 방법에 따른 계측치의 비교

김미자,허경회,이원진,허민석,이삼선,이진구,안병근,최순철 대한구강악안면방사선학회 2005 Imaging Science in Dentistry Vol.35 No.1

Purpose : To compare cephalometric measurement between measuring methods in digital and conventional lateral cephalometric radiograph. Materials and Methods : Twenty digital and conventional lateral cephalometric radiographs were selected. In digital group, cephalometric measurements were performed manually using hardcopies and automatically using VCeph^(TM) program on the monitor. In conventional group, the same measurements were performed manually on conventional films, and for automatic measurement conventional films were digitized by scanner. All measurements were performed twice by 4 observers, and 24 cephalometric variables were calculated and the time spent for each measurement was recorded. The differences in measurements data and the time spent for each measurement were compared within each group. Intra-observer and inter-observer comparisons were performed. Results : In both groups, no statistically significant difference between manual and automatic measurements was observed and most of the variables didn’t show statistically significant differences between methods. The observer with less experience tended to show statistically significant differences of measurements between methods, and differences from other observers. The differences of measurements between methods in digital group were lesser than those of conventional group with statistical significance in 8 variables out of 24. With automatic method and in digital group, the spent time was shorter. Conclusion : With direct digital radiograph, automatic method using manually idenitified landmarks can be preferable in cephalometric analysis.

노인의 임종과정에 대한 태도 유형 분석

김순이,김신미 성인간호학회 2003 성인간호학회지 Vol.15 No.3

Purpose: This study was performed to identify and understand the nature of attitude patterns regarding dying process exhibited in the elderly persons who lived in the community setting. Method: Q methodology was applied. Ten elderly were selected from the senior centers and requested to answer open ended questions by using written questionnaires. Additionally, 12 other elderly from different senior centers were interviewed in depth, and their statements were recorded via voice pen by researchers to derive Q-population. From the 120 Q-population, 33 Q-sample were selected, 22 P-sample were rated by 1 to 9 oint scale respectively for Q-sorting. For Q-type analysis, pc QUNAL was used. Result: Three types of attitude patterns were identified, which were valuing dignity, seeking provision of nature, and avoiding of dying process. Conclusion: The significance of this study is as follows : Discovery of 3 attitude patterns of elderly toward dying. better understanding about elderly's perspectives for favorable dying, and informations for possible development of nursing strategies for elderly who is facing death.

한국 비만 청소년의 스트레스와 대처방법에 관한 측정도구 개발연구

김이순,김영혜 韓國保健敎育.健康增進學會 2001 보건교육건강증진학회지 Vol.18 No.3

This study was attempted to develope a highly reliable and valid tool which is useful to assess the Korean obese adolescents' stress and coping method. The data were collected from the total of 600 obese students from middle and high schools in Pusan. The author used a convenience sampling method. The data collection was done from March 2 to July 11, 1999. The analysis of the data was done with SPSS Win(10.0) for descriptive statistics and factor analysis. The preliminary tool was composed of 72 items(stress items: 34, coping method items: 38) with the five point Likert scale. Item analysis and inter consistency were calculated for reliability and validity through pre-test. The preliminary tool was analyzed for reliability and validity. Finally, the tool was of 65 items(stress items; 33, coping method items: 32). The results were as follows : 1.Cronbach Coefficient Alpha for the 33 items of stress was .9485 and the 32 items of coping method was .8534. 2.The factor analysis was done in order to confirm construction and the items were extracted Oblimin rotation and Maximum likelihood extraction method. 3.The factor analysis showed 6 factors in stress and 10 factors in coping method. These 6 factors of stress explained 62.4% and 10 factors of coping method explained 57.4%. 4.Six factor of stress lable were 〈outward appearance〉, 〈boyfriend/ girlfriend〉, 〈occur an outbreak of disease〉, 〈mutual relation of family〉, 〈an obese figure〉, 〈be a burden on exercise〉. 5.Ten factor of coping method fable were 〈be concerned about another affairs〉, 〈recreation activities〉, 〈self-violence〉, 〈relaxation〉, 〈hobby activities〉, 〈avoid a situation〉, 〈communication〉, 〈music〉, 〈negative behavior〉, 〈positive thinking〉. The results of using this scale in a study will contribute to design an appropriate school health management of obese students, and also it will contribute to the development of nursing research.