코로나19 생활치료센터 격리대상자의 자율성

김단비 한국의료윤리학회 2021 한국의료윤리학회지 Vol.24 No.1

In Korea, COVID-19 patients with no symptoms, or only mild symptoms, are admitted to residential treatment centers rather that hospitals in order to ensure an adequate supply of hospital beds for patients in need of advanced medical treatment. However, COVID-19 residential treatment centers can raise ethical concerns regarding patient autonomy. In this article, I share my experiences as a nurse working at a residential treatment center in 2020 and discuss some of the ethical issues regarding patient autonomy that can arise within these facilities. 본 발표는 2020년 코로나19 생활치료센터 격리대상자와 의료진의 노력에 대한 생생한 기록이다. 감염병 전파 예방을 위해 개인의 자율성이 제한될 수도 있는데, 대표적인 예시가 생활치료센터 입소이다. 생활치료센터는 부족한 병상 문제를 타개하기 위한 아이디어로서, 입원치료가 필요한 환자에게 병상을 제공할 수 있도록, 무증상 또는 경증 환자를 의료시설이 아닌 다른 숙박 시설에 수용하도록 한 것이다. 매우 성공적인 방법이었지만, 이는 격리대상자의 자유와 자기결정권 제한이라는 윤리적 이슈를 야기한다. 본인은 생활치료센터에서 근무한 간호사로서의 경험을 공유하고자 한다. 무엇보다도 이것이 격리대상자의 자율성 제한과 관련한 문제를 논의하는 데 사용되기를 바란다.

거주형 치료 기관 실무자의 위기청소년 개입 경험 분석 - 국립중앙청소년디딤센터를 중심으로

공윤정,신학승,이은주,이혜은 부산대학교 교육발전연구소 2022 교육혁신연구 Vol.32 No.3

Purpose: In Korea, residential treatment programs are attempting to make a difference in lifestyle, career and school achievement and future plans of adolescents with various emotional and behavior problems. Therefore, this study was conducted with the aim of exploring in-depth the experiences of residential treatment intervention by youth workers at the National Youth Healing Center. Method: In this study, a focus-group interview (FGI) was conducted with eight staff members of the residential treatment program, the purpose of which was to explore staff perceptions of the intervention as well as change factors in the residency treatment program. The participants were five males and three females between the age of 20 and 30 years. The FGI was recorded and transcribed, and its content was analyzed through the consensual qualitative method, from which 3 upper categories, 11 categories and 25 themes were deduced. Results: The study's results showed that the most important interventions for youth workers were setting intervention goals, individualized intervention, youth workers as a role model, letting them know the consequences and responsibilities of actions, and interventions by process based on understanding the change process. Therapeutic factors perceived by youth workers were coping based on the understanding of youth relationship patterns, enduring difficulties of youth and building receptive relationships, daily stability experience through continued basic life management, and the experiences of positive presence via achievement. The results of the difficulties and copings experienced by youth workers included (a)frequent burn-outs and difficulties due to multiple roles and (b)cooperating and coping through trust and communications with other colleagues. Conclusion: This study is meaningful in that it explored the actual intervention experiences of youth workers at the Youth Healing Center, areas where they focus on for treatment, effective treatment factors, and difficulties and countermeasures of workers. Finally, the implications of this study and suggestions for subsequent studies were discussed. 연구목적: 최근 국내에서는 다양한 정서․행동문제를 가진 청소년들을 대상으로 이들의 생활습관, 학업, 진로, 정서․행동문제 등의 변화를 위한 거주형 치료 프로그램이 시도되고 있다. 이에 본 연구에서는 거주형 치료기관인 청소년디딤센터 실무자들의 거주형 치료 개입 경험을 심층적으로 탐색해보기 위한 목적으로 실시되었다. 연구방법: 이 연구에서는 거주형 치료재활 프로그램의 실무자 8명을 대상으로 포커스집단면접을 실시하여, 실무자들이 지각한 거주형 치료재활프로그램에서의 개입의 목표 및 변화의 요인을 탐색하였다. 연구참여자는 남자 5명, 여자 3명이었고, 나이는 20~30대였다. 포커스집단면접의 전 과정은 녹음한 후 전사하여 내용분석하여, 연구자들의 합의를 통하여 3개의 상위범주, 11개의 범주와 25개의 주제를 도출하였다. 연구결과: 청소년디딤센터 실무자들의 입교생들에 대한 중점적 개입영역은 변화를 위한 개입목표 설정, 입교생 특성을 고려한 개별화 개입, 도움을 주는 역할모델 되어주기, 합의한 규칙에 따라 행동의 결과와 책임을 알게 함, 입교생의 변화과정 이해에 기반한 과정별 개입이었다. 입교생의 변화에 효과적인 치료적 요인으로는 입교생 관계패턴에 대해 깊이 이해하고 대처함, 입교생의 어려움을 버텨내며 수용적 관계 형성, 숨쉬는 듯이 하는 지속적인 생활관리로 안정감 경험, 성공경험을 통한 긍정적 존재감 경험의 범주가 나타났다. 거주형치료에서 경험하는 어려움과 대처에는 빈번한 소진과 교사의 다중역할로 인한 어려움, 동료들 간의 신뢰와 소통을 통해 협조하고 대처의 범주를 확인할 수 있었다. 연구의 결과는 포커스집단에 참가한 실무자 1인, 질적연구 전문가 1인에게 검토를 받아 분석의 타당도를 확인하였다. 논의 및 결론: 본 연구는 거주형 치료기관인 청소년디딤센터 실무자들의 실제 개입 경험과 이들이 중점적으로 개입하는 영역 및 효과적 치료 요인, 실무자들의 어려움과 대처방안 등을 탐색하였다는 데 의의가 있다. 마지막으로, 이 연구의 시사점과 제한점, 후속연구를 위한 제언점들에 대해 논의하였다.

생활치료센터에 입소했던 코로나바이러스감염증-19 환자들의 체험: 현상학적 접근

정원석 한국보건사회연구원 2023 保健社會硏究 Vol.43 No.3

이 연구의 목적은 코로나19 환자들이 대체치료시설에서 겪은 체험을 사회복지학적 관점에서 확인하는 것이다. 이를 위해서 한 생활치료센터에 입소했던 경험이 있는 10명을 대상으로 일대일 심층 면접을 시행하였고, Colaizzi의 기술적 현상학적 연구 방법을 활용하여 분석하였다. 분석 결과, 코로나19 환자들은 자기결정권을 빼앗긴 채 생활치료센터에 입소하였는데, 적절한 치료를 받지 못한다는 생각으로 인해 정신적 고통이 가중되었다. 그러나 신체적 회복에 대한 믿음이 생기면서, 생활 태도가 긍정적으로 변화하였다. 따라서 의료사회복지사들이 대체치료시설에 파견되어 사회복지적 개입을 하는 것이 환자들의 안정과 회복에 도움이 될 것이다. 그리고 지역사회 사회복지사들의 전문적이고 지속적인 개입이 퇴소 후에도 남아있는 후유증을 완화할 수 있을 것이다. 이 연구를 바탕으로, 감염질환 세계적 대유행 상황에서 사회복지사의 역할 확대와 전문성 강화를 제언한다. This study analyzes the lived experience of COVID-19 patients in alternative care facilities from a social welfare point of view. Colaizzi’s descriptive phenomenological research method was used to analyze in-depth interviews that were conducted on 10 people who had experience in a Residential Treatment Center. The results of the interviews indicate that they were deprived of the right to self-determination when they entered the center. Moreover, the patients were psychologically distressed because they thought that they were not receiving appropriate treatment. Eventually, an optimistic outlook on their recovery helped them develop a more positive attitude towards their lives at the treatment center. Therefore, dispatching medical social workers to alternative care facilities will ensure greater psychological stability and a more stable recovery for patients. Furthermore, continuous and professional intervention made by community social workers will alleviate the after-effect that patients face after they are discharged. Therefore, expanding the role and professionalism of social workers is highly recommended during a pandemic.

청소년디딤센터의 설계영향요인 및 설계지침 제안 연구 - 국립청소년디딤센터를 중심으로 -

이수정(Lee, Su-Jung),김종무(Kim, Jong-Mu),윤혜경(Yoon, Hea-Kyung) 대한건축학회 2023 대한건축학회논문집 Vol.39 No.10

This study aims to identify design factors and propose guidelines for the National Youth Healing Center, focusing on residential treatment and rehabilitation for youths with emotional and behavioral disorders. To achieve this, the conditions of the National Youth Healing Center was assessed through three field visits and expert interviews, including the NYHC and Daegu NYHC. The design guideline analysis framework was established based on the concept and facilities outlined in the Youth Basic Law and the Youth Welfare Support Act for the National Youth Didim Center. The findings revealed eight key design influencing factors: functionality, natural integration, safety, adaptability, aesthetics, performance, cost-effectiveness, and maintenance. These factors were further categorized into architectural planning aspects, including site planning, layout, indoor environments, and outdoor facilities. Ultimately, the analyzed factors and content were synthesized to propose design guidelines for the National Youth Healing Centers residential treatment and rehabilitation facilities. These guidelines are expected to serve as essential references for the architectural design of the NYHC.

정서행동장애 아동·청소년 대상 거주형 치료재활시설 종사자의 행복감에 대한 내러티브 탐구

조미솔 ( Jo Mi Sol ),강지영 ( Kang Ji Young ) 한국정서행동장애학회(구 한국정서·행동장애아교육학회) 2021 정서ㆍ행동장애연구 Vol.37 No.2

본 연구는 정서행동장애 아동·청소년 대상 거주형 치료재활시설 종사자가 언제 행복감을 느끼며 그 행복감은 어떤 의미를 가지고 있는지를 살펴보고자 하였다. 거주형 치료재활시설의 종사자들은 대상자인 아동·청소년에게 가장 중요한 치료적 매개체이기에 이들의 행복감은 치료적 효과성에 매우 중요하다. 참여자의 경험을 깊이 있게 이해할 수 있는 내러티브 탐구방법을 적용하였으며, 2020년 10월 13일부터 12월 24일까지 6명의 종사자들 대상으로 총 7회기의 면접을 통해 질적 자료를 수집하였다. 분석 결과를 통해 거주형 치료재활시설 종사자의 행복감은 아이들과 함께 하면서 느끼는 행복감, 동료와 함께 하면서 느껴지는 행복감, 내 안에서 느껴지는 행복감, 주어진 환경 자체에서 느껴지는 행복감으로 분류되는 것으로 나타났다. 종사자들은 행복감의 의미로 만족 즐거움 보람, 사람 관계, 조건이 아닌 상태의 행복감을 향유하고 있었다. 연구결과를 바탕으로 아동·청소년 거주형 치료재활시설 종사자들의 행복감을 증진시키기 위하여 기관관리직과 담당부처 및 담당자의 인식개선, 동료 간 소통할 수 있는 지지체계 마련, 업무난이도에 따른 성공경험에 대한 기회 제공, 정기적 장기휴가 제공을 제언하였다. This study aimed to explore when workers at a residential treatment center for children and youth with emotional and behavioral disorders feel happy, and what happiness means for them. Since workers at a residential treatment center are the most important medium of treating children and youth, workers’ hapiness is ciritical for effective treatment. Narrative inquiry was conductied for a deep understanding of participants’ experiences and qualitative data were collected through 7 interviews with 6 workers from October 13 to December 24, 2020. The findings of this study were categorized under four themes, which are happiness with children and youth, happiness with colleagues, happiness in oneself and happiness from the physical environment. The meaning of happiness was classified into three categories that satisfactionㆍpleasureㆍworth, personㆍrelationship, and happiness no matter what Based on the findings, to improve workers’ happiness, we proposed changing the perception of people in management positions and the workers, establishing support and communication system, providing opportunities for success in work based on difficulty level of task, and providing vacations on a regular basis.

Quarantine Facility for Patients with COVID-19 with Mild Symptoms in Korea: Experiences from Eighteen Residential Treatment Centers

Yang Yuseon,김혜정,황지은 대한의학회 2020 Journal of Korean medical science Vol.35 No.49

With the rapid spread of coronavirus disease 2019 (COVID-19), a particularly sharp increase in the number of confirmed cases in Daegu and Gyeongbuk regions at the end of February, Korea faced an unprecedented shortage of medical resources, including hospital beds. To cope with this shortage, the government introduced a severity scoring system for patients with COVID-19 and designed a new type of quarantine facility for treating and isolating patients with mild symptoms out of the hospital, namely, the Residential Treatment Center (RTC). A patient with mild symptoms was immediately isolated in the RTC and continuously monitored to detect changes in symptoms. If the symptoms aggravate, the patient was transferred to a hospital. RTCs were designed by creating a quarantine environment in existing lodging facilities capable of accommodating > 100 individuals. The facilities were entirely divided into a clean zone (working area) and contaminated zone (patient zone), separating the space, air, and movement routes, and the staff wore level D personal protective equipment (PPE) in the contaminated zone. The staffs consisted of medical personnel, police officers, soldiers, and operation personnel, and worked in two or three shifts per day. Their duty was mainly to monitor the health conditions of quarantined patients, provide accommodations, and regularly collect specimens to determine if they can be released. For the past two months, RTCs secured approximately 4,000 isolation rooms and treated approximately 3,000 patients with mild symptoms and operated stably without additional spread of the disease in and out of the centers. Based on these experience, we would like to suggest the utilization of RTCs as strategic quarantine facilities in pandemic situations.

코로나19 팬데믹 상황시 생활치료센터의 입소자의 개인적 특성 및 센터 운영에 관한 논의 - 경기국제2 생활치료센터 사례를 중심으로

김석만(Kim, Suk-man),양정연(Yang, Jung-Yeon),이준협(Lee, Jun-Hyup) 한국보건기초의학회 2021 한국보건기초의학회지 Vol.14 No.2

Korea faced an unprecedented crisis in infectious disease management system as the number of confirmed cases of COVID-19 in Korea soared in March 2020. It was difficult not only for the confirmed patients but also for the seriously ill patients to be assigned beds, so the Residential Treatment Centers were introduced under the concept of isolating and treating asymptomatic or mild patients without treating them in hospitals or self-isolation. In this study, we examined user analysis, legal basis, and operational problems, focusing on the operation of the Gyeonggi International 2 Residential Treatment Center (hereinafter referred to as Ansan Residential Center), which quarantined and treated people diagnosed with COVID-19 from overseas. From March 26 to May 13, 2020, for 49 days, 115 confirmed patients with “COVID-19” who were hospitalized at Ansan Residential Treatment Center were analyzed for their general characteristics and medical records including length of stay and treatment results. Major results showed that 56 people were diagnosed with complete recovery in the Residential Treatment Center, 26 were moved to other Residential Treatment Centers on demand and 28 were taken to other hospitals due to worsening health conditions. The operational problems of Ansan Residential Treatment Center were the lack of operating principles, a lack of skilled medical personnel, a long-term delay in payment of allowances for working applicants and a lack of medical video-related facilities. Through this study, we found that Residential Treatment Center can be a positive factor that prevents the spread of COVID-19 in Korea, but we raise the need to comprehensively analyze the performance of the treatment in Residential Treatment Centers at the national level.

Surveillance of Close Contacts and Implications of Pediatric Patients with COVID-19–Experiences from a Single Residential Treatment Center

백예지,정원석,이기현,이은화,이세주,김진남,김정호,안진영,정수진,최준용,염준섭 연세대학교의과대학 2022 Yonsei medical journal Vol.63 No.3

Residential treatment centers (RTCs) are successful in isolating and closely monitoring adults confirmed with coronavirus disease2019 (COVID-19), but there are concerns for children who need care. This study was conducted as a retrospective analysis ofthe surveillance of guardians who entered an RTC with infected pediatric patients to identify the secondary attack rate of COVID-19 to close contacts in a single RTC and to provide directions for developing guidelines for caregivers who co-isolate with infectedchildren. When caregivers were admitted to this RTC, aside from negative confirmation before discharge, tests were additionallyperformed one or two times. There were 57 index children and adolescent patients who entered the RTC with theirparents as caregivers. The secondary attack rate by pediatric patients to close contacts outside their households was 25% (95%confidence interval, 10.0 to 40.0) (8 out of 32 contacts). The transmissibility of SARS-CoV-2 in children was close to zero at 6 daysafter the confirmation tests. It is reasonable to test the close contacts of pediatric patients after 7 days of isolation to identify infectionsamong caregivers.

논문 : 2. 자유주제(自由主題) ; 미국의 지역사회교정제도에 관한 연구 -보호관찰과 소년보호제도의 최신 경향을 중심으로-

신석환 ( Seok Hwan Shin ) 경성대학교 법학연구소 2007 경성법학 Vol.16 No.2