가족 돌봄 제공자를 위한 치매의 행동심리증상 대처 웹기반 교육 프로그램 개발

송준아(Song, Jun-Ah),박재원(Park, Jaewon),천홍진(Cheon, Hong-Jin),박명화(Park, Myonghwa) 한국노년학회 2015 한국노년학 Vol.35 No.2

본 연구는 가족 돌봄 제공자가 치매의 행동심리증상에 효율적으로 대처할 수 있도록 교육하기 위한 웹기반 교육 프로그램(Web-based educational program for behavioral and psychological symptoms of dementia, WebEd-BPSD)을 개발하고자 시도된 방법론적 연구이다. WebEd-BPSD는 총 2차 년도(1차 년도 2013년; 2차 년도 2014년)에 걸쳐 교육 요구도 분석(1단계), WebEd-BPSD 개발(2단계), WebEd-BPSD 평가(3단계)를 통해 개발되었다. 본 연구의 1단계에서는 치매의 행동심리증상에 대한 국․내외 문헌고찰과 가족 돌봄 제공자를 대상으로 한 포커스 그룹 인터뷰 결과를 근거로 WebEd-BPSD의 학습주제 및 내용을 선정하였다. 2단계에서는 1단계의 분석 결과를 바탕으로 선정된 치매의 행동심리증상에 대한 교육 컨텐츠를 구성하고 전문가의 내용 타당도 평가를 거쳐 최종적으로 ‘공격성(6분 56초)’, ‘초조행동(5분 30초)’, ‘무감동(3분 15초)’, ‘망상(7분 19초)’, ‘환각(6분 57초)’, ‘배회(7분 38초)’, ‘부적절한 배설행동(8분 17초)’, ‘부적절한 식사행동(6분 21초)’의 총 여덟 편으로 구성된 WebEd-BPSD을 제작하였다. 3단계에서는 서울 소재 4개의 치매지원센터를 이용하는 가족 돌봄 제공자(1차 년도 50명; 2차 년도 49명)와 전문가 집단(1차 년도 11명; 2차 년도 12명)에게 교육 프로그램에 대한 평가를 실시하였다. 가족 돌봄 제공자 및 전문가의 영상 및 내용 평가에 대한 전체 평균 점수는 1차 년도 3.43점, 3.25점, 2차 년도 3.38점, 3.54점이었고, 세부 항목별 만족도 평가에 대한 전체 평균 점수는 1차 년도 3.53점, 3.23점, 2차 년도 3.61점, 3.59점으로, 대체적으로 긍정적인 평가 결과를 얻었다. 본 연구를 토대로 추후 치매노인 관리와 관련된 다양한 주제에 대한 웹기반 교육 프로그램 개발의 필요성을 제언하는 바이다. The purpose of this study was to develop and evaluate web-based educational program to empower family caregivers in dealing with behavioral and psychological symptoms of dementia (BPSD) (WebEd-BPSD). The study was conducted in 2013 and 2014, consisting of three phases. In phase 1, literature reviews and focus group interviews with family caregivers were performed to select themes and contents for the WebEd-BPSD. In phase 2, validity of the themes and contents of the WebEd-BPSD were evaluated by professionals and eight sets of the WebEd-BPSD were finally produced: aggression (6’56”), agitation (5’30”), apathy (3’15”), delusion (7'19”), hallucination (6’57”), wandering (7’38”), inappropriate elimination (8’17”), and inappropriate eating behavior (6’21”). In phase 3, the WebEd-BPSD was evaluated by professionals (n=11 in 2013; n=12 in 2014) and family caregivers (n=50 in 2013; n=49 in 2014). The image and contents of WebEd-BPSD was rated 3.43, 3.38 by family caregivers and 3.25, 3.54 by professionals in 2013, 2014, respectively, showing that they were satisfied in general with the WebEd-BPSD. The findings suggested that it would be worthy to develop more contents that could be added to the WebEd-BPSD and to examine short term and long term effects of the program.

노인 외로움이 영향요인 분석

송준아(Song Jun-Ah),장성옥(Jang Sung-Ok),임여진(Lim Yeo-Jin),이숙자(Lee Sook-Ja),김순용(Kim Soon-Yong),설근희(Seol Geun-Hee) 기본간호학회 2007 기본간호학회지 Vol.14 No.3

Purpose: This study was done to investigate the relationship of family function, self-esteem, life satisfaction, and general characteristics to loneliness in community dwelling Korean elders and identify factors affecting loneliness. Method: With a cross-sectional causal-relationship design and a convenience sample, 205 elders residing in three districts of the city of Seoul, S. Korea were recruited. Participants were assessed using the Family APGAR Score, Self-Esteem Scale, Life-Satisfaction Scale, and Revised UCLA Loneliness Scale. Results: The mean score for degree of loneliness (Mean=39.61, SD=10.09) was just below the mean for the scale (Possible range 20-80). Loneliness had significant negative correlations with family function (r= -.400, p<.001), self-esteem (r= -.399, p<.001), and life satisfaction (r= -.644, p<.001). Other general characteristics that had significant or nearly significant relationships with loneliness were perceived current financial and health status, whether doing any exercise or physical activities, degree of close relationship with family members, and length of living in current residence. Among variables, life satisfaction (Standardized β = -.589, p<.001) and length of living in current residence (Standardized β = -.136, p<.05) significantly predicted degree of loneliness. Conclusion: Findings of this study allow a comprehensive understanding of loneliness and related factors among community dwelling elders in Korea. However, further studies with a larger random sample from various living environments are necessary.

우리나라 치매 관련기관 종사자의 치매전문교육 요구와 발전 방향

정수아(Jung, Sua),송준아(Song, Jun-Ah),천홍진(Cheon, Hongjin),김지연(Kim, Jiyeon) 한국노인간호학회 2021 노인간호학회지 Vol.23 No.2

Purpose: This study aimed to explore dementia-specialized education and the training needs of employees from various dementia-related institutions in South Korea and propose directions for future development of the standard curriculum. Methods: Qualitative data were generated from four round-table meetings with 44 participants recruited from the metropolitan centers for dementia (N=12), regional dementia-relief centers (N=15), long-term care settings (N=7), and public long-term care hospitals (N=10). Each meeting was held for about 120 minutes, and participants discussed the knowledge, skills, and attitudes required for their job, satisfactory and non-satisfactory experiences of education programs they had participated in, and what should improve. All contents discussed in each meeting were recorded and transcribed verbatim. Data were analyzed using a conventional content-analysis method. Results: Eight categories and 19 subcategories emerged under the three themes of (a) educational contents recognized as necessary, (b) advantages and disadvantages of completed dementia education, and (c) directions for improving educational programs for employees of dementia-related institutions. Conclusion: Dementia-specialized education and training should be standardized and structured systematically and differently depending on the job characteristics, type, and required level of expertise. Communication with and attitudes toward patients with dementia is re-emphasized as a common content regardless of occupation and institution; thus, sufficient training time should be secured. Qualified instructors and various platforms are also necessary to effectively deliver quality education.

성인기 흡연유형과 흡연영향변인

장성옥(Chang Sung-Ok),송준아(Song Jun-Ah),이수정(Lee Su-Jung) 한국성인간호학회 2008 성인간호학회지 Vol.20 No.1

Personhood communication with persons with dementia: Concept analysis

김지연(Kim, Jiyeon),송준아(Song, Jun-Ah) 한국노인간호학회 2021 노인간호학회지 Vol.23 No.4

Purpose: This paper aimed to clarify the meaning of personhood communication with persons with dementia, by identifying its attributes. Methods: Walker and Avant’s concept analysis method was employed. A literature review was performed using salient medical and health databases such as PubMed, Embase, and CINAHL between 1988 to June 2020. The literature review employed keywords such as “personhood”, “communication”, and “dementia”. Results: Personhood communication with persons with dementia is defined as providing social interaction based on their residual capacities, with adjustments being made in light of their remaining communication abilities, attentiveness to their emotions and respect for their individuality being shown, and decision-making rights being maintained. Conclusion: At the core of personhood communication is respect for persons with dementia and the goal of enabling them to be valid members of society. Further research is needed on the development of educational programs that impart the attributes of personhood communication with persons with dementia.

초기 치매환자 가족 돌봄제공자의 공유 의사결정에 대한 인식

김윤재(Kim Yun Jae),송준아(Song Jun Ah) 한국노년학회 2018 한국노년학 Vol.38 No.3

The purpose of this study was to explore perception about shared decision making of family caregivers of patients with early dementia (PWED). This study was conducted with a sample of 12 family caregivers (mean age = 71.4±10.4) of PWED from three dementia safety centers in Seoul. In-depth interviews were done for each participant about shared decision making and data were analyzed using qualitative content analysis. Six categories and 17 sub-categories identified for participants’ perception about shared decision making: means to facilitate communication with patients with dementia, means to secure autonomy of patients, opportunity to facilitate treatment, cause of increasing family caregivers’ burden, cause of worsening relationship with patients, and option for choices depending on priority change. The findings of this study can provide a knowledge basis for health care professionals and policy makers to understand how family caregivers of PWED think about shared decision making. It would be of great value to develop educational programs and practical guidelines about shared decision making for PWED and their family, which may contribute to respecting PWED’s self-determination right as well as reducing burden of their family. 본 연구의 목적은 초기 치매환자 가족 돌봄제공자의 공유 의사결정에 대한 인식을 탐색하는 데 있다. 이를 위해 서울시 3개 치매지원센터에 등록된 초기 치매환자를 돌보는 가족 돌봄제공자 12명(여성 8명, 평균연령=71.4±10.4세)을 대상으로 반 구조화된 개별 심층면담을 이용하여 수집된 자료에 대해 질적 내용분석을 시행하였다. 본 연구를 내용 분석한 결과 6개 범주, 17개의 하위 범주가 도출되었는데 구체적인 연구결과는 다음과 같다. 초기 치매환자 가족 돌봄제공자의 공유 의사결정에 관한 인식은 치매환자와의 의사소통 촉진 수단과 치매환자의 자율성 보장 수단, 치료 촉진 기회, 가족 돌봄제공자의 부담감 증가 원인, 치매환자와의 관계 악화 원인,우선순위 변화에 따른 선택 사항의 여섯 가지 범주로 나타났다. 또한, 공유 의사결정의 상황과 시기 및 공유 의사결정에 대한 인식이 가족 돌봄제공자의 경험을 통해 만들어졌다는 점을 알 수 있었다. 따라서 치매 관련 교육 시 간접경험을 통해 공유 의사결정을 선택 사항으로 생각하는 가족 돌봄제공자들에게 공유 의사결정을 경험할 수 있는 기회 등을 제공하는 것이 공유 의사결정에 대한 인식 제고에 도움이 될 수 있을 것으로 사료된다. 이상 결과에 근거하여 초기 치매환자의 자기결정권 존중과 가족 돌봄제공자들의 부담감을 감소시키기 위해 공유 의사결정을 성공적으로 할 수 있는 실제적이고 총체적인 교육 프로그램의 개발 및 평가 연구를 제언한다.

재가 치매노인 가족을 위한 배회관리 지침 개발

천홍진(Cheon, Hong Jin),송준아(Song, Jun-Ah) 한국노년학회 2016 한국노년학 Vol.36 No.4

본 연구의 목적은 재가 치매노인 가족이 치매노인의 배회를 효과적으로 관리하기 위한 지침을 개발하고 평가하는데 있다. 연구의 절차는 총 3단계로 구성되어 있으며 첫째, 배회관리 지침 개발 준비 단계에서는 치매노 인을 돌보는 가족 10인을 대상으로 포커스 그룹 및 개별 인터뷰를 시행하여 치매노인의 배회 관련 경험을 분석 하였다. 둘째, 지침 개발 단계에서는 문헌 고찰을 통해 예비 항목을 작성하고 전문가 8인의 내용타당도 검증 과정을 거쳐 최종안을 완성하였다. 셋째, 지침의 평가 단계에서는 치매노인 가족 13인을 대상으로 지침에 대해 교육하고 제공된 배회관리 지침 소책자를 이용하여 일주일 간 적용하도록 한 후 배회 관련 지식, 지침 적용 정도, 사용자 만족도를 설문지를 통해 평가하였다. 본 연구에서 최종적으로 개발된 지침은 ‘배회의 정의’, ‘배회의 원인’, ‘배회 가능성이 높은 경우’, ‘배회 예방’, ‘실종 예방’, ‘배회 발생 시 대처 방법’, ‘실종 발생 시 대처 방법’의 7가지 주제, 총 86항목으로 구성되었다. 배회관리 지침 사용 교육 전․후 가족의 배회 관련 지식 점수가 유의하게 향상하였고(p=0.014), 지침 적용 정도 9문항의 평균은 2.69~3.46(range: 1~4)점이었으며 사용자 만족도의 7개 항목 평균은 2.85~3.38(range: 1~4)점이었다. 본 연구에서 개발된 배회관리 지침은 국내 지역사회 거주 치매노인의 배회 특성과 가족의 요구를 반영하여 개발되었으며, 개발된 지침을 가족들에게 시범 적용하고 평가를 시도하였다는 점에서 의의가 있다. 본 배회관리 지침은 가족들이 치매노인의 배회에 대해 보다 잘이해하고 대처하며 배회로 인한 부정적 결과를 예방하는데 도움이 될 것으로 사료된다. The purpose of this study was to develop a wandering management guideline for family caregivers of community-dwelling elders with dementia (EWD). In the first stage of the study, focus group and individual interviews (n=10) were performed to analyze family caregivers’ experiences about wandering of the EWD under their care. In the second stage, preliminary contents for the guideline were made based on the interview results of family caregivers and reviews of literature. Final version of the guideline with 86 items was established after experts’ review using the Content Validity Index analysis. In the final stage, a pilot test was conducted to evaluate the guideline using a sample of 13 family caregivers of EWD. Family caregivers were educated about how to use the guideline and asked to complete a set of questionnaire to examine their knowledge about wandering, degree of application of the guideline, and satisfaction with the guideline. Family caregivers’ knowledge score was significantly improved (p=0.014) and the average scores in the process evaluation (9 items) and user satisfaction (7 items) about the guideline were 2.69-3.46 (range: 1-4), and 2.85-3.38 (range: 1-4), respectively. Further study with a large random sample is necessary to confirm the results of this study.

요양병원 입원 노인의 자아통합감과 죽음준비도가 임종간호선호도에 미치는 영향

백장미(Jangmi Baek),송준아(Jun-Ah Song) 한국노인간호학회 2023 노인간호학회지 Vol.25 No.2

Purpose: This study aimed to investigate ego integrity, readiness for death, and preferences of care near the end-of-life among hospitalized older adults in long-term care hospitals and identify factors that influence end-of-life care preference. Methods: A total of 181 older adults in long-term care hospitals participated in the study, and data collection was conducted from July 20th, 2020 to September 20th, 2020. Descriptive statistics, t-test, ANOVA, Pearson’s correlations, and multiple regression were used for data analysis. Results: The older adults in hospitalized in long-term care hospitals preferred pain management even at the risk of hastened death, while the least preferred option was autonomous decision-making, including artificially prolonging human life. Regarding end-of-life care preferences, ego-integrity (β=.18, p=.004) and death-readiness (β=.18, p=.005) were factors that only influenced the spiritual domain and in the pain domain, it was confirmed that only the ego-integrity (β=.16, p=.013) was affected. Conclusion: Although ego integrity and readiness for death did not affect all areas of end-of-life care preference among older adults in long-term care hospitals, they represent significant variables denoting positive acceptance of death and life satisfaction. As such, it is necessary to provide various opportunities for these factors to be considered in the overall process of aging. Furthermore, it has been confirmed that other variables can influence each subdomain of end-of-life care preference. Therefore, nurses should support hospitalized older adults in receiving end-of-life care according to their preferred domains.

요양병원 노인 환자 임종간호에 대한 간호사의 경험: 실무 과정과 장애 요인을 중심으로

김익태(Kim, Iktae),송준아(Song, Jun-Ah) 한국노인간호학회 2021 노인간호학회지 Vol.23 No.3

Purpose: The purpose of this study was to investigate the practical process and barriers of end-of-life nursing practice for older patients in long-term care hospitals by exploring nursing experts’ actual experiences. Methods: Qualitative data were collected through focus group interviews with 9 nurses in 3 different long-term care hospitals from April to May, 2019. All interviews were recorded and transcribed verbatim and analyzed using the content analysis method. Results: Five themes and 14 sub-themes emerged for nurses’ perception regarding end-of-life nursing practice in long-term care hospitals, whereas three themes and 10 sub-themes emerged for the barriers of end-of-life nursing practices. The results show that the end-of-life nursing practice is currently considered an additional area beyond nurses’ existing work in long-term care hospitals and the area of performance is focused almost exclusively on physical care. The care is especially lacking in psychological and spiritual areas. Moreover, aspects of practice vary by institutions, day or night shifts and individuals. Various factors that hinder nurses’ performances of end-of-life care are identified in the areas such as ignoring patients’ dignity, an underdeveloped system and lack of supportive environment. Conclusion: Findings of this study suggest the need to establish standardized protocols for end-of-life nursing care in long-term care hospitals and develop educational programs based on those protocols.

스마트폰을 이용한 대장내시경 장정결 동영상 교육의 효과

최미희(Choi, Mi-Hee),송준아(Song, Jun-Ah) 기본간호학회 2017 기본간호학회지 Vol.24 No.1

Purpose: The purpose of this study was to develop video assisted education on bowel preparation for colonoscopy (VEBPC) and use a snartphone to evaluate effects of the VEBPC. Methods: Adult patients who were scheduled for colonoscopy were recruited from a university general hospital and randomly assigned to three groups. Group 1 (n=30) watched the video using a computer set in the endoscope consulting room. Group 2 (n=29) watched it using a smartphone, and group 3, the control group (n=29) received education with existing instructions at the reservation- reception desk. Participants were evaluated on knowledge on taking bowel preparation agents and diet, compliance on taking bowel preparation agents and diet, satisfaction with education, and actual level of bowel preparation. Results: Group 1 and 2 showed significantly (p<.001) higher scores for knowledge, compliance, and satisfaction compared to the control group. However, in post-hoc test analyses there were no significant differences in these variables between group 1 and 2. No significant difference was found in the actual level of bowel preparation among the three groups. Conclusion: Findings from this study show that VEBPC using smartphone is a better option than existing educational methods. However, replication studies are necessary to confirm these findings.