병원중심 가정호스피스 대상자의 주호소, 의뢰사유 및 간호진단 분석

용진선 가톨릭대학교간호대학 호스피스교육연구소 2005 호스피스논집 Vol.9 No.-

The purpose of this study was to analyze major complaints, reasons for referring home hospice, and nursing diagnosis based on the NANDA of home hospice patients. This study was a descriptive survey that investigated 100 medical and nursing records of hospice from K hospital in Seoul during the period of February 2002 to May of 2003. The results of the study were summarized as follows: The mean number of complaints for one patient written by doctor was 2.15. Pain was most frequent complaint of patients (38 people) followed by general weakness (25 people), poor oral intake (24 people), dyspnea (18), and skin breakdown (15 people). The mean number of reasons for referring to home hospice care was 1.3. The most frequentlyused reason for referring was total parenteral nutrition administration (34 people) followed by IV chemo-port management (17), Foley-catheter management (16), and fluid therapy (15 people). There were 27 kinds of nursing diagnoses used for a total of 695 times counting the same diagnosis as one time for a patient. Themean number of nursing diagnosis used for one patient was approximately seven. Further research is needed to develop nursing intervention standards for home hospice patients.

가정 호스피스 대상자와 일반 가정간호 대상자에게 제공된 간호중재 비교

용진선,노유자,한성숙,김명자 한국간호과학회 2001 Journal of Korean Academy of Nursing Vol.31 No.5

가정간호대상자와 입원간호대상자의 간호만족도 및 간호사이미지 비교

용진선,한성숙,유인자,홍현자,Yong, Jin-Sun,Han, Sung-Suk,Yoo, In-Ja,Hong, Hyun-Ja 한국가정간호학회 2002 가정간호학회지 Vol.9 No.1

The purpose of the study was to compare both the nursing care satisfaction and the image of nurses as experienced by home health care clients and hospitalized clients. For the descriptive survey study. data were collected from 69 home heath care clients and 342 in-patients in a university hospital. The tools used for the study were modified by Quality Patient Care Scale(Wandelt & Ager. 1974) and Image of Nurses (송인자, 1993). The data were analyzed using Pearson Correlation. Scheffe test. factor analysis. t-test. and ANOVA. The major findings were as follows: Regarding nursing care satisfaction, the mean score of total nursing care satisfaction in home health care clients was 3.28 out of 4.0. Among five domains, the domain with the highest score was the psychosocial domain, followed by the general. the professional. the physical. and the communication domain. The level of nursing care satisfaction was not significantly different according to demographic variables except for age: the age group of 41-60 showed the highest score (p<0.05). The mean score of total nursing care satisfaction in hospitalized clients was 2.95 out of 4.0. Among five domains, the domain with the highest score was the psychosocial domain, followed by the physical and the communication. the professional. and the general domain. The level of nursing care satisfaction was not significantly different according to demographic variables except age: the higher the age the higher the score (p<0.05). The levels of nursing care satisfaction in all five domains were significantly higher in home health care clients than in hospitalized clients(p=0.0005). Regarding image of nurses, the mean score of total image of nurses in home health care clients was 3.32 out of 4.0. Among four domains, the domain with the highest score was the sincerity domain, followed by the kindness. the spirit. and the knowledge and skill domain. The level of image of nurses was not significantly different according to demographic variables. The mean score of total image of nurses in hospitalized clients was 3.05 out of 4.0. Among four domains. the domain with the highest score was the sincerity domain, followed by the kindness, the knowledge and skill, and the spirit domain. The level of image of nurses was not significantly different according to demographic variables. The levels of image of nurses in all four domains were significantly higher in home health care clients than in hospitalized clients (p=0.001). Both the levels of nursing care satisfaction and image of nurses, part of an evaluation for quality of nursing care were significantly higher in home health care clients than in hospitalized clients. In light of the findings, we could consider that home health care nurses provided client-centered comprehensive nursing care. However, nurses need to have methods that more promote the social recognition of the image of nurses and nursing care services as well as professional knowledge and skills.

가정 호스피스 대상자와 일반 가정간호 대상자에게 제공된 간호중재 비교

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

The purpose of the study was to compare home care nursing intervention activities analyzed by the Nursing Intervention Classification (NIC) system for hospice and general patients. For the descriptive survey study, data was collected by reviewing charts of 151 hospice patients and 421 general patients who registered in the department of home health care nursing at K Hospital. According to the NIC system application, there were 2380 total nursing interventions used for the hospice patients and 8725 for the general home care patients. For both sets of patients (hospice vs. general), the most frequently used nursing intervention in level 1 was the Physiological: Complex domain (40.13 vs. 31.06 percent), followed by the Safety domain; in level 2, the Risk Management class (28.4 vs. 27.70 percent), followed by Tissue Perfusion Management; and in level 3, Vital Sign Monitoring (6.18 vs. 4.84 percent), followed by Health Screening. In conclusion, the study showed that there was a lack of specialized hospice nursing interventions such as emotional, family and spiritual support, and care for dying hospice patients.

가족이 인지한 호스피스 환자의 간호요구 : Q방법론 적용 Q Methodology

용진선,한성숙,홍현자 가톨릭대학교 간호대학 호스피스 교육연구소 2003 호스피스논집 Vol.7 No.-

Purpose: The purpose of the study was to identify types of care needs of hospice patients from the family caregivers perspective through Q-methodology. Method: Twenty three Q-statements concerning care needs were collected through in-depth interviews of hospice patients. Data were collected from twenty family caregivers by sorting 23 Q-statements into 9 points standard from December 2002 to February 2003. Date analysis was performed by using a QUANL program. Result: Principal component analysis identified five types of care needs of the hospice patients which family caregiver perceived. Type 1 was named 'physical care needs type' and family caregivers perceived that their patients greatest need is physical care to be painless and comfortable. Type 2 was named 'care needs type for the future life after death' and family caregiver perceived that their patients need spiritual care for having hope about the next world. Type 3 was named 'emotional care needs type' and family caregivers perceived that their patients need emotional care for opening their minds and becoming stable. Type 4 was named 'religious service needs type' and family caregivers perceived that their patients need to have religious services such as mass, receiving prayers and the sacraments. Type 5 was named 'social care needs type' and family caregivers perceived that their patients need encouragement to go beyond themselves and to give loving services to others. In summary, family caregivers perceived that care for patients 'physical comfort is the priority. After achievingphysical care, family caregivers could perceive other aspects of care such as spiritual, social, and emotional care needs. In conclusion, we need to conduct further research to compare these results with the care needs of hospice patients themselves.

호스피스 환자의 돌봄 요구와 가족이 인지하는 환자의 돌봄 요구 비교: Q 방법론

용진선,홍현자,Yong, Jin-Sun,Hong, Hyun-Ja 한국호스피스완화의료학회 2004 한국호스피스.완화의료학회지 Vol.7 No.2

목적: 본 연구의 목적은 호스피스 병동에 입원한 호스피스 환자들의 돌봄 요구 유형과 가족간호자가 인지하는 환자의 돌봄 요구 유형을 파악하고, 두 군 간에 차이가 있는지 비교하여 호스피스 환자의 돌봄 요구를 만족시키기에 도움이 되는 방법을 모색하는데 필요한 기초 자료를 제공하고자 한다. 연구방법으로는 개인에 대한 내적 의미에 중심을 두고 인간의 주관성이나 태도 유형을 심층적으로 측정할 수 있는 연구 방법론인 Q방법론을 적용하였다. 방법: 본 연구를 위한 Q표본은 호스피스 환자들의 돌봄 요구에 대한 경험으로 구성된 23개의 진술문이다. 자료는 2002년 12월부터 2003년 2월까지 23개의 Q-표본을 이용하여 C 대학 K 병원 호스피스병동에 입원하고 연구에 동의한 환자 20명군과 이들을 간호하는 주 가족간호자 20명군으로 가족 20쌍의 P-표본으로부터 각각 수집하였다. 탈분포도는 정상 분포방식에 따라 9점 척도 상에 대상자의 의견과 일치하는 정도에 따라 분류하도록 하였으며, 면담시 대상자의 구술도 기록하였다. 자료 분석은 Quanl PC 프로그램을 통한 Q요인분석인 주인자 분석방법을 이용하여, 요구 유형을 파악하기 위하여 평균분석, 요인 가중치, 영역별 요인 분석, 요인 배열을 하였고, 요인수의 결정을 위해 아이겐값은 1.0 이상을 기준으로 하였다. 결과: 연구결과 호스피스 환자 군과 가족간호자 군이 인지한 호스피스 환자의 돌봄 요구 유형은 네 가지로 확인되었다. 신체적, 정서적, 영적, 그리고 사회적 돌봄 요구 유형. 돌봄 요구 유형에 대한 두 군 간의 전체 일치률은 48%이었다. 제 1유형은 '신체적 돌봄 요구형' 으로 통증조절이 안된 상태로 통증으로 인하여 심한 고통을 당하고 있어 주호소인 통증 및 신체적 안위에 대한 돌봄을 우선적으로 요구하였다. 두 군 간의 일치율은 62.5%이었다. 제 2유형은 '정서적 돌봄 요구형' 으로 가족과 친밀감과 사랑을 나누기를 원하고 죽음에 대한 두려움을 따뜻한 대화로써 정서적으로 지지 받기를 원하였다. 두 군 간의 일치율은 20%이었다. 제 3유형은 '영적 돌봄 요구형' 으로 대상자 모두 종교를 가지고 신심이 깊었으며 절대자에게 용서 받고 싶은 욕구가 많았고 기도와 사목자의 방문을 원하였다. 두 군 간의 일치율은 60%이었다. 제 4유형은 '사회적 돌봄 요구형'으로 자신이 하던 일에 대한 마무리와 봉사를 원하는 것으로 나타났다. 두 군 간의 일치율은 50%이었다. 이상으로 볼 때, 호스피스 환자와 가족간호자가 인지한 환자의 돌봄 요구는 큰 차이가 있다는 것을 알 수 있다. 따라서, 호스피스 간호사는 호스피스 환자의 돌봄 요구를 만족시키기 위해서 환자와 가족간호자간에 환자의 돌봄 요구에 대한 인지의 차이를 좁히기 위한 적절한 방법을 모색하고, 가족간호자에게 환자의 돌봄 요구를 사정하기 위한 교육을 시켜야 하겠다. Purpose: The purpose of tile study was to identify types of care needs of hospice patients and those from the family caregivers' perspective and to compare these two groups in reporting patients' care needs through Q-methodology. Methods: Twenty three Q-statements concerning care needs were selected through in-depth interviews of hospice patients. Data were collected from 20 hospice patients as well as 20 family caregivers respectively by sorting 23 Q-statements into 9 points standard. Data analysis was performed by using PC QUANL program. Results: Principal component analysis identified four types of care needs of the hospice patients. Overall, the accuracy of family caregiver reports was 48% in all types of care needs. Type 1 was named 'physical care needs type' for those whose greatest need was physical care to be free of pain and comfortable. The accuracy in Type 1 was 62.5%. Type 2 was named 'emotional care needs type' for those who would like to share love and intimacy with their family members. The accuracy in Type 2 was 20%. Type 3 was named 'spiritual care needs type' for those who would like to receive forgiveness from their God and prayers and visitation of clergy. The accuracy in Type 3 was 60%. Type 4 was named 'social care needs type' for those who would like to complete their ongoing work and to give service to others. The accuracy in Type 4 was 50%. Conclusion: There was a great difference between hospice patients and the family caregivers in reporting patients' care needs. Thus, hospice nurses need to educate family caregivers to more accurately assess patients' care needs.

호스피스 대상자의 돌봄 요구 유형에 관한 주관성 연구

용진선,한성숙 가톨릭대학교 간호대학 호스피스 교육연구소 2004 호스피스논집 Vol.8 No.-

Purpose: The purpose of the study was to identify types of care needs for hospice patients through Q-methodology. Method: Twenty three Q-statements were selected through in-depth interviews of hospice patients. Data were collected from 20 hospice patients by sorting 23 Q-statements into 9 points standard and then analyzed using PC QUANL program. Result: Type 1 was named 'the need for pain control type' and patients of this type had the greatest need of physical care to be free of pain and be comfortable. Type 2 was named 'the need for love and intimacy type' and patients of this type would like to share love and intimacy with their family members. Type 3 was named 'the needs for reliance on an Absolute Being type' and patients of this type would like to receive forgiveness from their God and prayers. Type 4 was named 'the need for accomplishment and service type' and patients of this type would like to complete their on going work and to give service to others. Conclusion: The study result could be basic data to perform effective nursing interventions for satisfying the care needs of hospice patients.

어머니가 유방암 진단을 받은 가족에서 가족 기능에 영향을 미치는 요소들

용진선 성인간호학회 1998 성인간호학회지 Vol.10 No.2

The purpose of this study was:1) to develop and test a theoretical model examining relationships among social support (and social network size), illness demands, marital adjustment, family coping, and an outcome measure of family functioning in response to a mother's breast cancer in the early postdiagnostic phase :2)to investigate the sources of functional social support :and 3) to assess characteristics of social support networks for Korean families with breast cancer. This study used a cross-sectional, correlational design with a causal modeling methodology to test the specified relationships in the recursive theoretical model. The convenience sample of this study consisted of 82 married Korean couple with recently diagnosed breast cancer in the child-rearing mother. Six standardized questionnaires were used to measure the theoretical concepts:social supports(ISSB), social network(ASSIS), illness demands(DOII), marital adjustment(DAS), family coping(F-COPES), and family functioning(FACESII). The theoretical model was tested on the aggregated couples' data (family data) and on mothers and fathers data. Path analysis results from the mothers and the fathers revealed different patterns. A core set of predictive variables were identified with three data sets showing consistent effects on family functioning level-marital adjustment and family coping, marital adjustment and family functioning, and family coping and family functioning. Namely, the level of family functioning was directly and positively affected by family coping behavior and the level of marital adjustment : the level of marital adjustment had a direct positive effect on family coping behavior. In two reduced models from couples' and mothers' data, three sets of predicted relationships were supported, social support and marital adjustment, social support and family coping, and illness demands and marital adjustment. The level of social support received had a direct positive effect on both the level of marital adjustment and family coping behavior, and the esperienced illness demands had a direct negative effect on the level of marital adjustment. Few significant gender differences were found in terms of 1) actual and perceived network sizes, need for support , and satisfaction with the support received for each type of functional social support, 2) total network size encompassing all types of functional social support, as well as, 3) the amount of functional social support received. These findings may prove useful for health care professionals working with Korean families with breast cancer or other chronic illnesses.

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.

가정간호대상자와 입원간호대상자의 간호만족도 및 간호사이미지 비교

용진선,한성숙,유인자,홍현자 한국보건간호학회 2004 한국보건간호학회 학술대회지 Vol.2004 No.12