요양보호사의 죽음에 대한 인식이 임종 돌봄 스트레스에 미치는 영향 : 전남지역 노인의료복지시설을 중심으로 = The Impact of Care Workers' Perceptions of Death on End-of-Life Care Stress - Focused on Long-Term Care Facilities in the Jeollanam-do -

다국어 초록 (Multilingual Abstract)

This study aimed to examine the level of care workers' perceptions of death and investigate how these perceptions influence end-of-life care stress. To achieve this, a convenience sampling of 209 care workers employed in long-term care facilities in Jeollanam-do was conducted, and their perceptions of death and end-of-life care stress were measured. The instruments used in this study were as follows: First, to measure perceptions of death, the tool developed by Yoshiyuki Inumija (2002) and modified by Cha Young-rye (2006) was utilized. This instrument consists of 32 items divided into four subcategories: positive perception (10 items), negative perception (10 items), interest in death (6 items), and respect for life (6 items), assessed on a 5-point Likert scale. Second, end-of-life care stress was measured using a modified version of the end-of-life nursing stress tool developed by Lee Yeon-ok (2004). This tool comprises 40 items across seven subcategories: negative attitudes toward the end of life of patients and caregivers (8 items), difficulty in allocating time for end-of-life patients (7 items), burden of end-of-life patient care (7 items), work overload (5 items), interpersonal conflicts (6 items), lack of professional knowledge and skills (3 items), and conflicts related to medical limitations (4 items), all evaluated on a 5-point Likert scale. The data analysis in this study utilized independent sample t-tests and One-way ANOVA to examine differences in perceptions of death and end-of-life care stress based on sociodemographic variables. Post-hoc analysis was conducted using Scheffé's test. In addition, Pearson correlation analysis was performed to explore the relationship between the two variables. Finally, multiple regression analysis was conducted to determine the effect of care workers' perceptions of death on end-of-life care stress. The analysis results can be summarized as follows. First, the results of the difference analysis based on sociodemographic variables revealed that perceptions of death varied according to educational level, job position, and the presence or absence of end-of-life care training. For example, care workers with higher educational levels demonstrated a stronger respect for life and more positive attitudes toward death compared to those with lower educational levels. Additionally, care workers in higher positions, such as managerial roles, were more likely to accept and perceive death positively than those in lower positions. Lastly, care workers who had received end-of-life care training exhibited more positive and accepting attitudes toward death compared to those who had not undergone such training. Second, regarding end-of-life care stress, differences were observed based on age, educational level, and facility size. Care workers aged 60 and above experienced higher levels of end-of-life care stress than those under 60, which can be attributed to greater physical fatigue and emotional burden associated with older age groups. Care workers with higher educational levels and those working in smaller facilities with fewer than 50 residents reported greater stress related to a lack of professional knowledge and skills compared to their counterparts. In terms of facility size, care workers in smaller facilities with fewer than 50 residents experienced relatively higher stress levels compared to those in larger facilities with 50 or more residents. This suggests that the lack of support systems in smaller facilities may contribute to the increased emotional burden on care workers. Stress related to work overload and lack of professional expertise was also more pronounced among care workers in smaller facilities, highlighting greater psychological pressure due to insufficient knowledge and skills compared to those in larger facilities. Third, the results of multiple regression analysis revealed that perceptions of death influenced end-of-life care stress. After controlling for other variables, negative perceptions of death had the greatest impact on end-of-life care stress, indicating that the more negatively death was perceived, the higher the stress levels experienced during end-of-life care. Respect for life also significantly influenced end-of-life care stress. In contrast, positive perceptions of death and interest in death were not found to have statistically significant effects on end-of-life care stress. In conclusion, the study confirmed the impact of care workers' perceptions of death on end-of-life care stress. Specifically, negative perceptions of death had the greatest influence on end-of-life care stress, while respect for life also significantly affected stress levels. In contrast, positive perceptions of death and interest in death were not found to have statistically significant effects on end-of-life care stress.
These findings highlight the need for programs aimed at improving care workers' negative perceptions of death and fostering respect for life. However, respect for life is an ethically significant issue, and the study revealed that higher levels of respect for life are associated with increased end-of-life care stress. Therefore, while programs to enhance respect for life should be implemented, separate training addressing end-of-life care stress is essential to alleviate the emotional burden during the caregiving process. This study underscores the importance of education and support programs that enable care workers to provide care in a more stable and positive environment. By fostering positive perceptions of death and reducing end-of-life care stress, such programs can create a supportive setting that benefits both care workers and the individuals they serve.

국문 초록 (Abstract)

본 연구는 요양보호사의 죽음에 대한 인식 정도를 알아보고 이들의 죽음에 대한 인식이 임종 돌봄 스트레스에 영향을 미치는지를 살펴보았다. 이를 위해 전남 소재 노인의료복지시설에 재직 중인 요양보호사 209명을 대상으로 편의 표집을 실시하고, 죽음에 대한 인식과 임종 돌봄 스트레스 등을 측정하였다. 본 연구의 도구로는 첫째, 죽음에 대한 인식을 측정하기 위해 이누미야 요시유키(2002)가 개발하고 차영례(2006)가 수정한 도구를 사용하였다. 긍정적 인식(10문항), 부정적 인식(10문항), 죽음에 대한 관심(6문항), 생명존중의지(6문항)의 4개 하위 영역으로 구성된 총 32문항을 5점 Likert 척도로 평가하였다. 둘째, 임종 돌봄 스트레스는 이연옥(2004)이 개발한 임종 간호 스트레스 도구를 수정하여 사용하였다. 이 도구는 환자 및 보호자의 임종에 대한 부정적 태도(8문항), 임종 환자에 대한 시간 할애의 어려움(7문항), 임종 환자 돌봄 부담감(7문항), 업무량 과중(5문항), 인간적 갈등(6문항), 전문 지식 및 기술 부족(3문항), 의료적 한계에 대한 갈등(4문항)으로 구성된 총 40문항을 5점 Likert 척도로 측정하였다. 본 연구의 자료 분석은 독립표본 t-검정과 ONE-way ANOVA 분석을 통해 인구사회학적 변수에 따른 죽음 인식과 임종 돌봄 스트레스의 차이를 확인하였으며, 사후검증으로 Scheffé 테스트를 사용하였다. 또한, Pearson 상관관계 분석을 통해 두 변수 간의 상관관계를 분석하였고, 마지막으로 요양보호사의 죽음에 대한 인식이 임종 돌봄 스트레스에 미치는 영향을 확인하기 위해 다중 회귀분석을 실시하였다. 분석 결과를 요약하면 다음과 같다. 첫째, 인구사회학적 변수에 따른 차이검증 결과 죽음에 대한 인식에 대해서는 학력, 직위, 임종 돌봄 교육의 유무 차이에 따라 차이가 있었다. 예를 들면, 교육 수준이 높은 요양보호사가 그렇지 않은 요양보호사보다 생명존중에 대한 인식이 강하며, 죽음에 대한 긍정적 태도를 보였다. 또한, 관리직과 같은 높은 직위에 있는 요양보호사가 그렇지 않은 요양보호사에 비해 죽음을 수용하거나 긍정적으로 인식할 가능성이 높았다. 마지막으로, 임종 돌봄에 대한 교육을 받은 요양보호사들은 그렇지 않은 요양보호사보다 죽음에 대해 보다 긍정적이고 수용적인 태도를 나타낸다. 둘째, 임종 돌봄 스트레스에서는 연령, 학력, 시설 인원에 따라 차이가 있었다. 60세 이상의 연령이 60세 미만보다 임종 돌봄 스트레스가 높게 나타났으며, 이는 신체적 피로와 정서적 부담이 높은 연령대에서 더 많이 경험되는 결과였다. 교육 수준이 높은 요양보호사와 50인 미만의 소규모 시설에서 근무하는 요양보호사들이 그렇지 않은 요양보호사에 비해 임종 돌봄 스트레스 중 전문지식과 기술 부족 항목에 대해 스트레스를 경험하는 것으로 나타났다. 시설 규모와 관련하여, 50인 미만의 소규모 시설에서 근무하는 요양보호사들은 50인 이상 시설에 근무하는 요양보호사에 비해 상대적으로 더 높은 스트레스를 경험하는 것으로 나타났으며, 이는 소규모 시설에서의 지원 체계 부족이 요양보호사들의 정서적 부담을 증가시키는 원인으로 작용할 수 있음을 나타낸다. 업무량 과중과 전문성 부족에 대한 스트레스는 또한 50인 미만의 소규모 시설에서 근무하는 요양보호사에게서 더 강하게 나타났으며, 이는 50인 이상 시설에서 근무하는 요양보호사보다 전문지식과 기술 부족으로 인한 심리적 부담이 더 크다는 것을 보여준다. 셋째, 다중회귀 분석을 통한 분석 결과에서는 죽음에 대한 인식이 임종 돌봄 스트레스도 영향을 미치는 것으로 나타났다. 통제 변수를 포함한 분석 결과, 죽음에 대한 부정적 인식이 임종 돌봄 스트레스에 가장 큰 영향을 미치는 것으로 나타났으며, 이는 죽음을 부정적으로 인식할수록 임종 돌봄 중에 경험하는 스트레스 수준이 높아짐을 의미한다. 생명존중의지 또한 임종 돌봄 스트레스에 영향을 미쳤다. 반면 죽음에 대한 긍정적 인식과 죽음에 대한 관심도는 임종 돌봄 스트레스에 통계적으로 유의미한 영향을 미치지 않는 것으로 나타났다. 따라서, 연구결과를 종합하면 요양보호사의 죽음 인식이 임종 돌봄 스트레스에 미치는 영향을 확인하였다. 특히, 죽음에 대한 부정적 인식이 임종 돌봄 스트레스에 가장 큰 영향을 미쳤으며, 생명존중 의지 또한 임종 돌봄 스트레스에 유의미한 영향을 주었다. 반면, 죽음에 대한 긍정적 인식과 죽음에 대한 관심은 임종 돌봄 스트레스에 통계적으로 유의미한 영향을 미치지 않는 것으로 나타났다. 이러한 결과는 요양보호사의 부정적 죽음 인식과 생명존중의식을 개선할 수 있는 프로그램이 필요하다. 다만 생명존중의지는 윤리적으로 가장 중요한 문제이고 생명존중의식이 높을수록 임종 돌봄 스트레스가 높기 때문에 생명존중의식 개선 프로그램을 제공하되, 임종 돌봄 스트레스와 관련하여 별도의 교육이 제공되어 임종 돌봄 과정에서의 정서적 부담 완화에 효과적인 방법을 찾아내야 할 것이다. 본 연구는 요양보호사들이 보다 안정적이고 긍정적인 환경에서 돌봄을 제공할 수 있도록 교육과 지원 프로그램의 필요성을 제기하며, 이를 통해 요양보호사들이 긍정적인 죽음 인식을 가지며 임종 돌봄 스트레스를 감소할 수 있는 환경 조성의 중요성을 강조한다.

목차 (Table of Contents)

• Ⅰ. 서론·················································································································1
• 1. 연구의 필요성 및 목적························································································1
• 2. 연구 문제 ···············································································································6
• 3. 용어의 정의·············································································································7
• Ⅱ. 이론적 배경 및 선행연구 고찰·······························································10
• 1. 죽음의 인식···········································································································10
• 2. 임종 돌봄(간호) 스트레스 ················································································13
• 3. 죽음에 대한 인식과 임종 돌봄 스트레스의 관계·········································16
• 4. 요양보호사의 인구사회학적 특성·····································································18
• Ⅲ. 연구방법·······································································································20
• 1. 연구모형 ···············································································································20
• 2. 자료수집·················································································································21
• 3. 측정도구·················································································································22
• 1) 죽음에 대한 인식 측정 도구 ·········································································22
• 2) 임종 돌봄 스트레스 측정 도구 ·····································································26
• 4. 자료분석·················································································································31
• Ⅳ. 연구결과·······································································································32
• 1. 연구 대상자의 일반적 특성···············································································32
• 2. 요양보호사의 죽음에 대한 인식 및 임종 돌봄 스트레스의
• 일반적인 경향······································································································34
• 3. 요양보호사의 인구사회학적 배경에 따른
• 죽음의 인식과 임종 돌봄 스트레스 차이······················································36
• 1) 요양보호사 연령에 따른 차이 ·······································································36
• 2) 요양보호사 학력에 따른 차이·········································································39
• 3) 요양보호사 근무지 시설 인원수에 따른 차이 ···········································42
• 4) 요양보호사 직위에 따른 차이 ·······································································45
• 5) 요양보호사 임종 돌봄 교육에 따른 차이 ···················································48
• 4. 요양보호사의 죽음에 대한 인식과 임종 돌봄 스트레스 간의
• 상관관계················································································································51
• 5. 요양보호사의 죽음에 대한 인식이 임종 돌봄 스트레스에 미치는
• 영향························································································································55
• 1) 죽음에 대한 인식 하위요인이 임종 돌봄 스트레스에 미치는 영향·······55
• 2) 죽음에 대한 인식 하위요인이 임종 돌봄 스트레스 중 환자 및 보호자의
• 임종에 대한 부정적 태도에 미치는 영향······················································57
• 3) 죽음에 대한 인식 하위요인이 임종 돌봄 스트레스 중 임종 환자에 대한
• 시간 할애 어려움에 미치는 영향···································································59
• 4) 죽음에 대한 인식 하위요인이 임종 돌봄 스트레스 중 임종 환자 돌봄
• 부담감에 미치는 영향·······················································································61
• 5) 죽음에 대한 인식 하위요인이 임종 돌봄 스트레스 중 업무량 과중에
• 미치는 영향·········································································································63
• 6) 죽음에 대한 인식 하위요인이 임종 돌봄 스트레스 중 임종 환자와의
• 인간적 갈등에 미치는 영향·············································································65
• 7) 죽음에 대한 인식 하위요인이 임종 돌봄 스트레스 중 전문지식과 기술
• 부족에 미치는 영향···························································································67
• 8) 죽음에 대한 인식 하위요인이 임종 돌봄 스트레스 중 돌봄 한계 갈등에
• 미치는 영향 ··················································································································69
• Ⅴ. 논의 및 결론·······························································································71
• 1. 논의·························································································································71
• 2. 연구의 의의와 제언 ···························································································74
• 3. 결론 ·······················································································································75
• 참고문헌··························································································································77
• Abstract··························································································································82
• <부록>······························································································································86