관상동맥우회술 환자의 불확실성, 회복탄력성과 자가 간호

다국어 초록 (Multilingual Abstract)

Purpose: The patients after coronary artery bypass graft surgery perceive uncertainty due to symptom, progress and prognosis related to coronary artery disease, which affects recovery from disease. However, there are difference in perception and response to stress among individuals, and resilience, which can explain this, enables the patients recovery from disruptive life challenges and further growth. In addition, self-care of patients is very important to prevent recurrence and maintain health even after recovery from postoperative conditions.This study aimed to identify factors related to self-care of patients by investigating uncertainty, resilience and self-care of patients who underwent coronary artery bypass surgery.
Method: A descriptive correlational design was used for the study. A convenience sample of 110 patients who visited outpatient clinic after coronary artery bypass surgery were enrolled at S hospital from April 2022 to September 2022. Data were collected using a structured questionnaire and from electronic medical record.
Collected data were analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation analysis, and multiple regression analysis with the IBM SPSS version 26.0.
Result: There were significant negative correlations between uncertainty and self-care maintenance (r=-.208, p<.05), and between uncertainty and self-care management(r=-.194, p<.05). There were significant positive correlations between resilience and self-care maintenance(r=.382, p<.01), and between resilience and self-care monitoring(r=.373, p<.01). There were significant negative correlations between uncertainty and resilience (r=-.285, p<.01). The significant factors related to self-care maintenance were resilience, abstinence from alcohol, and regular exercise behavior (adjusted R2=.249, p<.001). The significant factor related to self-care monitoring was resilience (adjusted R2=.141, p<.001). The significant factors related to self-care management were middle level of economic status and high level of economic status (adjusted R2=.095, p=.004).
Conclusion: This study demonstrated that the factors related to self-care in patients after coronary artery bypass surgery were resilience, regular exercise behavior, abstinence from alcohol, and economic status. Therefore, intervention to enhance resilience and self-regulation ability to maintain a healthy life style might be essential for patients after coronary artery bypass graft surgery in order to improve their self-care. Furthermore, it is necessary to assess the lifestyle and economic status of patients in advance and nursing intervention with a difference based on it should be considered.
Key words : Coronary artery bypass graft surgery, Uncertainty, Resilience, Self-care

국문 초록 (Abstract)

관상동맥우회술 환자는 관상동맥질환과 관련된 증상, 치료 경과 및 예후 등으로 인해 불확실성을 인지하게 되며 이는 질병 회복에 영향을 미친다. 그러나 스트레스에대한 인식과 반응은 개인에 따라 차이가 있는데, 이를 설명할 수 있는 회복탄력성은역경, 문제로부터 회복하게 하고 나아가 성장하도록 한다. 또한 수술 후 상태에서 회복된 이후에도 재발 방지와 건강 유지를 위해서 관상동맥우회술 환자의 자가 간호는매우 중요하다. 본 연구는 관상동맥우회술 환자의 불확실성, 회복탄력성 및 자가 간호를 조사하고 자가 간호의 관련 요인을 분석하기 위해 시도되었다.
본 연구는 서술적 상관관계 연구로 2022년 4월부터 2022년 9월까지 S 병원에서 관상동맥우회술을 받고 외래에 내원한 환자 중 수술 후 경과 기간이 3개월 이내인 환자110명을 편의 표집 하여 구조화된 설문지와 의무기록 열람을 통해 자료를 수집하였다. 수집된 자료는 IBM SPSS version 26.0을 이용하여 통계처리 하였으며 기술 통계, t-test, ANOVA, Pearson correlation coefficient, 다중회귀분석으로 분석하였다.
본 연구의 결과는 다음과 같다.
1. 대상자의 불확실성은 평균 35.32±11.50점으로 교육수준과 유의한 차이를 보였다(F=4.255, p=.007). 대상자의 회복탄력성은 평균 132.01±26.72점으로 경제적 상태와 유의한 차이를 보였다(F=5.966, p=.003). 대상자의 자가 간호는 세 개의 하위 영역별로 나누어 분석하였으며, 자가 간호 유지는 평균 74.77±14.99점으로 음주력(F=3.118, p=.048), 운동 습관(F=6.687, p=.002)과 유의한 차이를 보였으며, 자가 간호 관찰은 평균 72.06±18.52점으로 경제적 상태(F=3.360, p=.038)와 유의한 차이를 보였다. 자가 간호 관리는 평균 62.76±22.21점으로 경제적 상태(F=5.254, p=.007)와 유의한 차이를 보였다.
2. 대상자의 불확실성은 자가 간호 유지(r=-.208, p<.05), 자가 간호 관리(r=-.194, p<.05)와 유의한 음의 상관관계를 보였고, 회복탄력성은 자가 간호 유지(r=.382, p<.01), 자가 간호 관찰(r=.373, p<.01)과 유의한 양의 상관관계를 보였다. 불확실성과 회복탄력성은 유의한 음의 상관관계(r=-.285, p<.01)를 보였다.
3. 대상자의 자가 간호 유지 관련 요인은 회복탄력성(β=0.31, p=.001), 금주(β=-0.21, p=.040), 규칙적인 운동 습관(β=0.25, p=.005)으로 나타났다(adjusted R2=.249, p<.001). 대상자의 자가 간호 관찰 관련 요인은 회복탄력성(β=0.34, p<.001) 이었다(adjusted R2=.141, p<.001). 대상자의 자가 간호 관리 관련 요인은 높은 수준의 경제적 상태(β=0.37, p=.002), 중간 수준의 경제적 상태(β=0.26, p=.030)로 나타났다(adjusted R2=.095, p=.004).
이상의 결과를 통해 관상동맥우회술 환자의 자가 간호 관련 요인은 회복탄력성, 규칙적 운동습관, 금주상태, 경제적 상태로 나타났다. 따라서 관상동맥우회술 환자의 자가 간호 증진을 위해 대상자의 회복탄력성 향상 및 건강한 생활습관 유지를 위한자기 조절 능력 향상 중재가 필요하며, 대상자의 생활 습관 및 경제적 상태를 사전에 파악하여 그에 따른 차별점을 둔 간호 중재를 모색해야 할 것이다.
핵심되는 말 : 관상동맥우회술, 불확실성, 회복탄력성, 자가 간호

목차 (Table of Contents)

• 차 례 ··········································································· ⅰ
• 표 차 례 ······································································· ⅲ
• 부록차례 ······································································ ⅳ
• 국문요약 ······································································ ⅴ
• I. 서론 ·········································································· 1
• 1. 연구의 필요성 ·························································· 1
• 2. 연구 목적 ································································· 5
• 3. 용어의 정의 ······························································ 6
• II. 문헌고찰 ···································································· 8
• 1. 관상동맥우회술 환자의 불확실성과 자가 간호 ·············· 8
• 2. 관상동맥우회술 환자의 회복탄력성과 자가 간호 ··········· 11
• III. 연구방법 ··································································· 13
• 1. 연구설계 ·································································· 13
• 2. 연구대상 ·································································· 13
• 3. 연구도구 ·································································· 14
• 4. 자료 수집 방법 ·························································· 15
• 5. 윤리적 고려 ······························································ 16
• 6. 자료 분석 방법 ·························································· 16
• IV. 연구결과 ·································································· 17
• 1. 대상자의 특성 ··························································· 17
• 2. 대상자의 불확실성, 회복탄력성, 자가 간호 ··················· 23
• 3. 대상자의 일반적 특성과 질병관련 특성에 따른 불확실성,
• 회복탄력성, 자가 간호의 차이······································ 24
• 4. 불확실성, 회복탄력성, 자가 간호 상관관계 ··················· 40
• 5. 대상자의 자가 간호 관련 요인 ····································· 42
• V. 논의 ·········································································· 45
• VI. 결론 ········································································· 51
• 참고문헌 ········································································ 52
• 부 록 ············································································· 61
• 영문요약 ······································································· 69