• 대한간호학회지
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• 제22권4호
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• pp.636-652
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• 1992

This study identified the impact of childhood cancer on the Korean family. The purpose was to contribute knowledge for family nursing and pediatric hospice care practice with sick children and their families. This descriptive study was conducted during a 6 month period with children who were being treated for cancer at six university hospitals in Seoul. The data were gathered from members of 68 families ; 24(Group A), with a child newly diagnosed with cancer : 27(Group B), with a child under treatment and without complications, and 17 (Group C), with a child in relapse. Medical records, structured questionnaires and interviews were used for data collection. The questionnaires and interview schedules had been used previously in Martinson's research in the USA and China. The findings, conclusions, and suggestions are as follows. 1. The impact of childhood cancer on the family. Members of the family experienced fear, helplessness, guilty feelings, and anger at the time of the initial diagnosis and at relapse. Mothers complained of headache, anorexia and poor appetite, weight loss, sleep disturbance, and bad dreams. Many of the fathers either lost or changed jobs, and all working mothers stopped working. Half the parents reported changes in their marital relationships such as frequent quarrels but also stronger unity. Family members perceived cancer as the most frightening disease. Change in their world view was expressed as living on faith understanding suffering, determining to live a better life, wanting to live an upright life and valuing health as the most important. Religious activities are found most helpful through this difficult experience. Financial debt due to the treatment and care of the sick child, burdened 22 families. The above mentioned impact was most evidant in Group B(those presently undergoing treatment) and Group C(those in relapse). Findings indicate that nursing care should embrace the family of a child who is being treated for cancer. 2. Characteristics of the child with cancer The majority of the children in this sample had a diagnosis of leukemia. Their mean age was 6.8 and the ratio of boys to girls was 1.12 ; 1. The mean hospitalization frequency was 13.5 times and the mean duration of illness was 16.8 months. Most of 1.he children perceived cancer as the most frightening disease ; 32.7% of the children described their sickness as serious. Children in Group C were hospitalized more frequently, stayed in hospital for longer periods, and expressed their sickness as quite serious more often than the other two groups. These findings indicate how much comprehensive pediatric hospice nursing care services are needed along with relevant research and nursing education. 3. Characteristics of the families. The mean age of the father was 39.5 and the mother, 36,6 ; they are in their most productive life period. Mothers especially expressed feelings of financial uneasiness and powerlessness about giving up their jobs, and guilty feelings for not providing enough care and concern to other children due to taking care of the sick one. The burden of caring for the sick child can bring negative changes in family dynamics which they think provoke potential health problems in members of the family These findings suggest a need for nursing support and counselling resources. Findings also suggest the need for ethical inquiry about such questions as who should give information to the child in regard to diagnosis and prognosis, when, and how. Other suggestions included : 1) Quality health care for childhood cancer such as home care and pediatric hospice programs should be established. 2) Special and practical consideration for long-term patients should be made in the present insurance coverage. The reimbursement period for long-term patients should be lengthened. 3) Further in-depth qualitative studies are needed. 4) Education programs including guided practice experience for pediatric hospice care practitioners are needed.

• 한국노년학
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• 제29권2호
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• pp.477-488
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• 2009

본 연구는 노인요양시설에 거주하는 노인의 시설 입소초기(3개월)의 생생한 경험을 토대로 입소노인들이 겪는 어려움을 파악하여, 시설운영자들이 입소노인들의 입소초기 삶의 질과 연관된 요인들을 이해하는 근거자료로 이용될 수 있도록 하고, 입소초기에 입소노인들이 겪는 심리사회적 문제에 효과적으로 개입, 중재할 수 있는 프로그램 개발의 기초자료로 활용될 수 있도록 하기 위해 수행되었다. Patton에 의한 주제분석 방법을 적용한 질적 연구방법을 적용하였고 6명의 입소초기 노인들과의 다면적 심층 면담을 통하여 수집된 자료를 분석한 결과 입소과정 및 입소초기의 경험으로 자발적인 입소결정, 가족의 강권에 따른 입소결정, 자율성의 제한, 개별성의 결여, 입소 전 후의 생활 연계성의 단절, 관계형성의 제한, 미래자아상에 대한 부정적 예견 등의 중심주제가 도출되었다. 시설입소에 대한 노인들의 초기반응에 영향을 주는 근본적인 조건은 독립성과 자율성이었으며 이러한 것들은 입소와 관련된 의사결정 과정 뿐 만 아니라 입소 이후의 적응에도 많은 영향을 주는 것으로 나타났다. 이로부터 노인들에게 입소 후의 생활에서의 자율성을 비롯하여 일상 활동에 대한 선택의 기회를 부여하고, 입소노인의 안전을 위협하지 않는 한 스스로 할 수 있는 일은 직접 수행하게 함으로써 자신의 삶이 독립적이라 생각할 수 있도록 환경을 조성해주는 것이 입소시설에 대한 적응도를 향상시킬 것으로 생각된다. 또한 신체적, 인지적 기능이 비슷한 노인들 간의 활발한 사회적 교류를 통해 새로운 대인관계를 형성하여, 삶의 재편성(reorganization)과 안정화(stabilization)가 일어날 수 있도록 돕는 것이 필요하다고 본다.

• 한국콘텐츠학회논문지
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• 제11권11호
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• pp.231-240
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• 2011

본 연구는 앞으로의 노인장기요양보험 서비스의 확대 시 우선적인으로 방문물리치료 서비스 도입의 기초자료를 제공하는데 그 목적이 있으며 그를 위해 노인장기요양보험 하에서 물리치료 서비스를 제공하고 있는 노인시설 물리치료사들의 제도에 대한 인식조사를 실시하였다. 그 결과 노인장기요양보험에 대한 인지도는 88.1%로 높았으며 필요성에서도 높았지만 40세 이상에서 절대 필요하다는 응답이 60.3%로 더 높았다. 또한 수가는 방문간호를 기준으로 높게 책정해야 한다는 의견이 59.7% 가장 높았다. 방문물리치료서비스 중 가장 중요한 치료접근으로는 일상생활 지도가 40%로 가장 높았고, 서비스 주체로는 방문간호센터처럼 방문재활센터로 해야 한다는 의견이 69.4%를 차지했다. 방문물리치료 시행에 따른 기대효과는 50점 만점에 전체 평균 41.44점으로 나타났으며 특히 40세 이상에서 42.48점으로 나타나 전체적인 기대효과가 높은 것으로 나타났다.

• 대한간호학회지
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• 제27권2호
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• pp.303-314
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• 1997

This is descripitive study conducted to identify educational needs of mothers of nephrotic syndrome patients and tie degree of nerses' educational performances perceived by mothers who look after mainly nephrotic syndrome patients. The study subjects were composed of 74 mothers of nephrotic syndrome patients whose children were hospitalized in 2 Pediatric wards of University Hospital in Seoul and 1 in Pen from June in 1996 to Januaryin 1997. A questionaire for this study was item Kikert type 5 point scale, developed on the basis of previous literature and researcher's clinical experience and the reliability of the used instruments was α=.97. The data analysis was done by SAS. t-test, and ANOVA were done to determine the effect of general characteristics of subjects on their educational needs. Pearson correlation was done to measure relations between general characterictics of subjects and their educational needs and Stepwise Multiple Regression was done to test a variable affecting educational needs. The results were as follows. 1. Mean score of educational needs of subjects was 137.06(Maximum 176). The score of the educational needs of home care was the highes, but the question numbers(of that category) are smaller than others. So, the educational need of the diagnosis art treatment was regarded as the highest in contents. 2. The mean score of nurses' educational performances was very low, 74.91(Maximum 176). Nurse's educational performances score in the diagnosis and treatment of the disease ranked as the highest Burt that score in the care during hoapitalization was the highest in contents as the educational needs was. 3. The number of children excepting the patient (r²=.215289. p=.006) and the age of patient(r²=.23770, p=.001) were emerged as important variables affecting the degree of mother's educational need.

• 한국보건간호학회지
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• 제11권2호
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• pp.57-72
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• 1997

The objectives of this study are : 1) To understand self-care ability, living habits, utilization patterns of medical facililties for the elderly in Puk-Cheju county which has the highest percent age of senior citizens among Cheju rural community: 2) To identify factors which influence living quality and long life for the eldely 3) To develop health care service with a view to guaranteering living quality The eldely population of Puk-Cheju county was $10.8\%$ in 1995. It will be increasing and is projeted $23.0\%$ by 2030. The result indicated that utilizations rate by out-patient were 5.89 claims and utilizations rate by in-patient were 0.17 claims per person. The highest disease among respondents were disease of musculoskeletal system and connective tissue. A total of 310 elderlys were responded to analyze self-care ability and health behavior. The most important factors of long life were to have peaceful mind$(50.0\%)$. The common disease of acute and chronic disease was musculoskeletal system disease. $66.8\%$ of respondents went to hospital and local clinic when they got sick. The most needed health care service was home visiting service among public health center, representing $31.4\%$. The repondent's self-care ability and self-efficacy were relatively superiority. A total of 92 elderlys were conducted the intelligence test for the rate of dementia and their average age was 74.3. The result of Minimental State Scale indicated that 25% of respondents were suspected to be dementia. The followings are recommendations based on the survey result. 1) Concidering every conditions of self-care ability and health status for elderly. It is important to embody appopriate health care service. 2) Considering concrete method, it is necessary to establish health service, which match health status and self-care ability, and various planning for sepecial facilities for the elderly. 3) It is desiable to make actual programs for the elderly in each community level. 4) It must be develop the better use of volunteers and programs for prevention of dementia. Finally, Concerning the orgarnization of public health center, community health center need to be reorganized for health service for the elderly. It is important to develop and operate health promotion for the elderly, and it is necessary to form the foundation for the support of facilities equipments. This contribute to promote health status for the rural elderly.

• 한국노년학
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• 제31권2호
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• pp.195-209
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• 2011

이 연구는 지역사회에 거주하고 있는 중고령자의 미충족 돌봄요구 현황을 파악하고 관련요인을 밝히고자 수행한 이차자료 분석연구로, 전국의 45세 이상 일반가구 거주자를 대표하는 표본(n=10,254)을 표집하여 조사한 2006년 제 1차 고령화연구패널을 이용하였다. 미충족 돌봄요구는 기본적 일상생활수행과 도구적 일상생활수행에 있어 다른 사람의 도움을 필요로 하는 상태임에도 돌봐줄 수 있는 사람이 없는 경우로 정의하였다. 모든 분석은 대상 인구집단을 대표하는 추정 통계치를 구하고자 가중치를 적용하여 수행하였다. 연구 결과, 중장년의 7.3%, 젊은 노인의 14.5%, 그리고 고령 노인의 41.8%가 돌봄을 필요로 하는 상태였으나, 이 중 각각 34%, 33%, 24%가 돌봄요구를 충족받고 있지 못한 것으로 나타났다. 미충족 돌봄요구 관련요인은 연령 그룹에 따라 달랐는데, 중장년에서는 교육과 소득수준이 미충족 돌봄요구와 음의 상관관계를 갖고 있었던 반면, 젊은 노인과 고령 노인층에서는 독거만이 음의 상관관계를 가진 요인이었다. 결론적으로, 우리나라 지역사회 거주 중고령자 중 상당수가 미충족 돌봄요구가 있으며, 그 관련요인은 생애주기에 따라 차이가 있었다. 연구결과는 지역 사회 거주 중고령자의 미충족 돌봄요구를 최소화할 수 있도록 지역사회기반 재가서비스의 확충이 시급하며, 특히 교육수준이 낮은 중장년과 독거노인 대상의 서비스 개발 및 보급이 중요함을 시사한다.

• 성인간호학회지
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• 제12권4호
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• pp.690-705
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• 2000

This ethnography was based on Kleinman's explanatory model of a health care system. It is conducted to make thick discription of illness conception of the elderly in a sociocultural context. The basic assumptions were as follows. 1) A health care system is a cultural system, and as with any other cultural system, it is a system of symbolic meanings anchored in a particular arrangement of social institutions and patterns of interpersonal relationships; 2) In all societies health care activities are more or less interrelated. Therefore, they need to be in a holistic manner as socially organized responses to disease that constitute a special cultural system; health care system; 3) Health and illness experiences are the natural process of disease. Individuals who recognized a for state of health, their family, neighbors, and communities define the state, search for causes of the health problems, and response to it. According by, they proceed to search for healing stratagies. So, understanding of the illness experience is the starting point for health care. The study participants were 12 elders aged 60 or more. The fieldwork was conducted in an agricultural clan village of Namwon city. The data collection and analysis were cyclic, from descriptive observation, domain analysis, focused observation, taxanomic analysis, selected observation, componential analysis, and finally cultural themes were all analysed. Proxemic and text analysis techniques were used according to the characteristics of the data. The data of sociocultural context and descriptive data were collected from 1990 to 1992. Informations on illness concepts were collected during 1994 using focused observation. Data confirming and contrast observations were conducted from 1997 and 1999. Illness concepts of the elderly were taxonomized supernatural cause, non-supernatural cause, immediate cause, and ultimate cause. The supernatural ones were ancestors, god of home, god of village, and ghost such as 'sal(evil force of dead man)' and 'gagqui(ghost of begger)'. The non-supernatural ones were Ki, natural phenomenones, natural objects, foods, human and human behaviors. Immediate ones were insufficiency and overflows, discretion and consolidation, disorder and out of order, cloudness and contamination, and fluctuation and stagnation of supernatural cause and non-supernatural ones. Ultimate causes were intrusion and loss of supernatural and nonsupernatural ones. The cultural themes of illness concepts of the elderly are: 1) illness concepts are not based on causality principle, but on reciprocal principle; 2) illness concepts are affected by social level and charicteristics of the patients; 3) the causes of disease are recognized as imposed both positive and negative effects on health based on interpretation of the indiviuals; 4) illness concepts reflects on principles of everyday life of the society members such as hierachial structure and group cohesiveness; 5) illness concepts are ruled on principle of reciprocity and spread; 6) illness concepts are interrelated with physical environment of the participants. It can be concluded that the illness concepts of the elderly in a traditional clan village are a component of health care system as a cultural system based on these results. The these results can be a useful basis for gerontological nursing practice and education.

• 대한간호학회지
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• 제24권4호
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• pp.597-615
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• 1994

This study is designed to facilitate the creation of home environment conducive to the family taking care of chronic bed-ridden patients with more effective method. The need for this study has emerged against the background of marked changes in the structure of ailments and causes of death, resulting in the number and plights of chronic bed-ridden patients as well as of a rapid increase in demand for medical care and resulting premature discharge. Keeping these in mind, this study focused on home-wards where the majority of chronic bed-ridden patients are being cared for. Despite. their overriding importance, home-words are less than efficient in caring (or chronic bed-ridden patients. These circumstances require the designing of home-wards that can offer greater comfort to patients and at the same time make things easier for caregivers, on the basis of an overall analysis of patients' life and home - ward situation. According1y this study adopted a Participant Observation Method derived cultural anthropology, Toward this end, 3 patients were chosen as subjects of this study for intensive interviewing and participant observation. In the process of this field re-search efforts were made to collect emprical data, that is, to faithfully record the words of the subjects and their caregivers for analysis and interpretation. The findings of these analyses are as follows. Firstly, the chronic bed-ridden patients are mostly being taken care by close family members. Secondly, a room for the exclusive use of the patient, floor, kitchen, bathroom and multipurpose space were found to be necessary for proper caring of the patient. These spaces were respectively used with a view to 1) accomodating the patient as well as caregivers' activities, 2) keeping general and medical supplies and other appliances for patient's care and drying the patient's washing, 3) preparing and keeping the patient's foods and beverages, 4) keeping the supplies necessary for cleaning the patient's body and treating the patient's eliminations, 5) washing the patient's clothes, underwears and bedclothes. The patient's room in turn is subdivided into six portions in terms of uses : specifically the places for accomodating 1) the patient, 2) medical supplies, 3) medicines, 4) linens St clothes, 5) bedclothes and, 6) diapers. Thirdly, the activities of the caregiver are subdivided into seven key areas : hygiene, exercise, diet, elimination, therapeutic nursing, prevention of sore, and other activities. Each area is further classified into several different activities of caring. These activities we mainly carried out in the patient's room. Fourthly, the supplies for caring the chronic bed-ridden patient is divided into two large domains : medical and general supplies. Finally, three main problems areas were found in this study on the part of caregivers, that is, sore prevention, hygiene problem related frequent urination / defecation, the caregiver's physical, psych ological and emotional burden. In consideration of the aforesaid problem areas, a model home-ward was developed in this study. The newly-developed model has been found to have the following six advantages. Firstly, the time and effort required for maintaining the patient's hygiene are reduced, thus relievins the caregiver's physical and psychological bur-den. Secondly, the patient's hygiene can be maintained in satisfactory conditions, because the patient's eliminations are more easily removed. Thirdly, skin irritations caused by the patient's eliminations were remarkably reduced and so were the patient's sores due to moisture and bacteria. Fourthly, the home-ward have a tilt-table ef-fect thanks to the inclining room floor. This improves the patient's cardiovascular function as well as constantly changes pressed skin areas and thus prevents sores. Fifthly, improved shelf arrangements help make the best use of patient's supplies. Sixthly, the trouble of continuously changing clothes, underwears, diapers & bedclothes is remarkably reduced simply by covering the patient with cotton sheets when laid in bed. This is espected to cut down expenses by reducing the comsumptions of diapers and other disposable supplies.

• 여성건강간호학회지
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• 제5권3호
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• pp.410-419
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• 1999

This study sought to figure out women's functional status after childbirth under the Sanhujori. Functioal status was defined as the women's readiness to assume infant care responsibilities and resume her usual activities including household, social and community, self-care and occupational activity. A convenience sample of 211 women who are in the postpartal period of the range from 1 week to 3 months above and residing in Seoul. Korea was studied from January, 1997 to December, 1998 for two years. Mean age of respondents was 29.9 years and mean of the present postpartal period was 7.5 weeks. The present postpartal period was of 5-8 weeks 26.5%, 3-4weeks 26.1%, 9-12 week 23.7% and below 2 weeks 7.1%, 32.7% of women had a job and the mean period of return to job was 2.76 weeks. During Sanhujori the non professional care giver was family members from women's maiden home 73.5% and only 2% of husband. The period women needed for the recovery from now was 5.39 weeks and it means that women need 12.9weeks for recovery after childbirth. For the present subjective health status after childbirth, bad was 20.2%, good 18.3 and average 61.5% and for the recovery status, completely recovered 29.5%, slightly 61.8% and rarely 8.7%. The mean of functional status at the 7.5weeks was baby care activity 3.65, household 2.57, self-care 2.46, occupational 2.44 and social 1.53 in rank. Except baby care the functional status was generally low or very low. The related factors to the functional status were the period and subjective evaluation of Sanhujori women experienced, the present period of postpartum, and subjective feeling of recovery. This result strongly reflects the effects of Sanhujori culture and Sanhujori per se on women's postpartal life including functional status and reconfirmed the relationship between health status and the experience of Sanhujori after delivery as the previous findings from various study showed. It provides a challenge to the professional care givers to research further on the effects of Sanhujori on the health status, health recovery after abortion or delivery from the various aspects through the cross-sectional and longitudinal research for the refinement of the reality of Sanhujori not only as cultural phenomenon but as an inseparable factor influencing in women's postpartal healthy adaptation and for the appropriateness of intervention and quality of care for desirable health outcome.

• 대한간호학회지
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• 제28권4호
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• pp.958-969
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• 1998

In this study, we attempted to investigate the needs and problems of the terminal cancer patients and their family caregivers to provide them with nursing information to improve their quality of life and prepare for a peaceful death. Data was collected from August 1, 1995 to July 31, 1996 at the internal medicine unit of S hospital in Seoul area with the two groups of participants who were family members of terminal cancer patients seventy four of them were in-patients and 34 were out-patients who were discharged from the same hospital for home care. The research tool used in this study has been developed by selecting the questionnaires from various references, modifying them for our purpose and refining them based on the results of preliminary study. While general background information about the patients was obtained by reviewing their medical records, all other information was collected by interviewing the primary family caregivers of the patients using the questionnaire. The data collected were analyzed with the SPSS PC/sup +/ program. The results of this study are summarized as follows ; 1) Most frequently complained symptoms of the terminal cancer patients were in the order of pain(87%), weakness(86.1%), anorexia(83.3%) and fatigue (80.6%). 2) Main therapies for the terminal cancer patients were pain control (58.3%), hyperalimentation(47.2%) and antibiotics(21.3%). 3) Special medical devices that terminal cancer patients used most were oxygen device (11.1%), and feeding tube(5.6%). Other devices were used by less than 5% of the patients. 4) The mobility of 70.4% of the patients was worse than ECOG 3 level, they had to stay in bed more than 50% of a day. 5) Patients wanted their medical staffs to help relieve pain(45.4%), various physical symptoms(29.6%), and problems associated with their emotion(11.1%). 6) 16.7% of the family caregivers hoped for full recovery of the patients, refusing to admit the status of the patients. Also, 37% wished for the extension of the patient's life at least for 6 months. 7) Only 38.9% of the family members was preparing for the patient's funeral. 8) 45.4% of family caregivers prefer hospital as the place for the patient's death, 39.8% their own home, and 14.8% undetermined. 9) Caregivers of the patients were mostly close family members, i.e., spouse(62%), and sons and daughters or daughter-in-laws(21.3%). 10) 43.5% of the family caregivers were aware of hospice care. 46.8% of them learned about the hospice care from the mass media, 27.7% from health professionals, and the rest from books and other sources. 11) Caregivers were asked about the most difficult problems they encounter in home care, 41 of them pointed out the lack of health professionals they can contact, counsel and get help from in case of emergency, 17 identified the difficulty of finding appropriate transportation to hospital, and 13 stated the difficulty of admission in hospital as needed. 12) 93.6% of family caregivers demanded 24-hour hot line, 80% the visiting nurses and doctors, and 69.4% the volunteer's help. The above results indicate that terminal patients and their family caregivers demand help from qualified health professionals whenever necessary. Hospice care system led by well-trained medical and nursing staffs is one of the viable answers for such demands.