• 제목/요약/키워드: Illness perception

검색결과 130건 처리시간 0.026초

진단서의 증명력: 상해진단서를 중심으로 (Medical Certificate as an Evidence of Personal Injury)

  • 이동진
    • 의료법학
    • /
    • 제18권2호
    • /
    • pp.47-73
    • /
    • 2017
  • 진단서는 의사등이 진찰결과에 관한 판단을 표시하여 작성하는 문서로서 민 형사소송 등에서 증거로 쓰인다. 특히 상해의 증명에서 그 기능이 현저하다. 법은 허위진단서작성을 형사처벌하는 등으로 그 증명기능을 보호하기 위하여 힘쓰고 있다. 그러나 몇 가지 이유에서 진단서가 진실과 부합하지 아니하는 경우가 생긴다. 첫째, 의사등의 제1차적 관심은 환자의 효과적인 진단과 치료인데, 그에 필요한 정보수집 및 판단의 방법이 법정 등에서 진실을 찾는 것과 다를 수 있다. 둘째, 의사등은 종종 환자의 진술 등에서도 판단에 필요한 정보를 얻는데, 환자와의 치료적 대화 관계 등의 유지를 위하여 그 진술 등의 신빙성을 의심하는 것이 부적절한 경우가 있을 수 있다. 이는 결국 의사등이 증명이 아닌 다른 목적으로 수집한 정보로부터 내린 판단을 증명에 전용(轉用)하여 생긴 문제이고, 비용이 낮은 진단서 제도를 버릴 수 없는 한 불가피한 한계에 해당한다. 진단서에 의한 증명에 표현증명의 효력을 부여하여야 하는 경우와 그 증명력을 자유심증주의에 터 잡아 개별적으로 심사하여야 하는 경우를 나누어 후자에 대하여는 전면적인 증명력 심사를 가하고, 진단서 서식 자체를 개선하여 법원이나 수사기관 등이 위 둘 중 어느 경우에 해당하는지를 가리는 데 필요한 정보가 이미 진단서 자체에 드러나게 하는 개선이 필요하다.

  • PDF

화병역학연구 자료를 기반으로 한 화병 환자의 특성 (The Characteristics of Hwa-byung Patients Based on Hwa-byung Epidemiologic Data)

  • 김종우;정선용;서현욱;정인철;이승기;김보경;김근우;이재혁;김낙형;김태헌;강형원;김세현
    • 동의신경정신과학회지
    • /
    • 제21권2호
    • /
    • pp.157-169
    • /
    • 2010
  • Objectives : The aim of this study was to investigate the characteristics of Hwa-Byung(HB) patients, draw the clinical key issue of HB, and provide the data as the basis for development of Clinical Guideline of HB. Methods : The study participants included 151 subjects who thought they have HB in 9 site. For all patients, we used HB epidemiologic study protocol, which include the Korean version of the Structured Clinical Interview for the DSM-IV Diagnosis (SCID-1), diagnostic criteria of HB, symptoms check list, pattern identification tool, psychiastric psychological questionaires, and Framingham coronary risk score(FRS). Results : 1. For all participants, 62 % of subjects were diagnosed with HB. These patients had comorbid DSM-IV diagnoses with depression (65%) and anxiety (27%). But 22% of these patients had only HB. 2. HB patients had various physical symptoms when visiting, were diagnosed as various disease, and undergone medical treatments in the past. Among the diagonsed illness, Gastronitestinal diseases (51.6%), psychiatric disorders(40.9%), endocrine diseases(39.8%) were being the most frequent. The frequent physical symptoms of HB patients reported were chest discomfort, head ache, pallpitation, frequent sigh, amnesia, shoulder pain, dry mouth, eye fatigue etc. 3. HB patients had high scores in psychologic questionares, CES-D, STAI, and STAXI. It means that HB patients might be low-level emotional stability. 4. Participant had negative opinion about the treatment of HB that it would be difficult or impossible (65.7%), but they neglect the need of medical treatment. Conclusions : This result shows that HB is comorbid with various psychiatric disease, but it has different physio-psychological symptoms from others and there were only HB patients. so we identify HB is independent disease. Moreover, there were the wrong perception of HB which blocking treatments. These problems support that the neccesity of development of Clinical Guideline of HB.

입원아동과 간호사가 지각한 돌봄에 대한 연구 (Hospitalized Children and Their Nurses각 Perception of Caring)

  • 김정선;김신정
    • 대한간호학회지
    • /
    • 제22권3호
    • /
    • pp.297-315
    • /
    • 1992
  • Caring has been identified as the essence and unifying domin of nursing(Leininger). Many nurses believe that the art of nursing is comprised of actions that are predominantly caring in nature. Although caring has been the traditional ideology of nurses, it is only now beginning to emerge as the central construct for the development of nut sing research, theory and practice. The problem addressed by this study was to identify how hospitalized children and their nurses express the meaning of caring, how they think nurses should care for children and to describe their experiences of being cared for. The purpose was to provide theoretical understanding of caring as perceived in Korea to contribute to the development of Korean nursing knowledge. The subjects were 76 hospitalized children admitted to pediatric units in five teaching hospitals and 66 nurses who were caring for these children. In this descriptive study, data were collected from Nov 11, 1991 to Jan 30, 1992 by interviews and an open-ended questionnaire and analysed by van Kaam's method. Caring themes perceived by the children and their nurses were classified into eight categories, -helping, comfort, love, warmth(only by children), recovery from illness, health maintenance (only by nurses), presence, nurturance and responsibility. Ideal caring behaviors perceived by the children and their nurses were six categories, -to give help, provide comfort, give love, stay with, treat warmly and aid recovery. Subcategories of giving help were promptness and competence, detailed explanations and support and encouragement. Other subcategories of giving help reported only by nurses were individualizing care, recognizing needs and providing a familiar enviornment. Subcategories of maintaining comfort were making comfortable, alleviating pain ; one subcategory reported only by children was consolating. A subcategory of giving love was concern, two subcategories reported only by nurses were compassion and respect. Subcategories of staying with were playing with and touching : only nurses reported empathy, Subcategories of treating warmly were tenderness and kindness. In the experience of caring, there were 4 categories, -to give help, stay with, show concern and provide comfort. Both the hospitalized children and their nurses had experienced caring primarily from their mothers. Mothers' caring behaviors were direct, personal, basic, supportive nursing acts. On the other hand, nurses caring behaviors were task oriented skilled procedures and medically delegated acts. This study contributes understanding of the complexity of caring, more specifically the meaning and experience of caring and ideal caring behaviors. Research may be able to move into verification when instruments are developed to measure the complexity of caring beliefs, values and behaviors in Korea and other cultural settings.

  • PDF

소아암 환아 부모의 스트레스와 삶의 질 (Perceived Stress and Quality of Life in the Parents of Children with Cancer)

  • 이상혁;김지은;유철주;변경민;최태규
    • 정신신체의학
    • /
    • 제11권2호
    • /
    • pp.159-169
    • /
    • 2003
  • 연구목적: 본 연구의 목적은 소아암 환아 부모와 일반 부모 사이의 스트레스와 삶의 질을 비교하는 데 있다. 방 법: 스트레스 인자지각는 전반적인 스트레스평가 척도(global assessment of recent stress)를, 스트레스 반응(정신병리)은 간이정신진단척도(Symptom checklist-90-revised)를 이용하였다. 대응전략은 대응척도를 이용하였으며, 삶의 질은 스미스클라인비참 삶의 질 척도를 이용하였다. 결 과: 소아암 환아 부모군은 대인관계, 관계의 변화, 질병 및 상해, 경제적 문제, 비일상적인 사건 등과 관련한 스트레스인자 지각점수가 대조군보다 각각 유의하게 더 높았다. 대응전략에서는 소아암 환아 부모군이 대조군보다 자기 통제, 긍정적 재평가 점수가 각각 유의하게 더 높았다. 정신병리에서는 소아암 환아 부모군이 대조군보다 불안, 우울, 신체화, 공격성 점수가 각각 유의하게 더 높았다. 삶의 질 척도 점수는 소아암 환아 부모군이 대조군보다 유의하게 더 낮았다. 급성 백혈병 환아 부모 사이의 비교에서 대응전략에서는 ANLL 환아 부모가 ALL 환아 부모보다 거리감두기, 책임수용 점수가 각각 유의하게 더 높았다. 정신병리에서 ANLL 환아부모가 ALL 환아 부모보다 우울 점수가 유의하게 더 높았다. 결 론: 소아암 환아 부모들이 높은 스트레스 지각과 낮은 삶의 질을 보고하고 있으므로 이에 대한 스트레스 관리프로그램 등 정신사회적 개입이 필요하다.

  • PDF

장애아 어머니의 불확실성, 사회적 지지 및 무력감 (Uncertainty, Social Support & Powerlessness in Mothers of Handicapped Children)

  • 박은숙;오원옥
    • Child Health Nursing Research
    • /
    • 제5권2호
    • /
    • pp.151-166
    • /
    • 1999
  • The purposes of this study were to measure the degree of perceived uncertainty, social support & powerlessness, to examine the relationship between the perceived uncertainty, social support & powerlessness and then to find the predictors of powerlessness in mother's of handicapped children. The subjects of this study consist of 102 mothers of handicapped children, registered at rehabilitation & handicapped children school. Data was collected from September 1998 to March 1999. The tools used in this study were Mishel's the Parents' Perception of Uncertainty Scale (28 item, 4 likert scale), Miller's Powerlessness measurement Scale(28 itewt 4 likert scale) & Cohen's Interpersonal Support Evaluation List (40 items, 4 likert scale). Data was analyzed by t-test, ANOVA, Duncan comparison, Pearson Correlation coefficient & Stepwise multiple regression Results of this study are summarized as follows : 1. Mothers perceived their uncertainty to be slightly high(Mn 2.50). The degree of perceived uncertainty by the four components were followed as : lack of clarity(2.69), unpredictability(2.56), ambiguity(2.56) & lack of information(2.46). The degree of perceived uncertainty of the mothers of handicapped children revealed to be influenced significantly by age of children, admission experience, disability types of children. 2. The degree of mothers' powerlessness was measured to be slightly high(Mn 2.14). The degree of perceived powerlessness of the mothers with handicapped children revealed to be influenced significantly by age of children, duration of illness admission experience,8E marital status of the mothers. 3. Mothers perceived their social support to be slightly high(Mn 2.71). The degree of perceived social support revealed to be influenced significantly by sex of children, married state of mothers. 4. Mothers' uncertainty was related positively to the mothers' powerlessness(r=.33, p=.0008). And also mothers' powerlessness was related inversely to social support(r=-.50, p=.0001). But, mothers' uncertainty was not related to social support significantly. 5. To analyze the variables which affect powerlessness, stepwise regression was implemented. As a result, about 61% of the powerlessness were explained by social support, marital status of the mothers and perceived uncertainty. Based upon these results, it is recommended that the nurses, who are caring handicapped children and their families, provide various support programs for them to overcome their difficulties. Also programs which decrease the uncertainty & powerlessness used social support multidimensionally & individually are recommended to be developed.

  • PDF

간호서비스 질에 대한 환자의 인식과 만족도 및 재방문의도와의 관계 (The Relationships among Patient's Perception, Patient's Satisfaction of Nursing Service Quality and Revisiting intention)

  • 이선아
    • 간호행정학회지
    • /
    • 제4권2호
    • /
    • pp.307-319
    • /
    • 1998
  • This study is an empirical investigation and study on the measurement of nursing service quality as perceived by patients. A series of H1. H2. H3 alternative hypotheses were tested using a sample of 250 patients in Taegu City. Korea. HI hypothese were tested for application of five component of service quality (SERVQlTAL and SE RPERF : tangiblity. reliability. responsiveness. accessibility. understandability) in Taegu area Hospitals. Validity test - the five components of service quality were rearranged into two components of service quality (personal factor. nonpersonal factor). Although SERVQUAL was verified in USA. application for five components of service quality in Korea indicated that it need more analytical studies. Nobody can deny the fact that the recent growth of the nursing service quality is one of the most important driving forces of hospital management. In many hospitals. the nursing quality charges more than 50% of the medical service quality. As a result. many hospital managers should be enormous interests in the investment potentiality of the nursing service. However. doesn't many researchers invest their time and effort on the research of the quality control in nursing service. Nursing service management is the process to satisfy customer's desires and expectations through the various service activities. Presently nursing service are being faced with three Common tasks of improving quality of nursing service. competitively differential advantage and productivity because of quantitative expansion of Nursing service. Such a phenomenon is also found in our medical service industry. resulting from increasing demands for medical service owing to national medical insurance policy and consumer's attitude change emphasizing prevention of illness. excessiveness of medical facilities in large cities and increasing medical lawsuits due to influence of consumerism. Therefore. under such circumstances. this research on nursing service is conducted from nursing managements to improve the nursing service quality problems faced by medical institutions. The results of this theoretical/empirical research are as follows: 1. Nursing service Quality is regarded as patients' perceived quality and evaluated on the basis (5 dimension) of technical and functional quality. 2. Nursing service Quality is a concept of patients evaluation on the measurable multi-dimensions intrinsic and extrinsic attributes of service. 3. Nursing service Quality is conceptually defined as the difference between the perceived service and the expected service. 4. Korean consumers trend to evaluate nursing service quality based on such dimensions as responsiveness and reliability. understandability. accessibility. tangibility. 5. After analyzing whether or not there are some differences in respective medical institution. it was found that there are significant difference on understandability. reliability. communicability. courtesy. competence. 6. After analyzing the difference between the expected nursing service and the nursing perceived service, it was found that the expected nursing service is higher than the perceived service in every medical institution. 7. HI hypothesis was tested with regard to the validity test between SERVQUAL and SERVPERF in nursing service quality. The result of validity test between SERVQUAL and SERVPERF was found to have differential result. That is the R2 of SERVPERF is higher than that of SERVQUAL. Therefore. HI was verified in nursing management. H2. H3 hypotheses were tested whether or not the nursing service quality and patient satisfaction is the preceding variable. The result of H2 hypothes is that the nursing service quality is the preceding variable of patient satisfaction and the patient satisfaction is that of revisiting intention. After analyzing whether or not there is any differences on the demographic variable of five nursing service quality factor. it was found that there are statistically significant differences on communicability and courtesy at the sex. understand ability. accessibility and tangibility at the age. understandability at the academic background respectively.

  • PDF

한방간호접근을 위한 이론적 고찰 (A Literature Review for Approach of Oriental Nursing)

  • 강현숙
    • 대한간호학회지
    • /
    • 제23권1호
    • /
    • pp.118-129
    • /
    • 1993
  • In order to approach the nursing care of clients who are using oriental medicine and to understand the perception of the client who uses oriental medicine practices and the need to develop a model of nursing related to oriental medicine it is important to examine the major nursing concepts as they are found in oriental medicine and as they are differently defined according to the basic thought, theory and philosophical perspectives between East and West. Oriental medicine developed based on Sung Confucianism the teachings of Chut-zu, especially Tai-Chi-Tu Shuo and energy thought which are similar to traditional Korean Sasang Constitutional medicine. The basic theory on which oriental medicine is build is the theory of the five elements of Yin / Eum-Yang Theory(cosmic dual forces) and Meridian Theory. The most important attribute of Yin Yang is the concept of duality, confrontation and dependence, within Yin Yang but which do not exist separately. That is, the universe is a vast, indivisible entity within which all things exist in harmonious interdependence and balance. Harmony is achieved only when the two primorial forces, Yin and Yang, are brought into perfect balance. Each is contained within the other and there is a continuing interchange between the two. This also applies to the human body including human health which is defined as balanced harmony. The most universal connection of Yin and Yang is found in the universe where the five elements of life, fire, water, earth, wood and metal can be explained as having either Yin or Yang and therefore being in a state of connectedness but systematically circulating between the two, that is essentalilly one (the control of the unified ) or as coexistant poles of individual wholes (the pluralism of Yin Yang Theory) so that it is all unified(balanced) in the Great Absoulte. Human beings also maintain a balance of Yin and Yang in the five elements and this relationship is very important in approaching ·oriental medicine, The meridians are the channels in the body through which the life force flow throughout the body. In oriental medicine the meridians are seen as the railroad, the acupuncture points on the meridians as the stations and energy as the train. In the normal healthy organism, all are maintained in balance and in a contiuous circulation of energy. illness is the result of the energy flow becoming disarranged. Although practitioners of oriental medicine approach the client differently than do practitioners of Western medicine and their method of examining the patient is different, the basic objectives of the examination are the same for practitioners of both types of medicine. Therefore if each could be used to supplement the defiencies in the other and achieve a harmonious cooperation between the two, a higher level of care which is culturally appropriate to korean culture could be achieved. The traditional korean concept of health is a naturalistic view which emphasizes being in harmony with nature. Any manifestation of disease is considered a sign that the body is in a state of disequilibrium and is thus no longer in harmony with the universe. The wholistic view of the world held by practitioners of oriental medicine can be used by nursing in the development of a world view of nursing in which the human being is seen within the macrocosm as part of the natural phenomenon of the universe and but also as a microcosm of the universe, a universe which is a vast and indivisible entity within which all things exist in harmonious interdependence and balance. Interaction between human beings and their environment and the relationship of this interaction to health are concepts that are also found in nursing. Nursing views human brings, not as an accumulation of separate cells and organs but, as unified wholes interacted in very close relationship nth their environment. Nursing also maintains a view of human beings in which emphasis is placed on the role of the mind in explaining the concepts of harmony and balance in health. Although there are differences between oriental medicine and nursing in approaches to clients, the basic point of view and philosophy have many fundamental similarites. An understanding of the basic thought and philosophy of oriental medicine if applied to nursing, would allow for the development, not only of nursing related to oriental medicine, but of a nursing theory appropriate to the korean context.

  • PDF

한국문화에 따른 간호정립을 위한 기초조사연구 III -의료관을 중심으로- (A Study of the Construction of Nursing Theory in Korean Culture - View of Medicine-)

  • 박정숙;오윤정
    • 지역사회간호학회지
    • /
    • 제9권1호
    • /
    • pp.143-162
    • /
    • 1998
  • This is a study for the construction of nursing care based upon the Korean attitude toward medicine. Factors which were investigated include the source of nursing care, the reason for choosing care, the type of heath care chosen, the accessability of caregivers, and the desired location of death. The population examined in this study consisted of 517 adults distributed in six large cities and 191 adults from five rural communities. Data was analyzed using frequency, percent, Cronbach alpha, $X^2$ - test, t - test, F - test and scheffe post hoc contrast with an SAS program. The results of this study are summarized as follows: 1. Among sources of nursing care used, first rank rated-pharmacy(54.4), private hospital(18.2), general hospital(8.4), folk remedies in house (5.0), chinese hospital(2.8), prayer(2.8) and others(8.4), and the reasons for choosing nursing care rated 'the easiest method' (63.6), 'the best method'(15.7), 'reliable'(10.8) and 'lower cost burden'(4.6) in order of preference. 2. The type of nursing care chosen rated western medicine(6.80), chinese medicine(6.15), folk remedies(5.46), faith remedies(3.51) and divination remedies (1.41). There were significant differences in the effect recognition degree to various kinds of medicine. 3. The difference of the type of nursing care chosen according to general characteristics showed that urban residents were higher than rural community residents(t=2.15, p=0.0320) in western medicine, and urban residents, women, and singles were higher than rural community residents(t=2.04, p=0.0414), men (t= -2.89, p=0.0039), and married(t=2.50, p= 0.0126) on folk remedies. With repect to age and education those 21-30, under 20 and 31-40, graduated from college and graduate school were higher than above 51, above 61 (F = 7.76, p = 0.0001), graduated from elementary school(F=4.39, p=0.0006) on folk remedies. In other categories, rural community residents, women, younger people. Christians were higher than urban residents ( t = -2.73, p=0.0305), men(t= -4.15, p=0.0001), older people (F=2.48, p=0.0307), Catholic, Buddhist, or atheist (F= 70.18, p=0.0001) on faith remedies. Those graduated from high school and Buddhist were higher than unschooled, graduated from middle school(F=3.18, p= 0.0075), atheist, Catholic or Christian(F=18.32, p=0.0001) on divination redemies. There were significant differences concerning age and education level. 4. The accessibility of caregivers rated 'caregivers should be nearby if the patients need them' (50.0), 'caregivers must be there all day (24 hours)' (39.6), 'caregivers must be there at night only'(5.0), 'caregivers must be there during the day only'(2.6), 'caregivers always should visit during visiting hours' 0.4), 'caregivers don't need to be there at all' (1.2). The frist rank of suitable caregivers were rated as spouse(66.6), mother(24.2), daughter (3.6), daughter-in-law(1.9), and the reasons of thinking thus were rated as 'the most comfortable' (81.5), 'people should correctly with regards to family they'(7.1), 'the easiest' (5.4), 'take good care of the patient' (5.1) and 'lower cost burden' (0.4). 5. The desired location of death rated as the following: his/her house (91. 6) to the hospital(8. 4). A person going to encounter death in the hospital wanted his house(78.5) over the hospital(21.5), and a person dieing in the hospital prefered his house(52.9) over the hospital(47.1) as a funeral ceremony place. The following suggestions are made based on the above results. 1. A sampling method that enhances the re presentativeness should be used in regional and/or national related research and replicated to confirm the result of this study. 2. This study should be used to understand the Korean view of medical centers and to meet the expectations of patients in Korean nursing. 3. Research on the Korean traditional view of humans and expectations of the sick, health and illness, and health behavior, the perception of dying, the decision to heal, and the view of general medicine should continue to be conducted continuosly so that Korean nursing theory can be advanced on these concepts.

  • PDF

서울시 일 지역 주민의 인생회고 및 죽음준비 인식 (Community Dwellers' Perception of Past Life Recollection and Preparation for Death)

  • 강경아;이경순;박강원;김용호;장미자;이은
    • Journal of Hospice and Palliative Care
    • /
    • 제14권2호
    • /
    • pp.81-90
    • /
    • 2011
  • 목적: 본 연구는 서울시 노원구 주민을 대상으로 자신의 인생회고 및 품위 있는 죽음에 대한 인식 정도를 파악하고자 수행되었다. 방법: 본 연구는 서울시 노원구에 거주하는 40대 이상 성인을 대상으로 설문에 참여할 것을 서면 동의한 160명의 자료가 분석되었다. 본 연구팀에 의해 개발된 설문지는 내용타당도 검증절차를 통해 일부 문항이 수정되었으며, 설문내용은 총 28문항이었다. 수집된 자료는 서술적 통계방법을 이용하여 분석하였다. 결과: 대상자들이 가장 힘들었다고 회고하는 연령대는 30~40대였고 반면 가장 보람되었다고 생각하는 기간도 30~40대였다. 가장 힘든 인생고비경험에서, 개인적으로는 가족이 건강을 잃었을 때, 부부 및 자녀와의 갈등이 가장 힘들었던 사건으로 회고하고 있었고, 가장 힘들었던 사회관계는 삶에 대한 상실감 경험, 실패, 친척 및 친구의 배신 등 이었으며, 가장 보람되었다고 회고하는 내용에서, 개인적 사건은 목표성취, 인생의 역경 극복이었고, 가족관계에서는 자녀로 인한 즐거움이 월등히 높았고, 사회관계에서는 직업을 통한 사회공헌, 봉사활동, 성실한 종교생활이었다. 가장 후회하는 삶의 경험에는, 자신의 삶에서는 목적 없이 바쁘게만 살아온 것, 여유 있는 시간을 갖지 못한 것이었고, 부모형제관계에서는 부모의 뜻을 잘 살피지 못하고 많은 시간을 갖지 못한 것과 형제들과 불화이었으며, 자녀와의 관계에서는 올바로 훈육하지 못한 것과, 사랑을 많이 주지 못한 것이었다. 직장 및 사회관계에서는 원하는 직업을 갖지 못한 것과 관계보다는 일 중심으로 살아온 것과 대인관계 기술부족이 두드러진 회고내용이었으며 건강에 관해서는 운동이 부족한 점 등이었다. 대상자들이 인식하고 있는 임종과 죽음준비에 대한 내용으로, 약 60%에서 자신의 종교에 대한 강한 믿음을 가지고 있었고, 약 50%에서 종교에 따른 내세관을 소유하고 있었다. 무의미한 연명치료로 생명을 연장하는 상황에 처했을 경우, 약 87% 이상에서 본인 및 가족의 경우 모두 무의미한 연명치료 중단 의사를 가지고 있었으며, 불치의 질병인 경우 진단을 정확히 말해주기 원함, 유언장 및 사전의료의향서 작성하기 원함이 4점 척도 중 약 3.1점 이상으로 높게 나타났다. 결론: 본 연구결과를 토대로 중 노년층을 위한 죽음 준비교육 내용 중 인생회고 시간에서는 과거의 경험을 후회하는 사건이 아닌 일어난 사실 그대로 받아들이며 자신의 삶으로 통합하도록 돕는 기회가 주어져야 하며, 사전의료의향서를 작성함으로 연명치료 중단, 심폐소생술 금지, 임종 장소 등 자기결정권이 부여되는 품위 있는 죽음을 준비할 수 있도록 하는 수요자 중심의 죽음 준비교육을 제공해야 하겠다.

유가 공부론과 명상 - 퇴계 활인심방(活人心方)을 응용한 수양치료 모형 - (Confucian Cultivation of Mind and Meditation - The Care Model of Cultivation Applied by Toe-gye' 『The Method on Preservation of Human mind (活人心方)』)

  • 이연도
    • 한국철학논집
    • /
    • 제28호
    • /
    • pp.363-386
    • /
    • 2010
  • 이 논문은 유가 공부론과 명상의 관계에 대해 살펴본 것이다. 최근 우리 사회에는 마음의 병에 대한 관심이 높아지고 있다. 흔히 세계관과 인생관, 가치관에 대한 왜곡된 인식에서 비롯된 마음의 병은 정신의학적 방법으로 치료될 수 없다는 점에서 신경정신과적 질병과는 구분된다. 철학을 비롯하여 문학, 예술 등 다양한 인문학을 활용한 대체치료가 주목받고 있는 것도 이러한 이유에서이다. 명상 또한 이들 가운데 하나이다. '명상'은 흔히 불교에서 발전해 온 것으로 생각되지만, 유학과도 밀접한 연관성을 가지고 있다. 불교의 명상은 현실의 삶을 부정하지만, 유가의 명상 철학은 현실과 자아를 인정하는 데서 출발하고 있다. 또한 유가의 수양론과 명상 철학은 방법론적으로 중요한 의미를 지니고 있다. 일반적으로 진행되는 정신치료나 심리치료는 그 방법이 대개 대화를 통해 이루어진다. '대화치료(talking cure)'는 내담자 스스로 자신의 현 상황을 인지하고, 그 문제를 스스로 발견하는 것을 전제로 한다. 일반적으로 현재 인문학을 응용한 치료가 대상으로 삼고 있는 교정기관이나 군부대와 같은 특수기관 수용자에게는 사용하기에도 적합한 방법이 아니다. 이 점에서 '마음 다스리기'를 강조한 유가의 공부론과 명상법은 응용할 만한 충분한 가치가 있어 보인다. 여기에서는 유가 공부론과 명상의 관계가 이론적으로 어떤 관계인가를 살펴보고, 퇴계의 『활인심방』을 응용하여 인문치료의 한 모형을 제시하였다. 동양의 수양론이 '마음의 병'에 대해 의미있는 이론을 제시하고 있긴 하지만, 이를 구체적으로 현장에서 응용하기란 쉬운 일이 아니다. 이는 수양론 자체가 일생을 두고 수행해야 할 지침이며, 그 성격상 일시적인 수행이나 실습을 통한 효과를 기대하기 어렵기 때문이다. 여기에서 제시하는 수양 치료 모형은 이러한 한계를 전제로 한 것으로, 인문치료의 한국적 모형 개발이라는 목적에 따른 시도이다.