사별가족모임과 관련된 사별가족 태도 연구 (The Attitude of the Bereaved Family Attending a Bereavement Memorial Service)
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- Journal of Hospice and Palliative Care
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- 제8권2호
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- pp.143-151
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- 2005
목적: 가톨릭대학교 성빈센트병원 호스피스팀에서는 사별가족들에 대한 지지로서 해마다 사별가족모임 및 추모제를 실시해왔다. 호스피스 환자 및 사별가족의 어려움, 욕구, 대처양상, 품위 있는 임종에 대한 견해에 대해서는 선행연구가 진행되어 왔으나, 사별가족모임에 참석한 가족들의 태도에 대한 선행연구는 찾기가 어려웠다. 최근 1년 이내에 사별 경험이 있는 가족을 중심으로 견해조사를 실시하면서, 향후 사별가족지지프로그램에 대한 욕구와 보완점 파악, 객관적 기준을 마련하기 위해 본 연구를 시작하였다. 방법: 2003년 11월부터 2004년 10월까지 12개월 동안 성빈센트병원 호스피스 병동에서 임종한 사별가족 180가족들에게 초대장을 발송하였고, 사별가족모임에 참석한 22가족에게 설문지 조사하였고, 전화연결된 가족 18가족에 대해서는 연구자 1인이 전화설문을 시행하였다. 설문지는 일반적인 사항을 제하고는 개방형 질문으로 조사하였다. 결과: 총 응답자의 평균연령은 56세(
본고에서는 1795년 화성 행궁에서 정조의 어머니 혜경궁 홍씨의 회갑을 맞아 열린 봉수당진찬의 의례와 악무를 "원행을묘정리의궤(園行乙卯整理儀軌)" 및 "정조실록", "홍재전서(弘齋全書)"등의 봉수당진찬 의례기록과 <화성능행도병>등의 도상자료, 일기체의 한글가사 작품인 이희평(李羲平)의 <화성일기(華城日記)>등의 자료를 중심으로 분석하여 무대와 공연요소 중심으로 고찰하였다. 잔치의 주인공에게 충(忠)과 효(孝)의 의미를 담은 음악과 춤, 꽃과 음식, 술과 글을 예를 갖춰 올리는 궁중연향은 예악(禮樂)의 원리에 바탕을 둔 국가의례로서 조선왕조 500년 동안 고유한 음악문화를 형성해왔다. 그러나 조선왕조가 막을 내리면서 '예'라는 상징적이며 총체적인 틀 안에서 상호 유기적인 관계에 놓여있던 연례의 음악과 춤들이 개별 악곡과 춤으로 해체되어 '작품화'되었고. 궁중음악과 춤의 철학이나 원리, 시공간에 대한 이해는 현저히 축소된 채, 음악과 춤의 전통은 형식과 예술적 표현 중심으로 변화해왔다. 1990년대 이후, 궁중의례 전통의 재현(再現)을 목적에 둔 연구와 행사가 추진되면서, 이와 연관된 공연예술 활동도 점차 증가하고 있는 추세이며, 특히 봉수당진찬은 다양한 방식으로 현대무대화 하고 있다. 그러나 원전(原典)의 재현(再現) 및 복원(復原) 문제, 완성도 및 예술성에 대한 문제는 과제로 남아있으며, 지금까지는 "원행을묘정리의궤"에 수록된 의주의 외형적 재현에 관심을 두었을 뿐, 무대조건이나 공연요소에 중점을 둔 심도있는 분석은 부족하였다고 판단하였다. 이에 본 연구에서 무대구성과 공연요소 중심으로 분석해 본 결과, 조선시대 궁중연향 중에서 유일하게 '행궁'에서 개최된 봉수당진찬은 '예악의 정치'를 의례와 악무로 구현하는 궁중연향의 기본적인 면모를 보여주면서도 '군신동락(君臣同樂)'의 친화의 비중이 높은 연향이었음을 밝혔다. 내연과 외연의 성격이 섞인 봉수당진찬에서는 가림막을 최소화하여 신분의 차서(次序)와 남녀유별(男女有別)의 원리를 충족시키면서도 삼면에 둘러친 휘장 안에 외빈의 자리를 마련함으로써 술과 음식, 음악과 춤을 다 같이 공유하도록 배치되었다. 또한, 연향공간의 상징성을 내포한 차일을 백관들의 공간에 치고, 임금이 솔선하여 선찬(膳饌)과 산화(散華)를 명함으로써 군신동연(君臣同宴)의 의미와 범위를 확장시킨 점을 알 수 있었다. 이는 봉수당진찬이 '예악의 원리'가 강하게 드러나는 여느 궁중 연향에 비해 '정(情)'을 나누는 화친(和親)에 기반을 두었음을 알 수 있었다. 또한, 봉수당진찬에서는 여느 내연에서보다 임금의 역할과 비중이 높았으며, 특히 의주 외의 기록으로 전하는 여러 가지 상황 - 7작 이후에 정조가 신하들을 가까이 불러 나눈 대화, 신하들에게 음식과 꽃을 내림, 잔치를 주제로 직접 시를 짓고, 신하들에게도 이에 화답하게 한 일 등-은 의주에 따른 단선적인 연향의 진행에 변화를 주고, 연향의 의미를 확장시키는데 한 몫 하였다. 이밖에, 봉수당진찬의 주악과 정재의 구성을 분석해 본결과 연향에서 여러 인물들의 대화와 움직임이 매우 절제된 것은 여느 궁중연향과 비슷하지만, 춤과 음악을 통해 구현된 소리와 색채감은 매우 다채로웠다는 점을 알 수 있었다. 봉수당진찬에서는 정조 이전에 치러진 내연에 비해 다양한 종류의 정재를 상연하였고, 이 중에는 새롭게 초연된 레퍼토리도 있었으며, 또 기존의 공연을 새롭게 재구성한 것도 포함되어 있었다. 특히 <선유락>이나 <검무> 등, 지방 관아 및 민간의 레퍼토리를 궁중연향으로 수용한 점, 풍류방에서 즐겨 연주되기 시작한 생황을 <학무> 와 연계한 것은 전통적인 규범과 관습에 매이지 않고 새로운 것을 받아들이는 궁중연향의 '열린구조'를 보여준다는 점에서 시사하는 바가 크다.
Much has teed changed in the field of hospital administration in the It wake of the rapid development of sciences, techniques ana systematic hospital management. However, we still have a long way to go in organization, in the quality of hospital employees and hospital equipment and facilities, and in financial support in order to achieve proper hospital management. The above factors greatly effect the ability of hospitals to fulfill their obligation in patient care and nursing services. The purpose of this study is to determine the optimal methods of standardization and quality nursing so as to improve present nursing services through investigations and analyses of various problems concerning nursing administration. This study has been undertaken during the six month period from October 1971 to March 1972. The 41 comprehensive hospitals have been selected iron amongst the 139 in the whole country. These have been categorized according-to the specific purposes of their establishment, such as 7 university hospitals, 18 national or public hospitals, 12 religious hospitals and 4 enterprise ones. The following conclusions have been acquired thus far from information obtained through interviews with nursing directors who are in charge of the nursing administration in each hospital, and further investigations concerning the purposes of establishment, the organization, personnel arrangements, working conditions, practices of service, and budgets of the nursing service department. 1. The nursing administration along with its activities in this country has been uncritical1y adopted from that of the developed countries. It is necessary for us to re-establish a new medical and nursing system which is adequate for our social environments through continuous study and research. 2. The survey shows that the 7 university hospitals were chiefly concerned with education, medical care and research; the 18 national or public hospitals with medical care, public health and charity work; the 2 religious hospitals with medical care, charity and missionary works; and the 4 enterprise hospitals with public health, medical care and charity works. In general, the main purposes of the hospitals were those of charity organizations in the pursuit of medical care, education and public benefits. 3. The survey shows that in general hospital facilities rate 64 per cent and medical care 60 per-cent against a 100 per cent optimum basis in accordance with the medical treatment law and approved criteria for training hospitals. In these respects, university hospitals have achieved the highest standards, followed by religious ones, enterprise ones, and national or public ones in that order. 4. The ages of nursing directors range from 30 to 50. The level of education achieved by most of the directors is that of graduation from a nursing technical high school and a three year nursing junior college; a very few have graduated from college or have taken graduate courses. 5. As for the career tenure of nurses in the hospitals: one-third of the nurses, or 38 per cent, have worked less than one year; those in the category of one year to two represent 24 pet cent. This means that a total of 62 per cent of the career nurses have been practicing their profession for less than two years. Career nurses with over 5 years experience number only 16 per cent: therefore the efficiency of nursing services has been rated very low. 6. As for the standard of education of the nurses: 62 per cent of them have taken a three year course of nursing in junior colleges, and 22 per cent in nursing technical high schools. College graduate nurses come up to only 15 per cent; and those with graduate course only 0.4 per cent. This indicates that most of the nurses are front nursing technical high schools and three year nursing junior colleges. Accordingly, it is advisable that nursing services be divided according to their functions, such as professional, technical nurses and nurse's aides. 7. The survey also shows that the purpose of nursing service administration in the hospitals has been regulated in writing in 74 per cent of the hospitals and not regulated in writing in 26 per cent of the hospitals. The general purposes of nursing are as follows: patient care, assistance in medical care and education. The main purpose of these nursing services is to establish proper operational and personnel management which focus on in-service education. 8. The nursing service departments belong to the medical departments in almost 60 per cent of the hospitals. Even though the nursing service department is formally separated, about 24 per cent of the hospitals regard it as a functional unit in the medical department. Only 5 per cent of the hospitals keep the department as a separate one. To the contrary, approximately 12 per cent of the hospitals have not established a nursing service department at all but surbodinate it to the other department. In this respect, it is required that a new hospital organization be made to acknowledge the independent function of the nursing department. In 76 per cent of the hospitals they have advisory committees under the nursing department, such as a dormitory self·regulating committee, an in-service education committee and a nursing procedure and policy committee. 9. Personnel arrangement and working conditions of nurses 1) The ratio of nurses to patients is as follows: In university hospitals, 1 to 2.9 for hospitalized patients and 1 to 4.0 for out-patients; in religious hospitals, 1 to 2.3 for hospitalized patients and 1 to 5.4 for out-patients. Grouped together this indicates that one nurse covers 2.2 hospitalized patients and 4.3 out-patients on a daily basis. The current medical treatment law stipulates that one nurse should care for 2.5 hospitalized patients or 30.0 out-patients. Therefore the statistics indicate that nursing services are being peformed with an insufficient number of nurses to cover out-patients. The current law concerns the minimum number of nurses and disregards the required number of nurses for operation rooms, recovery rooms, delivery rooms, new-born baby rooms, central supply rooms and emergency rooms. Accordingly, tile medical treatment law has been requested to be amended. 2) The ratio of doctors to nurses: In university hospitals, the ratio is 1 to 1.1; in national of public hospitals, 1 to 0.8; in religious hospitals 1 to 0.5; and in private hospitals 1 to 0.7. The average ratio is 1 to 0.8; generally the ideal ratio is 3 to 1. Since the number of doctors working in hospitals has been recently increasing, the nursing services have consequently teen overloaded, sacrificing the services to the patients. 3) The ratio of nurses to clerical staff is 1 to 0.4. However, the ideal ratio is 5 to 1, that is, 1 to 0.2. This means that clerical personnel far outnumber the nursing staff. 4) The ratio of nurses to nurse's-aides; The average 2.5 to 1 indicates that most of the nursing service are delegated to nurse's-aides owing to the shortage of registered nurses. This is the main cause of the deterioration in the quality of nursing services. It is a real problem in the guest for better nursing services that certain hospitals employ a disproportionate number of nurse's-aides in order to meet financial requirements. 5) As for the working conditions, most of hospitals employ a three-shift day with 8 hours of duty each. However, certain hospitals still use two shifts a day. 6) As for the working environment, most of the hospitals lack welfare and hygienic facilities. 7) The salary basis is the highest in the private university hospitals, with enterprise hospitals next and religious hospitals and national or public ones lowest. 8) Method of employment is made through paper screening, and further that the appointment of nurses is conditional upon the favorable opinion of the nursing directors. 9) The unemployment ratio for one year in 1971 averaged 29 per cent. The reasons for unemployment indicate that the highest is because of marriage up to 40 per cent, and next is because of overseas employment. This high unemployment ratio further causes the deterioration of efficiency in nursing services and supplementary activities. The hospital authorities concerned should take this matter into a jeep consideration in order to reduce unemployment. 10) The importance of in-service education is well recognized and established. 1% has been noted that on the-job nurses. training has been most active, with nursing directors taking charge of the orientation programs of newly employed nurses. However, it is most necessary that a comprehensive study be made of instructors, contents and methods of education with a separate section for in-service education. 10. Nursing services'activities 1) Division of services and job descriptions are urgently required. 81 per rent of the hospitals keep written regulations of services in accordance with nursing service manuals. 19 per cent of the hospitals do not keep written regulations. Most of hospitals delegate to the nursing directors or certain supervisors the power of stipulating service regulations. In 21 per cent of the total hospitals they have policy committees, standardization committees and advisory committees to proceed with the stipulation of regulations. 2) Approximately 81 per cent of the hospitals have service channels in which directors, supervisors, head nurses and staff nurses perform their appropriate services according to the service plans and make up the service reports. In approximately 19 per cent of the hospitals the staff perform their nursing services without utilizing the above channels. 3) In the performance of nursing services, a ward manual is considered the most important one to be utilized in about 32 percent of hospitals. 25 per cent of hospitals indicate they use a kardex; 17 per cent use ward-rounding, and others take advantage of work sheets or coordination with other departments through conferences. 4) In about 78 per cent of hospitals they have records which indicate the status of personnel, and in 22 per cent they have not. 5) It has been advised that morale among nurses may be increased, ensuring more efficient services, by their being able to exchange opinions and views with each other. 6) The satisfactory performance of nursing services rely on the following factors to the degree indicated: approximately 32 per cent to the systematic nursing activities and services; 27 per cent to the head nurses ability for nursing diagnosis; 22 per cent to an effective supervisory system; 16 per cent to the hospital facilities and proper supply, and 3 per cent to effective in·service education. This means that nurses, supervisors, head nurses and directors play the most important roles in the performance of nursing services. 11. About 87 per cent of the hospitals do not have separate budgets for their nursing departments, and only 13 per cent of the hospitals have separate budgets. It is recommended that the planning and execution of the nursing administration be delegated to the pertinent administrators in order to bring about improved proved performances and activities in nursing services.