사회적 지지모임이 뇌·척수손상환자를 돌보는 가족의 부담감과 삶의 질에 미치는 효과

Abstract

[한글]

사회가 복잡해짐에 따라 각종 사고 등으로 인하여 뇌·척수손상환자를 포함한 만성질환자가 날로 증가하는 추세에 있다. 뇌·척수손상환자는 인지나 활동의 장애가 있으므로 환자를 돌보는 가족 누군가가 필요하다. 따라서 뇌·척수손상 환자와 같은 만성질환자를 돌

보는 가족은 많은 문제를 경험하며 그 대표적인 현상이 부담감이다. 부담감의 축적은 질적인 삶을 저해하므로 간호사는 부담감을 줄여주는 간호전략은 개발하여 가족의 안녕한 삶을 도와줘야 한다. 건강에 유용한 개념인 사회적 지지가 부담감을 감소시키는 유용한 방법으로 권장된다. 부담감과 같은 주관적이고 심리적인 문제해결은 사회적 지지 중에서도 특히 전문가나 동료 모임을 통한 그룹지지가 더 효과적이다.

본 연구는 뇌·척수손상환자를 돌보는 가족의 부담을 낮추고 삶의 질을 증진시키는데 사회적 지지모임이 효과가 있는지 그 효과를 확인하기 위하여 실시된 단일군 사전-사후검사 원시실험 설계이다.

연구의 이론적 기틀은 McCubbin과 McCubbin(1987)의 가족 스트레스 이론의 적응모델과 사회적 지지이론의 주효과 모형을 기초로 도출하였다. 뇌·척수손상환자를 돌보는 가족의 부담감에 영향을 미치는 선행변인들은 가족 스트레스 이론으로, 사회적 지지모임이 가족의 부담감과 삶의 질에 미치는 관계는 사회적 지지이론의 주효과 모형으로 설명하였다.

연구장소는 서울시내 군병원과 보훈병원 회의실과 물리치료실이였고, 사전에 협조하여 타인의 출입과 사용을 금하였다.

연구기간은 1992년 6뭘 1일부터 8월 28일까지였고, 편의추출에 의하여 뇌·척수손상환자를 돌보는 가족 44명을 최종 대상자로 하였다.

연구 절차는 사전 면접조사를 실시하고, 실험처치인 사회적 지지모임을 가졌다. 사회적 지지모임은 연구자가 촉진자의 역할을 하고 가족 중 리더가 인도자의 역할을 하였다. 모임의 그룹은 전부 5개로, 1개 그룹의 인원은 연구자와 8명에서 10명정도의 뇌·척수손상

환자를 돌보는 가족이었다. 모임의기간은 총 5주간 매 주 1회, 1회에 약 1시간 30분 정도가 소요되었다. 모임이 완전히 끝난 후 사후 면접조사를 하였다.

연구도구는 사회적 지지모임을 독립변인으로 하였고, 부담감과 삶의 질의 종속변인은 오가실(1992)의 부담감 측정도구와 Andrews(1976)의 삶의 질 도구를 연구자가 수정하여 사용하였다. 부담감에 영향을 미치는 선행변인들은 오가실(1984)이 번역한 Norbeck(1981)

의 사회적 지지측정 도구, Lawton(1972b)의 사기척도, 오가실(1992)의 가족의 건강상태 측정도구, Smilkstein(1978)의 가족관계기능도구와 연구자가 작성한 가족의 환자의미 인지도도구를 사용하였다.

자료분석은 SPSS를 이용하여 분석하였으며, 분석방법은 연구가설인 사회적 지지모임을 갖기 전과 가진 후 뇌·척수손상환자를 돌보는 가족의 부담감과 삶의 질 차이분석은 Paired t-test로 하였고, 가족의 부담감과 삶의 질에 영향을 미치는 예측변인은 Multiple reg ression으로 분석하였다. 가족과 뇌·척수손상환자의 일반적 특성에 따른 부담감과 삶의 질 차이분석은 Kruskal-Wallis one way ANOVA로 분석하였다. 그리고 사회적 지지모임이 형성되는 과정과 내용분석을 하였다.

연구결과는 다음과 같다.

1. 사회적 지지모임의 효과에 대한 가설검정은 모두 지지되었다.

가. 제 1가설 : "뇌·척수손상 환자를 주로 돌보는 가족의 부담감은 사회적 지지모임에 참여하기 전과 참여한 후에 차이가 있을 것이다"는 지지되었다(t=5.76, P<.001).

나. 제 2가설 : "뇌·척수손상환자를 주로 돌보는 가족의 삶의 질은 사회적 지지모임에 참여하기 전과 참여한 후에 차이가 있을 것이다"는 지지되었다(t=-4.83. P<.001).

2. 뇌·척수손상환자 가족의 부담감을 예측하는 선행변인은 가족의 건강상태와 가족의 관계기능이었고, 삶의 질을 예측하는 예측변인은 가족의 관계기능, 환자를 돌보는 가족의 어려움 및 가족의 교육정도였다.

3. 대상자의 일반특성에 따른 가족의 부담감과 삶의 질의 차이는 특성 모두에서 차이가 없었다.

4. 뇌·척수손상환자 가족의 부담감과 삶의 질은 유의하게 중정도의 역상관 관계가 있었다(r=- 44, P<.01).

5. 사회적 지지모임의 과정은 횟수가 진행됨에 따라 자조모임으로 형성되는 특성을 보였다.

이상의 연구 결과를 종합해 볼 때, 사회적 지지모임은 뇌·척수손상환자를 돌보는 가족의 부담감을 감소시키고, 삶의 질을 증진시키는 데 효과적인 방법임을 알 수 있다. 이 결과는 사회적 지지가 직접적으로 건강 증진에 유익하다는 주효과 모형의 주장을 지지하여 주었다. 그리고 사회적 지지모임이 잘 이루어지기 전에는 전문간호사가 촉진자의 역할을 하여 모임을 잘 구성한다면 자조모임으로 형성될 가능성이 높다고 본다.

따라서 간호사는 뇌·척수손상환자와 같은 만성질환자를 돌보는 가족은 부담감 등의 문제를 안고 생활하고 있음을 이해하고, 사회적 지지모임을 구성하여 촉진자의 역할을 함으로써 부담감을 완화시키고 삶의 질을 증진시키도록 해야 한다. 또한 가족 스스로의 자조

모임을 형성하도록 돕는 촉진자 역할도 해야 할 것이다.

The Effect of a Caregiver Social Support Group on Burden and Quality of life on

Family Primary Caregivers with Brain and Spinal Cord lnjuries.

Jeong, Chu-Ja

Department of Nursing The Graduate School of Yonsei University

(Directed by Professor Choi, Yun-Soon, Ed.D.)

The number of chronically disabled people has increased with the increase in

traffic and other accidents in today's complicated social life. Patients who are

chronically disabled are dependent on family primary caregivers over a long term.

Thus, the family carries substantial burden and a decrease in wellbeing related to

caring for a patient who is disabled. But this problem is generally not noticed in

our society because it is taken for granted that family members will care for

chronically ill patients.

A major part of the nurse's role should be helping these caregivers develop

nursing interventions which would minimize their burden.

Social support is widely posited as a valuable resource for individual wellbeing.

An important and useful method to reduce the burden of the caregiver is social

support, especially group social support. Thus social support groups are being used

with increasing frequency to help caregivers cope with the burden of caregiving.

This study was conducted to determine if a difference existed in burden and

quality of life before participation in a caregiver social support group and after

.

The study design was a pre-post test pre-experimental design for the purpose of

testing the effect of a caregiver social support group on the burden and quality of

life of family primary caregivers of patients with brain and spinal cord injuries.

The caregiver social support group as the experimental treatment was carried out

with five subgroups over a five weed period. Each subgroup consisted of 8-10

primary caregiver members which met as a social support group, weekly, for one and

half hour over the five week period. Caregiver social support was initiated by the

researcher and led by a peer member.

The theoretical framework for this study was derived from the family stress

theory by McCubbin and McCubbin(1987) and the main effect model of social support

theory.

The sample consisted of 44 family members who were identified as the family

primary caregivers for the patients with brain and spinal cord injuries.

The period of data collection was from June 1, 1992 to August 28,1992.

Data of pretest and posttest were collected through an interview using a

structured questionnaire .

The instruments used in this study were Burden Scale, Quality of life Scale,

NSSQ, Morale Scale, Symptom Checklist-48 Family APGAR, and the Family Perception

Scale about patients.

The collected data were analyzed using paried t-test, multiple regression,

Kruskal-Wallis one way ANOVA, and process and content analysis .

The results are as follows:

1. Hypothesis 1; "There will be a difference in burden between the time before

and after participation in a caregiver social support group" was supported (t=5.76,

P<.001).

2. Hypothesis 2; "There will be a difference in quality of life between the time

before and after participation in a caregiver social support group" was supported

(t=-4.83, P<.001).

3. The predictive variables for burden were the scores for the SCL-48, and the

(family APGAR, and for quality of life were the family APGAR, the primary

caregiver's degree of difficulty in caring, and the primary caregiver's educational

level.

4. There was no difference for burden or quality of life for the demographic

characteristics of the primary caregivers or of the patients with brain and spinal

cord injuries.

5. The relationship between burden and quality of life was found to be a

moderately negative correlation that was statistically significant(r=-.44, P<.01).

In conclusion, it was found that the caregiver social support group was an

effective nursing intervention for reducing primary caregiver burden and for the

improvement of quality of life for the primary caregiver.

[영문]

The number of chronically disabled people has increased with the increase in traffic and other accidents in today's complicated social life. Patients who are chronically disabled are dependent on family primary caregivers over a long term.

Thus, the family carries substantial burden and a decrease in wellbeing related to caring for a patient who is disabled. But this problem is generally not noticed in our society because it is taken for granted that family members will care for

chronically ill patients.

A major part of the nurse's role should be helping these caregivers develop nursing interventions which would minimize their burden.

Social support is widely posited as a valuable resource for individual wellbeing.

An important and useful method to reduce the burden of the caregiver is social support, especially group social support. Thus social support groups are being used with increasing frequency to help caregivers cope with the burden of caregiving.

This study was conducted to determine if a difference existed in burden and quality of life before participation in a caregiver social support group and after.

The study design was a pre-post test pre-experimental design for the purpose of testing the effect of a caregiver social support group on the burden and quality of life of family primary caregivers of patients with brain and spinal cord injuries.

The caregiver social support group as the experimental treatment was carried out with five subgroups over a five weed period. Each subgroup consisted of 8-10 primary caregiver members which met as a social support group, weekly, for one and

half hour over the five week period. Caregiver social support was initiated by the researcher and led by a peer member.

The theoretical framework for this study was derived from the family stress theory by McCubbin and McCubbin(1987) and the main effect model of social support theory.

The sample consisted of 44 family members who were identified as the family primary caregivers for the patients with brain and spinal cord injuries.

The period of data collection was from June 1, 1992 to August 28,1992.

Data of pretest and posttest were collected through an interview using a structured questionnaire .

The instruments used in this study were Burden Scale, Quality of life Scale, NSSQ, Morale Scale, Symptom Checklist-48 Family APGAR, and the Family Perception Scale about patients.

The collected data were analyzed using paried t-test, multiple regression, Kruskal-Wallis one way ANOVA, and process and content analysis .

The results are as follows:

1. Hypothesis 1; "There will be a difference in burden between the time before and after participation in a caregiver social support group" was supported (t=5.76, P<.001).

2. Hypothesis 2; "There will be a difference in quality of life between the time before and after participation in a caregiver social support group" was supported (t=-4.83, P<.001).

3. The predictive variables for burden were the scores for the SCL-48, and the (family APGAR, and for quality of life were the family APGAR, the primary caregiver's degree of difficulty in caring, and the primary caregiver's educational level.

4. There was no difference for burden or quality of life for the demographic characteristics of the primary caregivers or of the patients with brain and spinal cord injuries.

5. The relationship between burden and quality of life was found to be a moderately negative correlation that was statistically significant(r=-.44, P<.01).

In conclusion, it was found that the caregiver social support group was an effective nursing intervention for reducing primary caregiver burden and for the improvement of quality of life for the primary caregiver.