가족참여 환자교육이 가족지지 행위와 자가간호 수행에 미치는 효과

Abstract

[한글]

최근 우리나라에서도 관상동맥 질환의 이환율이 급증하고 있다. 관상동맥 질환은 적절한 의료처치 후에도 질병의 재발감소를 위한 자가간호 행위를 꾸준히 수행하여야 한다.

이에 따라 퇴원 전, 환자를 대상으로 하여 자가간호 교육을 제공하는 병원이 증가하고 있다. 그러나 관상동맥 질환자는 생명을 위협받은 극적인 경험으로 인해 교육을 수용하는 능력이 떨어져 있을 뿐 아니라 퇴원 후 환자 간호의 대부분이 가족에 의해 제공되고 있다는 점 때문에 환자만을 대상으로 하는 교육방법은 효과면에서 제한점이 있다고 지적되고 있다. 특히 우리나라는 가족 중심주의 문화이기 때문에 환자의 자가간호 수행을 위해서는 가족의 지지가 매우 중요하다는 주장이 제시되었다.

그러나 현재까지 건강관리 체계에 가족을 포함시켜 대상자의 자가간호수행에 미치는 효과를 검증한 연구가 드문 실정이며 가족의 지지를 유도할 수 있는 간호중재 방법도 개발되어 있지 않은 실정이다.

이에 본 연구에서는 관상동맥 질환자와 가족을 대상으로 환자교육시 가족을 참여시키는 간호중재방법이 환자에 대한 가족지지 행위와 환자의 자가간호 수행을 증진시키는 데 효과가 있는 지를 확인하기 위해 비동등성 통제군 사후 설계를 이용한 실험연구를 시도하였다.

연구기간은 1996년 12월 10일부터 1997년 1월 20일까지 실시한 예비 조사 결과 나타난 문제를 수정, 보완하여 1997년 9월 15일부터 1997년 12월30일까지의 총 3.5개월 동안 본 연구를 시행하였다.

연구대상자는 서울시내 2개 종합병원에 입원해 있는 환자를 유한 모집단으로 하여 대상자 선정기준에 따라 62명을 편의표출하여 실험군 31명, 통제군 31명으로 배정하였다. 연구절차는 홀수 주에 퇴원하는 대상자는 실험군으로, 짝수 주에 퇴원하는 대상자는 통제군으로 무작위 배정하였으며 실험군은 퇴원하는 주에 환자와 가족을 대상으로 연구보조원이 자가간호 수행에 대한 책자를 이용하여 개별교육하고 통제군은 퇴원하는 주에 환자만을 대상으로 실험군과 같은 교육책자를 이용하여 연구보조원이 개별교육하였다. 사후자료는 퇴원 4-6주 후 가족지지 행위와 자가간호 수행에 대한 질문지를 반송봉투를 동봉하여 우편으로 발송하여 수집하였다.

연구도구로는 가족지지 행위 측정도구, 자가간호 수행 측정도구, 자가간호지식 측정도구, 건강통제위 성격 측정도구를 사용하였다.

자료분석은 SPSS/PC**+ Program을 이용하였다. 제 1 가설 검정과 제 2가설 검정은 t-test를 이용해 실험군과 통제군의 평균을 비교하였으며, 가족지지 행위와 자가간호 수행과 관련된 변수를 파악하기 위해서는 Pearson correlation과 다중회귀 분석을 사용하였다.

연구결과는 다음과 같다.

1. '환자교육시 가족이 참여하는 실험군은 가족이 참여하지 않는 통제군에 비해 가족지지 행위정도가 높을 것이다'라는 제 1 가설은 실험군의 가족지지 행위가 100점 만점에 84.61점을, 통제군이 75.87점을 나타내어 두 집단이 통계적으로 유의한 차이를 나타내어(t=

3.64, p=.00) 지지되었다. 또한 가족지지 행위를 정서적 지지, 직접적 도움, 정보적 지지의 속성별로 구분하여 측정하였을 때에도 실험군이 통제군에 비해 유의하게 높은 것으로 나타났다.

2. '환자교육시 가족이 참여하는 실험군은 가족이 참여하지 않는 통제군에 비해 자가간호 수행정도가 높을 것이다'라는 제 2 가설은 실험군의 자가간호 수행점수가 167점 만점에 127.97점을, 통제군이 112.81점을 나타내어 두 집단이 통계적으로 유의한 차이를 보여(t=3.91, p=.00) 지지되었다. 또한 자가간호 수행을 주관적 자가간호 수행과 객관적 자가간호수행으로 나누어 분석하였을 때 실험군의 주관적 자가간호 수행은 150점 만점에 116.65점을, 통제군은 102.97점을 나타내어 실험군이 통제군에 비해 주관적 자가간호 수행이

유의하게 높은 것으로 나타났다(t=3.60,p=.00). 객관적 자가간호 수행은 실험군은 17점 만점에 11.32점을, 통제군은 9.84점을 나타내 두 집단간 평균값은 통계적으로 유의한 차이가 있는 것으로 나타났다 (t=3.71, p=.00).

3. 가족지지 행위와 관련된 변수를 파악하기 위해 자가간호에 대한 가족지식과 가족의 인구사회학적 특성을 독립변수로 투입하여 다중회귀분석을 실시한 결과 20%의 설명력을 나타냈으며, 자가간호에 대한 가족지식만이 가족지지 행위에 영향을 미치는 것으로 나타났다.

4. 자가간호 수행과 관련된 변수를 파악하기 위해, 환자의 인구사회학적 특성, 건강통제위 성격, 자가간호에 대한 환자지식, 자가간호에 대한 가족지식, 가족지지 행위를 독립변수로 투입하여 다중회귀분석을 실시한 결과 51%의 설명력을 나타내었으며, 가족지지 행위가 자가간호 수행에 가장 큰 독립적 영향력을 미치는 요인으로 나타났다.

이상의 연구결과를 종합해 볼 때 환자교육시 가족을 참여시켜 환자의 자가간호 수행에 대한 내용을 가족에게도 교육하는 가족참여 환자교육 방법은 자가간호에 대한 가족의 지식을 증진시켜 가족지지 행위와 환자의 자가간호 수행에 영향을 미친다는 것이 확인되었다. 그러므로 관상동맥 질환자의 퇴원 후 자가간호 수행을 증진시키기 위해서는 자가간호 교육제공시 가족을 참여시키는 것이 바람직하며, 가족의 지지가 환자의 자가간호 수행에 매우 중대한 영향을 미치므로 가족의 지지를 유도할 수 있는 다양한 간호중재술 개발에 관심을 기울여야 한다고 생각한다.

Effects of a Family Participated Education Program on the Self Care Behavior of

Cardiac Patients

Han, Ae-Kyung

Department of Nursing The Graduate School Yonsei University

The main purpose of this study was to compare the effects of two different

methods of education programs on the self care behavior of post discharge cardiac

patients.

The research employed a non-equivalent control group post-test quasi-experimental

design. The experimental group included family members and patients in the

education program and the control group included only patients. The content of the

education was identical to a booklet developed by the researcher.

A pilot study was done from December, 1996 to January, 1997. Self care behavior,

family support, knowledge on self care (patients and family members), and the locus

of control on health were measured before and after the treatment. Demographic

variables were surveyed only before the treatment and was included in the data

analysis for statistical control.

Sixty-two patients were randomly chosen from two medical center located in Seoul.

Thirty-one patients, who were discharged on odd number weeks, were assigned to the

experimental group and thirty-one patients, who were discharged on even number

weeks, were assigned to the control group, Subjects in both groups were educated

during the week of discharge. Four to six weeks after their discharge, a

questionnaire was mailed to the subjects in both groups. Data collection was done

from September, 1977 to December 1997.

Data analysis was done using the SPSS/PC+ program The hypotheses were tested

using the t-test, and for the purpose of identifying the variables related to

family support and patient's self care behavior, the Pearson correlation and

multiple regression analysis were done.

The summary of the results are as follows:

1. Hypothesis 1, which states' the experimental group will have a significantly

higher family support than the control group', was supported( p=,00).Family members

who participated in the education program showed significantly higher scores in

emotional and informational support, and provided more direct help than family

members who did not participate in the education program.

2. Hypothesis 2, which states 'the patients in the experimental proup will have a

higher self care behavior score than the patients in the control g개up',was also

supported (p=.00). The patients who participated in an education program with their

family members reported significantly higher self care behavior scores than the

patients who participated in an education program without family members.

3. According to the result of the multiple regression, family members' knowledge

of patient care was the only significant variable related to family support

behavior. As family members had mare knowledge of patient care, they were mare

likely to support patient's self care behavior.

4. According to the result of the multiple regression, family members' knowledge

of patient care and family support were two variables which were significantly

related to the patient's self care behavior. While the patient's own knowledge of

self care was not statistically significant, the family member's knowledge and

their support were significanly and positively related to the self care behavior of

the patient.

Based on these results, it is suggested that patient education of self care

should include family members if possible. Especially many cardiac patients, who

had experienced life threatening episodes, who will have difficult time

comprehending new information. Furthermore a great deal of patient care is provided

by the family members after discharge and it is important for them to know how to

help the patients. It is imperative for nurses to develop a structured teaching

program which encourges family participation.

[영문]

The main purpose of this study was to compare the effects of two different methods of education programs on the self care behavior of post discharge cardiac patients.

The research employed a non-equivalent control group post-test quasi-experimental design. The experimental group included family members and patients in the education program and the control group included only patients. The content of the education was identical to a booklet developed by the researcher.

A pilot study was done from December, 1996 to January, 1997. Self care behavior, family support, knowledge on self care (patients and family members), and the locus of control on health were measured before and after the treatment. Demographic variables were surveyed only before the treatment and was included in the data analysis for statistical control.

Sixty-two patients were randomly chosen from two medical center located in Seoul. Thirty-one patients, who were discharged on odd number weeks, were assigned to the experimental group and thirty-one patients, who were discharged on even number weeks, were assigned to the control group, Subjects in both groups were educated during the week of discharge. Four to six weeks after their discharge, a questionnaire was mailed to the subjects in both groups. Data collection was done from September, 1977 to December 1997.

Data analysis was done using the SPSS/PC+ program The hypotheses were tested using the t-test, and for the purpose of identifying the variables related to family support and patient's self care behavior, the Pearson correlation and multiple regression analysis were done.

The summary of the results are as follows:

1. Hypothesis 1, which states' the experimental group will have a significantly higher family support than the control group', was supported( p=,00).Family members who participated in the education program showed significantly higher scores in emotional and informational support, and provided more direct help than family members who did not participate in the education program.

2. Hypothesis 2, which states 'the patients in the experimental proup will have a higher self care behavior score than the patients in the control g개up',was also supported (p=.00). The patients who participated in an education program with their family members reported significantly higher self care behavior scores than the patients who participated in an education program without family members.

3. According to the result of the multiple regression, family members' knowledge of patient care was the only significant variable related to family support behavior. As family members had mare knowledge of patient care, they were mare likely to support patient's self care behavior.

4. According to the result of the multiple regression, family members' knowledge of patient care and family support were two variables which were significantly related to the patient's self care behavior. While the patient's own knowledge of self care was not statistically significant, the family member's knowledge and

their support were significanly and positively related to the self care behavior of the patient.

Based on these results, it is suggested that patient education of self care should include family members if possible. Especially many cardiac patients, who had experienced life threatening episodes, who will have difficult time comprehending new information. Furthermore a great deal of patient care is provided by the family members after discharge and it is important for them to know how to help the patients. It is imperative for nurses to develop a structured teaching program which encourges family participation.