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복막투석환자 부인의 돌봄 경험에 관한 질적 연구

Other Titles
 Qualitative study on caring experiences of the wives of patients with CAPD 
Issue Date
1992
Description
간호학과/석사
Abstract
[한글] 여러가지 만성질환 중에서도 만성 신부전증은 여러가지 선행질환과 합병증을 수반하고 있고 진행이 불가역적이며, 그 치료방법 중 하나인 복막투석요법은 철저하고 지속적인 관리를 요하기에 무엇보다도 가족의 배려와 지지가 요구된다. 이에 본 연구는 복막투석 환자의 부인이 환자를 돌보는 과정에서의 경험에 대해 밝히고 서술하므로서, 복막투석 환자와 부인의 적응과정을 도울 수 있는 간호증재방안을 위한 기초자료로 삼고자 하는데 궁극적인 목적을 둔다. 연구설계는 정성적 연구방법을 사용하여 복막투석 환자 부인이 환자를 돌보는 과정에서의 경험에 대해 심층적으로 파악하고자 하였다. 연구대상은 만성신부전을 진단받고 복막투석을 실시한 지 1년 이내이며 신장이식수술 일정이 잡히지 않은 환자의 부인으로서 Y대 학 부속병원과 G투석 상담실에 등록된 환자의 부인 중16명을 대상으로 하였다. 자료수집기간은 1992년 4월 1일에서 5월 30일까지 였다. 본 연구의 목적을 달성하기 위하여 자료는 심층면담과 관찰, 기록등을 통해 수집하였으며 전화면담을 추가하였다. 주요 연구결과는 다음과 같다. 1. 시기별 구분되는 양상에 있어 초기 신부전을 진단받은 후 대다수의 환자와 부인은 질병의 심각성을 인지하지 못하고 병원 지시에 따르지 않는 현상을 나타냈다. 복막투석을 결정하는 과정에 있어서 투석실시에 대해 병원 측의 통보를 받았을 때 이를 수응하는데 충격적이었다고 하였으며 많은 경우 증상이 최악으로 발전하기 전까지 투석을 막연히 연기하는 태도를 취하였다. 그러나 환자의 상태가 극도로 악화되었을 때 환자와 부인은 복막투석을 요청하는 태도의 변화를 보였다. 복막투석 실시 후에 환자의 건강상태가 호전되 면 이를 긍정적으로 평가하였으며 이와 반대로 환자의 이전 증상이 경감되지 않고 부작용이 있을 때 이에 대해 회의적인 태도를 취하였다. 2. 부인이 일차적인 간호제공자로서 역할을 담당하게 된 등기에는 도리, 의무, 책임, 자존심, 환자에 대한 연민, 정 등이 복합적으로 내재되어 있었다. 간호제공자로서의 역할을 수행함에 있어서는 CAPD의 수행과 식이준비 등의 돌봄의 행위와 심리적 지지간호가 포함되었다. 가정 내에서는 남편의 가장 역할을 수행하게 되며 그 밖에 주부의 역할, 자녀 관리 등은 계속 유지되어 역할 과중을 경험하였다. 따라서 자신을 돌보는데 소홀하였다. 3. 부인은 심리사회적으로 환자존재에 대한 부담, 끝없는 과정에 대한 부담을 경험하고 정서적으로는 혼란스러우며 현실을 회피하고자 하였다. 부부관계에서는 남편과 함께 있는 시간이 많아짐에 따라 의사소통이 원활해졌으며 성생활에서는 남편의 성기능이 저하되 었으나 이것이 부부관계에 문제를 초래하지는 않는다고 하였다. 4. 적응에 관련된 변수로서는 신에게 의지하는 것, 부인의 성격, 경제적 형편, 역할부담 정도, 환자의 상태호전 정도와 사회복귀 양상, 환자와의 일치정도, 사회적 지원체계 등이 제시되었다. 극복전략으로서는 사회적 지지체재활용, 심리적인 재정립, 주의전환, 이식계획, 건강추구행위 등이 제시되었다. Qualitative Study on Caring Experiences of the Wives of Patients with CAPD Hahn, Sook-Won Department of Nursing The Graduate School of Yonsei University (Directed by Profssor Lee, Won-Hee,R.N.,Ph.D.) CAPD is one of the therapies of chronic renal failure. Because it requires the thorough and continuous management, it needs family care and support. A nurse has to include family caregiver of CAPD patient among the objects of nursing. The purpose of this study was to explore and describe the experiences of wife caring for the CAPD patient and it was undertaken to provide preliminary data in the development of nursing intervention program for the promotion of adjustment process of wives and patients with CAPD. The research design utilized in this study was a qualitative research method. The objects were 16 wives of patients with CAPD, who had diagnosed the end-stage renal disease and were within one-year of having had CAPD. The sample was obtained from a university hospital and a dialysis service room in Seoul. The period for data collection was from April 1st to May 30th,1992. The data were collected through in-depth interviews, telephone interviews as well as observation and record. The findings were as follows. 1. According to the divisions of stage, there are different kinds of appearance. After having been diagnosed chronic renal failure, most patients and their wives were not perceived the seriousness of disease and then didn't comply with medical regimen. When they are informed of having dialysis, they are shocked and delayed the decision of dialysis until the worst. In the result, they requested to operate dialysis when patient's condition had taken a turn of worse. 2. Caregiver's role includes practical care and psychological supportive care. The wife substituted for the husband's role as breadwinner and continued taking charge of her family as homemaker, mother, and nurturer. As a result the wife experienced the excessive role, financial strain. So she did not take care of herself. 3. In psychological aspect, she experienced the burden of patient being, the burden of never-ending process, the emotional disturbance, and the avoidance of reality. Marital interaction was more closed than before because they had communicated with the other motile due to having had more time together. Sexual problem - decreasing sexual desire and difficulty in getting or maintaining of erection in patients - was reported, but it made no significant problem in marital relationship. 4. Several factors influenced the adjustment of the wives. Those factors were dependance to God, persona1 character, economic status, extent of role excess, patient's health condition, working status, and marital relationship. Social support system is a effective source but temporarilly. Coping strategy included use of social support, self regulation, conversion of attention, planning of renal transplantation, and health-seeking behaviors.
[영문] CAPD is one of the therapies of chronic renal failure. Because it requires the thorough and continuous management, it needs family care and support. A nurse has to include family caregiver of CAPD patient among the objects of nursing. The purpose of this study was to explore and describe the experiences of wife caring for the CAPD patient and it was undertaken to provide preliminary data in the development of nursing intervention program for the promotion of adjustment process of wives and patients with CAPD. The research design utilized in this study was a qualitative research method. The objects were 16 wives of patients with CAPD, who had diagnosed the end-stage renal disease and were within one-year of having had CAPD. The sample was obtained from a university hospital and a dialysis service room in Seoul. The period for data collection was from April 1st to May 30th,1992. The data were collected through in-depth interviews, telephone interviews as well as observation and record. The findings were as follows. 1. According to the divisions of stage, there are different kinds of appearance. After having been diagnosed chronic renal failure, most patients and their wives were not perceived the seriousness of disease and then didn't comply with medical regimen. When they are informed of having dialysis, they are shocked and delayed the decision of dialysis until the worst. In the result, they requested to operate dialysis when patient's condition had taken a turn of worse. 2. Caregiver's role includes practical care and psychological supportive care. The wife substituted for the husband's role as breadwinner and continued taking charge of her family as homemaker, mother, and nurturer. As a result the wife experienced the excessive role, financial strain. So she did not take care of herself. 3. In psychological aspect, she experienced the burden of patient being, the burden of never-ending process, the emotional disturbance, and the avoidance of reality. Marital interaction was more closed than before because they had communicated with the other motile due to having had more time together. Sexual problem - decreasing sexual desire and difficulty in getting or maintaining of erection in patients - was reported, but it made no significant problem in marital relationship. 4. Several factors influenced the adjustment of the wives. Those factors were dependance to God, persona1 character, economic status, extent of role excess, patient's health condition, working status, and marital relationship. Social support system is a effective source but temporarilly. Coping strategy included use of social support, self regulation, conversion of attention, planning of renal transplantation, and health-seeking behaviors.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/117313
Appears in Collections:
2. 학위논문 > 3. College of Nursing > 석사
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