척수손상자가 지각한 사회적 지지와 사회심리적 적응에 관한 연구

Abstract

[한글]

날로 복잡해지고 다양해진 현대사회 속에서 우리나라는 급속한 경제성장과 산업화, 이에 따른 교통량의 증가 등으로 각종 산업사고와 교통사고의 발생이 증가하고 있으며, 다른 나라에 비해 안전사고나 교통사고로 생기는 상해의 비율도 높아 이러한 사고들로 척수

손상자가 계속 증가하고 있다.

이들 척수손상자는 손상부위 이하의 운동, 감각상실 뿐 아니라 배변, 배뇨, 성기능의 상실을 초래하여 자신은 물론 주변 가족들까지 정신적, 사회·경제적으로 심한 타격을 받는다.

최근에는 의료기술의 놀라운 발달과 재활 치료로 과거에 비해 사망률이 현저히 감소하였고, 생명유지나 연장의 측면에서 적극적 사회 복귀가 중심 과제가 되었다. 이들은 신체적 손상의 영구성과 독립적 생활의 어려움으로 더욱 심각한 사회심리적 부적응의 문제를

겪는다. 그러나 이들이 사회심리적 부적응의 문제들을 혼자서 해결하는 것은 불가능한 일이다. 재활의 초기 단계에서부터 의료팀이 가족과 함께 이들의 온전한 재활을 위한 다각적 노력과 협조가 필요하며, 궁극적으로 이들을 사회가 수용하는 자세가 요구된다. 사회

심리적 적응에 사회적 지지가 중요한 변수로 많은 문헌과 연구에서 보고된 바, 본 연구에서는 척수손상자를 대상으로 지각한 사회적 지지 정도와 사회심리적 적응 정도를 파악하고, 사회심리적 적응에 영향을 미치는 주요 변인을 확인하여, 임상현장에서의 간호사정과 간호중재에 도움이 되고 이용할 수 있는 기초자료를 제공하려고 한다.

본 논문의 연구방법은 서술적 상관관계 연구이며, 연구대상은 서울시에 위치한 Y 대학 부속병원에서 입원치료를 받고 퇴원한 척수손상자를 중심으로 형성된 모임들의 회원으로 총 121명이었다.

연구도구는 구조화된 질문지로써 박지원(1985)에 의해 개발된 사회적 지지 측정도구와 Derogatis(1983)의 PAIS-SR를 Van Wert(1986)가 요약한 것을 기초로 김영경(1990)이 수정보완한 사회심리적 적응 측정도구이다.

자료수집 기간은 1992년 10월 1일부터 1992년 10월 26일 까지 26일간이었으며 수집된 자료는 SPSS/PC+를 이용하여 전산처리하였다.

자료분석은 각 변인의 특성에 따라 실수와 백분율, 평균, 표준편차, Pearson's correlation coefficients, t-test, ANOVA, 단계적 중희귀분석으로 분석하였다.

본 연구의 결과는 다음과 같다.

1) 대상자가 지각한 사회적 지지 정도는 평균평점이 3.60이었고 하부척도별 지지 정도는 건강 상황중심의 지지 3.94, 간접적으로 지각한 지지 3.67, 직접적으로 지각한 지지 3.19로 직접적으로 지각한 지지정도가 가장 낮았다. 13유형의 지지 제공자 중 형제 자매를

가장 많이 지지 제공자로 생각하고 있으며 지지 내용에서는 정서적 지지를 가장 많이 받고 있고, 이들에 대한 지지 만족도는 3.94로 높게 나타났다.

2) 대상자의 사회심리적 적응 정도는 평균평점이 3.11이었으며, 하부척도별 적응 정도는 전반적인 건강관리 정도 3.49, 가정내 환경 3.38, 확대가족 3.21, 심리적 고통 3.13, 사회적 환경 3.09, 직업적 환경 2.32 순으로 직업적 환경의 적응이 가장 낮았다. 다만 기

혼자만을 대상으로 한 성생활 부분을 포함하면 2.03으로 성생활 부분이 하부영역 중 가장 낮게 나타난다.

3) 대상자가 지각한 사회적 지지와 사회심리적 적응과의 관계는 통계적으로 유의하게 중등도의 순상관 관계가 있는 것으로 나타났다. 그러므로 "척수손상자가 지각한 사회적 지지가 높을수록 사회심리적 적응 정도는 높을 것이다"의 가설은 지지되었다(r = .62, p < .001).

4) 대상자의 인구사회학적 특성에 따른 지각한 사회적 지지의 차이는 직업이 있는 사람이 없는 사람보다(t = - 2.09, p < .05), 가정의 경제상태가 좋을수록 (F = 5.87, p < .01) 지각한 사회적 지지도 높았다.

의료혜택의 종류는 의료보험과 의료보호의 경우가 자동차보험이나 산업재해보험보다 지각한 사회적 지지가 높았으며 (F = 3.50, p < .05), 치료비 부담자가 본인이나 가족인 경우가 더 높은 지각한 사회적지지 정도를 나타냈다(t = 2.17, p < .05).

손상원인은 산업재해인 경우가 가장 낮은 지지 정도를 나타냈고(F = 5.62, p < .01), 손상 후 기간에 따른 지각한 사회적 지지 정도도 유의한 차이를 나타냈다(F = 4.58, p < .01).

5) 대상자의 인구학적 특성에 따른 사회심리적 적응의 차이는 종교에서 기독교인이 사회심리적 적응 정도가 가장 높았고(F = 3.48, p < .05), 교육정도에서 학력이 높을수록 (F = 2.93, p < .01), 가정의 경제수준이 높을수록(F = 16.86, p < .001) 잘 적응하며, 의

료혜택 종류에서 의료보험과 의료보호 대상자가 가장 높은 적응 정도를 나타냈고 (F = 5.00, p < .01), 치료비 부담자에서는 본인이나 가족인 경우가 보험에서 부담하는 경우보다 사회심리적 적응 정도가 통계적으로 매우 유의하게 높게 나타났다(t = 3.25, p < .01).

그리고 사고원인이 산업재해인 경우에 적응 정도가 가장 낮은 것을 알 수 있었다(F = 3.29, p < .05).

6) 대상자의 사회심리적 적응에 영향을 미치는 주요 변인을 파악하기 위해 단계적 중희귀분석을 한 결과 직접적으로 지각한 사회적 지지, 건강상황중심의 사회적 지지, 가정의 경제상태, 입원횟수, 나이가 유의한 변수로 채택되었으며 가장 중요한 예측요인은 직접적으로 지각한 사회적지지로 사회심리적 적응을 50.0% 설명할 수 있는 것으로 나타났다.

그러므로 본 연구의 결과를 근거로 척수손상자의 개인차를 고려하고, 유효한 사회적 지지원과 지지 내용을 파악하고 이를 활용하며, 사회심리적 적응의 가장 주요한 예측 요인인 직접적으로 지각한 사회적 지지를 증진 시킬 수 있는 간호중재를 제공함으로써 척수손상자의 사회심리적 적응을 도울 수 있을 것으로 생각한다.

A study of the relationship between the perceived social suppot and

psychosocial adjustment in individuals with spinal cord injuries

Hong, Yoon Mi

Department of Nursing The Graduate School of Yonsei University

(Directed by Prof. Kang, Kyu Sook )

With modern society getting more and more complicated and diversified day by day,

industralization with rapid economic growth and increasing volume of traffic have

inevitably made for an increase in the number of industrial disasters and

automobile accidents. The number of spinal cord injuries suffered by people caught

in these disasters and accidents continue to increase.

Individuals with spinal cord injuries suffer motor and sensory loss from the

injury leading to consequent functional disorders of defecation, urination and

sexual life, which cause great mental and socioeconomical problems not only to the

injured themselves but also to their families.

With the remarkable progress in medical treatment and rehabilitation, the death

rate has been reduced markedly as compared to the past. As return to society with a

positive image has become a key subject for individuals with spinal cord injuries,

all aspects of life maintenance or prolongation must be considered.

Many have serious problems of psychosocial maladjustment owing to the permanency

of their functisnal losses and their consequent difficulties in daily life. But it

is impossible for them to solve the problems by themselves. From the initial stage

of rehabilitation, it is important that medical staff and family members cooperate

and make every effort to help these individals achieve better rehabilitation, and

ultimately for society to have a favorable attitude to receive them.

In the literature and in various studies, it has been reported that social

support is an important factor to psychosocial adjuscment.

The propose of this study was to determine the degree of perceived social support

and psychosocial adjusement in individuals with spinal cord injuries, to confirm

the main variables influencing adjustment and finally to offer basic data that will

be helpful and available for nursing assessment and intervention in the clinical

settings.

The method of this study was a descriptive ocrrelation study. The subjects were a

total of 121 individuals with spinal cord injuries who were members of self help

groups mainly formed by persons discharged from Y University hospital in Seoul.

The tool for this study was a structured questionnaire using the social support

scale developed by Park Jee Won(1985) and one for psychosocial adjustment which Kim

Ygung Kyoung developed as a modification of Derogatis' (1983)PAIS-SR summarized by

Van Wet(1986).

Data was collected from Oct 1 to 26 1992 and the collected data were

computer-processed with SPSS/PC+.

The data were analysed using descriptive statistics, Pearson's correlation

coefficients, t-test ANOVA and stepwise mutiple regression according to the

characteristics of variables.

The results of this study are as fellows;

1) The mean score of perceived social support was 3.60. The range was from 2.39

to 4.91. For the scores of the subdimensions, the score for health-center ed

support was 3.94, indirectly perceived support, 3,67, and directly perceived

support, 3,19. The level of directly perceived support was the lowest.

Of the 13 types of supportive resources, the majority of the subjects perceived

their siblings as their major support resource. For type of support, emetional

support was selected by the largest number and the mean score for satisfaction with

the support available was a relatively high score of 3.94.

The range was from 2.57 to 5.00.

2) For the psychosocial adjusment level, the mean score was 3.11, with a range

from 2.14 to 4.15. For the scores on the subdimensions, adjustmnent to the

vocational environment was the lowest. The mean scores for other subdimensions were

for general health care, 3.49, family environment 3.38, expanded family, 3.21,

psychological suffering, 3.13, social environment, 3.09, and vocational environment

2.32. The score for the sexual life dimension, which was applied only to married

subjects, had the lowest score of 2.03.

3) The relationship between the perceived social support and the psychosocial

adjustment showed a significant correlation. Therefore, the hypothesis "The higher

the level of perceived social support the higher the level of psychosocial

adjustment" was accepted(r = .62, p < .001).

4) For the level of the social support according to the demographic

characteristics of the subjects, tee score of the subjects with jobs was higher

than that of the unemployed(t = -2.O9, p < .05), and subjects from families with

better economic situations reported higher levels of perceived social support(F =

5.87, p < .01). Regarding insurance, the level of the perceived social support was

higher for those with insurance than far those with automobile liability insurance

or workmen's accident compensation insurance (F = 3.50, p < .05), and for subjects

who themselves or whose family paid the medical fee there was a higher score for

perceived social support(t = 2.17,p < .05). Regarding cause of injury, those

injured in industrial disasters had the lowest score(F = 5.62, p< .01) and there

was also a significant difference in the levels of the perceived social support

acceding to the length of time since the injury(F = 4.58, p < .01).

5) Fer the differences in the psychosocial adjustment according to the

demographic characteristics of the subjects, there was a significant difference

according to religion, with Christians having the highest score(F = 3.48, p < .05),

according to education with adjustment scores increasing with educational level(F =

2.93, p < .01 ), according to the economic situation of the family with adjustment

scones increasing with economic level(F = 16.86, p < .001) and according to

insurance coverage with subjects having medical insurane showing the highest

adjustment score(P = 5.00, p < .01). As to who paid the medial fee, when it was the

subjects themselves or the family, there was a higher score for adjustment than for

those where the insurance company paid(t = 3.25, p< .01), and it was statistically

significant Regarding cause of injury, these from industrial disasters had the

lowest scores for adjustment(F = 3.29, p < .05).

6) The result of the stepwise multiple recession for determining the main

variables influencing the psyohosocial adjustment showed that the variables of

directly perceived social support, health state centered social support, the

economic conditions of the family, frequency of the hospitalization, and age were

selected as the significant variables.

The most important estimating factor was the directly percaived social support

which explained 50.0% of the variance for psychosocial adjustment.

In conclusion, on the basis of the results from this study, psycosocial

adjustment of individuals with spinal coed injuries could be promoted through

considering the personal differences, determining and utilizing significant social

support resources arts support types, and offering nursing interventions to

increase directly perceived social support as this was seen as the most important

estimating factors for psychosocial adjustment.

[영문]

With modern society getting more and more complicated and diversified day by day, industralization with rapid economic growth and increasing volume of traffic have inevitably made for an increase in the number of industrial disasters and automobile accidents. The number of spinal cord injuries suffered by people caught in these disasters and accidents continue to increase.

Individuals with spinal cord injuries suffer motor and sensory loss from the injury leading to consequent functional disorders of defecation, urination and sexual life, which cause great mental and socioeconomical problems not only to the injured themselves but also to their families.

With the remarkable progress in medical treatment and rehabilitation, the death rate has been reduced markedly as compared to the past. As return to society with a positive image has become a key subject for individuals with spinal cord injuries, all aspects of life maintenance or prolongation must be considered.

Many have serious problems of psychosocial maladjustment owing to the permanency of their functisnal losses and their consequent difficulties in daily life. But it is impossible for them to solve the problems by themselves. From the initial stage of rehabilitation, it is important that medical staff and family members cooperate and make every effort to help these individals achieve better rehabilitation, and ultimately for society to have a favorable attitude to receive them.

In the literature and in various studies, it has been reported that social support is an important factor to psychosocial adjuscment.

The propose of this study was to determine the degree of perceived social support and psychosocial adjusement in individuals with spinal cord injuries, to confirm the main variables influencing adjustment and finally to offer basic data that will be helpful and available for nursing assessment and intervention in the clinical settings.

The method of this study was a descriptive ocrrelation study. The subjects were a total of 121 individuals with spinal cord injuries who were members of self help groups mainly formed by persons discharged from Y University hospital in Seoul.

The tool for this study was a structured questionnaire using the social support scale developed by Park Jee Won(1985) and one for psychosocial adjustment which Kim Ygung Kyoung developed as a modification of Derogatis' (1983)PAIS-SR summarized by Van Wet(1986).

Data was collected from Oct 1 to 26 1992 and the collected data were computer-processed with SPSS/PC+.

The data were analysed using descriptive statistics, Pearson's correlation coefficients, t-test ANOVA and stepwise mutiple regression according to the characteristics of variables.

The results of this study are as fellows;

1) The mean score of perceived social support was 3.60. The range was from 2.39 to 4.91. For the scores of the subdimensions, the score for health-center ed support was 3.94, indirectly perceived support, 3,67, and directly perceived support, 3,19. The level of directly perceived support was the lowest.

Of the 13 types of supportive resources, the majority of the subjects perceived their siblings as their major support resource. For type of support, emetional support was selected by the largest number and the mean score for satisfaction with

the support available was a relatively high score of 3.94.

The range was from 2.57 to 5.00.

2) For the psychosocial adjusment level, the mean score was 3.11, with a range from 2.14 to 4.15. For the scores on the subdimensions, adjustmnent to the vocational environment was the lowest. The mean scores for other subdimensions were for general health care, 3.49, family environment 3.38, expanded family, 3.21, psychological suffering, 3.13, social environment, 3.09, and vocational environment 2.32. The score for the sexual life dimension, which was applied only to married subjects, had the lowest score of 2.03.

3) The relationship between the perceived social support and the psychosocial adjustment showed a significant correlation. Therefore, the hypothesis "The higher the level of perceived social support the higher the level of psychosocial adjustment" was accepted(r = .62, p < .001).

4) For the level of the social support according to the demographic characteristics of the subjects, tee score of the subjects with jobs was higher than that of the unemployed(t = -2.O9, p < .05), and subjects from families with better economic situations reported higher levels of perceived social support(F =

5.87, p < .01). Regarding insurance, the level of the perceived social support was higher for those with insurance than far those with automobile liability insurance or workmen's accident compensation insurance (F = 3.50, p < .05), and for subjects

who themselves or whose family paid the medical fee there was a higher score for perceived social support(t = 2.17,p < .05). Regarding cause of injury, those injured in industrial disasters had the lowest score(F = 5.62, p< .01) and there was also a significant difference in the levels of the perceived social support acceding to the length of time since the injury(F = 4.58, p < .01).

5) Fer the differences in the psychosocial adjustment according to the demographic characteristics of the subjects, there was a significant difference according to religion, with Christians having the highest score(F = 3.48, p < .05), according to education with adjustment scores increasing with educational level(F = 2.93, p < .01 ), according to the economic situation of the family with adjustment scones increasing with economic level(F = 16.86, p < .001) and according to insurance coverage with subjects having medical insurane showing the highest

adjustment score(P = 5.00, p < .01). As to who paid the medial fee, when it was the subjects themselves or the family, there was a higher score for adjustment than for those where the insurance company paid(t = 3.25, p< .01), and it was statistically

significant Regarding cause of injury, these from industrial disasters had the lowest scores for adjustment(F = 3.29, p < .05).

6) The result of the stepwise multiple recession for determining the main variables influencing the psyohosocial adjustment showed that the variables of directly perceived social support, health state centered social support, the economic conditions of the family, frequency of the hospitalization, and age were selected as the significant variables.

The most important estimating factor was the directly percaived social support which explained 50.0% of the variance for psychosocial adjustment.

In conclusion, on the basis of the results from this study, psycosocial adjustment of individuals with spinal coed injuries could be promoted through considering the personal differences, determining and utilizing significant social support resources arts support types, and offering nursing interventions to

increase directly perceived social support as this was seen as the most important estimating factors for psychosocial adjustment.