일 종합병원에 입원했던 뇌졸중 환자의 가정간호 의뢰일 추정과 가정간호사업 서비스 내용에 관한 연구

Abstract

[한글]

최근 우리 나라는 사회. 경제적 여건의 변화, 인구구조 및 질병구조의 변화, 보건의료 서비스의 변화라는 측면에서 가정간호사업의 필요성이 강조되고 있고, 행정당국, 의료계, 의료소비자인 국민모두가 범 국민적인 가정간호사 제도의 필요성애 대해 인식을 같이 하고 있다.

가정간호사업은 국가, 의료기완, 국민 등의 여러가지 측면에서 모두매개 이익을 가져올 것으로 기대되지만 아직까지 실제적으로 병원중심의 가정간호사업을 실시할 경우 입원기간을 얼마나 단축시킬 수 있는가에 대한 연구는 매우 미흡한 실정이다.

따라서 본 연구는 가정간호사업의 대상 질환으로 가장 중요한 질병으로 알려진 뇌졸증을 대상으로 Y대학 부속 병원내에 1992년 11월 1일에서 1993년 2월 28일까지 지난 4개월 동안 입원했던 50명의 뇌졸증 환자의 입원의무기록지를 후향적으로 분석해서 가정간호의

뢰일을 추정하고, 가정간호의뢰일 추정 기준을 도출하며, 입원기간 동안에 제공된 처치 및 간호, 검사내용을 근거로 하여 가정간호 서비스 내용을 제안함으로써 가정간호사업 체계정립에 필요한 기초자료로 제공하기 위해 시도되었다.

연구대상자중 신경과 이외의 다른 과에 입원한 환자, 자의퇴원, 가망없는 퇴원 및 사망한 환자, 다른 과나 다른 의료기관으로 transfer된 환자를 제외한 50명이 연구대상으로 선정되었다.

연구과정을 요약하면 먼저 뇌졸중 환자의 입원 의무기록지에서 가정간호의뢰일 추정에 필요로 되는 정보를 파악해낼 수 있는 분석기록지를 신경과 전문의의 자문 및 간호학 교수의 확인과정을 거쳐 개발하였고, 개발된 분석기록지의 타당도를 검증하였다. 그리고 가정간호의뢰일 추정은 연구자가 뇌졸증 환자의 입원의무기록지를 개개인 환자별로 분석하여 집중적인 치료를 받던 시기가 지나고, 가정간호로 의뢰될 수 있는 시기를 추정하였고 신경과 전문의가 개발된 분석기록지를 중심으로 입원의무기록지를 참고하여 가정간호의뢰일을 추정하고 난 후 충분한 토의를 거쳐 동의하는 시기로 결정하였다.

50명의 뇌졸증 환자를 대상으로 가정간호의뢰일을 추정할 때 사용된 모든 사항을 포함하여 가정간호의뢰일 추정기준을 도출하였다.

그리고 가정간호 서비스 내용을 구명하기 위해 입원부터 퇴원때까지의 의무기록지를 분석하여 병원에서 제공받은 처치 및 간호내용, 검사내용을 조사하였고, 신경과 전문의와 간호학 교수, 임상병리검사실 등의 자문을 구하였다.

연구결과를 요약하면 다음과 같다.

조기퇴원일 즉 가정간호의뢰일을 추정해본 결과 뇌졸증 환자의 실제 평균 입원기간은 12.9일이며, 7-29일 범위이었으나 가정간호의뢰일을 추정해 보면 평균 9.8일이었으며 범위는 5-25일로서 실제 평균 임원기간 보다 3일정도 감소시킬 수 있는 것으로 분석되었다.

가정간호의뢰일을 추정하는데 환자나 가족의 심리적 준비나 가정여건의 준비 등은 고려할 수 없었으나 재활의학과로 전과된 뇌졸증 환자 및 가정간호에 적합한 많은 수의 환자를 대상으로 하고, 입원시부터 퇴원계획을 하여 가정간호사업에 의뢰한다면 본 연구경과보다 입원기간이 더 단축될 것으로 기대된다.

도출된 가정간호의뢰일 추정기준은 첫째 혈전용해제 또는 항응고제 사용의 종료, 둘째 Coumadine 용량의 결정, 셋째 가정간호사가 Weakness 문제를 관리할 수 있는 시기, 넷째 동반질환의 조절, 다섯째 합병증의 치료, 여섯째 방사선, 특수검사 및 주요검사의 종료이다. 그 외에도 수액공급이 중단되는 시기, 타과 진료의뢰 종료일, 환자상태의 호전시기 등이 기준이 되었다.

뇌졸증 환자에게 병원에서 제공받은 처치 및 간호내용을 중심으로 신경과 전문의 및 간호학 교수의 자문을 구하여 가정간호사가 제공할 수 있는 서비스 내용을 분석한 결과 위생, 영양, 호흡, 배설, 피부, 활동, 투약, 체온유지, 사정 및 관찰, 교육 등 10가지 영역으로 이루어진 39개 활동이 가정간호 서비스 내용으로 된다.

그리고 병원에서 제공받은 임상병리검사와 방사선검사 및 특수검사중 균배양 검사와 동맥혈가스검사를 제외한 임상병리검사가 가정간호 서비스 내용이 될 수 있다.

이상과 같은 결과를 토대로 하여 다음과 같이 제언한다.

1. 좀 더 일반화된 가정간호의뢰일을 추정하기 위하여 가정간호에 적합한 대상자를 선택하여 본 연구에서 도출된 가정간호의뢰일 추정기준과 가정의 여건, 심리적 부담 등 기타 여건을 참작해서 현재 입원중인 환자에게 적응해 보는 전향적 연구가 필요하다.

2. 본 연구의 결과로 밝혀진 가정간호 서비스 내용에 대한 처방(Standing order)과 업무규례서(Protocol)의 작성에 관한 연구가 필요하다.

Estimation of Home Health Care Referral Date and Home Health Nursing Care Services

for Cerebral Vascular Accident Patients

Jang Seung-Won

Department of Nursing, The Graduate School of, Yonsei University

(Directed by Professor Euisook Kim)

There is an increasing demand for home health care services due to the growing

number of elderly people, socio-economic improvements. and changes in the disease

pattern from acute to degenerative diseases and the family structure. In addition,

hospital costs have risen and there is a shortage of ward apace in hospitals,

particularly since national health insurance was introduced. As one of the

alternatives to meet these problems is home health care service.

Home health care in Korea is at its planning stake by the government. In order to

establish effective hole health care service program and to obtain social support,

it is mandatory to carry out scientific studios related to cost-effectiveness of

the home health care and the characteristics of home health care. However, up to

now, there have been few studies in this field.

The purpose of this study was to estimate number of hospital days which can be

shortened if the home health care service were available and the types of horse

health nursing care that should be offered to CVA patients.

The referral date to hole health care service was estimated by the analysis of

medical records for 50 patients who were hospitalized at a private teaching General

Hospital in Seoul during from November 1, 1992 to February 28, 1993. Record

analysis form was developed by the researcher through a review of the literature,

advice from the physician who Is a neuro-medical specialist.

A referral date for patients was estimated cooperated with the physician as a

team through the analysis of the each patient's condition and medical treatment,

diagnostic testis, and nursing care activities.

In order to identify the types of necessary home health care services, hospital

care each patient received was analyzed through the medical records.

The following conclusion have been drawn from the result.

1. For the CVA patients, the mean period of hospitalization was 12.9 days.

However, the clean Period of hospitalization was estimated at 9.8 days if home

health care services were available.

2. The criteria for early discharging derived from microanalysis of 50 patients :

a. Thrombolytic therapy hart been completed.

b. Oral thrombolytic(Coumadine) level was determined.

c. Routine rehabilitation program was determined.

d. Other medical problem are manacled and controlled.

e. Treatment of residual complication has been completed.

f. Diagnostic tests has been completed.

3. Home nursing service consisted of 10 activity areas, namely sanitation,

nutrition, breathing, skin, body temperature maintenance, medication, assessment

and observation, and education. Considering the actual nursing care offered in the

hospital, the types of home health care service consisted of 39 different

activities in 10 different areas.

Exception of culture and artrial blood gas analysis, most of the diagnostic

testis performed in the hospital can be carried out by home healthcare service.

On the basis of the findings of this study, the following recommendations are

made :

1. Replication Study is necessary for the current hospitalized patients using

prospective method. Further research should include the effects of home environment

and psychosocial tractors of the patients related to early discharge and hole heal

th care.

2. Further study is required to develop standing orders and protocols for the

horse nursing care services faced on the findings.

[영문]

There is an increasing demand for home health care services due to the growing number of elderly people, socio-economic improvements. and changes in the disease pattern from acute to degenerative diseases and the family structure. In addition,

hospital costs have risen and there is a shortage of ward apace in hospitals, particularly since national health insurance was introduced. As one of the alternatives to meet these problems is home health care service.

Home health care in Korea is at its planning stake by the government. In order to establish effective hole health care service program and to obtain social support, it is mandatory to carry out scientific studios related to cost-effectiveness of

the home health care and the characteristics of home health care. However, up to now, there have been few studies in this field.

The purpose of this study was to estimate number of hospital days which can be shortened if the home health care service were available and the types of horse health nursing care that should be offered to CVA patients.

The referral date to hole health care service was estimated by the analysis of medical records for 50 patients who were hospitalized at a private teaching General Hospital in Seoul during from November 1, 1992 to February 28, 1993. Record

analysis form was developed by the researcher through a review of the literature, advice from the physician who Is a neuro-medical specialist.

A referral date for patients was estimated cooperated with the physician as a team through the analysis of the each patient's condition and medical treatment, diagnostic testis, and nursing care activities.

In order to identify the types of necessary home health care services, hospital care each patient received was analyzed through the medical records.

The following conclusion have been drawn from the result.

1. For the CVA patients, the mean period of hospitalization was 12.9 days. However, the clean Period of hospitalization was estimated at 9.8 days if home health care services were available.

2. The criteria for early discharging derived from microanalysis of 50 patients :

a. Thrombolytic therapy hart been completed.

b. Oral thrombolytic(Coumadine) level was determined.

c. Routine rehabilitation program was determined.

d. Other medical problem are manacled and controlled.

e. Treatment of residual complication has been completed.

f. Diagnostic tests has been completed.

3. Home nursing service consisted of 10 activity areas, namely sanitation, nutrition, breathing, skin, body temperature maintenance, medication, assessment and observation, and education. Considering the actual nursing care offered in the

hospital, the types of home health care service consisted of 39 different activities in 10 different areas.

Exception of culture and artrial blood gas analysis, most of the diagnostic testis performed in the hospital can be carried out by home healthcare service.

On the basis of the findings of this study, the following recommendations are made :

1. Replication Study is necessary for the current hospitalized patients using prospective method. Further research should include the effects of home environment and psychosocial tractors of the patients related to early discharge and hole health care.

2. Further study is required to develop standing orders and protocols for the horse nursing care services faced on the findings.