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지지간호가 군 요통환자의 우울.기분.만족에 미치는 영향

Other Titles
 (The) effect of supportive nursing care on depression, mood and satisfaction in millitary patients with low back pain 
Issue Date
1990
Description
간호학과/박사
Abstract
[한글] 지지간호는 간호상황에 있어서 중요한 개념으로서 신체적·정신적 건강을 증진시키는데 효과가 있다. 그러나, 지지개념에 대한 정의와 행위에 대해 연구자들은 의견이 거의 일치되고 있지 않았다. 본 연구는 Walker와 Avant(1983)의 개념분석과정에 의해 지지개념을 분석하고, 지지간호를 군병원 요통환자에게 적용하며 그 효과를 알아보기 위해 시도된 실험연구이다. 개념분석과정에 의해 지지욕구에 대한 인지, 상호호혜적인 관계형성, 경청과 감정이입, 건강에 관련된 정보제공 그리고 언어적·비언어적 반응의 확인을 포함한 일련의 속성들로 지지간호를 정의하였다. 지지간호의 효과를 확인할 목적으로 실시한 실험은 King(1970)의 대인 관계이론을 이론적 기틀로 하여, 군병원 요통환자에게 지지간호를 제공하고 종속변인을 우울·기분·만족으로 측정하는 Solomon 4 Group 설계에 의하였다. 연구대상자는 3개의 국군병원 신경외과병동에 입원해 있는 150명의 요통환자로서 실험군 36명, 사전-사후조사대조군 39명, 실험처치-사후조사대조군 36명, 사후조사대조군 40명이었다. 지지간호는 개념분석에 의해 정의된 속성에 따라 연구자가 요통환자에게 맞도록 개발하여 사용하였으며, 신체적 지지와 정보의 내용을 보완하기 위하여 연구자가 개발한 시청각자료를 이용하여, 매회 30분씩 5일동안 하루 걸러 한 번씩 제공하였다. 연구도구는 종속변인의 측정을 위해 Zung의 자가평가 우울척도, Ryman, Blersner, LaRocco의 형용사형 기분검사도구, LaMonica, Oberst, Nadea, Wolf의 환자 만족척도를 사용하였다. 자료수집기간은 1989년 4월 25일 부터 7월 7일까지로서 연구절차는 사전조사 실시하고 7일 후 지지간호를 5일간 주고, 실험직후에 네집단으로부터 사후조사를 하고 사후조사후 일주일 만에 실험군과 실험처치-사후조사대조군에게 추후조사를 하였다. 자료분석은 x**2-test, t-test, paired t-test, 분산분석, Meta Analysis를 이용하였다. 연구결과의 요약은 다음과 같다. 1) 가설, "지지간호를 받은 요통환자와 지지간호를 받지 않은 요통환자의 우울정도는 차이가 있을 것이다"는 이원분산분석에 의해 유의한 차이를 보여 지지되었다(F=8.49, P<.05). 2) 가설, "지지간호를 받은 요통환자와 지지간호를 받지 않은 요통환자의 기분정도는 차이가 있을 것이다"는 Meta Analysis에 의해 유의한 차이를 보여 지지되었다(Z meta=2.17, P<.05), 3) 가설, "지지간호를 받은 요통환자와 지지간호를 받지 않은 요통환자의 만족정도는 차이가 있을 것이다"는 이원분산분석에 의해 유의한 차이를 보여 지지되었다(F=13.67, P<.05). 4) 사전조사의 주효과와 사전조사와 실험처치의 상호작용에 의한 상호작용효과는 4개 연구집단에 대한 이원분산분석에 의해 유의하지 않은 것으로 나타났으므로, 요통환자의 우울·기분·만족의 변화에 영향을 미치지 않았다. 5) 새집단의 측정치인 실험군 사전조사, 사전-사후조사대조군 사전조사, 사후조사대조군 사후조사에 대한 분산분석에서 유의한 차이가 없는 것으로 나타나, 우연한 변수의 개입과 대상자성숙에 의한 효과가 대상자의 우울·기분·만족의 변화에 영향을 미치지 않았다. 6) 지지간호를 제공받은 집단의 사후조사와 일주일후 실시된 추후조사에서 관찰된 우울·기분·만족 점수에서 유의한 변화가 없는 것으로 나타나 지지간호의 효과는 지속되었다. 이상의 연구결과에 의하면, 개념분석과정에 의해 정의된 지지간호는 간호사에 의한 지지행위를 구체적으로 서술한 조직적인 간호처방으로서 요통환자의 우울·기분·만족의 긍정적 변화를 가져오는데 효과적인 것으로 밝혀졌다.
[영문] Support has always been considered an important nursing concept. However, there is no agreement among nurse researchers as to a conceptual definition of supportive nursing or meaningful supportive behaviors. Clarification of the concept, support in nursing, is necessary to promote communication among nurses on nursing behaviors that are effeotive in providing support and on understanding the relevant properties and chracteristics of the concept, supportive nursing care. The objectives of the study were: 1. to analyze the concept, support in nursing, in order to provide a definition of supportive nursing care, and 2. to operationalize the definition of supportive nursing care and use it as an experimental nursing intervention for patients with low back pain. The first part of the study used the concept analysis approach developed by Walker and Avant(1983) to define the concept or supprotive nursing care. The properties of supportive nursing care, defined by this analysis, included perception of supportive need, reciprocal interaction(Transaction), listening, providing empathy and information related to health, and confirmation of the patient's verbal and non-verbal response. The second part, the experimental part of the study, was done using King's(1970) Interpersonal Theory for Nursing. The concept, supportive nursing care, as defined in the conoept analysis was operationalized and used as the experimental intervention. The experiment tested the effectiveness of the independent variable, supportive nursing care on the dependent variables, depression, mood and patient, satisfaction, in the patients with low back pain in army hospitals. The instruments used to measure the dependent variables were Zung's(1965) Self-Rating Depression Scale, Ryman and Colleagues'(1974) Mood Questionnaire and LaMonica and Colleagues'(1986) Patient Satisfaction Scale. The experimental design used for this study was a Solomon 4 group experimental design. This design has the strength of allowing for observation of the main effects of supportive nuring care and pretesing, and for observation of the interaction effects of pretesting and supportive nursing care. The design includes one experimental group and three control groups. The subjects of this study were 150 young male patients with low back pain on Neuro-Surgical Wards in three general army hospitals. There were 35 in the experimental group, 39 in the pre-posttest control group, 36 in the treatment-posttest, cotrol group and 40 in the posttest only control group. Supportive nursing care, as operationalized by the researcher according to the concept analysis, was given to the patients in the experimental group and the treatment posttest control group, individually for 30 minute sessions, every other day for 5 days. Data collection was done using a questionnaire. The data were collected in a pretest one week before the supportive nursing care sessions, a posttest immediately after the sessions and a follow-up test one week later. Hypotheges testing was done using 2 x 2 factorial analysis of variance and Meta analysis(Stouffer's Z method). The regults of this study are summarized as follows; 1. Hypothesis Ⅰ, "There will be a difference on depression level between the patients with low back pain who receive supportive nursing care and those who do not receive supportive nursing care", was supportod (F=8.49, P<.05). 2. Hypothesis Ⅱ, "There will be a difference on mood level between the patients with low back pain who receive supportive nursing care and those who do not receive supportive nursing care", was supported (Z meta=2.17, P<.05). 3. Hypothesis Ⅲ, "There will be a difference on satisfaction level between the patients with low back pain who receive supportive nursing care and those who do not receive supportive nursing care", was supported(F=13.67, P<.05). 4. ANOVA, done to examine the interaction effect of history and maturation, showed no significant diffrence on the dependent variables between the observations of the pretest scores of the experimental group, the pretest scores of the pre-posttest control group and the posttest score of the posttest only control group. 5. To test for continuing effect of supportive nursing care, paired t-test was done to compare the scores for the dependent variables at the posttest and at the one week later follow-up test. No significant difference on the scores for the dependent variables was found between the posttest scores and the follow-up test scores for the two groups that received supportive nursing care, the experimental group and the treatment-posttest control group. In conclusion, it was found that in the case of young soldiers with low back pain in army hopitals, their depression level was decresed, their mood state was changed positively and their satisfaction level was increased by receiving supportive nursing care. Further, the effectiveness of the supportive nursing care lasted for at least one week in this study. The significance of this study to nursing is in the analysis of the concept of supportive nursing care and the demonstration of the effectiveness of supportive nursing care as an intervention within the limits of the study.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/118485
Appears in Collections:
2. 학위논문 > 3. College of Nursing (간호대학) > 박사
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