초기 파킨슨병 대상자의 간호교육요구도

Abstract

[한글]

본 연구는 파킨슨병으로 진단받은 초기 대상자의 간호교육요구도를 파악하기 위하여 시도된 횡단적 서술적 조사연구이다. 본 연구의 자료수집은 2007년 4월 9일부터 5월 20일까지 진행초기파킨슨병을 진단받은 외래 환자들 중 서울의 A병원 파킨슨센터 및 신경과 외래와 경기도의 B병원 신경과 외래에 내원하는 자 200명(H & Y stage I-III)에게 1: 1면담을 통한 질문지법을 통하여 이루어졌다. 질문지의 내용은 전체 50개 항목으로 대상자의 일반적 특성 9문항, 질병관련 특성 8문항, 질병 인식 5문항, 질병 지식 10문항, 심리적 상태 4문항, 신체적 상태 3문항, 간호교육요구도를 파악하는 11개 문항으로 구성되었다.주요 연구결과는 다음과 같다.1. 대상자의 특성은 평균 연령이 69.4세였고, 최종학력은 초등학교 졸 이하가 94명(47.0%), 고졸이하 33명(16.5), 대학교 이상이 45명(22.5%)으로 조사되었다. 최초 이상증상이 나타난 시기는 평균 5.9년(± 5.2) 전, 이상증상을 자각 후 병원을 방문하기까지는 평균 20개월(± 22.2), 이상증상을 자각 후 파킨슨병이라고 최초 진단을 받는 데에는 26개월(± 30.1)이 걸린 것으로 나타났다. 이상증상으로는 진전 144명(72.0%), 보행 장애 101명(50.5%), 움직임이 느려짐 65명(32.5%) 순으로 많았고, 이상증상 자각 후 가장 많이 방문한 기관은 한의원으로 107명(53.5%)이었다.2. 진단 전 인식에서는 중풍이라는 응답이 98명(49.0%)으로 가장 많았고, 다음으로는 수전증, 디스크, 동반질환의 합병증 순이었으며, 진단 전 파킨슨병에 대한 인식조사에서는 전혀 없었다 164명(82.0%), 있었다 36명(18.0%)이었다. 현재 파킨슨 약물의 효과에서는 좋다 104명(52.0%), 나쁘거나 없다는 각각 49명(24.5%), 47명(23.5%)순으로 나타났다.3. 지식은 10점 만점에서 평균7.5점(± 1.3)이었고, H & Y stage가 진행될수록(P=0.01), 증상발현 후 병원을 조기에 방문할수록(p=0.04), 진단 받은 지 오래될수록 지식 점수는 유의하게 높았다.(p=0.02)4. 심리상태는 자주 불안하다/ 자주 우울하다/ 가정과 직장생활이 어렵다/ 주위에 병을 알리고 싶지 않다는 항목에서 각각 165명(82.5%)/ 160명(80.0%)/ 154명(77.0%)/ 146명(73.0%)이 그렇다고 응답하여 높은 우울상태를 나타냈고, 신체적 상태는 124명(62.0%)이 아직은 혼자서도 일상생활이 가능하다고 응답했다.5. 간호교육요구도는 총점 11점에 평균 8.1점(± 2.1)이었고, 치료 중 병원을 방문해야 할 시기 192명(96.0%), 합병증 190명(95.0%), 약물정보 182명(91.0%), 질병 진행과정 179명(89.0%) 순으로 요구도가 높게 조사되었다.6. 간호교육요구도에 영향을 주는 요인으로는 질병 수가 많을수록 (p=0.02), 파킨슨 치료약물 외 복용약물 수가 많을수록(p=0.02), 최초 이상증상 발현 시기가 최근일수록(p=0.04), 신체적 장애가 적을수록 간호교육요구도는 높게 나타났다(p=0.00).본 연구를 통해 초기 파킨슨병 대상자의 간호교육요구도가 높음을 확인할 수 있었으며, 앞으로 이러한 요구도를 만족시킬 수 있는 초기 파킨슨병 대상자를 위한 간호교육 프로그램의 개발을 제언한다. 또한 파킨슨병의 조기진단 및 치료를 위해 노인들의 파킨슨병에 대한 인식을 높일 수 있는 전략 마련과 파킨슨병이 진행됨에 따라 변화하는 간호요구도에 따른 적절한 간호가 제공 될 수 있도록 후기 파킨슨병 대상자의 간호요구도 사정 또한 필요하다고 생각된다.

[영문]This is a cross and descriptive study aimed to assess nursing needs of patients with early stage Parkinson's disease. The study was conducted during the period from April 9 through May 20, 2007. A face-to-face questionnaire was administered to 200 outpatients visiting A hospital in Seoul and B hospital in Gyeonggi Province for treatment of Parkinson's disease (H&Y stage I~III). The questionnaire consisted of 50 items measuring general characteristics (9), illness-related characteristics (8), awareness of the disease (5), knowledge of the disease (10), psychological state (4), physical conditions (3) and educational nursing needs (11).The results of the study are summarized as follows:1. The mean age of respondents was 69.4 years. Of total respondents, 94 (47.0%) had a elementary school diploma and 45 (22.5%) had a college degree. The mean period following the onset of Parkinson's disease was 5.9 (± 5.2) years.Respondents took 20(± 22.2) months on average to see a doctor even after realizing abnormal symptoms. Respondents took 26(± 30.1) months on average to be diagnosed with Parkinson's disease after realizing abnormal symptoms. As for abnormal symptoms, 114 (72.0%) experienced tremor, 101 (50.5%) experienced gait disturbance and 65 (32.5%) experienced slow movement. The most frequently favored type of treatment was oriental medicine as 107 (53.5%) patients visited oriental medical clinics.2. Of total respondents, 98 (49.0%) respondents assumed that they had a stroke before being diagnosed with Parkinson's disease. Stroke was followed by essential tremor, disc and side effects of other illnesses among self-diagnosed diseases. The majority of respondents (164 or 82.0%) did not know about Parkinson's disease. As for medication treatment, 104 (52.0%) were satisfied with the outcomes of medication use, whereas 49 (24.5%) considered them unsatisfactory and 47 (23.5%) considered them nil.3. The mean score for knowledge of the disease was 7.5 (± 1.3) out of 10, and score was positively correlated to the H&Y stage (P=0.01) and the period following the diagnosis (P=0.02) but negatively correlated to the time span between the onset of symptoms and the first visit to a hospital (P=0.04).4. The most frequent psychological state was uneasiness (165 or 82.5), which was followed depression (160 or 80%), difficulties dealing with family and colleagues maintaining daily life (154 or 77.0%) and reluctance to avoid others (146 or 73.0%). As for physical conditions, 124 (62.0%) said they can perform daily activities without help.5. The mean score for educational nursing needs was 8.1 (8.1점(± 2.1) out of 11. Of total respondents, 192 (96.0%) wanted to know when they need to see a doctor, 190 (95.0%) wanted to know about side effects, 182 (91.0%) wanted to have information on medications, 179 (89.0%) needed the progress of the disease, 83 (41.%) wanted information on surgery and 79 (39.5%) wanted information on meetings and programs related to Parkinson's disease.6. Demand for educational nursing needs of patients was correlated to the number of diseases that patients were suffering from (p=0.02), the number of medications taken for other diseases than Parkinson's disease (p=0.02) and the time period after symptoms first appeared (p=0.04). Those patients who assumed that they had a stroke given symptoms showed a high level of demand for educational nursing needs (p=0.04) Those who did not have physical problems also showed a high level of demand for educational nursing needs (p=0.00)7. Variables that influence demand for educational nursing needs included the number of diseases except for Parkinson's disease, the number of medications taken for other diseases than Parkinson's disease, the time period after symptoms first appeared, self-diagnosed disease, the ability to perform roles and physical problems.The study signifies the role of nurses in helping elderly people learn about the Parkinson's disease and improve their knowledge of the disease. It is imminent to develop an assessment tool to measure demands for education for self-nursing and nursing care among patients with Parkinson's disease.