혈액 투석환자의 내외적 통제위 성격과 삶의 질과의 관계연구

Abstract

[한글]

만성 질병을 가지고 있는 환자는 그들의 건강문제가 완치되지 못하여 여러가지 신체적, 정신적, 사회적인 문제들을 일평생 지니고 살게된다.

만성 질환중의 하나인 만성 신부전증(Chronic Renal Failure)환자에게 실시되고 있는 혈액투석(Hemodialysis)요법은 환자의 주증상을 완화시켜주고 생명을 연장시켜 주는 효과적인 치료과정으로 인정되어 왔으나 이는 치유법이 아니라 신장기능 대치방안으로서 혈액투석 환자들은 혈액투석에 의존적인 삶을 살게되며 투석 중 합병증, 죽음에 대한 공포, 막대한 경제적 부담을 가지며 장기간의 치료후에도 생기는 우울하고 둔마된 감정등을 경험하고 있다. 또한 질병으로 신체기관의 기능상실을 초래하고 이는 열등한 자아개념으로 확대된다고 하였다. 이러한 모든 인간 행동의 주체가 되는 것은 성격이며 건강에 대한 개인의 행동양식은 그 사람의 성격에 의해 좌우된다고 하였다.

Rotter에 의해 발전된 통제위 개념은 인간은 내적·외적 통제위를 지니고 있으며 통제위 성격의 연구 결과들은 내적 통제자는 외적 통제자에 비해 정서적인 장애가 없고 외적 통제자는 불안, 우울등의 중상을 나타내어 많은 연구에서 개인의 내외적 통제위 성격 성

향에 따라 심리적인 상태가 다르다는 것을 시사하고 있다.

따라서 혈액투석 환자가 지각하는 내외적 통제위 성격 각각의 성향과 일상생활에서 얻는 만족이라고 할 수 있는 삶의 질(Quality of Life)과의 관계를 알아봄으로서 혈액 투석 환자의 심리적 간호중재에 도움이 되기 위한 자료를 제공하고자 본 연구를 시도하였다. 연구대상은 서울시내에 위치한 1개 대학 부속병원과, 2개의 종합병원, 3개의 혈액투석 전문 개인 병원의 인공신장실을 내원하여 혈액 투석 치료를 받는 환자로서 연구에 참여한 대상은 140명이었다. 자료수집 기간은 1990년 4월 15일부터 4월 30일까지였고 자료수집 방법으로는 질문지를 이용한 면접방법을 사용하였다.

연구도구는 내외적 통제위 성격을 측정하기 위하여 Wallston & Wallston등이 개발한 건강 통제위 척도를 사용하였고 삶의 질 정도를 측정하기 위하여 미국 National Conference of Cancer Nursing에서 Rectal Cancer(직장암) 환자를 대상으로 하여 제정한 Quality of Life Scale(O.L.S)를 연구자가 혈액투석 환자의 상황에 맞게 수정 보완하여 사용하였다.

수집된 자료는 전산통계처리하여 실수, 백분율, 최소값, 최대값, 평균, 표준편차, t-test, ANOVA, Pearson Correlation Coefficient 등의 통계방법으로 분석하였다.

본 연구의 결과는 다음과 같다.

1. 내외적 통제위 성격의 성향은 최소 1점에서 최대 6점까지의 분포를 보이는 데 대상자의 내적성향은 최소값이 1.17, 최대값이 6.00 이었으며, 평균이 4.48, 표준편차 0.95로 대상자들의 내적 성향이 평균보다 높음을 나타내었고 외적 성향은 최소값이 2.00, 최대 값이 5.25이었으며 평균 3.79, 표준편차 0.68로 내적 성향보다 낮게 나타났다.

2. 삶의 질 정도는 최소 0점에서 최대 10점까지의 분포를 보이는 데, 대상자의 삶의 질 정도는 최소값이 1.60, 최대값이 9.25이었고, 평균 5.14, 표준편차 1.60으로 삶의 질 정도가 낮은 편이었다.

3. 대상자의 내외적 통제위 성격과 삶의 질과의 관계를 분석한 결과, 내적 성향과 삶의 질과의 관계는 통계적으로 유의한 순상관 관계가 있는 것으로 나타났으며(r=.30, p<.01) 외적 성향과 삶의 질과의 관계는 통계적으로 유의한 역상관 관계가 있는 것으로 나타났

다(r=-.16, p<.05). 따라서 내적 통제위가 높을수록 삶의 질이 높고 외적 통제위가 높을수록 삶의 질이 낮았다.

4. 대상자의 일반적 특성중 가정 월수입이 높은 집단이 삶의 질이 높은 것으로 나타났으며(F=5.97, p<.05) 100만원 이상군, 60만원 이상 100만원 미만군, 30만원이상 60만원 미만군, 30만원 미만군의 순위로 삶의 질이 높게 나타났고, 종교가 있는 대상자 집단이 없는 대상자보다 삶의 질이 높은 것으로 나타났다(t=2.16, p<.05).

결론적으로, 내외적 통제위 성격 성향과 삶의 질 정도와는 유의한 관계가 있었으며 혈액투석 환자가 내적성향 일수록 삶의 질 정도가 높으며, 외적성향일수록 삶의 질 정도가 낮았다. 따라서 대상자의 삶의 질을 증진시귀고 심리적 간호 중재에 있어 통제위 성격을

고려할 것을 제언한다.

A Study of the Relationship Between the Internal - External Locus of Control and

Quality of Life

Kang, Kyung Ah

Department of Nursing, The Graduate School of Yonsei University

(Directed by Professor Kim, Cho - Ja, Ph.D.)

Because chronic disease is not curable but only controllable, patients who

suffers from a chronic disease may have physical, mental and social problems for

the rest of their lives.

This is particularly important when hemodialysis therapy is used for patients

with chronic renal failure. Hemodialysis is recognized as an effective procedure

but only as one in which the main symptoms are mitigated and life prolonged, that

is, it is an allopathic treatment, not a cure. And the hemodialysis patient who

lives dependently on hemodialysis, has complications, friars of death, serious

economic problems and experiences depressive feelings even after a long period of

treatment. In addition to the illness there is a loss of function of body organs

and that makes the patient feel inferior. The main factor influencing all of these

human behaviors is personality and personal behavior for health depends on

personality.

The locus of control developed by Rotter contains the concept that man has an

internal-external locus of control. According to the results of studies on locus of

control in personality, people with an internal locus of control do not have the

emotional problems that those with an external locus of control have. Those with an

external locus of control show feelings of insecurity, depression and melancholy.

These studies indicate that mental conditions differ according to the person's

internal-external locus of control.

So this study was designed to provide data for psychiatric nursing care for the

patient on hemodialysis. The aim was to examine the relationship between lotus of

control and quality of life, which is a measure of satisfaction with daily life.

The subjects for this study were 140 patients receving hemodialysis at one

university hospital, two general hospitals and three private clinics for

hemodialysis therapy in Seoul. The data were collected during the period from April

15, 1990 to April 30, 1990, and were obtained by use of a questionare and an

interview.

The instruments used for this study were for locus of control, the health locus

of control scale developed by Wallston & Wallston and for quality of life, the

Quality of Life Scale originally designed for rectal cancer patients by The

American National Conference on Cancer Nursing. The writer modified the latter to

make it suitable for hemodialysis patients. The data were analyzed by use of

descriptive statistics: mean: standard deviation: t-test: ANOVA: Pearson

Correlation Coefficient: using the SPSS program.

The results of this study are as follows:

1. The locus of control of the subjects showed a distribution from a minimum of 1

to a maximum of 6. The internal locus of control had a mean score of 4.48, a

standard deviation of 0.95, a minimum score of 1.17, and a maximum score of 6.00.

This shows that the internal locus of control is higher than the mid point on the

scale. And The external locus of control had a mean score of 3.79, a standard

deviation of 0.68, a minimum score of 2.00 and a maximum score of 5.25. The

external locus of control score was lower than the internal locus of control.

2. The quality of life showed a distribution from a minimum of 0 to a maximum of

10, a mean score of 5.14, a standard deviation of 1.60, a minimum score of 1.60,

and a maximum score of 9.25. The quality of life score was low in comparison with

other studies using this scale.

3. The result of this study of the relationship between locus of control and

quality of life indicated a significant correlation between interval locus of

control and quality of life(r=.30, p<.01). There was a negative correlation between

external locus of control and quality of life(r=-.16, p<.05). Therefore the higher

the internal locus of control, the higher the quality of life, and the higher the

external locus of control, the lower the quality of life.

4. When the demographic characteristics of the subjects were examined, it was

fecund that the higher monthly income, the better quality of life(F=5.97, p<.05),

and when a religion was considered, the quality of life was higher(t=2.16, p<.05).

In conclusion, this study showed a deep relationship between locus of control and

the quality of life : the higher the internal locus of control, the higher the

quality of life, and the higher the external locus of control, the lower the

quality of life. Therefore, if the quality of life is to be improved in patients on

hemodialysis therapy the locus of control must be considered in psychiatric nursing

ears.

[영문]

Because chronic disease is not curable but only controllable, patients who suffers from a chronic disease may have physical, mental and social problems for the rest of their lives.

This is particularly important when hemodialysis therapy is used for patients with chronic renal failure. Hemodialysis is recognized as an effective procedure but only as one in which the main symptoms are mitigated and life prolonged, that is, it is an allopathic treatment, not a cure. And the hemodialysis patient who lives dependently on hemodialysis, has complications, friars of death, serious economic problems and experiences depressive feelings even after a long period of treatment. In addition to the illness there is a loss of function of body organs and that makes the patient feel inferior. The main factor influencing all of these human behaviors is personality and personal behavior for health depends on personality.

The locus of control developed by Rotter contains the concept that man has an internal-external locus of control. According to the results of studies on locus of control in personality, people with an internal locus of control do not have the emotional problems that those with an external locus of control have. Those with an external locus of control show feelings of insecurity, depression and melancholy.

These studies indicate that mental conditions differ according to the person's internal-external locus of control.

So this study was designed to provide data for psychiatric nursing care for the patient on hemodialysis. The aim was to examine the relationship between lotus of control and quality of life, which is a measure of satisfaction with daily life.

The subjects for this study were 140 patients receving hemodialysis at one university hospital, two general hospitals and three private clinics for hemodialysis therapy in Seoul. The data were collected during the period from April 15, 1990 to April 30, 1990, and were obtained by use of a questionare and an

interview.

The instruments used for this study were for locus of control, the health locus of control scale developed by Wallston & Wallston and for quality of life, the Quality of Life Scale originally designed for rectal cancer patients by The American National Conference on Cancer Nursing. The writer modified the latter to make it suitable for hemodialysis patients. The data were analyzed by use of descriptive statistics: mean: standard deviation: t-test: ANOVA: Pearson Correlation Coefficient: using the SPSS program.

The results of this study are as follows:

1. The locus of control of the subjects showed a distribution from a minimum of 1 to a maximum of 6. The internal locus of control had a mean score of 4.48, a standard deviation of 0.95, a minimum score of 1.17, and a maximum score of 6.00. This shows that the internal locus of control is higher than the mid point on the scale. And The external locus of control had a mean score of 3.79, a standard deviation of 0.68, a minimum score of 2.00 and a maximum score of 5.25. The external locus of control score was lower than the internal locus of control.

2. The quality of life showed a distribution from a minimum of 0 to a maximum of 10, a mean score of 5.14, a standard deviation of 1.60, a minimum score of 1.60, and a maximum score of 9.25. The quality of life score was low in comparison with other studies using this scale.

3. The result of this study of the relationship between locus of control and quality of life indicated a significant correlation between interval locus of control and quality of life(r=.30, p<.01). There was a negative correlation between

external locus of control and quality of life(r=-.16, p<.05). Therefore the higher the internal locus of control, the higher the quality of life, and the higher the external locus of control, the lower the quality of life.

4. When the demographic characteristics of the subjects were examined, it was fecund that the higher monthly income, the better quality of life(F=5.97, p<.05), and when a religion was considered, the quality of life was higher(t=2.16, p<.05).

In conclusion, this study showed a deep relationship between locus of control and the quality of life : the higher the internal locus of control, the higher the quality of life, and the higher the external locus of control, the lower the quality of life. Therefore, if the quality of life is to be improved in patients on hemodialysis therapy the locus of control must be considered in psychiatric nursing ears.