표준진료지침(critical pathway)을 적용한 당뇨교육의 효과

Abstract

[한글]

과학의 발달과 생활양식의 변화는 수명연장과 더불어 질병양상을 만성질환으로 변화시키고 있다. 당뇨병은 만성 대사성 질환으로 여러 장기를 복합적으로 침범하기 때문에 합병증으로 인한 높은 재 입원률로 의료비 지출을 증가시키고 있다. 또한 당뇨병에 의한 사망은 해마다 증가되고 있어 우리 나라 국민 보건상의 중요한 문제로 대두되고 있다.

당뇨병은 일단 발병하면 완치가 어려우나 적절한 치료와 관리를 수행하면 질병 조절이 가능하므로 합병증을 예방할 수 있어 건강한 삶을 유지할 수 있다. 이에 당뇨병 환자가 자신의 질환에 대한 자가관리를 잘하기 위해서는 올바른 지식을 가지고 꾸준히 대처해 나

갈 수 있도록 실생활에 적응할 수 있는 당뇨교육이 중요하다.

이에 본 연구자는 제 2형 당뇨병으로 입원한 환자들에게 표준진료지침(Critical Pathway)을 적용한 새로운 당뇨교육 입원프로그램과 대부분의 병원에서 실시되고 있는 방법인 전통적인 당뇨교육프로그램과의 효과를 비교 분석하여 효과적인 당뇨교육프로그램 개발에 기여하고자 한다.

연구대상은 2001년 4월 10일에서 10월 15일까지 C대학병원에 제 2형 당뇨병으로 진단 받고 입원한 환자중 표준진료지침을 적용한 당뇨교육프로그램에 참여한 42명, 전통적인 당뇨교육프로그램에 참여한 34명, 총76명이었다. 자료는 교육 전과 교육 3개월 후에 질문지와 생리적 측정도구를 이용하여 수집하였다. 연구도구로는 이기업(1985)이 개발한 A, B형중 B형을 질병과 관련된 지식측정 도구로 이용하였고, 최정심(1984),구미옥(1992)이 개발한 도구를 본 연구자가 수정보완하여 자가간호이행 측정도구로 사용하였으며 혈당측정도구로 당화혈색소치를 이용하였다. 수집된 자료는 SAS Program을 통해 실수와 백분율, Chi-square test, t-test, ANOVA로 분석하였다. 연구결과는 다음과 같다.

제1가설 : "표준진료지침을 적용한 당뇨교육프로그램을 받은 실험군은 전통적 당뇨교육프로그램을 받은 대조군에 비해 질병과 관련된지식의 정도가 높을 것이다."는 기각되었다.

제2가설 : "표준진료지침을 적용한 당뇨교육프로그램을 받은 실험군은 전통적 당뇨교육프로그램을 받은 대조군보다 자가간호이행 정도 가 높을 것이다."는 기각되었다.

제3가설 : "표준진료지침을 적용한 당뇨교육프로그램을 받은 실험군은 전통적 당뇨교육프로그램을 받은 대조군보다 혈당조절이 정상 범주로 더 잘 개선될 것이다."는 채택되었다.

표준진료지침( Critical Pathway)을 적용한 입원교육프로그램이 당뇨병 치료 목표인 혈당조절에는 통계적으로 유의한 차이를 보였다. 질병과 관련된 지식과 자가간호이행은 전통적인 당뇨교육프로그램과의 통계적으로 유의한 차이는 없었다. 그러나 본 연구결과 전통적인 당뇨교육보다 표준진료지침을 적용한 당뇨교육이 질병과 관련된 지식이나 자가간호이행을 더 잘 증가시키는 것으로 나타났으므로 향후 더 많은 대상자를 확보한 후 반복연구를 통하여 표준진료지침을 적용한 당뇨교육의 효과에 대한 객관적인 근거자료를 더 많이 축적한 후에 당뇨교육프로그램으로 임상에 적용할 것을 제언한다.

[영문]

It seems that the development of science and changes in the mode of living today bring about the extension of the span of life and lead the aspects of disease to represent a chronic and metabolic tendency. In as much as diabetes is a chronic and metabolic disease and complicatedly invade internal organs, its complications show a high rehospitalization rate, which thereby gives rise to an increase in medical expenses. Furthermore, the death rate by diabetes increasing year by year, which raises a serious issue about the health of the people in Korea.

Diabetes, if attacked once, is hard to be completely recovered but with treatment and management can alleviate the state of the disease and so be able to prevent complications for the maintenance of a healthy life. In order for a diabetic to successfully carry out efficient self-care of the disease, it is needed to receive such education of diabetes as can be adapted to practical life so that the patient can incessantly cope with it with correct knowledge.

With this in mind, this study put its principal objective on making contribution to the development of effective programs for diabetes by analysing and comparing the effects of the new inpatient diabetic education program that applies the Critical Pathway, a new inpatient diabetic education system carried out for those who are hospitalized for type II diabetes with those of the traditional diabetic education program practised at most of hospitals.

Randomly sampled out as subjects of study were 76 diabetics in total, including 42 who took part in the diabetic education program that applied the Critical Pathway among inpatients who were diagnosed as having type II diabetes at C University

Hospital from April 10 through October 15, 2001, and 34 who participated in the traditional diabetic education program.

Data were collected before education and three months after education by means of a questionnaire poll and a physiological measurement tool. The tools utilized for this study depended upon B of A and B types which developed by Lee Gi-eop (1984)

was used to measure the levels of knowledge of disease, as well as upon the scale developed by Choi Jeong-sim (1985) and Gu Mi-ok (1992), which were corrected and complemented for use of measuring the performance of self-care behavior. And HbA1c were utilized to measure physiological aspects as a blood sugar measurement tool.

The data collected were analysed by means of real numbers, percentage, Chi-square test, t-test, and ANOVA using the SAS Program. Resultant findings were revealed, as follows:

Hypothesis Ⅰ : "The experimental group who have received the diabetic education program that applied the Critical Pathway will have a higher level of knowledge of disease, as compared with the control group who have received the traditional diabetic education program" was rejected.

Hypothesis Ⅱ : "The experimental group who have received the diabetic education program that applied the Critical Pathway will have a higher level of self-care behavior, as compared with the control group who have received the traditional diabetic education program" was rejected.

Hypothesis Ⅲ : "The experimental group who have received the diabetic education program that applied the Critical Pathway will better control blood sugar close to the normal category, as compared with the control group who have received the traditional diabetic education program" was accepted.

The inpatient diabetic education program that applied the Critical Pathway showed a statistically significant difference in having control over blood sugar, one of the principal therapeutic goals of diabetes. However no statistically significant difference was found from comparing the knowledge of disease and the performance of self-care behavior on the inpatient Critical Pathway program with those of the traditional one. However, the results of the present study revealed that the diabetic education program that applied the Critical Pathway represented a higher

increasing rate of knowledge of disease and better performance of self-care behavior, as compared with those of the traditional diabetic education program. Therefore, it is recommended for more follow-up studies to be conducted on more subjects and for the these diabetic education programs to be clinically applied to

patients after the accumulation of more objective data of the effects of the diabetic education applying the Critical Pathway.