보건소 방문간호사업의 간호활동 분석

Abstract

[한글]본연구는 중소도시 보건소의 방문간호대상가구에 대한 방문간호활동을 분석한 것이다. 이는 2000년도부터 방문간호사업 활성화를 위한 구체적인 운영지침의 시달등 정부의 새로운 방향전환을 함에 있어 우리나라 보건소 방문간호사업 가구에 대한 특성, 건강문제, 간호활동, 문제해결수준 및 방문간호요구도를 파악함으로써 체계적인 방문간호사업 기획에 기초자료를 제공하기 위한 목적으로 시도되었다.

이를 위하여 경기도 일개 시 보건소를 임의로 선택하여 방문간호사업 관리대상가구 총 736가구중 김의숙(1996)등이 제시한 방문간호기록지를 작성하기 시작한 1999년 3월부터 2000년 9월까지 1년 7개월간 등록된 가구로 간호문제가 많은 200가구를 추출하였다.

추출된 200가구의 가정건강기록부와 가정방문기록지를 분석하기위하여 기록분석지를 개발하여 분석하였다.

기록분석지를 이용하여 분석된 결과는 SPSS/PC 통계프로그램을 이용하여 처리였으며 빈도와 비율로 특성별 분포를 산출하였다.

본 연구조사는 일반적특성, 가족건강문제, 방문간호활동, 방문간호요구도, 방문간호결과에 대한 조사하여 파악된 결과가 다음과 같은 결론을 얻었다.

1. 대상가구는 200가구에 가구원수는 총 425명으로 평균가구원수는 2.2명이며, 89.6%가 생활보호대상가구였으며,특히 독거노인가구가 33%로 가장 많았다. 대상가구의 가구원 평균연령은 52.2세이었고 65세 이상노인인구가 45.1%이었다.

2. 문제가족유형은 취약가족, 환자가족, 위험행위가족, 주거환경문제가족, 정규관리가족순이였으며, 특히 환자가족중 만성질환자가족이 76.0%로 가장 많았고 그다음이 위험행위가족중 부적합한 건강관리가족이 47%, 취약가족중 장애가족이 35.0%, 소외가족이 33.0%이었고, 주거환경위험가족이 31.5%순이었다.

3. 가족분류의 중복빈도가 높은 가족은 만성질환자가족과 빈곤가족이 39가구, 만성질환자가족과 소외가족이 36가구, 노인가족과 빈곤가족이 34가구, 노인가족과 만성질환자가족과 빈곤가족이 29가구로 노인가족·빈곤가족·만성질환자가족이 주된 가족문제로 복합되어 있었다.

4. 가구원이 가지고 있는 만성질환은 24종류였다. 가구원의 만성질환상태는 관절염이 22.5%, 고혈압 16.4%, 당뇨 8.6%, 뇌졸중 7.5%, 정신질환 7.4%, 소화기질환 4.4%, 심장질환 4.2%, 백내장 3.6%, 호흡기질환 3.0%, 암 3.0%등 순의 빈도였고, 장애 9.4%였다.

5. 가정방문시 파악한 가구원의 주요문제는 근골격계문제 105건, 정신장애문제 46건, 소화기계문제 44건, 증상·증후가 불명확한 상태가 38건, 호흡기계문제 27건, 신장·비뇨기계문제 22건, 안과문제 22건, 피부질환문제 9건등 신체적증상이 있었고, 보건소/병의원/행정기관의뢰가 35건, 가족구성원의 갈등문제 32건,재정적문제 13건 일상생활불편 10건등 49개의 대상자 불편문제가 도출되었으며, 이는 주로 만성질환으로 인한 증상으로 나타났다.

6. 대상가구의 총방문횟수는 3,186회 였고, 평균방문기간은 평균 15.15개월이었다. 1회 평균방문시간은 18.2분이었으며, 등록기간이 길어짐에 따라 방문횟수와 1회 평균 방문시간이 줄어들고 있었다.

7. 총대상가구에 제공한 간호활동 빈도는 건강상태사정와 질병상태 및 건강관리양상 파악, 투약관리제공, 질병자가관리교육, 근육관절운동순으로 활동빈도가 높았다. 등록기간에 관계없이 간호활동의 제공빈도는 변화가 없었으나 투약제공관리는 등록기간이 증가함에 따라 그 빈도가 증가하였다.

8. 방문요구도는 가구의 자가관리능력인 문제에 대한 인식도와 문제대응을 위한 지시 및 기술정도, 지지자원 보유정도, 생활수준(지불능력)을 중심으로 측정하여 집중관리군이 12.1%, 정기관리군이 60.6%, 감시/추후관리군이 22.9%, 자가관리군이 4.4%빈도로 나타났다. 방문기간이 길어짐에 따라 집중관리군은 감소한 반면, 자가관리군은 증가하였으며 정기적관리군과 감시/추후관리군은 큰 변화가 없었다.

9. 방문간호결과로 간호활동이 제공됨으로서 대상가구에 상병조절, 환경적, 행정적, 정서/심리적, 경제적, 복지적, 가족갈등, 건강증진, 신체불편정도이 해결된 정도로 완전해결이 0.5%, 상당히해결이 14.5%, 호전이 62.2%, 변화없음이18.9% , 악화되었음이 3.9%빈도로 나타났다. 등록기간이 길어짐에 따라 변화없음가구가 감소하는데 등록 3개월보다 등록 4∼6개월에서 현저히 감소하였다. 또한 대상가구의 문제해결정도가 상당히 해결되고 있는 가구가 등록기간이 길수록 증가하고 있는데 등록 2개월에서 문제가 상당히 해결된 가구보다 등록 3개월째 문제가 상당히 해결된 가구가 2배정도 증가하였다.

간호활동은 주로 대상가구의 만성질환자발견과 치료관리에 주력했음을 볼수있었다.

방문간호활동으로 대상가구가 스스로 문제확인과 관리할 자가관리능력이 길러졌슴에도 불구하고, 사망·전출시에만 가구방문을 종결함으로서 자가관리능력이 길러진 이후의 간호활동은 단순히 말벗이나 정서적지지등 추후관리가 제공되었을 뿐이었다.

대상가구의 문제해결정도가 등록3개월째에 상당히해결이 많은것과 같이 대상가구의 건강관리는 2∼3개월째에 turning point가 되어 변화되어지는 것으로 보여짐에따라 간호활동도 대상가구의 자가관리능력을 고취시키는데 역점을 두어야겠다.

[영문]This study conducted an analysis of visiting nursing activities for the object households under the jurisdiction of local city public health centers. It was attempted for the purpose of providing basic data needed for formulating systematic visiting nursing strategies by grasping the characteristics, health problems, nursing activities, problem-solving levels and the needs of visiting nursing of the object households of public health centers in Korea, in an effort to achieve a turnaround of the government strategies for vitalizing visiting nursing activities that began in 2000.

For that purpose, a local city public health center was sampled out. Among all the 736 visiting nursing object households, those 200 problem ones were takes as subjects who had been registered for one

year and seven months from March 1999 through September 2000. Distributed to them were copies of the visiting nursing form created by Kim Eui-sook, et al (1996).

And then an analysis was carried out of those 200 households' home health records and visiting nursing form responses.

The results processed with statistic analysis using the SPSS/PC statistic program, and then distribution of characteristics was calculated by frequency and ratio.

Resultant findings were revealed of the respondents' general characteristics, family health matters, visiting nursing activities, the needs of visiting nursing, and the results of visiting nursing, as follows:

1. The number of members of the 200 households totaled to 425, the mean number of household members 2.2 those object households formed 89.6% who are in need of livelihood support, those old people leading a solitary life 33%, and the mean span of life of the object households represented 52.2 years of age.

2. Family problems type in vulnerable families, families with patient, families with risk behavior, families with residential problem, and families with follow-up needs. In particular, chronic disease families reflected the highest value by 76.0% among the families with patient, and then came in order of inappropriate health care families 47% among families with risk behavior disabled families 35.0% among vulnerable families, alienated families 33.0% and residential environment families 31.5% among families with residential problem.

3. Families of the highest multiple frequency in the family classification showed 39 households in chronic disease and underprivileged families, 36 in chronic and alienated families, 34 in old and underprivileged families, 29 in chronic disease and underprivileged families, which indicates old families, underprivileged families, chronic families as their principal family problems.

4. The respondents' chronic diseases represented 22.58% in arthritis, 16.4% in hypertension, 8.4% in diabetes, 7.5% in apoplexy, 7.4% in mental disorders, 4.4% in digestive trouble, 4.2% in heart trouble, 3.6% in cataract, 3.0% in respiratory diseases, 3.0% in cancer, and 9.4% in disableness.

5. Principal problems of household members identified at the time of home visits indicated 105 musculoskeletal disorder cases, 46 mental disorder ones, 44 digestive trouble ones, 38 uncertain symptom ones, 35 ones requested by public health centers, clinics or hospitals, or administrative organs, 32 family complication ones, 27 respiratory trouble ones, 22 renal or urologic disorder ones, 22 ophthalmic ones, 13 financial problem ones, 10 daily life inconvenience ones, 9 dermatologic disease ones, and other physical symptoms. From these 49 inconvenience problems were derived such as 35 cases requested by public health centers/clinics or hospitals/administration organs, 32 family members complication cases, and financial problem cases. And it was identified that they were developed for the most part to chronic symptoms.

6. The total number of visits on overall object households showed 3,186, the mean term of visits per household revealed 15.15 months, and the mean length of time per visit 18.2 minutes. The lengthened term of registration makes the number of visits and the length of time per visit reduced.

7. Frequency of nursing activities provided to the total object households was represented in order of grasping health conditions, disease states, health care, administration of medicine, education for home care and exercise for muscles and joints. The provision of nursing activities showed no change in frequency, irrespective of its length of registration term but administration of medicine increased in its frequency as the term of registration gets lengthened.

8. Requests for visits were determined according to the instructions, technical levels, the degrees of having support resources, standards of living (payability), being classified into an intensive care group, a regular care group 12.1%, a surveillance/follow-up care group 60.6%, and a self care reliance group 4.4%. When the length of a visit got lengthened, the quantity of the intentive care group got reduced, while the home care groups was on the increase but no significant changes were found both in the regular care group and in the surveillance/follow-up care group.

9. With provision of nursing activities as a result of visiting nursing, care for diseases, environmental, administrative, emotional/ psychological, economic, welfare, family complications, the promotion of health, physical inconveniences, etc., the degree of resolution achieved was revealed with a perfect resolution by 0.5%, a considerable resolution by 14.5%, an improvement by 62.2%, no change by 18.9%, and an aggravation by 3.9%. As the length of the registration term got lengthened, the number of no change families reduced, especially remarkably in 4-6 months after registration than in 3 months of registration. The longer the length of the registration term, the more the number of households that had resolved their problems to a certain extent. The number of households that have solved their problems in some degree in 3 months after registration increased twice as much as those which had solved their problems in some degree in 2 months after registration.

Notwithstanding that visiting nursing could lead the object households to identify and manage their problems themselves with their home care abilities, it ceased its activities in case of death or residental transfer. In consequence, nursing activities were deemed to be a role win serving as a conversational partner, an emotional supporter or a follow-up care provider. It was revealed that nursing activities focused principally on the detection of and care for chronic diseases of the object households.

It is recommended that we should lead nursing activities to inspire home care abilities of the object households inasmuch a turning point was reflected in their health8 care in a few months, as a considerable number of problems were resolved in three months after registration.