Care Systems in Community-Based Contexts: The Role of Navigation and Technology in Promoting Access to Human Services in a Referral Network

Miles, Joshua-Paul Northwestern University ProQuest Dissertations & T 2022 해외박사(DDOD)

The provision of social services is becoming increasingly complex as human service agencies, nonprofits, and government agencies recognize the importance of wraparound care. A wraparound approach to social service provision acknowledges the importance of providing comprehensive services that meet various individual, family, and community needs. This approach is enacted through SoC. Systems of care are interorganizational referral networks that use technology and personnel to coordinate care and mobilize resources. This dissertation explores how community-based SoC use technology and navigation services to support care provision. It uses theoretical frameworks from community development, ecology, community psychology, and technology design to answer three research questions: 1) how do community-based network members perceive or characterize CMT use in collaboration?; 2) how does the use of CMT by community-based organizations mediate access and connection to care?; and 3) how do community navigators in community-based SoC influence access to care? Research question 1 uses a mixed-method approach. It examines how community-based members understand and conceptualize CMT tools concerning care system work and the potential for different use categories to appear. Using semi-structured interviews with 13 care system personnel and examining 467 service episode data from the IRIS case management system, this research finds that the community-based care system sees variation across metrics that point to the provision of care (time to accept, time to close distribution of referrals). Computing these metrics highlights different user categories. Specifically, care system backbone personnel and affiliates (senders) are responsible for routing most service requests. Combinatorially, this difference in use surfaces qualitatively as community-based partners (receivers) point to a reliance on backbone staff as the primary routers of service requests. Although there is uneven use of the CMT, both partners and backbone personnel show that CMTs afford the ability to build community relationships and capacity. These technologies support community connection and resilience that extends past the technologies themselves. These findings expand theoretical explanations surrounding the affordances that case management technologies provide. Research question 2 is descriptively driven and examines the outputs of using these technologies. Specifically, this research question emphasizes care system process metrics like time to accept, rejection rate, time to close by service type, and organization. An examination of 467 service episodes from IRIS finds significant variation in process metrics across service type categories and organizations. These findings suggest that service complexity and service ambiguity influence how community-based organizations provide care. Research question 3 examines how community navigators influence community members' access to services. Through a grounded qualitative approach of interview data from 13 care system personnel, this dissertation finds that community navigators also serve as community resource advocates and consensus builders. The community resource advocate role emphasizes local use of community resources. The consensus builder role underlines the ability of a community navigator to create buy-in and awareness across care system stakeholders to ensure a community member's care-seeking journey is comprehensively supported. Overall, this dissertation provides five key contributions. First, it offers a detailed empirical observation of ecological system theory by explaining how care systems embody the mesosystem and the exosystem. This dissertation expands our understanding of technologies' active role in our development. Specifically, technologies can comprise complex systems of relationships and interactions. Technologies mediate our experiences with others and are co-constitutive. Second, this work extends our theoretical understanding of technological affordance by surfacing a different use category that may be relevant as case management technologies move to community-based contexts. Third, this work provides a typology that expands our understanding of the roles community navigators play that are unique from their counterparts. Fourth, this work serves as a resource and guide to scholars and community-based organizations to fully embrace the potential of technology and community navigators as modes to create social impact and support equitable community development. Finally, this work provides propositions for further research to expand and test the presented results.

Two Essays on Social Robots for the Elderly

Eunkyung Na 고려대학교 대학원 2023 국내박사

우리나라는 2025년에 초고령사회로 진입할 것이라는 전망되고 있다(KOSTAT, 2022). 이러한 급격한 고령화를 통한 인구구조 변화에 따른 노인 돌봄 문제는 우라니라를 포함한 주요 선진국에서 사회 문제로 부상하고 있다. 한편, 정보통신 기술은 사회 전반에 도입, 융합, 적용되고 있는데, 이러한 노인 돌봄 문제를 완화하거나 해결하기 위한 돌파구의 하나로서 지능형 보조 기술 혹은 소셜로봇의 사용이 모색되고 있다. 본 학위 논문은 노인요양의 대표적인 두 환경인 “장기요양시설”과 “가정내돌봄” 환경에서 이해관계자 그룹들(요양서비스 관리자, 요양보호사, 고령자)의 소셜로봇에 대한 인식, 태도를 심층적으로 탐구함으로써 노인 돌봄에서 소셜 로봇의 활용도를 높이는 데 귀중한 시사점을 제공하는 것을 목표로 한다. 이를 위해 본 학위 논문은 두개의 연구논문으로 구성되어 있다. 첫 번째 연구는 노인장기요양시설(Long-term care facility)에서 돌봄 로봇(Care robot)의 도입과 활용에 대한 조직 구성원의 인식과 태도에 관한 연구이다. 장기요양시설을 운영하는 데 중요한 역할을 하는 주요 구성 집단은 요양 서비스 관리자와 요양보호사이다. 본 연구는 사회표상이론(Social representations theory)을 기반으로 하여 반구조적(semi-structured) 개별 인터뷰와 내용분석(content analysis) 기법을 활용하여 관리자와 노동자 사이의 노인 장기요양시설에 돌봄 로봇 도입과 활용에 관련된 다양한 토픽(사회표상)들을 발견했다. 중심-주변(Core-periphery) 구조 분석을 통해 이 두 집단의 돌봄 로봇에 대한 상이한 태도를 확인할 수 있었다. 요양서비스 관리자는 요양보호사에 비해 돌봄로봇 도입에 있어 조심스러운 태도를 보였고, 고령의 거주자와 요양보호사 간의 형성되는 라포르(Rapport)가 돌봄로봇으로 대체될 수 없다는 의견이 중심 토픽으로 나타났다. 반면, 요양보호사는 육체 노동 완화나 작업의 효율화 같은 돌봄 로봇 도입을 통한 혜택(Benefits)이 중심 토픽으로 도출되었다. 전체적으로 돌봄로봇 도입에 있어 부정적인 견해와 관련된 토픽들은 노인장기요양이라는 서비스 운영의 복잡성과 고령의 거주자와의 대면업무와 관련되어 있다. 본 연구는 이러한 두 집단의 상이한 관점을 비교해 봄으로서 장기요양시설에서 돌봄 로봇의 도입과 활용에 있어 학술적, 산업적, 정책적 시사점을 제공했다. 두 번째 연구는 고독사와 사회적 고립 문제가 우려되는 취약계층인 독거 노인들이 집안에서 AI 스피커의 사용행태와 이용과 충족 이론(Uses and gratifications theory)을 기반으로 이용 동기에 관한 연구이다. 이를 위해 아리아(SKT의 AI 스피커)를 1년 이상 지속 사용하고 있는 20명의 독거노인의 자택을 방문하여 반구조적 심층 개별 면접을 집행하였다. AI 스피커 사용행태로는 고착화된 사용을 보이는 고정된 마인드셋(Fixed mindset)과 활용에 다양성을 추구하는 성장형 마인드셋(Growth mindset)을 고령의 사용자에서도 발견할 수 있었다. 인터뷰 참가자들이 경험한 AI 스피커 사용에 있어서 어려움은 음성인식 오작동(Incidental trigger), 자연어 이해오류(Lost in comprehension), 대화흐름의 단절(Breaks in conversation flow)이 도출되었다. 정규성을 기반으로한 사용 패턴으로는 개인의 하루일과의 흐름과 연결되어 규칙적인 사용을 보이는 일상적(Routine)사용과 비규칙적인 사용 패턴을 보이는 간헐적(Intermittent) 사용 행태로 분류되었다. AI 스피커 활용이 기존 미디어나 개인 활동과 관계성에 있어서는 대체성 (Substitute), 보완성 (Supplement), 고유성 (Unique)을 발견하였다. 독거노인들이 AI스피커 이용을 통해 충족된 심리적 충족(Psychological gratifications)과 AI 스피커 이용과정에서 만족감을 유발시키는 미디어 자체 기술적 특성, 그리고 가상 박탈 시나리오에 대한 이용자들의 반응에 관한 토픽들을 내용분석을 통해 추출해 냈다. 이 연구를 독거노인들이 획득한 심리적 충족으로는 고독감 완화(Alleviating loneliness), 안도감(Reassurance), 기분전환(Diversion), 즐거움(Enjoyment), 감성적 반려의식(Emotional companionship)이 토픽으로 추출되었다. 이용과정에서 만족감을 불러일으키는 기술 특성으로는 음성 제어 인터페이스로 누구나 쉽고 간편히 일상어로 조작할 수 있는 접근성(Accessibility), 언제나 시간의 구애가 없고 즉각적으로 서비스가 제공되는 실시간 가용성(Real-time availability), 그리고 서비스 제공에 있어 다양성과 정확성과 관련된 만능성(Versatility)이 도출되었다. 마지막으로 AI스피커의 가상으로 사용 중단과 박탈(Deprivation) 상황에 대한 반응으로는 애착(Attachment)과 불안(Anxiety)과 관련된 반응을 기반으로 3가지 사용자 유형을 발견하였다. 이러한 인터뷰 내용 분석 결과를 바탕으로 독거노인의 복지를 향상시키기 위한 학문적, 실무적이고 정책적인 시사점을 제공했다. Information and communication technology (ICT) has been widely introduced and disseminated across various sectors, including elderly care. Many advanced countries, including Korea, are facing the challenge of a super-aged society, with Korea expected to reach this status in 2025 (KOSTAT, 2022). The issue of elderly care has become a significant social problem, and the use of intelligent assistive technologies is being explored as a potential solution to alleviate or address these challenges. This study aims to provide valuable insights into enhancing the utilization of social robots in elderly care by examining stakeholders' perceptions and experiences in two representative settings: long-term care facilities and aging-in-place. The first essay analyzes the understanding and attitudes of key stakeholders regarding the introduction and use of care robots in long-term care facilities for the elderly. Care service managers and care workers, who play crucial roles in operating these facilities, are the main focus groups. Using social representation theory, this study uncovers diverse topics related to care robots and their associations among care service managers and care workers. By comparing the perspectives of these two groups, the study provides academic, industrial, and policy implications for the adoption and implementation of care robot systems in long-term care facilities. The second essay explores the use of AI speakers among older adults living alone and identifies the reasons behind their long-term use based on the uses and gratifications theory. A qualitative method was employed in this research. By employing semi-structured questionnaires and in-depth interviews with users of Aria (SKT’s AI speaker) who have been utilizing them for over a year, the study identifies topics related to their uses (users’ attitudes, difficulties in use, pattern of use, type of media use), their gratifications (psychological gratifications, technological features), and their responses toward hypothetical depreciation scenario. These findings provide theoretical, practical, and policy implications to enhance the well-being of older adults living alone.

Caring about More than Grades and Test Scores: The Work of Reputationally Caring Teachers

Chalfin, Gregory Max ProQuest Dissertations & Theses University of Nort 2020 해외박사(DDOD)

Using Nel Noddings’ definition of care as a theoretical framework (2005) alongside Elliot Eisner’s ecology of schooling (1988), this study examined how “reputationally caring” teachers approached assessment in their classrooms and their reasons for doing so. These topics were explored through interviewing and observing participants, in addition to analyzing documents related to their methods of assessment, utilizing the research methodology of educational criticism and connoisseurship. This qualitative study include four “reputationally caring” teachers. The term “reputational care” is of the author’s creation and refers to those teachers who are known by various school constituents: parents, students, colleagues, and administrators as teachers who demonstrate care by going above and beyond in their classroom, prioritizing student-teacher relationships.Individual context mattered greatly, and the study examined how the participants navigated obstacles to care within their respective environments. In addition, I considered the implications approaching assessment through a lens of care has for the field of education and for the professional development of teachers. Reputational care did not automatically carryover between communities, and detailed description of the participants’ environments and journeys to reputational care underscored the significance such an approach has for educational settings, including the introduction of Educative Care, a new contribution to the field of care and education that views teachers as empathic mentors. The participants of this study viewed their role as such, prioritizing relational care and viewing their relationships with their students and the holistic support of them as of paramount importance. This has implications for the field of education in considering the development and onboarding of teachers into new communities and for developing practices around faculty wellness, caring for those who provide care in educational communities.

성인기 발달장애 자녀 부모의 양육부담감과 우울의 관계 : 가족지원서비스와 평생교육의 다중가산조절효과 검증

한세은 연세대학교 사회복지대학원 2019 국내석사

People with developmental disabilities often need parental care throughout their lives. Particularly in the life-span, adult support narrows the scope of formal support and increases the burden on the family. This is a very high burden of parental care for parents of children with adult developmental disabilities, but most of the support and research for persons with developmental disabilities and families are concentrated before school age. The purpose of this study is to examine the relationship between care strain and depression among parents of children with developmental disabilities in adulthood and examine the multiple additive moderation effects of family support services and life-long education. The carry out this study, the survey data of 153 parents corresponding to the purpose of this study were utilized. Each researcher was sent to a disabled welfare center with prior consent to participate in the research, explaining the purpose and progress of the study, and finally participated in the study The specific results of the study are as follow. First, the gender of female was the highest with 79.1 percent as a general characteristic of the survey participants, and the age of parents was the highest with 63.5 percent for their fifties. In the case of education, the percentage of high school graduates was 64.9 percent, and household’s monthly income in more than 3 million won to less than 4 million won was the highest with 24.7 percent. Second, among the general characteristics of children, the gender of male was the highest with 68.0 percent, the age group from 19 to 24 years old was the highest with 46.4 percent. In addition, 64.1 percent had intellectual disabilities and 90.6 percent had severe disabilities with 1-3 grade. Third, as a result of using the support services, 52.3 percent of the respondents participated in life-long education and 52.7 percent of them did not use the family support services. Also, 89.3 percent of the respondents the using the care support services. Fourth, as a result of the technical analysis of the main variables, the average depression was 6.25. Care strain, an independent variable, was 1.97 on average. Fifth, as a result of examining the difference in care strain according to the general characteristics of the survey subject, children with disabilities were more burdened when they had multiple disabilities. Sixth, as a result of examining the difference of depression according to the general characteristics of the subject, 21.6 percent belonged to the high risk group among all the groups, and the father belonged to the risk group more. Seventh, as a result of the multiple additive moderation effects, the higher the care strain of parental care for the children with developmental disabilities in adulthood was, the higher the depression was. The life-long education service showed a moderating effect of reducing the negative effects of care strain, family support services also showed moderating effects at p<.1 level. In addition, the significance and tendency of the conditional effect size according to the level of the moderation variable showed significant difference. Therefore, the multiple additive moderation effect model of this study has been verified. Based on the above findings, the following are practical and policy suggestions: First, substantial support is needed to alleviate the burden of parental care for children with developmental disabilities in adulthood. Currently, the support services for the persons with developmental disabilities and their families are focused mainly on childhood. Therefore, the provision of practical support services for alleviating the burden of care should be gradually extended through the provision of systems for the parents and adult with developmental disabilities in adulthood. In this regard, it is necessary to activate ‘the weekly activity service’ implemented since March 2019 and to extend the social support so that developmental disabled persons can receive various services in the community even after graduation. Second, practical intervention is needed to promote parental mental health. Parental depression can affect not only individuals but also the entire family. In this study, the care strain for parents of children with developmental disabilities in adulthood has a positive(+) effect on depression. Thus, it seems that mental health promotion services and programs for parents should be expanded. For this, a psychological and emotional screening program for parents who raise children with developmental disabilities should be introduced to identify the risk group. In addition, for parents who are experiencing psychological and emotional difficulties, intensive emotional support services should be provided through specialized agencies and workforce connections. Third, to improve the effectiveness of family support service, which is an emotional support service, it is necessary to supplement and improve details. Unlike functional support services, family support services, which are emotional support services, continue to be provided even during adulthood, but their effectiveness is difficult to expect. This is because the contents of the service do not properly reflect the real needs of the persons with developmental disabilities and their families and lack of concrete and professional support due to the life cycle transition. Therefore, it is necessary to provide a communication window that can grasp the different needs of families according to the life-span of developmental disabilities and provide appropriate services for each needs. For this, it will need to professional treatment programs such as proven effective TSL (Thank You-Sorry-Love). Fourth, Expand functional support services for adults and families with developmental disabilities. It is found that lifelong education services for those with developmental disabilities are necessary for lifelong care. However, current lifelong education for persons with developmental disabilities is generally lacking in performance agency, professional workforce and infrastructure compared to their importance. Therefore, it is necessary to reconstruct the contents of lifelong education programs that combine special education and welfare services. Through such a proposal, we hope that a institution and effective services will be implemented to ease the care strain for parents of children with developmental disabilities in adulthood. 발달장애인은 전 생애에 걸쳐 부모의 돌봄이 필요한 경우가 많다. 특히, 생애주기상 성인기의 경우 공식적 지원의 폭이 좁아지며 가족 내 부담감이 더욱 커진다. 이로 인해 성인기 발달장애 자녀를 양육하는 부모의 양육부담감이 매우 높은 상황이지만, 발달장애인과 가족을 위한 지원과 연구는 대부분 학령기 이전에 집중되어 있다. 따라서 본 연구에서는 성인기 발달장애 자녀를 양육하는 부모의 양육부담감을 파악하고자 한다. 또한, 양육부담감과 우울 간 관계를 살펴보고 공식 지원서비스인 가족지원서비스와 평생교육의 다중가산조절효과(Multiple Additive Moderation Effects)를 살펴보고자 한다. 본 연구를 수행하기 위해 연구의 목적에 맞는 성인기 발달장애 자녀 부모 153명의 설문조사 자료를 활용하였다. 사전에 연구 참여 동의를 받은 장애인복지관 및 센터에 각 연구자가 파견되어, 연구의 목적 및 진행과정을 설명한 후 최종적으로 연구에 참여할 수 있도록 하였다. 연구의 결과는 다음과 같다. 첫째, 조사대상자의 일반적 특성으로 성별은 여자(어머니)가 121명(79.1%)으로 높은 비율을 차지했고, 연령은 50대가 94명(63.5)로 가장 많았다. 또한, 학력의 경우 고졸이하가 98명(64.9%)으로 높은 비율을 차지했고, 가정월수입은 300만원 이상에서 400만원 미만이 37명(24.7%)으로 가장 많았다. 둘째, 자녀의 일반적 특성으로는 남자 104명(68.0%)가 많았고, 연령은 만 19세부터 24세까지가 71명(46.4%)으로 가장 높은 비율을 차지했다. 장애유형은 지적장애가 98명(64.1%)였고, 장애등급은 1-3급에 해당하는 중증장애가 135명(90.6%)으로 대부분을 차지했다. 셋째, 조사대상자의 지원서비스 이용여부 결과로, 평생교육에 참여한 응답자가 80명(52.3%)으로 과반수 이상이었고, 가족지원 서비스를 이용하지 않은 응답자는 68명(52.7%)이었다. 돌봄지원서비스를 이용한 응답자는 117명(89.3%)으로 서비스를 이용한 응답자가 더욱 많았다. 넷째, 주요변수의 기술 분석 결과, 종속변수인 우울의 평균은 6.25로 나타났다. 또한 독립변수인 양육부담감(Care Strain)은 평균 1.97로 나타났다. 다섯째, 조사대상자의 일반적 특성에 따른 양육부담의 차이를 살펴본 결과, 자녀 장애유형이 중복장애일수록 양육부담이 더 높은 것으로 나타났다. 여섯째, 조사대상자의 일반적 특성에 따른 우울의 차이를 살펴본 결과, 전체집단 중 고위험군에 속한 비율은 32명(21.6%)으로 나타났고, 아버지인 경우 위험집단에 속하는 비율이 더욱 높았다. 일곱째, 다중가산조절효과 분석 결과 성인 발달장애 자녀를 양육하는 부모의 양육부담감이 높을수록 우울이 높은 것으로 나타났고, 이 때 평생교육 서비스는 양육부담감으로 인한 부정적 영향을 감소시키는 조절효과가 있는 것으로 나타났으며, 가족지원서비스도 p<.1 수준에서 조절효과가 있는 것으로 나타났다. 또한, 조절변수 수준에 따른 조건부효과 크기의 유의성 및 경향성 검증에서도 조건부효과 크기의 차이가 유의한 것으로 나타나 본 연구의 다중가산조절모형은 검증되었다. 이상의 연구 결과를 바탕으로 도출한 실천적·정책적 제언은 다음과 같다. 첫째, 성인기 발달장애 자녀 부모의 양육부담감 완화를 위한 실질적인 지원이 필요하다. 현재 발달장애인 당사자 및 가족을 위한 지원사업은 주로 아동기에 초점이 맞춰져 있는 것이 현실이다. 따라서 성인기 발달장애인 당사자와 부모를 위한 제도 마련을 통해 돌봄 부담 완화를 위한 실질적 지원서비스가 점차 확대 시행되어야 한다. 이와 관련하여 2019년 3월부터 시행되고 있는 주간활동서비스를 활성화할 필요가 있고, 발달장애인 당사자가 학교 졸업 이후에도 지역사회에서 다양한 서비스를 받을 수 있도록 사회적 지원의 폭을 확대해야 한다. 둘째, 부모의 정신건강증진을 위한 실천적 개입이 요구된다. 부모의 우울증상은 개인 뿐 아니라 가족 전체에 영향을 미칠 수 있다. 본 연구에서 성인기 발달장애 자녀를 양육하는 부모의 양육부담감이 우울에 정적영향(+)을 미치는 것으로 나타나, 부모를 위한 정신건강증진 서비스 및 프로그램이 확대 지원이 필요할 것으로 보인다. 이를 위해, 발달장애 자녀를 양육하는 부모를 위한 심리·정서와 관련한 스크리닝 프로그램을 도입하여 우울 위험군을 파악해야 한다. 또한, 심리·정서적 어려움을 보이는 부모를 위해 전문 기관 및 인력 연계를 통한 집중적인 정서 지원서비스를 제공해야 한다. 셋째, 정서적 지원서비스인 가족지원서비스 실효성 향상을 위해 세부 내용을 보완 및 개선할 필요가 있다. 기능적 지원서비스와 달리 정서적 지원서비스인 가족지원서비스는 성인기에도 지속적으로 제공되는 반면, 그 효과성은 기대하기 어려운 실정이다. 이는 서비스 내용이 발달장애인 당사자와 가족의 현실적 욕구를 제대로 반영하지 못하고 있고, 생애주기 전환에 따른 구체적이고 전문적인 지원이 부족했기 때문으로 보인다. 따라서 발달장애인 생애주기별로 상이한 가족의 욕구를 직접 파악할 수 있는 소통 창구를 마련하고, 각 욕구에 맞는 서비스를 제공해야 하며, 이를 위해 효과성이 검증된 TSL(Thank you-Sorry-Love) 가족치료프로그램과 같은 전문적 치료프로그램을 접목해야 할 것이다. 넷째, 성인기 발달장애인 당사자 및 가족을 위한 기능적 지원서비스를 확대해야 한다. 발달장애인 장애 특성상 평생 돌봄이 필요한 상황으로, 이들을 위한 평생교육 서비스 제공은 부모의 양육부담감 완화에 도움이 되는 것으로 나타났다. 하지만 현재 발달장애인 평생교육은 중요성에 비해 수행기관, 전문인력, 인프라 등이 전반적으로 부족한 상황으로 특수교육과 복지서비스를 결합한 형태의 평생교육 프로그램의 내용 재구성 및 양적 확대가 도모되어야 할 것이다. 이와 같은 제언을 통해 성인기 발달장애 자녀를 양육하는 부모의 양육 부담을 완화해줄 수 있는 제도와 효과적인 서비스가 실천되기를 기대해 본다.

가족간호와 간병인간호의 만족도 비교 연구

장희숙 목원대학교 2002 국내석사

본 연구는 종합병원에 입원한 환자들을 가족원에 의한 간호를 받는 그룹과 간병인의 간호를 받는 그룹으로 구분하여 환자나 보호자의 수용태도를 조사하여 환자간호에 따른 가족만족도를 비교·분석하고 그 결과를 토대로 환자를 둔 가족의 기능회복과 삶의 질을 증진시킬 수 있는 방안을 모색해 보는 데에 목적을 두었다. 이를 위해 본 연구에서는 대전시내 3개 종합병원에 입원하고 있는 환자와 보호자를 대상으로 가족간호 그룹과 간병인간호 그룹으로 분리하여 200명을 유의 표집하였고, 조사대상자인 환자와 보호자 200명중 161명에 대해 조사를 완료하였다. 수집된 자료는 SPSSWIN을 이용하여 분석하였는데, 주요 연구결과는 다음과 같다. 첫째, 간호형태별 만족도를 비교한 결과 가족간호와 간병인간호 중에서 환자만족도가 높은 것은 가족간호로 나타났다. 둘째, 간호형태에 따른 영역별 만족도를 비교해보면 신체적 만족도에 있어서는 간병인 간호그룹에서의 만족도가 크게 높았으나 정서적인 교류나 지지감의 측면에서는 가족 간호그룹의 만족도가 높은 것으로 나타났다. 셋째, 일상생활동작능력이 낮을수록 간병인 간호를 받는 것으로 나타났다. 넷째, 입원회수가 많을수록 가족간호자는 신체적·정서적·사회적·경제적 어려움을 겪게 되어 부담감이 커지는 것으로 나타났다. 끝으로, 입원기간이 길어질수록 간병인 이용에 대한 경제적 부담이 커지게 되어 가족의 부담감이 높은 것으로 나타났다. 이러한 연구결과를 근거로 하여 볼 때 가족간호와 간병인간호를 받는 환자의 만족도를 증진시키기 위해서는 환자의 일상동작능력이 증진·개선될 수 있는 프로그램이 실시되어야 할 것이다. 또한 가족간호자의 경우에는 가족간호 휴직제도를 적극적으로 활용하게 하여 간호부담감을 감소시켜 주는 것이 필요하다. 간병인간호의 경우에는 간병비에 대한 보험급여확대, 간병교육을 통해 간병인과 가족, 환자와의 관계형성이 적절하게 이루어져야 할 것이다. The purpose for this study is to search for means to improve family functions and life satisfaction of family members. In order to achieve the objective, we separated inpatients into two groups, the first group being cared for by their family members and the second group being cared for by professional caregivers. These groups were studies for receptiveness by patients and their guardians, and a satisfaction level by family members by type of care was analyzed. For this study, we randomly selected 200 patients and their guardians who are hospitalized in 3 general hospitals in Daejun City. These people were separated into two groups, a family care group and patients cared by professional caregivers, and subsequently obtained results from 161 samples. The completed survey data were analyzed using SPSSWIN statistical program. The main results of the research were as follows: First, results from the comparison of the satisfaction level between the two groups indicated that patient's level of satisfaction was higher when cared by family members. Second, when satisfaction levels for each category were compared for the care group, patients expressed higher level of satisfaction from the care by professional caregivers in terms of physical perspective, while in terms of emotional support and communication, patients indicated higher satisfaction from the care by family members. Third, as the patients have more difficulty in their body movements, they tend to be cared more by professional caregivers. Forth, as the number of hospitalization frequency increases, a physical, emotional, social and financial burden becomes heavier for the family caregivers. Lastly, as the duration for the hospitalization becomes longer, the family member's financial burden for the use of the professional caregivers increases. Based on the research results, in order to increase the satisfaction level of the patients who are cared by family members and professional caregivers, programs need to be developed to improve patient's physical movements. In addition, in case of family-member caregivers, the burden for the nursing should be reduced by actively seeking programs, such as special time-off policy for the care. In case of care by professional caregivers, an expansion of the insurance coverage for the professional care should be adopted and through education, a relationship between the caregiver, family members and the patient should be established.

배려 윤리의 교육적 의의와 도덕 교과에의 적용

이혜은 전북대학교 대학원 2011 국내박사

The concentration of human isolation and individualism in the contemporary society provokes the education problems like group alienation, academy violation, disappearance from home, suicide, etc. as disjoining the relationship among education subjects like between I and student, parents and student and students, etc. It is necessary, first of all, to recover the relationship between the teacher and the other for solving education problem that occurred in this relational disjoint. The education focused on knowledge-achievement-centered for entrance competition can not provide students with educational opportunity called human growth and development except recovering this relationship. So, this study tried to find out educational significance contained in Western care ethics to come up with moral education for relationship recovery. Further, this study illuminated the Ren and Jabee ideas immersed in the traditional ethic-viewpoint of Koreans and discussed about what previews they supplied to moral education. The subjects to establish for this study are as follows. First, this study tried to find that what the characteristics and their limitations of reason-centered ethic-viewpoint by Kant and Kohlberg contained in the education of current moral subject were. Second, this study tried to find that what the concept and characteristics of care ethics by Gilligan and Noddings and their educational significance were. Third, this study tried to find that what the concept and characteristics appeared in care ethics of the Ren idea in Confucianism and Jabee idea in Buddhism and their educational significance were. Fourth, this study tried to find that how we could apply care ethics to the moral and education in the 'relational dimension between humans' and 'relational dimension between human and nature'. It is researched that the concept and its characteristics of ethic-viewpoint focused on the reason by Kant and Kohlberg for achieving the first purpose and analyzed kinds of books, study reports and articles and moral text in middle school. The summary to discuss is as follows. Kant found out the final origin of moral rules enacted by persons from the reason. Kant called this autonomy and it is what the person compels himself against his original true nature. This autonomy and self-compulsion are principles of morality and the good and right action is decided according to whether it agrees with moral regulation. Accordingly, this study observed that moral education was directed to nurture humans for practicing moral act with the duty sense on moral regulation. Furthermore, this study considered that the 6-step moral development theory by Kohlberg was universally, gradually and successively developed and the morality in the highest dimension was justice. This study considered that this ethic-viewpoint by Kant and Kohlberg ignored woman due to being man-centered and individualized extremely as focusing on abstract quality, universality and impartiality and criticized the division of reason and feeling. Also, It is discussed that rational moral education based on moral philosophy by Kant and Kohlberg in contemporary education in middle school helped students to make justice judgement due to developing individual moral judgement ability but it is difficult to find out tenderness and care for the other. The contents to consider and discuss related books and articles for achieving the second purpose in this study is as follows. This study considered that ethic idea by Gilligan was considered to criticize the principle of justice by Kohlberg and to present care ethics, another standard possible to evaluate the morality development in women. Also, this study considered that the concept and character of ethic idea was considered by Noddings to criticize the existed ethics being interested in justice, impartiality and moral induction with the exception of care, to present the warm care to come out from natural inclination as new ethics and to focus on the human relationship between the person to receive care and the one to give care. Educational significance is discussed in the point which care ethics by Gilligan and Noddings was partially difficult but enlarged the width of comprehension on moral philosophy as focusing on care, interdependence and relationship. This study considered that related books and articles for achieving the third purpose in this study and the contents to discuss the concept of Ren idea in Confucianism and Jabee idea in Buddhism and care ethics contained in these is as follows. This study considered in the point which Ren could practice through human love by the spirit of royalty-mercy, self-denial and fortune-coming, filial piety, etc. as the concept which tendered with true mind in the human relationship among persons. Care ethics is what is displayed by the mean virtue by which humans overcome egoism, must return to the good original nature and cope suitably with not inclining toward extremity in the moral discord situation for practicing this Ren. This study considered that Buddhism character of Jabee idea had positive viewpoint on the human due to original nature possible to make every existence to be realized, make the affinity to be realized that the human is not independent existence but interdependent relationship and make the self-effacement to be negated that the self is as objective reality and meant that the self enlarged to all ecosystems as well as to one another. This study considered that the Jabee idea which saw the human as self-other-are-not-two relationship was relational care ethics to take after every existence like the equality relationship and the altruistic love beyond human-centered and person-centered one. This study considered that Ren idea in this context could become a plan possible to overcome educational crisis in the point called love education to nurture moral humans to present truly the good nature(loyalty) and practice education to set good example to others as a salutation of manner. It is discussed that educational significance in the point which Jabee idea could be a plan possible to overcome ecological crisis appeared as dividing and separating between humans and human and nature on the basis of love, equality and life-respect. In relation with the fourth study, It is presented that concrete plan on how Western care ethics and the care ethics contained in Ren and Jabee ideas could apply to contemporary moral and education in 'relational dimension between humans' and 'relational dimension between human and nature'. The similarities in Western care ethics and Ren and Jabee ideas are to stress on care mind to tender truly the others on the basis of relationship and to practice it to the extend of society, nation and human beings. In this context, It is also presented that the examples like care of self, care of a familiar person, care of stranger and distant person, care of human and ecological ethics on care of relationship between human and nature as additional contents to moral education in middle school.

A CASE STUDY : STUDENTS' PERCEPTIONS OF CARING MANNERS OF EDUCATION LEADERS AND ITS RELATION TO THEIR LEARNING OUTCOMES

이풍길 THE FLORIDA STATE UNIVERSITY 1993 해외박사

1. 연구의 필요성(문제의 제기) 오늘날 많은 학자들은 현재 이루어지고 있는 학교교육 활동에 있어 보다 중요한 무엇인가가 빠트려져 있는 것이 아닌가 하는 의문을 제기하고 있다. 그 의문의 중심에는 비록 학문적 성취도의 중요성을 인정하면서도 학교교육이 지나치게 지식 습득 위주의 학문적 성취에 치중되어 학생들이 사회의 구성인으로 올바르게 성장할 수 있는 기본적 바탕이 되는 도덕 ·인성 교육, 또는 전인교육의 중요성을 경시해 온 것에 대한 반성의 소리가 자리하고 있다. 즉 현재 발생하고 있는 각종 사회적 문제점들을 인식할 때 학교교육에 있어 학생들의 도덕성, 책임의식, 동기 의식 강화, 자신감, 만족감, 소속감 등의 비학문적 영역의 발달이 학문적 성취와 동등하거나 오히려 더욱 중요하게 인식되어져야 한다는 점에 대한 폭넓은 공감대가 형성되고 있는 것이다. 이러한 교육계의 자각과 반성을 통해 다양한 학문분야에서 Caring 윤리에 대한 높은 관심을 불러 일으키고 있으며 현재 우리 사회와 교육계가 직면하고 있는 제반 문제점의 해결을 위해 학교교육에 있어 Caring 윤리의 적극적 활용에 관한 심각한 논의가 필요함이 강조되고 있다. 특히 일선 교직자들에게 있어 자신의 의지, 의도 및 가치부여에 기초한 행위적 현상으로 볼 수 있는 Caring 윤리 개념과 이의 적용을 통한 교육적 가치에 대한 이해는 매우 중요한 의미를 지닌다고 할 수 있다. 2. 연구의 목적과 방법 본 연구는 학교교육에 있어 Caring 행동의 실제적 활용이 교육을 통한 학생들의 사회 ·직업적 특성의 발달에 미칠 수 있는 가치와 중요성을 실증적으로 검증하기 위해 다음의 주요 연구문제를 규명코자 하였다. 첫째, Caring 행동이나 태도에 대해 학생과 교직자 집단간에는 어떠한 인식상의 차이가 있는가?; 둘째, 학생들이 갖는 교직자 행동이나 태도에 대한 Caring 인지도와 이들 학생들의 직업 ·사회적 관련 특성의 발달과는 어떠한 상관관계가 있는가? 연구 방법으로 학교환경 및 특성, 교사의 역할, 교육목표 및 수월성 확보, 학생들의 학습성취 및 사회 ·직업적 특성의 발달 등과 관련된 영역들에 관한 광범위한 문헌연구와 표준화된 설문지를 통한 양적조사가 실시되었고 체크리스트를 이용한 면접 및 학습활동 관찰을 통한 질적조사를 병행하였다. 사례연구 조사대상은 미국 플로리다 주립대학 부설고등학교로 재학생, 교사 및 학교장을 포함한 행정직 인사등 3개 집단으로 구분되었다. 수집된 자료는 PC용 SPSS 프로그램을 사용하였으며 통계기법으로 χ²(chi-square)검증, T-test 및 단순상관관계 지수값(Pearson Product-Moment Correlation)이 이용되었고, 검사도구의 신뢰도와 타당도 조사를 위해 신뢰도 검증(Cronbach Coefficient Alpha Reliability)과 요인분석(Varimax Factor Analysis)이 실시되었다. 3. 연구의 결과 본 연구결과 교직자 집단과 학생 집단 및 학생 집단간에도 Caring의 개념과 Caring 행동유형에 대한 차이가 존재하는 것으로 나타났다. 특히 교사나 학교장 집단이 자신의 Caring 행동에 대해 지나치게 긍정적으로 생각하는 오류를 범하고 있는 것으로 나타나 교육지도자들은 자신의 관점에서 보다는 보다 더 학생들의 시각에서 생각하고 행동하는 노력이 요청되어진다. 교직자의 Caring 행동과 이에 대한 학생들의 인식도와 만족감, 소속감, 도덕적 성숙도, 학업성취 능력, 자아 능력 등의 5개 변인과의 상관관계는 .27~.57로 학업성적과 5개 변인간의 상관관계의 수준 .12~.26 보다 높은 것으로 조사되었다. 이러한 연구결과는 학교활동에 있어 의식적이든 무의식적이든 간에 행하게 되는 교사들의 Caring 행동이 지니는 교육적 가치를 재인식하고 규명하는 노력이 절실함을 대변하는 것으로 볼 수 있다. 본 연구에서는 학업성취도와 학년별 변인만 중심으로 Caring 행동에 대한 인식상의 차이를 다루었으나 기타 학생 개개인의 다양한 특성별로 각각의 Caring 행동유형에 대한 중요도와 같은 것은 추후 연구분석의 가치가 높은 것으로 사료된다.

간호사와 환자가 경험한 돌봄의 의미 분석

이윤미 부산대학교 대학원 1995 국내석사

Caring is the essence and it is the central unifying domain for the body of knowledge and practice in nursing. But, care has been unknown phenomenon that need to be explicated, analyzed and used in nursing care as the essence and unifying focus for the nursing profession. Therefore systematic investigation of caring is necessary to advance the displine of nursing and to provide qualitative nursing for patient. The problem addressed by this study was to identify now hospitalized patient and nurses express the meaning of caring. The purpose of this study is to research the phenomenon of caring by phenomenology approach of their experience of caring through interactions between patients and nurses to find out the meaning of caring conception. The subjects for this study were 15 nurses and 16 patients who had been admitted to a Pusan National university hospital for at least three days and whose age was over 20. The data were collected for 2 months from July 15 to september 15, 1994. Open ended questions were done by the researcher and all conversation were tape recorded. The data analysis was done by the phenmenological method of Van Kaam. The validity was assured by a person of nursing doctor course, 3 of professor of nursing, 2 of master's degree course. As a result, caring theme that patients and nurses have experienced were classified into eight categories - helping, concern, presence, instruction, love, activity, respect, observation (only by nurses). Form the result, This study contributes understanding of the construction of caring and conceptualization of caring. Ultimately we provide better nursing care to people and contribute to unify intellectual and practical dimension of professional nursing by getting rid of disagreement of caring concepts that patients and nurses have experienced.

가족 돌봄 청소년의 돌봄 활동이 정서적 반응에 미치는 영향 : 연령의 조절효과를 중심으로

박지영 조선대학교 대학원 2024 국내박사

Caring for an old, ill or disabled family members has a significant physical and affective effect on the caregiver. Young carers who care these family members aged under 18 often care and provide support to family members or relatives without knowing what they really do. Very little is known about young carers in Korea generally and much less about their experiences of family care activities and affects. Despite growing interests in young carers, there is still no specific quantified data to estimate or calculate how many young carers there are. The aim of this thesis is to figure out the influential relation between the adolescent′s caring activities and their affects. The general survey that conducted by Ministry of Health and Welfare last year included the adolescent population in the survey, however, the focusing group was mainly the young adult carers aged between 19 and 34. Hence, this quantified study was to verify the impact of family care activities and care activities on adolescent affects by applying the British young carer diagnostic tool-MACA-YC18 and PANOC-YC20-to adolescents aged 13 to 18 living in Gwangju Metropolitan city. A total of 1,392 questionnaires were collected through the survey, and 108 of them, which were significant as young carers, were selected as the final analysis sample. Looking at the main characteristics of the variables, the proportion of female adolescent was higher than mail adolescents, and there was no significant difference in the ratio of low and high age group. More than half of the samples provided cared to at least two family members. There were only 15 cases of applying for formal or informal external support for family care and approximately 75% of adolescents were found to have never applied for related support due to lack of access to related information or complicated procedures to apply. In a country-by-country comparison of the level of care activities, it was confirmed that Korea had the highest level of sibling care and personal care. In order to verify the impact of care activities on adolescents′ affects, the variables of care activities were divided into six categories: domestic tasks, household management, financial/practical care, personal care, emotional care and sibling care. The adolescents′ affects were divided into 4 categories: self-esteem, depression, stress and burn-out. As a result of the verification, it was found that domestic tasks, household management and emotional care had a significant effect on self-esteem. For self-esteem, domestic tasks had a significant negative effect and household management and emotional care had significant positive effects. It was found that domestic tasks and emotional care had a significant effect on depression. For depression, domestic tasks had a significant positive effect and emotional care had significant negative effect. It was found that domestic tasks, personal care and emotional care had a significant effect on stress. For stress, domestic tasks and personal care had a significant positive effects and emotional care had significant negative effect. It was found that domestic tasks and sibling care had a significant effect on burn-out. For burn-out, domestic tasks had a significant strong positive effect and sibling care had significant negative effect. A hierarchical regression analysis was conducted to verify the moderating effect of significant care activities on adolescents’ affects, and it was found that age had a significant moderating effect on emotional care and self-esteem, domestic tasks and stress, personal care and stress, sibling care and burn-out. Through the results of this study, it was confirmed that self-esteem decreases and depression, stress and burn-out increase as domestic tasks increase. In addition, it was also confirmed that self-esteem increases and depression and stress decrease as emotional care increases. And the moderating effect was significantly verified that as age increases, self-esteem increases when emotional care increases, stress increases more when domestic tasks and personal care increase and burn-out decreases a lot when sibling care increases. In conclusion, family care activities have both negative and positive impacts on adolescents’ affects simultaneously. It should be noted that emotional care has a positive impact on their affects, which can be attributed to the respect for adults, filial duty and family-centered culture in Korea. That is, it suggests that young carers can secure the support base to raise into healthy members in community, if appropriate support is provided through early detection of young carers. In order to do that, young carers should be legally defined so that they can access various support policies and services based on their legal rights as caregivers. Also it is necessary to establish more efficient and direct support system by unifying the subject of policy implementation for young carers. The most important thing is the continued recognition of young carer issue in the community. This is because if they are treated with only sympathy and compassion, young carers could be still hidden, ignored and be excluded from the welfare service area by themselves eventually. Additionally, active intervention at school is necessary for detection and the role of school social workers needs to be strengthened as the person bound in duty to give the notification. The limitation of this study is that the survey participants are only about 1.5% of all adolescents in Gwangju Metropolitan city, so it is quite difficult to say that they cover all of them. And the Korea′s unique affects, such as attachment(Jeong) and filial duty(Hyo) were not properly reflected in the questionnaire by using of British diagnostic tools. This thesis suggests that it is necessary to develop a young carer diagnosis tool that reflects the limitations presented in this study to detect young carers who actually participate in family caring and provide active support in advance.

Care Labor and the American Teacher

Anderson, Janel The University of Wisconsin - Madison ProQuest Dis 2023 해외박사(DDOD)

Care theory began as an ethical framework focused on the creation of classrooms and schools that treat students and communities in more empathetic and meaningful ways. Over thirty years after its application to the field, there is broad agreement that students need caring classrooms and teachers have come to be the primary providers of this care. There is room for concern however, that care's framework inadequately accounts for the racial, gendered, and economic constraints of women laboring in care work, particularly in K-12 schools. This inductive mixed-methods descriptive study offers insight into the ways these care obligations have transformed teachers' work. The current study uses survey data from 260 secondary teachers in the US as well as interview data to describe the work teachers do to provide students' academic, physical, social-emotional, and beyond school care and the challenges they face as they take on the labor care requires. Results reveal that care obligations have deep associations with a gendered workplace hegemony that influences what, how, and who is expected to provide care labor for children in schools. Care in teaching is tied to the valorized identity of "mother," capitalizing on women's socialization to provide maternal care. The valor associated with this maternal care operates to bind women to work that is intensifying, oppressive, and conducted within working conditions that are often unresponsive to the needs of teachers and their students. In addition, the teaching field has established no clear definitions of or boundaries around professional care obligations, leaving teachers obligated to provide care for students in what teachers describe as a virtually boundless labor condition. This entangles teachers in an oppressive double bind wherein they choose to do work that contributes to their own oppression, driven by a sense of urgency to provide the care they believe their students need. This study provides empirical evidence of the way modern care expectations are situated within teachers work and the social conditions impacting the field. There is further evidence that there is a relationship between the intensification of these care obligations and destabilizing dissatisfaction in the field that contributes to attrition. The teaching profession, federal and state governments, districts, and school leaders must work to clarify care expectations along with acceptable boundaries around teacher work. Schools must work to address teacher working conditions to ensure teachers are provided the necessary work time and structure needed to carry out the care work that is necessary to build and sustain caring schools for all children and has become recognized as an expected part of teacher professional work.