보건소 중심 호스피스 운영모델 개발 - 부산지역 일개 보건소 시범사업을 중심으로 -

김숙남,최순옥,김영재,이소라,Kim, Sook-Nam,Choi, Soon-Ock,Kim, Young-Jae,Lee, So-Ra 한국호스피스완화의료학회 2010 한국호스피스.완화의료학회지 Vol.13 No.2

목적: 호스피스 서비스의 원칙, 일선 보건소의 특수성과 지역사회 가용자원을 고려한 보건소 중심 호스피스 운영모델을 개발하기 위하여 이루어졌다. 방법: 호스피스 관련 선행연구, 문헌고찰, 관할지역 내 호스피스 실태조사 및 시범운영 평가를 통해 보건소 중심 호스피스 운영모델을 개발하는 연구이다. 2008년 1월부터 12월까지 부산광역시 1개 보건소와 부산지역 말기암환자 의료기관 및 호스피스를 전공하는 간호대학이 연구팀을 구성하여 호스피스 시범사업 운영체계 확립, 호스피스 서비스 전달체계 구성 및 제공 그리고 시범운영 평가를 통한 보건소 중심 호스피스 운영모델 개발의 3단계 추진과정을 거쳐 이루어졌다. 결과: '보건소 중심 호스피스 운영모델'은 보건소의 특수성과 해당 지역사회가 가지고 있는 자원간의 연계를 통한 총체적 서비스 제공이다. 지역암센터는 관할지역 보건소에 재정적, 행정적인 부분을 지원해 주고, 보건소는 호스피스사업 수행을 지원할 수 있는 협력대학에 사업을 위탁하여 전체 사업운영에 대한 기획을 위임하였다. 또한 사업지원단과 사업자문단을 통하여 호스피스 운영과 관련된 제반문제를 지원받는 체계를 구성하였다. 방문간호 팀으로부터 재가 말기암환자를 의뢰받은 호스피스 담당간호사는 환자를 등록시키고 초기사정을 거친 후 호스피스 팀 회의를 거쳐 서비스 우선순위를 정한 다음, 필요한 서비스와 함께 자원봉사 파견을 통한 총체적 서비스를 제공하였다. 이러한 운영모델은 재가 암환자를 중심으로 한 보건소 중심 호스피스사업을 실시할 수 있는 가능성을 제시한다. 결론: 보건소가 가지고 있는 지역사회 가용자원을 최대한 활용하는 '보건소 중심 호스피스 운영모델'은 의료시각지대에 있는 재가 암환자와 가족의 삶의 질 증진을 통해 지역 보건복지 정책의 질적 향상을 유도하게 될 것이다. Purpose: This study was a part of a drive to develop a community health center-based hospice management model which is concerned with hospice care at a community health care setting and available resources of the local community. Methods: Development of a community health center-based hospice management model involved evaluation of existing hospice-related research, including literature review, and research on hospice facilities at the study site, as well as evaluation of model operation. The latter involved community health center-based hospice test operation, and evaluation of test operation by a research team, including of a nursing professor majoring in hospice care and staffs from a community health center in Busan metropolitan city, regional cancer center, and regional terminal cancer patient medical institute. The study was conducted in the 2008 calendar year. Results: The community health center-based hospice management model provides service linked with local community resources, focusing on the local community health center. Financial and administrative assistance is provided by the regional cancer center, with collaboration from academic health care professionals who guide the operation management. The community health center hospice nurse in consultation with a visiting nurse team registers terminally-ill cancer patients and, after assessment, the hospice team prioritize hospice care during team meeting. Care is delivered by staffs and volunteers. Conclusion: The developed community health center-based hospice operation management model maximally utilizes available community health resources to produce qualitative improvement of regional health and welfare policy through improving the lives of home-based cancer patients and their family who are in medical blind spot.

노년층을 위한 마을단위 죽음준비 교육 프로그램 개발 및 효과

김숙남,김소영 한국지역사회간호학회 2021 지역사회간호학회지 Vol.32 No.4

Purpose: This study was conducted to investigate the effects of a community-based death education program for older adults. Methods: The study was conducted as a quasi-experimental study with a non-equivalent control group and pretest-posttest design. The subjects were community elders aged over 65 registered at a community health center and were convenience sampled. The experimental group consisted of 33 participants and the control group consisted of 32 participants. Experiments are conducted from June 18 to July 24, 2020. We tested our hypothesis using an independent t-test, and paired t-test. Results: The experimental group had significantly higher scores for psychological well-being than the control group after treatment (t=2.24, p=.028). In general attitude toward the use of life-sustaining technology, however, only the experimental group had a significant difference before and after the experiment with lower scores compared to the control group (t=-5.41, p<.001). Conclusion: We found that the community-based death education program developed in this study was partially effective in improving older adults’ psychological well-being and general attitude toward the use of life-sustaining technology.

보건소 호스피스완화케어 서비스를 제공받는 재가 말기암 환자의 삶의 질 구조분석

김숙남,최순옥,류지선,김정림 보건의료산업학회 2019 보건의료산업학회지 Vol.13 No.4

Objectives: The purpose of this study was to identify the predictors of quality of life (QOL) for terminal cancer patients admitted into the community health center, and to establish a hypothetical model to explain and verify causative relationships among the variables. Methods: Data were collected from January 2015 to June 2016. Participants were 237 registered patients in Busan Metropolitan City hospice & palliative care center. The descriptive and correlation statistics were analyzed using the SPSS/WIN 24.0, and the structural equation modeling procedure was performed using the AMOS 24.0 program. Results: The results of this study showed that the physical symptoms of terminal cancer patients were the most direct factors affecting the QOL, and satisfaction with health care services has a direct effect on the QOL. Conclusions: The study contributes to drawing up measures to improve QOL for terminally ill cancer patients who are living in the end-of-life section of the community by revealing the causal relationship to the QOL for terminal cancer patients.

지역사회에 거주하는 노인의 재가 생애말기 돌봄요구도와 사전 연명의료결정에 대한 태도

김숙남,김소영,조명주 한국통합사례관리학회 2022 한국케어매니지먼트연구 Vol.- No.44

본 연구는 지역사회에 거주하는 노인의 생애말기 돌봄요구도와 사전 연명의료결정에 대한 태도를 확인하여초고령화시대 지역사회 기반의 재가 생애말기 돌봄체계를 구축하는데 기초자료를 제공하기 위한 목적이다. 자료수집은 수도권(서울인천), 부산광역시, 대구광역시에 거주하는 65세 이상 노인 1,310명을 대상으로 연구보조원을 통하여 설문조사를 하였다. 수집된 자료는 SPSS WIN 26.0프로그램을 이용하여 기술통계, 독립 t-test, 일원배치분산분석(one-way ANOVA)과 Pearson correlation coefficient로 분석하였다, 노인의 재가 생애말기돌봄요구도는 평균 4.09점(5점 만점)이었고, 안위증진을 위한 지지요구가 가장 높았다. 사전 연명의료결정에 대한 태도는 평균 2.98점(4점 만점)으로 긍정적 태도를 보였고, 두 변수는 양의 상관관계를 보였다. 이러한 연구 결과를바탕으로 향후 재가 노인을 위한 생애말기돌봄체계는 신체·심리·사회·영적요구를 통합적으로 반영한 돌봄체계가필요하고, 사전 연명의료결정에 대한 노인의 자율성을 보장하기 위한 교육과 상담이 필수적으로 포함되어야 할것이다. 본 연구를 기반으로 향후 다양한 연구설계를 활용하여 재가 생애말기돌봄체계구축을 위한 연구성과를축적할 필요가 있다고 사료된다.

여성가장의 생의 의미 영향요인

김숙남,최순옥,이정지,신경일 한국모자보건학회 2004 한국모자보건학회지 Vol.8 No.2

좋은 죽음에 대한 인식, 연명치료 중단 및 안락사에 대한 종합병원 간호사의 태도

김숙남,김현주,Kim, Sook-Nam,Kim, Hyun-Ju 한국호스피스완화의료학회 2016 한국호스피스.완화의료학회지 Vol.19 No.2

목적: 본 연구는 간호사들을 대상으로 좋은 죽음에 대한 인식, 연명치료 중단과 안락사에 대한 태도수준과 변인 간의 관련성을 확인하여 생명윤리교육의 근거를 마련하는데 실제적인 자료로 활용하고자 이루어졌다. 방법: 연구 대상은 서울, 부산경남, 및 경북지역에 소재한 500병상 이상의 6개 종합병원에서 6개월 이상 근무한 간호사 중 본 연구의 목적을 이해하고 연구 참여를 허락한 자 218명을 대상으로 편의표집 하였다. 연구도구는 좋은 죽음 인식 측정도구(The Concept of Good Death Measure), 연명치료 중단 측정도구와 안락사 측정도구(Attitudes toward Euthanasia)를 사용하였다. 수집된 자료는 SPSS 21 WIN 프로그램을 이용 서술통계, Independent t-test와 one-way ANOVA 및 Pearson's correlation coefficient로 분석하였다. 결과: 간호사의 좋은 죽음에 대한 인식, 연명치료 중단과 안락사에 대한 태도는 보통 수준이었다. 간호사의 일반적 특성에 따른 좋은 죽음에 대한 인식, 연명치료 중단과 안락사에 대한 태도차이는 교육수준, 근무경력 및 신앙의 중요성에서 유의하게 나타났다. 좋은 죽음과 연명치료 중단에 대한 태도는 역 상관관계가 있었고, 연명치료 중단과 안락사에 대한 태도는 순 상관관계가 있었다. 결론: 말기환자를 돌보는 과정에서 발생하는 윤리적 문제를 다루는데 간호사들은 숙련되어야 한다. 좋은 죽음에 대한 간호사의 인식확립과 연명치료 중단과 안락사와 같은 존엄사와 관련된 개념에 대한 이해와 윤리적 갈등 상황에서의 판단과 해결능력에 관한 생명윤리교육의 활성화가 필요하다고 본다. Purpose: To provide practical data for bioethics education, we identified correlations between recognition of good death, attitude towards withdrawal of meaningless life-sustaining treatment, and attitude towards euthanasia in nurses. Methods: Using convenience sampling, we recruited 218 nurses who had at least six-month work experience in one of the six general hospitals with 500 or more beds in Seoul, Busan, and Gyeongsang province. All participants understood the purpose of the study and agreed to take part in the study. The research tools used included the Concept of Good Death Measure (CoGD), the measurement tool for attitudes towards withdrawal of meaningless life-sustaining treatment (WoMLST), and the measurement tool for attitudes towards euthanasia. Data were analyzed using an Independent t-test, one-way ANOVA, and Pearson's correlation coefficient using SPSS 21 for Windows. Results: Nurses had normal levels on CoGD, WoMLST, and attitudes towards euthanasia. Nurses' CoGD, WoMLST, and euthanasia scores significantly differed depending on their education level, working period, and the importance of religion to them. A negative correlation was found between the CoGD and WoMLST scores, and WoMLST and euthanasia scores were positively correlated. Conclusion: Nurses should be trained to deal with ethical issues that may arise while caring for terminal patients. It is necessary for nurses to understand the concepts related to CoGD, WoMLST, and euthanasia, and to promote bioethics education with focus on decision-making and problem-solving ability in ethically conflicting situations.

생애말기 환자를 돌보는 간호사의 영적간호 경험

김숙남,김소영,원형준 질적연구학회 2023 질적연구 Vol.24 No.2

Purpose: The purpose of this study was to explore the spiritual nursing experiences of nurses caring for end-of-life patients. Methods: In-depth interviews were conducted with eight nurses with more than five years of work experience at various types of hospice-specialized institutions from August 6, 2021, to September 10, 2021. The collected data were examined and described based on Colaizzi’s phenomenological method. Results: Thirteen clusters of themes and five categories were derived from the spiritual nursing experiences of nurses caring for end-of-life patients. The five categories were “Recognizing being a whole person,” “Deriving the underlying suffering,” Joining in spiritual healing,” “Carrying out one’s task by calling,” and “Growing through the accumulation and reflection of experience.” Conclusion: Spiritual care is an important task that must be provided for end-of-life patients. For nurses caring for end-of-life patients, spiritual care is the process of accompanying a patient as a soulmate for a better death, and it is meant as a practice of true love where people deal with spiritual suffering together. The findings of this study will guide nurses caring for end-of-life patients to provide appropriate spiritual care.

Development of a Community-Based Palliative Care Model for Advance Cancer Patients in Public Health Centers in Busan, Korea

김숙남,최순옥,신성훈,류지선,백정원 대한암학회 2017 Cancer Research and Treatment Vol.49 No.3

Purpose A feasible palliative care model for advance cancer patients is needed in Korea with its rapidly aging population and corresponding increase in cancer prevalence. This study describes the process involved in the development of a community-based palliative care (CBPC) model implemented originally in a Busan pilot project. Materials and Methods The model development included steps I and II of the pilot project, identification of the service types, a survey exploring the community demand for palliative care, construction of an operational infrastructure, and the establishment of a service delivery system. Public health centers (including Busan regional cancer centers, palliative care centers, and social welfare centers) served as the regional hubs in the development of a palliative care model. Results The palliative care project included the provision of palliative care, establishment of a support system for the operations, improvement of personnel capacity, development of an educational and promotional program, and the establishment of an assessment system to improve quality. The operational infrastructure included a service management team, provision teams, and a support team. The Busan Metropolitan City CBPC model was based on the principles of palliative care as well as the characteristics of public health centers that implemented the community health projects. Conclusion The potential use of the Busan CBPC model in Korea should be explored further through service evaluations.

재활 관련 자궁절제술을 받은 여성의 성생활적응 구조모형

김숙남 연세대학교 간호정책연구소 1998 간호학탐구 Vol.7 No.2

The purpose of this study was to develope and test the structural model for sexual satisfaction in women having hysterectomies. A hypothetical model was constructed on the basis of previous studies and a review of literature. Exogenous variables included in this model were woven's age, spouse's support, sexual identity. Endogenous variables were post operative physical status, post operative psychological status and sexual satisfaction. Empirical data for testing the hypothetical model was collected using a self-report questionnare from 205 women having hysterectomies at the outpatient clinics of four general hospitals and a mail survey in Pusan City. The Data was collected from January to February, 1998. Reliability of the eight instruments was tested with Cronbach's alpha which ranged from 0.762-0.901. For the data analysis, SPSS 7.5 WIN Program and LISREL 8.12 WIN Program were used for descriptive statistics and covariance structural analysis. The results of covariance structure analysis were as follows: 1. Hypothetical model showed a goad fit with the empirical data. [x²=0.46(df=1, P=.50), GFI=1.00, AGFI=.98, RMSR=.011, NNFI=1.03, NFI=1.00, standardized residuals(-.68-.68)] 2. Women's age(γ 11=-.17, t=-2.23) and sexual identity(γ 11=.78, t=14.37) had a significant direct effect on the spouse's support. 3. Post operative physical status( 21=.63, t=8.13) and spouse's support(γ 22=.24, t=4.26). women's age(γ=.16, t=2.74) had a significant direct effect on the post operative psychological status. Sexual identity had a direct(γ 23=.24, t=3.19), indirect(γ 23=.24, t=4.26) and total effect (γ 23=.48, t=6.25) on the sexual satisfaction. 4. Post operative psychological status(β 32=.32, t=2.23) had a significant direct effect on the sexual satisfaction. Spouse's support and sexual identity had a direct(γ 32=.15, t=2.01; γ33=.27, t=3.37) and total effect(γ 32=.23, t=3.49; γ 32=.49, t=6.67) on the sexual satisfaction. Post operative physical status had a significant total effect(β 31=.36, t=4.64) adding the indirect effect(β 31=.20, t=2.17). The results of this study showed that post operative psychological status had the most significant direct effect on sexual satisfaction after hysterectomy. Post operative physical status, spouse's support, sexual identity and women's age had a significant direct effect on this psychological status. The results of this study suggested that spouse's support should be included in the health professional support and educational program for promote sexual satisfaction after hysterectomy.

삼음교 지압이 초산부의 분만통증, 분만소요시간 및 실혈량에 미치는 효과

김숙남,최순옥 한국모자보건학회 2005 한국모자보건학회지 Vol.9 No.2

Objectives : The purpose of this study was to examine the effects treatment by San- Yin-Jiao(SP6) pressure on labor pain, length of delivery time, and quantity of blood loss for primipara women. Methods : The design of this study was quasi-experimental and non-synchronized with non-equivalent control group. The subjects comprised 59 primipara women who underwent normal vaginal delivery. The experimental group(n=28) received SP6 pressure and the control group(n=31) received SP-6 touch. Data were collected using a structured questionnaire consisting of general characteristics, a labor pain scale by numeric rating scale, length of delivery time and quantity of blood loss. Collected data were analyzed as frequency, percentage, χ2-test, t-test and Repeated Measures ANOVA using SPSS 11.0 WIN Program. Results : The labor pain scores were not significantly different between the two groups.The total length of delivery time in the SP-6 pressure group was significantly shorter than that of the SP-6 touch group(p=0.033). The quantity of blood loss was not significantly different between the two groups. Conclusions : These findings showed that SP-6 pressure was effective to shorten the length of delivery time, and that it did not increase blood loss. Therefore, SP6 pressure during labor could be applied as an effective nursing intervention. Nevertheless, to generalize the results it is necessary to replicate the study with a larger number of participants.