고혈압 여성노인의 자기효능감, 우울 및 분노가 건강증진행위에 미치는 영향

김애실 경희대학교 대학원 2015 국내석사

This study was attempted to investigate the effect of sociodemographic traits, health related traits, self-efficacy, depression, trait-anger and anger expression of the elderly women with hypertension on health promoting behavior (HPB), using a hierarchical regression analysis. A cross-sectional research design was used for this study and data were collected from June 23, 2014 to December 27, 2014. The subjects of this study were a total of 208 women aged 65 and older who were diagnosed with hypertension by physicians and living in the communities of G city and N city of Gyeonggi-do, understanding the purpose of this study and agreeing to participate. The participants completed the self-report questionnaires and collected data were analyzed with the SPSS 20.0 program. The results of this study are as follows: 1. With regard to the sociodemographic traits and health related traits of the elderly women with hypertension, religion (t=-1.98, p=.049) and the number of exercise per week(F=29.79, p<.001) had a significant difference in HPB. However, no significant difference was found between age, educational level, living with spouse, Occupation, Monthly income, perceived health Status, smoking, drinking, hypertension medication, hypertension education experience and BMI and HPB. 2. From the analysis of correlation between the HPB of the elderly women with hypertension and self-efficacy, depression and anger, it was found that self-efficacy and anger-control had a positive correlation, while depression had a negative correlation with HPB. 3. An analysis was made for the effect of sociodemographic traits, health related traits, self-efficacy, depression, trait-anger and anger expression on HPB. The finding shows that doing exercise (β=.36, p<.001) had the most significant influence on the HPB of the elderly women with hypertension, followed by depression (β=-.31, p<.001), trait-anger (β=.21, p=.002), anger-control (β=.20, p<.001), religion (β=.18, p=.001) and self-efficacy (β=.18, p=.003). 49% of HPB was explained by the variables in Model 4. As such, it was found that the major factors affecting the HPB of the elderly women with hypertension were in the order of exercise (health related trait), depression, trait-anger and anger-control (emotional factors), religion (sociodemographic trait) and self-efficacy (cognitive factor). However, it is reasonable to exercise caution to generalize the results of this study to the entire elderly women with hypertension because the study was conducted through questionnaires on the elderly women with hypertension living in the Gyeonggi region, represented by random sampling. Despite this limitation, however, exercise was found to be the most important factor for the HPB of the elderly women with hypertension, followed by depression, trait-anger, anger-control and self-efficacy. In particular, trait-anger and anger-control, which are psychological factors, were identified to have more important influence on the HPB than self-efficacy. Thus, when planning a program to promote the health of the elderly women with hypertension, psychological characteristics need to be first considered for nursing intervention.

지역사회 조현병 대상자를 위한 마음챙김 기반 스트레스 감소 프로그램의 효과

김애실 경희대학교 대학원 2021 국내박사

Background: People with schizophrenia in community-dwelling experience high stress levels. Mindfulness-based stress reduction program has been founded to be effective in reducing stress response and improving the quality of life of various populations. Purpose: To examine the effects of mindfulness-based stress reduction program for community-dwelling people with schizophrenia. Methods: A quasi-experimental, nonrandomized design was used in this study. Participants in this study were 28 people with schizophrenia (experimental group=14, control group=14) enrolled in two Community Mental Health Centers located in D and G province in South Korea. In the experimental group, mindfulness-based stress reduction program was applied to once a week, for 90 minutes over 8 weeks. Data were collected from April 2019 to July 2019. Outcome variables in this study were perceived stress, heart rate variability, positive and negative affect, subjective well-being. The outcomes were assessed and compared at baseline, immediately post-intervention, and at the 6weeks follow-up. Results: The experimental group showed significantly greater decrease in perceived stress, negative affect and also significantly greater improvement in heart rate variability, mindfulness, and quality of life compared to the control group. However, there was no significant improvement on measure of and positive affect, salivary cortisol compared to the control group. Conclusion: Our study findings indicate that the mindfulness-based stress reduction program is effective and could be recommended as a psychosocial intervention for reduction of stress, negative affect, and quality of life in people with schizophrenia.

조현병 환자의 내재화된 낙인과 삶의 질의 관계 : 자아존중감과 극복력의 매개효과

김은영 경희대학교 대학원 2019 국내석사

본 연구는 조현병 환자의 내재화된 낙인과 삶의 질의 관계에서 자아존중감과 극복력의 매개효과를 확인하기 위한 서술적 상관관계 연구이다. 본 연구의 자료수집 기간은 2018년 9월 10일부터 9월 30일까지이었다. 연구 대상자는 정신건강의학과 전문으로부터 조현병 진단을 받은 자로 서울시에 소재한 S대학병원 정신건강의학과 외래 방문 환자, 서울시 소재의 정신주간재활시설에 등록된 환자, 경기도 소재의 정신건강복지센터에 등록된 환자이며, 본 연구에 동의한 123명이다. 연구 도구는 한국어판 내재화된 낙인(Korean version of Internalized Stigma of Mental Illness Scale, K-ISMI), 자아존중감 척도(Self-esteem Scale, SES), 한국판 Cornor-Davidson 극복력 척도(Korean version of the Connor-Davidson Resilience Scale, K-CD-RISC), 한국판 조현병 환자의 삶의 질(Korean version of 4th revision of Schizophrenia Quality of Life, SQLS-R4K)을 사용하였다. 자료 분석은 SPSS/WIN 25.0 프로그램을 이용하여 서술적 통계, t-test, ANOVA, Pearson correlation coefficient, multiple regression analysis를 사용하여 분석하였다. 본 연구의 결과는 다음과 같다. 1) 대상자의 일반적 특성에 따른 내재화된 낙인의 차이를 분석한 결과 대상자의 결혼상태 (F=14.81, p<.001), 소득(F=6.91, p=.001)에 따라 내재화된 낙인에 유의한 차이가 있었으며, 대상자의 일반적 특성에 따른 자아존중감의 차이를 분석한 결과 대상자의 결혼상태(F=11.79, p<.001), 소득(F=6.12, p=.003)에 따라 유의한 차이가 있었다. 또한 대상자의 일반적 특성에 따른 극복력의 차이를 분석한 결과 대상자의 결혼상태(F=8.71, p<.001), 소득(F=3.29, p=.041)에 따라 극복력에 유의한 차이가 있었으며, 대상자의 일반적 특성에 따른 삶의 질의 차이를 분석한 결과 나이(F=5.06, p=.002), 결혼상태(F=9.35, p<.001), 동거인(F=3.80, p=.012), 소득(F=4.11, p=.019), 조현병 발병 나이(F=2.74, p=.047)에 따라 유의한 차이가 있었다. 2) 조현병 환자의 내재화된 낙인 평균점수는 116점 만점에 62.35(±12.47)점, 자아존중감은 40점 만점에 28.10(±4.50)점, 극복력은 100점 만점에59.25(±16.50)점, 삶의 질은 132점 만점에 80.52(±23.76)점 이었다. 3) 조현병 환자의 내재화된 낙인, 자아존중감, 극복력, 삶의 질 간의 상관관계를 분석한 결과, 내재화된 낙인은 자아존중감(r=-.722, p<.001), 극복력(r=-.617, p<.001),삶의 질(r=-.587, p<.001)과 부적상관이 있었다. 삶의 질은 자아존중감(r=.702, p<.001), 극복력(r=.512, p<.001)과 정적상관이 있는 것으로 나타났다. 4) 다중 회기분석을 통하여 매개효과를 분석 결과, 조현병 환자의 내재화된 낙인과 삶의 질의 관계에서 자아존중감은 완전 매개효과(Z=-4.80, p<.001)가 있었고, 극복력은 부분 매개효과(Z=-2.33, p=.020)가 있었다. 본 연구에서는 내재화된 낙인, 자아존중감, 극복력, 삶의 질의 상관관계와 조현병 환자의 내재화된 낙인과 삶의 질의 관계에서 자아존중감과 극복력 모두 매개효과가 있음을 확인하였다. 따라서 조현병 환자의 삶의 질을 높이기 위해서는 내재화된 낙인을 직접 다루기보다 자아존중감과 극복력에 초점을 둔 간호중재가 필요할 수 있다. The purpose of this study was to identify the mediating effects of self-esteem and resilience on the relation between internalized stigma and quality of life of schizophrenia patient. A cross-sectional descriptive survey was conducted. The total subject were 132 schizophrenia patient at outpatient of S university hospital, community mental health center, mental daytime rehabilitation facilities form September 10, 2018 to September 30, 2018. The measurements used in this study were the Korean Version of Internalized Stigma of Mental Illness Scale(Cronbach's ⍺=.92), Self-esteem Scale(Cronbach's ⍺=.81), Korean version of the Connor-Davidson Resilience Scale(Cronbach's ⍺=.94), Korean version of 4th revision of schizophrenia Quality of Life(Cronbach's ⍺=.95). The data were analyzed using SPSS/WIN 25.0 to conduct descriptive statistical analysis, t-test, ANOVA, Pearson correlation coefficient and multiple regression analysis. The results of this study are summarized as follows. 1) Internalized Stigma showed a significant difference depending on marital status (F=14.81, p<.001), monthly income (F=6.91, p=.001), and self-esteem showed a significant difference depending on marital status (F=11.79, p<.001), monthly income (F=6.12, p=.003). Resilience showed a significant difference depending on marital status (F=14.81, p<.001), monthly income (F=6.91, p=.001), and quality of life showed a significant difference depending on age(F=5.06, p=.002), marital status(F=9.35, p<.001), living status(F=3.80, p=.012), monthly income(F=4.11, p=.019), age of onset(F=2.74, p=.047). 2) The mean scores of the internalized stigma was 62.35(±12.47), self- esteem 28.10(±4.50), resilience 59.25(±16.50), quality of Life 80.52(±23.76). 3) Analysis of correlation between Internalized Stigma, self-esteem, resilience, quality of life revealed that internalized Stigma was negatively correlated with quality of life (r=-.587, p<.001), self-esteem(r=-.722, p<.001), resilience(r=-.617, p<.001). And quality of life was positively correlated with self-esteem(r=.702, p<.001), resilience(r=.512, p<.001). 4) Self-esteem had a full mediating effect on the relationship between internalized Stigma and quality of life(Z=-4.80, p<.001). Resilience also showed partial mediating effects on the relationship between Internalized Stigma and quality of life(Z=-2.33, p=.020). The results suggest that self-esteem and resilience plays an important role in the quality of life of in patients with schizophrenia. Therefore, mental health practitioners should focus on interventions to improve their self-esteem and resilience for quality of life.

정신간호사의 격리ㆍ강박 적용에 대한 의사결정 요인 탐색 : 포커스 그룹 인터뷰 적용

박경환 경희대학교 대학원 2016 국내석사

Introduction: While seclusion and restraint in mental health settings might be perceived as a necessary therapeutic method all the time, it should be carried out only when it is certainly necessary since the practice has a counter-therapeutic impact potentially for patients and psychiatric nurses. Nurses are the professional group who mostly use seclusion and restraint method within mental health settings. Deeper insights to understand the factors that influence nurses’ decision-making related to seclusion and restraint use are therefore warranted. Aim: The purpose of this study was to find influence factor to the seclusion and restraint decision making of psychiatric nurses. Method: Data were collected using focus group interview. Two focus group interviews were held with a total of 10 psychiatric nurses participating. All interviews were recorded as they were spoken and transcribed and data were analyzed using qualitative content analysis. Results: Eleven categories emerged from the three main themes. 1) Personal Factors area : ‘Personal qualities of a nurse’, ‘Value about the seclusion and restraint of nurses’, ‘Nurse, my condition’, ‘Negative experiences associated with seclusion and restraint’ 2) Related factors area :‘The degree of cooperation between nurse-doctor’, ‘Role model of senior and fellow nurse’ ‘The degree of nurse assistant staff’s aid’, ‘Therapeutic relationship with the patient’ 3) Environmental factors area: ‘Poor nursing work environment’, ‘Ward atmosphere about seclusion and restraint’, ‘Social atmosphere that to have caution’. These themes highlight how mental health nurses’ decision-making is influenced by individual factors, as well as, interpersonal and staff-related factors, environment factors. Conclusion : In conclusion, it helped to understand decision-making experiences and the factors which is related to seclusion and restraint. The results show the factors which influence psychiatric nurses to make a decision to use seclusion and restraint. Throughout the results, it is expected to reduce seclusion and restraint use in mental health settings. Furthermore, it is desired to provide a basis for the future development of seclusion and restraint reduction programs and also education programs.

병원간호사의 자기연민과 소진과의 관계

박근아 경희대학교 교육대학원 2020 국내석사

The purpose of this study is to identify the effect of each sub-factor of self-compassion and self-compassion on burnout and provide the basis for the intervention program that can contribute to the prevention of burnout of nurses. This study is a cross-sectional descriptive study to investigate the degree of self-compassion, burnout of nurse at H University Hospital in G city and to identify the relationship between nurse self-compassion and burnout. In this study, a total of 208 copies were included in the data analysis. The Korean version of the Self-Compassion Scale (K-SCS) and Maslach Burnout Inventory scale (MBI) were used as research tools. Data was analyzed by descriptive statistics, t-test, ANOVA, Scheffé test, Pearson correlation, and stepwise multiple regression using SPSS/WIN 26.0 program. The correlation results of this study showed that the six sub-factors of self-compassion all showed a negative correlation with burnout, and the higher the degree of self-compassion, the lower the burnout. According to the analysis, among general characteristic factors, marriage status, satisfaction with nursing jobs, and sub-factors of self-compassion, isolation and mindfulness factors affect burnout. The limitations of the present study and directions for future research were discussed in the conclusion section. 본 연구는 병원간호사를 대상으로 자기연민과 소진과의 관계를 파악할 뿐만 아니라, 병원간호사의 소진 예방에 기여하여 간호의 질 향상을 위한 연구로 제공하려 한다. 본 연구는 G시 H대학병원 간호사의 자기연민, 소진 정도를 확인하고 간호사의 자기연민과 소진과의 관계를 파악하기 위한 서술적 조사연구이다. 본 연구에서는 총 208명의 대상자를 자료 분석에 포함하였으며, 한국판 자기연민 척도(Korean version of the Self –Compassion Scale: K-SCS)와 Maslach Burnout Inventory(MBI) 척도를 연구도구로 사용하였다. 수집된 자료는 코딩화 하여 SPSS/PASW 26.0 프로그램을 이용해 t-test와 ANOVA, Scheffé test, Pearson Correlation Coefficient, 다중회귀분석(Stepwise Multiple Regression)을 이용하여 분석하였다. 연구결과, 자기연민의 6개 하위요인 모두 소진과 음의 상관관계를 보여 자기연민의 정도가 높을수록 소진이 낮음을 확인하였다. 또한, 일반적 특성요인 중 결혼 상태, 간호직에 대한 만족도와 자기연민의 하위요인 중 고립과 마음챙김 요인이 소진에 영향을 미치는 요인으로 나타났다. 연구의 의의, 제한점 및 제언은 결론에 논의하였다.

응급실 간호사의 노인학대 개입의도에 영향을 미치는 요인

정지혜 경희대학교 공공대학원 2017 국내석사

본 연구는 응급실 간호사를 대상으로 노인학대 개입의도에 영향을 미치는 요인을 파악하여 응급실 간호사들의 노인학대에 대한 관심증가와 간호중재적 개입 방안에 대한 교육과 실무를 위한 근거자료를 제공하기 위함이다. 본 연구는 횡단적 서술적 조사연구이며, 자료수집 기간은 2017년 3월2일부터 4월24일까지이다. 연구 대상자는 서울 및 수도권에 있는 13개의 2, 3차 상급병원에 근무하는 연구참여를 수락한 205명의 응급실 간호사이다. 본 연구의 도구는 노인학대 인식 16문항, 법적·제도적 지식 7문항, 노인학대 개입에 대한 태도 14문항, 노인학대 개입에 대한 주관적 규범 9문항, 노인학대 개입에 대한 자기효능감 8문항, 노인학대 개입의도 16개 문항으로 이루어져 있다. 수집된 자료는 SPSS 24.0프로그램을 이용하여 실수와 백분율, 평균과 표준편차, t-est, F-test, Sheffe test, Pearson correlation coefficient, multiple regression analysis로 분석하였다. 1) 응급실 간호사의 노인학대 인식정도는 평점 4점 만점에 평균(표준편차) 2.61(±0.44)점이고, 유형별로 살펴보면 성적학대가 3.08(±0.73)으로 가장 높은 인식도를 보였으며, 방임은 2.14(±0.59)로 인식도가 가장 낮게 나타났다. 대상자의 노인학대에 대한 법적, 제도적 지식을 측정하는 7개 문항을 제시하고 전체 응답 가운데 정답에만 점수를 주어 노인학대에 대한 법적·제도적지식 정도를 측정하였고 4.03±2.01로 나타났다. 대상자의 노인학대에 대한 태도, 주관적 규범, 자기효능감은 각각 평균 평점은 2.69±0.32, 2.65±0.54, 2.59±0.47로 나타났다. 2) 대상자의 일반적인 특성에 따른 제 변인간의 차이는 다음과 같다. 노인학대 인식은 성별(t=3.034, p<.01), 연령(t=3.059, p<.05)에 따라 차이가 나타났다. 법적·제도적 지식은 연령(F=2.846, p<.05), 최종학력(F=5.386 p<.01), 응급실 형태(F=6.192, p<.01), 병원근무경력(F=4.219, p<.01), 노인학대 교육경험 (t=3.014, p<.01)에 따라 차이를 나타났다. 노인학대 개입에 대한 주관적 규범은 연령(F=3.079, p<.05)에서 차이가 있었으며 노인학대 개입의도는 성별(t=2.946, p<01)에서 차이가 나타났다. 3) 대상자의 노인학대 개입의도와 변인들간의 상관관계분석 결과에서 독립변수인 노인학대 인식, 제도적, 법적 지식, 개입 태도, 주관적 규범, 자기효능감이 종속변수인 노인학대 개입 의도와 유의한 정적 상관관계를 보였다. 4) 노인학대 개입의도에 제 변인들이 영향을 미치는 정도를 파악하기 위해 다중 회귀분석을 실시하였으며 일반적 특성 중 노인학대 개입의도에 유의한 차이를 나타난 성별을 통제변수로 회귀 모형안에 포함하여 분석하였다. 분석결과, 노인학대 인식의 베타 값이 0.705로 종속변수인 노인학대 개입의도에 가장 많은 영향을 미쳤으며, 주관적 규범이 .170, 태도가 .116, 법적·제도적 지식이 .086으로 나타났고 이러한 변인들이 개입의도 총 변량의 68.2%의 설명력을 나타냈다.본 연구결과, 응급실 간호사의 노인학대 개입의도는 노인학대 인식이 높을수록, 노인학대에 대한 태도, 주관적 규범이 높을수록, 법적·제도적 지식이 높을수록 개입의도가 높아짐을 알 수 있었다. 따라서 응급실 간호사에 대한 노인학대 대상자의 개입과 중재를 위해서는 응급실 간호사를 대상으로는 노인학대에 대한 인식과 지식을 향상시키는 교육이 필요하며 병원조직 차원의 학대개입과 중재에 대한 구체적인 방안이 계획될 필요가 있음을 시사한다. Purpose: The purpose of this study was to examine the influencing factors on intention of intervening in elder abuse, such as nurses’ awareness of elder abuse and attitude towards, subjective norm of, and self-efficacy of intervening in elder abuse. Method: This study is a correlational descriptive study and data collection period is from March 2, 2017 to April 24, 2017. The instruments used in this study were 16 items of perceptions of elder abuse, 7 items of legal and institutional knowledge, 14 items of attitude of elder abuse intervention, 9 items of subjective norm of intervention of elder abuse, 8 items of self-efficacy of elder abuse intervention, 16 items of intervention intentions on elder abuse. The collected data were analyzed using the SPSS 24.0 Program, the regression, the Standard and the Standard Deviation, the t Test, the coefficient Test, the Sheffe Test, the Pearson correlation, and the Multiple regression Analysis. Result: 1) Mean value of the perception of elder abuse by emergency room nurses was 2.61 (± 0.44) out of 4 points, and the mean value of sexual abuse was 3.08 (± 0.73) which shows the highest recognition rate. The mean value of negligence was 2.14 (± 0.59) which shows the lowest recognition rate.2) The general characteristics of the subjects such as gender, age, final educational background, type of working hospital, type of emergency room, hospital work experience, career experience in emergency room, educational experience, perception of elder abuse according to educational location, intervention attitude and subjective norm shows significant difference between the perception (t = 3.034, p <.01) and the intervention intention (t = 2.946, p <.01) by the gender. Perception (T = 3.059, p <.05), legal and institutional knowledge (F = 2.846, p <.05) and subjective norm (F = 3.079, p <.05) showed significant differences according to age. Legal and institutional knowledge (F = 5.386 p <.01) showed a significant difference according to the final education level. In addition, there was a significant difference in the legal and institutional knowledge (F = 6.192, p <.01) depending on the type of working emergency room. There was a significant difference in the legal and institutional knowledge depending on the career experience (F = 4.219, p <.01) and the educational experience (t = 3.014, p <.01). 3) The results of the correlation analysis showed that the elder abuse awareness, institutional, legal nowledge, intervention attitude, subjective norm, and self - efficacy were statistically significant correlations with elder abuse intervention intention. 4) Multiple regression analysis was conducted to determine the degree to which the variables influence the intention to intervene in elder abuse. Among the general characteristics, the gender that showed a significant difference in the intention of elder abuse was included in the regression model as the control variable As a result, the beta value of the elder abuse awareness was 0.705, which had the greatest effect on the intention to intervene in elder abuse, with a subjective norm of .170, attitude of .116, and legal and institutional knowledge of .086 (F = 73.447, p <.001). These variables accounted for 68.2% of the total variance of intervention intention. Conclusions: The results of this study suggest that the higher the perception of elder abuse, the higher the attitude toward elder abuse, the higher the subjective norm, the higher the legal and institutional knowledge, the higher the intention of intervention. Therefore, in order to help emergency room nurse intervene and mediate the elder abuse, it is necessary to educate the emergency room nurse to improve the awareness and knowledge of the elder abuse, and concrete plan for the intervention and mediation of the hospital organization should be planned.

성인 전기 여성 정신질환자의 신체상, 병식, 정신건강자신감이 약물복용 이행에 미치는 영향

이은미 경희대학교 대학원 2019 국내석사

Purpose: The purpose of the present study was to provide basic data for education and program development for disease self-care to improve medication adherence by identifying the influence of body image, insight, and of early adulthood women psychiatric patients on medication adherence. Method: The present study was a descriptive survey, and data were collected from August 27 to September 20, 2018. The participants were 147 patients consenting to participate in the present study, who were early adulthood women psychiatric patients receiving outpatient care at hospitals in Seoul or Gyeonggi-do or community mental health centers (mental health welfare center, day rehabilitation center, a halfway house). A self-report body image scale developed and standardized with mental patients by Kim Jung-bum & Park Young–nam (1995) was used to measure participants’ body image. The scale consists of a total of 23 items. insight was measured using the Korean version of the Scale to Assess of Mental Disorder (SUMD-K), which was originally developed by Amador et al. (1991) and translated and standardized for schizophrenic patients by Song Jiyoung et al. (2006). The nine-item short foam version of the original scale, which consisted of 74 items, was used in order to reduce the interview time. The instrument is a semi-structured interview scale for insight. Mental health confidence was measured using the Korean version of Mental Health Confidence Scale (MHCS-K), originally developed by Carpinello et al. (2000) for psychiatric patients and translated and standardized for psychiatric patients by Kwon Ja-yeong (2014). It is a 16-item self-report scale. Medication adherence was measured using the Korean version of Medication Adherence Rating Scale (KMARS) originally developed by Thompson et al. (2000) for psychiatric patients and translated and standardized for psychiatric patients by Chang Jhin-goo et al. (2015). It is a 16-item self-report scale. The collected data were analyzed using descriptive statistics, t-test, ANOVA, Scheffe test, Pearson’s correlation, and multiple regression analysis with SPSS/WIN 25.0. The results of this study are as follows. 1) The general and disease-related characteristics of the participants were as follows. A total of 147 patients, of which 110 (74.8%) were diagnosed with schizophrenia, participated in the study, and their average age was 34.65±8.20 years. The majority of participants were single (124 participants, 84.4%), had educational level of high school graduation (79 participants, 53.7%), had a religion (94 participants, 63.9%), had a monthly family income between one and three million KRW (61 participants, 41.5%), and were living with family (114 participants, 44.6%). Participants who reported that they trust the medical staff were 103 (70.1%); the average duration of illness was 9.18±7.77 years, and 42 (28.6%) participants had four or more hospitalizations. A total of 56 (38.1%) participants reported that their knowledge on antipsychotics is average. Participants who experienced weight gain after taking antipsychotics were 101 (68.7%) with the average weight gain of 11.07 kg, and 28 (27.7%) participants reported that they voluntarily stopped taking medication due to weight gain. The average BMI was 25.23±5.33. 3) Correlational analysis of participants’ body image, insight, mental health confidence, and medication adherence showed that medication adherence was negatively correlated with body image and insight but positively correlated with mental health confidence. Especially, the correlation between body image and medication adherence was the highest. 4) The results of multiple regression analysis showed that the affected the medication adherence of the participants. factors that showed statistically significant correlation with the general characteristics, disease-related characteristics, medication characteristics, body image, insight, mental health confidence, and medication adherence of the participants were factors that had 42.9% of combined explanatory power including body image (β=-.32, p<.001), insight (β=-.24, p=.002), and mental health confidence (β=.24, p=.004), of which body image had the greatest influence. Conclusion: The results of the present study showed that body image, insight, and mental health confidence are important to increase the medication adherence of early adulthood women psychiatric patients. Particularly, measures to improve medication adherence should be considered by identifying 연구목적: 본 연구는 성인 전기 여성 정신질환자의 신체상, 병식, 정신건강자신감이 약물복용 이행에 미치는 영향을 파악하여 약물복용 이행을 향상시키기 위한 질병의 자가 관리 교육 및 프로그램 개발을 위한 근거 자료를 제공하기 위함이다. 연구 방법: 본 연구는 서술적 조사연구이며 자료수집 기간은 2018년부터 8월 27일부터 2018년 9월 20일까지이다. 연구 대상자는 서울 및 경기도의 소재의 병원에서 외래 치료를 받거나 지역사회정신보건기관(정신건강복지센터, 주간재활센터, 사회복귀시설)을 이용하고 있는 성인 전기 여성 정신질환자 중 연구에 참여하기로 동의한 환자 147명을 대상으로 하였다. 연구도구는 김정범과 박영남(1995)이 정신질환자를 대상으로 개발하고 표준화한 신체상 척도, Amador 등(1991)이 조현병 환자를 대상으로 개발한 Scale to Assessment Unawareness of Mental Disorder (SUMD)을 송지영 등(2006)이 번역하여 조현병 환자를 대상으로 표준화한 한국판 병식 평가 척도(SUMD-K) 단축형, Carpinello 등(2000)이 정신질환자를 대상으로 개발한 Mental Health Confidence Scale을 권자영(2014)이 번역하여 정신질환자를 대상으로 표준화한 한국판 정신건강자신감 척도(MHCS-K), Thompson 등 (2000)이 정신질환자를 대상으로 개발한 Medication Adherence Rating Scale을 장진구 등(2015)이 번역하여 조현병 환자에게 표준화한 한국판 약물 순응 척도(KMARS)를 사용하였다. 수집된 자료는 SPSS/WIN 25.0을 이용하여 기술 통계, t-test, ANOVA, Scheffe test, Pearson correlation, multiple regression analysis로 분석하였다. 본 연구 결과는 다음과 같다. 1) 대상자의 일반적 특성과 질병 관련 특성은 다음과 같다. 대상자는 총 147명으로 진단명은 조현병이 110명(74.8%), 평균 연령은 34.65±8.20세였다. 결혼 상태는 미혼이 124명(84.4%), 교육수준은 고졸이 79명(53.7%), 종교가 있는 대상자는 94명(63.9%), 가족의 월수입은 100~300만 원 미만이 61명(41.5%), 가족과 같이 사는 대상자가 114명(44.6%)으로 가장 많았다. 치료진을 신뢰한다고 응답한 대상자는 103명(70.1%), 평균 유병기간은 9.18±7.77년이었고, 입원 횟수는 4회 이상이 42명(28.6%), 현재 복용하는 항정신병약물에 대한 지식 정도는 보통이라고 응답한 대상자는 56명(38.1%), 항정신병약물복용 후 체중 증가를 경험한 대상자는 101명(68.7%)이었고, 체중 증가를 경험한 대상자는 평균 11.07kg이 증가하였고, 체중 증가로 인해 28명(27.7%)은 약물을 자의로 중단하였다고 응답하였고, 평균 BMI는 25.23±5.33 이었다. 2) 대상자의 신체상 점수는 92점 만점에 41.80±16.16이었으며, 병식은 27점 만점에 16.29±4.58, 정신건강자신감은 80점 만점에 47.76±14.52으로 나타났다. 대상자의 약물복용 이행은 10점 만점에 5.79±2.59으로 나타났으며, 종교가 있을수록, 유병기간은 20년 이상이 1~5년 미만 보다, 항정신병약물 복용 후 체중 증가가 있을 경우, 체중 증가로 인해 자의로 약물을 조절하지 않는 집단에서 약물복용 이행 점수가 높게 나타났으며, 연령과 치료진을 신뢰 정도가 약물복용 이행에 영향을 미치는 것으로 나타났다. 3) 대상자의 신체상, 병식, 정신건강자신감과 약물복용 이행간의 상관관계 분석 결과 약물복용 이행은 신체상, 병식과 음의 상관관계를 가지고 있었으며, 정신건강자신감과 양의 상관관계를 가지고 있었다. 특히 신체상과 약물복용 이행의 상관관계가 가장 높았다. 4) 다중 선형회귀 분석결과 대상자의 약물복용 이행에 영향을 미치는 요인은 신체상(β=-.32, p<.001), 병식(β=-.24, p=.002), 정신건강자신감(β=.24, p=.004)이었으며, 이 중 신체상이 가장 큰 영향을 미쳤다. 이들 변인들은 총 변량의 42.9%의 설명력을 나타내었다. 결론: 본 연구 결과는 성인 전기 여성 정신질환자의 약물복용 이행을 높이기 위해서는 신체상, 병식, 정신건강자신감이 중요하며, 특히, 신체상에 대한 부정적 인식을 파악하여 약물복용 이행을 증진할 수 있는 방안이 고려될 필요가 있다.

COVID-19 팬데믹 기간 보건교사의 직무스트레스와 소진 : 회복탄력성의 매개효과와 학교조직문화의 조절효과

정혜란 경희대학교 교육대학원 2022 국내석사

본 연구는 COVID-19 팬데믹 기간 학교 감염병 대응 경험을 한 보건교사를 대상으로 직무스트레스와 소진을 파악하고, 둘 간의 관계에서 회복탄력성의 매개효과와 학교조직문화의 조절효과를 검증하고자 하였다. 연구를 위해 전국의 초·중·고등학교에 근무하는 보건교사의 일반적 특성 및 직무 특성, 직무스트레스, 소진, 회복탄력성, 학교조직문화에 대한 자료를 수집하였으며, 총 223명의 설문 자료를 분석에 사용하였다. 수집된 자료는 SPSS win 25.0 통계 프로그램을 이용하여 빈도, 백분율, 평균, 표준편차, Pearson’s correlation coefficient, Multiple regression analysis로 분석하였고 SPSS process macro를 이용하여 매개효과 및 조절효과를 검증하였다. 본 연구의 주요 결과는 다음과 같다. 첫째, 보건교사의 직무스트레스는 5점 만점에 평균 3.82(±0.62)점, 소진은 5점 만점에 3.12(±0.75)점, 회복탄력성은 4점 만점에 2.60(±0.65)점, 학교조직문화는 5점 만점에 3.38(±0.74)점으로 측정되었다. 보건교사의 직무스트레스는 연령과 교직 경력에서 유의한 차이가 나타났으며, 소진은 연령과 근무학교규모, 역학조사의 실시경험에 따라 유의한 차이가 확인되었다. 둘째, 변수별 상관관계에서 보건교사의 소진과 직무스트레스(r=.591, p<.001)는 통계적으로 유의한 정(+)적 상관관계를 나타내고 있으며, 소진은 회복탄력성(r=-.450, p<.001)과 학교조직문화(r=-.476, p<.001)에서 유의한 부(-)적 상관관계가 있는 것으로 나타났다. 셋째, 보건교사의 소진에 영향을 미치는 요인에 대한 다중회귀분석 결과, 직무스트레스, 회복탄력성, 근무학교규모는 소진에 유의한 영향을 주는 것으로 나타났다. 직무스트레스가 높을수록, 회복탄력성이 낮을수록 소진이 높은 것으로 나타났으며, 보건교사의 소진에 영향을 미치는 가장 큰 요인은 직무스트레스(β=.468, t=7.236, p<.001)로 확인되었다. 넷째, 보건교사의 직무스트레스와 소진에 미치는 영향에서 회복탄력성의 매개효과를 검증한 결과, 직무스트레스는 회복탄력성(B=-.349, p<.001)에 유의한 영향을 미치며, 직무스트레스는 소진(B=.593, p<.001)에 유의한 영향을 미치는 것으로 나타났다. 회복탄력성은 소진(B=-.326, p<.001)에 유의한 영향을 미치는 것으로 확인되었으며, 회복탄력성의 부분매개효과를 검증하였다. 다섯째, 보건교사의 직무스트레스가 소진에 미치는 영향에서 학교조직문화의 조절효과를 검증한 결과, 직무스트레스와 소진, 학교조직문화와 소진 간에 유의한 영향이 확인되지 않았다. 본 연구는 COVID-19 팬데믹 기간 학교의 감염병 대응 경험을 한 보건교사의 직무스트레스와 소진을 파악하고 회복탄력성과 학교조직문화의 영향을 제시한 점에서 의의가 있다. 연구 결과를 통해 보건교사의 직무스트레스와 소진을 예방하기 위한 정책적 방안과 회복탄력성을 높이기 위한 심리적·정서적 지원 체계의 필요성을 파악하였다. 향후 학교조직문화의 영향을 제고하기 위한 구성원들의 역할 및 업무수행 정도에 대한 시사점을 제공하며, 후속 연구의 필요성을 제언한다. The purpose of this study is to identify job stress and burnout of health teachers during the COVID-19 pandemic, and to verify the mediating effect of resilience and the moderating effect of school organizational culture. The participants of the study were elementary, middle, and high school health teachers, and a total of 223 copies were included in the data analysis. As research tools, the Korean version of the Connor-Davidson Resilience Scale (K-CD-RISC), the Occupational Stress Scale, the Maslach Burnout Inventory Scale(MBI), and the School Organizational Culture Scale were used. The collected data were analyzed using the SPSS/WIN 25.0 program, and the mediating and regulatory effects were verified using the PROCESS macro. The results of this study, it was confirmed that job stress is the factor that has the greatest influence on burnout of health teachers during the COVID-19 pandemic, and the lower the age and teaching experience of the subject, the higher the job stress. In addition, it was confirmed that the subject's job stress and burnout showed a significant positive correlation, and burnout had a negative correlation with resilience and school organizational culture. The mediating effect of resilience was significantly confirmed in the effect on the subject's job stress and burnout. According to the results of this study, in order to prevent burnout of health teachers, it is necessary to prepare policy alternatives to reduce job stress and psychological and emotional support measures to increase resilience.

간호사의 업무스트레스와 소진과의 관계에서 분노표현방식의 매개효과 : 경력 집단별 비교

이혜영 경희대학교 공공대학원 2016 국내석사

This study aims to investigate the mediator effects of anger expression style in the relationship between job stress and burnout of nurses, and provide preliminary data for developing a stress-management and anger-control program that may help the nurses efficiently manage the job stress and anger originating from hospital work by comparing different groups based on their work experience (3 years or less / more than 3 years). This is a cross-sectional narrative study in which nurses who understood the purpose and method of the study and agreed to participate through a written consent were recruited from 3 different university hospitals located in Seoul, South Korea. A total of 454 subjects were included in the final analysis and investigation was carried out using self-reporting questionnaires. The data were collected from January 25th, 2016 to April 1st, 2016. The level of job stress, anger expression style and burnout were measured using research tools with verified validity and reliability from previous studies. The collected data were analyzed by using SPSS/WIN 18.0 and SPSS Process Macro 2.15 Program to calculate frequency, percentage, average and standard deviation and to conduct χ² test, ANOVA, Pearson Correlation and SPSS Process Macro Program. The results of the bootstrapping analysis showed that the job stress directly affected burnout in all of the three groups (all subjects, 3 years or less of work experience, more than 3 years of work experience) and the group with 3 years or less of work experience in particular showed more than twice the direct effect compared to the group with more than 3 years of work experience. In the group of all subjects, anger-out, anger-in and anger-control all showed mediator effects. Anger-out and anger-control played a functional role contributing to the decrease in burnout, whereas anger-in played a dysfunctional role contributing to the increase in burnout. Meanwhile, the group with 3 years or less of work experience showed mediator effects in anger-out and anger-in, and those with more than 3 years showed mediator effect in only anger-in. Mediator effect of anger-in was shown in all three groups, and the effect was greater than that of any other anger expression styles. Based on the aforementioned results, in order to reduce the burnout of nurses caused by job stress, it is necessary to provide a differentiated stress-management and anger-control program according to work experience. It would be most effective to focus on interventions that may lower job stress, reduce the use of anger-in and simultaneously use anger-out appropriately for the group with 3 years or less of work experience, and focus on interventions that may lower job stress and simultaneously reduce the use of anger-in for those with more than 3 years of work experience

지역사회에 거주하는 조현병환자의 대사증후군 위험요인

선민정 경희대학교 대학원 2020 국내석사

Purpose : Schizophrenia patients have a two to three times higher prevalence of metabolic syndrome than the general population. The purpose of this study is investigate the prevalence of metabolic syndrome and to identify the risk factors of metabolic syndrome in people with schizophrenia patients living in the community. Method : This study is a descriptive research to identify the prevalence and risk factors of metabolic syndrome in schizophrenic patients living in the community. The subjects were 100 schizophrenia patients who lived in S city and used mental health welfare center or mental rehabilitation facility. The study variables were self-report questionnaire, and general and disease-related characteristics, diagnostic tests for metabolic syndrome, lifestyle, depression (CES-D), and social support (MSPSS) were measured. Collected data were analyzed by descriptive statistical method, t-test, χ²-test, Fisher's exact test, and logistic regression using SPSS 24.0 program. The results of this study are summarized as follows. 1) The prevalence of metabolic syndrome was 42.0%. According to the diagnosis criteria of metabolic syndrome, abdominal obesity was 61.0%, hyperglycemia was 46.0%, hyperlipidemia was 45.0%, low density lipoprotein cholesterol was 30.0%, and hypertension was 28.0%. 2) The differences in general characteristics according to the presence or absence of metabolic syndrome were significantly different in occupation (χ² = 5.86, p = .015) and body mass index (χ² = 13.40, p = .001). In lifestyle, physical activity and weight control (t = 6.60, p <.001), eating habits (t = 7.87, p <.001), stress (t = 3.98, p <.001), sleep and rest (t = 3.64) , p <.001), and drug and health examinations (t = 5.36, p <.001) showed a significant difference between the normal and metabolic syndrome groups. The psychosocial characteristics of the subjects with or without metabolic syndrome showed depression (t = -5.18, p <.001), support of friends (t = 3.82, p <.001), and support of meaningful others (t = 2.29, p = .004) showed a statistically significant difference. 3) Multivariate logistic regression analysis revealed that risk factors for metabolic syndrome were body mass index, physical activity and weight control, eating habits, medication and health screening, and depression. The higher the body mass index (OR = 1.56, p = .005) and the depression score (OR = 1.18, p = .034), the higher the risk of metabolic syndrome. In contrast, lifestyle such as physical activity and weight control (OR = 0.68, p =. 024), eating habits (OR = 0.70, p = .009), drugs and health checkups (OR = .49, p = .011) were associated with a lower risk of metabolic syndrome. Conclusion : The risk factors for metabolic syndrome in the schizophrenic patients living in the community were body mass index, physical activity and weight control, eating habits, drug and medical examination, and depression. Therefore, nursing interventions for the management and prevention of metabolic syndrome in patients with schizophrenia should be continuous monitoring and education of healthy lifestyles. Also, psychosocial support for reduce depression should be considered. Keyword : Schizophrenia, Metabolic Syndrome, Lifestyle, Depression, Social Support 연구목적 : 조현병 환자는 대사증후군의 유병률이 일반인에 비하여 2∼3배가량 높은 것으로 나타나고 있다. 이에 본 연구는 지역사회에 거주하는 조현병 환자를 대상으로 대사증후군의 정도를 파악하고, 그 위험요인을 확인하고자 한다. 연구방법 : 본 연구는 지역사회에서 거주하는 조현병환자의 대사증후군 유병률과 위험요인을 파악하기 위한 서술적 조사연구이다. 연구대상자는 S시에 거주하며 정신건강복지센터 또는 정신재활시설을 이용하는 조현병 환자 100명이다. 연구변수는 자가보고식 설문지를 이용하여, 일반적 특성과 질병관련 특성, 대사증후군의 진단검사, 생활습관, 우울(CES-D), 사회적지지(MSPSS)를 측정하였다. 수집된 자료는 SPSS 24.0 프로그램을 이용하여 기술적 통계방법, t-test, χ²-test, Fisher’s exact test, logistic regression을 통해 분석하였다. 본 연구의 결과는 다음과 같다. 1) 대사증후군 유병률은 42.0%이었으며, 대사증후군 진단기준별로는 복부비만이 61.0%, 고혈당이 46.0%, 고지혈증이 45.0%, 저고밀도지단백콜레스테롤혈증이 30.0%, 고혈압이 28.0% 순으로 나타났다. 2) 대상자의 대사증후군 유무에 따른 일반적 특성의 차이는 직업유무(χ²=5.86, p=.015), 체질량지수(χ²=13.40, p=.001)에서 유의한 차이가 있었다. 생활습관에서는 신체활동과 체중조절(t=6.60, p<.001), 식습관(t=7.87, p<.001), 스트레스(t=3.98, p<.001), 수면과 휴식(t=3.64, p<.001), 약물과 건강검진(t=5.36, p<.001)에서 정상집단과 대사증후군 집단이 통계적으로 유의한 차이가 있었다. 대상자의 대사증후군 유무에 따른 심리사회적 특성에서는 우울(t=-5.18, p<.001), 친구의 지지(t=3.82, p<.001), 의미 있는 타인의 지지(t=2.29, p=.004)에서 통계적으로 유의한 차이가 나타났다. 3) 다변량 로지스틱 회귀분석 결과 대사증후군 위험요인은 체질량지수, 신체활동과 체중조절, 식습관, 약물과 건강검진, 우울로 나타났다. 체질량지수(OR=1.56, p=.005)와 우울 점수(OR=1.18, p=.034)가 높을수록 대사증후군의 위험도가 증가하였으며, 반대로 신체활동과 체중조절(OR=0.68, p=.024), 식습관(OR=0.70, p=.009), 약물과 건강검진(OR=0.49, p=.011)에 대한 생활습관이 좋을수록 대사증후군의 위험도가 감소하는 것으로 나타났다. 결론 : 본 연구결과 지역사회에 거주하는 조현병 환자의 대사증후군 위험요인으로는 체질량지수, 신체활동과 체중조절, 식습관, 약물과 건강검진, 우울로 확인되었다. 이에 따라 조현병 환자의 대사증후군 관리 및 예방을 위한 간호 중재시 대상자들의 생활습관을 파악하고, 건강한 생활습관에 대한 지속적인 모니터링과 교육이 필요하며, 우울을 감소할 수 있는 심리사회적 지원도 함께 고려되어야 할 필요가 있다. 주요어 : 조현병, 대사증후군, 생활습관, 우울, 사회적지지