호스피스 환자를 위한 원예요법 간호중재 프로그램 개발 및 효과

Other Titles
Development and Effects of Horticultural Therapy Nursing Intervention Program for Hospice Patients
Authors
송미옥
Issue Date
2009-12
Awarded Date
2010
Abstract
The purpose of this study is to develop a horticultural therapy nursing intervention program to meet the physiological and psychological nursing needs of hospice patients and to evaluate the effects of the program. A nonequivalent control group pretest-posttest design was used for the study. The subjects for the study were seventy hospice patients in K hospital in D city: thirty five hospice patients were assigned to the experimental group and thirty five to the control group. The data for the study were collected from April 29 to August 30 of 2008. The horticultural therapy nursing intervention program was consisted of indoor and outdoor horticultural activities. The program was conducted a total of 18 times (6 times per week for 3 weeks), and each activity took 30 minutes. The research tool were as follows: Self Reporting Depression Scale, designed by Zung (1965) and revised by Song (1977), Mood Status Scale developed by McNair and revised by Shin (1996), Lorr and Droppleman (1992), Quality of Sleep Scale developed by Oh, Song and Kim (1998), Fatigue Scale developed by Kim (2005), NRS of Pain from the Korean Version of Brief Pain Inventory by Yoon (1999), and Quality of Life Scale, developed by National Conference on Cancer Nursing (1983), and revised by Shin (2005). Serum cortisol level was measured for stress, and serum T cell and NK cell levels were measured for immune system functions. The data for the study were analyzed with SPSS/WIN 12.0 program, and a x² test and t-test were used for post verification of analysis. The results of this study were as follows : 1. Development of horticultural therapy nursing intervention program The program was developed in the five steps. The first step was data collection and analysis. From the data, it was found that the therapy had physical, psychological, social, and spiritual nursing problems. Therefore, a more appropriate horticultural therapy nursing intervention program should be developed to satisfy the hospice patient's various needs. The second step was the development of a horticultural therapy nursing intervention program. Based on the data, the indoor and outdoor horticultural activity were developed with special consideration for the hospice patients. In the third step, the group of experts in horticultural therapy nursing intervention program verified the content and appropriateness of the program, especially time allotment and the indoor and outdoor horticultural activity. The fourth step was the evaluation of the program according to the patients' satisfaction with the contents of the 18 programmes. The final step was a final review of the program. Based on the result of the patients' satisfaction level, the researcher replaced “the pressed flowers program” which ranked lowest, to “the comparison of texture of flowers program.” 2. Effects of horticultural therapy nursing intervention program 1) The experimental group which received a horticultural therapy nursing intervention program was significantly a lower level of depression than the control group (t=-3.68, p<.001). 2) The experimental group which received a horticultural therapy nursing intervention program was significantly a higher level of mood status than the control group (t=2.13, p=.036). 3) The experimental group which received a horticultural therapy nursing intervention program was significantly a higher level of the quality of sleep than the control group (t=5.93, p<.001). 4) The experimental group which received a horticultural therapy nursing intervention program was significantly a lower level of the fatigue than the control group (t=-4.77, p<.001). 5) The experimental group which received a horticultural therapy nursing intervention program was significantly a lower level of the pain than the control group (t=-8.47, p<.001) 6) The experimental group which received a horticultural therapy nursing intervention program was significantly a higher level of the quality of life than the control group (t=6.69, p<.001). 7) The experimental group which received a horticultural therapy nursing intervention program was significantly a lower level of the stress (serum cortisol) than the control group (t=-6.95, p<.001). 8) The experimental group which received a horticultural therapy nursing intervention program was significantly a higher level of the function of the immune system (serum T cell and serum NK cell) than the control group (t=9.36, p<.001)(t=7.87, p<.001). In conclusion, the horticultural therapy nursing intervention program which was developed by researcher to meet the physiological and psychological nursing needs of hospice patients proved effective in improving the hospice patient's depression, mood status, quality of sleep, fatigue, pain, quality of life, stress and immune system functions. Therefore, this program should be utilized and expanded to the larger population of hospice patients.
본 연구는 호스피스환자를 위한 원예요법 간호중재 프로그램을 개발하고 이를 호스피스환자에게 적용하여 대상자의 생리·심리적 반응에 미치는 효과를 검증하고자 시도된 비동등성 대조군 전후시차설계의 유사 실험연구이다. 본 연구의 자료수집은 2008년 4월 29일부터 8월 30일까지 D시 K대학병원에 입원한 호스피스환자를 대상으로 실험군 35명, 대조군 35명을 각각 선정하였다. 본 연구에서 적용한 원예요법 간호중재 프로그램은 실내·외 원예활동으로 구성되어 있으며 매회 30분씩 주 6회의 프로그램을 3주간 제공하였다. 연구도구는 Zung(1965)이 개발하고 송옥현(1977)이 번역한 우울 측정도구, McNair, Lorr와 Droppleman(1992)이 개발하고 신윤희(1996)가 수정한 기분상태 측정도구, 오진주 등(1998)의 수면 측정도구, 김경희(2005)의 피로 측정도구, 윤영호 등(1999)이 개발한 한국형 간이통증 조사지(Korean Version of Brief Pain Inventory, BPI-K)에서 제시된 숫자 측정 등급(NRS, Numeric Rating Scale)의 통증 측정도구, 1983년 미국종양간호학회에서 개발한 Quality of Life Scale(Q. L. S.)을 신임식(2005)이 수정·보완 한 삶의 질 측정도구를 사용하였다. 또한 스트레스 정도는 혈중 코티졸, 면역기능은 혈중 T세포, 혈중 자연살해세포를 검사하였다. 본 연구의 자료분석 방법은 SPSS Win 12.0 program을 이용하여 x² test, t-test로 검증하였다. 본 연구의 결과는 다음과 같다. 1. 원예요법 간호중재 프로그램 개발 원예요법 간호중재 프로그램 개발은 5단계의 과정으로 진행되었다. 제 1단계는 자료수집 및 분석단계로 호스피스환자는 신체적, 심리적, 사회적, 영적인 간호문제들이 있으므로 이러한 간호요구를 충족시킬 수 있는 원예요법 간호중재 프로그램 개발이 필요한 것을 확인하였다. 제 2단계는 개발단계로 분석한 자료에 근거하여 호스피스환자의 특성을 고려한 실내·외 원예활동으로 구성된 원예요법 간호중재 프로그램을 개발하였다. 제 3단계는 타당도 검증단계로 전문가 집단에게 자문을 구하여 실내·외 원예활동, 시간배정 등 프로그램의 내용 및 적절성에 대하여 검증하였다. 제 4단계는 평가단계로 18회수의 프로그램 내용을 호스피스환자에게 예비조사를 실시하여 만족도를 평가하였다. 제 5단계는 확정단계로 프로그램에 대한 만족도 결과에 기초하여 가장 낮은 점수로 나타난 ‘꽃누름’ 대신에 ‘꽃의 질감 비교’로 바꾸었다. 2. 원예요법 간호중재 프로그램 효과 제 1가설: 원예요법 간호중재 프로그램을 제공받은 실험군은 대조군보다 우울점수가 유의하게 감소되었다(t=-3.68, p<.001). 제 2가설: 원예요법 간호중재 프로그램을 제공받은 실험군은 대조군보다 기분상태점수가 유의하게 증가되었다(t=2.13, p=.036). 제 3가설: 원예요법 간호중재 프로그램을 제공받은 실험군은 대조군보다 수면의 질점수가 유의하게 증가되었다(t=5.93, p<.001). 제 4가설: 원예요법 간호중재 프로그램을 제공받은 실험군은 대조군보다 피로점수가 유의하게 감소되었다(t=-4.77, p<.001). 제 5가설: 원예요법 간호중재 프로그램을 제공받은 실험군은 대조군보다 통증점수가 유의하게 감소되었다(t=-8.47, p<.001). 제 6가설: 원예요법 간호중재 프로그램을 제공받은 실험군은 대조군보다 삶의 질점수가 유의하게 증가되었다(t=6.69, p<.001). 제 7가설: 원예요법 간호중재 프로그램을 제공받은 실험군은 대조군보다 스트레스 수준(혈중 코티졸)이 유의하게 감소되었다(t=-6.95, p<.001). 제 8가설: 원예요법 간호중재 프로그램을 제공받은 실험군은 대조군보다 면역기능(T세포: t=9.36, p<0.001, 자연살해세포: t=7.87, p<.001)이 유의하게 증가되었다. 결론적으로 호스피스환자의 간호요구를 충족시키기 위하여 개발한 본 원예요법 간호중재 프로그램은 호스피스환자의 생리적, 심리적 안정에 영향을 주어 우울, 기분상태, 수면의 질, 피로, 통증, 삶의 질, 스트레스 정도, 면역 기능에 긍정적인 효과가 있는 간호중재 프로그램으로 확인되었다. 따라서 호스피스환자에게 본 원예요법 간호중재 프로그램을 확대, 보급할 수 있는 방안이 모색되어야 할 것이다.
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http://kumel.medlib.dsmc.or.kr/handle/2015.oak/11049
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3. Thesis (학위논문) > 2. College of Nursing (간호대학) > 박사
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