조기진통 입원 임부 대상의 가상현실을 활용한 산전교육프로그램 개발 및 효과

Abstract

This study verified the effectiveness of a prenatal education program with the use of virtual reality (VR) for pregnant women hospitalized after preterm labor. This program was based on Cox’s (2003) Interaction Model of Client Health Behavior (IMCHB) as the theoretical basis. To develop VR prenatal education programs, we applied the ADDIE model which was conducted in five stages: analysis, design, development, implementation, and evaluation. The educational contents and methods were determined based on needs analysis through literature review were analyzed, surveys on educational needs through interviews were utilized, and content validity was verified by a group of experts. The contents of education were knowledge of preterm labor, relaxation, examination and treatment, symptoms and health management, nutrition and weight management, discharge education, and daily life management which consisted of six subject areas and 19 detailed items. The program of education was designed to include Cox's IMCHB, based on the analyzed prenatal education contents. The video production of education programs using VR was conducted according to the planning, filming, editing, and completion. The final completed VR prenatal education program was devised to enable education using the head mounted display (HMD). Further, through the program, it was also arranged that pregnant women with preterm labor can choose their own education via the user interface for nursing intervention concerning their state anxiety and preterm labor stress that such women may suffer from. The study design was a quasi-experimental design by a non-equivalent control group pretest-posttest design, and was conducted at two women's hospitals in metropolitan city D from May 2021 to September 2021. For hospitalized pregnant women with preterm labor, 15 subjects in the experimental group and 16 subjects in the control group were finally analyzed. SPSS Statistics 24.0 were used to analyze the data, the Chi-square test, Fisher's exact test, and Independent t-test were used to descriptive statistics and pre-homogeneity verification. The Kolmogorov-Smirnov test was used to the normality verification. Hypothesis test was performed using the Independent t-test, Wilcoxon signed-rank test, and Mann-Whitney U test. The results of this study are given as follows. The experimental group that participated in the prenatal education program using VR was measured significantly lower than the control group in terms of state anxiety (p<.009), stress of preterm labor (p<.002), the frequency of uterine contractions (p<.004), and uterine contraction intensity (p<.001), and significantly higher in terms of the degree of change in cervical length (p<.009). Practice behavior (p<.047) and self-efficacy of pregnancy health care (p<.001) were found to be significantly high. Therefore, it was possible to confirm the effective nursing intervention by providing an integrated intervention program in consideration of the physical, emotional, educational, and professional aspects of the subject based on various nursing contents of pregnant women hospitalized with prenatal education using VR. This study also verified the role of effective nursing intervention in providing necessary education and inducing physical relaxation to improve state anxiety, preterm labor stress, uterine contraction, degree of change in cervical length, practice behavior pregnancy health care and self-efficacy of pregnancy health care.

본 연구는 조기진통 입원 임부 대상의 가상현실을 활용한 산전교육프로그램을 개발하고 적용하여 효과를 검증하기 위한 목적으로 실시되었다. 본 프로그램은 이론적 기틀로 Cox (2003)의 대상자 건강행위 상호작용 모델(Interaction Model of Client Health Behavior, IMCHB)을 근거로 하였으며, 구체적인 개발을 위하여 ADDIE 모형의 분석, 설계, 개발, 실행, 평가 5단계에 기초하여 진행하였다. 교육내용과 방법은 선행연구분석, 면담을 통한 교육요구도 조사를 활용하였으며 전문가 집단을 통하여 내용타당도를 검증하였다. 그 결과 총 6개의 주제영역과 19개의 세부영역의 교육내용이 결정되었다. 가상현실 산전교육은 조기진통의 이해, 조기진통의 정서관리, 조기진통 검사 및 치료, 조기진통 증상 및 건강관리, 영양 및 체중관리, 퇴원교육 및 일상생활관리였다. 분석된 산전 교육내용을 Cox의 대상자 건강행위 상호작용 모델에 포함하여 프로그램을 설계하였다. 가상현실 산전교육프로그램 제작은 기획, 촬영, 편집, 영상완성의 과정에 따라 이루어졌고, 최종 완성된 가상현실 산전교육프로그램은 영상표시장치(Head Mounted Display, HMD)를 이용하여 교육이 가능하도록 개발하였다. 또한 조기진통 임부의 상태불안 및 조기진통 스트레스에 관한 간호중재를 위해 사용자 인터페이스(User Interface)를 활용하여 조기진통 임부가 스스로 교육을 선택할 수 있도록 개발하였다. 본 연구설계는 비동등성 대조군 전후 시차 설계를 이용한 유사실험 연구이며, 2021년 05월부터 2021년 09월까지 D 광역시의 2개의 여성전문병원에서 수행하였다. 입원한 조기진통 임부를 대상으로 실험군 15명과 대조군 16명을 최종 분석대상으로 하였다. 자료 분석은 SPSS Statistics 24.0을 이용하였으며 서술통계와 사전 동질성 검정은 Chi-square test, Fisher's exact test, Independent t-test로 분석하였다. 정규성 검정은 Kolmogorov-Smirnov test로 분석하였다. 가설검정은 Independent t-test, Wilcoxon signed rank test와 Mann-Whitney U test로 분석하였다. 본 연구에 대한 결과는 다음과 같다. 본 연구에서는 가상현실을 활용한 산전교육프로그램에 참여한 실험군이 대조군보다 상태불안(p<.009), 조기진통 스트레스(p<.002), 자궁수축빈도(p<.004), 자궁수축강도(p<.001)가 유의하게 낮게 측정되었으며, 자궁경부길이의 변화정도(p<.009)는 유의하게 크게 측정되었다. 임신건강관리 실천행위(p<.047), 임신건강관리 자기효능감(p<.001)은 유의하게 높게 측정되었다.따라서 본 연구는 가상현실을 활용한 산전교육프로그램을 입원한 조기진통 임부에게 다양한 간호내용을 중심으로 신체적, 정서적, 교육적, 전문적 측면을 고려하여 통합 중재프로그램을 제공함으로써 상태불안, 조기진통 스트레스, 자궁수축정도 감소, 자궁경부길이의 변화정도 향상, 임신건강관리 자기효능감 및 실천행위를 증진시키는 효과적인 간호중재임을 확인할 수 있었다.