중환자실 간호사의 좋은 죽음과 연명의료결정에 대한 인식이 임종간호태도에 미치는 영향

국문 초록 (Abstract)

연구 목적: 본 연구는 연명의료결정법 시행에 따라 변화되는 임종간호 상황에 놓인 중환자실 간호사의 좋은 죽음, 연명의료결정에 대한 인식과 임종간호태도 정도와 이들 변수간의 관계 및 임종간호태도에 영향을 주는 요인을 확인하고자 한다.

연구 방법: 자료수집 기간은 2018년 7월 2일부터 7월 30일까지이며, 구조화된 설문지를 이용하여 이루어졌다. 연구대상은 B광역시에 소재한 3개의 상급종합병원의 중환자실에 근무하는 간호사로서 연구의 목적을 이해하고 참여에 동의한 120명을 대상으로 하였다. 수집된 자료는 SPSS 24.0 program을 사용하여 대상자의 일반적 특성은 실수, 백분율, 평균, 표준편차로, 대상자의 일반적 특성에 따른 좋은 죽음, 연명의료결정에 대한 인식, 임종간호태도간의 차이 분석은 t-검정과 일원배치분산분석, 사후검정은 Scheffé test 검정으로 분석하였다. 세 변수간의 관계는 피어슨 상관계수로 분석하였으며, 임종간호태도 영향요인은 다중회귀분석으로 분석하였다.

연구 결과: 연구의 결과는 다음과 같다.
1. 대상자의 일반적 특성은 여성 92.7%, 연령은 25세에서 29세가 37.6%, 종교는 무교가 51.4%, 결혼 상태는 미혼이 75.2%, 학력은 간호학사가 77.1%, 간호전문학사가 11.9%이었다. 임상근무경력은 1년에서 3년 미만이 38.5%, 중환자실 근무경력은 3년 미만이 43.1%, 임종간호 교육을 받은 경험이 없는 간호사는 60.6%, 임종간호제공 횟수는 한 달 평균 1.9회였으며, 대상자의 50.5%가 한 달에 2회 이상 임종간호를 제공하는 것으로 나타났다. 임종과정에 있는 환자에게 연명의료를 제공한 경험이 “있다”가 89.0%, 연명의료 결정법이 제정되어 시행되고 있다는 사실을 “알고 있다” 80.7%, “알고 있지 않다” 19.3%이었다.
2. 대상자의 좋은 죽음에 대한 인식은 총 4점 만점에 평균평점이 3.05±0.30점이었고, 하부영역별로 친밀감 3.22±0.34점, 통제감 2.76±0.58, 임상증상 2.90±0.39점이었다. 연명의료결정 인식은 총 5점 만점에 평균평점이 3.55±0.27점이었다. 임종간호태도는 총 4점 만점에 평균평점이 2.98±0.27점이었다.
3. 대상자의 일반적 특성에 따른 좋은 죽음에 대한 인식은 최종학력(F=3.80, p=.025), 임상경력(F=5.19, p=.002), 중환자실 경력(F=3.81, p=.012)에서 통계적으로 유의한 차이가 있었다.
4. 대상자의 일반적 특성에 따른 연명의료결정 인식은 연령(F=5.46, p=.002), 결혼상태(F=-2.54, p=.012), 최종학력(F=7.90, p=.001), 임상경력(F=6.27, p=.001), 중환자실 경력(F=4.29, p=.007)에서 통계적으로 유의한 차이가 있었다.
5. 대상자의 임종간호태도는 중환자실 경력(F=3.29, p=.023)에서 통계적으로 유의한 차이가 있었다.
6. 대상자의 임종간호태도는 좋은 죽음에 대한 인식의 하부영역인 친밀감(r=.25, p=.008), 연명의료결정에 대한 인식(r=.27, p=.004)과 양의 상관관계가 있었다. 연명의료결정 인식은 좋은 죽음에 대한 인식의 하부영역인 친밀감(r=.20, p=.030)과 임상증상(r=.21, p=.022)과 양의 상관관계가 있었다.
7. 대상자의 임종간호태도에 영향을 미치는 요인은 중환자실 경력(=.20, p=.035), 친밀감(=.19, p=.041), 연명의료결정 인식(=.22, p=.017)이었다. 이와 같은 결과를 통해 중환자실 경력이 10년 이상일수록, 친밀감이 높을수록, 연명의료결정에 대한 인식이 높을수록 임종간호태도가 긍정적임을 알 수 있다. 이들 변수의 임종간호태도에 대한 설명력은 14%였다(F=6.84, p<.001, Adj R²=.140).

결론: 이상에서 중환자실 간호사의 좋은 죽음에 대한 인식의 하부영역인 친밀감, 연명의료결정에 대한 인식이 임종간호태도에 영향을 주는 요인으로 확인되었다. 따라서 중환자실 간호사의 임종간호태도의 영향요인인 좋은 죽음, 연명의료 결정에 대한 인식을 향상시키기 위한 다양한 프로그램을 개발하여 적용하는 것이 필요하다.

다국어 초록 (Multilingual Abstract)

Purpose: This study intends to understand the concept of a good death and the perception for life-sustaining treatment decision of the intensive care unit nurses who are placed in the deathbed nursing situation, which change according to the enforcement of life-sustaining treatment decision law, the extent of the attitude toward nursing care of the dying, and the relationships among these variables, and, at the same time, it is intended to provide a basic material for the development of the guidelines regarding the actual work of the deathbed nursing through the confirmation of the factors that influence the attitude toward nursing care of the dying.

Meathod: The time period of the collection of the data had been from July 2, 2018 to July 30, 2018. And the collection of the data had taken place by using a structured survey questionnaire. Regarding the subjects of the study, they had been the nurses who had been working in the intensive care units of the three upper-ranking general hospitals which were located in the B Metropolitan City. And the 120 persons who had understood the purpose of the research and had agreed to the participation had been the subjects. Regarding the data that had been collected, the SPSS 24.0 program had been used. Regarding the ordinary, special characteristics of the subjects, the analysis had taken place with the actual numbers, the percentages, the averages, and the standard divisions. And, regarding the analysis of the differences between the concept of a good death resulting from the special, general characteristics of the subjects, the perception for life-sustaining treatment decision, and the attitude toward nursing care of the dying, it had been done with the t-test and the one-way analysis of variance, and the post- test had been analyzed with the Scheffé test. The relationships among the three variables had been analyzed with the Pearson correlation coefficient. And the factors that influence the attitude toward nursing care of the dying had been analyzed with the multiple regression analysis.

Result: Results from this study are as follows.

1. Regarding general characteristics of the subjects, the women were 92.7%, the age between 25 years old and 29 years old was 37.6%, regarding the religion, no religion was 51.4%, regarding the situation of the marriage, single was 75.2%, regarding the academic background, the bachelor's degree in the nursing science was 77.1%, and the diploma degree in nursing was 11.9%. Regarding the career experience of having worked clinically, from 1 year to less than 3 years was 38.5%. Regarding the career experience of having worked in an intensive care unit, less than 3 years was 43.1%, the nurses who did not have the experience of receiving the deathbed nursing education was 60.6%. Regarding the number of the times of providing the deathbed nursing, the one month average was 1.9 times. And it appeared that 50.5% of the subjects provide 2 or more deathbed nursing per one month. Regarding the experience of having provided the life-sustaining treatment to a patient who had been in the process of dying, 'Yes, I have' was 89.0%. And, regarding the knowledge of the fact of the enactment and enforcement of the life-sustaining treatment decision low, 'Yes, I know' was 80.7% and 'No, I do not know' was 19.3%.
2. Regarding the concept of a good deaths of the subjects, the average grade point was 3.05±0.30 points out of the full score of 4 points. And, by the lower-part domain, the closure was 3.22±0.34 points, the personal control was 2.76±0.58, and the clinical was 2.90±0.39. Regarding the perception for life-sustaining treatment decision, the average grade point was 3.55±0.27 points out of the full score of 5 points. Regarding the attitude toward nursing care of the dying, the average grade point was 2.98±0.27 points out of the full score of 4 points.
3. Regarding the concept of a good death resulting from the special, general characteristics of the subjects, there were the statistically significant differences between the final levels of the education (F=3.80, p=.025), the clinical career (F=5.19, p=.002), and the clinical career at intensive care units (F=3.81, p=.012).
4. Regarding the perception for life-sustaining treatment decision resulting from the special, general characteristics of the subjects, there were the statistically significant differences between the ages (F=5.46, p=.002), the situations of the marriage (F=-2.54, p=.012), the final levels of the education (F=7.90, p=.001), the clinical career (F=6.27, p=.001), and the clinical career at intensive care units (F=4.29, p=.007).
5. Regarding the attitude toward nursing care of the dying of the subjects, there were the statistically significant differences between the clinical career at intensive care units (F=3.29, p=.023).
6. Regarding the attitude toward care of the dying of the subjects, there were the positive correlations with the closure (r=.25, p=.008), which is the lower part domain of the concept of good death and the perception for life-sustaining treatment decision (r=.27, p=.004). Regarding the perception for life-sustaining treatment decision, there were the positive correlations with the closure (r=.20, p=.030), and the clinical (r=.21, p=.022) which are the lower part domain of the concept of a good death.
7. Regarding the factors that had influenced the attitude toward nursing care of the dying, they were the clinical career at intensive care unit (=.20, p=.035), the closure (=.19, p=.041), and the perception for life-sustaining treatment decision (=.22, p=.017). Through such results, we can find out that, the more the clinical career at intensive care unit is longer than 10 years, the higher the closure, and the higher the perception for life-sustaining treatment decision, the attitude toward terminal care is positive. The explanatory power on the attitude toward terminal care of these above variables turned out 14% (F=6.84, p<.001, Adj R²=.140).

Conclusion: As shown above, it was confirmed that the closure which is the lower part domain of the concept of a good death of a nurse in an intensive care unit and the perception for life-sustaining treatment decision were the factors that have the influences on the attitude toward nursing care of the dying. As a result, it will be needed to develope and apply the diverse programs for improving the closure and the perception for life-sustaining treatment decision, which are the factors that have the influences on the attitude toward nursing care of the dying of the nurses in the intensive care units.

목차 (Table of Contents)

• I. 서론
• 가. 연구 필요성 1
• 나. 연구 목적 4
• 다. 용어 정의 5
• II. 문헌고찰
• 가. 좋은 죽음에 대한 인식 7
• 나. 연명의료결정에 대한 인식 9
• 다. 중환자실 간호사의 임종간호태도 11
• III. 연구방법
• 가. 연구 설계 14
• 나. 연구 대상 14
• 다. 연구 도구 16
• 라. 자료 수집 방법 18
• 마. 대상자의 윤리적 측면 18
• 바. 자료 분석 방법 19
• Ⅳ. 연구결과
• 가. 대상자의 일반적 특성 20
• 나. 대상자의 좋은 죽음, 연명의료결정 인식, 임종간호태도 정도 23
• 다. 대상자의 일반적 특성에 따른 좋은 죽음 인식 차이 25
• 라. 대상자의 일반적 특성에 따른 연명의료결정에 대한 인식 차이 28
• 마. 대상자의 일반적 특성에 따른 임종간호태도 차이 31
• 바. 대상자의 좋은 죽음, 연명의료결정 인식, 임종간호태도 간의
• 상관관계 34
• 사. 임종간호태도에 영향을 미치는 요인 36
• Ⅴ. 논의 38
• Ⅵ. 결론 및 제언
• 가. 결론 43
• 나. 제언 45
• 참고문헌 46
• 부록 54
• 감사의 글 74