노인요양시설의 인간 중심 케어(Person-centered care)에 대한 연구 = A Review of Person-centered Care in Nursing Homes

다국어 초록 (Multilingual Abstract)

The purpose of this study is to review person-centered care models and the scientific evidence for the impact of person-centered care in U.S. nursing homes, and to analyze the applicability of person-centered care for Korean long-term care system. The most commonly recognized person-centered care models were Eden Alternative, Green House, and Wellspring model. The core components of the three models were autonomy, close relationships, homelike environment, and staff empowerment. Thirty eight empirical studies including 10 model testing studies and 28 studies to examine the impact of person-centered care interventions indicated generally positive outcomes in terms of residents, family, and staff/organization level. The authors analyzed the current situation in the Korean long-term care system with respect to the specific core constructs of person-centered care, and proposed applicable models and practical suggestions in consideration of Korean context. Lastly,future considerations regarding policy and research were discussed.

국문 초록 (Abstract)

본 연구는 미국 장기요양에서 급속히 확산되고 있는 인간 중심 케어의 구체적인 모델 및 이와 관련한 실무에 대한 고찰을 통하여 우리나라의 장기요양제도에 적용 가능한 모델과 구체적인 실무 적용방안을 밝히기 위해 수행된 통합적 문헌고찰 연구이다. 대표적인 인간 중심 케어 모델로는 에덴 대안 모델, 그린 하우스 모델,웰스프링 모델이 있고 자기결정권, 친밀한 관계, 집 같은 환경, 직원 임파워먼트 향상이라는 공통점이 있다. 인간 중심 케어에 대한 연구 현황을 살펴보기 위해 38개의 연구 논문을 분석하였다. 10개의 모델 적용 효과 연구를 분석한 결과 3가지 모델들은 전반적으로 거주자들의 지루함, 무력감, 우울, 만족감 등 주로 심리사회적인측면에서 긍정적인 효과를 나타내었다. 인간 중심 케어에 기반한 중재 효과 평가 연구는 28개가 분석되었는데, 자기결정권을 촉진시키는 식사, 목욕, 케어활동 등은 거주자들의 참여, 상호작용, 자아인식, 문제행동 등 정서와 인지적 측면에서 긍정적인 효과를 나타냈고 친밀한 관계는 거주자, 가족, 직원 모두에서 삶의 질이나 선호, 서비스 질 문제에 대한 긍정적인 인식을 나타냈다. 집 같은 환경은 만족감, 활동 빈도에서 긍정적이었으며 직원 임파워먼트, 팀 운영 및 팀워크, 참여적이고 협력적인 관리자 스타일 등은 특히 직원 및 조직에서 업무에 대한 인식과 능력, 이직, 만족감 등의 긍정적인 효과를 나타내었다. 이러한 고찰을 바탕으로 우리나라 장기요양시설에서 인간 중심 케어를 증진시키기 위한 방향에 대해 논의하고 인간 중심 케어를 증진시킬 수 있는 정책과 제도의 변화 방향에 대해 제언하였다.

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