만성정신질환자 주거시설 실태와 서비스 및 삶의 만족도 인식

Abstract

The purpose of this study is to examine factors related to satisfaction at life in patients with chronic mental illness, by surveying the realities of residential facilities for chronic mental illness, and by grasping the satisfaction at service and at life that is recognized by dwellers for the residential facilities. By doing so, it is further aimed to offer basic materials to the development of community mental nursing service that installs and operates the diversely residential facilities, which meet the needs of patients with chronic mental illness and enhance the quality of life that is the ultimate goal of a human being. As for the subjects of a research, it conducted complete enumeration targeting the residential and institutionalized facilities that were registered in the Association of Korean Community Mental Rehabilitation Centers until July 5, 2005. Among 54 facilities that were registered nationwide, it excluded 1 facility that reported closing, 1 residential facility for alcohol, 3 facilities that rejected questionnaire, and 2 facilities that were blocked contact. And then, it widely distributed totally 513 copies of questionnaire to each of residential facilities by mail, targeting patients with chronic mental illness who dwell in the residential facilities. The collected questionnaires were 379 copies, and the ratio of collection accounted for 73.88%. Among them, it excluded 3 questionnaires that were responded unfaithfully, and 8 facilities that were lost questionnaires. The final analysis targeted 39 residential facilities and 376 patients with chronic mental illness. As for the period of collecting materials, it carried out from Oct. 17 to Nov. 2, 2005. As for a research tool, it used the scale that Park Eun-ju (2002) recomposed with 30 items in 4-mark scale after translating CSI (Client Satisfaction Inventory), which McMuty Walter devised, the scale that Lee Hui-suk (1991) recomposed with 30 items in 5-mark scale as for Family Environment Scale (FES R Form), which Moos & Insel(1974) developed, and the scale of satisfaction at life with 33 items in 5-mark scale, which Yang Ok-gyeong (1994) developed. As for the analysis of materials collected, it carried out descriptive statistics, frequency analysis, multi-response analysis, crosstabulation analysis, ANOVA, correlation analysis, and t-test method, by using SPSS 12.0 version. The results of research are as follows. 1. As for the socio-demographic characteristics for patients with chronic mental illness, those in their 30-40 (72.7%) dwell, and the unmarried (71.8%) are many. Those have highly academic background (72.8%) with more than high-school graduate. Basic allocatees (61.6%) are more than 1/2, and the majorities are registered disabled people (70.8%). As for the clinical characteristics, the schizophrenia (76.5%) is the most, and the period of having disease is mostly more than 5 years (79.64%). As for the characteristics related to dwelling, the resident period is mostly less than 2 years, and the right to participate in or to determine resident decision comes to brothers/sisters, parents, and the identical person in order. Even as for a role of main guardian, brothers/sisters have priority over parents. As for the resident cost, a case that the identical person first bears was the most. As for the resident motivation, it was the most in the necessity (37.7%) of independently life training. And the next was possessed by the reason (28.1%) that cannot live with family. What is considered most importantly in case of resident, was whether or not the aid of rehabilitation program (42.3%). The monthly utility expense is mostly received, and 120,000 won is expended per month. 3-4 persons live together in one room. As for a contact with family, the contact with around 1-3 times (41.3%) a month is the most, but it is desired to contact more than once a week. As for the family relations, 69.4% got better. Given leaving, the independent life (40.2%) is planned. The priority in what actually became help, was in order of the solution in eating and sleeping, of managing a disease, and of availability for daily life. Also, the priority in what was conducive the most, was in order of the solution in eating and sleeping, of economic aid, and of what came to have ability of a living plan. 2. Given seeing general characteristics in the residential facilities for patients with chronic mental illness, most of them are the registered facilities. The government subsidies are supported. Social welfare corporations (43.2%) and individuals (35.1%) are mainly forming the main body of operation. There were the most facilities that are operated independently with (43.2%) residential facilities. More than 1/2 comprise tenement houses, villas, and multi-household residence, and those are being operated through lease. The rental costs were much in corporations (55.6%) and individuals (36.1%). Seoul was distributed the most, and convenience of using transportation was very high. The majorities are occupied by cases (92.3%) in which a manager is a facility chief. The resident management (87.2%) is performed for 24 hours. As the average working personnel is 2-3 persons, more than 70% is being equipped with professional qualification for mental health. The career of mental health in these people is 5 years and 8 months, and the career of residential facilities is 2 years and 6 months. The priority in the standard of selecting residents, is in order of the rehabilitation will in the identical person, of the level in mental symptom, and of adaptation to community life. As for the institutions associated weekly, the majorities are community rehabilitation centers (47.5%) and mental health centers (32.5%). As for the evaluation of patients in the facilities, about 1/2 are carrying out. 3. The satisfaction at using services is 2.84 marks (the mean value 2.50). The satisfaction at family environment is 3.22 marks (the mean value 3.00). So it was indicated to be 'satisfactory' level higher than the mean value. Therefore, the satisfaction at services in the residential facilities was indicated to be satisfactory level in all. 4. The satisfaction at life in patients with chronic mental illness is 2.80 marks (the mean value 3.00), thus it was indicated to be satisfactory level lower than the mean value. 5. There was no difference in the satisfaction at using services in the residential facilities, the satisfaction at family environment, and the satisfaction at life, depending on socio-demographic characteristics. And it was indicated to be insignificant statistically. 6. The correlation between the satisfaction at life and the satisfaction at using services in the residential facilities, was in order of spheres such as the offer of program, information, and resources (r=.403), others (r=.359), family relations (r=.333), physical environment (r=.297), relationship with staff (r=.257), and relationship with persons living together (r=.105). Thus it was indicated to be significant statistically in the level of p<.01. 7. The correlation by sub-sphere between the satisfaction at life and the satisfaction at family environment, was in order of relational dimension (r=.478), individually growth dimension (r=.469), and system-maintenance dimension (r=.401) Thus it was indicated to be significant statistically in the level of p<.01 of all spheres. Through the results of research in the above, the satisfaction at life in patients with chronic mental illness is somewhat low level, but the satisfaction at services in the residential facilities was indicated to be high level. As for the results of this study, compared to the preceding researches, the satisfactory level at services in the residential facilities in patients with chronic mental illness was enhanced. The relationship with staff was indicated the relatively high satisfaction. But Similarly to other research reports, the satisfactory level at the whole life was indicated to be low. Patients with chronic mental illness fail to receive family's proper care and come to have difficulty in economic burden and in maintaining daily life, as the family proceeds with being fatigued due to long period of having a disease. Therefore, they come to shun living together at home after being discharged from the hospital, thus it becomes hindrance to mentally social rehabilitation. And, aiming at the steady treatment, they live in the residental facilities as an alternative of residence. In terms of the resident decision for the residential facilities, the decisive right in brothers/sisters has priority over the identical person and over parents (given failing to be respected self-determination), thus it becomes an obstacle to enhancing satisfactory level at life and to rehabilitation. This is relevant to the will of rehabilitation in the identical person who is the first priority in the standard of selecting, which is thought most importantly given the selection of residents. And, it has negative influence upon the independent life, which becomes the basis of rehabilitation treatment. Thus, given maximally respecting the autonomously self-determination, it is expected that an effect of rehabilitation service will be great, by which the identical person oneself reinforces the will and responsibility for rehabilitation. It needs to be provided services that combine custom and culture in our country. It will need to be offered services and programs that are reflected social flow and culture, supply 'customized service' in order to become actual help for the resident motivation and for the expectant value aiming to achieve a goal that they desire, recognize autonomy with minimal regulation, and respect and prioritize a sense of ego and the self-determination. In particular, it is required the diversely and individual programs that are expected individual growth, and the offer of services that associate with necessary information and resources.;본 연구는 만성정신질환 주거시설의 실태를 조사하고, 주거시설거주자가 인지하는 서비스와 삶의 만족도 수준을 파악하여, 만성정신질환자 삶의 만족과 관련된 요인을 알아보고자 하는 조사연구이다. 그리하여 향후 만성정신질환자의 요구충족과 인간의 궁극적 목표인 삶의 질을 향상시키는 다양한 주거시설을 설치하고 운영하는 지역정신 간호서비스 개발에 기초 자료를 제공하기 위함이다. 연구 대상자는 한국사회복귀시설협회에 2005년 7월 5일까지 등록된 주거 및 입소시설을 대상으로 전수조사 하였다. 전국에 등록된 54개 시설 중, 폐쇄신고시설 1개소, 알콜주거시설 1개소, 설문거부시설 3개소, 연락두절시설 2개소를 제외한 총 47개소의 주거시설에 거주하는 만성정신질환자를 대상으로 총 513부의 설문지를 각 주거시설에 우편으로 배포하였으며, 회수된 설문지는 379부로 회수율은 73.88%였다. 그 중 불성실하게 응답한 설문지 3부와 설문지가 분실된 8개소를 제외하고 최종 분석은 주거시설 39개소와 만성정신질환자 376명을 대상으로 하였다. 자료수집 기간은 2005년 10월 17일부터 11월 2일까지 실시하였다. 연구 도구는 McMuty Walter가 고안한 주거시설 서비스이용 만족척도(Client Satisfaction Inventory : CSI)를 박은주(2002)가 번역하여 4점 척도 30문항으로 재구성한 척도, Moos & Insel(1974)이 개발한 가정환경척도(Family Environment Scale : FES R Form)를 이희숙(1991)이 5점 척도 30문항으로 재구성한 척도, 양옥경(1994)이 개발한 5점 척도 33문항의 삶의 만족 척도를 사용하였다. 수집된 자료의 분석은 SPSS 12.0 버전을 이용하여 기술통계, 빈도분석, 다중응답분석, 교차분석, 분산분석, 상관관계분석, t-test 방법을 실시하였다. 연구 결과는 다음과 같다. 1. 만성정신질환자의 인구사회학적 특성은 30-40대(72.7%)가 거주하고 미혼(71.8%)이 많으며 고졸이상의 고학력(72.8%)이며 국민기초수급자(61.6%)가 1/2 이상이며, 장애등록자(70.8%)가 대부분이다. 임상적 특성은 정신분열(76.5%)이 가장 많고 대부분 유병기간이 5년 이상(79.64%)이다. 거주관련 특성은 입주기간이 2년 미만이 대부분이고 입주결정에 참여하거나 결정권은 형제/자매, 부모, 본인의 순이고 주보호자의 역할 역시 형제/자매가 부모보다 우선한다. 입주비용은 본인이 우선 부담하는 경우가 가장 많았고 입주 동기는 독립생활훈련이 필요해서(37.7%)가 가장 많고 그 다음이 가족과 함께 살 수가 없어서(28.1%)가 차지했다. 입주 시에 가장 중요하게 생각하는 것은 재활프로그램(42.3%)의 도움여부였다. 거의 월이용료를 수납하고 용돈으로 월 12만월을 지출하며 한 방에서 3-4명이 함께 기거하고, 가족과 연락은 월 1-3회(41.3%) 정도 연락이 가장 많지만 주 1회 이상 연락하기를 원하며 가족관계는 69.4%가 좋아졌다. 퇴거 시 독립생활(40.2%)을 계획하고 실제 도움이 된 것의 우선순위는 먹고 자는 것 해결, 병을 관리, 일상생활가능의 순이다. 또한 가장 도움이 된 것의 우선순위는 먹고 자는 것 해결, 경제적인 도움, 생활계획 능력을 갖게 된 것의 순서이다. 2. 만성정신질환자 주거시설의 일반적 특성을 보면, 거의 등록시설이고 국고보조금을 지원받고 사회복지법인(43.2%)과 개인(35.1%)이 운영주체의 주를 이루고 있다. 주거시설 단독으로 운영(43.2%)하는 시설이 가장 많았고 1/2 이상이 연립, 빌라, 다세대주택이며 임대를 하여 운영하고 있다. 임대비용은 법인(55.6%)과 개인(36.1%)가 많았다. 서울이 가장 많이 분포하고 있었으며 교통이용 편리성은 매우 높았다. 관리자가 시설장인 경우(92.3%)가 대다수를 차지하고 24시간 입주관리(87.2%)를 하고 평균 근무 인력은 2-3명으로 70%이상이 정신보건 전문자격을 갖추고 있다. 이들의 정신보건 경력은 5년 8개월이고 주거시설 경력은 2년 6개월이다. 입주자 선정기준의 우선순위는 본인의 재활의지, 정신증상정도, 공동생활적응의 순서이며 주간 연계기관은 사회복귀시설(47.5%)과 정신보건센터(32.5%)가 대다수이며 시설에서 환자의 평가는 1/2정도가 실시하고 있다. 3. 서비스이용 만족도는 2.84점(평균값 2.50), 가정환경 만족도는 3.22점(평균값 3.00)으로 평균값보다 높은 ‘만족’ 수준으로 나왔다. 그러므로 주거시설 서비스 만족도는 모두에서 만족수준인 것으로 나타났다. 4. 정신질환자의 삶의 만족도는 2.80점(평균값 3.00)으로 평균값보다 낮은 만족수준으로 나타났다. 5. 인구사회학적 특성에 따른 주거시설 서비스이용 만족도, 가정환경 만족도, 삶의 만족도는 차이가 없었으며, 통계적으로 유의하지 않는 것으로 나타났다. 6. 삶의 만족과 주거시설 서비스이용 만족도의 상관관계는 프로그램과 정보 및 자원제공(r=.403), 기타(r=.359), 가족관계(r=.333), 물리적 환경(r=.297), 직원관계(r=.257), 거주동거인 관계(r=.105) 영역 순으로 p<.01 수준에서 통계적으로 유의한 것으로 나타났다. 7. 삶의 만족과 가정환경 만족의 하위영역별 상관관계는 관계차원(r=.478), 개인성장차원(r=.469), 체계유지차원(r=.401) 순으로 모든 영역에서 p<.01 수준에서 통계적으로 유의한 것으로 나타났다. 이상의 연구 결과를 통해, 만성정신질환자의 삶의 만족은 다소 낮은 수준이나, 주거시설 서비스만족은 높은 수준으로 나타났다. 본 연구의 결과는 선행연구와 비교하여 만성정신질환자의 주거시설 서비스 만족수준이 향상되었다. 직원과의 관계에서 상대적으로 높은 만족도를 보였으나, 다른 연구보고와 유사하게 전체적인 삶의 만족수준은 낮은 것으로 나타났다. 만성정신질환자는 긴 유병기간으로 가족이 지쳐감에 따라 적절한 가족의 돌봄을 못 받고, 경제적 부담감, 일상생활유지에 어려움을 겪게 된다. 그러므로 퇴원 후 집에서 같이 사는 것을 꺼려하게 되어 정신사회재활에 방해가 되며 지속적인 치료를 위해 주거의 대안으로 주거시설에 입주한다. 주거시설 입주결정에 본인과 부모보다 형제/자매의 결정권이 우선하여(자기결정권을 존중받지 못한 경우), 삶의 만족수준을 높이고 재활하는데 방해하게 된다. 이것은 입주자 선정 시 가장 중요하게 생각하는 선정기준에서 1순위인 본인의 재활의지와 관련이 있으며 재활치료의 기본이 되어 독립생활을 하는데 부정적인 영향을 미치는데 자율적 자기결정권을 최대한 존중한다면 본인 스스로가 재활에 대한 의지와 책임을 강화하여 재활서비스의 효과가 클 것이라 예상된다. 우리나라 관습과 문화에 어우르는 서비스가 제공되어야 한다. 사회적 흐름과 문화가 반영되고 그들이 원하는 목적을 성취하도록 입주동기, 기대치, 실제도움이 되도록 ‘맞춤서비스’를 제공하고, 최소한의 규제로 자율성을 인정하고 자아감과 자기결정권을 존중하고 우선하는 서비스 및 프로그램을 제공해야 할 것이다. 특히 개인적 성장이 기대되는 다양하고 개별적인 프로그램과 필요한 정보와 자원을 연계하는 서비스제공이 요구된다.