정신과 보호사의 정신질환에 대한 태도

Abstract

For patients with mental illness, in order to provide effective treatment through comprehensive therapy, nurses as primary care givers and psychiatric technicians who help to establish therapeutic environment at psychiatric wards play an important role in various aspects, including identifying inpatients’ symptoms and aggravation early, providing appropriate intervention and treatment, taking measures to deal with emergencies, and promoting rehabilitation and social re&#8208;adaptation, as well as influencing general people’s attitude toward the patients. The subjects of this study were psychiatric technicians who took part in protecting the patients, and this study was attempted to provide primary data required for their on&#8208;the&#8208;job training programs and future research by investigating their attitudes toward mental illness and along with its influencing factors. The subjects were 166 psychiatric technicians who worked at national and public mental institutions, mental hospitals, psychiatric wards of university hospitals, and mental clinics, and they were selected by a convenient sampling method. Data were collected from October 23 to November 13, 2006. As an inventory, a translated questionnaire of the Opinion about Mental Illness (OMI) Scale developed by Cohen & Struening was used. This scale was composed of 51 questions based on 5 factors concerning attitudes of authoritarianism, benevolence, mental health ideology, imposing limitation on mental patients’ social lives, and interpersonal relationship. The reliability of the OMI scale was .84, and the total reliability of the study was .78. Each item was scored on the Likert 6 point scale. Data collected were analyzed by using the SPSS 12.0(ver.) program, finding frequency and percentage, and ANOVA, correlation analysis, and regression analysis (stepwise) were conducted. The results of this study were as follows. 1. Mean age of the subjects was 38 years old; most of them were married (60.2%) and didn’t have a child (40.4%). In education level and religion, less than high school graduates and no religion took the highest proportion of 63.9% and 47.6%, respectively. The largest type of hospitals at which they worked was mental hospitals (70.5%). In a question to ask whether they had a nursing assistant certificate or not, the most frequently answered reply was no (60.2%), and in total work experience, 10 years and more was seen to be the largest response (30.1%), but work experience at psychiatric wards was seen the greatest in 1 to 3 years (26.5%). The most frequently answered mean working hour per week was 40 hours or less (54.8%) and mean monthly income was 1,010&#8208;1,500 thousand won (55.4%). In a question to ask how they ended up working at psychiatric wards, they answered most frequently by their wills (67.5%). In a question that how many times they received on&#8208;the&#8208;job training for the last one year was none, the highest (30.1%), and satisfaction with the work at psychiatric wards was rather high (47.6%), and most of them answered they would keep this job as long as they needed (67.5%). They answered most frequently to a question of what was most needed for improving psychiatric technicians’ attitude was quality improvement through on&#8208;the&#8208;job training (47.7%), followed by treatment improvement and protection of human rights (39.8%), inclusion as a part of treatment team, and improving their job as a profession (12.5%). 2. In the relationship between their general characteristics and attitude toward mental illness, benevolence was seen higher in the age groups of 40-49 years, followed by the age group of 50-59, showing older age group having more warm&#8208;heartedness than the younger age group (F=2.501, p<.05). Also benevolence was higher in the married group than the unmarried group (F=3.448, p<.05). In educational background, mental health ideology was seen higher in the college graduates (52.52), followed by university graduates (50.84), and high school graduates (49.81), showing the attitude was higher in the group of college graduates and above (F=5.010, p<.05). Psychiatric technicians who worked at university hospitals were most warmhearted toward mental illness (F=3.064, P<. 05), while psychiatric technicians who worked at mental hospitals showed the most negative attitude, scoring the highest point at the attitude of social restrictiveness(F=3.376, p<.05). Psychiatric technicians who had a nursing assistant certificate showed to have high benevolence and mental health ideology, while those who didn’t have the certificate showed high authoritarianism (F=4.290, p<.05). The attitude of social restrictiveness was seen higher in the group of having no nursing assistant certificate (F=4.617, P<.05), and interpersonal etiology was seen higher in the group of having the certificate (F=5.413, p<.05). In the total work experience, psychiatric technicians with work experience 10 years and more showed higher benevolence(F=3.758, p<.05) and the lowest attitude of social restrictiveness, and those group showed more warmhearted attitude toward mental illness and generosity on mental patients’ social lives (F=3.638, p<.05). Psychiatric technicians with work experience 3 to 5 years showed the highest attitude of social restrictiveness. Psychiatric technicians who worked more than 10 years at psychiatric wards showed the highest benevolence(F=3.436, p<.05) and the lowest attitude social restrictiveness, but those group with work experience 3 to 5 years showed the highest attitude of social restrictiveness. Thus, psychiatric technicians with work experience 10 years and more at psychiatric wards showed more positive attitude toward mental illness than those with less work experience (F=3.980, p<.05). The factor of interpersonal etiology was seen the highest in the psychiatric technicians with work experience 5 to 10 years, followed by the group with 10 years and more, so that it can be said that psychiatric technicians with work experience more than 5 years showed more positive attitude toward mental illness than those with less work experience. Psychiatric technicians with mean 56-60 working hour per week showed the highest interpersonal etiology so that long working hour didn’t make them keep negative attitude (F=2.263, p<.05). The group with a monthly income less than one million won showed the highest authoritarianism, and the group with 3,010 thousand won and above the lowest (F=3.389, p<.05). The attitude of benevolence was seen the highest in the group with 3,010 thousand won and above, followed by the group with 1,010&#8208;1,500 thousand won, and the group with less than one million won (F=3.718, p<.05). The attitude of social restrictiveness was seen the highest in the group with 1,010&#8208;1,500 thousand won, followed by the group with less than one million won, and the group with 3,010 thousand won and above (F=4.730, p<.05). Thus, it can be said that the group with less monthly income showed more negative attitude toward patients with mental illness, and the group with more monthly income showed more positive attitude. In regard to how they ended up working at psychiatric wards, the attitude of benevolence was seen higher in case by other people’s influence including recommendation from acquaintance or being transferred from other units than the case by their own wills (F=8.292, p<.05). According to how many times they received on&#8208;the&#8208;job training, the group of having 1-3 times of training showed the most positive attitude in interpersonal etiology which was a cognitive factor, and the group of having none of the training showed the lowest, showing that there was required on&#8208;the&#8208;job training for them (F=3.435, p<.05). Psychiatric technicians responded to be satisfied with their work showed the highest benevolence, and those responded to be not satisfied showed the lowest benevolence so that the more they were satisfied with their work, the more they were warmhearted toward patients with mental illness (F=2.866, p<.05). 3. Variables showed significant differences in their attitudes of the OMI scale sub&#8208;factors and general characteristics were as follows. To authoritarianism, factors of nursing assistant certificates and monthly incomes were related, no certificate group and the group with monthly incomes less than one million won showed greater authoritative attitude over patients with mental illness. In attitude of benevolence, the 40-49 year age group and divorced and bereaved groups showed the greatest compassion, followed by the married group, and groups who showed warm&#8208;heartedness toward patients with mental illness were university hospital workers, the groups with total work experience 10 years and more and psychiatric ward experience 10 years and more, a monthly income more than 3,010 thousand won, and the group in which they worked at the ward by other people’s influence including recommendation from acquaintance or being transferred from other units, and the group who responded to be satisfied with their work. Mental health ideology was related to education background, and it was seen the highest in college graduates, followed by university graduates, and high school graduates and less, showing the groups of college graduates and above having more positive attitude. In the attitude of social restrictiveness on mental patients’ social lives, mental hospital workers, the group having a nursing assistant certificate, the groups with total work experience 3 to 5 years, and psychiatric ward experience 3 to 5 years, and psychiatric technicians with monthly incomes less than one million won showed negative attitude, agreeing with an idea that mental patients’ social lives should be limited in order to protect family and society. In interpersonal etiology, psychiatric technicians having nursing assistant certificates, psychiatric ward experience 3 to 5 years, mean 56-60 working hour per week, and having 1-3 times of on&#8208;the&#8208;job training showed positive attitude. 4. In the results of regression analysis (stepwise) on the factors influencing on psychiatric technicians’ attitude toward mental illness, the factor affected authoritarianism was mean monthly incomes; benevolence, mean monthly incomes and how they ended up working at psychiatric wards; mental health ideology, estimated period to work; social restrictiveness, mean monthly income; interpersonal etiology, psychiatric ward work experience. In conclusion, in order to maintain and promote psychiatric technicians’ positive attitude toward mental illness, high quality on&#8208;the job training programs should be developed and implemented systematically. Furthermore, as one of the factors influencing on their attitude was a monthly income, an appropriate monthly income and work environments should be secured.;우리나라는 1995년 정신보건법이 제정(1997년 시행)되어 장기간 입원 수용위주에서 탈피하여 지역사회 정신보건사업의 중요성이 강조되고 있으나 아직도 질병의 특성상 많은 수의 정신 장애인들이 병원이나 정신전문병원에서 치료받고 있는 것이 현실이며, 그 안에서 간호사와 함께 가장 오랜 시간동안 환자 곁을 지키는 사람이 보호사인 점을 감안하면 보호사가 환자들에게 미치는 영향을 간과할 수 없다. 본 연구는 정신과 병동에서 근무하는 보호사들을 대상으로 정신질환에 대한 태도를 조사하고, 태도에 영향을 주는 요인에 대해 파악하여 정신과 보호사의 향후 실무 교육과 연구에 기초자료를 제공하고자 하였다. 연구대상자는 국, 공립정신병원, 정신전문병원, 대학병원 정신과병동, 정신과 의원에 근무하는 정신과보호사 166명을 대상으로 편의 추출하였고, 조사기간은 2006년 10월 23일부터 11월 13일까지였다. 본 연구의 측정도구는 Cohen & Struening이 개발한 OMI척도(Opinion about Mental Illness Scale)를 번역한 설문지를 사용하였다. 본 연구에서 OMI척도의 신뢰도는 .84로 나타났고, 5가지 태도요인을 중심으로 총51문항으로 구성되어 있으며, 각 문항의 배점은 Likert 6점 척도를 이용하였다. 본 연구 전체의 신뢰도는 .78이다. 수집된 자료의 분석은 SPSS 12.0(ver.)을 이용하였고, 빈도와 백분율, ANOVA, 상관관계분석, 회귀분석(stepwise) 등을 사용하여 통계처리 하였다. 연구결과를 요약하면 다음과 같다. 1. 연구대상자는 평균 연령은 38세이고, 기혼이 많았으며(60.2%), 자녀는 미혼을 포함해 없는 경우가(40.4%) 많았다. 학력은 고졸이(63.3%) 가장 많았고, 종교는 없는 경우가 47.6%를 차지했으며, 근무하는 병원형태는 정신전문병원이(70.5%) 가장 많았다. 간호조무사 자격증은 없는 경우가(60.2%) 더 많았고, 총 근무경력은 10년 이상(30.1%), 정신과 근무경력은 1년 이상 3년 미만이 가장 많았다(26.5%). 주당 근무시간은 40시간이하(54.8%), 평균 월수입은 101-150만원(55.4%), 정신과 근무 동기는 자의(67.5%)로 선택한 경우가 더 많았다. 지난 1년간 정신과 영역의 실무교육 횟수는 없었다가(30.1%) 가장 많이 차지했고, 정신과 업무만족도는 만족이(47.6%) 가장 높게 나타났으며, 근무 예정기간은 필요한 기간까지 한다(67.5%)고 하였다. 정신과보호사의 태도를 향상시키기 위해 가장 먼저 개선해야 할 점으로는 실무교육과 이를 통한 자질함양(47.7%), 처우개선과 인권보호(39.8%), 치료 팀의 일원으로 포함 (12.5%) 이라고 응답하였다. 2. 일반적 특성과 정신질환에 대한 태도요인과의 관계를 보면 연령은 자비심에서 40대가 가장 높게 나타났고, 50대 이상이 그 다음을 차지하고 있어 상대적으로 젊은 사람들보다는 유의하게 온정적인 태도를 나타냈고 (F=2.501, p=.04), 기혼이 미혼 보다 유의하게 자비심이 높게 나타났다(F=3.448, p<.05). 정신건강관념은 교육배경 요인으로 전문대졸, 대졸, 고졸이하 순이었고, 전문대졸 이상에서 더 긍정적인 태도를 보이고 있다(F=3.685, p<.05). 대학병원에서 근무하는 보호사들이 정신질환에 대해 가장 온정적이었고 (F통계값=3.064, P<.05), 정신전문병원에서 일하는 보호사들이 사회생활제한성에서 가장 높은 점수를 얻어 부정적인 태도를 나타내었다. (F=3.376, p<.05). 간호조무사 자격증이 있는 보호사들이 자비심, 정신건강관념에서 높게 나왔으며, 권위의식은 자격증이 없는 군에서 높게 나타났다(F=4.290, p<.05). 사회생활제한성은 자격증이 없는 군에서 더 높게 나타났고 (F=4.617, P<.05), 대인관계원인에서는 자격증이 있는 군이 더 높게 나타났다(F=5.413, p<.05). 총 근무경력은 10년 이상 근무한 보호사군에서 자비심이 높게 나타났고(F=3.758, p<.05), 사회생활제한성에서는 10년 이상 근무한 보호사군이 가장 낮게 나타났고, 3년 이상 5년 미만에서 가장 높게 나타났으며, 10년 이상 장기 근무한 보호사군에서 정신질환에 대해 좀 더 온정적이고 정신질환자의 사회생활에 관대 한 것으로 나타났다(F=3.638, p<.05). 정신과 근무 년 한이 10년 이상 정신과에 근무한 보호사군에서 자비심이 가장 높게 나타났고(F=3.436, p<.05), 사회생활제한성은 10년 이상 정신과에 근무한 보호사군에서 가장 낮게 나타났으며, 3년 이상 5년 미만인 군에서 가장 높게 나타나서 10년 이상 근무한 보호사군에서 정신질환에 대해 좀 더 긍정적인 태도를 보이고 있는 것으로 나타났다(F=3.980, p<.05). 대인관계원인에서는 5년 이상 10년 미만인 보호사군에서 가장 높게 나타났고, 그다음이 10년 이상 근무한 보호사군으로 5년 이상 정신과에 근무한 보호사들이 더 긍정적인 태도를 가지고 있는 것으로 조사되었다. 주당 평균 근무시간이 56-60시간인 보호사군에서 대인관계원인이 가장 높게 나타나 근무시간이 길다고 부정적인 태도를 갖는 것이 아님을 나타내주었다(F=2.263, p<.05). 평균 월수입이 100만원 이하인 군이 권위의식이 가장 높게 나타났고 301만원 이상인 군에서 가장 낮게 나타났다(F=3.389 , p<.05). 자비심은 평균 월수입이 301만원 이상에서 가장 높게 나타났고 101-150만원, 100만원 이하 순으로 가장 낮게 나타났다(F=3.718, p<.05). 사회생활제한성은 101-150만원, 100만원이하 순으로 높게 나타났으며, 301만원 이상인군에서 가장 낮게 나타났다 (F=4.730, p<.05). 이를 통해 상대적으로 월수입이 낮은 군에서 정신질환자에 대한 부정적인 견해가 많았고, 월수입이 많은 군에서 정신질환자에 대한 태도가 긍정적임을 알 수 있다. 지인의 소개나 추천, 병원에서의 정신과 병동 발령 등 타의에 의해 정신과 병동에 근무하게 된 보호사군이 자비심에서 자의보다 오히려 높게 나타났다(F=8.292, p<.05). 실무교육 횟수에 따른 정신질환에 대한 태도는 인지적인 요소인 대인관계원인에서 연간 1-3회 실무교육을 받은 군에서 가장 긍정적인 태도를 나타내었고, 한 번도 교육을 받지 않은 군에서 가장 낮게 나타나 실무교육의 필요성을 대변해주고 있었다(F=3.435, p<.05). 업무에 만족한다고 응답한 보호사군에서 자비심이 가장 높게 나타났고, 매우 만족하지 않는다고 응답한 군이 가장 낮게 나타나 업무만족도가 높을수록 정신질환자에게 따뜻하고 온정적인 것으로 나타났다(F=2.866, p<.05). 3. OMI 척도 하부요인과 일반적 특성 중 각 태도요인에서 유의미한 차이를 나타낸 변인들을 중심으로 살펴보면 다음과 같다. 권위의식과 관련된 요인은 자격증유무와 월수입 요인이며, 자비심과 관련된 요인은 연령, 결혼 상태, 병원형태, 정신과 근무 년 한, 월수입, 정신과 근무 동기, 업무만족도로 나타났다. 정신건강관념과 관련된 요인은 교육배경이고, 사회생활제한성과 관련된 요인은 병원형태, 간호조무사 자격증 유무, 총 근무 경력, 정신과 근무 년 한, 월수입으로 나타났다. 대인관계원인과 관련된 요인은 자격증 유무, 정신과 근무 년 한, 주당 평균 근무시간, 실무교육 횟수로 나타났다. 4. 정신과보호사의 정신질환에 대한 태도에 영향을 주는 요인에 대해 회귀분석(stepwise)을 통해 알아본 결과 권위의식에 영향을 주는 요인은 평균월수입이고, 자비심에 영향을 주는 요인은 평균월수입과 정신과 근무동기, 정신건강관념에 영향을 주는 요인은 근무예정기간, 사회생활제한성에 영향을 주는 요인은 평균 월수입, 대인관계원인에 영향을 주는 요인은 정신과 근무경력으로 나타났다. 위와 같은 결과들은 정신질환 및 정신질환자에 대한 긍정적인 태도변화와 전문적인 이해를 위한 체계적이고 질적인 실무교육과 근로환경 개선의 필요성을 시사해주고 있다.