기동부자유 장기입원환자를 위한 환자복 설계 : 교통사고로 인한 부상환자를 중심으로

Abstract

본 연구의 목적은 교통사고로 인한 기동불능 장기입원 환자의 환자복 착용실태를 조하하여 기존 환자복의 문제점을 파악하고, 조사대상 환자의 특성을 고려하여 환자의 동작 수월성, 착탈의 용이성, 기능성 및 편리성이 향상된 환자복을 설계하는 것이다. 직접관찰 및 면담을 통해 작성된 설문지를 종합병원 정형외과와 신경외과 입원환자를 중심으로 하여 기존 환자복 착용 실태를 조사하였으며, 이 설문조사 결과로 파악된 문제점을 고려하여 트임을 달리한 실험 환자복 상의 2종류, 하의 4종류를 제작하고, 기존 환자복과의 비교를 위하여 2차에 걸친 착의 평가를 실시하였다. 설문조사 결과 조사대상 환자의 부상원인은 자동차로 인한 교통사고의 비율이 가장 높았으며, 손상된 신체부위로는 무릎 및 하지; 어깨와 팔; 항복부; 흉곽과 흉추; 요추골과 골반의 순으로 나타났다. 이들은 척추를 비롯한 몸통부의 손상비율이 높아서 몸통을 제대로 움직일 수 없는 기동불능 특빙을 보이며, 팔과 다리의 손상으로 인해 일상생활에 필요한 기본동작이 불가능하여 가족, 전문간병인, 간호사의 도움을 받아야 한다. 입원 기간은 조사대상자의 과반수가 41-80일 동안 입원하고 있었으며 조사대상자의 46.4%가 욕창이 발생하였으며 발생부위는 등과 엉덩이 부위의 비율이 가장 높게 나타났다. 착용하고 있는 환자복 형태는 파자마형의 투피스였으나, 착탈의가 불편하고 사이즈가 잘 맞지 않으며, 땀이 많이 나고 기브스나 보조기 착용으로 인한 불편함을 이유로 거의 모든(96.7%) 환자들이 병원에서 지급되는 상의나 하의, 또는 모두를 제대로 착용하지 않고 있었으며, 과반수 이상은 누운 상태로 환자복을 갈아입는 것과 배변시에 하의를 벗는 것이 특히 불편하다고 응답하였다. 기존 환자복에 대한 불만사항을 종합하여 각 동작과 치료시의 불편사항을 개선하기 위하여 실험 환자복을 제작하였다. 실험 환자복은 파자마 형의 투피스이며, 소재는 면 100%의 40수로 제작하였다. 착탈의시 환자의 동작이 수월하도록 실험 환자복의 트임구조를 변경하였다. 실험 환자복 상의의 트임은 소매위, 소매아래, 옆선을 조합하여 실험 환자복 상의 2종류, 하의는 옆선과 밑을 조합하여 4형을 제작하였으며, 각 트임은 환자의 피부에 자극을 주지 않도록 줄스냅으로 하였다. 1차 착의 평가를 위한 평가단으로는 피험자, 간병인집단(3명), 의류학 전공의 전문가집단(5명)이 구성되었고, 일반동작과 치료종작으로 나누어 각 동작의 수월성과 편리성을 평가하였다. 착의평가 결과 상의는 소매위, 소매아래, 옆선 모두에 트임이 있는 형태, 하의는 옆선과 밑반트임이 있는 형태가 각 동작에 대한 만족도가 가장 높게 나타났다. 또한 실제 환자의 간병을 하고 있는 가족을 대상으로 실시한 2차 착의평가에서는 기존 환자복보다 실험 환자복에 대한 만족도가 높게 나타나, 2차에 걸친 착의실험 결과 실험 환자복이 기존 환자복보다 동작수월성, 착탈의 용이성, 기능성 및 편리성이 향상된 것으로 나타났다. ; The purpose of this study is to create and suggest a design of patient garment improved in terms of easiness and comfort of movement. Mainly considering long-term inpatients with limited mobility, a series of research has been conducted to identify the patterns of patients move and related troubles they usually experience with their clothing. Direct observation and in-person interviews were conducted to develop a questionnaire, and followed a survey over patients hospitalized in orthopedics and neurosurgery departments. According to the survey result, 2 types of upper garments (Type UB and UC) and 4 types of trousers (Type TB, TC, TD, and TE) were created. And finally, for the purpose of comparison with the current patient garment (Type UA and TA), two rounds of wearing test were conducted. The survey reports that the major portion of inpatient s injury was from car accident. Knee and under-limbs, shoulder and elbow, lower part of stomach, chest and thoracic vertebrae, lumbar bone and pelvis were listed as the frequent injury part. Especially, spine related injury is reported to seriously cause the inaction of patients, and also damages on arms and legs let patients depend on their family, nurses and professional assistance, even for simple movements in daily life. The hospitalized period ranged from 41 to 80 days for more than the half of respondents, and 46.6% responded that they suffer from some sorts of swellings and boils, mostly in their back and buttocks. The survey respondents say that the current patient garment, although it is of two-piece pajama style which allows lots of rooms, is causing discomforts while putting on and taking off; hard to feel good fit; easily tend to be sweaty; and not easy to deal with while putting on plaster gyps or other treatment supports. For these reasons, as many as 96.7% of the respondents report that they don t usually keep wearing on the patient garment in original form, with upper garment and trousers together. Upon these complaints, a set of experimental new style patient garment has been developed to improve the easiness and comfort of movement, especially while putting on and during routine medical treatment. Developed two-piece pajama style, the experimental clothing was designed in 100% cotton of 40 threads. To make it easier for patients when they change cloth, the new upper garments were developed in three types by various styles of opening: each different set of openings, i.e. on front bodies, upper sleeve, under sleeve and side seam. Trousers were developed in five types, differently designing the side seam and bottom part. Snap fastener tape was used at openings to minimize irritation on patients skin. The first wearing test was conducted by three groups of testers ? patients, professional assistances and fashion major professional ?, to try the easiness and comfort of movement in terms of general movements and treatment-related movements. As for the general movements, upper garments Type UB and UC rated high satisfaction in their arm move. Regarding movements for urination, trousers Type TB, TC, TD and TE for patients group, and Type TC, TD and TE for professional assistances and fashion major professional group have acquired high satisfaction level. Especially, fashion major professional group have expressed strong dissatisfaction toward Type TA as to urination movements, suggesting the under open tends to be appropriate. For movements to lay stool, trouser Type TB and TC are the most satisfactory ones with rolling trousers down, while for rolling up Type TE, TC, TD, TB and TA, are rated satisfactory in listed order. Both ratings are indicating full side open is necessary for movements to lay stool regar dless of under open. As for the treatment-related movements, upper garments Type UC, UB, and UA are favored in the movements for intravenous injection, and Type UB, UC, and UA for blood pressure measuring in listed order. Regarding the movements of body temperature test, upper garments Type UB and UC are revealed as highly satisfactory. Meanwhile, for the movements of shifting posture, and taking off upper garments by pulling off and putting on sleeves, the most favored ones are, orderly, upper garments Type UC, UB, and UA. For the actions of snapping upper garments into beneath patient s back, of rolling body down to shift posture, and of snatching out upper garments flat under the body, upper garments Type UC is the most satisfactory one for all three groups. Conclusively, at the first wearing test, upper garment Type UC and trouser Type TC marked the highest satisfaction level for all three groups in its easiness and comfort of movement. (upper garments Type UC>UB>UA, Trousers Type TC>TE>TD>TB>TA) The second wearing test conducted to compare upper garment Type UC and trouser Type TC, again the most favored ones at the first test, with each of Type A and TA, the current ones, included real patients and their families in nursery, patients hospitalized long period with very limited mobility by car accident. For general arm movements, upper garment Type UC, and for the leg movements and movements for urination, trouser Type TC marked higher satisfaction level for each of patients and their family groups. Also, as for the movements of rolling pants down and rolling up, trouser Type TC marked higher satisfaction level. Conclusively, Type UC and TC are revealed more appropriate than Type UA and TA in general movement. In the area of the treatment-related movements, both of upper garments Type UC and UA indicated good satisfaction level on blood pressure measuring. Meanwhile, for the actions of pulling off and putting on sleeves while changing upper garment, Type UC marked high satisfaction level whereas Type UA marked high dissatisfaction level. As for the all other movements such as putting on upper garment, snapping upper garments into behind the patient s back, shifting posture to put on or take off upper garments lying down, Type UC constantly rated higher satisfaction level than Type UA, conclusively indicating Type UC and TC are more appropriate in term of easiness and comfort also in treatment-related movements.