한국인의 건강관행에 대한 민속과학적 접근

Abstract

In order that caring an essential quality of nursing practice be acceptable and satisfying, it is necessary that client’s culture is respected and that nursing practice is appropriate to that culture. Since cultural elements are an important influence on health practices and life patterns related to medical treatment, recovery from and prevention of disease, nurses need to have an understanding and knowledge of social and cultural phenomena to aid in the planning of nursing interventions. To understand the health practices surrounding health and illness, the health beliefs and practices of both folk and professional healing systems should be ascertained. Cultural data are required to provide care of high quality to clients and to reduce possible conflict between the client and the nurse. It is nursing’s goal to provide clients from various cultures with quality nursing care which is satisfying and valuable. The problem addressed by this study was to identify Korean health practices which would contribute to the planning of professional caring practice with the culture: ultimately this study was intended to make a contribution to the development of the science of nursing. The concrete objectives of this study were; 1) to identify Korean health practices, 2) to interpret the identical health practices through traditional cultural thought, and 3) to compare the Korean health practices with those of other culture The investigator used the ethnoscientific approach outlined by spradly in a qualitative study. To discover ancestral wisdom and knowledge related to traditional health practices, the subjects of this study were selected from residents of a small rural mountain village in south west Korea, a place considered to be maintaining and transmitting the traditional culture in a relatively well-preserved state because of being isolated from the modern world. The number of subjects was 18, aged 71 to 89. Research data were collected from January 8 to March 31 1990. Five categories of health practices were identified; “Manage one’s own mind”, “Moderation in all thing”, “Live in accord with nature”, “Live in mutuality with others”, and “Live to the best of one’s ability”. Values derived from these ways of thinking from Confucianism, Taoism and Buddhism help fashion a traditional way of life, exemplified by the saying “Beneficence to all”. Korean thought and philosophy is influenced primarily by Confucianism, Confucian principles of ethics, embedded deeply in the peoples’ minds, form the idea that “heaven and human being are intimately united” based on concept that “heaven is, so to speak, reason”. Twoe Gae’s theory of existential subjectivity develops the concept of self which is the basis of the spirit of reverence in modern Confucian philosophy. The human mind is granted from heaven out of the idea of matter, and what control the mind is the spirit of reverence. Hence the idea of “The primacy of the mind” and provided that one should control one’s own mind. The precepts of duty to parents, respect for elders and worship of ancestors, and moderation in all behavior put a restraint on life which directed that one live earnestly according to Nature’s laws with their neighbors. Not only Confucianism, but also Buddhism and Taoism have had an important effect upon these patterns of ideas. When compared with western culture, Korean health practices tend to be more inclusive, abstract and intuitive while western health practices found to be more concrete, practical and personal. Values and beliefs based an pragmatism and existentialism influence western civilization. Ethical values may be founded on utilitarianism, which considers what is good for the persons in their circumstances as the basis of conduct and takes a serious view of their practical lives including human aspirations rather than an absolute truth. These philosophical and ethical ideas are foundations for health practices related to active, practical and progressive attitudes. This study should enable nursing not only to understanding clients as reflection of the traditional culture when planning nursing practice, but to develop health education corresponding to cultural requirements for the purpose of protection against disease and improvement of health, and thus promote sound health practice. Eventually it is hoped that through these processes quality nursing care as the central idea of the science of nursing will be achieved. ; 看護의 本質인 돌봄이 看護對象者에게 滿足스러운 것으로 받아들여지기 위해서는 그 對象者의 文化를 尊重해야 하며, 그 文化와 一致되어야 한다. 즉 文化的 要素는 疾病의 治療, 回復, 豫防과 관련된 健康慣行 및 生活類型에 重要한 役割을 하기 때문에 看護師가 看護遂行을 하기 위해서는 社會文化的인 要因을 認識하고 理解할 必要가 있다. 즉 健康(疾病)에 따른 健康慣行의 理解를 위해 民俗的이고 專門的인 體系, 둘 다에서 健康信念과 慣行을 確認하여야만 對象者-看護師 사이에 衝擊 없는 豊富한 돌봄의 자료가 提示되어 多樣한 文化 속의 對象者에게 一致되고 滿足스러우며 有益한 質的看護를 提供할 수 있으리라 본다. 그러므로 本 硏究는 韓國 傳統文化 속에 鎔解되어 있는 健康(疾病)을 위한 健康慣行을 確認함으로써 國民이 文化的으로 一致되고 滿足스러운 健康慣行을 實踐할 수 있도록 도움을 주고자 한다. 硏究의 目的에 따른 具體的인 硏究目標는 다음과 같다. 1) 基層文化가 갖는 健康慣行을 確認한다. 2) 確認된 健康慣行을 傳統文化思想 속에서 解釋學的으로 探索한다. 3) 基層文化의 健康慣行을 比較文化的으로 檢討한다. 이러한 目的達成을 위하여 質的方法인 民俗科學的 接近法을 試圖하였으며, 固有한 傳統的 健康慣行에 대한 祖上의 智慧와 슬기를 發掘하기 위하여 外部와의 接觸이 적어서 傳統文化의 保存과 傳承이 比較的 잘 되고 있다고 考慮되는 農村山間地方의 長壽老人 18名을 對象으로 1990年 1月 8日부터 3月 31日까지 자료를 蒐集하였다. 그리하여 確認된 健康慣行을 傳統的文化思想 속에서 解釋學的으로 探索하고, 또한 比較文化的으로 檢討하였다. 硏究結果 對象者의 健康慣行은 “마음을 스스로 다스린다”, “과하지 않게 산다”, “自然 그대로 산다”, “서로 더불어 산다”, “열심히 산다” 등 5個의 範疇로 나타났다. 이러한 健康慣行의 思考의 原型에 위치하고 있는 價値觀은 土着思想인 “弘益人間”의 倫理的 價値觀 및 外來文化인 儒, 佛, 禪 思想이 誘入되어 우리식의 土着化를 形成하였다. 특히 儒敎의 絶對的인 影響을 받은 韓國人의 思考方式이나 生活態度 및 價値觀을 보면, 강한 道德性이 內在하고 있으며, “天卽理”에 의한 “天人合一”思想이 形成되고 退溪哲學의 敬에 기초한 “나”의 이른바 實存的 主體性이 確立되었다. 즉 “敬은 一心의 主宰로서 萬事의 本根”으로 마음은 하늘로부터 附與받았고, 이 마음을 主宰하고 制御하는 것은 敬이다. 그러므로 “마음은 一身의 主宰”라는 思考에서 벗어나지 못하고 오로지 마음을 스스로 다스려야만 孝道와 恭敬과 崇拜精神이 發興되며, 과하지도 덜하지도 않은 行動으로 節制하는 삶이 可能하며, 自然 그대로 家族을 中心으로 이웃과 더불어 열심히 사는 삶이 維持됨을 確認하였다. 이러한 行態에는 儒敎뿐만 아니라 佛敎, 道敎 및 民間信仰的 生活態度 및 價値觀도 至大한 影響을 미치게 됨을 알았다. 또한 比較文化的으로 檢討한 結果 代替로 韓國人은 마음을 中心으로 한 包括的, 抽象的, 直觀的인 健康慣行이 普遍的이고, 西歐人은 마음보다는 身體를 中心으로 한 具體的, 行動的, 自己 中心的 健康慣行이 實施됨을 알 수 있었다. 이는 西歐 文化思想인 實用主義 및 實存主義에 의한 價値 및 信念으로, 즉 行爲를 위해서 利益이 되는 것만이 眞理이며, 知識보다는 生活에 有用한 價値를 重視하고 人間의 欲求를 第一로 보는 功利主義로서 動的, 實踐的, 進步的 立場의 思考原型에 근거한 健康慣行 임을 確認할 수 있었다. 結果的으로 本 硏究는 看護對象者를 우리 固有 文化思想에 비추어 理解하도록 할 뿐만 아니라 疾病을 豫防하고 健康을 維持, 增進시킬 수 있는 文化要求에 附合되는 健康敎育을 시키고 健康慣行을 勸奬하여 質的인 看護로 發展될 것이다.