유·소아를 위한 포괄적 간호가 그들의 병원생활 적응에 미치는 영향에 관한 연구

Abstract

유·소아를 위한 포괄적간호(Comprehensive nursing care)가 그들의 병원 생활 적응에 미치는 영향에 관한 본 연구는 우리나라의 경우 유·소아를 위한 연구가 등한시 되고 있고 이에 관한 문헌을 찾아보기 어려운 실정이므로 이에 임상적 간호연구를 통해 1973년 4월 1일부터 1973년 5월 5일까지 연세의료원 소아병동에 입원한 환아 60 예를 대상으로 입원후 유·소아의 병원 생활 적응 상태(입원에 따른 불안 및 공포, 일반 적응성, 생활 습관의 변화)를 일정한 간호원리(유·소아의 기본 요구와 성장 발달에 따른 특수요구 및 개성적 요구의 충족)를 적용한 실험군 (30예)과 대조군 (30예)를 비교 관찰하므로 유·소아를 위한 임상 간호를 발전시키고 아울러 모아의 심리적 안전에 기여함을 목적으로 하였으며 그 결과는 다음과 같다. 1. 조사대상아 중에는 여아보다 (22예) 남아가 (38예) 많았고 최소연령 3세에서 최고연령 12세까지로 성별 및 연령별 구성은 양군에 있어 비슷하였다. 2. 대상아의 1(/)3이 3명의 형제를 가졌고 둘째가 가장 많았으며(38.3%) 대부분이 부모형제하고만 중등도의 생활을 영위하고 있다. 3. 조사대상아 중 과반수 (75~85%)가 식사, 수면, 배변 배뇨등을 자립적으로 할 수 있었고 대부분(75%)이 예방접종을 정규적으로 받고 있었다. 4. 입원시 반수 이상(55%)의 어머니들이 사전에 말로 타이르거나 설명해 주고 있었는데 사전 설명을 들은 경우 입원후 수긍하는 경향이 높았다.(x^(2)=4.6 P＜0.05). 5. 현재 앓고 있는 질병에 대한 반응은 여러가지였는데 이중 질병과 처치에 대해 공포를 나타내는 경우가 가장 많았고 (31.7%) 발병 원인을 잘못의 대가로 오해하는 경우 (25%) 가 그 다음으로 많았다. 6. 부모 및 친척과 헤어질때의 반응은 사전에 준비를 시킨 실험군에 있어 잘 헤어졌으며 (70%) 학령기아동(24.2%)이 학령전기 아동(66.7%)보다 불안반응이 훨씬 적었다. (x^(2)=4.34 P＜0.05, x^(2)=9.22 P＜0.005) 7. 환아중 반수이상(55%)이 의사나 간호원에 대한 공포반응을 나타냈으나 간호시의 반응은 실험군에 있어 대다수(80%)가 좋은 반응을 보였다. (x^(2)=4.8 P＜0.05). 8. 고통이 수반되는 치료 및 처치시에는 대다수(약70%)가 불안반응을 보였으며 양군에 있어서도 유사하였다(x^(2)=3.77 0.1＞P＞0.05). 9. 입원 중 야뇨증 수면장애 식사곤란등 퇴행현상은 대조군에 있어 현저히 많았으며 (x^(2)=2.3 P＞0.05, x^(2)=4.9 P＜0.05, x^(2)=3.88 P＜0.05). 실험군에 있어 병원생활 중 일반적응성이 높았고 (t=2.02 P＜0.05), 지능지수가 높은 경우 적응성이 높은 경향이 있었다(x^(2)=5.03 P＜0.05). 이와 같이 유·소아 간호시 포괄적 간호를 계획, 실시함이 그들의 병원생활적응에 효과가 있었으므로 간호원은 그들의 간호계획에 유·소아의 성장 발달에 따른 특수성과 개별적요구를 파악하여 적용하므로서 질병과 입원으로 인한 육체적 정신 심리적 외상을 가능한 막아야 할것으로 사려된다.;The goal of modern nursing is to provide comprehensive nursing care to patients, If comprehensive nursing care to children (within the hospital setting) is to be provided, consideration of the stage of growth and development of the child, is especially important, From clinical observation, it appeared that nurses often disregarded individual requirements of children in giving nursing care. Therefore, the purpose of this study is to show that comprehensive nursing care which is based on an understanding of the growth and development of the child contrIbutes to both the child and the mother's adaptability to the child's hospitalization. Methodt: Sixty children, three to twelve year of age, hospitalized at the Yonsei University Pediatric Ward were studied. From April 1, 1973 to May 5, 1973, children admitted to the hospital were assigned to either an experimental or a compare groups. There were 30 children in each group. The sex and age of the children in each group was similar. In both groups were more male than female children. In the experimental group, eash mother stayed with her child continiously during his hospitalization. In the compare groups, the mother or someother member of the family stayed with the child. Each day on the chIld's admission the investigator visited the ward from 1 - 2 P.M. to 9 - 10 P.M., in order to provide comprehensive care for the experimental group. The assistance given the nurses by the investigator was in the form of conferences regarding care and in giving direct care to the child and his mother. The compare group of children received nursing care as usually provided by the hospital. The instruments used to obtain the data for analysis were as follows: 1. The fear and anxiety reaction of the child was recorded by observation of the investigator for four areas: 1) separation from parent and relatives 2) reaction to Doctor and Nurse with white gowns 3) Reaction to nursing care 4) reaction to injection and tests, etc. 2. Regression in area of eating, sleeping, and elimination were recorded by the investigator by questioning the mother and by observation. 3. Adaptability to the hospitalization was recorded by direct, questionIng of the children for areas of emotional and social adjustment. For children older than 3 years of age or children not seriously ill, using the simple I·Q test this was passible for only 35 of the total 60 children. Result: 1. 55 Percents of the total 60 children had been prepared by their parents for hospitalization. The children who had received prior preparation accepted hospitalization more readily than those who had received no preparation. (X^(2) = 4.6 P＜0.05 ) 2. On admission 31.7 percent of the children expressed verbal fear of their disease or treatment. 25 percent felt that the disease was due to their mistake. 3. There was a significant difference in the reaction of the child to separation from the parent or relatives, between the two groups. The experimental groups showed less anxiety due to separation than the compare group.(X^(2) = 4.34 P < 0.05) In both groups there was less anxiety due to separation among schooI age (6-12 years) chiIdren than among preschool age (3-5 years) chi1drenu(X^(2) = 9.22 P < 0.05) 4. More than half of the children in both groups reacted with fear and avoidance to doctor and/or nurses wearing white gowns, (X^(2) = 0.06 P > 0.05) 5. The experimental group reacted more favorably to n nursing in general than the compare group.(X^(2) = 4.8 P ＜ 0.05) 6. There was no difference in the fear and refused reaction to special tests and/or such as X-rays and injections, etc, between the groups.(X^(2) = 3.77 0.1 ＞ P ＞ 0.05 7. More children in the compare group showed regressive tendencies in eating, sleepIng, and elimination habits than in expertmental groups. ( X^(2) = 2.3 P ＞ 0.05, X^(2) = 3.88 P ＜ 0.05, X^(2) = 4.9 P ＜ 0.05 ) 8. There was a signifIcant difference in the adaptability to hospitalization between the two groups. The experimental groups adapted more readily. ( X^(2) = 2 P ＜ 0.05 ) 9. For children who had higher I.Q,S. the adaptability to hospitalization was better regardless of the group.(X^(2) = 5.03 P ＜ 0.05) However, because of the small number of cases (60), this finding cannot, be extrapolated without further verification. The data demonstrates that there was a greater adaptability to hospitalization by the child when comprehensive nursing care was given. By planning care and applying knowledge of growth and development to meet, nurses are in a posItion to prevent some of the psychological trauma associated with hospitalization.