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근골격계 질환 노인의 자가관리부담 측정도구 개발 : Development of Self-management Burden Scale in the Elderly with Musculoskeletal Diseases

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dc.contributor.advisor이남주-
dc.contributor.author김성재-
dc.date.accessioned2017-07-13T06:44:22Z-
dc.date.available2017-07-13T06:44:22Z-
dc.date.issued2014-08-
dc.identifier.other000000021632-
dc.identifier.urihttps://hdl.handle.net/10371/118795-
dc.description학위논문 (박사)-- 서울대학교 대학원 : 간호학과, 2014. 8. 이남주.-
dc.description.abstract노인의 근골격계 만성질환은 통증과 기능불능을 유발하여 일상생
활에 지장을 주고, 삶의 질을 저하시킨다. 노인성 근골격계 질환은
완치가 아닌 관리와 조절로 치료 방향이 전환되면서 자가관리가 중
요하게 되었다. 노인은 남은 여생동안 계속적으로 질환을 관리하는
데 따른 부담을 가지게 된다. 이러한 자가관리에 따른 부담은 치료
의 불이행, 자원의 낭비, 그리고 나쁜 건강결과로 이어질 수 있다.
노인의 자가관리행위에 대한 선행연구는 상당히 많이 진행되었으나,
자가관리에 따른 부담은 건강결과에 영향을 줄 수 있는 간호학적으
로 중요한 개념이자 연구분야이지만 아직 명확한 개념분석이나 정
의가 되지 않았다. 따라서 근골격계 만성질환을 가진 노인환자의 자
가관리부담 개념을 분석하고, 그 과정에서 도출된 개념의 속성을 기
초로 자가관리부담을 통합적으로 측정할 수 있는 도구를 개발할 필
요가 있다.
본 연구의 첫 번째 목적은 근골격계 만성질환이 있는 노인의 자가
관리부담 개념을 분석하는 것이다. 개념분석방법은
Schwartz-Barcott과 Kim의 혼종모형을 이용하였고, 이론적 단계,
현장단계, 최종분석단계를 따랐다. 자료수집과 분석은 2013년 11월
15일부터 2014년 1월 20일까지 이루어졌다. 이론적 단계에서
1990년부터 2013년 8월 사이에 출판된 문헌을 PubMed,
EMBASSE, CINAHL, ProQuest Nursing 등의 온라인 검색엔진에
서 근골격계 질환, 노인, 자가관리부담 및 유사용어를
조합한 키워드로 검색하여 얻었다. 이론적 단계의 분석결과, 얻은
차원과 속성을 바탕으로 구성된 개방형 질문을 이용하여 현장단계
에서 참여자들에게 심층인터뷰를 수행하였다. 현장단계에 참여자는
골관절염과 골다공증성 골절을 경험한 노인 8명으로 한 달에 1회
이상 정기적인 정형외과 진료를 받고 있는 자이며, 참여자 중 골관
절염 환자 4명은 추가 인터뷰를 수행하였고, 골다공증성 골절 환자 4명의 자료는 이차자료를 재분석하였다. 인터뷰 자료분석은
Downe-Wamboldt의 질적내용분석방법 8단계를 따랐다. 개념분석
결과, 근골격계 질환 노인의 자가관리부담은 5개 차원과 7개 속성
으로 나타났다. 5개 차원은 신체적, 인지적, 정서적, 사회적, 경제적
차원이며, 7개 속성은 증상, 기동성, 인지능력, 부정
적 감정, 상호작용, 대처자원, 비용으로 구성되었다.
근골격계 질환 노인의 자가관리부담의 정의는 근골격계 만성통증
과 기능장애를 겪고 있는 노인들이 건강전문가들과 협력하여 스스
로 건강을 관리하고 치료적 지시를 이행하는 자가관리활동의 과정
과 그 결과로 신체적, 인지적, 정서적, 사회적, 경제적인 삶의 모든
영역에서 지각한 어려움, 버거움 및 부정적인 변화로 도출되었다.
두 번째, 연구의 목적은 근골격계 질환 노인의 자가관리부담 측정
도구를 개발하고 도구의 타당도와 신뢰도를 검증하는 것이었다. 도
구개발을 위한 연구방법은 초기문항도출, 전문가 타당도 검정, 예비
조사, 구성타당도 및 신뢰도 검증 단계 순서로 수행되었다. 연구대
상자는 서울노인복지센터를 이용하는 노인 중 관절염과 골다공증성
골절을 경험하고 한 달에 1회 이상 정기적인 정형외과 진료를 받고
있는 자로 예비조사에서는 20명, 구성타당도 및 신뢰도 검정 단계
에서는 232명이 참여하였다. 자료수집은 본 연구에 대해 설명을 듣
고 서면동의를 한 참여자에게 연구자 1인과 연구보조원 10인의 면
대면 설문지 질문형식으로 이루어졌다. 먼저, 초기문항도출 단계에
서 근골격계 질환 노인의 자가관리부담 7가지 속성을 개념틀로 관
련 문헌, 인터뷰 자료, 자가관리부담의 구성요인 및 지표로부터 70
개의 초기문항을 개발하였다. 둘째, 전문가 내용타당도 검정 단계에
서 임상전문가와 학계 전문가 10인으로부터 Lynn(1986)의 도구평
가방법에 따라 개별 문항들의 적절성을 평가받고 36개 문항으로 수
정, 통합하였다. 셋째, 예비조사 단계에서 참여자들로부터 개발된 도
구의 이해도와 적절성을 확인받았고, 예비조사 후 도구의 문항 수는
35개로 줄었고, 문항의 내용도 일부 수정되었다. 마지막으로 구성타당도와 신뢰도 검증을 수행하였다. 본 조사에는 근골격계 질환 노인
의 자가관리부담 측정도구, 일반적 특성 조사지, 준거타당도 검정을
위한 건강관련 삶의 질 측정도구(EQ-5D-5L)가 사용되었다. 구성
타당도 검정은 문항분석, 직교회전 주성분을 통한 탐색적 요인분석,
일반최소자승법을 이용한 확인적 요인분석, 신뢰도 검정, 준거타당
도 검정 단계를 거쳐 7요인 17문항으로 구성된 근골격계 질환 노인
의 자가관리부담 측정도구를 개발하였다. 개발된 측정도구는 모형의
적합도, 수렴타당도, 판별타당도가 확보되었음을 확인하였다. 개발된
최종 도구는 준거타당도 검증에서 활용된 건강관련 삶의 질과 -.58
(p<0.01)으로 통계적으로 유의한 음의 상관관계를 나타내었다. 최
종 도구의 신뢰도는 Cronbach's α .85로 나타났다. 이로써 본 연
구에서 개발된 근골격계 질환 노인의 자가관리부담 측정도구는 통
계적으로 구성타당도와 신뢰도를 지지받았다.
본 근골격계 질환 노인의 자가관리부담 개념분석과 도구 개발 연
구는 간호학문, 연구, 실무 측면에서 다음과 같은 의의를 찾을 수
있었다. 본 연구는 간호학에서 사용했으나 조명받지 못했던 자가관
리부담이라는 용어를 재발견하고, 그 개념의 현대적 의미를 찾아 고
유한 개념정의와 속성을 이끌어내었다. 만성질환자의 자가관리에 관
심있는 학자들에게 자가관리부담이라는 새로운 연구분야를 제
시할 수 있고, 특히 근골격계 만성질환 노인들에게는 자가관리부담
을 경감할 수 있는 간호중재나 간호정책을 개발하는데 본 연구의
개념분석결과나 측정도구가 도움이 될 수 있을 것으로 기대한다.
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dc.description.tableofcontents국문초록 ·························································································· i
I. 서론 ······························································································1
1. 연구의 필요성 ·················································································1
2. 연구의 목적 ·····················································································4
II. 문헌고찰 ·····················································································5
1. 노인성 근골격계 만성질환 ···························································5
2. 근골격계 질환 노인의 자가관리부담 ··········································6
1) 만성질환자 자가관리부담 ·························································6
2) 근골격계 질환 노인의 신체∙심리∙사회적 문제 ···················9
3) 근골격계 질환 노인의 경제∙제도적 문제 ··························14
3. 자가관리부담의 측정도구 ···························································17
III. 연구 설계 ·············································································22
1. 연구 설계 ·······················································································22
2. 윤리적 고려 ···················································································24
IV. 근골격계 질환 노인의 자가관리부담 개념분석 ·············25
1. 이론적 기틀 ···················································································25
1) Schwartz-Barcott와 Kim의 혼종모형 ·····························25
2) 혼종모형의 적용과정 ······························································27
2. 연구방법 ·························································································28
1) 이론적 단계 ··············································································28
2) 현장단계 ····················································································29
3) 최종분석단계 ············································································33
3. 연구결과 ·························································································34
1) 이론적 단계 ··············································································34
2) 현장 작업 단계 ········································································55
3) 최종분석단계 ············································································73
V. 근골격계 질환 노인의 자가관리부담 측정도구개발 ······77
1. 개념적 기틀 ···················································································77
2. 연구방법 ·························································································78
1) 연구대상자 ················································································78
2) 개발단계 ····················································································79
(1) 초기문항개발 ······································································79
(2) 내용타당도 검정 ································································80
(3) 예비조사 ··············································································81
(4) 구성타당도와 신뢰도 검증 ··············································82
3. 연구결과 ·························································································88
1) 초기문항개발 ············································································88
2) 전문가 내용타당도 검정 ························································92
3) 예비조사 ····················································································92
4) 구성타당도와 신뢰도 검증 ····················································94
5) 최종 도구의 개발 ··································································117
VI. 논의 ······················································································125
1. 개념분석 ······················································································125
2. 도구의 타당도와 신뢰도 ··························································130
VII. 결론 및 제언 ·····································································136
참고문헌 ······················································································139
ABSTRACT ··············································································199
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dc.formatapplication/pdf-
dc.format.extent9954164 bytes-
dc.format.mediumapplication/pdf-
dc.language.isoko-
dc.publisher서울대학교 대학원-
dc.subject자가관리-
dc.subject근골격계 질환-
dc.subject노인-
dc.subject개념분석-
dc.subject도구개발-
dc.subject.ddc610-
dc.title근골격계 질환 노인의 자가관리부담 측정도구 개발-
dc.title.alternativeDevelopment of Self-management Burden Scale in the Elderly with Musculoskeletal Diseases-
dc.typeThesis-
dc.contributor.AlternativeAuthorKim, Sungjae-
dc.description.degreeDoctor-
dc.citation.pagesix, 202-
dc.contributor.affiliation간호대학 간호학과-
dc.date.awarded2014-08-
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