S-Space Graduate School of Public Health (보건대학원) Dept. of Public Health (보건학과) Theses (Master's Degree_보건학과)
정신장애인 입원 장기화에 영향을 미치는 보호자 요인 : Familial factors associated with long term hospitalization among mental disableds
|dc.description||학위논문 (석사)-- 서울대학교 보건대학원 : 보건학과(보건정책관리 전공), 2015. 8. 김창엽.||-|
|dc.description.abstract||탈원화는 거스를 수 없는 세계적 추세이나, 한국에서는 가족들의 수용화에 대한 높은 요구로 인한 정신장애인의 수용화 문제가 불거지고 있다. 인권적 측면을 포함하여, 장기간의 입원은 정신장애인의 재활에 악영향을 미치기 때문에, 탈원화를 위한 과정은 지속되어야 한다. 본 연구는 장기 입원에 관련된 보호자 측의 요인들을 탐색함으로써, 그들의 미충족 필요와 요구를 반영하는 정책을 수립하기 위해서 시행되었다.
이 연구에서는 8명의 장기입원 조현병 및 조현정동장애 환자의 보호자들을 대상으로 개별 심층 면담을 하였다. 본 연구는 Colaizzi의 현상학적 방법을 사용하여 분석되었는데, 204개의 의미 있는 진술들이 선택되어 156개의 형성 의미를 도출하였고, 17개의 소주제와 6개의 범주가 완성되었다. 결과는 가족들의 경험과 욕구를 드러내기 위하여 총체적으로 기술되었다.
우선, 보호자들은 반복되는 재발로 인하여 퇴원을 두려워하는데, 이는 정서적 고통과 재정 문제 등과 같은 수많은 부담을 견뎌왔기 때문이었다.
둘째, 보호자들은 다양한 전략으로 차별과 낙인, 그리고 오명에 대응해 왔는데, 한편으로는 직접 차별의 주체가 되기도 하였다. 개인적 차별의 하나로써 과보호적 태도는 치료 결과에 대한 매우 높은 기준을 갖도록 한다.
또한 보호자들은 병원이 다른 정신보건 기관들에 비해 상대적으로 안전하다고 믿고 있었다. 그러나 장기 입원에 만족하는 것은 아니며, 국가가 환자의 재활과 지역사회 복귀에 적극적인 역할을 하기를 바라고 있었다.
이러한 보호자들의 요구는 정신장애인의 자기결정권과는 상충되는데, 이는 한국의 중요한 문화적 배경을 구성하는 가족주의에서 기인하는 것으로 보인다. 탈원화는 병상수의 감축뿐만 아니라, 지역사회 정신보건 체계의 굳건한 수립을 통하여 가족들의 부담을 줄여야만 성공적으로 정착될 것이다.
|dc.description.abstract||Although deinstitutionalization is global trend, institutionalization of mental disabled is pressing issue in Korea due to the family members high demand on institutionalization. As long-term psychiatric hospitalization is known to have harmful effects on rehabilitation of mental disabled, we have to continue the process of deinstitutionalization from the human rights perspectives.
The purpose of this study was to explore the family factors associated with long-term hospitalization, so that we could develop the policy which reflects the family members unmet need and demand.
In this study, eight family members of mentally ill patients in long-term psychiatric hospital due to schizophrenia or schizoaffective disorder were interviewed through the personal in-depth interview. This study was analyzed using Colaizzis method of phenomenology. Two-hundred and four significant statements were selected, and 156 formulated meaning were extracted from the statements, to be clustered into 17 themes. These themes were categorized to 6 theme clusters. Theses results were reported by holistic description that illustrates the families experiences and their desires.
First of all, family members of the patients with mental disorders were afraid of the mentally ill patients discharge and consecutive repetitive relapse of acute psychotic symptom. Thats because they have endured lots of familial burden on emotional distress, financial problems and so on.
Second, they have dealt with recognized discrimination, labelling, and stigma in various ways, while they have played a role as actors of discrimination. In over-protectional attitude, which is one of personal discrimination, they could be reassured only to very high standard of treatment outcome.
Third, they believed that mental hospitals are relatively safer than other kinds of institution. However, it does not mean that the family members has been satisfied with long term hospitalization being as they are. They really wanted the government to play an active role in the patients rehabilitation and their return to community.
Their demands conflicted with the concept of human rights which let the mental disabled to self-regulate their life. The reason is likely to be familism which constructs Eastern Asian culture. Concurrent deinstitutionalization and decreased familial burden are successful if community mental health system would be well-developed.
|dc.description.tableofcontents||I. 서 론 ··········································································································· 1
1. 연구 배경 및 목적 ················································································ 1
2. 선행연구 고찰 ························································································ 8
3. 연구 방법 ······························································································ 17
II. 본 론 ······································································································· 34
1. 대주제 1: 정신장애인 보호자가 됨 ················································· 34
2. 대주제 2: 정신장애인 보호자로서의 부담 ······································ 37
3. 대주제 3: 차별, 낙인, 그리고 오명 (흉) ········································ 45
4. 대주제 4: 낫지 않는 병, 그리고 치료 ············································ 50
5. 대주제 5: 그나마 믿을 곳은 병원 ··················································· 61
6. 대주제 6: 보호자들의 요구와 필요 ················································· 70
III. 고 찰 ······································································································ 76
1. 본 연구에 대한 평가와 의의 ····························································· 76
2. 연구의 방법론적 제한점 ····································································· 79
Ⅳ. 결 론 ······································································································ 93
III. 참고문헌 ································································································ 94
VI. 부록 - 각 주제들을 형성한 의미들 ··············································· 100
VII. Abstract ···························································································· 110
|dc.title||정신장애인 입원 장기화에 영향을 미치는 보호자 요인||-|
|dc.title.alternative||Familial factors associated with long term hospitalization among mental disableds||-|
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