8 research outputs found
Development and evaluation of a person-centered nursing intervention for frailty in pre-frail community-dwelling older adults
ํ์๋
ผ๋ฌธ (๋ฐ์ฌ)-- ์์ธ๋ํ๊ต ๋ํ์ : ๊ฐํธ๋ํ ๊ฐํธํ๊ณผ, 2018. 2. ๋ฐ์ฐํ.์ง์ญ์ฌํ ๊ฑฐ์ฃผ ๋
ธ์ธ์๊ฒ ํ์ฝ๊ณผ ์ ํ์ฝ ์ํ๋ ํํ ๋ณผ ์ ์๋ ์ค์ํ ๊ฑด๊ฐ ๋ฌธ์ ์ด๋ค. ํ์ฝ์ ์คํธ๋ ์ค์์ ์ ์ ํ ๊ฐ๋นํ ์ ์๋ ๊ฐ์ฒด์ ๋ฅ๋ ฅ์ด ์ ํ๋์ด ๋ํ๋๋ ์๋ฆฌํ์ ์ทจ์ฝ ์ํ ๋๋ ์ฆํ๊ตฐ์ ์๋ฏธํ๋ฉฐ ์ด๋ ๋์, ์์ค์
์, ์ฌ๋ง๋ฅ ๋ฑ์ ๋ถ์ ์ ๊ฑด๊ฐ ๊ฒฐ๊ณผ๋ฅผ ์ฆ๊ฐ์ํจ๋ค. ํนํ ํ ๊ฐ์ธ์ด ์ ํ์ฝ ์ํ์ ์ง์
ํ๋ฉด ๋น ๋ฅธ ์๋๋ก ํ์ฝ ์ํ๋ก ๋ฐ์ ํ๊ณ , ๊ฒฐ๊ณผ์ ์ผ๋ก ์ฌ๋ง์๊น์ง ์ด๋ฅผ ๊ฐ๋ฅ์ฑ์ด ์ฆ๊ฐํ๊ธฐ ๋๋ฌธ์ ์ ํ์ฝ ์ํ์ ๋
ธ์ธ์ ์ํ ํ์ฝ์๋ฐฉ์ค์ฌ๋ฅผ ๊ฐ๋ฐํด์ผ ํ๋ค. ๊ฐ์ธ์ ๊ฐ์น, ์๊ตฌ, ์ ํธ ๋ฑ์ ๊ณ ๋ คํ๋ ๋์์ ์ค์ฌ ๊ฐํธ๋ ๋ค์ํ ๊ฑด๊ฐ ์์ค๊ณผ ๋ณต์กํ ๊ฑด๊ฐ ์๊ตฌ๋ฅผ ๊ฐ์ง ๋
ธ์ธ์๊ฒ ํ์์ ์ด๋ค.
๋ณธ ์ฐ๊ตฌ์ ๋ชฉ์ ์ ์ง์ญ์ฌํ์ ๊ฑฐ์ฃผํ๋ ์ ํ์ฝ ์ํ์ ๋
ธ์ธ์ ๋์์ผ๋ก ๋์์ ์ค์ฌ ํ์ฝ์๋ฐฉํ๋ก๊ทธ๋จ์ ๊ฐ๋ฐํ์ฌ ์ ์ฉํ๊ณ ๊ทธ ํจ๊ณผ๋ฅผ ํ๊ฐํ๋ ๊ฒ์ด๋ค. ๋ณธ ํ๋ก๊ทธ๋จ์ Fried์ ํ์ฝ์ ์ํ(cycle of frailty) ๋ชจ๋ธ๊ณผ McCormack๊ณผ McCance์ ๋์์ ์ค์ฌ ๊ฐํธ(person-centered nursing framework)๋ฅผ ๋ฐํ์ผ๋ก ๊ตฌ์ฑํ ํ ์ ๋ฌธ๊ฐ ์ง๋จ์ ๋ด์ฉ ํ๋น๋ ๊ฒ์ฆ๊ณผ ์๋ฌธ ๋ด์ฉ์ ๋ฐ์ํ์ฌ ๊ฐ๋ฐ๋์๋ค. ํ๋ก๊ทธ๋จ์ ํจ๊ณผ ํ๊ฐ๋ฅผ ์ํ์ฌ ๋ฌด์์ ํต์ ๊ตฐ ์ ํ ์ค๊ณ๋ฅผ ์ ์ฉํ์๋ค. ์ฐ๊ตฌ๋์์๋ ์ ํ์ฝ ์ํ์ ์๋ ๋ง 65์ธ ์ด์ ๋
ธ์ธ์ผ๋ก ์คํ๊ตฐ 20๋ช
, ๋์กฐ๊ตฐ 20๋ช
์ผ๋ก 40๋ช
์ด ์ฐ๊ตฌ์ ์ต์ข
์ฐธ์ฌํ์๋ค. ์คํ๊ตฐ์๊ฒ๋ ๋์์ ์ค์ฌ ํ์ฝ์๋ฐฉ์ค์ฌ๋ฅผ 12์ฃผ๊ฐ ์ฃผ 2ํ, ์ด 24ํ ์ํํ์๊ณ , ๋์กฐ๊ตฐ์๊ฒ๋ ํ๋ก๊ทธ๋จ ์ข
๋ฃ ํ 4์ฃผ๊ฐ ์ด 4ํ์ ํ์ฝ์๋ฐฉ๊ต์ก์ ์ ๊ณตํ์๋ค. ์ฌ์ฉ๋ ์ฐ๊ตฌ ๋๊ตฌ๋ ์
๋ ฅ, ๊ฐ์ด์ ์ฒดํ๋๋ฅ๋ ฅ๊ฒ์ฌ, ํ๊ตญํ ์ง์ญ์ฌํ ๊ฑด๊ฐ๋
ธ์ธ ์ ์ฒดํ๋ ์ธก์ ๋๊ตฌ, ๊ฐ์ด์์ํ๊ฐ, ํ๊ตญํ ๋
ธ์ธ ์ฐ์ธ ๋จ์ถํ ์ฒ๋, ์ฌํ์ ์ง์ง ์ฒ๋, CHS ํ์ฝ์ง์, ์ฃผ๊ด์ ์๊ฐ์ฑ ์ด๋๊ฐ๋ ์ธก์ ๋๊ตฌ, ๋ชฉํ๋ฌ์ฑ์ฒ๋์ด๋ค. ์๋ฃ๋ SPSS IBM Statistics Program 21 ์ํํธ์จ์ด๋ฅผ ํ์ฉํ์ฌ ์์ ์ ํต๊ณ, ฯ2โtest, Fishers exact test, Independent tโtest, MannโWhitney U test๋ก ๋ถ์ํ์๋ค.
์ฐ๊ตฌ ๊ฒฐ๊ณผ, ๋ณธ ํ๋ก๊ทธ๋จ์ ์ด๊ธฐ ๊ฐ๋ณ ์ฌ์ , ์ง๋จ ์ค์ฌ์ ๊ฐ๋ณ ๋ชฉํ ์ค์ ๋ฐ ํ์ธ์ ํฌํจํ 2๊ฐ์ ์ธ์
, ๊ฒฉ์ฃผ๋ก ์งํ๋๋ 6ํ์ ์ ํ ์ง์ง๋ก ๊ตฌ์ฑ๋์๋ค. ์ฐธ์ฌ ๋์์์ 70%๋ ์ฌ์ฑ์ด์๊ณ , ํ๊ท ์ฐ๋ น์ 78.20์ธ์๋ค. ์ค์ฌ ์งํ ์คํ๊ตฐ์ ๋์กฐ๊ตฐ์ ๋นํ์ฌ ์
๋ ฅ ์ข์ธก(p=.022), ์
๋ ฅ ์ฐ์ธก(p=.009), ๊ฐ์ด์ ์ฒดํ๋๋ฅ๋ ฅ๊ฒ์ฌ ์ ์(p=.007), ํ๊ตญํ ์ง์ญ์ฌํ ๊ฑด๊ฐ๋
ธ์ธ ์ ์ฒดํ๋ ์ง๋ฌธ์ง ์ ์(p=.009), ๊ฐ์ด์์ํ๊ฐ ์ ์(p=.018), ์ฐ์ธ ์ ์(p=.001), CHS ํ์ฝ ์ง์(p<.001)๊ฐ ์ ์ํ ์ฐจ์ด๋ฅผ ๋ณด์ด๋ฉฐ ๊ธ์ ์ ์ธ ํจ๊ณผ๋ฅผ ๊ฐ์ ธ์ ๊ฐ์ค์ด ์ง์ง๋์๋ค. ์ฌํ์ ์ง์ง ์ฒ๋(ESSI)์ ์ ์์์๋ ์ ์ํ ์ฐจ์ด๊ฐ ์๋ ๊ฒ์ผ๋ก ๋ํ๋ ๊ฐ์ค์ด ๊ธฐ๊ฐ๋์๋ค.
๊ฒฐ๋ก ์ ์ผ๋ก ๋์์ ์ค์ฌ ํ์ฝ์๋ฐฉํ๋ก๊ทธ๋จ์ ์
๋ ฅ, ์ ์ฒด๊ธฐ๋ฅ, ์ ์ฒดํ๋, ์์์ํ, ์ฐ์ธ์ ์ฆ์ง ๋๋ ๊ฐ์ ์ ์ํฅ์ ๋ฏธ์น๊ณ , ํ์ฝ ์๋ฐฉ์ ํจ๊ณผ์ ์ธ ํ๋ก๊ทธ๋จ์ด๋ผ๊ณ ํ๋จ๋๋ค. ๋ํ ๋ณธ ์ฐ๊ตฌ๊ฒฐ๊ณผ๋ฅผ ํตํด ์ง์ญ์ฌํ ๊ฑฐ์ฃผ ์ ํ์ฝ ์ํ ๋
ธ์ธ์ ๋์์ผ๋ก ์ ์ ํ ์ค์ฌ๋ฅผ ํตํด์ ํ์ฝ์ผ๋ก์ ๋ฐ์ ์ ์๋ฐฉํ๊ณ , ๊ฑด๊ฐ์ ์ ์งยท์ฆ์ง์ํฌ ์ ์๋ค๋ ๊ทผ๊ฑฐ๋ฅผ ํ๋ณดํ๊ณ , ๋
ธ์ธ์ข
ํฉ๋ณต์ง๊ด์์์ ๋์์ ์ค์ฌ ํ๋ก๊ทธ๋จ์ ์คํ๊ฐ๋ฅ์ฑ์ ํ์ธํ์๋ค๋๋ฐ ์์๊ฐ ์๋ค. ์ง์ญ์ฌํ ๋
ธ์ธ์ข
ํฉ๋ณต์ง๊ด์ ๊ฐํธ์ฌ๋ฅผ ์ถฉ์ํ์ฌ ๋์์ ์ค์ฌ ํ๋ก๊ทธ๋จ์ ์ ์ฉํ๊ณ ์ง์ญ์ฌํ ๋
ธ์ธ ๊ฑด๊ฐ ์ฆ์ง์ ๊ธฐ์ฌํ์ฌ์ผ ํ๋ค.Background: Pre-frailty and frailty are common among the community-dwelling old people over 65 year. Frailty is a term generally used to represent multidimensional syndrome and a condition of the decline of adaptive capacity of the organism to poor homeostasis in times of acute events and increases adverse outcomes. In particular, once someone is pre-frail condition, they are more likely to head toward frailty status that is usually a rapidly progressive and self-perpetuating to death after all, thus we need to develop a nursing intervention for pre-frail older adults. Older adults are a priority target for person-centered care that is respectful of and responsive to individual values, needs, preferences because they have various health status and complex care needs. Purpose: The aim of this study was to develop a person-centered nursing intervention for frailty and to evaluate its effect on prevention of frailty in pre-frail community-dwelling older adults. Methods: The theoretical framework of this study was based on cycle of frailty model proposed by Fried and colleagues and the person-centered nursing framework developed by McCormack and McCance. A content validation by experts was done to construct a person-centered nursing intervention for frailty. Randomized controlled trial design was used to evaluate the effectiveness of the developed program. The study subjects were community-dwelling older adults aged above 65 years and classified as pre-frail of the CHS frailty index. In total, 40 older adults (20 in the experimental group and 20 in the control group) from a senior centers participated in the present study. The experimental group received group intervention sessions 2 days per week for 12 weeks. The control group attended lectures about prevention of frailty one day per week for 4 weeks. The instruments for program evaluation were JAMARโ hydraulic hand dynamometer, Short Physical Performance Battery (SPPB), Korean version of Community Healthy Activities Model Program for Seniors Questionnaire (K-CHAMPS), Mini Nutritional Assessment (MNA), Geriatric Depression Scale Short Form-Korea Version (GDSSF-K), ENRICHD Social Support Instrument (ESSI), Cardiovascular Health Study (CHS) Frailty Index, Borgs scale, Goal Attainment Scale (GAS). The descriptive analysis, ฯ2โtest, Fishers exact test, Independent tโtest, MannโWhitney U test were analyzed by using IBM SPSS Statistics 21.0 for Windows Program. Results: The PNIF consisted of initial individualized assessment, session 1 (exercise and physical activity), session 2 (nutrition and psychosocial support), telephone support. 70% were females and mean age of all participants was 78.20 years. The mean differences in left-hand grip strength (p=.022), right-hand grip strength (p=.009), SPPB (p=.007), K-CHAMPS (p=.009), MNA (p=.018), GDSSF-K (p=.001), CHS Frailty Index (p<.001) between the preโ and postโintervention of the experimental group were significantly different from those of the control group after 12 weeks. The differences in ESSI score were not significant between the two groups. Conclusion: The PNIF was effective in improving grip strength, physical function, physical activity, nutritional status, reducing depression, and preventing frailty. This study has significant meaning in identifying the feasibility of a person-centered nursing intervention for frailty at a senior center. We need more nursing staff for applying a person-centered nursing intervention and improving health status of community-dwelling older adults.โ
. ์๋ก 1
1. ์ฐ๊ตฌ์ ํ์์ฑ 1
2. ์ฐ๊ตฌ์ ๋ชฉ์ 5
3. ์ฉ์ด์ ์ ์ 6
โ
ก. ๋ฌธํ๊ณ ์ฐฐ 10
1. ์ง์ญ์ฌํ ๊ฑฐ์ฃผ ๋
ธ์ธ์ ํ์ฝ 10
2. ์ง์ญ์ฌํ ๊ฑฐ์ฃผ ๋
ธ์ธ์ ์ํ ํ์ฝ์๋ฐฉ์ค์ฌ 21
3. ๋์์ ์ค์ฌ ์ค์ฌ(PERSON-CENTERED CARE INTERVENTION) 31
โ
ข. ์ด๋ก ์ ๊ธฐํ 37
1. ์ฐ๊ตฌ์ ์ด๋ก ์ ๊ธฐํ 37
2. ์ฐ๊ตฌ๊ฐ์ค 40
โ
ฃ. ์ฐ๊ตฌ๋ฐฉ๋ฒ 41
1. ํ์ฝ์๋ฐฉํ๋ก๊ทธ๋จ ๊ฐ๋ฐ 41
2. ๋์์ ์ค์ฌ ํ์ฝ์๋ฐฉํ๋ก๊ทธ๋จ์ ํจ๊ณผ ํ๊ฐ 47
โ
ค. ์ฐ๊ตฌ๊ฒฐ๊ณผ 64
1. ํ๋ก๊ทธ๋จ ๊ฐ๋ฐ 64
2. ํ๋ก๊ทธ๋จ ํจ๊ณผํ๊ฐ 90
โ
ฅ. ๋
ผ์ 113
1. ๋์์ ์ค์ฌ ํ์ฝ์๋ฐฉํ๋ก๊ทธ๋จ ๊ฐ๋ฐ 113
2. ๋์์ ์ค์ฌ ํ์ฝ์๋ฐฉํ๋ก๊ทธ๋จ ํจ๊ณผ 119
3. ๊ฐํธํ์ ์์ 126
4. ์ฐ๊ตฌ์ ์ ํ์ 128
โ
ฆ. ๊ฒฐ๋ก ๋ฐ ์ ์ธ 130
1. ๊ฒฐ๋ก 130
2. ์ ์ธ 131
์ฐธ๊ณ ๋ฌธํ 132
๋ถ๋ก 162
ABSTRACT 224Docto