Journal of Hospice and Palliative Care

Korean Society for Hospice and Palliative Care (한국호스피스완화의료학회)
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Nurses' Perception on Fluid Therapy for Terminally Ill Patients

말기 환자의 수액요법에 대한 간호사의 인식

  • Jo, Hyeon-Sook (Department of Nursing, Suwon Women's College) ;
  • Cho, Ok-Hee (Department of Nursing, Jeju National University) ;
  • Yoo, Yang-Sook (The Catholic University of Korea, College of Nursing)
  • Received : 2010.02.13
  • Accepted : 2010.10.15
  • Published : 2010.12.01
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Abstract

Purpose: This study was conducted to investigate how nurses who take care of terminal patients perceive fluid therapy and how this therapy is currently being used in hospitals. Methods: This survey included 200 nurses, 87 of whom were working in the oncology units of 3 university hospitals in Seoul, Korea, and 113 were working in 18 hospice centers. The data for this study were collected by means of structured questionnaires and analyzed by using the Statistical Analysis System software. The differences in perception towards fluid therapy between nurses working in oncology units and those working in hospice centers were examined using the $x^2$ test and analysis of covariance. Results: Fluid therapy was perceived more negatively by the nurses from hospice centers than by those from oncology units. Continuous subcutaneous infusion was used in hospice centers, but not in oncology units. In addition, the average amount of fluid infused daily differed significantly between the oncology units and hospice centers. Conclusion: Our results show that there were differences in the perception towards fluid therapy between nurses in different clinical settings. Nurses caring for terminal and palliative care patients should not simply provide or withhold fluid therapy, but rather develop a wider range of views on fluid therapy, focusing on effective alternative interventions.

목적: 본 연구는 말기 환자에게 실시하는 수액요법에 대한 간호사들의 인식과 수액요법 실태를 파악하기 위한 서술적 조사연구이다. 방법: 대상자는 서울에 소재한 3개 대학병원의 암 병동 간호사 87명과 보건복지부의 호스피스 시범사업 지원기관으로 선정된 1개 호스피스기관의 간호사 113명, 총 200명이었다. 자료는 구조화된 설문지를 이용하여 2008년 3월 10일부터 3월 31일까지 수집하였으며, 수액요법에 대한 호스피스기관 간호사와 암 병동 간호사의 인식 차이는 $x^2test$와 ANCOVA로 알아보았다. 결과: 호스피스기관의 간호사가 암 병동 간호사에 비해 '말기 환자에게 수액을 주입하면 전신무력감이 호전되지 않는다', '수액을 주입하여도 섬망이나 안절부절함, 의식장애가 완화되지 않는다', '수액을 제한하면 폐부종이 감소되고 기침, 가래, 호흡곤란이 감소된다', '수액을 제한하면 복수가 최소화된다’고 응답한 경우가 많았다. 말기 환자에게 실시하는 수액요법에 대한 심리사회적인 측면의 인식도는 암 병동 간호사가 호스피스기관 간호사보다 높아 긍정적이었다. 호스피스기관이 암병동보다 말기 환자에게 수액을 말초정맥 혈관이나 지속적 피하 점적주사로 주입하는 경우가 많았으며, 주입하는 하루 평균 수액양이 적었다. 말기 환자에게 수액 요법을 하는 이유로 호스피스 기관은 '환자나 가족이 원해서'가 가장 많았으며, '환자 및 가족에게 치료를 지속하고 있다는 안정감을 주므로'와 '수액요법이 기본적인 처방이므로' 순이었으나 종합병원의 암 병동은 '환자나 가족에게 치료를 지속하고 있다는 안정감을 주므로', '환자나 가족이 원해서', '탈수를 교정하기 위해서' 순이었다. 결론: 종합병원의 암 병동 간호사들은 호스피스기관 간호사에 비하여 말기 환자에게 실시하는 수액요법에 대하여 긍정적이었으며, 두 기관 모두 환자나 가족이 원하여 말기 환자에게 수액요법을 시행하는 경우가 많았으므로 불필요한 수액요법을 시행하지 않도록 간호사는 물론 환자와 가족을 대상으로 교육을 하는 것이 필요하다고 생각한다.

Keywords

References

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