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노인환자와 가족의 임종의료결정 권리 및 사회복지사 역할 이해도 - 장기요양 입소 시설 사회복지사를 대상으로 -

A Study of Social Workers' Understanding of Elderly Patients' and Family Caregivers' Rights to End-of-Life Care Decisions and of Their Own Roles in the Process

  • 한수연 (남서울대학교 사회복지학과)
  • Han, Sooyoun (Department of Social Welfare, Namseoul University)
  • 투고 : 2014.10.07
  • 심사 : 2015.01.31
  • 발행 : 2015.03.01

초록

목적: 본 연구는 장기요양 입소시설의 사회복지사를 대상으로 임종의료결정 권리, 사회복지사의 역할 이해도를 분석하고, 이들의 상관관계를 분석하고자 한다. 방법: 본 연구는 설문지를 사용하여 수집된 자료 334부 중 분석에 포함하기 어려운 37부를 제외한 297부를 SPSS 20.0을 이용하여 T-test, 분산분석, 상관관계분석 등을 실시하였다. 결과: 사회복지사가 이해하는 노인환자와 가족의 임종의료결정 권리 이해도는 5점 만점에 $3.46{\pm}0.69$, 사회복지사 역할 이해도는 $3.48{\pm}0.84$이다. 사회복지사의 사전의료의향서 및 연명치료 결정 도움 경험, 임종의료결정 도움 업무, 근무 경력, 침상 수 등에 따라 임종의료 결정 권리 및 사회복지사 역할 이해도에 의미 있는 수준에서 집단 간 차이를 보였다. 임종의료결정 권리와 사회복지사 역할 이해도와의 상관관계는 의미 있는 수준에서 긍정적인 상관관계를 보였다(Pearson r=0.329, P<0.001). 결론: 장기요양 입소시설에서 노인환자와 가족에게 사전의료의향서 및 연명치료 결정 도움을 제공하는 사회복지사 역할의 중요성을 인식하고, 노인환자와 가족의 임종의료결정 권리를 보호하기 위하여 임종의료결정에서의 사회복지사 역할 수행을 위한 교육이나 훈련 프로그램의 개발이 필요하다.

Purpose: This study was aimed to analyze how social workers understand the rights for elderly patient and family caregiver to make end-of-life (EOL) care decisions and their roles the decision making process. Methods: The study employed a quantitative research method of collecting data from a structured questionnaire that was filled out by 334 social workers at long-term care facilities. Data were analyzed by descriptive statistics, mean differences, correlation between variables, using SPSS 20.0 program. Results: The mean score for the understanding the rights to an EOL care decision was $3.46{\pm}0.69$ and of their own roles $3.48{\pm}0.84$. The level of understanding significantly differed by social workers' experience of assisting a process to make an EOL care decision such as advance directives and life sustaining treatment, work experience, and the number of beds. Positive correlation was observed between the level of understanding of the rights for EOL care decisions and of social workers' roles (Pearson r=0.329, P<0.001). Conclusion: This study proposes development of an education program for social workers and devising standards for the EOL care decision making process to protect elderly patients, family caregivers as well as social workers in a long term care facility.

키워드

참고문헌

  1. Lee SS, Kim IK, Choi HJ. Population change and future strategies in China, Japan and Korea [Internet]. Sejong: Korea Institute for Health and Social Affairs; 2013 [cited 2014 Jun 14]. Available from: https://www.kihasa.re.kr/html/jsp/share/download_publication.jsp?
  2. 2013 Annual Report of National Bioethics Committee [Internet]. Seoul: Korea National Institute for Bioethics Policy; c2013 [cited 2014 Jun 14]. Available from: http://bprlib.kr/CORE/?moduleName=_core.LasSearchDetail&control_no=5452.
  3. Heo DS. Life sustaining medical treatment for terminal patients in Korea. J Korean Med Sci 2013;28:1-3.
  4. Han SY, Lee HJ. A discussion on elderly patients and their family caregivers' decision making for life sustaining treatments. GRI Review 2013;15:71-91.
  5. Sabatino CP. The evolution of health care advance planning law and policy. Milbank Q 2010;88:211-39. https://doi.org/10.1111/j.1468-0009.2010.00596.x
  6. Bomba PA. Morrissey MB, Leven DC. Key role of social work in effective communication and conflict resolution process: Medical Orders for Life-Sustaining Treatment (MOLST) Program in New York and shared medical decision making at the end of life. J Soc Work End Life Palliat Care 2011;7:56-82. https://doi.org/10.1080/15524256.2011.548047
  7. CMS Manual System [Internet]. Baltimore: Center for Medicare & Medicaid Service; c2013 [cited 2014 May 13]. Available from: http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R75SOMA.pdf.
  8. law.go.kr [Internet]. Sejong: National Health Insurance Service; c2014 [cited 2014 Aug 24]. Available from: http://www.law.go.kr/lsSc.do?menuId=0&subMenu=1&query=%EA%B5%AD%EB%AF%BC%EA%B1%B4%EA%B0%95%EB%B3%B4%ED%97%98 %EB%B2%95#liBgcolor1.
  9. Act on long-term care insurance for the aged [Internet]. Seoul: National Health Insurance Service; c2010. Available from: http://www.longtermcare.or.kr/portal/site/nydev/B0018/.
  10. Choi HK. A study on roles and competencies of social worker in hospice palliative care practice. Soc Sci Res Rev Kyungsung Univ 2013;29:225-48.
  11. Statutes rules and rule proposals [Internet]. Trenton: New Jersey Department of Health; c2014 [cited 2014 Jul 2]. Available from: http://www.state.nj.us/health/healthfacilities/rules.shtml.
  12. Advance directive for health care act [Internet]. Trenton: New Jersey Department of Health; c2011 [cited 2014 Jul 2]. Available from: hftp://www.njleg.state.nj.us/20042005/PL05/233_.PDF.
  13. Advance directive for mental health care act [Internet]. Trenton: New Jersey Department of Health; c2005 [cited 2014 Jul 2]. Available from: http://www.state.nj.us/health/advancedirective/documents/njsa_26.2h.53.pdf.
  14. Wikipedia.org [Internet]. San Francisco: Wikimedia Foundation Inc.; C2014 [cited 2014 Jul 10]. Available from: http://ko.wikipedia.org/wiki/%EC%9D%B4%ED%95%B4.
  15. Heyman JC, Gutheil IA. Social work involvement in end of life planning. J Gerontol Soc Work 2006;47:47-61. https://doi.org/10.1300/J083v47n03_04
  16. Kane MN., Hamlin ER, Hawkins WE. Perceptions of preparedness to assist elders with end-of-life care preferences. J Soc Work End Life Palliat Care 2005;1:49-69. https://doi.org/10.1300/J457v01n01_04
  17. Law for older American [Internet]. Chicago: American Bar Association; c2012 [cited 2014 Jul 24]. Available from: http://www.americanbar.org/groups/public_education/resources/law_issues_for_consumers/healthcare_directives.html.
  18. Black K. Promoting advance care planning through the National Healthcare Decisions Day initiative. J Soc Work End Life Palliat Care 2010;6:11-26. https://doi.org/10.1080/15524256.2010.489220
  19. Kim DS, Park HS, Kim JA, Choi JH, Park MJ. A study on nurses, doctors and hospice volunteers's perception of the hospice care and advanced directives about the terminal cancer patients. Global Health Nurs 2012;2:82-93.
  20. Park JW, Song JA. Knowledge, experience and preference on advance directives among community and facility dwelling elderly. J Korean Gerontol Soc 2013;33:581-600.
  21. Hong SW, Kim SM. Knowledge regarding advance directives among community-dwelling elderly. J Korean Acad Soc Nurs Edu 2013;19:330-40. https://doi.org/10.5977/jkasne.2013.19.3.330
  22. Social Work Policy Institution. Hospice social work: linking policy, practice and research. Washington, DC:National Association of Social Workers;2010.
  23. Taylor-Brown S, Sormanti M. End of life care. Health Soc Work 2004;29:3-5. https://doi.org/10.1093/hsw/29.1.3
  24. Black K. Health care professionals' death attitudes, experiences, and advance directive communication behavior. Death Stud 2007;31:563-72. https://doi.org/10.1080/07481180701356993
  25. medical-dictionary.thefreedictionary.com [Internet] Huntingdon Valley, PA: Farlex, Inc; c2009 [cited 2014 Jul 24]. Available from: http://medical-dictionary.thefreedictionary.com/Multisdisciplinary+ health+care+team.
  26. Katz RS, Genevay B. Our patients, our families, ourselves: the impact of the professional's emotional responses on end-of-life care. Am Behav Sci 2002;46:327-39. https://doi.org/10.1177/000276402237767
  27. Kirkendall AM, Waldrop D, Moone RP. Caring people with intellectual disabilities and life-limiting illness: merging personcentered planning and patient-centered, family-focused care. J Soc Work End Life Palliat Care 2012;8:135-50. https://doi.org/10.1080/15524256.2012.685440
  28. Gurtheil IA, Heyman JC. Communication between older people and their health care agents: results of an intervention. Health Soc Work 2005;30:107-16. https://doi.org/10.1093/hsw/30.2.107
  29. McInnis-Dittrich K. Dying, bereavement and advance directive. In: Social work with elders: a biopsychosocial approach to assessment and intervention. 2nd ed. Boston:Pearson;2005. p. 346-79.
  30. Moon JY, Lee HY, Lim CM, Koh Y. Medical residents' perception and emotional stress on withdrawing life-sustaining therapy. Korean J Crit Care Med 2012;27:16-23. https://doi.org/10.4266/kjccm.2012.27.1.16
  31. Kim SH, Son MS, Koh SO, Lee lh. Intensive care providers' perceptions of medically futile treatment: focus group interviews. Korean J Med Ethics 2012;15:370-84.

피인용 문헌

  1. Factors Influencing the Attitudes of Social Work Professionals toward Advance Care Planning vol.36, pp.4, 2015, https://doi.org/10.15709/hswr.2016.36.4.284
  2. 노인장기요양시설 서비스의 질 평가 탐색 : 포커스 그룹 연구 vol.31, pp.1, 2015, https://doi.org/10.5932/jkphn.2017.31.1.19