한국노년학

The Korean Gerontological Society (한국노년학회)
권호 표지
DOI QR코드

DOI QR Code

Exploratory Study of Person Centered Care Practice in Korean Long-term Care Facilities using DCM(Dementia Care Mapping) as a tool

DCM(Dementia Care Mapping)을 활용한 한국 요양시설에서의 사람중심케어 실천의 탐색적 연구

  • Kim, Dongseon (Department of Social Welfare, Woosong University)
  • 김동선 (우송대학교 사회복지학과)
  • Received : 2020.11.13
  • Accepted : 2021.01.22
  • Published : 2021.05.30
⟨ Previous Next ⟩

Abstract

This study aims to evaluate Person Centered Care practice and characteristics of care services in Korean long-term care facilities using Dementia Care Mapping as a tool. DCM, systematic observational evaluation tool for measuring dementia patients' QOL, was transformed into self-report rating scale. The process of transforming DCM into a scale of 34 items involves operationalization of DCM concepts and it's adaptation into Korean long-term care practices. Review by research team of Bradford university was added to maintain DCM concept and meaning in this scale. The scale with Cronbach alpha of .88 was surveyed on 343 care workers. Survey result shows PCC value practiced by them is 3.77(of 5 likert scale) and values on each categories of PCC reveal the characteristics of care in Korean facilities; attachment(4.02), comfort(3.95), inclusion(3.89), identity(3.67) and occupation(3.41). Dementia care in Korean facilities focuses on recipients'safety, comfort but lacks individualistic care and the meaningful and fulfilling occupation for patients. Looking at the organizational and individual factors influencing DCM values, the small facilities showed higher PCC values and there are no significant difference in PCC values between public and private facilities. Managers and care workers with career of 1~2 years showed higher PCC values compared to other career ranks and lengthes. This study suggests care practice should be centered on personhood of patients in long-term care facilities, for which introduction of unit care and education of PCC for service providers including support personnel are needed. DCM and Korean DCM scale developed in this study are suggested for the PCC-based assessment on care quality.

본 연구는 요양시설거주 치매환자들의 삶의 질을 사정하기 위해 개발된 DCM(Dementai Care Mapping)을 활용, 국내 장기요양시설에서의 사람중심케어 실천 정도 및 특성을 탐색하는 것을 목적으로 한다. DCM은 훈련받은 매퍼가 시설거주 치매노인을 관찰 사정하는 도구이지만 본 연구에서는 장기요양 시설 종사자들의 자기보고식 평가척도로 변용하였다. DCM의 개념을 34개의 문항으로 조작화하였으며 브래포드치매팀의 검토를 거쳐 총화평정척도로 만들었다. 본 척도의 신뢰도는 .88로 신뢰할 만 하며, 이를 국내 시설 종사자 343명을 대상으로 설문조사를 실시한 결과 평균점수는 3.77점(5점 척도)으로 나왔다. DCM의 하위카테고리 별 평균 점수는 애착(4.02), 편안함(3.95), 포용(3.89), 정체성(3.67), 주체성(3.41)으로 나타났다. 국내 요양서비스가 대상자의 안전과 편안함에 초점을 맞춘 신체수발에 주력하며 종사자와 대상자간에 애착이 형성되고 있지만, 개별적 케어(정체성)부족이나 대상자의 삶에서 의미있는 활동이 부족한 점(주체성)에서 사람중심케어가 취약함이 드러났다. 한편, DCM척도에 의한 사람중심케어의 특성을 조직 및 개인 특성에 따라 살펴보면, 시설의 규모가 작을수록 사람중심케어 실천이 높으며 공립과 민간시설간의 차이는 없었다. 또한 시설장과 직접 서비스제공자의 사람중심케어 실천이 높으며 경력이 1~2년인 종사자들의 사람중심케어 점수가 높은 것으로 나타났다. 본 연구는 국내 요양서비스에서 사람중심케어의 실천이 필요하며 이를 위한 구체적인 방안으로 유니트케어의 적용, 시설에서 직접 서비스제공자뿐 아니라 간호, 사회복지사등 전 직원을 대상으로 한 사람중심케어 교육 실시를 제언한다. 국내 요양서비스의 질평가에서도 사람중심케어의 관점이 강화돼야 하며 이를 위해 DCM 또는 직접 관찰이 어려운 상황에서는 대안으로 본 연구에서 개발한 한국형DCM척도의 활용을 제언한다.

Keywords

Acknowledgement

이 논문은 2019년 대한민국 교육부와 한국연구재단의 지원을 받아 수행된 연구임(NRF-2019S1A5B5A07087764)

References

  1. 김경숙, 최은숙, 박성애. (2007). 시설거주 치매노인의 행동심리증상에 관한 연구, 한국노년학, 27(1), 137-152.
  2. 김민규, 장예빛, 손정훈. (2018). 치매 친화적 환경으로서 '치매안심마을'에 대한 정책적 고찰, 노인복지연구, 73(1), 315-342. https://doi.org/10.21194/KJGSW.73.1.201803.315
  3. 김설. (2017). 노인요양시설에 근무하는 간호인력의 인간중심 케어 정도에 미치는 요인연구, Health& Nursing, 29(2), 59-71.
  4. 고병갑. (2019). 장기요양 서비스 제공자의 외재적 및 내재적 요인이 인간중심케어에 미치는 영향, 경남과학기술대학교 일반 대학원 석사학위논문.
  5. 보건복지부, 중앙 노인보호전문기관. (2016). 노인 학대 현황보고서.
  6. 보건복지부 중앙치매센터. (2018). 종사자를 위한 치매기초소양교육교재.
  7. 보건복지부. (2015). 제3차 치매관리종합계획(2016~2020): 보건복지부 인구정책실 노인정책과.
  8. 보건복지부. (2020). 제4차 치매관리종합계획(2021~2025): 보건복지부 인구정책실 노인정책과.
  9. 양윤정, 김정희. (2007). 요양시설 거주노인이 지각한 간호 요구, 노인간호학회지, 9(2), 115-123.
  10. 양정빈. (2010). 뇌졸중 생존 노인들의 건강관련 삶의 질 영향요인, 한국노년학, 30(4), 1239-1261.
  11. 이미진. (2011). 노인 장기요양서비스의 질 측정상의 쟁점에 대한 고찰, 사회복지정책, 38(1), 141-165. https://doi.org/10.15855/SWP.2011.38.1.141
  12. 이은경. (2015). 장기요양기관 유형에 따른 사람중심돌봄실행에 관한 연구, 울산대학교 일반대학원 석사학위논문.
  13. 임진섭. (2011). 노인장기요양시설의 거주자중심케어(Resident-Centered Care)에 영향을 미치는 요인과 경로에 관한 연구, 연세대학교 사회복지대학원 박사학위논문.
  14. 유선영. (2019). 치매노인 가족의 요양시설 입소의사결정에 대한 근거 이론적 접근, 한양대학교 대학원 간호학과 박사학위논문.
  15. 윤주영, Roberts, T., Bowers, B. J., & 이지윤. (2012). 노인요양시설의 인간 중심 케어(Person-centered care)에 대한 연구, 한국노년학, 32(3), 729-745.
  16. 중앙치매센터. 치매현황. https://www.nid.or.kr/main/main.aspx. (2020년 7월 31일 검색)
  17. 탁영란, 우해영, 유선영, 김지혜. (2015). 노인장기요양시설 종사자를 대상으로 한 인간중심돌봄 사정도구의 타당성 및 신뢰도 검증, 대한간호학회지, 45(3), 412-419. doi.org/10.4040/jkan.2015.45.3.412
  18. 황석영, 이지인, 이경준. (2018). 요양보호사의 인권의식이 치매노인 서비스 질에 미치는 영향-인권교육의 조절효과를 중심으로, 한국자치행정학보, 32(2), 225-245. https://doi.org/10.18398/KJLGAS.2018.32.2.225
  19. Barbara, A., Sousa, L., Nolan, M., & Figueiredo, D. (2015). Person-centredness in direct care workers caring for residents with dementia: Effects of a psycho-educational intervention, Dementia, 16(2), doi.org/10.1177/1471301215585667
  20. Barnett, E. (1995). A window of insight into quality care, Journal of Dementia Care, July/Aug, 23-26.
  21. Bond, J. (1992). The medicalization of dementia, Journal of Aging Studies, 6, 397-403. https://doi.org/10.1016/0890-4065(92)90020-7
  22. Blumenthal, MD. (1996). Quality of care-What is it? The New England Journal of Medicine, 335, 891-894. doi.org/10.1056/NEJM199609193351213
  23. Brooker, D. (2004). What is Person Centered Care for people with dementia? Reviews in Clinical Gerontology, 13(3), 215-222. doi.org/10.1017/S095925980400108X
  24. Brooker, D., Foster, N., Banner, A., Payne, M., & Jackson, L. (1998). The efficacy of Dementia Care Mapping as an audit tool: Report of a 3-year British NHS evaluation, Aging & Mental Health, 2, 60-70. doi.org/10.1080/13607869856957
  25. Brooker, D., Latham, I. (2006) Person-Centered Dementia Care, London: Jessica Kingsley Publishers.
  26. Capstick, A. (2003). The Theoretical Origins of Dementia Care Mapping, in A. Innes (ed.) Dementia Care Mapping: Applications across Cultures. Baltimore MD: Health Professions Press.
  27. Center for Applied Dementia Studies. (2018). Dementia Care Mapping Process and Application, Bradford: Bradford of University
  28. Cerejeira, J., Lagarto, L., Mukaetova-Ladinska, EB. (2012). Behavioral and psychological symptoms of dementia, Frontiers in Neurology, 3. doi.org/10.3389/fneur.2012.00073
  29. Chenoweth, L., Jeon, YH. (2007). Determining the efficacy of Dementia Care Mapping as an outcome measure and a process for change: A pilot study, Aging and Mental Health, 11(3), 237-245. doi.org/10.1080/13607860600844226
  30. Chenoweth, L., King, T., Jeon, Y. H., Bradat, H., Stein-Parbury, S., Norman, R., Haas, M., Luscombe, G. (2009). Caring for Aged Dementia Care Resident Study (CADRES) of person-centred care, dementia-care mapping, and usual care in dementia: a cluster-randomised trial, The Lancet Neurology, 8(4), 317-325. doi.org/10.1016/S1474-4422(09)70045-6
  31. Choi, JS., Lee, M. (2014). Psychometric Properties of a Korean Measure of Person-Directed Care in Nursing Homes, Research on social work practice, 24(6), 676-684. doi.org/10.1177/1049731513509897
  32. Crandall, LG., White, DL., Schuldheis S., & Talerico, KA. (2007). Initiating person-centered care practices in long-term care facilities, Journal of Gerontological Nursing, 33(11), 47-56. doi.org/10.3928/00989134-20071101-08
  33. Ebrahimi, Z., Patel, H., Wijk, H., Ekman, I., Olaya-Contreras, P. (2020). A systematic review on implementation of person-centered care interventions for older people in out-of-hospital settings, Geriatric Nursing, 8. 1-12. doi.org/10.1016/j.gerinurse.2020.08.004
  34. Edvardsson, D., Innes A. (2010). Measuring Person centered care: A critical comparative review of pubished tools, The gerontologist, 50(6), 834-846. doi.org/10.1093/geront/gnq047
  35. Edvardsson, D., Winblad, B., Sandman, PO. (2008). Person-centered care of people with severe alzheimer's disease: Current status and ways forward, The Lancet Neuroloy, 7(4), 362-367. doi.org/10.1016/S1474-4422(08)70063-2
  36. Edvardsson, D., Fetherstonhaugh, D., Nay, R., & Gibson, S. (2010). Development and initial testing of the Person-centered Care Assessment Tool(P-CAT), International Psychogeriatrics, 22(1), 101-108. doi.org/10.1017/S1041610209990688
  37. Fazio, S., Pace, D., Maslow, K., Zimmerman, S., & Kallmyer, B. (2018). Alzheimer's Association Dementia Care Practice Recommendations. The Gerontologist, 58(suppl_1), 1-9, doi.org/10.1093/geront/gnx182
  38. Flesner, MK. (2009). Person-centered care and organizational culture in long-term care, Journal of Nursing care Quality, 24(4), 273-276. doi.org/10.1097/NCQ.0b013e3181b3e669
  39. Fossey. J., Lee, L., & Ballard. C. (2002). Dementia Care Mapping as a research tool for measuring quality of life in care settings: psychometric properties, International Journal of Geriatric Psychiatry, 17(11), 1064-1070. doi.org/10.1002/gps.708
  40. Kitwood T.(1997). Dementia Reconsidered: The person comes FIrst, Buckingham: Open University Press.
  41. Kogan, AC., Wilber, K., & Mosqueda, L. (2016). Person-centered care for older adults with chronic conditions and functional impairment: A systematic literature review, Journal of the American Geriatrics Society, 64, 1-7. doi.org/10.1111/jgs.13873
  42. Lauver, DR., Ward, SE., Heidrich, SM., Keller, ML., Bowers, BJ., Brennan, PF., & Wells, TJ. (2002). Patient-centered interventions, Research in Nursing &Health, 25, 246-255. doi.org/10.1002/nur.10044
  43. Levy-Storms, L. (2013). Dementia care: The quality chasm. Dementia Initiative. White paper. https://nursinghometoolkit.com/additionalresources/DementiaCare-TheQualityChasm-AWhitePaper.pdf
  44. Lintern T., Woods B. & Phair L. (2000). Before and after training: a case study of interventions, Journal of Dementia Care, 8, 15-17.
  45. Livingston, G., Kelly, L., Lewis-Holmes, E., Baio, G., Morris, S., Patel, N., Omar, RZ., Katona, CZ., Cooperet, C. (2014). Non-pharmacological interventions for agitation in dementia: systematic review of randomised controlled trials, The British journla of Psychiatry, 205(6), 436-442. doi.org/10.1192/bjp.bp.113.141119
  46. Lyman, KA. (1989). Bringing the Social back in: A critique of the biomedicalisation of dementia, The Gerontologist, 29, 597-604. doi.org/10.1093/geront/29.5.597
  47. MacDonald AJ., Craig TK., Warner LA. (1985). The development of a short observation method for the study of the activity and contacts of old people in residential settings, Psychology Medicine, 15, 167-172. doi.org/10.1017/s0033291700021036
  48. McCormack, B. (2004). Person-centredness in gerontological nursing: an overview of the literature, Journal of Clinical Nursing, 13(1), 31-38. doi.org/10.1111/j.1365-2702.2004.00924.x
  49. Nolan, M. (2001). Successful ageing; Keeping the person in person-centered care, British Journal of Nursing, 10(7), 450-454. doi.org/10.12968/bjon.2001.10.7.5330
  50. Parker, J. (1999). Education and learning for the evaluation of dementia care: The perceptions of social workers in training, Education and Ageing, 14, 297-314.
  51. Post, S. (1995). The Moral Challenge of Alzheimer's Disease. Baltimore, MD: Johns Hopkins Press.
  52. Sabat, SR. (2002). Surviving Manifestationsof Selfhood in Alzheimer's Disease: A case study. Dementia. 1(1). doi.org/10.1177/147130120200100101
  53. Sidani, S., Streiner, D., LeClerc, C. (2012). Evaluating the effectiveness of the abilities-focused approach to morning care of people with dementia, International Journal of Older People Nursing, 7(1), 47-45. doi.org/10.1111/j.1748-3743.2011.00273.x
  54. Sjogren, K., Lindkvist, M., Sandman, PO., Zingmark, K., & Edvardsson, D. (2012). Psychometric evaluation of the Swedish version of the Person-Centered Care Assessment Tool (P-CAT), International Psychogeriatrics, 24(3), 406-415. doi.org/10.1017/S104161021100202X
  55. Sloane, PD., Hoeffer, B., Mitchell, CM., McKenzie, DA., Barrick, AL., Rader, J., Steward, BJ., Talerico, KA., Rasin, JH., Zink, RC., & Koch, GG. (2004). Effect of person-centered showering and the towel bath on bathingassociated aggression, agitation and discomfort in nursing home residents with dementia: A randomized, controlled trial, Journal of American Geriatrics Society, 52, 1795-1804. doi.org/10.1111/j.1532-5415.2004.52501.x
  56. Surr, CA, Griffiths, AW., Kelley, R. (2018). Implementing Dementia Care Mapping as a practice development tool in dementia care services: a systematic review, Clinical Interventions in Aging, 13, 165-177. doi.org/10.2147/CIA.S138836
  57. Thornton, A., Hatton, C., & Tatham, A. (2004). Dementia care mapping reconsidered: Exploring the reliability and validity of the observational tool, International Journal Geriatric Psychiatry, 19, 718-726. doi.org/10.1002/gps.1145
  58. White, DL., Newton-Curtis, L., Lyons, KS. (2008). Development and initial testing of a measure of person-directed care, The Gerontologist, 48(1), 114-123. doi.org/10.1093/geront/48.supplement_1.114
  59. Williams, J., Rees, J. (1997). The use of dementia care mapping as a method of evaluating care received by patients withdementia-an initiative to improve quality of life, Journal of Advanced Nursing, 25, 316-323. doi.org/10.1046/j.1365-2648.1997.1997025316.x
  60. Woods, RT. (2001). Discovering the person with Alzheimer's disease; cognitive, emotional and behavioural aspects, Aging Mental Health, 5(Supp.1), 7-16. doi.org/10.1080/713650008
  61. Younger, D., Martin, G. (2000). Dementia Care Mapping: An approach to quality audit of services for people with dementia in two health districts, Journal of Advanced Nursing, 32, 1206-1212. doi.org/10.1046/j.1365-2648.2000.01591.x