혈액투석 환자의 증상경험과 삶의 질 : 회복탄력성의 조절 및 매개효과 :Symptom Experience and Quality of Life in Patients on Hemodialysis : Moderating and Mediating effect of Resilience

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자료유형: 학위논문

저자정보: 조연희 (인제대학교, 인제대학교 일반대학원)

지도교수: 이윤미

발행연도: 2018

저작권: 인제대학교 논문은 저작권에 의해 보호받습니다.

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2019

혈액투석 환자의 증상경험과 삶의 질 관계에서 회복탄력성의 조절 및 매개효과

조연희 , 이윤미 성인간호학회지 2019.02 학술저널

2018

혈액투석 환자의 증상경험과 삶의 질 : 회복탄력성의 조절 및 매개효과

조연희 간호학과 2018.01 학위논문

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목적: 본 연구의 목적은 혈액투석 환자를 대상으로 증상경험, 회복탄력성과 삶의 질 정도를 확인하고, 증상경험과 삶의 질 관계에서 회복탄력성의 조절 및 매개효과를 파악함으로써 혈액투석 환자의 삶의 질을 높일 수 있는 중재 개발에 대한 기초 자료를 제공하고자 함이다.

방법: 본 연구의 대상은 B광역시 소재 일개 종합병원과 일개 혈액투석 전문병원 인공신장실에서 만성신부전을 진단받고 정기적으로 주 2회 이상 혈액투석 치료를 받는자로 연구의 목적을 이해하고 설문에 동의한 혈액투석 환자 105명이었다. 자료 수집은 2017년 12월 14일부터 2018년 1월 15일까지 구조화된 자가보고식 설문지를 이용하여 실시되었다. 수집된 자료는 SPSS window 24.0 program을 사용하여 빈도와 백분율, 평균과 표준편차, t-검정과 일원배치 분산분석, LSD 사후검정, 피어슨 상관계수, 위계적 다중회귀분석을 이용하여 분석하였다.

결과: 본 연구의 결과는 다음과 같다.
1. 대상자의 특성 중 연령은 평균 57.85±13.39세였으며, 남자는 61.9%(65명), 종교유무는 ‘있다’가 58.1%(61명), 결혼상태는 기혼이 55.2%(58명)이었으며, 교육정도는 고졸 43.8%(46명), 가구의 월수입은 100만원 미만이 57.1%(60명), 현재 도움을 많이 주는 사람은 다중응답으로 배우자가 33.3%(35명)로 가장 많았다. 투석받은 기간은 5년 미만이 41.9%(44명), 주당 혈액투석 횟수는 3회가 89.5%(94명), 한달 병원비는 10만원 미만 46.7%(49명)이었으며, 동반질환 유무는 ‘있다’가 79.0%(83명)로 가장 많았다.

2. 증상경험은 160점 만점에 33.06±26.38점이었고, 회복탄력성은 100점 만점에 56.05±19.53점이었고, 삶의 질은 130점 만점에 76.28±15.77점이었다.

3. 대상자의 특성에 따른 증상경험은 결혼상태(F=5.34, p=.006), 투석받은 기간(F=3.40, p=.021)에서 유의한 차이가 있었다. 회복탄력성은 가구의 월수입(F=2.64, p=.038)에서 유의한 차이가 있었다. 삶의 질은 동반질환 유무(t=-2.48, p=.015)에서 유의한 차이가 있었다.

4. 증상경험과 회복탄력성(r=-.36, p<.001), 증상경험과 삶의 질(r=-.50, p<.001) 사이에는 유의한 음의 상관관계가 있었다. 회복탄력성과 삶의 질(r=.67, p<.001)사이에는 유의한 양의 상관관계가 있었다.

5. 회복탄력성은 증상경험과 삶의 질의 관계에서 부분매개효과가 있었고(Z= -3.48, p<.001), 조절효과는 없는 것으로 나타났다.

결론: 본 연구의 결과를 종합해 볼 때, 혈액투석 환자의 증상경험과 삶의 질 관계에서 회복탄력성은 부분매개효과가 있는 것으로 확인되었다. 혈액투석 환자의 삶의 질을 향상시키기 위해서 대상자의 증상경험과 회복탄력성을 사정하고, 증상완화 중재와 더불어 회복탄력성을 증진시키는 중재가 필요하다.

Purpose: The purpose of this study is to identify symptom experience, resilience, and quality of life among patients on hemodialysis and to understand the moderating and mediating effects of resilience in the relationship between symptom experience and quality of life. This study aims to provide basic data for the development of interventions to improve quality of life among hemodialysis patients.

Methods: Participants were recruited from one general hospital and one hospital specializing in hemodialysis located in B metropolitan city. The participants included 105 patients diagnosed with chronic renal failure who had been receiving hemodialysis twice a week or more on a regular basis, understood the objective of this study, and agreed to complete the questionnaires. Structured self-report questionnaires were administered to the participants from December 14, 2017, to January 15, 2018. The collected data were analyzed through frequency and percentage, mean and standard deviation, t-test, one-way analysis of variance, least significant difference post-hoc test, Pearson''s correlation coefficient, and hierarchical multiple regression using SPSS Windows 24.0.

Results: The results of this study are as follows:
1. The average age of the participants was 57.85±13.39 years, 61.9% (n=65) were male, 58.1%(n=61) had religion, 55.2%(n=58) were married, 43.8%(n=46) had high school education, and 57.1%(n=60) had a monthly income of less than 1,000,000 KRW. From among multiple options, 33.3%(n=35) responded that it was their spouses who currently provided them with the most help. The proportion of those who had been receiving hemodialysis for less than five years was 41.9%(n=44), and 89.5%(n=94) had three hemodialysis sessions per week. The proportion of patients whose hospital expenses were less than 100,000 KRW per month was 46.7%(n=49), and 79.0%(n=83) had comorbid conditions.

2. The participants'' mean symptom experience score was 33.06±26.38 out
of 160. The mean resilience score was 56.05±19.53 out of 100, and the
mean quality of life score was 76.28±15.77 out of 130.

3. Significant differences in symptom experience scores were found according to participants'' marital status(F=5.34, p=.006) and their duration of dialysis(F=3.40, p=.021). There was a significant difference in resilience scores based on monthly household income(F=2.64, p=.038). A significant difference in the quality of life scores was found according to the presence of comorbid conditions(t=-2.48, p=.015).
4. There were significant negative correlations between symptom experience and resilience(r=-.36, p<.001) and between symptom experience and quality of life(r=-.50, p<.001). A significant positive correlation was found between resilience and quality of life(r=.67, p<.001).

5. Resilience had a partial mediating effect(Z=-3.48, p<.001) in the relationship between symptom experience and quality of life and did not have moderating effects.

Conclusion: Based on the results of this study, the resilience of hemodialysis patients has a partial mediating effect in the relationship between symptom experience and quality of life. To improve the quality of life among hemodialysis patients, it is necessary to address their symptom experience and resilience. Further development of interventions enhancing patients'' resilience in addition to symptom relief is needed.

#혈액투석 환자 #증상경험 #회복탄력성 #삶의 질

Ⅰ. 서론 ··································································1
가. 연구 필요성 ·····················································1
나. 연구 목적 ·······················································3
다. 용어 정의 ·····················································4
라. 연구의 제한점 ···················································5
Ⅱ. 문헌고찰 ····························································6
가. 혈액투석 환자의 삶의 질 ········································6
나. 증상경험 ······················································8
다. 회복탄력성 ·····················································10
Ⅲ. 연구 방법 ···························································12
가. 연구 설계 ·······················································12
나. 연구 대상 ·······················································12
다. 연구 도구 ·······················································13
라. 자료 수집 방법 ·················································14
마. 윤리적 고려 ·················································15
바. 자료 분석 방법 ··················································15
Ⅳ. 연구 결과 ···························································17
가. 일반적 특성 및 질병관련 특성 ··································17
나. 증상경험, 회복탄력성, 삶의 질 정도 ···························21
다. 대상자의 증상경험 정도 ········································23
라. 대상자의 특성에 따른 변수의 차이검정 ······················25
마. 증상경험, 회복탄력성과 삶의 질의 상관관계 ················31
바. 회복탄력성의 조절효과 ··········································32
사. 회복탄력성의 매개효과 ··········································35
Ⅴ. 논의 ································································38
Ⅵ. 결론 및 제언 ························································43
가. 결론 ·····························································43
나. 제언 ····························································45
참고문헌 ································································46
부록 ·····································································58
감사의 글 ·······························································81

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