본 연구는 치매국가책임제 일환으로 시행된 치매안심센터의 안정적 운영과 전문인력의 역할 확립을 위한 기초자료를 마련하고자 시행한 서술적 조사연구이다.
연구 대상자는 부산광역시와 경상남도에 위치한 19개 치매안심센터에 근무하는 간호사로, 연구에 참여하기로 동의한 126명을 대상으로 하였으며, 자료수집은 2019년 2월 25일부터 3월 30일까지 약 1달간 실시하였다.
본 연구는 문헌고찰과 치매안심센터 전문인력의 인터뷰를 통해 치매안심센터 간호사의 업무영역과 내용을 구성하고 전문가 자문을 거쳐 설문지를 개발하여 면대면 조사를 통해 자료를 수립하였다. 수집된 자료는 SPSS WIN 23.0 통계 프로그램을 사용하여, 빈도, 백분율, 평균, 표준편차, t-test, ANOVA, 사후검정으로 Scheffe-test로 분석하였다.
본 연구결과를 요약하면 다음과 같다.
1. 연구 대상자의 일반적 특성을 살펴보면, 평균 연령은 38.67±9.55세, 치매안심센터근무경력(개월) 9.47±4.78, 근무형태는 정규직이 42.1%, 비정규직이 57.9%이었다. 노인관련업무경력은 1년 이상 5년 미만이 49.2%, 간호사 1인당 월 상담자수는 100명 미만이 46%였다.
2. 치매안심센터 현황을 살펴보면, 행정구역상 부산광역시 소재 16곳, 경상남도 소재 3곳으로 총 19개이다. 운영기간은 부산광역시 평균 약 6개월, 경상남도는 약 5개월이었고, 운영형태에 따라 우선개소는 3곳, 정식개소는 16곳이었다. 치매안심센터 인력은 간호사 126명(54.55%), 사회복지사 44명(19.05%), 작업치료사 36명(15.58%), 상담심리사 15명(6.49%), 기타 10명(4.33%)로 나타났다. 근무형태는 정규직 71명(30.74%), 비정규직 160명(69.26%)이었다. 월 상담자수는 200명 이하가 169명(73.16%), 201명?500명 이하 55명(23.81%), 501명 이상이 7명(3.03%)로 나타났으며, 기관별 총예산은 500,000(×103) 이상?800,000(×103) 미만 2개(12.5%), 800,000(×103) 이상?1,000,000(×103) 미만 7개(43.75%), 1,000,000(×103) 이상 7개(43.75%)로 나타났다.
3. 치매안심센터 간호사가 수행하는 8가지 업무영역 가운데 중요하다고 인식하는 업무는「치매진단검진」(4.45±.68),「상담, 등록 및 분류」(4.29±.69),「치매예방관리사업」(4.19±.80),「치매대상자관리사업」(4.11±.84),「직원역량강화 및 직원복지관리」(4.07±.87),「행정업무 및 지역사회역량강화」(4.03±.94),「치매가족상담 및 돌봄지원사업」(4.00±.85),「사례관리」(3.75±.87) 순이었다.
업무영역 가운데 주로 수행하는 업무는「치매진단검진」(4.02±1.08),「상담, 등록 및 분류」(3.94±.90),「치매대상자관리사업」(3.66±1.13),「치매예방관리사업」(3.59±1.23),「행정업무 및 지역사회역량강화」(3.58±1.30),「직원역량강화 및 직원복지관리」(3.46±1.44),「치매가족상담 및 돌봄지원사업」(3.42±1.24),「사례관리」(3.26±1.00) 순으로 나타났다.
4. 치매안심센터 간호사의 45개 업무내용의 중요도 및 수행도 상위 순위를 살펴보면, 중요도는 ‘만75세이상 인지저하대상자의 치매선별검사(MMSE-DS)’(4.61±.55), ‘만60세이상 치매선별검사(MMSE-DS)’(4.59±.58), ‘진단검사-신경인지검사(CERAD-K, SNSBⅡ, LICA, MOCK-K)’(4.53±.59) 순으로 나타났고, 수행도는 ‘만60세이상 치매선별검사(MMSE-DS)’(4.44±.84), ‘치매소양기초교육’(4.16±.93), ‘조호물품제공서비스’(4.15±.90) 등의 순으로 나타났다.
5. 연구 대상자의 일반적 특성에 따른 업무영역의 중요도 및 수행도의 차이를 살펴보면, 업무 중요도는 근무형태에 따라「상담, 등록 및 분류」영역에서 유의한 차이가 있었고(t=5.58, p<.05), 보수교육이수여부는「치매대상자관리사업」업무에서 유의한 차이를 나타냈다(t=4.81, p<.05).
업무 수행도는 연령에 따라 「상담등록 및 분류」영역에서 유의한 차이가 있었고 (F=0.05, p<.05),「치매예방관리사업」(F=2.90, p<.05),「치매가족상담 및 돌봄지원사업」(F=3.70, p<.05)에서 유의한 차이를 보였다.
6. 일반적 특성에 따른 업무내용의 중요도 및 수행도의 차이를 살펴보면, 업무 중요도 결과, 연령은 ‘조호물품제공서비스’에 유의한 차이가 있었고(F=3.21, p<.05), 근무형태는 ‘만65세 이상 노인의 기초·심층·수시상담’(t=7.47, p<.01), ‘예산회계관리’의 업무내용과 유의한 차이를 보였다(t=6.63, p<.05). 노인업무근무경력은 ‘생활환경·경제적·사회생활지원’(F=5.44, p<.05)에서 유의한 차이를 보였다. 보수교육이수여부는 ‘맞춤형사례관리 선정기준에 적합한 대상자의 노인돌봄종합서비스연계’(t=5.35, p<.05), ‘치매 및 장기요양비급여 대상자의 인지기능 악화방지 프로그램기획 및 시행’(t=4.60, p<.05)에서 유의한 차이가 있었다.
업무 수행도 결과, 연령은 ‘건강·안전·일상생활지원안내’(F=0.50, p<.05)에서 유의한 차이를 보였고, 근무형태는 ‘맞춤형사례관리 선정기준에 적합한 대상자의 노인돌봄종합서비스연계’(t=8.89, p<.05), ‘장기요양 서비스연계’(t=4.45, p<.05), ‘예산회계관리’(t=4.25, p<.05) 에서 유의한 차이를 보였다. 치매안심센터근무경력에 따라 ‘진단검사(신경인지검사CERAD-K, SNSBⅡ, LICA, MOCK-K)’(F=3.61, p<.05), ‘조호물품제공서비스’(F=4.24, p<.01), ‘가족상담을 통한 돌봄부담분석 및 지원’(F=3.89, p<.05), ‘회기별프로그램기획 및 시행’(F=3.96, p<.01), ‘정기적인모임지원’(F=3.99, p<.01), ‘교류 및 휴식공간제공’(F=4.13, p<.01), ‘치매환자, 장기요양비급여대상자의 인지기능악화방지프로그램운영’(F=4.24, p<.01), ‘정기적인모임지원’(F=3.99, p<.01), ‘교류 및 휴식공간제공’(F=4.13, p<.01), ‘예산회계관리’(F=4.25, p<.05)에서 차이를 보였다. 노인업무근무경력은 ‘진단검사-신경인지검사(CERAD-K, SNSBⅡ, LICA, MOCK-K)’(F=3.61, p<.05), ‘생활환경·경제적·사회생활지원’(F=4.06, p<.01)에서 유의한 차이를 보였고, 월 상담자수는 ‘맞춤형사례관리 선정기준에 적합한 대상자의 노인돌봄종합서비스연계’(F=2.76, p<.05)에서 차이를 나타냈다.
본 연구를 통해 치매안심센터 간호사의 업무영역과 업무내용을 전반적으로 규명해 볼 수 있었다. 간호사가 중요하게 인식하고 수행 빈도가 높은「치매진단검진」업무는 향후 치매안심센터 간호사의 고유 업무영역으로 정립할 필요가 있다. 또한「치매예방관리사업」은 중요하게 인식하는 것과 비교해 수행도가 낮은 결과를 보였다. 치매안심센터의 설립목적과 연계해서 해석한다면 지역사회 대상자의 치매예방을 위한 프로그램 운영 및 대상자관리 업무수행에 비중을 높이는 것이 필요하다.
국가정책사업 초기단계에서 치매안심센터가 성공적인 결과를 이루기 위해서는 대상자에게 적절한 서비스를 제공할 수 있어야 한다. 이에 직군별 업무구분 및 의료인으로서 간호사의 역할이 정립될 수 있는 정책적 기반이 마련되어야 할 것이다.

This study is a descriptive research study to establish basic data for stable operation of Dementia Care Center as a part of national responsibility system for dementia and to establish the role of the professional workforce.
The subjects of this study were 126 nurses working in 19 dementia centers in Busan Metropolitan City and Gyeongsangnam-do Province who had agreed to participate in the study. Data collection was conducted for about one month, from February 25 to March 30, 2019.
This study first constructed questionnaires through literature review and interviewing experts working in Dementia Care Centers. The collected data were analyzed using SPSS WIN 23.0 by frequency, percentage, mean, standard deviation, paired t-test, t-test, and ANOVA. Post-test was conducted using Scheffe-test.
The results of this study are summarized as follows.
1. Regarding general characteristics of subjects, the average age was 38.67±9.55; the average working experience at the Dementia Care Center was 9.47±4.78 year; in terms of the form of work, 42.1% was regular workers and 57.9% was non-regular workers. 49.2% of the subjects had the work experience related to the elderly from one year to five years. For 46% of the subjects, the monthly number of counselees was less than 100.
2. The current number of Dementia Care Center in Busan and Gyeongsangnam-do is 19 in total, which consist of 16 in the Busan Metropolitan City and 3 in the Gyeongsangnam-do Province. The operation period was about 6 months on the average of Busan Metropolitan City and about 5 months on Gyongsangnam-do. There were 3 early access centers and 16 regular centers by the centers’ status. The dementia center staffs consisted of 126 nurses(54.55%), 44 social workers(19.05%), 36 occupational therapists(15.58%), 15 counseling psychologists(6.49%) and 10 other workers(4.33%). The number of regular workers was 71(30.74%); irregular workers was 160(69.26%). The centers with less than 200 counselees a month was 169(73.16%), 201 to 500 was 55(23.81%), and more than 501 was 7(3.03%). By its total budget, 2 centers had a budget of from 500,000(×103) to 800,000(×103); 7 had 800,000(×103) to 1,000,000(×103); 7 had more than 1,000,000(×103)
3. Among eight areas of task for nurses working in the Dementia Care Center, the tasks with most recognized importance are as following: 「Diagnosis of Dementia」 (4.45±.68),「Counseling, Register and Classification」 (4.29±.69),「Preventive Projects for Dementia」(4.16±.80),「Management of Targeted Dementia Patients」(4.11±.84),「Strengthening Workers’ Capacity and Management of Workers’ Welfare」(4.07±.87),「Administrative Affairs and Community Capacity Building」(4.03±.94),「Dementia Family Counseling and Care Support Project」(4.00±.85),「Case Management」(3.75±.87). By the frequency, the rank is as following: 「Diagnosis of Dementia」 (4.02±1.08), 「Counseling, Register and Classification」 (3.97±.90), 「Management of Targeted Dementia Patients」(3.66±1.13), 「Preventive Projects for Dementia」(3.59±1.23),
「Administrative Affairs and Community Capacity Building」(3.58±1.30), 「Strengthening Workers’ Capacity and Management of Workers’ Welfare」(3.46±1.44),「Dementia Family Counseling and Care Support Project」(3.42±1.24), 「Case Management」(3.26±1.00).
4. Among the 45 areas of duty for the nurses working in Dementia Care Center, the following duties ranked high in work importance and performance. For work importance, ‘Dementia Screening Test for Those Who Are with Cognitive Decline and Older than 75(MMSE-DS)’ had the highest score (4.61±.55), followed by ‘Dementia Screening Test for Those Who Are Older than 60(MMSE-DS)(4.59±.58)’ and ‘Diagnostic Tests-Neurocognitive Tests (CERAD-K, SNSBⅡ, LICA, MOCK-K)(4.53±.59).’ For work performance, ‘Dementia Screening Test for Those Who Are Older than 60(MMSE-DS)’ had the highest score(4.44±.84), followed by ‘Basic Education Regarding Dementia(4.59±.58),’ ‘Provision of Aid Goods(4.15±.90).’
5. Regarding the difference in the importance and performance of work areas in terms of the general characteristics of the study subjects, there was a significant difference in the work importance in 「Counseling, registration and classification」 area by the form of work(F=5.58, p<.05). Also, whether a subject completed maintenance education had a significant difference in 「Management of Targeted Dementia Patients」(F=4.81, p<.05).
For work performance,「Counseling, Register and Classification」 (F=0.05, p<.05),「Preventive Projects for Dementia」(F=2.90, p<.05), and 「Dementia Family Counseling and Care Support Project」(F=3.70, p<.05) had a statistically significant difference by age.
6. Regarding the difference of work importance and performance by general characteristics, for work importance, age made a significant difference in ‘Provision of Aid Goods(F=3.21, p<.05), and the form of work made a significant difference in ‘Basic, In-Depth, On Demand Counseling for Elderly Persons Older than 65’(F=7.47, p<.01) and ‘Budget and Account Management.’(F=6.63, p<.05). Work experience related to elderly people made a significant difference in ‘Providing Aid for Life Environmental, Economic, Social Life(F=5.44, p<.05),’ Whether the subject took a maintenance education made a difference in ‘Connecting to Day Care Service for Elderly Persons Appropriate for the Standards of Tailored Case Study(F=5.35, p<.05),’ ‘Planning and Implementing Programs by Days of Week(F=4.60, p<.05).
In terms of work performance, age made a significant difference in ‘Providing Information about Health, Safety, and Everyday Life(F=0.50, p<.05)’. Form of work made a significant difference in ‘Budget and Account Management(F=4.25, p<.05)’, ‘Connecting to Day Care Service for Elderly Persons Appropriate for the Standards of Tailored Case Management(F=8.89, p<.05)’ and ‘Connecting to Long-Term Care Service(F=4.45, p<.05)’. Work experience in Dementia Care Center made a significant difference in ‘Diagnostic Tests-Neurocognitive Tests (CERAD-K, SNSBⅡ, LICA, MOCK-K)(F=3.61, p<.05)’, ‘Planning and Implementing Programs by Days of Week(F=3.16, p<.05)’, ‘Operation of Program for Prevention of Deterioration of Cognitive Function for Dementia Patients and Non-Recipients of Long Term Care(F=4.24, p<.01)’, ‘Analyzing Burden of Taking Care and Providing Support by Family Consultation(F=3.89, p<.05)’, ‘Planning and Implementing Programs by Sessions(F=3.96, p<.01)’, ‘Supporting Regular Meeting(F=3.99, p<.01)’, ‘Providing Place for Interaction and Rest(F=4.13, p<.01)’, ‘Budget and Account Management(F=4.25, p<.05)’. Work experience related to elderly made a significant difference in ‘Diagnostic Tests-Neurocognitive Tests (CERAD-K, SNSBⅡ, LICA, MOCK-K)(F=3.61, p<.05)’, ‘Providing Aid for Life Environmental, Economic, Social Life(F=4.06, p<.01)’. The number of Monthly Counselees made a difference in ‘Connecting to Day Care Service for Elderly Persons Appropriate for the Standards of Tailored Case Management(F=2.76, p<.05)’.
This study made it possible to identify the duties and tasks of the nurses working in Dementia Care Center.?It is necessary to establish 「Dementia diagnosis examination」 service which nurses recognize as an important and frequently performed as an intrinsic work area for nurses in Dementia Care Center in the future. Also, 「Dementia Prevention Management Project」, which has a huge difference between work importance and performance score, showed low work performance score in comparison of recognized importance. In connection with the purpose of establishing the Centers for Disease Control and Prevention, it is necessary to put an emphasis on the operatio of program for the prevention of dementia in the community and managing those with mild cognitive impairment in the community.
In the early stages of the national policy project, the Center for Dementia and Rehabilitation should provide appropriate services to the target in order to the successful implementation of the policy. Therefore, it is necessary to assign duties appropriately and set up a policy basis to establish the role of nurses as medical personnel.