노인병원 환자 죽음에 대한 간호사의 경험

Abstract

우리나라는 노인 인구 증가와 더불어 만성질환 보유 노인 인구 증가율이 매우 높다. 이 때문에 노인병원 입원 환자가 늘고 있다. 노인환자의 노인병원 재원일수가 증가하고, 노인병원에서 임종하는 환자 수도 늘고 있다. 본 연구는 노인병원 환자 죽음의 전 과정을 간호하고 있는 간호사의 환자 죽음에 대한 경험을 깊이 이해하고 드러내기 위해 van Manen의 해석학적 현상학 연구방법으로 연구되었다. 본 연구에 사용된 자료는 어원적 의미, 관용구, 문학과 예술작품 및 노인병원 환자 죽음을 경험한 간호사 7명의 연구 참여자를 대상으로 일대일 심층면담을 통해 얻은 체험 자료이다. 체험 자료 수집 기간은 2014년 4월부터 2014년 9월까지이다. 연구 참여자는 S시와 G도에 위치한 4개의 노인병원에서 환자 죽음을 경험한 간호사이다. 연구 참여자 체험 자료는 일대일 심층면담과 이메일, 전화 면담 방법으로 연구 참여자 별 2~4회 진행되었으며 자료가 포화할 때까지 수집하였다. 본 연구는 본질에 집중, 실존적 조사, 해석학적 현상학적인 반성, 해석학적 현상학적 글쓰기 과정을 통해 노인병원 환자 죽음에 대한 간호사 경험의 본질을 드러냈다. 본 연구를 통해 드러난 노인병원 환자 죽음에 대한 간호사 경험의 본질적 주제는 ‘죽음장소에 내던져짐’, ‘힘겹게 반복되는 죽음이별’, ‘이별 후 희석되지 않는 감정파도’, ‘예정된 죽음을 맞이할 준비가 없는 곳’, ‘짓눌린 아픔에 무뎌져 감’, ‘살아있는 죽음과 동행하는 삶’, ‘잘 이별하고 잘 살기 위해 예(禮)를 다함’ 등 7가지로 도출되었다. 노인병원 간호사는 환자의 다양한 죽음을 맞닥뜨릴 준비가 안 된 상태로 근무를 시작하며, 힘겹게 반복되는 죽음이별 앞에서 수동적인 임종간호를 하고 있었다. 간호사에게 노인병원 환자 죽음으로 인해 가족이 죽었던 기억이 떠오르는 경험은 감정을 주체하기 어려운 체험이었다. 노인병원 간호사는 가족을 잃었던 과거와 환자를 잃은 현재, 자신이 죽음을 맞을 미래까지 생각하게 되는 시간의 연속성을 체험한다. 노인병원 간호사는 환자와 반복된 죽음이별 후 시간이 지나도 희석되지 않는 감정들을 경험한다. 환자 임종 시 드는 죄책감, 정든 환자 임종의 우울함, 긴박한 이별의 두려움 등의 감정파도는 반복되는 죽음이별을 더욱 힘겹게 만들고 알게 모르게 멍드는 몸과 마음을 갖게 한다. 간호사들은 노인병원이 죽음에 대해 예(禮)가 없는 공간이라고 진술하고 있다. 환자와 보호자를 위한 공간적, 관계적 배려를 찾기 어려운 곳이며, 환자 죽음의 형태를 결정하는 절대자는 보호자라고 말한다. 이런 공간에서 만나고 싶지 않은 임종으로 인해 생긴 다양한 아픔들을 노인병원 간호사는 지지받지 못한 채 감정을 감추고 일하고 있었다. 노인병원 간호사는 환자 죽음으로 인해 짓눌린 아픔에 무뎌진 채 일을 하는 동안 환자 죽음 모습들이 간호사 삶의 거울이 되어 스스로를 돌아보는 체험을 한다. 환자 죽음을 경험하는 노인병원 간호사는 죽음을 돌아가는 과정으로 받아들이고, 무의미한 연명치료를 거부하며 살아있는 죽음과 동행하는 삶을 살아가게 된다. 죽음에 대해 예(禮)가 없는 공간에서 방치된 죽음들을 아프게 경험하는 간호사는 드디어 잘 이별하고 잘 살기 위해 예(禮)를 다한 간호를 한다. 노인병원 간호사는 극한 고통 속 환자를 대변하는 일, 보호자를 안심시키며 간호사 스스로 안정하는 경험, 죽음이별을 정면으로 바라보고 잘 보내드리고 싶은 마음을 다한 간호를 실천하고 있었다. 본 연구를 통해 밝혀진 노인병원 환자 죽음에 대한 간호사 경험의 본질적 주제들은 노인병원 간호사의 임종간호 스트레스 경감과 임종간호 질 향상 방안 모색의 기초 자료를 제공할 것으로 기대된다.|In our country, together with the increase of the population of old people, the rate of increase of the population of old people carrying chronical disease is very high. The increase of the population of old people carrying chronical disease is causing increase in days of hospitalization of patients and also increase in patients deathbed in geriatric hospitals. This research, to reveal and understand nurses' experiences of the deaths of patients in geriatric hospital, is researched through Van Manen's analytic phenomenology research method. The result of this research will offer the fundamental materials of groping a plan of rise in nursing quality in geriatric hospitals. The data used in this research contains etymological meanings, idioms, literature, work of arts and also experienced research materials which are gained through one on one interview with 7 nurse research participants who has experienced death of patients in geriatric hospitals. The gathering of this experienced research materials is from April 2014 to September 2014. Research participants are nurses from 4 geriatric hospitals from city 'S' and state 'G' who have experienced death of patients. Research participant's experienced research material was run through one on one interview, email and by phone 2~4 times per participant and they were collected until they were saturated. This research reveals the essence of nurses' experiences of the deaths of patients in geriatric hospital through concentrating on the essence, existential examination, analytic phenomenological examination and analytic phenomenological writing process. The essential subjects of the experiences of nurses for the death of patients in geriatric hospitals are derived into the following 7 themes. ‘Thrown to death site’, ‘Difficult repetition of death and farewell’, ‘Emotional waves which never fades’, ‘Place with no preparation to greet the expected death’, ‘Getting dull from struck sorrow’, ‘Being together with living death’, ‘Showing courtesy to have good farewell and to live well’ Nurses in geriatric hospitals start working without the preparation to encounter different deaths of patients and are being passive when coming across difficult repetition of death farewells. Death of patients in geriatric hospitals that reminds the nurses the death of their own family members were a difficult experience which lead to unmanageable emotional breakdowns. Nurses in geriatric hospitals go through a continuous time of contemplation of the past when family members were dead, the present which patients have died and the future when I will one day face the death as well. Nurses in geriatric hospitals experience emotions that don't fade even a while after the death of the patients. Emotional waves such as guilty conscience during the deathbed, the death of patients who were close to you and the fear of nearness of death makes the farewell much more difficult and somehow bruises the heart and body. Nurses states that the geriatric hospital is a place where there are no courtesy for death. It is a place where spacial and relational consideration is hard to find and the absolute being who decides the form of patients' death is called the 'Guardian'. Nurses with different forms of hardships gained through encountering unwanted deaths in geriatric hospitals are being unsupported with their emotions just hidden. Nurses in geriatric hospitals become dull facing struck sorrow experiencing patients deaths and the death of the patients become the mirror of their own life leading them to look back at themselves. Nurses who experience patients deaths in geriatric hospitals accept death as 'returning home' process, refusing meaningless treatments for prolongation of life but choosing to be with the living death.; In our country, together with the increase of the population of old people, the rate of increase of the population of old people carrying chronical disease is very high. The increase of the population of old people carrying chronical disease is causing increase in days of hospitalization of patients and also increase in patients deathbed in geriatric hospitals. This research, to reveal and understand nurses' experiences of the deaths of patients in geriatric hospital, is researched through Van Manen's analytic phenomenology research method. The result of this research will offer the fundamental materials of groping a plan of rise in nursing quality in geriatric hospitals. The data used in this research contains etymological meanings, idioms, literature, work of arts and also experienced research materials which are gained through one on one interview with 7 nurse research participants who has experienced death of patients in geriatric hospitals. The gathering of this experienced research materials is from April 2014 to September 2014. Research participants are nurses from 4 geriatric hospitals from city 'S' and state 'G' who have experienced death of patients. Research participant's experienced research material was run through one on one interview, email and by phone 2~4 times per participant and they were collected until they were saturated. This research reveals the essence of nurses' experiences of the deaths of patients in geriatric hospital through concentrating on the essence, existential examination, analytic phenomenological examination and analytic phenomenological writing process. The essential subjects of the experiences of nurses for the death of patients in geriatric hospitals are derived into the following 7 themes. ‘Thrown to death site’, ‘Difficult repetition of death and farewell’, ‘Emotional waves which never fades’, ‘Place with no preparation to greet the expected death’, ‘Getting dull from struck sorrow’, ‘Being together with living death’, ‘Showing courtesy to have good farewell and to live well’ Nurses in geriatric hospitals start working without the preparation to encounter different deaths of patients and are being passive when coming across difficult repetition of death farewells. Death of patients in geriatric hospitals that reminds the nurses the death of their own family members were a difficult experience which lead to unmanageable emotional breakdowns. Nurses in geriatric hospitals go through a continuous time of contemplation of the past when family members were dead, the present which patients have died and the future when I will one day face the death as well. Nurses in geriatric hospitals experience emotions that don't fade even a while after the death of the patients. Emotional waves such as guilty conscience during the deathbed, the death of patients who were close to you and the fear of nearness of death makes the farewell much more difficult and somehow bruises the heart and body. Nurses states that the geriatric hospital is a place where there are no courtesy for death. It is a place where spacial and relational consideration is hard to find and the absolute being who decides the form of patients' death is called the 'Guardian'. Nurses with different forms of hardships gained through encountering unwanted deaths in geriatric hospitals are being unsupported with their emotions just hidden. Nurses in geriatric hospitals become dull facing struck sorrow experiencing patients deaths and the death of the patients become the mirror of their own life leading them to look back at themselves. Nurses who experience patients deaths in geriatric hospitals accept death as 'returning home' process, refusing meaningless treatments for prolongation of life but choosing to be with the living death.