전이성 척추 종양 환자의 퇴원 후 삶

Abstract

국 문 요 약

본 연구의 목적은 수술을 받고 퇴원한 전이성 척추 종양 환자의 삶의 경험을 분석함으로써, 이들의 삶의 질을 높이기 위한 방안을 모색 하고자 연구하였으며, 연구 방법은 질적 연구로 현상학적 방법으로 분석하였다. 자료 수집 기간은 2012년 3월 13일 부터 2012년 5월 15일까지였으며 참여자는 경기도에 소재한 일개 병원에서 수술을 받고 퇴원한 전이성 척추 종양 환자 및 보호자로 연구에 자의로 참여하기로 허락한 7명이다. 5명은 원발암 에서 척추로 전이한 척추 전이암 환자이며, 1명은 척수 내 역형성 상의세포종의 환자이며, 나머지 1명은 본 히펠 린다우병에 속하는 혈관아세포종 환자이다. 분석방법은 Colaizzi(1978)가 제시한 현상학적 방법으로 원 자료로부터 의미있는 진술을 도출, 재 진술, 구성된 의미를 끌어내어 주제, 주제모음, 범주로 정리 하였다.

연구의 결과는 다음과 같다.

범주 1은 “고통스러운 삶”이었으며 ‘통증 조절의 어려움’, ‘자살을 생각하게 됨’, ‘가족에게 고통을 줌’, ‘얼마 남지 않은 죽음을 앎’, ‘통증으로 인한 불면’, ‘약물 처방공급 문제’로 6개의 주제로 나타났다.

범주 2는 ‘신체적 변화로 인한 제한된 삶’이었으며 ‘걷기 힘듦’, ‘활동의 제한’, ‘배뇨와 배변 장애’, ‘욕창관리의 어려움’, ‘탈모로 인한 신체상 변화’로 5개의 주제로 나타났다.

범주 3은 “의존적인 삶”이었으며, ‘타인에게 의존하게 됨’, ‘재활병원 및 요양원의 선택’, ‘자신이 가족을 돌봄’으로 3개의 주제로 나타났다.

범주 4는 “역할 수행 변화로 인한 어려운 삶”이었으며, ‘자녀에게 역할을 다하지 못함에 대한 아쉬움’, ‘자녀의 지원’으로 2개의 주제로 나타났다.

범주 5는 “심리적 변화로 인한 삶”이었으며, ’질병의 원인에 대한 인식‘, ’치료과정에서 오는 우울감‘으로 2개의 주제로 나타났다.

범주 6은 “장애로써의 불확실성”이였으며, ‘국가 복지 정책에 대한 불만, ’편견과 배려의 부족‘, ’재활치료의 어려움‘, ’재발의 두려움을 가지고 직장생활 지속‘으로 4개의 주제로 나타났다.

범주 7은 “생의 주기에 따른 문제의 차이”였으며, ‘적극적인 치료에 대한 부담감’, ’젊음에 대한 안타까움과 새로운 치료에 대한 기대‘로 2개의 주제로 나타났다.

이상의 결과를 토대로 전이성 뼈 통증으로 심한 통증을 호소하는 전이성 척추 종양 환자들이 통증 조절에 대한 요구가 높으므로 퇴원 후 가정간호에서도 암성 통증에 대한 교육 및 관리에 초점을 맞추어야 할 것이며, 퇴원 후 근력저하가 있는 대상자들은 신체적 변화로 인하여 제한적이고 의존적인 삶을 살게 되고, 장애로써의 불확실한 미래에 대한 공포에 시달리고 있으므로 이에 맞는 간호 중재 및 사회적 지지체계가 강화되어야 할 필요가 있다.

이상의 연구를 통해 다음을 제언한다.

1. 전이성 척추 종양 환자를 대상으로 실시한 연구가 거의 없으므로 앞으로도 이들을 대상으로 한 연구가 필요하다.

2. 전이성 척추 종양 환자에게 퇴원 후 가정 간호에서 암성 통증에 대한 교육 및 관리에 초점을 맞추어야 할 것이다.

3. 근력 저하로 인하여 제한적이고 의존적인 삶을 살게 되는 전이성 척추 종양 환자에게 사회적 지지체계가 강화되어야 할 필요가 있다.

|ABSTRACT

The life after discharge of metastatic spine tumor patients

Moon, Chong nam Directed by Prof. Kim, Boon Han Dept. of Clinical Hospice Care & Special Nursing The Graduate School of Information in Clinical Nursing Hanyang University

The study aims to seek ways how to improve the quality of life by analyzing discharged patients who underwent surgery with metastatic spinal tumor. the study was conducted by the phenomenological method based on qualitative research. Data collection period was from 13 March 2012 to 15 May 2012. and the participants were discharged patients who underwent surgery in hospital located in Gyeonggi-do with metastatic spinal tumors and their guardians. Enlisted 7 people participated voluntarily. 5 people are patients with metastatic spine tumor that primary cancer metastasize to spine, 1 patient is anaplastic ependymoma, and another person is patient with hemagioblastoma belonging to the hipel Lindau disease. By using phenomenological methods that Colaizzi (1978) proposed, Significant statements derived from raw data(protocols) were restated general formation, General restatements lead to formulated meaning. Finally formulated meaning was organanized into themes, themeclusters and categories.

The results of the study are as follows.

Category 1 is summarized "distressed life". and it was classified under 6 heads respectively. ‘the difficulty of pain controlling', 'thinking suicide’, ‘Giving pains to family', 'knowing how much was left to die', ‘insomnia due to pain’, 'prescription of drugs supply problems’.

Category 2 is summarized "a limited life due to physical changes“. and it was classified under 5 heads respectively. 'walking disability', 'limitation of activity’, ' urination and defecation disorders', 'difficulty in managing bed sores', 'changes in body image due to hair loss’.

Category 3 is summarized "dependent life“ and it was classified under 2 heads respectively. ‘dependent on others', 'choice of rehabilitation hospitals and sanatorium'.

Category 4 is summarized “Difficult life due to changes of role performance". and it was classified under 2 heads respectively. ‘regretting to not fulfill the role to children outright ',' supporting for child'.

Category 5 is summarized "life due to psychological changes". and it was classified under 2 heads respectively. 'awareness of the causes of disease', 'the depression caused by treatment process’.

Category 6 is summarized "the uncertainty due to disability". and it was classified under 4 heads respectively. 'complaints about state welfare policy’, ‘prejudice and lack of care', 'the difficulties of rehabilitation', 'fear of recurrence in continued working life’.

Category 7 is summarized "life cycle according to the difference of the problem" . and it was classified under 2 heads respectively. ‘burden for aggressive treatment', ’sadness for youth and expectations for new treatment’.

Based on the above results, patients with metastatic spinal tumor who is complaining of severe pain due to metastatic bone pain need to be focused on the education for cancer pain and management in home care. After discharge the participants with the physical changes due to a lack of muscular strength lived a limited and dependent life and suffered from a fear of an uncertain future by disability, so they need to be strengthened nursing intervention and social support systems.

Through the study, the following is suggested.

1. There is a very little research conducted on patients with metastatic spinal tumors, so a study of them needs in the future.

2. After patients discharge from hospital, Patients with metastatic spinal tumors will be focused on education for cancer pain and management in home care.

3. Patients with metastatic spinal tumors who lived a dependent and limited life due to a lack of muscular strength need to be strengthened social support systems.; ABSTRACT

The life after discharge of metastatic spine tumor patients

Moon, Chong nam Directed by Prof. Kim, Boon Han Dept. of Clinical Hospice Care & Special Nursing The Graduate School of Information in Clinical Nursing Hanyang University

The study aims to seek ways how to improve the quality of life by analyzing discharged patients who underwent surgery with metastatic spinal tumor. the study was conducted by the phenomenological method based on qualitative research. Data collection period was from 13 March 2012 to 15 May 2012. and the participants were discharged patients who underwent surgery in hospital located in Gyeonggi-do with metastatic spinal tumors and their guardians. Enlisted 7 people participated voluntarily. 5 people are patients with metastatic spine tumor that primary cancer metastasize to spine, 1 patient is anaplastic ependymoma, and another person is patient with hemagioblastoma belonging to the hipel Lindau disease. By using phenomenological methods that Colaizzi (1978) proposed, Significant statements derived from raw data(protocols) were restated general formation, General restatements lead to formulated meaning. Finally formulated meaning was organanized into themes, themeclusters and categories.

The results of the study are as follows.

Category 1 is summarized "distressed life". and it was classified under 6 heads respectively. ‘the difficulty of pain controlling', 'thinking suicide’, ‘Giving pains to family', 'knowing how much was left to die', ‘insomnia due to pain’, 'prescription of drugs supply problems’.

Category 2 is summarized "a limited life due to physical changes“. and it was classified under 5 heads respectively. 'walking disability', 'limitation of activity’, ' urination and defecation disorders', 'difficulty in managing bed sores', 'changes in body image due to hair loss’.

Category 3 is summarized "dependent life“ and it was classified under 2 heads respectively. ‘dependent on others', 'choice of rehabilitation hospitals and sanatorium'.

Category 4 is summarized “Difficult life due to changes of role performance". and it was classified under 2 heads respectively. ‘regretting to not fulfill the role to children outright ',' supporting for child'.

Category 5 is summarized "life due to psychological changes". and it was classified under 2 heads respectively. 'awareness of the causes of disease', 'the depression caused by treatment process’.

Category 6 is summarized "the uncertainty due to disability". and it was classified under 4 heads respectively. 'complaints about state welfare policy’, ‘prejudice and lack of care', 'the difficulties of rehabilitation', 'fear of recurrence in continued working life’.

Category 7 is summarized "life cycle according to the difference of the problem" . and it was classified under 2 heads respectively. ‘burden for aggressive treatment', ’sadness for youth and expectations for new treatment’.

Based on the above results, patients with metastatic spinal tumor who is complaining of severe pain due to metastatic bone pain need to be focused on the education for cancer pain and management in home care. After discharge the participants with the physical changes due to a lack of muscular strength lived a limited and dependent life and suffered from a fear of an uncertain future by disability, so they need to be strengthened nursing intervention and social support systems.

Through the study, the following is suggested.

1. There is a very little research conducted on patients with metastatic spinal tumors, so a study of them needs in the future.

2. After patients discharge from hospital, Patients with metastatic spinal tumors will be focused on education for cancer pain and management in home care.

3. Patients with metastatic spinal tumors who lived a dependent and limited life due to a lack of muscular strength need to be strengthened social support systems.