서울시내 일 대학병원 응급실 내원 암 환자의 실태 조사

Abstract

국 문 요 약

본 연구는 S대학병원의 응급실에 내원한 암 환자의 실태를 조사함으로써 말기 암 환자의 간호 중재 방안 연구에 기초 자료를 제공하기 위한 후향적 서술 조사 연구이다. 연구 기간 및 대상은 2008년 10월 1일부터 2009년 3월 31일까지이며, S대학병원의 응급실에 내원한 16,467명의 환자 중 암 환자 4,189명을 대상으로 하였다. 자료수집 및 분석은 연구자가 작성한 연구 수집 도구와 Rhodes와 Watson(1987)이 개발한 불편감 측정도구를 기초로 하여 권미형(2003)이 수정·보완한 도구를 사용하여 4,189명의 자료를 대상으로 응급실 간호 기록지, 주치의 의무 기록지, 퇴원 요약지등으로 자료를 수집하였으며, 수집된 자료는 WIN SPSS 12.0을 이용하여 분석하였으며, 대상자의 일반적 특성, 질병 관련 특성, 응급실 내원 관련 특성을 실수와 백분율로 산출하였다.

본 연구의 결과를 요약하면 다음과 같다.

1. 암 환자의 질병 관련 특성을 보면 진단명은 간암(18.8%), 폐암(14.8%), 위암(13.0%), 대장암(8.6%), 유방암(7.9%) 순으로 나타났다. 병기는 3기가 72.5%로 가장 많았고, 전이 개수는 1개가 42.7%로 가장많았으며, 주호소는 통증(27.0%), 열(11.5%), 호흡곤란(8.7%) 순으로 나타났다. 체온은 고체온(14.4%)이, 맥박은 빈맥(34.5%)이 호흡은 빈호흡(3.6%)이 높게 나타났다. 혈압은 수축기 고혈압(44.9%)과 이완기 저혈압(29.3%)이 높게 나타났다. 출혈(5.8%), 통증(34.5%), 가족력이 있는 경우는 0.3%로 나타났으며, 수술을 한 경우는 40.5%로 나타났다. 투약은 30.5%로 이에 해당하는 1,276명에 대해 복용약물 종류를 조사한 결과 고혈압약(32.8%), 당뇨약(23.3%), 항암제(7.8%)순이었다.

2. 암 환자의 불편감은 통증(46.0%), 열·한기(34.2%), 활동어려움(24.2%), 오심(19.2%), 호흡곤란(17.2%)순으로 나타났다.

3. 암 환자의 응급실 내원 관련 특성을 보면 응급실 치료 후 경로로 퇴원(57.3%), 입원(41.0%), 전원(1.4%), 사망(0.2%)의 경로 순이었다.

4. 응급실 치료후 입원군(n=1,719)에 대한 주호소를 보면 통증(25.3%), 열(15.4%), 호흡곤란(10.8%)순으로 나타났고, 퇴원군(n=2,400)에 대한 주호소는 통증(28.1%), 열(8.7%), 검사시행(7.5%)순이었으며, 전원군(n=60)은 통증(23.3%), 검사시행(16.7%), 호흡곤란(11.7%)순으로, 사망군(n=10)은 DOA(3.0%), 통증(10.0%), 검사시행(10.0%), 호흡곤란(10.0%), 열(10.0%), 의식변화(10.0%), 출혈(10.0%), 무호흡(10.0%) 순으로 나타났다. 재방문 횟수는 1회(72.8%), 2회(18.0%)가 대부분이었으나 18회(0.0%) 내원한 환자도 한 명 있었다.

이상의 연구 결과를 통하여 암이라는 질병의 특성상 환자 자신의 고통뿐만 아니라 보호자나 가족들의 불편감을 해소할 수 있도록 암 환자 관리에 대한 국가보건 정책에 정보 제공의 역할을 할 수 있으며, 응급실내 암환자를 대상으로 한 적절한 간호중재를 수립할 수 있는 기초자료를 제공하는데 의의가 있다. 응급실 내원 환자 16,417명 중 암환자의 비율은 4,189명으로 25.5%에 해당하였으나 현재 응급실내 암환자를 대상으로 한 별도의 간호 중재 방안은 부재한 상태이다. 퇴원시 가정 호스피스연결, 입원시 병원호스피스, 사망시 응급실에서의 임종간호, 응급실과 호스피스와의 network이 급선무이다.; Research on the actual conditions of Cancer Patients in the Emergency Room in a University Hospital in Seoul

Jung, Mi Soon Directed by Professor Kim, Boon Han, R.N., Ph.D. Department of Clinical Hospice Care & Special Nursing The Graduate School of Information in Clinical Nursing Hanyang University

The purpose of this retrospective descriptive study was to survey the terminal cancer patients transported to the emergency room of a University hospital and thereby, provide for some basic data useful to nursing intervention in them. For this purpose, the researcher sampled 4,189 cancer patients out of 16,467 patients who had visited emergency room of a University hospital from October 1, 2008 through March 31, 2009. In order to collect and analyze the data, the researcher used a self-developed data collection scale and 'Discomfort Scale' developed by Rhodes and Watson (1987) and modified and complemented by Kwon Mi-hyeong (2003) to examine emergency room nursing records, physicians' diagnosing records and discharge documents for the sample. The data collected was processed using the SPSS WIN 12.0 program for real numbers and percentages about subjects' demographic variables, their disease characteristics and their characteristics with regard to uses of the emergency room.

The results of this study can be summarized as follows; 1. Subject's disease diagnosed most was liver cancer (18.8%), followed by 'lung cancer' (14.8%), 'stomach cancer' (13.0%), 'large intestine cancer' (8.6%) and 'breast cancer' (7.9%) in their order. 72.5% of them had progressed to the tertiary stage of cancer, while 42.7% were inflicted by cancer at a single organ. The more frequent appeal involved 'pain' (27.0%), followed by 'fever' (11.5%) and 'difficult breathing' (8.7%) in their order. 14.4% of them were suffering high body temperature, 34.5% of them were suffering tachycardia, and 3.6% of them were suffering tachypnea. 44.9% were suffering high blood pressure for the period of contraction, while 29.3% were suffering low blood pressure for the period of relaxation. 5.8% had ever suffered hemorrhage, 34.5% had suffered pain, and 0.3% had a family member who had suffered the cancer. 40.5% had undergone a surgery. 30.5% (n=1,276) had been medicated. As a result of surveying this group for the types of medicines, it was found that high blood pressure medicine was used most (32.8%), followed by diabetes medicine (23.3%) and anti-cancer medicine (7.8%) in their order.

2. Subjects' most inconvenience involved 'pain' (46.0%), followed by 'fever or chill' (34.2%), 'difficult activities' (24.2%), 'nausea' (19.2%) and 'difficult breathing' (17.2%) in their order.

3. In view of subjects' characteristics with regard to their uses of the emergency care unit, 'discharge' (57.3%) accounted for most of the cases, followed by 'hospitalization' (41.0%), 'refer to other hospitals' (1.4%) and 'death' (0.2%) in their order.

4. The most frequent appeal after treatment at emergency care unit was 'pain' (25.3%), followed by 'fever' (15.4%) and 'difficult breathing' (10.8%) in their order. On the other hand, the most frequent appeal of the group discharged (n=2,400) was 'pain' (28.1%), followed by 'fever' (8.7%) and 'medical examination' (7.5%) in their order. The most frequent appeal of the group referred to other hospitals (n=60) was 'pain' (23.3%), 'medical examination' (16.7%) and 'difficult breathing' (11.7%). The most frequent appeal of the group dead (n=10) was 'DOA' (13.0%), followed by 'pain' (10.0%), 'medical examination' (10.0%), 'difficult breathing' (10.0%), 'fever' (10.0%), 'weakened awareness' (10.0%), 'hemorrhage' (10.0%) and 'non-breathing' (10.0%) in their order. Most (72.8%) of the patients visited the hospital again, while (18.0%) visited the hospital three times. A patient visited the hospital 18 times (0.0%).

The above findings from this study will be used as the information for the national health policies about management of cancer patients to relieve not only the cancer patients of their pain but also their family members of their discomfort. This study may be significant in that it provided for some basic data useful to some proper nursing interventions in the cancer patients transported to the emergency room.

The patients transported to the emergency room for the period of the survey numbered 16,417, and the cancer patients accounted for 25.5% (n=4,189) of them, but special nursing intervention methods for such cancer patients have still to be developed. When they are discharged from the emergency room, it is deemed urgent to link them with the home hospice services, and when they are hospitalized, it is urgent to provide them with a death-bed nursing. And it is also urgent to network the emergency care units with the hospice services.