Social networks, spiritual well-being, and the quality of life in hemodialysis patients

간호학과/석사[한글] 본 연구는 혈액투석 환자의 영적, 사회연결망, 삶의 질 정도와 관련 요인을 확인하고자 시도된 서술적 상관관계 연구이다.본 연구 대상자는 혈액투석을 제공받고 있는 18세 이상의 성인으로 서울 및 경기소재의 종합병원 3곳과, 서울, 성남, 대전 소재의 내과 4곳에서 연구 참여에 동의한 130명을 조사하였다. 자료 수집은 2007년 4월 1일부터 6월 22일까지이며, 자료수집방법은 일대일 면담을 통한 질문지법을 통해 이루어졌고, 소요시간은 약 20분 정도였다. 연구도구는 Highfield(1992)에 의해 개발된 영적안녕 측정도구, Berkman(1979)의 Social Network Index를 수정 보완하여 만들어진 사회연결망 측정도구, Medical Outcome Survey SF-12(Ware et al, 1996)를 사용하였다. 연구의 주요 결과는 다음과 같다.1. 혈액투석 환자의 사회 연결망에서는 절친한 친구가 없는 경우가 24.6%이고, 한 달에 한번 이상 만나는 친구가 없는 경우도 35.4%로 높게 나타났다. 혈액투석 환자의 영적 안녕정도는 평균 111.7점으로 비교적 높게 나타났으며, 영적안녕의 하부 영역 중 자기수용(mean=3.72)과 희망(mean=3.42)점수가 비교적 높게 나타났다. 혈액투석 환자의 삶의 질 정도는 50점 평균의 T-score로 환산하였을 때, 신체적 삶의 질 점수가 35.65점, 정신적 삶의 질 점수가 44.37점으로 낮게 측정되었으며, 신체적 삶의 질이 정신적 삶의 질에 비해 낮았다.2. 혈액투석 환자의 특성에 따른 사회연결망은 가구 월수입이 높을수록, 배우자가 있는 경우, 혈액투석 진단시기가 1년 미만 일 때 연결망의 크기와 접촉빈도가 높았으며, 종교가 있는 경우(t=3.11, p=.002)와 교육수준이 높을수록(F=3.39, p=.04) 사회적 유대감이 높게 나타났다. 영적 안녕의 차이에 있어서는 교육수준이 높을수록(F=2.87, p=.06)영적안녕이 높았다. 여성보다 남성(t=2.54, p=.01)인 경우, 나이가 적을수록(F=4.83, p=.003), 종교가 없을 때, (t=2.17, p=.03), 직업을 가지고 있는 경우에(t=-2.99, p=.003) 신체적 삶의 질이 좋았으며, 반면, 나이가 많아질수록(t=3.43, p=.02), 배우자가 있을 때(t=-2.73, p=.01), 만성신부전 진단시기가 1년 미만일 때(t=3.07, p=.03)정신적 삶의 질이 좋았다.3. 혈액투석 환자의 사회 연결망에 따른 삶의 질을 살펴보면, 절친한 친구가 있을 때에(t=-1.87, p=.06)정신적 삶의 질이 높았으며, 가까운 친구 수가 3-5명인 집단이 다른 집단에 비해 월등히 정신적 삶의 질이 높았다(F=3.75, p=.01).4. 사회연결망은 영적 안녕(r=.34, p<.0001)과 정신적 삶의 질(r=.20, p=.02)과 통계적으로 유의한 양의 상관관계를 나타냈다. 영적안녕은 신체적 삶의 질(r=.20, p=.02)과 정신적 삶의 질(r=.48, p<.0001)모두와 양의 상관관계를 나타냈다.5. 신체적 삶의 질에 영향을 미치는 요소로써는 불확실성, 직업, 종교, 희망, 성별을 통해 총 23.9%의 설명력을 보였다. 즉, 혈액투석환자에서는 불확실성과 희망에 대한 영적 안녕정도가 높을수록 신체적 삶의 질에 대한 긍정적인 지각을 가지고 있었으며, 직업이 있는 경우에 삶의 질이 높아졌다. 그러나 종교가 있는 경우에 신체적 삶의 질이 오히려 낮아졌으며, 남성에 비해 여성들의 신체적 삶의 질이 낮게 나타난 것을 확인할 수 있다. 정신적 삶의 질에 영향을 미치는 요소로써는 자기수용과 배우자, 절친한 친구가 전체 모델의 34.6%를 설명하였다. 즉, 혈액투석환자에게서는 자기수용의 영적 안녕이 높을수록 정신적 삶의 질에 긍정적인 영향을 미쳤으며, 배우자와 절친한 친구가 있을 때에 정신적 삶의 질이 높게 나타났다.결론적으로, 혈액투석환자의 신체적 삶의 질을 향상시키기 위해서, 영적안녕 중 희망과 불확실성 정도를 사정한 후 간호중재를 제공해야 할 것이며, 정신적 삶의 질을 향상시키기 위해서는 배우자, 절친한 친구, 가까운 친구수를 통해 사회연결망을 확충하고, 영적안녕 중 희망, 자기수용, 대인관계, 절대자와의 관계 정도를 사정하여 이를 증진시킬 수 있는 간호중재방안을 개발하여야 할 것이다. [영문] The purpose of this study was to examine the levels and each influencing factor of spiritual well-being, social networks, and quality of life in patients treated on hemodialysis and to identify the relationship of these three concepts.130 patients who were 18 years old or older and receiving hemodialysis at one of three general hospitals in Seoul and Gyeonggi Province and of four internal medicine clinics in Seoul, Seongnam, and Daejeon participated in this study. Data were collected from April 1 to June 22, 2007 through one-on-one interview survey. The research tools included the Spiritual Health Inventory developed by Highfield(1992), the Social Network Inventory which revised and supplemented the Social Networks Index by Berkman(1979), and the Medical Outcome Survey SF-12(Ware et al., 1996). The major findings were as follows:1. As for the social networks of hemodialysis patients, 24.6% of the subjects have no confidants and 35.4% do not meet their close friends even once a month. Their mean scores of spiritual well-being were 111.7, which was relatively good. Among its subareas, they scored high on self-acceptance (mean=3.72) and on hope (mean=3.42). When their scores of quality of life were converted to T-score of mean 50 points, the subjects'' physical and mental component summary were 36.65 and 44.37 points, respectively, which were rather low. Their physical quality of life was lower than their mental quality of life.2. The subjects'' social networks were reviewed according to their characteristics. The results show that they were in touch with their social networks more frequently when their monthly household income was high, they had a spouse, and it was one year or less since they were diagnosed with hemodialysis. Their social connections were also high when they had a religion (t=3.11, p=.002) and a higher level of education (F=3.39, p=.04). The higher their educational background, the greater their spiritual weep-being (F=2.87, p=.06). Their physical quality of life was high when they were male (t=2.54, p=.01), younger (F=4.83, p=.003), had no religion (t=2.17, p=.03), and had a job (t=-2.99, p=.003). And their mental quality of life was high when they were older (t=3.43, p=.02), had a spouse (t=-2.73, p=.01), and it was one year or less since they were diagnosed with chronic renal failure (t=3.07, p=.03).3. The subjects'' quality of life was examined according to their social networks. The results show that their mental quality of life was high when they had confidants (t=-1.87, p=.06). Especially the group who had three to five close friends had considerably higher mental quality of life (F=3.75, p=.01) than other groups.4. There were statistically significant positive correlations between their social networks and spiritual well-being (r=.34, p<.0001) and between their social networks and mental quality of life (r=.20, p=.02). Their spiritual well-being was positively correlated with both the physical (r=.20, p=.02) and mental (r=.48, p<.0001) quality of life.5. The factors affecting the subjects'' physical quality of life include uncertainty, job, religion, hope, and gender, which accounted for 23.9% of the total explanatory power. The hemodialysis patients had a positive perception of physical quality of life when their spiritual well-being was high in respect to uncertainty and hope. Their physical quality of life also went up when they had a job, but it decreased when they had a religion. It is also confirmed that the female patients had a lower physical quality of life than their male counterparts. The factors affecting the patients'' mental quality of life were self-acceptance, spouse, and confidants, which explained about 34.6% of the entire model. In other words, their higher spiritual well-being in the aspect of self-acceptance had positive impacts on their mental quality of life. And their spouses and confidants contributed to their higher mental quality of life.In conclusion, to improve the physical quality of life in hemodialysis patients, it is important to assess the degree of hope and uncertainty among the spiritual well-being elements before providing nursing interventions. As for better mental quality of life, efforts should be made to expand the patients'' social networks in terms of spouse, confidants, the number of close friends and the frequency of socal contact with them, and sense of being socially connected. And the patients'' hope, self-acceptance, personal relationships, and relations with the absolute being should be evaluated so that the results can be used to develop nursing interventions to improve the patients'' mental quality of life.ope