만성폐쇄성 폐질환자를 위한 호흡재활 임파워먼트 프로그램 개발 및 효과
The Development and Effects of Pulmonary Rehabilitation Empowerment Program (PREP) for Chronic obstructive pulmonary disease (COPD)
- 주제(키워드) Chronic obstructive pulmonary disease (COPD) , Pulmonary Rehabilitation Empowerment Program (PREP) , respiratory self care activity , peak expiratory flowrate , dyspnea , exercise capacity , activity daily living status
- 발행기관 고려대학교 대학원
- 지도교수 유호신
- 발행년도 2013
- 학위수여년월 2013. 2
- 학위구분 박사
- 학과 일반대학원 간호학과
- 세부전공 간호과학
- 원문페이지 171 p
- 실제URI http://www.dcollection.net/handler/korea/000000039262
- 본문언어 한국어
- 제출원본 000045743278
초록/요약
Chronic obstructive pulmonary disease (COPD) shows a high morbidity and mortality rate worldwide, which imposes a major burden in our society and the medical use to cure this disease is increasing. As this disease progresses despite of any medical treatments, the goal of COPD therapy and nursing is to improve physiological function and to optimize functional capacity by maintaining the prevention of complications, progression of disease and to minimize and to control symptoms. It can be accomplished by maintaining pulmonary rehabilitation which includes medication, quitting smoking, oxygen therapy, immunizations, exercise, etc. Therefore, this research is focused on development based empowerment concept, which is a process of power gaining and strategy for behavioral change of pulmonary rehabilitation for COPD. The first phase is to prepare the conceptual framework of research literature, and to identify the major component of empowerment such as control, self esteem, self efficacy and support in a group. The second phase is to develop a final program based on the above conceptual framework through the process of designing preliminary program, evaluating validity of contents, revising and correcting. The last phase is to evaluate the effects of the finalized Pulmonary Rehabilitation Empowerment Program (PREP). This research is designed using randomized controlled trial with repeated measures to verify the effect of program. Pulmonary Rehabilitation Empowerment Program which is applied in this research has strategically used problem recognition and solving, decision making, positive reinforcement and support, interaction by group activities, etc. Pulmonary Rehabilitation Empowerment Program (PREP) is a nursing intervention program, in which comprehensive nursing service composed of the above major component was provided to COPD patients to improve their empowerment by direct education in admission period: 5 times per week, after discharge education: 2 times per 7 weeks, telephone counseling: 10 times, message : 15 times in 8 weeks, using nurses themselves, educational pamphlets and YouTube. Data collection was done from January 2012 to July 2012, subject selection was done among COPD patients admission of 1 general hospital in Seoul, 25 subjects as the experimental group (EC) and 25 subjects as the control group (CG). To evaluate the effects of the program, 5 categories: empowerment, respiratory self care activity, respiratory functions (peak expiratory flowrate and dyspnea), exercise capacity (6mins walking distance) and activity daily living status were measured in this research. Finally, data analysis is done by SPSS PC statistic program, general characteristics are done by technical statistics, homogeneity of general characteristics was done by χ²-test and Fisher’s exact test, before-homogeneity of general variables was done by t-test and Mann-Whitney U test, hypothesis evaluation was done by Repeated Measures ANOVA and Mann-Whitney U test. The results of research are as follows: Hypothesis 1: The COPD patients who have received Pulmonary Rehabilitation Empowerment Program (PREP) are far better than those who haven’t in terms of empowerment levels. Statistic has shown that there is a great difference between the EG and CG (F=40.73, p=< .001). Hypothesis 2: The COPD patients who have received Pulmonary Rehabilitation Empowerment Program (PREP) are far better than those who haven’t in terms of respiratory self care activity levels. Statistic has shown that there is a great difference between the EG and CG (F=38.18, p=< .001). Hypothesis 3: The COPD patients who have participated in Pulmonary Rehabilitation Empowerment Program (PREP) are far better than those who haven’t in terms of respiratory function such as peak expiratory flow rate and dyspnea. Sub Hypothesis 3-1: The COPD patients who have participated in Pulmonary Rehabilitation Empowerment Program (PREP) are far better than those who haven’t in terms of peak expiratory flowrate. Statistic has shown that there is a great difference between the EG and CG (F=19.46, p=< .001). Sub Hypothesis 3-2: The COPD patients who have participated in Pulmonary Rehabilitation Empowerment Program (PREP) are far lesser than those who haven’t in terms of dysnea. Statistic has shown that there is a great difference between the EG and CG (F=21.04, p=< .001). Hypothesis 4: The COPD patients who have participated in Pulmonary Rehabilitation Empowerment Program (PREP) are far better than those who haven’t in terms of exercise capacity levels(6mins walking distance). Statistic has shown that there is a great difference between the EG and CG (F=37.64, p=< .001). Hypothesis 5: The COPD patients who participated in Pulmonary Rehabilitation Empowerment Program (PREP) are far better than those who haven’t in terms of activity daily living status levels(6mins walking distance). Statistic has shown that there is a great difference between the EG and CG (F=50.18, p=< .001). In conclusion, Pulmonary Rehabilitation Empowerment Program (PREP) has been proven to be an effective nursing intervention program to improve empowerment, respiratory self care activity, respiratory function, exercise capacity and activity in daily living status. Therefore, if this program is utilized, it could improve empowerment and maintain pulmonary rehabilitation, and also prevent complications and progression of disease, minimize and to control symptoms, improve physiological function and optimize functional capacity of COPD patients.
more목차
논문 개요 i
Ⅰ. 서 론 1
1. 연구의 필요성 1
2. 연구의 목적 5
3. 연구의 가설 5
4. 용어 정의 6
Ⅱ. 문헌고찰 10
1. 만성폐쇄성폐질환과 호흡재활 10
2. 임파워먼트 프로그램 20
Ⅲ. 개념적 기틀 28
Ⅳ. 연구방법 31
1. 연구 설계 31
2. 연구 대상자 및 표집방법 32
3. 연구 도구 33
4. 호흡재활 임파워먼트 프로그램(PREP) 38
1) 프로그램 개발 절차 38
2) 프로그램 구성 및 내용 40
3) 프로그램 적용 46
4) 대조군에게 적용한 호흡재활 간호 54
5. 연구진행 및 자료수집 절차 59
6. 윤리적 고려 61
7. 자료분석방법 62
V. 연구결과 63
1. 대상자의 일반적 특성 63
2. 종속변수에 대한 실험군과 대조군의 사전 동질성 검정 68
3. 가설 검정 69
VI. 논의 79
1. 호흡재활 임파워먼트 프로그램(PREP) 79
2. 가설 검정 84
3. 간호학적 의의 94
VII. 결론 및 제언 96
1. 결론 96
2. 제언 102
부록 123
Abstract 147
