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서론
1. 연구의 필요성
현대사회는 과학의 발달과 첨단적 의료기술의 발전으로 급성전염성 질환의 발생률은 감소
하는 반면에 만성퇴행성 질환의 발생률은 증가하고 있는 실정이다(유명란, 1993).
만성신부전은 대표적인 만성퇴행성 질환으로 1989년 이후 매년 15∼20%의 증가율을 보이
고 있는데, 신장의 기능이 점차적으로 상실되어 불가역적인 상태가 되면 보존요법으로는 더
이상의 치료가 불가능하고 투석요법이나 신장이식을 받아야만 생명을 연장할 수 있다(김순
배, 1994 ;Stanfield, 1985).
만성신부전 대상자에게 실시되는 혈액투석은 효과적이고 안전한 신장기능 대치방안으로
인정받고 있으나, 투석대상자들은 혈액투석은 치유법이 아니고 대체요법이며, 기계에 의존한
삶을 살아야 한다는 사실과 더불어 투석시설의 부족으로 인한 불편감, 혈압변화와 혈관변형
등과 같은 부작용 및 엄격한 식이제한으로 본능적인 욕구가 좌절되는 상황속에서 심한 심리
적, 정서적 스트레스를 경험한다(서인순, 1990, 최연희, 1995 ;한대석, 1988 ; 한상식, 김종익,
1987 ; Burton, Kline, Lindsay & Heidenheim, 1986 , Levy, 1987 ; Roberts, 1986).
#초록#
The grafting of a kidney has been found to be the best medical treatment for patients
who have renal insufficiency failure, but the patients still have experienced much trouble
and apprehension. This study was done to further nursing theory developing for patients
who have has a kidney graft from another person. The research method followed
grounded theory methodology of Strauss and Corbin. The subjects were three female
and four male patients. This study done between Oct. 1997 and Mar. 1998. All of the
subjects were interviewed by the author. Interview were done by the long interview
technique and observation.
In the process of data analysis, 'heart-boiling' was found to be the core phenomenon.
The results were composed to 101 concepts. These concepts were grouped into nineteen
categories, and then to twelve categories.
There were 12 super-class categories as follows ;
'pain', 'heart-boiling', 'experience of dialysis', 'term of admission to a hospital',
'support of other person', 'dependence on God', 'direction', 'negative reaction', 'positive
reaction', 'comfortable', 'lacking', 'acceptance'.
In this process, 14 hypotheses were derived from the categories as follows.
(1) The more experience with dialysis that the patients have, the stronger the
heart-boiling will tend to be.
(2) The less experience with dialysis the patients have, the weaker the heart-boiling
will tend to be.
(3) The longer admission to hospital the patients have, the stronger the heart-boiling
will be.
(4) The shorter the admission to hospital the patients have, the weaker the heart
-boiling will be.
(5) The weaker the intense-grief is, the more positive the reaction to heart-boiling the
patients wall have.
(6) The stronger the intense-grief is, the more negative the reaction to heart-boiling
the patients will have.
(7) The stronger the support of other persons that the patients have, the more
positive the reaction to heart-boiling the patients will have.
(8) The weaker the support of other person that the patients have, the more negative
the reaction to heart-boiling the patients will have.
(9) The stronger the dependence on God that the patients have, the mare positive
reaction to heart-boiling the patients will have.
(10) The weaker the dependence on God that the patients have, the more negative
reaction to heart-boiling the patients will have.
(11) The more positive thoughts that the patients have, the more positive reaction to
heart-boiling the patients will have.
(12) The more negative thoughts that the patients have, the more negative reaction to
heart-boiling the patients will have.
(13) The more positive reaction the patients have, the more free from heart-boiling
the patients tend to be.
(14) The more negative reaction the patients have, the less free from heart-boiling the
patients tend to be.
From the analysis of observed data and comparing each class, 1 concluded that there
are four formula relation types between reaction of patients and heart-boiling.
(1) If patients have the experience of dialysis, have a long term admission to hospital,
are strong in heart-boiling, depend on God, have positive thoughts and another's strong
support, they experience release by positive reaction to the intense-grief.
(2) If patients have the experience of dialysis, have a short term admission to
hospital, are weak in heart-boiling, do not depend on God, have negative thoughts, and
have few supports from others, they experience attachment to heart-boiling thought a
negative reaction.
(3) If patients have the experience of dialysis, have a long term admission to hospital,
are strong in heart-boiling, do not depend on God, and have negative thoughts, they
experience attachment to heart-boiling through negative reaction in spite of support from
another.
(4) If patients have the experience of dialysis, have a long term admission into
hospital, are strong in heart -boiling and sat isfaction is low, but they have positive
thoughts, then they experience acceptance and harmony through the positive reaction to
heart-boiling.
The results of this study are expected to help the way nurses care for patients who
have had a kidney graft from another.
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