간호의 관심 :

환경(Environment)

• 2011.3.9

간호사는 왜 환경을 이해해야 하는가 ?

•Healthy environment lead to healthy people

•건강한 환경은 사람을 건강하게 한다 .

간호 : 환경 지킴이

Dictionary definition환경의 사전적 정의

•사람에게 두루 영향을 끼치는 자연이나 사회의 조건이나 형편 , 상태따위

•생활하고 있는 곳의 주변상태

Definitions 정의 (1)

• 아프거나 건강한 사람의 건강에 영향을 미치는 사람의 외부감염의

주된 원인이 되는 환경은 신선한 공기 , 맑은 물 , 적합한 배수 ,

청결 , 빛과 같은 것이다 (Nightingale, 1859).

• 삶과 발달에 영향을 미치는 모든 외적 조건과 영향 (Henderson,

1966)

Definitions 정의 (2)

• 사람이나 가족의 발달과 행위에 영향을 주는 모든 조건 , 상황 , 주위의 요소 (Roy, 1984)

• 환자가 자기 간호요구를 충족시키지 못하게 하는 어떤 주변 상황 (Orem, 1985)

사람과 환경의 상호교환적 관계 `

물리환경 사람 경제환경

사회 , 문화환경

정치환경

영향 영향

영향 영향

환경의 예

사회환경

물리환경

경제환경

정치환경

사회적 지지

역할

교육

가족

집단 ,

지역사회

결혼

규범

생활양상

물

식물

기후

공해

빛

소음

주택

산업장

사업체

교통

서비스유용성

서비스경비

기술

경제성장

법

정치세력

건강정책

정부구조

흥미집단

경제정책

사회환경의

하나로서

사람에게

중요한

기능을

하는 것이

사회적지지

(Social

support) 다 .

환경의 예

Social Variables

Physical Variables

Economic Variables

Political Variables

Roles Water Business Laws

Education Plants Industry Political power

Family Weather Transportation Health policy

Marriage Pollution Availability of services

Governmental structure

Norms Light Payment of services

Interest groups

Life-style Noise Technology Economic policy

Religion Shelter Economic growth

Litigation

Immediate physical environ-ment

•Safety factors•Mechanical injury•Thermal injury•Electrical injury•Radiation•Chemical hazards• Infection control

▫Temperature and humidity▫noise and odors▫Layout and decor

Physical environment of the community지역사회의 물리적 환경

Climate Geography Air Quality Water Quality Soil Quality Food Purity

Nursing Implications: Caring for the Environment

• Community health nurses are actively in-volved in identifying or intervening with en-vironmentally caused health problems.

• Epidemiology is the study of the incidence, distribution, and control of disease in a hu-man population.

• Nurses in the community may be involved in case-finding or health-screening programs that produce data for Epidemiologic studies.

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Nursing Implications: Caring for the Environment

• For example, nurses may identify a large number of cases of giardiasis. They then report their findings to the local water treatment authorities, who test the com-munity’s water supply and confirm the presence of the parasite. The nurses im-plement a program of preventive education in the area to curb further incidence of the disease.

• an intestinal infection caused by ingesting a flagellate protozoan, usually from water that contains the faeces of infected animals. The symptoms are prolonged diarrhoea and abdomi-nal pain.

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The Social Environment

• Structure of Social System: 사회체제의 구조 : structural com-ponents, among which are boundaries, norms, roles, and positions. 구조 , 규범 , 역할 , 지위 Нийгмийн тогтолцооны бүтэц: бүтцийн бүрэлдэхүүн хэсгүүд болон тэдгээрийн хил хязгаар, хэм хэмжээ, үүрэг болон байршил

Norms are expected behaviors. Хэм хэмжээ нь зан аашаар илэрхийлэгдэнэ.

Roles are sets of expected behaviors that are normatively defined Үүрэг нь хэм хэмжээгээр тодорхойлогдсон зан байдлаар илэрхийлэгдэнэ.

Positions are syntheses of related roles and represent the locations of persons in a social system. Байршил нь үүрэгтэй хамааралтай синтез бөгөөд хүний нийгмийн тогтоцоонд хаана байгаа байрлалыг заадаг.

• Process of Social System. 사 회 체 제 의 과 정 нийгмийн тогтолцооны процес

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The Social Environment•Types of Social Systems 사회체제의 형

태 : нийгмийн тогтолцооны төрөл Families гэр бүл Groups групп Communities хамт

олон These systems will be detailed in the

sessions of nursing clients. Эдгээр системүүд нь сувилахуйн хэрэглэгчид гэсэн хичээл дээр илүү нарийн авч үзнэ.

Social support Нийгмийн хангамжAn important function of the systems that compose the so-

cial environment is social support. Classic definitions of social support include: хүрээлэн буй нийгмийг бүрдүүлдэг нэг чухал үүрэг нь нийгмийн хангамж юм. Нийгмийн хангамжийн хамгийн сайн тодорхойлолтонд:дараах хамаарна

Information leading a person to believe he or she is cared for and loved, esteemed and valued, and belongs to a network of communication and mutual obligation (Cobb, 1976, p. 300) хүнд итгэдэг, өөрт нь хайртай, түүнийг халамжилдаг, үнэлдэг , нийгмийн ямар нэгэн сүлжээнд хамааралтай болон харилцан үүрэг хүлээсэн зэрэг мэдээлэлSupport accessible to an individual through social ties to other individuals, groups, and the larger community (Lin, Ensel, Simeone, and Kuo, 1979, p. 109) нийгмийн сүлжээ холбоогоороо дамжуулан хувь хүнийг бусад хүмүүстэй, бүлэгтэй болон нийгмийн арай том хэсэгтэй холбож дэмжиж өгөх

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Social support Нийгмийн хангамж

A flow of emotional concern, instrumental aid, in-formation, or appraisal between people (House, 1981, p. 26) хүмүүс хоорондын сэтгэл хөөрөл, эд материалын тусламж, мэдээлэл болон үнэлгээний урсгал Interpersonal transactions that include one or more of the following elements: expression of pos-itive affect; affirmation of another person’s behav-iors, perceptions, or view; giving aid to another (Norbeck, Lindsey, & Carrieri, 1981) дараах элементүүдийн нэг болон түүнээс дээш ийг багтаасан хувь хүмүүс хоорондын харилцаа: эерэг үр нөлөөтэй илэрхийлэл, өөр хэн нэгний үзэл суртал, зан аашийг хүлээн зөвшөөрсөн , өөр хэн нэгэнд тусалах тусламж

Functions and Sources of Social Sup-port Нийгмийн хангамжийн үйл ажиллагаа болон эх үүсвэр Pender (1996) identified four ways that social support may

positively affect health. Пэндэр эрүүл мэндэд эергээр нөлөөлж болох нийгмийн хангамжийн дөрвөн аргыг тодорхойлжээ. Social networks may Нийгмийн сүлжээ нь :

Create an environment that enhances self-esteem and well-being. Өөрийгөө үнэлэн болон эрүүл байдлыг хангах хүрээлэн буй орчинг бий болгох Decrease the likelihood of stressful life events. Стресс төрүүлсэн үйл явдалыг багасгах Provide feedback regarding the consequences of one’s actions for health and well-being. Эрүүл мэнд болон энх тунх байдлын төлөөх хэн нэгний үйлдэлийн үр дагаварыг дэмжих Buffer the negative effects of stressful events. Стресс төрүүлсэн үйл явдалын сөрөг үр дагаварыг багасгах

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Nursing Implications

Who provides support: Хэн дэмжлэг хийдэг вэ Does the client have a confidant? Үйлчлүүлэгч бат итгэлтэй байна уу? Are the spouse, family, and friends sup-portive? Хосууд, гэр бүл болон найзууд Does the client participate in organizations or activities? Үйлчлүүлэгч зохион байгуулалт болон үйл ажиллагаанд оролцдог уу? What helping behaviors are important to the client: fi-nancial assistance, emotional support, information sources, and so forth? Үйлчлүүлэгчид ямар төрлийн тусламж хэрэгтэй вэ? Санхүүгийн, сэтгэл санааны, мэдээллийн болон өөр ямар тусламж дэмлэг хэрэгтэй байна вэ? Is the support system adequate from the client’s per-spective: Is there enough support of the kind desired by the client? Үйлчлүүлэгчийн хүсэж байгаа тусламж дэмжлгийг хангалттай үзүүлж чадах уу?

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The Cultural Environ-ment

문화적 환경

•경험을 해석하는 습득된 지식과 사회적 행위 ” (Spradley, 1979, p. 5)

•인 종 , 국 민 , 가 치 , 언 어 와 의 사 소 통 , 가족체제 , 치유와 치료에 대한 신념 , 종교의 신념과 실행에 따라 영향을 받는다 .

The Cultural Environment Соёлын хүлээлэн буй орчин

•A classic definition of culture is “the acquired knowledge that people use to interpret experience and generate social behavior” (Spradley, 1979, p. 5) соёлын талаарх нэг сайн тодорхойлолт нь “ хүмүүсийн туршлага хуримтлуулахдаа мөн нийгмийн зан төлөвийг ойлгохдоо ашигладаг хүмүүсийн олж авсан мэдлэг” юм.

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The Cultural Environment Соёлын хүлээлэн буй орчин • A nurse anthropologist, Leininger(1991) de-

fined as the learned, shared, and transmit-ted values, beliefs, norms, and lifeways of a particular group that guided their thinking, decisions,m and actions in patterned ways(p.47) сувилагч антрапологч Leininger –ийн тодорхойлсоноор хүмүүсийн өөрсдийнх нь шийдвэр үзэл санааг нь тодорхой замаар дагуулдаг бусдаас суралцсан, дамжуулсан үнэлэмж , итгэл хэм хэмжээ, амьдралынх нь хэв маягыг хэлнэ гэсэн байна.

Cultural variables

• Cultural variables refer to those characteristics that a person exhibits or identifies with from a particular cultural group. These variables may or may not be exhibited by every person from a cultural group. Any individual, depending on personal experience, may have all, none, or any combination of these variables.

• Ethnic and racial identity• Value orientations• Language and communication• Family system

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사회구조와 세계관

기술

종교

혈연

문화정치

경제

교육인간의 건강과

간호에 주는 영향

건강체제에서 개인 , 가족 , 문화집단

Leininger 의 해돋이 모델

나이팅게일의 개념틀

정신적 환경 사회적 환경

환자의 상태와 본성

물리적 환경

청결 환기 공기 햇빛 소음 물침구 배수 보온 식이

의사소통충고변화

사망률질병의 예방

Readings

Cobb, s.(1976). Social support as a moderator of life stress. psychosomatic medicine, 38, 300-314.

Hous, J.S.(1981). work stress and social support. Read-ing. MA.: Addison-WesLey.

Kleffel. D.(1991). Rethinking the environment as a domain of nursing knowledge advances in nursing science, 14(1), 40-51.

Lin, N., Ensel, W.M., Simeone, R.S., & Kuo, W.(1979). Social support, stressful life en\vents and illness: A model and an empirical test. Journal of health and social behavior, 20, 109-119

Norbeck, J.S., Lindsey, A.M., & Garrieri, V.L.(1981). The development of an instrument to measure social support. Nursing Research, 30, 264-269.

Pender, N.J.(1996). health promotion in nursing prac-tice(3rd ed.). Stamford, CT: Appleton & Lange,

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Learning activities1. Review a newspaper or news maga-

zine for one week. What environmen-tal issues are receiving media atten-tion? As a nurse what actions could you take to affect these problems?

2. How social support can be applied to your client? Give a specific situation exampler.

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Infection Control(1)

• Infections are a serious sources of concern for hospitalized persons. Nosocomial infec-tion (those acquired in the hospital) can add time expense to a person’s hospital stay. For infections to develop, the follow-ing components must exist: hospital stay. For infections to develop, the following components must exist:

A significant number of microorganisms entering the hostA virulent microorganism (one that is effi-cient at causing disease)A susceptible host

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Infection control(2) • Hospitals, by nature, house many patho-

genic (infection-causing) microorganisms. Pathogens, microorganisms that are capa-ble of causing disease, prefer warm, moist, dark environment. Hospitalized persons have increased susceptibility to infection because of weakened natural defenses, such as breaks in the skin, and decreased or altered immune systems. Prevention of infection requires knowledge of principles of asepsis. Asepsis means freedom from in-fectious agents. One of the most important techniques in asepsis is hand washing. This is one of the first skills that nursing stu-dents learn and the technique that is most often neglected in practice.

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Nursing Implications

• Graham (1990) studied hand washing in an intensive care unit (ICU) and found that recommendation for frequency and duration of washing were not being met.

• Nursing care in relation to the immediate physical environment has four major goals:

1. To promote safety2. To control communicable disease3. To provide comfort and appropriate sen-

sory stimuli4. To maximize the person – environmental

fit

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Potential Injuries in the Hospital andPreventive Actions(1)

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Potential Injury Prevention

Falls Wipe up spilled liquids promptlyRemove objects in client’s pathwaysUse side rails and place call lights within reachNever leave infants unattendedKeep beds in lowest positionAvoid dangling electrical cords and drainage tubingUse brakes on beds and wheelchairsAccompany clients who are susceptible to dizziness, confusion, or weakness when they are ambulatingUse safe transferring techniques when moving clients

Electrical Shock Check line cords and plugs for defectsRemove cords from sockets by grasping the plugBe sure that clients who are attached to electrical devices are properly groundedCheck electrical equipment for proper functioning

Potential Injuries in the Hospital andPreventive Actions(2)

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Poisoning or Medica-tion-Re-lated In-juries

Remove harmful substances from clients’ bedsides when not in use (e.g., disinfec-tants, antiseptics, liquid soaps)Never put hazardous substances in drink-ing or medication cupsNever leave medications at bedsideCarefully check labels on medications and verify correct dosage before administering Identify clients correctly before administer-ing medicationsWatch for side effects; check for drug al-lergiesChart medications promptly after adminis-teringKeep medication supplies out of reach (e-specially in pediatric units)

Potential Injuries in the Hospital and Preventive Actions(3)

Burns

Radia-tion

Check temperature of bath water or hot com-presses before client useUse heating pads and heat lamps cautiously (pay attention to length of time used, dis-tance from heat source, and temperature of device)Caution clients from smoking in bed (particu-larly confused or drowsy clients)Avoid smoking near oxygen sourcesKnow agency policy regarding fire proceduresAvoid overloading electrical sockets

Watch for signs of radiation injury in clients receiving radiation therapyUse proper shielding; limit exposure time near clients who have radioactive implantsKnow hospital policy regarding radiation therapy

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Potential Childhood Injuries and Pre-ventive Actions(3)

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Potential Injury Prevention

Burns Teach child the meaning of “hot”Lock up matchesKeep hot liquids, electrical cords from hot appliances out of reachTurn pot handles away from reach when cookingPlace guards around heat sources (e.g., fireplaces, barbecue grills, por-table heaters)

Falls Block stairways safelyNever leave children unattended on high surfacesKeep crib rails up

Drowning, Suffo-cation

Never leave child unattended in bathroom (can drown in bathtub or toi-let)Never leave child unattended in swimming or warding poolsToys should be too large to swallow; small parts should be securely fas-tenedKeep buttons, coins, small candies, and so forth off floor and out of reachKeep plastic bags out of reach

Potential Childhood Injuries and Pre-ventive Actions(4)

Poisoning Keep medications, household cleaners, other hazardous substances out of reach

Vehicle Acci-dents

Use approved car seats for young childrenUse safety belts for older childrenTeach traffic safety to childrenUse approved helmets when riding motorcycles, snowmobilesTeach bicycle safety

General Safety Precautions Keep emergency numbers for fire, police, medical care, and poison control posted in a

conspicuous placeTeach older children what to do in emergency situations

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Infection Control(1)Õàëäâàðûí õÿíàëò

• Infections are a serious sources of concern for hospi-talized persons Õàëäâàðëàëò áîë ýìíýëýãò õýâòñýí õ¿ì¿¿ñèéí àþóëòàé íîöòîé ýõ ¿¿ñâýð þì. Nosocomial in-fection (those acquired in the hospital) can add time expense to a person’s hospital stay Nosocomial õàëäâàð(ýìíýëýãò îëæ àâñàí ) íü õ¿ì¿¿ñèéí ýìíýëýãò ¿ëäýõ õóãàöààã íýìýãä¿¿ëäýã áàéíà . For infections to develop, the following components must exist: hospital stay Õàëäâàðëàëòûí õºãæèëä, ýìíýëýãò ¿ëäýõ ìºðäëºãèéí íýã õýñýã áîëæ ºãºõ ¸ñòîé.

• ring the hostA virulent microorganism (one that is efficient at causing disease)àìü íàñàíä àþóëòàé áè÷èë áèåò( ýíý ãàíö ç¿éë ºâ÷èí ¿¿ñýõ ãîë øàëòãààí áäàéã)A susceptible host ºðòºìòãèé áèåò

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Infection control(2) Õàëäâàðûí õÿíàëò • Hospitals, by nature, house many pathogenic (infection-

causingõàëäâàð-øàëòãààí) microorganisms Ýìíýëýã¿¿ä,áàéãàëààñ , ãýð íü ºâ÷èí ¿¿ñãýõ ìàø îëîí áè÷èë áèåò àãóóëæ áàéäàã . Pathogens, microorganisms that are capable of causing disease, prefer warm, moist, dark envi-ronment ªâ÷èí ¿¿ñãýõ áè÷èë áèåò¿¿ä íü ºâ÷èí ¿¿ñãýõ ÷àäâàðòàé, õàëóóíä ÷èèãëýã, õàðàíõóé îð÷èíä òýñâýðòýé áàéäàã. Hospitalized persons have increased susceptibility to infection because of weakened natural defenses, such as breaks in the skin, and decreased or altered immune systems Ýìíýëýãò õýâòýæ áóé õ¿ì¿¿ñ õàëäâàðò ºðòºõ ìàãàäëàë íýìýãääýã, ÿã ë àðèñàà ç¿ññýí õ¿í øèã äàðõàëûí ñèñòåì õîðîãäîõ ýñâýë ººð÷ëºëò îðäîã áàéíà.. Prevention of infection requires knowledge of principles of asepsis Õàëäâàðààñ óðüä÷èëàí ñýðãèéëýõýä ýñðýã àðãà õýìæýýíèé çàð÷ìûí ìýäëýã õýðýãòýé. Asepsis means free-dom from infectious agents Ýñðýã àðãà íü õàëâàðûí íÿíãóóäààñ ÷ºëººëºõ ãýñýí óòãàòàé. One of the most im-portant techniques in asepsis is hand washing Òýäãýýð ýñðýã àðãà õýðýãñë¿¿äèéí õàìãèéí ÷óõàë íýã õýðýãñýë íü ãàðàà óãààõ ÿâäàë þì. . This is one of the first skills that nursing students learn and the technique that is most of-ten neglected in practice Ãàðàà óãààõ íü ñóâèëàã÷ îþóòíóóäûí õóâüä õàìãèéí ò¿ð¿¿íä ñóðàõ áà õàéõðàéìæã¿é îðõèëã¿é õàìãèéí èõ äàâòàæ áàéõ ¸ñòîé íýã àðãà þì. .

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Nursing Implications Ñóâèëàã÷èéí ¿¿ðýã• Graham (1990) studied hand washing in an intensive

care unit (ICU) and found that recommendation for frequency and duration of washing were not being met. Ãàðàõàì (1990 ) ýð÷èìòýé ýè÷èëãýý áîëãîí äýýð ãàð óãààõûã ñóäàëñàí áà ãàð óãààõ äàâòàìæ áîëîí ãàð óãààõ õóãàöàà õîîðîíäîî òààðàõã¿é áàéñàí.

• Nursing care in relation to the immediate physical environment has four major goals: ñóâèëàã÷èéí àñàðãàà áîëîí ÿðàëòàé áèå ìàõ áîäèéí îð÷èí 4 ìýðãýæëèéí çîðèëãîîð õîëáîãääîã.

1. To promote safety àþóëã¿é áàéäàë äýìæèõ2. To control communicable disease ºâ÷èíèé óÿëäàà

õîëáîîã õÿíàõ3. To provide comfort and appropriate sensory

stimulition òàâ òóõ áîëîí Мэдэрхүй сэргээх 4. To maximize the person – environmental fit Õ¿íий

òîîны дээд хязгаар – îð÷èíû òààëàìæ

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