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1 한국호스피스ㆍ완화의료학회지 Korean J Hosp Palliat Care Vol. 17, No. 1, 10-17, March 2014 pissn ㆍ eissn Original Article 의료인과간호학생의웰다잉의미에관한주관성연구 김선영ㆍ허성순 * ㆍ김분한 신경대학교간호학과, * 한양대학교간호학과박사과정, 한양대학교간호학부 Study of Subjective View on the Meaning of Well-dying Held by Medical Practitioners and Nursing Students: Based on Q-Methodology Seon Young Kim, M.S.W., R.N., Sung Soun Hur, M.S., R.N.* and Boon Han Kim, Ph.D. Department of Nursing Science, Shingyeong University, Hwaseong, *Doctor s Course at College of Nursing, Hanyang University, College of Nursing, Hanyang University, Seoul, Korea Purpose: This study was conducted to examine understanding of the meaning of well-dying and types of such views held by medical practitioners and nursing students. Methods: The Q-methodology was used to analyze the subjectivity of each item. The P-sample was made up of 22 medical practitioners or nursing students. The P-sample was instructed to rate 33 statements using a 7-point scale to obtain forced normal distribution. They were asked to make extra comments on the statements that were placed on both ends of the distribution curve. The PC-QUANL Program was used for the factor analysis of the collected data. Results: The participants had three types of meaning of well-dying. Total variance explained by these types was 57.97% where type 1 was reality-oriented, type 2 relationship-oriented and type 3 obeying-the-nature. Conclusion: The participants subjective views on well-dying influences their medical practice on patients who are facing death. Therefore, medical practitioners should have profound insights concerning life and death. To that end, a training program is needed to help medical practitioners develop a proper view on well-dying by subjectivity type. Key Words: Death, Terminal Care, Nurse practitioners, Nursing student 서론 1. 연구의필요성좋은죽음이란무엇이며, 우리는좋은죽음을어떻게준비해야할까? 죽음은자연적인현상으로개인적의미는매우다양하기때문에그의미를규정짓기란쉽지않다. 대부분의사람들은매일죽음을생각하며살아가 지는않지만좋은삶을산다면좋은죽음을맞을것이라는희망을갖고있으며 (1) 웰빙이란이름하에잘먹고잘사는것을최고의가치로인식하기도한다. 특히의료인은죽음이라는현상에자주노출되며삶과죽음에대한고민에서벗어나기힘들다. 건강증진을목표로하는의료체계내에서죽음은의료의실패로인식되기도하며지속적으로생을연장하는것이미덕으로여겨지기도한다. 다행히김수환추기경, 법정스님, Received August 8, 2013, Revised January 10, 2014, Accepted January 25, 2014 Correspondence to: Boon Han Kim College of Nursing, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul , Korea Tel: , Fax: , bhkim@hanyang.ac.kr This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright C 2014 by the Korean Society for Hospice and Palliative Care 10

2 김선영외 : 의료인과간호학생의웰다잉의미에관한주관성연구 11 Y대병원김모할머니등의죽음을바라보면서어떻게죽을것인가와관련된웰다잉에관한관심이점차증가하고있다 (2). 현재웰다잉은 잘죽는다, 좋은죽음, 복된죽음, 선종 ( 善終 ), 존엄사 등으로그의미들이혼합되어사용되고있다. 죽음을표현하는용어는서로다를수있으나죽음이란인생에서가장중요한과제이며 (3) 동시에궁극적으로는어떻게살것인가와연결된다 (4). 많은연구들에서좋은죽음의조건으로적절한수명, 무병사, 자손이나배우자보다먼저죽는것, 자손들에게폐를끼치지않는것, 가족과함께임종을맞이하는것, 자손이잘사는것을보고죽는것, 수면사, 무통사등을꼽는다 (5,6). 이처럼좋은죽음의조건이전반적삶의과정에의해결정되는임종순간의모습이나죽음의형태를보여준다면, 웰다잉은자신의죽음을인식하고준비함으로써의미있는삶을살면결과적으로좋은죽음을맞이하는임종준비과정을의미한다고볼수있다 (7). 즉, 임종과정을어떻게준비하고어떤죽음을맞이하느냐에따라죽음의의미가다를것이다. 임종장소가가정에서의료시설로변화됨에따라의료인은더자주임종과정에참여하게되었으며, 죽음에대한이들의태도, 인식, 가치는임종환자와가족에게그대로영향을미치게되었다 (8,9). 따라서의료인의긍정적인죽음관형성을위해서는간호교육과정에서부터이를반영하여교육이이루어져야한다 (8,9). 한편죽음과관련된선행연구들을살펴보면죽음인식 (5,6,10-14), 죽음과관련된태도 (10,11,15), 죽음유형과죽음에대한주관성연구 (2,14,16-18), 그리고임종장소 (13), 웰다잉교육 (9,19,20) 등에대한연구들이진행되었으나웰다잉에대한개념분석이이루어지지않은상황에서죽음에대한다양한개념들을혼용하여연구가진행된것을알수있다. 죽음이란인간이합리적으로이해하기힘든현상이며 (21), 특히, 웰다잉이란개인적경험과문화적배경에의해극히주관적으로경험하게되는현상으로일반적인연구방법으로는접근하기가쉽지않다 (18,22). 따라서의료인의웰다잉에대한의미와가치를확립하여임종을맞이하는대상자들이편안하고품위있는죽음을맞이할수있도록도와주기위해서는적절한방법론적접근이필요하다 (22). 이에본연구는 Q-방법론을적용하여최근이슈가되고있는 웰다잉 개념에대한주관성의구조를밝혀냄으로써의료인과간호학생의인식하는웰다잉에대한 태도를유형화하고, 웰다잉주관성의유형별특성을분석, 기술하여의료인과간호학생의죽음교육의자료로활용하고자한다. 2. 연구목적 연구의구체적인목적은다음과같다. - 웰다잉의미에관한의료인과간호학생의주관성을유형화한다. - 웰다잉의미에관한의료인과간호학생의주관성을유형별특성에따라분석하고기술한다. 1. 연구설계 대상및방법 본연구는의료인과간호학생의웰다잉의미와주관성의유형을파악하기위해 Q방법론을이용하였다. 2. 표집방법 1) P 표본 : 본연구를위한 P표본은 2개의 4년제간호학과학생 11명과경기도에위치한 3차종합병원의간호사 9명, 의사 2명을대상으로하였다. P표본의특성을파악하기위해직업, 성별, 연령, 종교유무, 간접적죽음경험유무와죽음경험의대상을조사하였다. 2) Q 표본 : 간호학과학생 8명, 호스피스전문병원임상간호사 3명을대상으로 2012년 4월 9일부터 4월 13일까지심층면담을통해웰다잉의미에대해중립적인심층면접을시행하였으며웰다잉, 좋은죽음, 죽음등과관련된선행연구를통해총 102개의 Q-모집단을구하였다. 질문내용은 웰다잉의미에대해어떻게생각하십니까?, 잘죽는다 (dying well) 는것은어떤모습이라고생각하십니까? 이었으며, 본연구에대한충분한이해가있고 Q-방법론의전문가인간호학교수 1명과간호학과박사과정대학원생 2명의의견교환및재조정을통하여최종 33개의 Q-표본진술문을선정하게되었다. 3) Q-분류과정및자료분석방법 : Q-표본으로선정된진술문이적힌카드를 P-표본인연구대상자가읽은후 Table 1. Distribution of Q-Sample Card. Variables (Disagree) (Neutral) (Agree) Weight Score No. of Card

3 12 한국호스피스ㆍ완화의료학회지 2014;17(1):10-17 자신의의견과일치하는정도에따라 7점척도상에강제정규분포하도록하였다. Q-표본분류과정은진술문을읽고반대 ( ), 중립 (0), 찬성 (+) 의세부분으로분류후가장동의하지않음, 가장동의함으로다시재분류하도록하여진행하였다 (Table 1). 4) 자료의분석 : 수집된자료는 7점척도상에가장동의하지않음을 1점으로, 가장동의함을 7점으로점수화하여코딩하였으며자료분석은 PC-QUANL 프로그램을이용하여주요인분석을시행하였다. 5) 윤리적고려 : 자료의수집에앞서연구대상자에게연구의목적과방법, 면담내용의녹음, 연구결과의출판등을설명하고참여의사를확인하여서면동의서를받았다. 연구에참여한대상자에게는소정의보상을함과 동시에대상자가원하는시간에연구자가직접대상자를방문하여연구를진행하였다. 연구의시작인터뷰내용의녹음여부를다시한번확인한후진행하였으며, 대상자의신원을확인할수있는이름과소속등은연구자를제외하고타인이알수없도록모든정보를삭제하였다. 결과 1. Q-유형분석 Q-유형분석결과웰다잉에관한의료인의주관성은 3개의유형으로나타났다. 이들유형은전체변량의 57.97% 를설명하는것으로확인되었다 (Table 2). 각유형간의상관 Table 2. Eigen Values, Variance, and Cumulative Percentage. Type 1 Type 2 Type 3 Eigen value Variance % Cumulative Table 3. Correlation between Types. Type 1 Type 2 Type 3 Type Type Type Type 1 (n=5) reality-oriented Table 4. Types, Factor Weights, Demographic Characteristics for P-Sample (N=22). Types Name FWS Job Gender Age Type 2 (n=11) relationship-oriented Type 3 (n=6) obeying-the-nature Having a religion Experience of indirect death The subject of death P@@ RN F 32 Yes Yes Patient/Family Member/Kinfolk K@@ RN F 24 No Yes Patient P@@ RN F 26 Yes Yes Kinfolk K@@ Student F 20 Yes Yes Family member Ch.@@ Student F 22 No No - K@@ RN F 27 Yes Yes Kinfolk H@@ RN F 29 Yes Yes Family member P@@ 0.75 Doctor M 29 Yes Yes Patient/Family member/kinfolk L@@ RN F 28 No No - L@@ Doctor F 28 Yes No - Y@@ Student F 19 No Yes Family member K@@ Student F 19 No Yes Family member H@@ Student F 19 No Yes Kinfolk L@@ Student F 20 Yes Yes Kinfolk Sh@@ Student F 19 Yes Yes Patient/Family member/kinfolk K@@ Student F 20 Yes Yes Family member S@@ RN F 35 Yes Yes Family member K@@ RN F 31 Yes Yes Patient/Family member K@@ RN F 28 Yes Yes Patient/Family member/kinfolk Oh@@ Student F 20 Yes Yes Kinfolk H@@ Student F 21 Yes Yes Kinfolk A@@ Student F 20 No No - FWS: factor weight score, RN: Registered Nurse, F: female, M: male.

4 김선영외 : 의료인과간호학생의웰다잉의미에관한주관성연구 13 관계는비교적낮게나타나모든유형이각기고유한유형임을알수있었다 (Table 3). 각유형에속한인구사회학적특성은 Table 4와항목별표준점수는 Table 5와같다. 의료인의웰다잉에관한모든유형이긍정적으로표준점수가동일하게높게나타난공통일치진술문은 마지막순간까지마음편하게죽고싶다 ( 평균Z=1.07) 이었다. 이와같은공통일치진술문은웰다잉을설명하는데고려되어야하는공통변인을의미한다. 2. 유형별해석대상자들의웰다잉의미와관련각유형의긍정적동 의와부정적동의를높게보인진술문을중심으로개별진술항목에대한특정유형의 Z값, 양극단에놓인진술문을선택한이유를기록한면담내용, 대상자들의인구사회학적및질병관련특성등을종합적으로참고하여분석하였다. 1) 유형 1: 현실중시형제1유형에속한대상자들은총 5명이었으며, 자는동안고통없이편안하게임종하는것이다, 병원비나경제적부담등과같은부담없이죽는것이다, 추한모습이아닌아름다운모습으로죽는것이다 였으며강하게비동의한항목은 젊었을때부터준비하는것이 Table 5. Q-Sample and Z-Score according to Types (N=22). Z-Score Q-Statement Type 1 (n=5) Type 2 (n=11) Type 3 (n=6) 1 To die peacefully with no pain while sleeping To not burden the people around me To promise donating my internal organs and cornea after death Well-dying is not necessary since nothing is value after death To forgive and to reconcile with family members and friends before death To die without any burden of worrying about medical bills and economic situation To die not in an ugly manner, but in a beautiful manner To die at a comfortable place such as home, not at a hospital To die after achieving one s lifelong dreams To not die away from home To accept death with dignity To die naturally after aging To have peace of mind until the moment of death To leave this world quietly after having done people favors while getting old enough To end my life for myself without being killed To die without the peace of mind because of one s sins is not a good way to die Wrongful death is not a desirable death Well dying is to be prepared since young age It is desirable to have a sudden death during the best years of one s life To die with my family s care I think those who kill themselves are courageous To make myself and my family prepare for my death I think that people with religion die comfortably because they have hope for heaven To get help from experts while dying To die with the conviction of going to heaven My own death is one of the matters I do not want to consider Funeral rituals or memorials are solemn processes for showing respect for the late Euthanasia is one of the desirable deaths To die after resolving all of my concerns with my surroundings To die before any of my children dies Not to lose my consciousness and keep my balance until death The family members and doctors should tell me the exact status of my health It is desirable for my doctor or family members not to tell the truth about my health status

5 14 한국호스피스ㆍ완화의료학회지 2014;17(1):10-17 다, 가족에게간호를받으면서죽는것이다, 자신이나가족들이준비할수있도록하는것이다 였다. 가족에게간호를받으면서죽는것이다, 자신이나가족들이준비할수있도록하는것이다 였다. 제1유형이다른유형에비해특히점수차이를보인항목이면서웰다잉진술에관해강하게동의하는항목은 죽을때까지몸을가누고의식을잃지않는것이다 ( 타유형과의차이 Z=1.742), 병원비나경제적부담등과같은부담없이죽는것이다 ( 타유형과의차이 Z=1.728), 추한모습이아닌아름다운모습으로죽는것이다 ( 타유형과의차이 Z=1.447), 자신의죽음은생각하고싶지않은일중하나다 ( 타유형과의차이 Z=1.439), 자는동안고통없이편안하게임종하는것이다 ( 타유형과의차이 Z=0.925) 였다. 반면제1형에서가장비동의한항목은 나이가다되어남에게많이베풀고조용히세상을떠나는것이다 ( 타유형과의차이 Z= 1.045), 가족에게간호를받으면서죽는것이다 ( 타유형과의차이 Z= 1.497), 자신이나가족들이준비할수있도록하는것이다 ( 타유형과의차이 Z= 1.922) 였다. 이러한특성은이들유형중인가가중치 를나타낸 15번대상자에게서도일관되게드러나고있는바, 죽을때까지의식을잃지않고지내다가가족들에게걱정끼치지않고죽는게가장좋을것같다. 가족들은당황스러워할수있겠지만나자신은마음편하고행복하게죽을수있을것같다 고답변하였다. 그리고인자가중치 을나타낸 2번대상자는 경제적인문제없이편안한상태에서고통스럽지않게죽음을맞이하고싶고마지막순간에는여자로써추한모습을보이고싶지않다 라고하였다. 이런점에서유형 1을 현실중시형 으로명명하였다. 2) 유형 2: 관계중시형제2형에속하는대상자는 11명으로웰다잉진술에관해강하게동의하는항목은 죽기전가족과친구들에게용서와화해를하고죽는것이다, 자신의꿈을이루거나삶을다이룬후죽는것이다, 나이가다되어남에게많이베풀고조용히세상을떠나는것이다 였다. 이와반대로비동의한항목은 자살하는사람은용기있는사람이라고생각한다, 안락사도좋은죽음의한방법이다 였다. 제2유형이다른유형에비해특히점수차이를보인항목은웰다잉진술에관해강하게동의하는항목은 내부장기나각막등기부를약속하고죽는것이다 ( 타유형과의차이 Z=2.025), 나이가다되어남에게많이 베풀고조용히세상을떠나는것이다 ( 타유형과의차이 Z=1.761), 죽기전가족과친구들에게용서와화해를하고죽는것이다 ( 타유형과의차이 Z=1.389) 였다. 반대로강하게비동의한항목은 자신의죽음은생각하고싶지않은일중하나다 ( 타유형과의차이 Z= 1.247), 안락사도좋은죽음의한방법이다 ( 타유형과의차이 Z= 1.265), 자살하는사람은용기있는사람이라고생각한다 ( 타유형과의차이 Z= 1.414) 였다. 이러한특성은이들유형중인자가중치 를나타낸 21번대상자에게서도일관되게나타난다. 내가살면서사람들에게도움을많이받았듯이내가이세상을떠날때도나로인해많은사람들이많은도움을받았으면한다. 나로인해행복해하는사람이있다면뿌듯할것같고또내가세상을떠나면서요란법석시끄럽게죽기보단편안하게조용히생을마감하고싶다 고답변하였다. 그리고인자가중치 를나타낸 17번대상자는 죽을때까지마음을짐을가지고죽는다면정말불행할것같고잘못한일에대해주변의용서를구하여죽을때마음이편했으면좋겠다 라고하였다. 따라서제2유형은 관계중시형 으로명명하였다. 3) 유형 3: 자연순응형제3형에속하는대상자는 6명으로웰다잉진술에관해강하게동의하는항목은 가족에게간호를받으면서죽는것이다, 살만큼살다가나이들어자연스럽게죽는것이다, 죄를지어마음편하게살지못하고생을마치는것은좋은죽음이아니다, 억울하게죽는것은좋은죽음이아니다, 임종기간동안전문가들의도움을받는것이다 로나타났다. 이와반대로비동의한항목은 내부장기나각막등의기부를약속하고죽는것이다, 추한모습이아닌아름다운모습으로죽는것이다, 병원이아닌집과같이심적으로편안한장소에서죽는것이다, 죽을때까지몸을가누고의식을잃지않는것이다 였다. 제3유형이다른유형에비해특히점수차이를보인항목은웰다잉진술에관해강하게동의하는항목은 가족에게간호를받으면서죽는것이다 ( 타유형과의차이 Z=1.858), 안락사도좋은죽음의한방법이다 ( 타유형과의차이 Z=1.320), 자신이나가족들이준비할수있도록하는것이다 ( 타유형과의차이 Z=1.191), 임종기간동안전문가들의도움을받는것이다 ( 타유형과의차이 Z=0.974) 였다. 반대로강하게비동의한항목은 죽을때까지몸을가누고의식을잃지않는것이다 ( 타유형과의차이 Z= 1.267), 병원비나경제적부담등과

6 김선영외 : 의료인과간호학생의웰다잉의미에관한주관성연구 15 같은부담없이죽는것이다 ( 타유형과의차이 Z= 1.517), 내부장기나각막등의기부를약속하고죽는것이다 ( 타유형과의차이 Z= 1.734), 추한모습이아닌아름다운모습으로죽는것이다 ( 타유형과의차이 Z= 1.765) 였다. 이러한특성은이들유형중인자가중치 를나타낸 20번대상자에게서도일관되게나타난다. 사랑하는가족들의배웅을받으며온정을느끼면서편안하게눈감고싶다. 물론가족들이마음이편치않을수도있지만죽는입장에서는가장행복하게죽음을맞이하는순간이가족과함께하는죽음인것같다 고답변하였다. 그리고인자가중치 를나타낸 5번대상자는따라서제3유형은 갑자기죽으면임종시가족과인사도나눌수없고남은가족도한이맺힐것같다. 또한자살하는사람은정신과적질환이나문제가있는사람이라생각한다. 억울하게죽지않고자연스럽게고통없이죽고싶다 라고하였다. 따라서제3유형은 자연순응형 으로명명하였다. 고찰죽음이란자신이갖고있는주관적경험과가치에따라또는의미와수용태도에따라, 문화적배경에따라다르게인식될수있다 (14,15). 특히다양한죽음을자주접하게되는의료인에게있어그의미는더중요할수있다. 이에본연구는 Q-방법론을적용하여 웰다잉 개념에대한주관성의구조를밝혀냄으로써의료인이인식하는웰다잉의의미에관한태도유형은어떠한특성을지니는지알아보고, 의료인의주관성을유형을분석, 기술해보았다. 웰다잉의의미에관한의료인의인식유형은 3개로분류되었으며각유형은비교적자연스러운측면에서의자연순응형과, 현실세계에의미를두는현실중시형, 그리고주변인과의관계를중시하는관계중시형으로구분됨을발견하였다. 본연구에서나타난가장설명력이높게나타난제1 유형현실중시형은기본적으로육체적고통없이편안히죽기를바라며생애발달주기와죽음의자연적순리를같은맥락으로인식하고있다고볼수있다. 죽을때까지의식을잃지않고현재모습이경제적, 신체적으로흐트러지는모습을기피하는특성을보이고있었다. 이것은일반적으로내세보다는현실을중시하고신체적고통, 경제적고통없이임종하는것을바라며끝까지치료를포기하지않고받기를희망한다는연구결과와일치한다 (2,18). 또한암묵적으로후회와미련없이 최선을다해살고건강을잘관리하면서긍정적인마음으로질병없이살고임종전오래앓지않다죽는것을행복한죽음으로인식한다는연구결과와도일치한다 (23). 이러한현실중시형에게는임종과정동안환자와가족의신체적고통과경제적부담이부정적으로인식될수있다. 따라서임종기동안환자와가족이경험하는다양한어려움과고통에대한교육뿐아니라적극적인돌봄에대한교육을제공하여이러한시각을변화시킬필요가있다. 제2유형관계중시형은죽음이개인만의사건이아닌남겨진이들에게죽음에대한새로운방향을제시하고삶을재조명할수있는것이라하였다. 자신의삶에있어반성적성찰과인간관계를통한자아를회복하는것으로보며, 타인에대한배려를통해삶을완성한다고본다. 이는좋은죽음의한형태로 (5,6) 일반적인한국적문화가반영된결과로볼수있다. 즉자연스러운죽음과더불어나이들어자식이잘되는것을보고죽기를원하는것이다 (2). 의료인을대상으로한연구에서사랑하는사람과함께임종을함께맞이하거나, 평화롭게죽는것을좋은죽음으로인식하였으며, 종교가없거나가족죽음경험이있는경우, 말기환자간호경험이있는경우, 좋은죽음에대한정보와교육경험은죽음태도에긍정적인영향을미치는것으로나타났다 (24). 따라서이들관계중시형에게는죽음의의미와태도를긍정적으로유지할수있는다양한웰다잉교육이제공되어야한다 (25). 제3유형자연순응형은주어진삶을살다가족의간호를받으며준비된임종을맞이하는것을중요하게인식하였다. 이유형은죽음을삶을끝으로인식하는내세관과더불어임종을가족과함께맞이하는것을희망한다는연구와비슷한결과를보인다 (2,18). 따라서이유형에게는환자가스스로죽음을준비할수있도록도울수있는의사소통능력, 의사결정과관련된부분의교육이강화될필요가있다 (26). 더불어현재의웰다잉과관련된교육은노년층 (20) 과노인관련종사자 (19) 를대상으로한것이주를이루고있다. 죽음의대한태도는짧은기간동안완성되는것이아니기때문에학부과정에서부터생명윤리, 웰다잉교육등이실시되어야한다 (8,9). 학부과정에서의죽음관련교육은죽음에대한긍정적인태도를바탕으로임상에서도성숙한돌봄을제공할수있을것으로사료된다 (9,26). 더불어임상에서근무하는간호사를대상으로한죽음교육도지속적으로제공되어야할필요가있다.

7 16 한국호스피스ㆍ완화의료학회지 2014;17(1):10-17 선행연구들에서연령, 성별, 교육정도, 종교유무등은죽음에대한태도에영향을미친다는보고가있으나 (15,27,28) 본연구는의료인이웰다잉에대한갖는태도를유형화하고자하였으므로의사, 간호사와간호학생을대상으로실시되었다. 따라서교육기간은조사하지않았으며연구에참여한대상자는 19세에서 35세까지로연령의분포정도가크지않았으며, 오직 2명만이남성이었으며, 7명은종교가없었고, 4명을제외한나머지대상자는모두죽음을직간접적으로경험한것으로조사되었다. 따라서향후연구에서는웰다잉에대한개념분석과더불어웰다잉에영향을미치는요인연구가시행되어야하며이러한연구결과들을바탕으로간호학생을포함한의료인을위한다양한죽음교육 ( 웰다잉 ) 프로그램이개발되어야할것이다. 요약목적 : 본연구는의료인과간호학생의웰다잉의미와주관성유형을확인하고, 유형별특성을분석하기위해 Q 방법론을적용한조사연구이다. 방법 : 간호학과학생 8명, 호스피스전문병원임상간호사 3명을대상으로심층면담과선행연구고찰을통해 102개의 Q-모집단을구성하였으며, 이후 Q-방법론의전문가인간호학과교수 1명과간호학과박사과정중인 2 명의의견교환및재조정을통하여총 33개의 Q-표본을선정하였다. 4년제간호학과학생 11명과경기도일개 3차종합병원의간호사 9명과의사 2명을대상으로총 22명의 P-표본을대상으로하였다. P-표본은선정된 33개의진술문을강제정상분포가되도록 7점척도상에분류하도록하였고, 양극단에분류한진술문과관련하여추가진술문을작성하도록하였다. 수집된자료는 PC-QUANL Program으로요인분석하였다. 결과 : 분류된의료인의웰다잉의미유형은모두 3가지로나타났으며이들유형에의해설명된전체변량은 57.97% 였다. 제1형은 현실중시형 으로부담없이아름다운모습으로임종하는것에의미를두었다. 제2형은 관계중시형 으로죽기전자선을베풀고주변인들과화해와용서의시간을갖는것에의미를두고있었다. 제3형은 자연순응형 으로살만큼살다가족의간호를받으며임종하는것에의미를두었다. 결론 : 웰다잉에관한의료인과간호학생의주관성은임종을맞이하는환자간호에영향을미친다. 따라서의료인과간호학생은삶과죽음에대한깊은통찰을가져 야하며, 이를위해웰다잉에대한주관성유형별특징에맞는죽음교육이필요하다. 중심단어 : 죽음, 임종간호, 간호사, 간호학생 참고문헌 1. Lee GJ, Hwang KH, Ra JR, Hong JA, Park CS. Concept analysis of good death. J Res Inst Hosp Palliat Care 2006;10: Shim HW. A study on the subjectivity of Koreans about well ddying-q methodological approach. J Korean Acad Fundam Nurs 2011;18: Hong MS. A study on attitude of nurses toward euthanasia. J Korea Community Health Nursing Academic Society 2000;14: Oh JT. The last present. Seoul:Sejong Books; Han NY, Yoon HJ, Park EW, Cheong YS, Yoo SM. Perception of a good death in the elderly. J Korean Acad Fam Med 2002;23: Kim MH, Kwon KJ, Lim YO. Study on 'good death' that Korean aged people recognize. Korean J Soc Welf 2004;56: Choi Jk. A study on the effects of elderly people's participation in religious activities and social support upon uneasiness about death [dissertation]. Cheongju: Cheongju Univ.; Korean. 8. Braun M, Gordon D, Uziely B. Associations between oncology nurses' attitudes toward death and caring for dying patients. Oncol Nurs Forum 2010;37:E Kim SH, Kim DH. Nursing students attitude to death, deathrelated education experience and educational needs. J Korean Acad Soc Nurs Edu 2011;17: Kim JH, Kang YW, Ryu K, Rie JI. Predictors of ego-integrity in the concept of successful aging among the elders. Korean J Soc Per Psychol 2009;23: Park HK. A study on determinants of the attitudes of the aged toward death : analysis on the attitudes toward the services of death education, social supports and ego integrity [dissertation]. Yongin: Kangnam Univ.; Korean. 12. Jeon SY. A study on the attifude of the people toward euthanasia. Journal of KSSSS 2009;18: Takezako Y, Tamiya N, Kajii E. The nursing home versus the hospital as the place of dying for nursing home residents in Japan. Health Policy 2007;81: Kim MA, Im SH. Subjectivity toward death among nursing students. Keimyung J Nurs Sci 2002;6: Jung SY, Lee EK, Kim BH, Park JH, Han MK, Kim IK. Attitude toward death in nuring students. J Korean Acad Soc Nurs Edu 2011;17: Kim BH, Kim JK. A Q study for meaning of cancer and

8 김선영외 : 의료인과간호학생의웰다잉의미에관한주관성연구 17 hospice. Journal of KSSSS 2002;7: Grosswiler P. Subjectivity or the death of the subject : Q theory Vs. postmodern theory. J Human Subjectivity. 2005;3: Yeun EJ. Subjectivity toward death among health care personnel - a Q-methodology. J Korean Acad Adult Nurs 1999;11: Jung EJ, Byun SH. Impact of education for welldying on workers related to senior welfare. JKCA 2012;12: Oh CT, Kim CG. Effects of death education on attitude toward death and depression in older adults. J Korean Gerontol Soc 2009;29: Jung JG. A study on death education program for old people. J East Asian Soc Thoughts 2007;16: Nuland SB. How we die: reflections of life's final chapter. New York:A.A. Knopt : Distributed by Random House, Inc.; Kim MS. Characteristics of the Korean s representation and understanding on happiness and good death. J Humanit Stud 2012;86: Jeong HS. Recognition towards good death among physicians and nurses in an area [dissertation]. Busan: Catholic Univ. of Pusan; Korean. 25. Shim HW. A study on the cognition and attitude on well-dying in undergraduate students-q methodological approach. J Korean Acad Fundam Nurs 2012;19: Jo KH. The meaning of dignified dying perceived by nursing students. J Korean Acad Soc Nurs Edu 2010;16: Kim SH, Kim DH. Nursing students' attitude to death, death-related education experience and educational needs. J Korean Acad Soc Nurs Edu 2011;17: Lee SM, Kim S. A study of Korean s perception on the meaning of life & death. J Korean Bioethcis Assoc 2012;13:1-18.

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1.. Volume 12, Number 1, 6~16, Factors influencing consultation time and waiting time of ambulatory patients in a tertiary teaching hospital Jee-In Hwang College of Nursing Science, Kyung Hee University :