ORIGINAL ARTICLE ISSN(Online) Child Health Nurs Res, Vol.21, No.1, January 2015: 백혈병경험청소년의

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1 ORIGINAL ARTICLE ISSN(Online) Child Health Nurs Res, Vol.2, No., January 205: 74-8 백혈병경험청소년의생의의미에영향을미치는요인 홍성실, 박호란 2 가톨릭대학교대학원, 2 가톨릭대학교간호대학 Predictors of Meaning in Life in Adolescents with Leukemia Sung-Sil Hong, Ho-Ran Park 2 Graduate School, The Catholic University of Korea, Seoul, 2 College of Nursing, The Catholic University of Korea, Seoul, Korea Purpose: The purpose of this study was to identify predictors of spiritual well-being and meaning in life for adolescents with leukemia. Methods: Participants were 02 adolescents (-2 years) recruited at C university hospital from June to August in 204. The eligible participants were diagnosed with leukemia and are on follow-up care at the outpatient clinic. Participants were assessed for spiritual well-being, meaning in life, self-esteem, and social support. Results: Levels of spiritual well-being and meaning in life for these adolescents with leukemia were 3.69 out of 6 and 3.0 out of 4, respectively. Self-esteem and social support from family were factors affecting spiritual well-being. Self-esteem, existential well-being and social support from family and friends were predictive for meaning in life and accounted for 68% of total variance. Conclusion: The results show that there are several factors affecting spiritual well-being and meaning in life in adolescents with leukemia. Therefore, nursing intervention programs for adolescents with leukemia should include strengthening self-esteem and social support as well as considering the spiritual aspect of life in order to find meaning in life beyond leukemia. Key words: Adolescent, Leukemia, Spiritual well-being, Meaning in life 연구의필요성 서론 백혈병은우리나라소아암발생중 위를차지하지만최근의학기술 의발달로 5 년생존율이 72.7% 까지높아졌다 (Ministry of Health and Welfare, 203). 암과같은생명위협질환을경험하고있는청소년들은 성장발달과정을겪어야함과동시에질병과맞서싸워야하는이중고 에직면해있어, 신체적으로는발달과업의성취가늦어질수있으며, Corresponding author Ho-Ran Park College of Nursing, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 37-70, Korea TEL FAX hrpark@catholic.ac.kr * 본연구는 204 년도가톨릭대학교간호대학의학술연구비에서일부지원을받아수행되었음. * This study was supported by research funding from College of Nursing, The Catholic University of Korea in 204. Key words 청소년, 백혈병, 영적안녕, 생의의미 Received 9 December 204 Received in revised form 2 January 205 Accepted 27 January 205 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non- Commercial License ( which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 심리사회적으로는불안, 두려움, 슬픔, 무력감등을경험하게된다 (Hendricks-Ferguson, 2006; Woodgate, 2005). 그러나다른관점에서청소년들은질병을자신에대한도전으로받아들이고이겨나가려는노력들을계속하게되고 (Moadel et al., 999) 이과정에서영적안녕과생의의미를추구하는노력들은회복의원동력으로작용하게된다 (Haase, 2004; Hart & Schneider, 997). 영성은역동적이고다학제적인개념으로 (Visser, Garssen, & Vingerhoets, 200) 청소년기의영적안녕은종교의식이아닌절대적힘과의관계를의미하며가족의종교적신념의영향을받는다 (Hart & Schneider, 997). 생의의미는상황에따라변화하는주관적인특성을지니며생의의미를잃어버리는것은삶을이어나가는동기를상실하는것으로 (Choi, Kim, Shin, Lee, & Jung, 2005) 생의의미는어려운상황에서역경을극복해나갈수있는힘이된다 (Yoon & Cho, 20). 청소년기의영적요구는생의의미와목적, 그리고희망에대한요구로설명될수있으며 (Hart & Schneider, 997; Yoon & Cho, 20), 암을경험하는청소년들의영적안녕은질병결과에긍정적영향을주고 (Richardson, 202; Visser et al., 200), 이들에게생의의미와목적을발견하게하고 74 Copyright 205 Korean Academy of Child Health Nursing

2 삶에동기를부여함으로자아정체성형성에도움을준다 (Bronk, 20; Haase, 2004). 한편자아존중감은건강한자아형성에중요한영향요인으로 (Rosenberg, 965), 청소년들이자신의의미와존재가치를발견하는과정을통해미래에대한목적의식을찾게된다 (Yoon & Cho, 20). 암을경험하는청소년들에게자아상확립이라는청소년기의발달과제는질환의힘든경험속에서매우어려운도전이지만, 그럼에도불구하고긍정적인자아상을형성하는것은암질환의어려운경험을극복하는원동력으로평가되고있다 (Hockenberry-Eaton, Dilorio, & Kemp, 995). 또한이들청소년들에게가족, 친구, 그리고의료진으로부터제공되는사회적지지는발달과업을달성하는동시에예후에대해염려하는암치료라는새로운환경에직면한청소년들이질병상황을극복하고스트레스를이겨나가는데중요한요인으로작용한다 (Kyngas et al., 200; Woodgate, 2006). 이처럼청소년들에게암질환은신체적인측면의문제뿐아니라사회적 영적문제들을야기하고나아가생의의미를상실할수있으므로암청소년을간호하는간호사는이들청소년에게신체, 정서, 사회및영적의통합적관점에서접근해야할것이다. 지금까지청소년의영적안녕과생의의미와관련된국내연구는건강한청소년에게초점이맞추어진단면적연구 (Kang, Kim, & Song, 2009; Kang, Kim, Song, & Sim, 2007; Yoon & Cho, 20) 에그치고있어암을경험하는청소년의특성을충분히반영하지못하고있다. 이에본연구는백혈병경험청소년의영적안녕과생의의미를파악하고선행연구에서생의의미영향요인으로밝혀진자아존중감과사회적지지를포함하여이에영향을미치는요인들을확인하고자하였다. 이를통해백혈병경험청소년의영적안녕을증진하고긍정적인생의의미를찾는데도움을주기위한간호중재를개발하는데기초자료를마련하기위해본연구를실시하였다. 연구목적본연구의목적은백혈병경험청소년들의영적안녕과생의의미정도를파악하고영적안녕과생의의미에영향을주는요인을파악하기위한것으로구체적인목적은다음과같다. ) 백혈병경험청소년들의자아존중감, 사회적지지, 영적안녕, 생의의미정도를파악한다. 2) 백혈병경험청소년들의제특성에따른영적안녕과생의의미정도의차이를파악한다. 3) 백혈병경험청소년들의자아존중감과사회적지지, 영적안녕, 생의의미간의관계를파악한다. 4) 백혈병경험청소년들의영적안녕및생의의미에영향을미치는요인을파악한다. 연구방법 연구설계본연구는백혈병경험청소년들의영적안녕과생의의미정도를파악하고영향요인을규명하기위한서술적조사연구이다. 연구대상본연구의표적모집단은백혈병으로진단받고관해유도요법을마친후 C대학병원외래에서추후관리를받고있는 -2 세청소년을대상으로하였다. 본연구에서대상청소년연령을 -2세로정한근거는 Crockett과 Peterson (993) 이청소년기를전기 (-5 세 ), 중기 (5-8 세 ), 후기 (8-2세 ) 로구분하여정의한것에의하였다. 대상자수는 Cohen의 Power analysis 공식에근거한 G*Power 3. 프로그램을이용하여다중회귀분석을위한유의수준.05, 검정력.95, 효과크기 0.5, 예측요인의수 6으로산정한대상자수가 89명이었으며 (Faul, Erdfelder, Lang, & Buchner, 2007), 본연구에서는탈락률을고려하여 02명으로부터자료를수집하였다. 연구도구영적안녕영적안녕측정은 Paloutzian과 Ellison (983) 에의해개발된 Spiritual Well-Being Scale (SWS) 의한국어판 (Cheung et al., 200) 을사용하였다. SWS는총 20문항으로종교적안녕 (Religious Well-Being Scale, RWS) 0문항과실존적안녕 (Existential Well-Being Scale, EWS) 0문항으로구성되어있으며, 각문항은 점부터 6점으로점수가높을수록영적안녕이높음을의미한다. SWS의개발당시신뢰도 Cronbach s α 는 SWS.89 (RWS.87, EWS.78) 였고, 본연구에서는 SWS.88 (RWS.87, EWS.80) 이었다. 생의의미생의의미는 Choi 등 (2005) 이개발한성인용생의의미측정도구를 Kang 등 (2007) 이청소년을대상으로수정한청소년생의의미측정도구를사용하였다. 이도구는총 33문항 8개하부영역으로, 4점 Likert 척도로구성되었으며점수가높을수록생의의미가높음을의미한다. Kang 등 (2007) 의연구에서신뢰도 Cronbach s α =.92였고, 본연구에서의 Cronbach s α =.94였다. 자아존중감자아존중감은 Rosenberg (965) 의자아존중감측정도구를 Jeon (974) 이번역한도구를사용하였다. 이도구는청소년부터성인까지를대상으로자신에대해지각하고있는느낌과평가의정도및자기수 홍성실, 박호란 75

3 Child Health Nurs Res, Vol.2, No., January 205: 74-8 용정도를묻는총 0 문항의 5 점 Likert 척도로구성되어있으며점수 신뢰도 Cronbach s α =.88 이었고, 본연구에서의 Cronbach s α =.94 였다. 가높을수록자아존중감이높은것을의미한다. Rosenberg (965) 의 연구에서도구의신뢰도 Cronbach s α = 이었고, 본연구에서의 Cronbach s α =.85 였다. 자료수집방법 자료수집은 C 대학병원연구윤리심의위원회의승인을받은후 ( 승 인번호 : MIRB-00074_3-002) 204 년 6 월부터 8 월까지시행하였다. 자 청소년이인지하는사회적지지청소년이인지하는사회적지지는 Zimet, Dahlem, Zimet와 Farley (988) 에의해개발된다차원적사회적지지측정도구 (The Multidimensional Scale of Perceived Social Support) 를한국어로번역하여사용하였다. 이도구는대학생들을대상으로그들이인지하는가족 (4문항 ), 친구 (4문항) 그리고특별한사람 (4문항) 으로부터의지지정도를 료수집전해당청소년과보호자에게연구의목적과절차, 방법, 연구대상자의권리등에대한정보를제공한후연구참여에자발적으로동의한청소년을대상으로설문지를제공하고응답하도록하였다. 자료수집시청소년은설문지를읽고직접기록하였으며, 청소년이설문지를작성하는동안발생할질문사항을대비하여연구자가함께있어주었다. 측정하는 7 점척도로개발되었으며점수가높을수록인지하는지지 정도가높음을의미한다. 본연구에서는특별한사람에의료진을포 함하여백혈병청소년들이인지하는가족, 친구, 그리고특별한사람으 로부터의지지정도를측정하였다. Zimet 등 (988) 의연구에서도구의 자료분석방법 수집된자료는 SPSS version 8.0 프로그램을이용하여분석하였다. 연구대상자의일반적인특성과영적안녕과생의의미관련변수들 Table. Scores for General Characteristics, Self-Esteem and Social Support (N=02) Characteristics or variables Categories n (%) or M±SD Minimum Maximum Age (year) 5.96± Age at diagnosis (year) 0.04± Time since diagnosis (year) 5.98± Gender Diagnosis Treatment Donor type in stem cell transplantation (n=28) Religion Male Female Acute lymphoblastic leukemia Acute myelogenous leukemia Chemotherapy only Chemotherapy, radiation Chemotherapy, transplantation Chemotherapy, radiation, transplantation Siblings Matched unrelated Others No Yes Catholic Presbyterian Buddhist Others 66 (64.7) 36 (35.3) 73 (7.6) 29 (28.4) 66 (64.7) 8 (7.8) 7 (6.7) (0.8) (43.) 58 (56.9) Subjective belief level 4.0± Religious activity None -2/year -2/month -2/week 56 (54.9) 9 (8.6) 7 (6.9) 20 (9.6) Subjective health status Healthy Moderate Not healthy 57 (55.9) 34 (33.3) (0.8) Self-esteem 2.9 ± Social supports Overall From family From friends From special someone 5.63 ± ± ± ± 백혈병경험청소년의생의의미에영향을미치는요인

4 백혈병경험청소년들의자아존중감점수는 5점만점에 2.9 ± 0.48 점으로중간이상을나타냈으며사회적지지점수는 7점만점에 5.63 ±.05점으로높았으며하부영역별로는가족으로부터의지지가친구와특별한사람으로부터의지지에비해높았다. 의정도는기술통계로분석하였고, 대상자특성에따른변수들간의차이는 t-test와 ANOVA로, 사후검정은 Scheffe 로분석하였다. 변수들간의상관관계는 Pearson correlation coefficients로분석하였고백혈병청소년들의영적안녕과생의의미의영향요인은 stepwise multiple regression analysis 로분석하였다. 연구결과 백혈병경험청소년의특성본연구대상자특성은 Table 과같다. 백혈병경험청소년들의평균나이는 5.96 ± 2.90세였고, 남자가 백혈병경험청소년의영적안녕과생의의미정도백혈병경험청소년들의영적안녕은 6점만점에 3.69 ± 0.77점으로중간수준으로나타났다. 하부영역별로는실존적안녕이 4. ± 0.75 점으로종교적안녕의 3.27±.05점보다높게나타났다. 백혈병경험청소년들의생의의미점수는 4점만점에 3.0 ± 0.42점으로높은점수를보였다 (Table 2). 64.7% 였다. 진단명은급성림프모구백혈병이 7.6% 였고, 치료유형은전 체청소년이항암화학요법을받았으며, 항암화학요법과이식요법을병행한경우가 6.7%, 항암화학요법과방사선요법및이식요법모두를받은대상자가 0.8% 였다. 이식요법을받은대상자 28명의이식제공유형은형제자매 6명, 타인 9명, 부모 3명이었다. 백혈병경험청소년들의진단당시나이평균은 0.04 ± 4.9세였고, 진단이후기간평균은 5.98 ± 3.88년이었다. 58명의청소년들이종교가있었고, 믿음정도는 0점만점에평균 4.0 ± 2.7점이었으며 54.9% 의청소년들이종교활동에참여하지않는다고답하였다. 청소년들이응답한주관적건강상태는 백혈병경험청소년의특성에따른영적안녕과생의의미백혈병경험청소년들의영적안녕은진단명 (p =.06), 종교유무 (p <.00), 종교활동빈도 (p <.00), 건강상태 (p <.00) 에따라차이가있어급성골수모구백혈병에서, 종교가있는청소년들에서, 종교활동빈도가월 -2회또는주 -2회인그룹에서, 건강상태가보통이상인그룹에서영적안녕점수가높았다. 생의의미는건강하다고응답한청소년들이그렇지않은청소년들에비해높은수준을나타냈다 (p <.00) (Table 2). 55.9% 가건강하다고답하였다. Table 2. Spiritual Well-Being and Meaning in Life by General Characteristics (N=02) Variables or characteristics Categories n (%) or M±SD Spiritual well-being Meaning in life M±SD t or F (p) M±SD t or F (p) Spiritual well-being Overall Religious Existential 3.69 ± ± ± 0.75 Meaning in life 3.0±0.42 Gender Male Female 66 (64.7) 36 (35.3) 3.62 ± ± (.75) 3.08± ± (.693) Diagnosis Acute lymphoblastic leukemia Acute myelogenous leukemia 73 (7.6) 29 (28.4) 3.8 ± ± (.06) 3.± ± (.59) Treatment Chemotherapy only Chemotherapy, radiation Chemotherapy, transplantation Chemotherapy, radiation, transplantation 66 (64.7) 8 (7.8) 7 (6.7) (0.8) 3.79 ± ± ± ± (.205) 3.± ± ± ± (.966) Religion No Yes 44 (43.) 58 (56.9) 3.27 ± ± ( <.00) 3.0± ± (.08) Religious activity None -2/year -2/month -2/week 56 (54.9) 9 (8.6) 7 (6.9) 20 (9.6) 3.36 ± 0.73 a 3.89 ± ± 0.57 b 4.27 ± 0.66 b 0.84 ( <.00) a<b* 3.02 ± ± ± ± (.95) Subjective health status Healthy Moderate Not healthy 57 (55.9) 34 (33.3) (0.8) 3.92 ± 0.67 a 3.56 ± 0.77 a 2.9 ± 0.70 b 0.3 ( <.00) a>b* 3.26 ± 0.37 a 2.92 ± 0.39 b 2.77 ± 0.39 b 3.20 ( <.00) a>b* *p < 홍성실, 박호란 77

5 Child Health Nurs Res, Vol.2, No., January 205: 74-8 Table 3. Intercorrelation Coefficients Among Spiritual Well-Being, Meaning in Life, Self-Esteem, and Social Support (N=02) Variables SWB RWB EWB MIL SE SS SS (Fa) SS (Fr) SS (SS) r (p) r (p) r (p) r (p) r (p) r (p) r (p) r (p) r (p) SWB RWB EWB.90 ( <.00).79 ( <.00).44 ( <.00) MIL.59 ( <.00).34 ( <.00).73 ( <.00) SE.54 ( <.00).29 (.003).70 ( <.00).75 ( <.00) SS SS (Fa) SS (Fr) SS (SS).5 ( <.00).5 ( <.00).4 ( <.00).4 ( <.00).34 ( <.00).30 (.002).28 (.004).3 (.002).56 ( <.00).6 ( <.00).45 ( <.00).42 ( <.00).68 ( <.00).68 ( <.00).57 ( <.00).53 ( <.00).56 ( <.00).6 ( <.00).45 ( <.00).44 ( <.00).86 ( <.00).87 ( <.00).88 ( <.00).62 ( <.00).67 ( <.00).6 ( <.00) SWB = Spiritual well-being; RWB = Religious well-being; EWB = Existential well-being; MIL = Meaning in life; SE = Self-esteem; SS = Social support overall; SS (Fa) = Social support from family; SS (Fr) =Social support from friends; SS (SS) =Social support from special someone. Table 4. Factors Affecting Spiritual Well-Being and Meaning in Life (N=02) Variables B S.E. β t (p) Adj R 2 F (p) Spiritual well-being Constant Self-esteem Social support from family (.00) 2.77 (.007) ( <.00) Meaning in life Constant Self-esteem Existential well-being Social support from family Social support from friends ( <.00) 3.5 (.00) 2.08 (.040) 2.35 (.02) ( <.00) 백혈병경험청소년의영적안녕, 생의의미, 자아존중감, 사회적지지의상관관계백혈병경험청소년들의영적안녕, 생의의미, 자아존중감, 사회적지지각변수간의관계는 Table 3과같다. 청소년들의영적안녕은자아존중감 (r = 54, p <.00), 사회적지지 (r =.5, p <.00) 와양의상관관계를보였고, 생의의미는영적안녕 (r =.59, p <.00), 자아존중감 (r =75, p <.00), 사회적지지 (r =.68, p <.00) 와양의상관관계가있었다. 서모든변수가공차한계가 0.이하였고, VIF값은 0보다크기않아다중공선성의문제가없는것으로나타났다. 백혈병경험청소년의영적안녕의영향요인은자아존중감 (β =.37, p =.00) 과사회적지지의하위요인중가족지지 (β =.28, p =.007) 로영적안녕을 33% 설명하였다 (F = 25.74, p <.00). 백혈병경험청소년의생의의미에영향을미치는요인은자아존중감 (β =.36, p <.00), 영적안녕의하위요인중실존적안녕 (β =.29, p =.00) 과사회적지지의하위요인중가족지지 (β =.8, p =.040) 와친 구지지 (β =.7, p =.02) 였으며청소년의생의의미를 68% 설명하였다 백혈병경험청소년들의영적안녕과생의의미영향요인 (F =55.8, p <.00). 백혈병경험청소년들의영적안녕과생의의미에영향을미치는요인을알아보기위해상관관계분석에서유의한차이를보였던변수들을모두포함한상태에서단계선택방법을사용하여다중회귀분석을시행한결과는 Table 4와같다. 먼저, 회귀분석의가정을검정하기위한 Durbin-Watson 통계량을이용한오차의자기상관을검정한결과는영적안녕을최종종속변수로한분석에서는.83, 생의의미를최종종속변수로한분석에서는 2.0로나타나자기상관의문제는없었다. 공차한계 (Tolerance) 와분산팽창계수 (Variance Inflation Factor, VIF) 값을이용한다중공선성을검정한결과, 영적안녕과생의의미를종속변수로한회귀분석모두에 논의 본연구는백혈병경험청소년들의영적안녕과생의의미에영향을미치는요인들을확인하여백혈병청소년들의영적안녕을추구하고생의의미를찾도록도울간호중재개발의기초자료를마련하기위해시도되었다. 백혈병경험청소년의영적안녕은급성골수모구백혈병, 종교가있는경우, 종교활동의빈도가월 -2회또는주 -2회인경우, 그리고건강이보통이상인그룹에서그렇지않은그룹에비해높은수준을보 78 백혈병경험청소년의생의의미에영향을미치는요인

6 였다. 생의의미는건강하다고느끼는청소년들이그렇지않은청소년들에비해높은수준을보였다. 소아암청소년들을대상으로한선행연구에서는성별과나이에따라영적안녕이다른수준을보였고 (Hendricks-Ferguson, 2006) 진단후기간이길어질수록영적안녕의수준이높았다 (Hendricks-Ferguson, 2008). 이러한차이는암을진단받은청소년들은그들의관심을다른무엇보다도체력이나신체상등그들이잃어버린것들에더욱집중하게된다는결과 (Hart & Schneider, 997) 와관련된것으로스스로를건강하다고여기는청소년들이영적안녕이나생의의미에도관심을가질심리적여유가있는것으로여겨진다. 본연구대상자인백혈병경험청소년의영적안녕수준은건강한국내중학생들보다는높았으나 (Kang et al., 2009) 소아암청소년들을대상으로한국외연구의결과 (Hendricks-Ferguson, 2006, 2008) 보다는낮았다. 이러한결과는청소년기가영적인관심이증가하는시기로질병을경험하는청소년들은절대적인힘에의지하려는경향이건강한청소년들에비해강하게표출된결과로생각해볼수있다. 반면국외연구결과와차이는본연구대상청소년들의믿음정도와종교활동참여빈도가낮은수준이었으며가족중심적인사회에서아동의질병과정에있을때가족의결속력이더욱강해지는문화적차이때문으로이해할수있을것이다. 본연구대상청소년들의생의의미는건강한청소년들을대상으로동일한측정도구를사용한선행연구들의결과 (Kang et al., 2009; Yoon & Cho, 20) 보다높은수준을보였다. 이러한결과는백혈병이비록생명을위협하는질병이지만, 다른한편으로는자신과미래에대한새로운도전이되어 (Moadel et al., 999) 힘든시간들을이겨나가면서자신의삶에새로운가치를부여하기때문일것으로생각된다. 본연구에서백혈병경험청소년들의자아존중감은건강한청소년들과비교하여낮거나 (Kang et al., 2009) 비슷한수준 (Yoon & Cho, 20) 이었으며, 소아암생존청소년의자아존중감보다는낮은수준 (Kwon, Kim, & Cha, 2009) 이었다. 이는본연구의대상청소년들이비록백혈병진단과치료로힘든질병과정을지내고있어자신의가치를발견하고스스로를소중하게여기는일이청소년들에게는쉽지않은일임을알수있었다. 본연구에서청소년들이인지하는사회적지지는높은수준을보였고. 하위영역중가족의지지가가장높아선행연구의결과 (Klineberg et al., 2006) 와일치하였다. 청소년기는또래집단의중요성이커지는시기이지만본연구대상청소년들은백혈병이라는질병으로인해입원치료및학업중단을경험하기도하며가족의보호아래지내고있기때문에가족의지지가친구나의료진으로부터의지지보다높았던것으로생각된다. 본연구에서백혈병경험청소년들의영적안녕은생의의미와양의상관관계가있었고, 자아존중감과사회적지지는영적안녕과생의의 미와양의상관관계를보여선행연구결과 (Haase, 2004; Kang et al., 2009; Richardson, 202; Yoon & Cho, 20) 와일치하였다. 이를통해백혈병청소년들에게자기자신을발견하도록도움을주고적절한사회적지지를제공함으로영적안녕을증진하고생의의미를찾는데긍정적인영향을줄것으로여겨진다. 백혈병경험청소년들의영적안녕에영향을미치는요인은자아존중감과가족의지지였으며, 생의의미의영향요인은자아존중감, 실존적안녕, 가족의지지, 친구의지지였다. 이러한결과는자아존중감과가족만족도가생의의미에영향요인이라고한선행연구 (Bronk, 20; Kyngas et al., 200; Yoon & Cho, 20) 와그리고영적측면이생의의미의영향요인이라고한연구결과 (Haase, 2004; Vachon, Fillion, & Achille, 2009) 와유사하다. 또한또래집단속에서소속감과삶의동기를찾는청소년기의특성을반영하고, 부모의적절한지지와영적인지지를통해스트레스상황을이겨낼힘을얻는다는연구결과 (Hart & Schneider, 997) 와도일맥상통한다. 본연구에서영적안녕중실존적안녕만이생의의미에영향요인이었는데이는청소년의영적요구가종교적의미에치우치기보다는삶의의미와목적그리고희망의요구를포함하고있음을 (Hart & Schneider, 997) 다시생각하게하는결과이다. 본연구는일개대학병원소아암센터외래를방문한백혈병청소년을대상으로단기간의편의추출로수집된자료로연구결과를일반화하는데신중을기해야할것이다. 본연구결과와논의를근거로다음과같이제언하고자한다. ) 본연구의대상인백혈병뿐아니라전체소아암아동및청소년으로대상을확대하여생의의미에대한반복연구를시행하는것이필요하다. 2) 본연구결과를바탕으로백혈병청소년을위한생의의미발견프로그램의개발및효과를검증하는후속연구를제언한다. 결론 본연구는백혈병경험청소년들의영적안녕과생의의미정도와영향요인을파악함으로써성인기로이행하는청소년들에게긍정적인삶의방향을찾는데도움을줄수있는간호중재의기초자료를마련하기위해시행되었다. 본연구의결과를통해백혈병경험청소년들이생의의미를찾기위해신체적인측면뿐아니라정서, 사회그리고영적인측면의지지가함께제공되어야함을보여준다. 본연구는국내소아백혈병의완치율과생존율이증가하는추세에서백혈병청소년들의생의의미에대한이해를높이는데도움을줄것으로기대되며, 영적안녕과생의의미에영향을미치는요인들을파악하고요인들간관련성을확인하 홍성실, 박호란 79

7 Child Health Nurs Res, Vol.2, No., January 205: 74-8 였다는점에서그의의가있다. 또한향후백혈병을포함한소아암아동및청소년의생의의미관련연구의기초자료및간호실무현장에서생의의미발견을위한간호중재프로그램개발및적용을위한근거가될수있으리라생각된다. Conflict of Interest No potential conflict of interest relevant to this article was reported. Acknowledgements This study was supported by research funding from College of Nursing, The Catholic University of Korea in 204. 요약 목적본연구의목적은백혈병경험청소년들의영적안녕과생의의미정도를알아보고영향을미치는요인을파악하기위함이다. 방법백혈병으로진단받고 C대학병원에서관해유도요법을마친후외래에서추후관리를받고있는 -2 세청소년 02명을대상으로자료를수집하였다. 영적안녕은 Paloutzian과 Ellison (983) 의영적안녕측정도구를, 생의의미는 Kang 등 (2007) 의청소년생의의미측정도구를사용하였고, 관련요인을파악하기위해자아존중감과사회적지지를측정하였다. 수집된자료는 SPSS를이용하여영적안녕과생의의미영향요인은 stepwise multiple regression analysis 로분석하였다. 결과백혈병경험청소년들의영적안녕은중간수준이었고생의의미는높은수준을나타냈으며자아존중감, 사회적지지, 영적안녕은생의의미와양의상관관계를보였다. 회귀분석결과영적안녕에영향을미치는요인은자아존중감과가족의지지였으며, 생의의미에영향을미치는요인은자아존중감, 실존적안녕, 가족의지지, 친구의지지였다. 결론백혈병경험청소년들이질병과정을성공적으로이겨내고생의의미를찾도록돕기위해서는자아존중감과실존적안녕을높이고가족및친구지지를촉진시켜줄수있는간호중재프로그램의개발과실행이필요하다고본다. References Bronk, K. C. (20). The role of purpose in life in healthy identity formation: A grounded model. New Directions for Youth Development, 20(32), Cheung, S. D., Lee, J. B., Park, H. B., Kim, J. S., Bai, D. S., Lee, K. H., et al. (200). A study on reliability and validity of the Korean version of spiritual well being scale. Journal of Korean Neuropsychiatric Association, 40(2), Choi, S. O., Kim, S. N., Shin, K. I., Lee, J. J., & Jung, Y. J. (2005). Development of meaning in life scaleⅡ. Journal of Korean Academy of Nursing, 35(5), Crockett, L. J., & Petersen, A. C. (993). Adolescent development: Health risks and opportunities for health promotion. In S. G. Millstein, A. C. Peterson, & E. O. Nightingale (Eds.), Promoting the health of adolescents: New directions for the twenty-first century (pp.3-27). New York, NY: Oxford University Press. Faul, F., Erdfelder, E., Lang, A. G., & Buchner, A. (2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39(2), Haase, J. E. (2004). The adolescent resilience model as a guide to interventions. Journal of Pediatric Oncology Nursing, 2(5), ;discussion, Hart, D., & Schneider, D. (997). Spiritual care for children with cancer. Seminars in Oncology Nursing, 3(4), Hendricks-Ferguson, V. (2006). Relationships of age and gender to hope and spiritual well-being among adolescents with cancer. Journal of Pediatric Oncology Nursing, 23(4), Hendricks-Ferguson, V. (2008). Hope and spiritual well-being in adolescents with cancer. Western Journal of Nursing Research, 30(3), Hockenberry-Eaton, M., Dilorio, C., & Kemp, V. (995). The relationship of illness longevity and relapse with self-perception, cancer stressors, anxiety, and coping strategies in children with cancer. Journal of Pediatric Oncology Nursing, 2(2), Jeon, B. J. (974). Self-esteem: A Test of Its Measurability. Yonsei Journal,, Kang, K. A., Kim, S. J., & Song, M. K. (2009). Relationship of self-esteem, meaning in life, and spiritual well-being in middle school students. Journal of Korean Academy of Child Health Nursing, 5(4), 백혈병경험청소년의생의의미에영향을미치는요인

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Journal of Educational Innovation Research 2016, Vol. 26, No. 2, pp DOI: * The Mediating Eff

Journal of Educational Innovation Research 2016, Vol. 26, No. 2, pp.159-177 DOI: http://dx.doi.org/10.21024/pnuedi.26.2.201608.159 * The Mediating Effects of Self-esteem on the Relationship between Social