[학위논문]토피어리요법이 경도인지장애를 가진 요양병원 노인의 인지기능, 우울 및 일상생활활동에 미치는 효과 Effects of Topiary Intervention on Cognitive Function, Depression and Activities of Daily Living among Elderly people with mild cognitive impairment원문보기
본 연구는 경도인지장애 노인을 위한 토피어리요법을 개발하고 그 효과를 확인하기 위해 시도되었다. 토피어리요법은 Lewin의 장이론을 기반으로 성공경험, 대리경험, 언어적 설득 및 정서조절의 네 가지 전략을 적용하여 ADDIE모형에 따라 총 다섯 단계의 절차를 거쳐 체계적으로 개발되었다. 개발된 토피어리요법의 효과를 검증하기 위해 비동등성 대조군 사전·사후 설계를 수행하였다. 본 연구에 참여한 대상자는 실험군 21명, 대조군 22명으로 실험군에게는 토피어리요법을 주 2회 5주 동안 총 10회 수행하였다. 실험군과 대조군 모두 ...
본 연구는 경도인지장애 노인을 위한 토피어리요법을 개발하고 그 효과를 확인하기 위해 시도되었다. 토피어리요법은 Lewin의 장이론을 기반으로 성공경험, 대리경험, 언어적 설득 및 정서조절의 네 가지 전략을 적용하여 ADDIE모형에 따라 총 다섯 단계의 절차를 거쳐 체계적으로 개발되었다. 개발된 토피어리요법의 효과를 검증하기 위해 비동등성 대조군 사전·사후 설계를 수행하였다. 본 연구에 참여한 대상자는 실험군 21명, 대조군 22명으로 실험군에게는 토피어리요법을 주 2회 5주 동안 총 10회 수행하였다. 실험군과 대조군 모두 인지기능, 우울 및 일상생활활동을 평가하였다. 수집된 자료는 SPSS win 23.0 프로그램을 이용하여 분석하였다.
본 연구의 결과는 다음과 같다.
토피어리요법 개발 본 연구의 토피어리요법은 ADDIE모형의 분석, 설계, 개발, 적용 및 평가의 단계로 진행하였으며, 토피어리요법의 목표인 인지기능 향상, 우울감소, ADL의 향상을 달성하기 위해 성공경험, 대리경험, 언어적 설득 및 정서조절의 네 가지 전략을 적용하였다. 분석단계에서는 문헌고찰, 요구조사를 통한 토피어리요법의 기초자료를 분석하였으며, 설계단계에서는 연구 목적을 명확화 하였으며, 연구관련 자료의 수집과 유형․무형의 자원을 확인하였다. 개발단계에서는 세부 목표 설정, 중재 초안 개발, 전문가 협의, 예비검사 및 최종 중재 개발을 수행하였다. 위와 같은 과정을 통한 토피어리요법 초안은 예비검사와 전문가 타당도를 거쳐 최종 토피어리요법(주 2회. 5주. 12회. 60분/회)으로 개발되었다.
토피어리요법의 효과 가설 1. “토피어리요법을 적용한 실험군은 적용하지 않은 대조군에 비해 인지기능이 높을 것이다.”는 지지되었다. 중재 후 실험군은 대조군에 비해 인지기능이 유의하게 높았다(t=2.42, p=.020).
가설 2. “토피어리요법을 적용한 실험군은 적용하지 않은 대조군에 비해 우울이 낮을 것이다.”는 지지되지 않았다. 중재 후 실험군과 대조군의 우울은 유의한 차이가 없었다(t=.99, p=.328).
가설 3. “토피어리요법을 적용한 실험군은 적용하지 않은 대조군에 비해 일상생활활동이 낮을 것이다.”는 지지되지 않았다. 중재 후 실험군은 대조군에 비해 일상생활활동은 유의한 차이가 없었다(t=.44, p=.665). 단 실험군에서 중재 전에 비해 중재 후의 일상생활활동은 유의하게 향상되었다.
가설 4. “토피어리요법 종료 2주 후 토피어리요법을 적용한 실험군은 적용하지 않은 대조군에 비해 인지기능이 높을 것이다.”는 지지되었다. 토피어리요법 종료 2주 후 실험군은 대조군에 비해 인지기능이 유의하게 높았다(F=4.84, p=.016). 가설 5. “토피어리요법 종료 2주 후 토피어리요법을 적용한 실험군은 적용하지 않은 대조군에 비해 우울이 낮을 것이다.”는 지지되지 않았다. 토피어리요법 종료 2주 후 실험군과 대조군의우울은 유의한 차이가 없었다(F=1.85, p=.164).
가설 6. “토피어리요법 종료 2주 후 토피어리요법을 적용한 실험군은 적용하지 않은 대조군에 비해 일상생활활동이 낮을 것이다.”는 지지되었다. 토피어리요법 종료 2주 후 실험군은 대조군에 비해 일상생활활동이 유의하게 향상되었다(F=3.57, p=.033).
결론적으로 본 연구에서 토피어리요법은 요양병원 경도인지장애 노인의 인지기능과 일상생활활동을 증진시켰다. 하지만 우울에는 영향을 미치지 못한 것으로 볼 수 있다. 추후 토피어리요법의 내용 및 전략의 수정보완 및 중재기간 확대를 반영한 후속연구가 필요할 것으로 본다. 또한 본 토피어리요법의 경도인지장애 노인에 대한 효과 확인을 위해서 요양원, 주간보호센터, 재가기반의 다양한 노인을 대상으로 표본 수를 증가시킨 후속연구를 제언한다.
본 연구는 경도인지장애 노인을 위한 토피어리요법을 개발하고 그 효과를 확인하기 위해 시도되었다. 토피어리요법은 Lewin의 장이론을 기반으로 성공경험, 대리경험, 언어적 설득 및 정서조절의 네 가지 전략을 적용하여 ADDIE모형에 따라 총 다섯 단계의 절차를 거쳐 체계적으로 개발되었다. 개발된 토피어리요법의 효과를 검증하기 위해 비동등성 대조군 사전·사후 설계를 수행하였다. 본 연구에 참여한 대상자는 실험군 21명, 대조군 22명으로 실험군에게는 토피어리요법을 주 2회 5주 동안 총 10회 수행하였다. 실험군과 대조군 모두 인지기능, 우울 및 일상생활활동을 평가하였다. 수집된 자료는 SPSS win 23.0 프로그램을 이용하여 분석하였다.
본 연구의 결과는 다음과 같다.
토피어리요법 개발 본 연구의 토피어리요법은 ADDIE모형의 분석, 설계, 개발, 적용 및 평가의 단계로 진행하였으며, 토피어리요법의 목표인 인지기능 향상, 우울감소, ADL의 향상을 달성하기 위해 성공경험, 대리경험, 언어적 설득 및 정서조절의 네 가지 전략을 적용하였다. 분석단계에서는 문헌고찰, 요구조사를 통한 토피어리요법의 기초자료를 분석하였으며, 설계단계에서는 연구 목적을 명확화 하였으며, 연구관련 자료의 수집과 유형․무형의 자원을 확인하였다. 개발단계에서는 세부 목표 설정, 중재 초안 개발, 전문가 협의, 예비검사 및 최종 중재 개발을 수행하였다. 위와 같은 과정을 통한 토피어리요법 초안은 예비검사와 전문가 타당도를 거쳐 최종 토피어리요법(주 2회. 5주. 12회. 60분/회)으로 개발되었다.
토피어리요법의 효과 가설 1. “토피어리요법을 적용한 실험군은 적용하지 않은 대조군에 비해 인지기능이 높을 것이다.”는 지지되었다. 중재 후 실험군은 대조군에 비해 인지기능이 유의하게 높았다(t=2.42, p=.020).
가설 2. “토피어리요법을 적용한 실험군은 적용하지 않은 대조군에 비해 우울이 낮을 것이다.”는 지지되지 않았다. 중재 후 실험군과 대조군의 우울은 유의한 차이가 없었다(t=.99, p=.328).
가설 3. “토피어리요법을 적용한 실험군은 적용하지 않은 대조군에 비해 일상생활활동이 낮을 것이다.”는 지지되지 않았다. 중재 후 실험군은 대조군에 비해 일상생활활동은 유의한 차이가 없었다(t=.44, p=.665). 단 실험군에서 중재 전에 비해 중재 후의 일상생활활동은 유의하게 향상되었다.
가설 4. “토피어리요법 종료 2주 후 토피어리요법을 적용한 실험군은 적용하지 않은 대조군에 비해 인지기능이 높을 것이다.”는 지지되었다. 토피어리요법 종료 2주 후 실험군은 대조군에 비해 인지기능이 유의하게 높았다(F=4.84, p=.016). 가설 5. “토피어리요법 종료 2주 후 토피어리요법을 적용한 실험군은 적용하지 않은 대조군에 비해 우울이 낮을 것이다.”는 지지되지 않았다. 토피어리요법 종료 2주 후 실험군과 대조군의우울은 유의한 차이가 없었다(F=1.85, p=.164).
가설 6. “토피어리요법 종료 2주 후 토피어리요법을 적용한 실험군은 적용하지 않은 대조군에 비해 일상생활활동이 낮을 것이다.”는 지지되었다. 토피어리요법 종료 2주 후 실험군은 대조군에 비해 일상생활활동이 유의하게 향상되었다(F=3.57, p=.033).
결론적으로 본 연구에서 토피어리요법은 요양병원 경도인지장애 노인의 인지기능과 일상생활활동을 증진시켰다. 하지만 우울에는 영향을 미치지 못한 것으로 볼 수 있다. 추후 토피어리요법의 내용 및 전략의 수정보완 및 중재기간 확대를 반영한 후속연구가 필요할 것으로 본다. 또한 본 토피어리요법의 경도인지장애 노인에 대한 효과 확인을 위해서 요양원, 주간보호센터, 재가기반의 다양한 노인을 대상으로 표본 수를 증가시킨 후속연구를 제언한다.
This study was undertaken to develop topiary intervention for the elderly with mild cognitive impairment and to confirm its effectiveness. Based on Lewin's field theory, topiary intervention was systematically developed through five steps according to the ADDIE model using four strategies: exper...
This study was undertaken to develop topiary intervention for the elderly with mild cognitive impairment and to confirm its effectiveness. Based on Lewin's field theory, topiary intervention was systematically developed through five steps according to the ADDIE model using four strategies: experience of success, representative experience, linguistic persuasion, and emotional regulation. The effectiveness of topiary intervention was verified using a nonequivalent control group, and pre-design and post-design were both performed. There were 21 subjects in the experimental group and 22 in the control group in the study, and topiary intervention was administered to the experimental group twice a week for five weeks in total. Cognitive function, depression, and activities of daily living were evaluated in both groups. The collected data were analyzed using the SPSS Win 23.0 program. The results of this study are as follows. The Development of Topiary Intervention The topiary intervention in this study was employed following the ADDIE model’s stages of analysis, design, development, implementation, and evaluation. The goals of topiary intervention, which include improving cognitive function, reducing depression, and improving ADL, were achieved by applying four strategies: success experience, vicarious experience, verbal persuasion, and emotional control. In the analysis stage, the basic data of topiary intervention were analyzed through literature review and demand survey. In the design stage, the purpose of research was clarified, research-related data were collected, and both tangible and intangible resources were identified. The development stage involved detailed goal setting, intervention drafting, expert consultation, preliminary inspection, and final intervention. The draft of topiary intervention that was created through the above process was developed into the final topiary intervention (twice a week for five weeks; 12 times; 60 minutes per session) after preliminary examination and expert validity check.
The Effect of Topiary Intervention Hypothesis 1. The hypothesis, "The experimental group where topiary intervention was applied will show higher cognitive function than the control group where the intervention was not applied,” was supported. After the intervention, the cognitive function of the experimental group was significantly higher than that of the control group (t = 2.42, p = .020).
Hypothesis 2. The hypothesis, "The experimental group where topiary intervention was applied will show lower depression than the control group where the intervention was not applied,” was not supported. There was no significant difference in depression between the experimental and control groups after the intervention (t = .99, p = .328).
Hypothesis 3. The hypothesis, "The experimental group where topiary intervention was applied will show lower activities of daily living than the control group where the intervention was not applied,” was not supported. There was no significant difference in the activities of daily living between the experimental and control groups after the intervention (t = .44, p = .665). However, the activities of daily living among those in the experimental group after the intervention were significantly improved compared to those before the intervention.
Hypothesis 4. The hypothesis, "Two weeks after the topiary intervention, the experimental group where topiary intervention was applied will show higher cognitive function than the control group where the intervention was not applied,” was supported. Two weeks after the topiary intervention, the cognitive function of the experimental group was significantly higher than that of the control group (F = 4.84, p = .016).
Hypothesis 5. The hypothesis, "Two weeks after the topiary intervention, the experimental group where topiary intervention was applied will show lower depression than the control group where the intervention was not applied,” was not supported. Two weeks after the topiary intervention, there was no significant difference in depression between the experimental and control groups after the intervention (F = 1.85, p = .164).
Hypothesis 6. The hypothesis, "Two weeks after the topiary intervention, the experimental group where topiary intervention was applied will show lower activities of daily living than the control group where the intervention was not applied,” was supported. Two weeks after the topiary intervention, the activities of daily living of the experimental group was significantly higher than that of the control group (F = 3.57, p = .033).
In conclusion, topiary intervention improved cognitive function and activities of daily living in elderly people with mild cognitive impairment in this study. However, it can be seen that it did not affect depression. Future research that reflects the revision and supplementation of the content and strategies of the topiary intervention and the extension of the intervention period is necessary. We propose a follow-up study with an increased number of samples including various elderly people based in nursing homes, daycare centers, and home care to confirm the effect of the topiary intervention on the elderly with mild cognitive impairment.
Key Words : topiary, development of topiary intervention, mild cognitive impairment, the elderly in Long-Term Care Hospital
This study was undertaken to develop topiary intervention for the elderly with mild cognitive impairment and to confirm its effectiveness. Based on Lewin's field theory, topiary intervention was systematically developed through five steps according to the ADDIE model using four strategies: experience of success, representative experience, linguistic persuasion, and emotional regulation. The effectiveness of topiary intervention was verified using a nonequivalent control group, and pre-design and post-design were both performed. There were 21 subjects in the experimental group and 22 in the control group in the study, and topiary intervention was administered to the experimental group twice a week for five weeks in total. Cognitive function, depression, and activities of daily living were evaluated in both groups. The collected data were analyzed using the SPSS Win 23.0 program. The results of this study are as follows. The Development of Topiary Intervention The topiary intervention in this study was employed following the ADDIE model’s stages of analysis, design, development, implementation, and evaluation. The goals of topiary intervention, which include improving cognitive function, reducing depression, and improving ADL, were achieved by applying four strategies: success experience, vicarious experience, verbal persuasion, and emotional control. In the analysis stage, the basic data of topiary intervention were analyzed through literature review and demand survey. In the design stage, the purpose of research was clarified, research-related data were collected, and both tangible and intangible resources were identified. The development stage involved detailed goal setting, intervention drafting, expert consultation, preliminary inspection, and final intervention. The draft of topiary intervention that was created through the above process was developed into the final topiary intervention (twice a week for five weeks; 12 times; 60 minutes per session) after preliminary examination and expert validity check.
The Effect of Topiary Intervention Hypothesis 1. The hypothesis, "The experimental group where topiary intervention was applied will show higher cognitive function than the control group where the intervention was not applied,” was supported. After the intervention, the cognitive function of the experimental group was significantly higher than that of the control group (t = 2.42, p = .020).
Hypothesis 2. The hypothesis, "The experimental group where topiary intervention was applied will show lower depression than the control group where the intervention was not applied,” was not supported. There was no significant difference in depression between the experimental and control groups after the intervention (t = .99, p = .328).
Hypothesis 3. The hypothesis, "The experimental group where topiary intervention was applied will show lower activities of daily living than the control group where the intervention was not applied,” was not supported. There was no significant difference in the activities of daily living between the experimental and control groups after the intervention (t = .44, p = .665). However, the activities of daily living among those in the experimental group after the intervention were significantly improved compared to those before the intervention.
Hypothesis 4. The hypothesis, "Two weeks after the topiary intervention, the experimental group where topiary intervention was applied will show higher cognitive function than the control group where the intervention was not applied,” was supported. Two weeks after the topiary intervention, the cognitive function of the experimental group was significantly higher than that of the control group (F = 4.84, p = .016).
Hypothesis 5. The hypothesis, "Two weeks after the topiary intervention, the experimental group where topiary intervention was applied will show lower depression than the control group where the intervention was not applied,” was not supported. Two weeks after the topiary intervention, there was no significant difference in depression between the experimental and control groups after the intervention (F = 1.85, p = .164).
Hypothesis 6. The hypothesis, "Two weeks after the topiary intervention, the experimental group where topiary intervention was applied will show lower activities of daily living than the control group where the intervention was not applied,” was supported. Two weeks after the topiary intervention, the activities of daily living of the experimental group was significantly higher than that of the control group (F = 3.57, p = .033).
In conclusion, topiary intervention improved cognitive function and activities of daily living in elderly people with mild cognitive impairment in this study. However, it can be seen that it did not affect depression. Future research that reflects the revision and supplementation of the content and strategies of the topiary intervention and the extension of the intervention period is necessary. We propose a follow-up study with an increased number of samples including various elderly people based in nursing homes, daycare centers, and home care to confirm the effect of the topiary intervention on the elderly with mild cognitive impairment.
Key Words : topiary, development of topiary intervention, mild cognitive impairment, the elderly in Long-Term Care Hospital
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