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정신병동 간호사의 폭력경험과 자기표현, 소진과의 관계

Title
정신병동 간호사의 폭력경험과 자기표현, 소진과의 관계
Other Titles
A study on the correlation between violence experience, assertiveness and burnout of nurses working in psychiatric wards
Authors
윤유경
Issue Date
2010
Department/Major
대학원 간호과학과
Publisher
이화여자대학교 대학원
Degree
Master
Advisors
이광자
Abstract
최근 전 세계적으로 작업장의 폭력은 심각한 문제로 떠오르고 있다. 우리나라 병원종사자도 62.9%가 일을 하면서 폭언이나 폭행 및 성희롱 등을 경험한 것으로 나타났다. 특히 정신과의 경우 환자에 의한 폭력행동이 정신 병리로 이해되어 치료자가 공격당하는 것을 당연하게 여겨왔고, 이중 환자와 가장 가까이에서 많은 시간을 보내는 간호사가 흔한 공격 대상이 되었다. 이렇듯 폭력에 반복 노출되면 정신병동 간호사는 감당하기 어려울 정도의 스트레스로 인해 소진에 이르게 된다. 본 연구는 폭력으로 인한 정신병동 간호사의 소진을 줄이고, 예방하는 중재방안을 수립하기 위해 폭력경험, 자기표현, 소진과의 관계를 파악하고자 시도된 상관관계연구이다. 연구대상자는 서울·인천에 소재하는 대학병원 12곳에서 근무하는 임상경력 1년 이상인 정신병동 간호사 92명, 일반병동 간호사 112명으로 총 204명으로 자료수집은 2010년 4월 9일부터 4월 28일까지 구조화된 설문지로 조사를 시행하였다. 연구도구는 일반적 특성 15문항, 폭력유형에 따른 빈도 16문항, 자기표현(Assertiveness Scale) 30문항, 소진(Maslach burnout inventory) 22문항인 총 83문항으로 구성되었다. 조사된 자료는 SPSS 12.0K for Windows 통계프로그램을 이용하여 실수, 백분율 등의 서술통계와 t-test, ANOVA, Pearson's Correlation Coefficient, Scheffe's test로 분석하였다. 본 연구의 결과를 요약하면 다음과 같다. 1. 폭력경험은 정신병동 간호사가 일반병동 간호사보다 많았다. 정신병동 간호사는 환자에 의한 신체적 위협과 신체적 폭력 경험이 많은 반면, 일반병동은 보호자와 의사에 의한 언어적 폭력이 많은 것으로 나타났다. 2. 자기표현능력은 정신병동과 일반병동 간호사간에 차이가 없었다. 3. 소진정도는 정신병동 간호사에 비해 일반병동 간호사가 더 높았고, 특히 정서적 탈진, 비인격화, 대인관여에서 높게 나타났다. 4. 정신병동 간호사는 정신과 근무에 대한 만족도가 보통이거나 간호직을 가능한 빨리 그만두고 싶어 하는 집단에서 폭력경험과 소진이 높았고, 정신과를 원하지 않았는데 부서배치를 받은 집단에서 소진정도가 높았다. 자기표현 능력은 30-39세 또는 폭력상황에서도 평소와 같이 자기표현을 하는 집단에서 높았다. 5. 일반병동 간호사는 직위가 일반간호사 혹은 근무부서가 내·외과계 병동이거나 현 근무지에 대한 만족도가 보통인 집단에서 폭력경험이 더 많은 것으로 나타났다. 자기표현 능력은 현 근무부서의 근무를 원했거나, 폭력상황 시에도 평소와 같게 자기표현을 하는 집단에서 높게 나타났다. 소진은 20-29세, 미혼, 임상경력이 짧을수록, 내과계 병동 근무, 현 근무지에 대한 만족도가 낮을수록, 간호직을 그만두고 싶어 할수록 높게 나타났다. 6. 정신병동과 일반병동 간호사는 폭력경험이 적을수록, 자기표현성이 높을수록 소진이 낮은 것으로 나타났다. 본 연구 결과 정신병동 간호사의 폭력경험이 더 많았고, 특히 환자에게 신체적 위협, 신체적 폭력을 많이 경험하고 있었다. 이러한 폭력경험으로 인해 정신병동 간호사의 소진은 높아지고, 폭력경험이 적거나 자기표현 능력이 높을수록 소진 정도가 낮아지는 것을 알 수 있었다. 이에 정신병동 간호사의 소진을 감소시키기 위해서는 예측불허인 폭력상황을 줄이는 방법보다 폭력상황 시 자기표현 능력을 향상시키는 중재프로그램 개발이 필요하겠다.;Recently, violence in the workplace has emerged as a serious problem all over the world. In Korea, 62.9% of personnel working in hospitals have experienced the violence such as abuse, assault and sexual harassment. Especially for psychiatric department, violent actions by psychiatric patients are understood as psychopathology, taken for granted that therapists are attacked by the patients. Of the therapists, nurses that spend more time at a location closest to the patients become a common target. Repeated exposures to the violence, however, eventually result in burnout due to stresses that are difficult to handle. This study was conducted to investigate the correlation between violence experience, assertiveness and burnout of nurses working in psychiatric wards to reduce their burnout caused by the violence and to establish a preventive interventional measure. Subjects of this study were composed of a total of 204 nurses with clinical experience of at least one year, working at 12 university hospitals in the area of Seoul and Incheon: 92 nurses working in psychiatric wards and 112 nurses working in general wards. Data collection was conducted using a structured questionnaire from April 9, 2010 to April 28, 2010. The questionnaire was composed of a total of 83 questions: 15 questions on general characteristics, 16 questions on the frequency by violence type, 30 questions on assertiveness scale and 22 questions on Maslach burnout inventory. Data collected was analyzed with the SPSS 12.0K for Windows software using descriptive statistics such as percentage and real numbers, as well as t-test, ANOVA, Pearson's correlation coefficient, and Scheffe's test The results of this study can be summarized as follows. 1. Nurses working in psychiatric wards experienced more violence than nurses working in general wards. It was shown that physical threat and assault were higher in nurses working in psychiatric wards, whereas verbal abuse caused by the patient’s protectors and doctors was higher in nurses working in general wards. 2. No statistically difference in assertiveness was found between nurses working in psychiatric wards and nurses working in general wards. 3. Degree of burnout was higher in nurses working in general wards compared to nurses working in psychiatric wards, particularly higher in emotional exhaustion, depersonalization and interpersonal involvement. 4. In the case of nurses working in psychiatric wards, there was higher violence experience and burnout in a group with moderate work satisfaction or in a group that wants to quit as soon as possible. There was higher burnout in a group that was arranged in the psychiatric department as opposed to their wish. Assertiveness ability was higher in a group with an age of 30-39 years old or in a group that expressed assertiveness as usual even in a violent situation. 5. In the case of nurses working in general wards, there was higher violence experience in a group with job position of general nurse, a group that work in medical or surgical wards, or a group with moderate workplace satisfaction. Assertiveness ability was higher in a group that wished to work in the current workplace or in a group that expressed assertiveness as usual even in a violent situation. Burnout was higher in a group with an age of 20-29 years old, a group with unmarried status, a group with shorter clinical experience, a group working in medical wards, a group with higher workplace unsatisfaction and a group with higher desire to quit nursing. 6. It was shown that burnout of nurses working in psychiatric and general wards occurred fewer times when violence experience was low and assertiveness ability was high . As the results of this study, nurses working in psychiatric wards experienced more violence, especially physical threat and assault caused by patients. Their burnout increased due to the violence experience, whereas their burnout decreased as the violence experience was lower or assertiveness ability was higher. Therefore, to reduce burnout of nurses working in psychiatric wards, it is necessary to develop an intervention to improve their assertiveness ability in a violent situation rather than a method to reduce an unpredictable violent situation.
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