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일반병동과 특수병동 간호사간의 환자안전문화와 안전간호활동 비교연구

Title
일반병동과 특수병동 간호사간의 환자안전문화와 안전간호활동 비교연구
Other Titles
A Comparative Study on Patient Safety Culture and Safety Nursing Activities of General Ward Nurses and Special Ward Nurses
Authors
이영선
Issue Date
2016
Department/Major
임상보건과학대학원 임상간호학전공
Publisher
이화여자대학교 임상보건과학대학원
Degree
Master
Advisors
양숙자
Abstract
본 연구는 일반병동과 특수병동 간호사의 환자안전문화와 안전간호활동을 분석 비교하고 이와 관련된 인구사회학적 요인을 찾기 위한 서술적 조사연구이다. 자료수집은 2016년 1월 8일부터 1월 14일까지 하였으며, 연구대상자는 경기도 A시의 B 대학병원에서 근무하고 있는 간호사로 일반병동 90명, 특수병동 90명 총 180명을 선정하였다. 환자안전문화는 미국의 보건 질 관리 기구(Agency for Healthcare Research and Quality[AHRQ], 2001)에서 개발한 환자안전문화 측정도구 Hospital Survey on Patient Safety Culture(HSPSC)를 김정은 등(2007)이 한글로 번안한 도구를 사용하였고, 안전간호활동은 의료기관평가인증원(Korea Institute for Healthcare Accreditation[KOIHA], 2014)에서 개발한 의료기관인증 조사기준의 환자안전 간호업무 관련 문항 중 본 연구 목적에 적합한 문항을 선택하여 측정하였다. 수집된 자료는 SPSS Window version 21.0을 이용하여 Chi-square, t-test, two way ANOVA로 분석하였다. 본 연구의 결과는 다음과 같다. 1. 환자안전문화는 총 5점 만점에 3.42±.29로 나타났으며, 일반병동은 3.53±.28, 특수병동은 3.30±.26으로 나타나 환자안전문화는 특수병동보다 일반병동에서 더 긍정적으로 나타났다. 환자안전문화의 하위영역 중에서는 의료과오 보고의 빈도에 대한 영역이 4.15±.61로 가장 높게 나타났고, 의료과오 자가 보고빈도에 대한 영역에서는 1.86±.78로 가장 낮게 나타났다. 하위영역 중에서 일반병동과 특수병동에서의 차이는 의료과오 자가보고빈도 영역을 제외한 모든 영역에서 유의하게 나타났다. 2. 병동 유형과 인구사회학적 특성에 따른 환자안전문화는 인구사회학적 특성 중 사고예방 우선순위(F=2.520, p=.043), 환자안전위원회 인지(F=4.280, p=.040)에서 유의하였다. 병원차원의 협조를 사고예방 우선순위를 둔 간호사와 환자안전위원회를 인지 하고 있는 간호사가 환자안전문화에 대해 더 긍정적인 것으로 나타났다. 병동유형과 인구사회학적 특성에 따른 환자안전문화의 상호작용 효과는 모두 유의하지 않은 것으로 나타났다. 3. 안전간호활동은 총 5점 만점에 4.47±.44로 나타났으며 일반병동은 4.61±.41, 특수병동은 4.31±.43로 나타났고, 특수병동 간호사보다 일반병동 간호사가 안전간호활동을 더 많이 수행하는 것으로 나타났다. 안전간호활동 하위영역에서 환자확인 영역이 4.61±.45로 가장 높았으며, 손 위생, 의료기기, 수술/시술, 낙상예방활동, 화재영역, 시설/환경, 의사소통 영역의 순으로 나타났다. 하위영역 중에서 일반병동 간호사와 특수병동 간호사에서의 차이는 모든 안전간호활동 하위영역에서 유의하게 나타났다. 4. 병동 유형과 인구사회학적 특성에 따른 안전간호활동의 상호작용효과는 병동유형과 주당 근무시간에서 유의한 것으로 나타났다(F=6.003, p=.015). 인구사회학적 특성 중에서는 연령(F=5.031, p=.002), 현병원 근무경력(F=3.117, p=.028), 현부서 근무경력(F=3.365, p=.037), 총 근무경력(F=4.625, p=.004), 환자안전위원회 인지(F=4.871, p=.029), 안전교육 경험횟수(F=2.770, p=.043)에서 유의한 것으로 나타났다. 환자안전위원회를 알고 있고, 안전교육 경험횟수가 많으며, 연령과 근무경력이 많은 간호사가 안전간호활동이 더 활발한 것으로 나타났다. 이상의 연구 결과를 종합해 볼 때, 환자안전문화 및 안전간호활동은 일반병동 간호사가 특수병동 간호사보다 높게 나타났다. 환자안전문화에는 환자안전위원회 인지와 사고예방 우선순위, 안전간호활동에는 연령, 근무경력, 환자안전위원회 인지, 안전교육 경험횟수가 인구사회학적 관련 요인으로 파악되었다. 따라서 환자안전문화 및 안전간호활동 증진을 위해서 본 연구에서 유의한 차이를 보인 관련요인들을 반영하여 임상현장에 맞는 교육자료의 개발 및 환자안전 교육 프로그램 적용이 필요하다.;This study is to identify patient safety culture, safety nursing activities, and its related socio-demographic characteristic factors among nurses in general ward and special ward. The data was collected from January 8th, 2016 to January 14th. The subjects were nurses working at a university hospital located in Kyeong-gi-do, “A” city. This study selected 90 nurses from general ward and 90 nurses from special ward, in total of 180. For patient safety culture, a patient safety culture measurement tool was used by Agency for Healthcare Research and Quality[AHRQ] (2001) and translated by Kim Jung-eun and others (2007) in Korean, was used. For safety nursing activities, questions related to patient safety nursing job in the Medical Institution Certification Standards developed by Korea Institute for Healthcare Accreditation [KOIHA] (2014) were used. Data were analyzed using SPSS Window version 21.0 program such as Chi-square, t‐test and two way ANOVA analysis. The results of the study are as follows; 1. Patient safety culture was found to be 3.42±.29 out of total 5 point. The general ward resulted in 3.53±.28, and special ward in 3.30±.26, which concludes that patient safety culture of general ward is more positive than that of special ward. Out of sub-areas of patient safety culture, medical malpractice report frequency was the highest as 4.15±.61 while medical malpractice self-report frequency was the lowest as 1.86±.78. Among sub-areas, difference between general ward and special ward was found in all sub-areas except number of events reported. 2. In patient safety culture according to ward type and socio-demographic characteristics, in perspective of ward demographic characteristics accident prevention priority (F=2.520, p=.043), whether to know about patient safety commission (F=4.280, p=.040) both have a primary effect. Nurses who put priority on hospital-wise cooperation and know about patient safety commission, had more positive patient safety culture than the nurses who did not know about patient safety commission. There was no significant difference in interaction effect. 3. Safety nursing activities was found to be 4.47±.44 out of 5. The general ward had score of 4.61±.41, while special ward was 4.31±.43, which shows that general ward nurses had more safety nursing activities than special ward nurses. In the sub-areas of safety nursing activities patient identification area had the highest score as 4.61±.45, in order of hand hygiene area, medical equipment area, operation/treatment area, fall prevention activities area, fire area, facility/environments area, and communication area. In all sub-areas of safety nursing activities, general ward nurses showed higher level of safety nursing activities than special ward nurses. 4. The subjects that are effective in safety nursing activities, according to ward type and socio-demographic characteristics, interaction effect ware shown in working hours per week only(F=6.003, p=.015). Major effects were found in age (F=5.031, p=.002) and current hospital working experience (F=3.117, p=.028) and current departments working experience (F=3.365, p=.037) and working experience (F=4.625, p=.004) and whether they know about patient safety commission (F=4.871, p=.029) and times of safety education (F=2.770, p=.043). Those who know about patient safety commission, who had more safety education, who are older and have longer working years nurses showed more lively safety nursing activities. As study results show that general ward nurses had higher points in most of sub-areas of patient safety culture and safety nursing activities than special ward nurses. The socio-demographic characteristics which presented differences in the patient safety culture were know about patient safety commission, the priority of accident prevention. The socio-demographic characteristics which presented differences in the safety nursing activities were age, work experience, know about patient safety commission, times of safety education. Therefore in order to promote patient safety culture and safety nursing activities of nurses, the variables that showed significant differences should be applied to development of educational materials in collaboration with clinical field and patient safety educational program.
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