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응급실 간호사의 업무중단 정도 및 관련요인

Title
응급실 간호사의 업무중단 정도 및 관련요인
Other Titles
The Degree of Work Interruption and Related Factors of Emergency Department Nurse
Authors
권용은
Issue Date
2020
Department/Major
임상보건융합대학원 임상간호학전공
Publisher
이화여자대학교 임상보건융합대학원
Degree
Master
Advisors
김미영
Abstract
응급실 간호사는 내원한 환자들에게 신속하고 정확한 간호를 수행해야 하지만 다양한 증상의 환자를 돌보는 과정에서 업무중단이 필수적으로 발생하므로, 업무중단 정도가 어느 정도인지 확인하는 것은 효율적인 업무수행을 위해 중요하다. 이에 본 연구는 응급실 간호사를 대상으로 업무중단 정도 및 관련요인을 파악하기 위하여 시도되었다. 연구대상은 서울 소재 종합병원 권역응급의료센터의 성인응급실에 근무하는 일반 간호사 23명을 대상으로 하였으며, 자료 수집은 2019년 8월 1일부터 9월 10일까지 실시하였다. 연구보조원은 4학년 간호대생 2명이 측정훈련을 받은 후, 주중과 주말을 포함하여 낮번과 초번시간에 1회 4시간, 총 30회를 관찰하여 자료를 수집하였다. 업무중단 정도는 Cole 등(2015)의 업무중단에 대한 관찰일지와 박정호 등(2000)의 한국 표준간호행위 분류를 참조하여 연구자가 제작하였다. 업무중단의 유무와 대상자의 업무시작, 업무중단, 업무재개, 업무종료시간을 stopwatch로 측정하여 업무중단의 빈도, 비율 및 업무중단 관련요인을 측정하였다. 수집된 자료는 IBM SPSS Statistics 22.0 프로그램을 이용하여 빈도와 백분율, 평균과 표준편차, t-test, χ2-test, ANOVA로 분석하였고, 사후검정은 Scheffé test로 분석하였다. 본 연구결과는 다음과 같다. 1. 응급실 간호사의 업무중단 빈도는 120시간 동안 736회로, 시간 당 6.3회였다. 업무중단 비율은 간호업무 소요시간과 업무중단 소요시간의 비(A/B)를 산출한 결과 9.1%를 나타냈다. 업무중단이 없을 경우 실제간호업무 평균소요시간은 1.78±1.79분이었지만, 업무중단이 있을 경우 2.52±1.90분으로 나타나 업무중단 여부에 따라 실제간호업무 소요시간이 유의하게 증가하였다(t=8.76, p<.001). 즉 간호업무 중 상담 및 교육(t=2.73, p=.008), 안전(t=5.81, p<.001), 환자간호 관리 및 정보관리(t=3.38, p=.001)에서 실제간호업무 소요시간이 유의하게 더 늘어났다. 2. 응급실 간호사의 업무중단 요인은 의사소통 455회(55.2%), 기타 141회(17.1%), 기계의 알람 115회(14.0%), 전화 72회(8.7%), 환자상태의 변화 41회(5.0%) 순이었다. 의사소통 요인으로 환자 및 보호자와의 의사소통(41.3%), 간호사(40.9%), 타 의료진(17.8%)의 순이었으며, 기타요인으로 물품준비(46.8%), 빠뜨린 간호업무(38.3%), 약품준비(7.1%), 환경문제(5.0%), 장비문제(2.8%) 순이었다. 3. 환자의 중증도에 따른 업무중단 빈도는 한국형 중증도 분류(KTAS) 3단계 523회, 2단계 118회, 4단계 124회로 유의한 차이를 나타냈다(χ2=32.94, p<.001). 환자의 중증도에 따른 업무중단 소요시간은 KTAS 2단계(73.98분), 3단계(284.78분), 4단계(65.02분)간에 유의한 차이를 나타냈다(F=4.02, p=.018). 환자의 중증도에 따른 실제간호업무 소요시간은 KTAS 2(889.27분), 3단계(2577.80분)가 4단계(792.35분)보다 실제간호업무 소요시간이 유의하게 더 길게 나타났다(F=9.58, p<.001). 환자의 중증도에 따른 업무중단 요인은 환자 및 보호자와의 의사소통(χ2=9.48, p=.009), 간호사와의 의사소통(χ2=10.91, p=.004), 기계의 알람(χ2=23.94, p<.001), 기타요인(χ2=6.02, p=.049)에 유의한 차이를 나타냈다. 4. 간호사의 업무에 따른 업무중단 빈도는 투약(285회), 환자 간호관리 및 정보관리(228회), 안전(155회)이 높았고, 유의한 관련성을 나타냈다(χ2=79.86, p<.001). 간호사의 업무에 따른 업무중단 소요시간은 유의한 차이를 나타냈으며(F=4.60, p<.001), 투약(152.45분)이 높게 나타났다. 간호업무에 따른 실제간호업무 소요시간은 투약(1584.12분)이 가장 높았으며, 배설간호(434.08분)에서 유의하게 높게 나타났다(F=113.19, p<.001). 간호사의 업무에 따른 업무중단 요인은 환자 및 보호자와의 의사소통(χ2=18.29, p=.011), 간호사와의 의사소통(χ2=26.02, p<.001), 전화(χ2=34.68, p<.001), 기타요인(χ2=73.02, p<.001)에 유의한 차이를 나타냈다. 이상의 연구결과, 응급실 간호사의 업무중단 빈도는 시간당 6.3회, 비율로는 9.1%를 차지하였으며, 업무중단의 주요요인으로 의사소통이 가장 높게 나타났다. 또한 KTAS 2,3단계가 4단계보다 업무중단 정도가 더 높았으며, 간호사의 업무 중에는 투약, 안전의 업무에서 업무중단 정도가 더 높게 나타났다. 따라서 응급실 내 환자의 중증도가 더 높은 단계에서 투약의 업무를 할 때 환자와 보호자 및 동료 간호사 간의 의사소통 요인에 의해 업무가 중단되므로 특히 간호사들 간에 효율적인 의사소통 방안이 강구되어야 응급실에서의 업무중단 정도가 완화될 수 있을 것이다. ;Emergency department nurses(ED) are required to perform prompt and accurate care to visiting patients, but interruptions are essential in the care of patients with various symptoms. It is important for ED nurses to confirm the degree of work interruption for efficient work performance. This study analyses the degree of interruptions to care provided by nurses and related factors. This study examined 23 ED nurses at the adult room of regional emergency medical center of general hospital in Seoul, Korea. Data was collected from 1th August to 10th September. Observations were done in 4 hours, total 30 times dedicated observation shifts that were randomized by weekday versus weekend, and by time of day versus evening, after the research assistants received the measurement training of two fourth grade nursing college students. This researcher made on the basis of a tool which was obtained through documentary consideration that was observation log by Cole et al.,(2015) and the classification of standard nursing activities in Korea (2000). Data was collected by using the structured questionnaire and stopwatch, including frequency of work interruption, time of start, interruption, resume and end on nursing intervention. It surveyed frequency, rate of work interruption and related factors while delivering care to patients. The collected data was analyzed using IBM SPSS Statistics 22.0 as well as descriptive statistics, t-test, χ2-test, ANOVA and Scheffé test. The study finding are follows; 1. The frequency of interruptions for ED nurses was 736 times over 120 hours, 6.3 times per hour. The ratio of work interruption was 9.1% by calculating the ratio (A/B) of the duration of nursing and interruption. The average time spent on uninterrupted nursing work was 1.78minutes (SD:1.79), while interrupted nursing work took 2.52minutes (SD:1.90). If there is a work interruption, the real time of nursing has significantly increased(t=8.76, p<.001). The real time of nursing on education and consultation(t=2.73, p=.008), safety management(t=5.81, p<.001), patient care management & information management (t=3.38, p=.001) were has significantly increased if there is interrupted. 2. The factors that caused ED nurses interrupted were communication 455 times(55.22%), the other 141 times(17.1%), the alarm 115 times (14.0%), the telephone 72 times(8.7%) and the patient status 41 times (5.0%). Among the communication factors were communication with patients and family(41.3%), nurses(40.9%) and other medical staff (17.8%). Other factors include preparation of goods(46.8%), missing nursing(38.3%), preparation of drugs(7.1%), environmental issues (5.0%), and equipment problems (2.8%). 3. The frequency of work interruption according to the severity of the patient was found to be significantly difference in KTAS 3(523times), KTAS 2(118times) and KTAS 4(124times)(χ2=32.94, p<.001). The average time spent on interruption of nursing was significantly difference between KTAS 2(73.98minutes), KTAS 3(284.79minutes) and KTAS 4(65.02minutes). The length of nursing intervention(excluding the length of the interruption) was KTAS 2(889.27minutes) and KTAS 3(2577.80minutes) significantly longer, than KTAS 4(792.35minutes)(F=9.58, p<.001). The factor of interruption according to the severity of the patient indicated significant difference in communication with patients and family(χ2=9.48, p=.009), communication with nurses(χ2=10.91, p=.004), alarm of the machine(χ2=23.94, p=.001), other factors(χ2=6.02, p=.049). 4. The frequency of work interruptions by nursing intervention was found to be significant difference in medication(285 times), patient care management & information management(228 times), safety management(155 times)(χ2=79.86, p<.001). It was significantly difference on the average time spent on interruption of nursing(F=4.60, p<.001) and medication was most long (152.45minutes). The length of nursing intervention(excluding the length of the interruption) was most long during medication(1584.12minutes) but elimination care(434.08minutes) was significantly difference(F=113.19, p<.001). The factor of interruption according to the nursing intervention indicated significant difference in communication with patients and family(χ2=18.29, p=.011), communication with nurses(χ2=26.02, p<.001), telephone(χ2=34.68, p<.001)and other factors(χ2=73.02, p<.001). Based on the findings above, the frequency of the ED nurses' work interruption was 6.3 times per hour and 9.1% in rate and the major factors of work interruption were communication factors. This research demonstrated the degree of interruption that the degree of interruptions is higher KTAS 2,3 than KTAS 4 and medication, safety management is higher than other nursing interventions. This research revealed that work interruption of ED nurses happened while delivering medication to the patient with more severity. Therefore, it seems necessary to improve the efficient communication skill with patient/family and nurses (especially nurses) for reducing unnecessary work interruption.
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