입원환자가 인식한 환자중심간호가 환자경험에 미치는 영향

Abstract

본 연구는 상급종합병원에 입원한 환자가 인식하는 환자중심간호와 환자경험정도를 파악하고 환자중심간호가 환자경험에 미치는 영향을 파악하기 위한 서술적 조사연구로 환자중심간호 향상을 위한 기초자료를 제공하고자 시도되었다. 연구대상은 서울시 소재 A병원에 입원하고 있는 환자 147명이며, 자료 수집은 2021년 10월 12일부터 10월 24일까지 실시되었다. 연구 도구로 사용된 환자중심간호는 Suhonen (2000)이 환자를 대상으로 개발한 도구를 양인숙(2008)이 번안한 도구를 사용하였고 도영경 등(2015)이 개발하고 건강보험심사평가원에 귀속된 환자경험평가 문항을 도구로 사용하였다. 수집된 자료는 IBM SPSS Statistics 26.0 프로그램을 이용하여 기술통계, t-test, ANOVA, Scheffé test, Welch’s F, Dunnett’s T3, Pearson’s correlation coefficient, Multiple linear regression으로 분석하였다. 본 연구의 결과는 다음과 같다. 1. 연구대상자의 환자중심간호는 5점 만점에 평균 3.78±0.60점이었고, 환자중심간호의 하위요인 중 환자중심간호 제공에 대한 인식은 3.68±0.69점, 환자중심간호 반영에 대한 인식은 3.89±0.59점이었다. 연구대상자의 환자경험은 100점 만점에 평균 84.46±13.83점이었으며, 환자경험의 하위요인은 간호사 영역 89.81±15.03점, 병원 환경 86.14±18.46점, 투약 및 치료과정 83.71±17.12점, 전반적 평가 83.44±11.73점, 의사 영역 82.60±19.19점, 환자권리보장 81.56±19.06점 순이었다. 2. 연구대상자의 일반적 특성 및 질병 관련 특성에 따른 환자경험은 대상자의 최종학력에 따라 환자경험 총점(F=4.728, p=.004), 간호사 영역(F=5.298, p=0.003), 의사 영역(F=4.431, p=.009), 환자권리보장(F=4.297, p=.010)에 유의한 차이를 나타냈다. 병원환경은 최종학력(F=4.398, p=.009), 진료과(F=3.435, p<.001), 재원기간(F=5.161, p=.008), 간호·간병통합서비스 병동 재원 여부(t=5.979, p<.001)에 따라 유의한 차이를 나타냈다. 3. 환자중심간호와 환자경험 간에 유의한 상관관계가 있었으며(r=.662, p<.001), 환자중심간호와 환자경험의 하위 영역인 간호사 영역(r=.527, p<.001), 의사 영역(r=.430, p<.001), 투약 및 치료 과정(r=.693, p<.001), 병원환경(r=.318, p<.001), 환자권리보장(r=.535, p<.001), 전반적 평가(r=.675, p<.001) 간에도 유의한 양의 상관관계를 나타냈다. 4. 환자중심간호에 따른 환자경험의 회귀모형을 검증한 결과, F=56.868(p<.001)로 유의한 차이가 있었으며 43.4%의 설명력을 나타냈다. 본 연구의 결과 환자경험에 영향을 미치는 변인은 환자중심간호이었으므로 환자경험 증진을 위해 환자중심간호에 대한 간호사 대상 교육과 직접간호시간 증진 및 간호전달체계 보완과 같은 처우개선의 필요성을 제시하였다.;Recently, the patient satisfaction questionnaire has been replaced by the patient experiences questionnaire as the latter makes it possible to measure actual patient-centeredness in medical service. Furthermore, it has been proved that patient-centered care had an impact on patient satisfaction. Therefore, the purpose of this study was to identify patients’ perception of patient-centered care, their experience in hospitals, and the relationship between the two. Data were collected from 147 inpatients from a general hospital in Seoul, South Korea through written questionnaires between October 12 – 24, 2021. IBM SPSS Statistics version 26.0 was used to analyze the respondents’ general characteristics, disease-related characteristics, as well as their perception of patient-centered care, and their experience. The collected data were analyzed using descriptive statistics, t-test, ANOVA, Scheffé test, Welch’s ANOVA, Dunnett’s test, Pearson’s correlation coefficient, and a multiple linear regression. The findings of this study are as follows. 1. The mean scores were 3.788±0.60 for the patient-centered care, 3.68±0.69 for the specific nursing interventions(Individualized Care Scale-A, ICS-A), and 3.89±0.59 for how they perceive individuality in their own scale(Individualized Care Scale-B, ICS-B), out of 5. The mean scores were 84.46±13.83 for patients’ experience, 89.81±15.03 for the nurses’ area, 86.14±18.46 for the hospital environment, 83.71±17.12 for the medication and treatment process, 83.44±11.73 for the overall estimation, 82.60±19.19 for the doctoral area, and 81.56±19.06 for the patient’s rights, out of 100. 2. Among the patients’ general and disease-related characteristics, education level had a significant difference on patient’s experience (F=4.728, p=.004), nurses’ area (F=5.298, p=0.003), doctoral area (F=4.431, p=.009), and patients’ rights (F=4.297, p=.010). Education level (F=4.398, p=.009), unit (F=3.435, p<.001), length of stay (F=5.161, p=.008), and whether it was an integrated nursing care service (t=5.979, p<.001) had significant differences on hospital environment. 3. Patient-centered care was positively correlated with patients’ experience (r=.662, p<.001), nurses’ area (r=.527, p<.001), doctoral area (r=.430 =, p<.001), medication & treatment process (r=.693, p<.001), hospital environment (r=.318, p<.001), patients’ right (r=.535, p<.001), and overall evaluation (r=.675, p<.001). 4. The factor which had a significant impact on patients’ positive experience was patient-centered care. The level of power was 43.4% and the regression model was statistically significant (F=56.868, p<.001). This finding shows that patients’ experience is preceded by patient-centered care. Therefore, to promote patient’s experience, spotlighted as a medical institute evaluation tool, our results suggest that efforts should be made to raise nurses’ awareness of patient-centered care and organizational support for nursing work environment. Therefore, improvement in supplementing the patient-centered delivery system, nurse education for patient-centered care, and sufficient time between nurse and patient is necessary.