상급 종합병원 간호사의 비판적 사고성향과 임상 의사결정능력이 환자안전역량에 미치는 영향

Abstract

The purpose of this study was to examine registered nurses’competency in terms of patient safety. The nurses included in the study worked in a tertiary hospital. Moreover, the study analyzed the effects of the nurses’critical thinking disposition and clinical decision making on patient safety. The data was collected from April 21, 2016 to May 6, 2016 in a general hospital located in Seoul, Korea. The subjects of the study included 190 nurses who had more than a year of work experience. The subjects were instructed to fill up a questionnaire, which was used as a study instruments. To assess the critical thinking disposition, the critical thinking disposition measurement developed by Yun (2004) was used in the study. To assess clinical decision making, the Clinical Decision Making in Nursing Scale developed by Jenkins (1985) and translated and revised by Baek (2005) was implemented. Furthermore, patient safety competency was evaluated by using the instrument that was developed by Lee (2012) and revised by Jang (2013) nurses in Korea. The collected data was analyzed through descriptive statistics, t-test, ANOVA, Scheffe test, Pearson’s correlation coefficient, and Multiple Linear Regression using SPSS 21.0. The results of the study were the following. 1. General characteristics of the subjects and patient safety related experience A total of 190 subjects participated in the study. Their average age was 29.05±4.97 years old. Majority of the subjects were women (96.8%), single (70.5%), and college graduates (70.5%). The average length of their clinical career was about 6 years and 10 months and 84.2% of the subjects was general nurses. About 98.9% of the subjects received education on patient safety. The patient safety education program included medication nursing, transfusion (13.2%), and fall (13.1%). Other areas that required further education were report system and classification of patient safety accident (22.7%) followed by high risk medication (12.9%). 73.2% of the subjects reported previous experience in patient safety accident. The methods considered as the most effective for patient safety education were simulation (31.1%) and case study (28.4%). 2. Subjects’patient safety competency The subjects’patient safety competency garnered an average of 4.02±0.44 points out of 5. In terms of subcategory, attitude obtained the highest score (4.08±0.43 points), followed by technique (4.06±0.59 points) and knowledge (3.71±0.68 points). Regarding patient safety competency depending on the subjects’ general characteristics, the patient safety competency was shown to be higher among the nurses who were older, married, had longer clinical career, and had higher position. According to the analysis of the general characteristics and subcategories of patient safety competence, there was no significant difference in most groups in terms of attitude; however, technique and knowledge were statistically and significantly higher among nurses who were older, married, had longer clinical career, and had higher position. The patient safety competency depending on the subjects’experience was statistically and significantly higher among the nurses who: had more experience in completing patient safety education; experienced patient safety accident; reported many times when a patient had accidents; experienced patient safety related tasks; and experienced hospital evaluation several times. 3. Analysis of the factors that affect the subjects’patient safety competency In consideration of the subjects’general characteristics under controlling patient safety related experience, the factors that significantly affected the subjects’patient safety competency were clinical decision making (β=.422, p=<.001) and critical thinking disposition (β=.143, p=.033). Furthermore, significant relationship was shown among the following: more than twice the hospital evaluation; more than six times of patient safety education; and experience in patient safety accident. The results of the study verified that both critical thinking disposition and clinical decision making had significant effects on patient safety competency. Therefore, it is necessary to develop an educational program that can develop critical thinking disposition stressing importance in patient safety competence and reinforce attitude and technique for effective clinical decision making. Accordingly, necessary supporting policies should be provided.;본 연구는 상급 종합병원에 근무하는 임상 간호사의 환자안전역량의 정도를 알아보고, 비판적 사고성향과 임상 의사결정능력이 환자안전역량에 미치는 영향을 분석하는 서술적 조사연구이다. 자료 수집은 2016년 4월21부터부터 5월6일까지 서울시에 소재한 상급 종합병원에 근무하는 경력 1년 이상 된 임상간호사 190명을 대상으로 시행되었다. 연구도구는 자가 보고식 설문지를 사용하였으며 간호사의 비판적 사고성향은 윤진(2004)이 개발한 비판적 사고성향 측정도구를 사용하였고, 간호사의 임상 의사결정능력은 Jenkins(1985)가 개발한 임상 의사결정능력 척도를 백미경(2005)이 번안, 수정한 도구로 측정하였으며, 환자안전역량은 Lee(2012)가 개발한 환자안전역량 측정도구를 장해나(2013)가 임상 간호사를 대상으로 수정한 도구를 사용하였다. 수집된 자료는 SPSS 21.0프로그램을 이용하여 기술통계, t-test, ANOVA, Scheffe test로 분석하였다. 환자안전역량, 비판적 사고성향, 임상 의사결정능력 간의 상관관계는 Pearson’s correlation coefficient를 이용하였고 간호사의 환자안전역량에 미치는 영향요인을 확인하기 위해 Multiple Linear Regression을 이용하여 분석하였다. 본 연구의 결과는 다음과 같다. 1. 대상자의 일반적 특성 및 환자안전관련 경험 대상자는 총 190명으로 평균 연령은 29.05±4.97세였고, 여성의 비율이 높았고(96.8%), 미혼이 많았으며(70.5%), 최종학력은 학사가 70.5%으로 가장 많았다. 총 임상경력은 평균 약 6년10개월이었고, 일반 간호사가 84.2%이었다. 환자안전에 관한 교육을 받은 대상자는 98.9%였고, 이수한 환자안전 교육내용은 투약간호 및 수혈(13.2%), 낙상(13.1%) 순이었으며, 추가교육이 필요하다고 생각되는 환자안전교육내용은 환자안전사고 보고체계 및 분류(22.7%), 고위험 약물(12.9%) 순이었다. 73.2%가 환자안전사고를 경험했고, 가장 효과적이라고 생각하는 환자안전교육방법은 시뮬레이션(31.1%), 사례연구(28.4%) 순이었다. 2. 대상자의 환자안전역량 대상자의 환자안전역량은 5점 만점에 평균 4.02±0.44점이었고, 영역별로는 태도영역이 4.08±0.43점으로 가장 높았으며 기술영역은 4.06±0.59점이었고, 지식영역은 3.71±0.68점 순으로 가장 낮았다. 대상자의 일반적 특성에 따른 환자안전역량의 차이를 살펴보면 환자안전역량은 연령이 많고, 기혼인, 임상경력이 많은, 직위가 높은 간호사에게서 통계적으로 유의하게 높게 나타났다. 대상자의 환자안전관련 경험에 따른 환자안전역량의 차이에서는 환자안전 교육이수 횟수가 많고, 환자안전 사고 경험이 있거나, 환자안전사고 발생 시 보고 횟수가 많은, 환자안전 업무를 경험한 경우, 의료기관 인증평가 경험이 많은 간호사에게서 통계적으로 유의하게 높은 것으로 나타났다. 3. 대상자의 환자안전역량에 미치는 영향요인 분석 대상자의 일반적 특성과 환자안전관련 경험을 통제한 상태에서 환자안전역량에 통계적으로 유의하게 영향을 미치는 것으로 나타난 요인은 임상 의사결정능력(β=.422, p=<.001)과 비판적 사고성향(β=.143, p=.033)으로 나타났다. 그 외에도 의료기관 인증평가 경험 2회 이상, 환자안전교육 경험 6회 이상과 환자안전 사고 경험 있음이 유의한 관계가 있는 것으로 나타났다. 이상의 연구결과를 통하여 비판적 사고성향과 임상 의사결정능력 모두 환자안전역량에 유의한 영향을 미치는 것을 확인하였다. 따라서 간호학부 교육과정 및 의료기관에서 간호사 개개인의 비판적 사고성향을 향상시키기 위해서는 환자안전역량의 지식영역을, 임상 의사결정능력을 향상시키기 위해서는 환자안전역량의 태도영역과 기술 영역을 강화시킬 수 있는 교육프로그램 개발과 지원정책 마련이 필요하다.