간호·간병통합서비스병동과 일반병동 간호사의 간호업무강도, 간호업무중단, 환자안전역량과 환자안전간호활동 비교

Abstract

This study is a descriptive research study to compare degrees of the nursing work intensity, the nursing work interruption, the patient safety competence, and the patient safety nursing activities of nurses working in the comprehensive nursing care service ward and the general ward and to identify an factor affecting the patient safety nursing activities. Data collection was conducted from 4-14 October 2023 through a convenience sample of 115 nurses in the comprehensive nursing care service ward and 116 nurses in the general ward working at A General Hospital, a senior general hospital in Seoul. As a study tool, the nursing work intensity measurement tool of clinical nurses developed by Mi Jin Seol (2022) and the nursing work interruption measurement tool developed by Eun-jeong Yu (2020) were used for the nursing work intensity and the nursing work interruption, respectively. In the case of the patient safety competences, the patient safety competence tool developed by Lee (2012) for nursing students was used after its modification and supplement by Jang Haena (2013), and in the case of the patient safety nursing activities, a tool developed Han Young-mi and Jung Myun Sook (2017) based on an assessment standard of the Korea Institute for Healthcare Accreditation (Standards for Accreditation and Assessment of Medical Institutions Ver. 2.0) was used. The collected data was analyzed using frequency, standard deviation, percentage and independent t-test, one-way ANOVA, Scheffe post-hoc test, Pearson’s correlation coefficients, and hierarchical multiple regression analysis for each variable through the SPSS 29.0 program. The results of this study are as follows. 1. The nursing work intensities were 3.42±.51 out of five points for the nurses in the comprehensive nursing care service ward and 3.83±.46 for those in the general ward, indicating that the score of those in the general ward was higher than that of those in the comprehensive nursing care service ward (t=-6.395, p=<.001). The nursing work interruptions were 3.07±.85 out of six points for the nurses in the comprehensive nursing care service ward and 3.98 ±.90 for those in the general ward, indicating that the latter had a higher score than the former (t=-7.861, p=<.001). The patient safety competences were 3.82±.39 out of five points for the nurses in the comprehensive nursing care service ward and 3.85 ± 0.34 for those in the general ward, showing no difference between the two (t=-0.513, p=.608). The patient safety nursing activities were 4.71±.40 out of five points for the nurses in the comprehensive nursing care service ward and 4.56±.41 for those in the general ward, indicating that the former had a higher score than the latter (t=2.890, p= .004). 2. In the case of the general ward, it was shown that the nurses with more than three years and less than five years of work experience in the current departments had more nursing work interruptions than ones with less than one year of work experience (F=2.988, p=.022). In the case of the comprehensive nursing care service ward, it was shown that the nurses with more than five years of total clinical experience had higher patient safety competences than ones with more than one year and less than five years of experience (F= 13.655, p=<.001), and the patient safety competences were higher when they had experiences in patient safety education (t=2.734, p=.007), patient safety work (t=2.441, p=.016), and hospital accreditation and assessment (t=2.336, p=.021). In the case of the general ward, it was shown that the nurses with total clinical experience of more than three years and less than five years and more than seven years had higher patient safety competences than ones with total clinical experience of more than one year and less than three years (F= 9.332, p=<.001), and ones with more than three years and less than five years of work experience in the current departments had higher patient safety competences than ones with more than one year and less than three years of experience (F=4.511, p=.002). In the case of the comprehensive nursing care service ward, it was shown that the nurses with more than seven years of total clinical experience had higher level of patient safety nursing activities than ones with more than one year and less than three years of experience, and ones with more than five years of experience were higher than ones with more than three years and less than five years of experience (F=3.004, p= .033). In addition, the nurses with the patient safety education experience showed higher level of patient safety nursing activities than ones without the education experience (t=3.511, p=<.001). In the case of the general ward, it was shown that the nurses with total clinical experience of more than seven years had higher level of patient safety nursing activities than ones with experience of more than one year and less than three years (F=3.789, p=.012), and ones with more than seven years of work experience in the current departments did higher level than ones with more than one year and less than three years of experience (F=6.855, p=<.001). 3. The patient safety nursing activities showed a positive correlation with the patient safety competences (r=.550, p=<.001). The nursing work interruptions also showed a positive correlation with the nursing work intensities (r=.497, p=<.001). In other words, this means that as the patient safety competences of nurses working in the comprehensive nursing care service ward and the general ward get higher, the level of the patient safety nursing activities appears higher, and as the frequency of the nursing work interruptions increases, the nursing work intensities appear higher. 4. Hierarchical multiple regression analysis was carried out to identify factors affecting the patient safety nursing activities of the nurses in the comprehensive nursing care service ward and the general ward. The ward types and the general characteristics were input into ModelsⅠand II, respectively, and the nursing work intensities, the nursing work interruptions, and the patient safety competences were input into Model Ⅲ. As a result of the study, it was shown that the patient safety competences (β=.564, p=<.001), the ward types (β=.238, p=<.001), and the work experience in the current departments (β=-.186, p=.016) were significant influencing factors. As a result of the study, it was shown that the patient safety competences (β=.564, p=<.001), the ward types (β=.238, p=<.001), and the work experience in the current departments (β=-.186 p=.016) were significant influencing factors. It was shown that explanatory power for the patient safety nursing activities was 3.5% (F=8.350, p=.004), 9.8% (F=3.497, p=<.001), and 35.2% (F=10.597, p=<.001) in Models Ⅰ, II, and III, respectively. As a result of this study, it was shown that the nurses in the comprehensive nursing care service ward had a higher level of patient safety nursing activities and a lower level of nursing work intensities and nursing work interruptions than ones in the general ward. It was found that the factors affecting the patient safety nursing activities were the patient safety competences, the ward types, and the work experience in the current departments. Therefore, it is important to enhance the patient safety competences of nurses in order to increase the level of the patient safety nursing activities in clinical practice, and it is necessary to differentiate and apply the patient safety education according to experience. In addition, it is necessary to expand application of the comprehensive nursing care service and to ease nurses' work intensities and minimize their work interruptions by arranging additional appropriate nursing personnel in the general ward and improving their working environment so that they can focus on patient safety. To this end, it is required to establish a system so that nurses can be appropriately arranged not on a medical institution level but on a national level.;본 연구는 간호·간병통합서비스병동과 일반병동 간호사의 간호업무강도,간호업무중단, 환자안전역량과 환자안전간호활동 정도를 비교하고, 환자안전간호활동에 영향을 미치는 요인을 파악하기 위한 서술적 조사연구이다. 자료 수집은 2023년 10월 4일부터 10월 14일까지 서울시 상급종합병원인 A종합병원에서 근무하는 간호·간병통합서비스병동 간호사 115명과 일반병동 간호사 116명을 편의표집하여 구조화된 설문지에 의해 자료를 수집하였다. 연구 도구로 간호업무강도는 설미진(2022)이 개발한 임상 간호사의 간호업무강도 측정 도구를 사용하였고, 간호업무중단은 유은정(2020)이 개발한 간호업무중단 측정 도구를 사용하였다. 환자안전역량은 Lee(2012)가 간호학생을 대상으로 개발한 환자안전역량 도구를 장해나(2013)가 간호사 대상으로 수정·보완한 도구를 사용하였고, 환자안전간호활동은 한영미, 정면숙(2017)이 의료기관평가인증원(의료기관인증평가기준집 Ver. 2.0)의 평가 기준을 토대로 개발한 도구를 사용하였다. 수집된 자료는 SPSS 29.0 프로그램을 이용하여 각 변수의 빈도, 표준편차, 백분율과 independent t-test, one-way ANOVA, Scheffé test 사후검정, Pearson’s correlation coefficient, 위계적 다중회귀분석을 이용하여 분석하였다. 본 연구의 결과는 다음과 같다. 1. 총 임상경력(χ2=13.464, p=.004), 현 부서 근무경력(χ2=14.540, p=.006)에서 간호·간병통합서비스병동과 일반병동 간호사 간의 차이가 있는 것으로 나타났다. 총 임상경력은 간호·간병통합서비스병동의 경우 5년 이상 7년 미만 간호사가 31.3%(36명)로 가장 많이 나타났고, 일반병동은 1년 이상 3년 미만 간호사가 38.8%(45명)로 가장 많이 나타났다. 현 부서 근무경력은 간호·간병통합서비스병동의 경우 3년 이상 5년 미만 간호사가 38.3%(44명)로 가장 많이 나타났고, 일반병동은 1년 이상 3년미만 간호사가 48.3%(56명)로 가장 많이 나타났다. 2. 간호업무강도는 5점 만점에 간호·간병통합서비스병동 간호사는 3.42±.51점, 일반병동 간호사는 3.83±.46점으로 일반병동 간호사가 간호·간병통합서비스병동 간호사보다 유의하게 높은 것으로 나타났다(t=-6.395, p=<.001). 간호업무중단은 6점 만점에 간호·간병통합서비스병동 간호사는 3.07±.85점, 일반병동 간호사는 3.98±.90점으로 일반병동 간호사가 간호·간병통합서비스병동 간호사보다 유의하게 높은 것으로 나타났다(t=-7.861, p=<.001). 환자안전역량은 5점 만점에 간호·간병통합서비스병동 간호사는 3.82±.39점, 일반병동 간호사는 3.85±.34점으로 두 집단 간의 차이는 없는 것으로 나타났다(t=-.513, p=.608). 환자안전간호활동은 5점 만점에 간호·간병통합서비스병동 간호사는 4.71±.40점, 일반병동 간호사는 4.56±.41점으로 간호·간병통합서비스병동 간호사가 일반병동 간호사보다 유의하게 높은 것으로 나타났다(t=2.890, p=.004). 3. 간호업무중단은 일반병동의 경우 현 부서 근무경력 3년 이상 5년 미만 간호사가 1년 미만 간호사보다 간호업무중단이 많은 것으로 나타났다(F=2.988, p=.022). 환자안전역량은 간호·간병통합서비스병동의 경우 총 임상경력 5년 이상 간호사가 1년 이상 5년 미만 간호사보다 높게 나타났으며(F=13.655, p=<.001), 환자안전교육(t=2.734, p=.007), 환자안전업무(t=2.441, p=.016), 병원인증평가(t=2.336, p=.021)의 경험이 있는 경우에 환자안전역량이 높은 것으로 나타났다. 일반병동의 경우 총 임상경력 3년 이상 5년 미만, 7년 이상 간호사가 1년 이상 3년 미만 간호사보다 환자안전역량이 높게 나타났으며(F=9.332, p=<.001), 현 부서 근무경력 3년 이상 5년 미만 간호사가 1년 이상 3년 미만 간호사보다 높게 나타났다(F=4.511, p=.002). 환자안전간호활동은 간호·간병통합서비스병동의 경우 총 임상경력 7년 이상 간호사가 1년 이상 3년 미만 간호사보다 환자안전간호활동 수준이 높게 나타났으며, 5년 이상 간호사가 3년 이상 5년 미만 간호사보다 높게 나타났다(F=3.004, p=.033). 또한 환자안전교육의 경험이 있는 경우에 환자안전간호활동 수준이 높게 나타났다(t=3.511, p=<.001). 일반병동의 경우 총 임상경력(F=3.789, p=.012)과 현 부서 근무경력(F=6.855, p=<.001) 7년 이상 간호사가 1년 이상 3년 미만 간호사보다 환자안전간호활동 수준이 높게 나타났다. 4. 환자안전간호활동은 환자안전역량(r=.550, p=<.001)과 양의 상관관계를 나타냈다. 간호업무중단는 간호업무강도(r=.497, p=<.001)와 양의 상관관계를 나타냈다. 5. 간호·간병통합서비스병동과 일반병동 간호사의 환자안전간호활동에 영향을 미치는 요인을 확인하기 위해 위계적 다중회귀분석을 시행하였다. ModelⅠ에 병동유형을 투입하였고, ModelⅡ에는 일반적 특성을 투입하였으며, ModelⅢ에서는 간호업무강도, 간호업무중단, 환자안전역량을 투입하였다. 연구 결과 병동유형(β=.238, p=<.001), 환자안전역량(β=.564, p=<.001), 현 부서 근무경력(β=-.186, p=.016)이 유의한 영향요인으로 나타났다. 환자안전간호활동에 대한 설명력은 ModelⅠ은 3.5%(F=8.350, p=.004), ModelⅡ는 9.8%(F=3.497, p=<.001), ModelⅢ에서는 35.2% (F=10.597, p=<.001)로 나타났다. 본 연구 결과 간호·간병통합서비스병동 간호사가 일반병동 간호사보다 환자안전간호활동 수준이 높게 나타났고, 간호업무강도와 간호업무중단은 낮게 나타났다. 환자안전간호활동에 영향을 주는 요인은 병동유형, 환자안전역량, 현 부서 근무경력으로 나타났다. 따라서 임상에서 환자안전간호활동 수준을 높이기 위해서는 간호사의 환자안전역량을 강화시키는 것이 중요하며, 경력이 높아지더라고 환자안전간호활동 수준이 향상될 수 있도록 환자안전교육을 경력에 따라 차별화하여 적용하는 것이 필요하다. 또한 간호·간병통합서비스를 확대 적용하고, 일반병동의 적정 간호인력 추가 배치 및 근무 환경을 개선함으로써 간호사의 업무강도를 완화하고 업무중단을 최소화하여 간호사가 환자안전에 집중할 수 있도록 지원이 필요하다. 이를 위해 의료기관 차원이 아닌 국가적 수준에서 간호사의 적정한 배치가 이루어질 수 있도록 제도 확립이 요구된다.