정신의료기관 간호사의 환자안전문화 인식과 환자안전관리 활동

Other Titles
Nurses' Perceptions of Patient Safety Culture and Patient Safety Activities in Mental Health Hospitals
Authors
김소영
Issue Date
2014-12
Awarded Date
2015
Abstract
The purpose of this study was to provide a basis for safer medical services by describing their perception of patient safety culture and patient safety activities, and analyzing the factors that affect patient safety activities among nurses working at mental health hospitals. The data was based on structured self-administered questionnaires collected from August to October, 2014. The study samples included 208 nurses on duty for more than three months in 14 mental health hospitals located in Metropolitan City A, Metropolitan City B, Metropolitan City C and Province D. To measure patient safety culture perceived by nurses, we used a questionnaire with 42 items modified to fit the situation of the mental health hospitals, interpreted by Je (2007) from the Hospital Survey on Patient Safety Culture and the Agency for Healthcare Research and Quality. For patient safety activities, we used a questionnaire with 32 items which were modified and complemented for the situation of the mental health hospitals from Lee (2009). The collected data was statistically analyzed by SPSS 20.0 including t-test, one-way ANOVA, Pearson's correlation coefficient and Stepwise multiple regression. The results of this study were as follows: 1) The mean scores of the patient safety culture were 3.57 on 5-point Likert scale. For the subdomain, the attitude of supervisor/manager on patient safety showed as 3.87 points, the highest, and the lowest showed the patient safety at the field as 3.14 points. 2) On the patient safety activities, the mean score was 3.90 out of 5. Within the subdomain, the score of the psychiatric problem situation was the highest points of 4.21, while domain of the environmental safety was the lowest as 3.67 points. 3) A significant difference was found for the patient safety culture at the domain of working time per week (t=3.10, p=.002). The nurses with fewer than 40 hours of working time per week (3.67 points) showed better recognition for the patient safety culture than those with over 40 hours of working time per week (3.49 points). 4) A significant difference was found for the patient safety activities at the domain of education (t=-2.30, p=.022) and working time per week (t=2.45, p=.015). The graduates of university or higher (4.06 points) were more likely to engage in the activities than the college (3.84 points) graduates. Those with fewer than 40 hours of working time per week (4.02 points) showed better performances for the patient safety activities than the nurses with over 40 hours of working time per week (3.81 points). 5) The perceptions of the patient safety culture and the patient safety activities were positively correlated (r=.60, p<.001). In other words, the higher the perception of the patient safety culture was, the higher the level of the patient safety activities was. 6) The factors influencing the patient safety activities were the communication and procedures (β=0.26, p<.001), the patient safety at the field (β=0.22, p<.001), the frequency of events reported (β=0.17, p=.004) and the attitude of supervisor/manager (β=0.15, p=.031). The explanatory power for the patient safety activities of these variables was 35%. In conclusion, a systematic approach at hospital level is needed to ensure the nurses’ work environment, as well as to improve the patient safety culture by refining patient safety activities by nurses at mental health hospitals.
본 연구는 정신의료기관 간호사의 환자안전문화 인식 및 환자안전관리 활동을 조사하고 환자안전관리 활동에 영향을 미치는 요인들을 분석하여 보다 안전한 의료 서비스를 제공하기 위한 기초자료로서 시행되었다. 자료 수집은 2014년 8월부터 10월까지 A특별시, B광역시, C광역시, D도에 소재한 14개 정신의료기관에서 3개월 이상 근무 중인 간호사 208명을 대상으로 구조화된 설문지를 이용하여 수집하였다. 환자안전문화 인식을 측정하기 위해서 미국 의료관리조사품질국에서 개발한 환자안전문화 병원조사지를 제우영 (2007)이 일반 간호사를 대상으로 사용한 문항을 가지고 정신의료기관 실정에 맞게 42문항으로 수정하여 사용하였다. 환자안전관리 활동은 이금옥 (2009)이 개발한 도구를 기초로 정신의료기관에 맞게 32문항으로 수정·보완하여 사용하였다. 수집된 자료는 SPSS 20.0 프로그램을 이용하여 빈도분석, t-test, one-way ANOVA, Pearson's correlation coefficient, Stepwise multiple regression으로 분석하였다. 본 연구의 결과는 다음과 같다. 1) 대상자가 인식하는 환자안전문화는 5점 척도에서 평균 3.57점이었다. 하부 영역별로 보면 직속상관/관리자 태도가 3.87점으로 가장 높았으며 환자의 안전도가 3.14점으로 가장 낮았다. 2) 대상자의 환자안전관리 활동은 5점 척도에서 평균 3.90점이었다. 하부 영역별로 보면 정신과적 문제 상황이 4.21점으로 가장 높았으며 환경안전이 3.67점으로 가장 낮았다. 3) 대상자의 일반적 특성에 따른 환자안전문화 인식의 차이는 주당 근무시간(t=3.10, p=.002)이 40시간 이하(3.67점) 집단이 40시간 초과(3.49점) 집단보다 환자안전문화에 대한 인식이 높았다. 4) 대상자의 일반적 특성에 따른 환자안전관리 활동에서 학력(t=-2.30, p=.022)은 4년제 이상(4.06점)이 전문대(3.84점) 졸업보다, 주당 근무시간(t=2.45, p=.015)은 40시간 이하(4.02점) 집단이 40시간 초과(3.81점) 집단보다 환자안전관리 활동에 대한 수행이 높았다. 5) 환자안전문화 인식과 환자안전관리 활동은 유의한 정적 상관관계를 보였다(r=.60, p<.001). 즉, 환자안전문화 인식이 높을수록 환자안전관리 활동도 높은 것으로 나타났다. 6) 환자안전관리 활동에 영향을 주는 요인은 의사소통과 절차(β=0.26, p<.001), 환자의 안전도(β=0.22, p<.001), 사건보고의 빈도(β=0.17, p=.004), 직속상관/관리자의 태도(β=0.15, p=.031))로 나타났다. 이 변수들의 전체 환자안전관리 활동에 대한 설명력은 35%였다. 결론적으로 정신의료기관 간호사의 환자안전관리 활동을 높이기 위해서는 간호사의 근무환경을 보장함과 동시에 환자안전문화가 자리 잡을 수 있도록 병원 차원의 체계적인 접근이 요구된다.
URI
http://kumel.medlib.dsmc.or.kr/handle/2015.oak/10915
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3. Thesis (학위논문) > 2. College of Nursing (간호대학) > 석사
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