응급실 다방문 발열 환아 보호자의 열 지식, 불안 및 자기효능감

Abstract

Purpose : This study aimed to identify the levels of knowledge of fever, the anxiety, and the self-efficacy of the caregivers of frequent emergency room visitors while investigating the relevance of their knowledge of fever, anxiety, and self-efficacy and the factors influencing the number of emergency room visits. Method : Data were collected from January 1 to May 25, 2019 in “D Metropolitan City” from 145 caregivers whose children were aged six or younger and who had visited an emergency room twice or more annually, mainly because of fever. The collected data were analyzed with a frequency analysis, Independent t-test, Fisher exact, One way ANOVA, Scheffé test, Dunnett T3, Pearson’s correlation, and Stepwise multiple regression using SPSS 25.0 software. Results : The caregivers’ scores for knowledge concerning fever was an average of 43.72 points out of 100. Concerning anxiety, the average score for trait anxiety was 47.50 points, while that of state anxiety was 47.22 points. The self-efficacy score was an average of 50.29 points on an 80-point scale. The number of emergency room visits varied depending on the body temperature measured at the visit, while variations were also observed in the caregivers’ knowledge of fever. This depends on the birth order of the child, the existence of past diseases in the child, and the body temperature measured at the visit. Anxiety and self-efficacy were also observed depending on the number of children, the birth order of the child, the existence of past disease in the child, and the body temperature measured at the visit. The number of emergency room visits showed a correlation with the caregivers’ knowledge of fever (r=-.27, p=.001), trait anxiety (r=.60, p<.001), state anxiety (r=.59, p<.001), and self-efficacy (r=-.59, p<.001). Knowledge of fever showed a correlation with trait anxiety (r=-.53, p<.001), state anxiety(r=-.49, p<.001), and self-efficacy (r=.45, p<.001), while self-efficacy was observed to be correlated with trait anxiety (r=-.84, p<.001) and state anxiety (r=-.87, p<.001). The stepwise regression analysis results revealed that among the factors that influence the number of emergency room visits of caregivers with sick children were self-efficacy (β=-.35, p=.002), trait anxiety (β=.31, p=.007), educational background of the caregivers (β=.22, p<.001), and gestational age of the child(β=-.22, p=.001). Additionally, these variables had an explanatory power of 48.0% concerning the number of emergency room visits. Conclusion : The results revealed that self-efficacy and the caregivers’ level of trait anxiety were among the major factors influencing the number of emergency room visits of caregivers with children who are frequent visitors to emergency rooms. It is expected that providing education concerning fever as well as support to caregivers of children who visits the emergency room for fever can enhance their self-efficacy and lower their anxiety levels. This, in turn, may reduce the number of unnecessary emergency room visits of children with fever and ultimately contribute toward addressing the issue of over-crowing in emergency rooms.

연구목적 : 본 연구는 응급실을 다방문한 경험이 있는 보호자들을 대상으로 열 지식, 불안 및 자기효능감 수준을 파악하고, 열 지식, 불안 및 자기효능감 간의 관련성 및 응급실 내원 횟수의 영향요인을 조사하기 위하여 시도되었다. 연구방법 : 자료 수집은 2019년 1월 1일부터 5월 25일까지 D광역시에서 이루어졌으며, 발열을 주호소로 응급실을 연간 2회 이상 방문한 경험이 있는 6세 이하 아동의 보호자 145명을 대상으로 하였다. 자료 분석은 SPSS 25.0을 이용하여 빈도분석, Independent t-test, Fisher exact, One way ANOVA, Scheffé test, Dunnett T3, Pearson’s correlation, Stepwise multiple regression으로 분석하였다. 연구결과 : 발열 환아 보호자의 열 지식은 100점 만점에 평균 43.72점, 불안은 80점 만점 중 기질불안은 평균 47.50점, 상태불안은 평균 47.22점이었다. 자기효능감은 85점 만점에 평균 50.29점으로 나타났다. 응급실 내원 횟수는 내원 시 측정된 열에 따라 차이가 있었으며, 열 지식은 환아의 출생 순위, 과거 질환의 유무, 내원 시 측정된 열에 따라, 불안 및 자기효능감은 자녀수, 출생 순위, 과거 질환의 유무, 내원 시 측정된 열에 따라 차이가 있었다. 응급실 내원 횟수는 열 지식(r=-.27, p=.001), 기질불안(r=.60, p<.001), 상태불안(r=.59, p<.001) 및 자기효능감(r=-.59, p<.001)과 상관관계가 있었다. 열 지식은 기질불안(r=-.53, p<.001), 상태불안(r=-.49, p<.001), 자기효능감(r=.45, p<.001)과 상관관계가 있었으며, 자기효능감은 기질불안(r=-.84, p<.001), 상태불안(r=-.87, p<.001)과 상관관계가 있는 것으로 나타났다. 단계적 회귀분석 결과, 환아 보호자의 응급실 내원 횟수에 영향을 미치는 요인은 자기효능감(β=-.35, p=.002), 기질불안(β=.31, p=.007), 보호자의 학력(β=.22, p<.001) 및 재태 기간(β=-.22, p=.001)으로 나타났으며, 이들 변수의 응급실 내원 횟수에 대한 설명력은 48.0%이었다. 결론 : 자기효능감과 기질불안은 응급실 다방문 환아 보호자의 응급실 내원 횟수에 영향을 미치는 주요 요인임을 확인하였다. 따라서 발열로 응급실을 방문하는 보호자에게 열 지식에 대한 교육과 지지를 제공함으로써 자기효능감을 높이고 불안을 감소시킬 수 있다면 발열 환아의 불필요한 응급실 방문을 줄일 수 있을 것이며, 궁극적으로 응급실 과밀화 현상을 해소하는데 도움이 될 것이다.