요양병원 간호사의 환자안전문화가 섬망간호 수행에 미치는 영향

Abstract

The purpose of this study is to identify the factors affecting of patient safety culture for nursing performance of delirium in long-term care facility nurses. The empirical data were collected from a self-administered survey using a structured questionnaire among 214 nurses working in 12 long-term care facilities located in P, D, C cities. Data collection was performed from February 15, 2022 to March 14, 2022. The data were analyzed by frequency, percentage, mean, standard deviation, t-test, ANOVA, Pearson’s correlation coefficients, and Hierarchical analysis with the SPSS/WIN 25.0 program.

The results of this study are as follows; First, the patient safety culture was indicated to be 3.47 on a 5-point scale. The area showing the highest patient safety culture was patient safety knowledge and attitude, and the lowest area with regard to patient safety culture was reporting patient safety events. Second, the score for nursing performance of delirium was 2.75 on a 4-point scale. Third, meaningful differences regarding nursing performance of delirium were dependent on marital status (t=-2.07, p=.040), number of patients per nurse (t=-2.79, p=.006), experience in nursing education about delirium (t=5.90, p＜.001), the delirium education route (F=7.80, p=.001), presence of manuals for delirium care on the ward (t=5.31, p＜.001), necessity of education for delirinm (t=3.36, p=.001), and patient safety rating of working unit (F=9.87, p＜.001). Fourth, there were significant positive correlations between the patient safety culture (r=.41, p＜.001), and nursing performance of delirium. Fifth, according to the results of the Hierarchical analysis of nursing performance of delirium, factors influencing the performance of delirium nursing care in long-term care facility nurses are the patient safety culture (β=.34, p＜.001), presence of manuals for delirium care on the ward (β=.25, p＜.001), experience in nursing education about delirium (β=.23, p=.001), necessity of education for delirium (β=.17, p=.003), the number of patients in charge per nurse (β=-.13, p=.020), marital status (β=.12, p=.031).

As a result of hierarchical analysis, the regression model was significant (F=17.88, p＜.001), the explanatory power of the model was 39%.

In conclusion, it is necessary to strengthen the patient safety culture in order to increase the performance of delirium nursing care for long-term care facility. In addition, delirium guidelines suitable for the characteristics of long-term care facility are needed, and it is necessary to strengthen patient safety culture through continuous delirium nursing education.

본 연구는 요양병원 간호사의 환자안전문화가 섬망간호 수행에 미치는 영향을 파악하기 위한 서술적 상관관계 연구이다. 연구대상은 P시와 D시, C시 3개 도시의 12개 요양병원 간호사 214명을 대상으로 하였다. 자료수집은 2022년 2월 15일부터 3월 14일까지 조사하였다.

연구 도구는 환자안전문화와 섬망간호 수행 설문지를 제공하였으며, 자료 분석은 SPSS version 25.0 통계프로그램을 이용하여 빈도분석, 백분율, 평균과 표준편차, t-test, ANOVA, Pearson's correlation, Hierarchical analysis를 사용하였으며 연구 결과는 다음과 같다.

첫째, 대상자의 환자안전문화는 평균 3.47점이며, 하위 영역 중 환자안전 지식/태도가 가장 높고 환자안전 사건(고)보고가 가장 낮게 나타났다. 둘째, 섬망간호 수행은 평균 2.75점으로 나타났다. 셋째, 일반적 특성에 따른 섬망간호 수행은 결혼상태(t=-2.07, p=.040), 간호사1인 담당환자 수(t=-2.79, p=.006), 섬망교육 경험(t=5.90, p＜.001), 섬망교육 방법(F=7.80, p=.001), 섬망지침 여부(t=5.31, p＜.001), 섬망교육 필요도(t=3.36, p=.001), 부서의 환자안전 정도평가(F=9.87, p＜.001)에서 유의한 차이가 있었다. 넷째, 섬망간호 수행은 환자안전문화(r=.41, p＜.001)와 통계적으로 유의한 상관관계가 있는 것으로 나타났다. 다섯째, 요양병원 간호사의 섬망간호 수행에 영향을 미치는 요인은 환자안전문화(β=.34, p＜.001), 섬망지침 여부(β=.25, p＜.001), 섬망교육 경험(β=.23, p=.001), 섬망교육 필요도(β=.17, p=.003), 간호사1인 담당 환자 수(β=-.13, p=.020), 결혼(β=.12, p=.031) 순으로 나타났다. 위계적 회귀분석 결과 회귀모형은 유의하였으며(F=17.88, p＜.001), 모형의 설명력은 39%로 나타났다.

결론적으로 요양병원 간호사의 섬망간호 수행을 높이기 위해서는 환자안전 문화 강화가 필요하다. 또한 요양병원 특성에 맞는 섬망지침이 필요하며 요양병원의 환자안전문화를 고려한 섬망간호 교육 프로그램의 개발이 필요하다.