간호사가 인식한 환자안전문화와 노인낙상 예방활동

Abstract

노인낙상은 의료분쟁을 일으키는 주요 쟁점의 하나로 해마다 증가하고 있고, 노인 인구 층이 두터워지고 의료소비자 권리가 중요해 지면서 이들의 간호를 다루는 간호사들은 환자안전문화 정착에 주목하고 있다. 이 연구의 목적은 간호사의 환자안전문화에 대한 인식수준과 노인낙상 예방활동에 대한 실천수준을 파악하기 위함이다. 연구대상은 2012년 2월 27일부터 3월 9일까지 서울 G지역 B 종합병원 250명 간호사를 대상으로 조사하였다. 설문지 문항의 신뢰도는 환자안전문화의 경우 Cronbach's ɑ .90이었고, 노인낙상 예방활동의 경우 Cronbach's α .92이었다. 수집된 설문지는 SPSS 18.0으로 분석하였다.

연구의 주요 결과는 다음과 같다. 1) 연구대상자는 연령 평균 30.5세, 경력 평균 7.12년인 젊은 일반 간호사들이었다. 이들은 년간 안전교육을 평균 2회 받았고 년간 사고보고 평균 0.88회를 경험하고 있었다. 2) 환자안전문화에 대한 인식은 48문항에 대하여 총 240점 만점에 평균 181.08로 긍정적 이었다. 5점 척도로 측정한 문항 중 평균 4.00이상이 16문항(33.33%)이 인식수준이 높았고, 평균 3.00이하가 5문항(10.41%)은 인식 수준이 낮았다. 가장 긍정적 인식을 나타낸 문항은 ‘환자안전문화란 안전의식을 높이고 질적 의료 서비스를 제공하는 것이다’가 평균 4.51(±0.67)이었고, 가장 부정적 인식을 나타낸 문항은 ‘병동에는 주어진 업무량을 다 해낼 수 있을 정도의 충분한 인력이 있다’가 평균 2.64(±1.31)이었다. 환자안전문화의 인식은 41세 이상의 연령 군, 기혼 군, 외래근무 군, 21년 이상의 경력 군, 안전관리 교육을 받은 군, 안전관리 수준이 훌륭하다고 생각하는 군에서 긍정적 인식수준을 나타냈다. 3) 노인낙상 예방활동의 실천은 38문항에 대하여 총 190점 만점에 평균 162.91로 대체로 잘 실천하고 있었다. 5점 척도로 측정한 문항 중 평균 4.00이상인 32문항(84.21%)에서 노인낙상 예방활동 실천수준이 높았고 평균 3.00이하인 1문항(2.63%)에 대해서는 노인낙상 예방활동 실천수준이 낮게 나타났다. 가장 실천수준이 높은 문항은 ‘이동할 때 침대나 s-cart의 side rail를 항상 올린다’가 4.85(±0.43)이었고 가장 실천수준이 낮은 문항은 ‘업무과다 시 낙상예방 활동을 소홀히 하게 된다’가 2.86(±1.05)이었다. 노인낙상 예방활동의 실천은 연령이 31세 이상 군, 기혼 군, 경력이 8년 이상 군, 안전교육을 받은 군, 1년 내 채혈 및 혈액관련 보고를 한 경험 군, 안전관리 수준이 훌륭하다고 생각한 군에서 실천 수준이 높았다. 4) 환자안전문화에 대한 인식과 노인낙상 예방활동 사이에는 피어슨 상관계수 0.69의 매우 유의한 순 상관관계가 나타났다. 즉 환자안전문화에 대하여 긍정적 인식 수준일수록 노인낙상 예방활동의 실천수준도 높아짐을 의미한다. 환자안전문화 인식은 노인낙상 예방활동에 의하여 48%설명될 수 있었으며 여기에 안전관리 수준이 추가되면 53%설명될 수 있었다. 이상의 결과는 노인낙상 예방활동의 실천수준을 높이고 안전관리 수준을 높이면 환자안전문화에 대한 인식수준도 높아져 환자안전문화 정착에 기여할 수 있음을 시사한다. 본 연구결과를 토대로 다음을 제언한다.

첫째, 병원의 안전사고나 환자안전 간호활동을 정확히 파악할 수 있는 도구 개발과 안전문화를 위한 시스템 구축이 필요하다. 둘째, 지속적이고 반복적인 간호사의 환자안전 교육과 평가가 필요하다. 셋째, 안전관리 수준을 높일 수 있는 이론과 기술을 융합한 연구가 필요하다. 넷째, 본 연구와 비교분석 할 수 있는 다양한 의료기관을 대상으로 한 반복연구를 제언한다.

| The elderly fall is one of the major issues causing the medical dispute. It has increased every year. As layer of the elderly population become thicker and health care consumer rights become important, the hospital nurses focus on patient safety culture has been settled. Purpose: The purpose of this study is to find the perception level of patient safety culture and practice level of elderly fall prevention activity among general hospital nurses. Methods: The data was collected from 250 nurses in a general hospital located in G city, Seoul, Korea between 27th February to 9th April and was analyzed using SPSS 18.0. The reliability of this perception level of patient safety culture and practice level of elderly fall prevention activity questionnaire had Cronbach's α .90 and .92 respectively. Result: 1) The mean age of subjects were 30.50 years old with 7.12 years of career. respectively. Safety and health program was trained 2 times per year. 2) Perception level of patient safety culture mean value were 181.08 from total 240 point. 16 items(33.33%) from 48 items were more than 4 in 5 pointed Likert scale showing high perception level. 5 items(10.41%) were under 3 showing low perception level. Question of the most positive perception was 'Patient safety culture is to increase safety awareness and to provide quality health care services'. The mean was 4.51(±0.67). Question of the most negative perception was 'The ward has sufficient staff given the amount of work enough to do almost'. The mean was 2.64(±1.31). From perception of patient safety culture, group of more than 41 years old, group of more than 21years career, group of married, group of hospital outpatient work, group of trained in safety management, and group of high level of safety management to think than group did not apply, was positive. 3) Practice level of elderly fall prevention activity mean value were 162.91 from total 190 point. 32 items(84.21%) from 38 items were more than 4 in 5 pointed Likert scale showing high practice level. One item(2.63%) was under 3 showing low practice level. Question of the most Practice level a high degree of the elderly fall prevention activity was 'When you move in bed or s-cat, raise the side rail of the bed is always'. The mean was 4.85(±0.43). Question of the most Practice level a low degree of the elderly fall prevention activity was 'When excessive work, they are the neglect of fall prevention activity'. The mean was 2.86(±1.05). From practice level of elderly fall prevention activity, group of more than 31 years old, group of more than 8years career, group of married, group of trained in safety management, group who had blood and blood related reports within one year and group of high level of safety management to think than group did not apply, was higher level. 4) There for these results implies the following. If the more positive about patient safety culture, the level of perceptions, the level of practice is higher. Patient safety culture could be explained 48% with elderly fall prevention activity and 53% when level of patient safety manage is added. Conclusion: This study suggests that good practice of elderly fall prevention activity and safety manage perception level contribute to settle down patient safety culture. Based on the results of this study, the following is suggested. First, development of tools to investigate exactly the hospital`s safety accident and safe patient care activities is required. And, construction of System for safety culture is needed. Second, evaluation and education is necessary in continuing and repeating patient safety. Third, study on converging theory and practice of patient safety management is needed. Fourth, repeat studies can be compared with this study is suggested.; The elderly fall is one of the major issues causing the medical dispute. It has increased every year. As layer of the elderly population become thicker and health care consumer rights become important, the hospital nurses focus on patient safety culture has been settled. Purpose: The purpose of this study is to find the perception level of patient safety culture and practice level of elderly fall prevention activity among general hospital nurses. Methods: The data was collected from 250 nurses in a general hospital located in G city, Seoul, Korea between 27th February to 9th April and was analyzed using SPSS 18.0. The reliability of this perception level of patient safety culture and practice level of elderly fall prevention activity questionnaire had Cronbach's α .90 and .92 respectively. Result: 1) The mean age of subjects were 30.50 years old with 7.12 years of career. respectively. Safety and health program was trained 2 times per year. 2) Perception level of patient safety culture mean value were 181.08 from total 240 point. 16 items(33.33%) from 48 items were more than 4 in 5 pointed Likert scale showing high perception level. 5 items(10.41%) were under 3 showing low perception level. Question of the most positive perception was 'Patient safety culture is to increase safety awareness and to provide quality health care services'. The mean was 4.51(±0.67). Question of the most negative perception was 'The ward has sufficient staff given the amount of work enough to do almost'. The mean was 2.64(±1.31). From perception of patient safety culture, group of more than 41 years old, group of more than 21years career, group of married, group of hospital outpatient work, group of trained in safety management, and group of high level of safety management to think than group did not apply, was positive. 3) Practice level of elderly fall prevention activity mean value were 162.91 from total 190 point. 32 items(84.21%) from 38 items were more than 4 in 5 pointed Likert scale showing high practice level. One item(2.63%) was under 3 showing low practice level. Question of the most Practice level a high degree of the elderly fall prevention activity was 'When you move in bed or s-cat, raise the side rail of the bed is always'. The mean was 4.85(±0.43). Question of the most Practice level a low degree of the elderly fall prevention activity was 'When excessive work, they are the neglect of fall prevention activity'. The mean was 2.86(±1.05). From practice level of elderly fall prevention activity, group of more than 31 years old, group of more than 8years career, group of married, group of trained in safety management, group who had blood and blood related reports within one year and group of high level of safety management to think than group did not apply, was higher level. 4) There for these results implies the following. If the more positive about patient safety culture, the level of perceptions, the level of practice is higher. Patient safety culture could be explained 48% with elderly fall prevention activity and 53% when level of patient safety manage is added. Conclusion: This study suggests that good practice of elderly fall prevention activity and safety manage perception level contribute to settle down patient safety culture. Based on the results of this study, the following is suggested. First, development of tools to investigate exactly the hospital`s safety accident and safe patient care activities is required. And, construction of System for safety culture is needed. Second, evaluation and education is necessary in continuing and repeating patient safety. Third, study on converging theory and practice of patient safety management is needed. Fourth, repeat studies can be compared with this study is suggested.