노인요양병원 간호사의 욕창 지식 및 욕창 예방수행에 관한 연구

Abstract

욕창은 노인의 건강관리에 중요한 요소로서 성공적인 욕창예방을 하기 위해서는 간호사에게 충분하고 정확한 지식이 요구된다. 정확한 지식은 정확한 방법으로 욕창간호 수행을 가능하게 한다. 본 연구는 노인요양병원 간호사의 욕창 지식과 욕창 예방 수행을 파악하여 노인요양병원에 근무하는 간호사들의 욕창예방 지침을 개발하기 위한 서술적 조사연구이다. 연구기간은 2011년 10월 6일부터 10월 18일까지였고, 연구 대상은 경기도에 위치한 노인요양병원 병원 평가등급 1등급에서 5등급에 해당하는 편의 추출된 14개의 노인요양병원에 근무 중인 간호사 335명의 자료가 분석에 이용되었다. 연구 도구는 구조화된 자가보고 형 설문지로 욕창 지식 측정도구는 이명옥(2000)의 지식 측정 도구를 사용하였으며 욕창 예방수행 도구로는 서금숙(2010)의 욕창 예방수행 도구를 사용하여 측정하였다. 자료분석은 SPSS WIN 18.0 program을 이용하여 통계 분석하였다. 본 연구의 결과는 다음과 같다. 1) 일반적 특성에 따른 욕창 지식 결과는 연령, 근무경력, 근무형태, 욕창관련교육여부, 욕창관련 교육프로그램, 병원등급 변수들과 유의한 차이가 있었다. 연령은 31세 부터 40세 이하에서 , 현 병원의 근무경력은 3년 이상 이면서, 근무형태로는 낮 근무만 하는 간호사가, 욕창 교육 경험 유무에서는 경험이 있는 간호사로, 욕창 관련 교육프로그램 종류에서는 전문 교육과정에 참여한 간호사가 욕창 지식이 높았다. 그리고 유의한 차이를 보인 병원등급에 따른 간호사의 욕창 지식수준에서는 병원1등급 군에 해당하는 간호사가 20.1±2.6/32점으로 전체평균점수 19.6±2.7/32점 보다 높게 나타났다. 2) 노인요양병원 간호사가 지각한 욕창 지식으로 측정된 점수는 총 32점 만점에 평균 19.6±2.7점 이었다. 하위 영역별 평균 점수에 있어서는 욕창 발생 위험요인 에 관한 지식은 13점 만점에 8.7±1.5점 이었고 , 욕창 치유방법에 관한 지식은 15점 만점에 8.7±2.0점 이었으며, 욕창 상태 사정에 관한 지식은 4점 만점에 2.1±0.9점 순으로 측정되었다. 이중에 욕창 상태 사정 지식이 가장 낮은 것으로 나타났다. 3) 욕창 예방수행은 예방수행과 예방수행 관련 장애요인을 포함한다. 욕창 예방수행에서 가장 높은 응답을 보인 문항으로는 94.8%가 ‘욕창 예방 전략계획을 수립한다’ 로 나타났으며, 욕창 발생 사정수행에 관한 문항에서는 85.6%에서 ‘환자가 입원하고 있는 동안’ 70.7%가 ‘모든 환자를 대상으로 실시한다’고 응답하였다. 욕창 예방 간호계획에 관한 문항에서는 51.8%가 ’입원하고 있는 동안 욕창 발생 시 간호계획을 변경 한다 ‘고 하였으며, 42%에서 간호계획 점검 시기로 ‘아주 가끔’ 점검 한다고 하였으며, 점검이유로는 42.5%가 ‘환자상태가 변화되었기 때문이다 ’ 라고 응답하였다. 욕창 예방수행 관련 장애요인으로는 가장 높게 응답한 문항에는 41.7%가 ‘인력부족,’ 과 ‘시간부족’ 때문이라고 하였으며 그다음으로 25.1%에서 ‘사정과 관련된 지식, 인식, 이해, 도구부족’ 이라고 응답하였다. 그 외 ‘환자상태변화 및 비협조’는 18.2%, ‘다른 간호업무가 우선 순위이다’는 15% 순으로 나타났다. 이상의 연구 결과로 노인요양병원에서 근무하는 간호사의 욕창 지식 수준 과 욕창 예방수행 정도를 파악 하였다. 그리고 욕창 예방을 위한 장애요인은 과중한 업무와 사정과 관련된 지식, 인식, 이해, 도구 부족으로 나타났다. 따라서 욕창예방과 관리의 전략을 계획 하는데 우선적으로 지식 결핍 부분을 보완한 교육 프로그램 개발이 필요하며 예방수행에 장애가 되는 요인을 분석하여 해결할 수 있는 방안을 모색해야 할 것이다. |Pressure ulcer is an important factor in elderly health care. The adequate, accurate knowledge of nurses is essential in achieving successful prevention of pressure ulcer. Accurate knowledge enables nurses to nurse pressure ulcer in accurate method. This study is a descriptive study for developing pressure ulcer prevention guidelines for nurses working at elderly nursing hospitals by analyzing the pressure ulcer nursing knowledge and pressure ulcer prevention of nurses in elderly nursing hospitals. The research period was from October 6 to October 18, 2011. The research was conducted on 396 nurses working at 14 elderly nursing hospitals in Gyeonggi-do that are rated from first-class to fifth-class (Health Assessment Review & Assessment Service, 2011). A total of 335 questionnaires, excluding 61 questionnaires inappropriate for data analysis, were used for data analysis. A structuralized self-report type questionnaire was used as the research tool. The knowledge measurement tool of Lee M. O. (2000), which had been formed by revising and complementing the tool of Beitz, Fey and O'Brien(1998), was used as the nursing knowledge measurement tool related with pressure ulcer. The pressure ulcer nursing tool is the tool that was developed by Moor and Price(2004) and was used after being translated into Korean and inverse translated by Seo, K. S. (2010). SPSS/PC WIN 18.0 was used for data analysis. The results of this study are as follows.

1) Pressure ulcer nursing knowledge perceived by nurses in elderly nursing hospitals was measured to be 19.6±2.7 points on average out of 32 points in total. The average score according to domain was presented as 8.7±1.5/13 for pressure ulcer risk factor, 8.7±2.0/15 for pressure ulcer treatment method, and 2.1±0.9/4 for pressure ulcer condition assessment. Among these domains, knowledge regarding pressure ulcer condition assessment was presented to be lowest. 2) Prevention of pressure ulcer includes prevention and obstacles related with prevention. For items related with pressure ulcer prevention, 94.8% established strategic plans for preventing pressure ulcer. For pressure ulcer condition assessment, 85.6% responded that assessment was conducted when the patient was hospitalized whereas 70.7% responded that assessment was conducted on all patients. For items related with nursing plan for preventing pressure ulcer, 51.8% answered that nursing plan is changed if pressure ulcer breaks out during hospitalization while 42% commented that nursing plan is inspected 'only once in a while'. 42.5% said that the reason for inspection was because the patient status had changed. For obstacles related with pressure ulcer prevention, 41.7% selected ‘lack of manpower’ and ‘lack of time’, while 25.1% answered ‘lack of knowledge, awareness, understanding, and tools related with assessment'. Other obstacles included ‘change in patient status and non-cooperation’ (18.2%) and ‘other nursing duties take priority’ (15%). 3) The results of pressure ulcer nursing knowledge according to general characteristics presented significant difference with age, work experience, working type, pressure ulcer-related education, pressure ulcer-related educational program, and hospital class. High level of pressure ulcer nursing knowledge was presented among nurses with the following characteristics: between the age of 31-40, worked at least 3 years in the current hospital, only works day shifts, and had participated in a specialized educational program with education on pressure ulcer. When observing differences between hospital class, the hospital class group presenting the highest score in pressure ulcer nursing knowledge was the first-class group with 20.1±2.6/32 points, which was 19.6±2.7/32 points higher than the mean score. On the other hand, all hospital class groups excluding the first-class hospital group presented lower scores than the mean score, with the third-class group presenting 19.2±2.6/32 points, fourth and fifth-class groups presenting 19.1±2.7/32 points, and second-class group presenting 17.7±2.1/32 points. However, the fact that the second-class hospital group had fewer research subjects must be taken into consideration. When comparing the items that presented the highest response rate on pressure ulcer prevention between hospital class groups, it can be known that the first, third, and fourth-class groups selected 'lack of manpower' as the obstacle for assessing risk of pressure ulcer whereas the second and fifth-class groups selected 'change in patient status and non-cooperation'. Also, 'lack of knowledge, understanding, awareness, and tools' related with assessment was presented between 21.5%~31.6% to be ranked as the second-highest response in all class groups. These research results verify the standard of pressure ulcer nursing knowledge and nursing performance of nurses in elderly nursing hospitals to contribute to the planning of strategies for preventing and managing pressure ulcer.; Pressure ulcer is an important factor in elderly health care. The adequate, accurate knowledge of nurses is essential in achieving successful prevention of pressure ulcer. Accurate knowledge enables nurses to nurse pressure ulcer in accurate method. This study is a descriptive study for developing pressure ulcer prevention guidelines for nurses working at elderly nursing hospitals by analyzing the pressure ulcer nursing knowledge and pressure ulcer prevention of nurses in elderly nursing hospitals. The research period was from October 6 to October 18, 2011. The research was conducted on 396 nurses working at 14 elderly nursing hospitals in Gyeonggi-do that are rated from first-class to fifth-class (Health Assessment Review & Assessment Service, 2011). A total of 335 questionnaires, excluding 61 questionnaires inappropriate for data analysis, were used for data analysis. A structuralized self-report type questionnaire was used as the research tool. The knowledge measurement tool of Lee M. O. (2000), which had been formed by revising and complementing the tool of Beitz, Fey and O'Brien(1998), was used as the nursing knowledge measurement tool related with pressure ulcer. The pressure ulcer nursing tool is the tool that was developed by Moor and Price(2004) and was used after being translated into Korean and inverse translated by Seo, K. S. (2010). SPSS/PC WIN 18.0 was used for data analysis. The results of this study are as follows.

1) Pressure ulcer nursing knowledge perceived by nurses in elderly nursing hospitals was measured to be 19.6±2.7 points on average out of 32 points in total. The average score according to domain was presented as 8.7±1.5/13 for pressure ulcer risk factor, 8.7±2.0/15 for pressure ulcer treatment method, and 2.1±0.9/4 for pressure ulcer condition assessment. Among these domains, knowledge regarding pressure ulcer condition assessment was presented to be lowest. 2) Prevention of pressure ulcer includes prevention and obstacles related with prevention. For items related with pressure ulcer prevention, 94.8% established strategic plans for preventing pressure ulcer. For pressure ulcer condition assessment, 85.6% responded that assessment was conducted when the patient was hospitalized whereas 70.7% responded that assessment was conducted on all patients. For items related with nursing plan for preventing pressure ulcer, 51.8% answered that nursing plan is changed if pressure ulcer breaks out during hospitalization while 42% commented that nursing plan is inspected 'only once in a while'. 42.5% said that the reason for inspection was because the patient status had changed. For obstacles related with pressure ulcer prevention, 41.7% selected ‘lack of manpower’ and ‘lack of time’, while 25.1% answered ‘lack of knowledge, awareness, understanding, and tools related with assessment'. Other obstacles included ‘change in patient status and non-cooperation’ (18.2%) and ‘other nursing duties take priority’ (15%). 3) The results of pressure ulcer nursing knowledge according to general characteristics presented significant difference with age, work experience, working type, pressure ulcer-related education, pressure ulcer-related educational program, and hospital class. High level of pressure ulcer nursing knowledge was presented among nurses with the following characteristics: between the age of 31-40, worked at least 3 years in the current hospital, only works day shifts, and had participated in a specialized educational program with education on pressure ulcer. When observing differences between hospital class, the hospital class group presenting the highest score in pressure ulcer nursing knowledge was the first-class group with 20.1±2.6/32 points, which was 19.6±2.7/32 points higher than the mean score. On the other hand, all hospital class groups excluding the first-class hospital group presented lower scores than the mean score, with the third-class group presenting 19.2±2.6/32 points, fourth and fifth-class groups presenting 19.1±2.7/32 points, and second-class group presenting 17.7±2.1/32 points. However, the fact that the second-class hospital group had fewer research subjects must be taken into consideration. When comparing the items that presented the highest response rate on pressure ulcer prevention between hospital class groups, it can be known that the first, third, and fourth-class groups selected 'lack of manpower' as the obstacle for assessing risk of pressure ulcer whereas the second and fifth-class groups selected 'change in patient status and non-cooperation'. Also, 'lack of knowledge, understanding, awareness, and tools' related with assessment was presented between 21.5%~31.6% to be ranked as the second-highest response in all class groups. These research results verify the standard of pressure ulcer nursing knowledge and nursing performance of nurses in elderly nursing hospitals to contribute to the planning of strategies for preventing and managing pressure ulcer.