환자안전사건 유형과 간호사의 사건보고 예측요인

Abstract

This paper presents a descriptive survey research to figure out the characteristics of nurses’ incidents reporting by the patient safety event type in the upper and lower level group and identify their predictors of incidents reporting. Data was collected on March 29~April 6, 2022. The subjects include nurses that worked at a general hospital in Incheon for six months or longer and provided direct nursing. A total of 228 questionnaires were distributed, and 208 were used in the final analysis except for 20 containing insincere responses. Collected data was analyzed with the SPSS VIN Ver 26.0 statistical program. The findings were as follows: 1. The upper and lower level group of incidents reporting recorded 50% and 50% in near misses reporting, 74.5% and 15.5% in no harm incidents reporting, and 87.0% and 13.0% in harmful incidents reporting, respectively. 2. The study examined nurses’ incident reporting attitudes and found that they scored 2.95±0.84 points out of five in worries about appraisal, 3.96±0.67 in belief in improvement, 4.02±0.76 in reporting intention. The level of incident reporting knowledge was 4.00±0.76 points out of five. Under patient safety competency, they scored 4.05±0.40 points out of five in patient safety attitude, 3.98±0.51 in patient safety skill, and 3.46±0.64 in patient safety knowledge. Under safety climate, they scored 3.38±0.61 points out of five in hospital organization and 3.40± 0.43 in the work unit. 3. There were significant differences in near misses reporting between the upper and lower level group according to safety education(x²=10.93, p=.012), reporting education (x²=8.58, p=.035), belief in improvement(t=-4.51, p<.001), reporting intention(t=-4.90, p<.001), incident reporting knowledge(t=-2.99, p=.003), safety climate of hospital organization(t=-2.59, p=.010) and safety climate of the work unit(t=-3.36, p=.001). There were significant differences in no harm incident reporting between the groups according to reporting education(t=-2.45, p=.016), belief in improvement(t=-4.00, p<.001), reporting intention(t=-4.90, p<.001), incident reporting knowledge(t=-3.75, p=.003), patient safety attitude(t=-3.16, p=.002), patient safety skill(t=-2.15, p=.033), and patient safety knowledge(t=-3.31, p=.001). In addition, there were significant differences in harmful incident reporting between the groups according to age(x²=8.69,p=.013),clinical career(t=-2.13, p=.038), overtime hours per week(t=2.36, p=.019), and patient safety attitude(t=-2.39, p=.018). 4. The study examined the nurses’ predictors of incidents reporting by the patient safety event type and found that belief in improvement(OR=2.40, p=.007), reporting intention(OR=2.00, p=.014), and patient safety knowledge(OR=2.16, p=.015) predicted near misses reporting. No harm incident reporting was predicted by the number of reporting education sessions(OR=1.38, p=.044), belief in improvement(OR=2.00, p=.048), and patient safety knowledge(OR=2.41, p=.017). Harmful incident reporting was predicted by overtime hours per week(OR=0.99, p=.014).

These findings show that nurses tended to under-report near misses and did not always report no harm and harmful incidents according to the types of patient safety events, raising a need to make efforts to inform nurses of the importance of incidents reporting and encourage them to report incidents and also put a greater emphasis on the need to report near misses that are under-reported. Different variables led to differences in the incidents reporting level between the upper and lower level group according to the types of patient safety events. There were no differences in near misses and no harm incidents according to general characteristics, which, however, caused differences in the patient safety characteristics. There were differences in harmful incidents between the upper and lower level group of incidents reporting according to clinical career. Safety and reporting education led to differences in near misses between the upper and lower level group, and reporting education led to differences in no harm incidents between the groups. These findings raise a need to plan and apply periodic safety and reporting education. Clinical career caused differences in harmful incidents between the upper and lower level group, which means that it is necessary for medical institutions to help nurses with a shorter career recognize the importance of patient safety and acquire the incident reporting procedure and system. There were different predictors of nurses’ incidents reporting according to the types of patient safety events. The predictors of near misses were belief in improvement, reporting intention, and patient safety knowledge. Those of no harm incidents were the number of reporting education sessions, belief in improvement, and patient safety knowledge. Harmful incidents were predicted by overtime hours per week. These findings raise a need to understand and approach patient safety events from different perspectives according to the different types. Furthermore, it is important to provide education with proper feedback after incidents reporting and improved real cases to help them believe in the effects of incidents reporting on improvement and also develop and apply educational programs for them to develop patient safety knowledge.

Key words: Patient safety events, Nurses, Incident reporting

|본 연구는 환자안전사건 유형별로 간호사의 사건보고 수준을 상하위 집단으로 구분하여 특성을 파악하고, 사건보고 예측요인을 확인하기 위해 시도된 서술적 조사연구이다. 자료수집은 2022년 3월 29일부터 2022년 4월 6일까지 진행하였고, 연구 대상자는 인천시 종합병원에서 근무하는 6개월 이상의 경력이 있고 직접 간호를 제공하는 간호사였다. 설문지는 228부를 배포하였고, 불성실한 응답 20부를 제외한 208부를 최종 분석에 사용하였다. 수집된 자료 분석은 통계프로그램 SPSS VIN Ver 26.0을 이용하여 분석하였다. 본 연구의 결과는 다음과 같다. 1. 사건보고 수준의 상위그룹과 하위그룹은 근접오류보고가 50%, 50%, 무해사건보고가 74.5%, 15.5%, 유해사건보고가 87.0%, 13.0%이었다. 2. 사건보고태도 수준은 5점 만점에 평가활용우려가 2.95±0.84점, 개선효과신념은 3.96±0.67점, 보고의도는 4.02점±0.76점으로 나타났고, 사건보고지식은 5점 만점에 4.00±0.76점, 환자안전역량은 5점 만점에 환자안전태도가 4.05±0.40점, 환자안전기술이 3.98±0.51점, 환자안전지식이 3.46±0.64점으로 나타났고, 안전분위기는 5점 만점에 병원조직이 3.38±0.61점, 근무부서는 3.40± 0.43점으로 나타났다. 3. 근접오류보고의 상하위그룹 간 차이는 안전교육(x²=10.93, p=.012)과 보고교육(x²=8.58, p=.035), 개선효과신념(t=-4.51, p<.001), 보고의도(t=-4.90, p<.001), 사건보고지식(t=-2.99, p=.003), 병원조직의 안전분위기(t=-2.59, p=.010), 근무부서의 안전분위기(t=-3.36, p=.001)에 따라 유의한 차이가 있었다. 무해사건보고의 상하위그룹 간 차이는 보고교육(t=-2.45, p=.016), 개선효과신념(t=-4.00, p<.001), 보고의도(t=-4.90, p<.001), 사건보고지식(t=-3.75, p=.003), 환자안전태도(t=-3.16, p=.002), 환자안전기술(t=-2.15, p=.033), 환자안전지식(t=-3.31, p=.001)에 따라 유의한 차이가 있었다. 유해사건보고의 상하위그룹 간 차이는 연령(x²=8.69, p=.013), 임상 경력(t=-2.13, p=.038), 주당 초과 근무시간(t=2.36, p=.019), 환자안전태도(t=-2.39, p=.018)에 따라 유의한 차이가 있었다. 4. 환자안전사건 유형별로 간호사의 사건보고 예측요인을 확인한 결과 근접오류보고는 개선효과신념(OR=2.40, p=.007), 보고의도(OR=2.00, p=.014), 환자안전지식(OR=2.16, p=.015)이었고 무해사건보고는 보고교육 횟수(OR=1.38, p=.044), 개선효과신념(OR=2.00, p=.048), 환자안전지식(OR=2.41, p=.017)이었고, 유해사건보고는 주당 초과근무 시간(OR=0.99, p=.014)이었다.

이상의 연구 결과는 환자안전사건 유형별 사건보고 수준이 근접오류에서 더욱 과소 보고되고 있으며 무해사건, 유해사건도 항상 보고하지 않는 것을 알 수 있다. 그러므로 간호사에게 사건보고의 중요성을 알리고 사건보고를 장려하는 노력이 필요하며, 특히 과소 보고되는 근접오류보고의 필요성에 대해 더욱 강조할 필요가 있다. 환자안전사건 유형별로 사건보고 수준의 상하위그룹에서 차이를 나타낸 변수는 다르게 나타났다. 근접오류와 무해사건은 일반적 특성이 차이를 나타내지 않았으나 환자안전관련 특성이 차이를 나타냈고, 유해사건은 일반적 특성인 임상경력에서 사건보고 수준의 상하위그룹에서 차이를 나타냈다. 안전교육 및 보고교육은 근접오류의 상하위 그룹에서 차이를 보였고, 보고교육은 무해사건의 상하위 그룹에서 차이를 보였다. 그러므로 주기적으로 안전교육과 보고교육이 시행되도록 계획하고 적용해야 한다. 임상 경력은 유해사건의 상하위 그룹에서 차이를 나타냈다. 그러므로 경력이 적은 간호사에게 환자안전의 중요성에 대해 가치를 심어주도록 노력해야 한다. 환자안전사건 유형별로 간호사의 사건보고 예측요인이 다르게 나타났다. 근접오류는 개선효과신념, 보고의도, 환자안전지식이 예측변수로 나타났고, 무해사건은 보고교육의 횟수, 개선효과신념, 환자안전지식, 유해사건은 주당 초과근무 시간으로 나타났다. 그러므로 환자안전사건을 유형별로 다른 관점으로 이해하고 접근해야 한다 더욱이, 사건보고의 개선에 대한 효과의 신념을 심어주기 위해 사건보고 후 적절한 피드백과 개선된 실제 사례를 예를 들어 교육하는 것이 중요하고. 환자안전지식을 갖추기 위한 프로그램의 개발과 교육이 필요하다.

주요어: 환자안전사건, 간호사, 사건보고