외국인 환자 간호에 대한 간호사의 문화역량 구조모형

학위논문 (박사)-- 서울대학교 대학원 : 간호학과, 2015. 2. 김금순.국내 의료기관을 이용하는 외국인 환자 수는 증가하는 추세로 문화적 차이를 민감하게 인식하고 필요한 지식을 바탕으로 간호를 제공할 수 있는 문화역량의 중요성이 강조되고 있다. 그 동안 문화역량에 대한 선행연구는 문화역량의 구성요소에 대한 연구가 대부분으로 영향요인을 고려한 통합적인 이해가 필요하다. 본 연구는 횡문화간호체험모델과 불안·불확실성 관리이론을 바탕으로 외국인 환자 간호경험이 있는 간호사의 문화역량과 영향 요인이 포함된 가설적 모형을 구축하여 변수간의 경로를 검증하였다. 간호사의 문화역량과 관련된 변수는 근간 이론과 문헌고찰을 근거로 선정하였다. 모형에 포함된 외생변수는 다문화경험, 자문화중심주의적 태도, 조직의 문화역량지지였으며, 내생변수는 문화간 불안, 문화간 불확실성, 대처전략, 문화역량이었다. 다문화경험, 자문화중심주의적 태도, 조직의 문화역량지지가 문화간 불안과 불확실성, 그리고 대처전략을 통해 간호사의 문화역량에 영향을 미친다는 가설적 모형을 구축하였다. 연구 대상자는 서울과 경기지역에 위치한 상급종합병원 근무자로, 외국인 환자 10명 이상을 간호한 경험이 있는 간호사 273명이었다. 자료 수집은 구조화된 설문지를 이용하였으며, SPSS와 AMOS 통계분석 프로그램을 이용하여 분석하였다. 모형의 적합도는 χ2=45.886, χ2/df=1.835, GFI=.966, AGFI=.926, CFI=.853, SRMR=.049, RMSEA=.055로 가설적 모형이 자료에 부합되는 것으로 나타났다. 검증결과 경로에 대한 15개 가설 중 12개 경로에 대한 가설이 지지되었다. 간호사의 문화역량에 직접적으로 영향을 미치는 요인은 다문화경험, 조직의 문화역량지지, 문화간 불안, 문화간 불확실성, 대처전략이었고, 이들 변수가 간호사의 문화역량을 52.8% 설명하는 것으로 나타났다. 간호사의 문화역량은 다문화 간호에 관한 교육을 통한 관련 지식 전달과 직·간접적인 다문화경험의 확대를 통해 발전할 수 있을 것이다. 외국인 환자를 돌보면서 나타나는 어려움에 적극적으로 대처할 수 있도록 문제 사례와 해결 방법을 공유하고 조직 차원에서 필요한 인력과 자원을 지원하여 외국인 환자 간호의 질을 향상시킬 수 있을 것이다.Recently, there has been increasing number of foreign patients using medical services in Korea. In order to provide effective medical Recently, there have been an increasing number of foreign patients that use medical services in South Korea. The development of cultural competence that considers cultural beliefs, behaviors and needs is important for providing effective medical services to foreign patients. While previous studies are mostly focused on components of cultural competence, a comprehensive understanding of influencing factors is required. The purpose of this study is to construct a hypothetical model that includes factors related to the cultural competence of nurses caring for foreign patients. The transcultural nursing immersion experience model and the anxiety/uncertainty management (AUM) theory were used to verify the paths between the variables. Variables relevant to the cultural competence of nurses are selected based on a literature review. The exogenous variables are multicultural experience, ethnocentric attitude and organizational cultural competency support. The endogenous variables are intercultural anxiety, intercultural uncertainty, coping strategy, and cultural competence. The hypothetical model constructs consist of multicultural experience, ethnocentric attitude and organizational cultural competency support, intercultural anxiety, intercultural uncertainty, and coping strategy effect on the cultural competence of nurses. The subjects are 273 nurses who work in general hospitals in Seoul and Kyung-Gi Do, Korea. The nurses have the experience to care for more than 10 foreign patients. The data is collected with a structured questionnaire and is analyzed with SPSS and AMOS statistics analysis program. The overall fitness indices of the hypothetical model were a well fit. The goodness of fit index for the final model was .966, adjusted goodness of the fit index was .926, comparative fit index was .853, standardized root mean square was .049, and the root mean squared error of approximation was .055. Among the 15 paths, 12 paths are supported with statistical significance. The multicultural experience, organizational cultural competency support, intercultural anxiety, intercultural uncertainty, and coping strategy were factors that have a direct influence on the cultural competence of nurses. However, ethnocentric attitude did not have a significant effect on the cultural competence of nurses. This model explained 52.8% of the variance in nurses cultural competence caring for foreign patients. Development of nurses cultural competence can be achieved by offering multicultural nursing education, increasing direct/indirect multicultural experience, and sharing problem-solving experience in order to promote the coping ability of nurses. Organizational support can be achieved by preparing relevant personnel and resources. Then, the quality of foreign patients nursing care will be ultimately improved.국문초록 i I. 서론 1 1. 연구의 필요성 1 2. 연구의 목적 3 3. 용어의 정의 4 II. 문헌고찰 7 1. 간호사의 문화역량 7 2. 문화역량에 영향을 미치는 요인 10 III. 연구의 이론적 기틀 20 1. 이론적 배경 20 2. 개념적 기틀 22 3. 가설적 모형 23 4. 연구 가설 25 IV. 연구 방법 26 1. 연구 설계 26 2. 연구 대상 26 3. 윤리적 고려 27 4. 연구 도구 27 5. 자료수집 방법 33 6. 자료분석 방법 34 V. 연구결과 35 1. 대상자의 특성 35 2. 측정변수의 서술적 통계 39 3. 측정변수 간의 상관관계 41 4. 구조모형 분석 43 5. 연구가설의 검증 50 6. 최종 모형 53 VI. 논의 54 VII. 결론 및 제언 62 참고문헌 64 부록 75 Abstract 92Docto

ICU Nurses' Perceptions of Communication Difficulties, Importance, Satisfaction and Communication Barrier with Patient Families

Purpose: This study was conducted to investigate ICU nurses perceptions of communication difficulties, the importance of and satisfaction with communication with doctors, other nurses, patients, and family, as well as to explore communication barrier with patient families. Methods: Investigators developed a 15-item communication perception questionnaire and 58-item communication barrier questionnaire. Communication barrier included 4 domains: nurses, family, environment, and patient condition. A total of 151 ICU nurses with a minimum of one year of ICU experience participated. Results: ICU patients (3.38±0.73) were the most difficult group to communicate with, followed by family (3.32±0.72), senior nurses (3.25±0.74), doctors (3.21±0.68), and nurse colleagues (2.64±0.73). Doctors (4.61±0.53) were the most important group to communicate with, followed by nurse colleagues (4.52±0.54), patients (4.49±0.58), senior nurses (4.44±0.55), and family (4.43±0.61). Satisfaction with communication was the highest with colleague nurses (3.60±0.68), then senior nurses (3.37±0.74), family (3.18±0.71), patients (3.09±0.75), and doctors (3.06±0.83).The total score of the communication barrier was 2.83±0.52, where each domain was scored as follows: patient condition 3.13±0.74, nurses 2.83±0.60, environment 2.81±0.66, and family 2.76±0.57. The ICU nurses reported that communication was difficult due to sudden deterioration in the patients condition, being too busy, a noisy environment, and information not being shared between family members. Significant differences were noted by age, clinical experience, and marital status of nurse respondents. Conclusion: The findings indicated that development of a protocol on communication between nurses and doctors as well as development of an educational program on communication skills are necessary

Development and Implementation of a Self-directed Critical Care Nursing e-Learning Program

Purpose: The purpose of this study was to develop a self-directed e-learning program for ICU nurses and to evaluate how the proposed e-learning program affects the level of knowledge, nursing performance and job satisfaction of ICU nurses. Methods: The e-learning program was developed with the Computer Assisted Instruction Design Model using sources of self-efficacy which included the inactive attainment, vicarious experience, and verbal persuasion of ICU nurses. The program was evaluated by experts. Following the revision of the program, it was applied to a total of 59 ICU nurses (experimental group n=29, control group n=30) from three hospitals. Four weeks later, we measured the level of knowledge, nursing performance and job satisfaction. Results The level of knowledge significantly improved in the experimental group (t=5.691, p<.001). Moreover, the level of nursing performance significantly increased in the areas of circulatory diagnostic test (t=2.143, p=.039), EKG (t=2.911, p=.006), aortic balloon pump (t=2.491, p=.017), and nebulizer therapy (t=2.085, p=.044). Overall, job satisfaction did not significantly increase (t=1.664, p=.105); however, job satisfaction in terms of relationships with coworkers (t=2.371, p=.023) and the needs of nursing performance (t=2.940, p=.006) were significantly increased. Conclusion The results showed that the proposed e-learning program using sources of self-efficacy from ICU nurses was an effective learning method to increase the level of knowledge and nursing performance. The propose de-learning program would be a useful teaching tool for ICU nurses improving the quality of ICU patient care