(A) study of factors influencing turnover intention of hospital nurses

간호학과/석사[한글] 오늘날 간호직은 다양한 역할과 전문직으로서의 성장단계에 있음에도 불구하고 간호원의 이직율이 높음으로 인하여 업무량 증대 및 간호원의 숙련도가 저하되어 간호의 기능이 효율적으로 운영될 수 없음이 문제가 되고 있다. 간호원의 이직 현상은 조직내의 다른 문제가 있음을 나타내는 증상이기 때문에, 조직의 문제를 발견해내고 그 해결은 개인의 기초 위에서 행해져야한다. 따라서 지금까지 간호원의 이직에 관한 연구들은 이직에 미치는 요인을 발견할 수만 있다면 이직을 예방하고 감소시킬 수 있다는 가정위에서 행해진 것이다. 본 연구의 목적은 간호 전문직의 발전과 간호의 질을 개선시키는데 도움이 되고자 간호원의 일반적 특성, 역할스트레스, 간호수행, 직무만족과 이직반응과의 관게를 파악하여 이직에 미치는 요인을 발견하고자 시도하였다. 연구대상은 서울 시내 S 종합병원 일반병동에 근무하는 간호원 144명을 대상으로 하여, 1982년 9월 18일부터 28일 사이에 질문지를 배부하고 수집하였다. 연구도구로는 Rizzo등이 개발한 역할스트레스 측정도구와 Schwirian이 개발한 간호수행평가를 위한 6-D Scale (Six Dimension Scale of Nursing Performance) 도구와 Paula등이 개발한 건강전문직 인력을 위한 직무만족 측정도구와 그리소 연구자가 문헌고찰을 통하여 작성한 이직반응 측정도구를 사용하였다. 수집된 자료는 제 변수 측정에 평균점수, 제 변수와 일반적 특성과의 관계에 ANOVA, 가설검증에 Pearson Correlation, 이직반응과 예측인자 다변수 상관성에 Stepwise Multiple Regression의 통계방법을 사용하여 분석하였다. 본 연구의 결과는 다음과 같다. 1. 선행연구를 근거로 한 가설검증에서는 제1가설, '역할스트레스가 높을수록 이직반응의 정도는 높을 것이다'는 r=.41, P<.01로 채택되었다. 제2가설, '간호수행정도가 높을수록 이직반응의 정도는 낮을 것이다'는 r= -.08, P>.05로 기각되었다. 제3가설, '직무만족도가 높을수록 이직반응의 정도는 낮을 것이다'는 r=-.41, P<.01로 채택되었다. 2. 대상자의 일반적 특성과 제 변수와의 관계에서는 직무만족과 근무년한이 유의한 관게를 보여 (F=3.84, P<,05) 근무년한이 길수록 직무에 만족하고 있음을 나타냈으며, 이직반응은 결혼여부 (F=7.12, p<.01), 최종학력 (F=6.89, p<.01), 직위 (F=3.27, P<.05)에서 유의한 관계를 보여, 미혼인 사람과 3년제 출신인 사람이 병원을 떠나려는 의도가 더 많았으며, 직위에서는 주임간호원의 이직반응이 제일 높게 나타났다. 3. 이직반응과 예측인자간의 다변수 상관성에서는 이직반응과 가장 높은 상관성을 나타낸 역할갈등만으로 이직반응을 20.4% 설명할 수 있었고 (F=36.33, P<.01)여기에 최종학력, 직무만족, 결혼여부를 첨가한 네 변수로 32.44%를 설명할 수 있었다. (F=15.68, P<.01) 이와같이 네 변수를 모두 합해서 이직반응을 32.44% 밖에 설명할 수 없었던 것으로 보아 이외에 다른 요인들이 이직반응에 미치고 있다고 생각되므로 앞으로 계속 연구가 필요하리라고 본다. A Study of Factors Influencing Turnover Intention of Hospital Nurses HUR, HEA KUNG Department of Nursing , The Graduate School of Yonsei University (Directed by Professor Kim, Cho Ja) At the present time, the nursing profession has problems related ot adequately providing nursing care although the nurse assumes many responsibilities and the prefession of nursing has pregreased. Yet inspite of this, adequate nursing care is not always given because of frequent nurse turnover. Because the phenomena of nurse turnover appears to be a symptom of other problems with the nursing organization, we must discover what the problem of the organization are and resolve them on an individual basis. Studies that have been done on nurse turnover have been studied on a basis to help prevention and reduction the high rate of turnover. This study was done for the purpose of analyzing the relationships between turnover intention, role stress, nursing performance, work satisfaction and the characteristics of the subjects. The subjects consisted of 114 nurses who were employed in S General Hospital in Seoul. Data collection was done from September 18th to September 28th , by means of a questionnaire. The instruments used for this study were the Role Stress Scale developed by Rizzo et al., the Nursing Performance Scale developed by Schwirian, the Work Satisfaction Scale developed by Pauls et al., and the Turnover Intention Scale developed by the researcher. The analysis of data was done by use of the Mean, ANOVA, pEARSON Correlation Coeffecient, and Stepwise Multiple Regression Aanlysis. The results of study were as follow : 1. Using the Pearson Correlation Coeffecient to th hypothese, it was found that : 1) The first hypothesis, " the higher the role stress, the higher the turnonver intention", was accepted. (r=.41, P<.01) 2) The second hypothesis, " the higher the level of nursing performance, the lower the turnover intention " was rejected. (r=-.08, P>.05) 3) The third hypothesis, " the higher the level of work satisfaction, the lower the turnover intention " was accepted. (r=-.41, P<.01) 2. Using the ANOVA test, it was found that : The relationships between turnover intention, marital status and education were significant at the .01 level and position was significant at the .05 level. And the relationship between work satisfaction and tenure was significant at the .05 level. 3. Using the Stepwise Multiple Regression analysis, it was found that : 1) 'Role conflict' could account for turnover intention in 20.4% of the sample (F=36.33, P<.01) 2) 'Education' when added to this accounted for 26.52% of turnover intention. (F=25.44, P<.01) 3) 'Work satisfaction' when added to this accounted for 31.55% of turnover intention. (F=21.51, P<.01) 4) 'Marital status' when added to this accounted for 32.44% of turnover intention. (F=16.68, P<.01) This indicated that other factors influence turnover intention, since the combination of variables explained only 32.44% of turnover intention. Therefore further study is needed to investigate the predictors of turnover intention. [영문] At the present time, the nursing profession has problems related ot adequately providing nursing care although the nurse assumes many responsibilities and the prefession of nursing has pregreased. Yet inspite of this, adequate nursing care is not always given because of frequent nurse turnover. Because the phenomena of nurse turnover appears to be a symptom of other problems with the nursing organization, we must discover what the problem of the organization are and resolve them on an individual basis. Studies that have been done on nurse turnover have been studied on a basis to help prevention and reduction the high rate of turnover. This study was done for the purpose of analyzing the relationships between turnover intention, role stress, nursing performance, work satisfaction and the characteristics of the subjects. The subjects consisted of 114 nurses who were employed in S General Hospital in Seoul. Data collection was done from September 18th to September 28th , by means of a questionnaire. The instruments used for this study were the Role Stress Scale developed by Rizzo et al., the Nursing Performance Scale developed by Schwirian, the Work Satisfaction Scale developed by Pauls et al., and the Turnover Intention Scale developed by the researcher. The analysis of data was done by use of the Mean, ANOVA, pEARSON Correlation Coeffecient, and Stepwise Multiple Regression Aanlysis. The results of study were as follow : 1. Using the Pearson Correlation Coeffecient to th hypothese, it was found that : 1) The first hypothesis, " the higher the role stress, the higher the turnonver intention", was accepted. (r=.41, P<.01) 2) The second hypothesis, " the higher the level of nursing performance, the lower the turnover intention " was rejected. (r=-.08, P>.05) 3) The third hypothesis, " the higher the level of work satisfaction, the lower the turnover intention " was accepted. (r=-.41, P<.01) 2. Using the ANOVA test, it was found that : The relationships between turnover intention, marital status and education were significant at the .01 level and position was significant at the .05 level. And the relationship between work satisfaction and tenure was significant at the .05 level. 3. Using the Stepwise Multiple Regression analysis, it was found that : 1) 'Role conflict' could account for turnover intention in 20.4% of the sample (F=36.33, P<.01) 2) 'Education' when added to this accounted for 26.52% of turnover intention. (F=25.44, P<.01) 3) 'Work satisfaction' when added to this accounted for 31.55% of turnover intention. (F=21.51, P<.01) 4) 'Marital status' when added to this accounted for 32.44% of turnover intention. (F=16.68, P<.01) This indicated that other factors influence turnover intention, since the combination of variables explained only 32.44% of turnover intention. Therefore further study is needed to investigate the predictors of turnover intention.restrictio

(The) effect of three analgesic administration methods on postoperative pain and recovery rate after gastrectomy

간호학과/박사[한글] 동통은 모든 인간이 경험하는 것이기 때문에 국제 간호사회에서는 동통경감을 간호목적의 하나로 설정하였으며 간호사들은 동통경감을 위한 간호중재에 대해서 많은 관심을 갖고 연구를 하고 있다. 수술은 조직의 손상을 일으키기 때문에 급성동통을 유발하며, 상복부 수술인 경우에는 환자의 70% 이상이 중등도 이상의 동통을 호소하며, 이러한 동통은 생리적 반응에 부정적 영향을 미친다고 한다. 그러므로 수술후 환자의 동통관리는 중요하며, 수술후 동통이 심한 기간에는 심리적 정서적 간호중재외에 진통제가 투여되므로 수술후에 진통제를 효율적으로 투여한다면, 환자의 동통을 감소시킬 뿐 아니라 생리적 반응을 향상시키게 되어 환자의 회복에 도움이 되리라고 생각한다. 이에 본 연구에서는 Roy의 적응체계 모형과 동통의 내인성 동통통제이론을 개념적 기틀로 하여 상복부수술 환자에게 경막외 투여방법, 규칙적 근육 투여방법, 전통적 근육 투여방법으로 진통제를 투여하고 각 투여방법에 따른 동통과 생리적 반응을 조사하기 위하여 대조군 사후실험설계를 사용하였다. 연구대상자는 1990년 6월 12일부터 8월 30일까지 Y대학 부속 S병원에 입원한 환자중 대상자 선정기준에 맞는 30명이며, 각군에 10명씩 성별을 구획으로 하여 무작위로 배정하였다. 연구도구로는 Endler의 신체위험 기질불안 측정도구, Eysenck의 성격 측정도구, Gracely 등의 동통 측정도구와 연구자가 작성한 생리적반응 조사표를 사용하였다. 자료분석은 SPSS PC와 SAS를 이용하였으며 분석에 사통한 통계방법은 x**2-test, 일원변량분석(ANOYA), Duncan 사후분석, 반복측정요인분석, Pearson correlation coefficient를 사용하였다. 연구결과의 요약은 다음과 같다. 1. 가설 ‘수술후 진통제의 경락외 투여군, 규칙적 근육 투여군과 전통적 근육 투여군간에는 동통정도에 차이가 있을 것이다.’는 통각에서만 유의한 차이를 보여(F=3.16, p＜.05) 부분적으로 지지되었다. 2. 가설 ‘수술후 진통제의 경막외 투여군, 규칙적 근육 투여군과 전통적 근육 투여군간에는 생리적 반응에 차이가 있을 것이다.’는 수면상태에서만 유의한 차이를 보여(F=5.55, p＜.01) 부분적으로 지지되었다. 3. 전통적 근육 투여군과 경막외투여군의 수술후 진통제 투여시간간격은 경막외투여군이 더 긴것으로 나타났다. 4. 수술후 36시간까지 동통은 보통이상이었으며, 변화양상은 규칙적으로 진통제를 제공하지 않은 전통적 근육 투여군과 경막외투여군이 통각변화에 주기를 나타내었다. 5. 성별, 연령, 성격, 신체위험 기질불안과 동통과는 유의한 상관관계가 없는 것으로 나타났다. 6. 수술후 경미한 합병증 발생의 빈도에서는 경막외투여군에서 배뇨곤란의 발생이 다른 두군보다 두배 이상 높은 것으로 나타났다. 이상의 연구결과에 의하면 경막외투여군이 동통감소에는 좋은 효과를 나타냈으나 배뇨곤란의 합병증 발생이 높았으며, 세 군간에 생리적 반응에서는 수면상태외에는 차이가 적게 나타났으므로 수술후환자의 진통제 투여방법의 선택은 환자의 동통수준과 생리적 반응을 기반으로 정해야 할 것이다. 그러나 진통제를 동통이 심해지기 전에 투여하는 것이 진통제 량을 감소시키면서 진통효과에 좋다는 보고들이 있으므로 일회 진통제 투여량과 진통제 투여시간을 달리하여 반복연구를 해볼 것을 제안한다. The Effect of Three Analgesic Administration Methods on Postoperative Pain and Recovery Rate after Gastrectomy Hur, Hea Kung Department of Nursing The Graduate School of Yonsei University (Directed by Prof. Yoo, Ji Soo, RN, Ph.D.) An acute pain is the common experience following surgery. After upper abdominal surgery more than 70% of the patients complained of having moderate to marked pain. The experience of postoperative pain negatively influences physiological well being and delays recovery from the operation. This study was designed to determine an effective method of analgesic administration for postoperative pain relief in patients who had had upper abdominial surgery. An experimental design method of cost test only was used for this clinical study. Thirty patients who had undergone major operations were randomly divided into three equal groups to receive different regimens of analgesics over the first 24 hours postoperatively. Patients in group A received 8.9mg of morphine by epidural infusion, those in group B received 150mg of meperidine intramuscularly, every four hour for 24 hours, and those in group C received 94mg of meperidine intramuscularly as needed. The subjects in this study were patients from surgical wards in a large hospital in Seoul, Korea. The data was collected was from June 12, 1990 to August 30, 1990. The instruments used for this study were the physiological danger trait anxiety scale developed by Endler et. al., the personality stale developed by Eysenck, the pain scale developed by Gracely et. al. and the physiological responses list developed by the researcher. Data was analyzed using x**2- teat, t -test, ANOVA, Duncan muliple test, Repeated measures ANOVA, Pearson correlation coefficient and Cronbach α The results of this study were as follows; 1. Hypothesis 1 :‘The pain score will differ for patients receiving analgesic by epidural infusion, regular four hourly intramucular injections and intramuscular injections as needed’ was partly supported. Among the three groups, patients receiving the epidural infusion of morphine reported the lowest pain sensation score(F=3.16, p＜.05). 2. Hppothesis 2 : ‘The physiological response will differ for patients receiving analgesic by epidural infusion, regular four hourly intramuscular injections and intramuscular injections as needed’ was partly supported. The physiological response in which there was a significant difference between three groups was the ability to sleep at night(F=5.55, p＜.01 ). Among three groups, patients receiving epidural infusion of morphine reported the best condition, that is, no sleeping disturance due to pain. 3. Patients receiving an epidural infusion of morphine had a longer interval time between analgesic injections than those receving intramuscular injections of meperidine as needed. 4. All the patients in thin studs had a moderate pain score for the first 36 hours postoperatively. But the hourly pattern for postoperative pain showed that the scores of patients in the epidural infusion group and those in the intramuscular injections as needed group had a cyclic pattern for the pain sensation score. 5. There was no statistically significant correlation among age, sex, personality, physical danger trait anxiety and the pain score. 6. Patients receiving an epidural infusion of morphine had urinary retention twice frequent than as compared to those in the other two groups. In summary patients receiving an epidural infusion of morphine showed the lowest pain sensation score, but the highest frequency of urinary retention. There was no statistically significant difference in the physiological responses among the three groups except for the ability to sleep at night. Therefore it is difficult to choose one method of analgesic administration for postoperative pain relief. It is important that the choice of analgesic administration should be based on the nurses' pain assessment and patients' physiological response. [영문] An acute pain is the common experience following surgery. After upper abdominal surgery more than 70% of the patients complained of having moderate to marked pain. The experience of postoperative pain negatively influences physiological well being and delays recovery from the operation. This study was designed to determine an effective method of analgesic administration for postoperative pain relief in patients who had had upper abdominial surgery. An experimental design method of cost test only was used for this clinical study. Thirty patients who had undergone major operations were randomly divided into three equal groups to receive different regimens of analgesics over the first 24 hours postoperatively. Patients in group A received 8.9mg of morphine by epidural infusion, those in group B received 150mg of meperidine intramuscularly, every four hour for 24 hours, and those in group C received 94mg of meperidine intramuscularly as needed. The subjects in this study were patients from surgical wards in a large hospital in Seoul, Korea. The data was collected was from June 12, 1990 to August 30, 1990. The instruments used for this study were the physiological danger trait anxiety scale developed by Endler et. al., the personality stale developed by Eysenck, the pain scale developed by Gracely et. al. and the physiological responses list developed by the researcher. Data was analyzed using x**2- teat, t -test, ANOVA, Duncan muliple test, Repeated measures ANOVA, Pearson correlation coefficient and Cronbach α The results of this study were as follows; 1. Hypothesis 1 :‘The pain score will differ for patients receiving analgesic by epidural infusion, regular four hourly intramucular injections and intramuscular injections as needed’ was partly supported. Among the three groups, patients receiving the epidural infusion of morphine reported the lowest pain sensation score(F=3.16, p＜.05). 2. Hppothesis 2 : ‘The physiological response will differ for patients receiving analgesic by epidural infusion, regular four hourly intramuscular injections and intramuscular injections as needed’ was partly supported. The physiological response in which there was a significant difference between three groups was the ability to sleep at night(F=5.55, p＜.01 ). Among three groups, patients receiving epidural infusion of morphine reported the best condition, that is, no sleeping disturance due to pain. 3. Patients receiving an epidural infusion of morphine had a longer interval time between analgesic injections than those receving intramuscular injections of meperidine as needed. 4. All the patients in thin studs had a moderate pain score for the first 36 hours postoperatively. But the hourly pattern for postoperative pain showed that the scores of patients in the epidural infusion group and those in the intramuscular injections as needed group had a cyclic pattern for the pain sensation score. 5. There was no statistically significant correlation among age, sex, personality, physical danger trait anxiety and the pain score. 6. Patients receiving an epidural infusion of morphine had urinary retention twice frequent than as compared to those in the other two groups. In summary patients receiving an epidural infusion of morphine showed the lowest pain sensation score, but the highest frequency of urinary retention. There was no statistically significant difference in the physiological responses among the three groups except for the ability to sleep at night. Therefore it is difficult to choose one method of analgesic administration for postoperative pain relief. It is important that the choice of analgesic administration should be based on the nurses' pain assessment and patients' physiological response.restrictio