당뇨병 환자의 영양관리를 위한 병원 임상영양사의 직무표준 활용도 평가 = Evaluation of job standards application of clinical dietetics for nutritional management of diabetic patients

다국어 초록 (Multilingual Abstract)

This study was carried out to evaluate clinical dietitian‘s job standards utilization for nutritional management of diabetic patients in hospitals. The questionnaire for survey was distributed to hospitals with more than 300 beds. The respondents were 96 clinical dietitians for diabetes care who work in corresponding hospitals. The developed questionnaire consisted of the current status of hospitals and job standards utilization for nutritional management of diabetes. This survey was conducted from September 7, 2015 to September 18, 2015.

1. General conditions from 96 hospitals on 2014 showed 738.9±425.1 beds were permitted averagely with 716.7±418.7 available beds. The average number of inpatients were marked 176,732±173,241.8 and outpatients numbered 582,295±501,695.2 separately. Hospitals with independent nutrition education room were 83.3%, on the contrary, hospitals with no such facilities scored 16.7%. Patient's foodservice operation type appeared as 50% direct managing in hospitals, 46.8% in consignment(part-consignment services included). And 40.0% of nutrition team organization were affiliating the administrative parts, 60.0% of nutrition team organization were affiliating the medical support parts.

2. Surveying the characteristics of respondents for job standards questionnaire for clinical dietician administering diabetes care, the dietician's work experience averaged 185.9±101.6 months, clinical dietician's work experience averaged 122.3±73.0 months, and diabetes work experience averaged 120.9±78.2 months. 96 respondents, clinical dieticians who were diabetes educator certificate holder was 41.7%, clinical dieticians who weren't diabetes educator certificate holder was 58.3%.

3. Job standards for diabetes clinical nutrition care is consisted of 4 duties, 19 tasks, 56 task element, and 108 work activity.
The total duty importance in the job standards which clinical dieticians in hospitals responded were 4.4±0.5. So the dieticians recognized importance of the total duties in the job standards for diabetes clinical nutrition care and the performance rate is 3.6±0.8, the level of difficulties were 3.1±0.7.
Out of 4 assignments, the importance of 'Nutrition intervention' was the highest by 4.5±0.5, the importance of 'Nutritional assessment' was the lowest by 4.4±0.4. In the performance rate, the 'Nutritional assessment' was the highest by 4.0±0.7 and the 'Nutrition monitoring·evaluation' was the lowest by 3.0±1.3. In the level of difficulties, the 'Nutrition diagnosis' was the highest by 3.4±0.9 and the 'Nutritional assessment' was the lowest by 2.7±0.7.
Out of 19 tasks, the importance and the performance rate of the 'Checking basic information' was the highest by 4.7±0.6 and 4.7±0.7, the importance of 'Examination of test data' was the lowest by 4.2±0.6. In the performance rate, 'Checking basic information' was the highest, and 'Nutrition monitoring·evaluation' was the lowest by 2.8±1.3. In the level of difficulties, 'Planning of nutrition intervention' was the highest by 3.5±1.0, 'Checking basic information' was the lowest by 1.8±0.9.
Out of 56 task elements, the importance of 'Height, body weight, body size date assessment' was the highest by 4.8±0.6, the importance of 'Examines physical function data' was the lowest by 3.6±1.0. In the performance rate, 'Verifies personal information' was the highest by 4.7±0.8, and 'Examines physical function data' was the lowest by 2.6±1.3. In the level of difficulties, 'Checks history of prescribed medication' was the highest by 3.7±1.1, and 'Verifies personal information' was the lowest by 1.6±1.0.
Out of 108 work activities, the importance of 'Evaluate blood glucose test results according to diabetes treatment guidelines', 'Evaluates current dietary habits', 'Educate the basic principles of the diet therapy and precautions', 'Describes daily intake amount and meal distribution' was the highest by 4.9±0.4, the imporatnce of 'Evaluate physical activity performance, cardiopulmonary function, sensory sensitivity or musculoskeletal function data' was the lowest by 3.6±1.0. In the performance rate, 'Verify age, sex, and ethnicity' and 'Addresses relationship between diabetes and dietary habits and emphasizes the practice of the diet therapy' showed the highest score by 4.7±0.7 and 'Evaluate physical activity performance, cardiopulmonary function, sensory sensitivity, or musculoskeletal function data' was the lowest by 2.6±1.3. In the level of difficulties, 'Assess type, effect, and side effects of current prescribed oral diabetes medications' 'Assess type, duration, and side effect of prescribed insulin regimen' showed the highest score by 3.7±1.2 and 'Verify age, sex, and ethnicity' was the lowest by 1.6±1.0.

4. The results analyzed from the surveys collected from 96 hospitals with more than 300 beds, the main causes influencing significantly to the standard job assessment analysis are foodservice operation type, the total number of permanent foodservice dieticians in hospital affiliation, permanent clinical service dieticians in consignment affiliation, permanent foodservice dieticians in consignment affiliation, permanent dieticians in consignment affiliation, the number of diabetes individual education and diabetes practical education cases, dietician work experience(months) and diabetes work experiences(months), excepting all of this above. Consisting of 11 causes, clinical dietician work experiences(months), number of permitted beds, type of hospital, total number of permanent clinical service dieticians in hospital affiliation, permanent dieticians in hospital affiliation, diabetes group education cases, further education availability, whether the hospital is diabetes education certified hospital, number of dieticians possessing diabetes educator certificate holder and check whether its clinical nutrition care job standards, and whether if the hospital is practical training agency of curriculum of clinical nutrition education. Among all of the causes, clinical dietician's work experiences(months) showed the most intimate positive correlativity on performance rate.

Consequently, these data can be used as job standards of clinical dietitians in hospitals and improvement clinical nutrition services. And it is considered that it's necessary to develop tasks of high scores to the importance and high scores to the difficulty, high scores to the importance and low scores to the performance, high scores to the difficulty and low scores to the performance by making an alternative plans.

목차 (Table of Contents)

• Ⅰ. 서론
• Ⅱ. 연구배경
• 1. 국내외 임상영양서비스 현황
• 2. 당뇨병 치료를 위한 임상영양서비스의 현황
• 3. 임상영양서비스를 위한 임상영양사의 직무표준 개발 및 활용
• 1) 영양사 직무 분석
• 2) 당뇨병 환자의 영양관리를 위한 임상영양사의 직무표준
• Ⅲ. 연구방법
• 1. 연구대상 및 기간
• 2. 연구내용 및 방법
• 1) 국내 의료기관 당뇨병 임상영양서비스 현황 조사
• 2) 임상영양사의 당뇨병 관리를 위한 직무표준 활용도 조사
• 3. 자료 처리 방법
• Ⅳ. 연구결과
• 1. 의료기관 임상영양서비스 현황
• 1) 조사대상 병원의 일반 현황
• 2) 조사대상 병원의 영양사 인력 현황
• 3) 당뇨병 환자를 위한 임상영양서비스 현황
• 4) 조사대상 병원의 기타 현황
• 2. 당뇨병 임상영양치료를 위한 직무표준 적용실태
• 1) 당뇨병 임상영양치료를 위한 직무표준 응답자의 특성
• 2) 직무표준 항목의 신뢰도
• 3) 임무의 중요도, 수행도, 난이도
• 4) 과업의 중요도, 수행도, 난이도
• (1) 과업의 중요도 및 수행도 관계 분석
• (2) 과업의 중요도 및 난이도 관계 분석
• (3) 과업의 수행도 및 난이도 관계 분석
• 5) 과업요소의 중요도, 수행도, 난이도
• 6) 업무내용의 중요도, 수행도, 난이도
• 3. 직무표준 수행도에 영향을 미치는 요인
• Ⅴ. 고찰
• Ⅵ. 요약 및 결론
• Ⅶ. 참고문헌
• 부록
• Abstract