간병서비스 제도화를 위한 법적 개선방안

송명환 사단법인 한국법이론실무학회 2024 법률실무연구 Vol.12 No.1

장기간 간병으로 인한 극단적인 경제적 · 심리적 부담은 '간병파산', ‘간병자살’, ‘간병살인’과 같은 비극으로 나타나고 있다. 특히 최근 고령화 심화, 가족구성의 변화 등으로 인해 간병 수요가 급격히 증가하는 추세다. 그러나 사적으로 간병인을 고용하는 경우 지불하여야 하는 간병비가 매일 11만원에서 14만원 선으로 경제적 부담이 상당한 수준이다. 그러나 현행법에서는 요양급여 대상으로 ‘간병’을 명시하고 있지 않아 간병이 필요한 환자들은 높은 비용을 부담하거나 환자 가족이 직접 환자를 간병해야 하는 상황이다. 국민들의 간병비 부담은 6조 9천억원에서 8조원에 달하며, 중증환자의 경우 월 200~300만원의 부담이 들어 국민 의료비 부담의 가장 큰 1위 원인이 되고 있다. 가족들이 직접 간병을 담당하는 경우 휴직 등 일자리 상실, 교통비 등 간접비용도 상당하여 저소득층의 빈곤화 원인으로 작용하며, 간병인을 고용하는 경우에도 병원 간호인력에 의해 간병이 제공되는 대다수 외국과 달리 사설간병인을 환자가 직접 고용하는 형태이기 때문에 간병서비스의 품질이 저열하고 국민 불만을 야기하는 상황이다. 간병은 의료기관이 제공하는 급여 대상이 아니며, 입원서비스에 포함되지 않아 간병 실수로 인한 환자 상태 악화 시 병원은 책임이 없는 문제가 발생하며, 현재는 간병인을 고용한 환자와 간병인의 사적계약 관계하에서의 법적 책임으로 귀결되는 구조이다. 또한 간병인도 정규 간호인력이 아니라 파출부 등 비자격 인력도 가능하여 품질관리가 되지 않아 간병의 질적 수준을 신뢰하기 어려운 상황이다. 정부에서도 이러한 문제 해결을 위하여 병원의 간호인력(간호사, 간호조무사 등)을 확충하여 간병서비스를 제공하고 건강보험을 적용하는 시범사업(일명 ‘포괄간호서비스’)을 추진하였다. 2015년 발생한 메르스(MERS) 사태 이후 병원 내 감염이 주요한 문제점의 하나로 지적되면서, ‘보호자 없는 병원 시범사업’으로 불리던 ‘포괄간호서비스’는 2015년 12월 의료법 개정으로 ‘간호간병통합서비스’로 법적 근거를 마련하였고, 2015년 말 112개 기관, 7,443개 병상에서 2021년 말 현재 621개 기관 64,108개 병상으로 증가하였다. 간호간병통합서비스의 도입은 의료 수요의 증가와 환자의 간병비 부담, 메르스 사태를 통해 나타난 한국식 간병문화의 문제점 등이 그 원인이 되어 우리나라도 이제 간병을 사회보장의 문제로 본격적으로 받아들이기 시작한 것으로 볼 수 있다. 그런데 지금의 간병비 급여화 정책은 수가 · 운영체계 등 실무적 쟁점들만 부각되고 있을 뿐 급여화에 따른 다양한 법적 쟁점들에 대해서는 본격적인 연구가 이루어지지 않고 있다. 본 연구는 간병에 대하여 기존의 선행연구와 달리 헌법상 보건권과 사회적 기본권으로부터 간병서비스의 규범적 근거를 살펴보고 관련 보건의료 관련 법률의 제·개정을 통한 입법적 개선방안에 대해서 고찰함으로써 간병의 사회화 가능성을 모색하고자 한다. The extreme economic and psychological burden of long-term care appears to be tragedies such as "care bankruptcy," "care suicide," and "care murder." In particular, the demand for nursing care is rapidly increasing due to the recent deepening aging and changes in family composition. However, if a caregiver is hired privately, the cost of care is around 110,000 won to 140,000 won every day, which is a significant economic burden. However, since the current law does not specify "care" for medical care benefits, patients in need of care have to pay high costs or their families have to take care of the patients themselves. The public's burden of nursing costs ranges from 6.9 trillion won to 8 trillion won, and in the case of severely ill patients, it costs 2 to 3 million won per month, making it the No. 1 cause of the burden of national medical expenses. If the family is in charge of nursing, indirect costs such as job losses and transportation costs are considerable, which causes poverty among low-income people, and unlike most foreign countries, where nursing is provided by hospital nursing personnel, the quality of nursing services is poor and people are dissatisfied. Nursing is not covered by medical institutions and is not included in hospitalization services, resulting in a problem that the hospital is not responsible for worsening the patient's condition due to nursing mistakes, and currently results in legal responsibility under the private contract relationship between the patient and the caregiver. In addition, caregivers are not regular nursing personnel, but non-qualified personnel such as dispatchers are also possible, making it difficult to trust the quality level of nursing care because quality control is not performed. To solve this problem, the government also promoted a pilot project (so-called ‘comprehensive nursing service’) to expand nursing staff (nurses, nursing assistants, etc.) in hospitals to provide nursing services and apply health insurance. After the MERS outbreak in 2015, hospital-acquired infections were pointed out as one of the major problems, and the 'comprehensive nursing service', which was called a 'hospital pilot project without guardians', was changed to 'integrated nursing service' with the revision of the Medical Service Act in December 2015. A legal basis was established, and the number increased from 7,443 beds in 112 institutions at the end of 2015 to 64,108 beds in 621 institutions as of the end of 2021. The introduction of integrated nursing care services was caused by the increase in medical demand, the burden of nursing care costs on patients, and the problems with the Korean nursing culture that emerged through the MERS outbreak. Korea has now begun to accept nursing as a social security issue in earnest. can see. However, the current nursing care reimbursement policy only highlights practical issues such as fees and operating systems, and no full-scale research has been conducted on various legal issues related to reimbursement. This study aims to explore the possibility of socialization of nursing by examining the normative basis of nursing as a basic constitutional right and examining legislative solutions through the enactment and revision of related social security and health care laws.

간호⋅간병통합서비스 병동의 시설개선을 위한 디자인요소

김민경,이현진 한국생태환경건축학회 2017 한국생태환경건축학회 논문집 Vol.17 No.6

Purpose : This study is to establish guidelines for the facilities of comprehensive nursing services suitable for the domestic situation, and to draw up the issues of the nursing service through the review of related domestic and foreign literature. It is hoped that this study is to suggest design factors for the improvement of nursing service facilities. Method : This study is limited to the looking into the literature in the field of nursing and architecture, which focuses on the understanding of domestic wards of hospitals performing comprehensive nursing services since 2013. The guidelines (2017) of the Korean Medical Law and the relevant international standards/ guidelines are based on those of the United Kingdom (HBN Guideline) and Canada (CSA). Result : The most important issue in the implementation of the comprehensive nursing service is to change the functions of NS according to the team nursing and the nursing area in the ward. It is also pointed out that the nursing movement becomes longer due to the unreasonable arrangement of the nursing rooms. The comprehensive nursing service is based on team nursing, and since the nurse's patient is determined, therefore, the basic unit cluster plan should be based on the nursing activity by providing effective nursing placement, patient privacy, comfort. It is also necessary to prepare measures to solve the separation of pollutants.

간호·간병통합서비스병동 간호사의 셀프리더십, 역할갈등, 간호근무환경이 간호서비스 질에 미치는 영향

김미선 ( Kim Mi Sun ),신성희 ( Shin Sung Hee ),서은주 ( Seo Eunju ) 경희대학교 동서간호학연구소 2021 동서간호학연구지 Vol.27 No.1

Purpose: This study aims to examine the relationships between the self-leadership, role conflict, nursing work environment, and quality of nursing service in comprehensive nursing care service wards and identify the factors that affect the quality of nursing service. Methods: The data were collected from 158 nurses working in comprehensive nursing care service wards from three general hospitals with 200 beds or more in Seoul, Korea. The data were analyzed by descriptive statistics, t-test, ANOVA, scheffe test, Pearson’s correlation coefficient, and multiple linear regression analysis of enter method using SPSS/WIN ver 22.0 program. Results: The factors of quality of nursing services were self-leadership (β=.44, p<.001), nursing work environment (β=.17, p=.014), and the work experience in comprehensive nursing care service wards (β=-.15, p=.035) explaining 32% of the total variance. Conclusions: The results indicated that self-leadership, work experience in the comprehensive nursing care service wards, and nursing work environment affect the quality of nursing services of nurses in the comprehensive nursing care service wards. It is necessary to make efforts for seeking various intervention strategies and improving nursing work environment.

부산지역 목회자의 교구간호산업 요구조사

손수경,강경자,이지현,이영은,박춘화 고신대학교 전인간호과학연구소 2002 전인간호과학연구 학술모음집 Vol.- No.-

The purpose of this study was to provide the basic resources for developing parish nursing program by investigating the demands of parish or churches on parish nursing service. Subjects of this study were 96 pastors conveniently in Busan. Research tools used for this study were modified version of the ones composed by Hwang(2000) with the help of the prior research and professionals referring to parish nurse program questionnaire by Djupe(1990). Data for study were collected from July. 1 to Oct. 31, 2001 by using questionnaire method. Data were analyzed by frequency, percentage, mean, standard deviation, χ²-test with SPSS./PC program. The summary of the study was as follows, 1. On the demands of parish nursing service for the subjects, 95.8% the necessity of parish nursing services. And they answered by their intention of asking for parish nursing service practice. 2. The subjects of this study wanted 71.9% of part time and 28.1% of full times duty. The method of payment was 41.8% of pay free and 55.2% of salaried. And engagement intention of parish nurse as preacher was 88.5%. 3. They demanded for parish nurses in hospice care(4.02±1.11), health screening (3.98±1.09), home visiting(3.97±1.16), group health education(3.81±1.12), organization of volunteer groups(3.75±1.12), individual health education (3.75±1.14), the advice on choosing hospital and hospital consultation(3.69±1.21) and individual counseling(3.51±1.31). 4. According to specified role for parish nurse of subjects, the nursing demands were as follows: physical symptom management and preparation before death in spiritual preparation for death, blood pressure check in health examination, home visiting in the make a call patient, management of chronic disease in group health education, disease management in individual health education, choice of hospital in the advice on choosing hospital and hospital consultation and physical problems in individual counseling. 5. In relation to the characteristics of the subjects and their church and the general demands(the necessity of parish nursing services and intention of practice) for parish nursing services, these had non significant differences. 6. In relation to the characteristics of the subjects and their church and the hope demands(duty pattern and method of payment and engagement intention of parish nurse as preacher) for parish nurses, these had non significant differences. In conclusion, the perception of parish nursing service was very high, also they had great demands for it. So Parish Nursing Service needs to do in order to promote health of the congregation. Before doing so, it would be better to make things known and to consider the relevant characteristics shown in the researched results.

의도적이고 계획적인 간호순회 수행으로 인한 환자가 경험하는 간호서비스 질과 간호사의 간호순회인식 개선

김윤숙,김나영,김진숙,양영은,정유민,최희영,오은,김동연 간호행정학회 2023 간호행정학회지 Vol.29 No.1

Purpose This descriptive study aimed to identify the effects of purposeful and timely nursing rounds on patients' perception of the quality of nursing services and nurses' perception of nursing rounds. Methods Intentional nursing rounds were conducted by communicating patients’ questions on pain, position, pump, potty, and possessions. A total of 144 nurses and 149 patients participated, and data were collected using self-report questionnaires. The independent t-test, chi-square test, and Wilcoxon’s rank-sum test were used to analyze the data with SPSS version 24.0. Results Although intentional nursing rounds improved the nurses’ perception of nursing rounds, there was no significant difference. The nurses’ benefit had the lowest score (3.36), and the benefit of communication with patients had the highest score (3.79). Intentional nursing rounds significantly improved the patients’ perception of the quality of nursing services in the intervention group. Among the factors of empathy (Z=4.98, p<.001) related to the quality of nursing services as perceived by the patient, assurance (Z=5.50, p<.001), reliability (Z=4.43, p<.001), and responsiveness (Z=5.02, p<.001) significantly increased. Conclusion Intentional nursing rounds positively affected patients’ perception of the quality of nursing service. It is important to improve intentional nursing rounds to enhance nurses’ perceptions of them. 목적 본 연구는 간호사의 의도적인 간호순회가 환자가 인지하는 간호서비스 질과 간호사가 인지하는 간호순회 인식에 미치는 영향을 확인하는 것을 목적으로 하는 서술적 설문조사연구이다. 방법 의도적인 간호순회는 통증(pain), 자세(position), 수액주입속도(pump), 배설(potty), 물품유형성 (possessions) 을 기반으로 확인하며 환자에게 질문하며 수행하는 간호순회이었다. 연구대상은 연구목적에 동의한 C 대학병원 144명의 간호사와 149명의 환자로 설문지 자기문답작성을 통해 조사하였고, 수집된 자료는 chi-test, t-test, ANOVA, Scheffé test을 이용하여 분석하였다. 결과 의도적인 간호순회는 간호사의 간호순회 인식에 증가를 가져왔으나 유의한 차이는 없었다. 간호순회 인식에서 간호사의 이익면이 가장 낮은 점수(3.36)를 보였고 환자와의 의사소통에 이익을 준다는 면이 가장 높은 점수(3.79)를 차지하였다. 의도적인 간호순회는 환자가 인지하는 간호서비스 질에서 공감성(Z=4.99, p<.001), 보장성(Z=5.50, p<.001), 신뢰성(Z=4.43, p<.001), 반응성 (Z=4.43, p<.001) 요인에서 기대하였던 간호서비스질보다 실제간호서비스 질이 중재군에서 유의하게 증가하였다. 결론 의도적인 간호순회는 환자가 인지하는 간호서비스 질에 긍정적인 효과를 보여준다, 간호순회 인식의 증가를 위해 의도적인 간호순회를 강화하는 것이 중요하다.

노인장기요양보험 재가방문간호 서비스 개발과 확대 방안

임지영,김주행 한국가정간호학회 2020 가정간호학회지 Vol.27 No.3

Purpose: This study aimed to investigate possible ways to expand the services of home-visit nursing through a review of the progress, achievements, and obstacles of home-visit nursing; a pilot project of an integrated home-service; the application of the Omaha System; as well as a case analysis of providing home-visit nursing services. Method: An integrated review was conducted using various source materials, including laws, previous studies, and a case analysis. Results: In case analysis of providing visiting nursing service, rehabilitation nursing, end-of-life nursing, and dementia care showed high nursing needs. It was necessary that the various home visit nursing services in the intervention area of the Omaha System, administrative services, case management, and center operation activities were all included in the payment systems of long-term care insurance. Conclusion: In the future, home visit nursing services of long-term care insurance should be reborn in the form of a center for integrated case management in the community, which would set long-term goals until the time of a client’s death and encompass the realm of human rights for health, quality of daily life, and a dignity of life.

간호업무 관련 법령의 정합성 연구: 간호사, 조산사, 전문간호사, 간호조무사를 중심으로

김민지 ( Kim Minji ),김인숙 ( Kim Insook ),이유리 ( Lee Yuri ) 한국보건사회연구원 2018 保健社會硏究 Vol.38 No.3

간호업무와 관련하여 2015년 12월 의료법 일부개정이 이루어졌고, 2018년 3월 전문간호사 자격 기준 근거가 시행규칙에서 의료법의 법률 차원으로 상향되었다. 이렇듯 법령의 개정을 통하여 간호업무 규정을 수정 및 보완하고 있으나, 여전히 간호업무와 관련해 일선 간호현장에서 문제점이 나타나고 있다. 본 연구에서는 간호사, 조산사, 전문간호사, 간호조무사를 중심으로 간호업무 근거 법령들을 살펴보고, 여러 법령 간에 정합성을 이루고 있는지 고찰하였다. 간호업무 관련 규정사항이 존재하는 법률은 총 14개이다. 법의 완전성을 분석한 결과, 전문간호사 업무 등에 관한 규정이 없는 흠결을 보였다. 일관성 관점에서는 의료법과 타 보건의료법령에 명시된 간호업무 간 일부 충돌이 나타났다. 수평적 정합성 분석결과, 산발적인 법령 규정으로 인해 해석이 일의적이지 않아 실제 간호업무 수행에 있어 혼란 가능성을 확인하였다. 수직적 정합성 분석결과, 간호업무 관련 일부 조문에서 일정 사항을 위임하였으나 하위 법령에 해당 규정이 없는 입법미비가 나타났다. 본 연구에서는 비정합적 요소들의 확인을 통해 간호업무 관련법령 정합성 제고 방안으로 현행 법체계를 유지하면서 정합성 결여 요소들을 제·개정 및 삭제하여 보완해나가는 방안과 산재하여 있는 간호 관련 법령들을 통합하여 간호법으로 제정하는 방안을 제시하였다. 추후 보건의료관련법령 개정 혹은 간호법 제정 시법체계의 정합성 확보를 위해 본 연구 결과를 활용할 수 있을 것으로 기대한다. Related to nursing services, the Medical Services Act was amended in December 2015 and the grounds of advanced practice nurse’s qualification was ruled in the law in March 2018. Although legislations related to nursing services have been modified constantly, there remain problems of nursing staffs those are not covered enough by current legislations. The purpose of this study was to review nursing services laws and regulations, especially for nurse, midwife, advanced practice nurse and nurse assistant and to examine legal coherence among them. There are 14 acts that have provisions related to nursing services. In terms of completeness there is no regulation about nursing services of advanced practice nurse. With respect to consistency there is contradiction among legislations provisions in the Medical Service Act and those in other health laws regulating nursing services. Based on analysis of horizontal coherence, confusion may occur because legislations exist sporadically which causes different interpretation. Vertical coherence analysis shows absence of some lower statutes in spite of the delegation. This study suggests two ways to enhance coherence. One is to maintain current legislations while amending the provision preventing them coherent. The other is to enact the unified Nurse Act. This study is meaningful as there is only few preceding research on legal coherence in health system.

간호사의 인간관계, 의사소통, 창의적 행동, 간호서비스가 셀프리더십에 미치는 영향

김희경 병원간호사회 2007 임상간호연구 Vol.13 No.1

Purpose: The purpose of this study was to examine the extent to which nurses' self-leaderships are related to interpersonal relations, communication, creative behaviors and nursing services in hospitals and provide basic data of self-leadership training program for nurses. Method: This study employed a correlational descriptive survey. Subjects were 204 nurses working at 10 hospitals. The instruments included the interpersonal relations scale by Schlein et al., the communication scale by Navran, the creative behavior scale by Basadur et al,, the nursing service scale by Parasuraman et al., and the self-leadership scale by Manz. The data were analyzed using t-test, ANOVA, and stepwise multiple regression. Results: Nurses' self-leaderships were found to be correlated to interpersonal relations, communication skills, creative behaviors and nursing services. Nursing services were found to be the most powerful variable, followed by interpersonal relations, creative behaviors and education which accounted for 59.8% of self-leadership among nurses surveyed. Conclusions: Nurses' self-leaderships were correlated to interpersonal relations, communication skills, creative behaviors, and nursing services, self-leadership was influenced by nursing services, interpersonal relations, creative behaviors and education. These findings suggest that nursing services, interpersonal relations, communication skills, and creative behaviors should be considered in developing a program to promote nurses' self-leaderships.

2015년 「의료법」 개정 및 포스트 코로나 시대 제언 - 간호사 관련 규정을 중심으로 -

차유경(Cha, Yu-Kyung) 한국법학회 2021 법학연구 Vol.81 No.-

2015년 「의료법」 개정은 간호사 업무와 관련된 ‘모호성’들이 해소된 중요한 기점으로 볼 수 있다. 법 개정 이전 「의료법」은 간호사의 업무를 추상적으로 ‘간호’ 혹은 ‘진료보조’만을 포함하는 것으로 규정하고 있었다. 여기에, ‘진료보조’를 간호사의 고유업무로 규정하면서도, 하위규칙에는 이를 간호조무사의 업무로 정하고 있어 법률의 정합성이 일치하지 않는 문제점도 있었다. 그 외에도, 의료기관의 간호조무사 대체 문제, 간호보조인력 양성 기관의 관리체계 부재 및 감염병에 취약한 병원 간호 환경 등이 주요 문제점들로 부각되었다. 2015년 「의료법」 개정을 통해 상기한 주요 문제들이 해소되었다. 간호사의 핵심 업무인 ‘간호과정’을 명확하게 반영할 수 있게 되었으며, 나아가 간호사의 업무에 간호 요구자에 대한 교육·상담 및 건강증진을 위한 활동 기획과 수행 등을 신설 하였다. 또한, 하위 규칙에 간호조무사의 업무로 규정된 ‘진료보조’를 삭제하였으며, 간호사에게 간호조무사 지도권을 부여하였다. 간호보조인력 양성 및 관리와 관련해서는, 간호조무사 양성기관 관리체계를 확립하여 간호보조인력의 질을 관리할 수 있는 계기가 되었으며, 간호인력들의 수급 불균형을 해결할 수 있도록 취업교육센터를 설치하고 지원하게 되었다. 한편, 코로나19 발생으로 인하여 전세계가 팬데믹 사태를 맞이하게 되었다. 이 때문에 여느 때보다 사태의 중심에 서 있는 간호사 역할의 중요성이 강조되고 있다. 이러한 관점에서 보았을 때, 2015년 개정 「의료법」은 간호·간병통합서비스를 도입하여 신종호흡기감염병으로 인한 병원 내 감염 문제 등에 효과적으로 대응할 수 있는 가능성을 열어 주었다. 간호·간병통합서비스는 도입 이후 입법 취지에 맞는 순기능도 있었지만, 서비스 체계 미비, 간호사의 업무 과중, 스트레스 증가 및 불합리한 보상 등이 문제가 되고 있어 개선 및 보완이 필요한 상황이다. 뿐만 아니라, 간호사들의 감염병 실무교육이 강조되고 있다. 더 나아가, 간호사들에게 희생적 역할은 강요되고 있지만, 그들의 처우 및 업무 환경에 대한 개선이 이루어지지 않고 있다. 따라서, 본 연구에서는 2015년 개정 「의료법」의 주요내용 중 포스트 코로나 시대에 간호사와 관련된 부분을 제도, 교육 및 처우 부분으로 나누어 개선방향에 대해 검토해 보고자 한다. 첫째, 간호·간병통합서비스를 내실화하여야 한다. 의료기관별·질환별·중증도별로 병동을 세분화하고, 체계화 된 시스템 내에서 간호사를 배치하여야 한다. 또한, 본 서비스 운영의 방식인 ‘팀 간호체계 방식’을 간호사가 적극 주도 할 수 있도록 하여 2015년 개정 「의료법」에서 신설된 ‘간호 요구자에 대한 교육·상담 및 건강증진 활동 기획·수행 업무’ 규정을 적극 활용할 수 있도록 하여야 한다. 이를 위해, 팀 간호체계 방식을 표준운영절차(SOPs)화 하여야 한다. 그리고 간호사들의 스트레스 완화를 위한 보호 시스템을 마련함으로써 서비스를 안정화 시킬 필요가 있으며, 서비스 병동을 환자질환별, 중증도별로 구분하여 이에 필요한 처치의 종류, 난이도, 방법 및 횟수 등을 고려하여 이에 대응하는 간호사들에 대한 보상이 이루어져야 한다. 둘째, 간호사의 감염병 실무 교육을 강화하여야 한다. 코로나19와 같은 신종호흡기감염병이 대유행하게 되면, 간호사의 감염병에 대한 지식이나 실무 대응 경험이 매우 중요하다. 간호사들의 실무교육은 현재 보수교육 등을 통해 이루어지고 있는데, 신종호흡기감염병과 유관한 교육들이 이론 위주로 소수 진행되고 있다. 따라서, 이번 코로나19 사태뿐만 아니라, 향후 발생할 또 다른 감염병에 대비하기 위해서는 신종호흡기감염병과 관련한 교육과정을 필수과목으로 증설하여야 하며, 특히 중증환자를 위한 기기사용법 등과 같은 실습을 기반으로 한 교육과정이 필요하다. 마지막으로, 간호사 최저 임금제를 도입하고 의료인 법정 인력기준 준수를 강화하여야 한다. 코로나19 발생으로 간호사들에게 희생적 역할과 책임감 등을 강요하고 있지만, 이에 반해 이들에 대한 처우와 업무 환경이 열악한 점에 대해서는 개선이 이루어지지 않고 있다. 우리나라는 간호사 배출 수에 비해 임상 간호사 수가 매우 적다. 그러한 이유는 ‘낮은 연봉 수준’과 ‘과중한 업무량’ 및 ‘열악한 근무 환경’ 등이 주요하게 작용하기 때문이다. 따라서, 간호사를 위한 최저 임금제를 도입하여 보건 전문직인 간호사들의 활동을 유인할 필요가 있으며, 낮은 연봉 수준으로 인해 저하된 동기를 고취시킬 필요가 있다. 더불어, 간호사 법정 인력기준 준수를 강화하여야 한다. 현행 「의료법」과 「의료법 시행규칙」에 인력기준이 있지만, 대부분의 의료기관들이 이를 준수하지 않고 있다. 이로 인해, 간호사들의 업무가 과중하게 부과되고 근무환경이 더욱 열악해져서 간호사들이 이직을 하게 되는 등 많은 부작용들이 나타나게 되었다. 따라서, 간호사들의 근무 환경 개선을 위해 의료기관의 간호사 법정 인력기준 준수 여부를 철저히 감시하고, 위반한 의료기관에 대해서는 그에 상응하는 행정처분을 부과함으로써 해당 문제를 개선하여야 한다. 한편, 의료기관들이 간호사 법정 인력기준 미준수의 이유로 ‘낮은 의료수가에서 비롯된 병원 경영상 재정난’을 이야기 한다. 이와 같은 문제를 해결하기 위해서는 ‘비급여 진료비용 공개 의무화’를 ‘의원급’까지 확대 할 필요가 있다 The revision of the 「Medical Service Law」 in 2015 can be seen as an important starting point where the ambiguity related to nurse work is resolved. Prior to the revision of the law, the 「Medical Service Law」 stipulated that nurses' duties were abstractly included only 'care' or 'assistance in medical treatment'. In addition, there was a problem that the consistency of the law did not coincide with that, which is 'assistance in medical treatment' was defined as the unique work of the nurse and the subordinate rules set it as the work of the nursing assistant. Furthermore, problems such as the replacement of nursing assistants in medical institutions, the absence of management system of nursing assistant training institutions, and the hospital nursing condition vulnerable to infectious diseases have been highlighted as major problems. Through the revision of the 「Medical Service Law」 in 2015, the above problems have been solved. The 'nursing process', which is the core task of nurses, was possible to clearly reflect. Furthermore, the work of the nurse was created to establish activities planning and performance for education and consultation to a person in need of nursing, planning of health promotion activities and implementation. In addition, the 'assistance in medical treatment', which is defined as a nursing assistant's job in the sub-rules, was deleted, and the nurse was given the right to supervise the nursing assistant. In relation to the training and management of nursing assistants, it became an opportunity to manage the quality of nursing assistants by establishing a management system for nursing assistant training institutions, and established and supported 'Employment Training Centers for Nursing Work Force' to solve the imbalance in supply and demand of nursing personnel. On the other hand, due to the outbreak of COVID-19, the world faced the crisis of Pandemic. For this reason, the importance of the role of a nurse who stands at the center of the situation is being emphasized more than ever. From this point of view, the revised 「Medical Service Law」 in 2015 introduced 'Integrated Nursing and Caring Service', opening the possibility of effectively responding to the problem of infection in hospitals caused by new respiratory infections. Since the introduction of the 'Integrated Nursing and Caring Service' through the revision of the 「Medical Service Act」 in 2015, it has had a net function that fits the legislative purpose, but there are problems such as insufficient service system, overload of the nurse's work, increased stress of nurses and unreasonable salary. In addition, nurses' practical training on infectious diseases is being emphasized. Furthermore, although the sacrificial role of nurses is being compelled, their treatment and work condition are not being improved. Therefore, in this study, the aim is to review that the major contents of the 「Medical Service Act」 revised in 2015 by dividing the part related to nurses into the system, education and treatment in context of so-called the post-corona world. First, 'Integrated Nursing and Caring Service' should be improved. The wards should be subdivided by medical institution, disease, and severity, and nurses should be assigned within a systematic system. In addition, the 'team-based nursing system', which is the method of operating this service, should be actively led by nurses so that the regulations of 'activities planning and performance for education and consultation to a person in need of nursing, planning of health promotion activities and implementation' newly established in the revised Medical Law of 2015 should be utilized. To achieve this, the team-based nursing system should be standardized operating procedures (SOPs). In addition, it is necessary to stabilize the service by providing a protection system to relieve the stress of nurses, and the service ward is divided by patient disease and severity, and salary for the nurses correspondi

사용자 경험 조사를 통한 간호 제품 및 서비스 혁신

안이레,신광수,연주한 충북대학교 국가미래기술경영연구소 2023 기술경영 Vol.8 No.3

Problems have been continuously raised about the workload of nurses in clinical settings. In particular, various social problems such as frequent turnover and retirement, job recruitment, and health difficulties of nurses are occurring due to this. Accordingly, previous studies have been studied on the dimensions of nurses' work motivation, organizational culture, and competency. However, there are insufficient studies to discover the unmet needs of nurses in the clinical field and find innovative ways to address them. Therefore, this study tried to discovery factors to improve nursing service, and to find a way to innovate medical products and services related to nursing work through an interview based on user experiences in the nursing field. To investigate user experiences in the nursing field, an interview was developed by dividing the nursing field into four main categories: 'medication nursing', 'excretory nursing', 'infection and safety nursing', and 'other nursing care'. In this study, based on interviews with 25 nurses in 5 hospitals, an attempt was made to identify unmet medical needs for medical products and services in each of the 4 nursing areas, and the results were derived by analyzing the collected data. This study sequentially derived 'keyword classification by nursing area', 'workload and time-consuming nursing practice by nursing area', and 'innovation ideas for medical products and services by nursing area'. The results of this study indicated that product innovation in medication nursing and innovation in nursing work using monitoring systems are needed from the user's point of view. This study presents implications for the efficiency of nurses' work in the clinical field by discovering the unmet needs of nurses and seeking innovative ideas for them.