SBAR 적용 시뮬레이션 교육이 간호학생의 의료팀간 의사소통능력 향상에 미치는 효과

하이경,이윤주,이연희,Ha, Yikyung,Lee, Yoonju,Lee, Yeon Hee 한국데이터정보과학회 2017 한국데이터정보과학회지 Vol.28 No.2

In this paper, we aim to evaluate the effect of simulation training with a focus on the application of SBAR for the improvement of communication skills of nursing students with physician. The results of the analysis of 25 videos recorded pre/post-simulation were as follows: In terms of the SBAR score, "the most recently measured vital signs" in stage B increased significantly (Z = -2.448, p =.014); the frequency of step-by-step progress in SBAR did not advance to the SBA or SBAR stage in the pre-simulation stage, but increased to 48% post-simulation. The frequencies of SBAR evaluation items mentioned in the post-simulation were the following order: the name of the patient (96%), nurse's name (80%), most recently measured oxygen saturation (76%), and main symptoms (60%). The results of the nurse's judgment (A), request for additional prescription or request for the doctor's direct patient visit (R) were not mentioned. Therefore, it is necessary to consider the application of SBAR in simulation training, which requires problem solving through cooperation with physicians, because it has a positive effect on education in nurse-physician communication. 본 연구는 간호학생을 대상으로 SBAR (situation, background, assessment, and recommendation) 적용에 중점을 둔 시뮬레이션 교육의 효과를 확인하여 간호사와 의사 간의 의사소통능력 향상을 위한 간호교육 개발의 기초자료를 제공하고자 시행되었다. 간호대학 3학년을 대상으로 호흡곤란 주제의 시나리오에 SBAR를 적용하는 사전, 사후시뮬레이션 진행 중 녹화된 25개의 동영상을 분석한 결과 SBAR 점수는 사후시뮬레이션에서 B단계의 '가장 최근에 측정한 활력징후 보고' 항목 (Z=-2.448, p=.014)과 '간호사가 판단한 상황' 항목 (Z=-3.464, p=.001)이 통계적으로 유의하게 증가하였다. SBAR 단계별 진행빈도는 사전시뮬레이션에서 SBA나 SBAR 단계로 진행된 경우가 없었으나 사후시뮬레이션에서는 48%로 증가하였다. 사후시뮬레이션에서 언급된 SBAR 평가항목별 빈도는 S단계의 환자이름 (96%), 간호사이름 (80%), B단계의 가장 최근에 측정한 산소포화도 (76%), S단계의 주증상 (60%)의 순서였다. 그러나 A단계에서 추가사정을 통한 간호사의 판단결과를 제시하는 것과 R단계의 추가처방 요청이나 의사의 직접 환자방문 요청은 언급되지 않았다. 따라서 SBAR 적용이 포함된 시뮬레이션교육이 간호사와 의사간의 의사소통교육에 긍정적 효과를 보여 추후 의사와의 협력을 통한 문제해결이 필요한 시뮬레이션교육에서 SBAR 적용을 적극적으로 고려하는 것이 필요하다.

입원 중인 자살시도 환자에 대한 간호사의 태도; 통합적 문헌고찰

하이경,이윤지,Ha, Yi Kyung,Lee, Yunji 한국중환자간호학회 2021 중환자간호학회지 Vol.14 No.3

Purpose : This study aims to identify nurses' attitudes toward patients hospitalized after attempting suicide and inform directions for research and interventions to establish a therapeutic environment. Methods : For integrative review, the five stages suggested by Whittemore and Knafl were followed. Articles and theses published before February 2021 were searched using eight databases and a manual search. The search terms were suicide, self-harm, emergency department (ED), intensive care unit (ICU), nurses, and attitudes. Results : Five studies met the inclusion criteria; three of them were descriptive studies, one was a qualitative study, and one a mixed-method study. In most studies (80%), the participants were ED nurses. ED/ICU nurses showed positive or neutral attitudes toward patients. All studies suggested that suicide-related education programs are needed to increase nurses' positive attitudes such patients. Conclusion : More research is required on ICU nurses' attitudes toward patients who have attempted suicide, and efforts to identify various aspects of such attitudes are necessary. In addition, suicide education programs and support from trained psychiatric personnel should be provided to establish a therapeutic environment.

간호대학 시뮬레이션 교육의 이행(transition)에 대한 개념 분석

하이경,방활란,이연희,Ha, Yi Kyung,Bang, Hwal Lan,Lee, Yeon Hee 한국중환자간호학회 2019 중환자간호학회지 Vol.12 No.2

Purpose : The purpose of this study was to identify the attributes, antecedents, and consequences of the transition of simulation-based learning (SBL) in nursing schools. Methods : The study was conducted in accordance with Walker and Avant's conceptual analysis process. We searched MEDLINE, CINAHL, EMBASE, Google Scholar, and RISS (Korean Education and Research Information Service) databases, resulting in nine studies for an in-depth review. Results : The attributes of transition of SBL include (1) preparing for a professional role, (2) practicing in a real clinical setting, and (3) progressing toward expected competency. Antecedents of the concept include novice status, changing roles, clinical experience in controlled settings, and expected competency in the clinical setting. Conclusion : The transition of SBL includes the important feature of progression toward expected competency. Further research is needed to identify graduate nurses' experiences during this transition to establish a strategy for improving it and developing a measurement tool that reflects attributes of the concept.

〈간호중재 4〉 개심술 환자의 입원 중 조기 운동프로그램 개발 및 적용에 관한 연구

하이경,이영희,정연이 한국간호과학회 2006 한국간호과학회 학술대회 Vol.2006 No.11

개심술 환자를 위한 조기 운동프로그램의 개발 및 적용에 관한 연구

하이경,정연이,Ha, Yi-Kyung,Jung, Yoen-Yi 한국중환자간호학회 2011 중환자간호학회지 Vol.4 No.1

Purpose: This study was to develop and evaluate stability and effects of an early exercise program for patients with open heart surgery. Methods: The subjects of this study were 30 patients who had either a coronary bypass surgery or a valvular heart surgery at a tertiary hospital in Seoul. The data was collected by observation and measurement from October 1, 2004 to November 15, 2004. Results: The early exercise program developed for this study consisted of range of motion exercise and walking. Intensity of walking was 1~3 METs and increased progressively to daily target distance. During exercise, the subjects were monitored heart rate, blood pressure and RPE (Rating of Perceived Exertion). The mean FIM (Functional Independent Measurements) score of subjects was significantly improved after the early exercise program. However, several complaints such as dizziness or pain were also reported. Most complaints were associated with chest tube and RPE. Conclusion: The early exercise program can help to recover patients' physical activities after surgery, and can be applied to most patients. Patients' RPE, dizziness and pain was possible limitations, therefore, active pain control and prevention of accidents for patients would be needed.

악화환자 인지 및 대응을 위한 시뮬레이션교육에서 간호대학생의 임상판단력과 간호수행: 후향적 혼합연구

하이경 한국중환자간호학회 2023 중환자간호학회지 Vol.16 No.2

Purpose : This retrospective mixed-methods study aimed to explore key considerations for designing effective simulated education in nursing, focusing specifically on the recognition and response to deteriorating patients. Methods : Quantitative and qualitative data were analyzed to assess the clinical judgment and performance of the nursing students. Descriptive statistics were used to analyze quantitative data related to prior knowledge, simulation satisfaction, clinical judgment, and nursing performance during deteriorating patient simulations. Qualitative content analysis was conducted for the reflective journal entries of the participants. Results : Quantitative analysis showed that most participants demonstrated a “being skillful” level of clinical judgment (33.1%) in effective response. At the beginner level, clinical judgment varied across effective noticing(39.7-82.8%), effective interpretating(77.6-82.8%), effective responding(3.4-86.2%), and effective reflecting(90.0-95.4%). Nursing performance in assessing patient respiration or SpO2 after request from a physician ranged from 46.6-48.3%. Qualitative analysis indicated that 48.5% of the participants anticipated a deteriorating condition and initiated appropriate actions, while 70% noticed patient unresponsiveness for the first time. Conclusion : To design an effective simulation program for identifying and addressing deteriorating patient care, a framework for observation and interpretation is essential, along with regular simulated training. It is important to design and assess simulation programs and to conduct thorough interviews with nursing students to gain insight into their clinical decisionmaking.

간호학생을 위한 의사소통 시뮬레이션교육프로그램의 지역사회간호학 교과적용을 위한 예비연구

하이경(Ha, Yi-Kyung) 한국산학기술학회 2015 한국산학기술학회논문지 Vol.16 No.4

본 연구는 의사소통 시뮬레이션교육프로그램을 개발하고 지역사회간호학 교과목에 적용가능성을 평가하기 위한 단 일군 전후설계로 시행되었다. 대상자는 3학년 간호학생 35명이었고 의사소통능력과 만족도에 대한 설문지로 조사했고 수집 된 자료는 교육 전후 의사소통능력의 비교는 paired t-test, 교육 후 만족도는 서술통계 후 분석했다. 본 연구를 통해 의사소통 시뮬레이션프로그램이 개발되었고 교육 후 간호학생의 만족도는 4.4/5점이다. 그러나 전반적인 의사소통능력에는 차이가 없 었고 하부 영역 중 역할수행능력에 대한 평균 점수는 사전 3.5/5점, 사후 3.7/5점으로 증가했으나(p<.001), 해석능력은 사전 3.6/5점, 사후 3.5/5점으로 감소했다(p=.029). 의사소통의 다른 세 영역은 교육 전후 유의한 차이가 없었다. 따라서 본 연구에 서 개발된 의사소통 시뮬레이션교육프로그램을 지역사회간호학교육에 적용 가능할 것으로 보이나 추후 효과적으로 의사소 통능력을 증가시키기 위한 전략에 대한 고려가 필요하다. The purpose of this study was to develop a communication simulation and evaluate its applicability of curriculum of community health nursing for nursing students. This study used one- group pretest-posttest design and participants were 35 junior nursing students. Data was collected through self-reported questionnaires of communicative competence and satisfaction and analyzed using paired-t test and descriptive statistics. There was no change of overall mean score of communicative competence, though the simulation program related to communication of community health nurses was developed and the score of satisfaction after the simulation was 4.4 out of 5. In the categories of communicative competence, the score of role competence was increased after simulation(p<.001) but interpretive competence was decreased(p=.029). And others were not significant changes. As these results, the developed simulation program was applicable to community health nursing course, but further consideration is needed about strategies of simulation to increase communicative competence.

시뮬레이션 교육에서 학습자의 몰입 측정에 대한 체계적 고찰

하이경(Ha, Yi Kyung) 학습자중심교과교육학회 2019 학습자중심교과교육연구 Vol.19 No.22

본 연구의 목적은 시뮬레이션 교육에서 학습자의 몰입을 측정한 양적 연구에서 사용된 도구의 개발과정과 신뢰도, 타당도를 평가하여 적절한 몰입 측정도구를 선정하기 위한 정보를 제공하는데 있다. 검색을 위한 국외 검색엔진은 CINAHL, PubMED, MEDLINE, EMBASE, Google Scholar, 국내 문헌검색엔진은 RISS, NDSL, KISTI, 국회도서관 전자저널 데이터베이스를 사용하여 2000년부터 2019년 7월 31일까지의 기간으로 설정하여 문헌을 검색한 후 체계적 문헌고찰 절차에 따라 최종적으로 10개 문헌을 선정하였다. 문헌을 분석한 결과 2013년 이후 10편의 연구가 발표되었고 모두 국내에서 시행되었으며 시뮬레이션 교육에서 최종 사용된 몰입 측정도구는 영어도구를 번역, 수정한 도구 3가지, 국내에서 개발된 원도구 1가지, 국내도구를 수정한 도구 1가지가 사용되었고 신뢰도 Cronbach α는 .79~.92 이었다. 타당도검정은 역번역을 시행한 실습몰입 도구와 확인적 요인분석을 시행한 개인플로우 척도 두 개뿐이었고 기존도구의 타당도검정을 위한 연구대상자와 몰입의 상황이 다름에도 불구하고 타당도가 검정되지 않은 도구를 최종 몰입측정도구로 사용하여부적절한 결과해석의 가능성이 있었다. 따라서 시뮬레이션 상황에서의 몰입 특성이 반영된 도구개발이 필요하며 측정된 몰입 정도에 근거하여 시뮬레이션 교육에서 입을 증진시키고 학습성과를 향상시키기 위한 시뮬레이션 교육 전략 수립을 위한 추후 연구가 필요하다. The purpose of this study was to review instruments for assessment of learner’s flow in simulation education and to inform for selecting appropriate instruments for flow measurements by evaluating the development process, reliability and validity. Ten quantitative research reports published from 2013 to September 2019 were selected from nine databases: CINAHL, PubMED, MEDLINE, EMBASE, Google Scholar, RISS, NDSL, KISTI, and the National Assembly Library. The final ten researches were selected under the systematic literature review as PRISMA process. The internal consistency, Cronbach’s alpha was between .79 and .92 in the final instruments. The validity test was only two of the clinical practice flow tools that conducted reverse translation and the individual flow scales that conducted a confirmatory factor analysis. Although the situations of flow with the participants in studies for validity testing of the original instruments were different, validity was not tested as a measuring tool of learner’s flow. So it was possible to analyze the results inappropriately by using a tool whose validity was not tested. Therefore, it is suggested that objectification, standardized tool development reflecting flow characteristics in simulation situations are required. That simulation education should be planned to enhance flow and improve learning outcome in simulation education based on measured degree of flow.

간호교육 : 중환자간호 기계환기 시뮬레이션교육이 간호학생의 임상판단력과 자신감에 미치는 영향

하이경 ( Yi Kyung Ha ),고진강 ( Chin Kang Koh ) 서울대학교 간호과학연구소 2012 간호학의 지평 Vol.9 No.2

Purpose: The purpose of this study was to evaluate the effects of mechanical ventilation simulation on the clinical judgment and self-confidence of nursing students. Methods: This study was a quasi-experimental study. From one university, 118 undergraduate nursing students participated in this study. Sixty students were in the intervention group, and fifty-eight students were in the control group. A simulation scenario utilizing a high-fidelity human simulator focusing on nursing care for patients with a mechanical ventilator was developed for this study. Data were collected with a self-report survey method before the intervention, right after intervention, and two weeks later. Results: Students in the intervention group showed significantly higher increases in clinical judgment and self-confidence than those in the control group at the immediate posttest. Moreover, 2 weeks later, the increase in clinical judgment and self-confidence from the pretest among the intervention group was significantly larger than those in the control group. Conclusion: Utilizing simulation education focusing on patients with a mechanical ventilator may contribute to training more competent nurses in the area of critical care nursing. It may also serve to provide a better critical care environment for the safety and health of patients.

COVID-19로 인한 성인간호학 임상실습의 교내대체실습에 참여한 간호대학생의 문제해결능력에 영향을 미치는 요인

하이경(Ha Yi Kyung),이연희(Lee Yeon Hee) 학습자중심교과교육학회 2021 학습자중심교과교육연구 Vol.21 No.2

Nursing education is a training for pre-service nursing professionals at the university level. Although nursing students may spend time on campus for theoretical courses and general education requirements, students must complete in-person clinical placement to fulfill the Bachelor of Nursing degree requirements. However the COVID-19 pandemic has changed the orders and structures of societies, particularly in the fields of medical and nursing professions. Many face-to-face courses and internships in clinical environments are affected by social distancing recommendations. The purpose of this study was to investigate the influence of alternative clinical practicum on junior nursing student’s problem-solving ability. A total of 125 junior nursing students participated in this study in a metropolitan city. Data were collected using a structured questionnaires including demographics, characteristics related to learning, learning style, learning motivation, learning flow and problem-solving ability from Jun 26 to July 3, 2020. Data were analyzed using descriptive statistics, t-test, ANOVA, Pearson’s correlation coefficient and multiple regression by SPSS 25.0 program. The influencing factors of the nursing student’s problem-solving ability were learning motivation, learning flow and converger learning style. Also, these factors explained 47.5% of the variance and learning motivation was the most influential factor (β=.418, p<.001) in the nursing student’s problem-solving ability. Based on these results, there is a need to develop teaching methods to provide a learning environment to plan meaningful clinical learning experiences and improve learning motivation and learning flow. 본 연구의 목적은 COVID-19로 인해 임상실습이 중단됨에 따라 성인간호학 임상실습의 교내대체실습에 참여한 간호대학생의 문제해결능력에 영향을 미치는 요인을 파악하는 것이다. 연구 참여자는 B 시 소재 일 대학에서 2020년 5월 11일부터 6월 17일까지 시행된 교내대체실습에 참여한 3학년 간호대학생 125명이었고 수업 평가 종료 후 설문지를 이용하여 자료를 수집하였다. 자료처리는 SPSS 25.0 프로그램을 활용하였으며 참여자의 일반적 특성과 참여도, 선호교수법, 학습유형은 기술통계로 분석하였고 일반적 특성에 따른 학습동기, 학습몰입, 문제해결능력 간의 차이는 t-test, one-way ANOVA로 분석하고 Scheffe‘s test로 사후분석하였으며 참여자의 문제해결능력에 미치는 영향요인은 입력 다중회귀분석으로 분석하였다. 그 결과, 참여자의 교내대체실습에 대한 참여도는 5점 만점에 4점 이상인 학생이 79.2% 이었고 사례기반학습을 선호하는 학생수가 38.4%로 가장 많았으며, 확산형 학습유형이 36.8%이었다. 학습동기는 일반적 특성에 따른 차이를 보이지 않았으나 학습몰입은 참여도가 높은 학생이 높았다(t=-2.64, p=.009). 문제해결능력은 학습유형에 따른 차이를 보였고 수렴형인 경우 문제해결능력이 높았다(F=4.83, p=.003). 간호대학생의 문제해결능력에 영향을 미치는 요인은 학습동기, 학습몰입, 수렴형의 학습유형으로 설명력은 47.5%이었으며 학습동기가 가장 큰 영향요인(β=.418, p<.001)이었다. 따라서 COVID-19로 인한 임상실습의 교내대체실습은 학습동기와 학습몰입을 향상시키기 위한 교수법 개발 및 수렴형 학습유형을 선호할 수 있도록 하는 학습환경을 제공하는 것이 필요하다. 향후 교내대체실습 효과를 비교하기 위한 추후 연구를 제언한다.