DACUM 기법에 의한 병원 임상영양사의 직무기술서 개발

차진아 ( Jin A Cha ),김강은 ( Kang Eun Kim ),김은미 ( Eun Mi Kim ),박미선 ( Mi Sun Park ),박유경 ( Yoo Kyoung Park ),백희준 ( Hee Joon Baek ),이송미 ( Song Mi Lee ),최수경 ( Soo Kyong Choi ),서정숙 ( Jung Sook Seo ) 대한영양사협회 2013 대한영양사협회 학술지 Vol.19 No.3

본 연구에서는 DACUM 기법을 통해 국내 병원 임상영양사의 직무를 조사 및 분석하고 그 결과를 바탕으로 도출된 임상영양사의 직무기술서를 평가함으로써 병원 임상영양사를 위한 직무기술서를 개발하고자 하였다. 2011년 7월초에 DACUM 워크숍을 통해 1차적으로 직무기술서를 도출하고 전문가 집단의 자문회의와 Delphi 조사 방법을 적용한 표적집단 면접을 통해 수정 및 보완 작업을 거쳐 직무기 술서를 도출하였다. DACUM 위원회의 패널로는 3차 의료기관에 종사하고 있는 현직 임상영양사 9인과 임상영양학을 전공하는 교수 4인, 직무분석을 담당하는 교수 1인 등 총 14명이 참여하였다. 전문가 자문단을 별도로 구성하였으며, 의사 1인, 간호사 1인, 임상영양분야 실무자 및 교수 5인이 포함된 전문가의 의견을 추가적으로 수렴하였다. 도출된 직무기술서는 2011년 7∼8월까지 전국 500병상 이상의 종합 병원 90개 중 설문조사에 응답한 46개 병원에서 각각 임상영양 실무책임자 1인으로부터 수집한 자료를 분석하여 현장 적합성을 평가하였다. 본 연구의 결과를 요약하면 다음과 같다. 1. 본 연구에서 DACUM 기법에 의해 처음 도출된 직무는 총 8개의 직무, 33개의 과업, 114개의 과업요소였으나 수정 보완작업을 거쳐 총 7개의 직무, 27개의 과업과 93개의 과업요소로 재분류되었다. 최종적으로 병원 임상영양사의 직무는 영양판정(A), 영양진단(B), 영양중재(C), 영양모니터링ㆍ평가(D), 자문ㆍ협력(E), 영양연구(F), 자기계발(G)로 도출되었다. 2. 각 직무영역별로 세부내용을 보면, (A) 영양판정은 A1. 영양 초기평가하기, A2. 식품영양관련 자료 수집·평가하기, A3. 의학적 자료 점검하기, A4. 신체계측 자료 수집·평가하기, A5. 신체증상 자료 점검하기, A6. 개인력 및 과거력 점검하기, A7. 영양 요구량 결정하기, A8. 영양판정 기록하기의 8개의 과업으로 구분하였다. (B) 영양진단은 B1. 영양진단 도출하기, B2. 우선순위 정하기, B3. 영양진단 기록하기로 나뉘었고, (C) 영양 중재는 C1. 영양중재 계획하기, C2. 영양처방 관리하기, C3. 영양상담하기, C4. 영양교육하기, C5. 영양집중지원하기, C6. 영양중재 기록하기로 구분 하였다. (D) 영양모니터링·평가는 4개의 과업으로 D1. 영양상태 모니터하기, D2. 영양중재과정 모니터하기, D3. 영양중재 결과 평가하기, D4. 영양모니터링·평가 기록하기로 구분하였다. (E) 자문·협력은 E1. 영양자문하기, E2. 협력관계 구축 및 유지하기로 (F) 영양연구는 F1. 질 향상 활동하기, F2. 연구 활동하기로 분류하였다. 마지막으로 (G) 자기계발은 G1. 전문성 향상, G2. 자기관리가 포함되었다. 3. 도출된 임상영양 직무기술서에 대한 평가를 위해 설문조사에 참여한 대상 병원의 유형은 상급종합 병원이 65.2%를 차지하였으며, 종합병원은 34.8%였다. 병원의 재원일수는 8.0±1.5일이었으며 병원 조직에서 영양부서는 6곳을 제외한 39개의 병원에서 진료부서 또는 진료지원부서에 속하였다. 또한 병원에서 영양부서가 단독으로 편제되어 있는 경우가 93%로 높은 비율을 보였다. 병원 임상 영양사의 성별은 여자가 100%로 나타났으며, 연령별 분포는 40∼49세가 가장 높은 비율을 보였다. 근무경력은 10년 이상인 경우가 50% 이상을 차지하였고 최종학력은 석사졸업이 가장 높은 것으로 나타났다. 4. 전체 과업요소의 인지된 중요도를 비교하면 6개의 과업요소를 제외한 대부분의 과업요소들이 4.0점 이상이었고 총 7개 직무영역에 대한 중요도는 ‘영양중재’가 4.6±0.6점으로 가장 중요도가 높게 나타났으며, ‘영양진단’과 ‘영양모니터링·평가’의 직무가 4.5점 이상으로 비교적 높게 조사 되었다. 전체 과업요소 중 수행도가 4.5점 이상으로 매우 자주 수행되는 과업요소가 13개, 4.0점 이상의 자주 수행되는 과업도 29개의 과업요소로 나타났으며, 직무영역 중 ‘영양중재’가 4.2±1.0점으로 높게 나타났다. 직무영역별 난이도를 조사한 결과에서는 ‘영양연구’ 업무가 4.1±0.9점으로 가장 높게 조사되었다. ‘영양진단’과 ‘자문·협력’은 각각 3.8±1.0점, 3.7±0.9점으로 비교적 어렵게 인식되는 직무로 나타났다. 직무영역별 과업요소 전체의 중요도, 수행도, 난이도의 평균은 각각 4.5±0.8점, 3.7±1.3점, 3.5±1.0점으로 나타났으며 유의적인 차이가 나타났다(P<0.001). 5. 임상영양사 업무의 중요도와 수행도 사이의 관계를 나타낸 격자도 분석에서 영양 초기평가하기, 영양요구량 결정하기, 영양판정 기록하기, 영양진단 도출하기, 영양중재 계획하기, 영양처방 관리하기, 영양교육하기, 영양집중지원하기, 영양중재 기록하기, 영양상태 모니터하기, 영양중재 과정 모니터하기는 중요도와 수행도가 모두 높은 영역(doing great)에, 식품영양관련 자료수집·평가하기, 의학적 자료 점검하기, 신체계측 자료수집·평가하기, 신체증상 자료 점검하기, 개인력 및 과거력 자료 점검하기, 영양진단의 우선순위 정하기, 영양진단 기록하기, 영양상담하기, 영양 모니터링·평가 기록하기는 수행도는 높으나 중요도가 낮은 영역(overdone)에 속하였다. 중요도가 높으나 수행도가 낮은 영역(focus here)에는 협력관계 구축 및 유지하기, 질 향상 활동하기가 속하였고, 중요도와 수행도가 모두 낮은 영역(low priority)은 영양중재 평가하기, 영양 자문 활동하기, 연구 활동하기, 전문성 향상하기, 자기관리하기가 속하는 것으로 나타났다. 이상의 결과를 볼 때, 본 연구에서 DACUM 기법에 의해 개발된 병원 임상영양사의 직무기술서는 현장에서 임상영양서비스를 수행하는데 가이드라인으로 사용될 수 있을 것으로 여겨지며, 인지된 중요도가 평균 이상으로 높지만 그에 비해 수행도가 미흡한 과업들에 대하여는 임상영양사에 대한 교육 실시, 업무 분담, 적정인원 배치 등 제도적인 뒷받침을 마련하여 수행도를 높일 수 있는 방안이 강구 되어야 할 것이다. 또한 질병별 맞춤형 임상영양 업무에 관한 후속연구를 통하여 보다 전문적인 환자 영양치료가 가능할 것으로 여겨진다. The present study was conducted to develop a standardized job description for clinical dietitians working in hospitals. A developing curriculum (DACUM) method was used for the job analysis of clinical dietitians. Based on DACUM analysis with 14 members, including clinical dietitians and professors majoring in clinical nutrition and job analysis, information on the duties, tasks, and task elements of clinical dietitians was determined. To verify the job descriptions derived from DACUM analysis, a total of 46 tertiary and general hospitals with over 500 beds were recruited for the survey. The final developed job description for clinical dietitians included 7 duties, 27 tasks, and 93 task elements. The duties consisted of nutritional assessment, nutrition diagnosis, nutrition intervention, nutrition monitoring·evaluation, consultation·cooperation, nutrition research, and self-development. The mean scores of perceived importance, performance, and difficulty on the clinical dietitian`s task elements (out of a maximum score of 5.0) were 4.5, 3.7, and 3.5, respectively, with significant differences between the items (P<0.001). The perceived importance and performance grid of clinical dietitian`s tasks showed that “construction and maintenance of collaboration” (E2) and “activity of quality improvement” (F1) received relatively low scores for performance despite their high importance scores; thus the performance of these tasks requires significant improvement. In conclusion, the job descriptions of clinical dietitians developed from this study are useful for the qualitative improvement of clinical nutrition services in hospitals.

코스메슈티컬 화장품의 소비가치와 만족도 -피부질환 고민을 중심으로-

이송이 ( Song-i Lee ),김민정 ( Min-jeong Kim ),박정아 ( Jeong-a Park ) 한국미용학회 2022 한국미용학회지 Vol.28 No.5

In the modern times, people have been concerning more about their skin diseases resulting from environmental pollution and climate changes. At the same time, the cosmeceutical market whose roles have become segmented and specialized has expanded its reach. This study aimed to investigate the consumption values and consumer satisfaction of cosmeceuticals depending on skin diseases. It is meaningful in that it suggests basic data which are needed for manufacturers to set a direction for production and develop marketing strategies. According to this study, respondents believe that ‘functional value’ is most important among consumption values. As ‘functional value’ increased, consumer satisfaction improved accordingly. Satisfaction with cosmeceuticals was high in all groups because most cosmeceuticals are now of high quality and perceived as the products which are effective in easing diverse skin diseases with soothing, moisturizing and whitening effects. Therefore, it is required for manufacturers to develop more diverse and new technologies and enhance product quality and performances. More diverse studies are required to facilitate the steadily growing cosmeceutical market.

영양 상담서비스 품질에 대한 환자의 만족도와 인식조사

최기보(Ki Bo Choi),이송미(Song Mi Lee),이승민(Seung Min Lee),이은(Eun Lee),박미선(Mi Sun Park),박유경(Yoo Kyoung Park),차진아(Jin A Cha),류은순(Eun Soon Lyu) 한국식품영양과학회 2017 한국식품영양과학회지 Vol.46 No.2

전국의 43개 상급종합병원과 20개 상급병원의 환자 1,095명을 대상으로 환자의 영양 상담서비스에 대한 인식을 조사하고, 만족도는 서비스 품질 개념을 적용하여 분석하였다. 환자의 영양 상담서비스 인식 평균점수는 4.54/5.00점이었다. 환자의 영양 상담서비스 만족도를 요인 분석한 결과 서비스 품질 5개 영역으로 추출되었고, 각각 공감성, 반응성, 유형성, 신뢰성, 전문성으로 명명, 분류하였다. 5개 영역의 전체 평균 점수는 4.56점/5.00이었고 공감성 4.62점, 반응성 4.52점, 유형성 4.53점, 신뢰성 4.65점, 전문성 4.61점이었다. 학력에 따른 차이에서 영양 상담서비스 품질 만족도 총 평균은 대졸 이상이 중졸 이하보다 유의적(P<0.001)으로 높았다. 수도권 병원의 만족도 점수는 비수도권 병원보다 전체 평균 점수와 반응성, 공감성, 전문성, 신뢰성(P<0.001), 유형성(P<0.05)에서 유의적으로 높았다. 상담횟수에서는 반응성 영역에서 상담을 1회 받은 군이 2회보다 유의적(P<0.01)으로 높은 만족도를 보였다. 환자의 영양 상담서비스 인식과 만족도 간에 신뢰성(r=0.721), 반응성(r=0.697), 공감성(r=0.690), 전문성(r=0.678), 유형성(r=0.622)에서 양(+)의 상관관계를 보였다. 이상을 살펴볼 때 비수도권 병원에서는 임상영양사 수의 확보를 통해 환자의 영양 상담서비스 품질을 향상시키는 것이 필요하겠다. 또한, 영양 상담이 반복될수록 환자의 기대치가 높아질 수 있으므로 임상영양사는 영양 상담 내용 및 기법에 변화를 주고 다양한 자료를 활용하여 영양 상담서비스 품질을 향상시킬 수 있을 것이다. 영양 상담서비스 품질 만족도와 영양 상담 인식 간에는 높은 상관관계가 있는데 서비스 품질 만족도에서 유형성과 반응성은 다른 영역보다 상대적으로 낮은 점수를 보였으므로, 상담실 분위기를 쾌적하게 하고 다양한 교육매체를 활용하며 환자와의 여유 있는 상담시간 및 선택적 상담시간 확보 등 해당 영역에 대한 관리가 특히 필요할 것으로 여겨진다. The objective of this study was to analyze patient satisfaction and perception of nutritional counseling services quality. A patient satisfaction and perception survey was conducted for 1,095 patients from 43 tertiary hospitals and 20 general hospitals. The number of returned questionnaires was 656 (response rate: 60.0%). Data from 633 questionnaires were analyzed after the questionnaires with unanswered items were excluded. Five domains were identified from the result of the factor analysis using the maximum likelihood and oblique rotation. The five domains were named empathy, responsiveness, tangibles, reliability, and skill and specialty. Patient perception mean score of nutritional counseling was 4.54/5.00. Patient satisfaction scores were significantly higher in empathy (P<0.001), responsiveness, and skill and specialty (P<0.01) with a college or graduate school education than in patients with a middle school education. There was no statistically significant difference between satisfaction scores in tertiary hospitals and those in general hospitals, but patients in capital hospitals reported significantly higher scores than their local counterparts in empathy, responsiveness, reliability, skill and specialty (P<0.001), and tangibles (P<0.05). In responsiveness, significantly higher (P<0.01) scores were observed in patients who received nutritional counseling only once compared to patients who received counseling two times. Patients perception of nutritional counseling services was significantly correlated with their satisfaction of five domains, reliability (r=0.721), responsiveness (r=0.697), empathy (r=0.690), skill and specialty (r=0.678), and tangibles (r=0.622).

병원 유형 및 지역에 따른 임상영양서비스에 대한 간호사의 인식

이한나 ( Han Na Lee ),이송미 ( Song Mi Lee ),박유경 ( Yoo Kyung Park ),이승민 ( Seung Min Lee ),이은 ( Eun Lee ),차진아 ( Jin A Cha ),박미선 ( Mi Sun Park ),이호선 ( Ho Sun Lee ),라미용 ( Mi Yong Rha ),류은순 ( Eun Soon Lyu ) 대한영양사협회 2014 대한영양사협회 학술지 Vol.20 No.4

The purpose of this study was to evaluate nurses` perception of clinical nutrition services. A cross-sectional survey design was performed. The research was accomplished by using questionnaires developed for this study and administered from September 12 to December 31, 2013 to 343 nurses at 43 tertiary hospitals and 20general hospitals. The percentage of nurses who recognized clinical nutrition certificate as issued from nation was 27.8%. The mean scores of perceived usefulness on clinical nutrition services was 4.23/5.00, whereas that of perceived implementation was 3.76/5.00. The mean scores of necessity of disease-specialized clinical dietitian at capital hospitals were significantly higher for obesity (P<0.01), cancer (P<0.05), and infant & childhood disease (P<0.01) than at local hospitals. The rates of nurses` experience in group education on cancerat capital hospitals (21.7%) was significantly higher than that at local hospitals (10.3%) (P<0.05). The means cores of perceived importance of clinical nutrition services were 4.46/5.00 for ‘group nutrition education’, 4.46/5.00 for ‘individual consultation’, and 4.40/5.00 for ‘nutrition management for enteral nutrition (EN) patients’. The most common reason why clinical nutrition services are important was ‘improving mal nutritional status’. To activate clinical nutrition services especially at local hospitals, clinical dietitians should give systematic assistance to patients and also institutional supports are needed.

전국 병원영양사의 직무만족도 현황 및 관련요인

장은희 ( Eun Hee Jang ),류은순 ( Eun Soon Lyu ),이송미 ( Song Mi Lee ),박유경 ( Yoo Kyung Park ),이은 ( Eun Lee ),차진아 ( Jin A Cha ),박미선 ( Mi Sun Park ),이호선 ( Ho Sun Lee ),라미용 ( Mi Young Rha ),이승민 ( Seung Min Lee ) 대한영양사협회 2014 대한영양사협회 학술지 Vol.20 No.4

The objective of this study was to examine job satisfaction status and its related factors among dietitians working in hospitals. A survey questionnaire was sent to dietitians working in tertiary, general, and convalescent hospitals in Korea. The study sample hospitals included all tertiary hospitals (n=43), and the sample of general hospitals (n=114) and convalescent hospitals (n=240) was randomly selected using a stratified sampling method. A total of 665 dietitians completed the survey questionnaire. The questionnaire included27 job satisfaction questions on task, stability·vision, working conditions, and relationship areas, and the questions on task improvement need. The job satisfaction scores in all four areas ranged from2.53/5.00 to 3.89/5.00, implying generally low job satisfaction level in hospital dietitians. The job satisfaction levels in the convalescent hospital group were significantly lower compared to those in the tertiary and general hospital groups. Whereas job satisfaction levels of tertiary and convalescent hospital groups did not differ by number of beds, those of the general hospital group increased significantly with the number of beds for all four areas. Multivariate regression analysis results showed that hospital type was a significant predictor of job satisfaction level for all four areas. Job satisfaction of relationship area was also significantly affected by the number of beds, whereas that of working conditions was influenced by annual income and working experience. The study findings provide useful information in planning clinical dietitians` optimal supply outlook for the improvement of clinical nutrition services.

병원 임상영양사의 업무별 소요시간 분석: 서울 및 경기 일부의 상급종합병원을 중심으로

엄미향 ( Mi Hyang Um ),박유경 ( Yoo Kyung Park ),이송미 ( Song Mi Lee ),차진아 ( Jin A Cha ),이은 ( Eun Lee ),류은순 ( Eun Soon Lyu ) 대한영양사협회 2015 대한영양사협회 학술지 Vol.21 No.2

The objective of this study was to document how clinical dietitians working at tertiary hospitals spend theirtime based on several categories of activities using a time measurement study. The questionnaires were distributed to 14 tertiary hospitals, and dietitians answered by classifying their work activities into several categories such as general care, indirect care, direct care, outpatient care, and food service management. A total of 129 clinical dietitians replied and their answers were analyzed according to the categories of activities. The times spent on the categories are as follows: general care (76.7 mins/day, 14%), indirect care (228.4 mins/day, 35%), direct care (120.1 mins/day, 22%), outpatient care (61.5 mins/day, 11%), and food service management (99.0 mins/day, 18%). The total working hours for dietitians was 590.0 mins, which exceeds the standard working hours of 540.0 mins (9 hrs) a day. From this study, we found that clinical dietitians spent very limited time on direct care. Times spent on activities were different according to type of employment and food service. Internship dietitians spent their more time on general care (P<0.001) while irregular dietitians spent more time on outpatient care (P<0.05). In contracted managed food service hospitals, clinical dietitians spent significantly less time on food service management (P<0.001). Regardless of doctors’ order and consultation fees, clinical dietitians performed more than 95 percent of free consultation to patients. Entry-level knowledge and skills of dietitians working at hospitals are very important for quality service, but it is equally important to create an administrative and social environment that encourages clinical dietitian to spend more time on direct patient care.

국내 상급종합병원과 전국 분포 종합병원의 임상영양서비스 실태 조사 연구: 전국 규모 설문조사를 통하여

엄미향 ( Mi Hyang Um ),박유경 ( Yoo Kyung Park ),이송미 ( Song Mi Lee ),이승민 ( Seung Min Lee ),이은 ( Eun Lee ),차진아 ( Jin A Cha ),박미선 ( Mi Sun Park ),이호선 ( Ho Sun Lee ),라미용 ( Mi Yong Rha ),류은순 ( Eun Soon Lyu ) 대한영양사협회 2014 대한영양사협회 학술지 Vol.20 No.3

The purpose of this study was to investigate the status of clinical nutrition services provided at tertiary hospitals and general hospitals in Korea. In total, 157 questionnaires were distributed to the departments of nutrition at hospitals on September 2013. The results of this study are as follows. The median number of beds was 607 and average length of stay was 8 days. 63.1% of dietitians had over 5 years of career experience. Nutritional screening rate was 97% in tertiary hospitals but only 67.2% in general hospitals (P¼ 0.001). The rate of equipment with computerized nutritional screening system was 100% in tertiary hospitals but 71.9% in general hospitals (P¼0.001). Hospitals with the best regarding nutritional care were hospitals accredited by JCI (Joint Commission International). On the other hand, hospitals not accredited by the JCI but KOIHA (Korea Institute for Healthcare Accreditation) showed the lowest performance rate of nutritional care. Nutrition support teams (NSTs) were established in all tertiary hospitals but in only 73% of general hospitals (P¼0.001). The rate of actively operating NSTs was 89% in tertiary hospitals but only 62% in general hospitals (P¼0.001). There is a need to provide proper standardized clinical nutrition services as a primary treatment and we observed large variations in the quality of nutritional service between hospitals. Therefore, local solutions are needed to implement nutritional programs and policies for improved service and care.

The Development of Test Evaluation Method for Building Integrated Photovoltaic Roof

Hyun-A Kim(김현아),Jung-Jin Choi(최정진),Song-Won Lee(이송원),Sang-Cheol Kim(김상철) 한국태양에너지학회 2014 한국태양에너지학회 학술대회논문집 Vol.2014 No.3

DEA모형을 이용한 상수관망 위험관 선정 방법에 관한 연구

이은환(Lee, Eun Hwan),이송이(Lee, Song I),김아린(Gim, A Rin),전환돈(Jun, Hwan don) 대한토목학회 2022 대한토목학회 학술대회 Vol.2022 No.10

마우스 동계골수이식 후 면역체계의 재생: I. 말초혈액 및 림프장기 세포의 숫적 변 화와 림프구아군의 분포

김성호,오헌,이송은,김순태,조성기,현병화,류시윤,Kim, Sung-Ho,Oh, Heon,Lee, Song-Eun,Kim, Soon-Tae,Jo, Sung-Kee,Hyun, Byung-Hwa,Ryu, Si-Yun,Daynes, Raymond A. 한국수의병리학회 1997 한국수의병리학회지 Vol.1 No.1

The cellularity and composition of the spleen lymph node thymus and peripheral blood and tempo of regeneration were studied at various time points after syngeneic bone marrow transplantation(BMT) in C3H/Hen mice. Significant depression of absolute lymphocyte count was noted on week 1 after lethal whole-body irradiation and BMT. In comparison to the lymph node thymus and spleen had an rapid regeneration of cellularity. The distinct cell populations($CD4^+,\;CD8^+,\;CD28^+,\;B220^+) have determined in the lymphoid tissue of mice subjected to irradiation. The relative representation of these subpopulations was significantly different from that in nonirradiated control. $CD4^+\;and\;CD8^+$ cells were present in very low numbers whereas the $B220^+$ cells reached more than normal range at 2 weeks after BMT. The number of $CD4^+$ cells returned to normal relatively soon than $CD8^+$ cell. At week 4 after BMT, the cellularity and composition of spleen lymph node and peripheral blood lymphocyte reached about 50% of the normal range therefore we can choose this time point for the other tests of immune function after BMT.