일개 신경외과 병동에서 발생 한 언어폭력에 대한 연구 : 간호사의 입장에서

남인순 경희대학교 공공대학원 2015 국내석사

본 연구는 일개 대학병원 신경외과 병동 간호사를 대상으로, 환자 또는 보호자들에 의해 일어나는 언어폭력의 사례를 파악하여 일개 대학병원 신경외과 병동에 맞는 원인 분석 틀을 마련하고, 언어폭력의 유발 원인과 실상을 분석 하였다. 자료 수집은 K 대학병원 신경외과 병동에서 최근 1년 동안 언어폭력 경험을 2014년 11월 1일부터 12월 15일까지 10명의 간호사를 통하여 27개의 언어폭력 일지를 수집하였으며, 27개의 언어폭력 일지 중 총 31건의 사례가 도출되었다. 수거된 사례를 기존의 언어폭력 원인을 분류한 연구를 중심으로 내용을 종합, 수정, 보완하여 일개 신경외과 병동의 특성에 맞는 원인으로 구성하고, 이를 피시본 다이어그램(Fishbone Diagram)에 적용하여 상위원인과 하위원인으로 구분하였다. 언어폭력이 일어나는 상위 원인은 ‘질병과 관련된 문제’, ‘병원자원과 관련된 문제’, ‘인력과 관련된 문제’, ‘인식과 관련된 문제’, ‘개인적 성향’이었고, 하위원인으로는 ‘질병과 관련된 신체적, 정서적 고통을 간호사에게 화풀이 함’, ‘가해자가 의식이 혼미하여 의도가 없는 폭력이었음’, ‘가해자가 음주상태로 취한 상태임’, ‘의료 시설이나 기구에 대한 불만을 간호사에게 화풀이 함’, ‘진료비에 불만을 가짐’, ‘의사의 설명, 검사, 처치, 결정, 수술 등의 지연에서 오는 불만’, ‘간호사의 업무상 실수’, ‘간호사의 언어, 태도에 대한 불만’, ‘간호사를 치료자가 아닌 성적 대상(여성)으로 봄’, ‘간호사를 치료자가 아닌 아랫사람으로 인식’, ‘환자나 보호자의 일방적인 행동’, ‘기타’였다. 상위원인과 하위원인을 바탕으로 환자나 보호자로부터 간호사가 경험한 언어폭력 실상을 살펴보았다. 첫째. ‘질병과 관련된 문제’의 경우 ‘질병과 관련된 신체적, 정서적 고통을 간 호사에게 화풀이 함’, ‘가해자가 의식이 혼미하여 의도가 없는 폭력이 었음’, ‘가해자가 음주상태로 취한상태임’으로 구성되었다. 둘째, ‘병원자원과 관련된 문제’의 경우 ‘의료 시설이나 기구에 대한 불만을 간호사에게 화풀이 함’, ‘진료비에 불만을 가짐’으로 구성되었다. 셋째, ‘인력과 관련된 문제’는 ‘의사의 설명, 검사, 처치, 결정, 수술 등의 지연에서 오는 불만’, ‘간호사의 업무상 실수’, ‘간호사의 언어, 태도에 대한 불만’으로 의사나 간호 인력의 부족이나 인력 관리가 원인으로 발생하 였다. 넷째, ‘인식과 관련된 문제’의 경우 간호사를 치료자가 아닌 성적 대상(여성) 으로 보거나 치료자가 아닌 아랫사람으로 인식하여 언어폭력이 일어났 다. 다섯째, ‘개인적 성향’의 경우 ‘환자나 보호자의 일방적인 행동’으로 언어폭력이 발생하였으며 언어폭력을 일으킨 환자나 보호자는 한명의 간호사 뿐만 아니라 여러 명의 간호사에게 언어폭력을 일으켰다. 일개 신경외과 병동에서 발생한 언어폭력 원인 분류에 사례를 다시 적용하여 빈도분석을 하였다. 최근 1년 동안에 일개 신경외과 병동 간호사가 환자나 보호자에 의해 일어난 언어폭력 원인을 살펴보면 ‘의사의 설명, 검사, 처치, 결정, 수술 등의 지연에서 오는 불만’이 20.5%로 가장 높았으며 ‘간호사의 언어, 태도에 대한 불만’이 12.8%로의 순이었다. 상위 원인은 ‘인력과 관련된 문제’가 38.4%으로 가장 높았으며, 그 다음이 ‘질병과 관련된 문제’가 25.7%순으로 의료기관 내의 인력관리가 중요함을 시사한다. 본 연구를 통해 간호사의 언어폭력을 예방, 대처하기 위해 의료기관은 의료서비스의 향상 및 간호사, 의사 등 의료진의 관리 차원에서 병원 폭력에 관심을 기울여야 할 것이다. 폭력 피해자인 간호사는 물론 언어폭력 행사자인 환자, 보호자까지 대상자를 확대한 심층적인 연구를 하여 환자나 보호자의 심리적 불안을 감소시킬 수 있는 정서적 치료 프로그램 개발과 환자나 보호자의 언어폭력 유형별 대처 방안에 대한 모델 제시가 필요할 것이다. This study examined cases of verbal abuse by patients and their guardians towards nurses at the neurosurgery ward of a university hospital and made a frame for the analysis of the causes of such verbal abuse and then analyzed the causes and current state of such verbal abuse. As for data collection, 27 daily records of verbal abuse were collected from 10 nurses from November 1st to December 15th, 2014 who had experienced verbal abuse at the neurosurgery ward of K university hospital within the recent one year. From the 27 daily records, 31 cases of verbal abuse were elicited. Based on preceding studies that classified the causes of verbal abuse, the collected cases were aggregated, modified and supplemented, producing the causes suitable for the features of the neurosurgery ward of a university hospital. The causes were then divided into upper-level and lower-level causes using Fishbone diagram. Based on the upper-level and lower-level causes, verbal abuse by patients and their guardians towards nurses were examined. First, 'problems related to disease' were composed of 'venting physical and emotional pain from disease on nurses,' 'verbal abuse committed unintentionally when the abuser was delirious,' and ‘verbal abuse committed when the abuser was drunken.' Second, 'problems related hospital resources' consisted of 'complaining to nurses about medical facilities or equipments' and ‘complaining about medical bill.' Third, ‘problems related to human resources' consisted of 'complaining about doctors' explanation, examination, treatment and decision and delay of operation,’ ‘nurses' mistakes at work,' and 'complaining about nurses' words and attitudes.' Those problems were caused by a shortage of doctors or nurses and the inappropriate management of human resources. Fourth, when it came to 'verbal abuse problems related to perception,' such problems occurred because the abusers perceived nurses not as medical staff but as sexual objects (women) or their subordinates. Finally, when it came to 'personal tendency,' verbal abuse occurred as ‘one-sided behavior by a patient or his or her guardian,' and the patient or the guardian did verbal abuse not to one but to several nurses. A frequency analysis was performed on the causes of verbal abuse that had occurred at the neurosurgery ward of K university hospital within the recent one year. According to the results, 'complaining about doctors' explanation, examination, treatment and decision and delay of operation,’ took first place with 20.5 percent, followed by 'complaining about nurses' words and attitudes,' which recorded 12.8 percent. As for the upper-level causes, 'problems related to human resources' recorded the highest figure of 38.4 percent, followed by 'problems related to disease,' which earned 25.7 percent. This suggests the importance of human resource management in medical institutions. This study showed that in order to prevent and handle verbal abuse towards nurses, medical institutions should pay attention to the improvement of medical services and verbal abuse on the level of managing medical staff including nurses and doctors. It is essential to carry out in-depth studies involving patients and their guardians, the verbal abusers, as well as nurses, the victims, to develop emotional treatment programs that reduce the emotional anxiety of patients and their guardians and to present a model for the handling of verbal abuse by patients and their guardians by type.

간호학생들의 병원 내 감염에 대한 지식 정도 : 간호학생을 대상으로

조미선 경희대학교 공공대학원 2017 국내석사

This study is descriptive research and the purpose is to investigate the knowledge about hospital infection and to develop an infection control education program, effective hospital infection and policy making. A questionnaire survey was conducted for 12 days from Nov. 7, 2016 with 120 nursing university students. The questionnaires were divided into the following areas: handwashing, respiratory, urinary tract infection, fluid therapy and catheter management, personal hygiene and disinfection management, which were developed and revised by Kim Bong-hee (2003)and used according to the use of the study. Analysis of the survey results was analyzed by frequency analysis, crossover analysis, and independent sample T-test. The questionnaires used in the study were 120 copies, and SPSS 18.0 was used for data analysis. The results of this study showed that the difference of infectious knowledge according to the experience of hospital practice was statistically significant. In the case of practice experience, the infection knowledge score average was higher. The mean score of the cases with hospital career experience was higher than no hospital experience cases, but it is considered that further study on the relevant part is needed as the number of difficult cases to obtain statistical significance. These characteristics and results suggest that it is necessary to strengthen the awareness and importance of infectious knowledge through practical training activities in hospitals where practitioners receive medical care and practical training as well as simple education in the future. In particular, in the case of the lower-level group with relatively higher education hours compared to the upper-level students, if intermittent simple event-based training is conducted based on a systematic practice curriculum related to infectious knowledge, it would have a significant effect on nursing students to increase level of importance in infection knowledge. Knowledge of infections acquired during schooling has a great impact even after becoming a nurse practicing in the real field. In addition, basic nursing ability in hospitals formed on the basis of school education should be considered as very important and interesting as it can affect patient 's life. In conclusion, it is necessary to reinforce education program about infectious disease management considering various aspects through gathering opinion, so that nurses can fully recognize the importance of hospital infection and prepare from nursing school.