수술실 소독간호사의 비기술적 술기 (Non-Technical Skills)의 체화 : 분석적 귀납법(Analytic Induction) 접근

국문 초록 (Abstract)

최근 수술실 환경은 성공적인 수술목표를 달성하기 위하여 각 전문분야
의료진의 임상술기 지식과 함께 환자의 안전에 중요한 영향을 미치는 비기술적
술기가 강조되고 있다. 특히, 수술 팀원들 중의 수술실 소독간호사는 기술적
술기와 비기술적 술기를 효과적으로 활용함으로써 다학제의 전문의료진과 필수
적으로 협동하며, 수술자원을 효율적으로 관리함으로써 직접적인 수술안전간호
에 영향을 미치고 있다. 수술실 소독간호사의 비기술적 술기는 Mitchell 등
(2013)에 의해 제시된 의사소통과 팀워크, 상황인식, 그리고 업무수행을 의미
하는 것이다. 이에 본 연구에서는 수술실 소독간호사가 실무상황에서 비기술적
술기를 적합하게 체화하는 것을 통해 수술실 소독간호사들의 실무역량증진과
수술안전간호의 이론적 근거를 명료화 하고자 하였다.
본 연구는 분석적 귀납법(analytic induction)을 적용하여 수술실 소독
간호사의 비기술적 술기의 체화를 탐구하였다. 본 연구참여자는 서울지역에
위치한 K 대학 G 병원 9 명, A 병원 2 명 그리고 경기도 K 대학병원 A 병원
1 명으로 구성하였고, 수술실 근무 10 년 이상의 경력이 있는 간호사를 연구
참여자로 선정하고, 총 12 명을 모집하여 면담하였다. 자료수집 방법은 관찰자적
참여자(participant as observer)로 참여관찰과 참여자의 심층면접을 통하여
자료수집을 하였다. 분석방법은 임상에서 보여지는 현상을 일상적인 사회적
맥락에서 그 과정을 관찰하고 분석하기 위해 Johnson(2004)에 의해 수정된
분석적 귀납법을 따랐다.
ii
본 연구 결과 확인된 수술실 소독간호사의 비기술적 술기인 의사소통과
팀워크, 상황인식 그리고 업무수행을 체화하는 고유사례의 특성 (unique case
features) 및 공유된 사례의 특성(shared case features)은 다음과 같다.
수술실 소독간호사의 의사소통과 팀워크의 체화는 각 환자의 임상적
특징에서 공유될 수 있는 차이점과 공통점을 분류하고, 다양한 수술상황을
적시에 확인하는 과정이 경험적 사례로 쌓이면서 이루어진다. 이는 성공적인
수술 목표를 달성하기 위해서 수술팀들 간의 효과적인 의사소통과 팀워크를
형성하는 과정이었다. 수술실 소독간호사의 의사소통과 팀워크의 고유사례의
특성은 3 가지로 진행성 팀워크, 상호성 팀워크 그리고 일시성 팀워크의 형태로
도출되었다. 진행성 팀워크는 개인의 독립적 수행도의 특징이 두드러졌고,
상호성 팀워크와 일시성 팀워크는 팀의 융합적인 사고의 피드백 과정으로
이루어진 전문적인 협력관계구조를 유지되고 있었다. 수술실 소독간호사의
의사소통과 팀워크의 체화에서 공유된 사례의 특성은 팀원들의 숙련성, 의료진
간의 파트너쉽 그리고 환자안전에 대한 팀의 중요성 인식정도로 제시되었다.
수술실 소독간호사의 상황인식의 체화는 전 수술과정동안 수술실 소독
간호사는 일반적인 상황과 비 정상적인 상황의 차이를 비교, 확인하여 수술
상황의 응급도에 따라 업무를 나열하였다. 그리고 상황을 조율하는 과정을 통해
통합적인 시각을 채워가는 과정의 축적을 통해 습득해 가는 과정이었다. 수술실
소독간호사의 상황인식의 고유사례 특성은 사례별 경험중심의 상황인식, 개인별
도제 중심적 상황인식과정, 수술팀 간의 정보교류중심의 상황인식 과정이다.
그리고 다양한 상황적 변화에 대한 대처능력이 체화된 수술실 소독 간호사는
새롭게 경험할 수술적 상황에 대해서 자기 주도적인 시뮬레이션 과정을 통한
상황인식과정의 패턴을 제시하였다. 수술실 소독간호사의 상황인식의 체화
iii
에서의 공유된 사례의 특성은 전문적인 책임감, 급박한 수술의 응급도로
제시되었다.
수술실 소독간호사가 업무수행의 체화는 개인의 경험과 자기개발에 의해
축적된 임상적 지식체가 지식의 틀로 구성되고, 수술간호 지침에 준거하여
표준화되어진다. 이는 프리셉터 교육 및 실무교육 과정을 통해 지식체로
공유되고, 실무상황에 활용화되어 환자지향성의 업무를 수행하게 된다. 이는
자기개발을 통해 수술간호의 진보와 함께 연계된 업무수행이 체화해간다.
수술실 소독간호사의 업무수행의 고유사례의 특성은 개인적 지식구축 중심의
업무과정, 대인관계 중심의 업무확장과정 그리고 특이사례 중심의 창의적
업무과정의 패턴으로 체화되었다. 그리고 수술실 소독간호사의 업무수행의
체화에서의 공유된 사례의 특성은 수술실 간호사가 전문간호직에 대한 주인
의식과 내재적인 자기개발 그리고 개인의 기질적 업무습득 성향으로 제시되었다.
수술실 소독간호사의 비기술적 술기의 체화는 각각의 비기술적 술기의
구성요소인 의사소통과 팀워크, 상황인식 그리고 업무수행의 공통된 범주와
선행연구결과를 통해 확인되어 고유사례의 특성(unique case features) 및
공유된 사례의 특성(shared case features)으로 도출되었다.
분석적 귀납법을 적용하여 수술실 소독간호사의 비기술적 술기를 체화
해가는 과정과 패턴을 탐구한 본 연구는 수술실 소독간호사의 실무 경험을 통해
체화의 실제적인 범주를 확인함으로써 실무적인 이해도를 증진시켰다는 점에 본
연구의 의의가 있다. 따라서 본 연구결과, 수술실 소독 간호사의 비기술적
술기의 체화를 통해 실무교육 안의 기초자료로 활용될 수 있을 것으로 사료된다.

목차 (Table of Contents)

• 목 차
• 논문개요 ································································································ i
• I. 서론 ·················································································· 1
• 1. 연구의 필요성 ················································································· 1
• 2. 연구 목적 ······················································································· 6
• 3. 연구 문제 ······················································································· 6
• 4. 용어 정의 ······················································································· 6
• II. 문헌고찰 ········································································· 10
• 1. 수술실 소독간호사의 비기술적 술기 ················································ 10
• III. 연구방법 ········································································ 16
• 1. 분석적 귀납법 ············································································· 18
• 2. 분석 1 단계: 관심현상 접근 ····························································· 20
• 1) 연구 참여자 선정 ···································································· 21
• 2) 연구의 가정 ··········································································· 22
• vi
• 3. 분석 2 단계: 현상 정의와 변이 확인 ················································ 24
• 1) 현상 정의 ·············································································· 24
• 2) 변이 확인 ·············································································· 25
• 3) 자료 수집 ·············································································· 26
• 4) 면담 질문 ·············································································· 27
• 5) 초기 범주 설정 ······································································· 31
• 4. 분석 3 단계: 사례의 형태와 연관성 확인··········································· 32
• 1) 고유 사례와 공유된 사례 ························································· 33
• 5. 분석 4 단계: 이론화 ······································································· 33
• 6. 연구자의 준비 ··············································································· 33
• 7. 윤리적 고려 ·················································································· 34
• 8. 연구의 질 확보 ············································································· 35
• IV. 연구결과 ········································································ 39
• 1. 연구 참여자의 일반적 특성 ····························································· 39
• 2. 수술실 소독간호사의 의사소통과 팀워크의 체화 ································· 43
• vii
• 1) 변이 확인 ············································································· 45
• 2) 초기 범주 설정 ········································································ 46
• 3) 고유 사례의 특성 ····································································· 49
• 4) 공유된 사례의 특성 ·································································· 67
• 3. 수술실 소독간호사의 상황인식의 체화 ·············································· 74
• 1) 변이 확인 ··············································································· 76
• 2) 초기 범주 설정 ········································································ 77
• 3) 고유 사례의 특성 ····································································· 80
• 4) 공유된 사례의 특성 ································································ 100
• 4. 수술실 소독간호사의 업무수행의 체화 ············································ 105
• 1) 변이 확인 ············································································· 107
• 2) 초기 범주 설정 ······································································ 108
• 3) 고유 사례의 특성 ··································································· 111
• 4) 공유된 사례의 특성 ································································ 126
• 5. 수술실 소독간호사의 비기술적 술기의 체화모형 ······························· 133
• V. 논 의 ············································································ 136
• VI. 결론 및 제언 ································································ 144
• 참고문헌 ············································································ 147
• viii
• 부 록 ············································································ 159
• Abstract ··········································································· 165

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