일 상급종합병원 간호사의 비판적 사고성향이 투약안전역량에 미치는 영향에서 시간압박감과 임상적 의사결정능력의 조절된 매개효과 = The Moderated Mediation Effect of Time Pressure and Clinical Decision Making Ability in the Relationship between Critical Thinking Disposition and Medication Safety Competency among Nurses in a Tertiary General Hospital

다국어 초록 (Multilingual Abstract)

Purpose :
The purpose of this study was to eamine the moderated mediating effects of time pressure and clinical decision making ability in the relationship between critical thinking disposition and medication safety competency among tertiary hospital nurses, thereby providing baseline data for establishing strategies to enhance medication safety competency in nurses.

Method :
The participants of this study sonsisted of 224 nurses with a minimum of 12months of work experience in a teriary general hospital. Data were collected using a structured self reported questionnaire. Data collection took place between July 4 and 10, 2025. Medication safety competency was measured using the Medication Safety Competence Scale (MSCS) developed by Park Jin-kyung (2019) for nurses. Critical thinking disposition was measured using the instrument developed by Kwon In-su et al. (2006) for measuring critical thinking disposition in nursing students. Time pressure was measured using the Time Pressure Scale, originally developed by Putrevu and Ratchford (1997), modified and supplemented by Teng et al. (2010) for use with nurses, and translated into Korean by Lee Hyun-ju (2021). Clinical decision making ability was measured using the Korean Clinical Decision Making Competence Scale for hospital nurses developed by Oh Sun-young (2023). The collected data were analyzed using frequency, percentage, mean and standard deviation, independent t-test, one-way ANOVA, Scheffé's test, Pearson's correlation coefficient, and PROCESS Macro Model 7 with bootstrapping by SPSS/WIN 27.0 program and PROCESS macro Ver. 5.0.

Results :
1) Regarding the general characteristics of participants, 214 (95.5%) were female, and the mean age was 29.20±4.26 years. In terms of marital status, 163 (72.8%) were unmarried, and 190 (84.8%) had no religion. For educational level, 165 (73.7%) held a bachelor's degree. The mean total clinical experience was 6.38±4.24 years, with the largest group having 5 to less than 10 years of experience (n=88, 39.3%). The mean experience in the current department was 3.49±2.73 years, with the largest group having 3 to less than 5 years (n=58, 25.9%). Regarding work department, 98 (43.8%) worked in internal medicine wards, which was the most common. For work type, 218 (97.8%) were shift workers, and 167 (74.6%) had received education on medication safety. The mean number of medication administrations per working day was 27.30±25.89 times, and among the types of medication administration, IV side shooting was the most frequent at 8.79±8.68 times.

2) The mean score for critical thinking disposition was 3.30±0.39 out of 5, time pressure was 4.63±1.23 out of 7, clinical decision making ability was 3.67±0.38 out of 5, medication safety competency was 3.87±0.40 out of 5.

3) The characteristics of participants that showed differences in medication safety competency were marital status (t=-2.17, p=.031), total clinical experience (F=2.86, p=.038), number of medication administrations (F=3.87, p=.022), and experience with medication safety education (t=2.70, p<.001).

4) Medication safety competency showed significant positive correlations with critical thinking disposition (r=.47, p<.001) and clinical decision making ability (r=.69, p<.001), and a significant negative correlation with time pressure (r=-.17, p=.009). Critical thinking disposition showed a significant negative correlation with time pressure (r=-.20, p=.003) and a significant positive correlation with clinical decision making ability (r=.69, p<.001). The correlation between time pressure and clinical decision making ability (r=-.09, p=.185) was not significant.

5) The moderated mediating effect of time pressure and clinical decision making ability on the relationship between critical thinking disposition and medication safety competency was significant (B=-.07, SE=0.04, 95% CI=-.146 ~ -.002).

Conclusion :
In conclusion, this study verified the moderated mediation effects of time pressure and clinical decision making ability on the relationship between critical thinking disposition and medication safety competency among nurses at tertiary hospitals. The results showed that critical thinking disposition indirectly influenced medication safety competency through clinical decision-making ability, and this mediation process was significantly moderated by the level of time pressure. Specifically, the indirect effect was .53 when time pressure was low, .46 at the mean level, and .40 when time pressure was high, indicating that the positive effect of critical thinking disposition systematically decreased as time pressure increased. Along with educational efforts to enhance nurses' critical thinking disposition and clinical decision making ability, organizational interventions to manage time pressure should be implemented, including adequate nurse staffing, workload monitoring, and standardization of medication processes

목차 (Table of Contents)

• Ⅰ. 서론 1
• 1. 연구의 필요성 1
• 2. 연구의 목적 4
• 3. 용어의 정의 5
• Ⅱ. 문헌고찰 7
• 1. 투약안전역량 7
• 2. 비판적 사고성향 12
• 3. 시간압박감 17
• 4. 임상적 의사결정능력 19
• 5. 비판적 사고성향, 시간압박감, 임상적 의사결정능력, 투약안전역량의 관계 26
• Ⅲ. 개념적 기틀 29
• Ⅳ. 연구방법 31
• 1. 연구설계 31
• 2. 연구대상자 31
• 3. 연구도구 32
• 4. 자료수집방법 34
• 5. 자료분석방법 34
• 6. 윤리적 고려 35
• Ⅴ. 연구결과 36
• 1. 대상자의 특성 36
• 2. 대상자의 비판적 사고성향, 시간압박감, 임상적 의사결정능력, 투약안전역량 정도 39
• 3. 대상자의 특성에 따른 투약안전역량의 차이 41
• 4. 대상자의 비판적 사고성향, 시간압박감, 임상적 의사결정능력, 투약안전역량의 상관관계 43
• 5. 비판적 사고성향과 투약안전역량의 관계에서 시간압박감과 임상적 의사결정능력의 조절된 매개효과 44
• Ⅵ. 논의 48
• Ⅶ. 결론 및 제언 58
• 참고문헌 62
• 부 록 85