간호업무 관련 의료법 개정의 의의와 향후 과제

이유리,최성경,김인숙 한국의료법학회 2017 한국의료법학회지 Vol.25 No.2

On 29 December 2015, the Medical Service Act regarding nursing services was amended and enforced from 30 December 2016. Provision on nurse's task was vague under previous Medical Service Act, which had a gap with actual nursing field. Nurses' roles may be replaced by nurse assistants so that boundaries between two professions were blurred. Also, nurse assistants were in the blind spot of supervision and audit which needs to quality control mechanism. In this regard, this study examined the revision of nursing services related Medical Services Act and reviewed significance and policy implication on revision. Firstly, nurse's mission and duties were specified. It recognized nurses role on health management professional which implies improved professionalism. Secondly, qualification management for nurse assistant was enforced. Nurse assistants are obtained accreditation of qualifications from the Minister of Health and Welfare after completing the curricula prescribed and passing the national examination. An education and training institutes for nurse assistants are assessed and accredited. Registered nurse assistants should declare their qualification as well as get refresher training. Thirdly, nurses give guidance on the assistance performed by nurse assistants which leads to division of mission and duties among nursing staffs. Future tasks of revised Medical Service Act are accumulating cases after amendment, developing supporting policy for management of nurse assistants, managing supply and demand on nursing staffs, and discussion of whole nursing professions including midwife, nurse practitioner, physician assistant, and others. 2015년 12월 29일 간호사 및 간호조무사와 관련된 의료법 일부 개정안이 국회 본회의를 통과하여 최종공포 되었다. 기존의 의료법에는 간호사의 업무가 추상적으로 명시되어 있어 실제 간호현장에 부합하지 않다는 것이 문제점으로 지적되어 왔고 간호사 수급불균형에 대한 대책으로 간호사의 역할을 간호조무사가 대체할 수 있도록 함으로써 간호사-간호조무사간의 업무 경계가 모호해진 상황이었다. 또한 간호조무사의 질 관리 및 감독이 사각지대에 있어 질적 수준의 제고가 필요하였다. 본 연구에서는 간호업무와 관련된 의료법 개정의 주요내용을 살펴보고 법 개정의 의의와 정책적 시사점을 도출하였다. 주요한 내용으로는 첫째, 간호사에 대한 업무는 의료법 제정 이후 64년 만의 첫 개정으로 개정된 의료법에서 간호의 전문성을 살리고 건강관리전문가로서의 간호사의 역할을 인정하는 방향으로 간호사의 업무규정이 구체화되었다. 둘째, 간호조무사에 대한 자격관리가 강화되었다. 간호조무사에게 보건복지부 장관 자격을 부여하였으며, 간호조무사 교육훈련기관의 지정·평가제도, 간호조무사의 자격신고 및 보수교육제도가 도입되었다. 셋째, 간호조무사의 업무에 대한 지도권이 간호사에게 있음을 법률에 명시함으로써 간호인력 별 역할분담 및 적정 간호인력 공급의 틀을 마련하였다. 간호업무와 관련된 의료법 개정의 향후 과제로서 간호인력 간 업무범위 구분에 따른 사례축적, 간호조무사 관리체계 세부지침 마련, 간호인력 수급관리 등이 이루어져야 할 것으로 보인다.

간호법 단독입법을 통한간호인력의 합리적 재편 방안

김종호 ( Jongho Kim ) 건국대학교 법학연구소 2015 一鑑法學 Vol.0 No.32

평균수명의 연장으로 인한 건강보험 진료비 증가, 의료기관 증가, 의료기관의 적정한 간호 인력확보의 필요성 증가와 같은 급격한 보건의료환경의 변화로 간호인력 수요가 증가하고 있다. 인구의 고령화로 인한 노인의료비 증가, 만성질환자 관리의 필요성 증가에 비용효과적인 대응을 위한 간호인력 수요도 커지고 있다. 또한 노인장기요양보험제도의 도입· 확대 등으로 간호서비스 제공영역이 의료기관에서 지역사회로 변화하면서 간호의 역할범위도 보다 확장되고 있다. 중동호흡기증후군(MERS) 사태에서 보는 바와 같이 포괄간호서비스 수요도 반드시 충족되어야 할 상황이다. 그러나 현재 우리나라 간호사는 다른 의료인력과 함께 의료법에 포괄적으로 규정되어 있어 명확한 법적 지위와 규제 내용이 부재하며 간호인력 간 업무와 책임한계가 불명확한 상황이다. 이는 급변하는 간호 관련 보건의료 환경변화에 간호서비스가 적절히 대응하지 못하게 할 뿐만 아니라 간호서비스의 질 저하를 초래할 우려가 있다. 특히, 진료보조업무에 있어서 간호사와 간호조무사간의 업무중복과역할혼란의 문제가 발생하고 있어 명확한 업무규정이 요구된다. 대부분의 국가들이 간호관련 단독법에 기반하여 간호인력 양성을 위한 교육과정과 업무를 명확히 규정함으로써 간호서비스의 책임성을 담보하고 있으며, 간호사가 간호보조인력에 대한 지도·감독의 권한을 부여함으로써 간호인력 간 업무중복의 문제를 피하고있다. 우리나라도 간호행위 관련 서비스의 책임강화와 간호인력 관련 문제발생 가능성을 최소화하고 간호인력 양성을 활성화함과 동시에 보건의료 환경변화에 적절히 대응할 수있는 인력수급 시스템을 구축할 수 있는 간호사 관련 단독입법이 필요하다. 이를 위하여 간호업무의 개념정의와 구체적인 행위구분, 면허·자격 응시기준, 교육기관 및 교육기간, 간호사중앙회, 보수교육 및 면허·자격신고제, 간호정책의 심의·의결을 위한 간호정책심 의위원회, 인력처우개선 및 복지증진, 인력확보와 취업촉진을 위한 간호인력개발센터 설치 등을 주요내용으로 하는 간호법 제정이 필요하다. More than 65 years ago, governments enacted laws which protect the public’s health and doctors assistant by overseeing and ensuring the safe practice of nursing. It is not uncommon to find various complementary therapies available at hospitals, either as part of nursing care, or as an extended health care service. Currently many hospitals and other healthcare facilities, such as long-term care facilities are being constructed to replace those at the end of their life and to meet the demand as the baby boomer population grows older in Korea. Many of these are designed according to a new understanding of the healing environment and the research behind evidence-based design. Small sized clinics are also beginning to change, not least because the Korean healthcare system can no longer afford a system that focuses on disease-based care. Healthcare is beginning to recognize the central place that wellbeing of mind, body, and spirit plays in health. In this rapidly changed medical environment, the nursing resources are most crucial factor to meet the broadly varied conditions. The nurse workforce generally consists of licensed nurses and nurses-aides. The physical setting is the patient’s first impression of a healthcare facility and one of the most important factors in the patient’s perceptions of the quality of care and their overall satisfaction. One of the key factors driving changes in healthcare is the concept of patient-centered care. Each of the items are necessary to satisfy patients by appropriate nursing care service. Nursing-sensitive outcomes are one indicator of quality of care and may be defined as variable patient or family caregiver state, condition, or perception responsive to nursing intervention. However, Korea has no Nurse Act separated from the Medical Service Act since 1951. This study discussed the necessity of single Nurse Act enactment independent from the Medical Act by arguing and comparing foreign jurisprudence and legislative connection between lower levels of nurse staffing and higher rates of adverse events. Complementing this study is a providing number of other research agendas addressing the growing nurse workload and rising rates of burnout and job dissatisfaction. Many stakeholders within the health care system, especially governments, hospitals and hospital organizations, doctor and nurse associations, nurse-aides foundations, and accreditation organizations, are aware of the lack of qualified nursing staff and related problems and are actively seeking solutions. High level general hospitals may cut spending for other personnel, such as unlicensed caregivers, housekeepers, and other support staff to enhancing their medical reputations. On the other hand, local clinic and small sized medical firms are insist that revise or enactment of new law may increasing cost of health care and they against preparing new bill. If no renovation is made in the medical law, the amount of nursing work performed by non-licensed nurse-aides in inpatient units could increase, and investments in medical technology and facilities to improve the quality of care could be deferred. Accordingly, researching a reasonable nursing resources reorganization plan through enactment of Nurse Act is summons in our time.

간호법안에 대한 검토 : 국민 간호증진 및 간호사 지위 향상을 위한 법률안을 중심으로

문상혁 원광대학교 법학연구소 2012 의생명과학과 법 Vol.7 No.-

No one can deny that in contemporary society, not only doctors but nurses play indispensable role for the health of nationals. In this acc ord, there came a necessity that law to protect the health right of nationals and improve the position of nurses should be established as independent law in tune with social reality and the trend of nursing science academic circle. However, though there is increasing demand of diverse and specialized nursing services like home nursing and aged nursing etc, present 「Medical Services Act」 prescribes the work of nurse as assisting doctor's assistant in medical action, so the reality is that the Act does not comprehend the work of nurse that is ever diversifying and specialized in tune with social changes. Therefore, there are impending demand to raise the quality of nursing service by clarifying the work scope of nurse and effectively regulating on nurses while securing the health right of the nationals by establishing independent law to promote the health of nationals and improve the position of nurse. In South Korea, the majority of professional occupations are regulated by individual laws, and also in majoradvanced countries of the world, nurse related laws are separately established and operated, so when it is considered that nurses play important role for the health of nationals, it is deemed that nurse related laws also need be established as independent law in view of social reality and nursing science academic circle. The past and present roles of nurses are undergoing unprecedented changes, and only law that reflects such changes can exercise social capability of norm. Therefore, partial modification of medical act al one by situation involves limitation to regulate the nursing work of nurses, and the medical act in that sense is insufficient to serve as normative instruction for nursing work and is not suitable as standard to judge the point of responsibility in nursing act. Hence, in this study, the foundation of 「Bill for promotion of national health and improvement of nurse position」 was prepared through survey on the relation with medical law based on nursing act (bills) initiated so far, and after, and after the work scope of nurse was specifically classified by distinguishing from doctor, problems of comprehensive rules of present medical act were reviewed. Also, for protection of the health right of nationals, the problems of nurse work condition and treatment improvement were examined.

간호법안에 대한 검토 - 국민 간호증진 및 간호사 지위 향상을 위한 법률안을 중심으로 -

문상혁 원광대학교 법학연구소 2012 의생명과학과 법 Vol.7 No.-

No one can deny that in contemporary society, not only doctors but nurses play indispensable role for the health of nationals. In this acc ord, there came a necessity that law to protect the health right of na tionals and improve the position of nurses should be established as i ndependent law in tune with social reality and the trend of nursing s cience academic circle. However, though there is increasing demand of diverse and specialized nursing services like home nursing and aged nursing etc, present 「Medical Services Act」 prescribes the work of nur se as assisting doctor's assistant in medical action, so the reality is t hat the Act does not comprehend the work of nurse that is ever dive rsifying and specialized in tune with social changes. Therefore, there are impending demand to raise the quality of nur sing service by clarifying the work scope of nurse and effectively re gulating on nurses while securing the health right of the nationals by establishing independent law to promote the health of nationals and i mprove the position of nurse. In South Korea, the majority of profess ional occupations are regulated by individual laws, and also in major advanced countries of the world, nurse related laws are separately est ablished and operated, so when it is considered that nurses play imp ortant role for the health of nationals, it is deemed that nurse related laws also need be established as independent law in view of social r eality and nursing science academic circle. The past and present roles of nurses are undergoing unprecedente d changes, and only law that reflects such changes can exercise soci al capability of norm. Therefore, partial modification of medical act al one by situation involves limitation to regulate the nursing work of n urses, and the medical act in that sense is insufficient to serve as n ormative instruction for nursing work and is not suitable as standard t o judge the point of responsibility in nursing act. Hence, in this study, the foundation of 「Bill for promotion of nati onal health and improvement of nurse position」 was prepared through survey on the relation with medical law based on nursing act (bills) ini tiated so far, and after, and after the work scope of nurse was speci fically classified by distinguishing from doctor, problems of comprehe nsive rules of present medical act were reviewed. Also, for protectio n of the health right of nationals, the problems of nurse work conditi on and treatment improvement were examined.

간호사의 업무로서의 ‘진료의 보조행위’에 대한 소고

원상철(Won, Sang-Chul) 한국법이론실무학회 2021 법률실무연구 Vol.9 No.3

일본에서 간호업무란 무엇인가에 대해서 법률상 명확히 정의한 규정은 없다. 단, 보건사 조산사 간호사법 제5조가 간호사를 정의하고, ‘후생노동부 장관의 면허를 받아 상병자나 간병부에 대한 요양상 돌봄 또는 진료를 보조하는 것을 업으로 하는자라고 하고 있는 것이나, 같은 법 제31조 제1항이 ’간호사가 아닌 자는 제5조에서 규정하는 업을 해서는 안된다라고 규정하고 있을 뿐이다. 또한 간호사를 규정하여 놓고 간호사가 아닌 자는 제5조에서 규정하는 업을 해서는 안 된다고 한다. 두 개가 간호업무(간호사의 업무독점 범위)이며 간호라고 일반적으로는 이해되고 있다. 무엇보다 간호사가 수행하는 업무의 내용을 반드시 구체적으로 도출할 수 있는 것은 아니며, 특히 간호사가 업으로서 실시할 수 있는지 여부의 경계선상의 행위가 존재한다. 간호사는 주치의 또는 치과의사의 지시가 있는 경우를 제외하고는 진료기계를 사용하여 의약품을 수여하고, 의약품에 대해 지시를 하며, 기타 의사 또는 치과의사가 하지 않으면 위생상 위해가 발생할 우려가 있는 행위를 해서는 안 되지만 임시응급조치를 할 수 있다. 이를 위반한 간호사는 형사처벌을 면치 못한다. 따라서 간호사의 업무가 무엇이고 진료보조 행위가 무엇을 의미하는지를 밝히는 것은 매우 중요한 작업이다. 본 연구에서는 일본 보조간법 제37조의 행위가 보조간법 제5조에서 규정하는 간호업무에 포함되는지 여부를 중심으로 간호사의 업무범위에 대해 검토한다. 현재 간호사법이 존재하지 않는 우리나라 상황에서 일본 법제의 연구는 중요한 시사점을 제공할 것으로 생각한다. In Japan, there is no clearly defined regulation on what nursing work is. However, Article 5 of the Public Health Nurses Midwifery Nurse Act defines a nurse as “a person who has obtained a license from the Minister of Health, Labor and Welfare and whose business is providing medical care for the sick or nursing staff or assisting in medical treatment,” Article 31 of the same Act Paragraph 1 of Article 1 only stipulates that ‘a person who is not a nurse must not engage in the business stipulated in Article 5.’ In addition, after stipulating nurses, non-nursing personnel should not engage in the business stipulated in Article 5. Both are nursing professions (the scope of the nurse’s monopoly) and are generally understood to be nursing. Above all, it is not always possible to derive the details of the work performed by a nurse, and in particular, there is an action on the borderline of whether a nurse can perform it as a profession. Nurses use medical machines to award medicines, give instructions for medicines, and do not perform any other act that may cause sanitary harm unless directed by the attending physician or dentist. You should not do it, but you can take temporary emergency measures. Nurses who violate this rule face criminal punishment. Therefore, it is very important to clarify what a nurse’s job is and what it means to act as a medical assistant. In this study, the scope of the nurse’s work is reviewed, focusing on whether the acts of Article 37 of the Japanese Assistant Act are included in the nursing work stipulated in Article 5 of the Assisted Act. In the current situation in Korea where there is no nurse law, a study on the Japanese legal system will provide important implications.

간호교육 4년 학제 일원화를 위한 ｢고등교육법｣ 개정의 주요 내용 및 현재적 의의

차유경(Cha, Yu Kyung) 대한교육법학회 2020 敎育 法學 硏究 Vol.32 No.3

과거 우리나라 간호교육 과정은 3년제 전문대학 간호과와 4년제 대학 간호학과로 이원화 되어 있었다. 2006년 ｢고등교육법｣ 개정안 발의를 기점으로 간호교육 4년 학제 일원화를 위한 움직임이 시작되었으며, 제17대~제19대 국회에 걸쳐 ｢고등교육법｣과 ｢의료법｣ 개정안 제출이 이루어졌고, 2011년~2016년 ｢고등교육법｣ 및 ｢의료법｣ 개정을 통해 마침내 제도의 일원화가 이루어졌다. 2011년 ｢고등교육법｣ 개정을 통해, 전문대학 내 의료인 양성을 위한 4년 수업연한의 과를 설치할 수 있도록 하고, 본 과정을 이수한 자들에게는 학사학위를 수여할 수 있는 법적 근거를 마련하였다. 4년제 간호과를 운영하고자 하는 전문대학은 교육여건 등의 기준을 갖추고 평가인증기구를 통해 지정 받도록 하였다. 또한, 전문대학 전공심화과정 입학조건으로 동일계열 전문대학 졸업 후 관련분야 재직 경력이 요구되었으나, 간호과에 한해 산업체 재직 경력이 없어도 입학이 가능하도록 함으로써 심화 교육 과정 선택의 자율성이 확대 되었다. 2012년 ｢의료법｣ 개정을 통해, 간호사 국가시험 응시자격을 평가인증기구의 인증을 받은 간호학을 전공하는 전문대학이나 대학을 졸업한 자로 제한하였다. 마지막으로, 2016년 ｢고등교육법｣은 전문대학에 개설된 수업연한 4년 교육과정의 명칭을 ‘과’에서 ‘학과’로 개정되어, 두 교육 과정이 모두 ‘학사학위’를 취득하는 동일한 과정 임에도 불구하고 명칭의 차이로 인해 유발될 수도 있는 차별 및 불이익을 방지코자 하였다. 상기 법률 개정으로 간호교육을 4년제로 일원화하고, 간호교육의 표준화를 위한 법적 토대를 마련하게 되었다. 현재 미국･독일 등 주요 서구 국가에서 간호 인력의 학사학위 과정 이수 필요성이 강조되고 있는 흐름에 비추었을 때, 이미 10여 년 전, 우리나라에서 이루어진 4년제 학사학위 과정으로의 간호교육 일원화는 제도적 차원의 선제적 선진화로 평가될 수 있다. 그러나, 일찍이 구축된 4년 학제를 통해, 우수한 인력들을 간호사로 배출하고 있음에도 불구하고, 의료 현장의 서비스 질 향상으로 이어지지 못하고 있다. 열악한 근로조건 등으로 인해 졸업생들이 간호사로서의 취업 포기나 해외 취업 등을 선택함으로써 일선 병원들은 간호사 부족 문제를 겪고 있다. 따라서, 간호사 처우 및 근무환경 개선을 통해 양질의 교육을 받은 인력이 노동시장으로 유입될 수 있도록 간호사법 제정 등과 같은 보다 적극적인 조치를 취할 필요가 있다. 한편, 개정 ｢고등교육법｣상 의료인 양성을 위한 전문대학 수업연한 및 학위에 관한 특례 규정은 현재 임의규정으로 되어 있다. 이로 인해, 자발적으로 신청하지 않은 전문대학들은 3년 학제 간호과로 남아 있어 4년제 일원화를 완전하게 이루지 못한 상태로 남아 있게 되었다. 또한, 간호사 면허 시험 응시자격 요건이 여전히 간호학을 전공하는 대학이나 전문대학을 졸업한 자로 규정되어 있어, 학사학위 취득이 간호사 면허 취득의 필수 조건으로 규정되어 있지 않다. 따라서, 의료인 양성을 위한 전문대학 수업연한 4년 규정을 강행규정화 하고, 간호사 면허 시험 응시자격 요건을 학사학위 취득자로 제한하는 등 제도의 통일성을 강화하는 방향으로 본 제도를 내실화 할 필요가 있다. In the past, the nursing curriculum in Korea was divided into a three-year junior college nursing department and a four-year university nursing department. The proposal to unify for the four-year school system of nursing education began with a legislative bill of amendment to the ｢HIGHER EDUCATION ACT｣ in 2006, and amendments to the ｢HIGHER EDUCATION ACT｣ and the ｢MEDICAL SERVICE ACT｣ were submitted in the 17th to 19th National Assembly. The system was finally unified through the revisions of the ｢HIGHER EDUCATION ACT｣ and the ｢MEDICAL SERVICE ACT｣ from 2011 to 2016. Through the revision of the ｢HIGHER EDUCATION ACT｣ in 2011, a four-year course in junior colleges designed to train medical personnel may be established, and a legal basis for conferring a bachelor s degree to those who completed this course was established. Junior colleges which want to operate a four-year course nursing department should have satisfied standards such as educational circumstances and should been designated through an accrediting institution. In addition, the prerequisite for admission to the advanced major course in junior colleges is that graduated from a junior college in the same department and has experience in the related field shall become eligible to apply for an advanced major course. Whereas the autonomy of choosing an advanced major course of been expanded by allowing the nursing department to be admitted even without a same career. Through the revision of the ｢MEDICAL SERVICE ACT｣ in 2012, nurse was restricted to those who has graduated from a university, college, or junior college with a major in nursing which is certified by an accrediting institution. Finally, in 2016 the amendment of ｢HIGHER EDUCATION ACT｣ was that the name of departments having a four-year course in junior colleges was revised from ‘Department’ based on junior colleges to ‘Department’ based on university, in order to prevent discrimination and disadvantages that may be caused by differences in names even though both curriculums are the same courses for obtaining a ‘Bachelor s degree’. With the revision of the law, nursing education was unified on a four-year school system basis and provides a legal basis for standardizing nursing education. In light of the current emphasis on the necessity of completing a bachelor s degree program for nursing personnel in major Western countries such as the United States and Germany, the unification of nursing education into a four-year bachelor s degree course in Korea more than 10 years ago can be evaluated as a proactive advancement at the institutional level. Nevertheless, despite the fact that the excellent workforce is produced as a nurse through the four-year school system established earlier, it has not led to improvement of service quality in the medical field. Due to poor working conditions, graduates are choosing to give up their jobs as nurses or to work overseas, leading hospitals are facing the problem of lack of nurses. Therefore, it is necessary to take more active measures such as enactment of the Nurses Act so that the personnel who have received high quality education can enter the labor market through the treatment of nurses and improvement of working environment. On the other hand, under the revised ｢HIGHER EDUCATION ACT｣, ‘Special Cases concerning Duration of Courses and Degree of Courses for Training Medical Personnel’ is currently non-mandatory provision. As a result, junior college that did not voluntarily apply remain in the three-year school system nursing department and have not fully achieved four-year unification. In addition, the qualification requirements for taking the nurse license exam are still defined as those who have graduated from a university or junior college majoring in nursing, so obtaining a bachelor s degree is not prescribed as a prerequis

간호 대학생의 환자 프라이버시 보호행동, 간호윤리의식 및 자아존중감의 관계

성기월 ( Ki Wol Sung ),김다솜 ( Da Som Kim ),한민영 ( Min Young Han ),곽은영 ( Eun Yeong Gwak ),김근영 ( Geun Yeong Kim ),김언주 ( Eon Ju Kim ),김현지 ( Hyun Ji Kim ),류선영 ( Sun Young Ryu ),문성은 ( Seong Eun Moon ),한선미 ( Seo 대구가톨릭대학교 사회과학연구소 2011 사회과학논총 Vol.10 No.-

The purpose of this study is to understand correlation between patient privacy act, nursing ethics, and self-esteem in nursing students. Subjects of the study include 234 students in third and fourth year of four-year nursing course in universities in Daegu and the period of collecting data was between 19 and 28 September, 2011. Patient privacy act was measured by using a tool created by Lee Miyeong (2005) but revised and supplemented so that it is suitable for students nurses who are the subjects of this research. Nursing ethics was measured by the tool created by Lee Yongsook (1990) and revised by Choi Yongran (2001). Rosenberg Self-Esteem Scale (RES) developed by Rosenberg (1965) and revised by Jeon Byeongjae (1974). The collected data was analyzed by Frequency Analysis, average and standard deviation, range and t-test, one-way ANOVA, Pearson`s Correlation, Stepwise Multiple Regression. Followings are the study result. 1) The average score of patient privacy act of student nurses was over the middle mark (81.48±12.36), and the average score of nursing ethics was the middle mark (72.40 ±8.29). The average score of self-esteem was over the middle mark (31.71±3.65). 2) The significant differences of the patient privacy act were grade (p=.013) and third year students. 3) In nursing students patient privacy act was positively related to nursing ethics. 4) The significant predictors of the patient privacy act were nursing ethics, self-esteem, and grades explaining 16.9% of patient privacy act. There should be a need of educational development which can raise student nurses` nursing ethics and self-esteem in order to improve student nurses` patient privacy act based on the result of the research.

내면연기는 항상 유익한 것일까?:

박상언(Park, Sang-Eon),김학수(Kim, Hack-Soo),최민오(Choi, Min-O) 한국인사관리학회 2017 조직과 인사관리연구 Vol.41 No.3

그간 감정노동의 대표적인 두 가지 수행전략인 표면연기와 내면연기의 효과성을 검증해 온 많은 선행연구들이 있어 왔다. 그 결과, 감정노동 수행자의 심리적 안녕이나 직무성과 등에 대해 표면연기는 비교적 일관된 부정적 효과가 있음이 확인되어 온 반면, 내면연기는 혼재된 결과 많아 일반화하기 어려운 경우가 많았다. 본 연구는 그간 감정노동 영역에서 많이 채택되지 않았던 역할 외적인 차원의 성과행동인 동료 간 도움행위를 종속변수로 삼아, 표면연기와 내면연기의 효과성을 재검증해 보고 있다. 특히 본 연구에서는 자원보존이론(the conservation of resources theory)에 기반하여, 내면연기의 경우 동료 간 도움행위와 비선형적인 영향관계에 있을 가능성을 가설화하고 이를 실증해 보았다. 또한 본 연구는 감정노동 관련 연구에서 다루지 않았던 LMX의 조절효과도 함께 확인해 보았다. 본연의 간호업무 수행과 더불어 감정노동을 병행하는 대표적인 전문서 비스직인 392명의 간호사들을 대상으로 획득한 설문자료를 분석한 결과, 표면연기는 동료 간 도움행위에 부정적인 영향을 미침을 확인할 수 있었다. 또한 내면연기는 동료 간 도움행위와 역U자형의 비선형적 영향관계에 있음을 확인하였다. 이러한 본 연구의 분석결과는 장기적이고 지속적인 내면연기가 항상 유익할 수만은 없으며, 그간의 선행연구들에서 내면연기의 효과성이 일관되게 확인되지 않았던 한 이유를 설명해 주는 것으로 해석되었다. 또한 LMX는 표면연기가 동료 간 도움행위에 미치는 부정적인 영향을 완화시키는 조절효과가 있음이 확인된 반면, 내면연기와 동료 간 도움행위 간의 비선형적 영향관계를 조절하는 효과는 확실하게 관찰되지 않았다. 이러한 분석결과가 함의하는 경영관리적 시사점과 함께, 본 연구의 한계점이 토론되었다. Up until now, most studies have dealt with the effectiveness of surface and deep acting as two typical forms of emotional labor strategies. According to these previous studies, surface acting consistently showed negative effects on the emotional laborer’s psychological well-being, job performance and so on. But, these studies had failed to produce consistent results on the relationships between deep acting and outcome variables such as satisfaction, behavior, and performance. This study has revisited the effects of surface and deep acting especially on helping behaviors in coworker relationship, a kind of out-role performance behavior, which has been rarely dealt in the domain of emotional labor as an outcome variable. Based on the conservation of resource theory, we proposed and inquired into two research questions. First, this study examined a curvilinear effect of deep acting on nurse’s helping behaviors in coworker relationship. Second, this study investigated a moderating effect of LMX, which is in nature both a job resource and job demand factor, on the relationship between emotional labor and helping behaviors in coworker relationship. This study collected data from 392 nurses. The results showed that nurse’s surface acting has negative effect on helping behaviors in coworker relationship. Instead, deep acting has inverted U-shape effect on helping behaviors in coworker relationship as expected in the hypothesis. In addition, LMX showed the positively moderating effect on the relationship between nurse’s surface acting and helping behaviors in coworker relationship, but not for the nonlinear relationship between deep acting and helping behaviors in coworker relationship. We discussed various research implications of this study and suggested future research directions.

수용-전념 치료(ACT) 프로그램이 임상 간호사의 업무 스트레스와 심리적 안녕감에 미치는 효과

문다나 ( Dhana Moon ) 한국동서정신과학회 2013 동서정신과학 Vol.16 No.1

본 연구는 인지행동치료의 제 3동향에 속하는 치료모델인 ACT를 조직 장면의 직장인 스트레스 해소 처치로 실시하여, 그 효과를 검증하는 것이 목적이다. 연구대상은 수도권 지역 A시 임상 간호사 22명이었으며, 측정도구는 간호사 업무 스트레스 척도, 심리적 안녕감 척도, 사회심리적 건강 척도, 수용-행동 질문지를 사용하였다. 본 연구의 처치 효과를 검증하기 위하여 사전-사후 검사와 실시 4주 후 추후 검사를 실시하였다. 연구 결과, ACT 치료 모델은 업무 스트레스 감소 및 심리적 안녕감과 사회심리적 건강의 향상, 수용-행동 향상에 유의미하게 효과적인 것으로 나타났다. 이러한 연구 결과들은 앞으로 ACT가 정신병리 문제 해결을 위한 임상 장면뿐 아니라, 일반적인 조직 장면에서도 적용할 수 있는 가능성을 보여 주는 것으로, 사람의 일생에서 업무 스트레스가 삶의 질에 미치는 영향을 고려할 때, ACT가 직장인의 정신 건강 향상에 기여할 수 있는 효용성을 보여 주는 것이다. 또한 연구의 결과를 바탕으로 본 연구의 제한점과 향후 연구 방향을 제시하였다. The purpose of this study was to examine the effect of ACT applied for the reduction of job stress of organizational situations. The study focused on 22 clinical nurses. The Burnout Scale, Psychological Well-being Scale, Psycho-sociological Well-being Inventory, and Acceptance and Action Questionnaire-16 were used as the measurement tools. The result of the study shows the ACT effectively relieved job stress and improve psychological well-being, Psycho-sociological Well-being and Acceptance-Action. The study results reveal that ACT may be applied not only to various clinical situations to alleviate the mental pathological problems, but also to the general organizational situations in a wide range. Furthermore, if job stress is considered to affect the quality of life of human beings, then the effectiveness of ACT could generally contribute to improve social and mental health. Also, the limitations and suggestions for additional studies regarding this issue were proposed based on the results of this study.

정신간호사의 감정노동전략이 직무소진과 직무열의에 미치는 영향

신소희 ( So Hee Shin ),장금성 ( Keum Seong Jang ) 대한보건협회 2016 대한보건연구 Vol.42 No.4

연구목적 : 본 연구는 정신간호사의 감정노동전략, 직무소진과 직무열의 정도를 파악하고, 감정노동전략 행위에 따라 직무소진과 직무열의에 미치는 영향을 검증하기 위한 서술적 조사연구이다. 연구방법 : 2011년 12월 5일부터 2012년 1월 20일까지 G광역시와 J도에 위치한 병원급 이상 의료기관 중 정신과에 근무하는 간호사를 대상으로 감정노동, 직무소진, 직무열의 도구를 사용하여 자료를 수집하였고 연구에 적합한 239부를 분석하였다. 연구결과 : 감정노동전략 중 표면행위와 직무소진은 정적 상관관계(r=.32, p<.01)이며, 직무소진을 예측하는 주요 변인이 표면행위(β=.305, p<.001)인 것으로 나타났다. 정신간호사의 내면행위는 직무열의와 순 상관관계(r=.31, p<.01)를 갖는 것으로 나타났으며, 직무열의에 가장 주요한 예측 변인은 내면행위(β=.228, p<.001)인 것으로 확인되었다. 결론 : 정신간호사의 감정노동전략이 그 형태에 따라 직무소진과 직무열의에 유의한 영향을 미치는 것을 알 수 있었다. 따라서 정신간호사의 직무소진을 자극하는 표면행위를 최소화하고, 직무열의를 높이는 내면행위를 이끌 수 있도록 구조화된 전략이 필요할 것으로 사료되며, 이는 조직의 성과를 향상시키는 유효한 수단의 하나로 풀이 될 수 있다. Objective : This study is descriptive research aimed to understand psychiatric nurses` emotional labor strategy, job burnout and job engagement level and to verify the impacts of the emotional labor strategy on job burnout and job engagement. Methods : This study collected data using emotional labor strategy, job burnout, job engagement tools from the nurses who were working in the department of psychotherapy in medical institutions in a level higher than a hospital, located in G. Metropolitan City and J. Province from December 5, 2011 through January 20, 2012 and analyzed 239 copies appropriate for the research. Results : It turned out that, of the emotional labor strategy, surface acting and job burnout had positive correlations(r=.32, p<.01), and the major variable that could predict job burnout was surface acting(β=.305, p<.001). It turned out that the psychiatric nurses` deep acting had a pure correlation with job engagement(r=.31, p<.01), and it was found that the most important variable in predicting job engagement was deep acting(β=.228, p<.001). Conclusion : It was noted that the psychiatric nurses` emotional labor strategy had significant impacts on their job burnout and job engagement according to the forms. Therefore, it is judged that it would be necessary to set up structured strategies in order to minimize the surface acting that might stimulate the psychiatric nurses` job burnout and to induce deep acting that could increase their job engagement, and this can be interpreted as one of the effective methods that can enhance the organization`s performance.