병원 간호사의 환자안전사건 소통하기에 대한 인식

박윤정,박미현 가톨릭대학교(성의교정) 가톨릭생명윤리연구소 2023 인격주의 생명윤리 Vol.13 No.1

This study is a descriptive study to investigate the influencing factors on the perception of Disclosure of Patient Safety Incidents among clinical nurses. A total of 206 clinical nurses were recruited from an online self-report questionnaire in hospitals with more than 400 beds. The results revealed that the scores of disclosure of patient safety incidents, patient safety culture, patient-centered care and ethical leadership of nurse managers were 97.41(±9.91), 3.79(±0.47), 68.17(±9.55) and 3.70(±0.83). The factors influencing on disclosure of patient safety incidents consist of patient safety development system of patient safety culture, the clinical context of patient-centered care, the patient safety priority order of Patient Safety culture, and work departments. These factors explained a total of 20% variance. In addition, it will be necessary to form a patient safety culture of a system improvement approach to patient safety incidents within medical institutions. Furthermore, it will be required to form a patient safety culture with a system improvement approach to patient safety incidents within medical institutions and active support at the nursing organization level to strengthen the patient-centered nursing competency of nurses.

환자안전사건을 겪은 일반인들은 경험한 환자안전사건 소통하기에 만족할 수 있을까?

표지희,이원,장승경,최은영,옥민수,이상일 한국의료윤리학회 2019 한국의료윤리학회지 Vol.22 No.4

This study examines people’s experiences with the disclosure of patient safety incidents (DPSI), which is known to be effective in decreasing medical disputes and improving the relationships between patients and medical professionals. Data on people’s experiences with, and the impacts of, patient safety incidents were collected by means of an online survey of 201 individuals. Only 30.3% (n=61) of participants had experienced full DPSI. The study found that those who experienced patient safety incidents with permanent disability or death were significantly less likely to report expressions of sympathy and regret from the relevant medical professionals than those who experienced patient safety incidents with a lower level of harm (p=0.003). The percentage of participants who reported sleep disorders was 35.3% for “no disclosure”, 28.1% for “partial disclosure”, and 31.3% for “full disclosure” (p=0.673). The results of the survey indicate that those who experience patient safety incidents do not in general receive proper responses from the relevant medical professionals. This in turn suggests that detailed guidelines and training programs for DPSI are required and that psychological and other forms of support should be provided to patients and caregivers who experience patient safety incidents. 이번 연구에서는 환자안전사건을 겪은 일반인들을 대상으로 환자안전사건 소통하기의 경험 여부를 알아보고 그 경험에 따라 환자안전사건으로 인한 어려움의 호소에 차이가 있는지 살펴보았다. 온라인 설문조사를 실시하여 경험한 환자안전사건의 특성(위해의 정도 등), 경험한 환자안전사건으로 인한 영향(수면장애, 식이장애 등), 환자안전사건 소통하기 경험(구성 요소별 경험까지), 인구사회학적 요인(성별, 연령대 등) 등의 자료를 수집하였다. 환자안전사건을 경험한 일반인 총 201명이 설문에 응답하였으며 환자안전사건 소통하기의 구성 요소 중 5가지 이상을 경험한 참여자는 30.3% (61명)에 불과하였다. 즉, 70% 에 가까운 참여자들이 환자안전사건 소통하기 과정을 부분적으로 경험하였거나 소통하기를 전혀 경험하지 못한 것으로 드러났다. 영구적 장애 또는 사망한 환자안전사건을 경험한 연구 참여자는 이보다 위해가 작은 사건을 경험한 연구참여자에 비하여 의료진이 발생한 환자안전사건에 대한 공감 및 유감을 표명하는 경우가 통계적으로 유의하게 낮았다(p=0.003). 환자안전사건 소통하기를 경험하지 못한 집단에서 수면장애를 호소한 분율은 35.3%였으나 부분적 소통하기나 완전한 소통하기를 경험한 집단은 그 분율이 각각 28.1%, 31.3%이었다(p=0.673). 이번 설문조사를 통하여 환자안전사건을 경험한 많은 환자 및보호자들이 의료진들로부터 제대로 된 환자안전사건 대응을 받지 못하고 있음을 확인할 수 있었다. 환자안전사건 소통하기의 가이드라인을 마련하고 교육을 진행할 때 환자안전사건의 위해 정도를 고려한 세부적 지침과 사례별 교육 및 훈련이 필요할 것으로 판단된다. 더불어 환자안전사건 소통하기 수행과는 별도로 환자안전사건을 경험한 환자 및 그 보호자를 위한 심리적, 신체적 지원책도 함께 제공될 필요가 있다.

미국의 사과법 및 디스클로져법의 의의와 그 시사점

이원,박지용,장승경 대한의료법학회 2018 의료법학 Vol.19 No.1

Recently in Korea, public interest about patient safety has increased because patient safety incidents occurred continuously. In addition, as the way of coping with medical personnel and medical institutions after occurrence of patient safety incident became controversial, the necessity of introducing apology law and disclosure law was raised. We analyzed the contents of apology law and disclosure law in U.S.A and critically examined the legislative movements in Korea. First, the Apology law requires that a medical personnel provide apology, consolation, sympathy to the patient for discomfort, pain, damage or death, and that the expression of apology shall be inadmissible as evidence of an admission of liability in civil action or administrative proceeding. The Apology law is divided into ‘full apology law’ and ‘partial apology law’ depending on whether mistake, error, fault, liability, and legal liability shall be inadmissible. Meanwhile, Disclosure law enforces or voluntarily enforces the law to communicate with the patient regarding the disclosure of the incident, the cause of incident, the compensation plan, and the measures to prevent the recurrence in the adverse incident that serious harm to the patient. In Korea, the concern about patient safety incidents has been amplified, and as the importance of communication between the medical personnel and patient has been recognized, the revision bill for the “Patient Safety Act”, which adopted the U.S.A apology or disclosure law, was submitted to the National Assembly. The purpose of this study was to critically review the contents of the revised legislation based on the analysis of the apology law and disclosure law in U.S.A. and to provide implications for future legislative direction. 최근 우리나라에서는 연속적으로 발생한 환자안전사건으로 인해 환자안전에 대한 사회적 관심이 높아졌다. 더불어 환자안전사건 발생 후 의료인 및 의료기관의 대응방식이 논란이 되면서, 사과법 및 디스클로져법 도입의 필요성이 제기되고 있다. 본 연구에서는 미국의 사과법과 디스클로져법 내용을 분석하고, 우리나라의 입법 움직임에 대하여 비판적으로 검토하고자 한다. 먼저 사과법은 의료인 등이 환자 측에게 불편감, 통증, 손상, 사망 등에 대해 사과나 위로, 공감 등을 표하는 경우, 사과 등의 표현은 민사재판 및 행정절차에서 법적인 증거로 사용할 수 없도록 하는 것을 그 주요 내용으로 한다. 사과법은 실수, 오류, 잘못, 책임, 법적 책임의 표현과 같은 규범적 평가요소를 증거법의 보호 범위에 포함하는지 여부에 따라 ‘완전한 사과법’과 ‘부분적 사과법’으로 구분된다. 한편, 디스클로져법은 의료기관이 심각한 위해가 발생한 사건 등에 있어 사건의 공개, 발생 원인, 보상계획, 재발방지대책 등에 관하여 환자 측과 소통하는 것을 법률상 강제하거나 자율적으로 유도하는 것을 그 주요 내용으로 한다. 한편, 최근 우리나라에서도 환자안전사고에 관한 관심이 증폭되고, 의료인 측과 환자 측의 의사소통의 중요성이 인식되면서, 위와 같은 미국의 사과법 또는 디스클로져법을 수용한 「환자안전법」 개정법률안이 국회에 제출되기도 하였다. 본 연구에서는 미국의 사과법 및 디스클로져법의 분석을 토대로 위 개정법률안의 내용을 비판적으로 검토함으로써 향후의 입법방향에 시사점을 제시하고자 한다.

Frequency, Expected Effects, Obstacles, and Facilitators of Disclosure of Patient Safety Incidents: A Systematic Review

옥민수,임소윤,조민우,이상일 대한예방의학회 2017 예방의학회지 Vol.50 No.2

Objectives: We performed a systematic review to assess and aggregate the available evidence on the frequency, expected effects, obstacles, and facilitators of disclosure of patient safety incidents (DPSI). Methods: We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for this systematic review and searched PubMed, Scopus, and the Cochrane Library for English articles published between 1990 and 2014. Two authors independently conducted the title screening and abstract review. Ninety-nine articles were selected for full-text reviews. One author extracted the data and another verified them. Results: There was considerable variation in the reported frequency of DPSI among medical professionals. The main expected effects of DPSI were decreased intention of the general public to file medical lawsuits and punish medical professionals, increased credibility of medical professionals, increased intention of patients to revisit and recommend physicians or hospitals, higher ratings of quality of care, and alleviation of feelings of guilt among medical professionals. The obstacles to DPSI were fear of medical lawsuits and punishment, fear of a damaged professional reputation among colleagues and patients, diminished patient trust, the complexity of the situation, and the absence of a patient safety culture. However, the factors facilitating DPSI included the creation of a safe environment for reporting patient safety incidents, as well as guidelines and education for DPSI. Conclusions: The reported frequency of the experience of the general public with DPSI was somewhat lower than the reported frequency of DPSI among medical professionals. Although we identified various expected effects of DPSI, more empirical evidence from real cases is required.

환자안전사건 소통하기에 대한 인식 및 교육 효과 분석: 간호사를 대상으로 한 예비 연구

이원,최은영,표지희,장승경,옥민수,이상일,Lee, Won,Choi, Eun-Young,Pyo, Jee-Hee,Jang, Seung-Gyeong,Ock, Min-Su,Lee, Sang-Il 한국의료질향상학회 2017 한국의료질향상학회지 Vol.23 No.2

Objectives: The purpose of this preliminary study was to identify the nurses' perception regarding disclosure of patient safety incidents (DPSI) and to evaluate the effectiveness of education for DPSI. Methods: DPSI education was conducted for nurses majoring in clinical nurse specialist at an university. Before and after the education, the nurses made a questionnaire to evaluate the perception of DPSI. The questionnaires were divided into four categories: first, overall perception of the DPSI; second, recognition evaluation of the DPSI using hypothetical case, third, opinion on legal and nonlegal measures for facilitating the DPSI; and fourth, socio-demographic factors. The Wilcoxon signed rank test was performed on the DPSI questionnaire response to compare the perceptions before and after the education. Results: A total of 10 nurses participated in the education. DPSI education showed the possibility of improving the overall perception, necessity, effect, obstacle, and promotion method of DPSI, although there were also several responses where there was no statistical significance. In particular, DPSI education led to statistically significance change in the perception of obstacles for DPSI. For example, the number of respondents who agreed to the item "DPSI will increase the incidence of medical lawsuits." was 7 before education but decreased to 3 after education (P-value: .025) Furthermore, nurses' perception of DPSI from this study was generally positive regardless of education. Conclusion:In the future, it will be necessary to carry out DPSI education and training and to evaluate its effectiveness for more nurses.

Frequency, Expected Effects, Obstacles, and Facilitators of Disclosure of Patient Safety Incidents: A Systematic Review

Ock, Minsu,Lim, So Yun,Jo, Min-Woo,Lee, Sang-il The Korean Society for Preventive Medicine 2017 Journal of Preventive Medicine and Public Health Vol.50 No.2

Objectives: We performed a systematic review to assess and aggregate the available evidence on the frequency, expected effects, obstacles, and facilitators of disclosure of patient safety incidents (DPSI). Methods: We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for this systematic review and searched PubMed, Scopus, and the Cochrane Library for English articles published between 1990 and 2014. Two authors independently conducted the title screening and abstract review. Ninety-nine articles were selected for full-text reviews. One author extracted the data and another verified them. Results: There was considerable variation in the reported frequency of DPSI among medical professionals. The main expected effects of DPSI were decreased intention of the general public to file medical lawsuits and punish medical professionals, increased credibility of medical professionals, increased intention of patients to revisit and recommend physicians or hospitals, higher ratings of quality of care, and alleviation of feelings of guilt among medical professionals. The obstacles to DPSI were fear of medical lawsuits and punishment, fear of a damaged professional reputation among colleagues and patients, diminished patient trust, the complexity of the situation, and the absence of a patient safety culture. However, the factors facilitating DPSI included the creation of a safe environment for reporting patient safety incidents, as well as guidelines and education for DPSI. Conclusions: The reported frequency of the experience of the general public with DPSI was somewhat lower than the reported frequency of DPSI among medical professionals. Although we identified various expected effects of DPSI, more empirical evidence from real cases is required.

환자안전사건 소통하기의 필요성: 윤리 및 의료의질 측면에서

옥민수,이상일 대한의사협회 2017 대한의사협회지 Vol.60 No.5

Physicians' Difficulties Due to Patient Safety Incidents in Korea: a Cross-Sectional Study

표지희,Eun Young Choi,이원,Seung Gyeong Jang,박영권,옥민수,Sang Il Lee 대한의학회 2020 Journal of Korean medical science Vol.35 No.17

Background: Medical professionals who experience patient safety incidents (PSIs) are vulnerable to emotional pain and other difficulties; such individuals are referred to as “second victims.” This study quantitatively examines the characteristics of physicians’ experiences of PSIs, along with the consequent difficulties and levels of post-traumatic stress disorder (PTSD), and post-traumatic embitterment disorder (PTED) regarding the events. Methods: An anonymous, self-report online survey was administered to physicians. This collected information regarding PSI characteristics (e.g., type, severity of harm) and impact (e.g., sleep disorder, consideration of career change), as well as participants' socio- demographic characteristics. Meanwhile, to quantitatively assess PSI impacts, PTSD and PTED scales were also administered. PSI characteristics and impacts were analyzed using frequency analysis, and the differing effects of indirect and direct PSI experience regarding consequent difficulties were analyzed using chi-square tests. Factors associated with PTSD and PTED scores were identified using linear regression. Results: Of 895 physicians, 24.6% and 24.0% experienced PSI-induced sleep disorder and eating disorder, respectively. Moreover, 38.9% reported being overly cautious in subsequent similar situations, and 12.6% had considered changing jobs or career. Sleep disorder was significantly more common among participants who directly experienced a PSI (32.8%) than among those with indirect experience (15.3%; P < 0.001). Linear regression showed that indirectly involved physicians had a lower mean PTSD score (by 8.44; 95% confidence interval, −12.28 to −4.60) than directly involved physicians. Conclusion: This study found that many physicians experience PSI-induced physical symptoms and behavioral responses, and that the severity of these symptoms varies depending on the type of incident and degree of harm involved. Our findings can provoke more active discussion regarding programs for supporting second victims, and can also encourage the establishing of a system for addressing PSIs that have already occurred, such as through disclosure of PSIs.

환자안전 인식 향상을 위한 의과대학생 대상 환자안전 역할극 교육의 효과

이원,표지희,장승경,최은영,옥민수,조민우,이상일 건강보험심사평가원 2021 HIRA RESEARCH Vol.1 No.1

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