간호사 확보수준이 수술한 암환자의 원내 사망 및 감염에 미치는 영향

국문 초록 (Abstract)

본 연구의 목적은 의료기관 간호사 확보수준이 수술한 암환자의 원내 사망과 원내 감염에 어떠한 영향을 미치는지 알아보고자 하였다. 이차자료를 이용하였으며, 2012년 상반기에 260개 의료기관에서 수술 후 사망률이 높은 6개 암으로 수술받은 암환자 24,510명을 대상으로 하였다. 단순 로지스틱 회귀분석과 일반화추정방정식(GEE) 모형을 이용하여 분석하였다. 환자 및 의료기관 특성(기관 종별 유형, 소재지, 수술건수)을 보정 후, 사망 가능성은 간호사 확보수준 0-1등급에 비해 2-3등급 군(odds ratio [OR], 1.46; 95% confidence interval [CI], 1.00-2.11), 6-7등급 군(OR, 3.28; 95% CI, 1.87-5.74)에서 더 높은 것으로 나타났다. 병원 감염이 발생할 가능성은 간호사 1인당 침상수가 하나씩 증가할 때마다 증가하여, 0-1등급 군에 비해 2-3등급 군은 6.63배(95% CI, 3.00-14.62), 4-5등급 군은 5.79배(95% CI, 1.88-17.78), 6-7등급 군은 8.4배(95% CI, 1.82-38.84) 높은 것으로 나타났다. 낮은 간호사 확보수준은 환자안전과 의료의 질을 반영하는 지표인 높은 수술 후 원내 사망과 감염발생과 관련이 있었다. 이는 적절한 간호사 확보 수준은 수술 후 암 환자 결과와 관련 있음을 보여준다. 수술한 암환자의 의료의 질 향상과 환자 안전을 위해서는 적절한 간호사 수가 확보되어야 하며, 이를 위한 정책 유지가 필요하다.

다국어 초록 (Multilingual Abstract)

This study was conducted to examine the influence of the nurse staffing level on the level of in-hospital death and infection in cancer patients who received surgery. Secondary data were used and the subjects of this study were 24,510 patients who received surgery for six types of cancer with a high postoperative mortality rate in the first half of 2012 at 260 hospitals. Simple logistic and GEE multiple logistic regression analyses were used. After adjusting for the patient and hospital characteristics, a greater likelihood of dying was found in the nurse staffing level 2-3 group (odds ratio [OR], 1.46; 95% confidence interval [CI], 1.00-2.11) and in the level 6-7 group (OR, 3.28; 95% CI, 1.87-5.74) compared to the level 0-1 group. The likelihood of in-hospital infection increased with each additional bed per nurse, being 6.63 times higher (95% CI, 3.00-14.62) in the level 2-3 group, 5.79 times higher (95% CI, 1.88-17.78) in the level 4-5 group, and 8.4 times higher (95% CI, 1.82-38.84) in the level 6-7 group, as compared to the level 0-1 group. A lower nurse staffing level was associated with higher in-hospital death and infection levels. This shows that an appropriate nurse staffing level is associated with superior postoperative cancer patient outcomes. Policies for providing adequate nurse staffing should be maintained for the sake of ensuring improved care quality and patient safety.

목차 (Table of Contents)

• 요약
• Abstract
• 1. 서론
• 2. 연구방법
• 3. 연구결과
• 4. 논의
• 5. 결론
• References

참고문헌 (Reference)

1 조성현, "입원환자 간호관리료 차등제 도입이후 간호사 확보수준의 변화" 간호행정학회 14 (14): 167-175, 2008

2 김윤미, "의료기관 간호사 확보수준이 수술환자의 사망, 폐렴, 패혈증, 요로감염에 미치는 영향" 한국간호과학회 42 (42): 719-729, 2012

3 김영혜, "암환자의 수술경험" 한국간호과학회 34 (34): 945-953, 2004

4 조수진, "간호관리료차등제 등급별 입원 환자의 건강 결과" 한국보건행정학회 21 (21): 195-212, 2011

5 Hideo Yasunaga, "Variation in cancer surgical outcomes associated with physician and nurse staffing: a retrospective observational study using the Japanese Diagnosis Procedure Combination Database" Springer Nature 12 (12): 1-7, 2012

6 Jonathan F. Finks, "Trends in Hospital Volume and Operative Mortality for High-Risk Surgery" New England Journal of Medicine (NEJM/MMS) 364 (364): 2128-2137, 2011

7 Eunhee Cho, "The Relationships of Nurse Staffing Level and Work Environment With Patient Adverse Events" Wiley-Blackwell 48 (48): 74-82, 2016

8 "Statistics Korea. Statistics of cause of death" Statistics Korea

9 Sofia Xesfingi, "Patient satisfaction with the healthcare system: Assessing the impact of socio-economic and healthcare provision factors" Springer Nature 16 (16): 2016

10 R. L. Kane, "Nurse staffing and quality of patient care" AHRQ 1530-4396, 2007

11 Linda H Aiken, "Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study" Elsevier BV 383 (383): 1824-1830, 2014

12 Sung-Hyun Cho, "Nurse Staffing and Patient Mortality in Intensive Care Units" Ovid Technologies (Wolters Kluwer Health) 57 (57): 322-330, 2008

13 Ministry of Health, "Notice 2006-106"

14 Health Insurance Review & Assessment Service, "KDRG classification"

15 American Cancer Society, "Infections in people with cancer" American Cancer Society

16 A. L. Rich, "Inequalities in outcomes for non-small cell lung cancer: the influence of clinical characteristics and features of the local lung cancer service" BMJ 66 (66): 1078-1084, 2011

17 Linda H. Aiken, "Implications of the California Nurse Staffing Mandate for Other States" Wiley-Blackwell 45 (45): 904-921, 2010

18 Laura M. Enomoto, "Impact of Surgeon and Hospital Volume on Mortality, Length of Stay, and Cost of Pancreaticoduodenectomy" Springer Nature 18 (18): 690-700, 2014

19 John D. Birkmeyer, "Hospital Volume and Surgical Mortality in the United States" New England Journal of Medicine (NEJM/MMS) 346 (346): 1128-1137, 2002

20 Emily V. A. Finlayson, "Hospital Volume and Operative Mortality in Cancer Surgery" American Medical Association (AMA) 138 (138): 721-725, 2003

21 Beatrice J. Kalisch, "Hospital Variation in Missed Nursing Care" SAGE Publications 26 (26): 291-299, 2011

22 Beatrice J. Kalisch, "Hospital Nurse Staffing" Ovid Technologies (Wolters Kluwer Health) 49 (49): 775-779, 2011

23 OECD, "Health at a glance 2015: OECD indicators" OECD Publishing

24 Eunhee Cho, "Effects of nurse staffing, work environments, and education on patient mortality: An observational study" Elsevier BV 52 (52): 535-542, 2015

25 S. Cho, "Effects of increasing nurse staffing on missed nursing care" 62 : 267-274, 2015

26 Linda H. Aiken, "Effects of Nurse Staffing and Nurse Education on Patient Deaths in Hospitals With Different Nurse Work Environments" Ovid Technologies (Wolters Kluwer Health) 49 (49): 1047-1053, 2011

27 Kyu-Won Jung, "Cancer Survival in Korea 1993-2002: A Population-Based Study" 대한의학회 22 (22): 5-10, 2007

28 정규원, "Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2012" 대한암학회 47 (47): 127-141, 2015