응급실과 완화의료 병동 간호사의 사전의료의향서에 대한 지식, 좋은 죽음 인식 및 의사소통 능력과 사전의료의향서에 대한 태도와의 관계

국문 초록 (Abstract)

응급실은 자주, 완화의료 병동은 일상적으로 임종상황에 자주 직면하며, 임종치료와 관련된 결정시 사전의료의향서 및 죽음에 대한 인식, 그리고 효과적인 의사소통기술이 중요하다. 하지만, 응급실 간호사를 대상으로 한 연구는 미비하다. 이에 본 연구의 목적은, 완화의료 병동 간호사와 비교하여 응급실 간호사의 사전의료의향서에 대한 태도와 의사소통 능력, 사전의료의향서에 대한 지식 및 좋은 죽음 인식이 사전의료의향서에 대한 태도에 미치는 영향을 조사하는 것이다.
본 연구는 상관관계 연구방법을 적용하여, 2021년 3월부터 8월까지 3개의 대학병원 간호사 153명(응급 간호사 59명, 완화의료 병동 간호사 94명)을 대상으로 사회관계망(social network service)을 통해 자료를 수집하였다.
완화의료 병동 간호사와 비교하여, 응급실 간호사의 사전의료의향서에 대한 태도는 덜 긍정적이었다(t=-2.04, p=.044). 또한, 완화의료 병동 간호사와 비교하여, 응급실 간호사의 사전의료의향서에 대한 지식이 낮았으며(t=-2.92, p=.004), 좋은 죽음 인식과 의사소통 능력은 두 군이 유사하였다. 사전의료의향서에 대한 긍정적 태도에 영향을 주인 요인은 좋은 죽음 인식이 가장 크며(B=.31, p<.001), 의사소통 능력(B=.16, p=.008), 완화의료 병동 근무(B=-1.47, p=.039)가 있었다. 부서별 차이를 나타낸 교육수준, 종교, 임상경력을 통제한 후 회귀분석의 설명력은 32%이었다(adj R2=0.32, F=8.646, p<.001).
결론적으로, 응급실 간호사의 사전의료의향서에 대한 태도는 완화의료 병동 간호사와 비교하여 덜 긍정적이었다. 또한 응급실 간호사의 사전의료의향서에 대한 지식은 완화의료 병동 간호사와 비교하여 현저히 낮았다. 좋은 죽음 인식 및 의사소통 능력이 높을수록 사전의료의향서에 대한 긍정적 태도에 영향을 미치는 것으로 나타났다. 또한, 응급실 근무에 비하여 완화의료 병동 근무도 사전의료의향서에 대한 긍정적 태도에 유의한 영향을 주는 것으로 나타났다. 본 연구결과를 기반으로 응급실 간호사의 응급실 간호사의 사전의료의향서에 대한 긍정적인 인식을 위해서 이에 대한 교육과 훈련이 필요함을 제언하는 바이다.

목차 (Table of Contents)

• Ⅰ. 서론
• 1. 연구의 필요성 ·······················································1
• 2. 연구 목적······························································5
• 3. 용어 정의······························································6
• Ⅱ. 문헌고찰
• 1. 사전의료의향서의 의미 및 현황 ·······························9
• 2. 사전의료의향서에 대한 태도 ··································10
• 3. 사전의료의향서에 대한 영향 요인 ···························13
• 3.1 사전의료의향서에 대한 지식································13
• 3.2 좋은 죽음 인식 ···················································14
• 3.3 의사소통 능력 ···················································17
• Ⅲ. 연구 방법
• 1. 연구 설계······························································19
• 2. 연구 대상······························································19
• 3. 자료수집방법························································20
• 4. 연구 도구······························································21
• 5. 자료 분석 방법·······················································23
• 6. 윤리적 고려···························································24
• Ⅳ. 연구 결과
• 1. 응급실과 완화의료 병동 간호사의 일반적 특성··········25
• 2. 응급실과 완화의료 병동 간호사의 사전의료의향서에 대한 태도,
• 사전의료의향서에 대한 지식, 좋은 죽음 인식 및 의사소통 능력
• 의 정도 비교 ····························································27
• 3. 일반적 특성(종교, 교육 수준 및 근무경력)별 사전의료의향서에
• 대한 태도의 차이······················································29
• 4. 사전의료의향서에 대한 지식, 좋은 죽음 인식 및 의사소통 능력
• 과 사전의료의향서에 대한 태도와의 상관관계············31
• 5. 사전의료의향서에 대한 지식, 좋은 죽음 인식 및 의사소통 능력
• 그리고 근무부서(응급실 vs. 완화의료)가 사전의료의향서에
• 대한 태도에 미치는 영향··········································33
• Ⅴ. 논의 ····································································35
• Ⅵ. 결론 및 제언
• 1. 결론 ·····································································43
• 2. 제언····································································45
• Ⅶ. 참고문헌 ···························································46
• 부록 ·······································································58
• ABSTRACT ··························································67