보건진료원 직무교육 평가연구

Abstract

[한글]

본 연구는 10년 동안의 보건진료원 직무교육을 분석하고 직무교육이 보건진료원의 업무수행에 도움된 정도와 농어촌등 보건의료를 위한 특별조치법에 명시된 보건진료원 업무수행에 도움된 정도를 파악하고, 직무교육의 구체적인 운영내용을 분석함으로써 효과적인 보건진료원 직무교육과정으로 개선하기 위한 목적으로 실시하였다.

연구방법은 두가지로 기존자료의 내용분석법과 설문지를 이용한 조사연구방법을 사용하였다. 내용분석으로는 10년 동안의 교육과정을 분석하였고, 교육과정의 도움정도는 설문지로 조사하였다

자료분석에서 내용분석은 교육내용과 내용별 시간수의 변화정도를 분석하였고, 설문지는 SPSS Windows를 이용하였다.

연구결과는 다음과 같다.

1. 10년 동안의 보건진료원 직무교육중 이론교육내용 및 시간수의 변화를 분석한 결과, 질병관리에 초점을 둔 교육영역은 시간수가 줄어든 반면에 건강증진 및 예방교육을 위주로 하는 교육영역은 시간수가 점차적으로 증가된 것으로 나타났다.

2. 직무교육(이론교육, 현지실습, 임상실습)의 업무수행에 도움된 정도는 평점4점에 전체평균이 3.04±.53으로 도움정도가 비교적 높게 나왔으며, 그중에서 임상실습 평균 3,16±.60, 이론교육 평균 3.11±.40, 현지실습 평균 2.84± .60으로 나타났다.

3. 직무교육과정중 이론교육영역에서 모자건강관리/가족계획영역이 평균 2.65±.62, 보건정보체계개발 평균 2.62±.83으로 도움정도가 낮았고, 이유로는 활용기회가 없음이 가장 높고, 교육내용 불충분, 교육방법 부적합, 교육항목 부적절, 교육시간부족 순으로 나타났다. 임상실습은 재활과/정형외과가 평균2.96±.86, ENT/안과 평균 2.97±.80으로 낮은 도움정도를 나타냈고 그 이유로는 직접경험부족, 실습기관의 성의부족, 실습지도 부족, 기간 부적절, 실습도구 부족 순으로 나타났다. 현지실습에서는 분만관리가 평균 2.06±.90으로 도움정도가 가장 낮았으며 이유는 해당사례가 없는 것, 직접경험 부족, 실습지도 부족, 실습기간 부족 순으로 나타났다.

4. 일반적 특성별 교육과정(이론교육, 임상실습, 현지실습)의 도움정도를 비교한 결과, 통계적으로 유의한 차이를 보인 것은 연령이 많을수록, 장학간호사보다 선발간호사가, 미혼보다는 기혼인 경우, 지원전에 이수한 프로그램이 많을수록, 자격 및 면허종류가 많을수록 도움정도가 높게 나타났다. 또한 통계적으로 유의하지는 않으나 근무지역이 '시'보다는 '군'일 경우, 직무교육을 이수한 지가 오래되지 않을수록 도움정도가 높은 것으로 나타났다(P<.05).

5. 농어촌등 보건의료를 위한 특별조치법에 명시된 보건진료원의 업무를 수행하는데 있어서의 직무교육의 도움정도는 평균 3.10±.47로 높게 나타났다. 그러나 업무중에서 보건업무와 의료행위에 대한 각각의 평균을 비교한 결과 의료행위가 평균 3.13±.46으로 보건업무 평균 3.06±.55 보다 다소 높게 나타났다.

6. 보건진료원 직무교육 총기간은 58.6%가 적당하다고 응답하였고, 그중 이론교육기간은 51.7%가 너무짧다고 응답하였고 48.3%가 적당하다고 응답하였다. 임상실습 장소는 50%가 1차, 2차, 3차 의료기관을 병행하는 것이 좋다고 반응하였고, 직무교육은 이론교육과

실습교육을 따로 분리하지 말고 이론교육과 실습교육을 동시에 병행할 수 있도록 하자는 의견이 48.3%로 나타났다. 현지실습시기는 이론교육과 임상실습 후에 하자는 의견이 56.9%를 차지했다.

이상의 결과를 종합해 볼 때, 직무교육과정 중에서 이론교육은 건강증진과 질병예방을 위주로 하는 교육영역에서 시간수가 매년 증가하였다. 또한 보건진료원 직무교육과정 중에서 실제 업무수행에 도움정도가 낮은 현지실습은 기존에 사용된 실습지침을 수정·보완하여 변화된 건강관리 환경에 맞는 구체적인 현지실습 지침서 개발이 요구된다.

[영문]

The study was done to improve the job training course for Community Health Practioners (CHPs) by analyzing over the last 10years of CHPs training courses and evaluating the level of help that the training provided to the CHPs in carrying out their work including jobs as stated under the Special Law for Rural Health

Services, and to analyze the management activities of the CHPs in order to develop a more effective CHP training program.

The methodologies used in the study were content analysis of existing materials and a questionnaire survey.

Content analysis was done to show changing levels in training content and time allotment and the survey results were analyzed using SPSS Windows.

The study results are as fellows.

1. According to the analysis of changing levels in theory content and time allotment over the last 10 years of the CHP training courses, it was shown that time allotment for the training area focused on disease management decreased while

the hours in the area of health improvement and disease prevention gradually increased.

2. The total average level of help from the job training(Theory, Practice and Field Practice) for carrying out the CHP work was found to be 3.04±.53 (of a possible 4), which indicates a high level of help. The average for clinical practices was 3,16±.60, for theory, 3.11±.40and for field Wactice, 2.84±.60.

3. For the theory content of the job training courses, the help level was low in the area of mother and child health management/family planning with an average of 2.65 ±.62 and in the area of health information system development with an average

of 2.62±.83. The reason for these deficiencies were, in order of frequency, few opportunities to apply learning, training content that was inadequate, training methodologies which were incongruent with content, improper training items and insufficient class hours. For the practice, the clinical work in

rehabilitation/orthopedics departments and in ENT/ophthalmology departments had averages of 2.96±.86 and 2.97±.80 respectively. This low level resulted from the lack of direct experience, lack of sincerity during the practice time, lack of practice guidance, insufficient time and lack of practice equipment, in that order.

For the field practice, the delivery management averaged 2.06 ±.90 as tole lowest help level. In this case 68% of respondents replied that there were no relevant reasons for this deficiency, 21% responsed that there was a lack of direct experience, 7%, a lack of practice guidance and 4.8%, insufficient time.

4. There were significant differences for several demographic variables when comparing the help level of the clinical courses (Practice and Field Practice). A higher help level was reported by older nurses as compared to younger ones, experienced nurses as compared to scholarship nurses, and married over single. Also

for nurses who had finished more other programs and were qualified or licensed in several areas the level was high. Although it was not statistically significant the level was higher if the work area was in a rural county, not a city, and if one had more recently completed the job training(P<.05).

5. The help level of the job training in the carrying out the CHP work including jobs as stated under the Special Law for Rural Health Services was high with an average of 3.10±.47. But comparing the average for public health related jobs with the average for medical treatment jobs, the average of tole latter was 3.13 ±.46, higher than the 3.06 ±.55 of the former.

6. Of the respondents 58.6% replies stated the period of job training for the CHP was adequate, but 51.7% reported that the period for theory courses was too short while an other 48.3% responded that it was sufficient. For practice locations, 50%

responsed that it was good to practice in medical institutions(primary, secondary and tertiary) at the same time. While 48.3% agreed that doing theory and practice simultaneously was good, and 56.9% agreed that field practice should be done after completing theory and practice training.

Hence, class time (or theory content should be increased in areas of health promotion and disease prevention. Also the development of new field practice guidelines suitable (or changing environments of health management are required in place of the existing ones which were considered low in help level to the practical work of the CHPs.