핵심간호능력 중심의 간호학 실습교육목표 개발

Abstract

[한글]

본 연구는 간호대학 졸업생의 간호능력 증진을 위해 간호사로서 요구되는 핵심간호능력을 중심으로 한 간호학실습목표의 설정을 목적으로 문헌분석 및 조사연구 방법을 사용한 방법론적 연구이다. 본 연구에서 간호학실습교육목표는 실습교육을 통해 최종적으로 달성되어야하는 목표로서 학제에 관계없는 기본적이고 공통적인 수준이며 또한 과목의 구분 없는 공통적인 실습목표이다.

연구의 구체적 목적은 1) 일반간호사에게 요구되는 핵심간호 능력의 설정과 2) 핵심간호능력 중심의 간호학실습목표의 설정이다.

핵심간호능력의 설정은 핵심간호능력에 대한 국내외 문헌 고찰 및 전문가 타당도 검증을 통해 이루어졌으며, 그 결과 자료수집능력, 기본간호능력, 의사소통능력, 비판적 사고능력, 교육능력, 지도력, 간호관리능력, 전문직 발전태도 및 실천능력, 윤리적· 법적 실무능력이 설정되었다.

간호학실습목표의 설정은 일차적으로 간호학학습목표 2000(대한간호협회)과 16개 대학의 간호학 실습지침서의 분석을 통해 이루어졌으며 분석에 포함된 것은 실습에 해당되는 3,333개 목표였다. 해당문헌의 분석은 대상이나 장소에 관계없이 동일한 행위목표를 진술하고 있는 목표들을 하나의 진술문으로 정리하고, 구체적이고 세부적인 수준의 목표는 이를 포괄하는 하나의 목표로 재진술 하는 과정을 통해 이루어졌으며, 우선 과목별 분석을 한 후 이를 종합하여 핵심간호능력으로 분류하고 신입간호사 직무기술서와 비교하고 최종적으로 43개의 간호학실습목표안을 설정하였다. 이와 같이 문헌분석을 통해 설정된 실습목표안에 대한 타당성 조사는 교수, 학생, 수간호사, 일반간호사를 대상으로 이루어졌으며, Fehring Validation Model(1987)을 수정, 적용하여 중요성 정도를 5점 척도로 측정하고 그 결과를 1점 만점으로 환산하여 0.8점 이상을 타당한 것으로 보고 모든 집단(교수, 수간호사, 일반간호사, 학생)에서 0.8점 이상 받은 39개를 공통간호학실습목표로 선정하였다. 설정된 39개의 간호학 실습목표를 핵심간호능력별로 보았을 때 자료수집능력에 ''간호력 수집'', ''신체검진'', ''관찰 및 감시'', ''조사 4개'', 기본 간호수행 능력에 ''생리적 욕구 유지·충족을 위한 간호'', ''안전과 안정의 욕구 유지·충족을 위한 간호'', ''사랑과 소속감의 욕구 유지·충족을 위한 간호'', ''자존의 욕구 유지·충족을 위한 간호'', ''자아 실현 욕구의 유지·충족을 위한 간호'', ''투약'', ''검사 및 수술 간호'', ''상처간호'', ''임종간호'' 9개, 의사소통능력에 ''이해 및 전달'', ''기록'', ''보고'', ''자료활용/전산활용'' 4개, 비판적 사고 능력에 ''우선순위결정'', ''지식 및 이론 적용'', ''간호과정적용능력'' 3개, 교육능력에 ''교육'', ''정보제공'', ''상담'', ''교육자료 개발'' 4개, 지도력에 ''지도력'', ''협동'', ''관계형성'', ''옹호'' 4개, 관리능력에 ''조직이해 및 평가'', ''환경관리 및 안전관리'', ''감염관리'', ''물품관리'', ''자원 활용'', ''입·퇴원 관리'' 6개, 전문직으로서의 법적 윤리적 실무 수행능력에 ''법적 실무'', ''윤리적 실무'' 2개, 전문직발전 태도 및 실천 능력에 ''질 관리'', ''전문직 역할'', ''연구'' 3개 였다.

이와 같은 핵심간호능력 중심의 공통적인 간호학실습교육목표는 간호학 실습교육과정 전체에 걸쳐 해당 능력이 확대되고, 심화될 수 있도록 계속성, 연계성, 통합성 있게 효과적으로 조직함으로서 학생의 능력 달성에 도움이 될 수 있을 것이며, 각 대학 수준에서의 간호학실습교육과정 개발 시 기초자료로서 활용 될 수 있을 것이다.

결론적으로 본 연구 결과는 간호사로서 갖추어야할 핵심간호능력을 성취하기 위해 이론적 지식을 실무에 통합하여 전인적인 간호를 제공할 수 있는 전문직 교육에 기여할 것이다.

[영문]This study was developed to set up Objectives of the Nursing Clinical Education by using the literature review and the data collection based on the Nursing Core Competency, which requires to promote the nursing school graduates competencies.

The purpose of this study was:

1. To set up the Nursing Core Competency required for staff nurse.

2. To set up Objectives for the Nursing Clinical Education based on the Nursing Core Competency.

The objectives of the Nursing Clinical Education in this study is to be achieved ultimately through the clinical practice. It is the common avenue of work and basic objective regardless of education system and curriculum.

The Nursing Core Competency was established by the literature review and verified by 15 experts.

Nursing Clinical Education Objectives are established by the literature review and analysis. And the validity of the objectives of Nursing Clinical Education, based on the Nursing Core Competency has been completed. The result concluded that 257 nursing professors, and 503 head nurses and 509 staff nurses who have less than 3 years clinical experience in 34 acute hospitals and 738 senior student nurses from 81 nursing schools were responded to the survey.

Results were as follows:

1. Set up the Nursing Core Competency. 9 out of 11 abilities excluding nursing intervention were data collection, basic nursing care, communication, critical thinking, teaching, leadership, nursing management, developing of professionalism and implementation, legal and ethical practice.

2. Set up the objectives of the Nursing Clinical Education. First, 44 out of 873 objectives were set up based on the guidelines of the Nursing clinical practice and 44 out of 2460 objectives were set up based on the Nursing Learning Objectives(2000). Secondly, each 44 objectives were classified by the Nursing Core Competency and compared to the job standard for the new staff nurse. 46 objectives were identified and 4 professors examined the content validity. Finally, 43 objectives were set up.

3. Fehring Validation Model(1987) was revised and applied for the content validity. Five scales were used to test for validation. The scale ranged from 0.2 as rarely important to 1 as very important. Every scale had an increment 0.2. Anything above 0.8 were considered as appropriate. Thus, 39 objectives were chosen as the Nursing clinical core competency.

1) Data collection abilities were 4 objectives such as nursing history taking, physical exam, observation and monitoring, investigation.

2) Basic nursing care abilities were 9 objectives which were maintenance of physiological needs, care for physical needs, maintenance of safety and security needs, care for love and belongingness, care for self esteem needs, care for self actualization needs, medication, care for procedure and operation, wound care and hospice care.

3) Communication abilities were 4 objectives such as understanding and expression, documentation, report, utilization of data computer.

4) Critical thinking abilities were 3 objectives which were prioritizing, knowledge based practice, application of nursing process.

5) Teaching abilities were 4 objectives such as education, providing information, counseling, designing teaching materials.

6) Leadership abilities were leadership, cooperation, relationship. Client advocacy.

7) Management abilities were 6 objectives which were understanding and evaluation of the organization, safety and environmental management, infection control, material management, utilization of resources and management of admission and discharge services.

8) Legal and ethical practice implementation abilities were 2 objectives such as legal practice and ethical practice.

9) Development and implementation of professionalism were 3 objectives such as quality improvement, professionalism and research.

The objectives of Nursing Clinical Education, based on the Nursing Core Competency will be very helpful to develop student nurses competency by effectively organizing expanding and deepening their abilities and also, will be used as a basic resource for the development of the Nursing Clinical Education in nursing college.

In conclusion, this study will contribute to the professional nursing education to provide the comprehensive nursing care by applying the knowledge to the nursing practice to achieve the Nursing Core Competency as a professional nurse.