환자중심의 Primary care team model 재구축 연구

Abstract

[한글]

본 연구는 환자중심의 간호전달체계 재구축을 목적으로 간호전달체계의 현황을 분석하는 조사연구이며 또 간호전달체계 모형을 설계하는 방법론적 연구이다.

자료수집은 서울시 소재 일 종합병원의 3개 병동의 간호사, 의사, 환자를 대상으로 설문지 조사와 대상 병원의 연구결과를 통하여 간호전달체계 현황을 분석하였으며, 국내외 간호전달체계 재구축 과정에 대한 문헌고찰과 국내 3개 종합병원 벤치마킹을 통해 간호전달체계모형(안)을 설계하였다.

2003년 9월 17일부터 12월 18일까지 3개 시범 병동에서 각 병동 특성에 맞게 설계한 간호전달체계 모형을 적용하였다. Action Cum Research 방법으로 Task Force Team의 9차례 회의를 통해 본 연구자의 간호전달체계 모형(안)의 적합성을 확인하여 최종 간호전달체계를 구축하였으며 이를 Primary Care Team Model로 명명하였다.

본 연구의 결과는 다음과 같다.

1. 간호전달체계 현황 분석

시범병동의 간호전달체계 특징으로 간호전달체계의 핵심구성요소인 간호의 분화, 업무의 유동성, 의사결정권한, 간호업무수행, 병동관리, 업무분담, 의사소통, 자율성을 분석하였다. 간호의 분화는 중등도의 복잡성을, 업무의 유동성은 중등도 이하로 낮게 나타났으며 의사결정권한은 일반간호사들에게 중등도 정도로 권한이 분권화 되어있는 것으로 나타나 환자 중심의 간호전달체계가 이루어지기 위해서는 더욱 분권화가 필요한 것을 알 수 있었다. 또 비효율적인 간호업무분담, 의사소통의 어려움, 신규간호사의 적응 어려움 등이 주요 문제점으로 분석되었다.

2. 간호전달체계 모형(안) 설계

현 간호전달체계의 핵심구성요소 분석 내용을 토대로 일반간호사에게 분권화, 효율적 간호업무분담, 원활한 의사소통, 신규간호사의 적응의 용이함 등을 위해 간호전달체계 모형(안)을 설계하였다.

3. 시범 병동에 간호전달체계 적용

각 병동에서 설계한 간호전달체계 모형 적용을 통하여 C병동에서 시행한 간호전달체계가 본 연구자가 설계한 간호전달체계 모형(안)의 간호전달체계 핵심구성요소와 가장 일치됨이 확인되었다.

4. 최종 간호전달체계 구축

최종 간호전달체계 모형으로 가장 간호사에게 권한이 부여된 C병동의 간호전달체계 모형을 수정하여 환자 중심의 Primary Care Team Model을 구축하였다.

본 연구는 의의는 임상현장에서 연구를 진행하면서 여러 가지 어려운 문제들과 여건들을 함께 토의하고 결정해 나간 팀웍 활동이었으며 그 구심점은 환자중심이었다. 앞으로 시범병동 확대로 Primary Care Team Model 적용을 위한 계속 연구를 통하여 본 모형의 검증이 이루어져야 한다.

환자 중심의 간호전달체계 재구축 성과가 더욱 효율적으로 이루어지기 위하여 병원의 타부서직원들과 다학제간에 팀을 이루어 함께 재구축을 할 수 있는 병원 차원에서의 장기 계획이 필요하다.

[영문]This study used two designs, a survey study to analyze the present nursing delivery system and a methodological study to design a new model for delivery of nursing. The purpose was to reconstruct the present nursing delivery system to a patient-oriented system.

Data collection was done using a survey with the same questions to nurses, doctors and patients on three wards in one general hospital in Seoul. Analysis of the survey for the present nursing delivery system, a literature review of documents on the process reconstruction, and benchmarking in three domestic hospitals provided the data to develop a new model for delivery of nursing.

Nursing delivery system models were designed according to the characteristics of the three sample wards and were applied on each ward from September 17 to December 18, 2003.

An Action Cum Research method was used and a Task Force Team, which met nine times, was confirmed the compatibility of the nursing delivery system model developed in this study. The final version was named the Primary Care Team Model.

The conclusions of the study are as follows:

1. Analysis showed that in the structure of the present nursing delivery system

There were 8 core elements including, differentiation of nursing, mobility of work, decentralization of power, work allocation, nursing practice, nursing management, communication, and autonomy.

Differentiation in nursing, which was the structural aspect of the nursing delivery system on the sample wards, showed complexity at middle levels, and work mobility appeared low from the mid levels. Some decentralization of power in decision-making was found for general nurses at the middle level but for patient-centered care it was found that there is a need for further decentralization.

Major problems were found to be ineffective division of nursing jobs, difficulties in communication, and difficulties in adaptation by new nurses.

2. Preliminary Nursing Delivery System Model

The Nursing Delivery System Model was designed to decentralize power to general nurses, to have an effective division of nursing jobs, smooth communication, and ease in adaptation by new nurses. Thus the model addresses problems that were identified in the analysis of the present nursing delivery system.

3. Application of the Nursing Delivery System to sample wards

Application of the nursing delivery system model developed in the study to each ward showed that the nursing delivery system used on C ward was the closest in its elements to the nursing delivery system model that was developed in this study.

4. Final construction of the Nursing Delivery System.

For the final nursing delivery system model, a patient-oriented Primary Care Team Model was constructed. Amendments were made from the nursing delivery system of C ward which gave the most power to nurses.

The benefit of this research was that it was carried out in the clinical setting and team work was used to discuss difficult problems and conditions to determine the clinical base which was patient-oriented nursing care. Increasing the number of demonstration wards will confirm the compatibility of the model.

For restructuring a patient-oriented nursing delivery system is more efficient, but to do the restructuring, it is necessary to develop a multidisciplinary team with other hospital team members and to develop a long-term plan for restructuring.