Teamwork, Perception of Patient Safety Culture and Safety Care Activity among Emergency Department Nurses

Abstract

This study is a cross-sectional survey conducted to understand the level of teamwork, perception of patient safety culture, and safety care activity among emergency department nurses, and to determine factors affecting safety care activity. The data were collected from January 1, 2020, to March 15, 2020. The subjects were 144 nurses with clinical experience of more than six months in the emergency rooms of two tertiary care hospitals and one general hospital located in the metropolitan area. Teamwork was measured using a scale developed by Larson and LaFasto (1989) and modified and supplemented by Kim Tae-baek (2006). Perception of patient safety culture was measured using the Hospital Survey On Patient Safety Culture (HSOPSC), which was developed by the Agency for Healthcare Research and Quality (2004) and translated by Kim Jeong-eun et al. (2007). Safety care activity was measured using a scale developed by Lee Gum-ok (2009) and modified by Chai Woo-ree (2017) for emergency department nurses. Using the SPSS 22.0 program, the collected data were analyzed based on descriptive statistics, independent t-test, one-way analysis of variance, Pearson’s correlation coefficient, and hierarchical multiple regression. The results of this study were as follows: 1. Teamwork among emergency department nurses averaged 3.72 out of five points. The highest component score was 3.74 points for mutual cooperation, followed by 3.72 points for goal sharing and 3.70 points for results-oriented. 2. Perception of patient safety culture among emergency department nurses averaged 3.33 out of five points. The highest component score was 3.66 points for supervisor/manager’s attitude toward safety, followed by 3.64 points for frequency of events reported, 3.47 points for communication, 3.28 points for patient safety level at work unit, 3.24 points for hospital environment, and 3.22 points for environment of work unit. 3. Safety care activity among emergency department nurses averaged 137.97 out of 170 points and 4.06 out of five points. The highest component score was 4.26 points for infection control, followed by 4.24 points for medication administration, 4.13 points for procedure/surgery, 4.12 points for verbal orders, 4.11 points for fall prevention, 4.08 points for emergency preparedness, 3.49 points for pressure ulcer prevention, and 3.48 points for safety environment. 4. The difference in safety care activity according to the general characteristics of emergency department nurses was statistically significant according to position. In addition, nurses who had experience in activities, such as safety committees related to patient safety in hospitals, were higher. 5. A significant positive relationship was found between teamwork and safety nursing activity. A significant positive relationship was also found between the perception of patient safety culture and safety care activity. 6. Hierarchical multiple regression analysis was performed to identify factors that affect safety care activity among emergency department nurses. The results showed that the general characteristics of position and experience in activities such as safety committees related to patient safety explained 8% of safety care activity. When teamwork and six composite measures of the perception of patient safety culture were also entered, 40% of safety care activity was explained, which means that those additional factors increased the explanatory power of the model by 32% of those factors. Of those factors, teamwork, hospital environment related to patient safety, and experience in activities such as safety committees related to patient safety, had a statistically significant influence on safety care activity. Based on the results of this study, considering the special working environment of the emergency department, emergency department nurses should be provided with the environment to improve teamwork and the perception of patient safety culture. In addition, education and training programs are necessary for reinforcing safety care activity among emergency department nurses.

본 연구는 응급실 간호사의 팀워크, 환자안전문화인식과 환자안전간호활동 정도를 파악하고, 환자안전간호활동에 영향을 미치는 요인을 확인하기 위해 시행된 횡단적 조사연구이다. 수도권 소재 상급 종합병원 2곳 및 종합병원 1곳에서 근무하는 응급실 경력 6개월 이상의 직접 간호를 제공하는 응급실 간호사 144명을 대상으로 2020년 1월 1일부터 2020년 3월 15일까지 자료 수집하였다. 팀워크는 Larson과 LaFasto (1989)가 개발하고 김태백(2006)이 번역하여 재구성한 도구를 사용하였고, 환자안전문화인식은 미국 AHRQ에서 개발한 HSOPSC 도구를 김정은 등(2007)이 번안한 도구를 사용하였으며, 환자안전간호활동은 이금옥(2009)이 개발하고 채우리(2017)가 응급실 간호사를 대상으로 수정·보완한 도구를 사용하였다. 수집된 자료는 SPSS 22.0 프로그램을 사용하여 기술통계, t-test와 ANOVA, 상관관계와 위계적 다중회귀분석을 시행하였다. 본 연구 결과는 다음과 같다. 1. 응급실 간호사의 팀워크는 5점 만점에 평균 3.72점으로 나타났다. 하위영역은 ‘상호협력’ 3.74점, ‘목표공유’ 3.72점, ‘결과지향’ 3.70점 순으로 나타났다. 2. 응급실 간호사의 환자안전문화인식은 5점 만점에 평균 3.33점으로 나타났다. 하위영역은 ‘환자안전과 관련된 관리자의 태도’ 3.66점, ‘사고보고의 빈도’ 3.64점, ‘환자안전과 관련된 의사소통 절차와 과정’ 3.47점, ‘부서 내 환자안전도 평가’ 3.28점, ‘환자안전과 관련된 병원환경’ 3.24점, ‘부서 내 환자안전문화’ 3.22점 순으로 나타났다. 3. 응급실 간호사의 환자안전간호활동은 170점 만점에 평균 137.97점이었으며, 평점평균은 5점 만점에 평균 4.06점으로 나타났다. 하위영역은 ‘감염예방’ 4.26점, ‘투약’ 4.24점, ‘수술 및 시술’ 4.13점, ‘구두처방’ 4.12점, ‘낙상예방’ 4.11점, ‘환자확인’ 4.08점, ‘응급상황’ 4.01점, ‘욕창예방’ 3.49점, ‘안전한 환경’ 3.48점 순으로 나타났다. 4. 응급실 간호사의 일반적 특성에 따른 환자안전간호활동의 차이를 확인한 결과 직위와 환자안전 관련활동 참여가 환자안전간호활동에 유의한 차이를 보이는 요인으로 책임간호사 군과 환자안전 관련활동에 참여한 간호사 군에서 환자안전간호활동 정도가 높았다. 5. 응급실 간호사의 팀워크, 환자안전문화인식과 환자안전간호활동의 상관관계를 분석한 결과 팀워크와 환자안전간호활동, 환자안전문화인식과 환자안전간호활동은 유의한 양의 상관관계를 보였다. 6. 간호사의 환자안전간호활동에 영향을 미치는 요인을 파악하기 위해 위계적 다중회귀분석을 시행한 결과 일반적 특성인 직위, 환자안전 관련활동 참여는 환자안전간호활동을 8% 설명하였고, 팀워크와 환자안전문화인식의 6가지 하위영역을 추가 투입한 결과 환자안전간호활동을 40% 설명하여 팀워크와 환자안전문화인식의 6가지 하위영역이 환자안전간호활동을 32% 추가적으로 설명하였다. 이 중 팀워크, 환자안전과 관련된 병원환경과 환자안전관련 활동에의 참여가 환자안전간호활동에 통계적으로 유의하게 영향을 미치는 요인으로 나타났다. 이상의 연구결과를 종합해 볼 때, 응급실의 특수한 근무환경을 고려하여 응급실 간호사의 팀워크와 환자안전문화인식을 증진시킬 수 있는 환경을 조성하고 다양한 프로그램 개발 및 교육이 필요하다. 또한, 환자안전간호활동에 대한 지속적인 평가와 연구를 통해 환자안전간호활동의 향상을 도모할 수 있을 것이다. 본 연구는 향후 응급실 간호사의 환자안전간호활동을 향상시키기 위한 전략을 수립하는 데에 기초자료로 활용될 수 있을 것이다.