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1 stress pissn X, eissn stress 2019;27(1): ORIGINAL ARTICLE 간호간병통합서비스병동간호사와일반병동간호사의업무스트레스, 소진및간호업무성과비교 김연실 1 ㆍ박정애 1 ㆍ서은경 2 1 두원공과대학교간호학과, 2 굿모닝병원간호부 A Comparative Study on the Job Stress, Burnout and Nursing Performance of Nurses in Comprehensive Nursing Care Service Wards and Nurses in General Wards Youn Sil Kim 1, Jung Ae Park 1, Eun Koung Seo 2 1 Department of Nursing, Doowon Technical University, Anseong, 2 Department of Nursing, Goodmorning Hospital, Pyeongtaek, Korea Received November 1, 2018 Revised February 11, 2019 Accepted February 11, 2019 Corresponding author Jung Ae Park Department of Nursing, Doowon Technical University, 51 Gwaneumdang-gil, Juksan-myeon, Anseong 17529, Korea Tel: Fax: ORCID: Youn Sil Kim ( Jung Ae Park ( Eun Koung Seo ( Copyright 2019 by stress. All rights reserved. Key messages 본연구는보호자가없는간호ㆍ간병통합서비스병동과일반병동의간호사를대상으로업무스트레스, 소진및간호업무성과를비교하였으며, 각요인의관계를확인하였다. 간호ㆍ간병통합서비스병동과일반병동간호사총 80명이대상이었고, 두집단의일반적특성은모두동질하였다. 간호ㆍ간병통합서비스병동간호사의업무스트레스및소진이일반병동간호사에비해유의미하게높게나타났다. 간호ㆍ간병통합서비스병동간호사의업무스트레스와소진은정적상관관계를보였다. 본연구결과는환자의만족도가높은간호ㆍ간병통합서비스제도의안정적인정착및확대를위해간호ㆍ간병통합서비스병동에근무하는간호사의업무스트레스와소진을해결하기위한적극적인전략개발연구에근거자료로활용될수있을것이다. 중심단어 : 간호간병통합서비스, 업무스트레스, 소진, 간호업무성과 Abstract Background: The purpose of this study was to compare job stress, burnout and nursing performance between nurses who work in comprehensive nursing care service wards and general wards. In addition we identified a correlation among job stress, burnout and nursing performance. Methods: The participants were 80 nurses (comprehensive nursing care service ward: 40, general wards: 40) and the data were collected using structured questionnaires to assess job stress, burnout and nursing performance. Results: There was no significant difference in general characteristics between comprehensive nursing care service wards nurses and general ward nurses. Comprehensive nursing care service wards nurses were statistically significantly higher in job stress and burnout than general ward nurses. While there was no difference in nursing performance. There was a positive correlation between job stress and burnout in comprehensive nursing care service wards. Conclusions: In order to establish a comprehensive nursing care service system with high patient satisfaction, it is necessary to study strategies to solve job stress and burnout of nurses and to improve job satisfaction and nursing performance. Key Words: Comprehensive nursing care service, Job stress, Burnout, Nursing performance 서론 핵가족화및여성의사회진출증가등사회여건의변화와생활양식의변화로가족기능이축소되면서환자는가족에 의해돌봄을받기어렵게되었고 (Hwang NM, 2010), 가족을대신하여간병인을두는사례가증가하게되었다. 간병비용의지출은환자보호자의경제적부담을높이며 (Hwang NM, 2012), 신분보장이제대로안되어있는간병인이간병

2 Study in Comprehensive Nursing Care Service Wards 47 서비스를제공하다보니사고위험에노출되어있어경제적인부담을넘어사회적문제로대두되고있다 (Ministry of Health and Welfare, 2016). 이문제를해결하기위해정부에서는 2010년에보호자없는병원, 포괄간호서비스의간병서비스제도시범사업을시작하였고, 2016년 4월부터는지금의간호ㆍ간병통합서비스로제도화되어운영되고있다. 간호ㆍ간병통합서비스란입원환자에대해보호자가상주하지않아도적정간호인력확보와팀간호체계도입및병동환경개선등을통해충실한간호서비스를제공하는포괄적간호간병서비스를말한다 (Ministry of Health and Welfare, 2016). 입원환자에게제공되는모든간호서비스는의료기관의간호사와간호조무사에의해제공받는것을원칙으로하며, 입원의료서비스의질을제고하고보호자의간병부담을경감시키기위한제도이다. 간호ㆍ간병통합서비스에서가장우선되고중요한것은환자의안전뿐만아니라양질의간호서비스를제공하는것이다. 선행연구를보면간호ㆍ간병통합서비스가간호사의적정배치로인해직접간호가증가되는결과를가져왔다. 간호사의확보수준이높을수록환자의일상생활수행능력이향상되었고 (Castle et al., 2011), 직접간호시간이많을수록환자의재원일수가단축되고환자간호의질이높아졌으며 (Kim JJ et al., 1996). 환자의회복결과의질이나환자의만족도가높아졌다 (Kim YM et al., 2014). 그러나간호ㆍ간병통합서비스로환자의만족도가높아지는긍정적인측면과는달리의료서비스를제공하는간호사측면에서이직의가장큰요인인업무스트레스와소진뿐아니라간호ㆍ간병통합서비스의운영성과를측정할수있는간호업무성과등다양한측면에서분석이이루어져야한다. 간호사의업무스트레스는 Lee NS et al.(2015) 의일반병동과포괄간호서비스병동간호사를비교한연구에서포괄간호서비스병동간호사업무스트레스가일반병동간호사보다높게나타났고, Lee MK et al.(2015) 의연구에서도직접간호가증가하는포괄간호서비스병동간호사의스트레스수준이높게나타났다. 그러나 Choi HN et al.(2018), Jung SM et al.(2017) 의연구에서간호ㆍ간병통합서비스병동과일반병동간호사간의업무스트레스는차이가없었다. 간호사인력확대로 1인당담당해야할환자수감소는스트레스를감소시키는요인으로작용한반면일상생활보조업무의증가와간호보조인력의관리감독등은스트레스를증가시키는요인으로고려되어진다 (Choi HN et al., 2018). 따라서간호대상자의특성을고려하여간호사의업무스트레스를비교하는반복연구가필요하다. 또한간호ㆍ간병통합서비스병동간호사는환자와보호자로부터부당한대우, 과도한업무량, 표준화되지못한업무분장등으로인해정체성혼란을경험하고, 환자안전에대한책임수준이높은반면낮은보상과인정으로점차소진되는것을확인하였고 (Park KW et al., 2017), 이는간호사의우울에도영향을미치는부정적결과 (Lee E et al., 2016) 를보 였다. 반면긍정적영향으로는전인간호를통해환자간호시간이증가하고환자의치료결과가향상되면서간호사의직무만족도가높아지고소진정도가낮아졌다는결과도있었다 (Rafferty et al., 2007). 또한최근시범사업부터시작하여간호ㆍ간병통합서비스제도가비교적안정적으로운영되는기관을대상으로실시한 Kim SE et al.(2017) 과 Kim BH et al.(2018) 의연구에서는간호사인력의확충과보조인력추가및이들의역할에대한정립이구축되어가면서간호사의소진도일반병동간호사와차이가없는것으로나타나간호사의소진에대해좀더확인할필요가있다. 간호업무성과는간호ㆍ간병통합서비스운영성과의과정평가측면에서중요한요소로, 간호ㆍ간병통합서비스병동간호사와일반병동간호사의간호업무성과를비교한 Choi HN(2018) 의연구에서간호ㆍ간병통합서비스병동간호사의간호업무성과가더높게나타났다. 반면에 Park JH et al. (2017) 과 Kim TJ et al.(2018) 의연구에서는차이가없는것으로나타나반복연구를통해이를확인할필요가있다. 간호ㆍ간병통합서비스병동의경우효율적인간호업무수행을위해환자당간호사비율이높아지고업무환경개선이이루어지는현시점에서간호업무성과에대한비교분석및간호업무성과를증진시킬수있는방안을모색하는것은의의가있을것이다. 의료서비스의질을높이고환자중심의의료서비스를제공하는간호간병통합서비스의제도화정착에있어가장고려되어야할사항은환자안전및양질의간호서비스제공이다 (Ko SH et al., 2004). 그러나양질의서비스를제공하기위해서는수요자측면의만족과함께공급자인간호인력의직무만족이야말로간호ㆍ간병통합서비스의질적보장을위해필요하다 (Shin OS et al., 2017). 이제도를발전시키고정착하기위해서는서비스를제공하는간호ㆍ간병통합서비스병동의간호인력의직무만족을위해근무환경조성및질좋은의료서비스를지속적으로제공할수있도록업무스트레스와소진을줄이고간호업무성과를높일수있는방법을모색해야한다. 따라서일반병동에비해간호ㆍ간병통합서비스병동의간호사들이느끼는업무스트레스, 소진및간호업무성과는어떠한지비교연구가필요한시점이다. 따라서본연구는간호ㆍ간병통합서비스도입후간호ㆍ간병통합서비스병동에서근무하는간호사와일반병동에근무하는간호사의업무스트레스, 소진및간호업무성과를파악하여비교조사하고간호ㆍ간병통합서비스병동과일반병동간호사의업무스트레스, 소진, 간호업무성과간의상관관계를확인함으로써이제도의정착화를위한기초자료를제공하고자한다. 연구방법 1. 연구설계본연구는구조화된설문지를활용하여간호ㆍ간병통합서비스병동간호사와일반병동간호사의업무스트레스, 소진,

3 48 Youn Sil Kim et al. 간호업무성과를파악하고비교하기위한서술적조사연구이다. 2. 연구대상본연구는경기지역에서간호ㆍ간병통합서비스를시범적으로시행한지 2 3년된병원 2곳을선정하였고, 간호ㆍ간병서비스병동과이와유사한진료과및입원환자로구성된일반병동에서근무하는간호사를대상으로자기기입식설문조사를실시하였다. 본연구에서는각병원간호ㆍ간병통합서비스병동과일반병동에설문지를균등하게배부하고, 배정된해당병동근무자중본연구목적에대해이해하고자발적으로참여를수락한간호사를대상으로하였다. 간호ㆍ간병통합서비스병동간호사 40명을대상으로자료수집을하였고, 이와동일하게일반병동간호사 40명을설문조사하였다. 연구자가직접설문지를회수하였으며, 설문지작성시회의실을제공하고충분한시간을제공한결과누락자료가없었으며, 최종적으로간호ㆍ간병통합서비스병동 40명과일반병동 40명을자료를분석하였다. 3. 연구도구 1) 업무스트레스간호사의업무스트레스를측정하기위해 Kim MJ et al.(1984) 이개발한 간호사가근무중에경험하는스트레스측정을위한도구 를사용하였다. 업무량과업무환경 5문항, 역할갈등 8문항, 업무의책임 3문항총 16문항으로구성되어있으며, 전혀그렇지않다 1점에서부터 매우그렇다 5 점까지 Likert 5점척도이며, 점수가높을수록업무스트레스가높음을의미한다. 도구개발당시 Cronbach s α=.94이었으며, 본연구에서의신뢰도는 Cronbach s α=.87이었다. 2) 소진간호사의소진을측정하기위해 Maslach et al.(1981) 이개발한소진척도 (Maslach Burnout Inventory, MBI) 도구를 Jung HY(2008) 이수정보완하여구성한척도를이용하였다. 총 22문항으로하위영역으로는정서적탈진 9문항, 비인격화 5문항, 개인적성취감저하 8문항으로구성되어있다. 전혀그렇지않다 1점에서부터 매우그렇다 5점까지 Likert 5점척도이며, 점수가높을수록소진이많이되었음을의미한다. 도구개발당시신뢰도는 Cronbach s α=.87이었으며, 본연구에서신뢰도는 Cronbach s α=.84이다. 3) 간호업무성과간호업무성과를측정하기위해 Ko YK et al.(2007) 이임상간호사를대상으로개발한도구를사용하였다. 간호업무성과는간호업무수행능력 7문항, 간호업무수행태도 4문항, 업무수준향상 3문항, 간호과정적용 3문항총 17문항으로구성되어있다. 전혀그렇지않다 1점에서부터 매우그렇다 5점까지 Likert 5점척도로, 점수가높을수록간호업무성과가높음을의미한다. 도구개발당시 Cronbach s α =.92 이었으며, 본연구에서신뢰도는 Cronbach s α=.94 이다. 4. 자료수집및윤리적고려 본연구의자료수집기간은 2018년 5월부터 8월까지 3개월동안이었다. 간호ㆍ간병통합서비스병동과일반병동에서근무하는간호사를대상으로조사하였으며, 연구대상자를윤리적으로보호하기위하여연구에대한설명문과함께연구참여동의서를배부하여연구참여동의서에서명을받았다. 설명문에는연구의목적과내용이설명되어있고, 설문자료가연구에만사용될것과비밀이보장되는점과대상자가언제라도중단할수있음이기술되어있었으며, 설문조사전다시한번연구의목적과취지에대해일대일로설명하였다. 설문조사는간호사근무전이나후에병원에서장소를제공한회의실에서설문지를작성하도록하여누락되는자료가없도록노력하였고연구자가직접회수하였다. 경기지역에간호ㆍ간병통합서비스를운영한지 2 3년된병원 2곳을선정하였고, 간호ㆍ간병서비스병동과이와유사한진료과및입원환자로구성된일반병동에서근무하는간호사를대상으로일반병동에설문지를균등하게배부하였다. 배정된해당병동근무자에게본연구에대한목적을설명하였으며, 연구목적에대해이해하고자발적으로동의한간호사를대상으로설문을실시하였다. 선정된병동의간호사에게설문응답에대한충실성과회수율을높이기위해참여해준모든대상자에게는감사의표시로소정의선물을제공하였다. 5. 자료분석 수집된자료는 SPSS 24.0 프로그램을이용하여다음과같이분석하였다. 간호ㆍ간병통합서비스병동과일반병동간호사의일반적특성은실수와백분율, 평균, 표준편차를이용하였고, 두집단간동질성은 test로분석하였다. 업무스트레스, 소진, 간호업무성과에대해정규성검정은 Shapiro-Wilk검정을이용하였다. 간호ㆍ간병통합서비스병동과일반병동간호사의업무스트레스와소진및간호업무성과는평균, 표준편차로, 차이검정은 independent t-test로분석하였다. 간호ㆍ간병통합서비스병동과일반병동간호사의업무스트레스와소진및간호업무성과의관계는 Pearson s correlation으로분석하였다. 결과 1. 간호ㆍ간병통합서비스병동과일반병동간호사의일반적특성및동질성검정 간호ㆍ간병통합서비스병동과일반병동간호사들의동질성검정에서일반적특성모두가동질한것으로나타났다. 참여대상자는 90% 이상이여성이었으며, 20대가가장많았다. 응답자 90% 이상이 3교대의근무형태를가지고있었고, 두그룹모두 80% 이상이일반간호사였다 (Table 1).

4 Study in Comprehensive Nursing Care Service Wards 간호ㆍ간병통합서비스병동과일반병동간호사의업무스트레스와소진및간호업무성과비교 업무스트레스와소진및간호업무성과에대해 Shapiro- Wilk로정규성검정결과정규분포하여, 간호ㆍ간병통합서비스병동과일반병동간호사의업무스트레스와소진, 간호업무성과차이는 independent t-test로분석하였으며, 그결과는 Table 2와같다. 간호ㆍ간병통합서비스병동과일반병동간호사의업무스트레스는간호ㆍ간병통합서비스병동간호사가 3.23±0.49점, 일반병동간호사가 2.97±0.44점으로간호ㆍ간병통합서비스병동이일반병동보다유의하게높은것으로나타났다 (t= 2.46, p=.016). 하위영역별간호ㆍ간 병통합서비스병동과일반병동간호사의업무스트레스는역할갈등이유의한차이를보였고 (t= 2.82, p=.006), 업무량과업무환경 (t= 1.68, p=.097), 업무책임 (t= 1.50, p=.137) 에서는유의한차이를보이지않았다. 소진에서도간호간병통합서비스간호사가 (2.96±0.36) 일반병동간호사 (2.65± 0.40) 보다유의하게높게나타났다 (t= 3.59, p=.001). 하위영역에서는정서적탈진 (t= 2.72, p=.008) 과비인격화 (t= 3.34, p=.001) 에서차이를보였다. 간호업무성과는두집단에서유의한차이를보이지않았다 (t=1.66, p=.101). Table 1. Comparison of general characteristics between comprehensive nursing care service wards and general wards (N=80) Characteristics Categories CW (n=40) GW (n=40) n (%) n (%) χ 2 p Age (year) (65.0) 19 (47.5) (27.5) 14 (35.0) 40 3 (7.5) 7 (17.5) Gender Female 36 (90.0) 37 (92.5) Male 4 (10.0) 3 (7.5) Marital status Single 31 (77.5) 29 (72.5) Married 9 (22.5) 11 (27.5) Education level College 11 (27.5) 11 (27.5) University 27 (67.5) 27 (67.5) Graduate school 2 (5.0) 2 (5.0) Working style non-shift work 2 (5.0) 2 (5.0) shift work 2 (5.0) 1 (2.5) 3 Shift work 36 (90.0) 37 (92.5) Before experiences (years) 1.26± ± Experiences in present unit (month) (32.5) 11 (27.5) (30.0) 10 (25.0) (37.5) 19 (47.5) Job position Staff nurse 37 (92.5) 32 (80.0) Charge nurse 3 (7.5) 8 (20.0) Monthly wage (10,000 won) 150 <200 1 (2.5) 1 (2.5) < (32.5) 8 (20.0) 250 < (47.5) 21 (52.5) (17.5) 10 (25.0) CW: Comprehensive Nursing Care Service Wards, GW: General Wards. Table 2. Differences in variables between comprehensive nursing care service wards and general wards (N=80) Variables Categories CW (n=40) M±SD GW (n=40) M±SD t p Job stres Work overload & Environment 3.48± ± Role conflict 3.06± ± Responsibility of work 3.15± ± Total 3.23± ± Burnout Emotional exhaustion 3.17± ± Dehumanization 2.91± ± Low self achievement 2.80± ± Total 2.96± ± Nursing erformance Performance capability 3.61± ± Performance attitude 3.64± ± Performance improvement 3.44± ± Nursing process application 3.73± ± Total 3.61± ± CW: Comprehensive Nursing Care Service Wards, GW: General Wards.

5 50 Youn Sil Kim et al. Table 3. Correlation of study variables (N=80) Ward types Variables Job stress Burnout Nursing performance r (p) Comprehensive nursing care service wards (N=40) Job stress 1 Burnout (.030) 1 Nursing performance (.265) (.947) 1 General wards (N=40) Job stress 1 Burnout (.001) 1 Nursing performance (.783) (.001) 1 3. 간호사의업무스트레스와소진및간호업무성과와의상관관계 간호ㆍ간병통합서비스병동의간호사와일반병동간호사의업무스트레스, 소진과간호업무성과와의상관관계분석결과는 Table 3과같다. 간호ㆍ간병통합서비스병동의간호사에서는업무스트레스와소진의관계에서통계적으로유의한정적상관관계가나타났다 (r=0.343, p=.030). 일반병동간호사의업무스트레스와소진은정적상관관계가나타났고 (r=0.508, p=.001), 소진과간호업무성과와의관계에서통계적으로유의한부적상관관계가있었다 (r= 0.486, p=.001). 고찰 본연구는간호ㆍ간병통합서비스병동과일반병동간호사의업무스트레스, 소진및간호업무성과를확인ㆍ비교하고그관계를분석함으로써, 간호ㆍ간병통합서비스가안정적으로정착및확산되는데있어간호업무효율성을높이는데기초자료를제공하고자시도되었다. 간호ㆍ간병통합서비스병동과일반병동간호사의업무스트레스와관련해서살펴보면, 간호ㆍ간병통합서비스병동간호사는 3.21점 (5점만점 ), 일반병동간호사는 2.93점으로, 간호ㆍ간병통합서비스병동간호사의업무스트레스가유의하게높게나타났다. 이는도구가달라직접비교하기는어려우나일반병동과포괄간호서비스병동간호사의업무스트레스를연구한 Lee NS et al.(2015) 의연구에서도포괄간호서비스병동의간호사업무스트레스가높게나타났고, Lee MK et al.(2015) 도본연구결과를지지한다. 그러나본연구와상반되어간호ㆍ간병통합서비스병동과일반병동간호사간의업무스트레스에차이가없었다는연구도있었다 (Jung SM et al., 2017; Kim SE et al., 2017; Choi HN et al., 2018; Kim SM et al., 2018). 간호ㆍ간병통합서비스병동의간호사 1인당담당해야할환자수의감소는스트레스를감소시키는원인이되기도하며, 환자와의일상생활보조업무수행의증가와간호보조인력의관리감독업무의증가는스트레스를증가시키는원인으로고려된다 (Choi HN et al., 2018). 이러한결과는본연구대상의료기관의경우간호ㆍ 간병통합서비스를시작한지채 2년 3년이된도입기단계에있는기관으로병원차원에서의인력및환경에대한개선이필요한상황이결과에영향을미친것으로생각된다. 또한업무의특성상간호간병통합서비스병동간호사의경우일반병동간호사에비해개인위생및배설, 식사보조, 체위변경등과같은직접간호활동이많은부분을차지하고있어업무량이증가하면서더많은스트레스에노출되어있다고보여진다. 직무스트레스의하위영역중에서는간호ㆍ간병통합서비스병동간호사의역할갈등으로인한직무스트레스가가장높게나타났다. 이는일반병동보다확대된간호사의역할을수행하면서도표준화되지못한업무분장으로인해간호사의정체성혼란을경험한 Park KW et al.(2017) 의연구와유사한결과이다. 따라서병원차원에서의충분한인력확충과인력간표준화된업무분장및환자와보호자를대상으로한서비스범위에대한명확한교육을통해간호사의역할갈등으로인한정체성의혼란및직무스트레스를감소시켜야할것이다. 간호ㆍ간병통합서비스병동과일반병동간호사의소진은 5점만점에각각 2.96점, 2.65점으로간호ㆍ간병통합서비스병동간호사의소진이유의하게높게나타났다. 같은연구도구를사용한 Kim SE et al.(2017) 의연구결과간호ㆍ간병통합서비스병동간호사 3.00점, 일반병동간호사 3.13점으로간호ㆍ간병통합서비스병동간호사의소진이낮게나타났으나집단간유의한차이는없었고 Kim BH et al.(2018) 의연구결과에서도간호ㆍ간병통합서비스병동간호사 2.96점, 일반병동간호사 3.01점으로간호ㆍ간병통합서비스병동간호사의소진이낮게나타났으나집단간유의한차이는없어본연구결과와상반된결과를보였다. 이는연구대상자가근무하는간호ㆍ간병통합서비스병동의입원환자의경우진료과에따른명확한제한을두고있지않아다양한간호요구를가지고있으며, 간호사인력배치는종합병원의표준배치수준인 1:10, 간호조무사는 1:25 30으로구성되어있는것으로확인되었다. 적정인력배치는간호사의소진에영향을미치는요인으로본연구대상자가근무하는병원은상향인력배치가아닌적정인력배치수준을유지하고있었으며, 또한일반병동에서수행하지않았던간호업무를수행함에따라업무부담이증가한데반해간호사의보상체계는야간전담간호사를제외하고는추가적인보상은이루어지지못하고있었다. 따라서간호업무부담은증가하는반면에보상체계

6 Study in Comprehensive Nursing Care Service Wards 51 에는변화가없어이것이간호간병통합서비스병동간호사의소진에영향을미친것으로생각된다. 효율적인간호간병통합서비스병동을운영하기위해서는간호사의스트레스를줄일수있도록인력배치뿐아니라표준화된업무분장과적절한보상및인정이필요하다고사료된다. 소진의하위영역을살펴보면정서적으로지쳤다는것을나타내는가장중요한지표인 (Im JA, 2015) 정서적탈진과비인격화에서유의한차이를보였다. 이는간호ㆍ간병통합서비스병동에서근무하는간호사의환자간호경험에대해연구한 Park KW et al.(2017) 의연구에서환자와보호자의지나친요구와보호자의불신으로간호사는지쳐가고새롭게집중된업무로인해소진된다는연구결과와유사한결과를보였다. Kim JH et al.(2017) 은간호ㆍ간병통합서비스운영에있어과도한업무량과간호인력간모호한역할분담과미흡한보상을문제점으로지적하고이를해결하기위한정책방향으로근무여건개선, 간호업무범위에대한체계적인분석과교육, 보상체계개발및평가시스템개발을제시하였다. 본연구를통해아직간호ㆍ간병통합서비스제도의시행초기에있는의료기관에서근무하는간호사의소진을감소시키기위해제도적인측면에서의개선은물론적절한휴식제공및중재프로그램의개발등을통해적극적인소진감소를위한전략을모색할필요가있다. 간호ㆍ간병통합서비스병동과일반병동간호사의간호업무성과는 5점만점에각각 3.61점, 3.79점으로일반병동간호사의간호업무성과가높게나타났으나통계적으로유의한차이는없었다. 간호업무성과의하위영역을보면업무수행능력, 업무수행태도, 업무수준향상, 간호과정적용의 4가지영역모두간호ㆍ간병통합서비스병동간호사보다일반병동간호사가높은점수를보였으나유의한차이는없었다. 간호ㆍ간병통합서비스를시행한지 1개월과 6개월시점에서간호업무성과를비교한연구 (Yeun YR, 2015) 에서는간호ㆍ간병통합서비스병동간호사의업무성과가일반병동간호사의업무성과보다유의하게높게나타나본연구와는차이가있었다. 그러나간호ㆍ간병통합서비스를시행한지 6개월이상된의료기관을대상으로한 Kim TJ et al.(2018) 과 Park JH et al.(2017) 의연구에서는간호업무성과에서두집단간에유의한차이가없는것으로나타나본연구결과와일치하였다. 따라서간호ㆍ간병통합서비스제도가확대운영되고있는현시점에서핵심인력인간호사의업무수행을높이기위해시기별로간호사의업무성과변화를고려하여다수의의료기관을대상으로한반복연구를통해결과를확인할필요가있다. 간호ㆍ간병통합서비스병동간호사의업무스트레스, 소진및간호업무성과의상관관계를살펴보면업무스트레스와소진간에유의한양의상관관계가있었다 (r=0.343, p=.030). 그러나 Kim SE et al.(2017) 의연구에서는간호ㆍ간병통합서비스병동간호사의소진에업무스트레스가유의한영향을미치지못한것으로나타나상반되는결과를보였다. 일반병동간호사를대상으로업무스트레스와소진의관계를확인 한연구 (Kim SE et al., 2017; Kim BH et al., 2018) 에서는소진에스트레스가유의한영향을미치는것으로나타났다. 또한일반간호사를대상으로업무스트레스와소진이유의한순상관관계가있었다는선행연구 (Kim WO et al., 2010; Choi KJ et al., 2013) 들과유사한결과를나타냈다. 이는간호ㆍ간병통합서비스를시행하여안정된시스템구축된경우에는일반병동보다업무효율이증가되고직무스트레스가감소되어소진에유의한영향요인이아닌것으로나타났다고보여진다 (Hwang NM, 2015). 본연구는간호ㆍ간병통합서비스운영 2 3년경과한의료기관을대상으로서비스제공자인간호사의측면에서인적관리차원의전략을마련하는기초자료를제시하였다는데연구의의의가있다. 그러나특정지역의 2개기관을대상으로한조사연구이므로연구결과를일반화하기위해서는다수의의료기관과많은표본수를확보한반복연구가이루어져야할것이다. 이상의연구결과를바탕으로간호ㆍ간병통합서비스제도의안정적정착과제도적확대운영을위해시간의흐름에따른단계적연구및간호사의직무만족및업무성과를높일수있는전략개발을위한추가연구가필요하다. Conflicts of interest The authors declared no conflict of interest. References Castle NG, Anderson RA. (2011). Caregiver staffing in nursing homes and their influence on quality of care. Using dynamic panel estimation methods. Medical Care. 49(6): doi: /MLR.0b013e31820fbca9 Choi HN, Lee MH. (2018). Comparing the Emotional Labor, Job stress and Nursing Performance of Nurses in the Comprehensive nursing care Ware and the General Ward. The Journal of Korean Academic Society of Home Care Nursing. 25(2): doi: /jkashcn Choi KJ, Han SS. (2013). The Influence of the Job Stress, Job Satisfaction and Social Support of Clinical Nurse s Burnout. Journal of East-West Nursing Research. 19(1): doi: /jewnr Hwang NM. (2010). An Analysis of the debates on introduction of public caregivers' services in acute medical centers. Health and Welfare Policy Forum. 170: Hwang NM. (2012). Institutionalization of care service issues and tasks. Health; Welfare Issue & Focus. 47:1-8. Hwang NM. (2015). Expend comprehensive nursing for the quality of hospitalization service in healthcare organization. Issue & Focus. 7:1-8. Im JA. (2015). Factors affecting turnover intention of nurses in comprehensive nursing care wards : job stress, emotional labor and burnout. (Master s thesis). Gachon University, Seongnam. Retrived from Jung HY. (2008). A Study in Relationship among Violence Experence, Coping and Burnout of Emergency Department Nurses. (Master s thesis). Inje University, Gangwondo. Jung SM, Yoon SH. (2017). Comparative Analysis Research of Inpatient Satisfaction with Nursing on Comprehensive Nursing Service Units & General Units and Nurses Work Stress. J Korean Acad Nurs Adm. 23(3): doi: /jkana Kim MJ, Gu MO. (1984). The Development of the stress tool for staff nurses working in the hospital. J Korean Acad Nurs Adm. 14(2): doi: /jnas Kim BH, Kang HY. (2018). Job Satisfaction, Job Stress, Burnout, and Turnover Intention of Comprehensive Nursing Care Service Ward Nurses and General Ward Nurses. Journal of the Korean Academia-Industrial. 19(5): doi: /KAIS Kim JH, Kim SJ, Park ET et al. (2017). Policy Issues and New Direction for Comprehensive Nursing Service in the National Health Insurance. J Korean Acad Nurs Adm. 23(3): doi: /jkana Kim JJ, Hwang KJ, Kim SH et al. (1996). A study about developing care delivery system of providing efficient patient care. J Korean Acad Nurs Adm. 35(3): Kim SE, Han JY. (2017). Clinical Nurses Job Stress, Emotional labor, Nursing Performance, and Burnout in Copprehensive Nursing Care Service Wards and General Wards. J Korean Acad Nurs Adm. 23(3): doi: /jkana Kim SM, Kim GM. (2018). Effects of Nurses Job Stress, Self-Efficacy, and Professional Self-Concept on Job Satisfaction : A Comparison on Comprehensive Nursing Care Wards and General Wards. Journal of the Korean Data Analysis Society. 20(3): Kim TJ, Yu JG. (2018). Comparative Study of Clinical Nurses Role Conflict, Emotional Labor and Nursing Performance between Comprehensive Nursing Care Service Wards and

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