DBPIA-NURIMEDIA

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1 한국간호교육학회지제 21 권제 4 호, 2015 년 11 월 J Korean Acad Soc Nurs Educ Vol.21 No.4, , November, 간호교육자가인지한국내간호학생들을위한국제보건핵심역량 * 이현경 1) 김희순 2) 조은희 1) 김상희 3) 김정희 4) 서론 연구의필요성국제사회는세계화의추세에따라국가간의인구이동이점차증가하고, 건강불평등, 전염성및비전염성질병의해소등의보건의료문제를해결하기위한공동의노력이강조되고있다. 우리나라의경우, 보건의료시장의개방, 의료기관의해외진출, 보건의료공적개발원조사업 (Official Development Assistance [ODA]) 확대등의변화로인해국외인구집단의건강문제해결에대한보건의료인력의역할이확대되었다. 이러한현상은간호사를비롯한보건의료인력의국제화역량에대한기대를증가시키는것으로해석되고있다 (Ministry of Health & Welfare, 2012). World Health Organization (WHO, 2009) 에서새천년개발목표달성을위한전략으로제시한간호사와조산사교육의국제적표준에서언급된것처럼, 간호교육프로그램에서문화적으로역량있고타국가의보건의료체계에서인구집단의요구를충족시킬수있는실무능력의개발이강조되고있다. 우리나라의경우외국인근로자, 결혼이주여성등다문화대상자의증가와보건 ODA 사업의확대와같은변화를직면하면서보건의료서비스의핵심인적자원인간호사의새로운역량개발의필요성이증가되고있다. 보건의료현장에서는 매년외국인환자가꾸준히증가하고, 특히환자의곁에서외국인환자를직접돌보는간호사의국제보건역량은필수적으로요구되고있으므로 (Park, Ha, Park, Yu, & Lee, 2014), 국제화시대에알맞은능력을갖춘간호사가되기위하여간호학생때부터미리준비될필요가있다. 지금까지간호교육과정에서다문화역량강화를위한교육과연구는어느정도이루어지고있는반면, 국제보건에대한관심에비해아직국제보건역량에대한합의는부족한실정이다. 국제보건은 전세계모든사람들의건강증진과형평성확보를목적으로한이론, 연구와실무영역으로정의되며, 범국가적인건강쟁점, 결정인자와해결책을강조하고보건의료와타학제의협력과개인수준의건강관리뿐아니라인구집단기반의예방적활동을포함 하는것으로정의된다 (Koplan et al., 2009). 국외에서는 2000년대후반들어타분야의보건의료인교육에서국제보건역량개발을위한노력이활발해짐을알수있다. 의과대학의학생들에게국외현장에서의료서비스의경험을제공하거나 (Drain et al., 2007), 국제보건이슈를교육과정에포함시키게되었고 (Bozorgmehr, Saint, & Tinnemann, 2011), 의과대학학생들과 (Association of Faculties of Medicine of Canada [AFMC] Resource Group/Global Health Education Consortium [GHEC] Committee, 2010) 보건대학학생들을위한 (Calhoun, Ramiah, Weist, & Shortell, 2008) 국제보건핵심역량이개발되었다. 최근미국보건대학 주요어 : 간호학생, 국제보건, 역량 * 이논문은 2014 년도연세대학교간호대학김모임간호학연구소글로벌리더십센터연구비지원에의하여이루어진것임. 1) 연세대학교간호대학김모임간호학연구소부교수 2) 연세대학교간호대학김모임간호학연구소교수 3) 연세대학교간호대학김모임간호학연구소조교수 4) 연세대학교간호대학김모임간호학연구소박사과정 ( 교신저자 kjh129@yuhs.ac) Received: September 10, 2015 Revised: November 12, 2015 Accepted: November 14, 2015 한국간호교육학회지 21(4), 2015 년 11 월 561

2 이현경외 교육협의회 (Association of Schools of Public Health [ASPH], 2011) 에서는국제보건역량을지역및국제수준에서인구집단의건강, 안전, 안녕증진을위한주요역량으로강조하면서, 7개영역의 36개국제보건역량개발을위한교육체계모형을제시하였다 (Ablah et al., 2014). 더나아가다학제적접근과협력이무엇보다강조되는전문분야인만큼다양한보건의료분야의전문가들에게공통으로요구되는역량개발의필요성이제기되었다. 이에 Consortium of Universities for Global Health (CUGH) 교육위원회에서 12개국제보건공통역량으로, 질병부담, 건강의사회적환경적결정인자, 건강과보건의료의세계화, 역량강화, 팀워크와협력, 윤리적추론, 전문직실무, 건강형평성과사회적정의, 프로그램관리, 사회적, 문화적및정치적인식, 전략적분석, 의사소통 (Wilson et al., 2014) 을제시하였다. 이처럼, 국외에서는국제보건역량이간호사를포함한보건의료인양성을위한교육과정에통합되고있음을알수있다. 간호학분야에서는 2012년에기존의의과대학학생들을위한국제보건핵심역량을수정, 보완하여미국의간호학교수들이지각한간호학생들을위한국제보건핵심역량이처음으로발표된바있다. 국제화시대의전문가로서갖춰야할핵심역량으로 국제사회의질병부담, 이민, 여행, 이동이건강에미치는영향, 건강의사회적, 환경적결정인자, 건강과보건의료의세계화, 자원이부족한환경에서의보건의료, 인간의권리이며개발자원으로서의건강 의 6개하부영역의총 30개의역량개발이필요한것으로보고되었다 (Wilson et al., 2012). 우리나라의경우 2주기간호교육인증평가에서대두된학습성과로인해간호학생들의국외환경변화에능동적으로대응하는능력함양의필요성에대한인식이확대되고있는시점에서, 간호학생들에게필요한국제보건핵심역량을확인하는시도는의미있다고사료된다. 현재, 우리나라의경우에는간호학생들을위한국제보건교과와비교과활동이일부이루어지고있으나 (Ministry of Health & Welfare, 2012), 핵심역량기반의체계적인프로그램내용구성과평가가부재한실정이다. 이에본연구는간호학생들의국제보건핵심역량을확인하여교육과정개발과평가를위한기초자료를제공하고자한다. 연구방법 연구설계본연구는국내간호교육자들의간호학생들에게필요한국제보건역량에대한설문을시행후, 국제보건분야전문가집단의토의를통해적절성을확인한혼합연구방법 (mixed-method research) 설계이다. 연구대상간호교육자설문을위한연구대상자는자료수집기간내에자발적으로연구참여에동의한 4년제간호대학 / 과전임교수로하였다. 잠재적설문대상자목록은전국의 4년제간호대학홈페이지에게시된 1,819명의전임교수중에이메일이공개된 1,640명으로구성되었다. 연구대상자의수는 Dillman (2000) 의표본수산정공식에따라 95% 신뢰수준, 5% 의표집오차를토대로계산시약 217명으로산출되었다. 선행연구에서온라인설문응답률이 21.4% 이하로낮게보고되어 (Porter & Whitcomb, 2007) 필요한대상자수확보를위하여, 1,640명의설문대상자에게 1차이메일발송 2주후에온라인설문상기메일을발송하였고, 그결과설문응답을완료한대상자는총 223명 (13.6%) 이었다. 7월 14일과 7월 17일에 1차이메일을발송하였고, 2주후인 7월 28일과 7월 31일에미응답자의참여요청에대한 2차이메일을발송하였다. 온라인상에서연구참여에동의한자는총 323명이었고, 이중 1차설문참가자는 178명이었고, 설문을완료한자는 112 명이었다. 미응답자의참여요청에대한 2차이메일의발송다음날부터 5일째되는 8월 5일에확인시설문을완료한자는 223명이었기에온라인설문을종료하였다. 설문결과의타당성을검토하고간호학생들의역량개발및교육과정의개발을위한방향을도출하기위해전문가집단은의도표집방법에따라연구책임자와국제보건사업또는교육에참여경험이있는 3명의간호대학교수로구성하였다. 연구도구 연구목적본연구의목적은국내간호학생의국제보건핵심역량에대한간호교육자들의인지정도를파악하고, 간호학생들에게필요한국제보건핵심역량을도출하기위함이다. 연구도구는 GHEC & AFMC가제시한국제보건역량을 Wilson et al. (2012) 이간호학생으로서갖추어야할역량으로수정보완한 Global Health Competencies for Nurses 를한국어로번안하여사용하였다. 도구의번안방법은위원회번역방법 (Behling & Law, 2000; Miller & Chandler, 2002) 을이용하여, 연구책임자와공동연구자 2인이각각독립적으로번역본초안을작성한후에, 3인의연구자가만나공동으로번역 562 한국간호교육학회지 21(4), 2015 년 11 월

3 간호교육자가인지한국내간호학생들을위한국제보건핵심역량 의적절성을검토하였고, 토의를통하여내용을합의하였다. 번역본의용어를확인하는과정에서 Global health 를 국제보건 으로 Health care 를 보건의료 로 Low-resource settings 를 자원이부족한환경 으로합의하였다. 이도구는 6개의역량영역인 국제사회의질병부담, 이민, 여행, 이동이건강에미치는영향, 건강의사회적, 환경적결정인자, 건강과보건의료의세계화, 자원이부족한환경에서의보건의료, 인간의권리이며개발자원으로서의건강 의총 30개역량으로구성되어있다. 각역량에대하여간호학생들에게필요한국제보건역량으로동의하는지에대해 전혀그렇지않다 1점에서 매우그렇다 4점까지의 4점리커트척도로측정하였다. 도구개발당시각하부영역별내적일관성신뢰도 Cronbach's α값은 국제사회의질병부담 영역은.81, 이민, 여행, 이동이건강에미치는영향 영역은.84, 건강의사회적, 환경적결정인자 영역은.89, 건강과보건의료의세계화 영역은.89, 자원이부족한환경에서의보건의료 영역은.84, 인간의권리이며개발자원으로서의건강 영역은.82였다. 본연구에서각하부영역별내적일관성신뢰도 Cronbach's α값은 국제사회의질병부담 영역은.80, 이민, 여행, 이동이건강에미치는영향 영역은.82, 건강의사회적, 환경적결정인자 영역은.88, 건강과보건의료의세계화 영역은.90, 자원이부족한환경에서의보건의료 영역은.90, 인간의권리이며개발자원으로서의건강 영역은.73 이었다. 또한, 대상자의인구학적특성을파악하기위하여연령, 성별, 직위, 전공, 지역의 5문항을포함하였다. 자료수집방법및윤리적고려본연구는간호학생들에게필요한국제보건역량에대해국내간호교육자들의인식정도를확인하기위해온라인설문조사를통해자료를수집하였고, 설문결과를토대로간호학생들의국제보건핵심역량도출을위하여전문가집단토의를진행하였다. Y대학교간호대학기관생명윤리위원회 ( 승인번호간대 IRB ) 의승인을받은후, 온라인설문을통한자료수집은 2014년 7월 14일부터 8월 5일까지시행하였다. 온라인설문은대상자의이메일로보내진설명문하단에온라인설문시스템 ( 에연결되는 URL을안내하였고, 설문참여동의를한경우에만단계적으로설문에참여할수있도록하였다. 온라인설문을통해얻어진자료에대해서는개별화된 ID 를부여하여컴퓨터의연구자료보관파일에암호화하여저장하였다. 연구진행을위한대상자의이메일주소와모바일상품권발송을위한핸드폰번호는연구책임자와연구윤리에 대한교육을받은연구원만접근가능한컴퓨터에저장하여보관하였고, 연구종료후폐기하였다. 설문조사에참여한대상자에게는모바일을통해소정의감사표시를하였다. 설문조사후, 연구책임자와 3명의국제보건전문가로구성된전문가집단이설문결과에대한적절성을확인하고, 국내간호학생들을위한국제보건핵심역량을도출하기위하여약 2시간의토의를진행하였다. 전문가집단은개발도상국에서국제보건연구또는실무경력이있으면서국제보건관련학부및대학원생대상정규교과목또는단기교육경력을가진간호대학전임교원으로구성하였다. 각전문가는토의전에핵심역량별설문결과를개별적으로검토하고, 토의시에직접의견을개진하였다. 현교육과정에포함되어야할간호학생의국제보건역량은토의와합의를거쳐도출하였다. 자료분석방법온라인설문조사를통해수집된자료는 SPSS WIN 20.0 패키지를이용하여빈도, 평균, 표준편차, 실수와백분율등서술적통계로분석하였다. 간호교육자들이인지한간호학생의국제보건역량은선행연구에서적용되었던것과동일한기준으로 (Deepthi, Kosala, Nilukshi, & Ponnampalam, 2013; Noll et al., 2013) 각역량에대하여 매우그렇다 와 그렇다 에응답한비율이 80% 이상인경우를간호학생들에게필요한국제보건핵심역량으로동의한것으로평가하여해당역량을일차적으로채택하였다. 연구결과의타당성확보를위하여분석한내용에대해연구책임자와국제보건분야전문성을가진간호대학교수 3인으로구성된전문가그룹에서분석결과를검토하고논의를통하여일치된역량을최종적으로도출하였다. 연구결과 대상자의일반적특성대상자의일반적특성에관하여분석한결과에서대상자의연령은평균 46.18±7.42세이며, 성별은여성이 98.7% 이었다. 학교에서의지위는조교수가 61% 로가장많이차지하였으며, 전공분야는성인간호학이 35% 로가장높은비율을나타냈다. 총 16개의시, 도에속한대학의교수들이참여하였고, 대학소재는서울 16.1%, 경기도 13.5%, 대구 12.6% 순으로나타났다 (Table 1). 간호교육자가인지한간호학생의국제보건역량간호대학교수들이간호학생들에게필요한국제보건역량에 한국간호교육학회지 21(4), 2015 년 11 월 563

4 이현경외 <Table 1> General Characteristics of the Participants Characteristics Categories n(%) Mean±SD Age(year) 46.18±7.42 Gender Male 3 ( 1.3) Female 220 (98.7) Position Assistant professors 136 (61.0) Professors 45 (20.2) Associate professors 35 (15.7) Others 4 ( 1.8) Full-time lectures 3 ( 1.3) Major area Adult nursing 78 (35.0) Community health nursing 40 (17.9) Pediatric nursing 23 (10.3) Mental health nursing 20 ( 9.0) Maternity nursing 17 ( 7.6) Others 17 ( 7.6) Nursing management 13 ( 5.8) Gerontological nursing 7 ( 3.1) Biological nursing 6 ( 2.7) Nursing informatics 2 ( 0.9) Region Seoul 36 (16.1) Gyeonggi-do 30 (13.5) Daegu 28 (12.6) Gyeongsangbuk-do 27 (12.1) Gyeongsangnam-do 22 ( 9.9) Busan 21 ( 9.4) Gangwon-do 19 ( 8.5) Chungcheongnam-do 9 ( 4.0) Daejeon 6 ( 2.7) Chungcheongbuk-do 6 ( 2.7) Gwangju 5 ( 2.2) Incheon 4 ( 1.8) Jeollabuk-do 4 ( 1.8) Ulsan 2 ( 0.9) Jeollanam-do 2 ( 0.9) Jeju 2 ( 0.9) (N=223) 대해어느정도동의하는지에대한질문에 그렇다 (3점) 와 매우그렇다 (4점) 에응답한문항별결과는 Table 2와같다. 응답자의약 80% 이상이동의한다고인지한역량은전체 30 개중 21개였다 (Table 3). 영역별로살펴보면, 건강의사회적, 환경적결정인자 가가장타당하다고하였으며 (94.3%), 이민, 여행, 이동이건강에미치는영향 (89.6%), 인간의권리이며개발자원으로서의건강 (88.0%), 국제사회의질병부담 (84.6%), 자원이부족한환경에서의보건의료 (82.8%), 건강과보건의료의세계화 (71.4%) 순으로나타났다. 역량별로살펴보면, 30개역량중 건강과인권간의관계를이해하고설명할수있다 (97.8%) 가거의모든응답자들이간호학생들에게필요한국제보건역량으로인지하고있었고, 건강의사회적, 환경적결정인자 영역에서 5개역량중 건강의주요사회적결정인자들을나열하 고그러한결정인자들이국가간및국내의기대여명의차이에미치는영향을열거할수있다 (87%) 를제외하고는거의 95% 이상의응답자들이동의하였다. 한편, 건강과보건의료의세계화 영역의모든역량과 자원이부족한환경에서의보건의료 영역의 2개역량, 인간의권리이며개발자원으로서의건강 영역의 1개역량은 매우그렇다 와 그렇다 로응답한비율이 60% 이상 80% 미만수준에그쳤다. 역량별로살펴보면 건강과보건의료의세계화 영역에서 해외여행이나무역이전염병및만성질환의확산에어떻게기여하는지분석할수있다 에 78.5% 가동의하였고, 보건의료서비스제공을위한여러나라의다양한보건의료체계를기술하고, 이들의건강과보건의료비용에미치는영향을설명할수있다 (76.2%), 국내외보건의료인력의가용성과부족을기술할수있다 (75.3%), 보건의료실무, 산업 564 한국간호교육학회지 21(4), 2015 년 11 월

5 간호교육자가인지한국내간호학생들을위한국제보건핵심역량 <Table 2> Agreement of Nursing Educators for Essential Global Health Competencies for Nursing Students Domain Competency Agreement(%) 1 Describe the major causes of morbidity and mortality around the world, and how the risk of disease varies with regions Describe major public health efforts to reduce disparities in global health (such as millenium Global burden of development goals and global fund to fight AIDS, TB, and malaria). disease Discuss priority setting, healthcare rationing and funding for health and health-related research. Subtotal Demonstrate an understanding the health risks posed by international travel or foreign birth Recognize when travel or foreign birth places a patient a risk for unusual diseases or unusual presentation of common diseases and make an appropriate assessment or referral Health implications 6 Describe how cultural context influences perceptions of health and disease of migration, travel 7 Elicit individual health concerns in a culturally sensitive manner and displacement 8 Communicate effectively with patients and families using a translator Identify world regions and/or travel activities associated with increased risk for life-threatening diseases including HIV/AIDS, malaria and multi-drug resistant tuberculosis Subtotal Describe how social and economic conditions such as poverty, education and life styles affect health and access to health care List major social determinants of health and their impact on differences in life expectancy Social and between and within countries. environmental Describe the impact of low income, education and communication factors on access to and determinants of quality of health care. health Describe the relationship between access to clean water, sanitation, food and air quality on 13 individual and population health Describe the relationship between environmental degradation and human health Subtotal Analyze how global trends in healthcare practice, commerce and culture, multinational agreements and multinational organizations contribute to the quality and availability of health 71.3 and healthcare locally and internationally. 16 Describe different national models or health systems for provision of healthcare and their respective effects on health and healthcare expenditure Globalization of 17 Analyze how travel and trade contribute to the spread of communicable and chronic diseases health and health Analyze general trends and influences in the global availability and movement of healthcare 18 care workers Describe national and global healthcare worker availability and shortages Describe the most common patterns of healthcare worker migration and its impact on healthcare availability in the country that the healthcare worker leaves and the country to 61.9 which he/she migrates. Subtotal Articulate barriers to health and healthcare in low-resource settings locally and internationally Demonstrate an understanding of cultural and ethical issues in working with disadvantaged populations Demonstrate the ability to adapt clinical skills and practice in a resource-constrained setting Healthcare in low-resource settings Health as a human right and development resource 24 Identify signs and symptoms for common major diseases that facilitate nursing assessment in the absence of advanced testing often unavailable in low-resource settings (cardiovascular 85.2 disease, cancer, and diabetes). 25 Describe the role of syndromic management and clinical algorithms for treatment of common illnesses Identify clinical interventions and integrated strategies that have been demonstrated to substantially improve individual and/or population health in low-resource settings 76.7 (e.g. immunizations, essential drugs, maternal child health programs). 27 For students who participate in electives in low-resource settings outside their home situations, a demonstration that they have participated in training to prepare for this elective Subtotal Demonstrate a basic understanding of the relationship between health and human rights Demonstrate familiarity with organizations and agreements that address human rights in healthcare and medical research Describe role of WHO in linking health and human rights, the universal declaration of 30 human rights, international ethical guidelines for biomedical research involving human 89.7 subjects (2002), declaration of Helsinki (2008). Subtotal 88.0 한국간호교육학회지 21(4), 2015 년 11 월 565

6 이현경외 과문화, 다국적협약, 다국적기관에서의세계화경향이건강과보건의료의질과이용에미치는지역적 / 국제적영향을분석할수있다 (71.3%), 국내외보건의료인력들의국제적이동과가용성에서의일반적인경향과영향을분석할수있다 (65.5%), 보건의료인력의국가간이동에서가장일반적인패턴을알고, 유출된국가와유입된국가의보건의료인의가용성에미치는영향을설명할수있다 (61.9%) 순으로나타났다. 또한 자원이부족한환경에서의보건의료 영역에서는 자원이부족한환경에서개인과인구집단의건강증진을향상시키는것으로입증된임상중재와통합적인전략을설명할수있다. (76.7%), 자원이부족한국외환경에서진행되는선택교과활동에참여하는학생들은이활동을위한사전교육에참여하였음을증명할수있다 (69.5%) 가낮게인식되어졌다. 인간의권리이며개발자원으로서의건강 영역에서는 보건의료와의학연구에서인권을나타내는기관과조약을설명할수있다. 에 76.7% 동의하였다. 요약하면, 매우그렇다 와 그렇다 로응답한비율이 80% 미만인문항을삭제하였을때 국제사회의질병부담, 이민, 여행, 이동이건강에미치는영향, 건강의사회적, 환경적결정인자, 자원이부족한환경에서의보건의료, 인간의권리이며개발자원으로서의건강 의 5개의영역에서총 21개역량이학부간호학생들에게필요한역량으로확인되었다 (Table 3). 국제보건핵심역량도출연구책임자와교수 3인이참석한전문가그룹에서전체설문응답결과를바탕으로채택된국제보건의역량의적절성을논의하였다. 설문을통해확인한국내간호교육자들이인지한역량뿐아니라, 채택되지못한 9개의역량도자유토론을실시하여재검토하였다. 국제보건역량의총 6개영역중 3개영역 국제사회의질병부담, 이민, 여행, 이동이건강에미치는영향, 건강의사회적, 환경적결정인자 의개별항목은모두적절하다고동의하였다. 한편, 나머지 3개영역, 건강과보건의료의세계화, 자원이부족한환경에서의보건의료, 인간의권리이며개발자원으로서의건강 영역에서는학부수준에서의역량개발가능성과유사성측면을고려하여일부역량의통합또는삭제가이루어졌다. 그결과, 설문조사에서국제보건역량에적절하다고응답한비율이 80% 미만인문항을삭제하였을때 5 개의영역에서총 21문항으로확인되었으나, 전문가그룹의토의에서 건강과보건의료의세계화 영역은학부학생들에게필수적인역량으로합의되어추가되었고, 최종적으로확인된국제보건역량은 6개영역의총 24문항으로나타났다 (Table 3). 첫번째영역인 국제사회의질병부담 은설문조사에서전반적으로응답자의 84.6% 가동의하였으므로모든항목을포함하기로합의하였다. 일부문장을수정하여, 기술하였다 의동사를 설명할수있다 의명시적동사로변경하였고, 3번역량인 건강및건강관련연구를위한우선순위설정, 보건의료서비스분배와재원을토의할수있다 는국제간호영역에서는기금이나예산이중요하므로이와관련된역량은포함되어야할것이라는의견이있어재원을 기금 으로수정하였다. 두번째영역인 이민, 여행, 이동이건강에미치는영향 의 6개역량에대하여설문응답자가간호학생들에게필요한역량으로동의한비율은평균 89.6% 였다. 이를바탕으로 4번역량인 해외여행이나국외출산이건강에미치는위험을설명할수있다, 7번역량인 개인의문화적배경을고려하여대상자의건강문제와관심을끌어낼수있다 와 8번역량인 통역자를활용하여환자및가족과효과적으로의사소통할수있다 는문장의변경없이모두타당하다고합의하였다. 한편, 5번역량은특이질환과비특이적질환을구분하지않고포괄할수있도록 질병 으로통칭하여, 해외여행이나국외출산이대상자에게질병이발생할위험에처할수있음을인식하고, 적절한사정이나의뢰를할수있다 로변경하였다. 6 번역량인 문화적맥락이건강과질병을인지하는데어떤영향을주는지기술할수있다 의내용은 기술할수있다 대신에 설명할수있다 로수정하였다. 9번역량은 생명을위협하는질환 의표현은삭제하고 여행활동 을 여행시주의해야할활동 으로수정하였다. 또한, 최근전세계적으로발병했던에볼라를포함하여 에이즈, 말라리아, 다제내성결핵, 에볼라와같은질환이발생할위험성이높은나라와여행시주의해야할활동에대해설명할수있다 로수정하였다. 세번째영역인 건강의사회적, 환경적결정인자 영역의 5 개모든역량은설문조사에서전반적으로 94.3% 가동의할정도로필수적인역량으로인지되었다. 내용의수정없이 기술할수있다 의동사를 설명할수있다 로수정하였다. 네번째영역인 건강과보건의료의세계화 는설문조사시모든항목에서응답자의 80% 미만이동의한것으로나타났으나전문가토의에서재검토가이루어졌다. 우선기존의 16번역량인 보건의료서비스제공을위한여러나라의다양한보건의료체계를기술하고, 이들의건강과보건의료비용에미치는영향을설명할수있다 는대학원수준에서도달해야할역량으로평가하여제외하였다. 18번문항인 보건의료인력들의국제적이동과가용성에서의일반적인경향과영향을분석할수있다 와 19번문항 국내외보건의료인력의가용성과부족을기술할수있다 및 20번문항 보건의료인력의국가간이동에서가장일반적인패턴을알고, 유출된국가와 566 한국간호교육학회지 21(4), 2015 년 11 월

7 한국간호교육학회지 21(4), 2015 년 11 월 567 <Table 3> Quantitative and Qualitative Results of Global Health Competencies for Nursing Students Original competency Quantitative results(survey) Qualitative results(expert group) Domain Competency Domain Competency Domain Competency Describe the major causes of morbidity and Describe the major causes of morbidity and Explain the major causes of morbidity and 1 mortality around the world, and how the risk 1 mortality around the world, and how the 1 mortality around the world, and how the of disease varies with regions. risk of disease varies with regions. risk of disease varies with regions. Global burden of disease Health implications of migration, travel and displacement Social and environmental determinants of health Describe major public health efforts to reduce disparities in global health (such as millenium development goals and global fund to fight AIDS, TB, and malaria). Discuss priority setting, healthcare rationing and funding for health and health-related research. Demonstrate an understanding the health risks posed by international travel or foreign birth. Recognize when travel or foreign birth places a patient a risk for unusual diseases or unusual presentation of common diseases and make an appropriate assessment or referral. Describe how cultural context influences perceptions of health and disease. Elicit individual health concerns in a culturally sensitive manner. Communicate effectively with patients and families using a translator. Identify world regions and/or travel activities associated with increased risk for life-threatening diseases including HIV/AIDS, malaria and multi-drug resistant tuberculosis. Describe how social and economic conditions such as poverty, education and life styles affect health and access to health care. List major social determinants of health and their impact on differences in life expectancy between and within countries. Describe the impact of low income, education and communication factors on access to and quality of health care. Describe the relationship between access to clean water, sanitation, food and air quality on individual and population health. Describe the relationship between environmental degradation and human health. Global burden of disease Health implications of migration, travel and displacement Social and environmental determinants of health Describe major public health efforts to reduce disparities in global health (such as millenium development goals and global fund to fight AIDS, TB, and malaria). Discuss priority setting, healthcare rationing and funding for health and health-related research. Demonstrate an understanding the health risks posed by international travel or foreign birth. Recognize when travel or foreign birth places a patient a risk for unusual diseases or unusual presentation of common diseases and make an appropriate assessment or referral. Describe how cultural context influences perceptions of health and disease. Elicit individual health concerns in a culturally sensitive manner. Communicate effectively with patients and families using a translator. Identify world regions and/or travel activities associated with increased risk for life-threatening diseases including HIV/AIDS, malaria and multi-drug resistant tuberculosis. Describe how social and economic conditions such as poverty, education and life styles affect health and access to health care. List major social determinants of health and their impact on differences in life expectancy between and within countries. Describe the impact of low income, education and communication factors on access to and quality of health care. Describe the relationship between access to clean water, sanitation, food and air quality on individual and population health. Describe the relationship between environmental degradation and human health. Global burden of disease Health implications of migration, travel and displacement Social and environmental determinants of health Explain major public health efforts to reduce disparities in global health (such as millenium development goals and global fund to fight AIDS, TB, and malaria). Discuss priority setting, healthcare rationing and funding/budget for health and health-related research. Demonstrate an understanding the health risks posed by international travel or foreign birth. Recognize when travel or foreign birth places a patient a risk for diseases and make an appropriate assessment or referral. Explain how cultural context influences 6 perceptions of health and disease. Elicit individual health concerns in a 7 culturally sensitive manner. Communicate effectively with patients and 8 families using a translator. Explain world regions and/or precautions for international travel associated with 9 increased risk for diseases including HIV/AIDS, malaria, multi-drug resistant tuberculosis, and Ebola. Explain how social and economic conditions such as poverty, education and 10 life styles affect health and access to health care. List major social determinants of health 11 and their impact on differences in life expectancy between and within countries. Explain the impact of low income, 12 education and communication factors on access to and quality of health care. Explain the relationship between access to 13 clean water, sanitation, food and air quality on individual and population health. Explain the relationship between 14 environmental degradation and human health. 간호교육자가인지한국내간호학생들을위한국제보건핵심역량

8 568 한국간호교육학회지 21(4), 2015 년 11 월 <Table 3> Quantitative and Qualitative Results of Global Health Competencies for Nursing Students(Continued) Original competency Quantitative results(survey) Qualitative results(expert group) Domain Competency Domain Competency Domain Competency 15 Analyze how global trends in healthcare practice, commerce and culture, multinational agreements and multinational organizations contribute to the quality and availability of health and healthcare locally and internationally. 15 Globalization of health and health care Healthcare in low-resource settings Health as a human right and development resource Describe different national models or health systems for provision of healthcare and their respective effects on health and healthcare expenditure. Analyze how travel and trade contribute to the spread of communicable and chronic diseases. Analyze general trends and influences in the global availability and movement of healthcare workers. Describe national and global healthcare worker availability and shortages. Describe the most common patterns of healthcare worker migration and its impact on healthcare availability in the country that the healthcare worker leaves and the country to which he/she migrates. Articulate barriers to health and healthcare in low-resource settings locally and internationally. Demonstrate an understanding of cultural and ethical issues in working with disadvantaged populations. Demonstrate the ability to adapt clinical skills Globalization of health and health care Healthcare in low-resource settings 15 Articulate barriers to health and healthcare in low-resource settings locally and internationally. Globalization of health and health care Demonstrate an understanding of cultural 16 and ethical issues in working with and practice in a resource-constrained setting. disadvantaged populations. 19 Identify signs and symptoms for common major diseases that facilitate nursing assessment Demonstrate the ability to adapt clinical in the absence of advanced testing often 17 skills and practice in a resource-constrained unavailable in low-resource settings (cardiovascular disease, cancer, and diabetes). setting. 20 Describe the role of syndromic management and clinical algorithms for treatment of common illnesses. Identify clinical interventions and integrated strategies that have been demonstrated to substantially improve individual and/or population health in low-resource settings (e.g. immunizations, essential drugs, maternal child health programs). For students who participate in electives in low-resource settings outside their home situations, a demonstration that they have participated in training to prepare for this elective. Demonstrate a basic understanding of the relationship between health and human rights. Demonstrate familiarity with organizations and agreements that address human rights in healthcare and medical research. Describe role of WHO in linking health and human rights, the universal declaration of human rights, international ethical guidelines for biomedical research involving human subjects (2002), declaration of Helsinki (2008). Health as a human right and development resource Identify signs and symptoms for common major diseases that facilitate nursing assessment in the absence of advanced testing often unavailable in low-resource settings (cardiovascular disease, cancer, and diabetes). Describe the role of syndromic management and clinical algorithms for treatment of common illnesses. Demonstrate a basic understanding of the relationship between health and human rights. Describe role of WHO in linking health and human rights, the universal declaration of human rights, international ethical guidelines for biomedical research involving human subjects (2002), declaration of Helsinki (2008). Healthcare in low-resource settings Health as a human right and development resource Explain how global trends in healthcare practice, commerce and culture, multinational agreements and multinational organizations contribute to the quality and availability of health and healthcare locally and internationally. Explain different national models or health systems for provision of healthcare and their respective effects on health and healthcare expenditure. Explain how travel and trade contribute to the spread of communicable and chronic diseases. Articulate barriers to health and healthcare in low-resource settings locally and internationally. Demonstrate an understanding of cultural and ethical issues in working with disadvantaged populations. Identify signs and symptoms for common major diseases that facilitate nursing assessment in the absence of advanced testing often unavailable in low-resource settings (cardiovascular disease, cancer, and diabetes). Explain the role of syndromic management and clinical algorithms for treatment of common illnesses. Explain clinical interventions and integrated strategies that have been demonstrated to substantially prevent disease and improve individual and/or population health in low-resource settings (e.g. immunizations, maternal and child health programs). Explain a basic understanding of the relationship between health and human rights. Explain role of WHO in linking health and human rights, the universal declaration of human rights, international ethical guidelines for biomedical research involving human subjects (2002), declaration of Helsinki (2008). 이현경외

9 간호교육자가인지한국내간호학생들을위한국제보건핵심역량 유입된국가의보건의료인의가용성에미치는영향을설명할수있다 와같은맥락이므로통합하여 보건의료인력들의국제적고용과이동에서의일반적인경향과영향을설명할수있다 로수정하여 16번역량으로채택하였다. 또한, 15번과 17 번역량은학부수준을고려하여 분석할수있다 를 설명할수있다 로변경하였다. 다섯번째영역인 자원이부족한환경에서의보건의료 에서설문응답자가동의한비율은평균 82.8% 였다. 23번역량의경우 83.4% 가동의하였지만 자원이제한된환경에적합한임상술기와실무를융통성있게적용할수있다 는학부수준에서성취가어려운역량으로평가하여제외하였다. 27번역량인 자원이부족한국외환경에서진행되는선택교과활동에참여하는학생들은이활동을위한사전교육에참여하였음을증명할수있다 는설문조사시응답자의 69.5% 만이필요한역량으로인지하였고, 선택교과활동으로제한하는상황임을의미하므로제외하였다. 24번역량인 자원이부족한환경에서주요질환에대한진단검사시행이어려운경우, 간호사정을잘수행할수있도록필요한질환의증상과징후를설명할수있다 는 자원이부족한환경에서주요질환에대한진단검사시행이어려운경우, 간호사정을잘수행할수있도록필요한질환의증상과징후를확인할수있다 로합의하여수정하였다. 25번역량인 흔한질환의치료를위한증상관리와임상적논리체계의역할을기술할수있다 는이해하기쉬운단어로변경하여, 흔한질환의치료를위한증상관리와임상절차를설명할수있다 로수정하였고, 26번역량인 자원이부족한환경에서개인과인구집단의건강증진을향상시키는것으로입증된임상중재와통합적인전략을설명할수있다 는구체적인내용인예방접종과모자보건프로그램을언급하여 자원이부족한환경에서예방접종과모자보건프로그램과같은질병예방및건강증진을위한중재와전략을설명할수있다 로수정하였다. 여섯번째영역인 인간의권리이며개발자원으로서의건강 은설문응답자가동의한비율이평균 88% 였다. 28번역량인 건강과인권간의관계를기본적으로이해하고설명할수있다 는 97.8% 로전체핵심역량중가장동의정도가높아수정없이필수역량으로채택하였다. 29번역량인 보건의료와의학연구에서인권을나타내는기관과조약을설명할수있다 는설문응답자가동의한비율이 76.7% 에그쳤고, 30번역량과유사한내용으로평가되어삭제하였다. 30번역량은 기술할수있다 를 설명할수있다 로변경하여 건강과인권을연계하는세계보건기구의역할, 세계인권선언, 생명의학연구에대한국제적윤리지침 (2002), 헬싱키선언 (2008) 등을설명할수있다 로수정하였다. 추가적으로, 전문가토의를통하여간호학사프로그램에서 학생들에게함양되어야할가장중요한역량으로강조된것은국제보건사업의목적과필요성을공여국과수원국의입장에서의이해, 법적및윤리적고려사항의설명, 다문화대상자에대한인간이해, 세계의보건문제와이슈에대한인지, 영어의사소통, 사회환경적건강결정인자의이해가언급되었다. 이러한역량의달성을위하여대학또는교육자는국내외국제보건의최근경향분석을통하여국제보건의전체적흐름을파악하고있어야하며, 공여국과수원국의입장이모두고려된윤리적인국제보건프로그램이기획되고수행, 평가될수있도록균형잡힌시각을가지는것이중요하다고보았다. 단순히잘포장된사례제시중심의교육은학생들에게국제보건에대한환상을가지게할수있으므로이를지양하는대신간호학생을위한현지체험중심의국제보건교육프로그램을적극적으로개발하여학생들이참여할수있는기회제공의필요성이강조되었다. 전문가들은학생들이평소에글로벌환경의건강이슈나변화등을파악하는노력을기울이고, 국제보건분야에서필요시되는핵심가치, 예를들어, 일차건강관리접근, 지속성있는프로그램, 세계시민정신등을심어주는것이앞으로나아갈방향임을언급하였다. 논의 본연구는세계화의흐름에따라간호학생들이국제적역량을겸비한간호사로준비될수있도록학부간호교육에서포함해야할국제보건핵심역량을도출하여, 교육과정및교과외활동의설계를위한기초자료를제공하고자국내에서처음으로시도되었다. 국외사례에서제시한기존의간호학생들을위한국제보건핵심역량은 6개영역의 30문항있었으나, 연구에참여한대다수의국내간호교육자들이인지한학부학생들에게기대하는국제보건핵심역량설문결과는 5개영역 21문항이었다. 그러나이를바탕으로전문가들이미래지향적으로간호학생에게요구되는역량으로일부역량의통합및삭제후총 24개의역량이도출되었다. 간호학생들이함양해야할 6개영역의국제보건역량중 건강의사회적, 환경적결정인자 영역은매우타당하다고한반면, 건강과보건의료의세계화 영역은상대적으로낮게평가되었다. 이는브라질의간호학교수들이인지한 건강의사회적, 환경적결정인자 영역이 4점만점에평균 3.78점으로가장높았고, 건강과보건의료의세계화 영역이평균 3.31점으로가장낮게나타난결과와일관되고 (Ventura et al., 2014), 미국간호대학교수들이인지한간호학생들에게필요한국제보건역량결과와유사하였다 (Wilson et al., 2012). 그러나, 세 한국간호교육학회지 21(4), 2015 년 11 월 569

10 이현경외 계화과정으로인한각나라의보건정책과보건의료서비스의변화는인구집단의건강문제에영향을미치는근접인자로알려진만큼 (Huynen, Martens, & Hilderink, 2005), 다양한분야의세계화과정이보건의료의질과이용에미치는영향을이해하고분석하는능력은필수적으로개발되어야할것이다. 실제로세계화와건강과의관련성을이해하고분석하는역량은최근 CUGH의교육위원회에서발표한보건의료인을위한 12개국제보건공통역량 (Wilson et al., 2014) 중의하나로제시될만큼중요하다고할수있다. 보건의료인교육은지역뿐만아니라전세계인구집단의건강형평성추구를위한변혁적이고상호의존적인시스템으로의혁신이필요하다고강조된만큼 (Frenk et al., 2010), 간호학생교육프로그램에도점차적인변화가예상된다. 미래사회의간호사는대상자들의해외여행과이주, 보건의료서비스와보건의료인력의이동, 국제기관활동과조약의증가등과같은세계화현상이각나라의보건의료체계및개인의건강수준에미치는정도를파악하고이에대응하는실무역량을요구받을것으로전망된다. 따라서, 학부간호교육과정에서부터급변하는국내외보건의료환경과이에따른건강에미치는영향을이해할수있는학습경험이제공될수있도록고려할필요가있다. 본연구에서조사한전체 30개의국제보건역량중건강과인권간의관계를이해할수있는역량은연구에참여한간호교육자의대부분 (97.8%) 이동의한것으로나타났다. 인권은간호대학의교육과정에서간호윤리와관련된교과목에서주로다루어지고있는데, 영국의경우, 간호대학의간호윤리와법관련교과목의핵심내용으로는포함되어있으나, 국제사회에서의인권의이슈는국내에비해상대적으로적게다루어지고있는것으로나타났다 (Chamberlain, 2001). 우리나라의간호윤리교과목의내용은의료인의전문직윤리판단을중심으로구성되어있어서, 대상자의건강권을인간의기본권리중의하나임을이해하고옹호하는지식과경험의전달은제한적인것으로보고되고있다 (Lee & Chong, 2013). 현재, UN 을중심으로 2015년이후 2030년까지성취할전세계의지속가능한목표 (Sustainable Development Goals [SDG]) 의설정에서, 건강은개발자원의필수요건이자인간의권리임이강조되고있다 (United Nations Development Programme, 2015). 따라서, 국제보건향상을위한간호사의역량으로건강과인권간의관계에대한이해증진을위한기존간호교육내용을확인하고보완하는것이필요할것으로사료된다. 본연구에서확인된간호학사프로그램에서함양되어야할다수의국제보건핵심역량은기존간호교육과정에서다루어지지않은내용이므로, 역량의수준을 Bloom 인지영역에따른분류에서지식과이해의수준으로낮추어설정하였다. 따라서, 특정교과목에서뿐만아니라다양한교과목과교과외활동 에서간호교육성과와연계하여학습됨으로써간호학생들에게요구되는새로운역량으로개발되어야할것이다. 더나아가, 교육기관차원에서는보건관련모든학생들을대상으로한국제보건이해단계, 국제보건을준비하는학생들을위한탐색단계, 국제보건현장실무를준비하는기본실무단계, 전문직으로서석사이상의심화단계 (Wilson et al., 2014) 와같은단계별교육프로그램의개발과운영이계획되어야할것이다. 또한, 국제보건의속성은다학제적협력을포함하고있고, 세계보건기구는이를전세계건강수준향상을위한중요한전략으로강조하고있다 (WHO, 2006). 이를위하여간호학개별전공뿐만아니라대학차원에서교과목및비교과활동개발을위한통합적인접근이권장되어진다. 미국의경우 2000 년이후에대학차원의교과목개발, 연구와사회봉사를위한통합기구설립, 자격증프로그램등국제보건교육프로그램들이급속하게증가하였음을알수있다 (Kerry et al., 2011). 메릴랜드대학의 (Johnson et al., 2014) 다학제적협력을통한국제보건교육프로그램사례처럼간호학뿐만아니라의학, 치의학, 약학, 법과사회복지전공등의학생들을대상으로한교육과정으로개발될수있도록대학차원의다학제적협력역량개발과기반조성을위한장기간의지속적인노력이필요할것으로사료된다. 또한, CUGH에서개설한국제보건교육과정개발과평가를위한온라인포럼은전세계의국제보건교육전문가들의교류의장으로권장되어지고있다 (Jogerst et al., 2015). 본연구는간호교육전문가집단인간호대학교수들이인지한핵심역량을확인함으로써, 향후국제간호분야의교육성과및교육내용개발의기초자료를제공하였다. 최근간호사의국제보건역량에대한요구는높아지고있으나, 아직간호학생들이달성해야할국제보건역량에대한합의가부족한시점에서, 본연구결과는향후국내간호학생들의국제보건역량개발을위한교과목및교과외활동개발을위한방향을제시하였다는점에서의의가있다. 결론및제언 본연구는국외에서제시된 Global Health Competencies for Nurses 을기반으로국내간호학생들에게필요한국제보건핵심역량을도출하고자시행되었다. 연구결과, 국내간호교육자들의대부분은 건강의사회적, 환경적결정인자 가간호학생들에게필요한국제보건역량으로인지한반면, 건강과보건의료의세계화 역량은낮게인지하는것으로나타났다. 최종적으로간호학생들에게필요하다고동의된국제보건핵심역량은 국제사회의질병부담, 이민, 여행, 이동이건강에미치는영향, 건강의사회적, 환경적결정인자, 건강과보건 570 한국간호교육학회지 21(4), 2015 년 11 월

11 간호교육자가인지한국내간호학생들을위한국제보건핵심역량 의료의세계화, 자원이부족한환경에서의보건의료, 인간의권리이며개발자원으로서의건강 의 6개영역에서총 24개역량으로확인되었다. 본연구결과는간호학교육과정개발시핵심역량기반의프로그램내용구성과평가에반영될수있을뿐만아니라, 간호학생들을위한국제보건교육과정개발의기틀을개발하는데기초자료로유용할것으로사료된다. 추후연구에서는본연구에서확인된국제보건핵심역량을토대로간호학생들의국제보건역량정도를확인한연구가시도될필요가있다. References Ablah, E., Biberman, D. A., Weist, E. M., Buekens, P., Bentley, M. E., Burke, D., et al. (2014). Improving global health education: Development of a global health competency model. The American Journal of Tropical Medicine And Hygiene, 90(3), Association of Faculties of Medicine of Canada (AFMC) Resource Group/Global Health Education Consortium (GHEC) Committee. (2010). Global health essential core competencies. Retrieved February 2, 2015, from files/globalhealth/basic_core_competencies_final_2010.pdf Association of schools public health. (2011). Global health competency model. Final version 1.1. Retrieved February 3, 2013, from GHCompsVersion1.1FINAL.Pdf Behling, O., & Law, K. S. (2000). Translating questionnaires and other research instruments: problems and solutions. Thousand Oaks, CA: Sage Publications. Bozorgmehr, K., Saint, V. A., & Tinnemann P. (2011). The global health' education framework: A conceptual guide for monitoring, evaluation and practice. Global Health, 7(8). Retrieved March 3, 2013, from com/content/7/1/8 Calhoun, J. G., Ramiah, K., Weist, E. M., & Shortell, S. M. (2008). Development of a core competency model for the master of public health degree. American Journal of Public Health, 98(9), Chamberlain, M. (2001). Human rights education for nursing students. Nursing Ethics, 8(3), Deepthi, E., Kosala, M., Nilukshi, A., & Ponnampalam, J. (2013). An evidence based approach to identifying competencies for a medical curriculum: A proposal based on medico-legal practice in Sri Lanka. American Journal of Educational Research, 1(3), Dillman, D. A. (2000). Mail and Internet surveys: The tailored design method (2nd ed.). New York, NY: Wiley. Drain, P. K., Primack, A., Hunt, D. D., Fawzi, W. W., Holmes, K. K., & Gardner, P. (2007). Global health in medical education: A call for more training and opportunities. Academic Medicine, 82(3), Frenk, J., Chen, L., Bhutta, Z. A., Cohen, J., Crisp, N., Evans, T., et al. (2010). Health professionals for a new century: Transforming education to strengthen health systems in an interdependent world. The Lancet, 376(9756), Huynen, M. M., Martens, P., & Hilderink, H. B. (2005). The health impacts of globalisation: A conceptual framework. Globalization and health, 1(1), 14. Retrieved September 29, 2015, from Jogerst, K., Callender, B., Adams, V., Evert, J., Fields, E., Hall, T., et al. (2015). Identifying interprofessional global health competencies for 21st-century health professionals. Annals of Global Health, 81(2), j.aogh Johnson, J. V., Riel, R. F., Ogbolu, Y., Moen, M., Brenner, A., & Iwu, E. (2014). Organizational learning and the development of global health educational capabilities: Critical reflections on a decade of practice. The Journal of Law, Medicine & Ethics, 42(s2), Kerry, V. B., Ndung'u, T., Walensky, R. P., Lee, P. T., Kayanja, V. F. I., Bangsberg, D. R., et al. (2011). Managing the demand for global health education. PLOS Medicine, 8(11), e Koplan, J. P., Bond, T. C., Merson, M. H., Reddy, K. S., Rodriguez, M. H., Sewankambo, N. K., et al. (2009). Towards a common definition of global health. The Lancet, 373(9679), Lee, K. H., & Chong, S. W. (2013). A study on the status and necessity of human rights education for nursing college. Journal of Law-Related Education, 8(1), Miller, A. M. & Chandler, P. J. (2002). Acculturation, resilience, and depression in midlife women from the former soviet union. Journal of Nursing Research, 51(1), Ministry of Health & Welfare. (2012). Reinforcement of cultural competency of the workforce in health care sector. September 2012 December 2012(in Korean). Sejong: 한국간호교육학회지 21(4), 2015 년 11 월 571

12 이현경외 Ministry of Health & Welfare. Retrieved December 1, 2014, from Detail.do?cond_research_name=&cond_organ_id=&cond_resea rch_year_start=&cond_research_year_end=&cond_brm_super_ id=nb &research_id= &pageIndex=14&leftMenuLevel=110 Noll, D. R., Channell, M. K., Basehore, P. M., Pomerantz, S. C., Ciesielski, J., Eigbe, P. A., et al. (2013). Developing osteopathic competencies in geriatrics for medical students. Journal of American Osteopath Association, 113(4), Park, H. S., Ha, S. J., Park, J. H., Yu, J. H., & Lee, S. H. (2014). Employment experiences of nurses caring for foreign patients. Journal of Korean Academy of Nursing Administration, 20(3), Porter, S. R., & Whitcomb, M. E. (2007). Mixed-mode contacts in web surveys paper is not necessarily better. Public Opinion Quarterly, 71(4), United Nations Development Programme. (2015). Post-2015 sustainable development agenda. Retrieved August 1, 2015, from post-2015-development-agenda.html Ventura, C. A. A., Mendes, I. A. C., Wilson, L. L., Godoy, S. D., Tamí-Maury, I., Zárate-Grajales, R., et al. (2014). Global health competencies according to nursing faculty from Brazilian higher education institutions. Revista Latino -Americana de Enfermagem, 22(2), Wilson, L., Harper, D. C., Tami-Maury, I., Zarate, R., Salas, S., Farley, J., et al. (2012). Global health competencies for nurses in the America. Journal of Professional Nursing, 28(4), Wilson, L., Callender, B., Hall, T. L., Jogerst, K., Torres, H., Velji, A., et al. (2014). Identifying global health competencies to prepare 21st century global health professionals: Report from the global health competency subcommittee of the consortium of universities for global health. The Journal of Law, Medicine & Ethics, 42(s2), World Health Organization. (2006). The world health report: 2006: Working together for health. Retrieved September 28, 2015, from _eng.pdf World Health Organization. (2009). Global standards for the initial education of professional nurses and midwives. Retrieved July 28, 2015, from nursing_midwifery/hrh_global_standards_education.pdf 572 한국간호교육학회지 21(4), 2015 년 11 월

13 간호교육자가인지한국내간호학생들을위한국제보건핵심역량 Global Health Competencies for Undergraduate Nursing Students in Korea * Lee, Hyeonkyeong 1) Kim, Hee Soon 2) Cho, Eunhee 1) Kim, Sanghee 3) Kim, Junghee 4) 1) Associate Professor, College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul 2) Professor, College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul 3) Assistant Professor, College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul 4) Ph.D. Student, College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul Purpose: The purpose of this study was to identify essential global health competencies for undergraduate nursing students in Korea. Methods: This study used a mixed methods design including an online survey with a convenient sample of 223 nursing educators, followed by an expert discussion with four nursing educators with expertise in global health. The global health competency was measured using the Global Health Competencies for Nurses in the America, which consists of 30 competencies in 6 domains. Each competency was measured by a 4-point Likert Scale, with at least 80% of 3 or 4 point scores indicating consensus that competency was considered essential for undergraduate nursing students. Results: Nursing educators most strongly agreed the competencies of the Social and Environmental Determinants of Health domain as essential global health competencies for nursing students. A total of 21 items in 5 out of 6 competency domains were initially identified with at least 80% agreement. Finally, the experts decided on 24 global health competencies through the revision and integration of several competencies. Conclusion: The findings indicate that nursing educators perceived that nursing students need to be prepared for responding to emerging global health needs. The proposed list of global health competencies can provide guidance to develop a framework for integrating global health into undergraduate nursing curriculums. Key words : Nursing students, Global health, Competency * This study was supported by the Yonsei University College of Nursing Global Leadership Center Research Grant in Mo-Im Kim Nursing Research Institute, Address reprint requests to : Kim, Junghee College of Nursing, Yonsei University 50, Yonsei-ro, Seodaemun-gu, Seou, , Korea Tel: kjh129@yuhs.ac 한국간호교육학회지 21(4), 2015 년 11 월 573