Kyu Eun Lee and Nam Sun Kim 의간호를제공할필요성을제기하였다. 이를위해서다양한문화적배경을가진대상자의문화적욕구를충족시키고만족스러운간호를제공하는횡문화간호 (transcultural nursing) 가바탕이되어야한다 [5]. 따라서실무현장에있는간호사는다문

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1 Original Article J Health Info Stat 2017;42(1):1-9 pissn eissn 간호대학생의횡문화간호자기효능감에대한영향요인 이규은, 김남선 가톨릭관동대학교간호학과 Factors Affecting Transcultural Self-efficacy among Nursing Students Kyu Eun Lee, Nam Sun Kim Department of Nursing, Catholic Kwnadong University, Gangneung, Korea Objectives: The purpose of this study is to identify the relationship among cultural competency, empathy and transcultural self-efficacy and to identify the predictors of transcultural self-efficacy among nursing students. Methods: The research design for this study was a descriptive survey using convenience sampling. Data collection was done using self-report questionnaires of 504 nursing students in G and C provinces. The data were analyzed using percentage, mean, standard deviation, t-test, ANOVA, Scheffé test, Pearson correlation analysis and hierarchical multiple regression with the SPSS Win 20.0 Program. Results: The mean score of transcultural self-efficacy was 5.99 ± 1.25 out of a possible 10. Transcultural self-efficacy showed a significantly positive correlation with cultural competency (r = 0.45, p < 0.001) and empathy (r = 0.25, p < 0.001). In the hierarchical multiple regression analysis, cultural skills, perspective taking, empathic concern and personal distress were significant predictors and explained 30.1% of transcultural self-efficacy. Conclusions: The results of this study showed that there are significant factors affecting the transcultural self-efficacy of nursing students. Based on these results, cultural education programs are needed to in order to improve cultural self-efficacy. Key words: Cultural competency, Empathy, Self-efficacy, Transcultural nursing 서론 연구의필요성최근우리나라는저출산, 고령화에따른생산인구의저하로외국인근로자, 국제결혼이민자및외국인유학생의증가등으로인해다인종, 다문화사회로급변하고있다. 2015년국내거주외국인은 174만명으로우리나라전체인구의 3.4% 를차지하고있는데이는국내거주외국인주민수를조사하기시작한 2006년거주외국인수가 54만명, 전체인구의 1.1% 이었던데비해 10년동안 3배이상, 연평균 14.4% 가증가한것이다 [1]. 이들국내거주외국인의증가는우리나라를다양한인종과문화가공존하는다문화사회로전환시키고있으며우리나라의문화, 의료, 복지등다양한측면에서의변화로이끌고있다. 최근조사에따르면우리나라에거주하고있는다문화대상자의 82.0% 가병 의원을이용한경험이있으며, 특히결혼이주여성의증가로인해임신과출산, 육아와관련하여의료기관이용과의료서비스에대한요구가더욱높아지고있다 [2]. 한편우리정부는외국인환자유치를부가가치가높은국가의미래핵심먹거리사업으로추진하면서 2015년외국인환자수가 30만명, 진료수입이 6,700억원에달하고있어 [3], 다양한문화적배경을가진환자가점점더증가하고있다. 이러한추세는간호사뿐만아니라간호대학생들도다양한문화를가진환자를간호할기회를증가시켰고 [4], 대상자가가진고유한문화적특성에맞는개별화된간호를수행하고, 다양한대상자가가진차이점과다양성을존중하는최적 Corresponding author: Nam Sun Kim beon-gil, Beomil-ro, Gangneung 25601, Korea Tel: , nskim@cku.ac.kr Received: November 28, 2016 Revised: January 5, 2017 Accepted: January 11, 2017 *This work was supported by research fund of Catholic Kwandong University (CKURF ). No potential conflict of interest relevant to this article was reported. How to cite this article: Lee KE, Kim NS. Factors affecting transcultural self-efficacy among nursing students. J Health Info Stat 2017;42(1):1-9. Doi: It is identical to the Creative Commons Attribution Non-Commercial License ( whichpermit sunrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited Journal of 1

2 Kyu Eun Lee and Nam Sun Kim 의간호를제공할필요성을제기하였다. 이를위해서다양한문화적배경을가진대상자의문화적욕구를충족시키고만족스러운간호를제공하는횡문화간호 (transcultural nursing) 가바탕이되어야한다 [5]. 따라서실무현장에있는간호사는다문화대상자의증가로인해요구되는횡문화간호를실천할수있는직무능력이필요하며이는곧횡문화간호자기효능감 [6] 이라고할수있다. 횡문화간호자기효능감은다양한대상자에게횡문화간호기술을수행할수있는자신감으로횡문화간호자기효능감이높은간호사는다른집단문화의전통, 신념, 관습과가치를이해하고개인, 가족, 공동체의문화적맥락내에서간호를제공할수있으며, 자신의횡문화적간호역량을증진시키기위해노력하고특별한상황적요구에대처할수있다. 즉, 다문화시대에간호전문직으로서대상자에게총체적간호를제공하기위하여횡문화간호자기효능감은필수적간호역량이라고할수있다 [5]. Leininger [7] 는횡문화적돌봄이론을통하여간호사는문화적가치, 신념, 관행에부합되는돌봄을제공하여대상자의건강과안녕또는질병, 불구, 죽음을예방해야한다고하였다. 실제로여러연구에서간호사가높은문화적역량을갖추었을때대상자의만족도가높았고건강지표도향상되는것으로나타났다 [8-11]. 그러나문화를고려하지않고간호를한다면간호대상자와간호제공자간의기대가다르고문화적갈등과문제가초래된다 [12]. 따라서다양한대상자를만나게되는간호사는전문인으로서자기중심적사고방식에서벗어나상대방을인격적으로존중해주고타인의감정을대리적으로경험하는공감적자세가필요하며 [13], 다문화대상자들과의공감능력을증가시킴으로대상자들의감정을잘파악하고경험할수있게되며, 인간의존엄성을이해하여접근할수있는역량을함양하게될수있다 [14]. 그러나간호사들의경우과중한업무부담과다문화에대한이해부족으로대상자에게문화적차이를고려한적절한간호를제공하는것이큰과제가되고있다 [15]. 향후다양한문화의대상자에게돌봄을제공할간호대학생은인종, 민족에대한편견이나선입견등에서벗어나그들을우리사회의구성원으로수용하고존중하며치료적상호작용을위해다문화사회를이해하고수용하며적응하도록준비되어야한다 [4]. 최근들어전세계적으로간호사및간호대학생의다문화대상자에대한문화간호의중요성이강조되고있는것과는달리우라나라에서는간호사를대상으로한횡문화간호관련연구가매우부족한실정이다. 따라서본연구는장차신입간호사가될간호대학생들을대상으로횡문화간호자기효능감의정도및영향요인을확인하여다양한대상자의요구에따른최적의간호를제공할수있도록준비시키고있는지를확인하는것이다. 본연구결과는추후횡문화간호자기효능감을증진시킬수있는간호교육과정개발의기초자료를제공하게될것이다. 연구목적본연구의목적은간호대학생의횡문화간호자기효능감의정도와횡문화간호자기효능감에영향을미치는요인을파악하는것이며이를위한구체적인목적은다음과같다. (1) 연구대상자의문화적역량, 공감능력및횡문화간호자기효능감정도를파악한다. (2) 연구대상자의일반적특성에따른문화적역량, 공감능력및횡문화간호자기효능감의차이를파악한다. (3) 연구대상자의횡문화간호자기효능감과문화적역량, 공감능력간의상관관계를파악한다. (4) 연구대상자의횡문화간호자기효능감에영향을미치는요인을파악한다. 연구방법 연구설계본연구는간호대학생의횡문화간호자기효능감에영향을미치는요인들을확인하기위한서술적조사연구이다. 연구대상본연구의대상자는한국의간호대학생을표적모집단으로하고연구자의연구접근성을고려하여 C도와 G도에위치한 4년제 2개대학에재학중인간호대학생전수 (518 명 ) 를근접모집단으로하였다. 이중자료수집일당시결석을하였거나자료수집에동의하지않은학생, 응답이불충분한 14명을제외한총 504명을연구대상으로하였다. 본연구에필요한대상자수는 G*Power 프로그램 [16] 을이용하여회귀분석을기준으로예측변수 18개, 유의수준 (α) 0.05, 검정력 (1-β) 0.80, 효과크기 (effect size) 0.05로했을때표본의크기는 418명으로산출되어, 본연구의대상자수인 504명은충분한것으로판단되었다. 연구도구문화적역량문화적역량이란다양한문화권에속한사람들의신념, 가치, 행동, 관습등을이해하고상호작용할수있는기술을습득하여행동할수있는능력으로 [17], 본연구에서는한국의간호대학생들을대상으로개발한도구 [18] 를사용하였다. 문화적역량도구는문화적인식 4문항, 문화적지식 9문항, 문화적민감성 4문항, 문화적기술 6문항, 문화적경험 4문항의총 27문항으로구성되었다. 각문항은 전혀아니다 (1 점 ) 에서 매우그렇다 (5점) 로구성되었으며, 점수가높을수록문화적역량수준이높음을의미한다. 이도구의신뢰도는 Cronbach s alpha 2

3 Transcultural Self-efficacy 값이도구개발당시 0.91 이었고, 본연구에서 0.91 이었다. 공감능력공감능력이란다른사람의사적인지각세계에들어가서그와함께느끼고생각하는능력 [19] 으로본연구에서는 Davis [20] 가개발한대인관계반응지수 (Interpersonal reactivity index) 를 Park et al. [21] 이번안한도구를사용하였다. 공감능력은관점취하기 7문항, 상상하기 7문항, 공감적관심 7문항, 개인적고통 7문항의총 28문항으로구성되었다. 각문항은 전혀그렇지않다 (1점 ) 에서 매우그렇다 (5 점 ) 로구성되었으며, 부정적문항은역환산하였다. 점수가높을수록공감능력수준이높음을의미한다. 이도구의신뢰도는 Cronbach s alpha 값이도구개발당시 0.83이었고본연구에서는 0.77이었다. 횡문화간호자기효능감횡문화간호자기효능감이란다양한문화적배경을가진대상자의문화적욕구를충족시키고만족스러운간호기술을수행 [12] 할수있는자신감으로, 본연구에서는 Jeffreys [6] 가개발하고 Kim [5] 이번안 수정한도구를사용하였다. 횡문화간호자기효능감은문화간호에대한인지영역 25문항, 실무영역 28문항, 정서영역 30문항의총 83문항으로구성되었다. 각문항은 자신없음 (1점 ) 에서 완전히자신있음 (10 점 ) 으로구성되었으며, 점수가높을수록횡문화간호자기효능감수준이높음을의미한다. 이도구의신뢰도는 Cronbach s alpha 값이도구개발당시 0.99이었고, 본연구에서는 0.98이었다. 자료수집방법및윤리적고려본연구는시작전연구자가소속하고있는대학교의기관생명윤리위원회의승인을받았다 (CKU ). 자료수집기간은 2016년 4 월 4일부터 5월 6일까지약 5주간 C도와 G도에위치한 4년제 2개대학에재학중인간호대학생전수를대상으로실습기간과시험기간을고려하여학년별로자료수집이가능한시간에이루어졌다. 자료수집시연구대상자에게연구의목적과취지를설명하고연구참여를동의한대상자에게연구참여동의서에서명을받았다. 연구참여동의서에는연구목적, 대상자의익명성, 비밀보장, 연구철회및연구자의연락처등의내용이포함되었고이에대해연구자와연구보조자가직접설명하여자발적인연구를보장하였다. 연구참여동의서를작성한학생에게는설문지를배부하여응답하도록하였다. 설문지작성에는 15-20분정도소요되었으며작성직후설문지와연구동의서를회수하였다. 설문지는 518부를배부하여최종적으로 505부 ( 회수율, 97.5%) 를회수하였다. 이중자료처리에부적절한 1부를제외한최종 504부 (97.3%) 를분석에사용하였다. 자료분석방법 수집된자료는 SPSS 20.0 프로그램 (SPSS Inc., Chicago, IL, USA) 을 이용하여유의수준 0.05 수준에서양측검정하였다. 연구대상자의일 반적특성과변수각각에대하여평균과표준편차로, 측정변수들간 의관련성을파악하기위해서 Independent t-test, ANOVA ( 사후검정은 Scheffé) 및 Pearson correlation coefficient 로구하였다. 또한간호대학생 의횡문화간호자기효능감에미치는영향을확인하기위해위계적회 귀분석 (hierarchical multipul regressin) 을수행하였다. 연구대상자의일반적특성 연구결과 연구대상자의일반적특성은 Table 1 과같다. 본연구의대상자는간 호대학생 504 명으로여학생 423 명 (83.9%), 남학생 81 명 (16.1%) 으로, 19 세이하 183 명 (36.3%), 세 245 명 (48.6%), 세 59 명 (11.7%), 26 세 이상 17 명 (3.4%) 이었다. 학년별분포는 1 학년 128 명 (25.4%), 2 학년 129 명 Table 1. General characteristics of participants (n=504) Characteristics Categories n (%) Mean±SD Age (y) (36.3) 20.55± (48.6) (11.7) (3.4) Gender Female 423 (83.9) Male 81 (16.1) Grades Freshman 128 (25.4) Sophomore 129 (25.6) Junior 123 (24.4) Senior 124 (24.6) Religion Protestantism 135 (26.8) Catholic 49 (9.7) Buddhism 35 (5.0) None 291 (57.7) Others 4 (0.8) Experience of visiting overseas Yes 269 (53.4) No 235 (46.6) Speak foreign languages Fluent 10 (2.0) Somewhat 351 (69.6) Not at all 143 (28.4) Have relative married to a foreigner Yes 52 (10.3) No 452 (89.7) Have a foreign friend Yes 117 (23.2) No 387 (76.8) Need multicultural nursing education SD, standard deviation. Much 117 (23.2) Somewhat 164 (52.4) Little 88 (17.5) Not at all 6 (1.2) Don t know 29 (5.8) 3

4 Kyu Eun Lee and Nam Sun Kim Table 2. Levels of cultural competency, empathy and transcultural self-efficacy (n=504) Variables Mean ± SD Min Max Range Cultural competency 3.04± Cultural awareness 4.21± Cultural knowledge 2.50± Cultural sensitivity 3.96± Cultural skills 2.68± Cultural experience 2.96± Empathy 3.48 ± Perspective taking 3.67± Fantasy 3.51 ± Empathic concern 3.62± Personal distress 3.12± Transcultural self-efficacy 5.99± Cognitive dimension 5.97± Practical dimension 5.65± Affective dimension 6.33± SD, standard deviation. (25.6%), 3학년 123명 (24.4%), 4학년 124명 (24.6%) 으로비슷하였다. 종교는개신교 135명 (26.8%), 가톨릭 49명 (9.7%), 불교 35명 (5.0%), 기타 4명 (0.8%), 종교가없는학생이 291명 (57.7%) 이었다. 외국어사용능력을스스로평가한결과외국어가유창한학생이 10명 (2.0%), 외국인과간단한대화가가능한학생이 351명 (69.6%), 외국인과대화가불가능한학생이 143명 (28.4%) 이었다. 외국인과결혼한친인척이있는학생이 52명 (10.3%), 외국인친구가있는학생이 117명 (23.2%) 이었다. 다문화간호대상자를위한간호교육의필요성에대해매우필요하다 117명 (23.2%), 필요하다 264명 (52.4%), 조금필요하다 88명 (17.5%), 필요하지않다 6명 (1.2%), 모르겠다 29명 (5.8%) 으로나타났다. 문화적역량, 공감능력및횡문화간호자기효능감의정도연구대상자의문화적역량, 공감능력및횡문화간호자기효능감의정도는 Table 2와같다. 연구대상자의문화적역량은응답범위 1-5 사 Table 3. Transcultural self-efficacy by general characteristics (n=504) Characteristics Categories n (%) Transcultural self-efficacy Mean±SD t or F (p) Scheffe Age (y) (36.3) 6.03± (0.952) (48.6) 5.97± (11.7) 5.96± (3.4) 5.94±1.01 Gender Female 423 (83.9) 1.27± (0.122) Male 81 (16.1) 5.79±1.13 Grades Freshman a 128 (25.4) 5.68 ± (0.001) a, b < c, d Sophomore b 129 (25.6) 5.86 ± 1.35 Junior c 123 (24.4) 6.20 ± 1.38 Senior d 124 (24.6) 6.23 ± 1.04 Religion Protestantism 135 (26.8) 5.87± (0.461) Catholic 49 (9.7) 5.96±1.16 Buddhism 35 (5.0) 6.17±1.63 None 291 (57.7) 6.03±1.21 Others 4 (0.8) 5.32±0.65 Experience of visiting overseas Yes 269 (53.4) 6.04± (0.331) No 235 (46.6) 5.93±1.22 Speak foreign languages Fluent a 10 (2.0) 6.59 ± (0.015) a, b > c Somewhat b 351 (69.6) 6.07 ± 1.18 Not at all c 143 (28.4) 5.76 ± 1.37 Have relative married to a foreigner Yes 52 (10.3) 5.95± (0.795) No 452 (89.7) 6.00±1.23 Have a foreign friend Yes 117 (23.2) 6.27± (0.005) No 387 (76.8) 5.91±1.26 Need multicultural nursing education SD, standard deviation. Much a 117 (23.2) 6.42 ± (0.001) a > b, c, d, e Somewhat b 264 (52.4) 5.91 ± 1.22 Little c 88 (17.5) 5.80 ± 1.15 Not at all d 6 (1.2) 5.60 ± 1.13 Don t know e 29 (5.8) 5.72 ±

5 Transcultural Self-efficacy 이에평균 3.04 ± 0.47점이었으며문화적역량의하위영역은문화적인식 4.21 ± 0.54점, 문화적지식 2.50 ± 0.64점, 문화적민감성 3.96 ± 0.63 점, 문화적기술 2.68 ± 0.74 점, 문화적경험 2.96 ± 0.80점이었다. 공감능력은응답범위 1-5점사이에평균 3.48 ± 0.33점이었으며, 하위 횡문화간호자기효능감은공감능력의하위영역인관점취하기 (r = 0.28, p <0.001), 상상하기 (r= 0.22, p <0.001), 공감적관심 (r= 0.28, p <0.001) 과는순상관관계를보였으나, 개인적고통 (r = -0.20, p < 0.001) 과는역상관관계를보였다. 영역은관점취하기 3.67± 0.47 점, 상상하기 3.51 ± 0.62 점, 공감적관심 3.62 ± 0.51점, 개인적고통 3.12 ± 0.48점이었다. 횡문화간호자기효능감은응답범위 1-10점사이에평균 5.99 ±1.25 점이었고, 하위영역은문화간호에대한인지영역 5.97± 1.55점, 실무영역 5.65 ± 1.48점, 정서영역 6.33 ±1.38점으로나타났다. 횡문화간호자기효능감에영향을미치는요인연구대상자의횡문화간호자기효능감에영향을미치는요인을검토하기위해먼저회귀분석의가정을검토하였다. 오차항의정규성검토를위해 P-P 도표를확인한결과정규분포를보였으며등분산검정을 위해잔차도표를확인한결과등분산성이확인되었다. 또한잔차의독 일반적특성에따른횡문화간호자기효능감의차이연구대상자의일반적특성에따른횡문화간호자기효능감의차이는 Table 3과같다. 연구대상자의횡문화간호자기효능감은학년 (F = 5.96, p = 0.001), 외국어실력 (F = 4.23, p = 0.015), 외국인친구유무 (t =2.79, p = 0.005) 및다문화간호대상자를위한간호교육의필요성 (F = 4.82, p = 0.001) 에따라유의한차이가있었다. 립성검정을위해더빈-왓슨 (Durbin-Watson) 값을검토한결과 로자기상관성이없는것으로나타났다. 독립변수들간의다중공선성을확인한결과분산팽창지수 (VIF) 는 로 10보다작았고, 공차한계 (tolerance) 는 로일반적으로다중공선성이없는것으로나타났다. 따라서본연구모형은회귀분석을위한가정을모두충족시켰다. 대상자의횡문화간호자기효능감에대한위계적회귀분석의결과 횡문화간호자기효능감과제변수간의상관관계연구대상자의횡문화간호자기효능감과제변수간의상관관계를확인한결과는 Table 4와같다. 횡문화간호자기효능감은문화적역량의하위영역인문화적인식 (r = 0.22, p <0.001), 문화적지식 (r = 0.23, p <0.001), 문화적민감성 (r = 0.34, p <0.001), 문화적기술 (r = 0.43, p < 0.001), 문화적경험 (r = 0.33, p < 0.001) 간순상관관계를보였다. 또한 는 Table 5와같다. 먼저 Model 1에서는통제변수로학년, 외국어능력및다문화간호대상자를위한간호교육의필요성을투입하였다. Model 2에서는문화적역량의하위영역인문화적인식, 문화적지식, 문화적민감성, 문화적기술, 문화적경험을추가로입력하였으며, Model 3 에서는공감능력의하위영역인관점취하기, 상상하기, 공감적관심, 개인적고통을넣어분석하였다. Table 4. Correlations among cultural competency, empathy and transcultural self-efficacy (0.400) (0.006) (0.016) (0.009) (0.058) (0.194) (0.001) 0.15 (0.001) (0.659) (0.019) 0.1 (0.019) (0.201) (0.001) (0.007) (0.071) 0.06 (0.153) , Cultural awareness; 2, Cultural knowledge; 3, Cultural sensitivity; 4, Cultural skills; 5, Cultural experience; 6, Perspective taking; 7, Fantasy; 8, Empathic concern; 9, Personal distress; 10, Transcultural self-efficacy. 5

6 Kyu Eun Lee and Nam Sun Kim Table 5. Affecting factors on transcultural self-efficacy Variables Model 1 Model 2 Model 3 ß (p) ß (p) ß (p) Grades: sophomore (0.005) (0.156) (0.207) Grades: junior (0.621) (0.152) (0.229) Su Grades: senior (0.049) (0.545) (0.411) Speak foreign languages: fluent (0.035) (0.035) (0.051) Speak foreign languages: somewhat (0.037) (0.906) (0.994) Need multicultural nursing education: much (0.019) (0.155) (0.478) Need multicultural nursing education: somewhat (0.499) (0.842) (0.790) Need multicultural nursing education: little (0.733) (0.523) (0.970) Need multicultural nursing education: not at all (0.924) (0.872) (0.515) Cultural awareness (0.295) (0.803) Cultural knowledge (0.481) (0.513) Cultural sensitivity (0.001) (0.059) Cultural skills ( <0.001) ( <0.001) Cultural experience (0.055) (0.141) Perspective taking (0.032) Fantasy (0.326) Empathic concern (0.003) Personal distress (0.014) F (p) 4.60 ( <0.001) ( <0.001) ( <0.001) R² Adj R² Model 1에서는횡문화간호자기효능감의변이를 6.1% 를설명하였으며유의한영향을미친변수는 2학년 (β = -0.15, p = 0.005), 4학년 (β = -0.11, p = 0.049), 외국어가유창한학생 (β = 0.10, p = 0.035), 외국인과간단한대화가가능한학생 (β = 0.09, p = 0.037), 다문화간호대상자를위한간호교육이매우필요하다고생각하는학생 (β = 0.20, p = 0.019) 이었다. 이들변수를통제하고문화적역량의하위영역을투입한 Model 2는횡문화간호자기효능감의 26.0% 를설명하였으며유의한영향을미친변수는외국어가유창한학생 (β = 0.09, p = 0.035), 문화적민감성 (β = 0.17, p = 0.001) 및문화적기술 (β = 0.34, p < 0.001) 이었다. 다시이들변수를통제하고공감능력의하위영역을투입한 Model 3에서는횡문화간호자기효능감의 30.1% 를설명하였으며문화적기술 (β = 0.34, p < 0.001), 관점취하기 (β = 0.10, p = 0.032), 공감적관심 (β = 0.14, p = 0.003), 개인적고통 (β = -0.10, p = 0.014) 의 4개변수가유의한영향을미쳤다. 결과적으로간호대학생의횡문화간호자기효능감에영향을미친영향요인은문화적기술, 관점취하기, 공감적관심및개인적고통이었다. 고찰 본연구는 2개대학에재학중인간호대학생을대상으로횡문화간호자기효능감의정도와일반적특성에따른횡문화간호자기효능감의차이및횡문화간호자기효능감에영향을미치는요인을파악하여 간호대학에서횡문화간호자기효능감을증진시킬수있는간호교육과정의개발과전략을수립하기위한기초자료를도출하기위하여시도되었다. 본연구에서횡문화간호자기효능감의정도는평균평점 5.99점이었으며, 하위영역은인지영역 5.97점, 실무영역 5.65점, 정서영역 6.33점으로중간점수보다약간높게나타났다. 이는동일한도구를사용하고간호사를대상으로한연구 [5] 의횡문화간호자기효능감 4.54점, 인지영역 4.93점, 실무영역 3.74점, 정서영역 4.95점보다는다소높았고, 간호대학생을대상으로한연구 [22] 의횡문화간호자기효능감 6.20점, 인지영역 6.32점, 실무영역 5.55점, 정서영역 6.72점보다는다소낮았다. 또한같은도구를사용하여미국간호대학생을대상으로한측정점수 7.41 점 [23], 2학기와 7학기에재학중인호주간호대학생을대상으로한측정점수 6.64점, 7.17 점 [24] 보다는다소낮았다. 국내간호대학생들은간호사보다횡문화간호자기효눙감점수가높았는데이는현재의대학생들이과거에대학을졸업한간호사보다해외경험이나외국인을접할기회가많아졌고다양한매스미디어를통한문화적지식과다문화에대한노출빈도가증가되어나타난결과로추정된다. 또한국내보다외국의간호대학생의횡문화간호자기효능감점수가높은이유는미국이나호주는다문화인구로구성되어있고그역사가길어간호학생들이다문화대상자에대한이해와관심이지속적으로증가해왔기때문으로여겨진다. 특히미국의경우에는간호교육에서간호현장실 6

7 Transcultural Self-efficacy 무와관련하여문화적역량이중요한용어로언급되고있으며 [25], 간호사자격시험에서도다문화관련문제가다루어지고있었다 [26]. 횡문화간호자기효능감은간호대학생의학년, 외국어실력및다문화간호대상자를위한간호교육의필요성에서유의한차이를보였다. 간호대학생은학년이증가할수록횡문화간호자기효능감이증가하는것으로나타났는데, 대상자의학년에따라횡문화간호자기효능감의차이가없었던연구결과 [22] 와는차이를보였다. 그러나 Sarafis and Malliarou [27] 는학년이증가할수록횡문화간호에대한인지와실무에대한다문화자기효능감이증가한다고하여본연구결과를지지하였는데, 학년이증가할수록대학의교육과정에서횡문화간호에대한학습을더많이한결과 [28] 로설명할수있을것이다. 횡문화간호자기효능감은외국어실력이유창한경우에유의하게증가하였는데외국인과의원활한의사소통능력은외국인을대하는데있어서자신감을갖게한다. 그러므로횡문화간호자기효능감을증진하기위해서일차적으로외국어능력을향상시켜야하며이를위해간호대학생스스로의노력과함께간호교육과정에서도이러한점을반영해야할것이다. 다문화대상자를위한간호교육이필요하다고응답한간호대학생일수록횡문화간호자기효능감점수가높았다. 이는 Chun [22] 의연구와일치하며, 횡문화간호자기효능감을증진시키기위해간호교육프로그램을통해다문화대상자와의장기간의관계형성과간호제공을통한다양한문화경험을할수있는기회를제공할필요가있다. 한편횡문화간호자기효능감은문화적역량및공감능력과유의한정적상관관계를나타냈다. 이러한결과는횡문화간호자기효능감을증가시키기위해다양한문화체험과더불어실질적인외국어능력, 면담기술및간호기술을학습할수있는교육프로그램을체계적으로제공할필요가있음을시사한다. 본연구에서문화적역량의정도는평균평점 3.04점이었고, 하위영역인문화적인식 4.21점, 문화적민감성 3.96점, 문화적경험 2.96점, 문화적기술 2.68점, 문화적지식 2.50점의순이었다. 이는한국의간호대학생을대상으로문화적역량도구를개발한연구 [18] 에서문화적역량 3.04점, 하위영역인문화적인식 4.07점, 문화적지식 3.71 점, 문화적민감성 2.77점, 문화적기술 2.68점, 문화적경험 2.62점과비교할때평균평점은같았으나하위영역의순위는다소다르게나타났다. 또한문화적역량을측정하는도구는달랐지만간호대학생의문화적역량을측정한연구에서중간정도를보인연구결과 [4,29] 와비슷하였다. 그러나간호사를대상으로조사한연구에서문화적역량의점수가중간보다약간낮게보고된것 [30,31] 과는차이가있었다. 이같은결과는연령이낮을수록다문화에대한접촉빈도가높고문화적역량이높게측정된다는선행연구 [4,29] 와같았다. 또한본연구에서공감능력은평균평점 3.48점으로중간보다높은 점수였으며, 하위척도인관점취하기 3.67점, 공감적관심 3.62점, 환상 3.51점, 개인적고통 3.12점의순이었는데, 동일한도구를사용하여간호대학생을대상으로한연구에서나타난 3.5점 [32], 3.6점 [33], 3.7점 [34] 보다는다소낮았다. 이와같이간호대학생들의공감능력의다소간의점수차이는표집한간호대학의위치나특성, 측정대상자나측정상황과관련된오차때문인것으로보이지만해석할때주의가필요하다. 마지막으로본연구에서횡문화간호자기효능감에영향을미치는요인을위계적회귀분석한결과, 가장영향을미치는요인은문화적기술이었다. 문화적기술은대상자가현재가지고있는문제와관련된문화적자료를수집하고문화에기초한건강사정을정확히수행할수있는능력 [35] 으로행위적영역에포함된다. 자기효능감이무엇인가를수행할수있다는자신감이므로행위적영역에해당하는문화적기술이문화적역량의다른하위영역보다영향을더많이미친것으로사료된다. 횡문화간호자기효능감을설명하는공감능력의하위영역은상대방의심리적관점이나태도를자발적으로취해보려는경향성 ( 관점취하기 ), 타자지향적인감정으로동정을느끼거나타인의감정을경험하는정도 ( 공감적관심 ), 타인의고통과불안에대해반응 ( 개인적고통 ) 하는공감능력을통해서횡문화간호자기효능감에영향을미쳤다 [36]. 이상과같이본연구에서횡문화간호자기효능감에영향을미치는요인은문화적기술, 공감적관심, 개인적고통, 관점취하기의 4가지변인이었는데이들변인이 30.1% 의설명력을보였다. 또한 Kim [5] 의연구에서는문화간호역량교육요구, 다문화에대한관심정도, 다문화대상자를돌본경험의 3가지요인이문화간호자기효능감의 28% 를설명하였다. 그러므로 2개의연구를기반으로추후계속적인연구를통해횡문화간호자기효능감에영향하는요인을확인해나갈필요가있겠다. 본연구는다문화사회로변화하고있는우리나라에서향후간호사가될간호대학생을대상으로횡문화간호자기효능감에영향하는요인을확인함으로써향후간호교육과정에서다문화대상자를위한횡문화간호자기효능감을높이기위한프로그램개발에구체적인시사점을확인시켰다는점에서의의가있다. 그러나모집단의대표성을확보하기위해각기다른지역의 2개간호대학생전수를표본으로하였으나여전히일반화에제한점이있다고하겠다. 결론및제언 본연구는 504명의간호대학생을대상으로횡문화간호자기효능감에대한영향요인을확인함으로써간호교육에서다문화대상자에대한관심을고취시켜횡문화간호에대한역량을강화하기위해기초자료를제공하고자시도하였다. 7

8 Kyu Eun Lee and Nam Sun Kim 본연구결과연구대상자의횡문화간호자기효능감은평균평점 5.99 점으로중간보다약간높았으며, 학년, 외국어실력, 외국인친구유무, 다문화간호대상자를위한간호교육의필요성에서차이를보였고, 문화적역량및공감능력과관련성이있었다. 또한횡문화간호자기효능감은문화적기술, 공감적관심, 개인적고통및관점취하기의 4개변수가 30.1% 의설명력을가지고있었다. 본연구결과를기반으로간호대학생의횡문화간호자기효능감을중진시킬수있는교육프로그램을개발 적용하는후속연구를제언한다. REFERENCES 1. Ministry of the Interio. Current status of foreign residents in Available at BoardArticle.do?bbsId=BBSMSTR_ &nttId=46311 [accessed on 18 June 2016]. 2. Ministry of Gender Equality and Family. A study on the national survey of multicultural families. Seoul: Ministry of Gender Equality and Family; 2012, (Korean). 3. Ministry of Health and Welfare. Available at front_new/cm/scm0307nc.jsp?par_menu_id=01 [accessed on 18 June 2016]. 4. Lee NY, Eo YS, Lee JW. Level of cultural competence (CC) and educational needs for cultural competence in nursing (CCN) in undergraduate nursing students. J Korean Acad Soc Nurs Educ 2015;21(1):16-27 (Korean). 5. Kim SH. Transcultural self-efficacy and educational needs for cultural competence in nursing of Korean nurses. J Korean Acad Nurs 2013; 43(1): (Korean). 6. Jeffreys MR. Development and psychometric of the transcultural selfefficacy tool: a synthesis of findings. J Transcultural Nurs 2000;11(2): Leininger M. Culture care theory: a major contribution to advance transcultural nursing knowledge and practice. J Transcultural Nurs 2002;13(3): Chae DH, Park YH, Kang KH, Lee TH. A study on factors affecting cultural competency of general hospital nurses. J Korean Acad Nurs Adm 2012;18(1):76-86 (Korean). 9. Lee EJ, Kim YK, Lee HK. A study on the cultural competence of community health practitioners. J Korean Acad Community Health Nurs 2012;23(2): (Korean). 10. McElmurry BJ, McCreary LL, Park CG, Ramos L, Martinez E, Parikh R, et al. Implementation, outcomes, and lesions learned from a collaborative primary health care program to improve diabetes care among urban Latino populations. Health Promot Practice 2009;10(2): Caffrey RA, Neander W, Markie D, Stewart B. Improving the cultural competence of nursing students: Results of integrating cultural content In the curriculum and an international immersion experience. J Nurs Educ 2005;44(5): Leininger MM, McFarland MR. Transcultural nursing: concepts, theories, research and practice. New York: McGraw-Hill; 2002, p Hoffman ML. Empathy and moral development: implications for caring and justice. New York: Cambridge University Press; Park YS, Lee SO, Lee HK. Difference of cultural competence and empathic ability according to multi-cultural experience of nursing students. J Korean Soc Muiticult Health 2015;5(2):39-47 (Korean). 15. Peek EH, Park CS. Effects of a multicultural education program on the cultural competence, empathy and self-efficacy of nursing students. J Korean Acad Nurs 2013;43(5): (Korean). 16. Faul, F, Erdfelder E, Lang A, Buchner A. G*Power 3: a flexible statistical power analysis for the social, behavioral, and biomedical sciences. Behavioral Research Methods 2007;39(2): St Clair A, McKenry L. Preparing culturally competent practitioner. J Nurs Educ 1999;38(5): Han SY. Development of a cultural competence scale for nursing students [dissertation]. Chonnam National University; Korea, Rogers CR. Empathic: an unappreciated way of being. The Counselling Psychologist 1975;5: Davis MH. A multidimensional approach to individual differences in empathy. JSAS Catalog of Selected document in Psychology 1980; 10: Park SH, Lee JH, Kim FJ. Effects of the multicultural program on the promotion of cultural sensitivity in college students. Korean J Youth Stud 2011;18(6): (Korean). 22. Chun HK. Study on relationship between transcultural self-efficacy and cultural competency of nursing student for subjects with various cultural background [dissertation]. Gachon University; Korea, Jeffreys MR, Dogan E. Evaluating the influence of cultural competence education on student transcultural self-efficacy perceptions. J Transcult Nurs 2012;23(2):

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