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1 Journal of the Korea Academia-Industrial cooperation Society Vol. 16, No. 3 pp , ISSN / eissn 김미연 1* 1 수원여자대학교간호학부 Affecting Factors on Clinical Competence of Nursing Students Mi-Yeon Kim 1* 1 Department of Nursing, Suwon Women's University 요약본연구는간호대학생의임상수행능력정도를확인하고임상수행능력에미치는영향정도를파악하기위해시도되었다. 연구대상자는경기도소재의일대학간호과 2학년에재학중인학생 207 명이었으며, 자료수집기간은 2014년 8월 25일부터 9월 15일까지이었다. 연구결과임상수행능력은간호학전공만족도, 임상실습만족도에따라통계적으로유의한차이가있었으며, 전문직자아개념, 비판적사고성향, 자기주도적학습능력과유의한양의상관관계가있었다. 대상자의임상수행능력에영향을미치는요인은자기주도적학습능력, 전문직자아개념, 비판적사고성향순이었다. 본연구결과에의하면간호대학생의임상수행능력영향요인을고려한효율적인교육프로그램의개발이요구된다. Abstract The purpose of this study was to investigate the level of clinical competence and influencing factors of clinical competence in nursing students. The data was collected using questionnaire from 207 students who running the 2nd grade courses of nursing curricula in college and was performed from August 25 to September 15. In clinical competence, there were significant differences in satisfaction of major, satisfaction of clinical experience. There was a positive correlation among clinical competence and professional self-concept, critical thinking disposition and self-directed learning ability. The most effective factor on clinical competence was self-directed learning ability, followed by professional self-concept and critical thinking disposition. The study findings suggest that to develop the effective learning program with achievement level of clinical competency for nursing students. Key Words : Clinical competence, Nursing student 1. 서론 1.1 연구의필요성간호교육은질적간호를제공할수있는전문직간호사를양성하기위해이론과실습교육을병행한다. 이론이이루어지는학교교육현장은간호대학생들의간호전문직에대한긍정적자아개념을길러주고다양한간호상황에서신속하고효율적으로판단할수있는비판적사고능력을함양하여근거중심의임상수행능력을겸비 한간호사를배출해야하는과제를안고있다 [1]. 실습교육이이루어지는임상현장에서는예측과통제가불가능한실습현장의특성과기존의폐쇄적이고주입식인교수학습법으로는학습자가실습교과목의학습목표를달성하기어려우므로교수가주도하기보다학생의자기주도적인학습이필요하며 [2], 학교에서배운지식을실무현장에연계하여간호대상자를능숙하게관리할수있는임상수행능력이좋은간호사를배양하는핵심적인역할을담당하고있다 [1]. * Corresponding Author : Mi-Yeon Kim(Suwon Women's Univ.) Tel: kong-jukim@swc.ac.kr Received January 10, 2015 Accepted March 12, 2015 Revised ((1st February 3, 2015, 2nd February 12, 2015, 3rd February 17, 2015) Published March 31,
2 간호대학생의임상수행능력은간호실무상황에서적절한지식, 기술, 태도, 판단을통해능숙하게역할을수행할수있는능력을의미한다 [3]. 최근임상상황은의료기술의발전, 재원일수의감소, 인구의노령화, 질병의복잡한변화와중증환자의증가등보건의료환경의변화와다양한대상자특성으로인해간호대학생에게보다전문성이높은임상수행능력을요구하고있다 [2]. 그러나최근연구결과에서환자의질적간호요구와간호사고위험으로인한현장실습의제한성으로 70% 이상의학생들이활력징후와관찰등비침습적인기본간호위주의임상실습을진행하고있어우리나라대부분의간호대학생들은임상실습전과정동안신규간호사로서의역할을수행하기에충분한실습경험을하지못한것으로나타났다 [4]. 따라서간호대학생이졸업후핵심간호능력을갖추도록하기위해서는먼저임상수행능력을높일수있는여러가지요인을확인하고임상실습교육에반영하며, 실습목표의달성을확인할수있는평가및임상실습교육프로그램의개발로이어져야한다 [5]. 전문직자아개념은전문직업인으로서의자기자신에대한정신적지각을말하며, 학교에서의교육과전문직사회즉직장생활을통하여향상된다 [6]. 전문직자아개념이높은간호사는자존감과자신에대한자아개념도향상되어간호전문직의발전을가져오며, 전문직자아개념이낮은간호사는간호의생산성이저하된다 [7]. 따라서긍정적자아개념의형성은업무의만족을주며, 전문직간호사로가는과정에있는간호대학생들의임상수행능력을향상시킨다고하며, 이러한자아개념은임상교수나선배간호사등의모델을통해형성된다고보고되고있다 [8]. 임상수행능력에영향을미치는중요한개념으로비판적사고가강조되고있다 [1]. 비판적사고는창의적사고와올바른평가와판단을통한문제해결을위한합리적이고논리적인사고이다 [9]. 현재의간호교육은주어진상황에서비판없이간호실무를수행하는것이아니라정보를적용, 분석, 종합, 추론하며, 의사결정시효율적으로판단하고자기의견을논리적으로제시할수있는능력과이러한능력을사용하고자하는성향을갖춘간호인재를길러내도록요구받고있다 [10]. 따라서우리간호교육에서는비판적사고를중요한간호교육목표로인식하고있으며, 간호대학생이교육과정을통해습득해야할핵심간호능력의하나로그중요성을강조한다. 자기주도적학습이란학습자스스로학습의필요성진단, 학습목표설정, 자원의선택, 적절한학습전략수행및학습결과를평가하는학습자주도의과정으로정의된다 [11]. 간호대학생의실습교육은실무현장에서부딪히는다양한상황에효과적으로대처해야하므로학생들스스로능동적으로학습하는자기주도적학습이필요하다고하였다 [12]. 또한자기주도적학습은학습자의문제해결능력을배양하는데영향을미치므로임상실습에서도임상문제를해결할수있는기술과경험을연결시킨다고보고하였다 [13]. 이에본연구는간호대학생의임상수행능력에대한영향요인으로서전문직자아개념, 비판적사고성향과자기주도적학습능력을알아보고관계성을파악하여이를토대로변화되어가는간호현장에서간호대학생들의임상수행능력을향상시킬수있는교육과정개발의기초자료를제공하고자시도되었다. 1.2 연구의목적본연구의목적은간호대학생의임상수행능력에미치는영향을파악하여간호대학생들의임상수행능력을향상시키기위한교육을확립하기위한기초자료를제공하기위함이며, 구체적인목적은다음과같다. 첫째, 간호대학생의전문직자아개념, 비판적사고성향, 자기주도적학습능력및임상수행능력을파악한다. 둘째, 간호대학생의일반적특성에따른전문직자아개념, 비판적사고성향, 자기주도적학습능력과임상수행능력의차이를파악한다. 셋째, 간호대학생의전문직자아개념, 비판적사고성향, 자기주도적학습능력및임상수행능력간의상관관계를파악한다. 넷째, 간호대학생의임상수행능력에영향에미치는요인을파악한다. 2. 연구방법 2.1 연구설계본연구는간호대학생의전문직자아개념, 비판적사고성향, 자기주도적학습능력이임상수행능력에미치는영향정도를파악하기위한서술적조사연구이다. 2.2 연구대상본연구의대상자는경기도수원시에소재한 3년제여 1885
3 한국산학기술학회논문지제 16 권제 3 호, 2015 자대학 2학년에재학중인학생으로 1학기이상의임상실습을경험한학생이며, 연구대상자의윤리적측면을고려하여연구목적, 익명성의보장, 연구참여자로서의권리에대해설명한후연구에참여하기로동의한 207명을편의추출하였다. 연구대상자수는 G* power 공식에의하여검정력.80, 유의수준.05, 효과크기.15으로계산하였을때 128명이산출되어, 본연구자수 207명은필요한표집수를충족하였다. 2.3 연구도구 전문직자아개념전문직자아개념도구는 Arthur[7] 가개발한전문직자아개념도구를간호대학생에게적합하도록수정한 Seo[14] 의도구를사용하였다. 전문직자아개념의영역은전문적실무, 만족감, 의사소통의총 27문항으로구성되었으며, 4점척도의자가보고도구로이중 7문항은부정적문항으로점수를역으로환산하였다. 그렇지않다 1점에서 그렇다 4점으로구성되었으며, 점수가높을수록전문직자아개념정도가높음을의미한다. Seo[14] 의연구에서신뢰도는 Cronbach s α=.85이었으며, 본연구에서의신뢰도는 Cronbach s α=.85이었다 비판적사고성향비판적사고성향의측정도구는 Yoon[15] 이개발한도구로사용하였다. 총 27문항으로 7개의하부영역으로구성되었다. 하부영역은지적열정 / 호기심 5문항, 신중성 4 문항, 자신감 4문항, 체계성 3문항, 지적공정성 4문항, 건전한회의성 4문항, 객관성 3문항으로이루어져있다. 각문항은 5점척도의자가보고도구로 전혀그렇지않다 1점, 매우그렇다 5점으로구성되었으며, 점수가높을수록비판적사고성향이높음을의미한다. 이중 2문항은부정적문항으로점수를역으로환산하였다. 도구개발당시신뢰도 Cronbach s α=.84 이었으며, 본연구에서의신뢰도는 Cronbach s α=.87이었다 자기주도적학습능력자기주도적학습능력의측정도구는 Lee[16] 가개발한도구로사용하였다. 총 45문항으로능력요소는학습계획, 학습실행, 학습평가로구성되고, 하위요소는학습욕구진단, 학습목표설정, 학습을위한자원파악, 기본적자기관리능력, 학습전략의선택, 학습실행의지속성, 결과에대 한노력귀인, 자기성찰로구성되어있다. 각문항은 5점척도의자가보고도구로 매우드물게 1점, 매우자주 5 점으로구성되었으며, 점수가높을수록자기주도적학습능력이높음을의미한다. 도구개발당시신뢰도 Cronbach s α=.94 이었으며, 본연구에서의신뢰도는 Cronbach s α=.93이었다 임상수행능력임상수행능력측정도구는 Lee[17] 가개발하고 Choi[18] 가수정 보완한것을사용하였다. 임상수행능력에관한 5 개영역은간호과정 11문항, 간호기술 11문항, 교육 / 협력관계 8문항, 대인관계 / 의사소통 6문항, 전문직발전 9문항등의총 45문항으로구성되었다. 5점척도의자가보고도구로 매우못한다 1점, 매우잘한다 5점으로구성되었으며, 점수가높을수록임상수행능력이높음을의미한다. Choi[18] 의연구에서신뢰도는 Cronbach s α=.92이었으며, 본연구에서의신뢰도는 Cronbach s α=.96이었다. 2.4 자료수집방법자료수집은 2014년 8월 25일부터 9월 15일까지총 207명을대상으로설문지를배포하여 207명모두에게설문지를회수하였다. 대상자는연구자가소속된 3년제여자대학에재학중인학생으로연구자또는연구보조원이직접대상자에게연구목적, 익명성의보장, 연구참여자로서의권리, 설문지작성중언제라도연구의참여를포기할수있음을설명한후연구에참여하기로동의한학생에게서면동의를받고자료를수집하였다. 설문지작성에소요된시간은 15-20분정도이였으며, 회수한설문지중불충분한설문지 17부를제외하고최종 190명의자료가분석되었다. 2.5 자료분석방법수집된자료는 SPSS 19.0 Version 을사용하여분석하였다. 대상자의일반적특성은실수와백분율로분석하였고, 전문직자아개념, 비판적사고성향, 자기주도적학습능력, 임상수행능력의정도는평균및표준편차로분석하였다. 대상자의일반적특성에따른전문직자아개념, 비판적사고성향, 자기주도적학습능력, 임상수행능력차이를분석하기위해 t-test 로분석하였고, 전문직자아개념, 비판적사고성향, 자기주도적학습능력, 임상수행능력의상관관계는 Pearson s correlation coefficients 로분석하였다. 대상자의임상수행능력에영향을미치는 1886
4 요인을알아보기위해단계별다중회귀분석을실시하였다. 3. 연구결과 3.1 대상자의일반적특성 본연구대상자의연령은 25세미만이 171명 (90.0%) 으로대다수를차지하였고, 종교는 없음 으로응답한학생이 103명 (54.2%) 이었다. 간호학전공에대한만족도는 107명 (56.3%) 이 만족 으로응답하였고, 임상실습만족도는 118명 (62.1%) 이 불만족 으로응답하였다 [Table 1]. [Table 1] General characteristic of the participants (N=190) Characteristics Categories n(%) Age(yr) <25 171(90.0) 25 19(10.0) Religion Yes 87(45.8) No 103(54.2) Satisfaction with nursing Satisfaction 107(56.3) No satisfaction 83(43.7) Satisfaction with clinical Satisfaction 72(37.9) practice No satisfaction 118(62.1) 3.2 대상자의전문직자아개념, 비판적사고성향, 자기주도적학습능력및임상수행능력본연구대상자의전문직자아개념, 비판적사고성향, 자기주도적학습능력및임상수행능력정도는다음과같다. 전문직자아개념은 4점만점에평균 2.85점이었고, 영역별로는만족감 2.99점, 융통성 2.89점, 기술 2.88점, 지도력 2.71점, 의사소통 2.63점순이었다. 비판적사고성향은 5점만점에평균 3.66점이었고, 영역별로는지적공정성 4.07점, 객관성 3.95점, 지적열정 / 호기심 3.67점, 건전한회의성 3.66점, 자신감 3.56점, 신중성 3.49점, 체계성 3.16점순이었다. 자기주도적학습능력은 5점만점에평균 3.51점이었고, 영역별로는학습평가 3.66점, 학습실행 3.63점, 학습계획 3.35점순이었다. 간호대학생의임상수행능력은 5점만점에평균 3.47점이었고, 영역별로는전문직발전 3.54점, 대인관계 / 의사소통 3.53점, 교육 / 협력관계 3.50점, 간호과정 3.46점, 간호기술 3.36순으로나타났다 [Table 2]. [Table 2] Professional self-concept, critical thinking disposition, self-directed learning ability and clinical competence of the subjects (N=190) Variables Mean±SD Min Max Range Professional self-concept 2.85± Professional practice 2.84± Leadership 2.71± Flexibility 2.89± Skill 2.88± Satisfaction 2.99± Communication 2.63± Critical thinking disposition 3.66± Intellectual passion/curiosity 3.67± Discretion 3.49± Self-confidence 3.56± Systemicity 3.16± Intellectual fairness 4.07± Sound doubt 3.66± Objectivity 3.95± Self-directed learning ability 3.51± Learning plan 3.35± Learning practice 3.63± Learning evaluation 3.66± Clinical competency 3.47± Nursing process 3.46± Nursing skill 3.36± Teaching/Coordinating 3.50± Interpersonal relationship/ communication 3.53± Professional development 3.54±
5 한국산학기술학회논문지제 16 권제 3 호, 2015 [Table 3] Professional self-concept, critical thinking disposition, self-directed learning ability and clinical competence the subjects according to general characteristics (N=190) Self-directed Professional Critical thinking learning Variables Categories self-concept disposition ability Clinical competence Mean±SD t(p) Mean±SD t(p) Mean±SD t(p) Mean±SD t(p) Age(yr) < ± ± ± ± ±0.42 (.420) 3.88±0.58 (.082) 3.78±0.63 (.013) 3.56±0.57 (.371) Religion Yes 2.91± ± ± ± No 2.79±0.34 (.012) 3.62±0.39 (.156) 3.46±0.47 (.100) 3.43±0.52 (.209) Satisfaction with Satisfaction 3.00± ± ± ± nursing Non satisfaction 2.64±0.29 (.000) 3.55±0.40 (.001) 3.32±0.43 (.000) 3.32±0.48 (.000) Satisfaction with Satisfaction 3.04± ± ± ± clinical practice Non satisfaction 2.73±0.32 (.000) 3.60±0.42 (.012) 3.43±0.49 (.002) 3.38±0.50 (.002) 3.3 일반적특성에따른전문직자아개념, 비판적사고성향, 자기주도적학습능력및임상수행능력대상자의일반적특성에따른전문직자아개념, 비판적사고성향, 자기주도적학습능력및임상수행능력의차이는 [Table 3] 과같다. 전문직자아개념은종교, 간호학전공만족도, 임상실습만족도에따라통계적으로유의한차이가있었다. 종교가있는학생이없는학생보다높고 (t=2.53, p=.012), 간호학전공에 만족 으로응답한학생이 불만족 으로응답한학생보다높게나타났으며 (t=8.75, p=.000), 임상실습에 만족 으로응답한학생이 불만족 으로응답한학생보다높게나타났다 (t=7.44, p=.000). 그러나연령에따른전문직자아개념의차이는통계적으로유의하지않았다. 비판적사고성향은간호학전공만족도, 임상실습만족도에따라통계적으로유의한차이가있었다. 간호학전공에 만족 으로응답한학생이 불만족 으로응답한학생보다높게나타났고 (t=3.29, p=.001), 임상실습에 만족 으로응답한학생이 불만족 으로응답한학생보다높게나타났다 (t=2.53, p=.012). 그러나연령과종교에따른전문직자아개념의차이는통계적으로유의하지않았다. 자기주도적학습능력은연령, 간호학전공만족도, 임상실습만족도에따라통계적으로유의한차이가있었다. 25세이상의연령이 25세미만보다높고 (t=-2.51, p=.013), 간호학전공에 만족 으로응답한학생이 불만족 으로응답한학생보다높게나타났으며 (t=4.98, p=.000), 임상실습에 만족 으로응답한학생이 불만족 으로응답한학생보다높게나타났다 (t=3.11, p=.002). 그러나종교에따른 자기주도적학습능력의차이는통계적으로유의하지않았다. 임상수행능력은간호학전공만족도, 임상실습만족도에따라통계적으로유의한차이가있었다. 간호학전공에 만족 으로응답한학생이 불만족 으로응답한학생보다높게나타났고 (t=3.63, p=.000), 임상실습에 만족 으로응답한학생이 불만족 으로응답한학생보다높게나타났다 (t=3.09, p=.002). 그러나연령, 종교에따른임상수행능력의차이는통계적으로유의하지않았다. 3.4 대상자의전문직자아개념, 비판적사고성향, 자기주도적학습능력및임상수행능력간의상관관계대상자의임상수행능력은전문직자아개념 (r=..570, p=.000), 비판적사고성향 (r=.586, p=.000), 자기주도적학습능력 (r=.682, p=.000) 과유의한양의상관관계가있었다. 즉, 전문직자아개념, 비판적사고성향, 자기주도적학습능력이높을수록임상수행능력이높았다. 또한전문직자아개념은비판적사고성향 (r=.545, p=.000), 자기주도적학습능력 (r=.605, p=.000) 과유의한양의상관관계를나타냈으며, 비판적사고성향은자기주도적학습능력 (r=.732, p=.000) 과유의한양의상관관계를나타냈다 [Table 4]. 3.5 대상자의임상수행능력에영향을미치는요인대상자의임상수행능력에영향을미치는요인을파악하기위해임상수행능력을종속변수로하고대상자의일 1888
6 [Table 4] Correlation of professional self-concept, critical thinking disposition, self-directed learning ability and clinical competence (N=190) Variables Professional self-concept Critical thinking Self-directed learning disposition ability Clinical competency Professional self-concept 1 Critical thinking disposition.545 (p=.000) 1 Self-directed learning ability.605 (p=.000).732 (p=.000) 1 Clinical competency.570 (p=.000).586 (p=.000).682 (p=.000) 1 [Table 5] Factors influencing of clinical competence (N=190) Variables B SE β t p Adjusted R² F(p) Self-directed learning ability (.000) Professional self-concept Critical thinking disposition 반적특성에서유의한차이를나타낸간호학전공만족도, 임상실습만족도와임상수행능력과유의한상관관계가나타난전문직자아개념, 비판적사고성향, 자기주도적학습능력을독립변수로하여단계별다중회귀분석을실시하였다. 독립변수들간의다중공선성의문제를확인한결과공차한계 (tolerance) 는 로모두 1.0 이하로나타났으며, 분산팽창인자 (variance inflation factor) 는 으로기준인 10이상을넘지않아다중공선성의문제는없는것으로나타났다. 임상수행능력에영향을미치는요인은자기주도적학습능력, 전문직자아개념, 비판적사고성향이통계적으로유의한영향요인으로나타났고 (F=57.610, p=.000), 회귀모형의설명력은 44.7% 였다. 이중에서자기주도적학습능력이가장큰예측요인으로확인되었다. [Table 5]. 4. 논의본연구는간호대학생의전문직자아개념, 비판적사고성향, 자기주도적학습능력이임상수행능력에영향을미치는정도를파악하여임상수행능력을높이기위한방안을모색하고자수행하였다. 본연구에서간호대학생의전문직자아개념은 4점만점에평균 2.85점으로같은도구를사용한 Lee[8] 의연구결과 (2.71점) 보다높은수준의결과가나왔으나 Shin[1] 의연구결과 (2.91 점 ) 보다는낮게나왔다. 하위요인별점 수의순위는만족감 2.99점, 전문적실무 2.88점, 의사소통 2.63점의순으로나타나의사소통, 전문적실무, 만족감의순으로나타난 Shin[1] 의연구결과와차이가있었다. Lee[8] 의연구대상자는간호사로서 11개국간호사의전문직자아개념을비교한 Arthur[7] 의연구에서한국이가장낮았다는연구결과를지지해주며우리나라간호사의전문직자아개념을고취시키는다양한정신교육이나훈련등이필요함을시사한다. 또한전문직자아개념이경력이쌓여감에따라낮아지는것을예방하기위하여간호지도자들스스로가좋은역할모델이되어야하며간호대학생및간호사들이긍정적인자아개념을확립할수있도록교육, 연구, 실무측면에서적극지원해야함을나타낸결과였다. 간호대학생을대상으로한 Shin[1] 의연구대상자는본연구의대상자보다학년이높고실습경험이많았는데이는간호대학생들의경우학년이높아짐에따른전문직자아개념의저하가없는것으로나타나간호실무현장에서의제도개선과지도자의역할이중요함을시사한다. 또한본연구에서는선행연구에서보다만족감의순위가높았는데이는실습환경의차이가있었고, 학년이올라감에따라실습에대한요구도가높아져연구결과의차이가있는것으로사료된다. 또한전문적실무영역은본연구뿐만아니라선행연구에서도낮은순위로나타났으므로이를보완하기위하여교내실습강화및실습현장에서의교육적역량강화등다양한프로그램의개발이필요함을시사한다. 간호대학생의비판적사고성향은 5점만점에평균 3.66점으로간호대학생을대상으로같은도구를사용한 1889
7 한국산학기술학회논문지제 16 권제 3 호, 2015 Chaung[19] 의 3.57점, Yang[20] 의 3.42점보다높은수준의결과가나왔다. 하위영역별로보면지적공정성 4.07 점이가장높게나타났으며, 객관성 3.95점, 지적열정 / 호기심 3.67점, 건전한회의성 3.66점, 자신감 3.56점, 신중성 3.49점, 체계성 3.16점의순으로나타났다. 간호대학생을대상으로한 Yang[20] 의연구에서는지적공정성 3.63 점, 객관성 3.59점, 지적열정 / 호기심 3.44점, 자신감 3.44 점, 건전한회의성 3.38점, 신중성 3.24점, 체계성 3.17점의순으로나타났고, Chaung[19] 의연구에서는객관성 3.95점, 지적공정성 3.79점, 건전한회의성 3.65점, 자신감 3.60점, 지적열정 / 호기심 3.53점, 신중성 3.29점, 체계성 3.19점의순으로나타나약간의차이가있지만지적공정성과객관성이높다는것과신중성과체계성이낮다는것은같은결과이었다. 이와같은결과는최근의간호교육이근거중심을강조하여타당한근거를토대로결론을도출하려는객관성은강화되었지만조직적이고체계적으로탐구하여결론에도달하는능력이부족하다여겨지므로비판적사고를향상시킬수있는교수법의적용과교육환경의변화가필요하다고생각된다. 자기주도적학습능력은 5점만점에평균 3.51점으로간호대학생을대상으로한 Park[21] 의연구결과 (3.38점 ) 와 Park[22] 의연구결과 (3.39 점 ) 보다높았고, Kwon[2] 의연구결과 (3.51 점 ) 와같았으며, Yang[23] 의연구결과 (3.59 점 ) 보다는낮은결과를나타내었다. 자기주도적학습능력의하위영역은학습평가 3.66점, 학습실행 3.63점, 학습계획 3.35점순으로나타났다. 간호학생을대상으로한 Park[21] 의연구에서학습평가 3.47점, 학습실행 3.41점, 학습계획 3.27점, Park[22] 의연구에서학습실행 3.53점, 학습평가 3.51점, 학습계획 3.23점으로나타난결과와비교할때학습계획이가장낮았던결과는유사하였다. 본연구에서학습계획이가장낮았던결과는개인스스로의학습요구를진단하고목표를설정하여이를달성하도록필요한인적, 물적자원을선택하는학습계획능력이낮음을나타낸다 [16]. Park [24] 의연구에서는학년이올라감에따라대학생활이익숙해지고중 고등학교시절보다다양한경험을하며의사결정에서의자율성과독립성이보장되어자기주도학습능력이높아진다하였는데이는본연구의대상자들은대학교 2학년학생으로학년이올라갈수록좋아질수있다는긍정적결과를예측할수있게하지만대학교육과정에서도자기주도적학습능력을향상시킬수있도록다양한프로그램의개발및제공이 필요하다생각된다. 임상수행능력은 5점만점에평균 3.47점으로간호대학생을대상으로한 Shin[1] 의연구결과 (3.45점 ) 보다높았고, Park[22] 의연구결과 (3.49점 ) 보다는낮게나왔다. 다소차이는있으나연구대상자의표집차이에서오는것으로볼수있고전반적으로는비슷한수준이었다. 하위영역을보면전문직발전 3.54점, 대인관계 / 의사소통 3.53 점, 교육 / 협력관계 3.50점, 간호과정 3.46점, 간호기술 3.36 점순으로나타나전문직발전영역이가장높았다. 이는 Shin[1], Park[22] 의연구결과에서전문직발전영역이가장높고간호과정, 간호기술의영역이낮게나타난것과일치하였다. 이러한연구결과는최근임상환경의변화로환자권리와질적인의료서비스요구가증가하면서학생들의임상실습이관찰위주와단순영역의기술적인분야에치중되고있어임상수행의경험을저하시켜오는결과라사료된다. 따라서간호대학생의핵심간호술기능력을높일수있는교내시뮬레이션의활성화, 통합실습등다양한프로그램의개발과적용이필요함을시사한다. 간호대학생의전문직자아개념은종교, 간호학전공만족도, 임상실습만족도특성에따라유의한차이가있었다. 종교가있고, 간호학전공만족도와임상실습만족도에 만족 으로응답한경우가 불만족 으로응답한경우보다유의하게높았다. 비판적사고성향은간호학전공만족도, 임상실습만족도특성에따라유의한차이가있었다. 간호학전공만족도에 만족 으로응답한경우, 임상실습만족도에 만족 으로응답한경우에서비판적사고성향이높은것으로나타났다. 또한자기주도적학습능력은연령, 종교, 간호학전공만족도, 임상실습만족도특성에따라유의한차이가있었다. 연령이높고, 종교가있으며, 간호학전공만족도와임상실습만족도에 만족 으로응답한경우에서자기주도적학습능력이높은것으로나타났다. 이러한결과는연령의증가에따라자기주도적학습능력이향상된다는 Park[24] 의연구결과를지지하며, 긍정적사고성향을가진학생이전문직자아개념, 비판적사고성향과자기주도적학습능력에서높은점수를얻었음을나타내므로간호대학생들이긍정적가치관을형성할수있도록도와주는멘토링제도, 교내동아리활동, 교양교육과정의편성등다각적인노력이필요하다고본다. 대상자의임상수행능력과전문직자아개념, 비판적사고성향및자기주도적학습능력간의상관관계는양의상 1890
8 관관계를나타냈다. 간호대학생의전문직자아개념, 비판적사고성향및자기주도적학습능력정도가높을수록임상수행능력정도가높고, 비판적사고성향, 자기주도적학습능력정도가높을수록전문직자아개념이높으며, 자기주도적학습능력정도가높을수록비판적사고성향정도가높은것으로나타났다. 간호대학생의임상수행능력에영향을미치는변수는자기주도적학습능력, 전문직자아개념, 비판적사고성향순으로유의한영향을미치고있는것으로나타났다. 이는간호대학생을대상으로한 Kwon[25], Jang[26] 의연구결과와부분적으로일치하여본연구의결과를지지해주었다. 또한본연구에서자기주도적학습능력이임상수행능력에유의한영향을미치고있는것으로나타난반면 Yang[5] 의연구에서는자기주도적학습능력이임상수행능력에유의한영향을미치지않는다고보고하여본연구와다른결과를나타내었다. 이는연구대상자와도구의차이가있고, Yang[5] 의연구에서자기주도적학습능력이임상수행능력에영향을미치는변수에서는제외되었지만정적상관관계가있었음을감안할때향후임상수행능력의향상을위해자기주도적학습능력을강화시킬필요가있다고생각된다. 이상의연구결과를통해전문직자아개념, 비판적사고성향, 자기주도적학습능력은임상수행능력과유의한양의상관관계가있음을확인하였다. 또한임상수행능력에영향을주는변수는자기주도적학습능력, 전문직자아개념, 비판적사고성향순임을확인하였다. 본연구결과를토대로간호대학생의임상수행능력을향상시키기위해역할극을활용한실습교육이간호대학생의자기주도적학습능력향상에도움이된다고사료된다. Kim[27] 의연구결과에의하면역할극을활용한실습교육과자기주도적학습능력이유의한정적상관관계가있으며, 역할극은학생들에게수기술증진과더불어학습에대한긍정적인태도와각역할에대한감정이입으로이론과실무를연계하는데효과적인교수전략이라하였다. 또한신규간호사교육에널리활용되고있는프리셉터쉽교육을간호대학생의임상실습에활용하는것이임상수행능력향상에도움이된다고사료된다. Hickey[28], Hong[29] 의연구에서는학생들의프리셉터쉽실습교육이이론과실무의차이를줄이며임상실무능력을향상시키는방법이라고평가하였으며, Lee[30] 의연구에서도프리셉터쉽에의해실습한학생이임상수행능력과임상 실습만족도가높았고비판적사고능력향상에도도움이된다고보고하였다. 따라서대학과실습기관의주기적이고지속적인산학간담회를통해학생에대한간호사의교육자적역할을강조할필요가있으며, 학교교육현장에서는역할극및시뮬레이션활용교육, 통합실습등을통하여임상실무능력이향상될수있도록교내실습이강화되어야할것이다. 5. 결론및제언본연구는간호대학생의전문직자아개념, 비판적사고성향, 자기주도적학습능력과임상수행능력의관련성을규명하고임상수행능력에영향을미치는변인을확인하고자시도되었다. 연구결과임상수행능력은전문직자아개념, 비판적사고성향, 자기주도적학습능력과유의한양의상관관계가있었고, 대상자의임상수행능력에영향을미치는요인은자기주도적학습능력, 전문직자아개념, 비판적사고성향순으로나타났음을확인하였다. 본연구결과를토대로다음을제언하고자한다. 첫째, 자기주도적학습능력이임상수행능력에중요한변수로나타났으므로자기주도적학습능력을향상시키기위한간호교육과정을개발하고그효과를확인하는연구가진행될것을제언한다. 둘째, 본연구의대상자가임상실습을 1학기만이수한 1개대학의간호대학생이므로결과의일반화에신중을가하여야하겠다. References [1] K. A. Shin, B. H. Cho, "Professional self-concept, critical thinking disposition and clinical competence in nursing students", The Journal of Korean Academic Society of Nursing Education, 19(3), pp , DOI: [2] M. S. Kwon, "The influence of self-directed learning and critical thinking disposition on clinical competence in nursing students", The Journal of Korean Academic Society of Nursing Education, 17(3), pp , DOI: [3] C. Barrett, F. Myrick, "Job satisfaction in preceptorship and its effect on the clinical performance of the 1891
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10 , DOI: [27] Y. H. Kim, y. M. Lee, "Relationship of learning motivation, self-directed learning ability and problem solving process of nursing students after practice evaluation of fundamentals of nursing course using role play", Journal of the Korea Academia-Industrial Cooperation Society, 13(1), pp , DOI: [28] M. T. Hickey, "Baccalaureate nursing graduates preceptions of their clinical instructional experiences and preparation for practice", Journal of Professional Nursing, 21(1), pp , DOI: [29] S. J. Hong, E. H. Kim, "Effects of preceptorship on nursing students clinical competency, stress of clinical practice and practice satisfaction in clinical practice", Journal of the Korea Academia-Industrial Cooperation Society, 15(10), pp , DOI: [30] J. D. Lee, C. S. Lee, The effects of preceptorship on nursing students critical thinking propencity, clinical competency and satisfaction of clinical practice, Journal of Korean Academy of Nursing Administration, 12(3), pp , 김미연 (Mi-Yeon Kim) [ 정회원 ] 2011 년 2 월 : 아주대학교대학원간호학과 ( 간호학석사 ) 2014 년 3 월 현재 : 수원여자대학교간호학과조교수 < 관심분야 > 성인간호, 중환자 1893
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