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1 Vol.7, No.2, February (2017), pp 간호대학생들의응급시뮬레이션간호수행영향요인 일반임상수행능력비판적사고디브리핑만족도를중심으로 최은희 곽윤경 요약 본연구는응급시뮬레이션상황에서간호대학생들의문제해결능력비판적사고디브리핑만족도가간호수행능력에미치는영향을파악하기위한목적으로수행되었다연구대상자들은시소재일대학의간호대학생학년명이었다대상자들은시뮬레이션실습전실험에대한전반적인설명을듣고시뮬레이션실습후설문지를작성하였다간호수행평가는학생이시뮬레이션상황에서간호수행을하는동안명의평가자가수행평가표에따라수행하였다수집된자료는프로그램을이용하여빈도분석분석을하였다연구결과응급시뮬레이션상황속의간호학생들의간호수행능력은일반임상수행능력비판적사고디브리핑만족도와유의한상관관계가있는것으로나타난반면일반적특성및문제해결능력은유의한상관관계가나타나지않았다회귀분석결과비판적사고와일반임상수행능력은간호수행에유의한영향을끼치지못하였으며디브리핑만족도의설명력도로시뮬레이션상황에서의간호수행을설명하기에는부족하였다핵심어임상수행능력비판적사고간호수행문제해결디브리핑 Abstract The purpose of this study was to find out factors affected to nursing performances of nursing students in simulation emergency situation. Participants had heard general explanation about this experimental research and did practice under emergency simmulation. After that, they did their answer to questionnarires. The evaluation of nursing performances capacity were done by a supervisor with checklist. Data were analyzed by SPSS 21.0 program using by t-test, ANOVA, scheffe test, pearson correlation coefficient, multiple regression. The results were that nursing performances in the simulation situation did not relate to Received (December 6, 2016), Review Result (December 20, 2016) Accepted (December 27, 2016), Published (February 28, 2017) Copyright 2017 HSST 505

2 general characteristics and problem solving but related with problem solving, critical thinking and debriefing satisfaction related to nursing performances in simulation situation, simulation debriefing satisfaction was only affecting factor by regression analysis. But problem solving and critical thinking were not affecting factors and debriefing satisfaction s coefficient of determination was 5.5%, it was not enough to describe of nursing performances with simulation debriefing satisfaction. Keywords: Clinical competency, Critical thinking, Nursing performance, Problem solving, Debriefing 서론 졸업이후숙련된간호사로실수나과오없이능숙하게대상자를돌보도록기대되어지는간호대학생들에게배운이론을실제상황에적용하는임상현장실습은매우중요하지않을수없다그러나대상자들의소비자적권리가존중되어지고현재의임상현장을고려할때간호대학생들이실제대상자들에게배운간호기술과지식을적용하고반복적으로훈련되는것은많은한계가있다특히응급상황은그특성상작은실수만으로도환자의생명에치명적손상을줄수있으므로더욱중요한실습상황이지만같은이유로현장실습의한계가크기때문에안전성과반복성을근거로세뮬레이션을통한응급간호임상실습이증가되고있다선행연구들은시뮬레이션기반응급간호교육이관련지식과술기를학습할수있는유용한방법으로수행자신감을높이고지식임상수행능력및문제해결능력향상에영향을미치는것으로보고하여시뮬레이션교육이임상간호수행능력을향상시킬수있는교육방법임을시사하였으나응급시뮬레이션교육에서임상수행능력에영향을미치는요인을파악한연구는찾아보기어렵다이에본연구는시뮬레이션교육관련선행연구들에서제시된임상수행능력영향요인인학업성취수준과실습만족도문제해결능력과비판적사고능력과디브리핑만족도가간호대학생들의응급간호시뮬레이션간호수행에미치는영향을파악하고자수행되었다 연구대상 연구방법 본연구는시소재일대학간호학과의학년학생명중연구목적을이해하고동의서에서명함으로써연구에참여하기를승낙한자를명을대상으로하였다 연구도구 간호수행대한심폐소생협회에서출간된응급상황시대처에대한평가표를수정보완하여간호교육경력 506 Copyright 2017 HSST

3 년이상교수인의내용타당도검사에서 Vol.7, No.2, February (2017) 이상인문항을선택하였다 문제해결능력한국교육개발원에서가개발한생애능력측정도구중대학생성인용문제해결능력진단지를사용했으며문항인본척도의개발당시및본연구에서의신뢰도는이었다 비판적사고이개발한지적통합창의성도전성개방성신중성객관성진실추구탐구성영역의총문항으로구성된점척도로연구에서의신뢰도는각각및이었다 일반적임상수행능력등이일반간호사에게분야에관계없이기본적인간호실무수행능력을파악하기위해개발한척도를사용했고개문항의본척도는개발당시및본연구신뢰도가이었다 시뮬레이션디브리핑만족도시뮬레이션디브리핑만족도는 가개발한 문항도구로측정하였다 점수가높 을수록만족도가높은것을의미하며개발당시및본연구에서의도구신뢰도는 이었다 자료수집 시뮬레이션교육은연구자가개발한심정지대상자간호사례를적용한시나리오를활용하였다대상자들은시뮬레이션실습전실험에대한전반적인설명을듣고시뮬레이션실습후설문지를작성하였다간호수행평가는시뮬레이션상황에서간호학과학생의간호수행여부에따라명의평가자가수행평가표에따라수행하였다 자료분석방법 수집된자료는을이용하여전산처리하였으며다음과분석하였다대상자의일반적특성과임상수행능력관련제변수는실수와백분율평균과표준편차로분석하였다일반적특성과임상수행능력관련특성에따른응급시뮬레이션상황에서의간호수행능력은와로분석하였다변수간상관관계는로분석하였다대상자의응급시뮬레이션상황에서의간호수행능력에영향을미치는변수는으로분석하였다 Copyright 2017 HSST 507

4 연구결과 대상자의일반적특성및주요변수 대상자의평균연령은 세이었으며여성이 명으로전체의 를차지하였다종교가 없는군이 명 이었다전공만족도가중이상으로높은대상자가 명 이었 으며인간관계는 명 가중이상으로나타났다 간호수행능력관련변수중문제해결능력은점만점에평균 점으로중간이상으로나타났 다비판적사고능력은점만점에평균 점으로중간이상으로나타났다임상수행능력은점 만점에평균 점으로중간이상으로나타났다디브리핑만족도는점만점에평균 점으로 높게나타났다 표 일반적특성 Gender Religion Satisfaction in major Personal relation Academic performance Satisfaction in clinical practice Characteristics N(%) or M±SD Age 22.62±3.32 Male 8( 4.3) Female 178(95.7) Yes 59(31.7) No 127(68.3) High 95(51.1) Moderate 89(47.8) Low 2( 1.1) Good 109(58.6) Moderate 77(41.4) Bad 0( 0.0) ( 5.9) (42.5) (44.1) <3.0 14( 7.5) High 64(34.4) Moderate 120(64.5) Low 2( 1.1) Problem solving 3.66±0.38 Critical thinking 2.83±0.28 Clinical competency 3.04±0.27 Debriefing satisfaction 4.43± Copyright 2017 HSST

5 Vol.7, No.2, February (2017) 일반적특성및간호수행관련제변수에따른간호수행능력의차이 대상자의성별종교전공에따른만족도및인간관계에따른응급시뮬레이션상황에서의간호수행능력은차이가없는것으로나타났다대상자의간호수행능력관련변수중학업성적임상실습에서의만족도에따라서는응급상황에서의간호수행능력에유의한차이가나타나지않았다문제해결능력비판적사고임상수행능력및시뮬레이션디브리핑만족도의경우평균이상과이하에따른간호수행능력을확인한결과임상수행능력과디브리핑만족도가유의한차이가나타났다 표 일반적특성및간호수행능력관련제변수와관련된간호수행능력차이 Characteristics Nursing performances M±SD t or F p Gender Religion Satisfaction in major Personal relation Academic performance Satisfaction in clinical practice Problem solving Critical thinking Clinical competency Debriefing satisfaction Male 19.13±3.04 Female 19.35±2.68 Yes 19.09±2.72 No 19.88±2.54 High 19.46±2.56 Lower than moderate 19.22±2.81 Good 19.60±2.61 Lower than moderate 18.99± ± ± ±2.89 < ±2.87 High 19.73±2.32 Lower than moderate 19.14± ±2.95 < ± ±2.93 < ± ±3.07 < ± ±2.82 < ± < Copyright 2017 HSST 509

6 간호수행능력관련변인상관관계 시뮬레이션상황에서의간호수행능력과대상자의일반적특성간호수행관련변인인문제해결능력비판적사고임상수행능력과시뮬레이션디브리핑만족도와의관계를확인한결과일반적특성과는유의한상관관계가나타나지않았다임상수행능력관련변수중비판적사고과임상수행능력과시뮬레이션디브리핑만족도가유의한상관관계가나타났다 표 간호수행능력관련변인들간상관성 Variables Nursing performance r(p) General Clinical competency.16(.025) Critical thinking.22(.002) Debriefing satisfaction.25(.001) 간호수행능력영향요인 시뮬레이션상황에서의간호수행관련변수인임상수행능력비판적사고와시뮬레이션디브리핑만족도의영향력을확인한결과임상수행능력과비판적사고는시뮬레이션상황에서의간호수행에유의한영향을미치지않았다단지시뮬레이션상황에서의디브리핑만족도가시뮬레이션상황에서의간호수행에영향을미쳤으나그영향력이로낮게나타났다 표 간호수행능력영향요인 Performance related variable β Constant Debriefing satisfaction 결론 본연구는선행연구에서검토된간호사의임상수행능력과관련요인인학업성적임상만족도문제해결능력비판적사고대상자가평가하는일반임상수행능력정도와시뮬레이션디브리핑만족도가응급시뮬레이션상황에서어떻게영향을미치는지를파악하고자수행되었다 510 Copyright 2017 HSST

7 Vol.7, No.2, February (2017) 본연구대상자는가여학생이었으며일반적특성으로전공만족도와임상수행능력관련변수로임상실습에대한만족도가낮은대상자가각각명으로이상이만족도가중간이상으로나타나전반적으로전공과임상실습에대한만족도가높다는것을알수있었다임상수행능력관련변수인문제해결능력은점으로같은도구로간호학과와사회복지과학생의문제해결능력을측정한선행연구결과에서나타난점보다높았다이러한차이는본연구의대상자는모두간호대학생인데반해등의연구대상자는간호학과와사회복지학과학생을대상으로한점을고려할때대학생들을학년때부터비판적사고추론및간호과정을통해과학적사고및문제해결을도모하도록지도하는간호학적특성이반영된것일수있으나대학생들의전공에따라실제적으로대학생들의문제해결능력이차이가있는지체계적인평가가추후되어야할것으로사료된다본연구에서는간호대학생들의비판적사고수준은점으로나타났는데이는의연구에서의점에비해낮은점수이다간호사가임상에서간호를할때가장요구되는것이비판적사고임을감안할때예비간호학생을대상으로비판적사고에대한예비분석과함께비판적사고향상을위한교육과정운영의필요성을제시하고있다고볼수있다임상수행능력은점으로학생의점보다낮게나타났다이는학생은간호사경력을가지고다시학사학위를취득하기위하여대학에재학중인면허간호사인데반해본연구의대상자는간호사임상실무경력이전혀없는년제간호학과재학생이기때문에나타난당연한결과라고사료된다또한본연구에서시뮬레이션상황에서의간호수행능력은점만점에점으로이상으로높게나타나대체적으로간호수행능력이높은것을알수있었다그러나본연구에서는교육자에의한평가만으로응급상황에서의간호수행능력을평가하였으므로대상자인간호대학생이지각하는간호수행능력을확인할수없었다추후연구에서는시뮬레이션상황에서간호수행에대한교육자에의한객관적평가와간호대학생의주관적평가를확인하여그동일성을확인할필요가있다고사료된다디브리핑만족도또한동일한연구가없어직접적인평가는불가하지만점만점에평균점으로매우높게나타나시뮬레이션실습에대한학생들의만족도를간접적으로확인할수있었다본연구에서는시뮬레이션상황에서의간호수행능력과일반적특성중대상자의전공만족도대인관계정도와임상수행능력관련변수인문제해결능력과는유의한상관관계가없었다이는시뮬레이션교육후에대상자의문제해결능력이향상되었다는기존의연구결과와는차이가있는결과이다그러나본연구에서사용한문제해결능력은간호학과대학생을대상으로개발된것이아닌전반적인대학생을대상으로개발된것으로도구타당도에서문제가있을수있어추후간호학과학생의문제해결능력을평가하는타당도높은도구를사용하여반복연구할필요가있다고사료된다문제해결능력과는달리시뮬레이션상황에서의간호수행능력은대상자의비판적사고임상수 Copyright 2017 HSST 511

8 행능력과시뮬레이션디브리핑만족도와유의한상관관계가있었다이는시뮬레이션교육이대상자의비판적사고임상수행능력을향상시킨다는기존의연구결과를지지하는결과이다이에반해응급시뮬레이션상황에서의간호수행능력은간호학과학생이지각하는문제해결능력비판적사고와임상수행능력에영향을받지않은것으로나타났다이는비판적사고가시뮬레이션기반교육을한후유의하게상승되지않는다고보고한결과와유사한결과로상황별시뮬레이션에서는시뮬레이션디브리핑만족도에비해간호대학생이가지고있는성향인문제해결능력비판적사고및임상수행능력이영향력이미비함을유추할수있겠다또한본연구에서시뮬레이션상황에서의간호수행능력은교육자에의해수행정도를객관적으로평가한것으로간호대학생이지각하는문제해결능력비판적사고및임상수행능력에의해영향을받지않았을수도있다이는추후간호대학생이지각하는시뮬레이션상황에서의간호수행에영향을미치는영향요인을파악하는반복연구를통해교육자에의한객관적간호수행능력과대상자가지각하는주관적간호수행능력에영향미치는요인을확인할필요가있음을제시하고있다그러나본연구는일개대학의연구이므로이를반복연구할필요가있으며시뮬레이션에서의객관적인간호수행과간호대학생이지각하는간호수행능력과의오차에영향미치는요인을명확하게하는것또한필요하다고사료된다본연구의응급시뮬레이션상황에서간호수행능력에유의하게영향을미치는유일한변수인시뮬레이션디브리핑만족도의경우에도영향력이에불가하여미비하다고할수있다이는시뮬레이션상황에서간호수행에영향미치는변인에대한문헌고찰을좀더체계화하여관련변수를확대한광범위연구를통해시뮬레이션상황에서의간호수행에영향변수를명확히할필요가있다본연구는연구대상이일지역일개교에국한되어있으므로연구결과를일반화하기에는제한점이있으나시뮬레이션교육에서의간호수행능력에영향변수를파악하려고한것은연구적의의가있다특히본연구에서는이미임상수행능력에영향을준다고알려진문제해결능력과비판적사고가응급간호시뮬레이션상황에서의교수자가평가한간호수행능력에영향을미치지못했다이는간호대학생이인지하는문제해결능력비판적사고및임상수행능력의향상이객관적핵심역량의성취를의미하지못하는것을의미하므로정량적인간호사핵심역량을향상시킬수있는교육방법을개발하는것이필요하다이를위해서는응급상황에서의시뮬레이션상황에서객관적간호수행능력에영향미치는변수확인을위한확대연구가지속적으로필요하다고사료된다 References [1] Hur, H. K. & Park, S. M Effects of simulation based education, for emergency care of patients with dyspnea, on knowledge and performance confidence of nursing students, The Journal of Korean Academic Society of Nursing Education, 18(1), Copyright 2017 HSST

9 Vol.7, No.2, February (2017) [2] Kim, H. R., Choi, E. Y. Kang, H. Y., & Kim, S. M The relationship among learning satisfaction, learning attitude, self-efficacy and the nursing students academic achievement after simulation based education on emergency nursing care, The Journal of Korean Academic Society of Nursing Education, 17(1), [3] Kim, Y. H. & Jang, K. S Effect of a simulation based education on cardio-pulmonary emergency care knowledge, clinical performance ability and problem solving process in new nurses, Journal of Korean Academy of Nursing, 41(2), , doi: /jkan [4] Lee, E. O., Lim, N. Y., Park, H. A., Lee, I. S. Kim, J. I., Bae, J. I., Lee, S. M. Nursing research and statistics analysi, Soomoonsa, (2009). [5] Lee, S. J. A study on the development of life-skills: communication, problem solving, and self-directed learning, , Korean Educational Development Institute, (2003). [6] Kwon, I. S., Lee, G. E., Kim, K. D., Kim, Y. H., Park, K. M., Park, H. S., Sohn, S. K., Lee, W. S., Jang, K. S. & Chung, B. Y. Development of a critical thinking disposition scale for nursing students, Journal of Korean Academy of Nursing, Vol.36 No.6, , (2006). [7] Son, J. T., Park, M. H. Kim, H. R., Lee, W. S., Oh, K. S. Analysis of RN-BSN students clinical nursing competency, Journal of Korean Academy of Nursing,37(5), , (2007). [8] Kim, C. S. Development and effect of high fidelity patient simulation education program for nursing students, Unpublished doctoral dissertation, Catholic University, (2012). [9] Sung, M. H Correlation between motivation to achieve, clinical competency and satisfaction in clinical practice for diploma and baccalaureate nursing students, Journal of Korean Academy of Fundamental Nursing, 17(1), [10] Kim, K. K., Yoon, J., Choi, K. Y., Park, S. Y., & Bae, J. H The effect of interdisplinary cooperation project learning on communication, problem solving, and self-directed learning ability of university students, The Journal of Korean Academic Society of Nursing Education, 14(2), [11] Lee, J. I Self esteem, self efficacy and critical thinking disposition of college students, Academic Society of Nursing Education, 15(2), [12] Son, J. T., Park, M. H. Kim, H. R., Lee, W. S., Oh, K. S Analysis of RN-BSN students clinical nursing competency, Journal of Korean Academy of Nursing,37(5), [13] Son, Y. J. & Song, Y. A Effects of simulation and problem based learning courses on student critical thinking, problem solving abilities and learning, The Journal of Korean Academic Society of Nursing Education, 18(1), [14] Lee, M. S. & Han, S. W Effect of simulation based practice on clinical performance and problem solving process for nursing students, The Journal of Korean Academic Society of Nursing Education, 17(2), [15] Yang, J. J Development and evaluation of a simulation based educatin course for nursing students, The Journal of Adult Nursing, 20(4), Copyright 2017 HSST 513

Journal of Educational Innovation Research 2019, Vol. 29, No. 2, pp DOI: 3 * Effects of 9th

Journal of Educational Innovation Research 2019, Vol. 29, No. 2, pp.357-378 DOI: http://dx.doi.org/10.21024/pnuedi.29.2.201906.357 3 * Effects of 9th Grade Students Participation in Career Curriculum Cluster