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Figure 1. Process Model of the experience of Practice among - vi -
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참여자 나이 결혼상태 교육정도 간호사과거간호사재직중경력근무과 PA 경력 현재근무과 A 32세 기혼 3년제대졸 6년 산부인과, 신경과, 이비인후과 3년 안과 B 43세 기혼 4년제대졸 10년 정형외과, 소아혈액종양 6년 6개월 유방외과 C 36세 기혼 3년제대졸 6년 내과중환자실, 회복실 4년 1개월 피부과 D 41세 미혼 대학원재학 10년 혈액종양내과, 정형외과 8년 흉부외과 E 38세 기혼 4년제대졸 7년 6개월 RICU 7년 흉부외과 F 33세 미혼 4년제대졸 4년 8개월 마취회복실 1년 4개월 안과 G 31세 기혼 3년제대졸 5년 2개월 소아청소년과 6년 2개월 신경외과 H 29세 미혼 4년제대졸 2년 외과 5년 검진센터 I 46세 기혼 3년제대졸 21년 내과, 신경외과, 정형외과 3년 산부인과 J 28세 미혼 3년제대졸 2년 산부인과, 소아과 2년 4개월 흉부외과 K 36세 기혼 4년제대졸 10년 수술장, 외과 2년 일반외과 L 33세 미혼 4년제대졸 8년 일반외과 1년 8개월 일반외과 - 20 -
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핵심범주 : 또다른간호사의이름으로살아가기 인과적조건 낯선역할에 대한직면기 고군분투의도전기 대인관계의갈등조정기 확대된역할의정립기 결과 * 삼교대업무의고단함 * 상급자의독려 * 새로운간호영역에대한기대 * 의사 / 간호사사이의호환업무에대한수용 * 불분명한업무에대한갈등 * 삼교대와다른형태의업무에대한실망감 * 질환위주의시선으로바꾸기 * 프로토콜없이배우기 * 자기방어전략구축하기 * 의사의경시 * 간호사의반감 * 환자의무지와혼란 * 시각의통합과확대 * 만능해결사 * 사례관리자 * PA로서의정체성확립 * 새로운간호영역의개척 * 여전히불투명한미래 중재적조건 : 교육제도의부재, 공식적인자격 / 소속 / 채용경로의부재, 불확실한업무의범위 Figure 1. Process Model of the experience of Practice among Physician Assistants with Nurse License - 26 -
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. 논의 - 72 -
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Baumeister & Leary, 1995-74 -
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Ⅵ. 결론및제언 - 78 -
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< 부록 1> 참여자의일반적특성 귀하의일반적특성에대한항목입니다. 해당되는곳에체크하시거나구체 적으로기록하여주시기바랍니다. 1. 귀하의나이는어떻게되십니까? 21-25 세 26-30 세 31-35 세 36-40 세 41-45 세 46-50 세 2. 귀하는기혼이십니까? 미혼이십니까? 기혼 미혼 3. 귀하의최종학력은어떻게되십니까?? 3년제대학졸 4년제대학졸 대학원석사재학중 대학원석사졸업이상 4. 귀하의간호사총임상경력을기록해주십시오. ( ) 년 ( ) 개월 5. 귀하의간호사재직중근무하셨던과를말씀해주십시오. ( ) 6. 귀하의총 PA(physician assisant) 임상경력을기록해주십시오. ( ) 년 ( ) 개월 7. 귀하의현재근무하시는과를말씀해주십시오 ( ) ***** 대단히감사합니다 **** - 86 -
< 부록 2> 연구대상자보호심의결과통보서 - 87 -
< 부록 3> 연구참여설명및동의서 - 88 -
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< 부록 4> 연구참여자모집포스터 - 92 -
Abstract Experience of Practice among Physician Assistants with Nurse License in Korea Lee, Kyoungeun Department of Nursing The Graduate School Seoul National University Physician assistant (PA) program has been introduced in Korea in 2000s without formal establishments of legal and educational system. However, the number of PA has increased rapidly since then due to the great needs of support for physicians. Currently, most of PAs consist of nurses who hold the nurse license, thus, more confusion arises in the role and identity of PA. In addition, its issue is closely related to the loss of professional nurses. Therefore, nursing profession needs to understand the practice of PAs in order to establish better system to utilize precious resources of nursing workforce and to integrate this workforce into the advanced practice nursing system. But not enough attention has been paid to PAs. The purpose of this study was to understand practical - 93 -
experience of PAs with a nurse license using grounded theory method. The research question was "What is the experience of practice among PAs who hold a nurse license?" The data were collected by individual in-depth interviews with 12 PAs who have worked for at least six months as a PA. All interviews were audio-recorded with consents of the research participants and they were transcribed verbatim for later analysis. The transcribed data were analyzed using grounded theory analysis, called constant comparative analysis. The results were as follows: 1. The average age of the participants was 35.5 years, and the average PA work experience was four years and two months 2. As a result of constant comparative analysis, the core category was emerged as living under another nurse s name. It indicates that the identity of PA is ultimately the same as an expanded nurse's role and identity. In this process, four phases were identified: facing a strange role ; struggling to challenge alone ; adjusting to interpersonal conflict ; and establishing an expanded role. The causal conditions were identified as 'the toughness of 3-shift work'; 'encouragement of seniors'; and 'expecting for new ground in nursing.' The intervening conditions were identified as no legal and educational system, no - 94 -
affiliation/lack of consistent recruitment, and uncertainty of the scope and depth of practice. The outcome was emerged as satisfaction of expanded role and still uncertain future, indicating contradiction between internal satisfaction and external unsatisfaction. In conclusion, this study demonstrates that PAs who hold a nurse license still consider themselves as a nurse, whose work has expanded much further. It suggests that current PA program needs to be integrated into the advanced practice nursing system. The results could be used as a basis for further researches and discussions to establish appropriate system for utilizing professional nursing workforce. Ultimately, the results will help develop a more effective and efficient health care system in Korea. Key word : physician assistant, practical experience, advanced practice nurse, qualitative research Student number: 2004-23362 - 95 -