J Korean Acad Psychiatr Ment Health Nurs Vol. 27 No. 2, 170-178, June 2018 ISSN (Print) 1225-8482 ISSN (Online) 2288-4653 https://doi.org/10.12934/jkpmhn.2018.27.2.170 김정은 1 김석선 2 이화여자대학교일반대학원간호과학과 1, 이화여자대학교간호대학 2 Educational Needs for Suicide Prevention Competencies among Visiting Nurses Kim, Jung Eun 1 Kim, Suk-Sun 2 1 Graduate School, Division of Nursing Science, Ewha Womans University, Seoul 2 College of Nursing, Ewha Womans University, Seoul, Korea Purpose: This study was done to identify and prioritize educational needs for suicide prevention competencies among 212 visiting nurses from 33 public health centers. Methods: Data were collected from August to October 2017 through self-administered questionnaires consisting of measures of suicide prevention competencies. Data were analyzed using descriptive statistics, paired t-test, and Borich's needs assessment model to determine the priority of educational needs. Results: Visiting nurses reported that enhancing skills in suicide prevention were more significant than improving knowledge. The highest priority need was utilizing counseling skills. In addition, other educational needs were prioritized as followed by; a strategic planning approach to suicide prevention, applying therapeutic communication, showing empathy, and using resources in the community. Conclusion: The findings suggest that developing intervention programs to enhance counseling and strategic planning skills are needed to improve suicide prevention competencies among visiting nurses. Key Words: Home health nursing; Suicide; Primary prevention; Needs assessment; Educational measurement 서론 1. 연구의필요성 국내의연간자살사망자수는 13,092명, 하루평균 35.8명, 1 시간에약 1.49명 [1] 으로 OECD 회원국사이에서자살률 1위를차지하고있다 [2]. 한명이자살하면평균 5~10명의자살자지인들이우울, 죄책감, 상실감등정서적문제를경험한다 [3] 는것을고려하면, 자살은자살자개인으로끝나는문제가아닌가족, 이웃, 지역사회전반에걸쳐고통을증가시키고국가 경쟁력을위협한다 [4]. 또한높은자살률과자살로인한지역사회의파급효과는직접비와간접비를포함하여 6조 5천억이상의경제적손실을초래하고있어자살예방이시급하다 [5]. 따라서정부는 2008년제2차자살예방종합대책을수립하고일반인을대상으로자살위험자의위험징후를발견하여전문기관에의뢰할수있는자살예방게이트키퍼 (gatekeeper) 를양성하는교육사업을시행해오고있다 [6]. 또한자살수단에대한관리강화와자살관련언론보도의개선을위해자살보도권고기준을배포하고, 생명존중문화를조성하기위한인식개선캠페인과홍보사업을시행하였다. 그러나목표하였던인구 주요어 : 방문간호사, 자살, 일차예방, 요구평가, 교육수준측정 Corresponding author: Kim, Suk-Sun https://orcid.org/0000-0002-8057-3655 College of Nursing, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Korea. Tel: +82-2-3277-2885, Fax: +82-2-3277-2850, E-mail: suksunkim@ewha.ac.kr - This study was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT and future Planning (No. 2015R1A2A2A01004575). Received: Feb 25, 2018 Revised: May 11, 2018 Accepted: Jun 7, 2018 This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. c 2018 The Korean Academy of Psychiatric and Mental Health Nursing http://www.mhnursing.or.kr
10만명당자살사망률 20명미만을달성하지못하고있는실정이다 [1,2,6]. 국외연구에따르면정신질환에대한편견과낙인의두려움으로인하여자살사고를가지고있는대상자들은정신의료서비스보다일차의료서비스를선호하며, 신체질환이있는노인의경우자살하기한달이내에일차의료서비스를이용하는것으로나타났다 [7-9]. 국내방문간호사는건강취약계층의가정을방문하여질병예방교육과상담, 간호술기등의업무를수행하기때문에대상자의자살예방및사고에즉각적으로조치할수있다 [10]. 또한방문간호사가접촉하는주요대상자는만성질병, 경제적빈곤층, 독거노인및 1인가구생활자로서이들은자살고위험군을포함하고있다 [5]. 이에대상자의신체적안전과정신건강증진을통한건강한생활유지를위하여방문간호사의자살예방교육요구를반영한자살예방역량강화프로그램이요구된다. 그러나국내에존재하는자살예방교육프로그램들은일반인을대상으로국외프로그램을번역하여사용하거나, 자살예방효과가증명되지않은프로그램을사용하고있는실정이다 [11]. 특히, 방문간호사에대한교육은사례관리매뉴얼, 전산프로그램활용능력이나특수간호술기에대한교육이대부분으로자살예방역량강화교육프로그램은부족한실정이다 [5,12,13]. 2018년정부는자살예방국가행동계획수립 [14] 을통해 방문간호사가자살위험성을조기에발견하고개입할수있도록교육을강화함 이라고자살예방국가행동계획을발표하였다. 이러한정부의정책에발맞추어자살을예방하고자살률을낮추기위해서는방문간호사를대상으로자살예방역량이지역사회현장에서요구되는영역임을규명하고이에따른체계적인교육이이루어질필요가있다. 또한방문간호사가스스로인식하는자신의자살예방역량수준과역량을높이기위해요구되는능력수준을파악하고이를토대로교육과정을설계하는것이필요하다 [15]. 따라서본연구는방문간호사가인식하는자살예방역량에대한현재자신의능력수준과요구되는능력수준간의차이를분석하고, Borich의요구도사정모델 (Borich s Needs Assessment Model)[16] 을활용하여자살예방역량강화에대한교육요구도의우선순위를제시하고자한다. 로자살예방을위해스스로인식하는현재자신의능력수준과요구되는능력수준을조사하여의우선순위를파악하는것이며, 구체적인목적은다음과같다. 연구대상자의일반적특성을파악한다. 연구대상자가인식하는자살예방역량에대한현재자신의능력수준과요구되는능력수준을파악한다. 자살예방역량에대한현재능력수준과요구되는능력수준의차이를파악한다. 연구대상자의자살예방역량강화교육에대한요구도의우선순위를파악한다. 연구방법 1. 연구설계 본연구는 Borich의요구도사정모델 [16] 을활용하여지역보건소의방문간호사를대상으로자살예방역량강화교육에대한요구도의우선순위를확인하기위한서술적조사연구이다. Borich의요구도사정모델 [16] 은공학, 음악학, 교육학등의다양한학문분야에서효과적인교육프로그램개발을위한교육요구도연구에서많이활용되고있다 [17]. Borich 의요구도사정모델 [16] 의수식은다음과같다 (Figure 1). 요구되는능력수준 (Required Competence Level, RCL) 은보건소방문간호사가자살예방역량에있어중요하다고생각하는정도를의미하며, 현재능력수준 (Present Competence Level, PCL) 은보건소방문간호사가자살예방역량에있어현재수행할수있는능력수준을의미한다. 본연구에서는보건소방문간호사들의자살예방역량에대한교육요구도를분석하기위해 요구되는능력수준 에서 현재능력수준 을뺀후그차이에대해각문항의요구되는능력수준의평균을곱한후전체사례수로나누어나온값에따라우선순위를결정하였다. 그값이클수록교육요구도의우선순위가높게측정되며, 요구되는 2. 연구목적 본연구의목적은보건소에근무하는방문간호사를대상으 Figure 1. Borich s needs assessment. Vol. 27 No. 2, 2018 171
김정은 김석선 능력수준 점수가높고 현재능력수준 점수가낮을때교육요구도값은커지게된다. 2. 연구대상연구대상자선정기준은 1) 보건소에서방문간호전담인력으로근무하고, 2) 의사소통에어려움이없는자이다. 제외기준은 1) 현재정신질환을진단받은상태이거나, 2) 정신약물치료등정신과치료를받고있는자이다. 자살과관련된설문이포함된본연구가정신과치료를받고있는방문간호사에게불안등심적, 정신적어려움을유발할수있기때문에제외하였다. 표본의크기는 G*Power 3.1.9 프로그램을이용하여산출하였으며, 예상표본수는대응표본 t 검정 (paired t-test) 분석방법을기준으로효과크기 0.25, 유의수준.05, 검정력.80로표본수를측정한결과필요한표본크기는 180명으로나타났다. 25% 의예상탈락률을고려하여 225부를배포하였고, 이중 220부의설문지가회수되었다. 응답이누락되거나불성실한설문지 8부를제외하고, 최종적으로 212부를분석에포함하였다. 3. 연구도구 1) 방문간호사의자살예방역량방문간호사의자살예방역량측정도구는방문간호사와간호사의자살예방활동과관련된역할을다룬문헌을분석 [5,10,15,18-25] 하여 17개예비문항을완성하였다. 설문의내용타당도를높이기위하여방문간호사경력 3년이상의간호사 5인과간호학과교수 1인으로구성된총 6명의전문가들에게연구의목적과필요성을설명하고직접대면하여문항의타당성을평가하도록하였다. 내용타당도지수 (content validity index) 는 4점척도 (1점, 전혀타당하지않음 ~4점, 매우타당함 ) 로측정하였고 [26] 내용타당도가평균.80 미만인 1문항 ( 자살계획까지세우고있는위험자에대해방문간호사가할수있는대처방법을알고적용하는능력 ) 이제거되어총 16개문항이선정되었다. 구성타당도를검증하기위해총 16개문항에대한요인분석을 요구되는능력수준 의문항들로실시하였다. 탐색적요인분석 (exploratory factor analysis) 은 Varimax 회전에의한주성분분석법을사용하여 2개요인이도출되었다. 요인적재량 (factor loading) 이.40 이하인 1문항 ( 자살예방을위한 방문간호사의역할의중요성을인지하는능력 ) 이제거되어총 15문항으로 2차탐색적요인분석을실시하였다. 그결과 Kaiser-Meyer Olkin (KMO) 는.94로나와표준향성의적절성이확인되었다. Bartlett의구형성검정을실시한결과, x 2 값이 4267.31 (p<.001) 로요인분석을시행하기적합한것으로나타났다. 직각회전인 Varimax 회전에의한주성분분석법을사용하여고유값 (eigen value) 1.00 이상을추출한결과 자살예방지식역량 과 자살예방기술역량 2개요인으로분류되었다. 2개요인에의해설명된변이는 75.7% 였다 (Table 1). 본설문도구의신뢰도를파악하기위하여자살예방역량측정도구의내적일관성신뢰도 Cronbach s 값은.96으로확인되었다. 4. 자료수집본연구는윤리적고려를위하여연구자소속대학교의생명윤리위원회의승인 (No. 140-9) 을받은후자료수집을시작하였다. 자료수집기간은 2017년 8월부터 2017년 10월까지 2개도시에소재한 33개의보건소에근무하는방문간호사를모집하였다. 연구자가직접방문하여보건소장의허락을받은후방문간호사들이이용하는보건소게시판에서면홍보물을게재하여모집하였다. 연구대상자에게연구의취지와목적을설명하고자발적으로연구에참여할것에동의한대상자중연구대상자선정기준에맞는 225명에게서면동의를받은후설문지를배부하여응답하도록하였다. 설문지설명문과동의서에설문내용이무기명으로처리되고, 개인정보와조사된자료에대한비밀이보장됨을명시하였다. 연구자가설문지를직접배부하고설문이끝난후바로회수하여, 대상자의정보가노출되지않도록하였다. 5. 자료분석본연구에서수집된자료는 SPSS/WIN 21.0 프로그램을이용하여다음과같이분석하였다. 연구대상자의일반적특성은실수와백분율로분석하였다. 연구대상자의자살예방역량에대한현재능력수준과요구되는능력수준은평균과표준편차로분석하였다. 연구대상자의자살예방역량에대한현재능력수준과요구되는능력수준의차이는 paired t-test로분석하였다. 연구대상자의자살예방역량강화교육요구도의우선순위는 Borich의요구도사정모델 [16] 을활용하여도출하였다. 172 Journal of Korean Academy of Psychiatric and Mental Health Nursing
Table 1. Factor Loading and Explained Variance (N=212) No Items Factor 1 Factor 2 (Knowledge) (Skills) 1 Ability to recognize the severity of the problem of suicide in Korea.65 2 Ability to recognize risk factors and protective factors of suicide.83 3 Ability to recognize information such as death from suicide, method of suicidal attempt, and time of attempted suicide.84 4 Ability to distinguish between misunderstanding and misinformation on suicide.79 5 Ability to recognize psychiatric and physiological symptoms such as depression and.60 insomnia in high-risk suicide groups 6 Ability to identify verbal, behavioral, situational, and emotional signs of suicide risks.61 7 Ability to utilize a screening tool for signs of suicide.65 8 Ability to know and apply coping strategies for visiting nurses on suicide risks.69 9 Ability to know and apply methods for referring suicide risks to a professional medical institution 10 Ability to know and apply available resources within the community to help and assist suicide risks 11 Ability to recognize suicide crisis counseling phone numbers 1577-0199 or 1588-9191.69 12 Ability to know and apply counseling skills for suicide risks.73 13 Ability to know and to understand and sympathize with the psychology of people who have experienced suicide 14 Ability to engage in therapeutic communication with suicide risks.78 15 Ability to recognize the ethical issues in suicide counseling.81 Cronbach's.95.97 Total Cronbach's.98 Eigen value 5.45 6.66 Explained variance (%) 34.1 41.6 Total explained variance (%) 75.7.81.83.76 연구결과 1. 대상자의일반적특성 본연구대상자의일반적특성은 Table 2와같다. 연구대상자의평균연령은 47.93±9.30세이었다. 연령대별로살펴보면 50~59세가 80명 (37.7%) 으로가장많았으며, 40~49세 70명 (33.0%), 40세미만 43명 (20.3%), 60세이상 19명 (9.0%) 순으로나타났다. 성별은전체대상자중 209명 (98.6%) 이여성이었으며남성은 3명 (1.4%) 이었다. 155명 (73.1%) 의대상자들은종교를가지고있으나 57명 (26.9%) 이종교를가지고있지않다고보고하였다. 최종교육형태는전문대학이 137명 (64.7%) 으로가장많았으며, 9명 (4.2%) 이석사학위이상의과정을이수한것으로나타났다. 보건소방문간호사의평균근무경력은 4.90±3.45년이었다. 188명 (88.7%) 이자살예방교육이필요하다고응답하였으며, 필요하지않다고응답한대상자는 5명 (2.4 %) 이었다. 교수방법으로시청각교육이 71명 (33.5%) 으로가장선호하였고, 다음으로강의 54명 (25.5%), 역할극 53명 (25.0%), 토론 29명 (13.7%) 순이었다. 전체대상자중 164명 (77.4%) 이자살예방교육을이수할의사가있다고보고하였다 (Table 2). 2. 자살예방역량요구도분석결과 1) 자살예방역량에대한현재능력수준과요구되는능력수준인식정도방문간호사가인식하는자살예방역량에대한현재능력수준과요구되는능력수준은 Table 3과같다. 문항별로살펴보 Vol. 27 No. 2, 2018 173
김정은 김석선 Table 2. General Characteristics of Participants Characteristics Age (year) Gender Religion Level of education Categories <40 40~49 50~59 60 Female Male Yes No Diploma Bachelor Above master (N=212) n(%) or M±SD 47.93±9.30 43 (20.3) 70 (33.0) 80 (37.7) 19 (9.0) 209 (98.6) 3 (1.4) 155 (73.1) 57 (26.9) 137 (64.7) 66 (31.1) 9 (4.2) Total career (year) 4.90±3.45 Needs of education Teaching method Willing to participate in educational program Very necessary Necessary Neutral Do not need Do not need at all Lecture Audiovisual education Discussion Role play Other Yes No Not response 79 (37.3) 109 (51.4) 19 (8.9) 4 (1.9) 1 (0.5) 54 (25.5) 71 (33.5) 29 (13.7) 53 (25.0) 5 (2.3) 164 (77.4) 20 (9.4) 28 (13.2) 면, 현재능력수준이높은문항은 우리나라자살문제심각성에대해인지하는능력 (3.82±0.91) 이가장높게나타났으며, 자살로인한사망및자살시도방법, 자살을시도한시간등에대한정보를인지하는능력 (3.35±0.98) 이가장낮게나타났다. 요구되는능력수준이가장높은문항은 우리나라자살문제심각성에대해인지하는능력 (3.76±0.78) 이었고 자살위험자에대한상담기술을알고적용하는능력 (2.86±0.90) 이가장낮게나타났다 (Table 3). 2) 자살예방역량에대한현재능력수준과요구되는능력수준의차이방문간호사가인식하는자살예방역량에대한현재능력수준과요구되는능력수준의평균차이를검증한결과는 Table 3 과같다. 방문간호사의자살예방역량에대한현재능력수준은요구되는능력수준과차이가있는것으로나타났으며, 1번과 2 번문항을제외한 13개문항에대하여통계적으로유의미한차 이가있는것으로나타났다 (p<.001). 자살예방역량에서현재능력수준과요구되는능력수준의차이 (gap) 가가장큰문항은 자살위험자에대한상담기술을알고적용하는능력 (0.55±0.97) 이고, 차이가가장작은문항은 우리나라자살문제심각성에대해인지하는능력 (0.07±0.83) 이었다 (Table 3). 3) Borich의요구도사정모델을활용한자살예방역량강화교육요구도분석본연구에서는자살예방역량에대한현재능력수준과요구되는능력수준의평균차이를검증하는것에서더나아가 Borich의요구도사정모델을활용하여의우선순위를도출하였다. Borich의요구도사정모델을활용하여자살예방역량강화교육에대한요구도산출결과는 Table 3과같다. 자살예방기술역량의 8개문항 (7,8,10,11,12,13,14,15) 에서우선순위가높게나타났다. 먼저 자살위험자에대한상담기술을알고적용하는능력 (12.19) 에대한교육요구도가가장높게나타났고그다음으로 자살위험자에대해방문간호사할수있는대처방법을알고적용하는능력 (10.58), 자살위험자와치료적의사소통을적용할수있는능력 (10.41), 자살을경험한주변사람의심리에대해알고공감하는능력 (9.98), 지역사회내자살위험자지원자원에대해알고적용하는능력 (9.37), 자살의징후선별도구를활용할줄아는능력 (9.07) 순으로나타났다. 반면, 자살예방지식역량 6개문항 (1,2,3,4,5,6) 은우선순위가낮게측정되었다. 그중 우리나라자살문제심각성에대해인지하는능력 (1.17) 에대한교육요구도가가장낮게나타났으며, 그다음으로 자살의위험요인과보호요인에대해인지하는능력 (4.48), 자살로인한사망및자살시도방법, 자살을시도한시간등에대한정보를인지하는능력 (6.17) 순으로낮게나타났다 (Table 3). 논의 본연구는만성질환자, 경제적빈곤층, 독거노인등자살고위험군 [5] 을자주대면하는방문간호사를대상으로자살예방역량강화에대한교육요구도를확인하였다는데의의가있다. 연구결과전체대상자중 88.7% 가스스로자살예방역량강화교육이필요하다고응답하였고, 77.4% 는자살예방교육을이수할의사가있다고보고하였다. 이는선행연구에서일차의료의사와보건소종사자를대상으로자살예방교육매뉴얼개발연구결과 95.2% 가자살예방교육이필요하며, 93.8% 는자살 174 Journal of Korean Academy of Psychiatric and Mental Health Nursing
Table 3. Present Competence Level, Required Competence Level, and Educational Needs for Suicide Prevention Competencies (N=212) Factors Borich s needs PCL RCL Gap Paired t-test Items assessment Rank M±SD Rank M±SD M±SD Rank Needs t p Overall 3.50±0.13 3.15±0.22 0.35±0.12 8.03±2.64 11.47 <.001 Knowledge Skills 1. Ability to recognize the severity of the problem of suicide in Korea 2. Ability to recognize risk factors and protective factors of suicide 3. Ability to recognize information such as death from suicide, method of suicidal attempt, and time of attempted suicide 4. Ability to distinguish between misunderstanding and misinformation on suicide 5. Ability to recognize psychiatric and physiological symptoms such as depression and insomnia in high-risk suicide groups 6. Ability to identify verbal, behavioral, situational, and emotional signs of suicide risks 7. Ability to utilize a screening tool for signs of suicide 8. Ability to know and apply coping strategies for visiting nurses on suicide risks 9. Ability to know and apply methods for referring suicide risks to a professional medical institution 10. Ability to know and apply available resources within the community to help and assist suicide risks 11. Ability to recognize suicide crisis counseling phone numbers 1577-0199 or 1588-9191 12. Ability to know and apply counseling skills for suicide risks 13. Ability to know and to understand and sympathize with the psychology of people who have experienced suicide 14. Ability to engage in therapeutic communication with suicide risks 15. Ability to recognize the ethical issues in suicide counseling 1 3.82±0.91 1 3.76±0.78 0.07±0.83 15 1.17 1.32.189 8 3.49±0.96 3 3.30±0.79 0.19±0.98 14 4.48 2.95.004 15 3.35±0.98 10 3.07±0.82 0.28±0.94 12 6.17 4.38 <.001 14 3.36±0.97 11 3.05±0.80 0.31±0.97 11 6.93 4.77 <.001 2 3.61±0.90 4 3.29±0.84 0.32±0.94 10 7.55 5.01 <.001 6 3.57±0.97 5 3.23±0.85 0.34±0.95 9 8.03 5.34 <.001 13 3.37±1.05 13 2.97±0.98 0.41±0.94 6 9.07 6.38 <.001 7 3.53±1.02 9 3.07±0.93 0.46±1.03 2 10.58 6.50 <.001 3 3.60±1.07 2 3.34±0.99 0.26±0.89 13 6.08 4.25 <.001 5 3.57±1.07 6 3.17±0.96 0.40±0.92 5 9.37 6.34 <.001 9 3.46±1.17 8 3.08±1.12 0.38±0.93 8 8.77 6.10 <.001 12 3.39±1.11 15 2.86±0.90 0.55±0.97 1 12.19 8.21 <.001 4 3.59±1.02 7 3.16±0.92 0.42±0.92 4 9.98 6.63 <.001 10 3.40±1.08 14 2.92±0.90 0.46±0.95 3 10.41 7.12 <.001 11 3.40±1.03 12 3.00±0.89 0.40±0.92 7 9.03 6.45 <.001 PCL=Present competence level; RCL=Required competence level. Vol. 27 No. 2, 2018 175
김정은 김석선 예방교육을이수할의사가있다 [5] 고보고한결과와유사하다. 우리나라의자살률은 10만명당 25.6명으로 OECD국가평균 12.1명보다 2배이상높은수치 [1] 로자살문제에대한사회적관심이증대되고자살고위험군관리강화를위한지역사회접근이강조됨에따라지역사회보건의료인의자살예방역량강화교육요구도가높은것으로해석된다. 본연구는방문간호사를대상으로 Borich의요구도사정모델 [16] 을활용하여자살예방역량강화에대한교육요구도의우선순위를도출한결과, 자살위험자에대한상담기술을알고적용하는능력, 자살위험자에대해방문간호사할수있는대처방법을알고적용하는능력, 자살위험자와치료적의사소통을적용할수있는능력, 자살을경험한주변사람의심리에대해알고공감하는능력 등자살위험자를상담하는기술과관련된문항에서교육요구도가높게나타났다. 보건의료인이자살위험자를만났을때부적절한의사소통과부정적인태도는자살예방을방해하는요인 [9,15,19,20,27] 이될수있기때문에자살위험자를상담하는기술과관련된문항의교육요구도가높은것으로해석된다. 그러나선행연구에서는일차의료의사와보건소종사자를위한자살예방교육매뉴얼이개발되었으나자살의원인과위험요인, 자살위험성평가와대처에대한교육을중심으로하고있다 [5]. 또한자살예방게이트키퍼양성을목적으로개발한한국형표준자살예방교육프로그램 보고듣고말하기 는자살의위험신호를확인하고자살사고에대한질문을한후전문기관에의뢰하는방법을포함 [13] 하고있지만방문간호사자살예방역량강화교육요구도우선순위를반영하고있지못하고있다. 자살위험이높은대상자들이정신질환에대한편견으로인하여정신건강전문가에게도움받는것을어려워한다는점 [7-9] 을고려할때, 지역사회일차의료서비스를제공하는보건의료인으로방문간호사는자살고위험군을돌보는제1차방어선이될수있다. 따라서방문간호사를대상으로자살고위험군을만났을때공감하여치료적의사소통기술을적용할수있는교육프로그램개발이필요하다고제언한다. 다음으로 지역사회내자살위험자지원자원에대해알고적용하는능력, 자살의징후선별도구를활용할줄아는능력 문항에서교육요구도가높게나타났다. 자살고위험군의경우정신질환이라는낙인에대한두려움으로전문가들을찾아가도움을요청하기보다는주변사람들에게자살을암시하는징후를보이는경우가많다 [18,19]. 방문간호사는자살고위험군으로간주되는취약계층 [5] 을자주만나기때문에자살위험자를조기발견하기위한자살위험징후선별도구를활용할 줄알고그결과를해석하여자살고위험자발견시대상자의안전을위해지역사회자원을활용하여전문상담기관에의뢰하는것이필요한것으로해석된다. 특히, 본연구에서는방문간호사를대상으로자살예방역량강화에대한교육요구도를파악하기위하여역량측정문항을개발하고 2가지요인으로분류하여요구도를분석하였다. 그결과, 자살예방지식역량 보다 자살예방기술역량 의우선순위가높은것으로나타났다. 교육요구도에서 자살예방기술역량 은단순한지식습득이상의간호수행의통합이요구되는행위적술기로실제시뮬레이션훈련을통해향상될수있는자살예방역량이다. 그러나기존의보건의료인을위한자살예방역량강화교육프로그램은단기자살예방워크숍과세미나형식으로지식전달위주의교육프로그램 [11] 으로진행되어, 방문간호사들의기술역량을강화하는데한계가있는것으로사료된다. 따라서본연구결과를바탕으로방문간호사의자살예방기술역량을강화하기위해서는시뮬레이션을활용한교육프로그램개발이필요하다고제언한다. 먼저방문간호사를대상으로가정방문시자살의위험징후를보이는대상자를대면하여선별도구를활용하여고위험자를조기에발견하고지역사회자원으로연계하는등의시뮬레이션시나리오개발이필요하다. 자살위기상황의사례를기반으로역할극을통해방문간호사가공감적의사소통기술을훈련할수있는교육을제공함으로써방문간호사의자살예방지식과기술역량을증진하는것이필요하다고제언한다. 본연구결과는의우선순위를도출하고자시도되었다는점에서의의를찾을수있지만, 방문간호사 212명의대상자에게만조사한자료이기때문에표본의대표성에제한이있기때문에연구결과를해석하는데주의가필요하다. 결론 본연구는방문간호사의자살예방역량강화에대한교육요구도우선순위를확인하여자살예방역량강화교육프로그램개발의근거자료를마련하기위한서술적조사연구이다. 연구결과 Borich의요구도사정모델을적용하여 자살위험자에대한상담기술을알고적용하는능력, 자살위험자에대해방문간호사할수있는대처방법을알고적용하는능력, 자살위험자와치료적의사소통을적용할수있는능력, 자살을경험한주변사람의심리에대해알고공감하는능력 등자살위험자를상담하는기술역량에대한교육요구도가높게나타났다. 176 Journal of Korean Academy of Psychiatric and Mental Health Nursing
다음으로 지역사회내자살위험자지원자원에대해알고적용하는능력, 자살의징후선별도구를활용할줄아는능력 에대한기술역량의교육요구도가높고 자살예방지식역량 보다 자살예방기술역량 의우선순위가높은것으로나타났다. 방문간호사는지역사회만성질환자에대한신체적건강을돌보는중요한직무를수행하기때문에방문간호업무를단순히지식과기술을알고이해하는수준이아니라방문간호대상자와치료적관계를형성하고공감적의사소통을통해담당업무를성공적으로수행할필요가있다. 따라서본연구의자살예방역량에대한교육요구도우선순위를바탕으로향후방문간호사의자살예방역량강화교육프로그램개발에근거를제시할수있을것이다. CONFLICTS OF INTEREST The authors declared no conflicts of interest. ORCID Kim, Jung Eun https://orcid.org/0000-0002-2787-6729 Kim, Suk-Sun https://orcid.org/0000-0002-8057-3655 REFERENCES 1. Statistics Korea. 2016 statistics for the aged. Cause of Death [Internet]. 2016 [cited 2017 Oct 19]. Available from: http://www.kostat.go.kr/portal/korea/kor_nw/2/6/1/index.board?bmode=read&aseq=363268 2. Organization for Economic Cooperation and Development. 2015 OECD health statistics [Internet]. 2015 [cited 2017 Oct 19]. Available from: https://www.oecd-ilibrary.org/social-issues-migration-healt h/data/oecd-health-statistics_health-data-en 3. Kim YA, Byeon JW. Trends and challenges on research of Korean studies in suicide survivors. The Korean Journal of Psychology: General. 2016;35(1):43-63. https://doi.org/10.22257/kjp.2016.03.35.1.43 4. Jung SH. Socioeconomic burden of suicide and depression in South Korea. Research Paper. Seoul: Ewha Womans University; 2005 November. 5. Lee YJ. Development of the education programs on suicide prevention for the physicians and the health care providers. Service Report. National Center for Mental Health; 2011 October. 6. Lee SY. Policy options for the improvement of suicide prevention programs. Health and Welfare Policy Forum. 2015;229: 34-49. 7. Bertolote JM, Fleischmann A, Leo DD, Wasserman D. Psychiatric diagnoses and suicide: revisiting the evidence. Crisis. 2004; 25(4):147-155. https://doi.org/10.1027/0227-5910.25.4.147 8. World Health Organization. Preventing suicide, a global imperative. Mental Health [Internet]. 2014 [cited 2018 Jan 31]. Available from: http://www.who.int/mental_health/suicide-prevention/exe _summary_english.pdf?ua=1 9. Chagnon F, Houle J, Marcoux I, Renaud J. Control-group study of an intervention training program for youth suicide prevention. Suicide Life-Threatening Behavior. 2007;37(2):135-144. 10. Bae HJ, Kim JH. Estimating need for home visiting nurse from public health centers. Perspectives in Nursing Science. 2015;12 (1):23-32. https://doi.org/10.16952/pns.2015.12.1.23 11. Hwang SY, Choi HS. A systematic review of suicide prevention programs for healthcare personnel. Journal of Korean Academy of Psychiatric and Mental Health Nursing. 2016;25 (4):386-398. https://doi.org/10.12934/jkpmhn.2016.25.4.386 12. Choi KW, Lim JY, Kim EJ. Development and effectiveness of counseling manual for community-based visiting nursing. The Journal of the Korea Contents Association. 2012;12(9):226-233. https://doi.org/10.5392/jkca.2012.12.09.226 13. Paik JW, Jo SJ, Lee SJ, Ong JY, Park JI. The effect of Korean standardized suicide prevention program on intervention by gatekeepers. Journal of Korean Neuropsychiatric Association. 2014;53(6):358-363. https://doi.org/10.4306/jknpa.2014.53.6.358 14. Ministry of Health and Welfare. Suicide prevention national action plan [Internet]. 2018 [cited 2018 April 23]. Available from: http://www.mohw.go.kr/react/al/sal0301vw.jsp?par_me NU_ID=04&MENU_ID=0403&CONT_SEQ=343649&page=1 15. Chan SW, Chien WT, Tso S. Evaluating nurses' knowledge, attitude and competency after an education programme on suicide prevention. Nurse Education Today. 2009;29(7):763-769. https://doi.org/10.1016/j.nedt.2009.03.013 16. Borich GD. A needs assessment model for conducting followup studies. Journal of Teacher Education. 1980;31(3):39-42. https://doi.org/10.1177/002248718003100310 17. Cho DY. Exploring how to set priority in need analysis with survey. The Journal of Research in Education. 2009;35(8):165-187. 18. Feldman MD, Franks P, Duberstein PR, Epstein R, Kravitz RL. Let s not talk about it: suicide inquiry in primary care. Annals of Family Medicine. 2007;5(5):412-418. https://doi.org/10.1370/afm.719 19. Wu CY, Lin YY, Yeh MC, Huang LH, Chen SJ, Liao SC, et al. Effectiveness of interactive discussion group in suicide risk assessment among general nurses in Taiwan: a randomized controlled trial. Nurse Education Today. 2014;34(11):1388-1394. Vol. 27 No. 2, 2018 177
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