기초간호자연과학회지 : 제 11 권제 2 호 2009 J Korean Biol Nurs Sci 2009; 11(2): 143-148 임상간호사의건강증진행위에영향을미치는요인에관한연구 김주현 1 이은희 2 현혜진 3 길정희 4 김진순 5 박양숙 6 박진숙 7 이호연 8 1 강원대학교간호학과교수 강원대학교건강돌봄연구소소장, 2 강릉대학교간호학과교수, 3 강원대학교간호학과교수, 4 춘천정신보건센터간호사, 5 당림리보건진료소진료소장, 6 춘천한방병원간호사, 7 강원대학교병원간호사, 8 서울의료원간호사 A Study of the Affecting Factors on the Health Promoting Behaviors of the Clinical Nurses Joohyun Kim 1, Eunhee Lee 2, Hae Jin Hyun 3, Jung Hee Gil 4, Jin Soon Kim 5, Yang Sook Park 6, Jin Sook Park 7, Ho Youn Lee 8 1 Professor, Department of Nursing, Kangwon National University, Chuncheon; 2 Professor, Department of Nursing, Kangreung National University, Wonju; 3 Professor, Department of Nursing, Kangwon National University, Chuncheon; 4 Nurse, Mental Health Center at Chuncheon, Chuncheon; 5 Nurse, Public Health Center at Danglim, Chuncheon; 6 Nurse, Chuncheon Traditional Medical Center, Chuncheon; 7 Nurse, Kangwon National University Hospital, Chuncheon; 8 Nurse, Seoul Medical Center, Seoul, Korea Purpose: The purpose of this study was to identify the affecting factors on the health promoting behaviors of the clinical nurses. Methods: This study was a trans-sectional survey research. The subjects of this study were 206 clinical nurses. The data were collected by questionnaires and medical records. Results: There were significant positive relationships between health promoting behavior and perceived health status, job satisfaction, familial support. There were significant negative relationships between health promoting behavior and depression. The significant affecting factors on the health promoting behaviors of the clinical nurses were depression, familial support and job satisfaction. These 3 factors explain 18.6% of the health promoting behaviors of the clinical nurses. Conclusion: This study provides the empirical evidence that health promoting behaviors of the clinical nurses are closely related to depression, familial support, and job satisfaction. This results can be used to develop health promoting program for clinical staff nurses. Key Words : Health promotion; Depression; Support; Job satisfaction 국문주요어 : 건강증진행위, 우울, 가족지지, 직무만족 1. 연구의필요성 서 건강이란소극적으로는질병이없는상태고, 가장적극적으로는세계보건기구의이상적이고규범적인정의인신체적, 론 Corresponding author : Eunhee Lee, Professor, Department of Nursing, Kangreung National University, 901 Heungeop-ri, Heung-myeon, Wonju 220-711, Korea Tel: 82-33-760-8305 Fax: 82-33-242-8840 E-mail: hjhyun@kangwon.ac.kr * 본연구는강원대학교건강돌봄연구소의연구비지원을받아수행된연구임. 투고일 : 2009년 9월 23 일심사의뢰일 : 2009년 9월 24 일게재확정일 : 2009년 11 월 25일 정신적, 사회적안녕으로정의되는데이러한정의는장애나질병이없다는것에초점을두지않고신체와심리적측면과사회적인측면, 즉인간의총체적인안녕상태라는긍정적인면을강조하고있다. 이러한건강에대한의식의변화와건강관리비용의상승으로많은사람들은일상생활속에서자신의안녕수준을증진시키고자하는건강증진행위에관심을가지게되었다 (Lim, 2005). 건강증진의개념이매우광범위하지만실제적으로일차건강관리수준의접근임을고려할때간호사들의건강증진자로서역할은매우중요한데그이유로간호사는건강생활실천자의모델로서직접간호제공자, 건강교육자, 건강행위촉진 143
144 김주현 이은희 현혜진외 5 인 자의직무를수행해야하기때문이다 (Park & Kim, 2000). 특히, 서비스대상인환자들이건강하지못한상태에있으므로간호제공과정에서장기간노출된근무환경은간호사의건강을위협할수도있고 (Kim, 1997), 불건강한상태에있는간호사는간호대상자에대한무관심, 환자간호의질과간호직에대한만족도를저하시키는요인이되어간호의질과양의변화를초래할우려가있다 (Cho, 1999). 그러므로간호사에게있어서건강의중요성은매우크며건강하지못한간호사는자신뿐아니라환자들에게도신뢰감을주지못하고, 환자들의건강한생활습관에도좋지않은영향을미친다. 따라서간호사는스스로가자신의건강상태를향상시키기위해자신의행위를변화시키고환자간호의질향상을위해무엇보다도적극적인건강증진행위가요구된다. 선행연구들을살펴보면간호사의지각된유익성, 사회적지지, 자기효능감이높을수록, 지각된장애성이낮을수록건강증진실천양식실천정도가높은것으로나타났으며 (Choi, 2006; Park & Kim, 2000), Lim (2002) 의연구에서는간호사의건강상태가좋을수록직장만족도가높게나타났고, 직업만족도에영향을주는변수로는주관적인현간호직만족도, 보수만족도, 정신건강상태등의세가지변수가직업만족도에영향을미치는중요한변수였다. Kim (2003) 의연구에서는일지역간호사의건강증진행위에영향을미치는주요예측요인은자기효능감, 수입, 지각된이익성, 피로, 가족지지로나타났으며, Oh (2004) 의연구에서는응급실간호사의건강증진행위와삶의질간에는직접적인관련성이있는것으로나타났다. 선행연구의결과건강증진행위에영향을주는요인으로는자기효능감, 지각된유익성, 지각된장애성, 사회적지지, 직장만족도, 건강상태, 보수만족도, 정신건강상태등으로나타났다. Sung (2004) 은여대생을대상으로한연구에서체질량지수와섭식장애, 우울과는유의한상관관계가있다고하였다. 또한비만은당뇨, 고혈압, 고지혈증, 심혈관계질환의주요원인으로콜레스테롤의상승과관련이있고헤모글로빈은영양상태판정에중요한요소이다 (Jarvis, 2000). 이에본연구에서는임상간호사를대상으로신체적요인으로는지각된건강상태와지각된비만정도, 신체체질량지수 (Body Mass Index, BMI), Cholesterol, Hemoglobin을, 심리적요인으로는우울을, 사회적요인으로는직무만족과가족지지등을조사하여그관계를파악하고임상간호사의건강증진행위에영향을미치는요인을규명함으로써간호사의바람직한건강관 리에도움을줄뿐만아니라향후좀더효율적인건강증진제공자로서의역할을하는데도움을줄수있는임상간호사들을위한건강증진프로그램을개발하기위한기초자료를제공하고자본연구를시도하였다. 2. 연구목적본연구는간호사의건강증진행위에영향을미치는요인을알아보기위함이며, 구체적인목적은다음과같다. 1) 간호사들의건강증진행위와관련요인과의상관관계를파악한다. 2) 건강증진행위에영향을주는요인을파악한다. 연구방법 1. 연구설계본연구는서울과강원지역의종합병원간호사들을대상으로건강증진행위에영향을미치는요인을파악하기위한횡단적조사연구이다. 2. 연구대상서울과강원지역의종합병원간호사들중연구목적을이해하고연구에참여하기를서면으로동의한간호사가대상이다. 3. 연구도구 1) 건강증진행위개인의자아실현이나성취를유지하고건강을증진하는활동으로 Walker, Sechrist와 Pender (1987) 가개발한 Health promotion Lifestyle Profile (HPLP) 를 Lee와 So (2009) 가번역한도구를이용하였다. 총 52 문항 4점척도로건강에대한책임감, 운동, 영양, 영적성장, 대인관계, 스트레스관리등 6개범주로구성되었으며본연구에서의신뢰도는 Cronbach s a=.933이었다. 2) 우울주관적인우울정도를 10점만점의숫자평정척도로측정하였다. 3) 비만정도주관적인비만정도를 10점만점의숫자평정척도로측정하였다.
임상간호사의건강증진행위에영향을미치는요인에관한연구 145 4) 직무만족주관적인직무만족을 10점만점의숫자평정척도로측정하였다. 5) 건강상태주관적인건강상태를 10점만점의숫자평정척도로측정하였다. 6) 가족지지주관적인가족의지지를받는정도를 10점만점의숫자평정척도로측정하였다. 7) 생리적측정신체체질량지수 (BMI), 헤모글로빈과콜레스테롤수치를측정하였다. 4. 자료수집방법본연구는 2009년 7월 1일부터 15일까지서울과강원지역에근무하는종합병원간호사를대상으로연구자가연구대상자를방문하여연구의목적을설명하고서면동의를받은후설문지를작성하게하였으며, 배포한 240부중무응답등의부적절한설문지 34부를제외한 206부를분석하였다. 생리적변수의경우는 2009년정기 6월직원정기건강검진기록을관련병원간호부와대상자의허락을얻어의무기록을열람하고연구자료로활용하였다. 5. 자료분석방법수집된자료는 SPSS 17.0을이용하여분석하였다. 1) 간호사의일반적특성과연구변수를기술적통계로분석하였다. 2) 변수간의상관관계는상관관계로분석하였다. 3) 건강증진행위에영향을미치는요인을알아보기위하여단계다중회귀분석을실시하였다. 연구결과 1. 대상자의일반적특성본연구대상자의일반적특성은다음과같다 (Table 1). 대상자의평균연령은 30.62 세이었고, 모두여성이었으며, 결혼상태는기혼 123명 (58.7%), 미혼은 81명 (39.3%), 기타 2명 (1.0%), 학력은전문대졸 138명 (67.8%), 대졸 57명 (27.7%), 대학원졸 11 명 (5.3%) 이었다. 근무경력은평균 7년 9개월 (93.07개월 ) 이었다. 종속변수에대한평균을보면 (Table 2), 건강증진행위는 4점척도에평균 2.37이었다. 주관적비만도는 10점척도로 5.38, BMI는평균 20.57 (kg/m 2 ) 이었고, 건강상태는 10점척도로평균 6.18이었다. 우울은 10점척도로평균 4.53으로나타났으며, 평균직무만족도는 10척도에평균 5.58이었으며, 가족지지는 10점척도에평균 6.35이었다. 또한콜레스테롤수치는평균 173.28 mg 이었으며, 헤모글로빈수치는평균 12.76 g/dl로나타났다. 2. 임상간호사의건강증진행위및관련변인간의상관관계임상간호사의건강증진행위의요인간의상관관계는다음과같다 (Table 3). 건강증진행위는지각된건강상태 (r=.232, p=.001), 직무만족 (r=.309, p=.000) 및가족지지 (r=.265, p=.000) 등과유의한정적상관관계가있는것으로나타났다. 건강증진행위는우울과유의한부적인상관관계 (r=-.347, p=.000) 가있는것으로나타났다. 지각된비만도는 BMI와유의한정적상관관계가있었고 (r=.488, p=.000), BMI는직무만족과유의한정적상관관계가있었다 (r=.165, p=.018). 지각된건강상태는 Table 1. General Characteristics of the Subjects (N=206) Table 2. Mean & Standard Deviation of Variables (N=206) Variables Mean (SD) or Freq (%) Age 30.62 (7.10) Duration of working 93.07 (82.55) as a nurse (month) Marital status Married 123 (58.7) Unmarried 81 (39.3) Educational level 3 year nursing college 138 (67.8) Bachelor 57 (27.7) Master 11 (5.3) Total 206 (100.0) Variables Mean SD Health promotion behavior 2.37 0.35 Perceived obesity 5.38 1.85 Body mass index 20.57 2.07 Perceived health status 6.18 1.87 Depression 4.53 1.31 Job satisfaction 5.58 1.69 Familial support 6.35 1.82 Cholesterol 173.28 27.13 Hemoglobin 12.76 1.01
146 김주현 이은희 현혜진외 5 인 Table 3. The Correlation Relationships among Variables (N=206) Variables 1 2 3 4 5 6 7 8 9 1. Health promotion behavior 1.000 -.046.059.232** -.347***.309***.265***.025.063.566.422.001.000.000.000.716.368 2. Perceived obesity 1.000.488***.035.085.047.086 -.025 -.054.000.614.225.506.218.726.437 3. BMI 1.000.017.043.165**.109 -.020 -.063.810.538.018.118.779.336 4. Perceived health status 1.000 -.290***.340**.158** -.028 -.035.000.000.024.914.616 5. Depression 1.000 -.281*** -.117 -.041.106.000.095.557.130 6. Job satisfaction 1.000.305***.015 -.072.000.831.303 7. Familial support 1.000.016 -.049.818.482 8. Cholesterol 1.000.035.616 9. Hemoglobin 1.000 BMI=Body mass index. Table 4. The Factors Affecting on the Health Promoting Behavior of the Clinical Nurses 논 의 Variables b R 2 Adjusted R 2 t p Depression -.150.120.116-4.208.000 Familial support.035.171.163 2.699.008 Job satisfaction.037.198.186 2.576.011 F=16.599 p=.000 R 2 =.198 Adjusted R 2 =.186 우울 (r=-.290, p=.000), 직무만족 (r=-.281, p=.000) 등과는유의한부적인상관관계가, 가족지지 (r=.158, p=.024) 과유의한정적상관관계가있는것으로나타났다. 직무만족과가족지지도유의한정적상관관계 (r=.305, p=.000) 를보였다. 생리적변수인콜레스테롤과헤모글로빈은건강증진행위에유의한상관관계가없는것으로나타났다. 3. 임상간호사의건강증진행위에영향을미치는요인임상간호사의건강증진행위에영향을미칠것으로고려되는지각된비만도, BMI, 지각된건강상태, 우울, 직무만족, 가족지지, 콜레스테롤, 헤모글로빈을포함하여다중회귀분석한결과, 유의한영향을미친것으로나타난변수는우울, 가족지지, 직무만족등이었으며임상간호사의건강증진행위를 18.6% 설명하였다 (Table 4). 3개요인중임상간호사의건강증진행위에가장영향을많이미친변수는우울로나타났다 (Table 4). 2007년보건통계자료에의하면보건의료종사자는이미 100만명을돌파했다 (Korea Medical Association. 2009). 그중종합병원의료인력의총수에서간호구성비율은 59% 에달한다. 임상간호사는전문직업인으로서환자의건강요구를효과적으로충족시키고질높은간호를제공 (Cha, 2008) 하여야하나복잡한인간관계의유지, 급증하는새로운지식과기술의습득, 환자들의질적간호요구, 부적절한근무조건으로많은스트레스를경험하고있으며업무중에건강하지못한환자와함께하기때문에유해한환경에노출됨으로써건강을위협받을수도있다. 따라서건강에대한위협은간호사개인의손실뿐아니라환자의간호에도질적인저하를가져올수있으므로간호사들은자신의건강을유지, 증진하기위한노력을해야할필요성이요구된다. 이에본연구에서는임상간호사를대상으로신체적요인으로는지각된건강상태와지각된비만정도, BMI, Cholesterol, Hemoglobin을, 심리적요인으로는우울을, 사회적요인으로는직무만족과가족지지등의관계를파악하여관련변인을규명하고자시행되었다. 본연구에서건강증진행위는 4점척도에서평균 2.37로보통을조금상회하는수준으로나타났다. 신체적요인인지각된건강상태는 10점척도에서평균5.38 로보통정도이었다. 생리적변수로측정된체질량지수는 20.57 (kg/m 2 ) 로정상범위 (18.8-24.9) 에속해있었으며 Cholesterol 173.28 mg, Hemoglobin 12.76 g/dl으로각각정상
임상간호사의건강증진행위에영향을미치는요인에관한연구 147 범주에해당되는것으로나타났다. 본연구에서임상간호사의건강증진행위에지각된비만도, BMI, 지각된건강상태등을포함하는신체적요인들이유의한영향을미치지않았는데이는간호사의건강증진행위가건강상태와유의한상관관계가있다고한연구결과 (Lee et al., 1996) 와건강증진행위에건강상태가유의한예측요인이라고한 Yi 등 (2004) 의연구결과와는상이한연구결과이었다. 이는임상에서근무하는간호사는대체적으로건강을유지하고있으며만약특정한질병이나이상징후가발생할시곧바로담당의사와상담하고즉각적으로치료하기에정상의범주에있는것으로생각되며, 이로인해건강증진행위에도유의한영향변인으로나타나지않은것으로생각된다. 이는임상간호사의신체적요인은건강증진행위에유의한영향을미치지않는것을의미한다고볼수있다. 심리적요인에서는우울이 10점척도에서 4.53점으로 Lee 와 Kim (2006) 의연구에서임상간호사의 40.8% 에서평균보다높은우울성향을보여심각한수준임을나타낸결과와는달리보통수준이었다. 본연구에서우울은직무만족과유의한부적상관관계가있는것으로나타났고임상간호사의건강증진행위의주요영향요인으로나타났음으로임상간호사의우울을감소시키기위한적극적인중재가필요하다고하겠다. 사회적요인과관련해서는교대업무특성상일정시간을할애하여건강증진행위를실천하기에어려움이있고육아문제가우선시되는기혼자의비율이 58.8% 임을감안한다면가족지지는무엇보다도중요한요인으로분석되는데사회적지지중가족지지가일생을통해계속되는사회적지지체계로서의중요한작용을하기때문이다. 본연구에서건강증진행위에가족지지가유의한영향요인으로나타난것은중년여성의건강증진행위에대한연구에서가족지지가가장큰영향요인이었다고보고한 Park (2008) 의연구결과와도일치하는것이며건강증진행위가가족지지와관련이있다는 Park 등 (2002) 의연구결과와도일치하는것이다. 본연구에서직무만족이건강증진행위, BMI, 지각된건강상태및가족지지와유의한정적상관관계가있었으며우울과는유의한부적인상관관계가있었고, 직무만족은임상간호사의건강증진행위에유의한영향요인으로나타났다. 직무만족이지각된건강상태와유의한정적상관관계를나타낸본연구결과는 Kim (1997) 의종합병원간호사의교대근무와건강상태에관한연구에서보고된직무만족도가높을수록 건강상태가좋았다고하는결과와일치하는것이다. 직무만족이가족지지와유의한정적상관관계를나타낸본연구결과는 Ko (2007) 의기혼간호사의역할갈등이직무만족에미치는영향에관한연구에서가정내역할갈등이직무만족에영향을미치고있다는연구보고와도일치하는것이라하겠다. 본연구에서직무만족이건강증진행위에유의한영향을미친요인으로나타난것은 Lee (2001) 의일부종합병원간호사의건강증진행위와관련요인에서간호사의건강증진행위에가장영향을미치는변인이직업만족도, 건강상태지각, 자기효능감등으로나타난것과일치하는결과이다. 건강증진행위관련연구에서영향요인으로지각된건강상태, 사회적지지와강인성, 자아존중감, 자기효능, 가족지지, 건강의중요성, 이익성, 장애성, 사회적지지와내적통제위등이보고되어왔다. 그러나간호사의건강증진행위와관련되어신체적, 심리적, 사회적영향요인을통합적으로파악한연구는거의없는실정이다. 본연구결과에서임상간호사의건강증진행위에우울, 가족지지, 직무만족등이유의한영향요인으로나타났고이중가족지지는향상시키기위한중재를하기는실제적으로어렵기때문에건강증진행위를증진시키기위해서는우울을감소시키고직무만족을증진시키는중재프로그램을개발하여야할것이다. 즉간호사로하여금건강증진행위를이행하게함으로서건강상태를유지하게하고, 이를바탕으로간호를더잘할수있게하려면심리적인면에서우울을관리하고주기적으로직무만족도를평가하고직무만족에영향을미치는요인들을고려하여직무만족이향상될수있도록하는방안이검토되어야할것이다. 결론및제언본연구는임상간호사의건강증진행위에영향을미치는요인을통합적으로파악하기위하여영향요인을지각된건강상태와지각된비만도, BMI, Cholesterol, Hemoglobin 등의신체적요인과우울의심리적요인및직무만족과가족지지등의사회적요인으로나누어분석하고유의하게영향을미치는요인을규명하고자하였다. 연구결과, 직무만족이건강증진행위, BMI, 지각된건강상태및가족지지와유의한정적상관관계가있었으며우울과는유의한부적인상관관계가있었고, 임상간호사의건강증진행위에유의한영향을미친요인으로는우울, 가족지지및직무만족인것으로나타났다. 따라서본연구에서유의한영
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