노인간호학회지제 9 권제 호, 07 년 8 월 J Korean Gerontol Nurs Vol.9 No., 8-9 pissn 384-877 eissn 383-8086 https://doi.org/0.7079/jkgn.07.9..8 부산대학교간호대학 Geriatric Hospital Nurses' Knowledge, Attitude toward Falls, and Fall Prevention Activities Kim, Sang-Hee Seo, Ji Min College of Nursing, Pusan National University, Yangsan, Korea Purpose: Elders in hospital are at risk for falls. Thus, there is a need to identify geriatric hospital nurses' knowledge and attitude toward falls, and fall prevention activities, and factors which influence fall prevention activities. Methods: Participants were 4 nurses from geriatric hospitals with more than 50 sick beds located in B city. Data were collected during August and September, 0. The self-report questionnaires included questions on knowledge and attitude toward falls, and fall prevention activities. Data were analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation coefficients, and multiple regression analysis with SPSS/WIN.0. Results: Scores for knowledge, attitude and fall prevention activities were relatively high. In the relationships between knowledge, attitudes and fall prevention activities, knowledge about falls had no correlation with attitude or prevention activities, but a correlation was found between attitude and fall prevention activities. Factors influencing fall prevention activities were attitude toward falls (β=.34, p<.00), age (β=., p=.008) and having received fall prevention education (β=.5, p=.044). Conclusion: Findings indicate that there is a need to implement education programs to improve nurses' attitude toward falls and fall prevention, and provide opportunities for frequent fall prevention training and education to increase the practice of fall prevention activities. Key Words: Knowledge, Attitude, Accidental falls, Accident prevention, Geriatric nursing 서론. 연구의필요성 노인인구가많아지면서입원하는노인의수도증가하는추세이며최근 6년사이에약 7배증가하였다 []. 이와함께요양병원수가급속히증가하여병상수가전체의료기관의 30.4% 로가장많은비중을차지하고, 입원환자수도약 3만명에이른다 []. 요양병원에입원하는노인에게서발생하는안전사고중가장빈번한것이낙상이다 [3]. 국내노인전문요양병원에입원한뇌졸중환자의 4.0% 가낙상을경험하였으며 [4], 요양시설노인환자의 8.4% 가 년에한번이상낙상을경험하는것으로보고되어 [5] 노인환자의낙상위험이매우높다. 노인의낙상은가볍게는혈종, 타박상, 부종을유발하고, 심 주요어 : 지식, 태도, 낙상사고, 사고예방, 노인간호 Corresponding author: Seo, Ji Min College of Nursing, Pusan National University, 49 Busandeahak-ro, Mulgeum-eup, Yangsan 506, Korea. Tel: +8-5-50-835, Fax: +8-5-50-8308, E-mail: seojimin@pusan.ac.kr - 이논문은제저자김상희의석사학위논문의축약본임. - This article is a condensed form of the first author's master's thesis from Pusan National University. Received: Feb 3, 07 / Revised: Apr 6, 07 / Accepted: Jun, 07 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 07 Korean Gerontological Nursing Society http://jkgn.org
하게는골절, 뇌손상등심각한신체적손상을주어노인낙상환자의 3/4정도가낙상으로인해사망하는것으로보고되었다 [6]. 노인환자의낙상은이러한신체적손상뿐만아니라재원일수의증가, 각종검사와시술및수술로인한치료비용의증가를가져오게되어가정과국가경제에부담을준다 [7]. 또한낙상사고는의료소송의원인이되며요양병원입원환자의의료소송중낙상사고가 위를차지하고있다 [8]. 병원에서발생하는낙상사고에대한책임은의료진에게있으며, 특히간호사는노인을직접대면하고 4시간의료서비스를제공하는위치에있기때문에낙상예방에대한일차적인책임을진다 [7]. 이에병원간호사회에서낙상방지를위한안전관리지침을개발하여전국병원에배포하는등간호사의낙상예방활동을촉진하기위해노력하고있다 [9]. 또한의료기관평가지침에도낙상위험환자에대한예방활동과낙상위험평가에대한내용이포함되어 [0], 간호사의낙상예방활동의중요성은더욱커지고있다 []. 노인환자의낙상예방을위해간호사는낙상위험요인을정확하게인식하고주기적으로사정하여적절한간호를제공하는것이매우중요하다. 특히요양병원입원환자는치매나뇌졸중등으로인한인지기능장애가있고보행또는화장실이용시도움을필요로하는거동불편노인이상당수를차지하고있어 [] 낙상위험이높다. 실제요양병원의낙상사고발생률이종합병원에비해높기 [3] 때문에요양병원간호사의낙상예방활동이더욱강조된다. 이와같이간호사의낙상예방활동의중요성이높아지면서낙상예방활동을증진하기위한방안을찾기위해낙상에대한지식과태도및낙상예방활동의관련성에대한연구가이루어지고있다 [,4]. 선행연구에서간호사의낙상에대한태도는일관성있게낙상예방활동과상관관계가있는것으로보고되고있는반면에, 낙상에대한지식과낙상예방활동의관련성은서로상반된결과가보고되고있어이들간의관계가명확하지않다 [,4,5]. 따라서간호사의낙상에대한지식과낙상예방활동의연관성에대해확인하는반복연구가필요하다. 선행연구를고찰해보면, 국내연구는종합병원간호사를대상으로낙상에대한지식, 태도, 예방활동을조사한연구가대부분이며 [,5,7-9], 요양병원간호사를대상으로한연구는 Jung과 Jung [4] 의연구 편에불과하여매우부족한실정이다. 국외에서도급성기병원간호사를대상으로낙상위험도사정정도와낙상예방간호활동을증진시키는교육적중재의효과를측정하는연구가대부분으로 [0], 간호사의낙상 예방에대한지식과태도를조사한연구는찾아보기힘들었을뿐아니라너싱홈이나장기입원병원의간호사를대상으로한연구가거의이루어지지않았다. 이에본연구는요양병원에서근무하는간호사를대상으로낙상에대한지식및태도, 낙상예방활동정도를파악하고낙상예방활동의영향요인을확인함으로써요양병원에입원한노인의낙상을예방하기위한낙상예방교육프로그램을개발하는데필요한기초자료를제공하고자한다.. 연구목적본연구는요양병원간호사를대상으로낙상에대한지식, 태도및낙상예방활동정도를파악하고낙상예방활동의영향요인을확인하기위함이며, 구체적인연구목표는다음과같다. 연구대상자의일반적특성과낙상사고관련특성을확인한다. 연구대상자의낙상에대한지식, 태도및낙상예방활동정도를확인한다. 연구대상자의특성에따른낙상에대한지식, 태도및낙상예방활동의차이를확인한다. 연구대상자의낙상에대한지식, 태도및낙상예방활동간의관계를확인한다. 연구대상자의낙상예방활동에영향을미치는요인을확인한다. 연구방법. 연구설계 본연구는요양병원에근무하는간호사를대상으로낙상에대한지식, 태도및낙상예방활동정도를파악하고낙상예방활동의영향요인을확인하기위한서술적상관관계연구이다.. 연구대상본연구는 0년건강보험심사평가원의자료에근거하여 B시에소재하는 ~3등급의 50병상이상요양병원에서근무하는간호사를대상으로하였다. 연구자가직접 7개의요양병원간호부서책임자에게전화로자료수집에대한협조를요청하였고, 이중자료수집을승인한 8개의요양병원에서자료 8 Journal of Korean Gerontological Nursing
를수집하였다. G*Power 3.0 프로그램을이용하여회귀분석의중간효과크기 0.5, 유의수준.05, 검정력.80, 예측변수 개 ( 일반적특성, 낙상사고관련특성, 낙상에대한지식과태도 ) 를기준으로필요한대상자수를산출한결과 3명이필요하였으며, 탈락률 0% 를고려하여 55명을연구대상자로선정하였다. 55 부의설문지중에응답이불성실한 3부를제외하고 4부가분석에사용되었다. 3. 연구도구 ) 일반적특성과담당환자낙상사고및낙상예방교육이수경험특성연구대상자의일반적특성은연령, 최종학력, 총임상경력으로구성되었다. 담당환자낙상사고와낙상예방교육이수경험특성은담당환자의낙상경험과횟수, 낙상예방교육이수경험, 낙상예방교육의종류, 교육시간, 교육받은횟수에대한질문으로구성되었다. ) 낙상에대한지식도구낙상에대한지식을측정하기위해본연구에서는 Kim과 Suh [7] 가개발한낙상에대한지식측정도구를노인간호학교수 인, 간호학교수 인, 요양병원수간호사 인의자문을받아수정 보완하여사용하였다. 도구는총 6문항으로만성질환, 낙상률, 낙상유형, 낙상발생시간및장소등에대한문항으로구성되었다. 그렇다 는정답으로 점, 아니다 와 모른다 는오답으로 0점으로채점하였다. 총점은최저 0점에서최고 6점까지이며, 점수가높을수록낙상에대한지식이높음을의미한다. 본연구에서도구의내적일관성신뢰도 Kuder-Richardson 0 계수는.70이었다. 4) 낙상예방활동도구낙상예방활동정도를측정하기위해 Kim [] 이입원노인환자를대상으로개발한낙상예방활동측정도구를노인간호학교수 인, 간호학교수 인, 요양병원수간호사 인의자문을받아수정 보완하여사용하였다. 도구는총 3문항으로병원내에서발생할수있는낙상에대한예방행위에대한문항으로구성되었다. 5점 Likert 척도로 해당없음 점, 전혀하지않는다 점, 가끔그렇게한다 3점, 자주그렇게한다 4 점, 항상그렇게한다 5점으로측정하였으며점수가높을수록낙상예방행위의수행정도가높음을의미한다. Kim [] 의연구에서도구의내적일관성신뢰도 Cronbach s 는.68이었으며, 본연구에서는.90이었다. 4. 자료수집본연구의자료수집은 P대학교병원임상시험심사위원회의승인 (IRB No. 05-0- 038) 을받은후 0년 8월 일에서 9월 일까지실시하였다. 연구자가직접요양병원을방문하여간호부서책임자에게연구목적에대해설명하고자료수집에대한동의를얻은후, 자료수집방법을설명하고자료수집, 취합및회수에대한협조를요청하였다. 연구자가연구설명문, 연구참여동의서와질문지를개별봉투에넣어밀봉하여간호부서책임자에게전달하였다. 간호부서책임자가연구대상자에게질문지를전달하였고, 연구대상자는연구목적과익명성이보장됨과연구목적이외에는자료를사용하지않을것등을기록한연구설명문을읽고연구참여를동의하는경우에동의서에서명한후직접질문지를작성하고, 작성된질문지를봉투에넣어간호부서책임자에게전달하였다. 간호부서책임자가질문지를취합하여연구자가병원을방문하였을때직접연구자에게전달하였다. 3) 낙상에대한태도도구낙상에대한태도를측정하기위해 Kim과 Suh [7] 가간호사를대상으로개발한낙상에대한태도측정도구를사용하였다. 도구는총 3문항으로낙상에대한관심, 병원낙상에대한생각등에대한문항으로구성되었다. 5점 Likert 척도로 전혀아니다 점, 아니다 점, 보통이다 3점, 그렇다 4점, 매우그렇다 5점으로측정하였다., 8, 9,, 번문항은역채점하였으며점수가높을수록낙상에대한관심이높음을의미한다. Kim과 Suh [7] 의연구에서도구의내적일관성신뢰도 Cronbach's 는.75였으며, 본연구에서는.63이었다. 5. 자료분석수집된자료는 SPSS/WIN.0 프로그램을이용하여분석하였다. 연구대상자의일반적인특성, 낙상사고관련특성, 낙상에대한지식, 태도및낙상예방활동정도는기술통계를산출하였다. 연구대상자의일반적특성과낙상사고관련특성에따른낙상에대한지식, 태도, 낙상예방활동의차이는 t-test, ANOVA, Scheffe test로분석하였다. 연구대상자의낙상에대한지식, 태도및낙상예방활동간의관계는 Pearson s correlation coefficient를산출하였다. 연구대상자의낙상예방활 Vol. 9 No., 07 83
동에영향을미치는요인은다중회귀분석 (multiple regression analysis) 의입력 (enter) 방법으로분석하였다. 연구결과. 연구대상자의일반적특성과담당환자낙상사고및낙상예방교육이수경험특성 Table. General Characteristics and Characteristics of Patient's Falls and Fall Prevention Education of the Participants (N=4) Characteristics Categories n(%) or M±SD Age (year) ~30 3~40 4~50 5 43 (30.3) 39 (7.5) 5 (35.9) 9 (6.3) 37.5±0.75 연구대상자의일반적특성과낙상사고관련특성에대한결과는 Table 과같다. 연구대상자의평균연령은 37.5세였으며, 4~50세가 5명 (35.9%) 으로가장많았고다음은 ~30세로 43명 (30.3%) 이었다. 학력은전문대졸이 97명 (67.6%) 으로많았고, 4년제대졸이상이 45명 (3.4%) 로나타났다. 임상경력은 0년이상이 44명 (3.0%) 으로가장많았고, 다음은 3년미만이 36명 (5.4%) 이었다. 담당환자의낙상사고를경험한연구대상자는 0명 (77.5%) 이었고, 횟수는 회가 35명 (4.6%), 3회가 30명 (.%) 순으로나타났다. 낙상예방에대한교육을받은경험이있는대상자는 03명 (7.5%) 이었고, 낙상예방교육종류는원내실무교육이 70 명 (68.0%) 으로가장많았으며최근 년간받은낙상예방교육시간은 4시간이상이 4명 (40.8%), 시간이 35명 (34.0%) 순이었으며, 낙상예방교육을받은횟수는 회가 49명 (47.6%), 회가 3명 (30.%) 으로나타났다.. 연구대상자의낙상에대한지식, 태도및낙상예방활동정도연구대상자의낙상에대한지식, 태도및낙상예방활동정도는 Table 와같다. 연구대상자의낙상에대한지식점수는 6점만점에평균 3.00±.5점, 백분위환산점수는 8.3점으로나타났다. 문항별정답률을살펴보면 과거낙상을경험한노인은다시낙상할가능성이높다 문항이 98.6% 로가장높은정답률을보였다. 그다음으로 시력장애가있는사람은낙상할위험이커진다 와 빈뇨, 야뇨, 요실금등배뇨장애는낙상의위험요인이다 문항의정답률이 95.8% 로나타났다. 정답률이 70% 이하인문항은 복용하는약물개수가많을수록낙상위험성이커진다 가 54.%, 질병수가많을수록낙상의위험성이커진다 가 6.3%, 당뇨약복용과낙상은관련이없다 가 64.% 로나타났다. 연구대상자의낙상에대한태도점수는 65점만점에 47.3 ±4.03점으로나타났고, 문항별평균은 5점만점에 3.86±0.3 Education Clinical career (year) Experience of a previous patient fall Number of previous patient falls (time) Received fall prevention education Type of fall prevention education (n=03) Length of education program (hour) (n=03) Number of education programs (time) (n=03) College University <3 3~5 6~9 0 Yes No None 3 4 Yes No CNE PEH CPE Others 3 4 3 97 (67.6) 45 (3.4) 36 (5.4) 3 (.8) 3 (.8) 44 (3.0) 8.9±7.6 0 (77.5) 3 (.5) 3 (.5) 6 (8.3) 35 (4.6) 30 (.) 9 (3.4).99±.55 03 (7.5) 39 (7.5) 3 (.6) 70 (68.0) 5 (4.6) 5 (4.8) 3 (.3) 35 (34.0) 3 (.9) 4 (40.8) 3.55±. 49 (47.6) 3 (30.) 3 (.3).5±.36 CNE=Continuing nurse education; PEH=Practical education in hospital; CPE=Continuing and practical education. 점으로나타났다. 문항별로살펴보면가장높은점수를보인문항은 나는환자가이동할때도움을요청하면즉시응답해야한다고생각한다 로 4.48±0.53점이었다. 점수가낮은문항은 나는현행환자입원시시행하는낙상예방교육이충분하다고생각한다 로.74±0.90점, 나는입원환자가낙상하는것은불가피하다고생각한다 가 3.0±0.93점, 나는낙상이환자상태때문에발생한다고생각한다 가 3.5±0.85점으로 84 Journal of Korean Gerontological Nursing
Table. Participants' Knowledge, Attitude, and Prevention Activities toward Falls (N=4) Variables Items n(%)*orm±sd Knowledge Attitude Prevention activities Elders who have fallen in the past have a high possibility to fall again. Visual impairment raises possibility of falling. Urinary frequency, nocturia, urinary incontinence, etc. are danger factors for fall accidents. Most elders' hip joint fractures are caused by accidental falls. In the hospital, most falls occur when getting in and out of bed. Among elderly inpatients' hospital safety accidents, falling is the most frequent. Falling increases the mortality rate in elders. There is no relation to falling for people with decreased sense in hands and feet Slipping is not falling. Diuretics have no relation to falling. Deafness has no relation to falling. Depression has no relation to falling. Taking a hypotensive drug has no relation to falling. Taking a diabetes drug has no relation to falling. The more severe the disease, the higher risk of falling. The more medicines taken, the higher risk of falling. Total score I think I should respond to patients immediately if they ask for help when they move. I am concerned about inpatients' accidental falls. I think I should assess the danger of falling related to patients when they are hospitalized. I think patients do not sustain much physical damage when they fall. I think I should take care to actively prevent patient falls. I am interested in nursing activity to prevent falls. I think fall prevention nursing has high priority. I will feel guilty if a patient falls. I think falling in the hospital is an important responsibility of the nursing providers. I think the hospital environment is safe from falling. I think falling is caused by the patients' condition. I think inpatient falls are inevitable. I think there is enough current fall prevention education for the patients when they are hospitalized. Total score I check if the siderail is up properly when a patient is in bed. When getting in and out of a wheel chair, and getting in and out of bed, I check whether the wheels are locked. I inform patients who have a high risk of falling, the position of the beeper and educate them on how to use it. I educate patients to ask for help from people close at hand when they feel tired or dizzy. I educate patients with high risk of falling to always hold the handrail when they are going up and down the stairs or getting in and out of bed. I explain to patients with high risk of falling to move their bodies slowly when they change position, and help them when necessary. I explain the method of using a wheelchair beforehand when patients with high risk of falling must use it. I put things on the side table of the patient's bed within their reach to prevent falling. When there is a high risk of falling, I remind patients and caregiver families of the danger of falling and factors related to falling. I suggest that patients with a high risk of falling wear well-fitting and non-slip shoes. I check to see if the floor of hospital rooms, bathrooms, etc. are slippery. I give medication after checking for risk of falling. I check if the illumination is bright enough for the patients. Total score 40 (98.6) 36 (95.8) 36 (95.8) 30 (9.5) 9 (90.8) 8 (90.) 7 (89.4) 3 (86.6) 5 (8.0) 4 (80.3) 0 (77.5) 03 (7.5) 00 (70.4) 9 (64.) 87 (6.3) 77 (54.) 3.00±.5 4.48±0.53 4.37±0.67 4.34±0.47 4.3±0.79 4.7±0.57 4.4±0.58 4.±0.68 3.90±0.75 3.77±0.78 3.39±0.77 3.5±0.85 3.0±0.93.74±0.90 47.3±4.03 4.80±0.43 4.73±0.50 4.68±0.57 4.64±0.54 4.6±0.67 4.6±0.55 4.46±0.7 4.44±0.7 4.38±0.66 4.37±0.77 4.3±0.76 4.3±0.80 4.5±0.89 58.37±5.98 *Percent of correct answer. Vol. 9 No., 07 85
나타났다. 연구대상자의낙상예방활동점수는 65점만점에 58.37± 5.98점으로나타났고, 문항별평균은 5점만점에평균 4.49± 0.57점이었다. 문항별로살펴보면, 환자가침대에있을때침상난간이잘올려져있는지확인한다 가 4.80±0.43점으로가장높은점수를보였으며, 환자에게조명이충분히밝은지확인한다 가 4.5±0.89점으로가장낮은점수를보였다. 3. 연구대상자의특성에따른낙상에대한지식, 태도및낙상예방활동의차이연구대상자의일반적특성과담당환자낙상사고및낙상예방교육이수경험특성에따른낙상에대한지식, 태도및낙상예방활동의차이는 Table 3과같다. 연구대상자의일반적특성에따른차이를분석한결과, 낙상에대한지식에서는유 의한차이를보인특성이없었다. 낙상에대한태도에서는학력에따라유의한차이가있었다 (t=.07, p=.040). 낙상예방활동에서는연령과임상경력에따라통계적으로유의한차이가있었으며, 연령에서는 ~30세보다 4세이상이낙상예방활동정도가유의하게높았다 (F=5.8, p<.00). 임상경력이 0년이상인대상자가 3년미만보다낙상예방활동정도가높은것으로나타났다 (F=5.4, p=.00). 담당환자낙상사고와낙상예방교육이수경험특성에따른차이를분석한결과, 낙상에대한지식에서는교육시간에따라유의한차이가있었고 (F=3.03, p=.033), 낙상예방교육을 시간받은대상자보다 4시간이상받은대상자가낙상에대한지식점수가높았다. 낙상예방활동에서는낙상예방교육이수경험에따라유의한차이를보여낙상예방교육을받은대상자가받지않은대상자보다낙상예방활동정도가높게나타났다 (t=.5, p=.036). Table 3. Differences in Knowledge, Attitude, and Fall Prevention Activities according to Participants' Characteristics (N=4) Characteristics Categories Age (year) ~30 3~40 4~50 5 Education Clinical career (year) Experience of a previous patient fall Number of previous patient falls (time) Received fall prevention education Type of fall prevention education Length of education program (hour) Number of education programs (time) College University <3 3~5 6~9 0 Yes No 3 4 No Yes No CNE PEH CPE Others 3 4 3 Knowledge Attitude Prevention activities M±SD t or F (p) M±SD t or F (p) M±SD t or F (p) 3.79±.0.9±.6.55±.56.±.85.89±.58 3.4±.40 3.39±.59.77±.35 3.9±.50.70±.64.9±.60 3.8±.3.96±.65.60±.87 3.00±.63 3.6±.98 3.38±.8.99±.49 3.0±.63 3.5±.5.7±.54 3.47±.3 4.80±.7 3.39±.0 a.00±.80 b 3.00±3.00 c 3.60±. d.8±.45.65±.64 3.83±.30.40 (.070) -0.75 (.453) 0.64 (.600) -0.7 (.476) 0.4 (.80) -0.07 (.94).34 (.63) 3.03 (.033) b<d.7 (.8) 46.5±4.0 47.53±3.67 48.05±3.85 46.33±5.9 47.76±3.88 46.±4.38 46.00±3.38 47.58±4.88 47.±4.6 48.5±3.75 47.60±4.3 46.09±3.79 47.53±3.60 48.37±3.7 47.3±4.5 47.0±4.89 45.93±3.77 47.4±3.99 46.84±4.38 47.69±5.73 47.3±3.7 47.53±4.8 47.80±.48 45.8±3.7 47.97±3.7 47.00±.64 47.85±4.49 46.73±4.0 48.70±3.49 46.95±4.3.74 (.60).07 (.040).95 (.4).84 (.067).53 (.94) 0.74 (.460) 0.05 (.983).66 (.8).47 (.090) 55.69±6.60 a 58.69±5.97 b 59.8±5.0 c 6.55±3.7 d 58.83±5.78 57.73±6.7 56.±5.95 a 57.35±6.57 b 58.54±6.4 c 6.0±4.4 d 58.64±6.5 57.7±5.63 58.9±6.3 60.00±5.36 58.70±5.73 55.73±7.59 57.68±5.6 59.8±5.39 56.46±7.7 6.3±3.49 58.8±5.73 6.80±3.64 58.60±6.8 56.9±5.95 59.0±5.44 58.66±8.38 60.59±4.5 58.55±5.8 59.34±5.4 57.90±6.58 a, b, c, d=scheffe test; CNE=Continuing nurse education; PEH=Practical education in hospital; CPE=Continuing and practical education. 5.8 a<c, d (<.00) 0.98 (.330) 5.4 (.00) a<d 0.76 (.447).75 (.4).5 (.036).57 (.058).43 (.070) 0.88 (.48) 86 Journal of Korean Gerontological Nursing
4. 연구대상자의낙상에대한지식, 태도및낙상예방활동간의관계 연구대상자의낙상에대한지식, 태도및낙상예방활동간의관계는 Table 4와같으며, 낙상에대한태도와낙상예방활동은상관관계 (r=.4, p<.00) 가있는것으로나타났다. Table 4. Correlations between Knowledge, Attitude, and Fall Prevention Activities (N=4) Variables Knowledge r(p) Attitude.3 (.37) 5. 연구대상자의낙상예방활동에영향을미치는요인 연구대상자의낙상예방활동에영향을미치는요인을확인하기위해다중회귀분석을한결과는 Table 5와같다. 회귀분석의가정검정에서오차항의정규성과등분산가정을만족하였으며, Durbin-Watson 통계량이.86으로 에가까워오차항의독립성과자기상관에문제가없었다. 공차한계 (tolerance) 가.8에 ~.98로.0 이하이고 0. 이상이었으며, 분산팽창인자 (Variance Inflation Factor, VIF) 도.0~.4로기준인 0을넘지않아독립변수간다중공선성의문제는없었다. 낙상예방활동에영향을미치는요인은낙상에대한태도 (β=.34, p<.00), 연령 (β=., p=.008), 낙상교육이수경험 (β=.5, p=.044) 순으로나타났으며, 6.6% 의설명력을보였다 (F=3.75, p<.00). 논 본연구는요양병원에서빈번하게발생하는낙상에대한 의 Attitude r(p) Prevention activities -.0 (.878).4 (<.00) Table 5. Factors Influencing Fall Prevention Activities of the Participants (N=4) Variables B SE β t p Attitude 0.5..34 4.69 <.00 Age.37.5..70.008 Received fall prevention education* *Dummy variable (0: N0, : Yes)..00.98.5.03.044 Adjustment R =.7, F=3.75, p<.00 간호사의지식, 태도및낙상예방활동정도를파악하고낙상예방활동의영향요인을확인하고자시행되었으며그결과를다음과같이분석하였다. 연구대상자의낙상에대한지식점수는 6점만점에평균 3점으로나타났고, 백분율로환산하면 8.3점으로비교적양호하였다. 요양병원간호사를대상으로낙상에대한지식을조사한연구 [4] 에서 79.9점으로본연구대상자의지식점수와유사하였다. 반면에상급종합병원간호사는 6.4점 [7] 이었고, 대학병원간호사를대상으로한연구에서는각각 58.4 점 [], 45.5점 [5] 으로나타나본연구대상자의점수가상대적으로높았다. 이는선행연구가다지선다형의문항을사용하였으나본연구에서는이분형의문항을사용하였고, 낙상에대한교육을받은대상자가 Kim과 Suh [7] 에서 57.%, Seo [] 에서 55.% 였는데본연구에서는 77.% 로낙상에대한교육을받은대상자가더많았던점과관련이있을것으로생각된다. 낙상예방교육을받은대상자가증가한것은 00년부터시작된의료기관인증제에서환자안전을위한낙상예방활동수행을평가하게되면서간호사의낙상예방활동의중요성이커지게되어병원에서낙상예방교육을의무적으로실시하게된실정을반영하는것으로생각된다. 낙상에대한지식측정도구에서 70% 이하의정답률을보인문항은 복용하는약물개수가많을수록낙상위험성이커진다 와 질병수가많을수록낙상의위험성이커진다, 당뇨약복용과낙상은관련이없다 로나타나, 연구대상자들은일반적으로낙상을일으킬수있는구체적인질환, 약물, 질병수나복용약물수가많을수록낙상의위험이커진다는것에대한지식이부족하였다. 간호사를대상으로한선행연구 [7,, 5] 에서도낙상을일으킬수있는위험약물과질환에대한정답률이낮게보고되어본연구결과와유사하였다. 또한노인환자를대상으로한연구 [] 에서도낙상의위험성을묻는문항에대해서는정답률이높았으나약물과낙상과의관련성을묻는문항은모두평균이하의정답률을보였다. Sohng 등 [4] 은 4종류이상의약물복용은낙상위험요인이된다고하였으며, Honeycutt과 Ramsey [3] 도투여약물수는낙상위험도와비례한다고하였다. 국내연구에서도복용하고있는약물의수가많을수록낙상의위험요인이높다고보고하였다 [4]. Yeom [5] 의연구에의하면 가지질병이있는경우는낙상경험에유의미한영향을미치지못하였으나 가지이상일경우는질병이없는경우에비해낙상발생가능성이높아진다고보고하였다. 따라서향후간호사를대상으로한낙상예방교육프로그램을개발하고교육할때여러가지질병을앓고 Vol. 9 No., 07 87
있거나약물을많이복용하고있는노인환자는특히낙상의위험이높다는것을특히강조하여교육해야할것으로생각된다. 낙상에대한간호사의태도는백분위환산점수로는평균 7.8점으로비교적양호하였다. 본연구와동일한도구를사용한연구를살펴보면, 대학병원과상급종합병원간호사를대상으로한 Seo [], Lee와 Choi [5], Kim [7] 의연구에서각각 7.8점, 74.8점, 76.0점으로본연구대상자와유사한반면에 Jung과 Jung [4] 의연구에서요양병원간호사의낙상에대한태도가 83.6점으로본연구대상자보다높은점수를보였다. 본연구대상자는 7.5% 가낙상관련교육을받은것으로조사된반면에 Jung과 Jung [4] 의연구대상자는 85.% 가교육을받은것으로조사되었는데, 이와같이높은교육이수율이낙상에대한태도에긍정적인영향을미친것으로생각된다. 요양병원간호사의낙상에대한태도를조사한연구가부족하므로이에대한반복연구를시행하여낙상에대한태도를확인해볼필요가있다. 낙상에대한태도문항중에가장높은점수를보인문항은 나는환자가이동할때도움을요청하면즉시응답해야한다고생각한다 였는데, 이는연구대상자가낙상예방의중요성을인식하고있으며, 낙상이발생할수있는상황에즉각적으로대처하려는태도를가지고있음을의미한다. 낙상에대한태도문항에서가장낮은점수를보인문항은 나는현행환자입원시시행하는낙상예방교육이충분하다고생각한다 였다. 이는입원시일반적으로시행하는낙상예방교육이주로침대난간사용법과보조조명의사용법에대한설명으로한정되어있기때문으로생각되며, 교육내용의부족과반복교육의필요성을시사하는결과이다. 입원노인환자를대상으로한 Kim [] 의연구에서도대상자의 47.3% 가낙상예방에대한설명을들은기억이나지않는다고응답하여, 노년기의기억력감퇴를감안할때입원시 회의낙상예방교육으로는부족한것으로생각된다. Shin 등 [6] 은노인을대상으로낙상예방교육을할때단순명료한지식을짧은시간에반복해서제공하는것이교육의효과를유지하는데중요하다고하였다. 이러한결과를볼때, 특히노인환자의경우입원기간동안규칙적이며꾸준한낙상예방교육이필요하다고생각한다. 두번째로낮은점수를보인문항은 나는입원환자가낙상하는것은불가피하다고생각한다 로나타났다. Evans 등 [7] 의연구에서도입원환자의생리적낙상위험요인을평가하여위험정도를예측하여간호를수행한다면낙상은충분히예방가능하다고하였다. 따라서요양병원간호사는낙상은불가피 한것이아니라예방이가능한사고라는것을인지하고, 낙상의위험요인을정확하게사정하여낙상을적극적으로예방하려는태도를가지는것이중요하다. 연구대상자의낙상예방활동점수는백분위환산점수로 89.9점이었다. 요양병원간호사를대상으로한연구 [4] 에서 87.5점으로본연구결과와유사하였다. 대학병원간호사를대상으로한연구 [] 에서 67.4점으로나타나본연구대상자의낙상예방활동점수가상대적으로높은편이었다. 환자가침대에있을때침상난간이잘올려져있는지확인한다 가가장높은점수를보였다. Krauss 등 [8] 은침상난간을올리는것이낙상으로인한신체적손상을막을수있는중요한낙상예방행위라고하였는데, 이에따르면본연구대상자는중요하면서도기본적인낙상예방활동을하고있음을알수있다. 반면에 환자에게조명이충분히밝은지확인한다 가가장낮은점수를보였다. 노인이입원하게되면새롭고낯선환경으로인해화장실, 가구, 조명의위치에익숙하지않아낙상사고가증가할수있는데, 특히낙상이주로밤에일어나므로 [7] 노인환자입원실은밤에도간접조명을켜두어야하고조명의밝기에관심을가져야한다는것을간호사에게교육해야할것이다. 연구대상자의담당환자낙상사고와낙상예방교육이수경험특성중낙상예방교육시간에따라낙상에대한지식정도가차이가있는것으로나타났지만교육횟수와는유의한차이를보이지않았다. 이는기관별 회교육시간이다르기때문에나타날수있는결과라고생각된다. 따라서교육횟수보다 회교육시간을충분하게유지하는것이필요하다. 연구대상자의학력에따라낙상에대한태도에서유의한차이가있었다. 4년제졸업자가 3년제졸업자보다낙상에대해관심이적은것으로나타났는데, 이는선행연구 [,5] 에서 4년제와 3년제졸업자의낙상에대한태도가유의한차이가없는것으로나타난것과차이가있었다. 학력을제외한연구대상자의특성모두낙상에대한태도와관련성이없는것으로나타났으며, 특히낙상예방교육이수경험에따라낙상에대한태도가유의한차이가없는것으로나타났다. Kim [7] 의연구에서도간호사의낙상예방교육이수경험에따라입원환자의낙상에대한태도에유의한차이가없는것으로보고되어본연구결과와유사하였다. 따라서현재간호사를대상으로시행되고있는낙상예방교육의내용과시간등을전반적으로분석하여문제점을찾아내고개선하는노력이필요하다. 연구대상자의연령, 임상경력, 낙상예방교육이수경험에따라낙상예방활동에서유의한차이를보였다. 4세이상, 임상경력이 0년이상또는낙상예방교육을받은대상자가낙상 88 Journal of Korean Gerontological Nursing
예방활동을많이하는것으로나타났다. 이는낙상예방교육을받은경험이있는간호사의낙상예방행위수행정도가높은것으로나타난선행연구 [,5] 와유사하였다. 연구대상자의낙상에대한지식과예방활동간에는유의한상관관계가나타나지않았다. 선행연구에서요양병원간호사 [4] 와대학병원간호사 [5] 의낙상에대한지식과예방활동간에유의한상관관계가나타나지않았고, Seo [] 의연구에서도대학병원간호사의낙상에대한지식은낙상예방활동에직접적인영향을미치지않는것으로나타나본연구결과를지지하였다. 또한본연구대상자의낙상에대한지식과태도는상관관계가나타나지않으며, 요양병원간호사 [4] 와대학병원간호사 [5] 의낙상에대한지식과태도는상관관계가없는것으로보고되어본연구결과와유사하였다. 또한 Seo [] 의연구에서대학병원간호사의낙상에대한지식과태도는상관관계가있었지만낮은강도를보였다 (r=.5). 이상의본연구와선행연구에서낙상에대한지식은태도및예방활동과관련성이없거나약한상관관계가있는것으로분석되었다. 이러한결과는연구에서사용한낙상에대한지식측정도구와연관이있을것으로생각된다. 간호사의낙상에대한지식을측정하는데모두 Kim과 Suh [7] 가개발한도구를사용하였다. 이도구는총 6문항중에 문항이낙상의위험요인에관한질문으로구성되어있고낙상예방의중요성과수행기술에관한문항이적어, 낙상에대한태도와예방활동에필요한지식을측정하는데한계가있다고생각한다. 국내에서이루어진간호사의낙상에대한지식연구의대부분이이도구 [7] 를사용하고있으므로, 간호사가낙상에대한태도를형성하고낙상예방활동을하는데필요한지식을측정할수있는도구를개발하여낙상에대한지식과태도및예방활동간의관계를분석하는연구가이루어져야할것으로생각된다. 요양병원간호사의낙상예방활동에영향을미치는요인은낙상에대한태도, 연령, 낙상예방교육이수경험으로나타났으며, 6.6% 의설명력을보였다. 낙상에대한관심이높고, 예방교육을받았으며, 연령이높을수록낙상예방활동을많이하는경향이있었다. 특히낙상에대한태도가가장영향력 (β=.34, p<.00) 이높은요인으로나타났다. 요양병원 [4] 과대학병원간호사 [,5] 의낙상에대한태도가낙상예방활동에가장많은영향을미치는것으로보고하여본연구결과와유사하였다. 이러한연구결과를통해간호사의낙상에대한태도가낙상예방활동을결정하는가장중요한요인임을알수있다. 따라서간호사의낙상예방활동을촉진하기위해서는먼저낙상예방에대한관심과낙상예방활동에참여하려는태도를형성 하는것이중요하다. Hook 등 [9] 은낙상에대한지식교육은낙상예방에대한태도를긍정적으로변화시킴으로써낙상예방활동수행을촉진한다고하였다. 따라서요양병원간호사의낙상예방활동을증진하기위해서는낙상에대한지식과태도를동시에향상시키는교육프로그램이필요하다. 낙상예방교육이수경험이그다음으로영향력이높았으며, 선행연구에서도낙상예방교육을받은간호사의낙상예방활동수행정도가높은것으로보고되었다 [,5]. 상급종합병원간호사를대상으로낙상예방교육에대한견해를조사한연구 [30] 에서가장도움이되는접근법으로최근에발생한낙상사고에대해직원들간에의사소통하는것이라고보고하였다. 이러한결과를볼때, 간호사를대상으로낙상예방교육을실시하는것이중요하며, 교육방법으로는낙상사고에대한경험담을나누고효과적인낙상예방방법에대한의견을교환하는것이효과적일것으로생각된다. 본연구는요양병원간호사의낙상예방활동에낙상에대한지식과태도가미치는영향을확인하였다는점에서의의가있다. 특히낙상에대한간호사의태도와일반적인특성및낙상사고관련특성의연관성을검증함으로써향후낙상예방교육프로그램개발에필요한기초적인정보를제공하였다. 그러나본연구에서요양병원간호사의낙상예방활동에영향을미치는요인의설명력이충분하지않으므로관련변수에대한추가적인탐색이필요하다. 또한낙상에대한태도측정도구는 Kim과 Suh [7] 가개발한도구로내적일관성신뢰도 Cronbach s 는.75였으나본연구에서는.63으로다소낮게나와연구결과의신뢰성확보에제한점이있다. 결론 본연구는요양병원에근무하는간호사를대상으로낙상에대한지식, 태도및낙상예방활동정도를파악하고낙상예방활동에영향을미치는요인을확인하기위한서술적상관관계연구이다. 연구결과를종합하면, 연구대상자의낙상에대한지식, 태도및예방활동정도는비교적양호하였고, 낙상에대한태도, 연령, 낙상예방교육이수경험이낙상예방활동에영향을주었으며, 이중에낙상에대한태도가가장영향력이높았다. 따라서요양병원간호사의낙상예방활동을증진하기위해서낙상에대한태도를향상시킬수있는, 특히낙상을예방가능한사고로인식하고낙상예방에더욱관심을가질수있도록효과적인교육프로그램을개발하고제공하여야할것이다. 이상의연구결과를토대로다음과같이제언하고자한다. Vol. 9 No., 07 89
첫째, 본연구는 ~3등급의요양병원간호사를대상으로이루어져일반화에있어제한점이있으므로향후연구대상자를확대하여반복연구가필요하다. 둘째, 본연구는낙상예방활동을자가보고형질문지를사용하여조사하였다는제한점이있으므로면접법또는관찰법을적용하여낙상예방활동을실제적으로측정하는연구가필요하다. 셋째, 간호사의낙상에대한태도를개선할수있는교육프로그램을개발하고효과를검증하는연구가필요하다. REFERENCES. National Health Insurance Corporation & Health Insurance Review and Assessment Service. 00 national health insurance statistical yearbook. Statistics Annual Report. Seoul: National Health Insurance Corporation; 0 Dec. Report No. -B55098-00000-0.. Lee TJ, Choi JY, Lee JM, Kim JH, Lee BJ. Social security fact book 06. Policy Report. Sejong: Ministry of Health and Welfare, and Korea Institute for Health and Social Affairs; 06 Dec. Report No. 05-65. 3. Sin HS. Factors related to patient safety culture in nursing home nurses [master's thesis]. [Daegu]: Catholic University of Daegu; 04. 5 p. 4. Sohng KY, Cho OH, Park MH. Medication use as a risk factor for falls among hospitalized stroke patients. Journal of Academy Fundamental Nursing. 006;3():60-7. 5. Park AJ, Lim NY, Kim YS, Lee YK, Song JH. Incidence and predictors of falls in institutionalized elderly. Journal of Muscle Joint Health. 0;8():50-6. https://doi.org/0.5953/jmjh.0.8..050 6. Oh HY, Im YM. Functional status and health care utilization among elders with hip fracture surgery from a fall. Korean Journal of Adult Nursing. 003;5(3):43-40. 7. Kim CG, Suh MJ. An analysis of fall incidence rate and its related factors of fall in inpatients. Journal of Korean Society of Quality Assurance in Health Care. 00;9():0-8. 8. Korea Consumer Agency. Consumer Dispute Settlement Commission decided to indemnify long-term care hospitals for safety accidents due to neglecting safety management [Internet]. Seoul: Korea Consumer Agency; 06 Jun 3 [updated 06 Jun 3; cited 07 May 9]. Available from: http://www.kca.go.kr/brd/m_3/view.do?seq=046&srchf r=&srchto=&srchword= 요양병원 &srchtp=0&itm_seq_=0 &itm_seq_=0&multi_itm_seq=0&company_cd=&company _nm=&pitem=0&page= 9. Park YW. Guideline for nursing safety management. 7th ed. Seoul: Hospital Nurses Association; 0. 37 p. 0. Ministry of Health and Welfare & Korea Health Industry Development Institute. Guidelines for hospital evaluation programme. Gyeonggi-do: Ministry of Health and Welfare & Korea Health Industry Development Institute; 008. 58 p.. Seo OI. Influence of knowledge and attitude on behaviors of falls prevention activities in patient among university hospital nurse [master's thesis]. [Seoul]: The Catholic University of Korea; 008. 33 p.. Park YH. Characteristics and ADL associated factors of elderly inpatients in long-term care hospitals: a survey of patients (03-04). The Korean Journal of Health Service Management. 06;0(3):59-7. https://doi.org/0.8/kshsm.06.0.3.59 3. Korea Medical Dispute Mediation and Arbitration Agency. Medical dispute mediation and arbitration statistical yearbook 06 [Internet]. Seoul: Korea Medical Dispute Mediation and Arbitration Agency; 07 Apr 7 [updated 07 Apr 7; cited 07 May 9]. Available from: https://www.k-medi.or.kr/lay/bbs/st7c96/a/5/view.do?article_seq=78&cpage=&rows=&condition=&keyword= 4. Jung JY, Jung GH. The affect factors of geriatric hospital nurse's falls prevention activities. Journal of Health Informatics and Statistics. 06;4():03-. https://doi.org/0.03/jhis.06.4..03 5. Lee IK, Choi JY. Factors associated with nurses' activities for hospital fall prevention. The Korean Journal of Rehabilitation Nursing. 03;6():55-6. https://doi.org/0.7587/kjrehn.03.55 6. Koh SL, Hafizah N, Lee JY, Loo YL, Muthu R. Impact of a fall prevention programme in acute hospital settings in Singapore. Singapore Medical Journal. 009;50(4):45-3. 7. Kim CG. Nurses' knowledge and attitude toward fall in hospitalized patients. Journal of Industrial Science. 0;8():-7. 8. Kim SH, Kim MH, Jung MH. The level of elderly fall prevention activities & perception of patient safety culture among university hospital nurses. Journal of the Korean Society of Living Environmental System. 03;0():8-7. 9. Choi AS, Oh PJ. A study on self-leadership, fall attitudes, and nurses' behavior to prevent patient falls. Journal of Korean Academy of Nursing Administration. 03;9(3):394-403. https://doi.org/0./jkana.03.9.3.394 0. Hempel S, Newberry S, Wang Z, Booth M, Shanman R, Johnsen B, et al. Hospital fall prevention: a systematic review of implementation, components, adherence, and effectiveness. Journal of the American Geriatrics Society. 03;6(4):483-94. https://doi.org/0./jgs.69. Kim MY. Fall-related knowledge and prevention behavior among hospitalized elderly inpatients [master's thesis]. [Daegu]: Keimyung University; 008. 6 p.. Her JY, Kim HJ. Relationship of risk factors, knowledge and attitude to falls in elderly inpatients. Journal of Korean Geron- 90 Journal of Korean Gerontological Nursing
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