Self-leadership, Critical Thinking Disposition, and Clinical Decision Making in Emergency Nurse

Abstract

The present study is a cross-sectional survey conducted to understand the level of self-leadership, critical thinking disposition, and clinical decision making of emergency nurses, and to determine factors affecting clinical decision making. Data were collected from 110 emergency nurses working, for one year or longer, at the emergency rooms at two tertiary care hospitals and one general hospital located in the metropolitan area from December 14, 2018, to February 28, 2019. Self-leadership was measured using a scale developed by Manz (1983) and modified and supplemented by Kim Han-seong (2002); critical thinking disposition was measured using a scale developed by Yun Jin (2004); and clinical decision making was measured by the Clinical Decision Making in Nursing Scale (CDMNS), which was developed by Jekins (1985), translated by Baek Mi-gyeon (2004), and modified by Oh In-suk (2015). Descriptive statistics, t-test, ANOVA, correlations, and multiple regression analysis were performed on the collected data using the SPSS 22.0 program. regression analysis The findings of the present study were as follows. 1. The average score for emergency nurses’ self-leadership was 3.52 out of five points. The highest component score was 3.90 points for “self-compensation” followed by 3.62 points for “self-expectations,” 3.51 points for “goal setting,” 3.43 points for “rehearsal,” 3.34 points for “self-criticism,” and 3.33 points for “constructive thoughts.” 2. The average score for critical thinking disposition of emergency nurses was 3.47 out of five points. The highest component score was 3.79 points for “intellectual integrity,” followed by 3.79 points for “objectivity,” 3.57 points for “self-confidence,” 3.51 points for “intellectual eagerness/curiosity,” 3.28 points for “systematicity,” 3.23 points for “healthy skepticism,” and 3.15 points for “prudence.” 3. The average score for clinical decision making of emergency nurses was 3.22 out of five points. The highest component score was 3.34 points for “evaluation and reevaluation of consequence,” followed by 3.33 points for “search for information and unbiased assimilation of new information,” 3.22 points for “canvassing of objectives and values,” and 2.97 points for “search for alternatives or options.” 4. Among the general characteristics of emergency room nurses, the score for clinical decision making was significantly different for shift pattern (t=-2.06, p=.042) and nurse satisfaction (F=4.12, p=.019). Differences in the clinical decision-making score by gender, age, marital status, religion, education level, total nursing experience, emergency room experience, and nursing positions were statistically nonsignificant. 5. A significant positive relationship (r=.487, p<.001) was found between self-leadership and clinical decision making. A significant positive relationship was also found between critical thinking disposition and clinical decision making (r=.551, p<.001). 6. Multiple regression analysis was performed to identify factors that affect clinical decision making of emergency nurses, and the results showed that the general characteristics of shift pattern and nurse satisfaction explained 9.4% (F=3.66, p=.015) of clinical decision making. When self-leadership and critical thinking disposition were also entered, 36.7% (F=12.06, p<.001) of clinical decision making was explained, which means that those two additional factors increased the explanatory power of the model by 27.3%. Of those factors, only critical thinking disposition had statistically significant influence on clinical decision making (β=.39, p=.001). The present study determined that the self-leadership and clinical decision making of emergency nurses are positively related, and critical thinking disposition is an important influencing factor for clinical decision making. Accordingly, considering the special working environment of the emergency room, emergency nurses should be provided with the environment and education to improve self-leadership and critical thinking disposition Through this provision, the clinical decision making of emergency nurses can be promoted, and research to improve their clinical decision making should continue.

본 연구는 응급실 간호사의 셀프리더십, 비판적 사고성향과 임상 의사결정능력 정도를 파악하고, 임상 의사결정능력에 영향을 미치는 요인을 확인하기 위해 시행된 횡단적 조사연구이다. 수도권 소재 상급 종합병원 2곳 및 종합병원 1곳에서 근무하는 응급실 경력 1년 이상의 응급실 간호사 110명을 대상으로 2018년 12월 14일부터 2019년 2월 28일까지 자료 수집하였다. 셀프리더십은 Manz(1983)가 개발한 도구를 김한성(2002)이 수정 · 보완한 도구로 측정하였고, 비판적 사고성향은 윤진(2004)이 개발한 도구를, 임상 의사결정능력은 Jekins(1985)가 개발한 The Clinical Decision Making in Nursing Scale(CDMNS)을 백미경(2004)이 번안하고 오인숙(2015)이 수정한 도구로 측정하였다. 수집된 자료는 SPSS 22.0 프로그램을 사용하여 기술통계, t-test와 ANOVA, 상관관계, 다중회귀분석을 시행하였다. 본 연구 결과는 다음과 같다. 1. 응급실 간호사의 셀프리더십은 5점 만점에 평균 3.52점으로 나타났다. 하위 구성요소는 ‘자기보상’ 3.90점, ‘자기기대’ 3.62점, ‘목표설정’ 3.51점, ‘리허설’ 3.43점, ‘자기비판’ 3.34점, ‘건설적 사고’ 3.33점 순으로 나타났다. 2. 응급실 간호사의 비판적 사고성향은 5점 만점에 평균 3.47점으로 나타났다. 하위 구성요소는 ‘지적공정성’ 3.79점, ‘객관성’ 3.79점, ‘자신감’ 3.57점, ‘지적열정/호기심’ 3.51점, ‘체계성’ 3.28점, ‘건전한 회의성’ 3.23점, ‘신중성’ 3.15점 순으로 나타났다. 3. 응급실 간호사의 임상 의사결정능력은 5점 만점에 평균 3.22점으로 나타났다. 하위 구성요소는 ‘결론의 평가와 재평가’ 3.34점, ‘정보에 대한 조사와 새로운 정보에 대한 일치화’ 3.33점, ‘가치와 목표에 대한 검토’ 3.22점, ‘대안과 선택의 조사’ 2.97점 순으로 나타났다. 4. 응급실 간호사의 일반적 특성 중 근무형태(t=-2.06, p=.042)와 간호직 만족도(F=4.12, p=.019)에서 임상 의사결정능력의 점수 차이가 통계적으로 유의하게 나타났다. 이외, 성별, 연령, 결혼상태, 종교, 학력, 총 임상경력, 응급실 경력, 직위에 따른 임상 의사결정능력의 점수 차이는 통계적으로 유의하게 나타나지 않았다. 5. 응급실 간호사의 셀프리더십과 임상 의사결정능력은 양의 상관관계(r=.487, p<.001)가 나타났다. 비판적 사고성향과 임상 의사결정능력도 양의 상관관계로 나타났다(r=.551, p<.001). 6. 응급실 간호사의 임상 의사결정능력에 미치는 요인을 파악하기 위해 다중회귀분석을 시행한 결과 일반적 특성인 근무형태, 간호직 만족도는 임상 의사결정능력을 9.4%(F=3.66, p=.015) 설명하였고, 셀프리더십과 비판적 사고성향을 추가 투입한 결과 임상 의사결정능력을 36.7%(F=12.06, p<.001) 설명하여 셀프리더십과 비판적 사고성향이 임상 의사결정능력을 27.3% 추가적으로 설명하였다. 이 중 비판적 사고성향만이 임상 의사결정능력에 통계적으로 유의하게 영향을 미치는 변수로 나타났다(β=.39, p=.001). 본 연구를 통해 응급실 간호사의 셀프리더십과 임상 의사결정능력 간에 양의 상관관계가 있으며, 비판적 사고성향은 임상 의사결정능력의 중요 영향 요소임을 확인하였다. 따라서 응급실의 특수한 근무환경을 고려하여 응급실 간호사에게 셀프리더십, 비판적 사고성향을 증진시킬 수 있는 환경과 교육을 제공하도록 해야 한다. 이를 통해 응급실 간호사의 임상 의사결정능력 향상을 도모할 수 있을 것이며, 응급실 간호사의 임상 의사결정능력 증진을 위한 연구 또한 지속적으로 이루어져야 할 것이다.