A Study on the Effects of Stroke Discharge Patient Linkage Program on Nurses' Working Environment and Discharge care plan Satisfaction

Abstract

This study is a study on the effect of the stroke discharge patient linkage project on nurses' working environment and satisfaction with the 퇴원환자연계서식(Discharge care plan). Due to the continuous increase in the number of stroke patients, the increase in medical expenses and social costs, and the poor re-discharge related medical service for stroke discharged patients, the Ministry of Health and Welfare Seoul National University Bundang Hospital was designated as a medical institution. In this study, the stroke discharge patient linkage project was set as the independent variable, and the nurse's working environment and satisfaction with the 퇴원환자연계서식(Discharge care plan) were set as the dependent variables. This study aims to provide basic data for providing consistent and systematic medical services to stroke patients by empirically analyzing the effects and effects of the stroke discharge patient linkage project on nurses by using these two dependent variables.In other words, the purpose of this study was to empirically investigate how the stroke discharge patient linkage program affects the nursing work environment and satisfaction with the 퇴원환자연계서식 (Discharge care plan). The results of this study can be used as basic data for providing quality medical services to stroke patients, improving the nursing work environment for nursing stroke patients, and providing quality nursing services for stroke patients. To this end, in this study, the following specific research questions were presented. 1. The stroke discharge patient linkage project will affect the creation of an environment for high-quality nursing care for nurses. 2. The stroke discharge patient linkage project will affect the cooperative relationship between nurses and doctors. 3. The stroke discharge patient linkage project will affect the manpower and material support for nurses. 4. The stroke discharge patient linkage project will affect nurses' satisfaction with the 퇴원환자연계서식(Discharge care plan) (integrated linkage form). In the theoretical background of this study, the theoretical background suitable for this study was reconstructed based on the analysis results of previous studies on the stroke discharge patient linkage project, nursing for stroke patients, the stroke nursing competency of nurses, and the nursing work environment. In the research method of this study, in order to confirm the research purpose and principle of the analysis of the effect of the stroke discharge patient linkage project on the nurse's working environment and satisfaction with the 퇴원환자연계서식(Discharge care plan), the research subject and research model are presented, and measurement tools and analysis methods are presented. I want to explain about it. Furthermore, the reliability and validity of the measurement tool of this study are verified, and the characteristics of the analysis variables are examined in detail. Next, a quantitative analysis method was used to solve the research problem. The results of this study are as follows: First, among the sub-factors of nurse participation in the stroke discharge patient linkage project, when the working department is an emergency room compared to the ward, among the factors of the nursing work environment, the effect on the participation of nurses has a statistically significant positive (+) effect. was found to affect Second, as a result of this study, nurses with a large number of patients in charge per day recognized that the stroke discharge patient linkage project was more necessary. Third, as a result of this study, among the sub-factors of the participation status of nurses in the stroke discharge patient linkage project, nurses working in emergency rooms and intensive care units compared to general wards, nurses with a relatively high tenure, among the sub-factors of the recognition and utilization of referral letters. In the case of nurses with a high reference rate of the 퇴원환자연계서식(Discharge care plan) (퇴원환자연계서식(Discharge care plan)), it was found that the effect on the foundation for quality nursing had a statistically significant positive (+) effect. Fifth, as a result of this study, among the sub-factors of the participation status of nurses in the stroke discharge patient linkage project, the working department was a nurse working in the emergency room and intensive care unit compared to the general ward, a nurse with a relatively high tenure, recognition of a referral letter and Among the utilization sub-factors, the effect of nurses with a high reference rate of the 퇴원환자연계서식(Discharge care plan) (integrated link form for discharge patients) on support for nurses and sufficient manpower and material support among the factors of the nursing work environment had a statistically significant positive (+) effect. was found to affect Sixth, as a result of this study, among the sub-factors of the participation status of nurses in the stroke discharge patient linkage project, the number of nurses working in the emergency room and intensive care unit compared to the general ward, the case of a relatively large number of nurses with an average number of patients in charge per day, and the letter of referral Among the sub-factors of awareness and utilization, the effect of nurses with a high reference rate of the 퇴원환자연계서식(Discharge care plan) (integrated link form for discharge patients) on the cooperative relationship between nurses and doctors among the factors of the nursing work environment was found to have a statistically significant positive (+) effect. It was understood. Based on the results of this study, the conclusions are as follows. First, in the stroke discharge patient linkage project, the 퇴원환자연계서식(Discharge care plan) (discharge patient integrated linkage form) is moving to other areas for treatment because access to high-quality medical services is low in areas other than the metropolitan area and large cities. It can be understood that a 퇴원환자연계서식(Discharge care plan) (integrated connection form for discharge patients) is essential. Second, considering the announcement of the 「Comprehensive Measures for Public Health Development (18.10)」 to resolve regional disparities in essential medical care, it is judged that it is necessary to establish a public health care cooperation system between local health care institutions to improve essential medical problems such as stroke patients.Third, in the institutional aspect, it is necessary to designate a responsible medical institution for each region/region and to induce and coordinate essential medical cooperation within the region and region, centering on public hospitals such as national university hospitals and regional medical centers. Fourth, the government should be in charge of establishing and conducting the project for establishing a public health and medical cooperation system, and local governments should be systematically equipped with a business plan submission and change review, subsidy grant and execution management, and performance and performance reporting system.

본 연구는 뇌졸중 퇴원환자 연계사업이 간호사의 근무환경과 퇴원환자연계서식(Discharge care plan)만족도에 미치는 영향에 관한 연구이다. 뇌졸중 환자의 수가 지속해서 증가와 진료비 및 사회적 비용의 증가, 그리고 원활하지 못한 뇌졸중 퇴원환자 재·퇴원 연계 의료서비스로 인한 문제점의 해결을 위해 보건복지부는 2019년 7월부터 분당서울대병원과 공동으로 뇌졸중 퇴원환자 연계사업을 시행하고 있다. 본 연구에서는 뇌졸중 퇴원환자 연계사업을 독립변수로 설정하였고, 간호사의 근무환경과 퇴원환자연계서식(Discharge care plan)에 대한 만족도를 종속변수로 설정하였다. 본 연구에서는 뇌졸중 퇴원환자 연계사업이 간호사들의 간호환경과 퇴원환자연계서식(Discharge care plan)에 대한 만족도에 어떤 영향을 미치는지를 파악함으로써, 위 사업이 간호사들에게 미치는 영향과 효과를 실증적으로 분석하는데 그 목적이 있다. 이는 뇌졸중 환자를 직접 간호하는 간호사들에 대한 근무환경의 개선과 뇌졸중 환자를 위한 통합적인 간호서비스 제공을 위한 기초자료로 사용될 수 있을 것이다. 이를 위해, 본 연구에서는 다음과 같은 구체적인 연구문제를 제시하였다. 1. 뇌졸중 퇴원환자 연계사업은 양질의 간호를 위한 환경 조성에 영향을 미칠 것이다. 2. 뇌졸중 퇴원환자 연계사업은 간호환경에 영향을 미칠 것이다. 3. 뇌졸중 퇴원환자 연계사업은 간호사의 퇴원환자 퇴원환자연계서식(Discharge care plan)에 대한 만족에 영향을 미칠 것이다. 본 연구에서는 총 400명 설문 응답자 중 323명의 재활병원에 근무하는 간호사를 최종 분석대상으로 선정하여, t 검정과 일원 배치 분산분석(One-way ANOVA), 상관 분석(Correlation Analysis)과 다중 회귀분석(Multi-regression Analysis)을 실시하였다. 이를 통해 도출된 연구결과는 다음과 같다. 첫째, 뇌졸중 퇴원환자 연계사업 간호사 참여 실태 하위 요인 중 근무 부서는 병동보다 응급실일 때 간호근무환경 요인 중 간호사의 참여에 미치는 영향은 통계적으로 유의미한 정적(+)영향을 미쳤다는 것이다. 둘째, 하루 평균 담당 환자 수가 많은 간호사일 때 뇌졸중 퇴원환자 연계사업에 대한 필요성을 더욱 중요하게 인식하고 있었다. 셋째, 일반 병동보다 응급실, 중환자실에 근무하는 근속 연수가 상대적으로 높은 간호사인 경우, 진료 회송서 인식 및 활용도 하위 요인 중 퇴원환자연계서식(Discharge care plan) 참조비율이 높은 간호사들이인 경우, 양질의 간호를 위한 기반에 미치는 영향은 통계적으로 유의미한 정적(+)영향을 미치는 것으로 파악되었다. 넷째, 근무 부서는 병동보다 응급실, 중환자실에 근무하는 간호사인 경우, 하루 평균 담당 환자 수가 많은 간호사인 경우, 진료 과목이 내과보다 재활의학과에 근무하는 간호사일 때 간호근무환경 요인 중 간호 관리자의 능력과 리더십에 미치는 영향은 통계적으로 유의미한 정적(+)영향을 미치는 것으로 파악되었다. 다섯째, 근무 부서는 일반 병동보다 응급실과 중환자실에 근무하는 간호사인 경우, 근속 연수가 상대적으로 높은 간호사인 경우, 진료 회송서 인식 및 활용도 하위 요인 중 퇴원환자연계서식(Discharge care plan) 참조비율이 높은 간호사인 경우가 간호근무환경 요인 중 간호사에 대한 지지와 충분한 인력과 물질적 지원에 미치는 영향이 통계적으로 유의미한 정적(+)영향을 보이는 것으로 파악되었다. 여섯째, 뇌졸중 퇴원환자 연계사업 간호사 참여 실태 하위 요인 중 근무 부서는 일반 병동보다 응급실과 중환자실에 근무하는 간호사인 경우, 상대적으로 하루 평균 담당 환자 수인 많은 간호사인 경우와 진료 회송서 인식 및 활용도 하위 요인 중 퇴원환자연계서식(Discharge care plan) 참조비율이 높은 간호사인 경우가 간호근무환경 요인 중 간호사와 의사의 협력관계에 정적(+)영향을 미치는 것으로 파악되었다. 본 연구결과를 토대로 결론을 살펴보면 다음과 같다. 뇌졸중 퇴원환자 연계사업에서 퇴원환자연계서식(Discharge care plan)은 수도권·대도시가 아닌 지역은 양질의 의료서비스에 대한 접근성이 낮아 진료를 위해 다른 지역으로 이동하고 있는 현실을 고려해 볼 때, 퇴원환자연계서식(Discharge care plan)의 활용률을 높이고, 뇌졸중 퇴원환자를 돌보는 간호사들의 근무환경 개선과 지역 보건의료기관 간 공공보건의료 협력체계 구축을 위한 후속연구가 필요하다는 것이다.