본 연구는 응급실 간호사의 비판적 사고성향, 문제해결능력과 중증도 분류역량의 정도를 확인하고, 중증도 분류역량에 미치는 영향요인을 규명하기 위한 서술적 조사연구이다. 본 연구의 대상자는 경기도 소재 권역응급의료기관 한 곳과 지역응급의료기관 두 곳의 응급실에 근무하는 간호사 중 근무경력 1년 이상이며 한국형 응급환자분류 (KTAS) 교육을 이수하고 중증도 분류업무를 수행하고 있는 간호사 118명을 대상으로 하였다. 자료수집기간은 2021년 8월 15일부터 9월 30일까지이며, 자료는 구조화된 설문지를 이용하여 수집하였다. 비판적 사고성향은 윤진(2004)이 개발한 도구를, 문제해결능력은 Heppner와 Petersen (1982)이 개발하고 전석균(1994)이 번안한 도구를, 중증도 분류역량은 문선희(2017)가 개발한 도구를 사용하였다. 수집된 자료는 SPSS version 25.0 프로그램을 이용하여 분석하였다.
본 연구의 주요결과는 다음과 같다.
1. 대상자의 비판적 사고성향의 평균은 89.59±10.25점(점수범위: 27∼135점)이었으며, 문제해결능력의 평균은 72.21±8.04점(점수범위: 21∼105점), 중증도 분류역량의 평균은 117.63±15.65점(점수범위: 30∼150점)이었다.
2. 일반적 특성에 따른 중증도 분류역량의 차이를 분석한 결과, 연령(F=4.78, p=.010), 응급실 경력(F=7.56, p<.001), 중증도 분류경력(F=8.22, p<.001)에 따라 통계적으로 유의한 차이가 있었다.
3. 중증도 분류역량은 비판적 사고성향(r=.56, p<.001), 문제해결능력(r=.62, p<.001)과 유의한 양의 상관관계를 보였고, 비판적 사고성향과 문제해결능력(r=.57, p<.001)도 유의한 양의 상관관계를 보였다.
4. 대상자의 중증도 분류역량에 영향을 미치는 요인을 확인하기 위해 위계적 회귀분석을 실시한 결과, 연령, 응급실 경력, 중증도 분류경력을 투입한 모형1에서 응급실 경력 10년 초과(β=.35, p=.046), 중증도 분류경력 18개월 이상(β=.25, p=.010)이 유의하게 나타났으며(설명력 19%), 비판적 사고성향과 문제해결능력을 투입한 모형2에서는 비판적 사고성향(β=.32, p<.001), 문제해결능력(β=.36, p<.001)이 유의하게 나타났다(설명력 52%).
이상의 연구 결과를 바탕으로 응급실 간호사의 비판적 사고성향, 문제해결능력, 응급실 경력, 중증도 분류경력이 중증도 분류역량의 영향요인으로 확인되었다. 이에 응급실 간호사의 중증도 분류역량의 향상을 위해서 비판적 사고성향과 문제해결능력을 높이기 위한 체계적이고 지속적인 프로그램의 개발과 적용이 필요하다.
Alternative Abstract
A cross-sectional descriptive design was used to examine the relations among emergency room (ER) nurses’ critical thinking disposition, problem-solving ability, and triage competency. Three hospitals in the Gyeonggi-do metropolitan area in Korea were chosen to enroll volunteers. At one regional emergency medical facility and two local emergency medical facilities, one hundred and eighteen ER nurses were recruited. Participants have at least one year of experience in the ER, have received Korean-style emergency patient classification training, and are using the KTAS tool to accomplish the classification work. Data were collected from August 2021 to September 2021. Participants completed self-reported questionnaires. The 'Yoon's Critical Thinking Disposition (YCTD)', the 'Problem Solving Inventory (PSI)', and the 'Triage Competency Scale (TCS)' were used to measure critical thinking disposition, problem-solving ability, and triage competency, respectively. SPSS Version 25.0 was used for data analysis. Participants’ characteristics and study variables, including critical thinking disposition, problem-solving ability, and triage competency were summarized using descriptive statistics. The differences between participants’ characteristics and triage competency were analyzed using T-test, ANOVA, Scheffe test. Pearson’s correlation coefficient was used to examine the correlations among critical thinking disposition, problem-solving ability, and triage competency. Hierarchical regression analysis used to identify the factors affecting triage competency. A p-value of < .05 was considered statistically significant.
The major results of this study are as follows.
1. The mean score of critical thinking disposition, problem-solving ability, and triage competency were 89.59±10.25 (range: 27-135), 72.21±8.04 (range: 21-105), and 117.63±15.65 (range: 30-150), respectively.
2. Elder ER nurses (age≥35) had significantly high triage competency (F=4.78, p<.05) compared with younger ER nurses (<30). Participants who had more ER experience (>10 years) had significantly high triage competency (F=7.56, p<.001) than those with less experience of ER (<6 years). In addition, ER nurses who had more triage experience (18 months) had more triage competency (F=8.22, p<.001) than those with less experience of triage (<12 months).
3. Triage competency was positively associated with critical thinking disposition (r=.56, p<.001) and problem-solving ability (r=.62, p<.001). In addition, critical thinking disposition was positively associated with problem-solving ability (r=.57, p<.001).
4. Two sets of hierarchical regression analyses were performed to examine the predict triage competency. In the first step of analysis, age, ER experience, and triage experience predicted 19% of the triage competency. Both predictors, ER nurses who had more ER experience (>10 years) and had more triage experience (18 months) were significant (β=.35, p=.046, β=.25, p=.010, respectively). In second step of analysis, age, ER experience, triage experience, critical thinking disposition, and problem-solving ability predicted 52% of the triage competency. Both predictors critical thinking disposition and problem-solving ability being significant (β=.32, p<.001, β=.36, p<.001, respectively). Both predictors critical thinking disposition and problem solving ability raised the prediction from 19% to 52%.
Critical thinking disposition, problem-solving ability, ER experience, and triage experience all have a role in triage competency, according to the findings of the study. Therefore, to improve ER nurses' triage competency, a systematic and ongoing program to improve critical thinking disposition and problem-solving capacity should be developed and implemented.hinking disposition, problem-solving ability, ER experience, and triage experience all have a role in triage competency, according to the findings of the study. It is vital to develop an environment that allows ER nurses to retain their jobs to increase their triage proficiency. Furthermore, a comprehensive and systematic education program needed to be developed and implemented.