요양병원 간호인력 배치수준이 환자결과에 미치는 영향에 관한 경로분석
Path Analysis of the Effects of Nurse Staffing on Patient Outcomes in Long-Term Care Hospitals
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초록
목적: 본 연구의 목적은 대한민국 요양병원의 간호인력 배치수준이 환자결과에 미치는 영향을 분석하는 것이다. 방법: 건강보험심사평가원의 2021년 요양병원 입원급여 적정성 평가 결과에 대해 2차 자료 분석을 수행하였다. 자료수집은 2023년 6월 19일부터 6월 27일까지 수행되었다. 연구대상 의료기관은 1,215개 병원이며, 연구자료는 SAS 9.4와 Mplus 8 소프트웨어를 활용하여 분석하였다. 결과: 간호사, 간호조무사, 간호인력 1인당 환자수는 각각 10.00명, 7.43명, 4.00명이었다. 경로분석 결과 간호사 1인당 환자수는 요양병원 입원환자의 일상생활수행능력 개선에 직접적인 영향을 미쳤으며, 유치도뇨관 보유, 욕창개선, 체중감소에는 간접적인 영향을 미쳤다. 간호조무사 1인당 환자수는 욕창발생과 욕창개선에 직접적인 영향을 미쳤으며, 간접효과는 없었다. 간호인력 1인당 환자수는 욕창개선에 직접적인 영향을 미쳤으며, 다른 환자결과에 대한 간접효과는 없었다. 결론: 요양병원의 간호사 배치수준과 환자결과를 개선하기 위하여 간호사와 간호조무사 배치수준을 별도로 산정하는 정책 수립을 제언한다.
Abstract
Purpose: The study aimed to examine the effects of nurse staffing levels on patient outcomes in long-term carehospitals in South Korea using path analysis. Methods: We conducted a secondary analysis of national data, whichincluded the 2021 hospital assessment results of long-term care hospitals from the Health Insurance Review andAssessment Service. Data collection was performed between June 19 and June 27, 2023. The study sampleconsisted of 1,215 hospitals, and we analyzed the data using SAS 9.4 and Mplus 8 software. Results: The averagenumbers of patients per registered nurse, certified nursing assistant, and nursing staff, including both registerednurses and certified nursing assistant, was 10.00, 7.43, and 4.00, respectively. Path analysis revealed that thenumber of patients per registered nurse had direct effects on improvements in activities of daily living and indirecteffects on indwelling catheterization, pressure ulcer improvement, and weight loss. The number of patients percertified nursing assistant had direct effects on new pressure ulcer development and pressure ulcer improvement,with no indirect effects. The number of patients per nursing staff had direct effects on pressure ulcer improvementand no indirect effects on other patient outcomes. Conclusion: The findings suggest that establishing policies toevaluate staffing levels of registered nurse and certified nursing assistants separately is necessary in order toimprove registered nurse staffing levels and patient outcomes in long-term care hospitals.
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