한국형 응급환자 분류도구 및 환자의존도에 따른 환자군별 간호시간과 간호사 배치수준
Nursing Hours and Nurse Staffing according to Korean Triage Acuity Scale and Patient Dependency
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목적: 본 연구의 목적은 응급환자의 중증도 및 환자의존도 별 간호시간을 측정하여 간호 사 배치 수준을 분석하는 것이다. 방법: 연구 대상은 2019년 10월 24일부터 26일까지 48시간 동안 3개 상급종합병원의 성인응급실을 방문한 환자와 동 시간에 근무한 간호사로, 시간대별 환자수와 간호사 배치 수준을 확인하였다. 응급환자의 중증도는 한국형 응급환자 분류도구(KTAS)를 사용하여 레벨 1(중증도가 가장 높음)에서 레벨 5(가장 낮음)까지로 분류하였다. 환자의존도는 6개 항목(주의관찰, 의사소통 등)으로 측정하였고 4개 그룹으로 분류하였다. 간호활동은 10분마다 관찰하였고, 환자 별 간호시간과 간호사 배치 수준은 중증도와 환자의존도에 따라 분석하였다. 결과: 48시간 관찰된 간호사와 환자의 비는 1:1.8-1:4.2명이었다. 간호사 1인당 휴식시간과 식사시간을 제외한 평균 근무시간은 8.57 시간이었고, 그 중 42.5%는 직접 간호 시간이었다. 중증도가 높은 환자와 의존도가 높은 환자의 간호시간과 간호사 배치수준이 높았다. KTAS 레벨1 환자의 간호시간은 시간 당 74.3분으로 레벨5 환자(14.8분)보다 5.02배 높았다. 환자의존도가 가장 높은 환자에게는 시간 당 87.4분의 간호가 제공되어, 가장 낮은 그룹(15.2분)보다 5.75배 많은 시간의 간호가 제공되었다. 같은 KTAS 레벨에서는 새로 입실 환자가 재실 환자보다 더 많은 시간의 간호를 받았다. 결론: 응급실은 시간대 별로 환자의 수, 중증도, 환자의존도가 큰 차이가 있는 것으로 나타났다. 따라서 응급실의 간호사 배치는 환자의 중증도와 환자의존도에 따라 결정되어야 한다.
Abstract
Purpose: The purpose of this study was to analyze nurse staffing according to patients' acuity and dependency by measuring nursing hours. Methods: The study sample included patients who visited the adult emergency departments (EDs) of three tertiary referral hospitals and nurses who worked on shifts for 48 hours from October 24 to 26, 2019. Hourly patient census and nurse staffing were analyzed. Patient acuity was measured using the Korean Triage and Acuity Scale (KTAS), ranging from Level 1 (highest) to Level 5 (lowest). Patient dependency was measured using six items (e.g., clinical attention and communication) and classified into four groups. Nursing activities were observed every 10 minutes and nursing hours per patient and nurse staffing were analyzed according to acuity and dependency. Results: Nurse-to-patient ratio ranged from 1:1.8 to 1:4.2 during the 48 hours of observation. The average work hours of nurses, excluding breaks and meals, was 8.57 hours; 42.5% of which was spent providing direct care. Higher acuity and dependency were associated with higher nursing hours and staffing level. Patients with KTAS Level 1 were provided 74.3 minutes per hour, 5.02 times higher than Level 5 (14.8 minutes). Patients in the highest dependency group were provided 87.4 minutes per hour, 5.75 times higher than the lowest group (15.2 minutes). Newly arrived patients received more nursing hours than continuously stayed patients within the same KTAS Levels. Conclusion: Large variations were found in hourly patient census, acuity, and dependency. Nurse staffing in EDs should be determined based on patient acuity and dependency.
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