• 간호행정학회지
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• 제15권3호
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• pp.391-402
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• 2009

Purpose: The purpose of this research was to describe the decision making experience of VIP ward nurses in the clinical practice adjustment process. The research question was about "how nurses adjust their clinical practice to nursing situations and develop decision making process in a VIP ward." Method: The methodology of collecting and analyzing the data was based on the grounded theory of Strauss and Corbin(1998). The data was collected through in-depth interviews with 10 nurses from July to November, 2007. Results: The core category of nursing care decision making process was named as "adjusting with flexibility and deepened insight." The clinical practice adjustment process in nursing care decision making has progressed through four preceding interlocking phases: 1) dependent phase, 2) defensive phase, 3) independent phase, 4) integrative phase. These phases were classified by the level of nurses' dependency, proactivity, presupposition and integration. Conclusion: The result of this study indicated that nurse's decision making depended on their experiences and the nature of social context in which nursing occurs. Therefore, it is important to elaborate an effective training program for nurses to develop the phases of nursing care decision making.

• 간호행정학회지
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• 제7권2호
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• pp.301-314
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• 2001

The main purpose of this research is to describe comprehensively the processes of clinical decision making in novice critical care nurses through clinical experience. This research was an exploratory, longitudinal study using a fieldwork approach incorporating "think-aloud" method and in-depth interviews with the study participants. The study participants consisted of 5 novice nurses assigned to critical care units at a tertiary medical center located in Seoul, among a group of 27 novice nurses who started at the same period at this hospital. The data were collected from March 1999 to April 2000. The major findings of the study is that the novice nurses followed the analytic linear model of clinical decision making in the beginning, but were changed increasingly to follow the comprehensive, integrated model of clinical decision making. Through repeated experience that resulted in increasing repertoire of clinical schema and familiarity of task environments of clinical practice the novice nurses expanded their ability to arrive at comprehensive integration of information and to arrive at accurate and time-efficient decisions. Both the analytic, linear model mostly used at the beginning period and the comprehensive, integrated model that seems to be the mode significantly dependent upon experience seem to have strengths and weaknesses as decision making processes in clinical situations. Hence, it is imperative to develop an effective orientation and training program for novice nurses through the use of clinical preceptors. In addition, students should be exposed to the process of clinical decision making early in their nursing education through an appropriate clinical experiences and clinical assignments.

• 근관절건강학회지
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• 제30권1호
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• pp.48-57
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• 2023

Purpose: The purpose of this study was to examine nurses' critical thinking disposition and knowledge sharing activity and professional work environment on clinical decision-making ability. Methods: The data collection period for this study was from May 24 to May 31, 2021. The data were collected from 167 nurses who consented to participate in this study and have worked for more than one year at general hospital in Seoul. The data were analyzed using the SPSS/WIN 25.0 program. Results: A significant positive correlation was found between clinical decision-making ability and critical thinking disposition, knowledge sharing activity, and a professional work environment. Critical thinking disposition (β=.32, p<.001), knowledge sharing activitiy (β=.24, p=.002) and professional work environment (β=.20, p=.006) had a significant effect on clinical decision-making ability. These factors explained 35.5% of clinical decision-making ability (F=24.22, p<.001). Conclusion: Therefore, in order to develop the critical thinking disposition of nurses, development of systematic educational programs and strategies for practical application are needed. Through this, nurses can improve the professional decision-making ability and clinical performance ability.

• 중환자간호학회지
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• 제15권2호
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• pp.27-38
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• 2022

Purpose : The purpose of this study was to identify the mediating effect of role clarity in the relationship between clinical decision-making abilities and job stress among advanced practice nurses at tertiary hospitals. Methods : The participants were 137 advanced practice nurses. The assessment tools were clinical decision-making in nursing scale, role ambiguity scale, and Korean occupational stress scale (KOSS-26). Data were analyzed with the SPSS/24.0 program and mediation analysis was performed according to the Baron and Kenny methods. Results : There were significant relationships between clinical decision-making abilities and job stress (r=-.33, p<.001), and role clarity and job stress (r=-.29, p=.001). Role clarity showed partial mediating effects in the relationship between clinical decision-making abilities and job stress (Z=2.02, p=.043). Conclusion : Therefore, to reduce advanced practice nurses' job stress, it is necessary to develop a program and strategies to increase their clinical decision-making abilities.

• 간호행정학회지
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• 제15권2호
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• pp.275-283
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• 2009

Purpose: This study investigated the effects of reeducation of nursing process on nurses' expertise, critical thinking disposition, and clinical decision making. Methods: Data were collected from March to June, 2007. The subjects were 47 Academic Credit Bank System Student Nurses. They were taught 'nursing process' during 1 semester(15weeks). 47 nurses were divided into three groups according to clinical experience(under 3 years, 3 to under 5 years, 5 years or more). After 15 weeks, the effects of education were compared using a paired t-test between pre-test and post-test. Results: There was a significant difference in the 3 to under 5 years experienced nurses's expertise(t=-3.659, p=.004) between the pre-test and post-test. There was a significant difference in the 5 years or more experienced nurses's expertise(t=-5.781, p<.001) and critical thinking disposition(t=-3.345, p=.003) between the pre-test and post-test. There were no significant differences in clinical decision making(accuracy, proficiency, and confidence) of 3 groups. Conclusion: Reeducation of nursing process is a valuable teaching and an evaluation strategy for 5 years or more experienced nurses to improve expertise and critical thinking disposition. We need to develop continuing education program for improving nurses' clinical decision making.

• 간호행정학회지
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• 제19권5호
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• pp.668-678
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• 2013

Purpose: This study was done to develop a realistic clinical case and investigate nurses' decision-making about nurses' ethical dilemmas with physicians in the fields of nursing practice. Methods: Case development and a hypothetical case study were used. Participants were 52 nurses. Data were collected in 2012 and 2013 using an open-ended questionnaire and interviews and analyzed using content analysis and descriptive statistics. Results: Various dilemma situations between nurses and physicians, such as violence, deathbed, medication prescription, and physicians' incapacity unfairness, were suggested. A clinical dilemma case about medication prescription was developed based on nurses' experiences. Nurses' responses to the developed case situation and responses were classified into five types. Various reasons were given for making the decisions and about 56% of the nurses decided to notify their supervisor without deleting nursing records. Conclusion: In this study, a realistic clinical dilemma case was developed, and nurses' ethical decision making was identified. These findings can be used in developing effective strategies for nurses to solve ethical dilemmas and to improve ethical decision-making abilities.

• 부모자녀건강학회지
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• 제15권1호
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• pp.20-32
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• 2012

Purpose: The purpose of this study was to identify clinical decision making pattern of pediatric nurses and analyze how it shows the differences in types of decision making pattern by nurses characters. Methods: A self-administered questionnaire was used to pediatric nurses of 4 general hospitals in Seoul from February 2004 to April 2004. The data of 251 nurses was analyzed by varimax rotation factor analysis, t-test, and ANOVA. Results: 6 decision making patterns were identified: Individual Patient-oriented, Pattern-oriented Intuitive, Typical Nursing Knowledge-oriented, Nursing Model-oriented, Medical Knowledge-oriented, and Patient-Family-Nurse Collaborative. Individual Patient-oriented, Pattern-oriented Intuitive, Typical Nursing Knowledge-oriented, and Nursing Model-oriented decision making pattern got meaningful differences in age, marital status, total number of years in nursing practice, and number of years in pediatric nursing practice. Conclusion: We expect the result of this study can be applied for promotion of understanding the decision making of nurses that occurs in pediatric nursing practice and also can be used as foundation data for development and expansion of pediatric nursing practice.

• 디지털융복합연구
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• 제20권4호
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• pp.769-777
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• 2022

본 연구의 목적은 요양병원 간호사의 임상의사결정능력에 미치는 영향요인을 규명하기 위함이다. 2021년 10월 11일부터 12월 10일까지 G도 소재 요양병원 간호사 174명을 대상으로 조사하였다. 수집된 자료의 분석은 SPSS 23.0을 이용하여 서술통계, t-test, ANOVA, Pearson's correlation, stepwise multiple regression으로 분석하였다. 연구결과 연구대상자의 임상의사결정능력은 비판적 사고성향(r=.494, p<.001), 간호근무환경(r=.451, p<.001)과 양의 상관관계를 나타내었으며, 비판적 사고성향과 간호근무환경이 임상의사결정능력을 33.1% 설명하였다. 간호사의 핵심능력인 임상의사결정능력의 향상을 위해서는 비판적 사고성향을 높이는 교육과 바람직한 간호근무환경 조성이 필요하다. 추후연구에서는 요양병원 간호사의 임상의사결정능력에 영향을 미치는 다양한 변수를 확인하는 연구와 임상의사결정능력 향상을 위한 프로그램 개발 및 효과를 위한 연구를 제언한다.

• 한국산학기술학회논문지
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• 제19권7호
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• pp.463-473
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• 2018

본 연구는 간호간병통합서비스 병동간호사를 대상으로 전문직 자율성, 역할갈등, 임상적 의사결정능력과의 관계와 함께 임상적 의사결정능력에 영향을 미치는 영향요인 파악을 목적으로 한 서술적 조사연구이다. 본 연구에서는 D시와 G시에 근로간호사 234명을 편의 표집하여 조사하였다. 자료수집은 2017년 10월 12일부터 11월 30일 사이에 D시와 G시에 소재하는 4개의 종합병원의 234명을 대상으로 연구 참여에 서면 동의한 간호사에게 자가 보고식 설문조사지를 사용하여 자료를 수집하였다. t-test, ANOVA, Pearson's coefficients와 단계적 회귀분석으로 자료를 분석하였다. 연구결과에서 임상적 의사결정능력은 평균평점 $3.38{\pm}0.78$점으로 중간수준으로 나타났다. 임상적 의사결정능력은 전문직 자율성과 양의 상관관계(r=.40, p<.001)를 보였으나, 역할갈등과는 음의 상관관계(r=-.21, p<.001)가 있는 것으로 나타났다. 임상적 의사결정능력에 미치는 영향은 근무경력, 교육수준, 전문직 자율성과 역할갈등이었으며, 임상적 의사결정능력에 대한 설명력은 38.7%였다. 임상적 의사결정 능력을 개선하기 위해 중요한 변수인 전문직 자율성과 역할갈등을 통해 간호사의 직무를 결정할 수 있는 임상적 의사결정능력을 향상시킬 필요가 있다. 그러므로, 본 연구 결과가 간호사의 임상적 의사결정능력 향상 프로그램 개발의 근거자료로 활용될 수 있을 것으로 기대하며, 개발된 교육프로그램의 타당성과 효과성을 분석하는 중재연구의 필요성을 제안하는 바이다.

• 디지털융복합연구
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• 제17권2호
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• pp.255-264
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• 2019

본 연구는 간호사의 비판적 사고 및 간호근무환경과 임상적 의사결정의 관련성을 확인하고 임상적 의사결정에 미치는 관련요인을 확인하기 위한 서술적 조사연구이다. 대상자는 서울시내 일개 상급 종합병원에서 근무하는 간호사 261명으로 자가보고식 설문지를 이용하여 자료수집 하였다. 자료분석은 SPSS 21.0 프로그램으로 기술적 통계, independent t-test, one-way ANOVA, Pearson's correlation coefficients, 위계적 회귀분석을 시행하였다. 임상적 의사결정은 연령, 학력, 직위, 교대근무, 임상경력에 따라 통계적으로 유의한 차이를 보였다. 임상적 의사결정은 비판적 사고 및 간호근무환경과 정의 상관 관계를 보였다. 임상적 의사결정에 대해 영향을 미치는 요인은 직위, 비판적 사고 중 임상적 의사결정, 간호근무환경 중 양질의 간호를 위한 기반 및 인적 물적 자원의 적절성으로 이를 통해 임상적 의사결정의 35.8%를 설명하였다. 그러므로 비판적 사고 향상과 더불어 간호의 전문성 향상을 위한 질 관리, 효과적 인적 물적 자원 관리를 위한 행정지원은 간호사의 임상적 의사결정능력을 향상시킨다.