간호사의 비판적 사고성향과 간호업무환경이 임상적 의사결정 능력에 미치는 영향

Abstract

The purpose of this study was to investigate the relationships among the critical thinking disposition, nursing work environments, and clinical decision making abilities of clinical nurses to provide basic data for strategies and developing programs to improve their clinical decision making abilities. Data were collected from 192 nurses who had worked for more than 6 months with a self-reported questionnaire in five general hospitals, from April 20 to May 22, 2015. The research variables were measured with the Critical thinking disposition scale (Yun, 2004), the Nursing work environment scale (Jo et al., 2011), and the Clinical decision making abilities scale used (Heo, 2014). The data were analyzed by Cronbach's αlpha, descriptive statistics, t-test, ANOVA, Pearson's correlation coefficient, and hierarchical multiple regression The results were as follows: 1. The mean score was 3.50 on critical thinking disposition. The mean score of the nursing work environments was 2.33, indicated that the subjects perceived negatively about nursing work environments. The mean scored 3.46 on clinical decision making abilities. The score was lower than that of nurses who worked in large-sized general hospitals of the metropolis or nursing specialists. 2. Critical thinking disposition was significantly different in age, marital status, position, total clinical experience, clinical experience in present hospital, and monthly salary. Nursing work environments was no significant differences in any general and job-related characteristics. Clinical decision making abilities was significantly different in age, marital status, educational level, position, total clinical experience, clinical experience in present hospital, and monthly salary. 3. Clinical decision making abilities was positively related to critical thinking disposition and nursing work environments. Multiple regression analysis showed that nurses' clinical decision making abilities significantly influenced by critical thinking disposition and nursing work environments which explained 42% of variance of clinical decision making abilities (F=15.39, p<.001). Consequently, these findings indicated that critical thinking disposition and nursing work environments are important predictors of clinical decision making ability of nurses. Based on these results, this study suggests the following: 1. It is needed to improve the nursing work environment where the nurses can make a decision with their nursing jobs through critical thinking and develop the educational programs to reinforce their critical thinking disposition for enhancing their clinical decision making abilities. 2. It will be needed the nursing curriculum which provide to nursing students with more opportunities for experiential learning to make a clinical decision through the nursing cases so that they will improve their clinical decision making abilities. The hospitals and nursing organizations should offer the systematic and organizational supports and the career-based educational programs. 3. The systematicity and prudence of critical thinking disposition scores were lower than that of other sub-factors. Therefore, further studies will be needed to make an inquiry into related variables such as work environments and situations that make the nurses have a low perception of systematicity and prudence. 4. Further studies will be needed to consider clinical decision making abilities including various variables and other areas and hospitals. Key words: Nurses, Critical thinking disposition, Work environment, Clinical decision-making.