노인요양시설 요양보호사의 인간중심돌봄과 환자안전문화가 치매노인 낙상예방행위에 미치는 영향

Abstract

본 연구는 노인요양시설에서 근무하는 요양보호사의 인간중심돌봄, 환자안전문화, 치매노인 낙상예방행위의 정도를 파악하여 치매노인 낙상예방행위에 미치는 영향을 확인함으로써, 요양보호사의 치매노인에 대한 낙상예방행위를 향상시키는 방안 마련의 기초자료를 제공하고자 시행되었다. 본 연구는 2022년 2월 1일부터 3월 25일까지 J지역에 소재한 입소정원 10인 이상 규모의 8개 노인요양시설에서 근무하는 요양보호사 185명을 대상으로 자료 수집을 실시하였으며, 자료는 구조화된 설문지를 이용하여 수집하였다. 수집된 자료는 SPSS WIN 25.0 프로그램을 이용하여 빈도, 백분율, 평균 및 표준편차, Independent t-test, One-way ANOVA, Scheffé's test, Pearson correlation coefficient, Stepwise multiple regression으로 분석하였다.

1. 대상자의 인간중심돌봄 정도는 5점 만점에 3.63±.45점이었다. 하부영역별로 살펴보면 거주 노인과의 업무 공유 4.16 ±.49점, 안위 4.07±.61점, 경영 구조 3.94 ±.54점, 개인적 특성 3.75±.61점, 개별 노인에 대한 이해 3.70±.64점, 지지관계 형성 3.11±.73점, 자율성 2.53±.86점이었다. 환자안전문화는 5점 만점에 3.79±.47점이었다. 하부영역별로 살펴보면 직무태도 3.89±.63점, 관리자 리더쉽 3.86±.57점, 조직시스템 3.70±.48점, 관리활동 3.69±.55점이었다. 치매노인 낙상예방행위 정도는 3.41±.32점이었다. 하부영역별로 살펴보면 환경관리 3.65±.53점, 관찰 3.61±.37점, 교육 3.56±.43점, 고위험군관리 3.54±.48점, 신체적지지 3.32±.40점, 정신 사회적지지 3.12±.44점, 낙상사정 3.01± .43점이었다.

2. 대상자의 일반적 특성에 따른 치매노인 낙상예방행위에 유의한 차이를 나타낸 변수는 연령(t=5.44, p=.006), 평균 돌봄 노인의 수(t=4.91, p=.005), 최근 1년간 낙상예방 교육경험(t=-2.85 p=.005), 최근 1년간 낙상예방 교육횟수(t=3.1 1 p=.028), 현재 근무 시설의 안전관리 수준(t=3.29, p=.045)이었다. 사후분석 결과 연령은 50대인 경우, 평균 돌봄 노인의 수에서는 5명 이하, 8∼9명인 경우가 치매노인 낙상예방행위가 높았고, 낙상예방 교육경험이 있는 경우, 낙상예방 교육횟수가 3회 이상인 경우, 시설의 안전관리 수준이 ‘매우 잘되어 있다’ 라고 응답한 경우에 치매노인 낙상예방행위가 유의하게 높았다.

3. 대상자의 치매노인 낙상예방행위는 인간중심돌봄 (r=.45, p<.001)과 환자안전문화(r=.42, p<.001)와 유의한 정적 상관관계가 있는 것으로 나타났다.

4. 대상자의 치매노인 낙상예방행위에 영향을 미치는 요인은 인간중심돌봄(β=.32 p=<.001), 환자안전문화(β=.26 p=.001), 낙상예방 교육경험(β=.19 p=.016)으로 나타났으며, 본 모형의 설명력은 31.4%이었다.

결론적으로, 본 연구에서는 노인요양시설 요양보호사의 치매노인 낙상예방행위에 영향을 미치는 요인으로 인간중심돌봄, 환자안전문화, 낙상예방 교육경험으로 확인하였다. 따라서 요양보호사의 치매노인 낙상예방행위 증진을 위해 인간중심돌봄 실천과 더불어 환자안전문화의 인식을 높이려는 노력과 실효성 있는 낙상예방 교육 및 프로그램 개발 등의 효과적인 방안이 모색되어야 한다.|The present study aimed to determine the level of person-centered care of eldercare facility workers, patient safety culture, and fall prevention behaviors of older adults with dementia, as well as to identify the effect of these factors on the fall prevention behaviors of older adults with dementia and provide a baseline for measures by which care workers can promote fall prevention behaviors of older adults with dementia. Data collection was conducted from February 1 to March 25, 2022. One hundred eighty-five care workers employed at eight eldercare facilities with a capacity of 10 or more patients, in area J, completed a structured questionnaire. The collected data's frequency, percentage, mean and standard deviation were analyzed, and independent t-test, one-way ANOVA, Scheffé's test, Pearson correlation coefficient, and stepwise multiple regression were performed on the data using the SPSS win 25.0 program.

The results of this study are as follows.

1. The degree of person-centered care of the participants was 3.63±0.45 out of 5, and those of its sub-items were 4.16±.49 for sharing work with residents, 4.07±.61 for Comport care, 3.94±0.54 for the management structure, 3.75±.61 for Personhood, 3.70±.64 for Knowing the person 3.11±.73 for the Support relationship and 2.53±.86 for autonomy. The degree of patient safety culture was 3.79±.47 out of 5, and those of its sub-items were 3.89±.63 for Work attitude, 3.86±.57 for leadership of manager, 3.70±.48 for Organizational systems, and 3.69±.55 for managerial activity. The mean score for the fall prevention behavior of older adults with dementia was 3.41±.32, and thos e for its sub-items were 3.65±.53 for Environmental management, 3.61±.37 for Observation, 3.56±.43 for Education, 3.54±.48 for High risk group management, 3.32±.40 for Physical support, 3.12±.44 for Psycho-social support, an d 3.01±.43 for Fall assessment.

2. The general characteristics variables of the participants that yielded significant differences in the fall prevention behavior of older adults with dementia were Age (t=5.44, p=.006), the average number of older adults under one’s care (t=4.91, p=.005), participation in fall prevention education in the past year (t=-2.85, p=.005), amount of fall prevention education in the past year(t=3.11, p=.028), and level of safety management in the current facility (t=3.29, p=.045). The post-analysis showed that the fall prevention behavior of older adults with dementia was significantly higher in the following cases: the care worker was in their 50s, there were five or fewer or 8 to 9 older adults under one’s care, the care worker had received fall prevention education in the past year, the care worker had participated in three or more instances of fall prevention education, and the facility had received a grade of “Very good” regarding its safety management level.

3. The participants’ fall prevention behavior of older adults with dementia had a statistically significant positive correlation with person-centered care(r=.45, p<.001) and patient safety culture(r=.42, p<.001).

4. Factors affecting participants’ fall prevention behavior of older adults with dementia were person-centered care (β=.32, p=<.001), patient safety culture (β=.26, p=.001), and participation in fall prevention education (β=.19, p=.016). The explanatory power of the model was 31.4%.

In conclusion, the factors influencing eldercare facility care workers regarding the fall prevention behavior of older adults with dementia identified in this study were person-centered care, patient safety culture, and participation in fall prevention education. Therefore, in addition to person-centered care practices, effective measures such as developing effective fall prevention education and programs and efforts to raise awareness regarding patient safety culture should be explored so that care workers can promote fall prevention behaviors in older adults with dementia.