• 대한지리학회지
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• 제33권1호
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• pp.109-122
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• 1998

본 연구는 지리교육에서 지리적 가치문제를 다룰 수 있는 가치 교수-학습 프로그램을 개발하고, 이 프로그램의 전개과정을 구성하였다. 본 연구에서 개발한 프로그램은 7단계의 수업절차 즉, 지리적 가치문제의 인식(지리적 가치문제의 내용 읽기, 그리고 관련된 행동 기술과 목록화), 지리적 가치문제의 분석(지리적 가치문제의 분석과 비교, 그리고 가치입장의 순위화), 의사결정, 의사결정의 정당화 그리고 행동화로 조직되었다. 그리고 본 프로그램을 실험집단에 적용하여 간단한 임상실험을 실기하였다. 그 결과, 지역사회문제에 대한 의사결정과정과 활동을 강조하는 본 프로그램은 학생들에게 주관적인 경험을 제공하고, 의사결정능력을 개발하고, 의사결정에 대한 책임의식을 심어줄 수 있는 것으로 나타났다. 그래서 본 수업 프로그램은 학생들의 민주시민으로서의 사회적 참여능력을 신장시키는데 도움을 줄 수 있을 것으로 생각된다.

• Journal of Hospice and Palliative Care
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• 제15권1호
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• pp.18-29
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• 2012

목적: 본 연구는 말기환자의 의료적 의사결정에 대한 임상간호사의 인식 구조와 유형을 분류하고 파악하여 향후 실무현장에서 말기 의료적 의사결정 수행능력 향상과 공유된 의료적 의사결정 체계를 구축하기 위해 기초자료를 제공하기 위한 Q 방법론을 적용한 조사연구이다. 방법: 관련 문헌고찰과 개방형 질문지 그리고 개별 면담을 통해 Q 모집단을 추출하여 167개의 Q 진술문을 표집하여 내용의 중복과 표현의 명확성 등을 고려하여 수정한 후 Q 모집단을 의미와 주제별로 6개의 범주로 분류한 다음 각 범주에서 대표적이거나 상이한 의미의 Q 진술문 34항목을 선정하였다. P 표본은 대학병원에서 근무하고 있는 2년 이상의 임상간호사 37명을 편의표집방법으로 선정하였으며 34개의 진술문은 Q 카드에 인쇄하여 연구대상자들로 하여금 강제 정상분포가 되도록 각자 의견의 중요도에 따라 9점 척도 상에 Q 분류하도록 하였고, 양극단에 분류한 진술문과 관련하여 대상자와 면담을 시행하였다. 수집된 자료는 PC-QUANL Program으로 요인분석 하였다. 결과: 분류된 말기환자의 의료적 의사결정에 대한 대상자의 유형은 모두 4가지로 나타났으며 이들 유형에 의해 설명된 전체 변량은 52.7%였다. 제1유형은 '환자 참여형'으로 의료적 의사결정에 대한 환자의 자율성 보장과 이와 관련된 규율이나 법적 장치의 정비와 가이드 라인 마련에 중점을 두었다. 제2유형은 '의료인 역할중시형'으로 환자의 자율성 존중이 실현되기 위한 의료인간의 공유된 의사결정에 중점을 두었다. 제3유형은 '개방적 죽음문화형'으로 평소 죽음에 대해 환자, 가족, 의료인과의 개방적이고 솔직한 대화의 분위기 조성을 효율적인 말기 의료적 의사결정의 실천적 행위로 인식하였다. 제4유형은 '가족의사결정 참여형'으로 말기 의료적 의사결정에 가족의 현존과 역할이 갖는 의미에 강조점을 두었다. 결론: 이상의 결과를 통하여 임상에서 말기환자의 의료적 의사결정에 대한 교육프로그램을 계획하고 수행할 때에는 각 유형에서 나타난 임상간호사의 인식을 반영한 통합적이고 다 학제적인 교육내용이 반영되어야 할 것으로 본다. 본 연구는 임상간호사를 대상으로 오늘날 우리 사회에서 중요시 되고 있는 말기환자의 의료적 의사결정과 연관된 다양한 관점들을 문화적 측면에서 조명했다는 점에서 의의가 있다. 따라서 성숙하고 통합적인 말기 의료적 의사결정 교육프로그램을 위한 기초자료로 유용하게 활용될 것으로 기대된다. 본 연구 결과를 바탕으로 제언을 하면, 첫째, 말기환자의 의료적 의사결정과 관련된 의학과 간호학 분야의 통합적이고 다 학문적인 공통교육과정 개발을 제언한다. 둘째, 본연구를 토대로 한국인의 말기 의료적 의사결정에 대한 태도 측정도구 개발을 제언한다.

• 한국직업건강간호학회지
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• 제22권4호
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• pp.285-294
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• 2013

Purpose: This study aimed to explore professional autonomy, nursing work environment, and clinical decision making ability and to determine predictors of clinical decision making ability among clinical nurses. Methods: A cross-sectional design was used in this study and 263 clinical nurses were selected from advanced-level hospitals with over 500 beds located in D metropolitan city. Independent t-test, ANOVA, Pearson's correlation coefficients and hierarchical multiple regression analyses were done with the SPSS/WIN 20.0 program. Results: Clinical nurses reported moderate levels of professional autonomy, nursing work environment and clinical decision making ability. Marital status, professional autonomy and nursing work environment accounted for 25% of variance in clinical decision making ability required in various clinical settings. Importantly, being married, higher level of professional autonomy, and greater satisfaction with work environment were significantly associated with better decision making ability. Conclusion: Findings indicate that improving the quality of decision making in the healthcare settings requires awareness of the multiple effects of individual, occupational and environmental features. Nurses' ability to make effective clinical decisions may rely on personal characteristics, the degree of autonomy in their job, and nurses' satisfaction with their work environment.

• Child Health Nursing Research
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• 제24권1호
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• pp.9-17
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• 2018

Purpose: The purpose of this descriptive survey study was to characterize the relationship between clinical decision-making and job satisfaction among pediatric nurses and to elucidate the mediating effects of the nurse-parent partnership on that relationship. Methods: The subjects of the study were 174 nurses who had worked in a pediatric ward in a university hospital, general hospital, or children's hospital. Data were collected from June 20, 2016 to August 10, 2016 and analysed using descriptive statistics, the t-test, analysis of variance, the Pearson correlation coefficient, and three-step mediated regression analysis in SPSS version 22.0 for Windows. Results: The nurse-parent partnership had significant effects on clinical decision-making and job satisfaction, with an explanatory power of 19% and 26%, respectively. The nurse-parent partnership had a partial mediating effect on the relationship between clinical decision-making and job satisfaction (Sobel test: Z=4.31, p<.001). Conclusion: The nurse-parent partnership had a partial mediating effect on the relationship between clinical decision-making and job satisfaction among pediatric nurses. Therefore, in order to improve the job satisfaction of pediatric nurses, it is necessary to develop effective educational programs and strategies to address their clinical decision-making and their experiences of the nurse-parent partnership.

• 가정간호학회지
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• 제21권2호
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• pp.147-155
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• 2014

Purpose: Clinical decision-making carried out by nurses is a complex process that influences the quality of care provided and various patient outcomes. This study examined the relationship between critical thinking disposition and clinical decision-making abilities in home health advanced practice nurses. Method: The study had a non-experimental correlational design. Data were collected from 100 home health advanced practice nurses in 20 hospitals. Results: The mean critical thinking disposition score was $3.69{\pm}.39$ out of 5 and the mean score for clinical decision-making abilities was $3.48{\pm}.22$ out of 5. In this correlation analysis, a significant positive correlation (r=.58, p<.001) was found between critical thinking disposition and clinical decision-making abilities of home health advanced practice nurses. Conclusion: In order to improve the clinical decision-making ability of home health advanced practice nurses, we need to improve their critical thinking disposition. In order to make this change, appropriate training program are needed to increase the critical thinking disposition and clinical decision-making abilities of home health advanced practice nurses.

• 간호행정학회지
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• 제19권5호
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• pp.613-621
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• 2013

Purpose: To identify the extents of nursing professionalism, clinical decision making abilities and job performance of advanced practice nurses and investigate the relationship among the variables Methods: Participants, selected by a convenience sampling method, were 135 advanced practice nurses working in 4 tertiary care general hospitals in 'B' Metropolitan City and in 1 tertiary care general hospital in 'J' city. Data collection was done from January 15 to February 28, 2013 using self-reporting questionnaires. Results: The average score for nursing professionalism of study participants was $81.19{\pm}7.56$. for clinical decision making abilities, $140.42{\pm}9.62$ and for job performance, $102.54{\pm}10.30$. These averages are relatively high. The relationship between the extent of nursing professionalism and the extent of clinical decision making abilities showed an intermediate level positive correlation (r=.45, p<.001). The relationship between the extent of nursing professionalism and the extent of job performance was also an intermediate level positive correlation (r=.42, p<.001). The extent of clinical decision making abilities and the extent of job performance was an intermediate level positive correlation (r=.41, p<.001). Conclusion: Developing a program, which can improve nursing professionalism and clinical decision making abilities of nurse, is required to enhance their job performance.

• 한국치위생학회지
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• 제13권6호
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• pp.925-932
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• 2013

Objectives : The purpose of the study is to improve autonomous decision-making ability by analyzing the relationship between autonomy and decision-making ability. Methods : The subjects were 176 dental hygienists in Busan. Self-reported questionnaire was fill out from May 2012 to January 2013. Results : The average of the degree of autonomy was $2.20{\pm}0.29$. Buddhists showed the highest score of $2.37{\pm}0.37$ (p<0.05). Buddhists had the higher education than other religions (p<.05). Clinical decision-making ability was $2.21{\pm}0.25$. Among the subcategories, statistically significant differences (p<.05) was shown by gender, degree of education, and religion in the domain of "Exploration of Choice and Alternatives"; Buddhists showed a higher score in the domains of "Assessment and Re-evaluation of Decisions" and "Review of Values and Goals," with significant difference of p<.05. Autonomy and clinical decision making revealed a positive correlation in the categories "Assessment and Re-evaluation of Decisions" (r=.518, p=.000), "Review of Values and Goals" (r=.610, p=.000), and "Investigation of Information and Synchronization of New Information" (r=.314, p=.000). Conclusions : To improve the performance of dental hygienists, working systems and training will be intensified to develop the autonomy and clinical decision making.

• 대한간호학회지
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• 제37권6호
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• pp.863-871
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• 2007

Purpose: The purpose of this study was to investigate the factors influencing nurses' clinical decision making focusing on critical thinking disposition. Methods: The subjects of this study consisted of 505 nurses working at one of the general hospitals located in Seoul. Data was collected by a self-administered questionnaire between December 2006 and January 2007. Data was analyzed by one way ANOVA, Pearson correlation coefficients, and stepwise multiple regression using SPSS Win 14.0. Results: The mean scores of critical thinking disposition and clinical decision making were 99.10 and 134.32 respectively. Clinical decision making scores were significantly higher in groups under continuing education, with a master or higher degree, with clinical experience more than 5 years, or with experts. Critical thinking disposition and its subscales have a significant correlation with clinical decision making. Intellectual eagerness/curiosity, prudence, clinical experience, intellectual honesty, self-confidence, and healthy skepticism were important factors influencing clinical decision making(adjusted $R^2=33%$). Conclusion: Results of this study suggest that various strategies such as retaining experienced nurses, encouraging them to continue with education and enhancing critical thinking disposition are warranted for development of clinical decision making.

• 간호행정학회지
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• 제17권4호
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• pp.443-450
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• 2011

Purpose: This study was a descriptive correlation study to increase understanding of, and relationships among critical thinking disposition, clinical decision making and job satisfaction of cancer center nurses. Method: The participants in this study were 150 nurses working in one cancer center located in Gyeonggi Province. The statistic program, SPSS WIN17.0 was used for data analysis and data were analyzed using t-test, ANOVA, and Pearson correlation. Results: The critical thinking disposition of the participants showed statistically significant differences according to areas of practice (F=4.426, p=.005), and current position (F=9.346, p=.000). For clinical decision making of the participants, statistically significant differences were found according to current position (F=10.667, p=.000). Furthermore, for job satisfaction, there were statistically significant differences according to income (F=6.779, p=.002), length of career (F=2.701, p=.033) and current position (F=5.423, p=.005). There were significant positive correlations for critical thinking disposition with clinical decision making, and with job satisfaction. Conclusions: The results of the study indicate that to improve clinical decision making and job satisfaction of cancer center nurses, it is necessary to increase critical thinking disposition. To make this change, appropriate programs are needed to increase critical thinking and clinical decision making of general cancer center nurses.

• 기본간호학회지
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• 제17권2호
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• pp.274-281
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• 2010

Purpose: The purpose of this study was to identify the correlation between level of professional autonomy and clinical decision making abilities in clinical nurses, and to provide basic information for promoting competency nurses in making independent decisions. Method: Data were collected from July 1 to July 18, 2008, and participants were 202 clinical nurses in general hospitals. Collected data were analyzed using descriptive statistics: frequency and percentage and Pearson correlation coefficients with the SPSS WIN 14.0 program. Results: The professional autonomy index for the nurses was 159.63 points. The clinical decision making ability index was 119.79 points. The most highly ranked factor in clinical decision making was search for information and unbiased assimilation of new information. There was a statistically significant difference in professional autonomy according to age, clinical experience, and type of duty. Relation between level of professional autonomy and clinical decision making showed a positive correlation. Conclusion: As a results show a significant correlation between professional autonomy and clinical decision making in clinical nurses, improvement in professional autonomy of clinical nurses, would be promoted through continuous support and training.