본 연구는 계획된 행위이론 기반으로 국?공립병원에서 근무하는 간호사의 간호전문직관, 도덕적 민감성, 사회적 지지와 신종감염병 환자 간호의도 간의 상관관계를 파악하고, 신종감염병 환자 간호의도에 영향을 미치는 요인을 규명하여 신종감염병 환자 간호의도를 긍정적으로 유도하기 위한 정책마련과 개선전략을 모색하고자 시도된 횡단적 서술연구이다.
신종감염병 환자 간호의도를 측정하기 위해 유혜라, 권보은, 장연수와 윤현경(2005)이 개발한 SARS 환자 간호의도 예측 도구를 바탕으로 이지연(2018)이 수정한 도구를 사용하였다. 간호전문직관은 윤은자, 권영미와 안옥희(2005)가 개발한 도구, 도덕적 민감성은 Han, Kim와 Kim, Ahn 등(2010)의 한국판 도덕적 민감성(K-MSQ) 도구, 사회적 지지는 Thomas와 Ganster (1995)의 도구와 King, Mattimore, King와 Adams (1995)의 도구를 종합하여 이상조(2016)가 수정한 도구를 사용하였다. K대학교 생명윤리위원회의 승인을 거친 후 2019년 4월 9일부터 2019년 4월 20일까지 전국 4개 보훈병원에 근무하는 간호사에게 연구 목적을 설명하고 동의를 구한 후 215부를 배부하고 응답이 미흡한 설문지를 제외한 200부를 최종분석에 이용하였다. 수집된 자료는 IBM SPSS Statistics Ver. 23.0을 이용하여 처리하였고 빈도, 백분율, 평균 및 표준편차, Independent t-test, One way ANOVA, Scheffe test, Pearson’s Correlation Coefficient, Stepwise Multiple Regression으로 분석하였다.

본 연구 결과는 다음과 같다.

본 연구 대상자의 신종감염병 환자 간호의도, 신념요인, 핵심요인, 간호 전문직관, 도덕적 민감성 및 사회적 지지의 정도 중 신종감염병 환자 간호의도는 ?3점에서 +3점 범위 중 0.17±1.23점 이었다. 신념요인은 ?3점에서 +3점 중 통제신념 1.08±0.72점, 행위신념 0.57±0.65점, 규범신념 ?0.20 ±0.94점 순으로 나타났고, 핵심요인에서는 ?3점에서 +3점 중 행위에 대한 태도 1.05±1.06점, 주관적 규범 0.77±1.02점, 지각된 행위통제 ?0.17±1.26점 순으로 나타났다. 간호전문직관은 5점 만점 중 3.46±0.48점 이었으며, 하위영역으로 간호의 전문성 3.71±0.46점, 사회적 인식 3.48±0.50점, 전문직 자아개념 3.33±0.51점, 간호의 독자성 3.24±0.76점, 간호실무 역할 3.05±0.56점 순이었다. 도덕적 민감성은 7점 만점 중 4.81±0.54점 이었으며, 하위영역으로는 환자중심 간호 5.14±0.84점, 전문적 책임 5.07±0.68점, 갈등 5.06±0.66점, 도덕적 의미 4.62±0.69점, 선행 4.22±0.65점 순으로 나타났다. 사회적 지지는 5점 만점에 3.98±0.45점이었으며, 가족의 지지 4.06 ±0.62점, 동료의 지지 3.99±0.52 점, 상사의 지지 3.90±0.57점 순으로 나타났다.
일반적 특성에 따른 신종감염병 환자 간호의도의 차이는 직위에서 책임간호사 이상이 일반간호사 보다 유의하게 높았고(t=-2.70, p=.007), 최종학력은 석사 이상이 학사보다 유의하게 높았다(F=5.33, p=.006). 근무부서는 기타 진료지원부서가 병동, 외래, 특수부서 보다 유의하게 높았으며 (F=8.79, p<.001), 근무 중 일상적 환자 접촉이 없는 대상자가 일상적 환자 접촉이 있는 대상자보다 통계적으로 유의하게 높았다(t=-4.28, p<.001).
대상자의 간호전문직관, 도덕적 민감성, 사회적 지지와 신종감염병 환자 간호의도 간의 상관관계는 신종감염병 환자 간호의도와 신념요인의 항목에서 행위신념(r=.18, p=.009)과 규범신념(r=.58, p<.001)은 양의 상관관계가 있는 것으로 나타났으며, 통제신념은 음의 상관관계(r=-.16, p=.028)가 있는 것으로 나타났다. 핵심요인에서는 행위에 대한 태도(r=.40, p<.001), 주관적 규범(r=.43, p<.001), 지각된 행위통제(r=.72, p<.001) 모두 양의 상관관계가 있는 것으로 나타났다. 또한 신종감염병 환자 간호의도는 간호전문직관(r=.35, p<.001), 도덕적 민감성(r=.33, p<.001), 사회적 지지(r=.21, p=.003)와 각각 양의 상관관계를 나타내었다.
본 연구 대상자의 신종감염병 환자 간호의도에 미치는 영향요인은 지각된 행위통제, 규범신념, 주관적 규범, 통제신념, 행위에 대한 태도, 도덕적 민감성이었다. 신종감염병 환자 간호의도에 대한 지각된 행위통제(β=.723, p<.001)의 설명력은 52%였으며, 규범신념(β=.241, p<.001)이 추가되면서 56%의 설명력을 보였다. 주관적 규범(β=.169, p=.001)이 추가되면서 58%의 설명력을 보였고, 통제신념(β=-.618, p<.001)이 추가되면서 60%의 설명력을 보였다. 도덕적 민감성(β=.216, p<.001)이 추가되면서 64%의 설명력을 보였고, 행위에 대한 태도(β=.101, p<.036)가 추가되면서 65%의 설명력을 나타냈다.
이상의 연구 결과를 종합해 볼 때, 신종감염병 환자 간호의도를 향상시키기 위해서는 지각된 행위통제와 주관적 규범, 행위에 대한 태도, 도덕적 민감성을 향상시켜야 하며, 도덕적 민감성의 향상을 위하여 간호윤리에 대한 교육 또한 병행되어야 한다. 이를 위해서 무엇보다 신종감염병 간호 수행 전 신종감염병 대응에 대한 철저한 교육과 훈련을 통한 감염병의 특성에 맞는 사전 경험을 제공하는 것이 중요하다.

Objective: This is a cross-sectional descriptive study that attempted to seek the establishment of policy and improvement strategy in order to affirmative induce the nursing intention for emerging infectious diseases patients by assessing the correlation among the views on nursing as a professional occupation, moral sensitivity, social support, and nursing intention for emerging infectious diseases patients of the nurses working at national and public hospitals, and by investigating the factors that affect the nursing intention for emerging infectious diseases patients on the basis of the planned behavior theory.

Methods: A tool modified by Ji Yeon Lee (2018) on the basis of the tool for predicting nursing intention for SARS patients developed by Hye Ra Yoo, Bo Eun Kwon, Yeon Soo Jang, and Hyun Gyeong Yoon (2005) was used to measure the nursing intention for emerging infectious diseases patients. Views on nursing as a professional occupation was measured by using the tool developed by Eun Ja Yoon, Yeong Mi Kwon and Ok Hee Ahn (2005), moral sensitivity was measured by Korean version of moral sensitivity (K-MSQ) tool of Han, Kim, Kim, and Ahn et al. (2010), social support was measured by using the tool that Sang Jo Lee (2016) modified by integrating the tool of Thomas and Ganster (1995) and the tool of King, Mattimore, King, and Adams (1995). After having obtained approval from the Bio-Ethics Committee of K University, 215 copies of the questionnaires were distributed to the nurses working at four war veterans hospitals throughout the country from April 9 to 20, 2019 by securing their consents for participation in the questionnaire survey with explanations on the purpose of the study. 200 questionnaires out of those retrieved with the exclusion of the questionnaires with inadequate answers to the questions were used in the final analysis. IBM SPSS Statistics Ver. 23.0 was used to process the data collected, and analysis was made by using frequency, percentage, average and standard deviation, Independent t-test, One way ANOVA, Scheffe test, Pearson’s Correlation Coefficient, and Stepwise Multiple Regression.

Results:
1. Among the nursing intention for emerging infectious diseases patients, belief factors, core factors, views on nursing as a professional occupation, moral sensitivity and extent of social support, the nursing intention for emerging infectious diseases patients received the score of 0.17±1.23 in the range of ?3～+3. Meanwhile, among the belief factors, faith on control, faith on behavior and faith on standards had scores of 1.08±0.72, 0.57±0.65 and ?0.20±0.94, respectively, in the in the range of ?3～+3. Regarding the core factors, attitude towards behavior, subjective standards and perceived control of behavior had scores of 1.05±1.06, 0.77±1.02 and ?0.17±1.26, respectively, in the in the range of ?3～ +3. Views on nursing as a professional occupation had score of 3.46±0.48 out of full score of 5.0 with its subordinate domains including specialization in nursing, social awareness, concept of self for professional occupation, identity of nursing, and role of practical nursing works had scores of 3.71±0.46, 3.48±0.50, 3.33±0.51, 3.24±0.76 and 3.05±0.56, respectively. Moral sensitivity had score of 4.81±0.54 out of full score of 7.0 with its subordinate domains including patient-oriented nursing, professional responsibility, conflict, moral significance and good deeds with scores of 5.14±0.84, 5.07±0.68, 5.06±0.66, 4.62±0.69 and 4.22±0.65, respectively. Social support had score of 3.98±0.45 out of full score of 5.0 with its subordinate domains including family support, support from colleague and support from superior having scores of 4.06±0.62, 3.99±0.52 and 3.90±0.57, respectively.

2. Difference in the nursing intention for emerging infectious diseases patients in accordance with the general characteristics in terms of the position of the nurses was significantly higher for those with position higher than responsible nurses in comparison to the ordinary nurses (t=-2.70, p=.007), while that in terms of the final academic degree completed was significantly higher for those with degree higher than master’s degree in comparison to those with bachelor’s degree (F=5.33, p=.006). In terms of the working department, it was significantly higher for those working at other treatment support department in comparison to those working at patient ward, outpatient and special departments (F=8.79, p<.001), while that for those who have no contact with patient in their daily work routine was statistically significantly higher than that for those with contact with patients in their daily work routine (t=-4.28, p<.001).

3. Correlation among the views of the subjects on nursing as a professional occupation, moral sensitivity, social support and nursing intention for emerging infectious diseases patients displayed positive correlation for faith on behavior (r=.18, p=.009) and faith on standards (r=.58, p<.001), while faith on control has negative correlation (r=-.16, p=.028) in the items of nursing intention for emerging infectious diseases patients and belief factors. Regarding the core factor, positive correlation was found for the attitude towards behavior (r=.40, p<.001), subjective standards (r=.43, p<.001) and perceived control of behavior (r=.72, p<.001). In addition, regarding the nursing intention for emerging infectious diseases patients, there was positive correlation with each of views on nursing as a professional occupation(r=.35, p<.001), moral sensitivity(r=.33, p<.001) and social support(r=.21, p=.003).

4. Factors that affect the nursing intention for emerging infectious diseases patients of the study subjects included perceived control of behavior, faith on standards, subjective standards, faith on control, attitude towards behavior and moral sensitivity. Explanation power of the perceived control of behavior on the nursing intention for emerging infectious diseases patients (β=.723, p<.001) was 52%, which increased to 56%, 58%, 60%, 64% and 65% when the faith on the standard (β=.241, p<.001), subjective standards (β=.169, p=.001), faith on control (β=-.618, p<.001), moral sensitivity(β=.216, p<.001) and attitude towards behavior (β=.101, p<.036) are added, respectively.

Conclusions: It is necessary to improve perceived control of behavior, subjective standard, attitude towards behavior and moral sensitivity in order to improve nursing intention for emerging infectious diseases patients, and education on nursing ethics must be executed concurrently to improve the moral sensitivity. For this purpose, it is most important to provide preliminary experiences appropriate for the characteristics of the infectious diseases through exhaustive education and training to cope with the emerging infectious diseases prior to execution of nursing for emerging infectious diseases.