목적: 치과위생사의 치과업무역역에 있어서의 업무와 관련된 분쟁에 대한 경험과 관련교육의 요구도를 분석하여 치과위생사를 대상으로 효과적인 교육 프로그램 개발의 자료를 제공하기 위함이다.
방법: 2014년 4월 1일부터 2014년 4월 30일까지 부산ㆍ경남소재 대학병원, 치과병원 및 치과의원에서 치과진료 보조업무를 하고 있는 치과위생사를 대상으로 자기기입식 설문조사를 하였다. 회수된 212명의 설문은 SPSS 18.0 프로그램을 이용하여 분석하였다. 응답자에 관한 기본적인 자료조사 및 환자와의 불평, 불만 및 의료분쟁 경험도와 함께 의료관계법의 이해도를 측정하고, 치과진료 및 의료분쟁에 대한 전반적인 의식성향을 비교분석하여 다음과 같은 결과를 얻었다.
결과 첫째, 전체 대상자중 59.4%가 환자의 불평, 불만 및 의료분쟁을 경험하였고 이중 24%는 법적인 문제로 진행을 경험하였고, 95.3%가 향후 의료분쟁이 발생할지도 모른다는 불안감 또는 의구심을 어느 정도 가지고 있었다.
둘째, 세부유형별 항목에 따른 환자의 문제제기 건수를 보면 치료내용 설명에 대한 환자의 이해부족 또는 오해로 문제가 된 경우가 1248건 중 108건(8.6%)으로 가장 높게 나타났으며, 의료분쟁 시 문제해결에 있어서 치료 전 설명 및 동의 의무의 이행 여부가 중요한 역할을 한다고 응답한 경우가 84.9%으로 나타났다.
셋째, 의무기록 수정 시 틀린 내용은 완전히 지우고 다시 써도 된다고 응답한 경우가 32.5%로 오답률이 가장 높게 나타났고, 치과위생사가 치주소파술을 해도 된다고 틀리게 응답한 경우가 26.9%으로 나타났다.
넷째, 재학 중 의료분쟁의 예방 및 대책에 관한 관련교육을 수료한 적이 없다는 경우가 70.3%, 졸업 후 의료분쟁의 예방 및 대책에 관한 보수교육을 수료한 적이 없는 경우가 68.9%으로 나타났으며, 의료분쟁의 예방 및 대책에 관한 교육의 필요성에 대해서 100%가 필요하다고 답하였다.
다섯째, 분쟁발생은 근무지형태별로 유의한 차이를 보이지 않았으나 분쟁의 법적진행 여부는 근무지와 근무경력에 따라 유의한 차이를 보였으며, 분쟁경험에 따른 의료분쟁에 대한 부담감 정도는 경험이 있는 군에서 부담감을 더 느끼는 것으로 조사되었다.
결론: 치과위생사와 관련한 환자의 불평, 불만 및 분쟁도 상당한 부분을 차지하고 있으며 앞으로 더욱 증가할 수 있는 가능성을 내포하고 있다. 그러므로 주의의무, 설명 및 동의의무 등의 의무를 다함은 물론, 이에 대한 인식을 제고하여야 한다. 또한 진료기록부의 중요성을 인식하고, 이에 대한 기록 및 관리를 철저히 하여 의료분쟁의 예방 및 분쟁해결에 대비하여야 할 것이다. 치과위생사의 직무범위에 대한 의료관계법의 이해도 증진이 필요하며, 이를 위해서는 의료분쟁에 대한 예방 및 대책과 관련된 교육기회를 확대하여야 할 것이다.
핵심 되는 말 : 치과위생사, 의료사고, 의료분쟁, 의료분쟁의 예방 및 대책에 관한 교육의 필요성
ABSTRACT
The experience of medical conflict and the educational needs of dental hygienists
Eun Mi. Yang ((Directed by Prof. Sang Jun, Park) Health Management Department of Graduate School of Public Health of Inje University
Purpose: This research was conducted to provide data to develop an effective educational program for dental hygienists by analysing their experiences of disputes related to performing dental duties as well as the needs of related education.
Method: A self-administered questionnaire survey was conducted targeting dental hygienists who were performing dental assistance at university hospital, dental hospital and dental clinic in Busan and Gyeongnam regions from April 1 to 30, 2014. Collected questionnaires of 212 dental hygienists were then analyzed with SPSS 18.0 program. Basic data investigation was carried out and their experiences of complaints and discontents from patients and of medical disputes and their understanding of medical related law were measured and their overall awareness tendencies of dentistry and medical disputes were analyzed and the following result was achieved.
Result First, 59.4% had experienced complaints, discontents and medical disputes and 24% of these had experienced a legal trouble developed from such and 95.3% were anxious and doubtful about a possible future medical dispute to some degree.
Second, looking at the number of problems presented by patients according to each item by detailed type, most of the problems were posed due to lack of understanding or misunderstanding of patients on details of treatment, showing the highest rate of 108 cases (8.6%) among 1,248 cases, and 84.9% answered that explanation before treatment and performance of duty with regard to an agreement to such play a critical role in resolving problems if a medical dispute arises.
Third, the highest rate of wrong answer was given by 32.5% answering that they can completely remove the wrong entries and rewrite them when they are correcting medical record and 26.9% gave a wrong answer that dental hygienists are allowed to perform a periodontal curettage.
Fourth, 70.3% answered that they had not completed education with regard to a prevention and countermeasures of medical disputes while in school and 68.9% reported that they had not completed refresher training on a prevention and countermeasures of medical disputes and 100% said that education on a prevention and countermeasures of medical disputes is necessary.
Fifth, occurrence of disputes did not show a significant difference by place of work, however, a possibility of development of dispute into a legal proceeding showed a significant difference depending on service career and it was investigated that the experienced group feels more pressures with regard to a medical dispute according to their experience of such.
Conclusion: Patients'' complaints, discontents and disputes related to dental hygienist are being a substantial part and are possible to be increased henceforth, Therefore, dental hygienists are required to fulfill duties with regard to precaution, explanation and agreement and to improve their awareness towards such. Furthermore, they shall recognize the importance of medical records and thoroughly record and manage such to prevent a medical dispute and to prepare to resolve such. Understanding of dental hygienists on medical related laws regarding the scope of duty is required to be enhanced and, in order to do so, opportunities to receive an education with regard to a prevention and countermeasures of medical disputes are to be expanded.
key words : dental hygienist, medical accident, medical dispute, educational needs
국문초록 ··············································································iABSTRACT ···········································································ⅲⅠ.서론 ······························································································1Ⅱ.연구 방법 및 내용 ········································································31.연구 방법 ························································································32.연구 내용 ·······················································································33.통계 처리··························································································3Ⅲ.연구 결과 ·····················································································41.연구 대상자들의 일반적 특성 ·····························································42.환자의 불평, 불만 및 의료사고, 분쟁의 경험도 ····································53.의료분쟁에 대한 예방 및 대책을 위한 참고사항 항목 ·························164.의료관계법의 이해도 측정 ·······························································215.의료사고, 분쟁 예방교육에 대한 사항 ···············································256.분쟁경험에 따른 부담감 정도와 교육의 필요성 ··································287.향후 의료분쟁의 증가 여부 및 원인 고찰 ·····································298.의료분쟁 예방 교육방법 ·····························································29Ⅳ.고 찰 ············································································31Ⅴ.결 론 ············································································37참고문헌 ················································································39부 록 ················································································40