근골격계 수술환자는 간호·간병통합서비스 병동에 입원한 환자 중 대다수를 차지한다. 이들은 수술로 인한 통증도가 높기 때문에 양질의 간호서비스가 필요하다. 따라서 간호사는 이러한 간호서비스 질을 높여주기 위해 근골격계 수술환자에게 통증관리를 잘해줘야 하며 통증관리를 위한 효율적인 의사소통을 제공하는 것이 필요하다.
이에 본 연구의 목적은 간호·간병통합서비스 병동에 입원한 근골격계 수술환자가 지각한 간호사의 의사소통 유형, 통증관리 만족도, 간호서비스 질의 정도 및 관계를 확인하고 간호서비스 질에 영향을 미치는 요인을 규명함으로써 대상자가 지각한 간호서비스 질을 증진시키기 위한 방안 마련에 기초자료를 제공하기 위함이다.
본 연구는 서술적 조사연구이며, 연구대상자는 B시 I병원과 K병원의 간호·간병통합서비스 병동에 입원한 근골격계 수술환자 152명을 대상으로 하였다. 자료수집 기간은 2019년 7월 26일부터 동년 10월 15일까지였다. 자료수집 방법은 K대학교의 기관생명윤리위원회의 승인을 받은 후 B광역시 I병원, K병원 간호부의 허락을 받고, 병동 수간호사에게 연구의 목적과 방법을 설명하고 협조를 받았다. 수간호사가 배치된 간호단위에 근무하는 경력 6개월 이상의 간호사에게 서면 동의를 받고 구조화된 설문지를 배부한 후, 환자가 직접 작성토록 한 후 회수하였다.
연구도구로 간호서비스 질 도구는 Parasuraman 등(1988)의 SERVQUAL모형을 근거로 하여 이미애(2004a)가 개발하고 이혜진(2011)이 수정?보완하고 최정숙(2013)이 다시 수정?보완한 도구를 사용하였다. 간호사의 의사소통 유형도구는 정수연(2013)이 개발한 도구를 사용하였다. 통증관리 만족도 측정 도구는 이윤영과 박광옥(2002)이 개발하고 유희정(2010)이 수정·보완한 도구를 사용하였다.
자료 분석방법은 SPSS WIN 23.0 통계프로그램을 이용하여 실수, 백분율, 평균과 표준편차, 최소값, 최대값, 평균, 평균평점과 표준편차, t-test, ANOVA와 Scheffe test, Pearson’s Correlation Coefficients, Stepwise Multiple Regression을 이용하여 분석하였다.

본 연구의 결과는 다음과 같다.

1. 대상자가 지각한 간호사의 의사소통 유형 정도는 평균 47.90±6.88점(도구범위: 11-55), 평균평점이 4.35±0.63점(척도범위: 1-5)이였고, 하위영역 중 간호사의 정보제공적 의사소통 유형 정도는 평균 26.49±3.80점(도구범위: 6-30), 평균평점이 4.42±0.63점(척도범위: 1-5), 간호사의 친화적 의사소통 유형 정도는 평균 21.41±3.55점(도구범위: 5-25), 평균평점이 4.28±0.71점(척도범위: 1-5)이었다. 대상자가 지각한 통증관리 만족도 정도는 평균 44.48±5.81점(도구범위: 10-50), 평균평점이 4.45±0.58점(척도범위: 1-5)이었고, 하위영역 중 간호사 수행능력은 평균 31.04±4.14점(도구 범위: 7-35), 평균평점이 4.43±0.59점(척도범위: 1-5), 통증약물 및 기구는 평균 8.93±1.24점(도구 범위: 2-10), 평균평점이 4.47±0.62점(척도범위: 1-5), 전반적인 만족도는 평균 4.51±0.74점(도구 범위: 1-5), 평균평점이 4.51±0.74점(척도범위: 1-5)이었다. 대상자가 지각한 간호서비스 질의 정도는 평균 8.52±15.03점(도구범위: -80-+80), 평균평점이 0.43±0.75점(척도범위:-4-+4)이었다.

2. 대상자의 일반적 특성에 따른 간호서비스 질 정도는 성별(t=-2.519, p=.013), 연령(F=2.985, p=.021), 교육정도(F=6.710, p=.002), 직업(F=2.507, p=.045), 월평균소득(F=2.869, p=.039), 근골격계 외 동반질환여부(t=2.308, p=.022), 현재 건강상태(F=3.397, p=.036), 치료에 대한 가족지지 정도(F=4.493, p=.013), 수술 전 통증여부(t=2.753, p=.007)에 따라 유의한 차이가 있었다.

3. 대상자가 지각한 간호서비스 질은 간호사의 정보제공적 의사소통 유형과는 r=.408(p<.011), 간호사의 친화적 의사소통 유형과는 r=.449(p<.001), 통증관리 만족도와 r=.460(p<.001)으로 양의 상관관계가 있었다.

4. 대상자가 지각한 간호서비스 질에 가장 큰 영향을 미치는 요인으로는 통증관리 만족도(β=.308, p=.001)로 나타났고, 그 다음으로는 학력(β=.268, p<.001), 간호사의 의사소통 유형의 하위영역 중 친화적 유형(β=.221, p=.022)순이었으며 전체 설명력은 30.1%이었다.

이상의 결과를 통하여 대상자가 지각한 통증관리 만족도가 높을수록, 학력은 중졸이하일수록, 간호사의 친화적 의사소통 유형의 성향이 강할수록 대상자가 지각한 간호서비스 질 정도가 높았다. 간호서비스 질에 가장 큰 영향을 미치는 요인은 통증관리 만족도이었고 그 다음으로 학력, 간호사의 친화적 의사소통 유형 순이었다. 따라서 대상자가 지각한 간호서비스 질을 향상시키기 위해서는 대상자의 학력을 고려하여 개별적 간호중재를 제공하고, 간호사를 대상으로 효율적인 통증관리와 친화적 의사소통을 증진시키는 프로그램을 실시하는 것이 필요하다.

Musculoskeletal surgical patients make up a majority of the patients hospitalized in comprehensive nursing care wards. They need high-quality nursing services as they feel great pain from the surgery. Therefore, it is important that nurses provide these patients with good pain management to improve the quality of nursing services and provide effective communication for pain management.
Therefore, the purpose of this study was to identify the degree of and correlations between the types of communication from nurses, the level of satisfaction with pain management, and the quality of nursing services as perceived by musculoskeletal surgical patients hospitalized in comprehensive nursing care wards, and to investigate the factors that affect the quality of nursing services, to ultimately provide basic data to enhance the quality of nursing services as perceived by the patients.
The study was a descriptive research study, and the participants were 152 musculoskeletal surgical patients hospitalized in comprehensive nursing care wards of I hospital and K hospital of B City. The data were collected from July 26 to October 15, 2019. To collect the data, the study was approved by the institutional review board of K University and received permission from the nursing departments of I hospital and K hospital of B Metropolitan City. Afterwards, the study’s purpose and methods were explained to the head nurses of the nursing wards and their agreement to cooperate was received. Structured surveys were completed by nurses with at least six months’ experience under the head nurses and who had given written consents. The patients were asked to directly fill out the surveys, which were then collected.
The tool used to assess the quality of nursing service in this study was based on the SERVQUAL model by Parasuraman et al.(1988), developed by Lee Mi Aie(2004a), edited by Lee Hye Jin(2011), and then re-edited by Choi Jung Sug(2013). The tool to assess the types of communication from the nurses used the tool developed by Jeong Su Yeon(2013). Assessment of the level of satisfaction with pain management used the tool developed by Lee Yoon Young and Park Kwang Ok(2002) and edited by Yoo Hee Jung(2010).
Analysis of the data used real numbers, percentages, means and standard deviation, minimums, maximums, mean ratings and standard deviations, t-test, ANOVA and the Scheffe test, Pearson’s Correlation Coefficients and Stepwise Multiple Regression using the SPSS WIN 23.0 statistical program.

The results of the study are as follows.

1. The mean score for the type of communication as perceived by the patients was 47.90±6.88 (tool range: 11?55), and the mean rating was 4.35±0.63(scale range: 1-5). Among the subfactors, the mean score for nurses’ information-providing communication was 26.49±3.80 (tool range: 6?30), and the mean rating was 4.42±0.63 (scale range: 1?5); the mean score for the degree of friendly communication was 21.41±3.55 (tool range: 5?25), and the mean rating was 4.28±0.71 (scale range: 1?5). The mean score for satisfaction with pain management perceived by the patients was 44.48±5.81 (tool range: 10?50), and the mean rating was 4.45±0.58 (scale range: 1?5). Among the subfactors, the mean score for nurses’ performance competences was 31.04±4.14 (tool range: 7?35), and the mean rating was 4.43±0.59 (scale range: 1?5), the mean score for pain drugs and equipment was 8.93±1.24 (tool range: 2?10), and the mean rating was 4.47±0.62 (scale range: 1?5); the mean score for the degree of overall satisfaction was 4.51±0.74 (tool range: 1?5), and the mean rating was 4.51±0.74 (scale range: 1?5). The mean score for patients’ perception of the degree of nursing services quality was 8.52±15.03 (tool range: -80?+80), and the mean rating was 0.43±0.75 (scale range: -4?+4).

2. Patients’ perceived quality of nursing services differed significantly by gender (t=-2.519, p=.013), age (F=2.985, p=.021), education level (F=6.710, p=.002), occupation (F=2.507, p=.045), monthly average income (F=2.869, p=.039), diseases other than musculoskeletal diseases (t=2.308, p=.022), current health status (F=3.397, p=.036), family support for the treatment (F=4.493, p=.013), and pre-surgical pain (t=2.753, p=.007).

3. Patients’ perceived quality of nursing services was positively correlated with nurses’ information-providing communications r=.408(p<.011), nurses’ friendly communications r=.449(p<.001), and the level of satisfaction with pain management r=.460(p<.001).

4. The factors that had the greatest effect on patients’ perceived quality of nursing services was the level of satisfaction with pain management (β=.308, p=.001), followed by education level (β=.268, p<.001), and nurses’ friendly communications among the nurses’ communication types (β=.221, p=.022). The total explanation power was 30.1%.

Through the above results, it was possible to identify that the quality of nursing service as perceived by the patients was greater with higher perceived satisfaction levels on pain management, an education level below middle school graduate and better levels of friendly communication from nurses. The factor with the greatest effects on the quality of nursing services was the satisfaction level with pain management, followed by education level and friendly communication from nurses. Therefore, in order to improve the quality of nursing services as perceived by patients, it is necessary to provide customized nursing interventions taking patients’ education levels into consideration and to develop programs to improve effective pain management and friendly communication by nurses.