본 연구는 COVID-19 환자를 간호한 감염병전담병원 간호사의 직무스트레스, 피로도가 소진에 미치는 영향을 파악하고, 마음챙김의 매개효과를 규명하고자 시도된 서술적 조사연구이다.
연구대상은 J도 소재 지방의료원 중 국가에서 지정한 COVID-19 감염병전담병원 4곳에서 근무 중인 COVID-19 환자를 직접 간호한 경험이 있는 임상경력 6개월 이상의 간호사 207명이었다. 자료 수집은 2021년 5월 1일부터 5월 30일까지 구조화된 설문지를 이용하여 실시하였다.
본 연구의 측정도구로 직무스트레스는 허선(2013)이 개발하고, 김옥녕(2021)이 수정·보완한 도구를, 피로도는 구효훈(2017)이 개발한 도구를, 마음챙김은 박성현(2006)이 개발한 도구를, 소진은 Pine, Aronson과 Kafry (1981)가 개발한 도구를 픽은희(1983)가 번안하고, 김신정(2007)이 사용한 도구를 문숙자(2010)가 내용타당도를 검증하여 수정·보완한 도구를 사용하였다.
수집된 자료는 SPSS/WIN 22.0 통계프로그램을 이용하여 빈도, 백분율, 평균, 표준편차, t-test, ANOVA, Sheffe test, Pearson’s correlation coefficient, multiful linear regression analysis, PROCESS Macro program을 사용하여 분석하였다.

본 연구의 결과는 다음과 같다.

1. 본 연구의 대상자는 총 207명이었다. 일반적 특성 중 성별은 여자가 195명(94.2%)으로 대부분을 차지하였고, 평균 연령은 35.5세, 결혼 상태는 미혼이 105명(50.7%)이었다. 종교는 ‘무’라고 응답한 자가 125명(60.4%), 학력은 학사가 141명(68.1%)이었으며, 직위는 일반간호사가 176명(85.0%)이었다. 총 근무경력은 평균 11.14년이었으며, COVID-19 환자 간호 당시 근무부서는 음압격리병동이 118명(57%), 근무형태는 교대근무자가 185명(89.4%)이었다. 일일평균 근무시간은 8시간 24분이었으며, 지난 1년간 신종감염병 관련 교육이수 횟수는 4회가 108명(52.2%)이었다. 과거 신종감염병 환자를 간호한 경험이 있는 대상자는 43명(20.8%)이었다.

2. 직무스트레스 정도는 5점 만점에 평균 3.33±0.69점이었으며, 피로도는 5점 만점에 평균 3.22±0.68점이었다. 마음챙김 정도는 5점 만점에 평균 3.77±0.73점이었으며, 소진 정도는 5점 만점에 평균 2.83±0.37점이었다.

3. 일반적 특성에 따른 직무스트레스는 성별(t=2.99, p=.003), 연령(F=2.95, p=.034), 직위(F=3.50, p=.032), 근무형태(t=-2.60, p=.010)에서, 피로도는 성별(t=3.37, p=.001), 연령(F=4.72, p=.003), 결혼상태(t=2.08, p=.039), 직위(F=4.87, p=.009), 총 근무경력(F=3.39, p=.009), 근무형태(t=-3.03, p=.003)에서, 소진은 결혼상태(t=2.63, p=.009)에서 통계적으로 유의한 차이가 있었다. 마음챙김은 일반적 특성에 따라 통계적으로 유의한 차이가 없었다.

4. 직무스트레스는 피로도(r=.77, p<.001), 소진(r=.47, p<.001)과 양의 상관관계가 있었으며, 마음챙김(r=-.23, p=.001)과는 음의 상관관계가 있었다. 피로도는 마음챙김(r=-.28, p<.001)과 음의 상관관계가 있었고, 소진(r=.64, p<.001)과는 양의 상관관계가 있었다. 마음챙김은 소진(r=-55, p<.001)과 음의 상관관계가 있었다.

5. 직무스트레스와 소진 간의 관계에서 마음챙김의 매개효과를 검정한 결과, 직무스트레스는 마음챙김에 유의한 영향을 미치지 못했다(β=-.03, p>.05). 또한, 직무스트레스는 소진에 유의한 영향을 미치지 못했으나(β=-.06, p>.05), 마음챙김은 소진에 부적영향을 미치는 것으로 나타났다(β=-.37, p<.001). 직무스트레스와 소진 간의 관계에서 마음챙김의 매개효과 유의성 검증결과, 직무스트레스의 소진에 대한 직접효과의 크기는 ?0.04이었고, 95% Bootstrap 신뢰구간(-0.11∼0.04)은 0을 포함하여 통계적으로 유의하지 않았다. 직무스트레스가 마음챙김을 매개하여 소진에 미치는 간접효과의 크기는 0.01이었고 95% Bootstrap 신뢰구간(-0.04∼0.05)은 0을 포함하여 통계적으로 유의하지 않았다.
피로도와 소진 간의 관계에서 마음챙김의 매개효과를 검정한 결과, 피로도는 마음챙김에 부적영향을 미치는 것으로 나타났다(β=-.27, p<.05). 피로도는 소진에 정적영향을(β=.62, p<.001), 마음챙김은 소진에 부적영향을 미치는 것으로 나타났다(β=-.37, p<.001). 피로도와 소진 간의 관계에서 마음챙김의 매개효과 유의성 검증결과, 피로도의 소진에 대한 직접효과의 크기는 0.34였고, 95% Bootstrap 신뢰구간(0.26∼0.41)은 0을 포함하지 않아 통계적으로 유의하였다. 피로도가 마음챙김을 매개하여 소진에 미치는 간접효과의 크기는 0.06이었고, 95% Bootstrap 신뢰구간(0.01∼0.11)은 0을 포함하여 통계적으로 유의하였다. 따라서 직무스트레스와 소진 간의 관계에서 마음챙김의 매개효과는 검증되지 못했고, 피로도와 소진 간의 관계에서 마음챙김의 매개효과는 검증되었다.

본 연구의 결과를 종합하면, COVID-19 환자를 간호한 감염병전담병원 간호사의 직무스트레스와 피로도는 소진에 영향을 미치고 직무스트레스와 소진 간의 관계에서 마음챙김의 매개효과는 없었으나, 피로도와 소진 간의 관계에서 마음챙김의 매개효과가 있음을 확인하였다. 따라서 COVID-19와 같은 감염병 환자를 돌보는 간호사의 직무스트레스, 소진을 예방하기 위해 충분한 휴식 보장, 적정 간호인력 수급 및 정서적 지지 등의 체계적인 업무시스템이 마련되어야 하며, 마음챙김과 같은 소진예방을 위한 프로그램을 개발하여 적용할 필요가 있다.

This study is a descriptive research study to identify the effects of job stress and fatigue on burnout of infectious disease specialized hospital nurses who cared for COVID-19 patients and examine the mediating effect of mindfulness.
The participants were 207 nurses with more than six months of clinical experience who cared for COVID-19 patients at four nationally-designated COVID-19 infectious disease hospitals among local public medical centers located in J-province. Data were collected using a structured questionnaire from May 1 to May 30, 2021.
As for measurement tools, this study used the job stress tool developed by Her (2013), modified and supplemented by Kim (2021); the fatigue tool developed by Koo (2017); the mindfulness tool developed by Park (2006); and the burnout tool developed by Pine, Aronson, and Kafry (1981), adapted by Peek (1983), and the tool used by Kim (2007), modified and supplemented by Moon (2010) after verifying the content validity.

The collected data were analyzed using frequency, percentage, mean, standard deviation, t-test, ANOVA, Sheffe test, Pearson’s correlation coefficient, multiple linear regression analysis, and PROCESS Macro program with SPSS/WIN 22.0.

The results are as follows.

1. The participants were 207 nurses. In terms of general characteristics, 195 (94.2%) were women, accounting for the majority. Their average age was 35.5 years old, 105 (50.7%) were single, 125 (60.4%) had no religion, 141 (68.1%) had a bachelor’s degree, and 176 (85.0%) were general nurses. The average total work experience was 11.14 years, and at the time of nursing COVID-19 patients, 118 (57%) were in the negative pressure isolation ward, and 185 (89.4%) worked in shift workers. The average daily working hours were 8 hours and 24 minutes, and 108 (52.2%) took four training sessions related to emerging infectious diseases over the past year. There were 43 participants (20.8%) who had previous experience caring for patients with novel infectious diseases.

2. The average job stress level was 3.33±0.69 out of 5, and the average fatigue level was 3.22±0.68 out of 5. The average level of mindfulness was 3.77±0.73 out of 5, and the average degree of burnout was 2.83±0.37 out of 5.

3. There were statistically significant differences in job stress according to gender (t=2.99, p=.003), age (F=2.95, p=.034), position (F=3.50, p=.032), and work type (t=-2.60, p=.010); differences in fatigue according to gender (t=3.37, p=.001), age (F=4.72, p=.003), marital status (t=2.08, p=.039), position (F=4.87, p=.009), total work experience (F=3.39, p=.009), and work type (t=-3.03, p=.003). There was a statistically significant difference in burnout according to marital status (t=2.63, p=.009). There was no statistically significant difference in mindfulness according to general characteristics.

4. Job stress had a positive correlation with fatigue (r=.77, p<.001) and burnout (r=.47, p<.001), while it had a negative correlation with mindfulness (r=-.23, p=.001). Fatigue was negatively correlated with mindfulness (r=-.28, p<.001) and positively correlated with burnout (r=.64, p<.001). Mindfulness had a negative correlation with burnout (r=-55, p<.001).

5. As a result of testing the mediating effect of mindfulness on the relationship between job stress and burnout, job stress did not have a significant effect on mindfulness (β=-.03, p>.05). While job stress did not have a significant effect on burnout (β=-.06, p>.05), mindfulness had a negative effect on burnout (β=-.37, p<.001). As a result of testing the significance of the mediating effect of mindfulness on the relationship between job stress and burnout, the magnitude of the direct effect of job stress on burnout was ?0.04 and the effect was not statistically significant because the 95% bootstrap confidence interval (-0.11∼0.04) includes 0. The magnitude of the indirect effect of job stress on burnout by mediating mindfulness was 0.01 and it was not statistically significant because the 95% bootstrap confidence interval (-0.04∼0.05) includes 0.
As a result of testing the mediating effect of mindfulness on the relationship between fatigue and burnout, fatigue had a negative effect on mindfulness (β=-.27, p<.05). While fatigue had a positive effect on burnout (β=.62, p<.001), mindfulness had a negative effect on burnout (β=-.37, p<.001). As a result of testing the significance of the mediating effect of mindfulness on the relationship between fatigue and burnout, the magnitude of the direct effect of fatigue on burnout was 0.34 and the effect was statistically significant as the 95% bootstrap confidence interval (0.26∼0.41) did not include 0. The magnitude of the indirect effect of fatigue on burnout by mediating mindfulness was 0.06 and it was statistically significant because the 95% Bootstrap confidence interval (0.01∼0.11) includes 0. Therefore, the mediating effect of mindfulness on the relationship between job stress and burnout was not verified, and the mediating effect of mindfulness on the relationship between fatigue and burnout was verified.

In summary, the job stress and fatigue of nurses working at the infectious disease hospitals who cared for COVID-19 patients affected burnout, and there was no mediating effect of mindfulness on the relationship between job stress and burnout. However, there was a mediating effect of mindfulness on the relationship between fatigue and burnout. Therefore, to prevent the job stress and burnout of nurses caring for patients with infectious diseases such as COVID-19, it is necessary to prepare systematic work systems such as ensuring sufficient rest, adequate supply of nurses, and emotional support and to develop and apply programs for preventing burnout, such as mindfulness.



Keywords: Job stress, Fatigue, Burnout, Mindfulness, Mediating effect