[Development of the Hospital Nurses' Silence Behavior Scale].

PURPOSE: This study aimed to develop a scale to measure hospital nurses' silence behavior and examine its validity and reliability. METHODS: A total of 52 preliminary items on hospital nurses' silence behavior were selected using a content validity test by seven experts on 53 candidate items derived from a literature review and in-depth interviews with 14 nurses. A total of 405 hospital nurses participated in a psychometric testing. Data analysis comprised item analysis, exploratory and confirmatory factor analyses, and convergent and discriminant validity tests. Pearson's correlation coefficient was used for assessing concurrent validity, and Cronbach's alpha was used for the reliability test. RESULTS: The final scale consisted of nine factors with 31 items, exhibiting acceptable model fit indices, convergent validity, and discriminant validity. The score of the entire scale was positively correlated with the 'Organizational Silence Scale (OSS)-the issues on which nurses remain silent' (r = .60, p < .001) and 'OSS-the reasons why nurses remain silent' (r = .68, p < .001). Cronbach's α of the scale was .92, and α of each subscale ranged from .71 to .90. CONCLUSION: The Hospital Nurses' Silence Behavior Scale is a useful tool for assessing multifaceted silence behavior among nurses. It can provide basic data for developing better communication strategies among nurses and other hospital staff.

Understanding experiences of cancer-related fatigue in patients with lung cancer after their cancer treatment: a qualitative content analysis.

PURPOSE: Cancer-related fatigue (CRF) is an important symptom affecting the quality of life of patients with lung cancer. However, research on the characteristics of CRF in lung cancer and their relationship to cancer treatment is limited. We aimed to explore the unique features of CRF in patients with lung cancer, and investigate the influencing factors. METHODS: Semi-structured interviews were conducted with 21 adult patients with lung cancer until data saturation was reached. The collected data were analyzed using qualitative content analysis. An inductive coding process and deductive content analysis incorporating the established CRF domains were employed. Patient data from electronic medical records were used for data triangulation. RESULTS: The analysis revealed five themes of CRF: (1) energy depletion, the double burden of illness and treatment, and daily life impediments; (2) feeling down and anxious; (3) neurovascular disturbances and changes in sensory perception; (4) cognitive impairment; and (5) personal and social isolation. CRF tended to improve over time, except for persistent emotional fatigue beyond 6 months. Patients who underwent surgery followed by adjuvant cancer treatment exhibited the most diverse CRF symptoms. The concurrent chemoradiation therapy group experienced significant physical fatigue, whereas the radiosurgery group reported distinct emotional fatigue. Certain factors, such as exercise, can serve as both alleviating and aggravating factors for CRF. CONCLUSION: Tailored interventions that take into account the multidimensional symptoms of CRF and patient characteristics are crucial. These findings will guide healthcare professionals when implementing patient-centered symptom management and patient education.

Performance of Early Warning Scoring Systems Regarding Adverse Events of Unanticipated Clinical Deterioration in Complementary and Alternative Medicine Hospitals.

PURPOSE: This study aims to examine the performance of early warning scoring systems regarding adverse events of unanticipated clinical deterioration in complementary and alternative medicine hospitals. METHODS: A medical record review of 500 patients from 5-year patient data in two traditional Korean medicine hospitals was conducted. Unanticipated clinical deterioration events included unexpected in-hospital mortality, cardiac arrest, and unplanned transfers to acute-care conventional medicine hospitals. Scores of the Modified Early Warning Score (MEWS), National Early Warning Score (NEWS), and National Early Warning Score 2 (NEWS2) were calculated. Their performance was evaluated by calculating areas under the receiver-operating characteristic curve for the event occurrence. Multiple logistic regression analyses were performed to determine the factors associated with event occurrence. RESULTS: The incidence of unanticipated clinical deterioration events was 1.1% (225/21101). The area under the curve of MEWS, NEWS, and NEWS2 was .68, .72, and .72 at 24 hours before the events, respectively. NEWS and NEWS2, with almost the same performance, were superior to MEWS (p = .009). After adjusting for other variables, patients at low-medium risk (OR = 3.28; 95% CI = 1.02-10.55) and those at medium and high risk (OR = 25.03; 95% CI = 2.78-225.46) on NEWS2 scores were more likely to experience unanticipated clinical deterioration than those at low risk. Other factors associated with the event occurrence included frailty risk scores, clinical worry scores, primary medical diagnosis, prescribed medicine administration, acupuncture treatment, and clinical department. CONCLUSIONS: The three early warning scores demonstrated moderate-to-fair performance for clinical deterioration events. NEWS2 can be used for early identification of patients at high risk of deterioration in complementary and alternative medicine hospitals. Additionally, patient, care, and system factors need to be considered to improve patient safety.

Experiences of using clinical pathways in hospitals: Perspectives of quality improvement personnel.

AIM: This study aimed to explore the experiences of quality improvement personnel in implementing clinical pathways (CPs) in Korean hospitals. DESIGN: A qualitative study using focus-group interviews was conducted with healthcare professionals in charge of CP development and management in hospitals. METHODS: Sixteen quality improvement personnel from eight tertiary and seven general hospitals were recruited using purposive sampling. The verbatim transcribed data were analysed using qualitative content analysis. RESULTS: Three key themes emerged: (1) the primary focus of CP development on surgeries through concerted efforts between management and frontline healthcare professionals; (2) CP fidelity management using indicators and feedback to relevant staff or departments; and (3) positive outcomes, despite concerns about system safety. The factors affecting CP use included availability of clinical evidence, flexibility of CPs, top management and clinical leadership, physicians' perceptions of CPs, computerized support systems, and external policies and regulations.

The Korea National Patient Safety Incidents Inquiry Survey: Characteristics of Adverse Events Identified Through Medical Records Review in Regional Public Hospitals.

OBJECTIVES: In 2019, the Korean National Patient Safety Incidents Inquiry was conducted in the Republic of Korea to identify the national-level incidence of adverse events. This study determined the incidence and detailed the characteristics of adverse events at 15 regional public hospitals in the Republic of Korea. METHODS: Medical records data of 500 randomly selected patients (discharged in 2016) were extracted from each of the 15 studied hospitals and reviewed in 3 stages. First, for each hospital, 2 nurses independently reviewed the medical records, using 41 screening criteria. Second, 2 physicians independently reviewed the records of those patients with at least 1 screening criterion from the first stage for adverse events occurrence and their characteristics. Third, a 9-member committee conducted a final review and compiled the final adverse event report. RESULTS: Among 7500 patients, 4159 (55.5%) had at least 1 screening criterion; 745 (9.9%) experienced 901 adverse events (incidence, 12.0%). By type of institution, adverse event incidence varied widely from 1.2% to 45.6%. In 1032 adverse events, the majority (33.5%) were "patient care-related." By severity, the majority (638; 70.8%) were temporary, requiring intervention, whereas 38 (4.2%) resulted in death. The preventability score was high for "patient care-related" and "diagnosis-related" adverse events. Duration of hospitalization was extended for 463 (44.9%) adverse events, with "diagnosis-related" (30.8%) and "surgery/procedural-related" (30.1%) types extended by at least 21 days. CONCLUSIONS: A review of medical records aids in identifying adverse events in medical institutions with varying characteristics, thus helping prioritize interventions to reduce their incidence.

The Korea National Patient Safety Incidents Inquiry Survey: Feasibility of Medical Record Review for Detecting Adverse Events in Regional Public Hospitals.

OBJECTIVES: We aimed to examine the Korea National Patient Safety Incidents Inquiry conducted in the Republic of Korea; specifically, we assessed the validity of screening criteria, interreviewer reliability, quality of medical records, and the time required for reviewing medical records. METHODS: A 3-stage retrospective medical record review was performed. The sensitivity and positive predictive value of the screening criteria for the adverse events were calculated, and interreviewer reliability was verified using the overall agreement rate and κ value. In addition, the results of medical record quality assessment and time required for review were analyzed. RESULTS: There were a total of 4159 patients (55.5%) with at least 1 of the 41 screening criteria. In stage 1, the overall percent of agreement was 81.9% when all negatives from the 2 reviewers were included, and the κ value was 0.64 (95% confidence interval [CI], 0.61-0.66). In stage 2, 84.6% of cases were a perfect match, and 87.4% were a partial match. The κ values were 0.159 (95% CI, 0.12-0.20) and 0.389 (95% CI, 0.35-0.43), respectively. The mean quality assessment scores were 3.18 of 4 points in stage 1 and 3.05 of 4 points in stage 2. In stage 1, it took an average of 13.02 minutes to asses each patient file; in stage 2, it took an average of 5.06 minutes. CONCLUSIONS: To increase the feasibility of medical record review for detecting adverse events, it is important not only to improve the reliability between reviewers but also to monitor the quality of medical records and the time required for review.

Using an Early Warning Score for Nurse Shift Patient Handover: Before-and-after Study.

PURPOSE: This study aimed to examine the impact of using an early warning score for shift patient handover on nurse and patient outcomes. METHODS: A before-and-after study was conducted with nurses and patients in three general wards in a tertiary teaching hospital. A short-time nurse education on the National Early Warning Score 2 and the use of a checklist for score calculation were performed from June 4, 2019 to June 30, 2019. Outcomes of nurse response (safety competency, handover quality, teamwork, safety climate, and documentation of vital signs and clinical concerns), patient response (deterioration occurrence postadmission, hospitalization length, and discharge status), and adverse events (mortality, cardiopulmonary arrest, and unplanned intensive care unit admission) were measured using questionnaires and medical record reviews. Data from 89 nurses and 388 patients were analyzed. RESULTS: Regarding nurse outcomes, handover quality (p < .001), teamwork (p = .004), safety climate (p = .018), and recordings of vital signs (p = .047) and clinical concerns (p = .008) increased after early warning score use. However, no significant change in the safety competency scores was observed. Regarding patient outcomes, there were no significant changes in the occurrence of deterioration, hospitalization length, discharge status, and occurrence of adverse events between preintervention and postintervention. CONCLUSION: Despite no significant changes in patient outcomes, using a simple, evidence-based early warning score for patient handover enhanced socio-cultural factors for patient safety, with improved patient monitoring. The findings provide evidence that supports the active implementation of an early warning score to improve patient safety.

Relationships Between Nurses' Work System, Safety-Related Performance, and Outcomes: A Structural Equation Model.

OBJECTIVES: We examined relationships between nurses' work system, safety-related performance, and outcomes based on a modified Systems Engineering Initiative for Patient Safety model. METHODS: A cross-sectional survey was conducted with 408 nurses from 2 general hospitals. Data on work system factors (person, organization, environment, tools, and task), processes (safety-related performance), and outcomes (staff and clinical outcomes) were collected. Structural equation modeling was used to determine the relationships between nurses' work system factors, safety-related processes, and outcomes. RESULTS: Structural equation modeling yielded a comparative fit index of 0.918, standardized root mean square residual of 0.055, and root mean square error of approximation of 0.054, indicating an acceptable model fit. The person factor had a significant positive direct effect on nurses' safety-related performance, and significant negative direct and indirect effects on the clinical outcome. The organization factor had significant positive direct effects on nurses' safety-related performance and staff outcome, and a negative indirect effect on the clinical outcome. The task factor had a significant positive direct effect on staff outcome. However, the environment and tools factors had no significant effects on safety-related performance or outcomes. CONCLUSIONS: The findings demonstrated the usefulness of the Systems Engineering Initiative on Patient Safety model to explain safety-related performance and outcomes, indicating differential effects of work system factors. Although the person factor significantly affected safety performance and clinical outcomes, the organization factor was the most influential component for promoting safety-related performance and staff and clinical outcomes. These results can be used to prioritize activities for patient safety.

[Relationships among Non-Nursing Tasks, Nursing Care Left Undone, Nurse Outcomes and Medical Errors in Integrated Nursing Care Wards in Small and Medium-Sized General Hospitals].

PURPOSE: This study aimed to identify the degree of non-nursing tasks and nursing care left undone in integrated nursing care wards, and examine their relationships with nurses' burnout, job satisfaction, turnover intentions, and medical errors. METHODS: A cross-sectional questionnaire survey was conducted. Data were collected using self-report questionnaires from 346 nurses working in 20 wards of seven small and medium-sized general hospitals, and analyzed using multiple regression and multiple logistic regression analysis with the SPSS WIN 25.0 program. RESULTS: The mean score for non-nursing tasks was 7.32±1.71, and that for nursing care left undone was 4.42 ± 3.67. An increase in non-nursing tasks (ß = .12, p = .021) and nursing care left undone (ß = .18, p < .001) led to an increase in nurses' burnout (F = 6.26, p < .001). As nursing care left undone (ß = .13, p = .018) increased, their turnover intentions also (F = 3.96, p < .001) increased, and more medical errors occurred (odds ratio 1.08, 95% confidence interval 1.02~1.15). CONCLUSION: Non-nursing tasks and nursing care left undone are positively associated with nurses' burnout, turnover intentions, and the occurrence of medical errors. Therefore, it is important to reduce non-nursing tasks and nursing care left undone in order to deliver high quality nursing care and in turn increase patient safety.

Psychometric Evaluation of the Korean Version of the Student Evidence-Based Practice Questionnaire (S-EBPQ).

PURPOSE: Evidence-based practice (EBP) is a key competency that undergraduate nursing students need to learn, as EBP competence is essential for the effective implementation of EBP. However, few studies have comprehensively assessed the aspects of EBP competence using a reliable and valid measure specific to Korean nursing students. This study aimed to translate the Student Evidence-Based Practice Questionnaire (S-EBPQ) into Korean and evaluate its psychometric properties. METHODS: The original S-EBPQ was translated into Korean. After a pilot test, a convenience sample of 249 college students with more than four weeks of clinical training experience was selected from three universities in September 2017. Reliability and construct validity were evaluated using exploratory and confirmatory factor analyses. Concurrent validity was evaluated by correlating the measure with informatics competency. RESULTS: The exploratory factor analysis revealed four factors that explained 66.3 of the variance. The confirmatory factor analysis yielded a 4-factor structure (χ2/df = 1.52, p < .001, standardized root-mean-square residual = .07, root-mean-square error of approximation = .07, goodness of fit index = .84, comparative fit index = .91). The Cronbach's α was .81 for the total scale. The scale's correlation with informatics competency was r = .55. CONCLUSIONS: The Korean S-EBPQ is a reliable and valid tool that has utility for assessing EBP competence in Korean nursing students and for making comparisons of the EBP competence of nursing students from other countries.

How to Improve Patient Safety Literacy?

The aim of this comparative study involving pre- and post-tests was to analyze the effectiveness of patient safety educational materials developed for the Comprehensive Plans for Patient Safety in Korea (2018-2022), and to suggest how to improve patient safety literacy. A face-to-face survey interview comprising items related to general information and patient safety literacy was completed by 217 patients and their families who visited three general hospitals in Seoul and one general hospital in Gyeonggi-do for treatment between 25 October and 15 November 2019. In the interview, the patients were asked questions about whether the patient safety educational materials were "easy to understand," provided "help in safe hospitalization," and enabled patients to practice patient safety independently ("do it yourself"). The literacy of the patient safety educational materials was analyzed using a paired t-test with a p value of 0.05. The comparison between patient safety literacy on pre- and post-tests revealed that among all participants, there were significant differences in "easy to understand," "help in safe hospitalization," and "do it yourself" scores. To improve patient safety literacy, patient education materials need to optimize communication by improving patients' knowledge, skills, and attitudes for maintaining and promoting healthy living.

Variation between hospitals and reviewers in detection of adverse events identified through medical record review in Korea.

OBJECTIVES: This study utilized the method of medical record review to determine characteristics of adverse events that occurred in the inpatient units of hospitals in Korea as well as the variations in adverse events between institutions. DESIGN: A two-stage retrospective medical record review was conducted. The first stage was a nurse review, where two nurses reviewed medical records of discharged patients to determine if screening criteria had been met. In the second stage, two physicians independently reviewed medical records of patients identified in the first stage, to determine whether an adverse event had occurred. SETTING: Inpatient units of six hospitals. PARTICIPANTS: Medical records of 2 596 patients randomly selected were reviewed in the first stage review. INTERVENTION(S): N/A. MAIN OUTCOME MEASURE(S): Adverse events. RESULTS: A total of 277 patients (10.7%) were confirmed to have had one or more adverse event(s), and a total of 336 adverse events were identified. Physician reviewers agreed about whether an adverse event had occurred for 141 patients (5.4%). The incidence rate of adverse events was at least 1.3% and a maximum of 19.4% for each hospital. Most preventability scores were less than four points (non-preventable), and there were large variations between reviewers and institutions. CONCLUSIONS: Given the level of variation in the identified adverse events, further studies that include more medical institutions in their investigations are needed, and a third-party committee should be involved to address the reliability issues regarding the occurrence and characteristics of the adverse events.

Relationships between the National Early Warning Score 2, clinical worry and patient outcome at discharge: Retrospective observational study.

AIMS AND OBJECTIVES: To examine the performance of the National Early Warning Score 2 and composite score for clinical worry in identifying patients at risk of clinical deterioration, and to determine relationships between National Early Warning Score 2, clinical worry score and patient outcome at discharge. BACKGROUND: The efficacy of early warning systems depends on patient population and care settings. Based on a theoretical framework on factors affecting clinical deterioration and patient outcomes, studies exploring the relationship between early warning systems and patient outcomes at discharge are sparse. DESIGN: Retrospective observational study. METHODS: A random sample of 732 medical records were reviewed. The area under the receiver operating characteristic curve was calculated to evaluate predictive abilities regarding the events of unanticipated in-hospital mortality, unplanned intensive care unit/ higher dependency bed admission and cardiac arrest. Multiple logistic regression analyses were performed to determine relationships between National Early Warning Score 2, clinical worry score and patient outcome. Reporting followed the STROBE checklist. RESULTS: National Early Warning Score 2 and clinical worry score significantly predicted the events within 24 hr of the assessment. After controlling for other patient, treatment and organisational characteristics, National Early Warning Score 2 was a significant factor associated with patient outcome, but clinical worry score was not. Specifically, patients at high risk based on National Early Warning Score 2 were less likely to have improved outcome. CONCLUSIONS: National Early Warning Score 2 and clinical worry score performed well for predicting deteriorating condition of patients. National Early Warning Score 2 was significantly associated with patient outcome. It can be used for efficient patient management for safe, quality care. RELEVANCE TO CLINICAL PRACTICE: National Early Warning Score 2 can be used for early assessment of not only clinical deterioration but also patient outcome and provide timely intervention, when coupled with clinical worry score.

Can patient and family education prevent medical errors? A descriptive study.

BACKGROUND: This study aims to increase understanding of how patient and family education affects the prevention of medical errors, thereby providing basic data for developing educational contents. METHODS: This descriptive study surveyed patients, families, and Patient Safety Officers to investigate the relationship between educational contents and medical error prevention. The Chi-square test and ANOVA were used to derive the results of this study. The educational contents used in this study consisted of health information (1. current medicines, 2. allergies, 3. health history, 4. previous treatments/tests and complications associated with them) and Speak Up (1. handwashing, 2. patient identification, 3. asking about medical conditions, 4. asking about test results, 5. asking about behaviour and changes in lifestyle, 6. asking about the care plan, 7. asking about medicines, and 8. asking about medicine interactions). RESULTS: In this study, the first criterion for choosing a hospital for treatment in Korea was 'Hospital with a famous doctor' (58.6% patient; 57.7% families). Of the patients and their families surveyed, 82.2% responded that hospitals in Korea were safe. The most common education in hospitals is 'Describe your medical condition', given to 69.0% of patients, and 'Hospitalisation orientation', given to 63.4% of families. The most important factors in preventing patient safety events were statistically significant differences among patients, family members, and Patient Safety Officers (p = 0.001). Patients and families had the highest 'Patient and family participation' (31.0% of patients; 39.4% of families) and Patient Safety Officers had the highest 'Patient safety culture' (47.8%). CONCLUSIONS: Participants thought that educational contents developed through this study could prevent medical errors. The results of this study are expected to provide basic data for national patient safety campaigns and standardised educational content development to prevent medical errors.

[The Effects of Hospitals' Family Friendly Management on Married Female Nurses' Retention Intention: Focused on the Mediating Effects of Work-Family Interface].

PURPOSE: This study examined the effect of hospitals' family-friendly management on married female nurses' retention intention. The focus was the mediating effects of the work-family interface (work-family conflict, work-family enrichment and work-family balance). METHODS: This study was a cross-sectional study. The participants were 307 nurses working at five public and five private hospitals with more than 200 beds in Seoul. Data were collected using structured questionnaires from September 10 to September 17, 2018 and analyzed with SPSS 24.0. Data were analyzed using an independent t-test, a one-way ANOVA, Pearson's correlation coefficients, and multiple regression following the Baron and Kenny method and Sobel test for mediation. RESULTS: There were significant correlations among family-friendly management, the work-family interface, and retention intention. Work-family conflict showed a partial mediating effect on the relationship between family-friendly management and retention intention. Work-family enrichment showed a partial mediating effect on the relationship between family-friendly management and retention intention. Work-family balance showed a partial mediating effect on the relationship between family-friendly management and retention intention. CONCLUSION: These findings indicate that both hospitals' family-friendly management and nurses' work-family interface are important factors associated with nurses' retention intention. Therefore, hospitals should actively implement family-friendly management for nurses and establish strategies to enhance nurses' work-family interface for effective human resource management.

The Relationship Between Patients' Safety-Related Behaviors and Safety Events and Patient Experiences in Korean Hospitals.

BACKGROUND AND PURPOSE: There is increasing interest in patient participation in healthcare aimed at enhancing safety. The purposes of this study were to examine levels of patients' safety-related behaviors and to determine their relationships with safety events and care experiences. METHODS: A cross-sectional survey was conducted with 360 patients in two tertiary general hospitals in Korea. The final dataset consisted of 341 patient responses. A questionnaire was developed to collect information concerning patients' safety-related behaviors, care experiences, and the occurrence of safety events. Univariate and multivariate analyses were performed. RESULTS: On average, patients participated in 10.0 (SD 5.4) safety-related behaviors. Sixty-five (19.1%) patients reported experiencing at least one adverse event related to medical management. The mean problem score for care experience was 39.4 (SD 27.8) out of 100.0. Multiple logistic analysis showed that patients with adequate health literacy and higher activation levels were more likely to have high safety-related behavior participation levels. High participation in safety-related behaviors was negatively associated with the occurrence of safety events. However, no significant relationship was found between patient participation and the total problem scores for care experience. IMPLICATIONS FOR PRACTICE: These findings suggest that efforts to support patients with limited health literacy and low activation levels are needed to facilitate patient participation. Active participation in safety-related behaviors can contribute to improving patient safety.

Psychometric properties of transitional care instruments and their relationships with health literacy: Brief PREPARED and Care Transitions Measure.

OBJECTIVE: To assess the psychometric properties of the Brief PREPARED (B-PREPARED) and the Care Transitions Measure (CTM) in patients discharged from hospitals in Korea, and examine their relationships with health literacy. DESIGN: A cross-sectional study with a follow-up telephone survey 4 weeks post-discharge. SETTING: Six medical and surgical wards in a tertiary hospital in Seoul. PARTICIPANTS: 293 patients discharged from general wards. MAIN OUTCOME MEASURES: Psychometric properties of the Korean versions of the B-PREPARED and the 15- and 3-item CTM (CTM-15 and CTM-3), and the 3-item Brief Screening Questionnaire for health literacy. RESULTS: All instruments discriminated well between patients who were satisfied with hospital care and the discharge process, and those who were not. One month post-discharge, the CTM-15 score was significantly higher in patients with good health status than the others, and the CTM-3 score was significantly higher in patients who used outpatient care than the others. However, no significant difference was found in the scores for all instruments by emergency department visits, rehospitalization, and medication adherence. Cronbach's alpha values were 0.69 for B-PREPARED, 0.91 for CTM-15 and 0.67 for CTM-3. Intraclass correlation coefficients were 0.64, 0.75 and 0.66, respectively. Approximately 33% of the participants had limited health literacy. After adjusting for other patient variables, those with inadequate health literacy had lower scores on all instruments. CONCLUSIONS: Although the three instruments had acceptable validity and reliability, they showed limited criterion validity. Patients with limited health literacy should be supported to ensure the quality of transitional care.

Patient Participation in Patient Safety and Its Relationships with Nurses' Patient-Centered Care Competency, Teamwork, and Safety Climate.

PURPOSE: This study's aim was to examine degrees of patient participation in patient safety activities in hospitals and to investigate their relationships with nurses' patient-centered care competency (PCC), teamwork, and safety climate. METHODS: A cross-sectional study design was used. Data were collected with 479 nurses from two general hospitals in Seoul, Korea, using a questionnaire designed to collect data on patient participation in patient safety activities, PCC, teamwork perceptions, and safety climate. The response rate was 74.1% (N = 355). Data were analyzed using descriptive statistics and multiple logistic regression analysis. RESULTS: The mean score for patient participation was 2.76 ± 0.46 of 4.0. The mean scores for PCC, teamwork, and safety climate were 3.61 ± 0.46, 3.64 ± 0.41, and 3.35 ± 0.57 of 5.0, respectively. Nurses who experienced high patient participation in patient safety activities (≥ 3.0) had higher scores for PCC, teamwork, and safety climate. Multiple logistic regression analysis revealed that PCC (OR = 2.31, 95% CI = 1.14-4.70) and safety climate (OR = 2.51, 95% CI = 1.09-5.78) scores were the significant factors associated with patient participation. CONCLUSION: The degree of patient participation in patient safety activities was not high. Nurses' PCC, teamwork, and safety climate were positively related with patient participation. In particular, the findings indicate that enhancing nurses' competency for patient-centered care and creating a strong safety climate are important to promote patient participation for safer health care.

Cancer site differences in the health-related quality of life of Korean cancer survivors: Results from a Population-based Survey.

OBJECTIVES: We investigated cancer site differences in the health-related quality of life (HRQOL) of cancer survivors. DESIGN AND SAMPLE: A secondary data analysis was conducted using the sixth Korea National Health and Nutrition Examination Survey (2013-2015). Participants were 15,461 adults (664 cancer survivors) with available EuroQol-5 Dimensions (EQ5D) information. MEASUREMENTS: Constructs from the revised Wilson and Cleary's model were examined. HRQOL status was measured using the EQ5D. EQ5D dimensional problems and indices were compared across cancer sites using multiple linear and quantile regression analyses. RESULTS: The most common problems across cancer sites were pain/discomfort and mobility. There were differences in EQ5D dimensional problems by cancer site: problems of usual activities in the cervix-cancer group and anxiety/depression in the thyroid cancer group were prevalent. Those with cervix cancer (vs. stomach) had higher EQ5D index scores; however, no significant differences were observed between other site subgroups. Subjective health perception and socioeconomic factors were significant determinants affecting HRQOL among cancer survivors with low EQ5D index scores. CONCLUSIONS: Subjective health status and socioeconomic characteristics are predicted to have a greater impact on survivors with low (vs. high) HRQOL. Socioeconomic and psychological support is essential to increase cancer survivors' HRQOL, regardless of cancer site.