Development of Strategic Plans for Advancing Nursing in Korea

PURPOSE: The aim of the study is to evaluate the current and prospective status of nursing in Korea and develop a strategic framework and plan to accommodate the increased demands on nurses in the changing health-care system. METHODS: This study used a mixed-methods approach including a literature review, an online survey with health-care consumers, expert panel interviews, and an analysis of strengths, weaknesses, opportunities, and threats to develop the strategic plans and framework. RESULTS: The vision of the strategic framework involved improving health and quality of life, and its mission was to elevate the status of Korea's nursing sector as a key health-care profession through high-quality and innovative nursing education, research, and practice. The five values in accordance with the mission and vision were innovation, creation, collaboration, excellence, and authenticity. Three strategic goals, namely, education, research, and practice, were identified, and 31 related strategic tasks were developed. CONCLUSION: In response to the rising social demand for a paradigm shift in nursing care services, there is a need for advancements in nursing education, research, and practice in Korea. This study provide some recommendations to achieve these aims.

Factors Related to Intensive Care Unit Nurses' Patient Centered Communication Competency / 중환자간호학회지

PURPOSE: This study aimed to provide primary data for developing a program to enhance communication competence by identifying the patient-centered communication competency level of Intensive Care Unit (ICU) nurses and the related factors.METHOD: Data were collected from August 28th to October 8th, 2015, from 199 ICU nurses working in 30 tertiary hospitals. The study questionnaire included items assessing the patient-centered communication competency of ICU nurses, nursing organizational culture, types of communication, the Teamwork Measurement Tool, the Perceived Nursing Work Environment tool, and the Wong & Law Emotional Intelligence Scale. The collected data were analyzed using descriptive statistics, a correlation test, and a multiple regression.RESULTS: The ICU nurses' mean score on patient-centered communication competency was 3.97 points. The factors influencing the patient-centered communication competency level of ICU nurses were professionalism (p =.002), innovation-oriented organizational culture (p =.015), and emotional intelligence (p < .001). These variables explained 42.2% of the total variance in the patient-centered communication competency of ICU nurses.CONCLUSION: These findings suggest the need for developing a patient-centered communication competency improvement program that focuses on improving ICU nurses' professionalism and emotional intelligence, and facilitates the creation of an innovation-oriented organizational culture.

Corrigendum: Health Communication Style, Competence, and Satisfaction of Hospital Outpatients / 의료커뮤니케이션

This correction is being published to revise the Introduction and Method of the article.

Effect of Nurses' Perception of Patient Safety Culture on Reporting of Patient Safety Events / 간호행정학회지

PURPOSE: This study was done to examine factors influencing nurses' perception of patient safety culture in reporting of patient safety events. METHODS: Structured questionnaires were used to collect data from 305 nurses who were involved in direct patient care. Data were analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation coefficients and multiple linear regressions with SPSS/WIN version 24.0. RESULTS: Patient safety events were reported as follows: 4.60±0.63 for harmful incidents, 4.02±0.82 for no harm incidents, and 3.59±0.97 for near misses. Patient safety event reporting was significantly positively correlated with patient safety culture. Regression analysis showed, factors influencing reports of harmful incidents were ‘feedback and communication about error’, ‘supervisor/manager expectations’ and ‘carrier of hospital’. Factors influencing reports of no harm incidents were ‘feedback and communication about error’. Factors influencing reports on near-misses were ‘teamwork across units’, ‘overall perceptions of safety’, and ‘feedback and communication about error’. CONCLUSION: Findings show that reports of near misses are relatively low and need to be strengthened. These results provide evidence that reporting on patient safety events would be enhanced through improved patient safety culture. Hospital managers could identify factors that affect reporting of each patient safety event and use it to develop intervention programs for risk management.

Effectiveness of Telephone-Delivered Cognitive Behavioral Therapy for Depression in Patients with Chronic Physical Health Conditions: A Meta-Analysis / 정신간호학회지

PURPOSE: This study was a systematic review and meta-analysis of randomized controlled trials of telephonedelivered cognitive behavioral therapy (T-CBT) among patients with chronic physical health conditions and has been conducted to evaluate its effectiveness on depression. METHODS: A literature search was conducted of electronic databases published from the journal inception to December 2017. Thirteen of 1,609 studies met the inclusion criteria. Selected studies were rated for quality assessment by two independent reviewers using Cochrane's collaboration tool. RESULTS: Meta-analysis showed that T-CBT significantly reduces depression. The effect size of T-CBT was small (d=−0.20, 95% CI: −0.29~−0.10, Z=4.09, p < .001) and showed low heterogeneity (I2=0.0%). The effect of T-CBT at the 12-month follow-up was not sustained (d=−0.19, 95% CI:−0.42~0.03, Z=1.66, p=.10). CONCLUSION: The current findings indicate that T-CBT for patients with chronic physical health conditions has a significant post-treatment effect on depression. T-CBT can be a useful intervention reducing barriers to treatment and improving depression in patients with chronic physical health conditions.

A Systematic Review on Nurse-Led Transitional Care Programs for Discharged Patients from Hospital to Home / 임상간호연구

PURPOSE: This study was to systematically review the contents and effects of nurse-led transitional care programs for discharged patients from hospital to home. METHODS: Randomized controlled trials published between 2005 and 2015 were searched in Pubmed, Embase, Cochrane(Central Register of Controlled Trials) and CINAHL. Data were analyzed using Cochrane Review Manager(Revman) software 5.3. RESULTS: Nine studies were selected and analyzed. Patient assessment, education and discharge planning were included in pre-discharge phase. Referring, communication and care planning were performed by nurses in transition phase. Home and phone visits, monitoring and multidisciplinary advices were included in post-discharge phase. Various outcome measures such as hospital utilization(30 days readmission and emergency department visit), quality of life, and cost were used to identify effectiveness of nurse-led transitional care programs. 30 days readmission(OR=.73, 95% CI 0.54, 0.98; p=.03) and emergency department visit(OR=.67, 95% CI 0.50, 0.88; p=.005) were statistically significant in meta-analysis. However, participant blinding was not done in seven studies which put at the risk of performance bias. CONCLUSION: The results indicated that nurse-led transitional care program is effective in reducing unnecessary hospital utilization. Nevertheless, small sample size and risk at performance bias are the limitation of this study. Thus, we suggest that well-designed randomized controlled trials need to be conducted.

The Clusters of Fever-Related Symptoms among Patients at the Emergency Room / 임상간호연구

PURPOSE: The purpose of this study was to investigate symptoms experienced by patients who reported fever at the emergency room (ER) and to identify any existing cluster of symptom related to fever. METHODS: The study used a retrospective and descriptive design with secondary data analysis. Data were abstracted from 665medical records of patients with fever who visited ER from September 1, 2015 to August 31, 2016 at a tertiary hospital. RESULTS: The most frequently reported symptoms included cold (43.9%), myalgia (24.1%), headache (16.2%), general weakness (15.3%), respiratory symptoms (12.3%), gastrointestinal (GI) symptoms (12.0%), mental change (4.5%), sweating(1.8%), and warmth (0.9%). Analysis of the symptoms related to fever revealed seven symptom clusters; Cluster 1 (n=190) included cold (100%) and myalgia (28.9%); Cluster 2 (n=37), headache (100%) and myalgia (32.4%); Cluster 3 (n=33), GI symptoms (100%), general weakness, headache, and cold; Cluster 4 (n=34), cold (100%), myalgia, headache, and respiratory symptoms; Cluster 5 (n=241), respiratory symptoms (10.8%); Cluster 6 (n=76): myalgia (75.0%) and general weakness, and Cluster 7 (n=54), cold (87.0%), general weakness, and respiratory symptoms. CONCLUSION: The results of this comprehensive symptom assessment are hoped to be helpful in developing better symptom management for ER patients with fever than before. Further research is warranted to verify the symptom clusters of this study in different clinical settings.

Development and Evaluation of an Evidence-based Nursing Protocol for Postoperative Nausea and Vomiting

PURPOSE: Postoperative nausea and vomiting (PONV) is very common among postoperative orthopedic surgical patients with patient-controlled analgesia (PCA), especially for narcotics. Therefore, the purpose of this study was to investigate the effects of an evidence-based PONV management protocol on nursing and patient outcomes. METHODS: A methodological study was conducted to develop PONV protocol and a quasi-experimental study to evaluate the effectiveness of protocol. The preliminary PONV protocol was drawn by conducting a systematic review and by reviewing clinical guidelines and best practice recommendations. Validation of the content was done by expert clinicians, and the clinical applicability was evaluated by staff nurses and patients. The effect was evaluated in clinical outcomes associated with PONV and nursing outcomes. RESULTS: In the experimental group, the occurrence of vomiting (z=2.147) was significantly decreased, the maintenance PCA (χ²=4.212) and the satisfaction of patients (z=5.007) were significantly higher. In the outcomes of nurses, the PONV knowledge of nursing care (z=3.791), awareness (z=2.982) and self-efficacy (z=2.745) were higher in the experimental group. The attitude towards evidence-based nursing practice (z=2.446) was significantly positive. CONCLUSION: The results show that an evidence-based approach to the implementation of PONV care is effective in improving patient clinical outcomes and quality of care.

Mixed Method Research Investigating Evidence-Based Practice Self-efficacy, Course Needs, Barriers, and Facilitators: From the Academic Faculty and Clinical Nurse Preceptors

PURPOSE: The current challenges faced by nurses in providing high quality and evidence-based practice (EBP) supported care require profound changes in nursing education. To understand the changes needed to strengthen EBP education, the researchers examined EBP self-efficacy, course needs, barriers, and facilitators for academic faculty and clinical nurse preceptors to teach EBP in undergraduate nursing curricula. METHODS: For this study, mixed-method approach was used with survey data collected from 73 academic faculty members from 54 universities. Further, 17 clinical nurse preceptors in three academic hospitals provided qualitative data for exploration of barriers and facilitators to teaching EBP. Data analysis used SPSS/WIN 21.0 and content analysis. RESULTS: Quantitative data showed that although the overall level of self-efficacy among faculty was moderate, the implementation levels were relatively low. Most faculty members agreed with the need to integrate EBP courses into undergraduate nursing curricula. The qualitative data showed that the barriers to teaching EBP were lack of knowledge, skill, and initial investment for teaching EBP; hierarchical, rules-oriented nursing culture; potential learner overloads in processing EBP; limited research dissemination and application. Facilitators were identified as the importance of EBP to the profession of nursing; collaboration in schools and hospitals; and continuing education in teaching/utilizing EBP. CONCLUSION: The findings indicate that for successful integration of EBP ni nursing education there is a need for faculty training and integrated EBP courses.

Psychometric Properties of Korean Version of Self-Efficacy of Evidence-Based Practice Scale

PURPOSE: This study is to evaluate the psychometric properties of the Korean version of the Self-Efficacy of Evidence-Based Practice (SE-EBP) scale, which was originally developed by Chang and Crowe. The beta-version of the SE-EBP is a modified version of the original SE-EBP, which measures the clinical nurses' confidence in finding, appraising, and implementing evidence into practice. Although the original SE-EBP has been validated, no study has been conducted to validate the Korean version of SE-EBP. METHODS: The original scale was translated into Korean through a process of forward and back translation of the original scale. After getting confirmation of the equivalence of the Korean forward translation by the original author, exploratory factor analysis and confirmatory factor analysis of data from 212 clinical nurses were used to test construct validity. Internal consistency was examined using Cronbach α coefficients. For the statistical analysis, STATA version 13.0 software program was used. RESULTS: Exploratory factor analysis of the 28 items revealed three factors with eigenvalues above 1, accounting for 60.2% of the total variance. Confirmatory factor analysis showed good fit of the three-factor structure which was statistically significant (χ2 = 718.61, df = 330, p < .01). For internal consistency, Cronbach a coefficient for the total scalewas .95, and itwas greater than .80 for each of the three subscales. CONCLUSIONS: The Korean version of SE-EBP scale showed evidence of adequate construct validity and reliability. This study might have contributed to a wider application of the SE-EBP scale, but further studies are needed to provide more evidence on the structure of the scale.

Synthesizing Quantitative Evidence for Evidence-based Nursing: Systematic Review

As evidence-based practice has become an important issue in healthcare settings, the educational needs for knowledge and skills for the generation and utilization of healthcare evidence are increasing. Systematic review (SR), a way of evidence generation, is a synthesis of primary scientific evidence, which summarizes the best evidence on a specific clinical question using a transparent, a priori protocol driven approach. SR methodology requires a critical appraisal of primary studies, data extraction in a reliable and repeatable way, and examination for validity of the results. SRs are considered hierarchically as the highest form of evidence as they are a systematic search, identification, and summarization of the available evidence to answer a focused clinical question with particular attention to the methodological quality of studies or the credibility of opinion and text. The purpose of this paper is to introduce an overview of the fundamental knowledge, principals and processes in SR. The focus of this paper is on SR especially for the synthesis of quantitative data from primary research studies that examines the effectiveness of healthcare interventions. To activate evidence-based nursing care in various healthcare settings, the best and available scientific evidence are essential components. This paper will include some examples to promote understandings.

Factors Related to N-Terminal Pro-B-Type Natriuretic Peptide as a Biomarker for Heart Failure

PURPOSE: This study aimed to examine the relationships between the N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels with the sociodemographic and clinical factors, self-care behaviors, and the physical symptom experiences in patients with heart failure. METHODS: This cross-sectional study utilized a convenience sample of adult outpatients and inpatients who attended a cardiology department in a tertiary hospital in Seoul, Korea. The data from 154 patients with heart failure were collected using a questionnaire, and their clinical data were extracted from their electronic medical records. RESULTS: Compared with the patients with high NT-proBNP levels, those with low NT-proBNP levels had significantly lower physical symptom experiences scores. Patients with low- and mid-NT-proBNP levels were more likely to be employed compared with those with high NT-proBNP levels. Patients with low NT-proBNP levels had higher left ventricular ejection fractions, and were less likely to have arrhythmias and comorbidities. CONCLUSION: The results from this study showed that patients with more severe heart failure had higher physical symptom experiences scores; hence, individualizing treatment approaches based on heart failure severity is necessary.

Development of Agenda Priority for Nursing Service Research and Development / 간호행정학회지

PURPOSE: The purpose of this study was to suggest agenda priorities for nursing service R&D (Research and Development) related policies development. METHODS: Two steps in developing the agendas and priorities were performed in this descriptive study. First, nursing service R&D agendas were extracted through needs assessment of nursing researchers and practitioners. Then, the priority of agendas was set by Analytic Hierarchy Process by ten experts who were representatives of nursing and other healthcare professionals. RESULTS: Six core areas and forty-six nursing service R&D agendas were developed. The priority of agendas was different according to the evaluation criteria depending on weight value of nursing services. CONCLUSION: In order to select and promote nursing service R&D projects within national healthcare policy, nursing service R&D policy should be proposed with consideration to the importance of the criteria in reflecting characteristics of nursing care. By strengthening R&D capabilities for quality improvement and sensitive awareness of national directions for healthcare R&D policies, nursing service R&D can be appropriately promoted.

Current Status of Home Visit Programs: Activities and Barriers of Home Care Nursing Services

PURPOSE: The purpose of this study was to examine the current status of home care nursing services provided by community health nurses and to identify barriers to the services. METHODS: A cross-sectional survey was conducted with three types of community health care nurses. Participants were 257 nurses, 46 of whom were hospital based home care nurses, 176 were community based visiting nurses, and 35 were long term care insurance based visiting nurses. A structured questionnaire on 7 domains of home care nursing services with a 4-point Likert scale was used to measure activities and barriers to care. Data were analyzed using SPSS WIN 21.0 program. RESULTS: Hospital based home care nurses showed a high level of service performance activity in the domain of clinical laboratory tests, medications and injections, therapeutic nursing, and education. Community based visiting nurses had a high level of service performance in the reference domain. Long term care insurance based visiting nurses showed a high level of performance in the service domains of fundamental nursing and counseling. CONCLUSION: The results show that although health care service provided by the three types of community health nurse overlapped, the focus of the service is differentiated. Therefore, these results suggest that existing home care services will need to be utilized efficiently in the development of a new nursing care service for patients living in the community after hospital discharge.

Effectiveness of Deep Breathing Exercise for Postoperative Pulmonary Complications Prevention: A Systematic Review / 기본간호학회지

PURPOSE: This study was done to evaluate effectiveness of deep breathing exercise as a postoperative intervention to prevent pulmonary complications. METHODS: A search of databases from 1990 to 2012 was done including MEDLINE, EMBASE, CINAHL, Cochrane Library and eight Korean databases. Ten studies met eligibility criteria. Researchers trained in systematic review, independently assessed the methodological quality of selected studies using the Cochrane's risk of bias tool. Data were analyzed using RevMan 5.2 program. RESULTS: Among ten RCTs in four studies, deep breathing exercise was compared with an instrument using interventions such as incentive spirometry, in the other four studies deep breathing exercise was compared with non-intervention, and in last two studies bundles of interventions including coughing and early ambulation were assessed. A significant difference was found between deep breathing exercise group and non-intervention group. The odds ratio (OR) of occurrence of pulmonary complications for deep breathing exercise versus non-intervention was 0.30. However, there was no significant difference between deep breathing exercise group and incentive spirometry group (OR=1.22). CONCLUSION: Deep breathing exercise is vital to improving cost-effectiveness and efficiency of patient care in preventing postoperative pulmonary complications. For evidence-based nursing, standardized guidelines for deep breathing in postoperative care should be further studied.

Impact of Methicillin-Resistance on Mortality in Children and Neonates with Staphylococcus aureus Bacteremia: A Meta-analysis / 감염과화학요법

BACKGROUND: Staphylococcus aureus bacteremia (SAB) is the Staphylococcal infections in blood, one of the most common and fatal bacterial infectious diseases worldwide in adults as well as children or neonates. Recently, some studies have yielded inconsistent findings about the association between methicillin-resistance and mortality in patients with SAB. We performed a meta-analysis to assess the impact of methicillin-resistance on mortality in children or neonates with S. aureus bacteremia. MATERIALS AND METHODS: We searched using electronic databases such as Ovid-Medline, EMBASE-Medline, and Cochrane Library, as well as five local databases for published studies during the period of 1 January 2000 to 15 September 2011. Two reviewers independently selected articles in accordance with predetermined criteria and extracted prespecified data based on standardized forms. All cohort studies, which compared in-hospital mortality or SAB-related mortality in children and neonates with methicillin-resistant S. aureus (MRSA) infection to those with methicillin-susceptible S. aureus (MSSA), were included. We conducted meta-analysis using the fixed-effect model to obtain pooled estimates of effect. RESULTS: Of 2,841 screened studies, seven cohort studies were finally selected for analysis. In children or neonates, MRSA bacteremia was associated with a higher mortality compared with MSSA bacteremia (pooled odds ratio [OR] 2.33, P = 0.0008, 95% confidence interval [CI] 1.42 to 3.82, I2 = 0%). Four studies reported SAB-related mortality, the pooled OR of these studies was 2.03 (P = 0.29, 95% CI 0.55 to 7.53, I2 = 0%). A significant increase in mortality associated with methicillin resistance was found in the subgroup analyses of the studies with only neonates (OR: 2.66, 95% CI: 1.46 to 4.85, P = 0.001), prospectively design ones (OR: 3.20, 95% CI: 1.66 to 6.15, P = 0.0005,), the larger studies (OR: 2.89, 95% CI: 1.62 to 5.16, P = 0.0003) and the higher quality studies (OR: 2.76, 95% CI: 1.50 to 5.06, P = 0.001). CONCLUSIONS: MRSA bacteremia is associated with increased mortality compared with MSSA bacteremia in children or neonates. Due to limited studies for mortality in children or neonates with SAB, further research is needed to evaluate the impact of methicillin resistance on mortality in those populations.

Healthcare Professional's Knowledge, Perception and Performance on Early Enteral Nutrition for Critically Ill Patients / 대한구급학회지

BACKGROUND: Proper nutritional supplement is one of the fundamental management domains for critical ill patients. While it shows positive effect on processing and prognosis of critical ill patients, early enteral nutrition is overlooked. This study explored healthcare professional's level of knowledge perception and performance on early enteral nutrition for critically ill patients. Data was collected from a convenient sample of 319 registered doctors, nurses and nutritionists in ICU at seven university hospitals. METHODS: A cross-sectional survey design was used. The participants were assessed by questionnaires, specifically designed for the study and verified for the content validity by professional reviewers related with critical ill patients. RESULTS: While the level of the perception of early enteral nutrition is high, the level of knowledge and performance are relatively low. The nurses showed a statistically significant difference on the level of knowledge, by their educational backgrounds and clinical experiences. Regarding the hospital support system, the doctors showed a significant difference on the level of perception and performance, while the nurses only showed that difference on the level of performance. It was shown that with higher the level of knowledge regarding the early enteral nutrition, the higher the level of performance. Further, the higher the level of perception, the higher the level of performance was observed. The hospital support system and the perception of the healthcare professionals are two most influential factors to affect the performance of the healthcare professionals related with the early enteral nutrition for the critically ill patients. CONCLUSION: To perform the proper early enteral nutrition, the hospital support system and the level of the healthcare professionals' perception, are two most important factors. Therefore, the efforts to build the hospital support system along with the educational provisions are needed.

Level of Beliefs, Knowledge and Performance for Evidence-Based Practice among Nurses Experienced in Preceptor Role / 간호행정학회지

PURPOSE: As Evidence-Based Practice (EBP) has increasingly been proven as a means of cost-effective and higher-quality healthcare, its successful implementing are challenging. This study done to identify EBP beliefs, knowledge and performance among nurses experienced as a preceptor. METHOD: A descriptive cross-sectional survey was conducted with a convenience sample of 249 preceptor nurses working in 9 general hospitals in Korea. Reliable and valid questionnaires (EBP beliefs scale, Evidence Based Practice Questionnaire, Research-related activities) were used and the data were analyzed using SPSS win 17.0. RESULT: Perceived beliefs on EBP were relatively positive (mean score 3.57 out of 5), and the level of knowledge was moderate (4.21 out of 7). However, performance of EBP was low (3.82 out of 7). Regularity in reading research journals and searching evidences using core web-database were rarely conducted. Statistically significant correlations were found between beliefs, knowledge and performance of EBP (all p<.05). CONCLUSIONS: This result indicates that education and training programs to facilitate EBP performance are needed among preceptor nurses.

Level and Correlation Factors of Uncertainty in Members of Families of a Patient with Mental Illness / 정신간호학회지

PURPOSE: The purpose of this study was to measure the level of uncertainty, credible authority, severity of illness and event familiarity in members of families where there is a patient with a mental illness and to examine the relationships among these variables. METHODS: Research data were collected from November 23 to December 7, 2010. Participants in the study were 96 family members who visited patients in a closed ward or out-patient department of one hospital in Goyang City. Self-report questionnaires were analyzed using the SPSS 18.0 Program. RESULTS: Mean scores were 79.8+/-11.23 for level of uncertainty in family members, 15.5+/-2.17 for credible authority, 13.3+/-2.02 for severity of illness, and 14.5+/-2.43 for event familiarity. Uncertainty in family members was significantly related to credible authority (r=-.52, p<.001), event familiarity (r=-.41, p<.001) and severity of illness (r=.22, p<.031). CONCLUSION: The results of the study indicate that credible authority, severity of the illness and event familiarity are major factors perceived uncertainty in members of families of these patients. This outcome suggests the need for a new trials in nursing interventions considering the effects of these variables.

Female College Students' Knowledge, Self-efficacy and Health Behaviors related to Bone Health / 여성건강간호학회지

PURPOSE: This study described female college students' knowledge, self-efficacy and health behaviors related to bone health. METHODS: A descriptive cross-sectional survey design was used. A total of 214 students were conveniently recruited from a school of nursing in Korea. Participants (mean age=21.2, SD=1.9 years) bone mineral density (BMD) was measured using dual energy x-ray absorptionmetry. Participants also completed a questionnaire consisting of knowledge test, self-efficacy scale and health behaviors related to bone health. Data were analyzed using SPSS/WIN 17.0 program. RESULTS: The mean BMD at left femoral neck site was 0.86 g/cm2 and 6.1~12.6%. Results showed that participants were below the expected range of BMD. Level of knowledge (correct rate=54%) and self-efficacy were moderate (mean 54.8 out of 84). More than 84% of subjects drank alcohol more than once a month and 58.4% did participate in regular exercise. Only 7.9% participants took calcium and vitamin-D rich foods every day. There were significant positive correlations between knowledge and self-efficacy (r=.17), health behaviors (r=.14) and self-efficacy and health behaviors (r=.28, all p<.05). CONCLUSION: These results suggest that health care professionals need to provide effective interventions for young women in order to enhance knowledge, self-efficacy and health behaviors related to bone health.