Long-term Outcomes of Endoscopic Intraductal Radiofrequency Ablation for Ampullary Adenoma with Intraductal Extension after Endoscopic Snare Papillectomy

Background/Aims@#There are limitations in treating ampullary adenomas with intraductal extension using conventional endoscopic modalities. Endoscopic intraductal radiofrequency ablation (ID-RFA) may be useful for treating intraductal (common bile duct [CBD] and/or pancreatic duct [PD]) extensions of ampullary adenomas, but long-term data are lacking. We thus evaluated the long-term outcomes of endoscopic ID-RFA for managing ampullary adenomas with intraductal extension. @*Methods@#Prospectively collected endoscopic ID-RFA database at Asan Medical Center was reviewed to identify consecutive patients with ampullary adenoma who underwent ID-RFA for intraductal extension between January 2018 and August 2021. Technical success, short-term and long-term clinical success, and adverse events were evaluated. @*Results@#A total of 29 patients (14 CBD, 1 PD, and 14 CBD and PD) were analyzed. All patients had undergone endoscopic snare papillectomy prior to ID-RFA. A median of one session of IDRFA (range, 1 to 3) for residual or relapsed intraductal extension of ampullary adenoma were successfully performed (technical success=100%). Both biliary and pancreatic stenting were routinely performed after ID-RFA to prevent ductal stricture. After a median follow-up of 776 days (interquartile range, 470 to 984 days), the short-term and long-term clinical success rates were 93% and 76%, respectively. Seven patients experienced procedural adverse events and three patients developed ductal strictures. @*Conclusions@#Endoscopic ID-RFA showed good long-term outcomes in treating residual or relapsed ampullary adenomas with intraductal extension. Repeated ID-RFA may be considered as an option for managing recurrence. Further studies are needed to standardize the procedure.

The Nurse Staffing in Intensive Care Units based on Nursing Care Needs: A Multicenter Study / 중환자간호학회지

Purpose@#: The aim of this study was to propose appropriate nurse staffing of adult intensive care units considering patients’ nursing care needs according to the Workload Management System for Critical Care Nurses (WMSCN). @*Methods@#: In a cross-sectional survey conducted in September 2017, 1,786 patients’ WMSCN scores, surveys from 2,145 nurses, and administrative data from 118 units in 41 hospitals were analyzed. The means (standard deviations) of the aforementioned scores and nursing hours per patient day were presented. Nurse-to-patient ratios and nurse-to bed ratios for staffing to meet patients’ nursing care needs were calculated. @*Results@#: The mean WMSCN scores were 109.50±17.17 in tertiary hospitals and 96.38±19.26 in general hospitals. Nursing hours per patient day were 12.47±2.80 in tertiary hospitals and 11.01±2.45 in general hospitals. Nursing hours per patient day correlated with WMSCN scores. Nurse-to-bed ratios required for the provision of ICU nursing care ranged from 1: 0.36 to 1: 0.48. @*Conclusion@#: Our findings provide evidence that current ICU nurse staffing is insufficient for meeting patients’ nursing care needs. We suggest adjusting the legal standards for adequate nurse staffing considering these needs.

Analysis of the Status of Nursing Shifts and Nurses’ Perceptions of Work Schedules in General Wards Based on the Government Guidelines for Night Shift Work / 임상간호연구

Purpose@#To analyze nurses’ shift work according to the government guidelines for night work and their perceptions of their work schedules. @*Methods@#The study sample included 487 nurses who provided information on their schedules, including the normal working hours of each shift, and overtime per shift during September 2020. Nurses’ perceptions were measured in terms of satisfaction, appropriateness for work-life balance, and fairness to their work schedule. @*Results@#One-third of the respondents worked more than 40 hours per week. The average overtime hour was 1.14 hours per shift. Unsocial hours (8 pm to 6 am on weekdays, midnight to midnight on weekends and public holidays) accounted for 56.4% of all working hours. During their last night shift, on average, nurses worked 9.62 hours and had a break of 39 minutes, although 20.5% reported no break. Sixty-eight percent of nurses had at least one between-shift break shorter than 48 hours after a consecutive night shifts. Fifty-seven percent were satisfied with their schedule. One-third perceived their schedule as appropriate for work-life balance, and two-thirds perceived that days off on weekends and nights were fairly distributed within the unit. Working and overtime hours had an inverse relationship with all three aspects of nurses’ perceptions. A higher proportion of unsocial hours and having no breaks during the night shift were associated with lower perceptions of fairness. @*Conclusion@#Reducing working hours, ensuring breaks during night shifts, and increasing rewards for unsocial hours are required to improve nurses’ perceptions and reduce turnover due to shift work.

The Nurse Staffing in Intensive Care Units based on Nursing Care Needs: A Multicenter Study / 중환자간호학회지

Purpose@#: The aim of this study was to propose appropriate nurse staffing of adult intensive care units considering patients’ nursing care needs according to the Workload Management System for Critical Care Nurses (WMSCN). @*Methods@#: In a cross-sectional survey conducted in September 2017, 1,786 patients’ WMSCN scores, surveys from 2,145 nurses, and administrative data from 118 units in 41 hospitals were analyzed. The means (standard deviations) of the aforementioned scores and nursing hours per patient day were presented. Nurse-to-patient ratios and nurse-to bed ratios for staffing to meet patients’ nursing care needs were calculated. @*Results@#: The mean WMSCN scores were 109.50±17.17 in tertiary hospitals and 96.38±19.26 in general hospitals. Nursing hours per patient day were 12.47±2.80 in tertiary hospitals and 11.01±2.45 in general hospitals. Nursing hours per patient day correlated with WMSCN scores. Nurse-to-bed ratios required for the provision of ICU nursing care ranged from 1: 0.36 to 1: 0.48. @*Conclusion@#: Our findings provide evidence that current ICU nurse staffing is insufficient for meeting patients’ nursing care needs. We suggest adjusting the legal standards for adequate nurse staffing considering these needs.

Analysis of the Status of Nursing Shifts and Nurses’ Perceptions of Work Schedules in General Wards Based on the Government Guidelines for Night Shift Work / 임상간호연구

Purpose@#To analyze nurses’ shift work according to the government guidelines for night work and their perceptions of their work schedules. @*Methods@#The study sample included 487 nurses who provided information on their schedules, including the normal working hours of each shift, and overtime per shift during September 2020. Nurses’ perceptions were measured in terms of satisfaction, appropriateness for work-life balance, and fairness to their work schedule. @*Results@#One-third of the respondents worked more than 40 hours per week. The average overtime hour was 1.14 hours per shift. Unsocial hours (8 pm to 6 am on weekdays, midnight to midnight on weekends and public holidays) accounted for 56.4% of all working hours. During their last night shift, on average, nurses worked 9.62 hours and had a break of 39 minutes, although 20.5% reported no break. Sixty-eight percent of nurses had at least one between-shift break shorter than 48 hours after a consecutive night shifts. Fifty-seven percent were satisfied with their schedule. One-third perceived their schedule as appropriate for work-life balance, and two-thirds perceived that days off on weekends and nights were fairly distributed within the unit. Working and overtime hours had an inverse relationship with all three aspects of nurses’ perceptions. A higher proportion of unsocial hours and having no breaks during the night shift were associated with lower perceptions of fairness. @*Conclusion@#Reducing working hours, ensuring breaks during night shifts, and increasing rewards for unsocial hours are required to improve nurses’ perceptions and reduce turnover due to shift work.

Infant Mother’s Experiences with the Sustained Nurse Home-Visiting Program

Purpose@#The purpose of this study was to understand the experiences of mothers of infants who received sustained nurse home visiting services. The program of sustained home visit by nurses (Seoul Maternal Early Childhood Sustained Home-Visiting Program) is an intervention program. Its effectiveness has been verified in Australia, where services are provided to families in a vulnerable families during the period from prenatal period until the newborn is 2 years old. @*Methods@#The study protocol used qualitative approaches. Eleven mothers of infants who received nursing services in December 2015 were invited for an in-depth interview. The data collected were subjected to directed content analysis. @*Results@#The following 4 themes were identified from the analysis: (1) reduction in suspicion and increased feeling of benefit from the visiting service, (2) emotional support to the parents and use of community resources, (3) reliance on friendly nurses, and (4) gaining confidence about parenting and motherhood. @*Conclusion@#Sustained nursing home visiting services can be applied effectively in South Korea. The concrete narrations and descriptions of the experiences of mothers in this study can be used as a base for education, practice, and research.

Nursing Hours and Nurse Staffing according to Korean Triage Acuity Scale and Patient Dependency / 임상간호연구

Purpose@#The purpose of this study was to analyze nurse staffing according to patients' acuity and dependency by measuring nursing hours. @*Methods@#The study sample included patients who visited the adult emergency departments (EDs) of three tertiary referral hospitals and nurses who worked on shifts for 48 hours from October 24 to 26, 2019. Hourly patient census and nurse staffing were analyzed. Patient acuity was measured using the Korean Triage and Acuity Scale (KTAS), ranging from Level 1 (highest) to Level 5 (lowest). Patient dependency was measured using six items (e.g., clinical attention and communication) and classified into four groups. Nursing activities were observed every 10 minutes and nursing hours per patient and nurse staffing were analyzed according to acuity and dependency. @*Results@#Nurse-to-patient ratio ranged from 1:1.8 to 1:4.2 during the 48 hours of observation. The average work hours of nurses, excluding breaks and meals, was 8.57 hours; 42.5% of which was spent providing direct care. Higher acuity and dependency were associated with higher nursing hours and staffing level. Patients with KTAS Level 1 were provided 74.3 minutes per hour, 5.02 times higher than Level 5 (14.8 minutes). Patients in the highest dependency group were provided 87.4 minutes per hour, 5.75 times higher than the lowest group (15.2 minutes). Newly arrived patients received more nursing hours than continuously stayed patients within the same KTAS Levels. @*Conclusion@#Large variations were found in hourly patient census, acuity, and dependency. Nurse staffing in EDs should be determined based on patient acuity and dependency.

The Relationship between Average Length of Stay and Nurse Staffing in General Hospitals from 1996 to 2016 / 간호행정학회지

Purpose@#To analyze the effects of average length of stay (ALOS) on RN staffing. @*Methods@#Public data of patient surveys collected 8 times between 1996 and 2016 were analyzed. The sample included 2,408,669 discharged patients from 2,266 general hospitals. The ALOS for each hospital was computed by dividing the sum of inpatient days by the number of discharges. RN staffing was defined as the number of RNs per 100 inpatients. ALOS was transformed into base-2 logarithmic values for regression analysis. @*Results@#ALOS decreased from 13.3 to 9.6 days.Large hospitals in the capital region had the greatest reduction, from 15.7 to 7.4 days. RN staffing increased from 32.7 to 54.8 RNs per 100 patients. ALOS had an inverse relationship with RN staffing. Controlling for other factors, a 50% reduction in ALOS was associated with increases in RN staffing by 12.18 and 13.72 RNs per 100 inpatients in large hospitals in the capital region and elsewhere, respectively. @*Conclusion@#Hospitals may have to increase staffing to respond to the increased workload resulting from the shortened ALOS. It remains uncertain whether such increases in staffing were sufficient for the increased workload. Changes in ALOS should be taken into account when determining appropriate staffing.

Nursing Hours and Nurse Staffing according to Korean Triage Acuity Scale and Patient Dependency / 임상간호연구

Purpose@#The purpose of this study was to analyze nurse staffing according to patients' acuity and dependency by measuring nursing hours. @*Methods@#The study sample included patients who visited the adult emergency departments (EDs) of three tertiary referral hospitals and nurses who worked on shifts for 48 hours from October 24 to 26, 2019. Hourly patient census and nurse staffing were analyzed. Patient acuity was measured using the Korean Triage and Acuity Scale (KTAS), ranging from Level 1 (highest) to Level 5 (lowest). Patient dependency was measured using six items (e.g., clinical attention and communication) and classified into four groups. Nursing activities were observed every 10 minutes and nursing hours per patient and nurse staffing were analyzed according to acuity and dependency. @*Results@#Nurse-to-patient ratio ranged from 1:1.8 to 1:4.2 during the 48 hours of observation. The average work hours of nurses, excluding breaks and meals, was 8.57 hours; 42.5% of which was spent providing direct care. Higher acuity and dependency were associated with higher nursing hours and staffing level. Patients with KTAS Level 1 were provided 74.3 minutes per hour, 5.02 times higher than Level 5 (14.8 minutes). Patients in the highest dependency group were provided 87.4 minutes per hour, 5.75 times higher than the lowest group (15.2 minutes). Newly arrived patients received more nursing hours than continuously stayed patients within the same KTAS Levels. @*Conclusion@#Large variations were found in hourly patient census, acuity, and dependency. Nurse staffing in EDs should be determined based on patient acuity and dependency.

The Relationship between Average Length of Stay and Nurse Staffing in General Hospitals from 1996 to 2016 / 간호행정학회지

Purpose@#To analyze the effects of average length of stay (ALOS) on RN staffing. @*Methods@#Public data of patient surveys collected 8 times between 1996 and 2016 were analyzed. The sample included 2,408,669 discharged patients from 2,266 general hospitals. The ALOS for each hospital was computed by dividing the sum of inpatient days by the number of discharges. RN staffing was defined as the number of RNs per 100 inpatients. ALOS was transformed into base-2 logarithmic values for regression analysis. @*Results@#ALOS decreased from 13.3 to 9.6 days.Large hospitals in the capital region had the greatest reduction, from 15.7 to 7.4 days. RN staffing increased from 32.7 to 54.8 RNs per 100 patients. ALOS had an inverse relationship with RN staffing. Controlling for other factors, a 50% reduction in ALOS was associated with increases in RN staffing by 12.18 and 13.72 RNs per 100 inpatients in large hospitals in the capital region and elsewhere, respectively. @*Conclusion@#Hospitals may have to increase staffing to respond to the increased workload resulting from the shortened ALOS. It remains uncertain whether such increases in staffing were sufficient for the increased workload. Changes in ALOS should be taken into account when determining appropriate staffing.

Estimation of Expected Nursing Hours Based on Patients’ Nursing Care Needs and a Comparison with Actual Nursing Hours in Comprehensive Nursing Care Wards / 간호행정학회지

Purpose@#To compare actual versus expected nursing hours based on patients’ nursing care needs. @*Methods@#The nursing care needs of 898 inpatients in 20 wards at 11 hospitals were measured using the 14 items developed by the National Health Insurance Service (NHIS). Nursing activities from 474 nursing personnel were observed every 10 minutes for 24 hours. Actual hours indicated direct care hours per patient day provided by registered nurses according to 3 types: (1) standard hours based on staffing standards approved by the NHIS, (2) scheduled hours excluding overtime hours, and (3) observed hours including overtime. Expected hours were estimated from the linear mixed effect model including hospital type, nursing care need items and their interaction terms. @*Results@#Standard hours ranged from 0.92 to 2.15; scheduled hours from 0.88 to 1.95; observed hours from 1.00 to 2.40; expected hours from 0.88 to 2.33. Eight hospitals had standard hours not meeting the expected hours and 2 hospitals did observed hours not meeting the expected hours due to nurses’ overtime. In 3 hospitals, all types of actual hours exceeded the expected hours. @*Conclusion@#Staffing needs to be determined based on patients’ care needs and to be improved to minimize nurses’ overtime work.

Radiologic Results of Three-Dimensional Templating for Total Shoulder Arthroplasty

Background@#The purpose of this study was to evaluate the radiologic results of total shoulder arthroplasty using computerized three-dimensional (3D) templating in preoperative planning. @*Methods@#Ten patients who underwent total shoulder arthroplasty using 3D templating preoperatively were enrolled in this study. A specialized computer program was used to reconstruct the 3D images of the shoulder from the computed tomographic images. The 3D images of various sizes of prostheses were used as the template in surgical planning of the shoulder arthroplasty. The size of the glenoid, humeral head, and stem measured in 3D templating were compared with those used in actual operation. Anatomical parameters, such as humeral head size, radius of curvature, and greater tuberosity to humeral head distance of the replaced shoulder, were measured and compared with those of the contralateral normal shoulder. @*Results@#The agreement rates between the glenoid size, head size, head thickness, and stem size estimated preoperatively by 3D templating and those measured in operation were 100%, 100%, 100%, and 80%, respectively. The difference in humeral head size, radius of curvature, and greater tuberosity to humeral head distance between the replaced shoulder and contralateral shoulder was 1.31 mm, 0.87 mm, and 1.17 mm, respectively. @*Conclusions@#In total shoulder arthroplasty, 3D templating seems to enable accurate prediction of sizes of the prostheses to be inserted and thus replication of normal anatomy.

Determining Nurse Staffing By Classifying Patients Based on their Nursing Care Needs / 간호행정학회지

Relationship between Psychological Correlates and Empathy in Medical Students: A Cross-Sectional Study

OBJECTIVE: Empathy is important in the education of medical students. Many psychosocial variables are related to empathy. The aim of the study was to investigate the relationship between empathy and psychosocial factors such as burnout, personality, self-esteem, and resilience. METHODS: The participants completed a set of self-reporting questionnaires, including questions related to socio-demographic characteristics, the Korean edition of the Jefferson Scale of Empathy, student version (JSE-S-K), Maslach Burnout Inventory General Survey (MBI-GS), NEO Five-Factor Inventory (NEO-FFI), Rosenberg Self-esteem Scale (R-SES), and Connor-Davidson Resilience Scale (CD-RISC). Partial correlation and regression analyses were performed. RESULTS: In male students, there were positive correlations between JSE-S-K and R-SES (r=0.229, p=0.002); conscientiousness of the NEO-FFI (r=0.153, p=0.037) and negative correlations, specifically between JSE-S-K and depersonalization of MBI (r=-0.206, p=0.005). In female students, there was positive correlations between JSE-S-K and personal accomplishment of MBI (r=0.384, p=0.004). In the multiple regression model, the JSE-S-K was affected by conscientiousness of the NEO-FFI (adjusted R² =0.245, β=0.201, p=0.001); depersonalization, personal accomplishment of the MBI-GS (β=-0.188, p=0.001, β=0.143, p=0.017); R-SES (β=0.176, p=0.004); sex (β=0.117, p=0.029). CONCLUSION: The present findings suggested that conscientiousness, depersonalization, personal accomplishment, self-esteem and sex have an influence on empathy. Therefore, these must be considered in medical education and can be helpful to nurture more empathetic doctors.

Effect of Crowding and Nurse Staffing on Time to Antibiotic Administration for Patients with Pneumonia in an Emergency Department / 간호행정학회지

PURPOSE: This study was conducted to identify the effect of crowding and nurse staffing on time to antibiotic administration for pneumonia patients in an emergency department (ED). METHODS: The sample included pneumonia patients visiting an ED from November 1, 2014 to February 28, 2015. Crowding was measured using ED occupancy rate, nurse staffing was measured as total length of stay per nurse and number of patients per nurse and the time duration was measured for the following processes: from patient arrival to prescription, from prescription to blood culture and antibiotic administration, and from blood culture to antibiotic administration. Data collected from the electronic medical records were analyzed using multivariate analyses. RESULTS: The mean times from arrival to antibiotics administration, from prescription to antibiotic administration, and from blood culture to antibiotic administration were 128.31, 47.29, and 15.60 minutes, respectively. Crowding, nurse staffing, work experience of the nurse and severity of the patient influenced the time duration of each process from patient arrival to antibiotic administration. CONCLUSION: The results reveal that crowding and nurse staffing affect length of time to antibiotic administration in pneumonia patients. Guidelines for safe nurse staffing in ED are required to improve patient outcomes.

The Seoul Healthy First Step Project: Introduction and Expansion, Program Content and Performance, and Future Challenges

With the motto ‘Equity from the Start for a Healthy Future’, the Seoul Healthy First Step Project (SHFSP) was launched in 2013 in an attempt to support women with young children, to improve the health and development of babies, and eventually to close the gap in child development. The SHFSP contains both universal components (universal risk assessment of mothers and universal home visitation after birth) and selective components (prenatal and postnatal sustained home visits, mothers' groups, and community service linkage), thereby taking a proportionate universality approach. For sustained home visits, the SHFSP introduced the Maternal and Early Childhood Sustained Home-visiting (MECSH) program from Australia, which has been proven to be effective in improving maternal and childhood outcomes. Between 2013~2017, the SHFSP has paid 58,327 visits to roughly 38 thousand families with babies. In 2017, the SHFSP covered 19.6% of families with newborn babies in Seoul. The SHFSP conducted internal satisfaction surveys of universal and sustained visitation service recipients, in which an overwhelming majority of mothers provided positive feedback. A performance assessment conducted in 2016 by an external organization showed that 93% of SHFSP service recipients were satisfied with the home visitations. Considering the popular support for the program from mothers and families in Seoul (the most affluent area in Korea) and the lack of a national home visiting program to promote early childhood health and development, this program should be expanded nationally in the near future.

Study for Revision of the Korean Patient Classification System / 임상간호연구

PURPOSE: The purpose of this study was to revise the KPCS-1 and to standardize the three patient classification systems for general ward, ICU and NICU. The actual utilization of the KPCS-1 score and each nursing activity was evaluated and the relationships between KPCS-1 score and nursing related variables were reviewed. METHODS: The 47,711 KPCS-1 scores of 6,931 patients who discharged from 1st to 30th April 2017 were analyzed and the statistical significance between KPCS-1 score and nursing related variables was reviewed by Generalized Estimating Equation. The revision of the KPCS-1 was carried out by Partial Least Square model. The 3 patient classification systems (KPCS-1,KPCSC and KPCSN) were standardized by professional reviews. RESULTS: KPCS-1 was a valid instrument to express nursing condition adequately and was revised as a new version which has 34 nursing activity items. The names and terminologies of pre-existing 3 patient classification systems developed by KHNA were standardized as KPCS-GW, KPCS-ICU, KPCS-NICU. CONCLUSION: KPCS-1 was a valid instrument to represent diverse nursing conditions precisely and was revised as a 34-item KPCS-GW. The terminologies of the other patient classification systems by KHNA were standardized as KPCS-ICU and KPCS-NICU.

Geographic Mobility and Related Factors among Newly Graduated Nurses / 한국간호교육학회지

PURPOSE: This study aimed to analyze the mobility of newly graduated nurses from regions where their nursing schools were located to regions where they took up their first jobs, and to identify factors influencing nurses' mobility. METHODS: Data from the Graduates Occupational Mobility Survey, collected annually from 2010 to 2014 by the Korea Employment Information Service, were analyzed. The sample consisted of 1,488 graduates and 1,229 nurses who were employed on a full-time basis in hospitals. Multiple logistic regression analysis was conducted to identify factors associated with geographic mobility. RESULTS: Among the nurses working in hospitals, 69.2% had their first jobs in their nursing school regions and 11.3% in their high school regions. Fifty-two percent of the nurses worked in the capital region; 47.2% thereof had moved from a non-capital region. Nurses were more likely to work in their nursing school region when they were female, were older, graduated from a high school located in their nursing school region, graduated from a college (vs. university), had a lower nursing school performance, and expected lower monthly wage, compared with those who left their nursing school region. CONCLUSION: Education and remuneration policies are required to reduce geographical mobility to the capital region.

Development of Staffing Levels for Nursing Personnel to Provide Inpatients with Integrated Nursing Care / 간호행정학회지

PURPOSE: To develop staffing levels for nursing personnel (registered nurses and nursing assistants) to provide inpatients with integrated nursing care that includes, in addition to professional nursing care, personal care previously provided by patients' families or private caregivers. METHODS: A time & motion study was conducted to observe nursing care activities and the time spent by nursing personnel, families, and private caregivers in 10 medical-surgical units. The Korean Patient Classification System-1 (KPCS-1) was used for the nurse manager survey conducted to measure staffing levels and patient needs for nursing care. RESULTS: Current nurse to patient ratios from the time-motion study and the survey study were 1:10 and 1:11, respectively. Time spent in direct patient care by nursing personnel and family/private caregivers was 51 and 130 minutes per day, respectively. Direct nursing care hours correlated with KPCS-1 scores. Nursing personnel to patient ratio required to provide integrated inpatient care ranged from 1:3.9 to 1:6.1 in tertiary hospitals and from 1:4.4 to 1:6.0 in general hospitals. The functional nursing care delivery system had been implemented in 38.5% of the nursing units. CONCLUSION: Findings indicate that appropriate nurse staffing and efficient nursing care delivery systems are required to provide integrated inpatient nursing care.

Competencies of Nurses in a Maternal Early Childhood Sustained Home-Visiting Program

PURPOSE: Competency is a key foundation of the nursing education curriculum and a baseline element of nursing practice. The purpose of this study was to explore the competencies of community health nurses in a maternal early childhood sustained home-visiting program based on nurses' field experiences. METHODS: The participants were 21 nurses who had more than 1 year of experience in this program. Reflective interviews were performed; lasting 1 hour per nurse, on August 18, 2016, and the collected data were analyzed using qualitative directed content analysis. RESULTS: Twenty-four themes were extracted for 9 competencies. The major themes included implementing a long-term relationship-based approach, providing client-led service rather than expert-led service, helping mothers with psychosocial difficulties, and applying skills in a practical manner in the home environment. CONCLUSION: In order to develop a home-visiting program as part of maternal-early childhood nursing practice, nurses should develop competencies that help them make significant and positive interventions. Results indicate that the curriculum for community health nurses should be changed to improve competencies in building relationships with clients and to focus on the application of skills in specific cases and in clinical practice.