How are new nurses satisfied with their jobs? From the work value perspective of Generations Y and Z nurses.

BACKGROUND: Job satisfaction has garnered significant interest across multiple disciplines as it plays a vital role in shaping human resource strategies. In the field of nursing, enhancing job satisfaction can help prevent workforce shortages. Work values and job-related characteristics are significant predictors of job satisfaction. However, the influence of factors may change as younger generations join the nursing workforce. Although research on generational commonalities and differences in work values is increasing, there is insufficient information on generational differences in the interplay between work values and job satisfaction. This study investigated the factors associated with job satisfaction of new nurses in each generational group based on a work value perspective. METHODS: A total of 280 new nurses (151 from Generation Y and 129 from Generation Z) were selected from the Graduates Occupational Mobility Survey. Multiple linear regression analyses were performed to determine the factors associated with job satisfaction in both groups. RESULTS: Most participants graduated with a diploma (61.1%), were paid less than the average salary of each group (60.4%), and conducted shift (72.9%) and overtime work (64.3%). Work values and job satisfaction levels were not significantly different between the two groups. Multiple linear regression analyses showed that career growth and task work values were associated with job satisfaction for Generation Z, while task, reputation, and environment work values were associated with job satisfaction for Generation Y. Among the job-related characteristics, nurses' job tenure was associated with job satisfaction in both groups; salary and overtime had varying relationships with job satisfaction between the two generations. CONCLUSIONS: Understanding generational differences is crucial for improving the effective management of new generational nurses. Our study findings support that different work value dimensions and job-related characteristics were associated with job satisfaction in each generation. Accordingly, it is essential to develop distinct initiatives, such as a well-structured program, to support the continued career growth of the new Generation Z nurses, thereby enhancing their job satisfaction. Furthermore, providing a conducive working environment that helps new-generation nurses overcome challenges and ensures personal lives should be considered.

Institutional delivery rate and associated factors among women in rural communities: analysis of the 2017-2018 Bangladesh Demographic and Health Survey.

BACKGROUND: Institutional delivery rate among women in rural communities in Bangladesh remains low after several governmental interventions. A recent analysis of maternal mortality in Bangladesh revealed that women in rural communities were more likely to die from maternal complications than those in urban areas. OBJECTIVE: This study assessed the institutional delivery rate and associated factors among women in rural communities in Bangladesh. DESIGN: This was a cross-sectional study that used the 2017-2018 Bangladesh Demographic and Health Survey for analysis. To determine the factors associated with institutional delivery, multivariate logistic regression analysis was performed. SETTING AND PARTICIPANTS: The study was conducted in Bangladesh and among 3245 women who delivered live births 3 years before the survey. MAIN OUTCOME MEASURE: The outcome variable was the place of delivery which was dichotomised into institutional and home delivery/other non-professional places. RESULTS: The institutional delivery rate was 44.82% (95% CI 42.02% to 47.65%). We found that women between the ages of 30 and 49 years (aOR=1.51, 95% CI 1.05 to 2.18), women whose partners attained higher education (aOR=2.02, 95% CI 1.39 to 2.94), women who had antenatal visits of 1-3 (aOR=2.54, 95% CI 1.65 to 3.90), 4-7 (aOR=4.79, 95% CI 3.04 to 7.53), and ≥8 (aOR=6.13, 95% CI 3.71 to 10.42), women who watched television (aOR=1.35, 95% CI 1.09 to 1.67) and women in the middle (aOR=1.38, 95% CI 1.05 to 1.82), rich (aOR=1.84, 95% CI 1.34 to 2.54) and richest (aOR=2.67, 95% CI 1.82 to 3.91) households were more likely to use institutional delivery. On the other hand, women who were working (aOR=0.73, 95% CI 0.60 to 0.89), women who were Muslims (aOR=0.62, 95% CI 0.44 to 0.89) and women who gave birth to two (aOR=0.61, 95% CI 0.48 to 0.77) or ≥3 children (aOR=0.46, 95% CI 0.35 to 0.60) were less likely to use institutional delivery. CONCLUSION: The study revealed that a low proportion of women in rural communities in Bangladesh used institutional delivery. The results of this study should be taken into account by policy-makers and governmental efforts when creating interventions or programmes aimed at increasing institutional delivery in Bangladesh.

Digital Literacy and Associated Factors in Older Adults Living in Urban South Korea: A Qualitative Study.

This study aimed to explore digital literacy among community-dwelling older adults in urban South Korea. A semistructured interview guide was developed using the Digital Competence ( 2.0 framework, which emphasizes the competencies for full digital participation in five categories: information and data literacy, communication and collaboration, content creation, safety, and problem-solving. The data were analyzed using combined inductive and deductive content analysis. Inductive analysis identified three main categories: perceived ability to use digital technology, responses to digital technology, and contextual factors. In the results of deductive analysis, participants reported varying abilities in using digital technologies for information and data literacy, communication or collaboration, and problem-solving. However, their abilities were limited in handling the safety or security of digital technology and lacked in creating digital content. Responses to digital technology contain subcategories of perception (positive or negative) and behavior (trying or avoidance). Regarding contextual factors, aging-related physical and cognitive changes were identified as barriers to digital literacy. The influence of families or peers was viewed as both a facilitator and a barrier. Our participants recognized the importance of using digital devices to keep up with the trend of digitalization, but their digital literacy was mostly limited to relatively simple levels.

Prevalence and associated factors of cognitive frailty in community-dwelling older adults: Results from the Korean longitudinal study of aging.

BACKGROUND: Cognitive frailty, a condition characterized by physical frailty with cognitive impairment, is emerging as a determinant of adverse health outcomes in older adults. However, its prevalence and correlation with associated factors are unknown in the aging population of Korea. OBJECTIVES: To estimate the prevalence of cognitive frailty and identify factors associated with it among older Korean adults. METHODS: A secondary analysis was performed using the Korean Longitudinal Study of Aging seventh survey dataset collected in 2018. Multinomial logistic regression analyses were conducted to examine the association between cognitive frailty and demographic, psychosocial, oral health and physical function factors. Individuals aged ≥65 years and without dementia were included (N = 1024). Participants were classified into four groups based on the presence or absence of physical frailty and mild cognitive impairment. This article is executed in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. RESULTS: The prevalence of cognitive frailty in the study sample was 11.2%. The results of multinomial logistic regression showed that advanced age, being female, lower education levels, heart disease, arthritis or rheumatoid arthritis, underweight, depression, non-social activity, poor oral health and functional limitation were significantly associated with cognitive frailty. CONCLUSIONS: Cognitive frailty is prevalent among community-dwelling older adults in Korea. The findings provide primary care providers with insights about effective strategies for identifying at-risk individuals and will guide the development of population-level interventions to prevent or delay the onset of physical frailty and cognitive impairment in older adults. IMPLICATIONS FOR PRACTICE: The findings provide practical information to healthcare providers for identifying cognitive frailty in older adults. The risk factors of cognitive frailty, such as psychosocial, oral health, and physical function factors, should be thoroughly monitored for older adults. Health personnel working in primary care have a critical role in identifying risk and beneficial factors and promoting preventative strategies that enhance health outcomes.

Understanding health-related quality of life trajectories among older adults with diabetes mellitus: Mixed methods research.

AIM: To examine health-related quality of life trajectories among older adults with diabetes mellitus (DM). DESIGN: A sequential explanatory mixed method study protocol. METHODS: In the quantitative phase, health-related quality of life trajectory over 5 years, from 2009 to 2013, of a national representative sample (N = 440) of older adults with DM was analysed using group-based modelling. Next, a qualitative multiple case study (N = 10) was conducted between November 2017 and April 2018. In the mixed phase, by linking the quantitative and qualitative data, similarities and differences among the four trajectories were identified. RESULTS: Four distinctive health-related quality of life trajectories could be distinguished: high then decrease, high stable, medium stable and low then increase. These differed in attitude towards DM, self-management of DM-related tasks, comorbidity-related health-related quality of life, coping with DM and financial concerns about medical needs. RELEVANCE TO CLINICAL PRACTICE: Our results help illuminate the heterogeneity of health-related quality of life trajectories in older adults with DM. This research may help healthcare providers understand the need to assess the HR-QoL comprehensively and promote HR-QoL for older adults with DM.

Mobile health applications for communication between caregivers of community-dwelling older adults: A scoping review.

It is unclear how mobile health (mHealth) technology can be used for monitoring and communication between caregivers with spatial constraints. This systematic scoping review identifies the characteristics, functions, facilitators, and barriers of mHealth used for communication between various types of caregivers for older adults. Guided by Joanna Briggs Institute Scoping Review Methodology, all published peer-reviewed and grey literature indexed in PubMed, EMBASE, CINAHL, Cochrane Library, and Google Scholar from January 2012 to April 2022 were reviewed. Sixteen of 854 studies met the inclusion criteria. Findings suggested mHealth was primarily used for monitoring older adults' health, educating about home care, alerting about emergencies, communicating with family members or health providers, and GPS-based location tracking. Responsibility for older adults and willingness to use facilitated usage, while old age-related challenges, illiteracy, lack of technical skills, and cell phone size and Internet connectivity-related limitations impeded it. These findings can help researchers and care providers design better mHealth solutions to provide families with real-time information on older adults.

Factors related to readiness for practice among undergraduate nursing students: A systematic review.

AIM: This systematic review identifies the factors and effective strategies related to nursing students' readiness for practice. METHOD: A search was conducted from 2012 to 2022 in PubMed, CINAHL, SCOPUS, PsycInfo and EMBASE databases, using a combination of predetermined keywords. Four authors made the selection independently and the methodological quality was assessed using the RoBANS, Analytical cross-sectional studies Critical Appraisal Tool and MMAT tools. Information was extracted using a matrix and analyzed through the thematic synthesis approach. RESULT: Studies (14,000) were identified from the search and 11 met the predetermined inclusion criteria. The main identified themes were personal characteristics, education-related factors, cognitive factors, psychological characteristics and social factors influencing readiness to practice. Some barriers also affect readiness for practice among undergraduate nursing students. CONCLUSION: Multiple personal, educational and community factors interact in diverse ways to influences nursing students readiness to practice. REGISTRATION: The protocol for the conduct of this study was registered on the International Prospective Register of Systematic Reviews (PROSPERO) with the registration number CRD42020222337.

Impact of patient-safety incidents on Korean nurses' quality of work-related life: A descriptive correlational study.

AIM: We investigated the impact of patient safety incidents on the quality of nurses' work-related lives, based on the Culture-Work-Health model. DESIGN: Descriptive correlational study. METHODS: An online survey was administered between March 10 and 18, 2020 to 622 nurses in South Korea who had experienced patient safety incidents within the past year. Descriptive analysis was performed along with inferential statistics, including one-way ANOVA, correlation, and multiple linear regression (p < 0.05). RESULTS: A multiple linear regression analysis was used to identify factors affecting participants' quality of work-related life. Significantly influential factors were resonant leadership, just culture, organizational support, organizational health, and overall work experience. CONCLUSIONS: Resonant leadership and culture positively affects nurses' quality of work-related life. Therefore, it is critical to evaluate nurses' perceptions of these factors and use these factors in creating administrative interventions to assist nurses in improving their work experiences.

Personal Factors and Clinical Learning Environment as Predictors of Nursing Students' Readiness for Practice: A Structural Equation Modeling Analysis.

PURPOSE: It is essential to ensure the readiness for practice among undergraduate nursing students since the purpose of such education is to cultivate competent nurses who deliver high-quality and safe nursing. Astin's theory of student involvement suggests that this is affected by their personal factors and learning environment. METHODS: We conducted a cross-sectional study between November 16, 2020 and December 21, 2020 which examined personal factors and aspects of the clinical learning environment among senior nursing students (n = 838) enrolled across 54 nursing schools in Korea. The participants were asked to fill out a self-administered online survey, which assessed demographic characteristics, self-esteem, depression, work-life balance, clinical learning environment, anxiety during clinical practicum, and readiness for practice. Readiness for practice was measured using the Casey-Fink Readiness for practice survey. We used structural equational modeling to test our hypothetical model. RESULTS: The nursing students' readiness for practice was significantly affected by their self-esteem, work-life balance satisfaction, and clinical learning environment. Anxiety during clinical practicum directly influenced their readiness for practice. CONCLUSION: Increasing self-esteem and work-life balance satisfaction, and improving their clinical learning environment by providing sufficient educational and clinical support, could help facilitate the transition from nursing schools to real-world practice for nursing students.

Advanced Practice Nurses' Experiences on Patient Safety Culture in Hospital-Based Home Healthcare: A Qualitative Descriptive Study.

Purpose: Despite the increasing interest in patient safety, most research have been conducted in hospital settings, thereby demonstrating an overall lack of research regarding patient safety culture in home healthcare. South Korea has three types of home healthcare services based on hospitals, public health centers, and long-term care insurance. Home healthcare nurses in hospitals require a master's degree and advanced nursing skills. They play important roles in ensuring patients' safe transition into home health care. This study aimed to explore the experience of patient safety culture among South Korean advanced practice nurses in hospital-based home healthcare. Methods: This qualitative descriptive study was conducted through purposive sampling, whereby twenty advanced practice nurses involved in home healthcare were recruited from twelve hospitals located in three different cities throughout South Korea. Face-to-face semi-structured interviews were conducted, and the collected data were analyzed through inductive and deductive content analyses. Results: Three main categories were finally confirmed: (a) teamwork climate, (b) safety climate, and (c) working condition. The sub-categories of the teamwork climate included the collaboration between patients, caregivers, and nurses, collaboration within medical institutions, and collaboration among the individuals involved in community partnerships. The sub-categories of the safety climate included nurses' commitment to patient safety, the associated institutions' commitment to patient safety, and the government's commitment to patient safety. The sub-categories of the working condition included the frontline working environments and the associated institutions' support aimed at ensuring effective working environments. Conclusion: Cultivating patient safety culture is crucial for ensuring the safe transition of patients from acute care hospitals to home healthcare. This study revealed significant aspects of patient safety culture in hospital-based home healthcare, allowing for the continuum of care among the associated patients. Such aspects include communicating with caregivers, building community partnerships, understanding unexpected home environments, and enhancing the safety of nurses.

Factors Influencing Military Nurses' Reporting of Patient Safety Events in South Korea: A Structural Equation Modeling Approach.

PURPOSE: This study explored how just culture, authentic leadership, safety climate, patient safety knowledge, and safety motivation all affect military nurses' reporting of patient safety events. METHODS: This study adopted a cross-sectional and descriptive correlational design. Data were collected from 303 nurses working across eight military hospitals under the jurisdiction of the Armed Forces Medical Command in South Korea, from June 17 to July 25, 2020. The hypothesized model was then validated using structural equation modeling. RESULTS: The participating military nurses did not show any proactive attitudes toward reporting near misses when compared with their responses to adverse or no-harm events. The final model exhibited goodness of fit. Herein, both safety climate (ß = 0.35, p = .009) and patient safety knowledge (ß = 0.17, p = .025) directly influence patient safety event reporting. Moreover, just culture indirectly influences patient safety event reporting (ß = 0.31, p = .002). The discovered influencing factors account for 22.9% of the variance in explaining patient safety event reporting. CONCLUSIONS: Our findings indicate that just culture, safety climate, and patient safety knowledge either directly or indirectly affected patient safety event reporting among military nurses. These findings then serve to provide a theoretical basis for developing more effective strategies that would then improve military nurses' patient safety behaviors.

Health-Related Quality of Life Trajectories Among Older Adults With Diabetes Mellitus: A Group-Based Modeling Approach.

BACKGROUND: Health-related quality of life (HR-QoL) is an important issue among older adults with diabetes mellitus. However, information on longitudinal changes in HR-QoL over time using the illness trajectory model is limited. PURPOSE: The purpose of this study was to identify patterns of temporal change in HR-QoL and their predictors using longitudinal data and a group-based modeling approach. METHODS: European Quality of Life-5 Dimensions data for 440 older adults with diabetes mellitus were drawn from the nationwide Korea Health Panel Survey conducted from 2009 to 2013. Latent class growth analysis and multinomial logistic regression models were used to identify the predictors of HR-QoL trajectories. RESULTS: Four distinct classes of HR-QoL trajectory were identified: high decrease (n = 46, 10.5%), high stable (n = 232, 52.7%), medium stable (n = 157, 35.7%), and low increase (n = 5, 1.1%). Participants in ``high decrease" and ``high-stable" classes tended to be men who were highly educated, physically active, and adherent to their medication regimen. High economic status, few chronic diseases, independence in activities of daily living, and high self-rated health status were also identified as indicators of being in the ``high-decrease" and ``high-stable" class group. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: A salient finding of this study is that HR-QoL trajectories in older adults with diabetes mellitus are not homogeneous but instead diverge into four distinct classes. Most participants showed no major changes in HR-QoL across the 5-year period, regardless of HR-QoL level. To prevent patients with diabetes from experiencing chronically low levels of HR-QoL, comprehensive assessment and individualized care based on HR-QoL are necessary.

A structural equation modeling of reproductive health promoting behaviors among female adolescents in the Philippines.

AIMS: Integrated reproductive health promoting behaviors, including safe sexual intercourse, preventing sexually transmitted diseases, sexual responsibility, and genital health management, are essential for adolescents in developing countries. The Philippines is currently facing several reproductive health threats. The aim of this study was to identify factors affecting reproductive health promoting behaviors based on a theoretical model using structural equation modeling. METHODS: In this cross-sectional study and a structural equation modeling, a total of 227 female adolescents in the Philippines participated in a self-reported questionnaire survey. RESULTS: The results indicated that reproductive health knowledge (ß = .14, p = .033), attitudes regarding reproductive health behaviors (ß = .31, p = .027), and reproductive health self-efficacy (ß = .31, p = .002) influenced participants' reproductive health promoting behaviors. Social norms (ß = .31, p = .021) influenced reproductive health self-efficacy and indirectly influenced reproductive health promoting behaviors. Attitude toward gender roles (ß = .20, p = .020) was associated with reproductive health knowledge. CONCLUSIONS: This study confirmed the direct effect of reproductive health knowledge, attitudes regarding reproductive behaviors, and reproductive health self-efficacy, as well as the indirect effect of social norms, on reproductive health promoting behaviors using structural equation modeling.

A policy review of the process of the Integrated Nursing Care Service System in South Korea.

AIM: This study aimed to analyse the policy formation process of South Korean Integrated Nursing Care Service System (INCSS). BACKGROUND: Due to the shortage of chronic nursing staff in Korea, many nursing services have been overlooked, which has led to a customary caregiving culture that relied on inpatient families. To improve this, Korea legislated the INCSS in 2015. METHODS: This study retrospectively analysed policy formation process of the INCSS using Kingdon's Multiple-Streams Framework from on-offline materials generated between 1994 and 2015. RESULTS: The caregiving culture, which was raised as one of the main causes of the Middle East Respiratory Syndrome coronavirus (MERS-CoV) infection spread, has garnered intensive attention from media and politicians. The streams of problem, politics and policy that each flowed independently were coupled, the policy window finally opened leading to successful legislation. CONCLUSIONS: The leading political activities of the United Healthcare Civic-Group, in which general nurses were the core, were effective in introducing the system. IMPLICATIONS FOR NURSING MANAGEMENT: This study's results could be used for promoting hospital-based healthcare policy intervention by enhancing general nurses' political competence.

Doctoral education, advanced practice and research: An analysis by nurse leaders from countries within the six WHO regions.

Doctoral education, advanced practice and research are key elements that have shaped the advancement of nursing. Their impact is augmented when they are integrated and synergistic. To date, no publications have examined these elements holistically or through an international lens. Like a three-legged stool they are inter-reliant and interdependent. Research is integral to doctoral education and influential in informing best practice. This significance and originality of this discussion paper stem from an analysis of these three topics, their history, current status and associated challenges. It is undertaken by renowned leaders in 11 countries within the six World Health Organisation (WHO) regions: South Africa, Egypt, Finland, United Kingdom, Brazil, Canada, United States, India, Thailand, Australia, and the Republic of Korea. The first two authors used a purposive approach to identify nine recognized nurse leaders in each of the six WHO regions. These individuals have presented and published papers on one or more of the three topics. They have led, or currently lead, large strategic organisations in their countries or elsewhere. All these accomplished scholars agreed to collect relevant data and contribute to the analysis as co-authors. Doctoral education has played a pivotal role in advancing nurse scholarship. Many Doctor of Philosophy (PhD) prepared nurses become faculty who go on to educate and guide future nurse researchers. They generate the evidence base for nursing practice, which contributes to improved health outcomes. In this paper, the development of nursing doctoral programmes is examined. Furthermore, PhDs and professional doctorates, including the Doctor of Nursing Practice, are discussed, and trends, challenges and recommendations are presented. The increasing number of advanced practice nurses worldwide contributes to better health outcomes. Nonetheless, this paper shows that the role remains absent or underdeveloped in many countries. Moreover, role ambiguity and role confusion are commonplace and heterogeneity in definitions and titles, and regulatory and legislatorial inconsistencies limit the role's acceptance and adoption. Globally, nursing research studies continue to increase in number and quality, and nurse researchers are becoming partners and leaders in interdisciplinary investigations. Nonetheless, this paper highlights poor investment in nursing research and a lack of reliable data on the number and amount of funding obtained by nurse researchers. The recommendations offered in this paper aim to address the challenges identified. They have significant implications for policy makers, government legislators and nurse leaders.

Developing an integrated curriculum for patient safety in an undergraduate nursing program: a case study.

BACKGROUND: Nursing students' practical training should begin when students can apply core knowledge, skills, and attitudes related to patient safety. This necessitates an integrated curriculum in nursing education that links practice to the theory concerning patient safety to enhance patient safety competencies and quality in nursing care. This study aimed to develop an integrated curriculum that incorporates patient safety factors in the existing curriculum to increase patient safety competencies in nursing students. METHOD: A case study approach was adopted to explain the development processes of a new curriculum integrating patient safety in the existing outcome-based curriculum of a nursing college. Based on the existing outcome-based curriculum of a nursing college, a four-step process was performed to integrate patient safety component, including quality improvement, into the curriculum: 1) literature review, 2) analysis of course syllabus, 3) selection of courses related to patient safety topics, and 4) development of evaluation tool. RESULTS: The integrated patient safety curriculum was based on six topics: patient safety principles, teamwork, communication, patient engagement, risk management and, quality improvement, and International Patient Safety Goals. Based on the characteristics of the course according to the level of students in each year, the curriculum was integrated to address patient safety topics in seven courses (four theoretical and three practical). A Patient safety Competency self-assessment checklist was developed for students to naturally acquire patient safety competencies in clinical settings. CONCLUSIONS: This study demonstrated that patient safety topics should be addressed in both theoretical and practical settings across the entire nursing curriculum per the continuity and sequence of education principles.

Association of Nurse Staffing With Nosocomial Infections of Very Low-Birth-Weight Infants.

Prior studies have reported inconsistent findings regarding the relationship between nurse staffing and nosocomial infections in very low-birth-weight (VLBW) infants. Little is known about whether similar associations occur in Korea. The purpose of this study was to identify the nurse staffing of neonatal intensive care units (NICUs) in Korea and to verify the association between nurse staffing and nosocomial infections among VLBW infants in NICUs. We selected 4654 VLBW infants admitted to 52 hospitals. Nosocomial infections were defined as incidence of bloodstream infection, urinary tract infection (UTI), or rotavirus infection. The average number of NICU patients per nurse was 4.51(minimum-maximum: 2.38-8.16). Hospitals with a higher number of patients per nurse exhibited a significant increased UTI rate (P = .005) and rotavirus infection rate (P = .025) in the univariate analysis. After adjusting for all patient and hospital characteristics, UTI significantly increased with increasing number of patients per nurse (odds ratio [OR] = 1.79; 95% confidence interval, 1.29-2.47), while bloodstream infection (OR = 0.93; 95% confidence interval, 0.79-1.09) and rotavirus infection (OR = 1.14; 95% confidence interval, 0.92-1.41) were not significant. These findings revealed that a nurse staffing in NICUs is an important factor for preventing UTI among VLBW infants.

Impact of Medicare Advantage penetration and hospital competition on technical efficiency of nursing care in US intensive care units.

This study aimed to evaluate technical efficiency of US intensive care units and determine the effects of environmental factors on technical efficiency in providing quality of nursing care. Data were obtained from the 2014 National Database of Nursing Quality Indicators and the Centers for Medicare and Medicaid Services. Data envelopment analysis was used to estimate technical efficiency for each intensive care unit. Multilevel modeling was used to determine the effects of environmental factors on technical efficiency. Overall, Medicare Advantage penetration and hospital competition in a market did not create pressure for intensive care units to become more efficient by reducing their inputs. However, these 2 environmental factors showed positive influences on technical efficiency in intensive care units with certain levels of technical efficiency. The implications of the study results for management strategies and health policy may vary according to the levels of technical efficiency in intensive care units. Further studies are needed to examine why and how intensive care units with particular levels of technical efficiency are differently affected by certain environmental factors.

Promotion and Persistence of HIV Testing and HIV/AIDS Knowledge: Evidence From a Randomized Controlled Trial in Ethiopia.

We use data from a randomized controlled trial in Ethiopia and examine the causal effects of HIV/AIDS education, home-based voluntary HIV counseling and testing (VCT), and conditional cash transfers (CCT) for facility-based VCT on HIV/AIDS knowledge and demand for HIV testing. HIV/AIDS education significantly increases HIV/AIDS knowledge but has a limited effect on testing take-up. However, when HIV/AIDS education is combined with either home-based VCT or CCT for facility-based VCT, take-up increases substantially by about 63 and 57 percentage points, respectively. We also demonstrate evidence of persistence in test-taking behavior, where past HIV testing does not dampen demand for testing. Lastly, we find suggestive evidence that home-based VCT could be more effective at detecting HIV-positive cases relative to CCT for facility-based VCT. Our findings highlight the importance of geographic accessibility in the testing decision and persistence in demand for HIV testing. Copyright © 2016 John Wiley & Sons, Ltd.

Effects of community-based case management by visiting nurses for low-income patients with hypertension in South Korea.

AIM: To assess the effects of a visiting nurse-driven community-based case management program for low-income adults with hypertension. METHODS: This single group pretest-post-test study included 22 newly registered low-income adult patients with hypertension in a public health center in Seoul. Visiting nurses delivered a case management program for 2-8 months. Pretest and post-test measurements of blood pressure (BP), knowledge level, and self-management level in terms of diet, lifestyle, physical activity, and medication were obtained. RESULTS: The visiting nurse-driven case management was effective in reducing the BP level and improving the knowledge and self-management level of the low-income adults with hypertension in the community. CONCLUSION: This study serves as a baseline for visiting nurse-driven case management for low-income patients with hypertension. Its findings suggest that visiting nurse-driven case management targeting the self management of BP can foster improved BP control for newly diagnosed hypertensive patients in low-income populations.