Purpose: This study was to identify ethical dilemma, coping types, job satisfaction and turnover intention in order to examine nurses' ethical recognition. Methods: The subjects were 1,225 registered nurses who were working in 111 general hospitals with more than 300 beds in Korea. The data were collected from August 15 to September 15, 2010 by using the self-reported questionnaires. The data were analyzed by descriptive statistics, t-test, ANOVA, $Scheff\acute{e}$ test and Pearson's correlation coefficient, using the SPSS/WIN 17.0 program. Results: The mean score of the level of ethical dilemma was 0.69/1, and nursing practice area was the highest (M=0.75). The result showed that nurses experienced ethical dilemma in many cases in their practice. The mean score of the level of coping with ethical dilemma was 1.43/3. The score of the job satisfaction of the participants was 2.97/5, and that of the turnover intention was 2.94/5. The ethical dilemma demonstrated significant correlations with coping (r=.255, p<.001), turnover intention (r=.079, p=.005), and job satisfaction (r=-.212, p<.001). Conclusion: Nurses need to get education on reducing ethical conflict as well as training to develop strategies for effective coping with ethical dilemma in practice. Futhermore, it is necessary to take efforts as a whole to increase nurses' job satisfaction and to reduce their turnover intention.

Purpose: The purpose of this study is to investigate nurses readiness to self-directed learning and its correlations with nursing practice competence in a tertiary hospital in Seoul, Korea. Methods: A cross sectional survey design was utilized to assess nurses readiness to self-directed learning and job performance. The data used in this study were obtained from 286 nurses who have been working on general ward for over 1 year. Data were analyzed by ANOVA, t-test, Pearson's correlation analysis, and multiple regression using SAS 9.1 program. Results: The mean score of the readiness to self-directed learning is 3.56 and that of nursing practice competence is 2.71. The readiness to self-directed learning was statistically different according to level of education, and clinical work experience. Nursing practice competence was also significantly different according to level of education, clinical work experience, marital status, age, and working division. The readiness to self-directed learning and nursing practice competence seem to have significant positive correlation to each other (r=.555, p<.001). The readiness to self-directed learning explains 32.0% of nursing practice competence (F=20.20, p<.001). Conclusion: These findings indicate that program development for enhancing the readiness to self-directed learning is needed to improve nursing practice competence. We also need continuous efforts to improve nurses initiatives and creativity.

Purpose: The objective of this research was to measure health literacy level of the visitors of a university hospital's out patient clinic and to consider its influence factors. Methods: Subjects were 400 visitors in an outpatient clinic of a university hospital. By using self-report questionnaire which included Newest Vital Sign (NVS) and general information inquiry, the level of health literacy and its influence factors were measured. The data were analyzed by using t-test, ANOVA, and Pearson's correlation. Results: The NVS score of subjects was $3.54({\pm}1.91)$ out of maximum 6 scale. The factors that have significant relationships with the health literacy were age, sex, marital status, educational background, monthly income, health information source, number of diseases, number of medications and drinking status. Participants who are men, in old age, having lack of supportive relationship, having low levels of education, having low income, having more comorbid diseases & medications, tend to have lower NVS score compared to others. Conclusion: We suggest extending our research results for evaluating the risky group to improve the health literacy and to develop the strategic methods for better health outcomes.

Purpose: The purpose of this study was to identify the effect of exercise therapy on low back pain, self-urination disorder, bleeding, and hematoma in Percutaneous Coronary Intervention (PCI) patients. Methods: A total of 64 PCI patients were recruited from C hospital located in C city, from June until August of 2010. The patients were divided into two groups as the exercise and control group. Thirty-two participants in the exercise group took bedrest for two hours after PCI, and then received excise therapy. The other 32 participants in the control group took the usual 8-hour bedrest with intermittent back care by the unit nurses. Results: In the relieving effect of low back pain, exercise group reported pain reduced faster than the control group. On the other hand, there were no significant differences between the two groups in alleviant of self-urination disorder, bleeding, and hematoma. Conclusion: Exercise therapy for reducing patients' low back pain showed to be an effective nursing intervention. Since there was no bleeding or hematoma after PCI in the exercise group, this study provided the ground suggesting that it might be possible to reduce the bedrest time after PCI without increased risk of bleeding or hematoma.

Purpose: This study was to evaluate the effects of foot reflexology massage on the central pain, fatigue and sleep in stroke patients. Methods: The study utilized a non-equivalent control group pretest and posttest design. Subjects were contacted at the oriental medicine ward of D hospital in B city for strokes. The subjects were 25 in the experimental group and 23 in the control group. Collected data were analyzed central pain, fatigue and the change of sleep between pre and post foot reflexology massage using a t-test, $x^2-test$, Fisher's exact test by SPSS 12.0 Win program. Results: There were significant decrease in the central pain, fatigue and change of sleep between pre and post foot reflexology massage. Conclusion: The results proved that foot reflexology massage was an effective stroke patients to decrease in the central pain, fatigue and change of sleep. Therefore, this foot reflexology massage should be effective as a stroke patients.

Purpose: This study aimed to investigate the types of nursing organizational culture and its relationships with nurses' satisfaction with life, and job satisfaction. This study was eventually aimed to create healthier and more positive nursing organizational culture. Methods: This study utilized a descriptive correlational method to explore mediating effects of the types of nursing organizational culture on nurses' satisfaction with life and their job. Data were collected from a total of 1,801 nurses who have worked for more than 3 years in 35 different hospitals with more than 100 beds. Using SPSS 17.0 and Sobel Test Calculator, t-test, one way ANOVA, Duncan test, multiple regression and sobel test were used for data analysis. Results: The analysis showed that the nurses had a hierarchical organizational culture. Also the subjects' job satisfaction was significantly correlated with innovation, relation, and hierarchy-oriented factors and satisfaction with life. Conclusion: Innovative organizational culture is a leading factor in determining nurses' professional satisfaction. In view of the above it is recommended that strategies for creating innovative organizational culture and its application to nursing practice.

Purpose: This study was done to develop performance appraisal guidelines based on the standardized appraisal tool developed in a previous study. Methods: A preliminary investigation was done to draw up a draft guidelines through a literature review. To verify the content validity of the guidelines, 10 nurse managers reviewed the standardized appraisal tool and draft guidelines. Through this process, the performance appraisal guidelines were revised and supplemented. In order to examine the reliability and validity of the guidelines, 13 nurse managers conducted performance appraisal for 178 nurses. Results: As a result, the items of pre-existing tool was reduced from 63 to 30 for usefulness, and guidelines for each items were developed. Conclusion: The revised performance appraisal tool and guidelines are expected to be useful in objectively evaluating nursing performance objectively.

Purpose: The purpose of this study was to examine the effects of early passive range of motion (ROM) exercise on ROM of lower extremities and foot edema in hemiplegic patients after stroke. Methods: The data were collected between August 2009 and April 2010 from 11 patients in the experimental group and 13 in the control group. The passive ROM exercise was performed twice a day for 2 weeks. Results: In the experimental group, ROM of lower extremities (flexion of hip, flexion of knee and ankle) increased significantly compared to that of the control group. There was no significant difference in foot edema between the two groups. Conclusion: The results indicated that the early passive ROM exercise can improve the ROM of lower extremities, but not the foot edema in patients after stroke.

Purpose: This paper was to develop an elbow restraint which can reduce the side effects of the wrist restraint which was frequently used in an intensive care unit and to evaluate its application. Methods: A nonequivalent control group non-synchronized design was used. Subjects were 38 patients (elbow restraint group: 18, wrist restraint group: 20) and 20 nurses who used both restraints in medical intensive care unit at G National University Hospital. Restraints were applied to subjects for 72 hours. Data were collected from December 1, 2009 through March 31, 2010. The data collected were analyzed using $x^2-test$, Fisher's exact test, t-test, and ANCOVA using SPSS 12.0 program. Results: Elbow restraint significantly decreased range of wrist motion reduction, swelling and significantly increased the convenience of wearing restraint compared to wrist restraint. Conclusion: The new elbow restraint are more efficient than the old wrist restraint, which have been used in an intensive care unit, in terms of convenience of restraint application, range of joint motion and prevention of swelling.

Purpose: The purpose of this study is to develop a detailed clinical model for recording initial nursing assessment items, and to test the applicability of the model to facilitate semantic interoperability for sharing and exchanging nursing information. Methods: First, the researchers extracted items by analyzing initial nursing assessment records. Second, defining characteristics were identified by analyzing nursing records and reviewing the literature. Third, value sets for defining characteristics were identified and types and cardinalities of defining characteristics were defined based on the value sets. Finally, the detailed clinical model was tested through evaluation by experts and comparison with the initial nursing assessment in a clinical setting. Results: Sixty-one detailed clinical models were developed with 178 defining characteristics and value sets. The experts evaluation and comparison with the initial nursing assessment in a clinical setting showed that the detailed clinical model developed in this study was valid. Conclusion: Use of this detailed clinical model can ensure that the Electronic Health Record contains meaningful and valid information and supports semantic interoperability of nursing information. This use will promote quality in the nursing records and eventually quality of nursing care.

Purpose: This study was conducted to develop and evaluate an oral care protocol for cancer patients receiving chemotherapy. Methods: The participants in this study were cancer patients in Severance hospital in Seoul. A total of 31 patients were assigned to the experimental group, and 29 patients to the control group. Data were collected from August 1 to October 5, 2010. The protocol included definition and symptom of oral mucositis, self-check method of oral status, prophylactic method of oral mucositis (oral care, eating habits, and gargling) and management of oral mucositis. Oral Assessment Guide (OAG) was used as the measurement tool of oral mucositis in this study, Oral Care Performance Scale was used as the measurement tool of oral care performance status. Data were analyzed with a $x^2-test$ and t-test, and repeated measures ANOVA, using SPSS/WIN 18.0 program. Results: Patients in the experimental group receiving the oral care protocol had a significant difference (t=-2.938, p=.005) in the oral care performance compared to the control group. However, there was no significant difference (F=1.255, p=.274) in the oral mucositis status between two groups. Conclusion: This study showed that the oral care protocol could improve oral care performance status for the patients under chemotherapy.