Purpose: This study was to identify the effects of a manual booklet as an aid to clinical performance in newly graduated nurses. Methods: The research design was a nonequivalent control group pretest-posttest design. The study was performed from June 14 to September 17, 2010 with an experimental group (n=23) and a control group (n=22) using a questionnaire with 45 new nurses who graduated from nursing colleges in 2010, and had less than 12 months work experience at a general hospital in B city. A pocketable nursing-work manual booklet was provided for the experimental group nurses so that they could use it as a reference in the work place. Results: Scores on performance of nursing work showed a significant difference between the experimental group and control group (t=-5.257, p=.001). Conclusion: Results of the present study indicate that a manual booklet of nursing work is very helpful in improving the clinical performance of new nurses. New nurses, who have some knowledge of nursing learned at school but have less clinical experience, can be helped effectively with a practical manual booklet for improving their work performance.

Purpose: This study was to identify topics for evidence-based clinical nursing practice guidelines in Korea. Methods: Data were collected from 330 staff nurses from 10 general hospitals and 53 nurses in charge of nursing education in 110 hospitals with over 500 beds. Using open questions, the nurses identified activities which could not be verified, which lacked consistency among nurses, clinical units and/or hospitals, which were not based on the up-to-date knowledge and which needed reform. The data were analysed by content analysis using a qualitative methodology. Results: Collected data consisted of 1882 clinical topics, which were classified into 50 topics, 207 mid-categories, and 456 sub-categories. The most frequent topics in order of frequency were medications, central line management, intravenous injections, urinary catheterization, perioperative nursing care, skin tests, pressure ulcer care, blood transfusions, laboratory examination-culture, respiratory care which were performed routinely in clinical setting by staff nurses. Conclusion: The research findings indicate the urgent need to develop evidence-based clinical nursing practice guidelines related to these research findings. Further research is needed to identify topics related to health promotion, and symptom/management of health problem.

Purpose: This study was done to identify nursing interventions clinically applicable to relieve displeasure and anxiety of patients having an operation in which loud noise was unavoidable. Methods: Participants were 34 patients scheduled to have a total knee replacement. They were assigned to either the control (17 patients) or experimental (17 patients) group. Data were collected from September to November 2010. The instruments used for the survey included noise-control earplugs, a noise level meter (TES-1358) and a structured scale measuring degree of noise perception, displeasure and anxiety. Data were analyzed using frequency, percentage, standard deviation, $x^2$-test, and t-test with the SPSS WIN 18.0 program. Results: Hypothesis 1: 'The displeasure levels of the experimental group of patients wearing earplugs will be lower than the control group patients without earplugs' was accepted (t=-20.769, p<.001). Hypothesis 2: 'The anxiety levels of the experimental group of patients wearing earplugs will be lower than the control group patients without earplugs' was accepted (t=-6.298, p<.001). Conclusion: Based on these findings, the wearing of earplugs for patients having a surgical operation with loud noises is recommended as an effective nursing intervention to relieve patient displeasure and anxiety during their surgical operations.

Purpose: The purpose of this research was to develop and train caregivers in tracheostomy tube care using a self-management program to assist patients with an 'at home' tracheostomy procedure. Caregivers' self-efficacy and knowledge of tracheostomy management before and after the training was also identified. Methods: Research participants were the main caregivers for patients with tracheostomies who were affiliated with a 'Home Healthcare Center'. Training and observation were done at 'A Hospital' and 'G Hospital' both affiliated with 'K University' in Seoul. Data were collected from May 3, 2010 to January 25, 2011 and analyzed using Wilcoxon signed rank test with SPSS program version 12.0. Results: Significant differences were found for the pre and post evaluation of the 'self-management program' for the implementation of tracheostomy care. The development and implementation of the 'self-management program' improved the main caregivers' knowledge of tracheostomy tube management (Z=-3.599, p<.001). Conclusion: Results show that this program has identified an effective nursing intervention for promoting the caregivers' knowledge of tracheostomy care and self-efficacy. We recommend that further research should be done to test primary caregivers' maintenance of knowledge and self-efficacy in tracheostomy tube management and identify factors affecting knowledge and self-efficacy in the care of these patients.

Purpose: The purpose of this study was to develop and provide a standardized nursing intervention program for stroke patients with dysphagia and evaluate the effectiveness of the program. Methods: Data on the number of tube feedings, incidence of aspiration pneumonia and length of stay were collected from 42 patients in the control group and 51 patients in the experimental group over the 6 months of this study. The data were analyzed using $x^2$-test and t-test. Results: The number of tube feedings in the experimental group was significantly lower than control group (p=.002). The incidence of aspiration pneumonia in the experimental group was not significantly lower than the control group (p=.097). Length of stay in the experimental group was significantly shorter than the control group (p<.001). Conclusion: The results of this study indicate that a standardized nursing intervention program for stroke patients with dysphagia could be useful to decrease tube feedings and length of stay.

Purpose: The purpose for this study was to identify the present working status and tasks of nurse administrators in response to requirements of expanding nurses' roles in hospitals. Methods: The design of the study was descriptive-exploratory. The participants were 338 registered nurses who were working in hospital administrative departments. The data were collected from January 17, to March 20, 2011, and analyzed with descriptive statistics. Results: The majority of nurse administrators worked in quality assurance departments while no nurse administrators assigned in finance/taxation departments. Duties of nurse administrators were developed as 117 tasks in 11 divisions. Conclusion: These results suggest that expanding nurses' roles require developing job descriptions, nursing curricula emphasizing hospital administration, positive relationships with other health professions and a supportive system.

Purpose: The purpose of this study was to identify the types and causes of non-value-added (NVA) activities in nursing practice, and to determine the frequency of each NVA type and causes of NVA in clinical area. Methods: This study was conducted using Delphi technique. First, in order to identify NVA and their causes, 24 nurses with 7 years or more of clinical experience were recruited from medical/surgical units in six general hospitals in Korea. Then the NVA types and causes were tested using a larger sample of 130 nurses with more than 3 years of clinical experience at two general hospitals in Korea. Results: NVA was categorized into 6 different types, which are repeating, duplicating, waiting, reverse-proxy working, reworking, and searching. The most prevalent NVAs were repeating and duplicating works. Reworking and searching were less frequent types than others. The causes of NVA were classified into personnel-related, supporting departments, records, regulations, information, materials or instruments, and others. Among them, personnel-related and supporting departments were reported with the highest scores. Conclusion: NVA leads to waste cost and time. These results demonstrated the situations and causes of NVA occurred in nursing practice. Further studies on the typology and moderation of NVA activities are warranted to improve the efficiency and quality of nursing care in day-to-day practice.

Purpose: Evidence-based practice (EBP) has emerged as a marker for healthcare quality and a global issue in nursing care. This study was conducted to identify Korean registered nurses' knowledge, attitudes, and practice about EBP in Korea. Methods: With a cross-sectional design, the EBP questionnaire (EBPQ) was administered to a convenience sample of nurses (N=453) recruited from 44 general hospitals. To increase the response rate, the directors of nursing were individually contacted by the researchers. The final response rate was 95.7%. Results: The majority of participants were females (99.3%), staff nurses (57.8%), and with bachelors degree (40.6%). Most of them (314, 73.4%) had ever heard about EBP. The overall mean score for the EBPQ was $4.72{\pm}0.69$ out of maximum score of 7. The mean score for the knowledge of EBP, attitudes towards EBP, and practice/use of EBP were $4.61{\pm}0.75$, $4.85{\pm}0.94$, and $4.90{\pm}0.88$, respectively. Educational level, age, and exposure to EBP were statistically significant predictors of Korean nurses' EBP perception. Conclusion: The findings showed that nurses with higher education are more likely to use and value the best available evidence for practice. This study suggests needs not only for further exploration but also for developing educational plans provided by each institute to assist nurses with the process of EBP and the associated skills.

Purpose: This study was to develop a post-operative exercise program, apply it to patients undergone lumbar spinal fusion surgery, and evaluate the effectiveness of the program on pain and disability activities of daily living. Methods: Fifty six patients who had lumbar spinal fusion were enrolled in this study. The patients were divided into two groups; 28 patients in the intervention group completed post-operative lumbar exercise program including walking for four weeks and 28 patients in the control group only did walking exercises. The degrees of pain on low back and leg were evaluated using visual analog scale (VAS) and the functional outcome was evaluated using the Korean version of Oswestry Disability Index (KODI) before surgery and 5 weeks after surgery. The data were analyzed using descriptive statistics, Chi-square test, t-test with SPSS 18.0 program. Results: Low back and leg pain of the participants in both experimental and control groups were improved after surgery compared to pre-surgery pain. However, there was no statistically significant difference between the groups. KODI score in the intervention group was significantly lower than that of the control group (p=.014). Conclusion: The developed post-operative exercise program in patients with lumbar spinal fusion surgery seems to be a useful intervention to reduce disability in activities of daily living.

Purpose: This study was conducted to investigate the incidence of blood hemolysis and repeated blood sampling and to identify factors contributing to hemolysis and repeated blood sampling in the emergency department. Methods: A cross-sectional descriptive design was used. Participants were the patients who came to emergency department and are required a blood sampling for electrolyte level. All blood samples were collected by emergency department nurses and determined for hemolysis by experienced laboratory technologists. Data were analyzed using $x^2$-test, Fisher's exact test, Mann-Whitney u test and Binary Logistic Regression to determine significant differences. Results: A total of 402 valid samples were collected. Of these, 30 blood samples (7.5%) were found to be hemolyzed and 9 (2.2%) to be recollected. Statistically significant factors affecting on hemolysis and repeated blood sampling included the time of bloods sampling (night), the time of tourniquet application, and too-fast blood draw into the test tube. Conclusion: We recommend that nurses who take the blood sampling to consider the findings of the study and take the related factors into account as they set up the standardized care protocol in order for nursing quality improvement.

Purpose: The purpose of this study was to develop and evaluate a new-nurse education program utilizing both e-learning and instructor demonstration. Methods: From August to December in 2009, the e-learning education program about insulin injection was developed. The control (C) group was educated via instructor demonstration from April 15 to October 6 in 2009, and the experimental (E) group was educated via both e-learning and instructor demonstration from January 5 to October 13 in 2010. After each education, knowledge and educational effectiveness were checked. Results: Satisfaction with the education contents in the E group was significantly higher than those of the C group (Z=-3.72, p<.001), and satisfaction with the education method in the E group was higher than those of the C group (Z=-2.98, p=.003). Usefulness (Z=-3.33, p=.001), application (Z=-2.62, p=.009), and confidence (Z=-2.61, p=.009) in the E group were all higher than those of the C group. 78.9% in the E group reused the e-learning program after the experimental education. Conclusion: Combined educational program with e-learning and instructor demonstration had both merits of online efficiency and face-to-face education. It would be useful especially for new-nurses to improve their nursing skills in accomplishing their roles.

Purpose: The purpose of this study was to investigate the sleep patterns and the factors related to sleep disturbance in mechanically ventilated patients in intensive care units (ICUs). Sleep patterns in this study included both quality and quantity of sleep. Methods: Forty-four subjects were recruited in ICUs at a tertiary university hospital in D city. Data were collected using questionnaires, observation, and medical record from June, 2008 to May, 2009. Results: The total mean of sleep quality was $1.99{\pm}1.68$. The mean of total sleep time per 24-hour period was $3.75{\pm}1.94$hour (range 1-7.25) in mechanically ventilated ICU patients. The main sleep disturbance factors were listed as frequent nursing activities, attachment of medical appliances, and noise. All these factors were also significantly related to the sleep quality. Conclusion: These results indicated that mechanically ventilated patients were both qualitatively and quantitatively deprived of sleep far more than other ICU patients. In summary, a deeper understanding of sleep characteristics in mechanically ventilated ICU patients could help nurses to improve sleep derangements and patient outcome.

Purpose: The purpose of this study was to conduct a retrospective investigation on the general characteristics of pressure ulcer and influencing factors of pressure ulcer stage during hospitalization. Methods: A total of 614 patients were selected between January 1, and December 31, 2009 from one acute university hospital if they had pressure ulcers on admission or newly developed pressure ulcer during hospitalization. The data were analyzed using the SPSS WIN 12.0 with percentage, mean, standard deviation, t-test, Chi-square test, ANOVA, and multiple regression analysis. Results: Influencing factors of pressure ulcer stage at discharge were eating (${\beta}=-.068$, p=.047), elimination (${\beta}=-.145$, p<.001), active exercise and movement (${\beta}=-.505$, p<.001), albumin levels (${\beta}=.166$, p<.001), and inflammatory markers (CRP)(${\beta}=-.091$, p=.005). These variables accounted 55.8% of the variance in ulcer stage. Conclusion: Study results indicate that nurses' active role on pressure ulcer care and systematic approach are necessary to manage acutely ill inpatients' pressure ulcers.

Purpose: The purpose of this study was to investigate the predictors of delirium in patients after orthopedic surgery. Methods: Participants were 121 orthopedic surgery patients from one university affiliated hospital located in Seoul. The instrument of Delirium Observation Screening Scale (DOS) developed by Schuurmans et al. (2003) was utilized. Data were collected from September 1st, 2010 to March 31st, 2011 and analyzed using SPSS 12.0 with descriptive statistics, t-test, chi-square test and logistic regression. Results: The delirium in patients after orthopedic surgery was occurred in 9 (7.4%) out of 121 patients. Several factors were associated with the delirium occurrence age, admission route, preadmission Activity of Daily Living (ADL), preadmission hearing aid use, preadmission walking degree, diagnosis, type of surgery, Intensive Care Unit (ICU) stay after surgery, restraint, drainage tube, time of admission to surgery, preoperative albumin and preoperative sodium. Preadmission ADL, preoperative sodium and time of admission to surgery were the significant predictors of the delirium occurrence. Conclusion: Study results may help nurses predicting and detecting delirium early and providing preventive measures to the patients with high risk of delirium after orthopedic surgery.

Purpose: The purpose of this study was to investigate the effects of a structured preoperative PCA education on the knowledge and attitude regarding PCA usage, level of pain, and the consumption of analgesics after operation for colorectal surgery patients. Methods: This study was conducted from 18 Feb to 2 May, 2008. Participants were 80 colorectal cancer patients who would use the IV-PCA after colorectal surgery in a cancer hospital in Gyeonggi-do, Korea. Two groups, experimental and control were consisted of 40 patients each. The 20-minute structured education regarding PCA usage was applied to each patient individually in the experimental group but only the routine anesthetic consultation was given to each patient in the control group the day before the surgery. The SPSS/PC 10.0 program was introduced to analyze the collected data on frequency, percentage, mean, standard deviation, $x^2$-test, t-test and paired t-test. Results: The experimental group with the structured preoperative PCA education showed higher knowledge and more positive attitudes regarding the PCA usage than the control group. Also the experimental group showed better pain control and lower consumption of analgesics at 4, 8 and 24 hours after than the control group. Conclusion: The structured preoperative PCA education is an effective nursing intervention for improving the knowledge and attitude of the colorectal surgery patients on the PCA usage, and enabling the patient to take the analgesic more effectively with lower consumption, while reducing the patients' pain after operation.