Purpose: The purpose of this study is to investigate the association between the nurse staffing level and the patient mortality using Korean National Health Insurance data. Methods: The data of 1,068,059 patients from 913 hospitals between 2015 and 2016 were analyzed. The nurse staffing level was categorized based on the bed-to-nurse ratio in general wards, intensive care units (ICUs), and hospitals overall. The x² test and generalized estimating equations (GEE) multilevel multivariate logistic regression analyses were used to explore in-hospital mortality and 30-day mortality after admission. Results: The in-hospital mortality rate was 2.9% and 30-day mortality after admission rate was 3.0%. Odd Ratios (ORs) for in-hospital mortality were statistically lower in general wards with a bed-to-nurse ratio of less than 3.5 compared to that with 6.0 or more (OR=0.72, 95% CI=0.63~0.84) and in ICUs with a bed-to-nurse ratio of less than 0.88 compared to that with 1.25 or more (OR=0.78, 95% CI=0.66~0.92). ORs for 30-day mortality after admission were statistically lower in general wards with a bed-to-nurse ratio of less than 3.5 compared to that with 6.0 or more (OR=0.83, 95% CI=0.73~0.94) and in ICUs with a bed-to-nurse ratio of less than 0.63 compared to that with 1.25 or more (OR=0.85, 95% CI=0.72~1.00). Conclusion: To reduce the patient mortality, it is necessary to ensure a sufficient number of nurses by improving the nursing fee system according to the nurse staffing level.

Purpose: Extravasation of diagnostic and therapeutic materials might occur when the intravascular solution leaks into the surrounding tissues. Injury associated with extravasation depends on various factors. It may range from mild skin reaction to severe necrosis. However, the incidence rate for extravasation is largely unknown because of the limited reporting in Korea. Therefore, this study was conducted to identify the incidence of extravasation and nurses' attitude and knowledge of extravasation for providing high-quality nursing care. Methods: Three acute care hospitals were surveyed to estimate the occurrence of extravasation. Knowledge and attitude toward extravasation were investigated from 793 nurses working in six hospitals. Results: The incidence rate of extravasation was 0.5%. Extravasation commonly occurred in elderly patients aged 66 or older (59.9%) and internal medicine (48.2%), and it happened 13.73±20.68 days after hospitalization on average. It mostly occurred in the forearm site (52.9%) and was mainly caused by parenteral nutrition (33.6%). The mean scores of nurses' knowledge and attitude were 14.63±2.86 and 28.91±36.00, respectively. There was a significant negative correlation between the subjects' knowledge and attitude (r=-.11, p=.002). Conclusion: It is necessary to have a reporting system that can accurately monitor the occurrence of extravasation for patient safety management. In addition, it is necessary to develop a protocol that can be applied to clinical practice and a nurse education program.

Purpose: This study aimed to identify the relationships among disease severity, anxiety, depression, social support, unpleasant symptoms and self-care among patients with atrial fibrillation based on the unpleasant symptom theory, and to examine the mediating effects of unpleasant symptoms. Methods: A cross-sectional study was conducted. The participants were 216 patients with atrial fibrillation who were being followed up on an outpatient basis at a university hospital in Seoul. Data were collected from November 1, 2020 to June 30, 2021, using self-report questionnaires. Data were analyzed using IBM SPSS/WIN 27.0 and PROCESS macro with 95% bias-corrected bootstrap confidence interval(CI). Results: The average age of participants in this study was 66.0years. Disease severity (β=10.19, p<.001) and depression (β=1.53, p<.001) had significant positive relationships with unpleasant symptoms. Also, unpleasant symptoms (β=-0.03, p=.006) had a negative relationship with physical activity, which is a subscale of self- care. Social support (β=0.06, p<.001) was positively related with physical activity. Unpleasant symptoms showed a mediation effect in the relationship between disease severity and physical activity (Bias corrected bootstrap CI -0.65, -0.04). Depression had an indirect effect on physical activity that was mediated by unpleasant symptoms (Bias corrected bootstrap CI -0.11, -0.00). Conclusion: The findings of this study suggest that integrated strategies including physical, psychological, and social factors should be considered to promote self-care in patients with atrial fibrillation.

Purpose: The purpose of this study was to examine the level of Person-centered Critical Care Nursing (PCCN) and the factors influencing PCCN for nurses in Intensive Care Units (ICU). Methods: This study was designed by cross-sectional descriptive correlational study. The participants included 147 ICU nurses in two general hospitals in Seoul, Korea. Demographic characteristics, PCCN, communication skills, professionalism, and work environment were measured. The collected data were analyzed using descriptive statistical analysis, independent t-test, One-way ANOVA, Pearson's correlation coefficient, and stepwise multiple linear regression with the SPSS/Win 25.0 program. Results: The average age of the participants was 29.6±4.7 years and the mean work experience in the ICU was 4.67±3.52 years. The level of PCCN was 3.70±0.41, which was moderate to high, and it significantly showed a positive correlation with therapeutic communication skills (r=.66, p<.001), global interpersonal communication competence (r=.42, p<.001), professionalism (r=.38, p<.001), and work environment (r=.16, p=.048). The factors influencing PCCN were identified as therapeutic communication skill and global interpersonal communication competence (Adj R²=.45, p<.001). Conclusion: The findings of this study were confirmed that the strategies to promote PCCN are necessary to enhance therapeutic communication skill and global interpersonal communication competence. In addition, they may be particularly meaningful in providing basic data for nursing education and future intervention development research to promote PCCN for the ICU nurses. For improving PCCN for healthcare providers in ICU, further studies should be conducted to develop education and intervention programs.

Purpose: The purpose of this study was to evaluate risk factors of pressure injuries in patients after neurosurgery. Methods: A retrospective case-control study was conducted using 273 patients undergoing neurosurgery admitted to a general hospital from 2015 to 2021. Data were collected from September 1 to 30, 2021. The data were analyzed using the SPSS/WIN 26.0 program. Results: Risk factors significantly influencing the occurrence of pressure injuries in the patients undergoing neurosurgery were hypertension (OR=3.12, p=.024), postoperative hypoalbuminemia (OR=0.30, p=.028), and prolonged operative duration (OR=1.00, p=.001). The regression model explained 86.0% of the variance of the outcome variable. Conclusion: In order to prevent surgery-related pressure injuries in patients undergoing neurosurgery, thorough blood pressure management, avoidance of hypoalbuminemia, and preventive nursing intervention considering operative duration are required.

Purpose: This study was conducted to explore the relationships among new nurses' meaning of work, organizational commitment, professional self-image, and retention intention through path analysis. Methods: The participants were 872 nurses with less than a year of clinical experience working at general or tertiary hospitals over 500 beds in Korea. The data were collected using structured questionnaires from May 15, 2021 to June 28, 2021, and analysis was conducted using SPSS/WIN 22.0 and AMOS 21.0 programs. Results: Retention intention was explained by meaning of work, organizational commitment, and professional self-image, its explanatory power was 46.5%. The mediating effect of professional self-image was found on the relationship between meaning of work and retention intention. Conclusion: To encourage the retention intention among new nurses, an environment where new nurses can set a high value on the meaning of work and sense of accomplishment should be created, and a strategy to improve organizational commitment and professional self-image should be established.

Purpose: The purpose of this study is to identify the factors influencing the intention to report child abuse of emergency room nurses based on the health belief model. Methods: This was a descriptive study that used a cross-sectional design. A total of 188 emergency room nurses working at general hospitals with more than 300 beds in Seoul participated in the study. Data were analyzed using descriptive statistics, t-test, ANOVA, Pearson's correlation coefficient and multiple regression analysis with the SPSS 25.0 program. Results: Correlations and regression analyses showed that the perceived severity (β=.14, p=.024), perceived barrier (β=-.25, p<.001), and self-efficacy (β=.31, p<.001) were factors influencing emergency room nurses' intention to report child abuse, and the explanatory power of the model was 33.0%. Conclusion: The results of this study related to the health belief model, being a valid theoretical basis for child abuse reporting intention research, significantly suggest new research directions in the future. In addition, to increase the nurses' intention to report child abuse in the emergency room, the influencing factors identified in this study can be utilized and develop specific interventions using the health belief model.

Purpose: The purpose of this study was to examine the psychological distress related to quality of life (QoL) of patients with colorectal cancer receiving 5-fluorouracil (5-FU) chemotherapy at home with disposable Elastomeric infusion pumps. Methods: In this study, 179 colorectal outpatients were recruited between September 2019 and January 2021. National Cancer Center Psychological Symptom Inventory scores, general self-efficacy, and the EORTC QLQ-C30 scores were measured. Data were analyzed using Independent t-test, One-way ANOVA with Bonferroni post hoc analysis, and hierarchical multiple linear regression with the SPSS/WIN 26.0 programs. Results: The overall prevalence of psychological distress was 52.0% in colorectal patients. In multiple regression, psychological distress (β=-.20, p=.005), appetite loss (β=-.20, p=.001), chemotherapy cycles (β= .19, p=.002), fatigue (β=-.16, p=.035), physical functioning (β=-.16, p=.024), and emotional functioning (β=-.15, p=.025) were significant factors of QoL, and the final model explained 45.0% of the total variance of QoL. Conclusion: Supporting patients toward decreased psychological distress and increased physical and emotional functioning, especially in the first or second cycle of chemotherapy, could be used to improve their QoL. To consider the thresholds for clinical importance, it is necessary to increase the interpretation of psychological distress in clinical practice and further research.