Purpose: The purpose of this study was to identify which nursing interventions are the most effective in fall prevention for hospitalized patients. Methods: From 3,675 papers searched, 34 were selected for inclusion in the meta-analysis. Number of fallers, falls, falls per 1,000 hospital-days, and injurious falls, fall protection activity, knowledge related to falls, and self-efficacy about falls were evaluated as outcome variables. Data were analyzed using the Comprehensive Meta Analysis (CMA) 2.2 Version program and the effect sizes were shown as the Odd Ratio (OR) and Hedges's g. Results: Overall effect size of nursing interventions for fall prevention was OR=0.64 (95% CI: 0.57~0.73, p <.05) and Hedges's g= - 0.24. The effect sizes (OR) of each intervention ranged from 0.34 to 0.93, and the most effective nursing intervention was the education & environment intervention (OR=0.34, 95% CI: 0.28~0.42, p<.001), followed by education intervention (OR=0.57, 95% CI: 0.50~0.67, p=.001). Subgroup analyses showed that multifaceted interventions (OR=0.76, 95% CI: 0.73~0.79, p<.001) were more effective than unifactorial interventions, and that activities for prevention of falls (OR=0.08, 95% CI: 0.05~0.15, p<.001) showed the largest effect size among outcome variables. Conclusion: Falls in hospitalized patients can be effectively prevented using the nursing interventions identified in this study. These findings provide scientific evidence for developing and using effective nursing interventions to improve the safety of hospitalized patients.

Purpose: This study identified effects of dietary and physical activity interventions including dietary interventions or physical activity interventions alone or combined dietary-physical activity interventions to improve symptoms in metabolic syndrome including abdominal obesity, high triglycerides, low high density lipoprotein cholesterol, elevated blood pressure, and elevated fasting glucose through meta-analysis. Methods: Articles on metabolic syndrome X published from 1988 to 2013 were searched through electronic databases, Google Scholar, and reference reviews. Methodological quality was assessed by the checklist, SIGN (Scottish Intercollegiate Guidelines Network). Results: In the meta-analysis, there were 9 articles reporting 13 interventions with 736 participants. Using random effect models, the dietary and/or physical activity interventions showed a lower mean difference in waist circumference ( - 1.30 cm, 95% CI: - 2.44~ - 0.15, p=.027). The combined dietary-physical activity interventions showed a lower mean difference in waist circumference ( - 2.77 cm, 95% CI: - 4.77~ - 0.76, p=.007) and systolic blood pressure ( - 5.44 mmHg, 95% CI: - 10.76~ - 0.12, p=.044). Additionally, interventions of over 24 weeks yielded a lower mean difference in waist circumference ( - 2.78 cm, 95% CI: - 4.69~ - 0.87, p=.004) and diastolic blood pressure ( - 1.93 mmHg, 95% CI: - 3.63~ - 0.22, p=.026). Conclusion: The findings indicate that dietary and/or physical activity interventions for metabolic syndrome reduce central obesity with no adverse effects. This finding provides objective evidences for dietary and physical activity management on metabolic syndrome as an efficient intervention.

Purpose: The purpose of this paper was to discuss the need for translation studies in dementia care and current translational endeavors, and to provide recommendations for evolving evidence-based dementia care. Methods: A literature review yielded current evidence and translational efforts. Results: Dementia care interventions need to be implemented at various service levels. Barriers to translation include evidence gaps, lack of the use of a conceptual framework to explain the implementation process, and unsupportive funding mechanisms for applying innovations. Conclusion: There is clear evidence of the need for and benefits of evidence-based dementia care for patients with dementia, family caregivers, and care professionals. The urgent need now is finding ways to advance translational activities and facilitate future research into translation science.

Purpose: The purpose of this study, which was guided by the Resiliency Model of Family Stress, Adjustment, and Adaptation, was twofold: (a) to explore family and parental adaptation and factors influencing family adaptation in Korean families of children with Down syndrome (DS) through a quantitative methodology and (b) to understand the life with a Korean child with DS through a qualitative method. Methods: A mixed-methods design was adopted. A total of 147 parents of children with DS completed a package of questionnaires, and 19 parents participated in the in-depth interviews. Quantitative and qualitative data were analyzed using stepwise multiple regression and content analysis respectively. Results: According to the quantitative data, the overall family adaptation scores indicated average family functioning. Financial status was an important variable in understanding both family and parental adaptation. Family adaptation was best explained by family problem solving and coping communication, condition management ability, and family hardiness. Family strains and family hardiness were the family factors with the most influence on parental adaption. Qualitative data analysis showed that family life with a child with DS encompassed both positive and negative aspects and was expressed with 5 themes, 10 categories, and 16 sub-categories. Conclusion: Results of this study expand our limited knowledge and understanding concerning families of children with DS in Korea and can be used to develop effective interventions to improve the adaptation of family as a unit as well as parental adaptation.

Purpose: The purpose of this study was to identify and understand nurses' experiences of the death of patients in geriatric hospitals. Methods: Van Manen's hermeneutic phenomenological analysis was applied in the interpretation of experiential descriptions of seven nurses who had experienced the death of patients in a geriatric hospital. Results: The essential subjects derived from the experience of the nurses on the death of patients in a geriatric hospital are covered in the following 7 themes. 'Placed in death site', 'Difficult repetition of death and farewell', 'Emotional waves that rushes in after farewell', 'Dilemmas in a place with no preparation to greet expected death', 'Getting dull from continually being struck with sorrow', 'Being together with living death', and 'Showing courtesy for a good farewell and living well'. Conclusion: The results of this research will contribute to the development of policy on all the deaths of patients in geriatric hospitals and suggest basic data that need to be applied in real practice and directions to introduce plans for realistic improvements in nursing care of deathbed patients in geriatric hospitals.

Purpose: The usability, user satisfaction, and impact of electronic nursing record (ENR) systems were investigated. Methods: This mixed-method research was performed as a time-motion (TM) study and a survey which were carried out at six hospitals between August and November 2013. The TM study involved 108 nurses from medical, surgical, and intensive care units at each hospital, plus an additional 48 nurses who served as nonparticipating observers. In the survey, 1879 volunteer nurses completed the Impact of ENR Systems Scale, the System Usability Scale, and a global satisfaction scale. Qualitative and quantitative analyses were performed. Results: The mean scores for the ENR impact, system usability, and satisfaction were 4.28 (out of 6), 58.62 (out of 100), and 74.31 (out of 100), respectively, and they differed significantly between hospitals (F=43.43, p<.001, F=53.08 and p<.001, and F=29.13 and p<.001, respectively). A workflow fragmentation assessment revealed different patterns of ENR system use among the included hospitals. Three user characteristics-educational background, practice period, and experience of using paper records-significantly affected the system usability and satisfaction scores. Conclusion: The system quality varied widely among the ENR systems. The generally low-to-moderate levels of system usability and user satisfaction suggest many opportunities for improvement.

Purpose: This study was conducted to develop and test the effects of a motivational interviewing self-management program for use with elderly patients with diabetes mellitus. Methods: A non-equivalent control group pretest-posttest design was used. The participants were 42 elderly diabetic patients (experimental group: 21, control group: 21). The motivational interviewing self-management program for elders with diabetes mellitus developed in this study consisted of a 12-week program in total (8 weeks for group motivational interviewing and education and 4 weeks for individual motivational interviewing on the phone). Data were collected between February 13 and May 3, 2013 and were analyzed using t-test, paired t-test, and repeated measure ANOVA with SPSS/WIN 18.0. Results: For the experimental group, significant improvement was found for self-efficacy, self-care behavior, glycemic control and quality of life (daily life satisfaction, influence of disease) as compared to the control group. Conclusion: The study findings indicate that the motivational interviewing self-management program is effective and can be recommended as a nursing intervention for elderly patients with diabetes mellitus.

Purpose: To investigate the validity and reliability of the Korean Version of the Assault Response Questionnaire (ARQ-K) measuring the intensity of reaction to victimization of emergency nurses in Korea. Methods: An internal consistency reliability and construct validity using exploratory and confirmatory factor analysis were conducted using SPSS WIN (20.0) and AMOS (20.0). Survey data were collected from 321 nurses who worked in 3 levels - wide regional emergency centers, regional emergency centers, appointed emergency centers - of emergency care facilities in Busan, Korea. Results: The Cronbach's alpha values regarding internal consistency were .77~.93 for the subscales of ARQ-K. Factor loadings of the 26 items on the four subscales ranged from .59 to .84. The four-subscale model was validated by confirmatory factor analysis (${\chi}^2/df=3.85$, p<.001, RMR=.06, GFI=.80, NFI=.81, TLI=.83, CFI=.85, RMSEA=.09). Conclusion: This study shows that the Korean Version of the Assault Response Questionnaire is a valid and reliable instrument to assess nurses' reaction to victimization of emergency nurses in Korea.

Purpose: The purpose of this study was to develop and evaluate a self-management program based on INR monitoring for patients with cardiac valve replacement. Methods: This program was comprised of five weekly sessions based on Sousa's Enhance-Behavior Performance Model. The first session included individual teaching, and the other four sessions included Prothrombin Time International Normalized Ratios (PT INR) self-monitoring, telephone counseling and self-management checklist recording. Participants were patients who had cardiac valve replacement. They were randomly assigned to the experimental or control group. Sixteen in the experimental group participated in the self-management program and seventeen in the control group participated in general care. Self-management knowledge, self-efficacy, self-management behavior and PT INR were measured as dependent variables. Data were analyzed using Mann Whitney U-test, t-test and ANCOVA. Results: The experimental group showed significantly higher post-test scores in self-management knowledge (t=5.86, p<.001), self-efficacy (F=18.32, p<.001), and self-management behavior (t=3.44, p=.002) compared to the control group. Also, the experimental group showed significantly higher frequency in maintaining the treatment range of PT INR compared to the control group (${\chi}^2=4.80$, p=.028). Conclusion: The results of the research on the self-management program based on PT INR monitoring showed that it is effective in improving self-management knowledge, self-efficacy, and self-management behavior as well as maintaining treatment range of PT INR of patients with cardiac valve replacement.

Purpose: The purpose of the study was to examine mission statements and their elements and to investigate correlations between mission statements and organizational performance. Methods: The current research was a descriptive study based on the examination of mission statements of 353 hospitals that posted mission statements on their webpage and 92 hospitals that made their income statements public. Results: The most common mission element was 'identification of principal services', which accounted for 92.6%. Mission statements of hospitals included the average of 4.82 mission elements out of 9, and the objective of medical quality improvement was 0.81 among 6 objectives of IOM (Institute of Medicine). Net profit of hospitals with mission statements that have above average number of mission elements were significantly higher (t=2.71, p=.008) than those of other hospitals. Net profit was significantly correlated with mission statements (r=.26, p<.001), and mission elements (r=.29, p<.001). Conclusion: The results of the study empirically reveal that mission statements in the hospital affect organizational performance. That is, better organizational performance is shown for hospitals with better, more diversified, and more firmly stated mission statements which include identification of target customers, identification of principal services, contribution to society as a non-profit organization, and concern for employees.

Purpose: The purpose of this study was to develop a self-management program applying Dongsasub training based on self-efficacy theory, and to verify the program effectiveness on self-esteem as well as self-efficacy, self-management behaviors, and blood pressure. Methods: The study design was a non-equivalent, pre-post controlled quasi-experiment study. Thirty-eight patients aged 65 and older from a senior welfare center in Seoul participated in this study (20 patients in the experimental group and 18 patients in the control group). The self-management program applying Dongsasub training consisted of eight sessions. After development was complete the program was used with the experimental group. Outcome variables included self-efficacy, self-esteem, self-management behaviors measured by questionnaires, and blood pressure measured by electronic manometer. Results: Self-efficacy (t=2.42, p=.021), self-esteem (t=2.57, p=.014) and self-management behaviors (t=2.21, p=.034) were significantly higher and systolic blood pressure (t=-2.14, p=.040) was significantly lower in the experimental group compared to the control group. However, diastolic blood pressure (t=-.85, p=.400) was not significantly different between the two groups. Conclusion: The results indicate that the self-management program applying Dongsasub training can be used as a nursing intervention in community settings for improving self-management behaviors for older adults with hypertension.

Purpose: To identify the effects of foot reflexology massage on fatigue, stress and depression of postpartum women. Methods: A nonequivalent control group pre-post design was used. A total of 70 women in a postpartum care center were recruited and were assigned to the experimental group (35) or control group (35). Foot reflexology massage was provided to the experimental group once a day for three days. Data were collected before and after the intervention program which was carried out from December, 2013 to February, 2014. Data were analyzed using Chi-square test, Fisher's exact test, and t-test. Results: The level of fatigue in the experimental group was significantly lower than the control group (t= - 2.74, p=.008). The level of cortisol in the urine of women in the experimental group was significantly lower than the control group (t= - 2.19, p=.032). The level of depression in the experimental group was significantly lower than the control group (t= - 3.00, p=.004). Conclusion: The results show that the foot reflexology massage is an effective nursing intervention to relieve fatigue, stress, and depression for postpartum women.

Purpose: The purpose of this study was to identify the factors relating to resilience for adolescents with leukemia and examine the relationship between these factors. Methods: From June to September in 2014, 199 adolescents aged 11 to 21 participated in the study as they visited the out-patient clinic at C university hospital for follow-up care. To verify the predictors and the effects of resilience, uncertainty, symptom distress, perceived social support, spiritual perspective, defensive coping, courageous coping, hope, and self-transcendence were measured. Collected data were analyzed using hierarchical regression analysis with the SAS statistics program. Results: The final regression model showed that courageous coping, hope, and self-transcendence were significant predictors related to resilience in adolescents with leukemia and explained for 63% of the variance in resilience. Conclusion: The findings indicate that adolescent-oriented intervention programs enhancing courageous coping, hope, and self-transcendence should be provide for adolescents with leukemia in order to overcome illness-related stress and support physical, psychological and social adjustment.

Purpose: The purpose of this study was to investigate the levels of physical symptoms, anxiety, depression, and quality of life (QOL) during chemotherapy for colorectal cancer patients in South Korea and to identify factors influencing their QOL. Methods: Data were collected from 144 colorectal cancer patients receiving chemotherapy during 2012 at one general hospital located in Seoul. Physical symptoms were measured by the M. D. Anderson Symptom Inventory-Gastrointestinal Cancer Module, and anxiety and depression were measured by the Hospital Anxiety Depression Scale. QOL was measured by the Functional Assessment of Cancer Therapy-Colorectal. Data were analyzed using descriptive statistics, t-test, one-way ANOVA, $Scheff{\acute{e}}$ post hoc test, Pearson correlation and stepwise multiple regression. Results: Mean age of the participants was 56.6 and most of them were not employed. In terms of cancer stage, 38.2% were in stage 3, followed by stage 4 (34.7%). The most frequent symptom was lack of appetite, followed by sleep disturbance and fatigue. The mean score for anxiety was 5.40 with a prevalence of 23% and that of depression 8.85 with a prevalence of 64.6%. The mean score for quality of life was 81.93 out of 136 and 75.3% of the variance in QOL was explained by depression, symptoms, anxiety, treatment place, and occupational status. Depression was the strongest predictive factor. Conclusion: Oncology professionals need to pay special attention to relieving depression as well as physical symptoms to improve QOL during chemotherapy for colorectal cancer patients.

Purpose: The purpose of this study was to develop a scale to evaluate empowerment in woman with breast cancer and to examine the validity and reliability of the scale. Methods: The development process for the initial items included a literature review, interviews, and construction of a conceptual framework. The identified items were evaluated for content validity by experts, resulting in 3 factors and 48 preliminary items. Participants were 319 women with breast cancer recruited to test reliability and validity of the preliminary scale. Data were analyzed using item analysis, confirmatory factor analysis, criterion related validity, internal consistency and test-retest reliability. Results: The final scale consisted of 30 items and 3 factors. Factors, including 'intrapersonal factor' (14 items), 'interactional factor' (8 items), and 'behavioral factor' (8 items), were drawn up after confirmatory factor analysis. Goodness of fit of the final research model was very appropriate as shown by ${\chi}^2/df=1.86$, TLI=.90, CFI=.92, SRMR=.06, and RMSEA=.05. Criterion validity was evaluated by total correlation with the Cancer Empowerment Questionnaire .78. Cronbach's alpha for total items was .93 and test-retest reliability was .69. Conclusion: Findings from this study indicate that the scale can be used in the development of nursing interventions to promote the empowerment of women having breast cancer.