Purpose : This study compares experiences of ethical dilemma between nurses working in intensive care units and those in general units under specific situations of treatment decisions and confidentiality. Method : This cross-sectional descriptive study utilizes the self-report survey method. The survey questionnaires were completed by 50 and 52 nurses working in intensive care units and general units, respectively. The instrument, which consisted of 16 items of ethical dilemma situations about treatment decision and confidentiality, was used. The mean scores for each item were compared between the two groups. Results : The study found no differences in terms of age, gender, education level, clinical experience in years, and being educated on healthcare ethics. For 9 out of 16 items, the mean scores of nurses in intensive care units were significantly higher than those of nurses in general units. Conclusions : Nurses in intensive care units experienced ethical dilemmas regarding treatment decisions and confidentiality more often than those in general units. This study emphasizes the need to establish strategies for improving the ethical competence of critical care nurses.

Purpose : This methodological study develops an oral health assessment tool for critically ill patients. Method : From February 15 to April 30, 2014, this study was conducted to test the validity and reliability of the tool at two general hospitals and three medical and surgical intensive care units (ICUs) in Seoul, Korea. Results : The result of the intraclass correlation coefficient to test the between-observer reliability by analyzing the oral health assessment scores before and after oral nursing care showed that .93 of before oral care and .90 of after oral care. The correlation coefficient values of .68 (p<.001) and .71 (p<.001) before and after providing oral nursing care, respectively, indicated the presence of a statistically significant correlation between the tool and the criterion. Using the paired t-test, the differentiated validity of the tool was tested in patients who had developed pneumonia after entering the ICU. A statistically significant difference in scores was found between the time of entering the ICU and that of developing pneumonia (t=-8.73, p<.001), which provided evidence for the differentiated validity of the tool. Conclusions : Since the validity and reliability of the tool developed in this study were verified, this tool can be used to assess the oral health conditions of critically ill patients.

Purpose : This study develops a substantive theory on the recipients' experience of adapting to a permanent pacemaker. Method : The study used the grounded theory method developed by Strauss and Corbin (1998). The participants of the study were 13 adults who had received a permanent pacemaker during the previous year. The study addressed the research question "what is the experience of adaptation in people who had received permanent pacemakers?" From October 2016 to March 2017, data were collected from the participants through in-depth interviews. Results : The core category indicating the essence of the adaptation experience was shown to be "accepting the pacemaker as part of my body and living in line with it." Conclusions : In nursing practice, the results of this study will assist nurses in improving their communications with and developing guidelines or interventions for their clients who have received permanent pacemakers. In the field of nursing education, this study is expected to provide a framework to understand the experiences of future nurses and other healthcare workers working with permanent pacemaker recipients.

Purpose : This study investigates pediatric nurses' knowledge and attitudes regarding iatrogenic narcotic analgesic withdrawal symptoms management (INAWSM). Methods : In this cross-sectional study, 253 pediatric nurses working at a tertiary hospital in Seoul participated. Instruments were the inventory consisting questionnaires on 35 items knowledge and 12 items attitude for INAWSM. Further, descriptive statistics, t-test, and analysis of variance were used to evaluate the nurses' knowledge and attitudes. Results : The correct answers rate of knowledge toward INAWSM was 44.9%. With respect to the pediatric nurses' attitudes, the participants scored an average value of $2.83{\pm}0.25$ out of 4 points. The factor related to the knowledge and attitude level was age, pediatric nursing experience, educational experience, and educational needs. Conclusions : Results revealed that pediatric nurses had inadequate knowledge and attitude on INAWSM despite a compulsory education. Therefore, it is necessary to develop an efficient INAWSM educational program.

Purpose : This study was performed to identify the influencing factors of unplanned intensive care unit (ICU) readmission. Methods : The study adopted a Rretrospective case control cohort design. Data were collected from the electronic medical records of 844 patients who had been discharged from the ICUs of a university hospital in Incheon from June 2014 to December 2014. Results : The study found the unplanned ICU readmission rate was to be 6.4%(n=54). From the univariate analysis revealed that, major symptoms at $1^{st}$ ICU admission, severity at $1^{st}$ ICU admission (CPSCS and APACHE II), duration of applying ventilator application during $1^{st}$ ICU admission, severity at $1^{st}$ discharge from ICU (CPSCS, APACHE II, and GCS), and application of $FiO_2$ with oxygen therapy, implementation of sputum expectoration methods, and length of stay of ICU at $1^{st}$ ICU discharge were appeared to be significant; further, decision tree model analysis revealed that while only 4 variables (sputum expectoration methods, length of stay of ICU, $FiO_2$ with oxygen therapy at $1^{st}$ ICU discharge, and major symptoms at $1^{st}$ ICU admission) were shown to be significant. Conclusions : Since sputum expectoration method was the most important factor to predictor of unplanned ICU readmission, a assessment tool for the patients' capability of sputum expectoration needs to should be developed and implemented, and standardized ICU discharge criteria, including the factors identified from the by empirical evidences, might should be developed to decrease the unplanned ICU readmission rate.

Purpose : This study examined the factors influencing posttraumatic and conflict management styles for nursing performance in intensive care units (ICUs). Methods : In this study, 250 nurses from eight general hospitals in three cities participated. Structured self-report questionnaires were used to collect data on posttraumatic, conflict management styles, and nursing performance. Finally, the data were analyzed by SAS 9.3 program. Results : The mean of total sum scores was 31.29, and the high risk of posttraumatic symptoms was 61.2%. It was noted that nursing performance is significantly correlated with collaboration, compromise, accommodation styles, and intrusion. Collaboration styles (${\beta}=0.39$, p<.001) and hyperarousal (${\beta}=-0.22$, p=.050), ICU experience below 1 year (${\beta}=-0.21$, p=.027) and that of 5-10 years (${\beta}=-0.19$, p=.049), and compromise style (${\beta}=0.16$, p=.049) were found to be the factors influencing nursing performance with 35.9% explanatory power value of regression model. Conclusions : The results of the study reveal that conflict management styles, hyperarousal, and ICU experience are factors predicting the successful performance of ICUs. These findings emphasize the need of developing interventions to reduce stress symptoms and conflicts in ICUs.

Purpose : This study develop a Video Recording-Based Standardized Handoff (VRSH) program at shift change for ward nurses. Methods : The study was conducted in five medical, three surgical, and one comprehensive nursing care service wards affiliated with a secondary general hospital. In this methodological study, the VRSH program was developed between April and December, 2017. It is noted that 65 nurses who were involved in the VRSH program participated in this study. Results : In line with the modified Situation, Background, Assessment, Recommendation tool, the VRSH program consisted of three phases. In the VRSH program, the average time for handoff duration was 3-5 minutes per patient. More than 90% of the ward nurses were satisfied with the VRSH program since it benefited them by reducing overtime work and improving the performance, as well as effective communication, of nurses. The content analysis of nurses' VRSH program experience, revealed three categories and eight sub-categories. Conclusions : This study provides evidence that the VRSH program improves effective nursing performance and, the handoff communication and relationships between nurses. Future studies on large sample sizes and multiple settings are required to substantially evaluate the impact of the VRSH program on clinical outcomes.

Purpose : The purpose of this study was to identify the association between safety care activity and documentation of nursing records among nurses working in hospitals and to provide basic data for developing hospital policy for the documentation of nursing records. Methods : By using a self-reported questionnaire, data were collected from 212 nurses working in six general hospitals in Jeju province from November 2015. Data were analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation coefficients, and stepwise multiple regression with the SAS WIN 9.2 program. Results : Safety care activity was positively correlated with the documentation of nursing records (r=.83, p<.001). The documentation of nursing records was significantly predicted by safety care activity, working department, and nursing delivery system, and 70.9% of the variance in the documentation of nursing records was explained (F=172.31, p<.001). Conclusions : In this study, safety care activity was the most influencing factor for the documentation of nursing records. Improving work circumstances and building a system are required for nurses' safety care activity to lead to good documentation of nursing records.

Purpose : This study aimed to investigate the public's perception of reimbursement for the education and counseling services provided to advanced practice nurses in intensive care units. Method : This was a secondary data analysis study. The original data were collected utilizing an online panel. The sample comprised 615 individuals aged between 19 and 49 years nationwide. The study variables included the public's perception of reimbursement for education and counseling services, age, gender, education level, income, and health status. Variables such as past experience of being admitted to an intensive care unit by self, family, or relatives and the recognition of advanced practice nurses were also examined. Results : The mean of the perception score was 3.15 on a 4-point scale ranging from 1 (strongly disagree) to 4 (strongly agree). Among the participants, 89.2% answered "somewhat agreed" or "strongly agreed" to the question about the education and counseling services being covered by the National Health Insurance. Moreover, education level, past experience of being admitted to an intensive care unit by self, family, or relatives, and recognition of advanced practice nurses were significantly associated with the perception score. Conclusion : Efforts should be made to publicize the need for the education and counseling services that are provided to advanced practice nurses in intensive care units.

Purpose : This study evaluated the nutritional status and effect of nutritional support team (NST) management in critically ill patients. Methods : From January 2015 to August 2017, the study retrospectively investigated 128 patients aged above 19 years admitted to a medical intensive care unit (MICU). The patients were divided into two groups: NST (n=65) and non-NST (n=63) groups. Nutritional status, classification of bedsore risks, incidence rate of bedsore and clinical outcomes were compared. Results : The study found a higher rate of the use of enteral nutrition in the NST group (${\chi}^2=45.60$, p < .001). The prescription rate of parenteral nutrition (PN) was found to be lower in the NST group (4.6%) compared to the non-NST group (60.3%). There was a higher PN of total delivered/required caloric ratio in the NST, compared to the non-NST, group (${\chi}^2=3.33$, p=.025). There were significant differences for higher albumin levels (t=2.50, p=.014), higher total protein levels (t=2.94, p=.004), and higher proportion of discharge with survival rates (${\chi}^2=18.26$, p < .001) in the NST group. Conclusions : Providing NST management to critically ill patients showed an increase in the nutrition support. Further, to achieve effective clinical outcomes, measures such as nutrition education and continuous monitoring and management for the provision of nutritional support by the systemic administration of a nutritional support team should be considered.