Purpose: This study was performed to identify the key elements for the improvement of healthcare services for foreigners in Korea. Method: Delphi technique was used for this study. As the members of an expert panel for this study, 32 healthcare professionals, who were physicians, nurses, administrators, and care coordinators, with at least 6 months of experiences in international clinics and healthcare services in five metropolitan areas in Korea participated. Data collections were conducted three times from August to October, 2009. The priority and the importance were analyzed using descriptive statistics in SPSS Win 15.0. Result: The key element selected most frequently by the experts was the 'Healthcare providers' abilities for foreign languages' followed by 'Guidelines for facing medical accidences and disputes', 'Information and guide for healthcare services written in English', 'Informed consent preventing medical disputes', 'System of healthcare service fees for foreigners'. Conclusions: The key elements for the improvement of healthcare services for foreigners in Korea were mostly the requirements for effective communication with the foreign clients and the systemic support. The key elements identified in this study can be applied usefully for the development of strategies to improve the quality of healthcare services for foreigners.

Purpose: The purpose of this study was to examine the effects of preceptor nurses' self-leadership on role recognition and job satisfaction. Method: The participants were 171 preceptor nurses worked in one of three general hospitals in Seoul. The data were collected from April 12 to May 12, 2011 and analyzed using descriptive statistics, t-test, ANOVA, pearson correlation, Scheffe, and regression with SPSS Win 19.0 program. Result: The results of the study were as followed. The average score for preceptor nurses' self-leadership was 3.55, for role recognition, 3.81 and for job satisfaction, 3.28. The factors of the preceptors' self-leadership affecting role recognition were self-expectation (${\beta}$=260, p=.002) and goal setting (${\beta}$=199, p=.030), and those factors accounted for 18.9% of explanatory power. The factors of self-leadership influencing job satisfaction were self-expectation (${\beta}$=18.3, p=.021), and rehearsal (${\beta}$=-168, p=.030), and those factors accounted for 31.3% of explanatory power. Among the factors of self-leadership, self-expectation influenced both role recognition and job satisfaction. Conclusions: The results of the study indicate that to improve preceptor's role recognition and job satisfaction, there should be special training programs to enhance preceptor's self leadership.

Purpose: This study was done to examine the relationships among practice environment, nursing professionalism, career commitment, and turnover intention in nurses working in small-medium sized hospitals. Method: This study utilized a descriptive correlational design. Data were collected using structured questionnaires from 362 nurses in 7 small-medium sized hospitals and analyzed with SPSS 18.0. Result: The mean scores for practice environment, nursing professionalism, career commitment, and turnover intention were 2.29 on a 4-point scale and 3.13, 2.78, 3.51 on a 5-point scale, respectively. The practice environment showed significantly positive correlations with nursing professionalism and career commitment. Nursing professionalism showed a significantly positive correlation with career commitment. The highest significant negative correlation was between practice environment and turnover intention. Nursing professionalism and career commitment had negative correlations with turnover intention. Factors having significant influence on turnover intention included age, assigned ward, average wage, practice environment, and career commitment. These factors explained 43.0% of variance in turnover intention. Practice environment was identified as the most important variable in explaining turnover intention. Conclusions: The results of this study demonstrate the necessity of improving the practice environment and increasing nurses' career commitment if turnover intention in small-medium sized hospitals is to be lowered.

Purpose: This study was done to identify the relationship between transformational leadership by head nurses and positive psychological capital, psychological well-being, stress and somatization of staff nurses. Method: Participants in this study were 300 staff nurses in general hospitals located in G and B cities. Data were collected using self-administered questionnaires and analyzed using SPSS Win 18.0 program. Result: The major findings were as follows; 1) There were positive influences of transformational leadership on positive psychological capital, psychological well-being, and a negative effect on stress. 2) Positive psychological capital had a positive influence on psychological well-being, and negative effects on stress and somatization. 3) In the analysis of the mediating role of the positive psychological capital, transformational leadership was shown to indirectly affect psychological well-being and stress through positive psychological capital. Conclusions: These findings suggest that transformational leadership has important influences on employees' psychological well-being and stress via employees' positive psychological capital. To enhance psychological well-being and reduce stress for nurses, it is important to develop not only the leadership of head nurses but also the positive psychological capital of staff nurses.

Purpose: The purpose of this study was to examine nurses' cognition of the diagnosis related group (DRG) in long-term care hospitals and changes in nursing care after application of the DRG system. Method: This study was a descriptive survey involving 161 nurses working in 12 long-term care hospitals located in Gwangju city and Chonnam area. Data were analyzed using the SPSS 18.0 version program. Data analyses utilized descriptive test, chi-square test, Fisher's exact probability test, t-test, and one-way ANOVA. Result: There was no change in cognition of DRG in 55.3% of the nurses, and 26.1% takes to 'change positively'. More than half of the respondents (57.8%) agreed to the application of DRG. After application of DRG, the nurses responded 'there were changes in nursing care' in 23 of the 25 care items. Two items had an increase in nursing care. Conclusions: No distinct changes in nursing care were evident after DRG application. Therefore, there is need to provide education programs related to DRG for nurse in long-term care hospitals.

Purpose: The purpose of this study was to explore the use of outcome indicators and perception of outcome evaluation of oncology advanced practice nurses (APNs). Method: A total of 111 oncology APNs from hospitals which have over 400 beds were surveyed. The participants' use of outcome indicators and perception of outcome evaluation were collected using a questionnaire including 84 outcome indicators for APNs developed by Sung et al. and 13 items on APNs' contribution to the hospitals developed by Kleinpell (2005). Data were analyzed using descriptive statistics, t-test, and $x^2$ test. Result: Twelve items out of 84 outcome indicators were used over 50% of the time and 57 items could be used in the future by the participants. Seven of the 10 top-ranking outcome indicators in use were education related and were also expected to be used frequently in the future. The score for participants' perception of outcome evaluation was average-high, 3.82 out of 5. Conclusions: The results of the study show that the main outcome indicator for oncology APNs is education related, and thus the use of education related outcome indicators is recommended to make oncology APNs' activities be more visible.

Purpose: As Evidence-Based Practice (EBP) has increasingly been proven as a means of cost-effective and higher-quality healthcare, its successful implementing are challenging. This study done to identify EBP beliefs, knowledge and performance among nurses experienced as a preceptor. Method: A descriptive cross-sectional survey was conducted with a convenience sample of 249 preceptor nurses working in 9 general hospitals in Korea. Reliable and valid questionnaires (EBP beliefs scale, Evidence Based Practice Questionnaire, Research-related activities) were used and the data were analyzed using SPSS win 17.0. Result: Perceived beliefs on EBP were relatively positive (mean score 3.57 out of 5), and the level of knowledge was moderate (4.21 out of 7). However, performance of EBP was low (3.82 out of 7). Regularity in reading research journals and searching evidences using core web-database were rarely conducted. Statistically significant correlations were found between beliefs, knowledge and performance of EBP (all p<.05). Conclusions: This result indicates that education and training programs to facilitate EBP performance are needed among preceptor nurses.

Purpose: Communication in hospitals is one of the major factors in patient safety. So, the purpose of this study was to identify the relationship between intra-organizational communication satisfaction and the safety attitude of nurses in hospitals. Method: A descriptive survey design with convenience sampling was used. Data collection was done using a self-report questionnaire answered by 278 nurses from one university hospital located in Kyeoung-gi Province, Korea. Result: Intra-organizational communication satisfaction positively correlated with safety attitude (r=.747, p<.01). Among the 6 sub dimensions of safety attitude, perceptions of management (r=.675, p<.01), job satisfaction (r=.640, p<.01) and teamwork climate (r=.600. p<.01) were strongly related to intra-organizational communication satisfaction. Multiple regression analysis was done to identify explanation power of intra-organizational communication satisfaction against safety attitude. The model was significant (F=48.540, p<.01). Intra-organizational communication satisfaction accounted for 60.9% of variance in safety attitude (Adj $R^2$=.609). Conclusions: The results of this study indicate that higher levels of intra-organizational communication satisfaction promote positive safety attitude in hospital nurses and that communication media quality is an important factor in patient safety attitude. Therefore, developing interventions to revitalize intra-organizational communication level based on communication media quality will help in the construction of positive safety attitude in nurses.

Purpose: This study was conducted to develop an evaluation framework for QI activity in medical institutions and to analyze QI activity cases by applying the developed evaluation framework. Method: A four-phase process was employed to develop the evaluation framework, and a descriptive survey was used for the QI case study. Data were collected in April, 2010 by examining 157 QI activity cases presented at conferences and published in Journal of Korean Society of Quality Assurance in Health Care over the past three years. Developed QI activity evaluation instruments were used for data collection. Data were analyzed using the SPSS 18.0 for Windows program. Result: A QI Activity Evaluation Framework was developed. This framework consisted of 45 items. The department with the highest level of QI participation was the nursing department. The most frequent QI activity theme was patient safety. QI activity levels in Korean medical institutions are relatively equalized without significant differences according to institution characteristics. Conclusions: From the quality aspect of QI activity, more systematic and scientific approaches are required to upgrade QI activity. This study could provide methodological guidelines for QI activity and be useful in setting goals and directions for QI activity in medical institutions in Korea.

Purpose: This study was done to: (a) examine relationships between creative nursing practice and job satisfaction, and organizational commitment that nurses perceive in a hospital, and (b) identify creative nursing practice factors affecting job satisfaction and organizational commitment. Method: Using self-report questionnaires including 25 items of the Creative Nursing Practice Index, a descriptive study was conducted with a sample of 387 nurses working in the nursing care units of a general hospital in Seoul, Korea. Data were analyzed, using independent t-test, ANOVA, Pearson correlation, and hierarchical multiple regression analysis. Result: The mean score for nurses performance of creative practice was $2.29{\pm}0.46$ (range 1 to 4). Creative nursing practice had positive correlation with nurses' job satisfaction (r=.427, p<.001) and organizational commitment (r=.433, p<.001). Creative nursing practice factors influencing job satisfaction were implementing customized care (${\beta}$=.158, p=.010), making new knowledge (${\beta}$=.257, p<.001), and searching ideas (${\beta}$=.209, p<.001). Nurses' organizational commitment was influenced by implementing customized care (${\beta}$=.192, p=.002), making new knowledge (${\beta}$=.158, p=.028), searching ideas (${\beta}$=.254, p<.001), sharing ideas (${\beta}$=.250, p=.003), and validating ideas (${\beta}$=.189, p=.036). Conclusions: The results indicate a need to develop nurses' creative competency to pursue quality care as well as increase nurses' job satisfaction and organizational commitment.

Purpose: The purpose of this study was to investigate the effect of a short message service intervention on adherence to maximal barrier precautions (MBP) and catheter-related blood stream infections. Method: The data were collected from March to September, 2008, at an 826-bed university-affiliated hospital in Daejeon. The study participants were 24 physicians who were inserting central catheters and 133 patients (control group 78 and intervention group 55) with central catheter insertions. The researcher sent the message (adherence to MBP and optimal recommendations) to each internal medicine doctor using the short message service (SMS) for cellular phones. Messages were sent monthly for 3 months. Data were analyzed by chi-square test and t-test using SPSS 12.0 windows program. Result: Adherence to maximal barrier precautions was significantly increased from 44.9% to 69.1% (p=.006) after the SMS intervention. But changes in the rate of CRBSI (catheter related blood stream infection) between the intervention group (1.89) and the control group (4.45) were not significant (p=.323). Conclusions: The results indicate that the SMS intervention is effective in increasing the adherence to maximal barrier precautions and the SMS intervention can be recommended for utilization in infection control nursing practice.