Purpose: This study was a retrospective survey to examine economic feasibility of home care services for patients with diabetic foot. Methods: The participants were 33 patients in the home care services (HC) group and 27 in the non-home care services (non-HC) group, all of whom were discharged early after inpatient treatment. Data were collected from medical records. Direct medical costs were calculated using medical fee payment data. Cost-effectiveness ratio was calculated using direct medical costs paid by the patient and the insurer until complete cure of the diabetic foot. Effectiveness was the time required for a complete cure. Direct medical costs included fees for hospitalization, emergency care, home care, ambulatory fees, and hospitalization or ambulatory fees at other medical institutions. Results: Mean for direct medical costs was 11,118,773 won per person in the HC group, and 16,005,883 won in the non-HC group. The difference between the groups was statistically significant (p=.042). Analysis of the results for cost-effectiveness ratio showed 91,891 won per day in the HC patients, and 109,629 won per day in the non-HC patients. Conclusion: Result shows that the cost-effectiveness ratio is lower HC patients than non-HC patients, that indicates home care services are economically feasible.

Purpose: The purpose of this study was to explore the relationship between cost and revenue for inpatient nursing activities in general wards. Methods: Data were collected from 12 medical-surgical wards in one general hospital from January 1 to December 31, 2010. The nursing activities were categorized into 2 groups according to nursing service payment type in terms of the Korea health insurance system. Descriptive statistics were used to identify nursing activities and nursing activity costs. Results: Of 140 nursing activities identified as performed in general wards, payment for 69 items was included in nursing management fees. The percentage of each cost for the nursing units was 90% for labor, 4% for materials, and 6% for operating expenses. The cost for medical support nursing service accounted for 38% of costs and nursing management fees, 62%. The average profit and loss was -237,257,000 won. The cost recovery rate for nursing service was only 44%. Conclusion: The results indicate a need to measure the economic value of nursing activities performed in general wards and use it as a basis for establishing an adequate reimbursement system for nursing service.

Purpose: This study was performed to identify the effects of self-leadership and job involvement on clinical competence in general hospital nurses. Methods: The participants in this study were 443 staff nurses working in general hospitals and having more than 6 months of nursing experience. Data were collected using self-administered questionnaires. Results: There were significant positive correlations between nurses' self-leadership and job involvement, and between nurses' self-leadership and clinical competence. In the multiple regression analysis, clinical career, type of department and self-leadership were significant predictors in explaining nurses' clinical competence and accounted for 28% of the variance in nurses' clinical competence. Conclusion: Study findings suggest that nurses' self-leadership is defined as having an important influence on nurses' clinical competence. In order to strengthen nurses' clinical competence, there is a need to develop education programs to increase nurses' self-leadership.

Purpose: This study was conducted to investigate and compare the characteristics and relations of nursing practice environment, professionalism and job satisfaction among nurses in general hospitals according to hospital size. Methods: The participants included 314 staff and charge nurses who were working in the general medical/surgical nursing units in one large hospital, three medium sized hospitals, and four small hospitals. Data collected through using self-report questionnaire were analyzed using the SPSS and SAS statistical programs. Results: Nursing practice environment and job satisfaction had significant differences according to hospital size. Both of these scales were highest for medium hospitals and lowest for small hospitals. For all hospital sizes there were positive correlations between each of the variables. Multiple regression analysis showed that both nursing practice environment and job satisfaction were affected by hospital size, but professionalism was not. Conclusion: The results of this study indicate that nursing practice environment and job satisfaction vary with the size of the hospital. Therefore, further study is necessary to identify the work environment variables of nurses for performance management and to implement appropriate policies.

Purpose: This descriptive study was done to identify effects of perceived organizational support (POS) on job involvement and organizational citizenship behavior (OCB) in hospital nurses. Methods: Data were collected from Oct. 1 to Nov. 15, 2011. Participants in this study were 324 nurses working in 6 general hospitals in S, K, and C cities. Data were analyzed using descriptive statistics, t-test, ANOVA, Scheff$\acute{e}$ test, Pearson correlation coefficients, and multiple regression. Results: POS was positively correlated with job involvement, and OCB (altruism, conscientiousness, courtesy, sportsmanship and civic virtue). Factors influencing job involvement were POS and marital status, which accounted for 15.7% of the variance, marital status influenced altruism, which accounted for 4% of the variance, POS influenced conscientiousness, which accounted for 10% of the variance, religion and marital status influenced courtesy, which accounted for 6.5% of the variance, age influenced sportsmanship, which accounted for 7.9% of the variance, and POS and clinical career influenced civic virtue, which accounted for 23.1% of the variance. Job involvement mediated on the relation between perceived organizational support and organizational citizenship behavior. Conclusion: The results of the study indicate that hospital administrators should explore ways of improve POS for better job involvement, conscientiousness, and civic virtue.

Purpose: This study was done to examine interpersonal relations, hope, professional self-concept and turnover intention according to adult attachment styles in early stage nurses. Methods: A survey using a structured questionnaire was conducted with 245 nurses who work in one of six general hospitals. Additionally, a qualitative method was used to obtain data on experiences in interpersonal relations. Data were analyzed using SPSS/WINdows 14.0 and qualitative data from open question in the survey questionnaire were analyzed using content analysis. Results: There was a significant difference in interpersonal relations, hope, and professional self-concept according to adult attachment styles. In the interpersonal relation of early stage nurses, 8 themes were identified, of which the most frequent were: a comfortable relationship with my co-workers (43%) and stress from the relationship (34%). Conclusion: Findings from this study should be useful in the development of programs to promote adult attachment and professional self-concept for early stage nurses.

Purpose: This study was done to develop a nursing competency scale according to a clinical ladder system for intensive care nurses. Methods: Index of content validation was done by 20 clinical experts and 80 nurses in Intensive Care Units (ICU). Results: The process and results of study are as follows. First, 12 nursing competencies were used in the establishment of the clinical ladder system (Jang, 2000). Second, the first draft of the competency lists was developed. It was based on the clinical nurses' behavioral indicators of nursing competency by Jang (2000), and was modified and supplemented through various literature reviews including competency standards for specialist intensive care nurses in Australia and consultation with 2 clinical nurses with over 10 years experience in the ICU. Third, the draft was examined by 20 clinical experts for content validity. Finally, the final draft was analysed using clinical validity where 20 nurses in each ladder participated. The final number of items was fixed at 309. Conclusion: The tool represents expected nursing competency of nurses working in ICU. Intensive care nurses can recognize their strengths and weaknesses, and identify directions for their professional growth by analysing results of their competency evaluation using this tool.

Purpose: This study was conducted to identify ethical climate factors in hospitals and analyze their influence on job satisfaction and organizational commitment. Methods: A convenience sample of 196 nurses from one national university hospital in J city participated in this descriptive study survey. Instruments included the Ethical Climate Questionnaire, Job Satisfaction Scale, and Organizational Commitment Scale. Cronbach's ${\alpha}$ and factor analysis were done to test reliability and construct validity of the scales. Data were collected from March 15 to March 25, 2013 and analyzed using descriptive statistics, one-way ANOVA, t-test, Pearson correlation, and multiple regression with SPSS/WIN 18.0. Results: Seven ethical climate factors were identified; laws and professional codes, social responsibility, company rules and procedures, self-interest, personal morality, efficiency, and friendship. Factors influencing job satisfaction were friendship (${\beta}$=.25), social responsibility (${\beta}$=.20), laws and professional codes (${\beta}$=.20), and educational level (${\beta}$=.27), explaining 37.6% of variance in job satisfaction. Factors influencing organizational commitment included social responsibility (${\beta}$=.29), friendship (${\beta}$=.27), laws and professional codes (${\beta}$=.23), and age (${\beta}$=.19), with explanatory power of 44.6%. Conclusion: Results can be used as preliminary data for developing new strategies to establish positive ethical climates in hospital environments and thus enhance nurses' job satisfaction and organizational commitment.

Purpose: The purpose of this study was to analyze factors affecting work engagement and burnout among clinical nurses according to resilience. Methods: The study design was a descriptive survey and questionnaires were collected from 182 clinical nurses who worked in hospitals in "J" province. Data were analyzed using frequency, percentage, mean, standard deviation, independent t-test, one-way ANOVA, Scheff$\acute{e}$ test, Pearson correlation, and hierarchical multiple regressions. Results: The mean score of resilience, work engagement, burnout were $3.47{\pm}0.38$, $4.29{\pm}0.98$, $2.25{\pm}0.82$ respectively. Resilience had 26.3% of the influence on work engagement and 50.5% of the influence on burnout. Sub-variables of causal analysis and empathy of resilience were statistically useful as factors influencing burnout. Conclusion: Resilience has been identified as a factor affecting work engagement and burnout. Therefore, nursing departments and nurse managers should strive to develop programs for the promotion of resilience.

Purpose: The purpose of this study was to identify the mediating effect of professionalism in the relationship between clinical competence and field adaptation in newly graduated nurses. Methods: The participants in this study were 213 nurses from four tertiary hospitals who had less than 12 months of nursing experience. Data were collected during January and February, 2013. A structured questionnaire was used for data collection and data were analyzed using descriptive statistics, Pearson correlation coefficients, and path analysis with the SPSS/WIN 21.0 and AMOS 21.0 programs. Results: The mean score for clinical competence was $2.85{\pm}0.25$, for professionalism, $3.10{\pm}0.30$, and for field adaptation, $2.79{\pm}0.37$. There was a significant positive relationship between clinical competence and field adaptation. Also, professionalism was positively correlated with field adaptation. Professionalism showed mediating effects between clinical competence and field adaptation. Improvement of clinical competence increased professionalism and the increased professionalism raised the field adaptation. Conclusion: Based on these findings, orientation programs including strategies to increase professionalism, should be established to promote effective field adaptation in newly graduated nurses. These orientation programs can strengthen professionalism, the mediator between clinical competence and field adaptation in newly graduated nurses.

Purpose: This study was designed to describe the burnout experiences of nurses counseling people living with HIV/AIDS (PLWHA) in hospital-based counseling services in Korea. Methods: A qualitative research technique with focus group interviews was used and the data were collected in 2012. Participants were 13 counseling nurses from 16 medical hospitals in South Korea who had worked full-time for more than six months as a counseling nurse for PLWHA. The 13 nurses made up 68.4% of all 19 official HIV counseling nurses in South Korea. Data were collected using focus group interviews and analyzed with the content analysis methodology of Downe-Wamboldt. Results: Burnout experience of counseling nurses for PLWHA was analyzed for two domains-causes of, and effects of burnout. Each domain was classified into three categories; personal, job-related, and relationships. Further 17 sub-categories and 47 concepts were discovered. Conclusion: In this study various causes and effects of burnout experienced by nurses counseling PLWHA were identified. These findings can be used in developing effective strategies for nurses, administrators, and health policy makers to solve the burnout of counseling nurses. Further research is required to develop detailed and practical job description for nurses counseling PLWHA.