Purpose: To examine the current fees for nursing care and propose the strategies for improvement. Method: The number of subjects for this study was 86, including 36 chief executives of the nursing department, 14 of the health insurance department and 33 nursing managers. Data were analyzed by SPSS WIN 12.0 program. A researcher-developed questionnaire with 30 items was utilized. Results: 61% hospital had improved the nursing management fee grade after adoption of the differentiated nursing management fee schedules. After grade improvement, the time for direct nursing care increased. Also, the patient health outcome, nurse's job satisfaction were improved and more nurses were employed in general nursing units. Many subjects addressed that ICU and more nursing units were needed to adopt the differentiated nursing management fee schedules and "bed to nurse ratio" needed to be changed to "patients to nurse ratio" and specialized by the nursing units. Conclusion: The health policy in reference to fees for nursing care needs to get improved further in order to provide the quality-assured nursing care.

Purpose: The purpose of this study was to examine the effect of absolute bed rest(ABR) on occurrence of bleeding, discomfort and back pain after kidney biopsy. Method: This study was the nonequivalent control group posttest design. The experimental group was allowed to stay in beds for 18 hour-bed rest(BR) after 6 hour-ABR while the control group was allowed to stay ABR for 24 hours. Results: No bleeding sign was showed for all the patients. Discomfort of voiding, eating, ABR in the control group appeared at a higher level. Three subjects in the control group needed nelaton catheterization, whereas no catheterization was required in the experimental group. There was no significant difference in back pain. However, the control group used more pain killer with significant difference. From these results. Conclusion: There was no significant correlation between ABR time and bleeding. On the other hand, the discomfort of the experimental group appeared at a lower level by reducing ABR time. Therefore, Reduction of ABR time after kidney biopsy would be more efficient way for patients.

Purpose: The purpose of this study was to examine quality of life with patients in 12 months after coronary artery bypass graft surgery, compared with general population. Method: A cross-sectional comparative study was designed. Study participants were 90 adults who had undergone CABG surgery (n=45) in experimental group and general population (n=45) in control group. The subjects were asked the questionnaire (SF-36, Short Form-36) regarding the quality of life. The data were analyzed by the SPSS 13.0 program including frequency, percentage, $x^2$ test, t-test and One-Way ANOVA. Results: There were no significant differences in the quality of life between two groups including physical functioning (t=-.938, p=.351), role-physical limitation (t=-.322, p=.748), bodily pain (t=-.938, p=.351), general health (t=-.1418, p=.888), vitality (t=-.816, p=.417), social functioning (t=.720, p=.474), role-emotional limitation (t=-.710, p=.479), mental health (t=-.431, p=.667). Conclusion: Even though patients in experimental group had operation experience, the quality of life examined on the time of 1 year after bypass surgery is similar in that of general population. We suggest the study change the design as examination of quality of life before and after coronary artery bypass graft surgery.

Purpose: This study was performed to determine the effects of foot reflexology on pain and quality of sleep in patients with terminal cancer. Method: Quai-experimental research design was used. The subjects of this study were consisted of 19 for experimental group and 18 for control group. Visualue Scale(VAS) was used as the measurement tool of pain in this study, Verra & Snyder-Halpern Sleep Scale(VSH) and Visual Analogue Scale(VAS) were used as the measurement tool of perceived quality of sleep. Data were analyzed using statistical methods such as frequency, percent, $x^2$-test, t-test using SPSS WIN 12.0 program. Results: The hypothesis 1 that the experimental group with reflexology has less degree of pain than the control group without reflexology was supported (t=5.41, p<.001). The hypothesis 2 that the experimental group with reflexology has higher degree of VSH Scale than the control group without reflexology was supported(t=2.37, p=.02). The hypothesis 3 that the experimental group with reflexology has the difference among the mean of sleep VAS Scale during the 12 measurement periods was not supported(F=1.63, p=.08), and no significant interactions between group and time. Conclusion: It is considered that reflexology is effective for reducing cancer pain and improving quality of sleep in patients with terminal cancer.

Purpose: The purpose of this study was to examine the effect of diet education on nutritional status in patients with gastrectomy. Method: This study was designed with a nonequivalent control group pre-post test. Ten patients were assigned to the experimental group and fifteen were assigned to the control group. The experiemental group was given the diet education by multimedia including complications after gastrectomy, the way of how to prevent these complications, precautions that patients need to be follow, and food that patients should and shouldn't eat. Data were analysed with a $x^2$-test(Fisher' exact test) and Independent sample t-test, Repeated measures ANOVA, using SPSS WIN 15.0 program. Results: There were significant differences in weight, daily caloric intake, knowledge score between experimental and control group. However, there was a no significant difference in blood profile(albumin, total protein, hemoglobin) between two groups. Conclusion: This study shows that the diet education with multimedia could improve nutritional status for the patients who had gastrectomy.

Purpose: Women with gynecologic cancer often experience various physical and psychological symptoms relating to the cancer and its treatment. The purpose of this study was to identify symptom clusters. Method: A survey was conducted on 184 women with diagnoses of cervical, ovarian or endometrial cancer. Fifty symptoms were assessed for prevalence, severity and interference, and symptom clusters were identified. Cluster analysis was done using SPSS version 12.0. Results: Fatigue was identified as the most prevalent symptom (81.52%), lack of vaginal lubrication (2.26) as the most severe symptom, and lack of vaginal lubrication as the most interfering one (2.15). Identified six clusters were: Anorexia-pain cluster (loss of appetite, taste change, weight loss, appearance change, alopecia, weakness, pain), Fatigue cluster (lack of concentration, lack of memory, fatigue, dry mouth), Urinary-bowel distress cluster (urinary difficulty, constipation), Abdominal discomfort cluster (lower abdominal pain, abdominal pain, bloating), Emotional distress (sadness, anxiety-worry, nervousness, restlessness), and Menopausal cluster (sweating, hot flush, fever). Conclusion: The result of this study provides fundamental data to health care professionals in developing interventions for effective symptom management for women with gynecologic cancer by understanding identified 6 symptom clusters.

Purpose: The purpose of this study was to develop a performance tool to evaluate operating room nurses. Method: In the first stage, 59 preliminary items were selected after two focus group meetings were carried out using as background a reference review. At this stage 59 items were developed. Next, the selected preliminary items were modified by an expert group of nurses with over 10 years experience, nurses holding doctoral degrees and professors in nursing. In the third and fourth stage, these items were analyzed by the expert group to determine validity and tested by hospital nurses with over 10 years experience to determine reliability Results: For the final tool, the 59 items, 47 items for the performance evaluation dimension and 12 items for the competence evaluation dimension were found to be valid and reliable. Cronbach's $\alpha$ was .9622, a promising alpha value for the total instrument. Conclusion: This tool is an efficient performance evaluation instrument providing meaningful feedback for operating room nurses.

Purpose: This study was conducted to develop an organizational instrument on socialization for new graduate nurses in the workplace, and to test its reliability and validity. Method: A methodological design was used to develop the instrument. Data were collected from new clinical nurses in 188 hospitals nationwide in Korea. In the first stage, 159 items were developed through a literature review. In the second stage, seven experts conducted a content validity test and the number of items was reduced to 155. In the third stage, factor analysis was performed to analyze the data collected from 198 nurses in 8 hospitals using the modified instrument. A total of 65 items were included and a five-point Likert scale was used. In the fourth stage, the final evaluation instrument was finalized as comprising 11 factors in 7 domains, using 39 items developed from analysis of the data collected from 1,410 nurses using the 40 items. It was comprised of 11 factors in 7 domains. The SPSS 11.0 windows program was used. Results: Accumulated variation for the 11 factor-39 items nurse organizational instrument on socialization was 67.22%. The results of the reliability test indicated that Cronbach's coefficient for the total 39 items was over 0.97. Conclusion: The instrument developed in this study has a high degree of reliability and validity.

Purpose: This study was done to provide basic data for developing an in-service education program to improve nurses' quality. First, frequency of nursing activities and competency levels of emergency nurses according to their career ladders were compared through job analysis and then practical education programs were presented on based of the results. Method: Data were collected from 335 nurses working in emergency rooms in 31 tertiary hospitals. Data collection was done from September to November 2005 using the job analysis questionnaire. Results: There were 41 nursing activities that showed differences in frequency and 78 activities that showed differences in perceived competency level. Irrespective of emergency nurses' careers, activities that show high frequency but low competency were sputum liquefying therapy, assessment of cranial nerve function, identification of diagnostic radiology, and communication with various departments. In-service education content according to nurse's career ladders was presented by adding high frequency nursing activities and activities with low competency level even though having high frequency. Conclusion: There is a need to develop and provide in-service education programs, which consider nurses' difference in frequency and competency level for their career ladders.

Purpose: This study was done to provide support material to traditional nursing interventions through investigation of the effect of Auricular acupressure therapy for female staff in the hospital who have dysmenorrhea but cannot be absent from work even with severe symptoms affecting their work and therefore cannot get proper pain management. Method: The participants in this study were 62 women were working in the G-university hospital in Jin-ju, assigned to experimental (30) and 32 control groups (32). The study method was a quasi-experimental, nonequivalent control group non-synchronized design. The experimental group received acupressure treatment (a pin was attached to tape) on the special stimulation points in the inside of the ear, 5 times for 5 seconds, morning, afternoon, and night. Tape without the pressure pin was applied to the same points for women in the control group to evaluate placebo effect. Data were collected from May to November 2007 and were analyzed using SPSS PC+ 12 version. Descriptive statistics, t-test, $x^2-test$, Fisher's exact test, paired t-test, were used to analyze the data. Results: The experimental group showed a significant decrease in dysmenorrhea compared to the control group (t=-2.743, p<.01). In the sub-part, the experimental group showed menstruation related pain (t=-3.726, p<.01), menstruation related to behavioral change (t=-2.421, p<.05) and symptoms however, there was no significant difference related to attention deficit, water retention, and negative image. Conclusion: Application of auricular acupressure therapy was approved for this study and although auricular acupressure therapy was not effective for all of the symptoms, it was effective for dysmenorrhea.

Purpose: This study was designed as a epidemiologic study for determining priorities of nursing care in women with high risk groups of coronary heart disease(CHD) using risk factors. Method: Subjects were 1015 women who received health screenings at a hospital in Kyunggi, Korea, over one year period from January to December 2006. Results: The 37.9% of women had multiple risk factors for developing coronary heart disease. The most significant risk factors on CHD were the age older than 70 years (OR=11.45), the age between 60-69 (OR=4.65), the age between 50-59 (OR=3.20), having $HbA_1C$ over 7% (OR=2.38), high risk groups of L/H ratio (OR=1.98), and the waist to stature ratio (WSR) over 0.5 (OR=1.33). Conclusion: The findings suggest that women older than 50 years should be considered as an overt target population for CHD prevention, even in the absence of other risk factors. Also, $HbA_1C$ and WSR can be efficient indicators for CHD screening.

Purpose: The aim of this study was to develop instrument measuring the relocation stress syndrome for patients transferred from intensive care unit to general ward in Korea. Method: For item construction, components were drawn from an extensive review of the literature, existing instruments and the result of qualitative approach. A total 48 items were selected for the first draft. Ten experts evaluated this instrument for content validity and the number of items was reduced to 29. To refine and test reliability and validity of the instrument, data were collected from the 594 patients following transfer from intensive care unit. Results: Preliminarily twenty-nine items were generated through content validity and a pilot study. Using corrected items to total correlation coefficient, this instrument was further shortened to a 25 item scale. Factor analysis extracted a total of 23 items with a 5-point Likert-type scale. Relocation Stress Syndrome (RSS) included three subscales; physical factors (12 items), Patient's recognition to health care providers (8 items), and emotional factors (3 items). The RSS established content validity, construct validity, and reliability. Conclusion: This instrument demonstrates good reliability and validity, and therefore it is an appropriate measurement of assessing relocation stress syndrome in ICU to ward transition period.

Purpose: The purpose of this study was to investigate factors related to delirium occurrence in the ICU patients. Method: The sample were 99 patients in the ICU in a university affiliated hospital located in Kyunggi-do. Data were collected from September $1^{st}$ to October $31^{st}$, 2006. The instrument, CAM-ICU developed by Ely et al.(2001) was utilized. Data were analyzed by SPSS 13.0 for descriptive statistics, t-test, chi-square and multiple regression. Results: The delirium in the ICU patients was occurred in 22 (22.2%) out of 99 patients. There were significant differences in factors related to delirium occurrence, such as past medical history, long hospitalization, long ICU hospitalization, restraints, intubation or tracheostomy experience, ventilator experience, high pain score, and high anxiety score. Duration of ICU hospitalization, level of anxiety and past medical history were the significant predictors of the delirium occurrence(${\ss}$=44.5%). Conclusion: This study results recommend that specific nursing strategies needed to be developed to increase the detection of delirium in the ICU patients. The ICU nurses should recognize the incidence of delirium and prevent it in ICU settings.

Purpose: This study was to classify patient severity score for hemodialysis patients. Method: The subject of this study was 1,575 patients. To study the severity of the patients, we used t-test and ANOVA. The congruity was measured by Kappa coefficient and the severity in each medical facility was analyzed by ANOVA. Result: The results showed that there was a significant difference according to the levels of medical center (F=171.187, p<.0001). Categorizing the severity of the patients in each medical facility, group II and III of the secondary medical institution had higher ratio than the primary medical institution. There was not a single patient coming under group IV in both of the primary or secondary medical institutions. However, the tertiary medical institutions had more subjects in group II and III than the primary and secondary medical institutions. The group IV with the highest severity had 11 patients(1.5%), demonstrating that the tertiary medical institution had higher severity patients than the primary or secondary medical institutions. Conclusion: The results of this study appropriately reflects the repayment system of medical expenses by the government. Also, it provides the fundamental information to develop nursing fee system taken into account of the systemic differences among the primary, secondary and tertiary medical institutions.

Purpose: The purpose of this study was to identify the effects of multimedia educational program of the prevention of respiratory disorders on knowledge and behavior of preschool children. Method: The research design used a nonequivalent control group pre-posttest. 32 subjects in the control group received no intervention, 33 subjects in experimental group received a multimedia educational program that consists of video, named 'The strong girl and weak girl', 5 different picture boards, method of hand washing, tooth brushing, and reinforcement. The data were analyzed by using $x^2$-test and t-test for determining of homogeneity and testing the hypothesis. Results: There were significant increases in knowledge and behavior in the experimental group compared to the control group. Conclusion: From the results of this study, the multimedia educational program significantly increased knowledge and behaviors of preschool children for preventing respiratory disorders. These findings suggest that a multimedia educational program can be used as an efficient nursing intervention of preschool children for preventing respiratory disorders.

Purpose: Music intervention has long been used in research of patients undergoing surgical operation in reducing anxiety level and improve surgical outcome. However, there are few studies that have considered a patient's music preference. We investigated the effect of the tailored music intervention which chose music according to the patient's preference on anxiety level and vital signs. Method: The subjects were 50 patients who received regional anesthesia for surgical operation at D hospital in Pohang city from April, 2006 to November, 2006. All of the subjects were randomly assigned either music group (30 subjects) or non-music group (20 subjects). As the patients arrived in the operating room, vital signs were monitored until the subjects were transferred to the recovery room, while Spielberger's STAI-KYZ questionnaires were applied twice to measure preoperative and intra-operative anxiety. The data were analyzed by 2-test, t-test, one-way ANCOVA and repeated measures ANOVA using SPSS 12.0/PC+. Results: There were no significant differences between the two groups on vital signs. All of the vital signs increased when the subjects arrived in the operating room, but decreased quickly once the operation began, regardless of the groups. However, the music group reported significantly less intra-operative anxiety, compared to the non-music group (F=15.208, p<.000), when preoperative anxiety was treated as a covariance. Conclusion: The findings support that the use of music which was chosen by patients during the surgery significantly reduced patient's intra-operative anxiety during regional anesthesia.