Purpose: This study was conducted to develop standards ensuring nursing process-based care of patient admission and discharge, to develop a performance measurement tool evaluating the care applied according to the standards, and finally to determine validity of the standards and the tool. Methods: The standards and the tool were reviewed by a panel of experts and refined based on the panel's suggestions. Validity of the standards and the tool were examined through surveying a total of 302 hospital nurses. Results: The mean validity scores of the performance measurement standards and the tool were 4.11 and 4.09, respectively, out of 5.00. So the performance measurement standards and the tool in this study were found to be acceptable in evaluating quality of nursing care provided at patient admission and discharge. Conclusion: This result indicates that the performance measurement standards and the tool developed in this study are valid instruments to monitor and improve quality of nursing care for patient admission and discharge.

Purpose: The objective of this research was to explore levels of patient safety and safe nursing activities depending on the level of nurse staffing, in order to provide effective management of nurse personnel. Methods: The research was conducted with 455 nurses from eight hospitals in B city. Data were collected according to the level of nurse personnel from second (nurse vs. patient ratio of 2.0-2.5) to fifth (ratio of 3.5-4.0) rank. The survey tools were, 'Questionnaire on Patient Safety, a Hospital Survey on Patient Safety Culture developed by AHRQ (2007), and 'Questionnaire on Patient Safety Nursing Act, in which the questions were selected from nursing-related items (Medication 6 & Safety Nursing Assurance Act 4) in the Safety Evaluation developed by Evaluation Institute of Medical Institution. Data were analyzed with SPSS PC 12.0 program using descriptive statistics, $x^2$ test, ANCOVA and $Scheff{\grave{e}}$. Results: The nurses' overall cognition level on patient safety and safe nursing activities showed that nurses who are in the second and third rank had higher scores than those in lower ranks. Conclusion: The results of this study indicate that hospitals need a higher ratio level for nurse personnel in order to assure patient safety and safe nursing activities.

Purpose: Multi-drug resistant (MR) infections among intensive care unit (ICU) patients with oral intubation and a ventilator are serious nosocomial infections. This study was done to compare the effects of oral care and ventilator circuit on reduction of MR infections. Methods: A total of 92 participants were recruited from an ICU at C University Hospital in G-city, Korea, assigned to one of 4 groups and evaluated: group I received oral care with sponge and reusable circuit; group II received oral care with tooth brush and reusable circuit; group III received oral care with sponge and disposable circuit; group IV received oral care with tooth brush and disposable circuit. Results: Prevalence rate of MR infections was highest in group I (47.8%), followed by group II (30.4%), group IV (19.0%), and group III (13.6%). Of the four groups, group III showed a significantly decreased MR infections (p=.035) and higher possibility of survival rate as time passes according to survival analysis (p=.019). Conclusion: Results of this study indicate that using disposable ventilator circuit significantly decreases MR infections and raises the possibility of a higher survival rate as time passes. According to this study, the use of disposable ventilator circuit is useful in prevention of MR infections.

Purpose: This study was to analyze the characteristics and effect size of intervention studies applied to cancer-related fatigue in Korea. Methods: For meta-analysis, a total of 963 studies were retrieved from search engines. And 19 studies with a total of 721 participants published from 1990 to 2010 were selected upon their satisfaction with the inclusion criteria. Two authors independently extracted data from the selected studies and assessed the methodological quality. The data was analyzed by the RevMan 5.0 program of Cochrane library. Results: Intervention studies included 4 studies on foot-reflexo-massage (21.1%), comprehensive program (21.1%), and exercise (21.1%), respectively, 3 for hand-reflexo-massage (15.8%), and 4 for others. The effect size of the intervention studies shown higher effect size in order of exercise (d=-1.80), and foot & hand-reflexo-massage (d=-0.55). Conclusion: This study suggest that exercise can reduce the intensity of cancer-related fatigue, even though the number of intervention studies and randomized controlled trials were very few. There is limited evidence that reflexo-massage is effective in reducing cancer-related fatigue.

Purpose: This methodological study translated, adapted, and validated the evidence based guideline of RNAO (Registered Nurses Association of Ontario) in Canada, for acute stroke care to domestic circumstances. Methods: Quality of the RNAO guideline was evaluated using AGREE tool. Then the guideline was translated into Korean and a preliminary guideline was established After checking content validation by an expert group, the Korean version of the guideline was applied to clinical settings to see its applicability. Results: The RNAO guideline in Korea was deemed appropriate. The Korean version of the guideline was drawn up with 56 items in 3 areas in stroke system related nursing, nursing of acute stroke inpatients, and stroke nursing assessment. A questionnaire survey was performed on appropriateness, enforceability, and applicability of those recommendations. A total of 54 recommendations were finalized after deleting 2 items below CVI 0.7 and correcting 3 items by taking professional advices. After trial application of the guideline to 40 stroke patients hospitalized at a ward of a hospital in Seoul, its performance was improved but was not statistically significant. Conclusion: This guideline is expected to contribute to improving nursing quality by offering it as a guide to evidence based practices for acute stroke care in Korea.

Purpose: The purpose of this study was to compare the body temperature (BT), blood pressure (BP) and shivering in patients undergoing operation under general anesthesia between the heated humidification circuit tube (HHCT) group and the non-HHCT group. Methods: Data were extracted from the participants' medical records from September 1st to December 30th, 2009. The HHCT group consisted of 50 cases who were applied with heated and humidified gas via a specially designed circuit under general anesthesia. The HHCT which was adjusted at $41^{\circ}C$ was applied from induction of general anesthesia to extubation. In comparison, the non-HHCT group consisted of 50 cases who were applied with gas through standard breathing circuit without heat and humidification. Collected data were analyzed by $x^2$ test, t-test and repeated measures ANOVA. Results: The BT and shivering were significantly different between two groups (p<.001). But the BP was was not signigicantly different between the HHCT group and the non-HHCT group. Conclusion: The application of heated and humidified gases to patients under general anesthesia was effective in preserving the body temperature and reducing the shivering.

Purpose: This study was aimed to provide information on the awareness of patient safety culture and safety care activities among operating room (OR) nurses and to analyze the factors influencing the safety care activities. Methods: For this descriptive research, self-reported questionnaires were administered to 168 OR nurses who were working at the university-affiliated and general hospitals. The collected data were analyzed using descriptive statistics, t-test, ANOVA, $Scheff{\grave{e}}$ test, Pearson's correlation coefficient and Stepwise multiple regression with SPSS/WIN 17.0. Results: The mean score of the awareness on patient safety culture was 3.27 out of 5 points and that of safety care activity was 4.31 out of 5. The statistically significant difference was found between experience of safety education and the awareness on patient safety culture. Also, the scores of safety care activities were significantly different according to OR nurses' position, education levels, and experience of safety education. There was a positive correlation between the awareness of patient safety culture and safety care activity. Their explanatory power on safety care activity was 8.8%, which includes working environment in operating room 3.3% and nursing position 5.5%. Conclusion: Compared to the level of patient safety activities, the OR nurses' awareness on patient safety culture was low. Given the specific characteristics and conditions in each hospital, it needs to increase the OR nurses' awareness on patient safety culture and activities related to patient safety.

Purpose: This research was done to identify relationships among job stress, fatigue, job satisfaction, and commitment to organization in emergency department nurses. Methods: Research participants were 513 nurses who worked in the emergency department of 17 tertiary centers and 28 secondary hospitals. Data collection for this descriptive correlational study was done from May to July 2010 using self report questionnaires, and analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation coefficient with the SAS 9.2 program. Results: There were statistically significant differences in organizational commitment according to age, religion, total clinical experience, emergency department experience, current position, frequency of night shift, average sleep hours, wage level, numbers of beds in unit, and reason for working. A positive correlation was found between job stress and fatigue, and between job satisfaction and commitment to organization for the emergency department nurses and a negative correlation between job stress and Job satisfaction, and fatigue and Job satisfaction. Conclusion: Results of this research indicate that job stress in emergency department nurses was the principal variable affecting job satisfaction and commitment to organization along with fatigue. Appropriate stress management strategies based on identification of job stress for these nurses should lead to development of improved management of nursing manpower and a reduction in stress.

Purpose: The purpose of this study was to investigate parent expectation and satisfaction with respect to pediatric inpatient care and to identify the variables related to parent satisfaction. Methods: The study was conducted in pediatric wards of a tertiary children's hospital in Korea. The participants were 361 parents of children who were inpatients. Data were collected using a structured questionnaire (The Pediatric Family Satisfaction Questionnaire) at the time of discharge. Results: The highest parent expectation domain was medical service. The parents were most satisfied with nursing service and least satisfied with general hospital service and accommodation. The parents expressed lower satisfaction with hospital facilities, equipment, noise, cleanliness, and communication by health care professionals. Parents with younger children reported higher expectation from the complete hospital service and those who had a longer length of stay reported higher expectation from the nursing service. Conclusion: To improve the quality of hospital services, we need to understand parent expectation and improve and provide clear communication. In addition, the general hospital service and accommodation should not be overlooked for improvement.

Purpose: This study was aimed to evaluate the effects of Labor Support Behaviors (LSB) one-to-one application and partner's delivery participation on the delivery satisfaction and delivery results among mothers who delivered premature birth and low birth weight infant. Methods: The data were collected from 30 mothers in the experimental group and 27 in the control group from April 23, 2009 to April 22, 2010. The collected data were analyzed using percentage, mean, standard deviation, $x^2-test$ (Fisher's exact test) and t-test with SPSS. Results: The satisfaction levels of the experimental group and the control group women were $3.73{\pm}0.43$ and $3.72{\pm}0.34$ as mean values, respectively, showing not statistically different (t=0.07, p=.945). None showed less than 7 point of Apgar score at 1 minute in the experimental group while 5 out of 27 did (18.5%) in the control group, which was statistically meaningful. Also, the emergent cesarian section cases were 3 out of 33 (9.1%) in the experimental group and 5 out of 32 (15.6%) in the control group, demonstrating lower emergency cesarian section rate in the experimental group than the control group, but showing not statistically different ($x^2=0.643$, p=.475). Conclusion: The results of this study show that LSB one-to-one application and partner's participation has affirmative effects on 1 minute Apgar scores of newborns.

Purpose: The purpose of this study was to investigate the relationship between clinical knowledge and provision of pressure ulcer care and to identify factors associated with performance of care. Methods: Participants were 202 nurses working in one of 6 small to medium hospitals. Self-report questionnaire were used and data were collected from December 11 to 18, 2009. Results: Mean score for knowledge about pressure ulcer care was 0.81. In subcategories, knowledge of risk factors inducing pressure ulcers was 0.93, knowledge of assessment of pressure ulcers was 0.90, and knowledge of treatment methods for pressure ulcers was 0.61. Mean score for performance of care activities for patients with pressure ulcers was 3.63/5. There was a significant positive correlation between knowledge and performance (r=.319, p<.001). According to multiple regression analysis, general perception (${\beta}=.306$, p<.001), knowledge (${\beta}=.247$, p<.001), and hospital size (${\beta}=.156$, p= .015) had an impact on the extent of nurses' performance of pressure ulcer care. Conclusion: Study results indicate that further education on pressure ulcer care is necessary to enhance nurses' knowledge about pressure ulcers and to increase rate of performance of pressure ulcer care.

Purpose: To identify the effects of clinical practicum reinforcement program on nursing student's clinical competency and satisfaction in the ICU. Methods: The study utilized a quasi-experimental pretest-posttest research design. The participant was 76 senior nursing students, who were engaged in two week-long clinical practicum in ICU at the C university hospital in a G city, Korea. The clinical practicum reinforcement program was applied to the experimental group (n=39), while the control group (n=37) was involved in the conventional practicum program. The collected data were analyzed using descriptive analysis, $x^2$/Fisher's exact test, and t-test, ANCOVA with SPSS/WIN 18.0 program. Results: After 2 weeks' clinical practicum, the experimental group showed a statistically significant increase in the clinical performance abilities by self evaluation, when compared to the control group. Clinical instructor's evaluation on the student's clinical performance revealed that the experimental group showed higher level in nursing activity than that of the control group (p<.001). However, there was no significant difference between the two groups in terms of the satisfaction on the clinical practicum program except the learning guidance and the evaluation. Conclusion: The clinical practicum reinforcement program is an effective one for improving the student's clinical competency.

Purpose: Head-up position during sleep is one of the non-pharmacologic interventions for the treatment of orthostatic hypotension. Because the head-up position causes discomfort in many patients, this approach may not be acceptable to all patients. We compared the systolic blood pressure in erect position, orthostatic hypotension, orthostatic disability score, and the improvement rates of orthostatic hypotension between the 20 cm head-up group and the 10 cm head-up group. Methods: A control pre/post-test design was used. Between August 1, 2009 and November 15, 2010, we consecutively enrolled patients who showed orthostatic hypotension in patients with Parkinsonian disorders. Sixty-seven patients were prospectively enrolled and forty-four patients were completed the study. Results: There were no statistically significant differences found in the systolic blood pressure in erect position, orthostatic hypotension, and orthostatic disability scores between the two groups. However, five patients showed improvement in 20 cm head-up group and one patient was showed improvement in 10 cm head-up Group. Conclusion: Orthostatic hypotension is decreased with 20 cm head-up position in some patients with Parkinsonian disorders (p=.034). Further research investigating the relationships between orthostatic hypotension and head-up position are warranted.

Purpose: This research was done to compare the pain relief effects of various nursing interventions, such as cold therapy, attention diversion and 10% Lidocaine spray during arteriovenous fistula needling for patients on hemodialysis, and also to identify and develop more effective nursing interventions for pain relief in these patients. Methods: This research was conducted from October 1, 2010 to January 31, 2011 with 8 hemodialysis patients, who were on regular dialysis (3 times a week) at K University Hospital in Seoul and had an arteriovenous fistula within the past 3 months. Each patient received the three nursing interventions (cold therapy, attention diversion and 10% Lidocaine spray therapy) prior to the arteriovenous fistula needling and applied in turn with the series being repeated 4 times. After each intervention, physiologic indexes, subjective and objective pain were measured at the time of needling. ANOVA was used with SPSS/WIN 12.0 to analyze pain scores and comparison of physiologic indexes (BP, pulse). Results: No significant differences were found for subjective pain (p=.574), objective pain (p=.562) and total pain (p=.506) among the 3 interventions. Systolic blood pressure (p=.689), diastolic blood pressure (p=.969) and pulse (p=.980) also showed no significant difference among the 3 interventions. Conclusion: These 3 interventions are all possible for pain relief during arteriovenous fistula needling for these patients. However, the only interventions that nurses can do independently are cold therapy and attention diversion so we recommend that these nursing interventions be used.