Purpose: This study was conducted to develop standards to ensure nursing process-based care of oxygen therapy and airway suctioning and to develop a performance measurement tool to evaluate 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 366 hospital nurses. Results: The mean validity scores of the performance measurement standards and the tool were 3.58 and 3.55, respectively, out of 4.00. 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 oxygen therapy and airway suctioning.

Purpose: To present necessary data for improvement in communications between health professionals in as characterized by nurses' communications. Methods: This study was a descriptive survey research design with a survey of 1,510 registered nurses working in general hospitals (of at least 1,900 beds) in Seoul. A questionnaire on communication in the ICU, nurse-physician and nurse-nurse, was used. Data were collected from January 9 to 20, 2012, and the response rate was 85.0%. Results: Cronbach ${\alpha}$ values ranged from .75 to .89, except for .59 for accuracy (nurse-physician), with .89 overall. The highest mean score was for perception for timeliness [$3.83{\pm}.57$], followed by shift communication (nurse-nurse) [$3.64{\pm}.66$], openness (nurse-nurse) [$3.64{\pm}.65$], accuracy (nurse-nurse) [$3.14{\pm}.61$], openness (nurse-physician) [$2.90{\pm}.75$], understanding (nurse-physician) [$2.82{\pm}.65$], and accuracy (nurse-physician) [$2.70{\pm}.59$]. Subscales of openness, understanding, and shift communication were strongly associated with communication satisfaction. The general characteristics of nurses with different perceptions of communications included age, clinical experience, work pattern, and department. Conclusion: Proactive activities to improve accuracy, openness and mutual understanding between physicians and nurses are required for patient safety. Further studies are also needed to reassess communications and evaluate the relationship between patient outcomes and nurses' job satisfaction after application of strategies to improve communications.

Purpose: This study was done to develop a valid and reliable Classification System for Critical Care Nursing (CSCCN) to be used in Intensive Care Units (ICUs). Methods: Head nurses and staff nurses of 17 ICUs in 6 hospitals classified 307 patients to verify interrater reliability. To verify construct validity, the staff nurses classified 404 patients according to CSCCN comparing difference in medical department and type of stay in ICU. For conversion index, 78 patients from 4 ICUs of 'S' hospital were classified and nursing time was measured by 107 nurses and 18 nurse aids using stopwatches. Results: The developed CSCCN has 11 categories, 76 nursing activities and 101 criteria. The reliability was verified as having high agreement (r=.946). The construct validity was verified comparing differences in medical department and type of stay in ICU. According to scores, four groups in the CSCCN classification were identified. According to the conversion index, one score on the CSCCN means 7.2 minutes of nursing time. Conclusion: CSCCN can be used to measure diverse and complex nursing demands including psycho-social aspects of ICU patients and convert nursing demands to numbers.

Purpose: The purpose of this study is to identify the effect of low sodium dialysate (LSD) rather than conventional dialysate on interdialytic weight gain (IWG), blood pressure (BP), and intradialytic side-effects (ISEs) in patients on maintenance hemodialysis (HD). Methods: The study was performed in 43 patients, who were treated in the university hospital over 8 weeks. Each participant's serum sodium set point was measured using dialysate sodium 140 mEq/L during the first 4 weeks. For the next 4 weeks dialysate sodium concentrate (134,136,and138 mEq/L) was provided to each participant but only to an experimental group (EG) (n=22) based on the individual set point, although 140 mEq/L dialysate was given to all of the control group (CG) (n=21). Consequently, outcomes including IWG, BP, and ISE were evaluated. Results: In EG, difference of pre-HD SBP (p=.047) and post-HD serum sodium (p=.006) were significantly decreased compared to CG. Also, ISEs was not more frequent in EG. However, the differences were not statistically significant, IWG (kg & %), pre-HD DBP, post-HD SBP & DBP, and serum osmolality in EG. Conclusion: Individual application of LSD in patients on maintenance hemodialysis is beneficial to decrease pre-HD SBP and post-HD serum sodium without increasing ISE. Therefore, LSD can be better treatment than conventional dialysate.

Purpose: In assessing patients' neurological status following a stroke it is very important to have a valid tool for early detection of neurological deterioration. NIHSS is considered the best tool to reflect neurological status in patients with ischemic stroke. An education program on use of NIHSS was planned for nurses caring for these patients and the effects of the program were evaluated. Methods: The NIHSS education program (NEP) which includes online and video lectures, and practical education was provided to the nurses from April to July, 2010. To examine the effect of NEP, nursing records of patients with ischemic stroke who were admitted to a stroke center were analyzed. Two groups, a historical control group (n=100) and the study group (n=115) were included. Results: Nursing records for neurologic symptoms for each patient increased (41.0% versus 100.0%, p<.001), and especially, visual disturbance, facial palsy. limb paralysis and ataxia, language disturbance, dysarthria, and neglect symptoms significantly increased (all p<.001). Nurse notification to the doctor of patients with neurological changes increased (21.0% versus 39.1%, p=.004), and nurses' neurological deterioration detection rates also increased (37.5% versus 84.6%, p=.009). Conclusion: NEP improved the quality of nursing records for neurological assessment and the detection rate of neurological deterioration.

Purpose: This study aimed to prove the effect of exercise therapy on discomfort and low back pain after cerebral endovascular surgery through femoral artery. Methods: The study employed a non-equivalent control group pretest-posttest design. Data were collected from 74 participants and were divided equally into two groups as experimental and control groups. In the experimental group, exercise therapy was applied in 2 hours, 4 hours, and 6 hours after cerebroendovascular surgery. The level of discomfort, back pain, hemorrhage, and hematoma was observed and recorded as a pretest. In the posttest, low back pain, hemorrhage, and hematoma were measured in 2.5 hours, 4.5 hours, and 6.5 hours, and discomfort was measured in 6.5 hours. The study was conducted from April to September, 2012. Data were analyzed with descriptive study, Chi-square test, t-test, repeated measure ANOVA and Bonferroni using SPSS/WIN 18.0 version. Results: The exercise therapy after cerebral endovascular surgery helps in reducing the level of discomfort (t=-2.37, p=.020) and low back pain (F=5.15, p=.005) without the side effects of hemorrhage or hematoma. Conclusion: Therefore, the exercise therapy was an efficient intervention for patients after cerebral endovascular surgery with discomfort and low back pain. Nurses could apply non-pharmacological interventions such as exercise therapy to avoid pharmacological side-effects.

Purpose: The purpose of this study was to identify the frequency and severity of role conflict experienced by nurses in the hospital. Methods: For this survey a self-report questionnaire on nurses' role conflict was used for data collection. Participants were 472 nurses in hospitals with over 500 beds. The questionnaire had 82 items classified into five categories (role activity, relationships between: nurse-nurse, nurse-patient/caregiver, nurse-doctor, and nurse-other department staff). The questionnaire was developed through focus group interviews with nurses according on their work experiences and literature reviews that were validated by the researchers. Data were analyzed using descriptive statistics for frequency and severity of nurses' role conflict. Cronbach's ${\alpha}$ for the questionnaire was .95 (frequency), .97 (severity). Results: Mean score for nurses' role conflict was 1.64. The highest frequency for nurses' role conflict was in the category, relationship between nurse and patients or their families ($2.00{\pm}0.46$). The highest severity for nurses' role conflict was in the category; relationship between nurses and doctors ($1.96{\pm}0.56$). Conflict about nurses' role activity showed both high frequency ($1.99{\pm}0.39$) and severity ($1.95{\pm}0.43$). Conclusion: Results indicate a need to develop programs to improve interpersonal relationship so as to reduce role conflict and encourage nurses' professional satisfaction and achievement.

Purpose: The specific aims of this study were to define fever from the nurse's and physician's perspectives, describe fever management method and decision-making, and identify differences of definition of fever and fever managements between nurses and physicians. Methods: A cross-sectional survey using a 23-item questionnaire was used. A total of 305 nurses and physicians were surveyed, and 246 useful questionnaires were returned. Results: Body temperature of $36.5{\sim}38.3^{\circ}C$ were considered as adult febrile, and fever managements were initiated when the temperature was $37.0{\sim}38.0^{\circ}C$. More than half of the nurses and physicians, made a clinical decision regarding fever managements based on their own experiences. The most frequently used interventions in nursing practice were antipyretics, intravenous hydration, and external cooling. Nurses provided external cooling to lower body temperature than physicians (Z=-4.67, p<.001). Most participants reported that they needed a fever management protocol. Conclusion: Based on the information obtained, nurses respond with sensitivity to lower body temperature. We found significant differences among nurses, between nurses and physicians in approaching care of adult febrile patients.

Purpose: The purpose of this study was to apply laughter therapy to clinical practice and investigate its effects on patients' anxiety and depression in order to increase the quality of nursing for patients with inflammatory bowel disease (IBD). Methods: The study was conducted based on the non-equivalent control group pretestposttest design. The participants include 20 patients with IBD in the control group and 17 in the experiment group. Data was collected from July 10th, 2011 to January 22nd, 2012. Laughter therapy was administered once a day for five consecutive days. Results: The anxiety score was significantly different between the two groups and indicates that laughter therapy is effective for reducing anxiety among patients with IBD. Futhermore, there were differences in the depression scores of the experiment group between the pre-test and post-test, but no significant differences were found between the two groups. Conclusion: The results show that laughter therapy was effective in reducing anxiety among patients with IBD but did not decrease depression directly. Considering that the experiment group had a bigger reduction rate in depression scores than the control group. However, it is expected that laughter therapy will serve as an emotional nursing intervention for patients with IBD.

Purpose: This study aimed to describe how nurses in neurological intensive care units (ICU) perceive their roles about patient transfer and liaison. Methods: A cross-sectional survey was conducted using a questionnaire developed for the study. Data were collected from a convenience sample of 115 nurses working in the neurological intensive care units ofsix university hospitals. Data were analyzed using SPSS software (version 15.0). Results: Staff nurses were mainly in charge of patient transfer, and the awareness about its importance was significantly related with the burden about the practice of patient transfer (p<.001). Patient liaison was mainly conducted by staff nurses as well. Liaison practice wassuggested to be started from the ICU at the time of transfer; the suggested time for completion of liaison service and evaluation was when patients were adjusted to the transferred ward. Preparing job descriptions and increasing nursing staffing for patient liasion service were strongly recommended. Conclusion: The results suggest that the ICU nurses' burden in relation to patient transfer is commensurate with their awareness about itsimportance. To improve the continuity of care from ICU to transferred ward, it isrequired to reduce the burden about patient transfer and improve perceptions about patient liaison.

Purpose: This study was conducted to adapt the previously developed intravenous infusion guidelines with good quality for development of the evidence-based intravenous infusion nursing practice guideline in Korea. Methods: Guideline adaptation process was conducted according to guideline adaptation manual version 2.0 developed by NECA (Kim, Kim et al., 2011) which consisted of three main phases, 9 modules including a total of 24 steps. Results: Adapted intravenous infusion nursing practice guideline was consisted of 19 domains and 180 recommendations. The domains and number of recommendations in each domain were: general guide, 4; assessment, 1; vascular access device selection, 4;site selection, 14;site preparation, 5;site care, 29; maintaining patency, 11; blood sampling via vascular access, 4; vascular access device exchange and removal, 9; add-on device selection, 27; infusion related complications, 63; education, 7; and documentation and report, 2. There were 11.9% of A, 28.4% of B, 58.7% of C in grade of recommendations. Conclusion: Adapted intravenous infusion nursing practice guideline is expected to contribute providing an evidence based practice guides for intravenous infusion. The guideline is recommended to be disseminated to nurses nationwide to improve the efficiency of intravenous infusion practice.

Purpose: The purpose of this study was to evaluate the effect of illustrated children's book in providing information about tonsillectomy to improve post tonsillectomy pain control and compliance to treatment for preschoolers. Methods: The design of the study was a quasi-experimental, post-test only design. Subjects were preschoolers aged between 3 and 7 years old who were admitted to a hospital for tonsillectomy. A group of 25 children were assigned to an experimental group, and another 25 were assigned to a control group. The data were analysed using SPSS 12.0 program. The homogeneity between two groups was examined using $x^2-test$. The hypotheses testing was conducted using t-test. Results: The experimental group had lower pain score than control group at 8 hour after tonsillectomy (p<.05). Pain score was also lower in the experimental group after 24 hour after the surgery (p<.05). The experimental group had higher pain questionnaire score than control group at 8 hours after surgery, however the difference was not significant. The experimental group showed better compliance to treatment than the control group (p<.05). Conclusion: Providing illustrated children's book for the purpose of providing information about tonsillectomy was effective intervention for the control of post tonsillectomy pain and improvement of compliance to treatment for preschoolers. Illustrated children's book could be applied as a nursing intervention to relieve post tonsillectomy pain and improve compliance to treatment for preschoolers.

Purpose: The purpose of this study was to develop a website-based patient safety culture promotion program that could be implemented by nurses in real work scenarios. Methods: This study was a methodological study. A patient safety culture promotion program, called 'Safe Culture, Save Patients' was developed, based on structuration theory and performance engineering approaches. Results: This program was delivered in the form of a website containing contents about changes in the work environment, information about accidents and the improvement process details, as well as a program for motivation. The program was tested about the validity on contents and usability - a panel of 14 experts confirmed its validity using the contents validity index (CVI), with a resulting S-CVI of .980. Usability was evaluated by 11 nurses, which allowed finalize the program. Conclusion: The 'Safe Culture, Save Patients' program was a valid program that could be applied in clinical practice immediately. The results of this study warrant further studies to evaluate the effects of this patient safety culture promotion program.