Purpose: This study was performed to investigate nurses' experience of bullying in clinical fields. Methods: Participants were 309 nurses working in general hospitals. Data were collected using self- report questionnaires which were evaluated in terms of workplace bullying, burnout, organizational commitment, turnover intention and nursing productivity. Results: Of the participants 17.2% reported being victims of workplace bullying of nurses in general hospital, based on the operational definition of bullying. Coping response to workplace bullying was mainly passive such as enduring, ignoring, and evading. Experience of workplace bullying was positively correlated with burnout and turnover intention and negatively correlated with organizational commitment and productivity. Conclusion: The findings suggest that there is a need for assessment of the reality of workplace bullying of nurses in clinical areas as well carefully reviewing the problem and impact. A supportive system, education programs and improved workplace climate are recommended to reduce workplace bullying in clinical fields.

Purpose: Examining current status of nursing intershift handover practice would provide opportunity to identify areas in need of improvement. The aim of this study was to describe nursing intershift handover practice in Korean hospitals. Methods: A cross-sectional survey using questionnaire was used to collect data. A total of 788 nurses working in general hospitals had participated. Results: More than half of the nurses participated responded that they used kardex for verbal handover (51.8%). The average time took for handover was 40.2 minutes (SD=14.7). Only 5.8% of nurses were satisfied with intershift handover practice. 72.9% of respondents did not have manuals for handover and 86% of nurses considered intershift handover manuals were necessary. Most nurses considered intershift handover pratice as an important component for patient safety (99.2%). The causes of handover error were interruption during handover, high work load, and stress/fatigue of nurses. Conclusion: The findings of this study indicated a need to develop handover practice guidelines which outline pertinent details. Intershift handover practice guidelines could provide consistency and structure to the information that is handed over.

Purpose: This study was conducted to describe the relationship of parents' stress, coping, and partnership between nurse and parents whose children were hospitalized in the Pediatric Intensive Care Unit. Methods: A descriptive correlation study design was used. The participants were 81 parents whose children were hospitalized at S-hospital located in Seoul from October 18 to November 27, 2012. This study used the 'Parental Stress Scale: Pediatric Intensive Care Unit,' the coping scale, and 'Pediatric Nurse Parents Partnership Scale, PNPPS'. The data were analyzed using t-test, ANOVA and pearson correlation. Results: The parents of children hospitalized in pediatric intensive care unit were experiencing high level of stress ($3.22{\pm}0.82$). There was a significant positive correlation between parents' coping and nurse parents partnership (p<.001), however there was no relationship between parents' stress and coping, and parents' stress and nurse parents partnership. Conclusion: Nurse-parents partnership had significant relationship with parents' coping In the care of children hospitalized in pediatric intensive care unit. The results of this study provided a foundation to recognize importance of nurse parents partnership and to develop intervention program for nurses and parents to improve their partnership.

Purpose: The purpose of this study was to identify effects of abdominal massage or oral lactic acid fermented milk to prevent constipation in patients immobilized after spinal surgery. Methods: Participants were 60 patients who underwent spinal surgery (20 in the abdominal massage group, 20 in the lactic acid group, and 20 in the control group). Preoperative constipation was assessed and after starting to eat following surgery, patients were given abdominal massage or lactic acid fermented milk for three days. Then bowel movements were checked using the constipation assessment scale and enemas. Results: Constipation score in the control group without treatment increased from $4.85{\pm}4.73$ to $10.25{\pm}4.28$ whereas, in the abdominal massage group or lactic acid group, the scores decreased from $6.40{\pm}3.71$ to $5.23{\pm}3.43$ and from $5.25{\pm}3.78$ to $4.50{\pm}3.18$ respectively. Also, enemas were given for 15 of 20 in the control group but only 7 of 20 in the abdominal massage group and 4 of 20 in lactic acid group. Conclusion: Results of this study indicate that abdominal massage or lactic acid fermented milk to alleviate constipation in patients with immobility following spinal surgery is highly effective according to the constipation score and need for enemas.

Purpose: This study was aimed to describe Helicopter Emergency Medical Services (HEMS) and analyze the flight nurses' activities in HEMS. Methods: Data were collected retrospectively from the air transportation reports that contained data of 168 patients transported by aircraft to G University medical center in Incheon since June, 2012 to March, 2013. Data were analyzed using descriptive statistics, and Mann-Whitney U test. Results: Average distance of flights was 44.0 km, duration of field treatment took 13.6 minutes, and duration of a flight from scene to hospital was 14.5 minutes. Nursing activities were categorized into 12 direct nursing activities and 5 nursing management activities, and a total number of 7806 nursing activities were occurred in HEMS. The most frequently performed nursing activity was measurement and monitoring (27.9%) followed by medication (11.5%) and respiratory management (8.7%). The most frequent nursing management were information management (11.0%). Nursing activities performed were significantly different depending on the patient's level of consciousness, cause of illness, crew configuration, and type of transportation. Conclusion: This study described HEMS nursing activities performed by flight nurses. Difference in nursing activities according to patient characteristics, crew configuration and type of transportation requires flight nurses to be prepared through educational programs to improve nursing activities and nursing management during air transportation.

Purpose: The purpose of this study was to develop the evaluation indicators of positive nursing organizational culture in a clinical setting. Methods: The evaluation indicators of positive nursing organizational culture were developed from a literature review and a focus group interview. The content validity testing was done using a clinical expert panel. The content utility testing was done using a survey questionnaire. Results: The evaluation indicators of positive nursing organizational culture consists of 88 indicators representing the eight domains with the 24 categories. The average scores in evaluation indicators of positive nursing culture included the importance (3.29 points in average), the potential for further utilization (3.14 points in average) and the current state of extension agency (2.80 points in average). Conclusion: The developed evaluation indicators can be applied to measure the nursing organizational culture, which would be the basic data to manage human resources effectively in a clinical setting.

Purpose: This study was done to examine predictive validity of Critical Care Non-verbal Pain Scale (CNPS) and develop criteria for pain assessment using CNPS with critically ill patients who have communication problems. Methods: Data were collected from intensive care units at three major general hospitals in Seoul and Kyunggi province. During each observation, a nurse assessed pain severity using CNPS ratings (range 0-9) at four treatment stages: at rest, during central catheter dressing change (nonpainful procedure), position change and suctioning (routine painful procedures). Patients also assessed their pain using a self-report 4-point VRS-4. Results: There were significant differences between the four treatment stages except between "at rest" and "nonpainful procedure". Strong correlations were found between CNPS and VRS-4 for "at rest" (r=.552, p<.001), central catheter dressing change (r=.505, p<.001), position change (r=.709, p<.001), and suctioning (r=.662, p<.001). ROC curve analysis of CNPS based on 3 point on VRS-4 showed the cutoff point was 3 for CNPS, the starting point for pain management with 73% sensitivity, 92.2% specificity, 73% positive predictive value, and 92.8% negative predictive value. Conclusion: Results indicate that CNPS is a valid tool for measuring pain in critically ill patients with communication problems and 3 point should be the standardized pain treatment point.

Purpose: This study was done to examine the effects of assertiveness training on Intensive Care Unit (ICU) nurses' assertive behavior, job stress, communication conflict, and self-esteem toward improving their communication skills and coping. Methods: The assertiveness training program was developed to a 10-hour program consisting of 3 sessions. The goals were to understand assertive behavior and learn how to practice assertive communication in general conflict situations and/or a difficult conflict situation in the ICU. Participants were 65 nurses recruited from a tertiary teaching hospital and of these, 27 nurses completed the program. Data were collected from Jan. 30th to Mar. 28th, 2009 using a questionnaire which included demographic characteristics, assertive behaviour scale, job stress scale, communication conflict inventory-specific, and self-esteem scale. Data were analyzed using SPSS v. 14.0 for $x^2$ test and t-test. Results: ICU nurses in the experimental group had a significant increase in aspects of assertive behavior and a decrease in job stress. Conclusion: The results of the study indicate that assertiveness training is effective in increasing ICU nurses' assertive behavior and decreasing job stress through reinforcement of assertiveness behavior.

Purpose: The aim of this study was to determine the risk factors contributed to unplanned readmission to intensive care unit (ICU) and to investigate the prediction model of unplanned readmission. Methods: We retrospectively reviewed the electronic medical records which included the data of 3,903 patients who had discharged from ICUs in a university hospital in Seoul from January 2011 to April 2012. Results: The unplanned readmission rate was 4.8% (n=186). The nine variables were significantly different between the unplanned readmission and no readmission groups: age, clinical department, length of stay at 1st ICU, operation, use of ventilator during 24 hours a day, APACHE II score at ICU admission and discharge, direct nursing care hours and Glasgow coma scale total score at 1st ICU discharge. The clinical department, length of stay at 1st ICU, operation and APACHE II score at ICU admission were the significant predictors of unplanned ICU readmission. The predictive model's area under the curve was .802 (p<.001). Conclusion: We identified the risk factors and the prediction model associated with unplanned ICU readmission. Better patient assessment tools and knowledge about risk factors could contribute to reduce unplanned ICU readmission rate and mortality.

Purpose: This study was aimed to find out the effect of core competency and teaching style on preceptor self-efficacy among preceptors. Methods: One hundred twelve nurses working at four university hospitals with previous preceptor experience participated in the survey. The data were analyzed by t-test, ANOVA, Pearson correlation coefficients and multiple regression. Results: The preceptors used 'judgment-initiative' teaching style most frequently, and reported the highest scores in the role model dimension of core competency. There were significant positive relations between age (r=.266, p=.005), clinical experience (r=.274, p=.004), preceptorship experience (r=.204, p=.032), core competency (r=.593, p<.001) and preceptor self- efficacy. But preceptor self-efficacy was not significantly different depending on the teaching style (F=0.72, p=.54). The most predictive factors of the preceptor self-efficacy were core competency and teaching style (judgment)(F=31.849, p<.001). The explained variance for preceptor self-efficacy was 35.9% in the model. Conclusion: The preceptor self-efficacy is essential for the preceptors' successful teaching experience and the clinical competency improvement of the entry level nurses. Management for an effective preceptor training program needs to focus on the improvement of core competency of preceptors, which will lead to strengthen their self-efficacy.

Purpose: This study was conducted to investigate the differences in sleep disturbance, stress, self-efficacy and depression by fatigue level and to identify the factors influencing fatigue in hemodialysis patients. Methods: This study used a cross-sectional design and the subjects were 195 patients undergoing hemodialysis in a local unit. Data were collected using a structured questionnaire and medical records from June to August 2012. The data were analyzed using descriptive statistics, independent t-test, one way ANOVA, $Scheff{\grave{e}}$ test, and Pearson's correlation coefficients. Also a multiple regression analysis was used to assess the independent association between fatigue status and indices of sleep disturbance, stress, self-efficacy and depression. Results: A total of 99 (50.8%) subjects experienced a high level of fatigue and 96 (49.2%) experienced a low level of fatigue. There were significant differences in the levels of sleep disturbance, stress, self-efficacy and depression between the two groups. Fatigue was significantly correlated to sleep disturbance, stress, self-efficacy and depression. The most important factor related to fatigue was stress, followed by sleep disturbance. These factors explained about 37% of fatigue of the respondents. Conclusion: The results of this study showed that sleep disturbance and stress were significant predictors of fatigue in hemodialysis patients. Possible interventions for minimizing fatigue in patients undergoing long-term hemodialysis should be aimed to manage the known contributing factors.

Purpose: The purpose of this study was to identify factors influencing chemotherapy-induced peripheral neuropathy among colorectal cancer patients receiving oxaliplatin. Methods: A total of 132 patients hospitalized for chemotherapy were surveyed at K University Hospital in Seoul, Korea. This study was a descriptive causal relationship study using a self-report questionnaire survey method. Correlation and multiple regression analysis between the factors were performed using SPSS 18.0. Results: The regression model was significant (F=31.64, p<.001), which meaned that the experience of chemotherapy-induced peripheral neuropathy among the participants was statistically significant. The factors influencing the chemotherapy-induced peripheral neuropathy were depression (${\beta}=.34$, p<.001), followed by anxiety (${\beta}=.32$, p<.001), medical staff support (${\beta}=-.17$, p=.037) and the level of knowledge of anticancer drugs (${\beta}=-.16$, p=.045). The explanatory power of these factors on the chemotherapy-induced peripheral neuropathy of colorectal cancer patients was 69%. Conclusion: The factors influencing the chemotherapy-induced peripheral neuropathy of colorectal cancer patients receiving oxaliplatin were identified as depression, anxiety, level of knowledge of anticancer drugs and medical staff support.