Purpose: This study was conducted to identify relationships among circadian types, sleep quality, and adaptation to night shifts among nurses working on two or three day night duties. Methods: The participants were 199 ward nurses from two university hospitals in Gyeongnam province. Each nurse worked on two or three day night duties. Data were collected between September 24 and October 14, 2012 and analyzed using t-test, ANOVA, $Scheff{\grave{e}}$ test, Pearson correlation, and multiple regression with SPSS/WIN 14.0 program. Results: Mean scores for sleep quality and adaptation to night shifts was $4.92{\pm}1.46$ on a 10-point scale and $2.66{\pm}0.47$ on a 5-point scale respectively. There were no significant differences in sleep quality and adaptation to night shifts according to circadian types of nurses. There were significant correlation between sleep quality and adaptation to night shifts (r=.25, p<.001). Factors affecting adaptation to night shifts were preference for night shifts, and subjective health status, which together explained about 35% of the total variance. Conclusions: Nurses working on two or three day night duties had low level of sleep quality and adaptation to night shifts. It is necessary to improve preference for night shifts and subjective health status for improving adaptation to night shifts of nurse.

Purpose: Korean health insurance extended application of the Diagnosis Related Groups (DRG) payment system to tertiary and general hospitals from July, 2013. This study was done to develop a DRG fee adjustment mechanism applied to levels of nurse staffing to assure quality nursing service. Methods: Nurse stafffing grades among hospitals in Korea were analyzed. Differences and ratio of inpatient costs by nurse staffing grades in DRG fees and differences of DRG fee between tertiary and general hospitals were compared. Results: In 2013, nurse staffing grades in tertiary and general hospitals had improved, but other hospital nurse staffing grades remained at the 2001 level. Gaps of inpatient costs between first and seventh nurse staffing grades were over 10% in 4 out of 7 DRG diagnosis; However differences of DRG fee between tertiary and general hospitals were only 4.51% and 4.72% respectively. A DRG fee adjustment mechanism was developed that included nurse staffing grades and hospitalization days as factors of the formula. Conclusion: Current DRG fees motivate hospitals to decrease nurse staffing grades because cost reduction is bigger than compensation. This DRG fee adjustment mechanism reflects nurse staffing supply to motivate hospitals to hire more nurses as a reasonable compensation system.

Purpose: This study was conducted to provide baseline data to develop work patterns for nurses that are suitable to Korean hospitals. Shift work patterns and nurses' preferences for working condition were examined. Methods: Questionnaires for nurse departments and nurses were mailed to 478 hospitals from June 1 to July 30, 2012. Nurse departments of 174 hospitals and 1,409 nurses responded to the questionnaire. Data were analyzed using SPSS statistical program. Results: Of the nurses, 89.4% were working three shifts. Of the hospitals, 17.3% had implemented fixed night work. Although 80% of nurses preferred fixed time work, only 24.9% of hospitals had fixed working hours. Of the nurses, 57% agreed with night work as fixed but potential night nurses accounted for only 17% of the respondents. Sixty-three percent of the nurses agreed on short time work during busy hours. There were preference differences according to age, marital status and clinical career. Conclusion: As many nurses reported a preference for various flexible working patterns rather than three shift work, there is a need for new decisions on hospital policy to ensure improved working conditions for nurses and enhanced job security. Legal requirements also need to be considered for various work patterns.

Purpose: To provide clear estimates of the adoption and use of electronic nursing records (ENRs) with standard terminology in Korea and identification of the scope and use as well as perceived or potential benefits of ENRs. Methods: A survey was done of 733 hospitals at three levels: tertiary advanced hospitals, general hospitals, and community hospitals. After performing a literature review a modified version of an existing survey tool was used for 2 months in 2012. The collected information related to EHR functionality and coverage of nursing documentation and nursing process, application of standard terminology, and perceived satisfaction and benefits of ENRs. Results: The response rate was 39.4% (289/733), and 202 hospitals (70.1%, 95% CI64.8~75.5%) of the respondents had ENR systems (82.5% of tertiary hospitals, 66.7% of general hospitals, and 70.1% of community hospitals). Out of these hospitals less than 10% had ENRs fully covering nursing documentation. The adoption rate of standard terminology was 55%, and hospital satisfaction with ENRs was 70%. But personalized care was identified as needing improvement in ENRs. Conclusion: The ENR adoption rate was high but there are many potential opportunities for improving ENR systems in terms of the data standardization and personalized care.

Purpose: The purpose of this study was to investigate risk factors related to delirium and to develop screening model on delirium occurrence in MICU (Medical Intensive Care Unit) patients. Methods: For developing a preliminary tool for delirium, the data of 166 patients were collected and analyzed. In order to estimate the accuracy and discriminating power for the developed screening model, 98 patients were enrolled. The data used in this study were collected by EMR (Electronic Medical Record) review from January to September in 2012. The collected data were analyzed using SPSS/PC Win 18.0 program. Results: Screening model on delirium in MICU patients was developed using the results of logistic regression. The total score of screening model was 24 point and measuring point was 10 point. When the measuring point is over 10 point, it means that the risk of delirium occurrence is high. The discriminating power and the validity of screening model showed AUC .908 (p <.001) and .935 (p <.001) respectively. This result showed that the screening model on delirium which developed in this study was an appropriate model for screening the delirium risk group in MICU. The sensitivity of the screening model was 83%, specificity 89% and accuracy 84%. Conclusion: The developed screening model on delirium occurrence in MICU should be combined with EMR for screening and preventing delirium in a high risk group.

Purpose: This study aimed to develop an educational program on nursing records especially focused on legal issues, and to test the effects of the educational program on nurses' knowledge, performance, and behavior. Methods: A textbook on legal issue-focused nursing records and an instrument with 36 items rated on a 5-point scale (1-5) for measuring the nurses' charting-related performance and behavior were developed from November 2007 through March 2008. A nonequivalent control group pretest-posttest design was employed to test the effects of the education program. Knowledge was self-reported by the Nurse Charting Knowledge Scale, while performance and behavior were measured by their nurse managers. The pretest and posttest were conducted from March through May in 2008. A total of 226 Korean nurses participated in this study. Data were analyzed with descriptive statistics, t-test, Chi-square, paired t-test, Spearman's coefficient, and multiple regression. Results: Nurses who received the intervention showed greater levels of knowledge (t=10.28, p<.001), performance (t=2.53, p=.013), and behavior scores (t=3.07, p=.002) than those of the control group. The factors influencing the improvement of knowledge were 'job attitude' (t=-3.32, p=.001) and 'career in present unit' (t=2.95, p=.004). The factor influencing the improvement of performance was 'career in present unit' (t=-3.39, p=.001). The factor influencing the improvement of behavior was 'job attitude' (t=-3.46, p=.001). Conclusion: The educational program on legal issue-focused nursing records was effective in improving nurse charting-related knowledge, performance, and behavior.

Purpose: This study was conducted to investigate the effects of preparatory nursing information and information offering by SMS on anxiety and nursing satisfaction among family members of ICU (Intensive Care Unit) inpatients. It utilized a quasi-experimental research design with a non-equivalent and non-synchronized control group. Methods: The experimental group and the control group were offered a booklet guiding ICU and were offered face-to-face information by nurses using Power Point. The experimental group was additionally offered SMS (short message service) message on patient's safety at night every morning during the hospital stay between 8 and 9 am. All participants in the experimental group and the control group were measured in reference to anxiety at the point of hospitalization and were surveyed anxiety and nursing satisfaction on the third day of hospital stay. Results: The anxiety demonstrated no significant difference between the groups, while the nursing satisfaction was significantly higher in the experimental group than that of the control group. Conclusion: Proving direct information and indirect information via SMS message were considered effective in improving the family member's satisfaction with nursing care. The frequencies of SMS message and the contents of the message and information need to be defined and specified in the given population.

Purpose: This study was aimed to investigate the relationship between the level of stress and the quality of life among the adult recipients of living donor liver transplantation. Methods: Participants were 213 outpatients who received living donor liver transplantation at least 3 months prior to this study. Stress was measured using a modified version of the Kidney Transplant Recipient Stressor Scale (KTRSS), and the quality of life was measured using SF-36 version 2. Results: The mean of scaled stress level and quality of life of liver transplant recipients were $2.44{\pm}0.13$, $69.28{\pm}18.25$, respectively. There was an inverse correlation between those two parameters. Therefore lower stress could improve quality of life. Conclusion: For the liver transplantation recipients, improving the quality of life is to be the ultimate goal of health-related mediation. Liver transplantation recipients would need to cultivate self-care ability to manage stress, and improving their quality of life.

Purpose: The purpose of this study is to examine the nurse's role performance and the perception of the importance of role among nurses practicing in a cancer care facility. Methods: A descriptive study design was applied with convenient sampling of 175 nurses working at a cancer care facility in Daegu, Korea. Data was collected using a structured questionnaire from July 1, 2013 to July 5, 2013. Results: Cancer care facility nurse's role performance score was measured on average $3.23{\pm}0.64.$ Oral medication was the most frequently performed role, followed by encouragement, care related to medication, and pain management. The perception of the importance of nurse's role was measured on average $3.31{\pm}0.35$. Care related to medication was regarded as the most important, followed by transfusion, oral medication, and intravenous & intramuscular medication. Nurse's role performance was different according to nurse's age (F=3.21, p=.024) and current practice area (F=3.73, p=.012). The perception of the importance of nurse's role was different only in relation to current practice area (F=6.82, p<.001). Conclusion: Nurses practicing in oncology setting frequently involve encouraging patients and pain management. Training programs designed to facilitate frequently performed and highly regarded nurse's roles are required for nurses practicing in oncology setting.

Purpose: This study was to evaluate the effect of supportive nursing care program for patients with total hip arthroplasty. Methods: Forty-two patients with total hip arthroplasty were enrolled in this study from September, 20, 2011 to January, 3, 2012. The participants were assigned to one of two groups: Twenty-six subjects in the experimental group were provided with supportive nursing care program which comprised of 6 nurse visits pre and post operation and 4 follow-up phone calls after discharge. Another 26 subjects received conventional nursing care program as a control group. Hip function, anxiety, and uncertainty were evaluated before the intervention, and 5 weeks after completion of the intervention. The analysis included descriptive statistics, Chi-square test, and t-test by SPSS 18.0. Results: Hip function was significantly increased in the experimental group (t=-3.31, p<.002). Anxiety and uncertainty group was significantly lower in the experimental group (t=7.12, p<.001 and t=4.66, p<.001). Conclusion: The results of this study indicate that the supportive care intervention for patients receiving total hip arthroplasty could be utilized as a nursing intervention to improve hip function and to reduce anxiety and uncertainty of patients receiving total hip arthroplasty.

Purpose: The purpose of this study was to describe restraint use in care of patients with psychiatric disorders in an attempt to avoid unnecessary restraint use and provide information for developing standards regarding restraint use as a therapeutic maneuver. Methods: For this descriptive study, discharge records from N National Mental Hospital in the year 2009 were reviewed by trained nurses during Dec. 24, 2010 and Mar. 31, 2011. There were 596 restrains applied on 232 of 1,322 discharges. Data collected include general characteristic of patients, the frequency of restraint use, time since admission when restraint was applied, time of the day when restraint was applied, duration of restraint application, place of occurrence, reasons for restraint use, and degree of damage to the patent. Work experience of nurses who applied restraints, number of workforce at the time of restraint, and season of the year was also identified. Descriptive statistics, Chi-square test, t-test, ANOVA, $Scheff{\grave{e}}$ and Jonckheere-Terpstra were applied using SPSS 14.0 to analyze the data. Results: There were 596 restraint uses among 232 patients. Restraints were applied most frequently on males in their 40s, patients diagnosed with schizophrenia, and patients repeating admissions more than 6 times. Restraints were frequently applied within first week following admission, between 16:00 and 20:00, and the average duration of restraint was 5 hours. There were significant differences according to diagnoses of patients in the season restraint occured, time, place of occurrence, reason for restraint, and duration of restraint. Patients with alcoholism received longer restraint application. Conclusion: In order to avoid unnecessary restraint use in patients with psychiatric disorders, nurses and other health care team members need to acknowledge a group of patients such as patients with schizophrenia and alcoholism who relatively frequently restrained or receiving longer restraint. Reasonable and careful decision need to be made when applying restraint in the care of patients with alcohol problem.

Purpose: The purpose of this study was to evaluate the effects of periodic reminding interventions on medication adherence, self-efficacy, and pain intensity for home-based lung cancer patients. Methods: A quasi-experimental nonequivalent control group, pretest and posttest design was used. The intervention comprised of individual education by tailored image-combined medication instructions, daily reminding text message, and weekly telephone calls for four weeks. The subjects in this study consisted of 62 lung cancer patients (31 in the experimental group, and 31 in the control group). Mann-Whitney U-test was applied to analyze the data. Results: Experimental group who received periodic reminding intervention program better adhered to prescribed medication compared to the control group (z=-6.14, p<.001). Experimental group demonstrated higher level of self-efficacy compared to the control group (z=-6.74, p<.001). Experimental group experienced less intense average pain compared to the control group (z=-6.29, p<.001). Conclusion: The findings suggest that periodic reminding interventions can be applied as an effective nursing intervention to promote medication adherence and self-efficacy to improve and pain management for home-based lung cancer patients.

Purpose: This study investigated some extent of nurses' knowledge level of sepsis in the intensive care units (ICUs). Methods: A total of 178 nurses from 5 ICUs at one hospital were asked to complete a structured questionnaire from September 10, 2012 to September 17, 2012. The questionnaire was composed of 30 items invented by Robson and colleagues and based on the guidelines published by Dellinger and colleagues. Independent t-test and ANOVA with post-hoc test were used for statistical analyses. Results: The mean score about sepsis of ICU nurses was $25.1{\pm}3.3$, and the average percentage who got correct answers was 83.8%. Of the participants, 25.3% thought they knew about understood sepsis well, and 89.1% wanted to have a sepsis screening tool. Conclusion: The ICU nurses' knowledge level on sepsis was low. Continuing education for ICU nurses is, therefore, required. For this, the development of educational programs and screening tools about sepsis should be preceded.

Purpose: The purpose of this study was to identify the effects of balancing taping therapy on reducing headache in patients with angina pectoris undergoing nitrate IV therapy. Methods: A non-equivalent control group non-synchronized design was used. A total of 50 patients with angina pectoris undergoing nitrate therapy at G hospital participated in the study. For measuring pain intensity, the Visual Analogy Scale (VAS) and Non-Verbal Pain Behavior Scale were used. Data were analyzed using SPSS 19.0 program. Results: No significant differences were observed between the experimental and control groups in pain intensity. However, the number of times of analgesics of experimental group was significantly lower than those of control group. Conclusion: Balance taping can be effective in pain for patients undergoing nitrate IV therapy. Therefore, utilizing the balance taping can be useful method to reduce headache in patients with angina pectoris during the IV therapy of nitrate.