Purpose: The purpose of this study was to develop a Clinical Ladder System (CLS) model for staff nurses working in inpatient units of tertiary care hospitals in Korea. Methods: The study was carried out in 2 steps. First, a nursing competence evaluation scale was developed. Second, evaluation of the nursing competences, qualifications, and professional activities of 230 nurses from five tertiary care hospitals was done by 49 head nurses between Feb. and Dec., 2014. Nurses were selected by head nurses according to their clinical experience and expected behavioral characteristics at each level of the ladder. Results: A nursing competence scale was developed consisting of 5 subcategories (clinical practice, ethical practice, education, leadership, and professional development) and 11 elements, and 5 levels of behavioral indicators for each element. Cronbach's alphas for the entire tool and subcategories were over .853 and stability of the scale was confirmed. There were significant differences in nursing competence according to the 5 levels of the ladder. Conclusion: The findings indicate that the proposed CLS model with a standard score for nursing competence, recommended or obligatory criteria for qualifications and professional activities provides a good tool for developing nurses' competences and retaining excellent nurses in clinical practice.

Purpose: This study aimed to develop nursing practice standards of hemodialysis care according to admission types. Methods: The standards were developed in four phases. Phase 1: The preliminary standards of hemodialysis care were developed based on literature review and evaluation of professional experts. Phase 2: Content validity was evaluated by 34 professional experts and the standards were modified and revised. Phase 3: Clinical validity was evaluated by 212 hemodialysis nurses. Expert group validated and verified the final outcome. Phase 4: Final standards of hemodialysis care according to admission types were developed. Results: The standard of hemodialysis care for out-patients included 5 standards, 9 contents, 43 nursing activities. The standard for in-patients included 6 standards, 10 contents, 50 nursing activities. The standards for critical patients included 4 standards, 10 contents, 43 nursing activities. There were differences in nursing activities according to admission type. Time required to meet the standards were different according to admission types. Conclusion: The findings of this research demonstrated that the time required for hemodialysis care and appropriate number of nurse would be different according to admission types. Different nursing workload according to admission type of hemodialysis patients need to be considered in allocating nursing manpower.

Purpose: The purpose of this study was to examine the effects of foot mats on reducing levels of fatigue, discomfort, lower extremity edema and skin temperature in scrub nurses during surgery. Methods: This study employed one group repeated measures design in which 16 scrub nurses (ages 22-38) stood on steel footstools (SF) during scrub as the conventional test and stood on SF with foot mats as the experimental test. Levels of fatigue, discomfort, lower extremity edema and skin temperature were measured before the first surgical hand scrub and right after the first surgery of the day for 3 consecutive days in both tests. Results: The changes in levels of fatigue and discomfort were significantly different between tests (p<.001~.033). Edema, determined by the differences in circumferences of the ankles and calves before and after the surgery was also significantly different between groups (p=.001~.011). However, the change in skin temperature on the foot tops of both feet was not different between tests (p=.351~.467). Conclusion: The results of this study show that using foot mats on top of the steel footstool is effective in reducing the levels of fatigue, discomfort and lower extremity edema in scrub nurses during surgery.

Purpose: The aim of this study was to analyze various nursing services of delivery room nurses by hospital level, and identify importance and frequency to provide baseline data to establish delivery room nurses' roles. Methods: Through DACUM analysis technique, service descriptions, duties, and tasks were derived from the literature. A survey was done of 242 nurses from delivery rooms of hospitals, general hospitals, superior general hospitals, and special hospitals. Importance and frequency of each service were measured using a 4point scale, and results were analyzed using SPSS. Results: Nursing services for delivery room nurses consisted of 18 duties and 86 tasks. Duties with the highest importance were 'labor support' and 'infection management', and those with lowest importance were 'collaborative care' and 'communication'. The duty with the highest frequency was 'labor support', and lowest frequency was 'communication'. There were differences between importance and frequency depending on the size of hospitals. Conclusion: Results of this first study on nursing services of delivery room nurses. delivery room nurses are performing a wide range of nursing services and the various types are clarified including importance and frequency.

Purpose: The purpose of this study was to identify patient satisfaction about nursing care provided by Advanced Practice Nurses (APN) using the La Monica-Oberst Patient Satisfaction Scale (LOPSS). Methods: The investigation was conducted including 263 patients who experienced care provided by 41 APNs at a tertiary hospital in Korea. Patient satisfaction with nursing care was measured using 41-item LOPSS. We analyzed the data using descriptive statistics, independent t-test and one-way ANOVA. Results: Overall patient satisfaction with APN care was high. The LOPSS scores for APNs were 52.26 for good impression, 61.75 for interpersonal support, 81.32 for dissatisfaction and 195.93 for total score. "APNs talk down to me" was a reverse coding item which demonstrated the highest score for patient satisfaction. Among patients' characteristics, age and type of main caregiver were independent factors related to patients's satisfaction. Among APN's characteristics, work experience was significantly related to patients' satisfaction. Conclusion: This study identified patient satisfaction regarding nursing care provided by APNs. High patient satisfaction in APN services demonstrated APNs' contribution to quality improvement in health care services. It is recommended that various outcome research about APN service needs to be performed.

Purpose: The purpose of this study was to investigate the effect of clinical nurses' communication competency and emotional intelligence on organizational performance. Methods: Two hundred and fifty nurses who currently work at two superior general hospitals in Seoul, Korea, participated in the study. Data were collected between March and April, 2015. Global Interpersonal Communication Competence Scale (GICC-15) developed by Hur (2003) was used to measure communication competency. Wong & Law's emotional intelligence scale (WLEIS) developed by Wong & Law (2002) was used to measure emotional intelligence. Organizational performance scale developed by Brewer & Selden (2000) was used to measure organizational performance. Results: The results were summarized as follows: 1) The means of communication competency, emotional intelligence and organizational performance were 3.61, 4.84, and 3.59 respectively. 2) There were positive correlations between communication competency, emotional intelligence and organizational performance. 3) The variance of organizational performance accounted for was 26.0% (adj $R^2=.26$). Conclusion: These findings suggest that developing human resources in nursing is important for better organizational performance.

Purpose: The purpose of this study was to evaluate nursing protocols for superficial cryotherapy in different medical institutions. Methods: The study was conducted with a cross-sectional descriptive design. The medical institutions including general hospitals, hospitals, and geriatric hospitals were randomly selected. A total of 435 nurses from 126 institutions completed a questionnaire. Data were collected from December 2014 to June 2015. Results: Forty-two institutions (39.5%) had nursing protocol for cryotherapy. The nurses reported that durations of cold application were 2 minutes to 5 hours. Frequently used cold therapy devices in order of frequency were frozen gel packs, ice packs, and frozen IV fluid bags. There were variances in the duration of cold application according to the types of institution ($x^2=7.78$, p=.020) and nursing units ($x^2=26.42$, p<.001). In addition, intervals of cold application were different according to the nursing units (x=12.23, p=.032). There were differences in cold application instruments by regional groups (x=70.38, p<.001). Most of the nurses (95.6%) responded that national nursing protocol for superficial cryotherapy were needed. Conclusion: There were difficulties in providing consistent nursing interventions because of the practical differences and absence of evidence-based guidelines for cryotherapy. The researchers recommend that basic studies with various instruments be conducted and proper nursing protocols be developed for cryotherapy.

Purpose: The purpose of this study was to evaluate the effects of a group art therapy on decreasing job stress and burnout of clinical oncology nurses. Methods: The study was conducted using a non-equivalent control group, non-synchronized design with repeated measures. A total of 29 clinical oncology nurses participated in the study; 15 were assigned in the experimental group, and 14 in the control group. Data were collected from May to July, 2014. The study questionnaires were administered in three different time points (pretest, 8th week, and 12th week). Data were analyzed using $x^2-test$, Fisher's exact test, t-test, paired t-test, and repeated measures ANOVA. Results: The first hypothesis "the experimental group with group art therapy will have lower job stress than that of the control group" was support (F=7.88, p=.003). The second hypothesis, "the experimental group will have lower burnout than that of the control group" was not statistically supported (F=1.80, p=.188). Conclusion: The findings of the study indicated that the group art therapy for oncology nurses may positively influence in decreasing job stress, which open a venue for developing a nursing intervention with group art therapy for clinical nurses in future.

Purpose: To identify user requirements for electronic nursing record (ENR) systems so as to ensure system usability. Methods: A mixed methods approach were applied in three steps : (i) task and workflow analysis with literature review of nursing documentation, (ii) literature reviews of system usability, and (iii) Use Case idenfication and consensus-based validation. We analyzed the nursing activity logs collected from a time-motion investigation of six hospitals. The Use Cases were validated by eight clinical experts from different hospitals and two experts from academia in a sequential Delphi survey. Consensus was achieved for the significance score and agreement among the panel. Results: Eight task groups and patterns of task flow were observed, which were translated into nine Use Cases. The specification of Use Cases was derived from principles, guidelines, and recommendations on nursing documentation and electronic health record systems, which was organized into three requirements of each Use Case: functionality, information, and design characteristics. Each Use Case achieved an agreement of 50~70%, and significance scores of 4 or 5 on a 5-point Likert scale. Conclusion: The nine Use Case identified were considered to be important and adequate in terms of both clinical and informatics contexts.

Purpose: The purpose of the study was to identify and describe illness experiences of men with myocardial infarction. Methods: Data were collected through individual in-depth interviews with 10 male patients. Analysis was done using phenomenological analysis. Results: Five theme clusters including 11 themes emerged. 1) "Unexpected grave disease instantly dividing life and death" describes the great ignorance of symptoms and experience as a survivor narrowly escaping death. 2) "A disease still not considered a disease" illustrates the paradoxical and confusing situation between low level of awareness of the severity of the disease and high level of reflection on their unhealthy lifestyles. 3) "Fighting against me for health" illustrates their resolution and action to maintain health while experiencing helplessness. 4) "Relationships in a no-win situation" contains defensive posture due to social stigma and the dilemma of family breadwinners. And 5) "Introspection of past and future life" describes positive turnings in life through enlightenment in addition to remorseful feeling about the past and persistent worry of death. Conclusion: Health professionals need to support men with myocardial infarction by providing family-oriented and empowerment-based self-management interventions to lead to success in their illness journey and to improve their quality of life.

Purpose: This study was performed to develop a valid and reliable Korean Patient Classification System for Critical Care Nurses (KPCSC). Methods: Tertiary and general hospitals with various levels of ICU nurse staffing were included. To verify interrater reliability, data collectors and staff nurses of 15 ICUs in 11 hospitals classified 262 patients. To verify construct validity, the staff nurses classified 457 patients according to KPCSC comparing difference by medical department and type of stay in ICU. For conversion index, 195 patients from 10 ICUs in 7 hospitals were classified and nursing time was measured by 174 nurses, 7 head nurses, 18 charge nurses, 37 nurse aids and 1 secretary. Results: The developed KPCSC has 11 categories, 82 nursing activities and 115 criterias. Reliability was found to have high agreement (r=.96). Construct validity was verified by comparing differences in medical department and type of stay in ICU. According to scores, four groups in the KPCSC were identified. One score on the KPCSC indicates 6.12 minutes of nursing time. Conclusion: The findings show that the KPCSC can be used to measure new and complex nursing demands including rehabilitation and the safety of ICU patients.

Purpose: The purpose of this study was to analyze the image of nurses portrayed on Korean TV dramas. Methods: Among the medical dramas aired on TV from 2000 to 2013, sixteen different Korean TV dramas were selected. For analyzing the dramas, 'the checklist for monitoring media images of nurses and nursing' was used after obtaining the permission from the original author. Two evaluators evaluated each drama and synchronized the final scores after comparing individual scores. Results: The roles of nurses were found to be such a supportive role (93.8%), and a professional role (75.0%). The nurses images portrayed on the selected TV drama included being kind, accountable, having humanism (81.2%), and professional insights (56.2%), whereas nurses's administrative role such as a manager were not represented. A half of scenes that nurses showed up, nurses were asking asking for help to doctors or other hospital administrators. Conclusion: Since TV dramas on air in Korea still underrepresented the roles of the professional nurses, providing the media with advice to improve the images of nurses is necessary in future. Concrete and sustainable strategies for improving nurses image are required.