Purpose: This study was to investigate the nationwide operational status of the professional medical support staffs (PMSS) who practice the expanded roles in the hospital setting. Methods: The data were obtained through survey from 36 hospitals with over 500 beds from 25th May to 12th July 2016. Data from 1,666 PMSS were analyzed. Results: Since the job titles varied, we classified them into 5 groups according to their roles; advanced practice nurse, clinical nurse expert, PA (physician assistant), coordinator, and others. There were differences in the operation status of PMSSs depending on the region, nurse staffing grade and number of hospital beds. Qualification criteria varied from hospital to hospital, and almost half of the hospitals didn't have any qualification standards for them. There were differences in age, educational level, clinical careers, rewards, and job satisfaction in 5 groups. Especially PA group had low salary, poorer working conditions, more difficulties in performing their work, and lower job satisfaction than other groups. Most PMSS (99.5%) were using a delegated prescription authority, however only 68.3% had job description and 19.9% had documented delegated role. Conclusion: Adequate training curriculum, documented delegated roles, and the protocols for legal protection and efficient medical services are needed.

Purpose: Nursing workplace spirituality (NWS) has received attention as a new and meaningful subject for nursing to consider, but little is known about the relation of NWS to nursing. The purpose of this study was to identify the effect of NWS on job satisfaction, burnout and turnover intention. Methods: Participants were 145 clinical nurses, who had worked for over 6 months in one of four general hospitals in B city. Data were collected using self-reported questionnaires and analyzed using descriptive statistics, independent t-test, ANOVA, Pearson coefficient and hierarchical multiple regression. Results: In the second hierarchy controlling general characteristics, significant predictors of job satisfaction were burnout and NWS, which explained 45.0% of the variance. NWS had more influence on job satisfaction than burn out, and the model was suitable. NWS showed no statistically significant effect on burnout and turnover intention, when general characteristics and job related factors were controlled. Conclusion: Findings indicate that nursing workplace spirituality has a positive influence on job satisfaction, but no direct influence on burnout or turnover intention, which may indicate an indirect influence. Nurse managers need to develop the NWS enhancement program and provide them to nurse to improve job satisfaction.

Purpose: The purpose of this study was to evaluate the effects of oral stimulation interventions on the transition from tube to oral feeding in preterm infants through systematic review. Methods: The randomized clinical trials published between 1980 and 2015 were searched using domestic and international databases, and five randomized studies were selected for this study. The quality of study was assessed by assessment tool from the SIGN and meta-analysis was performed using the Cochrane Review Manager software Version 5.3 (RevMan). Results: Oral stimulation intervention in preterm infants decreased the transition time from tube to oral feeding (Post Menstrual Age, Day of life). Especially, a significant medium effect size was found in the number of days needed on the transition (ES=-4.95, p=.02). The oral stimulation intervention also had a significant large effect on the length of stay at hospital (ES=-8.33, p<.001). Conclusion: Based on the findings, oral stimulation interventions could be useful to facilitate the transition from tube to oral feeding in preterm infants in terms of reducing the length of stay at hospital and the number of days needed on transition.

Purpose: This study was done to investigate the correlation of illness perception, coping strategy and health status in patients with acute coronary syndrome who had undergone a coronary angioplasty. Methods: A descriptive correlational design was used in this study. A total of 102 patients with acute coronary syndrome was recruited. Data were collected using structured questionnaires including scales for the illness perception, the coping strategy, and health status. Data were analyzed using descriptive statistics, t-test, one-way ANOVA, Pearson correlation coefficient, and multiple regression analysis. Results: Health status showed significant correlations with illness perception (r=-.44, p<.001) and avoidance coping (r=-.33, p=.001); illness perception, avoidance coping explained 21% of variance in health status (F=8.58, p<.001). The factors that influenced health status were illness perception (${\beta}=-.37$, p<.001), and avoidance coping (${\beta}=-.21$, p<.001). Conclusion: The findings of this study indicate that illness perception and avoidance coping were significant variables for health status in patients with acute coronary syndrome who had undergone a coronary angioplasty.

Purpose: This study was done to investigate the correlation among symptom experience, self-efficacy, depression, and medication adherence in patients with chronic obstructive pulmonary disease (COPD). Methods: Participants were 100 patients with COPD recruited in one general hospital in Seoul. A structured questionnaire was used to measure the study variables. Data were analyzed using descriptive statistics, t-test, ANOVA, and Spearman correlation coefficient. Results: Symptom experience and depression were positively correlated (r=.41, p<.001), symptom experience and self-efficacy were negatively correlated (r=-.21, p=.035). Depression was negatively correlated with self-efficacy (r=-.60, p<.001) and medication adherence (r=-.48, p<.001). Self-efficacy and medication adherence were positively correlated(r=.76 p<.001). Conclusion: Findings from this study indicate that depression and self-efficacy are important variables related to medication adherence in patients with chronic obstructive pulmonary disease. Therefore, depression and self-efficacy should be assessed, and customized nursing interventions should be provided in order to increase medication adherence.

Purpose: This study examined post-traumatic stress (PTS) and the factors affecting it among general hospital nurses after the MERS(Middle East Respiratory Syndrome) epidemic. Methods: Data were collected from 170 nurses who worked at general hospitals since the first reported MERS outbreak. The IES-R-K assessed PTS. Data were analyzed using SPSS. Results: The mean PTS level was 7.80 points (range: 0~88); 7.1% of the participants were at a high risk. Nurses who had been in contact with patients suspected or diagnosed with MERS had high post-traumatic levels; those who had been quarantined during the MERS outbreak had relatively higher PTS levels. Shift-work nurses had higher PTS levels than those with fixed working hours. Above charge' nurses stress levels were higher than staff nurses' stress levels. The results showed that factors including contact with an MERS-suspected or diagnosed patient, position at work, and working status of MERS-affected nurses explained 16% of the PTS. Among the main variables, nurses' above charge position was the greatest factor affecting PTS. Discussion: It is necessary to develop intervention studies and programs considering these variables. Furthermore, development and implementation of differentiated programs should be done considering the position of above charge nurses.

Purpose: The aim of this study was to develop the nursing management core task and competency matrix for hospital unit managers. The perceived level of importance and performance of identified core competencies by unit managers were also investigated. Methods: Literature review and expert survey identified nursing management core task and competencies. Subsequently, the core task and competency matrix was developed and validated by expert panel. A survey of 196 nurse managers from 3 cities identified perceived importance and performance of core competiences. Results: Thirty-eight nursing management core task and thirty-seven nursing management core competencies were identified comprising five categories; Clinical practice knowledge, Evidence-based practice, Employee development, Strategic planning and Initiative. Based on the core task and competencies, the task and competency matrix for unit managers was developed. In the analysis of importance and performance of core competencies, the mean score of importance ($3.50{\pm}0.30$) was higher than the mean score of performance ($3.03{\pm}0.34$). Conclusion: The development of core task and competencies for unit managers in hospitals provides a guide for the development and evaluation of programs designed to increase competence of unit managers.

Purpose: In this study an investigation was done of injuries from inpatient falls and diagnostic tests and treatment after falls to identify what factors affect the occurrence of injury from inpatient falls in a tertiary hospital. Methods: Data for this cross-sectional study were retrieved for 428 fall events from data reported between January 1 and December 31, 2015 and were retrieved from the patient-safety reporting system in the hospital's electronic health records. A multivariate logistic regression model was developed with STATA 13.0. Results: Of the patients, 197 (46.0%) had physical injuries due to falls, 119 (27.8%) were given further diagnostic tests, and 358 (83.6%) received treatment including close observation after inpatient falls. Logistic-regression results identified that age, department, and risk factors had significant impact on injuries from falls. Conclusion: Findings indicate that to reduce the severity of injury after inpatient falls, each hospital should regularly evaluate identified factors, design fall-prevention practices specialized for elders and vulnerable patients, and initiate environmental and equipment innovations.

Purpose: A National survey was conducted to assess neonatal intensive care nurses' practice, barriers, knowledge, and belief regarding Kangaroo Care (KC). Methods: A descriptive survey was conducted. Kangaroo care questionares were sent to nurses in all hospitals in Korea whose were identified as providing neonatal intensive care services(N=263). Descriptive statistics were used to summarized the data. Results: Among 67 neonatal care units, 61.1% adapted KC in their practice. About 60% of nurses in the KC providing hospital actually practiced KC. Major barrier of practicing KC were infant safety concerns, as well as work load of nurses. Respondants who had practiced KC were more knowledgable and were more positive in their belief regarding KC. Conclusion: The findings suggest that in order to overcome barriers of practicing KC, educational programs are recommended designed for nurses. In addition, development of KC practice guideline is necessary to facilicate successful and safe KC.

Purpose: The purpose of this study was to investigate the reality, status of clinical nurses' emotional labor and the relationship with physical discomfort, burnout, depression and social support. Methods: A thousand three hundred sixteen clinical nurses from 42 hospitals nationwide participated in this study. Questionnaires were developed for evaluating the reality and status of emotional labor of clinical nurses after interviewing focus groups and reviewing literatures. Data were analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation coefficient. Results: Ninety eight percent of nurses had answered having emotional labor and they experienced 82 times per year, 9.6 times during last a month which means they experience it every other day. The one who provoke emotional labor were patients, guardians, physicians, supervisor, and colleagues in sequence. Eighty percent of nurses had intention to leave their jobs after experiencing emotional labor. They were doing more surface acting than deep acting of emotional labor. Conclusion: Clinical nurses in Korea experienced excessively high level of emotional labor and delayed responding to clients' requests due to lack of time for caring each patient was revealed as one of the main causes of emotional labor.

Purpose: This study was to present improvement strategy and the problems of the nursing fee in national health insurance system. Methods: A total of 23 nursing activities performed by nurses were selected. Data were collected the relative value score and criteria of the Health Insurance Review & Assessment Agency. Sixty clinical nursing experts panels were composed and nursing time surveyed self-reported method. The actual fee was calculated through the nursing time, relative value score and actual labor costs. Nextly, the labor costs analyzed was compared with that in the national health insurance. Results: Although the practices were mainly performed by the nurse, other occupations have been recorded as main practitioners and the time of the nursing activity is partially improperly reflected. Additionally, although the nurse practiced mainly in glucose (semi-quantitative) test, it was confirmed that the principal practitioner was described as a clinical pathologist. The the labor cost gap was estimated that is 9.3 times (median) and 11.9 times (average) in this analysis. Conclusion: This study suggests that it is necessary to legislate a policy that can improve the quality of clinical nursing by reinforcing the appropriateness and improving nursing fee through reflection of the actual time spent for nursing care.

Purpose: This study was aimed to compare nursing competency, self-esteem, and job stress between floating nurses and clinical nurses. Methods: The data were collected between October $1^{st}$ and December $31^{st}$, 2015, from 43 floating nurses and 57 clinical nurses working at a tertiary care hospital in Seoul. The collected data were analyzed with SPSS/WIN 23.0, using descriptive statistics and the t-test, $x^2$ test, ANCOVA, ANOVA, $Scheffe{\acute{e}}$ test, Pearson correlation coefficients, and Stepwise multiple regression. Results: The nursing competency of clinical nurses was significantly higher than that of floating nurses (F=4.370, p=.039). For both floating and clinical nurses, nursing competency was positively correlated with self-esteem (floating nurses, r=.47, p=.002; clinical nurses, r=.62, p<.001). Also, For both floating and clinical nurses, the most significant predictor of nursi ng competency was self-esteem(floating nurses, ${\beta}=0.45$, p=.001; clinical nurses, ${\beta}=0.60$, p<.001). Conclusi on: Efforts are needed to increase the nursing competency of the floating nurse through the improvement of the floating system, the nursing work environment, and continuous education. Also, as self- esteem is the most effective predictor of nursing competence, nursing intervention is needed to improve self-esteem of the floating nurse.

Purpose: The study aimed to examine quality of sleep in hemodialysis patients and explore physical, physiological, and psychological factors determining sleep quality. Methods: The survey was conducted among 165 patients on maintenance hemodialysis at a university hospital. Data were collected from July to October in 2015. The sleep quality and its related factors were assessed by standardized questionnaires, anthropometric measures, and lab tests after obtaining a written consent from the participant. Results: The mean age of the participants was 62.58 years old, and 67.9% of the participants experienced sleep disorders such as 'not falling asleep within 30 minutes' or 'frequently waking up at night'. Pain (t=-3.29, p=.007) and depression (t=-6.028, p<.001) were significantly different between the group with sleep disorder and the other without. The demographic factors (age, shared room, sleep during the day), physical factors (pain and symptom), and psychological factors (depression and trait and status anxiety) together explained 20.0% of variance in sleep quality. Conclusion: Sleep disorder was frequently experienced among the patients on maintenance hemodialysis. The effective nursing strategies should focus on sleep environment, pain and depression management. Further study is warranted to explore the effect of physiological factors related to the disease on sleep disorder in this population.