Purpose: This study was done to develop an evidence-based nursing clinical practice guideline for Moisture associated skin damage (MASD) prevention and management for patients in Korea. Methods: The guideline adaptation process was used and conducted according to the guideline adaptation manual developed by the Korean Hospital Nurses Association. It consists of three main phases and 9 modules including a total of 24 steps. Results: The adapted MASD clinical practice guideline consisted of 4 sections, 8 domains and 28 recommendations. The number of recommendations in each section was: 7 on MASD assessment, 14 on MASD prevention and management, 4 on education, and 3 on organizational policy. Of the recommendations, 3.6% were marked as A grade, 28.6% as B grade, and 67.8% as C grade. Conclusion: This MASD clinical practice guideline is the first to be developed in Korea. The developed guideline will contribute to standardized and consistent MASD prevention and management. The guideline can be recommended for dissemination and utilization by nurses nationwide to improve the quality of MASD prevention and management. Regular revision is recommended.

Purpose: This descriptive study was conducted to identify the effects of hospital organizational culture and work environment on nurses' intent to stay at work. Methods: Participants of this study were 234 nurses who have worked at a local general hospital in the Chungcheong province for at least 6 months. The data were collected from July 17 to 28, 2017, using self-reported questionnaires and analyzed with multiple regression using SPSS version 22.0. Results: Clinical experience (${\beta}=.38$, p<.001), institutional support (${\beta}=.33$, p<.001), and relation-oriented culture (${\beta}=.24$, p<.001) affected intent to stay at work among nurses. These variables accounted for 34.8% of the variance in intent to stay at work among nurses. Conclusion: This study confirms the effects of the work environment and organizational culture on nurses' intent to stay at work. Efforts for improving the work environment and organizational culture need for retaining nurses in a hospital. We suggest further research to identify the other factors associated with intent to stay at work among nurses.

Purpose: This study was conducted to evaluate the effects of early knee joint exercise education program on pain, knee ROM, and satisfaction among patients with a total knee replacement arthroplasty. Methods: An experimental study with non-equivalent groups was conducted using 32 patients for an experimental group and 32 patients for a control group. The experimental group received knee joint exercise education including systemic continuous passive motion (CPM) exercise and knee exercise. The control group received conventional CPM exercise. Pain, flexion and flexion contracture range of motion, and patient satisfaction were evaluated by $x^2$ test, Fisher's exact test, t-test, and repeated measures ANOVA using the SPSS 23.0 Windows program. Results: There were a significant improvement in patients' knee flexion and satisfaction in the experimental group compared to the control group. There was no significant difference in pain and flexion contracture between the two groups. Conclusion: The findings suggest that the proposed education program is efficient and effective when providing nursing care after a total knee replacement arthroplasty.

Purpose: The purpose of this descriptive study was to identify the influence of health literacy and health empowerment on health behavior practice in elderly patients with coronary artery disease. Methods: 239 elderly outpatients older than 65 years of age were included. The data were analyzed with descriptive statistics including independent t-test, ANOVA, and hierarchical regression. Results: Major factors having a significant impact on health behavior practice were health literacy (${\beta}=.26$, p<.001) and health empowerment (${\beta}=.32$, p<.001). Health literacy was increased by 4.7% after controlling for general and health-related characteristics. Health empowerment increased by 5.9% after controlling for general and health-related characteristics, and health literacy. The two variables explained 35% of the variance in health behavior practice (F=7.74, p<.001). Conclusion: The main findings of this study can be utilized as the foundation for developing programs to promote health empowerment and health behavior practice of the elderly population. Furthermore, the results of the study can also be used to establish health-related strategies.

Purpose: The purpose of this study was to identify the relationship between response to violence, resilience and burnout and to investigate the factors that affect burnout in emergency room nurses. Methods: Data from 237 nurses in 15 emergency rooms were collected using a structured questionnaire. Data were analyzed using SPSS 23.0, and the analyses included descriptive statistics, t-test, Mann-Whitney test, ANOVA, Kruskall Wallis test, Pearson correlation, and hierarchical multiple regression. Results: Burnout was positively correlated with response to violence and negatively correlated with resilience in emergency room nurses. Response to violence (${\beta}=.466$, p<.001), resilience (${\beta}=-.308$, p<.001), and religion (${\beta}=-.131$, p=.011) were significant predictors of burnout, and they explained 39.9% of emergency room nurses' burnout. Conclusion: Response to violence and resilience were identified as significant factors affecting burnout in emergency room nurses. Therefore, it is necessary to develop strategies to cope effectively with violence and to develop programs that can strengthen resilience.

Purpose: This cross-sectional survey study explored the moderating effect of social support between hierarchy-oriented nursing organizational culture and turnover intention in clinical nurses. Methods: Data were collected using self-report questionnaires from 240 nurses working at three general hospitals in February 2018. Hierarchy-oriented nursing organizational culture, turnover intention and social support were measured using 5, 6, and 8 items, respectively, of validated instruments. Descriptive analysis and hierachical multiple regression were conducted using SPSS/WIN 21.0. Results: Nurses rated $3.66{\pm}0.50$ for hierarchy-oriented nursing organizational culture, $3.40{\pm}0.64$ for turnover intention, and $3.77{\pm}0.56$ for social support respectively. Nurses' turnover intention was positively correlated with hierarchical organizational culture, but negatively with social support. The moderating effect of social support was not significant in the relationship between hierarchical nursing organizational culture and turnover intention. Conclusion: It is required to improve the hierarchy-oriented nursing organizational culture. Institutional preparation and education are urgently needed to strengthen the boss and peer support for clinical nurses and finally to reduce turnover intention.

Purpose: The purpose of this study was to propose a revised Clinical Ladder System(CLS) Model for nurses based on the evaluation of clinical competence and professional activities of nurses working in general hospitals. Methods: Data were collected between September 10 and October 30, 2017. Participants were 50 head nurses from 10 general hospitals with over 400 beds located in Seoul City and Gyeonggi Province. Each head nurse evaluated clinical competence, qualifications, and professional activities of 5 staff nurses at each of the 5 levels of CLS in her unit. The total number of the nurses evaluated was 245. Data were analyzed with descriptive statistics and t-test, one-way ANOVA, and $Scheff{\acute{e}}$. Results: Over 80% of the nurses were university graduates. As the CLS levels increased, clinical competence, qualifications, and professional activities also increased significantly. Education material development and quality improvement activities were carried out by nurses from level 2, research and evidence based practice activities were carried out from level 3, and nurses at level 4 or 5 participated in most of the professional activities as leaders. Conclusion: In order to retain excellent nurses in general hospitals, recognizing and rewarding nurses according to the revised model of the CLS are recommended.

Purpose: This study was conducted to identify nurses'critical thinking disposition, self-leadership and clinical competency in small to medium sized hospitals less than 300beds. Methods: Data were collected using the questionnaire from 227 nurses in Incheon city and Gyeonggi province from March to April, 2017. The data were analyzed using t-test, ANOVA and $Scheff{\acute{e}}^{\prime}s$ test to identify differences in critical thinking disposition, self-leadership and clinical competency. Pearson correlation coefficients were used to identify the correlation among the study variables, and multiple regression was used to identify factors contributing to clinical competency. Results: There were significant differences in critical thinking disposition according to age, marital status, clinical career, career in currently working department and education about leadership. Significant differences in self-leadership were identified according to marital status, work position, working department, work type, education about leadership, and turnover intention. Clinical competency was significantly different depending on age, education, monthly income, work position, career in currently working department, work type, education about critical thinking disposition and education about leadership. Clinical competency was positively correlated critical thinking disposition and self-leadership. Critical thinking deposition, monthly income and self-leadership explained 30.1% of clinical competency of nurses working in small to medium sized hospitals. Conclusion: The results of this study suggest that we need to improve nurses'critical thinking disposition, self-leadership, and the clinical competency.

Purpose: The purpose of this study was to understand morality identity, occupational stress and authentic leadership and identify factors contributing to turnover intention among intensive care unit (ICU) nurses. Methods: Data were collected from 230 nurses at the university hospitals in Daegu, Ulsan and Busan between February 15 and March 23, 2017. Instruments measuring turnover intention, moral identity, occupational stress, and authentic leadership were utilized. Statistical analysis included t-test, ANOVA, Pearson correlational analysis, and hierarchical regression analysis. Results: A total of 207 nurses in ICU participated in this study. The power of explanation with age and dependents on turnover intention was 4.1%. With inclusion of occupational stress, moral identity, and authentic leadership factors put into the model, further 20.4% was explained. The explanatory power of the turnover intention in the final model was 23.6% (F=11.63 p<.001), and occupational stress was the key factor explaining turnover intention (${\beta}=.28$, p<.001). Predictive factors contributing to turnover intention were age, occupational stress, moral identity, and authentic leadership in final model. Conclusion: These findings demonstrated occupational stress, moral identity and authentic leadership as critical factors contributing turnover intention of ICU nurses. It is necessary to promote nursing manager's authentic leadership, and to encourage moral identity in ICU nurses. In addition, providing intervention programs to reduce occupational stress for ICU nurses is necessary.

Purpose: This study was a retrospective cohort study to evaluate the effect of evidence-based guidelines for catheter dysfunction among hemodialysis patients, Success rate and bleeding complications in catheterization were examined. Methods: We performed a retrospective cohort study, including 94 patients with catheter dysfunction who were receiving hemodialysis at a university hospital; 55 in the control group and 39 in the protocol group. This protocol was composed of the catheter dysfunction assessment, conservative management of catheter dysfunction, drug management of catheter dysfunction, catheter function test and maintenance management. Data were analyzed with a Chi-square test and t-test using SPSS/WIN 23.0 program. Results: The patency rate of the protocol group was significantly higher than that of the control group. The rate of bleeding complications was not statistically significant for either the control group or the protocol group before or after application. Conclusion: The application of the guidelines effectively increased the patency rate of the catheter without bleeding complications. It is hoped that this guideline can be disseminated to nurses nationwide to improve the efficiency of catheter function for hemodialysis patients.

Purpose: The study was conducted to investigate correlations between self-management and physiological measurements of patients on hemodialysis according to their age. Methods: The subjects were 120 patients on hemodialysis at three hospitals in S and G cities. Data were collected using a structured questionnaire and medical records. The collected data were analyzed using descriptive statistics including t-test, ANOVA, and Pearson's correlation analysis with the SPSS 23.0 program. Results: The levels of compliance with self-management were highest in the middle-aged group. There was no significant difference in physiological measurements between the different age groups. Conclusion: The results suggest that nurses should consider characteristics of different age groups to improve the levels of self-management and physiological measurements.