Purpose: This paper is a report of a concept analysis of 'quality of pediatric nursing care', Methods: Rodgers's evolutionary method of concept analysis was used. Data were collected from published literature related to quality of pediatric nursing care. Results: Quality of pediatric nursing care was identified with three dimensions and seven attributes: 1) nurse's character: technical competence, interpersonal competence, 2) nurse's activities: developmentally appropriate care, attentiveness, entertainment, 3) nurse-parent interaction: nurse-parent partnership, emotional support. Antecedents of quality of pediatric nursing care were 'child and parent's expectation about pediatric nursing care', 'previous caring experience of pediatric nurses'. Consequences of quality of pediatric nursing care were 'meet child and parent's needs' and 'better health outcomes.' Conclusion: 'Quality of pediatric nursing care' is a core concept in pediatric nursing practice. Appropriate instruments to operationalize the concept need to be developed.

Purpose: The purposes of this study were to explain the phenomena of hot flashes in climacteric women by using Mexameter, Skin Thermometer, Corneometer, and Laser Doppler Perfusion Imager (LDPI) objectively and to identify the interrelation between the subjective and objective measurements of hot flashes by comparing the two as reported in retrospective questionnaires. Methods: The participants were one hundred women (45-60 yr) who were not currently on hormone therapy, and had reached hot flash scores of 10 or higher. Hot flashes were measured in a temperature and humidity controlled room for 7 hr from 10 am to 5 pm. Hot flashes were measured subjectively and recorded via the Hot Flash Diary Report. When participants felt the hot flashes, they were measured objectively by Mexameter, Skin Thermometer, Corneometer, and LDPI. Results: The frequency of hot flashes in participants ranged from 1 to 7 times. When hot flashes occurred in participants, the erythema, skin temperature, skin hydration, and blood perfusion showed statistically significant changes in all measurements. But, the subjective and objective measurements of hot flashes showed only weak correlations. Conclusion: Results indicate a need for future research with subjective and objective measuring instruments chosen depending variations identified for the study.

Purpose: The study was conducted to describe body shapes of school age children using the degree of obesity index (DOI) and body mass index obesity index classified by the Ministry of Education, Science and Technology (M-BOI) and Seoul Metropolitan Office of Education (S-BOI). Methods: In this cross sectional descriptive study health screening data for school children collected in 2007 was used. Results: Data were analyzed for 2,193 4th-6th grade boys (52%) and girls who attended 4 schools in rural areas. DOI determined that only 44.3% of students had average weight. This proportion was much lower than the results of other methods (74.3-77.6%). All three methods defined girls (51.3-61.8%) as skinnier than boys. Skinny and average body shaped children classified by DOI and obese children classified by S-BOI were heavier and taller and presented higher degrees of obesity (DO) and BMI scores than by other methods. M-BOI and S-BOI presented statistically significant positive correlations with weight, height, DO and BMI, while DOI was not correlated with height. Conclusion: BMI based body shape classifications provide a more rigorous classification of body shape which are favorable for school health professionals with limited resources and policy makers for internationally comparable references.

Purpose: The purpose of this study was to identify the role adaptation process experienced by executive directors of nursing department of general hospitals. Methods: Data were collected from 9 executive nursing directors though in-depth interviews about their experiences. The main question was "How do you describe your experience of the process of role adaptation as an executive nursing director?" Qualitative data from field and transcribed notes were analyzed using Strauss & Corbin's grounded theory methodology. Results: The core category of experience of the process of role adaptation as an executive nursing director was identified as "entering the center with pushing and pulling". The participants used five interactional strategies; 'maintaining modest attitudes', 'inquiring about trends of popular feeling', 'making each person a faithful follower', 'collecting & displaying power', 'leading with initiative'. The consequences of role adaptation in executive nursing directors were 'coexisting with others', 'immersing in one's new role with dedication', and 'having capacity for high tolerance'. The types of role adaptations of executive directors in nursing department were friendly type, propulsive type, accommodating type. Conclusion: The results of this study produced useful information for executive nursing directors on designing a self-managerial program to enhance role adaptation based on interactional strategies.

Purpose: To determine whether the practice of not routinely changing ventilator circuits in patients who require prolonged mechanical ventilation is associated with ventilator-associated pneumonia (VAP). Methods: Patients were divided into two groups, ventilator circuits were routinely changed every 7 days for the control group (39) and every 14 days for the experimental group (40) over a period of 1 yr (April 1, 2009-March 31, 2010). Pediatric patients (age 17 yr or less) were not included. VAP was diagnosed by the criteria of the Centers of Disease Control and Prevention (CDC). Incidence of VAP and characteristics of infection were evaluated. Results: In the experimental group, 2 episodes of pneumonia were observed in 40 patients and 1,322 ventilator days. The rate of VAP was 1.5 per 1,000 ventilator days. There was 1 episode of pneumonia in 39 patients and 481 ventilator days for the control group. The rate of VAP was 2.1 per 1,000 ventilator days. The difference between both groups was not significant (p=.695). Conclusion: Extending ventilator circuit change interval from 7 days to 14 days does not increase the risk for VAP.

Purpose: While there are a number of studies on children with disabilities, there have been few studies on mothers of children with autism. The purpose of this study was to explore the process of life transition of mothers who have children with autism. Methods: From June 2007 to May 2009, the researcher interviewed 15 mothers of children with autism living in Seoul City, Gyeonggi or Chonbuk Provinces, and then analyzed the data gathered using the constant comparative method of grounded theory. Results: "Living together holding a string of fate" was a core category showing along the continuum of life. The basic social process of life transition encompassed 5 stages: stages of denying, wandering, devoting, mind controlling, and finally accepting. These five stages proceeded in phases, though returned back to the wandering stage occasionally. Conclusion: This study has opened the door to understanding how mothers of children with autism experienced life transition. The findings suggest that differentiated support and care at each stage should be given and there is the need to develop transition assessment tools for mothers of children with autism.

Purpose: The purpose was to develop a preliminary scale to measure Korean adolescents' health behaviors through a qualitative approach, to evaluate the scale psychometrically, and to develop a final scale. Methods: Participants were 61 adolescents for qualitative interviews and 1,687 adolescents for the psychometric evaluation. Procedure included content analysis of interviews to identify health behavior categories for Korean adolescents, pre-test to confirm that preliminary scale items were understandable, content validity by an expert panel, development of the web-based computer-assisted survey (CAS), and psychometric analysis to determine reliability and validity of the final scale. Results: A final scale was developed for both paper-and-pencil and CAS. It consisted of 14 health behaviors (72 items), including stress and mental health (10), sleep habits (5), dietary habits (12), weight control (4), physical activity (4), hygiene habits (5), tobacco use (5), substance use (2), alcohol consumption (4), safety (4), sexual behavior (9), computer use (3), health screening (4), and posture (1). Conclusion: The scale's strong points are: 1) Two thirds of the final scale items are Likert scale items, enabling calculation of a health behavior score. 2) The scale is appropriate to Korean culture. 3) The scale focuses on concrete health behaviors, not abstract concepts.

Purpose: In this study cardiovascular health status and health behavior of Korean women based on their household income were explored. Methods: For this cross-sectional study, 91 women residing in the community were recruited to complete survey questionnaires and biophysical tests including blood pressure (BP), body mass index (BMI), body fat rate, waist circumference (WC), and blood chemistry tests. Results: Compared to non-low income women (NLIW), low income women (LIW) were more likely to be older, less educated, and jobless, and further more LIW were postmenopause and reported having been diagnosed with hypertension or hypercholesterolemia. Significant differences were found in systolic BP, triglyceride level, BMI, body fat rate, and WC between the groups. Two fifths of the LIW had indications for metabolic syndrome. Their 10-yr risk estimate of myocardioal infarction or coronary death demonstrated a higher probability than that of NLIW. Although these significant differences were due to age gap between the groups, advanced age is known to be one of the key characteristics of LIW as well as a non-modifiable risk factor. Conclusion: Effective community programs for vulnerable women at risk of cardiovascular disease should be based on strategies targeting unhealthy behaviors and modifiable risk factors.

Purpose: This study was conducted to assess optimal needle length for gluteal intramuscular injections (IM) via simple skinfold thickness (SFT). Methods: For this study, 190 healthy adults were recruited and grouped into eight groups according to gender and body mass index (BMI) (kg/$m^2$). The Korean Society for the Study of Obesity criteria defines a BMI under 20 as underweight, 20.1-22.9 as normal, 23-24.9 as overweight and over 25 as obese. For each participant, the SFT of dorsoguteal (DG) and ventrogluteal (VG) sites were measured using a caliper. Subcutaneous tissue thickness was acquired through ultrasonic images. Results: For men in the overweight and obese groups at the DG site, for the obese group at the VG site, and for women in the normal weight, overweight and obese groups at both sites, the mean subcutaneous tissue thickness exceeded 1.84 cm, the minimal length for a 1 inch needle used for IM. At the DG site, optimal intramuscular needle length (OINL) was 1.4 times in women and 1.0 times in men compared to SFT. At the VG site, OINL was 1.3 times in women and 0.9 times in men compared to SFT. Conclusion: The results of this study suggest that SFT is a reliable index to determine optimal needle length with minimal effort prior to IM.

Purpose: This study was done to investigate differences in health behaviors by job stress level in male and female workers in a large-sized company. Methods: Participants were 576 male and 228 female workers who completed questionnaires. Job stress was measured using the 'Short Form Korean Occupational Stress Scale (SF-KOSS)'. Health behaviors included smoking, alcohol consumption, regular exercise, and diet. Frequency, mean, SD, chi-square test, and multivariate logistic regression using SAS version 9.1 were used to analyze data. Results: Smoking, drinking and regular exercise rates were not different by job stress level in male or female workers. Only regular diet was significantly different by job stress level in male and female workers. From multivariate analysis, the alcohol consumption rates for female workers differed by marital status. Regular exercise rate was significantly related to age for male workers and type of employment for female workers. After adjusting for demographic and work-related characteristics, regular diet significantly differed by shift work for male workers and marital status and shift work for female workers. Conclusion: The findings of the study indicate that nursing interventions should be developed to manage job stress to improve diet habits for male and female workers in large-sized companies.

Purpose: The purpose of this study was to examine the effects of case-base learning (CBL) using video on clinical decision-making and learning motivation. Methods: This research was conducted between June 2009 and April 2010 as a nonequivalent control group non-synchronized design. The study population was 44 third year nursing students who enrolled in a college of nursing, A University in Korea. The nursing students were divided into the CBL and the control group. The intervention was the CBL with three cases using video. The controls attended a traditional live lecture on the same topics. With questionnaires objective clinical decision-making, subjective clinical decision-making, and learning motivation were measured before the intervention, and 10 weeks after the intervention. Results: Significant group differences were observed in clinical decision-making and learning motivation. The post-test scores of clinical decision-making in the CBL group were statistically higher than the control group. Learning motivation was also significantly higher in the CBL group than in the control group. Conclusion: These results indicate that CBL using video is effective in enhancing clinical decision-making and motivating students to learn by encouraging self-directed learning and creating more interest and curiosity in learning.

Purpose: This study was done to evaluate the formal education program provided by the Korean government for care workers for frail elderly people. Methods: This study was a cross-sectional survey in which 438 certified care workers who had completed the education program participated. Data were collected from June to October 2009, using a self-report questionnaire consisting of satisfaction with, and understanding of the education program. Results: The participants had a mean age of 46.7 yr, 87.9% were female and 58.2% were high school graduates. For the theory part of the education, the highest score for understanding was for 'supporting household & activities of daily living' while the lowest score for understanding was for 'care for death and dying'. For the practical education, the highest score for understanding was for 'talking with the client' and the lowest score was for 'first aid & basic life support'. There was a significant difference in satisfaction and understanding of the theoretical and practical parts according to educational level. Conclusion: Continuing education programs are needed for care workers for elders, both in the theoretical and practical areas. Also the content of programs should address the weak points of this formal education program.

Purpose: This study was designed to identify burnout and factors influencing burnout in contingent nurses. Methods: A cross-sectional design was conducted with a sample of 228 contingent nurses randomly selected from 25 general hospitals in Korea. The tools used for this study were scales measuring burnout (8 items), job stress (8 items), job satisfaction (9 items), self efficacy (9 items), organizational commitment (9 items), empowerment (9 items), autonomy (7 items) and social support (8 items). The data were analyzed using SPSS 15.0 employing Pearson correlation coefficients and multiple regression analysis. Results: The mean score for burnout in contingent nurses was 3.05 points. Factors influencing burnout in contingent nurses were identified as job stress (${\beta}$=.40), satisfaction level with current ward (${\beta}$=-.25), organizational commitment (${\beta}$=-.21), job satisfaction (${\beta}$=-.19) and empowerment (${\beta}$=-.16). These factors explained 65.0% of burnout reported by contingent nurses. Conclusion: The results indicate which factors are major factors influencing burnout in contingent nurses in general hospitals. Therefore, these factors may serve as predictors of burnout in contingent nurses.

Purpose: This study was done to identify participation by home healthcare nurses in clinical decision making and factors influencing clinical decision making. Methods: A descriptive survey was used to collect data from 68 home healthcare nurses in 22 hospital-based home healthcare services in Korea. To investigate participation, the researcher developed 3 scenarios through interviews with 5 home healthcare nurses. A self-report questionnaire composed of tools for characteristics, factors of clinical decision making, and participation was used. Results: Participation was relatively high, but significantly lower in the design phase (F=3.51, p=.032). Competency in clinical decision making (r=.45, p<.001), perception of the decision maker role (r=.47, p<.001), and perception of the utility of clinical practice guidelines (r=.25, p=.043) were significantly correlated with participation. Competency in clinical decision making (Odds ratio [OR]=41.79, p=.007) and perception of the decision maker role (OR=15.09, p=.007) were significant factors predicting participation in clinical decision making by home healthcare nurses. Conclusion: In order to encourage participation in clinical decision making, education programs should be provided to home healthcare nurses. Official clinical practice guidelines should be used to support home healthcare nurses’ participation in clinical decision making in cases where they can identify and solve the patient health problems.

Purpose: This study was conducted to examine whether the level of classification for long-term care service under longterm care insurance reflects resource utilization level for residents in nursing homes. Methods: From 2 long-term care facilities, the researchers selected 95 participants and identified description and time of care services provided by nurses, certified caregivers, physical therapists and social workers during a 24-hr-period. Results: Resource utilization level was: 281.04 for level 1, 301.05 for level 2 and 270.87 for level 3. Resource utilization was not correlated with level. Differences in resource utilization within the same level were similar with the coefficient of variance, 22.7-27.1%. Physical function was the most influential factor on long-term care scores (r=.88, p<.001). The level for long-term care service did not reflect differences in resource utilization level of residents on long-term care insurance. Conclusion: The results of this study indicate that present grading for long-term care service needs to be reconsidered. Further study is needed to adjust the long-term care classification system to reflect the level of resource utilization for care recipients on the long-term care insurance.