• Journal of Korean Academy of Nursing
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• v.37 no.5
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• pp.801-809
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• 2007

Purpose: This study was aimed at exploring the current status of graduate programs for an advanced practice nurse(APN) to recommend future directions of APN education. Methods: A total of 142 students enrolled in seven APN specialty programs, 67 professors who were involved in APN education, and nine nurse administrators participated in the study. Data was collected by questionnaires and focus group interviews. Results: The current definition of APN was found not to be specific enough to represent expected roles of APN in regards to knowledge, attitudes, roles, and skills. Standard curricula employed regardless of the area of APN specialty, lack of qualified clinical practice settings, as well as prepared instructors were found to be problematic. Conclusion: The following needs to be addressed: 1. redefining of APN roles, 2. tailoring specialty areas of APN, 3. consolidating educational programs, and 4. ensuring APN role models and faculty. Suggesting a CNS role in Korean APN, areas of APN should be rearranged toclarify their roles and educational programs need to be further developed to meet the expectations and quality of APNs. It is necessary to ensure APN's employment in the health care system by laws and policies to perform advanced nursing roles.

• Neonatal Medicine
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• v.15 no.1
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• pp.38-43
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• 2008

Purpose : The purpose of this study was to evaluate the relationship between cord serum adiponectin (APN) and IGF-I concentrations and fetal growth. Methods : Umbilical cord serum APN and IGF-I concentrations were measured in healthy term singleton deliveries (n=72). The association of cord serum APN and IGF-I concentrations was evaluated in relation to birth weight, height, head circumference, gender, ponderal index, placental weight, feto-placental (F/P) weight ratio, maternal weight gain, and maternal body mass index (BMI). Results : The mean cord serum APN was 29.2${\pm}$10.46 $\mu$g/mL. The cord serum APN and birth weight demonstrated a bell-shape relationship. The cord serum APN concentration was higher in females than males (P=0.001). The cord serum APN was negatively correlated with maternal BMI (r=-0.301, P=0.027), but the mean cord serum APN concentration was not correlated with birth height, birth head circumference, ponderal index, placental weight, F/P ratio, or maternal weight gain. The mean cord serum concentrations of IGF-I was 51.26${\pm}$21.54 ng/mL. The cord serum IGF-I concentration was positively correlated with birth weight (r=0.312, P=0.009), but not birth height, ponderal index, placental weight, F/P weight ratio, or maternal BMI. Conclusion : APN demonstrated a bell-shaped relationship with birth weight in healthy term infants. IGF-I was highly correlated with fetal growth, especially birth weight.

• Perspectives in Nursing Science
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• v.14 no.1
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• pp.37-44
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• 2017

Purpose: This study aimed to provide information on the developmental process and current status of Advanced Practice Nurses (APN) and to suggest ways for activating APN roles in Korea. Methods: We reviewed literatures to explore domestic and international trends related to the roles, practice settings, scope of practice, regulatory policies, and political environment of APN. Results: Interest in the APN role has been gaining ground worldwide. While the roles of APN in the USA, Taiwan and Japan have been changed in terms of legislation and institutional regulations, the role of APN in 12 fields except for APN in home care has not been legislated since qualification was specified in Korean Medical Law. Many problems were found in vitalizing APN roles: absence of legal regulations on the scope of practice or health insurance coverage for APN, increase the number of medical support staffs who are not qualified, and a disagreement regarding the qualification field and practical field. Conclusion: This study presents snapshots and vitalizing strategies of practice, and regulation for APN to develop their unique roles in Korea. The tasks and duties of APN should be identified specifically to fulfill their roles. In terms of national health insurance policy APN's Nursing care should be reimbursed just as nursing care of APN in home care.

• Journal of Korean Clinical Nursing Research
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• v.26 no.2
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• pp.240-253
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• 2020

Purpose: This study was conducted to provide basic data for the systematization of 13 areas related to Advanced Practice Nurses (APN). Methods: The three-phase study was conducted as follows. 1) review of APN system and curriculum, 2) Focus Group Interviews (FGI) with 9 APNs, 6 physicians, and 3 nursing professors on the APN system, 3) analysis of clinical practice of the 13 APN areas, and of the accreditation and certification system for APNs, medical board, and medical subspecialty board. Based on the above data, a systematic plan was drawn. Results: The 13 APN areas could be divided into 7 groups based on a review of the APN system and curriculum for the 13 areas. Analysis based on clinical practice showed that the 13 APN areas could be divided into 4 groups. Two themes and seven categories emerged in FGI. The two themes were 1) 13 APN areas that need to be discussed, 2) improving the curriculum for APN. Considering these themes from FGI and the system of the medical subspecialty board, results could be integrated into 2 groups - clinical area and non-clinical area. Conclusion: The 13 APN areas need to be integrated in order to activate the APN system. For that, further discussions on improvements and a standard curriculum according to legislation related to APN should be carried out.

• Journal of Korean Biological Nursing Science
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• v.9 no.1
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• pp.85-102
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• 2007

Purpose: Knowledge on pathophysiology is important to understand diseases and patient conditions and also in providing advanced nursing care. This study was performed to investigate the present situation, knowledge, and educational need on pathophyiology of advanced practice nurses(APN). Method: Eighty-four APN, who is practicing in hospitals nationwide, were surveyed with structured questionnaires developed by researchers. The questionnaire were composed of 109 items with 4 point scales with the contents of general characteristics, educational experience on pathophyisology, educational need, and knowledge on major and subcategories of pathophysiology. Result: The 77.1% of APN had experience of taking pathophysiology lecture and the lecturer were mainly medical doctors(39.8%) and APN(32.4%). The 61.5% of APN answered that the knowledge on pathophysiology was helpful and 97.6% of APN thought pathphysiologic education is needed in clinical practice. Seven major categories of pathophysiology showed higher scores were water imbalance, heart diseases, hemodynamic disorders, arterial vessel disorders, electrolyte imbalance, diseases of the digestive system, and diseases of the respiratory systems. Educational needs on the major and subcategories of pathphysiology were different by the field of APN and also by the clinical experiences as APN. APN also responded that there is a necessity to change the present curricular more specific to each practice field and more focus on the clinical practice. Conclusion: It was confirmed that educational and clinical need on the pathophysiology is very high and there is urgent need to change current curricular more specific to the field of APN and also clinical practice. This survey will help to identify and clarify the areas of change and to improve the education for the APN.

• Perspectives in Nursing Science
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• v.6 no.1
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• pp.39-53
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• 2009

The purpose of this study is to grasp the present system of Advanced Practice Nurse(APN) and to suggest strategies for enhancing the recognition of APNs institutionally in Korea. We searched and reviewed literature and materials about the APN development process and present situation and related laws. We recognized that there were many kinds of problems in the APN system of Korea: a weak support from health care system, obscured classification of APN's services, confusion of qualifications, and lack of compensation from the national health insurance system. We should, therefore, identity the list of Korean APN's services and provide further studies about patient's outcome cared by APNs. Also, there is a need to create a demand for APNs to keep the quality of services guaranteed by APN. APN system must be established to progress forward in order to provide good benefits for the people.

• Clinical and Experimental Pediatrics
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• v.62 no.12
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• pp.433-437
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• 2019

Acute pyelonephritis (APN) should be detected and treated as soon as possible to reduce the risk of the development of acquired renal scarring. However, in the medical field, urine culture results are not available or considered when the prompt discrimination of APN is necessary and empirical treatment is started. Furthermore, urine culture cannot discriminate APN among children with febrile urinary tract infection (UTI) (pyelitis, lower UTI with other fever focus). Therefore, the usefulness of urine culture for diagnostic purposes is small and the sampling procedure is invasive. Congenital hypoplastic kidney is the most common cause of chronic kidney injury in children. Thus, it is desirable that a main target be detected as early as possible when imaging studies are performed in children with APN. However, if APN does not recur, no medical or surgical treatment or imaging studies would be needed because the acquired renal scar would not progress further. Therefore, the long-term prognosis of APN in young children, particularly infants, depends on the number of recurrent APN, not other febrile UTI. New methods that enable prompt, practical, and comfortable APN diagnosis in children are needed as alternatives to urinary catheterization for urine culture sampling.

• Clinical and Experimental Pediatrics
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• v.64 no.7
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• pp.347-354
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• 2021

Background: Neutrophil gelatinase-associated lipocalin (NGAL) has emerged as a valuable biomarker of urinary tract infection (UTI) in children. Purpose: This study aimed to compare the diagnostic accuracy of urinary NGAL (uNGAL) with those of serum C-reactive protein (CRP) and white blood cell (WBC) count for predicting UTI and acute pyelonephritis (APN) in febrile children. Methods: The medical charts of children undergoing uNGAL measurements between November 2017 and August 2019 were retrospectively reviewed. Patients with a suspected or diagnosed UTIs were included. The diagnostic accuracies of uNGAL, serum CRP, and WBC count for detecting UTI and APN were investigated. Independent predictors of UTI and APN were investigated using multivariable logistic regression analyses. Results: A total of 321 children were enrolled in this study. The uNGAL levels were higher in the UTI group (n=157) than in the non-UTI group (n=164) (P<0.05). Among children with a UTI, uNGAL levels were higher in the APN group (n=70) than, the non-APN group (n=87) (P<0.05). In the multivariate analysis, uNGAL was independently associated with UTI and APN (both P<0.05). Serum CRP and WBC count were not correlated with the presence of UTI and APN. Receiver operating curve analyses showed that the uNGAL level had the highest area under the curve (AUC) for predicting UTI and APN, respectively (AUC, uNGAL vs. CRP vs. WBC count, 0.860 vs. 0.608 vs. 0.669 for UTI; 0.780 vs. 0.680 vs. 0.639 for APN, all P<0.05, respectively). The predictive values and likelihood ratios of uNGAL were superior to those of serum CRP and WBC count for detecting UTI and APN at each cutoff level. Conclusion: UNGAL may be more useful than serum CRP and WBC count for identifying and assessing UTI in febrile children.

• Journal of Korean Clinical Nursing Research
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• v.26 no.2
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• pp.217-231
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• 2020

Purpose: To identify the clinical role of Advanced Practice Nurses (APN), and evaluate how other medical personnel perceive their work(difficulty, importance). Methods: A questionnaire survey was performed with 277 health care providers (APN 52, nurses 88, and medical doctors 137 [professors 51, fellows 44, & residents 42]) in a single, tertiary hospital. The questionnaire was categorized into 6 domains (total 40 tasks): 6 tasks on identifying health issues (A); 3 tasks on prescribing and conducting diagnostic tests (D); 18 tasks on disease treatment (T); 4 tasks regarding prescribing medicine (M); 3 tasks regarding medical collaboration (C); 6 tasks regarding patient education (E). The survey measured the frequency, difficulty, and importance of APN's clinical tasks, and evaluated the willingness of authorizing clinical tasks to APN. Results: The most frequent tasks for APN were A domain, lowest were T domain. The scores for perceived job difficulty were lower than those for job importance in all groups. The proportion of willingness to legally delegate clinical practices to APN was higher in A and E domains, but lower in D and T domains. However, professors, who spent the most time with APN, showed a higher willingness to legally delegate clinical practice. The participants favored medical doctors as substitutes for tasks which were not legislated for delegated job performance. Conclusion: In this study identified clinical roles that medical doctors considered possible for legal delegation to APN were identified. The results can be used as evidence for the legalization of the practice of APN.

• Childhood Kidney Diseases
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• v.25 no.2
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• pp.84-91
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• 2021

Purpose: We aimed to study the association of plasma neutrophil gelatinase-associated lipocalin (pNGAL) and leukocyte differential count in children with febrile urinary tract infection (UTI). Methods: Medical records of 154 children aged 1 month to 13 years with febrile UTI who were hospitalized were retrospectively reviewed. Associations between pNGAL levels and blood leukocyte differential count at admission and after 48 hours of treatment were investigated in children with or without acute pyelonephritis (APN). Results: The APN group (n=82) showed higher pNGAL levels, neutrophil count, monocyte count, and neutrophil-to-lymphocyte ratio (NLR), compared to the non-APN group (n=72) (all P<0.05). After adjustment for age and sex, pNGAL showed positive correlations with neutrophil count and NLR in both groups (all P<0.05). Additionally, it was correlated with the monocyte-to-lymphocyte ratio (MLR) only in the APN group (P<0.05). Before and after treatment, pNGAL was positively correlated with neutrophil count, NLR, and MLR in patients with APN while it was related with neutrophil count and NLR in those without APN (all P<0.05). Areas under the receiver operating curve of pNGAL, neutrophil count, NLR, and MLR for predicting APN were 0.804, 0.760, 0.730, and 0.636, respectively (all P<0.05). Only pNGAL was independently associated with the presence of APN in a multivariable logistic regression analysis (P<0.05). Conclusion: In children with febrile UTIs, pNGAL might be associated with leukocyte differential count and the presence of APN.