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This second study on the effectiveness of nursing organization was designed to test the relationships between effectiveness of nursing organizations and structural variables that had been significant variables in the first study, the group design variable and the personal characteristic variables that had not been analysed in the first study based on personal resource productivity model. The data were collected through self-reported questionnaires completed by 605 nurses working in hospitals in seoul and 782 patients being hospitalized in 5 tertiary hospitals in Seoul. The results showed that according to the canonical correlation analysis, the managing job design, nursing delivery system. nurse's age career, and formalization were revealed as predicting variables of a nurses' job satisfaction and patients satisfaction among the five hospitals. Hospitals in which the team nursing method was used showed a higher score in nurses' job satisfaction and patient satisfaction than in hospitals which used the functional nursing model.

This study was designed to test relationship between effectiveness of nursing organizations and structural and managerial variables of nursing organizations that are described in the Robbins Organizational theory model. The data were collected through self reported questionnaires from 605 nurses working in, and 782 patients hospitalized in, five tertiary hospitals in seoul. Results showed that according to MANOVA there was a significant difference in nurses job satisfaction and patient satisfaction among the five hospitals. According to cluster analysis of the structural and managerial variables of nursing organizations, the five hospitals were divided into two clusters and there was no significant difference in nurses job satisfaction or patient satisfaction between the two clusters. According to canonical correlation analysis the formalization and centralization of structural variables were shown to be predicting variables for nurses job satisfaction, and the managing job design and managing change of managerial variables were shown to be predicting variables for nurses job satisfaction.

The purpose of this study was to contribute to the development of clinical instruction by students' ratings of teaching effectiveness in clinical nursing education. The subjects were comprised of graduating class 618 students from 24 nursing colleges in the nation. The instruments used in this study were "general characteristics and status of clinical nursing education" developed by the researcher and "Instrument to Measure Effectiveness of Clinical Instructors " by Reeve (1994). The 50 questions used in the questionaire were categorized into 13 components subject to factor analysis. The 13 components were interpersonal relationships, communication skills, role model, resource for students, favorable to students, encouraging to think for selves, teaching methods, evaluation, finding assignments for objectives, organization of subject matter, professional competence, knowledge of subject matter and working with agency personnel. The results of this study are as follows 1. Status of clinical nursing educaion: 1) Clinical nursing education were led by nursing professors(44.9%), a team of both nuring professor and head nurse(6.8%), instructors from specific hospital(15.1%), instuctos for a specific subject(14.6%), and head nurse (6.8%). For 3-year program students, 34.6% of the clinical nursing education were led by instructors from specific hospital and 51.4% of the education by nursing professors for Bachelor's program. 2) The contents for clinical education comprised of Conference being the most frequent of 34.5%; a combination of Nursing skills, Orientation, Conference etc. 22.0%; Nursing process 21.7%; Orientation 13.5%; Inspection (making rounds) 6.4%, and Nursing skills of 2% being the least frequent. 3) Students' preference of clinical teachers from the highest to the lowest were instructors for a specific subject being the most desired(44.9%) followed by nursing professor, head nurse, a team of both nursing professor and head nurse, and instructors from specific hospital being the least desired. 4) Students felt that the qualification for clinical teachers should be at least a master's degree holder and 5 or more years of clinical experience. The reason they felt was because knowledge and experience are imperative for professional education. 2. Clinical teaching effectiveness: The total points for teaching effectiveness was 147.97(mean of 2.95 +/- 0.98) where the total score is considered to be an average rating. 3. Teaching effectiveness as status of clinical nursing education: 1) The score ratings for the clinical instructors from the highest to the lowest were as follows; instructors for a specific subject, instructors from specific hospitals, a team of both nursing professors and head nurses, nursing professors, head nurses, which resulted in significunt differ-ence(F=4.53, P<0.001). 2) The rating scores based on the teaching program from the highest to the lowest were as follws; nursing skills, nursing process, a combination of nursing skills, orientation, conference etc., conferences, orientation, inspection, which resulted in significunt difference(F-10.97, P<0.001). 4. Based on 13 categorized components from the questionaires, questions related to communication skills scored the highest points of 3.20 where inquiries regarding resource for students scored the lowest points of 2.38. 5. Among the 13 categorial components from the questionaire, Interpersonal relationship, Communication skills, Resource for students, Encouraging to think for selves, Evaluation, Teaching method, Finding assignment for objectives, Organization of subject matter, Professional competence, and Working with agency personnel, instructors for a specific subject scored the highest points and head nurse scored the lowest, which resulted in significant diference. Favorable for students, instructors for a specific subject scored highest points and nursing professor scored the lowest, which resulted in significant deference (F=5.39, P<0.001). Role model and Professional competence, instructors for a specific subject scored the highest points and head nurse scored the lowest, with minimum variation(F-1.29, p>0.05:F=1.64,P>0.05). 6. Based on 13 categorial components as a whole, the highest points scored among the 5 groups of clinical teachers was instructors for a specific subject and the lowest, by head nurse(F=1.94, P<0. 001). A team of both nursing professor and head nurse attained higher score in clinical education than their independent education.

Cost effectiveness is a recent and newly emerging approach in nursing evaluation studies. Nursing is in a unique position among health care providers to respond to these efforts and is ready to provide evidence of its cost-effectiveness because nurses has long advocated a holistic view of patient care, that means, nurses are unique position to identify the full range of costs and effects. The cumulative evidence showed that nurses provided cost-effective care that substituted for physician services in many situations and new and important services in long-term care and nursing homes. The purpose of this article is to review, critique, and synthesize research on the cost-effectiveness of nursing care from the research methodology perspective. Two major problems are apparent from this review. First, there is no uniform approach to identifying and valuing resources used in producing nursing intervention options. Second, although it is not difficult to find reports of cost savings, the cost to effect ratio was not used to evaluate the relationship between the cost and effects of alternative options. Based on my analysis, the nursing CEA literature seemed to have huge variation in methods, so that it is not easy to compare the CEA methods among studies. There are still such methodological problems as we found in the literature review. Many of the studies reviewed here would have profited from improved designs. Therefore, future cost-effectiveness analyses should include methodological progress in the context of nursing area application such as the definition and quantification of multi-attribute effectiveness measures, employment of sensitivity analysis, a concept of discount. Nurse and nurse researchers should consider cost-effectiveness questions when addressing other research questions. Because these efforts are forcing policy makers to consider the economics of nursing, nurses should demonstrate and document the value of nursing as compared to other uses of society's health care resources.

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• Cost-effectiveness Analysis of Home Care Services for Patients with Diabetic Foot
  Chong Rye Song, Yong Soon Kim, Jin Hyun Kim
  Journal of Korean Academy of Nursing Administration.2013; 19(4): 437.     CrossRef

The purpose of the study was to identify the effect of structured patients education had on prevention of osteoporosis, with fracture and the resulting of life style changes in patients. In this study, a non equivalent control group pre and a post test design was employed. Data were collected through an interview process using questionnaires from April to December of 1999. The subjects, consisting of 59 patients with fractures and over 40 years of age, were diagnosed in K University Hospital. This study tested the patients knowledge at three times. The times were before the program 2 weeks into the program, and 6 months after education program. Life style change related to prevention of osteoporosis was shown twice (before and 6 months after the education program) in the experimental group, and control group went without it. The instruments used for this study were developed by literature review according to a reliability test. Data was analyzed using X2 test and t test to determine similarities between the experimental and control groups. The hypothesis was tested using repeated measures of ANOVA, t-test and Pearson correlation coefficients. The results of the study were summarized as follows: 1. The first hypothesis was accepted: a higher level of knowledge about osteoporosis was found in experimental groups who received education than to the control group during the period (F=19.82, p=.0001). 2. The second hypothesis was accepted: a higher level of life style changes about osteoporosis on experimental group were recorded than as compared to control group (t=3.55, p=.001). 3. The third hypothesis was accepted: the higher the knowledge about osteoporosis the higher the level of performance of life style changes about prevention of osteoporosis (r=.600, p=.0001). In conclusion, structured patient education in patient with fractures improved the level of knowledge about osteoporosis and more likely undergo of life style changes 6 months after the education program. Also reeducation would be needed 6 months after program ends. That is structured patient education in pamphlet form would be very effective in nursing intervention that may to result in life style changes. Therefore further research is needed to reinforce the education material and to generalize the education effect.

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• The Effects of a Group Educational Intervention on the Prevention of Osteoporosis in Breast Cancer Patients
  Bong Hae Ma, Chai-Soon Park, Hee Chong Baek
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  Yunmi Kim, Jung Hwan Kim, Dong Sook Cho
  Journal of Korean Academy of Nursing.2015; 45(2): 293.     CrossRef
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The purpose of the present study is 1) to explain major effect models (main, moderating, and mediating) of social support and statistical methods for testing the effect models and 2) to analyze and evaluate the consistency in the use of the effect models and its statistical methods in Korean nursing studies. A total of 57 studies were selected from Journal of Korean Academy of Nursing, Journal of Korean Academic Society of Adult Nursing, Journal of Korean Women's Health Nursing Academic Society, Journal of Fundamentals of Nursing, Journal of Korean Community Nursing, Journal of Korean Psychiatric and Mental Health Nursing Academic Society, and Journal of Korean Pediatric Nursing Academic Society published in the year of 1990-1999. In results, most studies on social support performed in Korea Nursing Society were about a main effect model. There are few studies on moderating or mediating model of social support. Thus, it was difficult to find research findings how, why, under what conditions social support impacted on health outcomes. Most studies on the moderating or mediating effect model of social support used statistical methods for testing main effect model rather than for testing moderating or mediating effect model. That is, there are inconsistency between effect models of social support and its statistical methods in Korean nursing researches. Therefore, it is recommended to perform studies on moderating or mediating effect model and use appropriate statistical methods.

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The purpose of the present study is to identify the mediation effect of hope between fatigue and psychosocial adjustment in women with breast cancer. The framework for this study was guided by concepts and propositions derived from the theoretical and empirical literature on fatigue, hope and adjustment. The design of this study is a descriptive correlation study using a cross-sectional design. One hundred and twenty two outpatients with early breast cancer, receiving post-surgical radiation therapy or chemotherapy, were selected from three major medical centers in Seoul, Korea. A packet including PABCF (Psychosoical Adjustment to Breast Cancer Factor), revised RPFS (Revised Piper Fatigue Scale), HHI (Herth Hope Index), and self-addressed return envelope was given to the participants at seven to eight weeks post surgery. The questionnaires were to be completed at home and returned to the researcher by mail. The obtained data were analyzed using three regression equations guided by Baron and Kenny (1986); first, hope was regressed on fatigue; second, psychosocial adjustment was regressed on fatigue; and third, psychosocial adjustment was regressed on fatigue and hope, simultaneously. In the first equation, fatigue explained 4% of the variance in hope. In the second equation, fatigue explained 47% of the variance in psychosocial adjustment. In the last equation, hope and fatigue significantly explained the variance in psychosocial adjustment. Therefore, all conditions for the test of mediation effect of hope were satisfied. For the test of the mediation effect, the beta coefficients of fatigue on psychosocial adjustment on the second and third regression equations were compared. The beta coefficients were decreased from .69 (p < .001) on the second regression equation to .63 (p < .001) on the third regression equation. Thus, the hypothesis of this study was supported. As a result of this study, the negative Influence of fatigue on psychosocial adjustment is dampened through the mediator effect of hope in women with breast cancer. Therefore, when planning care for the adverse effect of fatigue on psychosocial adjustment, oncology nurses should consider hope as a mediator between fatigue and psychosocial adjustment to breast cancer.

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