Journal of Korean Academy of Nursing

The Mediating Role of Psychological Resilience in Chinese Nursing Students’ Professional Identity and Learning Burnout: Liu Zhang, Qin Zhang, ShuWen Li, YuHong Li, GuoCui Wu, Ying Chen, YunNa Zhou; J Korean Acad Nurs 2024;54(4):509-518. Published online November 25, 2024; DOI: https://doi.org/10.4040/jkan.24044

Abstract PDF ePub: Purpose
This study investigated whether professional identity predicts learning burnout among Chinese nursing students, and whether resilience moderates this relationship.
Methods
This cross-sectional study recruited 635 students from a nursing college at a medical university in Hefei, China. Data were collected using the professional identity questionnaire, learning burnout scale for college students, and 10-item Connor-Davidson Resilience Scale. Pearson’s correlation analysis was used to investigate the relationships between variables. The mediation effect was evaluated using linear regression and the bootstrap method in SPSS.
Results
Nursing students exhibited intermediate learning burnout levels (score: 54.95 ± 10.42). Professional identity was positively correlated with psychological resilience (r = .42, p < . 001), whereas learning burnout was negatively correlated with professional identity (r = - .54, p < . 001) and psychological resilience (r = - .57, p < . 001). Psychological resilience mediated the relationship between professional identity and learning burntout to the tune of 32.8%.
Conclusion
Psychological resilience mediates the relationship between professional identity and learning burnout. Thus, nursing educators can mitigate student burnout by developing their students' professional identities and psychological resilience.

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Experiences of Patients and Their Families Receiving Medical Services Provided by Advanced Practice Nurses at Tertiary General Hospitals: Mi-Kyeong Jeon, Su Jung Choi, Ji Eun Han, Eun Kyung Kwon, Jeong Hee Park, Jeong Hye Kim; J Korean Acad Nurs 2024;54(4):594-606. Published online November 4, 2024; DOI: https://doi.org/10.4040/jkan.24069

Abstract PDF ePub: Purpose
This study aimed to understand and describe the experiences of patients and their families who have received medical services from advanced practice nurses in tertiary general hospitals in Korea.
Methods
Data were collected through four focus group interviews with 20 patients and their families who had received medical services from advanced practice nurses for more than six months at four tertiary hospitals from November 29 to December 28, 2023. Verbatim transcripts were analyzed using qualitative content analysis.
Results
The four themes extracted from the experiences of patients and their families were as follows: unfamiliar medical personnel encountered during the treatment process, healthcare professionals who exhibited excellence, companions to light my way through the tunnel of illness, and an advanced practice nurse system that must be activated urgently.
Conclusion
The study’s findings indicate that patients and their families view the care provided by advanced practice nurses as excellent, reliable, and holistic. Research suggests that advanced practice nurses are valuable healthcare professionals in team-based care. The findings suggest that hospitals should utilize an advanced practice nurse system to improve patient outcomes and ensure the quality of care.

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Development and Effectiveness of Progressive Simulation Education Program on Medication Safety for Nursing Students: Se-Young Jung, Eun-Young Kim; J Korean Acad Nurs 2024;54(4):563-576. Published online October 14, 2024; DOI: https://doi.org/10.4040/jkan.24054

Abstract PDF ePub: Purpose
This study aimed to develop and verify a progressive simulation education program aimed at enhancing nursing students’ medication safety competency.
Methods
A non-equivalent control group pretest-posttest design was adopted. The participants were 40 third-year nursing students with no prior simulation education experience, comprising 20 each in the experimental and control groups. The experimental treatment utilized a hybrid simulation approach incorporating both full-body mannequins and standardized patients and was, conducted over three sessions with durations of 65, 80, and 95 minutes for the first, second, and third sessions, respectively, for a total of 240 minutes. The program was constructed based on Jeffries’ simulation model.
Results
The levels of medication safety competencies, communication self-efficacy, learning self-efficacy, and problem-solving abilities of the experimental group were significantly higher than that of the control group.
Conclusion
Our results confirm that the program effectively improves nursing students’ medication safety competence, communication self-efficacy, learning self-efficacy, and problem-solving ability. Therefore, this program can serve as a basis for developing educational strategies related to medication safety for nursing education institutions. Furthermore, the program is anticipated to have a positive impact on novice nurses’ education and practice in clinical settings.

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Legal and Practical Solutions for the Expanding the Roles of Medical Support Staff Nurses: Choi, Su Jung , Kim, Min Young; J Korean Acad Nurs 2024;54(3):300-310. Published online August 31, 2024; DOI: https://doi.org/10.4040/jkan.24075

Abstract PDF: Purpose
Medical support staff nurses have traditionally performed various supportive tasks for physicians, often extending beyond standard nursing roles. Despite these long-standing practices, there is a notable lack of official recognition and legal protection for these expanded responsibilities, leading to increasing legal concerns. Therefore, there is a need for proposing a rational solution to address these issues.
Methods
The number of medical support staff nurses is rising, particularly as they fill gaps left by the 2024 resident physician strike. The study focuses on identifying potential challenges arising from this shift and developing strategic improvements to address these challenges effectively.
Results
This study proposed legally expanding the scope of nursing duties and creating a robust system for training and certifying nurses to handle these responsibilities effectively, by integrating these roles within the advanced practice nurse (APN) framework.
Conclusion
Integrating these roles within the framework of APN can offer a sustainable and legally sound solution to the ongoing healthcare crisis, ensuring patient safety and safeguarding healthcare workers’ legal rights.

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An Exploratory Study on Non-Contact Nursing Experiences of Clinical Nurses during the COVID-19 Pandemic: Byun, Hye Min , Yun, Eun Kyoung; J Korean Acad Nurs 2024;54(3):446-458. Published online August 31, 2024; DOI: https://doi.org/10.4040/jkan.24045

Abstract PDF: Purpose
This study aimed to understand the non-contact nursing experiences of clinical nurses during the COVID-19 pandemic.
Methods
A qualitative research design applying thematic analysis was used. The participants were purposive sampled from three institutes: a tertiary hospital, a general hospital, and a residential treatment center in Seoul. Data were collected between December 2021 and January 2022 through individual in-depth interviews with 12 clinical nurses. The data were analyzed using Braun and Clarke’s method to identify the meaning of the participants’ experiences.
Results
During the COVID-19 pandemic, the fields where the participants performed non-contact nursing included intensive care units and isolation wards of hospitals, a residential treatment center, and home cares. Their tasks in non-contact nursing commonly involved remote monitoring using digital devices or equipment, consultation and education. From their experiences performing tasks in these fields, the four theme clusters and nine themes were derived. The four theme clusters are as follows: (1) Confusion of nursing role; (2) Conflict due to insufficient support system; (3) Concern about the quality of nursing; (4) Reflection on the establishment of nursing professionalism.
Conclusion
This study highlights the necessity for institutionalizing professional nursing areas, nursing education, and practical support by clarifying the purpose and goals of non-contact nursing and developing nursing knowledge through frameworks.

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How Do We Approach Quality Care for Patients from Middle Eastern Countries? A Phenomenological Study of Korean Nurses’ Experiences: Jang, Dael , Choi, Seonhwa , Hwang, Gahui , Kim, Sanghee; J Korean Acad Nurs 2024;54(3):372-385. Published online August 31, 2024; DOI: https://doi.org/10.4040/jkan.24036

Abstract PDF: Purpose
Although more people from Middle Eastern countries are visiting South Korea for medical treatment, Korean nurses lack experience in treating them. Understanding and describing Korean nurses’ experiences can help them provide quality care to these patients by enhancing their competency in culturally appropriate care. This study described the experiences of nurses who provide care to Middle Eastern patients in clinical settings in South Korea.
Methods
We conducted a phenomenological study to describe nurses’ experience of caring for patients from Middle Eastern countries. Ten nurses with prior experience in caring for these patients were recruited from a university-affiliated tertiary hospital. Semi-structured face-to-face interviews were conducted between May 1 and June 4, 2020. The transcribed data were analyzed using Giorgi’s phenomenological method to identify the primary and minor categories representing nurses’ experiences.
Results
Four major categories (new experiences in caring for culturally diverse patients, challenges in caring for patients in a culturally appropriate manner, nursing journey of mutual agreement with culturally diverse patients, and being and becoming more culturally competent) and 11 subcategories were identified.
Conclusion
Nurses experience various challenges when caring for Middle Eastern patients with diverse language and cultural needs. However, nurses strive to provide high-quality care using various approaches and experience positive emotions through this process. To provide quality care to these patients, hospital environments and educational programs must be developed that center on field nurses and students and support them in delivering quality care while utilizing their cultural capabilities.

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Development of the Hybrid Clinical Practicum Environment Scale for Nursing Students: Yoon, Seoyoung , Yeom, Hye-Ah; J Korean Acad Nurs 2024;54(3):340-357. Published online August 31, 2024; DOI: https://doi.org/10.4040/jkan.24016

Abstract PDF: Purpose
This study aimed to develop a Hybrid Clinical Practicum Environment Scale for Nursing Students (HCPES-NS) and verify its validity and reliability.
Methods
The HCPES-NS was constructed following the DeVellis guidelines. The initial items were written based on a literature review and individual in-depth interviews. Content validity was verified through an expert panel review. To confirm the validity and reliability of the scale, a survey was conducted with 449 nursing students enrolled in 12 nursing colleges. Data were analyzed using item analysis, exploratory factor analysis, confirmatory factor analysis, concurrent validity, and reliability tests.
Results
Factor analysis showed that the HCPES-NS consists of 15 items on five subdomains: clinical site atmosphere, interpersonal relationship, alternative online practicum contents, provision of learning information, and clinical performance facilitation. A higher score indicated a more positive perception of the clinical practicum environment. The concurrent validity of the HCPES-NS was confirmed by its positive correlation with the Clinical Learning Environment Scale (r = .77). The Cronbach’s α reliability of the HCPES-NS was .84.
Conclusion
The HCPES-NS is both valid and reliable. This scale reflects the clinical practicum environment and includes an online practicum factor. It may be used effectively by faculty members and educators to evaluate nursing students’ perceptions of clinical practicum environments.

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Analysis of the Adequacy of Nurse Staffing Level through the Estimation of Nursing Activity Hours and Implementation of Focus Group Interviews in a Tertiary Hospital: Using a Mixed-Method Design: Kim, Hyun-Joo , Lee, Sun-Hee , Lee, Jai-Jung , Seong, Sun-Suk , Yang, Hee , Lee, Hyang-Yuol; J Korean Acad Nurs 2024;54(2):237-249. Published online May 31, 2024; DOI: https://doi.org/10.4040/jkan.22142

Abstract PDF: Purpose
This study aimed to examine the adequacy of current nurse staffing levels by identifying nursing activities and workload.
Methods
The study used a mixed-method design. A nursing activity survey was conducted using the work sampling method over 2 working days with 119 general ward nurses. A focus group interview was conducted with 12 nurses. Quantitative and qualitative data were analyzed using SPSS 20.0 and content analysis, respectively.
Results
The most amount of time was spent on medication (in direct nursing) and electronic medical record documentation (in indirect nursing). The appropriate nurse-to-patient ratio is 1:7.7 for the day shift, 1:9.0 for the evening shift, and 1:11.9 for the night shift. However, the current nurse-to-patient ratio is 1:9.4, 1:11.0, and 1:13.8 for the day, evening, and night shifts, respectively. Therefore, the current nurse staffing level is insufficient for the workload. In the focus group interview, the main reasons cited for being unable to complete tasks within working hours were communication and coordination, and the nursing electronic medical record. The essential nursing activities of basic nursing and emotional support were overlooked owing to a heavy workload. Therefore, an adequate nurse staffing level should be higher than the measured quantitative workload.
Conclusion
These results suggest the general wards of tertiary hospitals should evaluate the adequacy of their current nurse staffing and allocate sufficient nurses to improve patient safety and nursing care quality.

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Descriptive Review of Patents in Healthcare and Nursing: Based on Network Analysis: Jeon, Misun , Youn, Nayung , Kim, Sanghee; J Korean Acad Nurs 2024;54(1):1-17. Published online February 29, 2024; DOI: https://doi.org/10.4040/jkan.23064

Abstract PDF: Purpose
The significance of the healthcare industry has grown exponentially in recent years due to the impact of the fourth industrial revolution and the ongoing pandemic. Accordingly, this study aimed to examine domestic healthcare-related patents comprehensively. Big data analysis was used to present the trend and status of patents filed in nursing.
Methods
The descriptive review was conducted based on Grant and Booth’s descriptive review framework. Patents related to nursing was searched in the Korea Intellectual Property Rights Information Service between January 2016 to December 2020. Data analysis included descriptive statistics, phi-coefficient for correlations, and network analysis using the R program (version 4.2.2).
Results
Among 37,824 patents initially searched, 1,574 were selected based on the inclusion criteria. Nursing-related patents did not specify subjects, and many patents (41.4%) were related to treatment in the healthcare delivery phase. Furthermore, most patents (56.1%) were designed to increase effectiveness. The words frequently used in the titles of nursing-related patents were, in order, “artificial intelligence,” “health management,” and “medical information,” and the main terms with high connection centrality were “artificial intelligence” and “therapeutic system.” Conclusion: The industrialization of nursing is the best solution for developing the healthcare industry and national health promotion. Collaborations in education, research, and policy will help the nursing industry become a healthcare industry of the future. This will prime the enhancement of the national economy and public health.

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Association between Resilience, Professional Quality of Life, and Caring Behavior in Oncology Nurses: A Cross-Sectional Study: Jeon, Misun , Kim, Sue , Kim, Sanghee; J Korean Acad Nurs 2023;53(6):597-609. Published online December 31, 2023; DOI: https://doi.org/10.4040/jkan.23058

Abstract PDF: Purpose
The degree of caring behavior of oncology nurses is a crucial factor in the care provided to patients with cancer. In this study, we aimed to investigate factors related to oncology nurses’ caring behavior, including their resilience and professional quality of life.
Methods
A cross-sectional descriptive study was conducted with 107 oncology nurses at an urban tertiary hospital from May 18 to 24, 2015. We used a self-report questionnaire to measure resilience, professional quality of life, and degree of caring behavior. Data analysis included descriptive statistics, correlations, and multiple regression analysis using SPSS/WIN 20.0.
Results
Oncology nurses presented with low levels of resilience and caring behavior, and high levels of compassion satisfaction, burnout, and secondary traumatic stress. There was a statistically significant relationship between the degree of caring behavior, resilience (r = .43, p < .001), compassion satisfaction (r = .51, p < .001), and burnout (r = - .42, p < .001), as well as between secondary traumatic stress and burnout (r = .34, p < .001). Factors associated with oncology nurses’ degree of caring behavior were compassion satisfaction (t = 6.00, p < .001) and educational level (t = 3.45, p = .001).
Conclusion
This study demonstrates that oncology nurses’ degree of caring behavior is related to their professional quality of life and education. These findings suggest that enhancing oncology nurses’ healthy coping strategies at both the individual and organizational levels can further develop holistic nursing care. Additionally, it is necessary to examine the factors affecting nurses’ compassion satisfaction and to try to promote this aspect.

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National Petition Analysis Related to Nursing: Text Network Analysis and Topic Modeling: Ko, HyunJung , Jeong, Seok Hee , Lee, Eun Jee , Kim, Hee Sun; J Korean Acad Nurs 2023;53(6):635-651. Published online December 31, 2023; DOI: https://doi.org/10.4040/jkan.23052

Abstract PDF: Purpose
This study aimed to identify the main keyword, network structure, and main topics of the national petition related to “nursing” in South Korea.
Methods
Data were gathered from petitions related to the national petition in Korea Blue House related to the topic “nursing” or “nurse” from August 17, 2017, to May 9, 2022. A total of 5,154 petitions were searched, and 995 were selected for the final analysis. Text network analysis and topic modeling were analyzed using the Netminer 4.5.0 program.
Results
Regarding network characteristics, a density of 0.03, an average degree of 144.483, and an average distance of 1.943 were found. Compared to results of degree centrality and betweenness centrality, keywords such as “work environment,” “nursing university,” “license,” and “education” appeared typically in the eigenvector centrality analysis. Topic modeling derived four topics: (1) “Improving the working environment and dealing with nursing professionals,” (2) “requesting investigation and punishment related to medical accidents,” (3) “requiring clear role regulation and legislation of medical and nonmedical professions,” and (4) “demanding improvement of healthcare-related systems and services.” Conclusion: This is the first study to analyze Korea's national petitions in the field of nursing. This study's results confirmed both the internal needs and external demands for nurses in South Korea. Policies and laws that reflect these results should be developed.

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Perspectives of Frontline Nurses Working in South Korea during the COVID-19 Pandemic: A Combined Method of Text Network Analysis and Summative Content Analysis: Lee, SangA , Lee, Tae Wha , Lee, Seung Eun; J Korean Acad Nurs 2023;53(6):584-596. Published online December 31, 2023; DOI: https://doi.org/10.4040/jkan.23048

Abstract PDF: Purpose
This study aimed to explore the perspectives of frontline nurses working during the novel coronavirus disease 2019 (COVID-19) pandemic.
Methods
An online qualitative study was conducted using a pragmatic approach. The data were collected in August 2021. Registered Korean nurses who provided direct nursing care to patients with confirmed COVID-19 were eligible for this study. An online survey was used to gather free-text data, which were then analyzed using machine-based network analysis and summative content analysis.
Results
The analysis examined the responses of 126 participants and led to the identification of six prominent themes. These themes were further classified into three distinct levels: personal, task, and organizational. The identified themes are as follows: “collapse of personal life,” “being overwhelmed by the numerous roles required,” “personal protective equipment was sufficiently provided, but that is not enough,” “changes in interprofessional collaboration,” “inappropriate workforce management,” and “diverted allocation of healthcare services and resources.” Conclusion: Our findings highlight areas for improvement in resources, systems, and policies to enhance preparedness for future pandemics.

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Nursing Students’ Experiences of Observing the Use of Physical Restraints: A Qualitative Study: Ha, Sun Mi; J Korean Acad Nurs 2023;53(6):610-621. Published online December 31, 2023; DOI: https://doi.org/10.4040/jkan.23032

Abstract PDF: Purpose
The purpose of this study was to understand the experiences of final-year undergraduate nursing students in observing the use of physical restraints on patients in the course of clinical practice.
Methods
Three focus group interviews were conducted with 12 Korean nursing students who could provide sufficient information about their observation of physical restraints. The collected data was analyzed through conventional content analysis.
Results
The data were classified into four theme clusters, and nine themes. The four theme clusters included ‘recognized as an unavoidable means,’ ‘experienced problems with the use of physical restraints,’ ‘realized the importance of the nurse's role and efforts,’ and ‘aspire to learn about correct use of physical restraints.’ While nursing students recognized the necessities and problems of using physical restraints in clinical practice, and the importance of nurses’ role and effort, the results found that education related to the use of physical restraints should be more systematic within the nursing curriculum.
Conclusion
This study highlights the necessity of educating nursing students to ensure they acquire accurate knowledge and awareness regarding the use of physical restraints, and suggests the inclusion of systematic guidelines through simulation or extracurricular activities.

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The Impact of Self-Efficacy on Nurses’ Well-Being: Does Digital Competence Matter?: Li, Yali , Jing, Qi , Feng, Taiwen , Yang, Xiaoling; J Korean Acad Nurs 2023;53(4):385-396. Published online August 31, 2023; DOI: https://doi.org/10.4040/jkan.23037

Abstract PDF: Purpose
Drawing on person–environment fit theory and social cognitive theory, this study aimed to examine how self-efficacy affects nurses’ workplace well-being via person-job fit and the moderating role of digital competence.
Methods
A two-wave survey was conducted to collect data. Data were collected from six hundred and ninety-five nurses at three Chinese hospitals between May 2022 and September 2022. We employed hierarchical regression analysis and bootstrapping to analyze the data.
Results
Self-efficacy positively influenced person-job fit (β = .55, p < .001), which positively affected nurses’ workplace well-being (β = .32, p < .001). Person-job fit mediated the effect of self-efficacy on nurses’ workplace well-being. Additionally, digital competence strengthened the positive impact of self-efficacy on person-job fit (β = .12, p < .001).
Conclusion
Recruiting nurses with both self-efficacy and digital competence benefits hospitals. It is critical for nurses to improve their digital competence for achieving person-job fit and attaining workplace well-being in the post-coronavirus disease 2019 (COVID-19) era.

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Analysis of Media Trends and Social Perceptions on Nursing Law Legislation: Lee, Seung-Hee , Joo, Min-Ho; J Korean Acad Nurs 2023;53(4):439-452. Published online August 31, 2023; DOI: https://doi.org/10.4040/jkan.23030

Abstract PDF: Purpose
This study aimed to derive considerations for the enactment of nursing law by analyzing the trends and social perceptions of nursing law mentioned in major daily newspapers, cafes, and blogs.
Methods
Main texts and comments that included nursing law as a keyword were collected from major daily news and online postings from January 2021 to August 2022. The data collected through web crawling were analyzed using a TousFlux program used for big data analysis.
Results
During the period of study, the awareness level around nursing law enactment increased. In particular, public concern over nursing law enactment intensified due to the two political parties' policy pledges related to nursing law in January 2022 and the failure to introduce the nursing law to the national assembly judiciary committee in May 2022. Except in December 2021, public perception of nursing law enactment was generally favorable, with public opinion tilting more in favor of than against enactment.
Conclusion
Public opinion should be considered when drafting and implementing the nursing law to make it easier for the people to understand what the law constitutes. In addition, it is necessary to pay attention to and continuously promote the relationship between medical care and nursing in the nursing law system of developed nations. Lastly, nursing law enactment can enhance nurses' retention intention and provide a sense of efficacy to medical services.

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Effectiveness of Simulation-Based Education for Caring Patients with COVID-19: Lee, Min Hye , Noh, Eun-Young; J Korean Acad Nurs 2023;53(4):397-411. Published online August 31, 2023; DOI: https://doi.org/10.4040/jkan.22151

Abstract PDF: Purpose
The role of medical staff gained immense significance in the context of the prolonged coronavirus disease (COVID-19) pandemic. However, few studies had explored the impact of simulation-based education on the ability of nursing students to care for the patients of COVID-19. This study provided nursing students with simulation-based education in caring for the patients of COVID-19 and confirmed its effectiveness.
Methods
This study used a non-equivalent control group pretest-posttest design. The participants were recruited from the nursing departments of two universities in Korea through convenience sampling. A total of 79 participants were included: 37 in the intervention group and 42 in the control group. The intervention group received four sessions of simulation training based on the National League for Nursing Jeffries simulation theory.
Results
The intervention group showed an improvement compared to the control group in terms of knowledge related to coronavirus, confidence in performing infection control skills, and perception of preparedness for caring for the patients of COVID-19, with a high-level of satisfaction and self-confidence in learning. There was no significant difference between the two groups in terms of anxiety.
Conclusion
This simulation is expected to be a significant strategy for alleviating the global burden in terms of staff safety and patient outcomes by improving the competencies of prospective medical staff in responding to pandemics.

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Effects of a Modified Six-Sigma-Methodology-Based Training Program on Core Competencies in Rehabilitation Nurse Specialists: Gu, Jiayi , Luo, Lan , Li,, Chengjuan , Ma, Sumin , Gong, Fanghua; J Korean Acad Nurs 2023;53(4):412-425. Published online August 31, 2023; DOI: https://doi.org/10.4040/jkan.22122

Abstract PDF: Purpose
Nurses play an important role in ensuring patient rehabilitation and are involved in all aspects of multidimensional rehabilitation. Therefore, strengthening rehabilitation nursing education is vital to ascertain high-quality rehabilitation and optimum outcomes. This study examined the effectiveness of a new teaching reform—a modified Six-Sigma-based training program—against a conventional educational program on rehabilitation specialist nurses’ core competencies, post-training performance, and satisfaction.
Methods
A quasi-randomized controlled trial was conducted to assess the effectiveness of the modified training program. We recruited 56 learners from the 2020 training course at the Hunan Rehabilitation Specialist Nurse Training Base as the control group. Sixty learners from the base’s 2021 training course were recruited as the intervention group. Data were collected in a consistent manner from both groups after the training program was implemented.
Results
Those who underwent the modified training program showed better improvement in all core competencies than those who underwent the conventional training program (p < .05); the scores for theoretical knowledge, clinical nursing lectures, reviews, and nursing case management improved significantly following the teaching reform (p < 0.05). Further, overall satisfaction as well as base management and theoretical teaching satisfaction improved significantly (p < .05).
Conclusion
The modified training program strengthens rehabilitation nurses’ base management abilities; enhances their core competencies; expands their interest in and breadth, depth, and practicability of theoretical courses; and updates the teaching methods.

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Development and Validation of a Dignity in Care Scale of Terminally Ill Patients for Nurses: Ahn, Yun Sil , Oh, Pok Ja; J Korean Acad Nurs 2023;53(3):340-358. Published online June 30, 2023; DOI: https://doi.org/10.4040/jkan.23039

Abstract PDF: Purpose
This study aimed to develop an instrument to showcase Dignity in Care of Terminally Ill Patients for Nurses and to examine its validity and reliability.
Methods
A total of 58 preliminary items on dignity in care of terminally ill patients for nurses were selected using content validity analysis and expert opinions on 97 candidate items derived through a literature review and qualitative focus group interviews. Questionnaires were administered to 502 nurses caring for terminally ill cancer patients at hospice and palliative care institutions. The data were analyzed using item analysis, exploratory and confirmatory factor analysis, convergent and discriminant validity, and Pearson correlation for criterion validity, reliability was tested using Cronbach’s alpha.
Results
The final instrument consisted of 25 items, with four factors identified through confirmatory factor analysis. Four factors-ethical values and moral attitudes, interaction-based communication, main-taining comfort, professional insight and competence–accounted for 61.8% of the total variance. Cronbach’s ⍺ for total items was .96, and test-retest reliability of intraclass correlation coefficient was .90.
Conclusion
Since its validity and reliability have been verified through various methods, the Dignity in Care Scale of Terminally Ill Patients for Nurses can be used for develop nursing interventions and improve dignity in care of terminally ill patients.

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Development and Evaluation of Evidence-Based Nursing Protocol for Extracorporeal Membrane Oxygenation to Critically Ill Patients: Kim, Soomi , Kim, Chul-Gyu; J Korean Acad Nurs 2023;53(3):275-294. Published online June 30, 2023; DOI: https://doi.org/10.4040/jkan.22109

Abstract PDF: Purpose
This study aimed to develop an evidence-based extracorporeal membrane oxygenation (ECMO) nursing protocol for critically ill patients receiving ECMO treatment by using an adaptation process, and to verify the effects of the protocol.
Methods
The protocol was developed according to the adaptation guidelines. A non-randomized controlled trial was conducted to test the protocol’s effects. Data were collected between April 2019 and March 2021. The differences in physiological indicators and complication rates between the two groups were investigated using a chart review to evaluate patient outcomes. The nurses’ outcome variables were evaluated using a questionnaire.
Results
First, after reviewing 11 guidelines by appraisal of the guidelines for research and evaluation collaboration II, 5 guidelines with a standardization grade of over 50 points were selected. An ECMO nursing protocol was developed based on these guidelines. Second, there were no statistically significant differences in physiological indicators between the two groups of patients. However, the experimental group showed a statistically significant decrease in the infection rate (p = .026) and pressure injury rates (p = .041). The levels of satisfaction with ECMO nursing care, and empowerment and performance of the nurses who used the ECMO nursing protocol were higher than those of nurses who did not (p < .001).
Conclusion
This protocol may help prevent infections and pressure injuries in patients, and improve nurses’ satisfaction and empowerment. The nursing protocol developed for critically ill patients receiving ECMO treatment can be utilized in evidence-based nursing practice.

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Pathway Analysis on the Effects of Nursing Informatics Competency, Nursing Care Left Undone, and Nurse Reported Quality of Care on Nursing Productivity among Clinical Nurses: Yu, Mi , Kim, Se Young , Ryu, Ji Min; J Korean Acad Nurs 2023;53(2):236-248. Published online April 30, 2023; DOI: https://doi.org/10.4040/jkan.22110

Abstract PDF: Purpose
Nursing informatics competency is used to manage and improve the delivery of safe, high-quality, and efficient healthcare services in accordance with best practices and professional and regulatory standards. This study examined the relationship between nursing informatics competency (NIC), nursing care left undone, and nurse reported quality of care (NQoC) and nursing productivity. A path model for their effects on nursing productivity among clinical nurses was also established.
Methods
Data were collected using structured questionnaires answered by 192 nurses working in a tertiary hospital located in J city, Korea, and analyzed using SPSS/WIN 23.0 and AMOS 21.0 program.
Results
The fit indices of the alternative path model satisfied recommended levels χ2 = .11 (p= .741), normed χ2 (χ2/df) = .11, SRMR = .01, RMSEA = .00, GFI = 1.00, NFI = 1.00, AIC = 18.11. Among the variables, NIC (β = .44, p < .001), NQoC (β = .35, p < .001) had a direct effect on nursing productivity. Due to the mediating effect of NQoC on the relationship between NIC and nursing productivity, the effect size was .14 (95% CI .08~.24). Meanwhile, nursing care left undone through NQoC in the relationship between NIC and nursing productivity, has a significant mediation effect (estimate .01, 95% CI .00~.03). The explanatory power of variables was 44.0%.
Conclusion
Education and training for enhancing NIC should be provided to improve nursing productivity, quality of care and to reduce missed nursing care. Furthermore, monitoring the quality of nursing care and using it as a productivity index is essential.

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Factors Affecting Radiation Protective Behaviors in Perioperative Nurses Applying the Theory of Planned Behavior: Path Analysis: Jang, Se Young , Kim, Hee Sun , Jeong, Seok Hee , Kim, Young Man; J Korean Acad Nurs 2023;53(2):222-235. Published online April 30, 2023; DOI: https://doi.org/10.4040/jkan.22099

Abstract PDF: Purpose
The aim of this study was to identify the factors explaining protective behaviors against radiation exposure in perioperative nurses based on the theory of planned behavior.
Methods
This was a cross-sectional study. A total of 229 perioperative nurses participated between October 3 and October 20, 2021. Data were analyzed using SPSS/WIN 23.0 and AMOS 23.0 software. The three exogenous variables (attitude toward radiation protective behaviors, subjective norm, and perceived behavioral control) and two endogenous variables (radiation protective intention and radiation protective behaviors) were surveyed.
Results
The hypothetical model fit the data (χ2/df = 1.18, SRMR = .02, TLI = .98, CFI = .99, RMSEA = .03). Radiation protective intention (β = .24, p = .001) and attitude toward radiation protective behaviors (β = .32, p = .002) had direct effects on radiation protective behaviors. Subjective norm (β = .43, p = .002) and perceived behavior control (β = .24, p = .003) had direct effects on radiation protective intention, which explained 38.0% of the variance. Subjective norm (β = .10, p = .001) and perceived behavior control (β = .06, p = .002) had indirect effects via radiation protective intention on radiation protective behaviors. Attitude toward radiation protective behaviors, subjective norm, and perceived behavioral control were the significant factors explaining 49.0% of the variance in radiation protective behaviors.
Conclusion
This study shows that the theory of planned behavior can be used to effectively predict radiation protective behaviors in perioperative nurses. Radiation safety guidelines or education programs to enhance perioperative nurses’ protective behaviors should focus on radiation protective intention, attitude toward radiation protective behaviors, subjective norm, and perceived behavioral control.

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Factors Related to Clinical Competence among Graduating Nursing Students during the COVID-19 Pandemic: A Cross-Sectional Study: Chung, Su Kyoung , Kim, Jinsook , Bhandari, Pratibha; J Korean Acad Nurs 2023;53(2):145-154. Published online April 30, 2023; DOI: https://doi.org/10.4040/jkan.22087

Abstract PDF: Purpose
This study investigated clinical competency, COVID-19-related anxiety, coping strategies, self-efficacy, and perceived stress among graduating nursing students during the COVID-19 pandemic.
Methods
We conducted a cross-sectional survey. Participants were recruited from universities located in four major cities in South Korea. General demographic information, clinical competency, self-efficacy, perceived stress, COVID-19-related anxiety, and coping strategies were assessed using reliable questionnaires. Descriptive statistics, correlations, and multiple regression tests were used to analyze the data.
Results
The mean clinical competency, self-efficacy, perceived stress, adaptive coping, and maladaptive coping were 138.16 ± 18.34, 83.85 ±14.02, 21.37 ± 5.79, 53.15 ± 4.64, and 30.98 ± 6.73, respectively. COVID-19-related anxiety was reported by 4.3% of participants. Clinical competency was significantly positively correlated with self-efficacy (r = .44, p < .001) and adaptive coping (r = .20, p = .035) and was significantly negatively correlated with maladaptive coping (r = .20, p = .035). The predictors of clinical competency were self-efficacy (β = .434, p < .001) and adaptive coping (β = .173, p < .039), which explained 23% of the variance in clinical competency.
Conclusion
Self-efficacy and adaptive coping strategies are significant predictors of clinical competence during the pandemic. Planning and implementing various curricular and non-curricular activities to increase senior students' self-efficacy and adaptive coping strategies will help prepare competent nursing graduates for the pandemic when they enter the nursing workforce.

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Effects of a Nursing Simulation Learning Module on Clinical Reasoning Competence, Clinical Competence, Performance Confidence, and Anxiety in COVID-19 Patient-Care for Nursing Students: Kim, Ye-Eun , Kang, Hee-Young; J Korean Acad Nurs 2023;53(1):87-100. Published online February 28, 2023; DOI: https://doi.org/10.4040/jkan.22130

Abstract PDF: Purpose
This study aimed to develop a nursing simulation learning module for coronavirus disease 2019 (COVID-19) patient-care and examine its effects on clinical reasoning competence, clinical competence, performance confidence, and anxiety in COVID-19 patient care for nursing students.
Methods
A non-equivalent control group pre- and post-test design was employed. The study participants included 47 nursing students (23 in the experimental group and 24 in the control group) from G City. A simulation learning module for COVID-19 patient-care was developed based on the Jeffries simulation model. The module consisted of a briefing, simulation practice, and debriefing. The effects of the simulation module were measured using clinical reasoning competence, clinical competence, performance confidence, and anxiety in COVID-19 patient-care. Data were analyzed using χ² -test, Fisher’s exact test, t-test, Wilcoxon signed-rank test, and Mann– Whitney U test.
Results
The levels of clinical reasoning competence, clinical competence, and performance confidence of the experimental group were significantly higher than that of the control group, and the level of anxiety was significantly low after simulation learning.
Conclusion
The nursing simulation learning module for COVID-19 patient-care is more effective than the traditional method in terms of improving students’ clinical reasoning competence, clinical competence, and performance confidence, and reducing their anxiety. The module is expected to be useful for educational and clinical environments as an effective teaching and learning strategy to empower nursing competency and contribute to nursing education and clinical changes.

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Keyword Network Analysis and Topic Modeling of News Articles Related to Artificial Intelligence and Nursing: Ha, Ju-Young , Park, Hyo-Jin; J Korean Acad Nurs 2023;53(1):55-68. Published online February 28, 2023; DOI: https://doi.org/10.4040/jkan.22117

Abstract PDF: Purpose
The purpose of this study was to identify the main keywords, network properties, and main topics of news articles related to artificial intelligence technology in the field of nursing.
Methods
After collecting artificial intelligence-and nursing-related news articles published between January 1, 1991, and July 24, 2022, keywords were extracted via preprocessing. A total of 3,267 articles were searched, and 2,996 were used for the final analysis. Text network analysis and topic modeling were performed using NetMiner 4.4.
Results
As a result of analyzing the frequency of appearance, the keywords used most frequently were education, medical robot, telecom, dementia, and the older adults living alone. Keyword network analysis revealed the following results: a density of 0.002, an average degree of 8.79, and an average distance of 2.43; the central keywords identified were ’education,’ ‘medical robot,’ and ‘fourth industry.’ Five topics were derived from news articles related to artificial intelligence and nursing: ‘Artificial intelligence nursing research and development in the health and medical field,’ ‘Education using artificial intelligence for children and youth care,’ ‘Nursing robot for older adults care,’ ‘Community care policy and artificial intelligence,’ and ‘Smart care technology in an aging society.’ Conclusion: The use of artificial intelligence may be helpful among the local community, older adult, children, and adolescents. In particular, health management using artificial intelligence is indispensable now that we are facing a super-aging society. In the future, studies on nursing intervention and development of nursing programs using artificial intelligence should be conducted.

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The Effects of the Combined Biofeedback and Brief Emotion Regulation Nursing Intervention Based on the Gross Model for Sexually Abused Adolescents: Kim, Jieun , Park, Wanju; J Korean Acad Nurs 2022;52(6):608-623. Published online December 31, 2022; DOI: https://doi.org/10.4040/jkan.22088

Abstract PDF: Purpose
This study aimed to evaluate the effects of a combined biofeedback and brief emotion regulation (C-BABER) program for sexually abused adolescents.
Methods
This study employed a non-equivalent control group pretest-posttest design. The participants included 26 sexually abused adolescents from eight Sunflower Centers of South Korea–with 13 in the experimental group and 13 in the control group. The experimental group received four sessions of the individual C-BABER program, each lasting 60 minutes.
Results
Compared with the control group, sexually abused adolescents in the experimental group exhibited significant score differences in traumatic symptoms, including depression (Z = - 2.24, p = .025), dissociation (Z = - 2.21, p = .027), anxiety (Z = - 2.02, p = .044), and posttraumatic stress (Z = - 2.01 p = .045); and impulsivity, including positive urgency (Z = - 3.35, p = .001) and negative urgency (Z = - 2.28, v = .023). Additionally, the experimental group exhibited significant score differences in meta-mood, including emotional attention (Z = - 2.45, p = .014), emotional clarity (Z = - 2.30, p = .021), and emotional repair (Z = - 2.28, p = .022); and emotional regulation modes, including emotional suppression (Z = - 2.65,p = .008) and cognitive reappraisal (Z = - 1.98, p = .047). Regarding bio-attention, significant changes were identified in the experimental group for the bio-attention rate and attention maintenance time in the posttest compared to the pretest (p = .001).
Conclusion
The C-BABER program for sexually abused adolescents is effective in decreasing traumatic symptoms and impulsivity, and in improving meta-mood, emotional regulation mode, and bio-attention. Therefore, we recommend providing sexually abused adolescents the C-BABER program to help them regulate their emotions and effectively adapt to their lives.

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Factors Influencing Preventive Behaviors for COVID-19 in Undergraduate Nursing Students: A Cross-Sectional Descriptive Study: Choi, Jeong Sil , Kim, Kyung Mi; J Korean Acad Nurs 2022;52(6):554-563. Published online December 31, 2022; DOI: https://doi.org/10.4040/jkan.22047

Abstract PDF: Purpose
This study aimed to determine how undergraduate nursing students’ knowledge and health beliefs affected their COVID-19-related infection-prevention behaviors.
Methods
This study used a descriptive survey. A total of 188 undergraduate nursing students from two universities in South Korea participated in this study. The data were collected from June 2020 to August 2020. Factors influencing infection-prevention behaviors were identified using multiple regression analysis.
Results
The participants’ mean knowledge level regarding COVID-19 was 84.05 ± 11.78 out of 100. The average health belief score was 2.80 ± 0.32 points out of 5. COVID-19-related preventive health behaviors were correlated with experiences of searching for COVID-19 information (r = .22, p < .01), perceived severity (r = .24, p < .01), perceived benefits (r = .29, p < .01), cues to action (r = .30, p < .01), knowledge (r = .27, p < .01), and perceived barriers (r = - .19, p < .05). Factors that significantly affected COVID-19-related preventive health behaviors were the participants’ years of study, experiences regarding COVID-19 prevention education, perceived severity, perceived barriers, and cues to action.
Conclusion
COVID-19-related preventive health behaviors are promoted by increasing awareness about the disease and promoting COVID-19 education in nursing curriculums.

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The Validity and Reliability of the Korean Version of Readiness for Practice Survey for Nursing Students: Lee, Tae Wha , Ji, Yoonjung , Yoon, Yea Seul; J Korean Acad Nurs 2022;52(6):564-581. Published online December 31, 2022; DOI: https://doi.org/10.4040/jkan.22032

Abstract PDF: Purpose
This study aimed to evaluate the validity and reliability of the Korean version of the Readiness for Practice Survey (K-RPS).
Method
The English Readiness for Practice Survey was translated into Korean using the Translation, Review, Adjudication, Pretesting, and Documentation (TRAPD) method. Secondary data analysis was performed using the dataset from the New Nurse e-Cohort study (Panel 2020) in South Korea. This study used a nationally representative sample of 812 senior nursing students. Exploratory and confirmatory factor analyses were also conducted. Convergent validity within the items and discriminant validity between factors were assessed to evaluate con-struct validity. Construct validity for hypothesis testing was evaluated using convergent and discriminant validity. Ordinary α was used to assess reliability.
Results
The K-RPS comprises 20 items examining four factors: clinical problem solving, learning experience, professional responsibilities, and professional preparation. Although the convergent validity of the items was successfully verified, discriminant validity between the factors was not. The K-RPS construct validity was verified using a bi-factor model (CMIN/DF 2.20, RMSEA .06, TLI .97, CFI .97, and PGFI .59). The K-RPS was significantly correlated with self-esteem (r = .43, p < .001) and anxiety about clinical practicum (r = - .50, p < .001). Internal consistency was reliable based on an ordinary α of .88.
Conclusion
The K-RPS is both valid and reliable and can be used as a standardized Korean version of the Readiness for Practice measurement tool.

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An Analysis of Tasks of Nurses Caring for Patients with COVID-19 in a Nationally-Designated Inpatient Treatment Unit: Jung, Minho , Kim, Moon-Sook , Lee, Joo-Yeon , Lee, Kyung Yi , Park, Yeon-Hwan; J Korean Acad Nurs 2022;52(4):391-406. Published online August 31, 2022; DOI: https://doi.org/10.4040/jkan.22056

Abstract PDF: Purpose
The purpose of this study was to provide foundational knowledge on nursing tasks performed on patients with COVID-19 in a nationally-designated inpatient treatment unit.
Methods
This study employs both quantitative and qualitative approaches. The quantitative method investigated the content and frequency of nursing tasks for 460 patients (age ≥ 18y, 57.4% men) from January 20, 2020, to September 30, 2021, by analyzing hospital information system records. Qualitative data were collected via focus group interviews. The study involved interviews with three focus groups comprising 18 nurses overall to assess their experiences and perspectives on nursing care during the pandemic from February 3, 2022, to February 15, 2022. The data were examined with thematic analysis.
Results
Overall, 49 different areas of nursing tasks (n = 130,687) were identified based on the Korean Patient Classification System for nurses during the study period. Among the performed tasks, monitoring of oxygen saturation and measuring of vital signs were considered high-priority. From the focus group interview, three main themes and eleven sub-themes were generated. The three main themes are “Experiencing eventfulness in isolated settings,” “All-around player,” and “Reflections for solutions.” Conclusion: During the COVID-19 pandemic, it is imperative to ensure adequate staffing levels, compensation, and educational support for nurses. The study further propose improving guidelines for emerging infectious diseases and patient classification systems to improve the overall quality of patient care.

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Influence of Learning Presence of Non-Face-to-Face Class Experience in Nursing Students on Academic Achievement: Mediating Effect of Learning Flow and Moderated Mediation of Digital Literacy: Ryu, Eui Jeong , Jang, Keum Seong , Kim, Eun A; J Korean Acad Nurs 2022;52(3):278-290. Published online June 30, 2022; DOI: https://doi.org/10.4040/jkan.21241

Abstract PDF: Purpose
This study aimed to identify the mediating effect of learning flow and the moderated mediation effect of digital literacy on the effect of the learning presence of non-face-to-face class experience in nursing students on academic achievement.
Methods
Participants were 272 nursing students from six universities in two different cities. A self-report questionnaire was used to measure learning presence, learning flow, digital literacy, and academic achievement. Analysis was performed using SPSS 26.0 and SPSS PROCESS Macro (4.0).
Results
The mediating effect of learning flow on the effect of learning presence on academic achievement was 0.42, and the moderated mediation index of digital literacy was 0.17. Learning flow showed a mediating effect on the relationship between learning presence and academic achievement. Digital literacy had a moderated mediation effect on the relationship between learning presence and academic achievement that was mediated by learning flow.
Conclusion
The intensity of the mediating effect of nursing students’ learning presence on academic achievement through learning flow increases as the level of digital literacy increases. These results suggest that educational programs considering the level of learning presence, learning flow, and digital literacy are required to promote the academic achievement of nursing college students.

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Willingness to Use and Appropriate Payable Cost for Visiting Nurse Service for the Elderly in the Community: Seo, Soyoung , Jang, Soong-nang; J Korean Acad Nurs 2022;52(1):105-119. Published online February 28, 2022; DOI: https://doi.org/10.4040/jkan.21193

Abstract PDF: Purpose
This study aimed to measure willingness to use (WTU) and appropriate payable cost of visiting nurse service for the elderly and explore their impact factors.
Methods
The study included 752 participants selected from data that were completed in 2017 for the elderly aged over 60 nationwide. Logit and Tobit regression analysis were performed to confirm the influencing factors.
Results
The study found that 39.1% of the elderly in the community were WTU the visiting nurse service, and they reported that the cost per visit was 12,650 Korean Won. The factors influencing WTU were having less than moderate subjective health status (OR = 1.63, p = .011), being part of a social participating groups (OR = 1.50, p = .046), or participation in senior health promotion programs (SHPPs) (OR = 1.96, p = .003). The cost was also influenced by less than moderate subjective health status (β = 4.37, p = .021), being part of a social participating groups (β = 4.41, p = .028), or participation in SHPPs (β = 4.87, p = .023). Additionally, elderly people living alone who were used as covariates were highly WTU (OR = 2.20, p = .029).
Conclusion
This study provides evidence to predict demand for visiting nurse service and reflects consumer value in setting the service cost. This is the first study to derive cost from consumers' perspective regarding the service for the elderly. As it is the result of an open-ended survey, follow-up studies are needed to estimate more reliable and reasonable results.

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