Journal of Korean Academy of Nursing

Research Papers

Mediating effect of grit on the influence of nurses’ silence behavior on medication safety competence: a cross-sectional study: Haengsuk Kim, Wanju Park; J Korean Acad Nurs 2025;55(1):81-92. Published online February 20, 2025; DOI: https://doi.org/10.4040/jkan.24088

Abstract PDF ePub: Purpose
This study investigated the mediating effect of grit in the relationship between silence behavior and medication safety competence among nurses.
Methods
The study included 166 nurses from four university hospitals and general hospitals in Seoul and Gyeonggi-do, South Korea. Data were collected from March 1 to 10, 2024, using self-report questionnaires. Data were analyzed using the t-test, analysis of variance, Scheffé’s test, and Pearson’s correlation coefficients with IBM SPSS Statistics ver. 23.0 (IBM Corp.). A mediation analysis was performed using Hayes’s PROCESS macro model 4 and the bootstrapping method.
Results
Medication safety competence showed significant correlations with silence behavior (r=–.21, p=.008) and grit (r=.43, p<.001). Furthermore, grit partially mediated the relationship between silence behavior and medication safety competence.
Conclusion
This study indicates that grit is a significant mediator in the relationship between silence behavior and medication safety competence. Therefore, an integrated approach that reduces silence behavior and promotes grit is essential for strengthening nurses’ medication safety competence. Ultimately, these strategies will help ensure patient safety by improving medication safety competence.

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Structural Topic Modeling Analysis of Patient Safety Interest among Health Consumers in Social Media: Kim, Nari , Lee, Nam-Ju; J Korean Acad Nurs 2024;54(2):266-278. Published online May 31, 2024; DOI: https://doi.org/10.4040/jkan.23156

Abstract PDF: Purpose
This study aimed to investigate healthcare consumers’ interest in patient safety on social media using structural topic modeling (STM) and to identify changes in interest over time.
Methods
Analyzing 105,727 posts from Naver news comments, blogs, internet cafés, and Twitter between 2010 and 2022, this study deployed a Python script for data collection and preprocessing. STM analysis was conducted using R, with the documents’ publication years serving as metadata to trace the evolution of discussions on patient safety.
Results
The analysis identified a total of 13 distinct topics, organized into three primary communities: (1) “Demand for systemic improvement of medical accidents,” underscoring the need for legal and regulatory reform to enhance accountability; (2) “Efforts of the government and organizations for safety management,” highlighting proactive risk mitigation strategies; and (3) “Medical accidents exposed in the media,” reflecting widespread concerns over medical negligence and its repercussions. These findings indicate pervasive concerns regarding medical accountability and transparency among healthcare consumers.
Conclusion
The findings emphasize the importance of transparent healthcare policies and practices that openly address patient safety incidents. There is clear advocacy for policy reforms aimed at increasing the accountability and transparency of healthcare providers. Moreover, this study highlights the significance of educational and engagement initiatives involving healthcare consumers in fostering a culture of patient safety. Integrating consumer perspectives into patient safety strategies is crucial for developing a robust safety culture in healthcare.

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Review Paper

Patient Safety Management Activities of Korean Nurses: A Meta-Analytic Path Analysis: Jeong, Seohee , Jeong, Seok Hee; J Korean Acad Nurs 2022;52(4):363-377. Published online August 31, 2022; DOI: https://doi.org/10.4040/jkan.22022

Abstract PDF

Purpose
This study aimed to test a hypothetical model of Korean nurses’ patient safety management activities using meta-analytic path analysis.
Methods
A systematic review, meta-analysis, and meta-analytic path analysis were conducted following the PRISMA and MOOSE guidelines. Seventy-four studies for the meta-analysis and 92 for the meta-analytic path analysis were included. The R software program (Version 3.6.3) was used for data analysis.
Results
Four variables out of 49 relevant variables were selected in the meta-analysis. These four variables showed large effect sizes (ESr = .54) or median effect sizes (ESr = .33∼.40) with the highest k (number of studies) in the individual, job, and organizational categories. The hypothetical model for the meta-analytic path analysis was established using these variables and patient safety management activities. Twelve hypothetical paths were set and tested. Finally, the perception of the importance of patient safety management and patient safety competency directly affected patient safety management activities. In addition, self-efficacy, the perception of the importance of patient safety management, patient safety competency, and patient safety culture, indirectly affected patient safety management activities.
Conclusion
Self-efficacy, the perception of the importance of patient safety management, patient safety competency, and the organization’s patient safety culture should be enhanced to improve nurses’ patient safety management activities.

Citations

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The influencing factors of pediatric nurses’ perception of patient safety culture and partnership with patients’ parents on patient safety nursing activities in South Korea: a descriptive study
Seo Jin Lee, Young Ran Han
Child Health Nursing Research.2024; 30(4): 255. CrossRef
Effects of Nurse-Nurse Collaboration and Nurse-Physician Collaboration on Nursing Performance in Nurses: The Mediating Effect of Patient Safety Management Activities
JaHyun Kim, Seok Hee Jeong, Hee Sun Kim, Sunmi Kim
Journal of Korean Academy of Nursing Administration.2024; 30(4): 343. CrossRef
Mediating Effects of Job Satisfaction between Nurses’ Perceptions of Patient Safety Culture and Their Safety Nursing Activities
I Jung Han, Young Ran Han
Journal of Korean Academy of Fundamentals of Nursing.2023; 30(1): 46. CrossRef
The Effects of Professional Autonomy, Job Satisfaction, and Perceived Patient-Safety Culture on Nurses' Patient-Safety Management Activities: A Cross-Sectional Study
Bokja Koak, Junglim Seo, Eunji Song, Haneul Shin, Jaehee Jeon
Korean Journal of Adult Nursing.2023; 35(2): 117. CrossRef

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Research Papers

Effect of Patient Safety Training Program of Nurses in Operating Room: Zhang, Peijia , Liao, Xin , Luo, Jie; J Korean Acad Nurs 2022;52(4):378-390. Published online August 31, 2022; DOI: https://doi.org/10.4040/jkan.22017

Abstract PDF

Purpose
This study developed an in-service training program for patient safety and aimed to evaluate the impact of the program on nurses in the operating room (OR).
Methods
A pretest–posttest self-controlled survey was conducted on OR nurses from May 6 to June 14, 2020. An in-service training program for patient safety was developed on the basis of the knowledge–attitude–practice (KAP) theory through various teaching methods. The levels of safety attitude, cognition, and attitudes toward the adverse event reporting of nurses were compared to evaluate the effect of the program. Nurses who attended the training were surveyed one week before the training (pretest) and two weeks after the training (posttest).
Results
A total of 84 nurses participated in the study. After the training, the scores of safety attitude, cognition, and attitudes toward adverse event reporting of nurses showed a significant increase relative to the scores before the training (p < .001). The effects of safety training on the total score and the dimensions of safety attitude, cognition, and attitudes toward nurses’ adverse event reporting were above the moderate level.
Conclusion
The proposed patient safety training program based on KAP theory improves the safety attitude of OR nurses. Further studies are required to develop an interprofessional patient safety training program. In addition to strength training, hospital managers need to focus on the aspects of workflow, management system, department culture, and other means to promote safety culture.

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Effect of Counting Error Prevention Training on Operating Room Nurses’ Counting Error Prevention Awareness and Perceptions of Patient Safety
Myung Jin JANG, Mi Kyung HONG, Mi Jeong LEE, Kyung A LEE, Yang Ok KIM, Jin A JEON, Hana KO
Korean Journal of Health Promotion.2024; 24(1): 20. CrossRef

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Effects of Second Victim Experiences after Patient Safety Incidents on Nursing Practice Changes in Korean Clinical Nurses: The Mediating Effects of Coping Behaviors: Jeong, Seohee , Jeong, Seok Hee; J Korean Acad Nurs 2021;51(4):489-504. Published online August 31, 2021; DOI: https://doi.org/10.4040/jkan.21089

Abstract PDF

Purpose
This study was investigated the mediating effect of coping behaviors in the relationship between the second victim experiences after patient safety incidents and the nursing practice changes.
Methods
A cross-sectional survey was performed using structured questionnaires. Participants were 218 clinical nurses in general tertiary hospitals in South Korea. Data were collected through an online survey and snowball sampling from August 11 to September 6 2020. Data were analyzed using SPSS 23.0 program. A mediation analysis was performed using multiple regression and a simple mediation model applying the PROCESS macro with 95% bias-corrected bootstrap confidence interval.
Results
The mean scores of second victim experiences was 3.41/5. Approach coping (β = .55, p < .001) and the avoidant coping (β = - .23, p = .001) showed mediation effects in the relationship between second victim experiences and constructive change in nursing practice. Avoidant coping (β = .29, p < .001) showed a mediation effect in the relationship between second victim experiences and defensive change in nursing practice.
Conclusion
Coping behaviors has a mediating effect on the relationship between second victim experiences and nursing practice changes. To ensure that nurses do not experience second victim, medical institutions should have a culture of patient safety that employs a systematic approach rather than blame individuals. They also need to develop strategies that enhance approach coping and reducing avoidant coping to induce nurses’ constructive practice changes in clinical nurses in experiencing second victims due to patient safety incidents.

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Factors influencing negative outcomes for nurses who experience patient safety incidents: An integrative review
Hanseulgi Lee, Nam‐Ju Lee, Nari Kim
International Nursing Review.2025;[Epub] CrossRef
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Seohee Jeong, Sunmi Kim, Hyoung Eun Chang, Seok Hee Jeong
BMC Nursing.2025;[Epub] CrossRef
Changes in Nursing Practice Among Clinical Nurses After Experiencing a Patient Safety Incident: Partial Least Squares Structural Equation Modeling
Sunmi Kim, Seohee Jeong, Seok Hee Jeong, Majd Mrayyan
Journal of Nursing Management.2025;[Epub] CrossRef
“Learn from Errors”: Post-traumatic growth among second victims
Huanhuan Huang, Tong Liu, Ying Peng, Xingyao Du, Qi Huang, Qinghua Zhao, Mingzhao Xiao, Yetao Luo, Shuangjiang Zheng
BMC Public Health.2024;[Epub] CrossRef
Nurse Leader Perspectives and Experiences on Caregiver Support Following a Serious Medical Error
Marie M. Prothero, Madeline Sorhus, Katherine Huefner
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Prevalence of the second victim phenomenon among intensive care unit nurses and the support provided by their organizations
Maria Kappes, Pilar Delgado‐Hito, Verónica Riquelme Contreras, Marta Romero‐García
Nursing in Critical Care.2023; 28(6): 1022. CrossRef
The mediating role of coping styles in the relationship between second victim experience and professional quality of life among nurses: a cross-sectional study
Xizhao Li, Chong Chin Che, Yamin Li, Ling Wang, Mei Chan Chong
BMC Nursing.2023;[Epub] CrossRef
Associations among workplace incivility, stress coping, and nursing performance in hospital nurses: A path analysis
Eun Ha Kim, Yeojin Yi
Journal of Nursing Scholarship.2023; 55(4): 834. CrossRef
Influence of Clinical Nurses’ Second-Victim Experience and Second-Victim Support in Relation to Patient Safety Incidents on Their Work-Related Outcomes
Su Jin Jung, Youngjin Lee, Sun Hyoung Bae
Journal of Korean Academy of Nursing Administration.2022; 28(4): 331. CrossRef
Profiles of second victim symptoms and desired support strategies among Korean nurses: A latent profile analysis
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Original Articles

Analysis of Subgroups with Lower Level of Patient Safety Perceptions Using Decision-Tree Analysis: Shin, Sun Hwa; J Korean Acad Nurs 2020;50(5):686-698. Published online October 31, 2020; DOI: https://doi.org/10.4040/jkan.20044

Abstract PDF

Purpose
This study was aimed to investigate experiences, perceptions, and educational needs related to patient safety and the factors affecting these perceptions.
Methods
Study design was a descriptive survey conducted in November 2019. A sample of 1,187 Koreans aged 20-80 years participated in the online survey. Based on previous research, the questionnaire used patient safety-related and educational requirement items, and the Patient Safety Perception Scale. Descriptive statistics and a decision tree analysis were performed using SPSS 25.0.
Results
The average patient safety perception was 71.71 (± 9.21). Approximately 95.9% of the participants reported a need for patient safety education, and 88.0% answered that they would participate in such education. The most influential factors in the group with low patient safety perceptions were the recognition of patient safety activities, age, preference of accredited hospitals, experience of patient safety problems, and willingness to participate in patient safety education.
Conclusion
It was confirmed that the vulnerable group for patient safety perception is not aware of patient safety activities and did not prefer an accredited hospital. To prevent patient safety accidents and establish a culture of patient safety, appropriate educational strategies must be provided to the general public.

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Structural Topic Modeling Analysis of Patient Safety Interest among Health Consumers in Social Media
Nari Kim, Nam-Ju Lee
Journal of Korean Academy of Nursing.2024; 54(2): 266. CrossRef
Analysis of Factors Related to Domestic Patient Safety Incidents Using Decision Tree Technique
Jieun Shin, Ji-Hoon Lee, Nam-Yi Kim
Risk Management and Healthcare Policy.2023; Volume 16: 1467. CrossRef
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Eun-Hye Lee, Sun-Hwa Shin, Goo-Churl Jeong
International Journal of Environmental Research and Public Health.2022; 19(5): 2841. CrossRef
Development and Effectiveness of a Patient Safety Education Program for Inpatients
Sun Hwa Shin, Mi Jung Kim, Ho Jin Moon, Eun Hye Lee
International Journal of Environmental Research and Public Health.2021; 18(6): 3262. CrossRef

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Development and Evaluation of Electronic Health Record Data-Driven Predictive Models for Pressure Ulcers: Seul Ki Park, Hyeoun-Ae Park, Hee Hwang; J Korean Acad Nurs 2019;49(5):575-585. Published online January 15, 2019; DOI: https://doi.org/10.4040/jkan.2019.49.5.575

Abstract PDF

Abstract Purpose

The purpose of this study was to develop predictive models for pressure ulcer incidence using electronic health record (EHR) data and to compare their predictive validity performance indicators with that of the Braden Scale used in the study hospital.

Methods

A retrospective case-control study was conducted in a tertiary teaching hospital in Korea. Data of 202 pressure ulcer patients and 14,705 non-pressure ulcer patients admitted between January 2015 and May 2016 were extracted from the EHRs. Three predictive models for pressure ulcer incidence were developed using logistic regression, Cox proportional hazards regression, and decision tree modeling. The predictive validity performance indicators of the three models were compared with those of the Braden Scale.

Results

The logistic regression model was most efficient with a high area under the receiver operating characteristics curve (AUC) estimate of 0.97, followed by the decision tree model (AUC 0.95), Cox proportional hazards regression model (AUC 0.95), and the Braden Scale (AUC 0.82). Decreased mobility was the most significant factor in the logistic regression and Cox proportional hazards models, and the endotracheal tube was the most important factor in the decision tree model.

Conclusion

Predictive validity performance indicators of the Braden Scale were lower than those of the logistic regression, Cox proportional hazards regression, and decision tree models. The models developed in this study can be used to develop a clinical decision support system that automatically assesses risk for pressure ulcers to aid nurses.

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Ju Hee Lee, Jae Yong Yu, So Yun Shim, Kyung Mi Yeom, Hyun A Ha, Se Yong Jekal, Ki Tae Moon, Joo Hee Park, Sook Hyun Park, Jeong Hee Hong, Mi Ra Song, Won Chul Cha
Korean Journal of Adult Nursing.2024; 36(3): 191. CrossRef
Could we prove the nursing outcomes utilising clinical data warehouse? Effectiveness of pressure ulcer intervention in Korean tertiary hospital
Moonsook Kim, Se Yeon Park, Meihua Piao, Earom Lim, Soon Hwa Yoo, Minju Ryu, Hyo Yeon Lee, Hyejin Won
International Wound Journal.2023; 20(1): 201. CrossRef
Data‐driven approach to predicting the risk of pressure injury: A retrospective analysis based on changes in patient conditions
Yinji Jin, Ji‐Sun Back, Sun Ho Im, Jong Hyo Oh, Sun‐Mi Lee
Journal of Clinical Nursing.2023; 32(19-20): 7273. CrossRef
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Eunji Ko, Seunghye Choi
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Patient Safety Teaching Competency of Nursing Faculty: Shinae Ahn, Nam-Ju Lee, Haena Jang; J Korean Acad Nurs 2018;48(6):720-730. Published online January 15, 2018; DOI: https://doi.org/10.4040/jkan.2018.48.6.720

Abstract PDF

Abstract Purpose

The purpose of this study was to investigate patient safety teaching competency of nursing faculty and the extent of teaching patient safety topics in the nursing curriculum.

Methods

A national survey was conducted with full-time nursing faculty in 4-year nursing schools. Regional quota sampling method was used. An online survey was sent to 1,028 nursing faculty and 207 of them were completed. Among the 207, we analyzed data from 184 participants. The revised Health Professional Education in Patient Safety Survey was used. Data were analyzed using descriptive statistics, independent t-test, one-way ANOVA, Pearson's correlation analysis, and multiple linear regression analyses.

Results

The faculty's self-confidence was lower than their perceived importance of patient safety education. The mean score of teaching patient safety was 3.52±0.67 out of 5, and the contents were mostly delivered through lectures. The extent of faculty's teaching varied depending on faculty's clinical career, teaching subjects, participation in practicum courses, and previous experience of patient safety education. The significant predictors of the extent of teaching patient safety were the faculty's self-confidence in teaching patient safety (β=.39) during clinical practicum, their perceived importance of patient safety education during lectures (β=.23), and the teaching subject (β=.15).

Conclusion

To enhance the competency of nursing faculty for effective patient safety education, a patient safety education program tailored to faculty characteristics should be developed and continuously provided for faculty. In addition, it is necessary to improve patient safety curriculum, strengthen clinical and school linkages, and utilize various education methods in patient safety education.

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Developing an integrated curriculum for patient safety in an undergraduate nursing program: a case study
Yoonjung Ji, Hyeonkyeong Lee, Taewha Lee, Mona Choi, Hyejung Lee, Sanghee Kim, Hyunok Kim Do, Sunah Kim, Sang Hui Chu, Jeongok Park, Young Man Kim, Soyoon Park
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Characteristics and Risk Factors for Falls in Tertiary Hospital Inpatients: Eun-Ju Choi, Young-Shin Lee, Eun-Jung Yang, Ji-Hui Kim, Yeon-Hee Kim, Hyeoun-Ae Park; J Korean Acad Nurs 2017;47(3):420-430. Published online January 15, 2017; DOI: https://doi.org/10.4040/jkan.2017.47.3.420

Abstract PDF

Abstract Purpose

The aim of this study was to explore characteristics of and risk factors for accidental inpatient falls.

Methods

Participants were classified as fallers or non-fallers based on the fall history of inpatients in a tertiary hospital in Seoul between June 2014 and May 2015. Data on falls were obtained from the fall report forms and data on risk factors were obtained from the electronic nursing records. Characteristics of fallers and non-fallers were analyzed using descriptive statistics. Risk factors for falls were identified using univariate analyses and logistic regression analysis.

Results

Average length of stay prior to the fall was 21.52 days and average age of fallers was 61.37 years. Most falls occurred during the night shifts and in the bedroom and were due to sudden leg weakness during ambulation. It was found that gender, BMI, physical problems such elimination, gait, vision and hearing and medications such as sleeping pills, antiarrhythmics, vasodilators, and muscle relaxant were statistically significant factors affecting falls.

Conclusion

The findings show that there are significant risk factors such as BMI and history of surgery which are not part of fall assessment tools. There are also items on fall assessment tools which are not found to be significant such as mental status, emotional unstability, dizziness, and impairment of urination. Therefore, these various risk factors should be examined in the fall risk assessments and these risk factors should be considered in the development of fall assessment tools.

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Operating Room Nurses' Experiences of Securing for Patient Safety: Kwang-Ok Park, Jong Kyung Kim, Myoung-Sook Kim; J Korean Acad Nurs 2015;45(5):761-772. Published online October 30, 2015; DOI: https://doi.org/10.4040/jkan.2015.45.5.761

Abstract PDF

Purpose

This study was done to evaluate the experience of securing patient safety in hospital operating rooms.

Methods

Experiential data were collected from 15 operating room nurses through in-depth interviews. The main question was "Could you describe your experience with patient safety in the operating room?". Qualitative data from the field and transcribed notes were analyzed using Strauss and Corbin's grounded theory methodology.

Results

The core category of experience with patient safety in the operating room was 'trying to maintain principles of patient safety during high-risk surgical procedures'. The participants used two interactional strategies: 'attempt continuous improvement', 'immersion in operation with sharing issues of patient safety'.

Conclusion

The results indicate that the important factors for ensuring the safety of patients in the operating room are manpower, education, and a system for patient safety. Successful and safe surgery requires communication, teamwork and recognition of the importance of patient safety by the surgical team.

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Sun Aee Kim, Eun-Mi Kim, Ju-Ry Lee, Eui Geum Oh
Journal of Korean Academy of Nursing Administration.2018; 24(4): 319. CrossRef
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U-Eun Choi, Hyun-Young Kim
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Factors related to Nurses' Patient Identification Behavior and the Moderating Effect of Person-organization Value Congruence Climate within Nursing Units: Young Mee Kim, Seung-Wan Kang, Se Young Kim; J Korean Acad Nurs 2014;44(2):198-208. Published online April 30, 2014; DOI: https://doi.org/10.4040/jkan.2014.44.2.198

Abstract PDF

Purpose

This research was an empirical study designed to identify precursors and interaction effects related to nurses' patient identification behavior. A multilevel analysis methodology was used.

Methods

A self-report survey was administered to registered nurses (RNs) of a university hospital in South Korea. Of the questionnaires, 1114 were analyzed.

Results

The individual-level factors that had a significantly positive association with patient identification behavior were person-organization value congruence, organizational commitment, occupational commitment, tenure at the hospital, and tenure at the unit. Significantly negative group-level precursors of patient identification behavior were burnout climate and the number of RNs. Two interaction effects of the person-organization value congruence climate were identified. The first was a group-level moderating effect in which the negative relationship between the number of RNs and patient identification behavior was weaker when the nursing unit's value congruence climate was high. The second was a cross-level moderating effect in which the positive relationship between tenure at the unit and patient identification behavior was weaker when value congruence climate was high.

Conclusion

This study simultaneously tested both individual-level and group-level factors that potentially influence patient identification behavior and identified the moderating role of person-organization value congruence climate. Implications of these results are discussed.

Citations

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Content Analysis of Patient Safety Incident Reports Using Text Mining: A Secondary Data Analysis
On-Jeon Baek, Ho Jin Moon, Hyosun Kim, Sun-Hwa Shin
Korean Journal of Adult Nursing.2024; 36(4): 298. CrossRef
Compare Value Congruence of Nurse-Patient Assignment with Work Performance in Neonatal Intensive Care Unit
Hye Min Kim, Dong Yeon Kim, Ji Young Kim, Ga Young Kim, Seol Hee Moon
Journal of Korean Academy of Nursing Administration.2021; 27(5): 355. CrossRef
Structural empowerment and nurses’ patient identification behaviors: a cross-sectional study
Young Mee Kim, Se Young Kim
International Journal of Health Care Quality Assurance.2019; 32(5): 832. CrossRef

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Development and Validation of the Korean Patient Safety Culture Scale for Nursing Homes: Sook Hee Yoon, Byungsoo Kim, Se Young Kim; J Korean Acad Nurs 2013;43(3):379-388. Published online June 28, 2013; DOI: https://doi.org/10.4040/jkan.2013.43.3.379

Abstract PDF

Purpose

The purpose of this study was to develop a tool to evaluate patient safety culture in nursing homes and to test its validity and reliability.

Methods

A preliminary tool was developed through interviews with focus group, content validity tests, and a pilot study. A nationwide survey was conducted from February to April, 2011, using self-report questionnaires. Participants were 982 employees in nursing homes. Data were analyzed using Cronbach's alpha, item analysis, factor analysis, and multitrait/multi-Item analysis.

Results

From the results of the analysis, 27 final items were selected from 49 items on the preliminary tool. Items with low correlation with total scale were excluded. The 4 factors sorted by factor analysis contributed 63.4% of the variance in the total scale. The factors were labeled as leadership, organizational system, working attitude, management practice. Cronbach's alpha for internal consistency was .95 and the range for the 4 factors was from .86 to .93.

Conclusion

The results of this study indicate that the Korean Patient Safety Culture Scale has reliability and validity and is suitable for evaluation of patient safety culture in Korean nursing homes.

Citations

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