This study was conducted to measure the effects of clinical application of a Nursing Diagnosis Protocol. The dependent variables were the degree of patient's satisfaction and the degree of nurse's satisfaction with the nursing activity. Analysis of the effect of the use of the nursing diagnosis protocol was based on the nursing record. The subjects for this study were 61 nurses (experimental group 31, control group 30) and 155 patients (experimental group 55, control group 100) on four internal medicine wards in K University Hospital in Seoul. Data collection was done from August to October 12.1988. - The results obtained in this study can be summarized as follows, 1. Effect of the clinical application of the nursing diagnosis protocol. 1) The first hypothesis ; " nurses who use the nursing diagnosis protocol will have higher degrees of satisfaction than those who use traditional methods" was rejected.(t= .54, df=58, p=.59). 2) The second hypothesis ; " patients nursed by nurses using the nursing diagnosis protocol will have higher degrees of satisfaction than those nursed with traditional methods" was supported(t=1.93, df=154, p= ,05). 3) The third hypothesis: Major hypothesis ; "the nursing records of the experimental group, who used the nursing diagnosis protocol, will be more detailed than those of the control group " was supported (t=6.40, df=79.90, p=.000). (1) The first subhypothesis ; "The recorded data collection of the experimental group will be more detailed than . that of the control group" was rejected (t= 1.79, df=118, p=.07). (2) The second subhypothesis : "The recorded patient's problem statement of the experimental group will be more detailed than that of the control group" was supported. (3) The third subhypothesis : "The nursing record of the experimental group will be more convenient for implementation than that of the control group" was supported. 2. Factors related to the nurse's degree of satisfaction with protocol. 1) No general characteristics(age, religion, education level, duty career, present duty career) were related to the Burse's degree of satisfaction. 2) Variables related to the nurse's degree of satisfaction were "satisfaction as a nurse" and "consider nursing as lifelong job" (t=-2.6, df=13.2 2, p=.02, t=2,41, df=23.85, p=.02). 3. Factors related to the patient's degree of satisfaction. 1) General characteristics related to the patient's degree of satisfaction with nurses using the protocol were ass. educational level, and being married.(F=5.17, df=3/153, p=.00, t=-2.39, df=154, p=.01, f=5.91, df=2/153, p=.00) 2) The variables previous hospitalization, duration of hospitalization, the hospital unit, presence of a relative, medical insurance, or medical diagnosis were not related to the patient's degree of satisfaction. I. The experimental group's nursing record was more detailed than the control group's record with regard to the physical and psychological state of the patients. As noted above, the experimental group nurses, who use a nursing diagnosis had protocol were less satisfied than the: control group who used traditional methods of the recording, but experimental group patients had a higher degree of satisfaction than the control group patients. The nursing records of experimental group, using the nursing diagnosis protocol was more detailed than that of the control group. If the nursing diagnosis protocol is used in clinical nursing practice, the quality of nursing care may be improved.

This study was conducted to investigate the present situation and problems related to the use of nursing diagnosis in practice. The data were obtained from 332 subjects (27 director of nursing service, 302 staff nurses) who worked in university hospitals in Korea from July through August 1988 using a mailed questionnaire. Data were analyzed by frequency, X2 test and t-test. The findings were as follows : 1. Clinical use of nursing diagnosis by directors of nursing service and staff nurses. 1) The majority of the nursing departments (88.9 %) conducted group education on nursing diagnosis during the last 5 years and 81.5% of them kept a record formet for nursing diagnosis ; 88 .9 % of them had had prior experience with the nursing diagnosis. 2) Most of nurses (97.0%) had received education on nursing diagnosis, 2. Factors related to the clinical use of nursing diagnosis in nursing service departments and by staff nurses. 1) The one factor related to the use of nursing diagnosis in the nursing service department was the existence: of a record. 2) Factors related to the use of nursing diagnosis by the staff nurses were the organization style of the nursing service department, group education during the last 5 years, existence of a record, the attitude of the director of nursing service, and prior experience of the use of the nursing diagnosis as characteristics of nursing service department and educational experience of nursing diagnosis as a character of nurse. 3. Problems with the use of nursing diagnosis. 1) The primary problem was the lack of time and personnel (mean : 3.757) I the second problem was the lack of knowledge and will to use nursing diagnosis in practice by the staff nurses(mean : 3.546). 2) There was no significant difference in problems expressed by the director of nursing services and the nurses. The majority of nurses who worked in the university hospitals expressed interest in and concern about the use of nursing diagnosis. Most of the nurses had had education about on nursing diagnosis but use in practice was limited. The primary problem was lack of time and manpower Strategies for improving use of the nursing diagnosis in practice: 1) Strengthening the education about nursing diagnosis and a holistic approach to understanding human beings. 2) Develop protocols for the use of nursing diagnosis. 3) Eliminate the language barrier regarding nursing diagnosis by translation into in Korean. 4) Decentralization of the nursing service to promote accountability by individual nurses for use of nursing diagnosis.