Purpose: : The purposes of this study were to examine the relationships between knowledge, awareness, safe environment, and performance of standard precautions and identify factors associated with performance of standard precautions.
Methods: : This study was a descriptive research. A structured questionnaire on knowledge, awareness, safe environment, and performance of standard precautions was used for the survey with a convenience sample of 150 caregivers. Data were collected from July to August 2019 and were analyzed using descriptive statistics, independent t-test, one way ANOVA, Pearson’s correlation coefficient, and multiple regression with SPSS/WIN 25.0 program.
Results: : The mean scores on knowledge, awareness, safe environment, and performance of standard precautions were 15.77±3.34, 7.35±1.91, 4.55±2.05, and 55.20±10.11 respectively. Performance of standard precautions showed a statistically significant positive correlation with knowledge (r=.54, p<.001), awareness (r=.54, p<.001), and safe environment (r=.50, p<.001). Awareness (β=.24, p=.025) and safe environment (β=.35, p<.001) were significantly associated with factors of performance of standard precautions. Also, education level (high school and above college), affiliated institution (private association), and importance of infection control education (moderate) were significantly associated with factors of performance of standard precautions.
Conclusion : The results of the study indicate that factors influencing the performance of standard precautions of caregivers were awareness and safe environment. Therefore, to improve implementation of the standard precautions among caregivers, a safe environment within the hospital must be supported, and appropriate infection management education needs to be provided to caregivers to improve their knowledge and awareness of the standard precautions.

Purpose: : This study examined the effects of an integrated management program on physical function, cognitive function, and depression in patients with subacute stroke.
Methods: : A nonequivalent control group design was adopted. The participants were assigned to either the experimental group (n=20) or control group (n=23). The experimental group received an 8-week integrated management program and standard rehabilitation service (i.e., physical therapy and occupational therapy), while the control group received the standard rehabilitation service only. Physical function was measured as gait speed and balance ability using the Berg Balance Scale (BBS). Cognitive function was measured with neuro-behavioral cognitive status examination (NCSE), and depression was measured using the Beck Depression Inventory-II (BDI-II). Repeated measure ANOVA was used to determine changes in physical function, cognitive function, and depression over 8-weeks.
Results: : The interaction between group and time was significant, indicating that the experimental group showed improvement in gait speed, balance ability, cognitive function (linguistic ability, linguistic memory, reasoning), and a decrease in depression compared to the control group.
Conclusion : These results indicate that the integrated management program developed herein was beneficial in restoring physical function, cognitive function, and depression in subacute stroke patients.

Purpose: : This study identified the factors affecting the clinical competence of emergency unit nurses caring for foreign patients.
Methods: : This study utilized a descriptive correlation design. Participants were 112 emergency unit nurses working in different hospitals designated as the government’s emergency medical centers and agencies in 2018. The collected data were analyzed using descriptive statistics, independent t-test, one-way ANOVA, Pearson’s correlation coefficients, and multiple linear regression analysis.
Results: : Subjects’ clinical competence showed positive relationships with cultural competency (r=.45, p<.001) and intercultural communication (r=.53, p<.001). Factors that affect the clinical competence of subjects showed intercultural communication (β=0.38, p=.001).
Conclusion : It is necessary to develop programs to improve intercultural communication, factors that influence clinical competence of emergency unit nurses, and apply them to practical fields.

Purpose: : This study investigated the occurrence of postoperative ileus and its related factors in patients after spinal surgery.
Methods: : After a retrospective review of data from patients who underwent spinal surgery at a single hospital located in Busan from 2012 through 2016, a total of 253 patients were included. The subjects were divided into non-ileus and ileus groups. We compared patient-, surgery-, and postoperative hematologicalrelated factors.
Results: : A total of 41 (16.2%) out of 253 patients experienced postoperative ileus. Data analysis revealed significant differences between the two groups in mean age (68.44 vs 60.50 years), occupation (9.8 vs 28.8%), cardiovascular comorbidity (63.4 vs 37.7%), approach of surgery (supine/prone: 29.3/70.7 vs 12.7/87.3%), duration of anesthesia (5.86 vs 4.43 hours), narcotic use (75.6 vs 56.6%), postoperative serum hemoglobin level (3 days: 10.81 vs 11.41 g/dL), postoperative serum protein (immediately/3 days: 5.30/5.43 vs 5.62/5.68 g/dL), postoperative albumin level (3 days: 3.17 vs 3.40 g/dL), postoperative C-reactive protein level (3 days: 11.44 vs 8.36 mg/dL), postoperative bed stabilization period (3.32 vs 2.50 days), and onset of bowel movement (2.59 vs 1.94 days). In multivariate logistic regression, age and time of anesthesia were independent risk factors of postoperative ileus.
Conclusion : To detect ileus after spinal surgery early, nurse education is needed with intensive screening on advanced age, surgery-related factors, and postoperative hematological indices.

Purpose: : This study examined the effects of work environment and organizational culture on tertiary hospital nurses’ turnover intention.
Methods: : A cross-sectional design was used, with a convenience sample of 371 hospital nurses from 16 units of three tertiary hospitals in South Korea. Data were collected through a self-report survey conducted during September and October 2016. Data were analyzed using the chi-square test, Fisher’s exact test, independent t-test, and binary logistic regression analysis.
Results: : A total of 43.7% of the participants were identified as having turnover intention within 1 year. Factors related to turnover intention among hospital nurses were age, marital status, and total clinical career. Furthermore, a relationship-oriented organizational culture showed a negative association with turnover intention.
Conclusion : These findings suggest it is important to provide appropriate motivational programs and incentives for nurses according to their clinical career to decrease turnover intention. Moreover, establishing a relationship-oriented organizational culture will also help to reduce the turnover intention of tertiary hospital nurses.

Purpose: : Based on Quint’s theory and the relevant literature, this study constructed a structural equation model for explaining and predicting end-of-life care performance in clinical nurses.
Methods: : A self-administered questionnaire was used to collect data from 265 nurses between September 1 and September 30, 2016. The data were analyzed using SPSS ver. 21 and AMOS ver. 21.
Results: : The goodness of fit of the modified model was found to be relatively satisfactory (χ2=114.82, Nomed χ2(χ2/df)=2.44, SRMR=.06, GFI=.94, AGFI=.89, CFI=.95, TLI=.91, RMSEA=.07). End-of-life care performance was affected by the attitudes toward nursing care of the dying, working unit, and death anxiety. The attitudes toward such care had the highest effect on end-of-life care performance.
Conclusion : The results suggest that end-of-life care performance is directly and indirectly affected by attitudes toward nursing care of the dying, participation in end-of-life care education, working unit, death perception, and death anxiety. To improve clinical nurses’ end-of-life care performance, effective programs to promote death anxiety and attitudes toward nursing care of the dying need to be developed. In addition, hospital nursing organizations should attempt to produce concrete measures for death anxiety and terminal care attitudes in clinical nurses.

Purpose: : The 2020 Dietary Guidelines Advisory Committee specifically noted that meal frequency is associated with risks for cardiovascular disease, type 2 diabetes, and all-cause mortality, although the current evidence on meal frequency is conflicting. As meal frequency itself is affected by various factors, the aim of the study was not only to examine its relationships with cardiometabolic risk but also to identify the mediating effects of dietary quality. Methods: : This study used a descriptive correlational design. In all 8,141 healthy adults participated in the study. Measurements included meal frequency, cardiometabolic risk, and diet quality. Data were analyzed using descriptive statistics, Pearson’s correlation coefficient analysis, and process macro bootstrapping model 4. Results: : The meal frequency was 3.52±0.61 times per day, the risk of cardiovascular metabolic diseases was 0.01±0.61 points, and the diet quality was 62.08±13.87 points. In mediation analysis, the effect of meal frequency on cardiometabolic risk score was completely mediated by diet quality. Conclusion : Improved diet quality in healthy adults should be considered when designing meal frequency interventions aimed at reducing their cardiometabolic risk, as the effect of meal frequency support on cardiometabolic risk was found to be mediated by diet quality.

Purpose: : Developing infection control capabilities during the COVID-19 pandemic was critical. This study aimed to develop a simulation program to control patients with COVID-19 in nursing students and examine the effects on COVID-19 knowledge, COVID-19 nursing intention, self-efficacy learning, and clinical performance. Methods: : The study used nonequivalent control group pretest-posttest design. Sixty nursing students were recruited from two different colleges using purposive sampling. For the intervention group(n=30), the pretest was administered before the simulation program, involving six sessions of online lectures and simulation practices. Immediately, the posttest was conducted following the program. Results: : COVID-19 knowledge (t=9.87, p ＜.001), COVID-19 nursing intention (t=4.45, p ＜.001), learning self-efficacy (t=6.49, p ＜.001), and clinical performance (t=6.77, p ＜.001) increased significantly after the program, revealing the positive effect of the COVID-19 infection control simulation program in nursing students. Conclusion : The results of the study and the curriculum may be used as practical evidence for COVID-19 infection control in nursing schools and medical institutions.

Purpose: : This retrospective mixed-methods study aimed to explore key considerations for designing effective simulated education in nursing, focusing specifically on the recognition and response to deteriorating patients. Methods: : Quantitative and qualitative data were analyzed to assess the clinical judgment and performance of the nursing students. Descriptive statistics were used to analyze quantitative data related to prior knowledge, simulation satisfaction, clinical judgment, and nursing performance during deteriorating patient simulations. Qualitative content analysis was conducted for the reflective journal entries of the participants. Results: : Quantitative analysis showed that most participants demonstrated a “being skillful” level of clinical judgment (33.1%) in effective response. At the beginner level, clinical judgment varied across effective noticing(39.7-82.8%), effective interpretating(77.6-82.8%), effective responding(3.4-86.2%), and effective reflecting(90.0-95.4%). Nursing performance in assessing patient respiration or SpO2 after request from a physician ranged from 46.6-48.3%. Qualitative analysis indicated that 48.5% of the participants anticipated a deteriorating condition and initiated appropriate actions, while 70% noticed patient unresponsiveness for the first time. Conclusion : To design an effective simulation program for identifying and addressing deteriorating patient care, a framework for observation and interpretation is essential, along with regular simulated training. It is important to design and assess simulation programs and to conduct thorough interviews with nursing students to gain insight into their clinical decision-making.

Purpose: : This study aimed to investigate the characteristics and risk factors associated with pressure injuries related to medical devices among patients admitted to the intensive care unit (ICU).Method : A retrospective study analyzed data from 462 ICU patients. Statistical analyses, including independent t-tests, Fisher’s exact tests, and logistic regression were performed to analyze the data. Results: : Among the 154 subjects, there were a total of 198 medical device–related pressure injuries (MDRPI). Stage 2 and deep tissue pressure injuries were the most frequent. MDRPI occurred most frequently on the face, with nasogastric tubes being its leading cause, followed by endotracheal tubes. The risk factors for MDRPI included male sex (odds ratio [OR]=1.78, 95% confidence interval [CI]=1.12-2.83), department at the time of ICU admission (OR=4.29, 95% CI=2.01-9.15), post-surgery ICU admission (OR=0.43, 95% CI=0.25-0.73), application of extracorporeal membrane oxygenation machines (OR=2.72, 95% CI=1.06-6.95), number of medical devices (OR=1.16, 95% CI=1.05-1.30), inotropic drug administration (OR=2.33, 95% CI=1.19-4.60), and sedative use (OR=2.53, 95% CI=1.17-5.45). Conclusion : These results enable the determination of the characteristics and risk factors associated with MDRPI. It is crucial to acknowledge the risk factors for MDRPI in ICU patients and establish a prevention strategy.