Behavioral and psychological symptoms of dementia (BPSD) and delirium superimposed on dementia (DSD) can lead to severe complications if they are not accurately identified and managed. Effective dementia care therefore requires clear differentiation, systematic assessment, and appropriate nursing interventions. This study aimed to develop VRDementia: BPSD/DSD, a virtual reality simulation program, and to qualitatively examine its validity and usability as a development-based pilot study. Methods: Using the ADDIE model (Analysis, Design, Development, Implementation, Evaluation), the program was systematically developed. During the analysis phase, qualitative interviews and literature reviews identified educational needs among nurses in long-term care hospitals. Key challenges included distinguishing agitation/aggression (BPSD) from hyperactive DSD, and depression (BPSD) from hypoactive DSD. Based on these findings, four case-based scenarios were created. Content validity and usability were qualitatively evaluated through semi-structured interviews with five experienced nurses (≥5 years of clinical experience). Results: The program consists of four sessions addressing agitation/aggression and depression (BPSD), and hyperactivity and hypoactivity (DSD). Nurses practice symptom assessment, therapeutic communication, physician reporting, and nursing interventions. The simulation is accessible via head-mounted display (HMD), mobile devices, and PC (including laptops). Qualitative feedback indicated that participants perceived the program as useful and applicable for dementia care education, including its potential use in interdisciplinary training contexts. Conclusion: VRDementia: BPSD/DSD is a valid, practical educational tool that improves nurses’ competence in distinguishing and managing BPSD and DSD. This program may contribute to higher quality dementia care in clinical settings.

Purpose: Emergency room bouncing has become a critical social issue in South Korea. While the government seeks to address this problem by imposing stricter penalties, healthcare providers remain reluctant to accept high-risk patients. This study aimed to analyze the structural causes of emergency patient refusal using a game-theoretic framework, with a focus on the asymmetry between emergency care regulations and medical malpractice risks. Methods: A non-cooperative game model was developed to analyze strategic interactions between the government and healthcare providers. A minimax approach was used to evaluate the impact of maximum liability (approximately 1 billion Korean won [KRW]) and administrative fines for delays in emergency patient transfer. Specifically, a break-even analysis was conducted to estimate the surgical volume required to offset this liability under a realistic fee schedule. Results: The expected loss from accepting a high-risk emergency patient substantially exceeded the penalty for refusal. Simulations indicated that, even under optimistic revenue assumptions, it would take more than 66 years of accident-free operations for a specialist to offset a single liability of 1 billion KRW. Consequently, refusal remains the rational dominant strategy for providers seeking to avoid professional bankruptcy. Conclusion The primary cause of transfer delays is a structural imbalance characterized by high risk and low returns, in which medical fees do not cover the substantial liabilities imposed by recent judicial rulings. Without state indemnification for accidents caused by force majeure and exemptions from criminal liability, legislative efforts that merely mandate acceptance will accelerate the collapse of the emergency medical infrastructure.

Background and Objectives: This study aimed to analyze the outcomes of Fontan surgery in the Republic of Korea, as there were only a few studies from Asian countries. Methods: The medical records of 1,732 patients who underwent Fontan surgery in 10 cardiac centers were reviewed. Results: Among them, 1,040 (58.8%) were men. The mean age at Fontan surgery was 4.3±4.2 years, and 395 (22.8%) patients presented with heterotaxy syndrome. According to the types of Fontan surgery, 157 patients underwent atriopulmonary (AP) type; 303, lateral tunnel (LT) type; and 1,266, extracardiac conduit (ECC) type. The overall survival rates were 91.7%, 87.1%, and 74.4% at 10, 20, and 30 years, respectively. The risk factors of early mortality were male, heterotaxy syndrome, AP-type Fontan surgery, high mean pulmonary artery pressure (mPAP) in pre-Fontan cardiac catheterization, and early Fontan surgery year. The risk factors of late mortality were heterotaxy syndrome, genetic disorder, significant atrioventricular valve regurgitation (AVVR) before Fontan surgery, high mPAP in pre-Fontan cardiac catheterization, and no fenestration. Conclusions In Asian population with a high incidence of heterotaxy syndrome, the heterotaxy syndrome was identified as the poor prognostic factors for Fontan surgery. The preoperative low mPAP and less AVVR are associated with better early and long-term outcomes of Fontan surgery.

Purpose: This study aimed to determine the impact of work environment, missed nursing care, and non-nursing tasks on the job stress of hospital nurses. Methods: A descriptive, cross-sectional survey of 164 nurses working in three hospitals was conducted. Data were collected using structured questionnaires and analyzed using descriptive statistics, t-test, one-way analysis of variance, Pearson’s correlation coefficient, and multiple regression analysis using SPSS/WIN 26.0. Results: Hospital Nurses' job stress was negatively correlated with the work environment (r=-.37, p<.001). Job stress had a statistically significant positive correlation with non-nursing tasks (r=.34, p<.001);however, it had no significant correlation with missed nursing care (r=.05, p=.552). Regression model analysis revealed that the variables associated with job stress were non-nursing tasks (β=.29, p<.001) and the foundation for quality nursing care (β=-.25, p=.034), which are subdomains of the work environment. In contrast, missed nursing care was not determined to be a significant factor. Conclusion To effectively manage nurses' job stress, nurse managers should provide higher quality care by reducing the number of non-nursing tasks and creating a positive work environment, especially by providing adequate nursing workforce and material support.

Purpose: This study aimed to explore the influence of teamwork and grit on job adaptation and intention to remain among advanced beginner nurses. Methods: A cross-sectional descriptive research design employing a survey method was used. The study involved 203 advanced beginner nurses with 13~36 months of experience working at a tertiary hospital. Collected data were analyzed using descriptive statistics, independent t-tests, one-way ANOVA, Pearson's correlation coefficients, and hierarchical regression analysis. Results: Job adaptation positively correlated with teamwork (r=.58, p<.001) and grit (r=.65, p<.001). Intention to remain was also positively correlated with teamwork (r=.32, p<.001) and grit (r=.59, p<.001). A hierarchical multiple regression model including control variables, teamwork, and grit accounted for 64% of the factors influencing job adaptation. Another hierarchical multiple regression model, incorporating control variables, teamwork, and grit, explained 44% of the factors influencing the intention to remain. Among the related factors, grit emerged as the most influential in regarding job adaption and intention to remain. Conclusion These findings underscore the importance of establishing a support system to bolster grit, enhancing adaptation to the job and fostering intention to remain among advanced beginner nurses.

Purpose: This study aimed to determine the impact of work environment, missed nursing care, and non-nursing tasks on the job stress of hospital nurses. Methods: A descriptive, cross-sectional survey of 164 nurses working in three hospitals was conducted. Data were collected using structured questionnaires and analyzed using descriptive statistics, t-test, one-way analysis of variance, Pearson’s correlation coefficient, and multiple regression analysis using SPSS/WIN 26.0. Results: Hospital Nurses' job stress was negatively correlated with the work environment (r=-.37, p<.001). Job stress had a statistically significant positive correlation with non-nursing tasks (r=.34, p<.001);however, it had no significant correlation with missed nursing care (r=.05, p=.552). Regression model analysis revealed that the variables associated with job stress were non-nursing tasks (β=.29, p<.001) and the foundation for quality nursing care (β=-.25, p=.034), which are subdomains of the work environment. In contrast, missed nursing care was not determined to be a significant factor. Conclusion To effectively manage nurses' job stress, nurse managers should provide higher quality care by reducing the number of non-nursing tasks and creating a positive work environment, especially by providing adequate nursing workforce and material support.