Purpose: This study aimed to evaluate the performance of a clinical ladder system in a tertiary hospital by examining how nurses' clinical competence and perceptions of the system affect organizational commitment. Methods: The study involved 394 nurses working at a tertiary hospital. Data were collected from May 3 to July 10, 2023, using a self-reported questionnaire. Statistical analyses, including descriptive statistics, independent t-tests, one-way ANOVA, Kruskal-Wallis test, Scheffé post-hoc test, Pearson correlation, and hierarchical regression analysis, were performed using SPSS 27.0. Results: Nurses who applied for promotion to the CN III level and current CN III nurses reported higher clinical competence, perceptions of the clinical ladder system, and organizational commitment than those who did not and those at lower levels (p<.001). A positive correlation existed among all independent variables.Controlling for general characteristics, the effects of clinical competence and perceptions of the clinical ladder system explained 49% of organizational commitment variance (Adjusted R 2 =.49, F=33.43, p<.001). Conclusion Greater clinical competence and positive perceptions of the clinical ladder system are likely to enhance organizational commitment, emphasizing its effectiveness in fostering better organizational outcomes.

Purpose: This study investigated the effects of a nursing leadership program on self-leadership, interpersonal relationships, clinical performance, problem-solving abilities, and nursing professionalism among nursing students in South Korea. Methods: A quasi-experimental study was conducted. The Practice-Driven Nursing Leadership Program for Students (PDNLP-S) was developed based on the ADDIE model (analysis, design, development, implementation, and evaluation). This quasi-experimental study design included 60 nursing students. The experimental group (n=30) participated in the PDNLP-S for 120-minute sessions over 5 weeks, while the control group (n=30) received usual lectures. The PDNLP-S included lectures, discussions, and individual and group activities to cultivate core nursing leadership competencies such as individual growth, collaboration, nursing excellence, creative problem-solving, and influence. Data were analyzed using descriptive statistics, the Mann-Whitney U-test, and the independent t-test with IBM SPSS Windows ver. 26.0. Results: The experimental group demonstrated significant improvements in self-leadership (t=3.28, p=.001), interpersonal relationships (t=3.07, p=.002), clinical performance (U=268.50, p=.004), and problem-solving abilities (t=2.20, p=.017) compared to the control group. No significant difference was observed in nursing professionalism (t=0.50, p=.311). Conclusion This study demonstrates that the PDNLP-S improved nursing students’ self-leadership, interpersonal relationships, clinical performance, and problem-solving abilities. The PDNLP-S can play a significant role in cultivating future nurse leaders by enhancing these nursing leadership competencies among nursing students.

Purpose: This study aimed to assess the impact of a non-face-to-face diabetes self-management program based on self-efficacy theory and focusing on health literacy. Methods: A quasi-experimental, nonequivalent control group pre–post design was used. Participants from a community health promotion center were included if they (1) were 30–70 years of age, (2) had type 2 diabetes with glycated hemoglobin (HbA1c) ≥6.5%, and (3) had internet access via computers or mobile devices. The 8-week program was developed based on self-efficacy theory, and it included virtual education using an online platform, telephone counseling, videos, and social networking site activities considering health literacy. Fasting blood glucose levels, HbA1c levels, diabetes self-efficacy, social support, depression, and self-management behaviors were assessed. Data were analyzed using the independent t-test, paired t-test, and others. Results: Post-test results showed that the intervention group had significantly lower fasting blood glucose levels and improved diabetes self-efficacy, social support, and self-management behaviors compared with the control group. An analysis of the pre-to-post changes in scores indicated that the intervention group had significantly greater improvements in fasting blood glucose levels, diabetes self-efficacy, and overall diabetes self-management behaviors than those observed in the control group. Conclusion Non-face-to-face programs based on self-efficacy theory that consider health literacy can provide effective diabetes management support to patients when in-person diabetes management at community health centers is challenging.

Purpose: This study aimed to develop a question-answering chatbot that provides accurate and consistent answers to questions that may arise during the recovery process of patients with coronary artery disease after percutaneous coronary intervention, and to evaluate the chatbot. Methods: The chatbot was developed through the stages of analysis, design, implementation, and evaluation. It was evaluated by five experts, and the user experience was evaluated by 27 patients who underwent percutaneous coronary intervention. Furthermore, chatbot utilization was analyzed based on user experience logs. Results: The chatbot was constructed as a question-answering database that included three categories: coronary artery disease, percutaneous coronary intervention, and post-intervention management. The question-answering chatbot, referred to as the “Cardiovascular Strong” channel, has been launched and implemented. An expert evaluation of the chatbot revealed no usability issues or necessary modifications. The overall result of the user experience evaluation was 4.26 points. Based on the user experience log, the question-answer accuracy was 84.6%, and medications during post-intervention management were the most frequently searched topic, accounting for 110 cases (20.8%) out of a total of 528. Conclusion The chatbot that was developed to provide information via real-time answers to questions after the intervention can be easily accessed in clinical settings with no time or space constraints. It also will contribute to providing accurate disease-related information via the familiar KakaoTalk platform.

Purpose: The study aimed to provide essential baseline data for developing measures to enhance the mental well-being of shift-working nurses. Methods: The data were collected from September 11 to 30, 2024, among 151 shift-working nurses at hospitals nationwide. The collected data were analyzed using descriptive statistics, t-tests, ANOVA, Scheffé tests, Pearson's correlation, and hierarchical multiple regression analysis with IBM SPSS Statistics version 30.0. Results: A statistically significant correlation was identified between the primary variables of interest: quality of sleep, health-promoting behaviors, and mental well-being. The findings indicated that poor sleep quality (β=-.32, p<.001) and health-promoting behaviors (β=.55, p<.001) were significant factors affecting the mental well-being of shift-working nurses. The explanatory power of these variables was 56.0%. Conclusion This study findings confirmed that the quality of sleep and health-promoting behaviors are related to the mental well-being of shift-working nurses and simultaneously influence it. In other words, to promote the mental health of shift-working nurses, it is essential for nurse managers to focus on managing sleep quality and for an organizational culture that encourages health-promoting activities to be established.

Purpose: Obesity is a well-established risk factor for dyslipidemia. Normal-weight obesity (NWO) is associated with lipid profile abnormalities. However, research in Korea on the relationship between NWO and dyslipidemia is limited. Therefore, this study evaluated the relationship between obesity types, including NWO, and dyslipidemia, and investigated these relationships by age and sex. Methods: Secondary data analysis was performed using data from the 9th Korea National Health and Nutrition Examination Survey conducted in 2022. In total, 3,805 participants were analyzed using complex sample multiple logistic regression based on body mass index and body fat percentage (BF%). Results: NWO was significantly associated with an increased risk of dyslipidemia relative to normal weight non-obesity (odds ratio: 1.66, 95% confidence interval: 1.34~2.06). Notably, individuals with NWO under the age of 65 and men had a higher risk of dyslipidemia, underscoring the importance of targeted health management in these populations. Conclusion NWO was positively correlated with dyslipidemia. Therefore, the role of clinical nurses in early screening for NWO is of considerable importance, particularly among high-risk populations such as men under the age of 65. To support obesity management and the prevention of dyslipidemia, nursing interventions aimed at reducing BF% by promoting lifestyle modifications and regular monitoring are essential.

Purpose: This study aimed to evaluate the effects of an intervention combining warm therapy (via a thermoelectric-element tourniquet) and a distraction-based approach (via an augmented reality-based app known as TWINKLE) on pain, stress, and satisfaction during intravenous catheterization in adults. Methods: A randomized controlled trial was conducted in South Korea with 93 healthy adults who were randomly assigned to one of three groups: the experimental group (TWINKLE app with warm therapy), the comparison group (warm therapy only), and the control group (no treatment). Participants’ pain, stress, and satisfaction, as well as practitioner satisfaction, were measured after the intervention. Results: Pain scores differed significantly among the three groups (F = 5.68, p = .005), with the experimental group showing significantly lower scores than the control group (p = .003). Stress levels were also significantly lower in the experimental group than in the other groups (F = 9.42, p < .001). Participant satisfaction was highest in the experimental group (F = 17.65, p < .001), while nurse satisfaction was significantly higher in the comparison group than in the experimental and control groups (F = 67.91, p < .001), suggesting that the additional distraction intervention may have increased nurses’ workload. Conclusion Combining digital distraction with warm therapy using a thermoelectric-element tourniquet effectively reduces pain and stress while improving patient satisfaction during intravenous catheterization. Further research is needed to optimize this approach, with a particular focus on targeting digital distraction interventions to patients with higher levels of procedural anxiety and finding ways to minimize practitioner workload.

Purpose: This study aimed to perform a genome characterization of Streptococcus mitis KHUD 011, a strain isolated from the oral microbiome of a healthy Korean individual, and to compare its genomic features with other S. mitis strains. Materials and Methods: The strain was identified through 16S rRNA gene sequencing, and its genome was sequenced using the PacBio Sequel II platform. De novo assembly and annotation were performed, followed by comparative genomic analysis with three additional strains (S. mitis NCTC 12261, S022-V3-A4, and B6). Pan-genome and phylogenetic analyses were conducted to identify strain-specific genes and assess inter-strain genomic diversity. Results: The genome of S. mitis KHUD 011 consisted of 1,782 protein-coding genes, with a G+C content of 40.24%. Pan-genome analysis identified 1,263 core gene clusters (50.0%), 496 dispensable clusters (19.7%), and 763 strain-specific clusters (30.3%). KHUD 011 displayed 88 strain-specific genes, particularly associated with cell wall/membrane biogenesis, transcriptional regulation, and carbohydrate metabolism. Phylogenetic analysis placed KHUD 011 closely with NCTC 12261, forming a distinct cluster apart from other strains. Conclusion The genome characterization of S. mitis KHUD 011 underscores substantial inter-strain genomic diversity influenced by host interactions, ecological niches, and health status. The identified strain-specific genes, particularly those associated with cell wall/ membrane biogenesis, transcriptional regulation, and carbohydrate metabolism, suggest adaptations to the oral microbiome and its interaction with the host. These findings highlight the ecological versatility of S. mitis and the importance of exploring strains from diverse environments to better understand their role within the host and the broader microbiome.

Background: Barriers to treatment with intravenous thrombolysis (IVT) for patients with acute ischemic stroke (AIS) in South Korea remain incompletely characterized. We analyze a nationwide prospective cohort to determine patient-level features associated with delayed presentation and non-treatment of potential IVT-eligible patients. Methods: We identified consecutive patients with AIS from 01/2011 to 08/2023 from a multicenter and prospective acute stroke registry in Korea. Patients were defined as IVT candidates if they presented within 4.5 hours from the last known well, had no lab evidence of coagulopathy, and had National Institute of Health Stroke Scale (NIHSS) ≥ 4. Multivariable generalized linear mixed regression models were used to investigate the associations between their characteristics and the IVT candidates or the use of IVT among the candidates. Results: Among 84,103 AIS patients, 41.0% were female, with a mean age of 69 ± 13 years and presentation NIHSS of 4 [interquartile range, 1–8]. Out of these patients, 13,757 (16.4%) were eligible for IVT, of whom 8,179 (59.5%) received IVT. Female sex (adjusted risk ratio [RR], 0.90; 95% confidence interval [CI], 0.86–0.94) and lower years of education (adjusted RR, 0.90; 95% CI, 0.84–0.97 for 0–3 years, compared to ≥ 13 years) were associated with a decreased likelihood of presenting as eligible for IVT after AIS; meanwhile, young age (adjusted RR, 1.12; 95% CI, 1.01–1.24 for ≤ 44 years, compared to 75–84 years) was associated with an increased likelihood of being an IVT candidate. Among those who were eligible for IVT, only age was significantly associated with the use of IVT (adjusted RR, 1.09; 95% CI, 1.03–1.16 for age 65–74 and adjusted RR, 0.83; 95% CI, 0.76–0.90 for ≥ 85 years, respectively). Conclusion Most patients with AIS present outside IVT eligibility in South Korea, and only 60% of eligible patients were ultimately treated. We identified increased age, female sex and lower education as key features on which to focus interventions for improving IVT utilization.

Background: This study aimed to investigate the size and characteristics of pediatric clinic closure during the coronavirus disease 2019 (COVID-19) period and what career paths pediatricians chose after closure. Methods: This study utilized database of the Health Insurance Review and Assessment Service from 2013 to 2022. We examined the trend of the number of pediatric clinics in operation over the past 10 years. Additionally, the study identified factors associated with the closure of pediatric clinics during the COVID-19 pandemic. Furthermore, the affiliations of representatives who closed their clinics during the pandemic were tracked as of December 2022. Results: In 2019, there were 2,229 pediatric clinics. During the COVID-19 pandemic, 364 (16.3%) of these clinics closed. Factors associated with the closure of pediatric clinics included pediatricians over the age of 65, operational periods of less than 5 years, and lower levels of medical expenses. As of 2022, among the 364 clinics that closed, 108 pediatricians (29.7%) retired or ceased working, and 127 pediatricians (34.9%) still employed in pediatricrelated healthcare institutions. A concerning phenomenon is that the remaining 129 pediatricians (35.4%) transitioned to unrelated healthcare institutions. Conclusion We have identified the magnitude and factors contributing to pediatric clinic closures. A more pressing issue is that over one-third of the pediatricians have transitioned to non-specialty fields following the closure of their clinics. Pediatrics represents a critical and essential medical field. Health authorities must develop strategies to prevent the avoidable collapse and subsequent exodus of pediatricians.