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Depressive symptoms among adolescents are a major concern for increased risk of adverse health condition outcomes later in life. Specifically, previous studies have reported that multicultural adolescents experience more depressive symptoms than non-multicultural ones. Using the Korean Children and Youth Panel Survey, this study examined the relationships between ego-resilience, social support, and depression among multicultural adolescents in South Korea, as well as the moderating effect of social support on the association between ego-resilience and depression.A total of 1500 multicultural adolescents were included in the analyses, where generalized estimating equation models were employed.Depression scores increased slightly from 2012 to 2015. Higher levels of ego-resilience, family support, and friend support were associated with lower levels of depression, while teacher support was not a significant predictor. The moderating effect of friends and family support on the association between ego-resilience and depression was not statistically significant.To reduce the level of depression among multicultural adolescents, future research should develop interventions that enhance ego-resilience ability, as well as necessary social systems that strengthen family and friend support.Supportive interventions, such as enhancing ego-resilience to reduce depression should be provided to multicultural adolescents. It is recommended to include family and friends to develop effective intervention programs for multicultural adolescents who are suffering from depression.

This study aimed to determine the effect of overtime on alertness at work among rotating-shift nurses in South Korea and to investigate whether these effects of overtime vary across the different types of shifts.Nurse overtime is prevalent in healthcare settings to manage nursing shortages and staffing needs; however, it negatively affects patient and nurse outcomes. Furthermore, little attention has been paid to the effects of previous overtime shifts and overtime for consecutive shifts on alertness during work.A prospective observational study was employed. The study followed STROBE checklist for observational studies.Data were collected between June 2019 and February 2020 from 82 nurses who worked in acute care hospitals. An ecological momentary assessment was used to capture real-time data of overtime and alertness. Alertness scores were estimated using the sleep/wake data measured by an actigraph. Mixed-effect models were employed to investigate the association between overtime and alertness.A majority of the shift nurses worked overtime. Episodes of a decline in alertness scores to the level of increased accident or serious error risk (alertness score ≤80) were most frequently seen during night shifts (98.9%), followed by day (59.8%) and evening shifts (10.1%). Previous-day overtime hours and consecutive overtime days were associated with decreased alertness scores during work. A significantly positive correlation was observed between alertness scores ≤80 and previous-day overtime hours and consecutive overtime days in all shifts.The study findings indicate that a majority of nurses who work overtime experience decreased alertness while on duty.Policy development at the government, organisational and unit level is needed to guarantee adequate rest for shift nurses by adjusting work schedules and assignments and limiting overtime.

To systematically review the existing literature reporting symptoms in childhood and adolescent and young adult cancer survivors and to meta-analyse the pooled prevalence of symptoms.Cancer survivors experience various symptoms caused by cancer treatments and their late effects. These symptoms are associated with adverse health outcomes. However, estimates of symptom prevalence vary largely, and no comprehensive review of symptoms has been conducted for childhood and adolescent and young adult cancer survivors.A systematic review.This systematic review is registered in PROSPERO registry and was performed following the PRISMA guidelines. PubMed, EMBASE, Cochrane Library, Web of Science, Scopus and CINAHL were searched up to July 2021. Three investigators assessed the eligibility of studies, extracted data and performed quality assessment. The pooled prevalence of symptoms was calculated using a random-effect model. Subgroup analysis was conducted to identify heterogeneity.Sixty-one studies were used to synthesise symptom prevalence, involving 114,184 participants. There were 24 physical symptoms and 10 psychological symptoms reported in two or more studies. The most studied physical symptoms were fatigue and sleep disturbance, and the most studied psychological symptoms were anxiety and depression. Among physical symptoms, drowsiness had the highest prevalence, followed by dry mouth and fatigue. Among psychological symptoms, worry and nervousness had the highest prevalence, followed by difficulty concentrating.Physical and psychological symptoms are common in the target population. This review provides an up-to-date overview of symptom prevalence, identifying areas for future research.Education about possible symptoms related to cancer and its treatment should be given while in treatment. Symptoms should also be monitored throughout the survivorship period. Nurses have a critical role in identifying and making referrals for psychological symptoms as well as promoting preventative strategies that enhance well-being.

Aims To determine the effects of sleep parameters and fatigue on the decline in alertness of nurses across shifts. Background Shift work can lead to nurse fatigue owing to insufficient sleep and inadequate recovery time between shifts. Nurse fatigue has adverse effects on alertness and can affect provision of quality care. Methods An observational study using wrist actigraphs was conducted from 2019-2020. Participants were 82 rotating-shift nurses who provided direct nursing care in acute hospitals in South Korea. They wore actigraphs for 14 days to measure sleep parameters and predict hourly alertness and reported subjective fatigue before and after every shift. Results Nurses demonstrated shorter sleep hours, lower sleep efficiency, and longer sleep latency before night shifts compared to other shifts. Fatigue was the highest before day shifts. Sleep parameters and fatigue significantly affected the steep decline in alertness in participants with alertness scores below 70. Conclusions Sleep parameters and fatigue level contributed to the differences in decline in alertness across shifts. Implication for nursing management Findings inform nurse managers, administrators, and intervention development to reduce fatigue, improve sleep quantity and quality, and increase alertness among rotating-shift nurses. Management, institutional, and individual factors should be considered when developing interventions.

AIMS The study aimed to review the evidence about existing digital interventions for childhood cancer survivors and examine their effectiveness on health outcomes. DESIGN Systematic review and meta-analysis. DATA SOURCES PUBMED, EMBASE, Cochrane, CINAHL, Web of Science, PsycArticles, SCOPUS and PQDT Global databases were searched, and the date last searched was 16 September 2019. REVIEW METHODS This systematic review followed PRISMA guidelines. Randomized and nonrandomized controlled trials, as well as before-and-after studies, were included. The main outcomes were health-related quality of life and moderate-to-vigorous physical activity. Two authors independently reviewed included studies and assessed methodological quality. Meta-analysis was conducted using statistical software STATA 16.0. RESULTS Out of the eight eligible studies, four were included in the meta-analysis. The digital self-management interventions were not effective on health-related quality of life and moderate-to-vigorous physical activity. Additionally, the digital self-management interventions increased the moderate-to-vigorous physical activity over time but was not statistically significant. CONCLUSIONS There is insufficient evidence on the effectiveness of digital self-management interventions in improving health outcomes among childhood cancer survivors. Future randomized controlled trials should be conducted from multiple locations and should include objective measures and means to encourage interaction with health care providers. IMPACT Digital interventions are increasingly implemented to improve health outcomes among childhood cancer survivors, but their results are inconsistent. Well-designed digital interventions may be beneficial for this population over time. The recommendations proposed in the current review may be useful for developing digital interventions and designing related studies in the future, thereby reducing late effects and improving healthy behaviours among this population.

This study aimed to estimate the overall presenteeism prevalence in the nursing workforce.Nurses are more prone to presenteeism, which is associated with adverse outcomes for both nurses and patients. However, comprehensive information on the global prevalence of presenteeism in nursing workforce is lacking.Seven databases were systematically searched without year or language restrictions in July 2021. Studies that reported the prevalence rate of presenteeism among nurses were included. A meta-analysis was performed using a random-effects model.A total of 28 studies from 14 countries were included. The overall pooled estimate of presenteeism prevalence among nursing workforce was 49.2% (95% CI: 0.411, 0.574). Subgroup analyses showed that the prevalence of presenteeism was higher when the reporting time frame was1 month and1 year compared with ≤1 month or ≥1 year.The results of this meta-analysis showed the substantial prevalence of presenteeism in the nursing workforce with variations across different reporting time frames.The findings can be used to support nurse managers, administrators and policymakers in recognizing the prevalence of presenteeism and developing relevant prevention strategies against presenteeism among global nursing workforce.

Purpose: The purpose of this study was to describe the profile of graduates from accelerated second-degree Bachelor of Science in Nursing programs and to analyze the relative efficiency of nursing colleges using data envelopment analysis.Methods: An online survey link was emailed to the deans of nursing colleges, who were then asked to send the link to graduates of the respective colleges. The survey questionnaire included demographics, reasons for applying to the accelerated second-degree Bachelor of Science in Nursing program, employment after graduation, and nursing career satisfaction.Results: Sixty-two graduates of the accelerated second-degree Bachelor of Science in Nursing program responded to the survey. The mean age at admission was 24.28 (± 3.01) years. Reasons for applying to the accelerated second-degree Bachelor of Science in Nursing program were primarily increasing job security and using it as a stepping stone to another career. Nursing career job satisfaction was 4.81 (± 1.07) and more than 82% recommended this program. The data envelopment analysis found the average efficiency score to be 0.84 (± 0.20) and 4 nursing colleges to be relatively efficient.Conclusion: The accelerated second-degree Bachelor of Science in Nursing program can be considered to be an effective means to produce quality nurses with non-nursing bachelor degrees in a short time; however, outcomes of this program need to be systematically monitored to maintain quality level. Through this, competent nurses with knowledge of adjacent studies will be added to the nursing workforce.

Purpose This study aimed to examine the effects of work environments and occupational fatigue on care left undone in rotating shift nurses, and to identify the indirect (mediation) effect of work environments on care left undone through nurses' occupational fatigue in South Korean acute care hospitals. Design This study employed a cross-sectional design using an online survey to collect data from 488 rotating shift nurses of acute care hospitals in Korea between November and December 2018. Methods A mobile schedule management application for shift nurses was used to advertise the study and to send a link to the online survey. The survey included questions on the nurses' work environment characteristics, care left undone activities, and the Korean version of the Occupational Fatigue Exhaustion/Recovery scale. Poisson regression was used to explore the relationships among work environments, occupational fatigue, and care left undone. Hayes' Model 4 and a bootstrapping analysis were used to identify the mediating effect of occupational fatigue on the relationship between work environments and care left undone. Findings The average number of tasks left undone was 3.45 (SD = 2.19). The higher the acute and chronic fatigue levels noted among nurses, the higher were the occurrences of care left undone. Conversely, the higher the intershift recovery level, the lower were the occurrences of care left undone. The results showed a positive relationship between care left undone and overtime hours and the number of patients per nurse. Moreover, nurses' occupational fatigue mediated the relationship between work environments and care left undone. Night shifts per month and the number of consecutive days off had an indirect effect on care left undone through occupational fatigue. Conclusions High levels of occupational fatigue and poor intershift recovery among nurses can lead to care left undone. Nurses' occupational fatigue mediates the effect of work environment on care left undone. Clinical relevance It is crucial for healthcare administrators and leaders to develop policies and mandatory regulations to facilitate better working conditions for nurses, consequently reducing their occupational fatigue and decreasing the occurrence of care left undone in acute care hospitals.

Objectives This study utilized the method of medical record review to determine characteristics of adverse events that occurred in the inpatient units of hospitals in Korea as well as the variations in adverse events between institutions. Design A two-stage retrospective medical record review was conducted. The first stage was a nurse review, where two nurses reviewed medical records of discharged patients to determine if screening criteria had been met. In the second stage, two physicians independently reviewed medical records of patients identified in the first stage, to determine whether an adverse event had occurred. Setting Inpatient units of six hospitals. Participants Medical records of 2 596 patients randomly selected were reviewed in the first stage review. Intervention(s) N/A. Main Outcome Measure(s) Adverse events. Results A total of 277 patients (10.7%) were confirmed to have had one or more adverse event(s), and a total of 336 adverse events were identified. Physician reviewers agreed about whether an adverse event had occurred for 141 patients (5.4%). The incidence rate of adverse events was at least 1.3% and a maximum of 19.4% for each hospital. Most preventability scores were less than four points (non-preventable), and there were large variations between reviewers and institutions. Conclusions Given the level of variation in the identified adverse events, further studies that include more medical institutions in their investigations are needed, and a third-party committee should be involved to address the reliability issues regarding the occurrence and characteristics of the adverse events.

Sleep disturbance is prevalent in caregivers and associated with negative physical, mental, and functional outcomes. This study examined the effects of sleep disturbance on daytime functions (sleepiness, fatigue, mood, cognitive alertness), care-related quality of life, and daily parenting interactions in 20 mothers of children with autism spectrum disorder for 10 consecutive days using ecological momentary assessment design. Participants responded about daytime functions four times and care-related quality of life and daily parenting interactions once using an online survey. Sleep disturbance was significantly related to all daytime functions and frustration with childcare. Therefore, development of sleep hygiene interventions is warranted to effectively reduce the impact of sleep disturbance and enable these mothers to better tackle daily physical and mental challenges.

To identify patterns of declining alertness at work among fixed night shift nurses using an objective measure and to determine the effect of sleep parameters on the decline in alertness at work.A prospective observational study.Data were collected from 65 fixed night shift nurses who provided direct nursing care for patients in Korean hospitals between September 2020 and March 2021. Participants wore an actigraph for 14 days on their non-dominant hand to measure sleep parameters and predict their hourly alertness scores. They completed an online survey to provide their demographic information. Mixed-effect models were employed to determine the association between sleep parameters and the decline in alertness.The alertness scores of fixed night shift nurses constantly dropped every working hour. Scores dropped below 20% after 4 h from the beginning of the shift and below 30% after 6 h. Increased minutes in bed, minutes asleep and sleep efficiency reduced the risk of decreased alertness scores below 70. Increased sleep latency was associated with an increased risk of alertness scores dropping below 70.The alertness of fixed night shift nurses drops steeply during regular hours and remains low during overtime. Sleep parameters contribute to the decline in alertness at work among fixed night shift nurses.This study identified patterns of decline in alertness among fixed night shift nurses and the contributing factors for this decline, using an objective measure. The findings have important implications for the development of future interventions to improve the sleep hygiene of fixed night shift nurses to enhance their alertness at work.

To examine the predictive ability of the frailty index in estimating gender-specific mortality in a population of Korean adults.A descriptive and prospective longitudinal design.Data were used from the Korean Longitudinal Study of Aging conducted from 2006 through 2018. A total of 10,254 adults aged 45-98 years at baseline were included. A 41-item deficit accumulation frailty index was measured, based on multi-domain assessment such as self-rating of health, physical condition, mental status, cognitive function, activities of daily living, instrumental activities of daily living and chronic conditions. We categorized the frailty index into robust (≤0.10), prefrail (0.10-0.25) and frail (≥0.25). Cox's proportional hazards regression analysis was employed to determine the association between the frailty index and all-cause mortality.A total of 4705 individuals (45.9%) were categorized as robust, 4178 (40.7%) as prefrail and 1371 (13.4%) as frail. The frailty index increased with age, and females were found to have a higher frailty index than males. The survival probabilities were significantly lower in older adults (aged ≥65) compared with adults and significantly lower in males compared with females. Compared with the robust group, the risk of mortality in the prefrail and frail groups was 1.37 and 2.57 times higher, respectively. The association between frailty status and all-cause mortality was similar in adults and older adults, while the hazard ratios were higher in frail group of males than that of females.The frailty index had a predictive ability for all-cause mortality with respect to age and sex.Using a frailty index among community-dwelling adults could be beneficial to support healthcare providers in early detection of individuals with frailty and facilitate the development of more effective interventions for reducing mortality.

PURPOSE The aim of this study was to identify the patterns of the decline in the alertness of rotating-shift nurses during working hours across different shift types (day, evening, and night) using an objective measure. DESIGN An observational study using ReadiBand wrist actigraphs was conducted. METHODS Data were collected from June 2019 to February 2020. Participants were rotating-shift nurses (N = 82) who provided direct nursing care for patients in acute care hospitals in South Korea. Nurses wore actigraphs continuously for 14 days on their non-dominant hand to identify sleep-wake cycles and predict their alertness scores hourly. All participants completed a sleep diary. FINDINGS Nurses working during night shifts had lower average alertness scores (mean = 77.12) than nurses working during day (mean = 79.05) and evening (mean = 91.21). Overall, alertness showed a declining trend and the specific patterns of decline differed across shifts. Participants with alertness scores less than 70 or 80 demonstrated a significant decline in alertness across all shifts. CONCLUSIONS Distinct patterns of decline in alertness per nursing shift were revealed. Each shift feature should be considered when developing interventions to increase nurses' alertness, promote high-quality care provision, and ensure patient safety. CLINICAL RELEVANCE The implementation of interventions to increase alertness among shift nurses is needed at the organizational level, and the cooperation of nursing managers and administrators is required.

Aims To determine the effects of work schedule characteristics on occupational fatigue and recovery among rotating-shift nurses in South Korea. Background Understanding the effects of work schedule characteristics on occupational fatigue is important to prevent adverse nurse outcomes and to ensure patient safety. Methods This study used secondary data analysis with a cross-sectional design. Data were collected on 436 rotating-shift nurses in 2018. Nurses' occupational fatigue and recovery were measured using the Occupational Fatigue Exhaustion/Recovery Scale. We used quantile regression models. Results The scores for acute and chronic fatigue and intershift recovery were 70.40, 73.39, and 29.82, respectively. Overtime hours, number of night shifts, number of consecutive days off, and breaks were significant influential factors in some quantiles of acute fatigue, chronic fatigue, and intershift recovery, while total working hours was only associated with chronic fatigue in the 25th quantile. Conclusions The quantile and linear regression models revealed different results for work schedule factors that affect occupational fatigue and intershift recovery among rotating-shift nurses. Implication for nursing management These findings have important implications for developing targeted strategies and policies to reduce occupational fatigue and improve intershift recovery for rotating-shift nurses with different levels of occupational fatigue and recovery.

Long-term childhood cancer survivors (CCS) may experience physical, social, and emotional struggles posttreatment. Our aim was to explore the experiences of CCS dealing with the late effects of cancer treatment from their own perspectives. This study employed a qualitative descriptive design to explore and describe the experience of dealing with late effects among CCS. Semi-structured interviews were conducted with 15 CCS in Korea. Participants were selected by purposive and snowball sampling and individually interviewed during the period from September to November 2020. Conventional content analysis was used to analyze data and identify themes. Two main themes and seven subthemes emerged. The two main themes were: “Things I encountered while crossing a bridge” and “Living as a survivor”. The participants reported both positive and negative experiences with dealing with the late effects of cancer treatment. The main themes indicated that late effects exert significant impacts on the lives of CCS in both positive and negative ways. Healthcare providers and researchers should pay attention to early intervention needs of CCS and their support systems to strengthen their positive experiences in dealing with late effects during their survivorships.

Purpose The purpose of this study was to investigate partnerships with nurses, social support and readiness for discharge among mothers of premature infants in the neonatal intensive care unit (NICU) and to examine the factors associated with readiness for discharge. Methods A survey was conducted among 85 mothers of premature infants hospitalized in a NICU in Seoul, Korea. The collected data were analyzed with descriptive statistics, the t-test, one-way analysis of variance, Pearson’ correlation coefficients, and multiple linear regression using SPSS version 25.0. Results The results of the regression analysis showed that partnerships with nurses (β=.32, p=.011) and parenting experience (β=.32, p=.001) were significantly associated with readiness for discharge. Conclusion To improve the readiness for discharge among mothers of premature infants, developing strategies to strengthen their partnership with nurses and to provide family-centered care will be needed.

Aims To examine the relationship between breaks and patient safety in Korean hospitals and determine the mediating effect of missed nursing care on this relationship. Background Breaks during working hours can affect patient safety; however, few studies have examined the relationship between breaks and patient safety in hospitals and their findings were conflicting. Methods A cross-sectional online survey was conducted with 399 nurses in Korean hospitals. Multiple linear regression was used to explore the association between breaks, missed nursing care and patient safety. Model 4 of Hayes's (2018) and bootstrapping analysis were employed to identify the mediating effect of missed nursing care. Results Average break time per shift was about 15 min; most participants had breaks of less than 30 min. Missed nursing care was a complete mediator of the relationship between breaks and patient safety. Conclusion Break length has an indirect effect on patient safety, medication errors and falls with injury through missed nursing care. Implications for nursing management More discussion is needed to develop policy and mandatory regulations to ensure sufficient breaks and adequate nurse staffing to reduce missed nursing care and enhance patient safety.

Most nurses in Korea work rotating shifts, an important contributor to fatigue. The Occupational Fatigue Exhaustion Recovery (OFER) Scale assesses work-related fatigue among nurses. In this study, we aimed to translate and culturally adapt the Korean version of this scale (OFER-K) with nurses working rotating shifts in Korea. Instrument adaptation was performed using committee-based translation, cognitive interviewing, and expert panel interviewing. Criterion validity, convergent validity, construct validity, internal consistency, and test-retest reliability were examined as psychometric properties of the OFER-K. An online survey was completed by 331 nurses; 107 of these nurses completed a second survey after 1 month to assess test-retest reliability. The overall Cronbach's alpha was 0.88. The correlation between participants' initial and retest responses for the total scale was 0.64 (p < .001). The chronic fatigue subscale was stable over time, t(106) = -1.76, p = .08. Criterion and convergent validity were supported by correlations between the OFER-K scale and the Chalder Fatigue Questionnaire, Epworth Sleepiness Scale, and Pittsburgh Sleep Quality Index. Confirmatory factor analysis showed a good fit using a three-factor model. The findings of this study showed that the OFER-K scale is a reliable and valid instrument for assessing chronic fatigue, acute fatigue, and inter-shift recovery in Korean nurses. Future research using this scale may lead to a better understanding of the antecedents and consequences of nurse fatigue and could provide important information to nurse researchers, administrators, and policymakers for developing interventions to reduce nurse fatigue.

Background Few studies have evaluated technical efficiency of nursing care, and no such studies have been conducted in intensive care units (ICUs). Purpose To explore relative technical efficiency of US ICUs and identify organizational factors associated with efficiency in providing quality of nursing care. Methods A total of 404 adult ICUs from the 2014 National Database of Nursing Quality Indicators were included. Data envelopment analysis was used to estimate technical efficiency, and multilevel modeling was employed to determine effects of organizational factors on efficiency. Results Nurse-to-patient ratio showed the strongest positive correlation with technical efficiency. Units in non-Magnet and small-size hospitals had higher technical efficiency than those in Magnet and medium- or large-size hospitals. Conclusions A higher nurse-to-patient ratio greatly improved technical efficiency of nursing care in ICUs and the effect differed between hospitals. Administrators and policy makers can translate the study findings into management strategies to provide efficient nursing care in ICUs.

Purpose: The aim of the study is to evaluate the current and prospective status of nursing in Korea and develop a strategic framework and plan to accommodate the increased demands on nurses in the changing health-care system. Methods: This study used a mixed-methods approach including a literature review, an online survey with health-care consumers, expert panel interviews, and an analysis of strengths, weaknesses, opportunities, and threats to develop the strategic plans and framework. Results: The vision of the strategic framework involved improving health and quality of life, and its mission was to elevate the status of Korea's nursing sector as a key health-care profession through high-quality and innovative nursing education, research, and practice. The five values in accordance with the mission and vision were innovation, creation, collaboration, excellence, and authenticity. Three strategic goals, namely, education, research, and practice, were identified, and 31 related strategic tasks were developed. Conclusion: In response to the rising social demand for a paradigm shift in nursing care services, there is a need for advancements in nursing education, research, and practice in Korea. This study provide some recommendations to achieve these aims. Keywords: education, nursing, health policy, nurse's role, research

Gender differences in alcohol use have narrowed over the decades. This study aimed to explore changes in alcohol consumption patterns between 2007 and 2016 to identify gender convergence in alcohol use in Korea. Data from the Korea National Health and Nutrition Examination Survey were used. For all respondents (41,662 girls/women and 32,041 boys/men) aged &ge, 12 years, lifetime drinking, current drinking, age of drinking onset, heavy alcohol use, and binge drinking were analyzed. Gender differences in heavy alcohol use and binge drinking decreased from 2007 to 2016 (p = 0.001 and p &lt, 0.001, respectively). The prevalence of heavy alcohol use and binge drinking decreased in boys/men (67.5% to 63.9%, p = 0.001, 63.4% to 60.9%, p = 0.001, respectively), but not in girls/women (50.2% to 50.4%, p = 0.279, 30.6% to 32.0%, p = 0.994, respectively). The proportion of lifetime abstainers decreased among both girls/women (24.3% to 19.1%, p &lt, 0.001) and boys/men (12.1% to 9.7%, p = 0.01). In girls/women, the mean age of drinking onset decreased (from 24.1 to 23.6 years, p = 0.017), however, in boys/men, significant changes were not observed (from 18.9 to 18.7 years, p = 0.307). Healthcare providers should be aware of the growing health risks resulting from increased unhealthy alcohol use in women and develop gender-specific preventive interventions.

OBJECTIVE To identify the occurrence of late symptom effects among childhood cancer survivors (CCS), generate subgroups using a latent class analysis and determine whether the subgroups differ in demographic and health-related characteristics and health-promoting lifestyle. METHODS A cross-sectional survey was conducted on 130 adult CCS in Korea. The Memorial Symptom Assessment Scale was used to perform a latent class analysis based on symptom occurrence to generate subgroups. RESULTS Difficulty in concentration, lack of energy, worrying, drowsiness, irritability, pain, difficulty in sleeping, nervousness, sadness and dry mouth appeared in more than 50% of the CCS. The three symptom subgroups identified were "all high" (46.2%), "high physical moderate psych" (26.9%) and "moderate physical low psych" (26.9%). The percentage of non-smokers was the highest in the moderate physical low psych subgroup (85.7%; p = .009), and the percentage of heavy alcohol consumption was the highest in the high physical moderate psych subgroup (31.4%; p = .013). Spiritual growth scores and interpersonal relationship scores were statistically different between subgroups (F = 3.35, p = .038; F = 7.55, p = .001 respectively). CONCLUSION The results could guide the development of intervention programmes to strengthen spiritual growth and interpersonal relationships and facilitate further examination of the causal relationship between smoking and drinking and late symptoms of CCS.

Background: An 8-hour shift system with faster rotation (e.g., shift changes every 2 to 5 days) is common for nurses at acute hospitals in Korea. However, there is a lack of information regarding nurses’ perceptions and experiences of rotating shift schedules, as well as the ways in which rotating-shift work affects patient outcomes. This study aimed to identify and describe emergent themes and offer new insights into nurses’ perceptions and experiences of rotating-shift work in Korea. Moreover, it explored the relationship between rotating-shift work and nurse and patient outcomes.Methods: A qualitative descriptive design was employed. Focus group interviews were conducted with 24 rotating-shift nurses at Korean acute care hospitals. Qualitative data were collected between January and February 2019, and conventional content analysis was employed. Results: Three themes and eight subthemes emerged. Major themes were unsatisfactory work schedules, the impact of shift work on nurses' lives, and the impact of schedule-related fatigue on overall work performance.Conclusion: Study findings highlight the importance of optimal scheduling, to reduce fatigue among rotating-shift nurses. Managers and administrators may improve nurse performance and patient safety by reviewing scheduling practices, considering the potential impact of shift schedules on nurse and patient outcomes, and addressing nurse’s scheduling issues. Furthermore, hospital authorities should consider revising schedules to include sufficient breaks between shifts. This study addressed issues that stem from rotating shift work, affecting both nurses and patients. Nurse interviews clarified these issues, which were classified according to theme. This study aimed to find practical solutions for shift planning problems, particularly in Korea, and to inform the development of scheduling guidelines for rotating-shift work in the future.

Objectives To systematically summarize research employing serious games in nurse education, to examine their effectiveness, to provide recommendations and implementation strategies, and to suggest future directions for the development and application of serious games in nurse education. Design A systematic review. Data sources An online search of the CINAHL, Medline, PubMed, EMBASE, PsycINFO, SCOPUS, and Web of Science databases, and a manual search of the reference lists of selected studies or review articles published in English and Korean between 1990 and July 2020. Review methods. This systematic review was conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. Articles that employed a serious game approach in nurse education were included. Two authors independently screened and reviewed the articles and assessed the methodological quality using the Cochrane risk-of-bias tools. Results A total of seven studies met the inclusion criteria: three randomized controlled trials and four quasi-experimental studies. Heterogeneity was found across all studies regarding the application of serious games, platforms, and gamification elements. Most of the studies evaluated the effectiveness of serious games using knowledge tests, while two studies evaluated skills performance. Two randomized controlled trials and two one group before and after studies reported that the use of serious games improved nursing students' and nurses' knowledge and performance. Conclusions This systematic review does not provide comprehensive insights into the effectiveness of serious games in nurse education. However, based on the evidence reviewed, we provide suggestions for developing and implementing serious games in nurse education to enhance students' knowledge and performance.

Purpose The aims of this study were to examine relationships among peer victimization, supportive parenting, and depression in South Korean adolescents and the moderating effect of supportive parenting on the peer victimization-depression relationship. Methods Data were drawn from the Korean Children and Youth Panel Survey performed from 2010 to 2016. The first-year middle-school panel collected from the first year of middle school to the first year of university was used, and the final sample size was 1750. Generalized estimating equation models were employed to examine relationships among peer victimization, supportive parenting, and depression. Results About 6% of participants reported the experience of peer victimization at least once during the previous year. Females were more likely to report higher level of depression compared to males. Participants who were from lower family income, reported the past experience of peer victimization, and reported less supportive parenting were more likely to report higher level of depression compare to the counterpart. The moderating effect of supportive parenting on the association between peer victimization and depression was not statistically significant. Conclusions Participants who had experienced of peer victimization and less supportive parenting showed higher levels of depression. The supportive parenting did not have significant moderating effect on the relationship between peer victimization and depression. Practice Implications Future research on adolescent depression should include development of interventions targeting both adolescent students' behaviors and their parents' styles of parenting aimed at the reducing the rate of peer victimization and the level of depression among adolescents in South Korea.

Background The nursing education system has changed with the increased emphasis on patient safety in healthcare settings. Early education in patient safety is crucial to preparing nurses to be competent in patient care. Therefore, providing undergraduate patient safety education courses using an innovative approach is essential to enhancing patient safety and quality in nursing care. Objectives This study aimed to examine the effects of a patient safety course using a flipped classroom approach on patient safety competency among undergraduate nursing students in South Korea. Design A pre- and post-test quasi-experimental design with a non-equivalent control group was adopted. Settings This study was conducted in the college of nursing at a university in Seoul, South Korea. Participants A total of 75 undergraduate nursing students participated. All students enrolled in the patient safety course comprised the experimental group (n = 32); those with similar characteristics to the experimental group (age, gender, and year) but did not take the course comprised the control group (n = 43). Methods A total of 14 sessions (28 h) addressing the topics from the World Health Organization patient safety curriculum guide were delivered using a flipped classroom approach. The teaching methods included online learning and quizzes, case studies, small and large discussions, incident report tasks, and group projects including the development of strategies for patient safety. A survey including a demographic questionnaire and the Patient Safety Competency Self-Evaluation tool was administered at the beginning and end of the fall semester. Results Pre- and post-test results demonstrated a significant increase in students' patient safety competency including attitude, skills, and knowledge. Mean scores of patient safety competency in the experimental group were significantly higher than in the control group. Conclusions The flipped-classroom patient safety course was shown to be effective in improving patient safety competency in terms of attitude, skills, and knowledge among undergraduate nursing students.

Nurses have reported higher rates of sickness presenteeism than other workers, which is particularly problematic because this problem is linked to care quality and patient safety. This secondary data analysis study aimed to identify the prevalence of sickness presenteeism and explore related factors among shift and non-shift nurses using the Fifth Korean Working Conditions Survey. A total of 272 nurses in Korean hospitals were included. The survey included questions on working conditions, health status, and sickness presenteeism. A multivariate logistic regression was used to identify associated factors of sickness presenteeism. Overall, 21.8% of the participants reported experiencing sickness presenteeism, shift nurses experienced more sickness presenteeism than non-shift nurses. Sickness presenteeism was greater in shift nurses who did not have rest breaks during work and in nurses who experienced quick return. Additionally, the odds of sickness presenteeism were approximately four times greater in shift nurses who experienced sleep disturbance and about four times higher in shift nurses who experienced health problems. Among non-shift nurses, the odds of sickness presenteeism were about 15 times greater in those who worked ≥53 h per week. Nurse managers and administrators should prevent sickness presenteeism in hospital nurses to provide quality care and enhance productivity.

Purpose This study aimed to determine the moderating effects of help-seeking attitude and sleep quality on the relationship between depression and missed nursing care among nurses in Korean hospitals. Design This secondary analysis used a cross-sectional survey design. The study data were collected from 263 nurses in two Korean hospitals from 2018 to 2019. Methods The survey consisted of the MISSCARE Survey, Beck Depression Inventory-II, Attitudes Toward Seeking Professional Psychological Help-Short Form, and Pittsburgh Sleep Quality Index. Following the guidelines of Hayes, we used the SPSS PROCESS macro for testing the moderating effects of help-seeking attitude and sleep quality on the relationship between depression and missed nursing care. Findings Of the 263 study participants, 37.6% had mild depression. Depression was positively correlated with negative help-seeking attitude and poor sleep quality. Depression and sleep quality were positively associated with missed nursing care. The moderating effects of help-seeking attitude and poor sleep quality on the relationship between depression and missed nursing care were observed. The slope test revealed that depression with negative help-seeking attitude had a positive effect on missed nursing care. Furthermore, depression with good sleep quality had a positive effect on missed nursing care. Conclusions The findings suggest that efforts to enhance sleep quality and reduce depression by improving help-seeking attitude would be helpful to decrease missed nursing care among hospital nurses. Clinical relevance Nurses' sleep quality, level of depression, and help-seeking behavior is crucial globally in delivering quality nursing care without omission. Healthcare institutions and nursing managers should implement evidence-based strategies to enhance nurses' help-seeking attitude and sleep quality to decrease the risk of depression and missed nursing care.

Nurses deal with ethical decisions as they protect patients&rsquo, rights, but a consensus on effective approaches to nursing ethics education is lacking. The &ldquo, four topics&rdquo, method can facilitate decision-making when nurses experience ethical dilemmas in practice. This study aimed to describe nursing students&rsquo, perspectives on and experiences of a case-centered approach to nursing ethics education using the four topics method. This qualitative study consisted of two phases. First, we delivered case-centered nursing ethics education sessions to nursing students using the four topics method. Then, we conducted two focus group discussions that explored students&rsquo, perspectives on and experiences of nursing ethics education. Data were analyzed using conventional content analysis. Four themes were identified: the importance of ethics education as perceived by nursing students, problems in current nursing ethics education, the experience of case-centered nursing ethics education using the four topics approach, and suggestions for improving nursing ethics education. The case-centered approach using the four topics method is effective in enhancing nursing students&rsquo, nursing ethics ability. It is crucial to understand that nursing students would like to set up their own ethical standards and philosophy. Continuous efforts to encourage students&rsquo, participation and to provide ethical reflection opportunities during clinical practice are needed to better connect theory with clinical practice.

Aim To systematically evaluate the effect of work schedule characteristics on fatigue among shift nurses in hospital settings. Background The complexity and multidimensional nature of nursing work may lead to fatigue. This review mainly focused on work schedule characteristics that may mitigate the fatigue in nurses. Evaluation Six databases were searched, and eight relevant research articles published between 2000 and 2018 were identified. Key issues The reviewed articles provided evidence supporting the association of work schedule characteristics such as total working hours, overtime, shift length and number of monthly night and evening shifts with fatigue. In addition, studies provided evidence for the positive association between insufficient rest period between shifts and fatigue among shift nurses in hospital settings. Conclusion The reviewed studies provided mixed results regarding the associations between work schedule characteristics and nurse fatigue. However, quick returns and days called to work on days off were consistent factors contributing to nurse fatigue. More evidence is needed to arrive at a definitive conclusion about such relationships. Implication for nursing management Nursing managers and administrators need to carefully review current rotating shift system and examine its impact on nurse fatigue as well as ensure enough resting time when developing nurse schedules.

The aim of this study was to examine the effect of nurse staffing on both rehospitalizations and emergency department emergency department visits among short-stay nursing home residents in the United States. Data for 11,132 US nursing homes were drawn from the 2016 Nursing Home Compare. We found that the Five-Star Quality Rating System's staffing rating is a significant predictor for the rates of rehospitalization and emergency department visit among short-stay nursing home residents. The results also showed the importance of registered nurse staffing in nursing home caring for short-stay residents. Administrators and policy-makers can employ the findings to formulate management strategies that will reduce rehospitalizations and emergency department visits among nursing home residents.

This study aimed to evaluate technical efficiency of US intensive care units and determine the effects of environmental factors on technical efficiency in providing quality of nursing care. Data were obtained from the 2014 National Database of Nursing Quality Indicators and the Centers for Medicare and Medicaid Services. Data envelopment analysis was used to estimate technical efficiency for each intensive care unit. Multilevel modeling was used to determine the effects of environmental factors on technical efficiency. Overall, Medicare Advantage penetration and hospital competition in a market did not create pressure for intensive care units to become more efficient by reducing their inputs. However, these 2 environmental factors showed positive influences on technical efficiency in intensive care units with certain levels of technical efficiency. The implications of the study results for management strategies and health policy may vary according to the levels of technical efficiency in intensive care units. Further studies are needed to examine why and how intensive care units with particular levels of technical efficiency are differently affected by certain environmental factors.

Data envelopment analysis (DEA) is an advantageous non-parametric technique for evaluating relative efficiency of performance. This article describes use of DEA to estimate technical efficiency of nursing care and demonstrates the benefits of using multilevel modeling to identify characteristics of efficient facilities in the second stage of analysis. Data were drawn from LTCFocUS.org , a secondary database including nursing home data from the Online Survey Certification and Reporting System and Minimum Data Set. In this example, 2,267 non-hospital-based nursing homes were evaluated. Use of DEA with nurse staffing levels as inputs and quality of care as outputs allowed estimation of the relative technical efficiency of nursing care in these facilities. In the second stage, multilevel modeling was applied to identify organizational factors contributing to technical efficiency. Use of multilevel modeling avoided biased estimation of findings for nested data and provided comprehensive information on differences in technical efficiency among counties and states.

연구목적: 본 연구는 간호사의 임상경력단계에 따른 경력개발제도에 대한 간호사의 인식을 파악하고, 경력개발제도에 대한 인식, 전문직 자아개념과 임파워먼트와의 관계를 파악하여 간호사 경력개발제도의 개선의 근거 마련하고 전문직 자아개념과 임파워먼트의 증대 방안 모색을 통한 인적자원관리에 기여하고자 시도 된 서술적 상관관계 연구이다. 연구방법: 서울시 소재 일 상급종합병원에서 근무하는 중환자실, 수술실, 응급실 간호사 162명을 대상으로 설문지를 이용하여 경력개발제도에 대한 인식, 전문직 자아개념, 임파워먼트를 측정하였다. 수집된 자료는 SPSS WIN 18.0 프로그램을 활용하여 서술적 통계, t-test, ANOVA, Pearson's Correlation Coefficient, Multiple linear Regression을 시행하였다. 연구결과: 간호사의 임상경력단계에 따른 경력개발제도에 대한 인식은 전임 2 간호사가 신입 간호사, 일반 간호사, 전임 1 간호사보다 높은 인식을 가지고 있었다. 경력개발제도에 대한 인식과 전문직 자아개념, 임파워먼트에는 통계적으로 유의한 양의 상관관계가 있었다. 다중회귀분석을 실시한 결과 경력개발제도에 대한 전반적 이해, 경력개발제도에 대한 기대효과, 최종학력, 임상경력단계가 전문직 자아개념의 42% 설명하는 것으로 나타났고, 경력개발제도에 대한 전반적 이해, 전문적 활동 참여에 대한 인식, 경력개발제도에 대한 기대효과, 임상경력단계가 임파워먼트를 42% 설명하였다. 결론: 전문직 자아개념과 임파워먼트에 영향을 미친 변수로 나타난 경력개발제도에 대한 인식을 향상시킬 수 있는 방안을 개발하여 적용을 통한 효과 검증이 요구되며, 간호 관리자들의 제도 운영과 관련된 장애요인의 파악 및 세심한 제도 개선이 필요하다.