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Volume 17(4); December 2011

Original Articles
PURPOSE
The purpose of this study was to explore the effect of empowerment on nursing performance, job satisfaction, organizational commitment and turnover intention in hospital nurses.
METHODS
The subjects were 345 nurses at a general hospital in D city. Data were collected by structured questionnaire from January 10 to February 15, 2009. Data were analyzed by using descriptive statistics, ANOVA, Scheffe's test, and Pearson correlation coefficient, multiple regression by SPSS win 17.0 program.
RESULTS
The mean scores were 3.60(+/-.43) of empowerment, 3.80(+/-.38) of nursing performance, 3.49(+/-.55) of job satisfaction, 4.70(+/-.74) of organizational commitment, and 2.34(+/-.84) of turnover intention. Empowerment was correlated with nursing performance, job satisfaction, and organizational commitment positively, but correlated with turnover intention negatively. As a result of multiple regression, empowerment has 34.3% of the explanatory power on nursing performance, 24.0% on job satisfaction, 30.7% on organizational commitment, and 15.6% on turnover intention.
CONCLUSION
Empowerment was a critical variable affecting nursing job performance, job satisfaction, organizational commitment, and turnover. Also, if various variable - active and adequate child-care support system, provided conditions continue to study, and adequate and appropriate compensation for nursing performance - affecting empowerment are managed, nurses' empowerment level will rise at the same time.

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The Emergence of the North Texas Korean American Nurses Society and its Contributions to Korean Immigrant Societies in the U.S.
Ho Soon Michelle Cho, Mee Kyung Cho, Kyoung Eun Lee
J Korean Acad Nurs Adm 2011;17(4):402-412.   Published online December 31, 2011
DOI: https://doi.org/10.11111/jkana.2011.17.4.402
PURPOSE
To describe the emergence of the North Texas Korean American Nurses Society (NTKANS) and to examine its sociocultural contributions to Korean immigrant societies in the U.S. for the last half century.
METHODS
The study used retrospective historical analysis to explore the first North Texas Korean immigrant nurses' footsteps. Using Christy's historical research methodology, this study explored themes found in the NTKANS Minutes, the directories, and newspapers, and compared them with historical nursing contexts found in documents, immigrant nurse's pictures, and letters. Interviews with twenty first immigrant Korean nurses, the members, were also used as main data.
RESULTS
Since its emergence in 1969, the NTKANS have contributed to local Korean societies through community medical services, financial supports to local Korean associations, local publications, and opening Korean school. In addition, the society has contributed to the other Korean immigrant nursing societies in the U.S.
CONCLUSION
The sociocultural contributions NTKANS had made to Korean immigrant societies were not possible without its members' enormous efforts, personal struggles, and altruistic dedications. The trials and tribulations these immigrant nurses have overcome and the achievements they made for last half century would greatly inspire students and nurses in Korea who may seek international leadership and scholarship.

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Effects of Perceived Patient Safety Culture on Safety Nursing Activities in the General Hospital Nurse's
Hwa Young Kim, Hye Sook Kim
J Korean Acad Nurs Adm 2011;17(4):413-422.   Published online December 31, 2011
DOI: https://doi.org/10.11111/jkana.2011.17.4.413
PURPOSE
This descriptive correlation study was done to identify how perception of patient safety culture of general hospital nurses affects safety during nursing activities. Data from this study should provide information on management of patient safety as well as improvement in patient safety.
METHOD
Participants in this study were 357 clinical nurses working in a general hospital in M city which had two medical evaluations. A survey was conducted to gather the data.
RESULTS
The score for perception of patient safety culture of the general hospital nurses was 3.42, out of a possible 5 points, and the score for safety care activities was 3.90. There was a statistically significant positive relationship between the nurses' perception of patient safety culture and their safety care activities, Perception of patient safety culture, Supervisor/manager, communication and procedures, and frequency of accident reporting were factors that impacted significantly on safety nursing activity.
CONCLUSION
The results of the study indicate that patient safety cultural perception significantly affects the safety of nursing activities and thus systematic educational strategies to increase perception should be provided to increase the level of patient safety culture. Also, other specific methods that increase the level of patient safety culture should be considered.

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A study on Burnout, Emotional labor, and Self-efficacy in Nurses
Ya Ki Yang
J Korean Acad Nurs Adm 2011;17(4):423-431.   Published online December 31, 2011
DOI: https://doi.org/10.11111/jkana.2011.17.4.423
PURPOSE
This study was conducted to investigate the relationship of burn out, emotional labor and self-efficacy in nurses, and to identify predictors of burnout.
METHOD
The participants were 268 nurses working in C university hospital in G city. Data were collected from May 1 to May 31, 2010, and analyzed using SPSS/WIN 12.0.
RESULTS
The mean score per item for burnout was 3.13, the mean emotional labor score was 3.15, and the mean of self-efficacy score was 3.42. Burnout showed negative correlation with self-efficacy (r=-.339, p=.000), and showed positive correlation with emotional labor (r=.511, p=.000). Variables that predicted burnout were emotional labor, self-efficacy, gender, number of assigned patient per duty (37.8%).
CONCLUSION
The findings of this study indicate a need to develop programs for nurses to increase self-efficacy and to control the emotion, and the need for further studies to examine causal relationship among burn out, emotional labor and self-efficacy.

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PURPOSE
The purpose of this study was to identify the factors influencing the intention of the reuse in patients admitted in university hospital emergency medical center.
METHOD
The participants were 253 patients admitted to a niversity hospital emergency medical center. Data were collected with self-administrated questionnaires and analyzed by hierarchical multiple regression.
RESULTS
Patient satisfaction with nursing care service and switching cost were positively correlated with reuse by patients while the perceived risk was negatively correlated. As levels of satisfaction with nursing care services and switching cost increase, intention of reuse increases. Satisfaction with nursing care service, switching cost and perceived risk in emergency medical center influence intention to reuse and explain 68.8% of total variation of intention to reuse.
CONCLUSION
Findings provide strong empirical evidence for importance of atient satisfaction with nursing care service, the switching costs and the perceived risk in explaining the intention of reuse an emergency medical center.
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Relationship between Critical Thinking Disposition, Clinical Decision Making and Job Satisfaction of Cancer Center Nurses
Sam Chul Jung, Dukyoo Jung
J Korean Acad Nurs Adm 2011;17(4):443-450.   Published online December 31, 2011
DOI: https://doi.org/10.11111/jkana.2011.17.4.443
PURPOSE
This study was a descriptive correlation study to increase understanding of, and relationships among critical thinking disposition, clinical decision making and job satisfaction of cancer center nurses.
METHOD
The participants in this study were 150 nurses working in one cancer center located in Gyeonggi Province. The statistic program, SPSS WIN17.0 was used for data analysis and data were analyzed using t-test, ANOVA, and Pearson correlation.
RESULTS
The critical thinking disposition of the participants showed statistically significant differences according to areas of practice (F=4.426, p=.005), and current position (F=9.346, p=.000). For clinical decision making of the participants, statistically significant differences were found according to current position (F=10.667, p=.000). Furthermore, for job satisfaction, there were statistically significant differences according to income (F=6.779, p=.002), length of career (F=2.701, p=.033) and current position (F=5.423, p=.005). There were significant positive correlations for critical thinking disposition with clinical decision making, and with job satisfaction.
CONCLUSION
The results of the study indicate that to improve clinical decision making and job satisfaction of cancer center nurses, it is necessary to increase critical thinking disposition. To make this change, appropriate programs are needed to increase critical thinking and clinical decision making of general cancer center nurses.

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Emotional Labor Experienced by Ambulatory Care Nurses
Mi Ra Song, Kuem Ju Park
J Korean Acad Nurs Adm 2011;17(4):451-461.   Published online December 31, 2011
DOI: https://doi.org/10.11111/jkana.2011.17.4.451
PURPOSE
The purpose of this study was to explore emotional labor experienced by nurses in ambulatory care setting.
METHOD
The phenomenological method developed by Giorgi was used for this study. The participants were 9 nurses who had experienced emotional labor. Data were collected between May and August 2010 by face-to-face interviews. The interview was recorded and then transcribed.
RESULTS
The constituents associated with the meaning of the nurses' experiences of emotional labor in ambulatory care setting were as followings: bearing down of suffering emotions coming up from the bottom, feeling loneliness when having to undertake care alone by oneself, having conflict between nursing professional and services, managing mind by means of both internal and external resources, getting ridding oneself of conflict with forced emotions over time.
CONCLUSIONS
The results of this study should contribute to a deeper understanding of the meaning of emotional labor experienced by nurses in ambulatory care. The results also highlight the need to develop programs for nurses in ambulatory care setting to help them express their real action.

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    Yeong Ok Ryu, Eun Ko
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Perception of Patient Safety Culture and Safety Care Activity among Nurses in Small-Medium Sized General Hospitals
Na Joo Lee, Jeong Hee Kim
J Korean Acad Nurs Adm 2011;17(4):462-473.   Published online December 31, 2011
DOI: https://doi.org/10.11111/jkana.2011.17.4.462
PURPOSE
This study was done to identify the factors affecting the perception of patient-safety-culture and the level of safety-care-activity among nurses in small-medium sized general hospitals.
METHOD
Data were collected during April and May 2011, from 241 nurses of five hospitals. A hospital survey questionnaire on patient-safety-culture and safety-care-activity was used. Collected data were analyzed using descriptive statistics, Pearson correlation, t-test, ANOVA, Scheffe test and multiple-regression.
RESULTS
There were significant differences in the level of perception of patient-safety-culture according to the nurses' age, type of hospital, position, work department, and knowing whether there was a Patient-Safety committee in their hospitals. Nurses with higher perceived level of the patient-safety-culture performed more safety-care-activities. Factors influencing on the safety-care-activities were general patient safety, having had safety-education, patient-to-nurse ratio, employment status, and the level of reporting medical errors. These factors explained 22.9% of the safety-care-activity.
CONCLUSIONS
The study findings suggest that in order to improve the nurses' perceived level of patient-safety-culture and safety-care-activity, the hospitals need to establish patient-safety committees and communication systems, and openness to reporting medical errors are needed. Better work conditions to ensure appropriate work time, regulate patient-to-nurse ratio, and nursing education standards and criteria, are also required.

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Affecting Factors of Nurses' Burnout in Secondary General Hospitals
Seung Mi Park, In Sun Jang, Jeong Sil Choi
J Korean Acad Nurs Adm 2011;17(4):474-483.   Published online December 31, 2011
DOI: https://doi.org/10.11111/jkana.2011.17.4.474
PURPOSE
This study was conducted to identify factors affecting nurses' burnout in secondary general hospitals.
METHODS
Data were collected through structured questionnaires from 241 nurses working at the secondary general hospitals with below 400 beds in the P, C, and S city between April and May, 2009. Data analysis was done with independent t test, ANOVA, Pearson correlation coefficient, and multiple stepwise multiple regression with SPSS WIN v 17.0.
RESULTS
Burnout was significantly different according to religion, age, clinical experiences, and shift work. Burnout score of the subjects was 58/100. Burnout of the subjects were positively correlated with job stress and negatively correlated with hardness, self efficiency, self esteem, spiritual wellbeing, social support, and job satisfaction. The explained variances for burnout was 51.8% and factors affecting nurses' burnout in secondary general hospitals were job stress, hardness, self efficiency, job satisfaction and shift work.
CONCLUSION
These results showed the significant factors fo nurses' burnout in secondary general hospitals. These findings can be utilized to development of strategies for reducing job stress and enhancing hardness, self efficiency and job satisfaction.

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Evaluation of a Fall Risk Assessment Tool to Establish Continuous Quality Improvement Process for Inpatients' Falls
Ihn Sook Park, InSook Cho, Eun Man Kim, Min Kyung Kim
J Korean Acad Nurs Adm 2011;17(4):484-492.   Published online December 31, 2011
DOI: https://doi.org/10.11111/jkana.2011.17.4.484
PURPOSE
The aims of study were; (1) to evaluate the validity and sensitivity of a fall-risk assessment tool, and (2) to establish continuous quality improvement (CQI) methods to monitor the effective use of the risk assessment tool.
METHODS
A retrospective case-control cohort design was used. Analysis was conducted for 90 admissions as cases and 3,716 as controls during the 2006 and 2007 calendar years was conducted. Fallers were identified from the hospital's Accident Reporting System, and non-fallers were selected by randomized selection. Accuracy estimates, sensitivity analysis and logistic regression were used.
RESULTS
At the lower cutoff score of one, sensitivity, specificity, and positive and negative predictive values were 82.2%, 19.3%, 0.03%, and 96.9%, respectively. The area under the ROC was 0.60 implying poor prediction. Logistic regression analysis showed that five out of nine constitutional items; age, history of falls, gait problems, and confusion were significantly associated with falls. Based on these results, we suggested a tailored falls CQI process with specific indexes.
CONCLUSION
The fall-risk assessment tool was found to need considerable reviews for its validity and usage problems in practice. It is also necessary to develop protocols for use and identify strategies that reflect changes in patient conditions during hospital stay.

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Influence of Nurses' Sense of Coherence on Their Stress and Quality of Life
Kyeongsug Kim, Smi Choi
J Korean Acad Nurs Adm 2011;17(4):493-507.   Published online December 31, 2011
DOI: https://doi.org/10.11111/jkana.2011.17.4.493
PURPOSE
The aim of this study was to investigate the effect of sense of coherence (SOC) on occupational stress, psychosocial stress and quality of life (QOL) of nurses working in a hospital.
METHODS
The participants were 401 nurses working in S hospital in Seoul. A stratified random sampling was performed for the all nurses in S hospital which were grouped by age and work unit. Data were collected by a self-report survey. Data analyses included descriptive statistics, t-test, Pearson correlations, multiple linear regressions, and ANOVA.
RESULTS
This study showed nurses' occupational stress was at high risk and their psychosocial stress, at low risk. It also showed that those two types of stress are mutual predictors for each other and that SOC was a predictor for both types of stress. For QOL, SOC was also a predictor in SF-36 and MCS (Mental Component Summary). Therefore, SOC may be considered as a major controlling factor for stress and QOL.
CONCLUSION
The results indicate the need to develop programs that enhances nurses' SOC, programs that could be utilized as an intervention to reduce nurses' stress and to promote nurses' QOL.

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The Relationship Among Nurses' Parenting Stress and Turnover Intention
Su Jung Kang, Souk Young Kim
J Korean Acad Nurs Adm 2011;17(4):508-515.   Published online December 31, 2011
DOI: https://doi.org/10.11111/jkana.2011.17.4.508
PURPOSE
The purposes of this study were to understand correlation of parenting stress and turnover intention of nurses, and to provide basic data for effective nursing management.
METHODS
Subjects included 287 nurses who had children and worked in hospitals. Data were collected through organized questionnaires from September 1st to 30th 2010. Collected data was analyzed with descriptive statistics, t-test, ANOVA, correlation analysis using PASW statistics 18 program.
RESULTS
The average score for parenting stress of the participants was 3.12 out of 5. Nurture stress was statistically different depending on age, job position, shift work, night duty and stages of family development. The average score for turnover intention of the participants was 3.34 out of 5. Turnover intention was statistically different depending on age, number of children and stages of family development. As a result of correlation analysis of parenting stress and turnover intention, turnover intention showed positive correlation with daily stress, stress caused from taking parent role and average parenting stress.
CONCLUSION
This study indicates that parenting stress is related with turnover intention, nursing managers should make efforts to decrease parenting stress in order to reduce turnover intention of nurses.

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Causal Relationships Among Perceived Risk, Satisfaction, Switching Cost and Loyalty in Outpatient Health Services
Young Hee Yom, Kyu Eun Lee
J Korean Acad Nurs Adm 2011;17(4):516-523.   Published online December 31, 2011
DOI: https://doi.org/10.11111/jkana.2011.17.4.516
PURPOSE
The purpose of this study was to examine the causal relationships of perceived risk, satisfaction, switching cost and loyalty in outpatient health services.
METHOD
A survey using a structured questionnaire was conducted with 393 hospital outpatients. The analysis of data was done with both SPSS Win 17.0 for descriptive statistics and AMOS 18.0 for structural equation model.
RESULTS
The causal model yielded Chi-square=31.44 (p=<.001), df=4, GFI=.98, AGFI=.87, CFI=.97, RMSR=.04, NFI=.96, IFI=.97 and showed relatively good fit indices. Perceived risk had a significant direct effect on customer satisfaction. Customer satisfaction, financial switching cost and relational switching cost had significant direct effects on customer loyalty. Perceived risk and customer satisfaction had significant indirect effects on customer loyalty.
CONCLUSION
These results suggest that we should decrease the perceived risk and improve the customer satisfaction and switching cost to retain loyal customers. Further study with both a larger sample from various hospitals and a longitudinal design is necessary.

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Role Performance and Related Factors of the Clinical Research Coordinator
Youn Sun Hwang, Il Sun Ko
J Korean Acad Nurs Adm 2011;17(4):524-537.   Published online December 31, 2011
DOI: https://doi.org/10.11111/jkana.2011.17.4.524
PURPOSE
The purpose of this study was to analyze the role performance and related factors of the Clinical Research Coordinator (CRC).
METHODS
A quantitative, cross-sectional design was used. Data were collected using a structured questionnaire from 134 Clinical Research Coordinators in 4 hospitals and analyzed using descriptive statistics, t-test, ANOVA, and Pearson correlation coefficient.
RESULTS
The scores for role performance of CRC were high (average 336.51 points of a possible 420 points, mean average 5.74+/-0.67 of a possible 7) and the degree of role performance in the management task sub dimension (mean average 6.12+/-0.77 of a possible 7) was higher than any other sub dimension. Role performance of the CRC was also related to job satisfaction (r=.198, p=.023).
CONCLUSION
The study results indicate that most CRC are nurses and perceive their role as very important. Further the CRC performance of activities of management task and the Coordination/Advocacy task sub dimension were high and higher levels of job satisfaction were related to higher levels of role performance of CRC was. Therefore, strategies related to improvement in the fringe benefit system and work environment should be developed to increase job satisfaction and thus increase job performance.

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A Review of Research on Hospital Nurses' Turnover Intention
Jong Kyung Kim, Myung Ja Kim
J Korean Acad Nurs Adm 2011;17(4):538-550.   Published online December 31, 2011
DOI: https://doi.org/10.11111/jkana.2011.17.4.538
PURPOSE
The purpose of this study was to review articles, thesis and dissertation on turnover intention of hospital nurses in order to identify overall trends in turnover intention of nurses and suggest strategies for reducing turnover intention.
METHOD
Thirty research papers on turnover intention of nurses were reviewed.
RESULT
These papers were journal articles and thesis regarding nurses who worked in general wards, intensive nursing units, and emergency rooms in hospital. The tools used to measure turnover intention were Lawler (1983), Mobley (1982), and Lee (1995), and others. Most of tools were composed of 1-11 items, with 4-7 point Likert scales. Reported reliability was .55 to .91. The mean score for turnover intention was between 2.40 and 3.85. The important results revealed that job satisfaction, organizational commitment, and stress affected turnover intention of hospital nurses.
CONCLUSION
The findings from this review indicate that to reduce turnover intention for hospital nurses, a nurse manager should increase job satisfaction, organizational commitment, and reduce stress by developing a good culture and work climate. Moreover it is necessary to assess stress and job satisfaction of nurses, and to manage nurses' welfare, including night duty policy, salary, and career ladder.

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Perception About the Elderly Among Undergraduate Students Interested in the Elderly Care Business
Mi Ja Shin
J Korean Acad Nurs Adm 2011;17(4):551-560.   Published online December 31, 2011
DOI: https://doi.org/10.11111/jkana.2011.17.4.551
PURPOSE
The purpose of this study was to identify the perception about the elderly among undergraduate students interested in the elderly care business.
METHOD
In this descriptive research, a total of 183 undergraduate students were participated. The instrument was consisted of a 18-item semantic differential scale developed by Sanders et al (1984). Data were analyzed using descriptive statistics, t-test, ANOVA, Scheffe test, Pearson's correlation coefficients by SPSS 18.0.
RESULT
Undergraduate students' perception about the elderly was slightly positive(2.98+/-1.51). The significant factors associated with the perception about the elderly were gender, age, present residing state with the elderly, experience of residing with the elderly at the past. Male students' perception about the elderly was more positive than female. Among 18 items, 'wise' and 'knowledgeable' was highly related to the perception about the elderly(r=.671, p=.001).
CONCLUSION
These findings indicate that the items of optimistic, attractive, flexible and good were the impressive perceptions about the elderly for the undergraduate students. The result of this study can be utilized to promote perception about the elderly among undergraduate students.
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