Purpose This study aimed to identify the effects of shared leadership, communication skills, and team effectiveness, as perceived by nurses and nursing assistants in comprehensive nursing service units.
Methods A cross-sectional research design was adopted, and the sample included 306 nurses, nurse assistants, and caregivers working in nine hospitals with fewer than 500 beds in two South Korean cities. The data were analyzed using descriptive statistics, t-tests, ANOVA, Pearson’s correlation coefficient, and four-step hierarchical regression analysis.
Results The factors influencing team effectiveness in the hierarchal multiple regression analysis were shared leadership (β=.57, p<.001) and communication skills (β=.18, p<.001). These factors explained 49% of the total variance.
Conclusion To enhance team effectiveness in compressive nursing service units, educational programs focusing on shared leadership and communication skills among nurses, nursing assistants, and caregivers must be developed.
Purpose This study aimed to compare and identify factors affecting delirium nursing stress among nurses in comprehensive nursing care service wards and general wards. Methods Using structured questionnaires, data were collected from 230 nurses working in two tertiary university hospitals. Data were analyzed using descriptive statistics, t-tests, ANOVA, Pearson's correlation coefficient, and multiple regression analysis using SPSS/WIN 27.0. Results The average delirium nursing stress score for nurses in comprehensive nursing care service wards was 2.98±0.30 out of 4 points, which was significantly higher than 2.89±0.29 points for nurses in general wards (t=2.17, p=.031).
Factors influencing delirium nursing stress among comprehensive nursing care service ward nurses included nursing work environment (β=-.58, p<.001) and conflicts with medical staff and other departments related to delirium patients (β=.24, p=.006), explaining power of 44% (F=12.13, p<.001). For general ward nurses, the nursing work environment(β=-.39, p<.001) was the main influencing factor, explaining power of 17% (F=3.93, p<.001). Conclusion Both types of nurses require improvements in their work environment. Strategies to reduce conflict between medical staff and other departments are essential in comprehensive nursing care service wards.
Purpose This study aimed to determine the impact of work environment, missed nursing care, and non-nursing tasks on the job stress of hospital nurses. Methods A descriptive, cross-sectional survey of 164 nurses working in three hospitals was conducted. Data were collected using structured questionnaires and analyzed using descriptive statistics, t-test, one-way analysis of variance, Pearson’s correlation coefficient, and multiple regression analysis using SPSS/WIN 26.0. Results Hospital Nurses' job stress was negatively correlated with the work environment (r=-.37, p<.001). Job stress had a statistically significant positive correlation with non-nursing tasks (r=.34, p<.001); however, it had no significant correlation with missed nursing care (r=.05, p=.552). Regression model analysis revealed that the variables associated with job stress were non-nursing tasks (β=.29, p<.001) and the foundation for quality nursing care (β=-.25, p=.034), which are subdomains of the work environment. In contrast, missed nursing care was not determined to be a significant factor. Conclusion To effectively manage nurses' job stress, nurse managers should provide higher quality care by reducing the number of non-nursing tasks and creating a positive work environment, especially by providing adequate nursing workforce and material support.
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Purpose This study aimed to investigate the relationships among nursing skill mix, missed nursing care, and adverse events according to the nursing skill mix and the factors influencing. Methods This study is a descriptive survey that used survey data were collected from 158 nurses working in comprehensive nursing care wards in small and medium-sized hospitals. The data were analyzed using the t-test, analysis of variance, and multiple regression analysis. Results The average age of the study participants was 37.9 years, and they had over 10 years of experience. The average mean ratio of nursing skill mix 1 was 69.98. For nursing skill mix 2, the average mean ratio was 68.44%. The mean score for missed nursing care was 1.33, and the mean score for adverse events was 1.90 points. The factors affecting adverse events experience were missed nursing care, total work experience of >3 years, number of beds between ≥200 and <300. Conclusion Our findings suggest that patient safety and management education should consider the nurses’ age and total work experience. Furthermore, nursing workforce management, particularly focusing on nursing assistants in small- and medium-sized hospitals, is essential for fostering a safer healthcare environment.
Purpose The aim was to develop guidelines for delegating nursing tasks among nurses in integrated nursing care wards. Methods This was a methodological approach. Literature reviews were conducted on delegation policies and practices for nurses in Korea and other countries to explore the area of nursing delegation. Focus group interviews were performed with nurses to identify the strength and weakness of the delegation of nursing tasks in clinical practice, and qualitative content analysis was conducted based on the interview. Ten areas and 115 items were derived through these steps, and their validity was confirmed using the Delphi technique. Results The delegation guidelines of nursing tasks consisted of nine domains, 21 sub-categories, and 101 items, including Nurses and nursing assistants' duties, the necessity of delegation, definition of terms, scope of delegation, considerations for delegation, procedure, characteristics, and principles of delegation, and educational content for delegation. Conclusion These guidelines can help nurses to make decisions about delegating nursing tasks according to the delegation procedure.
Education on the delegation of nursing tasks is necessary for both nurses and nursing assistants. The guidelines developed in this study can serve as a standard for delegating nursing tasks to ensure patient safety.
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Purpose To explore the relationship between nursing care needs and acuity based on the Korean Patient Classification System for Critical Care Nurses (KPCSC) and APACHE II, and to identify their prognostic value in predicting mortality. Methods A total of 617 patients admitted to a surgical intensive care unit in a tertiary hospital from January 1 to June 30, 2021 were included. The correlation between KPCSC and APACHE II scores, and their predictive power regarding mortality were examined. Results KPCSC and APACHE II scores showed a significant, positive correlation (r=.32, p<.001). The KPCSC score was significantly correlated with 10 out of 11 KPCSC categories and 2 out of 3 APACHE II domains, whereas the APACHE II score had a significant correlation with all APACHE II domains and only 4 out of 11 KPCSC categories. Both KPCSC and APACHE II demonstrated moderate discriminatory performance in predicting ICU and in-hospital death, and their AUC values were not significantly different. Conclusion KPCSC, reflecting the severity of illness, predicted mortality as well as APACHE II. However, KPCSC was found to consider factors other than severity, such as patient dependency, which substantiates its value as an assessment tool for nursing care needs.
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Purpose This study examined patients’ call bell use and the relationship between call bell use and nursing care needs.
Methods: Nursing staff was asked to report patients’ call bell use during 15 shifts over five days in integrated nursing care wards. Nursing care needs were measured using summary scores of nursing activities and activities of daily living (ADLs). The relationship between call bell use and nursing care needs was analyzed using a zero-inflated negative binomial regression model.
Results: A total of 251 patients used call bells 235 times, with an average of 0.94 times per day. Only 72 patients (28.7%) used call bells once or more per day (range, 1~14 times), whereas the rest did not use call bells. Male gender, a high risk for falling, and a higher score on nursing activities were associated with a greater likelihood of using call bells. Pain and higher dependency on ADLs were associated with an increase in the frequency of call bell use.
Conclusion: Patients' call bell use needs to be minimized by meeting their nursing care needs to improve patient safety and nursing performance.
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Purpose To develop a web-based solution for patient need-driven staffing (PNDS) that automatically determines nurses’ staffing requirements.
Methods: Activities provided by nurses in four integrated nursing care wards (INCWs) and non-INCWs each in a tertiary hospital were observed over three days. Nursing hours per patient hour (NHPPH) were calculated by dividing nursing hours by patient stay hours per day. Patient needs were evaluated using 19 items.
Results: The nurse-patient ratios in INCWs and non-INCWs were 1:4.5 and 1:8.1 (including overtime), respectively. Admitted and transferred-in patients had higher NHPPHs than those with continuing stays. The patients were classified into five groups: Group A for admissions and transfers-in, and Groups 1~4 for the remainder. In INCWs, the nurse-patient ratios ranged from 1:5.3 (Group 1) to 1:2.4 (Group 4), and Group A required 1:3.0, the secondhighest level. In non-INCWs, ratios ranged from 1:9.4 (Group 1) to 1:5.2 (Group 4 and Group A). The PNDS solution was developed to determine staffing requirements by classifying patients into five groups using the entered data on patient needs, assigning the group’s NHPPH to each patient, and calculating the staffing ratio required in the unit.
Conclusion: The PNDS is expected to support staffing decisions to meet patient needs.
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Purpose This study aimed to explore the factors influencing the infection control performance of nurses working in comprehensive nursing care service wards during the coronavirus disease 2019 (COVID-19) pandemic.
Methods: Data were collected from 107 nurses working in the comprehensive nursing care service unit at four general hospitals from March 15 to April 3, 2021. Factors influencing infection control performance were analyzed using hierarchical multiple regression analysis.
Results: Awareness of importance (β=.55), surgical ward (β=.29), and infection control organizational culture (β=.25) were the factors affecting the infection control performance of nurses working in comprehensive nursing care service wards. The total explanatory power was 46%.
Conclusion: Nurses must establish a positive infection control organizational culture as leaders in team leaders to enhance the infection control performance of nurses working in comprehensive nursing care service wardss. Moreover, the awareness of the risks of COVID-19 and ways to use the defense environment more efficiently should be strengthened.
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Purpose The purpose of this study was to identify the influence of emotional labor and work-life balance on the organizational commitment of nurses in comprehensive nursing care service wards.
Methods: A cross-sectional descriptive study was designed. Data collection was conducted for a total of 171 nurses in comprehensive nursing care service wards in two H university hospitals in Gyeonggi-do. Data were collected from March 5 to 30, 2021 using questionnaires on topics including emotional labor, work-life balance, organizational commitment, and general characteristics. Data were analyzed using descriptive statistics, independent t-test, One-way ANOVA, Pearson’s correlation analysis, and hierarchical regression analysis.
Results: Organizational commitment was influenced by working experience in current unit, future work plan, emotional modulation efforts in profession, patient-focused emotional suppression, and work-life balance.
Conclusion: The findings of this study suggest that in order to increase organizational commitment, it is important to support organizational efforts and systems such as an emotional management program that can strengthen the positive aspects of emotional labor, and leisure activities and childcare support programs that can improve work-life balance.
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Purpose This study examined the subjective frame of patient satisfaction in the comprehensive nursing care services and explored future directions by investigating subjective frame types.
Methods: P-Samples were collected from 30 patients who underwent the comprehensive nursing care service. To enable a forced normal distribution, 31 Q-samples were classified on a 9-point scale considering the degree of agreement. The collected data were analyzed by principal component factor analysis and varimax rotation using the PQ method program.
Results: The subjective frame of patient satisfaction with the comprehensive nursing care service was divided into four types. Considering the characteristics of each, the types were labeled as “the formation of relationships with the surroundings”, “autonomous decision-making”, “non-verbal empathy”, and “therapeutic support resources”. Each type can be classified into therapeutic relationship and therapeutic process categories.
Conclusion: This study revealed changes in expectations regarding new medical services and that the subjective frames that affect the formation of satisfaction are diverse. The study results are expected to be used as basic data to develop strategies for creating a therapeutic environment that improves patient satisfaction in the comprehensive nursing care service.
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Results: Grade 1 GHs increased from 6.9% in 2018 to 39.6% in 2020, whereas grades 6-7 decreased from 31.8% to 17.6%. NGHs with grades 6-7 decreased from 81.8% to 61.6%. GHs and NGHs with no reported staffing grades decreased from 10.6% to 0% and from 63.2% to 14.8%, respectively. The estimated annual revenue growth per nurse from inpatient nursing care fees resulting from 1-grade improvements in staffing was 1.44~7.26 million Korean won (KRW) and 1.25~9.75 million KRW for GHs and NGHs, respectively, while the results from night shift nursing fees were 2.37~5.54 million KRW and 2.20~5.14 million KRW for GHs and NGHs, respectively.
Conclusion: The increased revenues should be utilized to augment nurses’ wages and staffing levels as the guidelines recommend.
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Purpose The purpose of this study was to explore the experiences of the relationship between nurses working on comprehensive nursing care service wards and the inpatients on those wards.
Methods: The phenomenological research method was used. Participants in the study were seven women.
Data were collected through individual in-depth interviews from December, 2018 to January, 2019 Results: Five theme clusters were extracted that described nurses’ patient experiences for comprehensive nursing care service wards. They are “Expansion of relationship formation”, “Transition of place to provide nursing care”, “Expansion of communication”, “Maintaining professional boundaries” and “Realization of professional nursing”.
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PURPOSE The purpose of this study was to explore and analyze the latest trends in domestic research related to integrated nursing care service and to present a practical direction for future research. METHODS This study was focused on domestic nursing research related to integrated nursing care service as published in journals until March 20, 2019. After reviewing the quality of the papers, 34 papers were finally selected for analysis. In order to analyze the overall trends, the analysis was reviewed by year, source, research design, and subjects, and content analysis was used to identify trends by topic. RESULTS From the content analysis, the top categories were divided into nurses' view and patients' view, with both nurses' view and patients' view for the subcategories of ‘input’, ‘process’ and ‘output’ respectively. From both the nurse and patient view, the sub-category ‘input’ included ‘service environment’, ‘process’ and ‘service throughput’ and for the ‘output’ subcategory, three subjects, ‘performance’, ‘service-related perception change’ and ‘social psychological change’ were derived from the nurses' view, and two subjects ‘performance’ and ‘service-related perception change’ were derived from the patients' view. CONCLUSION In order for future studies to provide practical basic data for stable settlement and improvement of integrated nursing care service, it is necessary to develop and study various aspects without bias, and in a balanced and integrated manner.
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PURPOSE This study was done to evaluate the adequacy of nurse staffing in integrated nursing care. METHODS Statistical data on integrated nursing care from the National Health Insurance Corporation was used in this study. We extracted hospital data and patient data related to patient needs for nursing care. We analyzed the differences in patient needs by staffing level of each type of medical institution. RESULTS Approximately 70% of medical institutions provided nursing care by the mid level of nurse staffing, which was 1:6, 1:10 and 1:12 in the tertiary hospital, general hospital and semi-hospital, respectively. The patients' characteristics were significantly different by hospital type. Especially, the distribution of the main diagnosis was completely different between the tertiary hospital and semi-hospital. In the tertiary hospital, the patient needs measured by severity and activities of daily living dependency were higher at higher staffing level than at lower staffing level. However, the nurse staffing was less relevant to the patient needs in the general hospital and semi-hospital. CONCLUSION To provide high-quality nursing care, accurate workload forecasting is required at the start, and then the standard nurse staffing level can established based on workload forecasting.
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PURPOSE This study was done to identify issues surrounding comprehensive nursing care within the national health insurance, analyze results and problems within national health insurance and to suggest new policy directions for stability. METHODS A literature search was performed using RISS, KISS, PUBMED databases. Eighteen studies were analyzed. RESULTS For implementation of comprehensive nursing care, there was improvement in nursing and in facilities. By improvement of structure, this new system showed positive outcomes in term of patient satisfaction and indicators related to patient safety. However, issues related to overload, job stress and evaluation of the system remain. In order to establish this system, staffing levels for nurses and nurse aids need to be adjusted to appropriate levels that reflect requirements for nursing. In addition, range of work needs to be determined clearly. Lastly, regular and systematic evaluation is needed to provide safe quality services to patients and to prevent waste of financial resources. CONCLUSION Comprehensive nursing care needs to be implemented in ways that patients can be provided with safe and high quality service. There is a need to resolve several issues to allow this new system to function.
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PURPOSE To develop staffing levels for nursing personnel (registered nurses and nursing assistants) to provide inpatients with integrated nursing care that includes, in addition to professional nursing care, personal care previously provided by patients' families or private caregivers. METHODS A time & motion study was conducted to observe nursing care activities and the time spent by nursing personnel, families, and private caregivers in 10 medical-surgical units. The Korean Patient Classification System-1 (KPCS-1) was used for the nurse manager survey conducted to measure staffing levels and patient needs for nursing care. RESULTS Current nurse to patient ratios from the time-motion study and the survey study were 1:10 and 1:11, respectively. Time spent in direct patient care by nursing personnel and family/private caregivers was 51 and 130 minutes per day, respectively. Direct nursing care hours correlated with KPCS-1 scores. Nursing personnel to patient ratio required to provide integrated inpatient care ranged from 1:3.9 to 1:6.1 in tertiary hospitals and from 1:4.4 to 1:6.0 in general hospitals. The functional nursing care delivery system had been implemented in 38.5% of the nursing units. CONCLUSION Findings indicate that appropriate nurse staffing and efficient nursing care delivery systems are required to provide integrated inpatient nursing care.
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PURPOSE The purpose of this study was to compare the costs and benefits of home nursing care services between public health centers (PHC) and private hospitals. METHOD Participants were 105 patients who had received home nursing care services from a private hospital or public health center. From a societal perspective, the researcher identified the costs and benefits of the services using performance data and calculated the net benefit and benefit/cost ratio. RESULT The net benefit of the home nursing care service based in the PHC was 165.9 million won and benefit/cost ratio was 2.0, while the net benefit of the home nursing care services by the private hospital was 141.1 million won and benefit/cost ratio was 1.7. Both types of programs were economically validated. CONCLUSION Home nursing care services were basically efficient as the results showed a positive net benefit. A cost-benefit analysis indicated that the PHC-based home nursing care services were more efficient than that of the private hospital. With limited human resources and management standards in public health centers, results suggest the need for a more systematic management of the home nursing care service to improve the health of this vulnerable community population.
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