Influence of Learning Presence of Non-Face-to-Face Class Experience in Nursing Students on Academic Achievement: Mediating Effect of Learning Flow and Moderated Mediation of Digital Literacy

Purpose@#This study aimed to identify the mediating effect of learning flow and the moderated mediation effect of digital literacy on the effect of the learning presence of non-face-to-face class experience in nursing students on academic achievement. @*Methods@#Participants were 272 nursing students from six universities in two different cities. A self-report questionnaire was used to measure learning presence, learning flow, digital literacy, and academic achievement. Analysis was performed using SPSS 26.0 and SPSS PROCESS Macro (4.0). @*Results@#The mediating effect of learning flow on the effect of learning presence on academic achievement was 0.42, and the moderated mediation index of digital literacy was 0.17. Learning flow showed a mediating effect on the relationship between learning presence and academic achievement. Digital literacy had a moderated mediation effect on the relationship between learning presence and academic achievement that was mediated by learning flow. @*Conclusion@#The intensity of the mediating effect of nursing students’ learning presence on academic achievement through learning flow increases as the level of digital literacy increases. These results suggest that educational programs considering the level of learning presence, learning flow, and digital literacy are required to promote the academic achievement of nursing college students.

Reflection-related Research in Korean Nursing: A Literature Review / 간호행정학회지

PURPOSE: This study was conducted to analyze research on reflection in Korean nursing, and suggest future directions for effective application of reflective practice in Korean nursing education and practice. METHODS: A review was performed using domestic databases including RISS, KISS, DBpia, and NDSL. Twenty-three papers were analyzed according to general characteristics, key variables regarding reflection, and findings regarding reflection. RESULTS: Reflection in nursing research has received attention since 2005, generating almost half the publications in the last 3 years. Key variables regarding reflection were classified into reflection-related general term (34.7%), reflective action (8.6%), and reflection writing method (56.7%). Findings regarding reflection were categorized into correlation of reflection with other variables (26.1%), learning evaluation using a reflective journal (22.2%), effects of applying reflection as an intervention (47.4%), and Korean Self-Reflection and Insight Scale validation (4.3%). CONCLUSION: Results indicate that reflection or reflective practice is an important component in integrating theories to practice, and that reflective practice is a prerequisite to becoming a professional nurse as well as a crucial tool for ideal changes in nursing. Considerable effort should be made to define the concept of reflective practice and effectively apply it to nursing education and practice in Korea.

A Survey on Nurses' Perception, Satisfaction, and Needs related to Continuing Education / 간호행정학회지

PURPOSE: This study was conducted to investigate perception, satisfaction and needs for continuing education for nurses in Korea. METHODS: Participants were selected 1,106 using disproportional stratified sampling for the 110,601 members of the 10 affiliated organizations of the Korean Nurses Association and 873 nurses participated in the online survey. Data were collected from February 2 to 27, 2015, and analyzed using the SPSS/WIN 24.0 program. Descriptive statistics, independent t-test, One-way ANOVA, and Scheffé test were conducted. RESULTS: The perception of continuing education averaged 0.69 on a scale of 1, satisfaction with continuing education was 3.66 out of 5, and need for continuing education was 4.33 out of 6. Perception, satisfaction and needs for continuing education showed significant differences depending on age, marriage, education, work department, type of work and clinical career, while perception and satisfaction differed more among type of institution and the affiliated groups. CONCLUSION: For the development of continuing education for nurses, it is necessary to establish an integrated information system for nurse continuing education and to develop various education programs for career development.

Factors related to Self-leadership of Korean Clinical Nurses: A Systematic Review and Meta-analysis / 간호행정학회지

PURPOSE: In this study a systematic review and meta-analysis was used to examine the variables related to self-leadership in Korean clinical nurses. METHODS: A search and screening of the literature uncovered, 49 related studies done between 2003 and 2016 were then reviewed. A meta-analysis of 44 studies from doctoral dissertations, master's thesis and published articles was also carried out. The correlational effect size (ESr) for each related variable was calculated. RESULTS: Sixty-nine related variables were identified from the systematic review. Twenty-three (5 personal, 13 professional and 5 organizational) variables were eligible for meta-analysis. The overall effect size was .47. The personal factors (ESr=.48) and the professional factors (ESr=.44) had larger effect size than the organizational factors (ESr=.28). Factors with the largest effect size among personal, professional and organizational factors were self-efficacy (ESr=.58), nursing service (ESr=.68) and supervisor's leadership (ESr=.36) respectively. CONCLUSION: The results of this study show that for Korean clinical nurses individual factors including personal or professional factors have a stronger impact on self-leadership than organizational factors. It is necessary to develop interventions and training programs which focus on improving self-efficacy to promote self-leadership in clinical nurses.

A Literature Review of Research on Medical Service Design in Korea / 간호행정학회지

PURPOSE: Purpose of this study was to analyze research on the service design process applied to domestic medical service areas. METHODS: A review was made through domestic databases including RISS, KISS, DBpia, and NDSL and for the analysis framework: a medical service classification code which integrated the medical service area and the design fields. RESULTS: In the healthcare service field there were 9 studies (69.2%) in the medical area, 1 study (7.7%) each in nursing and oriental medicine, and 2 studies (15.4%) in healthcare. According to analysis results based on the medical service classification code, there were 5 studies in prevention and management, 6 studies in curative care, 1 each in rehabilitation and ancillary care. Double diamond process was used in 8 studies. CONCLUSION: Service design was applied mainly to the curative care in the domestic medical settings but little research on service design in the long-term nursing care area was identified. As a strategy to improve the quality of nursing service, it is necessary to adopt the service design process for various nursing service areas in Korea.

A Study on Evaluation System for Nursing Bachelor Degree Program Outcomes: Focus on Improvement in Nursing Leadership Ability / 간호행정학회지

PURPOSE: This study was conducted to develop a nursing leadership program outcome evaluation system, required for accreditation of nursing education. METHODS: A methodological design was used. To ensure the theoretical validity of the evaluation system, learning objectives for nursing education programs and job descriptions for nurses in Korea were verified by analyzing the relationships in the five attributes of the nursing leadership concept. The nursing leadership program outcome evaluation system was developed based on the Kim & Park's developmental model (2008). RESULTS: The nursing leadership program outcome evaluation system was established, including implementation level, education curriculum, level of performance, evaluation method, rubrics, and Close-the-Loop. CONCLUSION: The developed evaluation system can be actively used in nursing education, and contribute to enhancing the leadership competencies of nursing students and graduate nurses.

Structural Model of Evidence-Based Practice Implementation among Clinical Nurses

PURPOSE: This study was conducted to develop and test a structural model of evidence-based practice (EBP) implementation among clinical nurses. The model was based on Melnyk and Fineout-Overholt's Advancing Research and Clinical Practice through Close Collaboration model and Rogers' Diffusion of Innovations theory. METHODS: Participants were 410 nurses recruited from ten different tertiary hospitals in Korea. A structured self-report questionnaire was used to assess EBP knowledge/skills, EBP beliefs, EBP attitudes, organizational culture & readiness for EBP, dimensions of a learning organization and organizational innovativeness. Collected data were analyzed using SPSS/WINdows 20.0 and AMOS 20.0 program. RESULTS: The modified research model provided a reasonable fit to the data. Clinical nurses' EBP knowledge/skills, EBP beliefs, and the organizational culture & readiness for EBP had statistically significant positive effects on the implementation of EBP. The impact of EBP attitudes was not significant. The dimensions of the learning organization and organizational innovativeness showed statistically significant negative effects on EBP implementation. These variables explained 32.8% of the variance of EBP implementation among clinical nurses. CONCLUSION: The findings suggest that not only individual nurses' knowledge/skills of and beliefs about EBP but organizational EBP culture should be strengthened to promote clinical nurses' EBP implementation.

Action Research in Hospital Settings: A Literature Review of International Nursing Journals / 간호행정학회지

PURPOSE: Purpose of this study was to identify major trends of action research from 2006 to 2013 and suggest directions for activating and advancing domestic action research in nursing. METHODS: A review was made of 118 action research studies in hospital settings reported in international journals. Search from PubMed, Ovid, and CINHAL was done using analysis criteria developed by the researchers. General and methodological characteristics and focus on changing outcomes of action research were analyzed. RESULTS: The major group of researchers belonged to colleges/universities (40.7%). Methods included use of qualitative methods (61.0%), research questions (24.6%), and use of theoretical models (35.6%). Prevalent data collection methods were interviews (20.2%), and 48.3% showed more than a 1-cycle process including spiral circulation structure. Focus of changing outcomes of the 56 papers including more than 1-cycle were practice (66.1%), environment (8.9%), client-nurse (7.1%). CONCLUSION: Trends in action research in nursing were identified providing necessary reasons to increase action research in nursing as follows: needs of various researchers including stakeholders as well as healthcare providers, various research designs including unconstrained reflection and writing, specific presentation of adapted theoretical models and action strategies, and quality assurance for validity and reliability of research processes and outcomes.

Strengthening of Advanced Beginner's Nursing Competence through Concept Mapping: Focus Groups / 한국직업건강간호학회지

PURPOSE: This study was to evaluate the strengthening process of advanced beginner's nursing competence through the concept mapping methods. METHODS: This study was conducted with focus group study for 1 month from November to December 2012 (n=5). Data were analyzed through open coding, axial coding and selection coding stage. RESULTS: Advanced beginner to represent the experience of nursing empowerment and the three categories of the nine concepts were derived. The first category is 'able to see the entire search.' This concept is to start a search query, the search process of thinking, behavior change is expected. The second category is 'behavior change through the acquisition of knowledge.', and this concept is the embodiment of knowledge, confidence rising, and action changing. The third category is 'nursing empowerment', the aesthetic, ethical, and personal knowledge acquisition, as well as self-growth. CONCLUSION: Advanced beginner saw the full flow through the concept mapping and obtained knowledge, and changed behavior. Thus, the concept mapping is effective to strengthen the nursing competence.

Development of an Instrument to Measure Triage Nursing Work in Emergency Room / 한국간호교육학회지

PURPOSE: The purpose of this study was to develop an instrument to assess emergency room nurses' knowledge and performance of triage nursing. METHODS: The instrument was developed through the stages of conceptual construction, item development, and validity and reliability testing. For the validity and reliability testing, data collected from 48 emergency room nurses using questionnaires was analyzed through descriptive statistics, factor analysis, and reliability coefficients. RESULTS: The knowledge part consisted of 30 items in nine areas, and its reliability was low (KR-20 =0.50). The correct answer rate was 71.8%. The performance section derived from the factor analysis was composed of two factors with nine items in the triage domain and three factors with 12 items in the non triage domain. The explanatory powers of these factors for the domains were 66.1% and 70.4%, respectively. The overall reliability (Cronbach's alpha) was .95, and the reliabilities for the two domains were .88 and .91, respectively. The nurses' mean performance level was 3.2(+/-0.45). CONCLUSION: The specific contents of the triage nursing work were identified from the developed scale; further research is necessary to in order to develop a scale capable of higher reliability and validity.

Systematic Search for Guidelines to Prevent Catheter-associated Urinary Tract Infections-Part II: Using the Ovid MEDLINE / 간호행정학회지

PURPOSE: To implement evidence-based nursing, it is important to know where and how to find the best available evidence. This study was conducted to identify the results of a search from Ovid MEDLINE and to compare the results from Ovid MEDLINE with those from PubMed MEDLINE. METHODS: Four different approaches via Ovid MEDLINE were used to search for guidelines on preventing catheter-associated urinary tract infections. Outcomes of this study were the number of records and relevant literature, and the sensitivity and precision of the search methods via Ovid MEDLINE. RESULTS: The number of retrieved items ranged 23 to 6,005 and that of relevant studies, 5 to 8 of 8. Simple searches resulted in the highest sensitivity of 100.0%. When using MeSH terms and limits feature, the precision was highest (21.7%) among four approaches for literature searches. Simple searches in Ovid had higher sensitivity and lower precision than those in PubMed. CONCLUSION: Simple searches in Ovid may be inefficient for busy clinicians compared to PubMed. However, to ensure a comprehensive and systematic literature search, using Ovid MEDLINE in addition to PubMed is recommended.

Concept Analysis of Nursing Leadership / 간호행정학회지

PURPOSE: The purpose of this study was to provide a concept analysis of nursing leadership. METHODS: The concept analysis process of Walker and Avant (2011) was used. A review of the literature was conducted using several databases, including PubMed, CINAHL, Ovid-Medline, DBpia, and KISS. The databases were searched using the following terms 'nursing leadership', 'nursing' & 'leadership', and 'nurse & 'leadership', and for studies published from January 2000 to March 2015. Strict inclusion and exclusion criteria were applied. RESULTS: Analysis of these studies indicated nursing leadership attributes were individual growth, collaboration, nursing excellence, creative problem solving, and influence. The antecedents of nursing leadership were the individual maturity level, construction of mutual trust and confidential relationships, and a job requirement. The consequences were improvement in nursing productivity, development of a supportive work environment, and satisfaction with the nursing profession. CONCLUSION: The findings in this study provide a definite concept of nursing leadership. The findings also provide the theoretical evidence for the development of nursing leadership competencies in nursing students and professional nurses.

An Example of Systematic Searching for Guidelines to Prevent Catheter-associated Urinary Tract Infections - Part I: Using the PubMed Database / 간호행정학회지

PURPOSE: Effective literature searching is essential to support evidence-based nursing. The aim of this study was to present our recent systematic search experience to identify guidelines in PubMed for prevention of catheter-associated urinary tract infections. METHODS: Five approaches to the literature search via PubMed were employed. The searches were restricted to items published from 1980 to 2010, for patients admitted to hospital, and in the English language. The search results were compared using the number of records and relevant items, and the sensitivity and precision of each search strategy. RESULTS: The individual approaches retrieved 19-141 of records and 3-6 of relevant items. Sensitivity ranged from 37.5% to 75.0% with the highest values for simple searches and a search combining MeSH terms and free textwords with a methodological search filter. Precision varied from 4.3% to 21.7% and the highest precision was found for MeSH terms with limits feature. CONCLUSION: The simple search in PubMed is an appropriate way for nurses in a busy clinical practice to search the literature for evidence. However, several approaches using MeSH terms, free textwords, limits feature or methodological search filters are also required to have more efficient and better informed search results.

Effects of an Action Learning based Creative Problem-Solving Course for Nursing Students / 간호행정학회지

PURPOSE: This study was conducted to identify the effects of an action learning based creative problem-solving (CPS) course on problem solving, creativity and team-member exchange in nursing students. METHODS: A quasi-experimental study applying a non-equivalent control group pre-post design was employed. Sophomore nursing students (32 in the experimental group and 33 in the control group) were recruited from a university in G-city, Korea. Problem solving, creativity and team-member exchange were measured for the pretest and posttest using self-report questionnaires. Kolmogorov-Smirnov test, Chi-square, Fisher's exact test, t-test, and ANCOVA with SPSS/Win 20.0 program were used to analyze the data. RESULTS: The scores for problem solving, creativity and team-member exchange in the experimental group were significantly higher than those of the control group. CONCLUSION: Results of this study indicate that an action learning based CPS course is an effective teaching method to improve nursing students' competencies. In the future longitudinal studies are needed to assess the long term effects of the course.

Analysis of Research Articles Published in the Journal of Korean Academy of Nursing Administration for 3 Years (2010~2012) / 간호행정학회지

PURPOSE: The purpose of this study was to identify the major trends in research studies in the Journal of Korean Academy of Nursing Administration from 2010 to 2012. METHODS: A review using analysis criteria developed by researchers was done of 132 studies published between 2010 and 2012. Research design, participants, research domain, and keywords were analyzed from the Journal of Korean Nursing Administration. RESULTS: Job satisfaction, stress, organizational commitment, safety, turnover, nursing education, and performance were found to be major keywords. Of the research in the Journal, quantitative methods were used in 93.2% of studies. The major setting and participants were hospitals (58.2%) and nurses (65.5%) respectively. Prevalent analysis methods used were t-test, ANOVA, correlation, regression, chi-square, AMOS, and factor analysis. Major domains in the articles were: controlling, directing, staffing, nursing management education, and professionalism & legal principles. CONCLUSION: Through this study, the research trends in nursing administration were identified, but there is a need to include more of the following topics in future research: new concepts in nursing policy, enhanced deliberations of IRB, rationalization of the effects in sample size calculations, theoretical development of planning and organizing, and development of interventions for management support of the nursing management process.

A Journey to Action Research in a Clinical Nursing Context / 간호행정학회지

PURPOSE: The purpose of this study was to examine the effectiveness of Action Research (AR) approach in nursing. METHODS: Participants were 64 perioperative nurses recruited from C hospital in Gwangju, Korea. The nurses were engaged in the project through 2 cycles of planning, acting, observing, and reflecting. A mixed-methods design was used to examine changes in participants and their knowledge management practice. Quantitative data were analyzed using SPSS 20.0 program and qualitative reflection data underwent content analysis. RESULTS: During the project, participants developed standardized pre-operative checklists and opened an Internet Cafe to better manage their perioperative nursing information. At the end of the project, there was a significant increase in nurses' knowledge management (p=.015) and the rate of surgical material prescription errors decreased from 8.0% to 2.9%. Core AR project team members' teamwork skills and organizational commitment increased significantly (p=.040, p=.301, respectively). The main themes that emerged from the qualitative data were learning how to solve problems in practice, facilitating team activities through motivation, barriers of large participation, and rewarded efforts and inflated expectations. CONCLUSION: The AR project contributed to empowering participants to solve local problems. AR is a useful methodology to promote changes in practices and research participants.

Comparison of Reflection Hierarchy, Team Learning Climate, and Learning Organization Building on Nursing Competency in Clinical Nurses / 간호행정학회지

PURPOSE: The purpose of this study was to identify clusters of nursing competency, and investigate the influence of reflective thinking, team learning climate, and learning organization building according to nursing competency clusters. METHODS: Participants were 244 clinical nurses who worked in 4 general hospitals in Gwangju Metropolitan City. Data were collected by self-report questionnaires during June and July, 2011. Nursing competency, levels of reflection hierarchy, team learning climate, and learning organization building were measured. Data were analyzed using frequencies, means, t-test, one-way ANOVA, Pearson correlation coefficients, and K-means cluster analysis with SPSS/WIN 20.0 version. RESULTS: Nursing competency correlated positively with intensive reflection, reflection, team learning climate, and learning organization building (p<.001). There were three clusters of nursing competency in a clinical ladder, which were derived from cluster analysis, grouped as high, middle, and low competency. Intensive reflection, reflection, team learning climate, and learning organization building showed significant differences according to grouping of nursing competency. CONCLUSION: The results indicate that developing intensive reflection, reflection, team learning climate, and learning organization building would be useful strategies for enhancement of nursing competency.

Creation of Intellectual Capital in Hospital Organizations and Factors Influencing Creation of Intellectual Capital / 간호행정학회지

PURPOSE: This study was designed to identify creation of intellectual capital and factors influencing the creation of intellectual capital in hospital organizations. METHODS: A cross-sectional design was used, with a convenience sample of 300 nurses from three general hospitals in Gwangju and South Cholla province. The tools used for this study were scales measuring creation of intellectual capital (8 items), social capital (20 items), knowledge management (8 items). Data was analyzed with descriptive statistics, Pearson's correlation coefficient and regression using the SPSS WIN 18.0 program. RESULTS: There were significantly positive relationships between social capital and knowledge management with creation of intellectual capital. The mean score for creation of intellectual capital in hospital organizations was 4.59 points. Factors influencing creation of intellectual capital in hospital organization were identified as knowledge management (beta=.625), shared values & action (beta=.166), and participation in civic activities (beta=.118). These factors explained 59.3% of the variance in creation of intellectual capital in hospital organizations. CONCLUSION: The results indicate which factors are major factors influencing creation of intellectual capital and therefore, serve as predictors of creation of intellectual capital in hospital organizations.

Effects of Action Learning Approaches on Learning Outcomes in Nursing Management Courses / 간호행정학회지

PURPOSE: The purpose of this study was to identify effects of action learning approaches on learning outcomes of students taking nursing management courses. METHODS: The questionnaire surveys were completed between March 2011 and June 2012 by 109 undergraduate seniors in the nursing department of C University. Survey data were obtained 3 times: before, in and after the study of nursing management. The course consisted of lectures and clinical practices. Learning outcomes were measured through problem solving skills, team efficacy, and class satisfaction. Collected data were analyzed using repeated measures ANOVA with the SPSS 20.0 program. RESULTS: Scores for problem solving skills (F=13.67, p<.001) and team efficacy (F=4.49, p=.012) showed statistically significant increases after the course. The scores also increased significantly after the lectures for 5 of 9 problem solving skill subscales: analysis skill, divergent thinking, decision making, assessment, feedback, and after the clinical practices for 2 subscales: divergent thinking, and execution and risk taking. Class satisfaction score also increased after both the lectures and the clinical practices. CONCLUSION: The findings from this study suggest that an action learning approaches for nursing management courses would be a useful teaching and learning method to achieve learning outcomes.

Development of a Clinical Ladder System for Operating Room Nurses / 간호행정학회지

PURPOSE: This study was a methodological research conducted to develop a clinical ladder system for operating nurses. METHODS: Participants were 20 OR nurses, working in C Hospital, who had a mean tenure of 6 years and 10 months. Data collection consisted of 4 focus group interviews during May and June 2009. The content analysis method of Kim and Lee (1986) was used to analyze the data. Two clinical expert groups consisting of 16 nurses verified the content validity of the preliminary system from September 16 to 26, 2009 using Kim's tool (1999). RESULTS: The final clinical ladder system consisted of goals, core values, and 4 domains of practice related to core values, which were defined as professional value, perioperative nursing practice, education/research, and collaboration/leadership. Eleven nursing competencies and 44 behavior indicators were included in accordance with the 4-step ladder. The 4 operation systems for the clinical ladder system were the promotion system, continuous learning system, reward system, and support system. CONCLUSION: The results indicate that nursing managers need to pay more attention to developing a clinical ladder system for nurses.