Effect of Nurses' Emotional Labor on Customer Orientation and Service Delivery: The Mediating Effects of Work Engagement and Burnout

BACKGROUND: The emotional labor performed by organization members affects psychological well-being at the individual level, which consequently affects results at the organizational level. Moreover, despite evidence that the customer orientation and service level of nurses greatly affect hospital management, studies that comprehensively analyze emotional labor, work burnout, and work engagement related to customer orientation and service level are lacking. This study investigated relationships and paths by designing a model of the effect of emotional labor performed by nurses on the level of service delivery and customer orientation. METHODS: This survey-based study was based on a path analysis designed to verify a hypothesized model involving emotional labor performed by nurses, level of service delivery, customer orientation, work engagement, and burnout. Questionnaires were distributed to 378 nurses in general hospitals with more than 500 beds located in Seoul, Republic of Korea, between March 25 and April 8, 2013. RESULTS: The results showed that deep acting and work engagement had direct and indirect effects on increasing the level of service delivery and customer orientation of nurses. However, surface acting had an indirect effect on reducing the level of service delivery and customer orientation. CONCLUSION: It would be more effective to develop interventions to enhance deep acting and work engagement than to attempt to reduce surface acting and work burnout in clinical nursing settings.

A Predictive Model on North Korean Refugees' Adaptation to South Korean Society: Resilience in Response to Psychological Trauma

PURPOSE: This study investigated prediction of North Korean refugees' adaptation to the South Korean society and verified the goodness of fit between a hypothetical model and actual data in order to suggest the best model. METHODS: This survey was conducted with 445 North Korean refugees living in a metropolitan area. Data were collected from September 1st to November 20th, 2012, and analyzed using SPSS Windows 18.0 and AMOS 17.0. RESULTS: Traumatic experiences of North Korean refugees increased self-efficacy and psychological trauma. Acculturation stress decreased self-efficacy and increased passive coping. Self-efficacy affected active and passive coping, decreased psychological trauma, and increased resilience. Resilience is successful adaptation and refers to North Korean refugees' abilities to adapt effectively to stress. In particular, self-efficacy as the main parameter affecting resilience was confirmed. CONCLUSIONS: The results suggest that resilience can be improved through self-efficacy. It was the most significant factor decreasing psychological trauma and increasing resilience. Therefore, we need to develop programs for self-efficacy. The results also provide basic data for policy making for North Korean refugees.

Effects of Nurses' Perception of Servant Leadership on Leader Effectiveness, Satisfaction and Additional Effort: Focused on the Mediating Effects of Leader Trust and Value Congruence

PURPOSE: This study was done to examine the effects of nurses' perception of servant leadership on leader effectiveness, satisfaction and promoting additional effort. The focus was the mediating effects of leader trust and value congruence. METHODS: Data were collected from 361 RN-BSN students and nurses participating in nationally attended in-service training programs. Data were analyzed using descriptive statistics and structural analysis with SPSS 17.0 windows program and Amos 7.0. RESULTS: Direct effects of nurses' perception of servant leadership were negative, but mediating effects of trust and value congruency were positively correlated with leader effectiveness, satisfaction and additional effort, that is servant leadership should be effective through mediating factors. CONCLUSION: The study results indicate that if the middle managers of nurses can build leader trust and value congruency between nurses through servant leadership, leader effectiveness, satisfaction and additional effort on the part of the nurses could result in a positive change in the long term.

Effects of Normal Saline for Maintenance of Arterial Lines of Surgical Patients

PURPOSE: The purpose of this study was to analyze the effectiveness of saline solution vs. heparinized-saline for maintenance of arterial lines and to detect changes in platelet and aPTT as physiological indexes. METHODS: In this nonequivalent control group, non-synchronized, double-blind study the effects of heparinized and saline solution on the maintenance of arterial lines were compared. Fifty five patients received the heparinized solution and fifty nine patients received the saline solution. All patients who had surgery in K-university hospital between September and December 2011 were eligible for participation in the study. RESULTS: There was no statistically significant difference between the saline and the heparin group in the maintenance time of the arterial lines or the number of irrigations. There was no statistically significant difference between the groups in changes in the number of platelets and aPTT for interaction between the groups and time intervals. CONCLUSION: The results indicate that saline solution can be used as an irrigation solution for the maintenance of arterial lines of adult surgical patients, rather than heparinized-saline, in view of potential risk factors in the use of heparin.

Effects of Thera-Band(R) Resistance Training Including Isometric Exercise in Total Knee Replacement Patients

BACKGROUND: The purpose of this study was to assess the effects of an exercise program using isometric and isotonic thera band exercises. METHODS: Data were collected from 30 total knee replacement patients hospitalized in the orthopedics department at 'B' hospital (control=15, experimental=15). The control group performed isometric exercises for one week while the experimental group performed three or more rounds of both isometric and isotonic exercises, including Thera-Band(R) exercises, everyday for four weeks. RESULTS: The experimental group improved significantly in muscular strength (Z=-1.99, P=0.047) and self-efficacy (Z=19.48, P=0.000), and showed lower levels of depression than the control group (Z=8.60, P=0.003). However, no difference was found in pain experience between the two groups. CONCLUSIONS: Exercise programs using the isometric and Thera-Band(R) resistance training improve muscular strength and self-efficacy and relieve depression in total knee replacement patients.

A Predictive Model on Turnover Intention of Nurses in Korea

PURPOSE: The purpose of this study was to propose and test a predictive model that could explain and predict Korean nurses' turnover intentions. METHODS: A survey using a structured questionnaire was conducted with 445 nurses in Korea. Six instruments were used in this model. The data were analyzed using SPSS 15.0 and Amos 7.0 program. RESULTS: Based on the constructed model, organizational commitment, and burnout were found to have a significant direct effect on turnover intention of nurses. In addition, factors such as empowerment, job satisfaction, and organizational commitment were found to indirectly affect turnover intention of nurse. The final modified model yielded chi2=402.30, p<.001), chi2/df=2.94, RMSEA=0.07, RMR=0.03, GFI=0.90, AGF=0.87, NFI=0.88, CFI=0.92 and good fit indices. CONCLUSION: This structural equational model is a comprehensive theoretical model that explains the related factors and their relationship with turnover intention in Korean nurses. Findings from this study can be used to design appropriate strategies to further decrease the nurses' turnover intention in Korea.

Contingent Nurses' Burnout and Influencing Factors

PURPOSE: This study was designed to identify burnout and factors influencing burnout in contingent nurses. METHODS: A cross-sectional design was conducted with a sample of 228 contingent nurses randomly selected from 25 general hospitals in Korea. The tools used for this study were scales measuring burnout (8 items), job stress (8 items), job satisfaction (9 items), self efficacy (9 items), organizational commitment (9 items), empowerment (9 items), autonomy (7 items) and social support (8 items). The data were analyzed using SPSS 15.0 employing Pearson correlation coefficients and multiple regression analysis. RESULTS: The mean score for burnout in contingent nurses was 3.05 points. Factors influencing burnout in contingent nurses were identified as job stress (beta=.40), satisfaction level with current ward (beta=-.25), organizational commitment (beta=-.21), job satisfaction (beta=-.19) and empowerment (beta=-.16). These factors explained 65.0% of burnout reported by contingent nurses. CONCLUSION: The results indicate which factors are major factors influencing burnout in contingent nurses in general hospitals. Therefore, these factors may serve as predictors of burnout in contingent nurses.

New Nurse Turnover Intention and Influencing Factors

PURPOSE: The study was done to identify turnover intention in new nurses according to characteristics of the nurses and other factors affecting turnover and to provide data to set up a strategy to reduce the turnover. METHODS: Data were collected from 1,077 new nurses who had less than 12 months employment experience and worked in one of 188 hospitals. Eight research instruments were used. Data analysis was done using SPSS WIN 15.0 program. RESULTS: Several factors influence new nurse turnover intention. The average score for turnover intention was 2.12. The scores for subscales were self efficacy, 3.76, nursing performance, 3.90, job satisfaction, 2.09, organization commitment, 1.28, stress, 1.32, burnout, 2.82 and nursing organizational culture, 3.29. Turnover intention was related to self efficacy, nursing performance, job satisfaction, organization commitment, stress, burnout, nursing organizational culture, duration of in-class training, duration of on the job training, number of hospital beds, length of employment and duration of employment in current workplace. The predicting factors for turnover intention were burnout, stress, duration of employment in the current workplace, self efficacy and nursing performance. Those factors explained 51.6% of turnover intention. CONCLUSION: New nurse turnover intention can be reduced by mitigating the factors affecting this intention.

The Effects of Danjeon Breathing Exercise on Vital Capacity, Physical Fitness, Anxiety and Depression among Older Adults

PURPOSE: The purpose of this study was to examine the effects of Danjeon Breathing Exercise (DBE) on vital capacity, physical fitness, anxiety and depression among older adults. METHODS: This study employed the nonequivalent control group pretest-posttest design. The experimental group participated in a 12-week DBE program. Vital capacity and physical fitness were measured with a health measurement system (HELMAS). Anxiety and depression were measured with SCL-90-R-K. Data were collected from 37 community-dwelling older adults (experimental group=21, control group=16) in the Seoul metropolitan area. The data were analyzed by chi2-test, Mann-Whitney test and ANCOVA. RESULTS: The experimental group taking DBE reported significant increases in flexibility than the control group, but differences in vital capacity and balance were not significant. Older adults taking DBE showed significant decreases in the anxiety and depression levels. CONCLUSION: A DBE program may be a useful nursing intervention for older adults to improve their flexibility and to reduce anxiety and depression.

Predictors of Employment Intention for Mentally Disabled Persons / 간호학회지

PURPOSE: This study was conducted to determine the predictors of employment intention for mentally disabled persons. METHODS: Mentally disabled persons who had participated in rehabilitation programs in one of 16 mental health centers and 9 community rehabilitation centers located in Seoul and Kyunggi province were recruited for this study. A random sampling method was used and 414 respondents were used for final analysis. Data was analyzed by Pearson's correlation, and stepwise multiple regression using the SPSS Win 14.0. RESULTS: The predictors influencing employment intention of the mentally disabled person were observed as employment desire (beta=.48), guardian's expectation (beta=.26), professional's support (beta=.23), financial management (beta=.10), eating habits (beta=.07), and quality of life (beta=-.01). Six factors explained 61.1% of employment intention of mentally disabled persons. CONCLUSION: The employment intention of a mentally disabled person was influenced by employment desire, diet self-efficacy, guardian's expectation, professional's support, quality of life, financial management and eating habits.

A Study on the Sustainable Effects of Reeducation on Cardiopulmonary Resuscitation on Nurses' Knowledge and Skills / 간호학회지

PURPOSE: This study was to analyze the sustainable effects of cardiopulmonary resuscitation (CPR) reeducation on nurses' knowledge and skills. METHODS: A repeated experimental design was used for a single sample group of 47 nurses working for a general hospital. The nurses were tested on their skill of CPR 3 times at an interval of 4 months. In order to test nurses' knowledge and skills, the researcher used a CPR assessment program linked to an adult practice doll (Anne). RESULTS: 1) The amount of decrease of nurses' knowledge about CPR between points of time was wide between the first and second points of time but small between the second and third time owing to the effects of reeducation between the two points of time. 2) Nurses' skills between the first and second time dropped but they improved between the second and third time owing to the effects of reeducation. CONCLUSION: As confirmed by the above findings, reeducation of CPR clearly affects nurses' knowledge and skills. Given the fact that the same period of time (4 months) elapsed between the 3 tests, it could be argued that the reeducation at the second test served to maintain nurses' knowledge and enhance their skills.

Effects of Muscle Strengthening Exercises Using a Thera Band on Lower Limb Function of Hemiplegic Stroke Patients / 간호학회지

PURPOSE: This study was to verify the effect of muscle strengthening exercises using a Thera-Band on the lower limbs. METHODS: The design utilized for this study was a nonequivalent control group pretest-posttest design. A control group (16) and experimental group (16) were selected from stroke patients of K Oriental Medicine Hospital who were hospitalized for 5 months from December 2005 through April 2006. While only acupuncture therapy and physical therapy were used on the control group, acupuncture, physical therapy and additional muscle strengthening exercises using a red thera band were used on the experimental group. Muscle strengthening was performed 20 minutes per session, more than one session a day for 4 weeks. Hypotheses for this study were verified using Two-way repeated ANOVA and ANCOVA using a pre test score as a covariate. RESULTS: The experimental group with thera band muscle strengthening exercises showed a decrease in asymmetry weight loading percentage(F=14.704, P= .010), range of knee (Z=-3.15, P= .001) & deep tendon reflex score(Z=-2.52, P= .012) and moving performance(F=12.328, P= .001)compared to the control group. CONCLUSION: It is confirmed that muscle strengthening exercises using a Thera-Band can be used as an effective nursing intervention to improve the function of the lower limb of hemiplegic stroke patients.

Predicting Factors on Eating Behavior in Coronary Artery Disease Patients / 간호학회지

PURPOSE: This study was aimed to identify the factors that influence eating behaviors in coronary artery disease patients and to create data for nursing which is thought to improve the eating behavior. METHOD: The study population was coronary artery disease patients who were treated on an outpatient basis. The measurements were eating behavior, diet self-efficacy, perceived-benefits, perceived-seriousness, family support and medical team support. All of the measurement tools above were thoroughly modified to verify validity and reliability. Statistical analysis was done by the SPSS PC 12.0 program. RESULTS: The influencing factors for the eating behavior was diet self-efficacy (beta=0.476), social support (beta=0.253), chest pain (beta=0.177), smoking (beta=-0.173) and regular exercise (beta=.169), which explained 46.2%. CONCLUSION: Eating behaviors of coronary artery disease patients were influenced by diet self-efficacy, family support and the presence of chest pain. Therefore, the development of a program for efficient dietary education that prevents the progression of coronary artery disease is needed.

Development of E-Mail Education for Hyperlipidemia Health Check-up and Application Effects / 간호학회지

PURPOSE: This study was to monitor the effects of forming desirable eating and exercise habits and change the blood lipid levels by developing and applying E-Mail educational programs for a hyperlipidemia health check-up. METHOD: The research design used a nonequivalent control group pre-post test. Ninety-nine subjects (Exp.=50, Cont.=49) were selected randomly and the male subjects agreed to a hyperlipidemia health check-up at a comprehensive medical screening center. This study verified validity and reliability through factor analysis on a life habit measurement tool. The data was analyzed with SPSS win 12.0 using an chi-square-test,t-test, ANOVA and ANCOVA. RESULT: Eatingand exercise habit scores of the experimental group which were educated through E-Mails changed considerably more than that of the control group which was not educated. Total-cholesterol and LDLcholesterol in the experimental group was considerably lower than that in the control group, but HDL-cholesterol increased considerably. Triglycerides, however, didn't show change. CONCLUSION: An E-Mail educational program may be applied as a hyperlipidemia health check-up nursing intervention strategy.

Influencing Factors on Self-Esteem in Adolescents / 간호학회지

PURPOSE: This research has been conducted in order to understand the major factors that affect self-esteem of adolescents. METHODS: Data was collected by questionnaires from 1155 students at middle and high school in Seoul and Kyungkido, Korea. The Instrument tools utilized in this study were self-esteem, body-image, problematic behavior, depression, school adjustment, social support tool and thoroughly modified to verify validity and reliability. The collected data have been analyzed using SPSS 11.0 program. The variable of family harmony and counseling partner was treated as a dummy variable. Seven outliers which were bigger than 3 in absolute value were found, so after taking them off, Multiple Regression was used for further analysis. RESULT: The major factors that affect self-esteem of adolescents were depression, social support, body-image, problematic behavior, school adjustment, and family harmony, which explained 54.7% of self-esteem. CONCLUSION: It has been confirmed that the regression equation model of this research may serve as a self-esteem prediction factors in adolescents.

Influencing Factors on Self-Esteem in Adolescents / 간호학회지

PURPOSE: This research has been conducted in order to understand the major factors that affect self-esteem of adolescents. METHODS: Data was collected by questionnaires from 1155 students at middle and high school in Seoul and Kyungkido, Korea. The Instrument tools utilized in this study were self-esteem, body-image, problematic behavior, depression, school adjustment, social support tool and thoroughly modified to verify validity and reliability. The collected data have been analyzed using SPSS 11.0 program. The variable of family harmony and counseling partner was treated as a dummy variable. Seven outliers which were bigger than 3 in absolute value were found, so after taking them off, Multiple Regression was used for further analysis. RESULT: The major factors that affect self-esteem of adolescents were depression, social support, body-image, problematic behavior, school adjustment, and family harmony, which explained 54.7% of self-esteem. CONCLUSION: It has been confirmed that the regression equation model of this research may serve as a self-esteem prediction factors in adolescents.

The Effects of a Health Promotion Program for Elderly / 간호학회지

PURPOSE: The purpose of this study was to develop and to evaluate a health promotion program for elderly. METHOD: Subjects were 63 elderly women (experimental group:33, control group:30). The study was a nonequivalant control group pretest-posttest design. The data was analyzed with an SPSS Window program, then the data was computed for the purpose of each study. RESULT: 1. In designing the program, the experimental group was given health education - 2 times per week, for 8 weeks - and they participated in recreation programs and stretching exercises five times a week. 2. Stretching exercises including health education, significantly affected the total Cholesterol, HDL-cholesterol, triglycerides, health behavior and self-efficacy. 3. The body fat weight was not significantly affected by the stretching exercises. CONCLUSION: This program was tested to promote the health of elderly and verified as an effective nursing intervention program, because the outcome of this program ascertains that this program enhances self efficacy of exercise, reduces Cholesterol and triglyceride levels' increases HDL-cholesterol, and helps promote the understanding of heath behavior.

Development of a Scale to measure the Effectiveness of Oriental Nursing Education / 간호학회지

PURPOSE: The aim of this study was to design and evaluate a scale for measuring reliability and validity in the field of oriental nursing education. METHOD: A questionnaire was administered to 495 university nursing students using a convenience sampling method. The period of time for collecting data was from September 2003 to January 2004. RESULT: The derived outcome tool consisted of 6 factors and 22 inquires on the basis of a conceptual frame of three domains (knowledge, attitude, and skill), As a result of the item analysis, 22 items were selected and the internal consistency alpha coefficient was .767. The value of Cronbach' Alpha of knowledge(factor 1) was .885, attitude(factor2)was .756, and skill (factor 3) was .610. The three factors accounted for 65.110% of the variance in the total scale. Addressing the explanatory variance of each domain Cognitive domain was 22.477%, affective domain was 20.543%, and psychomotor domain was 17.090%. CONCLUSION: Further studies need to be done to verify educational evaluation and apply our outcomes to oriental nursing education.

Factors Predicting Depression in Hemodialysis Patients / 간호학회지

PURPOSE: This study was done to provide fundamental data for developing a depression prediction model by discovering main factors that affect depression in patients who do maintenance hemodialysis. METHOD: The subjects were 191 patients doing maintenance hemodialysis selected from outpatient dialysis clinics at 9 major general hospitals, The Instrument tools utilized in this study were adapted from depression, fatigue, sleep disturbance, stress, adaptation,symptoms, daily activities, and role limitation and thoroughly modified to verify reliability and validity. The collected data was analyzed with a SPSS-PC 11.0 Window Statistics Program for real numbers, percentage, average, standard deviation, and multiple regression. RESULTS: The correlation factor for depression was (M=2.54) fatigue(M=3.12), sleep disturbance (M=2.82), stress(M=3.04), adaptation(M=2.53), daily activities(M=2.24), symptoms(M=2.37), and role limitation(M=2.24). The strongest factor that affected depression was explained by symptoms of the patients who performed hemodialysis. The analysis of the factors that affected depression revealed a 58.4% prediction in symptoms, stress, role limitation, and adaptation. CONCLUSION: It has been confirmed that the regression equation model(Depression=7.351 + .266*symptoms + .260*stress -.189*adaptation + .057*fatigue) of this research may serve as a prediction factor for depression in Hemodialysis Patients.

Effecting Factors on Depression in Patients with Fibromyalgia / 간호학회지

PURPOSE: The purpose of this research was to provide basic data in the control of depression found in patients with fibromyalgia by analysing the main factors that affect them. METHOD: The subjects were 207 out-patients in three university medical centers diagnosed with fibromyalgia according to the conditions by American College of Rheumatology (1990). Depression was measured by the CES-D Scale. Dependant variables, such as stress and anxiety were measured by the VAS Scale and physical activity was measured using 10(4-point-scale) questions developed by the researcher. The number of tender points was converted to scores based on the criteria of the ACR(1990) and of Yunus. Self-efficacy was measured by the Self-Efficacy Scale developed by Lorig et al.(1989) for arthritis patients. RESULT: The main factors that affect depression of patients with fibromyalgia were self-efficacy, anxiety, physical activity, tender points fatigue, and family support, which explained 49% of the depression. CONCLUSION: It has been confirmed that the regression equation model of this research may serve as a predictor of depression in patients with fibromyalgia.