Nursing leaders' perceptions of the state of nursing leadership and the need for nursing leadership education reform: A qualitative content analysis from South Korea.

AIM: This study aimed to clarify nursing leaders' perceptions of nursing leadership education and practice. BACKGROUND: Leadership is an essential competency that is required in nursing practice. It is also necessary to pay more attention to the development of nurses' leadership to improve patient safety and outcomes. METHODS: Participants were 15 nursing leaders. We adopted qualitative content analysis for data collected through individual and/or focus group interviews and analysed using the process of coding, condensing and categorizing. RESULTS: The results revealed the following five major themes with categories: (1) nursing leadership-commitment to nurses, the nursing profession and the organisation; (2) nursing leadership abilities-competency and compatibility, personality and traits; (3) importance of nursing leadership education to enhance educational efficiency and to nurture next-generation nursing leaders; (4) difficulties in nursing leadership education: lack of perception and difficulty of implementation; and (5) strategies for nursing leadership education: contents and methods. CONCLUSIONS: Nursing leaders' perception of nursing leadership was extended to nurses, organisations and nursing professions. Competency, capability, innate personality and traits are required nursing abilities that are acquired through education. IMPLICATIONS FOR NURSING MANAGEMENT: Experience and theoretical-based nursing leadership education should be introduced gradually and systematically from the beginning of nurses' careers.

[Chronically Ill Patients' Perception of Hospital Nurses].

PURPOSE: The purpose of this qualitative research was to investigate chronically ill patients' perception of hospital nurses. METHODS: Individual in-depth interviews and qualitative content analysis were used for data collection and analysis respectively. Participants were 13 chronically ill hospitalized patients or outpatients in three universities hospitals. All interviews were recorded and transcribed verbatim. Data were analyzed using the qualitative content analysis suggested by Graneheim and Lundman (2004). RESULTS: Three themes emerged from the 10 sub-themes, which were categorized from the 21 condensed meaning units by interpreting the underlying meanings. The three themes were "person giving comfort and support by caring", "person facilitating the process of healing", and "person taking the initiative in power relations". Two themes involved positive experiences of patients and the other included negative ones. CONCLUSION: The results showed that the participants perceived the hospital nurses as devoted to caring for patients and facilitating treatments, but authoritative in performing their duty. Based on these results, it is recommended that hospital nurses improve their nursing knowledge, skills and humanistic attitude.

[Development of Job Satisfaction Scale for Clinical Nurses].

PURPOSE: This study was performed to develop the Job Satisfaction Scale for Clinical Nurses (JSS-CN) and verify its validity and reliability. METHODS: A preliminary 42-item version of the JSS-CN was developed through literature reviews and in-depth interviews. The draft scale was developed using thirty-seven items selected following content validity evaluation. Finally, thirty-three items with response options on a 5-point Likert scale were selected based on internal consistency reliability and construct validity. Subsequently, the test-retest reliability and convergent validity of the JSS-CN were verified. RESULTS: Six factors, namely, recognition from the organization and professional achievement, personal maturation through the nursing profession, interpersonal interaction with respect and recognition, accomplishment of accountability as a nurse, display of professional competency, and stability and job worth, were identified, which explained 59.7% of the total variance. The JSS-CN's Cronbach's α for the total scale was .95, and the intra-class correlation coefficient was .90. The correlation coefficient between the scores of the JSS-CN and Slavitt's scale was .75, and that between the JSS-CN and job performance was .53. CONCLUSION: Results showed that the JSS-CN has good reliability and validity. Therefore, it is concluded that the JSS-CN could be a useful tool for the measurement of the job satisfaction of clinical nurses in Korea.

[Experience of Becoming a Father of a High Risk Premature Infant].

PURPOSE: This study was performed to identify the experience of becoming a father of a high risk premature infant. METHODS: Grounded theory was used for this research. The participants were 12 fathers who had premature infants lighter than 2,500g of birth weight, less than 37 weeks of gestational age and having stayed 2 weeks or longer in a NICU right after birth. Theoretical sampling was done to identify participants and indepth interviews were done for the data collection. For data analysis, the process suggested by Corbin and Strauss was used. RESULTS: For these participants the core phenomenon of the experience of becoming a father of a high risk premature infant was 'striving through with belief and patience'. The phenomenon was 'being frustrated in an unrealistic shock'. Contextual conditions were 'uncertainty in the health status of the premature baby' and 'no one to ask for help' and intervening conditions were 'possibility in the health recovery of the premature baby' and 'assistance from significant others'. Action/interaction strategies were 'withstanding with belief in the baby' and 'enduring with willpower as head of the family' and the consequence was 'becoming a guardian of the family'. CONCLUSION: For the participants, the process of becoming the father of a high risk premature infant was striving through the situation with belief in their babies' ability to overcome the crisis and waiting for the babies' recovery with patience.

[Experience of Spiritual Conflict in Hospice Nurses: A Phenomenological Study].

PURPOSE: This aim of this phenomenological study was to describe and understand the experience of spiritual conflict in hospice nurses by identifying the meanings and structures of the experience. METHODS: Participants were 12 nurses working for one year or more at hospice units of general hospitals in a metropolitan city and experiencing of spiritual conflict as hospice nurses. Over six months data were collected using individual in-depth interviews and analyzed with the method suggested by Colaizzi. RESULTS: The experience of spiritual conflict in participants was organized into three categories, six theme-clusters, and 13 themes. The participants felt existential anxiety on death and a fear of death which is out of human control and skepticism for real facts of human beings facing death. They also experienced agitation of fundamental beliefs about life with agitation of the philosophy of life guiding themselves and mental distress due to fundamental questions that are difficult to answer. Also they had distress about poor spiritual care with guilty feelings from neglecting patients' spiritual needs and difficulties in spiritual care due to lack of practical competencies. CONCLUSION: Findings indicate the experience of spiritual conflict in hospice nurses is mainly associated with frequent experience of death in hospice patients. The experience of spiritual conflict consisted of existential anxiety, agitation of fundamental beliefs and distress over poor spiritual care. So, programs to help relieve anxiety, agitation and distress are necessary to prevent spiritual conflict and then spiritual burnout in hospice nurses.

[Leadership Experience of Clinical Nurses: Applying Focus Group Interviews].

PURPOSE: The purpose of this study was to understand and describe the leadership experience of clinical nurses. METHODS: During 2014, data were collected using focus group interviews. Three focus group interviews were held with a total of 20 clinical nurses participating. All interviews were recorded as they were spoken and transcribed and data were analyzed using qualitative content analysis. RESULTS: Fifteen categories emerged from the five main themes. 1) Thoughts on the leadership category: to lead others, to cope with problem situations adequately and to serve as a shield against difficulties. 2) Situations requiring leadership: situation that requires correct judgement, coping and situations that need coordination and cooperation. 3-1) Leadership behaviors: other-oriented approach and self-oriented approach. 3-2) Leadership behavior consequences: relevant compensation and unfair termination. 4-1) Facilitators of leadership: confidence and passion for nursing and external support and resources. 4-2) Barriers to leadership: non-supportive organization culture and deficiency in own leadership competencies. 5) Strategies of leadership development: strengthen leadership through self-development and organizational leadership development. CONCLUSION: In conclusion, the results indicate that it is necessary to enhance clinical nurses' leadership role in healthcare. Enhancement can be achieved through leadership programs focused on enlarging leadership experience, constant self-development, leadership training, and development of leadership competencies suited to the nursing environment.

[Effects of an Integrated Internet Addiction Prevention Program on Elementary Students' Self-regulation and Internet Addiction].

PURPOSE: The purpose of this study was to develop an integrated internet addiction prevention program and test its effects on the self-regulation and internet addiction of elementary students who are at risk for internet addiction. METHODS: A quasi-experimental study with a nonequivalent control group pretest-posttest design was used. Participants were assigned to the experimental group (n=28) or control group (n=28). Contents of the program developed in this study included provision of information about internet addiction, interventions for empowerment and methods of behavioral modification. A pre-test and two post-tests were done to identify the effects of the program and their continuity. Effects were testified using Repeated measures ANOVA, simple effect analysis, and Time Contrast. RESULTS: The self-regulation of the experimental group after the program was significantly higher than the control group. The score for internet addiction self-diagnosis and the internet use time in the experimental group were significantly lower than the control group. CONCLUSION: The effects of the integrated internet addiction prevention program for preventing internet addiction in elementary students at risk for internet addiction were validated.

[Role adaptation process of elementary school health teachers: establishing their own positions].

PURPOSE: The purpose of this study was to explore and identify patterns from the phenomenon of the role adaptation process in elementary school health teachers and finally, suggest a model to describe the process. METHODS: Grounded theory methodology and focus group interviews were used. Data were collected from 24 participants of four focus groups. The questions used were about their experience of role adaptation including situational contexts and interactional coping strategies. Transcribed data and field notes were analyzed with continuous comparative analysis. RESULTS: The core category was 'establishing their own positions', an interactional coping strategy. The phenomenon identified by participants was confusion and wandering in their role performance. Influencing contexts were unclear beliefs for their role as health teachers and non-supportive job environments. The result of the adaptation process was consolidation of their positions. Pride as health teachers and social recognition and supports intervened to produce that result. The process had three stages; entry, growth, and maturity. CONCLUSION: The role adaptation process of elementary school health teachers can be explained as establishing, strengthening and consolidating their own positions. Results of this study can be used as fundamental information for developing programs to support the role adaptation of health teachers.

[Experience in acceptance of hospice by patients with terminal cancer: a phenomenological research].

PURPOSE: The purpose of this study was to further understanding of the experience in acceptance of hospice by patients with terminal cancer and to explore the structure of this experience. METHODS: A phenomenological methodology was used for the study. Participants were nine patients who were admitted to the hospice unit of a university hospital. In-depth interviews were done for data collection and the data were analyzed using Colaizzi's method. RESULTS: Four categories, eight theme clusters and 18 themes were identified for the experience in acceptance of hospice by patients with terminal cancer. The three categories were 'Hope for a comfortable death', 'Overcoming barrier of prejudice about hospice', 'Incessant craving for life', 'The last consideration for self and family'. CONCLUSION: While accepting the hospice care, participants experienced inner conflict between giving up medical treatments that prolong life and choosing a comfortable death, and also experienced an incessant craving for life. By accepting hospice care, they showed a human dignity that entails careful concerns for both self and family members.

[Experience of job satisfaction in clinical nurses: application of focus group methodology].

PURPOSE: The purpose of this study was to describe the experiences of job satisfaction in clinical nurses. METHODS: Data was collected from three focus groups composed of 17 hospital nurses. Each focus group had an interview for an average of two and a half hours with the guidance of researchers. The main question was "how do you describe your lived experience of job satisfaction as a clinical nurse?" Qualitative data from the field notes and transcribed notes were analyzed using a grounded theory methodology developed by Strauss and Corbin. RESULTS: The core category of experience of job satisfaction in clinical nurses was identified as "Finding success." Supportive interpersonal relationships and environment affected this category. In the process of attaining job satisfaction through finding success, the participants were using four interactional strategies such as giving meaning, finding self-esteem, extending the horizon of life, and strengthening self-capability. The dimensions of job satisfaction in clinical nurses were the sense of achievement, stability, and pride. CONCLUSION: The results of this study yields very useful information for nursing managers to design a program which enhances job satisfaction of clinical nurses based on interactional strategies.