Nurse staffing, nurses prioritization, missed care, quality of nursing care, and nurse outcomes.

AIM: To examine the relationships among nurse staffing, nurses prioritization of nursing activities, missed care, quality of nursing care, and nurse outcomes. BACKGROUND: Inadequate staffing is associated with increased missed care, which threatens the quality of care and nurse outcomes. METHODS: The study sample included 2114 staff nurses from 156 medical or surgical units of 49 general hospitals who had participated in a cross-sectional survey conducted in 2015. Nurse staffing was measured using the patient-to-nurse ratio and perceived staffing adequacy. The Missed Nursing Care Survey was used to measure how frequently nurses had missed each of 24 activities. Multilevel regression analyses were employed to examine the relationships among variables. RESULTS: The prevalence of missed care differed by nursing activity. Poorer staffing was associated with an increased number of missed activities. A higher number of missed activities and poorer staffing were associated with poorer patient safety, quality of nursing care and job satisfaction, and a higher intent to leave. Nurses gave the highest priority to focused patient reassessments, timely medications, and patient teaching, under hypothetical conditions of improved staffing. CONCLUSION: Adequate staffing is required to reduce missed care and to improve quality of care and nurse outcomes.

[Analysis of the nursing practice in a medical ICU based on an electronic nursing record].

PURPOSE: The purpose of this study was to identify the entity of critical care nursing practices through analyzing nursing statements described by electronic nursing records in a MICU. METHODS: 176,459 nursing statements of 188 patients during a 6 month-stay were analyzed statement by statement according to the nursing process(nursing phenomena, nursing diagnosis, & nursing activity) and 21 nursing components of Saba's Clinical Care Classification. RESULTS: Among 176,459 single statements, the statements of nursing activity ranked first in number. The contents of the statements were analyzed and categorized by main themes. Among 489 categorized themes, the number of themes of nursing phenomena statements was the highest. When analyzed by Saba's clinical Care Classification, the nursing statements mainly included a physiological component. Among 21 components, the respiratory component ranked in the first position in nursing phenomena, nursing diagnosis and nursing activity. The extra statements not included in the 21 components were 9,294(15.1%) in nursing phenomena and 21,949(22.7%) in nursing activity. Most are statements related to tests and the doctor. CONCLUSION: The entity of MICU nursing practice expressed by electronic nursing records was mainly focused on physiological components and more precisely on respiratory components.

[Stages of change in smoking cessation and factors related to re-smoking after coronary artery bypass graft surgery].

PURPOSE: The purpose of this study was to investigate the stages of change in smoking cessation after a Coronary Artery Bypass Graft(CABG) and to identify the related factors. METHODS: The subjects (n=157) were patients who underwent a CABG in a university hospital from March 1998 to October 2005 and were smokers before the CABG. Data was collected via chart review and a telephone interview, and analyzed with descriptive statistics, chi(2) test, one-way ANOVA, and Kruskal-Wallis procedure by the SPSS/PC win 12.0 program. RESULTS: The subjects smoked for an average of 34 years (21 cigarettes per day) before surgery. Eleven percent of the subjects were in pre-contemplation, 6.4% in contemplation, 13.5% in preparation, 4.5% in action, and 64.5% in the maintenance stage. Nicotine dependence and self-efficacy were different among the groups with different stages of change in smoking cessation. Nicotine dependence was the lowest (p=0.00) and self-efficacy was the highest (p=0.00) in the maintenance stage. The number of subjects in pre-contemplation and contemplation significantly increased 6 years after surgery (p=0.05). CONCLUSIONS: To implement effective smoking cessation interventions for CABG patients, the intervention should be developed to accommodate individual readiness for smoking cessation, especially so for those who had a CABG more than 6 years previously.

[A preliminary survey of nurses' understanding of delirium and their need for delirium education - in a university hospital -].

PURPOSE: The purpose of this survey was to investigate clinical nurses' understanding of delirium and their educational need of delirious patient care. METHOD: A survey questionnaire regarding nurses' general perception and understanding of delirium, experience with delirious patients and educational need was developed and conducted with 179 clinical nurses in a university hospital in Seoul. Data was analyzed using descriptive statistics. RESULTS: Nurses thought that delirium was one of the most important nursing problems and they considered it to be more treatable than to be preventable. However, the majority of nurses were not confident in caring for delirious patients. Nurses reported that delirium happened most often after surgery, and that possible contributing factors could be changes in physical environment and anxiety/stress, as well as medication and long-term isolation. Thirteen nursing interventions were identified but half of the nurses utilized only one or two of the thirteen. The most frequently used intervention was reorienting the patient followed by medication and emotional support, presenting family, and close observation. 99.5% of nurses addressed the importance of professional education on delirium care, especially in the area of intervention and management. CONCLUSION: The results support the strong need for development of a multi-component educational program on delirium care.

A preliminary report on the differences in the perceived impacts of undergraduate bioscience knowledge on clinical practice among Korean RNs.

PURPOSE: Nursing has evolved as a unique and independent field over the last decades. Unfortunately, many nurses in Korea express concern that they lack appropriate background knowledge in bioscience necessary to practice nursing competently. To determine the reasons of their concerns, we examined the perceptions of RNs regarding bioscience courses in their undergraduate (Baccalaureate and 3 year diploma program) and their perceived relations to the practice of nursing. METHODS: The structured questionnaires were sent to 3 university-affiliated tertiary hospitals in Seoul, Korea. RESULTS: The responses given by the nurses in the two groups were similar. The nurses in this study reported that the bioscience courses they took as undergraduates had little relation to their professional tasks. This lack of link between bioscientific knowledge and nursing practice may be partly due to the fact that the courses are taught by non-nursing faculties who are not familiar with nursing tices. It also appears that bioscience knowledge deficit was most prominent during nursing assessment regardless of the program they attended or the unit they are currently working. CONCLUSION: Bioscience courses should be integrated into the nursing curriculum properly and taught by nursing faculty who have a strong background in biological sciences.

The effects of self-efficacy promoting cardiac rehabilitation program on self-efficacy, health behavior, and quality of life.

BACKGROUND: Ischemic heart disease results from athesclerotic changes of the coronary artery. These changes are aggravated by hypercholesterolemia, smoking, obesity, lack of exercise, coronary-prone personality, and stress. Because these risk factors affect not only the prevalence of the ischemic heart disease but also recurrence of the disease, cardiac rehabilitation programs were introduced to help patients with ischemic heart disease reduce risk factors. Diverse cardiac rehabilitation programs are needed to motivate participation in cardiac rehabilitation and to enhance patients' quality of life. OBJECTIVES: To examine the effect of a self-efficacy promoting cardiac rehabilitation program on self-efficacy, health behavior and quality of life of patients with ischemic heart disease. METHODS: Data were collected from 45 hospitalized ischemic heart disease patients. Medical records were reviewed to obtain demographic and clinical characteristics. Data regarding self-efficacy, health behavior, and quality of life were obtained from interviews using structured questionnaires. The nonequivalent control group non-synchronized design was used to conduct this study. One session of conventional group education was given to patients in the control group while they were in the hospital. Patients in the experimental group participated in a newly developed cardiac rehabilitation program. It focused on strengthening self-efficacy with four self-efficacy sources - performance accomplishment, vicarious experiences, verbal persuasion and physical status using two individualized in-hospital education sessions and four weekly telephone counseling follow-up calls after discharge. RESULTS: Four weeks after discharge, the increment of total self-efficacy score was significantly higher in the experimental group than in the control group (p<.01). There was also a significant difference in the total quality of life scores increments between the two groups (p<.01). However, no significant changes were noted in the increments of total health behavior scores between the two groups. CONCLUSION: A cardiac rehabilitation program focusing on promoting self-efficacy was effective in improving self-efficacy, and quality of life of patients with ischemic heart disease.