Effects of registered nurse staffing levels, work environment, and education levels on adverse events in nursing homes.

This study examined the effects of nurse staffing levels, work environment, and education levels on adverse events in nursing homes. A cross-sectional study was conducted involving 216 nurses working in 62 nursing homes in South Korea, using self-reported questionnaires and data from the National Health Insurance Service of South Korea. A logistic regression model was used to investigate the effects of nurse staffing levels, work environment, and nursing education levels on the adverse events experienced by residents. An increase of one resident per nurse was significantly associated with a higher incidence of medication error, pressure ulcers and urinary tract infections. A poor work environment increased the incidence of adverse events. Compared to nurses with a bachelor's degree or higher, those with diplomas reported increased incidence rates of pressure ulcers. Improving the health outcomes of residents in nursing homes requires efforts that strengthen the nursing workforce in terms of numbers and educational level, and which improve their work environment at institutional and policy levels.

Sonerilacardamomensis (Melastomataceae), a new species from Cambodia.

Sonerilacardamomensis, a new species of family Melastomataceae from the Central Cardamom Protected Area in Koh Kong province of southwestern Cambodia, is described and illustrated. The species is similar to S.violifolia Hook.f. ex Triana, but is readily distinguished by its cordate leaf base, lack of setae at the nodes, longer pedicels, smaller petals, smaller hypanthiums and smaller capsules.

Development and Validation of the Nursing Home Care-related Quality of Life Scale.

OBJECTIVES: We developed an instrument to assess nursing home residents' quality of life (QOL), with a focus on QOL-related factors modifiable through nursing home care, within the South Korean context; then, we tested its validity and reliability. DESIGN: The scale was constructed through a literature review, qualitative interviews, expert panel review, and a focus group interview; then, it was validated through survey research. SETTING AND PARTICIPANTS: Residents (N = 667) from 42 nursing homes in South Korea participated in scale validation. METHODS: Ninety-nine items across 5 dimensions were initially drafted through a literature review and qualitative interview data. The expert panel review and a focus group interview yielded a scale with 31 items across 3 dimensions. Next, using survey data from nursing home residents, we examined the construct and concurrent validity and reliability (using Kuder-Richardson 20) of the 31-item QOL scale. RESULTS: Through a series of factor analyses, the 31 items were reduced to 17 items across 2 dimensions: Environment and Services (13 items) and Social Interaction (4 items). This 17-item scale was further examined for model fitness and reliability. The scale had acceptable to good fit (root mean square error of approximation = 0.07 and 0.07; comparative fit index = 0.83 and 0.98 for Environment and Services and Social Interaction, respectively), and good concurrent validity and internal consistency (Kuder-Richardson 20 = 0.72). CONCLUSIONS AND IMPLICATIONS: This 17-item scale is a valid and reliable tool to assess nursing home residents' QOL in South Korea, with a focus on factors modifiable through nursing home care. Through more research to test its usefulness, validity, and reliability, the scale can be used as an index of nursing home care quality and contribute to the development of strategies to improve nursing home residents' QOL.

Older Adult Residents' Perceptions of Daily Lives in Nursing Homes.

PURPOSE: This study aimed to explore older adults' perceptions of their daily lives in South Korean nursing homes. DESIGN: We employed a qualitative descriptive study using semistructured interviews. METHODS: We conducted individual, semistructured interviews with 21 older adult residents from five nursing homes in South Korea and analyzed the data using thematic analysis. FINDINGS: Five themes related to older adults' perceptions of their daily lives in nursing homes emerged: enhanced comfort, aspiring to maintain physical and cognitive functions as human beings, desire for meaningful interpersonal relationships, feelings of confinement and limited autonomy, and acceptance of and adaptation to life in a facility. These themes indicated the positive and negative aspects of nursing home residence, and facilitators and challenges to enhancing older adult residents' quality of life (QOL). CONCLUSIONS: Policy, practice, and research endeavors are required to improve older adult residents' QOL, such as adequate professional nursing care for physical and psychological comfort and residents' health and functional status, sufficient activity programs and meaningful relationships, person-centered care to enhance residents' autonomy, and homelike environments. CLINICAL RELEVANCE: This study demonstrates that healthcare providers, researchers, and policymakers should consider nursing home residents' QOL to examine the quality of care within the setting and facilitate the development of appropriate strategies to improve QOL among this population.

Activities of daily living and rehabilitation needs for older adults with a stroke: A comparison of home care and nursing home care.

AIM: To compare the changes in benefit levels of activities of daily living (ADLs), rehabilitation, and long-term care services (LTCS) in older adults with a stroke in different modalities of LTCS, which include home care and nursing home care. METHODS: This study analyzed national data regarding LTCS from 2008 to 2009 in South Korea. The data about 7668 older adults with a stroke were extracted from a pool of 182,535 total beneficiaries. In order to control for the baseline differences between older adults who received home care and those who received nursing home care, propensity score matching (PSM) was carried out and there were 1099 matched pairs of participants ( n = 2198). After the PSM, the changes in ADLs and rehabilitation between the two groups were analyzed by using a paired t-test and the changes in LTCS benefit levels were compared by using the χ2 -test. RESULTS: The ADLs and rehabilitation needs of the older adults who received home care improved, while the older adults who received nursing home care experienced deterioration. After 1 year, the LTCS benefit levels were significantly different between the home care and the nursing home care groups CONCLUSION: All of the ADLs, rehabilitation needs, and LTCS benefit levels for 1 year had improved in the home care patients, while they worsened in those who received nursing home care. This finding provides evidence to direct the policy of LTCS and offers information to guide older adults with a stroke and their family when deciding between the modalities of LTCS.

[Predictors of Turnover among New Nurses using Multilevel Survival Analysis].

PURPOSE: The purpose of this study was to examine factors influencing new graduate nurse turnover. METHODS: This study was carried out as a secondary analysis of data from the 2010 Graduates Occupational Mobility Survey (GOMS). A total of 323 nurses were selected for analysis concerning reasons for turnover. Data were analyzed using descriptive statistics and multilevel survival analysis. RESULTS: About 24.5% of new nurses left their first job within 1 year of starting their jobs. Significant predictors of turnover among new nurse were job status, monthly income, job satisfaction, the number of hospitals in region, and the number of nurses per 100 beds. CONCLUSION: New graduate nurses are vulnerable to turnover. In order to achieve the best health of the nation, policy approaches and further studies regarding reducing new graduate nurse turnover are needed.

Nurse staffing level and overtime associated with patient safety, quality of care, and care left undone in hospitals: A cross-sectional study.

OBJECTIVE: The purpose of this study was to explore the association of nurse staffing and overtime with nurse-perceived patient safety, nurse-perceived quality of care, and care left undone. DESIGN: A cross-sectional survey. SETTING AND PARTICIPANTS: A total of 65 hospitals were selected from all of the acute hospitals (n=295) with 100 or more beds in South Korea by using a stratified random sampling method based on region and number of beds, and 60 hospitals participated in the study. All RNs working on the date of data collection in units randomly selected from the list of units in each hospital were invited to participate. The analyses in this study included only bedside RNs (n=3037) and hospitals (n=51) with responses from at least 10 bedside RNs. METHODS: We collected data on nurse staffing level, overtime, nurse-perceived patient safety, nurse-perceived quality of care, nurse-reported care left undone, and nurse characteristics through a nurse survey. Facility data from the Health Insurance Review Agency (HIRA) were used to collect hospital characteristics. Multilevel logistic regression models considering that nurses are clustered in hospitals were used to analyze the effects of hospital nurse staffing and overtime on patient safety, quality of care, and care left undone. RESULTS: A higher number of patients per RN was significantly associated with higher odds of reporting poor/failing patient safety (OR=1.02, 95% CI=1.004-1.03) and poor/fair quality of care (OR=1.02, 95% CI=1.01-1.04), and of having care left undone due to lack of time (OR=1.03, 95% CI=1.01-1.05). Compared with RNs who did not work overtime, RNs working overtime reported an 88% increase in failing or poor patient safety (OR=1.88, 95% CI=1.40-2.52), a 45% increase in fair or poor quality of nursing care (OR=1.45, 95% CI=1.17-1.80), and an 86% increase in care left undone (OR=1.86, 95% CI=1.48-2.35). CONCLUSIONS: Our findings suggest that ensuring appropriate nurse staffing and working hours is important to improve the quality and safety of care and to reduce care left undone in hospitals.

Barriers to performing stretching exercises among Korean-Chinese female migrant workers in Korea.

OBJECTIVE: The purpose of this study was to investigate the barriers to performing stretching exercise experienced by Korean-Chinese female migrant workers during a community-based 12-week stretching exercise intervention trial. DESIGN AND SAMPLE: Qualitative secondary data analysis was conducted using telephone counseling interview transcripts from 27 middle-aged, Korean-Chinese migrant women workers. MEASURES: A semistructured interview question asking barriers to performing stretching exercise was given to women who did not adhere to recommended stretching exercise. During the 12-week home-based stretching exercise intervention trial, six telephone calls were made to participants biweekly to elicit barriers to performing stretching exercise. Directed content analysis approach was utilized using three barrier categories: intrapersonal, interpersonal, and work-related environmental factors based on the ecological model. RESULTS: Participants experienced an average of 2.5 barriers during the study period. Intrapersonal barriers included lack of time and lack of motivation, and interpersonal barriers included no family to provide support and also a feeling resistance from coworkers. Work-related environmental barriers included frequent job changes, long working hours, lack of rest time, and unpredictable job demands. CONCLUSIONS: The findings highlight that migrant workers in Korea face unique work-related difficulties which present barriers to exercise.

Effects of a 12 week self-managed stretching program among Korean-Chinese female migrant workers in Korea: a randomized trial.

AIM: The purpose of this study was to assess the efficacy of a 12 week, self-managed, community-based stretching program on musculoskeletal fitness, musculoskeletal symptoms, and acculturative stress, in Korean-Chinese female migrant workers in Korea. METHODS: This was a randomized controlled trial with random assignment of eligible full-time Korean-Chinese female migrant workers to a stretching exercise intervention (n=40) or an enhanced stretching exercise intervention (n=40) condition. Both conditions received a 6 min stretching exercise program that included an orientation and three work-related musculoskeletal disorder (WMSD) educational classes. Between educational classes, the enhanced stretching exercise condition also received mobile phone text messaging and telephone counseling to increase self-efficacy (confidence in overcoming barriers) and provide social support. Flexibility, muscle strength, musculoskeletal symptoms, and acculturative stress were assessed at baseline and 12 weeks. RESULTS: Significant increase in flexibility was noted for both conditions, but acculturative stress was significantly reduced only in the standard intervention condition. Muscle strength and WMSD symptoms had no significant changes at the 12 week follow up in both conditions. CONCLUSION: The 12 week, self-managed, community-based, stretching exercise program was effective to increase flexibility. The standard stretching intervention without any enhancements may be a more cost-effective way to increase flexibility. Longitudinal studies, however, are needed to see if the long-term effects are greater in the enhanced intervention for the migrant worker population.

Application of community-based participatory research principles: preventing work-related musculoskeletal disorders among female Korean-Chinese migrant workers in Korea.

The primary purpose of this study was to describe the intervention development process using the National Occupational Research Agenda (NORA) research framework. The intervention was then implemented to prevent work-related musculoskeletal disorders among female Korean-Chinese migrant workers living in Korea. The secondary purpose was to determine how community-based participatory research (CBPR) principles could be applied to the intervention development process. A literature review, a focus group of the target population, key informant interviews, and community committee meetings with the researchers were conducted. Several CBPR principles, including developing community resources and promoting an equitable partnership between the researchers and the migrant community, ensured the appropriateness of the stretching intervention program for the ethnic migrant group, promoting program participation. It is suggested that occupational health nurses consider the CBPR approach in program development for underserved migrant workers.