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The novel coronavirus disease 2019 (COVID-19) spread rapidly worldwide. Nursing home (NH) residents are the most vulnerable high-risk population to infection. Professional registered nurses’ (RNs’) infection control is irreplaceable. We used a secondary data analysis method using the government's senior citizen welfare department large data set about all NHs (N = 3,389) across Korea between January 20 and October 20, 2020. Bed size positively associated with the mortality rate (No. of COVID-19 resident deaths / No. of total residents) ( p = .048). When the proportion of RNs to total nursing staff was higher, the infection rate was 0.626% lower ( p = .049), the mortality rate was 0.088% lower ( p = .076), the proportion of confirmed COVID-19 cases per resident out of the total number of NHs was 44.472% lower ( p = .041), and the proportion of confirmed COVID-19 deaths per resident out of the total number of NHs was 6.456% lower ( p = .055). This study highlighted nurse staffing criteria and suggests that increasing RNs in NHs will reduce infection and mortality rates during the COVID-19 pandemic. We strongly suggest NHs hire at least one RN per day to properly function, and a minimum of four RNs to provide a fully competent RN workforce in long-term care settings in Korean NHs.

This study aimed to investigate the effect of organizational factors and nursing staff in geriatric hospitals on COVID-19 incidences and deaths. This study is a retrospective study using secondary data from governments nationwide in Korea. We used the number of COVID-19-confirmed cases and deaths among geriatric hospital patients and nurse staffing levels. When the registered nurse (RN) level was higher than the sample mean, the number of COVID-19-confirmed cases by geriatric hospital was significantly lower (4.302%; p = .049) and the number of deaths by geriatric hospitals was marginally significantly lower (1.436%; p = .053). This study presented the national description of geriatric hospitals during the COVID-19 pandemic for patients in terms of organizational and nursing staff factors. Our findings highlight the impact of nurse staffing skill mix and the number of geriatric hospitals related to the COVID-19 pandemic in Korea. It is necessary to allocate a realistic designation of infection-control staff and establish a clear standard so infection-control activities in geriatric hospitals can proceed systematically.

We aimed to evaluate the usability of a smartphone application consisting of standardized nursing language (SNL) using NANDA, Nursing Intervention Classification, and Nursing Outcome Classification for nursing home nurses.Applying convenience sampling, a total of 14 experts and 15 real users were invited to test and evaluate the smartphone application independently. For the usability evaluation of the developed application, the Korean version of the Mobile Application Rating Scale for experts and Mobile Application Rating Scale: User Version developed by Stoyanov et al. were used.Both groups determined that the SNL application was quite informative about SNL and efficient function; however, the engagement was quite lower than other categories.Although SNLs were scientifically developed for several decades, the widely available technological application for registered nurses in different languages is urgently needed to improve quality of nursing care.The identified problems and recommendations by users and experts using heuristic evaluation will be reflected in the application's final version to be used for research.

(1) Background: The nursing home (NH) research field lacks quality reporting about meta-analyses (MAs), and most gradings of MA evidence are biased on analyzing the effectiveness of independent variables in randomized control trials. (2) Objectives: This study aimed to perform a critical methodological review of MAs in the NH research field. (3) Methods: We searched the articles from four databases (PubMed, MEDLINE, CINAHL, and PsycINFO) until 15th January 2021. We reviewed a total of 41 published review articles in the NH research field. (4) Results: The studies primarily fell into the following categories: medicine (17/41), nursing (7/41), and psychiatry or psychology (6/41); 36.6% of the reviewed studies did not use any validated MA guidelines. The lowest correctly reported PRISMA 2000 guideline item was protocol and registration (14.6%), and more than 50% of articles did not report risk of bias. Moreover, 78.0% of studies did not describe missing reports of effect size formula. (5) Discussion: NH researchers must follow appropriate and updated guidelines for their MAs in order to provide validated reviews, as well as consider statistical issues such as the complexity of interventions, proper grouping, and scientific effect-size calculations to improve the quality of their study. Future quality review studies should investigate more diverse studies.

This study aimed to identify the terminologies of NANDA-I, NOC, NIC, and NNN linkages that have been used for nursing home (NH) residents. This study used a retrospective descriptive design. Data accrued from 57 registered nurses (RNs) in 25 Korean NHs. The RNs randomly selected one resident and assessed for applied NANDA-I, NOC, and NIC from the previous 7 days by reviewing nursing charts and records. Finally, the data of 57 residents in 25 NHs were collected. Results: We identified seven NNN linkages: risk for falls–fall prevention behavior–fall prevention, self-care deficit: bathing/hygiene–self-care: activities of daily living (ADL)–self-care assistance: bathing/hygiene, impaired memory–memory–cognitive stimulation, chronic confusion–neurological status: consciousness–medication management, chronic confusion–memory–medication management, impaired walking–mobility–exercise promotion: strength training, and impaired walking–ambulation–exercise promotion: strength training. The identified core NANDA-I, NOC, NIC, and NNN linkages for NH residents from this study provide a scope of practice of RNs working in NHs.

This study aimed to investigate the effects of psychosocial work environment on the retention intentions of care coordinators taking care of patients with chronic illness. A descriptive survey study was conducted with a convenience sample of care coordinators who organized patients and treatment teams that offered professional and persistent treatment. A total of 132 participants were recruited from 19 October to 19 November 2020. The data were analyzed through descriptive statistics, t-tests, ANOVA, Scheffé post hoc, and hierarchical multiple regression using SPSS 26.0. The results showed that work organization and job content (β = 0.254, p = 0.014) and value at the workplace (β = 0.245, p = 0.034) had significant effects on the retention intentions of participants. The final model of the study explained 40.1% of participants’ retention intentions (F = 11.830, p &lt, 0.001). The development of educational programs and implementation of policies for improving the psychosocial work environment were found to be essential for increasing the retention intentions of professional care coordinators.

Purpose: The purpose of this study was to investigate what opinions and perceptions people have about nursing and the role of nursing staff in nursing homes (NHs) on Social Networking Service (SNS) by analyzing large-scale data through social big-data analysis. Methods: This study investigated changes in perception related to nursing and nursing staff in NHs during the COVID-19 pandemic era using target channels (blogs, cafes, Instagram, communities, Twitter, etc.). Data were collected on the channel from 12 September 2019 to 11 September 2020, 6 months before and after 12 March 2020 when the COVID-19 pandemic was declared. Selected keywords included “nursing,” “nurse,” and “nursing staff,” and included words were “long-term care settings,” “geriatric hospital,” and “nursing home.” Text mining, opinion mining, and social network analysis were conducted. Results: After the COVID-19 pandemic, the frequency of keywords increased about 1.5 times compared to before. In March 2020 when the COVID-19 pandemic was declared, the negative phrase “be infected” ranked number one, resulting in a sharp 8% rise in the percentage of negative words in that month. The related words that have risen in rank significantly, or were newly ranked in the Top 30 after the pandemic, were related with COVID-19. Conclusion: The public began to realize the role of nursing staff in the prevention and management of mass infection in NHs and the importance of nursing staff after the pandemic. Further studies should examine the perceptions of those who have received nursing services and include a wide range of foreign channels.

The appropriate use of the data analysis method in a longitudinal design remains controversial in gerontological nursing research. The objective of the current study is to compare statistical approaches between a hierarchical-linear model (HLM) and a latent-growth model (LGM) in random effects, variance explained, growth trajectory, and model fitness. Secondary analysis of longitudinal data was used. Two variables were chosen to demonstrate the comparison between statistical methods. The HLM was superior in addressing unbalanced data in repeated-measures analysis of variance (ANOVA) and multivariate ANOVA because its nested data structure and random effects could be estimated. The LGM had advantages in modeling growth trajectories and model-fit comparisons. Superior to the HLM, the LGM reported more acceptable data fit, reporting a quadratic model, and successfully differentiated between and within components. The current research provides some evidence for applying appropriate statistical methods when addressing longitudinal datasets in gerontological nursing research. [ Research in Gerontological Nursing, 12 (6), 275–283.]

Purpose To encourage the enactment of laws about mandatory nurse staffing in nursing homes, researchers should provide evidence of concrete nurse hours per resident day (HPRD). This article estimates optimal nurse staffing HPRD to achieve increased quality-of-care outcomes for nursing home residents. Design Secondary analysis of longitudinal data. Methods This study used secondary analysis of longitudinal nursing home survey data. Nurse staffing HPRD and quality-of-care survey data accrued from nursing homes operating under long-term-care insurance in Korea. The collected data include a total of six quarterly base measurements on nurse staffing HPRD and 15 quality indicators from 2014 to 2017. The proposed optimization model emerged to most appropriately combine nurse staffing HPRD to increase quality-of-care outcomes for nursing home residents by 3% to 8%. Optimal outcome measures were fixed as best outcomes and compiled from 15 nursing-sensitive quality indicators. Findings Constrained nonlinear optimization was used for analysis. A 12% increase in registered nurse (RN) HPRD (from 0.168 HPRD [10 min 5 s] to 0.177 [10 min 38 s]) aligned with a 3% improvement in quality-of-care outcomes. A 20% RN HPRD increase aligned with a commensurate 5% to 8% increase in compiled quality-of-care outcomes (from 0.168 HPRD [10 min 5 s] to 0.202 HPRD [12 min 6 s]) without increasing certified nurse aide HPRD. About a 30% RN HPRD increase aligned with a commensurate 5% to 8% increase in compiled quality-of-care outcomes (from 0.168 HPRD [10 min 5 s] to 0.218 HPRD [13 min 6 s]) without increasing certified nurse aide HPRD. Conclusions It is urgent to institute mandatory nurse HPRD for nursing homes in Korea by law. This research provides evidence that increasing nursing HPRD improved residents' outcomes in nursing homes. Clinical relevance Findings from the optimization model implied that stable care by RNs in nursing homes is a key factor in achieving acceptable quality of care for residents.

Background Presenteeism, the act of going to work while sick, is associated with increases in medication errors, patient falls, diminished quality of care, and higher costs. To date, presenteeism has not been described among nursing students. Purpose This study described presenteeism in nursing students from 3 different international nursing programs. Method A self-administered survey with open-ended responses was used. Results While nearly all student respondents believed going to class and clinical experiences put their classmates and patients at risk, the overall presenteeism rate was 85.5% for class and 69.5% for clinical experiences. Although there were significant differences between universities for reasons for presenteeism, a lack of opportunity for making up missed lecture or clinical time predominated. Conclusion Nursing students in 3 culturally different cities reported going to class and clinical experiences while sick despite recognizing the safety risk.

Geriatric nursing activities are closely related to patient safety, therefore, nurses’ efforts to improve patient safety in geriatric hospitals are important. In the present study, we investigated the relationships between person-centered care practice, patient safety competence, and patient safety during nursing activities in geriatric hospitals. We used the following tools to investigate the factors affecting patient safety during nursing activities: (a) the Korean version of the Person-Centered Care Assessment Tool (P-CAT), (b) the Patient Safety Competence Assessment Tool for Nurses, and (c) the Patient Safety Nursing Activities Assessment Tool for geriatric nurses. The questionnaire survey was completed by 186 geriatric nurses in 12 geriatric hospitals from 1 August to 31 August 2018. We analyzed the survey data using a t-test, one-way ANOVA, Pearson’s correlation coefficient, and multiple regression. We identified patient safety skills (β = 0.417, p &lt, 0.001) and age (β = 0.209, p = 0.035) as key factors that influence patient safety during nursing activities. Therefore, to improve the quality of patient safety during nursing activities conducted by geriatric nurses, it is necessary to develop strategies to improve patient safety skills and expand the pool of competent nurses with clinical experience.

The purpose of this study was to investigate the influence of dementia literacy, internal health locus of control, and fear of dementia on dementia-preventive behaviors among middle-aged people with chronic diseases. The participants were middle-aged individuals with chronic diseases who had been taking medications for at least three months, recruited using convenience sampling. A total of 123 participants were recruited between 13 and 31 March 2020, using self-reported questionnaires. Data were then analyzed through independent t-test, one-way ANOVA, Pearson’s correlation coefficient, and multiple linear regression using the SPSS/WIN 25.0. The results showed that health condition perceived as healthy and dementia literacy were the leading factors influencing dementia-preventive behaviors. These variables showed a 16% explanatory power for dementia-preventive behaviors. Therefore, when the participants’ perceived health condition was healthy and the dementia literacy score was higher, the level of dementia-preventive behaviors was also higher. It is necessary to develop educational programs to increase dementia literacy as a major variable in dementia-preventive behaviors, and further research on its efficacy should be conducted. When providing dementia-preventive education programs to middle-aged people who have been exposed to chronic diseases, it is necessary to consider their level of perceived health condition and dementia literacy.

Background: Machine learning (ML) can keep improving predictions and generating automated knowledge via data-driven predictors or decisions. Objective: The purpose of this study was to compare different ML methods including random forest, logistics regression, linear support vector machine (SVM), polynomial SVM, radial SVM, and sigmoid SVM in terms of their accuracy, sensitivity, specificity, negative predictor values, and positive predictive values by validating real datasets to predict factors for pressure ulcers (PUs). Methods: We applied representative ML algorithms (random forest, logistic regression, linear SVM, polynomial SVM, radial SVM, and sigmoid SVM) to develop a prediction model (N = 60). Results: The random forest model showed the greatest accuracy (0.814), followed by logistic regression (0.782), polynomial SVM (0.779), radial SVM (0.770), linear SVM (0.767), and sigmoid SVM (0.674). Conclusions: The random forest model showed the greatest accuracy for predicting PUs in nursing homes (NHs). Diverse factors that predict PUs in NHs including NH characteristics and residents’ characteristics were identified according to diverse ML methods. These factors should be considered to decrease PUs in NH residents.

The purpose of this study was to estimate how much resident outcomes can improve with an increase in hours per resident day (HPRD) of registered nurses (RNs) staffing. Nursing home (NH) staff in Korea have serious problems with inappropriate nurse staffing standards and poor working conditions, which lead to poor quality of care for NH residents. This study used a longitudinal survey design. A quota sampling was used with a total of several repeated survey measurement from 2017 to 2020 (n = 74). The independent variable was the amount of nurse staffing HPRD and the outcome variable was the compiled outcome of 15 quality-of-care indicators. Data were directly collected from all participating NHs. A longitudinal, multilevel model was used for analysis. An increase of one unit of RN HPRD (60 min) corresponded to a decrease of about 10.5% of residents with deteriorated quality of care outcomes. This study emphasized that increasing RN HPRD decreased residents&rsquo, deteriorated outcomes in NHs. This suggests that professional RNs must be secured to an appropriate level to improve the quality of care for NH residents.

Purpose: The purpose of this study was to examine the factors associated with nursing home (NH) registered nurses&rsquo, (RNs&rsquo, ) intention to stay in their workplace. Methods: A cross-sectional questionnaire survey was used in this study. Organizational NH data were acquired from the administrators of 56 NHs. Individual RN data were acquired from 189 RNs in 56 NHs across Korea. The questionnaire assessed RNs&rsquo, intention to stay in their workplace as well as potential associated factors, including individual and organizational factors. Multilevel regression analysis was used to determine which factors explain RNs&rsquo, intention to stay in their workplace. Findings: NH RNs&rsquo, intention to stay was positively associated with RNs&rsquo, years of experience in NHs, career promotion opportunities, and perceptions of NH resident safety culture. At the organizational level, no factors were found to significantly relate to the intention to stay of NH RNs. Conclusions: Although this study found that organizational factors have no statistically significant relationship with RNs&rsquo, intention to stay, organizational support must precede changes in individual factors that have significant relationships. Clinical Relevance: Organizational (NH) and individual (RN) efforts must be made to enhance RNs&rsquo, intention to stay because individual factors can change after implementing efforts such as providing educational programs, promotional opportunities, and forming a positive resident safety culture at an organizational level.

Background: A machine learning (ML) system is able to construct algorithms to continue improving predictions and generate automated knowledge through data-driven predictors or decisions. Objective: The purpose of this study was to compare six ML methods (random forest (RF), logistics regression, linear support vector machine (SVM), polynomial SVM, radial SVM, and sigmoid SVM) of predicting falls in nursing homes (NHs). Methods: We applied three representative six-ML algorithms to the preprocessed dataset to develop a prediction model (N = 60). We used an accuracy measure to evaluate prediction models. Results: RF was the most accurate model (0.883), followed by the logistic regression model, SVM linear, and polynomial SVM (0.867). Conclusions: RF was a powerful algorithm to discern predictors of falls in NHs. For effective fall management, researchers should consider organizational characteristics as well as personal factors. Recommendations for Future Research: To confirm the superiority of ML in NH research, future studies are required to discern additional potential factors using newly introduced ML methods.

Background: To compare machine learning (ML) methods beyond traditional regression analysis using a real dataset on nurse staffing and falls in nursing homes.Methods: We used a total of 6 ML algorithms to compare the superiority of ML over traditional regression methods. We applied three representative ML algorithms—random forest (RF), logistics regression, support vector machine (SVM): linear, polynomial, radial, and sigmoid—to the preprocessed dataset to develop a prediction model (N = 60). We used an accuracy measure to evaluate prediction models.Results: RF was the most accurate model (0.883), followed by the logistic regression model (0.867). Using RF procedures, we identified a total of 6 variables as predictors of falls including hours per resident day of administrative staff, proportion of nursing home residents with psychiatric medications, aggressive behaviors and cognitive dysfunction, urinary incontinence, current number of residents in each nursing home, and the maximum capacity of each nursing home.Conclusions: The appropriate choice of prediction model is quite challenging for nursing researchers. For effective fall management, researchers should consider organizational characteristics as well as personal factors. The examination of related factors on falls is quite meaningful in that preventing falls contributes to improving the quality of life and care of residents and decreases health care costs.

This paper presents a few meal-monitoring systems for elder residents (especially patients) in LTCFs by using electronic weight and temperature sensors. These monitoring systems enable to convey the information of the amount of meal taken by the patients in real-time via wireless communication networks onto the mobile phones of their nurses in charge or families. Thereby, the nurses can easily spot the most patients who need immediate assistance, while the families can have relief in seeing the crucial information for the well-being of their parents at least three times a day. Meanwhile, the patients tend to suffer burns of their tongues because they can hardly recognize the temperature of hot meals served. This situation can be avoided by utilizing the meal temperature-monitoring system, which displays an alarm to the patients when the meal temperature is above the reference. These meal-monitoring systems can be easily implemented by utilizing low-cost sensor chips and Arduino NANO boards so that elder-care hospitals and nursing homes can afford to exploit them with no additional cost. Hence, we believe that the proposed monitoring systems would be a potential solution to provide a great help and relief for the professional nurses working in elder-care hospitals and nursing homes.

Purpose The aim of this study was to examine the effectiveness of an older-adult exercise program in a senior-living complex campus. Design A longitudinal one-group design was used. Methods To supply residents with tools to maintain or improve general quality of life, balance, endurance, depression, and functional mobility, the Wellness and Fitness Center at the research setting provided a wide assortment of user-friendly equipment with many options. One fitness director in the selected setting evaluated participants every 6 months with 33 participants using the Senior Fitness Test (SFT). Findings Repeated ANOVAs identified factors impacting the effects of the exercise program using PROC MIXED SAS 9.0. The improvement or deterioration rate of SFT scores was tested as a time effect in balance, upper body strength, and lower body flexibility. A statistically significant gender effect emerged on the 6-minute walk, which measured aerobic endurance and the chair-sit-and-reach test, which measured lower body flexibility. Conclusions The 8-foot-up-and-go, arm-curl, chair-stand, and chair-sit-and-reach tests showed statistically significant improvement over time, which means balance, upper body strength, lower body strength, and lower body flexibility improved. Clinical Relevance Developing customized exercise protocols and using standardized measurement tools should be encouraged to enhance effective research and consistent measurement of exercise programs.

The incidence rate of middle-aged ischemic stroke patients has been increasing. Because of their high risk of recurrence, it is important for them to adhere to their self-care performance. The purpose of this study was to investigate predictors of self-care performance among middle-aged ischemic stroke patients. A descriptive correlational and cross-sectional survey design was used. About 140 participants who had been diagnosed with ischemic stroke within a year and visited neurological outpatients were investigated. Participants answered self-report questionnaires, the Secondary Stroke Prevention Knowledge Scale, the Health-Related Hardiness Scale, and the Subjective Self-Care Performance Scale. Hardiness, secondary-stroke-prevention knowledge, age, and stroke-diagnosis duration had statistically significant influences on self-care performance; hardiness had the largest effect. This study highlighted hardiness as the major predictor of self-care performance. To improve middle-aged ischemic stroke patients’ self-care performance, nurses need an integrated approach that considers a patient’s age, diagnosis duration, secondary-stroke-prevention knowledge, and, especially, hardiness.

Purpose This study compares the expected nurse-to-patient ratio, penalties for violating these regulations, and the laws enacted in the medical and nursing fields in Korea and advanced countries like Germany, Australia, the United States, and Japan. Methods This study deployed an integrative review method and used search terms such as “nursing law,” “nurse ratio,” “nurse,” “nurse staffing,” “health,” and “staffing” to find articles published in English, Korean, German, or Japanese through Cumulative Index to Nursing and Allied Health Literature Plus with Full Text, the Westlaw (International Materials-Jurisdiction) site, US government and state sites (federal parliament, National Conference of State Legislatures), and Google Scholar. Results Compared with medical laws in other advanced countries, Korean laws are quite crude and its nurse-to-patient ratio does not reflect patients' status. Korea also lacks strict penalties for nurse staffing ratio violations. Conclusion Korea requires a strong regulatory apparatus for nurse staffing in health-care organizations to improve the quality of its health-care services and patient safety.

Background and aims Effective delegation improves job satisfaction, responsibility, productivity and development. The ageing population demands more nurses in long-term-care hospitals. Delegation and leadership promote cooperation among nursing staff. However, little research describes nursing delegation and leadership style. We investigated the relationship between registered nurses’ delegation confidence and leadership in Korean long-term-care hospitals. Methods Our descriptive correlational design sampled 199 registered nurses from 13 long-term-care hospitals in Korea. Instruments were the Confidence and Intent to Delegate Scale and Multifactor Leadership Questionnaire. Results Confidence in delegation significantly aligned with current-unit clinical experience, length of total clinical-nursing experience, delegation-training experience and leadership. Transformational leadership was the most statistically significant factor influencing delegation confidence. Implications for Nursing Management When effective delegation integrates with efficient leadership, staff can deliver optimal care to long-term-care patients.

Background Quality ratings could provide vital information to help people in choosing a nursing home. Purpose This study investigated factors aligned with quality ratings of nursing homes. Methods We employed a cross-sectional descriptive design to assess publicly available data on 1,354 nursing homes with 30 or more beds in the Republic of Korea. After excluding 289 nursing homes with no reported quality-evaluation ratings, we analyzed the 2015 data of 1,065 nursing homes. To prevent multicollinearity among independent variables, we carefully selected the final set of variables based on clinical and theoretical meaningfulness to direct nursing care. Quality, the ordinal outcome, was scored from 1 to 5 with a higher score indicating higher quality of the organization. We constructed a multivariate ordered logistic regression model. Results Higher quality ratings of nursing homes was significantly related to the number of unoccupied beds (OR=0.99, p=.024), registered nurses (RNs) (OR=1.30, p=.003), qualified care workers (OR=1.03, p=.011), cognitive-improvement programs (OR=1.05, p=.024), and other programs for residents' activities (OR=1.09, p Conclusion The number of RNs had the strongest influence on the publicly reported quality rating, while the rating of qualified care workers demonstrated little effect and that of nursing assistants had no effect. The number of RNs could be used as a crucial indicator for high-quality homes; more resident-engaging programs also demonstrated better quality of nursing home care.

Despite cumulative and integrative evidence of registered nurse (RN) staffing on nursing home residents’ outcomes worldwide, few studies integrate the effects of residents’ case mix, healthcare markets, and nurse staffing on psychotropic-medication use and weight loss in Korea. This article examined the relationship between nurse staffing and residents’ quality-of-care outcomes, controlling for long-term healthcare market characteristics in Korea. Using a multilevel cross-sectional design, a disproportionate stratified random sampling was used. Of 87 nursing homes contacted, 60 agreed to participate. Weighted linear regression was used to test the hypotheses. RN hours per resident day (HPRD) had a statistically significant positive impact on reducing the number of residents with psychotropic medication (s = − .331, p = .008). Greater RN HPRD positively marginally related to fewer residents with cognitive impairment (s = − 0.201, p = .139). Higher turnover of RN staff related to decreased proportions of residents with weight loss (s = − .331 p = .008). Policymakers should cautiously consider requiring mandatory nurse staffing in nursing homes in Korea, where it is still acceptable to have certified nurse aids as substitutes for RNs.

The aim of this study was to examine the effectiveness of an older adult exercise program in a senior-living complex campus.A longitudinal one-group design was used.To supply residents with tools to maintain or improve general quality of life, balance, endurance, depression, and functional mobility, the Wellness and Fitness Center at the research setting provided a wide assortment of user-friendly equipment with many options. One fitness director in the selected setting evaluated participants every 6 months with 33 participants using the Senior Fitness Test (SFT).Repeated ANOVAs identified factors impacting the effects of the exercise program using PROC MIXED SAS 9.0. The improvement or deterioration rate of SFT scores was tested as a time effect in balance, upper body strength, and lower body flexibility. A statistically significant gender effect emerged on the 6-minute walk, which measured aerobic endurance and the chair sit-and-reach test, which measured lower body flexibility.The 8-foot up-and-go, arm curl, chair stand, and chair sit-and-reach tests showed statistically significant improvement over time, which means balance, upper body strength, lower body strength, and lower body flexibility improved.Developing customized exercise protocols and using standardized measurement tools should be encouraged to enhance effective research and consistent measurement of exercise programs.

Methods: This systematic review was guided by a preliminary literature review that identified relevant research terms including nurse(ing) staffing, license, certification, healthcare professionals, and nursing law. An online search of the electronic bibliographic databases MEDLINE, CINAHL, OVID, Westlaw (International materials- Jurisdiction), U.S. National Conference of State Legislatures, and Google Scholar yielded journal articles, nursing acts, and websites from 2009 to 2015. Results: Most nursing laws require staffing committees in each hospital to develop staffing strategies. Staffing committees should include direct-care nurses. Illinois, Oregon, Washington, and Texas require at least 50~60% registered nurses on the committee. Nursing laws in California, New York, and Massachusetts proposed a specific nurse–patient staffing ratio in consideration of the severity of need of patients or units. Furthermore, California enacted minimum staffing ratios. California reported decreased patient mortality, decreased turnover of nursing staff, and increased satisfaction and retention of nurses. Conclusion: It is timely to have nursing laws worldwide that establish minimum numbers of nurses with professional competencies for the health and safety of global citizens.

Purpose To investigate the relationship between nurse staffing and quality of care in nursing homes in Korea. Methods This study used a cross-sectional design to describe the relationship between nurse staffing and 15 quality-of-care outcomes. Independent variables were hours per resident day (HPRD), skill mix, and turnover of each nursing staff, developed with the definitions of the Centers for Medicare & Medicaid Services and the American Health Care Association. Dependent variables were prevalence of residents who experienced more than one fall in the recent 3 months, aggressive behaviors, depression, cognitive decline, pressure sores, incontinence, prescribed antibiotics because of urinary tract infection, weight loss, dehydration, tube feeding, bed rest, increased activities of daily living, decreased range of motion, use of antidepressants, and use of restraints. Outcome variables were quality indicators from the U.S. Centers for Medicare & Medicaid and 2013 nursing home evaluation manual by the Korean National Health Insurance Service. Findings The effects of registered nurse (RN) HPRD was supported in fall prevention, decreased tube feeding, decreased numbers of residents with deteriorated range of motion, and decreased aggressive behavior. Higher turnover of RNs related to more residents with dehydration, bed rest, and use of antipsychotic medication. Conclusions Study results supported RNs’ unique contribution to resident outcomes in comparison to alternative nurse staffing in fall prevention, decreased use of tube feeding, better range of motion for residents, and decreased aggressive behaviors in nursing homes in Korea. More research is required to confirm the effects of nurse staffing on residents’ outcomes in Korea. Clinical Relevance We found consistency in the effects of RN staffing on resident outcomes acceptable. By assessing nurse staffing levels and compositions of nursing staffs, this study contributes to more effective long-term care insurance by reflecting on appropriate policies, and ultimately contributes to the stable settlement of the long-term care insurance system for elders.

Introduction The quality of nursing home care has been problematic in both the United States and South Korea; quality is limited to inadequate nurse staffing levels. This article addresses how South Korean nursing home education and training requirements, nurse staffing standards, and actual nurse staffing levels compare with those in the United States. Methods The study used secondary documents and data to compare the two countries. Results Korea has lower registered nurse and certified nursing assistant standards and actual staffing levels than the United States. In contrast, staffing standards and actual staffing levels for care workers who provide direct care to residents are higher in Korea than in the United States. Conclusions Research is needed in Korea to establish an empirical basis for educational requirements, staffing standards, and staffing levels in nursing homes.

Purpose This study identified factors related to the quality of care in nursing homes, and elicited consensus opinions from experts on nursing homes. Methods A Delphi questionnaire was developed based on a review of the literature using the keywords "nursing homes," "workforce," and "quality of care." A total of two Delphi surveys were conducted with 14 experts. The important and urgent factors related to the quality of care for nursing home residents emerged. Results A consensus was achieved on the important and urgent factors relating to the quality of care. The related factors were grouped into four sections: Organizational Characteristics, Staffing Characteristics, the Long-Term Care Market and Legal and Policy Issues, and Nursing Processes. In total, 23 items were important factors and 26 items were urgent factors relating to the quality of care. In addition, the unanimous advocacy by the experts for increased hours per resident day for registered nurses (RNs, 41 minutes 59 seconds) was much higher than the current hours per resident day of RNs in Korea. Conclusion To provide optimal care for residents in nursing homes in Korea, the mandatory and essential placement of RNs with professional knowledge and skills is paramount.

This study investigated the relationship between nurse staffing and quality of life (QOL) in Western New York State nursing homes. This was a cross-sectional, correlational study. The independent variables were hours per resident day (HPRD), skill mix, and turnover rate of nursing staff. The outcomes were measured using the self-reported QOL instrument. No coefficients were statistically significant with registered nurses’ (RNs) HPRD. Certified nursing assistant (CNA) HPRD had a statistically significant positive impact on the spiritual well-being domain. There was a statistically negative relationship between the amount of licensed practical nurse (LPN) HPRD and food enjoyment; and the ratio of more RNs to fewer LPNs and CNAs had a statistically significant negative influence on the meaningful-activity, food-enjoyment, and security domains. The turnover of RNs had a statistically negative relationship with the sum of each domain. None of the coefficients was statistically significant with LPN turnover.

To investigate the relationship between nurse staffing and quality of life in nursing homes.This is a descriptive, correlational study. The independent variables were nursing staffing hours per resident day (HPRD), skill mix HPRD, and turnover rate of nursing staff. The data for the dependent variables were collected using the quality of life (QOL) section of minimum data set (MDS) version 3.0. Hierarchical linear models were used for data analysis.Few staffing variables were statistically associated with residents' QOL. More RN HPRD were associated with better comfort and enjoyment domains, more licensed practical nurses (LPN) HPRD were associated with better dignity, and more certified nurse assistant (CNA) HPRD were associated with better functional competence domains. In terms of skill mix, the unique contribution of more RNs (to less LPN or CNAs) was supported in the functional competence of residents. However, surprising results were that: (a) as the HPRD of RNs increased, the scores of meaningful activity and relationship decreased; and (b) the contribution of LPNs (more LPNs to less RNs) were supported in the autonomy and spiritual well-being domains. Interestingly, nursing staff turnover is positively correlated with some domains of QOL: (a) a higher score in the enjoyment domain with increased RN turnover; and (b) a higher score in privacy, relationship, and individuality domains with increased turnover of LPNs.This is a preliminary study to investigate the relationship between nursing staffing and QOL for nursing home residents. Further examination is needed to confirm the relationship and provide policy guidelines, including nurse staffing recommendations.

Responses of 2369 newly licensed registered nurses from 3 generational cohorts-Baby Boomers, Generation X, and Generation Y-were studied to identify differences in their characteristics, work-related experiences, and attitudes. These responses revealed significant differences among generations in: job satisfaction, organizational commitment, work motivation, work-to-family conflict, family-to-work conflict, distributive justice, promotional opportunities, supervisory support, mentor support, procedural justice, and perceptions of local job opportunities. Health organizations and their leaders need to anticipate intergenerational differences among newly licensed nurses and should provide for supportive working environments that recognize those differences. Orientation and residency programs for newly licensed nurses should be tailored to the varying needs of different generations. Future research should focus on evaluating the effectiveness of orientation and residency programs with regard to different generations so that these programs can be tailored to meet the varying needs of newly licensed nurses at the start of their careers.

Objective: The aims of this study were to describe how repeated-measures analysis of variance (ANOVA) and the hierarchical linear model (HLM) are used to evaluate intervention effect and to compare these methods, especially in relation to their requirements regarding assumptions, number of repeated measures, completeness of repeated measures, and equal intervals between measurements. Approach: Alzheimer's Disease Assessment Scale (ADAS) data sets (101 residents in 14 nursing homes, five times) were analyzed to explain differences between repeated-measures ANOVA and the HLM. Results: More detailed information is available when HLM is used. For example, repeated-measures ANOVA showed that there is a statistically significant difference on overall mean ADAS scores between the married and nonmarried groups. The HLM analysis showed more detailed information; the ADAS score of the married group was higher by 6.4 than that of the nonmarried group on the adjusted average ADAS scores (during the whole data collection period). Repeated-measures ANOVA does not provide results on the within-subject changes with days. The HLM provides the specific conclusion that ADAS scores were increased by the one unit of "days" variable (0.017) when days were included. Discussion: Hierarchical linear model is a powerful statistical method that can be applied to longitudinal research to evaluate an intervention at multiple levels. The major differences between the repeated-measures ANOVA and the HLM can be summarized as follows: The HLM (a) has less strict assumptions, (b) has more flexible data requirements (dealing with the missing data), and (c) stresses individual change over group differences. More stringent assumptions should be satisfied in repeated-measures ANOVA than in the HLM. The HLM may resolve important statistical issues that have existed in repeated-measures ANOVA. The HLM has more flexible data requirements in that it (a) can be utilized when the measurement data collection points are unequal and (b) may be used when researchers do not have data for all follow-up points, whereas the repeated-measures ANOVA requires a fixed time series design (equal interval, equal number of time points).

The purpose of this article is to review the advantages and disadvantages of using Minimum Data Set (MDS) data for nursing research, the psychometric characteristics of the MDS 2.0, and threats to the validity of its psychometric characteristics. The defined major advantages of the MDS are: (a) it provides continuous evaluation of residents’ health and functional status, and (b) it enables facility evaluation at the nursing home level. The reviewed articles from the literature report that MDS 2.0 has moderate to moderate/high validity and reliability; however, the psychometric properties of MDS 2.0 are still controversial, mainly because the instrument has failed to identify depression in older nursing home residents.

The use of dolls as a therapeutic intervention for nursing home residents with dementia is relatively new. The current article describes a research study implemented with nursing home residents in Korea to examine the effects of doll therapy on their mood, behavior, and social interactions. A one-group, pretest–posttest design was used to measure the impact of doll therapy on 51 residents with dementia. Linear regression demonstrated statistically significant differences in aggression, obsessive behaviors, wandering, negative verbalization, negative mood, and negative physical appearance after introduction of the doll therapy intervention. Interactions with other individuals also increased over time. Findings support the benefits of doll therapy for nursing home residents with dementia; however, further research is needed to provide more empirical evidence and explore ethical considerations in the use of doll therapy in this vulnerable population. [ Journal of Psychosocial Nursing and Mental Health Services, 53 (1), 13–18.]

Background: Korea is one of the fastest aging societies; the number of elderly who die due to Alzheimer dementia has increaseddramatically. The benefits of hospice care were recognized in effective pain management, advance-care planning, decreasedhospitalization, decreased aggressive treatment, and increased job satisfaction. To estimate life expectancy of residents withdementia precisely is difficult, exacerbating the ability to provide palliative care for residents with dementia. However, theunderuse of hospice care in nursing homes (NHs) is a major problem in Korea. Few researchers have identified the needs ofpeople dying with dementia in NHs in Korea. The purpose of this paper was to review and discuss hospice-eligibility assessmenttools. Methods: Four tools were available for discussion at the point of investigation: the Functional Assessment Staging Scale,Alzheimer’s Hospice Placement Evaluation Scale, Advanced Dementia Prognostic Tool from the U.S. Hospice Medicare guidelines,and Global Deterioration Scale. Results: Major problems are underuse of hospice care and lack of guidelines to assess hospice in patients with dementia inKorea. Conclusion: Successfully categorizing elders with dementia as hospice enrollees in Korea will improve the quality of end-of-lifecare for increasing numbers of elders with dementia and their family members.

Background: Approximately 8% of nurse positions are expected to be vacant by 2020 in Korea, and the shortage in small- to medium-sized hospitals is more serious in Korea. It has been suggested that efficient use of inactive nurses would help alleviate this problem. Most inactive Korean nurses reported the major reasons for leaving the nursing profession were marriage, pregnancy, and children rearing. A large portion of inactive Korean nurses reported they want to return to work. Purpose : This study was designed to uncover the factors determining recently reemployed nurses’ intentions to continue in their current job in Korea. Methods: A descriptive, correlation study design was used. A total of 312 Korean reemployed nurses were surveyed between August 8 and October 30, 2012 using an instrument to measure factors that impact intention to continue in their current job. Results: Findings from a multiple-regression analysis demonstrated that the level of life conflict among reemployed nurses with partners and children was higher than those with neither partner nor children. Older reemployed nurses were statistically unlikely to have life conflict. Reemployed nurses in large hospitals and part-time nurses were more likely to be satisfied with their working environment. Results of multiple ordinary-least-squares regression analysis demonstrated positive statistically significant relationships between “job content” and “intention to continue in their current job,” and “working environment” with “intention to continue in their current job”. Conclusion/Implication for Practice: Most reemployed nurses were unlikely to stay in their current positions. In the nursing profession, each nurse’s ability to achieve their own growth in affirmative working conditions could be the major factor impacting intent to continue in the nursing profession and in the current nursing position in Korea.

The purpose of this study was to complete an integrated literature review of the relationship between staffing and quality outcomes in nursing homes. The majority of the reviewed studies showed better outcomes with higher nursing staff but depended heavily on cross-sectional observational studies and failed to differentiate RNs from other nursing staff. A total of 28 articles relating nurse staffing and quality outcomes were systematically reviewed and synthesized. However, each study examined different aspects of staffing and different resident or organizational outcomes, making determination of appropriate staffing levels difficult. The reviewed studies have not clearly defined the relationship between differing levels of nurse-staffing skill mix and specific structure, process, outcome, and composite indicators of quality. The inconsistent findings suggest that further research is needed in this area.