Purpose
The purposes of this study were to develop a prediction model for pressure injury using a machine learning algorithm and to integrate it into clinical practice.
Methods
This was a retrospective study of tertiary hospitals in Seoul, Korea. It analyzed patients in 12 departments where many pressure injuries occurred, including 8 general wards and 4 intensive care units from January 2018 to May 2022. In total, 182 variables were included in the model development. A pressure injury prediction model was developed using the gradient boosting algorithm, logistic regression, and decision tree methods, and it was compared to the Braden scale.
Results
Among the 1,389,660 general ward cases, there were 451 cases of pressure injuries, and among 139,897 intensive care unit cases, there were 297 cases of pressure injuries. Among the tested prediction models, the gradient boosting algorithm showed the highest predictive performance. The area under the receiver operating characteristic curve of the gradient boosting algorithm's pressure injury prediction model in the general ward and intensive care unit was 0.86 (95% confidence interval, 0.83~0.89) and 0.83 (95% confidence interval, 0.79~0.87), respectively. This model was integrated into the electronic health record system to show each patient's probability for pressure injury occurrence, and the risk factors calculated every hour.
Conclusion
The prediction model developed using the gradient boosting algorithm exhibited higher performance than the Braden scale. A clinical decision support system that automatically assesses pressure injury risk allows nurses to focus on patients at high risk for pressure injuries without increasing their workload.

PURPOSE
The purpose of this study was to identify the effects of multi-mode simulation learning on critical thinking disposition, on the problem solving process and on clinical competence of nursing students.
METHODS
A non-equivalent control group with pre-posttest was designed. The participants in this study were 65 students who were enrolled in an emergency and critical nursing course at N university. The treatment group consisted of 33 juniors in 2010 and the control group 32 juniors in 2011. Collected data were analyzed using chi-square, independent t-test, and ANCOVA with the SPSS/WIN 18.0 for Window Program.
RESULTS
There were significant increases in problem solving process and clinical competence in the treatment group who participated in the multi-mode simulation learning compared to the control group who did not (t=-2.39, p=.020; F=12.76, p=.001). However, there were no significant differences in critical thinking disposition between the treatment and control group (t=0.40, p=.692).
CONCLUSION
Multi-mode simulation is an effective teaching and learning method to enhance the problem solving process and clinical competence of nursing students. Further exploration is needed to develop and utilize multi-mode simulation for diverse scenarios, depending on emergency nursing educational goals and environments and to develop a universal method to measure outcomes.

Citations

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PURPOSE
This study was to identify the perceptions of nursing student on the clinical practice environment and related variables.
METHODS
The subjects of this study were 180 nursing students from a college participated in clinical practice at four regional hospitals. Data was collected with the questionnaire tool for the perceptions of clinical practice environment.
RESULTS
The students highly satisfied in the major had significantly high perception in innovation, personalization, student involvement, and clinical practice satisfaction. The students with a low level of stress and a clearly named guidance nurse were significantly high in the perceptions of task orientation, innovation, personalization, student involvement, and practice satisfaction. Clinical practice environment variables such as task orientation, innovation, individualization, personalization, student involvement, and practice satisfaction were significantly correlated with each other. In student characteristics, the main variables directly influencing the perceptions of clinical practice environment were religion, the level of stress, and the method of guidance.
CONCLUSION
Understanding the students' perspective would be valuable for promoting a positive clinical practice environment. Developing a cooperative system between the college and educational hospitals is necessary for effective clinical practice education

PURPOSE
The purpose of this study was to analyze how a nursing student recognizes PBL with simulation education and its relationship to academic achievement.
METHODS
The study objects were the students in C college who learn through PBL using simulator for 15 weeks(September 2007 to December 2007). Learning element recognition was developed by Cho(2002) and three key evaluations(performance, self-evaluation, and colleague evaluation) were designed by professors.
RESULTS
Learning element recognition ranged from 2.37 to 4.83 with the average at 3.94. For Learning element recognition, students who preferred discussion score 4.15. This was statistically more significant than those who do not. Students who preferred presentations show significantly higher score in colleague evaluation. For Learning element recognition and academic achievement, self-evaluation and colleague evaluation showed relationship to PBL learning element.
CONCLUSION
There was definitely a relationship with PBL learning element and academic achievement after learning the PBL with simulation education.

PURPOSE
This study was to evaluate clinical competence in relation to self-directed learning, critical thinking disposition, and participating in PBL(Problem-Based Learning) group activities of nursing students.
METHODS
Data were collected from 108 nursing students in Oct. 2006.
RESULTS
Clinical competence had a significant positive correlation with self-directed learning, critical thinking disposition, and participation in PBL group activities. There was a significant difference in clinical competence according to interpersonal relationship. Participation in PBL group activities was the most influential factor of clinical competence(R2=.34). Also, the influence of clinical competence increased with the addition of self-directed learning(R2=.42).
CONCLUSION
It is essential to encourage the self-directed learning and participation in PBL group activities for the improvement of clinical competence. It is relatively important for clinical competence to consider the educational environment systematically.

PURPOSE
The purpose of this study was to investigate the knowledge and learning needs on coronary artery disease in diabetic patients by glycemic control.
METHODS
The subjects consisted of 188 patients at the hospital who had diabetes mellitus. Data was obtained using a knowledge and learning needs questionnaire from January to April 2006.
RESULTS
Treatment method, the levels of fasting blood glucose(FBG), and 2-hour postprandial blood glucose (PP2hr) showed meaningful differences between normo-glycemic group(HbA1c<7%) and hyper-glycemic group (HbA1c> or =7%). The levels of knowledge on coronary artery disease by glycemic control tend to show higher in normo-glycemic group. Etiology and prevention of coronary artery disease were significantly higher in normo- glycemic group than in hyper-glycemic group. The levels of learning needs on coronary artery disease by glycemic control tend to show higher in normo-glycemic group. The learning needs on items of diet control were higher in normo-glycemic group than in hyper-glycemic group.
CONCLUSION
On the base of these results, we should focus on the coronary artery disease education for hyper-glycemic group. Also individual coronary artery disease educational program should be developed for the patients with different level of knowledge and learning needs.

PURPOSE
This study was conducted to develop an integrated undergraduate course including a PBL based on a blended learning strategy, and evaluate learners' responses.
METHODS
The learning contents of cardiovascular, respiratory, and musculoskeletal medical systems, and nursing diagnoses of 'activity and rest' domain (NANADA's classification II, 2005) were analyzed. Six clinical scenarios with the clients in different life cycles were developed for PBL. Classical lecture and group presentation with on-line self learning were implemented in addition to PBL. The developed course was implemented on 84 junior nursing students in a university for 7 weeks with 5 hours per day, two days per week. Students were asked to complete structured questionnaires including problem solving, critical thinking, and nursing diagnosis differentiation abilities.
RESULTS
Learner's evaluation was positive in problem solving skills and in the differentiation ability of nursing diagnoses relevant to an 'activity and rest' functional health pattern.
CONCLUSION
Development and implementation of integrated courses based on a blended learning method need to be continued to enhance students' thinking and self-directed learning abilities. Supporting strategies for individual learners should be added for successful blended learning such as individual on-line feedback and consideration of individual learning outcomes.

PURPOSE
The purpose of this study was to develop an e-learning orientation program for nursing students(junior), to evaluate the program, and to find out its effects on adapting to clinical practicum.
METHODS
The e-learning orientation program was developed according to ADDIE model(analysis, design, develop, implement, evaluate) using an Active Tutor Program. Twelve nursing professionals and 31 nursing students(learners) evaluated the e-learning orientation program. Thirty one nursing students participated in the e-learning orientation program both on-line and off-line.
RESULTS
The e-learning orientation program consisted of 5 parts including 'Taking a lesson in gastrointestinal tract', 'Fundamental nursing skill and reading a medical chart', 'Taking a ward orientation by head nurse', 'Clinical practice with preceptors', and 'Writing for case report'. Adapting scores to clinical practicum were significantly different between pre-test and post-test(t=-5.76, p=.000).
CONCLUSION
The e-learning orientation program of on-line and off-line has an effect on adapting to clinical practicum for nursing students.

PURPOSE
This study aimed at developing the problem-based learning packages on the respiratory and cardiac system of an adult- health nursing course, and to examine the effect of PBL on the knowledge, learning attitude and motivation in nursing students. METHOD: A total of 7 PBL packages were developed through the analysis of learning contents and integration of concepts. Clinical scenarios used in 7 PBL packages were selected and composed at a respiratory and a cardiovascular unit, a medical ICU and a chest-surgery unit of C university hospital in G-city. The PBL method was implemented 3 hours a week for 12 weeks to 35 students of an experimental group, and the conventional lecture was implemented to 38 students at C college of C province from Sept. to Dec. 2002. A pretest-posttest experimental design was used. RESULT: The PBL students (n=35) scored significantly higher knowledge than conventional students (n=38) in the area of problem solving (t=3.418, p=. 001). But, there is no significant difference in the memory-dependent knowledge. Also, The level of learning attitude (t=3.570, p=. 001) and learning motivation (t=3.446. p=. 001) was significantly higher in PBL students. CONCLUSION: PBL method appears to be effective in improving nursing students' problem-solving knowledge and positive learning attitude and motivation.

The purpose of this study is to present an actual example for procedures for developing a PBL package based on philosophical backgrounds derived from Problem-based learning. To perform a systemic study on the operations of an intergrated curricula under multi-disciplines, a research team made up of several professors with different academic backgrounds was formed. Among the four situations for the patients with perception-adjustment disorder, especially a procedure for the development of PBL package which can be used in the emergency room situation has been proposed. The little(2000)'s PBL package model has been applied for this study. Tha package includes course objectives, learning objectives, concept map, situation scenario, tutor guide, and evaluation method. It is believed that learning objectives achievement procedures designed as a part of a problem-based learning package development procedures for the nursing of patients with perception-adjustment can be achieved at the same level as the learning objectives for the science of nursing founded by the Korean Nurses Association.

Nurses in today's challenging health care settings need to be skilled critical thinkers and clinical experts. The nurse must be able to use a broad knowledge base to mobilize resources, coordinate actions and evaluate outcomes in complex new situations. So the national licensing examination for registered nurses is change to improve the quality of professional competency of nurses in Korea. Prior to this, learning objectives should be developed and improved periodically. The purpose of this study is to describe the nursing competency to provide base line data for developing learning objectives in adult health nursing. This study was conducted by means of a questionnaire which was developed by the researcher after reviewing the literature. The questionnaire was based on learning objectives which were developed by a nation-wide nursing faculty majoring in adult health nursing. The subjects were 45 nurses in a middle level hospital. The collected data were treated using SPSS Win 7.5 Statistical Package so as to obtain such descriptive statistics as mean score, frequency, and to test reliability test, nonpar-Friedman test. To summarize the major findings in this study, it showed the scope of nursing competency and can guide the direction of study and methodological criteria to develop learning objectives. Recommendations for further research are: firstly, it is necessary to state learning objectives with learners'behavioral terminology; secondly, to overcome locality in scope of this study, there is a need to analyze with nation-wide sampling by an in-depth statistical analysis; thirdly, because the subjects of this study are mostly three-year graduate nurses, there is a need to compare this study with other studies of different subjects.

The purpose of the study was to investigate two areas as a basis for providing an educational program for pulmonary rehabilitation. A) the learning needs about chronic obstructive pulmonary disease in patients with chronic obstructive pulmonary disease and B) the perception of nurses of the same learning needs. The subjects consisted of 57 patients, with chronic obstructive pulmonary disease, at the general hospital in Seoul and 71 nurses, who were working in the medical ward. Data was obtained from a "learning need" questionnaire between October 29 and November 19, '99. Data was analyzed using SAS program for t-test, ANOVA, Scheff test. The result were as follows: 1. The learning needs of the nurses(mean 4.36 +/- .38) were higher than those of the patients (mean 3.56 +/- .83). (t=6.78, P=.001) 2. The highest ranked patient education needs were as follows ; a)"how to control dyspnea", b)"cause for activating dyspnea", and c)"how to minimize the necessity of oxygen in daily living": and nurses' learning needs were ; a)"how to cope with the risk situation", b)"management after discharge", and c)"how to control dyspnea". 3. In the patient group, those who had a college degree or higher education and paid their own hospital expenses were higher in the learning needs. According to the above results, we should consider an educational program which is realistic and effective for patients by evaluating the items the patients really want to learn about and how much they know about the evaluated items.