The emergency department (ED) is where hand hygiene problems are significant as the procedures in the ED are often high risk and invasive. To date, there have been no comprehensive reviews on hand hygiene in EDs. The aim of this study was to investigate hand hygiene compliance (HHC) rate, factors affecting the HHC rate, and intervention strategies to improve HHC in EDs. Electronic databases were used to search for research published from 1948 to January 2018. The databases included ovidMEDLINE, ovidEMBASE, the Cochrane Library, CINAHL, Koreamed, and Kmbase. All study designs were included. Two reviewers independently extracted the data and assessed the bias risk using reliable and validated tools. A narrative synthesis was performed. Twenty-four studies, including 12 cross-sectional surveys and 12 interventional studies, were included. Of the 12 interventional studies reviewed, only 33% (N ¼ 4) reported HHC rates of more than 50%. Factors that influenced HHC included types of healthcare worker, hand hygiene indication, ED crowding, positive attitudes towards HHC, patient location, auditing hand hygiene, and type of shift. Almost all of the studies (83.3%) applied multimodal or dual interventions to improve HHC. A range of strategies, including education, monitoring and providing feedback, campaigns, and cues, effectively improved HHC. The review findings indicate that there is a room for improvement in HHC in EDs. Future randomized controlled trials are necessary to determine which intervention modalities are most effective and sustainable for HHC improvement.

Based on this research, the development of an anger expression intervention program for nurses is recommended to establish the means of expressing the suppressed emotions, which would help the nurses experience less interpersonal problems.

This study was done to identify learning experiences and self-confidence and to analyze nursing students' self-confidence according to learning experiences for core nursing skills (CNS). Method: Participants were 502 final year nursing students. Data were collected using a structured questionnaire and analyzed using descriptive statistics and t-test. Results: Over 60% of participants had practiced 15 items of the 24 CNS in the basic nursing lab (BNL). In clinical practice (CP), they had practiced five items but experienced only one item in a simulation lab (SL). Items with the highest confidence level were vital signs (4.69) followed by blood sugar test (4.60), pulse oximeter (4.38), and oral medication (4.12). Items with the lowest confidence level were blood transfusion (2.17) followed by enema (2.64) and indwelling catheterization (2.67). The group with CNS experience in the practice curriculum was generally more confident than the group with no experience. Self-confidences in some skills was significantly different depending on availability of SL, credits for BNL and CP, and presence of preceptors. Conclusion:Results indicate a need to develop practice education strategies such as changing the CP to practice-centered learning with preceptors and including well-designed SL to increase confidence of nursing students.

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The purposes of this study were to identify nursing students' levels of anxiety in simulation based nursing education and to understand the relationship of anxiety and personal satisfaction of simulation, self-efficacy, and clinical competence during simulation. Methods: This study was a descriptive study with 84 senior nursing students at a private university in South Korea. Level of anxiety was measured with STAI (the State-Trait Anxiety Inventory) prior to the stimulation practice. After the debriefing, satisfaction scores were measured with SSE (Satisfaction with Simulation Experience scale), self-efficacy scores with the modified measurement developed by Roh and Park, and scores for clinical skills with a scale developed by the Korea Association of Cardiopulmonary Resuscitation. Results: Nursing students exhibited moderate to severe anxiety in simulation practice (Mean 49.51, SD 8.60). Self-efficacy was negatively correlated to anxiety (r=-.25, p=.022). Conclusion: Decreasing students' anxiety levels needs to be addressed to increase the self-efficacy of the simulation practice.