Sung-Hyun Cho

Background: Temporal variations in bed occupancy rates are an important determinant of nursing workload in intensive care units (ICUs). However, few studies have characterised these patterns or incorporated them into estimates of nurse staffing requirements. Aims: This study aimed to describe weekly variations in ICU occupancy rates and illustrate nurse staffing requirements under scenarios based on occupancy rates. Study Design: A cross‐sectional study analysed data from patients admitted to ICUs at a tertiary hospital in Seoul, South Korea, between 2022 and 2023. Generalised additive mixed models (GAMMs) characterised nonlinear occupancy patterns. Nurse staffing requirements were estimated at 1‐min intervals under two staffing scenarios: nurse‐to‐patient ratios of 1:1 (Scenario 1) and 1:2 (Scenario 2) in a 20‐bed unit. Results: In total, 25 872 hourly observations from 6147 ICU patients were analysed. The mean occupancy rate was 83.2% in medical ICUs and 60.5% in surgical ICUs. The GAMMs showed nonlinear hour‐of‐week patterns ( p < 0.001), with estimated occupancy rates varying by 6.66 percentage points in medical ICUs (79.91%–86.57%) and 23.57 percentage points in surgical ICUs (48.83%–72.41%). Under Scenario 1, the mean number of nurses required was 16.6 in medical ICUs and 12.1 in surgical ICUs. Staffing requirements remained within ±15% of the mean in medical ICUs but exceeded the upper limit for 13.08 h in surgical ICUs (Wednesday 10:53 PM–Thursday 11:57 am) and fell below the lower limit for 25.80 h (Saturday 4:27–9:19 PM and Sunday 12:50 PM–Monday 9:44 am). The difference between the highest and lowest staffing requirements per shift was 1.2 nurses in medical ICUs and 4.3 nurses in surgical ICUs under Scenario 1, compared with 0.6 and 2.2 nurses, respectively, under Scenario 2. Conclusions: Monitoring ICU occupancy at hourly levels may inform nurse staffing planning. Relevance to Clinical Practice: Hospital administrators may consider these temporal patterns when allocating nursing resources.

Purpose: This study examined how nurse staffing and parental caregiving burden influence patient experiences in pediatric wards. Methods: The sample included 326 parents of pediatric patients at a tertiary children’s hospital. Nurse staffing was measured using parent-perceived staffing adequacy (4-point scale) and registered nurse hours per patient day (RN HPPD). Parent experiences were evaluated using the Child Hospital Consumer Assessment of Healthcare Providers and Systems (Child HCAHPS), with items rated on 3-, 4-, or 11-point scales and subsequently converted to scores on a 0–100 scale. Parents also reported their caregiving burden experienced during their child’s hospitalization. Results: Among the Child HCAHPS domains, nurse–parent communication received the highest score, while lower scores were reported in child-specific domains, including teen involvement, quietness, and child comfort. Most parents (80.4%) stayed at the hospital either all or nearly all the time, and 63.5% perceived caregiving as burdensome. Commonly reported burdens included economic and work-related challenges, physical and psychological stressors, and responsibilities related to caring for other children. Higher levels of parent-perceived staffing adequacy and greater RN HPPD were significantly associated with better patient experiences. Conclusion: Improving nurse staffing may alleviate parental caregiving burden and improve patient and parent experiences in pediatric wards.

OBJECTIVES: This study aimed to compare maternal outcomes and the home environment between non‑vulnerable families with children under 2 receiving universal home visiting services and vulnerable families receiving sustained home visiting services.METHODS: This study was conducted in Seoul, Korea, where the country’s first nurse‑led early childhood home visiting program was introduced. A total of 551 mother‑child dyads participated in cross‑sectional surveys conducted at various child ages (6±2 weeks, 6±1 months, 12±1 months, and 24±1 months). Universal home visiting services were provided within six weeks postpartum to non‑vulnerable families, while vulnerable families received sustained services consisting of 25 visits over 24 months. Maternal knowledge of sudden infant death syndrome (SIDS) and childcare, maternal distress, and the Korean Infant‑Toddler Home Observation for Measurement of Environment (K‑IT‑HOME) were assessed.RESULTS: Overall, the universal home visitation group demonstrated higher levels of maternal knowledge regarding SIDS and childcare compared to the sustained home visitation group (all p-values <0.05), while the sustained home visitation group reported higher levels of maternal distress (p<0.001). The total K‑IT‑HOME score was 1.47 points higher in the universal home visitation group than in the sustained home visitation group (p0.05).CONCLUSIONS: This study demonstrated that disparities in maternal outcomes and home environments persisted in early childhood between the sustained and universal home visitation groups.

Khang YH, et al. J Korean Med Sci. 2025 Oct;40(45):e296. https://doi.org/10.3346/jkms.2025.40.e296

Aim: To compare nurse work hours and nursing activities between high‐staffed and low‐staffed general wards to examine the effects of increased staffing on nurse workload and nursing care.Design: A secondary analysis was conducted using cross‐sectional data collected at a tertiary teaching hospital in South Korea in January 2020.Methods: Nursing activities provided by 350 nurses were observed every 10 min during their shifts for three observation days in four high‐ and four low‐staffed wards. Nurse‐to‐patient ratios, nurse work hours, nursing activities and the composition of nursing hours (direct care, indirect care and associated work) were analysed.Results: After excluding non‐productive personal time, nurses in the low‐staffed wards worked 9.28 h, which indicates 1.28 h of overtime work on average, while the high‐staffed wards recorded 7.90 h of productive work time. The nurse‐to‐patient ratio in the high‐staffed wards was 1:4.73, whereas that in the low‐staffed wards was 1:8.87. The proportion of direct care hours out of nurse work hours was higher in the low‐staffed wards (30.9%) than in the high‐staffed wards (25.7%). Nurses in the low‐staffed wards provided a greater number of direct care hours, and the largest difference in direct care hours between the two groups was found on night shifts. Nurses in the high‐staffed wards spent more time communicating with patients and charting, whereas nurses in the low‐staffed wards spent more time on vital signs and medications.Conclusion: Improved staffing had positive impacts on patients and nurses. Patients benefited from better staffing through increased communication with nurses. Better staffing also reduced overtime work and activities conducted during night shifts.Implications for the Profession and Patient Care: Adequate staffing is essential to improve patient care quality and reduce nurse workload. Nursing activities must be prioritised and redesigned to maximise the benefits of increased staffing on patient and nurse outcomes.Reporting Method: We have adhered to the STROBE reporting guidelines.No Patient or Public Contribution: The aim of this study was to compare nurse work hours and nursing activities between high‐staffed and low‐staffed wards.

Introduction Randomised controlled trials (RCTs) of early childhood home-visiting interventions led by nurses have been conducted mainly in Western countries, whereas such trials have been limited in non-Western cultures, including Asia. In South Korea, a national nurse home visit programme (Korea Early Childhood Home-visiting Intervention (KECHI)) was developed in 2020 and launched throughout the country. We designed a pragmatic RCT to evaluate the effectiveness of KECHI on child health and development and maternal health. Methods and analysis Eligible participants will be pregnant women at Ethics and dissemination This trial has received full ethical approval from the Institutional Review Board of the Seoul National University Hospital. Written consent will be obtained from the participants. The results will be reported at conferences, disseminated through peer-reviewed publications and used by the Korean government to expand the KECHI services. Trial registration number NCT04749888.

Purpose : This study aimed to investigate changes in critical nursing activities from 2009 to 2020 and explore the relationship between nurse staffing and such activities in intensive care units.Methods : A total of 446,445 adult patients admitted to intensive care units in tertiary and general hospitals from 2009 to 2020 were identified using the National Health Insurance claims database. The Critical Nursing Activities Index was calculated based on the following critical nursing activities: ventilator, extracorporeal membrane oxygenation (ECMO), and continuous renal replacement therapy (CRRT). Trend analysis was performed to analyze changes in critical nursing activities over 12 years and to assess linear trends across different staffing levels.Results : The annual utilization days for ventilators, ECMO, and CRRT, as well as the Critical Nursing Activities Index significantly increased over the study period (p-for-trend＜.001) in tertiary and general hospitals, except for ventilator use in general hospitals. Ventilator, ECMO, and CRRT utilization exhibited a significant upward trend with higher nurse staffing levels (Bonferroni adjusted p-for-trend＜.001). The Critical Nursing Activities Index was significantly higher in hospitals with higher staffing levels compared to those with lower staffing levels (Bonferroni adjusted p ＜.05).Conclusion : The findings underscore the need for improved nurse staffing levels in intensive care units. Government policies should ensure that staffing levels align with critical nursing activities among critically ill patients to uphold the quality of care.

Purpose: The aims of this study are to examine the trajectories of nursing hours per patient day (NHPPD) over the course of hospitalization according to the patient's length of stay (LOS) and to estimate changes in the total nursing hours during hospitalization, average NHPPD, and the number of nurses additionally required when the LOS was reduced by 1 day.Design: This retrospective longitudinal study analyzed patient data collected from a tertiary university hospital located in Seoul, South Korea. The study sample included 11,316 inpatients who were discharged between September 1 and October 31, 2022.Methods: NHPPD over the course of each patient's hospitalization was estimated using the total score of the Korean Patient Classification System‐1 (KPCS‐1), which nurses evaluated and recorded every day from admission to discharge. The NHPPD trajectories were examined using linear mixed models to analyze repeated KPCS‐1 measurements and control for the effects of patient characteristics. The changes in the average NHPPD when LOS was reduced by 1 day were estimated using maximum and minimum estimations. The impact of a 1‐day reduction in LOS on staffing requirements was calculated as the number of nurses additionally required to work each shift and to be hired.Findings: The average LOS was 5.6 days, and the short (1–6 days) and medium (7–14 days) LOS groups accounted for 78.9% and 14.3% of patients, respectively. The NHPPD trajectories showed a “rise‐peak‐decline” pattern. Patients in the short LOS group received the most NHPPD on day 1 (day of admission) or day 2, whereas the NHPPD for patients in the medium LOS group peaked on days 3–6. After peaking, the NHPPD tended to decrease toward the end of hospitalization, with the least NHPPD on the day of discharge, followed by the day before discharge. When LOS was reduced by 1 day, the average NHPPD was estimated to increase by 7.7–50.0% in the maximum estimation, and 0.9–12.5% in the minimum estimation. In response to a 1‐day reduction, 1.10–7.44 nurses were additionally required to care for 100 patients each shift and 5.28–35.70 additional nurses needed to be hired in the maximum estimation. In the minimum estimation, these values were 0.13–1.85 additional nurses per shift and 0.65–8.90 additional nurses to be hired, respectively.Conclusions: Since NHPPD exhibited a “rise‐peak‐decline” trajectory, reducing the LOS by 1 day was estimated to increase the average NHPPD and lead to additional staffing requirements. The additional nurse requirement for a 1‐day reduction was not constant; instead, it increased with each day subtracted from an already shorter LOS.Clinical Relevance: Sufficient nurse staffing is necessary to provide increased NHPPD as a result of shortened LOS. Changes in the LOS should be considered when determining nurse staffing requirements.