Purpose: Nurses frequently encounter morally complex clinical situations that generate moral distress, which, if unresolved, may accumulate as moral residue and progress to moral injury. This review synthesizes current evidence on moral resilience and ethical practice environments and proposes an integrated framework for sustainable ethical practice in hospitals. Methods: A narrative review of literature was conducted to examine moral distress, moral injury, moral resilience, ethical climate, psychological safety, and speaking-up climate. Conceptual integration was undertaken to present a multilevel strategy framework and a stepwise model linking individual, relational, and organizational factors. Results: Moral resilience, defined as the capacity to maintain or restore moral integrity under moral adversity, comprises four domains: response to moral adversity, personal integrity, relational integrity, and moral efficacy. Higher moral resilience is associated with lower burnout, turnover intention, and quiet quitting and may mediate the relationship between ethical climate and work engagement. However, individual resilience alone is insufficient in hierarchically structured and psychologically unsafe environments. In such contexts, sustainable ethical practice requires institutionalized ethical climate, psychological safety, protected speaking-up systems, and structured ethics support. Conclusion: Sustainable ethical practice is achieved when moral resilience is strengthened at the individual level and embedded within team culture and organizational policy.

본 연구는 간호사의 호모포비아와 성소수자 건강 관련 지식이 성소수 자 환자에 대한 긍정적 실천에 미치는 영향을 확인하기 위해 수행되었 다. 연구대상은 전국 4개 지역의 6개 의료기관에 근무하는 간호사 361명 으로, 2021년 2월부터 4월까지 구조화된 설문지를 통해 자료를 수집하 였다. 수집된 자료는 IBM SPSS Statistics 25.0 프로그램을 이용하여 기술통계, t-검정, 일원분산분석, 피어슨 상관분석, 다중회귀분석으로 분 석하였다. 연구결과, 첫째, 간호사의 호모포비아는 120점 만점에 80.47± 16.40점, 성소수자 건강관련 지식은 14점 만점에 6.92±1.72점 성소수자 에 대한 긍정적 실천은 150점 만점에 104.32±16.33점이었다. 둘째, 긍 정적 실천척도는 호모포비아와 유의한 음의 상관관계를 보였다(r=-.36, p<.001). 셋째, 긍정적 실천에 유의한 영향을 미치는 요인은 호모포비아 (β=-.32, p<.001)와 성소수자 관련 교육 필요성(β=.20, p<.001)으로 나타 났다. 이상의 결과는 간호사의 호모포비아를 낮추고 성소수자 건강 관련 교육을 강화할 경우, 성소수자 환자에 대한 긍정적 실천을 향상시킬 수 있음을 시사한다. 따라서 성소수자에 대한 간호사의 문화적 감수성과 포 용적 돌봄 태도를 높이기 위한 체계적인 교육 프로그램 개발이 필요하 다.

본 연구는 요양병원 간호사가 지각하는 팀 리더의 코칭 리더십과 재난 준비 도가 안전행동에 미치는 영향을 규명하고자 수행되었다. C시에 위치한 요양병 원에서 1년 이상의 임상경력을 가진 간호사 124명을 대상으로 구조화된 설문조 사를 실시하였으며, 자료는 SPSS/WIN 25.0 프로그램을 이용하여 분석하였다. 연구 결과, 코칭 리더십, 재난 준비도, 안전행동은 모두 중간 수준 이상으로 나타 났다. 코칭 리더십은 재난 준비도 및 안전행동과 정적 상관관계를 보였으며, 재 난 준비도 또한 안전행동과 유의한 관련성을 나타냈다. 다중회귀분석 결과, 코 칭 리더십이 안전행동의 가장 강력한 영향 요인이었고, 재난 준비도 역시 유의 한 예측 요인으로 확인되었다. 이러한 결과는 팀 리더의 코칭 리더십 강화와 체 계적인 재난 준비 교육이 간호사의 안전행동을 향상시키는 데 효과적임을 시사 한다.

본 연구는 심리사회적 근로환경이 간호사의 일-삶의 균형 및 심리적 웰빙에 미치는 영향을 MZ세대와 기성세대로 구분하여 파악하는 것을 목적으로 하고 있다. 연구대상은 제7차 근로환경조사에 포 함된 446명(MZ세대 259명, 기성세대 169명)의 활동 간호사였다. 자료분석에서는 특성에 따른 일-삶의 균 형과 심리적 웰빙의 차이, 심리사회적 근로환경이 일-삶의 균형과 심리적 웰빙에 미치는 영향을 파악하기 위해서 일반선형모형분석이 사용되었다. 두 집단 간 차이 분석 결과, 기성세대 간호사가 MZ세대보다 상사 의 사회적 지지 정도와 업무에 반영 정도를 더 높게 인식하고 있었다. 영향요인 분석에서는 MZ세대에서 일-삶의 균형이 “빠른 속도로 일함” 및 “공정한 대우”와 부적 관계가 있는 것으로 나타났다. 또한 MZ세대 에서 심리적 웰빙은 “빠른 속도로 일함”과는 부적 관계, “충분한 업무시간”과는 정적 관계가 있는 것으로 나타났다. 기성세대에서는 심리적 웰빙이 “충분한 업무시간” 및 “적절한 보상”과 정적 관계가 있었다. 결론 적으로, MZ세대 간호사의 일-삶의 균형 증진을 위해 간호업무 신속성에 대한 이해 증진과 공정한 대우 강화가 필요하다. 또한, MZ세대 간호사의 심리적 웰빙의 증진을 위해 충분한 인력배치가 필요하다.

Purpose: This study aimed to evaluate the effects of a simulation-based Room of Errors patient safety education program on patient safety-related nursing activities and critical reflection competency of new nurses. Method: A randomized controlled pretest–posttest design was used. A total of 63 new nurses participated, with 32 assigned to the experimental group and 31 to the control group. The experimental group received a team-based simulation intervention, with participants collaboratively identifying and addressing patient safety hazards within Room of Errors scenarios. Results: In the experimental group, patient safety-related nursing activity scores increased significantly after the intervention (t = 2.70, p = .011), while the control group showed no significant change (t = 0.23, p = .816). Additionally, critical reflection competency scores improved significantly in the experimental group (t = 3.66, p < .001), with no significant change observed in the control group (t = -0.53, p = .603). The between-group difference in change scores for critical reflection competency was statistically significant (t = 2.77, p = .007). Conclusion: The simulation-based Room of Errors education program effectively enhanced patient safety-related nursing activities and critical reflection competency among new nurses, suggesting its value as a training method for developing essential competencies in clinical practice.

Purpose: The objective of this study was to gain insight into the experiences of nurses who provided care for patients with COVID-19 in residential treatment centers (RTCs) during the pandemic. Methods: This study adopted qualitative methodology and conducted in-depth interviews with seven nurses from three residential treatment centers between July 11 and August 27, 2022. Inductive content analysis was employed, which consisted of data understanding, open coding, grouping, categorization, and abstraction. Results: Three themes and eleven subthemes were extracted from the data. The themes identified were "A struggle from beginning to end," "Unexpected challenges," and "Insecure system like a house built on sand." Nurses encountered difficulties in all aspects of the center's operations. Frequently, they were required to perform tasks outside of their responsibilities. During this process, nurses encountered difficulties due to unexpected challenges. Conclusion: Nurses encountered significant challenges in providing care to patients in an under-resourced and disorganized environment. They were compelled to assume diverse responsibilities for managing the center owing to the lack of clear protocols and guidelines and frequent changes. Unlike nurses in hospitals, nurses in RTCs spend a greater proportion of their time on non-medical issues, which can lead to emotional exhaustion. Based on these findings, it is imperative to establish clear guidelines and protocols to effectively run residential treatment centers in the future.

Purpose: This study aimed to explore, in depth, the changes in nurses’ perceptions and organizational culture following repeated experiences with healthcare accreditation. Methods: A qualitative content analysis design was employed to explore nurses’ perceptions of healthcare accreditation. In-depth semi-structured interviews were conducted with 14 nurses from a spine and joint specialty hospital in Seoul who had experienced both the third and fourth accreditation cycles. Data were collected from July 9 to July 30, 2025. To enhance analytical depth, the Balanced Scorecard (BSC) framework was adopted as an interpretive lens, encompassing four perspectives: financial, customer, internal process, and learning and growth. Results: Twenty themes were identified and organized into four thematic clusters aligned with the BSC framework (1) ‘The Hospital’s Reputation built on Nurses Burnout’, (2) ‘The Gap between Accreditation Standards and Clinical Realities’, (3) ‘The Need for Process Improvement and Link between Accreditation and Practice’, (4) ‘Fostering a Collaborative Culture and Strengthening Leadership Competence’ Conclusion: From the BSC perspective, healthcare accreditation positively influenced clinical standardization (internal process), hospital reputation (customer), and professional development (learning and growth), but imposed significant resource imbalances (financial) on frontline nurses. To enhance future accreditation effectiveness, policies should establish fair compensation and support systems, apply flexible evaluation criteria reflecting hospital size and resources, and integrate patient and staff satisfaction indicators into the evaluation framework.

Purpose: Following to the government's announcement of the "Essential healthcare policy package" and its plan to increase medical school admissions by 2,000 beginning in 2025 to address workforce shortages, a healthcare policy conflict occurred, causing significant disruptions in medical services. This study aimed to identify the nurses’ care experiences in the changed healthcare environment, particularly one year after the healthcare policy conflict. Methods: This study used a qualitative approach with content analysis. Data were collected through focus group interviews with 19 nurses from tertiary general hospitals who could provide detailed accounts of their patient care experiences in the changed healthcare environment following the healthcare policy conflict. The main question was, "What changes have occurred in the nursing field since the healthcare policy conflict?" The specific objective was to examine the challenges nurses faced in providing patient care during the healthcare policy conflict and to identify their effects on nursing practice. Results: Five main themes and 17 subthemes were identified. The themes were: (1) changing in the nursing practice environment due to healthcare policy conflict, (2) challenges in the healthcare setting caused by the absence of medical residents, (3) adaptation of the healthcare environment to change, (4) changes resulting from the expansion of tasks and deployment of medical support nursing workforce, and (5) the present and future of the healthcare setting one year after the healthcare policy conflict. Conclusion: This study found that the absence of residents during healthcare policy conflict increased inurses’ medical support tasks and challenges, including communication issues. Over time, the healthcare setting adapted, with faster prescription processes, higher patient satisfaction, and improved quality of care due to the involvement of the medical support nursing workforce. Nursing duties expanded beyond their traditional scope to address care gaps resulting from healthcare policy conflict. Additionally, medical support tasks such as prescriptions and procedures, previously performed in legal gray areas, were shown to be feasible within a formal legal framework. Defining the roles of newly assigned medical support nursing workforce and providing support is necessary. Based on these findings, future research should examine nursing workforce management, task allocation after residents’ return, and nurses’ experiences in both general and specialized units.

Purpose: This study aimed to provide a detailed understanding of nurses’ experiences with fall management in wards equipped with a video-based fall detection system. Methods: In-depth, semi-structured interviews were conducted with 10 nurses from an integrated nursing care ward at K Hospital in City C, where the system had been implemented. The interviews focused on nurses’ actual experiences and reflections regarding fall management. Data were systematically analyzed using Hsieh and Shannon’s conventional content analysis, which identified meaningful categories and themes. Results: The analysis identified six themes and 15 subthemes. The main themes were: Context of falls and limitations in management falls occurred through interactions between patient behaviors and environmental factors, while current assessment and management systems did not adequately address these complexities. Need for structured response processes after introducing video-based fall detection although video-based systems were implemented, fall recognition and responses remained experience-based and situation-dependent, highlighting the need for standardized, systematic procedures. Perceived limitations of video-based fall detection systems the system presented challenges such as delayed and false alarms, which reduced real-time responsiveness and affected clinical reliability. Practical benefits of video-based fall management and changes in nursing practice video verification improved the objectivity and accuracy of fall reporting, enhancing the consistency and systematization of nursing practice. Strategies for system use according to ward environment tailored use of the system based on ward characteristics and patient composition was suggested to optimize monitoring efficiency and fall prevention. Future directions for improved fall management strategies to enhance patient and caregiver awareness through video-based education and to improve ward environments were proposed as approaches for developing a preventive, smart-care model. Conclusion: The findings of this study indicate future directions and challenges for technology-based nursing practice in fall management, highlighting the need to develop new assessment frameworks, as well as educational and research strategies that reflect nurses’ experiences in diverse contexts, given the practical changes introduced by the video-based fall detection system and the limitations of current assessment tools.

Purpose: This study aimed to identify the status of medication errors by nurses using patient safety incident reports and to gain a detailed understanding of nurses' experiences with medication errors. Methods: An explanatory sequential mixed-methods design was used, combining a retrospective analysis of 204 patient safety incident reports on nurses’ medication errors with a qualitative study that explored the experiences of eight nurses through thematic analysis. Results: Most of the medication errors occurred during day shifts in intensive and trauma intensive care units. Injectable drugs accounted for 37.7% of errors, with dosage errors being most frequent. Although 67.6% of incidents resulted in no adverse effects, 65.7% were classified as adverse events, and 89.2% of predicted outcomes indicated potential physical harm to patients. Qualitative analysis of interviews yielded 36 meaningful statements, organized into 11 sub-themes and 3 main themes: (1) the whirlwind of negative emotions caused by medication errors, (2) obstacles in the clinical environment hindering adherence to medication principles, and (3) insights and reflections gained from medication error experiences. Conclusion: Organizations can prevent medication errors by improving workload distribution, ensuring safe environments, addressing staffing shortages, promoting a patient safety culture, and providing psychological support for affected nurses to improve their mental health and productivity.

Purpose: This study interprets how infection control nurses (ICNs) experienced and understood administrative support during infection-prevention activities, and to clarify how this support influenced their practice, well-being, and professional identity in post-pandemic clinical settings. Methods: This qualitative study used interpretative phenomenological analysis. Through purposive and snowball sampling, six ICNs from tertiary and general hospitals in Korea, each with at least 3 years of ICN experience and direct involvement in the COVID-19 response, participated in two semi-structured, in-depth interviews between August 20 and September 3, 2025. Interviews were audio-recorded, transcribed verbatim, and analyzed first idiographically, then across cases, following Smith’s procedures. Reflexive notes and an audit trail ensured analytic rigor. Results: Analysis identified six interrelated themes, expressed in participants’ terms and specific work contexts. First, the realities and challenges of infection-prevention practice reflected ongoing workload pressure, delayed outcome visibility, and crisis-driven surges that caused moral strain. Second, meanings and experiences of managerial support indicated that support was genuine when leaders listened, made prompt decisions, and backed ICN judgments; its absence led to isolation and role fatigue. Third, the operation of resources and institutional arrangements showed that staffing, budgets, equipment, and clear decision pathways either enabled or limited timely, consistent action. Fourth, organizational culture and interprofessional barriers revealed that hierarchical norms, siloed routines, and skepticism hindered cooperation, while open, learning-oriented environments supported the adoption of precautions. Fifth, emotional turbulence and professional identity highlighted tensions between enforcement and caregiving roles, which undermined self-efficacy; recognition and small practice successes restored pride in the specialized role. Finally, conditions for recovery and change emphasized that practical support and formal acknowledgment-along with after-action reviews, protocol updates, cross-disciplinary drills, and aligned incentives-helped transform individual learning into resilient, sustainable organizational capability. Conclusion: For ICNs, administrative support extends beyond resources by providing authority, psychological safety, and feasibility for infection-prevention efforts. To maintain prevention measures beyond crises, hospitals should ensure governance structures, rapid decision-making channels, stable staffing and budgets, and regular debriefings with protocol updates. Connecting infection-control performance to recognition and professional development may reduce burnout, strengthen professional identity, and enhance patient safety.

Purpose: This study aimed to examine the experiences of nurses who worked with substitute nurses and to identify the essence and structure of these experiences. Methods: Fourteen nurses from three tertiary hospitals in Seoul, each operating an independent a substitute nurse system, participated. Data were collected through individual interviews conducted from January 10 to February 22, 2025. Data analysis was performed using Colaizzi’s phenomenological method. Results: The study's results were organized into 35 themes, 13 theme clusters, and 5 categories: ‘‘The inescapable nature of shift work without a substitute’’, ‘‘Various perspectives on the introduction of substitute nurses’’, ‘‘Positive changes brought by substitute nurses’’, ‘‘Limitations of substitute workforce operation and the gap with actual practice’’, and ‘‘The supplementation and expansion of staff nurse system are essential’’. Conclusion: The substitute nurse system effectively reduced care gaps and staff nurse burden, however, it also exposed significant challenges, including staffing shortages and insufficient preparation for substitute nurses. Participants emphasized the need for system improvements, such as increasing substitute nurses numbers, strengthening pre-deployment training, and adopting more flexible staffing models. Despite these challenges, participants expressed optimism about the system's potential to improve nurse well-being, enhance patient care quality, and support organizational development. This study provides essential data on nurses’ experiences with substitute nurses in tertiary hospitals, which can inform strategies for effective implementation and sustainability of the substitute nurse system in clinical practice, supporting its successful integration and long-term benefits for both nurses and patients.

본 연구는 임상간호사의 간호전문직관, 공감능력, 회복탄력성이 간호업무성과에 미치는 영향을 확인하기 위한 서술적 조사연구이다. 전라남도 Y시에 소재한 종합병원에 근무 중인 간호사 170명을 대상 으로 설문조사를 실시하였으며, 자료분석은 SPSS version 26.0.프로그램을 사용하여 t-test, one-way ANOVA, 사후검증은 Scheffé test, Pearson correlation coefficient, stepwise multiple regression을 활용하 였다. 회귀분석 결과, 회복탄력성(β=.49)과 간호전문직관(β=.27)은 간호업무성과에 유의한 영향을 미치 는 요인으로 나타났으며, 이 두 변수는 간호업무성과를 약 44.8%를 설명하였다. 임상간호사의 간호업무성 과를 향상시키기 위해 회복탄력성과 간호전문직관을 강화하는 교육프로그램 개발 및 조직적인 전략이 필 요함을 시사한다. 따라서 지역 병원 임상간호사의 간호업무성과 증진을 위한 기초자료로 활용될 수 있다.

본 연구는 간호사의 높은 직무 스트레스와 소진에 대응하기 위해, 부정적 경 험을 긍정적 성장의 서사로 전환하는 내러티브 접근법인 'Re-Story 코칭 모델' 을 개발하고 타당화했다. 반복되는 직무 현장의 어려움에서 비롯되는 서사 정체 성의 왜곡 문제에 주목하여, 본 연구는 코칭 연구의 지평을 확장해 간호사의 복 잡한 내면을 다룬다. 초기 모델은 문헌고찰과 SWOT 분석을 통해 도출되었으 며, 12명 전문가의 델파이 조사를 통해 타당성을 확보했다. 연구 결과, '온전함' 회복을 핵심으로 신뢰·조율·진정성에 기반한 '공감의 장' 안에서 개방하기, 전 환하기, 발견하기, 체화하기의 네 가지 핵심 요소가 유기적으로 상호작용하는 다차원적 모델이 확립되었다. 본 모델은 간호사가 자기 이야기의 주체적 저자가 되도록 역량을 부여하는 구체적인 방법론을 제시하며, 소진을 예방하고 회복탄 력성을 높이는 자기 주도적 성장을 촉진하고, 지지적 관계를 통해 더 건강한 간 호 조직 문화를 조성하는 데 기여한다.

본 연구는 노인환자를 돌보는 요양병원이라는 특수한 환경에서 정서 적, 윤리적 요인이 간호업무수행에 미치는 영향을 분석하고자 요양병원 간호사의 공감역량과 윤리적민감성, 환자중심간호, 간호업무수행 간의 구 조적 관계를 파악하고, 간호업무수행 향상을 위한 이론적, 실무적 기초자 료를 제공하기 위해 수행되었다. 연구대상은 국내 요양병원간호사 230명 을 편의표집 하였으며, 연구결과로 모형 적합도는 χ²/df=165.517, CFI=.945, TLI=.928, RMSEA=.092로 양호하였으며, 공감역량은 윤리적민 감성(β=.478, p<.001)과 환자중심간호(β=.716, p <.001)에 유의미한 영향을 미쳤으며, 간호업무수행(β=.431, p <.001)에는 간접적으로 영향을 미치는 것으로 나타났다. 윤리적민감성은 간호업무수행(β=.188, p <.001)에, 환자 중심간호는 간호업무수행에 매개요인으로 작용하였다(β=.477, p <.001). 간호업무수행 향상과 환자중심간호를 실천하기 위한 간호인력 배치 기준 을 재정비하고, 다학제 팀의료 상호 협업 중심의 전인적인 돌봄 지원 체 계를 구축하는 것을 제시한다.

Purpose: This study applied a mixed-methods design to examine the effects of the nurse shift system improvement pilot project, organized by the Ministry of Health and Welfare, on ward nurses’ quality of life, job satisfaction, and patient safety nursing activities, as well as to explore their overall evaluation of the project through in-depth interviews. Methods: Using a mixed-methods approach, this study simultaneously conducted quantitative analyses of ward nurses’ quality of life, job satisfaction, and patient safety nursing activities, along with qualitative research through in-depth interviews to explore overall perceptions of the nurse shift system improvement pilot project. Results: Patient safety nursing activities showed a significant positive correlations with quality of life (r=.24, p=.017) and job satisfaction (r=.21, p=.038). There was also a significant positive correlation between quality of life and job satisfaction (r=.63, p<.001). As a result of the qualitative analysis, eight facilitating factors and five hindering factors related to the pilot project were identified. Conclusion: Through the research, the effectiveness of the pilot project and the factors influencing nurses were identified. Accordingly, strategies are needed to enhance patient safety nursing activities by improving nurses’ quality of life and job satisfaction in pilot project wards.

Purpose: This study aimed to clarify the attributes of the concept of nurses' righteousness through concept analysis and to provide foundational data for fostering nurses' morality in nursing education and practice. Methods: Walker and Avant's (2004) concept analysis method was applied to identify the conceptual attributes, antecedents, and consequences. A total of 40 domestic and international studies published from 2010 to 2024 were analyzed. Results: The concept attributes were training for a righteous life, fulfilling the duties assigned to oneself, relationship-oriented nursing with concern and empathy, respect for human rights and fair nursing, acting for the benefit of the community, and courage to do the right thing. The antecedents of nurses' righteousness were nurses' moral values, ethical awareness, patient-nurse interaction, and patientnurse communication, consequences of nurses’ righteousness confirmed to be nurses' moral integration, nurses' personal growth, improved quality of nursing, improved patient satisfaction, and growth of nursing organizations. Conclusion: This study is significant in that it defines the concept of nurses' righteousness and presents a theoretical basis for developing basic qualities as a nurse. Based on these findings, education and the development of programs focused on nurses' righteousness are recommended.

Purpose: This study explored the comprehensive experiences of nurses who volunteered for medical services at Saemangeum Jamboree using a systematic qualitative Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis framework. Methods: Semi-structured in-depth interviews were conducted with 12 nurses between March and October 2024. The collected data were analyzed using a conventional content analysis methodology with ATLAS.ti 6.2 software. Subsequently, the derived subcategories were systematically organized and classified within a SWOT matrix framework to provide structured insights into the experiences of the volunteer nursing. Results: The comprehensive analysis yielded 125 meaningful codes, which were systematically categorized into 23 distinct sub-themes and ultimately structured into 14 overarching themes within the SWOT matrix framework. The identified strengths included nursing expertise and clinical competency, building therapeutic trust through patient-centered care, and creative problem-solving in crisis situations. The identified weaknesses included experiencing physical and emotional exhaustion, language barriers due to limited foreign language proficiency, and initial resource constraints that compromised the quality of care. The opportunities identified included patient thankfulness reinforcing commitment to duty and guardians, valuable experience in cross-disciplinary collaboration highlighting the importance of teamwork, and increased sponsorship resources throughout the event progression. The identified threats encompassed a lack of response from administrative organization, absence of standardized nursing protocols or manuals, occurrence of the coronavirus disease 2019, ambiguity in roles and responsibility, and insufficient measures to ensure physical safety in the service area. Conclusion: The comprehensive findings of this study suggest that maximizing the effectiveness of nurse volunteers and enhancing volunteer satisfaction in future large-scale international events requires strengthened pre-event training programs, establishment of a systematic resource management system, and development of comprehensive response protocols for various emergency situations. This study provides essential foundational data and practical insights for planning and operating medical volunteer programs at similar international events and contributes valuable knowledge to the field of disaster nursing and humanitarian healthcare delivery.

Purpose: This study aimed to explore the experiences, essence, and structure of charge nurses operating in rotational appointment systems in tertiary hospitals. Methods: This qualitative study adopted a phenomenological approach. The participants were 11 charge nurses with rotational role experience working in tertiary hospitals in a metropolitan area. Data were collected through individual in-depth interviews lasting an average of 40~60 minutes and, conducted between July 8 and August 30, 2024. Colaizzi's phenomenological method was used for data analysis, which led to the identification of 35 themes, 14 theme clusters, and five categories. Results: The study revealed five categories: (1) ‘Taking the first step as a charge nurse,’ (2) ‘Enduring the weight of being a charge nurse,’ (3) ‘Creating my own charge nurse role,’ (4) ‘Mixed emotions returning after completing the rotation,’ and (5) ‘Ready to take the leap to the next level.’ The findings indicated that charge nurses experienced significant personal and professional growth while performing their roles. They demonstrated leadership, coordinated tasks and personnel, supported staff development, resolved issues, and facilitated communication. This role had a positive impact on both individual professional development and organizational efficiency. Despite initial feelings of anxiety and fear, charge nurses embraced challenges and contributed to improvements in organizational culture and patient safety while setting new goals for continuous growth even after completing their roles. Even in the post-term, they continued to expand their perspectives as nursing managers, increased their influence, and set new goals while pursuing ongoing growth and development. Conclusion: This study provides an in-depth understanding of the experiences of charge nurses in rotational systems in tertiary hospitals. Given the crucial role of charge nurses in the nursing leadership pipeline, it is essential to establish comprehensive hospital-wide programs to nurture leadership skills among front-line nursing managers and create supportive policies that fully enable their engagement.

Purpose: This qualitative study aimed to explore and interpret the meaning and essence of end-of-life care as experienced by nurses in internal medicine wards caring for patients who had completed advance directives (AD). It sought to understand the psychological conflicts, ethical dilemmas, and evolving perceptions of care encountered by nurses during the end-of-life process. Additionally, the study focuses on providing foundational data to support the clinical implementation of the AD system, thereby contributing strategies that improve the quality of end-of-life care and uphold patients' rights and dignity in hospital settings. Methods: A qualitative content analysis was conducted using in-depth, semi-structured interviews with 12 nurses from internal medicine wards in tertiary hospitals located in Seoul and surrounding metropolitan areas. Participants had direct experience in providing end-of-life care for patients with ADs. Interviews focused on capturing nurses’ real-life experiences and reflections related to such care. Data were analyzed systematically following the eight-step qualitative content analysis method proposed by Downe and Wamboldt, allowing for the identification of meaningful categories, themes, and patterns. Results: Analysis revealed five major themes and 16 subthemes. The major themes included: (1) Experiences of repeated end-of-life care and advance directives in internal medicine wards, reflecting the frequent encounters of nurses with terminally-ill patients and their ADs; (2) Multifaceted experiences of end-of-life care based on ADs, suggesting the complexities of care shaped by the presence or absence of ADs; (3) Limitations and dilemmas in AD implementation, highlighting the ethical conflicts arising from low public awareness and inconsistent clinical practices; (4) Shifts in perceptions of life and death, including the development of practical attitudes towards death through repeated exposure to dying patients, illustrating the evolving views of nurses; and (5) Hopes for improving end-of-life care in internal medicine wards, emphasizing the need for enhanced care environments, educational support, and institutional backing. Conclusion: The findings underscore the importance of increasing awareness and improving the clinical application of ADs. Establishing systematic support structures is essential to respect patient autonomy and enhance the quality of end-of-life care in internal medicine wards.