INTRODUCTION
1. Study Rationale
As the elderly population continues to increase rapidly in South Korea (henceforth, Korea), the 2023 National Survey of Older Koreans, conducted in accordance with the Welfare of Senior Citizens Act, reported that orthopedic diseases were among the most prevalent conditions among adults aged 65 years and older, following hypertension, hyperlipidemia, and diabetes mellitus [1]. Moreover, the number of adults aged 65 years and older who were hospitalized due to orthopedic diseases increased by 8.5%~12.3% compared with the previous year’s figure [1]. Older adults with orthopedic diseases experience problems such as restricted joint movement and immobility due to decreased physical capacity, which can lead to a decline in activities of daily living [2]. Continuous monitoring and attentive nursing care are therefore essential to prevent and manage these problems. Orthopedic units (OUs) play a critical role in older adults’ postoperative functional recovery and rehabilitation, and the demand for orthopedic surgery continues to increase with the growing elderly population [3]. In this context, nurses’ competencies in providing specialized nursing interventions and coordinating multidisciplinary collaboration are essential for promoting both patients’ physical recovery and psychological well-being [4]. Accordingly, it is necessary to identify the factors associated with geriatric nursing performance among nurses in OUs.
Geriatric nursing performance refers to the process of identifying and addressing older adults’ health-related needs by developing and implementing nursing plans to maintain their health, functioning, and well-being [5]. As the proportion of older patients in hospitals continues to increase, the role of nurses in improving the quality of care has become increasingly important, particularly in managing the complexity of older adults’ health problems and providing care based on a comprehensive understanding of their unique needs [6]. Thus, nurses should possess specialized knowledge and appropriate attitudes toward the aging process as well as the characteristics of older adults to provide high-quality nursing care and promote older patients’ quality of life [5]. Previous research has identified various factors influencing geriatric nursing performance, including professional self-concept among nurses in long-term care hospitals and perceptions of older adults among general hospital nurses [7,8]. However, few studies have specifically examined nurses working in OUs.
Geriatric nursing stress refers to the psychological and physiological burden experienced by nurses caring for patients aged 65 years and older, characterized by a level of pressure that can interfere with their job performance and lead to various difficulties in providing nursing care [9]. Older patients often present with complex health problems and an increased risk of falls, and they also require repeated education as well as counseling throughout the nursing process. Consequently, nurses must devote more time and stay vigilant when caring for these patients, resulting in a greater workload [10]. Prior studies have reported that higher levels of geriatric nursing stress are associated with lower levels of geriatric nursing performance [11]. In this context, OUs are experiencing an increasing proportion of older patients compared with other hospital units. Given the substantial nursing workload associated with prolonged bed rest, fall risk, and postoperative care among these patients [3], further research is required to examine the relationship between geriatric nursing stress and geriatric nursing performance among nurses working in OUs.
Resilience is an individual’s ability to overcome stress or adversity and to adapt flexibly to changing demands [12]. Previous studies have shown that resilience plays a key role in nurses’ ability to manage and cope with stress [11]. Furthermore, resilience enables nurses to draw upon internal and external resources to overcome adversity, thereby enhancing their well-being and competencies. This is important in nurses’ job performance [13], and prior research has demonstrated that resilience positively influences geriatric nursing performance [11]. These findings suggest that nurses’ resilience may play a vital role in effectively managing stress and improving geriatric nursing performance.
Positive nursing organizational culture refers to a work environment that promotes harmony and collaboration based on nursing values while fostering professional nursing practice and the development of nurses’ competencies [14]. In such an environment, nurses can experience personal growth and job satisfaction, which promotes positive changes in the thoughts and behaviors of members of the healthcare team [14]. A positive nursing organizational culture facilitates collaboration through transparent communication and trust, enhances work efficiency and productivity, and establishes an environment that enables nurses to adapt flexibly to changing circumstances [15]. Although few studies have examined the direct relationship between positive nursing organizational culture and geriatric nursing performance, previous research has demonstrated that a positive nursing organizational culture positively influences person-centered care [16]. Among the key characteristics of geriatric nursing is the need to simultaneously manage multiple chronic conditions and diverse care needs, requiring nurses to exhibit not only physical care but also emotional sensitivity and effective collaboration skills. A positive organizational climate and a culture of mutual respect are crucial in such an environment in cultivating organizational commitment [14], which may, in turn, contribute to more efficient and consistent geriatric nursing performance.
Geriatric nursing performance among nurses in OUs is important in optimizing functional recovery and the quality of life of older patients, who often experience slower postoperative recovery and a higher risk of complications [3]. Older patients with osteoarticular conditions particularly experience complex challenges as persistent pain and physical stiffness not only impair their ability to perform daily activities but may also contribute to psychological withdrawal and depressive symptoms [3]. Accordingly, OU nurses should assess patients’ physical, social, and psychological readiness for discharge and identify their individual nursing needs to develop comprehensive care plans aimed at minimizing discharge-related concerns such as mobility limitations, pain, and the absence of a caregiver at home [4]. Complex health problems and prolonged rehabilitation associated with these orthopedic conditions can impose increased stress among nurses caring for older patients. Meanwhile, resilience is instrumental in overcoming stress and maintaining work continuity [13], while a positive nursing organizational culture provides a foundation for reducing nurses’ stress and delivering patient-centered care by encouraging a collaborative work environment [15,16]. This study aimed to identify the levels of geriatric nursing stress, resilience, positive nursing organizational culture, and geriatric nursing performance among nurses in OUs. It also examined the relationships among these variables and analyzed the factors associated with geriatric nursing performance. Through these efforts, the study sought to provide foundational data for improving the quality of geriatric nursing care in a super-aged society and informing healthcare policy and clinical practice.
2. Study Purpose
This study aimed to examine the levels of geriatric nursing stress, resilience, positive nursing organizational culture, and geriatric nursing performance, as well as the relationships among these variables, and to analyze the factors associated with geriatric nursing performance among OU nurses. Specific objectives were as follows:
1. To identify the subjects’ general characteristics
2. To assess the levels of geriatric nursing stress, resilience, positive nursing organizational culture, and geriatric nursing performance among the subjects
3. To examine the differences in geriatric nursing performance according to the subjects’ general characteristics
4. To investigate the relationships among geriatric nursing stress, resilience, positive nursing organizational culture, and geriatric nursing performance among the subjects
5. To determine the factors associated with geriatric nursing performance among the subjects
METHODS
Ethic statement: This study was approved by the Institutional Review Board (IRB) of Inje University (IRB No. INJE IRB 2025-04-008). Informed consent was obtained from the participants.
1. Study Design
This cross-sectional descriptive study explored the levels and relationships among geriatric nursing stress, resilience, positive nursing organizational culture, and geriatric nursing performance. It also determined the factors associated with OU nurses’ geriatric nursing performance. The study was reported in accordance with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines (https://www.strobe-statement.org).
2. Study Subjects
Subjects were convenience-sampled from nurses who had worked for at least 6 months in OUs at four hospitals located in B Metropolitan City and G Province. Nurses in managerial positions, including charge nurses and nursing department managers, were excluded because their job duties differed from those of staff nurses. The required sample size was calculated using G*Power 3.1.9.4 based on a significance level (α) of .05, a medium effect size of .15, a statistical power of .80, and 11 independent variables (geriatric nursing stress, resilience, positive nursing organizational culture, sex, age, educational level, job position, clinical experience, number of hospital beds, experience living with older adults, and experience with geriatric nursing education). The resulting required sample size was 123 subjects. To account for a 6% anticipated dropout rate, 131 questionnaires were distributed, and all 131 completed questionnaires were included in the final analysis. This exceeded the minimum required sample size and provided a statistical power of .84.
3. Study Instruments
1) General Characteristics
The subjects’ general characteristics were assessed using eight items (sex, age, educational level, job position, total clinical experience, number of hospital beds, experience living with older adults, and experience with geriatric nursing education) that had shown significant associations in previous studies and were considered theoretically and practically important [5-8].
2) Geriatric Nursing Performance
Geriatric nursing performance was measured using the Geriatric Nursing Performance Scale developed by Kim [5] for nurses. The instrument comprises 53 items across nine subdomains: sleep care (6 items), activities of daily living care (5 items), nutritional care (5 items), elimination care (7 items), pain management (5 items), injury prevention care (7 items), skin care (6 items), therapeutic communication (6 items), and medication management (6 items). Each item was rated on a 5-point Likert scale according to the level of geriatric nursing performance (1 point for “never,” 2 points for “rarely,” 3 points for “sometimes,” 4 points for “often,” and 5 points for “always”). The total score ranges from 53 to 265, with higher scores indicating a higher level of geriatric nursing performance. In the present study, the mean item score, calculated by dividing the sum of the item scores by the total number of items, was used for analysis. The mean item score ranged from 1 to 5, with higher scores indicating a higher level of geriatric nursing performance. Cronbach’s α was .96 in Kim’s study [5] and .97 in this study.
3) Geriatric Nursing Stress
Geriatric nursing stress was measured using the Geriatric Nursing Stress Scale, developed by Gu and Kim [17] for nurses and subsequently modified and supplemented by Choi and Lee [9]. This scale comprises 23 items across three subdomains: nursing work-related stress (7 items), older patient-related stress (8 items), and caregiver-related stress (8 items). Each item was rated on a 4-point Likert scale according to the level of geriatric nursing stress (1 point for “strongly disagree,” 2 points for “disagree,” 3 points for “generally agree,” and 4 points for “strongly agree”). The total score ranges from 23 to 92, with higher scores indicating a higher level of geriatric nursing stress. The mean item score, calculated by dividing the sum of the item scores by the total number of items, was used for analysis in this study. Scores ranged from 1 to 4, with higher scores indicating greater levels of geriatric nursing stress. Cronbach’s α was .95 in the original study by Gu and Kim [17], .80 in the study by Choi and Lee [9], and .92 in the present study.
4) Resilience
Resilience was measured using the Korean version of the Connor-Davidson Resilience Scale, originally developed by Connor and Davidson [12] for the general adult population and individuals with post-traumatic stress disorder and subsequently translated and validated by Baek et al. [18]. This instrument comprises 25 items across five subdomains: tenacity (9 items), persistence (8 items), optimism (4 items), support (2 items), and spirituality (2 items). Each item was rated on a 5-point Likert scale according to the level of resilience (0 points for “strongly disagree,” 1 point for “disagree,” 2 points for “neither agree nor disagree,” 3 points for “agree,” and 4 points for “strongly agree”). The total score ranges from 0 to 100, with higher scores indicating a higher level of resilience. The mean item score, calculated by dividing the sum of the item scores by the total number of items, was used for analysis in this study. Scores ranged from 0 to 4, with higher scores indicating a higher level of resilience. Cronbach’s α was .89 in the original study by Connor and Davidson [12], .93 in the study by Baek et al. [18], and .95 in this study.
5) Positive Nursing Organizational Culture
Positive nursing organizational culture was measured using the tool developed by Kim and Kim [14] for nurses. This tool comprises 26 items across four subdomains: active leadership of nursing managers (7 items), pursuit of shared values (7 items), development of trust-based organizational relationships (8 items), and a fair management system (4 items). Each item was rated on a 5-point Likert scale according to the degree of positive nursing organizational culture (1 point for “strongly disagree,” 2 points for “disagree,” 3 points for “neither agree nor disagree,” 4 points for “agree,” and 5 points for “strongly agree”). The total score ranges from 26 to 130. The mean item score, calculated by dividing the sum of the item scores by the total number of items, was used for analysis in this study. Scores ranged from 1 to 5, with higher scores indicating a more positive perception of the nursing organizational culture. Cronbach’s α was .95 in Kim and Kim’s study [14] and .96 in this study.
4. Data Collection
The study was conducted with the approval of the Institutional Review Board of Inje University (approval No. INJE IRB 2025-04-008). Data were collected from May 12 to August 31, 2025. The research team visited the nursing departments of four hospitals located in B Metropolitan City and G Province to explain the purpose of the study and obtain preliminary approval. The team then met with the department heads in person to provide details on the necessity, purpose, procedures, and ethical considerations of the study, ultimately obtaining their approval to conduct the research. Nurses with at least 6 months of experience working in OUs, excluding those in managerial positions, were provided with information about the study’s purpose, procedures, and ethical considerations by the department heads. Nurses who agreed to participate provided written informed consent and were then provided with the questionnaire. Subjects completed the questionnaire independently, which took approximately 15 to 20 minutes. The questionnaires were then placed in opaque envelopes, sealed with double-sided tape, and submitted to the nursing department, where they were personally collected by the research team.
5. Data Analysis
The collected data were analyzed using the IBM SPSS/WIN 29.0 program (IBM Corp.), and the specific analysis methods were as follows:
• Subjects’ general characteristics were analyzed using frequencies, percentages, means, and standard deviations.
• Levels of geriatric nursing stress, resilience, positive nursing organizational culture, and geriatric nursing performance were analyzed using means and standard deviations.
• Differences in geriatric nursing performance according to the general characteristics were analyzed using independent t-tests and one-way ANOVA, with Scheffé’s test used for post hoc comparisons.
• Correlations among geriatric nursing stress, resilience, positive nursing organizational culture, and geriatric nursing performance were analyzed using Pearson correlation coefficients.
• Factors associated with geriatric nursing performance were analyzed using multiple linear regression analysis.
RESULTS
1. Subjects’ General Characteristics
The subjects’ mean age was 30.61±6.70 years, with those under 30 years of age comprising the largest proportion of the sample (52.7%, n=69). Most of the subjects were female (91.6%, n=120), had a bachelor’s degree or higher (90.8%, n=119), and were staff nurses (80.2%, n=105). More than half of the subjects had less than 5 years of total clinical experience (53.4%, n=70) and worked at hospitals with 100 to fewer than 300 beds (77.1%, n=101). Regarding experience living with older adults, 66.4% (n=87) reported no such experience, and 66.4% (n=87) reported having received education related to older adults (Table 1).
2. Levels of Geriatric Nursing Performance, Geriatric Nursing Stress, Resilience, and Positive Nursing Organizational Culture
The mean item score for geriatric nursing performance was 3.97±0.56 out of 5 points, while that for geriatric nursing stress was 2.91±0.45 out of 4 points. For resilience, the mean item score was 2.67±0.63 out of 4 points, and that for positive nursing organizational culture was 3.75±0.66 out of 5 points (Table 2).
3. Differences in Geriatric Nursing Performance According to General Characteristics
Significant differences in geriatric nursing performance were observed according to age (F=3.51, p=.033) and experience living with older adults (t=2.17, p=.032). Results of Scheffé’s post hoc test indicated that subjects under the age of 30 years and those in their 30s had significantly lower levels of geriatric nursing performance than those aged 40 years or older. Subjects who had experience living with older adults additionally demonstrated higher levels of geriatric nursing performance than those without such experience (Table 3).
4. Correlations Among Geriatric Nursing Performance, Geriatric Nursing Stress, Resilience, and Positive Nursing Organizational Culture
Geriatric nursing performance was positively correlated with resilience (r=.52, p<.001) and a positive nursing organizational culture (r=.46, p<.001). In addition, resilience was positively correlated with a positive nursing organizational culture (r=.44, p<.001) (Table 4).
5. Factors Associated With Geriatric Nursing Performance
Multiple linear regression analysis was performed to identify factors associated with geriatric nursing performance. Age and experience living with older adults, which showed significant differences in geriatric nursing performance according to general characteristics, along with major variables of resilience and positive nursing organizational culture, were used as independent variables. Age and experience living with older adults were treated as dummy variables as they were categorical variables. Prior to the analysis, the Durbin-Watson statistic was calculated to be 2.02, indicating no systematic autocorrelation among the error terms. The tolerance values ranged from .75 to .99, exceeding the threshold of 0.1, while the variance inflation factor values ranged from 1.00 to 1.33, all below 10, indicating no evidence of multicollinearity among the independent variables. Results showed that factors significantly associated with geriatric nursing performance were a positive nursing organizational culture (β=.36, p<.001), resilience (β=.33, p<.001), age ≥40 years (β=.23, p=.002), and experience living with older adults (β=.20, p=.004), with the model explaining 40% of the variance in geriatric nursing performance (Table 5).
DISCUSSION
The study aimed to examine the levels of geriatric nursing stress, resilience, positive nursing organizational culture, and geriatric nursing performance among nurses working in OUs; to investigate the relationships among these variables; and to determine the factors associated with geriatric nursing performance. The findings were intended to provide evidence for improving the quality of geriatric nursing and informing healthcare policy as well as clinical practice in the context of a super-aged society. Results showed that resilience and a positive nursing organizational culture were significantly associated with geriatric nursing performance among OU nurses.
The mean item score for geriatric nursing performance was 3.97 out of 5 points. Prior research using the same instrument reported a mean score of 3.78 among nurses in tertiary hospitals [6], which was somewhat lower than that observed in the present study. In contrast, a study conducted on nursing care providers working in long-term care hospitals reported a higher mean score of 4.15 [19]. Although these findings may suggest that nursing care providers at long-term care hospitals demonstrate higher levels of geriatric nursing performance than nurses at teaching hospitals, direct comparisons should be made cautiously as differences exist in institutional characteristics [19]. In long-term hospitals, the work environment is focused primarily on older patients and results in a relatively greater demand for geriatric nursing care and more frequent exposure to geriatric nursing practice, which may explain this finding [8]. Conversely, OUs primarily focus on surgery and rehabilitation, which may contribute to differences in nursing performance. Therefore, the findings of this study may reflect the specific nursing demands and clinical characteristics of OUs.
The mean item score for geriatric nursing stress was 2.91 out of 4 points. In a previous study examining nurses working at teaching hospitals using the same instrument, the mean score was 3.03 [20], which was slightly higher than the score in this study. Meanwhile, a study involving nurses and nursing personnel in long-term care hospitals reported a mean score of 2.87 [21], which is slightly lower. A large proportion of patients in OUs experience pain, and many require pain relief through various interventions beyond pharmacological treatment. Nurses in these units therefore play a significant role in pain assessment and management, which are closely related to postoperative functional recovery and patient outcomes [22]. Long-term care hospitals, which primarily manage chronic conditions, differ from acute-care hospitals such as general and teaching hospitals in that they provide less intensive medical intervention but emphasize continuous and repetitive care over an extended period of time [21]. Thus, the workload of nurses in OUs may be relatively greater than that of nurses in long-term care hospitals, partly explaining the level of geriatric nursing stress observed in this study.
The mean item score for resilience was 2.67 out of 4 points. This was higher than the score of 2.38 reported in a study on general hospital nurses using the same instrument [13] but lower than the score of 3.52 reported among nurses in long-term care hospitals [23]. These differences in mean scores for resilience may be related to nurses’ clinical experiences. In the present study, subjects had an average of 5.86 years of clinical experience, compared with 10.6 years in the study on long-term care hospitals [23]. This finding is consistent with earlier studies showing that accumulated clinical experience enhances work proficiency and coping abilities across diverse clinical situations, contributing to greater levels of resilience [24]. The Korean version of the Connor-Davidson Resilience Scale has been widely applied in previous research involving nurses, with its validity established across various populations. The reliability of the instrument in this study was high (Cronbach’s α=.95), supporting its appropriateness for assessing resilience. However, because the instrument was not specifically developed to reflect nurses’ occupational and psychological characteristics, future studies should consider comparative analyses using resilience measures targeted at nursing populations.
The mean item score for positive nursing organizational culture was 3.75 out of 5 points. In a previous study on nurses in teaching hospitals, the mean score was 3.77 [25], which was similar to the present finding and indicated an overall moderate-to-high level of perceived positive nursing organizational culture. Kim and Kim, developers of the scale, suggested that effective teamwork promoted a collaborative division of tasks, reduced delays and avoidance of responsibility, and facilitated efficient task performance, allowing nurses to experience a greater sense of achievement and fulfillment despite substantial workloads [14]. OUs represent complex clinical environments in which older patients frequently undergo surgery for fractures, joint replacement, amputation, and other conditions, requiring repeated interventions such as pre- and postoperative care, mobility assistance, rehabilitation, and discharge preparation [4]. Nursing care that considers the patient’s individual needs and psychological resilience is particularly important, and multidisciplinary collaboration based on trust, respect, and effective communication among nurses is imperative [4]. A positive nursing organizational climate can therefore promote active engagement in work, boost job satisfaction, and support nurses’ continued professional development [25]. Such trust-based cooperation may aid in building a positive nursing organizational culture within OUs.
Geriatric nursing performance differed significantly according to age and experience living with older adults. Subjects under the age of 30 years and those in their 30s demonstrated significantly lower levels of geriatric nursing performance than those aged 40 years or older. Nurses who had experience living with older adults additionally showed higher levels of geriatric nursing performance than those without such experience. This aligns with findings from prior research that revealed that geriatric nursing performance increased with age [26] and that it was significantly associated with experience living with older adults [27].
In the correlation analysis, geriatric nursing performance was observed to be positively correlated with both resilience and positive nursing organizational culture. Resilience was also positively correlated with positive nursing organizational culture. The positive association between geriatric nursing performance and resilience is consistent with past findings of a study on general hospital nurses [11]. Although higher levels of positive nursing organizational culture were associated with higher levels of geriatric nursing performance in this study, comparisons with past research are difficult because few studies have examined the relationship between these two variables. The positive correlation between resilience and positive nursing organizational culture was similar to the results of another former study involving general hospital nurses [28]. Given the limited evidence regarding these relationships, however, further replication studies are necessary to clarify the link between these variables.
Multiple linear regression analysis was performed to identify factors associated with geriatric nursing performance by using age, experience living with older adults, resilience, and positive nursing organizational culture as independent variables. Results showed that positive nursing organizational culture, resilience, being 40 years old or older, and having experience living with older adults were significantly associated with geriatric nursing performance, in descending order of association. This indicates that higher levels of positive nursing organizational culture and resilience, being 40 years old or older, and having experience living with older adults are associated with higher levels of geriatric nursing performance.
Positive nursing organizational culture demonstrated the strongest association with geriatric nursing performance, consistent with past studies suggesting that a positive organizational culture contributes to person-centered care [28]. Hence, a supportive organizational climate may enable nurses to engage more actively and effectively in geriatric nursing. A multidisciplinary team approach is required in OUs to facilitate postoperative rehabilitation [4], and a positive organizational culture may promote effective communication among healthcare providers, along with the advancement of integrated and safe interventions for older patients with mobility limitations and an increased risk of falls. Therefore, sustained and systematic efforts to foster a positive nursing organizational culture are important for improving the quality of geriatric nursing performance in clinical settings. Strengthening an organizational culture that respects differences and incorporates diverse perspectives may ultimately provide meaningful support for nurses’ geriatric nursing performance.
Resilience was the second strongest factor associated with geriatric nursing performance, which is consistent with findings from studies among general hospital nurses [11]. Being an individual’s capacity to maintain control and overcome adverse circumstances [13], resilience is an essential psychological resource for nurses who must continuously adapt to changing clinical environments [24]. Research suggests that resilience not only buffers the effects of stress but also helps nurses adapt to challenging situations while also promoting personal growth [13]. Nurses in OUs are frequently exposed to unpredictable situations among older patients immediately after surgery such as postoperative pain and delirium [3]. In such circumstances, nurses with higher resilience may be better able to manage work-related stress and sustain proactive nursing practices that facilitate the early identification of patient deterioration and functional recovery. Programs designed to enhance OU nurses’ resilience should thus be developed and implemented to help nurses adapt flexibly to changing clinical environments and maintain high levels of geriatric nursing performance. In a study by Moon [29], who implemented a participatory resilience-enhancement program delivered remotely through platforms such as Zoom and BAND among nurses in long-term care hospitals, greater improvements in resilience were observed in the experimental group than in the control group. This suggests that remotely delivered resilience-enhancement programs may be feasible and effective for strengthening nurses’ psychological and emotional capacities. Based on this evidence, developing and implementing various participatory programs aimed at building resilience among OU nurses may lead to the improvement of both their resilience and the quality of geriatric nursing.
Last, being 40 years old or older and having experience living with older adults were significantly associated with geriatric nursing performance. This may be explained by the possibility that accumulated life experience and interactions with older adults through cohabitation enhance nurses’ understanding of geriatric patients [21], thereby improving nursing performance. Older orthopedic patients may experience considerable fear regarding physical recovery, and seasoned nurses may provide stable and confident care that bolsters patients’ trust and encourages early ambulation as well as participation in rehabilitation. Similarly, nurses with experience living with older adults may have a deeper understanding of geriatric patients and therefore approach them more effectively, leading to higher levels of geriatric nursing performance. Such experience may aid in the provision of holistic and attentive, family-like care beyond task-oriented interventions. Accordingly, consideration should be given to nurses’ personal experiences and clinical expertise when staffing OUs. Simultaneously, educational programs should be provided to junior nurses to foster positive attitudes and empathy toward older adults.
Collectively, the findings highlight that geriatric nursing performance among nurses in OUs is associated not only with individual characteristics but also with organizational and psychological factors. Positive nursing organizational culture particularly demonstrates the strongest influence and represents an important organizational factor closely related to patient safety. Therefore, strategic support is required at the institutional level to strengthen multidisciplinary collaboration and establish a positive nursing organizational culture based on mutual respect for professional expertise. Moreover, integrating systematic resilience-enhancement interventions and creating an educational environment in which senior nurses can impart their clinical knowledge and experiences may help promote high-quality, holistic geriatric nursing in OUs.
Geriatric nursing stress was not significantly associated with geriatric nursing performance in this study. Previous studies have suggested that stress may have both positive and negative effects on job performance [20]. The current findings may be due to the practical characteristics of OUs, where complex interventions involving pre- and postoperative care and rehabilitation are repeatedly performed [4]. This sense of accomplishment derived from supporting patients’ functional recovery may have attenuated the potential negative effects of stress. Previous studies have also reported inconsistent findings regarding the relationship between geriatric nursing stress and geriatric nursing performance. Some have found that lower stress is associated with higher levels of performance [11], whereas others have reported that higher stress is associated with higher nursing performance [30]. Therefore, this relationship should be interpreted with caution. Further studies should examine the association between geriatric nursing stress and performance while considering both stress intensity and its chronicity and duration.
CONCLUSION
The present study examined the levels and relationships among geriatric nursing stress, resilience, positive nursing organizational culture, and geriatric nursing performance among nurses working in OUs, and it determined the factors associated with geriatric nursing performance. Results showed that positive nursing organizational culture, resilience, being aged 40 years or older, and having experience living with older adults were significantly associated with geriatric nursing performance. To improve geriatric nursing performance among OU nurses, therefore, effective intervention programs should be developed to build resilience and a positive nursing organizational culture at both the individual and organizational levels. A multidisciplinary outcome feedback system that enables healthcare providers to share patients’ postoperative recovery indicators should be established to facilitate these efforts and create an environment in which nurses can experience a greater sense of professional achievement. Case-based simulation training tailored to acute orthopedic care and rehabilitation should also be introduced to enhance nurses’ professional competence and provide a foundation for delivering high-quality care to older patients. The effectiveness of these training programs should be further evaluated through future replication studies. While prior findings regarding the relationship between geriatric nursing stress and geriatric nursing performance have been inconsistent, further studies are required to clarify this relationship. Although the high reliability of the instruments used in this study ensured consistency in the responses, the possibility of item redundancy due to similarities among items should also be considered. Future research should thus employ item response theory to rigorously assess the discriminative properties of the instruments. Finally, because this study was limited to nurses working in OUs at hospitals located in B Metropolitan City and G Province, additional replication studies involving diverse geographical regions and healthcare institutions are warranted.
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