[Development and Effects of a Person-Centered Fall Prevention Program for Older Adults with Dementia in Long-Term Care Hospitals: For Older Adults with Dementia and Caregivers in Long-Term Care Hospitals].

PURPOSE: This study examined the effects of a person-centered fall prevention program for older adults with dementia in long-term care hospitals. METHODS: A nonequivalent control group pretest-posttest design was used. The study sample included 42 older adults with dementia (experimental group: 21, control group: 21) and 42 caregivers (experimental group: 21, control group: 21). The program comprised 48 sessions held over 12 weeks and included exercise intervention with resistance and balance, dance walking (45~60 min, three times/week), cognitive and emotional intervention (35~50 min, once per week), and person-centered fall prevention education (10 min, once per week). The program for caregivers consisted of six educational sessions (i.e., fall prevention competency enhancement and person-centered care strategy education, 80 min, once per week) for six weeks. Data were collected before participation and 12 weeks after program completion from February 18 to May 12, 2019. Data analysis was conducted using the chi-square test, t-test, and Mann-Whitney U test with SPSS/WIN 21.0. RESULTS: The experimental group of older adults with dementia showed significant improvement in physical and cognitive functions, and a decrease in depression, and behavioral and psychological symptoms, when compared with the control group. caregivers in the experimental group exhibited significant improvement in fall-related knowledge and person-centered care of older adults with dementia compared to the control group. CONCLUSION: The study findings indicate that this program was effective as a nursing intervention for fall prevention among older adults with dementia in long-term care hospitals.

The Effects of a Tripod Approach for Cancer Patients on Illness Stress, Health-Promoting Lifestyle, Hope, and Resilience.

BACKGROUND: Health-related exercise and education program for cancer patients are necessary to provide physical and emotional support to enable efficient and appropriate self-management at home. OBJECTIVE: This study aimed to investigate the effects of a tripod approach including physical exercise, education, and emotional support program on illness stress, health promotion lifestyle, hope, and resilience in cancer patients. INTERVENTIONS/METHODS: This was a quasi-experimental repeated-measures study using a pre-post design with a nonhomogeneous control group. A total of 72 cancer patients (experimental group = 37, control group = 35) who were currently receiving treatment and staying at home were enrolled. RESULTS: The experimental group showed significantly lower illness stress scores (F = 17.35, P < .001) and increase in health promotion lifestyle scores (F = 4.05, P = .048) compared with the control group, especially social relationships (t = 1.85, P = .073) and stress management (t = 2.30, P = .027). However, there were no effects on hope and resilience. Also, illness stress showed significant changes after 6 weeks (t = -3.35, P = .001) and after 10 weeks (t = -5.04, P < .001). Overall health promotion lifestyle showed changes after 10 weeks (t = 2.25, P = .030), with meaning of life (t = 2.57, P = .014), stress management (t = 2.30, P = .027), and medical behaviors (t = 2.46, P = .019) especially showing significant changes. CONCLUSIONS: The results showed that the tripod approach had positive effects on illness stress and health promotion lifestyle of cancer patients staying at home. Further study to improve positive emotions such as hope and resilience is needed. IMPLICATIONS FOR PRACTICE: Based on our findings, combining nursing intervention with physical exercise, education, and emotional support could be incorporated into cancer patients in community and early survivorship care plans in clinical practice.

Effects of an evidence-based practice education program using multifaceted interventions: a quasi-experimental study with undergraduate nursing students.

BACKGROUND: Although Evidence-Based Practice (EBP) should be introduced early on in nursing education to develop students' independence and self-learning ability, there are few such courses for undergraduate nursing students in Korea. This study examined the effects of the EBP education program for undergraduate nursing students (EBP-EPUNS) on nursing students' knowledge, skills, attitudes, competencies, and future use of EBP. METHODS: A quasi-experimental study design with pre-test, intervention, and post-test was used. The participants were 44 nursing students (experimental: 22, control: 22). A 20-h long EBP-EPUNS consisting of 5-step EBP components was provided through 8 sessions spread across 4 weeks. RESULTS: An independent t-test and a repeated-measures ANOVA showed that the experimental group had statistically significant higher post-test scores on EBP knowledge (p < 0.001), skills (p < 0.001), attitudes (p < 0.001), competencies (p < 0.001), future use of EBP (p = 0.001), and critical thinking (p < 0.001), compared to the control group. CONCLUSION: The EBP education program was effective in improving the knowledge, skills, attitudes, competencies, and future use of EBP among nursing students. Hence, we recommend the EBP education program as a general education course for undergraduate nursing students to promote needed proficiency in EBP.

[Structural Equation Model for Sleep Quality of Female Shift Work Nurses].

PURPOSE: This study aimed to develop and test a structural model for sleep quality in female shift work nurses. The hypothetical model was constructed on the basis of Spielman's 3P model of insomnia and previous research related to the sleep quality of shift nurses. METHODS: This cross-sectional study used structural equation modeling and recruited 285 female shift work nurses from four general and university hospitals with over 300 beds located in C and J cities in Gyeongsangnamdo. Data were collected from September 27 to October 20, 2016, and then analyzed using descriptive statistics, Pearson's correlation, and structural equation modeling. The study used SPSS/Win 18.0 and AMOS 18.0 in processing the data. RESULTS: The final model showed good fit to the empirical data: χ²/df=2.19, SRMR=.07, RMSEA=.07, AGFI=.85, TLI=.91, GFI=.93, GFI=.89, NFI=.87. The factors that influenced sleep quality were sleep hygiene (ß=.32), perceived shift work status (ß=-.16), stress response (ß=.16), shift work experience (ß=.15), perceived health status (ß=-.14), and circadian rhythm (ß=-.13) explaining 36.0% of the variance. CONCLUSION: The model of sleep quality of the shift work nurses constructed in this study is recommended as a model to understand and predict the sleep quality of shift work nurses. The results suggest that strategies for improving the sleep quality of shift work nurses should focus on sleep hygiene, perceived health status, stress response, circadian rhythm, perceived shift work status, and shift work experience.

[Development and Effects of a Coping Skill Training Program for Caregivers in Feeding Difficulty of Older Adults with Dementia in Long-Term Care Facilities].

PURPOSE: We developed and tested the effects of a coping skill training program for caregivers in feeding difficulty among older adults with dementia in long-term care facilities. METHODS: A non-equivalent control group pretest-posttest design was used. The subjects comprised 34 caregivers (experimental group: 17, control group: 17) and 40 older adults with dementia (experimental group: 20, control group: 20). The developed program was delivered in 4-hour sessions over 6 weeks (including 2 weeks of lectures and lab practice on feeding difficulty coping skills, and 4 weeks of field practice). Data were collected before, immediately after, and 4 weeks after the program (January 3 to April 6, 2016). The data were analyzed using t-test and repeated measures ANOVA using SPSS/WIN 20.0. RESULTS: Compared to their counterparts in the control group, caregivers in the experimental group showed a significantly greater improvement in feeding knowledge and feeding behavior, while older adults with dementia showed greater improvements in feeding difficulty and Body Mass Index. CONCLUSION: The study findings indicate that this coping skill training program for caregivers in feeding difficulty is an effective intervention for older adults with dementia in long-term care facilities.

[Development and Effects of Combined Exercise Program for Older Adults with Sarcopenia Based on Transtheoretical Model].

PURPOSE: The purpose of this study was to develop and examine the effects of combined exercise program for older adults with sarcopenia based on transtheoretical model (TTM). METHODS: A non-equivalent control group with a pretest-posttest design was used. The subjects consisted of 43 older adults with sarcopenia in precontemplation stage, contemplation stage and preparation stage of TTM (experimental group: 22, control group: 21). The developed program consisted of 36 sessions for 12 weeks including combined exercise (60 minutes) and TTM based strategies for enhancing exercise behavior (10 minutes) per session. Data were collected before, immediately after the program between July 31 to October 27, 2017. The data were analyzed using independent t-test, Mann-Whitney U test with SPSS/WIN 18.0. RESULTS: Compared with their counterparts in the control groups, older adults with sarcopenia in the experimental group showed a significantly greater improvement in process of exercise behavior change, pros and cons of decisional balance for exercise behavior, exercise self-efficacy, parameters of muscle, and the level of physical performance. CONCLUSION: The study findings indicate that this combined exercise program for older adults with sarcopenia based on TTM model was effective and can be recommended as a nursing intervention for older adults with sarcopenia.

Efficacy of a Home-Based Exercise Program After Thyroidectomy for Thyroid Cancer Patients.

BACKGROUND: The objective of this study was to determine the effect of a home-based exercise program on fatigue, anxiety, quality of life (QoL), and immune function of thyroid cancer patients taking thyroid hormone replacement after thyroidectomy. METHOD: This quasi-experimental study with a non-equivalent control group included 43 outpatients taking thyroid hormone replacement after thyroidectomy (22 in the experimental group and 21 in the control group). After education about the home-based exercise program, subjects in the experimental group underwent 12 weeks of aerobic, resistance, and flexibility exercise. A comparative analysis was conducted between the two groups. RESULTS: Patients in the experimental group were significantly less fatigued or anxious (p < 0.01). They reported significantly improved QoL (p < 0.05) compared to those in the control group. Natural killer cell activity was significantly higher in the exercise group compared to that in the control group (p < 0.05). CONCLUSION: A home-based exercise program is effective in reducing fatigue and anxiety, improving QoL, and increasing immune function in patients taking thyroid hormone replacement after thyroidectomy. Therefore, such a home-based exercise program can be used as an intervention for patients who are taking thyroid hormone replacement after thyroidectomy.

Comparison of Walking, Muscle Strength, Balance, and Fear of Falling Between Repeated Fall Group, One-time Fall Group, and Nonfall Group of the Elderly Receiving Home Care Service.

PURPOSE: The purpose of this study was to provide information to develop a program to prevent repeated falls by analyzing the difference in gait, muscle strength, balance, and fear of falling according to their fall experience. METHODS: The study subjects were 110 elderly individuals aged over 60 years who agreed to their participation in this research. The study participants were categorized into a repeated fall group (n = 40), a one-time fall group (n = 15), and a nonfall group (n = 46) of the elderly. Measurements of gait, muscle strength, balance, and fear of falling were taken in each group. RESULTS: With regard to gait, there were significant differences among three groups in gait cycle (F = 3.50, p = .034), speed (F = 13.06, p < .001), and cadence (F = 5.59, p = .005). Regarding muscle strength in the upper and lower limbs, statistically significant differences were shown among three groups in muscle strength of upper (F = 16.98, p < .001) and lower (F = 10.55, p < .001) limbs. With regard to balance, the nonfall group had significantly greater results than the one-time fall group and repeated fall group in dynamic balance (F = 10.80, p < .001) and static balance (F = 8.20, p = .001). In the case of the fear of falling, the repeated fall group had significantly higher score than other two groups (F = 20.62, p < .001). CONCLUSION: This study suggests that intervention program should be tailored to fall risk factors to enhance gait and balance and lower body muscle strength and reduce the fear of falling to prevent repeated incidences of falls in this population.

[Development and Effects of a Motivational Interviewing Self-management Program for Elderly Patients with Diabetes Mellitus].

PURPOSE: This study was conducted to develop and test the effects of a motivational interviewing self-management program for use with elderly patients with diabetes mellitus. METHODS: A non-equivalent control group pretest-posttest design was used. The participants were 42 elderly diabetic patients (experimental group: 21, control group: 21). The motivational interviewing self-management program for elders with diabetes mellitus developed in this study consisted of a 12-week program in total (8 weeks for group motivational interviewing and education and 4 weeks for individual motivational interviewing on the phone). Data were collected between February 13 and May 3, 2013 and were analyzed using t-test, paired t-test, and repeated measure ANOVA with SPSS/WIN 18.0. RESULTS: For the experimental group, significant improvement was found for self-efficacy, self-care behavior, glycemic control and quality of life (daily life satisfaction, influence of disease) as compared to the control group. CONCLUSION: The study findings indicate that the motivational interviewing self-management program is effective and can be recommended as a nursing intervention for elderly patients with diabetes mellitus.

Development and validation of an instrument to assess knowledge and skills of evidence-based nursing.

AIMS AND OBJECTIVES: To develop an objective instrument to measure nurses' entry-level knowledge of and skills in evidence-based practice, and to evaluate the validity and reliability of the instrument. BACKGROUND: To promote evidence-based practice in nursing, nurses should initially receive education about evidence-based practice knowledge and learn the skills, and this should be followed by measurement with an instrument that was developed to evaluate the extent to which they are prepared to use evidence-based practice knowledge and skills. Although some self-report instruments have been developed to measure evidence-based practice in nursing, an objective instrument to evaluate nurses' evidence-based practice knowledge and skills is not available at present. DESIGN: A methodological study. METHODS: This study was conducted in two stages: the instrument development and its psychometric evaluation, including its validity and reliability. An instrument, 'Knowledge and Skills of Evidence-based Nursing,' was developed. Content validity was assessed by five experts in evidence-based nursing, and the construct validity was evaluated by the known-groups method. Reliability was examined with internal consistency reliability and inter-rater reliability. RESULTS: A content validity index >0·80 was achieved. For construct validity, there were statistically significant differences between the evidence-based practice and nonevidence-based practice groups in total scores and in the scores on each subscale of the Knowledge and Skills of Evidence-based Nursing. Cronbach's alpha was 0·96, and the inter-rater reliability was excellent. CONCLUSIONS: The Knowledge and Skills of Evidence-based Nursing is a valid and reliable instrument for objectively assessing nurses' evidence-based practice knowledge and skills; it is quick to complete and to score the answers. RELEVANCE TO CLINICAL PRACTICE: Because the Knowledge and Skills of Evidence-based Nursing objectively assesses nurses' evidence-based practice knowledge and skills, it can be used to examine the effects of evidence-based practice education. Moreover, the Knowledge and Skills of Evidence-based Nursing may contribute to the promotion of evidence-based practice projects in clinical settings because it can measure the extent to which nurses are prepared to use their evidence-based practice knowledge and skills.

[Development and effects of emotional intelligence program for undergraduate nursing students: mixed methods research].

PURPOSE: This study was conducted to develop and test the effects of an emotional intelligence program for undergraduate nursing students. METHODS: The study design was a mixed method research. Participants were 36 nursing students (intervention group: 17, control group: 19). The emotional intelligence program was provided for 4 weeks (8 sessions, 20 hours). Data were collected between August 6 and October 4, 2013. Quantitative data were analyzed using Chi-square, Fisher's exact test, t-test, repeated measure ANOVA, and paired t-test with SPSS/WIN 18.0. Qualitative data were analyzed using content analysis. RESULTS: Quantitative results showed that emotional intelligence, communication skills, resilience, stress coping strategy, and clinical competence were significantly better in the experimental group compared to the control group. According to the qualitative results, the nursing students experienced improvement in emotional intelligence, interpersonal relationships, and empowerment, as well as a reduction in clinical practice stress after participation in the emotional intelligence program. CONCLUSION: Study findings indicate that the emotional intelligence program for undergraduate nursing students is effective and can be recommended as an intervention for improving the clinical competence of undergraduate students in a nursing curriculum.

[Analysis of trends and contents of nursing doctoral dissertations in Korea].

PURPOSE: This study aimed to identify contents and trends of Korean nursing doctoral dissertations in terms of research methodology and theoretical characteristics. METHODS: The design of the study was descriptive study and a total of 1,089 quantitative studies completed between 1982 and 2010 were reviewed using the analytical framework developed by the researchers. RESULTS: The majority of studies utilized the experimental design (51.5%) and the others were survey design (38.8%) and methodological design (5.0%). Study subjects were shown as patients (45%), care givers (11.2%), ordinary persons (40.6%) and others (3.2%). There were growing trends in experimental design and patients as subjects. The prevailing data collection settings were hospitals (45.8%) and community (27.8%). The theoretical frameworks that studies were based on were the existing theories (37%) and a newly developed theoretical framework by a researcher (25.2%). a framework derived from other studies by the researcher (25.2%). Majority of studies (78.5%) employed a single theory as a theoretical framework. However, 31.8% of studies had no theoretical framework based on. CONCLUSION: Findings of this study provided the opportunities to shed new light on the current status of Korean doctoral dissertation and to deliberate on the future direction of nursing studies in Korea.

[Effects of an elder health promotion program using the strategy of elder health leader training in senior citizen halls].

PURPOSE: This study was conducted to develop and test the effects of an elder health promotion program and apply strategies for elder health leader training sessions with elders at senior citizen halls. METHODS: A nonequivalent control group pretest-posttest design was used. Participants were 49 elders at a senior citizen hall (intervention: 27, control: 22). The elder health promotion program consisted of health education and exercise. A professional leader led the program for 4 weeks, and then an elder health leader and research assistant led for 8 weeks (total 12 weeks). Scales for elder health promoting behaviors, perceived health status, life satisfaction and senior citizen hall capability were used and physical fitness levels were measured. Data were collected between April 21 and July 28, 2010 and analyzed using Chi-square, Fisher's exact test, t-test, and repeated measure ANOVA with SPSS/WIN 12.0. RESULTS: Health promoting behaviors, physical fitness, perceived health status, and senior citizen hall capacity were significantly better in the experimental group after the intervention compared to the control group. CONCLUSION: Study findings indicate that elder health promotion programs applying strategies of elder health leader training are effective and can be recommended as nursing interventions for health promotion of these elders.

[Effects of community health promotion project for garlic cultivating farmers based on self-efficacy theory and community capacity building framework].

PURPOSE: This study was conducted to test the effects of a community health promotion project for farmers cultivating garlic. Bandura's self-efficacy theory (1986) and Chaskin's community capacity framework (2001) were used as the theoretical framework. METHODS: A nonequivalent control group pretest-posttest design was used. Study participants were 72 garlic farmers (intervention: 36, control: 36). The community health promotion project consisted of health promotion program and community capacity building strategies and was provided for 12 weeks (8 during farming off-season and 4 during farming season). Data were collected between February 23 and May 31, 2009 and were analyzed using chi-square test, Fisher's exact test, t-test, and repeated measure ANOVA using SPSS/WIN 12.0. RESULTS: For the experimental group, significant improvement was found for self-efficacy, farming related health behavior, physical fitness (muscle strength, muscle endurance, upper body flexibility, lower body flexibility, cardiovascular endurance, balance, agility), farmer's syndrome, and health related quality of life as compared to the control group. CONCLUSION: The findings of the study indicate that the community health promotion project for garlic farmers is effective and can be recommended as a nursing intervention for health promotion of garlic cultivating farmers.

[Educational needs assessment on research ethics among nursing researchers].

PURPOSE: This study aimed to investigate the educational needs of research ethics among nursing researchers. METHODS: Convenience sample of 161 nursing professors and 262 master or doctoral nursing students participated in the study. Data was collected with self-reported questionnaire from June to August 2009, and analyzed with descriptive statistics using SPSS WIN (version 14.0). RESULTS: Among 161 nursing professors, about 31.7% has educated nursing ethics in the postgraduate course. The most common course was nursing research or methodology (62.7%), and median education time was 2 hr. Areas that showed difficulty in understanding was the conflict of interest and plagiarism for professors and falsification and fabrication for graduate students. Average knowledge on the research ethics was 75.4 points for professors and 61.6 points for students based on the 100 points. CONCLUSION: Educational needs of research ethics among nursing professors and students in the postgraduate course was high. We recommend both basic and advanced research ethics educational programs for the nursing researchers. The basic course should be at least 6 hr and include various cases and something to discuss.

Meta-analysis of the effects of exercise interventions on functional status in older adults.

A meta-analysis was conducted to quantify the impact of exercise interventions on the functional status of older adults. Searches of Medline and CINAHL databases revealed 19 randomized controlled trials reporting 30 interventions (n = 2,201). Fixed- and random-effects models were used to estimate overall mean effect sizes (ESs) for functional and physical performance outcomes and activities of daily living (ADL). Modest but statistically significant ESs were found for functional performance and physical performance but not for ADL. Exercise improved functional and physical performance but the improvement may be insufficient to have an impact on ADL. Further studies are needed to determine exercise's effects on ADL and to identify moderators associated with functional status outcomes in older adults.

[Barriers to health behaviors in male and female elderly people in Korea].

PURPOSE: This study was done to investigate the practice level of 14 health behaviors between male (N=139) and female (N=175) elderly and to identify the barriers to each health behavior of elderly people in Korea. METHODS: Data were collected from 314 elderly people (65 yr and older) living in metropolitan, urban, and rural areas. Descriptive statistics, chi(2)-test and ordinal logistic regression were used in data analysis using the SPSS Win 15 version. RESULTS: 1) The performances were different in some health behaviors between male and female elderly people. Male elderly showed better performances in balanced diet, regular exercise, and more than 30 min of exercise, while female elderly showed better performances in restriction of fat and cholesterol, restriction on alcohol, and smoking. There were no differences in stress management and health prevention behaviors between the two groups. 2) The common significant barriers in health behaviors of the elderly in Korea were the lack of habit and physical discomfort. However, the lack of perceived benefit was a significant barrier in male elderly. Lack of time and lack of family support were significant barriers in female elderly people in Korea. CONCLUSION: These results suggest that tailored strategies should be developed considering the gender difference to reduce the main barriers of each health behavior in order to improve the health status of elderly people.

[The development & effect of a tailored fall prevention exercise for older adults].

PURPOSE: This study was conducted to develop and to determine the effect of an tailored falls prevention exercise for older adults. METHOD: Subjects consisted of 59 older adults (experimental group: 29, control group: 30) living at nursing homes. Experimental group participated in tailored falls prevention exercise for 16 weeks (3 times a week, 50 min every session). Data were collected before the exercise, 16 weeks & 24 weeks after the beginning of exercise. RESULTS: 1) the experimental group significantly improved the muscle strength of hip extensor & flexor, knee extensor & flexor, ankle dorsiflexor, & plantar flexor compared to the control group. 2) the experimental group significantly decreased the mean time for 10 times chair stand. 3) the experimental group significantly increased the standing time on one leg and the number of heel raise for 30 seconds compared to the control group. In addition more older adults in the experimental group completed the tandem stance and semi-tandem stance for 10 seconds than the control group. 4) The experimental group significantly decreased the mean time of 6m walk and the fall frequency compared to the control group. CONCLUSIONS: This results suggest that tailored falls prevention exercise for older adults can improve muscle strength, static & dynamic balance and decrease the fall frequency of older adults.

[A review of exercise interventions for fall prevention in the elderly].

PURPOSE: This study was done to suggest directions for developing exercise interventions for fall prevention in the elderly in Korea in the future. METHOD: Twenty five articles for fall prevention exercises were reviewed and analyzed. RESULT: 84.0% of subjects were older adults age 65 and older living in the community. The most frequently performed interventions were lower limb strength and balance exercises together 43.3%, group exercise 70.0%, exercise 3 times/week 60.0%, 60 min per session 36.7%, duration of 12 weeks and 1 year 23.3% each. The most frequently used outcome variables were static balance 84.0%, lower limb muscle strength 72.0%, dynamic balance 56.0 %, and falls 56.0 %. The effect of exercise interventions on fall prevention was inconclusive. Lower limb strength exercises with resistance were effective for increasing muscle strength. Balance exercises with various movements for balance were effective for increasing balance. CONCLUSION: Exercise interventions for fall prevention is recommended for older adults with risk factors of falling. The desirable type of exercise intervention is lower limb strength and balance exercise together.

[The effects of a diabetic educational program for coping with problem situation on self-efficacy, self care behaviors, coping and glycemic control in type 2 diabetic patients].

PURPOSE: This study was conducted to develop and to test the effects of an educational program for coping with problem situations as a nursing intervention in the diabetic patient. METHOD: A non-equivalent control group pretest-posttest design was used in this study. Data were collected from January to March, 2002. The subjects of the study consisted of 31 diabetic patients(experimental group: 17 patients, control group: 14 patients). The intervention of an educational program for coping with problem situations was applied to the experimental group for 4 weeks (total 8 hours). Data were collected before the educational program, immediately after and 1 months later and were analyzed with repeated measures ANOVA, t-test, and paired t-test. RESULT: 1. There was a significant difference in self efficacy between the experimental and control groups (F=13.793, p=0.001). 2. There was a significant difference in self care behavior between the experimental and control groups (F=4.583, p=0.041). 3. There was a significant difference in coping behavior of the problem situation between the experimental and control groups (F=62.018, p=0.000). There was a significant difference according to experimental stages (F=4.546, p=0.015) and interaction between education and experimental stages (F=12.039, p=0.000). 4. There was a significant difference in glycemic control between the experimental and control groups (t=-3.112, p=0.004). CONCLUSION: These results support that a diabetic educational program for coping with problem situations is effective in promoting and maintaining self efficacy, self care behavior, problem coping behaviors and in improving glycemic control. Thus this program can be recommended as an effective nursing intervention of in-depth education for diabetic patient.