Incidence and predictors of multimorbidity among older adults in Korea: a 10-year cohort study.

BACKGROUND: Due to the rapid growth of the older adult population, multimorbidity has become a global concern for an aging society. Multimorbidity has been associated with poor health outcomes, including low quality of life and a high risk of mortality, resulting in an overload of healthcare systems. However, multimorbidity incidence and its related factors are poorly understood among older adults. This study aimed to determine whether sociodemographic characteristics, lifestyle, and psychosocial factors predict multimorbidity incidence among older adults in Korea. METHODS: This longitudinal study used the Korean Longitudinal Study of Aging (KLoSA) dataset from 2008 to 2018. The KLoSA is a panel survey of nationally representative samples aimed at providing data for developing socioeconomic policies for the increasing aging population in Korea. The study sample included 1967 older adults aged 65 years and over who had none or one of the chronic diseases at the baseline in 2008. Multimorbidity incidence was defined as the co-existence of two or more chronic diseases among 12 doctor-diagnosed diseases based on self-reports. Cox's proportional hazards models were used to identify significant predictors of multimorbidity incidence over a 10-year follow-up period. RESULTS: Among 1967 respondents (female 54.5%, mean age 72.94), 625 (31.8%) incidents of multimorbidity were reported, contributing to 47.5 incidents per 1000 people after 10 years of follow-up. Low levels of social interaction, obesity, past smoking habits, and current or past drinking habits were identified as significant predictors of multimorbidity incidence among older adults in Korea. CONCLUSIONS: This study identified older adults at high risk for multimorbidity incidence. These groups require more attention from health care providers in the course of chronic disease monitoring and management. Specific interventions and health policies to promote social interaction and a healthy lifestyle are essential to delay multimorbidity incidence. This longitudinal approach will contribute to developing preventive strategies to reduce the incidence of multimorbidity among older adults.

Nurses in advanced roles as a strategy for equitable access to healthcare in the WHO Western Pacific region: a mixed methods study.

BACKGROUND: The Western Pacific region constitutes one-quarter of the world's population and has diverse health needs. While dialogue on and promotion of advanced practice nurses are ongoing, this study investigated the current responsibilities of nurses in advanced roles, future healthcare needs, and the implications of these components for nurses' professional development within the Western Pacific region. METHODS: This study employed three phases, a descriptive survey on the current status of nurses in advanced roles in the Western Pacific region, followed by a Delphi survey, and exploratory interviews. A total of 55 national experts with clinical, academic, and/or government-related backgrounds from 18 countries participated from December 2017 - December 2018. The descriptive survey via email to identify the status of nurses in advanced roles and a working definition was developed. This formed the basis for the Delphi survey, which identified key barriers and challenges for enhancing the development of nurses in advanced roles within the country (round 1) and for the region (rounds 2 and 3). Lastly, semi-structured individual interviews were conducted to identify strategies for establishing nurses in advanced roles to improve equitable access to healthcare. RESULTS: Thirty-seven roles and characteristics were identified and categorized for nurses performing advanced roles. Emergency care, critical care, elderly health, child health, and rural/remote communities were identified as fields with particular need for nurses in advanced roles in the Western Pacific region. Providing effective services, influencing government leadership, and advocating for health system sustainability were deemed necessary to improve equitable healthcare access. We found that nurses in advanced roles are not limited to clinical tasks within the hospital but are poised for active participation in primary healthcare, education/teaching, professional leadership, quality management, and research. CONCLUSIONS: Demand for nurses in advanced roles is high in the Western Pacific region and 15 items were identified across five core strategic areas to enhance development of nurses in advanced roles. Governmental-level recommendations include establishing legislative protection, improving systems for remuneration, strengthening supportive channels, and conducting national needs assessments.

Establishing a nurse-managed health center for the urban poor in Dhaka, Bangladesh.

OBJECTIVES: Despite the rise in community health problems in populations living in urban slums, activities of community health nurses are limited in Bangladesh. This study aimed to describe how a nurse-managed health center (NMHC) was developed in Dhaka, Bangladesh. DESIGN: An exploratory-descriptive research design was used. SAMPLE AND MEASUREMENTS: The commitment phase was conducted to establish partnerships in the community. Involvement of community leaders and members and partnerships with various organizations were established successfully in the commitment phase. The assessment phase was completed by implementing personal interviews, community site visits, and household surveys of 172 households in the community. Action plans were developed and strategies were followed to change the community during the planning phase. RESULTS: Household survey results showed that community people suffered from non-communicable diseases, risk behaviors, and inadequate housing conditions. The high-priority community needs included nutrition and chronic management services, behavior change programs, and a clean environment. Action plans for health programs based on community needs and strategies such as securing manpower and equipment were developed. CONCLUSIONS: The systematic process of creating a NMHC, and the necessity of the community health nurse's role in responding to health needs of the urban poor in Dhaka, Bangladesh was confirmed.

Effects of registered nurse staffing on quality of care and resident outcomes in nursing homes.

Few studies focus on Registered Nurse (RN) staffing and resident health outcomes in Korean nursing homes. This study aimed to investigate the effects of RN staffing on quality of care and resident outcomes in South Korean nursing homes. The study was a secondary data analysis of 5679 participants from the National Health Insurance Service. A mixed-effect linear model and multinomial logistic regression model assessed resident outcomes and quality of care, respectively. The number of RNs significantly affected patient mortality. The overall evaluation rating for quality of care in nursing homes increased as the number of RNs increased. Level of RN staffing in nursing homes influenced health management and quality of care for residents. A variety of efforts are needed to strengthen the workforce of RNs in nursing homes, including enacting a law for safe RN staffing and converting the evaluation of nursing home quality into health outcomes.

Day care vs home care: Effects on functional health outcomes among long-term care beneficiaries with dementia in Korea.

OBJECTIVES: First, to compare changes in cognitive function, behavioral symptoms, and physical function for Korean Long-Term Care Insurance (LTCI) beneficiaries with dementia in day care (DC) and home care (HC) settings over 1 year. Second, to examine the association between LTCI service type and the aforementioned health outcomes. METHODS: A retrospective matched cohort study was conducted using the national data set of the National Health Insurance Service in Korea. We identified 7822 beneficiaries with dementia who received either DC or HC services consistently for 1 year from 2008 to 2009. The propensity score matching method was used, yielding 416 participants in each group. Paired samples t-tests and logistic regression analyses were conducted. RESULTS: Baseline differences between the two groups are present. According to multiple regression models, DC, when compared with HC, was related to less deterioration in cognitive and physical function but was associated with less improved behavioral symptoms 1 year after the LTCI enrollment. In the comparison between matched cohorts, DC, when compared with HC, was associated with less cognitive decline, less disability progression, and similar decrease in behavioral symptoms. CONCLUSIONS: Cognitive function and disability declined less in the DC group, compared with the HC group. Conversely, behavioral symptoms showed a similar decrease between the two groups after 1-year follow-up. Further research is necessary to examine key features of DC services that have helped delay functional deterioration and alleviate behavioral symptoms.

Interprofessional global health competencies of South Korean health professional students: educational needs and strategies.

BACKGROUND: There is growing recognition of the importance of educating health professional students to enhance their competence in collaborating with individuals from other health professions in the area of global health. This study aimed to identify the performance levels in interprofessional global health competencies (IGHC) of health professional students, their educational needs, and the strategies for successfully developing IGHC. METHODS: This study used a mixed methods design involving an online survey followed by focus group interviews. A sample of 325 fourth-year undergraduate students from 14 health-related majors completed a self-report online survey (38.8% response rate). The performance of IGHC was measured on a five-point Likert scale using the IGHC items developed by the Consortium of Universities for Global Health. Additionally, 12 senior students and five professors in global health-related majors participated in focus group interviews. The students' educational needs and priorities were analysed using the Borich needs assessment and the Locus for Focus model. RESULTS: The participants' IGHC mean score was 3.11 (SD = 0.55) and differed by previous global health activity experiences (t = - 2.10, p = .037). Nine competencies in six domains using the Locus for Focus model were identified as a priority for global health education. Suggested strategies to enhance IGHC included establishing IGHC education in formal curricula, developing value-based content and outcomes, and engaging students in learning activities. CONCLUSIONS: It is necessary to design an interprofessional pre-departure course to achieve the priority IGHC and to organise learning activities where there is cooperation in problem solving while applying the expertise of each major within resource-limited settings. This study supports future health professional education that should foster enhanced roles and scopes of practice as changing agents to assure the achievement of sustainable development goals.

Development and evaluation of the Korean Health Literacy Instrument.

The purpose of this study is to develop and validate the Korean Health Literacy Instrument, which measures the capacity to understand and use health-related information and make informed health decisions in Korean adults. In Phase 1, 33 initial items were generated to measure functional, interactive, and critical health literacy with prose, document, and numeracy tasks. These items included content from health promotion, disease management, and health navigation contexts. Content validity assessment was conducted by an expert panel, and 11 items were excluded. In Phase 2, the 22 remaining items were administered to a convenience sample of 292 adults from community and clinical settings. Exploratory factor and item difficulty and discrimination analyses were conducted and four items with low discrimination were deleted. In Phase 3, the remaining 18 items were administered to a convenience sample of 315 adults 40-64 years of age from community and clinical settings. A confirmatory factor analysis was performed to test the construct validity of the instrument. The Korean Health Literacy Instrument has a range of 0 to 18. The mean score in our validation study was 11.98. The instrument exhibited an internal consistency reliability coefficient of 0.82, and a test-retest reliability of 0.89. The instrument is suitable for screening individuals who have limited health literacy skills. Future studies are needed to further define the psychometric properties and predictive validity of the Korean Health Literacy Instrument.

Development of the short form of the Korean Health Literacy Scale for the elderly.

We developed and examined a shortened form of the Korean Health Literacy Scale (KHLS) with a sample of 543 elderly in South Korea. Rasch analysis of the KHLS was conducted to examine the unidimensionality of the scale, along with a confirmatory factor analysis to evaluate both the item fit and item difficulty. Based on these data the KHLS was narrowed down to 12 of the original 24 items (7 comprehension and numeracy questions and 5 health-related questions). The internal consistency of the resulting short form (S-KHLS) was 0.80. The S-KHLS is a short and reliable scale for testing the health literacy skills of elderly Korean adults.

The factors that are associated with nurse immigration in lower- and middle-income countries: An integrative review.

AIM: This study aims to synthesize the factors associated with nurse emigration from lower and middle-income countries. DESIGN: Integrative review. METHODS: An in-depth search of registries and five databases yielded 9466 records. Using the PRISMA guidelines, 11 were chosen after screening by two authors independently. The mixed methods appraisal tool (MMAT) was used to assess the risk of bias. RESULTS: The destination countries were Europe and North America, with an inclination for nurse migration of 14.3%-85%. Emigration factors were poor salary, working conditions, poor quality  healthcare infrastructure; outdated healthcare technologies, lack of employment opportunities, younger age, relationship status (single), living environment, social pressure, urban residence, work experience, insecurity, high crime rates, political corruption and foreign language skills. PUBLIC CONTRIBUTION: Healthcare authorities and nursing leaders must implement practical measures to minimize nurse emigration.

Perspectives of Frontline Nurses Working in South Korea during the COVID-19 Pandemic: A Combined Method of Text Network Analysis and Summative Content Analysis.

PURPOSE: This study aimed to explore the perspectives of frontline nurses working during the novel coronavirus disease 2019 (COVID-19) pandemic. METHODS: An online qualitative study was conducted using a pragmatic approach. The data were collected in August 2021. Registered Korean nurses who provided direct nursing care to patients with confirmed COVID-19 were eligible for this study. An online survey was used to gather free-text data, which were then analyzed using machine-based network analysis and summative content analysis. RESULTS: The analysis examined the responses of 126 participants and led to the identification of six prominent themes. These themes were further classified into three distinct levels: personal, task, and organizational. The identified themes are as follows: "collapse of personal life," "being overwhelmed by the numerous roles required," "personal protective equipment was sufficiently provided, but that is not enough," "changes in interprofessional collaboration," "inappropriate workforce management," and "diverted allocation of healthcare services and resources." CONCLUSION: Our findings highlight areas for improvement in resources, systems, and policies to enhance preparedness for future pandemics.

[The Validity and Reliability of the Korean Version of Readiness for Practice Survey for Nursing Students].

PURPOSE: This study aimed to evaluate the validity and reliability of the Korean version of the Readiness for Practice Survey (K-RPS). METHOD: The English Readiness for Practice Survey was translated into Korean using the Translation, Review, Adjudication, Pretesting, and Documentation (TRAPD) method. Secondary data analysis was performed using the dataset from the New Nurse e-Cohort study (Panel 2020) in South Korea. This study used a nationally representative sample of 812 senior nursing students. Exploratory and confirmatory factor analyses were also conducted. Convergent validity within the items and discriminant validity between factors were assessed to evaluate construct validity. Construct validity for hypothesis testing was evaluated using convergent and discriminant validity. Ordinary α was used to assess reliability. RESULTS: The K-RPS comprises 20 items examining four factors: clinical problem solving, learning experience, professional responsibilities, and professional preparation. Although the convergent validity of the items was successfully verified, discriminant validity between the factors was not. The K-RPS construct validity was verified using a bi-factor model (CMIN/DF 2.20, RMSEA .06, TLI .97, CFI .97, and PGFI .59). The K-RPS was significantly correlated with self-esteem (r = .43, p < .001) and anxiety about clinical practicum (r = -.50, p < .001). Internal consistency was reliable based on an ordinary α of .88. CONCLUSION: The K-RPS is both valid and reliable and can be used as a standardized Korean version of the Readiness for Practice measurement tool.

Does a nurse-led postpartum self-care program for first-time mothers in Bangladesh improve postpartum fatigue, depressive mood, and maternal functioning?: a non-synchronized quasi-experimental study.

Purpose: This study aimed to test the efficacy of a nurse-led postpartum self-care (NLPPSC) intervention at reducing postpartum fatigue (PPF) and depressive mood and promoting maternal functioning among first-time mothers in Bangladesh. Methods: A non-synchronized quasi-experimental design was used. First-time mothers were recruited during postpartum and assigned to the experimental or control group (34 each). The experimental group received the NLPPSC in the hospital, a 1-day intervention that focused on increasing self-efficacy. The control group received usual care. Data on PPF, depressive mood, maternal functioning, self-care behaviors, postpartum self-efficacy, and self-care knowledge were collected at postpartum 2 weeks (attrition 23.5%) and 6 weeks (attrition 16.1%). Data were analyzed using descriptive statistics, bivariate statistics, and linear mixed model analysis. Results: One-third (33.3%) of new mothers experienced depressive mood (Edinburgh Postnatal Depression Scale scores of ≥13 points). The NLPPSC intervention was statistically significant in decreasing PPF (ß=-6.17, SE=1.81, t=-3.39, p<.01) and increased maternal functioning at postpartum 6 weeks in the experimental group (ß=13.72, t=3.73, p<.01) compared to the control. Knowledge was also statistically significant for increased maternal functioning over time (ß=.37, SE=.18, t=2.03, p<.05). However, there were no statistically significant differences in depressive mood over time. Conclusion: The NLPPSC intervention was feasible and effective in improving fatigue and maternal functioning in Bangladeshi mothers by postpartum 6 weeks. Postpartum care knowledge was effective in improved maternal functioning and thus supports implementing the NLPPSC intervention for new mothers after childbirth.

Effects of self-efficacy, affectivity and collective efficacy on nursing performance of hospital nurses.

AIM: This paper is a report of a study conducted to examine the influence of self-efficacy and affectivity (individual-level variables) and collective efficacy (group-level variable) on nursing performance among hospital nurses. BACKGROUND: Previous studies of nursing performance, which have focused on individual factor outcomes, have shown limitations. Due to the heavy focus on the analysis of single-level performances, the influence of organizational contextual factors on nursing performance has rarely been studied. Hence, for a better understanding of nurses' professional development and effective functioning in hospitals, there is a need to study the effects of organizational characteristics as well as individual characteristics on nursing performance. METHOD: A descriptive-correlational design was used with a convenience sample of 1996 nurses selected from 182 nursing units in 28 hospitals in six metropolitan cities and seven provinces in Korea. Data were collected in 2006 using self-administered questionnaires, which were analysed with using descriptive statistics, Pearson correlation coefficients and multilevel analysis. RESULTS: Individual-level variables, including job position, years of experience, employment status, self-efficacy and positive affectivity were positively related to nursing performance. Collective efficacy and the number of in-service meetings within units were statistically significant group-level variables. Group-level variables reduced the error variances in nursing performance. CONCLUSION: Understanding the effects of group-level variables on nursing performance improves performance management approaches in hospitals.

Development of Performance Indicators for Clinical Research Coordinators Using the Balanced Scorecard in South Korea.

BACKGROUND: This is a methodological study that aims to develop performance indicators based on a balanced scorecard for the clinical research coordinator (CRC) position. METHODS: The CRC performance indicators were developed through a literature review, a data review, expert consultations, focus group interviews, and content validity verification. We also used these data to confirm whether the performance indicators were appropriately indexed. RESULTS: We developed 10 strategies and 31 performance management indicators based on the 4 perspectives of the balanced scorecard (financial, customer, internal business process, and learning and growth). CONCLUSIONS: This research developed CRC performance indicators using a balanced scorecard in order to improve the quality of CRC work performance. These indicators establish the direction that tasks should take; they motivate CRCs by being associated with the compensation system, competence development programs, and a balanced performance evaluation system.

Community health practitioner's practice guideline for a changing health care: Korean contribution.

AIMS AND OBJECTIVES: The specific aims of the study were (1) to identify community residents' health problems and community health practitioners' activities, (2) to explore community health practitioners' perception of the practice guidelines and (3) to provide recommendations for the development of a new practice guideline in the future. BACKGROUND: Community health practitioners in Korea are recognised as a critical component of the public health workforce in rural areas. Community health practitioners are registered nurses with six months special training, who have the chief responsibility of delivering primary health care to remote or isolated communities. Although there has been numerous changes in focus of community health practitioners practice over the two decades, community health practitioners guidelines have never been updated since being first developed in 1981. DESIGN: This investigation employed a cross-sectional survey and focus group interview. METHODS: The samples included two different groups: 1003 community health practitioners participated in a survey and a group of 12 community health practitioners participated in a focus group interview. A measure of perception of the guideline was developed from Mansfield's work. Goolsby's criteria were revised and used to guide the focus group interview. RESULTS: The participants recognised that the role of community health practitioners is in a process of transition and expect to use well developed guidelines that will allow an appropriate response to the needs of the community. Community health practitioners are generally supportive of practice guidelines although they report various contextual, social and resource barriers to the use of practice guidelines. Finally, the researchers have provided recommendations for the development of new community health practitioners practice guidelines. CONCLUSION: A newly developed community health practitioners guideline should assist in articulating new roles and responsibilities in the practice of community health practitioners and establish a foundation for knowledge, skills and training necessary for them to work independently. RELEVANCE TO CLINICAL PRACTICE: New services made available for under-recognised health problems may be a direct outcome of newly developed guidelines.

Health problems and health behaviors of Korean preschoolers living with parents and under guardianship.

PURPOSE: A comparative analysis was conducted to identify and compare the health status and behaviors of preschoolers attending daycare centers in South Korea between children living with parents and those under guardianship. DESIGN: The study design was descriptive and correlational. SAMPLE: Data were collected from 152 parents and 85 guardians of preschool children using a structured questionnaire. RESULTS: Of 237 children, 23.9-32.5% were overweight or obese, while 13.8-30.0% were underweight. Boys under guardianship were more likely to be obese. Hand-foot-mouth disease and atopic dermatitis were more prevalent among children living with parents, while those under guardianship were less likely to have dentistry visits, more likely to be absent from childcare due to pneumonia, and had significantly fewer health-related conversations with their guardians. In relation to health behaviors, the frequency of tooth-brushing and high-calcium food consumption was significantly lower among children under guardianship than among those living with parents. CONCLUSION: Compared with children living with parents, those under guardianship were exposed to unfavorable circumstances in terms of health management practices and health behaviors, which implies that the guardians were less interested in health care and dealt inappropriately with the health problems of their foster children.

Development of Performance Indicators for Clinical Research Coordinators Using the Balanced Scorecard in South Korea.

BACKGROUND: This is a methodological study that aims to develop performance indicators based on a balanced scorecard for the clinical research coordinator (CRC) position. METHODS: The CRC performance indicators were developed through a literature review, a data review, expert consultations, focus group interviews, and content validity verification. We also used these data to confirm whether the performance indicators were appropriately indexed. RESULTS: We developed 10 strategies and 31 performance management indicators based on the 4 perspectives of the balanced scorecard (financial, customer, internal business process, and learning and growth). CONCLUSIONS: This research developed CRC performance indicators using a balanced scorecard in order to improve the quality of CRC work performance. These indicators establish the direction that tasks should take; they motivate CRCs by being associated with the compensation system, competence development programs, and a balanced performance evaluation system.

Changing healthcare issues and context for elderly women in Asia: implications for a research agenda for nursing.

In this descriptive review, the current healthcare issues and context for elderly women in Asia are discussed and a nursing research agenda to promote better health security is proposed. Chesney and Ozer's multilevel circular framework of key content areas of women's health was applied to organize and critique the literature. The results indicate that elderly Asian women display morbidity and mortality differentials and are influenced by gender and social factors, as well as health policy issues. The research agenda for nursing that is proposed in this article includes activating health promotion research, employing family and community-based participatory approaches, supporting gender-sensitive social and health policies, and promoting comprehensive and culturally competent international research on health transitions for elderly women.

The Relationships among Postpartum Fatigue, Depressive Mood, Self-care Agency, and Self-care Action of First-time Mothers in Bangladesh.

PURPOSE: Postpartum fatigue can impact maternal well-being and has been associated with levels of perceived self-care. This study aimed to examine the relationship among fatigue, depressive mood, self-care agency, and self-care action among postpartum women in Bangladesh. METHODS: A descriptive cross sectional survey was done with 124 first-time mothers from two tertiary hospitals in Dhaka, Bangladesh. The Modified Fatigue Symptoms checklist, Denyes' Self Care Instrument, the Edinburgh Postnatal Depression Scale, and items on sociodemographic and delivery-related characteristics, were used in Bengali via translation and back-translation process. RESULTS: High fatigue levels were found in 18.5%(n=23) and 73.4% had possible depression (n=91). There was a significant negative relationship between fatigue and self-care agency (r=-.31, p < .001), and self-care action (r=-.21, p < .05). Fatigue differed by level of self-care agency (t=4.06, p < .001), self-care action (t=2.36, p=.023), newborn's APGAR score (t=-2.93, p=.004), parental preparation class participation (F=15.53, p < .001), and postpartum depressive mood (t=-4.64, p < .001). CONCLUSION: Findings suggest that high level of self-care efficacy and behaviors can contribute to fatigue management, and highlight the need for practical interventions to better prepare mothers for postpartum self-care, which may, in turn, alleviate postpartum fatigue.

[Development of a performance measurement scale for hospital nurses].

PURPOSE: The aim of this study was to develop a performance measurement scale for nurses in the hospital setting and to test the reliability and validity of the scale. METHODS: This study was conducted in three phases including an application of conceptual framework, development of scale items, and test of validity and reliability of the scale. In order to test validity and reliability, data was collected from 1,966 nurses who work in twenty eight hospitals nation-wide. The data was analyzed by the SAS 8.0 program using descriptive statistics, factor analysis, and reliability coefficients. RESULTS: The Performance measurement scale consisted of 4 factors which included competency, attitude, willingness to improve, and application of nursing process, and a total of 17 items. The Four factors explained 63.45% of the total variance, and Cronbach's alpha of the scale was .92. CONCLUSION: The performance measurement scale developed by this study is a reliable and valid instrument that is utilized effectively to evaluate the performance of hospital nurses. Furthermore, it could be used as a stepping stone to assess educational needs of nurses, develop professionalism among nurses, and improve quality of nursing care in the hospital setting.