Educational approach for public health ethics in nursing: Focusing on COVID-19.

Background: With the increasing ethical challenges and dilemmas faced by nurses due to various disasters such as COVID-19 worldwide, there is a need for a new public health ethics education curriculum to strengthen competencies for ethical responses in the nursing field. Objectives: This study was aimed to identify the impact of a teaching method utilizing news articles and panel discussion material in the public health ethics education program on nursing students' thinking regarding ethical issues. Design: This was an exploratory study to identify the thinking styles inherent in ethical reflection by analyzing the reflection contents written by nursing students using text mining techniques. Participants: 73 among the students taking a nursing ethics course at a university in Seoul, South Korea, voluntarily participated in this study after providing informed consent. Methods: The public health ethics program was conducted with sessions held once a week for a total of 7 weeks, and reflections written by nursing students were collected as text files during session 5 to 7. In this study, data preprocessing process, keyword analysis, and LDA topic modeling were sequentially conducted utilizing the R program according to the data analysis procedure of text mining techniques. Ethical considerations: This study was conducted under ethics approval from the institution where participants were recruited. Findings and discussion: The results of this study show that the teaching method utilizing news articles enhanced rational ethical deliberation from the cognitive aspect, whereas the teaching method utilizing panel discussion material strengthened the response to emotions on a more internal level. Conclusions: The teaching method utilizing news articles and panel discussion materials in public health ethics education is expected to be mutually complementary and effective, so further studies are recommended.

Identifying patterns of lifestyle behaviours linked to sociodemographic characteristics and health conditions among young adults in South Korea.

AIMS: To identify specific patterns of lifestyle behaviours among young adults and examine the relationships of the patterns to sociodemographic characteristics and health conditions (hypertension, diabetes and obesity). DESIGN: Descriptive, correlational study. METHODS: Data from a nationally representative sample of 4562 young adults aged 19-39, who participated in the 2016-2018 Korea National Health and Nutrition Examination Survey, were analysed. Latent class analysis was used to identify the patterns of lifestyle behaviours, including smoking, alcohol use, physical activity and vaccination. Generalized linear regression analysis was used to examine the relationships among lifestyle behaviour patterns, sociodemographic characteristics and health conditions. RESULTS: Three patterns of lifestyle behaviours were identified: physically active (6.9%), high risk (21.5%) and passive (71.6%). The membership of these three patterns was significantly associated with sociodemographic characteristics (age, sex, education level, occupation and living arrangement). Among the three groups, young adults in the high-risk group were found to be significantly associated with all three health conditions (hypertension, diabetes and obesity) while controlling for sociodemographic characteristics. CONCLUSION: These results indicate that young adults are likely to engage in unhealthy lifestyle behaviours that are related to individual socioeconomic conditions, which could negatively affect their health conditions. IMPACT: This study provides insights into the lifestyle behaviours among young adults who have been recognized to be socially disadvantaged. This could help develop education and prevention programmes tailored to specific patterns of lifestyle behaviours for improving health while considering their socioeconomic contexts. NO PATIENT OR PUBLIC CONTRIBUTION: This applies to this research as the focus was on young adults in South Korea only.

Factors influencing blood pressure classification for adults: Gender differences.

AIM: Hypertension is a common condition contributing to many diseases. Factors influencing blood pressure (BP) classification for adults have changed over time. This study aimed to identify factors influencing BP classification according to gender. METHODS: Data from the Sixth Korean National Health and Nutrition Examination Survey (2014) were used in this descriptive, cross-sectional study. Participants were 1555 adults (589 men, 966 women). Measures included demographic, health-related, and lifestyle factors. RESULTS: Compared with the male normal BP group, in the male prehypertension group, body mass index, problem drinking, and reduced sleep duration were higher; and in the male hypertension group, age, poor subjective health status, body mass index, diabetes, problem drinking, smoking, and sodium intake were higher. Compared with the female normal BP group, age, and body mass index were higher in the female prehypertension group; and age, poor subjective health status, body mass index, menopause, and diabetes were higher in the female hypertension group. CONCLUSION: Hypertension and prehypertension prevention interventions for adults should be distinguished according to gender.

Development and Evaluation of a Quick Response Code-Based Nursing Education Program for Operating and Recovery Room Nurses.

The purpose of this study was to develop and evaluate the effectiveness of a quick response code-based nursing education program to improve the competence of operation and recovery room nurses. An experimental methodological design was used to develop a quick response code-based nursing educational program and analyze its effects and nurses' satisfaction with its use. The quick response code-based nursing education program was developed in five steps based on the ADDIE model: analysis, design, development, implementation, and evaluation. The program was built on smartphones, and a Web site was linked to it. After testing the program for 40 days, nurses' attitudes toward various medical devices were significantly less negative. Nurses were able to use a large number of medical devices and were highly satisfied and willing to engage with the quick response code-based nursing educational program. In the context of nursing education, introducing educational content using quick response codes helps to improve nurses' knowledge and competence in providing high-quality nursing care and medical services.

Effects of a System Thinking-Based Simulation Program for Congestive Heart Failure.

This study evaluated a system thinking-based simulation program for the care of patients with congestive heart failure. Participants were 67 undergraduate nursing students from a nursing college in Seoul, South Korea. The experimental group was given a 4-hour system-thinking program and a 2-hour simulation program, whereas the control group had a 4-hour case study and a 2-hour simulation program. There were significant improvements in critical thinking in both groups, but no significant group differences between educational methods (F = 3.26, P = .076). Problem-solving ability in the experimental group was significantly higher than in the control group (F = 5.04, P = .028). Clinical competency skills in the experimental group were higher than in the control group (t = 2.12, P = .038). A system thinking-based simulation program is a more effective learning method in terms of problem-solving ability and clinical competency skills compared to the existing simulation program. Further research using a longitudinal study is needed to test the long-term effect of the intervention and apply it to the nursing curriculum.

Effects of stress appraisal on the quality of life of adult patients with multiple myeloma and their primary family caregivers in Korea.

BACKGROUND: Modern treatment for multiple myeloma (MM) has improved disease control and prolonged survival; thus, maintenance of quality of life (QoL) is considered a great concern for MM patients and their caregivers. The purpose of this study was to identify dyadic associations between stress appraisal and the QoL of patients with MM and their caregivers in Korea. METHODS: A total of 102 MM patient-caregiver dyads participated in this study. They independently reported their stress appraisal and QoL. The study was guided by a transactional model of stress and coping, and analyzed by using the actor-partner interdependence model. RESULTS: The results revealed good data adjustment with acceptable indices: χ2  = 6.211 (df = 6), CFI = 0.999, TLI = 0.994, RMSEA = 0.019, and SRMR = 0.043. MM patients' QoL were significantly correlated with caregivers' QoL. The stress appraisals of patients and caregivers mutually influenced each other's QoL. The patients' illness perception and the caregivers' burden were strong predictors for their QoL. The self-efficacy of patients and caregivers was also associated with their QoL. CONCLUSIONS: Our findings suggest that the way patients and caregivers perceive and respond to stress plays a significant role in their QoL during the treatment experience. Interventions designed to reconstruct negative perspectives and improve self-efficacy may help both patients and caregivers to improve their QoL.

The Effects of Tonsillectomy Education Using Smartphone Text Message for Mothers and Children Undergoing Tonsillectomy: A Randomized Controlled Trial.

BACKGROUND: Tonsillectomy is the most common type of surgical procedure performed in preschool children. Due to short period of hospitalization, mothers are expected to manage their children's care at home. However, they are rarely provided with sufficient information about postoperative management. This study aims to determine the effectiveness of providing caregivers with information on tonsillectomy care by smartphone text messaging in increasing their mothers' knowledge, reducing the anxiety, and improving the sick-role behavior of pediatric tonsillectomy patients. MATERIALS AND METHODS: A sample of 61 pediatric patients and their mothers was recruited. Participants were randomly assigned into either the experimental group (n = 27) or the control group (n = 34). The control group was given information about the tonsillectomy by conventional textual and verbal means, whereas the experimental group received the same information in the form of 10 text messages during the period from hospitalization to their first follow-up visits. RESULTS: Results of mixed design, two-way analysis of variance indicated significant interaction effects between time points and groups for mothers' knowledge (F = 4.26, p = 0.043) and children's anxiety (F = 3.32; p = 0.037). Thus, the results do support the effectiveness of tonsillectomy education using smartphone text messaging in increasing mothers' knowledge and reducing children's anxiety. CONCLUSIONS: These results can be applied to preoperative and postoperative interventions for children not only for tonsillectomy but also for many other operations. The development of various educational programs using smartphone text messaging for postoperative patient management would also be valuable.

Analyzing Korean Public Health Centers' Infectious Disease Disaster Response Experiences with a Focus on Business Continuity.

Objective: This study aims to provide basic data for establishing strategies to maintain the core functions of health centers, and enable an effective response to emergency tasks in the event of future infectious disease disasters. Methods: The participants were 41 workers from two public health centers in Seoul. They all had prior experience in responding to the early and middle stages of the COVID-19 pandemic. Data were collected through Focus Group Discussions, and then analyzed using the deductive method of content analysis. Results: The participants' experiences during the infectious disease disaster crisis were examined through ten categories: governance and coordination, information management, human resources, essential medical supplies and equipment, infrastructure, administration, finance and logistics, community engagement and risk communication, delivery of essential services, security, and additional considerations for vulnerable populations. The analysis of the results made it apparent that new systems and policies were imperative for responding appropriately to the concerns and experiences of the public healthcare center staff, and for improving the response to future epidemics. Conclusion: We found that to prepare for infectious disaster situations in the future, it is necessary for health centers to establish a mid- to long-term business continuity plan to ensure the continuation and stability of their operations. Additionally, it was found that health professionals in public health centers also believe in the necessity of education and training programs on disaster preparedness, based on Business Continuity Planning proposed by the World Health Organization. They deem these essential to sustain routine tasks for the management of the health of local community residents during outbreaks of novel infectious diseases in the future.

The impact of user's perceived ability on online health information acceptance.

The purpose of this study was to explain how perceived ability affects users' acceptance of online health information in Korea. Data were collected by a Web-based survey, and, in total, 449 samples were used for final analysis. The hypothetical model of this study was based on the Technology Acceptance Model. A structural equation modeling was used to evaluate the relationship between the included variables. The final model with appropriate relations exhibited an adequate fit to the data. This study provides evidence that perceived ease of use, perceived usefulness, and perceived credibility significantly affect how individuals use health information from the Internet. The subjective health knowledge and Internet efficacy exerted strong indirect effects on users' attitude and intention to use the online health information via the mediators of perceived ease of use, perceived usefulness, and perceived credibility. This study supports the hypothesis that the perceived ability of users is related to their acceptance of online health information. Users' perceived ability, including subjective health knowledge and Internet efficacy, was confirmed as a prerequisite for their health information use on the Internet. The results demonstrated that perceived ease of use, perceived usefulness, and perceived credibility are substantive mediators. Future research should consider a wider array of characteristics of health information and users and incorporate these characteristics for the provision of more useful, user-centered health information.

Understanding the online health information user profiles in Korea: from a psychological perspective.

This study was conducted to explore the profiles of online health information users in terms of certain psychological characteristics and to suggest guidelines for the provision of better user-oriented health information service. The cross-sectional study design was used with convenient sampling by Web-based questionnaire survey in Korea. To analyze health information user profiles on the Internet, a two-step cluster analysis was conducted. The results reveal that online health information users can be classified into four groups according to their level of subjective knowledge and health concern. The findings also suggest that four clusters that exhibit distinct profile patterns exist. The findings of this study would be useful for health portal developers who would like to understand users' characteristics and behaviors and to provide more user-oriented service in a satisfactory manner. It is suggested that to develop a full understanding of users' behaviors regarding Internet health information service, further research would be needed to explore users' various needs, their preferences, and relevant factors among users across a variety of health problem-addressing Web sites at different professional levels.

A transformative service research for healthy transition to adulthood of young people living alone in Korea.

This study was conducted to explore phenomena related to the physical, psychological and social health vulnerabilities of young people who lived alone and to establish strategy for service implementation to facilitate their healthy transition to adulthood. In accordance with the double diamond process of service design, five workshops involving 12 participants and 9 experts were held from July to November 2018 in the D-district of Seoul, Korea. As a result, the participants were identified as a difficult group to engage in health management because of their features: unconcern for health, inevitable neglect for health or fixation of lifestyle far from health. They were also a special group that was undergoing a double transition: the transition to adulthood and from living with their parents to living alone. Therefore, the strategy for them was derived that had to be in an indirectly and incidentally effective for health through the settlement of independent life and habit formation by transitional care as part of a nudge effect. The findings of this study can provide a basis for health and social care strategies and policies concerning young people who live alone. A follow-up study is proposed, which will involve the actualisation and application of a program based on the intervention strategy derived from these findings.

[An Exploratory Study on the Policy for Facilitating of Health Behaviors Related to Particulate Matter: Using Topic and Semantic Network Analysis of Media Text].

PURPOSE: This study aimed to analyze the mass and social media contents and structures related to particulate matter before and after the policy enforcement of the comprehensive countermeasures for particulate matter, derive nursing implications, and provide a basis for designing health policies. METHODS: After crawling online news articles and posts on social networking sites before and after policy enforcement with particulate matter as keywords, we conducted topic and semantic network analysis using TEXTOM, R, and UCINET 6. RESULTS: In topic analysis, behavior tips was the common main topic in both media before and after the policy enforcement. After the policy enforcement, influence on health disappeared from the main topics due to increased reports about reduction measures and government in mass media, whereas influence on health appeared as the main topic in social media. However semantic network analysis confirmed that social media had much number of nodes and links and lower centrality than mass media, leaving substantial information that was not organically connected and unstructured. CONCLUSION: Understanding of particulate matter policy and implications influence health, as well as gaps in the needs and use of health information, should be integrated with leadership and supports in the nurses' care of vulnerable patients and public health promotion.

[Topic Modeling and Keyword Network Analysis of News Articles Related to Nurses before and after "the Thanks to You Challenge" during the COVID-19 Pandemic].

PURPOSE: This study was conducted to assess public awareness and policy challenges faced by practicing nurses. METHODS: After collecting nurse-related news articles published before and after 'the Thanks to You Challenge' campaign (between December 31, 2019, and July 15, 2020), keywords were extracted via preprocessing. A three-step method keyword analysis, latent Dirichlet allocation topic modeling, and keyword network analysis was used to examine the text and the structure of the selected news articles. RESULTS: Top 30 keywords with similar occurrences were collected before and after the campaign. The five dominant topics before the campaign were: pandemic, infection of medical staff, local transmission, medical resources, and return of overseas Koreans. After the campaign, the topics 'infection of medical staff' and 'return of overseas Koreans' disappeared, but 'the Thanks to You Challenge' emerged as a dominant topic. A keyword network analysis revealed that the word of nurse was linked with keywords like thanks and campaign, through the word of sacrifice. These words formed interrelated domains of 'the Thanks to You Challenge' topic. CONCLUSION: The findings of this study can provide useful information for understanding various issues and social perspectives on COVID-19 nursing. The major themes of news reports lagged behind the real problems faced by nurses in COVID-19 crisis. While the press tends to focus on heroism and whole society, issues and policies mutually beneficial to public and nursing need to be further explored and enhanced by nurses.

Consumers' disease information-seeking behaviour on the Internet in Korea.

AIM AND OBJECTIVES: This study was conducted to explain the relationships of the factors affecting consumers' disease information-seeking behaviour on the Internet in Korea. BACKGROUND: Similar to other countries, Korea is facing an increasing use of Internet as a resource of health information. With the paradigm shifts towards consumer-centred health service, it is expected that more health care consumers will use the Internet actively in the future. DESIGN: A survey was conducted using a self-selected convenience sample. METHODS: A conceptual model was derived by extending technology acceptance model and tested via structural equation modelling. RESULTS: The overall goodness of fit of the conceptual model was acceptable. Consumers' health consciousness, perceived health risk and Internet health information use efficacy were found to influence consumers' beliefs, attitude and intention of use disease information on the Internet. But Internet health information use efficacy did not significantly influence perceived usefulness. It was also identified that consumers' perceived credibility of the information in the websites was the main determinant in forming of attitude towards disease information on the Internet. CONCLUSIONS: Technology acceptance model has been extended and examined successfully in explaining consumers' disease information-seeking behaviour on the Internet. It was found that consumers' cognitive and affective characteristics, determined as initiators in health-related behaviour, also impacted consumers' disease information-seeking behaviour on the Internet. RELEVANCE TO CLINICAL PRACTICE: These findings may be used to help nurses to predict and identify the factors affecting individual's use of disease information on the Internet. Based on this knowledge, nurses will be able to develop nursing intervention programmes for the patients' health management.

Empowerment, job satisfaction, and organizational commitment: comparison of permanent and temporary nurses in Korea.

AIM: This study was conducted to describe and compare empowerment, job satisfaction, and organizational commitment between permanent and temporary nurses in Korea. BACKGROUND: Since Korea's economic crisis of 1997, Korea's labor market has been undergoing dramatic modification, and the rate of temporary nurses employed in health care organizations has gradually increased. However, studies focusing on nurses' employment status, which potentially affect the individual and hospital organization, have been rarely conducted. METHODS: This was a descriptive comparative study. The convenient sample of 416 nurses from 19 hospitals in Korea completed a structured questionnaire. RESULTS: Overall, permanent nurses presented higher levels of job satisfaction, organizational commitment, and empowerment than did temporary nurses. CONCLUSIONS: The results of this study indicated that health care administrators should develop strategies to close the gap of perceptions between permanent and temporary nurses in Korea. The results of this study also imply that such opportunities and compensation plans related with administrative recognition should be made available to the temporary nurses to manage their workforces more efficiently.

Effects of Trait Anger and Anger Expression on Job Satisfaction and Burnout in Preceptor Nurses and Newly Graduated Nurses: A Dyadic Analysis.

PURPOSE: The preceptor-newly graduated nurse (NGN) relationship is integral to the successful experience of clinical teaching and learning and new nurses' transition. However, interpersonal conflicts between them are common. Little is known whether their anger contributes to their level of job satisfaction and burnout. This study aimed to examine the effects of each nurse's anger on job satisfaction and burnout in preceptor-NGN dyads. METHODS: A cross-sectional, correlational survey design was used. This study involved 121 preceptor-newly graduate nurse dyads in two hospitals in South Korea. Nurses completed a questionnaire about demographics, the State-Trait Anger Expression Inventory-Korean version, a job satisfaction measure, and the Copenhagen Burnout Inventory. This study adopted the Actor-Partner Interdependence Model to handle dyadic data. RESULTS: Preceptor nurses reported higher frequencies of feeling anger than did new nurses and appear to have higher levels of trait anger, anger-out, and burnout. Both the preceptors' and NGNs' trait anger was positively associated with preceptors' burnout. Suppressing anger was closely related to the nurses' own job satisfaction and burnout. Preceptors with a higher level of anger-control had higher job satisfaction, and NGNs with a higher level of anger-control had less burnout. CONCLUSION: The results indicate that preceptors and new nurses appear to experience significant anger, which is closely associated with their job satisfaction and burnout during their preceptorship. Anger management training programs geared toward educating both preceptors and new nurses about appropriate anger expression in the workplace should be developed to retain valuable nurses.

Longitudinal Effects of Body Mass Index and Self-Esteem on Adjustment From Early to Late Adolescence: A Latent Growth Model.

BACKGROUND: Mental and physical development during adolescence is a factor that may affect quality of life in adulthood. PURPOSE: The aims of this study were to investigate the developmental trajectories of body mass index (BMI), self-esteem, and adjustment among students from early to late adolescence and to examine the longitudinal relationships among these variables. METHODS: Data from 2006 to 2012 were collected from the Korean Welfare Panel Study. Of the initial sample of 521 students, 487 completed a validated questionnaire measuring BMI, self-esteem, and adjustment. Latent growth curve modeling analyses were conducted to examine the relationships among the variables. RESULTS: Univariate linear growth models showed a significant increase in BMI and significant declines in both self-esteem and adjustment across three time points from childhood to adolescence. The goodness of fit of the multivariate conditioned model supported the validity of the proposed longitudinal model (comparative fit index = .93, root mean square error of approximation = .08). Change in BMI was significantly linked with change in adjustment (ß = .18, p < .05) but not with change in self-esteem, whereas change in self-esteem exerted a statistically significant effect on change in adjustment (ß = .47, p < .001). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Our findings indicate that BMI and self-esteem are key determinants of student adjustment in school settings. Therefore, future health education interventions should focus on enhancing the positive physical and mental self-concepts of students, which should improve health and social behavior among students and subsequently afford a better quality of life for these students in adulthood.

Critical to quality in telemedicine service management: application of DFSS (Design for Six Sigma) and SERVQUAL).

Telemedicine generally refers to the use of communications and information technologies for the delivery of health care. owever, telemedicine is not merely a simple combination of health care and technology. The researchers propose a systematic approach for assessing needs of telemedicine customers, called critical-to-quality (CTQ) in Six Sigma, with a purpose of continuous quality improvement. The combination approach using DFSS (Design for Six Sigma) and SERVQUAL (Service Quality Framework) was applied to define the critical quality attributes of telemedicine service management and to match them with the current telemedicine process. With a step-by-step procedure, telemedicine service process was reviewed and all the important CTQ candidates identified via a case study. The findings suggest that nurses need further understanding and research methods that will improve and manage the quality of health care service in various medical fields.

[Predictors of employment intention for mentally disabled persons].

PURPOSE: This study was conducted to determine the predictors of employment intention for mentally disabled persons. METHODS: Mentally disabled persons who had participated in rehabilitation programs in one of 16 mental health centers and 9 community rehabilitation centers located in Seoul and Kyunggi province were recruited for this study. A random sampling method was used and 414 respondents were used for final analysis. Data was analyzed by Pearson's correlation, and stepwise multiple regression using the SPSS Win 14.0. RESULTS: The predictors influencing employment intention of the mentally disabled person were observed as employment desire (beta=.48), guardian's expectation (beta=.26), professional's support (beta=.23), financial management (beta=.10), eating habits (beta=.07), and quality of life (beta=-.01). Six factors explained 61.1% of employment intention of mentally disabled persons. CONCLUSION: The employment intention of a mentally disabled person was influenced by employment desire, diet self-efficacy, guardian's expectation, professional's support, quality of life, financial management and eating habits.

[Development and Analysis of System Dynamics Model for Predicting on the Effect of Patient Transfer Counseling with Nurses].

PURPOSE: This study aimed to construct a management model for patient transfer in a multilevel healthcare system and to predict the effect of counseling with nurses on the patient transfer process. METHODS: Data were collected from the electronic medical records of 20,400 patients using the referral system in a tertiary hospital in Seoul from May 2015 to April 2017. The data were analyzed using system dynamics methodology. RESULTS: The rates of patients who were referred to a tertiary hospital, continued treatment, and were terminated treatment at a tertiary hospital were affected by the management fee and nursing staffing in a referral center that provided patient transfer counseling. Nursing staffing in a referral center had direct influence on the range of increase or decrease in the rates, whereas the management fee had direct influence on time. They were nonlinear relations that converged the value within a certain period. CONCLUSION: The management fee and nursing staffing in a referral center affect patient transfer counseling, and can improve the patient transfer process. Our findings suggest that nurses play an important role in ensuring smooth transitions between clinics and hospitals.