Effects of an Online Health Management Program for South Korean Adolescents with Complex Congenital Heart Disease during Their Transition to Adulthood: A Randomized Controlled Trial.

Adolescents with complex congenital heart disease (CHD) are at risk of experiencing complications later in life. The purpose of this study was to develop an online health management program for adolescents with complex CHD and to evaluate its effects on self-efficacy, health behavior, and health-related quality of life. A randomized controlled trial design was used. A total of 29 adolescents with complex CHD were divided into an experimental group of 15 and a control group of 14. Participants in the intervention group took part in the 4-week online health management program (weekly online group sessions, 1:1 phone coaching, dietary diary feedback, and provision of health information) developed based on self-efficacy theory, while those in the control group received standard medical follow-up. Data were collected from August 2021 to March 2022 using a questionnaire-including the Korean Self-Rated Abilities for Health Practices: Health Self-Efficacy Measure (K-SRAHP) and Pediatric Cardiac Quality of Life Inventory (PCQLI)-and an ActiGraph accelerometer to track physical activity and sleep. The intervention group showed significant improvements in health self-efficacy (p = 0.003), psychosocial impact (p = 0.013), daily step counts (p = 0.011), and moderate to vigorous-intensity physical activity (p = 0.027). Additionally, a decrease in weekend leisure time sedentary behavior (p = 0.035) was observed. However, there were no significant differences in sleep behavior between two groups. The online health management program significantly enhanced self-efficacy, health behavior, and psychosocial impact in adolescents with complex CHD. These findings will inform the development of policies for transitional medical care tailored to adolescents with complex CHD.

Infant sleep interventions with sleep measurements using actigraphy: A systematic review.

AIM: This review investigated the outcomes and methodological quality of infant sleep intervention studies utilizing actigraphy. BACKGROUND: Parents need appropriate support for infant sleep from nurses. There are few methodological reports of actigraphy in infant sleep intervention studies that objectively measure infant sleep in a natural setting. DESIGN: This was a systematic review study. DATA SOURCES: Ovid MEDLINE, Embase, Cochrane, CINAHL and PsycINFO were searched from database establishment to 30 December 2021. REVIEW METHODS: This systematic review utilized the Cochrane Collaboration review guidelines. RESULTS: Eleven sleep intervention studies were reviewed. Three used extinction-based behavioural interventions, and eight included parental education programs. The infant sleep interventions positively affected the sleep outcomes of both infants and parents. Fairly consistent effects were found on infants' number of awakenings and sleep onset latency. However, parental psychosocial outcomes were inconsistent. All studies reported device placement, the algorithm for analysis, the use of a sleep diary and number of days/nights, but external movements affecting infants' sleep records were insufficiently reported. Only two studies had a low risk of bias. CONCLUSIONS: The infant sleep interventions had positive effects on both infants and their parents. Comprehensive methodological considerations are required for more standardized assessments using actigraphy for infant sleep evaluation.

Mothering children at a paediatric intensive care unit with strict visiting hours: A qualitative study.

BACKGROUND: Although a child- and family-centred care (CFCC) philosophy has been emphasized and adopted for decades in paediatric critical care settings in several countries, numerous issues from parents' perspectives regarding the philosophy remain unresolved. To facilitate the full translation of CFCC into clinical practice, health care professionals need an in-depth understanding of family experiences. Real-life mothering experiences, including maternal roles and identities, remain largely unknown at paediatric intensive care units (PICUs) in the Republic of Korea, where family visitation, presence, and participation are restricted. AIM: To explore mothering experiences at a PICU where family visitation is strictly constrained, and to identify maternal needs and values. STUDY DESIGN: We conducted a qualitative descriptive study of eight individual in-depth interviews with seven mothers of hospitalized children. Qualitative data were analysed using inductive thematic analysis. FINDINGS: Five major themes, along with four subthemes, emerged: (1) shifts in maternal roles and responsibilities, (2) shifts in interpersonal relationships, (3) desire for CFCC in the PICU, (4) practising self-defined mothering roles, and (5) reconstructing maternal identities. The themes revealed the experiences of becoming mothers of a child in a constrained PICU. Ultimately, mothers demanded that the unit improve its physical and cultural environments through, for example, liberalized family visitation and participation in the care of their children. CONCLUSIONS: Nursing professionals should lead the charge for humanizing a restrictive PICU in the Republic of Korea by ensuring a safe and open environment and mothering continuity based on child- and family-centred holistic care. RELEVANCE TO CLINICAL PRACTICE: Effective interventions must be developed and tested to globally establish and fully implement strong evidence-based CFCC in PICUs; constant co-commitment among children, families, health care professionals, and institutions is also necessary.

Experiences of trust in mothers of hospitalized children toward pediatric nurses.

Trust is an essential component of qualified nursing care and correlated with mothers' satisfaction during child's hospitalization. This exploratory qualitative study was conducted to gain a better understanding of trust from mothers of hospitalized children toward pediatric nurses. Data were collected using semi-structured, in-depth interviews with eight mothers with recently hospitalized children. Collected data were analyzed using thematic analysis. As a result, three themes were identified from this study: "assessing the trustworthiness of pediatric nurses," "overcoming emotional burden caused by the child's hospitalization," and "newly recognizing the importance of pediatric nurses." Seven sub-themes were identified. Mothers reported guilt and stress due to their responsibility as the primary caregiver when children were hospitalized. However, mothers felt empowered and gained confidence when trusting pediatric nurses, recognizing their importance, and accepting their help. The result highlights the essential nature of the mother's trust in pediatric nurses, which in turn facilitated emotional support and empowerment for the mothers. Based on this study's insights into the unique experiences of trust from mothers of hospitalized children, pediatric nurses can explore strategies to facilitate trust-building. Based on these findings, pediatric nurses can develop trust-building strategies, tools to assess the level of trust, and interventions to facilitate trust-building.

Effectiveness of a Strength-Based Intervention into Nursing Education in South Korea.

Purpose: This study aimed to examine the effectiveness of strength-based interventions integrated into the nursing education. Materials and Methods: The participants were 259 baccalaureate nursing students in South Korea. Over 15 weeks, strength-based intervention was integrated into the regular nursing curriculum. Stress, resilience, and well-being of the participants were measured before and after the intervention. The data were analyzed using a linear mixed model via the SPSS statistics 21.0. program. Results: There was a negative weak association between stress and well-being and between stress and resilience (r = -0.164, p = 0.009 and r = -0.138, p = 0.029, respectively) and a positive moderate association between well-being and resilience (r = 0.561, p<0.001). After adjusting the covariates, the interaction of group*time for stress and resilience were significant after the intervention, reflecting a higher status of stress and improved resilience. (p= 0.046 and 0.030 respectively). Conclusion: Integrating strength-based interventions into the nursing curriculum was effective in improving the mental health of Korean nursing students. Future research is needed to identify various ways of applying positive psychology to the nursing education.

Perinatal women's experiences of childbirth and parenting during the COVID-19 pandemic: A qualitative descriptive study.

In this study, we described perinatal women's experiences of childbirth and parenting during the COVID-19 pandemic, guided by the qualitative descriptive methodology. We interviewed 14 women who gave birth during the pandemic. Data were analyzed using inductive qualitative content analysis. Our results showed that perinatal women experienced fear of COVID-19 infection, depression, and difficulties related to childbirth and parenting. They believed that online services and sharing information through social networking were helpful. They were looking forward to participating in outdoor activities to promote children's development and suggested enforcing untact (no contact) services for perinatal women in the post-COVID-19 era.

Missed nursing care and its influencing factors among neonatal intensive care unit nurses in South Korea: a descriptive study.

PURPOSE: Preventing missed care is important in neonatal intensive care units (NICUs) due to neonates' vulnerabilities. This study examined missed care and its influencing factors among NICU nurses. METHODS: Missed care among 120 Korean NICU nurses was measured using a cross-culturally adapted online questionnaire. The frequency of missed care for 32 nursing activities and the significance of 23 reasons for missed care were collected. RESULTS: All participants had missed at least 1 activity, missing on average 19.35 activities during a typical work-day. The most common missed item was "provide developmental care for the baby". The most common reason for missed care was "emergency within the unit or deterioration of one of the assigned patients". The final regression model explained 9.6% of variance in missed care. The average daily number of assigned patients receiving inotropes or sedation over the last month influenced the total number of missed care items. CONCLUSION: Missed care was affected by nurses' workload related to the number of patients taking medication. Frequently missed activities, especially those related to developmental care, require patience and time, conflicting with safety prioritization and inadequate working conditions. NICU nurses' working conditions should be improved to ensure adequate time for nursing activities.

A qualitative study of the sleep ecology of infants under 2 years old and their mothers in South Korea.

OBJECTIVES/DESIGN: Infancy is a crucial period for establishing an individual's sleep pattern, and it is a common period during which infants and mothers experience sleep problems. The aim of this qualitative study was to explore the sleep ecology of infants under 2 years of age and their mothers. SETTING/PARTICIPANTS: The study participants were 20 mothers with infants aged 3-19 months living in South Korea. METHODS: Data were collected through in-depth interviews and analyzed using the thematic analysis. RESULTS: Five themes related to the sleep of infants and their mothers emerged from the data: (1) changes in sleep patterns, (2) room-sharing, (3) environmental factors affecting sleep, (4) efforts to improve sleep quality, and (5) infant sleep and the mother's health. The sleep patterns of infants and their mothers were mutually interrelated, and were strongly affected by various environmental factors, including infants' biological maturity (a microsystem) as well as cultural factors (a macrosystem). Culture had an especially profound effect on sleep patterns of infants, similar to the effects of microsystem-level factors. CONCLUSIONS: To improve the sleep quality of infants and mothers, an ecological approach considering the biological characteristics and cultural contexts of infants is required based on an understanding of sleep as a phenomenon that evolves in a relationship of mutual influence between infants and mothers.

Effects of school-based "We Fit" weight control programme in adolescents.

AIM: This study examined the effects of a 12-week school-based "We Fit" weight control programme. DESIGN: A nonequivalent control group was used, with a non-synchronized pretest-posttest design. METHODS: In total, 109 Korean high school adolescents participated. The programme comprised exergaming, diet diary and counselling, health education, and social networking service-based group discussions. Anthropometric factors, physiological factors and physical activity (daily steps and sitting time) were measured in the intervention and the control groups before and after the intervention. Programme satisfaction was assessed post-intervention. Data were analysed using descriptive statistics; the chi-square, Mann-Whitney U and t tests; and generalized estimating equations. RESULTS: The intervention group showed a significantly decreased waist circumference, increased skeletal muscle mass, increased high-density lipoprotein cholesterol, decreased low-density lipoprotein cholesterol and reduced weekend sitting time. CONCLUSION: This study adds to the evidence for the applicability and effectiveness of healthy weight control programmes using exergames for adolescents in school settings.

Experiences of nurses caring for perinatal women and newborns during the COVID-19 pandemic: A descriptive qualitative study.

AIM: Nurses are pivotal in caring for patients infected with COVID-19. Little is known about experiences of nurses in maternity care during the pandemic. Therefore, this study aimed to describe nurses' experiences of caring for perinatal women and newborns during the pandemic. DESIGN: A descriptive qualitative study was conducted. METHODS: Data were collected from August-November 2020 using focus group and in-depth interviews. A total of 24 nurses working in maternity and newborn care units participated in the study. Content analysis method was used for data analysis. RESULTS: The participants' clinical experience ranged from 6 months-26 years. Three major themes emerged as follows: "making every effort to prevent COVID-19 infection," "caring for perinatal women and newborns with COVID-19 infection or suspected infection" and "job stress and professional growth during the pandemic." Participants reported that they needed more support in terms of staffing and mental health.

Social Determinants of Health and Well-Being of Adolescents in Multicultural Families in South Korea: Social-Cultural and Community Influence.

Objectives: Adolescents in multicultural families (AMFs) are exposed to numerous stressors and face environmental vulnerability within the family, school, and community systems, which may affect their health and well-being. Concrete discussion on policies is lacking due to insufficient data on the levels of well-being of AMFs in South Korea. This study aimed to investigate social-cultural and community factors affecting their well-being. Methods: A cross-sectional study was conducted with a convenience sample of 206 AMFs (aged 13-18 years) from 16 general schools and three multicultural schools across eight large cities. AMFs completed a self-administrative questionnaire assessing well-being, individual factors (acculturative stress, health behavior), social and community factors (social support, sense of community), and environmental factors (school type, economic status). Data were analyzed using structural equation modeling. Results: Social support and sense of community significantly and directly affected well-being. The economic status and type of school had an indirect effect on well-being, whereas the effect of acculturative stress was not significant. Factors significantly affecting adolescents' well-being were social support, sense of community, economic status, and type of school. Conclusion: Addressing well-being may be the strategy leading AMFs to grow into healthy adults. These results could help educators, health professionals, and policymakers to identify ways to enhance the well-being of AMFs.

Experiences of Fathers of Young Children With Severe Congenital Heart Defects in Korea: A Qualitative Descriptive Study.

PURPOSE: This qualitative descriptive study sought to explore the experiences of fathers of children with severe congenital heart defects (CHDs) in Korea. METHODS: The participants were nine fathers of children under 5 years of age who had undergone open heart surgery within the last 5 years. Data were collected using in-depth individual interviews from February to March 2015. Qualitative data were analyzed using the thematic analysis method. RESULTS: Three themes and nine sub-themes emerged from the data. The three themes were "heartbreaking suffering," "self-control during a great struggle," and "being a father of a child with CHD." This study described coping strategies that fathers used to balance their life, including self-control, redefinition of the situation, and seeking family support resources, which enabled them to practice normalization and live an ordinary life despite limitations. CONCLUSION: The findings of this study indicate that considerable psychological distress of fathers was similar to that of mothers for weeks to months after the sudden diagnosis of CHD and heart operations. The results also depict the coping strategies, contemporary fathering experience and the parenting role of fathers in raising children with severe CHDs. PRACTICE IMPLICATIONS: Healthcare professionals should understand the experience of fathers of children with severe CHDs and their needs for social support. It is also necessary to develop nursing interventions that focus on fathers' needs.

Self-directed learning and professional values of nursing students.

Professional nursing values are important concepts in developing the identity of nursing professional among nursing students. Self-directed learning as an ability can drive motivation to enhance professional nursing values and merits examination. This study aimed to examine the associations between self-directed learning and professional nursing values in nursing students. A cross-sectional descriptive design was employed with a sample of 800 nursing students. The measurement tools were the Self-Rating Scale of Self-Directed Learning and Korean version of the Nurses Professional Values Scale-Revised. Path analysis was used to evaluate relationships among self-directed learning, professional nursing values, and general participant characteristics. Self-directed learning had significantly positive effects on professional nursing values. Male nursing students were more likely to have higher levels of self-directed learning. Our findings suggest that self-directed learning can be an effective pedagogical method to instill and reinforce professional nursing values in nursing students. In addition, nursing educators should consider sex differences in the learning styles of nursing students.

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PURPOSE: The purpose of this study was to investigate the effects of a positive psychology-based mental health promotion program for high school students. METHODS: This study used a randomized control group pretest-posttest design. A total of 47 high school students participated from two high schools in Gyeonggi Province. They were randomly assigned to an experimental group (n=24), which participated in the 8-session program, or to a control group (n=23). Psychological well-being, depression, and self-esteem were measured. RESULTS: A significant difference in psychological well-being was observed between the two groups after the program. However, there were no significant between-group differences in depression or self-esteem. CONCLUSION: The positive psychology-based mental program was effective at increasing psychological well-being in adolescents, especially high school students. This study suggests that a school curriculum could incorporate positive psychology-based mental programs for high school students to promote their mental health.

Effects of a Community Outreach Program for Maternal Health and Family Planning in Tigray, Ethiopia.

PURPOSE: We examined the effects of a community outreach program for maternal health in Tigray, Ethiopia, on women's knowledge about pregnancy, childbirth, postpartum care, and family planning, and assessed their participation in antenatal care, postpartum checkups, institutional childbirth, and contraceptive use. METHODS: We recruited Ethiopian women of reproductive age (15 to 49 years) in Tigray, Ethiopia. Two villages in Tigray, Kihen and Mesanu, which have similar population sizes and living environments, were chosen as the intervention and comparison groups, respectively. A two-group pretest-posttest design with cluster sampling was employed. We conducted self-report questionnaire surveys using face-to-face interviews. The 2.5-year community outreach program was developed based on Rogers' diffusion of innovation theory. It consisted of mass media use and health education for lay women in the community, along with training of health care providers, including nurses, midwives, and health extension workers, in maternal health care. RESULTS: The intervention group showed significant increases in knowledge and behaviors regarding maternal health and family planning compared to the comparison group (p < .001). In particular, there was a dramatic increase from 10.8% to 93.5% in the institutional birth rate in the intervention group. CONCLUSION: The community outreach program and health care professional training effectively improved knowledge and behaviors regarding maternal health in Ethiopian women. Mass media and interpersonal communication channels for health education may be useful health interventions in developing countries.

Working experiences of nurses during the Middle East respiratory syndrome outbreak.

AIMS: To explore working experiences of nurses during Middle East respiratory syndrome outbreak. BACKGROUND: Since the first case of Middle East respiratory syndrome was reported on May 20, 2015 in South Korea, 186 people, including health care workers, were infected, and 36 died. DESIGN: A qualitative descriptive study. METHODS: Seven focus groups and 3 individual in-depth interviews were conducted from August to December 2015. Content analysis was used. RESULTS: The following 4 major themes emerged: "experiencing burnout owing to the heavy workload," "relying on personal protective equipment for safety," "being busy with catching up with the new guidelines related to Middle East respiratory syndrome," and "caring for suspected or infected patients with caution." Participants experienced burnout because of the high volume of work and expressed safety concerns about being infected. Unclear and frequently changing guidelines were 1 of the common causes of confusion. Participants expressed that they need to be supported while caring for suspected or infected patients. CONCLUSION: This study showed that creating a supportive and safe work environment is essential by ensuring adequate nurse staffing, supplying best-quality personal protective equipment, and improving communication to provide the quality of care during infection outbreak.

Completeness of Human Papilloma Virus Vaccination: A Systematic Review.

PROBLEM: It has been reported that some adolescents and young women who started taking human papillomavirus (HPV) vaccination are not completing all three doses. The aim of this study was to systematically review intervention studies on HPV vaccination completion. ELIGIBILITY CRITERIA: Intervention studies with a comparison group that assessed HPV vaccination completion rate as the primary outcome variable in adolescents and adults younger than 26years of age, and published in English from 2006 to 2016, were eligible for review. SAMPLE: Five studies from a literature search of CINAHL, EMBASE, PsycARTICLES, PubMed, SCOPUS, and Web of Science databases were included in this review. RESULTS: The overall quality of the reviewed studies was moderate, and the studies have mainly been conducted in a high-income country. Intervention strategies were DVD-based education on HPV and reminders that were delivered via either electronic or non-electronic methods. Some studies used fixed type of electronic reminders. Others chose preference-based electronic reminders, allowing participants to select one or two delivery options from e-mail, text message, automated telephone message, or Facebook message. Non-electronic reminders were letters sent by standard mail. CONCLUSIONS: The rates of HPV vaccination completeness increased with the interventions. However, the completeness rate of HPV vaccination remained unsatisfactory and lower than its initiation rate. IMPLICATIONS: Educational and reminder interventions for HPV vaccination could contribute to HPV vaccination completion. However, this review highlights the need for more high-quality studies to identify the best way to promote vaccination completion.

Association of Weight Control Behaviors with Body Mass Index in Korean Adolescents: A Quantile Regression Approach.

PURPOSE: Adolescents are interested in weight control but likely practice unhealthy weight control behaviors. This study aimed to examine weight control behaviors associated with body mass index (BMI) in Korean adolescents. DESIGN AND METHODS: In this descriptive cross-sectional study of 16- to 19-year-old adolescents (97 girls and 90 boys), analyses were conducted of physical activity, sedentary behaviors, dietary behaviors, and self-efficacy for physical activity and diet. Daily steps were measured using pedometers. Height and weight were self-reported. We conducted descriptive statistics and quantile regression analysis using STATA 14.0. RESULTS: About 10% were underweight, and 8.6% overweight and obese. Average weekday and weekend steps/day were <10,000. Only 4.3% reported performing moderate-to-vigorous physical activity (MVPA) daily. Less than half (42.5%) reported that they had three meals/day every day. Most (89.3%) had milk less than once/day. Quantile regression showed that, for the 5th BMI percentile group, (1) age (ß = 0.941) and milk consumption (ß = 2.148) were significantly positively associated with BMI, whereas (2) dietary self-efficacy (ß = -0.083) was significantly negatively associated with BMI. For the 95th percentile group, having three meals/day (ß = 2.558) was significantly positively associated with BMI, whereas MVPA (ß = -5.440) and muscle-strengthening exercise (ß = -3.392) were significantly negatively associated with BMI. CONCLUSIONS: Milk consumption was positively associated with BMI of underweight adolescents, whereas physical activities were negatively associated with BMI of overweight and obese adolescents. PRACTICE IMPLICATION: Weight control programs for adolescents may need to be tailored for differing BMI levels.

Body esteem is a mediator of the association between physical activity and depression in Korean adolescents.

PURPOSE: This study examined whether body-esteem would mediate the association between physical activity and depression in adolescents. METHODS: A total of 848 Korean high school students aged 15 to 18years completed a questionnaire on body-esteem, physical activity recall, and depression. Path analysis was used to test mediating effects of body-esteem on the association between physical activity and depression. RESULTS: Girls showed a significantly higher level of depressive symptoms than boys. Boys showed significantly higher levels of physical activity and body-esteem than girls. Body-esteem mediated the relation of physical activity with depression. CONCLUSIONS: Physical activity might reduce the risk of depression in addition to supporting body-esteem in adolescents. Interventions that reinforce healthy body-esteem and encourage physical activity would help prevent depression in adolescents. Future studies should examine the effects of programs addressing physical activity and body-esteem among adolescents with depressive symptoms.

Weight Control in Adolescents: Focus Groups With Korean Adolescents and Their Teachers.

PURPOSE: This qualitative descriptive study sought to identify perceptions about and status of weight control in adolescents from the perspective of adolescents and their teachers. METHODS: Focus groups were used with six separate groups, 20 adolescents divided into four groups and 14 teachers divided into two groups. The qualitative data were analyzed using a thematic analysis in NVivo 11.0. Consolidated criteria for reporting qualitative studies (COREQ) were followed. RESULTS: We extracted three themes and 12 sub-themes with 52 meaningful codes. Both adolescents and teachers stated that perceptions about weight control in adolescents were overly weighted toward management of one's appearance. The adolescents reported an increase in weight gained during adolescence, especially after entering high school, and they noted a lack of participation in physical activities and the presence of unhealthy dietary behaviors. However, adolescents perceived excessive weight gain during adolescence as natural, as long as they studied hard. Their teachers and parents were also permissive about weight gain resulted from study. The participants suggested that a weight control program for adolescents should be conducted in schools and should include every student in order to avoid discrimination. In addition, teacher involvement was emphasized to promote participation of adolescents in a school program. CONCLUSION: Our findings indicate that adolescents, especially those in a society emphasizing academics, need to practice healthy weight control behaviors. A school-based weight control program involving teachers and peers would be suitable and should be provided to all students regardless of weight classification.