Workload-Related Issues among Nurses Caring for Patients with Behavioral and Psychological Symptoms of Dementia: A Scoping Review.

BACKGROUND/OBJECTIVES: As the elderly population grows, the prevalence of dementia is rising, with 70-95% of patients in hospital settings exhibiting problematic behaviors such as aggression. These behaviors significantly contribute to increased nursing workloads, affecting nurses' well-being and patient care quality. This study aims to review workload-related issues among nurses caring for dementia patients, highlighting the need for targeted interventions to mitigate stress and improve care quality. METHODS: A scoping review was conducted using the five-stage framework of Arksey and O'Malley. The literature search covered studies published between 2013 and 2023, focusing on quantitative research about nurses' workload-related stress when managing patients with dementia and problematic behaviors. Databases such as PubMed and PsycINFO were searched, and 13 studies were selected based on predefined inclusion and exclusion criteria. RESULTS: The review revealed that problematic behaviors, particularly aggression, significantly increase nurses' stress and workload. This stress has negative consequences on nurses' physical and mental health, often leading to burnout, decreased job satisfaction, and a decline in care quality. Inadequate staffing and support systems exacerbate these issues. CONCLUSIONS: Targeted education, sufficient staffing, and support are essential to reduce the workload and stress experienced by nurses caring for dementia patients. Implementing these strategies can enhance the quality of care provided and improve the well-being of healthcare professionals.

Diabetes self-care activities and its correlates in patients with diabetic neuropathy.

BACKGROUND: Diabetic neuropathy is the most common chronic complication observed in patients with diabetes and has significant clinical implications, such as decreased quality of life and increased morbidity and mortality rates. Studies on the factors affecting diabetes self-care activities pertaining to patients with diabetic neuropathy are limited. Therefore, a more in-depth study targeting individuals with diabetic neuropathy is required to develop patient-centred nursing interventions. AIM: This study aimed to identify diabetes self-care activities among patients with diabetic neuropathy and determine their correlates. METHODS: This study employed a descriptive correlational design and the study subjects consisted of 99 patients with diabetic neuropathy. Descriptive statistics and hierarchical regression analyses were used to analyse the factors affecting diabetes self-care activities. This study follows the STROBE guidelines to ensure rigorous reporting of cross-sectional studies. RESULTS: Our findings revealed positive correlations between diabetes self-care activities and factors including knowledge of diabetes foot care, diabetes foot care practices, interpretation of diabetic neuropathy and foot care confidence. Foot care confidence positively correlated with diabetes foot care knowledge, practices and interpretation of neuropathy, but negatively related to diabetic stress. In determining the impact of these factors on diabetes self-care activities, hierarchical regression analysis revealed that patients with higher diabetes foot care practices and foot care confidence demonstrated higher levels of diabetes self-care activities. CONCLUSION: The study findings confirmed that diabetic foot care practices and foot care confidence significantly influenced self-care activities in patients with diabetic neuropathy. Considering these results, customizing the intervention content to match diabetic foot care practices and diabetic foot care confidence can enhance self-care activities in patients with diabetic neuropathy. PATIENT OR PUBLIC CONTRIBUTION: Survey questionnaires were completed by patients with diabetic neuropathy in this study.

The Relationships among communication competence, professional autonomy and clinical reasoning competence in oncology nurses.

AIMS: To investigate the relationships among communication competence, professional autonomy and clinical reasoning and to identify the factors that influence clinical reasoning competence in oncology nurses. DESIGN: Cross-sectional descriptive design. METHODS: Participants included 147 oncology nurses with more than a year of clinical experience in cancer wards. The Global Interpersonal Communication Competence Scale, Schutzenhofer Professional Autonomy Scale and Nurses Clinical Reasoning Scale (NCRS) were used to collect data. Data were analysed using descriptive statistics, independent t-test, one-way ANOVA, Pearson correlation analysis and hierarchical multiple regression analysis. RESULTS: Communication competence (r = 0.59) and professional autonomy (r = 0.46) showed significant positive relationships with clinical reasoning competence. Clinical experience, communication competence, age and professional autonomy were statistically significant predictors and explained 48.6% of clinical reasoning competence. CONCLUSIONS: The clinical reasoning competence of oncology nurses increases proportionally with their communication competence and professional autonomy. Therefore, oncology nurses must reinforce their communication competence and professional autonomy to enhance their clinical reasoning competence. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The reinforcement of communication competence and professional autonomy is necessary for oncology nurses to enhance their clinical reasoning competence. In order to improve nurses' communication competence, practical-focused communication education programmes must be designed and deployed systematically and periodically. In addition, to increase nurses' professional autonomy, it is necessary to expand their clinical experiences through the regular rotation of working units and to make institutional efforts to retain experienced nurses. REPORTING METHOD: We have adhered to STROBE checklist. PATIENT OR PUBLIC CONTRIBUTION: Participants in the study were recruited online. They were informed of the study's purpose, method and usability and the survey could only be conducted if they consented to participate voluntarily.

An exploratory study of the practical impact of the COVID-19 pandemic on nursing tasks in clinical settings.

AIMS: To identify and compare new or increased nursing tasks in South Korea during the pandemic, categorized by hospital type and department. BACKGROUND: Although COVID-19 is no longer considered a global public health emergency, the threat of novel infectious diseases remains. Reflecting on the COVID-19 pandemic is essential to prepare effectively for future outbreaks. METHODS: This cross-sectional exploratory study, following the STROBE checklist, included 948 registered nurses with more than a year of clinical experience currently working in various hospitals. Questionnaires gathered demographic data, work characteristics, and the frequency of nursing task performance. Statistical analysis encompassed descriptive and inferential methods. RESULTS: The most common new or increased nursing task across all hospital types was 'Access control for family caregivers.' General wards prioritized tasks related to family caregivers, while specialized units like ICU and ER focused on infection control. CONCLUSION: Understanding how COVID-19 has impacted nursing tasks is crucial for gaining insights into efficient resource allocation, targeted education, and policy formulation during similar public health crises. The pandemic has given rise to new family caregiver-related tasks in the nursing profession. Consequently, continuous nursing research is essential for establishing guidelines and fostering a supportive work environment, which is crucial for the successful implementation of these tasks.

Asian Cohort for Alzheimer's Disease (ACAD) pilot study on genetic and non-genetic risk factors for Alzheimer's disease among Asian Americans and Canadians.

INTRODUCTION: Clinical research in Alzheimer's disease (AD) lacks cohort diversity despite being a global health crisis. The Asian Cohort for Alzheimer's Disease (ACAD) was formed to address underrepresentation of Asians in research, and limited understanding of how genetics and non-genetic/lifestyle factors impact this multi-ethnic population. METHODS: The ACAD started fully recruiting in October 2021 with one central coordination site, eight recruitment sites, and two analysis sites. We developed a comprehensive study protocol for outreach and recruitment, an extensive data collection packet, and a centralized data management system, in English, Chinese, Korean, and Vietnamese. RESULTS: ACAD has recruited 606 participants with an additional 900 expressing interest in enrollment since program inception. DISCUSSION: ACAD's traction indicates the feasibility of recruiting Asians for clinical research to enhance understanding of AD risk factors. ACAD will recruit > 5000 participants to identify genetic and non-genetic/lifestyle AD risk factors, establish blood biomarker levels for AD diagnosis, and facilitate clinical trial readiness. HIGHLIGHTS: The Asian Cohort for Alzheimer's Disease (ACAD) promotes awareness of under-investment in clinical research for Asians. We are recruiting Asian Americans and Canadians for novel insights into Alzheimer's disease. We describe culturally appropriate recruitment strategies and data collection protocol. ACAD addresses challenges of recruitment from heterogeneous Asian subcommunities. We aim to implement a successful recruitment program that enrolls across three Asian subcommunities.

Suggestion for item allocation to 8 nursing activity categories of the Korean Nursing Licensing Examination: a survey-based descriptive study.

PURPOSE: This study aims to suggest the number of test items in each of 8 nursing activity categories of the Korean Nursing Licensing Examination, which comprises 134 activity statements including 275 items. The examination will be able to evaluate the minimum ability that nursing graduates must have to perform their duties. METHODS: Two opinion surveys involving the members of 7 academic societies were conducted from March 19 to May 14, 2021. The survey results were reviewed by members of 4 expert associations from May 21 to June 4, 2021. The results for revised numbers of items in each category were compared with those reported by Tak and his colleagues and the National Council License Examination for Registered Nurses of the United States. RESULTS: Based on 2 opinion surveys and previous studies, the suggestions for item allocation to 8 nursing activity categories of the Korean Nursing Licensing Examination in this study are as follows: 50 items for management of care and improvement of professionalism, 33 items for safety and infection control, 40 items for management of potential risk, 28 items for basic care, 47 items for physiological integrity and maintenance, 33 items for pharmacological and parenteral therapies, 24 items for psychosocial integrity and maintenance, and 20 items for health promotion and maintenance. Twenty other items related to health and medical laws were not included due to their mandatory status. CONCLUSION: These suggestions for the number of test items for each activity category will be helpful in developing new items for the Korean Nursing Licensing Examination.

Korean nurses' energy drink consumption and associated factors.

This study aimed to examine the energy drink consumption pattern of Korean nurses and related factors. A descriptive cross-sectional design was utilized, and data were collected through a self-reporting questionnaire. Participants were Korean nurses working in hospitals. Data were analyzed by descriptive statistics, chi-square test, and binomial logistic regression test. A total of 388 nurses participated in the study. Approximately two-thirds of the nurses consumed energy drinks in addition to caffeinated coffee and/or tea. They usually consumed energy drinks during working hours and at the workplace. In comparison with nonconsumers, nurses who consumed energy drinks perceived that they had a stimulating effect and could replace regular drinks. Having colleagues who consume energy drinks and perceiving that energy drinks had an arousal effect were shown to be associated factors for energy drink consumption; thus, it is necessary to develop educational strategies targeting these groups of nurses. The reasons for the dependence of hospital nurses on energy drinks should be further investigated.

The impact of changes in nursing practicum caused by COVID-19 pandemic on new graduate nurses.

BACKGROUND: The impact of the COVID-19 pandemic has brought about major changes throughout nursing education. Most clinical practicum has been substituted by skills laboratories, simulation laboratories, virtual simulation or written assignments. Nursing students who have experienced this change in practicum have fears about their future role as new graduate nurses. However, to date, no studies have been conducted exploring how their fears work when they become new graduate nurses. OBJECTIVES: To investigate the status of nursing practicum at nursing universities before and during the COVID-19 pandemic, and to explore the relationship between difficulties in nursing tasks, work readiness, reality shock, and organizational socialization among new graduate nurses with nursing practicum experience during this pandemic. DESIGN: Descriptive comparative research design. PARTICIPANTS: 178 new graduate nurses with a clinical experience from 1 month to less than 12 months and graduating from nursing universities in 2021, the 3rd grade in 2020 and the 4th grade in 2021. METHODS: Cross-sectional study via a self-administered online questionnaire measuring difficulties in nursing tasks, work readiness, reality shock, and organizational socialization. Data were analyzed by descriptive statistics, independent t-tests, Pearson correlation. RESULTS: New graduate nurses were divided into 72 in the Clinical/Clinical group and 106 in the Clinical/Substitute group. There was a significant difference in the difficulties in nursing tasks (t = -2.342, p = .020), but there were no significant differences in work readiness, reality shock, and organizational socialization between the two groups. CONCLUSIONS: Efforts in the clinical field to increase the adaptation of new graduate nurses could prevent problems that may arise due to the restrictions and absence of clinical practicum. Discussions should be continued to develop and implement efficient nursing practicum education that not only can reduce the gap between nursing education and nursing practice, but also respond appropriately to any pandemic situation.

Factors contributing to chronic obstructive pulmonary disease patients' functional performance: Structural equation modelling based on theory of unpleasant symptoms.

AIM: This study aimed to predict the functional performance of patients with chronic obstructive pulmonary disease by clarifying the relationship among disease severity, uncertainty, social support, symptom experience, coping, and functional performance. DESIGN: A model-testing design was used. METHODS: The subjects of this study were outpatients with chronic obstructive pulmonary disease who visited the respiratory clinic of a general hospital in Seoul, Korea. The data were collected using validated instruments from July 2018 to April 2019, of which 202 questionnaires in total were used for data analysis. Collected data were analysed by using IBM SPSS v27.0 and Mplus 8.0. RESULTS: The severity of the disease, uncertainty, and symptom experience should be reduced to improve the functional performance of chronic obstructive pulmonary disease patients. Furthermore, reduced uncertainty can improve functional performance by reducing symptom experience. Nursing interventions for the improvement of pulmonary function and reduction of symptom experience should be developed.

Evaluating the cutoff score of the advanced practice nurse certification examination in Korea.

AIM: This study aimed to evaluate the cutoff score of the Advanced Practice Nurse (APN) certification examination determined using two standard-setting methods and to compare it with the current score. BACKGROUND: The APN qualification is established by passing a certification examination. However, the method of determining the passing criterion is different among countries. In Korea, the passing criterion has been predetermined as 60% of the total score or above without any theoretical or empirical basis. DESIGN: In this study, two typical and popular standard-setting methods, the modified Angoff and Bookmark methods, were used to determine the passing criterion of the APN certification examination. METHODS: The performance data of a gerontological APN certification examination were used to conduct standard setting with both the modified Angoff and Bookmark methods. The total number of examinees in the dataset was 121. Item analysis with a 2-parameter logistic model was performed based on the item response theory using the Bilog-MG3.0 program. A total of 5 raters in APN education and clinical nursing practice were selected. RESULTS: The modified Angoff and Bookmark methods gave cutoff scores of 113 and 110.5 with passing ratios of 52.9% and 57.0%, respectively. These results were different from the conventional cutoff score of 90 with a passing ratio of 93.4%. CONCLUSION: The present arbitrary fixed cutoff score should be reconsidered to improve the robustness of the APN qualification and standard-setting methods should be employed to determine an adequate cutoff score for the APN certification examination to ensure the competency of APNs in providing advanced care.

Development of international nursing standard-based curriculum for North Korean nurses.

BACKGROUND: The types of nursing care and education have been advanced in different ways between South and North Korea during the past 73 years following division of Korea. The contents of the nursing education curriculum in North Korea do not match international standards. In preparation for the unification of the two Koreas, identifying and examining North Korean nursing education are needed. AIM: To develop a curriculum for North Korean nurses to in accordance with the international nursing standards. METHODS: This study consisted of two phases. First, we reviewed the literature, analyzed in-depth interviews with North Korean nurse defectors, and evaluated the contents and scope of nursing education in North Korea. Next, we developed a nursing education curriculum for North Korea through discussion with nursing education experts. RESULTS: The nursing curriculum for North Korean nurses comprised 96 credits (21 credits for fundamental major courses and 75 credits for mandatory major courses) according to the standards of the Korea Institute of Nursing Education and Evaluation. The proposed curriculum I comprised 84.5 credits, with 14.5 credits for major courses and 70 credits for mandatory major courses. Proposed curriculum II considered the capabilities and clinical experiences of North Korean nurses and comprised 52 credits with 6 credits for major courses and 46 credits for mandatory major courses. CONCLUSION: A nursing curriculum was proposed to match the nursing practice competencies of North Korean nurses to international standards. This curriculum can be expected to improve the quality of nursing care in North Korea, facilitate the integration of nursing workforces, and ultimately promote the health of the people during unification. IMPLICATIONS FOR NURSING POLICY: The nursing curricula proposed in this study could be a significant measure to nurture nursing manpower and contribute to narrowing the nursing gaps between South and North Korea in the process of Korea's unification.

[Development and Evaluation of Health Empowerment Scale for North Korean Women Defectors].

PURPOSE: This study developed an instrument to evaluate the health empowerment of North Korean women refugees and examined its validity and reliability. METHODS: Through literature review and focused group interviews, 66 preliminary items with three constructs, including perceived control, perceived competence, and goal internalization were selected based on Menon's psychological health empowerment model. A questionnaire survey was conducted with 239 North Korean women refugees in the community from August 31 to September 4, 2020. Content, construct, convergent, and discriminative validity were evaluated. Cronbach's α was used to evaluate the reliability of scale. RESULTS: The final instrument consisted of 31 items with three factors that were identified through confirmatory factor analysis. The convergent validity showed that the correlation coefficient was .52 (p < .001), which confirmed the validity of the developed measurement tool. Cronbach's α for all the items was .94, and Cronbach's α for the factors was .76~.91. CONCLUSION: This health empowerment scale has been developed to include aspects of health empowerment, provide a conceptual framework, and offer objective indicators to evaluate the effectiveness of a health education program.

Nurses' experiences of communicating with patients with aphasia.

AIM: This study explored nurses' experiences of communicating with patients with aphasia. DESIGN: A naturalistic paradigm approach was adopted to describe the phenomenon of interest. METHODS: Participants were neurological nurses employed in various neurological departments and recruited using purposive sampling. Group interviews were conducted for 1 hr and 30 min using semi-structured open-ended questions. The Consolidated Criteria for Reporting Qualitative Research checklist was followed. RESULTS: Four generic categories were derived: "Conversations with the aphasic patients are frustrating, which leads to impatience among nurses, and they eventually dismiss the patients," "Feeling responsible for communicating with aphasic patients but also experiencing guilt for not being able to give adequate care in practice," "Concerns about communication methods with aphasic patients" and "Desire to learn ways to communicate with aphasic patients." Appropriate education and support should be given to nurses to facilitate communication with aphasic patients to ensure that they are not excluded from medical benefits because of communication difficulties.

Health capacity building for middle-aged Laotian women with a risk of metabolic syndrome through a non-communicable disease prevention program.

The aims of the researchers were to develop an NCD prevention program including training for professionals who implement such programs, and to evaluate its effects on diabetes mellitus knowledge, hypertension knowledge, self-efficacy, and self-care in community-dwelling, middle-aged Laotian women. The study design was a randomized controlled trial. The study sample was composed of Laotian women aged 40 to 59 years living in Vientiane, Laos who fulfilled more than one diagnostic criterion for metabolic syndrome. This study provides a guide for low- and middle-income countries to develop future health capacity building programs for NCD prevention in middle-aged women.

Psychometric evaluation of drinking refusal self-efficacy questionnaire-shortened revised adolescent in Laos.

This study evaluated the psychometric properties of Lao version of Drinking Refusal Self-Efficacy Questionnaire-Shortened Revised Adolescent (L-DRSEQ-SRA). A total of 406 Laotian adolescents from six lower secondary schools, were randomly selected for the evaluation of the following psychometric properties. The original factor model was confirmed via confirmatory factor analysis in Lao adolescents, the convergent and discriminant validity were found appropriate. The mean score of L-DRSEQ-SRA in the non-drinking group was significantly higher than in the drinking group. The L-DRSEQ-SRA showed acceptable internal consistency and test-retest reliability. The psychometric characteristics of the L-DRSEQ-SRA were established throughout this study.

[An Evaluation of the Validity and Reliability of the Face Mask Use Scale's Korean Version among Community-Dwelling Adults].

PURPOSE: This study evaluated the validity and reliability of the Korean version of the Face Mask Use Scale (K-FMUS) among community-dwelling adults. METHODS: The participants of the study were community-dwelling adults in Korea using face masks during the COVID-19 pandemic. The English FMUS was translated into Korean using forward and backward translation procedures. The construct validity and reliability of the K-FMUS were evaluated using the exploratory and confirmatory factor analyses and the internal consistency reliability test. RESULTS: The K-FMUS comprised 6 items divided into 2 factors. The variance of the factors was approximately 79.1%, which suggested that the scale indicated the effectiveness of face mask usage. The two factors were labeled as face mask use in society (4 items) and face mask use at home (2 items). Cronbach's α value for the overall scale was .88. CONCLUSION: The K-FMUS is a valid and reliable scale that can be used to measure face mask usage among community-dwelling adults in Korea during the COVID-19 pandemic.

Nurses' Experience of Nursing Workload-Related Issues during Caring Patients with Dementia: A Qualitative Meta-Synthesis.

The behavioral and psychological symptoms of dementia (BPSD), which appear in all dementia patients, demand sizable commitments of time and effort from nurses. This study aims to identify issues related to the workloads of nurses who provide care for dementia patients via qualitative meta-synthesis. Eleven articles were selected using a systematic review flowchart, which were then evaluated for their quality using the Critical Appraisal Skills Program checklist. Collected data were analyzed using a line-of-argument method. Theme clusters were "increased workload due to characteristics of dementia", "increased mental stress", "difficulty associated with playing a mediator role in addition to nursing duties", and "lacking systematic support for dementia patient care". To reduce the workload and mental stress of nurses in dementia care, supportive measures appropriate for their occupational characteristics should be developed, based on workload estimates that account for the attributes of dementia patients.

Perceived Health Status and its Correlates among Middle-Aged Laotians.

The purpose of this study is to identify the determinants of perceived health status among Laotian aged 40 to 59. A total of 922 men or women in their 40's or 50's living in Vientiane Capital and Province, Lao People's Democratic Republic were included in the study. Hierarchical multiple regression was used to analyze the data. Perceived health status was negatively correlated with chance health locus of control and physical symptom frequency and positively correlated with doctors health locus of control. Age, drinking, difficulty in health utilization, physical activity, physical symptom frequency, and doctors health locus of control explained 23.5% of the variance in perceived health. To prevent the non-communicable disease, action should be taken not only at the individual level but also at the healthcare system level. In the health care fields, the targeted intervention based on the findings of this study should be devised.

Caffeine and high energy drink use and knowledge by nurses in three countries.

AIM: The purpose of this study was to examine nurses' use and knowledge of caffeine and high energy drinks (HED) in three countries. METHODS: Nurses in each country completed a survey on caffeine and HED use and knowledge. RESULTS: In a sample of 182 nurses, caffeine use was high with 92% of nurses in Korea, 90.8% in Italy and 88.1% in the United States (US) having at least one cup of coffee a day while 64% of Koreans and 11.9% of those in the US had at least one HED per day. In Korea 68% of nurses (Italy 63.1% and 35.8% US) had at least one cup of caffeinated tea per day. Most agreed there is a need to educate nurses about HED, which contain high amounts of caffeine. Over half of nurses in Korea (58%) and the US (56.7%) said their colleagues consume HED at work. CONCLUSION: Findings of this study indicate many nurses are consuming caffeine at work and there is a need for education. It is unclear how caffeine affects nurses' clinical performance, which raises the issue of patient safety. Further research is needed regarding safe amounts of caffeine while nurses are on the job as well as an understanding of how HED additives may affect the well-being and clinical care of nurses.