[The Development of a Tool for Assessment of Spiritual Distress in Cancer Patients].

PURPOSE: This study was conducted to develop a scale to measure spiritual distress in cancer patients. METHODS: A total of 69 preliminary items for the spiritual distress assessment tool (SDAT) were compiled, based on a literature review, selection of empirically relevant items through concept analysis of hybrid models, confirmation of content validity by experts, cognitive interviews, and a pretest. Self-administered questionnaires were collected between April 1 and July 31, 2018, from 225 cancer patients at four medical institutions and one nursing home. The data were analyzed using item analysis, exploratory factor analysis, convergent and discriminant validity, and Pearson correlation for criterion validity. Reliability was tested by Cronbash's α coefficient. RESULTS: The final version of the SDAT consisted of 20 items. Five-factors, loss of peace, burden of family, avoidance of confronting death, guilt and remorse, regret for not being able to apololgize and forgive were extracted, and showed 62.8% of total variance. The factors were confirmed through convergent and discriminant validity. Criterion validity was confirmed by functional assessment chronic illness therapy spiritual well-being scale 12 (FACIT-Sp12). The overall Cronbach's α was .91, and the coefficients of each subscale ranged from .78~.83. CONCLUSION: The SDAT for cancer patients is valid and reliable. It is suggested that the tool can be used to measure spiritual distress in cancer patients.

[Trends of Concept Development in Nursing Published in Korean Journals].

PURPOSE: The purpose of this study was to identify trends of nursing concept development in Korean journal papers to improve accurate understanding of nursing concepts. METHODS: A systematic review of 216 concept development articles published from 1970 to 2018 that met the inclusion criteria was conducted using Research Information Sharing Service (RISS) databases. RESULTS: The most common method of concept development was Walker and Avant's concept analysis method, identified in 139 (64.3%) of the 216 studies, followed by 48 examples of hybrid models (22.2%) and 15 examples of evolutionary methods (6.9%). Chinn and Kramer's method, Norris's clarification, Wilson's method, and others were also used. The concepts of "spirituality" and "fatigue" were most frequently analyzed. Among the 139 studies that used Walker and Avant's concept analysis method, 127 studies (91.4%) applied all the recommended steps; the others applied the recommended steps partially, omitting description of model cases/additional cases, antecedents/consequences, and empirical indicators. Among the studies using the hybrid model, among two (5.7%) did not describe attributes, three (8.5%) did not provide definitions, and 16 (45.7%) did not present empirical indicators in the final stage. CONCLUSION: Among concept development studies published in Korean journals, Walker and Avant's concept analysis method is most commonly used. In case of most studies using Walker and Avant's method a suitable concept analysis process is applied, but in case of other studies using the other concept development method, a suitable concept analysis process is not applied. Therefore, a suitable concept analysis process must be applied for concept development in nursing research.

Debriefing methods and learning outcomes in simulation nursing education: A systematic review and meta-analysis.

OBJECTIVES: Simulation can serve as an effective educational method to provide experience and opportunities to learn about the nursing management of clinical cases in a secure environment. Numerous debriefing methods have been used in simulation in nurse education to improve clinical competencies and learning outcomes. However, there is insufficient evidence to identify the debriefing methods that are most effective in improving learning outcomes. In this systematic review and meta-analysis, the focus is on debriefing methods and learning outcomes in simulation in nurse education. DESIGN: This systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. DATA SOURCES: Studies published from January 1995 to December 2016 were identified from PubMed, Embase, MEDLINE, PsycINFO, Web of Science, CINAHL, the Cochrane Library, and Korean databases. REVIEW METHODS: Experimental studies that used debriefing methods in simulation in nurse education were included as review studies. Studies that used identical validated measurement tools were included in the meta-analysis. We applied a random-effects model with subgroups. Effect sizes for learning outcomes according to debriefing methods were calculated using standardized mean differences. RESULTS: A total of 18 studies were selected through systematic review and 7 studies were included in the meta-analysis using four types of scales measuring learning outcomes after debriefing. The overall effect size of the learning outcomes, according to the type of debriefing method, was 0.31. The results regarding debriefing methods were statistically non-significant in the learning outcomes (95% CI [-0.33-0.96], Z = 0.95, p = 0.34). A symmetric shape indicated a lack of publication bias. CONCLUSIONS: The study findings indicated that structured debriefing helped to improve learning. Future studies are needed to provide effective debriefing strategies with larger sample sizes.

[Development and Validation of the New Version of Spirituality Assessment Scale].

PURPOSE: The purpose of this study was to develop a new version of Spirituality Assessment Scale (N-SAS) and verify its reliability and validity. METHODS: The total of 59 preliminary items for the N-SAS were selected through a literature review, two rounds of experts' content validation, cognitive interviews, and pre-tests. Verification of its reliability and validity was divided into two phases. In Phase I, questionnaires were collected from 219 adults. Reliability was tested using Cronbach's alpha, validity with item analysis, and exploratory factor analysis. In Phase II, questionnaires developed based on the results of Phase I were collected from 225 adults. Reliability was tested using Cronbach's alpha, validity with confirmatory factor analysis, and criterion validity. RESULTS: The final version of the N-SAS comprised two dimensions (vertical and horizontal), four domains (relationship with God; meaning of life and self-integration; self-transcendence; and relationship with others, neighborhoods, and nature), and 44 items were identified. Total Cronbach's α was .97; those of each subscale ranged from .79 to .98. N-SAS scores were positively correlated with the scores of Howden's Spiritual Assessment Scale (r=.81, p<.001). CONCLUSION: Findings suggest that the N-SAS can be used to measure spirituality in adults. The use of N-SAS is expected to facilitate perceiving patient's spiritual needs and providing spiritual care.

[Corrigendum: Evolutionary Concept Analysis of Spirituality].

This corrects the article on p. 242 in vol. 47, PMID: 28470161.

[Evolutionary Concept Analysis of Spirituality].

PURPOSE: This study was done to clarify attributes, antecedents, and consequences of spirituality. METHODS: Rodgers's evolutionary concept analysis was used to analyze fifty seven studies from the literature related to spirituality as it appears in systematic literature reviews of theology, medicine, counseling & psychology, social welfare, and nursing. RESULTS: Spirituality was found to consist of two dimensions and eight attributes: 1) vertical dimension: 'intimacy and connectedness with God' and 'holy life and belief', 2) horizontal dimension: 'self-transcendence', 'meaning and purpose in life', 'self-integration', and 'self-creativity' in relationship with self, 'connectedness' and 'trust' in relationship with others·neighbors·nature. Antecedents of spirituality were socio-demographic, religious, psychological, and health related characteristics. Consequences of spirituality were positive and negative. Being positive included 'life centered on God' in vertical dimension, and among horizontal dimension 'joy', 'hope', 'wellness', 'inner peace', and 'self-actualization' in relationship with self, 'doing in love' and 'extended life toward neighbors and the world' in relationship with others·neighbors·nature. Being negative was defined as having 'guilt', 'inner conflict', 'loneliness', and 'spiritual distress'. Facilitators of spirituality were stressful life events and experiences. CONCLUSION: Spirituality is a multidimensional concept. Unchangeable attributes of spirituality are 'connectedness with God', 'self-transcendence', 'meaning of life' and 'connectedness with others·nature'. Unchangeable consequences of spirituality are 'joy' and 'hope'. The findings suggest that the dimensional framework of spirituality can be used to assess the current spiritual state of patients. Based on these results, the development of a Korean version of the scale measuring spirituality is recommended.

Concept Analysis of Female Sexual Subjectivity based on Walker and Avant's Method.

PURPOSE: The purpose of this study was to clarify attributes, antecedents, and consequences of female sexual subjectivity. METHODS: Walker and Avant's concept analysis process was used to analyze 27 studies from the current literature that relates to female sexual subjectivity. A systematic literature review of women's study in sociology, psychology, theology, law, health science, and nursing was reviewed. RESULTS: The defining attributes of female sexual subjectivity were sexual self-awareness, sexual decision making, sexual desire, and good sexual communication with partner. The antecedents of female sexual subjectivity were social environment, sexual education, sexual experience, and interpersonal relationship. The consequences of female sexual subjectivity were safe sex, prevention of sexual victimization, and sexual satisfaction. CONCLUSION: Female sexual subjectivity is defined as sexual self-awareness, sexual decision making, sexual desire to seek sexual pleasure and safety, and effective communication with partner in terms of sexual behavior, sexual experience and sexual health. Based on these results, a scale measuring female sexual subjectivity is needed.

The job analysis of Korean nurses as a strategy to improve the Korean Nursing Licensing Examination.

PURPOSE: This study aimed at characterizing Korean nurses' occupational responsibilities to apply the results for improvement of the Korean Nursing Licensing Examination. METHODS: First, the contents of nursing job were defined based on a focus group interview of 15 nurses. Developing a Curriculum (DACOM) method was used to examine those results and produce the questionnaire by 13 experts. After that, the questionnaire survey to 5,065 hospital nurses was done. RESULTS: The occupational responsibilities of nurses were characterized as involving 8 duties, 49 tasks, and 303 task elements. Those 8 duties are nursing management and professional development, safety and infection control, the management of potential risk factors, basic nursing and caring, the maintenance of physiological integrity, medication and parenteral treatments, socio-psychological integrity, and the maintenance and improvement of health. CONCLUSION: The content of Korean Nursing Licensing Examination should be improved based on 8 duties and 49 tasks of the occupational responsibilities of Korean nurses.

Effects of a three-month therapeutic lifestyle modification program to improve bone health in postmenopausal Korean women in a rural community: a randomized controlled trial.

In this randomized controlled trial, we examined the effects of a 3-month therapeutic lifestyle modification (TLM) intervention on knowledge, self-efficacy, and health behaviors related to bone health in postmenopausal women in rural Korea. Forty-one women ages 45 or older were randomly assigned to either the intervention (n = 21) or control (n = 20) group. The intervention group completed a 12-week, 24-session TLM program of individualized health monitoring, group health education, exercise, and calcium-vitamin D supplementation. Compared with the control group, the intervention group showed significant increases in knowledge and self-efficacy and improvement in diet and exercise after 12 weeks, providing evidence that a comprehensive TLM program can be effective in improving health behaviors to maintain bone health in women at high risk of osteoporosis.

Effects of community-based case management by visiting nurses for low-income patients with hypertension in South Korea.

AIM: To assess the effects of a visiting nurse-driven community-based case management program for low-income adults with hypertension. METHODS: This single group pretest-post-test study included 22 newly registered low-income adult patients with hypertension in a public health center in Seoul. Visiting nurses delivered a case management program for 2-8 months. Pretest and post-test measurements of blood pressure (BP), knowledge level, and self-management level in terms of diet, lifestyle, physical activity, and medication were obtained. RESULTS: The visiting nurse-driven case management was effective in reducing the BP level and improving the knowledge and self-management level of the low-income adults with hypertension in the community. CONCLUSION: This study serves as a baseline for visiting nurse-driven case management for low-income patients with hypertension. Its findings suggest that visiting nurse-driven case management targeting the self management of BP can foster improved BP control for newly diagnosed hypertensive patients in low-income populations.

Factors affecting quality of life in Korean patients with chronic heart failure.

AIM: Poor health-related quality of life (HRQOL) in patients with chronic heart failure (CHF) may be one of the most common predictors of mortality and rehospitalization. This study was conducted to identify factors affecting HRQOL in Korean patients with CHF using two HRQOL measurements. METHODS: The study included a sample of 114 patients. HRQOL was measured by the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and the World Health Organization's Quality of Life Instrument - Short Version (WHOQOL-BREF). Multiple regression analyses were performed to analyze the relationship between the factors and HRQOL. RESULTS: Significant correlations were found between MLHFQ and WHOQOL-BREF in total and component scores, with the two exceptions of WHOQOL-BREF psychological and MLHFQ physical or total. The perceived economic status, functional status, and sex were factors identified as having an effect on HRQOL. CONCLUSION: The MLHFQ was better able to differentiate sex, comorbidity, and functional status. Further studies are needed to implement cost-effective nursing interventions for patients with CHF to improve their HRQOL.

Female College Students' Knowledge, Self-efficacy and Health Behaviors related to Bone Health.

PURPOSE: This study described female college students' knowledge, self-efficacy and health behaviors related to bone health. METHODS: A descriptive cross-sectional survey design was used. A total of 214 students were conveniently recruited from a school of nursing in Korea. Participants (mean age=21.2, SD=1.9 years) bone mineral density (BMD) was measured using dual energy x-ray absorptionmetry. Participants also completed a questionnaire consisting of knowledge test, self-efficacy scale and health behaviors related to bone health. Data were analyzed using SPSS/WIN 17.0 program. RESULTS: The mean BMD at left femoral neck site was 0.86 g/cm2 and 6.1~12.6%. Results showed that participants were below the expected range of BMD. Level of knowledge (correct rate=54%) and self-efficacy were moderate (mean 54.8 out of 84). More than 84% of subjects drank alcohol more than once a month and 58.4% did participate in regular exercise. Only 7.9% participants took calcium and vitamin-D rich foods every day. There were significant positive correlations between knowledge and self-efficacy (r=.17), health behaviors (r=.14) and self-efficacy and health behaviors (r=.28, all p<.05). CONCLUSION: These results suggest that health care professionals need to provide effective interventions for young women in order to enhance knowledge, self-efficacy and health behaviors related to bone health.

Ecological risk factors of childhood obesity in Korean elementary school students.

The purpose of this study was to examine ecological correlates of obesity among Korean children. Cross-sectional data, including measurements of height and weight, were collected by questionnaire from 1,644 children in the fifth and sixth grades. A multiple logistic regression model incorporating individual- and school-level variables determined factors of childhood obesity. Intrapersonal factors associated with obesity included gender, computer use, and dissatisfaction with body image; significant interpersonal factors included low level of the father's education and encouragement to engage in physical activity. School-level factors that were significant predictors included location in Gyeonggi province, having two or more school exercise facilities, physical-education classes of 2 hr per week, higher fat content of school lunch, and higher number of classes in the school. The findings indicate that multifaceted, multilevel prevention strategies to manage and prevent childhood obesity should include behavioral modification, familial support, and improvement of school environments.

Effects of visiting nurses' individually tailored education for low-income adult diabetic patients in Korea.

OBJECTIVE: To describe the effects of individually tailored education by visiting nurses for low-income adult diabetic patients. DESIGN AND SAMPLE: This one-group pretest-posttest study included 96 newly registered low-income adult diabetic patients in a public health center in DJ-gu (similar to a county in the United States) in 2006; the patients met the selection criteria. MEASURES: Diabetes knowledge, self-management, and blood glucose levels were compared before and after education. INTERVENTION: 15 visiting nurses delivered individually tailored education for 60-90 min/month for 7 months. RESULTS: After education, diabetes knowledge (p<.001) and self-management in all categories of lifestyle (p<.001), diet (p<.001), exercise (p<.001), foot care (p<.001), medication (p=.004), and insulin therapy (p=.022) significantly improved. The mean fasting blood glucose (FBG) level decreased by 14.53 mg/dl; this decrease was insignificant (p=.117). However, the relationship between education and FBG levels was significant (χ(2)=40.11, p=.005). CONCLUSIONS: Tailored education effectively improved the patients' knowledge of diabetes and self-management. Therefore, regular, individually tailored education on a long-term basis by visiting nurses can provide essential education to low-income adult diabetic patients for maintaining self-management.

Development of a community health promotion center based on the World Health Organization's Ottawa Charter health promotion strategies.

AIM: To describe the development process of nursing school-led community health promotion centers (CHPC) to improve the health of the surrounding communities. METHODS: This study design was a research and development study. (i) Assessment of health needs by interviewing 359 people in the community to select health programs for the community health promotion center. (ii) Five health promotion strategies from the Ottawa Charter were applied to develop the community health promotion center for a city community. RESULTS: (i) The people in the community had higher socioeconomic status levels and better health behaviors compared to the general Korean population, and they also listed chronic health problem management as their first priority health service. (ii) Development of the community health promotion center was done based on the five World Health Organization's Ottawa Charter Health Promotion Strategies: build healthy public policy, create supportive environments, strengthen community actions, develop personal skills, and reorient health services. CONCLUSIONS: The present study showed that the WHO's five Ottawa Charter Health Promotion Strategies were useful for developing health promotion centers in the community.

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.

Factors related to incidence of eye disorders in Korean patients at intensive care units.

AIMS: The purpose of this study was to identify the incidence rate of eye disorders and further to identify factors related to incidence of eye disorders in intensive care unit patients. BACKGROUND: Although the incidence of eye disorders in intensive care unit patients is very high, it is difficult to come to an accurate estimate of number of eye disorders in intensive care unit patients because eye disorders are often perceived to be minor problems. DESIGN: A retrospective, descriptive survey design was used. METHOD: The medical records of a total 235 patients with eye disorders were identified through a review of the medical records of 2,500 patients hospitalised in the intensive care units of Yonsei University Hospital, Seoul, Korea from January to December, 2004. To examine factors related to eye disorders, 522 patients without eye disorders from the cohort of 2,265 patients were randomly selected. Factors related to incidence of eye disorder were included in a multiple logistic regression model, after screening by the chi-squared test. RESULTS: The incidence rate for eye disorders in the intensive care unit patients was 8.6%. From the multiple regression model, the following odds ratios (95% confidence intervals) of eye disorder were estimated; length of stay in intensive care unit of at least seven days: 2.8 (1.70-4.70); death: 2.5 (1.47-4.29); drowsy mental state: 2.2 (1.10-4.37); stupor mental state: 7.0 (3.20-15.45); coma mental state: 10.8 (3.47-33.74); no self-respiration: 1.9 (1.00-3.52); positive end expiratory pressure: 2.9 (1.66-4.92); sedatives: 4.2 (2.26-7.74); muscle relaxants: 2.3 (1.11-4.95). CONCLUSIONS: Factors related to incidence of eye disorders in intensive care unit patients identified in this study support the need to pay attention to eye problems and eye care in intensive care unit patients. RELEVANCE TO CLINICAL PRACTICE: An evidence-based eye care protocol should be provided as routine care to prevent eye complication, especially in critically ill patients with mechanical ventilators, positive end expiratory pressure, sedatives or muscle relaxants and for patients whose mental status is decreased.

Development of a-health information website evaluation categories with items for diabetes mellitus.

As one of four major causes of death in Korea, diabetes mellitus has dramatically increased since the 1980s because of westernized lifestyles. Diabetes patients try to learn the knowledge and skills necessary for disease care since diabetes management is highly dependent on self- management. To do this, patients pursue more health information and proper sources for themselves. This study developed an evaluation tool including categories with items necessary for evaluation of Websites for health information on diabetes mellitus, as a method to offer consumers certified high quality health information on diabetes.

Health promotion behaviors and quality of life among community-dwelling elderly in Korea: a cross-sectional survey.

As individuals live longer, health promotion behaviors become even more important, particularly with regard to maintaining functional independence and improving quality of life (QoL). The purpose of this study was to explore the relationship between health promotion behaviors and QoL in Korean elderly living in the community. This study was a descriptive-correlational study to explore the relationship between health promotion behaviors and QoL among the community-dwelling elderly in Korea. A convenience sample of 2000 community residents who were over 65 years old and cognitively intact were selected from 32 senior centers and 242 public health centers in Korea. A total of 1920 were included in the analyses, following the exclusion of 80 incomplete questionnaires and subject refusals. Participants who consented to participate in the study were interviewed by trained interviewers with a structured questionnaire. The results of the study showed that there were statistically significant differences in QoL of the elderly related to exercise participation, alcohol abstinence and blood pressure (BP) check-up (p<.05). Multiple regression analysis revealed that perceived health status, number of chronic illnesses, activities of daily living, BP checkup, exercise, and gender were statistically significant predictors of QoL. R(2) for this whole regression model was .412, indicating that approximately 41.2% of the variance in QoL was accounted for by the linear combination of these variables. Nurses should enhance the QoL in elderly persons by facilitating health promotion behaviors through formal nursing interventions which will maintain and increase a healthy and active life.

Development and evaluation of the Web-based wound care course for undergraduate nursing students.

PURPOSE: This study developed a web-based wound care course for undergraduate nursing students and evaluated the course's content, system, and student-satisfaction. METHODS: This study was done in three stages, the development of the web-based wound care course, the implementation and evaluation of the course. The course was developed based on the ARCS model. 80 undergraduate nursing students to Y University in Korea used the web-based wound care program during four weeks. After that, they completed questionnaires, evaluating the contents, system, and their satisfaction. RESULTS: Eighteen learning objectives were used to create the web-based wound care course and the course was developed with 7 chapters and 20 subsections. The analysis of the questionnaires showed a mean score for content and system-related items of 3.04 each, out of a possible 4 points. Student satisfaction items had a mean score of 2.89. CONCLUSIONS: The web-based course allowed students access to the course anytime and anywhere, and according to their own learning abilities. However this advantage would only be possible when nurse educators develop qualitative web-based course to meet the demand of a complex health care system as well as the needs of the students and the effectively incorporate it into traditional lectures.