Validity and reliability of the self-care behaviour scale for patients with left ventricular assist device.

AIMS: To evaluate the validity and reliability of the self-care behaviour scale for patients with left ventricular assist devices. DESIGN: Methodological study. METHODS: The English version of the scale was translated into Korean, and it was then back-translated into English. Survey data were collected from 32 patients with left ventricular assist device in South Korea, and construct validity, content validity and reliability were analysed. RESULTS: The original self-care behaviour scale comprises three domains and 33 items, whereas the Korean self-care behaviour scale comprises 27 items and five domains: device management, wound management, symptom monitoring, activated healthcare system and self-care management. Cronbach's alpha for the overall scale was 0.94, and that for the five domains ranged from 0.36 to 0.90. The intraclass correlation coefficient for the overall scale was 0.89, and the five domains ranged from 0.71 to 0.88. CONCLUSION: The newly evaluated scale would be valid and reliable in measure self-care behaviour for patients with a left ventricular assist device. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Patients can manage the left ventricular assist device on their own based on evidence and use it as a tool for effective communication with medical professionals.

Factors influencing the supportive care needs of female patients with genital cancer in South Korea.

Genital cancers are particularly important compared to other cancers because of the psychological impact they have on the individual. This study investigated the complexity in illness and quality of life among female genital cancer patients and determined the effects of these factors on supportive care needs to provide evidential data for the development of nursing intervention strategies to reduce supportive care needs in female genital cancer patients. This cross-sectional study collected data from July 22 to August 17, 2021. The study subjects were 103 female outpatients and inpatients aged 19 years or older who were treated for cervical cancer, endometrial cancer, ovarian cancer, or other female genital cancers such as vulvar cancer and vaginal cancer in a university hospital in Korea. The data were analyzed with t-tests and Scheffé's test using SPSS 26.0. The factors affecting supportive care needs were examined using hierarchical regression. The average age of the subjects was 56.41 (±9.91) years. Cervical cancer was the most common diagnosis at 42.7%, followed by ovarian cancer at 34.0%, and endometrial cancer at 21.4%. The factors affecting supportive care needs included a middle school education or below (ß = 0.21, P = .028), unemployment (ß = 0.23, P = .018), complexity in illness (ß = 0.32, P < .001), and quality of life (ß = -0.68, P < .001). Developing a strategy for managing the complexity in illness and quality of life caused by various variables including disease stage and type of treatment is necessary to reduce the supportive care needs of female genital cancer patients. Improving their quality of life through effective communication with healthcare providers is essential.

Combined effect of left ventricular ejection fraction and obesity on sedentary behavior in patients with coronary artery disease.

Sedentary behavior has been associated with poor adherence to treatment in patients with coronary artery disease. Low left ventricular ejection fraction and obesity have been separately linked to increased sedentary behavior in patients with coronary artery disease. However, the combined effect of low left ventricular ejection fraction and obesity on sedentary behavior in patients with coronary artery disease has not been thoroughly investigated. Therefore, this study aimed to examine the combined influence of left ventricular ejection fraction and obesity on sedentary behavior in patients with coronary artery disease. This descriptive cross-sectional study enrolled 200 inpatients aged ≥ 20 years who were diagnosed with coronary artery disease at a tertiary hospital in Korea between March and August 2022. Data were collected using structured questionnaires, and multivariate logistic regression analysis was performed to determine the combined effect of left ventricular ejection fraction and obesity on sedentary behavior in patients with coronary artery disease. Among the 111 patients with sedentary behavior, 38 (34.2%) had both low left ventricular ejection fraction and obesity, whereas only 11 (12.4%) of the 89 patients without sedentary behavior had both low left ventricular ejection fraction and obesity. In multivariate logistic regression analysis, patients with coronary artery disease who had both low left ventricular ejection fraction and obesity had the highest risk of sedentary behavior compared to those without either low left ventricular ejection fraction or obesity (odds ratio = 13.98, 95% confidence interval = 5.19-37.69, P < .001). The co-existence of low left ventricular ejection fraction and obesity in patients with coronary artery disease may be associated with sedentary behavior. Therefore, evaluating both left ventricular ejection fraction and obesity when assessing sedentary behavior in patients with coronary artery disease may be valuable in implementing patient-centered approaches for the secondary prevention and management of sedentary behavior in patients with coronary artery disease. However, further prospective cohort studies with larger sample sizes are required to establish causal relationships and explore interventions to mitigate sedentary behavior in this population.

The impact of family care visitation programme on patients and caregivers in the intensive care unit: A mixed methods study.

AIMS: To track changes in the haemodynamic and respiratory indicators of patients and evaluate families' caring experiences via the visitation programme in the intensive care unit (ICU). BACKGROUND: Although most people recognise the importance of family care visitation programme in the ICU, objective research results on the effect on patients and caregivers are still insufficient. DESIGN: Mixed methods. METHODS: In this a quasi-experimental investigation and qualitative study, after executing the programme with families of ICU patients in a general hospital in South Korea from June to July 2019, changes in haemodynamic and respiratory indicators for control (n = 28) and experimental groups (n = 28) were analysed; the experimental group families' experiences were analysed through in-depth interviews; the qualitative study's reporting rigour was checked against the COREQ guidelines and TREND checklist for a quasi-experimental study. Qualitative and quantitative data were examined using content analysis and repeated-measures analysis of variance, respectively. RESULTS: There was a significant change in systolic and diastolic blood pressure in the haemodynamic indicator, and the respiratory indicator in both groups increased slightly over time and then gradually stabilised; there were no significant differences or interactions between groups regarding time of systolic blood pressure. The respiratory rate significantly decreased only in the experimental group. There was a significant increase in oxygen saturation over time, as well as interactions between time and group and between groups. Four themes were extracted from families' experiences. CONCLUSION: The haemodynamic and respiratory indicators of the group using patient- and family-centred care (PFCC) showed a stable effect on critically ill patients, which increased families' satisfaction. In future, interventions should encourage family participation in the ICU for successful PFCC. RELEVANCE TO CLINICAL PRACTICE: The findings provided evidence for the importance of PFCC through changes in objective haemodynamic and respiratory indicators.

Reliability and validity of the Self-Efficacy in Palliative Care Scale among nurses.

OBJECTIVES: To provide appropriate palliative care, nurses should have appropriate level of self-efficacy in palliative care, but the levels among nurses were low. To improve the levels effectively, self-efficacy in palliative care should be assessed using reliable and valid instruments. The purpose of this study was to examine the reliability and validity of the Self-Efficacy in Palliative Care Scale in Korean nurses. METHODS: In this cross-sectional, observational study, 272 nurses (mean age: 30 years) were enrolled from 6 university-affiliated medical centers or community hospitals in South Korea. Data on self-efficacy and demographic characteristics were collected. Validity was assessed by exploratory and confirmatory factor analyses (SPSS and Mplus). Reliability and homogeneity were assessed by Cronbach's alpha and item analyses (SPSS), respectively. RESULTS: The exploratory and confirmatory factor analyses supported the 4-factor structure (communication, assessment and symptom management, psychosocial and spiritual management of patient and family, and multiprofessional teamworking) with factor loadings >.60 and with good model fit: root mean square error of approximation =.07, Tucker-Lewis index =.94, comparative fit index =.95, and standardized root mean square residual =.04. Cronbach's alphas for the total scale and each of the subscales ranged from .883 to .965. The corrected item-total correlation coefficients of all items ranged from .61 to .90. SIGNIFICANCE OF RESULTS: The findings of this study supported the reliability and validity of this instrument among Korean nurses. This instrument can be used to assess nurses' self-efficacy in palliative care and to test intervention effects on it.

Child-rearing experiences of female nurses working three shifts in South Korea: A qualitative study.

AIM: To explore the experience of balancing a career with raising school-aged children and working three shifts and to suggest working environment changes to balance these roles BACKGROUND: Female nurses working three-day shift rotations experience irregular life patterns, parenting conflicts, and confusion over nursing roles. INTRODUCTION: This qualitative study examined nurses with early school-aged children who work three-day shift rotations in South Korea. METHODS: A descriptive phenomenological approach employed in-depth interviews to collect data from 12 married, female nurses with children aged 4-9 years. Data were analyzed using Colaizzi's phenomenological method, and reporting rigor was demonstrated using the Consolidated Criteria for Reporting Qualitative Research checklist. FINDINGS: Four themes emerged in our findings: (1) challenging phase: facing a great crisis that completely shatters the axis of life; (2) chaos phase: endless inner conflict between work and parenting; (3) solutions for coping phase: struggling to continue a nursing career; and (4) expanding phase: stepping into the expanded world of care. CONCLUSION: Nurses working three-day shift rotations try to balance their lives through interactions between nursing and child-rearing. Further research is needed to create an environment that promotes this balance. IMPLICATIONS FOR NURSING PRACTICE AND POLICY: To provide a better work-life balance, policymakers should foster a participatory and supportive management style, ensure adequate nurse staffing, implement a flexible work system, provide clinical career opportunities, encourage professional autonomy and responsibility, and promote in-service and shared social information or continuing education.

Factors influencing self-esteem after radical prostatectomy in older adult patients.

Older adult patients with prostate cancer experience symptoms such as uncontrolled sexual and urinary dysfunction after radical prostatectomy, which lowers self-esteem. Lack of access to information about the illness increases uncertainty, requiring interventions from healthcare providers. This study aimed to identify factors affecting the self-esteem of older adult patients who underwent prostate cancer surgery and provided data for establishing nursing strategies to promote healthy lifespans. This cross-sectional study examined participants over 65 years old who underwent radical prostatectomy at two university hospitals in 2017. The results indicated that the most influential factor for self-esteem was inconsistency-related uncertainty, followed by postoperative symptom experience and healthcare provider support. These variables explained 43% of the variance in self-esteem. To improve self-esteem among older adult patients who undergo radical prostatectomy, integrated programs that include sexual-related symptom management, such as erectile dysfunction and incontinence, and healthcare provider support should be developed to reduce inconsistency-related uncertainty.

Predictors of Depression among Individuals Receiving the Basic Livelihood Security Program Benefits in Korea: A Study Based on the Sixth and Seventh Korea National Health and Nutrition Examination Survey (2013-2018).

The purpose of this study is to verify the relationship between oral health behaviors and depression and influencing factors on depression to establish strategies that can contribute to improvement of mental health problems such as depression in vulnerable social class recipients. This study is a descriptive correlation study conducted on basic livelihood recipients over the age of 19 who responded to the 6th~7th (2013~2018) National Health and Nutrition Examination Survey. In this study, a total of 2749 people who met the criteria for subject selection were included in final analysis after requesting and downloading their raw data from the National Health and Nutrition Examination Survey through the consent process mandated by the Korea Centers for Disease Control and Prevention. Of the 2749 subjects, 279 were diagnosed with depression, accounting for 10.1% of the total. The collected data were analyzed using t-tests and chi-squared tests, and factors affecting depression were analyzed by logistic regression analysis. Our results showed that the factors affecting depression were 1.74 times for men (95% CI = 1.29-2.24), 1.37 times for older people (95% CI = 1.01-1.87), and 1.66 times for low education (95% CI = 1.21-2.27). Subjects with impairment in daily activities had 1.89 times (95% CI = 1.43-2.52) higher risk. Subjects with moderate physical activity and subjects with economic activity showed a lower risk (95% CI = 0.30-0.73) and 0.52 times (95% CI = 0.30-0.72), respectively, than subjects who did not. We confirmed that the probability of being diagnosed with depression decreased, and the perceived health status was 0.36 times lower (95% CI = 0.22-0.61) than those with good status. Therefore, it is necessary to prepare countermeasures that reflect various aspects in consideration of not only age and gender, but also daily life and emotional state when establishing policies for vulnerable classes such as recipients of basic livelihood.

The Influence of Burnout on Patient Safety Management Activities of Shift Nurses: The Mediating Effect of Compassion Satisfaction.

This study aims to investigate the levels of burnout, compassion satisfaction (CS), and patient safety management activities (PSMA) among nurses on shift work in general hospitals and to examine the mediating effect of CS on the relationship between burnout and PSMA. This was a descriptive-correlational study, conducted with a convenience sample of 301 nurses from four general hospitals. Data were collected from 1 August to 4 September 2021, using self-report questionnaires. Data were analyzed using the t-test, analysis of variance, Tukey test, Pearson's correlation coefficient, and multiple regression analyses. Mediation analysis was performed according to the Baron and Kenny, and Sobel Tests. Significant relationships were found between shift nurses' burnout and CS (r = -0.66, p < 0.001), burnout and PSMA (r = -0.32, p < 0.001), and PSMA and CS (r = 0.32, p < 0.001). Compassion satisfaction showed partial mediating effects on the relationship between burnout and PSMA (Z = -3.21, p = 0.001). The higher the burnout of shift-working nurses, the lower the patient safety management activity. Therefore, an effective support system at the organizational level as well as individual efforts are necessary to enhance CS and reduce burnout of shift-working nurses.

Factors Influencing Early Readmission after Discharge against Medical Advice from the Emergency Department.

Discharge against medical advice (DAMA) and readmissions are important issues worldwide and can lead to adverse clinical outcomes, financial burden, and exposure of healthcare workers to unintended medical disputes. This study aimed to identify factors that affect readmissions within 48 h after DAMA. This retrospective study utilized the medical records of patients who visited an emergency medical center in Korea for treatment and were readmitted during a 10-year period. Factors predicting readmission after being DAMA were identified using logistic regression analysis. The total number of patients who were DAMA during the study period was 5445, of which 351 were readmitted to the emergency department within 48 h (6.4%). Factors influencing readmission included medical aid (odds ratio (OR) = 2.02, 95% confidence interval (CI): 1.46-2.83) and foreign worker insurance (OR = 2.07, 95% CI: 1.04-4.09) as their health insurance, as well as presenting for readmission by car (OR = 1.41, 95% CI: 1.08-1.82). Healthcare workers should treat patients who are DAMA and those who are likely to return with a more careful and preventative management strategy so that potential clinical, legal, and economic impacts of DAMA can be mitigated.

Factors Affecting the Intention to Modify Lifestyle in the Cardiovascular Disease Risk Group in Korea.

This study aimed to identify people at risk of cardiovascular diseases (CVD) using the Framingham risk score (FRS) and to examine their willingness to modify their lifestyle. A descriptive correlational study with 1229 participants, aged 30-74 years, without cardiovascular or cerebrovascular diseases who visited a health examination center in South Korea was conducted. Of 1229 participants, 455 were identified as high risk for CVD with an FRS of 10 or higher. A logistic regression analysis confirmed age, sex, muscle training, and weekly drinking frequency as predictors of intention to quit smoking; age, smoking, and waist to height ratio (WHtR) as predictors of intention to quit drinking; sex and WHtR as predictors of intention to engage in physical exercise; and hypertension and body mass index as predictors of intention of muscle training. People at high risk for CVD lack willingness to modify their lifestyle, and aggressive, customized intervention is needed to promote lifestyle modification.

Life-Changing Experiences of Mothers with School-Age Children during the COVID-19 Pandemic: Focusing on Their Health Risk Perceptions and Health-Related Behaviors.

This study aimed to explore health risk perceptions, changes in health-related behaviors, and life experiences of mothers with school-age children during the early coronavirus disease (COVID-19) pandemic. Data were collected between 16 July and 10 September 2020, by individual interviews and analyzed through qualitative content analysis. After the twelve participants' experiences were analyzed, four themes and ten sub-themes were derived. The four themes were: "Struggling to identify the substance of COVID-19," "Taking the initiative to protect the health of the family," "Frustrated by the brutal reality of no end in sight," and "Trying to adjust wisely to an inevitable new lifestyle." The findings suggest that while the world remains in an ongoing battle with COVID-19, national health institutions should prepare a health education system for specific infection prevention methods that can be practiced by individuals in daily life.

Emergency Healthcare Providers' Knowledge about and Attitudes toward Advance Directives: A Cross-Sectional Study between Nurses and Emergency Medical Technicians at an Emergency Department.

This study aimed to explore and compare knowledge levels about advance directives (ADs) and life-sustaining treatment (LST) plans in end-of-life patients between emergency nurses and emergency medical technicians (EMTs). Using a cross-sectional study design and convenience sampling, 96 nurses and 68 EMTs were recruited from 12 emergency medical centers. A survey on knowledge about and attitudes toward ADs was performed using both online and offline methods between November and December 2019. Emergency healthcare providers were conceptually knowledgeable regarding ADs and LST, although approximately half or fewer had knowledge about ADs (such as the legal process for preparation, family or healthcare providers' role, and the healthcare proxy). The knowledge levels of nurses and EMTs were moderate. Nurses had significantly greater knowledge relative to EMTs about ADs and LST. Positive attitudes of emergency healthcare providers were also moderately low, with nurses having less positive views than EMTs. Significant differences regarding ADs were found, with younger emergency healthcare providers having fewer career years, no personal end-of-life experiences, and less need for ADs having less knowledge. Emergency healthcare providers' knowledge about and attitudes toward ADs were moderately low, with EMTs demonstrating a greater knowledge deficit and nurses exhibiting lower positive attitudes. Younger and novice providers had lower knowledge, but younger providers had more positive attitudes, implying that professional education and training should begin early in their careers to enhance their confidence for emergency delivery of advanced care planning.

The Effect of a Multifaceted Family Participation Program in an Adult Cardiovascular Surgery ICU.

OBJECTIVES: To develop and implement a patient- and family-centered care program for patients in a cardiovascular surgery ICU. DESIGN: Prospective, pre- and postintervention evaluations were conducted. SETTING: The cardiovascular surgery ICU was located in a tertiary hospital. PARTICIPANTS: Participants included 56 family members of patients in cardiovascular surgery ICU between May and July 2019. INTERVENTIONS: Providing personalized treatment plans for patients by: 1) providing an ICU diary, 2) communicating with the medical staff, 3) providing personal care using ICU visitation kit, and 4) guiding bedside range of motion exercises. The experimental group received a guided ICU diary and education program from a nurse, including the application of a family participation visitation program. Family members were provided with customized information from the ICU diary and communicated with the medical staff for approximately 10 minutes. Family members were instructed on how to perform personal care using an "ICU visitation kit" during visitation hours when permitted to participate in bedside activities for approximately 10-minute intervals. MEASUREMENTS AND MAIN RESULTS: Scores for satisfaction with the provided care and information increased significantly for the experimental group compared with the control group (t = 8.62; p < 0.001). Anxiety levels decreased significantly after intervention in both groups (t = -7.05; p < 0.001 and t = -12.94; p < 0.001) with a significant association observed between group and time point (F = 20.50; p < 0.001). However, no significant change was observed in satisfaction with decision-making following intervention in either group, and no significant association was noted between groups and time points for this variable (F = 0.24; p = 0.626). CONCLUSIONS: This set of implemented family participation processes significantly improved satisfaction and reduced anxiety in family members of critically ill patients.

Effectiveness of blood glucose control protocol for open heart surgery patients.

AIMS: To evaluate the effectiveness of a tailored blood glucose control protocol for postoperative cardiac surgery patients treated in intensive care. DESIGN: Retrospective study. METHODS: Data for the control group (non-tailored protocol) were collected from medical records at a tertiary hospital in Seoul, Korea between April-July 2015. Data for the experimental group (tailored protocol) were obtained from medical records between April-July 2016. After adjusting the target blood glucose range, eliminating single-dose insulin administration and extending the blood glucose measurement time interval, data for blood glucose measurements, time for reaching and maintaining target blood glucose, mean number of daily blood glucose measurements and insulin dose adjustments for the experimental group were collected. RESULTS: In the experimental group (where the target blood glucose rate was increased) the hypoglycaemia rate and the variation in blood glucose decreased significantly compared with the control group. In particular, the experimental group maintained relatively stable blood glucose levels by retaining a small variation range in glucose, regardless of the presence of diabetes. Time required for maintaining target blood glucose, mean number of daily blood glucose measurements and insulin dose adjustments per patient decreased. CONCLUSION: The tailored protocol contributes to the safe and effective control of blood glucose in critical care patients after cardiac surgery and to the efficiency of nurses administering it. IMPACT: This study has two significant impacts. The application of the tailored protocol has a positive impact on patients' blood glucose management, a critical component of treatment for postoperative cardiac patients in intensive care units. It also has a positive impact on the efficiency of nurses applying it. The results of this study are thus expected to facilitate successful implementation of clinical protocols for critical care after heart surgery.

Effects of Handgrip Strength on 10-Year Cardiovascular Risk among the Korean Middle-Aged Population: The Korea National Health and Nutrition Examination Survey 2014.

Handgrip strength is a simple, inexpensive health status indicator and can be used to assess mortality rate and cardiovascular disease (CVD) risk. This study used data from the Sixth Korea National Health and Nutrition Examination Survey (2014) to determine the effective use of handgrip strength to predict CVD risk. We analyzed data from 2427 adults aged from 40 to 64 years without CVD at baseline. Relative handgrip strength was calculated as the sum of the maximal absolute handgrip strength of both hands divided by body mass index, and the 10-year risk of CVD was calculated using the Framingham risk score. We performed logistic regression analysis to assess the association between handgrip strength and 10-year CVD risk. Results showed that CVD risk increased with age (95% CI: 1.19-1.33, p < 0.001). Men were 38.05 times more likely to develop CVD than women (95% CI: 15.80-91.58, p < 0.001). Every increase by 1 in handgrip strength reduced the 10-year CVD risk by 1.76 times (95% CI: 1.58-3.71, p < 0.001), and when waist-to-height ratio was <0.50, the CVD risk decreased by 3.3 times (95% CI: 0.16-0.56, p < 0.001). Developing specific modifications and improving lifestyle habits that could lead to increased handgrip strength and reduced obesity, which could prevent CVD, is recommended.

Effects of a person-centred care intervention in an intensive care unit: Using mixed methods to examine nurses' perspectives.

AIM: We identified nurses' experiences and changes in person- and family-centred care (PFCC) after applying a family-visiting programme in an intensive care unit (ICU). BACKGROUND: Critical care provision is shifting to include communication among patients, families and health care providers. METHODS: We used mixed methodology and a group pre- and post-test design. In 2019, 30 ICU nurses completed an 8-week programme, including keeping a diary and completing fundamental care activities. A survey of PFCC nursing performance was completed pre- and post-programme, and 15 nurses were interviewed post-programme. Performance differences were examined through paired t tests; qualitative data were analysed by thematic analysis. RESULTS: The pre- and post-scores were 3.06 ± 0.34 and 4.00 ± 0.29, respectively (t = 17.38, p =.000), and five main themes and 13 subtopics were revealed. Most nurses 'discovered the importance of nursing through a truthful relationship with ICU patients' families'. CONCLUSION: For effective PFCC, changes in nurses' perceptions and hospital organisation are required, such as improving the ICU working environment, assigning suitable health care personnel to provide care and implementing open-visit programmes. IMPLICATIONS FOR NURSING MANAGEMENT: Hospital policymakers and nurse managers should take care to provide staff support and high-quality patient care to realize effective PFCC.

Psychometric Testing of the Korean Version of the Attitudes toward the Advance Directives in Low-Income Chronically Ill Older Adults.

The purpose of this study was to examine the psychometric properties of the Advance Directive Attitude Survey in Korean (K-ADAS), a measure of attitudes toward advance directives (ADs). A total of 118 low-income, community-dwelling older adults (mean age, 75.09 years) participated. An exploratory factor analysis (EFA) was conducted to determine the factor structure of the K-ADAS. Validity was further assessed by known associations of the K-ADAS with perceived susceptibility and severity using part of the Advance Care Planning surveys. Its reliability was examined by calculating alpha coefficients. EFA determined a three-factor structure model with good model fit. Validity was further supported with significant correlations between the K-ADAS and susceptibility and severity. Reliability was supported by adequate level of Cronbach's alpha. The K-ADAS was a valid and reliable measure for assessment of AD attitudes with a sound model fit. Thus, the K-ADAS can be used to assess AD attitudes among community-dwelling elders.

Factors Affecting Care Workers' Coping Abilities in Emergencies to the Korean Elderly.

This study provides basic data for enhancing coping abilities in emergencies concerning direct long-term care (LTC) workers, which is necessary for providing safe care for elderly patients living in facilities and at home. A survey was conducted including 327 care workers who officially qualified as long-term providers for elderly patients through elderly care facilities and a domiciliary service center. The majority (91.4%) of the care workers surveyed experienced an emergency, but of them, only 36.4% performed first aid and 56.8% failed to perform first aid, for which the emergency was reported to nurses. The average score regarding first aid knowledge was 8.40 out of 21, and the mean scores for the subtopics of basic life support and general first aid were low (3.56 out of 7 and 5.84 out of 14, respectively). Nearly three-quarters (72.5%) responded that they were unaware of emergency coping methods, and the score for coping abilities in emergencies was also low (52.93 out of 100). The results indicate that factors affecting coping abilities in emergencies were related to the size of the workplace and first aid experience. We propose the development and implementation of an emergency coping training program focusing on case studies for direct LTC workers.

Correlates of advance directive treatment preferences among community-dwelling older people with chronic diseases.

BACKGROUND: Concerns over the creation of advance directives (ADs) and the factors associated with treatment directive decisions among Korean community-dwelling older people with chronic diseases have rarely been addressed. OBJECTIVES: This study aimed to examine knowledge, attitudes and barriers/benefits regarding ADs and their associations with AD treatment preferences among chronically ill, low-income, community-dwelling older people. METHODS: Using a descriptive, correlational design, older people who were recipients of home visiting service for chronic disease management participated in this study. Home visiting nurses collected data on knowledge, attitudes and perceived barriers/benefits and treatment directives using questionnaires during home visits. RESULTS: Older people (N = 112, mean age = 74.9 years, women = 83.9%) who had chronic diseases such as hypertension (56.3%), diabetes mellitus (40.2%) and cardiovascular disease/stroke (22.3%) participated. Approximately half of the participants preferred hospice care (54.5%), while a few of them preferred aggressive treatments: cardiopulmonary resuscitation (CPR) (14.3%), ventilation support (9.8%) and haemodialysis (8.9%). Being married was associated with the likelihood of preferring CPR (odds ratio [OR] = 11.79) and ventilation support (OR = 9.99), higher education with CPR (OR = 1.23) and haemodialysis (OR = 1.16), and having a cardiovascular disease (CVD)/stroke with CPR (OR = 6.46) and hospice care (OR = 3.06). Among the modifiable factors, greater perceived barriers increased the likelihood of CPR preference (OR = 1.12) but decreased the likelihood of hospice care preference (OR = 0.96). Greater perceived benefits decreased the likelihood of CPR preference (OR = 0.81) and ventilation support (OR = 0.89), and AD knowledge decreased the likelihood of haemodialysis preference (OR = 0.23). CONCLUSION: The multidimensional factors were differently associated with each of the AD treatment preferences. Modifiable factors, including perceived barriers and benefits and knowledge, should be improved to help low-income, community-dwelling older people select adequate AD treatment preferences. IMPLICATIONS FOR PRACTICE: Additional information regarding AD treatments and some modifiable and non-modifiable correlates can be integrated into primary and palliative/supportive care in public health. The current home visitation service may also benefit from incorporating AD discussions while extending the service to embrace AD issues in addition to disease management.