Development of an intentional rounding protocol for nursing undergraduates to apply in clinical practice / 한국간호교육학회지

Purpose@#This study aimed to develop an intentional rounding protocol to enhance the clinical competence of nursing students. @*Methods@#An intentional rounding protocol for nursing students’ clinical practice was developed following the ADDIE (Analysis, Design, Development, Implementation, and Evaluation) model. A convenient sampling method was used to select 23 junior year university nursing students during their clinical practice in adult nursing. The program evaluation included a quantitative assessment (communication and relationship efficacy, empathy, and patient safety competency) and focus group interviews. @*Results@#The intentional rounding protocol focused on the 4Ps (pain, position, potty, and possessions) and encompassed aspects such as level of consciousness, pain management, personal care needs, intravenous injection, oxygen administration, nasogastricasoenteric tube care, maintenance of urine collection bags, and the identification of environmental fall risks. Nursing students performed intentional rounding at least twice a day. Following the implementation of this protocol, nursing students demonstrated a significant improvement in communication and interpersonal efficacy. The focus group interviews revealed four main themes: growth of human relationships, acquiring knowledge in and about the clinical field, becoming a nurse, and barriers in reality. @*Conclusion@#The intentional rounding protocol has the potential to enhance nursing students’ communication and interpersonal skills during clinical practice and to provide them with positive experiences in nursing clinical education. Therefore, it is recommended that this protocol be incorporated into nursing clinical practice education.

A Structural Equation Model for Posttraumatic Growth among Cured Patients with COVID-19

Purpose@#This study aimed to develop and test a model for posttraumatic growth among cured patients with COVID-19. This model was based on Calhoun and Tedeschi’s Posttraumatic Growth model and a literature review. @*Methods@#The participants comprised 223 patients cured from COVID-19 who were ≥ 19 years of age. The data were collected through an online questionnaire from March 21 to 24, 2022.The assessment tools included the Impact of Event Scale: Revised Korean version, the Connor-Davidson Resilience Scale, the Distress Dis-closure Index, the Multidimensional Scale of Perceived Social Support, the Korean version of the Event-related Rumination Inventory, and the Korean version of the Post-traumatic Growth Inventory. Data were analyzed using the IBM SPSS version 24.0 and IBM AMOS 26.0. @*Results@#The modified model showed appropriate goodness of fit (χ 2 = 369.90, χ 2 /degree of freedom = 2.09, SRMR = .09, RMESA = .07, CFI = .94, TLI = .93). The post-traumatic growth of cured patients with COVID-19 was explained through distress perception, self-disclosure, and deliberate rumination, with the explanatory power being 70.0%. @*Conclusion@#This study suggests preparing a disaster psychology program involving experts who can activate deliberate rumination is necessary. Further, this study may serve as basic data for developing a program to enhance the post-traumatic growth of patients cured from COVID-19.

Antibody response to COVID-19vaccination in patients on chronic hemodialysis

Purpose@#Since patients on hemodialysis (HD) are known to be vulnerable to coronavirus disease 2019 (COVID-19), many studies were conducted regarding the effectiveness of the COVID-19 vaccine in HD patients in Western countries. Here, we assessed antibody response of HD patients for 6 months post-vaccination to identify the duration and effectiveness of the COVID-19 vaccine in the Asian population. @*Materials and Methods@#We compared antibody response of the COVID-19 vaccine in HD patients with healthy volunteers. Patient and control groups had two doses of ChAdOx1 nCoV-19 and mRNA-1273, respectively. Immunoglobulin G (IgG) was measured before vaccination, 2 weeks after the first dose, 2 and 4 weeks, 3 and 6 months after the second dose. Neutralizing antibody was measured before vaccination and at 2 weeks, 3 and 6 months after second dose.Since the third dose was started in the middle of the study, we analyzed the effect of the third dose as well. @*Results@#Although antibody production was weaker than the control group (n=22), the patient group (n=39) showed an increase in IgG and neutralizing antibody after two doses. And, 21/39 patients and 14/22 participants had a third dose (BNT162b2 or mRNA-1273 in the patient group, mRNA-1273 in the control group), and it did not affect antibody response in both group. Trend analysis showed IgG and neutralizing antibody did not decrease over time. Age, sex, and HD vintage did not affect antibody production in HD patients. Patients with higher body mass index displayed better seroresponse, while those on immunosuppressants showed poor seroresponse. @*Conclusion@#Two doses of vaccination led to significant antibody response in HD patients, and the antibody did not wane until 6 months.

The impact of grit, gratitude disposition and stress on psychological well-being among nursing students during the Covid-19 pandemic: a structural equation modeling / 한국간호교육학회지

Purpose@#The purposes of this study were to develop and test a model for the effects of grit, gratitude disposition, and stress on the psychological well-being of nursing students during the Coronavirus-2019 pandemic. @*Methods@#The data were collected from June 9 to June 27, 2021. A total of 286 nursing students responded to an online questionnaire. In the hypothesis’s model, the exogenous variables were grit and gratitude disposition, and the endogenous variables were nursing students’ stress and psychological well-being. Data were analyzed using the SPSS/WIN and AMOS programs. @*Results@#The final model showed the following indices of goodness of fit: χ2 =78.30, χ2 /df=3.01, GFI=.95, CFI=.96, TLI=.94, SRMR=.05, and RMSEA=.08. Nursing students’ psychological well-being was explained by their grit, gratitude disposition, and stress directly and indirectly, with these three variables explaining 56% of psychological well-being. @*Conclusion@#This study identified factors affecting the psychological well-being of nursing students in a state of increased stress due to the COVID-19 pandemic. The results of this study can be a basis for developing and applying a program to enhance nursing students' psychological well-being.

Factors that Affect Remission of Chemotherapy-Induced Peripheral Neuropathy Symptoms: Short-Term Prospective Study

Purpose@#Patients experiencing chemotherapy-induced peripheral neuropathy (CIPN) apply various palliative care as well as drugs in their daily life to alleviate symptoms. There is a need to identify the influence of these efforts and patients’ psychosocial status on the relief of CIPN symptoms. This short-term prospective study investigated how prescription drugs, non-pharmacological behaviors (exercise, massage, and heat therapy), and psychological states (social support, depression, and anxiety) affected CIPN symptoms. @*Methods@#Participants scheduled to receive postoperative platinum or taxane-based chemotherapy were enrolled consecutively.CIPN was measured with the Neurotoxicity-12 subscale of the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity-12 instrument. Data were collected three times during the 4 or 5 cycles of chemotherapy. @*Results@#At the end of the 2nd chemotherapy cycle, 93.1% of participants reported CIPN symptoms. Multiple regression analyses showed that a heat therapy (β = -.34, p < .001), massage (β = -.21, p = .012), and walking 5 times or more per week (β = -.26, p = .021) provided relieve for CIPN symptoms. Depression (β = .19, p = .027) significantly exacerbated CIPN symptoms. @*Conclusion@#These results suggested that a comprehensive management program that includes walking, heat therapy, massage, and mood therapy should be encouraged. Moreover, patients should be educated at chemotherapy initiation to understand appropriate interventions that can relieve CIPN symptoms.

The Reliability and Validity of Korean Version of Wong and Law Emotional Intelligence Scale (K-WLEIS)

The aim of this study was to evaluate the reliability and validity of the Korean version of the Wong and Law Emotional Intelligence Scale (K-WLEIS). Methods: Data were collected from 360 nursing students using a self reported questionnaire. Exploratory and confirmatory factor analysis were used to test construct validity. Convergence validity was identified by correlation with communication competency.Item convergent and discriminant validity were also analyzed. Reliability was evaluated internal consistency and test-retest reliability. Results: The results of exploratory factor analysis showed that the eigen values ranged from 1.34 to 5.86 and 73.2% of the total explained variance. Confirmatory factor analysis showed adequate model fit indices (χ 2 /df 1.89, RMSEA .07, GFI .89, CFI .95, and TLI .93) and standardized factor loadings (.48 to .87). The average extracted variances (.71 to .79) and composite reliability (.80 to .87) validated convergence and discriminant validity of the items. Test-retest reliability of intra-class correlation coefficient was .90 and the Cronbach’s alpha coefficient was .88. Conclusion: The K-WLEIS is an appropriate scale for measuring the emotional intelligence of Korean nursing students.Therefore, it is expected that the K-WLEIS will be used for nursing education programs to improve nursing students’ emotional intelligence.

Evaluation of Validity of the Korean Triage and Acuity Scale

PURPOSE@#The aim of this study was to identify the predictive validity of the Korean Triage and Acuity Scale (KTAS).@*METHODS@#This methodological study used data from National Emergency Department Information System for 2016. The KTAS disposition and emergency treatment results for emergency patients aged 15 years and older were analyzed to evaluate its predictive validity through its sensitivity, specificity, positive predictive value, and negative predictive value.@*RESULTS@#In case of death in the emergency department, or where the intensive care unit admission was considered an emergency, the sensitivity, specificity, positive predictive value, and negative predictive value of the KTAS were 0.916, 0.581, 0.097, and 0.993, respectively. In case of death in the emergency department, or where the intensive or non-intensive care unit admission was considered an emergency, the sensitivity, specificity, and positive predictive value, and negative predictive value were 0.700, 0.642, 0.391, and 0.867, respectively.@*CONCLUSION@#The results of this study showed that the KTAS had high sensitivity but low specificity. It is necessary to constantly review and revise the KTAS level classification because it still results in a few errors of under and over-triage. Nevertheless, this study is meaningful in that it was an evaluation of the KTAS for the total cases of adult patients who sought help at regional and local emergency medical centers in 2016.

Evaluation of Validity of the Korean Triage and Acuity Scale

PURPOSE: The aim of this study was to identify the predictive validity of the Korean Triage and Acuity Scale (KTAS). METHODS: This methodological study used data from National Emergency Department Information System for 2016. The KTAS disposition and emergency treatment results for emergency patients aged 15 years and older were analyzed to evaluate its predictive validity through its sensitivity, specificity, positive predictive value, and negative predictive value. RESULTS: In case of death in the emergency department, or where the intensive care unit admission was considered an emergency, the sensitivity, specificity, positive predictive value, and negative predictive value of the KTAS were 0.916, 0.581, 0.097, and 0.993, respectively. In case of death in the emergency department, or where the intensive or non-intensive care unit admission was considered an emergency, the sensitivity, specificity, and positive predictive value, and negative predictive value were 0.700, 0.642, 0.391, and 0.867, respectively. CONCLUSION: The results of this study showed that the KTAS had high sensitivity but low specificity. It is necessary to constantly review and revise the KTAS level classification because it still results in a few errors of under and over-triage. Nevertheless, this study is meaningful in that it was an evaluation of the KTAS for the total cases of adult patients who sought help at regional and local emergency medical centers in 2016.

Contributions and Limitations of National Cervical Cancer Screening Program in Korea: A Retrospective Observational Study

PURPOSE: The purpose of this study was to evaluate the contributions and limitations of the cervical cancer screening test with accuracy in Korea. METHODS: This was a retrospective observational study. The study population consisted of all participants who underwent cervical cancer screening test from 2009 to 2014. The data were obtained from National Health Information Database (NHID) which represents medical use records of most Koreans. As the indices for contributions and limitations of the screening test, crude detection rate, incidence rate of interval cancer, sensitivity, specificity, and positive predictive value were used. RESULTS: The crude detection rate of screening test per 100,000 participants increased from 100.7 in 2009 to 102.1 in 2014. The incidence rate of interval cancer per 100,000 negatives decreased from 13.0 in 2009 to 10.2 in 2014. The sensitivities of screening test were 88.7% in 2009 and 91.2% in 2014, and the specificities were 98.5% in 2009 and 97.7% in 2014. The positive predictive value of screening decreased from 6.2% in 2009 to 4.3% in 2014. CONCLUSIONS: The Korean national cervical cancer screening program has improved in accuracy and has contributed to detection of early stage of cervical cancer over the years. Along with efforts to promote participation in cancer screening programs, quality control over the screening program should be enhanced.

The Relevance between Biological Nursing Subjects and Registered Nurse Licensure Examination Workbook in Republic of Korea and the United States of America

PURPOSE: This is a descriptive study to investigate the relevance between biological nursing science subjects (structure and function of the human body (SFHB), mechanism and effects of drugs (MED), clinical microbiology) and examination workbook items for Registered Nurse Licensure Examination (RNLE) in Republic of Korea (ROK) and the United States of America (USA). METHODS: RNLE 8 workbooks which were published by the Korean Nurses Association were utilized for analysis of Korean RNLE. Saunders comprehensive review for the NCLEX-RN® examination was used for analysis of US RNLE. The relevance between items in the standard syllabuses of biological nursing science subjects (SFHB, MED, clinical microbiology) and the RNLE items of these workbooks in ROK and the USA was analyzed. RESULTS: The relevance rates of ROK and the USA were 3.6% vs 0.4% in SFHB, 8.9% vs 23.0% in MED, and 4.5% vs 5.8% in clinical microbiology. CONCLUSION: In SFHB, the relevance of the RNLE in ROK was higher than that of the USA. However in MED the relevance of the RNLE in USA was higher than that of the ROK. Since medications are one of major tasks of nurses, it is necessary to increase the number of related items in the RNLE in ROK.

Psychometric Properties of Korean version of Nurse Emotional Labor Strategy Scale (K-NELSS) / 간호행정학회지

PURPOSE: Purposes of this study were to develop a Nurse Emotional Labor Strategy Scale in Korean (K-NELSS) and to evaluate its psychometric properties. METHODS: The 14 items Emotional Labor Strategy Scale (ELSS) was translated into Korean and modified to apply to nurses. Two hundred and fifty nurses working in various units completed the questionnaire. Factor validity using confirmatory factor analysis, construct validity using correlation with burn-out, and criterion validity using correlation with Korean-Emotional Labor Scale (K-ELS) were identified. Reliability was tested by Cronbach's α. RESULTS: K-NELSS has 3 domains: surface acting, deep acting, and expression of naturally felt emotions. Confirmatory factor analysis showed moderate goodness of fit (RMSEA=.80, SRMR=.07, CFI=93, TFI=.92). Correlation between surface acting and burn-out was r=.37 (p < .001), and between K-NELSS and K-ELS were r=.57 (p < .001) in surface action and r=.62 (p < .001) in deep acting. Cronbach's αs for surface acting, deep acting, and expression of naturally felt emotions were .89, .88, .84, respectively. CONCLUSION: Psychometric properties of K-NELSS indicate that it is a useful and reliable tool to assess emotional labor of Korean nurses. In addition, with a small number of items, it is relatively easy to use.

Risk Factors on Suicidal Ideation and Suicidal Attempt among Community dwelling Older Adults: Based on 2014 Community Health Survey / 재활간호학회지

PURPOSE: The purpose of this study was to investigate the factors affecting suicidal ideation and suicidal attempts of older adults aged 65 years and older. METHODS: A part of the 2014 Community Health Survey data were used for analysis. Responses of 3,287 older adults living in Chungbuk province were analyzed using complex sample multiple logistic regression analysis. RESULTS: The percentages of older people who experienced suicidal ideation and attempt during the past year were 21.7% and 0.8%, respectively. Limitation of daily living activities, pain/discomfort, stress and depression were significant risk factors of older adults' suicidal ideation. The significant risk factor of suicidal attempt was suicidal ideation, followed by depression and limitation of daily activities. The frequencies of elderly people using professional counseling related to the stress, depression or suicidal ideation were very low showing 2.1%, 1.8%, and 1.4% respectively. The protective impact of counselling on suicidal ideation and attempt were not able to be identified because of the low rate of participation of counselling program in this study. CONCLUSION: The common risk factors of suicidal ideation and attempt were depression and the limitation of daily activity; therefore, community services for them should be emphasized. In addition, there should be an effort to increase the utilization rate of professional counselling and to identify the effects of counselling on the prevention of suicidal behaviors.

Psychometric Properties and Item Evaluation of Korean Version of Night Eating Questionnaire (KNEQ)

PURPOSE: The aim of this study was to develop a Korean version of Night Eating Questionnaire (KNEQ) and test its psychometric properties and evaluate items according to item response theory. METHODS: The 14-item NEQ as a measure of severity of the night eating syndrome was translated into Korean, and then this KNEQ was evaluated. A total of 1171 participants aged 20 to 50 completed the KNEQ on the Internet. To test reliability and validity, Cronbach's alpha, correlation, simple regression, and factor analysis were used. Each item was analyzed according to Rasch-Andrich rating scale model and item difficulty, discrimination, infit/outfit, and point measure correlation were evaluated. RESULTS: Construct validity was evident. Cronbach's alpha was .78. The items of evening hyperphagia and nocturnal ingestion showed high ability in discriminating people with night eating syndrome, while items of morning anorexia and mood/sleep provided relatively little information. The results of item analysis showed that item2 and item7 needed to be revised to improve the reliability of KNEQ. CONCLUSION: KNEQ is an appropriate instrument to measure severity of night eating syndrome with good validity and reliability. However, further studies are needed to find cut-off scores to screen persons with night eating syndrome.

Adaptation and Evaluation of the Incontinence Care Protocol

PURPOSE: This study was done to develop an evidence-based incontinence care protocol through an adaptation process and to evaluate the effects of the protocol. METHODS: The protocol was developed according to the guideline of adaptation. A non-randomized controlled trial was used for testing the effects of the new Incontinence Care Protocol. A total of 120 patients having bowel incontinence with Bristol stool type 5, 6, and 7 and admitted to intensive care units were recruited to this study. The newly developed incontinence care protocol was used with patients in the experimental group and conventional skin care was given to patients in the control group. Outcome variables were incontinence-associated dermatitis (IAD) severity, pressure ulcer occurrence and severity. RESULTS: The experimental group had significantly less severe IAD (t=6.69, p<.001), lower occurrence of pressure ulcers (chi2=7.35, p=.007), and less severity of pressure ulcers (Mann-Whitney=86.00, p=.009) than the control group. CONCLUSION: Use of this incontinence care protocol has the effects of preventing pressure ulcers and inhibiting worsening of IAD and pressure ulcers. Therefore, this incontinence care protocol is expected to contribute to managing IAD and pressure ulcers.

Psychometric Properties of Korean Version of Modified Leeds Sleep Evaluation Questionnaire (KMLSEQ) / 재활간호학회지

PURPOSE: The Leeds Sleep Evaluation Questionnaire (LSEQ) translated into Korean was modified to easily apply and reduce respondents' confusion and was evaluated for psychometric properties and discriminant ability. METHODS: A total of 960 Korean adults aged 45 years and older participated in this cross-sectional survey. To test reliability, validity and discriminant ability, Cronbach's alpha, correlation analysis, confirmatory factor analysis, simple regression analysis and receiver operating characteristics (ROC) curve analysis were used. RESULTS: Item-total correlations ranged between .62~.85 and Cronbach's alpha was .95. Area under ROC was .86 (95% CI: .83~.90) and the optimal cutoff score was identified as < or = 66 (sensitivity, .77; specificity, .84; positive/negative predictive values, .49/.95). Using this cutoff score, the prevalence of insomnia in the study sample was 25.8% and tended to be more common in female and older groups. CONCLUSION: The data supported the psychometric properties of Korean Modified Leeds Sleep Evaluation Questionnaire (KMLSEQ) as an acceptable sleep measurement. In addition, KMLSEQ is likely to be a useful screening tool for insomnia.

Patients with Persistent New-Onset Diabetes after Transplantation Have Greater Weight Gain after Kidney Transplantation

The purpose of the present study was to evaluate the difference in BMI pattern between patients with persistent new-onset diabetes after transplantation (P-NODAT) and without new-onset diabetes after transplantation (N-NODAT) in a retrospective matched case-control (1:3) analysis. Thirty-six patients who developed P-NODAT were identified among 186 adult renal transplant recipients with no evidence of pretransplant diabetes mellitus who underwent kidney transplantation from September 1997 to March 2008 and were treated with a triple regimen including tacrolimus. The controls were selected to match the patients for pretransplant BMI, age at transplantation (+/- 5 yr), and date of transplantation (+/- 12 months). Finally, 20 P-NODAT patients and 60 N-NODAT patients were selected. The pre- and posttransplant BMI data were collected every 16 weeks for up to 80 weeks. The clinical characteristics did not differ between the P-NODAT group and N-NODAT group. BMI increased faster in the P-NODAT group than in the N-NODAT group. The mixed-model analysis showed that patients with P-NODAT exhibited a faster increase in BMI. P-NODAT is associated with posttransplant weight gain. The risk of P-NODAT should be considered in patients with rapid weight gain after transplantation.

The Influence of Uncertainty and Social Support on General Well-being among Hemodialysis Patients / 재활간호학회지

PURPOSE: The purpose of this study was to explore factors affecting uncertainty and general well-being based on Uncertainty in Illness Theory. METHODS: Data were collected from 125 outpatients who had received hemodialysis. The path model among four concepts, such as period of hemodialysis, social support, uncertainty, and general well-being, was tested. Tangible support, positive social interaction, affectionate, and emotional/informational support were measured as social support. Adaptation in the model was operationalized as general well-being which consisted of anxiety, depression, positive well-being, self-control, and general health. RESULTS: All paths were statistically significant at the level of alpha=.05. The significant paths were the path from period of hemodialysis to uncertainty (t=-2.86), social support to uncertainty (t=-2.01), uncertainty to general wellbeing (t=-2.85), and social support to general well-being (t=3.55). CONCLUSION: Patients who perceived low uncertainty and high social support were likely to feel well-being. Therefore, nurses should give patients appropriate information according to their needs and have meaningful interaction with patients to reduce their uncertainty and render social support.

Korean Versions of Self-reported Sleep Questionnaires for Research and Practice on Sleep Disturbance / 재활간호학회지

PURPOSE: To identify Korean versions of self-reported sleep questionnaires for cross-cultural research and practice on sleep disturbance, we searched self-reported sleep questionnaires which have been developed to measure general sleep patterns. They should be qualitative, easy to take permission, do not obligate to pay, do not need any skill or professional help for scoring and have been reported high reliability and validity. METHODS: General Sleep Disturbance Scale (GSDS), Leeds Sleep Evaluation Questionnaire (LSEQ), and Pittsburgh Sleep Quality Index (PSQI) were identified based on all criteria. Korean version of GSDS, LSEQ, and PSQI were developed according to the methods combined the guidelines for the process of cross-cultural adaptation of self-reported measures with decentering method. RESULTS: Three Korean versions of self-reported sleep questionnaires were suitable for epidemiological study. They are not full length and easy to read. It requires less than 10 minutes for each subject to complete as well as for researchers to score. CONCLUSION: Psychometric analysis study is necessary to evaluate the reliability and validity of those Korean versions of self-reported sleep questionnaires.

Intravenous albumin for the prevention of contrast-induced nephropathy in patients with liver cirrhosis and chronic kidney disease undergoing contrast-enhanced CT

BACKGROUND: The purpose of this study was to evaluate the incidence of contrast-induced nephropathy (CIN), and the effect of intravenous albumin for prophylaxis of CIN in patients with liver cirrhosis (LC) and chronic kidney disease (CKD). METHODS: We conducted a retrospective study of 81 subjects with LC and CKD (estimated glomerular filtration rate (eGFR) or =25% or > or =0.5mg/dL in serum creatinine level. RESULTS: Overall, CIN developed in three patients (3.7%). Of the 81 subjects, 43 received sodium bicarbonate solution and 38 received albumin. Both groups were comparable with regard to age, sex, diabetes mellitus, and baseline eGFR. The albumin group showed a significantly poorer liver function profile. CIN incidence did not differ significantly between the groups: it occurred in one (2.3%) of the 43 subjects receiving sodium bicarbonate and two (5.3%) of the 38 subjects receiving albumin (P=0.6). However, the albumin group showed a significantly smaller increase in body weight (P=0.03). CONCLUSION: The incidence of CIN in patients with LC and CKD undergoing contrast-enhanced CT after preventive measures was relatively low. The incidence of CIN was not significantly different between sodium bicarbonate and albumin groups.

Factors Affecting Preparation Stage to Quit Smoking in Men

PURPOSE: This study was done to investigate factors affecting preparation stage to quit smoking in men. METHODS: Based on data from the Community Health Survey conducted in Chungbuk Province in 2008, we estimated rates and odds ratio (OR) of smoking cessation intention for 2,639 men who were current smokers. Multivariate logistic regression analyses were used to identify factors affecting preparation stage to quit smoking. RESULTS: Among current male smokers, the rate of smoking cessation intention was 17.1%. The OR of factors affecting smoking cessation was as follows: Compared to men with middle school education, the OR for rate of smoking cessation intention in men with high school education was 1.47 (p=.018), and for college or higher, 1.55 (p=.017). Compared to being single, the OR for cohabitation after marriage was 1.61 (p=.011) and living alone after marriage, 2.23 (p=.005). The OR for attempt to quit smoking, exposure to secondhand smoke and participation in smoking education were 6.80 (p<.001), 1.32 (p=.020) and 1.69 (p=.005), respectively. CONCLUSION: Results of this study show that it is necessary to decrease exposure to secondhand smoke and to increase participation in smoking cessation education targeting current smokers to move them from precontemplation or contemplation stage to preparation stage.