A Prediction Model of Exercise Level in Patients with Ankylosing Spondylitis

Purpose@#This study aimed to construct and test a hypothetical model to explain the predictive factors and causal pathways for exercise levels in patients with ankylosing spondylitis based on the self-determination theory. A conceptual framework was constructed assuming that autonomy support by health care providers would satisfy the three basic psychological needs of patients, which would increase their autonomous motivation for exercise, resulting in its initiation and continuation. @*Methods@#This cross-sectional study included 221 patients with ankylosing spondylitis who were visiting rheumatology clinics in two tertiary hospitals. Health Care Climate Questionnaire-exercise regularly, Basic Psychological Needs Satisfaction scale, Behavior Regulation in Exercise Questionnaire-2, and exercise level were used to collect data. @*Results@#The fitness of the hypothetical model met the recommended level (χ2/df ≤ 3, SRMR ≤ .08, RMSEA ≤ .08, GFI ≥ .90, AGFI ≥ .85, NFI ≥ .90, TLI ≥ .90, CFI ≥ .90). The model effect analysis revealed that autonomy support by health care providers had a positive effect on patients' autonomy, competence, relatedness, autonomous motivation, and exercise level. Competence and relatedness had positive effects on autonomous motivation and exercise level, respectively. Autonomous motivation had a positive effect on exercise level. @*Conclusion@#The predictive factors of exercise level in patients with ankylosing spondylitis were autonomous motivation, health care providers' autonomy support, competence, and relatedness. Considering these factors, we recommend the development of an effective program for improving exercise levels in these patients.

Effects of a Cognitive Behavior Therapy Program for Patients with Fibromyalgia Syndrome:A Randomized Controlled Trial

Purpose@#This study developed a cognitive behavioral therapy program aimed at altering the physical condition, emotions, and behaviors of fibromyalgia patients, and confirmed the program’s clinical applicability. The program was developed by analyzing previous studies conducting in-depth interviews with fibromyalgia patients, drawing on cognitive behavior theory to establish the program contents, recruiting experts to test its validity, and conducting a preliminary survey. @*Methods@#To confirm the program’s effect, this study used a randomized controlled trial design. The participants were outpatients diagnosed with fibromyalgia in Dong-A University Hospital, Busan. The 30 patients in the experimental group took part in the program, which comprised 8 sessions (90 to 120 minutes) based on cognitive behavior theory, delivered over 8 weeks. Hypothesis testing was carried out using the repeated measures ANOVA. @*Results@#The analysis revealed significant differences between the experimental and control groups in positive automatic thoughts, pain, fatigue, depression, and interpersonal relationships. However, there was no significant difference between the groups in terms of sleep disorders and negative automatic thoughts. @*Conclusion@#This program is a positive effect on physical condition, emotions, and behaviors. It is thus expected to be used to help fibromyalgia patients improve their disease conditions.

Effects of a Cognitive Behavior Therapy Program for Patients with Fibromyalgia Syndrome:A Randomized Controlled Trial

Purpose@#This study developed a cognitive behavioral therapy program aimed at altering the physical condition, emotions, and behaviors of fibromyalgia patients, and confirmed the program’s clinical applicability. The program was developed by analyzing previous studies conducting in-depth interviews with fibromyalgia patients, drawing on cognitive behavior theory to establish the program contents, recruiting experts to test its validity, and conducting a preliminary survey. @*Methods@#To confirm the program’s effect, this study used a randomized controlled trial design. The participants were outpatients diagnosed with fibromyalgia in Dong-A University Hospital, Busan. The 30 patients in the experimental group took part in the program, which comprised 8 sessions (90 to 120 minutes) based on cognitive behavior theory, delivered over 8 weeks. Hypothesis testing was carried out using the repeated measures ANOVA. @*Results@#The analysis revealed significant differences between the experimental and control groups in positive automatic thoughts, pain, fatigue, depression, and interpersonal relationships. However, there was no significant difference between the groups in terms of sleep disorders and negative automatic thoughts. @*Conclusion@#This program is a positive effect on physical condition, emotions, and behaviors. It is thus expected to be used to help fibromyalgia patients improve their disease conditions.

The influence of nursing students’ perfectionism tendency and perception of instructor caring on incivility experienced by nursing students / 한국간호교육학회지

Purpose@#The purpose of this study was to identify the influences of nursing students perfectionism tendencies and their perception of instructor caring on incivility experienced by nursing students during clinical practice. @*Methods@#A descriptive correlational study was conducted. The participants were 244 nursing students from five universities in B city. Data were analyzed using an independent t-test, ANOVA, Pearson’s correlation coefficient, Scheffé test and a stepwise regression analysis. @*Results@#The mean score for incivility in nursing students was 2.61 out of 5 points. The explanatory power of the model for incivility was in nursing students 52.8% of the variance in training in student’s university hospital (β=-.15, p=.002), total period of clinical practice (β=.17, p<.001), confidence through caring (β=-.23, p<.001), respectful sharing (β=-.15, p=.005), supportive learning climate (β=-.15, p=.005), self-oriented perfectionism (β=.14, p=.004), and socially prescribed perfectionism (β=.18, p<.001). @*Conclusion@#The research results suggest that instructor caring is an important factor in regard to the incivility of nursing students. Organizational efforts and institutional devices will be needed to improve the incivility in clinical environments. By communicating with students and showing them respect, clinical nurses will help nursing students cope with incivility and recognize the clinical practice education environment positively.

The Moderating Effect of Supervisor's Support in Relation to Violence Experience between Co-workers and Organizational Commitment of Nurses Working in Special Departments of a Hospital / 간호행정학회지

Purpose@#This study was conducted to investigate the moderating effect of supervisor's support in relation to violence experience and organizational commitment among staff of special department nurses. @*Methods@#Participants in this study were nurses working in the emergency, operating and intensive care units of five general hospitals in B city. Data were collected from Aug. 6 to Sep. 14, 2018. Data were analyzed using t-test, ANOVA, Pearson's correlation coefficients and multi-group path-analysis. @*Results@#The organizational commitment showed a negative correlation with violence experience (r=-28, p<.001) and a positive correlation with supervisor's support (r=.27, p<.001). There was a negative correlation (r=-.37, p<.001) between violence experience and supervisor's support. As a result of verifying the moderating effect of supervisor's support in relation to violence experience and organizational commitment, there was no significant difference in the path between the high and low supervisor's support groups (∆x 2 =1.07, p=.300). @*Conclusion@#There was no buffering effect of supervisor's support in relation to violence experience and organizational commitment of nurses in special departments. Further research is needed to explore variables that show a moderating effect on the relationship between violence experience and organizational commitment.

A Meta-Analysis on the Effects of Mind-Body Therapy on Patients with Irritable Bowel Syndrome

Purpose@#Previous randomized controlled trials (RCT) found that mind-body therapy can improve the health outcomes of patients with irritablebowel syndrome (IBS). The purpose of this meta-analysis was to identify the combined effects of mind-body therapy on patients’ IBSsymptoms, quality of life, anxiety, and depression. @*Methods@#A systematic literature search was conducted using various databases such asPubMed, EMBASE, CINAHL CENTRAL, DBpia, RISS, and KISS. The primary outcome variables were IBS symptoms and quality of life; the secondaryoutcome variables were anxiety and depression. Comprehensive Meta-Analysis version 3.0 was used to analyze the extracted data.The effect size was calculated using standardized mean difference (SMD) and 95% confidence interval (CI). @*Results@#Eleven final RCTs wereused for this meta-analysis. Mind-body therapy was found to have a significant effect on the IBS patients’ symptoms (SMD, -0.63; 95% CI,-0.77 to -0.48), quality of life (SMD, 1.03; 95% CI, 0.40 to 1.66), anxiety (SMD, -0.28; 95% CI, -0.47 to -0.09), and depression (SMD,-0.31; 95% CI, -0.06 to -0.12). @*Conclusion@#This meta-analysis reveals that mind-body therapy significantly improves IBS patients’ symptoms,quality of life, anxiety, and depression. The results suggest that, in the future, appropriate mind-body therapy should be applied toKoreans suffering from IBS. Moreover, the therapy’s long-term effects should be assessed.

Effects of Parity and Breast Feeding Duration on the Risk of Osteoporosis in Postmenopausal Korean Women: A Systematic Review and Meta-Analysis

OBJECTIVES: To summarize the evidence regarding the association of parity and breast feeding duration with the risk of osteoporosis in postmenopausal Korean women. This was because studies have been inconsistent regarding the effect of parity and breast feeding duration on the risk of osteoporosis. METHODS: A systematic literature search of relevant studies published by December 26, 2018 was conducted in PubMed, EMBASE, the Cochrane Library, CINAHL, RISS, KISS, KMbase, and KoreaMed. Outcome estimates of odds ratio (OR) or standardized mean difference were pooled with fixed or random-effect model. In case of heterogeneity, subgroup analysis was conducted. RESULTS: Seven cross-sectional studies (with 3,813 subjects) were included in the analysis. OR for osteoporosis was 1.43 (95% confidence interval [CI] = 1.09–1.88, P = 0.010) in postmenopausal women with higher parity compared to those with less parity. Moreover, OR for osteoporosis was 1.93 (95% CI = 1.28–2.93, P = 0.002) in postmenopausal women with longer durations of breast feeding than in those with shorter durations of breast feeding. CONCLUSIONS: This study revealed that duration of breast feeding increased the risk of osteoporosis in postmenopausal Korean women. More cohort studies with high quality research designs are needed to confirm our results.

Influencing Factors and Consequences of Near Miss Experience in Nurses' Medication Error / 간호학회지

PURPOSE: This study aimed to predict the influencing factors and the consequences of near miss in nurses' medication error based upon Salazar & Primomo's ecological system theory. METHODS: A convenience sample of 198 nurses was recruited for the cross-sectional survey design. Data were collected from July to September 2016. Using the collected data, the developed model was verified by structural equation modeling analysis using SPSS and AMOS program. RESULTS: For the fitness of the hypothetical model, the results showed that χ² (χ²=258.50, p<.001) was not fit, but standardized χ² (χ²/df=2.35) was a good fit for this model. Additionally, absolute fit index RMR=.06, RMSEA=.08, GFI=.86, AGFI=.81 reached the recommended level, but the Incremental fit index TLI=.82, CFI=.85 was not enough to reach to the recommended level. With the path diagram of the hypothetical model, caution (β=−.29 p<.001), patient safety culture (β=−.20, p=.041), and work load (β=.18, p=.037) had a significant effect on the near miss experiences in nurses' medication error, while fatigue (β=−.06, p=.575) did not affect it. Moreover, the near miss experience had a significant effect on work productivity (β=−.25, p=.001). CONCLUSION: These results have shown that to decrease the near miss experience by nurses and increase their work productivity in hospital environments would require both personal and organizational effort.

Concept Analysis of the Work Interruption by Nurses / 간호행정학회지

PURPOSE: The purpose of this study was to identify the attributes, antecedents, and consequences of nurse's work interruptions. METHODS: Walker and Avant's concept analysis method was used to analyze this concept. Relevant articles published before August 2018 were searched through MEDLINE, CINAHL, EMBASE, KISS, and RISS databases using “interruption,” “work or task,” and “nurse” as keywords. RESULTS: The attributes of work interruption by nurses were as follows: 1) new tasks to do; 2) cognitive transition of work priorities; 3) loss of work continuity; 4) tasks to be resumed. The antecedents of work interruption were intrusion of unplanned events, internal and external factors that result in nurses forgetting their original intentions, an unpredictable work environment, and cultural climate where interruptions are considered as a part of the work process. The consequences of work interruption were decline in job satisfaction, trigger of work errors, lengthening of work completion time, decline in work productivity, increase in work stress, and delay of transferring needed information in a timely manner. CONCLUSION: The results of this study provide basic data to reduce the negative consequences of nurses' work interruptions, and contribute to expanding the knowledge necessary for improving patients' safety and nurses' performance.

The Impact of Organizational Commitment and Positive Psychological Capital on Job Embeddedness of Nurses in Trauma Centers / 간호행정학회지

PURPOSE: The purpose of this study was to investigate factors affecting job embeddedness of nurses in trauma centers. METHODS: This study was a cross-sectional study using structured questionnaires completed by 140 nurses in three regional trauma centers in Korea. Data were collected from July 15 to September 10, 2017, and analyzed using SPSS/WIN 23.0 program. RESULTS: The mean score of organizational commitment was 3.65±0.75, positive psychological capital was 3.00±0.45, and job embeddedness was 3.00±0.45. The organizational commitment showed a significant positive correlation with positive psychological capital (r=.36, p<.001) and job embeddedness (r=.60, p<.001), and positive psychological capital also showed a significant positive correlation with job embeddedness (r=.74, p<.001). The factors affecting job embeddedness of nurses in trauma centers were positive psychological capital (β=.61, p<.001), organizational commitment (β=.38, p<.001), and marital status (β=-.14, p=.017). CONCLUSION: The results of this study suggest that to enhance job embeddedness, it is necessary to develop education and programs to strengthen organizational commitment and positive psychological capital of nurses in trauma centers. In addition, for unmarried nurses, interest and consideration are needed to enhance job embeddedness and to reduce turnover.

Effects of Parity and Breastfeeding Duration on Bone Density in Postmenopausal Women

PURPOSE: This study aimed to identify the effect of parity and breastfeeding duration and the occurrence of lumbar vertebral and femoral neck osteoporosis in Korean postmenopausal women. METHODS: This study analyzed the data of 1,770 women based on the 2010e2011 results of the Korea National Health and Nutrition Examination Survey. Extracted data concerning bone density included variables known to be associated with osteoporosis. Complex sample multivariate logistic regression analysis was conducted to determine whether parity and breastfeeding duration were associated with osteoporosis in postmenopausal women. RESULTS: Parity was not associated with postmenopausal osteoporosis in the femoral neck or lumbar vertebrae; however, the risk of femoral neck osteopenia was significantly higher in women with a history of 12e24 months of breastfeeding than in women who breastfed for less than 12 months (odds ratio = 2.12, 95% confidence interval = 1.07–4.21). In women who breastfed for 24 months or longer, the risk of lumbar vertebral osteoporosis was significantly higher than in those who breastfed for less than 12 months (odds ratio = 2.73, 95% confidence interval = 1.18–6.32). CONCLUSION: Breastfeeding duration may affect the occurrence of lumbar vertebral or femoral neck osteopenia or osteoporosis. Therefore, women who breastfeed for one year or more require education on the risk of bone loss and the need for preventive measures such as adequate calcium intake and physical exercise.

Influencing Factors and Consequences of Near Miss Experience in Nurses' Medication Error

PURPOSE@#This study aimed to predict the influencing factors and the consequences of near miss in nurses' medication error based upon Salazar & Primomo's ecological system theory.@*METHODS@#A convenience sample of 198 nurses was recruited for the cross-sectional survey design. Data were collected from July to September 2016. Using the collected data, the developed model was verified by structural equation modeling analysis using SPSS and AMOS program.@*RESULTS@#For the fitness of the hypothetical model, the results showed that χ² (χ²=258.50, p<.001) was not fit, but standardized χ² (χ²/df=2.35) was a good fit for this model. Additionally, absolute fit index RMR=.06, RMSEA=.08, GFI=.86, AGFI=.81 reached the recommended level, but the Incremental fit index TLI=.82, CFI=.85 was not enough to reach to the recommended level. With the path diagram of the hypothetical model, caution (β=−.29 p<.001), patient safety culture (β=−.20, p=.041), and work load (β=.18, p=.037) had a significant effect on the near miss experiences in nurses' medication error, while fatigue (β=−.06, p=.575) did not affect it. Moreover, the near miss experience had a significant effect on work productivity (β=−.25, p=.001).@*CONCLUSION@#These results have shown that to decrease the near miss experience by nurses and increase their work productivity in hospital environments would require both personal and organizational effort.

Usefulness of Korean Version of Behavioral Cue Checklist for Predicting of Patient Violence in Emergency Departments

PURPOSE: This study aimed to evaluate the usefulness of a behavioral cue checklist (BCC) containing 17 items developed by Wilkes et al. (2010) for identifying potentially violent patients in emergency departments. METHODS: This was a prospective observational study to evaluate the usefulness of the Korean version of a BCC (K-BCC) as an assessment tool for predicting patient violence in emergency departments, and was conducted over 4 weeks in a regional emergency medical center located in B City. A total of 1,324 patients were finally analyzed. RESULTS: Logistic regression analysis was performed to investigate whether each item of the K-BCC predicts violence, and a parsimonious set of 8 statistically significant items was selected for the tool. Receiver operating characteristic analysis of the BCC showed that the area under the curve was .97 (95% confidence interval: .94~1.0). The sensitivity, specificity, positive predictive value, and negative predictive value at the cut-off score of 2 were 75.6%, 98.9%, 68.2%, and 99.2%, respectively. CONCLUSION: The K-BCC was found to be useful in predicting patient violence toward emergency department staff. This tool is simple, and fast to use and can play a significantly role identifying potentially violent patients. Owing to this advance identification, this tool can be helpful in preventing the potential for violence from manifesting as violent behaviors.

A Study of Subjectivity among Nursing Students Regarding Suicide Attempters / 한국간호교육학회지

PURPOSE: To identify the types and characteristics of subjective structures among nursing students toward individuals who attempt suicide. METHODS: A group of 32 third- and fourth-year nursing students with experience in clinical practice rated 35 Q-statements on a nine-point scale according to their opinion. Data analysis was conducted using the PC-Quanl program. RESULTS: Subjectivity among nursing students toward individuals who attempt suicide was analyzed for three types. Type 1 (social responsibility emphasis) subjectivity recognizes the social responsibility for suicide attempts and emphasizes the importance of social support systems as a preventive effort. Type 2 (rational reprimand) subjectivity emphasizes the willpower and effort to overcome challenges in life, because happiness and unhappiness are dependent on one's thoughts and will. Type 3 (situation acceptance) subjectivity regards the suicide attempt as an optional means to avoid a deeply strenuous, painful, and difficult situation. CONCLUSION: This study investigated the subjectivity of nursing students toward individuals who attempt suicide and to provide a better understanding of them. In addition, the development of training programs that take advantage of the subjective characteristics of individuals based on subjectivity types demonstrated in this study is expected to provide nursing students with useful educational materials for their future careers as nurses.

Nurses' Safety in the Hospital Environment: Evolutionary Concept Analysis / 간호행정학회지

PURPOSE: The purpose of this study was to analyze the concept of nurses' safety within the context of the hospital environment. METHODS: We used Rodgers' method of evolutionary concept analysis and reviewed the relevant literature and noted and categorized characteristics that appeared frequently. RESULTS: Nurses' safety was defined as safe status and safe activity among nurses. Three key defining attributes were identified as: (a) the minimization of actual or perceived risk, (b) personal duties and rights, and (c) ensuring within a safe working environment. Antecedents of nurses' safety were categorized into three dimensions: (a) individual, including vigilance and knowledge gained through education and training; (b) institutional, including safety provision in the organizations; and (c) national, including legislation. The outcomes of nurses' safety included the following: (a) continued competence in nurses' work; (b) enhancement of the quality of patient care; and (c) reductions in nurses' turnover rates. CONCLUSION: Nurses' safety ensures that qualified nurses are able to continue to perform their duties and provide good patient care. The findings of this study could contribute to future research examining nurses' safety. In addition, appropriate tools must be developed to measure the concept.

Factors Affecting Prostate Cancer Screening Behavior

PURPOSE: This study was to examine the factors affecting prostate cancer screening behavior in Korean men using the health belief model (HBM). METHODS: It was a descriptive cross-sectional survey. A total of 121 participants answered questionnaires which included general characteristics, knowledge, and HBM variables related to prostate cancer and prostate cancer screening tests. RESULTS: Only 18 participants (14.9%) had had a prostate cancer screening test before. Participants who had had a prostate cancer screening test were more likely to perceive lower health status (odds ratio: 0.61 [95% confidence interval: 0.39, 0.93]), higher perceived sensitivity (odds ratio: 3.55 [95% confidence interval: 1.11, 11.36]), and higher self-efficacy (odds ratio: 5.77 [95% confidence interval: 1.51, 22.08]) than participants who had not had a test. CONCLUSION: We recommend developing an educational program which can increase the level of perceived sensitivity and self-efficacy to involve themselves in prostate cancer screening test actively.

Effect of Nurses' Job Stress on Job Satisfaction: Mediating Effect of Head Nurses' Emotional Leadership Perceived by Nurses / 간호행정학회지

PURPOSE: The purpose of this study was to identify the mediating effect of head nurses' emotional leadership as perceived by nurses in the relationship between nurses' job stress and job satisfaction. METHODS: Study participants were 278 staff nurses currently working at two university hospitals in Busan, Korea. SPSS/WIN 21.0 program was used for data analysis to analyze descriptive statistics, t-test, correlation, and stepwise multiple regression. The significance level was set at p<.05. RESULTS: Nurses' job satisfaction had a significant correlation with job stress (r=-.31, p<.001) and emotional leadership of nurse managers as perceived by nurses (r=.53, p<.001). Also, head nurses' emotional leadership experienced by nurses had a partial mediating effect in the relationship between nurses' job stress and job satisfaction. CONCLUSION: The results of this study show that the nurse managers' emotional leadership has an important influence on nurses' job stress and job satisfaction. Therefore, head nurses' emotional leadership is very important for effective human resource management and the hospital should offer education and training to booster head nurses' leadership by developing emotional intelligence to promote staff job satisfaction.

Validity and Reliability of ARQ-K (Korean Version of the Assault Response Questionnaire) for Emergency Department Nurses in Korea

PURPOSE: To investigate the validity and reliability of the Korean Version of the Assault Response Questionnaire (ARQ-K) measuring the intensity of reaction to victimization of emergency nurses in Korea. METHODS: An internal consistency reliability and construct validity using exploratory and confirmatory factor analysis were conducted using SPSS WIN (20.0) and AMOS (20.0). Survey data were collected from 321 nurses who worked in 3 levels - wide regional emergency centers, regional emergency centers, appointed emergency centers - of emergency care facilities in Busan, Korea. RESULTS: The Cronbach's alpha values regarding internal consistency were .77~.93 for the subscales of ARQ-K. Factor loadings of the 26 items on the four subscales ranged from .59 to .84. The four-subscale model was validated by confirmatory factor analysis (chi2/df=3.85, p < .001, RMR=.06, GFI=.80, NFI=.81, TLI=.83, CFI=.85, RMSEA=.09). CONCLUSION: This study shows that the Korean Version of the Assault Response Questionnaire is a valid and reliable instrument to assess nurses' reaction to victimization of emergency nurses in Korea.

Concept Analysis of Health Inequalities / 간호행정학회지

PURPOSE: The purpose of this study was to explore ways to define the concept of health inequality. METHODS: The concept analysis process by Walker and Avant was used to clarify the meaning of health inequality. RESULTS: Defining attributes of health inequality included differences in health status between individuals or groups, infringement of fundamental rights to health, unfair use of medical services, and social discrimination. The antecedents of health inequality included differences in demographic characteristics (age, gender, education, occupation, residential location), limitations in accessibility to health care, and social exclusion. Consequences of health inequality were increased costs for medical care, decreased health-related quality of life, and lack of ability to cope with health problems resulting in crisis situations, increases in morbidity and mortality, and shortening of life span. The concept was clarified through presentation of model, borderline, related, and contrary cases. CONCLUSION: Results of this study can be used to guide the direction of future studies through concept analysis in which conceptual attributes in the context of health inequality are examined. Also, based on the result of this study, development of standardized tools to measure health inequality is recommended as well as development of educational programs to reduce health inequalities.

Factors Influencing Human Papillomavirus Vaccination Adoption Stages Based on the Precaution Adoption Process Model

PURPOSE: This study aimed to identify the factors influencing human papillomavirus (HPV) vaccination adoption stages using the Precaution Adoption Process model. METHODS: A total of 173 female university students from B metropolitan city participated. Demographics, factors contributing to action, knowledge, health beliefs, and self-efficacy related to the HPV vaccination were measured. The collected data were analyzed using descriptive statistics and multiple logistic regression analysis using SPSS for Windows version 21.0. RESULTS: Factors that contributed to the transition from the unaware and unengaged stages to the undecided about action stage included age, economic status, experience of recommendation from doctors, perceived severity of cervical cancer, and perceived barriers. Factors that contributed to the transition from the undecided about action stage to the deciding to act stage were perceived benefit and self-efficacy of the HPV vaccination. Factors that contributed to the transition from the deciding to act stage to the acting and maintenance stages were experience of recommendation from doctors and perceived severity of cervical cancer. CONCLUSION: These results suggest that aggressive HPV vaccination campaigns increase awareness. Further studies should develop tailored strategies for promoting HPV vaccination that emphasize health beliefs and self-efficacy.