[A comparison study using mixed methods on foreign residents' satisfaction with Korean health care services].

PURPOSE: This study was conducted to examine and compare satisfaction with Korean health care services for Americans, Chinese and Russians who resided in Korea. METHODS: A questionnaire was distributed to 252 participants (81 Americans, 89 Chinese, 82 Russians). Three focus group interviews were subsequently conducted in order to obtain a greater understanding of participants' experience and perspectives. RESULTS: The average satisfaction score was 3.09, with Americans and Russians showing significantly higher scores than Chinese. Overall, participants reported higher satisfaction in 'Facility', 'Quality of care' and 'Nursing services' as opposed to 'Information/education'. 'Care with cultural respect' as well as communication related services. Data from the focus group interviews were categorized into 12 sub-categories, 7 categories and 2 themes. The two themes were common experience and contrasting experience. Common experience included 4 categories, 'Quality of care', 'Hospital facility and health care system', 'Language barrier' and 'Information and education'. Contrasting experience included 3 categories, 'Medical cost', 'Health care personnel' and 'Accessibility'. CONCLUSION: Results of this study provide basic knowledge on foreign residents' satisfaction and experience with Korean health care services. Further research is needed with foreigners from different cultural backgrounds. Administrative and educational efforts are required to improve communication skills and cultural competency.

Effect of a structured skin care regimen on patients with fecal incontinence: a comparison cohort study.

PURPOSE: The purpose of this study was to measure the effect of a structured skin care regimen for critically ill patients with fecal incontinence. DESIGN: A nonrandomized, quasi-experimental research design (comparison cohort) was used for data collection. SUBJECTS AND SETTING: Seventy-six patients with fecal incontinence, Bristol stool form 5, 6, and 7, and Braden Scale score of 16 or less in the intensive care units (ICUs) at Samsung Medical Center in Seoul, South Korea, participated in the study. METHODS: Of the 76 subjects enrolled, 38 were assigned to the experimental group and 38 to the control group. Participants in the active intervention group were being cared for in an ICU; participants in the comparison group were cared for on cardiac, thoracic surgery, general surgery, and neurosurgical ICUs. A structured skin care regimen was developed and implemented, which included the regular use of a no-rinse skin cleanser, application of a skin protectant, and an indwelling fecal drainage system when indicated. Stool consistency was evaluated via the Bristol stool chart. Nurses trained in data collection determined Incontinence-Associated Dermatitis and its Severity (IADS) scores and assessed the perianal and sacral skin for occurrence of pressure ulcers daily over a 7-day period. RESULTS: Patients in the intervention group had significantly lower IADS scores (t = 4.836, P < .001) than subjects in the control group and were less likely to develop a pressure ulcer than were patients in the control group (5 vs. 19, χ2 = 11.936, P = .001). Patients with higher IADS scores were significantly more likely to develop a pressure ulcer (OR = 1.168, 95% CI = 1.074-1.271). CONCLUSION: A structured skin care regimen decreased IADS scores and occurrence of pressure ulcers. Higher IADS scores were associated with an increased risk for development of pressure ulcers.

[Structural equation modeling on health-related quality of life in patients with obstructive sleep apnea].

PURPOSE: This study was done to test structural equation modeling of health-related quality of life (QOL) of men with obstructive sleep apnea in order to identify parameters affecting QOL and provide guidelines for interventions and strategies to improve QOL in these patients. METHODS: Model construction was based on 'The conceptual model of patient outcome in health-related QOL' by Wilson and Cleary, using the variables; age, physiological factors, social support, cognitive appraisal, symptoms and QOL. Participants were 201 adult male patients recruited at a tertiary university hospital in Seoul. Data were collected via questionnaires, polysomnography, and clinical records. RESULTS: Age and symptoms directly influenced QOL. Social support and cognitive appraisal about sleep did not have a direct influence on QOL, but indirectly affected it via symptoms. QOL was lower in patients who were younger and had more severe symptoms. Symptoms were more severe for patients with lower social support and more dysfunctional cognitive appraisal. When social support was lower, cognitive appraisal was more dysfunctional. CONCLUSION: These results suggest it is necessary to not only manage symptoms, but also apply interventions to increase social support and cognitive appraisal about sleep in order to increase QOL in patients with obstructive sleep apnea.

[Experiences of family caregivers of patients with terminal cancer].

PURPOSE: This study done to identify the experiences of families caring for patients with terminal cancer. The question was, "What is the caregiving experience of a family who has a member with terminal cancer?" METHODS: Grounded Theory was applied and in-depth interviews were done with 11 family members. Interviews were recorded with the interviewees' consent and were transcribed and analyzed. Participants' relationships to patients were 6 spouses, 4 daughters, and 1 mother. The ages of the participants were between 32 and 62, with an average of 47.5. RESULTS: The study showed "enduring with bonds" as the main category and the main factor affecting this category was the "patients' diagnosis of terminal cancer." The caregiving experience was divided into four stages: shock, confusion, struggle, and acceptance. Mediating factors were relationship with the patient, intimacy with the patient, social support, communication, and trust. Conclusively, participants underwent internal maturity, and changes occurred in family and social and personal life. CONCLUSION: The families took care of the patients with responsibility and love. The study results should help with the understanding of a family with a member with terminal cancer and should be used to develop nursing, mediating, and consulting programs for these caregivers.

Nurses' perceptions of medication errors and their contributing factors in South Korea.

AIM: The aim of this study was to identify Korean nurses' perceptions of medication errors. BACKGROUND: Knowing nurses' perceptions of medication errors is important in developing prevention strategies for medication errors. METHODS: A cross-sectional descriptive survey was conducted. A convenient snowballed sample of 220 nurses from seven hospitals was obtained. Participants were asked to identify contributing factors of medication errors, reporting and strategies to prevent medication errors. RESULTS: A total of 224 of 330 (67.9%) questionnaires were returned. Over half (63.6%) of the participants had been involved in medication errors once or more in the past month. For factors contributing to medication errors, 99 nurses (45.0%) answered 'advanced drug preparation and administration without rechecking'. Only 13.5% of participants informed patients and their families of medication errors and 28.3% of participants submitted an incident report. Medication errors occurred most often during the day-shift. CONCLUSIONS: Developing strategies to reduce nurses' fear of punishment and supporting nurses' attitudes in a constructive manner are needed. IMPLICATIONS FOR NURSING MANAGEMENT: Effective strategies for nursing are needed, particularly during the day-shift, and during routine medication administration. In addition, non-punitive reporting systems of medication error should be established and patients should be included in reporting.

A comparative study on the validity of fall risk assessment scales in korean hospitals.

PURPOSE: The purpose of this study was to compare the validity of three fall risk assessment scales including the Morse Fall Scale (MFS), the Bobath Memorial Hospital Fall Risk Assessment Scale (BMFRAS), and the Johns Hopkins Hospital Fall Risk Assessment Tool (JHFRAT). METHODS: This study was a prospective validation cohort study in five acute care hospitals in Seoul and Gyeonggi-Do, Korea. In total, 356 patients over the age of 18 years admitted from December 2009 to February 2010 participated. The three fall risk assessment scales listed above were tested for sensitivity, specificity, positive predictive and negative predictive values. A receiver-operating characteristic (ROC) curve was generated to show sensitivities and specificities for predicting falls based on different threshold scores for considering patients at high risk. RESULTS: Based on the mean scores of each scale for falls, the MFS at a cut-off score of 50 had a sensitivity of 78.9%, specificity of 55.8%, positive predictive value of 30.8%, and negative predictive value of 91.4%, which were the highest values among the three fall assessment scales. Areas under the curve of the ROC curves were .761 for the MFS, .715 for the BMFRAS, and .708 for the JHFRAT. CONCLUSIONS: Accordingly, of the three fall risk assessment scales, the highest predictive validity for identifying patients at high risk for falls was achieved by the MFS.

[Educational needs assessment on research ethics among nursing researchers].

PURPOSE: This study aimed to investigate the educational needs of research ethics among nursing researchers. METHODS: Convenience sample of 161 nursing professors and 262 master or doctoral nursing students participated in the study. Data was collected with self-reported questionnaire from June to August 2009, and analyzed with descriptive statistics using SPSS WIN (version 14.0). RESULTS: Among 161 nursing professors, about 31.7% has educated nursing ethics in the postgraduate course. The most common course was nursing research or methodology (62.7%), and median education time was 2 hr. Areas that showed difficulty in understanding was the conflict of interest and plagiarism for professors and falsification and fabrication for graduate students. Average knowledge on the research ethics was 75.4 points for professors and 61.6 points for students based on the 100 points. CONCLUSION: Educational needs of research ethics among nursing professors and students in the postgraduate course was high. We recommend both basic and advanced research ethics educational programs for the nursing researchers. The basic course should be at least 6 hr and include various cases and something to discuss.

[Model construction of sexual satisfaction in patients with a colostomy].

PURPOSE: This study was designed to construct and test the structural equation model on sexual satisfaction in patients with a colostomy. METHODS: The model construction was based upon Roy's adaptation model. Stoma-related discomfort (SRD), age, frequency of sexual intercourse, treatment modality, and gender affect sexual satisfaction and are mediated by physical, psychosocial, and interdependence modes. Each mode was conceptualized as sexual function, body image/depression, and marital intimacy. The patients were 112 colostomates with colorectal cancer who were asked to complete a mail-back survey on their demographic data, SRD, body image, depression, marital intimacy, sexual function, and sexual satisfaction. Data were analyzed using SPSS WIN 15.0 and AMOS WIN 7.0. RESULTS: Significant variables for sexual satisfaction in the final model were body image affected by SRD, depression affected by body image and SRD, marital intimacy affected by depression, and sexual function affected by marital intimacy. CONCLUSION: The results of this study suggest that specific guidelines for SRD are necessary to improve sexual satisfaction among colostomates. Nurses should be vigilant in monitoring depression and body image disturbance, and providing appropriate interventions to increase marital intimacy. Treatment modality, gender, and age should be considered in developing education programs pertaining to sexuality.

An evaluation of Web-based education as an alternative to group lectures for diabetes self-management.

This study evaluated the efficacy of Web-based diabetes self-management education for newly diagnosed patients with type II diabetes as an alternative to group lectures. Using a non-equivalent control group, pretest-post-test design, the participants in the Web group (n = 15) took part in a Web-based diabetes self-management program, while those in the lecture group (n = 16) attended 3 h of group lectures provided by health-care professionals specializing in diabetes care. The outcome variables were measured at the baseline (T0), and 6 weeks (T1) and 3 months (T2) after the interventions. The glycosylated hemoglobin (HbA1c) percentage and diabetes care knowledge in the Web group improved significantly from T0 to T1, while the diabetes care behavior improved significantly from T0 to T1 and from T1 to T2. The diabetes care knowledge and diabetes care behavior in the lecture group improved significantly from T0 to T1, but the HbA1c percentage did not change significantly between any times. These results show the potential of the Web-based program as an alternative to group lectures for diabetes self-management education.

[Application and evaluation of a web-based education program on blood-borne infection control for nurses].

PURPOSE: To develop a web-based program on blood-borne infection control and to examine the effect of the newly developed program on perceived threat of diseases, knowledge, preventive health behaviors for blood-borne infections, and incidence rates of accidental needle sticks and other sharp object injuries in nurses. METHODS: The program was developed through the processes of analysis, design, development, implementation, and evaluation. The research design involved a nonequivalent control group for pretest and posttest experiments. The setting was a 745-bed general hospital located in Korea. RESULTS: The program was designed and developed after consulting previous studies. After development of the program was completed, it was evaluated and revised by a panel of experts. The total score for perceived threat of diseases, knowledge, preventive health behaviors in the experimental group was significantly higher compared to the control group (p<.05). The incidence rates for needle sticks and other sharp object injuries in the experimental group were significantly lower compared to the control group (p<.05). CONCLUSION: Application of a Web-based, blood-borne infection control program is effective, and can be expanded to other healthcare workers who also have a high risk of blood-borne infections.

[A study on exercise behavior, exercise environment and social support of middle-aged women].

PURPOSE: The purpose of this study was to identify exercise environments and social support associated with exercise behaviors in middle-aged women. METHOD: Subjects were 207 women aged between 41 and 59 yr in an urban community. The research instruments utilized in this study were exercise stages, exercise environments, exercise partners and social support scale. Subjects were given a self-report questionnaire. Data was analyzed using the SPSS Win program. RESULT: The subjects were in the stages of precontemplation (3.4%), contemplation (25.1%), preparation (40.6%), action (5.8%), and maintenance (25.1%). Subjects who engaged in regular exercise were 30.9%. The mean score of the exercise environment was 6.34. The mean score of social support was 21.28, and 65.7% of subjects had exercise partners. The score of the exercise environment was significantly associated with the exercise stage (p=.01). The number of exercise partners of regular exercise groups was significantly greater than that of non-regular exercise groups (p=.00). The score of social support of regular exercise groups was significantly greater than that of non-regular exercise groups (p=.00). The score of social support was significantly associated with the exercise stage (p=.00). CONCLUSION: Exercise environments and social support need to be considered in planning exercise programs to improve exercise behavior among middle-aged women.

[Task analysis of the job description of gerontological nurse practitioners based on DACUM].

PURPOSE: The aim of this study was to develop and to analyze the task of gerontological nurse practitioners (GNPs) in Korea. METHODS: The definition of GNP and job description was developed based on developing a curriculum (DACUM) by 7 panels who have experienced in DACUM analysis and gerontological nursing. One hundred sixty nurses who were working at long term care facilities were participated. The questionnaire included frequency, importance, and difficulty of duties, tasks, and task elements. The data were collected in November 2006, analyzed by descriptive statistics. RESULTS: The job description of GNPs in Korea revealed 5 duties, 23 tasks, and 86 task elements. On the all five duties, the highest duty in frequency and in importance was professional nursing care (3.25+/-0.35, 3.49+/-0.29). But the highest duty in difficulty was research (3.24+/-0.46). 'Prevent health problem (3.42+/-0.43, 3.56+/-0.33)', 'Teach other staffs (2.83+/-0.77, 3.39+/-0.43)', 'Develop the evidence-based standards (2.43+/-0.76, 3.22+/-0.43)', 'Develop the self (2.81+/-0.65, 3.26+/-0.42)', and 'Participate the team activities' were the highest score in frequency and in criticality of tasks. 'Provide emotional support to older adults and families (3.16+/-0.41)', 'Counsel older adults and their families (3.14+/-0.49)', 'Do clinical research (3.32+/-0.49)', 'Quality insurance (3.25+/-0.49)', and 'Build collaborative system (3.18+/-0.47)' were perceived the most difficult tasks. CONCLUSION: The political efforts for the legislation of role and task of GNPs were needed.

[Illness experience of people with chronic hepatitis B in Korea].

PURPOSE: The purpose of this study was to explore the experiences of people with chronic hepatitis B (CHB) in Korea. The specific aim was to identify major problems that people with CHB face and strategies that they are dealing with. METHODS: A grounded theory method was utilized. The data were collected by individual in-depth interviews from 12 CHB patients from one of the major hospitals in Korea. RESULTS: After constant comparative analysis, a core category emerged as "illness management with self-reliance and will." Seven major strategies that were identified in dealing with the illness were maintaining receptive and positive attitudes; restraining excessive work and greed; searching for information; controlling illness information; adhering to practices for not spreading the viral disease; abstaining from alcohol and smoking and maintaining healthy eating habits; nd using alternative therapies. The outcomes that result from employing these strategies were identified as burden, depression and helplessness, stress for maintaining compliance, and dispirited interpersonal relationships. CONCLUSION: The results of this study suggest that most people with CHB in Korea have problems in psychosocial area. Thus health professionals need to provide not only informational support but also emotional one to improve quality of life of the people with CHB.

[Educational issues and strategies to improve APN education].

PURPOSE: This study was aimed at exploring the current status of graduate programs for an advanced practice nurse(APN) to recommend future directions of APN education. METHODS: A total of 142 students enrolled in seven APN specialty programs, 67 professors who were involved in APN education, and nine nurse administrators participated in the study. Data was collected by questionnaires and focus group interviews. RESULTS: The current definition of APN was found not to be specific enough to represent expected roles of APN in regards to knowledge, attitudes, roles, and skills. Standard curricula employed regardless of the area of APN specialty, lack of qualified clinical practice settings, as well as prepared instructors were found to be problematic. CONCLUSION: The following needs to be addressed: 1. redefining of APN roles, 2. tailoring specialty areas of APN, 3. consolidating educational programs, and 4. ensuring APN role models and faculty. Suggesting a CNS role in Korean APN, areas of APN should be rearranged to clarify their roles and educational programs need to be further developed to meet the expectations and quality of APNs. It is necessary to ensure APN's employment in the health care system by laws and policies to perform advanced nursing roles.

Subjective and objective caregiver burden in Parkinson's disease.

PURPOSE: Parkinson's disease (PD) is a common neurodegenerative disorder characterized by motor disabilities and increasing dependence on others for daily life activities with consequent impact on patients' and caregivers' quality of life. The aim of this study was to elucidate the burden on primary caregivers of patients with PD, and identify related factors. METHODS: A cross-sectional descriptive study. Seventy-six primary caregivers of PD patients in a neurology outpatient clinic, Seoul, Korea completed structured questionnaires, of which 68 were analyzed. The structured self-report questionnaire included (1) demographic information on the caregivers, (2) information regarding the disease characteristics of the patients, and (3) the subjective and objective caregiver burdens as assessed on Montgomery, Gonyea, & Hooyman's scale. RESULTS: The mean age of the caregivers was 54.56 years, and spouses represented the largest proportion(47.0%). Caregivers of PD patients experienced high levels of burden (mean scores on the subjective and objective burdens were 45.22 and 34.90, respectively), which were comparable to the caregiver burdens in stroke, and higher than the caregiver burdens in general chronic disease. Older caregivers and spousal caregivers experienced significantly higher burdens (p=.004 and p=.019, respectively). A greater motor disability and higher modified Hoehn and Yahr grade were related to higher caregiver burden (p=.001 and p=.018, respectively). CONCLUSION: Caring for PD patients is associated with a high level of caregiver burden. Therefore, healthcare professionals should identify the burden of caregivers who look after PD patients and develop comprehensive management strategies both for patients and their caregivers.

Comfort and quality of life of cancer patients.

PURPOSE: This study aimed to quantify the comfort level and quality of life (QoL) of cancer patients, to identify the variables associated with comfort level and QoL, and to identify the relationship between comfort level and QoL. METHODS: This was a cross-sectional descriptive study. The participants comprised 100 cancer patients, of which 98 were analyzed. Participants completed a self-reporting questionnaire that included the Hospice Comfort Questionnaire and the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire-C30 at outpatient clinics, inpatient units, at home, and a day-care chemotherapy unit. RESULTS: The mean age of the participants was 53.36 years, and 56.1% of them were female. The mean ± standard deviation score for total comfort was 61.50 ± 12.02, with the sociocultural comfort score being the highest (71.05 ± 16.01), followed by physical comfort (60.30 ± 16.71), psychospiritual comfort (57.65 ± 16.81), and environmental comfort (56.32 ± 16.86). There were significant subgroup differences in educational attainment, the site where they completed the questionnaire, and perceived disease status and prognosis. The QoL score for global health status was 46.34 ± 20.76, and comfort was significantly correlated with all dimensions of QoL (r = -.549 - .581). CONCLUSION: This study showed lower comfort level in psychospiritual and environmental comfort than physical and sociocultural comfort in cancer patients. Improvement in environment and psychospiritual support is suggested as strategies to enhance the comfort of cancer patients.

Quality evaluation of randomized controlled trials on complementary and alternative medicine.

PURPOSE: This study aims to describe the research characteristics and analyze the methodological quality of randomized clinical trials on complementary and alternative medicine (CAM). METHODS: A total of 76 studies using randomized controlled trials (RCTs) on CAM (16 by Koreans, 60 by internationals) published in the 6 years from 2000 to 2005 were reviewed systematically and analyzed with assessment criteria developed by the researchers on the basis of Jadad guidelines. RESULTS: Most of the studies were carried out in the area of medicine, nursing and CAM. More than 80% of the study subjects were patients. CAM modalities for independent variables were mainly on energy medicine, mind-body medicine and manipulative and body-based practices, while dependent variables were mostly physiological and psychological indexes. Most of the studies utilized randomization (93.4%) and identified the dropout rate (90.8%), whereas allocation concealment (49.3%) and double-blinding (18.9%) were specified in a small number of studies. The overall quality of RCTs based on the assessment criteria of this study was satisfactory. However, the quality score of the Korean studies (2.87) was lower than that of the international studies (3.37). CONCLUSION: The methodological objectivity of CAM studies has been improving in spite of controversy over the scientific bases of CAM. More Korean studies with rigorous experimental design are needed to build up the evidence-based practice of CAM.

Effects of aromatherapy massage on anxiety and self-esteem in korean elderly women: a pilot study.

This study investigated the effects of aromatherapy massage on the anxiety and self-esteem experienced by Korean elderly women. A quasi-experimental, control group, pretest-posttest design was used. The subjects comprised 36 elderly females: 16 in the experimental group and 20 in the control group. Aromatherapy massage using lavender, chamomile, rosemary, and lemon was given to the experimental group only. Each massage session lasted 20 min, and was performed 3 times per week for two 3-week periods with an intervening 1-week break. The intervention produced significant differences in the anxiety and self-esteem and no significant differences in blood pressure or pulse rate between the two groups. These results suggest that aromatherapy massage exerts positive effects on anxiety and self-esteem. However, more objective, clinical measures should be applied in a future study with a randomized placebo-controlled design.

[Research trend of complementary and alternative medicine].

PURPOSE: This study was done to describe the research trend of Complementary and Alternative Medicine(CAM) in Korea and internationally. METHOD: A Systematic review of CAM related literature published from 2000 to 2005 was done. A comprehensive search by using 34 CAM modalities as search terms to identify all articles dealing with CAM was undertaken from 4 databases: PubMed, RICHIS, KoreaMed, and Riss4U. A Total of 588 abstracts and 223 original articles were reviewed by two independent reviewers using systematic analysis guidelines. Data regarding the types of study design, characteristics of subjects and researchers, and classification of CAM modalities was recorded. The outcome measures of CAM were identified. RESULTS: CAM research has been rapidly increasing worldwide in the last decade. In Korea, nursing(53.5%) followed by medicine(42.7%) occupied the majority of CAM research in comparison to medicine(42.9%) and disciplines in CAM(25.0%), like homeopathy, internationally. Prevailing research designs in Korea were experimental and quasi-experimental, however, randomized clinical trials were found. Internationally, survey research was dominant, with the exception of randomized clinical trials that were mostly an experimental design. CONCLUSION: The findings suggest that a robust research design in CAM research is needed to accumulate strong scientific evidence and to adopt nursing interventions from CAM modalities.