Association between type 2 diabetes mellitus and depression among Korean midlife women: a cross-sectional analysis study.

BACKGROUND: The prevalence of depression is higher among midlife women, and they have less control over their diabetes during the menopausal transition. However, there is limited evidence on the association between type 2 diabetes mellitus and depression among Korean women in their midlife. This study aimed to examine the association between type 2 diabetes mellitus and depression and explore the levels of awareness and treatment of depression among Korean midlife women with T2DM. METHODS: This is a cross-sectional analysis study conducted using data from the Korea National Health and Nutrition Examination Surveys of 2014, 2016, and 2018. Korean women aged 40-64 years who randomly participated in the surveys were included, and 4,063 midlife women were selected as study participants. The diabetes progression status of the participants was classified into diabetes, pre-diabetes, and non-diabetes. Furthermore, the Patient Health Questionnaire-9 was used for screening depression. Participants' awareness rate, treatment rate among incident cases of depression, and treatment rate among awareness cases of depression were also analyzed. For data analysis, the Rao-Scott χ2 test, multiple logistic regression, and linear regression were conducted using SAS 9.4 software program. RESULTS: The prevalence of depression significantly differed between diabetes, pre-diabetes, and non-diabetes groups. However, depression awareness, treatment/incident, and treatment/awareness rates did not differ statistically between the diabetes progression status groups. Compared to the non-diabetes group, diabetes group had a higher odds ratio of depression after adjusting for general and health-related factors. Thus, the diabetes group had significantly higher PHQ-9 scores than the non-diabetes group after adjusting for covariates. CONCLUSIONS: Women in their midlife who have type 2 diabetes mellitus tend to have higher levels of depressive symptoms and are at risk of depression. However, we found no significant differences between diabetes and non-diabetes regarding the awareness and treatment rates of depression in South Korea. We recommend that future studies focus on developing clinical practice guidelines aimed at additional screening and intervention for depression in midlife women with type 2 diabetes mellitus to ensure prompt treatment and improved outcomes.

Development of a discharge education program using the teach-back method for heart failure patients.

BACKGROUND: Heart failure (HF) patients have difficulties in self-management after discharge. This study aimed to develop a discharge education program for HF patients using the teach-back method (TBM). METHODS: As a methodological study to develop a program, we applied the analysis, design, development, implementation, and evaluation (ADDIE) model comprised of (1) analysis using EMR data, systematic review, and focus group interviews, (2) design and development of a program draft, (3) tests of program validity using 15 experts, 10 nurses, and 10 patients, and (4) development of the final program. The content validity index (CVI), and understandability and actionability of the educational material were used. RESULTS: The discharge education program provides definitions and information about medication, symptom/weight/diet management, physical activity, and other precautions. The educational method uses TBM. The overall CVI for the program was 0.96, and all item CVIs were greater than 0.8. The understandability and actionability were 90.2 and 91.3 % in patients, and 94.6 and 86.8 % in nurses. The contents and methods of the program were appropriate for patients and providers. CONCLUSIONS: We expect the discharge education program using TBM to enhance self-management among HF patients. The process we used to develop this program could guide researchers and clinical practice.

Undergraduate nursing students' experience of learning respiratory system assessment using flipped classroom: A mixed methods study.

BACKGROUND: Knowledge and skill acquisition to perform an accurate respiratory system assessment is a key competency expected in undergraduate nursing students. Learning physical assessment requires the integration of multiple knowledge bases and skills; hence, applying an innovative teaching approach, such as the flipped-classroom (FC) approach, fosters an active and student-centered learning environment for physical assessment class. OBJECTIVES: This study evaluated FC's feasibility in delivering respiratory system assessment content in a health assessment course and explored the changes in nursing students' perceptions regarding student-centeredness and active learning environments before and after applying FC. DESIGN: A single group pre- and post-test concurrent mixed-methods design was used. SETTINGS: This study was conducted in a private nursing college in South Korea. PARTICIPANTS: A convenience sample of 91 second year undergraduate nursing students enrolled in a health assessment course. METHODS: FC was offered at one didactic session of a physical assessment course. In the FC, students completed a self-directed pre-class activities using online lecture videos and reading materials prior to the class and participated in interactive team-based learning activities inside the classroom. Skills lab practicum took place after the FC. Students' perceptions regarding student-centeredness and active learning environments, in terms of teaching, social, and cognitive presences were measured before (T1) and after (T2) conducting the FC. Qualitative data were obtained at T2 using free-response questions, which required students to comment on their FC experience. RESULTS: Participants' perceptions of student-centeredness significantly increased from T1 to T2. Although student-perceived teaching and social presence in their learning environment showed upward trends from T1 to T2, these changes were not statistically significant. Students considered FC an acceptable approach to foster active learning in a supportive learning environment. CONCLUSIONS: This study revealed that incorporating FC to deliver respiratory system assessment content was feasible and considered acceptable by undergraduate nursing students.

Effectiveness of Discharge Education With the Teach-Back Method on 30-Day Readmission: A Systematic Review.

OBJECTIVES: Teach-back methods are reported to improve patient outcomes by encouraging patient understanding and participation and are increasingly being used in various clinical settings. This study attempts to identify the effectiveness of discharge education using the teach-back method on 30-day readmission. METHODS: MEDLINE, CINAHL, Embase, The Cochrane Library, and Web of Science were used to search experimental studies. The search terms were "discharged patient," "teach-back," and "30-day readmission" published in English up until July 2017. Two trained reviewers performed a critical appraisal of retrieved studies using the Risk of Bias Assessment tool for Nonrandomized Studies. Data were analyzed using Cochrane Review Manager (Revman) software 5.2. RESULTS: A total of five studies were analyzed (3 studies on heart failure, 1 study on total joint replacement, and 1 study on a coronary artery bypass graft). The main content of the teach-back education was to confirm and reinforce the patients' comprehension of health-related information. Among the five studies, three studies were included in the meta-analysis. The odds ratio of 30-day readmission for discharge education with the teach-back method and usual care was 0.55 (95% confidence interval, 0.34-0.91; P = 0.02). The I2 score was 0%, which means that the analyzed studies are homogeneous. CONCLUSIONS: The results indicate that discharge education with the teach-back method resulted in a 45% reduction in 30-day readmission. However, only a few studies were included in the analysis, and they showed a high risk of selection bias. Therefore, we suggest that well-designed randomized controlled trials be conducted.

The association of depressive symptoms to sleep-related symptoms during menopausal transition: racial/ethnic differences.

OBJECTIVES: Despite an increasing number of studies reporting significant associations of depression to sleep problems in general, few studies have been conducted on racial/ethnic variations in the associations among midlife women in their menopausal transition. The purpose of this study was to determine the associations between depressive symptoms and sleep-related symptoms in a multiethnic group of midlife women while considering the women's race/ethnicity and menopausal status. METHODS: This was a secondary analysis of the data from 1,054 midlife women in two larger studies. The depression index for midlife women and the sleep index for midlife women were used to measure sleep-related symptoms and depressive symptoms. Descriptive and inferential statistics including hierarchical multiple regression analyses were used for data analyses. RESULTS: In the regression models by race/ethnicity, the total numbers (0.294 in non-Hispanic [NH] African Americans ≤ ß ≤ 0.410 in NH Asians), and total severity scores (0.141 in Hispanic ≤ ß ≤ 0.365 in NH Whites) of depressive symptoms were positively associated with the total severity of sleep-related symptoms (all P < 0.01). In the regression models by menopausal status, the total numbers (ß = 0.106 in premenopausal and 0.443 in postmenopausal) and total severity scores (0.272 ≤ ß ≤ 0.561) of depressive symptoms were positively associated with the total severity scores of sleep-related symptoms (all P < 0.05). CONCLUSIONS: Further studies with diverse groups of midlife women using objective measurements and biomarkers are warranted to confirm the findings.

The efficacy of a technology-based information and coaching/support program on pain and symptoms in Asian American survivors of breast cancer.

BACKGROUND: Pain is a common problem, especially in the first few years of breast cancer survivorship. Asian American survivors of breast cancer reportedly have inadequate cancer pain management, and subsequently report a lower quality of life compared with other racial/ethnic groups. Technology-based programs could improve the cancer pain management process. The purpose of the current study was to examine the efficacy of a technology-based information and coaching/support program on cancer pain and its accompanying symptoms among Asian American survivors of breast cancer. METHODS: The current study adopted a randomized pretest/posttest group design. The sample included 115 Asian American survivors of breast cancer (49 in the control group and 66 in the intervention group). The participants' background features, pain (frequency and distress), accompanying symptom distress (global, physical, and psychological), and 4 theory-based mediators (attitude, self-efficacy, perceived barriers, and social influence) were measured using multiple instruments at 3 time points (pretest, after 1 month, and after 3 months). The current study used an intent-to-treat approach and conducted linear mixed model growth curve analyses. RESULTS: There were significant decreases noted in all outcome variables, including pain and symptoms over time in both groups. There were greater decreases in physical symptom distress scores among the intervention group compared with the control group (P = .0229). The mediators as a whole significantly explained overall decreases in general, physical, and psychological symptom distress scores after 3 months in both groups and the intervention group's greater decreases in general, physical, and psychological symptom distress scores after 1 month. CONCLUSIONS: The technology-based program described herein could help to reduce cancer pain and its accompanying symptoms among Asian American survivors of breast cancer.

Type 2 Diabetes and Musculoskeletal Symptoms Among Midlife Women.

PURPOSE: The purpose of this study was to describe the association between type 2 diabetes and musculoskeletal symptoms among midlife women from 4 major racial/ethnic groups in the United States. METHODS: This is a secondary data analysis using the data from 164 participants aged 40 to 60 years of 2 larger survey studies (62 with type 2 diabetes and 102 without type 2 diabetes). In the original studies, the participants completed multiple questionnaires on background characteristics, health status, menopausal status, and musculoskeletal symptoms. The Musculoskeletal Symptom Index for Midlife Women was used to determine the number and severity of musculoskeletal symptoms. For data analysis, independent t tests, Mann-Whitney U tests, and multiple regression analyses were used. RESULTS: The mean number of musculoskeletal symptoms was significantly higher in women with vs without type 2 diabetes as was the mean severity score. In subgroup analyses, among each menopausal stage and non-Hispanic white women, there were significant differences in the numbers and total severity scores between those with type 2 diabetes and without type 2 diabetes. When background characteristics, health status, and menopausal status were controlled, having diagnosis of type 2 diabetes was positively associated with the numbers and total severity scores of musculoskeletal symptoms. CONCLUSION: Study findings supported significant associations of type 2 diabetes with musculoskeletal symptoms among midlife women. Further studies are recommended to confirm relationships in larger populations.

Sleep-related symptoms of midlife women with and without type 2 diabetes mellitus.

OBJECTIVES: The purpose of this study was to determine the associations between type 2 diabetes mellitus and sleep-related symptoms among midlife women from four major racial/ethnic groups in the United States. METHODS: The data from 164 participants of two larger Internet survey studies (62 women diagnosed with type 2 diabetes and 102 women without diabetes) were included. In the original studies, multiple instruments including the questions on background characteristics, health status, and menopause status and the Sleep Index for Midlife Women were used. The data were analyzed using χ tests, independent t tests, Mann-Whitney U tests, and hierarchical multiple regression analyses. RESULTS: The mean total number of sleep-related symptoms was significantly higher in those with type 2 diabetes (9.95 ±â€Š5.83) than those without diabetes (7.25 ±â€Š6.08) (t = 2.81, P = 0.006). The mean total severity score of sleep-related symptoms was also significantly higher in those with type 2 diabetes (33.42 ±â€Š22.41) than those without diabetes (21.87 ±â€Š21.40) (t = 3.29, P = 0.001). Among postmenopausal women and Asian women, there were significant differences in total numbers and total severity scores between those with type 2 diabetes and those without diabetes (all P < 0.05). When background characteristics, health status, and menopause status were controlled, having a diagnosis of type 2 diabetes was positively associated with total numbers (ß=0.143, P = 0.047) and total severity scores (ß=0.176, P = 0.014) of sleep-related symptoms. CONCLUSIONS: This secondary analysis supported significant associations of type 2 diabetes to sleep-related symptoms of midlife women from four major racial/ethnic groups in the United States.

Evidence-based nursing education for undergraduate students: A preliminary experimental study.

With increasing needs for evidence-based practice, the well-designed EBP education is necessary to enhance the critical thinking and decision-making skills of nursing undergraduates. This study is to evaluate the effectiveness of an evidence-based practice education program with blended learning on undergraduate nursing students. In this preliminary experimental study, 45 senior nursing undergraduates were recruited from a university in Seoul, Korea. Self-selection was used to create two groups: an intervention group and a control group consisting of 21 and 24 students, respectively. The intensive 30-hours evidence-based practice education program was provided to the intervention group. Evidence-based practice knowledge, self-efficacy, and evidence utilization were evaluated as outcome variables at baseline and two months after the intervention. There were no significant differences between the intervention and control groups on the background characteristics and outcome variables (p > .05). There were significant increases in evidence-based practice knowledge (Z = -5.28), self-efficacy (t = -6.42), resource utilization (Z = -2.60), and databases utilization (t = -2.98) in the intervention group, when compared with the control group (p < .01). Further studies are recommended to develop the evidence-based practice train-the-trainer program for nursing educators and to maximize the effectiveness of utilizing blended learning in evidence-based practice education.

Readmission of High-Risk Discharged Patients at a Tertiary Hospital in Korea.

This study aims to investigate the readmission rates of major disease groups as stated by the Centers for Medicare and Medicaid Services and to identify risk factors related to readmission in Korea. We studied 2,973 patients discharged from a 2,200-bed tertiary referral hospital in South Korea, from April 1, 2016, to March 31, 2017. Using electronic medical records, we calculated the 30-day readmission rates of seven diseases: acute myocardial infarction, chronic obstructive pulmonary disease (COPD), heart failure (HF), pneumonia, stroke, coronary artery bypass graft (CABG), and total hip arthroplasty/total knee arthroplasty. We used Cox proportional hazards regression analysis to identify risk factors affecting readmission in this retrospective, observational study. For 2,973 consecutively discharged patients, the 30-day unplanned readmission rate was 10.3%. The readmission rate of HF (19.0%) was the highest, followed by pneumonia (13.7%), CABG (12.0%), and COPD (10.5%). Factors associated with readmission were polypharmacy (hazard ratio [HR]: 2.06; 95% confidence interval [CI]: 1.60-2.64), hospitalization history in the previous 6 months (HR: 1.81; 95% CI: 1.41-2.32), and comorbidity (HR: 1.16; 95% CI: 1.11-1.23). Therefore, the discharge intervention program for high-risk discharge patients with polypharmacy, admission history, and comorbidity should include medication reconciliation.

Preliminary study of outcome-based clinical practicum for undergraduate nursing students.

AIM: A growing trend in South Korean nursing education is toward outcome-based education. In response, there is now a greater emphasis on achieving the learning outcomes that are outlined in the curricula of outcome-based education. This study aimed to describe the effectiveness of outcome-based clinical practicum for nursing students. METHODS: In this preliminary longitudinal study, 62 third-year nursing students were enrolled from a university in Seoul, Korea. Three parameters of proficiency were measured three times in the students for 1 year including: achievement of expected learning outcomes, nurses' core competence, and critical thinking. For the data analysis, a descriptive analysis and repeated-measures ANOVA were used with the IBM SPSS v. 23.0 software program. RESULTS: Completing the outcome-based clinical practicum was associated with a significantly enhanced achievement of expected learning outcomes, nurses' core competency, and critical thinking. All of the six expected learning outcomes significantly improved across the pre-, mid-, and postpracticum time points. CONCLUSIONS: The outcome-based clinical practicum improved the achievement of the expected learning outcomes, nurses' core competency, and critical thinking of the nursing students. Further study is recommended to investigate students' and educators' qualitative experiences of outcome-based clinical practicum.

Psychometric Properties of Korean Version of Self-Efficacy of Evidence-Based Practice Scale.

PURPOSE: This study is to evaluate the psychometric properties of the Korean version of the Self-Efficacy of Evidence-Based Practice (SE-EBP) scale, which was originally developed by Chang and Crowe. The beta-version of the SE-EBP is a modified version of the original SE-EBP, which measures the clinical nurses' confidence in finding, appraising, and implementing evidence into practice. Although the original SE-EBP has been validated, no study has been conducted to validate the Korean version of SE-EBP. METHODS: The original scale was translated into Korean through a process of forward and back translation of the original scale. After getting confirmation of the equivalence of the Korean forward translation by the original author, exploratory factor analysis and confirmatory factor analysis of data from 212 clinical nurses were used to test construct validity. Internal consistency was examined using Cronbach α coefficients. For the statistical analysis, STATA version 13.0 software program was used. RESULTS: Exploratory factor analysis of the 28 items revealed three factors with eigenvalues above 1, accounting for 60.2% of the total variance. Confirmatory factor analysis showed good fit of the three-factor structure which was statistically significant (χ2=718.61, df=330, p<.01). For internal consistency, Cronbach α coefficient for the total scale was .95, and it was greater than .80 for each of the three subscales. CONCLUSIONS: The Korean version of SE-EBP scale showed evidence of adequate construct validity and reliability. This study might have contributed to a wider application of the SE-EBP scale, but further studies are needed to provide more evidence on the structure of the scale.

[Mixed Method Research Investigating Evidence-Based Practice Self-efficacy, Course Needs, Barriers, and Facilitators: From the Academic Faculty and Clinical Nurse Preceptors].

PURPOSE: The current challenges faced by nurses in providing high quality and evidence-based practice (EBP) supported care require profound changes in nursing education. To understand the changes needed to strengthen EBP education, the researchers examined EBP self-efficacy, course needs, barriers, and facilitators for academic faculty and clinical nurse preceptors to teach EBP in undergraduate nursing curricula. METHODS: For this study, mixed-method approach was used with survey data collected from 73 academic faculty members from 54 universities. Further, 17 clinical nurse preceptors in three academic hospitals provided qualitative data for exploration of barriers and facilitators to teaching EBP. Data analysis used SPSS/WIN 21.0 and content analysis. RESULTS: Quantitative data showed that although the overall level of self-efficacy among faculty was moderate, the implementation levels were relatively low. Most faculty members agreed with the need to integrate EBP courses into undergraduate nursing curricula. The qualitative data showed that the barriers to teaching EBP were lack of knowledge, skill, and initial investment for teaching EBP; hierarchical, rules-oriented nursing culture; potential learner overloads in processing EBP; limited research dissemination and application. Facilitators were identified as the importance of EBP to the profession of nursing; collaboration in schools and hospitals; and continuing education in teaching/utilizing EBP. CONCLUSION: The findings indicate that for successful integration of EBP ni nursing education there is a need for faculty training and integrated EBP courses.

Effectiveness of nursing management information systems: a systematic review.

OBJECTIVES: The purpose of this study was to review evaluation studies of nursing management information systems (NMISs) and their outcome measures to examine system effectiveness. METHODS: For the systematic review, a literature search of the PubMed, CINAHL, Embase, and Cochrane Library databases was conducted to retrieve original articles published between 1970 and 2014. Medical Subject Headings (MeSH) terms included informatics, medical informatics, nursing informatics, medical informatics application, and management information systems for information systems and evaluation studies and nursing evaluation research for evaluation research. Additionally, manag(*) and admin(*), and nurs(*) were combined. Title, abstract, and full-text reviews were completed by two reviewers. And then, year, author, type of management system, study purpose, study design, data source, system users, study subjects, and outcomes were extracted from the selected articles. The quality and risk of bias of the studies that were finally selected were assessed with the Risk of Bias Assessment Tool for Non-randomized Studies (RoBANS) criteria. RESULTS: Out of the 2,257 retrieved articles, a total of six articles were selected. These included two scheduling programs, two nursing cost-related programs, and two patient care management programs. For the outcome measurements, usefulness, time saving, satisfaction, cost, attitude, usability, data quality/completeness/accuracy, and personnel work patterns were included. User satisfaction, time saving, and usefulness mostly showed positive findings. CONCLUSIONS: The study results suggest that NMISs were effective in time saving and useful in nursing care. Because there was a lack of quality in the reviewed studies, well-designed research, such as randomized controlled trials, should be conducted to more objectively evaluate the effectiveness of NMISs.