The Effects of a Tripod Approach for Cancer Patients on Illness Stress, Health-Promoting Lifestyle, Hope, and Resilience.

BACKGROUND: Health-related exercise and education program for cancer patients are necessary to provide physical and emotional support to enable efficient and appropriate self-management at home. OBJECTIVE: This study aimed to investigate the effects of a tripod approach including physical exercise, education, and emotional support program on illness stress, health promotion lifestyle, hope, and resilience in cancer patients. INTERVENTIONS/METHODS: This was a quasi-experimental repeated-measures study using a pre-post design with a nonhomogeneous control group. A total of 72 cancer patients (experimental group = 37, control group = 35) who were currently receiving treatment and staying at home were enrolled. RESULTS: The experimental group showed significantly lower illness stress scores (F = 17.35, P < .001) and increase in health promotion lifestyle scores (F = 4.05, P = .048) compared with the control group, especially social relationships (t = 1.85, P = .073) and stress management (t = 2.30, P = .027). However, there were no effects on hope and resilience. Also, illness stress showed significant changes after 6 weeks (t = -3.35, P = .001) and after 10 weeks (t = -5.04, P < .001). Overall health promotion lifestyle showed changes after 10 weeks (t = 2.25, P = .030), with meaning of life (t = 2.57, P = .014), stress management (t = 2.30, P = .027), and medical behaviors (t = 2.46, P = .019) especially showing significant changes. CONCLUSIONS: The results showed that the tripod approach had positive effects on illness stress and health promotion lifestyle of cancer patients staying at home. Further study to improve positive emotions such as hope and resilience is needed. IMPLICATIONS FOR PRACTICE: Based on our findings, combining nursing intervention with physical exercise, education, and emotional support could be incorporated into cancer patients in community and early survivorship care plans in clinical practice.

Risk factors of repeated falls in the community dwelling old people.

This study aimed to provide evidence for the development of an algorithm to identify older adults with a high risk for repeated falls, along with strategies to prevent repeated falls, by analyzing the known physical, psychological, and environmental factors related to falls in older adults. One hundred fifty-seven community-dwelling older adults aged 65 years or older who experienced a fall within the past year were enrolled in this study. Participants' physical, psychological, environmental, and fall prevention-related characteristics were surveyed using structured questionnaires to identify the risk factors for repeated falls. The use of antidepressants, depression score, and compliance with fall prevention behaviors were found to differ significantly between the two groups, and the use of antidepressants and depression were found to be significant predictors of repeated falls. Depression should be considered as a major variable when developing an algorithm to identify the risk of repeated falls among older adults living at home. Also, the practice of fall prevention behaviors was higher in the repeated-falls group, likely due to that group's efforts to prevent additional falls.

Implementation of Structured Documentation and Standard Nursing Statements: Perceptions of Nurses in Acute Care Settings.

Nurses implement structured documentation using standardized nursing terminologies in computerized healthcare settings. Nurses' perceptions, shaped by their experiences of implementing such documentation, are an important indicator for the documentation system's optimal maintenance and improvement. The purpose of this study was to describe perceptions of nurses using SYSTEM featuring standard nursing statements and structured documentation. A quantitative cross-sectional study design was used. A total of 42 nurses from a tertiary teaching hospital participated in this study. A researcher-developed survey questionnaire included seven questions asking nurses' perceptions of nursing process phases and SYSTEM's usefulness, effectiveness, necessity, assistance in decision making, and suggestions for SYSTEM improvement. As results, the assessment phase was perceived to be the most necessary, while the planning phase was perceived to be the most unnecessary. Perceived disadvantages were decreased patient care time, increased charting time, and standard nursing statements not covering diverse patients' conditions. These disadvantages conflicted with perceived advantages. For successful implementation of electronic nursing records, stakeholders at clinical, information technology, and administrative levels should cooperate closely to address adverse consequences from implementation of structured documentation and standardized nursing terminologies.

Moderate-Intensity Exercise Induces Neurogenesis and Improves Cognition in Old Mice by Upregulating Hippocampal Hippocalcin, Otub1, and Spectrin-α.

Exercise increases the levels of neurogenic factors and enhances neurogenesis, memory, and learning. However, the molecular link between exercise and neurogenesis is not clear. The purpose of this study was to examine the effects of exercise intensity on cognitive function and protein expression in the hippocampus of old mice. To compare the effects of aerobic exercise intensity on cognition in old mice, we exposed 18-month-old mice to low- and moderate-intensity treadmill exercise for 4 weeks. Moderate-intensity exercise improved cognitive function in the old mice, while low-intensity exercise did not. To investigate the underlying mechanisms, two-dimensional electrophoresis was used to examine protein expression. Using peptide fingerprinting mass spectrometry, we identified 19 proteins that were upregulated in the hippocampus following exercise training, and seven of these proteins were normalized by the control value. Among them, the levels of 14-3-3 zeta and heat shock protein 70, which have been shown to be induced by exercise training and related to neurogenesis, were dramatically increased by moderate exercise. Hippocalcin, α-spectrin, ovarian tumor domain-containing ubiquitin aldehyde-binding protein 1 (otub1), mu-crystallin, serine racemase, and rho GDP dissociation inhibitor 1, which are related to neurogenesis, neuroprotection, and synaptic strength, were upregulated in the hippocampus by moderate exercise. In addition, we confirmed that neurogenic markers, including doublecortin and the neuronal nuclei antigen, and hippocalcin, otub1, and spectrin-α are potential molecular links between hippocampal neurogenesis and exercise in the elderly. Thus, these results showed that steady moderate-intensity exercise delayed the declines in cognitive function in the elderly through the activation of multiple factors.

The Effect of a Telephone-Based Self-management Program Led by Nurses on Self-care Behavior, Biological Index for Cardiac Function, and Depression in Ambulatory Heart Failure Patients.

PURPOSE: This study was conducted to examine the effects of a telephone-based self-management support program led by nurses on self-care behavior, biological index for cardiac function, and depression. METHODS: This study is a quasi-experiment in nonequivalent control group design. Thirty-eight heart failure patients underwent medical treatment at the hospital (18 heart failure patients in the experimental group and 20 heart failure patients in the control group). The experimental group (n = 18) received the telephone-based self-management support program, which included a 30-minute face-to-face education session and four telephone consultation and education sessions. The face-to-face education session was conducted at the first visit to the outpatient clinic. Thereafter, weekly telephone consultations and education sessions were performed for 4 weeks. Data were analyzed using descriptive statistics, Chi-square test, Fisher's exact test, independent t test, paired t test, and repeated measures analysis of variance using the SPSS/WIN 21.0. RESULTS: The participants in the experimental group showed significantly increased self-care behavior scores (t = 6.65, p < .001), decreased N-terminal pro-brain natriuretic peptide level (U = -2.28, p = .022), improved left ventricular ejection fraction values (t = 2.24, p = .032), and decreased depression scores (t = -3.49, p = .001) compared with the control group. CONCLUSION: The findings indicate that the telephone-based self-management program is an effective intervention to improve self-management in heart failure patients.

Factors influencing falls in the frail elderly individuals in urban and rural areas.

BACKGROUND: Falls in older people commonly cause morbidity and mortality, loss of independence, and poor quality of life. Differences in residential environments might influence falls experienced by elderly people in urban and rural areas. AIM: The purpose of this study was to provide data through the comparative analysis of physical and environmental factors influencing falls in the frail elderly individuals in urban and rural areas, which might be used for developing the fall prevention program. METHODS: A total of 534 frail elderly individuals living in regional communities were assessed over 2 months. Discomfort when walking, avoiding falls, awareness of falls, physical activity, fear of falling, depression, and a safety score for the home environment were measured. RESULTS: Frail elderly individuals in urban and rural areas had significant differences in terms of their prior experience of falls; the number of falls; the intake of hypertension medication, arthritis medication, and painkillers, respectively, discomfort when walking; physical activity; and the safety score of their home environments. There were significant differences between the frail elderly individuals living in urban and rural areas with the highest incidence of falls with regard to their education level, marital status, residential types, the intake of arthritis medication and painkillers, walking discomfort, physical activity, and the safety score of their home environments. In the factors influencing falls of frail elderly individuals in urban areas, stroke, visual impairment, and the fear of falling were significant explanatory variables. In the factors influencing falls of frail elderly individuals in rural areas, dizziness, walking discomfort and the fear of falling were significant explanatory variables. DISCUSSION: These results indicate that different factors influence falls among the elderly living in different residential areas. CONCLUSION: Based on these results, a multidimensional customized fall prevention program should be considered by various factors according to residential environments to effectively prevent falls among elderly adults.

Effects of Music Therapy on the Cardiovascular and Autonomic Nervous System in Stress-Induced University Students: A Randomized Controlled Trial.

OBJECTIVE: Stress is caused when a particular relationship between the individual and the environment emerges. Specifically, stress occurs when an individual's abilities are challenged or when one's well-being is threatened by excessive environmental demands. The aim of this study was to measure the effects of music therapy on stress in university students. DESIGN: Randomized controlled trial. PARTICIPANTS: Sixty-four students were randomly assigned to the experimental group (n = 33) or the control group (n = 31). INTERVENTION: Music therapy. OUTCOME MEASURES: Initial measurement included cardiovascular indicators (blood pressure and pulse), autonomic nervous activity (standard deviation of the normal-to-normal intervals [SDNN], normalized low frequency, normalized high frequency, low/high frequency), and subjective stress. After the first measurement, participants in both groups were exposed to a series of stressful tasks, and then a second measurement was conducted. The experimental group then listened to music for 20 minutes and the control group rested for 20 minutes. A third and final measurement was then taken. RESULTS: There were no significant differences between the two groups in the first or second measurement. However, after music therapy, the experimental group and the control group showed significant differences in all variables, including systolic blood pressure (p = .026), diastolic blood pressure (p = .037), pulse (p < .001), SDNN (p = .003), normalized low frequency (p < .001), normalized high frequency (p = .010), and subjective stress (p = .026). CONCLUSION: Classical music tends to relax the body and may stimulate the parasympathetic nervous system. These results suggest music therapy as an intervention for stress reduction.

Effects of a Stroke Primary Prevention Program on Risk Factors for At-Home Elderly.

BACKGROUND To prevent stroke from occurring, stroke risk factors in at-risk subjects should be controlled and the diseases causing stroke should be managed. This study evaluated a nursing intervention to prevent stroke in at-risk elderly living at home. The program consisted of stroke and nutrition education as well as exercise guidance. MATERIAL AND METHODS This study targeted 93 elderly people living at home residing in E province with 1 or more stroke risk factors, including high blood pressure, diabetes, hyperlipidemia, obesity, smoking, or drinking alcohol. The 12-week program included a stroke education class once a week, a nutrition management class once a week, and exercise guidance 3 times a week. Each session lasted 50-70 min. Each disease education and nutrition management session lasted for 20 min and each exercise session lasted for 30-50 min. RESULTS The experimental group's body mass index (BMI) (t=8.27, p<.001), systolic blood pressure (t=2.39, p=.021), fasting blood sugar (t=0.39, p=.700), total cholesterol (t=4.18, p<.001), triglyceride levels (t=2.50, p=.016), and depression scores (t=5.48, p<.001) were significantly reduced and high-density phospholipid protein levels increased significantly by the end of the program (t=-2.94, p=.005). CONCLUSIONS Based on the results of this study, participating in a stroke prevention program enabled at-risk elderly participants who lived at home in rural areas to perform health-promoting behaviors. This program may reduce the incidence of stroke by reducing risk factors and managing stroke precursor diseases.

Effects of a randomized controlled recurrent fall prevention program on risk factors for falls in frail elderly living at home in rural communities.

BACKGROUND: Falling can lead to severe health issues in the elderly and importantly contributes to morbidity, death, immobility, hospitalization, and early entry to long-term care facilities. The aim of this study was to devise a recurrent fall prevention program for elderly women in rural areas. MATERIAL/METHODS: This study adopted an assessor-blinded, randomized, controlled trial methodology. Subjects were enrolled in a 12-week recurrent fall prevention program, which comprised strength training, balance training, and patient education. Muscle strength and endurance of the ankles and the lower extremities, static balance, dynamic balance, depression, compliance with preventive behavior related to falls, fear of falling, and fall self-efficacy at baseline and immediately after the program were assessed. Sixty-two subjects (mean age 69.2±4.3 years old) completed the program--31 subjects in the experimental group and 31 subjects in the control group. RESULTS: When the results of the program in the 2 groups were compared, significant differences were found in ankle heel rise test, lower extremity heel rise test, dynamic balance, depression, compliance with fall preventative behavior, fear of falling, and fall self-efficacy (p<0.05), but no significant difference was found in static balance. CONCLUSIONS: This study shows that the fall prevention program described effectively improves muscle strength and endurance, balance, and psychological aspects in elderly women with a fall history.

Improving the quality of sleep with an optimal pillow: a randomized, comparative study.

Because sleep comprises one-third of a person's life, using an optimal pillow for appropriate neck support to maintain cervical curve may contribute to improve quality of sleep. Design of orthopedic pillow conforms to orthopedic guidelines to ensure the right support of the cervical curve. The aim of this study was to investigate effect of different pillow shape and content on cervical curve, pillow temperature, and pillow comfort. A feather pillow is regarded as a standard pillow, and a memory foam pillow is one of the most popular pillows among pillow users. We, therefore, compared these two pillows with an orthopedic pillow. Twenty healthy subjects (10 men and 10 women; age range, 21-30 years) participated in the study. Each subject was asked to assume the supine position with 3 different pillows for 30 minute in each trial and then cervical curve, pillow temperature, and pillow comfort were measured. When comparing the cervical curve of the 3 different pillows, that of the orthopedic pillow was significantly higher than that of the other 2 pillows (p < 0.001). The degree of temperature increase was significantly lower for the orthopedic pillow than for the memory foam and feather pillows (p < 0.001). The visual analog scale (VAS) score of pillow comfort was significantly higher in orthopedic pillow than the other 2 pillows. This study shows that pillow shape and content plays a crucial role in cervical curve, pillow temperature, and pillow comfort and orthopedic pillow may be an optimal pillow for sleep quality.

[Effects of a fall prevention program on falls in frail elders living at home in rural communities].

PURPOSE: This study was conducted to determine the effects of a fall prevention program on falls, physical function, psychological function, and home environmental safety in frail elders living at home in rural communities. METHODS: The design of this study was a nonequivalent control group pre posttest design. The study was conducted from July to November, 2012 with 30 participants in the experimental group and 30 in the control group. Participants were registered at the public health center of E County. The prevention program on falls consisted of laughter therapy, exercise, foot care and education. The program was provided once a week for 8 weeks and each session lasted 80 minutes. RESULTS: The risk score for falls and depression in the experimental group decreased significantly compared with scores for the control group. Compliance with prevention behavior related to falls, knowledge score on falls, safety scores of home environment, physical balance, muscle strength of lower extremities, and self-efficacy for fall prevention significantly increased in the experimental group compared with the control group. CONCLUSION: These results suggest that the prevention program on falls is effective for the prevention of falls in frail elders living at home.

Perceived health, life satisfaction, and cardiovascular risk factors among elderly Korean immigrants and elderly Koreans.

Acknowledging that changes in sociocultural environment influence health status, the purpose of this study was to compare perceived health, life satisfaction, and cardiovascular health in elderly Korean immigrants and elderly Koreans. In this cross-sectional study, a convenience sample of 88 elderly Korean immigrants and 295 elderly Koreans 65 and older were recruited from Korean communities in the United States and Korea. Respondents' perceived health was measured by self-assessment; life satisfaction was self-assessed using a dichotomous scale of general satisfaction with life; and cardiovascular health status was surveyed by self-report of major diagnosed cardiovascular risk factors (i.e., hypertension, hyperlipidemia, diabetes mellitus) and body mass index measurement for obesity. Despite having better perceived health and life satisfaction, elderly Korean immigrants also had higher prevalence of cardiovascular risk factors. The findings provide health care providers with useful information for effective health assessment of minority immigrants.

Depressive symptoms in community-dwelling elderly Korean immigrants and elderly Koreans: cross-cultural comparison.

Depression among minority older adults is a prevalent underrecognized medical illness. Changes in cultural norms and social conditions because of immigration have a significant influence on mental health. The purpose of this study was to assess the interrelationships between acculturation, geographical location, gender, and depressive symptoms in community-dwelling elderly Korean immigrants and elderly Koreans. In this cross-sectional study, a convenience sample of 88 elderly Korean immigrants and 295 elderly Koreans was recruited separately from senior centers and senior apartments. Depressive symptoms were assessed with the Korean Geriatric Depression Scale-Short Form and acculturation with years of living in the United States. Acculturation had no significant relationship with depressive symptoms (r = 0.01, p = 0.94). Depressive symptoms were highly present in both elderly Korean immigrants and elderly Koreans. The prevalence of depressive symptoms was higher in women. This study provides baseline data for development of culturally specific, community-based intervention programs for better management of mental health of elderly Korean immigrants.

Evaluation of the Korean Version of Physical Activity Scale for the Elderly (K-PASE).

PURPOSE: The purpose of this study was to develop a Korean version of Physical Activity Scale for the Elderly (K-PASE) from PASE and to evaluate the validity and reliability of the K-PASE. This scale was originally developed by Washburn et al. (1993). A valid and reliable physical activity scale for the elderly is needed to assess accurately physical activity of the elderly, because there has been no valid and reliable physical activity scale for the elderly in Korea. METHODS: The K-PASE was developed from PASE through linguistic validation and cultural adaptation for use with this population. Convenient sampling was used to recruit participants. Reliability was evaluated by conducting the test-retest and convergent validity was evaluated by Pearson correlation. RESULTS: Test-retest reliability, assessed over a 2 week interval, was r=.94. Convergent validity was established by correlating the K-PASE scores between related variables which were the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) and hand-grip strength. Scores of the K-PASE had a low significant correlation with TMIG-IC (r=.246, p<.001), and hand-grip strength (r=.251, p<.001). The mean score of physical activity of Korean elderly assessed by the K-PASE was 96.5. CONCLUSION: We conclude that the K-PASE is a reliable and valid instrument to assess physical activity for Korean elderly.

Comparison of body composition, handgrip strength, functional capacity, and physical activity in elderly Koreans and Korean immigrants.

Immigration to a foreign country has a significant impact on a person's health status and health management behavior. The purpose of this pilot study was to examine body composition (body mass index and muscle area of the mid-upper arm and mid-calf), handgrip strength, functional capacity, and physical activity in elderly Koreans and Korean immigrants. In this cross-sectional study, a convenience sample of 87 elderly Korean immigrants and 294 elderly Koreans were recruited from senior centers and senior apartments in the United States and Korea. Compared with elderly Koreans, elderly Korean immigrants had higher mid-calf muscle area (p = 0.06), handgrip strength (p = 0.01), and functional capacity (p = 0.01) and less physical activity (p < 0.01). Older men were more physically active and had more muscle areas, greater handgrip strength, and better functional capacity than older women, whereas older women had higher BMI scores than older men. This study provides motives for the development of health promotion intervention studies (e.g., culturally relevant exercise programs incorporating strength training). Future studies could identify culturally relevant strategies to promote physical activity in elderly Korean immigrants and especially elderly Korean women in both groups.

Epidemiology of needlestick and sharps injuries among professional Korean nurses.

Although needlestick and sharps injuries (NSI) are known to affect professional nurses at high rates, most studies depend on officially reported data and few have been undertaken in Korea. Thus, we surveyed a large cross-section of nurses from a hospital in Gangneung (response rate, 97.9%). Four hundred thirty-two incidents of NSI were reported by 263 nurses (79.7%) in the previous 12-month period (average, 1.31 events/nurse/year). Syringe needles were the most common devices, affecting 67.3% and comprising 52% of all NSI events. Sixty percent of all NSI events involved contaminated devices. Opening an ampoule or vial was the most common cause (affecting 35.2% of all nurses and accounting for 15.9% of all NSI events). Logistic regression indicated that nurses working in "other" departments were 5.4 times more likely to suffer any NSI (odds ratio [OR] = 5.4; 95% confidence interval [95% CI] = 2.0-15.2; P < .05) and 4.7 times more likely to incur a syringe-needle injury than nurses in intensive care units or inpatient departments (OR = 4.7; 95% CI = 2.0-11.6; P < .05). Younger-than-average nurses (< 27 years) were 4.5 times more likely to suffer NSI (OR = 4.5; 95% CI = 1.7-12.6; P < .05) and 3.1 times more likely to incur a syringe-needle injury (OR = 3.1; 95% CI = 1.4-7.0; P < .05). Working mixed shifts also increased the risk of any NSI (OR = 4.0; 95% CI = 1.7-10.4; P < .05) or syringe-needle NSI (OR = 4.4; 95% CI = 2.0-10.1; P < .05). Overall, our study suggests that NSI are common among Korean hospital nurses and represent a significant occupational burden for this large Asian demographic. Intervention and preventive strategies to help reduce their NSI exposures are urgently required in this country.

[Effects of biophysical index, knowledge, and self management compliance of patients with primary hypertension by a self management compliance promotion program].

PURPOSE: This study was to develop and prove the effects of a self management compliance promotion program for primary hypertension patients who reside in rural communities. METHOD: The content of the self management compliance promotion program developed by this study was as follows: A leader trains patients as a group or individually, in walking, education and green tea therapy from the first to twelfth week. From the thirteenth to twenty fourth week, the patients should perform walking and green tea therapy by themselves. One hundred twenty subjects volunteered to participate in the study, who were among those registered as hypertension patients in the 14 community health clinics located in Chungcheongbuk-do. RESULT: Systolic blood pressure, total cholesterol, low-density lipoprotein cholesterol, triglyceride, step width, and degree of obesity decreased significantly. High-density lipoprotein cholesterol, step length, knowledge of hypertension, and self management compliance significantly increased. CONCLUSION: A self management compliance promotion program for primary hypertensive patients enhances biophysical index and knowledge on hypertension, thus ultimately suggesting a nursing intervention for promoting self management compliance.

Hand dermatitis among Korean nursing students.

We used a previously validated questionnaire survey, which was translated into Korean and given to 270 students from a university-based nursing school in Seoul. A total of 202 questionnaires were received. The students' hand dermatitis prevalence ranged from 6.9% in the first year to 22.9% in the fourth year. Logistic regression indicated that students with systemic allergies were 4.2 times as likely to suffer from hand dermatitis. Year of study and living arrangements were also shown to have statistically significant correlations with hand dermatitis. Overall, this study suggests that hand dermatitis might be less prevalent among Korean nursing students when compared with their international counterparts. However, the identification of systemic allergies as a significant risk factor was consistent with previous reports from other countries.

[The development & effect of a tailored fall prevention exercise for older adults].

PURPOSE: This study was conducted to develop and to determine the effect of an tailored falls prevention exercise for older adults. METHOD: Subjects consisted of 59 older adults (experimental group: 29, control group: 30) living at nursing homes. Experimental group participated in tailored falls prevention exercise for 16 weeks (3 times a week, 50 min every session). Data were collected before the exercise, 16 weeks & 24 weeks after the beginning of exercise. RESULTS: 1) the experimental group significantly improved the muscle strength of hip extensor & flexor, knee extensor & flexor, ankle dorsiflexor, & plantar flexor compared to the control group. 2) the experimental group significantly decreased the mean time for 10 times chair stand. 3) the experimental group significantly increased the standing time on one leg and the number of heel raise for 30 seconds compared to the control group. In addition more older adults in the experimental group completed the tandem stance and semi-tandem stance for 10 seconds than the control group. 4) The experimental group significantly decreased the mean time of 6m walk and the fall frequency compared to the control group. CONCLUSIONS: This results suggest that tailored falls prevention exercise for older adults can improve muscle strength, static & dynamic balance and decrease the fall frequency of older adults.

Epidemiology of musculoskeletal symptoms among Korean hospital nurses.

We investigated the epidemiology of musculoskeletal symptoms (MSS) among a complete cross-section of 330 nurses from a large Korean hospital, by means of a questionnaire survey (response rate: 97.9%). The prevalence of MSS at any body site was 93.6%, with symptoms most commonly reported at the shoulder (74.5%), lower back (72.4%), neck (62.7%), lower legs (52.1%) and hand/wrist (46.7%). Logistic regression indicated that nurses who undertook manual handling of patients were 7.2 times as likely to report MSS (OR 7.2, 95%CI 1.2-42.3, P = .0275), while nurses suffering from periodic depression experienced a 3.3-fold MSS risk (OR 3.3, 95%CI 1.3-8.3, P = .0104). Overall, our study suggests that Korean nurses incur a very high MSS burden when compared internationally. A greater commitment is needed to improve physical conditions, occupational tasks and psychosocial work issues among nurses in this country.