The mediating and moderating role of recovery experience between occupational stress and turnover intention in nurses caring for patients with COVID-19.

AIM: This study aimed to investigate the relationships among occupational stress, recovery experience and turnover intention among nurses caring for patients with coronavirus disease 2019 (COVID-19). BACKGROUND: The high turnover intention among nurses affect patient safety quality of patient care. DESIGN: The cross-sectional study design was used. This study was guided by STROBE. METHODS: Convenience sampling identified 202 registered nurses working in the COVID-19 wards of three tertiary general hospitals in two cities in South Korea. The collected data were analysed using SPSS version 26.0, and the PROCESS macro in SPSS was employed to estimate path coefficients and assess the adequacy of the model. The moderating effects of recovery experience on the pathway in which occupational stress of the participants affects turnover intention were verified using model 1 of the SPSS PROCESS macro proposed by Hayes. RESULTS: The recovery experience did not significantly mediate the relationship between occupational stress and turnover intention. However, it had significant moderating effect on the relationship between occupational stress and turnover intention (ß = .005, 95% CI [.001, .010]). The effect of occupational stress on turnover intention was dependent on recovery experience. CONCLUSION: The results revealed that occupational stress among nurses caring for patients with COVID-19 affect the turnover intention and the level of recovery experience moderates this relationship. Thus, not only during the COVID-19 pandemic but also during challenging times of various infectious disease outbreaks, hospitals can enhance the health and well-being of nurses and promote the retention of nursing staff. IMPLICATIONS FOR THE PROFESSION: During the COVID-19 pandemic, nurses have been exposed to understaffing and overwhelming workloads. However, policies for nurses' welfare and benefits are still insufficient, even as the pandemic comes to an end. The results of this study indicate that sufficient rest and appropriate nursing personnel are of utmost importance to nurses. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Validity and reliability of the Korean version of authentic leadership among ICU nurses.

BACKGROUND: Authentic leadership affects the safety climate or job satisfaction of nurses, especially in intensive care unit (ICU). It is extremely challenging to find a suitable instrument for measuring authentic leadership among Korean nurses. Because the existing scales were developed within a Western cultural context and among business students, a new scale for measuring authentic leadership among Korean nurses must be evaluated. OBJECTIVES: This study aimed to assess the reliability of the Korean version of the Authentic Leadership Inventory (K-ALI) for ICU nurses. DESIGN: A cross-sectional study and secondary data analysis were used. METHODS: This study evaluated 203 ICU registered nurses from four South Korean university hospitals. The ALI developed by Neider and Schriesheim was developed. The reliability and validity of this scale were analyzed using Cronbach's alpha and factor analysis. RESULTS: The factor analysis identified two subconstructs that accounted for 57.3 % of the total variance. The overall model fit indices for the K-ALI from the confirmatory factor analysis were an acceptable fit. Cronbach's alpha for the internal consistency of the reliability was 0.92. CONCLUSION: Using the K-ALI, nurses can assess authentic leadership and develop or demonstrate their professional leadership.

Coping as a Mediator of the Relationship between Stress and Anxiety in Caregivers of Patients with Acute Stroke.

According to Lazarus and Folkman's theory, stress and coping affect an individual's anxiety, which is an adaptive outcome. This study examined the mediation effects of stress-coping strategies on the relationship between stress and anxiety in caregivers of patients with acute stroke. A cross-sectional descriptive design was used to analyze a total of 131 caregivers caring for patients with acute stroke at a university hospital. The Caregivers Stress Scale, Ways of Coping Questionnaire, and Korean Beck Anxiety Inventory were used to quantify the participants' responses. Our results revealed that emotion-focused coping (ß = .56, p < .001) partially mediated the relationship between stress and anxiety (Z = 3.30, p < .001), suggesting its ability to exacerbate anxiety in the short term by acting as a mediator between stress and anxiety. Developing appropriate coping strategies for caregivers of patients with acute stroke is therefore critical for reducing their anxiety.

Mediating effects of self-directed learning on the relationship between critical thinking and problem-solving in student nurses attending online classes: A cross-sectional descriptive study.

BACKGROUND: With the increased prevalence of online education due to the coronavirus 2019 pandemic and advancements in information technology, essential competencies, such as critical thinking, self-directed learning, and problem-solving ability, should be examined among student nurses taking online classes. OBJECTIVES: Based on the findings of several studies suggesting that critical thinking does not affect problem-solving, this study aimed to examine the relationship among critical thinking, self-directed learning, and problem-solving in student nurses attending online classes, and to determine whether self-directed learning could mediate the relationship between critical thinking and problem-solving. DESIGN: Cross-sectional, descriptive design. SETTING: K University in South Korea. PARTICIPANTS: In total, 138 junior and senior nursing students were enrolled. METHODS: The critical thinking disposition scale for nursing students, self-directed learning scale, and problem-solving scale for college students were used to quantify participants' responses. RESULTS: Our results revealed significant positive correlations among critical thinking, self-directed learning, and problem-solving. Furthermore, self-directed learning (ß = 0.78, p < 0.001) had a significant mediating effect on the relationship between critical thinking and problem-solving ability (Z = 5.10, p < 0.001). CONCLUSION: Developing and implementing appropriate self-directed learning programs are critical for improving problem-solving ability affected by critical thinking among student nurses engaged in online education.

Effects of a transformative learning theory based debriefing in simulation: A randomized trial.

Debriefing, based on reflection, is imperative in simulation. Mezirow's transformative learning theory (TLT) uses critical reflection in providing care to patients, which involves clinical judgment in nursing. The aim of this study was to compare the effects of TLT-versus a non-TLT-based debriefing protocol on knowledge, problem-solving process, critical thinking disposition, and clinical judgment in nursing students. A randomized controlled trial was performed. Fifty-six junior nursing students were assigned to the TLT (n = 26) and the control (n = 30) groups in South Korea. Debriefing protocols based on Mezirow's TLT for the experimental group and gather-analyze-summarize-based debriefing for the control group were used for four weeks. Scores of the TLT group were significantly higher than those of the control group in the problem-solving process, critical thinking disposition, and clinical judgment of reflection. We identified the main effects of group, time, and time-by-group interaction for clinical judgment (noticing, interpreting, and responding), except for knowledge between the two groups. The TLT debriefing approach in simulation can be tailored to improve problem-solving, critical thinking, and clinical judgment outcomes, which are vital to nursing education related to the provision of care to patients.

Experiences of hospitalization among pregnant women with preterm labor in Korea: a phenomenological study.

Purpose: The purpose of this study was to describe pregnant women's lived experiences of hospitalization due to preterm labor in Korea. Methods: This qualitative study adopted a phenomenological approach. Individual in-depth interviews were conducted with nine participants, over the age of 20 years, who had been hospitalized for more than 1 week after being diagnosed with preterm labor. All interviews were audio-taped and verbatim transcripts were made for analysis. The data were analyzed following Colaizzi's phenomenological method. Results: The participants' ages ranged from 26 to 36 years, and all were married women. They were hospitalized for 13.1 days on average. Five thematic clusters emerged from the analysis. 'Withstanding hospitalization for the fetus's well-being' describes women's feelings during preterm labor and their endurance during their prolonged hospitalization, rooted in their conviction that the fetus comes first. 'Endless frustration in the hospital' encompasses women's emotions while lying in bed and quietly thinking to themselves. 'Unmet physiological needs' describes participants' awareness of their inability to independently handle human physiological needs given the need for careful and limited movement. 'Gratitude for the support around oneself' reflects the support from family and medical staff. 'Shifting perceptions and accepting one's circumstances' describes accepting hospitalization and making efforts to spend their remaining time in the hospital in a meaningful way. Conclusion: The findings in this study provide a deeper understanding and insights into the experiences of Korean women with preterm labor during hospitalization, underscoring the need to develop interventions for these patients.

[Nurses' Experiences of the COVID-19 Crisis].

PURPOSE: This study aimed to develop a situation-specific theory to explain nurses' experiences of the COVID-19 crisis. METHODS: The participants were 16 hospital nurses who experienced the COVID-19 crisis. Data were collected through in-depth individual interviews from September 2, 2020 to January 20, 2021. Transcribed interview contents were analyzed using Corbin and Strauss's grounded theory method. RESULTS: A total of 38 concepts and 13 categories were identified through an open coding process. The core category found was becoming a pioneering nurse who turns crises into opportunities. The causal conditions were the chaos of being exposed defenselessly to an unexpected pandemic, fear caused by a nursing care field reminiscent of a battlefield, and moral distress from failing to protect patients' human dignity. The contextual conditions were feeling like the scapegoat of the hospital organization, increasing uncertainty due to the unpredictable state of COVID-19, and relative deprivation due to inappropriate treatment. The central phenomenon was suffering alone while experiencing the dedication of the COVID-19 hero image. The action/interactional strategy were efforts to find a breakthrough and getting the nurse's mind right, and the intervening conditions were gratitude for those who care for broken hearts and getting used to myself with repetitive work. The Consequences were becoming an independent nurse and frustration with the unchanging reality. CONCLUSION: This study provides the foundation for the nurse's situation-specific theory of the COVID-19 crisis by defining the crisis perceived by nurses who cared for COVID-19 patients and suggesting types of coping with the crisis.

The effects of indoor ambient temperature at work on physiological adaptation in night shift nurses.

AIM: To examine the effects of indoor ambient temperature on thermal comfort, night work tolerance (fatigue, sleepiness and night adaptation) and urinary melatonin in night shift nurses. BACKGROUND: Night shift induces physical stress and mental stress. Night shift work and ambient temperature are associated with work performance. The working environment must be improved for successful night shift working. However, the effects of indoor ambient temperature on night shift nurses are unclear. METHODS: In this crossover study, 20 participants were divided into two groups of 10 and were assigned to work in one of two thermo-controlled environments (23°C vs. 26°C) during two consecutive night shifts. Thermal and humidity sensation vote, night work tolerance, body temperature and urinary melatonin were assessed. RESULTS: There were significant differences between the two groups in thermal sensation and body temperature. There were no significant differences in humidity sensation vote or night work tolerance. Urinary melatonin levels decreased significantly during the second 23°C night shift. CONCLUSION: A temperature of 23°C may exert a positive effect on night shift adaptation. IMPLICATIONS FOR NURSING MANAGEMENT: Nurses and nursing managers should assess thermal comfort during night shifts, and improved thermal comfort level should be provided to nurses.

Patients' Experiences of Diabetes Self-Management Education According to Health-Literacy Levels.

Diabetes self-management is an important part of patient care for those with diabetes. The purpose of this study was to explore patients' experiences with diabetes self-management education and how these experiences differed by health-literacy levels. A descriptive qualitative design was conducted. In 2016, 20 patients with diabetes who took a formal diabetes self-management course at a university hospital in South Korea were interviewed. A conventional content analysis was conducted. Patients with low health-literacy misunderstood diabetes management, showed passive attitudes towards seeking information, and had difficulty obtaining detailed information. Patients with high health-literacy wanted systematic, in-depth, individualized counselling on lifestyle modifications and medications. Patients' experiences with diabetes self-management education revealed differences in their health-literacy dimensions. In addition to practising health-literacy precautions, the content and delivery of diabetes self-management education need to be accommodated according to patients' health-literacy levels to obtain better outcomes.

Nontraditional Cardiac Rehabilitation in Korean Patients with Coronary Artery Disease.

PURPOSE: This pilot investigation sought to compare outcomes including depression, anxiety, stress, mindful awareness, and exercise capacity between exercise-focused cardiac rehabilitation (ECR) and meditation-focused cardiac rehabilitation (MCR) programs for patients with coronary artery disease (CAD) who had percutaneous coronary intervention (PCI). DESIGN: A nonrandomized pretest-posttest design was employed. METHODS: Two different interventions (ECR vs. MCR) were implemented with participants of each group for 12 weeks. Questionnaires assessing depression, anxiety, stress, and mindful awareness and measures of peak VO2 were completed before and after the 12-week interventions. FINDINGS: Thirteen patients completed the cardiac rehabilitation (CR) programs. Meditation-focused cardiac rehabilitation was associated with significantly greater reductions in depression as compared to ECR; there were no significant differences between the two groups on other outcomes. CONCLUSIONS: The MCR program has similar effects to improve the physical and psychological outcomes, compared with the ECR program. CLINICAL RELEVANCE: There is potential for patients with CAD to participate in and benefit from nontraditional CR programs, and such CR could play a role in secondary prevention of CAD.

Effects of team-based learning on problem-solving, knowledge and clinical performance of Korean nursing students.

BACKGROUND: Team-based learning (TBL) has been used as a learner-centered teaching strategy in efforts to improve students' problem-solving, knowledge and practice performance. Although TBL has been used in nursing education in Korea for a decade, few studies have studied its effects on Korean nursing students' learning outcomes. OBJECTIVES: To examine the effects of TBL on problem-solving ability and learning outcomes (knowledge and clinical performance) of Korean nursing students. DESIGN: Randomized controlled trial. PARTICIPANTS: 63 third-year undergraduate nursing students attending a single university were randomly assigned to the TBL group (n=32), or a control group (n=31). METHODS: The TBL and control groups attended 2h of class weekly for 3weeks. Three scenarios with pulmonary disease content were employed in both groups. However, the control group received lectures and traditional case study teaching/learning strategies instead of TBL. A questionnaire of problem-solving ability was administered at baseline, prior to students' exposure to the teaching strategies. Students' problem-solving ability, knowledge of pulmonary nursing care, and clinical performance were assessed following completion of the three-week pulmonary unit. RESULTS: After the three-week educational interventions, the scores on problem-solving ability in the TBL group were significantly improved relative to that of the control group (t=10.89, p<.001). In addition, there were significant differences in knowledge, and in clinical performance with standardized patients between the two groups (t=2.48, p=.016, t=12.22, p<.001). CONCLUSION: This study demonstrated that TBL is an effective teaching strategy to enhance problem-solving ability, knowledge and clinical performance. More research on other specific learning outcomes of TBL for nursing students is recommended.

Effects of mindfulness-based stress reduction on depression, anxiety, stress and mindfulness in Korean nursing students.

BACKGROUND: Nursing students often experience depression, anxiety, stress and decreased mindfulness which may decrease their patient care effectiveness. Mindfulness-based stress reduction (MBSR) effectively reduced depression, anxiety and stress, and increased mindfulness in previous research with other populations, but there is sparse evidence regarding its effectiveness for nursing students in Korea. OBJECTIVES: To examine the effects of MBSR on depression, anxiety, stress and mindfulness in Korean nursing students. DESIGN: A randomized controlled trial. PARTICIPANTS/SETTING: Fifty (50) nursing students at KN University College of Nursing in South Korea were randomly assigned to two groups. Data from 44 students, MBSR (n=21) and a wait list (WL) control (n=23) were analyzed. METHODS: The MBSR group practiced mindfulness meditation for 2 h every week for 8 weeks. The WL group did not receive MBSR intervention. Standardized self-administered questionnaires of depression, anxiety, stress and mindfulness were administered at the baseline prior to the MBSR program and at completion (at 8 weeks). RESULTS: Compared with WL participants, MBSR participants reported significantly greater decreases in depression, anxiety and stress, and greater increase in mindfulness. CONCLUSION: A program of MBSR was effective when it was used with nursing students in reducing measures of depression, anxiety and stress, and increasing their mindful awareness. MBSR shows promise for use with nursing students to address their experience of mild depression, anxiety and stress, and to increase mindfulness in academic and clinical work, warranting further study.

Effects of problem-based learning vs. traditional lecture on Korean nursing students' critical thinking, problem-solving, and self-directed learning.

BACKGROUND: Problem-based learning (PBL) is a method widely used in nursing education to develop students' critical thinking skills to solve practice problems independently. Although PBL has been used in nursing education in Korea for nearly a decade, few studies have examined its effects on Korean nursing students' learning outcomes, and few Korean studies have examined relationships among these outcomes. OBJECTIVES: The objectives of this study are to examine outcome abilities including critical thinking, problem-solving, and self-directed learning of nursing students receiving PBL vs. traditional lecture, and to examine correlations among these outcome abilities. DESIGN: A quasi-experimental non-equivalent group pretest-posttest design was used. PARTICIPANTS/SETTING: First-year nursing students (N=90) were recruited from two different junior colleges in two cities (GY and GJ) in South Korea. METHODS: In two selected educational programs, one used traditional lecture methods, while the other used PBL methods. Standardized self-administered questionnaires of critical thinking, problem-solving, and self-directed learning abilities were administered before and at 16weeks (after instruction). RESULTS: Learning outcomes were significantly positively correlated, however outcomes were not statistically different between groups. Students in the PBL group improved across all abilities measured, while student scores in the traditional lecture group decreased in problem-solving and self-directed learning. Critical thinking was positively associated with problem-solving and self-directed learning (r=.71, and r=.50, respectively, p<.001); problem-solving was positively associated with self-directed learning (r=.75, p<.001). CONCLUSION: Learning outcomes of PBL were not significantly different from traditional lecture in this small underpowered study, despite positive trends. Larger studies are recommended to study effects of PBL on critical student abilities.

Review of outcomes of cardiac support groups after cardiac events.

Cardiac support groups may positively affect adjustment after cardiac events and quality of life (QoL). However, although participation in support groups is presumed to be beneficial, there were few studies regarding the potential benefit. The purpose of this review was to examine studies focused on the effects of cardiac support groups on health-related outcomes. Four studies met the inclusion criteria for review. Eight categories of support group outcomes were identified, including psychological outcomes, health behaviors, clinical health, health-related QoL, self-reported health conditions, social support, life situation, and knowledge. Most cardiac support group outcomes, though positive, were not statistically significantly different from those of control groups in studies reviewed. Psychosocial need of patients following cardiac events is indicated, including stress management and social support, and encouraging the establishment of realistic individual goals. More research is needed to establish cost-effective formats for support groups and to determine specific outcomes that can be achieved.

[Analyses of studies on cardiac rehabilitation for patients with cardiovascular disease in Korea].

PURPOSE: This study was to analyze research reports published in Korea on cardiac rehabilitation for patients with cardiovascular disease. METHODS: Based on inclusion criteria, 19 research reports were included in this review. Published year of selected articles was between 1996 and 2008. Nineteen studies were analyzed by guidelines of the cardiac rehabilitation programs done by the American Heart Association (AHA) and Scottish Intercollegiate Guidelines Network (SIGN). RESULTS: The characteristics of patients were mostly of ischemic heart disease, 50-59 yr old, and male. Educational sessions were administered twice, and each lesson lasted less than 30 min. Exercise was done 3 times per week for 6 weeks. Most educational content were about risk factors, but there was no information, such as coping with feelings. Most exercise was performed as ROM, treadmill, and cycle ergometer. A large percentage of outcome indicators were health behavior, hemodynamic changes, and exercise capacity. There was more 'no effect' than 'positive effect' in trait anxiety and depression, whereas similar in physiologic domain. CONCLUSION: Various types of cardiac rehabilitation in Korea were performed by researchers. Therefore, we need to develop the standard protocol, to add psychosocial intervention, and to study cost effectiveness of cardiac rehabilitation.

[The life of patients with a heart transplant].

PURPOSE: The main purpose of this study was to develop a substantive theory on the life of patients with heart transplantation in the context of Korean society and culture. The question for the study was "What is the life of patients like with a heart transplant?". METHOD: A grounded theory method guided the data collection and analysis. Participants for this study were 12 adults who regularly visited a Cardiovascular ambulatorium in a medical center. The data was collected through an in-depth interview and analyses were performed simultaneously. RESULT: 'Developing a new life to live on borrowed time' was the core category in this study. It revealed two types of life, one is living in peace and another is thinking positive. CONCLUSION: This study provides a framework for the development of individualized nursing interventions to care for patients with Heart Transplantation. The findings may provide pointers for health professionals about ways to improve support for heart transplant recipients.