Meta-Analysis of Flipped Learning Effects in Nursing Education.

BACKGROUND: This study is a meta-analysis confirming the effect size of clinical competence, critical thinking ability, self-directedness, and learning satisfaction, the outcome variables of flipped learning applied to nursing education. METHODS: We selected 18 related studies that analyzed data using CMA (Comprehensive Meta-Analysis 2.2). RESULTS: The effect size of the entire study was Hedges' g = 0.68 (95% CI = 0.43~0.92). The heterogeneity of the overall effect size was I2 = 90.7% (Q = 246.67, p < 0.001); critical thinking ability had an effect size of Hedges' g = 0.87, learning satisfaction of Hedges' g = 0.79, clinical competence of Hedges' g = 0.53, and self-directedness of Hedges' g = 0.37. The differences were statistically significant. CONCLUSION: Flipped learning can effectively improve nursing students' clinical competence, critical thinking ability, self-direction, and learning satisfaction.

Performance of a Community-based Noncommunicable Disease Control Program in Korea: Patients 65 Years of Age or Older.

BACKGROUND: In Korea, the Korean Community-based Noncommunicable Disease Prevention and Control Program (KCNPC) was implemented in 2012 for the management of patients with chronic diseases. Nineteen primary care clinics, public health centers, and education and consulting centers (ECCs) participated in the implementation of this program. This study assessed the effectiveness of this chronic disease control model by comparing mortality rate and the incidence of complications between patients participating in the KCNPC program and a control group. METHODS: Using data from the National Health Insurance Service and data from hypertension and diabetes patients registered with 19 ECCs between January 1, 2010 and December 31, 2012, hypertension and diabetes patients who had been treated at a clinic were selected. The final analysis included 252,900 patients, with the intervention group and control group having 126,450 patients each. Survival for the two groups was analyzed using the Kaplan-Meier method. Complications were analyzed using the Cox proportional hazards model. RESULTS: The 5-year survival rate in the intervention group (0.88) was higher than that in the control group (0.86). Cox proportional hazards analysis showed that the intervention group had lower risk for mortality (0.84; 95% confidence interval [CI], 0.82-0.86) compared to the control group. Hospitalization due to complications and the proportional risk of hospitalization were also lower in the intervention group. CONCLUSION: The KCNPC model for prevention and control of chronic disease in Korea was found to be effective for hypertension and diabetes patients. Therefore, the KCNPC will be necessary to strengthen the capabilities of local communities, primary medical institutions, and individuals for prevention and control of chronic disease. Expanding the efficient prevention and control policies of the KCNPC to a nationwide scale may be effective as has been demonstrated through limited implementation in some regions.

The Mediating Effect of Insecure Adult Attachment on the Relationship between Smartphone Addiction and Self-Directed Learning in University Students.

(1) Purpose: This study aimed to explore the mediating effect of insecure adult attachment on the relationship between smartphone addiction and self-directed learning in university students. (2) Methods: In total, 235 university students participated in this study. Data analysis was carried out through a three-stage verification procedure: Sobel test using technical statistics, Pearson correlation, and multiple regression analysis. (3) Results: Smartphone addiction was positively correlated with insecure adult attachment, attachment anxiety, and self-directed learning, whereas self-directed learning had a significant negative correlation with insecure adult attachment and attachment anxiety. Insecure adult attachment had a mediating effect on the relationship between smartphone addiction and self-directed learning. (4) Conclusion: Higher levels of smartphone addiction indicated higher levels of insecure adult attachment and reduced self-directed learning ability. Therefore, while the prevention of smartphone addiction is critical for improving self-directed learning skills, programs should be developed to foster the formation of secure adult attachment among university students.

Causal Relationships Between Modifiable Risk Factors of Cognitive Impairment, Cognitive Function, Self-Management, and Quality of Life in Patients With Rheumatic Diseases.

BACKGROUND: Rheumatic diseases are one of the most common types of chronic conditions that affect cognitive functions. PURPOSE: To develop and verify a hypothetical model of causal relationships between modifiable risk factors for cognitive impairment, cognitive function, self-management, and quality of life in patients with rheumatic diseases. METHODS: A hypothetical model was developed on the basis of empirical evidence. The fitness of the model was verified on 210 patients with rheumatic diseases. RESULTS: The prevalence of cognitive impairment was 49.0%. Smoking, underlying diseases, pain, and fatigue had a significant direct effect on cognitive impairment. Only cognitive impairment had a significant direct effect on self-management. Fatigue, anxiety, depression, and cognitive function had a significant direct effect on quality of life. CONCLUSIONS: The importance of proper management of symptoms and health habits should be emphasized to prevent and delay the progression of cognitive impairment and improve adherence to self-management regimens and quality of life.

Changes in the dysphagia and nutritional status of patients with brain injury.

AIMS AND OBJECTIVES: To evaluate the degree of improvement in the dysphagia and nutritional status of patients with brain injuries after removal of the nasogastric tube. BACKGROUND: The nurse should assess patients' dysphagia, after removal of the nasogastric tube, and immediately reflect the changes in patient care. Accordingly, the critical roles of nurses in caring for patients with dysphagia involve providing appropriate nutritional therapy as well as preventing aspiration pneumonia and nutritional imbalance. Assessment of the patient's dysphagia on a regular basis and analysis of nutritional status according to the degree of dysphagia are necessary to determine the appropriate timing for providing nursing interventions and to develop protocols for the provision of a therapeutic diet. DESIGN: Prospective observational study. METHODS: This study was conducted on 56 patients with dysphagia after a brain injury. Data were collected using the Gugging Swallowing Screen (GUSS) test and Swallowing Symptom Questionnaire (SSQ). Descriptive statistics, chi-square tests, t tests, and MANOVA were analysed using SPSS 22.0. RESULTS: Patient's dysphagia was observed over the course of 2 weeks. After 14 days, the severity of dysphagia decreased from 91.1%-35.7%, while the number of participants with normal swallowing increased from 1.8%-58.9%. Dysphagia in patients with brain injury improved gradually over time. A significant difference was observed in the serum albumin level of patients with dysphagia (F = 9.51, p = .003, Wilk's λ = .034). CONCLUSIONS: Most of the patients with brain injury developed moderate dysphagia immediately after removal of the nasogastric tube. However, after 14 days had elapsed, the percentage of patients recovering from dysphagia increased to 58.9%. Proper dietary patterns were not adequately provided depending on the degree of patient's dysphagia after removal of the nasogastric tube. Assessing the degree of dysphagia using the GUSS test and providing appropriate diet prevent malnutrition in patients with dysphagia. RELEVANCE TO CLINICAL PRACTICE: This study was conducted in patients who developed complications of dysphagia after a brain injury. Using the Gugging Swallowing Screen (GUSS) test, the changes in the degree of dysphagia were repeatedly measured at different times: 4, 7 and 14 days after the removal of the nasogastric tube. Provision of appropriate diet and changes in the nutritional status were analysed to determine the proper timing for nursing intervention in patients with dysphagia. The data obtained from this study could serve as a basis for developing diet provision protocols for patients with dysphagia.

A tailored relocation stress intervention programme for family caregivers of patients transferred from a surgical intensive care unit to a general ward.

AIMS AND OBJECTIVES: To develop and examine a relocation stress intervention programme tailored for the family caregivers of patients scheduled for transfer from a surgical intensive care unit to a general ward. BACKGROUND: Family relocation stress syndrome has been reported to be similar to that exhibited by patients, and investigators have emphasised that nurses should make special efforts to relieve family relocation stress to maximise positive contributions to the well-being of patients by family caregivers. DESIGN: A nonequivalent control group, nonsynchronised pretest-post-test design was adopted. METHODS: The study subjects were 60 family caregivers of patients with neurosurgical or general surgical conditions in the surgical intensive care unit of a university hospital located in Incheon, South Korea. Relocation stress and family burden were evaluated at three times, that is before intervention, immediately after transfer and four to five days after transfer. RESULTS: This relocation stress intervention programme was developed for the family caregivers based on disease characteristics and relocation-related needs. In the experimental group, relocation stress levels significantly and continuously decreased after intervention, whereas in the control group, a slight nonsignificant trend was observed. Family burden levels in the control group increased significantly after transfer, whereas burden levels in the experimental group increased only marginally and nonsignificantly. No significant between-group differences in relocation stress or family burden levels were observed after intervention. CONCLUSIONS: Relocation stress levels of family caregivers were significantly decreased after intervention in the experimental group, which indicates that the devised family relocation stress intervention programme effectively alleviated family relocation stress. RELEVANCE TO CLINICAL PRACTICE: The devised intervention programme, which was tailored to disease characteristics and relocation-related needs, may enhance the practicality and efficacy of relocation stress management and make meaningful contribution to the relief of family relocation stress, promote patient recovery and enhance the well-being of patients and family caregivers.

Changes in complementary and alternative medicine use across cancer treatment and relationship to stress, mood, and quality of life.

OBJECTIVES: Complementary and alternative medicine (CAM) use is prevalent, but specific use of CAM across cancer treatment is underinvestigated. The objectives of this study were to assess changes in CAM use across cancer treatment; specific reasons for and satisfaction with specific types of CAM used; and associations of CAM use with stress, mood, and quality of life (QOL) in women with newly diagnosed breast cancer. DESIGN AND SETTING: Seventy-seven women with early-stage breast cancer who underwent active cancer treatment participated in the study. Data were collected three times: shortly after cancer diagnosis and 2 months and 6 months after the start of adjuvant cancer therapy. OUTCOME MEASURES: CAM Questionnaire, Impact of Event Scale (stress), Profile of Mood State (mood), and Functional Assessment of Cancer Therapy-Breast Cancer (QOL). RESULTS: Mean age was 52.4 years, and 94%-97% of women used on average five to six CAMs across three time points. Women largely started CAM use before cancer diagnosis and continued across cancer treatment. The five most common CAMs were prayer (88.3%), multivitamin use, massage, and vitamins E and C, followed by music, meditation, green tea, chiropractic care, and vitamin A, with little changes in types of CAM use across cancer treatment. Satisfaction was high, and satisfaction with prayer was the highest. Prayer, meditation, and music were used specifically for a feeling of control, whereas vitamins were used to improve the immune system, showing clear patterns. Stress, mood disturbance, and QOL declined significantly over time, p<0.001-0.04, but the number of CAMs used was unrelated to these variables. CONCLUSIONS: CAM use was highly prevalent with multiple CAMs and continued throughout cancer treatment. Prayer was the most common CAM; it had the highest satisfaction rating and the perception of being most helpful. The effect of long-term CAM use requires further investigation on psychological and biobehavioral outcomes with consideration of demographic and clinical characteristics.

Patterns and clinical correlates of pain among brain injury patients in critical care assessed with the critical care pain observation tool.

This study was conducted to assess the patterns and clinical correlates of acute pain in brain injury patients during the critical care period using the Critical Care Pain Observation Tool (CPOT). Data were collected from 31 brain-injury patients admitted to an intensive care unit (ICU) at a university hospital located in Incheon, Republic of Korea. Glasgow Coma Scale and CPOT scores were assessed on days 1, 3, 6, 9, and 14 after ICU admission. Results showed that temporal changes in pain intensity displayed a consistent pattern in critical care patients with a brain injury during the first 14 days of ICU admission. Mean pain score was highest on day 1, decreased rapidly to reach a minimum on day 3 or 6, and then increased on day 9. In most patients, pain reduced slightly on day 14. Mean CPOT scores were significantly higher in the nonsurgery group than in the surgery group. There was also a nonsignificant trend of higher pain intensity scores among patients with moderate brain injury compared with those with severe injury. CPOT scores immediately after endotracheal suctioning were significantly higher than before endotracheal suctioning, but CPOT scores 20 minutes after suctioning were similar to those before suctioning. The present study may be meaningful in terms of presenting valid clinical information regarding the patterns and characteristics of acute pain in brain injury patients who are often unable to self-report on the presence and intensity of pain.

[Analysis of trends and contents of nursing doctoral dissertations in Korea].

PURPOSE: This study aimed to identify contents and trends of Korean nursing doctoral dissertations in terms of research methodology and theoretical characteristics. METHODS: The design of the study was descriptive study and a total of 1,089 quantitative studies completed between 1982 and 2010 were reviewed using the analytical framework developed by the researchers. RESULTS: The majority of studies utilized the experimental design (51.5%) and the others were survey design (38.8%) and methodological design (5.0%). Study subjects were shown as patients (45%), care givers (11.2%), ordinary persons (40.6%) and others (3.2%). There were growing trends in experimental design and patients as subjects. The prevailing data collection settings were hospitals (45.8%) and community (27.8%). The theoretical frameworks that studies were based on were the existing theories (37%) and a newly developed theoretical framework by a researcher (25.2%). a framework derived from other studies by the researcher (25.2%). Majority of studies (78.5%) employed a single theory as a theoretical framework. However, 31.8% of studies had no theoretical framework based on. CONCLUSION: Findings of this study provided the opportunities to shed new light on the current status of Korean doctoral dissertation and to deliberate on the future direction of nursing studies in Korea.

[Accuracy of references in eight nursing journals in Korea].

PURPOSE: This study was to investigate the reference accuracy in major nursing journals in Korea. METHODS: The references in articles from eight nursing journals from 2006 were compared with PubMed for authors, year, title, journal, volume, and page accuracy. Four hundred sixty-six references were reviewed. Errors were classified as major or minor and categorized by bibliographic headings (author, title, journal, year, volume and page). RESULTS: Of the 466 references, 223(47.9%) had citation errors. The reference error rates ranged from 28.6% to 58.7%. Most errors occurred in the author element (37.9%), followed by title (20.9%), journal (19.0%), page (13.9%), volume (5.9%), and year (2.4%). CONCLUSION: This study identified a considerable error rate in the references of nursing journals. Inaccuracy of references is a reflection on scholarly work of authors and journals. Authors and Editorial committees are responsible for the accuracy of references.

[Analysis of research papers published in the Journal of Korean Academy of Nursing].

PURPOSE: This study was to determine the current trend of nursing research as exploring both quantitative and qualitative methodologies, and to provide the explicit direction to improve the quality of published papers. METHODS: Total of 366 articles published between 2004 and 2006 was reviewed using the criteria of analysis. RESULTS: There was more number of quantitative studies than qualitative studies. More studies were conducted with subjects who had health problems, and studies that targeted women and elderly population have been significantly increased. In quantitative methodology, utilization of experimental and quasi-experimental designs has been increased, however descriptive study was dominant as yet. In qualitative methodology, studies using grounded theory and phenomenology were frequently published. It was noted that theoretical framework and rational for sample size were rarely presented in quantitative study. Philosophical position and the process of preparation for study, which guided the research, were not clearly described in qualitative study. CONCLUSION: The findings of this review suggest that published studies have been improved and diversified, however, detailed and clear evaluation tool that assesses study process and method should be developed as a way to further improve the quality of published papers.

Effects of nasogastric tube feeding on serum sodium, potassium, and glucose levels.

PURPOSE: To examine whether significant alterations in serum sodium, potassium, and glucose levels occurred after nasogastric tube feeding with iso-osmolar formula in acute brain infarction patients. DESIGN AND METHODS: Serum sodium, potassium, and glucose levels were analyzed by a retrospective medical record review of 85 nasogastric tube-fed patients. FINDINGS: The mean values of serum sodium and potassium levels on the day before, and 1st, 2nd, and 3rd days of nasogastric feeding were within the normal range. Alterations in the incidence rates of high, normal, and low level of serum sodium and potassium after tube feeding were not statistically significant. The mean blood glucose levels on the day before, and 1st, 2nd, and 3rd days of tube feeding were above normal, and the increase after tube feading was not statistically significant. CONCLUSIONS: Enteral tube feeding using iso-osmolar formula did not significantly alter serum sodium and potassium balance. However, most participants were hyperglycemic before and after tube feeding, indicating that hyperglycemia can be induced in the acute stages of brain infarction regardless of tube feeding.

Sex differences in immune responses and immune reactivity to stress in adolescents.

The immune system is the body's major defense mechanism against disease. However, psychosocial factors, such as stress, can modulate various immune responses. Although they have been examined in adult humans and other animals, sex differences in immune responses and immune reactivity to stress have rarely been examined in adolescents, particularly comparing healthy and asthmatic adolescents. In 151 healthy and asthmatic high school adolescents (91 females and 60 males), natural killer cell (NK) cytotoxicity, polymorphonuclear leukocyte (PMN) superoxide release, lymphocyte proliferative responses, and CD subsets were measured twice: once during mid-semester and again during final examinations. There was little difference in these measures between healthy and asthmatic adolescents. Similarly, only sex difference was noted in NK cytotoxicity at a 25:1 effector-to-target cell ratio, with males showing significantly higher responses than females. For PMN superoxide release, females significantly increased their responses during final examinations, whereas males demonstrated no changes. For lymphocyte proliferative responses, both females and males increased their responses during final examinations, but the magnitude of increase was much greater in males. Furthermore, racial comparisons indicated that African American adolescents (n = 16), as compared with Caucasian adolescents (n = 128), had significantly higher responses in PMN superoxide release to N-Formyl-Met-Leu-Phe (FMLP) activation during mid-semester and lymphocyte proliferative responses at both time points. Nevertheless, the overall findings indicate limited differences in immune responses and immune reactivity to stress in adolescents between males and females, healthy and asthmatic adolescents, and Caucasians and African Americans. However, further investigations with larger samples are warranted.