The impact of Value Incentive Program (VIP) on the quality of hospital care for acute stroke in Korea.

OBJECTIVES: This study aims to analyze the impact of Value Incentive Program (VIP) on the quality improvement of acute stroke care, and to determine the difference of effect by the size of hospitals. INTERVENTIONS: Adopting the VIP on the fifth acute stroke quality assessment. DESIGN/SETTING/PARTICIPANTS: Using paired t-test and student t-test, we compared the quality assessment results of the third assessment, which was publicly reported without the VIP implementation and the fifth assessment, on which the VIP was applied. The subjects of the third assessment were acute stroke admissions in 201 hospitals (44 tertiary and 157 general hospitals) from January to March 2010. The fifth assessment included 201 hospitals (42 tertiary and 159 general hospitals) from March to May 2013. MAIN OUTCOME MEASURES: Seven process indicators of acute stroke quality assessment and in-hospital mortality rate. RESULT: In comparison to the third assessment, five of the seven process indicators showed statistically significant improvement in the fifth assessment. Also, there were significant decreases in the interquartile ranges of five process indicators. This phenomenon was more notable in general hospitals. The in-hospital mortality rate of hemorrhagic stroke in general hospitals showed a statistically significant decrease from 20.8% in the third assessment to 11.6% (P < 0.05) in the fifth assessment. CONCLUSION: This study demonstrated that the VIP was effective in improving quality of acute stroke care. The improvement was more prominent in general hospitals, and led to reduced quality gaps among hospitals.

Knowledge Level of Human Papillomavirus, Cervical Cancer and Vaccination Status among Mothers with Daughters in High School.

PURPOSE: The goal of this study was to examine knowledge level of human papillomavirus (HPV), cervical cancer, and vaccination status among Korean mothers' with a daughter in high school. METHODS: A cross-sectional descriptive study was conducted with a convenience sample of 234 Korean mothers. RESULTS: The mean score of HPV knowledge level was 4.21 out of 20, and cervical cancer knowledge was 3.88 out of 7. There were low levels of daughters' who received HPV vaccination (3.8%) and high levels of mothers' intention to get their daughters' vaccinated with HPV (85.0%). The major barrier to HPV vaccination was the concern for side effect from the vaccination. The most effective recommendation for HPV vaccination came from health care providers. CONCLUSION: HPV educational programs targeting mothers of daughters in high school is needed. Future studies need to determine actual HPV vaccination rates and factors related to high uptake using a larger sample from various socioeconomic background.

Effects of a nurse-led cognitive-behavior therapy on fatigue and quality of life of patients with breast cancer undergoing radiotherapy: an exploratory study.

BACKGROUND: Radiotherapy can have multiple adverse effects, including patient complaints of persistent fatigue and low quality of life. Cognitive-behavior therapy (CBT) has alleviated fatigue and improved QOL of cancer patients; however, little is known about the effects of nurse-led CBT on breast cancer patients undergoing radiotherapy. OBJECTIVE: The purpose of this study was to analyze the effects of a nurse-led CBT program on fatigue and QOL of patients with breast cancer undergoing radiotherapy. METHODS: This study was performed using a quasi-experimental pretest/posttest design, with a nonequivalent control group. The participants were patients with breast cancer (N = 71: experimental group = 35, control group = 36) undergoing radiotherapy at P University Hospital in Korea. The experimental group received a 6-week intervention program that included cognitive restructuring, education about the disease and medical treatment, relaxation therapy, and rehabilitation exercise. RESULTS: After the 6-week intervention, the level of fatigue increased in patients in both groups. However, the increase in the experimental group was lower than that in the control group. Quality of life of the experimental group was significantly higher than that of the control group. CONCLUSIONS: The nurse-led CBT seemed to control fatigue level and improve QOL. Therefore, the use of nurse-led CBT for patients with breast cancer undergoing radiotherapy must be promoted. IMPLICATIONS FOR PRACTICE: Active involvement of experienced nurses in the counseling program should be considered. In addition, further research must be conducted into the implementation of the nurse-led cognitive-behavioral intervention to a broader spectrum of patients.

Women Religious and Married Women's Attitudes toward Menopause and Menopausal Symptoms.

PURPOSE: This study was done to extend the understanding and knowledge of menopause by comparing attitudes toward menopause and menopausal symptoms of women religious and married women. METHODS: The data were collected by self-report questionnaires from 126 women religious and 131 married women, between 40 and 59 years of age who lived in P city, D city and K province. A structured questionnaire was used which included demographic and health-related information, attitudes toward menopause, and menopausal symptoms. Data were analyzed by using chi2-test, t-test, and Pearson correlation coefficients with the SPSS/WIN 14.0 program. RESULTS: The mean score for attitudes toward menopause of women religious and married women was 69.46 +/- 6.15 and 66.98 +/- 6.12 respectfully, and the difference was significant (p=.001). The mean score for menopausal symptoms of women religious and married women was 41.33 +/- 23.55 and 55.99 +/- 30.81 respectively, and the difference was also significant (p<.001). Attitudes toward menopause were negatively correlated with menopausal symptoms (r=-.27, p<.001).

[Effects of a cognitive-behavioral nursing intervention on anxiety and depression in women with breast cancer undergoing radiotherapy].

PURPOSE: The purpose of this study was to analyze the effects of a cognitive-behavioral nursing intervention on anxiety and depression of patients with breast cancer undergoing radiotherapy. METHODS: A nonequivalent control group design was used for the study. The research participants were patients with breast cancer (N=71; experimental group=35, comparison group=36) who received radiotherapy at P university hospital. The experimental group received a 6-week cognitive-behavioral nursing intervention (2 hr/week), which included nursing counseling, education about treatment choices for breast cancer and possible side effects and management strategies during radiotherapy, and rehabilitation exercise. RESULTS: Following the intervention, the experimental group showed significantly lower levels of anxiety (Experimental group=34.60+/-6.35, Comparison group=44.63+/-9.93, t=3.552, p<.001) and depression (Experimental group=10.20+/-6.61, Comparison group=17.81+/-10.85, t=3.542, p<.001) than the comparison group. CONCLUSION: The findings from this study showed that cognitive-behavioral counseling applied by nurses is very effective to reduce anxiety and depression among patients with breast cancer. Therefore, providing nursing counseling to broader spectrum of patients with cancer should be considered. Further research would warrant future clinical application of nursing counseling.

Attitude, beliefs, and intentions to care for SARS patients among Korean clinical nurses: an application of theory of planned behavior.

PURPOSE: This study examined Korean clinical nurses' intentions to care for SARS patients and identify determinants of the intentions. Theory of planned behavior was the framework to explain the intentions of Korean nurses for SARS patients care. METHODS: A convenient sample of six hundreds and seventy nine clinical nurses from four university-affiliated hospitals located in Seoul and in Kyung-gi province was used. Self-administered (83-items) questionnaire was used to collect data. Intentions, attitude, subjective norm, perceive behavioral control, behavioral beliefs, normative beliefs, and control beliefs were the study variables. All items were measured using 7-point Likert scale (-3 to +3). Data were analyzed using descriptive statistics, Pearson correlation method, and stepwise multiple regression methods. RESULTS: Intentions and attitudes toward SARS patient care among Korean clinical nurses were moderate, but their subjective norm and perceive behavioral control of SARS patients care were negative. Stepwise multiple regression analysis indicated that attitude toward SARS patient care, perceived behavioral control, subjective norm were the determinants of the intentions for SARS patients care as theory proposed. Among the behavioral beliefs, "SARS-patient caring would be a new experience", "during SARS-patient caring, I should be apart from my family", "after completing SARS-patient caring, I would be proud of myself being able to cope with a stressful event" and "with my SARS-patient caring, patients could recover from SARS" were the significant determinants. Among the normative beliefs, colleague approval, spouse approval, and physician approval were significant determinants of the intentions. Among the control beliefs, "SARS-patient caring would be a challenge" "SARS-patient caring is a professional responsibility", "tension during the care of SARS patients" and "support from team members" were the significant determinants of the intentions. CONCLUSIONS: Korean clinical nurses in this study were not willing to care for SARS patients and showed negative attitude toward the care. They believed their friends and family were not approved their care for SARS patients. Nurses were in conflicts between professional responsibilities to care for SARS patients and personal safety. This study was the first to understand stress and burden of Korean clinical nurses who are in front line to care for newly developed communicable disease such as SARS. Under the circumstance where several fatal communicable diseases are predictable, conflicts between professional responsibility and their personal risks should be taken into considerations by nurses themselves and by nursing administrators in order to improve quality of care.