Grounded Theoretical Approach on Illness Experience Process in Middle Aged Women with Brain Tumor / 재활간호학회지

Purpose@#The purpose of this study was to develop a substantive theory that can understand the process of illness experience in brain tumor patients and explain their experiences. @*Methods@#Data were analyzed by Corbin & Strauss's grounded theory method. @*Results@#As a result of this study, the core category of brain tumor patients was the reintegration process to adapt to the changed me. This reintegration process has experience of illness through the stages of shock, ambivalent recognizer, relief, re-anxiety and readaptation. During the process of this illness experience, causal conditions were the testimony of the body, the threat of death, the contextual condition were the vulnerability of the woman, the search for the alternative, and the central phenomenon appeared to be the ambivalence toward escape versus acceptance. The interventional conditions were hopes of discovery, common patient wishes. The positive aspects of action/interaction were bright vision of the illness, prevention of recurrence, facing the illness, and the negative aspect was mental sequela. As a result, the paradoxical gift growth of the disease and recovery of normalization were derived. @*Conclusion@#The disease experience of these brain tumor patients was found to be through the stages of shock stage, ambivalent stage, relief stage, re-anxiety stage, re-adaptation stage. This reintegrated into the changed body and reality, and the transition of life was made by the illness event of brain tumor.

A New Self-management Scale with a Hierarchical Structure for Patients with Type 2 Diabetes

Purpose@#The aims of this study were to develop a new instrument for measuring self-management with a hierarchical structure [the Diabetes Self-Management Scale (DSMS)] in patients with type 2 diabetes, and evaluate its psychometric properties. @*Methods@#The DSMS instrument was developed in three phases: (1) conceptualization and item generation; (2) content validity and pilot testing; and (3) field testing of its psychometric properties. A convenience sample of 473 participants was recruited in three university hospitals and one regional health center, South Korea. @*Results@#Exploratory and confirmatory factor analyses yielded two second-order component models explaining the common variance among six first-order factors. Principal axis factoring with a varimax rotation accounted for 60.88% of the variance. Confirmatory factor analysis of the hierarchical structure revealed the following fit indices: χ2/df = 1.373, standardized root-mean-square residual = .050, goodness-of-fit index = .935, incremental fit index = .975, comparative fit index = .974, and root-mean-square error of approximation = .039. All Cronbach' α values for internal consistency exceeded the criterion of .70. All of the intraclass correlation coefficients for test–retest reliability exceeded .70 except that for the taking-medication subscale. The components of the DSMS were moderately correlated with the comparator measures of self-efficacy and health literacy administered for convergent validity. @*Conclusion@#The DSMS is a new instrument for measuring the complex nature of self-management in patients with type 2 diabetes, comprising 17 items scored on a five-point Likert scale. The DSMS exhibits satisfactory psychometric properties for five reliability and validity metrics, and so is a suitable instrument to apply in both research and clinical practices.

A New Self-management Scale with a Hierarchical Structure for Patients with Type 2 Diabetes

Purpose@#The aims of this study were to develop a new instrument for measuring self-management with a hierarchical structure [the Diabetes Self-Management Scale (DSMS)] in patients with type 2 diabetes, and evaluate its psychometric properties. @*Methods@#The DSMS instrument was developed in three phases: (1) conceptualization and item generation; (2) content validity and pilot testing; and (3) field testing of its psychometric properties. A convenience sample of 473 participants was recruited in three university hospitals and one regional health center, South Korea. @*Results@#Exploratory and confirmatory factor analyses yielded two second-order component models explaining the common variance among six first-order factors. Principal axis factoring with a varimax rotation accounted for 60.88% of the variance. Confirmatory factor analysis of the hierarchical structure revealed the following fit indices: χ2/df = 1.373, standardized root-mean-square residual = .050, goodness-of-fit index = .935, incremental fit index = .975, comparative fit index = .974, and root-mean-square error of approximation = .039. All Cronbach' α values for internal consistency exceeded the criterion of .70. All of the intraclass correlation coefficients for test–retest reliability exceeded .70 except that for the taking-medication subscale. The components of the DSMS were moderately correlated with the comparator measures of self-efficacy and health literacy administered for convergent validity. @*Conclusion@#The DSMS is a new instrument for measuring the complex nature of self-management in patients with type 2 diabetes, comprising 17 items scored on a five-point Likert scale. The DSMS exhibits satisfactory psychometric properties for five reliability and validity metrics, and so is a suitable instrument to apply in both research and clinical practices.

Improvement of the qualification system in Korea for foreign nurses eligible to take Korean nursing licensing examination / 보건의료교육평가

Purpose@#We aimed to review and provide a quality improvement for the document utilized by the relevant Korean government body to verify and evaluate foreign university/college graduates’ eligibility for nursing and qualification to take the Korean nursing licensing examination. @*Methods@#This was a descriptive study. We analyzed the current Korean qualification system for foreign graduates to Korean nursing licensing examination and the same system utilized in some other countries. Then, we created a draft of the reviewed qualification standards document based on the 2 prior analyses and their comparisons, and applied a questionnaire in an open hearing with 5 experts to enhance the draft’s quality. Finally, we presented and discussed the final draft. @*Results@#The reviewed criteria of the qualification standards included confirming whether the foreign graduate’s university has an accreditation provided by its relevant government body, the exclusion of foreign graduates’ provision of several documents previously required, a minimum number of credits (1,000 hours) for their original course, a 3-year minimum enrollment period for their original course, and a mandatory reassessment of the foreign graduates’ university recognition in a 5-year cycle. @*Conclusion@#We believe that by creating a review draft that addresses the flaws of the current document utilized to determine the qualification for foreign graduates to take the Korean nursing licensing examination, we have simplified it for a better understanding of the application process. We hope that this draft will contribute to a more objective and equitable qualification process for foreign university nurse graduates in Korea.

Factors Influencing Quality of Life of Elderly People with Dementia / 기본간호학회지

PURPOSE: The purpose of this study was to identify the factors that affect quality of life in elderly people with dementia. METHODS: The participants for this descriptive correlational study were 97 elderly patients with dementia who were attending a daycare center or were being cared for at home. Data were collected from the participants using the Mini-Mental Status Examination-Dementia Scale, the Geriatric Depression Scale (Short Form), Activity of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) Scale. RESULTS: There were statistically significant differences in quality of life of elders with dementia according to mobility, using dementia day-care center, and cohabitation. In multiple regression analysis, depression, activity of daily of living, using dementia day-care centers and cohabitation were significant predictors of quality of life and the four variables explained 60% of the variance in quality of life. CONCLUSION: Findings indicate that to enhance the quality of life for elders with dementia, depression needs to be decreased and regular use of daycare service recommended. Further, various programs enhancing physical ability need to be developed and used with these elders.

Perception of Patient Safety Risk Factors and Performance Level of Safety Care Activities among Hospital Nurses / 한국간호교육학회지

PURPOSE: The purpose of this study was to identify the level of perception of safety risk factors and the degree of performance of safety nursing activities in order to develop an education program to improve the safety of patients. METHODS: The subjects were 217 nurses from 3 university hospitals in Incheon. Data were collected with structured questionnaires and analyzed using descriptive analysis, t-test, and ANOVA using SPSS 22.0. RESULTS: The level of perception of patient's safety risk factors and safety care activities was 2.93 and 4.68, respectively. Perception of patient safety risk factors which belonging to the risk type of therapeutic devices, equipment, service and infrastructure all scored below average; also in addition, behavior, performance, and violence risk type and work system, information and communication risk type showed relatively low perception levels. Safety nursing activities showed a low level of performance in accurate communication among medical teams, management of fire and disaster, security management, use of restraints, identification of patients, and correct performance of operations and procedures. CONCLUSION: Based on these results, it is necessary to improve the safety of patients by taking proper management measures along with education.

A Structural Equation Model Linking Health Literacy to Self-efficacy, Self-care Activities, and Health-related Quality of Life in Patients with Type 2 Diabetes

PURPOSE: Health literacy has been attracting increasing attention because low health literacy is considered an important predictor of adverse health outcomes in many chronic conditions, including diabetes. However, it is unclear how health literacy is associated with health outcomes. The purpose of this study was to formulate a hypothetical structural equation model linking health literacy to self-efficacy, self-care activities, and health-related quality of life (HRQOL) in patients with type 2 diabetes. METHODS: cross-sectional survey design was employed, and 459 patients with type 2 diabetes were recruited from outpatient clinics in two university hospitals. The patients completed a pack of questionnaires. The hypothetical model was tested using structural equation modeling analysis. RESULTS: The values of multiple fit indices indicated that the proposed model provided a good fit to the data. Health literacy exerted not only a direct effect on self-care activities, but also an indirect effect on self-care activities via self-efficacy. However, health literacy exerted only an indirect effect on HRQOL. This structural model was invariant across hemoglobin-A1c-controlled and hemoglobin-A1c-uncontrolled groups. Based on R2 values, the final model accounted for 20.0% of the variance in selfefficacy, 61.0% of the variance in self-care activities, and 16.0% of the variance in HRQOL. CONCLUSIONS: This study suggests that self-care activities are crucial to the link between health literacy and HRQOL. Both health literacy and self-efficacy need to be considered in clinical practice for enhancing self-care activities in patients with type 2 diabetes. This approach may ultimately improve HRQOL in these patients.

Cognitive Function, Physical Function, Problematic Behaviors of Elders using Dementia Daycare Service and Reasons for Stopping Daycare / 기본간호학회지

PURPOSE: Purpose of this retrospective study was to investigate cognitive function, physical function, and problematic behaviors of elders who attended dementia daycare centers, and to identify reasons why they stopped using the center. METHODS: Participants were 176 elders, 60 years or over, attending one of four dementia daycare centers in Incheon. Data were collected from center documents. RESULTS: Mean age was 80.5 years. When admitted to the centers mean scores for the mini-mental status examination, activity of daily living, and instrumental activity of daily living (IADL) were 12.31, 9.53, and 25.09 respectively. Participants received day care service for an average of 17.98 months. The reasons for leaving the center were worsening dementia and health (40.2%), and problematic behaviors (20.1%). CONCLUSION: Results show that elders began to use day care services when their cognitive function and IADL had declined considerably. As the ultimate goal of dementia daycare service is to delay the worsening of cognitive capability and decreases in activities daily living, the effect of the service can be maximized when the service is provided as early as possible in the course of progressively severe dementia. Active promotion should be exerted in the community to encourage early use of this service.

Clinical Alarms in Intensive Care Units: Perceived Obstacles of Alarm Management and Alarm Fatigue in Nurses / 대한의료정보학회지

OBJECTIVES: The purpose of this descriptive study was to investigate the current situation of clinical alarms in intensive care unit (ICU), nurses' recognition of and fatigue in relation to clinical alarms, and obstacles in alarm management. METHODS: Subjects were ICU nurses and devices from 48 critically ill patient cases. Data were collected through direct observation of alarm occurrence and questionnaires that were completed by the ICU nurses. The observation time unit was one hour block. One bed out of 56 ICU beds was randomly assigned to each observation time unit. RESULTS: Overall 2,184 clinical alarms were counted for 48 hours of observation, and 45.5 clinical alarms occurred per hour per subject. Of these, 1,394 alarms (63.8%) were categorized as false alarms. The alarm fatigue score was 24.3 +/- 4.0 out of 35. The highest scoring item was "always get bothered due to clinical alarms". The highest scoring item in obstacles was "frequent false alarms, which lead to reduced attention or response to alarms". CONCLUSIONS: Nurses reported that they felt some fatigue due to clinical alarms, and false alarms were also obstacles to proper management. An appropriate hospital policy should be developed to reduce false alarms and nurses' alarm fatigue.

The Effect of the Experience of Diabetes Education on Knowledge, Self-Care Behavior and Glycosylated Hemoglobin in Type 2 Diabetic Patients / 한국간호교육학회지

PURPOSE: This study was to identify the effect of the experience of diabetes education on knowledge, self-care behavior and glycosylated hemoglobin (HbA1C). Further, this study was held to examine about patient's preferred methods of education and re-education frequency. METHODS: 166 type 2 diabetes patients from two hospitals in Incheon participated in this study. Data were analyzed by using descriptive analysis, t-test, ANOVA, Scheffe's test and multiple regression analysis. RESULTS: 72.3% patients needed re-education and the average interval of re-education was 8.53 months. Patients preferred education methods were lectures, practical training, and studying from pamphlet. Depending on the frequency of diabetes education, there were significant differences in the level of diabetes knowledge (F=10.88, p<.001) and self-care behaviors (F=4.59, p=.012), but there was not significant difference with HbA1C (F=1.53, p=.220). As to how much the diabetes education helped managing diabetes, there was a significant difference in the level of self-care behaviors (t=2.01, p=.049), but there were not significant differences in level of knowledge (t=1.10, p=.275) and HbA1C (t=-.33, p=.746). The experience of diabetes education was a significant factor which influenced patient's knowledge (t=3.93, p<.001) and self-care behaviors (t=2.21, p<.001). But HbA1C was not influenced by the experience of diabetes education (t=-1.68, p=.096). CONCLUSION: It is necessary to provide diabetes education with appropriate interval and methods and subjects that reflect the needs of patient through the study results.

Effects of Provision of Concrete Information about Patient-controlled Analgesia in Hysterectomy Patients

PURPOSE: This study was to investigate the effects of the provision of concrete information about patient-controlled analgesia (PCA) in hysterectomy patients. METHODS: Study design was a nonequivalent control group non-synchronized pre- and post-test design. Sixty subjects participated were assigned to experimental group (30 patients) or control group (30 patients) at one university hospital. Concrete information about PCA was composed of three sections: explanation with a leaflet, practice of using PCA, and question and answer session. RESULTS: The experimental group who received concrete information about PCA before surgery had statistically higher knowledge level about PCA, more positive attitude toward pain control analgesia, a lower pain score, and a higher satisfaction level of the use of PCA post-surgery compared to the control group who received general information before surgery. CONCLUSION: Provision of concrete information about PCA was an effective nursing intervention that reduced post-operative pain for patients and increased their satisfaction with using PCA. It is recommended that concrete information about PCA be provided by nurses to promote the use of PCA and consequently reduce patient's pain post-surgery.

Comparison of Attitudes toward Death among Nursing Students from South Korea, Japan and Indonesia / 한국호스피스완화의료학회지

PURPOSE: This study was performed to compare nursing students' attitudes toward death among South Korea, Japan and Indonesia, and to confirm the need for death education in nursing. METHODS: A total of 294 nursing students completed a questionnaire titled as the Death Attitude Profile-Revised (Wong, Recker, Gesser. 1994). Participating students were from two nursing schools in South Korea, two in Japan and one in Indonesia. Data were analyzed by using descriptive statistics and inferential statistics including, chi2-test, ANOVA and multiple comparison analysis. RESULTS: The total mean score of the DAP-R for the three countries combined was 3.84+/-0.73. By country, the mean was the highest for Indonesian students (4.32+/-0.71), followed by Korean (3.75+/-0.57) and Japanese (3.56+/-0.70) respectively. In relation to subcategories, Indonesian students showed the highest mean score for death avoidance (3.67+/-1.38) and approach acceptance (5.37+/-1.00). Korean students marked the highest (5.51+/-0.91) in neutral acceptance and Japanese students scored the best (3.63+/-1.46) in escape acceptance. Nursing students who had an experience of caring terminally ill patients tended to be affirmative in approach acceptance (P=0.047). There were significant differences in each of the four subcategories except fear of death among the three countries (P<0.001). CONCLUSION: The above results indicate it is necessary to develop education programs based on each country's social and cultural background to help nursing students form desirable attitudes toward death.

Factors Influencing Compliance with Standard Precautions in Intensive Care Unit and Emergency Room Nurses / 기본간호학회지

PURPOSE: The purpose of this study was to investigate the level of knowledge, attitude and compliance with standard precautions and to identify predicting factors of compliance with standard precautions in ICU and ER nurses. METHODS: The participants were 228 ICU and ER nurses working in one of three university hospitals and one general hospital. Collected data included general characteristics, features related to infection risk, and knowledge, attitude and compliance with standard precautions. For the final analysis, 218 questionnaires were used. RESULTS: Within the previous one year, 103 (47.3%) nurses experienced pricking injury from syringe needles or other sharp materials, 111 (50.9%) nurses reported exposure to patients' blood and body fluid. In general, the scores for knowledge, attitude and compliance were all high. Compliance scores for nurses in intensive care units were significantly higher than those of nurses in emergency. There were significant correlations of knowledge, attitude, and compliance with standard precautions. Attitude and work place were significant factors predicting compliance with standard precautions. CONCLUSION: The results indicate that to increase nurse's compliance with standard precautions, continuous efforts to enhance positive attitudes and at the same time, improve work environments and use individualized approaches based on the work units are needed.

Relationship between Intake and Output Balance and Body Weight Changes in Intensive Care Unit Patients / 기본간호학회지

PURPOSE: The purpose of this study was to identify differences between intake and output balance and body weight changes and to identify factors related to differences in critically ill patients. METHODS: The participants for this descriptive correlational study were 65 medical surgical ICU patients. The data were collected from patient medical records. RESULTS: Mean age of the patients was 63.80 years (+/-15.21). Body weight changes for 48 hours averaged 281.54g (+/-2210.48). I&O balance for 48 hours corrected for insensible loss averaged 398.1mL. Differences ranged from 45mL to 7,535mL. In the distribution of absolute difference between body weight change and intake and output balance, only 40% of the patients were within less than 1,000mL. Factors relating to accurate measure of intake and output were ventilation methods, respiration patterns, and edema status. CONCLUSION: Although mean values of weight change and I&O balance for all patients were very close, the range of differences was very wide indicating that, for many patients, intake and output is not an appropriate indicator of body fluid balance. Therefore, because of the frequency fever and/or hyperventilation, nurses need to use caution when using intake and output balance only to estimate current body fluid status for critically ill patients.

Effects of Aroma Hand Massage on the Stress Response and Sleep of Elderly Inpatients / 기본간호학회지

PURPOSE: This study was done to examine the effects of aroma hand massage on stress response and sleep in hospitalized elderly patients. METHODS: A non-equivalent pre-and post-test design was used. Sixty-six hospitalized patients were recruited using a convenience sampling method and assigned to the experimental (n=34) or the control group (n=32). For the experiment, bergamot, lavender, and roman camomile oil were mixed in 2:1:1 ratio to provide aroma hand massage to both hands of each patient in the experimental group for 5 minutes per hand, for 3 days. Post-test data collection was conducted three days after completion of the hand massage. RESULTS: The experimental group had significantly lower stress score (t=-2.648, p=.010, and anxiety scores (t=-4.166, p=.000), and higher sleep measurement scores (t=2.328, p=.023) than those in the control group. CONCLUSION: These results indicate that short-term application of aroma hand massage for hospitalized elderly patients has a positive effect on hospitalization stress, anxiety, and sleep. Therefore, aroma hand massage should be applied as a nursing intervention to reduce stress response and enhance sleep in elderly hospitalized patients.

Change of Stress and Nursing Needs after Hospitalization in Preterm Labor Women / 여성건강간호학회지

PURPOSE: This study was to examine the change of stress and nursing needs in preterm labor women after hospitalization. METHOD: Forty seven women with preterm labor who were admitted in two university hospitals participated in the survey and they were completed the questionnaires on admission day and 5thday after admission. Questionnaires included in modified Antepartum Hospital Stressor Inventory (AHSI) and Nursing Needs for Preterm Labor. The collected data were analyzed by paired t-test and Pearson correlation test. RESULT: The stress level was not decreased significantly after hospitalization. Among them, the stresses about fetus and medical staff were decreased significantly after hospitalization, but those about pregnant women, husband and environment were increased significantly after hospitalization. The difference in the level of nursing needs between the two different days was not significant except the physical needs. The total level of stress and nursing needs were correlated significantly on the 5th day after hospitalization. CONCLUSION: These results indicate that stress and nursing needs of preterm labor women undergo changes after hospitalization. Therefore, development of the program being followed by stressors which change from day to day and further studies are required in order to examine the decreasing of the stress.

A Comparison of the Factors Influencing the Life Satisfaction of the Elderly According to their Cognitive Impairment Level

PURPOSE: This study was conducted to analyze the factors that influence the life satisfaction of the elderly according to their cognitive impairment level. METHODS: This study was conducted by dividing 3,012 elderly residents of a regional community into three groups based on the scores of the Korean version of the Mini-Mental State Examination: a normal group without any cognitive impairment, a suspicious group with a mild level of cognitive impairment, and a high risk group with a high level of cognitive impairment. Researchers made phone calls, house calls, and personal visits to health centers and shelters for the elderly to gather the information required for this study. RESULTS: The results of this study revealed that social relationships, depression, and activities of daily living had a significant impact on life satisfaction for the normal group, while social relationships and depression had a high impact on life satisfaction for the suspicious group, and social relationships had high impact on the life satisfaction of the high risk group. CONCLUSION: Based on the results of this study, we suggest that programs that promote development of the social relationship networks of the elderly should be established to promote their life satisfaction.

Comparison in Care Burden, Fatigue, and Life Contentment of Caregivers by Gender Relationship with Demented Elders / 여성건강간호학회지

PURPOSE: This study was done in order to examine the differences in gender respect to care burden, fatigue, and life contentment of family caregivers of elderly with dementia. METHODS: The setting of the study was a community-based dementia care center providing daycare services. One hundred ninety four caregivers were recruited for the survey. A structured questionnaire was used which included demographic information, care burden, fatigue, and general contentment scales. Caregivers were classified into 4 groups by gender relationship with care recipients. RESULTS: The majority of the caregivers were middle-aged and elderly. More than twice as many were female rather than male caregivers. The results showed that women caregivers expressed more fatigue than men overall (p< .05). In the gender relationships, a different combination of man-woman appeared to have more burdens than that of a woman-woman group (p< .05). For fatigue, the man caregiver-woman elderly group showed a higher fatigue score than a woman-man group (p< .05). However, there was no significant difference in life contentment among groups. CONCLUSION: These results suggest that caregiver's gender and gender relationship with elders could be considerable factors when the nurses make a plan in the community for dementia nursing management services.

Factors Related to Fall in Elderly Patients with Osteoporosis / 성인간호학회지

PURPOSE: The purpose of this study was to identify risk factors of fall and to examine its results among patients aged 60 and over diagnosed with osteoporosis. METHODS: A retrospective descriptive survey was conducted with 91 patients admitted in a university hospital in a city. Data were collected using an interview method with a structured questionnaire, and were analyzed using descriptive statistics and multiple logistic regression. RESULTS: In patients with osteoporosis, the intrinsic risk factors of falls were aging (OR = 3.742), gait disturbance (OR = 12.565), taking one or fewer medicine (OR = 7.873), and having two or more diseases (OR = 5.173). The extrinsic risk factors included the use of a bed (OR = 3.093), slippery floors (OR = 12.130), bathroom mat without anti-slip rubber backing (OR = 3.564), and presence of a night light on the passage from the bedroom to the bathroom (OR = 2.980). CONCLUSION: For the elderly aged over 70 who are most vulnerable to falls, screening tests such as bone mineral density (BMD) should be conducted in health examinations and the risk of fracture caused by osteoporosis should be communicated to the vulnerable elderly. Besides, development of new exercise programs combining weightbearing exercise is needed to prevent bone loss and increase functional activities.

Relationships between Dementia Knowledge, Attitude, Self-Efficacy, and Preventive Behavior among Low Income Middle-Aged Women / 성인간호학회지

PURPOSE: This correlational study was to examine the relationships between dementia knowledge, attitude, self-efficacy and preventive behavior of low income middled-aged women. METHODS: The subjects for this study were 125 low income middle aged women living in I city. The data were collected using the questionnaires for dementia knowledge, attitude, self-efficacy and preventive behavior. The data analysis was done by descriptive statistics, t-test, ANOVA, Pearson product moment correlation and stepwise multiple regression analysis. RESULTS: The mean of dementia knowledge was 13.96 out of 20, attitude was 43.98 out of 60, self-efficacy was 54.07 out of 75 and preventive behavior was 25.98 out of 36. The positive correlations were revealed between dementia knowledge (r=.458, p=.000), attitude (r=.498, p=.000), self-efficacy (r=.573, p=.000) and preventive behavior. The influencing factors for dementia preventive behavior were self-efficacy, belief in Buddhism and attitude which accounted for 42.5% of the total variance. CONCLUSION: Dementia knowledge, attitude and self-efficacy were identified as variables that correlate dementia preventive behavior. Also, self-efficacy is the most influential factor affecting dementia preventive behavior. On the basis of these results, it is necessary for nurses to consider using dementia knowledge and mode of efficacy expectation in order to improve dementia preventive behavior.