The Impact of Practice Environment and Resilience on Burnout among Clinical Nurses in a Tertiary Hospital Setting.

The purpose of this study was to examine practice environment, resilience, and burnout and to identify the impacts of practice environment and resilience on burnout among clinical nurses working at a tertiary hospital. A cross-sectional secondary data analysis was conducted using a convenience sample of 199 nurses. The nurses completed survey questionnaires regarding practice environment, resilience, and burnout. The majority of the nurses were below the age of 30, single, and worked in medical-surgical wards. Approximately, 92% of the nurses reported moderate to high burnout, with a mean practice environment score of 2.54 ± 0.34 and resilience score of 22.01 ± 5.69. Practice environment and resilience were higher in the low level of burnout than in the moderate to high level of burnout. After controlling for demographic and occupational characteristics, resilience and nursing foundations for quality of care were significant predictors of burnout (OR = 0.71, p = 0.001; OR = 0.01, p = 0.036, respectively), explaining 65.7% of the variance. In a mixed practice environment, increased resilience and nursing foundations for quality of care lowered nurses' burnout. Our findings suggest that interventions focused on enhancing individual resilience and practice environment and building better nursing foundations for quality of care should be developed and provided to alleviate burnout in clinical nurses working at tertiary hospitals. Nursing and hospital administrators should consider the importance of practice environment and resilience in nurses in developing interventions to decrease burnout.

Perceptions of video-facilitated debriefing in simulation education among nursing students: Findings from a Q-methodology study.

BACKGROUND: In simulation nursing education, learning occurs through certain debriefing activities. A learning strategy considering the perceptions of learners participating in video-facilitated debriefing (VFD), a key component of simulation-based learning, is highly likely to be an effective debriefing method. PURPOSE: This study aimed to identify the patterns of nursing students' perceptions of VFD after simulation. METHODS: Q-methodology was utilized to explore subjective perceptions regarding VFD among nursing students. A sample of 39 participants, who had simulation and debriefing experience, at a college of nursing in Seoul, Korea was recruited to participate in the study, and they classified 45 selected Q-samples into a nine-point normal distribution grid. Analysis for collected data was used a PC-QUANL program. RESULTS: Three patterns emerged as nursing students' perceptions of VFD in simulation education: positive immersion, reluctant traditionalist, and support seeker, which explained 59.5% of the total variance: 46.7%, 7.7%, and 5.1%, respectively. CONCLUSIONS: To conduct a successful debriefing in nursing education, these different perceptions of VFD should be considered by nursing faculty and educators. The findings of this study that identify the perceptions of nursing students on participating in debriefing can be used for establishing effective debriefing teaching strategies in simulation-based learning.

Attitudes About Coping With Fatigue in Patients With Gastric Cancer: A Q-Methodology Study.

Cancer-related fatigue is the most common symptom in patients with cancer. Coping methods for cancer-related fatigue differ from those of patients without cancer, as the situations faced by patients with cancer are unique. This study aimed to identify subjectivity concerning coping with fatigue in Korean patients with gastric cancer. Q-methodology was used to examine subjective perceptions regarding coping with fatigue among Korean patients with gastric cancer. A convenience sample of 33 participants, who had been hospitalized in 2 university hospitals in South Korea, was recruited to participate in the study and 37 selected Q-samples were classified into a normal forced distribution using a 9-point bipolar grid. The obtained data were analyzed by using PC-QUANL for Windows. Three factors representing distinct attitudes about coping with fatigue emerged among Korean patients with gastric cancer: an optimistic mind, dependency on medicine, and exercise preference. The 3 factors explained 39.4% of the total variance (23.7%, 7.9%, and 7.8%, respectively). Based on the study findings, it is important to develop customized nursing interventions that consider the characteristics of each patient group with gastric cancer. Health professionals should assess the attitudes of patients with gastric cancer about coping with fatigue, explore their situation, and consider their lifestyle.

Perceptions of resilience in patients undergoing peritoneal dialysis: A Q-methodology study.

Resilience is a potential human psycho-social ability that can reduce negative emotion and promote adaptation to adversity. Most previous studies on resilience have highlighted positive factors for patients with chronic illnesses; however, very few focus on the resilience of patients undergoing peritoneal dialysis (PD) using a qualitative approach. Using Q-methodology, we identified the perceptions of resilience of patients undergoing PD. We recruited 33 Korean participants undergoing PD in a university hospital, and classified 37 Q-samples into a 9-point normal distribution grid. Collected data were analyzed using the PC-QUANL program. The perceived subjectivity of the resilience of Korean patients undergoing PD was categorized as three factors: "support-based acceptance," "gloomy isolation," and "active life-oriented." The three factors explained 47.4% of the total variance. The eigenvalues were 9.99, 3.40, and 2.26, respectively. These findings suggest that a differentiated approach is needed for interventions to enhance the resilience of patients undergoing PD. This study highlights that clinical nurses and health professionals should understand the perceptions of resilience of patients undergoing PD, and consider their viewpoints in the caring and treatment process.

Factors influencing blood pressure classification for adults: Gender differences.

AIM: Hypertension is a common condition contributing to many diseases. Factors influencing blood pressure (BP) classification for adults have changed over time. This study aimed to identify factors influencing BP classification according to gender. METHODS: Data from the Sixth Korean National Health and Nutrition Examination Survey (2014) were used in this descriptive, cross-sectional study. Participants were 1555 adults (589 men, 966 women). Measures included demographic, health-related, and lifestyle factors. RESULTS: Compared with the male normal BP group, in the male prehypertension group, body mass index, problem drinking, and reduced sleep duration were higher; and in the male hypertension group, age, poor subjective health status, body mass index, diabetes, problem drinking, smoking, and sodium intake were higher. Compared with the female normal BP group, age, and body mass index were higher in the female prehypertension group; and age, poor subjective health status, body mass index, menopause, and diabetes were higher in the female hypertension group. CONCLUSION: Hypertension and prehypertension prevention interventions for adults should be distinguished according to gender.

Subjectivity About Sexual Ethics Among Korean Undergraduate Students Using Q Methodology.

PURPOSE: Most undergraduate students are in the phase of gaining mental and physical autonomy from their parents as they expand their worlds. The ways that sexual ethics are established during this time may have an important influence on healthy lifestyles and the maintenance of social order. This study aims to determine a typology of undergraduate students' sexual ethics and the characteristics that compose the types. METHODS: Q methodology, which analyzes the subjectivity of each type of attitude, was used. The 44 selected Q statements from 43 participants were classified into the shape of a normal distribution using a 9-point scale. The collected data were analyzed using the PC-QUANL program. RESULTS: The results revealed three discrete groups of students with respect to sexual ethics: traditional absolute purity type, open-minded compromise type, and rational responsibility type. CONCLUSIONS: The results of this study indicate that different approaches to educational programs on sexual ethics are recommended for undergraduate students based on the three types studied.

Attitudes toward stress and coping among primary caregivers of patients undergoing hemodialysis: A Q-methodology study.

Introduction Hemodialysis (HD) causes many life changes, not only for patients undergoing it but also for their families by allowing them to rely on this lifesaving equipment unless they receive a kidney transplant. The stress of the primary caregivers, who spends the most time in the family taking care of the patient undergoing HD, is quite high. This study was to identify attitudes about stress and coping among primary caregivers of HD patients. Methods Q-methodology was undertaken because it integrates quantitative and qualitative research methods. A convenience sample of 33 primary caregivers of HD patients participated. Forty selected Q-samples were obtained from each participant and were classified into a forced normal distribution using a nine-point grid. Data was analyzed using a pc-QUANL program. Findings Three discrete factors emerged as follows: Factor I (they reduced their stress by participating in religious activities; religious sublimation), Factor II (they always worried about the caregiving situations and about the patients' conditions; nervousness), and Factor III (they thought it better to accept their stressful situations; leading handler). Three factors accounted for 44.5% of all the variance, including Factor I (26.0%), Factor II (10.1%), and Factor III (8.4%). The eigenvalues were 8.58, 3.34, and 2.79, respectively. Discussion The subjectivities of the three factors that were identified can be applied during the planning stages of effective interventions for stress and coping. Healthcare workers in clinical practices should consider assesses primary caregivers' attitudes about stress and coping and approaches their situation to cope with it and to adapt to lifestyle changes.

Perceptions about cancer-related fatigue among cancer patients using Q methodology.

PURPOSE: Cancer-related fatigue (CRF) is a common subjective feeling and disabling symptom complex experienced by patients with cancer. This study aimed to identify the subjective perceptions of Korean patients with cancer about CRF to help the development of basic intervention strategies for these patients. METHODS: Q methodology was used to examine the subjective perceptions of patients with cancer about CRF. Thirty-one patients with cancer, hospitalized at a university hospital in Seoul, Korea, were recruited into this study and classified 41 selected Q statements using a nine-point scale. Data were analysed using PC-QUANL for Windows. RESULTS: Data analysis revealed that distinct perceptions about CRF do exist among Korean patients with cancer. Three types of perceptions were identified: dominant self-reliance, positive-conformist and self-deprecating exhaustion. These three types explained 53.0% of the variance (40.2%, 8.2% and 4.6%, respectively). CONCLUSIONS: This study identified three types of perceptions about CRF among Korean patients with cancer. These findings provide baseline data to develop customised interventions for caring strategies. This study also informs health professionals in other countries about the perceptions of Korean patients with cancer about CRF.

Decision-making regarding organ donation in Korean adults: A grounded-theory study.

The aim of this study was to identify the hidden patterns of behavior leading toward the decision to donate organs. Thirteen registrants at the Association for Organ Sharing in Korea were recruited. Data were collected using in-depth interview and the interview transcripts were analyzed using Glaserian grounded-theory methodology. The main problem of participants was "body attachment" and the core category (management process) was determined to be "pursuing life." The theme consisted of four phases, which were: "hesitating," "investigating," "releasing," and "re-discovering. " Therefore, to increase organ donations, it is important to find a strategy that will create positive attitudes about organ donation through education and public relations. These results explain and provide a deeper understanding of the main problem that Korean people have about organ donation and their management of decision-making processes. These findings can help care providers to facilitate the decision-making process and respond to public needs while taking into account the sociocultural context within which decisions are made.

Attitudes toward simulation-based learning in nursing students: an application of Q methodology.

SBL is a highly advanced educational method that promotes technical/non-technical skills, increases team competency, and increases health care team interaction in a safe health care environment with no potential for harm to the patient. Even though students may experience the same simulation, their reactions are not necessarily uniform. This study aims at identifying the diversely perceived attitudes of undergraduate nursing students toward simulation-based learning. This study design was utilized using a Q methodology, which analyzes the subjectivity of each type of attitude. Data were collected from 22 undergraduate nursing students who had an experience of simulation-based learning before going to the clinical setting. The 45 selected Q-statements from each of 22 participants were classified into the shape of a normal distribution using a 9-point scale. The collected data was analyzed using the pc-QUANL program. The results revealed two discrete groups of students toward simulation-based learning: 'adventurous immersion' and 'constructive criticism'. The findings revealed that teaching and learning strategies based on the two factors of attitudes could beneficially contribute to the customization of simulation-based learning. In nursing education and clinical practice, teaching and learning strategies based on types I and II can be used to refine an alternative learning approach that supports and complements clinical practice. Recommendations have been provided based on the findings.

[Development and testing of a nurse turnover intention scale (NTIS)].

PURPOSE: The purpose of this study was to develop a measurement tool of nurse's turnover intention. METHODS: Data were collected from questionnaires completed by 678 nurses who worked in 3 university hospitals in South Korea and analyzed using the SPSS 18.0 and AMOS 18 programs. Thirty-seven preliminary items were selected from 161 basic items extracted via a literature review and in depth interviews with 6 hospital nurses. Three steps with factor analysis were undertaken to verify the reliability and validity of the preliminary instruments. Finally, confirmative factor analysis was carried out. RESULTS: As a result of the analysis, 3 factors including 10 items were selected. Cronbach's Alpha for the 10 items was .83, for job satisfaction (4 items), .78, for interpersonal relationships (3 items), .80, and for work performance (3 items), .74, which was stable. CONCLUSION: This study is meaningful because through it a scale reflecting Korean culture was developed to measure turnover intention in nurses. Further studies that test the psychometrics of this scale in more diverse samples are warranted.

Health promotion behavior in middle-aged Koreans: a cross sectional survey.

This cross-sectional study was conducted to verify self-efficacy, self-esteem, and social support as characteristics of health promotion behavior in middle-aged Koreans, and the influence of social support on self-efficacy and self-esteem with respect to health promotion behavior. Data were collected from 310 subjects in South Korea using a self-administered questionnaire. We found a significant finding that self-efficacy positively influences health promotion behavior, focusing on the moderating effect of social support. Self-efficacy affected health promotion behavior (P < 0.01) as did social support. Mean self-efficacy, self-esteem, health promotion behavior, and social support scores were 50.27, 29.35, 124.39, and 76.51, respectively. This finding provides strong evidence that social support can be used as a model to understand health promotion behavior. Individualized nursing interventions based on social support and self-efficacy theory should be utilized in high-risk middle-aged patients so as to assist and improve health promotion behavior. Also, in community practice settings, nurses should consider that increased social support and self-efficacy are required to improve health promotion behaviors.

[Subjectivity of nursing college students' awareness of gender equality: an application of Q-methodology].

PURPOSE: This study was done to identify the awareness of gender equality among nursing college students, and to provide basic data for educational solutions and desirable directions. METHODS: A Q-methodology which provides a method of analyzing the subjectivity of each item was used. 34 selected Q-statements from each of 20 women nursing college students were classified into a shape of normal distribution using 9-point scale. Subjectivity on the equality among genders was analyzed by the pc-QUANL program. RESULTS: Four types of awareness of gender equality in nursing college students were identified. The name for type I was 'pursuit of androgyny', for type II, 'difference-recognition', for type III, 'human-relationship emphasis', and for type IV, 'social-system emphasis'. CONCLUSION: The results of this study indicate that different approaches to educational programs on gender equality are recommended for nursing college students based on the four types of gender equality awareness.

Psychometric testing of the Depressive Cognition Scale in Korean adults.

This study translated the Depressive Cognition Scale (DCS) from English into Korean and tested the reliability and validity of the scale. Data were from a convenient sample of 795 community-dwelling Korean adults with a self-administered questionnaire. With regard to the reliability estimate, the internal consistency of the Korean version of the DCS (K-DCS) was acceptable, where the Chronbach's alpha is .93 and the average item-to-total correlation r = .760. With regard to the validity estimate, the mean scores of the K-DCS were significantly different according to gender, age, and marital status. A single factor was extracted that accounted for 67.37% of the total variance. The average score of the K-DCS also correlated significantly with the subscales of the Korean version of the Profile of the Mood States Brief Form. These findings suggest that the K-DCS can be used as a reliable and valid measure of depressive cognition among Korean adults.

Application of the transtheoretical model to identify aspects influencing condom use among Korean college students.

Increasing condom use requires an understanding of the influencing factors. Previous research has used psychosocial theories such as the social cognitive theory and health belief to explain AIDS risk factors and condom use. However, it is still difficult to effectively predict the multidimensional factors associated with condom use. The present study utilizes the transtheoretical model to investigate condom use among college students by examining stages of change for condom use and measuring decisional balance and self-efficacy for each stage. The aim was to identify the variables affecting condom use so as to provide scientific data that would aid the development of effective strategies for increasing condom use.

Verification of the profile of mood states-brief: cross-cultural analysis.

This international study investigated whether the mood states of adults can be compared between different settings and cultures using the same instrument, namely, by comparing the psychometric properties of the Profile of Mood States-Brief (POMS-B) using data gathered in the United States and Korea. The Korean research instrument was a translation of the original POMS-B, and was evaluated psychometrically for each country separately as well as for the two countries combined, based on a convenience sample of 184 adults: The POMS-B was administered to 69 native English speakers and the Korean version (K-POMS-B) was administered to 115 native Korean speakers. The mean total mood disturbance (TMD) score was 23.59 (SD = 16.7): 26.11 (SD = 15.9) for the Americans and 21.06 (SD = 17.5) for the Koreans. Cronbach's alpha coefficient was high for both versions. The content validity index was 96% in the K-POMS-B. The Korean version of the POMS-B seems to be ready for use in research.

Internet addiction in Korean adolescents and its relation to depression and suicidal ideation: a questionnaire survey.

This study examined the relationship of Internet addiction to depression and suicidal ideation in Korean adolescents. The participants were 1573 high-school students living in a city who completed the self-reported measures of the Internet Addiction Scale, the Korean version of the Diagnostic Interview Schedule for Children-Major Depression Disorder-Simple Questionnaire, and the Suicidal Ideation Questionnaire-Junior. A correlational survey design was employed. Among the samples, 1.6% was diagnosed as Internet addicts, while 38.0% was classified as possible Internet addicts. The prevalence of Internet addiction did not vary with gender. The levels of depression and suicide ideation were highest in the Internet-addicts group. Future studies should investigate the direct relationship between psychological health problems and Internet dependency.

[Development of a nursing professional values scale].

PURPOSE: The purpose of this study was to develop an instrument to measure nursing professional values. METHOD: Forty preliminary items were selected by classifying 223 basic items extracted via a literature study and in-depth interviews of subjects and testing the relevance of their contents. In order to verify the reliability and relevance of the preliminary instrument, data was collected from 504 nurses in 3 general hospitals. RESULT: As a result of the item analysis, 29 items were selected from a total of 40 items. Five factors were extracted by factor analysis, and the total variance was 51.5%. For the explanation of variances by factors, the 1st factor, 'self-concept of the profession' accounted for 14.8%, the 2nd factor, 'social awareness' 12.1%, the 3rd factor, 'professionalism of nursing' 9.8%, the 4th factor, 'the roles of nursing service' 9.1%, and the 5th factor, 'originality of nursing', 5.6%. Cronbach's Alpha of those 29 items was .9168, which was high. CONCLUSION: This paper is meaningful in a way that it developed a tool capable of measuring nursing professional values, which reflects the characteristics of our country. In order to re-verify the relevance and stability of this tool, it is necessary that comparative studies should be conducted.

A Q-methodological study on nursing students' attitudes toward nursing ethics.

PURPOSE: Professional nursing ethics is a living, dynamic set of standards for nurses'professional moral behavior. Furthermore, in daily clinical nursing training, nursing students are constantly confronted with decision-making that is moral in nature. The aim of this study was to identify the perceived ethical attitudes in the clinical training process of senior nursing students using Q-methodology to offer basic strategies for nursing ethics education and thereby improve patients'care. METHODS: Q-methodology provides a scientific method for identifying perception structures that exist within certain individuals or groups. Thirty-seven participants in a university rated 38 selected Q-statements on a scale of 1-9. The collected data were analyzed using pc-QUNAL software. RESULTS: Principal component analysis identified 3 types of ethical attitudes in nursing students in Korea. The categories were labeled Sacred-life, Science-realistic and Humane-life. Sacred-life individuals think that a life belongs to an absolute power (God), not a man, and a human life is a high and noble thing. Science-realistic individuals disagreed that allowing an induced abortion or embryo (human) duplication is unethical behavior that provokes a trend, which takes the value of a life lightly; most of them took a utilitarian position with respect to ethical decisions. Humane-life individuals exhibit a tendency toward human-centered thought with respect to ethical attitudes. CONCLUSION: This study will be of interest to educators of students of nursing and hospital nursing administrators. Also, the findings may provide the basis for the development of more appropriate strategies to improve nursing ethics education programs.