Hardiness Mediates Stress and Impact Level in ED Nurses Who Experienced a Violent Event.

INTRODUCTION: This secondary analysis examined the mediating effect of hardiness between stress and impact level in ED nurses who experienced a violent event. METHOD: This correlational study was conducted from June to August 2014. We used the visual analog scale to measure stress level, the Impact of Event Scale-Revised to measure impact level after the violent event, and the Dispositional Resilience Scale to measure hardiness. We then analyzed mediating effects with the Sobel test. Data were collected in 31 emergency medical centers located in B city in Korea. Data from 321 ED nurses who experienced a violent event were analyzed. Most nurses (91.9%) were women, with a mean age of 28.73 years. The main outcome measure was the mediating effect of hardiness between stress and impact level after ED nurses experienced violence. RESULTS: We found that both violence-related stress (B = 0.22, P < .001) and hardiness (B = -0.33, P = .037) were significant predictors of impact level from a violent event. Based on results of a Sobel test, hardiness partially mediated the relationship between violence-related stress and impact level from a violent event (Z = 2.03, P = .044). DISCUSSION: Hardiness had an effect on reducing the impact level of ED nurses who had experienced a violent event and had a mediating role in mitigating their stress. Therefore, we recommend the development of an intervention program that emphasizes the improvement of hardiness in ED nurses.

The relationship between the BRAF(V600E) mutation in papillary thyroid microcarcinoma and clinicopathologic factors.

BACKGROUND: The BRAF(V600E) mutation, which accounts for about 60-80% papillary thyroid carcinoma(PTC), has been identifiedas a prognostic marker for risk stratification of PTC patients. However, the BRAF(V600E) mutation as a prognostic marker in papillary thyroid microcarcinoma (PTMC) is unclear. METHODS: We performed a retrospective review of 101 patients who underwent surgery for PTMC. We studied the prevalence of the BRAF(V600E) mutation. The associations between the BRAF(V600E) mutation and clinicopathologic characteristics were analyzed. RESULTS: The BRAF(V600E) mutation was observed in 72 patients (71.3%). There was no statistically significant correlation in age, gender, multifocality, extrathyroidal extension, presence of Hashimoto thyroiditis, and lymph node metastasis between the BRAF(V600E) mutant group and wild group. CONCLUSIONS: The BRAF(V600E) mutation is not significantly associated with prognostic factors in PTMC.

Tai chi for lower urinary tract symptoms and quality of life in elderly patients with benign prostate hypertrophy: a randomized controlled trial.

Tai chi exercise has been recommended as suitable for the improvement of health in the elderly. The purpose of this study was to investigate the effects of tai chi on lower urinary tract symptoms (LUTSs), quality of life (QoL), and sex hormone levels in patients with benign prostate hypertrophy (BPH). The elderly patients with BPH were randomized to receive tai chi or usual care. Fifty-six participants were randomized into either the tai chi group (n = 28) or the control group (n = 28). After 12 weeks of treatment, the tai chi group showed significant improvement in LUTS and QoL. There was a significant effect of tai chi on testosterone but no significant effect on insulin or glucose. No serious adverse events were observed during the study period. In conclusion, our results suggest that 12 weeks of tai chi may improve LUTS and QoL in elderly patients with BPH.

Development and Validation of a Nursing Work Interruption Scale.

Work interruption disturbs nurses' flow of thinking, diminishes work efficiency, induces burnout, and causes errors that can threaten patients' lives. Therefore, it is important to identify the causes and measure the extent of work interruption. This study developed a self-report scale and established its validity and reliability for use in hospital settings. Through literature review and in-depth interviews with nurses, we identified two components and developed 25 preliminary items. These items were reviewed by nursing experts for content validity and pilot tested among 20 hospital nurses; subsequently, a 16-item preliminary instrument was finalized. A total of 359 questionnaires were included in the final analysis, and exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed. Two factors and 12 items were derived from two rounds of EFA, with a cumulative percentage of variance of 55.73%. Construct validity was established through CFA. The predictive validity and internal consistency reliability of the developed scale were also established. Thus, the 12-item Work Interruption Measurement Scale for Nurses comprising two domains (human and environmental factors) was developed. This scale can be useful in assessing work interruption experienced by nurses and for developing and assessing the effectiveness of interventions pertaining to nurses' work interruption.

Emergency Room Nurses' Experiences in Person-Centred Care.

Implementing person-centred care is often considered difficult in congested emergency rooms. The purpose of this study was to understand person-centred care experienced by emergency room nurses in depth and examine the essence of emergency room nurses' lived experience of the person- centred care. Eight nurses working in the emergency room of a large hospital in South Korea and who had over six months of experience were surveyed via semi-structured interviews in February 2019. The data were transcribed and analysed using Colaizzi's framework. The major findings related to person-centred care experiences among emergency room nurses were: (1) feeling distanced from patients; (2) guilt and frustration; (3) accepting patients' symptoms and emotions as they are; (4) person-centred care as a domain of nursing that cannot be replaced by machines; and (5) nursing as an art wherein the minutest details make a difference. Providing person-centred practice in the emergency room is difficult, but it will not only improve the quality of patient care but also increase the job satisfaction of nurses. Based on an in-depth understanding of person-centred care experienced by emergency nurses, it will contribute to enhancing the quality of nursing care in the emergency room.

[A Prediction Model of Exercise Level in Patients with Ankylosing Spondylitis].

PURPOSE: This study aimed to construct and test a hypothetical model to explain the predictive factors and causal pathways for exercise levels in patients with ankylosing spondylitis based on the self-determination theory. A conceptual framework was constructed assuming that autonomy support by health care providers would satisfy the three basic psychological needs of patients, which would increase their autonomous motivation for exercise, resulting in its initiation and continuation. METHODS: This cross-sectional study included 221 patients with ankylosing spondylitis who were visiting rheumatology clinics in two tertiary hospitals. Health Care Climate Questionnaire-exercise regularly, Basic Psychological Needs Satisfaction scale, Behavior Regulation in Exercise Questionnaire-2, and exercise level were used to collect data. RESULTS: The fitness of the hypothetical model met the recommended level (χ²/df ≤ 3, SRMR ≤ .08, RMSEA ≤ .08, GFI ≥ .90, AGFI ≥ .85, NFI ≥ .90, TLI ≥ .90, CFI ≥ .90). The model effect analysis revealed that autonomy support by health care providers had a positive effect on patients' autonomy, competence, relatedness, autonomous motivation, and exercise level. Competence and relatedness had positive effects on autonomous motivation and exercise level, respectively. Autonomous motivation had a positive effect on exercise level. CONCLUSION: The predictive factors of exercise level in patients with ankylosing spondylitis were autonomous motivation, health care providers' autonomy support, competence, and relatedness. Considering these factors, we recommend the development of an effective program for improving exercise levels in these patients.

[Effects of a Cognitive Behavior Therapy Program for Patients with Fibromyalgia Syndrome: A Randomized Controlled Trial].

PURPOSE: This study developed a cognitive behavioral therapy program aimed at altering the physical condition, emotions, and behaviors of fibromyalgia patients, and confirmed the program's clinical applicability. The program was developed by analyzing previous studies conducting in-depth interviews with fibromyalgia patients, drawing on cognitive behavior theory to establish the program contents, recruiting experts to test its validity, and conducting a preliminary survey. METHODS: To confirm the program's effect, this study used a randomized controlled trial design. The participants were outpatients diagnosed with fibromyalgia in Dong-A University Hospital, Busan. The 30 patients in the experimental group took part in the program, which comprised 8 sessions (90 to 120 minutes) based on cognitive behavior theory, delivered over 8 weeks. Hypothesis testing was carried out using the repeated measures ANOVA. RESULTS: The analysis revealed significant differences between the experimental and control groups in positive automatic thoughts, pain, fatigue, depression, and interpersonal relationships. However, there was no significant difference between the groups in terms of sleep disorders and negative automatic thoughts. CONCLUSION: This program is a positive effect on physical condition, emotions, and behaviors. It is thus expected to be used to help fibromyalgia patients improve their disease conditions.

Development and evaluation of a self-management application for patients with gout.

AIM: The present study aimed to develop a self-management application for patients with gout and determine the clinical feasibility of the application. METHODS: A self-management application (GoutCare) was developed from July 1, 2016, to October 30, 2016, by reflecting on the key elements of Fisher & Fisher's information-motivation-behavioral skills model. In order to determine the clinical feasibility of the application, a non-equivalent, control group, pre-test-posttest study was conducted among patients with gout who visited a university hospital from January to April 2017. Twenty-seven subjects in the experimental group used the smartphone allocation for 8 weeks, and 29 subjects in the control group were provided a leaflet with information on gout self-management. Knowledge of gout, self-management attitude, perceived social support, self-efficacy, self-management performance, and health-related quality of life before and after the intervention were measured using a structured questionnaire. RESULTS: The self-management application (GoutCare) developed for patients with gout was found to be effective in improving the knowledge of gout, self-management attitude, perceived social support, self-efficacy, self-management performance, and physical health-related quality of life. CONCLUSION: In conclusion, the application contributed to improving the self-management performance and health-related quality of life in the patients with gout. Therefore, this application can be used as a nursing intervention program for promoting self-management in patients with gout.

[A Meta-Analysis on the Effects of Mind-Body Therapy on Patients with Irritable Bowel Syndrome].

PURPOSE: Previous randomized controlled trials (RCT) found that mind-body therapy can improve the health outcomes of patients with irritable bowel syndrome (IBS). The purpose of this meta-analysis was to identify the combined effects of mind-body therapy on patients' IBS symptoms, quality of life, anxiety, and depression. METHODS: A systematic literature search was conducted using various databases such as PubMed, EMBASE, CINAHL CENTRAL, DBpia, RISS, and KISS. The primary outcome variables were IBS symptoms and quality of life; the secondary outcome variables were anxiety and depression. Comprehensive Meta-Analysis version 3.0 was used to analyze the extracted data. The effect size was calculated using standardized mean difference (SMD) and 95% confidence interval (CI). RESULTS: Eleven final RCTs were used for this meta-analysis. Mind-body therapy was found to have a significant effect on the IBS patients' symptoms (SMD, -0.63; 95% CI, -0.77 to -0.48), quality of life (SMD, 1.03; 95% CI, 0.40 to 1.66), anxiety (SMD, -0.28; 95% CI, -0.47 to -0.09), and depression (SMD, -0.31; 95% CI, -0.06 to -0.12). CONCLUSION: This meta-analysis reveals that mind-body therapy significantly improves IBS patients' symptoms, quality of life, anxiety, and depression. The results suggest that, in the future, appropriate mind-body therapy should be applied to Koreans suffering from IBS. Moreover, the therapy's long-term effects should be assessed.

Effects of Parity and Breastfeeding Duration on Bone Density in Postmenopausal Women.

PURPOSE: This study aimed to identify the effect of parity and breastfeeding duration and the occurrence of lumbar vertebral and femoral neck osteoporosis in Korean postmenopausal women. METHODS: This study analyzed the data of 1,770 women based on the 2010-2011 results of the Korea National Health and Nutrition Examination Survey. Extracted data concerning bone density included variables known to be associated with osteoporosis. Complex sample multivariate logistic regression analysis was conducted to determine whether parity and breastfeeding duration were associated with osteoporosis in postmenopausal women. RESULTS: Parity was not associated with postmenopausal osteoporosis in the femoral neck or lumbar vertebrae; however, the risk of femoral neck osteopenia was significantly higher in women with a history of 12-24 months of breastfeeding than in women who breastfed for less than 12 months (odds ratio = 2.12, 95% confidence interval = 1.07-4.21). In women who breastfed for 24 months or longer, the risk of lumbar vertebral osteoporosis was significantly higher than in those who breastfed for less than 12 months (odds ratio = 2.73, 95% confidence interval = 1.18-6.32). CONCLUSION: Breastfeeding duration may affect the occurrence of lumbar vertebral or femoral neck osteopenia or osteoporosis. Therefore, women who breastfeed for one year or more require education on the risk of bone loss and the need for preventive measures such as adequate calcium intake and physical exercise.

Meta-analysis of the Effect of a Pulmonary Rehabilitation Program on Respiratory Muscle Strength in Patients with Chronic Obstructive Pulmonary Disease.

PURPOSE: Pulmonary rehabilitation (PR) programs are important in the treatment of patients with chronic obstructive pulmonary disease (COPD) but vary widely in type, duration, and efficacy. This meta-analysis investigated the effect of PR programs on respiratory muscle strength in patients with COPD. METHODS: PubMed, Embase, and CINAHL were searched. The primary outcome variables were maximal expiratory pressure (MEP) and maximal inspiratory pressure (MIP). The secondary outcome variables were the modified Borg score after the 6-min walking test, percent predicted forced expiratory volume in 1 second (FEV1%pred), and percent FEV1/forced volume capacity (FVC). Comprehensive Meta-Analysis, version 3.0, was used to analyze the data. The effect size was calculated using the standardized mean difference (SMD) and 95% confidence interval (CI). RESULTS: Twenty randomized controlled trials (with 992 participants) were included in the analysis. The PR programs had a significant effect on the MEP (SMD, 0.87; 95% CI, 0.42-1.32; p < .001), MIP (SMD, 0.53; 95% CI, 0.13-0.93; p = .009), and modified Borg score (SMD, -0.37; 95% CI, -0.52 to -0.22; p < .001) in patients with COPD. There was no effect on FEV1%pred (SMD, 0.09; 95% CI, -0.12 to 0.30; p = .406) or FEV1/FVC% (SMD, 0.04; 95% CI, -0.17 to 0.26; p = .702). CONCLUSION: PR programs improve respiratory muscle strength in patients with COPD. Strategies for selecting a suitable PR program need to be developed, and future studies should evaluate the long-term effects of such programs on pulmonary function.

[Influencing Factors and Consequences of Near Miss Experience in Nurses' Medication Error].

PURPOSE: This study aimed to predict the influencing factors and the consequences of near miss in nurses' medication error based upon Salazar & Primomo's ecological system theory. METHODS: A convenience sample of 198 nurses was recruited for the cross-sectional survey design. Data were collected from July to September 2016. Using the collected data, the developed model was verified by structural equation modeling analysis using SPSS and AMOS program. RESULTS: For the fitness of the hypothetical model, the results showed that χ² (χ²=258.50, p<.001) was not fit, but standardized χ² (χ²/df=2.35) was a good fit for this model. Additionally, absolute fit index RMR=.06, RMSEA=.08, GFI=.86, AGFI=.81 reached the recommended level, but the Incremental fit index TLI=.82, CFI=.85 was not enough to reach to the recommended level. With the path diagram of the hypothetical model, caution (ß=-.29 p<.001), patient safety culture (ß=-.20, p=.041), and work load (ß=.18, p=.037) had a significant effect on the near miss experiences in nurses' medication error, while fatigue (ß=-.06, p=.575) did not affect it. Moreover, the near miss experience had a significant effect on work productivity (ß=-.25, p=.001). CONCLUSION: These results have shown that to decrease the near miss experience by nurses and increase their work productivity in hospital environments would require both personal and organizational effort.

Effects of Parity and Breast Feeding Duration on the Risk of Osteoporosis in Postmenopausal Korean Women: A Systematic Review and Meta-Analysis.

OBJECTIVES: To summarize the evidence regarding the association of parity and breast feeding duration with the risk of osteoporosis in postmenopausal Korean women. This was because studies have been inconsistent regarding the effect of parity and breast feeding duration on the risk of osteoporosis. METHODS: A systematic literature search of relevant studies published by December 26, 2018 was conducted in PubMed, EMBASE, the Cochrane Library, CINAHL, RISS, KISS, KMbase, and KoreaMed. Outcome estimates of odds ratio (OR) or standardized mean difference were pooled with fixed or random-effect model. In case of heterogeneity, subgroup analysis was conducted. RESULTS: Seven cross-sectional studies (with 3,813 subjects) were included in the analysis. OR for osteoporosis was 1.43 (95% confidence interval [CI] = 1.09-1.88, P = 0.010) in postmenopausal women with higher parity compared to those with less parity. Moreover, OR for osteoporosis was 1.93 (95% CI = 1.28-2.93, P = 0.002) in postmenopausal women with longer durations of breast feeding than in those with shorter durations of breast feeding. CONCLUSIONS: This study revealed that duration of breast feeding increased the risk of osteoporosis in postmenopausal Korean women. More cohort studies with high quality research designs are needed to confirm our results.

[Development and testing of an instrument to measure family's emotional response toward physically restrained patients].

PURPOSE: This was a methodological research to develop an instrument to assess the emotional response of family members of physically restrained patients. METHODS: A primary instrument with 68 questions was developed based on literature review and semi-structured interviews with family members. A group of experts revised individual questions and removed 4 irrelevant questions. This secondary instrument, then, was tested with 199 family members of physically restrained patients in intensive care units of a university hospital. The validity and reliability of the instrument were tested by factor analysis. RESULTS: After item analysis, 3 questions with a correlation coefficient under .30 were discarded and the questions with a factor loading under .45 on Varimax Rotation were also removed. After factor analysis on the final 37 questions, 7 factors were identified; avoidance, shock, helplessness, grudge, depression, anxiousness, and acceptance. The total variance explained was 55.63%. The reliability of this instrument was 0.93 of Cronbach's alpha. CONCLUSION: This instrument was statistically reliable and valid to measure family's emotional response to physical restraints of the patients. This instrument can be useful in assessing the effects of nursing interventions for family members of restrained patients.

[Usefulness of Korean Version of Behavioral Cue Checklist for Predicting of Patient Violence in Emergency Departments].

PURPOSE: This study aimed to evaluate the usefulness of a behavioral cue checklist (BCC) containing 17 items developed by Wilkes et al. (2010) for identifying potentially violent patients in emergency departments. METHODS: This was a prospective observational study to evaluate the usefulness of the Korean version of a BCC (K-BCC) as an assessment tool for predicting patient violence in emergency departments, and was conducted over 4 weeks in a regional emergency medical center located in B City. A total of 1,324 patients were finally analyzed. RESULTS: Logistic regression analysis was performed to investigate whether each item of the K-BCC predicts violence, and a parsimonious set of 8 statistically significant items was selected for the tool. Receiver operating characteristic analysis of the BCC showed that the area under the curve was .97 (95% confidence interval: .94~1.0). The sensitivity, specificity, positive predictive value, and negative predictive value at the cut-off score of 2 were 75.6%, 98.9%, 68.2%, and 99.2%, respectively. CONCLUSION: The K-BCC was found to be useful in predicting patient violence toward emergency department staff. This tool is simple, and fast to use and can play a significantly role identifying potentially violent patients. Owing to this advance identification, this tool can be helpful in preventing the potential for violence from manifesting as violent behaviors.

[The reactions of emergency department nurses to violence: Q-methodological approach].

PURPOSE: The purpose of this study was to identify the reactions of emergency department nurses to violence. METHODS: Q-methodology which provides a method of analyzing the subjectivity of each item was used. Thirty emergency department nurses classified 33 selected Q-statements into a normal distribution using a 9 point scale. The collected data was analyzed using the Quanl PC Program. RESULTS: Three types of reactions to violence were identified. The first type(emotional and physical reactions) showed a sense of regret on the selection of an occupation and emotional and physical reactions such as anxiety, fear, depression, hopelessness, heart palpitations and trembling hands due to the violence. The second type(problem solving) actively coped to prevent the occurrence of violence, grasped the causes of violence and sought out a problem solving plan. The third type(anger reactions) felt a lot of anger against violence, and resented their reality of working under conditions of inadequately secured facilities and systems. CONCLUSION: The emotional and physical reactions type and the anger reactions type should be required to attend educational programs to improve attitudes and abilities to solve the problems in a more active and positive manner.

[The attitudes of nurses toward transsexuals].

PURPOSE: The purpose of this study was to identify the attitude of nurses toward transsexuals. METHOD: The Q-methodology which provides a method of analyzing the subjectivity of each item was used. Twenty-nine nurses classified the 50 selected Q-statements into a normal distribution using a 9 point scale. The collected data was analyzed using the Quanl PC program. RESULT: Four types of attitudes toward transsexuals were identified. The first type (humanitarian acceptance) showed an attitude of respecting transsexuals as human beings and understanding and accepting their desires and difficulties. The second type (superficial understanding) understood the psychological conflicts and suffering of transsexuals but could not accept them as members of families or society. The third type (insufficient understanding) did not feel a sense of rejection toward transsexuals but showed a lack of understanding of their desires and difficulties. The fourth type (rejection) failed to understand the desires and difficulties of transsexuals and showed a sense of rejection toward them, in addition to regarding them as sexually immoral people. CONCLUSION: The results of the study indicate that different approaches of educational programs based on the four types of attitudes toward transsexuals are recommended.

The Effects of Low-Dose Ketamine on Acute Pain in an Emergency Setting: A Systematic Review and Meta-Analysis.

OBJECTIVES: Currently ketamine is not used often as an analgesic in the emergency department (ED). Nonetheless, it can increase the efficiency of opioids and decrease their side effects. The purpose of this systematic review and meta-analysis was to evaluate whether low-dose ketamine in the ED provides better analgesia with fewer adverse effects. METHODS: The PubMed, EMBASE, and Cochrane Library databases were searched by two reviewers independently (last search performed on January 2016). Data were also extracted independently. RESULTS: A total of 6 trials involving 438 patients were included in the current analysis. Our subgroup analysis of pain reduction indicates that the favorable effects of ketamine were similar or superior to those of placebo or opioids, although these effects were heterogeneous. However, low-dose ketamine was associated with a higher risk of neurological (relative risk [RR] = 2.17, 95% confidence interval [CI] = 1.37-3.42, P < 0.001) and psychological events (RR = 13.86, 95% CI = 4.85-39.58, P < 0.001). In contrast, the opioid group had a higher risk of major cardiopulmonary events (RR = 0.22, 95% CI = 0.05-1.01, P = 0.05). CONCLUSIONS: The efficiency of ketamine varies depending on the pain site, but low-dose ketamine may be a key agent for pain control in the ED, as it has no side effects. It may also help to reduce the side effects of opioids.

[Influence of lifetime sports activity based on a ground reaction force on bone mineral density in Korean adults].

PURPOSE: The purpose of this study was to retrospectively describe the childhood sports activity level of Korean adult men and women and to determine whether a higher level of childhood sports activity was positively associated with adult bone mineral density. METHODS: A cross-sectional study of 100 Korean men (n=40) and women (n=60) was completed. Participants completed a detailed lifetime sports activity questionnaire and had their bone mineral density of the femur and lumbar spine measured using dual energy x-ray densitometry (DEXA). All sports activities were classified into four categories of peak strain score on the basis of ground reaction forces (GRF). RESULTS: During the age of high school, women and men who participated in a high intensity sports activity demonstrated higher bone density in the femur site after adjustment for the effects of body weight, fat body mass, lean body mass, the level of calcium intake, and breast feeding period than those who did not participate in sports activity at all. CONCLUSION: These results highlight the need to participate in high intensity sports activity during high school age as a means of increasing peak bone mass in the femur site.

[Validity and Reliability of ARQ-K (Korean Version of the Assault Response Questionnaire) for Emergency Department Nurses in Korea].

PURPOSE: To investigate the validity and reliability of the Korean Version of the Assault Response Questionnaire (ARQ-K) measuring the intensity of reaction to victimization of emergency nurses in Korea. METHODS: An internal consistency reliability and construct validity using exploratory and confirmatory factor analysis were conducted using SPSS WIN (20.0) and AMOS (20.0). Survey data were collected from 321 nurses who worked in 3 levels - wide regional emergency centers, regional emergency centers, appointed emergency centers - of emergency care facilities in Busan, Korea. RESULTS: The Cronbach's alpha values regarding internal consistency were .77~.93 for the subscales of ARQ-K. Factor loadings of the 26 items on the four subscales ranged from .59 to .84. The four-subscale model was validated by confirmatory factor analysis (χ²/df=3.85, p<.001, RMR=.06, GFI=.80, NFI=.81, TLI=.83, CFI=.85, RMSEA=.09). CONCLUSION: This study shows that the Korean Version of the Assault Response Questionnaire is a valid and reliable instrument to assess nurses' reaction to victimization of emergency nurses in Korea.