Experiences of Nurses Speaking Up in Healthcare Settings: A Qualitative Metasynthesis.

AIM: To systematically review and synthesise qualitative research on nurses' experiences of speaking up in various contexts and to identify factors facilitating or impeding such a behaviour. DESIGN: This review was conducted as a qualitative metasynthesis, utilising the qualitative meta-ethnography approach. METHODS: A total of 6250 articles were screened. Two reviewers screened titles, abstracts and full texts. A total of 15 studies were included in this review. Researchers conducted a quality appraisal using the JBI critical appraisal checklist for qualitative research. An a priori protocol was created and registered on the Open Science Framework. DATA SOURCES: Literature searches were conducted in five international bibliographic databases (MEDLINE, Embase, PsycINFO, CINAHL and ProQuest Dissertations and Theses Global) and five Korean databases (RISS, KISS, DBpia, KCI and NDSL). RESULTS: Three main themes were identified from the 15 studies used in the metasynthesis: (1) decisional complexity of speaking up, (2) motivators for speaking up and (3) barriers to speaking up. Nurses experienced challenges in speaking up. They were, and continue to be, concerned about negative responses. Hierarchy structure and poor work environment were identified as barriers to speaking up; professional responsibility and a supportive atmosphere were identified as facilitators for speaking up. CONCLUSIONS: This review synthesised nurses' experiences of speaking up and influencing factors. Speaking up is crucial for nurses to improve patient safety, as frontline nurses are ideally positioned to observe early indicators of unsafe conditions in healthcare delivery. IMPACT: Identified motivators and barriers of nurses' speaking-up behaviour offer considerations and opportunities for healthcare leaders and managers. This could lead to improvement in patient safety through the establishment of a safety culture that facilitates nurses' speaking-up behaviour. REPORTING METHOD: The review adhered to the ENTREQ guideline. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution has been made in this review.

Feasibility and acceptability of measuring positivity resonance in nurse-patient telehealth videoconferencing visits: A mixed-methods observational study.

AIM: To investigate the feasibility and acceptability of the training process, procedures, measures and recruitment strategies necessary for a future investigation to test the reliability and validity of using positivity resonance measures in health care encounters. BACKGROUND: Although the measurement of positivity resonance is promising, and non-participant observation is considered effective, their approaches to studying nurse-patient relationships have not been fully explored. DESIGN: A mixed-methods observational study. METHODS: Video recordings of 30 nurse-patient dyads completing telehealth video visit encounters were edited and coded using behavioural indicators of positivity resonance. A post-visit survey gathered data on the participants' perceptions of positivity resonance and the study procedures. The research team completed memos and procedural logs to provide narrative data on the study's training, coding, recruitment and operational procedures. The study included 33 persons with cancer and 13 oncology nurses engaging in telehealth video visit encounters at an academic oncology ambulatory care center located in the southeastern United States. RESULTS: Study procedures were found to be feasible and acceptable to participants. An adequate sample of participants (N = 46) were enrolled and retained in the study. Interrater reliability, as evidenced by Cohen's weighted kappa, ranged from .575 to .752 and interclass correlation coefficients >.8 were attainable within a reasonable amount of time and with adequate training. Behavioural indicators of positivity resonance were observed in all telehealth visits and reported by the participants in the perceived positivity resonance survey. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist guided reporting. CONCLUSIONS: Designing research around the concept of positivity resonance is an innovative and feasible approach to exploring how rapport is cultivated within nurse-patient relationships. RELEVANCE TO PROFESSIONAL PRACTICE: Measuring positivity resonance may hold promise for exploring patient and nurse outcomes including trust, responsiveness, health-related behaviours, well-being, resilience and satisfaction. REPORTING METHOD: The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist guided the reporting of results to ensure that adequate details of the study were provided to ensure an accurate and complete report. PATIENT OR PUBLIC CONTRIBUTION: Planning of the research design and study procedures was done in consultation with nurse clinicians with experience with telehealth and managers responsible within the practice setting where the study was conducted. This ensured the study procedures were ethical, safe, secure and did not create unnecessary burden to the study participants. The study included collecting data from nurse and patient participants about the acceptability of the study procedures.

The Impact of Artificial Intelligence-Assisted Learning on Nursing Students' Ethical Decision-making and Clinical Reasoning in Pediatric Care: A Quasi-Experimental Study.

The integration of artificial intelligence such as ChatGPT into educational frameworks marks a pivotal transformation in teaching. This quasi-experimental study, conducted in September 2023, aimed to evaluate the effects of artificial intelligence-assisted learning on nursing students' ethical decision-making and clinical reasoning. A total of 99 nursing students enrolled in a pediatric nursing course were randomly divided into two groups: an experimental group that utilized ChatGPT and a control group that used traditional textbooks. The Mann-Whitney U test was employed to assess differences between the groups in two primary outcomes: (a) ethical standards, focusing on the understanding and applying ethical principles, and (b) nursing processes, emphasizing critical thinking skills and integrating evidence-based knowledge. The control group outperformed the experimental group in ethical standards and demonstrated better clinical reasoning in nursing processes. Reflective essays revealed that the experimental group reported lower reliability but higher time efficiency. Despite artificial intelligence's ability to offer diverse perspectives, the findings highlight that educators must supplement artificial intelligence technology with strategies that enhance critical thinking, careful data selection, and source verification. This study suggests a hybrid educational approach combining artificial intelligence with traditional learning methods to bolster nursing students' decision-making processes and clinical reasoning skills.

Implementation of Continuous Capnography Protocol in a Postanesthesia Care Unit for Adult Patients at High-risk of Postoperative Respiratory Depression.

PURPOSE: This project aimed to implement a continuous capnography protocol in the postanesthesia care unit (PACU) for postoperative adult patients who are at high risk for respiratory failure. DESIGN: A preintervention and postintervention quality improvement design with retrospective chart reviews evaluated patient demographics (age, weight, body mass index [BMI], perioperative fluid intake and output, use of intraoperative positive-end expiratory pressure), length of surgery, average length of PACU stay, incidence of respiratory events, and adherence to a PACU capnography protocol. METHODS: Preimplementation data were collected from retrospective chart reviews over a 3-month period. A continuous capnography protocol was implemented for same-day surgery patients with a BMI of 35 kg/m2 or greater and who received general anesthesia. Postimplementation data were collected over 3 months in addition to adherence to the capnography protocol. This was presented using descriptive statistics. FINDINGS: Age, length of surgery, weight, BMI, perioperative fluid intake and output, and use of positive-end expiratory pressure did not impact PACU length of stay. The average PACU length of stay decreased from 76.76 to 71.82 minutes postimplementation but was not statistically significant (P = .470). The incidence of respiratory events was 6% (n = 3). After the implementation of the continuous capnography protocol, adherence to the continuous capnography monitoring was 86% (n = 43). CONCLUSIONS: Patients who are at high risk for postoperative respiratory failure may benefit from continuous capnography monitoring in the PACU. Capnography monitoring may decrease PACU length of stay and provide earlier detection of pending respiratory depression or failure than pulse oximetry alone.

The use of photovoice in nursing education: A scoping review.

Given the variety of uses of photovoice in nursing education, the importance of clarifying and describing this method is apparent. This scoping review aimed to explore the evidence on the use of photovoice in nursing education, describe the state of knowledge in this area, and identify knowledge gaps within the existing literature. A comprehensive search was performed in seven databases including MEDLINE, CINAHL, Embase, and Education Full Text. Three gray literature databases (ProQuest Dissertations and Theses Global database, EThOS, and PapersFirst) were also searched. This scoping review was conducted with reference to the JBI scoping review guidelines and reported using the PRISMA-ScR statement. A total of 22 studies published between 2001 and 2022 were included in this scoping review. The findings indicate that photovoice is used globally in nursing education to teach in various courses and content areas within online, hybrid, and in-person environments. Despite the heterogeneity within the definition of photovoice and associated pedagogical strategies, the results of this scoping review suggest that photovoice can serve as an educational tool for nursing students.

Cyberethics in nursing education: Ethical implications of artificial intelligence.

As the use of artificial intelligence (AI) technologies, particularly generative AI (Gen AI), becomes increasingly prevalent in nursing education, it is paramount to address the ethical implications of their implementation. This article explores the realm of cyberethics (a field of applied ethics that focuses on the ethical, legal, and social implications of cybertechnology), highlighting the ethical principles of autonomy, nonmaleficence, beneficence, justice, and explicability as a roadmap for facilitating AI integration into nursing education. Research findings suggest that ethical dilemmas that challenge these five principles can emerge within the context of nursing education; however, adherence to these very principles, which is essential to improving patient care, can offer solutions to these dilemmas. To ensure the ethical and responsible use of Gen AI in nursing education, these principles must be woven into the fabric of curricula, and appropriate guidelines must be developed. Nurse educators have a pivotal role in strategizing comprehensive approaches for ethical AI integration, establishing clear guidelines, and instilling critical thinking among students. Fostering lifelong learning and adaptability is key to ensuring that future nurses can successfully navigate the constantly evolving landscape of health care technology. Future research should investigate the long-term impacts of AI utilization on learning outcomes and ethical decision-making.

Couple-Oriented Interventions for Mental Health: A Scoping Review.

The purpose of this research was to systematically examine and collate evidence on couple-oriented interventions for mental health to identify trends in the literature, review research strategies, and suggest directions for future research. A systematic search included studies relating to couple-oriented interventions for preventing mental disorders and/or promoting mental health. We identified a total of 52 studies, which included 55 articles. Our findings revealed that interventions were delivered through various modes, including face-to-face, telephone, and online, with the majority of couple-oriented interventions operating in conjoint sessions. The most common intervention was for selective prevention targeting patients with cancer and their partners. This review provided evidence of the applicability of theoretical frameworks, dyad analysis, and measurements associated with couple-oriented interventions. Findings can help family nurse practitioners and health care professionals advance strategies to develop and implement evidence-based, couple-oriented interventions for primary prevention of mental disorders and the promotion of mental health.

A systematic review of videoconferencing in health professions education: the digital divide revisited in the COVID-19 era.

OBJECTIVES: During the COVID-19 pandemic, educators shifted from traditional lectures to videoconferencing. This systematic review explored the use of videoconferencing as a teaching tool in response to the pandemic as well as issues related to digital equity and inclusion. CONTENT: The review was conducted using the Joanna Briggs Institute for Systematic Reviews methodology and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement. SUMMARY: A total of nine studies met eligibility criteria. The participants in the included studies were medical students from various parts of the world. Technical difficulties and lack of human interactions were identified as barriers to learning through videoconferencing. OUTLOOK: To achieve full success, pedagogical videoconferencing must prioritize digital equity and a universal design for learning. Although useful for maintaining education during the pandemic, in the future, videoconferencing will present challenges related to the digital divide as well as opportunities as a teaching tool for nurse educators globally.

Exploring Nurse and Patient Experiences of Developing Rapport During Oncology Ambulatory Care Videoconferencing Visits: Qualitative Descriptive Study.

BACKGROUND: Although videoconferencing between oncology patients and nurses became routine during the pandemic, little is known about the development of clinician-patient rapport in this care environment. Evidence that virtual visits may challenge nurses' ability to form connections with patients, demonstrate empathy, and provide support suggests that videoconferencing may not ensure optimal care for persons with cancer. Establishing rapport during videoconferencing visits (VCVs) is important in oncology nursing, as rapport enables the nurse to provide emotional support and assistance to patients as they navigate their cancer journey. OBJECTIVE: This study investigated the nature of nurse-patient rapport in ambulatory cancer care videoconferencing telehealth visits. Objectives included exploring (1) how patients with cancer and nurses describe experiences of and strategies for cultivating rapport and (2) similarities and differences between rapport in videoconferencing and in-person visits (IPVs). METHODS: In this qualitative descriptive study, interviews were conducted from October 2021 to March 2022 with 22 participants, including patients with cancer (n=10, 45%) and oncology nurses (n=12, 55%), about their experiences of rapport building during VCVs. All interviews were analyzed using conventional content analysis. Data from nurses and patients were analyzed separately using identical procedures, with a comparative analysis of patient and nurse results performed in the final analysis. RESULTS: Most patients in the study had experienced 3-5 video visits within the past 12 months (n=7, 70%). Half of the nurse participants (n=6, 50%) reported having participated in over 100 VCVs, and all had experiences with videoconferencing (ranging from 3 to 960 visits) over the past 12 months. In total, 3 themes and 6 categories were derived from the patient data, and 4 themes and 13 categories were derived from the nurse data. Comparisons of themes derived from participant interviews identified similarities in how nurses and patients described experiences of rapport during VCVs. Three themes fit the collective data: (1) person-centered and relationship-based care is valued and foundational to nurse-patient rapport in oncology ambulatory care regardless of how care is delivered, (2) adapting a bedside manner to facilitate rapport during VCVs is feasible, and (3) nurses and patients can work together to create person-centered options across the care trajectory to ensure quality care outcomes. Barriers to relationship building in VCVs included unexpected interruptions from others, breaks in the internet connection, concerns about privacy, and limitations associated with not being physically present. CONCLUSIONS: Person-centered and relationship-based approaches can be adapted to support nurse-patient rapport in VCVs, including forming a personal connection with the patient and using active listening techniques. Balancing the challenges and limitations with the benefits of videoconferencing is an essential competency requiring additional research and guidelines. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/27940.

Nursing faculty experiences with student incivility in South Korea: a qualitative study.

BACKGROUND: Student academic incivility is a serious problem in nursing education because it negatively influences the learning process, wellbeing of faculty members, and faculty-student relationships. The aim of this study was to explore nursing faculty experiences related to student incivility in nursing education. METHODS: We used an exploratory qualitative methodology and conducted in-depth interviews with 14 nursing faculty members working at 11 nursing universities in South Korea. A qualitative content analysis was carried out. RESULTS: The six themes that emerged from the faculty experiences were nursing student indifference to teachers' expectations; ignoring behavioral standards in school life; differing responses to uncivil student behavior; self-reflection as a nursing educator; negative impact on faculty in a nursing education context; and awareness of civility in a nursing education context. CONCLUSION: Dealing with student academic incivility in nursing education is one of the most challenging tasks for faculty members, and it should be managed to provide a comfortable learning environment. The present study delineated the uncivil behavior experienced by the faculty and their negative effects in the educational context and suggested alternatives to manage student incivility and foster a positive educational environment through the eyes of the faculty. The findings of this study suggest an evidence-based direction for fostering a culture of civility in nursing schools.

The impact of resilience on turnover among newly graduated nurses: A 1-year follow-up study.

AIM: This study aimed to analyse the impact of resilience on turnover among newly graduated nurses. BACKGROUND: Nurse turnover is a major issue in nurse management that results in economic losses and affects patient and nurse outcomes. Newly graduated nurses experience stress and burnout during their transition period, leaving their job due to contextual and personal factors. Nurses' resilience affects turnover directly and indirectly through the mediating effect of stress and burnout. METHODS: We conducted a 1-year follow-up study to investigate factors influencing the turnover of newly graduated nurses. Survival analysis was used to analyse factors influencing the turnover. RESULTS: Turnover probability increased steadily and was approximately 0.20 within 2 years. Resilience was a significant factor affecting newly graduated nurses leaving their job in a short period of time. CONCLUSION: Newly graduated nurses' resilience is a significant factor influencing the turnover within a short period of time. Personal resources such as resilience and work environment should be considered for retaining newly graduated nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers should recognize the impact of resilience on newly graduated nurses' turnover during the transitional period and establish strategies to enhance such resilience to promote a smooth transition and ultimately reduce turnover.

Factors associated with eating performance in older adults with dementia in long-term care facilities: a cross-sectional study.

BACKGROUND: The purpose of this study was to investigate factors influencing eating performance in older adults with dementia (OAWDs) in long-term care (LTC) facilities. METHODS: This cross-sectional study examined risk factors for compromised eating performance by comparing both independent and dependent older adults with dementia. The study participants were 117 OAWDs in LTC facilities in South Korea. Measurements included (a) general characteristics, (b) activities of daily living (ADL) including eating performance, (c) cognitive function, (d) physical capability, (e) grip strength, (f) Behavioral Psychological Symptoms of Dementia (BPSD), and (g) depression. Data were analyzed by the percentage, mean and standard deviation, Chi-square test, t-test, and logistic regression. RESULTS: The eating independent group had more comorbidities than the dependent group (t = 2.793, p < .006); had significantly higher cognition (t = 4.108, p < .001) and physical capability (t = 5.258, p < .001); and had stronger grip strength (t = 2.887, p = .005). Comorbidities and physical capability were determinants for independent eating performance (Odds Ratio [OR] = 1.969, p = .014; OR = 1.324, p < .001). CONCLUSIONS: It is suggested that maintaining physical capability should be encouraged to support independent eating performance by OAWDs in LTC facilities. The results of this study could serve as a basis for developing function-focused care to maintain the residual eating performance of OAWDs in Korean LTC facilities. This is a subject area that has not been fully explored.

Pedagogical foundations of cybercivility in health professions education: a scoping review.

BACKGROUND: Teaching cybercivility requires thoughtful attention to curriculum development and content delivery. Theories, models, and conceptual and theoretical frameworks (hereafter "tools") provide useful foundations for integrating new knowledge and skills into existing professional practice and education. We conducted this scoping review to identify tools used for teaching cybercivility in health professions education. METHODS: Using Arksey and O'Malley's scoping review framework, we searched six biomedical and educational databases and three grey literature databases for articles available in English published between January 1, 2000 and March 31, 2020. Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews), we screened and extracted relevant data, and reported the results of the search. RESULTS: The search resulted in 2272 articles, with 8 articles included in this review after inclusion criteria were applied. Four articles (50%) were peer-reviewed journal papers while the other 4 (50%) were dissertations. Eleven unique tools were identified by this review: (1) Transpersonal Caring Theory, (2) Theory of Workplace Incivility, (3) Conceptualization of Incivility, (4) Media Ecology Theory, (5) Principlism, (6) Salmon's Five Stage Model of Online Learning, (7) Learner-Centered Educational Theory, (8) Gallant and Drinan's 4-Stage Model of Institutionalization of Academic Integrity, (9) Theory of Planned Behavior, (10) Communication Privacy Management Theory, and (11) Moral Development Theory. Based on the tools analyzed in our scoping review, we determined three features of cybercivility pedagogy to which the tools provided a guide: (1) behavioral manifestations, (2) academic integrity, and (3) digital professionalism. CONCLUSIONS: The reviewed tools provide a pedagogical foundation and guidance for teaching various properties of cybercivility. Future studies should be expanded to include a broader literature body and non-English literature to provide the global perspective and global skills needed by a diverse population of learners.

Improving Care of Skilled Nursing Patients: Implementation of Early Sepsis Recognition.

An aging population with underlying health conditions, such as heart disease and diabetes, is at high risk for infections, including pneumonia, influenza, and coronavirus disease 2019 (COVID-19). In particular, the number of individuals in skilled nursing and long-term care facilities is increasing and older adults are at greatest risk. Research reveals these infections can lead to sepsis, septic shock, and death unless detected early through a sepsis screening process. The current quality improvement project demonstrates the capabilities of an early sepsis recognition screening tool in a skilled nursing facility and explores process changes required to operate facilities with high quality care. [Journal of Gerontological Nursing, 47(8), 37-44.].

A qualitative analysis of nursing students' tweets during the COVID-19 pandemic.

The COVID-19 outbreak has profoundly changed daily life and the ways in which students learn and interact. This study explores the nature and content of tweets posted by students enrolled in nursing programs (hereafter nursing students) in the United Kingdom, the United States, and South Korea during the COVID-19 pandemic between March 4 and April 7, 2020. A total of 8856 tweets from the Twitter accounts of 95 self-identified nursing students were included in our qualitative analysis. The findings revealed five categories of tweet content: (i) reactions to COVID-19; (ii) everyday life; (iii) role as a student; (iv) social connections; and (v) sociopolitical issues. Students shared concerns about the impact of COVID-19 on their education, discussed their experiences as nursing students, tweeted details of their daily lives, and sought social connections for support as well as for information sharing. The findings of this study can inform nurse educators to better understand their students' responses to and sentiments about the COVID-19 pandemic. Nurse educators should incorporate this understanding into curricula for pandemic preparedness and response efforts.

The Korean Version of the Academic Cyberincivility Assessment Questionnaire for Nursing Students in South Korea: Validity and Reliability Study.

BACKGROUND: Cybercivility, the practice of what to say and how to say it in online environments, encourages individuals to treat each other with respect. However, the anonymity of online communities may lead some individuals to behave in ways that violate social and cultural norms. These individuals treat others with a lack of regard and even bully others in faceless online confrontations. This practice of cyberincivility can be found across the internet, on commercial sites, and in schools offering online courses. Research on cybercivility and cyberincivility has increased in the United States, where instruments have been developed to measure the impact of cyberincivility in health profession education. However, there is no available instrument that measures nursing students' online behaviors in South Korea. OBJECTIVE: The aim of this study was to develop and evaluate a Korean version of the Academic Cyberincivility Assessment Questionnaire developed in the United States. METHODS: Data were collected from 213 nursing students in three South Korean colleges. The Academic Cyberincivility Assessment Questionnaire developed by De Gagne and colleagues was adapted to measure students' knowledge of cybercivility, and their experiences with and acceptability of cyberincivility. Content validity was tested using the content validity index (CVI). Criterion validity was tested using the digital citizenship scale. Reliability was evaluated using Cronbach alpha. The goodness-of-fit of construct validity was determined through exploratory and confirmatory factor analyses. RESULTS: The CVI was 0.8 or higher for all items. Kuder-Richardson Formula 20, measuring reliability of the knowledge scale, was 0.22 and Cronbach alpha, measuring reliability of the experience scale, was .96. The goodness-of-fit of the model was Chi square=5568.63 (P<.001), the comparative fit index (CFI) was 0.92, and the root mean square error of approximation (RMSEA) was 0.08, which satisfied the criteria. The reliability of the acceptability scale was .96, and the goodness-of-fit indices satisfied the criteria (minimum Chi square/df=2.34, Tucker-Lewis Index =0.92, incremental fit index=0.93, root mean square residual=0.05, CFI=0.93, and RMSEA=0.08). CONCLUSIONS: This study extended and reevaluated the US version of cybercivility scales in a culturally distinct context. The three dimensions of cybercivility include knowledge, experience, and acceptability. Acceptability is well-validated as a dimension, whereas the knowledge dimension requires reexamination for application to Koreans. A revision of the instrument is needed that considers the cultural differences between South Korea and the United States. This paper calls for more attention to be paid to contextualized cybercivility scales among health professions in countries outside the United States.

The effect of function-focused care on long-term care workers in South Korea.

The purpose of this study was to identify the effects of the Korean Function-Focused Care Program (K-FFCP) for residents of long-term care facilities (LTCRs) on long-term care workers' (LTCWs) knowledge, self-efficacy, and outcome expectations about function-focused care, as well as on their job satisfaction. The study adopted a quasi-experimental repeated-measures design. Participants included 50 LTCWs from two long-term care facilities (24 in the experimental group and 26 in the control group). Multivariate analysis of covariance showed that the effects of K-FFCP were significant on knowledge, efficacy, outcome expectation, and job satisfaction. Outcomes that could not be measured using scales were assessed through a focus group interview. The results suggest that LTCWs would benefit from a long-term educational program on function-focused care.

Health-Related Quality of Life Among Survivors of Cancer in Adolescence: An Integrative Literature Review.

PROBLEM: Adolescence is a critical developmental period, but little research is available on the quality of life for individuals ages 10-19, especially those who have faced a life-threatening illness. This integrative review examines factors related to quality of life among survivors of a childhood cancer that occurred during adolescence. ELIGIBILITY CRITERIA: The Garrard Matrix Method guided this review of studies that were conducted from 1990 to 2017. Studies were eligible if participants were diagnosed with cancer during adolescence, the studies followed survivorship from cancer diagnosis to treatment completion, and health-related quality of life measures were taken. SAMPLE: Fifteen articles met the inclusion criteria. RESULTS: Most survivors of a childhood cancer that occurred during adolescence reported physical and psychological health-related quality of life scores similar to, or higher than, healthy controls. Risk factors for poorer quality of life were type of cancer, type of treatment, late effects, and time since diagnosis. Factors for better quality of life were older age, positive feelings such as happiness and optimism, social support, and coping strategies. Most studies used the Short Form-36 and the PedsQL Generic Core Scales to measure quality of life. CONCLUSIONS: Protective factors such as social support and subjective feelings positively affected quality of life. IMPLICATIONS: In order to promote the best patient outcomes, relevant protective factors that improve quality of life should be incorporated in long-term care plans for survivors of a childhood cancer that occurred during adolescence.

Long-Term Effects of a Self-management Program for Older Women With Urinary Incontinence in Rural Korea: A Comparison Cohort Study.

PURPOSE: The purpose of the study was to examine the long-term effects of a urinary incontinence (UI) self-management program for older women on the severity, knowledge, and attitudes regarding UI. DESIGN: This was a quasi-experimental design (nonrandomized trial) with intervention and comparison groups. SUBJECTS AND SETTING: Participants were recruited from a primary health care facility in rural Korea. Forty-four older women with UI were assigned to either the intervention or the control group. Of 44 participants, 26 (17 experimental and 9 control) completed the study: 7 participants did not meet inclusion criteria (eligibility criteria partially relied on scores of a validated instrument measuring UI severity administered after initial consent to study participation), and 6 dropped out of the intervention group because of admission to hospital, hearing problems, difficulty traveling to meetings, and disinterest in the program. Five subjects in the comparison group were lost to follow-up. METHODS: The intervention group (n = 17) underwent a 5-session UI self-management educational program held once weekly. Its contents included a lecture, instruction on pelvic muscle exercises, and assignments related to action plans (exercises and a daily bladder diary). The study's main outcome measures were the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) score, along with knowledge and attitudes toward UI measured by the UI knowledge scale (UIKS) and UI attitude scale (UIAS). Data were collected at baseline, immediately following the intervention, and at the 1-year follow-up. Repeated-measures analysis of variance was used to analyze changes in ICIQ-SF, UIKS, and UIAS scores over time. RESULTS: A significant improvement in UI severity was found in the intervention group, who showed a gradually decreasing ICIQ-SF score from at pretest to 5 weeks and 12 months, while it increased over the 12-month period in the control group (main effect of group, F = 17.31, P < .001; main effect of time, F = 8.45, P = .001; interaction effect, F = 22.54, P < .001). There was no significant improvement in UIKS scores over time. Scores on the UIAS changed significantly over time in the experimental group (χ = 6.76, P = .034), but the mean score at 1-year follow-up (mean ± standard deviation: 2.61 ± 0.56) was lower than the mean score at baseline (2.64 ± 0.19). CONCLUSIONS: Study findings suggest that the UI self-management educational program is effective for improving UI and related lower urinary tract symptoms and feasible to conduct as a long-term intervention program for older women living in communities. However, strategies for a systematic follow-up management are needed for long-term retention of improved UI knowledge and attitudes toward incontinence.

Effects of a Hybrid Education Programme for Korean Mothers of Children with Atopic Dermatitis.

Atopic dermatitis (AD), a common childhood skin disorder, can limit a child's learning and physical activities. South Korean mothers, as primary caregivers, experience anxiety and helplessness when caring for their ill children. The aim of this study was to develop a hybrid AD education programme (consisting of a face-to-face session followed by 8 online sessions) and evaluate its effects on anxiety, caregiving efficacy and caregiving behaviour among mothers of children with AD. Twenty mothers of patients with AD treated in a South Korean hospital received one on-site session and 8 weekly online modules. After the intervention, mothers' mean±standard deviation anxiety reduced (from 50.3 ± 14.2 to 31.7 ± 6.3 points, t = 5.75, p < 0.001). Their caregiving efficacy and caregiving behaviour improved significantly, from 18.3 ± 3.5 to 29.4 ± 3.2 points (t = -9.64, p < 0.001) and from 47.7 ± 7.7 to 78.8 ± 4.9 points (t = -14.4, p < 0.001), respectively. The effects of the hybrid education programme for this population were significant. Healthcare providers should consider examining the programme nationwide, including in rural areas, while investigating its long-term effects.