Unveiling nurses' end-of-life care experiences: Moral distress and impacts.

BACKGROUND: Nurses providing care to patients with end-of-life or terminal illnesses often encounter ethically challenging situations leading to moral distress. However, existing quantitative studies have examined moral distress using instruments that address general clinical situations rather than those specific to end-of-life care. Furthermore, qualitative studies have often been limited to participants from a single unit or those experiencing moral distress-induced circumstances. A comprehensive and integrated understanding of the overarching process of moral distress is vital to discern the unique circumstances surrounding end-of-life care and its consequential impacts. RESEARCH OBJECTIVES: To explore the moral distress experiences of nurses who are frequently involved in caring for patients with end-of-life or terminal illnesses and apply it to two existing theories: the model of moral distress and the ecological model. RESEARCH DESIGN: A qualitative descriptive approach was employed. PARTICIPANTS AND RESEARCH CONTEXT: Seven focus group interviews involving 30 nurses were performed. The subsequent transcriptions underwent rigorous content analysis. ETHICAL CONSIDERATIONS: We obtained Institutional Review Board approval from a university. Focus group interviews were conducted with nurses who agreed to participate and signed the consent form. FINDINGS: The moral distress-inducing factors and nurses' perceived impact of moral distress were identified and categorized based on moral distress theories and ecological models. A total of 15 categories and 30 subcategories across the following 4 domains were derived: (1) intrapersonal, (2) interpersonal, (3) organizational, and (4) structural factors. CONCLUSIONS: End-of-life-specific circumstances induced moral distress among nurses, with both negative and positive impacts identified. Effective organizational and policy support is essential to manage conflicts, form a healthy organizational culture, provide training, and prevent unnecessary expenses due to the negative consequences of moral distress.

Efficient biotransformation of naringenin to naringenin α-glucoside, a novel α-glucosidase inhibitor, by amylosucrase from Deinococcus wulumuquiensis.

Amylosucrase (ASase) efficiently biosynthesizes α-glucoside using flavonoids as acceptor molecules and sucrose as a donor molecule. Here, ASase from Deinococcus wulumuqiensis (DwAS) biosynthesized more naringenin α-glucoside (NαG) with sucrose and naringenin as donor and acceptor molecules, respectively, than other ASases from Deinococcus sp. The biotransformation rate of DwAS to NαG was 21.3% compared to 7.1-16.2% for other ASases. Docking simulations showed that the active site of DwAS was more accessible to naringenin than those of others. The 217th valine in DwAS corresponded to the 221st isoleucine in Deinococcus geothermalis AS (DgAS), and the isoleucine possibly prevented naringenin from accessing the active site. The DwAS-V217I mutant had a significantly lower biosynthetic rate of NαG than DwAS. The kcat/Km value of DwAS with naringenin as the donor was significantly higher than that of DgAS and DwAS-V217I. In addition, NαG inhibited human intestinal α-glucosidase more efficiently than naringenin.

Microbial communities in the fermentation of Meju, a Korean traditional soybean brick.

Meju is a traditional Korean soybean brick characterized by diverse microbial communities. The microbial communities in Meju were identified at the phylum and genus levels using high-throughput sequencing. During Meju fermentation, diverse factors such as total bacterial cell numbers, moisture content, salinity, pH, enzyme activities, and free amino acids were monitored. After 30 days of fermentation, microbial adaptation and increased protease activity resulted in significant changes, including an increase in pH and alterations in free amino acid content by day 70. Bacterial community analysis revealed significant changes in Bacillus, Lactococcus, and Enterococcus levels as fermentation progressed. The decrease in pH during fermentation was influenced by lactic acid bacteria, which affected bacterial dynamics. At the end of fermentation, the fungal community was dominated by Monascus, Aspergillus, and Scopulariopsis, which affected the free amino acid levels. These results indicate that pH and moisture content may be significant factors in determining microbial communities.

The relationship between suicide bereavement and suicide ideation: Analysis of the mediating effect of complicated grief.

People who have experienced suicide bereavement within social relationships are known to have high risk for suicide, which means that their suicide ideation is high. However, little is known about how suicide bereavement leads to suicide ideation. Therefore, this study aims to understand the pathway of suicide bereavement on suicide ideation by analyzing the mediating effect of complicated grief, which does not abate over time and is known to be highly related to suicide ideation. Data of 1224 people aged 19 or older with bereavement (636 bereaved by suicide and 585 by other causes) were obtained from the Longitudinal study on Suicide Survivors' Mental Health (LoSS) WAVE I [2015-2018], the first nationally-representative longitudinal study in South Korea. Suicide ideation, the dependent variable, was measured by the Scale for Suicide Ideation (SSI), and complicated grief, severe grief that does not abate over time, was measured by the Korean version of the Inventory of Complicated Grief (K-ICG). The results show that suicide bereavement was found to have a significant effect on suicide ideation, and that complicated grief plays a mediating role in the path of suicide bereavement to suicide ideation (Effect = 0.667, [0.387, 0.981]). Based on these findings, clinical and policy suggestions were discussed to understand and prevent suicide ideation of people with suicide bereavement.

Nurses' Perceived Needs and Barriers Regarding Pediatric Palliative Care: A Mixed-Methods Study.

Purpose: This study aimed to describe nurses' perceived needs and barriers to pediatric palliative care (PPC). Methods: Mixed methods with an embedded design were applied. An online survey was conducted for nurses who participated in the End-of-Life Nursing Education Consortium- Pediatric Palliative Care (ELNEC-PPC) train-the-trainer program, of whom 63 responded. Quantitative data were collected with a survey questionnaire developed through the Delphi method. The 47 items for needs and 15 items for barriers to PPC were analyzed with descriptive statistics. Qualitative data were collected through open- ended questions and analyzed with topic modeling techniques. Results: The mean scores of most subdomains of the PPC needs were 3.5 or higher out of 4, and those of PPC barriers ranged from 3.22 to 3.56, indicating the items in the questionnaire developed in this study properly reflect each factor. The needs for PPC were divided into 4 categories "children and adolescents," "families," "PPC management system," and "community-based PPC." Meanwhile, PPC barriers were divided into 3 categories "healthcare delivery system," "healthcare provider," and "client." The keywords derived from the topic modeling were perception, palliative, children, and education for necessities and lack, perception, medical care, professional care providers, service, and system for barriers to PPC. Conclusion: In this study, by using mixed-methods, items of nurses' perceived needs and barriers to PPC were identified, categorized, and weighted, and their meanings were explored. For the stable establishment of PPC, the priority should be given to improving perceptions of PPC, establishing an appropriate system, and training professional care providers.

Understanding Educational Barriers and Needs of North Korean Defector Nursing Students: A Qualitative Descriptive Study.

INTRODUCTION: A growing number of North Korean defector students enter nursing schools in South Korea. Many of them, however, quit nursing school and fail to obtain a nurse license. The purpose of this study was to describe the educational barriers and needs of North Korean defector nursing students. METHOD: A qualitative descriptive approach was employed. Convenience sampling was used, and 14 students participated. Qualitative content analysis was employed. RESULTS: Five themes emerged: lack of preparation for higher education, multiple language barriers, differences in education and culture, lack of support and resources, and lack of information and understanding. DISCUSSION: South Korean government needs to provide North Korean defector students with more practical supportive programs. South Korean nursing schools need to provide more transcultural education for South Korean students and supportive adaptation programs for North Korean defector students to produce culturally competent nurses who provide culturally congruent health care.

[The effect of senior simulation on nurses' attitude toward the elderly].

PURPOSE: This study was performed to explore the effect of senior simulation on nurses' attitudes toward the elderly. METHOD: Twenty-seven nurses working in various settings such as acute hospitals, community health centers, geriatric hospitals, and clinics were recruited. Among them, 25 subjects completed the whole experimental protocol. Aging Semantic Differential Scaling was utilized to evaluate attitudes toward the elderly and 'Suit for Experiencing Being Aged' from the Sakamoto Model was provided for the experiment. Before and after the experiment subjects filled out questionnaires. RESULT: Attitude score before experiment was 4.36, which indicates neutral attitude. Objective attitude scores were not different significantly after experiment. However subjective statements indicated attitude changes in a positive way. CONCLUSION: Senior simulation can affect nurses' attitude toward elderly in subjective way. That is, nurses became more empathetic and understanding to elderly's physical limitations and felt more initiative nursing approach were needed in caring elderly.

[Prevalence and risk factors of orthostatic hypotension among the community-dwelling aged].

PURPOSE: This study was to identify the prevalence of orthostatic hypotension and its association with risk factors of orthostatic hypotension aged over 60 in Seoul and Chungju, Korea. METHOD: The data were collected from the 22th of August, 2000 to the 7th May 2001. The participants were 74 community-dwelling aged who could stand up from sitting position without assistance. Subjects were interviewed with structured questionnaire in order to ask experience of previous falls, hours in per day, symptoms related orthostatic hypotension and demographic characteristics. Orthostatic hypotension was assessed at 1 minute after the subjects standing from sitting position and defined as 20 mmHg or greater decrease in systolic blood pressure after standing. RESULT: The prevalence of orthostatic hypotension was 17.1%. The mean drop of systolic blood pressure was 27.46 mmHg among orthostatic hypotension subjects. The significant variables which explain the occurrence of orthostatic hypotension was the basal systolic blood pressure, the hit ratio of discriminant function with basal systolic blood pressure was 69.7%. CONCLUSION: Finding indicate that this study will contribute to develop nursing strategies to identify risk factors and to prevent orthostatic hypotension for the aged.

Prevalence and potential determinants of musculoskeletal disease symptoms among care workers in long-term care facilities in South Korea.

AIM: The purpose of this study was to investigate the degree and influencing factors of musculoskeletal disease symptoms among care workers in long-term care facilities in South Korea. METHODS: Participants in this cross-sectional study were 265 care workers in 15 long-term care facilities. Data were collected between 1 and 27 August 2011, using the Korea Occupational Safety and Health Agency (KOSHA) code H-30-2003 and analyzed using logistic regression with SPSS ver. 18.0. RESULTS: Of the care workers, 88.7% had pain in at least one of the six body parts. The highest prevalence of musculoskeletal disease symptoms was in the lower back and legs. Among the organizational factors, there were significant differences in neck pain by work shift and patient grade. Neck pain was more severe in the 8 h shift group than 12-24 h shift group. Care workers caring for patients who were classified in the first patient grade of long-term care insurance had 4.73 times more complaints of musculoskeletal symptoms in the neck, 9.54 times (95% confidence interval [CI] = 3.37-27.02) in the hand and wrist, 4.37 times (95% CI = 1.59-12.03) in the lower back, and 2.96 times (95% CI: 1.17-7.51) in the leg and foot. CONCLUSION: To prevent and manage musculoskeletal disease symptoms, activities and the intensity of work should be arranged systematically and planned, and the improvement of organizational factors such as appropriate assignment by patients' severity is considered.