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Volume 54(4); November 2024
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Editorial
Climate Change and Nursing
Yoomi Jung
J Korean Acad Nurs 2024;54(4):475-477.   Published online November 4, 2024
DOI: https://doi.org/10.4040/jkan.24098
PDFePub
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Review Paper
Exploring Symptom Cluster Patterns in Adult Cancer Patients Undergoing Chemotherapy: A Systematic Review
Pan Yang, Hui-juan Mei, Hao-yu Zhao, Rong-rong Wu, Yong-qin Ge, Yin Lu
J Korean Acad Nurs 2024;54(4):478-494.   Published online November 25, 2024
DOI: https://doi.org/10.4040/jkan.24041
AbstractAbstract PDFSupplementary MaterialePub
Purpose

This systematic review aimed to scrutinize the progression of symptom cluster research in adult cancer patients who received primary or adjuvant chemotherapy between 2001 and 2023, providing a comprehensive understanding of clinical practice and future research.

Methods

PubMed, Ovid MEDLINE, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, and Web of Science databases were searched for theme words and free words related to symptom clusters, cancer, and chemotherapy. Eligible studies were published between January 1, 2001, and May 30, 2023; adults who were diagnosed with cancer and received primary or adjuvant chemotherapy were evaluated.

Results

Twenty-eight studies were included in this review. The Memorial Symptom Assessment Scale emerged as the predominant instrument and exploratory factor analysis was the most frequently employed statistical method to identify symptom clusters. Psychological, gastrointestinal, and physical image symptom clusters were the most commonly delineated. Furthermore, the temporal stability of the symptom clusters showed varying dynamics, with psychological symptom clusters displaying relative consistency over time.

Conclusion

Interventions are needed for the most common and stable symptoms in patients with cancer undergoing chemotherapy. Future endeavors may necessitate more longitudinal studies to delve deeper into the temporal stability and dynamic variations of symptom clusters. Such investigations hold promise for advancing symptom cluster research, elucidating the underlying mechanisms, and fostering the development of targeted interventions, thereby enriching the symptom management paradigm in oncological care.

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Research Papers
Perceptual Factors Associated with Gestational Weight Gain: A Cross-Sectional Survey
Sehee Kim, Sukhee Ahn
J Korean Acad Nurs 2024;54(4):495-508.   Published online November 1, 2024
DOI: https://doi.org/10.4040/jkan.24052
AbstractAbstract PDFePub
Purpose

Recent years have seen an increase in the number of pregnant women whose weight gain during pregnancy exceeds the recommended range. This study was intended to determine the relationships among demographic attributes, key perceptual factors, and gestational weight gain (GWG).

Methods

This cross-sectional study was conducted between April and July 2022. First-time pregnant women beyond 36 weeks of gestation who were recruited via social media completed an online survey. Data were analyzed using one-way ANOVA, chi-square test, and logistic regression, all performed using SPSS software.

Results

Of the 369 participants, 63 (17.1%) exceeded the recommended GWG guidelines, while 148 (40.1%) fell within the recommended range, and the remaining 158 (42.8%) had inadequate GWG. Being overweight or obese before pregnancy significantly increased the risk of excessive GWG (p < .001). This risk was also significantly greater for women with low internal weight locus of control (OR = 0.58, 95% CI 0.41~0.82), high external weight locus of control (OR = 1.75, 95% CI 1.31~2.34), and negative body image (OR = 0.62, 95% CI 0.51~0.75).

Conclusion

The growing trend of excessive GWG among pregnant women is influenced by a combination of prepregnancy body mass index (BMI) and perceptual factors, including weight locus of control and body image. These findings underscore the need to implement weight management intervention strategies before pregnancy, taking into consideration BMI, and to enhance positive body image and internal locus of control.

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The Mediating Role of Psychological Resilience in Chinese Nursing Students’ Professional Identity and Learning Burnout
Liu Zhang, Qin Zhang, ShuWen Li, YuHong Li, GuoCui Wu, Ying Chen, YunNa Zhou
J Korean Acad Nurs 2024;54(4):509-518.   Published online November 25, 2024
DOI: https://doi.org/10.4040/jkan.24044
AbstractAbstract PDFePub
Purpose

This study investigated whether professional identity predicts learning burnout among Chinese nursing students, and whether resilience moderates this relationship.

Methods

This cross-sectional study recruited 635 students from a nursing college at a medical university in Hefei, China. Data were collected using the professional identity questionnaire, learning burnout scale for college students, and 10-item Connor-Davidson Resilience Scale. Pearson’s correlation analysis was used to investigate the relationships between variables. The mediation effect was evaluated using linear regression and the bootstrap method in SPSS.

Results

Nursing students exhibited intermediate learning burnout levels (score: 54.95 ± 10.42). Professional identity was positively correlated with psychological resilience (r = .42, p < . 001), whereas learning burnout was negatively correlated with professional identity (r = - .54, p < . 001) and psychological resilience (r = - .57, p < . 001). Psychological resilience mediated the relationship between professional identity and learning burntout to the tune of 32.8%.

Conclusion

Psychological resilience mediates the relationship between professional identity and learning burnout. Thus, nursing educators can mitigate student burnout by developing their students' professional identities and psychological resilience.

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Exploring Traumatic Experiences and Posttraumatic Growth among Korean Veterans: A Photovoice Study
Riah Kim, Heese Choi, Minsung Kim
J Korean Acad Nurs 2024;54(4):519-533.   Published online October 14, 2024
DOI: https://doi.org/10.4040/jkan.24049
AbstractAbstract PDFePub
Purpose

This study aimed to explore traumatic experiences and posttraumatic growth among Korean veterans.

Methods

A qualitative study was conducted using photovoice. Purposive sampling strategies yielded five veterans who had experienced traumatic events. Participants engaged in three discussion sessions between August 5, 2023, and October 28, 2023. The collected data were analyzed using photovoice document analysis and thematic analysis.

Results

Study results identified the following themes: ‘The collapse of my life as a result massive trauma,’ ‘Sinking into endless isolation and disconnection,’ ‘The process of finding myself through reflection,’ and ‘My life journey moving forward together.’ Despite the irreversible damage caused by traumatic experiences during military service, the participants continuously reflected on the meaning of their trauma and posttraumatic growth, thereby recovering their authentic selves.

Conclusion

Veterans who have experienced traumatic events face severe difficulties, however through their efforts at recovery, they recognize the individuals they are now. This study suggests the need for social support and highlights the necessity of providing various opportunities and policy assistance to traumatized veterans.

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Factors Influencing Clinical Nurses’ Perception of Structural and Content Career Plateau
Ji Hye Kim, Ji Yun Lee
J Korean Acad Nurs 2024;54(4):534-546.   Published online October 23, 2024
DOI: https://doi.org/10.4040/jkan.24002
AbstractAbstract PDFePub
Purpose

This study was intended to provide basic data for reducing the career plateaus of clinical nurses.

Methods

The participants were 288 clinical nurses who worked at five hospitals, general hospitals, and tertiary hospitals in Seoul, Gyeonggi, and Chungcheong provinces and had more than one year of clinical experience. The research data were collected from December 26, 2022, to April 7, 2023, using structured questionnaires and analyzed using SPSS software. The study conducted mean, standard deviation, percentage, t-test, ANOVA, Pearson‘s correlation coefficient, and hierarchical regression analysis.

Results

Perceived organizational support was identified as the factor influencing structural career plateaus. Factors influencing content career plateaus included growth needs, skill variety, organizational justice, and perceived organizational support.

Conclusion

The above research results suggest that to increase the motivation of clinical nurses and reduce career plateaus, it is necessary to improve awareness and systems of human resource management at the organizational level.

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The Effects of a Self-Efficacy Theory-Based Exercise Program for Patients Undergoing with Total Knee Arthroplasty
Kyung-Hye Park, Hee-Young Kang
J Korean Acad Nurs 2024;54(4):547-562.   Published online October 22, 2024
DOI: https://doi.org/10.4040/jkan.24027
AbstractAbstract PDFSupplementary MaterialePub
Purpose

This study was performed to develop a self-efficacy theory-based exercise program for total knee arthroplasty (TKA) and to test the program’s efficacy in ameliorating knee pain and restoring function as measured by lower extremity muscle strength, 3 meter walking time, Korean Western Ontario McMaster Index (WOMAC), exercise self-efficacy, and length of hospital stay for TKA patients.

Methods

This quasi-experimental study incorporating a non-equivalent control group and pretest-posttest non-synchronized design non-synchronous design was applied to assess self-efficacy reinforcement strategies based on self-efficacy theory. The exercise program consisted of the following steps: TKA, education to prevent postoperative complications, and muscle strength exercises. Respective exercise and control groups included 29 and 27 participants. The experimental group received eight sessions of the program from three weeks before TKA to four weeks after TKA. Collected data were analyzed using the chi-square test, Mann–Whitney U test, and ranked ANCOVA and t-tests using IBM SPSS Statistics 23.

Results

Experimental group showed significant improvement in lower extremity muscle strength (F = 8.63, p = .005), 3 meter walking time (z = - 5.02, p < .001), WOMAC index (z = - 2.22, p = .027), self-efficacy for exercise (z = - 3.29, p = .001), and length of hospital stay (t = - 2.11, p = .040) compared to the control group. No significant differences in knee pain and range of motion were observed.

Conclusion

These findings indicate that a self-efficacy theory-based exercise program can be an effective exercise strategy that patients undergoing TKA can easily follow at home without assistance. It is thus recommended as an exercise intervention for TKA patients.

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Development and Effectiveness of Progressive Simulation Education Program on Medication Safety for Nursing Students
Se-Young Jung, Eun-Young Kim
J Korean Acad Nurs 2024;54(4):563-576.   Published online October 14, 2024
DOI: https://doi.org/10.4040/jkan.24054
AbstractAbstract PDFePub
Purpose

This study aimed to develop and verify a progressive simulation education program aimed at enhancing nursing students’ medication safety competency.

Methods

A non-equivalent control group pretest-posttest design was adopted. The participants were 40 third-year nursing students with no prior simulation education experience, comprising 20 each in the experimental and control groups. The experimental treatment utilized a hybrid simulation approach incorporating both full-body mannequins and standardized patients and was, conducted over three sessions with durations of 65, 80, and 95 minutes for the first, second, and third sessions, respectively, for a total of 240 minutes. The program was constructed based on Jeffries’ simulation model.

Results

The levels of medication safety competencies, communication self-efficacy, learning self-efficacy, and problem-solving abilities of the experimental group were significantly higher than that of the control group.

Conclusion

Our results confirm that the program effectively improves nursing students’ medication safety competence, communication self-efficacy, learning self-efficacy, and problem-solving ability. Therefore, this program can serve as a basis for developing educational strategies related to medication safety for nursing education institutions. Furthermore, the program is anticipated to have a positive impact on novice nurses’ education and practice in clinical settings.

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Experiences of Unmarried Women Undergoing Planned Oocyte Cryopreservation
Miok Kim, Kim Mingyoung
J Korean Acad Nurs 2024;54(4):577-593.   Published online November 30, 2024
DOI: https://doi.org/10.4040/jkan.24064
AbstractAbstract PDFePub
Purpose

The present study investigated the experiences of unmarried women undergoing planned oocyte cryopreservation (OC).

Methods

Data were collected from August 2022 to February 2023 through individual in-depth interviews with thirteen unmarried women undergoing planned OC. Data were analyzed using Colazzi’s phenomenological method.

Results

The findings revealed four distinct clusters. The first cluster, “Safeguards against Future Uncertainty,” examined experiences associated with uncertainties in several aspects of reproductive health threats and decision-making regarding planned OC. The second cluster, “Indescribable Pain and Chaos,” explored the psychological and physical pain, complications, concerns about repeat procedures, and uncertainties about the use of frozen oocytes experienced during the planned OC process and afterward. The third cluster, “Motivation to Rebuild Resilience,” explored participants’ resilience in overcoming difficulties and shocks during the planned OC process and regaining their inner strength through the support of family and friends. The fourth cluster, “Finally Freeing the Mind,” focused on the sense of liberation from the pressure of marriage and childbirth, which enabled participants to engage in their present self and concentrate on self-stability and growth in preparation for the future.

Conclusion

The present study enhances our understanding of the emotional difficulties and distress experienced by women considering OC, thereby assisting in improving approaches for psychological support and clinical management. Furthermore, providing insights into these first-hand experiences to women considering planned OC, healthcare professionals, and policymakers could help establish systems to support the decision-making process.

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Experiences of Patients and Their Families Receiving Medical Services Provided by Advanced Practice Nurses at Tertiary General Hospitals
Mi-Kyeong Jeon, Su Jung Choi, Ji Eun Han, Eun Kyung Kwon, Jeong Hee Park, Jeong Hye Kim
J Korean Acad Nurs 2024;54(4):594-606.   Published online November 4, 2024
DOI: https://doi.org/10.4040/jkan.24069
AbstractAbstract PDFePub
Purpose

This study aimed to understand and describe the experiences of patients and their families who have received medical services from advanced practice nurses in tertiary general hospitals in Korea.

Methods

Data were collected through four focus group interviews with 20 patients and their families who had received medical services from advanced practice nurses for more than six months at four tertiary hospitals from November 29 to December 28, 2023. Verbatim transcripts were analyzed using qualitative content analysis.

Results

The four themes extracted from the experiences of patients and their families were as follows: unfamiliar medical personnel encountered during the treatment process, healthcare professionals who exhibited excellence, companions to light my way through the tunnel of illness, and an advanced practice nurse system that must be activated urgently.

Conclusion

The study’s findings indicate that patients and their families view the care provided by advanced practice nurses as excellent, reliable, and holistic. Research suggests that advanced practice nurses are valuable healthcare professionals in team-based care. The findings suggest that hospitals should utilize an advanced practice nurse system to improve patient outcomes and ensure the quality of care.

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Effect of the Spinning Babies Program on Birth Outcomes and Satisfaction during Labor: A Non-Randomized Controlled Trial
Mi-Yeon Jeong, Hyang Mi Jung
J Korean Acad Nurs 2024;54(4):607-619.   Published online November 20, 2024
DOI: https://doi.org/10.4040/jkan.24097
AbstractAbstract PDFePub
Purpose

This study evaluated the effects of the Spinning Babies program applied during labor on birth outcomes and satisfaction among pregnant women.

Methods

This non-equivalent control group, non-synchronized post-test only design study included 42 participants (22 in the experimental group and 20 in the control group). The Spinning Babies program was conducted four times in the experimental group during the first and second stages of delivery for 50 min per session. The program comprised performing pelvic circles on a birth ball, followed by wide squatting and adopting of open knee-chest and side-lying positions.

Results

Compared with those in the control group, pregnant women in the experimental group had a significantly shorter labor time (t = - 6.64, p < .001), a higher success rate for normal vaginal delivery (χ2 = 4.86, p = .043), improved Apgar scores of newborns (z2 = - 2.18, p = .029), differences in neonatal oxygen therapy use (χ2 = 4.86, p = .043), and improved birth satisfaction (t = 11.99, p < .001).

Conclusion

The Spinning Babies program improves the birth environment by increasing the normal vaginal delivery success rate, as well as pregnant women’s birth satisfaction, and promotes neonatal health.

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Factors Affecting the Intention to Use Smartmonitor-Based Mobile Health in Middle-Aged in Patients Applying the Technology Acceptance Model II
Ol Eum Joo, Yi Kyung Ha
J Korean Acad Nurs 2024;54(4):620-632.   Published online November 13, 2024
DOI: https://doi.org/10.4040/jkan.24091
AbstractAbstract PDFePub
Purpose

This study aimed to identify factors that influence the intention to use smart monitor-based mobile health (SBM) technology among middle-aged inpatients, based on the technology acceptance model II (TAM II).

Methods

A total of 222 participants were surveyed. Data were analyzed using SPSS Statistics 23.0 and IBM SPSS Amos 23. Seven exogenous variables–social influence (SI), personal self-efficacy, (PSE), environmental self-efficacy (ESE), health literacy, health concerns, resistance to innovative technology (RIT), accessibility (AC)– and three endogenous variables–perceived ease of use (PEOU), perceived usability (PU), and intention to use (ITU)–were investigated.

Results

The hypothesized path model demonstrated a good fit for the data. SI (β = .13, p = .042), PU (β = .46, p < .001), and PEOU (β = .16, p = .008) had significant direct effects on the ITU, which explained 39.5% of the variance. Additionally, SI (β = .27, p < .001), ESE (β = .16, p = .010), RIT (β = - .12, p = .026), AC (β = .28, p < .001), and PEOU (β = .20, p = .001) indirectly affected ITU through PU, which explained 50.7% of the variance. Furthermore, PSE (β = .38, p < .001) indirectly influenced ITU via PEOU, which explained 38.4% of the variance.

Conclusion

This study demonstrates that the TAM II can be used to effectively predict ITU in SBMs among middle-aged inpatients. To expand the intention to use SBMs, it is necessary to develop SBMs that include content and programs that promote PU, SI, and PEOU.

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Validity and Reliability of the Korean Version of the Occupational Coping Self-Efficacy Scale for Nurses
Youngrye Park, Sunah Park, Hee Ran Kang
J Korean Acad Nurs 2024;54(4):633-644.   Published online November 30, 2024
DOI: https://doi.org/10.4040/jkan.24094
AbstractAbstract PDFePub
Purpose

This study aimed to evaluate the validity and reliability of the Korean version of the occupational coping self-efficacy for nurses (K-OCSE-N) scale.

Methods

The English version of the OCSE-N scale was translated into Korean using a translation and back-translation process. Data were gathered from 213 nurses employed in a general hospital in South Korea. The content validity was assessed using the content validity index. The construct validity was verified through exploratory and confirmatory factor analyses. Criterion validity was assessed using Pearson’s correlation coefficients with the job stress coping and general self-efficacy scales. Reliability was examined using item-total score correlation and Cronbach’s α coefficient for internal consistency.

Results

The exploratory factor analysis identified two factors that explained 61.8% of the cumulative variance: occupational burden and relational difficulty. In confirmatory factor analysis, the model exhibited adequate fit (χ2/df = 2.07, GFI = .95, SRMR = .04, RMSEA = .07, CFI = .97, and TLI = .95), with both convergent and discriminant validity deemed acceptable. The criterion validity presented a positive correlation of the K-OCSE-N with both job stress coping (r = .72, p < .001) and general self-efficacy (r = .72, p < .001). The internal consistency of the scale using Cronbach’s α for the total items was .89.

Conclusion

The K-OCSE-N scale is a valid and reliable tool for measuring nurses’ occupational coping self-efficacy. This study suggests that various intervention studies can use the scale to assess and strengthen nurses’ occupational coping self-efficacy in nursing practice.

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