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Volume 47(1); February 2017
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Original Articles
Effects of a Cognitive Training Program on Cognitive Function and Activities of Daily Living in Patients with Acute Ischemic Stroke
Eun Young Oh, Mi Sook Jung
J Korean Acad Nurs 2017;47(1):1-13.   Published online February 28, 2017
DOI: https://doi.org/10.4040/jkan.2017.47.1.1
AbstractAbstract PDF
Purpose

The purpose of this study was to examine the effects of a cognitive training program on neurocognitive task performance and activities of daily living (ADL) in patients who had a stroke.

Methods

The research design for this study was a nonequivalent control group non-synchronized design. Patients were assigned to the experimental (n=21) or control group (n=21). The experimental group received a 4-week cognitive training program and usual care (i.e., rehabilitation service), while the control was received usual care only. Cognitive function was measured with a standardized neurocognitive test battery and ADL was assessed at baseline and one and two months after completion of the intervention. Repeated measures ANOVA was used to determine changes in cognitive function and ADL over 2 months.

Results

The interaction of group and time was significant indicating that the experimental group showed improvement in attention, visuospatial function, verbal memory, and executive function compared to the control group which had a sustained or gradual decrease in test performance. A significant group by time interaction in instrumental ADL was also found between the experimental group with gradual improvement and the control group showing no noticeable change.

Conclusion

Findings show that the cognitive training program developed in this study is beneficial in restoring cognitive function and improving ADL in patients following a stroke. Further study is needed to investigate the long-term relationship between cognitive training participation and cognitive improvement and effective functioning in daily living.

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Structural Equation Modeling of Self-Management in Patients with Hemodialysis
Jieun Cha
J Korean Acad Nurs 2017;47(1):14-24.   Published online February 28, 2017
DOI: https://doi.org/10.4040/jkan.2017.47.1.14
AbstractAbstract PDF
Purpose

The purpose of this study was to construct and test a hypothetical model of self-management in patients with hemodialysis based on the Self-Regulation Model and resource-coping perspective.

Methods

Data were collected from 215 adults receiving hemodialysis in 17 local clinics and one tertiary hospital in 2016. The Hemodialysis Self-management Instrument, the Revised Illness Perception Questionnaire, Herth Hope Index and Multidimensional Scale of Perceived Social Support were used. The exogenous variable was social context; the endogenous variables were cognitive illness representation, hope, self-management behavior, and illness outcome. For data analysis, descriptive statistics, Pearson correlation analysis, factor analysis, and structural equation modeling were performed.

Results

The hypothetical model with six paths showed a good fitness to the empirical data: GFI=.96, AGFI=.90, CFI=.95, RMSEA=.08, SRMR=.04. The factors that had an influence on self-management behavior were social context (β=.84), hope and cognitive illness representation (β=.37 and β=.27) explaining 92.4% of the variance. Self-management behavior mediated the relationship between psychosocial coping resources and illness outcome.

Conclusion

This research specifies a more complete spectrum of the self-management process. It is important to recognize the array of clinical resources available to support patients' self-management. Healthcare providers can facilitate self-management through collaborative care and understanding the ideas and emotions that each patient has about the illness, and ultimately improve the health outcomes. This framework can be used to guide self-management intervention development and assure effective clinical assessment.

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Turnover Experience of Male Nurses
Hyunsu Kim, Jeongseop Lee
J Korean Acad Nurs 2017;47(1):25-38.   Published online February 28, 2017
DOI: https://doi.org/10.4040/jkan.2017.47.1.25
AbstractAbstract PDF
Purpose

The aim of this study was to identify turnover experiences of men in nursing and to derive a substantive theory on the turnover experience of men who are nurses.

Methods

Data were collected through in-depth interviews with 13 men who had worked as a nurse for 1 year or more, and had a turnover experience during that period. Collected data were analyzed on the basis of Strauss and Corbin's grounded theory.

Results

The core category in the turnover experiences of the respondents was ‘seeking a stable place for me’. In the analysis of the core category, types of ‘contentment’, ‘seeking’, ‘survival’ and ‘confusion’ were identified. The sequential stages of these nurses’ turnover experience were ‘confrontation’, ‘incertitude’, ‘retrying’ and ‘realization’. However, when a problem arose in the process, they returned to the stage of confusion. Thus, these stages could occur in a circular fashion.

Conclusion

These findings provide a deep understanding of the turnover experience of men in nursing and offers new information about how they adapt to nursing practice. The findings should be useful as foundational data for men who hope to become nurses and also for managers responsible for nurses who are men.

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Factors Influencing Post Traumatic Stress Disorder in Crime Scene Investigators
Seon Mi Nho, Eun A Kim
J Korean Acad Nurs 2017;47(1):39-48.   Published online February 28, 2017
DOI: https://doi.org/10.4040/jkan.2017.47.1.39
AbstractAbstract PDF
Purpose

The purpose of this study was to verify the relationships among social support, resilience and post traumatic stress disorder (PTSD), and especially to identify factors influencing PTSD in police crime scene investigators.

Methods

A cross-sectional design was used, with a convenience sample of 226 police crime scene investigators from 7 Metropolitan Police Agencies. Data were collected through self-report questionnaires during July and August, 2015. Data were analyzed using t-test, χ2-test, Fisher's exact test, and binary logistic regression analysis with SPSS/WIN 21.0 program.

Results

The mean score for PTSD in police crime scene investigators was 13.69. 11 points. Of the crime scene investigators 181 (80.1%) were in the low-risk group and 45 (19.9%) in high-risk group. Social support (t=5.68, p<.001) and resilience (t=5.47, p<.001) were higher in the low-risk group compared to the high-risk group. Logistic regression analysis showed that resilience (OR=4.74, 95% CI: 1.57~14.35), and social support (OR=2.13, 95% CI: 1.23~3.69) are effect factors for PTSD low group.

Conclusion

For effective improvement of PTSD in police crime scene investigators, intervention programs including social support and strategies to increase should be established.

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Difficulties in Caring for Psychiatric Patient as Experienced by Non-Psychiatric Nurses
Jaewon Joung, Mi Young Jang, Jihyun Shim, Yoonhi Ko, Sung Hee Shin
J Korean Acad Nurs 2017;47(1):49-59.   Published online February 28, 2017
DOI: https://doi.org/10.4040/jkan.2017.47.1.49
AbstractAbstract PDF
Purpose

The purpose of this study was to identify non-psychiatric nurses' difficulties in caring for patients with mental illness.

Methods

Data were collected from eighteen general medical-surgical nurses working at a university hospital in Seoul, Korea. This study involved two focus group discussions and three in-depth individual interviews. All interviews were recorded and transcribed as they were spoken, and data were analyzed using qualitative content analysis.

Results

General medical-surgical nurses experienced difficulties in 3 categories, 9 subcategories, 27 codes. The three categories were ‘nurse’ related factors, ‘patient’ related factors, ‘resource’ related factors. The nine categories were ‘unpreparedness’, ‘nursing barriers due to stigma’, ‘undervaluing and avoidance of psychiatric nursing’, ‘eroding into the trap of a vicious cycle’, ‘facing unapproachable patients’, ‘dealing with unhelpful family members’, ‘burdening already overburdened staff’, ‘obstructive environment’, and ‘isolation of staff with heavy responsibilities’.

Conclusion

The results of this study indicate the need to develop psychiatric mental health education programs for non-psychiatric nurses. Education about psychiatric mental health and support from institutions for non-psychiatric nurses can reduce their negative attitude toward psychiatric patients and difficulties in caring for psychiatric patients.

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Prediction Model for Health-Related Quality of Life in Hospitalized Patients with Pulmonary Tuberculosis
Kwang-Sim Jang, Gyeong-Suk Jeon
J Korean Acad Nurs 2017;47(1):60-70.   Published online February 28, 2017
DOI: https://doi.org/10.4040/jkan.2017.47.1.60
AbstractAbstract PDF
Purpose

This study was conducted to construct and test a structural equation model of health-related quality of life (HRQoL) among hospitalized patients with pulmonary tuberculosis (PTB).

Methods

Participants were 256 patients with PTB who were 20 years or older and admitted in two national tuberculosis hospitals. The patients participated in pulmonary function testing and responded to structured questionaries.

Results

The goodness-of-fit statistics of the final hypothetical model were as follows: χ2/df=2.19, RMSEA=.07, SRMR=.05, GFI=.95, NFI=.95, CFI=.96, TLI=.92, and PCFI=.52. Symptoms and general health perception had significant direct effects, and subjective economic status, social support and stigma had significant indirect effect on HRQoL of hospitalized patients with PTB. These variables explained 64% of variance in the prediction model.

Conclusion

Findings suggest that strategies and intervention for physical symptoms and depressive symptoms are crucial to improve the quality of life in hospitalized patients with PTB. The development of various social support programs is also recommended.

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Hermeneutic Phenomenological Study on Caring Experience of the Mothers of Children with Epilepsy
Woo Joung Joung, Myungsun Yi
J Korean Acad Nurs 2017;47(1):71-85.   Published online February 28, 2017
DOI: https://doi.org/10.4040/jkan.2017.47.1.71
AbstractAbstract PDF
Purpose

The purpose of this study was to develop a deeper understanding of the experience of mothers caring for children with epilepsy.

Methods

Data were collected through individual in-depth interviews and observation from 12 mothers of children with epilepsy. Data were collected from December, 2014 to February, 2015 and analyzed using van Manen's hermeneutic phenomenological methodology to identify essential themes of their experience.

Results

The essential themes that fit into the context of the 4-existential grounds of time, body, other people, and space were: Lived time-ongoing influence of the past, living in insecure present, fearful future with no answer; Lived body-bonded body, burned out state; Lived other-burden but also support, shrunken down; Lived space-narrowed range of activity, widened horizon.

Conclusion

The findings in this study show in-depth understanding of the hardships of mothers who are caring for children with epilepsy. The beauty and greatness of these mothers are revealed through the analysis of various phenomenological materials such as literary and artistic work reflecting socio-cultural context, as well as vivid care experiences of mothers of children with epilepsy. This will be helpful in increasing understanding of the nature of caregivers' experience for medical professionals dealing with patients and caregivers. Also it helps to improve the understanding of the disease among the general public, followed by a more warming and caring attitude towards patients and family members. Finally, it will enhance psychological well-being and overall quality of life of the epileptic children and their families.

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Development of the Meaning in Life Scale for Older Adults
Si Eun Lee, Gwi-Ryung Son Hong
J Korean Acad Nurs 2017;47(1):86-96.   Published online February 28, 2017
DOI: https://doi.org/10.4040/jkan.2017.47.1.86
AbstractAbstract PDF
Purpose

The purpose of this study was to develop and test the psychometric properties of the newly developed instrument, Meaning in Life, for elderly Korean people.

Methods

Ten older adults participated in the qualitative research used to develop the initial items. Participants for the psychometric testing were 371 community-dwelling older adults. Validity and reliability analyses included content, construct, and criterion-related validities, internal consistency, and test-retest reliability.

Results

The Meaning in Life Scale consisted of 12 items with three distinct factors; value of life, source of life, and will to live, which explained 86.7% of the total variance. A three-factor structure was validated by confirmatory factor analysis. Criterion-related validity was supported by comparison with the Purpose in Life Test (r=.74). Reliabilities were secured with test-retest reliability of Intra-class Correlation Coefficient (ICC) .85 and the Cronbach's alpha coefficient .90.

Conclusion

The results of this study indicate that this instrument is useful to measure meaning in life in Korean elders.

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Experience of Spiritual Conflict in Hospice Nurses: A Phenomenological Study
Byoung Sook Lee, Su Young Kwak
J Korean Acad Nurs 2017;47(1):98-109.   Published online February 28, 2017
DOI: https://doi.org/10.4040/jkan.2017.47.1.98
AbstractAbstract PDF
Purpose

This aim of this phenomenological study was to describe and understand the experience of spiritual conflict in hospice nurses by identifying the meanings and structures of the experience.

Methods

Participants were 12 nurses working for one year or more at hospice units of general hospitals in a metropolitan city and experiencing of spiritual conflict as hospice nurses. Over six months data were collected using individual in-depth interviews and analyzed with the method suggested by Colaizzi.

Results

The experience of spiritual conflict in participants was organized into three categories, six theme-clusters, and 13 themes. The participants felt existential anxiety on death and a fear of death which is out of human control and skepticism for real facts of human beings facing death. They also experienced agitation of fundamental beliefs about life with agitation of the philosophy of life guiding themselves and mental distress due to fundamental questions that are difficult to answer. Also they had distress about poor spiritual care with guilty feelings from neglecting patients' spiritual needs and difficulties in spiritual care due to lack of practical competencies.

Conclusion

Findings indicate the experience of spiritual conflict in hospice nurses is mainly associated with frequent experience of death in hospice patients. The experience of spiritual conflict consisted of existential anxiety, agitation of fundamental beliefs and distress over poor spiritual care. So, programs to help relieve anxiety, agitation and distress are necessary to prevent spiritual conflict and then spiritual burnout in hospice nurses.

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The Lived Experience of Patients with Heart Transplantation: A Phenomenological Study
Younghui Hwang, Myungsun Yi
J Korean Acad Nurs 2017;47(1):110-120.   Published online February 28, 2017
DOI: https://doi.org/10.4040/jkan.2017.47.1.110
AbstractAbstract PDF
Purpose

The purpose of this study was to describe the lived experience of patients with heart transplantation in Korea.

Methods

Individual indepth interviews and a focus group interview were used to collect the data from nine patients who had heart transplantations in 2015. All interviews were audio-taped and verbatim transcripts were made for the analysis. Data were analyzed using Colaizzi's phenomenological method.

Results

Among the nine participants, eight were men. Mean age was 57.30 years. Six theme clusters emerged from the analysis. ‘Joy of rebirth obtained by good luck’ describes the pleasure and expectation of new life after narrow survival. ‘Suffering from adverse drug effects’ illustrates various psychosocial difficulties, such as low self-esteem, helplessness, alienation, and burnout, arising from the side effects of medications. ‘Body and mind of being bewildered’ illustrates disintegrated health and haunting fear of death. ‘Alienation disconnected with society’ describes isolated feeling of existence due to misunderstandings from society. ‘Suffering overcome with gratitude and responsibility’ includes overcoming experience through various social supports and suitable jobs. Finally, ‘acceptance of suffering accompanied with new heart’ illustrate changed perspective of life itself.

Conclusion

The findings in this study provide deep understanding and insights of the lived experience of heart related illness for these patients and should help in the development of tailored-interventions for patients with heart transplantation.

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Reliability and Validity of the Korean Version of the Cancer Stigma Scale
Hyang Sook So, Myeong Jeong Chae, Hye Young Kim
J Korean Acad Nurs 2017;47(1):121-132.   Published online February 28, 2017
DOI: https://doi.org/10.4040/jkan.2017.47.1.121
AbstractAbstract PDF
Purpose

In this study the reliability and validity of the Korean version of the Cancer Stigma Scale (KCSS) was evaluated.

Methods

The KCSS was formed through translation and modification of Cataldo Lung Cancer Stigma Scale. The KCSS, Psychological Symptom Inventory (PSI), and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core 30 (EORTC QLQ-C30) were administered to 247 men and women diagnosed with one of the five major cancers. Construct validity, item convergent and discriminant validity, concurrent validity, known-group validity, and internal consistency reliability of the KCSS were evaluated.

Results

Exploratory factor analysis supported the construct validity with a six-factor solution; that explained 65.7% of the total variance. The six-factor model was validated by confirmatory factor analysis (Q (χ2/df)= 2.28, GFI=.84, AGFI=.81, NFI=.80, TLI=.86, RMR=.03, and RMSEA=.07). Concurrent validity was demonstrated with the QLQ-C30 (global: r=-.44; functional: r=-.19; symptom: r=.42). The KCSS had known-group validity. Cronbach's alpha coefficient for the 24 items was .89.

Conclusion

The results of this study suggest that the 24-item KCSS has relatively acceptable reliability and validity and can be used in clinical research to assess cancer stigma and its impacts on health-related quality of life in Korean cancer patients.

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Association between Awareness of Nutrition Labels and Menstrual Cycle Irregularity in Korean Women: The Fifth Korea National Health and Nutrition Examination Survey (2010~2012)
Hae Young Yoo, Eunjung Ryu, Ji-Su Kim, Kyung-do Han
J Korean Acad Nurs 2017;47(1):133-141.   Published online February 28, 2017
DOI: https://doi.org/10.4040/jkan.2017.47.1.133
AbstractAbstract PDF
Purpose

The aim of this study was to identify the relationship between awareness of nutrition labeling and menstrual cycle irregularity in women from a nationally representative sample of the Korean population.

Methods

A cross-sectional analysis was performed using hierarchical multivariable logistic regression analysis models. A total of 4,324 women aged 19~54 years from the 2010~2012 Korean National Health and Nutrition Examination Survey participated in the study. The participants were classified into three groups based on self-report responses to a questionnaire about their awareness of nutrition labels: Reading, Not-Reading, and Not-Knowing Groups.

Results

The Reading, Not-Reading, and Not-Knowing Groups comprised 46.4%, 44.9%, and 8.7% of the participants, respectively, and 53.6% of the participants had never used nutrition labels. In the Not-Knowing Group, irregular menstrual cycles for more than 3 months were significantly more common than women with irregular menstrual cycles for up to 3 months and women with regular menstrual cycles. Women in the Not-Knowing Group were more likely to exhibit menstrual cycle irregularity (adjusted odds ratio: 1.63, 95% confidence interval: 1.10~2.41) compared to women in the Reading Group after adjusting for age, body mass index, smoking status, alcohol intake, exercise regularity, stress, depression, suicidal ideation, metabolic syndrome, age at menarche, parity, and use of oral contraceptives.

Conclusion

No awareness of nutrition labeling appears to be associated with a higher prevalence of menstrual cycle irregularity in a nationally representative group of Korean women.

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