Journal of Korean Academy of Nursing

Factors Affecting the Quality of Life in Low-Income Older Adults with Sarcopenia: A Cross-Sectional Study: Nho, Ju-Hee , Kim, Eun Jin; J Korean Acad Nurs 2023;53(1):1-11. Published online February 28, 2023; DOI: https://doi.org/10.4040/jkan.22126

Abstract PDF: Purpose
This study aimed to identify the factors influencing quality of life (QoL) of low-income older adults (LOAs) with sarcopenia.
Methods
A convenience sample of 125 older adults was recruited from Jeonbuk Province, South Korea. Data were collected using a self-report questionnaire that included nutritional status, the Depression Anxiety Stress Scale-21, and the World Health Organization Quality of Life Instrument-Older Adults Module. Additionally, grip strength and appendicular skeletal muscle mass, were evaluated, along with the short physical performance battery.
Results
Sarcopenia and severe sarcopenia were observed in 43.2% and 56.8% of participants, respectively. Using multiple regression analysis, depression (β = - .40, p < .001), nutritional status (β = .24, p = .003), and anxiety (β = - .15, p = .042) were identified as factors affecting the QoL of the older adults in low-income groups with sarcopenia, the explanatory power of these variables was 44%.
Conclusion
The results of this study can be used to develop a nursing intervention program and establish policies to improve depression, anxiety, and nutritional status to enhance QoL of LOAs with sarcopenia.

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Development and Psychometric Evaluation of the Ischemic Stroke Distress Scale (ISDS): Kang, Jaejin , Yoo, Yang-Sook; J Korean Acad Nurs 2023;53(1):12-27. Published online February 28, 2023; DOI: https://doi.org/10.4040/jkan.22090

Abstract PDF: Purpose
This study aimed to develop a scale to measure distress in patients with ischemic stroke and verify its validity and reliability.
Methods
Preliminary items were developed from literature review and in-depth interviews. The final preliminary scale was confirmed through a content validity test of eight experts and a preliminary survey of 10 stroke patients. The participants for psychometric testing were 305 stroke patients in the outpatient clinic. Validity and reliability analyses included item analysis, exploratory and confirmatory factor analysis, convergent validity, known-group validity, and internal consistency of the scale.
Results
The final scale consisted of 17 items and 3 factors. The three distinct factors were ‘self-deprecation, worry about future health, and withdrawal from society’ and this structure was validated using a confirmatory factor analysis. Convergent validity was supported by comparison with the Center for Epidemiologic Studies Depression Scale (r = .54, p < .001) and Brief Illness Perception Questionnaire (r = .67, p < .001). Known-groups validity was verified by dividing groups according to ‘duration since diagnosis’ (t = 2.65, p = .009), ‘presence of sequela’ (t = 10.16, p < .001), and ‘awareness of distress’ (t = 12.09, p < .001). The internal consistency of the scale using Cronbach’s α for the total items was .93.
Conclusion
The Ischemic Stroke Distress Scale is a valid and reliable tool that reflects stroke distress effectively. It is expected to be used as a basic tool to develop various intervention strategies to reduce distress in ischemic stroke patients.

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Conceptual Analysis of Career Anchors of Nurses: Oh, Jae Woo , Kim, Mi Ran; J Korean Acad Nurs 2023;53(1):28-38. Published online February 28, 2023; DOI: https://doi.org/10.4040/jkan.22091

Abstract PDF: Purpose
This study aimed to provide a theoretical basis for career anchors of nurses by defining and organizing its concept.
Methods
Using the Walker and Avant concept analysis, a total of 29 articles were analyzed through a literature search in this study.
Results
The career anchors of nurses are individual career choice motives, a self-concept where in competency and values are harmonized, which act as a desire for growth and development in nursing, and are actions that maintain careers. Additionally, they indicate the direction for achieving individual career goals and act as a core value expected of nurses by nursing organizations, indicating continuous and integrated professional growth and development of the nursing profession.
Conclusion
The career anchors of nurses identified in the results contribute to securing patient safety, providing quality care through policies, institutionalizing bases for career development, preventing nurse turnover, and retaining skilled nurses.

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Intention to Delegate Clinical Practice of Medical Specialists in Accordance with the Enactment of the Scope of Practice for Advanced Practice Nurses: Kim, Min Young , Choi, Su Jung , Kim, Jeong Hye , Leem, Cho Sun , Kang, Young-ah; J Korean Acad Nurs 2023;53(1):39-54. Published online February 28, 2023; DOI: https://doi.org/10.4040/jkan.22098

Abstract PDF: Purpose
This study aimed to investigate the nationwide intention to delegate clinical practice of medical specialists in accordance with the enactment of the scope of practice for advanced practice nurses (APNs).
Methods
Data were collected from October to December 2021 using Google Surveys. In total, 147 medical specialists from 12 provinces responded to the survey. The survey questionnaire was categorized into four legislative draft duties, according to the scope of practice (a total of 41 tasks): Twenty-nine tasks on treatments, injects, etc., performed under the guidance of a physician and other activities necessary for medical treatment (treatment domain); two tasks on collaboration and coordination; six tasks on education, counseling, and quality improvement; four regarding other necessary tasks. Participants were asked whether they were willing to delegate the tasks to APN.
Results
The intention to delegate tasks to APN was higher for non-invasive tasks such as blood sampling (97.3%) or simple dressing (96.6%). Invasive tasks such as endotracheal tube insertion (10.2%), sampling: bone marrow biopsy & aspiration (23.8%) showed low intention to delegate in the treatment domain. Participants who were older, male, and had more work careers with APN, showed a higher intention to delegate tasks.
Conclusion
To prevent confusion in the clinical setting, a clear agreement on the scope of APN practice as APN delegated by physicians should be established. Based on this study, legal practices that APN can perform legally should be established.

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Keyword Network Analysis and Topic Modeling of News Articles Related to Artificial Intelligence and Nursing: Ha, Ju-Young , Park, Hyo-Jin; J Korean Acad Nurs 2023;53(1):55-68. Published online February 28, 2023; DOI: https://doi.org/10.4040/jkan.22117

Abstract PDF: Purpose
The purpose of this study was to identify the main keywords, network properties, and main topics of news articles related to artificial intelligence technology in the field of nursing.
Methods
After collecting artificial intelligence-and nursing-related news articles published between January 1, 1991, and July 24, 2022, keywords were extracted via preprocessing. A total of 3,267 articles were searched, and 2,996 were used for the final analysis. Text network analysis and topic modeling were performed using NetMiner 4.4.
Results
As a result of analyzing the frequency of appearance, the keywords used most frequently were education, medical robot, telecom, dementia, and the older adults living alone. Keyword network analysis revealed the following results: a density of 0.002, an average degree of 8.79, and an average distance of 2.43; the central keywords identified were ’education,’ ‘medical robot,’ and ‘fourth industry.’ Five topics were derived from news articles related to artificial intelligence and nursing: ‘Artificial intelligence nursing research and development in the health and medical field,’ ‘Education using artificial intelligence for children and youth care,’ ‘Nursing robot for older adults care,’ ‘Community care policy and artificial intelligence,’ and ‘Smart care technology in an aging society.’ Conclusion: The use of artificial intelligence may be helpful among the local community, older adult, children, and adolescents. In particular, health management using artificial intelligence is indispensable now that we are facing a super-aging society. In the future, studies on nursing intervention and development of nursing programs using artificial intelligence should be conducted.

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Effect of Digital Health Interventions on Psychotic Symptoms among Persons with Severe Mental Illness in Community: A Systematic Review and Meta-Analysis: Oh, Eunjin , Gang, Moonhee; J Korean Acad Nurs 2023;53(1):69-86. Published online February 28, 2023; DOI: https://doi.org/10.4040/jkan.22121

Abstract PDF: Purpose
This study aimed to evaluate the effects of digital health interventions on the psychotic symptoms among people with severe mental illness in the community.
Methods
A systematic review and meta-analysis were conducted in accordance with the Cochrane Intervention Research Systematic Review Manual and PRISMA. A literature search was conducted of published randomized controlled trials (RCTs) for digital health interventions from January 2022 to April 2022. RevMan software 5.3 was used for quality assessment and meta-analysis.
Results
A total 14 studies out of 9,864 studies were included in the review, and 13 were included in meta-analysis. The overall effect size of digital health interventions on psychotic symptoms was - 0.21 (95% CI = - 0.32 to - 0.10). Sub-analysis showed that the reduction of the psychotic symptoms was effective in the schizophrenia spectrum group (SMD = - 0.22; 95% CI = - 0.36 to - 0.09), web (SMD = - 0.41; 95% CI = - 0.82 to 0.01), virtual reality (SMD = - 0.33; 95% CI = - 0.56 to - 0.10), mobile (SMD = - 0.15; 95% CI = - 0.28 to - 0.03), intervention period of less than 3 months (SMD = - 0.23; 95% CI = - 0.35 to - 0.11), and non-treatment group (SMD = - 0.23; 95% CI = - 0.36 to - 0.11).
Conclusion
These findings suggest that digital health interventions alleviate psychotic symptoms in patients with severe mental illnesses. However, well-designed digital health studies should be conducted in the future.

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Effects of a Nursing Simulation Learning Module on Clinical Reasoning Competence, Clinical Competence, Performance Confidence, and Anxiety in COVID-19 Patient-Care for Nursing Students: Kim, Ye-Eun , Kang, Hee-Young; J Korean Acad Nurs 2023;53(1):87-100. Published online February 28, 2023; DOI: https://doi.org/10.4040/jkan.22130

Abstract PDF: Purpose
This study aimed to develop a nursing simulation learning module for coronavirus disease 2019 (COVID-19) patient-care and examine its effects on clinical reasoning competence, clinical competence, performance confidence, and anxiety in COVID-19 patient care for nursing students.
Methods
A non-equivalent control group pre- and post-test design was employed. The study participants included 47 nursing students (23 in the experimental group and 24 in the control group) from G City. A simulation learning module for COVID-19 patient-care was developed based on the Jeffries simulation model. The module consisted of a briefing, simulation practice, and debriefing. The effects of the simulation module were measured using clinical reasoning competence, clinical competence, performance confidence, and anxiety in COVID-19 patient-care. Data were analyzed using χ² -test, Fisher’s exact test, t-test, Wilcoxon signed-rank test, and Mann– Whitney U test.
Results
The levels of clinical reasoning competence, clinical competence, and performance confidence of the experimental group were significantly higher than that of the control group, and the level of anxiety was significantly low after simulation learning.
Conclusion
The nursing simulation learning module for COVID-19 patient-care is more effective than the traditional method in terms of improving students’ clinical reasoning competence, clinical competence, and performance confidence, and reducing their anxiety. The module is expected to be useful for educational and clinical environments as an effective teaching and learning strategy to empower nursing competency and contribute to nursing education and clinical changes.

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Determinants of Problem Drinking by Regional Variation among Adult Males in Single-Person Households: Geographically Weighted Regression Model Analysis: Ahn, Junggeun , Choi, Heeseung , Kim, Jiu; J Korean Acad Nurs 2023;53(1):101-114. Published online February 28, 2023; DOI: https://doi.org/10.4040/jkan.22131

Abstract PDF: Purpose
This study aimed to identify regional differences in problem drinking among adult males in single-person households and predict the determinants.
Methods
This study used data from the 2019 Community Health Survey. Geographically weighted regression analysis was performed on 8,625 adult males in single-person households who had been consuming alcohol for the past year. The Si-Gun-Gu was selected as the spatial unit.
Results
The top 10 regions for problem drinking among adult males in single-person households were located in the Jeju-do and Jeollanam-do areas near the southern coast, whereas the bottom 10 regions were located in the Incheon and northern Gyeonggi-do areas. Smoking, economic activity, and educational level were common factors affecting problem drinking among this population. Among the determinants of regional disparities in problem drinking among adult males in single-person households, personal factors included age, smoking, depression level, economic activity, educational level, and leisure activity, while regional factors included population and karaoke venue ratio.
Conclusion
Problem drinking among adult males in single-person households varies by region, and the variables affecting each particular area differ. Therefore, it is necessary to develop interventions tailored to individuals and regions that reflect the characteristics of each region by prioritizing smoking, economic activity, and educational level as the common factors.

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The Experience of Gynecologic Cancer in Young Women: A Qualitative Study: Kim, Sung-Jin , Shin, Hyunjeong; J Korean Acad Nurs 2023;53(1):115-128. Published online February 28, 2023; DOI: https://doi.org/10.4040/jkan.22119

Abstract PDF: Purpose
This study aimed to understand the experiences of women under 40 years of age with gynecologic cancer.
Methods
Semi-structured individual in-depth interviews were conducted with 14 Korean female patients aged 21~39 years with gynecologic cancer. The data were analyzed using Corbin and Strauss' grounded theory approach, including open coding, context analysis, and integrating categories.
Results
Grounded theory analysis revealed nine categories and a core category of ‘the journey to find my life after losing the life as a typical woman.’ The categories that emerged as the conditions are ‘Unwelcomed guest, cancer,’ ‘Completely devastated life as an ordinary woman,’ ‘Uncertain future,’ ‘Losing my physical characteristics as a woman,’ and ‘Life tied with treatments.’ The actions/interactions were ‘Decrease of interpersonal relationships,’ ‘A lonely battle to overcome alone,’ and ‘The power to overcome hardships.’ The consequence was ‘Live my own life.’ Conclusion: This study contributes to the development of a substantive theory of the experience of gynecologic cancer in young women, which has been on the rise in recent years. The study’s results are expected to be used as a basis for providing nursing care to help young women with gynecologic cancer adapt to their disease.

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Effects of Clinical Nurses’ Job Crafting on Organizational Effectiveness Based on Job DemandsResource Model: Lee, Eun Young , Kim, Eungyung; J Korean Acad Nurs 2023;53(1):129-143. Published online February 28, 2023; DOI: https://doi.org/10.4040/jkan.22138

Abstract PDF: Purpose
This study aimed to examine the mediating effects of clinical nurses’ job crafting on organizational effectiveness based on the job demands-resources model proposed by Bakker and Demerouti (2017).
Methods
The participants consisted of 393 nurses working in nursing units of a tertiary general hospital located in Cheongju region. The data, collected using questionnaire from August 9 to August 20, 2021, were analyzed using SPSS 23.0 and AMOS 27.0.
Results
The goodness-of-fit (GoF) test results on the modified model (χ 2 = 2.7, GFI = .94, SRMR = .03, RMSEA = .06, NFI = .92, CFI = .94, TLI = .92, AGFI = .90), indicated that the GoF index satisfied the recommended level. Regarding the effects of each variable on organizational effectiveness, job crafting showed statistically significant direct (β = .48, p < .001), indirect (β = .23, p < .001), and total effects (β = .71, p < .001). Burnout showed statistically significant direct effect (β = - .17, p < .001). Work engagement showed statistically significant direct (β = .41, p < .001) and total effects (β = .41, p < .001). The factors explaining organizational effectiveness were job crafting, burnout, and work engagement, which had an explanatory power of 76.7%.
Conclusion
Nurses’ job crafting is an important mediating factor for enhancing the organizational effectiveness of nursing organizations. Hospitals should develop job-crafting success cases and related education and training programs as a strategy for enhancing the job crafting of nurses and, consequently organizational effectiveness.

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