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Volume 42(2); April 2012
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Original Articles
Role Transition from Clinical Nurse to Case Manager for Medical-aid Beneficiaries: Taking Root in a Barren Land
Eun-Jun Park, Chunmi Kim, Seung Joo Lim
J Korean Acad Nurs 2012;42(2):149-160.   Published online April 30, 2012
DOI: https://doi.org/10.4040/jkan.2012.42.2.149
AbstractAbstract PDF
Purpose

The purpose of this study was to explain the role transition process to nurse case managers (NCMs) for Medical-aid beneficiaries in Korea.

Methods

Fourteen NCMs were interviewed regarding their experiences of becoming proficient in the new role of case manger. Data were analyzed through the application of grounded theory.

Results

'Taking root in a barren land' was the core category explaining the role transition process of NCMs. They engaged in four stages: launching, trial and error, proficiency, and wait-and-see stages. NCMs showed not only fear but also passion for case management practice. Despite their passion and effort, NCMs went through a period of trial and error. After becoming skilled, NCMs went through a stage of wait-and-see often because of job insecurity related to temporary position or few opportunities for promotion. Factors influencing NCMs' role transition process included their understanding of client characteristics, belief in case management, and support from their colleagues and families.

Conclusion

NCMs experience many challenges in the process of becoming proficient NCMs. To help with their role transition, there is a need for education programs, preceptorship programs, research on their roles and functions, and regulation for securing NCMs' employment and career stability.

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Effects of Mindfulness Meditation Program on Perceived Stress, Ways of Coping, and Stress Response in Breast Cancer Patients
Gwangsoon Kang, Sangeun Oh
J Korean Acad Nurs 2012;42(2):161-170.   Published online April 30, 2012
DOI: https://doi.org/10.4040/jkan.2012.42.2.161
AbstractAbstract PDF
Purpose

Purpose of this study was to examine the effects of the Mindfulness Meditation program on perceived stress, ways of coping, salivary cortisol level, and psychological stress response in patients with breast cancer.

Methods

This was a quasi-experimental study with a non-equivalent control group pre-post test design. Participants in this study were 50 patients who had completed breast cancer treatment (experimental group, 25, control group, 25). The experimental group received the Mindfulness Meditation program for 3 hours/session/ week for 8 weeks. Data were analyzed using χ2-test and t-test for subject homogeneity verification, and ANCOVA to examine the hypotheses.

Results

The experimental group had significantly lower scores for perceived stress, emotional focused coping, salivary cortisol level, and psychological stress response compared to the control group. However, no significant differences were found between two groups for the scores on problem focused stress coping.

Conclusion

According to the results, the Mindfulness Meditation program was useful for decreasing perceived stress, emotional focused coping, salivary cortisol level, and psychological stress response. Therefore, this program is an effective nursing intervention to decrease stress in patients with breast cancer.

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Factors Influencing Quality of Life in Married Immigrant Women in Korea
Eun Kwang Yoo, Hye Jin Kim, Myoung-Hee Kim
J Korean Acad Nurs 2012;42(2):171-180.   Published online April 30, 2012
DOI: https://doi.org/10.4040/jkan.2012.42.2.171
AbstractAbstract PDF
Purpose

The purpose of this study was to identify the factors influencing quality of life of married immigrant women in Korea.

Methods

The participants included 508 married immigrant women who met the eligibility criteria and agreed to participate in the study. Participants were evaluated for subjective assessment of married immigrant-related constructs using a self-report questionnaire, for self-esteem, self-efficacy, and quality of life (QOL). The analysis was done using SPSS for Windows, version 10.1, and included stepwise regression.

Results

The major findings were as follows; 1) There were significant relationships between marital satisfaction (r=.39, p=.001), violence by the husband during the couple's arguments (r= -.24, p<.001), satisfaction with life in Korea (r=.39, p<.001), self-esteem (r=.16, p<.001), self-efficacy (r=.51, p<.001) and quality of life. 2) Marital satisfaction, self-efficacy, education level and satisfaction life with in Korea were significant factors, which explained 53% of the variance in quality of life (F=43.97, p<.001). Multiple regression analysis revealed that a powerful predictor of QOL for married immigrant women was self-efficacy.

Conclusion

Developing nursing interventions to enhance self-efficacy toward improvement of QOL among married immigrant women is recommended.

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Breast Feeding Rates and Factors Influencing Breast Feeding Practice in Late Preterm Infants: Comparison with Preterm Born at Less than 34 Weeks of Gestational Age
Gun Ja Jang, Sang Lak Lee, Hyeon Mi Kim
J Korean Acad Nurs 2012;42(2):181-189.   Published online April 30, 2012
DOI: https://doi.org/10.4040/jkan.2012.42.2.181
AbstractAbstract PDF
Purpose

This study was done to compare breast feeding rates and factors influencing feeding practice between late preterm (34≤GA<37) and preterm infants (GA<34).

Methods

A survey was done of 207 late preterm and 117 preterm infants in neonatal intensive care units (NICU) of 4 university hospitals in D city. Data were collected from July 2009 to June 2010 from 324 medical records in the NICU. Breast-feeding at home was checked either by telephone survey or questioning during hospital visits.

Results

Rate of breast feeding for late preterm infants was significantly lower than for preterm infants. There was no significant difference in breast-feeding at home. We found differences in factors influencing breast feeding between the two groups. Factors influencing feeding for late preterm infants were type of delivery, mothers' occupation, feeding type during hospitalization, time elapse from hospital discharge, total admission days, infant's body weight at first feeding and length of NPO (nothing by mouth). Factors influencing feeding for preterm infants were birth order, maternal disease and obstetric complications, and one-minute Apgar score.

Conclusion

Results of the study show low rates of breast-feeding for late preterm infants indicating a need for breast-feeding education for mothers of these infants.

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Effects of a Smoking Cessation Education on Smoking Cessation, Endothelial Function, and Serum Carboxyhemoglobin in Male Patients with Variant Angina
Sook-Hee Cho
J Korean Acad Nurs 2012;42(2):190-198.   Published online April 30, 2012
DOI: https://doi.org/10.4040/jkan.2012.42.2.190
AbstractAbstract PDF
Purpose

The aim of this study was to evaluate the effects of a smoking cessation education on endothelial function and carboxyhemoglobin levels in smokers with variant angina.

Methods

A nonequivalent control group pretest-posttest design was used. Participants were 60 male smokers with variant angina admitted to one hospital: the control group (30) between September and December, 2009, and the experimental group (30) between February and May, 2010. Endothelial function, as defined by flow-mediated vasodilation (FMD) of the brachial artery, and serum carboxyhemoglobin (COHb) were determined at baseline and at 3 months after the initiation of education in both groups.

Results

Three months after the program, smoking cessation was successful in 22 of the 30 smokers in the experimental group, but only in 4 of 30 smokers in the control group (p<.001). After the education, the experimental group showed a significant increase in FMD, and a significant decreased in serum COHb compared with the control group.

Conclusion

The findings indicate that this smoking cessation education program is effective for hospitalized smokers with variant angina.

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Impact of level of physical activity on healthcare utilization among Korean adults
Jiyun Kim, Seungmi Park
J Korean Acad Nurs 2012;42(2):199-206.   Published online April 30, 2012
DOI: https://doi.org/10.4040/jkan.2012.42.2.199
AbstractAbstract PDF
Purpose

This study was done to identify the impact of physical activity on healthcare utilization among Korean adults.

Methods

Drawing from the 2008 Korean National Health and Nutrition Examination Survey (NHANES IV-2), data from 6,521 adults who completed the Health Interview and Health Behavior Surveys were analyzed. Association between physical activity and healthcare utilization was tested using the χ2-test. Multiple logistic regression analysis was used to calculate the odds ratios of using outpatient and inpatient healthcare for different levels of physical activity after adjusting for predisposing, enabling, and need factors. A generalized linear model applying a negative binomial distribution was used to determine how the level of physical activity was related to use of outpatient and inpatient healthcare.

Results

Physically active participants were 16% less likely to use outpatient healthcare (OR, 0.84; 95% CI, 0.74-0.97) and 23% less likely to use inpatient healthcare (OR, 0.77; 95% CI, 0.63-0.93) than physically inactive participants. Levels of outpatient and inpatient healthcare use decreased as levels of physical activity increased, after adjusting for relevant factors.

Conclusion

An independent association between being physically active and lower healthcare utilization was ascertained among Korean adults indicating a need to develop nursing intervention programs that encourage regular physical activity.

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Depression and Risk Factors in Patients with Crohn's Disease
Ok-Hee Cho, Yang-Sook Yoo, Suk-Kyun Yang
J Korean Acad Nurs 2012;42(2):207-216.   Published online April 30, 2012
DOI: https://doi.org/10.4040/jkan.2012.42.2.207
AbstractAbstract PDF
Purpose

This study was conducted to determine the risk factors among patients with depression with Crohn's disease.

Methods

Data were collected by questionnaire from 276 patients who were diagnosed with Crohn's disease at a tertiary hospital located in Seoul. Measurements included patients' demographic characteristics, clinical characteristics, depression level, and health-related quality of life. Data were analyzed using t-test, χ2-test, Wilcoxon rank sum test, and logistic regression analyses.

Results

The incidence rate of depression (BDI-II≥14scores) was 31.9% (n=88). Univariate analysis revealed that being a woman, school graduation status, economic status (low), BMI(<18.5Kg/m2), disease duration (≥3 years), CDAI (≥150 scores), frequency of hospital admission (≥2), extra-intestinal manifestation (arthralgia, stomatitis), administration of 5-aminosalicylic acid, and disease related quality of life (SIBDQ<50 scores) were associated with depression. Multivariate analysis revealed that economic status (low), school graduation status, and quality of life (SIBDQ<50 scores) were more likely to report high level of depression.

Conclusion

Future research should consider managing depression as an essential component of comprehensive care for patients with Crohn's disease. In addition, further research is needed to develop strategies to better improve quality of life among patients with Crohn's disease who are depressed.

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Factors Associated with Human Papillomavirus related Stigma, Shame, and Intent of HPV Test
Hae Won Kim
J Korean Acad Nurs 2012;42(2):217-225.   Published online April 30, 2012
DOI: https://doi.org/10.4040/jkan.2012.42.2.217
AbstractAbstract PDF
Purpose

This study was conducted to examine the factors associated with HPV (Human Papillomavirus) related stigma, shame and intent to have HPV test among adult women.

Methods

Data were collected from December 1, 2009 to January 31, 2010, and participants were 324 women who visited an obstetric gynecologic clinic. They anticipated testing positive for HPV. Then HPV related stigma, shame, intent to have HPV testing and HPV knowledge were measured. Descriptive statistics, Mann-Whitney U test, Kruskal Wallis test and multivariate adjusted logistic regression were used for data analysis.

Results

The levels of stigma and shame were higher than average. Intent to have HPV test was high and HPV knowledge was low. Women who answered that HPV is not sexually transmitted had lower HPV stigma than did women who answered they didn't know (OR=0.20, 95%CI 0.06-0.68). Women with lower stigma showed lower intent to have HPV test than women with higher stigma (OR=0.46, 95%CI 0.26-0.82).

Conclusion

Basic HPV information should be fully understood for women especially prior to HPV test. Normalizing HPV stigma is necessary for women who perceive HPV as sexually transmitted and women intending to have HPV test.

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The Lived Experience of Stigma among Mentally Ill Persons
Myung Sun Hyun, Young Hee Kim, Hee Sun Kang, Kyoung A Nam
J Korean Acad Nurs 2012;42(2):226-235.   Published online April 30, 2012
DOI: https://doi.org/10.4040/jkan.2012.42.2.226
AbstractAbstract PDF
Purpose

The purpose of this study was to explore the subjective experiences of stigma among mentally ill persons.

Methods

Phenomenological methodology was used for the study. Participants were twelve people with mental illness enrolled at the S community mental health center in GyeongGi-Do. Data were collected via in-depth interviews from August 30 to October 1, 2010 and analyzed using Colaizzi's framework.

Results

Four themes and sixteen formulated meanings were identified for the stigma experiences of participants with mental illness. The four themes were 'Incapable of struggling against unfair treatment', 'Living as an outsider', 'Being constrained by oneself', 'Being in suspense over disclosure of oneself'.

Conclusion

The results from this study underscore the need for an educational and awareness programs to reduce public stigma among the general population and self-stigma among people with mental illness. In addition, efforts are also needed to prioritize mental illness stigma as a major public health issue at the government and community level.

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Caregiver Burden in Caring for Elders Before and After Long-term Care Service in Korea
Hung Sa Lee
J Korean Acad Nurs 2012;42(2):236-247.   Published online April 30, 2012
DOI: https://doi.org/10.4040/jkan.2012.42.2.236
AbstractAbstract PDF
Purpose

Purposes of this study were: evaluation of family burden of caring for elders who receive long term care services, and examination of differences in burden before and after the introduction of long term care service in Korea.

Methods

Data were collected by questionnaires from 416 caregivers of elders who were registered with the Long Term Care Insurance Corporation in six cities. Data were collected in September, 2010 and analyzed using descriptive statistics, paired t-test, and ANOVA with the Scheffe test, and stepwise multiple regression.

Results

Family burden decreased significantly after long-term care service was initiated. Subjective burden decreased from 2.93 to 2.69 (t=11.78, p<.001), and objective burden, from 3.40 to 3.10 (t=12.73, p<.001). Stepwise multiple regression analysis revealed that factors affecting subjective burden were family relations (F=13.60, p=.003), age (F=5.47, p=.019), job (F=6.98, p=.008), and education (F=4.59, p=.032), and that factors affecting objective burden were living together (F=17.66, p<.001), job (F=13.34, p=.003), monthly income (F=6.61, p=.010), and type of service (F=6.62, p=.010).

Conclusion

The results of this first study to investigate caregiver burden after the Korean Long-term Care Insurance System was begun provide positive information for the development of strategies to decrease family burden in long term care.

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Accidental Mortality and Compensation Payment in School Activities among Elementary, Middle and High School Students in Seoul over Twenty Years (1988-2007)
Sun Mi Shin, Hee Woo Lee
J Korean Acad Nurs 2012;42(2):248-257.   Published online April 30, 2012
DOI: https://doi.org/10.4040/jkan.2012.42.2.248
AbstractAbstract PDF
Purpose

The purpose of this study was to identify accidental mortality during school activities of students in elementary, middle or high school in Seoul and consequent compensation payment.

Methods

Fifty-eight students died due to accidents during the period 1988 through 2007. Data were obtained from the Seoul School Safety and Insurance Association, and Seoul Metropolitan Office of Education. Chi-square, t test, and ANCOVA were used in the data analysis.

Results

Among students, 75.9% were male and 37.9% were high school students. Accidental mortality was 1.61 per one million students (2.33 for male, and 0.82 for female students, and 0.93, 2.13 and 2.31 for elementary, middle and high school students, respectively). Mortality caused by drowning and falls per one million student was 0.85 and 0.74 for male, and 0.23 and 0.35 for female students. After age, year and cause were adjusted using ANCOVA, the mean compensation payment was 40,615 thousand won for male, and 62,000 thousands for female students. Highest compensation payment was 127,137 thousand for cerebral concussion after age, gender, year and cause were adjusted.

Conclusion

To decrease student accidental mortality, especially drowning and falls, development of efficient safety-enforcing education is essential to prevent injuries and avoid preventable compensation costs.

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Development and Evaluation of a Program to Promote Self Management in Patients with Chronic Hepatitis B
Jin-Hyang Yang
J Korean Acad Nurs 2012;42(2):258-268.   Published online April 30, 2012
DOI: https://doi.org/10.4040/jkan.2012.42.2.258
AbstractAbstract PDF
Purpose

The purpose of this study was to identify the effects of the program to promote self management for patients with chronic hepatitis B.

Methods

The research was a quasi-experimental design using a non-equivalent control group pre-post test. The participants were 61 patients, 29 in the experimental group and 32 in the control group. A pretest and 2 posttests were conducted to measure main variables. For the experimental group, the self-management program, consisting of counseling-centered activities in small groups, was given for 6 weeks. Data were analyzed using χ2, t-test, and repeated measures ANOVA with PASW statistics program.

Results

There were statistically significant increases in knowledge, self-efficacy, active ways of coping, and self-management compliance but not in passive ways of coping in the experimental group compared to the control group over two different times.

Conclusion

The results of this study indicate that the self-management program is effective in increasing knowledge, self-efficacy, active ways of coping, and self-management compliance among patients with chronic hepatitis B. Therefore, it can be usefully utilized in the field of nursing for patients with chronic disease as a nursing intervention for people with chronic hepatitis B.

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Development and Effectiveness of Expressive Writing Program for Women with Breast Cancer in Korea
Eun Young Park, Mungsun Yi
J Korean Acad Nurs 2012;42(2):269-279.   Published online April 30, 2012
DOI: https://doi.org/10.4040/jkan.2012.42.2.269
AbstractAbstract PDF
Purpose

To develop a expressive writing program for women with breast cancer and to identify its effects on stress physical symptom, cancer symptom, anxiety, depression, and QOL.

Methods

A non-equivalent control pre-post design was used. Participants were recruited from self-help groups in six hospitals and were assigned to the experimental group (29) or control group (29). Data were collected before, after, and at four weeks after the intervention program. Changes in the variables were evaluated to test effects of the developed program, using χ2-test, Fisher's exact test, repeated measures ANOVA, and paired t-test.

Results

The expressive writing program was developed for women with breast cancer based on Pennebaker's expressive writing. Significant differences were found between the two groups for stress related to physical symptoms (p<.00) and quality of life (p=.024). No significant differences were found in cancer symptoms, anxiety, or depression between the two groups.

Conclusion

The results indicate that the expressive writing program designed to express cancer-related deep thoughts and emotions helps in decreasing physical symptoms and improving QOL. Further studies are needed to identify the effect on emotions such as anxiety and depression for women with breast cancer with above average levels of anxiety and depression.

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Experiences of Family Caregivers of Patients with Terminal Cancer
Eun Sook Choi, Keum Soon Kim
J Korean Acad Nurs 2012;42(2):280-290.   Published online April 30, 2012
DOI: https://doi.org/10.4040/jkan.2012.42.2.280
AbstractAbstract PDF
Purpose

This study done to identify the experiences of families caring for patients with terminal cancer. The question was, "What is the caregiving experience of a family who has a member with terminal cancer?"

Methods

Grounded Theory was applied and in-depth interviews were done with 11 family members. Interviews were recorded with the interviewees' consent and were transcribed and analyzed. Participants' relationships to patients were 6 spouses, 4 daughters, and 1 mother. The ages of the participants were between 32 and 62, with an average of 47.5.

Results

The study showed "enduring with bonds" as the main category and the main factor affecting this category was the "patients' diagnosis of terminal cancer." The caregiving experience was divided into four stages: shock, confusion, struggle, and acceptance. Mediating factors were relationship with the patient, intimacy with the patient, social support, communication, and trust. Conclusively, participants underwent internal maturity, and changes occurred in family and social and personal life.

Conclusion

The families took care of the patients with responsibility and love. The study results should help with the understanding of a family with a member with terminal cancer and should be used to develop nursing, mediating, and consulting programs for these caregivers.

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Homebound status and Related Factors According to Age in Female Elders in the Community
Kyungwon Choi, EunA Park, In-Sook Lee
J Korean Acad Nurs 2012;42(2):291-301.   Published online April 30, 2012
DOI: https://doi.org/10.4040/jkan.2012.42.2.291
AbstractAbstract PDF
Purpose

The purpose of this study was to investigate homebound status and significant related factors for community-dwelling female elders according to age.

Methods

The participants were female elders over 65 years of age registered in public health centers. Data were collected by interviewing the elders, who voluntarily completed the entire survey. For data analysis, descriptive statistics and multiple logistic regression were performed using SPSS version 18.0.

Results

There were statistically significant differences in homeboundness and related factors between the young-old (65 to 74 years of age) and the old-old (75 years of age or older). The level of homeboundness of the old-old was higher than that of the young-old. Multiple logistic regression showed, timed "up and go", depression, and fear of falling as significantly associated with homebound status of the young-old, while hand grip strength (right), timed "up and go", static balance ability, severity of urinary incontinence, and fear of falling as significant for the old-old.

Conclusion

The findings of this study indicate that homebound status and related factors for elders are different according to age, and therefore, interventions to prevent and help homebound elders get over being homebound should be developed according to age.

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Analysis of Trends and Contents of Nursing Doctoral Dissertations in Korea
Kwang-Ja Lee, Younhee Kang, Mee Ock Gu, Kyunghee Kim, Oksoo Kim, Yeon-Ok Suh, Eunyoung Suh, Soo Yang, Eun-Hyun Lee, Ja Hyung Lee, Myoung-Ae Choe, Yang Sook Hah
J Korean Acad Nurs 2012;42(2):302-309.   Published online April 30, 2012
DOI: https://doi.org/10.4040/jkan.2012.42.2.302
AbstractAbstract PDF
Purpose

This study aimed to identify contents and trends of Korean nursing doctoral dissertations in terms of research methodology and theoretical characteristics.

Methods

The design of the study was descriptive study and a total of 1,089 quantitative studies completed between 1982 and 2010 were reviewed using the analytical framework developed by the researchers.

Results

The majority of studies utilized the experimental design (51.5%) and the others were survey design (38.8%) and methodological design (5.0%). Study subjects were shown as patients (45%), care givers (11.2%), ordinary persons (40.6%) and others (3.2%). There were growing trends in experimental design and patients as subjects. The prevailing data collection settings were hospitals (45.8%) and community (27.8%). The theoretical frameworks that studies were based on were the existing theories (37%) and a newly developed theoretical framework by a researcher (25.2%). a framework derived from other studies by the researcher (25.2%). Majority of studies (78.5%) employed a single theory as a theoretical framework. However, 31.8% of studies had no theoretical framework based on.

Conclusion

Findings of this study provided the opportunities to shed new light on the current status of Korean doctoral dissertation and to deliberate on the future direction of nursing studies in Korea.

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