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Volume 44(2); April 2014
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Original Articles
A Structural Model for the Practice of Life Safety Behavior in School-age Children
Myung-Ock Chae
J Korean Acad Nurs 2014;44(2):119-128.   Published online April 30, 2014
DOI: https://doi.org/10.4040/jkan.2014.44.2.119
AbstractAbstract PDF
Purpose

This study is an examination of the paths in which the primary factors of anxiety, impulsiveness, knowledge of life safety practice, attitudes towards life safety practice, interpersonal support, and self-efficacy from Pender's Health Promotion Model influence the practice of life safety behavior in school-age children.

Methods

The sample consisted of 489 5th and 6th grade students recruited from five elementary schools in Seoul City and four provinces, South Korea. Data were analyzed using descriptive statistics, correlations, factor analysis, and structural equation modeling.

Results

Attitudes towards life safety practice, interpersonal support, self-efficacy and impulsiveness directly influenced practice of life safety behavior. Anxiety did not have a direct influence on practice of life safety behavior, but indirectly affected it. In this modified model, 52.0% of the practice of life safety behavior was explained by the primary factors.

Conclusion

To facilitate the practice life safety behaviors in late childhood, a positive attitude towards life safety needs to be developed along with decreasing impulsiveness and enhancing self-efficacy.

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Development of Critical Thinking Skill Evaluation Scale for Nursing Students
So Young You, Nam Cho Kim
J Korean Acad Nurs 2014;44(2):129-138.   Published online April 30, 2014
DOI: https://doi.org/10.4040/jkan.2014.44.2.129
AbstractAbstract PDF
Purpose

To develop a Critical Thinking Skill Test for Nursing Students.

Methods

The construct concepts were drawn from a literature review and in-depth interviews with hospital nurses and surveys were conducted among students (n=607) from nursing colleges. The data were collected from September 13 to November 23, 2012 and analyzed using the SAS program, 9.2 version. The KR 20 coefficient for reliability, difficulty index, discrimination index, item-total correlation and known group technique for validity were performed.

Results

Four domains and 27 skills were identified and 35 multiple choice items were developed. Thirty multiple choice items which had scores higher than .80 on the content validity index were selected for the pre test. From the analysis of the pre test data, a modified 30 items were selected for the main test. In the main test, the KR 20 coefficient was .70 and Corrected Item-Total Correlations range was .11-.38. There was a statistically significant difference between two academic systems (p=.001).

Conclusion

The developed instrument is the first critical thinking skill test reflecting nursing perspectives in hospital settings and is expected to be utilized as a tool which contributes to improvement of the critical thinking ability of nursing students.

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A Path Analysis on Factors Influencing Second Primary Cancer Screening Practices in Stomach, Colon, and Breast Cancer Survivors
Young Hee Yang
J Korean Acad Nurs 2014;44(2):139-148.   Published online April 30, 2014
DOI: https://doi.org/10.4040/jkan.2014.44.2.139
AbstractAbstract PDF
Purpose

This study was conducted to identify the factors influencing second primary cancer (SPC) screening practice by examining the relationships of physical symptoms, knowledge and attitudes regarding SPC screening, perceived risk, primary cancer type, and demographic factors of cancer survivors.

Methods

Participants were 308 survivors of stomach, colon, or breast cancer recruited from 2 university hospitals in Korea. Data were collected using a questionnaire and analyzed using IBM SPSS 21.0 and AMOS 18.0.

Results

The proportion of participants taking all cancer screenings according to national guidelines was 40%. They had moderate knowledge and a relatively positive attitude regarding SPC screening and high cancer risk perception. The participants had taken fewer SPC screenings after than before cancer diagnosis. The factors influencing cancer risk perception were age, physical symptoms, knowledge regarding SPC and primary cancer type (stomach). The factors influencing SPC screening practice were age, gender, economic status, knowledge regarding SPC screening, and primary cancer types (colon).

Conclusion

It is important for clinical professionals to recognize that survivors of cancer are susceptible to another cancer. Education on SPC screening for these survivors should focus on communicating with and encouraging them to have regular cancer screenings.

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Effects of Open or Closed Suctioning on Lung Dynamics and Hypoxemia in Mechanically Ventilated Patients
Eun Young Lee, Su Hyun Kim
J Korean Acad Nurs 2014;44(2):149-158.   Published online April 30, 2014
DOI: https://doi.org/10.4040/jkan.2014.44.2.149
AbstractAbstract PDF
Purpose

This study was conducted to compare effects of open and closed suctioning methods on lung dynamics (dynamic compliance, tidal volume, and airway resistance) and hypoxemia (oxygen saturation and heart rate) in mechanically ventilated patients.

Methods

This study was a cross-over repeated design. Participants were 21 adult patients being treated with endotracheal intubation using a pressure-controlled ventilator below Fraction of Inspired Oxygen (FiO2) 60% and PEEP 8 cmH2O. Data were collected at baseline and 1, 2, 3, 4, 5, and 10 minutes after suctioning. Data were analyzed using two-factor ANOVA with repeated measures on time and suctioning type.

Results

Effects of the interaction between suction type and time were significant for oxygen saturation and heart rate but not significant for dynamic compliance, tidal volume, or airway resistance. Prior to performance of suctioning, tidal volume and oxygen saturation were significantly lower, but airway pressure and heart rate were significantly higher using the closed suctioning method as compared with the open suctioning method.

Conclusion

For patients on ventilator therapy below FiO2 60% and PEEP 8cmH2O, open suctioning performed after delivery of 100% FiO2 using a mechanical ventilator may not have as much negative impact on lung dynamics and hypoxemia as closed suctioning.

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Structural Equation Modeling on Contraception Behavior of Unmarried Men and Women in Korea: Gender Difference
Shin Woo Hwang, Chae Weon Chung
J Korean Acad Nurs 2014;44(2):159-169.   Published online April 30, 2014
DOI: https://doi.org/10.4040/jkan.2014.44.2.159
AbstractAbstract PDF
Purpose

The purpose of this study was to test and validate a model to predict contraception behavior in unmarried men and women.

Methods

Data were collected from a questionnaire survey of 180 unmarried men and 186 unmarried women 20 years of age or over who had sexual relationships in the past 6 months. Participants were from Seoul, Kyunggi, Daegu, and Busan and data collection was done from February 19 to April 16, 2013.

Results

Model fit indices for the hypotheoretical model fitted to the recommended levels. Out of 15 paths, 11 were statistically significant in both. Predictors of contraception behavior in unmarried men and women were intention to use contraception and self-efficacy for contraception. Exposure to sexual content was directly significant to the intention in men only. Self-efficacy for contraception was affected by perceived threat of pregnancy and gender role attitude. In women, the two predictors were also significant except for the effect of exposure to sexual contents.

Conclusion

Results indicate that an intervention program which increases self-efficacy in unmarried men and women contributes to effective contraception behavior. In addition, proper sexual education programs using positive aspect of mass media can help develop active participation for contraception behavior.

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Development and Evaluation of Breastfeeding Promotion Program for Mothers with Breast Engorgement following Cesarean Birth
Jeongsug Cho, Sukhee Ahn
J Korean Acad Nurs 2014;44(2):170-178.   Published online April 30, 2014
DOI: https://doi.org/10.4040/jkan.2014.44.2.170
AbstractAbstract PDF
Purpose

This study was to develop a breastfeeding promotion program and to test effects of the program on levels of breast discomfort, breast size, sodium in breast milk, and type of feeding in mothers with breast engorgement following cesarean birth.

Methods

A non-synchronized non-equivalent control group pretest-posttest design was used in this study. The participants were 70 postpartum mothers who were admitted to a postpartum care center and experienced breast engorgement following cesarean birth. The planned nursing intervention was the breastfeeding promotion program consisting of breast massage and 1:1 breastfeeding education, counseling, and support focusing on individualized problem solving provided for 10 days. Fifty-three women completed the program (experimental group 26, control group, 27). Measurements were level of breast discomfort, breast size, sodium in breast milk and type of feeding at pre and posttest.

Results

Women who participated in the program experienced lower scores for breast discomfort, greater decrease in breast size, lower levels of sodium in breast milk, and practiced breastfeeding more than those in the control group.

Conclusion

Results indicate that this breastfeeding promotion program is effective in reducing breast engorgement and improving breastfeeding practices, and is therefore recommended to enhance breastfeeding promotion practice in postpartum care centers.

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A Structural Model for Health Risk Behavior of Late Adolescents: Based on 2010 Korea Adolescent Health Survey
Young-Ju Jee, Young-Hae Kim
J Korean Acad Nurs 2014;44(2):179-188.   Published online April 30, 2014
DOI: https://doi.org/10.4040/jkan.2014.44.2.179
AbstractAbstract PDF
Purpose

This study was done to construct and test a structural model to explain health risk behavior of late adolescents.

Methods

Data for this study were secondary data from the 2010 Korea Adolescent Health Survey based and 3,675 high school students who participated. Data were analyzed using SPSS 18.0 and AMOS 19.0 programs.

Results

After 7 lines were removed, fitness statistics for the hypothetical model were appropriate (χ2=559.13, p<.001, GFI=.98, SRMR=.03, RMSEA=.04, NFI=.88, IFI=.90, CFI=.90, TLI=.86, AIC=671.13). The result showed that drinking-smoking is directly affected by 5 variables (32.5%), obesity is directly affected by 2 variables (0.7%), lack of physical activity is directly affected by 5 variables (22.2%), skipping of breakfast is directly affected by 3 variables (11.9%), improper sleep is directly affected by 3 variables (7.5%), and psychological adaptation is directly affected by 4 variables (26.8%).

Conclusion

The results of this study, indicate that late adolescents' health risk behavior is affected by many factors with complicate correlations suggesting further study compare youth health risk behaviors in a variety of environments.

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The Effects of an Asthma Management Education Program for Preschoolers
Soyoun Yim
J Korean Acad Nurs 2014;44(2):189-197.   Published online April 30, 2014
DOI: https://doi.org/10.4040/jkan.2014.44.2.189
AbstractAbstract PDF
Purpose

This study was conducted to develop an asthma management education program for preschool children using Roy's adaptation theory as a framework and examining the effects of this program on adaptation to asthma treatment.

Methods

A non-equivalent control group pre-post-test design was used with 43 preschool children diagnosed with asthma and required to be hospitalized for inhalation therapy. An intervention group (n=23) participated in the educational program and a control group (n=20) received regular treatment. The education program was conducted and evaluated from June 30 to October 31 2012, a maximum 3 times every 24 hours during hospitalization. Two nurses conducted the program using the teaching method of Gagné and Briggs; instruction design theory through questionnaires to measure perception of disease, behavior of adaptation to treatment with inhalation therapy.

Results

Effects of asthma management education program; scores for face-pain rating decreased and time of adaptation to treatment increased significantly in the experimental group compared to the control group but no significant differences were found for perception of the disease's cause and treatment.

Conclusion

Results indicate that the asthma management education program has positive effects on adaptation to asthma treatment of preschoolers.

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Factors related to Nurses' Patient Identification Behavior and the Moderating Effect of Person-organization Value Congruence Climate within Nursing Units
Young Mee Kim, Seung-Wan Kang, Se Young Kim
J Korean Acad Nurs 2014;44(2):198-208.   Published online April 30, 2014
DOI: https://doi.org/10.4040/jkan.2014.44.2.198
AbstractAbstract PDF
Purpose

This research was an empirical study designed to identify precursors and interaction effects related to nurses' patient identification behavior. A multilevel analysis methodology was used.

Methods

A self-report survey was administered to registered nurses (RNs) of a university hospital in South Korea. Of the questionnaires, 1114 were analyzed.

Results

The individual-level factors that had a significantly positive association with patient identification behavior were person-organization value congruence, organizational commitment, occupational commitment, tenure at the hospital, and tenure at the unit. Significantly negative group-level precursors of patient identification behavior were burnout climate and the number of RNs. Two interaction effects of the person-organization value congruence climate were identified. The first was a group-level moderating effect in which the negative relationship between the number of RNs and patient identification behavior was weaker when the nursing unit's value congruence climate was high. The second was a cross-level moderating effect in which the positive relationship between tenure at the unit and patient identification behavior was weaker when value congruence climate was high.

Conclusion

This study simultaneously tested both individual-level and group-level factors that potentially influence patient identification behavior and identified the moderating role of person-organization value congruence climate. Implications of these results are discussed.

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Development and Validity of Workplace Bullying in Nursing-Type Inventory (WPBN-TI)
Younju Lee, Mihyoung Lee
J Korean Acad Nurs 2014;44(2):209-218.   Published online April 30, 2014
DOI: https://doi.org/10.4040/jkan.2014.44.2.209
AbstractAbstract PDF
Purpose

The purpose of this study was to develop an instrument to assess bullying of nurses, and test the validity and reliability of the instrument.

Methods

The initial thirty items of WPBN-TI were identified through a review of the literature on types bullying related to nursing and in-depth interviews with 14 nurses who experienced bullying at work. Sixteen items were developed through 2 content validity tests by 9 experts and 10 nurses. The final WPBN-TI instrument was evaluated by 458 nurses from five general hospitals in the Incheon metropolitan area. SPSS 18.0 program was used to assess the instrument based on internal consistency reliability, construct validity, and criterion validity.

Results

WPBN-TI consisted of 16 items with three distinct factors (verbal and nonverbal bullying, work-related bullying, and external threats), which explained 60.3% of the total variance. The convergent validity and determinant validity for WPBN-TI were 100.0%, 89.7%, respectively. Known-groups validity of WPBN-TI was proven through the mean difference between subjective perception of bullying. The satisfied criterion validity for WPBN-TI was more than .70. The reliability of WPBN-TI was Cronbach's α of .91.

Conclusions

WPBN-TI with high validity and reliability is suitable to determine types of bullying in nursing workplace.

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Validation of a Modified Early Warning Score to Predict ICU Transfer for Patients with Severe Sepsis or Septic Shock on General Wards
Ju Ry Lee, Hye Ran Choi
J Korean Acad Nurs 2014;44(2):219-227.   Published online April 30, 2014
DOI: https://doi.org/10.4040/jkan.2014.44.2.219
AbstractAbstract PDF
Purpose

To assess whether the Modified Early Warning Score (MEWS) predicts the need for intensive care unit (ICU) transfer for patients with severe sepsis or septic shock admitted to general wards.

Methods

A retrospective chart review of 100 general ward patients with severe sepsis or septic shock was implemented. Clinical information and MEWS according to point of time between ICU group and general ward group were reviewed. Data were analyzed using multivariate logistic regression and the area under the receiver operating characteristic curves with SPSS/WIN 18.0 program.

Results

Thirty-eight ICU patients and sixty-two general ward patients were included. In multivariate logistic regression, MEWS (odds ratio [OR] 2.02, 95% confidence interval [CI] 1.43-2.85), lactic acid (OR 1.83, 95% CI 1.22-2.73) and diastolic blood pressure (OR 0.89, 95% CI 0.80-1.00) were predictive of ICU transfer. The sensitivity and the specificity of MEWS used with cut-off value of six were 89.5% and 67.7% for ICU transfer.

Conclusion

MEWS is an effective predictor of ICU transfer. A clinical algorithm could be created to respond to high MEWS and intervene with appropriate changes in clinical management.

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Outcomes of Home Monitoring after Palliative Cardiac Surgery in Infants with Congenital Heart Disease
Sang Wha Kim, Ju-Yeon Uhm, Yu Mi Im, Tae-Jin Yun, Jeong-Jun Park, Chun Soo Park
J Korean Acad Nurs 2014;44(2):228-236.   Published online April 30, 2014
DOI: https://doi.org/10.4040/jkan.2014.44.2.228
AbstractAbstract PDF
Purpose

Common conditions, such as dehydration or respiratory infection can aggravate hypoxia and are associated with interstage mortality in infants who have undergone palliative surgery for congenital heart diseases. This study was done to evaluate the efficacy of a home monitoring program (HMP) in decreasing infant mortality.

Methods

Since its inception in May 2010, all infants who have undergone palliative surgery have been enrolled in HMP. This study was a prospective observational study and infant outcomes during HMP were compared with those of previous comparison groups. Parents were trained to measure oxygen saturation, body weight and feeding volume and to contact the hospital through the hotline for emergency situations. Telephone counseling was conducted by clinical nurse specialists every week post discharge.

Results

Forty-one infants were enrolled in HMP. Nine hundred telephone counseling sessions were conducted. Seventy-three infants required telephone triage with the most common conditions being gastrointestinal (50.7%) and respiratory symptoms (32.9%). With HMP intervention, interstage mortality decreased from 18.6% (8/43) to 9.8% (4/41) (χ2=1.15, p=.283).

Conclusion

Results indicate that active measures and treatments using the HMP decrease mortality rates, however further investigation is required to identify various factors that contribute to hemodynamic complications during the interstage period.

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