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Volume 47(2); April 2017
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Review Article
Effects of Psychoeducational Intervention for Cancer Survivors: A Systematic Review and Meta-Analysis
Jin-Hee Park, Sun Hyoung Bae
J Korean Acad Nurs 2017;47(2):143-163.   Published online April 28, 2017
DOI: https://doi.org/10.4040/jkan.2017.47.2.143
AbstractAbstract PDFSupplementary Material
Purpose

This study was a systematic review and meta-analysis designed to investigate effects of psychoeducational intervention for cancer survivors.

Methods

Ten databases were searched. Two reviewers independently performed the selection of the studies, data extraction and assessment. The risk of bias was assessed using Cochrane Collaboration's tool. To estimate the effect size, meta-analysis of the studies was performed using Comprehensive Meta-Analysis and RevMan programs.

Results

Of 18,781 publications identified, 35 met inclusion criteria, and 25 studies were used to estimate effect size of psychoeducational intervention. Effect sizes (standardized mean difference [SMD]) were heterogeneous and random effects models were used in the analyses. Psychoeducational intervention was effective for quality of life (n=2,410, ES=0.23; 95% CI: 0.09~0.37), coping and self-efficacy (n=179, ES=0.68; 95% CI: 0.26~1.11), anxiety (n=1,786, ES=-0.26; 95% CI: -0.37~-0.15), depression (n=1,910, ES=-0.28; 95% CI: -0.37~-0.18), and psychological distress (n=2,242, ES=-0.31; 95% CI: -0.46~-0.17). Subgroup analysis showed that counseling was the most effective intervention for quality of life, and behavioral therapy was an effective intervention for all positive and negative outcomes. Publication bias was not detected except for psychological distress.

Conclusion

Psychoeducational intervention appears to be effective in improving quality of life and coping and self-efficacy, and it is effective in reducing psychological symptoms in cancer survivors. Behavioral therapy, especially, is commonly effective in improving psychosocial outcomes. However, low-quality evidence, variability in the designs of existing studies, and publication bias suggest that additional high-quality trials should be conducted in the future.

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Original Articles
Effects of a Strength Based I-Change Smoking Cessation Program for Smoking Middle School Boys
Jung Hee Kim, Yeon Hee Choi
J Korean Acad Nurs 2017;47(2):164-177.   Published online April 28, 2017
DOI: https://doi.org/10.4040/jkan.2017.47.2.164
AbstractAbstract PDF
Purpose

This study was done to develop a strength based I-change smoking cessation program for middle school boys and identified its effects.

Methods

The study design was a nonequivalent control group pre-post test design. The participants were 97 middle school students from D city, who were in school from April 6 to September 25, 2015. The experimental group participated in the strength based I-change smoking cessation program, while the comparative group participated in a general smoking cessation program. The control group did not participate in any program. Data analyses involved χ2-test, Fishers' exact test, Bonferroni test, and Repeated measures ANOVA, with the IBM SPSS for Windows (version 20.0) program.

Results

Compared to the comparison and control groups, the experimental group showed significant improvement in knowledge, attitude, self-efficacy, behavior change. Also cotinine in urine and modeling of social influence in the experimental group significantly decreased after the strength based I-change smoking cessation program.

Conclusion

These findings indicate that the strength based I-change smoking cessation program is an effective intervention for middle school boys who smoke. The findings suggest that such programs can be used at public health centers or through school health education to decrease smoking in adolescents.

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The Relationships among Perceived Parental Bonding, Illness Perception, and Anxiety in Adult Patients with Congenital Heart Diseases
Nayeon Shin, Youha Jang, Younhee Kang
J Korean Acad Nurs 2017;47(2):178-187.   Published online January 15, 2017
DOI: https://doi.org/10.4040/jkan.2017.47.2.178
AbstractAbstract PDF
Abstract Purpose

The purposes of this study were to identify the relationships among perceived parental bonding, illness perception, and anxiety and to determine the influences of perceived parental bonding and illness perception on anxiety in adult patients with congenital heart diseases.

Methods

In this study a descriptive correlational design with survey method was utilized. The participants were 143 adult patients with congenital heart disease being cared for in the cardiology out-patient clinic of A medical center. Data were collected using the Parental Bonding Instrument, Illness Perception Questionnaire Revised Scale, and Cardiac Anxiety Questionnaire Scale. Data were analyzed using descriptive statistics, independent t-test, one-way ANOVA, Pearson correlation analysis, and hierarchial regression analyses.

Results

There showed significant positive relationships of anxiety with maternal overprotection, consequences, and personal control respectively. Among predictors, maternal overprotection (b=.45), consequence (b=.26), and personal control (b=-.03) had statistically significant influence on anxiety.

Conclusion

Nursing interventions to decrease maternal overprotection and negative consequence, and to enhance personal control are essential to decrease the anxiety of adult patients with congenital heart diseases.

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Effects of a Relapse Prevention Program on Insight, Empowerment and Treatment Adherence in Patients with Schizophrenia
Jaewon Joung, Sungjae Kim
J Korean Acad Nurs 2017;47(2):188-198.   Published online April 28, 2017
DOI: https://doi.org/10.4040/jkan.2017.47.2.188
AbstractAbstract PDF
Purpose

The purpose of this study was to develop a relapse prevention program (RPP) and examine the effects of the RPP on insight, empowerment, and treatment adherence in patients with schizophrenia.

Methods

A non-equivalent control group pretest-posttest design was used. Participants were 54 inpatients who had a diagnosis of schizophrenia (experimental group: 26, control group: 28). The study was carried out from February 7, 2012 to February 6, 2013. Over a 10-day period prior to discharge each participant in the experimental group received three one-hour sessions of RPP a one-to-one patient-nurse interaction. Data were collected using Assess Unawareness of Mental Disorder (SUMD), Empowerment Scale, and Insight and Treatment Attitude Questionnaire (ITAQ) and analyzed using PASW 18.0 with chi-square test, independent t-test, Mann-Whitney U test, and ANCOVA.

Results

The experimental group had a significant increase in insight and treatment adherence compared to the control group. However, there was no significant difference in empowerment between the two groups.

Conclusion

Findings indicate that the RPP for patients with schizophrenia was effective in improving insight and treatment adherence. A longitudinal study is needed to confirm the persistence of these effects of RPP in patients with schizophrenia.

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Effects of Group Counseling Program Based on Goal Attainment Theory for Middle School Students with Emotional and Behavioral Problems
In Ju Jeong, Soo Jin Kim
J Korean Acad Nurs 2017;47(2):199-210.   Published online April 28, 2017
DOI: https://doi.org/10.4040/jkan.2017.47.2.199
AbstractAbstract PDF
Purpose

The purpose of this study was to examine the effects of a group counseling program based on goal attainment theory on self-esteem, interpersonal relationships, and school adjustment of middle school students with emotional and behavioral problems.

Methods

Forty-four middle school students with emotional and behavioral problems (22 in the experimental group and 22 in the control group) from G city participated in this study. Data were collected from July 30 to September 24, 2015. The experimental group received the 8-session program, scheduled once a week, with each session lasting 45 minutes. Outcome variables included self-esteem, interpersonal relationship, and school adjustment.

Results

There were significant increases for self-esteem (t=3.69, p=.001), interpersonal relationship (t=8.88, p<.001), and school adjustment (t=4.92, p<.001) in the experimental group compared to the control group.

Conclusion

These results indicate that the group counseling program based on goal attainment theory is very effective in increasing self-esteem, interpersonal relationship, and school adjustment for middle school students with emotional and behavioral problems. Therefore, it is recommended that the group counseling program based on goal attainment theory be used as an effective psychiatric nursing intervention for mental health promotion and the prevention of mental illness in adolescents.

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Structural Equation Modeling on Smoking Cessation Intention in Male Technical High School Students
Eun Su Do, Eunsuk Choi
J Korean Acad Nurs 2017;47(2):211-221.   Published online April 28, 2017
DOI: https://doi.org/10.4040/jkan.2017.47.2.211
AbstractAbstract PDF
Purpose

This study was done to develop and test a structural model on smoking cessation intention in technical high school men. The conceptual model was based on the theory of reasoned action and health promotion model.

Methods

From May 29 to April 13, 2015, 413 technical high school students who smoked completed a structured questionnaire. Data were analyzed to calculate the direct and indirect effects of factors affecting smoking cessation intention. The SPSS WIN 20.0 and AMOS 21.0 programs were used.

Results

The hypothetical model was a good fit for the data. The model fit indices were χ2/df=2.36, GFI=.95, AGFI=.92, NFI=0.97, and RMSEA=.05. Self-esteem had direct and indirect effects on smoking cessation intention. Attitude, subjective norm, and self-efficacy had direct effects on smoking cessation intention. Smoking knowledge and environmental factor had indirect effects on smoking cessation intention. This model explained 87.0% of the variance in smoking cessation intention.

Conclusion

These results indicate that technical high school students' intention to stop smoking can be improved through an increase in self-esteem, negative environmental factors, attitude toward smoking cessation, subjective norm about smoking cessation, and self-efficacy for smoking cessation.

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Development and Effects of a Children's Sex Education Program for the Parents of Lower Elementary Grade Students
Eun Mi Lee, Hyunlye Kim
J Korean Acad Nurs 2017;47(2):222-232.   Published online April 28, 2017
DOI: https://doi.org/10.4040/jkan.2017.47.2.222
AbstractAbstract PDF
Purpose

This study was done to develop a children's sex education program for the parents of lower elementary grade students and to evaluate its effects on sexual knowledge, gender role attitude, parent efficacy for child's sex education, and marital consistency.

Methods

A quasi-experimental with a non-equivalent control group pretest-posttest design was used. The participants were 29 couples (58 parents, experimental group=28, control group=30) from G city. The 5-week (5-session) program was developed based on ‘A theory of protection: parents as sex educators’ and used the case-based small group learning method. Data were collected during July and August 2015. The characteristics of the program developed in the present study were a theoretical-based, client-centered, multi-method.

Results

After the intervention, the experimental group showed a significant improvement in sexual knowledge, gender role attitudes, parent efficacy for child's sex education, and marital consistency, compared to the control group. The effect sizes of the program were .64 (knowledge), .65 (gender role attitudes), and .68 (parent efficacy).

Conclusion

The results of this study provided implications for the parents as effective sex educator and the role expansion of school health nurses.

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Factors Influencing Burnout among Mothers of Children with Cerebral Palsy
Ji-Young Seo, Hae-Jin Lee, Mi-Ae You
J Korean Acad Nurs 2017;47(2):233-241.   Published online April 28, 2017
DOI: https://doi.org/10.4040/jkan.2017.47.2.233
AbstractAbstract PDF
Purpose

The purpose of this study was to examine the effects of parental stress, social support, and coping behavior on burnout among mothers caring for children with cerebral palsy.

Methods

Participants in this cross-sectional, descriptive study were 185 mothers who completed a self-report structured questionnaire. The data were analyzed using descriptive statistics, t-test, one-way ANOVA, correlation and multiple linear regression analyses with IBM SPSS Win 22 program.

Results

Parental stress and coping behavior were strong predictors of burnout among mothers of children with cerebral palsy. These variables explained 50.0% of the variance in burnout. Social support was not a predictor of burnout. A higher level of burnout was associated with higher levels of parental stress and lower levels of social support and coping behavior.

Conclusion

Mothers of children with cerebral palsy are vulnerable to burnout. These results show that effective strategies for reducing parental stress and improving positive coping behavior are needed to reduce burnout in these mothers.

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Evolutionary Concept Analysis of Spirituality
Il Sun Ko, So Young Choi, Jin Sook Kim
J Korean Acad Nurs 2017;47(2):242-256.   Published online April 28, 2017
DOI: https://doi.org/10.4040/jkan.2017.47.2.242
AbstractAbstract PDF
Purpose

This study was done to clarify attributes, antecedents, and consequences of spirituality.

Methods

Rodgers's evolutionary concept analysis was used to analyze fifty seven studies from the literature related to spirituality as it appears in systematic literature reviews of theology, medicine, counseling & psychology, social welfare, and nursing.

Results

Spirituality was found to consist of two dimensions and eight attributes: 1) vertical dimension: ‘intimacy and connectedness with God’ and ‘holy life and belief’, 2) horizontal dimension: ‘self-transcendence’, ‘meaning and purpose in life’, ‘self-integration’, and ‘self-creativity’ in relationship with self, ‘connectedness’ and ‘trust’ in relationship with others·neighbors·nature. Antecedents of spirituality were socio-demographic, religious, psychological, and health related characteristics. Consequences of spirituality were positive and negative. Being positive included ‘life centered on God’ in vertical dimension, and among horizontal dimension ‘joy’, ‘hope’, ‘wellness’, ‘inner peace’, and ‘self-actualization’ in relationship with self, ‘doing in love’ and ‘extended life toward neighbors and the world’ in relationship with others·neighbors·nature. Being negative was defined as having ‘guilt’, ‘inner conflict’, ‘loneliness’, and ‘spiritual distress’. Facilitators of spirituality were stressful life events and experiences.

Conclusion

Spirituality is a multidimensional concept. Unchangeable attributes of spirituality are ‘connectedness with God’, ‘self-transcendence’, ‘meaning of life’ and ‘connectedness with others·nature’. Unchangeable consequences of spirituality are ‘joy’ and ‘hope’. The findings suggest that the dimensional framework of spirituality can be used to assess the current spiritual state of patients. Based on these results, the development of a Korean version of the scale measuring spirituality is recommended.

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A Structural Model for Premenstrual Coping in University Students: Based on Biopsychosocial Model
Myung-Ock Chae, Hae Ok Jeon, Ahrin Kim
J Korean Acad Nurs 2017;47(2):257-266.   Published online April 28, 2017
DOI: https://doi.org/10.4040/jkan.2017.47.2.257
AbstractAbstract PDF
Purpose

The aims of this study were to construct a hypothetical structural model which explains premenstrual coping in university students and to test the fitness with collected data.

Methods

Participants were 206 unmarried women university students from 3 universities in A and B cities. Data were collected from March 29 until April 30, 2016 using self-report structured questionnaires and were analyzed using IBM SPSS 23.0 and AMOS 18.0.

Results

Physiological factor was identified as a significant predictor of premenstrual syndrome (t=6.45, p<.001). This model explained 22.1% of the variance in premenstrual syndrome. Psychological factors (t=-2.49, p=.013) and premenstrual syndrome (t=8.17, p<.001) were identified as significant predictors of premenstrual coping. Also this model explained 30.9% of the variance in premenstrual coping in university students. A physiological factors directly influenced premenstrual syndrome (β=.41, p=.012). Premenstrual syndrome (β=.55, p=.005) and physiological factor (β=.23, p=.015) had significant total effects on premenstrual coping. Physiological factor did not have a direct influence on premenstrual coping, but indirectly affected it (β=.22, p=.007). Psychological factors did not have an indirect or total effect on premenstrual coping, but directly affected it (β=-.17, p=.036).

Conclusion

These findings suggest that strategies to control physiological factors such as menstrual pain should be helpful to improve premenstrual syndrome symptoms. When developing a program to improve premenstrual coping ability and quality of menstrual related health, it is important to consider psychological factors including perceived stress and menstrual attitude and premenstrual syndrome.

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The Recovery Process of Alcohol Dependent Men Living in a Therapeutic Community
Sungye Kang
J Korean Acad Nurs 2017;47(2):267-276.   Published online April 28, 2017
DOI: https://doi.org/10.4040/jkan.2017.47.2.267
AbstractAbstract PDF
Purpose

The purpose of this study was to explore the recovering process of men who had abused alcohol and has lived in a therapeutic community.

Methods

Individual in-depth interviews were used to collect data from 10 of these men who has lived in the therapeutic community for more than one year. Qualitative data from field notes and transcribed notes were analyzed using the grounded theory methodology developed by Strauss and Corbin.

Results

The core category about the recovering process of the men who had abused alcohol and are now in the therapeutic community was identified as “reconstructing a broken life”. The recovering process of these men in the therapeutic community consisted of four phases; ‘self-awareness stage’, ‘unfreezing stage’, ‘readjustment stage’, and ‘challenging stage’.

Conclusion

In this study “reconstructing a broken life”, as the core category vividly showed joys and sorrows of men who had abused alcohol and has lived in the recovering process of managing the yoke of life-long disease. In this process of recovery from alcoholic dependence the men gradually adjusted themselves to their given condition. Also they gained coping strategies to care for, and protect themselves. Therefore health care providers can establish supportive programs in the clinical field to empower these men by reflecting their proactive coping strategies.

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Experience of Becoming a Father of a High Risk Premature Infant
Jeong Eon Park, Byoung Sook Lee
J Korean Acad Nurs 2017;47(2):277-288.   Published online April 28, 2017
DOI: https://doi.org/10.4040/jkan.2017.47.2.277
AbstractAbstract PDF
Purpose

This study was performed to identify the experience of becoming a father of a high risk premature infant.

Methods

Grounded theory was used for this research. The participants were 12 fathers who had premature infants lighter than 2,500g of birth weight, less than 37 weeks of gestational age and having stayed 2 weeks or longer in a NICU right after birth. Theoretical sampling was done to identify participants and indepth interviews were done for the data collection. For data analysis, the process suggested by Corbin and Strauss was used.

Results

For these participants the core phenomenon of the experience of becoming a father of a high risk premature infant was ‘striving through with belief and patience’. The phenomenon was ‘being frustrated in an unrealistic shock’. Contextual conditions were ‘uncertainty in the health status of the premature baby’ and ‘no one to ask for help’ and intervening conditions were ‘possibility in the health recovery of the premature baby’ and ‘assistance from significant others’. Action/interaction strategies were ‘withstanding with belief in the baby’ and ‘enduring with willpower as head of the family’ and the consequence was ‘becoming a guardian of the family’.

Conclusion

For the participants, the process of becoming the father of a high risk premature infant was striving through the situation with belief in their babies' ability to overcome the crisis and waiting for the babies' recovery with patience.

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