Journal of Korean Academy of Nursing

Factors Related to Persistent Postoperative Pain after Cardiac Surgery: A Systematic Review and Meta-Analysis: Bae, Jaewon , Shin, Sujin; J Korean Acad Nurs 2020;50(2):159-177. Published online April 30, 2020; DOI: https://doi.org/10.4040/jkan.2020.50.2.159

Abstract PDF: Purpose
This study aimed at identifying factors related to persistent postoperative pain after cardiac surgery and estimating their effect sizes.
Methods
The literature search and selection was conducted in four different databases (CINAHL, Cochrane Library, PubMed, and PQDT) using the Preferred Reporting Items for Systematic Review and Meta-Analysis Statement. A total of 14 studies met the inclusion criteria and were systematically reviewed. For the meta-analysis, R was used to analyze 30 effect sizes of for both individual and operative factors as well as publication biases from a total of nine studies.
Results
The meta-analysis revealed that persistent postoperative pain after cardiac surgery was related to one individual factor (gender) and two operative factors (acute postoperative pain and use of the internal mammary artery). Operative factors (OR=5.26) had a larger effect size than individual factors (OR=1.53).
Conclusion
Female gender, acute pain after surgery, and use of the internal mammary artery are related factors to persistent postoperative pain. The development of interventions focusing on modifiable related factors, such as acute postoperative pain, may help to minimize or prevent PPP after cardiac surgery.

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Trends of Concept Development in Nursing Published in Korean Journals: Lee, Sumi , Lee, Jinhae , Hwang, Yugyeong , Ko, Il Sun; J Korean Acad Nurs 2020;50(2):178-190. Published online April 30, 2020; DOI: https://doi.org/10.4040/jkan.2020.50.2.178

Abstract PDF: Purpose
The purpose of this study was to identify trends of nursing concept development in Korean journal papers to improve accurate understanding of nursing concepts.
Methods
A systematic review of 216 concept development articles published from 1970 to 2018 that met the inclusion criteria was conducted using Research Information Sharing Service (RISS) databases.
Results
The most common method of concept development was Walker and Avant’s concept analysis method, identified in 139 (64.3%) of the 216 studies, followed by 48 examples of hybrid models (22.2%) and 15 examples of evolutionary methods (6.9%). Chinn and Kramer’s method, Norris’s clarification, Wilson’s method, and others were also used. The concepts of “spirituality” and “fatigue” were most frequently analyzed. Among the 139 studies that used Walker and Avant’s concept analysis method, 127 studies (91.4%) applied all the recommended steps; the others applied the recommended steps partially, omitting description of model cases/additional cases, antecedents/consequences, and empirical indicators. Among the studies using the hybrid model, among two (5.7%) did not describe attributes, three (8.5%) did not provide definitions, and 16 (45.7%) did not present empirical indicators in the final stage.
Conclusion
Among concept development studies published in Korean journals, Walker and Avant’s concept analysis method is most commonly used. In case of most studies using Walker and Avant’s method a suitable concept analysis process is applied, but in case of other studies using the other concept development method, a suitable concept analysis process is not applied. Therefore, a suitable concept analysis process must be applied for concept development in nursing research.

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Prediction Models of Mild Cognitive Impairment Using the Korea Longitudinal Study of Ageing: Park, Hyojin , Ha, Juyoung; J Korean Acad Nurs 2020;50(2):191-199. Published online April 30, 2020; DOI: https://doi.org/10.4040/jkan.2020.50.2.191

Abstract PDF: Purpose
The purpose of this study was to compare sociodemographic characteristics of a normal cognitive group and mild cognitive impairment group, and establish prediction models of Mild Cognitive Impairment (MCI).
Methods
This study was a secondary data analysis research using data from “the 4th Korea Longitudinal Study of Ageing” of the Korea Employment Information Service. A total of 6,405 individuals, including 1,329 individuals with MCI and 5,076 individuals with normal cognitive abilities, were part of the study. Based on the panel survey items, the research used 28 variables. The methods of analysis included a c2-test, logistic regression analysis, decision tree analysis, predicted error rate, and an ROC curve calculated using SPSS 23.0 and SAS 13.2.
Results
In the MCI group, the mean age was 71.4 and 65.8% of the participants was women. There were statistically significant differences in gender, age, and education in both groups. Predictors of MCI determined by using a logistic regression analysis were gender, age, education, instrumental activity of daily living (IADL), perceived health status, participation group, cultural activities, and life satisfaction. Decision tree analysis of predictors of MCI identified education, age, life satisfaction, and IADL as predictors.
Conclusion
The accuracy of logistic regression model for MCI is slightly higher than that of decision tree model. The implementation of the prediction model for MCI established in this study may be utilized to identify middle-aged and elderly people with risks of MCI. Therefore, this study may contribute to the prevention and reduction of dementia.

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Effects of Oral Gargling with Aroma Solution in Psychiatric Inpatients: A Non-Randomized Controlled Trial: Jung, Yun Ah , Kim, Hee Sook; J Korean Acad Nurs 2020;50(2):200-209. Published online April 30, 2020; DOI: https://doi.org/10.4040/jkan.2020.50.2.200

Abstract PDF: Purpose
The purpose of this study was to examine the effects of oral gargling with an aromatic solution on xerostomia, objective oral status, and oral health-related quality of life in psychiatric inpatients.
Methods
A nonequivalent control group with a non-synchronized design was used in this study. The experimental group (n=34) received oral gargling with an aroma solution, while the control group (n=33) gargled with 0.9% normal saline. Dependent variables were measured at pre-, post-, and follow-up test. Data were analyzed using an c2-test, Fisher’s exact probability test, t-tests, and repeated measures ANOVA using SPSS/WIN v.21.0.
Results
After the intervention, significant differences were revealed in xerostomia (F=15.30, p <.001), objective oral status (F=38.44, p <.001), and oral health-related quality of life (F=62.70, p <.001) with an interaction effect between group and time.
Conclusion
These findings indicate that gargling with an aroma solution is more effective than 0.9% normal saline for the oral health of psychiatric inpatients. Therefore gargling with an aroma can be safely recommended as a brief, economical, and positive intervention in clinical settings.

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Development of a Scale for Alcohol Drinking Prevention Behavior in Early Elementary School Based on Ajzen’s Theory of Planned Behavior: Kim, Younkyoung , Lee, Chong Mi , Kang, Seo Young; J Korean Acad Nurs 2020;50(2):210-227. Published online April 30, 2020; DOI: https://doi.org/10.4040/jkan.2020.50.2.210

Abstract PDF: Purpose
This study aimed to develop a scale to measure variables related to alcohol drinking prevention behavior in early elementary school, based on the theory of planned behavior.
Methods
A scale was developed to measure variables related to alcohol drinking prevention behavior. Initial items for direct evaluation were constructed through a literature review, and those for belief-based indirect measure were generated through interviews with 30 second- and third-grade elementary school students. The collected data from 286 third-grade elementary school students were then subjected to item analysis, exploratory and confirmative factor analysis, criterion-related validity testing, and internal consistency assessment.
Results
The final scale consisted of 35 items. Intention, attitudes, subjective norms, and perceived behavioral control explained 82.7% of the variance; behavioral beliefs, normative beliefs, and control beliefs explained 65.6% of the variance; and evaluation of outcome, motivation to comply, and power of control beliefs explained 72.8% of the variance. The confirmatory factor analysis indicated that the theoretical models had a satisfactory goodness of fit. Criterion-related validity was confirmed between the direct evaluation variables and the indirect measure variables (attitudes r=.64, p <.001; subjective norms r=.39, p <.001; perceived behavioral control r=.62, p <.001). Cronbach’s a was .89 for the direct evaluation variables and .93 for the indirect measure variables.
Conclusion
The scale developed in this study is valid and reliable. It could be used to measure and explain variables related to alcohol drinking prevention behavior in early elementary school.

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Development of an Instrument to Assess the Nursing Professional Pride: Jeon, JaeHee , Lee, EunHee , Kim, EunJoo; J Korean Acad Nurs 2020;50(2):228-241. Published online April 30, 2020; DOI: https://doi.org/10.4040/jkan.2020.50.2.228

Abstract PDF: Purpose
The purpose of this study was to develop an instrument to assess nursing professional pride.
Methods
Fifty-six preliminary items were identified through literature review and focus group interview of nurses working in a hospital. Of these, 45 preliminary instruments were completed over 0.80 of content validity index. To verify the reliability and validity of the preliminary instrument, data were collected from 294 nurses. The data were analyzed using factor analysis and multidimensional scaling analysis.
Results
From the factor analysis, 27 significant items were divided into 5 subscales. These subscales were as follows: feeling of vocation, role satisfaction, role of problem solver, self-achievement, and willingness to stay. The nursing professional pride also established criterion-related validity, discriminant validity, and group validity. Cronbach’s a of the instrument was .92, and the subscales ranged from .74 to .85.
Conclusion
The developed scale for nursing professional pride shows validity and reliability. The significance of this study is the development of an instrument capable of measuring nursing professional pride. To verify the relevance of this instrument, conducting comparative studies is suggested.

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Development and Effects of Smartphone App-Based Walking Exercise Program for Taxi Drivers: Based on Bandura’s Self Efficacy Theory: Choi, Yun Ha , Chae, Min-Jeong; J Korean Acad Nurs 2020;50(2):242-254. Published online April 30, 2020; DOI: https://doi.org/10.4040/jkan.2020.50.2.242

Abstract PDF: Purpose
The purpose of this study was to examine the effects of smart-phone app-based walking exercise programs for taxi drivers on self-efficacy and outcome expectations for exercise, health-related quality of life, walking as an exercise, and physiological indexes.
Methods
A nonequivalent control group with a pre-post-test design was used. The subjects were recruited in G metropolitan city. Subjects were assigned to the experimental (n=31) or control groups (n=30). The smart phone app-based walking exercise program consisted of educations via the app, twelve short message services, and one individual telephone counseling session, which was spread over 12 weeks.
Results
Self-efficacy, outcome expectations, and health-related quality of life had significantly higher pre-post test differences in scores in the experimental group. Additionally, blood pressure, body mass index, and waist circumference had significantly decreased prepost- test difference levels in the experimental group. Walking as an exercise (which consisted of days walked, number of steps walked, and amount of time walked) had significantly increased in the experimental group after 7~12 weeks in the period following the intervention program rather than 1~6 weeks after the program.
Conclusion
The smart phone app-based walking exercise program based on the self-efficacy theory demonstrates a significant effect on improving self-efficacy, outcome expectations physical activities, and health-related quality of life for taxi drivers. Therefore, it is recommended to actively use the program as a tool to promote self-efficacy, physical activities, and health behaviors in taxi drivers.

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Mothers’ Experiences of Caring for Children with Precocious Puberty: A Q-Methodological Approach: Lee, Hye Jin , You, Mi-Ae; J Korean Acad Nurs 2020;50(2):255-270. Published online April 30, 2020; DOI: https://doi.org/10.4040/jkan.2020.50.2.255

Abstract PDF: Purpose
This study explored experiences of mothers caring for children with precocious puberty.
Methods
Q-methodology was used for analyzing individual subjectivity. Seventy Q-statements were selected and scored by 50 participants on an 11-point scale. The collected data were analyzed using the PC QUANL program.
Results
The following eight types of care experiences of mothers of children with precocious puberty were identified: Type I-1: hypersensitive and best-result oriented, Type I-2: treatment burden, Type II-1: treatment-oriented, Type II-2: self-blame, Type III-1: accepting and compliant, Type III-2: treatment confused, Type IV-1: serious and engaged, and Type IV-2: naturalism- oriented.
Conclusion
These results can help develop specific education

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Effect of a Physical Activity Promoting Program Based on the IMB Model on Obese-Metabolic Health Outcomes among Obese Older Adults with Knee Osteoarthritis: Kim, Jung-Suk , Kim, Chun-Ja; J Korean Acad Nurs 2020;50(2):271-285. Published online April 30, 2020; DOI: https://doi.org/10.4040/jkan.2020.50.2.271

Abstract PDF: Purpose
This study examined the effects of a physical activity promoting program based on the Information-Motivation-Behavioral Skills (IMB) model on physical activity and health outcomes among obese older adults with knee osteoarthritis.
Methods
This study utilized a randomized controlled trial with a convenience sample of 75 obese older adults with knee osteoarthritis in a university hospital. The older adults in the intervention group participated in a 12-week program involving weekly group sessions and monitoring calls with education booklets and video clips for exercise dances, while those in the control group received an usual care. Outcomes were measured using self-report questionnaires, anthropometrics, and blood analyses. The intervention effects were analyzed using Mann-Whitney U test and ANCOVA.
Results
The mean age of participants was 74.9 years with 84.0% women. The intervention group at 12 weeks showed significantly greater improvements in self-efficacy for physical activity (F=81.92, p <.001), physical activity amounts (Z=-2.21, p =.044), knee joint function (F=15.88, p <.001), and health-related quality of life (F=14.89, p <.001) compared to the control group. Among obese-metabolic outcomes, the intervention group at 12 weeks showed a significant decrease in visceral fat mass (F=7.57, p =.008) and improvement in high-density level cholesterol (F=9.51, p =.003) compared to the control group.
Conclusion
Study findings support the need for an IMB based physical activity program for promoting physical activity, knee function and health outcomes in obese older adults with knee osteoarthritis. Longitudinal studies are warranted to confirm the persistence of obese-metabolic effects in clinical settings.

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Effect of Resistance Exercise Program for Middle-Aged Women with Myofascial Pain Syndrome on Shoulder Pain, Angle of Shoulder Range of Motion, and Body Composition Randomized Controlled Trial, RCT: Kim, WonJong , Hur, Myung-Haeng; J Korean Acad Nurs 2020;50(2):286-297. Published online April 30, 2020; DOI: https://doi.org/10.4040/jkan.2020.50.2.286

Abstract PDF: Purpose
This study aimed to identify the effects of myofascial pain syndrome on shoulder pain, range of motion, and body composition around the shoulder in middle-aged women.
Methods
A total of 72 women participated in the randomized controlled trial. The subjects were grouped into an experimental group (n=39) and a control group (n=33). The experimental group received a resistance exercise program using an elastic band for 8 weeks, 3 days a week. The control group followed a normal daily for 8 weeks. Measurements were conducted three times; before the experimental treatment (pre-test), the 2nd and 8th weeks after treatment.
Results
Regarding the general characteristics and homogeneity of the dependent variables, there were no significant differences between the two groups, except for the thickness of the left and right muscles and the left fat. After treatment, shoulder pain was significantly different between the two groups (F=18.54, p <.001) and the range of shoulder motion was significantly different (left, F=86.70, p <.001; right, F=98.66, p <.001). Furthermore, there were a significant differences in the thickness of muscles between the two groups (left, F=40.20, p <.001; right, F=29.57, p <.001); however, the thickness of fat was not significantly different.
Conclusion
The resistance exercise program reduces shoulder pain and improves the range of motion of the shoulder joint and increases muscle mass on around the shoulder. It suggests to conduct a study to confirm the long-term exercise effect.

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Scale Development and Model Validation for the Process of Exercise Engagement for People with Prediabetes: Chang, Shu-Chuan , Yeh, Hsiu-Chen , Kuo, Yu-Lun; J Korean Acad Nurs 2020;50(2):298-312. Published online April 30, 2020; DOI: https://doi.org/10.4040/jkan.2020.50.2.298

Abstract PDF: Purpose
This study had two objectives: 1) to develop a scale for the process of exercise engagement (SPEE) for prediabetic individuals (PDIs); 2) to validate a structural model for the process of exercise engagement for PDIs.
Methods
A cross-sectional survey with simple random sampling was conducted from September 2013 to December 2015 (in Taiwan). A total of 310 PDIs were enrolled for scale development and model validation via item analysis, factor analyses, and structural equation modeling. The Kuo model was used as the basis for developing the Chinese version of the SPEE for PDIs.
Results
The SPEE contains five subscales with a total of twenty-one items that account for 54.9% to 65.9% of the total variance explained for assessing participants’ process of engagement during exercise. For Kuo model validation, the model measures indicated goodness of fit between the Kuo model and sample data. Analysis further revealed a direct effect between the creating health blueprints (CHB) stage and the spontaneous regular exercise (SRE) stage (b=.60).
Conclusion
The SPEE includes five subscales for assessing the psychological transition and behavioral expression at each stage of the process of exercise engagement for PDIs. The SPEE for people with prediabetes provides deeper insights into the factors of behavioral change stages that are required to initiate long-term health care outcomes and avoid developing diabetes. These insights are significant as they allow for patient- specific mapping and behavior modification to effect exercise.

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