Journal of Korean Academy of Nursing

Designing Appropriate Mixed Methods Nursing Research: Im, YeoJin; J Korean Acad Nurs 2021;51(2):133-137. Published online April 30, 2021; DOI: https://doi.org/10.4040/jkan.51201

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A Study on Dispatched Nursing during the Japanese Colonial Era: Kim, Sook Young , Cho, Eunhyung , Joung, Sun ei; J Korean Acad Nurs 2021;51(2):138-149. Published online April 30, 2021; DOI: https://doi.org/10.4040/jkan.20239

Abstract PDF: Purpose
This study aimed to explore the characteristics of dispatched nursing, a type of private nursing called Hasutsu, during the Japanese colonial period in Korea. This specialized and professional nursing was a form of a dispatched nursing service provided by nurses associations.
Methods
This study reviewed a literature on visiting nursing, a literature on dispatched nursing, focusing on data collected during the Japanese colonial period from August 1910 to August 1945. Study design was a document research study of historical records. Results: The dispatched nursing service was established by the Japanese nurses in Korea. More than 60 nurses associations operated to meet the demands in the modern Korean nursing period. It was found that some associations tried to raise the nursing fees. Also, the practice of employing visiting nurses who did not have a license was criticized severely in the newspapers. Considering that the data was limited in this study, the existence of Korean nurses association employing Korean visiting nurses has not been specifically identified.
Conclusion
The findings reveal some aspects of dispatched nursing provided by the nurses associations in that era. The nurses associations developed their own specialized service independently by dispatching nurses to fulfill the needs of people not only with cheaper nursing fares than hospitals but with convenient nursing care services, including customized care for infectious diseases. A study of modern historical records of Korean nurses would facilitate deeper research into Korean nursing history.

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Impact of Obesity on Urinary Tract Infections in Korean Adults: Secondary Data Analysis Using Community-Based Cohort Study: Seo, Seung Hee , Jeong, Ihn Sook , Lee, Eun Joo; J Korean Acad Nurs 2021;51(2):150-161. Published online April 30, 2021; DOI: https://doi.org/10.4040/jkan.20228

Abstract PDF: Purpose
This study investigated the incidence of urinary tract infection (UTI) in community-dwelling adults and identified the association between obesity and UTI.
Methods
The participants were 4,926 adults aged over 40 years who had no UTIs at the baseline survey of the Korean Genome Epidemiology Study. Obesity was defined according to the cirtieria of Korean Society for the Study of Obesity using body mass index (BMI) data. UTI was defined as those who had self-reported UTI or had either nitrite, or both leukocytes and blood in the urine dipstick test. Hazard ratio (HR) and 95% confidence interval (CI) were calculated using a multivariate Cox proportional hazards regression analysis to identify the association between the obesity and UTI.
Results
The incidence proportion of UTI was 5.1%, and the incidence density per 1,000 person-years was 25.5. After controlling general characteristics, people with BMI ≥30.0 kg/m² remained 1.66 times (HR = 1.66, 95% CI = 1.06~2.60; p < .05) more likely to have UTI than those with normal weight. This trend was also present in men or people aged ≥ 60 years. Among women aged ≥ 60 years, people with BMI ≥ 30.0 kg/m² were 1.98 times (HR = 1.98, 95% CI = 1.01~3.86; p < .05) more likely to have UTI than those with normal weight.
Conclusion
The BMI ≥ 30.0 kg/m² is a risk factor of UTIs in Korean adult men over 40 years and women aged ≥ 60 years. It is necessary to emphasize the importance of obesity management to men or women aged ≥ 60 years, specifically.

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Factors Influencing Re-Employment of Newly Graduated Nurses: Longitudinal Study: Oh, Yun Kyung , Kim, Eun-Young; J Korean Acad Nurs 2021;51(2):162-172. Published online April 30, 2021; DOI: https://doi.org/10.4040/jkan.20158

Abstract PDF: Purpose
The purpose of this study was to identify factors influencing the re-employment of newly graduated nurses.
Methods
A longitudinal design was employed. The participants in this online survey study were 138 newly graduated nurses who had left their first jobs. Data were collected from June 2019 to January 2020 and analyzed using descriptive statistics, chi-square tests, t-tests, Cox’s proportional hazards models with the IBM SPSS ver. 26.0 for Windows program.
Results
About 76.1% of the participants were re-employed within one year of leaving their first jobs and the average period until re-employment was about 14 weeks. Cox’s proportional hazards models revealed that factors affecting re-employment among newly graduated nurses were social support (hazard ratio [HR] = 1.39, 95% confidence interval [CI] = 1.01~1.91; p = .042), job search efficacy (HR = 1.33, 95% CI = 1.01~1.77;p = .047), and extrinsic outcome expectation (HR = 1.39, 95% CI = 1.08~1.79; p = .010).
Conclusion
Social support, job search efficacy, and extrinsic outcome expectation can play a significant role in the re-employment of newly graduated nurses. It is necessary to establish strategies to enhance their social support, job search efficacy, and extrinsic outcome expectation in order to increase the re-employment of newly graduated nurses.

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Comparison of the Effects of Education Only and Exercise Training Combined with Education on Fall Prevention in Adults Aged 70 Years or Older Residing in Elderly Residential Facilities: Hong, Chahwa , Lee, Haejung , Lee, Misoon; J Korean Acad Nurs 2021;51(2):173-187. Published online April 30, 2021; DOI: https://doi.org/10.4040/jkan.20203

Abstract PDF: Purpose
To compare the effects of education only and exercise training combined with education on fall knowledge, fall efficacy, physical activity, and physical function in adults aged 70 years or older residing in elderly residential facilities.
Method
A three-group pre- and posttest design was utilized: education only (EO; n = 23), education and TheraBand (ET; n = 22), and education and walking (EW; n = 22). Fall education was provided for all three groups. In addition, TheraBand exercise training was provided for the ET and a walking exercise for the EW. Data were collected from November 1st, 2017 to February 15th, 2019 and analyzed with χ² test, paired t-test, and one-way ANOVA using IBM SPSS/WIN ver. 22.0.
Results
Compared with the EO, the ET and the EW were more effective in terms of fall efficacy, physical activity, and lower extremity muscle strength. The EW showed higher improvement in walking abilities than the EO and the ET.
Conclusion
Exercise training combined with education is more effective in preventing falls among community-dwelling adults aged 70 years or older. When considering fall prevention programs for older adults, both TheraBand and walking exercise training combined with education can be chosen based on the participant’s physical status. Aggressive strategies to improve daily walking are required to maintain walking abilities among community-dwelling adults aged 70 years or older.

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Effects of Program to Promote Obesity Prevention Behaviors on Pre-Schoolers: Focused on Kindergartener in Korea: Hwang, Inju , Bang, Kyung-Sook; J Korean Acad Nurs 2021;51(2):188-202. Published online April 30, 2021; DOI: https://doi.org/10.4040/jkan.20217

Abstract PDF: Purpose
This study aimed to develop a program to promote obesity prevention behaviors for pre-schoolers and to confirm the effectiveness of the program in Korea.
Methods
The program comprised 8 sessions for 4 weeks including combined classroom lectures and physical activities. A non-equivalent control group pre-post test study design was used, and seventy two children, aged 5 to 6 years (experimental group: 33, control group: 39) and their parents participated in the study. To examine the effectiveness of the program, children’s knowledge, intake of sugar-added beverages and fruits & vegetables, time of outdoor play and screen time, and parental self-efficacy were measured. Data were analyzed with SPSS/WIN ver. 22.0 and R 4.0.2, using descriptive analysis, chi-square test, Fisher’s exact test, the independent t-test, and Analysis of covariance (ANCOVA).
Results
The results showed that the experimental group reported significantly increased knowledge (p < .001) and longer time of outdoor play on weekends (p = .033). However, there were no significant differences in the intake of sugar-added beverages and fruits & vegetables, screen time, and parental self-efficacy in the two groups.
Conclusion
This study confirms the applicability of an obesity prevention intervention at kindergartens in Korea. The results can be used as basic data for the study of childhood obesity prevention in Korea.

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Face Mask Usage, Knowledge and Behavior of Face Mask Usage in Older Adults Living Alone in the COVID-19 Era: Han, A-Reum , Park, Yeon-Hwan; J Korean Acad Nurs 2021;51(2):203-216. Published online April 30, 2021; DOI: https://doi.org/10.4040/jkan.20252

Abstract PDF: Purpose
This study analyzed the current status of face mask usage. It also identified factors related to the knowledge and behavior regarding the same among older adults living alone during the COVID-19 pandemic.
Methods
This descriptive study was conducted via a telephone survey involving 283 older adults living alone in S City from March to April 2020. Knowledge and behavior pertaining to face mask usage were measured using Hilda Ho’s Face Mask Use Scale; reliability of the measurement was Kuder-Richardson formula-20 = .62, Cronbach’s α = .92. Data were analyzed using descriptive analysis, independent t-test, Pearson’s correlation coefficient, and multiple linear regression.
Results
Older adults used one mask for 3.55 days on an average. The knowledge level was 9.97 (± 1.84) out of 12 and behavior level was 15.49 (± 1.55) out of 16. Level of education (β = - .31, p < .001), living region (β = .13, p = .017), personal income (β = .12, p = .041) significantly affected the face mask usage-related knowledge, and living region (β = .15, p = .010) significantly affected the face mask usage-related behavior.
Conclusion
Older adults living alone are aware of the effects of using face masks. However, their mask usage is inappropriate, for example, the prolonged use of the same mask. Considering the low level of face mask usage-related knowledge, it is necessary to develop customized education programs and infectious disease prevention strategies for older adults possessing low educational levels living alone in urban-rural complex areas.

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Influence of Self-care on Burnout in Primary Family Caregiver of Person with Dementia: Kwon, Jeong Hwa , Hong, Gwi-Ryung Son; J Korean Acad Nurs 2021;51(2):217-231. Published online April 30, 2021; DOI: https://doi.org/10.4040/jkan.20274

Abstract PDF: Purpose
The purpose of this study was to identify the influence of self-care on burnout experienced by primary family caregivers of persons with dementia.
Methods
The subjects of the study were 156 primary family caregivers of persons with dementia at home in Korea. Data were analyzed using descriptive statistics, independent t-test, one-way ANOVA, Pearson correlation coefficient, and hierarchical multiple regression using IBM SPSS Statistics ver. 24.0 for Windows.
Results
The mean scores for self-care and burnout were 42.35 and 61.60, respectively. Self-care, subjective health status, living with a person with dementia, and behavioral and psychological symptoms of dementia were significant factors affecting burnout in family caregivers. Self-care was identified as the strongest factor affecting burnout, explaining 13.9% of burnout with controlling factors in caregivers and care receivers.
Conclusion
To prevent burnout in primary family caregivers of persons with dementia, self-care of family caregivers should be emphasized. In nursing education, family caregivers should be recognized and approached as nursing clients who are responsible for taking care of their health. In nursing practice and research, digital self-care or self-care improvement intervention programs should be designed to help family caregivers, and further studies on self-care centered on health of family caregivers should be conducted.

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Information Resource Network Analysis of Factors Influencing Breastfeeding Planning and Duration: Lee, Eunyoung , Cho, Insook , Cho, Seong Jin , Lee, Eunju; J Korean Acad Nurs 2021;51(2):232-244. Published online April 30, 2021; DOI: https://doi.org/10.4040/jkan.20280

Abstract PDF: Purpose
This study aimed to identify the modifiable factors affecting breastfeeding planning and duration among healthy mothers and their use of breastfeeding information resources.
Methods
A cross-sectional survey was conducted in a community setting. Four hundreds participants were recruited at five pediatric clinics and three community health centers located in Paju-si and Goyang-si, Gyeonggi-do, between January and May 2019. Based on the breastfeeding decision-making model, driven by Martens and Young’s work, the survey items consisted of demographics, childbirth and breastfeeding characteristics, and breastfeeding information resources. In the analysis, 389 responses were used in the t-test, ANOVA, and logistic regression. Information resource networks were compared before and after childbirth including a subgroup analysis depending on the breastfeeding duration.
Results
The modifiable factors affecting breastfeeding planning and duration were antenatal and postpartum breastfeeding education and the provision of information in the hospital. The frequency of Internet use and websites visited were notable and potentially modifiable factors, which were also observed in the networks showing different relationship patterns according to participant subgroups and times. The childbirth event increased the centralization of the network in the planned group, while the network of the non-planned group was more diffused after childbirth. The network of the short-term breastfeeding group was characterized by a more centralized pattern and the resources of high betweenness centrality than the long-term group.
Conclusion
Breastfeeding education is a consistent factor that affects breastfeeding behavior. A well-designed internet-based approach would be an effective nursing intervention to meet the needs of women seeking breastfeeding information and changing their behaviors.

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The Lived Experience of Body Alteration and Body Image with Regard to Immediate Breast Reconstruction among Women with Breast Cancer: Ahn, Jeonghee , Suh, Eunyoung E.; J Korean Acad Nurs 2021;51(2):245-259. Published online April 30, 2021; DOI: https://doi.org/10.4040/jkan.21028

Abstract PDF: Purpose
The purpose of this study was to explore the lived experience of body alteration and body image with regard to immediate breast reconstruction among women with breast cancer.
Methods
Data were collected from July to December 2020 through individual in-depth interviews with 15 women who had undergone immediate breast reconstruction due to breast cancer. Verbatim transcripts were analyzed using Colaizzi’s phenomenological analysis.
Results
The following four theme clusters emerged. First, “revalued meaning of breasts due to cancer” illustrated the fact that cancer removal surgery brought the participants to reconsider the meaning of their breasts. Second, “had no choice but breast reconstruction” demonstrated the participants’ decision-making process of not wanting to lose breasts. Third, “unsatisfied breasts despite reconstruction” portrayed the distress due to the unexpected surgical outcomes. Finally, “restarted everyday routines with the altered body” described the healing process of the participants by accepting their changed body.
Conclusion
In Korea, where family-centeredness and fidelity are highly valued, women perceived their breasts not only as a symbol of femininity but as the mediator connecting the self to family. Despite the distress related to imperfect breasts, the participants were thankful for their reconstructed breasts. Breast reconstruction helped them return to daily life as the psychological trauma of breast cancer was healed. The participants rebuilt their body image by accepting their scarred new body. This may allow health professionals to provide constructive and culturally appropriate counseling in advance by providing insight into women’s perception of their body image with regard to breast reconstruction.

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