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Volume 42(3); June 2012
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Original Articles
Structural Equation Modeling on Successful Aging in Elders - Focused on Selection · Optimization · Compensation Strategy -
Doo Nam Oh
J Korean Acad Nurs 2012;42(3):311-321.   Published online June 29, 2012
DOI: https://doi.org/10.4040/jkan.2012.42.3.311
AbstractAbstract PDF
Purpose

This study was designed to construct and test a structural equation modeling on specific domain health status and the Selection · Optimization · Compensation (SOC) strategy affecting successful aging in elderly people.

Methods

The model construction was based on the SOC model by Baltes and Baltes. Interviews were done with 201 elderly people aged 65 or older. Interview contents included demographics, functional health status, emotional health status, social health status, SOC strategies, and successful aging. Data were analyzed using SPSS 15.0 and AMOS 7.0.

Results

Model fit indices for the modified model were GFI=.93, CFI=.94, and RMSEA=.07. Three out of 7 paths were found to have a significant effect on successful aging in this final model. Functional health status had a direct and positive effect on successful aging. Emotional health status influenced successful aging through SOC strategies.

Conclusion

This study suggests that interventions for improving functional health status and for strengthening SOC strategies are critical for successful aging. Continuous development of a variety of successful aging programs using SOC strategy is suggested.

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Development and Evaluation of a Small Group-based Cardiocerebrovascular Disease Prevention Education Program for Male Bus Drivers
Eun Young Kim, Seon Young Hwang
J Korean Acad Nurs 2012;42(3):322-332.   Published online June 29, 2012
DOI: https://doi.org/10.4040/jkan.2012.42.3.322
AbstractAbstract PDF
Purpose

This study was conducted to examine effects of a small group-based cardiocerebrovascular disease (CVD) prevention education program on knowledge, stage of change and health behavior among male bus drivers with CVD risk factors.

Methods

A non-equivalent control group pretest-posttest design was used. Participants were 68 male bus drivers recruited from two urban bus companies. Participants from the two groups were selected by matching age, education and risk factors. Experimental group (n=34) received a small group-based CVD prevention education program 8 times over 6 weeks and 3 times through telephone interviews at 2-week intervals. Data were collected between December, 2010 and March, 2011, and were analyzed using chi-square test, t-test, and repeated measure analysis of variance with SPSS/Win18.0.

Results

Experimental group showed significantly higher scores in CVD prevention knowledge (p<.001) and health behavior (p<.001) at 6 and 12 weeks after intervention. Participants in pre-contemplation and contemplation stages made progress to contemplation and action. This was significantly better at 6 and 12 weeks after intervention (p<.001).

Conclusion

Results suggest that small group-based education programs for CVD prevention are effective in increasing knowledge, stage of change, and health behavior to prevent CVD among male bus drivers with CVD risk.

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The Effects of Pre-operative Visual Information and Parental Presence Intervention on Anxiety, Delirium, and Pain of Post-Operative Pediatric Patients in PACU
Je-Bog Yoo, Min-Jung Kim, Soo-Hyun Cho, Yoo-Jung Shin, Nam-Cho Kim
J Korean Acad Nurs 2012;42(3):333-341.   Published online June 29, 2012
DOI: https://doi.org/10.4040/jkan.2012.42.3.333
AbstractAbstract PDF
Purpose

The purpose of this study was to test whether pre-operative visual information and parental presence had positive effects on anxiety, delirium, and pain in pediatric patients who awoke from general anesthesia in a post-surgical stage.

Methods

This study used a non equivalent control-group post test design (n=76). Independent variables were provision of pre-operative visual information and parental presence for post-surgical pediatric patients in PACU (post anesthesia care unit). Dependent variables were anxiety, delirium, and pain in the pediatric patients measured three times at 10 minute intervals after extubation in the PACU. Measurements included Numerical Rating Scale for assessing state anxiety, Pediatric Anesthesia Emergence Delirium Scale by Sikich & Lerman (2004) for delirium, and Objective Pain Scale by Broadman, Rice & Hannallah (1988) for pain.

Results

Experimental group showed significantly decreased state anxiety at time points-10, 20, and 30 minutes after extubation. Delirium was significantly lower at 10 minutes and 30 minutes after extubation in the experimental group. Pain was significantly lower at 10 minutes after extubation in the experimental group.

Conclusion

The results of this study suggest that this intervention can be a safe pre-operative nursing intervention for post-surgical pediatric patients at PACU.

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Subjectivity of Nursing College Students' Awareness of Gender Equality: An Application of Q-methodology
Eun Ja Yeun, Hye Jin Kwon, Hyun Jeong Kim
J Korean Acad Nurs 2012;42(3):342-350.   Published online June 29, 2012
DOI: https://doi.org/10.4040/jkan.2012.42.3.342
AbstractAbstract PDF
Purpose

This study was done to identify the awareness of gender equality among nursing college students, and to provide basic data for educational solutions and desirable directions.

Methods

A Q-methodology which provides a method of analyzing the subjectivity of each item was used. 34 selected Q-statements from each of 20 women nursing college students were classified into a shape of normal distribution using 9-point scale. Subjectivity on the equality among genders was analyzed by the pc-QUANL program.

Results

Four types of awareness of gender equality in nursing college students were identified. The name for type I was 'pursuit of androgyny', for type II, 'difference-recognition', for type III, 'human-relationship emphasis', and for type IV, 'social-system emphasis'.

Conclusion

The results of this study indicate that different approaches to educational programs on gender equality are recommended for nursing college students based on the four types of gender equality awareness.

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A Proposal to Improve Nursing Fee Differentiation Policy for General Hospitals Using Profitability-Analysis in the National Health Insurance
Sungjae Kim, Jinhyun Kim
J Korean Acad Nurs 2012;42(3):351-360.   Published online June 29, 2012
DOI: https://doi.org/10.4040/jkan.2012.42.3.351
AbstractAbstract PDF
Purpose

The purpose of this study was to propose optimal hospitalization fees for nurse staffing levels and to improve the current nursing fee policy.

Methods

A break-even analysis was used to evaluate the impact of a nursing fee policy on hospital's financial performance. Variables considered included the number of beds, bed occupancy rate, annual total patient days, hospitalization fees for nurse staffing levels, the initial annual nurses' salary, and the ratio of overhead costs to nursing labor costs. Data were collected as secondary data from annual reports of the Hospital Nursing Association and national health insurance.

Results

The hospitalization fees according to nurse staffing levels in general hospitals are required to sustain or decrease in grades 1, 2, 3, 4, and 7, and increase in grades 5 and 6. It is suggested that the range between grade 2 and 3 be sustained at the current level, the range between grade 4 and 5 be widen or merged into one, and the range between grade 6 and 7 be divided into several grades.

Conclusion

Readjusting hospitalization fees for nurse staffing level will improve nurse-patient ratio and enhance the quality of nursing care in hospitals. Follow-up studies including tertiary hospitals and small hospitals are recommended.

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Nurses’ Cardiopulmonary Resuscitation Performance during the First 5 minutes in In-Situ Simulated Cardiac Arrest
Eun Jung Kim, Kyeong Ryong Lee, Myung Hyun Lee, Jiyoung Kim
J Korean Acad Nurs 2012;42(3):361-368.   Published online June 12, 2012
DOI: https://doi.org/10.4040/jkan.2012.42.3.361
AbstractAbstract PDF
Abstract Purpose

The purpose of this study was to analyze the cardiopulmonary resuscitation skills and teamwork of nurses in simulated cardiac arrests in the hospital.

Methods

A descriptive study was conducted with 35 teams of 3 to 4 registered nurses each in a university hospital located in Seoul. A mannequin simulator was used to enact simulated cardiac arrest. Assessment included critical actions, time elapsed to initiation of critical actions, quality of cardiac compression, and teamwork which comprised leadership behavior and communication among team members.

Results

Among the 35 teams, 54% recognized apnea, 43% determined pulselessness. Eighty percent of the teams compressed at an average elapsed time of 108 ± 75 seconds with 35%, 36%, and 67% mean rates of correct compression depth, rate, and placement, respectively. Thirty- seven percent of the teams defibrillated at 224± 67 seconds. Leadership behavior and communication among team members were absent in 63% and 69% of the teams, respectively.

Conclusion

The skills of the nurses in this study cannot be considered adequate in terms of appropriate and timely actions required for resuscitation. Future resuscitation education should focus on improving the quality of cardiopulmonary resuscitation including team performance targeting the first responders of cardiac arrest.

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Effects of a Yoga-focused Prenatal Program on Stress, Anxiety, Self Confidence and Labor Pain in Pregnant Women with In Vitro Fertilization Treatment
Chung Sin Shim, Young-Sook Lee
J Korean Acad Nurs 2012;42(3):369-376.   Published online June 29, 2012
DOI: https://doi.org/10.4040/jkan.2012.42.3.369
AbstractAbstract PDF
Purpose

The purpose of this study was to identify the effects of a Yoga-focused prenatal program on the stress, anxiety, self confidence and labor pain of pregnant women who had in vitro fertilization (IVF) treatment.

Methods

A quasi experimental study with a non-equivalent control group pretest-posttest design was used. The data collection period and meditation program were between January 9 and August 31, 2009. Forty-six women who were pregnant following IVF, and were between 12-20 weeks gestation, participated in the study (23 experimental group, 23 control group). Data were analyzed using Chi-square test, Mann-Whitney U Test, ANCOVA, and Cronbach's alpha coefficients with the SPSS 12.0 for Windows Program.

Results

Although the sample size was limited, women who participated in the program showed statistically significant improvements in stress, anxiety, labor pain, and labor confidence for women pregnant after IVF.

Conclusion

The result indicate that this 12-week Yoga-focused educational program can be utilized for women pregnant following IVF to reduce their stress, anxiety, and labor pain, and to increase delivery confidence. It is suggested that the Yoga-focused educational program be offered to every pregnant woman.

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Factors Affecting Preparation Stage to Quit Smoking in Men
Jeong-Woon Yeon, Hyeongsu Kim, Kunsei Lee, Sounghoon Chang, Heejung Choi, Eunmi Ham, Jun Pyo Myong
J Korean Acad Nurs 2012;42(3):377-384.   Published online June 29, 2012
DOI: https://doi.org/10.4040/jkan.2012.42.3.377
AbstractAbstract PDF
Purpose

This study was done to investigate factors affecting preparation stage to quit smoking in men.

Methods

Based on data from the Community Health Survey conducted in Chungbuk Province in 2008, we estimated rates and odds ratio (OR) of smoking cessation intention for 2,639 men who were current smokers. Multivariate logistic regression analyses were used to identify factors affecting preparation stage to quit smoking.

Results

Among current male smokers, the rate of smoking cessation intention was 17.1%. The OR of factors affecting smoking cessation was as follows: Compared to men with middle school education, the OR for rate of smoking cessation intention in men with high school education was 1.47 (p=.018), and for college or higher, 1.55 (p=.017). Compared to being single, the OR for cohabitation after marriage was 1.61 (p=.011) and living alone after marriage, 2.23 (p=.005). The OR for attempt to quit smoking, exposure to secondhand smoke and participation in smoking education were 6.80 (p<.001), 1.32 (p=.020) and 1.69 (p=.005), respectively.

Conclusion

Results of this study show that it is necessary to decrease exposure to secondhand smoke and to increase participation in smoking cessation education targeting current smokers to move them from precontemplation or contemplation stage to preparation stage.

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Development and Validation of Self-Efficacy Scale for Self-Management of Breast Cancer (SESSM-B)
Ran Lee, Soo Hyun Kim, Keun Sook Lee, Myung Kyung Seo
J Korean Acad Nurs 2012;42(3):385-395.   Published online June 12, 2012
DOI: https://doi.org/10.4040/jkan.2012.42.3.385
AbstractAbstract PDF
Abstract Purpose

This purpose of this study was to develop and validate a Self-Efficacy Scale for Self-Management of Breast Cancer (SESSM-B).

Methods

The SESSM-B was developed and validated as follows: Item generation, pilot study, and tests of validity and reliability. Twenty-one items were developed through evaluation by 10 experts and 13 items were finally confirmed through item analysis and factor analysis. Psychometric testing was performed with a convenience sample of 303 women with breast cancer. Data were analyzed using factor analysis, Pearson correlation coefficients, and Cronbach’s alpha.

Results

Five factors evolved from the factor analysis, which explained 69.8% of the total variance. The first factor ‘coping with psycho-informational demand’ explained 17.2%, 2nd factor ‘maintenance of healthy lifestyle’ 14.5%. 3rd factor ‘management of side-effects' 13.3%, 4th factor ‘therapeutic compliance’ 12.8%, and 5th factor ‘sexual life’ 11.9%. SESSM-B also demonstrated a concurrent validity with health-related quality of life scale, EORTC QLQ-C30 & BR23. The internal consistency, Cronbach’s alpha, was .78, and reliability of the subscales ranged from .61 to .79.

Conclusion

The results of this study suggest that the SESSM-B is an easy, reliable, and valid instrument to measure self-efficacy for self-management of breast cancer.

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Risk Factors and Features of Critically Ill Patients with Deep Vein Thrombosis in Lower Extremities
Hwasoon Kim, Ok Min Cho, Hyo Im Cho, Ju Yeun Kim
J Korean Acad Nurs 2012;42(3):396-404.   Published online June 12, 2012
DOI: https://doi.org/10.4040/jkan.2012.42.3.396
AbstractAbstract PDF
Abstract Purpose

The purpose of this study was to identify the features, risk scores and risk factors for deep vein thrombosis in critically ill patients who developed deep vein thrombosis in their lower extremities.

Methods

The participants in this prospective descriptive study were 175 adult patients who did not receive any prophylactic medication or mechanical therapy during their admission in the intensive care unit.

Results

The mean age was 62.24 (± 17.28) years. Men made up 54.9% of the participating patients. There were significant differences in age, body mass index, and leg swelling between patients who developed deep vein thrombosis and those who did not have deep vein thrombosis. The mean risk score was 6.71(± 2.94) and they had on average 4.01(± 1.35) risk factors. In the multiple logistic regression, body mass index (odds ratio= 1.14) and leg swelling (odds ratio= 6.05) were significant predictors of deep vein thrombosis.

Conclusion

Most critically ill patients are in the potentially high risk group for deep vein thrombosis. However, patients who are elderly, obese or have leg edema should be closely assessed and more than one type of active prophylactic intervention should be provided.

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Effects of A-solution on Halitosis and Oral Status in Preoperative NPO Patients
Ji-Ah Song, Myung-Haeng Hur
J Korean Acad Nurs 2012;42(3):405-413.   Published online June 29, 2012
DOI: https://doi.org/10.4040/jkan.2012.42.3.405
AbstractAbstract PDF
Purpose

The aim of this study was to explore the effects of A-solution on halitosis and oral status in preoperative NPO patients.

Methods

A nonequivalent control group, non-synchronized pretest-posttest design was used in this study. The participants in this study were 66 patients who were admitted for gynecologic surgery. The experimental treatment was to give oral gargling with A-solution, blended essential oils and diluted with distilled water. To identify the experimental treatment effects, halitosis, salivary pH, and oral status were measured by a portable halitosis detector, visual analogue scale, Bromo Thymol Blue (BTB), Bromo Cresol Purple (BCP) test paper and oral assessment guide. Data were analyzed using χ2-test, t-test with PASW 18.0 version.

Results

Participants were homogeneous before experimental treatment. Objective halitosis in the experimental group, measured by a portable halitosis detector (t= -8.34, p<.001) was significantly lower than the control group. Subjective halitosis was significantly lower in the experimental group (t= -9.29, p<.001). Salivary pH was significantly different between two groups (t=8.81, p<.001). Oral status was significantly better in the experimental group (t= -13.31, p<.001).

Conclusion

These findings indicate that oral gargling using A-solution is effective in reducing patient halitosis, and improving oral status.

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Development and validation of the Korean Nursing Delirium Scale
Kyoung-Nam Kim, Cheol-Ho Kim, Kwang-Il Kim, Hyun-Jung Yoo, Si-Young Park, Yeon-Hwan Park
J Korean Acad Nurs 2012;42(3):414-423.   Published online June 29, 2012
DOI: https://doi.org/10.4040/jkan.2012.42.3.414
AbstractAbstract PDF
Purpose

The aims of this study were to develop and test the validity of the Korean Nursing Delirium Scale (Nu-DESC) for older patients in hospital.

Methods

The Korean Nu-DESC was developed based on the Nu-DESC (Gaudreau, 2005), and revised according to nursing records related to signs and symptoms of older patients with delirium (n=361) and the results of a pilot study (n=42) in one general hospital. To test the validity of the Korean Nu-DESC, 75 older patients whom nurses suspected of delirium from 731 older patients from 12 nursing units were assessed by bedside nurses using the Korean Nu-DESC. A Receiver Operating Characteristic Curve of the Korean Nu-DESC was constructed with an accompanying Area Under the Curve (AUC).

Results

Specific examples such as irritable, kidding, sleeping tendency, which were observed by bedside nurses in Korea, were identified in the five features of signs and symptoms of delirium in the instrument. The Korean Nu-DESC was psycho-metrically valid and had a sensitivity and specificity of .81-.76 and .97-.73, respectively. The AUC were .89, .74.

Conclusion

Results of this study indicate that the Korean Nu-DESC is well-suited for widespread clinical use in busy inpatients settings and shows promise as a research instrument.

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Accuracy, Precision, and Validity of Fever Detection using Non-invasive Temperature Measurement in Adult Coronary Care Unit Patients with Pulmonary Catheters
Gaeul Joo, Kyeong-Yae Sohng
J Korean Acad Nurs 2012;42(3):424-433.   Published online June 29, 2012
DOI: https://doi.org/10.4040/jkan.2012.42.3.424
AbstractAbstract PDF
Purpose

To investigate the accuracy, precision and validity of fever detection of tympanic membrane (TM), temporal artery (TA) and axillary temperature (AT) compared with pulmonary artery temperature (PA).

Methods

Repeated-measures design was conducted for one year on 83 adult cardiac care unit patients with pulmonary artery catheters after open heart surgery. Sequential temperature measurements were taken three times at 20-minute intervals. Accuracy, precision, repeatability, and validity of fever detection were analyzed.

Results

Mean pulmonary artery temperature was 37.04℃ (SD 0.70℃). The mean (SD) offsets from PA, with the mean reflecting accuracy and SD reflecting precision, were -1.31℃ (0.75℃) for TA, -0.20℃ (0.24℃) for TM, and -0.97℃ (0.64℃) for AT. Percentage of pairs with differences within ±0.5℃ was 9.6% for TA, 19.7% for AT, and 91.6% for TM. Repeated measurements with all three methods had mean SD values within 0.04℃. Sensitivity, specificity, and positive and negative predictive values of tympanic measurements were 0.76, 1.0, and 1.0, and 0.90, respectively.

Conclusion

Results show that TM best reflects PA, and is most consistent, accurate, and precise. AT tends to underestimate PA, and TA is least accurate and precise. Therefore tympanic membrane measurement is a reliable alternative to other non-invasive methods of measuring temperatures.

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Health-related Quality of Life in Korean Patients with Rheumatoid Arthritis: Association with Pain, Disease Activity, Disability in Activities of Daily Living and Depression
Dong Choon Uhm, Eun Sook Nam, Ho Yeon Lee, Eun Bong Lee, Young Im Yoon, Gong Ju Chai
J Korean Acad Nurs 2012;42(3):434-442.   Published online June 29, 2012
DOI: https://doi.org/10.4040/jkan.2012.42.3.434
AbstractAbstract PDF
Purpose

The purpose of this predictive study was to identify factors affecting health related quality of life (HRQoL) in patients with rheumatoid arthritis (RA).

Methods

The participants in this study were 131 patients with RA who were recruited from the outpatient clinic of a university hospital in Seoul. Disease activity in rheumatoid arthritis was evaluated by calculating the Disease Activity Score 28. Disability in activities of daily living (ADL) was assessed with the Korean Health Assessment Questionnaire, and depression with The Center for Epidemiologic Studies Depression Scale. HRQoL was evaluated using The Short Form 36 Health Survey. Data were analyzed using descriptive statistics, correlation, and hierarchical multiple regression.

Results

Pain, disability in ADL, disease activity, and depression correlated negatively with physical and mental dimensions of HRQoL. But hierachical multiple regression analysis revealed that disability in ADL and depression were the only variables negatively influencing physical and mental QoL after adjustment for influences of sociodemographic variables.

Conclusion

Results of this study suggest that disability in ADL and depression, rather than disease activity and pain have profound effects on HRQoL in patients with RA. Further studies are needed to assess the predictive ability of disease activity and pain on HRQoL in this population.

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A Comparison of the Rates of Hemolysis and Repeated Blood Sampling using Syringe needles versus Vacuum tube needles in the Emergency Department
Young Hee Sung, Moon Sook Hwang, Jee Hyang Lee, Hyung Doo Park, Kwang Hyun Ryu, Myung Sook Cho, Young Hee Yi, S. Song
J Korean Acad Nurs 2012;42(3):443-451.   Published online June 29, 2012
DOI: https://doi.org/10.4040/jkan.2012.42.3.443
AbstractAbstract PDF
Purpose

This study was done to compare the rates of hemolysis and repeated sampling in blood samples obtained by a syringe needle versus a vacuum tube needle.

Methods

A randomized, prospective study was used to evaluate the differences between the two blood sampling methods. The study group consisted of patients seen in the emergency department (ED) for blood sampling to determine electrolyte level. ED patients were randomly assigned to either the syringe group or the vacuum tube group. All blood samples were collected by experienced ED nurses and hemolysis was determined by experienced laboratory technologists. Data were analyzed using Fisher's exact test and binary logistic regression.

Results

One hundred forty-five valid samples were collected (74 in the syringe group versus 71 in the vacuum tube group). 5 of 74 (6.8%) blood samples in the syringe group and 8 of 71 (11.3%) in the vacuum tube group hemolyzed. Repeated blood sampling occurred for 2 of 74 (2.7%) and 3 of 71 (4.2%) in each group respectively. There were no significant differences in rates of hemolysis and repeated sampling between two groups (B=1.97, p=.204; B=2.36, p=.345).

Conclusion

Venipuncture with syringe needles can be recommended for ED nurses to obtain blood samples.

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Corrigendum
Erratum
J Korean Acad Nurs 2012;42(3):452-452.   Published online June 29, 2012
DOI: https://doi.org/10.4040/jkan.2012.42.3.452
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