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Volume 43(3); June 2013
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Original Articles
Comparison of Antimicrobial Effect of Alcohol Gel according to the Amount and Drying Time in Health Personnel Hand Hygiene
Yoon Jung Ji, Jae Sim Jeong
J Korean Acad Nurs 2013;43(3):305-311.   Published online June 28, 2013
DOI: https://doi.org/10.4040/jkan.2013.43.3.305
AbstractAbstract PDF
Purpose

The purpose of this study was to compare the effect of alcohol gel according to the amount and drying time in health personnel hand hygiene and to promote in their practice adequate and effective hand hygiene.

Methods

The cross-over experimental study was performed with 14 volunteers. Hands were artificially contaminated with 5 mL of 108 CFU/mL of Serratia marcescens (ATCC 14756) and four different alcohol gel hand hygiene methods varying by the amount of alcohol gel (2 mL vs. 1 mL) and drying time (complete vs. incomplete) were compared. Samples were collected by glove juice sampling procedures.

Results

Mean log reduction values of the four different hand hygiene methods were 2.22±0.36, 1.26±0.53, 1.49±0.60, 0.89±0.47 respectively for the 4 groups: adequate amount (2mL) and complete dry (30 seconds rubbing followed by 2 min air-dry), inadequate amount (1 mL) and complete dry, adequate amount and incomplete dry (15 seconds rubbing and no air-dry), and inadequate amount and incomplete dry. The difference was statistically significant in the adequate amount and complete dry group compared to other three groups (p<.001).

Conclusion

Only alcohol gel hand hygiene with adequate amount and complete drying was satisfactory by U.S. FDA-TFM efficacy requirements for antiseptic hand hygiene products.

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A Structural Model for Quality of Life of Infertile Women
Ju Hee Kim, Hye Sook Shin
J Korean Acad Nurs 2013;43(3):312-320.   Published online June 28, 2013
DOI: https://doi.org/10.4040/jkan.2013.43.3.312
AbstractAbstract PDF
Purpose

The purpose of this study was to test a model for quality of life among infertile women. This model was based primarily on the concept of the Fertility Quality of Life by Boivin et al. (2011) and the Infertility Resilience Model by Rindenour (2009).

Methods

Fifteen measurable variables were used to estimate quality of life. They included endogenous variables such as fertility quality of life and resilience, and exogenous variables such as infertility related stress, depression, marital adjustment, and family support. Data sets (n=203) used for analysis were collected in a general hospital which had, on average, 400 assisted reproductive technologies per month.

Results

The assessment of the modified model indicated acceptable fit, with χ2/d.f=2.07, GFI=.90, AGFI=.89, NFI=.89, CFI=.91, RMSEA=.07. Depression, infertility related stress, marital adjustment, resilience, and family support had direct influences on quality of life.

Conclusion

The results of this study should contribute to the development of nursing intervention programs to enhance quality of life using factors that affect fertiQol (fertility quality of life) of infertile women.

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Comparison of the Factors Influencing Young Adolescents' Aggression according to Family Structure
Eun Kyoung Yun, Sung Hee Shin
J Korean Acad Nurs 2013;43(3):321-330.   Published online June 28, 2013
DOI: https://doi.org/10.4040/jkan.2013.43.3.321
AbstractAbstract PDF
Purpose

This cross-sectional study was done to compare factors influencing young adolescents' aggression according to family structure.

Methods

Participants were 680 young adolescents aged 11 to 15 years (113 in single father families, 136 in single mother families, 49 in grandparent families, and 382 in both-parent families). All measures were self-administered. Data were analyzed using SPSS 18.0 program and factors affecting young adolescents' aggression were analyzed by stepwise multiple regression.

Results

Levels of young adolescents' aggression and all variables were significantly different among the four family structure groups. Factors influencing young adolescents' aggression were also different according to these 4 groups. For single father families, depression-anxiety and family hardiness significantly predicted the level of young adolescents' aggression (adjusted R square=.37, p<.001). For single mother families, depression-anxiety, gender, and friends' support significantly predicted the level of young adolescents' aggression (adjusted R square=.58, p<.001). For grandparent families, depression-anxiety and family support significantly predicted the level of young adolescents' aggression (adjusted R square=.58, p<.001). For both-parent families, depression-anxiety, family hardiness, and friends' support significantly predicted the level of young adolescents' aggression (adjusted R square=.48, p<.001).

Conclusion

Nurses working with young adolescents should consider family structure-specific factors influencing aggression in this population.

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The Lifestyle Modification Coaching Program for Secondary Stroke Prevention
Heejeong Kim, Oksoo Kim
J Korean Acad Nurs 2013;43(3):331-340.   Published online June 28, 2013
DOI: https://doi.org/10.4040/jkan.2013.43.3.331
AbstractAbstract PDF
Purpose

The purpose of this study was to investigate the effects of the lifestyle modification coaching program on self efficacy, lifestyle and physiologic indexes related to the recurrence of stroke in patients with stroke.

Methods

Sixty-one patients with stroke registered with a stroke center participated in this study. Of the participants, 32 were assigned to the experimental group and 29 to the control group. Self efficacy, alcohol drinking, smoking, physical activity, BMI (body mass index), WHR (waist-hip ratio), blood lipid level, and blood pressure were measured both for the baseline, as well as after intervention. The lifestyle modification coaching program consisted of an 8-week telecoaching session following face-to-face education. The control group received only the face-to-face education.

Results

There were significant differences in physical activities, WHR, blood pressure within and between groups after intervention. The lifestyle modification coaching program had significant influences on blood pressure even after gender, age, and physical activity had been adjusted.

Conclusion

The results of the study indicate that lifestyle modification coaching program is effective for physical activity, abdominal obesity and blood pressure. Therefore it can be used by nurses in hospitals and communities as one of the secondary stroke prevention programs for patients with stroke.

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Effects of Tai Chi on Fall Risk Factors: A Meta-Analysis
Moonkyoung Park, Rhayun Song
J Korean Acad Nurs 2013;43(3):341-351.   Published online June 28, 2013
DOI: https://doi.org/10.4040/jkan.2013.43.3.341
AbstractAbstract PDF
Purpose

This study was done to analyze the effects of Tai Chi on fall-related risk factors through meta-analysis of randomized clinical trials published in English and Korean between 2000 and 2010.

Methods

Using health related database and hand search of references and Google, 28 randomized studies were collected from doctoral dissertation and published peer reviewed articles. The Comprehensive Meta-analysis version 2.0 was used for the analysis.

Results

The effect sizes for Tai Chi for 3 months were significant with ES=0.54 for static balance, ES=0.24 for dynamic balance, ES=0.69 for balance measured by scale, and ES=0.40 for flexibility, ES=0.48 for muscle strength, ES=0.71 for ADL, and ES=0.37 for fear of falling. Also, the effect sizes of Tai Chi for 6 months were significant for most fall-related variables. The 6 month data for flexibility was not analyzed since only one study was published.

Conclusion

The analysis of studies of randomized clinical trials indicate that Tai Chi is effective in improving balance, flexibility, muscle strength, activities of daily living, and fear of falling when applied for 3 or 6 months. The findings provide the objective evidence to apply Tai Chi as a fall preventive intervention.

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Effects of ASPAN's Evidence-based Clinical Practice Guidelines for Promotion of Hypothermia of Patients with Total Knee Replacement Arthroplasty
Je Bog Yoo, Hyun Ju Park, Ji Yeoun Chae, Eun Ju Lee, Yoo Jung Shin, Justin Sangwook Ko, Nam Cho Kim
J Korean Acad Nurs 2013;43(3):352-360.   Published online June 28, 2013
DOI: https://doi.org/10.4040/jkan.2013.43.3.352
AbstractAbstract PDF
Purpose

In this study an examination was done of the effects of the American Society of PeriAnesthesia Nurses (ASPAN) Evidence-Based Clinical Practice Guidelines on body temperature, shivering, thermal discomfort, and time to achieve normothermia in patients undergoing total knee replacement arthroplasty (TKRA) under spinal anesthesia.

Methods

This study was an experimental study with a randomized controlled trial design. Participants (n=60) were patients who underwent TKRA between December 2011 and March 2012. Experimental group (n=30) received active and passive warming measures as described in the ASPAN's guidelines. Control group (n=30) received traditional care. Body temperature, shivering, thermal discomfort, time to achieve normothermia were measured in both groups at 30 minute intervals.

Results

Experimental group had slightly higher body temperature compared to control group (p=.002). Thermal discomfort was higher in the experimental group before surgery but higher in the control group after surgery (p=.034). It decreased after surgery (p=.041) in both groups. Time to achieve normothermia was shorter in the experimental group (p=.010).

Conclusion

ASPAN's guidelines provide guidance on measuring patient body temperature at regular intervals and on individualized and differentiated hypothermia management which can be very useful in nursing care, particularly in protecting patient safety and improving quality of nursing.

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Effect of Anorexia and Neuropathic Pain Induced by Cisplatin on Hindlimb Muscles of Rat
Gee Su Yang, Myoung-Ae Choe
J Korean Acad Nurs 2013;43(3):361-369.   Published online June 28, 2013
DOI: https://doi.org/10.4040/jkan.2013.43.3.361
AbstractAbstract PDF
Purpose

The purpose of this study was to examine the effect of anorexia and neuropathic pain induced by cisplatin on hindlimb muscles of rats.

Methods

Adult male Sprague-Dawley rats were divided into two groups, a cisplatin-treated group (n=10) and a control group (n=10). In the cisplatin-treated group, cisplatin at a dose of 2 mg/kg was injected intraperitoneally two times a week up to a cumulative dose of 20 mg/kg over 5 weeks, and in the control group saline (0.9% NaCl) was injected intraperitoneally at the same dose and duration as the cisplatin-treated group. At 34 days all rats were anesthetized, after which the soleus and plantaris muscles were dissected. Withdrawal threshold, body weight, food intake, activity, muscle weight, Type I and II fiber cross-sectional areas and myofibrillar protein content of the dissected muscles were determined.

Results

Compared with the control group, the cisplatin-treated group showed significant decreases (p<.05) in withdrawal threshold, activity, food intake, body weight, Type I and II fiber cross-sectional areas, myofibrillar protein content and weight of the soleus and plantaris muscles.

Conclusion

Muscular atrophy in hindlimb occurs due to anorexia and neuropathic pain induced by the cisplatin treatment.

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Effects of a Maternal Sexuality Education Program for Mothers of Preschoolers
Eun Mi Lee, Young-Ran Kweon
J Korean Acad Nurs 2013;43(3):370-378.   Published online June 28, 2013
DOI: https://doi.org/10.4040/jkan.2013.43.3.370
AbstractAbstract PDF
Purpose

The purpose of this study was to evaluate effects of a maternal sexuality education program for mothers of preschoolers.

Methods

A quasi-experimental with non-equivalent control group pretest-posttest design was conducted. The participants were 55 mothers of preschoolers in G city (Experimental group=27, Control group=28). The experimental group received the maternal sexuality education, and the control group received the program after the experiment. Data were collected during October and November 2012 through self-administered questionnaires at two times: prior to the intervention and after the intervention. Data were analyzed using χ2-test, Fisher's exact test and t-test.

Results

After the intervention, mothers in the experimental group reported significant differences in knowledge of sex (t=3.74, p<.001), attitude toward sex (t=4.31, p<.001), parent-efficacy on child sexuality education (t=11.96, p<.001). compared to mothers in the control group.

Conclusion

These results indicate that a sexuality education program for mothers of preschoolers is effective in improving knowledge of sex, attitude toward sex, and parent-efficacy on child sexuality education. Therefore further study should be done with larger and varied participants to confirm the effects of sexuality education programs for mothers of preschoolers.

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Development and Validation of the Korean Patient Safety Culture Scale for Nursing Homes
Sook Hee Yoon, Byungsoo Kim, Se Young Kim
J Korean Acad Nurs 2013;43(3):379-388.   Published online June 28, 2013
DOI: https://doi.org/10.4040/jkan.2013.43.3.379
AbstractAbstract PDF
Purpose

The purpose of this study was to develop a tool to evaluate patient safety culture in nursing homes and to test its validity and reliability.

Methods

A preliminary tool was developed through interviews with focus group, content validity tests, and a pilot study. A nationwide survey was conducted from February to April, 2011, using self-report questionnaires. Participants were 982 employees in nursing homes. Data were analyzed using Cronbach's alpha, item analysis, factor analysis, and multitrait/multi-Item analysis.

Results

From the results of the analysis, 27 final items were selected from 49 items on the preliminary tool. Items with low correlation with total scale were excluded. The 4 factors sorted by factor analysis contributed 63.4% of the variance in the total scale. The factors were labeled as leadership, organizational system, working attitude, management practice. Cronbach's alpha for internal consistency was .95 and the range for the 4 factors was from .86 to .93.

Conclusion

The results of this study indicate that the Korean Patient Safety Culture Scale has reliability and validity and is suitable for evaluation of patient safety culture in Korean nursing homes.

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Overcoming Experiences of Family Members Caring for Elderly Patients with Dementia at Home
Mi Ra Sung, Myungsun Yi, Dong Young Lee, Hye Young Jang
J Korean Acad Nurs 2013;43(3):389-398.   Published online June 28, 2013
DOI: https://doi.org/10.4040/jkan.2013.43.3.389
AbstractAbstract PDF
Purpose

The purpose of the study was to understand and describe the overcoming experiences of family members caring for elderly patients with dementia at home.

Methods

Data came from autobiographies on the overcoming experiences of caregiving from 31 participants, who had submitted the autobiographies to a public contest held by the Seoul Metropolitan Center for Dementia in 2012. Data were analyzed using qualitative content analysis.

Results

Four overcoming stages emerged from the analysis: confronting stage; challenging stage; integrating stage; and transcendental stage, representing transformation of experiences from frustration and suffering to happiness and new hope in life. The confronting stage illustrates severe negative feelings and exhaustion occurring after the diagnosis of dementia. The challenging stage signifies major driving forces in taking good care of their patients. It includes tender loving memories about the patients as well as family and social supports. The integrating stage shows genuine empathy for the patients' situation and the happiness of 'here and now', while the transcendental stage represents new hope in the future.

Conclusion

Health professionals need to support caregivers to find true meaning of caring and happiness in everyday life, while providing specific information on dementia care and relieving various negative feelings.

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A Structural Model for Primiparas' Breastfeeding Behavior
Hyun-Joo Yang, Ji-Min Seo
J Korean Acad Nurs 2013;43(3):399-408.   Published online June 28, 2013
DOI: https://doi.org/10.4040/jkan.2013.43.3.399
AbstractAbstract PDF
Purpose

The study was done to construct and test a structural model to explain primipara breastfeeding behavior.

Methods

The participants were 213 primiparas on postpartum wards. Data were analyzed using the PASW 18.0 and AMOS 19.0 programs.

Results

Fitness statistics for the hypothetical model were appropriate (χ2 =38.50, p=.070, GFI=.96, RMSEA=.05, AGFI=.93, NFI=.95, TLI=.97, CFI=.98, PNFI=.57, χ2/df=1.43). Breastfeeding behaviors were directly influenced by intention to breastfeed, perceived effectiveness of breastfeeding, and the amount of supplementary feeding. The amount of supplementary feeding had the largest direct impact on breastfeeding behavior. The largest total effect on breastfeeding behavior was intention to breastfeed. The environment of the maternity hospital indirectly influenced breastfeeding behavior. These factors explained 18.9% of variance in the primipara breastfeeding behavior.

Conclusion

The results of the study indicate that in order to promote primipara breastfeeding the amount of supplementary feeding immediately after the birth should be limited and an environment that encourages exclusive breastfeeding in the hospital should be provided. The results also suggest it is necessary to provide nursing interventions that increase the intention to breastfeed and the perceived effectiveness of breastfeeding.

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Life Experience of Patients suffering from Crohn's Disease
Yang-Sook Yoo, Eun-Ju Lee, Ok-Hee Cho
J Korean Acad Nurs 2013;43(3):409-419.   Published online June 28, 2013
DOI: https://doi.org/10.4040/jkan.2013.43.3.409
AbstractAbstract PDF
Purpose

The purpose of this study was to describe and explore the experience process of life of patients with Crohn's disease.

Methods

Using a grounded theory methodology, 24 interviews were performed with 7 men and 5 women, 17-47 years of age, suffering from Crohn's disease.

Results

'Tuning of two conflicting lives' was identified as the core category, and 5 subcategories were identified and they were integrated into the core category. The identified outcomes were 'Living a withdrawn life', 'coping flexibly', 'drifting with tangled emotions' and 'maintaining long-term remission'.

Conclusion

When caring for these patients, it is important to identify needs, allow patients to express what they want at that moment and support them in maintaining a daily life that can be perceived as normal.

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Effect of Kegel Exercise to Prevent Urinary and Fecal Incontinence in Antenatal and Postnatal Women: Systematic Review
Seong-Hi Park, Chang-Bum Kang, Seon Young Jang, Bo Yeon Kim
J Korean Acad Nurs 2013;43(3):420-430.   Published online June 28, 2013
DOI: https://doi.org/10.4040/jkan.2013.43.3.420
AbstractAbstract PDF
Purpose

The aim of this study was to review the literature to determine whether intensive pelvic floor muscle training during pregnancy and after delivery could prevent urinary and fecal incontinence.

Methods

Randomized controlled trials (RCT) of low-risk obstetric populations who had done Kegel exercise during pregnancy and after delivery met the inclusion criteria. Articles published between 1966 and 2012 from periodicals indexed in Ovid Medline, Embase, Scopus, KoreaMed, NDSL and other databases were selected, using the following keywords: 'Kegel, pelvic floor exercise'. The Cochrane's Risk of Bias was applied to assess the internal validity of the RCT. Fourteen selected studies were analyzed by meta-analysis using RevMan 5.1.

Results

Fourteen RCTs with high methodological quality, involving 6,454 women were included. They indicated that Kegel exercise significantly reduced the development of urinary and fecal incontinence from pregnancy to postpartum. Also, there was low clinical heterogeneity.

Conclusion

There is some evidence that for antenatal and postnatal women, Kegel exercise can prevent urinary and fecal incontinence. Therefore, a priority task is to develop standardized Kegel exercise programs for Korean pregnant and postpartum women and make efficient use of these programs.

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Adaptation Experiences in South Korea of Men defecting from North Korea
Kyoung Mi Kim, Miyoung Kim
J Korean Acad Nurs 2013;43(3):431-441.   Published online June 28, 2013
DOI: https://doi.org/10.4040/jkan.2013.43.3.431
AbstractAbstract PDF
Purpose

The study was done to explore meanings and essence of the experience in South Korea of men defectors from North Korea.

Methods

Data were collected from March, 2011 to May, 2012, through in-depth interviews with ten men defectors. Data analysis was conducted using the process of hermeneutic phenomenological reflection.

Results

Eight essential themes were extracted; 'buoyant expectation for a new life', 'feeling guilty about family left behind in North Korea', 'inability to become acclimatized due to communication difficulties', 'inability to socialize with South Koreans due to different lifestyles', 'finding strength through trustworthy acquaintances', 'continuing reconciliation with oneself while trying to assimilate into South Korean culture', 'self-realization of one's original self', and 'continuing to feel out the possibility of a future in South Korea'.

Conclusion

The findings indicate that North Korean men who defect to South Korea shape their identity through three phases: forming self-image during escape from North Korea, trying to become accustomed to South Korean society, and finding their own identity by self-realization of their original self. Eventually, the whole process enables them to recover their identity, to feel a sense of belonging, and to discover possibilities for a better future.

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A Predictive Model of Depression in Rural Elders-Decision Tree Analysis
Seong Eun Kim, Sun Ah Kim
J Korean Acad Nurs 2013;43(3):442-451.   Published online June 28, 2013
DOI: https://doi.org/10.4040/jkan.2013.43.3.442
AbstractAbstract PDF
Purpose

This descriptive study was done to develop a predictive model of depression in rural elders that will guide prevention and reduction of depression in elders.

Methods

A cross-sectional descriptive survey was done using face-to-face private interviews. Participants included in the final analysis were 461 elders (aged≥ 65 years). The questions were on depression, personal and environmental factors, body functions and structures, activity and participation. Decision tree analysis using the SPSS Modeler 14.1 program was applied to build an optimum and significant predictive model to predict depression in rural elders.

Results

From the data analysis, the predictive model for factors related to depression in rural elders presented with 4 path-ways. Predictive factors included exercise capacity, self-esteem, farming, social activity, cognitive function, and gender. The accuracy of the model was 83.7%, error rate 16.3%, sensitivity 63.3%, and specificity 93.6%.

Conclusion

The results of this study can be used as a theoretical basis for developing a systematic knowledge system for nursing and for developing a protocol that prevents depression in elders living in rural areas, thereby contributing to advanced depression prevention for elders.

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