Journal of Korean Academy of Nursing

Development of Caring as a Human Science: 50 Years of History of the Korean Society of Nursing Science: Kim, Jeung-Im , Suh, Eunyoung E. , Song, Ju-Eun , Im, YeoJin , Park, Jin-Hee , Yu, Soyoung , Jang, Sun Joo , Kim, Da-Hee; J Korean Acad Nurs 2020;50(3):313-332. Published online June 30, 2020; DOI: https://doi.org/10.4040/jkan.20142

Abstract PDF: Purpose
This year 2020 marks the 50th anniversary of the founding of the Korean Society of Nursing Science (KSNS). This study wasaimed to explore development of caring and describe the 50 years of history of KSNS within the sociocultural context of Korea regardingacademic footsteps, meanings, and implications for the future.
Methods
This study used a historical research methodology using a literaturereview and bibliometric analysis. Relevant literature was reviewed and the published abstracts in the Journal of Korean Academy ofNursing (JKAN) were analyzed using VOSviewer.
Results
Birth control and family planning in the 1970s was the main research topic. In the1980s, the development of nursing concepts, theories, and philosophies was the mission of KSNS to extend the disciplinary boundary. In the1990s, the progress of KSNS to become one of the woman-dominant healthcare professionals was the mission in the given period. Expandingthe frontiers of KSNS to the extent of global standards was the undertaking of the nursing scholars in the 2000s. Lastly, in the 2010s,the quality and quantity improvement of KSNS and JKAN is expected to make our future even prosperous. The map visualization of the 50years of research accumulation showed the comparable opposition of quantitative vs. qualitative research methodologies, equation modeling,and instrument development.
Conclusion
These clusters of research demonstrates the efforts to make nursing evidence by Koreannursing scholars for the last five decades. The growth in the slope of KSNS and outcomes of JKAN are to carry on to an unimaginable extentin the future.

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Nurse Staffing and Health Outcomes of Psychiatric Inpatients: A Secondary Analysis of National Health Insurance Claims Data: Park, Suin , Park, Sohee , Lee, Young Joo , Park, Choon-Seon , Jung, Young-Chul , Kim, Sunah; J Korean Acad Nurs 2020;50(3):333-348. Published online June 30, 2020; DOI: https://doi.org/10.4040/jkan.19203

Abstract PDF: Purpose
The present study investigated the association between nurse staffing and health outcomes among psychiatric inpatients in Koreaby assessing National Health Insurance claims data.
Methods
The dataset included 70,136 patients aged 19 years who were inpatientsin psychiatric wards for at least two days in 2016 and treated for mental and behavioral disorders due to use of alcohol; schizophrenia,schizotypal and delusional disorders; and mood disorders across 453 hospitals. Nurse staffing levels were measured in three ways: registerednurse-to-inpatient ratio, registered nurse-to-adjusted inpatient ratio, and nursing staff-to-adjusted inpatient ratio. Patient outcomesincluded length of stay, readmission within 30 days, psychiatric emergency treatment, use of injected psycholeptics for chemical restraint,and hypnotics use. Relationships between nurse staffing levels and patient outcomes were analyzed considering both patient and systemcharacteristics using multilevel modeling.
Results
Multilevel analyses revealed that more inpatients per registered nurse, adjusted inpatientsper registered nurse, and adjusted inpatients per nursing staff were associated with longer lengths of stay as well as a higher risk of readmission.More adjusted inpatients per registered nurse and adjusted inpatients per nursing staff were also associated with increased hypnoticsuse but a lower risk of psychiatric emergency treatment. Nurse staffing levels were not significantly associated with the use of injectedpsycholeptics for chemical restraint.
Conclusion
Lower nurse staffing levels are associated with negative health outcomes of psychiatricinpatients. Policies for improving nurse staffing toward an optimal level should be enacted to facilitate better outcomes for psychiatricinpatients in Korea.

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Parental Factors Associated with Smartphone Overuse in Preschoolers: A Systematic Review and Meta-Analysis: Lee, Gumhee , Kim, Sungjae , Yu, Heajin; J Korean Acad Nurs 2020;50(3):349-368. Published online June 30, 2020; DOI: https://doi.org/10.4040/jkan.19186

Abstract PDF: Purpose
This study aimed to identify parental factors associated with smartphone overuse in preschoolers.
Methods
A systematic reviewwas conducted according to PRISMA guidelines. Relevant studies published in peer-reviewed journals from 2009 to June 2019 were identifiedthrough systematic search in 10 electronic databases (PubMed, CINAHL, Cochrane Central, EMBASE, Web of Science, NDSL, KISS, KMbase,KoreaMed, and RISS). Standardized effect sizes were calculated to quantify the associations of parental factors with smartphoneoveruse in preschoolers using meta-analysis.
Results
A total of 30 cross-sectional studies involving 7,943 participants met the inclusioncriteria. The following were negatively correlated with smartphone overuse in preschoolers: mother’s parenting self-efficacy (r =-.35),mother-child attachment (r =-.28), mother’s positive parenting behavior (r =-.28), mother’s positive parenting attitude (r =-.25), and father’sparenting involvement (r =-.15). Further, maternal factors such as smartphone addiction tendency (r =.41), parenting stress (r =.40), negativeparenting behavior (r =.35), negative parenting attitude (r =.14), smartphone usage time (r =.26), employment status (r =.18), and age(r =.12) were positively correlated with smartphone overuse in preschoolers.
Conclusion
Several parental factors influence smartphoneoveruse in preschoolers. These findings emphasize the need to assess and enhance the parental factors identified in this study to preventsmartphone overuse in preschoolers. Accordingly, we recommend the development of preventive interventions to strengthen parent-relatedprotective factors and mitigate risk factors.

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Effects of First Assisted Reproductive Technologies on Anxiety and Depression among InfertileWomen: A Systematic Review and Meta-Analysis: Ha, Ju-Young , Ban, Seon-Hwa , Lee, Hae-Jung , Lee, Misoon; J Korean Acad Nurs 2020;50(3):369-384. Published online June 30, 2020; DOI: https://doi.org/10.4040/jkan.19187

Abstract PDF: Purpose
The purpose of this study was to analyze anxiety and depression among infertile women at different time points during the firstIn Vitro Fertilization (IVF) or Intracytoplasmic Sperm Injection (ICSI) treatment through a systematic review and meta-analysis.
Methods
Seven out of 3,011 studies were included for meta-analysis. To estimate the effect size, a meta-analysis of the studies was performedusing the RevMan 5.3 program. We compared the measurement outcomes at three time points: before the start of treatment (T0), cancellationof treatment after pregnancy detection (T2), one to six months after treatment (T3). The effect size used was the standardizedmean difference (SMD).
Results
In comparing the different time points of the pregnant women from their cycle, significantly lower levelsof depression were found at T2 than at T0. In non-pregnant women, anxiety at T2 and depression at T2 and T3 were significantly higherthan those at T0. At T2 and T3, the non-pregnant women reported higher levels of anxiety and depression compared with the pregnantwomen.
Conclusion
Anxiety and depression in infertile women undergoing the first IVF or ICSI are associated with the time points andpregnancy status after treatment. These findings suggest that attention should be paid to helping infertile women prepare for and copewith treatment and treatment failure.

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A Meta-Analysis on the Effects of Mind-Body Therapy on Patients with Irritable Bowel Syndrome: Choi, Eun Hui , Kim, Moon Ja , Lee, Eun Nam; J Korean Acad Nurs 2020;50(3):385-400. Published online June 30, 2020; DOI: https://doi.org/10.4040/jkan.19224

Abstract PDF: Purpose
Previous randomized controlled trials (RCT) found that mind-body therapy can improve the health outcomes of patients with irritablebowel syndrome (IBS). The purpose of this meta-analysis was to identify the combined effects of mind-body therapy on patients’ IBSsymptoms, quality of life, anxiety, and depression.
Methods
A systematic literature search was conducted using various databases such asPubMed, EMBASE, CINAHL CENTRAL, DBpia, RISS, and KISS. The primary outcome variables were IBS symptoms and quality of life; the secondaryoutcome variables were anxiety and depression. Comprehensive Meta-Analysis version 3.0 was used to analyze the extracted data.The effect size was calculated using standardized mean difference (SMD) and 95% confidence interval (CI).
Results
Eleven final RCTs wereused for this meta-analysis. Mind-body therapy was found to have a significant effect on the IBS patients’ symptoms (SMD, -0.63; 95% CI,-0.77 to -0.48), quality of life (SMD, 1.03; 95% CI, 0.40 to 1.66), anxiety (SMD, -0.28; 95% CI, -0.47 to -0.09), and depression (SMD,-0.31; 95% CI, -0.06 to -0.12).
Conclusion
This meta-analysis reveals that mind-body therapy significantly improves IBS patients’ symptoms,quality of life, anxiety, and depression. The results suggest that, in the future, appropriate mind-body therapy should be applied toKoreans suffering from IBS. Moreover, the therapy’s long-term effects should be assessed.

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Prevalence of Menstrual Disorders according to Body Mass Index and Lifestyle Factors: The National Health Insurance Service-National Health Screening Cohort in Korea, 2009~2016: Park, SoMi , Yoon, Tae Woong , Kang, Dae Ryong , Chung, ChaeWeon; J Korean Acad Nurs 2020;50(3):401-410. Published online June 30, 2020; DOI: https://doi.org/10.4040/jkan.20054

Abstract PDF: Purpose
This study was performed to identify the prevalence of menstrual disorders in Korean women based on body mass index (BMI)and lifestyle factors, by utilizing the Korean National Health Insurance Database.
Methods
A retrospective observational study designwas used for the secondary data analysis. Data of women aged 15 to 49 years who were diagnosed with menstrual disorders were extractedfrom The National Health Insurance Service-National Health Screening Cohort in Korea from 2009 to 2016. The age-standardizedprevalence rate of menstrual disorders was calculated using SAS version 9.4, and a Chi-square test and Cochran-Armitage test were performed.
Results
In total, 2,219,445 cases were extracted from the database. The prevalence of menstrual disorders significantly increasedfrom 8.6% to 11.6% (Z=135.16, p for trend <.001) over the past eight years. In particular, it was higher in underweight womenthan in women with normal weight across all years (Z=-4.18~-14.72, p <.001). Moreover, statistically significant differences in the prevalenceof menstrual disorders were found to be associated with drinking and smoking in all years and with physical activity levels in part(p <.05~.001).
Conclusion
These findings present compelling evidence on the prevalence of menstrual disorders based on a national database.Since the prevalence of menstrual disorders has steadily increased and differs based on BMI and lifestyle factors, educational andclinical interventions are necessary to promote risk awareness and appropriate behavioral changes among Korean women.

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The Predictive Strength of Students’ Self-Efficacy, Problem Solving Skills to Perform Catheter Care: Ozlem, Dogu Kokcu , Celalettin, Cevik; J Korean Acad Nurs 2020;50(3):411-418. Published online June 30, 2020; DOI: https://doi.org/10.4040/jkan.20002

Abstract PDF: Purpose
The aim of this study was to determine the predictive strength of students’ self-efficacy, problem-solving skills, and other characteristicsin performing intravenous practices and monitor phlebitis and infiltration.
Methods
This cross-sectional study was carried outwith 736 third and fourth-year students studying at the Health Sciences Faculties of Balikesir and Sakarya universities. The data were collectedusing the Self-Efficacy Scale, Problem-Solving Inventory and Catheter Care and Infiltration Monitoring Questionnaire.
Results
Theparticipants’ mean Catheter Care and Infiltration Monitoring Questionnaire score significantly and positively correlated with their meanSelf-Efficacy Scale score on a moderate level (r=.25; p <.001) but significantly and negatively correlated with their mean Problem-SolvingInventory score on a moderate level (r=-.21; p <.001). In other words, because a low Problem-Solving Inventory score indicates that theperson’s problem-solving skill is high, the Care and Infiltration Monitoring Questionnaire score increased as the problem-solving skill increased.While the Self-Efficacy Scale predicted the year of study and catheter care and infiltration monitoring variables positively, theProblem-Solving Inventory predicted the satisfaction with the profession variable negatively.
Conclusion
Self-efficacy, problem-solving, likingthe profession, and year of study predict success in catheter care and infiltration monitoring. For this reason, guidance may be providedin the development of a comprehensive education system toward increasing students’ problem-solving skills, self-efficacy, and professionalknowledge and skills.

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Effect of Emotional Coaching Program for Clinical Nurses on Resilience, Emotional Labor, and Self-efficacy: Ryu, Kyung , Kim, Jong Kyung; J Korean Acad Nurs 2020;50(3):419-430. Published online June 30, 2020; DOI: https://doi.org/10.4040/jkan.19194

Abstract PDF: Purpose
This study aimed to assess the effect of the emotional coaching program for hospital nurses.
Methods
The study used anon-equivalent control group pretest-posttest design, and participants included 60 nurses (30 in the experimental group and 30 in thecontrol group) who worked at a general hospital. The experimental group attended four sessions, one per week, with each session lastingtwo and a half hours. Collected data were analyzed using descriptive statistics, Fisher’s exact test, x² test, t-test, paired t-test, and repeatedmeasures ANOVA using SPSS WIN 23.0 program.
Results
Significant differences were shown between the experimental and the controlgroups regarding emotional labor (F=68.40, p<.001), resilience (F=48.77, p<.001), and self-efficacy (F=15.31, p<.001).
Conclusion
Theemotional coaching program for nurses is useful for enhancing nurses’ emotional labor management, resilience, and self-efficacy. In addition,this program may serve as a basis for providing emotional coaching to nurses in the future.

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Factors Influencing Health Behavior Related to Particulate Matter in Older Adults: Park, Min Kyung , Kim, Gwang Suk; J Korean Acad Nurs 2020;50(3):431-443. Published online June 30, 2020; DOI: https://doi.org/10.4040/jkan.19201

Abstract PDF: Purpose
This study aimed to investigate health behavior related to particulate matter (PM) in older adults and examine the factors affectingit.
Methods
A cross-sectional survey design was used. Data were collected from 150 voluntary older adult participants from Songpa-gu inSeoul. The survey questions measured service perception and experience related to PM, risk perception related to PM, attitude toward riskof PM, and health behavior related to PM.
Results
The average score for health behavior related to PM was 79.37, ranging from 51 to 115.There was a significant positive correlation between health behavior related to PM and risk perception related to PM (r=.58, p <.001) as wellas between health behavior related to PM and attitude toward risk of PM (r=.70, p<.001). Multiple linear regression revealed that healthbehavior related to PM was predicted by levels of the existence of disease related to PM (β=.14, p=.019), service experience related to PM(b=.20, p=.021), risk perception related to PM (b=.20, p=.019), and attitude toward risk of PM (b=.44, p<.001). The model including thesevariables accounted for 47.0% of health behavior related to PM.
Conclusion
Korean older adults have the low level of health behaviorrelated to PM. The findings of this study emphasize that risk perception and attitude toward risk of PM should be evaluated, and theunderlying diseases related to PM and their service experience should be considered in developing intervention to improve health behaviorrelated to PM.

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Development of Job-Esteem Scale for Korean Nurses: Choi, Hyun Ju , Jung, Kwuy Im; J Korean Acad Nurs 2020;50(3):444-458. Published online June 30, 2020; DOI: https://doi.org/10.4040/jkan.19209

Abstract PDF: Purpose
The purpose of this study was to develop the Job Esteem Scale for Korean Nurses (JES-KN) and verify its validity and reliability.
Methods
Preliminary items were based on the attributes and indicators elicited from a concept analysis study on Korean nurses’ job-esteem.The final preliminary tool for the main survey was confirmed through the content validity test of 10 experts and preliminary surveyof 20 hospital nurses. The final preliminary scale was used on 350 hospital nurses in the scale testing phase for the main survey designedto test the validity and reliability of the scale.
Results
The final scale consisted of 28 items and 6 factors, these factor explained 66.6% ofthe total variance. The correlation between the total score and factors ranged from .64 and .84, validating that each sub-factor is suitableto explain job esteem. The correlation coefficient between this scale and the Job Satisfaction Scale for Clinical Nurses ranged from .41 to.70, and the internal consistency for the scale using Cronbach’s a for the total items was .94.
Conclusion
The JES-KN is a valid and reliabletool that reflects the reality of clinical sites accordingly. The JES-KN may well be used effectively to assess and evaluate the job esteem ofKorean nurses.

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Effect of Lifestyle Intervention Program for Overweight and Obesity Pregnant Women: Choi, Hye Kyung , Kim, Hyeon Ok; J Korean Acad Nurs 2020;50(3):459-473. Published online June 30, 2020; DOI: https://doi.org/10.4040/jkan.19228

Abstract PDF: Purpose
This study was conducted to identify the effects of a lifestyle intervention program on weight gain, dietary habits, fatigue andpregnancy stress, blood pressure, and neonatal birth weight, using Cox’s interaction model of client health behavior for overweight andobese women.
Methods
This was a quasi-experimental research with a non-equivalent control group pre-post test design. A total of 52patients who met the selection criteria, including 25 in the experimental group and 27 in the control group, were the subjects of the study;they comprised overweight and obese pregnant women who were receiving prenatal care at A and B women’s hospital in J province. Thelifestyle intervention program ran for 12 weeks in total and consisted of interactions involving affective support, health information, andprofessional/technical competencies. The data collection period was from February 1, 2017 to August 31, 2017.
Results
This study showeddifferences in the appropriate weight gain rate (x²=6.17, p=.013), suppression of an increase in fatigue (t=-2.32, pp =.012), and an increasein pregnancy stress (t=-1.87, p=.034). Yet, no differences in physical activity, dietary habits change, blood pressure, and neonatal birthweight (p>.05) were found.
Conclusion
The study findings indicate that this program could be an effective intervention for the control ofappropriate weight gain, fatigue, and pregnancy stress. Therefore, a lifestyle intervention program based on Cox’s interaction model of clienthealth behavior could be an efficient strategy for a positive health outcome of overweight and obesity pregnant women.

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Development and Validation of the Self-Care for Aspiration Pneumonia Prevention Scale in the Community Dwelling Elderly with Risk of Dysphasia: Yang, Eun Young , Lee, Shin-Young; J Korean Acad Nurs 2020;50(3):474-486. Published online June 30, 2020; DOI: https://doi.org/10.4040/jkan.20041

Abstract PDF: Purpose
The purpose of this study was to develop and validate a Korean version of the Self-Care for Aspiration Pneumonia Prevention(SCAPP-K) scale in older adults at risk of dysphasia.
Methods
The Hertz and Baas model of scale development and validation was used. Inthe development stage, items were generated via literature review and interviews with medical experts, older adults, and caregivers. Tenexperts assessed the items for content validity. Subsequently, 12 older adults participated in a pilot test to determine the comprehensibilityand appropriateness of the SCAPP-K scale. The validation stage involved a cross-sectional survey with 203 older adults for exploratoryfactor analysis (EFA) and 200 older adults for confirmatory factor analysis (CFA) and to determine convergent and discriminant validity. Totest the validity and reliability of the scale, EFA using principal component analysis with varimax rotation and CFA were conducted, andconvergent and discriminant validity as well as internal consistency reliability were determined.
Results
As a result of EFA, three self-carefactors (knowledge, resources, behaviors) with 21 items were validated. The CFA and convergent and discriminant validity indicated theapplicability of the three-factor self-care scale. The reliability of the SCAPP-K scale was acceptable, with Cronbach’s a=.87~.91.
Conclusion
The SCAPP-K scale has acceptable validity and reliability and can contribute to clinical practice, research, and education to improveself-care for the prevention of aspiration pneumonia in older adults at risk of dysphasia.

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Validity and Reliability of the Korean Version of the Menopause-Specific Quality of Life: Park, Jin-Hee , Bae, Sun Hyoung , Jung, Young-Mi; J Korean Acad Nurs 2020;50(3):487-500. Published online June 30, 2020; DOI: https://doi.org/10.4040/jkan.20049

Abstract PDF: Purpose
This study aimed to evaluate the validity and reliability of the Korean version of Menopause-Specific Quality of Life (MENQOL).
Methods
The MENQOL was translated into Korean according to algorithm of linguistic validation process. A total of 308 menopausal womenwere recruited and assessed using the Korean version of MENQOL (MENQOL-K), the World Health Organization Quality of Life BriefVersion (WHOQOL-BREF), and Center for Epidemiological Studies Depression Scale (CES-D-K). In estimating reliability, internal consistencyreliability coefficients were calculated. Validity was evaluated through criterion validity and construct validity with confirmatory factor analysesusing SPSS 23.0 and AMOS 25.0 software.
Results
In item analyses, the “increased facial hair” symptom was excluded because of thelow contribution of MENQOL-K. The confirmatory factor analysis supported good fit and reliable scores for MENQOL-K model, and thefour-factor structure was validated (x²=553.28, p <.001, NC=1.84, RMSEA=.05, AGIF=.85, AIC=765.28). The MENQOL-K consists of 28 itemsin 4 domains, including vasomotor (3 items), psychosocial (7 items), physical (15 items), and sexual subscales (3 items). There was an acceptablecriterion validity with moderately significant correlation between MENQOL-K and WHOQOL-BREF. The Cronbach’s a for the 4subsacles ranged from .80 to .93.
Conclusion
The MENQOL-K is a valid and reliable scale to measure condition-specific quality of life forperimenopausal and postmenopausal women. It can be used to assess the impact of menopausal symptoms on the quality of life of Koreanwomen in clinical trials.

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