Journal of Korean Academy of Nursing

Integrated and Person-Centered Nursing in the Era of the 4^th Industrial Revolution: Kim, Hyoung Suk , Jang, Sun Joo , Kim, Jeung-Im; J Korean Acad Nurs 2021;51(3):261-264. Published online June 30, 2021; DOI: https://doi.org/10.4040/jkan.51301

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Effectiveness of Drinking Reduction Program Focused on Self-Determination Enhancement for College Students with Problematic Drinking: Ma, Jin-Kyoung , Yoo, Moon-Sook; J Korean Acad Nurs 2021;51(3):265-279. Published online June 30, 2021; DOI: https://doi.org/10.4040/jkan.20247

Abstract PDF: Purpose
This study examined the impact of a drinking reduction program on drinking motivation, drinking refusal self-efficacy, and problematic drinking behaviors in college students with problematic drinking habits.
Methods
This study incorporated a non-equivalent control group prepost-test design. Study participants included 58 college students who scored 12 or more in the AUDIT-K test (Alcohol Use Disorders Identification Test-Korean version) (experimental group: 30; control group: 28). The intervention consisted of eight sessions and was conducted once a week. It was designed to promote autonomy, competence, and relatedness-the three elements of basic psychological needs in self-determination theory. The participants were assessed before the intervention, immediately after, and four weeks post intervention. Data were collected from October 12 to December 31, 2017. The analysis employed the chi-square test, Fisher’s exact test, independent t-test, and repeated measures ANOVA using SPSS/WIN 22.0.
Results
The mean age of participants was 21.8 years. There were 30 men (51.7%) and 28 women (48.3%). The differences in drinking motivation, drinking refusal self-efficacy, and problematic drinking behaviors were statistically significant for the group by time interaction (F = 42.56, p < .001; F = 54.96, p < .001; F = 39.90, p < .001, respectively). Conclusion: The findings indicate that the intervention effectively decreases drinking motivation, increases drinking refusal self-efficacy, and decreases problematic drinking behaviors. It can be an efficient strategy for college students with problematic drinking habits to enhance their self-determination ability.

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Development of a Diabetic Foot Ulceration Prediction Model and Nomogram: Lee, Eun Joo , Jeong, Ihn Sook , Woo, Seung Hun , Jung, Hyuk Jae , Han, Eun Jin , Kang, Chang Wan , Hyun, Sookyung; J Korean Acad Nurs 2021;51(3):280-293. Published online June 30, 2021; DOI: https://doi.org/10.4040/jkan.20257

Abstract PDF: Purpose
This study aimed to identify the risk factors for diabetic foot ulceration (DFU) to develop and evaluate the performance of a DFU prediction model and nomogram among people with diabetes mellitus (DM).
Methods
This unmatched case-control study was conducted with 379 adult patients (118 patients with DM and 261 controls) from four general hospitals in South Korea. Data were collected through a structured questionnaire, foot examination, and review of patients’ electronic health records. Multiple logistic regression analysis was performed to build the DFU prediction model and nomogram. Further, their performance was analyzed using the Lemeshow–Hosmer test, concordance statistic (C-statistic), and sensitivity/specificity analyses in training and test samples.
Results
The prediction model was based on risk factors including previous foot ulcer or amputation, peripheral vascular disease, peripheral neuropathy, current smoking, and chronic kidney disease. The calibration of the DFU nomogram was appropriate (χ² = 5.85, p = .321). The C-statistic of the DFU nomogram was .95 (95% confidence interval .93~.97) for both the training and test samples. For clinical usefulness, the sensitivity and specificity obtained were 88.5% and 85.7%, respectively at 110 points in the training sample. The performance of the nomogram was better in male patients or those having DM for more than 10 years.
Conclusion
The nomogram of the DFU prediction model shows good performance, and is thereby recommended for monitoring the risk of DFU and preventing the occurrence of DFU in people with DM.

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3 Web of Science

Influences of Autonomic Function, Salivary Cortisol and Physical Activity on Cognitive Functions in Institutionalized Older Adults with Mild Cognitive Impairment: Based on Neurovisceral Integration Model: Suh, Minhee; J Korean Acad Nurs 2021;51(3):294-304. Published online June 30, 2021; DOI: https://doi.org/10.4040/jkan.20282

Abstract PDF: Purpose
This study aimed to investigate objectively measured physical activity (PA) in institutionalized older adults with mild cognitive impairment (MCI) and to elucidate the influence of autonomic nervous function, salivary cortisol, and PA on cognitive functions based on neurovisceral integration model.
Methods
Overall cognitive function was evaluated using the mini-mental state examination (MMSE) and executive function was evaluated using semantic verbal fluency test and clock drawing test. Actigraph for PA, HRV and sAA for autonomous function, and the geriatric depression scale for depression were used. Saliva specimens were collected in the morning for sAA and cortisol.
Results
Ninety-eight older adults from four regional geriatric hospitals participated in the study. They took 4,499 steps per day on average. They spent 753.93 minutes and 23.12 minutes on average in sedentary and moderate-to-vigorous activity, respectively. In the multiple regression analysis, lower salivary cortisol level (β = - .33, p = .041) and greater step counts (β = .37, p = .029) significantly improved MMSE score. Greater step count (β = .27, p = .016) also exerted a significant influence on verbal fluency, and greater sAA (β = .35, p = .026) was significantly associated with a better clock drawing test result.
Conclusion
Salivary cortisol, sAA and physical activity were significantly associated with cognitive functions. To prevent older adults from developing dementia, strategies are needed to increase their overall PA amount by decreasing sedentary time and to decrease salivary cortisol for cognitive function, and to maintain their sympathetic nervous activity for executive function.

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2 Web of Science

Development of a Positive Nursing Organizational Culture Measurement Tool: Kim, Mi Jung , Kim, Jong Kyung; J Korean Acad Nurs 2021;51(3):305-319. Published online June 30, 2021; DOI: https://doi.org/10.4040/jkan.21014

Abstract PDF: Purpose
The purpose of this study was to develop a measurement tool for a positive nursing organizational culture and to verify its reliability and validity.
Methods
A conceptual framework and construct factors were extracted through an extensive literature review and indepth interviews with nurses. The final version of the preliminary tool for the main survey was confirmed by experts through a content validity test and a preliminary survey of 40 nurses. Subsequently, the final tool was developed using a validity and reliability test containing 43 preliminary items. The final version of the tool was used with 327 hospital nurses in the testing phase for the main survey to assess validity and reliability.
Results
From the factor analysis, 4 factors and 26 items were selected. The factors were positive leadership of the nursing unit manager, pursuit of common values, formation of organizational relationships based on trust, and a fair management system. The entire determination coefficient was 67.7%. These factors were verified through convergent, discriminant, and concurrent validity testing. The internal consistency reliability was acceptable (Cronbach’s α = .95).
Conclusion
Both the validity and reliability of the scale were confirmed demonstrating its utility for measuring positive nursing organizational culture. It is expected to be used for education, research, and practical performance policies regarding the nursing organizational culture.

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6 Web of Science

Job Retention Process among Working People with Mental Illness: A Grounded Theory Approach: Hyun, Myung Sun , Nam, Kyoung A , Kim, Hyunlye , Kim, Su Young; J Korean Acad Nurs 2021;51(3):320-333. Published online June 30, 2021; DOI: https://doi.org/10.4040/jkan.21016

Abstract PDF: Purpose
The study was conducted to explore the experiences of job retention among working people with mental illness.
Methods
The participants were members with mental illness at the S Community Mental Health Center in Gyeonggi Province and who had been working for more than six months. The data were collected through in-depth interviews with 11 participants between June 27 and August 20, 2018. The data were analyzed through Corbin and Strauss’s grounded theory method.
Results
The core category was struggling to take root in the community as a productive member. The core phenomenon was the desire to be a productive person, and the causal condition was the willingness to change for a purposeful life. The action and interaction strategies included maintaining regular living patterns, maintaining medication, developing one’s tips for self-management, and self-approval. The intervening conditions were difficulties in forming social relationships, presence of symptoms, social resources, and acceptance of one’s mental illness. The consequences were restoration of family relationships, healthy pleasure through work, social inclusion, development of self-worth, and transition to an independent person.
Conclusion
Working people with mental illness are struggling to take root in the community as a productive member. This study suggests that a holistic understanding of the job retention experience among people with mental illness is required. The findings will provide the basis for developing interventions that can improve job retention among working people with mental illness.

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Development and Evaluation of Resilience Enhancement Program Applying Mindfulness Meditation in Patients with Ileostomy: Shin, Jee Hye , Choi, Ja Yun; J Korean Acad Nurs 2021;51(3):334-346. Published online June 30, 2021; DOI: https://doi.org/10.4040/jkan.21019

Abstract PDF: Purpose
The purpose of this study was to develop a resilience enhancement program applying mindfulness meditation (REP-MM) and evaluate the effects of the program on post-traumatic stress (PTS), resilience, and health-related quality of life (HRQoL) in patients with ileostomy.
Methods
The REP-MM was developed by combining the resilience enhancement program with mindfulness meditation according to four patterns. The program was developed through identifying patients’ needs, reviewing relevant literature, developing a preliminary program, and testing content validity and user evaluation. The participants were 55 patients with ileostomy. We conveniently assigned 27 patients to the experimental group and 28 to the control group. The study was conducted in conducted in a hospital from January 22 to May 30, 2019. The REPMM was provided to the experimental group, and conventional ileostomy care was provided to the control group using a nonequivalent control-group pretest-posttest design. Results: ANCOVA revealed that the levels of PTS (F = 321.64, p < .001), resilience (F = 111.86, p < .001), and HRQoL (F = 31.08, p < .001) in the experimental group were higher than those in the control group when comparing pretest to posttest changes.
Conclusion
The REP-MM is effective in PTS, resilience, and HRQoL in patients suffering from post-stoma creation crisis. The REP-MM can induce positive self-recognition changes in patients with ileostomy through dispositional, situational, relational, and philosophical interventions. We suggest nurses reduce PTS and improve resilience and HRQoL in patients with ileostomy.

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3 Web of Science

Effects of a Cognitive Behavior Therapy Program for Patients with Fibromyalgia Syndrome: A Randomized Controlled Trial: Kong, Kyoung Ran , Lee, Eun Nam; J Korean Acad Nurs 2021;51(3):347-362. Published online June 30, 2021; DOI: https://doi.org/10.4040/jkan.21025

Abstract PDF: Purpose
This study developed a cognitive behavioral therapy program aimed at altering the physical condition, emotions, and behaviors of fibromyalgia patients, and confirmed the program’s clinical applicability. The program was developed by analyzing previous studies conducting in-depth interviews with fibromyalgia patients, drawing on cognitive behavior theory to establish the program contents, recruiting experts to test its validity, and conducting a preliminary survey.
Methods
To confirm the program’s effect, this study used a randomized controlled trial design. The participants were outpatients diagnosed with fibromyalgia in Dong-A University Hospital, Busan. The 30 patients in the experimental group took part in the program, which comprised 8 sessions (90 to 120 minutes) based on cognitive behavior theory, delivered over 8 weeks. Hypothesis testing was carried out using the repeated measures ANOVA.
Results
The analysis revealed significant differences between the experimental and control groups in positive automatic thoughts, pain, fatigue, depression, and interpersonal relationships. However, there was no significant difference between the groups in terms of sleep disorders and negative automatic thoughts.
Conclusion
This program is a positive effect on physical condition, emotions, and behaviors. It is thus expected to be used to help fibromyalgia patients improve their disease conditions.

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Validity and Reliability of the Korean Version of Person-Centered Practice Inventory–Staff for Nurses: Kim, Sohyun , Tak, Sunghee H; J Korean Acad Nurs 2021;51(3):363-379. Published online June 30, 2021; DOI: https://doi.org/10.4040/jkan.21027

Abstract PDF: Purpose
The purpose of this study was to evaluate the validity and reliability of the Korean version of Person-Centered Practice Inventory– Staff (PCPI-S) for nurses.
Methods
The English PCPI-S was translated into Korean with forward and backward translation. Data were collected from 338 nurses at one general hospital in Korea. Construct validity was evaluated with confirmatory factor analysis, convergent validity, and discriminant validity. Known-group validity was also evaluated. Cronbach’s α was used to assess the reliability.
Results
The PCPI-S Korean version consisted of 51 items in three areas: prerequisites, the care environment, and person-centered process. The comparative fit index (CFI) and values of person-centered care process were improved after engagement and having sympathetic presence items were combined as one component. The construct validity of PCPI-S Korean version was verified using four-factor structures (.05 < RMSEA < .10, AGFI > .70, CFI > .70, and AIC). The convergent validity and discriminant validity of the entire PCPI-S question were verified using a two-factor structures (AVE > .50, construct reliability > .70). There was an acceptable known-group validity with a significant correlation between the PCPI-S level and the degree of person-centered care awareness and education. Internal consistency was reliable with Cronbach’s α .95.
Conclusion
The Korean version of PCPI-S is valid and reliable. It can be used as a standardized Korean version of person-centered care measurement tool. Abbreviation: RMSEA = root mean square error of approximation; AGFI = adjusted goodness of fit index; AIC = Akaike information criterion; AVE = average variance extracted.

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8 Web of Science

Associations between Cigarette and Electronic Cigarette Use and Sleep Health in Korean Adolescents: An Analysis of the 14th (2018) Korea Youth Risk Behavior Surveys: Lee, Bo Gyeong , Lee, Haein; J Korean Acad Nurs 2021;51(3):380-389. Published online June 30, 2021; DOI: https://doi.org/10.4040/jkan.21034

Abstract PDF: Purpose
This study aimed to understand the relationship between cigarette and electronic cigarette (e-cigarette) use and sleep health among Korean adolescents.
Methods
Using the 14th Korea Youth Risk Behavior Survey, we included 52,928 adolescents who responded to sleep satisfaction and sleep duration. Participants were classified into four groups: non-users, cigarette-only users, e-cigarette-only users, and dual users of both products. To examine the associations between cigarette and e-cigarette use and sleep health, data were analyzed using complex samples cross tabulation and complex samples logistic regression.
Results
Of the four groups, dual users reported the lowest level of sleep satisfaction and sleep duration; 57.0% and 86.9% of dual users were not satisfied with their sleep and have insufficient sleep duration, respectively. The proportion of students who were not satisfied with their sleep was higher among cigarette-only users compared to e-cigarette-only users (52.7% vs. 45.8%), but the two groups reported similar rates of insufficient sleep duration (84.2% vs. 84.3%). Compared to non-users, cigarette-only users, e-cigarette-only users, and dual users were more likely to not be satisfied with sleep (odds ratios [ORs] were 1.49, 1.36, and 1.75, respectively) and had significantly higher odds of experiencing insufficient sleep duration (ORs were 1.85, 2.06, and 2.34, respectively).
Conclusion
E-cigarette-only use and dual use as well as cigarette-only use were associated with poor sleep health. Therefore, to improve adolescent sleep health, health professionals should provide sleep intervention strategies considering the association between smoking and sleep health.

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2 Web of Science

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