Journal of Korean Academy of Nursing

Challenges for the Activation of Advanced Practice Nursing in Korea: Yi, Young Hee; J Korean Acad Nurs 2024;54(3):297-299. Published online August 31, 2024; DOI: https://doi.org/10.4040/jkan.24074

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Legal and Practical Solutions for the Expanding the Roles of Medical Support Staff Nurses: Choi, Su Jung , Kim, Min Young; J Korean Acad Nurs 2024;54(3):300-310. Published online August 31, 2024; DOI: https://doi.org/10.4040/jkan.24075

Abstract PDF: Purpose
Medical support staff nurses have traditionally performed various supportive tasks for physicians, often extending beyond standard nursing roles. Despite these long-standing practices, there is a notable lack of official recognition and legal protection for these expanded responsibilities, leading to increasing legal concerns. Therefore, there is a need for proposing a rational solution to address these issues.
Methods
The number of medical support staff nurses is rising, particularly as they fill gaps left by the 2024 resident physician strike. The study focuses on identifying potential challenges arising from this shift and developing strategic improvements to address these challenges effectively.
Results
This study proposed legally expanding the scope of nursing duties and creating a robust system for training and certifying nurses to handle these responsibilities effectively, by integrating these roles within the advanced practice nurse (APN) framework.
Conclusion
Integrating these roles within the framework of APN can offer a sustainable and legally sound solution to the ongoing healthcare crisis, ensuring patient safety and safeguarding healthcare workers’ legal rights.

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Effects of Non-Pharmacological Interventions on Major Adverse Cardiac Events in Patients Underwent Percutaneous Coronary Intervention: Systematic Review and Meta-Analysis: Jo, Sojeong , Lee, Haejung , Park, Gaeun; J Korean Acad Nurs 2024;54(3):311-328. Published online August 31, 2024; DOI: https://doi.org/10.4040/jkan.24019

Abstract PDF: Purpose
In this study a systematic review and meta-analysis investigated the impact of non-pharmacological interventions on major adverse cardiac events (MACE) in patients with coronary artery disease who underwent percutaneous coronary intervention (PCI).
Methods
A literature search was performed using PubMed, Cochrane Library, EMBASE, and Cumulative Index to Nursing & Allied Health Literature databases up to November 2023. The risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. Effect sizes and 95% confidence intervals were calculated using R software (version 4.3.2).
Results
Eighteen randomized studies, involving 2,898 participants, were included. Of these, 16 studies with 2,697 participants provided quantitative data. Non-pharmacological interventions (education, exercise, and comprehensive) significantly reduced the risk of angina, heart failure, myocardial infarction, restenosis, cardiovascular-related readmission, and cardiovascular-related death. The subgroup meta-analysis showed that combined interventions were effective in reducing the occurrence of myocardial infarction (MI), and individual and group-based interventions had significant effects on reducing the occurrence of MACE. In interventions lasting seven months or longer, occurrence of decreased by 0.16 times, and mortality related to cardiovascular disease decreased by 0.44 times, showing that interventions lasting seven months or more were more effective in reducing MI and cardiovascular disease-related mortality.
Conclusion
Further investigations are required to assess the cost-effectiveness of these interventions in patients undergoing PCI and validate their short- and long-term effects. This systematic review underscores the potential of non-pharmacological interventions in decreasing the incidence of MACE and highlights the importance of continued research in this area (PROSPERO registration number: CRD42023462690).

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Moderating Effect of General Self-Efficacy on the Relationship between Pregnancy Stress, Daily Hassles Stress, and Preterm Birth Risk in Women Experiencing Preterm Labor: A Cross-Sectional Study: Cho, Hyun-Jeong , Kim, Jeung-Im; J Korean Acad Nurs 2024;54(3):329-339. Published online August 31, 2024; DOI: https://doi.org/10.4040/jkan.24008

Abstract PDF: Purpose
This study investigated the moderating role of general self-efficacy (GSE) on how stress caused by pregnancy and daily hassle affect the risk of preterm birth (PTB) in women experiencing preterm labor.
Methods
This cross-sectional study included 196 pregnant women experiencing preterm labor before 37 weeks of gestation. We used IBM SPSS Statistics 27 and employed Hayes process macro version 4 (model 1) and hierarchical regression to analyze the moderating effect of GSE on the relationship between pregnancy stress, daily hassle stress, and PTB risk.
Results
Stress caused by pregnancy and daily hassle was positively correlated to PTB risk (r = .54, p < .001; r = .25, p < .001, respectively). While GSE did not significantly correlate with pregnancy stress, it negatively correlated with daily hassle stress (r = - .19, p = .009). GSE significantly moderated the relationship between combined stressors and PTB risk. As GSE levels increased, escalation in PTB risk in response to increasing stress levels was a more pronounced, highlighting a complex interaction between higher GSE levels and response to escalating stress levels. This model accounted for 39.5% of the variance in the PTB risk.
Conclusion
Higher GSE may amplify the impact of stress on PTB risk, rather than mitigate it, which suggests a more nuanced role of GSE in the stress response of pregnant women at risk of preterm labor. GSE should be considered in care strategies, and managing its impact on stress perception and responses in pregnant women is crucial.

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Development of the Hybrid Clinical Practicum Environment Scale for Nursing Students: Yoon, Seoyoung , Yeom, Hye-Ah; J Korean Acad Nurs 2024;54(3):340-357. Published online August 31, 2024; DOI: https://doi.org/10.4040/jkan.24016

Abstract PDF: Purpose
This study aimed to develop a Hybrid Clinical Practicum Environment Scale for Nursing Students (HCPES-NS) and verify its validity and reliability.
Methods
The HCPES-NS was constructed following the DeVellis guidelines. The initial items were written based on a literature review and individual in-depth interviews. Content validity was verified through an expert panel review. To confirm the validity and reliability of the scale, a survey was conducted with 449 nursing students enrolled in 12 nursing colleges. Data were analyzed using item analysis, exploratory factor analysis, confirmatory factor analysis, concurrent validity, and reliability tests.
Results
Factor analysis showed that the HCPES-NS consists of 15 items on five subdomains: clinical site atmosphere, interpersonal relationship, alternative online practicum contents, provision of learning information, and clinical performance facilitation. A higher score indicated a more positive perception of the clinical practicum environment. The concurrent validity of the HCPES-NS was confirmed by its positive correlation with the Clinical Learning Environment Scale (r = .77). The Cronbach’s α reliability of the HCPES-NS was .84.
Conclusion
The HCPES-NS is both valid and reliable. This scale reflects the clinical practicum environment and includes an online practicum factor. It may be used effectively by faculty members and educators to evaluate nursing students’ perceptions of clinical practicum environments.

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Temporal Exploration of New Nurses’ Field Adaptation Using Text Network Analysis: Ahn, Shin Hye , Jeong, Hye Won , Yang, Seong Gyeong , Jung, Ue Seok , Choi, Myoung Lee , Kim, Heui Seon; J Korean Acad Nurs 2024;54(3):358-371. Published online August 31, 2024; DOI: https://doi.org/10.4040/jkan.24034

Abstract PDF: Purpose
This study aimed to analyze the experiences of new nurses during their first year of hospital employment to gather data for the development of an evidence-based new nurse residency program focused on adaptability. Methods: This study was conducted at a tertiary hospital in Korea between March and August 2021 with 80 new nurses who wrote in critical reflective journals during their first year of work. NetMiner 4.5.0 was used to conduct a text network analysis of the critical reflective journals to uncover core keywords and topics across three periods. Results: In the journals, over time, degree centrality emerged as “study” and “patient understanding” for 1 to 3 months, “insufficient” and “stress” for 4 to 6 months, and “handover” and “preparation” for 7 to 12 months. Major sub-themes at 1 to 3 months were: “rounds,” “intravenous-cannulation,” “medical device,” and “patient understanding”; at 4 to 6 months they were “admission,” “discharge,” “oxygen therapy,” and “disease”; and at 7 to 12 months they were “burden,” “independence,” and “solution.” Conclusion: These results provide valuable insights into the challenges and experiences encountered by new nurses during different stages of their field adaptation process. This information may highlight the best nurse leadership methods for improving institutional education and supporting new nurses’ transitions to the hospital work environment.

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How Do We Approach Quality Care for Patients from Middle Eastern Countries? A Phenomenological Study of Korean Nurses’ Experiences: Jang, Dael , Choi, Seonhwa , Hwang, Gahui , Kim, Sanghee; J Korean Acad Nurs 2024;54(3):372-385. Published online August 31, 2024; DOI: https://doi.org/10.4040/jkan.24036

Abstract PDF: Purpose
Although more people from Middle Eastern countries are visiting South Korea for medical treatment, Korean nurses lack experience in treating them. Understanding and describing Korean nurses’ experiences can help them provide quality care to these patients by enhancing their competency in culturally appropriate care. This study described the experiences of nurses who provide care to Middle Eastern patients in clinical settings in South Korea.
Methods
We conducted a phenomenological study to describe nurses’ experience of caring for patients from Middle Eastern countries. Ten nurses with prior experience in caring for these patients were recruited from a university-affiliated tertiary hospital. Semi-structured face-to-face interviews were conducted between May 1 and June 4, 2020. The transcribed data were analyzed using Giorgi’s phenomenological method to identify the primary and minor categories representing nurses’ experiences.
Results
Four major categories (new experiences in caring for culturally diverse patients, challenges in caring for patients in a culturally appropriate manner, nursing journey of mutual agreement with culturally diverse patients, and being and becoming more culturally competent) and 11 subcategories were identified.
Conclusion
Nurses experience various challenges when caring for Middle Eastern patients with diverse language and cultural needs. However, nurses strive to provide high-quality care using various approaches and experience positive emotions through this process. To provide quality care to these patients, hospital environments and educational programs must be developed that center on field nurses and students and support them in delivering quality care while utilizing their cultural capabilities.

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Effects of a Pre-Conception Care Program in Women with Inflammatory Bowel Disease: A Mixed-Methods Study Including a Randomized Controlled Trial: Lee, Young Jin , Kim, Hae Won , Kim, Yeon Hee , Yang, Suk-Kyun , Kim, Ji-Yeon; J Korean Acad Nurs 2024;54(3):386-402. Published online August 31, 2024; DOI: https://doi.org/10.4040/jkan.24010

Abstract PDF: Purpose
The purpose of this study was to conduct a pre-conception care program for women of childbearing age with inflammatory bowel disease (IBD) in Korea and verify its effects on self-efficacy for IBD management, IBD-related pregnancy knowledge, and IBD-related pregnancy anxiety. It also aimed to explore the changes in participants through the program.
Methods
A convergent mixed-methods study design was adopted. In the quantitative phase, 35 women (17 and 18 in the intervention and control group, respectively) participated. The intervention group attended a program that included small-group sessions and individual tele-coaching. To confirm the effects, data were collected before and one and four weeks after the intervention. In the qualitative stage, focus group interviews and tele-coaching were conducted with the intervention group.
Results
After the program ended, significant differences were observed over time between the intervention and control groups for self-efficacy for IBD management (Wald χ² = 4.41, p = .036), IBD-related pregnancy knowledge (Wald χ² = 13.80, p < .001) and IBD-related pregnancy anxiety (Wald χ² = 8.61, p = .003). Qualitative data analysis revealed the following themes: (1) improving confidence in IBD management and awareness for planned pregnancy; (2) improving IBD awareness related to pregnancy and childbirth; and (3) relieving anxiety about and actively facing pregnancy.
Conclusion
This study is meaningful in that, to the best of our knowledge, it is the first to develop a pre-conception care program for women diagnosed with IBD and confirm its effectiveness. Furthermore, this program is expected to be suitable for patient counseling and education in clinical practice.

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The Influence of Diversity Management of Nursing Organization on Organizational Commitment: Double Mediating Effect of Diversity Sensitivity Orientation and Positive Nursing Organizational Culture: Jeon, Hwi Gon , Jang, Keum Seong , Kim, Eun A; J Korean Acad Nurs 2024;54(3):403-417. Published online August 31, 2024; DOI: https://doi.org/10.4040/jkan.23120

Abstract PDF: Purpose
The aim of this study was to identify the double mediating effect of effect of diversity sensitivity orientation and positive nursing organizational culture between diversity management and organizational commitment.
Methods
Participants were 245 nurses working in six tertiary hospitals located in 3 different regions. Data collection was conducted from February 13, 2023 to March 6, 2023 through online self-reported questionnaire. The data were analyzed by IBM SPSS Statistics 27 and SPSS PROCESS Macro 4.2 program.
Results
The direct effect of diversity management on organizational commitment was significant (β = .21, p < .001). The indirect effect of diversity management on organization commitment was .34 (95% confidence interval [CI] = .23~.47). The double mediating effect of diversity sensitivity orientation and positive nursing organizational culture in the relationship between diversity management and organizational commitment was .02 (95% CI = .00~.05).
Conclusion
Diversity sensitivity orientation and positive nursing organizational culture show double mediating effect on the relationship between diversity management and organizational commitment. Education program and human resource management strategy for enhancing diversity management, diversity sensitivity orientation and positive nursing organizational culture should be provided to improve organizational commitment, and which are needed active support of the association and nursing organization.

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Factors Influencing Oncofertility in Gynecological Cancer Patients: Application of Mixed Methods Study: Kim, Minji , Ha, Juyoung; J Korean Acad Nurs 2024;54(3):418-431. Published online August 31, 2024; DOI: https://doi.org/10.4040/jkan.23151

Abstract PDF: Purpose
This study aimed to identify factors influencing oncofertility and to explore the oncofertility experiences of patients with gynecological cancer using quantitative and qualitative methods, respectively. Methods: An explanatory sequential mixed-methods study was conducted. The quantitative study involved 222 patients with gynecological cancer recruited from online cafes and hospitals. Data were analyzed using IBM SPSS Statistics 28. For qualitative research, eight patients with gynecological cancer were interviewed. Data were analyzed using theme analysis method. Results: Oncofertility performance was quantitatively assessed in 40 patients (18.0%). Factors that significantly affected oncofertility were fertility preservation awareness (odds ratio [OR] = 14.97, 95% confidence interval [CI]: 4.22~53.08), number of children planned before cancer diagnosis (OR = 6.08, 95% CI: 1.89~19.62; OR = 5.04, 95% CI: 1.56~16.29), monthly income (OR = 3.29, 95% CI: 1.23~8.86), social support (OR = 1.08, 95% CI: 1.01~1.17), and anxiety (OR = 0.79, 95% CI: 0.66~0.95). Qualitative results showed three theme clusters and eight themes: (1) themes for determinant factors affecting oncofertility selection: ‘desire to have children’ and ‘special meaning of the uterus and ovaries;’ (2) themes for obstructive factors affecting oncofertility selection: ‘fertility preservation fall behind priorities,’ ‘confusion caused by inaccurate information,’ and ‘my choice was not supported;’ (3) themes for support factors affecting oncofertility selection: ‘provide accurate and reasonable information about oncofertility,’ ‘addressing the healthcare gap,’ and ‘need financial support for oncofertility.’ Conclusion: Financial support, sufficient information, social support, and anxiety-relief interventions are required for oncofertility in patients with gynecological cancer.

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Effectiveness of the Eye Care Protocol in the Intensive Care Unit Patients: A Randomized Controlled Trial: Lim, Kyu Won , Ha, Shin Young , Kang, In Soon; J Korean Acad Nurs 2024;54(3):432-445. Published online August 31, 2024; DOI: https://doi.org/10.4040/jkan.24017

Abstract PDF: Purpose
This study investigated the effects of an eye care protocol (ECP) on patients in the intensive care unit (ICU).
Methods
This study utilized a randomized controlled design. Participants were patients who met the inclusion criteria and were admitted to the ICU (36 in the experimental group and 38 in the control group). The experimental group received an ECP, while the control group received standard eye care, starting the day after admission, for a duration of 10 days. The ECP classifies the degree of eyelid obstruction into three stages based on the degree of exposure to the lower eyelid conjunctiva and cornea. The protocol included cleansing with normal saline gauze, administering eye drops, applying silicone and polyurethane films, and recommending consultation with an ophthalmologist if necessary. The effectiveness of ECP was assessed by analyzing tear volume, hyperemia, chemosis, and eye discharge. Data analysis was conducted using SPSS 27.0, employing the Mann-Whitney U-test and generalized estimating equations.
Results
On day 5, the experimental group demonstrated a significant increase in tear volume in both eyes compared with the control group. However, no statistically significant differences were observed in the incidence of hyperemia, chemosis, and eye discharge on days 5 and 10 of the intervention.
Conclusion
The application of the ECP in this study increased tear volume in ICU patients, thereby reducing discomfort caused by dry eyes. It has the potential to prevent complications such as damage to the surface of the eyeball resulting from decreased tear volume.

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An Exploratory Study on Non-Contact Nursing Experiences of Clinical Nurses during the COVID-19 Pandemic: Byun, Hye Min , Yun, Eun Kyoung; J Korean Acad Nurs 2024;54(3):446-458. Published online August 31, 2024; DOI: https://doi.org/10.4040/jkan.24045

Abstract PDF: Purpose
This study aimed to understand the non-contact nursing experiences of clinical nurses during the COVID-19 pandemic.
Methods
A qualitative research design applying thematic analysis was used. The participants were purposive sampled from three institutes: a tertiary hospital, a general hospital, and a residential treatment center in Seoul. Data were collected between December 2021 and January 2022 through individual in-depth interviews with 12 clinical nurses. The data were analyzed using Braun and Clarke’s method to identify the meaning of the participants’ experiences.
Results
During the COVID-19 pandemic, the fields where the participants performed non-contact nursing included intensive care units and isolation wards of hospitals, a residential treatment center, and home cares. Their tasks in non-contact nursing commonly involved remote monitoring using digital devices or equipment, consultation and education. From their experiences performing tasks in these fields, the four theme clusters and nine themes were derived. The four theme clusters are as follows: (1) Confusion of nursing role; (2) Conflict due to insufficient support system; (3) Concern about the quality of nursing; (4) Reflection on the establishment of nursing professionalism.
Conclusion
This study highlights the necessity for institutionalizing professional nursing areas, nursing education, and practical support by clarifying the purpose and goals of non-contact nursing and developing nursing knowledge through frameworks.

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Concept Analysis of Social Intelligence of Nurses Using Hybrid Model: Lee, Kyung Ran , Lee, Na Kyoung , Oh, Hee , Park, Kyoung Ae; J Korean Acad Nurs 2024;54(3):459-474. Published online August 31, 2024; DOI: https://doi.org/10.4040/jkan.23121

Abstract PDF: Purpose
The purpose of this study was to conduct a concept analysis of social intelligence in nurses so that applying social intelligence to the nursing field.
Methods
In this study, we followed the hybrid model procedure, involving the following steps: First, in the theoretical stage, the attributes and definitions of the concept of social intelligence were determined through literature review. Second, the concepts’ reality was confirmed during fieldwork. In the final analysis stage, the results confirmed in the theoretical and fieldwork stages were compared and analyzed to confirm the properties and definition of the concept.
Results
Nurses’ social intelligence consists of three dimensions: social cognitive nursing competency, human-centered social evolution, and skills for solving complex nursing situations. Nurses’ social intelligence is a professional nursing competency that flexibly coordinates complex nursing situations, developed through accumulating experiences of continuous reflection and relationship expansion based on receptive listening and social sensitivity in clinical interpersonal relationships.
Conclusion
Nurses’ social intelligence is widely used in clinical practice and is shown to have a significant direct and indirect impact on clinical nursing. To effectively apply social intelligence in the clinical context, individual and organizational efforts are required to share and transfer knowledge and capacity-building methods through collective intelligence and education.

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