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Volume 40(4); August 2010
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Original Articles
Development of a Web-based Education Program for Nurses working in Nursing Homes on Human Rights of Older Adults
Ki-Kyong Kim
J Korean Acad Nurs 2010;40(4):463-472.   Published online August 31, 2010
DOI: https://doi.org/10.4040/jkan.2010.40.4.463
AbstractAbstract PDF
Purpose

This study was done to develop a web-based education program for nurses working in nursing homes. The focus was on the rights of older adults.

Methods

The program was designed based on the Network-Based Instructional System Design (NBISD) model and was operated and evaluated between July 2007 and June 2008.

Results

Out of nursing records of 40 residents from a nursing home, the final 7 cases were deducted through classification using the Resource Utilization Group (RUG)-III. The data on needs for education was collected from 28 nurses working in 15 nursing homes located in Seoul and Gyeonggi Province, who agreed to complete a self-report questionnaire. A comprehensive review of the literature and two focus groups interviews were used to search for risk factors and guidelines for protection of human rights. The education program was developed based on Kolb's experiential learning model and composed of 5 units, which included content on types of human rights and rights to death with dignity, elder abuse, physical liberty, and self-determination. The program was positively evaluated showing a score of 3.35 (SD=0.37) out of 4.

Conclusion

The educational program developed in this study should promote nurses' sensitivity to the rights of elders and improve nurses' behaviors in protecting the rights of elders residing in nursing homes.

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Effects of Oral Care with Essential Oil on Improvement in Oral Health Status of Hospice Patients
Hee-Young Kang, Song-Sook Na, Yun-Kyung Kim
J Korean Acad Nurs 2010;40(4):473-481.   Published online August 31, 2010
DOI: https://doi.org/10.4040/jkan.2010.40.4.473
AbstractAbstract PDF
Purpose

This study was done to examine the effects of oral care with essential oil in improving the oral health status of hospice patients with terminal cancer.

Methods

The participants were 43 patients with terminal cancer admitted to K hospital in G city, Korea. Twenty-two patients were assigned to the experimental group and 21 to the control group. Participants in the experimental group received special mouth care with essential oil (application of essential oil mixture consisting of geranium, lavender, tea tree, and peppermint). The control group received special mouth care with 0.9% saline. The special mouth care was performed twice daily for one week in both groups. The scores for subjective oral comfortness, objective oral state, and numbers of colonizing Candida albicans were measured before and after the treatment.

Results

The score for subjective oral comfortness and objective oral state were significantly higher in the experimental group compared to the control group. The numbers of colonizing Candida albicans significantly decreased in the experimental group compared to the control group.

Conclusion

Oral care with essential oil could be an effective oral health nursing intervention for hospice patients with terminal cancer.

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An Analysis of the Meaning of Respite for Family Caregivers of Elderly with Dementia
Mi Ryeong Song, Yong-Mi Lee, Suk-Hee Cheon
J Korean Acad Nurs 2010;40(4):482-492.   Published online August 31, 2010
DOI: https://doi.org/10.4040/jkan.2010.40.4.482
AbstractAbstract PDF
Purpose

This study was a qualitative research study in which focus group interviews were used to collect data on the meaning of respite for family caregivers who are taking care of elders with dementia.

Methods

The focus group interviews and participants consisted of 2 family caregiver groups, for a total of 8 people taking care of their elders and 5 professional caregivers working in a geriatrics hospital or social welfare institutions. Content analysis was used and debriefing notes were referred in order to analyze the data.

Results

The meaning of respite in this research was measured using 4 main categories: 'Temporary break from routine', 'direct help', 'psychological comfort', 'valuables which cannot be taken easily' and 9 subcategories: 'Temporary diversion of attention', 'temporarily free from my duty', 'taking care of oneself', 'receiving economic help', 'empathize with others', 'comfort based on trust', 'resting together with the elder', 'no time to rest', 'cannot get out of one's obligatory duty'.

Conclusion

The findings of the study show that rest means not only a temporary relief from caretaking, but also a real respite based on the patients' stable state and comfort. These results indicate a new meaning for respite, that the first step of respite program has to begin even when the caregivers do not recognize the need for respite.

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Effects on Couples' Communication, Intimacy, Conflict and Quality of Life by Foot Massage between Immigrants
Dong-choon Uhm
J Korean Acad Nurs 2010;40(4):493-502.   Published online August 31, 2010
DOI: https://doi.org/10.4040/jkan.2010.40.4.493
AbstractAbstract PDF
Purpose

The purpose of this study was to evaluate the effects on immigrant couples' communication, intimacy, conflict and quality of life when using foot massage.

Methods

The research design consisted of pre-and-post test consecutive experimental design through a nonequivalent control group. Data were collected July 6, 2009 to February 27, 2010. The 36 couples were divided into two groups, experimental and control with 18 couples in each group. Foot massage was applied twice a week for 6 weeks by the couples in the experimental group.

Results

There were statistically significant increases in communication (p=.011), intimacy (p<.001), quality of life (p=.017) between the couples in the experimental group compared to the control group. There was also a statistically significant decrease in conflict (p=.003) between the couples in the experimental group compared to the control group.

Conclusion

Foot massage can be applied as a nursing intervention for improvement of marital relationship in immigrant couples.

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The Changing Pattern of Physical and Psychological Health, and Maternal Adjustment Between Primiparas Who Used and Those Who did Not Use Sanhujori Facilities
Ju-Eun Song, Bo-Lim Park
J Korean Acad Nurs 2010;40(4):503-514.   Published online August 31, 2010
DOI: https://doi.org/10.4040/jkan.2010.40.4.503
AbstractAbstract PDF
Purpose

The purpose of this study was to compare levels of postpartum fatigue, depression, childcare stress, and maternal identity according to postpartum period between primiparas who used Sanhujori facilities and those who did not.

Methods

The research design was a longitudinal descriptive study using self-report questionnaires. Participants were 55 healthy primiparas who delivered at one of 3 hospitals in Chungnam, 21 using Sanhujori facilities and 34 not using these facilities during the first three weeks after childbirth. Data were collected from October 2008 to April 2009 at three measurement points, 2-4 days after childbirth (T1), 4-6 weeks (T2), and 12-14 weeks (T3). Data were analyzed using the SPSS 17.0 WIN program.

Results

There was a significant difference in childcare stress between the two groups at 4-6 weeks after childbirth. Postpartum depression and childcare stress at 4-6 weeks were significantly higher than those of the other postpartum periods, while maternal identity was significantly lower.

Conclusion

Child care stress is the most important issue among women who use Sanhujori facilities and the 4-6 week period after childbirth is very difficult to primiparas. These results indicate that nursing interventions for primiparas in Sanhujori facilities should focus on reducing childcare stress. Furthermore proper follow-up programs at 4-6 weeks are needed to decrease the difficulties in adjustment by new mothers.

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Educational Needs Assessment on Research Ethics among Nursing Researchers
Ihn Sook Jeong, Mee Ock Gu, Keum Soon Kim, Kwang Ja Lee, Soo Yang
J Korean Acad Nurs 2010;40(4):515-523.   Published online August 31, 2010
DOI: https://doi.org/10.4040/jkan.2010.40.4.515
AbstractAbstract PDF
Purpose

This study aimed to investigate the educational needs of research ethics among nursing researchers.

Methods

Convenience sample of 161 nursing professors and 262 master or doctoral nursing students participated in the study. Data was collected with self-reported questionnaire from June to August 2009, and analyzed with descriptive statistics using SPSS WIN (version 14.0).

Results

Among 161 nursing professors, about 31.7% has educated nursing ethics in the postgraduate course. The most common course was nursing research or methodology (62.7%), and median education time was 2 hr. Areas that showed difficulty in understanding was the conflict of interest and plagiarism for professors and falsification and fabrication for graduate students. Average knowledge on the research ethics was 75.4 points for professors and 61.6 points for students based on the 100 points.

Conclusion

Educational needs of research ethics among nursing professors and students in the postgraduate course was high. We recommend both basic and advanced research ethics educational programs for the nursing researchers. The basic course should be at least 6 hr and include various cases and something to discuss.

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Relationship of Social Support and Meaning of Life to Suicidal Thoughts in Cancer Patients
Yeon Jung Kim, Kwang Ja Lee
J Korean Acad Nurs 2010;40(4):524-532.   Published online August 31, 2010
DOI: https://doi.org/10.4040/jkan.2010.40.4.524
AbstractAbstract PDF
Purpose

This study was done to explore the relationship of social support and meaning of life to suicidal thoughts among patients with cancer.

Methods

Data were collected by questionnaires from 138 patients who had been in cancer treatment at medical clinics and 8 patients who were members of an internet cancer association. The data were collected between August and November 2009 and analyzed using SPSS 12.0.

Results

Of the participants, 47.3% reported having had suicidal thoughts and 16.4% had attempted suicide since the diagnosis of cancer. The study participants received most support from family members, but 73.3% reported experiencing an existential vacuum. The suicide attempt group had significantly higher scores according to gender, age, level of education, diagnosis, treatment modality, level of activity, caregiver and social support compare to the suicide thought group. Suicidal thoughts were negatively related to social support and meaning of life was positively associated with social support. Support from family and friends and diagnosis explained 50.0% of variance for suicidal thoughts with 36.0% of variance being explained by family support.

Conclusion

Nurses should be able to identify risk factors for suicide in cancer patients. Prevention and intervention efforts need to be directed toward improving social support, family support in particular, and assisting patients finding meaning in life after a diagnosis of cancer.

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Structural Equation Modeling on Quality of Life in Stroke Survivors
Minhee Suh, Smi Choi-Kwon
J Korean Acad Nurs 2010;40(4):533-541.   Published online August 31, 2010
DOI: https://doi.org/10.4040/jkan.2010.40.4.533
AbstractAbstract PDF
Purpose

This study was designed to test structural equation modeling of the quality of life of stroke survivors in order to provide guidelines for development of interventions and strategies to improve their quality of life.

Methods

The participants in the study were patients who visited the neurology outpatient department of a tertiary hospital in Seoul between June 25 and October 15, 2009. Data collection was carried out through one-on-one interviews. Demographic factors, functional independence, social support, nutritional status, post-stroke biobehavioral changes and quality of life were investigated.

Results

The final analysis included 215 patients. Fitness of the hypothetical model was appropriate (χ2=111.5, p=.000, GFI=.926, AGFI=.880, RMSA=.068, NFI=.911, CFI=.953). Functional dependency, social support and post-stroke biobehavioral changes were found to be significant explaining variance in quality of life. Post-stroke biobehavioral changes had the strongest direct influence on quality of life. Nutritional status had an indirect effect on the quality of life.

Conclusion

To improve the quality of life of stroke survivors, comprehensive interventions are necessary to manage post-stroke biobehavioral changes, and strengthening social support networks that can contribute to enhancing the quality of life of stroke survivors.

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Factors Influencing Depression in Elderly People Living at Home
Myeong Ja Moon
J Korean Acad Nurs 2010;40(4):542-550.   Published online August 31, 2010
DOI: https://doi.org/10.4040/jkan.2010.40.4.542
AbstractAbstract PDF
Purpose

This study was done to identify the factors which influence depression for elderly people who live at home.

Methods

The participants were 134 elderly people living at home in M city. Data were collected from April 2 to 30, 2009 and analyzed using SPSS/WIN 12.0 and AMOS 5.0 program. I assumed path coefficients by doing path analysis to understand synthetically causal relationship which influences on depression.

Results

Social support, sleep pattern and self esteem had significant direct effects on life satisfaction and accounted for 50% of the total variance in life satisfaction. Physical symptoms, sleep pattern and life satisfaction also had significant direct effects on depression and accounted for 59% of the variance in depression. But social support, self assertiveness and self esteem were not significant for depression.

Conclusion

These results provide guidance for designing useful strategies to reduce depression in elderly people living at home.

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Psychometric Evaluation of a Need Scale for Cancer Patients Undergoing Follow-up Care
Eun-Hyun Lee, Seongmi Moon, Soo-Yeon Cho, Young Taek Oh, Mison Chun, Sung Hwan Kim, Jae-Sung Kim, Hye Kyung Kim
J Korean Acad Nurs 2010;40(4):551-560.   Published online August 31, 2010
DOI: https://doi.org/10.4040/jkan.2010.40.4.551
AbstractAbstract PDF
Purpose

The purpose of this present study was to develop and evaluate the psychometric properties of a needs scale for patients with cancer undergoing follow-up care (NS-C).

Methods

A preliminary NS-C of 48 was derived from literature reviews and in-depth interviews with patients with cancer. Content validation of the items was established by oncology physicians and nurses. Each item was scored on a five-point Likert scale. The preliminary NS-C and Eastern Cooperative Oncology Group (ECOG) performance status questionnaires were administered to 873 patients with cancer recruited from three university hospitals. The data were analyzed using factor analysis, multidimensional scaling analysis, ANOVA, Pearson correlation coefficients, and Cronbach's alpha.

Results

From the factor analysis, 25 significant items in six subscales were derived. The subscales were named physical symptoms, diet and exercise, support, relationship with health professionals, treatment/prognosis, and keeping mind under control. The NS-C also established item convergent and discriminant validity, and known-groups validity. Cronbach's alpha of the subscales ranged from .90 to .92.

Conclusion

This study suggests that the NS-C is an easy, reliable and valid instrument to measure the needs of patients with cancer. Health professionals may use the NS-C for patients with cancer both in practice and research.

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Evaluation of Mental Status in High-Risk Neonates using Infants Coma Scale
Young-Mee Ahn, Min Sohn, Sang-Mi Lee
J Korean Acad Nurs 2010;40(4):561-570.   Published online August 31, 2010
DOI: https://doi.org/10.4040/jkan.2010.40.4.561
AbstractAbstract PDF
Purpose

This was a cross sectional descriptive study to introduce the Infants Coma Scale (ICS), describe mental status of high risk infants using ICS and explore the relationships between ICS and clinical variables in infants hospitalized in a neonatal intensive care unit of a university hospital in Korea.

Methods

After ICS was developed and tested by the authors, a research nurse evaluated the mental status of the infants using the English version of ICS and obtained clinical information on the infants from their medical records.

Results

Data from 88 infants were analyzed. About 60% were male, 90% were preterm births, and 40% had pathologic abnormalities. Their mean gestational age was 32.4 (±3.50) weeks and the mean birth weight was 1,842 (±728.6) grams. The Cronbach's alpha for the ICS was .78. There was a statistically significant positive correlation between ICS total score and five clinical variables including gestational age, birth weight, 1 and 5 min Apgar scores and respiration status.

Conclusion

Mental status is an important parameter in nursing assessment. ICS is a valid and reliable instrument, which clinicians can easily use to evaluate the mental status of high risk infants.

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Effects of a Taegyo Program on Parent-Fetal Attachment and Parenthood in First Pregnancy Couples
Kyung Mi Yang, Soon-Lae Kim
J Korean Acad Nurs 2010;40(4):571-579.   Published online August 31, 2010
DOI: https://doi.org/10.4040/jkan.2010.40.4.571
AbstractAbstract PDF
Purpose

The purpose of this study was to explore the effects of a Taegyo program on parents-fetal attachment and parenthood in first pregnancy couples (mothers and spouses).

Methods

The research design was a nonequivalent control group pretest-posttest experiment. Study participants were 52 first pregnancy couples visiting two medium-scale obstetrics and gynecology clinics located in Gwangju. A total of 52 couples were assigned to the experimental group (25 couples) and the control group (27 couples). The experimental couples were provided with a Taegyo program for 4 weeks. Data were analyzed by chi square test, t-test, and ANCOVA using the SPSS program.

Results

Post-treatment maternal-fetal attachment, paternal-fetal attachment and motherhood significantly increased in the experimental group as compared to the control group, but post-treatment fatherhood, anxiety, blood pressure and pulse of participants in the experimental group showed no significant difference from those in the control group.

Conclusion

From these results, it is suggested that the Taegyo program has beneficial effects in enhancing parent-fetal attachment and motherhood in first pregnancy couples. Therefore, a Taegyo program can be recommended as a nursing intervention program for first pregnancy couples.

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Effect of Decreased Locomotor Activity on Hindlimb Muscles in a Rat Model of Parkinson's Disease
Yongbum Kim, Myoung-Ae Choe
J Korean Acad Nurs 2010;40(4):580-588.   Published online August 31, 2010
DOI: https://doi.org/10.4040/jkan.2010.40.4.580
AbstractAbstract PDF
Purpose

The purpose of this study was to examine effects of decreased locomotor activity on mass, Type I and II fiber cross-sectional areas of ipsilateral and contralateral hindlimb muscles 21 days after establishing the Parkinson's disease rat model.

Methods

The rat model was established by direct injection of 6-hydroxydopamine (6-OHDA, 50 µg) into the left substantia nigra after stereotaxic surgery. Adult male Sprague-Dawley rats were assigned to one of two groups; the Parkinson's disease group (PD; n=17) and a sham group (S; n=8). Locomotor activity was assessed before and 21 days after the experiment. At 22 days after establishing the rat model, all rats were anesthetized and soleus and plantaris muscles were dissected from both ipsilateral and contralateral sides. The brain was dissected to identify dopaminergic neuronal death of substantia nigra in the PD group.

Results

The PD group at 21 days after establishing the Parkinson's disease rat model showed significant decrease in locomotor activity compared with the S group. Weights and Type I and II fiber cross-sectional areas of the contralateral soleus muscle of the PD group were significantly lower than those of the S group.

Conclusion

Contralateral soleus muscle atrophy occurs 21 days after establishing the Parkinson's disease rat model.

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Fall Risk in Low-Income Elderly People in One Urban Area
Kyung Won Choi, In-Sook Lee
J Korean Acad Nurs 2010;40(4):589-598.   Published online August 31, 2010
DOI: https://doi.org/10.4040/jkan.2010.40.4.589
AbstractAbstract PDF
Purpose

The purpose of this study was to investigate the factors that increase of the risk for falls in low-income elders in urban areas.

Methods

The participants were elderly people registered in one of public health centers in one city. Data were collected by interviewing the elders, assessing their environmental risk factors, and surveying relevant secondary data from the public health center records. For data analysis, descriptive statistics and multiple logistic regression were performed using SPSS version 14.

Results

Stroke, diabetes, visual deficits, frequency of dizziness, use of assistive devices and moderate depression were statistically significant risk factors. The comorbidity of chronic diseases with other factors including depression, visual deficit, dizziness, and use of assistive devices significantly increased the risk of falls. From multiple logistic regression analysis, statistically significant predictors of falls were found to be stroke, total environmental risk scores, comorbiditiy of diabetes with visual deficits, and with depression.

Conclusion

Fall prevention interventions should be multifactorial, especially for the elders with stroke or diabetes, who were identified in this study as the high risk group for falls. A fall risk assessment tool for low-income elders should include both the intrinsic factors like depression, dizziness, and use of assistive devices, and the extrinsic factors.

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Development and Evaluation of a Transitional Care Program for Patients Discharged from Military Hospitals
Seun Young Joe
J Korean Acad Nurs 2010;40(4):599-609.   Published online August 31, 2010
DOI: https://doi.org/10.4040/jkan.2010.40.4.599
AbstractAbstract PDF
Purpose

The purpose of this study was to develop and evaluate a transitional care program for patients discharged from military hospitals. The study consists of two phases: developing the program and evaluating its effectiveness.

Methods

The conceptual framework used to guide the development of the program was Meleis's transition theory. A quasi-experimental design was employed for this study. Participants were recruited from patients discharged from one military hospital, 72 in the control group and 56 in the experiment group. Data were analyzed using SPSS WIN 12.0 program with chi-square, Fisher's exact test, independent t-test, and mixed model.

Results

Participants in the transitional care program reported promoting a positive personal condition, and more healthy patterns of response in the first week after being discharged and a smoother discharge transition.

Conclusion

The transitional care program developed for discharge patients from military hospital promoted discharge readiness and promoted smooth discharge transition.

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