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Volume 49(4); August 2019
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Review Article
Effect of Autogenic Training for Stress Response: A Systematic Review and Meta-Analysis
Eunju Seo, Soukyoung Kim
J Korean Acad Nurs 2019;49(4):361-374.   Published online January 15, 2019
DOI: https://doi.org/10.4040/jkan.2019.49.4.361
AbstractAbstract PDF
Abstract Purpose

This study was conducted to evaluate the effectiveness of autogenic training on stress responses through a systematic review and meta-analysis.

Methods

A systematic search was conducted using eight core electronic databases (Embase, CENTRAL, Medline, CINAHL, PsycInfo, DBpia, KISS, and RISS). To estimate the effect size, a meta-analysis of the studies was performed using RevMan 5.3.5 program.

Results

A total 21 studies out of 950 studies were included in the review, and 11 were included for meta-analysis. These studies showed that autogenic training decreased anxiety and depression, and increased the high frequency of heart rate variability. Calculations to understand the effect of autogenic training on anxiety, through a meta-analysis, observed a reduction effect of anxiety score by 1.37 points (n=85, SMD=-1.37: 95% CI -2.07 to -0.67), in the studies on short-term intervention targeting healthy adults. On the other hand, similar calculations to understand the effect of autogenic training on depression observed, a reduction effect on the depression score by 0.29 point (n=327, SMD=-0.29: 95% CI -0.50 to -0.07), in the studies on long term intervention targeting the patient group.

Conclusion

Autogenic training is effective for adults’ stress management, and nurses will be able to effectively perform autogenic training programs for workers’ stress relief at the workplace.

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Original Articles
A Structural Model for Chemotherapy Related Cognitive Impairment and Quality of Life in Breast Cancer Patients
Jung Ran Lee, Pok Ja Oh
J Korean Acad Nurs 2019;49(4):375-385.   Published online January 15, 2019
DOI: https://doi.org/10.4040/jkan.2019.49.4.375
AbstractAbstract PDF
Abstract Purpose

This study aimed to develop and test a structural model for chemotherapy-related cognitive impairment of breast cancer patients based on a literature review and Hess and Insel's chemotherapy-related cognitive change model.

Methods

The Participants consisted of 250 patients who were ≥19 years of age. The assessment tools included the Menopause Rating Scale, Symptom Experience Scale, Hospital Anxiety and Depression Scale, Everyday Cognition, and Functional Assessment of Cancer Therapy-Breast Cancer. Data were analyzed using the SPSS 21.0 and AMOS 21.0 programs.

Results

The modified model was a good fit for the data. The model fit indices were χ 2=423.18 (p<.001), χ 2/df=3.38, CFI=.91, NFI=.91, TLI=.89, SRMR=.05, RMSEA=.09, and AIC=515.18. Chemotherapy-related cognitive impairment was directly influenced by menopausal symptoms (β=.38, p=.002), depression and anxiety (β=.25, p=.002), and symptom experiences (β=.19, p=.012). These predictors explained 47.7% of the variance in chemotherapy-related cognitive impairment. Depression and anxiety mediated the relations among menopausal symptoms, symptom experiences, and with chemotherapy related cognitive impairment. Depression and anxiety (β=-.51, p=.001), symptom experiences (β=-.27, p=.001), menopausal symptoms (β=-.22, p=.008), and chemotherapy-related cognitive impairment (β=-.15, p=.024) had direct effects on the quality of life and these variables explained 91.3%.

Conclusion

These results suggest that chemotherapy-related toxicity is highly associated with cognitive decline and quality of life in women with breast cancer. Depression and anxiety increased vulnerability to cognitive impairment after chemotherapy. Nursing intervention is needed to relieve chemotherapy-related toxicity and psychological factor as well as cognitive decline for quality of life in patients undergoing chemotherapy.

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The Effects of Hospitals’ Family Friendly Management on Married Female Nurses’ Retention Intention: Focused on the Mediating Effects of Work-Family Interface
Jin Hwa Lee, Jee-In Hwang
J Korean Acad Nurs 2019;49(4):386-397.   Published online January 15, 2019
DOI: https://doi.org/10.4040/jkan.2019.49.4.386
AbstractAbstract PDF
Abstract Purpose

This study examined the effect of hospitals’ family-friendly management on married female nurses’ retention intention. The focus was the mediating effects of the work-family interface (work-family conflict, work-family enrichment and work-family balance).

Methods

This study was a cross-sectional study. The participants were 307 nurses working at five public and five private hospitals with more than 200 beds in Seoul. Data were collected using structured questionnaires from September 10 to September 17, 2018 and analyzed with SPSS 24.0. Data were analyzed using an independent t-test, a one-way ANOVA, Pearson's correlation coefficients, and multiple regression following the Baron and Kenny method and Sobel test for mediation.

Results

There were significant correlations among family-friendly management, the work-family interface, and retention intention. Work-family conflict showed a partial mediating effect on the relationship between family-friendly management and retention intention. Work-family enrichment showed a partial mediating effect on the relationship between family-friendly management and retention intention. Work-family balance showed a partial mediating effect on the relationship between family-friendly management and retention intention.

Conclusion

These findings indicate that both hospitals’ family-friendly management and nurses’ work-family interface are important factors associated with nurses’ retention intention. Therefore, hospitals should actively implement family-friendly management for nurses and establish strategies to enhance nurses’ work-family interface for effective human resource management.

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Development of a Quantitative Model on Adolescent Cyberbullying Victims in Korea: A System Dynamics Approach
Mi Jin You, Eun Mi Ham
J Korean Acad Nurs 2019;49(4):398-410.   Published online January 15, 2019
DOI: https://doi.org/10.4040/jkan.2019.49.4.398
AbstractAbstract PDF
Abstract Purpose

This study used a system dynamics methodology to identify correlation and nonlinear feedback structures among factors affecting adolescent cyberbullying victims (CV) in Korea and to construct and verify a simulation model.

Methods

Factors affecting CV were identified by reviewing a theoretical background in existing literature and referencing various statistical data. Related variables were identified through content validity verification by an expert group, after which a causal loop diagram (CLD) was constructed based on the variables. A stock-flow diagram (SFD) using Vensim Professional 7.3 was used to establish a CV model.

Results

Based on the literature review and expert verification, 22 variables associated with CV were identified and the CLD was prepared. Next, a model was developed by converting the CLD to an SFD. The simulation results showed that the variables such as negative emotions, stress levels, high levels of conflict in schools, parental monitoring, and time spent using new media had the strongest effects on CV. The model's validity was verified using equation check, sensitivity analysis for timestep and simulation with 4 CV adolescent.

Conclusion

The system dynamics model constructed in this study can be used to develop intervention strategies in schools that are focused on counseling that can prevent cyberbullying and assist in the victims’ recovery by formulating a feedback structure and capturing the dynamic changes observed in CV. To prevent cyberbullying, it is necessary to develop more effective strategies such as prevention education, counseling and treatment that considers factors pertaining to the individual, family, school, and media.

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Reliability and Validity of Korean Version of Nursing Students’ Anxiety and Self-Confidence with Clinical Decision Making Scale
Mi Yu, Young Eun, KA White, KyungJa Kang
J Korean Acad Nurs 2019;49(4):411-422.   Published online January 15, 2019
DOI: https://doi.org/10.4040/jkan.2019.49.4.411
AbstractAbstract PDF
Abstract Purpose

The purpose of this study was to adapt, modify, and validate the Nursing Anxiety and Self-Confidence with Clinical Decision-Making Scale (NASC-CDM©) for Korean nursing students.

Methods

Participants were 183 nursing students with clinical practice experience in two nursing colleges. The construct validity and reliability of the final Korean version of the NASC-CDM© were examined using exploratory and confirmatory factor analyses and testing of internal consistency reliability. For adaptation and modification, the instrument was translated from English to Korean. Expert review and a cross-sectional survey were used to test the instrument's validity.

Results

The Korean version of the NASC-CDM© (KNASC-CDM) was composed of 23 items divided into four dimensions: (i) Listening fully and using resources to gather information; (ii) Using information to see the big picture; (iii) Knowing and acting; and (iv) Seeking information from clinical instructors. The instrument explained 60.1% of the total variance for self-confidence and 63.1% of the variance for anxiety; Cronbach's α was .93 for self-confidence and .95 for anxiety.

Conclusion

The KNASC-CDM can be used to identify anxiety and self-confidence in nursing students’ clinical decision-making in Korea. However, further research should be done to test this instrument, as it is classified differently from the original NASC-CDM© version.

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Person-Centered Relational Care Experienced by Critical Care Nurses: An Interpretative Phenomenological Analysis Study
Myoung Sun Jang, Sungjae Kim
J Korean Acad Nurs 2019;49(4):423-436.   Published online January 15, 2019
DOI: https://doi.org/10.4040/jkan.2019.49.4.423
AbstractAbstract PDF
Abstract Purpose

The aim of the study was to explore nurses’ experience of person-centered relational care in the context of critical care.

Methods

Key interview questions were developed based on the human-to-human relationship model suggested by Travelbee. Data were collected through in-depth interviews with a purposive sample of 11 nurses having more than 2 years of working experience in intensive care units. An interpretative phenomenological analysis was conducted to analyze the data.

Results

Four super-ordinate and nine sub-ordinate themes were identified. Emerged super-ordinate themes were as follows: (1) encountering a live person via patient monitoring systems; (2) deep empathic connection; (3) humanistic and compassionate care, and (4) accompanying the journey to the end. Study findings revealed that nurses in intensive care units experienced ‘balancing emotions’ and ‘authenticity’ in caring when entering human-to-human relationships with dying patients. The phenomenon of person-centered relational care in intensive care units was found to subsume intrinsic attributes of empathy, compassion, and trust, similar to the central concepts of Travelbee's theory.

Conclusion

The interpretative findings in this study provide deeper understanding of Travelbee's human-to-human relationship model. The technological environment in intensive care units did not hinder experienced nurses from forming human-to-human relationships. These themes need to be emphasized in critical care nursing education as well as in nursing management. The results of this study will contribute to understanding nurse-patient caring relationships in depth, and help improve the quality of nursing care in intensive care units.

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Factors Affecting Clinical Practicum Stress of Nursing Students: Using the Lazarus and Folkman's Stress-Coping Model
Sung Hae Kim, JuHee Lee, MiRa Jang
J Korean Acad Nurs 2019;49(4):437-448.   Published online August 29, 2019
DOI: https://doi.org/10.4040/jkan.2019.49.4.437
AbstractAbstract PDF
Purpose

This study was conducted to test a path model for the factors related to undergraduate nursing students' clinical practicum stress, based on Lazarus and Folkman's stress-coping model.

Methods

This study utilized a path analysis design. A total of 235 undergraduate nursing students participated in this study. The variables in the hypothetical path model consisted of clinical practicum, emotional intelligence, self-efficacy, Nun-chi, and nursing professionalism. We tested the fit of the hypothetical path model using SPSS/WIN 23.0 and AMOS 22.0.

Results

The final model fit demonstrated a satisfactory statistical acceptance level: goodness-of-fit-index=.98, adjusted goodness-of-fit-index=.91, comparative fit index=.98, normed fit index=.95, Tucker-Lewis index=.92, and root mean square error of approximation=.06. Self-efficacy (β=−.22, p=.003) and Nun-chi behavior (β=−.17, p=.024) were reported as significant factors affecting clinical practicum stress, explaining 10.2% of the variance. Nursing professionalism (β=.20, p=.006) and self-efficacy (β=.45, p<.001) had direct effects on emotional intelligence, explaining 45.9% of the variance. Self-efficacy had indirect effects on Nun-chi understanding (β=.20, p<.001) and Nun-chi behavior (β=.09, p=.005) through emotional intelligence. Nursing professionalism had indirect effects on Nun-chi understanding (β=.09, p=.005) and Nun-chi behavior (β=.09, p=.005) through emotional intelligence. The variables for self-efficacy and nursing professionalism explained 29.1% of the Nun-chi understanding and 18.2% of the Nun-chi behavior, respectively.

Conclusion

In undergraduate nursing education, it is important to identify and manage factors that affect clinical practicum stress. The findings of this study emphasize the importance of Nun-chi, self-efficacy, emotional intelligence, and nursing professionalism in the development of an educational strategy for undergraduate nursing students.

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Motherhood Ideology and Parenting Stress according to Parenting Behavior Patterns of Married Immigrant Women with Young Children
So-Hyun Moon, Miok Kim, Hyeun Na
J Korean Acad Nurs 2019;49(4):449-460.   Published online January 15, 2019
DOI: https://doi.org/10.4040/jkan.2019.49.4.449
AbstractAbstract PDF
Abstract Purpose

This study aims to provide base data for designing education and counseling programs for child-raising by identifying the types, characteristics and predictors of parenting behaviors of married immigrant women.

Methods

We used a self-report questionnaire to survey 126 immigrant mothers of young children, who agreed to participate, and who could speak Korean, Vietnamese, Chinese, Filipino, or English, at two children's hospitals and two multicultural support centers. Statistical analysis was conducted using descriptive analysis, K-means clustering, χ 2 test, Fisher's exact test, one-way ANOVA, Schéffe's test, and multinominal logistic regression.

Results

We identified three clusters of parenting behaviors: ‘affectionate acceptance group’ (38.9%), ‘active engaging group’ (26.2%), and ‘passive parenting group’ (34.9%). Passive parenting and affectionate acceptance groups were distinguished by the conversation time between couples (p=.028, OR=5.52), ideology of motherhood (p=.032, OR=4.33), and parenting stress between parent and child (p=.049, OR=0.22). Passive parenting was distinguished from active engaging group by support from spouses for participating in multicultural support centers or relevant programs (p=.011, OR=2.37), and ideology of motherhood (p=.001, OR=16.65). Ideology of motherhood was also the distinguishing factor between affectionate acceptance and active engaging groups (p=.041, OR=3.85).

Conclusion

Since immigrant women's parenting type depends on their ideology of motherhood, parenting stress, and spousal relationships in terms of communication and support to help their child-raising and socio-cultural adaptation, it is necessary to provide them with systematic education and support, as well as interventions across personal, family, and community levels.

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Effectiveness of Health Promotion Program Using Action Planning Strategy for Young Adults
Su Hyun Kim, Min Ji Kim, Sang Hee Kim, So Yeon Kim, Chae Yeon Park, Jee Yun Bang
J Korean Acad Nurs 2019;49(4):461-471.   Published online January 15, 2019
DOI: https://doi.org/10.4040/jkan.2019.49.4.461
AbstractAbstract PDF
Abstract Purpose

The purpose of this study was to evaluate the effectiveness of a health promotion program utilizing action planning strategy for young adults.

Methods

A non-equivalent control group pre-post-test design was used. One hundred three university students participated in the study. Participants in the experimental group (n=51) were provided the health promotion program utilizing action planning strategy for five weeks. The program consisted of weekly sessions that included action planning and group feedback. The control group (n=52) was provided with health information every week for 5 weeks. Program outcomes, including self-efficacy, physical activity health behaviors, total exercise time per week, daily cigarette consumption, frequency of alcohol drinking per month, nutritional health behaviors, and subjective health status, were assessed at baseline and at follow-up after 5 weeks.

Results

The participants in the experimental group demonstrated significant increases in self-efficacy, physical activity health behaviors, weekly exercise time, and nutritional health behaviors and significant decreases in daily cigarette consumption than those in the control group.

Conclusion

The health promotion program utilizing action planning strategy is a brief and effective intervention to promote health behaviors among young adults. Further investigation is warranted to assess the program's effectiveness among other age groups and populations at high risk for chronic illness.

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The Development and Evaluation of a Health Literacy-Adapted Self-Management Intervention for Elderly Cancer Patients Undergoing Chemotherapy
Yoon Sun Kim, Young Sook Tae, Kwuy-Im Jung
J Korean Acad Nurs 2019;49(4):472-485.   Published online January 15, 2019
DOI: https://doi.org/10.4040/jkan.2019.49.4.472
AbstractAbstract PDF
Abstract Purpose

This study aimed to develop and evaluate the effectiveness of an adapted health literacy self-management intervention for elderly cancer patients undergoing chemotherapy.

Methods

The intervention in this study was systematically developed through the six stages of Intervention Mapping Protocol and was based on Fransen et al's causal pathway model. A quasi-experimental trial was conducted on a total of 52 elderly patients (26 in an experimental group and 26 in a control group) undergoing chemotherapy in Korea. The intervention consisted of seven sessions over 5 weeks. The experimental tool for this study was an adapted health literacy self-management intervention, which was designed to promote a reduction in the symptom experience and distress of elderly cancer patients through the promotion of self-management behavior. To develop efficient educational materials, the participants’ health literacy was measured. To educate participants, clear communication and the teach-back method were used. In addition, for the improvement of self-efficacy, four sources were utilized. For the promotion of self-management behavior, five self-management skills were strengthened. Data were collected before and after the intervention from June 4 to September 14, 2018. The data were analyzed with SPSS/WIN 21.0.

Results

Following the intervention, self-management knowledge and behavior and, self-efficacy significantly improved in experimental group. Symptom experience and distress decreased in the experimental group compared to the control group.

Conclusion

The self-management intervention presented in this study was found to be effective in increasing self-management knowledge and behavior and, self-efficacy, and ultimately in reducing symptom experience and distress for elderly patients undergoing chemotherapy.

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The Effect on Pain of Buzzy® and ShotBlocker® during the Administration of Intramuscular Injections to Children: A Randomized Controlled Trial
Birsen Sivri Bilgen, Serap Balcı
J Korean Acad Nurs 2019;49(4):486-494.   Published online January 15, 2019
DOI: https://doi.org/10.4040/jkan.2019.49.4.486
AbstractAbstract PDF
Abstract Purpose

To investigate the effect of Buzzy® and ShotBlocker® on reducing pain induced by intramuscular penicillin injections in children.

Methods

This was a randomized controlled study. A total of 150 Turkish children aged 7~12 years who presented to our pediatric emergency clinic and met the inclusion criteria were recruited. The children were randomly assigned to each group (control=50, Buzzy®=50, ShotBlocker®=50). Data were collected using an information form, the State-Trait Anxiety Inventory for Children, Visual Analog Scale, and Faces Pain Scale-Revised.

Results

The children in the control group had significantly higher pain scores during the penicillin injection than the children in the ShotBlocker® and Buzzy® groups. The children in the Buzzy® group had significantly less pain than the children in both the ShotBlocker® and control groups (p<.001).

Conclusion

Buzzy® was more effective compared with ShotBlocker® in this study.

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The Mediating Effects of Learning Motivation on the Association between Perceived Stress and Positive-Deactivating Academic Emotions in Nursing Students Undergoing Skills Training
Wei Wang, Huiying Xu, Bingmei Wang, Enzhi Zhu
J Korean Acad Nurs 2019;49(4):495-504.   Published online January 15, 2019
DOI: https://doi.org/10.4040/jkan.2019.49.4.495
AbstractAbstract PDF
Abstract Purpose

Nursing students experience a high degree of perceived stress during skills training. The resulting academic sentiment is worthy of research. This study examined the learning motivation as a mediator in the association between perceived stress and positive deactivating academic emotions in nursing students undergoing skills training.

Methods

A survey was conducted on 386 third-year undergraduate nursing students at a university in Changchun, China, in 2017. The survey included the items on perceived stress, learning motivation during nursing skill training, and general academic emotion. There were 381 valid responses (response rate=98.7%). Based on the results of partial correlation and stepwise multiple regression equations, the study examined the mediation model between perceived stress, learning motivation and positive-deactivating academic emotions using process 2.16 (a plug-in specifically used to test mediation or moderation effect in SPSS).

Results

There was a significant negative correlation between students’ perceived stress and learning motivation during nursing skills training and positive-deactivating academic emotions. Nervousness, loss of control, and interest in developing reputation had significant predictive effects on positive-deactivating academic emotions. The mediating model was well supported.

Conclusion

Learning motivation during nursing skills training lessened the damage of perceived stress on positive-deactivating academic emotions. Improving students’ motivation to learn could reduce their perceived stress and build more positive emotions. Positive emotions during learning played an important role in helping nursing students improve skills and enhance their nursing competence.

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