Journal of Korean Academy of Nursing

Analysis of Research Topics and Trends in the Journal of Korean Academy of Nursing to Improve Its International Influence: Yu, Soyoung , Kim, Jeung-Im , Park, Jin-Hee , Jang, Sun Joo , Suh, Eunyoung E. , Song, Ju-Eun , Im, YeoJin; J Korean Acad Nurs 2020;50(4):501-512. Published online August 31, 2020; DOI: https://doi.org/10.4040/jkan.20167

Abstract PDF: Purpose
The purpose of this study was to analyze articles published in the Journal of the Korean Academy of Nursing (JKAN) between 2010 and 2019, along with those published in three international nursing journals, to improve JKAN’s international reputation.
Methods
The overall characteristics of JKAN’s published papers and keywords, study participants, types of nursing interventions and dependent variables, citations, and cited journals were analyzed. Additionally, the keywords and study designs, publication-related characteristics, journal impact factors (JIF), and Eigenfactor scores of International Journal of Nursing Studies (IJNS), International Nursing Review (INR), Nursing & Health Sciences (NHS), and JKAN were analyzed and compared.
Results
Among the four journals, JKAN’s score was the lowest in both the journal impact factor and Eigenfactor score. In particular, while the JIF of INR and NHS has been continuously increasing; JKAN’s JIF has remained static for almost 10 years. The journals which had cited JKAN and those which JKAN had cited were mainly published in Korean.
Conclusion
JKAN still has a low IF and a low ranking among Social Citation Index (E) journals during the past 10 years, as compared to that of four international journals. To enhance JKAN’s status as an international journal, it is necessary to consider publishing it in English and to continuously improve the conditions of other publications.

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Continuity of Care in Chronic Diseases: A Concept Analysis by Literature Review: Hu, Jingjing , Wang, Yuexia , Li, Xiaoxi; J Korean Acad Nurs 2020;50(4):513-522. Published online August 31, 2020; DOI: https://doi.org/10.4040/jkan.20079

Abstract PDF: Purpose
This study aimed to utilize concept analysis to obtain a better understanding of the concept of “continuity of care” in chronic diseases.
Methods
The concept of continuity of care was analyzed using the Walker and Avant method. Covering literature in English from 1930 to 2018, the data sources included CINAHL Complete, Academic Search Complete, MEDLINE, PsyARTICLES, Health Source: Nursing/ Academic Edition, Google Scholar, Science Direct, and the Cochrane Library.
Results
A comprehensive definition of concept of continuity of care was developed based on a systematic search and synthesis. The key defining attributes were identified as (a) care over time, (b) the relationship between an individual patient and a care team, (c) information transfer, (d) coordination, and (e) meeting changing needs. The antecedents of continuity of care were having a chronic disease, inexperienced with disease management, a poorly coordinated healthcare system, and medical care limitations. The consequences of continuity of care were decreasing hospital admissions, reducing costs, reducing emergency room visits, improving the quality of life, improving patient satisfaction, and delivering good healthcare.
Conclusion
The thorough concept analysis provides insight into the nature of “continuity of care” in chronic diseases and also helps ground the concept in healthcare.

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Effectiveness of Multi Interventional Package on Selected Parameters of Metabolic Syndrome among Women - A Pilot Study: Elizabeth, Attonassary Jose , Aruna, Swaminathan , Mercy, Parayidathil Joseph; J Korean Acad Nurs 2020;50(4):523-532. Published online August 31, 2020; DOI: https://doi.org/10.4040/jkan.20012

Abstract PDF: Purpose
The purpose of the study was to compare the effectiveness of multi interventional package (MIP) and lifestyle interventions (LI) on physiological parameters of women with metabolic syndrome, to compare the effectiveness of MIP and LI on biochemical parameters of women with metabolic syndrome and to compare the effectiveness of MIP and LI on socio-psychological parameters of women with metabolic syndrome.
Methods
A quasi experimental nonequivalent control group design with two experimental groups and one control group was used to collect data from 60 self-help group women. Samples were selected by multistage sampling. Reflexology foot massage, dietary modification, moderate intensity exercise and structured education were given to MIP group and dietary modification, moderate intensity exercise and structured education were given to LI group for 12 weeks. Control group received routine care. Demographic and clinical data sheets were used to collect basic information. Knowledge was assessed by a knowledge questionnaire. Physiological (weight, body mass index, waist circumference and blood pressure) and biochemical parameters (HDL, triglycerides and FBS) were assessed before and after the intervention.
Results
The study found significant change in the physiological and biochemical parameters of metabolic syndrome as well as knowledge among the MIP group and LI group compared to the control group (p < .001).
Conclusion
MIP and LI are effective in controlling the parameters of metabolic syndrome. Hence the guidance may be provided to women with metabolic syndrome for adopting necessary lifestyle changes as well as reflexology foot massage to control the physiological and biochemical parameters of metabolic syndrome.

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Disease Prevention Knowledge, Anxiety, and Professional Identity during COVID-19 Pandemic in Nursing Students in Zhengzhou, China: Sun, Yuyan , Wang, Dongyang , Han, Ziting , Gao, Jie , Zhu, Shanshan , Zhang, Huimin; J Korean Acad Nurs 2020;50(4):533-540. Published online August 31, 2020; DOI: https://doi.org/10.4040/jkan.20125

Abstract PDF: Purpose
This study aimed to evaluate nursing students’ understanding of the prevention of COVID-19, as well as their anxiety towards the disease and their perception of their professional identity in the wake of the pandemic, in Zhengzhou, China.
Methods
A cross-sectional study was designed to investigate 474 nursing students by cluster sampling using a stratified questionnaire from February 15 to March 31, 2020. Multiple linear regression was used to identify the factors affecting professional identity. Binary and multiple logistic regression were used to identify the factors affecting anxiety.
Results
Responders with a high level of understanding of COVID-19 and frequent use of behavioral strategies for its prevention comprised 93.2% and 30.0% of the cohort, respectively. Professional identity was significantly associated with gender and anxiety (p < .050). The prevalence of anxiety among nursing students was 12.4%. Male (odds ratio [OR] = 2.39; 95% confidence interval [CI] = 1.26~4.52), sophomores (OR = 5.30; 95% CI = 1.61~7.45), and infrequent use of prevention measures (OR = 3.49; 95% CI = 1.16~5.19) had a significant effect on anxiety.
Conclusion
Anxiety during the COVID-19 epidemic gives an adverse effect on the professional identity of nursing in students. Nursing education institutions need to provide psychological counseling services for nursing students, in addition to improving their teaching of COVID-19 prevention strategies.

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The Incidences of Catheter Colonization and Central Line-Associated Bloodstream Infection According to Tegaderm vs. Chlorhexidine Gluconate (CHG)-Tegaderm Dressing: Kim, Eunji , Lee, Haejung; J Korean Acad Nurs 2020;50(4):541-553. Published online August 31, 2020; DOI: https://doi.org/10.4040/jkan.19215

Abstract PDF: Purpose
In spite of the recent application of a general infection control method, central line-associated infections is still relatively high in Korea. Central line bundle with Chlorhexidine gluconate (CHG) tegaderm dressing was reported to be effective in reducing catheter colonization and central line-associated bloodstream infections (CLABSI). Therefore, this study aimed to examine the incidences of catheter colonization occurrence and CLABSI while using Tegaderm vs. CHG Tegaderm dressings.
Methods
We used a descriptive design. 400 patients who had central venous catheters were selected from four hospitals in the Korean National Healthcare-associated Infections Surveillance System. Of all subjects, 200 used Tegaderm ^TM (Tegaderm group), and the remaining 200 used CHG Tegaderm (CHG Tegaderm group) dressing at the catheter insertion site. Data were analyzed using the c 2 test or Fisher’s exact test, t-test, and logistic regression analysis using SPSS WIN 21.0.
Results
In the Tegaderm and CHG Tegaderm groups, CLABSI incidences were 5.89 and 1.79 per 1,000 catheter-days, catheter colonization incidences were 3.93 and 1.43 per 1,000 catheter-days, and central line bundle compliance rates were 26.0% and 49.0%, respectively. Catheter colonization risk factors were ‘reinsertion after failure’ and ‘Tegaderm dressing’ at the central line insertion site. CLABSI risk factors were ‘incomplete performance of 7 central line bundle items’ and ‘Tegaderm dressing’ at the central line insertion site.
Conclusion
A further prospective study is needed to examine the effects of central line bundle with CHG Tegaderm dressing, avoiding central line reinsertion after failure, and improving the bundle compliance in reducing catheter colonization and CLABSI.

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A Structural Equation Model of Health-Related Quality of Life among Older Women Following Bilateral Total Knee Replacement: Lee, Hyun Ok , Yoo, Jae Soon; J Korean Acad Nurs 2020;50(4):554-570. Published online August 31, 2020; DOI: https://doi.org/10.4040/jkan.19216

Abstract PDF: Purpose
This study aimed to develop and test a structural equation model of health-related quality of life among older women following bilateral total knee replacement based on a literature review and Wilson and Cleary’s model of health-related quality of life.
Methods
One hundred ninety three women who were diagnosed with osteoarthritis, were older than 65 years, and were between 13 weeks and 12 months of having a bilateral total knee replacement were recruited from an outpatient clinic. Data were collected from July 2017 to April 2018 using a structured questionnaire and medical records. Data were analyzed using SPSS/WIN 22.0, AMOS 22.0, and Smart PLS 3.2.4.
Results
The fitness of the hypothetical model was good, with coefficients of determination (R² ) ranging between .28 and .75 and predictive relevance (Q² ) between .26 and .73. The standardized root mean square residual of the model fit indices for the hypothetical model was .04; which explained 64.2% of physical and 62.5% of mental health-related quality of life. Self-efficacy, symptom status, functional status, and general health perceptions had a significant direct effect on physical health-related quality of life, while social support, symptom status, and general health perceptions had a significant direct effect on participants’ mental-health-related quality of life.
Conclusion
To improve the physical and mental quality of life of older women who receive bilateral knee replacement, nursing-based intervention strategies that reduce symptoms, improve functional status, and increase health perceptions, self-efficacy, and social support are needed. The most important factor is the symptom status.

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Effects of BeHaS Program on Health Behavior, Physiologic Index and Self-Esteem of the Elderly Living Alone with Metabolic Syndrome Based on Community Based Participatory Research: Kim, Jong Im , Kim, Sun Ae , Park, Keumok , Kim, Jiyoung , Lee, Lina , Choi, Si Wan , Ku, Bon Jeong; J Korean Acad Nurs 2020;50(4):571-582. Published online August 31, 2020; DOI: https://doi.org/10.4040/jkan.19261

Abstract PDF: Purpose
This study aimed to determine the effects of a 12-week metabolic syndrome BeHaS (Be Happy and Strong) program in elderly people with metabolic syndrome living alone, based on a community-based participatory research (CBPR).
Methods
A nonequivalent control group pre-posttest design was used, and the participants were 43 elderly people living alone (experimental group 24, control group 19). The experimental group received a one-hour program per week and two individual health consultations during 12 weeks. The control group received two sessions about the metabolic syndrome and two individual health consultations. The effects of health behavior, blood pressure, blood sugar levels, abdominal circumference, triglycerides, and self-esteem were evaluated. The data were analyzed using the independent t-test and Mann-Whitney U test.
Results
The health behavior with respect to the metabolic syndrome in the experimental group increased significantly (t = - 3.19, p = .002). Both diastolic blood pressure and abdominal circumference decreased in the experimental group (t = 2.00, p = .028 and t = 3.91, p < .001). No significant differences were observed between the groups in systolic blood pressure, fasting blood sugar levels, triglycerides, and self-esteem.
Conclusion
The 12-week metabolic syndrome BeHaS program using community resources improves the health of elderly people with metabolic syndrome living alone. Based on these findings, further studies on the effectiveness of the metabolic syndrome BeHaS program and the experiences of those who participated in the CBPR are warranted.

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Opening Status of the Korea Midwifery Birthing Centers and Development of Midwifery Practice Guideline: Song, Ji Young , Park, Young-Joo; J Korean Acad Nurs 2020;50(4):583-598. Published online August 31, 2020; DOI: https://doi.org/10.4040/jkan.20032

Abstract PDF: Purpose
This study was to investigate the operational status of the midwifery birthing centers (MBCs) and midwives’ job status (Phase 1) and to develop midwifery practice guidelines (MPG) (Phase 2) in Korea.
Methods
In the first phase, the subjects were 15 midwives who operated 11 of 14 MBCs that were opened as of August 2018. The questionnaire consisted of items to measure the operational status of the MBC and midwives’ job status. In the second phase, the MPG was developed from literature review, interviews with five midwives opening their MBCs, surveys with 74 midwives, and a validity evaluation conducted by seven experts.
Results
The distribution of operating MBCs was five in Gyunggi-do, two each in Seoul and Incheon, one each in Busan, Chungcheongbuk-do, Gyeongsangbuk-do, Gyeongsangnam-do and Jeju-do. The mean age of midwives was 54.3 and all were female. In 2017, a total of 762 births including 81 homebirths were performed by midwives. The job performance was highest in the order of neonatal care 3.81, childbirth care 3.56, and postpartal care 3.53, respectively. The MPG included seven areas of prenatal care, childbirth care, postpartal care, neonatal care, primary health care, law/ ethics, and administration, with 56 tasks and 166 task elements.
Conclusion
This study provides the valid basic data for the operational status of the MBC and the midwives’ job status. The MPG describes the midwife’s job and may be used as basic data for preparing policies for the development of midwifery practice in Korea.

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Development and Evaluation of the Life Respect Enhancement Program for Nursing Officers: Hwang, Sunyoung , Choi, Heeseung; J Korean Acad Nurs 2020;50(4):599-610. Published online August 31, 2020; DOI: https://doi.org/10.4040/jkan.20055

Abstract PDF: Purpose
The present study was conducted to develop the Life Respect Enhancement Program and test its effectiveness on suicide knowledge, suicide intervention skills, self-efficacy in suicide prevention, and gatekeeper behaviors among nursing officers.
Methods
The program was developed according to the ADDIE model and finalized after practical need analysis, expert verification, and a preliminary study. The present study used a concurrent embedded mixed-method research design. To compare the effects of the Program and the control group on the outcome variables, a quantitative study was conducted using a nonequivalent control group with a pretest-posttest design. Quantitative data were analyzed using c 2 -tests, t-tests, and RM-ANOVA. A qualitative study was conducted using FGI with six members of the experimental group 3 months after intervention completion.
Results
In total, 56 nursing officers participated in the 3-month follow-up test. Compared to the control group, the experimental group showed significant improvements in suicide knowledge, suicide intervention skills, and self-efficacy in suicide prevention scores at post-test. The significant group differences in suicide knowledge and suicide intervention skills were maintained at 3 months. The gatekeeper behavior scores of the experimental group were also significantly higher than those of the control group at 3 months. Qualitative analysis of the participants’ experiences with the Program yielded two themes and seven sub-themes.
Conclusion
The newly developed Life Respect Enhancement Program demonstrates significant effects on suicide knowledge, suicide intervention skills, and gatekeeper behaviors. Thus, this program is recommended to promote suicide prevention competencies among nursing officers in military clinical settings.

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The Reliability and Validity of Korean Version of Wong and Law Emotional Intelligence Scale (K-WLEIS): Jeong, Harim , Choi, Heejung , Park, Myungsook; J Korean Acad Nurs 2020;50(4):611-620. Published online August 31, 2020; DOI: https://doi.org/10.4040/jkan.20109

Abstract PDF: Purpose
The aim of this study was to evaluate the reliability and validity of the Korean version of the Wong and Law Emotional Intelligence Scale (K-WLEIS). Methods: Data were collected from 360 nursing students using a self reported questionnaire. Exploratory and confirmatory factor analysis were used to test construct validity. Convergence validity was identified by correlation with communication competency. Item convergent and discriminant validity were also analyzed. Reliability was evaluated internal consistency and test-retest reliability. Results: The results of exploratory factor analysis showed that the eigen values ranged from 1.34 to 5.86 and 73.2% of the total explained variance. Confirmatory factor analysis showed adequate model fit indices (χ² /df 1.89, RMSEA .07, GFI .89, CFI .95, and TLI .93) and standardized factor loadings (.48 to .87). The average extracted variances (.71 to .79) and composite reliability (.80 to .87) validated convergence and discriminant validity of the items. Test-retest reliability of intra-class correlation coefficient was .90 and the Cronbach’s alpha coefficient was .88. Conclusion: The K-WLEIS is an appropriate scale for measuring the emotional intelligence of Korean nursing students. Therefore, it is expected that the K-WLEIS will be used for nursing education programs to improve nursing students’ emotional intelligence.

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External Validation of Carbapenem-Resistant Enterobacteriaceae Acquisition Risk Prediction Model in a Medium Sized Hospital: Seo, Su Min , Jeong, Ihn Sook; J Korean Acad Nurs 2020;50(4):621-630. Published online August 31, 2020; DOI: https://doi.org/10.4040/jkan.20137

Abstract PDF: Purpose
This study was aimed to evaluate the external validity of a carbapenem-resistant Enterobacteriaceae (CRE) acquisition risk prediction model (the CREP-model) in a medium-sized hospital.
Methods
This retrospective cohort study included 613 patients (CRE group: 69, no-CRE group: 544) admitted to the intensive care units of a 453-beds secondary referral general hospital from March 1, 2017 to September 30, 2019 in South Korea. The performance of the CREP-model was analyzed with calibration, discrimination, and clinical usefulness.
Results
The results showed that those higher in age had lower presence of multidrug resistant organisms (MDROs), cephalosporin use ≥ 15 days, Acute Physiology and Chronic Health Evaluation II (APACHE II) score ≥ 21 points, and lower CRE acquisition rates than those of CREP-model development subjects. The calibration-in-the-large was 0.12 (95% CI: - 0.16~0.39), while the calibration slope was 0.87 (95% CI: 0.63~1.12), and the concordance statistic was .71 (95% CI: .63~.78). At the predicted risk of .10, the sensitivity, specificity, and correct classification rates were 43.5%, 84.2%, and 79.6%, respectively. The net true positive according to the CREP-model were 3 per 100 subjects. After adjusting the predictors’ cutting points, the concordance statistic increased to .84 (95% CI: .79~.89), and the sensitivity and net true positive was improved to 75.4%. and 6 per 100 subjects, respectively.
Conclusion
The CREP-model’s discrimination and clinical usefulness are low in a medium sized general hospital but are improved after adjusting for the predictors. Therefore, we suggest that institutions should only use the CREP-model after assessing the distribution of the predictors and adjusting their cutting points.

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Secondary Data Analysis on the Factors Influencing Premenstrual Symptoms of Shift Work Nurses: Focused on the Sleep and Occupational Stress: Baek, Jihyun , Choi-Kwon, Smi; J Korean Acad Nurs 2020;50(4):631-640. Published online August 31, 2020; DOI: https://doi.org/10.4040/jkan.19230

Abstract PDF: Purpose
This study aimed to examine premenstrual symptoms (PMS) of shift nurses and identify the association between PMS, sleep, and occupational stress.
Methods
This study was conducted with a secondary data analysis that used data from the Shift Work Nurse’s Health and Turnover study. The participants were 258 nurses who were working in shifts including night shifts. PMS, sleep patterns (sleep time and sleep time variability), sleep quality, and the occupational stress of each participant were measured using the Moos Menstrual Distress Questionnaire, a sleep diary, an actigraph, the Insomnia Severity Index, and the Korean Occupational Stress Scale, respectively. Data were analyzed using SPSS 23 and STATA 15.1 to obtain descriptive statistics, Pearson’s correlation coefficients, multiple linear regression with generalized estimating equations (GEE) and Baron and Kenny’s mediating analysis.
Results
The average PMS score, average sleep time, average sleep time variability, average sleep quality score, and average occupational stress score of the participants was 53.95 ± 40.45, 7.52 ± 0.89 hours, 32.84 ± 8.43%, 12.34 ± 5.95, and 49.89 ± 8.98, respectively. A multiple linear regression analysis with GEE indicated that sleep time variability (B = 0.86, p = .001), and sleep quality (B = 2.36, p < .001) had negative effects on nurses’ PMS. We also found that sleep quality had a complete mediating effect in the relationship between occupational stress and PMS.
Conclusion
These findings indicate that both sleep time variability and sleep quality are important factors associated with PMS among shift work nurses. To improve shift nurses’ PMS status, strategies are urgently needed to decrease sleep time variability and increase sleep quality.

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