Journal of Korean Academy of Nursing

Assessment of Risk Factors for Postoperative Delirium in Older Adults Who Underwent Spinal Surgery and Identifying Associated Biomarkers Using Exosomal Protein: Baek, Wonhee , Lee, JuHee , Jang, Yeonsoo , Kim, Jeongmin , Shin, Dong Ah , Park, Hyunki , Koo, Bon-Nyeo , Lee, Hyangkyu; J Korean Acad Nurs 2023;53(4):371-384. Published online August 31, 2023; DOI: https://doi.org/10.4040/jkan.22146

Abstract PDF: Purpose
With an increase in the aging population, the number of patients with degenerative spinal diseases undergoing surgery has risen, as has the incidence of postoperative delirium. This study aimed to investigate the risk factors affecting postoperative delirium in older adults who had undergone spine surgery and to identify the associated biomarkers.
Methods
This study is a prospective study. Data of 100 patients aged ≥ 70 years who underwent spinal surgery were analyzed. Demographic data, medical history, clinical characteristics, cognitive function, depression symptoms, functional status, frailty, and nutritional status were investigated to identify the risk factors for delirium. The Confusion Assessment Method, Delirium Rating Scale-R-98, and Nursing Delirium Scale were also used for diagnosing deliri-um. To discover the biomarkers, urine extracellular vesicles (EVs) were analyzed for tau, ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), neurofilament light, and glial fibrillary acidic protein using digital immunoassay technology.
Results
Nine patients were excluded, and data obtained from the remaining 91 were analyzed. Among them, 18 (19.8%) developed delirium. Differences were observed between partici-pants with and without delirium in the contexts of a history of mental disorder and use of benzodiazepines (p = .005 and p = .026, respectively). Tau and UCH-L1—concentrations of urine EVs—were comparatively higher in participants with severe delirium than that in partici-pants without delirium (p = .002 and p = .001, respectively).
Conclusion
These findings can assist clinicians in accurately identifying the risk factors before surgery, classifying high-risk patients, and predicting and detecting delirium in older patients. Moreover, urine EV analysis revealed that postoperative delirium following spinal surgery is most likely associated with brain damage.

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The Impact of Self-Efficacy on Nurses’ Well-Being: Does Digital Competence Matter?: Li, Yali , Jing, Qi , Feng, Taiwen , Yang, Xiaoling; J Korean Acad Nurs 2023;53(4):385-396. Published online August 31, 2023; DOI: https://doi.org/10.4040/jkan.23037

Abstract PDF: Purpose
Drawing on person–environment fit theory and social cognitive theory, this study aimed to examine how self-efficacy affects nurses’ workplace well-being via person-job fit and the moderating role of digital competence.
Methods
A two-wave survey was conducted to collect data. Data were collected from six hundred and ninety-five nurses at three Chinese hospitals between May 2022 and September 2022. We employed hierarchical regression analysis and bootstrapping to analyze the data.
Results
Self-efficacy positively influenced person-job fit (β = .55, p < .001), which positively affected nurses’ workplace well-being (β = .32, p < .001). Person-job fit mediated the effect of self-efficacy on nurses’ workplace well-being. Additionally, digital competence strengthened the positive impact of self-efficacy on person-job fit (β = .12, p < .001).
Conclusion
Recruiting nurses with both self-efficacy and digital competence benefits hospitals. It is critical for nurses to improve their digital competence for achieving person-job fit and attaining workplace well-being in the post-coronavirus disease 2019 (COVID-19) era.

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Effectiveness of Simulation-Based Education for Caring Patients with COVID-19: Lee, Min Hye , Noh, Eun-Young; J Korean Acad Nurs 2023;53(4):397-411. Published online August 31, 2023; DOI: https://doi.org/10.4040/jkan.22151

Abstract PDF: Purpose
The role of medical staff gained immense significance in the context of the prolonged coronavirus disease (COVID-19) pandemic. However, few studies had explored the impact of simulation-based education on the ability of nursing students to care for the patients of COVID-19. This study provided nursing students with simulation-based education in caring for the patients of COVID-19 and confirmed its effectiveness.
Methods
This study used a non-equivalent control group pretest-posttest design. The participants were recruited from the nursing departments of two universities in Korea through convenience sampling. A total of 79 participants were included: 37 in the intervention group and 42 in the control group. The intervention group received four sessions of simulation training based on the National League for Nursing Jeffries simulation theory.
Results
The intervention group showed an improvement compared to the control group in terms of knowledge related to coronavirus, confidence in performing infection control skills, and perception of preparedness for caring for the patients of COVID-19, with a high-level of satisfaction and self-confidence in learning. There was no significant difference between the two groups in terms of anxiety.
Conclusion
This simulation is expected to be a significant strategy for alleviating the global burden in terms of staff safety and patient outcomes by improving the competencies of prospective medical staff in responding to pandemics.

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Effects of a Modified Six-Sigma-Methodology-Based Training Program on Core Competencies in Rehabilitation Nurse Specialists: Gu, Jiayi , Luo, Lan , Li,, Chengjuan , Ma, Sumin , Gong, Fanghua; J Korean Acad Nurs 2023;53(4):412-425. Published online August 31, 2023; DOI: https://doi.org/10.4040/jkan.22122

Abstract PDF: Purpose
Nurses play an important role in ensuring patient rehabilitation and are involved in all aspects of multidimensional rehabilitation. Therefore, strengthening rehabilitation nursing education is vital to ascertain high-quality rehabilitation and optimum outcomes. This study examined the effectiveness of a new teaching reform—a modified Six-Sigma-based training program—against a conventional educational program on rehabilitation specialist nurses’ core competencies, post-training performance, and satisfaction.
Methods
A quasi-randomized controlled trial was conducted to assess the effectiveness of the modified training program. We recruited 56 learners from the 2020 training course at the Hunan Rehabilitation Specialist Nurse Training Base as the control group. Sixty learners from the base’s 2021 training course were recruited as the intervention group. Data were collected in a consistent manner from both groups after the training program was implemented.
Results
Those who underwent the modified training program showed better improvement in all core competencies than those who underwent the conventional training program (p < .05); the scores for theoretical knowledge, clinical nursing lectures, reviews, and nursing case management improved significantly following the teaching reform (p < 0.05). Further, overall satisfaction as well as base management and theoretical teaching satisfaction improved significantly (p < .05).
Conclusion
The modified training program strengthens rehabilitation nurses’ base management abilities; enhances their core competencies; expands their interest in and breadth, depth, and practicability of theoretical courses; and updates the teaching methods.

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Exploring Spatial Variations and Factors associated with Walking Practice in Korea: An Empirical Study based on Geographically Weighted Regression: Kim, Eunjoo , Lee, Yeongseo , Yoon, Ju Young; J Korean Acad Nurs 2023;53(4):426-438. Published online August 31, 2023; DOI: https://doi.org/10.4040/jkan.23045

Abstract PDF: Purpose
Walking practice is a representative indicator of the level of physical activity of local residents. Although the world health organization addressed reduction in prevalence of insufficient physical activity as a global target, the rate of walking practice in Korea has not improved and there are large regional disparities. Therefore, this study aimed to explore the spatial variations of walking practice and its associated factors in Korea.
Methods
A secondary analysis was conducted using Community Health Outcome and Health Determinants Database 1.3 from Korea Centers for Disease Control and Prevention. A total of 229 districts was included in the analysis. We compared the ordinary least squares (OLS) and the geographically weighted regression (GWR) to explore the associated factors of walking practice. MGWR 2.2.1 software was used to explore the spatial distribution of walking practice and modeling the GWR.
Results
Walking practice had spatial variations across the country. The results showed that the GWR model had better accommodation of spatial autocorrelation than the OLS model. The GWR results indicated that different predictors of walking practice across regions of Korea.
Conclusion
The findings of this study may provide insight to nursing researchers, health professionals, and policy makers in planning health programs to promote walking practices in their respective communities.

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Analysis of Media Trends and Social Perceptions on Nursing Law Legislation: Lee, Seung-Hee , Joo, Min-Ho; J Korean Acad Nurs 2023;53(4):439-452. Published online August 31, 2023; DOI: https://doi.org/10.4040/jkan.23030

Abstract PDF: Purpose
This study aimed to derive considerations for the enactment of nursing law by analyzing the trends and social perceptions of nursing law mentioned in major daily newspapers, cafes, and blogs.
Methods
Main texts and comments that included nursing law as a keyword were collected from major daily news and online postings from January 2021 to August 2022. The data collected through web crawling were analyzed using a TousFlux program used for big data analysis.
Results
During the period of study, the awareness level around nursing law enactment increased. In particular, public concern over nursing law enactment intensified due to the two political parties' policy pledges related to nursing law in January 2022 and the failure to introduce the nursing law to the national assembly judiciary committee in May 2022. Except in December 2021, public perception of nursing law enactment was generally favorable, with public opinion tilting more in favor of than against enactment.
Conclusion
Public opinion should be considered when drafting and implementing the nursing law to make it easier for the people to understand what the law constitutes. In addition, it is necessary to pay attention to and continuously promote the relationship between medical care and nursing in the nursing law system of developed nations. Lastly, nursing law enactment can enhance nurses' retention intention and provide a sense of efficacy to medical services.

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An Investigation of the Cumulative Effects of Depressive Symptoms on the Cognitive Function in Community-Dwelling Older Adults: Analysis of the Korean Longitudinal Study of Aging: Kim, Eunmi , Oh, Jinkyung , Huh, Iksoo; J Korean Acad Nurs 2023;53(4):453-467. Published online August 31, 2023; DOI: https://doi.org/10.4040/jkan.23018

Abstract PDF: Purpose
This study investigated the cumulative effects of depressive symptoms on cognitive function over time in community-dwelling older adults. Methods: Data were investigated from 2,533 community-dwelling older adults who participated in the Korean Longitudinal Study of Aging (KLoSA) from the 5th (2014) to the 8th wave (2020). The association between cumulative depressive symptoms and cognitive function was identified through multiple regression analysis. Results: When the multiple regression analysis was conducted from each wave, the current depressive symptoms scores and cognitive function scores were negatively associated, regardless of the waves (B5th = - 0.26, B6th = - 0.26, B7th = - 0.26, and B8th = - 0.27; all p < .001). Further, when all the previous depressive symptoms scores were added as explanatory variables in the 8th wave, the current one (B8th = - 0.09, p < .001) and the previous ones (B5th = - 0.11, B6th = - 0.09, and B7th = - 0.13; all p < .001) were also negatively associated with the cognitive function score. The delta R² , which indicates the difference between the model’s R² with and without the depressive symptoms scores, was greater in the model with all the previous and current depressive symptoms scores (6.4%) than in the model with only the current depressive symptoms score (3.6%). Conclusion: Depressive symptoms in older adults have a long-term impact. This results in an accumulated adverse effect on the cognitive function. Therefore, to prevent cognitive decline in older adults, we suggest detecting their depressive symptoms early and providing continuous intervention to reduce exposure to long-term depressive symptoms.

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Analysis of ROX Index, ROX-HR Index, and SpO 2 /FIO 2 Ratio in Patients Who Received HighFlow Nasal Cannula Oxygen Therapy in Pediatric Intensive Care Unit: Choi, Sun Hee , Kim, Dong Yeon , Song, Byung Yun , Yoo, Yang Sook; J Korean Acad Nurs 2023;53(4):468-479. Published online August 31, 2023; DOI: https://doi.org/10.4040/jkan.22152

Abstract PDF: Purpose
This study aimed to evaluate the use of the respiratory rate oxygenation (ROX) index, ROX-heart rate (ROX-HR) index, and saturation of percutaneous oxygen/fraction of inspired oxygen ratio (SF ratio) to predict weaning from high-flow nasal cannula (HFNC) in patients with respiratory distress in a pediatric intensive care unit.
Methods
A total of 107 children admitted to the pediatric intensive care unit were enrolled in the study between January 1, 2017, and December 31, 2021. Data on clinical and personal information, ROX index, ROX-HR index, and SF ratio were collected from nursing records. The data were analyzed using an independent t-test, χ² test, Mann–Whitney U test, and area under the curve (AUC).
Results
Seventy-five (70.1%) patients were successfully weaned from HFNC, while 32 (29.9%) failed. Considering specificity and sensitivity, the optimal cut off points for predicting treatment success and failure of HFNC oxygen therapy were 6.88 and 10.16 (ROX index), 5.23 and 8.61 (ROX-HR index), and 198.75 and 353.15 (SF ratio), respectively. The measurement of time showed that the most significant AUC was 1 hour before HFNC interruption.
Conclusion
The ROX index, ROX-HR index, and SF ratio appear to be promising tools for the early prediction of treatment success or failure in patients initiated on HFNC for acute hypoxemic respiratory failure. Nurses caring for critically ill pediatric patients should closely observe and periodically check their breathing patterns. It is important to continuously monitor three indexes to ensure that ventilation assistance therapy is started at the right time.

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A Structural Equation Model on Social Re-Adjustment of Stroke Patients: Based on Roy’s Adaptation Model: Kim, Jungmi , Kim, Hwasoon; J Korean Acad Nurs 2023;53(4):480-495. Published online August 31, 2023; DOI: https://doi.org/10.4040/jkan.22140

Abstract PDF: Purpose
This study aimed to develop and test a structural equation model on social re-adjustment of individuals with stroke based on a literature review and Roy’s adaptation model.
Methods
This study involved 321 participants who had a stroke and visited the outpatient department after discharge. The hypothetical model was developed based on Roy’s adaptation model and a comprehensive review of previous literature on the topic. The model comprised four exogenous variables (neurological damage, gender [man], age, and social support) and five endogenous variables (activities of daily living, acceptance of disability, depression, rehabilitation motivation, and social re-adjustment). The data were analyzed using SPSS Windows software version 22.0 and AMOS 23.0.
Results
Out of 28 research hypotheses, 18 were supported, and they indicated approximately 64% probability of social re-adjustment. Social re-adjustment is directly and significantly affected by age, social support, activities of daily living, and depression. Social re-adjustment is indirectly affected by neurological impairment, gender (men), age, social support, and rehabilitation motivation.
Conclusion
Continuous assistance and care should be provided for individuals with disabilities caused by sudden neurological damage to facilitate gradual improvement in their social re-adjustment. To enhance social re-adjustment, especially among older adults, newly developed interventions should focus on improving their activities of daily living, preventing depression, and enhancing support from family and healthcare personnel.

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