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Volume 44(5); October 2014
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Review Articles
Review of Meta-analysis Research on Exercise in South Korea
Youngshin Song, Moonhee Gang, Sun-Ae Kim, In-Soo Shin
J Korean Acad Nurs 2014;44(5):459-470.   Published online October 31, 2014
DOI: https://doi.org/10.4040/jkan.2014.44.5.459
AbstractAbstract PDF
Purpose

The purpose of this study was to evaluate the quality of meta-analysis regarding exercise using Assessment of Multiple Systematic Reviews (AMSTAR) as well as to compare effect size according to outcomes.

Methods

Electronic databases including the Korean Studies Information Service System (KISS), the National Assembly Library and the DBpia, HAKJISAand RISS4U for the dates 1990 to January 2014 were searched for 'meta-analysis' and 'exercise' in the fields of medical, nursing, physical therapy and physical exercise in Korea. AMSTAR was scored for quality assessment of the 33 articles included in the study. Data were analyzed using descriptive statistics, t-test, ANOVA and χ2-test.

Results

The mean score for AMSTAR evaluations was 4.18 (SD=1.78) and about 67% were classified at the low-quality level and 30% at the moderate-quality level. The scores of quality were statistically different by field of research, number of participants, number of databases, financial support and approval by IRB. The effect size that presented in individual studies were different by type of exercise in the applied intervention.

Conclusion

This critical appraisal of meta-analysis published in various field that focused on exercise indicates that a guideline such as the PRISMA checklist should be strongly recommended for optimum reporting of meta-analysis across research fields.

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Effects of Dignity Interventions on Psychosocial and Existential Distress in Terminally ill Patients: A Meta-analysis
Pok Ja Oh, Sung-Rae Shin
J Korean Acad Nurs 2014;44(5):471-483.   Published online October 31, 2014
DOI: https://doi.org/10.4040/jkan.2014.44.5.471
AbstractAbstract PDF
Purpose

This study was done to evaluate the effects of dignity interventions on depression, anxiety and meaning of life in terminally ill patients.

Methods

PubMed, Cochrane Library CENTRAL, EMBASE, CINAHL and several Korean databases were searched. The main search strategy combined terms indicating dignity intervention, presence of terminal illness and study design. Methodological quality was assessed using Cochrane's Risk of Bias for randomized studies and Risk of Bias Assessment tool for non randomized studies. Data were analyzed by the RevMan 5.2.11 program of Cochrane Library.

Results

Twelve clinical trials met the inclusion criteria with a total of 878 participants. Dignity intervention was conducted for a mean of 2.2 weeks, 2.8 sessions and an average of 48.7 minutes per session. Effect sizes were heterogeneous and subgroup analysis was done. Dignity interventions had a significant effect on depression (ES=-1.05, p<.001, I2=15%) and anxiety (ES=-1.01, p<.001, I2=0). For meaning of life, dignity interventions were effective (ES=-1.64, p=.005) and effect sizes were still heterogeneous.

Conclusion

Results support findings that dignity interventions can assist terminal ill patients in reducing emotional distress and improving meaning of life. Further well-designed dignity studies will lead to better understanding of the effects of treatments on spiritual well-being.

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Trends in Nursing Research in Korea: Research Trends for Studies Published from the Inaugural Issue to 2010 in the Journal of Korean Academy of Nursing and the Journals Published by Member Societies under Korean Academy of Nursing Science
Myoung-Ae Choe, Nam Cho Kim, Kyung Mi Kim, Sung Jae Kim, Kyung Sook Park, Young Soon Byeon, Sung Rae Shin, Soo Yang, Kyung Sook Lee, Eun Hyun Lee, In Sook Lee, Tae Wha Lee, Myung Ok Cho, Jin Hak Kim
J Korean Acad Nurs 2014;44(5):484-494.   Published online October 31, 2014
DOI: https://doi.org/10.4040/jkan.2014.44.5.484
AbstractAbstract PDF
Purpose

The purpose of this study was to identify trends for studies published in the Journal of Korean Academy of Nursing and journals published by member societies from inaugural issues to 2010.

Methods

A total of 6890 studies were analyzed using descriptive statistics.

Results

Quantitative studies accounted for 83.6% while qualitative studies accounted for 14.4%. Most frequently used research designs were quasi-experimental (91.1%) for experimental research and survey (85.2%) for non-experimental research. Most frequent study participants were healthy people (35.8%), most frequent nursing interventions, nursing skills (53.5%), and 39.8% used knowledge, attitude and behavior outcomes for dependent variables. Most frequently used keyword was elderly. Survey studies decreased from 1991 to 2010 by approximately 50%, while qualitative studies increased by about 20%. True experimental research (1.2%) showed no significant changes. Studies focusing on healthy populations increased from 2001-2005 (37.5%) to 2006-2010 (41.0%). From 1970 to 2010, studies using questionnaire accounted for over 50% whereas physiological measurement, approximately 5% only. Experimental studies using nursing skill interventions increased from 1970-1980 (30.4%) to 2006-2010 (64.0%). No significant changes were noted in studies using knowledge, attitude and behavior (39.9% ) as dependent variables.

Conclusion

The results suggest that further expansion of true experimental, qualitative studies and physiological measurements are needed.

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Original Articles
Factors Affecting Social Competence in School-aged Children according to Alcohol Consumption by Parents'
Jin-A Lee, Young-Ran Kweon
J Korean Acad Nurs 2014;44(5):495-503.   Published online October 31, 2014
DOI: https://doi.org/10.4040/jkan.2014.44.5.495
AbstractAbstract PDF
Purpose

The purpose of this study was to identify factors affecting the social competence of school-aged children according alcohol consumption by their parents.

Methods

The participants were 558 5th grade elementary school students. Data were collected using structured questionnaires from September 17 to October 2 2013, and analyzed using descriptive statistics, χ2-test, t-test, ANOVA, Pearson correlation coefficients, and Stepwise multiple regression analysis with the SPSS PC+ 21.0 program.

Results

Participants were classified into three groups according to alcohol use; Non-use parent group (52.7%), social use parent group (31.0%), and problem use parent group (16.3%). Participants whose parents were problem users had significantly lower scores on emotional awareness and expression (F=14.45, p<.001), social support (F=5.82, p=.003), and social competence (F=16.33, p<.001) compared to students in the other two groups. In school-aged children with parents who were alcohol abusers, the variables that predicted social competence was friend support (66.0%).

Conclusion

These results emphasize the importance of focusing on the crucial role of peer support in the development of social competence in school-aged children of parents who abuse alcohol. Further, for these children, interventions aimed at improving social support and children's emotional awareness and expression may be most beneficial.

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Bone Mineral Density, Biochemical Bone Turnover Markers and Factors associated with Bone Health in Young Korean Women
Young-Joo Park, Sook Ja Lee, Nah-Mee Shin, Hyunjeong Shin, Yoo-Kyung Kim, Yunjung Cho, Songi Jeon, Inhae Cho
J Korean Acad Nurs 2014;44(5):504-514.   Published online October 31, 2014
DOI: https://doi.org/10.4040/jkan.2014.44.5.504
AbstractAbstract PDF
Purpose

This study was done to assess the bone mineral density (BMD), biochemical bone turnover markers (BTMs), and factors associated with bone health in young Korean women.

Methods

Participants were 1,298 women, ages 18-29, recruited in Korea. Measurements were BMD by calcaneus quantitative ultrasound, BTMs for Calcium, Phosphorus, Osteocalcin, and C-telopeptide cross-links (CTX), body composition by physical measurements, nutrients by food frequency questionnaire and psychosocial factors associated with bone health by self-report.

Results

The mean BMD (Z-score) was -0.94. 8.7% women had lower BMD (Z-score≤-2) and 14.3% women had higher BMD (Z-score≥0) than women of same age. BTMs were not significantly different between high-BMD (Z-score≥0) and low-BMD (Z-score<0) women. However, Osteocalcin and CTX were higher in women preferring caffeine intake, sedentary lifestyle and alcoholic drinks. Body composition and Calcium intake were significantly higher in high-BMD. Low-BMD women reported significantly higher susceptibility and barriers to exercise in health beliefs, lower bone health self-efficacy and promoting behaviors.

Conclusion

Results of this study indicate that bone health of young Korean women is not good. Development of diverse strategies to intervene in factors such as exercise, nutrients, self-efficacy, health beliefs and behaviors, shown to be important, are needed to improve bone health.

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Posttraumatic Growth, Dyadic Adjustment, and Quality of Life in Breast Cancer Survivors and Their Husbands
Seunghee Song, Eunjung Ryu
J Korean Acad Nurs 2014;44(5):515-524.   Published online October 31, 2014
DOI: https://doi.org/10.4040/jkan.2014.44.5.515
AbstractAbstract PDF
Purpose

The purpose of this study was to identify whether the couple perceived breast cancer as a traumatic event, to evaluate the association among posttraumatic growth, dyadic adjustment, and quality of life and to explore the predictors affecting quality of life of the couple.

Methods

A cross-sectional comparative survey design was utilized. Participants were 57 couples recruited from a national cancer center in Korea. Data were analyzed using paired t-test, McNemar test and independent t-test. On the basis of variables found to be significantly associated with quality of life, multiple regression was used to examine the simultaneous influence of multiple predictors.

Results

Breast cancers survivors and spouses perceived breast cancer as a traumatic event (43.9% and 24.6%, respectively). The global quality of life was explained by perception as trauma (β=-19.79) and posttraumatic growth (β=0.46) in survivors, and perception as trauma (β=-18.81) and dyadic adjustment (β=0.53) in spouses.

Conclusion

Results suggest that future research should use qualitative methods to evaluate why contemplating reasons for cancer contributed to posttraumatic growth, examine other potential predictors of quality of life such as dyadic adjustment and intimacy, and identify links between posttraumatic growth and other psychological outcomes such as distress and well-being, using prospective analyses.

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A Predictive Model of Fall Prevention Behaviors in Postmenopausal Women
Hyun-Jung Jang, Sukhee Ahn
J Korean Acad Nurs 2014;44(5):525-533.   Published online October 15, 2014
DOI: https://doi.org/10.4040/jkan.2014.44.5.525
AbstractAbstract PDF
Abstract Purpose

This study was done to propose and test a predictive model that would explain and predict fall prevention behaviors in postmenopausal women. The health belief model was the theoretical basis to aid development of a nursing intervention fall prevention program.

Methods

Data for 421 postmenopausal women were selected from an original data set using a survey design. The structural equation model was tested for 3 constructs: modifying factors, expectation factors, and threat factors. Expectation factors were measured as relative perceived benefit (perceived benefit minus perceived barrier), self-efficacy, and health motivation; threat factors, as perceived susceptibility (fear of falling) and perceived severity (avoiding activity for fear of falling); and modifying factors: level of education and knowledge about fall prevention. Data were analyzed using SPSS Windows and AMOS program.

Results

Mean age was 55.7 years (range 45-64), and 19.7% had experienced a fall within the past year. Fall prevention behaviors were explained by expectation and threat factors indicating significant direct effects. Mediating effect of health beliefs was significant in the relationship between modifying factors and fall prevention behaviors. The proposed model explained 33% of the variance.

Conclusion

Results indicate that fall prevention education should include knowledge, expectation, and threat factors based on health belief model.

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Current State of Influenza Vaccination and Factors Affecting Vaccination Rate among Pregnant Women
Og Son Kim, Sung Won Yoon
J Korean Acad Nurs 2014;44(5):534-541.   Published online October 31, 2014
DOI: https://doi.org/10.4040/jkan.2014.44.5.534
AbstractAbstract PDF
Purpose

This study was done to examine the actual state of influenza vaccination among pregnant women and factors affecting vaccination rate.

Methods

Data were collected using self-report questionnaires. Participants were pregnant women who participated in a prenatal education program at an acute care hospital in 2013. Data collected from 218 pregnant women were analyzed using the SPSS 18.0 Program.

Results

Only 48.6% of the pregnant women had received vaccination when the influenza was prevalent. Statistically significant factors affecting the influenza vaccination rate among pregnant women were vaccination experience in the previous year, knowledge and attitude about vaccination, and gestation period.

Conclusion

Results indicate that the influenza vaccination rate among pregnant women is lower than that of elders, healthcare workers, and patients with chronic diseases, who have been considered to be the mandatory vaccination recipients. Therefore, it is necessary to develop programs and policies which provide information including safety of vaccines for pregnant women and to induce positive attitudes towards vaccination for these women, in order to ultimately improve the vaccination rate.

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Incidence and Factors Influencing Oral Mucositis in Patients with Hematopoietic Stem Cell Transplantation
Kwan Suk Jo, Nam Cho Kim
J Korean Acad Nurs 2014;44(5):542-551.   Published online October 31, 2014
DOI: https://doi.org/10.4040/jkan.2014.44.5.542
AbstractAbstract PDF
Purpose

This study was done to examine the incidence of oral mucositis in hematopoietic stem cell transplantation patients and to identify factors influencing oral mucositis and patient outcomes according to severity.

Methods

In this retrospective study, data were collected from electronic medical records of 222 patients who had received hematopoietic stem cell transplantation. Oral mucositis was evaluated using WHO's assessment scale. Data were analyzed using Chi-square test, Fisher exact test, Spearman's correlation, Ordinal logistic regression, ANOVA and Kruskal-Wallis test.

Results

A total of 69.8% of the patients evaluated developed oral mucositis (grade II and over). As a results of ordinal regression, factors influencing oral mucositis severity were found to be diagnosis, type of transplantation, oxygen inhalation and the number of antiemetics administration before transplantation. The severity of oral mucositis was found to increase the days of hospitalization, days of TPN administration, days of using antibiotics and the number and dosage of analgesics.

Conclusion

The results would help predict severity of oral mucositis in hematopoietic stem cell transplantation patients and suggest that provision of appropriate nursing assessment and oral care would improve patient outcomes.

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Predictors of Hospitalization for Alcohol Use Disorder in Korean Men
Hae-Sook Hong, Jeong-Eun Park, Wan-Ju Park
J Korean Acad Nurs 2014;44(5):552-562.   Published online October 31, 2014
DOI: https://doi.org/10.4040/jkan.2014.44.5.552
AbstractAbstract PDF
Purpose

This study was done to identify the patterns and significant predictors influencing hospitalization of Korean men for alcohol use disorder.

Methods

A descriptive study design was utilized. Data were collected using self-report questionnaires from 143 inpatients who met the DSM-5 alcohol use disorder criteria and were receiving treatment and 157 social drinkers living in the community. The questionnaires included Alcohol Use Disorders Identification Test (AUDIT), Alcohol Problems, Alcohol Expectancy Questionnaire (AEQ), Life Position, and The Korean version of the Children of Alcoholics Screening Test (CAST-K). Data were analyzed using descriptive statistics, t-test, χ2-test, F-test, Pearson correlation coefficients, and logistic regression with forward stepwise.

Results

AUDIT had significant correlations with alcohol problems, alcohol expectancy, and parents' alcoholism. In logistic regression, factors significantly affecting hospitalization were divorced (OR=4.18, 95% CI: 1.28-13.71), graduation from elementary school (OR=28.50, 95% CI: 8.07-100.69), middle school (OR=6.66, 95% CI: 2.21-20.09), high school (OR=6.31, 95% CI: 2.59-15.36), drinking alone (OR=9.07, 95% CI: 1.78-46.17), family history of alcoholism (OR=2.41, 95% CI: 1.11-5.25), interpersonal relationship problems (OR=1.28, 95% CI:1.17-1.41), and sexual enhancement of alcohol expectancy (OR=0.83, 95% CI: 0.72-0.94), which accounted for 53% of the variance.

Conclusion

Results suggest that interpersonal relationship programs and customized cognitive programs for social drinkers in the community are needed to decreased alcohol related hospitalization in Korean men.

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Construct Validity of the Life Transition Scale for Parents of Children with Autism
Ae Ran Lee, Sun Woo Hong, Se Jin Ju
J Korean Acad Nurs 2014;44(5):563-572.   Published online October 31, 2014
DOI: https://doi.org/10.4040/jkan.2014.44.5.563
AbstractAbstract PDF
Purpose

The study was done to identify the construct validity and reliability of the life transition scale (LTS) for parents who have children with autism.

Methods

Exploratory factor analysis (EFA) and confirmative factor analysis (CFA) were conducted to identify the most adequate measurement model for structural validity. Convergent validity and discriminant validity were also conducted for structural validity. Data were collected from 208 parents through self-reported questionnaires and analyzed with SPSS/WIN 15.0 and AMOS 20.0 version.

Results

A four factor-structure was validated (χ2=541.23, p<.001, GFI=.82, RMSEA=.07, IFI=.89, CFI=.89, PNFI=.73, Q (χ2/df)=2.20) at the 3rd order of EFA and CFA, and factors were named as denying, wandering, despairing, and accepting. Both convergent and determinant validity for LTS were 100%. Cronbach's alphas for the reliability of each structure were .77-.90 and .83 for total structure.

Conclusion

The four structures, 24-item instrument showed satisfactory reliability and validity. LTS has the potential to be appropriate for assessing the transition process of life for parents who have children with autism and provides basic directions for differentiated support and care at each stage.

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Risk Factors for Deliberate Self-extubation
Young Shin Cho, Jung Hee Yeo
J Korean Acad Nurs 2014;44(5):573-580.   Published online October 31, 2014
DOI: https://doi.org/10.4040/jkan.2014.44.5.573
AbstractAbstract PDF
Purpose

This study was conducted to analyze intubation survival rates according to characteristics and to identify the risk factors affecting deliberate self-extubation.

Methods

Data were collected from patients' electronic medical reports from one hospital in B city. Participants were 450 patients with endotracheal intubation being treated in intensive care units. The collected data were analyzed using Kaplan-Meier estimation, Log rank test, and Cox's proportional hazards model.

Results

Over 15 months thirty-two (7.1%) of the 450 intubation patients intentionally extubated themselves. The patients who had experienced high level of consciousness, agitation. use of sedative, application of restraints, and day and night shift had significantly lower intubation survival rates. Risk factors for deliberate self-extubation were age (60 years and over), unit (neurological intensive care), level of consciousness (higher), agitation, application of restraints, shift (night), and nurse-to-patient ratio (one nurse caring for two or more patients).

Conclusion

Appropriate use of sedative drugs, effective treatment to reduce agitation, sufficient nurse-to-patient ratio, and no restraints for patients should be the focus to diminish the number of deliberate self-extubations.

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Effectiveness of a Self-management Program using Goal Setting based on a G-AP for Patients after a Stroke
Min Gyeong Park, Yeongmi Ha
J Korean Acad Nurs 2014;44(5):581-591.   Published online October 31, 2014
DOI: https://doi.org/10.4040/jkan.2014.44.5.581
AbstractAbstract PDF
Purpose

This study was conducted to develop a self-management program using goal setting for patients after a stroke. The program was based on a theory-based Goal setting and Action Planning framework (G-AP), and the effectiveness of the program was examined.

Methods

A non-equivalent control group pretest-posttest design was used. The experimental group (n=30) received the self-management program using goal setting based on the G-AP over 7 weeks. The education was delivered individually with a specifically designed stroke workbook. The control group (n=30) received only patient information leaflets about stroke.

Results

There were significant differences between the two groups. Stroke knowledge, self-efficacy, and health behavior compliance were significantly higher (all p<.001), and hospital anxiety (p<.001) and depression (p<.001) were significantly lower in the experimental group compared to the control group.

Conclusion

This self-management program using goal setting based on a G-AP was found to be useful and beneficial for patients in stroke rehabilitation settings.

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Corrigendum
Corrigendum: Effects of Newborn Care Education for First-time Fathers on Their Knowledge and Confidence in Newborn Care at Postpartum One Month
Hye-Sun An, Kyung-Sook Bang
J Korean Acad Nurs 2014;44(5):592-592.   Published online October 31, 2014
DOI: https://doi.org/10.4040/jkan.2014.44.5.592
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