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Volume 38(6); December 2008
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Original Articles
Development of a Structural Equation Model to estimate University Students' Depression
Kwang-Hi Park
J Korean Acad Nurs 2008;38(6):779-788.   Published online December 31, 2008
DOI: https://doi.org/10.4040/jkan.2008.38.6.779
AbstractAbstract PDF
Purpose

This study was designed to construct a structural model explaining depression in university students.

Methods

Data were collected from 1,640 university students by questionnaire, and analyzed using AMOS 5.0 to test the hypothetical model.

Results

Fitness statistics for the modified model were GFI=.93, AGFI=.89, NFI=.91, and RMSEA=.081. All the 12 paths in the modified model proved to be statistically significant. Depression of university students accounted for 52% of the covariance by the factors. The factor that had the most influence on depression was individual vulnerability, and followed by sequence order, stress, social support, coping, and self-efficacy. Depression was influenced directly by individual vulnerability, stress, social support, and coping, and indirectly by individual vulnerability, stress, social support, and selfefficacy.

Conclusion

A screening and management system for the high risk group is needed to effectively prevent depression and reduce rate of depression in university students. Detailed support programs which specifically deal with prevailing stressors should be developed to effectively reduce the harmful effects of individual vulnerability and stress. It is anticipated that the model constructed in this study could be utilized as a reference in developing various strategies to prevent and intervene depression in university students.

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Case Management Process identified from Experience of Nurse Case Managers
Eun-Jun Park, Chunmi Kim
J Korean Acad Nurs 2008;38(6):789-801.   Published online December 31, 2008
DOI: https://doi.org/10.4040/jkan.2008.38.6.789
AbstractAbstract PDF
Purpose

The purpose of this study was to develop a substantive theory of case management (CM) practice by investigating the experience of nurse case managers caring for Medical Aid enrollees in Korea.

Methods

A total of 12 nurses were interviewed regarding their own experience in CM practice. Data were recorded and analyzed using grounded theory.

Results

Empowerment was the core category of CM for Medical Aid enrollees. The case managers engaged in five phases as follows, phase of inquiring in advance, building a relationship with the client, giving the client critical mind, facilitating positive changes in the client's use of healthcare services, and maintaining relationship bonds. These phases moved gradually and were circular if necessary. Also, they were accelerated or slowed depending on factors including clients' characteristics, case managers' competency level, families' support level, and availability of community resources.

Conclusion

This study helps understand what CM practice is and how nurses are performing this innovative CM role. It is recommended that nurse leaders and policy makers integrate empowerment as a core category and the five critical CM phases into future CM programs.

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The Lived Experience of Struggling against Illness for Patients with Amyotrophic Lateral Sclerosis
Sung Ye Kang
J Korean Acad Nurs 2008;38(6):802-812.   Published online December 31, 2008
DOI: https://doi.org/10.4040/jkan.2008.38.6.802
AbstractAbstract PDF
Purpose

The purpose of this study was to identify and describe phenomenological structures of the lived experience of struggling against an illness for patients with Amyotrophic Lateral Sclerosis (ALS).

Methods

The participants were 7 patients with ALS recruited by snowball sampling who agreed to participate in this research and could verbally communicated with the researcher. Data were collected by long term-repeated interviews with participants in their own homes. Data were analyzed using Colaizzi's method of phenomenology.

Results

Four categories were extracted as follows: 'Being seized with fear of death', 'Living a marginal life', 'Accepting hard fate', and 'Clinging to faint life'. Seven theme clusters were identified as: 'Wandering to find a healing method with ominous signs in the body', 'Having a diagnosis of ALS is like a bolt from the blue and struggling against illness with faint hope', 'Being forced out to the edge of life with anguish', 'Filling one's heart with hatred and longing toward becoming estranged from the world', 'Living with stigma as a stumbling block with bitter grief in one's heart', 'Accepting every things as one's fate with self controlled fear of death', and 'Attaching to desire to live'.

Conclusion

The results of this study can be used to develop the programs to support patients with ALS and their family.

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Development of an Osteoporosis Awareness Scale for Women
Euysoon Choi, Juhu Kim, Miyoung Chung, Kyunghye Hwang
J Korean Acad Nurs 2008;38(6):813-821.   Published online December 31, 2008
DOI: https://doi.org/10.4040/jkan.2008.38.6.813
AbstractAbstract PDF
Purpose

This study was conducted to develop an instrument measuring awareness of osteoporosis.

Methods

The process included construction of a conceptual framework, generation of 86 preliminary items, verification of content validity, selection of secondary items, verification of construct validity and extraction of final items. The 86 items were reviewed for content validity by two groups of experts and were tested to evaluate inter item correlation coefficient by two groups of adult women. From June to August 2007, data were collected from 383 adult women who lived in Seoul and provinces in Korea. Data were analyzed by performing item analysis, Varimax factor analysis and Cronbach's alpha.

Results

There were 31 items in the final instrument categorized into 5 factors. The factors were labeled as "preventive behaviors (10 items)", "risk factors (5 items)", "characteristics of osteoporosis (6 items)", "improving bone health (5 items)", and "bone physiology (5 items)". Cumulative percent of variance was 60.92% and eigen values ranged from 1.20 to 12.44. Cronbach's alpha was .948 and ranged from .804 to .917.

Conclusion

Validity and reliability of the scale are confirmed in this study showing its utility for measuring awareness of osteoporosis for women. Utilization of the scale will also contribute to designing an appropriate prevention program for osteoporosis.

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Effects of Community-based Case Management Program for Clients with Hypertension
Ae-Young So, Yun-Mi Kim, Eun-Young Kim, Chang-Yup Kim, Cheol-Hwan Kim, Hee-Gerl Kim, Eun-Young Shin, Weon-Seob Yoo, Ggod-Me Yi, Kyung-Ja June
J Korean Acad Nurs 2008;38(6):822-830.   Published online December 31, 2008
DOI: https://doi.org/10.4040/jkan.2008.38.6.822
AbstractAbstract PDF
Purpose

The purpose of this study was to analyze effects of a community-based case management program for clients with hypertension living in the community.

Methods

The research design was a one group pre and post-test design with 30 participants with hypertension who agreed to participate in the 8-12 week case management program provided by case managers from the National Health Insurance Corporation in 2002. Data were collected three times, before and after the case management services, and 6 months later. Outcomes included changes in blood pressure, knowledge of hypertension and daily life practices, including alcohol consumption, smoking, exercise, and medication adherence.

Results

Repeated-measures ANOVA and post-hoc tests of means revealed significant differences before and after service for systolic blood pressure, daily life practices (monitoring body weight and BP, low salt and cholesterol and high vegetable diet, and stress-relief practices), and exercise. The goal for medication adherence was attained after service. Significant improvements from baseline to 6 months after service were observed in measures of salt and vegetables in diet. There were no significant differences on hypertension knowledge, alcohol consumption or smoking behavior between before service and after, and at 6 months.

Conclusion

The findings provide preliminary evidence that case management intervention can have positive outcomes on BP control, daily life practices, exercise, and medication adherence for clients with hypertension. However, additional interventions are needed to sustain long-term effects.

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Development of a Web-based Senescence Preparation Education Program for Successful Aging for Middle-aged Adults
Young-Mi Jung
J Korean Acad Nurs 2008;38(6):831-842.   Published online December 31, 2008
DOI: https://doi.org/10.4040/jkan.2008.38.6.831
AbstractAbstract PDF
Purpose

The purpose of this study was to develop a web-based senescence preparation education program to promote successful aging.

Methods

This program was developed based on Network-Based Instructional System Design (NBISD) model, using the following 5 processes: analysis, design, development, implementation, and evaluation. The program was operated for 10 weeks from March 17 to May 25, 2008.

Results

There were 4 menu bars, introduction, related data, lecture room, and communication on the main page. In the operation of this program, HTML, ASP, JAVA Script, Namo web editor, Edit Plus, Front Page and multimedia technology were applied. The program content consisted of understanding elderly people, physical health, activity & exercise, nutrition, medication use, psychological health, intellectual health, understanding death, welfare system and leisure activity.

Conclusion

This program could be a useful means to provide senescence preparation information to middle-aged adults. Also, it is expected to offer individualized learning opportunities to many learners in various settings. Nurses should further develop and facilitate various learning strategies including web- based programs for elder care.

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Effects of a Breast Feeding Promotion Program for Working Women
Ji-Won Yoon, Young-Joo Park
J Korean Acad Nurs 2008;38(6):843-852.   Published online December 31, 2008
DOI: https://doi.org/10.4040/jkan.2008.38.6.843
AbstractAbstract PDF
Purpose

The purpose of this study was to measure the effects of a breast feeding promotion program for working women on breast feeding continuation, mother-infant attachment, and maternal sensitivity.

Methods

The design of this study is nonequivalent control group design with repeated measures.

Results

There were significant differences in breast feeding continuation between two groups at each time point except 2 days and 1 week after delivery. The scores of mother-infant attachment and maternal sensitivity of experimental group were higher than those of the control group, but there were no significant differences between two groups.

Conclusion

Although some modifications in contents and administration will be required to increase the effectiveness of the program, breast feeding promotion program for working women can be an effective nursing intervention which can facilitate breast feeding continuation and mother-infant relationships.

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Task Analysis of the Job Description of Gerontological Nurse Practitioners based on DACUM
Keum Soon Kim, Yeon-Hwan Park, Nan Young Lim
J Korean Acad Nurs 2008;38(6):853-865.   Published online December 31, 2008
DOI: https://doi.org/10.4040/jkan.2008.38.6.853
AbstractAbstract PDF
Purpose

The aim of this study was to develop and to analyze the task of gerontological nurse practitioners (GNPs) in Korea.

Methods

The definition of GNP and job description was developed based on developing a curriculum (DACUM) by 7 panels who have experienced in DACUM analysis and gerontological nursing. One hundred sixty nurses who were working at long term care facilities were participated. The questionnaire included frequency, importance, and difficulty of duties, tasks, and task elements. The data were collected in November 2006, analyzed by descriptive statistics.

Results

The job description of GNPs in Korea revealed 5 duties, 23 tasks, and 86 task elements. On the all five duties, the highest duty in frequency and in importance was professional nursing care (3.25±0.35, 3.49±0.29). But the highest duty in difficulty was research (3.24±0.46). 'Prevent health problem (3.42±0.43, 3.56±0.33)', 'Teach other staffs (2.83±0.77, 3.39±0.43)', 'Develop the evidence-based standards (2.43±0.76, 3.22±0.43)', 'Develop the self (2.81±0.65, 3.26±0.42)', and 'Participate the team activities' were the highest score in frequency and in criticality of tasks. 'Provide emotional support to older adults and families (3.16±0.41)', 'Counsel older adults and their families (3.14±0.49)', 'Do clinical research (3.32±0.49)', 'Quality insurance (3.25±0.49)', and 'Build collaborative system (3.18±0.47)' were perceived the most difficult tasks.

Conclusion

The political efforts for the legislation of role and task of GNPs were needed.

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Factors explaining Quality of Life in Individuals with Coronary Artery Disease
In Sook Park, Rhayun Song, Sukhee Ahn, Hee Young So, Hyun Li Kim, Kyung Ok Joo
J Korean Acad Nurs 2008;38(6):866-873.   Published online December 31, 2008
DOI: https://doi.org/10.4040/jkan.2008.38.6.866
AbstractAbstract PDF
Purpose

The study was done to compare quality of life by gender, and to identify factors which explain quality of life in individuals with coronary artery disease.

Methods

For the survey, 91 individuals (53 men and 38 women) agreed to participate in the study. Cardiovascular risk factors, systolic blood pressure, body mass index, total cholesterol, triglyceride, high density lipoprotein-cholesterol, and low density lipoprotein-cholesterol, health behavior as well as quality of life, were measured. Descriptive statistics, t-test, correlation and hierarchical multiple regression with SPSS WIN 12.0 were used to analyze the data.

Results

Significant gender differences were found for education, smoking status, chronic disease, perceived health status, and quality of life within sub-dimensions. Hierarchical regression analysis showed gender (men), age, perceived health status, cardiovascular risk scores, and health behaviors together explained 40.2% (adjusted R2) of variance in quality of life.

Conclusion

As the factors explaining quality of life in individuals with coronary artery disease have been identified as gender (men), age, perceived health status, and health behaviors, health promotion programs designed for this population should focus on these factors for effective behavioral modification, and consequent improvement in quality of life.

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Study on the Changes in Limb Circumferences and Muscle Areas of Critically Ill Patients using Ventilators
Young-Hui Hwang, Myoung-Ae Choe
J Korean Acad Nurs 2008;38(6):874-880.   Published online December 31, 2008
DOI: https://doi.org/10.4040/jkan.2008.38.6.874
AbstractAbstract PDF
Purpose

The purpose of this study was to identify muscle atrophy in critically ill patients on ventilators. A comparison was made between limb circumferences and muscle areas on the day of admission to an intensive care unit (ICU) and on the 8th day after admission.

Methods

The data were collected from 30 critically ill patients using ventilators at S hospital ICU in Seoul during the period from October 2005 to April 2006. Limb circumferences and skinfold thickness were measured on the day of admission and on the 8th day after admission to the ICU. Limb circumferences and skinfold thickness were measured on the right mid-arm, right mid-thigh, and right mid-calf using a measuring tape and a skinfold calipers. Limb muscle areas were calculated by an equation after measuring limb circumferences and skinfold thickness. The data were analyzed by paired t-test and independent t-test.

Results

1) Mid-arm circumference, mid-thigh circumference and mid-calf circumference on the 8th day after admission to the ICU were significantly less than those on the day of admission to the ICU, 2) Mid-arm muscle area, mid-thigh muscle area and mid-calf muscle area on the 8th day after admission to the ICU were significantly less than those on the day of admission to the ICU, 3) Steroid and vecuronium medication didn't affect changes in limb circumferences (mid-arm, mid-thigh, mid-calf) and muscle areas (mid-arm, mid-thigh, mid-calf) on the 8th day after admission to the ICU compared to the day of admission.

Conclusion

Limb muscle atrophy may occur on the 8th day after admission to the ICU in critically ill patients using ventilator.

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Psychometric Evaluation of the Korean Social Support Questionnaire
Kasil Oh, Kyong-Ok Oh, Sook-Ja Lee, Jeong-Ah Kim, Chu-Ja Jeong, Hye-Ryoung Kim, Hoa-Yun Jun, Jung-Hee Kang
J Korean Acad Nurs 2008;38(6):881-890.   Published online December 31, 2008
DOI: https://doi.org/10.4040/jkan.2008.38.6.881
AbstractAbstract PDF
Purpose

Research related to social support in Korea has been hampered by paucity of measurement tools reflecting Korean culture. The aim of the study was to develop Korean social support questionnaire (KSSQ) based on the Korean social support pyramid and to test psychometric properties of the KSSQ.

Methods

The questionnaire was administered to 701 subjects and 658 college students. Psychometric analyses included factor analyses, expert validity, criterion-related validity, internal consistency, and test-retest reliability.

Results

A principal components analysis support for construct validity, eliciting a three factor solution accounting for 65.46% of variance in scores. Concurrent and discriminant validity supported criterion-related validity. Internal consistency of reliability was support with Cronbach's alpha of .97-.98 for the entire scale. Test-retest reliability was .76.

Conclusion

This initial testing of KSSQ to measure Korean social support demonstrates evidence of reliability and validity. Assessment of known-group validity and norm establishment of KSSQ are suggested to provide further sound psychometric properties and practical measurement tools.

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The Effects of an Environmental Education with Newspaper in Education (NIE) on the Environmental Concern and Practice
Ki-Wol Sung
J Korean Acad Nurs 2008;38(6):891-901.   Published online December 31, 2008
DOI: https://doi.org/10.4040/jkan.2008.38.6.891
AbstractAbstract PDF
Purpose

The purpose of this study was to develop an environmental education program using newspaper articles in education (NIE) and to evaluate changes in concern and practice for environmental protection after NIE.

Methods

The design was a nonequivalent control group pretest-posttest design. The participants were university students in nursing, of which 31 were assigned to the experimental group and 43 to the control group. The education was carried out for 2 hr, once a week for 7 weeks. Data were analyzed with SPSS WIN 14 program, and included χ2 test, independent t-test, and repeated measure ANOVA.

Results

NIE showed significant differences in the changes of attitude toward environment (F=4.461, p=.036).

Conclusion

Findings suggest that this NIE in environmental education was effective in changing students' attitudes toward the environment. Therefore this NIE is recommended for inclusion in education for university students in nursing.

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Effects of a Strengthening Program for Lower Back in Older Women with Chronic Low Back Pain
Hee-Kyoung Hyoung
J Korean Acad Nurs 2008;38(6):902-913.   Published online December 31, 2008
DOI: https://doi.org/10.4040/jkan.2008.38.6.902
AbstractAbstract PDF
Purpose

The purpose of this study was to identify effects of a strengthening program for the lower back in older women with chronic low back pain.

Methods

The research design was a nonequivalent control group pretest-posttest experiment. The experimental group consisted of 16 older women and the control group, 14, all of whom had experienced low back pain for at least 3 months. The strengthening program for the lower back included lumbar stabilization exercises and education on pain management in daily living. For an 8 week period, exercises were done 3 days a week and on one day education was also given.

Results

Pain and disability scores decreased significantly in the experimental group compared to the control group. Flexibility, life satisfaction and lumbar muscle strength scores increased significantly in the experimental group compared to the control group.

Conclusion

Low back pain and disability can be relieved, and flexibility, muscle strength, and life satisfaction increased through a program to strengthen the lower back. It is suggested that a program to strengthen the lower back would be an effective nursing intervention for older women with low back pain.

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Effect of a Tooth-brushing Education Program on Oral Health of Preschool Children
Bok-Hee Kang, Sun-Nam Park, Kyeong-Yae Sohng, Jung-Soon Moon
J Korean Acad Nurs 2008;38(6):914-922.   Published online December 31, 2008
DOI: https://doi.org/10.4040/jkan.2008.38.6.914
AbstractAbstract PDF
Purpose

To examine the effect of tooth-brushing education on the oral health of preschoolers.

Methods

A quasi-experimental design with a non-equivalent control group was used. Two kindergartens were selected and 39 preschoolers from one kindergarten were assigned to the experimental group with tooth-brushing education and 39 from the other kindergarten to the control group. The tooth-brushing education program included 1 session on oral health education, individual tooth-brushing instruction for 1 week and supervised tooth-brushing after lunch for 4 weeks. Oral health behavior including use of tooth paste, tooth-brushing time and method of tooth-brushing, plague, streptococcus mutans, lactobacillus and dental caries were measured before and after the education. Fisher's exact test, t-test and paired t-test with the Window SAS 9.1 program were used to analyze the data.

Results

A significant increase in the use of tooth paste, tooth-brushing time and the practice of correct tooth-brushing and a decrease in plague and development of dental caries were observed in the experimental group.

Conclusion

This tooth-brushing education was partially effective in improving oral health of preschoolers.

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Influence of Age, Gender, and Severity on Recovery of Patients with Brain Injury
Hyun Soo Oh, Wha Sook Seo
J Korean Acad Nurs 2008;38(6):923-932.   Published online December 31, 2008
DOI: https://doi.org/10.4040/jkan.2008.38.6.923
AbstractAbstract PDF
Purpose

This study was conducted to investigate the individual and cross influences of age, gender, and severity on recovery of patients with brain injury.

Methods

For the purpose of the study, traumatic or spontaneous brain injury patients admitted to the intensive care unit (ICU) were conveniently selected. The data regarding outcomes were collected 3 months after admission.

Results

Individual influences of the study variables on patients' recovery were significant, except for gender. But while the individual influence of gender on recovery was not significant, cross influence of gender and age was significant, but only for the sub-dimension of 'arousalbility and awareness'. The study results also showed that 3-way cross influence of gender, age, and severity was only significant on the sub-dimension of 'arousalbility and awareness'.

Conclusion

The sub-dimension of recovery cross influenced by the demographic factors of gender and age, and severity was 'arousalbility and awareness'. This might indicate that the study variables that cross influencing recovery had more influence on consciousness compared to physical function and psycho-social adaptation.

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