Journal of Korean Academy of Nursing

From Bioethics to Data Sharing for Transparency in Nursing Research: Kim, Jeung-Im; J Korean Acad Nurs 2020;50(6):737-739. Published online December 31, 2020; DOI: https://doi.org/10.4040/jkan.50503

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Characteristics of Aerobic Exercise as Determinants of Blood Pressure Control in Hypertensive Patients: A Systematic Review and Meta-Analysis: Lee, Sun Hee , Chae, Young Ran; J Korean Acad Nurs 2020;50(6):740-756. Published online December 31, 2020; DOI: https://doi.org/10.4040/jkan.20169

Abstract PDF: Purpose
The purpose of this study was to evaluate the effect on blood pressure (BP) and heart rate (HR) according to aerobic exercise characteristics in adults with hypertension using a systematic review and meta-analysis.
Methods
The related researches were selected from PubMed, EMBASE, Cochrane library, CINAHL, PsycINFO, SPORTDiscus and 5 domestic databases up to September 4, 2019. To estimate the effect size, random effect models were used to derive weighted mean differences (WMD) and their 95% confidence intervals (CI) of aerobic exercise on BP and HR.
Results
A total of 37 RCTs with 1,813 samples were included. Aerobic exercise was found to significantly reduce systolic BP (WMD, - 8.29 mmHg; 95% CI, - 10.12 to - 6.46), diastolic BP (WMD, - 5.19 mmHg; 95% CI, - 6.24 to - 4.14) and HR (WMD, - 4.22 beats/min; 95% CI, - 5.36 to –3.09). In detail, systolic BP and diastolic BP were significantly decreased in all groups of exercise types, frequency and duration. Systolic BP and diastolic BP were significantly decreased in the moderate and vigorous-intensity group. Exercise characteristics with the most dramatical change in systolic BP were water-based training, moderate-intensity, 3 times a week and 8 to 11 weeks of duration. In diastolic BP, the greatest effect size was over 24 weeks of exercise.
Conclusion
Moderate aerobic exercise, especially water-based exercise can be an important part of lifestyle modification for hypertensive patients. Also, it can be recommended in a variety of clinical settings for lowering BP and HR. However, there is insufficient evidence that low-intensity exercise is effective in lowering BP.

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A Meta-Analytic Path Analysis on the Outcome Variables of Nursing Unit Managers’ Transformational Leadership: Systemic Review and Meta-Analysis: Kim, Sunmi , Seok Hee, Jeong; J Korean Acad Nurs 2020;50(6):757-777. Published online December 31, 2020; DOI: https://doi.org/10.4040/jkan.20205

Abstract PDF: Purpose
The purpose of this study was to identify the outcome variables of nursing unit managers’ transformational leadership and to test a hypothetical model using meta-analytic path analysis.
Methods
A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Data analysis, conducted using R version 3.6.2 software, included 49 studies for the meta-analysis and 119 studies for meta-analytic path analysis.
Results
In the meta-analysis, four out of 32 outcome variables were selected. These four variables were empowerment, nursing performance, job satisfaction, and organizational commitment, which showed larger effect sizes than the median and more than five k. The hypothetical model for the meta-analytic path analysis was established by using these four variables and transformational leadership. A total of 22 hypothetical paths including nine direct effects and 13 indirect effects were set and tested. The meta-analytic path analysis showed that transformational leadership had direct effects on the four variables. Finally, eight direct effects, 12 indirect effects, and six mediating effects were statistically significant, and the hypothetical model was verified.
Conclusion
Nursing unit managers can use the transformational leadership to improve empowerment, nursing performance, job satisfaction, and organizational commitment of nurses. This study empirically showed the importance of transformational leadership of nursing managers. This finding will be used as evidence to develop strategies for enhancing transformational leadership, empowerment, nursing performance, job satisfaction, and organizational commitment in nursing science and practice.

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Motives for Empathy among Clinical Nurses in China: A Qualitative Study: Zhu, Yu , He, Ming-Mei , Zhu, Ji-Min , Huang, Li , Li, Bai-Kun; J Korean Acad Nurs 2020;50(6):778-786. Published online December 31, 2020; DOI: https://doi.org/10.4040/jkan.20123

Abstract PDF: Purpose
This study aimed to explore the motives of clinical nurses for experiencing empathy with patients and their families based on a self-determination theory framework.
Methods
Semi-structured face-to-face interviews with twenty-one nurses at four tertiary hospitals in Anhui, China, were conducted, recorded and transcribed. A content analysis with a directed approach was performed.
Results
An analysis of the interview transcripts revealed three categories of empathy motivation: autonomous motivation, controlled motivation and a lack of empathy motivation. Autonomous motivation included personal interests, enjoyment and a sense of value, pure altruism, assimilation, and recognition of the importance of empathy. Controlled motivation highlighted pressures from oneself and others, the possibility of tangible or intangible rewards, and avoidance of adverse effects. Finally, a lack of empathy motivation referred to a lack of intention for empathy and denial of the value of empathy.
Conclusion
This study provides a deep understanding of the motives underlying empathy in nurses. The results reveal the reasons for empathy and may support the development of effective strategies to foster and promote empathy in nurses.

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Cut-Off Values of the Post-Intensive Care Syndrome Questionnaire for the Screening of Unplanned Hospital Readmission within One Year: Kang, Jiyeon , Jeong, Yeon Jin , Hong, Jiwon; J Korean Acad Nurs 2020;50(6):787-798. Published online December 31, 2020; DOI: https://doi.org/10.4040/jkan.20233

Abstract PDF: Purpose
This study aimed to assign weights for subscales and items of the Post-Intensive Care Syndrome questionnaire and suggest optimal cut-off values for screening unplanned hospital readmissions of critical care survivors.
Methods
Seventeen experts participated in an analytic hierarchy process for weight assignment. Participants for cut-off analysis were 240 survivors who had been admitted to intensive care units for more than 48 hours in three cities in Korea. We assessed participants using the 18-item Post-Intensive Care Syndrome questionnaire, generated receiver operating characteristic curves, and analysed cut-off values for unplanned readmission based on sensitivity, specificity, and positive likelihood ratios.
Results
Cognitive, physical, and mental subscale weights were 1.13, 0.95, and 0.92, respectively. Incidence of unplanned readmission was 25.4%. Optimal cut-off values were 23.00 for raw scores and 23.73 for weighted scores (total score 54.00), with an area of under the curve (AUC) of .933 and .929, respectively. There was no significant difference in accuracy for original and weighted scores.
Conclusion
The optimal cut-off value accuracy is excellent for screening of unplanned readmissions. We recommend that nurses use the Post-Intensive Care Syndrome Questionnaire to screen for readmission risk or evaluating relevant interventions for critical care survivors.

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Predictive Model for Quality of Life of the Older Men Living Alone: Kim, Su Jin , Jeon, Gyeong-Suk; J Korean Acad Nurs 2020;50(6):799-812. Published online December 31, 2020; DOI: https://doi.org/10.4040/jkan.20087

Abstract PDF: Purpose
This study aimed to construct and test a predictive model that explains and predicts the quality of life in older men living alone.
Methods
A self-report questionnaire was used to collect data from 334 older adult men living along aged 65 years or over living in Jeollanam-do provinces. The endogenous variables were depression, self-rated health, instrumental activity of daily life, health promotion behaviors, the number of social participation activities and quality of life. Data were analyzed using the SPSS 21.0 and AMOS 21.0 programs.
Results
The final model with 14 of the 8 analysed paths showed a good fit to the empiri cal data: χ²= 173.26(p < .001, df = 53),normed χ²= 3.27, GFI = .92, NFI = .90, CFI = .93, TLI = .89, RMSEA = .08 and SRMR = .06. Activities had direct effect on quality of life of older men living alone and social support had both direct and indirect effects. Meanwhile, function and socioeconomic status showed only indirect effects.The variables included in the eight significant paths explained 83.7% of variance in the prediction model.
Conclusion
Instrumental activities of daily living and social support effect directly on quality of life in the older men living alone. Findings suggest that health care providers including community nurses need to provide social support as well as empowerment programs of instrumental activities of daily living and health promotion for improving quality of life of the older men living alone.

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Actor and Partner Effects of Couple’s Daily Stress and Dyadic Coping on Marital Satisfaction: Won, Su Kyung , Seol, Kyoung Ok; J Korean Acad Nurs 2020;50(6):813-821. Published online December 31, 2020; DOI: https://doi.org/10.4040/jkan.20162

Abstract PDF: Purpose
This study aimed to identify the actor and partner effects of daily stress and dyadic coping on marital satisfaction using the Actor-Partner Interdependence Mediational Model (APIeM).
Methods
Participants were 314 couples who met the study’s eligibility criteria. Data were collected from March to April 2016 through apartment and cooperative company communities in Seoul. Two APIeMs of positive and negative dyadic coping were analyzed using SPSS 20.0 and Mplus 7.4. All measures were self-administered.
Results
Daily stress and positive and negative dyadic coping in both spouses had direct actor effects on their marital satisfaction. Daily stress in both spouses had an indirect actor effect on marital satisfaction through their positive and negative dyadic coping. The husband’s daily stress had an indirect partner effect on the wife’s marital satisfaction through his positive dyadic coping, while the wife’s positive dyadic coping had a direct partner effect on the husband’s marital satisfaction. The husband’s daily stress had an indirect partner effect on the wife’s marital satisfaction through his negative dyadic coping, while the wife’s negative dyadic coping had a direct partner effect on the husband’s marital satisfaction.
Conclusion
Dyadic coping is an effective way to deal with couple’s daily hassles as it increase their satisfaction in marriage.

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Identifying Trajectories of Behavioral Problems in Children with Allergic Diseases: Secondary Data Analysis of the 5th to 7th Panel Study of Korean Children: Son, Miseon , Ji, Eunsun; J Korean Acad Nurs 2020;50(6):822-836. Published online December 31, 2020; DOI: https://doi.org/10.4040/jkan.20177

Abstract PDF: Purpose
This study aimed to identify latent classes of behavioral problem trajectories in children with allergic diseases and investigate their predictors.
Methods
This study used data from the 5th to 7th Panel Study of Korean Children. The participants included 840 children aged 4~6 years with allergic diseases. Statistical analyses were conducted using latent class growth analysis and multinomial logistic regression.
Results
The trajectories of both internalizing and externalizing behavioral problems in children with allergic diseases were classified into five groups, that is deteriorative, recovering, changing 1 (decreasing-increasing), changing 2 (increasing-decreasing), and low state persistent group. For the internalizing behavioral problems, predictors were temperament, father’s education, family interaction, and disconnection in peer interaction. For the externalizing behavioral problems, predictors child’s gender, temperament, marital conflict, parenting stress, family interaction, and parenting environment.
Conclusion
Deteriorative group has high-risk behavioral problems in children with allergic diseases. We suggest to provide interventions considering latent problem trajectories based on ecological environments for allergic children.

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Effects of Hospital Characteristics on Employment Rate, Working Period and Retirement of Ward Nurses in Korea: A Retrospective Cohort Study Based on HIRAS Data: Seo, Hee-Jung , Kim, Gi Yon , Chang, Sei-Jin; J Korean Acad Nurs 2020;50(6):837-847. Published online December 31, 2020; DOI: https://doi.org/10.4040/jkan.20190

Abstract PDF: Purpose
The purpose of this study was to investigate the effects of hospital characteristics on employment rate, working period, and retirement of ward nurses in Korea through a retrospective cohort study based on HIRAS data.
Methods
Data were obtained from a report on medical care institutions of Health Insurance Review & Assessment Service (HIRAS). Data from 259,941 nurses who were working for a day or more from January 1, 2012, to December 31, 2016, at 2,942 medical care institutions were analyzed. Life table method analysis, Kaplan-Meier analysis, and Cox proportional hazard regression analysis were conducted.
Results
The employment rates of 5 yeas and 10 years for the total sample were 38% and 28%, respectively. The estimated mean value of the working period was 3,642.7 days (SE: 17.4 days). Cox proportional hazard regression analyses revealed that nurses who were working at the general hospital/hospital, clinic, and nursing hospital were more likely to leave the hospital compared to those who were working at the 3rd general hospital. Nurses who were working at the medical institutions which were located in cities and countries, established by the private foundation, rated lower levels of nursing, and owned an insufficient number of beds, nurses and doctors were more likely to leave their workplace compared to those of the counterparts.
Conclusion
This study indicates that hospital characteristics may play a significant role in retirement and working period of ward nurses in Korea. The improvement of hospital conditions to reduce ward nurses’ retirement are needed.

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Development and Validation of the Nurse Needs Satisfaction Scale Based on Maslow’s Hierarchy of Needs Theory: Kim, Hwa Jin , Shin, Sun Hwa; J Korean Acad Nurs 2020;50(6):848-862. Published online December 31, 2020; DOI: https://doi.org/10.4040/jkan.20195

Abstract PDF: Purpose
The purpose of this study was to develop an instrument to evaluate the needs satisfaction of nurses and examine its validity and reliability.
Methods
The initial items for the instrument were developed through a literature review and interviews, using the conceptual framework of Maslow’s hierarchy of needs theory. The initial items were evaluated for content validity by 14 experts. Four hundred and eighty-six clinical nurses participated in this study through offline and online surveys to test the reliability and validity of the instrument. The first evaluation (n = 256) was used for item analysis and exploratory factor analysis, and the second evaluation (n = 230) was used to conduct a confirmatory factor analysis and to assess the criterion-related validity and internal consistency of the instrument. Test-retest reliability was analyzed using data from 30 nurses.
Results
The final instrument consisted of 30 items with two sub-factors for five needs that were identified through the confirmatory factor analysis. The criterion-related validity was established using the five need satisfaction measures (r = .56). Cronbach’s a for total items was .90, and test-retest reliability was .89.
Conclusion
The findings from this study indicate that this instrument has sufficient validity and reliability. This instrument can be used for the development of nursing interventions to improve the needs satisfaction of clinical nurses.

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Development and Effectiveness of Practice Application Program of Intravenous Infusion EvidenceBased Nursing Practice Guideline - for Small and Medium Sized Hospitals: Hong, Inhwa , Eun, Young; J Korean Acad Nurs 2020;50(6):863-875. Published online December 31, 2020; DOI: https://doi.org/10.4040/jkan.20196

Abstract PDF: Purpose
This study was conducted to develop and test the effects of a program for practice application of intravenous infusion evidence based nursing practice (EBP) guidelines in small and medium-sized hospitals.
Methods
A mixed method research design was used, combining non-equivalent control group pre-post test design with qualitative study analysis. The subjects consisted of 55 nurses. The practice application program was developed based on the Advancing Research and Clinical practice through close Collaboration (ARCC) model. Data were collected for analysis in the following areas: nurses’ EBP organizational culture and readiness, EBP beliefs, EBP implementation, importance about intravenous infusion, and performance about intravenous infusion, with data assessed using valid and reliable instruments. Patient outcomes were collected from the hospital’s medical records. Data were analyzed using t-test, χ² -test, and Shapiro-Wilk test, with qualitative content analysis used for interview data.
Results
Following the intervention, nurses’ EBP organizational culture and readiness, EBP beliefs, EBP implementation, and performance of intravenous infusion and perceptions of its importance showed significant improvement in the experimental group. Phlebitis rates decreased in the experimental group compared to the control group.
Conclusion
This program is effective to improve nurse’s perception and practice of evidence based nursing. Therefore we recommend to use this program at same levels of hospitals.

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