Journal of Korean Academy of Nursing

Practical Consideration of Factor Analysis for the Assessment of Construct Validity: Park, Jin-Hee , Kim, Jeung-Im; J Korean Acad Nurs 2021;51(6):643-647. Published online December 31, 2021; DOI: https://doi.org/10.4040/jkan.51601

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Effectiveness of the Infectious Disease (COVID-19) Simulation Module Program on Nursing Students: Disaster Nursing Scenarios: Hwang, Won Ju , Lee, Jungyeon; J Korean Acad Nurs 2021;51(6):648-660. Published online December 31, 2021; DOI: https://doi.org/10.4040/jkan.21164

Abstract PDF: Purpose
This study aimed to develop an emerging infectious disease (COVID-19) simulation module for nursing students and verify its effectiveness.
Methods
A one-group pretest–posttest quasi-experimental study was conducted with 78 under-graduate nursing students. A simulation module was developed based on the Jeffries simulation model. It consisted of pre-simulation lectures on disaster nursing including infectious disease pandemics, practice, and debriefings with serial tests. The scenarios contained pre-hospital settings, home visits, arrival to the emergency department, and follow-up home visits for rehabilitation.
Results
Disaster preparedness showed a statistically significant improvement, as did competencies in disaster nursing. Confidence in disaster nursing increased, as did willingness to participate in disaster response. However, critical thinking did not show significant differences between time points, and neither did triage scores.
Conclusion
The developed simulation program targeting an infectious disease disaster positively impacts disaster preparedness, disaster nursing competency, and confidence in disaster nursing, among nursing students. Further studies are required to develop a high-fidelity module for nursing students and medical personnel. Based on the current pandemic, we suggest developing more scenarios with virtual reality simulations, as disaster simulation nursing education is required now more than ever.

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Types of Perception Toward Quarantine Measures among Patients Infected with COVID-19: Kim, Geun Myun , Lee, Jung Un , Jung, Hae Kyung , Nam, Soo Gyung , Sim, So Hyeong , Chang, Soo Jung; J Korean Acad Nurs 2021;51(6):661-677. Published online December 31, 2021; DOI: https://doi.org/10.4040/jkan.21141

Abstract PDF: Purpose
This study was conducted to identify the types of perception toward quarantine measures at hospitals or community treatment centers among patients infected with COVID-19.
Methods
This study applied Q-methodology. Two hundred and nineteen Q populations were constructed based on related literature and in-depth interviews with 5 adults infected with COVID-19 and who experienced quarantine and hospitalization. Interviews were performed from November 14 to 29, 2020. A total of 45 Q samples were extracted and Q sorting was performed using a 9-point scale for 30 adult subjects who experienced quarantine at hospitals and community treatment centers. The data were analyzed using the PC-QUANL program.
Results
The perception of subjects toward quarantine measures was classified into the following six types: ‘passive acceptance’, ‘social stigma perception’, ‘appreciation of daily life through awareness of the realities of illness’, ‘why me?’, ‘fearful perception’, and ‘positive meaning’.
Conclusion
The perception of quarantine measure among patients with COVID-19 is identified as six types with positive and negative emotional characteristics. This result will contribute to the development of individualized strategies to address psychosocial health problems among patients with infectious diseases.

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Factors Influencing Nurses’ Performance of Care in COVID-19 Wards: Kim, Yoon Sun , Kim, Mi-Ae; J Korean Acad Nurs 2021;51(6):678-688. Published online December 31, 2021; DOI: https://doi.org/10.4040/jkan.21131

Abstract PDF: Purpose
The purpose of this study was to identify factors influencing nurses’ performance of care in COVID-19 wards.
Methods
The participants were 132 nurses who worked in COVID-19 wards at three hospitals, and were recruited from April 1 to May 31, 2021. Data were analyzed using descriptive statistics, t-test, ANOVA, and multiple regression analysis with SPSS/WIN 24.0 program.
Results
Nursing performance was significantly and positively correlated with ethical sensitivity (r = .75, p < .001), nursing professionalism (r = .67, p < .001), and social support (r = .67, p < .001). Nursing professionalism was positively correlated with ethical sensitivity (r = .64, p < .001) and social support (r = .55, p < .001). Multiple regression analysis for nursing performance revealed that the most significant factor was ethical sensitivity (β = .47, p < .001). Ethical sensitivity, nursing professionalism, and social support explained 66.0% of total variance in nursing performance.
Conclusion
Ethical sensitiviy, nursing professionalism, and social support significantly influence nurses’ performace of care in COVID-19 wards. It suggests that intervention programs should be directed at improving nurses’ ethical sensitivity, bolstering social support, and enhancing nursing professionalism.

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Nurses’ Experiences of the COVID-19 Crisis: Lee, Jung-Hoon , Song, Yeoungsuk; J Korean Acad Nurs 2021;51(6):689-702. Published online December 31, 2021; DOI: https://doi.org/10.4040/jkan.21160

Abstract PDF: Purpose
This study aimed to develop a situation-specific theory to explain nurses’ experiences of the COVID-19 crisis.
Methods
The participants were 16 hospital nurses who experienced the COVID-19 crisis. Data were collected through in-depth individual interviews from September 2, 2020 to January 20, 2021. Transcribed interview contents were analyzed using Corbin and Strauss’s grounded theory method.
Results
A total of 38 concepts and 13 categories were identified through an open coding process. The core category found was becoming a pioneering nurse who turns crises into opportunities. The causal conditions were the chaos of being exposed defenselessly to an unexpected pandemic, fear caused by a nursing care field reminiscent of a battlefield, and moral distress from failing to protect patients’ human dignity. The contextual conditions were feeling like the scapegoat of the hospital organization, increasing uncertainty due to the unpredictable state of COVID-19, and relative deprivation due to inappropriate treatment. The central phenomenon was suffering alone while experiencing the dedication of the COVID-19 hero image. The action/interactional strategy were efforts to find a breakthrough and getting the nurse’s mind right, and the intervening conditions were gratitude for those who care for broken hearts and getting used to myself with repetitive work. The Consequences were becoming an independent nurse and frustration with the unchanging reality.
Conclusion
This study provides the foundation for the nurse's situation-specific theory of the COVID-19 crisis by defining the crisis perceived by nurses who cared for COVID-19 patients and suggesting types of coping with the crisis.

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Collaborative Disaster Governance Recognized by Nurses during a Pandemic: Rim, Dahae , Shin, Hyunsook , Jeon, Hyejin , Kim, Jieun , Chun, Hyojin , Oh, Hee , Shon, Soonyoung , Shim, Kaka , Kim, Kyung Mi; J Korean Acad Nurs 2021;51(6):703-719. Published online December 31, 2021; DOI: https://doi.org/10.4040/jkan.21163

Abstract PDF: Purpose
We aimed to identify collaborative disaster governance through the demand and supply analysis of resources recognized by nurses during the COVID-19 pandemic.
Methods
We used a descriptive study design with an online survey technique for data collection. The survey questions were developed based on focus group interviews with nurses responding to COVID-19 and expert validity testing. A 42-question online survey focusing on disaster governance was sent to nurses working in COVID-19 designated hospitals, public health offices, and schools. A total of 630 nurses participated in the survey. Demand and supply analysis was used to identify the specific components of disaster governance during a pandemic situation and analyze priority areas in disaster governance, as reported by nurses.
Results
Demand and supply analysis showed that supplies procurement, cooperation, education, and environment factors clustered in the high demand and supply quadrant while labor condition, advocacy, emotional support, and workload adjustment factors clustered in the high demand but low supply quadrant, indicating a strong need in those areas of disaster governance among nurses. The nurses practicing at the public health offices and schools showed major components of disaster governance plotted in the second quadrant, indicating weak collaborative disaster governance.
Conclusion
These findings show that there is an unbalanced distribution among nurses, resulting in major challenges in collaborative disaster governance during COVID-19. In the future and current pandemic, collaborative disaster governance, through improved distribution, will be useful for helping nurses to access more required resources and achieve effective pandemic response.

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Knowledge Structure of Chronic Obstructive Pulmonary Disease Health Information on HealthRelated Websites and Patients’ Needs in the Literature Using Text Network Analysis: Choi, Ja Yun , Lim, Su Yeon , Yun, So Young; J Korean Acad Nurs 2021;51(6):720-731. Published online December 31, 2021; DOI: https://doi.org/10.4040/jkan.21086

Abstract PDF: Purpose
The purpose of this study was to identify the knowledge structure of health information (HI) for chronic obstructive pulmonary disease (COPD).
Methods
Keywords or meaningful morphemes from HI presented on five health-related websites (HRWs) of one national HI institute and four hospitals, as well as HI needs among patients presented in nine literature, were reviewed, refined, and analyzed using text network analysis and their co-occurrence matrix was generated. Two networks of 61 and 35 keywords, respectively, were analyzed for degree, closeness, and betweenness centrality, as well as betweenness community analysis.
Results
The most common keywords pertaining to HI on HRWs were lung, inhaler, smoking, dyspnea, and infection, focusing COPD treatment. In contrast, HI needs among patients were lung, medication, support, symptom, and smoking cessation, expanding to disease management. Two common sub-topic groups in HI on HRWs were COPD overview and medication administration, whereas three common sub-topic groups in HI needs among patients in the literature were COPD overview, self-management, and emotional management.
Conclusion
The knowledge structure of HI on HRWs is medically oriented, while patients need supportive information. Thus, the support system for self-management and emotional management on HRWs must be informed according to the structure of patients’ needs for HI. Healthcare providers should consider presenting COPD patient-centered information on HRWs.

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Effects of Early Oral Feeding versus Delayed Oral Feeding on Bowel Function, Gastrointestinal Complications and Surgical Recovery after Cesarean Section under Regional Anesthesia: Systematic Review and Meta-Analysis: Kim, HyoJin , Jeon, YeongKyung , Yoon, SoYoung , Lee, GeumMoon; J Korean Acad Nurs 2021;51(6):732-745. Published online December 31, 2021; DOI: https://doi.org/10.4040/jkan.21127

Abstract PDF: Purpose
This study aimed to assess combined effects of early oral feeding after Cesarean section (C/S) under regional anesthesia on bowel function, gastrointestinal complications and surgical recovery.
Methods
A systematic literature search was conducted using KISS, RISS, PubMed, CINAHL, EMBASE, CENTRAL and Google Scholar to identify randomized clinical trials comparing early oral feeding (EOF) with delayed oral feeding (DOF) after C/S. Outcome variables were bowel function and gastrointestinal complications and surgical recovery. Effect size was calculated using weighted mean differences (WMDs) and relative risks (RRs), with 95% confidence intervals (CIs).
Results
Seven studies involving 1,911 patients from 568 studies, 7 studies were included in meta-analysis. EOF was significantly associated with shorter time to recover bowel movement compared with DOF (WMD, - 2.50; CI, - 3.50~- 1.50). EOF was not associated with nausea (RR, 1.15; CI, 0.87~1.53) and vomiting (RR, 0.96; CI, 0.65~1.42), but lower incidence of abdominal distension (RR, 0.70; CI, 0.50~0.98). EOF was significantly associated with shorter time to discontinuation of intravenous fluids (WMD, - 8.88; 95% CI, - 16.65~- 1.11) and removal of urinary catheter (WMD, - 15.23; CI, - 25.62~- 4.85).
Conclusion
This meta-analysis provides evidence that EOF after C/S under regional anesthesia not only accelerates return of bowel function and surgical recovery but also reduces gastrointestinal complications. These results suggest that EOF should be offered to women who have undergone C/S to improve the recovery experience and reduce overall medical costs.

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The Influence of Family Function on Occupational Attitude of Chinese Nursing Students in the Probation Period: The Moderation Effect of Social Support: J Korean Acad Nurs 2021;51(6):746-757. Published online December 31, 2021; DOI: https://doi.org/10.4040/jkan.21103

Abstract PDF: Purpose
The purpose of this study was to explore the factors influencing the occupational attitudes of nursing students in the probation period.
Methods
Nursing students in the probation period from five hospitals completed an anonymous survey. The instruments included the nursing occupational attitude scale, family adaptability, partnership, growth, affection, and resolve index, and perceived social support scale. The study examined the moderation model between family function, perceived social support, and occupational attitudes using PROCESS 3.2.
Results
For nursing students, when social support was low, family function had a significant positive impact on occupational attitudes and intentions, and the effect was much higher than that of perceived social support.
Conclusion
Family function has a significant positive explanatory effect on attitude and intention (β = .13, p < .001 and β = .12, p < .001); the interaction term between family function and perceived social support are significant (β = .01, p < .001 and β = .01, p < .001). Perceived social support has a significant moderating effect on the relationship between family function and occupational attitudes of nursing students in the probation period. Family function has a significant difference in the occupational attitudes and intentions of nursing students with low perceived social support. Nursing students perceive social support in the probation period has a significant moderation effect in the relationship between their family function and occupational attitudes. Interns with low family function should be given more social support to improve their occupational attitudes.

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Job Analysis of Nurse Care Coordinators for Chronic Illness Management in Primary Care Settings: Using Developing a Curriculum Process: Hwang, Ju-Hee , Choi, Yong-Jun , Kim, Mi-Sook , Yi, Seng-Eun , Park, Yong-Soon , Kim, Ji-Hyang , Yoon, Ju-Young , Shin, Dong-Soo; J Korean Acad Nurs 2021;51(6):758-768. Published online December 31, 2021; DOI: https://doi.org/10.4040/jkan.21065

Abstract PDF: Purpose
This study aimed to conduct a job analysis of nurse carecoordinators and to identify the frequency, importance and difficulty of each task of their job.
Methods
A committee for developing a curriculum (DACUM) was formed and members of the committee defined nurse care coordinators’ jobs and enumerated the duties, tasks and task elements by applying the DACUM technique. Then nurse care coordinators enrolled in the pilot project evaluated the frequency, importance and difficulty of each task.
Results
From the job descriptions of nurse care coordinators, we identified 12 duties and 42 tasks. Each task comprised 1~5 task elements. Among tasks, ‘assess the patient’s general health status’ was carried out most frequently. Nurse care coordinators perceived that ‘check vital signs’ and ‘strengthen patient competence to promote health behaviors’ were more important than all other tasks. The most difficult task was ‘develop professionalism as a nurse care coordinator’.
Conclusion
The nurse care coordinators' roles developed in this study will serve as the key guidelines for human resource management of care coordinators. Further, job specifications for nurse care coordinators need to be developed, which is necessary for designing education and training programs. We also need to integrate primary health care as an essential component in nursing education.

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Validity and Reliability of the Korean Version of Assessment of Health Literacy in Breast and Cervical Cancer Screening: Shin, Hye Sook , Chi, Eunlim , Han, Hae-Ra; J Korean Acad Nurs 2021;51(6):769-781. Published online December 31, 2021; DOI: https://doi.org/10.4040/jkan.21108

Abstract PDF: Purpose
Health literacy is a significant determinant of health and health behaviors such as cancer screening. Despite its significance, there are limited instruments available to assess health literacy targeting Koreans. The purpose of this study was to test the psychometric properties of Korean translation of a validated health literacy instrument in cancer screening—Korean version of assessment of health literacy in breast and cervical cancer screening (K-AHL-C).
Methods
A total of 555 women aged 20~65 participated in the online survey study. Of 52 items addressing five domains included in the original version, we focused on 36 items addressing three key domains closely associated with cancer screening: familiarity, health navigation, and comprehension.
Results
During content validation, two items from the health navigation domain were removed, yielding 34 items. Using Rasch analysis and confirmatory factor analysis, we found the evidence of construct validity of K-AHL-C. The Korean version was also significantly correlated with measures of Functional Health Literacy scale, cancer prevention behaviors, and subjective health status, suggesting convergent validities respectively. Finally, K-AHL-C had acceptable reliability coefficients (α) ranging from 0.71 to 0.92 for each domain and the total scale.
Conclusion
These psychometric properties support the K-AHL-C is a valid and reliable instrument for measuring Koreans’ health literacy in cancer screening. Also it is expected to use the instrument to detect breast and cervical cancer early and improve the screening rate, and ultimately to contribute to the promotion of women's health and women's health nursing practice.

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