Journal of Korean Academy of Nursing

Effects of a Nursing Simulation Learning Module on Clinical Reasoning Competence, Clinical Competence, Performance Confidence, and Anxiety in COVID-19 Patient-Care for Nursing Students: Kim, Ye-Eun , Kang, Hee-Young; J Korean Acad Nurs 2023;53(1):87-100. Published online February 28, 2023; DOI: https://doi.org/10.4040/jkan.22130

Abstract PDF: Purpose
This study aimed to develop a nursing simulation learning module for coronavirus disease 2019 (COVID-19) patient-care and examine its effects on clinical reasoning competence, clinical competence, performance confidence, and anxiety in COVID-19 patient care for nursing students.
Methods
A non-equivalent control group pre- and post-test design was employed. The study participants included 47 nursing students (23 in the experimental group and 24 in the control group) from G City. A simulation learning module for COVID-19 patient-care was developed based on the Jeffries simulation model. The module consisted of a briefing, simulation practice, and debriefing. The effects of the simulation module were measured using clinical reasoning competence, clinical competence, performance confidence, and anxiety in COVID-19 patient-care. Data were analyzed using χ² -test, Fisher’s exact test, t-test, Wilcoxon signed-rank test, and Mann– Whitney U test.
Results
The levels of clinical reasoning competence, clinical competence, and performance confidence of the experimental group were significantly higher than that of the control group, and the level of anxiety was significantly low after simulation learning.
Conclusion
The nursing simulation learning module for COVID-19 patient-care is more effective than the traditional method in terms of improving students’ clinical reasoning competence, clinical competence, and performance confidence, and reducing their anxiety. The module is expected to be useful for educational and clinical environments as an effective teaching and learning strategy to empower nursing competency and contribute to nursing education and clinical changes.

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Association between Resilience, Professional Quality of Life, and Caring Behavior in Oncology Nurses: A Cross-Sectional Study: Jeon, Misun , Kim, Sue , Kim, Sanghee; J Korean Acad Nurs 2023;53(6):597-609. Published online December 31, 2023; DOI: https://doi.org/10.4040/jkan.23058

Abstract PDF: Purpose
The degree of caring behavior of oncology nurses is a crucial factor in the care provided to patients with cancer. In this study, we aimed to investigate factors related to oncology nurses’ caring behavior, including their resilience and professional quality of life.
Methods
A cross-sectional descriptive study was conducted with 107 oncology nurses at an urban tertiary hospital from May 18 to 24, 2015. We used a self-report questionnaire to measure resilience, professional quality of life, and degree of caring behavior. Data analysis included descriptive statistics, correlations, and multiple regression analysis using SPSS/WIN 20.0.
Results
Oncology nurses presented with low levels of resilience and caring behavior, and high levels of compassion satisfaction, burnout, and secondary traumatic stress. There was a statistically significant relationship between the degree of caring behavior, resilience (r = .43, p < .001), compassion satisfaction (r = .51, p < .001), and burnout (r = - .42, p < .001), as well as between secondary traumatic stress and burnout (r = .34, p < .001). Factors associated with oncology nurses’ degree of caring behavior were compassion satisfaction (t = 6.00, p < .001) and educational level (t = 3.45, p = .001).
Conclusion
This study demonstrates that oncology nurses’ degree of caring behavior is related to their professional quality of life and education. These findings suggest that enhancing oncology nurses’ healthy coping strategies at both the individual and organizational levels can further develop holistic nursing care. Additionally, it is necessary to examine the factors affecting nurses’ compassion satisfaction and to try to promote this aspect.

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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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Psychometric Properties of the Korean Version of Self-Efficacy for HIV Disease Management Skills: Kim, Gwang Suk , Kim, Layoung , Shim, Mi-So , Baek, Seoyoung , Kim, Namhee , Park, Min Kyung , Lee, Youngjin; J Korean Acad Nurs 2023;53(3):295-308. Published online June 30, 2023; DOI: https://doi.org/10.4040/jkan.23016

Abstract PDF: Purpose
This study evaluated the validity and reliability of Shively and colleagues’ self-efficacy for HIV disease management skills (HIVSE) among Korean participants.
Methods
The original HIV-SE questionnaire, comprising 34 items, was translated into Korean using a translation and back-translation process. To enhance clarity and eliminate redundancy, the author and expert committee engaged in multiple discussions and integrated two items with similar meanings into a single item. Further, four HIV nurse experts tested content validity. Survey data were collected from 227 individuals diagnosed with HIV from five Korean hospitals. Construct validity was verified through confirmatory factor analysis. Criterion validity was evaluated using Pearson’s correlation coefficients with the new general self-efficacy scale. Internal consistency reliability and test-retest were examined for reliability.
Results
The Korean version of HIV-SE (K-HIV-SE) comprises 33 items across six domains: “managing depression/mood,” “managing medications,” “managing symptoms,” “communicating with a healthcare provider,” “getting support/help,” and “managing fatigue.” The fitness of the modified model was acceptable (minimum value of the discrepancy function/degree of freedom = 2.49, root mean square error of approximation = .08, goodnessof-fit index = .76, adjusted goodness-of-fit index = .71, Tucker-Lewis index = .84, and comparative fit index = .86). The internal consistency reliability (Cronbach’s α = .91) and test-retest reliability (intraclass correlation coefficient = .73) were good. The criterion validity of the K-HIV-SE was .59 (p < .001).
Conclusion
This study suggests that the K-HIV-SE is useful for efficiently assessing self-efficacy for HIV disease management.

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Association between Visual Impairment and Nutritional Risk among Older Adults with Diabetes: A Population-Based Cross-Sectional Study: Yang, Eunjin , Lee, Kyung Hee; J Korean Acad Nurs 2023;53(2):167-176. Published online April 30, 2023; DOI: https://doi.org/10.4040/jkan.22141

Abstract PDF: Purpose
Despite the high prevalence of visual impairment caused by diabetic retinopathy and nutritional problems among older adults with diabetes, evidence regarding factors related to nutritional risk in this population is limited. Therefore, this study aimed to identify the correlates of nutritional risk among older adults with diabetes, focusing on visual impairment.
Methods
This study was a secondary data analysis of the 2020 National Survey of Older Koreans aged 65 years and above. The sample comprised 2,376 older adults with diabetes, and complex sample ANOVA and Rao–Scott chi-square tests were used to compare the groups according to visual impairment. Complex-sample logistic regression analyses were conducted to verify the association between visual impairment and nutritional risk.
Results
Older adults with diabetes, who also have severe visual impairment, are more likely to have nutritional risk status than those without impairment after controlling for covariates (odds ratio [OR] = 2.44, 95% confidence interval [CI] 1.16~5.13). Among the covariates, depression (OR = 3.58, 95% CI 2.60~4.94), dependent activities of daily living status (OR = 2.79, 95% CI 1.60~4.86), and experience of hospitalization during the past year (OR = 2.51, 95% CI 1.57~4.03) were strongly associated with nutritional risk.
Conclusion
Severe visual impairment increases the nutritional risk among older adults with diabetes. Therefore, it is essential to prevent visual impairment due to exacerbation of diabetes through appropriate management. Additionally, tailored nutritional interventions for visually impaired older adults with diabetes that consider visual characteristics are required.

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Factors Influencing the Intention for Continual Fertility Treatments by the Women Undergoing Assisted Reproductive Technology Procedures: A Cross-Sectional Study: Kim, Miok , Kim, Minkyung , Ban, Minkyung; J Korean Acad Nurs 2024;54(1):59-72. Published online February 29, 2024; DOI: https://doi.org/10.4040/jkan.23095

Abstract PDF: Purpose
This cross-sectional study aimed to identify factors influencing the intention for continual fertility treatments among women undergoing assisted reproductive technology (ART).
Methods
A total of 197 women were recruited through convenience sample from fertility hospitals in Gyeonggi-do and Busan, South Korea. Data were collected using a self-report questionnaire incorporating measures of uncertainty; Depression Anxiety Stress Scales; Fatigue Severity Scale; Coping Scale for Infertility-Women; spousal support; treatment environment; and intention for continual fertility treatment. Descriptive statistics, chi-square tests, t-tests, and logistic regression analysis were conducted using IBM SPSS 26.0.
Results
As many as 70.6% of the participants expressed an intention for continual fertility treatments. Logistic regression analysis revealed that factors such as uncertainty (odds ratio [OR] = 0.44, 95% confidence interval [CI] 0.20~0.95), active coping (OR = 4.04, 95% CI 1.11~14.71), treatment environment (OR = 2.77, 95% CI 1.26~6.07), and the duration of marriage (OR = 2.61, 95% CI 1.24~5.49) were significantly related with this intention.
Conclusion
These findings underscore the significance of uncertainty management, having proactive coping strategies, having supportive treatment environments, and considering the duration of marriage concerning women’s intention for continual fertility treatment in the context of ART. The implications of these results extend to the development of nursing intervention programs aimed at providing crucial support for women undergoing ART and seeking to continue their infertility treatment.

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Impact of Anthropometric Indices of Obesity on the Risk of Incident Hypertension in Adults with Prehypertension: A Secondary Analysis of a Cohort Study: Jang, Se Young , Kim, Jihun , Kim, Seonhwa , Lee, Eun Sun , Choi, Eun Jeong; J Korean Acad Nurs 2024;54(1):18-31. Published online February 29, 2024; DOI: https://doi.org/10.4040/jkan.23067

Abstract PDF: Purpose
This study aimed to investigate the impact of anthropometric indices of obesity (body mass index [BMI], waist circumference, waist hip ratio, and body fat percentage) on the incidence of hypertension in adults with prehypertension.
Methods
A longitudinal study design using secondary data form the Korean Genome and Epidemiology Study was employed. The study included 1,838 adults with prehypertension tracked every two years from 2001 to 2018. Statistical analyses, including frequency assessments, number of cases per 1,000 person-years, log-rank tests, Kaplan-Meier curves, and Cox’s proportional hazards regression, were conducted using SPSS version 25.
Results
Over the observation period (15,783.6 person-years), 1,136 individuals developed hypertension. The incidence of hypertension was significantly higher in the obesity groups defined by BMI (hazard ratio [HR] = 1.33), waist circumference (HR = 1.34), waist hip ratio (HR = 1.29), and body fat percentage (HR = 1.31) compared to the non-obese group. These findings indicate an increased risk of hypertension associated with obesity as measured by these indices.
Conclusion
The study underscores the importance of avoiding obesity to prevent hypertension in individuals with prehypertension. Specifically, BMI, waist circumference, waist hip circumference, and body fat percentage were identified as significant risk factors for hypertension. The results suggest the need for individualized weight control interventions, emphasizing the role of health professionals in addressing the heightened hypertension risk in this population.

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National Petition Analysis Related to Nursing: Text Network Analysis and Topic Modeling: Ko, HyunJung , Jeong, Seok Hee , Lee, Eun Jee , Kim, Hee Sun; J Korean Acad Nurs 2023;53(6):635-651. Published online December 31, 2023; DOI: https://doi.org/10.4040/jkan.23052

Abstract PDF: Purpose
This study aimed to identify the main keyword, network structure, and main topics of the national petition related to “nursing” in South Korea.
Methods
Data were gathered from petitions related to the national petition in Korea Blue House related to the topic “nursing” or “nurse” from August 17, 2017, to May 9, 2022. A total of 5,154 petitions were searched, and 995 were selected for the final analysis. Text network analysis and topic modeling were analyzed using the Netminer 4.5.0 program.
Results
Regarding network characteristics, a density of 0.03, an average degree of 144.483, and an average distance of 1.943 were found. Compared to results of degree centrality and betweenness centrality, keywords such as “work environment,” “nursing university,” “license,” and “education” appeared typically in the eigenvector centrality analysis. Topic modeling derived four topics: (1) “Improving the working environment and dealing with nursing professionals,” (2) “requesting investigation and punishment related to medical accidents,” (3) “requiring clear role regulation and legislation of medical and nonmedical professions,” and (4) “demanding improvement of healthcare-related systems and services.” Conclusion: This is the first study to analyze Korea's national petitions in the field of nursing. This study's results confirmed both the internal needs and external demands for nurses in South Korea. Policies and laws that reflect these results should be developed.

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Emotional Intelligence, Academic Motivation, and Achievement among Health Science Students in Saudi Arabia: A Self-Deterministic Approach: Mahrous, Rasha Mohammed , Bugis, Bussma Ahmed , Sayed, Samiha Hamdi; J Korean Acad Nurs 2023;53(6):571-583. Published online December 31, 2023; DOI: https://doi.org/10.4040/jkan.23028

Abstract PDF: Purpose
This study used a self-deterministic approach to explore the relationship between emotional intelligence (EI), academic motivation (AM), and achievement among health science students.
Methods
A descriptive cross-sectional study was conducted in three cities of Saudi Arabia (Dammam, Riyadh, and Jeddah). A convenience sample of 450 students was incorporated using the multistage cluster sampling technique. The online survey contained three sections: students' basic data and academic achievement level, the modified Schutte self-report inventory, and the Academic Motivation Scale lowercase.
Results
This study revealed moderate overall scores for EI (57.1%), AM (55.6%), and grade point average (GPA) (57.6%). The overall EI score, its domains, and GPA had significant positive correlations with overall AM and intrinsic and extrinsic motivation (p < .01). Amotivation had an insignificant correlation with GPA (p < .05), but it was negatively correlated with EI and its domains (p < .01). Multiple regression analysis proved that EI domains predicted 5.0% of GPA variance; emotions appraisal and expression (β = .02, p = .024), regulation (β = .11, p = .032), and utilization (β = .24, p < .01). EI domains also predicted 26.0% of AM variance; emotions appraisal and expression (β = .11, p = .04), regulation (β = .33, p < .01), and utilization (β = .23, p < .01). Moreover, AM predicted 4.0% of the variance in GPA; intrinsic (β = .25, p = .004) and extrinsic (β = .11, p = .022) motivation. AM also predicted 25.0% of the variance in EI: intrinsic (β = .34, p < .01) and extrinsic motivation (β = .26, p = .026).
Conclusion
EI and AM have a bidirectional influence on each other, significantly shaping the GPA of health sciences students in Saudi Arabia, where intrinsic motivation has a predominant role. Thus, promoting students' AM and EI is recommended to foster their academic achievement.

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Ensuring the Use of Effective Interventions in Nursing and Health Science: Implementation Mapping: Ten Hoor, Gill A , Park, Jiyoung , Kok, Gerjo; J Korean Acad Nurs 2023;53(5):497-499. Published online October 31, 2023; DOI: https://doi.org/10.4040/jkan.23128

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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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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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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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The Reliability and Validity of the Korean Version of the 5C Psychological Antecedents of Vaccination Scale: Bae, SuYeon , Kim, HeeJu; J Korean Acad Nurs 2023;53(3):324-339. Published online June 30, 2023; DOI: https://doi.org/10.4040/jkan.23021

Abstract PDF: Purpose
This study aimed to valuate the reliability and validity of the Korean version of the 5C Psychological Antecedents of Vaccination (K-5C) scale.
Methods
The English version of the 5C scale was translated into Korean, following the World Health Organization guidelines. Data were collected from 316 community-dwelling adults. Content validity was evaluated using the content validity index, while construct validity was evaluated through confirmatory factor analysis. Convergent validity was examined by assessing the correlation with vaccination attitude, and concurrent validity was evaluated by examining the association with coronavirus disease 2019 (COVID-19) vaccination status. Internal consistency and test-retest reliability were also evaluated.
Results
Content validity results indicated an item-level content validity index ranging from .83 to 1, and scale-level content validity index, averaging method was .95. Confirmatory factor analysis supported the fit of the measurement model, comprising a five-factor structure with a 15-item questionnaire (RMSEA = .05, SRMR = .05, CFI = .97, TLI = .96). Convergent validity was acceptable with a significant correlation between each sub-scale of the 5C scale and vaccination attitude. In concurrent validity evaluation, confidence, constraints, and collective responsibility of the 5C scale were significant independent predictors of the current COVID-19 vaccination status. Cronbach’s alpha for each subscale ranged from .78 to .88, and the intraclass correlation coefficient for each subscale ranged from .67 to .89.
Conclusion
The Korean version of the 5C scale is a valid and reliable tool to assess the psychological antecedents of vaccination among Korean adults.

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Internal Structure of the Health-Related Quality of Life Instrument with 8-Items in a Nationally Representative Population: Lee, Eun-Hyun; J Korean Acad Nurs 2023;53(3):359-369. Published online June 30, 2023; DOI: https://doi.org/10.4040/jkan.23007

Abstract PDF: Purpose
This study evaluated the internal structure (structural validity, internal consistency, and measurement invariance) of the Health-Related Quality of Life Instrument with Eight Items (HINT-8), developed to measure Korean people’s health-related quality of life.
Methods
A secondary analysis was conducted using data from the Korea National Health and Nutrition Examination Survey, involving 6,167 adults aged over 18 years. The structural validity of the HINT-8 was assessed using exploratory graph analysis and confirmatory factor analysis. Internal consistency and measurement invariance were analyzed using McDonald’s omega (ω) and multigroup confirmatory factor analysis, respectively.
Results
The HINT-8 had a single dimension and good internal consistency (ω = .804). The one-dimension HINT-8 ex-hibited matric invariance but not scalar invariance across sociodemographic groups (sex, age, education, and marital status). Further, it exhibited scalar or partial scalar invariance across medical condition groups (hypertension, diabetes, depressive symptoms, and cancer).
Conclusion
The study finds that the HINT-8 demonstrated satisfactory structural validity and internal consistency, indicating its suitability for practice and research. However, the HINT-8 scores cannot be compared across different groups regarding sex, age, education, and marital status, as the interpretation varies within each sociodemographic category. Conversely, interpretation of the HINT-8 is consistent for individuals with and without hypertension, diabetes, depressive symptom, and cancer.

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Effects of Health Education Using Virtual Reality for Adolescents: A Systematic Review and MetaAnalysis: Park, SoMi , Chung, ChaeWeon , Kim, Gaeun; J Korean Acad Nurs 2023;53(2):177-190. Published online April 30, 2023; DOI: https://doi.org/10.4040/jkan.23003

Abstract PDF: Purpose
This study aimed to evaluate the effects of health interventions using virtual reality (VR) on improving knowledge, attitudes, and skills; and inducing behavioral change among adolescents.
Methods
This study is a systematic review and meta-analysis following PRISMA guidelines. We searched Cochrane, MEDLINE, Embase, CINAHL, Scopus, Web of Science, and Korean databases between database inception and April 10, 2021. Based on heterogeneity, a random- or fixed-effects model was used, as appropriate, to calculate effect sizes in terms of the standardized mean difference (SMD) and odds ratio (OR). Studies were selected if they verified the effects of health education using VR on adolescents; there was an appropriate control group; and if the effects of education were reported in terms of changes in knowledge, attitudes, skills, or behaviors.
Results
This analysis included six studies (n = 1,086). The intervention groups showed greater responses in knowledge and attitudes (SMD = 0.57, 95% confidence interval (CI) [0.12 to 1.02]), skills related to health behavior (SMD = -0.45, 95% CI [-0.71 to -0.19]), and behavioral change after 12 months (OR = 2.36, 95% CI [1.03 to 5.41]).
Conclusion
The results confirm the effectiveness of health interventions using virtual reality (VR). Although the analysis include a small number of studies, a case can be made for health interventions using VR to be utilized as educational methods and strategies to prevent risky behaviors among adolescents.

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The Effect of Socioeconomic Status to Depression of Perimenopause Women: Pathway Analysis Using the Reserve Capacity Model: Park, Mi-Ran , Choi, Hye Seung , Lee, Ju-Young; J Korean Acad Nurs 2023;53(2):249-259. Published online April 30, 2023; DOI: https://doi.org/10.4040/jkan.22133

Abstract PDF: Purpose
Based on the Reserve Capacity Model, this study investigated the effects of pre- and postmenopausal women’s socioeconomic status (SES) on depression, focusing on the mediating effects of self-esteem, happiness, and family relationship satisfaction with social network relationships.
Methods
This cross-sectional study involved secondary analysis of national data on 771 perimenopause women gathered from the 16th Korea Welfare Panel Study (KOWEPS) 2021. A path analysis model was constructed to evaluate the relationship between SES, social network satisfaction, self-esteem, perceived health status, and depression. Data were analyzed using ADANCO 2.3.1 and Mplus 8.4.
Results
Although SES had no direct effect on depression, it did affect depression through self-esteem, happiness, and satisfaction with family relationships.
Conclusion
The findings of this study indicate that perimenopausal women’s personal resources—psychosocial variables such as self-esteem and happiness—had a higher effect on depression than tangible reserves like SES. Therefore, interventions for enhancing self-esteem and happiness may prevent depression in perimenopausal women effectively.

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Associations between the Frequency and Quantity of Heated Tobacco Product Use and Smoking Characteristics among Korean Smoking Adolescents: Lee, Haein , Lee, Bo Gyeong; J Korean Acad Nurs 2023;53(2):155-166. Published online April 30, 2023; DOI: https://doi.org/10.4040/jkan.22125

Abstract PDF: Purpose
Although heated tobacco product (HTP) use among adolescents is an emerging public health problem, little is known about the frequency and quantity of HTP use. Thus, we investigated the associations between the frequency and quantity of HTP use and smoking characteristics (i.e., combustible cigarette [CC] and electronic cigarette [EC] use, and attempts to quit smoking) among CC-smoking adolescents.
Methods
We analyzed nationally representative data from 2,470 Korean adolescents who were current CC smokers. To investigate our aim, we conducted multinomial logistic and logistic regression analyses.
Results
We found that daily and heavier CC users had greater likelihoods of more frequent and heavier HTP use. In addition, dual users of CCs and ECs were more likely to use HTPs more frequently and heavily than CC users who did not use ECs. Moreover, daily EC users had the highest risk of frequent and heavy HTP use. The frequency and quantity of HTP use were not associated with attempts to quit smoking. Compared to CC-only use, dual use of CCs and HTPs was not associated with quitting attempts, and triple use of CCs, ECs, and HTPs was associated with a lower likelihood of quitting attempts.
Conclusion
HTP use was less likely to displace CC use and promote attempts to quit smoking. Thus, strict regulations are required to prevent the promotion of HTPs as a substitute for CCs or as a means of quitting smoking. Additionally, health professionals should consider preventive interventions for HTP, as well as CC and EC use among adolescents.

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Factors Affecting Radiation Protective Behaviors in Perioperative Nurses Applying the Theory of Planned Behavior: Path Analysis: Jang, Se Young , Kim, Hee Sun , Jeong, Seok Hee , Kim, Young Man; J Korean Acad Nurs 2023;53(2):222-235. Published online April 30, 2023; DOI: https://doi.org/10.4040/jkan.22099

Abstract PDF: Purpose
The aim of this study was to identify the factors explaining protective behaviors against radiation exposure in perioperative nurses based on the theory of planned behavior.
Methods
This was a cross-sectional study. A total of 229 perioperative nurses participated between October 3 and October 20, 2021. Data were analyzed using SPSS/WIN 23.0 and AMOS 23.0 software. The three exogenous variables (attitude toward radiation protective behaviors, subjective norm, and perceived behavioral control) and two endogenous variables (radiation protective intention and radiation protective behaviors) were surveyed.
Results
The hypothetical model fit the data (χ2/df = 1.18, SRMR = .02, TLI = .98, CFI = .99, RMSEA = .03). Radiation protective intention (β = .24, p = .001) and attitude toward radiation protective behaviors (β = .32, p = .002) had direct effects on radiation protective behaviors. Subjective norm (β = .43, p = .002) and perceived behavior control (β = .24, p = .003) had direct effects on radiation protective intention, which explained 38.0% of the variance. Subjective norm (β = .10, p = .001) and perceived behavior control (β = .06, p = .002) had indirect effects via radiation protective intention on radiation protective behaviors. Attitude toward radiation protective behaviors, subjective norm, and perceived behavioral control were the significant factors explaining 49.0% of the variance in radiation protective behaviors.
Conclusion
This study shows that the theory of planned behavior can be used to effectively predict radiation protective behaviors in perioperative nurses. Radiation safety guidelines or education programs to enhance perioperative nurses’ protective behaviors should focus on radiation protective intention, attitude toward radiation protective behaviors, subjective norm, and perceived behavioral control.

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Factors Influencing the COVID-19 Vaccination Intentions in Parents for Their Children Aged 5~11: Korea, April 2022: Choi, In Suk , Kim, Eun A; J Korean Acad Nurs 2023;53(2):208-221. Published online April 30, 2023; DOI: https://doi.org/10.4040/jkan.22096

Abstract PDF: Purpose
This study aimed to investigate COVID-19 vaccination intentions in Korean parents for their children aged 5 to 11 years and the factors influencing them.
Methods
A cross-sectional online survey of 363 parents of children aged 5 to 11 years was conducted in Korea in April 2022. Data were analyzed using independent t-test, χ2-test, Fisher’s exact test, and hierarchical logistic regression analysis using SPSS/WIN 26.0 and MedCalc software version 20.113.
Results
Of 363 Korean parents with children aged 5 to 11, 42.4% intended to vaccinate their children. Significant factors influencing vaccination intention were the second or third birth order of children (OR = 3.45, 95% CI = 1.45~8.21), vaccine hesitancy-confidence (OR = 2.00, 95% CI = 1.51~2.65), vaccine hesitancy-collective responsibility (OR = 1.57, 95% CI: 1.10~2.25), and COVID-19 anxiety-avoidance (OR = 1.55, 95% CI = 1.13~2.11).
Conclusion
Findings suggest that COVID-19 vaccine campaigns based on reliable information and evidence from health authorities are needed to increase COVID-19 vaccination. Well-designed health communications for the target population may help to increase parental vaccine acceptance.

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Factors Affecting the Quality of Life in Low-Income Older Adults with Sarcopenia: A Cross-Sectional Study: Nho, Ju-Hee , Kim, Eun Jin; J Korean Acad Nurs 2023;53(1):1-11. Published online February 28, 2023; DOI: https://doi.org/10.4040/jkan.22126

Abstract PDF: Purpose
This study aimed to identify the factors influencing quality of life (QoL) of low-income older adults (LOAs) with sarcopenia.
Methods
A convenience sample of 125 older adults was recruited from Jeonbuk Province, South Korea. Data were collected using a self-report questionnaire that included nutritional status, the Depression Anxiety Stress Scale-21, and the World Health Organization Quality of Life Instrument-Older Adults Module. Additionally, grip strength and appendicular skeletal muscle mass, were evaluated, along with the short physical performance battery.
Results
Sarcopenia and severe sarcopenia were observed in 43.2% and 56.8% of participants, respectively. Using multiple regression analysis, depression (β = - .40, p < .001), nutritional status (β = .24, p = .003), and anxiety (β = - .15, p = .042) were identified as factors affecting the QoL of the older adults in low-income groups with sarcopenia, the explanatory power of these variables was 44%.
Conclusion
The results of this study can be used to develop a nursing intervention program and establish policies to improve depression, anxiety, and nutritional status to enhance QoL of LOAs with sarcopenia.

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The Experience of Gynecologic Cancer in Young Women: A Qualitative Study: Kim, Sung-Jin , Shin, Hyunjeong; J Korean Acad Nurs 2023;53(1):115-128. Published online February 28, 2023; DOI: https://doi.org/10.4040/jkan.22119

Abstract PDF: Purpose
This study aimed to understand the experiences of women under 40 years of age with gynecologic cancer.
Methods
Semi-structured individual in-depth interviews were conducted with 14 Korean female patients aged 21~39 years with gynecologic cancer. The data were analyzed using Corbin and Strauss' grounded theory approach, including open coding, context analysis, and integrating categories.
Results
Grounded theory analysis revealed nine categories and a core category of ‘the journey to find my life after losing the life as a typical woman.’ The categories that emerged as the conditions are ‘Unwelcomed guest, cancer,’ ‘Completely devastated life as an ordinary woman,’ ‘Uncertain future,’ ‘Losing my physical characteristics as a woman,’ and ‘Life tied with treatments.’ The actions/interactions were ‘Decrease of interpersonal relationships,’ ‘A lonely battle to overcome alone,’ and ‘The power to overcome hardships.’ The consequence was ‘Live my own life.’ Conclusion: This study contributes to the development of a substantive theory of the experience of gynecologic cancer in young women, which has been on the rise in recent years. The study’s results are expected to be used as a basis for providing nursing care to help young women with gynecologic cancer adapt to their disease.

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Keyword Network Analysis and Topic Modeling of News Articles Related to Artificial Intelligence and Nursing: Ha, Ju-Young , Park, Hyo-Jin; J Korean Acad Nurs 2023;53(1):55-68. Published online February 28, 2023; DOI: https://doi.org/10.4040/jkan.22117

Abstract PDF: Purpose
The purpose of this study was to identify the main keywords, network properties, and main topics of news articles related to artificial intelligence technology in the field of nursing.
Methods
After collecting artificial intelligence-and nursing-related news articles published between January 1, 1991, and July 24, 2022, keywords were extracted via preprocessing. A total of 3,267 articles were searched, and 2,996 were used for the final analysis. Text network analysis and topic modeling were performed using NetMiner 4.4.
Results
As a result of analyzing the frequency of appearance, the keywords used most frequently were education, medical robot, telecom, dementia, and the older adults living alone. Keyword network analysis revealed the following results: a density of 0.002, an average degree of 8.79, and an average distance of 2.43; the central keywords identified were ’education,’ ‘medical robot,’ and ‘fourth industry.’ Five topics were derived from news articles related to artificial intelligence and nursing: ‘Artificial intelligence nursing research and development in the health and medical field,’ ‘Education using artificial intelligence for children and youth care,’ ‘Nursing robot for older adults care,’ ‘Community care policy and artificial intelligence,’ and ‘Smart care technology in an aging society.’ Conclusion: The use of artificial intelligence may be helpful among the local community, older adult, children, and adolescents. In particular, health management using artificial intelligence is indispensable now that we are facing a super-aging society. In the future, studies on nursing intervention and development of nursing programs using artificial intelligence should be conducted.

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