Journal of Korean Academy of Nursing

Analysis of the Adequacy of Nurse Staffing Level through the Estimation of Nursing Activity Hours and Implementation of Focus Group Interviews in a Tertiary Hospital: Using a Mixed-Method Design: Kim, Hyun-Joo , Lee, Sun-Hee , Lee, Jai-Jung , Seong, Sun-Suk , Yang, Hee , Lee, Hyang-Yuol; J Korean Acad Nurs 2024;54(2):237-249. Published online May 31, 2024; DOI: https://doi.org/10.4040/jkan.22142

Abstract PDF: Purpose
This study aimed to examine the adequacy of current nurse staffing levels by identifying nursing activities and workload.
Methods
The study used a mixed-method design. A nursing activity survey was conducted using the work sampling method over 2 working days with 119 general ward nurses. A focus group interview was conducted with 12 nurses. Quantitative and qualitative data were analyzed using SPSS 20.0 and content analysis, respectively.
Results
The most amount of time was spent on medication (in direct nursing) and electronic medical record documentation (in indirect nursing). The appropriate nurse-to-patient ratio is 1:7.7 for the day shift, 1:9.0 for the evening shift, and 1:11.9 for the night shift. However, the current nurse-to-patient ratio is 1:9.4, 1:11.0, and 1:13.8 for the day, evening, and night shifts, respectively. Therefore, the current nurse staffing level is insufficient for the workload. In the focus group interview, the main reasons cited for being unable to complete tasks within working hours were communication and coordination, and the nursing electronic medical record. The essential nursing activities of basic nursing and emotional support were overlooked owing to a heavy workload. Therefore, an adequate nurse staffing level should be higher than the measured quantitative workload.
Conclusion
These results suggest the general wards of tertiary hospitals should evaluate the adequacy of their current nurse staffing and allocate sufficient nurses to improve patient safety and nursing care quality.

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Experiences of Transitional Care for Medicaid Case Managers: Hwang, Yunhee , Lee, Gaeon; J Korean Acad Nurs 2023;53(5):556-569. Published online October 31, 2023; DOI: https://doi.org/10.4040/jkan.23031

Abstract PDF: Purpose
This phenomenological study tried to understand the essence of the transitional care experience of medicaid case managers and its structural meaning. In addition, it was attempted to establish a system of transitional care and seek support measures for medicaid case managers.
Methods
The participants of this study were 7 medicaid case managers who had spent more than 1 year and 6 months in medicaid pilot project. Data were collected with individual in-depth interviews from June to December 2021. The data were analyzed by Giorgi's phenomenological analysis method.
Results
The seven constituents derived from the results of this study were 'struggle to establish a living environment', 'dedication to supporting independent living', 'anxiety about safety', 'pressure on care responsibilities', ‘distress in building the pilot project’, 'pride in role', and 'expectation for improvement'.
Conclusion
The study results provide a comprehensive understanding of the transition care reality for medicaid case managers. They also shed light on managers’ perceptions and attitudes. These findings can serve as fundamental information for establishing support measures for medicaid case managers and transitional care systems.

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An Investigation of the Cumulative Effects of Depressive Symptoms on the Cognitive Function in Community-Dwelling Older Adults: Analysis of the Korean Longitudinal Study of Aging: Kim, Eunmi , Oh, Jinkyung , Huh, Iksoo; J Korean Acad Nurs 2023;53(4):453-467. Published online August 31, 2023; DOI: https://doi.org/10.4040/jkan.23018

Abstract PDF: Purpose
This study investigated the cumulative effects of depressive symptoms on cognitive function over time in community-dwelling older adults. Methods: Data were investigated from 2,533 community-dwelling older adults who participated in the Korean Longitudinal Study of Aging (KLoSA) from the 5th (2014) to the 8th wave (2020). The association between cumulative depressive symptoms and cognitive function was identified through multiple regression analysis. Results: When the multiple regression analysis was conducted from each wave, the current depressive symptoms scores and cognitive function scores were negatively associated, regardless of the waves (B5th = - 0.26, B6th = - 0.26, B7th = - 0.26, and B8th = - 0.27; all p < .001). Further, when all the previous depressive symptoms scores were added as explanatory variables in the 8th wave, the current one (B8th = - 0.09, p < .001) and the previous ones (B5th = - 0.11, B6th = - 0.09, and B7th = - 0.13; all p < .001) were also negatively associated with the cognitive function score. The delta R² , which indicates the difference between the model’s R² with and without the depressive symptoms scores, was greater in the model with all the previous and current depressive symptoms scores (6.4%) than in the model with only the current depressive symptoms score (3.6%). Conclusion: Depressive symptoms in older adults have a long-term impact. This results in an accumulated adverse effect on the cognitive function. Therefore, to prevent cognitive decline in older adults, we suggest detecting their depressive symptoms early and providing continuous intervention to reduce exposure to long-term depressive symptoms.

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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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Effects of Clinical Nurses’ Job Crafting on Organizational Effectiveness Based on Job DemandsResource Model: Lee, Eun Young , Kim, Eungyung; J Korean Acad Nurs 2023;53(1):129-143. Published online February 28, 2023; DOI: https://doi.org/10.4040/jkan.22138

Abstract PDF: Purpose
This study aimed to examine the mediating effects of clinical nurses’ job crafting on organizational effectiveness based on the job demands-resources model proposed by Bakker and Demerouti (2017).
Methods
The participants consisted of 393 nurses working in nursing units of a tertiary general hospital located in Cheongju region. The data, collected using questionnaire from August 9 to August 20, 2021, were analyzed using SPSS 23.0 and AMOS 27.0.
Results
The goodness-of-fit (GoF) test results on the modified model (χ 2 = 2.7, GFI = .94, SRMR = .03, RMSEA = .06, NFI = .92, CFI = .94, TLI = .92, AGFI = .90), indicated that the GoF index satisfied the recommended level. Regarding the effects of each variable on organizational effectiveness, job crafting showed statistically significant direct (β = .48, p < .001), indirect (β = .23, p < .001), and total effects (β = .71, p < .001). Burnout showed statistically significant direct effect (β = - .17, p < .001). Work engagement showed statistically significant direct (β = .41, p < .001) and total effects (β = .41, p < .001). The factors explaining organizational effectiveness were job crafting, burnout, and work engagement, which had an explanatory power of 76.7%.
Conclusion
Nurses’ job crafting is an important mediating factor for enhancing the organizational effectiveness of nursing organizations. Hospitals should develop job-crafting success cases and related education and training programs as a strategy for enhancing the job crafting of nurses and, consequently organizational effectiveness.

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Lived Experience of Middle-Aged Patients with Complex Regional Pain Syndrome: Seo, Young-suk , Lee, Sunhee; J Korean Acad Nurs 2022;52(6):598-607. Published online December 31, 2022; DOI: https://doi.org/10.4040/jkan.22086

Abstract PDF: Purpose
This qualitative study aimed to explore the lived and true meaning of experiences of middle-aged patients with complex regional pain syndrome.
Methods
The participants were 10 men and women aged 40 to 60 years who received outpatient treatment at a university hospital, could communicate, and agreed to participate in the study. Data were collected through individual interviews using open and semi-structured questions from September 2019 to July 2021 and were analyzed using the content analysis method suggested by Hsieh and Shannon (2005).
Results
As a result of this study, 42 summarized semantic units related to life experience, 15 subthemes, and seven themes were derived. The seven themes were “pressed by severe pain,” “frustrated because I cannot be part of the community,” “distressed because people do not recognize my disease,” “sad about conflicts with family,” “unmotivated because of desperate life,” “appreciating for support,” and “putting oneself together and living daily life.” Conclusion: The vivid experiences of the participants derived in this study are the basic data for developing treatment guidelines. In the future, we propose a study on life and family care experiences according to the developmental characteristics of the life cycle of patients with complex regional pain syndrome and develop and apply programs to support patients and their families.

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The Development of Automated Personalized Self-Care (APSC) Program for Patients with Type 2 Diabetes Mellitus: Park, Gaeun , Lee, Haejung , Khang, Ah Reum; J Korean Acad Nurs 2022;52(5):535-549. Published online October 31, 2022; DOI: https://doi.org/10.4040/jkan.22046

Abstract PDF: Purpose
The study aimed to design and develop an automated personalized self-care (APSC) program for patients with type 2 diabetes mellitus. The secondary aim was to present a clinical protocol as a mixed-method research to test the program effects.
Methods
The APSC program was developed in the order of analysis, design, implementation, and evaluation according to the software development life cycle, and was guided by the self-regulatory theory. The content validity, heuristics, and usability of the program were verified by experts and patients with type 2 diabetes mellitus.
Results
The APSC program was developed based on goal setting, education, monitoring, and feedback components corresponding to the phases of forethought, performance/volitional control, and self-reflection of self-regulatory theory. Using the mobile application, the participants are able to learn from educational materials, monitor their health behaviors, receive weekly-automated personalized goals and feedback messages, and use an automated conversation system to solve the problems related to self-care. The ongoing two-year study utilizes a mixed method design, with 180 patients having type 2 diabetes mellitus randomized to receive either the intervention or usual care. The participants will be reviewed for self-care self-efficacy, health behaviors, and health outcomes at 6, 12, 18, and 24 months. Participants in the intervention group will be interviewed about their experiences.
Conclusion
The APSC program can serve as an effective tool for facilitating diabetes health behaviors by improving patients’ self-care self-efficacy and self-regulation for self-care. However, the clinical effectiveness of this program requires further investigation.

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A Longitudinal Study of the Reciprocal Relationship between Depression and Income among Korean Older Men and Women: Lee, Jeong , Jeon, Gyeong-Suk; J Korean Acad Nurs 2022;52(4):451-463. Published online August 31, 2022; DOI: https://doi.org/10.4040/jkan.22052

Abstract PDF: Purpose
This study examined the reciprocal relationships between depression and income, and gender differences in these relationships among older adults in South Korea.
Methods
Using 2015 to 2019 of the Korea Welfare Panel Study (KoWePS), we studied 6,070 older adults (2,394 men and 3,676 women) aged 60 years over in 2015. The generalized estimating equation was employed to explore the effect of an individual income on depression and the reverse causal link-that of depression on income.
Results
The study found the reciprocal relationships between income and depression. Income has a significant impact on depression. Higher-income was linked to decreased risks of the Center for Epidemiologic Studies Depression (CES-D) scores among older adults (B = - 0.121, p < 0.001). Estimates of the reverse causal link show that higher CES-D scores were also linked to income reduction among Korean older adults (B = - 0.007, p < 0.001). In addition, we also observed gender differences in the impact of income on depression but not in the reverse causal link. Income has more detrimental to psychological consequence for older men (B = - 0.108, p < 0.001) than older women (B = - 0.057, p < 0.001).
Conclusion
The finding implies that both psychological and social protection policies for the elderly are needed in view of gender perspective.

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Influence of Social Capital on Depression of Older Adults Living in Rural Area: A Cross-Sectional Study Using the 2019 Korea Community Health Survey: Jung, Minho , Kim, Jinhyun; J Korean Acad Nurs 2022;52(2):144-156. Published online April 30, 2022; DOI: https://doi.org/10.4040/jkan.21239

Abstract PDF: Purpose
This study aimed to investigate the influence of social capital on the depression of older adults living in rural areas.
Methods
Data sets were obtained from the 2019 Korea Community Health Survey. The participants were 39,390 older adults over 65 years old living in rural areas. Indicators of social capital included trust, reciprocity, network, and social participation. Depression—the dependent variable—was measured using the Patient Health Questionnaire-9 (PHQ-9). Hierarchical ordinal logistic regression was conducted to identify factors associated with depression after adjusting the data numbers to 102,601 by applying the Synthetic Minority Oversampling Technique (SMOTE).
Results
The independent variables—indicators of social capital—exhibited significant association with the depression of older adults. The odds ratios of depression were higher in groups without social capital variables.
Conclusion
To reduce depression, we recommend increasing social capital. Factors identified in this study need to be considered in older adult depression intervention programs and policies.

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Validity and Reliability of the Korean Version of the Couple Satisfaction Index: Kim, Suk-Sun , Gil, Minji , Kim, Daeun , Kim, Sunhai , Heo, Dayeon , Moon, Nan Young; J Korean Acad Nurs 2022;52(2):228-227. Published online April 30, 2022; DOI: https://doi.org/10.4040/jkan.21177

Abstract PDF: Purpose
The study aimed to translate the Couple Satisfaction Index (CSI 32) into Korean, to evaluate the reliability and validity of CSI 32 and short-form (CSI 16, 4) in the Korean context, and to determine a cut-off score for Korean couples.
Methods
Korean Versions of the Couple Satisfaction Index (K-CSI) 32 was translated, back-translated, and reviewed by five bilingual experts. Confirmatory factor analysis (CFA) was conducted with data from a sample of 218 couples (N = 436) to test construct validity. Validity and reliability were evaluated. The receiver’s operating characteristics curve analysis was used to obtain the cut-off score.
Results
The construct validities of K-CSI 32, 16, and 4 were verified using one-factor structures. The results of CFA showed a slightly better fit for K-CSI 16 and 4 than for K-CSI 32. Convergent validity was supported by significant positive correlations of K-CSI with Kansas Marital Satisfaction Scale, Dyadic Adjustment Scale, and Family Relationship Assessment Scale. Moreover, the significant differences in K-CSI between normal and depressive group demonstrated known-group validity. Cut-off scores of 105.5 on K-CSI 32, 50.25 on K-CSI 16, and 13.25 on K-CSI 4 were validated to identify distressed couple relationships.
Conclusion
For clinical practice, the reliable and valid K-CSI 32 has the potential to measure changes in couple satisfaction after couple therapy or interventions. Applying K-CSI 32 may facilitate research on couple and family relationships in nursing and contribute to the discussion on the role of couple satisfaction in mental health.

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Willingness to Use and Appropriate Payable Cost for Visiting Nurse Service for the Elderly in the Community: Seo, Soyoung , Jang, Soong-nang; J Korean Acad Nurs 2022;52(1):105-119. Published online February 28, 2022; DOI: https://doi.org/10.4040/jkan.21193

Abstract PDF: Purpose
This study aimed to measure willingness to use (WTU) and appropriate payable cost of visiting nurse service for the elderly and explore their impact factors.
Methods
The study included 752 participants selected from data that were completed in 2017 for the elderly aged over 60 nationwide. Logit and Tobit regression analysis were performed to confirm the influencing factors.
Results
The study found that 39.1% of the elderly in the community were WTU the visiting nurse service, and they reported that the cost per visit was 12,650 Korean Won. The factors influencing WTU were having less than moderate subjective health status (OR = 1.63, p = .011), being part of a social participating groups (OR = 1.50, p = .046), or participation in senior health promotion programs (SHPPs) (OR = 1.96, p = .003). The cost was also influenced by less than moderate subjective health status (β = 4.37, p = .021), being part of a social participating groups (β = 4.41, p = .028), or participation in SHPPs (β = 4.87, p = .023). Additionally, elderly people living alone who were used as covariates were highly WTU (OR = 2.20, p = .029).
Conclusion
This study provides evidence to predict demand for visiting nurse service and reflects consumer value in setting the service cost. This is the first study to derive cost from consumers' perspective regarding the service for the elderly. As it is the result of an open-ended survey, follow-up studies are needed to estimate more reliable and reasonable results.

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Healthcare Considerations for Special Populations during the COVID-19 Pandemic: A Review: Kim, Jeung-Im , Im, YeoJin , Song, Ju-Eun , Jang, Sun Joo; J Korean Acad Nurs 2021;51(5):511-524. Published online October 31, 2021; DOI: https://doi.org/10.4040/jkan.21156

Abstract PDF: The coronavirus disease 2019 (COVID-19) has emerged as a threat to human health and public safety. People of all ages are susceptible to severe acute respiratory syndrome coronavirus 2 infection. However, the clinical manifestations of this infection differ by age. This study purposes to describe healthcare considerations for special populations, such as children, pregnant and lactating women, and older adults, who may have unique healthcare needs, in the pandemic situation. To realize the research purpose, we conducted a review of the practice guidelines of public documents and qualified studies that were published online/offline during a specific period. The review identified current knowledge on care for newborns, children in schools, pregnant women (from antenatal to postpartum care), and older adults suffering from high-risk conditions. Subsequently, we summarize vaccination guidance for special populations and, finally, discuss the issues currently affecting special populations. Therefore, this current knowledge on care for special populations helps nurses to provide accurate information on vaccinations aimed at preventing COVID-19 and protecting the masses from infection. Currently, the scarcity of information on COVID-19 variants necessitates further research on measures to reduce pandemic spread.

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The Effects of Programs on Body-Image Improvement in Adolescents: A Systematic Review and Meta-Analysis: Yun, Hyun Jung , Seo, Kyoungsan , Han, Dallong; J Korean Acad Nurs 2021;51(5):597-616. Published online October 31, 2021; DOI: https://doi.org/10.4040/jkan.21104

Abstract PDF: Purpose
This study’s objective was to investigate the effects of programs that improve adolescents’ body image, using a systematic review and meta-analysis.
Methods
A literature search was performed in eleven electronic databases, using preferred reporting items for systematic reviews and meta-analysis guidelines. Population characteristics, contents of the programs, and measured outcomes were systematically reviewed from 21 selected studies. To estimate the size of the effects, meta-analysis was conducted using Comprehensive Meta-Analysis software.
Results
The contents of the programs that aimed to improve body image included physical, psychological, interpersonal, and sociocultural interventions. Sixteen studies were meta-analyzed to estimate the effect size of body-image improvement programs. Results showed that the program for body-image improvement had significant effects on body satisfaction (effect size [ES] = 0.56, 95% confidence interval [CI] = 0.23 to 0.89), and body dissatisfaction (ES = - 0.15, 95% CI = - 0.23 to - 0.08).
Conclusion
The program for body image improvement in adolescents includes a combination of physical, psychological, interpersonal relationship, and socio-cultural dimensions. The program that seeks to improve body image appears to be effective at increasing body satisfaction, and at reducing body dissatisfaction in adolescents. Thus, it is necessary to develop and apply multidimensional programs for adolescents to have a positive body image.

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Validity and Reliability of Korean Version of the Self-Efficacy for Managing Chronic Disease 6-Item Scale: Kim, Sook-Nam , Lee, Hyun-Ju , Kim, So-Young , Lee, Nayoon; J Korean Acad Nurs 2021;51(5):617-629. Published online October 31, 2021; DOI: https://doi.org/10.4040/jkan.21069

Abstract PDF: Purpose
The aim of this study was to examine the validity and reliability of the Korean version of the self-efficacy for managing chronic disease 6-item scale (SECD-6-K).
Methods
The English version of the Self-Efficacy for Managing Chronic Disease 6-item Scale first underwent forward and backward translation procedures. The SECD-6-K was then used to collect data from 350 adults diagnosed with chronic diseases. Content, construct, convergent, discriminant, and criterion validity were all evaluated. Reliability was assessed using Cronbach’s α. SPSS 25.0 and the data were analyzed using AMOS 26.0 software.
Results
The SECD-6-K consists of six items in two domains: disease management and health behavior. The results for construct, convergent, and discriminant validity were good. Exploratory factor analysis produced eigen values between 2.27 and 3.28, with factors total explained cumulative variance of 91.1%. Confirmatory factor analysis supported goodness of fit and reliability for the modified SECD-6-K model. The criterion validity also showed significant correlation with both the Patient Health Questionnaire and 12-item Short-Form Health Survey version 2. Finally, reliability was found to be excellent.
Conclusion
This study identified the high reliability and validity of SECD-6-K. The SECD-6-K is an appropriate tool for determining Korean patients’ self-efficacy in managing their chronic conditions. Therefore, this scale may be used in clinical settings as well as in educational and research settings.

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The Lived Experience of Body Alteration and Body Image with Regard to Immediate Breast Reconstruction among Women with Breast Cancer: Ahn, Jeonghee , Suh, Eunyoung E.; J Korean Acad Nurs 2021;51(2):245-259. Published online April 30, 2021; DOI: https://doi.org/10.4040/jkan.21028

Abstract PDF: Purpose
The purpose of this study was to explore the lived experience of body alteration and body image with regard to immediate breast reconstruction among women with breast cancer.
Methods
Data were collected from July to December 2020 through individual in-depth interviews with 15 women who had undergone immediate breast reconstruction due to breast cancer. Verbatim transcripts were analyzed using Colaizzi’s phenomenological analysis.
Results
The following four theme clusters emerged. First, “revalued meaning of breasts due to cancer” illustrated the fact that cancer removal surgery brought the participants to reconsider the meaning of their breasts. Second, “had no choice but breast reconstruction” demonstrated the participants’ decision-making process of not wanting to lose breasts. Third, “unsatisfied breasts despite reconstruction” portrayed the distress due to the unexpected surgical outcomes. Finally, “restarted everyday routines with the altered body” described the healing process of the participants by accepting their changed body.
Conclusion
In Korea, where family-centeredness and fidelity are highly valued, women perceived their breasts not only as a symbol of femininity but as the mediator connecting the self to family. Despite the distress related to imperfect breasts, the participants were thankful for their reconstructed breasts. Breast reconstruction helped them return to daily life as the psychological trauma of breast cancer was healed. The participants rebuilt their body image by accepting their scarred new body. This may allow health professionals to provide constructive and culturally appropriate counseling in advance by providing insight into women’s perception of their body image with regard to breast reconstruction.

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Face Mask Usage, Knowledge and Behavior of Face Mask Usage in Older Adults Living Alone in the COVID-19 Era: Han, A-Reum , Park, Yeon-Hwan; J Korean Acad Nurs 2021;51(2):203-216. Published online April 30, 2021; DOI: https://doi.org/10.4040/jkan.20252

Abstract PDF: Purpose
This study analyzed the current status of face mask usage. It also identified factors related to the knowledge and behavior regarding the same among older adults living alone during the COVID-19 pandemic.
Methods
This descriptive study was conducted via a telephone survey involving 283 older adults living alone in S City from March to April 2020. Knowledge and behavior pertaining to face mask usage were measured using Hilda Ho’s Face Mask Use Scale; reliability of the measurement was Kuder-Richardson formula-20 = .62, Cronbach’s α = .92. Data were analyzed using descriptive analysis, independent t-test, Pearson’s correlation coefficient, and multiple linear regression.
Results
Older adults used one mask for 3.55 days on an average. The knowledge level was 9.97 (± 1.84) out of 12 and behavior level was 15.49 (± 1.55) out of 16. Level of education (β = - .31, p < .001), living region (β = .13, p = .017), personal income (β = .12, p = .041) significantly affected the face mask usage-related knowledge, and living region (β = .15, p = .010) significantly affected the face mask usage-related behavior.
Conclusion
Older adults living alone are aware of the effects of using face masks. However, their mask usage is inappropriate, for example, the prolonged use of the same mask. Considering the low level of face mask usage-related knowledge, it is necessary to develop customized education programs and infectious disease prevention strategies for older adults possessing low educational levels living alone in urban-rural complex areas.

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Diabetes Self-Management Experience of Patients with Diabetes: Focused on the Visually Impaired: Chang, Sun Ju , Lee, Kyoung-eun , Yang, Eunjin , Kim, Hee Jung; J Korean Acad Nurs 2021;51(1):92-104. Published online February 28, 2021; DOI: https://doi.org/10.4040/jkan.20231

Abstract PDF: Purpose
This study aimed to understand and describe the diabetes self-management experience of visually impaired people with diabetes.
Methods
Ten participants were recruited through a website used by the visually impaired from February to March 2020. Data were collected through two focus group interviews conducted in June 2020; each group consisted of five participants. All interviews were recorded with the consent of the participants and transcribed verbatim. The transcribed data were analyzed using qualitative content analysis.
Results
Seven categories were as follows; a two-faced, lifelong companion, an unprepared encounter, struggle to live, love-hate relationship with family, strategies to adapt, lessening attention to self-management, the desire to learn properly.
Conclusion
It can be concluded that the visually impaired have fewer opportunities for receiving diabetes self-management education than general diabetic patients. Consequently, plans to improve the education available to such patients are required. Additionally, psychological counseling and diabetes education for patients’ families are necessary, and improving the perception of medical workers regarding the visually impaired will be prove useful.

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Family’s Perception of Proxy Decision Making to Authorize Do Not Resuscitate Order of Elderly Patients in Long Term Care Facility: A Q-Methodological Study: Cho, Hyeon Jin , Kang, Jiyeon; J Korean Acad Nurs 2021;51(1):15-26. Published online February 28, 2021; DOI: https://doi.org/10.4040/jkan.20188

Abstract PDF: Purpose
This study aimed to distinguish and describe the types of perceptions of do not resuscitate (DNR) proxy decisions among families of elderly patients in a long-term care facility.
Methods
This exploratory study applied Q-methodology, which focuses on individual subjectivity. Thirty-four Q-statements were selected from 130 Q-populations formed based on the results of in-depth interviews and literature reviews. The P-samples were 34 families of elderly patients in a long-term care hospital in Busan, Korea. They categorized the Q-statements using a 9-point scale. Using the PC-QUANL program, factor analysis was performed with the P-samples along an axis.
Results
The families’ perceptions of the DNR proxy decision were categorized into three types. Type I, rational acceptance, valued consensus among family members based on comprehensive support from medical staff. Type II, psychological burden, involved hesitance in making a DNR proxy decision because of negative emotions and psychological conflict. Type III, discreet decisions, valued the patients’ right to self-determination and desire for a legitimate proxy decision. Type I included 18 participants, which was the most common type, and types II and III each included eight participants.
Conclusion
Families’ perceptions of DNR proxy decisions vary, requiring tailored care and intervention. We suggest developing and providing interventions that may psychologically support families.

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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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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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2 Web of Science

The Disease Management Experience of Patients with Asthma: Grounded Theory Approach: Kim, Bohye , Kim, Oksoo; J Korean Acad Nurs 2020;50(5):714-727. Published online October 31, 2020; DOI: https://doi.org/10.4040/jkan.20139

Abstract PDF: Purpose
The aim of this study was to develop a situation-specific theory to explain the disease management experience of patients with asthma.
Methods
Twenty participants with asthma were selected using the theoretical sampling method. The data were acquired through in-depth interviews conducted from June to October 2018 and analyzed using the grounded theory approach of Strauss and Corbin.
Results
In total, 69 concepts, 30 subcategories, and 13 categories were generated to explain the disease management experience of patients with asthma. The core category of the disease management experience of patients with asthma was ‘management of the disease to prevent aggravation of symptoms over the lifetime’. The disease management process of asthma patients included three steps: the ‘cognition phase’, the ‘adjustment phase’, and the ‘maintenance phase’. However, some patients remained in the ‘stagnation phase’ of disease management, which represents the result of the continual pursuit of risky health behavior. There were three types of disease management experiences among patients with asthma: ‘self-managing’, ‘partially self-managing’, and ‘avoidant’.
Conclusion
This study shows that patients with asthma must lead their disease management process to prevent exacerbation of their symptoms. It is imperative to develop nursing strategies and establish policies for effective disease management of patients with asthma based on their individual disease management processes and types.

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1 Web of Science

Qualitative Study on the Experience of Patients with Meniere Disease: Joung, Woo Joung; J Korean Acad Nurs 2020;50(5):699-713. Published online October 31, 2020; DOI: https://doi.org/10.4040/jkan.20115

Abstract PDF: Purpose
The purpose of this study was to understand and describe the experiences of patients with Meniere disease.
Methods
Data were collected from February 19, 2019, to February 5, 2020, through individual in-depth interviews with 13 Meniere patients. Verbatim transcripts were analyzed using Colaizzi’s phenomenological analysis.
Results
The experiences of patients with Meniere disease were clustered into the following four themes from 22 meaning units: 1) Complex unfamiliar symptoms that shatter both balance of the body and peace of the heart; 2) A disease that medical treatment and health professionals cannot cure; 3) Suffering hardships that cannot be understood by non-Meniere sufferers; and 4) Making daily efforts to become healthier. Symptoms of Meniere disease are life-shattering and depressing because they are neither visible nor easily curable. Over time, as they accepted the reality of living with the disease, the participants would shift their focus from complete symptomatic cure to leading a healthy and more balanced life.
Conclusion
This study shows that Meniere disease has a pervasive impact on all aspects of the patients’ lives. Patients are prone to experiencing restrictions in their social functioning and activities. They also experience psychosocial problems due to the unseen nature of their symptoms. This study elucidates the experiences of Meniere patients and the need for nursing intervention to help improve their quality of life and ability to self-manage. Lastly, this study shows the need for a coordinated interdisciplinary approach to raising public awareness of the disease.

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Effects of BeHaS Program on Health Behavior, Physiologic Index and Self-Esteem of the Elderly Living Alone with Metabolic Syndrome Based on Community Based Participatory Research: Kim, Jong Im , Kim, Sun Ae , Park, Keumok , Kim, Jiyoung , Lee, Lina , Choi, Si Wan , Ku, Bon Jeong; J Korean Acad Nurs 2020;50(4):571-582. Published online August 31, 2020; DOI: https://doi.org/10.4040/jkan.19261

Abstract PDF: Purpose
This study aimed to determine the effects of a 12-week metabolic syndrome BeHaS (Be Happy and Strong) program in elderly people with metabolic syndrome living alone, based on a community-based participatory research (CBPR).
Methods
A nonequivalent control group pre-posttest design was used, and the participants were 43 elderly people living alone (experimental group 24, control group 19). The experimental group received a one-hour program per week and two individual health consultations during 12 weeks. The control group received two sessions about the metabolic syndrome and two individual health consultations. The effects of health behavior, blood pressure, blood sugar levels, abdominal circumference, triglycerides, and self-esteem were evaluated. The data were analyzed using the independent t-test and Mann-Whitney U test.
Results
The health behavior with respect to the metabolic syndrome in the experimental group increased significantly (t = - 3.19, p = .002). Both diastolic blood pressure and abdominal circumference decreased in the experimental group (t = 2.00, p = .028 and t = 3.91, p < .001). No significant differences were observed between the groups in systolic blood pressure, fasting blood sugar levels, triglycerides, and self-esteem.
Conclusion
The 12-week metabolic syndrome BeHaS program using community resources improves the health of elderly people with metabolic syndrome living alone. Based on these findings, further studies on the effectiveness of the metabolic syndrome BeHaS program and the experiences of those who participated in the CBPR are warranted.

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2 Web of Science

Development and Validation of the Self-Care for Aspiration Pneumonia Prevention Scale in the Community Dwelling Elderly with Risk of Dysphasia: Yang, Eun Young , Lee, Shin-Young; J Korean Acad Nurs 2020;50(3):474-486. Published online June 30, 2020; DOI: https://doi.org/10.4040/jkan.20041

Abstract PDF: Purpose
The purpose of this study was to develop and validate a Korean version of the Self-Care for Aspiration Pneumonia Prevention(SCAPP-K) scale in older adults at risk of dysphasia.
Methods
The Hertz and Baas model of scale development and validation was used. Inthe development stage, items were generated via literature review and interviews with medical experts, older adults, and caregivers. Tenexperts assessed the items for content validity. Subsequently, 12 older adults participated in a pilot test to determine the comprehensibilityand appropriateness of the SCAPP-K scale. The validation stage involved a cross-sectional survey with 203 older adults for exploratoryfactor analysis (EFA) and 200 older adults for confirmatory factor analysis (CFA) and to determine convergent and discriminant validity. Totest the validity and reliability of the scale, EFA using principal component analysis with varimax rotation and CFA were conducted, andconvergent and discriminant validity as well as internal consistency reliability were determined.
Results
As a result of EFA, three self-carefactors (knowledge, resources, behaviors) with 21 items were validated. The CFA and convergent and discriminant validity indicated theapplicability of the three-factor self-care scale. The reliability of the SCAPP-K scale was acceptable, with Cronbach’s a=.87~.91.
Conclusion
The SCAPP-K scale has acceptable validity and reliability and can contribute to clinical practice, research, and education to improveself-care for the prevention of aspiration pneumonia in older adults at risk of dysphasia.

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3 Web of Science

Factors Influencing Health Behavior Related to Particulate Matter in Older Adults: Park, Min Kyung , Kim, Gwang Suk; J Korean Acad Nurs 2020;50(3):431-443. Published online June 30, 2020; DOI: https://doi.org/10.4040/jkan.19201

Abstract PDF: Purpose
This study aimed to investigate health behavior related to particulate matter (PM) in older adults and examine the factors affectingit.
Methods
A cross-sectional survey design was used. Data were collected from 150 voluntary older adult participants from Songpa-gu inSeoul. The survey questions measured service perception and experience related to PM, risk perception related to PM, attitude toward riskof PM, and health behavior related to PM.
Results
The average score for health behavior related to PM was 79.37, ranging from 51 to 115.There was a significant positive correlation between health behavior related to PM and risk perception related to PM (r=.58, p <.001) as wellas between health behavior related to PM and attitude toward risk of PM (r=.70, p<.001). Multiple linear regression revealed that healthbehavior related to PM was predicted by levels of the existence of disease related to PM (β=.14, p=.019), service experience related to PM(b=.20, p=.021), risk perception related to PM (b=.20, p=.019), and attitude toward risk of PM (b=.44, p<.001). The model including thesevariables accounted for 47.0% of health behavior related to PM.
Conclusion
Korean older adults have the low level of health behaviorrelated to PM. The findings of this study emphasize that risk perception and attitude toward risk of PM should be evaluated, and theunderlying diseases related to PM and their service experience should be considered in developing intervention to improve health behaviorrelated to PM.

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5 Web of Science

Development and Effect of a Fall Prevention Program Based on the King's Goal Attainment Theory for Fall High-Risk Elderly Patients in Long-Term Care Hospital: Bom Mi Park, Ho Sihn Ryu, Kyeung Eun Kwon, Chun Young Lee; J Korean Acad Nurs 2019;49(2):203-214. Published online April 30, 2019; DOI: https://doi.org/10.4040/jkan.2019.49.2.203

Abstract PDF: Purpose
The purpose of this study to develop a fringed fall prevention program based on King's goal attainment theory and education. This study is applied to the personal, interpersonal, and social systems of fall high-risk patients to test its effects.
Methods
This study was a nonequivalent control group pre- and post-test design. There were 52 fall high-risk patients in the experimental group and 45 in the control group. The experimental group received six sessions, with the group sessions lasting 60 minutes and the individual sessions lasting 20~30 minutes. Data were analyzed using descriptive statistics, an χ²-test, a paired sample t-test, and a Wilcoxon signed-ranks test utilizing IBM SPSS software.
Results
For the 3-month intervention period, the fall prevention program was found to be particularly effective for patients in the experimental group (from 3.38 to 1.69 per 1000 patient days; p=.044), as opposed to the control group (from 1.94 to 1.49 per 1000 patient days; p=.300). For the 6-month follow up period, the fall prevention program was again found to be effective for patients in the experimental group (from 3.26 to 0.76 per 1000 patient days; p=.049) compared to the control group (from 1.98 to 1.01 per 1000 patient days; p=.368).
Conclusion
These results indicate that the fringed fall prevention program is very effective in reducing falls, not only during the intervention period, but also after the intervention period has ended. We can therefore recommend this program for use concerning fall high-risk patients in long-term care hospitals.

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Effects of a Web-Based Korean Triage and Acuity Scale Learning Program on Triage Self-Efficacy and Triage Performance Ability for Nurses in Emergency Department: Hyo-Jin Kim, Hee-Young Kang; J Korean Acad Nurs 2019;49(2):171-180. Published online April 30, 2019; DOI: https://doi.org/10.4040/jkan.2019.49.2.171

Abstract PDF: Purpose
The Korean Triage and Acuity Scale (KTAS) is a tool used to classify the severity and urgency of emergency department (ED) patients, focusing on their symptoms. In consideration of the importance of the KTAS, a web-based learning program has emerged as a new mode of education; it enables ED triage nurses to access it anytime and anywhere, and according to their own learning abilities. This study aimed to develop a web-based KTAS learning program and evaluate its effects on self-efficacy and triage performance ability in ED nurses.
Methods
A quasi-experimental design with a non-equivalent control group pretest-posttest was used. The conceptual framework was Bandura's self-efficacy theory. There were 30 participants in the experimental group and 29 in the control group. The experimental group attended an orientation and 4 sessions of a web-based KTAS learning program. The learning program lasted 280 minutes over five weeks, consisting of 40 minutes of orientation and four 60-minute sessions.
Results
The scores of self-efficacy, triage performance ability in KTAS level, and chief complaints significantly increased in the experimental group compared to the control group. In addition, the numbers of under-triage in KTAS significantly decreased in the experimental group in comparison to the control group.
Conclusion
The results suggest that the learning program was effective in improving ED nurses' level of self-efficacy and triage performance ability (KTAS level and KTAS chief complaint). Accordingly, the web-based KTAS learning program can be applied as an education intervention to improve ED nurses' triage skill.

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8 Web of Science

Evaluation of Validity of the Korean Triage and Acuity Scale: Heejung Choi, Jong Sun Ok, Soo Young An; J Korean Acad Nurs 2019;49(1):26-35. Published online February 28, 2019; DOI: https://doi.org/10.4040/jkan.2019.49.1.26

Abstract PDF: Purpose
The aim of this study was to identify the predictive validity of the Korean Triage and Acuity Scale (KTAS).
Methods
This methodological study used data from National Emergency Department Information System for 2016. The KTAS disposition and emergency treatment results for emergency patients aged 15 years and older were analyzed to evaluate its predictive validity through its sensitivity, specificity, positive predictive value, and negative predictive value.
Results
In case of death in the emergency department, or where the intensive care unit admission was considered an emergency, the sensitivity, specificity, positive predictive value, and negative predictive value of the KTAS were 0.916, 0.581, 0.097, and 0.993, respectively. In case of death in the emergency department, or where the intensive or non-intensive care unit admission was considered an emergency, the sensitivity, specificity, and positive predictive value, and negative predictive value were 0.700, 0.642, 0.391, and 0.867, respectively.
Conclusion
The results of this study showed that the KTAS had high sensitivity but low specificity. It is necessary to constantly review and revise the KTAS level classification because it still results in a few errors of under and over-triage. Nevertheless, this study is meaningful in that it was an evaluation of the KTAS for the total cases of adult patients who sought help at regional and local emergency medical centers in 2016.

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13 Web of Science

Latent Class Analysis for Health-Related Quality of Life in the Middle-Aged Male in South Korea: Youngsuk Cho, Dong Moon Yeum; J Korean Acad Nurs 2019;49(1):104-112. Published online February 28, 2019; DOI: https://doi.org/10.4040/jkan.2019.49.1.104

Abstract PDF: Purpose
This study aimed to identify types of quality of life (QoL) based on the 5 dimensions of EQ-5D and predict factors affecting types of QoL.
Methods
This study was a secondary analysis using data from the Korean Health Panel Survey- II(2012). Participants were 2,071 middle-aged men who had completed the additional survey in 2012 and the data were analyzed using SPSS 20.0 and Mplus 5.21 for latent analysis.
Results
Three latent classes of QoL were identified: serious (2.4% of the sample), threatened (15.5%), and stable types (82.0%). The types and characteristics of QoL among the latent classes differed. On comparing latent type 1 with latent type 2, the socioeconomic status (p<.05), employment status (p<.05), and subjective health status (p<.001) were found to be significant. On comparing latent type 1 with latent type 3, the socioeconomic status (p<.05), current smoking status (p<.001), and subjective health status (p<.001) were found to be significant. On comparing latent type 2 with latent type 3, the socioeconomic status (p<.05), subjective health status (p<.001), stress (p<.001) were found to be significant.
Conclusion
The results showed significant heterogeneity in types of QoL and the predictors of QoL by types were different. These findings provide basic information for developing nursing interventions to improve QoL. Specific characteristics depending on the subtypes should be considered during the development of interventions.

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4 Web of Science

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