The purpose of this study was to determine the incidence of malnutrition among patients on admission to hospital, to monitor changes in their nutritional status during hospitalization, and to determine the factors which might affect changes in nutritional status. The subjects for the study were patients who were admitted to general medicine for more than one week. Patients suffering from cardiovascular, renal disease, or dehydration were excluded. Nutritional assessment of the patients was performed on admission and nutritional status was reassessed one week and two weeks after admission. The nutritional assessment tool consisted of subjective history taking and anthropometric measurements. Biochemical measurements were performed only on admission. For anthropometric assessment ; patients' body weight, subcutaneous skinfolds thickness, % of body fat, body mass index, and lean body mass were measured using caliper or Bio impedance Analyzer. Factors which might influence current nutritional status, like dietary intake, anorexia, nausea, vomiting, diarrhea, sleep disturbance, and number of day of NPO for diagnostic examinations were analyzed. The results are as follows : 1. Of the 59 patients who were studied, 61% were male and 39% female. The nutritional status of all of the 59 subjects was reassessed one week after admission, but it was only done for 22 subjects at two weeks. 2. The anthropometric measurements, including weight, body mass index, lean body mass, body fat, and skin fold thickness, were all significantly decreased at one week after admission compared to the values at admission. On the other hand, two weeks after admission, only body weight and abdominal skinfolds thickness were decreased. 3. The subjects reported anorexia for an average of two days, sleep disturbance for two days, and no food intake due to diagnostic test for one day. In the second week of hospitalization almost none of the patients complained of gastrointestinal symptoms or sleep disturbance except anorexia Food consumption which was measured based on rice intake was 60% of the food served during the first week of hospitalization, and 66% during the second week of hospitalization. 4. There was no correlation between the subjective nutritional assessment and anthropometric assessment. 5. There was no statistical significance in anthropometric measurements among the patients with various diseases whereas sleep disturbance and no food intake due to various diagnostic test was prominent in patients with gastrointestinal diseases.
The incidence of reported acute pain is still high which indicates a lack of knowledge in clinical pain assessment and management. This study was carried out to investigate strategies of post-operative pain assessment in terms of patterns of criteria adopted and how these are influenced by prior experience. The research approach, phenomenography, was adopted in data analysis. The subjects of this study consisted of 10 nurses from post-operative care units from a University Hospital in Seoul, Korea. Findings revealed that the nurses mostly relied on "how it usually is" and "how the patient looks" as strategies of post operative pain assessment and "I have learned the typology of patients" as a frame of reference of post operative assessment.
Parents are primary care taker for the children and have an important role for the assessment and managent of children's pain following surgery. The purpose of the present study was to examine the validity and clinical utilization of the Postoperative Pain Measure for Parents (PPMP) developed by Chambers et al. Subjects were 52 children aged 4-12 years admitted for tonsillectomy and other minor surgery and their mothers. Faces Pain Scale, State Anxiety, and Postoperative Pain Measure for Parents were used. The data were collected by two research assistant on the operation day and 1st day after surgery at hospital during the period of July 20 to August 28, 1998. The results are as follows: 1. Eta correlation coefficient between 15 items of PPMP and child rated pain were calculated. Correlation coefficients were more than .2 for both day. 2. Internal consistency for PPMP were .82 and .83. 3. The scores of the PPMP were 10.73 (SD=3.71) and 9.27(SD=4.07) on the operation day and 1st day after surgery and there was no significant difference between two days(p=.056) On the other hand, there was a significant difference on the child rated pain by Faces Pain Scale between operation day and 1st day after surgery(p=.001). 4. The correlation(Spearman Rho) between PPMP and child rated pain were .40(p=.003) and .56(p=.000). The score of the PPMP and the children's state anxiety were highly correlated on the operation day and 1st day after surgery (.60, .52, p=.000). 5. Partial correlation between PPMP and child rated pain except state anxiety were .18(p=.23) and .48(p=.001) on the opration day and 1st day after surgery. 6. Using a cut-off score 10 out of 15, the measure showed excellent sensitivity (>80%) and moderate specificity (46.15%, 60% ). This study provides preliminary evidence for the use of the PPMP as a valid pain assessment tool with children between the ages of 4-12 years following surgery. It is suggested to explore the validity with a different subjects with other surgery and to examine the validity for infant and younger children.
The author investigated pain experiences of 90 cancer patients and adequacy of pain treatment they have received during their stay at a large medical center in T city between October 1994 and August 1995. Pain was assessed by the Shortened BPQ and results are summarized as follows: As for ratings of "worst pain" during the 24 hour period, 70% of the patients reported they had "severe" pain. As for ratings on "pain now" 43% of the cancer patients reported "moderate to severe" pain. Over 46% of the patients reported a pain relief score of 0(not at all) or 1(somewhat) even after receiving pain medication. Adequacy of analgesic treatment was evaluated by comparing the patient's reported level of pain and the analgesic use, namely, the pain management index(PMI). The PMI indicated that 58% of the patients were undertreated for the pain control. In review of nurse's notes, systematic pain assessment was scarcely recorded, although pain documentation appeared in 70% of the notes; and the contents were mostly simple description. In conclusion, the results of patient's pain ratings, the PMI and poor pain documentation in the nurse's notes implied poor pain assessment and management.
This study was to test the effectiveness of Web-based multimedia contents for Physical Examination and Health Assessment on learning achievement.
Multimedia contents based on Jung's teaching and learning structure model were used to enhance learning achievement. Learning achievement was measured by the knowledge of Physical Examination and Health Assessment. The participants of this study were students in a BSN and RN-BSN program in a university located in Seoul. 59 students in the experimental group received lectures using web-based multimedia contents and 75 students in the control group received regular lectures.
The mean score of the degree of educational achievement in the experimental group(mean=31.09) was significantly higher than in the control group(mean=25.55)(t=-3.883, p=.000).
These web-based multimedia contents were found to maximizethe effectiveness of the teaching process when used as a teaching aid, and yet kept the strength of a face to face teaching learning method. This program is recommended as part of a main text, vital teaching aid or cyber lecture materials in nursing schools and in health care educational institutions.
This study was to develop Web-based multimedia content for Physical Examination and Health Assesment.
The multimedia content was developed based on Jung's teaching and learning structure plan model, using the following 5 processes : 1) Analysis Stage, 2) Planning Stage, 3) Storyboard Framing and Production Stage, 4) Program Operation Stage, and 5) Final Evaluation Stage.
The web based multimedia content consisted of an intro movie, main page and sub pages. On the main page, there were 6 menu bars that consisted of Announcement center, Information of professors, Lecture guide, Cyber lecture, Q&A, and Data centers, and a site map which introduced 15 week lectures. In the operation of web based multimedia content, HTML, JavaScript, Flash, and multimedia technology(Audio and Video) were utilized and the content consisted of text content, interactive content, animation, and audio & video. Consultation with the experts in context, computer engineering, and educational technology was utilized in the development of these processes.
Web-based multimedia content is expected to offer individualized and tailored learning opportunities to maximize and facilitate the effectiveness of the teaching and learning process. Therefore, multimedia content should be utilized concurrently with the lecture in the Physical Examination and Health Assesment classes as a vital teaching aid to make up for the weakness of the face-to-face teaching-learning method.
This study defines a vulnerable group in a community that has become the main target of a national health project also, it is descriptive research to suggest an evidence-based direction to meet their deficit health-related needs.
This research examined 833 families and 1,835 family members of the financially vulnerable class that was registered in a home visiting program of a public health center. Among them, 892 persons who had health problems, and their family members were examined in detail to find out their characteristics of vulnerability and health needs by assessment during a nurses home visit. Frequency distribution, stepwise-regression and factor analysis were used to analyze the data.
The vulnerable group that was defined with social indexes set as standards, involved substantial characteristics of vulnerability. The characteristics of demand showed tendencies of being clustered in 5 factors needs of intensive nursing care, chronic nursing care problems and helplessness, maintenance of family functioning with a disability, deficient problem solving ability, and simple financial fragility.
Categorization of needs is an evidence-based estimator of workload in nurse home visiting services, and can be used as a basic resource for direction to meet the deficit needs of a vulnerable group.
This study was to compare the predictive validity of Norton Scale(1962), Cubbin & Jackson Scale(1991), and Song & Choi Scale(1991).
Data were collected three times per week from 48-72hours after admission based on the four pressure sore risk assessment scales and a skin assessment tool for pressure sore on 112 intensive care unit(ICU) patients in a educational hospital Ulsan during Dec, 11, 2000 to Feb, 10, 2001. Four indices of validity and area under the curve(AUC) of receiver operating characteristic(ROC) were calculated.
Based on the cut off point presented by the developer, sensitivity, specificity, positive predictive value, negative predictive value were as follows : Norton Scale : 97%, 18%, 35%, 93% respectively; Cubbin & Jackson Scale : 89%, 61%, 51%, 92%, respectively; and Song & Choi Scale : 100%, 18%, 36%, 100% respectively. Area under the curves(AUC) of receiver operating characteristic(ROC) were Norton Scale .737, Cubbin & Jackson Scale .826, Song & Choi Scale .683.
The Cubbin & Jackson Scale was found to be the most valid pressure sore risk assessment tool. Further studies on patients with chronic conditions may be helpful to validate this finding.
The purpose of this study is to provide a comprehensive overview of the various measures available for assessment of oxaliplatin-induced peripheral neuropathy (OXLIPN) and to evaluate the measurement properties of each assessment tool.
A systematic review was conducted to identify existing measures for OXLIPN found in the databases of PubMed, Cochrane Library, Embase, RISS and KoreaMed. The quality of the 24 identified tools was evaluated based on their properties of measurement including content validity, internal consistency, criterion validity, construct validity, reproducibility, responsiveness, floor-ceiling effects and interpretability.
Ten (41.7%) of the 24 tools were identified as specific measures for assessing OXLIPN and the most popular type of measures were clinical grading systems by clinicians (58.3%) and only 29.2% of measures were identified as patient reported outcomes. The most frequently used tool was National Cancer Institute-Common Toxicity Criteria (NCI-CTC), but the validity of NCI-CTC has not been reported appropriately. Overall, the Neuropathic Pain Symptom Inventory (NPSI) received the best psychometric scores, and the Chemotherapy-induced Peripheral Neuropathy Assessment Tool (CIPNAT) and Functional Assessment of Cancer Therapy/Gynaecologic Oncology Group-neurotoxicity-12 (FACT/GOG-Ntx-12) followed NPSI.
To select appropriate measure, evidences should be accumulated through the clinical use of tools. Therefore, practitioner and researchers are urged to report relevant statistics required for the validation of the currently used measures for assessment of OXLIPN.
This study was done to investigate the level of transcultural self-efficacy (TSE) and related factors and educational needs for cultural competence in nursing (CCN) of Korean hospital nurses.
A self-assessment instrument was used to measure TSE and educational needs for CCN. Questionnaires were completed by 285 nurses working in four Korean hospitals. Descriptive statistics, t-test, ANOVA, Pearson correlation coefficients, and multiple regression were used to analyze the data.
Mean TSE score for all items was 4.54 and score for mean CCN educational needs, 5.77. Nurses with master's degrees or higher had significantly higher levels of TSE than nurses with bachelor's degrees. TSE positively correlated with English language proficiency, degrees of interest in multi-culture, degree of experience in caring for multi-cultural clients, and educational needs for CCN. The regression model explained 28% of TSE. Factors affecting TSE were degree of interest in multi-culture, degree of experience in caring for multi-cultural clients, and educational needs for CCN.
The results of the study indicate a need for nurse educators to support nurses to strengthen TSE and provide educational program for TSE to provide nurses with strategies for raising interests in cultural diversity and successful experiences of cultural congruent care.
The purpose of this study was to examine the effects of an individualized nutritional education programs on nutrient intake and nutritional status of patients with colorectal cancer who are undergoing palliative chemotherapy.
Forty patients with colorectal cancer (19 experimental and 21 control patients) were recruited from a chemotherapy ward at S University Hospital in Seoul, Korea. The experimental group received two individualized nutritional counseling sessions and two telephone counseling sessions over 6 weeks. The control group received nutritional counseling after completion of data collection. Nutritional education included general guidelines for food intake while receiving chemotherapy, dietary guidelines for patients with colorectal cancer, daily meal schedules to overcome cancer, and dietary guideline for each chemotherapy side effect. Data were analyzed using χ2-test and t-test with the SPSS program 17.0.
Two group comparison revealed that the experimental group had significantly improved calorie (
Study results indicate that this individualized nutritional education programs are effective in enhancing nutrient intake and nutritional status of patients with colorectal cancer who are undergoing palliative chemotherapy.
This study was done to identify the time interval to pressure ulcer and to determine the optimal time interval for position change depending on pressure ulcer risk in patients using foam mattress in intensive care units.
The Braden scale score, occurrence of pressure ulcers and position change intervals were assessed with 56 patients admitted to an intensive care unit from April to November, 2011. The time to pressure ulcer occurrence by Braden scale risk group was analyzed with Kaplan-Meier survival analysis and log rank test. Then, the optimal time interval for position change was calculated with ROC curve.
The median time to pressure ulcer occurrence was 5 hours at mild or moderate risk, 3.5 hours at high risk and 3 hours at very high risk on the Braden scale. The optimal time interval for position change was 3 hours at mild and moderate risk, 2 hours at high and very high risk of Braden scale.
When foam mattresses are used a slight extension of the time interval for position change can be considered for the patients with mild or moderate pressure ulcer risk but not for patients with high or very high pressure ulcer risk by Braden scale.
This study was done to develop tool to evaluate the core competencies regarding nursing cancer patients on chemotherapy, and to verify the reliability and efficacy of the developed tool.
A tool to evaluate the core competencies was developed from a preliminary tool consisting of 112 items verified by expert groups. The adequacy of the preliminary tool was analyzed and refined to the final evaluation tool containing 76 items in 8 core competencies and 18 specific competencies. The evaluation tool is in the form of a self-report, and each item is evaluated according to a 3-point scale. From September 22 to October 14, 2011, 349 survey responses were analyzed using SPSS 20.0 and the WINSTEPS program that employs the Rasch model.
Results indicated that there were no inappropriate items and the items had low levels of difficulty in comparison with the knowledge levels of the study participants. The results of factor analysis yielded 18 factors, and the reliability of the tools was very high with Cronbach's α=.97.
The results of this study can be used for training and evaluation of core competencies for nursing cancer patients, and for standardizing nursing practices associated with chemotherapy.
The purpose of this study was to validate the Needs Assessment Tool for Case Management (NATCM) for use with Korean medical aid beneficiaries.
Psychometric testing was performed with a sample of 645 Korean medical aid beneficiaries, which included 41 beneficiaries who were selected using proportional sampling method, to examine intraclass correlation coefficients (ICC). Data were evaluated using item analyses, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), Cronbach's alpha, and ICC.
Through psychometric testing the final version of NATCM was found to consist of two subscales: 1) Appropriateness of Health Care Utilization (5 items) and 2) Self Care Ability (6 items). The two subscale model was validated by CFA (RMSEA=.08, GFI=.97, and CFI=.93). Internal consistency measured by Cronbach's alpha was .82, and subscale reliability ranged from .79 to .84. The ICC of the NATCM between case managers was .73 and between case managers and health care professionals. .82.
This study suggests that the final version of NATCM is a brief, reliable, and valid instrument to measure needs of Korean medical aid beneficiaries. Therefore, the NATCM can be effectively utilized as an important needs assessment as well as outcome evaluation tool for case management programs in Korea.
The study was designed to determine the discriminating ability of a Bayesian network (BN) for predicting risk for pressure ulcers.
Analysis was done using a retrospective cohort, nursing records representing 21,114 hospital days, 3,348 patients at risk for ulcers, admitted to the intensive care unit of a tertiary teaching hospital between January 2004 and January 2007. A BN model and two logistic regression (LR) versions, model-I and -II, were compared, varying the nature, number and quality of input variables. Classification competence and case coverage of the models were tested and compared using a threefold cross validation method.
Average incidence of ulcers was 6.12%. Of the two LR models, model-I demonstrated better indexes of statistical model fits. The BN model had a sensitivity of 81.95%, specificity of 75.63%, positive and negative predictive values of 35.62% and 96.22% respectively. The area under the receiver operating characteristic (AUROC) was 85.01% implying moderate to good overall performance, which was similar to LR model-I. However, regarding case coverage, the BN model was 100% compared to 15.88% of LR.
Discriminating ability of the BN model was found to be acceptable and case coverage proved to be excellent for clinical use.
The purpose of this study was to develop and validate a hospice·palliative care performance measure which would cover more than just physical symptoms or quality of life.
Through an intensive literature review, the author chose questions that measured aspects of physical, emotional, spiritual, social, or practical domains pertinent to hospice·palliative care for inclusion in the scale. Content validation of the questions was established by 15 hospice·palliative care professionals. A preliminary Hospice Palliative Care Performance Scale (HPCPS) of 20 questions was administered to 134 pairs of terminal cancer patients from 5 hospice palliative care units and their main family caregiver. A validation study was conducted to evaluate construct validity and internal consistency.
Factor analysis showed 14 significant questions in five subscales; Physical, Emotional, Spiritual, Social, and Patient' rights. There were no significant differences between the ratings by patients and family members except for three out of the 14 questions. The measure demonstrated construct validity, and Cronbach's α of the subscales ranged from .73 to .79.
The HPCOS demonstrated acceptable validity and reliability. It can be used to assess effectiveness of hospice·palliative care for terminal cancer patients in practice and research.
This was a cross sectional descriptive study to introduce the Infants Coma Scale (ICS), describe mental status of high risk infants using ICS and explore the relationships between ICS and clinical variables in infants hospitalized in a neonatal intensive care unit of a university hospital in Korea.
After ICS was developed and tested by the authors, a research nurse evaluated the mental status of the infants using the English version of ICS and obtained clinical information on the infants from their medical records.
Data from 88 infants were analyzed. About 60% were male, 90% were preterm births, and 40% had pathologic abnormalities. Their mean gestational age was 32.4 (±3.50) weeks and the mean birth weight was 1,842 (±728.6) grams. The Cronbach's alpha for the ICS was .78. There was a statistically significant positive correlation between ICS total score and five clinical variables including gestational age, birth weight, 1 and 5 min Apgar scores and respiration status.
Mental status is an important parameter in nursing assessment. ICS is a valid and reliable instrument, which clinicians can easily use to evaluate the mental status of high risk infants.
This study aimed to investigate the educational needs of research ethics among nursing researchers.
Convenience sample of 161 nursing professors and 262 master or doctoral nursing students participated in the study. Data was collected with self-reported questionnaire from June to August 2009, and analyzed with descriptive statistics using SPSS WIN (version 14.0).
Among 161 nursing professors, about 31.7% has educated nursing ethics in the postgraduate course. The most common course was nursing research or methodology (62.7%), and median education time was 2 hr. Areas that showed difficulty in understanding was the conflict of interest and plagiarism for professors and falsification and fabrication for graduate students. Average knowledge on the research ethics was 75.4 points for professors and 61.6 points for students based on the 100 points.
Educational needs of research ethics among nursing professors and students in the postgraduate course was high. We recommend both basic and advanced research ethics educational programs for the nursing researchers. The basic course should be at least 6 hr and include various cases and something to discuss.
The purpose of this study was to determine the significant factors for risk estimate of aspiration and to evaluate the efficiency of the dysphagia assessment tool.
A consecutive series of 210 stroke patients with aspiration symptoms such as cough and dysphagia who had soft or regular diet without tube feeding were examined. The dysphagia assessment tool for aspiration was compared with videofluoroscopy using Classification and Regression Tree (CART) analysis.
In CART analysis, of 34 factors, the significant factors for estimating risk of aspiration were cough during swallowing, oral stasis, facial symmetry, salivary drooling, and cough after swallowing. The risk estimate error of the revised dysphagia assessment tool was 25.2%, equal to that of videofluoroscopy.
The results indicate that the dysphagia assessment tool developed and examined in this study was potentially useful in the clinical field and the primary risk estimating factor was cough during swallowing. Oral stasis, facial symmetry, salivary drooling, cough after swallowing were other significant factors, and based on these results, the dysphagia assessment tool for aspiration was revised and complemented.
To evaluate the effects of case management using Resident Assessment Instrument-Home Care (RAI-HC) in home health service for older people.
All elders were assessed at baseline and 3 months later using RAI-HC. The change of function in the intervention group was compared with that of a conventional intervention group. Function was measured with Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), Cognitive Performance Scale (CPS), Depression Rating Scale (DRS), Pain and the number of Clinical Assessment Protocols (CAP).
Among ninety two elders participated in the program, 59 were allocated to the case management group and 33 to the conventional group. The intervention, home health service by a nurse over a 3 month period, consisted of comprehensive assessment, case conference for care plan, direct care, education and referral, and outcome evaluation. The percent of elders whose function improved in the intervention group was greater than the conventional group for depression (odds ratio [OR]: 10.941, confidence interval [CI]: 2.338-51.206), IADL (OR: 4.423, CI: 1.151-16.999) and the number of CAP (OR: 11.443, CI: 3.805-34.410).
Case management was effective for older people in the community. The effect might have resulted from individual, systematic intervention, however, standards of service including eligibility criteria for case management and collaboration of multi-disciplines is required for more effective home health service programs.