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Research Papers
Sleep Deprivation and Fatigue among Nurses Working Consecutive Night Shifts: A Prospective Observational Study
Min, Ari , Seo, Jisu , Kang, Minkyung , Hong, Hye Chong
J Korean Acad Nurs 2024;54(2):139-150.   Published online May 31, 2024
DOI: https://doi.org/10.4040/jkan.23164
AbstractAbstract PDF
Purpose
This study aimed to identify changes in sleep patterns and fatigue levels during consecutive night shifts among shift nurses and to determine the association between sleep parameters and increased fatigue levels during work.
Methods
This prospective observational study employing ecological momentary assessments was conducted using data collected from 98 shift nurses working in Korean hospitals between June 2019 and February 2021. The sleep patterns were recorded using actigraphy. The participants reported their fatigue levels at the beginning and end of each night shift in real time via a mobile link. Linear mixed models were used for the analysis.
Results
Nurses spent significantly less time in bed and had shorter sleep durations during consecutive night shifts than on off-duty days, whereas their wake times after sleep onset were much longer on off-duty days than on on-duty days. Fatigue levels were higher on the second and third night-shift days than on the first night-shift days. A shorter time spent in bed and asleep was associated with a greater increase in fatigue levels at the end of the shift than at the beginning.
Conclusion
Nurses experience significant sleep deprivation during consecutive night shifts compared with off-duty days, and this sleep shortage is associated with a considerable increase in fatigue levels at the end of shifts. Nurse managers and administrators must ensure sufficient intershift recovery time during consecutive night shifts to increase the time spent in bed and sleeping.
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Psychometric Properties of the Fall Risk Perception Questionnaire-Short Version for Inpatients in Acute Care Hospitals
Choi, Jeeeun , Lee, Sujin , Park, Eunjin , Ku, Sangha , Kim, Sunhwa , Yu, Wonhye , Jeong, Eunmi , Park, Sukhee , Park, Yusun , Kim, Hye Young , Kim, Sung Reul
J Korean Acad Nurs 2024;54(2):151-161.   Published online May 31, 2024
DOI: https://doi.org/10.4040/jkan.23127
AbstractAbstract PDF
Purpose
Patients’ perception of fall risk is a promising new indicator for fall prevention. Therefore, a fall risk perception questionnaire that can be used rapidly and repeatedly in acute care settings is required. This study aimed to develop a short version of the fall risk perception questionnaire (Short-FRPQ) for inpatients.
Methods
For the psychometric measurements, 246 inpatients were recruited from an acute care hospital. The construct (using confirmatory factor analysis and discriminant validity of each item), convergent, and known-group validities were tested to determine the validity of the Short-FRPQ. McDonald’s omega coefficient was used to examine the internal consistency of reliability.
Results
In the confirmatory factor analysis, the fit indices of the Short-FRPQ, comprising 14 items and three factors, appeared to be satisfactory. The Short-FRPQ had a significantly positive correlation with the original scale, the Korean Falls Efficacy Scale-International, and the Morse Fall Scale. The risk of falls group, assessed using the Morse Fall Scale, had a higher score on the Short-FRPQ. McDonald’s omega coefficient was .90.
Conclusion
The Short-FRPQ presents good reliability and validity. As patient participation is essential in fall interventions, evaluating the fall risk perception of inpatients quickly and repeatedly using scales of acceptable validity and reliability is necessary.
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Development and Validation of the Nurse Needs Satisfaction Scale Based on Maslow’s Hierarchy of Needs Theory
Kim, Hwa Jin , Shin, Sun Hwa
J Korean Acad Nurs 2020;50(6):848-862.   Published online December 31, 2020
DOI: https://doi.org/10.4040/jkan.20195
AbstractAbstract PDF
Purpose
The purpose of this study was to develop an instrument to evaluate the needs satisfaction of nurses and examine its validity and reliability.
Methods
The initial items for the instrument were developed through a literature review and interviews, using the conceptual framework of Maslow’s hierarchy of needs theory. The initial items were evaluated for content validity by 14 experts. Four hundred and eighty-six clinical nurses participated in this study through offline and online surveys to test the reliability and validity of the instrument. The first evaluation (n = 256) was used for item analysis and exploratory factor analysis, and the second evaluation (n = 230) was used to conduct a confirmatory factor analysis and to assess the criterion-related validity and internal consistency of the instrument. Test-retest reliability was analyzed using data from 30 nurses.
Results
The final instrument consisted of 30 items with two sub-factors for five needs that were identified through the confirmatory factor analysis. The criterion-related validity was established using the five need satisfaction measures (r = .56). Cronbach’s a for total items was .90, and test-retest reliability was .89.
Conclusion
The findings from this study indicate that this instrument has sufficient validity and reliability. This instrument can be used for the development of nursing interventions to improve the needs satisfaction of clinical nurses.
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Original Article
Analysis of Subgroups with Lower Level of Patient Safety Perceptions Using Decision-Tree Analysis
Shin, Sun Hwa
J Korean Acad Nurs 2020;50(5):686-698.   Published online October 31, 2020
DOI: https://doi.org/10.4040/jkan.20044
AbstractAbstract PDF
Purpose
This study was aimed to investigate experiences, perceptions, and educational needs related to patient safety and the factors affecting these perceptions.
Methods
Study design was a descriptive survey conducted in November 2019. A sample of 1,187 Koreans aged 20-80 years participated in the online survey. Based on previous research, the questionnaire used patient safety-related and educational requirement items, and the Patient Safety Perception Scale. Descriptive statistics and a decision tree analysis were performed using SPSS 25.0.
Results
The average patient safety perception was 71.71 (± 9.21). Approximately 95.9% of the participants reported a need for patient safety education, and 88.0% answered that they would participate in such education. The most influential factors in the group with low patient safety perceptions were the recognition of patient safety activities, age, preference of accredited hospitals, experience of patient safety problems, and willingness to participate in patient safety education.
Conclusion
It was confirmed that the vulnerable group for patient safety perception is not aware of patient safety activities and did not prefer an accredited hospital. To prevent patient safety accidents and establish a culture of patient safety, appropriate educational strategies must be provided to the general public.
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Review Article
Nurse Staffing and Health Outcomes of Psychiatric Inpatients: A Secondary Analysis of National Health Insurance Claims Data
Park, Suin , Park, Sohee , Lee, Young Joo , Park, Choon-Seon , Jung, Young-Chul , Kim, Sunah
J Korean Acad Nurs 2020;50(3):333-348.   Published online June 30, 2020
DOI: https://doi.org/10.4040/jkan.19203
AbstractAbstract PDF
Purpose
The present study investigated the association between nurse staffing and health outcomes among psychiatric inpatients in Koreaby assessing National Health Insurance claims data.
Methods
The dataset included 70,136 patients aged 19 years who were inpatientsin psychiatric wards for at least two days in 2016 and treated for mental and behavioral disorders due to use of alcohol; schizophrenia,schizotypal and delusional disorders; and mood disorders across 453 hospitals. Nurse staffing levels were measured in three ways: registerednurse-to-inpatient ratio, registered nurse-to-adjusted inpatient ratio, and nursing staff-to-adjusted inpatient ratio. Patient outcomesincluded length of stay, readmission within 30 days, psychiatric emergency treatment, use of injected psycholeptics for chemical restraint,and hypnotics use. Relationships between nurse staffing levels and patient outcomes were analyzed considering both patient and systemcharacteristics using multilevel modeling.
Results
Multilevel analyses revealed that more inpatients per registered nurse, adjusted inpatientsper registered nurse, and adjusted inpatients per nursing staff were associated with longer lengths of stay as well as a higher risk of readmission.More adjusted inpatients per registered nurse and adjusted inpatients per nursing staff were also associated with increased hypnoticsuse but a lower risk of psychiatric emergency treatment. Nurse staffing levels were not significantly associated with the use of injectedpsycholeptics for chemical restraint.
Conclusion
Lower nurse staffing levels are associated with negative health outcomes of psychiatricinpatients. Policies for improving nurse staffing toward an optimal level should be enacted to facilitate better outcomes for psychiatricinpatients in Korea.
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Original Articles
Changes in Nutritional Status of General Medical Patients During Hospitalization
Young Hee Yang, S Mi Choi-Kwon, Eun Kyung Kim
Journal of Nurses Academic Society 1997;27(1):49-60.   Published online March 30, 2017
DOI: https://doi.org/10.4040/jnas.1997.27.1.49
AbstractAbstract PDF

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.

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Ways of Assessing Post-operative Pain
Sung Ok Chang, Hesook Suzie Kim, Bjorn Sjostrom, Donna Swartz-Barcott
Journal of Korean Academy of Nursing 2001;31(7):1189-1196.   Published online March 29, 2017
DOI: https://doi.org/10.4040/jkan.2001.31.7.1189
AbstractAbstract PDF

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.

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A Study on the Preliminary Validation of a Postoperative Pain Measure for Parents for Children's Pain Assessment after Surgery
Hee Sun Shin, Yeon Yi Jung
Journal of Korean Academy of Nursing 2000;30(4):847-856.   Published online March 29, 2017
DOI: https://doi.org/10.4040/jkan.2000.30.4.847
AbstractAbstract PDF

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.

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Assessment of pain and adequacy of pain management in hospitalized cancer patients
Yeong Hee Shin
Journal of Korean Academy of Nursing 1999;29(5):1113-1122.   Published online March 29, 2017
DOI: https://doi.org/10.4040/jkan.1999.29.5.1113
AbstractAbstract PDF

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.

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The Effect of Web-based Multimedia Contents for a Course of Physical Examination and Health Assessment
Pok Ja Oh, Il Ok Kim, Sung Rae Shin, Hoe Kyung Jung
Journal of Korean Academy of Nursing 2005;35(5):810-816.   Published online March 28, 2017
DOI: https://doi.org/10.4040/jkan.2005.35.5.810
AbstractAbstract PDF
Purpose

This study was to test the effectiveness of Web-based multimedia contents for Physical Examination and Health Assessment on learning achievement.

Method

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.

Results

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).

Conclusion

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.

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Development of Web-based Multimedia Content for a Physical Examination and Health Assessment Course
Pok Ja Oh, Il Ok Kim, Sung Rae Shin, Hoe Kyung Jung
Journal of Korean Academy of Nursing 2004;34(6):994-1003.   Published online March 28, 2017
DOI: https://doi.org/10.4040/jkan.2004.34.6.994
AbstractAbstract PDF
Purpose

This study was to develop Web-based multimedia content for Physical Examination and Health Assesment.

Method

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.

Results

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.

Conclusions

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.

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Working with Vulnerable Families: A Nurse Home Visiting Perspective
In Sook Lee
Journal of Korean Academy of Nursing 2004;34(6):1025-1034.   Published online March 28, 2017
DOI: https://doi.org/10.4040/jkan.2004.34.6.1025
AbstractAbstract PDF
Purpose

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.

Method

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.

Result

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.

Conclusion

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.

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A Comparative Study on the Predictive Validity among Pressure Ulcer Risk Assessment Scales
Young Hee Lee, Ihn Sook Jeong, Seong Sook Jeon
Journal of Korean Academy of Nursing 2003;33(2):162-169.   Published online March 28, 2017
DOI: https://doi.org/10.4040/jkan.2003.33.2.162
AbstractAbstract PDF
Purpose

This study was to compare the predictive validity of Norton Scale(1962), Cubbin & Jackson Scale(1991), and Song & Choi Scale(1991).

Method

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.

Result

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.

Conclusion

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.

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Review Article
Properties of the Measures to Assess Oxaliplatin-induced Peripheral Neuropathy: A Literature Review
Sang Hui Chu, Yoon Ju Lee, Young Joo Lee, Charles S. Cleeland
J Korean Acad Nurs 2015;45(6):783-801.   Published online December 31, 2015
DOI: https://doi.org/10.4040/jkan.2015.45.6.783
AbstractAbstract PDF
Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

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Original Articles
Transcultural Self-efficacy and Educational Needs for Cultural Competence in Nursing of Korean Nurses
Sun-Hee Kim
J Korean Acad Nurs 2013;43(1):102-113.   Published online February 28, 2013
DOI: https://doi.org/10.4040/jkan.2013.43.1.102
AbstractAbstract PDF
Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

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Effects of Individualized Nutritional Education Programs on the Level of Nutrient Intake and Nutritional Status of Colorectal Cancer Patients Undergoing Palliative Chemotherapy
Kwi Ock Park, Smi Choi-Kwon
J Korean Acad Nurs 2012;42(6):799-809.   Published online December 31, 2012
DOI: https://doi.org/10.4040/jkan.2012.42.6.799
AbstractAbstract PDF
Purpose

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.

Methods

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.

Results

Two group comparison revealed that the experimental group had significantly improved calorie (p=.038) and total protein intake (p=.001), and serum albumin percentage change (p=.040). Body weight did not increase but remained the same as the baseline in both groups.

Conclusion

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.

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Optimal Time Interval for Position Change for ICU Patients using Foam Mattress Against Pressure Ulcer Risk
Hyean Jeong Kim, In Sook Jeong
J Korean Acad Nurs 2012;42(5):730-737.   Published online October 31, 2012
DOI: https://doi.org/10.4040/jkan.2012.42.5.730
AbstractAbstract PDF
Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

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Development and Validation of a Tool for Evaluating Core Competencies in Nursing Cancer Patients on Chemotherapy
Sung Hae Kim, Jae Hyun Park
J Korean Acad Nurs 2012;42(5):632-643.   Published online October 31, 2012
DOI: https://doi.org/10.4040/jkan.2012.42.5.632
AbstractAbstract PDF
Purpose

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.

Methods

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

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.

Conclusion

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.

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Validation of a Needs Assessment Tool for Case Management in Korean Medical Aid Beneficiaries
Yang Heui Ahn, Eui Sook Kim, Ok Kyung Ham, Soo Hyun Kim, Soon Ok Kim, Myung Kyung Song
J Korean Acad Nurs 2012;42(4):549-558.   Published online August 31, 2012
DOI: https://doi.org/10.4040/jkan.2012.42.4.549
AbstractAbstract PDF
Purpose

The purpose of this study was to validate the Needs Assessment Tool for Case Management (NATCM) for use with Korean medical aid beneficiaries.

Methods

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.

Results

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.

Conclusion

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.

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Predictive Bayesian Network Model Using Electronic Patient Records for Prevention of Hospital-Acquired Pressure Ulcers
In Sook Cho, Eunja Chung
J Korean Acad Nurs 2011;41(3):423-431.   Published online June 13, 2011
DOI: https://doi.org/10.4040/jkan.2011.41.3.423
AbstractAbstract PDF
Purpose

The study was designed to determine the discriminating ability of a Bayesian network (BN) for predicting risk for pressure ulcers.

Methods

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.

Results

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.

Conclusion

Discriminating ability of the BN model was found to be acceptable and case coverage proved to be excellent for clinical use.

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Development and Validation of the Hospice Palliative Care Performance Scale
So-Hi Kwon
J Korean Acad Nurs 2011;41(3):374-381.   Published online June 13, 2011
DOI: https://doi.org/10.4040/jkan.2011.41.3.374
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Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

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Evaluation of Mental Status in High-Risk Neonates using Infants Coma Scale
Young-Mee Ahn, Min Sohn, Sang-Mi Lee
J Korean Acad Nurs 2010;40(4):561-570.   Published online August 31, 2010
DOI: https://doi.org/10.4040/jkan.2010.40.4.561
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Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

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Educational Needs Assessment on Research Ethics among Nursing Researchers
Ihn Sook Jeong, Mee Ock Gu, Keum Soon Kim, Kwang Ja Lee, Soo Yang
J Korean Acad Nurs 2010;40(4):515-523.   Published online August 31, 2010
DOI: https://doi.org/10.4040/jkan.2010.40.4.515
AbstractAbstract PDF
Purpose

This study aimed to investigate the educational needs of research ethics among nursing researchers.

Methods

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).

Results

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.

Conclusion

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.

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Comparison for Risk Estimate of Aspiration between the Revised Dysphagia Assessment Tool and Videofluoroscopy in Post-Stroke Patients
Kyung Hee Moon, Hyun Sook Sohn, Eun Seok Lee, Eun Kyung Paek, Eun Ju Kang, Seung Hee Lee, Na Ri Han, Meen Hye Lee, Deog Young Kim, Chang Gi Park, Ji-Soo Yoo
J Korean Acad Nurs 2010;40(3):359-366.   Published online June 30, 2010
DOI: https://doi.org/10.4040/jkan.2010.40.3.359
AbstractAbstract PDF
Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

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Effects of Case Management using Resident Assessment Instrument-Home Care (RAI-HC) in Home Health Services for Older People
Kyung Ja June, Ji Yun Lee, Jong Lull Yoon
J Korean Acad Nurs 2009;39(3):366-375.   Published online June 29, 2009
DOI: https://doi.org/10.4040/jkan.2009.39.3.366
AbstractAbstract PDF
Purpose

To evaluate the effects of case management using Resident Assessment Instrument-Home Care (RAI-HC) in home health service for older people.

Methods

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).

Results

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).

Conclusion

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.

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J Korean Acad Nurs : Journal of Korean Academy of Nursing
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