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Original Article
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
AbstractAbstract 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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Review Article
Effectiveness of Telemonitoring Intervention in Children and Adolescents with Asthma: A Systematic Review and Meta-Analysis
Youjin Jung, Jimin Kim, Dong Ah Park
J Korean Acad Nurs 2018;48(4):389-406.   Published online January 15, 2018
DOI: https://doi.org/10.4040/jkan.2018.48.4.389
AbstractAbstract PDF
Abstract Purpose

This review aimed to evaluate the effectiveness of telemonitoring (TM) in the management of children and adolescents with asthma.

Methods

We searched Ovid-MEDLINE, Ovid-EMBASE, CENTRAL (Cochrane Central Register of Controlled Trials), CINAHL (Cumulative Index to Nursing and Allied Health Literature), and 5 domestic databases to identify randomized controlled trials (RCTs) published through December 2017. Two reviewers independently selected relevant studies, assessed methodological quality and extracted data. We performed a meta-analysis of TM versus usual care and summarized the intervention characteristics of included studies.

Results

Of the 3,095 articles identified, 8 RCTs (9 articles) were included in this review. The type of TM intervention of included studies was varying across studies (transmitted data, transmission frequency, data review, etc.). The pooled asthma control score was not significantly different between TM and usual care (standardized mean difference 0.04, 95% confidence interval (CI) -0.20~0.28). Another pooled analysis demonstrated no statistically significant difference in asthma exacerbation between TM and usual care (odds ratio 0.95, 95% CI 0.43~2.09). Overall, the pooled results from these studies revealed that TM did not lead to clinically significant improvements in health outcomes, but some studies in our analysis suggested that TM increased patient medication adherence and intervention adherence.

Conclusion

The current evidence base does not demonstrate any differences between TM intervention and usual care, but TM intervention might be considered a promising strategy for the delivery of self-management support for children and adolescents with asthma. Further well-designed studies are needed to assess the effects on clinical outcomes.

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Original Articles
Structural Equation Model of Health-Related Quality of Life in School Age Children with Asthma
Yunsoo Kim, Ho Ran Park
J Korean Acad Nurs 2018;48(1):96-108.   Published online January 15, 2018
DOI: https://doi.org/10.4040/jkan.2018.48.1.96
AbstractAbstract PDF
Abstract Purpose

This study aimed to construct and test a hypothetical model of the quality of life of school-age children with asthma based on the health-related quality of life model by Wilson and Cleary.

Methods

Data were collected from 205 pairs of pediatric outpatients diagnosed with asthma and their parents in Seoul and Gyeonggi-do from July 2016 to April 2017. The exogenous variables were asthma knowledge, number of accompanying allergic diseases, and social support. The endogenous variables were asthma self-efficacy, asthma symptom control, perceived health status, parental quality of life, and children's quality of life. For data analysis, descriptive statistics, factor analysis, and structural equation modeling were performed.

Results

Eighteen of the twenty-four hypotheses selected for the hypothetical model were attentive and supported statistically. Quality of life was explained by asthma self-efficacy, asthma symptom control, perceived health, parental quality of life, and asthma knowledge with 83.5%.

Conclusion

Strategies for promoting self-efficacy and enforcing asthma knowledge will be helpful for the improvement of health-related quality of life with school-aged asthmatic children.

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Comparision of Group and Individual Social Support on Burden and Family Functioning in Families with Asthmatic Children
Hoa Yun Jun
Journal of Korean Academy of Nursing 1999;29(2):418-428.   Published online March 29, 2017
DOI: https://doi.org/10.4040/jkan.1999.29.2.418
AbstractAbstract PDF

The main purpose of this study was to identify the effects of group social support and individual social support on the reduction of burden and improvement in family functioning of families with asthmatic children. The design of this study was a randomized pre-posttest quasi-experimental design to compare the two experimental groups. The theoretical framework for this study was derived from the study of burden in family caregivers by Suh and Oh(1993) based on the main effect model of social support theories. The data were collected from February 12, 1998 to May 29, 1998 at the pediatric out patient department of a university hospital located in Suwon city. The sample consisted of 39 family members who were identified as families with asthmatic children, Eighteen subjects were randomly assigned to the group social support group and 21 were assigned to the individual social support group. Group and individual social support members were seen for 60 to 90 minutes, four times over one to three weeks. The instruments used in this study were the Burden Scale developed by Suh and Oh(1993), the Visual Analogue Scale, and the Family Adaptability Cohesion Evaluation Scale(FACES-III) developed by Olson, Portner, and Lavee(1985). The collected data were analyzed using Mann-Whitney test, x2-test, Wilcoxon sign rank test, t-test, ANOVA(Scheff), pearson correlation coefficient, multiple regression, and social support process and content analysis. The results are as follow ; 1. There was no significant difference before the experimental treatment among the subjects in the group social support group and individual social support group for general characteristics, burden, or family functioning. 2. Hypothesis 1 ; "There will be a greater reduction on the burden score of the group social support group compared to the individual social support group" was not statistically significant(U=174.5, p=.683). The burden scores showed a significant decrease after participation in social support as compared to before participation for both groups. However there was a tendency for more reduction in the burden scores for the group social support than for individual social support. 3. Hypothesis 2 ; "There will be a greater improvement in the family functioning scores for the group social support group compared to the individual social support group" was not statistically significant(U=153.0, p=.309). There was a tendency toward improvement in the family functioning scores of the group social support as compared to that of the individual social support. 4. According to the length of the treatment period, families with asthmatic children displayed affirmative responses, and the families set up a self-help group of mothers with asthmatic children n order to share their experiences, to get information and to solve their problems. In conclusion, it was found that group social support was the more effective nursing intervention for reducing burden and for improving family functioning of families with asthmatic children.

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Effect of Asthma Management Education Program on Stress and Compliance of Patients with Allergic Asthma to House Dust Mite
Yang Sook Yoo, Ok Hee Cho, Eun Sin Kim, Hye Sun Jeong
Journal of Korean Academy of Nursing 2005;35(4):686-693.   Published online March 28, 2017
DOI: https://doi.org/10.4040/jkan.2005.35.4.686
AbstractAbstract
Purpose

This study was designed to examine the effect of asthma management education program applied to allergic asthma patients receiving immunotherapy due to house dust mite on their stress and compliance with health care regimens.

Methods

A quasi experimental design with non-equivalent control group and non-synchronized design was used. The subjects of this study were 61 patients who were receiving immunotherapy at intervals of a week after their symptoms were diagnosed as house dust mite allergic asthma at the pulmonary department of a university hospital in Seoul. They were divided into an experimental group of 29 patients who received asthma management education and a control group of 32 patients. The asthma management education program was composed of group education (once) and reinforcement education (three times) with environmental therapy and immunotherapy to house dust mite.

Results

Stress significantly decreased in the experimental group compared to that in the control group. Compliance with health care regimens significantly increased in the experimental group compared to that in the control group.

Conclusions

The results suggested that the asthma management education program is effective for the management of stress and the improvement of compliance in patients with allergic asthma to house dust mite.

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Effects of Education about Action Plans according to Self-Monitoring on Self-Management Adherence, Knowledge, Symptom Control, and Quality of Life among Adult Asthma Patients: A Randomized Controlled Trial
Ja Yun Choi, Young-Ran Kweon
J Korean Acad Nurs 2017;47(5):613-623.   Published online January 15, 2017
DOI: https://doi.org/10.4040/jkan.2017.47.5.613
AbstractAbstract PDF
Abstract Purpose

This study was conducted to identify the effects of education regarding action plans according to a self-monitoring program on self-management adherence, knowledge, symptom control, and health-related quality of life (HRQoL) among adults with asthma.

Methods

Thirty-four patients were randomly assigned to the intervention group and thirty-two to the control group in this study. A tailored 50-minute intervention based on the contents of self-monitoring and action plans developed by the National Heart Lung and Blood Institute was provided to the intervention group. Structured and well developed questionnaires were used to measure the dependent variables.

Results

There were no differences in all general and clinical characteristics, and the dependent variables between two groups in the pre-test. In the post-test, there were differences in the level of self-management adherence (t=4.41, p<.001), knowledge (t=2.26, p=.027), symptom control (t=-2.56, p=.013), and total HRQoL (t=2.14, p=.036) between the two groups, although there was a difference only in the sub-domain of emotion (t=2.03, p=.047) in HRQoL.

Conclusion

This study found that action plans according to self-monitoring that enhance a participatory interaction in the treatment and care could help patients with moderate to severe asthma to engagead equately in self-care, to control their symptoms, and to improve their HRQoL. Further studies are still needed to identify longitudinal effects of this program.

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The Effects of an Asthma Management Education Program for Preschoolers
Soyoun Yim
J Korean Acad Nurs 2014;44(2):189-197.   Published online April 30, 2014
DOI: https://doi.org/10.4040/jkan.2014.44.2.189
AbstractAbstract PDF
Purpose

This study was conducted to develop an asthma management education program for preschool children using Roy's adaptation theory as a framework and examining the effects of this program on adaptation to asthma treatment.

Methods

A non-equivalent control group pre-post-test design was used with 43 preschool children diagnosed with asthma and required to be hospitalized for inhalation therapy. An intervention group (n=23) participated in the educational program and a control group (n=20) received regular treatment. The education program was conducted and evaluated from June 30 to October 31 2012, a maximum 3 times every 24 hours during hospitalization. Two nurses conducted the program using the teaching method of Gagné and Briggs; instruction design theory through questionnaires to measure perception of disease, behavior of adaptation to treatment with inhalation therapy.

Results

Effects of asthma management education program; scores for face-pain rating decreased and time of adaptation to treatment increased significantly in the experimental group compared to the control group but no significant differences were found for perception of the disease's cause and treatment.

Conclusion

Results indicate that the asthma management education program has positive effects on adaptation to asthma treatment of preschoolers.

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Evaluation of an Education Program for Patients with Asthma who use Inhalers
Jong Kyung Lee, Young Hee Yang
J Korean Acad Nurs 2010;40(2):202-212.   Published online April 30, 2010
DOI: https://doi.org/10.4040/jkan.2010.40.2.202
AbstractAbstract PDF
Purpose

This study was done to evaluate the effectiveness of an education program for patients with asthma who use inhalers.

Methods

The research design for this study was a non-equivalent control group quasi-experimental study. Participants in this study were 36 patients for the control group, and 43 patients for the experimental group. The experimental group participated in the education program. The control group received the usual care. Data were collected before and 1 month and 2 months after the program finished and were analyzed using the SPSS 12.0 program.

Results

The experimental group had significantly higher scores of knowledge of inhalers, and inhalation technique compared to the control group. However, no significant differences were found between two groups for PEFR, asthma instability, and satisfaction with inhalers.

Conclusion

According to the results, the education program was effective in improving knowledge of inhalers, and inhalation technique. Therefore, it is recommended that this education program be used in clinical practice as an effective nursing intervention for patients with asthma on inhalers.

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Computerized Measurement for Asthma-Specific Quality of Life: Comparison with a Conventional Paper-and-Pencil Questionnaire
Eun-Hyun Lee
J Korean Acad Nurs 2009;39(6):781-787.   Published online December 31, 2009
DOI: https://doi.org/10.4040/jkan.2009.39.6.781
AbstractAbstract PDF
Purpose

The purpose of this study was to evaluate a computerized touch-screen version of the asthma-specific quality-of-life (cA-QOL) questionnaire against the conventional paper-and-pencil version (pA-QOL) for equivalence, time for completion, user preference, and ease of use.

Methods

A total of 261 patients were recruited. A randomized cross-over design was used. Patients in group A completed the cA-QOL first while waiting to see a physician, and completed the pA-QOL version after seeing the physician. Patients allocated in group B completed these questionnaires in the reverse order. The patients were asked questions about user preference and ease of use of the cA-QOL. The time taken to complete both versions of the questionnaire was measured.

Results

Weighted kappa coefficients of all items showed almost perfect agreement. The time required to complete the pA-QOL is faster than the time for cA-QOL. The patients who preferred the cA-QOL were 37.5%, while those who preferred the pA-QOL were 29.9%. Most patients reported that the cA-QOL was "easy" or "very easy" to complete.

Conclusion

The cA-QOL is the computerized equivalent of the pA-QOL. The findings herein demonstrate that the cA-QOL can be helpful to nurses in busy practices for assessing, collecting, and evaluating their patients' health related quality of life.

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