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9 "Chronic Illness"
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Original Articles
Testing a Middle-Range Theory of Self-Care of Chronic Illness: A Validation for Korean Adult Patients with Severe Hypertension
Eunha Gil, Heeyoung Oh
J Korean Acad Nurs 2018;48(5):521-533.   Published online October 31, 2018
DOI: https://doi.org/10.4040/jkan.2018.48.5.521
AbstractAbstract PDF
Purpose

The aims of this study are to provide a theoretical framework for improving the self-care of adults with severe hypertension and to examine the practical suitability of a middle-range theory of self-care for chronic illness by validating the structural model.

Methods

Data were collected at a university hospital in D metropolitan city from July 1 to August 14, 2015. A total of 224 Korean adult patients with severe hypertension were recruited. Data were analyzed using SPSS 22.0 and AMOS 22.0.

Results

The results show that the fit index of the hypothetical model meets the recommended level; 7 out of 8 hypothetical model paths were statistically significant. Motivation, self-efficacy, support from others, and accessibility to care showed statistical significance and explained 67.3% of the self-care process. The self-care process explained 45.3%, 63.6%, and 26.5% of quality of life, health, and illness stability, respectively.

Conclusion

This model can be used as a theoretical framework for improving self-care among adult Korean patients with severe hypertension. Moreover, the practical suitability and validity of the middle-range theory of self-care for chronic illness is secured.

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Chronically Ill Patients' Perception of Hospital Nurses
Byoung-Sook Lee, Mi-Aie Lee, Yong-Sook Eo
J Korean Acad Nurs 2018;48(3):311-322.   Published online June 30, 2018
DOI: https://doi.org/10.4040/jkan.2018.48.3.311
AbstractAbstract PDF
Purpose

The purpose of this qualitative research was to investigate chronically ill patients' perception of hospital nurses.

Methods

Individual in-depth interviews and qualitative content analysis were used for data collection and analysis respectively. Participants were 13 chronically ill hospitalized patients or outpatients in three universities hospitals. All interviews were recorded and transcribed verbatim. Data were analyzed using the qualitative content analysis suggested by Graneheim and Lundman (2004).

Results

Three themes emerged from the 10 sub-themes, which were categorized from the 21 condensed meaning units by interpreting the underlying meanings. The three themes were “person giving comfort and support by caring”, “person facilitating the process of healing”, and “person taking the initiative in power relations”. Two themes involved positive experiences of patients and the other included negative ones.

Conclusion

The results showed that the participants perceived the hospital nurses as devoted to caring for patients and facilitating treatments, but authoritative in performing their duty. Based on these results, it is recommended that hospital nurses improve their nursing knowledge, skills and humanistic attitude.

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Nursing Need of Patients with Chronic Illness: A Primary Study for Development for the Nursing Center of Chronic Illness
Pyoung Sook Lee, So In Kim, Soon Yong Kim, Sook Ja Lee, Eun Sook Park, Young Joo Park, Ho Shin Rhu, Sung Ok Chang, Kuem Sun Han, Min Hyun Suk
Journal of Korean Academy of Nursing 2002;32(2):165-175.   Published online March 29, 2017
DOI: https://doi.org/10.4040/jkan.2002.32.2.165
AbstractAbstract PDF

PURPOSE: The purpose of this descriptive study was to identify the nursing needs of patients with chronic illness. METHOD: The subjects of this study were 636 patients with chronic illness, 323 general nurses, and 106 public health nurses. The instruments used for this study were questionnaires including perceived functions of nursing from the center for chronic illness, preference to placement, intention to use, needs to receive services from the center for chronic illness, strategies management for nursing, and nursing needs of chronically ill patients. RESULTS: The mean of perceived functions for nursing from the center were 3.1(0.5) in public health nurses, 2.9 (0.59) in general nurses, and 2.4(1.33) in chronically ill patients. Regards of needs to receive on services of the nursing centers were, the regularly physical examination, for health educational services which was perceived highest request amongst chronically ill patients. We found the means of each specific need as 2.2(0.6), for physical health, 2.1(0.7), for psychosocial health, and 1.8(0.6) for spiritual health. CONCLUSION: From the results of this study, it is suggested that establishing a nursing center for chronically ill patients consider physical, psychosocial, for spiritual health needs of chronically ill patients. It is also a consideration that direct care for symptom management and health education in the nursing center be implemented.

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Construct a Structural Model for Health Promoting Behavior of Chronic Illness
Sook Ja Lee, So In Kim, Pyoung Sook Lee, Soon Yong Khim, Eun Sook Park, Young Joo Park, Ho Shin Ryu, Sung Ok Chang, Kuem Sun Han
Journal of Korean Academy of Nursing 2002;32(1):62-76.   Published online March 29, 2017
DOI: https://doi.org/10.4040/jkan.2002.32.1.62
AbstractAbstract PDF

PURPOSE: This study was designed to construct a structural model for health promoting behavior of patients with chronic disease. The hypothetical model was developed based on the literature review and Pender's health promotion model.
METHOD
Data was collected by questionnaires from 1748 patients with chronic disease in General Hospital from December 1999 to July 2000 in Seoul. The disease of subject were cardiac disease included hypertension peptic ulcer, pulmonary disease included COPD and asthma, DM, and chronic kidney disease. Data analysis was done with SAS 6.12 for descriptive statistics and PC-LISREL 8.13 Program for Covariance structural analysis.
RESULTS
1. The fit of the hypothetical model to the data was moderate, it was modified by excluding 4 path and including free parameters to it. The modified model with path showed a good fitness to the empirical data (x2=591.83, p<.0001, GFI=0.97, AGFI= 0.94, NNFI=0.95, RMSR=0.01, RMSEA=0.05). 2. The perceived benefits, perceived barriers, self-efficacy, self-esteem, and the plan for action were found to have significant direct effect on health promoting behavior of chronic disease. 3. The health concept, health perception, emotional state, social support were found to have indirect effects on health promoting behavior of chronic disease.
CONCLUSION
The derived model in this study is considered appropriate in explaining and predicting health promoting behavior of patients with chronic disease. Therefore, it can effectively be used as a reference model for further studies and suggested implication in nursing practice.

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A Theory Construction on the Care Experience for Spouses of Patients with Chronic Illness
Kyung Sook Choi, Young Eun
Journal of Korean Academy of Nursing 2000;30(1):122-136.   Published online March 29, 2017
DOI: https://doi.org/10.4040/jkan.2000.30.1.122
AbstractAbstract PDF

Chronic illness requiring attention and management during a long period of time puts great burden onto patients, their family and society. For patients with chronic illnesses, providing social support is the most important, and the fundamental support comes from their spouses. Amount and quality of support from spouses seems to differentiated according to the sex of patients. Female patients tend to believe that their spouses are not very supportive. Therefore, the researchers assessed the burden of husbands of female arthritis patients to discover the factors that result in greater burden. Also, they developed a theoretical model of husbands' care for their wives through a qualitative research into husbands' experience.
Method
1: The study material was 650 female arthritis patients registered in an arthritis clinic. The questionnaire about the disease experience of female arthritis patients and the burden of husbands were sent. Returned questionnaires numbered 210(32.3%) and 27 were excluded because of inadequate answers. The remaining 183 questionnaires were analyzed. The mean age of the patients was 51 years and the mean age of spouses was 55 years. The mean marital period was 28 years. The average duration since diagnosis was 9.1 years. Education level was varied from primary school to graduate school, and average income/month was 1,517,300 won.
Method
2: Initial questionnaire studies on the burden of husbands were performed. Among 183 responding husbands, 23 consented to participate for a qualitative research. Data was obtained by direct and telephone interviews. The mean age of participants was 58 years, and the educational level and socioeconomic status also varied.
Result
1. Husbands' burden: The average burden was 57.68 with a range of 6-96. 2. Burden and general characteristics: The husband's burden correlated with the age of the patients, numbers in the family, therapy methods, patient's level of discomfort, patient's disease severity, patient's level of dependence and the husband's understanding of the level of severity. 3. Linear correlation analysis on burden: The husbands' burden is explained in 22.5% by husband's recognition of level of severity and husbands' age. 4. There were four patterns of the burden on husbands: both objectve burden and subjective burden were high(pattern I), both of objectve burden and subjective burden were low(pattern II), objective burden was high but subjective burden was low(pattern III), objective burden was low but subjective burden was high(pattern IV). The pattern was correlated with the family income, educational level of the patients and their husbands, therapy methods, patient's level of discomfort, patient's disease severity, patient's level of dependence and husband's understanding of level of severity. 5. The core category of the caring experience of the husbands with arthritis patients was "companionship". The causal factor was the patients' experience due to symptoms : physical disfigurement, pain, immobility, limitation of house chores, and limitation of social activities. Contextural factors are husbands' identification of housework and husbands' concern about the disease. The mediating factors are economic problems, fear of aging, feeling of limitation and family support. The strategy for interaction is mind control and how to solve emotional stress. The "companionship" resulted from caring activities, participation of household activities, helping patients' to coping with emotional experience. 6. Companionship is established through the process of entering intervention, and caring state of mind. Entering intervention is the phase of participation of therapy and involvement of houseworks. The caring phase consists of decision on therapy, providing therapy, providing direct care, and taking over the household role of wife. Through caring phase, the changing phase set a stage in which husbands consolidate the relationship with their wives, and are reminded of the meaning of marriage. As a result, in changing phase, husbands' companionship is enhanced. In conclusion, nursing care of chronic illnesses should include a family member especially the spouse. All information on disease shoud be provided to patients and whole family member. Strong support should also be provided to overcome difficulties in taking over role of other sex. Then the quality of life of patients and families will be much improved.

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Model Development of Change of Family Functioning with Chronic Illness
Eun Ok Lee, He Sook Kim, Young Sook Park, Misoon Song, Insook Lee, Yeon Hwan Park
Journal of Korean Academy of Nursing 1999;29(3):467-484.   Published online March 29, 2017
DOI: https://doi.org/10.4040/jkan.1999.29.3.467
AbstractAbstract PDF

The main objectives of this study were to investigate the concept of family function from the perspective of the contemporary Korean family, and to construct model of change of family function whit chronic illness. The hybrid model approach was applied in which three phases(theoretical phase, empirical phase, and analytic phase) of concept development were explored for family functioning. The study was conducted from 1997 to 1998. In empirical phase, two groups of purposive samples were drawn : normal family group composed of six families without ill family member, and ill family group composed of seven families of which wives have rheumatoid arthritis. Only families with child(or children)in primary or secondary schools were included in the study. The results were as follows: In theoretical phase, six dimensions of family concept were emerged : affective, structural, control, cognitive, financial, and reproductive dimension. In order to analyze the Korean normal family function in middle class with middle-age women, financial and reproductive dimension were not included. In empirical phase, five dimensions(affective, structural, control, cognitive, and external relationship) were fond from the normal family data. External relationship dimension is very important factor as a resource of the support, especially when their parents or siblings had no help or support to them. In the affective dimension, Korean family emphasized harmony and balance rather than affective expression harmony and balance rather than affective expression between couples and between parents and children. They also showed common goals of the families to solve their problems to control the family members. The priority of the goals was getting into the higher education of their children or helping their unhealthy parents or family members. Six dimension(affective, structural, control, cognitive, external relationship, and financial) of family functions were emerged from the ill family data. From the analysis of ill family data, types of restructuring house chore after wives illness were developed : (a) negociated, (b) accomodated, and (c) isolated, enduring types. Although the dimensions of family functioning identified in this study are similar to the conceptualizations that exist in the western literature, there where distinct differences in the nature of major themes and subconcepts under these family function dimensions.

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Perceived Stress, Mood State, and Symptoms of Stress of the Patient with Chronic Illness
Kuem Sun Han
Journal of Korean Academy of Nursing 2003;33(1):87-94.   Published online March 28, 2017
DOI: https://doi.org/10.4040/jkan.2003.33.1.87
AbstractAbstract
Purpose

The purpose of this study was to identify the factors influencing Symptoms of Stress in patients with chronic illness.

Method

Data were collected by questionnaires from 1,748 patients with chronic disease in General Hospital in Seoul. Chronic diseases of were cardiac disease including hypertension, peptic ulcer, pulmonary disease included COPD and asthma, DM, and chronic kidney disease. The data were analyzed using descriptive statistics, pearson correlation coefficients, and stepwise multiple regression.

Result

1. The level of symptoms of stress was moderate(M=2.17). 2. The score of symptoms of stress showed significantly positive correlation with the score of mood state(r=.58, p=.00), perceived stress(r=.57, p=.00), and ways of coping(r=.33, p=.00). The symptoms of stress showed significantly negative correlation with the score of social support(r=-.37, p=.00) and self-esteem(r=-.19, p=.00). 3. The most powerful predictor of symptoms of stress was mood state and the variance explained was 34%. A combination of mood state, ways of coping, perceived stress, social support, and duration of illness account for 45% of the variance in symptoms of stress of the patients with chronic illness.

Conclusion

This study suggest that mood state, ways of coping, perceived stress, and social support are significantly influencing factors on symptoms of stress of the patients with chronic illness.

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Transitional Care for Older Adults with Chronic Illnesses as a Vulnerable Population: Theoretical Framework and Future Directions in Nursing
Youn-Jung Son, Mi-Ae You
J Korean Acad Nurs 2015;45(6):919-927.   Published online December 31, 2015
DOI: https://doi.org/10.4040/jkan.2015.45.6.919
AbstractAbstract PDF
Purpose

Effective transitional care is needed to improve the quality of life in older adult patients with chronic illness and avoid discontinuity of care and adverse events. The aim of this article is to provide an overview of the key features, broader implications, and the utility of Meleis' transition theory intended for the transitional care of older adults with chronic illnesses. We present the role of nurse in the context of transitional care and propose future directions to increase the quality of nursing care.

Methods

The online databases Cumulative Index of Nursing and Allied Health Literature, MEDLINE, and Science Direct were searched for relevant literature published since 1970 along with textbooks regarding nursing theory.

Results

An evaluation of the usefulness of transition theory based on transitional care in older adult patients with chronic illnesses is provided. Healthy transition should be the expected standard of nursing care for older adults across all healthcare settings.

Conclusion

Nurses need to contribute to the development of transitional care for vulnerable populations; however, transition theory needs to be enhanced through additional theoretical work and repeated evaluations of the applicability in areas of transitional care.

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Effects of a Multi-disciplinary Approached, Empowerment Theory Based Self-management Intervention in Older Adults with Chronic Illness
Chorong Park, Misoon Song, Belong Cho, Jaeyoung Lim, Wook Song, HeeKyung Chang, Yeon-Hwan Park
J Korean Acad Nurs 2015;45(2):192-201.   Published online April 30, 2015
DOI: https://doi.org/10.4040/jkan.2015.45.2.192
AbstractAbstract PDF
Purpose

The purpose of this study was to develop a multi-disciplinary self-management intervention based on empowerment theory and to evaluate the effectiveness of the intervention for older adults with chronic illness.

Methods

A randomized controlled trial design was used with 43 Korean older adults with chronic illness (Experimental group=22, Control group=21). The intervention consisted of two phases: (1) 8-week multi-disciplinary, team guided, group-based health education, exercise session, and individual empowerment counseling, (2) 16-week self-help group activities including weekly exercise and group discussion to maintain acquired self-management skills and problem-solving skills. Baseline, 8-week, and 24-week assessments measured health empowerment, exercise self-efficacy, physical activity, and physical function.

Results

Health empowerment, physical activity, and physical function in the experimental group increased significantly compared to the control group over time. Exercise self-efficacy significantly increased in experimental group over time but there was no significant difference between the two groups.

Conclusion

The self-management program based on empowerment theory improved health empowerment, physical activity, and physical function in older adults. The study finding suggests that a health empowerment strategy may be an effective approach for older adults with multiple chronic illnesses in terms of achieving a sense of control over their chronic illness and actively engaging self-management.

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