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Review Paper
Effects of Non-Pharmacological Interventions on Major Adverse Cardiac Events in Patients Underwent Percutaneous Coronary Intervention: Systematic Review and Meta-Analysis
Jo, Sojeong , Lee, Haejung , Park, Gaeun
J Korean Acad Nurs 2024;54(3):311-328.   Published online August 31, 2024
DOI: https://doi.org/10.4040/jkan.24019
AbstractAbstract PDF
Purpose
In this study a systematic review and meta-analysis investigated the impact of non-pharmacological interventions on major adverse cardiac events (MACE) in patients with coronary artery disease who underwent percutaneous coronary intervention (PCI).
Methods
A literature search was performed using PubMed, Cochrane Library, EMBASE, and Cumulative Index to Nursing & Allied Health Literature databases up to November 2023. The risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. Effect sizes and 95% confidence intervals were calculated using R software (version 4.3.2).
Results
Eighteen randomized studies, involving 2,898 participants, were included. Of these, 16 studies with 2,697 participants provided quantitative data. Non-pharmacological interventions (education, exercise, and comprehensive) significantly reduced the risk of angina, heart failure, myocardial infarction, restenosis, cardiovascular-related readmission, and cardiovascular-related death. The subgroup meta-analysis showed that combined interventions were effective in reducing the occurrence of myocardial infarction (MI), and individual and group-based interventions had significant effects on reducing the occurrence of MACE. In interventions lasting seven months or longer, occurrence of decreased by 0.16 times, and mortality related to cardiovascular disease decreased by 0.44 times, showing that interventions lasting seven months or more were more effective in reducing MI and cardiovascular disease-related mortality.
Conclusion
Further investigations are required to assess the cost-effectiveness of these interventions in patients undergoing PCI and validate their short- and long-term effects. This systematic review underscores the potential of non-pharmacological interventions in decreasing the incidence of MACE and highlights the importance of continued research in this area (PROSPERO registration number: CRD42023462690).
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Research Papers
Effects of a Pre-Conception Care Program in Women with Inflammatory Bowel Disease: A Mixed-Methods Study Including a Randomized Controlled Trial
Lee, Young Jin , Kim, Hae Won , Kim, Yeon Hee , Yang, Suk-Kyun , Kim, Ji-Yeon
J Korean Acad Nurs 2024;54(3):386-402.   Published online August 31, 2024
DOI: https://doi.org/10.4040/jkan.24010
AbstractAbstract PDF
Purpose
The purpose of this study was to conduct a pre-conception care program for women of childbearing age with inflammatory bowel disease (IBD) in Korea and verify its effects on self-efficacy for IBD management, IBD-related pregnancy knowledge, and IBD-related pregnancy anxiety. It also aimed to explore the changes in participants through the program.
Methods
A convergent mixed-methods study design was adopted. In the quantitative phase, 35 women (17 and 18 in the intervention and control group, respectively) participated. The intervention group attended a program that included small-group sessions and individual tele-coaching. To confirm the effects, data were collected before and one and four weeks after the intervention. In the qualitative stage, focus group interviews and tele-coaching were conducted with the intervention group.
Results
After the program ended, significant differences were observed over time between the intervention and control groups for self-efficacy for IBD management (Wald χ2 = 4.41, p = .036), IBD-related pregnancy knowledge (Wald χ2 = 13.80, p < .001) and IBD-related pregnancy anxiety (Wald χ2 = 8.61, p = .003). Qualitative data analysis revealed the following themes: (1) improving confidence in IBD management and awareness for planned pregnancy; (2) improving IBD awareness related to pregnancy and childbirth; and (3) relieving anxiety about and actively facing pregnancy.
Conclusion
This study is meaningful in that, to the best of our knowledge, it is the first to develop a pre-conception care program for women diagnosed with IBD and confirm its effectiveness. Furthermore, this program is expected to be suitable for patient counseling and education in clinical practice.
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Influence of Illness Uncertainty on Health Behavior in Individuals with Coronary Artery Disease: A Path Analysis
Jeong, Hyesun , Lee, Yesul , Park, Jin Sup , Lee, Yoonju
J Korean Acad Nurs 2024;54(2):162-177.   Published online May 31, 2024
DOI: https://doi.org/10.4040/jkan.23136
AbstractAbstract PDF
Purpose
This study aimed to investigate the influence of uncertainty-related factors on the health behavior of individuals with coronary artery disease (CAD) based on Mishel’s uncertainty in illness theory (UIT).
Methods
We conducted a cross-sectional study and path analysis to investigate uncertainty and factors related to health behavior. The study participants were 228 CAD patients who visited the outpatient cardiology department between September 2020 and June 2021. We used SPSS 25.0 and AMOS 25.0 software to analyze the data.
Results
The final model demonstrated a good fit with the data. Eleven of the twelve paths were significant. Uncertainty positively affected danger and negatively affected self-efficacy and opportunity. Danger had a positive effect on perceived risk. Opportunity positively affected social support, self-efficacy, perceived benefit and intention, whereas it negatively affected perceived risk. Social support, self-efficacy, perceived benefit and intention had a positive effect on health behavior. We found that perceived benefit and intention had the most significant direct effects, whereas self-efficacy indirectly affected the relationship between uncertainty and health behavior.
Conclusion
The path model is suitable for predicting the health behavior of CAD patients who experience uncertainty. When patients experience uncertainty, interventions to increase their self-efficacy are required first. Additionally, we need to develop programs that quickly shift to appraisal uncertainty as an opportunity, increase perceived benefits of health behavior, and improve intentions.
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Effects of a Health Partnership Program Using Mobile Health Application for Male Workers with Cardiovascular Risk Factors in Small and Medium Enterprises: A Randomized Controlled Trial
Kim, Eun Jin , Hwang, Seon Young
J Korean Acad Nurs 2024;54(1):44-58.   Published online February 29, 2024
DOI: https://doi.org/10.4040/jkan.23090
AbstractAbstract PDF
Purpose
This study aimed to apply a health partnership program using commercially available mobile health apps to improve cardiovascular risk factors in male employees and verify its effectiveness.
Methods
Using a randomized control group pretest-posttest design, male employees with cardiovascular risk factors from five small and medium-sized workplaces were randomly assigned to an experimental group (n = 32) and a control group (n = 31). The experimental group was encouraged to use three mobile health apps for 12 weeks to acquire the necessary cardiovascular disease-related information and practice strengthening training, walking, and diet management appropriate to their level. They also received feedback on their weekly activities and motivational text messages from health partners. Hypotheses were tested using the SPSS WIN 22.0.
Results
The experimental group showed a significant difference compared to the control group in terms of their perception of mobile health app (p < .05), self-efficacy for exercise and diet, self-management partnership, and cardiovascular disease prevention health behavior (p < .001). In particular, there were significant decreases in the body mass index, ratio, serum fasting blood sugar, total cholesterol, and triglyceride in the experimental group (p < .001); however, there was no significant difference in high-density lipoprotein-cholesterol.
Conclusion
Intervention using mobile apps based on partnership with health managers is effective in improving the objective cardiovascular risk index in male employees; therefore, such intervention should be continuously used as a useful lifestyle modification strategy in the workplace.
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Psychometric Properties of the Korean Version of Self-Efficacy for HIV Disease Management Skills
Kim, Gwang Suk , Kim, Layoung , Shim, Mi-So , Baek, Seoyoung , Kim, Namhee , Park, Min Kyung , Lee, Youngjin
J Korean Acad Nurs 2023;53(3):295-308.   Published online June 30, 2023
DOI: https://doi.org/10.4040/jkan.23016
AbstractAbstract PDF
Purpose
This study evaluated the validity and reliability of Shively and colleagues’ self-efficacy for HIV disease management skills (HIVSE) among Korean participants.
Methods
The original HIV-SE questionnaire, comprising 34 items, was translated into Korean using a translation and back-translation process. To enhance clarity and eliminate redundancy, the author and expert committee engaged in multiple discussions and integrated two items with similar meanings into a single item. Further, four HIV nurse experts tested content validity. Survey data were collected from 227 individuals diagnosed with HIV from five Korean hospitals. Construct validity was verified through confirmatory factor analysis. Criterion validity was evaluated using Pearson’s correlation coefficients with the new general self-efficacy scale. Internal consistency reliability and test-retest were examined for reliability.
Results
The Korean version of HIV-SE (K-HIV-SE) comprises 33 items across six domains: “managing depression/mood,” “managing medications,” “managing symptoms,” “communicating with a healthcare provider,” “getting support/help,” and “managing fatigue.” The fitness of the modified model was acceptable (minimum value of the discrepancy function/degree of freedom = 2.49, root mean square error of approximation = .08, goodnessof-fit index = .76, adjusted goodness-of-fit index = .71, Tucker-Lewis index = .84, and comparative fit index = .86). The internal consistency reliability (Cronbach’s α = .91) and test-retest reliability (intraclass correlation coefficient = .73) were good. The criterion validity of the K-HIV-SE was .59 (p < .001).
Conclusion
This study suggests that the K-HIV-SE is useful for efficiently assessing self-efficacy for HIV disease management.
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Development and Evaluation of Motivational Interviewing Pulmonary Rehabilitation Program Based on Self-Determination Theory for Patients with Chronic Obstructive Pulmonary Disease
Jang, Jun Hee , Min, Hye Sook
J Korean Acad Nurs 2023;53(2):191-207.   Published online April 30, 2023
DOI: https://doi.org/10.4040/jkan.22093
AbstractAbstract PDF
Purpose
This study aimed to develop a motivational interviewing pulmonary rehabilitation program based on self-determination theory to maintain pulmonary rehabilitation-related health behaviors in patients with chronic obstructive pulmonary disease. The program was developed by reviewing the literature on pulmonary rehabilitation guidelines, drawing on the self-determinism theory to establish its contents, recruiting experts to test its validity, and conducting a preliminary survey.
Methods
A quasi-experimental design was used to confirm the effect of the program. The participants were outpatients diagnosed with chronic obstructive pulmonary disease at three general hospitals in Busan. There were 33 subjects: 15 in the experimental group and 18 in the control group. The experimental group performed a motivational interviewing pulmonary rehabilitation program which comprised 11 sessions delivered over 10 weeks. The outcomes were measured using basic psychological needs, dyspnea, 6-minute walking distance, and functional status. Intervention effects were analyzed using repeated-measures ANOVA.
Results
The analysis revealed significant differences between the experimental and control groups in competence among the subdomains of basic psychological needs, dyspnea during exercise, and functional status.
Conclusion
The developed program affects physical conditions and can be applied as an effective clinical nursing intervention to continuously improve the pulmonary rehabilitation behavior of patients with chronic obstructive pulmonary disease.
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Validity and Reliability of Korean Version of Self-Care Chronic Obstructive Pulmonary Disease Inventory (SC-COPD) and Self-Care Self-Efficacy Scale (SCES-COPD)
Choi, Ja Yun , Yun, So Young
J Korean Acad Nurs 2022;52(5):522-534.   Published online October 31, 2022
DOI: https://doi.org/10.4040/jkan.22062
AbstractAbstract PDF
Purpose
This study examined the validity and reliability of the Korean version of the Self-Care in Chronic Obstructive Pulmonary Disease Inventory (SC-COPDI) and the Chronic Obstructive Pulmonary Disease Self-Care Self-Efficacy Scale (SCES-COPD). The SC-COPDI consists of the Self-Care Maintenance Scale (SCMES), Self-Care Monitoring Scale (SCMOS), and Self-Care Management Scale (SCMAS).
Methods
The original tool was translated using a back-translation process. Participants were 241 patients with COPD at the Chonnam National University Hospital in Korea. The construct validity was verified through confirmatory factor analysis, and reliability was verified using Cronbach’s α.
Results
The SCMES consisted of 10 items of three factors―one of four factors was deleted from the original tool. In the SC-MOS, there were six items of two factors after two items were deleted from the original tool. The SCMAS consisted of the original 10 items of three factors. The SCES-COPD consisted of six items of two factors, with one item removed from the original tool. The model fit indices of all tools were good, and the construct validity was confirmed. Cronbach’s α of SCMES was .72, SCMOS was .90, SCMAS was .81, and SCES-COPD was .85.
Conclusion
The Korean version of SC-COPDI and SCES-COPD are valid and reliable instruments for measuring selfcare in people with COPD. These instruments can be used in self-care studies of COPD patients in Korea.
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Review Paper
Knowledge Structure of Chronic Obstructive Pulmonary Disease Health Information on HealthRelated Websites and Patients’ Needs in the Literature Using Text Network Analysis
Choi, Ja Yun , Lim, Su Yeon , Yun, So Young
J Korean Acad Nurs 2021;51(6):720-731.   Published online December 31, 2021
DOI: https://doi.org/10.4040/jkan.21086
AbstractAbstract PDF
Purpose
The purpose of this study was to identify the knowledge structure of health information (HI) for chronic obstructive pulmonary disease (COPD).
Methods
Keywords or meaningful morphemes from HI presented on five health-related websites (HRWs) of one national HI institute and four hospitals, as well as HI needs among patients presented in nine literature, were reviewed, refined, and analyzed using text network analysis and their co-occurrence matrix was generated. Two networks of 61 and 35 keywords, respectively, were analyzed for degree, closeness, and betweenness centrality, as well as betweenness community analysis.
Results
The most common keywords pertaining to HI on HRWs were lung, inhaler, smoking, dyspnea, and infection, focusing COPD treatment. In contrast, HI needs among patients were lung, medication, support, symptom, and smoking cessation, expanding to disease management. Two common sub-topic groups in HI on HRWs were COPD overview and medication administration, whereas three common sub-topic groups in HI needs among patients in the literature were COPD overview, self-management, and emotional management.
Conclusion
The knowledge structure of HI on HRWs is medically oriented, while patients need supportive information. Thus, the support system for self-management and emotional management on HRWs must be informed according to the structure of patients’ needs for HI. Healthcare providers should consider presenting COPD patient-centered information on HRWs.
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Research Papers
Job Analysis of Nurse Care Coordinators for Chronic Illness Management in Primary Care Settings: Using Developing a Curriculum Process
Hwang, Ju-Hee , Choi, Yong-Jun , Kim, Mi-Sook , Yi, Seng-Eun , Park, Yong-Soon , Kim, Ji-Hyang , Yoon, Ju-Young , Shin, Dong-Soo
J Korean Acad Nurs 2021;51(6):758-768.   Published online December 31, 2021
DOI: https://doi.org/10.4040/jkan.21065
AbstractAbstract PDF
Purpose
This study aimed to conduct a job analysis of nurse carecoordinators and to identify the frequency, importance and difficulty of each task of their job.
Methods
A committee for developing a curriculum (DACUM) was formed and members of the committee defined nurse care coordinators’ jobs and enumerated the duties, tasks and task elements by applying the DACUM technique. Then nurse care coordinators enrolled in the pilot project evaluated the frequency, importance and difficulty of each task.
Results
From the job descriptions of nurse care coordinators, we identified 12 duties and 42 tasks. Each task comprised 1~5 task elements. Among tasks, ‘assess the patient’s general health status’ was carried out most frequently. Nurse care coordinators perceived that ‘check vital signs’ and ‘strengthen patient competence to promote health behaviors’ were more important than all other tasks. The most difficult task was ‘develop professionalism as a nurse care coordinator’.
Conclusion
The nurse care coordinators' roles developed in this study will serve as the key guidelines for human resource management of care coordinators. Further, job specifications for nurse care coordinators need to be developed, which is necessary for designing education and training programs. We also need to integrate primary health care as an essential component in nursing education.
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Factors Influencing the COVID-19 Vaccination Intentions in Nurses: Korea, February 2021
Park, Ju Young , Ha, Jiyeon
J Korean Acad Nurs 2021;51(5):537-548.   Published online October 31, 2021
DOI: https://doi.org/10.4040/jkan.21110
AbstractAbstract PDF
Purpose
This study aimed to identify the factors influencing COVID-19 vaccination intentions in nurses.
Methods
The participants were 184 nurses in Korea. Data were collected using a Google Form online survey method in February, 2021, and analyzed using an independent t-test, one-way ANOVA, Pearson correlation, and multiple regression analysis with the SPSS/WIN 26.0 program.
Results
COVID-19 vaccination intention in nurses was correlated significantly with vaccine hesitancy (r = .58, p < .001), risk perception of COVID-19 (r = .22, p = .003), perception of vaccination as a professional duty (r = .59, p < .001), and attitude towards workplace infection control policies (r = .20, p = .007). Vaccine hesitancy (β = .40, p < .001) and the perception of vaccination as a professional duty (β = .44, p < .001) significantly influenced COVID-19 vaccination intention. The model developed in this study explained 50% of the variation in COVID-19 vaccination intention.
Conclusion
Improving the perception of vaccination as a professional duty and lowering vaccine hesitancy may enhance nurses’ COVID-19 vaccination intention. Above all, it is necessary to provide programs to encourage voluntary recognition of vaccination as a professional duty and develop strategies to reduce hesitancy toward COVID-19 vaccinations.
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Validity and Reliability of Korean Version of the Self-Efficacy for Managing Chronic Disease 6-Item Scale
Kim, Sook-Nam , Lee, Hyun-Ju , Kim, So-Young , Lee, Nayoon
J Korean Acad Nurs 2021;51(5):617-629.   Published online October 31, 2021
DOI: https://doi.org/10.4040/jkan.21069
AbstractAbstract PDF
Purpose
The aim of this study was to examine the validity and reliability of the Korean version of the self-efficacy for managing chronic disease 6-item scale (SECD-6-K).
Methods
The English version of the Self-Efficacy for Managing Chronic Disease 6-item Scale first underwent forward and backward translation procedures. The SECD-6-K was then used to collect data from 350 adults diagnosed with chronic diseases. Content, construct, convergent, discriminant, and criterion validity were all evaluated. Reliability was assessed using Cronbach’s α. SPSS 25.0 and the data were analyzed using AMOS 26.0 software.
Results
The SECD-6-K consists of six items in two domains: disease management and health behavior. The results for construct, convergent, and discriminant validity were good. Exploratory factor analysis produced eigen values between 2.27 and 3.28, with factors total explained cumulative variance of 91.1%. Confirmatory factor analysis supported goodness of fit and reliability for the modified SECD-6-K model. The criterion validity also showed significant correlation with both the Patient Health Questionnaire and 12-item Short-Form Health Survey version 2. Finally, reliability was found to be excellent.
Conclusion
This study identified the high reliability and validity of SECD-6-K. The SECD-6-K is an appropriate tool for determining Korean patients’ self-efficacy in managing their chronic conditions. Therefore, this scale may be used in clinical settings as well as in educational and research settings.
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Factors Influencing Health Behavior Compliance in Adult Moyamoya Patients
Kim, Bo Eun , Song, Ju-Eun
J Korean Acad Nurs 2021;51(1):80-91.   Published online February 28, 2021
DOI: https://doi.org/10.4040/jkan.20222
AbstractAbstract PDF
Purpose
The purpose of this study was to identify factors influencing health behavior compliance in adult patients with moyamoya.
Methods
A descriptive correlation study was conducted to investigate the factors influencing health behavior compliance. Participants were 142 adult patients diagnosed with moyamoya disease who were hospitalized or visited an outpatient clinic in the Gyeonggi province. Data were collected from December 16, 2019 to April 14, 2020 using self-report questionnaires and analyzed using the IBM SPSS 26.0 Win software.
Results
The hierarchical multiple regression analysis demonstrated that self-efficacy (β = .60, p < .001), social support (β = .13, p = .032), and age (β = .21, p = .005) affected the health behavior of adults with moyamoya disease. These 3 variables explained 62.0% of the variance of health behavior compliance, and the most influential factor was self-efficacy.
Conclusion
Based on the results of this study, it concludes that nursing interventions should be focused on self-efficacy and social support to improve health behavior compliance with adult patients diagnosed with moyamoya disease. For that, various strategies to enhance self-efficacy and social support should be developed and actively applied in the clinical setting for adult moyamoya patients.
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Original Articles
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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Qualitative Study on the Experience of Patients with Meniere Disease
Joung, Woo Joung
J Korean Acad Nurs 2020;50(5):699-713.   Published online October 31, 2020
DOI: https://doi.org/10.4040/jkan.20115
AbstractAbstract PDF
Purpose
The purpose of this study was to understand and describe the experiences of patients with Meniere disease.
Methods
Data were collected from February 19, 2019, to February 5, 2020, through individual in-depth interviews with 13 Meniere patients. Verbatim transcripts were analyzed using Colaizzi’s phenomenological analysis.
Results
The experiences of patients with Meniere disease were clustered into the following four themes from 22 meaning units: 1) Complex unfamiliar symptoms that shatter both balance of the body and peace of the heart; 2) A disease that medical treatment and health professionals cannot cure; 3) Suffering hardships that cannot be understood by non-Meniere sufferers; and 4) Making daily efforts to become healthier. Symptoms of Meniere disease are life-shattering and depressing because they are neither visible nor easily curable. Over time, as they accepted the reality of living with the disease, the participants would shift their focus from complete symptomatic cure to leading a healthy and more balanced life.
Conclusion
This study shows that Meniere disease has a pervasive impact on all aspects of the patients’ lives. Patients are prone to experiencing restrictions in their social functioning and activities. They also experience psychosocial problems due to the unseen nature of their symptoms. This study elucidates the experiences of Meniere patients and the need for nursing intervention to help improve their quality of life and ability to self-manage. Lastly, this study shows the need for a coordinated interdisciplinary approach to raising public awareness of the disease.
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Review Article
Continuity of Care in Chronic Diseases: A Concept Analysis by Literature Review
Hu, Jingjing , Wang, Yuexia , Li, Xiaoxi
J Korean Acad Nurs 2020;50(4):513-522.   Published online August 31, 2020
DOI: https://doi.org/10.4040/jkan.20079
AbstractAbstract PDF
Purpose
This study aimed to utilize concept analysis to obtain a better understanding of the concept of “continuity of care” in chronic diseases.
Methods
The concept of continuity of care was analyzed using the Walker and Avant method. Covering literature in English from 1930 to 2018, the data sources included CINAHL Complete, Academic Search Complete, MEDLINE, PsyARTICLES, Health Source: Nursing/ Academic Edition, Google Scholar, Science Direct, and the Cochrane Library.
Results
A comprehensive definition of concept of continuity of care was developed based on a systematic search and synthesis. The key defining attributes were identified as (a) care over time, (b) the relationship between an individual patient and a care team, (c) information transfer, (d) coordination, and (e) meeting changing needs. The antecedents of continuity of care were having a chronic disease, inexperienced with disease management, a poorly coordinated healthcare system, and medical care limitations. The consequences of continuity of care were decreasing hospital admissions, reducing costs, reducing emergency room visits, improving the quality of life, improving patient satisfaction, and delivering good healthcare.
Conclusion
The thorough concept analysis provides insight into the nature of “continuity of care” in chronic diseases and also helps ground the concept in healthcare.
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Original Articles
Effects of Spouse-Participated Health Coaching for Male Office Workers with Cardiocerebrovascular Risk Factors
So Hee Kang, Seon Young Hwang
J Korean Acad Nurs 2019;49(6):748-759.   Published online December 30, 2019
DOI: https://doi.org/10.4040/jkan.2019.49.6.748
AbstractAbstract PDF
Purpose

This study aimed to examine the effect of spouses participating in health coaching on stage of the change, health behaviors, and physiological indicators among male office workers with cardiocerebrovascular disease (CVD) risk factors and compare the findings with trainers who provided health coaching only to workers.

Methods

A quasi-experimental pretest-posttest design was used. Convenience sampling was used to recruit participants from a manufacturing research and development company in the city of Gyeonggi province. The health coaching program for the experimental group (n=26) included individual counseling sessions according to workers' stage of change, and provision of customized health information materials on CVD prevention to workers and their spouses for 12 weeks through mobile phone and email.

Results

After 12 weeks of intervention, the total score for health behavior, and scores on the sub-areas of exercise and health checkups significantly improved in the experimental group, but there were no significant differences in the scores of stage of the change and physical indicators. The results of a paired t-test showed a significant decrease in the body mass index, abdominal circumference, systolic blood pressure, diastolic blood pressure, total cholesterol and triglyceride values, and a significant increase in the high-density lipoprotein cholesterol value in the experimental group after the intervention.

Conclusion

To improve the health of male workers with CVD risk factors in the workplace, sharing health information with their spouses has proven to be more effective than health coaching for only workers. Therefore, it is important to develop strategies to encourage spousal participation when planning workplace health education for changing health-related behaviors.

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Effects of a Daily Life-Based Physical Activity Enhancement Program for Middle-Aged Women at Risk for Cardiovascular Disease
Kyung Ae Kim, Seon Young Hwang
J Korean Acad Nurs 2019;49(2):113-125.   Published online April 30, 2019
DOI: https://doi.org/10.4040/jkan.2019.49.2.113
AbstractAbstract PDF
Purpose

The purpose of this study was to examine the effects of a daily life-based physical activity enhancement program performed by middle-aged women at risk for cardiovascular disease.

Methods

This study used a randomized control group pretest-posttest design. Middle-aged women aged 45 to 64 were recruited from two outpatient cardiology departments, and randomly assigned to an experimental group (n=28) and a control group (n=30). For the experimental group, after providing one-on-one counseling and education, we provided customized text messages to motivate them in daily life. To monitor the practice of physical activity, they also used an exercise diary and mobile pedometer for 12 weeks. Subjects' physical activities (MET-min/week) were measured using the International Physical Activity Questionnaire (IPAQ). Their physiological data were obtained by blood tests using a portable analyzer, and the data were analyzed using the SPSS 21.0/WIN program.

Results

There were significant differences in exercise self-efficacy, health behavior, IPAQ score, body fat, body muscle, and fasting blood sugar between the two groups. However, there were no significant differences in total cholesterol, hemoglobin A1c, high-density lipoprotein cholesterol, and waist-to-hip ratio.

Conclusion

Strengthening physical activity in daily life without being limited by cost burden and time and space constraints. Therefore, it is essential to motivate middle-aged women at risk for cardiovascular disease to practice activities that are easily performed in their daily lives.

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Comparison of Effects of Oral Health Program and Walking Exercise Program on Health Outcomes for Pregnant Women
Hae-jin Park, Haejung Lee
J Korean Acad Nurs 2018;48(5):506-520.   Published online October 31, 2018
DOI: https://doi.org/10.4040/jkan.2018.48.5.506
AbstractAbstract PDF
Purpose

To compare the effects of the Interaction Model of Client Health Behavior (IMCHB)-based oral health program (OHP) and walking exercise program (WEP) on oral health behaviors, periodontal disease, physical activity, and psychological indicators (depression, stress, and quality of life) in pregnant women.

Methods

A nonequivalent control group pretest-posttest design was adopted to compare the effects of a 12-week OHP and WEP on pregnant women (n=65). Pregnant women were randomly assigned to the oral health group (OHG; n=23), walking exercise group (WEG; n=21), or control group (CG; n=21). Data were analyzed by the χ2-test, Fisher's exact test, Scheffe test, and repeated measures ANOVA, using the Statistical Package for the Social Sciences for Windows (version 21.0).

Results

The OHG and WEG showed significant improvements in oral health behaviors, periodontal disease, and psychological indicators as compared to the CG. The WEG showed significant improvement in physical activity as compared to the OHG and CG.

Conclusion

These findings indicate that the IMCHB-based OHP and WEP were effective in improving periodontal disease, physical activity, and psychological indicators. However, further studies are needed to identify the positive effects of the OHP and WEP on birth outcomes.

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Self-Management Experiences of the Adolescents with Chronic Kidney Disease
Sug Young Lee, Heesun Shin
J Korean Acad Nurs 2018;48(3):266-278.   Published online January 15, 2018
DOI: https://doi.org/10.4040/jkan.2018.48.3.266
AbstractAbstract PDF
Abstract Purpose

The aim of this study was to develop a substantive theory on self-management conducted by the adolescents with chronic kidney disease from their lived experience.

Methods

Data was collected through in-depth interviews from May to December in 2015 with thirteen adolescents with chronic kidney disease. The data collected were analyzed on the basis of Strauss and Corbin's grounded theory.

Results

The core of the category found in this study was “overcoming the unstable sense of self- control and integrating disease experience into their life”. The causal conditions triggering the central phenomenon were “restriction in daily life” and “manifestation and aggravation of symptom”. The central phenomenon in the experience of self-management within the adolescents with chronic kidney disease was “unstable sense of self control”. The intervening condition for unstable self control were “micro system support” and “motivational resources”. This study found that the adolescents with chronic kidney disease followed a series of strategies when they faced the central phenomenon, including; passive coping, reappraisal of illness, active coping, compliance with treatment, controlling physical activity, and adjusting school life. With these strategic approaches, the adolescents with chronic kidney disease could maintain their active lifestyles and achieve their health behaviors. The process of self-management by these adolescents passed through four phases; limited experience caused by diseases, effort for normalization, reorganizing their daily lives, and integration with daily lives and self-management.

Conclusion

This Study explored the process and experience of self-management of adolescents with chronic kidney disease. These findings can be used for basis for developing substantive theory and nursing intervention strategy for adolescents with chronic kidney diseases.

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Review Article
Effectiveness of Non-Pharmacologic Interventions in Chemotherapy Induced Peripheral Neuropathy: A Systematic Review and Meta-Analysis
Pok-Ja Oh, You Lim Kim
J Korean Acad Nurs 2018;48(2):123-142.   Published online January 15, 2018
DOI: https://doi.org/10.4040/jkan.2018.48.2.123
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Abstract Purpose

This study was conducted to evaluate the effectiveness of non-pharmacologic interventions in chemotherapy-induced peripheral neuropathy (CIPN).

Methods

PubMed, Cochrane Library CENTRAL, EMBASE, CINAHL, and several Korean databases (Until August 2017) were searched. The main search strategy combined terms for peripheral neuropathy and presence of neoplasms. The risk of bias was assessed using the Cochrane's Risk of Bias tool for randomized studies and the Risk of Bias Assessment tool for non-randomized studies. To estimate the effect size, a meta-analysis of the studies was performed using the Rev Man 5.3 program of the Cochrane Library random-effects models were used in the analyses.

Results

Twenty-two studies with a total of 954 participants met the inclusion criteria. Of the 22 studies, 12 were used to estimate the effect size of the non-pharmacologic interventions. The non-pharmacologic interventions used in patients with CIPN were exercise, acupuncture, massage, and foot bath. The acupuncture significantly reduced CIPN symptoms and signs (d=-0.71) and CIPN pain (d=-0.73) (p<.001). Massage and foot bath were also effective in reducing CIPN symptoms (d=-0.68; 95% CI=-1.05, -0.30; p<.001; I2=19%).Exercis-es were effective in improving muscle strength and endurance(d=-0.55) and quality of life (d=-2.96), but they were not significantly effective in improving CIPN.

Conclusion

Although these results provide little evidence of the effectiveness of acupuncture, massage, and foot bath in the treatment of CIPN, they suggest that these interventions can reduce CIPN symptoms in patients with cancer. However, the findings of this study should be interpreted with caution as there is a relative lack of data in this field, and additional well-designed studies are needed. PROSPERO registration: CRD42017076278.

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Original Articles
Structural Equation Modeling on Successful Aging in Elders with Chronic Obstructive Pulmonary Disease Based on Selection-Optimization-Compensation Strategy
Young Mi Jang, Rhayun Song
J Korean Acad Nurs 2017;47(4):488-498.   Published online August 31, 2017
DOI: https://doi.org/10.4040/jkan.2017.47.4.488
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Purpose

The focus of the study was on the selection-optimization-compensation (SOC) strategy to predict successful aging mediated by dyspnea symptoms in older adults with chronic obstructive pulmonary disease. The model was constructed based on the hypotheses that coping strategy and social support of the elders predict successful aging through the SOC strategies.

Methods

Participants were 218 outpatients with chronic obstructive pulmonary disease recruited for the study. Data collection was done from March 25 to September 11, 2015, and analyzed using SPSSWIN 22.0 and AMOS 21.0.

Results

The hypothetical model appeared to be fit to the data. Seven of eight hypotheses selected for hypothetical model were statistically significant. The SOC strategy has only significant indirect effects through dyspnea symptoms on successful aging. Coping strategy, social support, SOC strategies and dyspnea symptoms explained 62% of variance in successful aging.

Conclusion

The SOC strategies with social support and dyspnea symptoms significantly explained successful aging among patients with chronic obstructive pulmonary disease. Nursing strategies should be focused on social support and coping strategies to optimize SOC strategies so that older adults with chronic obstructive pulmonary disease are able to manage dyspnea symptoms and eventually achieve successful aging.

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Prevention Stages for Sexually Transmitted Diseases of College Students
Soon Bok Chang
Journal of Nurses Academic Society 1997;27(2):423-432.   Published online March 30, 2017
DOI: https://doi.org/10.4040/jnas.1997.27.2.423
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This is a descriptive study to understand the preventive stage for STDs to provide a basis for sex education for college students. The colleges were selected by quota sampling in five representative cities in Korea, but the1,691 college students were selected by convenient sampling in the cities nationwide, and the data were collected by self-reporting using questionnaire consisting of 33 items. The results were as follows : 1. Their mean ages were 21.8 for female and 23.3 for male students, 2. 78.0% of the males and 46.5% of the females permitted premarital sex, 57.1% of male and 10.3% of female college students had experienced sexual intercourse, 7.1% of males and 2.4% of females had experienced pregnancy, 10.3% of males and 3.4% of females had been infected with STDs, 72.1% of male and 13.8% of female didn't use condoms at the time of infection. 3. Most of the factors related to STDs infection, such as drinking, smoking, frequency of sexual intercourse, pregnancy, knowledge of STDs, the score of STDs prevention were statistically higher in the male student group than in the female group. 4. The student's mean score of knowledge about STDs was similar between the male group(7.80)and the female group(7.84) with a possible score range from 0-18. 5. Only fifteen percent of male and 9.6% of female students expressed that they will do something to prevent STD. 6. The group having the experience of sexual intercourse(t=3.924, P=.048) and the group of having experience of contracting STDs(t=16.638, P=.000) had shown statistically higher STDs prevention score than the group not having that kind of experience, but the group not having experience with pregnancy didn't show any difference from the group not having experience with pregnancy. Considering that 57.1% of males and 10.3% of females had sexual intercourse experience, 78% of male and 46.5% of female permitted premarital sex, 10.3% of male and 3.4% of female had been infected with STDs. It could be concluded that the college students were ignorant about the prevention of STDs and had unrealistic stage of the STDs prevention. Therefore, enforcement of education for the prevention of STDs including the dynamics of the sexual intercourse and STDs infection is needed.

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Factors Influencing Functional Status in People with Chronic Lung Disease
Eui Geum Oh, Cho Ja Kim, Won Hee Lee, So Sun Kim, Bo Eun Kwon, Yeon Soo Chang, Ji Yeon Lee, Young Jin Kim
Journal of Korean Academy of Nursing 2002;32(5):643-653.   Published online March 29, 2017
DOI: https://doi.org/10.4040/jkan.2002.32.5.643
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PURPOSE: The purpose of this study was to identify factors that influence the functional status of chronic lung disease patients. METHOD: A descriptive, correlational study design was used. The study was conducted at the outpatient respiratory clinic of the large university hospital in Korea. A convenience sample of 128 chronic lung patients (age = 64.2 yrs; 106 COPD, 17 bronchiectasis, 5 DILD) with mean FEV1 64.4 % predicted. Functional status was measured with SIP. Physical variables (FEV1% predicted, dyspnea, fatigue, pulmonary symptom distress), psychological variables (mood, stress), and situational variable (sleep quality) were examined. Dyspnea was measured by the BDI, fatigue was measured with the MFI. Mood was measured with the modified Korean version of POMS. Sleep quality was measured with the Pittsburgh Sleep Quality Index. Potential independent variables for the regression were age, gender, years since diagnosis, FEV1% predicted, dyspnea, fatigue, pulmonary symptom distress, stress, and sleep quality. RESULT: In general, functional status was relatively good. In regression analysis, functional status were significantly influenced by dyspnea, mood, age and fatigue. These variables explained 70 % of the variances in functional status. CONCLUSION: The results suggest that psychophysiologic symptom management should be a focus to enhance the functional status in this group.

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Predictors of Intention to Quit Smoking among Patient with Coronary Heart Disease
Eun Kyung Kim, Mae Ja Kim, Mi Ryung Song
Journal of Korean Academy of Nursing 2002;32(3):355-363.   Published online March 29, 2017
DOI: https://doi.org/10.4040/jkan.2002.32.3.355
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PURPOSE: The purpose of this study was to examine the level of intention to quit smoking and to identify factors influencing intention to quit among patients with coronary heart disease. Method: The subjects consisted of 80 male patients with coronary heart disease (angina pectoris, myocardial infarction) at three hospitals in Seoul. The data were collected with self reporting in a structured questionnaire. Stepwise multiple regression was used to identify predictors of intention to quit. Included variables were attitudes toward smoking cessation, subjective norms, perceived behavioral control, usefulness of smoking cessation, and previous attempts to quit. RESULT: 1. The mean score for intention to quit was 11.1(+/-6.1) which was lower than median score of the scale. 2. There were significant correlations between the all predictive variables and the intention to quit(r=.24-.48, p<.05). 3. usefulness of smoking cessation, perceived behavioral control, and previous attempts to quit explained 34.6% of the variance for intention to quit. CONCLUSION: usefulness of smoking cessation, perceived behavioral control, and previous attempts to quit were identified as important variables in explaining the intention to quit smoking among patients with coronary heart disease. Thus, it is necessary to try to enhance this factors for increasing intention to quit among patients with coronary heart disease.

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Effects of a Occupational Health Promotion Program for Prevention of Cardiovascular Disease
Jee Won Park, Yong Soon Kim, Gi Yon Kim
Journal of Korean Academy of Nursing 2002;32(2):196-205.   Published online March 29, 2017
DOI: https://doi.org/10.4040/jkan.2002.32.2.196
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PURPOSE: The purposes of this study was to evaluate an occupational health promotion program for the prevention of cardiovascular disease. METHOD: This study employed a quasi-experimental non-equivalent pre and post test to evaluate the program. The subjects of this study were 48 employees selected by convenience sampling who were suspected of having hypertension and hyperlipidemia in routine physical examinations and who were working in A University Hospital in Suwon. 25 subjects were assigned to the experimental group and 23 to the control group. Data collection was done using questionnaries before and after the subjects used the program. RESULTS: The results of this study showed that systolic blood pressure, ALT, gamma-GTP in the experimental group was lower than that of the control group. There were significant differences between two groups in the percentage of 'irregularity of diet' and in health behavior compliance. There were significant differences between the two groups in the number of complaints of symptoms after using the program. CONCLUSION: This study shows that there were no obvious differences between the two groups in all areas, but this program had a positive effect on health behavior changes. It is expected that employees' lifestyles can be changed through continuous health promotion programs.

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The Influencing Factors on Health Behavior of Patients with Coronary Artery Disease
Young Whee Lee, Hwa Soon Kim, Eui Young Cho
Journal of Korean Academy of Nursing 2002;32(1):40-49.   Published online March 29, 2017
DOI: https://doi.org/10.4040/jkan.2002.32.1.40
AbstractAbstract PDF

PURPOSE: The purpose of this study was to investigate the influencing factors on health behavior among patients with coronary artery disease.
METHOD
The subjects were 95 patients who visited the out-patient department of a university hospital for follow-up. The four health belief concepts (motivation, benefit, barrier, seriousness), general self-efficacy, health behaviors on medication, diet, exercise, stress management, smoking, and drinking were measured.
RESULT
There were significant differences in the health behavior scores of subjects according to family support and the experience of surgical procedure. Subjects were found to have a high degree of compliance in taking medication. However subjects reported the lowest degree of compliance in regular exercise. In the multiple regression analysis, surgical procedure and motivation were significant predictors to explain diet. Motivation and barrier were significant predictors to explain exercise. Self-efficacy, motivation and family support were significant predictors to explain stress management. Family support and seriousness explained 16% of variance in drinking. Also, family support explained 30% of variance in smoking.
CONCLUSION
Since predicting factors on each health behavior indicator were different, then nurses should consider these differences to construct strategy enhancing patient's recovery.

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A Structural Model for Health Promoting Behaviors in Patients with Chronic Respiratory Disease
Young Joo Park, So In Kim, Pyoung Sook Lee, Soon Yong Khim, Sook Ja Lee, Eun Sook Park, Ho Shin Ryu, Sung Ok Chang, Kuem Sun Han
Journal of Korean Academy of Nursing 2001;31(3):477-491.   Published online March 29, 2017
DOI: https://doi.org/10.4040/jkan.2001.31.3.477
AbstractAbstract PDF

PURPOSE: This study was designed to construct a structural model for health promoting behavior in patients with chronic respiratory disease. A hypothetical model was developed based on the literature review. METHOD: Data was collected by questionnaires from 235 patients with chronic respiratory disease in a General Hospital in Seoul. Data analysis was done using SAS 6.12 for descriptive statistics and the PC-LISREL 8.13 Program for Covariance Structural Analysis. RESULT: The results are as follows : 1. The fit of the hypothetical model to the data was moderate. It was modified by excluding 2 path and including free parameters and 3 path to it. The modified model with path showed a good fitness to the empirical data(X2=80.20, P=0.05, GFI=0.95, AGFI=0.88, NNFI=0.95, NFI=0.96, RMSR=0.01, RMSEA =0.06). 2. The perceived benefits, self-efficacy, and a plan of action were found to have significant direct effects on the health promoting behavior in patients with chronic respiratory disease. 3. The health perception, self-esteem, and activity related to affect were found to have indirect effects on the health promoting behavior in patients with chronic respiratory disease. CONCLUSION: The modified model of this study is considered appropriate in explaining and predicting health promoting behavior in patients with chronic respiratory disease. Therefore, it can effectively be used as a reference model for further studies and suggested direction in nursing practice.

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A Structural Model Based on Pender's Model for Quality of Life of Chronic Gastric Disease
Eun Sook Park, So In Kim, Pyoung Sook Lee, Soon Yong Khim, Sook Ja Lee, Young Joo Park, Ho Shin Ryu, Sung Ok Chang, Kuem Sun Han
Journal of Korean Academy of Nursing 2001;31(1):107-125.   Published online March 29, 2017
DOI: https://doi.org/10.4040/jkan.2001.31.1.107
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This study was designed to construct a structural model for quality of life of chronic gastric disease. The hypothetical model was developed based on the literature review and Pender's health promotion model. Data were collected by questionnaires from 459 patients with chronic gastric disease in a General Hospital from July 1999 to August 2000 in Seoul. Data analysis was done with SAS 6.12 for descriptive statistics and PC-LISREL 8.13 Program for Covariance structural analysis. The results are as follows : 1. The fit of the hypothetical model to the data was moderate, thus it was modified by excluding 1 path and including free parameters and 2 path to it. The modified model with path showed a good fitness to the empirical data (Chi2=934.87, p<.0001, GFI=0.88, AGFI=0.83, NNFI=0.86, RMSR =0.02, RMSEA=0.07). 2. The perceived barrier, health promoting behavior, self-efficacy, and self-esteem were found to have significant direct effects on the quality of life. 3. The health concept, health perception, emotional state, and social support were found to have indirect effects on quality of life of chronic gastric disease. In conclusion, the derived model in this study is considered appropriate in explaining and predicting quality of life of chronic gastric disease. Therefore it can effectively be used as a reference model for further studies and suggested direction in nursing practice.

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Perceived Exercise Self-Efficacy and Exercise Benefits/Barriers of Korean Adults with Chronic Diseases
Yun Hee Shin, Hee Jung Jang
Journal of Korean Academy of Nursing 2000;30(4):869-879.   Published online March 29, 2017
DOI: https://doi.org/10.4040/jkan.2000.30.4.869
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The purpose of this study was to assess the perceived exercise self-efficacy and exercise benefits/barriers of Korean adults with chronic diseases, and the relationship between the two variables. For the study, 249 Korean adults with chronic diseases with ages ranging from 18 to 79 years were recruited from hospitals or health centers in five Korean cities and surrounding rural areas. The research instruments were the scales that researchers psychometrically verified the Exercise Self-Efficacy Scale, developed by Bandura (1997), and the Exercise Benefits/ Barriers Scale, developed by Sechrist, Walker, and Pender(1987). Results of descriptive analysis showed that Korean adults with chronic diseases perceived relatively low exercise self-efficacy and relatively high exercise benefits/ barriers. Exercise self-efficacy was significantly correlated with gender, education, regular exercise, and exercise benefits/barriers was significantly correlated with gender, regular exercise. Pearson correlation coefficient showed the significant relationship between the two variables. Further researches, which are a study to evaluate a causal structure for Pender's Health Promotion Model and an intervention study to increase physical activity of chronic patients, are recommended.

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A Study on the Circadian Blood Pressure Rhythm of Diabetic Patients
Hwa Soon Kim, Wha Sook Suh
Journal of Korean Academy of Nursing 2000;30(3):741-749.   Published online March 29, 2017
DOI: https://doi.org/10.4040/jkan.2000.30.3.741
AbstractAbstract PDF

This study was performed to investigate the relationship between reversed circadian blood pressure and risk factors of peripheral vascular disease in non-insulin-dependent diabetes mellitus (NIDDM) subjects. The subjects in this study were 18 NIDDM patients who were hospitalized in a medical unit of an university medical center located in Incheon, Korea, between November, 1998 and March, 1999. Blood pressure was measured with a mercury sphygmomanometer by 2 trained examiners every 2 hours during 24 hours. NIDDM subjects were divided into a dipper group and non-dipper group. Dippers are defined as those who show a mean nighttime blood pressure(BP) drop of more than 10% compared with daytime BP. Non-dippers are defined as those who show a mean nighttime BP drop of less than 10%, or an elevation in BP compared with daytime BP. Daytime BP included values obtained between 6 a.m. and 10 p.m. Night time BP included values obtained between 10 p.m. and 6 a.m. Data was analyzed by SPSS/PC package. Chi-square( 2) test was used for the comparison of sex between The dipper group and non-dipper group. Mann-Whitney test was used for comparisons of values of the risk factors of peripheral vascular disease and the frequency of complications of diabetes between the dipper group and non-dipper group. The results are as follows. There were no significant differences in daytime systolic, diastolic, and mean blood pressures between the dipper group and non-dipper group. However, night time systolic, diastolic, and mean blood pressures in the non-dipper group were significantly nigher than those in the dipper group (p=.021). There were no differences in sex, age, body, weight, duration of diabetes, serum lipid levels, BUN and HbA1c between the two groups. On the contrary, 87.5% of non-dipper group subjects showed having hypertension, 30% of dipper group subjects showed having hypertension and this difference was statistically significant (p=.018). All of the non-dipper group subjects (N=8) showed having at least one diabetic complication. However, 40% of the dipper group subjects (N=10) showed having no diabetic complication at all and this difference was also statistically significant (p=.049). There were no significant differences in frequency of nephropathy, neuropathy and retinopathy between the dipper group and non-dipper group.

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