Journal of Korean Academy of Nursing

The Effects of a Self-Efficacy Theory-Based Exercise Program for Patients Undergoing with Total Knee Arthroplasty: Kyung-Hye Park, Hee-Young Kang; J Korean Acad Nurs 2024;54(4):547-562. Published online October 22, 2024; DOI: https://doi.org/10.4040/jkan.24027

Abstract PDF Supplementary Material ePub: Purpose
This study was performed to develop a self-efficacy theory-based exercise program for total knee arthroplasty (TKA) and to test the program’s efficacy in ameliorating knee pain and restoring function as measured by lower extremity muscle strength, 3 meter walking time, Korean Western Ontario McMaster Index (WOMAC), exercise self-efficacy, and length of hospital stay for TKA patients.
Methods
This quasi-experimental study incorporating a non-equivalent control group and pretest-posttest non-synchronized design non-synchronous design was applied to assess self-efficacy reinforcement strategies based on self-efficacy theory. The exercise program consisted of the following steps: TKA, education to prevent postoperative complications, and muscle strength exercises. Respective exercise and control groups included 29 and 27 participants. The experimental group received eight sessions of the program from three weeks before TKA to four weeks after TKA. Collected data were analyzed using the chi-square test, Mann–Whitney U test, and ranked ANCOVA and t-tests using IBM SPSS Statistics 23.
Results
Experimental group showed significant improvement in lower extremity muscle strength (F = 8.63, p = .005), 3 meter walking time (z = - 5.02, p < .001), WOMAC index (z = - 2.22, p = .027), self-efficacy for exercise (z = - 3.29, p = .001), and length of hospital stay (t = - 2.11, p = .040) compared to the control group. No significant differences in knee pain and range of motion were observed.
Conclusion
These findings indicate that a self-efficacy theory-based exercise program can be an effective exercise strategy that patients undergoing TKA can easily follow at home without assistance. It is thus recommended as an exercise intervention for TKA patients.

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Development and Effectiveness of Progressive Simulation Education Program on Medication Safety for Nursing Students: Se-Young Jung, Eun-Young Kim; J Korean Acad Nurs 2024;54(4):563-576. Published online October 14, 2024; DOI: https://doi.org/10.4040/jkan.24054

Abstract PDF ePub: Purpose
This study aimed to develop and verify a progressive simulation education program aimed at enhancing nursing students’ medication safety competency.
Methods
A non-equivalent control group pretest-posttest design was adopted. The participants were 40 third-year nursing students with no prior simulation education experience, comprising 20 each in the experimental and control groups. The experimental treatment utilized a hybrid simulation approach incorporating both full-body mannequins and standardized patients and was, conducted over three sessions with durations of 65, 80, and 95 minutes for the first, second, and third sessions, respectively, for a total of 240 minutes. The program was constructed based on Jeffries’ simulation model.
Results
The levels of medication safety competencies, communication self-efficacy, learning self-efficacy, and problem-solving abilities of the experimental group were significantly higher than that of the control group.
Conclusion
Our results confirm that the program effectively improves nursing students’ medication safety competence, communication self-efficacy, learning self-efficacy, and problem-solving ability. Therefore, this program can serve as a basis for developing educational strategies related to medication safety for nursing education institutions. Furthermore, the program is anticipated to have a positive impact on novice nurses’ education and practice in clinical settings.

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Development of the Hybrid Clinical Practicum Environment Scale for Nursing Students: Yoon, Seoyoung , Yeom, Hye-Ah; J Korean Acad Nurs 2024;54(3):340-357. Published online August 31, 2024; DOI: https://doi.org/10.4040/jkan.24016

Abstract PDF: Purpose
This study aimed to develop a Hybrid Clinical Practicum Environment Scale for Nursing Students (HCPES-NS) and verify its validity and reliability.
Methods
The HCPES-NS was constructed following the DeVellis guidelines. The initial items were written based on a literature review and individual in-depth interviews. Content validity was verified through an expert panel review. To confirm the validity and reliability of the scale, a survey was conducted with 449 nursing students enrolled in 12 nursing colleges. Data were analyzed using item analysis, exploratory factor analysis, confirmatory factor analysis, concurrent validity, and reliability tests.
Results
Factor analysis showed that the HCPES-NS consists of 15 items on five subdomains: clinical site atmosphere, interpersonal relationship, alternative online practicum contents, provision of learning information, and clinical performance facilitation. A higher score indicated a more positive perception of the clinical practicum environment. The concurrent validity of the HCPES-NS was confirmed by its positive correlation with the Clinical Learning Environment Scale (r = .77). The Cronbach’s α reliability of the HCPES-NS was .84.
Conclusion
The HCPES-NS is both valid and reliable. This scale reflects the clinical practicum environment and includes an online practicum factor. It may be used effectively by faculty members and educators to evaluate nursing students’ perceptions of clinical practicum environments.

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Sleep Deprivation and Fatigue among Nurses Working Consecutive Night Shifts: A Prospective Observational Study: Min, Ari , Seo, Jisu , Kang, Minkyung , Hong, Hye Chong; J Korean Acad Nurs 2024;54(2):139-150. Published online May 31, 2024; DOI: https://doi.org/10.4040/jkan.23164

Abstract PDF: Purpose
This study aimed to identify changes in sleep patterns and fatigue levels during consecutive night shifts among shift nurses and to determine the association between sleep parameters and increased fatigue levels during work.
Methods
This prospective observational study employing ecological momentary assessments was conducted using data collected from 98 shift nurses working in Korean hospitals between June 2019 and February 2021. The sleep patterns were recorded using actigraphy. The participants reported their fatigue levels at the beginning and end of each night shift in real time via a mobile link. Linear mixed models were used for the analysis.
Results
Nurses spent significantly less time in bed and had shorter sleep durations during consecutive night shifts than on off-duty days, whereas their wake times after sleep onset were much longer on off-duty days than on on-duty days. Fatigue levels were higher on the second and third night-shift days than on the first night-shift days. A shorter time spent in bed and asleep was associated with a greater increase in fatigue levels at the end of the shift than at the beginning.
Conclusion
Nurses experience significant sleep deprivation during consecutive night shifts compared with off-duty days, and this sleep shortage is associated with a considerable increase in fatigue levels at the end of shifts. Nurse managers and administrators must ensure sufficient intershift recovery time during consecutive night shifts to increase the time spent in bed and sleeping.

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Psychometric Properties of the Fall Risk Perception Questionnaire-Short Version for Inpatients in Acute Care Hospitals: Choi, Jeeeun , Lee, Sujin , Park, Eunjin , Ku, Sangha , Kim, Sunhwa , Yu, Wonhye , Jeong, Eunmi , Park, Sukhee , Park, Yusun , Kim, Hye Young , Kim, Sung Reul; J Korean Acad Nurs 2024;54(2):151-161. Published online May 31, 2024; DOI: https://doi.org/10.4040/jkan.23127

Abstract PDF: Purpose
Patients’ perception of fall risk is a promising new indicator for fall prevention. Therefore, a fall risk perception questionnaire that can be used rapidly and repeatedly in acute care settings is required. This study aimed to develop a short version of the fall risk perception questionnaire (Short-FRPQ) for inpatients.
Methods
For the psychometric measurements, 246 inpatients were recruited from an acute care hospital. The construct (using confirmatory factor analysis and discriminant validity of each item), convergent, and known-group validities were tested to determine the validity of the Short-FRPQ. McDonald’s omega coefficient was used to examine the internal consistency of reliability.
Results
In the confirmatory factor analysis, the fit indices of the Short-FRPQ, comprising 14 items and three factors, appeared to be satisfactory. The Short-FRPQ had a significantly positive correlation with the original scale, the Korean Falls Efficacy Scale-International, and the Morse Fall Scale. The risk of falls group, assessed using the Morse Fall Scale, had a higher score on the Short-FRPQ. McDonald’s omega coefficient was .90.
Conclusion
The Short-FRPQ presents good reliability and validity. As patient participation is essential in fall interventions, evaluating the fall risk perception of inpatients quickly and repeatedly using scales of acceptable validity and reliability is necessary.

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Analysis of the Adequacy of Nurse Staffing Level through the Estimation of Nursing Activity Hours and Implementation of Focus Group Interviews in a Tertiary Hospital: Using a Mixed-Method Design: Kim, Hyun-Joo , Lee, Sun-Hee , Lee, Jai-Jung , Seong, Sun-Suk , Yang, Hee , Lee, Hyang-Yuol; J Korean Acad Nurs 2024;54(2):237-249. Published online May 31, 2024; DOI: https://doi.org/10.4040/jkan.22142

Abstract PDF: Purpose
This study aimed to examine the adequacy of current nurse staffing levels by identifying nursing activities and workload.
Methods
The study used a mixed-method design. A nursing activity survey was conducted using the work sampling method over 2 working days with 119 general ward nurses. A focus group interview was conducted with 12 nurses. Quantitative and qualitative data were analyzed using SPSS 20.0 and content analysis, respectively.
Results
The most amount of time was spent on medication (in direct nursing) and electronic medical record documentation (in indirect nursing). The appropriate nurse-to-patient ratio is 1:7.7 for the day shift, 1:9.0 for the evening shift, and 1:11.9 for the night shift. However, the current nurse-to-patient ratio is 1:9.4, 1:11.0, and 1:13.8 for the day, evening, and night shifts, respectively. Therefore, the current nurse staffing level is insufficient for the workload. In the focus group interview, the main reasons cited for being unable to complete tasks within working hours were communication and coordination, and the nursing electronic medical record. The essential nursing activities of basic nursing and emotional support were overlooked owing to a heavy workload. Therefore, an adequate nurse staffing level should be higher than the measured quantitative workload.
Conclusion
These results suggest the general wards of tertiary hospitals should evaluate the adequacy of their current nurse staffing and allocate sufficient nurses to improve patient safety and nursing care quality.

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The Effects of Stress Vulnerability and Parental Burnout on Mental Health in Women with Early School-Age Children during the COVID-19 Pandemic: Mediating Effect of Spirituality: Yeom, Mijung , Kwon, Min; J Korean Acad Nurs 2024;54(1):106-117. Published online February 29, 2024; DOI: https://doi.org/10.4040/jkan.23150

Abstract PDF: Purpose
This study examined the effects of stress vulnerability and parental burnout on the mental health of women with early schoolaged children, with a focus on the mediating role of spirituality.
Methods
A survey was conducted among 171 women with early schoolaged children in Gyeonggi Province, Gangwon Province, and Seoul. Data were collected from September to December 2022 using the Korean-Symptom Check List 95, the Parental Burnout Assessment, and the Spirituality Assessment Scale. The data were analyzed using structural equation modeling with SPSS/WIN 22.0 and AMOS 20.0.
Results
The study model demonstrated a good fit, explaining 40.5% of the variance in mental health through stress vulnerability, parental burnout, and spirituality. Spirituality had a significant direct impact on mental health. Additionally, participants’ spirituality directly influenced their mental health, while stress vulnerability and parental burnout indirectly affected their mental health and were mediated through spirituality.
Conclusion
Stress vulnerability and parental burnout are negatively associated with mental health, while spirituality partially mediates these effects. Implementing a program to promote spirituality is suggested to assist mothers in recognizing the value and meaning of parenting activities during nursing interventions for mental health.

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Factors Influencing the Intention for Continual Fertility Treatments by the Women Undergoing Assisted Reproductive Technology Procedures: A Cross-Sectional Study: Kim, Miok , Kim, Minkyung , Ban, Minkyung; J Korean Acad Nurs 2024;54(1):59-72. Published online February 29, 2024; DOI: https://doi.org/10.4040/jkan.23095

Abstract PDF: Purpose
This cross-sectional study aimed to identify factors influencing the intention for continual fertility treatments among women undergoing assisted reproductive technology (ART).
Methods
A total of 197 women were recruited through convenience sample from fertility hospitals in Gyeonggi-do and Busan, South Korea. Data were collected using a self-report questionnaire incorporating measures of uncertainty; Depression Anxiety Stress Scales; Fatigue Severity Scale; Coping Scale for Infertility-Women; spousal support; treatment environment; and intention for continual fertility treatment. Descriptive statistics, chi-square tests, t-tests, and logistic regression analysis were conducted using IBM SPSS 26.0.
Results
As many as 70.6% of the participants expressed an intention for continual fertility treatments. Logistic regression analysis revealed that factors such as uncertainty (odds ratio [OR] = 0.44, 95% confidence interval [CI] 0.20~0.95), active coping (OR = 4.04, 95% CI 1.11~14.71), treatment environment (OR = 2.77, 95% CI 1.26~6.07), and the duration of marriage (OR = 2.61, 95% CI 1.24~5.49) were significantly related with this intention.
Conclusion
These findings underscore the significance of uncertainty management, having proactive coping strategies, having supportive treatment environments, and considering the duration of marriage concerning women’s intention for continual fertility treatment in the context of ART. The implications of these results extend to the development of nursing intervention programs aimed at providing crucial support for women undergoing ART and seeking to continue their infertility treatment.

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Development of Nursing Clinical Judgment Scale: Kwon, Shi Nae , Park, Hyojung; J Korean Acad Nurs 2023;53(6):652-665. Published online December 31, 2023; DOI: https://doi.org/10.4040/jkan.23042

Abstract PDF: Purpose
This study aimed to develop a nursing clinical judgment scale (NCJS) and verify its validity and reliability in assessing the clinical judgment of nurses.
Methods
A preliminary instrument of the NCJS comprising 38 items was first developed from attributes and indicators derived from a literature review and an in-depth/focus interview with 12 clinical nurses. The preliminary tool was finalized after 7 experts conducted a content validity test based on a data from a preliminary survey of 30 hospital nurses in Korea. Data were collected from 443 ward, intensive care unit, emergency room nurses who voluntarily participated in the survey through offline and online for the verification of the construct validity and reliability of the scale.
Results
The final scale comprised 23 items scored on a 5-point Likert scale. Six factors – integrated data analysis, evaluation and reflection on interventions, evidence on interventions, collaboration among health professionals, patient-centered nursing, and collaboration among nurse colleagues – accounted for 64.9% of the total variance. Confirmatory factor analysis supported the fit of the measurement model, comprising six factors (root mean square error of approximation = .07, standardized root mean square residual = .04, comparative fit index = .90). Cronbach’s α for all the items was .92.
Conclusion
The NCJS is a valid and reliable tool that fully reflects the characteristics of clinical practice, and it can be used effectively to evaluate the clinical judgment of Korean nurses. Future research should reflect the variables influencing clinical judgment and develop an action plan to improve it.

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A Caring Program for Health Promotion among Women Who Have Experienced Trauma: A QuasiExperimental Pilot Study: Kim, Goun , Kim, Heejung , Park, Jeongok , Kang, Hee Sun , Kim, Soojin , Kim, Sunah; J Korean Acad Nurs 2023;53(5):500-513. Published online October 31, 2023; DOI: https://doi.org/10.4040/jkan.22120

Abstract PDF: Purpose
Women are more vulnerable to post-traumatic stress (PTS) than men, causing several health problems. Nurses should understand and work with women who have experienced trauma and provide interventions to promote their physical, social, and mental health.
Methods
This quasi-experimental pilot study used a one-group pre-test/post-test design. Data were collected from 14 women recruited between December 2019 and May 2020 from a self-sufficiency support center in South Korea for sexually-exploited women who had experienced trauma. The program consisted of six one-on-one intervention sessions per week for six weeks. Each session averaged 60~120 minutes. Participants were assessed at pre-test, post-test, and one-month follow-up. Changes in outcome variables over time were analyzed using the Wilcoxon signed-rank and Friedman tests.
Results
The caring program for health promotion was divided into six sessions: understanding the self, sharing traumatic events and negative emotions, reframing the meaning of traumatic events, identifying thoughts and physical and emotional responses, developing health promotion activities, and maintaining a positive attitude during the process of change. As a result of the caring program, PTS (F = 36.33, p < .001), depression (F = 24.45, p < .001), health-promoting behaviors (F = 7.06, p = .004), and self-esteem (F = 19.74, p < .001) among the participants differed significantly at pre-test, post-test, and follow-up.
Conclusion
This study provides foundational information for the implementation of a theory-driven program by nurses in clinical and community settings to provide comprehensive care for women who have experienced trauma.

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A Structural Equation Model on Social Re-Adjustment of Stroke Patients: Based on Roy’s Adaptation Model: Kim, Jungmi , Kim, Hwasoon; J Korean Acad Nurs 2023;53(4):480-495. Published online August 31, 2023; DOI: https://doi.org/10.4040/jkan.22140

Abstract PDF: Purpose
This study aimed to develop and test a structural equation model on social re-adjustment of individuals with stroke based on a literature review and Roy’s adaptation model.
Methods
This study involved 321 participants who had a stroke and visited the outpatient department after discharge. The hypothetical model was developed based on Roy’s adaptation model and a comprehensive review of previous literature on the topic. The model comprised four exogenous variables (neurological damage, gender [man], age, and social support) and five endogenous variables (activities of daily living, acceptance of disability, depression, rehabilitation motivation, and social re-adjustment). The data were analyzed using SPSS Windows software version 22.0 and AMOS 23.0.
Results
Out of 28 research hypotheses, 18 were supported, and they indicated approximately 64% probability of social re-adjustment. Social re-adjustment is directly and significantly affected by age, social support, activities of daily living, and depression. Social re-adjustment is indirectly affected by neurological impairment, gender (men), age, social support, and rehabilitation motivation.
Conclusion
Continuous assistance and care should be provided for individuals with disabilities caused by sudden neurological damage to facilitate gradual improvement in their social re-adjustment. To enhance social re-adjustment, especially among older adults, newly developed interventions should focus on improving their activities of daily living, preventing depression, and enhancing support from family and healthcare personnel.

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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

Abstract 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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The Effect of Socioeconomic Status to Depression of Perimenopause Women: Pathway Analysis Using the Reserve Capacity Model: Park, Mi-Ran , Choi, Hye Seung , Lee, Ju-Young; J Korean Acad Nurs 2023;53(2):249-259. Published online April 30, 2023; DOI: https://doi.org/10.4040/jkan.22133

Abstract PDF: Purpose
Based on the Reserve Capacity Model, this study investigated the effects of pre- and postmenopausal women’s socioeconomic status (SES) on depression, focusing on the mediating effects of self-esteem, happiness, and family relationship satisfaction with social network relationships.
Methods
This cross-sectional study involved secondary analysis of national data on 771 perimenopause women gathered from the 16th Korea Welfare Panel Study (KOWEPS) 2021. A path analysis model was constructed to evaluate the relationship between SES, social network satisfaction, self-esteem, perceived health status, and depression. Data were analyzed using ADANCO 2.3.1 and Mplus 8.4.
Results
Although SES had no direct effect on depression, it did affect depression through self-esteem, happiness, and satisfaction with family relationships.
Conclusion
The findings of this study indicate that perimenopausal women’s personal resources—psychosocial variables such as self-esteem and happiness—had a higher effect on depression than tangible reserves like SES. Therefore, interventions for enhancing self-esteem and happiness may prevent depression in perimenopausal women effectively.

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Effects of Clinical Nurses’ Job Crafting on Organizational Effectiveness Based on Job DemandsResource Model: Lee, Eun Young , Kim, Eungyung; J Korean Acad Nurs 2023;53(1):129-143. Published online February 28, 2023; DOI: https://doi.org/10.4040/jkan.22138

Abstract PDF: Purpose
This study aimed to examine the mediating effects of clinical nurses’ job crafting on organizational effectiveness based on the job demands-resources model proposed by Bakker and Demerouti (2017).
Methods
The participants consisted of 393 nurses working in nursing units of a tertiary general hospital located in Cheongju region. The data, collected using questionnaire from August 9 to August 20, 2021, were analyzed using SPSS 23.0 and AMOS 27.0.
Results
The goodness-of-fit (GoF) test results on the modified model (χ 2 = 2.7, GFI = .94, SRMR = .03, RMSEA = .06, NFI = .92, CFI = .94, TLI = .92, AGFI = .90), indicated that the GoF index satisfied the recommended level. Regarding the effects of each variable on organizational effectiveness, job crafting showed statistically significant direct (β = .48, p < .001), indirect (β = .23, p < .001), and total effects (β = .71, p < .001). Burnout showed statistically significant direct effect (β = - .17, p < .001). Work engagement showed statistically significant direct (β = .41, p < .001) and total effects (β = .41, p < .001). The factors explaining organizational effectiveness were job crafting, burnout, and work engagement, which had an explanatory power of 76.7%.
Conclusion
Nurses’ job crafting is an important mediating factor for enhancing the organizational effectiveness of nursing organizations. Hospitals should develop job-crafting success cases and related education and training programs as a strategy for enhancing the job crafting of nurses and, consequently organizational effectiveness.

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Determinants of Problem Drinking by Regional Variation among Adult Males in Single-Person Households: Geographically Weighted Regression Model Analysis: Ahn, Junggeun , Choi, Heeseung , Kim, Jiu; J Korean Acad Nurs 2023;53(1):101-114. Published online February 28, 2023; DOI: https://doi.org/10.4040/jkan.22131

Abstract PDF: Purpose
This study aimed to identify regional differences in problem drinking among adult males in single-person households and predict the determinants.
Methods
This study used data from the 2019 Community Health Survey. Geographically weighted regression analysis was performed on 8,625 adult males in single-person households who had been consuming alcohol for the past year. The Si-Gun-Gu was selected as the spatial unit.
Results
The top 10 regions for problem drinking among adult males in single-person households were located in the Jeju-do and Jeollanam-do areas near the southern coast, whereas the bottom 10 regions were located in the Incheon and northern Gyeonggi-do areas. Smoking, economic activity, and educational level were common factors affecting problem drinking among this population. Among the determinants of regional disparities in problem drinking among adult males in single-person households, personal factors included age, smoking, depression level, economic activity, educational level, and leisure activity, while regional factors included population and karaoke venue ratio.
Conclusion
Problem drinking among adult males in single-person households varies by region, and the variables affecting each particular area differ. Therefore, it is necessary to develop interventions tailored to individuals and regions that reflect the characteristics of each region by prioritizing smoking, economic activity, and educational level as the common factors.

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Effect of Digital Health Interventions on Psychotic Symptoms among Persons with Severe Mental Illness in Community: A Systematic Review and Meta-Analysis: Oh, Eunjin , Gang, Moonhee; J Korean Acad Nurs 2023;53(1):69-86. Published online February 28, 2023; DOI: https://doi.org/10.4040/jkan.22121

Abstract PDF: Purpose
This study aimed to evaluate the effects of digital health interventions on the psychotic symptoms among people with severe mental illness in the community.
Methods
A systematic review and meta-analysis were conducted in accordance with the Cochrane Intervention Research Systematic Review Manual and PRISMA. A literature search was conducted of published randomized controlled trials (RCTs) for digital health interventions from January 2022 to April 2022. RevMan software 5.3 was used for quality assessment and meta-analysis.
Results
A total 14 studies out of 9,864 studies were included in the review, and 13 were included in meta-analysis. The overall effect size of digital health interventions on psychotic symptoms was - 0.21 (95% CI = - 0.32 to - 0.10). Sub-analysis showed that the reduction of the psychotic symptoms was effective in the schizophrenia spectrum group (SMD = - 0.22; 95% CI = - 0.36 to - 0.09), web (SMD = - 0.41; 95% CI = - 0.82 to 0.01), virtual reality (SMD = - 0.33; 95% CI = - 0.56 to - 0.10), mobile (SMD = - 0.15; 95% CI = - 0.28 to - 0.03), intervention period of less than 3 months (SMD = - 0.23; 95% CI = - 0.35 to - 0.11), and non-treatment group (SMD = - 0.23; 95% CI = - 0.36 to - 0.11).
Conclusion
These findings suggest that digital health interventions alleviate psychotic symptoms in patients with severe mental illnesses. However, well-designed digital health studies should be conducted in the future.

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The Experience of Gynecologic Cancer in Young Women: A Qualitative Study: Kim, Sung-Jin , Shin, Hyunjeong; J Korean Acad Nurs 2023;53(1):115-128. Published online February 28, 2023; DOI: https://doi.org/10.4040/jkan.22119

Abstract PDF: Purpose
This study aimed to understand the experiences of women under 40 years of age with gynecologic cancer.
Methods
Semi-structured individual in-depth interviews were conducted with 14 Korean female patients aged 21~39 years with gynecologic cancer. The data were analyzed using Corbin and Strauss' grounded theory approach, including open coding, context analysis, and integrating categories.
Results
Grounded theory analysis revealed nine categories and a core category of ‘the journey to find my life after losing the life as a typical woman.’ The categories that emerged as the conditions are ‘Unwelcomed guest, cancer,’ ‘Completely devastated life as an ordinary woman,’ ‘Uncertain future,’ ‘Losing my physical characteristics as a woman,’ and ‘Life tied with treatments.’ The actions/interactions were ‘Decrease of interpersonal relationships,’ ‘A lonely battle to overcome alone,’ and ‘The power to overcome hardships.’ The consequence was ‘Live my own life.’ Conclusion: This study contributes to the development of a substantive theory of the experience of gynecologic cancer in young women, which has been on the rise in recent years. The study’s results are expected to be used as a basis for providing nursing care to help young women with gynecologic cancer adapt to their disease.

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The Moderating Effect of Organizational Justice on the Relationship between Self-Efficacy and Nursing Performance in Clinical Nurses: Kim, Ju-Ra , Ko, Yukyung , Lee, Youngjin , Kim, Chun-Ja; J Korean Acad Nurs 2022;52(5):511-521. Published online October 31, 2022; DOI: https://doi.org/10.4040/jkan.22076

Abstract PDF: Purpose
This study aimed to examine the moderating effect of organizational justice on the relationship between self-efficacy and nursing performance among clinical nurses.
Methods
In January 2021, a cross-sectional survey was conducted with 224 clinical nurses recruited from a university-affiliated hospital in Suwon, South Korea. Participants completed online-based, self-report structured questionnaires. Collected data were analyzed using multiple regression and a simple model of PROCESS macro with a 95% bias-corrected bootstrap confidence interval.
Results
Self-efficacy and organizational justice were found to be significant predictors of nursing performance. These two predictors explained the additional 34.8% variance of nursing performance in the hierarchical regression model, after adjusting the other covariates. In addition, organizational justice moderated the relationship between self-efficacy and nursing performance among the clinical nurses. In particular, at low self-efficacy level, participants with high organizational justice had higher nursing performance compared to those with low organizational justice.
Conclusion
Enhancing organizational justice can be used as an organizational strategy for improving the organizational culture in terms of distribution, procedure, and interaction. Ultimately, these efforts will contribute to the improvement of nursing performance through a synergistic effect on organizational justice beyond nurses’ individual competency and self-efficacy.

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The Development of Automated Personalized Self-Care (APSC) Program for Patients with Type 2 Diabetes Mellitus: Park, Gaeun , Lee, Haejung , Khang, Ah Reum; J Korean Acad Nurs 2022;52(5):535-549. Published online October 31, 2022; DOI: https://doi.org/10.4040/jkan.22046

Abstract PDF: Purpose
The study aimed to design and develop an automated personalized self-care (APSC) program for patients with type 2 diabetes mellitus. The secondary aim was to present a clinical protocol as a mixed-method research to test the program effects.
Methods
The APSC program was developed in the order of analysis, design, implementation, and evaluation according to the software development life cycle, and was guided by the self-regulatory theory. The content validity, heuristics, and usability of the program were verified by experts and patients with type 2 diabetes mellitus.
Results
The APSC program was developed based on goal setting, education, monitoring, and feedback components corresponding to the phases of forethought, performance/volitional control, and self-reflection of self-regulatory theory. Using the mobile application, the participants are able to learn from educational materials, monitor their health behaviors, receive weekly-automated personalized goals and feedback messages, and use an automated conversation system to solve the problems related to self-care. The ongoing two-year study utilizes a mixed method design, with 180 patients having type 2 diabetes mellitus randomized to receive either the intervention or usual care. The participants will be reviewed for self-care self-efficacy, health behaviors, and health outcomes at 6, 12, 18, and 24 months. Participants in the intervention group will be interviewed about their experiences.
Conclusion
The APSC program can serve as an effective tool for facilitating diabetes health behaviors by improving patients’ self-care self-efficacy and self-regulation for self-care. However, the clinical effectiveness of this program requires further investigation.

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A Longitudinal Study of the Reciprocal Relationship between Depression and Income among Korean Older Men and Women: Lee, Jeong , Jeon, Gyeong-Suk; J Korean Acad Nurs 2022;52(4):451-463. Published online August 31, 2022; DOI: https://doi.org/10.4040/jkan.22052

Abstract PDF: Purpose
This study examined the reciprocal relationships between depression and income, and gender differences in these relationships among older adults in South Korea.
Methods
Using 2015 to 2019 of the Korea Welfare Panel Study (KoWePS), we studied 6,070 older adults (2,394 men and 3,676 women) aged 60 years over in 2015. The generalized estimating equation was employed to explore the effect of an individual income on depression and the reverse causal link-that of depression on income.
Results
The study found the reciprocal relationships between income and depression. Income has a significant impact on depression. Higher-income was linked to decreased risks of the Center for Epidemiologic Studies Depression (CES-D) scores among older adults (B = - 0.121, p < 0.001). Estimates of the reverse causal link show that higher CES-D scores were also linked to income reduction among Korean older adults (B = - 0.007, p < 0.001). In addition, we also observed gender differences in the impact of income on depression but not in the reverse causal link. Income has more detrimental to psychological consequence for older men (B = - 0.108, p < 0.001) than older women (B = - 0.057, p < 0.001).
Conclusion
The finding implies that both psychological and social protection policies for the elderly are needed in view of gender perspective.

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Structural Equation Modeling for Quality of Life of Mothers of Children with Developmental Disabilities: Focusing on the Self-Help Model: Yang, Mi Ran , Yu, Mi; J Korean Acad Nurs 2022;52(3):308-323. Published online June 30, 2022; DOI: https://doi.org/10.4040/jkan.22013

Abstract PDF: Purpose
This study aimed to construct and test a predictive model for the quality of life (QOL) in mothers of children with developmental disabilities (DB). The hypothesized model included severity of illness, distress, uncertainty, self-help, and parenting efficacy as influencing factors, QOL as a consequence based on the Braden’s Self-Help Model.
Methods
The data were collected through a direct and online surveys from 206 mothers in 8 locations, including welfare or daycare centers, developmental treatment centers, and The Parents’ Coalition for the Disabled located in two provinces of Korea. Data were analysed using SPSS/WIN 23.0 and AMOS 21.0 program.
Results
The fit indices of the predictive model satisfied recommended levels; χ² = 165.79 (p < .001), normed χ² (χ² /df) = 2.44, RMR = .04, RMSEA = .08, GFI = .90, AGFI = .85, NFI = .91, TLI = .93, CFI = .95. Among the variables, distress (β = - .46, p < .001), parenting efficacy (β = .22, p < .001), and self-help (β = .17, p = .018) had direct effects on QOL. Severity of illness (β = - .61, p = .010) and uncertainty (β = - .08, p = .014) showed indirect effects. The explanatory power of variables was 61.0%.
Conclusion
The study results confirm the utility of Braden’s Self-Help Model. They provide a theoretical basis for improving QOL in mothers of children with DB. Nursing intervention strategies that can relieve mothers’ distress and uncertainty related to disease and enhance parenting efficacy and self-help behavior should be considered.

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Influence of Learning Presence of Non-Face-to-Face Class Experience in Nursing Students on Academic Achievement: Mediating Effect of Learning Flow and Moderated Mediation of Digital Literacy: Ryu, Eui Jeong , Jang, Keum Seong , Kim, Eun A; J Korean Acad Nurs 2022;52(3):278-290. Published online June 30, 2022; DOI: https://doi.org/10.4040/jkan.21241

Abstract PDF: Purpose
This study aimed to identify the mediating effect of learning flow and the moderated mediation effect of digital literacy on the effect of the learning presence of non-face-to-face class experience in nursing students on academic achievement.
Methods
Participants were 272 nursing students from six universities in two different cities. A self-report questionnaire was used to measure learning presence, learning flow, digital literacy, and academic achievement. Analysis was performed using SPSS 26.0 and SPSS PROCESS Macro (4.0).
Results
The mediating effect of learning flow on the effect of learning presence on academic achievement was 0.42, and the moderated mediation index of digital literacy was 0.17. Learning flow showed a mediating effect on the relationship between learning presence and academic achievement. Digital literacy had a moderated mediation effect on the relationship between learning presence and academic achievement that was mediated by learning flow.
Conclusion
The intensity of the mediating effect of nursing students’ learning presence on academic achievement through learning flow increases as the level of digital literacy increases. These results suggest that educational programs considering the level of learning presence, learning flow, and digital literacy are required to promote the academic achievement of nursing college students.

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3 Web of Science

Development and Effects of a Person-Centered Fall Prevention Program for Older Adults with Dementia in Long-Term Care Hospitals: For Older Adults with Dementia and Caregivers in LongTerm Care Hospitals: Lim, Jeong Ok , Gu, Mee Ock; J Korean Acad Nurs 2022;52(3):341-358. Published online June 30, 2022; DOI: https://doi.org/10.4040/jkan.21230

Abstract PDF: Purpose
This study examined the effects of a person-centered fall prevention program for older adults with dementia in long-term care hospitals.
Methods
A nonequivalent control group pretest-posttest design was used. The study sample included 42 older adults with dementia (experimental group: 21, control group: 21) and 42 caregivers (experimental group: 21, control group: 21). The program comprised 48 sessions held over 12 weeks and included exercise intervention with resistance and balance, dance walking (45~60 min, three times/week), cognitive and emotional intervention (35~50 min, once per week), and person-centered fall prevention education (10 min, once per week). The program for caregivers consisted of six educational sessions (i.e., fall prevention competency enhancement and person-centered care strategy education, 80 min, once per week) for six weeks. Data were collected before participation and 12 weeks after program completion from February 18 to May 12, 2019. Data analysis was conducted using the chi-square test, t-test, and Mann―Whitney U test with SPSS/WIN 21.0.
Results
The experimental group of older adults with dementia showed significant improvement in physical and cognitive functions, and a decrease in depression, and behavioral and psychological symptoms, when compared with the control group. caregivers in the experimental group exhibited significant improvement in fall-related knowledge and person-centered care of older adults with dementia compared to the control group.
Conclusion
The study findings indicate that this program was effective as a nursing intervention for fall prevention among older adults with dementia in long-term care hospitals.

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2 Web of Science

Development and Evaluation of an Integrated Health Management Program for Psychiatric Patients with Metabolic Syndrome: Kwak, Yun Bock , Kim, Ji Young; J Korean Acad Nurs 2022;52(3):261-277. Published online June 30, 2022; DOI: https://doi.org/10.4040/jkan.21222

Abstract PDF: Purpose
This study developed an integrated health management program for metabolic syndrome in psychiatric patients and examined its effects on self-efficacy, healthy lifestyle, physiological indicators, knowledge of metabolic syndrome, attitudes toward healthy behavior, and social support.
Methods
A non-equivalent control group pretest posttest design was used. The participants were 65 psychiatric patients with metabolic syndrome in psychiatric rehabilitation centers, with 33 in the experimental group and 32 in the control group. The experimental group participants engaged in daily mobile application and walking exercises three times a week for more than 40 minutes over 8 weeks, while those in the control group were provided education booklets. The outcomes were measured using self-report questionnaires, anthropometrics, and blood analyses. Intervention effects were analyzed using the independent t-test, Mann—Whitney U test, ANCOVA, and Ranked ANCOVA.
Results
The experimental group showed a significant increase in self-efficacy (F = 8.85, p = .004, η_p2 = .13) and knowledge of metabolic syndrome (t = 2.60, p = .012, d = 0.60) compared to the control group. Additionally, the experimental group demonstrated a significant decrease in waist circumference (Z = - 2.34, p = .009, d = 0.58) and body mass index (Z = - 1.91, p = .028, d = 0.47) compared to the control group.
Conclusion
The integrated health management program for psychiatric patients with metabolic syndrome is effective in improving self-efficacy and knowledge of metabolic syndrome and decreasing physiological indicators such as waist circumference and body mass index.

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4 Web of Science

Effect of Virtual Reality Program for Alleviating Behavioral and Psychological Symptoms of Dementia Patients: Park, Seon-Min , Choi, Seung-Yi , Kim, Jung-Hee; J Korean Acad Nurs 2022;52(2):121-133. Published online April 30, 2022; DOI: https://doi.org/10.4040/jkan.22008

Abstract PDF: Purpose
This study examined the impact of a virtual reality intervention program based on psychological needs on behavioral and psychological symptoms, apathy, and quality of life (QOL) in patients with dementia or mild cognitive impairment living in nursing facilities.
Methods
This study is nonequivalent control group pretest-posttest design of quasi-experimental study. The study collected data from November 18, 2020 to July 24, 2021 from patients with dementia or mild cognitive impairment (30 in the experimental group and 30 in the control group) at three nursing facilities in G city using self-reporting and caregiver-informant reporting methods. The analysis employed the chi-square test, Fisher’s exact test, paired t-test, independent t-test, Wilcoxon signed rank test, Mann–Whitney U, repeated measures ANOVA, GEE, using SPSS/WIN 27.0.
Results
The severity of behavioral and psychological symptoms (Wald χ2 = 2.68, p = .102) and the care burden of caregivers (Wald χ2 = 1.72, p = .190) were not significant and was no significant time and group interaction effect (Wald χ2 = 0.63, p = .426, Wald χ2 = 0.52, p =. 471). The difference in apathy and QOL score were statistically significant for the group-time interaction (F = 43.65, p < .001; F = 4.35, p= .041).
Conclusion
The virtual reality intervention program of this study shows a positive effect on the apathy reduction and QOL of patients with dementia or mild cognitive impairment residing in nursing facilities.

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3 Web of Science

Experience of Peer Support Work among People with Mental Illness in the Community: A Grounded Theory Approach: Hyun, Myung Sun , Kim, Hyunlye , Nam, Kyoung A , Kim, Su Young; J Korean Acad Nurs 2022;52(2):187-201. Published online April 30, 2022; DOI: https://doi.org/10.4040/jkan.21208

Abstract PDF: Purpose
This study discovered a substantive theory of the experience and process of peer support work among people with mental illness.
Methods
The participants were members of community-based mental health facilities and had been working as peer supporters for more than six months. The data were collected through in-depth interviews with twelve participants and analyzed using Corbin and Strauss’s grounded theory approach.
Results
The core category was “becoming a healer going with patients in the journey of recovery,” and the core phenomenon was “identity confusion as a peer supporter.” The causal conditions were “starting peer support work without certainty” and “standing at the boundary between the therapist and patient.” The intervening conditions were “willingness to become a successful peer supporter,” “feeling a sense of homogeneity with the patient,” “accepting the mental illness,” and “support from people around.” The action and interaction strategies were “letting go of greed,” “being open about oneself,” “developing professional skills,” “maintaining wellness in the body and mind,” and “being with the patient.” The consequences were “becoming a useful person,” “changing attitude toward life,” “expansion of the sense of self-existence,” “recovering from mental illness,” and “discovering a role as peer supporter.” Finally, the substantive theory of “becoming a healer going with patients in the journey of recovery” was derived.
Conclusion
This study provides a holistic understanding of peer support work and the implications of interventions to help people with mental illness in a person-centered recovery process.

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2 Web of Science

Incidence and Risk Factors of Dyslipidemia after Menopause: Jeong, Ihn Sook , Yun, Hae Sun , Kim, Myo Sung , Hwang, Youn Sun; J Korean Acad Nurs 2022;52(2):214-227. Published online April 30, 2022; DOI: https://doi.org/10.4040/jkan.21188

Abstract PDF: Purpose
This study was aimed at investigating the incidence and risk factors of dyslipidemia in menopausal women using a Korean community-based longitudinal study.
Methods
The subjects were 245 postmenopausal women without dyslipidemia who had participated in the Ansan-Ansung cohort study from 2001~2002 (baseline) to 2015~2016 (seventh follow-up visit). The dyslipidemia incidence was measured as incidence proportion (%) and incidence rate per 100 person-years. The predictors of developing dyslipidemia were analyzed with Cox’s proportional hazard model.
Results
The incidence of new dyslipidemia during the follow-up period was 78.4% (192 patients), and 11.9 per 100 person-years. Mean duration from menopause to developing dyslipidemia was 5.3 years in new dyslipidemia cases. The triglyceride/high density lipoprotein (TG/HDL-C) ratio at baseline (hazard ratio = 2.20; 95% confidence interval = 1.39~3.48) was independently associated with developing dyslipidemia.
Conclusion
Dyslipidemia occurs frequently in postmenopausal women, principally within five years after menopause. Therefore, steps must be taken to prevent dyslipidemia immediately after menopause, particularly in women with a high TG/HDL-C ratio at the start of menopause.

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Development and Evaluation of Health Empowerment Scale for North Korean Women Defectors: Lim, Semi , Kang, Younhee; J Korean Acad Nurs 2022;52(1):80-91. Published online February 28, 2022; DOI: https://doi.org/10.4040/jkan.21174

Abstract PDF: Purpose
This study developed an instrument to evaluate the health empowerment of North Korean women refugees and examined its validity and reliability.
Methods
Through literature review and focused group interviews, 66 preliminary items with three constructs, including perceived control, perceived competence, and goal internalization were selected based on Menon’s psychological health empowerment model. A questionnaire survey was conducted with 239 North Korean women refugees in the community from August 31 to September 4, 2020. Content, construct, convergent, and discriminative validity were evaluated. Cronbach’s α was used to evaluate the reli-ability of scale.
Results
The final instrument consisted of 31 items with three factors that were identified through confirmatory factor analysis. The convergent validity showed that the correlation coefficient was .52 (p < .001), which confirmed the validity of the developed measurement tool. Cronbach’s α for all the items was .94, and Cronbach's α for the factors was .76~.91.
Conclusion
This health empowerment scale has been developed to include aspects of health empowerment, provide a conceptual framework, and offer objective indicators to evaluate the effectiveness of a health education program.

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Healthcare Considerations for Special Populations during the COVID-19 Pandemic: A Review: Kim, Jeung-Im , Im, YeoJin , Song, Ju-Eun , Jang, Sun Joo; J Korean Acad Nurs 2021;51(5):511-524. Published online October 31, 2021; DOI: https://doi.org/10.4040/jkan.21156

Abstract PDF: The coronavirus disease 2019 (COVID-19) has emerged as a threat to human health and public safety. People of all ages are susceptible to severe acute respiratory syndrome coronavirus 2 infection. However, the clinical manifestations of this infection differ by age. This study purposes to describe healthcare considerations for special populations, such as children, pregnant and lactating women, and older adults, who may have unique healthcare needs, in the pandemic situation. To realize the research purpose, we conducted a review of the practice guidelines of public documents and qualified studies that were published online/offline during a specific period. The review identified current knowledge on care for newborns, children in schools, pregnant women (from antenatal to postpartum care), and older adults suffering from high-risk conditions. Subsequently, we summarize vaccination guidance for special populations and, finally, discuss the issues currently affecting special populations. Therefore, this current knowledge on care for special populations helps nurses to provide accurate information on vaccinations aimed at preventing COVID-19 and protecting the masses from infection. Currently, the scarcity of information on COVID-19 variants necessitates further research on measures to reduce pandemic spread.

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1 Web of Science

An Evaluation of the Validity and Reliability of the Face Mask Use Scale’s Korean Version among Community-Dwelling Adults: Lee, Kyungmi , Shin, Nayeon , Kang, Younhee; J Korean Acad Nurs 2021;51(5):549-560. Published online October 31, 2021; DOI: https://doi.org/10.4040/jkan.21111

Abstract PDF: Purpose
This study evaluated the validity and reliability of the Korean version of the Face Mask Use Scale (K-FMUS) among community-dwelling adults.
Methods
The participants of the study were community-dwelling adults in Korea using face masks during the COVID-19 pandemic. The English FMUS was translated into Korean using forward and backward translation procedures. The construct validity and reliability of the K-FMUS were evaluated using the exploratory and confirmatory factor analyses and the internal consistency reliability test.
Results
The K-FMUS comprised 6 items divided into 2 factors. The variance of the factors was approximately 79.1%, which suggested that the scale indicated the effectiveness of face mask usage. The two factors were labeled as face mask use in society (4 items) and face mask use at home (2 items). Cronbach’s α value for the overall scale was .88.
Conclusion
The K-FMUS is a valid and reliable scale that can be used to measure face mask usage among community-dwelling adults in Korea during the COVID-19 pandemic.

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1 Web of Science

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