Journal of Korean Academy of Nursing

Original Articles

Factors Affecting Clinical Practicum Stress of Nursing Students: Using the Lazarus and Folkman's Stress-Coping Model: Sung Hae Kim, JuHee Lee, MiRa Jang; J Korean Acad Nurs 2019;49(4):437-448. Published online August 29, 2019; DOI: https://doi.org/10.4040/jkan.2019.49.4.437

Purpose

This study was conducted to test a path model for the factors related to undergraduate nursing students' clinical practicum stress, based on Lazarus and Folkman's stress-coping model.

Methods

This study utilized a path analysis design. A total of 235 undergraduate nursing students participated in this study. The variables in the hypothetical path model consisted of clinical practicum, emotional intelligence, self-efficacy, Nun-chi, and nursing professionalism. We tested the fit of the hypothetical path model using SPSS/WIN 23.0 and AMOS 22.0.

Results

The final model fit demonstrated a satisfactory statistical acceptance level: goodness-of-fit-index=.98, adjusted goodness-of-fit-index=.91, comparative fit index=.98, normed fit index=.95, Tucker-Lewis index=.92, and root mean square error of approximation=.06. Self-efficacy (β=−.22, p=.003) and Nun-chi behavior (β=−.17, p=.024) were reported as significant factors affecting clinical practicum stress, explaining 10.2% of the variance. Nursing professionalism (β=.20, p=.006) and self-efficacy (β=.45, p<.001) had direct effects on emotional intelligence, explaining 45.9% of the variance. Self-efficacy had indirect effects on Nun-chi understanding (β=.20, p<.001) and Nun-chi behavior (β=.09, p=.005) through emotional intelligence. Nursing professionalism had indirect effects on Nun-chi understanding (β=.09, p=.005) and Nun-chi behavior (β=.09, p=.005) through emotional intelligence. The variables for self-efficacy and nursing professionalism explained 29.1% of the Nun-chi understanding and 18.2% of the Nun-chi behavior, respectively.

Conclusion

In undergraduate nursing education, it is important to identify and manage factors that affect clinical practicum stress. The findings of this study emphasize the importance of Nun-chi, self-efficacy, emotional intelligence, and nursing professionalism in the development of an educational strategy for undergraduate nursing students.

Citations

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Effects of stress on burnout among infection control nurses during the COVID-19 pandemic: the mediating effects of social support and self-efficacy
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The effect of verbal violence, clinical practice stress, and coping with stress on nursing students’ major satisfaction during clinical practice
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Structural Equation Model for Sleep Quality of Female Shift Work Nurses: Ji Yeong Jeong, Mee Ock Gu; J Korean Acad Nurs 2018;48(5):622-635. Published online October 31, 2018; DOI: https://doi.org/10.4040/jkan.2018.48.5.622

Abstract PDF

Purpose

This study aimed to develop and test a structural model for sleep quality in female shift work nurses. The hypothetical model was constructed on the basis of Spielman's 3P model of insomnia and previous research related to the sleep quality of shift nurses.

Methods

This cross-sectional study used structural equation modeling and recruited 285 female shift work nurses from four general and university hospitals with over 300 beds located in C and J cities in Gyeongsangnamdo. Data were collected from September 27 to October 20, 2016, and then analyzed using descriptive statistics, Pearson's correlation, and structural equation modeling. The study used SPSS/Win 18.0 and AMOS 18.0 in processing the data.

Results

The final model showed good fit to the empirical data: χ²/df=2.19, SRMR=.07, RMSEA=.07, AGFI=.85, TLI=.91, GFI=.93, GFI=.89, NFI=.87. The factors that influenced sleep quality were sleep hygiene (β=.32), perceived shift work status (β=−.16), stress response (β=.16), shift work experience (β=.15), perceived health status (β=−.14), and circadian rhythm (β=−.13) explaining 36.0% of the variance.

Conclusion

The model of sleep quality of the shift work nurses constructed in this study is recommended as a model to understand and predict the sleep quality of shift work nurses. The results suggest that strategies for improving the sleep quality of shift work nurses should focus on sleep hygiene, perceived health status, stress response, circadian rhythm, perceived shift work status, and shift work experience.

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Associations between the Timing and Nutritional Characteristics of Bedtime Meals and Sleep Quality for Nurses after a Rotating Night Shift: A Cross-Sectional Analysis
Jung Hoon Park, Hyuntae Park, Seongryu Bae, Jiyeon Kang
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Hyojin Nam, Jinyoung Chang, Mickey Trockel, Isa Okajima, Chien-Ming Yang, Ngan Yin Chan, Shirley Li, Sooyeon Suh
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Psychosocial factors affecting sleep quality of pre-employed firefighters: a cross-sectional study
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Secondary Data Analysis on the Quality of Sleep and Related Factors of Novice and Experienced Shift Work Nurses
Minjeong Yu, Smi Choi-Kwon
Journal of Korean Academy of Nursing.2020; 50(5): 646. CrossRef
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Jiwon Kang, Wonjung Noh, Youngjin Lee
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Work-related Characteristics and Sleep Quality of Nurses in Comprehensive Nursing Care Units of Small-medium Sized Hospitals
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Journal of Korean Academy of Fundamentals of Nursing.2019; 26(4): 260. CrossRef

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Psychoeducational Approach to Distress Management of Newly Diagnosed Patients with Breast Cancer: Jin-Hee Park, Mison Chun, Yong Sik Jung, Sun Hyoung Bae, Young-Mi Jung; J Korean Acad Nurs 2018;48(6):669-678. Published online January 15, 2018; DOI: https://doi.org/10.4040/jkan.2018.48.6.669

Abstract PDF

Abstract Purpose

The purpose of this study was to examine the effects of integrated psychoeducational program for distress management of newly diagnosed patients with breast cancer.

Methods

A quasi-experimental trial was conducted. The participants consisted of 47 female patients with breast cancer assigned to an intervention group (n=25) and control group (n=22). The intervention group participated in integrated psychoeducational program, consisting of individual face-to-face education and telephone-delivered health-coaching sessions. Data were collected at three time points: pre-intervention (T1), post-intervention (T2), and 6-month follow-up (T3). Study instruments were Distress thermometer, Supportive Care Needs Survey Short Form 34 and Functional Assessment of Cancer Therapy-Breast.

Results

Compared with the control group, breast cancer patients in the intervention group reported lower distress and supportive care needs than the control group. The intervention group reported higher quality of life (QOL) overall and higher emotional well-being than the control group.

Conclusion

These findings indicate that the integrated psychoeducational program is an effective intervention for reducing distress and supportive care needs and increasing QOL of newly diagnosed patients with breast cancer. Oncology nurses need to provide psychoeducational intervention to support patients with breast cancer in managing their distress and helping them adjust to their life.

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Jin-Hee Park, Yong Sik Jung, Min Hee Hur, Yu Jin Jeong
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The Effects of Laughter Therapy Program on Perceived Stress, and Psycho-Neuro-Endocrino-Immuno Responses in Obese Women: Do Young Lee, Myung Sun Hyun; J Korean Acad Nurs 2018;48(3):298-310. Published online January 15, 2018; DOI: https://doi.org/10.4040/jkan.2018.48.3.298

Abstract PDF

Abstract Purpose

The purpose of this study was to examine the effects of the laughter therapy program on perceived stress and psycho-neuro-endocrine-immune responses in obese women.

Methods

A nonequivalent control group with a pretest-posttest design was used. The participants (n=60), whose age ranged from 30 to 50 years (pre-menopausal and body mass index of over 25 kg/m²), were assigned to the experimental group (n=24) or control group (n=26). The experimental group was provided with the laughter therapy program (12 sessions) for 6 weeks.

Results

There were significant differences in perceived stress, psychological stress response, fasting blood sugar, interleukin-6, and tumor necrosis factor alpha between the two groups after the program. However, there were no significant differences in normalized low frequency (norm LF), normalized high frequency (norm HF), LF/HF ratio, and cortisol between the two groups after the program.

Conclusion

It was found that the laughter therapy program had positive effects on some variables in terms of perceived stress and psycho-neuro-endocrine-immuno responses. It is suggested that the laughter therapy in this study can provide the direction for developing a program for obese women.

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Factors Influencing Burnout among Mothers of Children with Cerebral Palsy: Ji-Young Seo, Hae-Jin Lee, Mi-Ae You; J Korean Acad Nurs 2017;47(2):233-241. Published online April 28, 2017; DOI: https://doi.org/10.4040/jkan.2017.47.2.233

Abstract PDF

Purpose

The purpose of this study was to examine the effects of parental stress, social support, and coping behavior on burnout among mothers caring for children with cerebral palsy.

Methods

Participants in this cross-sectional, descriptive study were 185 mothers who completed a self-report structured questionnaire. The data were analyzed using descriptive statistics, t-test, one-way ANOVA, correlation and multiple linear regression analyses with IBM SPSS Win 22 program.

Results

Parental stress and coping behavior were strong predictors of burnout among mothers of children with cerebral palsy. These variables explained 50.0% of the variance in burnout. Social support was not a predictor of burnout. A higher level of burnout was associated with higher levels of parental stress and lower levels of social support and coping behavior.

Conclusion

Mothers of children with cerebral palsy are vulnerable to burnout. These results show that effective strategies for reducing parental stress and improving positive coping behavior are needed to reduce burnout in these mothers.

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A Model for Predicting Career Satisfaction of Nurses Experiencing Rotation: Sook Shin, Mi Yu; J Korean Acad Nurs 2017;47(4):551-561. Published online January 15, 2017; DOI: https://doi.org/10.4040/jkan.2017.47.4.551

Abstract PDF

Abstract Purpose

This study aimed to present and test a structural model for describing and predicting the factors affecting subjective career satisfaction of nurses experiencing rotation and to develop human resources management strategies for promoting their career satisfaction related to rotation.

Methods

In this cross-sectional study, we recruited 233 nurses by convenience sampling who had over 1 year of career experience and who had experienced rotation at least once at G university hospital. Data were collected from August to September in 2016 using self-reported questionnaires. The exogenous variables consisted of rotation perception and rotation stress. Endogenous variables consisted of career growth opportunity, work engagement, and subjective career satisfaction. A hypothetical model was tested by asymptotically distribution-free estimates, and model goodness of fit was examined using absolute fit, incremental fit measures.

Results

The final model was approved and had suitable fit. We found that subjective career satisfaction was directly affected by rotation stress (b=.20, p=.019) and work engagement (b=.58, p<.001), indirectly affected by rotation perception (b=.43, p<.001) through career growth opportunity and work engagement. However, there was no total effect of rotation stress on subjective career satisfaction (b=-.09, p=.270). Career growth opportunity directly and indirectly affected subjective career satisfaction (b=.29, p<.001; b=.28, p<.001). These variables accounted for 65% of subjective career satisfaction.

Conclusion

The results of this study suggest that it is necessary to establish systematic and planned criteria for rotation so that nurses can grow and develop through sustained work and become satisfied with their career.

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Influences of Oral Health Behaviors, Depression and Stress on Periodontal Disease in Pregnant Women: Hae-Jin Park, Hae Jung Lee, Soo Hyun Cho; J Korean Acad Nurs 2016;46(5):653-662. Published online October 31, 2016; DOI: https://doi.org/10.4040/jkan.2016.46.5.653

Abstract PDF

Purpose

The purpose of this study was to identify the influences of oral health behaviors, depression, and stress on periodontal disease in pregnant women.

Methods

The participants in this study were 129 pregnant women. Data were collected using questionnaires which included individual characteristics, oral health care behaviors, the Center for Epidemiological Studies-Depression scale (CES-D), a global measure of perceived stress, and pregnancy stress. A dentist measured periodontal probing depth and classified stages of periodontal disease according to the Community Periodontal Index (CPI). Data were analyzed using descriptive statistics, Pearson correlation, and multiple regression.

Results

Periodontal disease had significant correlations with oral health care behaviors (r=-.56, p <.001), perceived stress (r=.44 p <.001), pregnancy stress (r=.37 p <.001), diet (r=-.33, p <.001) and depression (r=.18 p =.046). Factors influencing periodontal disease for these pregnant women were being in the 2nd (β=.27, p <.001) or 3rd trimester (β=.45, p <.001), having a pregnancy induced disease (β=.20, p =.002), performing higher oral health behaviors (β=-.30, p <.001), and having higher perceived stress (β=.17, p =.028). The explanation power of this regression model was 61.6% (F=15.52, p <.001).

Conclusion

The findings of this study indicated that periodic assessment of periodontal disease is essential for pregnant women who are in 2nd or 3rd trimester and have pregnancy induced diseases. Enhancing oral health care behaviors and reducing perceived stress are indicated as effective strategies to reduce periodontal disease in pregnant women.

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Factors Influencing Musculoskeletal Symptoms in Military Personnel during Basic Combat Training: Jeong Min Yi, Gwang Suk Kim; J Korean Acad Nurs 2016;46(4):523-533. Published online August 31, 2016; DOI: https://doi.org/10.4040/jkan.2016.46.4.523

Abstract PDF: Purpose
This study was done to examine physical, psycho-social, and individual factors influencing musculoskeletal symptoms among Korean military trainees.
Methods
Using a correlation study design, military trainees who had completed almost of all the basic combat training (BCT) days were recruited from two military training units selected by convenience sampling. Data from 415 participants were analyzed.
Results
Prevalence of musculoskeletal symptoms was 29.6% defined as a participant having pain or discomfort in one or more body parts during training hours for more than seven consecutive days. Back/pelvic (10.8%), knees (10.1%), shoulders (7.7%), feet/toes (5.6%), ankles (4.8%) were prone to musculoskeletal symptoms. Musculoskeletal symptoms appeared to be related to physical exertion during BCT, stress during BCT, social support from fellow trainees, or previous musculoskeletal injuries. In the logistic regression model, physical exertion during BCT (OR=2.27, 95% CI: 1.42~3.65), stress during BCT (OR=1.79, 95% CI: 1.15~2.78), and previous musculoskeletal injuries (OR=1.58, 95% CI: 1.01~2.47) were the significant factors affecting prevalence of musculoskeletal symptoms.
Conclusion
Findings indicate that physical exertion and psycho-social stress should be managed to prevent musculoskeletal symptoms in military trainees with more attention being given to trainees having a history of musculoskeletal injuries.

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Development and Effects of Assertiveness Training applying Dongsasub Training for Nursing Students in Clinical Practice: Myoungsuk Kim; J Korean Acad Nurs 2016;46(4):490-500. Published online August 31, 2016; DOI: https://doi.org/10.4040/jkan.2016.46.4.490

Abstract PDF

Purpose

This study was conducted to develop assertiveness training applying Dongsasub training for junior nursing students, and to verify effectiveness of the training on assertiveness behavior, self-esteem, clinical practice stress, and clinical competence.

Methods

The study design was a non-equivalent control group non-synchronized design. Participants were 63 nursing students in clinical training (31 students in the experimental group and 32 students in the control group). The assertiveness training applying Dongsasub training consisted of four sessions. Outcome variables included assertiveness behavior, self-esteem, clinical practice stress, and clinical competence. Data were analyzed using Chi-square, Fisher's exact test and independent samples t-test with SPSS/WIN 21.0.

Results

Scores of assertiveness behavior (t=-2.49, p=.015), self-esteem (t=-4.80, p<.001) and clinical competence (t=-2.33, p=.023) were significantly higher and clinical practice stress (t=4.22, p<.001) was significantly lower in the experimental group compared to the control group.

Conclusion

Results indicate that the assertiveness training applying Dongsasub training can be used as a nursing intervention to lower clinical practice stress and improve the clinical competence of nursing students.

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Spiritual and Psychosocial Effects of the Spirituality Promotion Program on Clinical Nurses: Imsun Seo, Jinsun Yong, Junyang Park, Juhu Kim; J Korean Acad Nurs 2014;44(6):726-734. Published online December 31, 2014; DOI: https://doi.org/10.4040/jkan.2014.44.6.726

Abstract PDF

Purpose

The purpose of this study was to evaluate the effects of the Spirituality Promotion Program(SPP) for young nurses working in the stressful university hospital environment.

Methods

The study included 41 nurses in the experimental group, nurses who had worked less than 5 years and completed 8 weeks of SPP between June and July in 2011. The control group, 44 nurses, also received the same program after the study was completed. For the study, a survey was conducted of all participants concerning spirituality, perceived stress, positive and negative affect, empathy, job satisfaction, and leadership practice.

Results

No significant difference was found between the two groups on study variables. Perceived stress decreased significantly in the experimental group (p=.012). Spirituality (p=.019), positive affect (p=.014), empathy (p=.004), job satisfaction (p=.016), and leadership practice (p=.021) increased significantly in the experimental group.

Conclusion

The results show that the Spirituality Promotion Program has positive effects on the spiritual and psychosocial aspect of young nurses. Continuation of this program for nurses is recommended in order to help them develop their selfcare ability and improve nursing competency.

Citations

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Hyun Sook Lee, Ju Hyun Jin, Ju Ri Lee, Hye Jin Kim, Yeon Jae Jung
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A Systematic Review of Psychological Distress as a Risk Factor for Recurrent Cardiac Events in Patients with Coronary Artery Disease: Jin-Hee Park, Sun Hyoung Bae; J Korean Acad Nurs 2011;41(5):704-714. Published online October 31, 2011; DOI: https://doi.org/10.4040/jkan.2011.41.5.704

Abstract PDF

Purpose

The purpose of this study was to determine whether psychological distress is an independent risk factor for recurrent cardiac events in patients with coronary artery disease (CAD).

Methods

A prospective cohort of studies that measured psychological distress and the incidence of recurrent cardiac events in the adult population were included. Three computerized databases were assessed (PubMed, CINAHL, and PSYCINFO). Meta-analysis was conducted using a random-effects model to determine summary estimates of risks of major recurrent cardiac events associated with each psychological distress. Of 506 publications identified, 33 met inclusion criteria, and 24 studies were used to estimate effect size of psychological distress on recurrent cardiac events.

Results

Mean number in the research sample was 736 and mean time of follow-up was 4.0 years. Depression, anxiety, anger, and hostility as psychological factors were studied. According to estimation of effect size using random model effect, depression (OR=1.39, 95% CI: 1.22-1.57), anxiety (OR=1.22, 95% CI: 0.96-1.56), and anger/hostility (OR=1.29, 95% CI: 1.07-1.57) CAD patients in significantly increased risk for recurrent cardiac events.

Conclusion

Finding suggests that psychological distress in forms of depression, anxiety, anger, and hostility impact unfavorably on recurrent cardiac events in CAD patients.

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Relationship of Prenatal Stress and Depression to Maternal-Fetal Attachment and Fetal Growth: Mi-Kyung Kwon, Kyung-Sook Bang; J Korean Acad Nurs 2011;41(2):276-283. Published online April 30, 2011; DOI: https://doi.org/10.4040/jkan.2011.41.2.276

Abstract PDF

Purpose

Prenatal depression is associated with potential negative consequences for the mother and infant. The purpose of this study was to examine pregnant women's stress, and depression and their impact on maternal-fetal attachment and fetal growth.

Methods

Data were collected by means of a questionnaire and fetal sonogram from a convenience sample of 166 pregnant women.

Results

Women who have a low educational level, poor health and are dissatisfied with their marriage showed low maternal-fetal attachment. Prenatal depression had significant correlations with length of pregnancy and level of stress. Even though correlation between maternal stress and fetal weight (r=-.15, p=.099) and correlation between maternal depression and maternal-fetal attachment (r=-.13, p=.095) were not statistically significant, the impact of the prenatal psychological state of mothers can not be ignored as it relates to fetal health.

Conclusion

Maternal-fetal attachment and fetal growth can be affected by maternal emotional state, including stress or depression. These findings suggest that primary care nurses in hospitals and public health centers should provide prenatal depression screening and nursing intervention programs for management and prevention of prenatal stress and depression.

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The Changing Pattern of Physical and Psychological Health, and Maternal Adjustment Between Primiparas Who Used and Those Who did Not Use Sanhujori Facilities: Ju-Eun Song, Bo-Lim Park; J Korean Acad Nurs 2010;40(4):503-514. Published online August 31, 2010; DOI: https://doi.org/10.4040/jkan.2010.40.4.503

Abstract PDF

Purpose

The purpose of this study was to compare levels of postpartum fatigue, depression, childcare stress, and maternal identity according to postpartum period between primiparas who used Sanhujori facilities and those who did not.

Methods

The research design was a longitudinal descriptive study using self-report questionnaires. Participants were 55 healthy primiparas who delivered at one of 3 hospitals in Chungnam, 21 using Sanhujori facilities and 34 not using these facilities during the first three weeks after childbirth. Data were collected from October 2008 to April 2009 at three measurement points, 2-4 days after childbirth (T1), 4-6 weeks (T2), and 12-14 weeks (T3). Data were analyzed using the SPSS 17.0 WIN program.

Results

There was a significant difference in childcare stress between the two groups at 4-6 weeks after childbirth. Postpartum depression and childcare stress at 4-6 weeks were significantly higher than those of the other postpartum periods, while maternal identity was significantly lower.

Conclusion

Child care stress is the most important issue among women who use Sanhujori facilities and the 4-6 week period after childbirth is very difficult to primiparas. These results indicate that nursing interventions for primiparas in Sanhujori facilities should focus on reducing childcare stress. Furthermore proper follow-up programs at 4-6 weeks are needed to decrease the difficulties in adjustment by new mothers.

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Ju Hee Kim, Hye Sook Shin, So Young Kim, Hye Kyung Lee, So Hee Lim
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