Journal of Korean Academy of Nursing

Research Article

Development of a Well-Dying Awareness Scale for Middle-Aged adults in Korea: a mixed-methods study: Yu Jin Jung, Eun Joung Choi; Received October 15, 2024 Accepted February 2, 2025 Published online March 28, 2025; DOI: https://doi.org/10.4040/jkan.24121 [Epub ahead of print]

Abstract PDF ePub: Purpose
This study aimed to develop a valid and reliable tool to measure awareness of well-dying among middle-aged adults.
Methods
A mixed-methods approach was adopted, consisting of a qualitative phase to identify the characteristics of well-dying and a quantitative phase to validate the instrument with middle-aged participants. Initially, 76 items were generated through a literature review and in-depth interviews, and these were reduced to 35 items through expert validation. A pilot survey was conducted with 112 individuals aged 40–65, selected via quota sampling from 17 administrative regions in South Korea. Based on the pilot survey results, the instrument was refined to 32 items for the main survey. The main survey included 314 participants recruited through quota sampling in Busan and Ulsan Metropolitan Cities and Gyeongsang Region. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and reliability testing were performed to validate the instrument.
Results
The final scale comprised 23 items across six factors. EFA demonstrated an explanatory power of 69.1%, with factor loadings ranging from 0.53 to 0.88. CFA confirmed the instrument’s validity, and reliability was established with a Cronbach’s α of .93.
Conclusion
This instrument is a validated and reliable tool for measuring middle-aged individuals’ awareness of well-dying. It can serve as an effective resource for evaluating and assessing well-dying awareness in the middle-aged population.

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Original Articles

Effects of a Relapse Prevention Program on Insight, Empowerment and Treatment Adherence in Patients with Schizophrenia: Jaewon Joung, Sungjae Kim; J Korean Acad Nurs 2017;47(2):188-198. Published online April 28, 2017; DOI: https://doi.org/10.4040/jkan.2017.47.2.188

Abstract PDF

Purpose

The purpose of this study was to develop a relapse prevention program (RPP) and examine the effects of the RPP on insight, empowerment, and treatment adherence in patients with schizophrenia.

Methods

A non-equivalent control group pretest-posttest design was used. Participants were 54 inpatients who had a diagnosis of schizophrenia (experimental group: 26, control group: 28). The study was carried out from February 7, 2012 to February 6, 2013. Over a 10-day period prior to discharge each participant in the experimental group received three one-hour sessions of RPP a one-to-one patient-nurse interaction. Data were collected using Assess Unawareness of Mental Disorder (SUMD), Empowerment Scale, and Insight and Treatment Attitude Questionnaire (ITAQ) and analyzed using PASW 18.0 with chi-square test, independent t-test, Mann-Whitney U test, and ANCOVA.

Results

The experimental group had a significant increase in insight and treatment adherence compared to the control group. However, there was no significant difference in empowerment between the two groups.

Conclusion

Findings indicate that the RPP for patients with schizophrenia was effective in improving insight and treatment adherence. A longitudinal study is needed to confirm the persistence of these effects of RPP in patients with schizophrenia.

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The Effect of Behavior Modification on Enhancing Patient Adherence to Tuberculosis Treatment Regimens: Eun Lee Chung; Journal of Nurses Academic Society 1996;26(3):697-708. Published online March 30, 2017; DOI: https://doi.org/10.4040/jnas.1996.26.3.697

Abstract PDF

Most efforts to improve tuberculosis treatment adherence target the patient and his or her behavior. This study examined the effects of behavioral modification training for these patients. Based on Bandura's behavioral principles of modeling, intervention strategies using a video program were devised to elicit specific patient target behaviors considered to improve patients' adher ence to tuberculosis treatment regimens. A random assignment, two-group (experimental group and control group) research design including 81 subjects was used. The main outcomes measured were pill taking measured with the Medication Event Monitaring System(MEMS) Medication Cap, patients' self-efficacy, and their knowledge of tuberculosis. The findings are as follows: 1) There was a significant difference between the experimental group and the control group in patients' feelings of self-efficacy. That is, the patients who received the behavior modification program showed greater feeling of self-efficacy to initiate and change their behavior for the tuberculosis treatment regimen than the patients who did not receive the program(t=3.51, p=0. 01). 2) There was a significant difference between the experimental group and the control group in patients' knowledge of tuberculosis. That is, the patients who received the behavior modification program showed higher level of knowledge of tuberculosis than the patients who did not receive the program(t=2.15, p=0.03). 3) There was a significant difference between the experimental group and the control group in patients' adherence to tuberculosis treatment regimens. That is, the patients who received the behavior modification program showed greater adherence to the treatment regimens than the patients who did not receive the program(t=5.11, P=0.00). The study findings provided useful insights into nursing practice, particularly in planning intervention strategies aimed at enhancing patients' adherence in tuberculosis that may also be relevant to other chronic diseases with patient adherence problems.

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A Survey on the Delay Time Before Seeking Treatment and Clinical Symptoms in Patients with Acute Myocardial Infarction: Oh Jang Park, Cho Ja Kim, Hyang Yeon Lee, Hae Ok Lee; Journal of Korean Academy of Nursing 2000;30(3):659-669. Published online March 29, 2017; DOI: https://doi.org/10.4040/jkan.2000.30.3.659

Abstract PDF

Many patients of acute myocardial infarction showed delay time before seeking treatment although they needed immediate thrombolytic therapy once they perceived their symptoms. The objectives of this study were to identify the relationship between clinical symptoms and the delay, and to find the time spent before seeking the treatment. This study was a retrospective research. The delay time for the treatment consisted of the length of delay from symptom onset to patients' decision (T1), from patients' decision making to finding transportation (T2), and from taking transportation to the first hospital arrival(T3). The subjects were 89 patients who were admitted in the ICU and Cardiac Ward at Chonnam University Hospital with the first attack of acute myocardial infarction. The data was collected for three months from March 1st to May 31st of 1998 through questionnaires and reviewing patients' charts: The chart information was suppled by two nurses working at the ICU and Cardiac Ward. The data was analyzed by using frequency, mean and ANOVA through the SAS program. The results of study summarized as follows: 1. Sixty two patients (69.7%) were male and twenty seven patients (30.3%) were female, the ratio of male to female was 2.3 : 1. 2. In daily life, the 70.8% of the patients felt chest pain and discomfort fatigue in 67.4%, dyspnea in 57.3%, and pain in arm, neck, and jaw in 52.8%. During the attack, 97.8% of the patients felt chest pain and discomfort dyspnea in 82.1%, pain in arm, neck, jaw in 67.4% and perspiration in 51.7%. 3. The length of time a patient spent seeking time for treatment (T1+T2+T3) was 94.6 minutes, in which the time for patients' decision making for treatment (T1) was 70.3 minutes, time for finding transportation (T2) was 8.2 minutes, and time for the transportation of the patient to the first hospital (T3) was 16.1 minutes. Time for patients' decision making to go to a hospital(T1) was 74.2% of the total time sought for treatment.

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Decision Tree Model of the Treatment-Seeking Behaviors Among Korean Cancer Patients
Hyo-Sook Oh, Hyeoun-Ae Park
Cancer Nursing.2004; 27(4): 259. CrossRef

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Treatment-seeking Behavior among those with Signs and Symptoms of Acute Myocardial Infarction: Cho Ja Kim, Gi Yon Kim; Journal of Korean Academy of Nursing 1999;29(3):605-613. Published online March 29, 2017; DOI: https://doi.org/10.4040/jkan.1999.29.3.605

Abstract PDF

The main purposes of this study were to determine the interval between the onset of symptoms of myocardial infarction and treatment-seeking time and identify the factors related to the interval time. This study used a retrospective design, The sample consisted of 45 patients aged over 30 who were diagnosed with an acute myocardial infarction at two large university affiliated medical center from September 1, 1997 to June 30, 1998. Data was collected by using questionnaires, which included demographic data, premonitory clinical signs and symptoms of myocardial infarction, and a measure of the severity of the signs and symptoms. Also semi-structured interviews and chart reviews were used to obtain information related to treatment seeking time. The results of this study are summarized as follows: 1. The most frequent premonitory clinical symptom was chest pain(92.9%), the second, was perspiration(81.0%), and the next were nausea(40.5%) and dyspnea(38.1%). Thirty two patients reported having more than four premonitory signs and symptoms. Patients described the characteristics of chest pain as "something very heavy pressing down "(26.2%), "felt like my chest would burst"(24.4%), or "sharp pain"(16.7%). Over 95% of the sample reported having chest pain. 2. Twenty two (52.4%) patients reported to have "very severe" premonitory pain. 3. The mean time interval between the onset of signs and symptoms and the arrival at the medical center was 6.39+/-0.80 hours in 42 samples, the mean time from the onset to arrival at a local hospital was 3.27+/-.39 hours and for transfer from a local hospital to the medical center was 4.75+/-.87 hours in patients who had arrived at medical center via local hospital. 4. The severity of premonitory signs and symptoms did not differ significantly according to existence of premonitory signs and symptoms. 5. There was no significant relationship between treatment-seeking time and age, gender, marital status, economic status, occupation, or residence. But education had significant relationship(r=-0.51, p=0.01). Analysis of difference of the time interval according to the premonitory signs and symptoms showed that the time was shorter in patients who experienced nausea or dysnea(U=115.50, p=0.01, U=132.00, p=0.04), however the severity of premonitory signs and symptoms did not have statistical significance.

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Factors associated with needlestick and sharp injuries among hospital nurses: A cross-sectional questionnaire survey
Eunhee Cho, Hyeonkyeong Lee, Miyoung Choi, Su Ho Park, Il Young Yoo, Linda H. Aiken
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Morbidity and mortality rates in women with heart disease: Lessons in gender differences from Korea
Myoung-Ae Choe, Kyungeh An
Contemporary Nurse.2003; 14(2): 158. CrossRef

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The Comparison of the Effectiveness of Pelvic Floor Muscle Exercise and Biofeedback Treatment for Stress Incontinence in Korean Women: Young Hee Choi, Myung Sook Sung, Jae Yup Hong; Journal of Korean Academy of Nursing 1999;29(1):34-47. Published online March 29, 2017; DOI: https://doi.org/10.4040/jkan.1999.29.1.34

Abstract PDF

This study evaluated the Comparison of the Effectiveness of Pelvic Floor Muscle exercise and Biofeedback treatment for Genuine Stress Incontinence I assigned 60 participants to 2 groups : 30 to the pelvic floor muscle exercise group and 30 to the biofeedback group. Treatment protocol lasted for 6 weeks. Peak pressure, and duration time of pelvic muscle contraction were evaluated by a perineometer. Lower urinary symptoms, sexual matter and life style scores were achieved by using Jackson's scale. The treatment efficacy of the pelvic floor muscle exercise is compared with the biofeedback group and the main results of the comparison are as follows: 1. Pelvic muscle contraction 1) The peak pressure in the biofeedback group was significantly increased(P=0.000). 2. The frequency and quantity of incontinence 1) The frequency of incontinence in the biofeedback group was significantly decreased(P=0.000). 2) The quantity of incontinence in the biofeedback group was significantly decreased(P=0.000). 3. The lower urinary symptoms Daily frequency(P=0.000), nocturia(P=0.000), urgency(P=0.000), bladder pain(P=0.000), unexplained incontinence(P=0.048), wearing protection(P=0.022), changing outer clothing(P=0.005), hesitancy(P=0.008), intermittent stream(P=0.000), abnormal strength of stream(P=0.004), retention(P=0.000), incomplete emptying(P=0.000), and inability to stop mid steam(P=0.006) of the lower urinary symptoms in the biofeedback group were significantly decreased. 4. The sexual matters The dry vagina(P=0.004) and pain during sexual intercourse(P=0.002) in the biofeedback group was significantly decreased. 5. The life style. The fluid intake restriction(P=0.007), affected daily task(P=0.003), avoidance of places & situation(P=0.003), interference in Physical activity(P=0.002), interference in relationship with other people(P=0.01), and feeling about the rest of life with urinary symptom(P=0.000) in the biofeedback group were significantly decreased. In conclusion, the biofeedback treatment was more effective than the pelvic floor muscle exercise in genuine stress incontinence.

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Effect of Pila-dance to Ease Urinary Incontinence of Middle-aged Women
Hye-Jeon Hong
The Korean Journal of Physical Education.2018; 57(2): 431. CrossRef
The Convergence Study on the Effects of Three Pelvic Floor Muscle Excercise on Thickness of Pelvic Floor Muscle and Abdominal Muscles
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Effect of Endurance Exercise during Dexamethasone Treatment on the Attenuation of Atrophied Hind-limb Muscle Induced by dexamethasone in Rats: Myoung Ae Choe; Journal of Korean Academy of Nursing 1998;28(4):893-907. Published online March 29, 2017; DOI: https://doi.org/10.4040/jkan.1998.28.4.893

Abstract PDF

The purpose of this study was to determine the effect of regular exercise during dexamethasone injection in the body weight, weight of hind-limb muscles, myofibrillar protein content and glutamine synthetase activity. 180-200g female Wistar were divided into four groups: control, exercise, dexamethasone injection(dexa), and exercise during dexamethasone injection(D+E) group. The dexa group received daily subcutaneous injection of dexamethasone at a dose of 4mg/kg body weight for 7days. The exercise group ran on a treadmill for 60min/day(20minutes every 4 hours) at 10m/min and a 10degrees grade. The control group received daily subcutaneous injection of normal saline at a dose of 4mg/kg body weight for 7 days. The D+E group ran on a treadmill for 60min/day(20minutes every 4 hours) at 10m/min and a 10degrees grade during dexamethasone injection. Body weight of the control group increased significantly from days of experiment, that of the dexa group decreased significantly from day 4 of the dexa group decrease significantly from day 4 of the experiment resulting in a 82.4% decrease compared to the first day of the experiment. Body weight of the D+E group decrease significantly from day 5 of experiment resulting in a 81.77% decrease compared to the first day of the experiment. Body weights, muscle weight and myofibrillar protein content of the plantaris and gastrocnemius decrease significantly and muscle weight of the sleys tended to decrease with dexamethasone injection. Glutamine synthetase activity of the hind-limb muscles increase significantly with the dexamethasone injection. The relative weight of the soleus was comparable to the control group and that of plantaris decrease significantly and that of gastrocnemius tended to decrease compared to that of the control in the dexa group. Body weight and muscle weight of the plantaris and gastronemius of the exercise group were comparable to the control group, and the muscle weight of soleus showed a tendency to increase. The relative weight of the soleus increased significantly and that of the plantaris and gastrocnemius were comparable to the control in the exercise group. Myofibrillar protein content of the soleus and plantaris increased significantly and there was no change of GS activity of the hind-limb muscles compared to the control in the exercise group. Body weight of the D+E group was comparable to the dexa group, muscle weight of the hind-limb muscles increased significantly. Myofibrillar protein content of the soleus and plantaris increase significantly and that of the gastrocnemius tendency to increase compared to the dexa group. Body weight and muscle weight of the plantaris and gastrocnemius of the D+E group did not recover to that of the control group. Muscle weight of the soleus recovered to that of the control group. The relative weight and myofibrillar protein content of the hind-limb muscles recovered to that of the control group. From these results, it is suggested that regular exercise during dexamethasone injection might attenuate the muscle atrophy of the hind-limb muscles.

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Effect of DHEA Administration Alone or Exercise combined with DHEA before Steroid Treatment on Rat Hindlimb Muscles
Myoung-Ae Choe, Gyeong-Ju An
Journal of Korean Academy of Nursing.2009; 39(3): 321. CrossRef

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Pre- and In-Hospital Delay in Treatment and in-Hospital Mortality after Acute Myocardial Infarction: Kyuneh An, Bongyeun Koh; Journal of Korean Academy of Nursing 2003;33(8):1153-1160. Published online March 28, 2017; DOI: https://doi.org/10.4040/jkan.2003.33.8.1153

Abstract PDF

Purpose

1) To identify the time taken from symptom onset to the arrival at the hospital (pre-hospital delay time) and time taken from the arrival at the hospital to the initiation of the major treatment (in-hospital delay time) 2) to examine whether rapid treatment results in lower mortality. 3) to examine whether the pre- and in-hospital delay time can independently predict in-hospital mortality.

Methods

A retrospective study with 586 consecutive AMI patients was conducted.

Results

Pre-hospital delay time was 5.25 (SD=10.36), and in-hospital delay time was 1.10 (SD=1.00) hours for the thrombolytic therapy and 50.24 (SD=121.18) hours for the percutaneous transluminal coronary angioplasty(PTCA). In-hospital mortality was the highest when the patients were treated between 4 to 48 hours after symptom onset using PTCA (rho=.02), and when treated between 30 minutes and one hour after hospital arrival using thrombolytics (rho=.01). Using a hierarchical logistic regression model, the pre- and in-hospital delay times did not predict the in-hospital mortality.

Conclusion

Pre- and in-hospital delay times need to be decreased to meet the desirable therapeutic time window. Thrombolytics should be given within 30 minutes after arrival at the hospital, and PTCA should be initiated within 4 hours after symptom onset to minimize in-hospital mortality of AMI patients.

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Comparison of Clinical Manifestations and Treatment-Seeking Behavior in Younger and Older Patients with First-time Acute Coronary Syndrome
Seon Young Hwang
Journal of Korean Academy of Nursing.2009; 39(6): 888. CrossRef

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The Effect of Dialysate Flow Rate on Dialysis Adequacy and Fatigue in Hemodialysis Patients: Sun Mi Cha, Hye Sook Min; J Korean Acad Nurs 2016;46(5):642-652. Published online October 31, 2016; DOI: https://doi.org/10.4040/jkan.2016.46.5.642

Abstract PDF

Purpose

In this single repeated measures study, an examination was done on the effects of dialysate flow rate on dialysis adequacy and fatigue in patients receiving hemodialysis.

Methods

This study was a prospective single center study in which repeated measures analysis of variance were used to compare Kt/V urea (Kt/V) and urea reduction ratio (URR) as dialysis adequacy measures and level of fatigue at different dialysate flow rates: twice as fast as the participant’s own blood flow, 500 mL/min, and 700 mL/min. Thirty-seven hemodialysis patients received all three dialysate flow rates using counterbalancing.

Results

The Kt/V (M±SD) was 1.40±0.25 at twice the blood flow rate, 1.41±0.23 at 500 mL/min, and 1.46±0.24 at 700 mL/min. The URR (M±SD) was 68.20±5.90 at twice the blood flow rate, 68.67±5.22 at 500 mL/min, and 70.11±5.13 at 700 mL/min. When dialysate flow rate was increased from twice the blood flow rate to 700 mL/min and from 500 mL/min to 700 mL/min, Kt/V and URR showed relative gains. There was no difference in fatigue according to dialysate flow rate.

Conclusion

Increasing the dialysate flow rate to 700 mL/min is associated with a significant nicrease in dialysis adequacy. Hemodialysis with a dialysate flow rate of 700 mL/min should be considered in selected patients not achieving adequacy despite extended treatment times and optimized blood flow rate.

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Gender Difference in Osteoporosis Prevalence, Awareness and Treatment: Based on the Korea National Health and Nutrition Examination Survey 2008~2011: Yunmi Kim, Jung Hwan Kim, Dong Sook Cho; J Korean Acad Nurs 2015;45(2):293-305. Published online April 30, 2015; DOI: https://doi.org/10.4040/jkan.2015.45.2.293

Abstract PDF

Purpose

The aim of the study was to assess and identify gender differences in factors associated with prevalence, awareness, and treatment of osteoporosis.

Methods

Data for 3,071 men and 3,635 women (age≥ 50) from the Korea National Health and Nutrition Examination Survey 2008~2011 were included. Osteoporosis was defined by World Health Organization T-score criteria. Impact factors and odds ratios were analysed by gender using multivariate logistic regression.

Results

Osteoporosis prevalence rates were 7.0% in men and 40.1% in women. Osteopenia rates were 45.5% and 46.0% respectively. Among respondents with osteoporosis, 7.6% men and 37.8% women were aware of their diagnosis. Also 5.7% men with osteoporosis and 22.8% women were treated. Higher prevalence was found among respondents who were older, at lower socioeconomic levels, with lower body mass index and shorter height in both genders, and among women with fracture history, and non-hormonal replacement therapy. Awareness and treatment rates for the risk groups were similar compared to the low risk controls for both genders. Fracture history increased awareness and treatment rates independently for both genders. Women with perceived poor health status and health screening had increased awareness and treatment rates, but not men.

Conclusion

Results indicate that postmenopausal women have a higher prevalence of osteoporosis than men and awareness and treatment rates were higher than for men. Despite gender difference in prevalence, osteoporosis was underdiagnosed and undertreated for both genders. Specialized public education and routine health screenings according to gender could be effective strategies to increase osteoporosis awareness and treatment.

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Update on Irritable Bowel Syndrome Program of Research: Margaret Heitkemper, Monica Jarrett, Sang-Eun Jun; J Korean Acad Nurs 2013;43(5):579-586. Published online October 31, 2013; DOI: https://doi.org/10.4040/jkan.2013.43.5.579

Abstract PDF

Purpose

This article provides an update and overview of a nursing research program focused on understanding the pathophysiology and management of irritable bowel syndrome (IBS).

Methods

This review includes English language papers from the United States, Europe, and Asia (e.g., South Korea) from 1999 to 2013. We addressed IBS as a health problem, emerging etiologies, diagnostic and treatment approaches and the importance of a biopsychosocial model.

Results

IBS is a chronic, functional gastrointestinal disorder characterized by recurrent episodes of abdominal pain and alterations in bowel habit (diarrhea, constipation, mixed). It is a condition for which adults, particularly women ages 20-45, seek health care services in both the United States and South Korea. Clinically, nurses play key roles in symptom prevention and management including designing and implementing approaches to enhance the patients' self-management strategies. Multiple mechanisms are believed to participate in the development and maintenance of IBS symptoms including autonomic nervous system dysregulation, intestinal inflammation, intestinal dysbiosis, dietary intolerances, alterations in emotion regulation, heightened visceral pain sensitivity, hypothalamic-pituitary-adrenal dysregulation, and dysmotility. Because IBS tends to occur in families, genetic factors may also contribute to the pathophysiology. Patients with IBS often report a number of co-morbid disorders and/or symptoms including poor sleep.

Conclusion

The key to planning effective management strategies is to understand the heterogeneity of this disorder. Interventions for IBS include non-pharmacological strategies such as cognitive behavior therapy, relaxation strategies, and exclusion diets.

Citations

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Meta-Analysis of Spiritual Intervention Studies on Biological, Psychological, and Spiritual Outcomes: Pok-Ja Oh, Young-Hyun Kim; J Korean Acad Nurs 2012;42(6):833-842. Published online December 31, 2012; DOI: https://doi.org/10.4040/jkan.2012.42.6.833

Abstract PDF

Purpose

The purpose of this study was to evaluate the effectiveness of spiritual intervention studies by examining biological, psychological, and spiritual outcomes.

Methods

From electronic databases 2522 studies were retrieved, of which 21 studies met the inclusion criteria. These studies had 1411 participants. Two authors independently extracted data from the selected studies and assessed the methodological quality. The data were analyzed using the RevMan 5.1 program of the Cochrane library.

Results

Overall effect size of spiritual intervention on spiritual and psychological (depression and anxiety) outcomes were moderate (d=-0.65 to d=-0.76, p<.001). The effects on biological outcomes (pain and functional status) ranged from -0.51 to -0.39, respectively. No publication bias was detected as evaluated by a funnel plot. Spiritual intervention had a moderate effect on psychological and spiritual outcomes and a smaller effect on biological outcomes.

Conclusion

The results of this study suggest that spiritual intervention can relieve depression and anxiety. Further randomized controlled trials studies are needed to evaluate the effects of spiritual intervention on biological outcomes.

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