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Research Paper
Triglyceride-glucose parameters as predictors of diabetes mellitus incidence in Korean adults: a secondary analysis of the Korean Genome and Epidemiology Study
Yu Jin Park, Miseon Shin, Hyun Seon Jeon, Eun Hee Yang
Received September 5, 2024  Accepted February 6, 2025  Published online April 1, 2025  
DOI: https://doi.org/10.4040/jkan.24108    [Epub ahead of print]
AbstractAbstract PDFePub
Purpose
This study aimed to evaluate the association between triglyceride-glucose (TyG)–related parameters and the incidence of diabetes mellitus in Korean adults. Data were obtained from the Korean Genome and Epidemiology Study (KoGES).
Methods
This secondary analysis examined data from 6,816 adults aged 40–69 years who participated in the KoGES from 2001 to 2020. TyG–related parameters, including the TyG index, TyG–body mass index (TyG–BMI), TyG–waist circumference (TyG–WC), and TyG–waist-to-height ratio (TyG–WHtR), were assessed. Cox proportional hazards models were employed to determine the association between these parameters and the incidence of diabetes mellitus, with adjustments made for demographic, lifestyle, and health-related characteristics.
Results
Higher levels of all TyG–related parameters were significantly associated with an increased risk of developing diabetes mellitus. Specifically, participants in the highest quartile of the TyG index, TyG–BMI, TyG–WC, and TyG–WHtR exhibited significantly higher hazard ratios for diabetes mellitus incidence compared with those in the lowest quartile (p<.001 for all). Notably, the TyG index demonstrated a stronger predictive value for diabetes mellitus than traditional measures such as the homeostatic model assessment of insulin resistance.
Conclusion
TyG–related parameters are robust predictors of diabetes mellitus incidence in Korean adults. These findings support the incorporation of TyG–related measures into clinical settings for the early identification and intervention of high-risk populations. Utilizing these parameters for early diagnosis and preventive strategies may significantly enhance diabetes mellitus management.
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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]
AbstractAbstract PDFePub
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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Research Paper
Effects of a nursing leadership program on self-leadership, interpersonal relationships, clinical performance, problem-solving abilities, and nursing professionalism among nursing students in South Korea: a quasi-experimental study
Sunmi Kim, Young Ju Jeong, Hee Sun Kim, Seok Hee Jeong, Eun Jee Lee
J Korean Acad Nurs 2025;55(1):137-151.   Published online February 25, 2025
DOI: https://doi.org/10.4040/jkan.24110
AbstractAbstract PDFePub
Purpose
This study investigated the effects of a nursing leadership program on self-leadership, interpersonal relationships, clinical performance, problem-solving abilities, and nursing professionalism among nursing students in South Korea.
Methods
A quasi-experimental study was conducted. The Practice-Driven Nursing Leadership Program for Students (PDNLP-S) was developed based on the ADDIE model (analysis, design, development, implementation, and evaluation). This quasi-experimental study design included 60 nursing students. The experimental group (n=30) participated in the PDNLP-S for 120-minute sessions over 5 weeks, while the control group (n=30) received usual lectures. The PDNLP-S included lectures, discussions, and individual and group activities to cultivate core nursing leadership competencies such as individual growth, collaboration, nursing excellence, creative problem-solving, and influence. Data were analyzed using descriptive statistics, the Mann-Whitney U-test, and the independent t-test with IBM SPSS Windows ver. 26.0.
Results
The experimental group demonstrated significant improvements in self-leadership (t=3.28, p=.001), interpersonal relationships (t=3.07, p=.002), clinical performance (U=268.50, p=.004), and problem-solving abilities (t=2.20, p=.017) compared to the control group. No significant difference was observed in nursing professionalism (t=0.50, p=.311).
Conclusion
This study demonstrates that the PDNLP-S improved nursing students’ self-leadership, interpersonal relationships, clinical performance, and problem-solving abilities. The PDNLP-S can play a significant role in cultivating future nurse leaders by enhancing these nursing leadership competencies among nursing students.
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Review Paper
Effectiveness of non-pharmacological interventions to reduce internalized stigma in people with severe mental illness: a systematic review and meta-analysis
Soyoung Kim, Sun Hyoung Bae, Myung-Sun Hyun
J Korean Acad Nurs 2025;55(1):1-18.   Published online February 25, 2025
DOI: https://doi.org/10.4040/jkan.24072
AbstractAbstract PDFePub
Purpose
This study systematically reviewed and analyzed the effects of non-pharmacological interventions on internalized stigma among people with severe mental illness.
Methods
A systematic review and meta-analysis were conducted following the Cochrane Intervention Research Systematic Review Manual and Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. This study targeted people with severe mental illness as the population, interventions aimed at reducing internalized stigma, comparisons with control groups, and internalized stigma as the outcome. A literature search was performed across multiple databases, including PubMed, EMBASE, the Cochrane Library, CINAHL, PsycArticles, RISS, KMbase, and KoreaMed. The risk of bias was evaluated using the Cochrane Risk of Bias 2.0 tool. Effect sizes were computed using Hedges’s g, and subgroup analyses were conducted with Comprehensive Meta-Analysis software version 4.0.
Results
Of 2,388 papers, 15 were included in the meta-analysis. The overall effect size (Hedges’s g) of the intervention was –0.60 (95% confidence interval, –1.01 to –0.19), indicating a statistically significant reduction in internalized stigma (Z=–2.88, p=.004). Subgroup analyses revealed that the intervention type (p=.008) and session length (p=.011) were significant moderators influencing the effectiveness of the interventions.
Conclusion
Tailoring interventions by considering variables such as the intervention type and session length could enhance the effectiveness of non-pharmacological interventions for reducing internalized stigma among people with severe mental illness (PROSPERO: CRD42023418561).
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Research Papers
Reliability and validity of the Korean version of the Nurses Professional Values Scale-3 for nursing students: a methodological study
Eun Hee Yang, Mi Yu
J Korean Acad Nurs 2025;55(1):93-106.   Published online February 20, 2025
DOI: https://doi.org/10.4040/jkan.24113
AbstractAbstract PDFePub
Purpose
This study aimed to adapt the Nurses Professional Values Scale-3 (NPVS-3) for Korean nursing students and assess its reliability and validity.
Methods
The NPVS-3 was translated into Korean using forward and back translation with expert review. Data from 206 nursing students at four universities were analyzed to assess content, construct, discriminant, and criterion validity, as well as internal consistency.
Results
The Korean version (NPVS-3K) consisted of 21 items in three subscales: caring (eight items), activism (eight items), and professionalism (five items), explaining 60.9% of the total variance. For convergent validity, standardized coefficients for the items ranged from .56 to .81, construct reliability ranged from .89 to .95, and the average variance extracted ranged from .61 to .72. The model was validated by confirmatory factor analysis (χ2=526.00 [p<.001], χ2/degrees of freedom=2.83, standardized root mean residual=.03, goodness of fit index=.81, comparative fit index=.87, Turker Lewis index=.85). Discriminant validity was confirmed using a multi-trait and multi-item matrix. Criterion validity showed positive correlations between the three NPVS-3K factors and professional identity (factor 1: r=.40, p<.001; factor 2: r=.55, p<.001; factor 3: r=.43, p<.001). Internal consistency, as measured by Cronbach’s α, was .94 overall, with subscale values of .90 for caring, .92 for activism, and .78 for professionalism.
Conclusion
The NPVS-3K demonstrated satisfactory validity and reliability, establishing it as a valuable tool for assessing the professional values of Korean nursing students. Additionally, it can aid in developing educational strategies to strengthen these values, although further research is required to confirm its broader applicability.
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Factors influencing smartphone overdependence in university students: an ecological model: a descriptive study
Jeong Soon Yu, Myung Soon Kwon
J Korean Acad Nurs 2025;55(1):64-80.   Published online February 20, 2025
DOI: https://doi.org/10.4040/jkan.24092
AbstractAbstract PDFePub
Purpose
This study investigated the factors influencing smartphone overdependence in university students using an ecological model and descriptive research.
Methods
Data were collected from 482 students at 13 universities in the six regions in South Korea from October 20, 2020, to March 25, 2021. Data analysis involved descriptive statistics, the chi-square test, the independent samples t-test, analysis of variance, and hierarchical multiple regression.
Results
The significant ecological factors influencing smartphone overdependence included self-awareness of smartphone overdependence (β=.33, p<.001), autonomy (β=–.25, p<.001), average daily smartphone usage time (β=.18, p<.001), gender (β=.15, p=.001), college year (β=.15, p=.020), forming relationships with others as a motivation for smartphone use (β=–.15, p=.008), friend support (β=.14, p=.006), and age (β=–.12, p=.047). The model explained 34.9% of the variance.
Conclusion
The study emphasized the role of personal and interpersonal factors, in smartphone overdependence among university students. Tailored intervention strategies are necessary to address smartphone overdependence, considering the unique characteristics of students’ environments. A significant aspect of this study is that it provides an explanation of the multidimensional factors contributing to smartphone overdependence among university students, including intrapersonal, interpersonal, and environmental influences.
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Mediating effect of grit on the influence of nurses’ silence behavior on medication safety competence: a cross-sectional study
Haengsuk Kim, Wanju Park
J Korean Acad Nurs 2025;55(1):81-92.   Published online February 20, 2025
DOI: https://doi.org/10.4040/jkan.24088
AbstractAbstract PDFePub
Purpose
This study investigated the mediating effect of grit in the relationship between silence behavior and medication safety competence among nurses.
Methods
The study included 166 nurses from four university hospitals and general hospitals in Seoul and Gyeonggi-do, South Korea. Data were collected from March 1 to 10, 2024, using self-report questionnaires. Data were analyzed using the t-test, analysis of variance, Scheffé’s test, and Pearson’s correlation coefficients with IBM SPSS Statistics ver. 23.0 (IBM Corp.). A mediation analysis was performed using Hayes’s PROCESS macro model 4 and the bootstrapping method.
Results
Medication safety competence showed significant correlations with silence behavior (r=–.21, p=.008) and grit (r=.43, p<.001). Furthermore, grit partially mediated the relationship between silence behavior and medication safety competence.
Conclusion
This study indicates that grit is a significant mediator in the relationship between silence behavior and medication safety competence. Therefore, an integrated approach that reduces silence behavior and promotes grit is essential for strengthening nurses’ medication safety competence. Ultimately, these strategies will help ensure patient safety by improving medication safety competence.
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Development and effects of a media-based reproductive health promotion program for male high school students at male high school: a quasi-experimental study
Joon-Young Lee, Yeoungsuk Song
J Korean Acad Nurs 2025;55(1):34-49.   Published online February 20, 2025
DOI: https://doi.org/10.4040/jkan.24050
AbstractAbstract PDFePub
Purpose
This quasi-experimental study was conducted to develop a media-based reproductive health promotion program (MRHPP) among male high school students and to evaluate its effectiveness.
Methods
The ADDIE model (analysis, design, development, implementation, and evaluation model) was used to develop the MRHPP based on Ajzen’s theory of planned behavior. The research was conducted using a non-equivalent control group with a pretest-posttest design (experimental group=23; control group=22). The program consisted of six sessions and was conducted twice a week. The participants were assessed through a pre-test, post-test immediately after training (post-test 1), and follow-up after 4 weeks (post-test 2) by using questionnaires. The collected data were analyzed using descriptive statistics, the independent t-test, chi-square test, Fisher’s exact test, and repeated-measures analysis of variance.
Results
The analysis of the group-by-time interaction showed statistically significant differences in attitudes toward reproductive health behavior (RHB) (F=4.09, p=.049), subjective norms of RHB (F=5.31, p=.026), and intention to engage in RHB (F=3.78, p=.016). The effect sizes for attitudes, subjective norms, and intention to engage in RHB ranged from 0.75 (medium) to 1.02 (large) (p<.001) at post-test 1, and those for attitudes and subjective norms of RHB ranged from 0.36 (small) to 0.69 (medium) (p<.001) at post-test 2.
Conclusion
The MRHPP was demonstrated to be an effective intervention for promoting reproductive health behavior among male high school students.
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A qualitative meta-synthesis of the essence of patient experiences of dialysis
Soyoung Jang, Eunyoung E. Suh, Yoonhee Seok
J Korean Acad Nurs 2025;55(1):119-136.   Published online February 19, 2025
DOI: https://doi.org/10.4040/jkan.24102
AbstractAbstract PDFePub
Purpose
This study aimed to understand the experiences of dialysis and their meaning among patients with chronic kidney disease through a meta-synthesis of the existing literature. Since 2010, the prevalence of end-stage renal disease has doubled in South Korea, which has the sixth-highest incidence worldwide. Although most kidney disease patients undergo dialysis to attenuate disease-related symptoms and prolong their lives, the implications of dialysis on their lives, together with the role played by patients’ significant others, remain underexplored. Similarly, existing research has not considered both patients with hemodialysis and peritoneal dialysis.
Methods
In this meta-synthesis, seven electronic databases (PubMed, CINAHL, EMBASE, PsycINFO, DBpia, KISS, and RISS) were searched for the terms “dialysis” and “qualitative.” Thirty qualitative studies were selected for examination.
Results
The overriding theme observed in the studies was “I do not have much time left.”–navigating the dual realities of one’s limited existence, while other key themes were: (1) the inevitable experience of the troubles of dialysis, (2) life is extended, but deteriorating in every aspect, (3) accepting dialysis with a positive outlook for life, and (4) essential support experienced in an exhausting life.
Conclusion
These findings are important for the design and delivery of practical and tailored nursing interventions to help patients overcome the various challenges related to dialysis treatment, and improve their quality of life.
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Formative versus reflective measurement models in nursing research: a secondary data analysis of a cross-sectional study in Korea
Eun Seo Park, Young Il Cho, Hyo Jin Kim, YeoJin Im, Dong Hee Kim
J Korean Acad Nurs 2025;55(1):107-118.   Published online February 19, 2025
DOI: https://doi.org/10.4040/jkan.24095
AbstractAbstract PDFePub
Purpose
This study aimed to empirically verify the impact of measurement model selection on research outcomes and their interpretation through an analysis of children’s emotional and social problems measured by the Pediatric Symptom Checklist (PSC) using both reflective and formative measurement models. These models were represented by covariance-based structural equation modeling (CB-SEM) and partial least squares SEM (PLS-SEM), respectively.
Methods
This secondary data analysis evaluated children’s emotional and social problems as both reflective and formative constructs. Reflective models were analyzed using CB-SEM, while formative models were assessed using PLS-SEM. Comparisons between these two approaches were based on model fit and parameter estimates.
Results
In the CB-SEM analysis, which assumed a reflective measurement model, a model was not identified due to inadequate fit indices and a Heywood case, indicating improper model specification. In contrast, the PLS-SEM analysis, assuming a formative measurement model, demonstrated adequate reliability and validity with significant path coefficients, supporting the appropriateness of the formative model for the PSC.
Conclusion
The findings indicate that the PSC is more appropriately analyzed as a formative measurement model using PLS-SEM, rather than as a reflective model using CB-SEM. This study highlights the necessity of selecting an appropriate measurement model based on the theoretical and empirical characteristics of constructs in nursing research. Future research should ensure that the nature of measurement variables is accurately reflected in the choice of statistical models to improve the validity of research outcomes.
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Nomogram for predicting changes in cognitive function in community dwelling older adults with mild cognitive impairment based on Korea Longitudinal Study of Ageing Panel Data: a retrospective study
Hyuk Joon Kim, Hye Young Kim
J Korean Acad Nurs 2025;55(1):50-63.   Published online February 7, 2025
DOI: https://doi.org/10.4040/jkan.24059
AbstractAbstract PDFePub
Purpose
This study aimed to identify factors associated with normal cognitive reversion and progression to dementia in older adults with mild cognitive impairment (MCI) residing in the community and to develop a nomogram.
Methods
This longitudinal study used secondary data from the Korea Longitudinal Study of Ageing Panel Data (2006–2018). The study included 1,262 participants aged 60 or older, with initial Mini-Mental State Examination scores ranging from 18 to 23. Data were analyzed using the Rao-Scott chi-square test, panel binary logistic regression, and receiver operating characteristic (ROC) curve in Stata ver. 17.0 (Stata Corp.).
Results
The rate of reversion from MCI to normal cognition was 37.0% after 2 years and 32.9% after 12 years. The rate of progression to dementia was 18.0% after 2 years and 30.2% after 12 years. In the nomogram for reversion to normal cognition, the most significant influences were grip strength, depression, number of meetings, age, and regular exercise, with an area under the ROC curve (AUC) of .66. In contrast, in the nomogram for progression to dementia, the most significant influences were age, grip strength, instrumental activities of daily living, number of social meetings attended, depression, and regular exercise, with an AUC of .69.
Conclusion
These nomograms can serve as an effective intervention tool for preventing dementia in the field of community health care since they can serve as a visual technique for presenting information on risk to individuals with MCI.
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Serial mediation effects of social support and antepartum depression on the relationship between fetal attachment and anxiety in high-risk pregnant couples of South Korea
Mihyeon Park, Sukhee Ahn
J Korean Acad Nurs 2025;55(1):19-33.   Published online February 4, 2025
DOI: https://doi.org/10.4040/jkan.24070
AbstractAbstract PDFePub
Purpose
This study examined the direct effects of fetal attachment, social support, and antepartum depression on anxiety in pregnant women with high-risk pregnancy-related conditions and their husbands. Furthermore, it aimed to explore the serial mediation effects of social support and antepartum depression in the relationship between fetal attachment and anxiety.
Methods
A survey-based study was conducted among pregnant women diagnosed with high-risk pregnancy conditions at 24–32 weeks and their husbands, recruited from a pregnant women’s online community between January 20, 2021 and July 20, 2022. Data were collected from 294 individuals (147 couples) using self-report questionnaires. Correlations between variables were analyzed using the IBM SPSS software ver. 26.0 (IBM Corp.), and the mediation effects were assessed using the PROCESS macro, model 6.
Results
In the maternal model, maternal-fetal attachment directly affected anxiety (p=.005), with antepartum depression partially mediating this relationship (95% confidence interval [CI], –0.26 to –0.01). In the paternal model, paternal-fetal attachment had no direct effect on anxiety (p=.458). However, social support and antepartum depression fully mediated the relationship between paternal-fetal attachment and anxiety (95% CI, –0.14 to –0.03).
Conclusion
The findings indicate that social support in the relationship between fetal attachment and depression in high-risk pregnant women and their partners can have direct or indirect effects on the negative emotions of high-risk pregnant couples. It is necessary to assess the level of anxiety in couples experiencing high-risk pregnancies and provide comprehensive nursing interventions that address fetal attachment, social support, and antepartum depression in order to reduce anxiety.
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Validity and Reliability of the Korean Version of the Occupational Coping Self-Efficacy Scale for Nurses
Youngrye Park, Sunah Park, Hee Ran Kang
J Korean Acad Nurs 2024;54(4):633-644.   Published online November 30, 2024
DOI: https://doi.org/10.4040/jkan.24094
AbstractAbstract PDFePub
Purpose

This study aimed to evaluate the validity and reliability of the Korean version of the occupational coping self-efficacy for nurses (K-OCSE-N) scale.

Methods

The English version of the OCSE-N scale was translated into Korean using a translation and back-translation process. Data were gathered from 213 nurses employed in a general hospital in South Korea. The content validity was assessed using the content validity index. The construct validity was verified through exploratory and confirmatory factor analyses. Criterion validity was assessed using Pearson’s correlation coefficients with the job stress coping and general self-efficacy scales. Reliability was examined using item-total score correlation and Cronbach’s α coefficient for internal consistency.

Results

The exploratory factor analysis identified two factors that explained 61.8% of the cumulative variance: occupational burden and relational difficulty. In confirmatory factor analysis, the model exhibited adequate fit (χ2/df = 2.07, GFI = .95, SRMR = .04, RMSEA = .07, CFI = .97, and TLI = .95), with both convergent and discriminant validity deemed acceptable. The criterion validity presented a positive correlation of the K-OCSE-N with both job stress coping (r = .72, p < .001) and general self-efficacy (r = .72, p < .001). The internal consistency of the scale using Cronbach’s α for the total items was .89.

Conclusion

The K-OCSE-N scale is a valid and reliable tool for measuring nurses’ occupational coping self-efficacy. This study suggests that various intervention studies can use the scale to assess and strengthen nurses’ occupational coping self-efficacy in nursing practice.

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Experiences of Unmarried Women Undergoing Planned Oocyte Cryopreservation
Miok Kim, Kim Mingyoung
J Korean Acad Nurs 2024;54(4):577-593.   Published online November 30, 2024
DOI: https://doi.org/10.4040/jkan.24064
AbstractAbstract PDFePub
Purpose

The present study investigated the experiences of unmarried women undergoing planned oocyte cryopreservation (OC).

Methods

Data were collected from August 2022 to February 2023 through individual in-depth interviews with thirteen unmarried women undergoing planned OC. Data were analyzed using Colazzi’s phenomenological method.

Results

The findings revealed four distinct clusters. The first cluster, “Safeguards against Future Uncertainty,” examined experiences associated with uncertainties in several aspects of reproductive health threats and decision-making regarding planned OC. The second cluster, “Indescribable Pain and Chaos,” explored the psychological and physical pain, complications, concerns about repeat procedures, and uncertainties about the use of frozen oocytes experienced during the planned OC process and afterward. The third cluster, “Motivation to Rebuild Resilience,” explored participants’ resilience in overcoming difficulties and shocks during the planned OC process and regaining their inner strength through the support of family and friends. The fourth cluster, “Finally Freeing the Mind,” focused on the sense of liberation from the pressure of marriage and childbirth, which enabled participants to engage in their present self and concentrate on self-stability and growth in preparation for the future.

Conclusion

The present study enhances our understanding of the emotional difficulties and distress experienced by women considering OC, thereby assisting in improving approaches for psychological support and clinical management. Furthermore, providing insights into these first-hand experiences to women considering planned OC, healthcare professionals, and policymakers could help establish systems to support the decision-making process.

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The Mediating Role of Psychological Resilience in Chinese Nursing Students’ Professional Identity and Learning Burnout
Liu Zhang, Qin Zhang, ShuWen Li, YuHong Li, GuoCui Wu, Ying Chen, YunNa Zhou
J Korean Acad Nurs 2024;54(4):509-518.   Published online November 25, 2024
DOI: https://doi.org/10.4040/jkan.24044
AbstractAbstract PDFePub
Purpose

This study investigated whether professional identity predicts learning burnout among Chinese nursing students, and whether resilience moderates this relationship.

Methods

This cross-sectional study recruited 635 students from a nursing college at a medical university in Hefei, China. Data were collected using the professional identity questionnaire, learning burnout scale for college students, and 10-item Connor-Davidson Resilience Scale. Pearson’s correlation analysis was used to investigate the relationships between variables. The mediation effect was evaluated using linear regression and the bootstrap method in SPSS.

Results

Nursing students exhibited intermediate learning burnout levels (score: 54.95 ± 10.42). Professional identity was positively correlated with psychological resilience (r = .42, p < . 001), whereas learning burnout was negatively correlated with professional identity (r = - .54, p < . 001) and psychological resilience (r = - .57, p < . 001). Psychological resilience mediated the relationship between professional identity and learning burntout to the tune of 32.8%.

Conclusion

Psychological resilience mediates the relationship between professional identity and learning burnout. Thus, nursing educators can mitigate student burnout by developing their students' professional identities and psychological resilience.

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Review Paper
Exploring Symptom Cluster Patterns in Adult Cancer Patients Undergoing Chemotherapy: A Systematic Review
Pan Yang, Hui-juan Mei, Hao-yu Zhao, Rong-rong Wu, Yong-qin Ge, Yin Lu
J Korean Acad Nurs 2024;54(4):478-494.   Published online November 25, 2024
DOI: https://doi.org/10.4040/jkan.24041
AbstractAbstract PDFSupplementary MaterialePub
Purpose

This systematic review aimed to scrutinize the progression of symptom cluster research in adult cancer patients who received primary or adjuvant chemotherapy between 2001 and 2023, providing a comprehensive understanding of clinical practice and future research.

Methods

PubMed, Ovid MEDLINE, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, and Web of Science databases were searched for theme words and free words related to symptom clusters, cancer, and chemotherapy. Eligible studies were published between January 1, 2001, and May 30, 2023; adults who were diagnosed with cancer and received primary or adjuvant chemotherapy were evaluated.

Results

Twenty-eight studies were included in this review. The Memorial Symptom Assessment Scale emerged as the predominant instrument and exploratory factor analysis was the most frequently employed statistical method to identify symptom clusters. Psychological, gastrointestinal, and physical image symptom clusters were the most commonly delineated. Furthermore, the temporal stability of the symptom clusters showed varying dynamics, with psychological symptom clusters displaying relative consistency over time.

Conclusion

Interventions are needed for the most common and stable symptoms in patients with cancer undergoing chemotherapy. Future endeavors may necessitate more longitudinal studies to delve deeper into the temporal stability and dynamic variations of symptom clusters. Such investigations hold promise for advancing symptom cluster research, elucidating the underlying mechanisms, and fostering the development of targeted interventions, thereby enriching the symptom management paradigm in oncological care.

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Research Papers
Effect of the Spinning Babies Program on Birth Outcomes and Satisfaction during Labor: A Non-Randomized Controlled Trial
Mi-Yeon Jeong, Hyang Mi Jung
J Korean Acad Nurs 2024;54(4):607-619.   Published online November 20, 2024
DOI: https://doi.org/10.4040/jkan.24097
AbstractAbstract PDFePub
Purpose

This study evaluated the effects of the Spinning Babies program applied during labor on birth outcomes and satisfaction among pregnant women.

Methods

This non-equivalent control group, non-synchronized post-test only design study included 42 participants (22 in the experimental group and 20 in the control group). The Spinning Babies program was conducted four times in the experimental group during the first and second stages of delivery for 50 min per session. The program comprised performing pelvic circles on a birth ball, followed by wide squatting and adopting of open knee-chest and side-lying positions.

Results

Compared with those in the control group, pregnant women in the experimental group had a significantly shorter labor time (t = - 6.64, p < .001), a higher success rate for normal vaginal delivery (χ2 = 4.86, p = .043), improved Apgar scores of newborns (z2 = - 2.18, p = .029), differences in neonatal oxygen therapy use (χ2 = 4.86, p = .043), and improved birth satisfaction (t = 11.99, p < .001).

Conclusion

The Spinning Babies program improves the birth environment by increasing the normal vaginal delivery success rate, as well as pregnant women’s birth satisfaction, and promotes neonatal health.

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Factors Affecting the Intention to Use Smartmonitor-Based Mobile Health in Middle-Aged in Patients Applying the Technology Acceptance Model II
Ol Eum Joo, Yi Kyung Ha
J Korean Acad Nurs 2024;54(4):620-632.   Published online November 13, 2024
DOI: https://doi.org/10.4040/jkan.24091
AbstractAbstract PDFePub
Purpose

This study aimed to identify factors that influence the intention to use smart monitor-based mobile health (SBM) technology among middle-aged inpatients, based on the technology acceptance model II (TAM II).

Methods

A total of 222 participants were surveyed. Data were analyzed using SPSS Statistics 23.0 and IBM SPSS Amos 23. Seven exogenous variables–social influence (SI), personal self-efficacy, (PSE), environmental self-efficacy (ESE), health literacy, health concerns, resistance to innovative technology (RIT), accessibility (AC)– and three endogenous variables–perceived ease of use (PEOU), perceived usability (PU), and intention to use (ITU)–were investigated.

Results

The hypothesized path model demonstrated a good fit for the data. SI (β = .13, p = .042), PU (β = .46, p < .001), and PEOU (β = .16, p = .008) had significant direct effects on the ITU, which explained 39.5% of the variance. Additionally, SI (β = .27, p < .001), ESE (β = .16, p = .010), RIT (β = - .12, p = .026), AC (β = .28, p < .001), and PEOU (β = .20, p = .001) indirectly affected ITU through PU, which explained 50.7% of the variance. Furthermore, PSE (β = .38, p < .001) indirectly influenced ITU via PEOU, which explained 38.4% of the variance.

Conclusion

This study demonstrates that the TAM II can be used to effectively predict ITU in SBMs among middle-aged inpatients. To expand the intention to use SBMs, it is necessary to develop SBMs that include content and programs that promote PU, SI, and PEOU.

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Experiences of Patients and Their Families Receiving Medical Services Provided by Advanced Practice Nurses at Tertiary General Hospitals
Mi-Kyeong Jeon, Su Jung Choi, Ji Eun Han, Eun Kyung Kwon, Jeong Hee Park, Jeong Hye Kim
J Korean Acad Nurs 2024;54(4):594-606.   Published online November 4, 2024
DOI: https://doi.org/10.4040/jkan.24069
AbstractAbstract PDFePub
Purpose

This study aimed to understand and describe the experiences of patients and their families who have received medical services from advanced practice nurses in tertiary general hospitals in Korea.

Methods

Data were collected through four focus group interviews with 20 patients and their families who had received medical services from advanced practice nurses for more than six months at four tertiary hospitals from November 29 to December 28, 2023. Verbatim transcripts were analyzed using qualitative content analysis.

Results

The four themes extracted from the experiences of patients and their families were as follows: unfamiliar medical personnel encountered during the treatment process, healthcare professionals who exhibited excellence, companions to light my way through the tunnel of illness, and an advanced practice nurse system that must be activated urgently.

Conclusion

The study’s findings indicate that patients and their families view the care provided by advanced practice nurses as excellent, reliable, and holistic. Research suggests that advanced practice nurses are valuable healthcare professionals in team-based care. The findings suggest that hospitals should utilize an advanced practice nurse system to improve patient outcomes and ensure the quality of care.

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Perceptual Factors Associated with Gestational Weight Gain: A Cross-Sectional Survey
Sehee Kim, Sukhee Ahn
J Korean Acad Nurs 2024;54(4):495-508.   Published online November 1, 2024
DOI: https://doi.org/10.4040/jkan.24052
AbstractAbstract PDFePub
Purpose

Recent years have seen an increase in the number of pregnant women whose weight gain during pregnancy exceeds the recommended range. This study was intended to determine the relationships among demographic attributes, key perceptual factors, and gestational weight gain (GWG).

Methods

This cross-sectional study was conducted between April and July 2022. First-time pregnant women beyond 36 weeks of gestation who were recruited via social media completed an online survey. Data were analyzed using one-way ANOVA, chi-square test, and logistic regression, all performed using SPSS software.

Results

Of the 369 participants, 63 (17.1%) exceeded the recommended GWG guidelines, while 148 (40.1%) fell within the recommended range, and the remaining 158 (42.8%) had inadequate GWG. Being overweight or obese before pregnancy significantly increased the risk of excessive GWG (p < .001). This risk was also significantly greater for women with low internal weight locus of control (OR = 0.58, 95% CI 0.41~0.82), high external weight locus of control (OR = 1.75, 95% CI 1.31~2.34), and negative body image (OR = 0.62, 95% CI 0.51~0.75).

Conclusion

The growing trend of excessive GWG among pregnant women is influenced by a combination of prepregnancy body mass index (BMI) and perceptual factors, including weight locus of control and body image. These findings underscore the need to implement weight management intervention strategies before pregnancy, taking into consideration BMI, and to enhance positive body image and internal locus of control.

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Factors Influencing Clinical Nurses’ Perception of Structural and Content Career Plateau
Ji Hye Kim, Ji Yun Lee
J Korean Acad Nurs 2024;54(4):534-546.   Published online October 23, 2024
DOI: https://doi.org/10.4040/jkan.24002
AbstractAbstract PDFePub
Purpose

This study was intended to provide basic data for reducing the career plateaus of clinical nurses.

Methods

The participants were 288 clinical nurses who worked at five hospitals, general hospitals, and tertiary hospitals in Seoul, Gyeonggi, and Chungcheong provinces and had more than one year of clinical experience. The research data were collected from December 26, 2022, to April 7, 2023, using structured questionnaires and analyzed using SPSS software. The study conducted mean, standard deviation, percentage, t-test, ANOVA, Pearson‘s correlation coefficient, and hierarchical regression analysis.

Results

Perceived organizational support was identified as the factor influencing structural career plateaus. Factors influencing content career plateaus included growth needs, skill variety, organizational justice, and perceived organizational support.

Conclusion

The above research results suggest that to increase the motivation of clinical nurses and reduce career plateaus, it is necessary to improve awareness and systems of human resource management at the organizational level.

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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
AbstractAbstract PDFSupplementary MaterialePub
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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Exploring Traumatic Experiences and Posttraumatic Growth among Korean Veterans: A Photovoice Study
Riah Kim, Heese Choi, Minsung Kim
J Korean Acad Nurs 2024;54(4):519-533.   Published online October 14, 2024
DOI: https://doi.org/10.4040/jkan.24049
AbstractAbstract PDFePub
Purpose

This study aimed to explore traumatic experiences and posttraumatic growth among Korean veterans.

Methods

A qualitative study was conducted using photovoice. Purposive sampling strategies yielded five veterans who had experienced traumatic events. Participants engaged in three discussion sessions between August 5, 2023, and October 28, 2023. The collected data were analyzed using photovoice document analysis and thematic analysis.

Results

Study results identified the following themes: ‘The collapse of my life as a result massive trauma,’ ‘Sinking into endless isolation and disconnection,’ ‘The process of finding myself through reflection,’ and ‘My life journey moving forward together.’ Despite the irreversible damage caused by traumatic experiences during military service, the participants continuously reflected on the meaning of their trauma and posttraumatic growth, thereby recovering their authentic selves.

Conclusion

Veterans who have experienced traumatic events face severe difficulties, however through their efforts at recovery, they recognize the individuals they are now. This study suggests the need for social support and highlights the necessity of providing various opportunities and policy assistance to traumatized veterans.

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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
AbstractAbstract PDFePub
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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Review Paper
Legal and Practical Solutions for the Expanding the Roles of Medical Support Staff Nurses
Choi, Su Jung , Kim, Min Young
J Korean Acad Nurs 2024;54(3):300-310.   Published online August 31, 2024
DOI: https://doi.org/10.4040/jkan.24075
AbstractAbstract PDF
Purpose
Medical support staff nurses have traditionally performed various supportive tasks for physicians, often extending beyond standard nursing roles. Despite these long-standing practices, there is a notable lack of official recognition and legal protection for these expanded responsibilities, leading to increasing legal concerns. Therefore, there is a need for proposing a rational solution to address these issues.
Methods
The number of medical support staff nurses is rising, particularly as they fill gaps left by the 2024 resident physician strike. The study focuses on identifying potential challenges arising from this shift and developing strategic improvements to address these challenges effectively.
Results
This study proposed legally expanding the scope of nursing duties and creating a robust system for training and certifying nurses to handle these responsibilities effectively, by integrating these roles within the advanced practice nurse (APN) framework.
Conclusion
Integrating these roles within the framework of APN can offer a sustainable and legally sound solution to the ongoing healthcare crisis, ensuring patient safety and safeguarding healthcare workers’ legal rights.
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Research Papers
An Exploratory Study on Non-Contact Nursing Experiences of Clinical Nurses during the COVID-19 Pandemic
Byun, Hye Min , Yun, Eun Kyoung
J Korean Acad Nurs 2024;54(3):446-458.   Published online August 31, 2024
DOI: https://doi.org/10.4040/jkan.24045
AbstractAbstract PDF
Purpose
This study aimed to understand the non-contact nursing experiences of clinical nurses during the COVID-19 pandemic.
Methods
A qualitative research design applying thematic analysis was used. The participants were purposive sampled from three institutes: a tertiary hospital, a general hospital, and a residential treatment center in Seoul. Data were collected between December 2021 and January 2022 through individual in-depth interviews with 12 clinical nurses. The data were analyzed using Braun and Clarke’s method to identify the meaning of the participants’ experiences.
Results
During the COVID-19 pandemic, the fields where the participants performed non-contact nursing included intensive care units and isolation wards of hospitals, a residential treatment center, and home cares. Their tasks in non-contact nursing commonly involved remote monitoring using digital devices or equipment, consultation and education. From their experiences performing tasks in these fields, the four theme clusters and nine themes were derived. The four theme clusters are as follows: (1) Confusion of nursing role; (2) Conflict due to insufficient support system; (3) Concern about the quality of nursing; (4) Reflection on the establishment of nursing professionalism.
Conclusion
This study highlights the necessity for institutionalizing professional nursing areas, nursing education, and practical support by clarifying the purpose and goals of non-contact nursing and developing nursing knowledge through frameworks.
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How Do We Approach Quality Care for Patients from Middle Eastern Countries? A Phenomenological Study of Korean Nurses’ Experiences
Jang, Dael , Choi, Seonhwa , Hwang, Gahui , Kim, Sanghee
J Korean Acad Nurs 2024;54(3):372-385.   Published online August 31, 2024
DOI: https://doi.org/10.4040/jkan.24036
AbstractAbstract PDF
Purpose
Although more people from Middle Eastern countries are visiting South Korea for medical treatment, Korean nurses lack experience in treating them. Understanding and describing Korean nurses’ experiences can help them provide quality care to these patients by enhancing their competency in culturally appropriate care. This study described the experiences of nurses who provide care to Middle Eastern patients in clinical settings in South Korea.
Methods
We conducted a phenomenological study to describe nurses’ experience of caring for patients from Middle Eastern countries. Ten nurses with prior experience in caring for these patients were recruited from a university-affiliated tertiary hospital. Semi-structured face-to-face interviews were conducted between May 1 and June 4, 2020. The transcribed data were analyzed using Giorgi’s phenomenological method to identify the primary and minor categories representing nurses’ experiences.
Results
Four major categories (new experiences in caring for culturally diverse patients, challenges in caring for patients in a culturally appropriate manner, nursing journey of mutual agreement with culturally diverse patients, and being and becoming more culturally competent) and 11 subcategories were identified.
Conclusion
Nurses experience various challenges when caring for Middle Eastern patients with diverse language and cultural needs. However, nurses strive to provide high-quality care using various approaches and experience positive emotions through this process. To provide quality care to these patients, hospital environments and educational programs must be developed that center on field nurses and students and support them in delivering quality care while utilizing their cultural capabilities.
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Temporal Exploration of New Nurses’ Field Adaptation Using Text Network Analysis
Ahn, Shin Hye , Jeong, Hye Won , Yang, Seong Gyeong , Jung, Ue Seok , Choi, Myoung Lee , Kim, Heui Seon
J Korean Acad Nurs 2024;54(3):358-371.   Published online August 31, 2024
DOI: https://doi.org/10.4040/jkan.24034
AbstractAbstract PDF
Purpose
This study aimed to analyze the experiences of new nurses during their first year of hospital employment to gather data for the development of an evidence-based new nurse residency program focused on adaptability. Methods: This study was conducted at a tertiary hospital in Korea between March and August 2021 with 80 new nurses who wrote in critical reflective journals during their first year of work. NetMiner 4.5.0 was used to conduct a text network analysis of the critical reflective journals to uncover core keywords and topics across three periods. Results: In the journals, over time, degree centrality emerged as “study” and “patient understanding” for 1 to 3 months, “insufficient” and “stress” for 4 to 6 months, and “handover” and “preparation” for 7 to 12 months. Major sub-themes at 1 to 3 months were: “rounds,” “intravenous-cannulation,” “medical device,” and “patient understanding”; at 4 to 6 months they were “admission,” “discharge,” “oxygen therapy,” and “disease”; and at 7 to 12 months they were “burden,” “independence,” and “solution.” Conclusion: These results provide valuable insights into the challenges and experiences encountered by new nurses during different stages of their field adaptation process. This information may highlight the best nurse leadership methods for improving institutional education and supporting new nurses’ transitions to the hospital work environment.
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Review Paper
Effects of Non-Pharmacological Interventions on Major Adverse Cardiac Events in Patients Underwent Percutaneous Coronary Intervention: Systematic Review and Meta-Analysis
Jo, Sojeong , Lee, Haejung , Park, Gaeun
J Korean Acad Nurs 2024;54(3):311-328.   Published online August 31, 2024
DOI: https://doi.org/10.4040/jkan.24019
AbstractAbstract PDF
Purpose
In this study a systematic review and meta-analysis investigated the impact of non-pharmacological interventions on major adverse cardiac events (MACE) in patients with coronary artery disease who underwent percutaneous coronary intervention (PCI).
Methods
A literature search was performed using PubMed, Cochrane Library, EMBASE, and Cumulative Index to Nursing & Allied Health Literature databases up to November 2023. The risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. Effect sizes and 95% confidence intervals were calculated using R software (version 4.3.2).
Results
Eighteen randomized studies, involving 2,898 participants, were included. Of these, 16 studies with 2,697 participants provided quantitative data. Non-pharmacological interventions (education, exercise, and comprehensive) significantly reduced the risk of angina, heart failure, myocardial infarction, restenosis, cardiovascular-related readmission, and cardiovascular-related death. The subgroup meta-analysis showed that combined interventions were effective in reducing the occurrence of myocardial infarction (MI), and individual and group-based interventions had significant effects on reducing the occurrence of MACE. In interventions lasting seven months or longer, occurrence of decreased by 0.16 times, and mortality related to cardiovascular disease decreased by 0.44 times, showing that interventions lasting seven months or more were more effective in reducing MI and cardiovascular disease-related mortality.
Conclusion
Further investigations are required to assess the cost-effectiveness of these interventions in patients undergoing PCI and validate their short- and long-term effects. This systematic review underscores the potential of non-pharmacological interventions in decreasing the incidence of MACE and highlights the importance of continued research in this area (PROSPERO registration number: CRD42023462690).
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Research Paper
Effectiveness of the Eye Care Protocol in the Intensive Care Unit Patients: A Randomized Controlled Trial
Lim, Kyu Won , Ha, Shin Young , Kang, In Soon
J Korean Acad Nurs 2024;54(3):432-445.   Published online August 31, 2024
DOI: https://doi.org/10.4040/jkan.24017
AbstractAbstract PDF
Purpose
This study investigated the effects of an eye care protocol (ECP) on patients in the intensive care unit (ICU).
Methods
This study utilized a randomized controlled design. Participants were patients who met the inclusion criteria and were admitted to the ICU (36 in the experimental group and 38 in the control group). The experimental group received an ECP, while the control group received standard eye care, starting the day after admission, for a duration of 10 days. The ECP classifies the degree of eyelid obstruction into three stages based on the degree of exposure to the lower eyelid conjunctiva and cornea. The protocol included cleansing with normal saline gauze, administering eye drops, applying silicone and polyurethane films, and recommending consultation with an ophthalmologist if necessary. The effectiveness of ECP was assessed by analyzing tear volume, hyperemia, chemosis, and eye discharge. Data analysis was conducted using SPSS 27.0, employing the Mann-Whitney U-test and generalized estimating equations.
Results
On day 5, the experimental group demonstrated a significant increase in tear volume in both eyes compared with the control group. However, no statistically significant differences were observed in the incidence of hyperemia, chemosis, and eye discharge on days 5 and 10 of the intervention.
Conclusion
The application of the ECP in this study increased tear volume in ICU patients, thereby reducing discomfort caused by dry eyes. It has the potential to prevent complications such as damage to the surface of the eyeball resulting from decreased tear volume.
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J Korean Acad Nurs : Journal of Korean Academy of Nursing
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