Job Analysis of Nurse Care Coordinators for Chronic Illness Management in Primary Care Settings: Using Developing a Curriculum Process

Purpose@#This study aimed to conduct a job analysis of nurse carecoordinators and to identify the frequency, importance and difficulty of each task of their job. @*Methods@#A committee for developing a curriculum (DACUM) was formed and members of the committee defined nurse care coordinators’ jobs and enumerated the duties, tasks and task elements by applying the DACUM technique. Then nurse care coordinators enrolled in the pilot project evaluated the frequency, importance and difficulty of each task. @*Results@#From the job descriptions of nurse care coordinators, we identified 12 duties and 42 tasks. Each task comprised 1~5 task elements. Among tasks, ‘assess the patient’s general health status’ was carried out most frequently. Nurse care coordinators perceived that ‘check vital signs’ and ‘strengthen patient competence to promote health behaviors’ were more important than all other tasks. The most difficult task was ‘develop professionalism as a nurse care coordinator’. @*Conclusion@#The nurse care coordinators' roles developed in this study will serve as the key guidelines for human resource management of care coordinators. Further, job specifications for nurse care coordinators need to be developed, which is necessary for designing education and training programs. We also need to integrate primary health care as an essential component in nursing education.

How Much Do Older Adults Living Alone in Rural South Korea Know About Dementia? / 예방의학회지

OBJECTIVES: This study aimed to examine the level of dementia knowledge of older Korean adults living alone in rural areas and to identify related factors. METHODS: A cross-sectional descriptive design was applied. The participants were 231 older adults living alone who were recruited from 12 of the 13 primary health care posts in the rural area of Chuncheon. Participants’ level of dementia knowledge was assessed using the Dementia Knowledge Scale. Data were analyzed using descriptive statistics, and the t-test, analysis of variance, chi-square test, and Mann-Whitney test were applied. RESULTS: Participants’ mean age was 77.3±5.4 years, and women comprised 79.7% of the sample. Over half of the participants (61.9%) had no formal education, and all the participants were enrolled in Medical Aid. The participants’ average percentage of correct answers was 61.6%. The highest rate (94.4%) was for the item “Dementia can change one’s personal character.” The item with the lowest proportion of correct answers was “Dementia is not treatable” (23.4%). Dementia knowledge was significantly associated with age, education, health coverage, source of living expenses, and dementia risk. CONCLUSIONS: Dementia knowledge among Korean rural older adults living alone was relatively low. Participants’ misconceptions about symptoms and treatment could hinder them from seeking early treatment. The results of this study suggest the need for active outreach and health care delivery for rural older adults living alone in South Korea.

Study on the biodegradation of perfluorooctanesulfonate (PFOS) and PFOS alternatives

OBJECTIVES: In this study, we investigated the biodegradation features of 4 perfluorooctanesulfonate (PFOS) alternatives developed at Changwon National University compared to those of PFOS. METHODS: Biodegradation testing was performed with microorganisms cultured in the good laboratory practice laboratory of the Korea Environment Corporation for 28 days following the Organization for Economic Cooperation and Development guidelines for the testing of chemicals (Test No. 301 C). RESULTS: While C₈F₁₇SO₃Na, PFOS sodium salt was not degraded after 28 days, the 4 alternatives were biodegraded at the rates of 20.9% for C₁₅F₉H₂₁S₂O₈Na₂, 8.4% for C₁₇F₉H ₂₅S₂O₈Na₂, 22.6% for C₂₃F₁₈H₂₈S₂O₈Na₂, and 23.6% for C₂₅F₁₇H₃₂O₁₃S₃Na₃. CONCLUSIONS: C₂₅F₁₇H₃₂S₃O₁₃Na₃, C₂₃F₁₈H₂₈S₂O₈Na₂, and C₁₅F₉H₂₁S₂O₈Na₂ were superior to PFOS in terms of biodegradation rates and surface tension, and thus they were considered highly applicable as PFOS alternatives. Environmental toxicity, human toxicity, and economic feasibility of these compounds should be investigated prior to their commercialization.

Perceptions of Caregivers and Medical Staff toward DNR and AD / 한국호스피스완화의료학회지

PURPOSE: This study is aimed to investigate perceptions of caregivers and medical staff toward do not resuscitate (DNR) and advance directives (AD). METHODS: Participants were 141 caregivers and 272 medical staff members from five general hospitals. A questionnaire used for the study consisted of 20 items: 14 about DNR perceptions, three about AD, one each for age, gender and employment. RESULTS: Both medical staff and caregivers strongly recognized the need for DNR and AD, and the level of recognition was higher with medical staff than caregivers (DNR chi2=44.56, P=0.001; AD chi2=16.23, P=0.001). The main reason for the recognition was to alleviate sufferings of patients in the terminal phase. In most cases, DNR and AD were filled out when patients with terminal conditions were admitted, and patients made the decisions by consulting with their guardians. Medical staff better recognized the need and for growing demand for guidelines for the DNR and AD decision making process than caregivers (chi2=7.41, P=0.0025). CONCLUSION: This study showed that patients highly rely on their caregivers when making decisions for DNR and AD. Thus, it is important that patients and caregivers are provided with objective information about the decisions. Since participants' strong support for DNR and AD was mainly aimed at alleviating patients' suffering, further study is needed in the association with hospice care. Medical staff also needs to understand the different views held by caregivers and fully consider the disparity when informing patients/caregivers to make the DNR and AD decisions.

Older Adults' Perception of Chronic Illness Management in South Korea / 예방의학회지

OBJECTIVES: Despite the recent emphasis on a patient-centered chronic care model, few studies have investigated its use in older adults in South Korea. We explored how older Korean adults perceive and cope with their chronic illness. METHODS: We conducted focus group interviews in Seoul, Korea in January 2010. Focus groups were formed by disease type (hypertension and type 2 diabetes) and gender using purposive sampling. Inclusion criteria were patients aged 60 and over who had been diagnosed with diabetes or hypertension and received care at a community health center for at least six months prior to participation. Interview data were analyzed through descriptive content analysis. RESULTS: Among personal factors, most participants felt overwhelmed when they received their diagnosis. However, with time and control of their acute symptoms using medication, their worry diminished and participants tended to denying being identified as a patient or sick person. Among socio-familial factors, participants reported experiencing stigma with their chronic illness and feeling it was a symbol of weakness. Instead of modifying their lifestyles, which might interfere with their social relationships, they resorted to only following their medicine regime prescribed by their doctor. Participants also reported feeling that their doctor only prescribed medications and acted in an authoritative and threatening manner to induce and reinforce participants\' compliance with treatment. CONCLUSIONS: For successful patient-centered management of chronic illnesses, supportive environments that include family, friends, and healthcare providers should be established.

Occupational Stress and Related Factors among Aged Security Guards / 산업간호학회지

PURPOSE: Occupational stress is a determinant risk factor for cardiovascular disease and work disability. This study aims to describe occupational stress and identify its related factors among aged security guards. METHODS: A random sample of 76 aged security guards were interviewed by three research assistants. The criteria of the subjects were as follows : 50 or older male with 40 or more working hours a week working with colleagues ranged from 3 to 50. The data were collected in September, 2007 and analyzed by multiple regression using SAS Version 9.1. RESULTS: The mean score of occupational stress among aged security guards was 47.2. The mean scores of its sub-scales were 31.3(physical environment), 33.8(occupational demand), 80.8occupational control), 44.6(interpersonal conflict), 51.3 (occupational insecurity), 53.6(occupational system), 57.5(lack of reward), and 30.3(work environment). The scores of occupational control, interpersonal conflict, and occupational insecurity were higher than the scores of Korean average occupational stress sub-scales. Significant variables affecting occupational stress and its sub-scales were work place, work type, and employment type. CONCLUSION: In order to reduce occupational stress among security guards, sufficient occupational control and interpersonal conflict control, appropriate reward, and employment stability should be considered. Also long working hours and work shift should be improved.

Occupational Stress and Related Factors among Aged Security Guards / 산업간호학회지

PURPOSE: Occupational stress is a determinant risk factor for cardiovascular disease and work disability. This study aims to describe occupational stress and identify its related factors among aged security guards. METHODS: A random sample of 76 aged security guards were interviewed by three research assistants. The criteria of the subjects were as follows : 50 or older male with 40 or more working hours a week working with colleagues ranged from 3 to 50. The data were collected in September, 2007 and analyzed by multiple regression using SAS Version 9.1. RESULTS: The mean score of occupational stress among aged security guards was 47.2. The mean scores of its sub-scales were 31.3(physical environment), 33.8(occupational demand), 80.8occupational control), 44.6(interpersonal conflict), 51.3 (occupational insecurity), 53.6(occupational system), 57.5(lack of reward), and 30.3(work environment). The scores of occupational control, interpersonal conflict, and occupational insecurity were higher than the scores of Korean average occupational stress sub-scales. Significant variables affecting occupational stress and its sub-scales were work place, work type, and employment type. CONCLUSION: In order to reduce occupational stress among security guards, sufficient occupational control and interpersonal conflict control, appropriate reward, and employment stability should be considered. Also long working hours and work shift should be improved.

Compliance with Nosocomial Infection Control and Related Factors among Emergency Room Nurses / 기본간호학회지

PURPOSE: This study was done to examine the level of compliance and the relation of related factors of nosocomial infection control among nurses in emergency rooms. The data will provide fundamental information for developing programs for nosocomial infection control in the emergency room. METHOD: Study participants were 183 nurses working in emergency rooms in general hospitals that had more than 500 beds and were located in Daegu, Daejeun, and Pusan. The survey was carried out from March 7 to March 26, 2006 and a structured questionnaire was used. Descriptive statistics, t-test, ANOVA and Sheffe test with SPSS 14.0 were used to analyze the data. RESULTS: The average level for practice of infection control was relatively low. Levels of compliance were high when the participants had: 1) regular conferences for nosocomial infection control, 2) positive perception of protection devices, 3) knowledge of whom to report and experiences of reporting needle stick injuries, 4) hospital guidelines for infection control and 5) enough equipment supplies from the hospital. CONCLUSION: Nosocomial infection control among emergency room nurses could be improved via personal, psychosocial, and organizational factors and related education.

Oral Health-Related Quality of Life (OHQoL) and Related Factors among Elderly Women / 기본간호학회지

PURPOSE: The purpose of this study was to identify factors associated with oral health-related quality of life among elderly women living in the community. METHOD: The participants were 162 elderly women aged 65 and older who lived in D city. Descriptive statistics, ANOVA, Pearson correlation coefficients and stepwise multiple regression were used with SPSS/PC windows program to analyze the data. RESULTS: The major findings of this study are as follows: 1) there were statistical differences in OHQoL for spouse presence, educational level, monthly income, self-rated health, number of teeth and chronic disease, and types of denture. 2) OHQoL was positively related to age, number of chronic disease and nutrition. Also, OHQoL was negatively related to educational level, monthly income, number of teeth, and diet habit. 3) Significant factors influencing OHQoL were self-rated health and nutritional status. CONCLUSION: Based on these results, it is necessary to do further study on oral health of those who have 20 or more teeth. Oral health promotion programs focusing on prevention are necessary for elderly women in the high risk group.

A Structural Model of Family Health in Married Middle-aged / 성인간호학회지

PURPOSE: this study was to develop and test the structural model that explains husband and wife compatibility and family health of married middle-aged. A hypothetical model explaining husband and wife compatibility and family health based on literature reviews. There were three theoretical variables and twelve observed variables in hypothetical model. METHODS: Data collection was carried out May through July 2005. Data were collected by self-reporting questionnaires from 854 married middle-aged who lived in Seoul, Busan, Daegu, Kyungnam, Kyungpook. Collected data was analyzed using SPSS/WIN 12.0 for descriptive statistics, Pearson Correlation coefficient, and Kolmogorov-Smirnov analysis. RESULTS: LISREL program was used to find the best fit normal which assumes causal relationship among variables. This model was to be good fitting and parsimonious to measure husband and wife compatibility and family health of married middle-aged. CONCLUSION: Differentiation of self and husband and wife compatibility predicted level of family health. Therefore, a family health improvement program needs to include these two variables.

BMI, Depression, and Fluid Deficit in Hospitalized Elders / 기본간호학회지

PURPOSE: This study was done to examine the differences in the fluid volume deficit according to levels of depression and BMI. The results of this study will provide fundamental information for developing nursing interventions for hydration management. METHOD: The participants were 51 hospitalized elderly people in K province. Data were collected from September 4 to 30, in 2006. A structured questionnaire was used for the data collection. Frequencies, Percentages, Means, Standard Deviation, t-test, Mann-Whitney U test, and Kruskal-Wallis test were used with the SPSS Program to analyze the data. RESULTS: There were significant differences in the fluid volume deficit between elders in the depressed and normal groups. Participants who had a BMI of less than 21kg/m2 had the highest fluid volume deficit. CONCLUSION: Water is an essential part of the human body although it is least studied in elderly people. Health care providers need to increase awareness of the importance of hydration status among hospitalized elderly people with chronic illnesses.

A Case of Probable Moyamoya Disease (Unilateal Moyamoya Disease) Coexisting Arteriovenous Malformation

The authors report a unique case of unilateral Moyamoya disease with a rare combination of arteriovenous malformation (AVM) who presented with intracerebral hemorrhage (ICH). A 50-year-old man suffered from sudden onset of mental deterioration and right hemiparesis. Brain computed tomography (CT) showed intracerebral hemorrhage on left thalamus. Brain CT angiography and cerebral digital subtraction angiography (DSA) revealed AVM combined with unilateral moyamoya disease involving left middle cerebral artery (MCA) and choroid plexus in left lateral ventricle. Intraventricular hemorrhage and hydrocephalus were managed conservatively. A rare case of unilateral Moyamoya disease accompanied by a cerebral arteriovenous malformation is described and discussed with review of pertinent literature.

Subjectivity of Korean Nursing Students' Experiences of Geriatric Hospital Practices / 성인간호학회지

PURPOSE: This study elicited Korean students' experiences of nursing practice at geriatric hospitals. METHOD: A purposive sample of 26 Korean nursing students was recruited from K College of Nursing located in Daegu, Korea. Inclusion criteria were nursing students who: 1) finished nursing practice at geriatric hospitals, 2) were oriented and communicable, and 3) understood research purpose and agreed to participate in this study. Individuals were interviewed using Q-methodology. RESULTS: The majority of the participants had experience of living with the elderly and volunteering related to elder care. Data analysis showed that participants' experiences of nursing practices were consisted of three types: skill acquiring-oriented, relationship-oriented, and practice system-oriented. CONCLUSION: Nursing practices at geriatric hospitals provided opportunities of having positive attitude toward the elderly for nursing students. Nursing students' experiences were divided into at least three different types. Nursing educators need to develop curriculum for gerontological nursing practice tailoring to theses differences.

A Case of Congenital Hepatic Fibrosis with Variceal Bleeding / 대한소아소화기영양학회지

Congenital hepatic fibrosis is an inherited, congenital disorder of the liver characterized by portal hypertension and hepatic fibrosis. We experienced a case of congenital hepatic fibrosis with esophageal varix in a 9-year-old male. He complained hematemesis, hematochezia, dizziness. In laboratory examination, AST/ALT was slightly increased. Esophageal varix was noted by an endoscopic examination. Hepatosplenomegaly and hypoechoic lesion of periportal area were seen by abdominal CT scanning. Histologic finding of liver biopsy showed fibrous tracts containing dilated bile ductules connecting adjacent portal spaces that were widened by mature fibrosis. Endocopic sclerotherpy and ligation was done. We summarized a case with review of literatures.

Quantification of Organic Acids in Amniotic Fluid for Prenatal Diagnosis of Organic Acidemia / 소아과

PURPOSE: Since 1997, the quantification of organic acids in urine has become possible in Korea. This helped to diagnose a great variety of inborn errors of metabolism. However, we still don't know the normal value of organic acids in amniotic fluid, therefore it is impossible for doctors to make a correct diagnosis of inborn errors of metabolism in prenatal care. We tried to confirm the normal value of organic acid in amniotic fluid. METHODS: From Jan. 1998 to Dec. 2001, we carried out amniocentesis and were able to obtain 43 samples of amniotic fluid from between 16 and 20 weeks of gestation, and quantified 82 organic acids to come up with a normal value. Organic acid concentrations were quantified with gas chromatography, and the individual acids were identified with mass spectrometry. To isolate organic acids from amniotic fluid, we used a solvent extraction method with ethylacetate. Derivatization was done with MSTFA(N-methy-N-trimethylsilylfluoroacetamide). RESULTS: The results of this study showed that when organic acid concentrations in amniotic fluid were compared with those in urine, TCA cycle intermediates(lactate, pyruvate, malate, 2-ketoglutarate, citrate etc) and ketone body(3-hydroxybutyric acid, acetoacetate etc) were found at significantly higher levels. CONCLUSION: Because TCA cycle intermediate in amniotic fluid is found at high concentrations, we could expect that diagnosis of mitochondria disorder is difficult. Organic acids other than TCA cycle intermediates were undetectable in amniotic fluid. Therefore, prenatal diagnosis of organic acidemias is possible. In our study, the prenatal diagnosis of methylmalonic acidemia could be made by using the measurement of methylmalonic acid in the amniotic fluid taken at high risk pregnancy with a family history of methylmalonic acidemia.

Urine Organic Acid Analysis of Patients with Febrile Seizures / 소아과

PURPOSE: Febrile seizure, the most common seizure disorder in children between 6 months and 5 years of age, is mostly caused by viral infections, except severe CNS infection. It can also be caused by disorders in organic acid metabolism, especially accompanied by fever. Therefore we decided to investigate the relationship between children with febrile seizures and disorders in organic acid metabolism. METHODS: We examined 54 children with febrile seizure who visited Chunchon Sacred Heart Hospital Emergency Department from February 2002 to January 2004. We conducted urine organic acid analysis, CBC, urine analysis, serum ammonia and gas analysis. RESULTS: Thirteen(24.1%) patients showed ketonuria, eight(14.8%) patients showed lactic aciduria and ketonuria, two(3.7%) patients showed pyruvic aciduria, and one(1.8%) showed mandelic aciduria. CONCLUSION: Twenty four of 54(44.4%) showed abnormal findings in urine organic acid analysis. Most results are ketonuria or lactic aciduria with ketonuria. They may show in fasting, severe infection or ketolytic defect(ex, 3-ketothiolase deficiency). Patients with 3-ketothiolase deficiency, can develop seizures during fever, and fasting state. Therefore further evaluation is necessary.

Korean Women's Causal Perceptions of Hwabyung / 여성건강간호학회지

PURPOSE: This study elicited Korean women's perceptions of the life situations that contribute to Hwabyung, a culture bound psychiatric illness in Korea, and delineated a typology of the perceived causative factors for this illness. METHOD: A purposive sample of 21 Korean women was recruited from a church, a senior center in Seoul and a clinic that provides traditional Korean and westernized medical services to patients in the Gyeonggi area. Inclusion criteria were: 1) the diagnosis of Hwabyung by a traditional doctor or "stress reaction and depression" by a westernized doctor; and 2) a score greater than 40 on the Hwabyung Self Report Instrument. Surveys using the HSRI and individual interviews using Q methodology were used. RESULT: The average age of the participants was 53.7 years (range 35-84). The mean score on the HSRI was 46.2 (range = 42-52). Data analysis showed that participants perceived three life situations to cause Hwabyung: vulnerable situation, lowered self esteem, and negative life events. CONCLUSIONS: Korean women, suffering from Hwabyung, perceived at least three different causal patterns for this illness. Nursing care plans should be tailored to meet these differences.