Validation of Adult Fall Assessment Scale Korean Version for Adult Patients in General Hospitals in Korea / 임상간호연구

Purpose@#The purpose of this study was to test the predictive validity of the Fall Assessment Scale-Korean version (FAS-K) and to find the most appropriate cutoff score to screen high-risk fall groups in adult patients in general hospitals in Korea. @*Methods@#We performed a prospective evaluation study in medical and surgical ward patients at two major general hospitals in Seoul. Data were collected from Nov. 1, 2018 to Feb. 28, 2019, nurses performed 651 observation series. The researcher measured the fall risk assessment score by applying FAS-K, MFS (Morse Fall Scale), and JHFRAT (Johns Hopkins Hospital Fall Risk Assessment tool) to the patients twice a week between 10 am and 12 noon. Data were analyzed using Pearson's corelation coefficients, and the sensitivity, specificity, predictive value, and the area under the curve (AUC) of the three tools. Results: The FAS-K was positively correlated with the MFS (r=.70, p<.001) and the JHFRAT (r=.82, p<.001). According to the receiver operating characteristics (ROC) curve analysis of the FAS-K, sensitivity, specificity, and positive and negative prediction values were 85.3%, 49.4%, 8.5%, and 98.4%, respectively, when the FAS-K score was 4. Therefore, the cut-off score of the FAS-K to identify groups with high fall risk was 4. @*Conclusion@#The FAS-K is a valid tool for measuring fall risk in adult inpatients.In addition, the FAS-K score, 4, can be used to identify high-risk fall groups and know specific points in time to provide active interventions to prevent falls.

Intradialytic exercise improves physical function and reduces intradialytic hypotension and depression in hemodialysis patients

BACKGROUND/AIMS@#As numbers of maintenance hemodialysis patients are growing, debilitating conditions of muscle wasting and atrophy are becoming some of the greatest concerns in end-stage renal disease patients. Exercise training has various potential benefits in terms of prevention of a sustained decline in functional status. This study aimed to evaluate the physical, psychological, laboratory, and dialysis-related effects of intradialytic exercise.@*METHODS@#We enrolled 22 patients from a hemodialysis center for a 6-month non-randomized prospective trial. Combination of aerobic exercise with bicycle ergometer and anaerobic exercise with elastic bands was conducted during hemodialysis. Data including physical fitness test results, dialysis-related measurements, and biochemical laboratory results were collected at baseline, 3, and 6 months. Depression and quality of life were assessed using Beck Depression Inventory and Short Form-36 health survey.@*RESULTS@#After exercise completion, there were significant improvements in back muscle power, forward and backward trunk flexibility, vertical jump, elbow flexion, sit to stand test, and 6-minute walk test (p < 0.05). No significant changes were observed in dry weight, blood pressure, Kt/V, and biochemical variables, except for intradialytic hypotension (p < 0.05). For depression, Beck Depression Inventory showed statistically significant enhancement (p < 0.05). Scores of Short Form-36 health survey did not show significant increase in each domain, except for bodily pain (p < 0.05).@*CONCLUSIONS@#Combined aerobic and anaerobic exercise training during dialysis was found to be effective on physical health status, intradialytic hypotension, and depression in terms of mental health. Therefore, the findings of the current study may provide an appropriate guidance for encouraging exercise by nephrologists.

Development of Fall Assessment Scale in Adult Inpatients / 임상간호연구

PURPOSE: The purpose of this study was to develop a valid Adult Fall Assessment Scale Korean version (FAS-K) for inpatients in general hospitals in Korea. METHODS: This a 14 item FAS-K was developed based on a review of national and international research and expert opinions in related field. Interrater reliability of FAS-K was analyzed using the ICC (Intraclass Correlation Coefficients). To examine the validity of FAS-K, a CVI (Content Validity Index), the Pearson correlation coefficients between FAS-K and two widely used scales, the Morse Fall Scale (MFS) and the Johns Hopkins Hospital Fall Risk Assessment Tool (JHFRAT), and the Mann-Whitney test were used. RESULTS: The ICC was .958. The CVI ranged from .70 to 1.00. The FAS-K was significantly associated with the MFS (r=.74, p<.001) and with the JHFRAT (r=.87, p<.001), verifying the concurrent validity of FAS-K. As for the construct validity of FAS-K, significant differences between the fall and non-fall groups were found not only in the MFS (Z=−3.23, p=.001) but also in the FAS-K (Z=−3.10, p=.002). CONCLUSION: The findings indicate that the FAS-K is a reliable fall risk assessment tool with high validity.

Corrigendum: A Comparative study on communicatioin competence, nursing professionalism, work environment and job satisfaction between outpatient nurses and ward nurses / 의료커뮤니케이션

There was an error in the title of the article.

The effect of Arteriovenous Fistula Cannulation Direction and Puncture Distance on the Recirculation Rate of Hemodialysis Patients / 중환자간호학회지

PURPOSE: The purpose of this study was to compare the effect of recirculation rate according to cannulation direction and interval among hemodialysis patients with arteriovenous fistula (AVF).METHOD: The research used repeated measures design. This study was conducted among thirty patients who received hemodialysis three times a week for longer than a year through AVF at the I University hospital. Three different types of interventions were administered to the participants each week for three weeks. Needles were placed at a different distance and in a different direction each week: 7 cm apart from each other in antegrade direction during the first week, 5 cm apart in retrograde direction in the following week, and 7 cm apart in retrograde direction in the third week.RESULTS: No significant differences in the recirculation rate were found due to any of the three tested methods (p = 1.00).CONCLUSION: This finding suggests that, if the patients have well-functioned AVF, we can choose an appropriate intervention from among the three methods in consideration of the patient's diverse needs.

A Comparative Study on Communicatioin Competence, Nursing Professionalism, Work Environment and Job Satisfaction between Outpatient Nurses and Ward Nurses / 의료커뮤니케이션

PURPOSE: The purpose of this study was to compare communication competence, nursing professionalism, work environment and job satisfaction between outpatient nurses and ward nurses, and to identify the correlation among variables.METHODS: The participants were 90 outpatient nurses and 98 ward nurses at the two general hospitals. Data were collected using self-administered questionnaires. Data were analyzed using descriptive statistics, χ2-test, independent t-test and Pearson's correlation coefficient.RESULTS: There were statistically significant differences between two groups in nursing professionalism, possibilities for development, commitment to the workplace, social support from colleagues, social community at work and job satisfaction, outpatient nurses showed higher level than ward nurses except commitment to the workplace. The work environment variables and nurses' job satisfaction were mostly correlated. Job satisfaction showed significant negatively correlated with quantitative demands, emotional demands and role conflicts in both groups nurses.CONCLUSION: These findings showed that nursing work environments were the most important factor for job satisfaction of both group nurses. Therefore, it is necessary to put efforts in improving nursing work environment and to develop diverse strategies for human resource management.

Characteristics of Fall Events and Fall Risk Factors among Inpatients in General Hospitals in Korea / 임상간호연구

PURPOSE: The purpose of this study was to investigate the present status of falls among inpatients in general hospitals and to identify the fall risk factors that reflect the characteristics of domestic hospitals. METHODS: Data were collected between December 15, 2016 and January 15, 2017 from 32 Korean hospitals having 500 or more beds. First, 42 risk factors were extracted based on literature review and expert opinions. Then the importance of each factor was evaluated by 223 nurses from medical and surgical adult ward and intensive care units in 40 hospitals. RESULTS: The incidence rate of falls in 18 hospitals was 3.87 per 1,000 total discharged patients and 0.55 per 1,000 patient-days, and the rate of injury-related falls was 40.5%. Major risk factors for falling were identified as the following: being over 65 years of age, history of falls during admission, physical mobility disorders requiring assistance, physical factors (dizziness or vertigo, unstable gait, general weakness, walking aids, visual problems), cognitive factors (delirium, lack of understanding on limitations), neurological disease, CNS medications CONCLUSION: The findings provide information that can be in the development of a fall risk assessment tool for inpatients in general hospitals in Korea.

Differences of Pre-Post Simulation Training on Problem solving, Performance confidence and Critical thinking Skill in Nursing Students according to Degree of Self-leadership / 한국간호교육학회지

PURPOSE: The aim of this study was to evaluate differences of pre-post simulation training in problem solving ability, performance confidence, and critical thinking skill according to degree of nursing students' self-leadership. METHODS: This study was a descriptive survey using a self-report questionnaire. One hundred eighty nursing students participated in this study which programed a simulation scenario of pre-post operative patients' care. Descriptive statistics, paired t-test, ANCOVA with IBM SPSS 21.0 program were used for data analysis. RESULTS: After the simulation training, both the above-average subjects and below-average subjects in self-leadership significantly improved their problem-solving ability, performance confidence, and critical thinking skill. compared with their previous level. The subjects who rated above-average in self-leadership, improved their degree of problem-solving ability, performance confidence, and critical thinking skill significantly more than those who were below-average in self-leadership. CONCLUSION: Self-leadership of nursing students is an important element in effective simulation training.

Development of the Cognitive Function Scale for Breast Cancer Patients

PURPOSE: This is the methodological study to develop the cognitive function scale for breast cancer patients. METHODS: Study was consisted with 1st and 2nd items developing and testify for reliability and validity of them. 94 breast cancer patients in 2 university hospitals and 1 general hospitals responded to a questionnaire that assessed cognitive function scale. Collected data were analysed using the program SPSS/PC Win 21.0. Structural validity was determined factor analysis and convergent validity. This method yielded Cronbach's α value as an internal consistency for the reliability. RESULTS: Factor analysis resulted in six factors and 24 items accounted for 76.31% of the variance. Cronbach's α of scale developed was high as a .95. CONCLUSION: The developed cognitive function scale in breast cancer patients scale has reliability and validity as linear analogue scale witch quantitatively measure the subjectivity. Over these results, providing the way on an assessment in cognitive function in effect for breast cancer patients, it is supposed to contribute the development of nursing knowledge about the cognitive function in breast cancer patients.

Critical Care Nursing Courses in Bachelor of Science in Nursing Programs: Present and Future Directions / 중환자간호학회지

PURPOSE: This study examined the status of critical care nursing education in bachelor of science in nursing (BSN) to suggest future directions.METHODS: The target of the survey was 185 BSN programs that were certified by the Korean Accreditation Board of Nursing Education as of October 31, 2016. We structurally reviewed the curriculums and the course syllabi.RESULTS: Forty-eight courses of 42 BSN programs were analyzed. Only five programs offered both theoretical and practical courses in critical care nursing; 22 offered theoretical courses and 26 offered practical courses. Most courses were offered as electives with 1 or 2 credits, and were taught by faculty who were experts in adult health nursing.CONCLUSION: The results show that there is a quantitative shortage of critical care nursing education in the curriculum of BSN programs in Korea. The lack of knowledge and skills on critical care can lead to a burden of new intensive care unit nurses and is a threat to patients' health. It is necessary to develop a practical and integrative curriculum for critical care nursing education.

Biomarkers of Physiological Disturbances for Predicting Mortality in Decompressive Craniectomy / 대한신경손상학회지

OBJECTIVE: Of many critical care regimens, the management of physiological disturbances in serum is particularly drawing an attention in conjunction with patient outcome. The aim of this study was to assess the association of serum biochemical markers with mortality in head trauma patients with decompressive craniotomy. METHODS: Ninety six patients with acute subdural hematoma underwent decompressive craniectomy between January 2014 and December 2015. The clinical data and laboratory variables of these patients were recorded and analyzed retrospectively. The pre-operative and post-operative day (POD) 0, day 1 and day 2 serum variables were measured. These were compared between the survivors and non-survivors. RESULTS: The factors of a large amount of intra-operative blood loss, shorter length of intensive care unit stays, and the needs for mechanical ventilation were related with mortality in the patients with decompressive craniectomy. These clinical factors were associated with the physiological derangements of sera. The average difference in serum chloride concentration between the pre-operative and POD 2 measurements (p=0.0192) showed a statistical significance in distinguishing between survivors and non-survivors. The average differences in albumin (p=0.0011) and platelet count (p=0.0004) between the pre-operative and POD 0 measurements suggested to be strong predictors of mortality in decompressive craniectomy. CONCLUSION: Isolated values of physiological biomarkers are not sufficient enough to predict in-hospital mortality. This study emphasizes the importance of a combined prognostic model of the differences in the pre-operative and post-operative hyperchloremia, thrombocytopenia, and hypoalbuminemia to identify the risk of mortality in decompressive craniecomy.

Prevalence of Masked Hypertension: a Population-Based Survey in a Large City by Using 24-Hour Ambulatory Blood Pressure Monitoring

BACKGROUND AND OBJECTIVES: We estimated the prevalence of hypertension and hypertension subtypes in a large semi-urban city in Korea, using 24-hour ambulatory blood pressure monitoring (ABPM) in a randomly selected sample population. SUBJECTS AND METHODS: A random sample (aged 20-65 years) from a city with an adult population of approximately 600000 was selected by using a list-assisted random digit dialing method. The 24-hour ABPM and conventional blood pressure measurement (CBPM) of these individuals were obtained. RESULTS: Among the 496 participants, valid 24-hour ABPM and CBPM were obtained from 462 (93%) individuals. The estimated prevalence of hypertension in Goyang was 17.54% by CBPM and 32.70% by 24-hour ABPM (p<0.01). In the age stratified analysis, both CBPM and 24-hour ABPM showed increased prevalence of hypertension with age. The estimated prevalence of masked hypertension was 16.22% and that of white-coat hypertension was 1.08%. Men had a higher prevalence of masked hypertension than women (20.79% vs. 11.86%, p=0.0295). The estimated prevalence of masked hypertension was 17.5%, 20.58%, 24.34%, and 13.29% in the age categories of 30s, 40s, 50s, and 60s, respectively. The estimated prevalence of masked uncontrolled hypertension was 26.79% in patients with hypertension who were taking antihypertensive medications. CONCLUSION: The estimated prevalence of hypertension by 24-hour ABPM was higher than that by CBPM, revealing high prevalence of masked hypertension. The high prevalence of masked hypertension supports the adoption of ABPM in the national population survey and clinical practice to improve public health and reduce health care costs.

A Program to Build Preschooler's Eating Habit Based on Social Cognitive Theory

BACKGROUND: Human diet and eating habits are formed in childhood so that eating habits in this period have a great impact on the nutritional status of children. Eating behaviors of children are formed by those of family members at home or their diet at preschool and mass media. The purpose of this study was to develop a program to build healthy dietary habits in preschoolers based on Social Cognitive Theory, which emphasizes the dynamic interaction among an action, an individual and its environment, and to explore the effects of the program. METHODS: A non-equivalent control group, pretest-posttest design was be used in this study. All participants were dyads of preschoolers and one of their parents collected from two day care centers, 18 for the experimental group and 16 for the control group. The program was evaluated by their Knowledge about Nutrition and Dietary Habits among Preschoolers and Parents Perception of Preschoolers' Dietary Habits. The program was conducted between March and June, 2015. RESULTS: At follow-up, knowledge related to nutrition (t=-2.74, p=0.010) and dietary habits (t=-3.67, p<0.001) among the preschoolers were significantly higher in the experimental group than in the control group. However, the perception of parents on the change of their children's eating habit didn't show significant difference (t=1.13, p=0.265). CONCLUSIONS: The results of this study is able to be used in dietary education of preschool children as one of the evidence, and be applied as an example of children's health promotion to help them have ideal eating habits, through cooperation with a university in community and day care centers.

The usefulness of contrast-enhanced ultrasonography in the early detection of hepatocellular carcinoma viability after transarterial chemoembolization: pilot study

BACKGROUND/AIMS: The therapeutic effect of transarterial chemoembolization (TACE) against hepatocellular carcinoma (HCC) is usually assessed using multidetector computed tomography (MDCT). However, dense lipiodol depositions can mask the enhancement of viable HCC tissue in MDCT. Contrast-enhanced ultrasonography (CEUS) could be effective in detecting small areas of viability and patency in vessels. We investigated whether arterial enhancement in CEUS after treatment with TACE can be used to detect HCC viability earlier than when using MDCT. METHODS: Twelve patients received CEUS, MDCT, and gadoxetic-acid-enhanced dynamic magnetic resonance imaging (MRI) at baseline and 4 and 12 weeks after TACE. The definition of viable HCC was defined as MRI positivity after 4 or 12 weeks. RESULTS: Eight of the 12 patients showed MRI positivity at 4 or 12 weeks. All patients with positive CEUS findings at 4 weeks (n=8) showed MRI positivity and residual viable HCC at 4 or 12 weeks. Five of the eight patients with positive CEUS findings at 4 weeks had negative results on the 4-week MDCT scan. Four (50%) of these eight patients did not have MRI positivity at 4 weeks and were ultimately confirmed as having residual HCC tissue at the 12-week MRI. Kappa statistics revealed near-perfect agreement between CEUS and MRI (kappa=1.00) and substantial agreement between MDCT and MRI (kappa=0.67). CONCLUSIONS: In the assessment of the response to TACE, CEUS at 4 weeks showed excellent results for detecting residual viable HCC, which suggests that CEUS can be used as an early additive diagnosis tool when deciding early additional treatment with TACE.

Awareness and Ethical Attitudes Toward 'Do-Not-Resuscitate (DNR)' for Cancer Patients

PURPOSE: This descriptive study was conducted to investigate awareness and attitudes toward 'Do-Not-Resuscitate (DNR)'. METHODS: Study data were collected from July 24 to September 30, 2011 using structured questionnaires. Study subjects were 209 patients suffering from cancer at "C" Univ. hospital located in Seoul and Cancer Patient Coalition in Seoul. The purpose of the study was explained directly to them. All the data of 209 questionnaires were collected and analyzed without dropping out. RESULTS: In terms of awareness toward DNR, 61.5% said DNR is "necessary" because "their recoveries are impossible" (51.7%) and "they want dignified deaths" (41.1%). When it comes to ethical attitudes toward DNR according to demographic characteristics, there were significant differences both between genders (p<.032) on "Medical staff should tell hopeless patients their conditions openly" and between level of education and monthly income (p<.013) on "DNR decision should be made according to the guideline, if needed". CONCLUSION: The result of this study suggests that decisions on DNR should be made not by only families and doctors but by patients themselves as well. For this, sufficient explanations and education programs for DNR need to be developed and DNR decision including both patient's and family's demand should be standardized.

The Impact of Mechanical Bowel Preparation in Elective Colorectal Surgery: A Propensity Score Matching Analysis

PURPOSE: To evaluate the influence of preoperative mechanical bowel preparation (MBP) based on the occurrence of anastomosis leakage, surgical site infection (SSI), and severity of surgical complication when performing elective colorectal surgery. MATERIALS AND METHODS: MBP and non-MBP patients were matched using propensity score. The outcomes were evaluated according to tumor location such as right- (n=84) and left-sided colon (n=50) and rectum (n=100). In the non-MBP group, patients with right-sided colon cancer did not receive any preparation, and patients with both left-sided colon and rectal cancers were given one rectal enema before surgery. RESULTS: In the right-sided colon surgery, there was no anastomosis leakage. SSI occurred in 2 (4.8%) and 4 patients (9.5%) in the non-MBP and MBP groups, respectively. In the left-sided colon cancer surgery, there was one anastomosis leakage (4.0%) in each group. SSI occurred in none in the rectal enema group and in 2 patients (8.0%) in the MBP group. In the rectal cancer surgery, there were 5 anastomosis leakages (10.0%) in the rectal enema group and 2 (4.0%) in the MBP group. SSI occurred in 3 patients (6.0%) in each groups. Severe surgical complications (Grade III, IV, or V) based on Dindo-Clavien classification, occurred in 7 patients (14.0%) in the rectal enema group and 1 patient (2.0%) in the MBP group (p=0.03). CONCLUSION: Right- and left-sided colon cancer surgery can be performed safely without MBP. In rectal cancer surgery, rectal enema only before surgery seems to be dangerous because of the higher rate of severe postoperative complications.

Comparison of Climacteric Symptoms and Cognitive Impairment in Breast Cancer Survivors and Healthy Women

PURPOSE: This study was to compare climacteric symptoms and cognitive impairment in breast cancer survivors (n=51) and healthy women (n=51). METHODS: This study was conducted from January 4th, 2012 to February 16th, 2012. We individually matched healthy women to breast cancer survivors based on age and education, and assessed a questionnaire regarding climacteric symptoms and cognitive impairment. Data were analyzed by using chi2, t-test, and Pearson correlation with the SPSS/Win 12.0 program. RESULTS: The average score for the climacteric symptoms (19.71) was significantly different (t=-2.78, p=.006) to the average for the breast cancer survivors (15.53). The average cognitive impairment score for the breast cancer survivors (86.37) was significantly different (t=-2.45, p=.016) to the average score for the healthy women (67.92). The climacteric symptoms score showed a significant relationship with cognitive impairment. CONCLUSION: These results support that adjuvant chemotherapy and anti-hormone therapy are associated with climacteric symptoms and adverse cognitive effects in breast cancer survivors.

Effect of Changes in Nursing Delivery System on Satisfaction of Nurses and Patients and Direct Nursing Time / 간호행정학회지

PURPOSE: Purpose of this research was to identify effects of application of a modified primary nursing system. METHODS: Measurement was done of direct nursing time and satisfaction of nurses and patients before and after one month of the modified primary nursing system in a surgery unit in C university hospital, Seoul. RESULTS: There was no statistically significant difference between average for patient satisfaction (4.24) before and (4.11) after application of the modified primary nursing system. Total average for nurse satisfaction with the nursing delivery system was 2.89 before application and, 3.34 after, indicating some significant differences (t=-4.06, p<.001). The KPCS-1 was 10.19 before application of the modified primary nursing system and 9.52 after application. Recalculated into direct nursing time, the average direct nursing time for one patient was 92 minutes before application, and 85.98 minutes after, indicating no significant difference. CONCLUSION: Through this research an attempt was made to build and test a modified primary nursing system. Results indicate that the most important thing is to clearly regulate office work and safely implement the new system.

Factors Affecting Sexual Function of Breast Cancer Women After Receiving Cancer Treatment

PURPOSE: The purpose of this study was to identify factors affecting sexual function in breast cancer women after receiving cancer treatment. METHODS: The participants were 152 patients treated at medical center. Data were collected through a structured questionnaire from 'October 4th to December 30th', 2011. The instruments used in this study were sexual function, pain, fatigue, body image, depression, anxiety, stress and spousal support. Data were analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation coefficients and stepwise multiple regression with the SPSS 18.0. RESULTS: The mean score of sexual function was 14.37. The lowest score among sexual function was arousal. The scores of sexual function was significantly different by age, menopause, tumor stage. There were significant correlations between sexual function, pain, body image, fatigue and depression. In multiple regression analysis, factors affecting sexual function were identified as age, tumor stage, pain, body image and fatigue that explained 62.5% of the variance. CONCLUSION: The findings indicate that it is necessary to develop a more effective sexual function improvement program for breast cancer women after receiving cancer treatment.

Ankle-brachial blood pressure differences before and during anesthesia

BACKGROUND: In surgeries involving the upper extremities and breast, the blood pressure is frequently measured at the ankles. As the blood pressure is used as a pain indicator in the full surgical anesthesia, the ankle blood pressure higher than the brachial blood pressure may be misinterpreted by the anesthesiologist, in determining the depth of the anesthesia. This paper investigated whether the ankle blood pressure is significantly higher than the brachial blood pressure before the anesthesia induction, during induction, and after tracheal intubation. METHODS: Two hundred seventeen patients requiring general anesthesia for elective surgery were included in this study. Ankle and brachial blood pressure were simultaneously measured before the anesthesia induction, during induction, and after tracheal intubation. RESULTS: The ankle blood pressure was higher than the brachial blood pressure before induction, during induction, and after tracheal intubation. Ankle-brachial blood pressure differences were significantly higher before induction and after intubation as compared to that during induction. The correlation coefficient between the systolic ankle-brachial blood pressure difference before induction and that after tracheal intubation was 0.623. In 33 child patients with an ankle-brachial blood pressure index > or =1 before induction, there were no significant differences in the ankle-brachial blood pressure during induction. The brachial systolic blood pressure could be predicted by simple and multiple regression equations (R2 = 0.349-0.828). CONCLUSIONS: The results of the study suggest that the anesthesiologists need to consider the ankle-brachial blood pressure differences in monitoring the anesthesia, in cases where the brachial blood pressure cannot be measured during surgery.