Evidence-based Clinical Nursing Practice Guideline for Management of Inpatient Falls: Adopting the Guideline Adaptation Process / 기본간호학회지

Purpose@#Despite research efforts, current fall rates are still higher than expected. To approach this problem, we developed guidelines on preventing falls in hospitals. @*Methods@#Four guidelines were selected by the K-AGREE II process. Recommendations from each guideline were retrieved and evaluated based on the quality of evidence and the strength of the recommendations. Recommendations followed the grading system of the Korean Hospital Nurses Association’s Guideline Adaptation Manual. In the external review, 13 practice nurses from 5 hospitals and 13 panel experts including doctors, nursing managers, and pharmacists participated. @*Results@#The final guideline consisted of 5 sections and 341 recommendations. The first two sections were composed of recommendations for institutional readiness for change process and management, and Section 3 was divided into assessment of risk factors, preventive intervention and post-fall management. The summary of falls risk factors included seven components. Multifaceted interventions were modeled into six strategies. The final sections consisted of recommendations for implementing fall improvement programs and for sustaining effective prevention programs. @*Conclusion@#Given that falls result from various combinations of risk factors, the present guideline contains multifaceted assessments and interventions including risk-targeted strategy. This guideline will contribute to decreasing fall rates in hospitals by stimulating compliance with evidence-based practice.

The Level of Successful Aging and Influencing Factors of the Community Elderly

BACKGROUND: The purpose of this study was to understand the level of successful aging and to analyze the factors that affect successful aging. METHODS: This study was a descriptive study. The data collection of this study using questionnaires was from October 1, 2017 to December 30, 2017, and the 169 elderly people living in Chungcheongnam-do were surveyed. RESULTS: The mean level of successful aging of the subjects was 3.57 (±0.58), which was higher than the median, it was significantly different among the presence of religion, participation in senior facility, regular exercise, pain, and subjective health status. Regression analysis showed that the factors that have the greatest influence on the successful aging of the subjects were the participation in senior facility (β=0.24, P<0.001), self-esteem support (β=0.20, P=0.024), emotional support (β=0.19, P=0.048), regular exercise (β=0.19, P=0.002), and pain (β=−0.14. P=0.029). The explanatory power of these variables on successful aging was 53% (F=20.37, P<0.001). CONCLUSIONS: This study showed that emotional support and support for self-esteem were important in successful aging, and that pain, which was not considered in previous studies, was an important factor.

The Level of Successful Aging and Influencing Factors of the Community Elderly

BACKGROUND@#The purpose of this study was to understand the level of successful aging and to analyze the factors that affect successful aging.@*METHODS@#This study was a descriptive study. The data collection of this study using questionnaires was from October 1, 2017 to December 30, 2017, and the 169 elderly people living in Chungcheongnam-do were surveyed.@*RESULTS@#The mean level of successful aging of the subjects was 3.57 (±0.58), which was higher than the median, it was significantly different among the presence of religion, participation in senior facility, regular exercise, pain, and subjective health status. Regression analysis showed that the factors that have the greatest influence on the successful aging of the subjects were the participation in senior facility (β=0.24, P<0.001), self-esteem support (β=0.20, P=0.024), emotional support (β=0.19, P=0.048), regular exercise (β=0.19, P=0.002), and pain (β=−0.14. P=0.029). The explanatory power of these variables on successful aging was 53% (F=20.37, P<0.001).@*CONCLUSIONS@#This study showed that emotional support and support for self-esteem were important in successful aging, and that pain, which was not considered in previous studies, was an important factor.

Factors Influencing Subjective Happiness in Korean Nursing Students / 한국간호교육학회지

PURPOSE: The purpose of this study was to determine subjective happiness related factors in Korean nursing students. METHODS: A purposive sample of 200 nursing students was recruited for the cross-sectional survey design. The instruments were perceived stress scale, major satisfaction scale, resilience scale, and subjective happiness scale. Data were analyzed using descriptive statistics, hierarchical linear regression, and the Sobel test for testing mediating effects. RESULTS: The mean score of stress, major satisfaction, resilience and subjective happiness was 2.21, 3.95, 3.60 and 5.03, respectively. Perceived health status, stress_positive perception, stress_negative perception, resilience_self confidence, resilience_positivity, resilience_social support had significant effects on subjective happiness. Explained variance for the subjective happiness was 53.4%. Resilience had a partial mediating effect in the relationship between stress and subjective happiness (Sobel test: Z=-5.67, p<.001). Also, resilience had a mediating effect in the relationship between major satisfaction and subjective happiness (Sobel test: Z=5.65, p<.001). CONCLUSION: Based on the findings of this study, nursing intervention programs focusing on improving resilience are recommended to improve subjective happiness in nursing students.

A Study on Fecal Incontinence and Depression of Rural Women

PURPOSE: The purposes of this study were to identify the prevalence and influencing factors of fecal incontinence, and to analyze the association between fecal incontinence and depression. METHODS: The subjects of this study were 233 women living in rural areas, and data were collected using questionnaires from February 24 to May 30, 2012. Fecal incontinence was measured with the Continence Grading Score, and depression with the Geriatric Depression Scale. Collected data were analyzed using SPSS through chi2-test, Fisher's exact test, t-test and ANOVA. RESULTS: Of the subjects, 16.7% had fecal incontinence. The prevalence of fecal incontinence was higher in older women (chi2=23.55, p<.001), those with vaginal delivery (chi2=4.81, p=.049), those with parity of 4 or more (chi2=13.47, p=.003), and those with urinary incontinence (chi2=26.36, p<.001). The level of depression was significantly higher in older women (F=19.27, p<.001), those with low academic qualification (F=18.17, p<.001), those with urinary incontinence (F=4.15, p=.043), and those with fecal incontinence (F=14.90, p<.001). CONCLUSION: These results suggest that there should be supports by public health care for fecal incontinence prevention and care programs in order to promote the physical and emotional health of rural women.

Factors Influencing Depression among Nursing Students / 한국간호교육학회지

PURPOSE: The purpose of this study was to investigate the level and factors influencing depression among nursing students. METHODS: The data were collected from nursing students attending 3 universities who expressed a willingness to participate in the study through a questionnaire which surveyed them about depression, stress, social support, self-efficacy, self-esteem, and wellbeing in May, 2012. The collected data from 235 nursing students were analyzed using a SPSSWIN 19.0. RESULTS: The mean score of depression (using MDI) among nursing students was 16.7, which denotes a minor depressive mood. 49.1% of variance with regard to depression among nursing students was explained by stress, self-esteem, wellbeing and self-efficacy. CONCLUSION: There is a need to develop a depression prevention program for nursing students and to reduce stress and increase self-esteem, wellbeing and self-efficacy in order to establish an effective program.

Correlation between History of Exposure to Obscene Material, Sexual Attitudes and Intercourse Experience among University Students / 기본간호학회지

PURPOSE: The purpose of this study was to analyze the history of exposure to obscene material, and examine sexual attitudes and intercourse experience in order to develop an effective program for university students. METHOD: The data were collected in May, 2012 from 385 students attending 3 universities in Korea. An independent t-test and ANOVA were used to determine the differences with regard to sexual attitudes and intercourse experience according to general characteristics and history of exposure to obscene material. RESULTS: Sexual attitudes significantly differed according to timing of first exposure to obscene material (p<.001). Intercourse experience was significantly different according to timing of first exposure to obscene material (p=.016) and type of exposure to obscene material (p=.032). There was a negative correlation between first exposure to obscene material and sexual attitudes (p<.001), and a positive correlation between first exposure to obscene material and intercourse experience (p=.017). CONCLUSION: Results of this study indicate that history of exposure to obscene material should be considered as an important variable in managing the sexual health of university students.

A Study on Urinary Incontinence Related Health Problems in Women above Middle Age in Rural Areas and Their Coping with the Problems

PURPOSE: The purpose of this study was to identify the current urinary incontinence states in women above middle age dwelling in rural areas and their coping with the problems. METHODS: The participants were 261 women above middle age. Data were collected from February to May, 2012 using a structured questionnaire. The data were analyzed with the SPSS/WIN 20 program. RESULTS: The frequency of urinary incontinence in women above middle age was 45.4%. There were significant differences in urinary incontinence due to age, education, job status, frequency of delivery, and menstrual status. And, there were significant relations among urinary symptoms, difficulty of ADL, incontinence stress and depression. Frequently used coping-methods with urinary incontinence were washing frequently in order to avoid awful smell, paying attention to perineal cleaning, and going to restroom frequently. CONCLUSION: Community nurses who are in charge of primary health care ought to assess urinary incontinence and develop a urinary incontinence program that includes psychological and social factors.

Married Immigrant Women's Utilization of Health Care and Needs of Health Services

PURPOSE: The purpose of this study was to analyze married immigrant women's utilization of health care and their demand for public health care services. METHODS: This study was conducted through descriptive survey with 102 married immigrant women in 2 cities, and survey was done from November, 2010 to May, 2011. RESULTS: The results were as follows. Of respondents, 70% were using medical services in Korea and only 38.2% of them were satisfied with services. Major difficulties in using health care services were 'access problem' (35.7%), 'communication problem' (27.7%), and 'medical cost' (19.8%). The respondents' main sources of health information were family (56%), health care center (15%). The types of health information and education demanded by respondents were children's health care (22.1%), pregnancy and delivery (21.1%), and common disease care (20.0%). The most wanted services from public health care institutions were vaccination (24.5%), health promotion (21.5%), and leisure activity programs (20.6%). There was a statistically significant difference in period of immigration and public health care demands. CONCLUSION: For married female immigrants, it is recommended to provide tailored public health care services such as outreach service and visiting nursing care service, and to set up different language signs for common disease patients.

Evaluation of a Fall Risk Assessment Tool to Establish Continuous Quality Improvement Process for Inpatients' Falls / 간호행정학회지

PURPOSE: The aims of study were; (1) to evaluate the validity and sensitivity of a fall-risk assessment tool, and (2) to establish continuous quality improvement (CQI) methods to monitor the effective use of the risk assessment tool. METHODS: A retrospective case-control cohort design was used. Analysis was conducted for 90 admissions as cases and 3,716 as controls during the 2006 and 2007 calendar years was conducted. Fallers were identified from the hospital's Accident Reporting System, and non-fallers were selected by randomized selection. Accuracy estimates, sensitivity analysis and logistic regression were used. RESULTS: At the lower cutoff score of one, sensitivity, specificity, and positive and negative predictive values were 82.2%, 19.3%, 0.03%, and 96.9%, respectively. The area under the ROC was 0.60 implying poor prediction. Logistic regression analysis showed that five out of nine constitutional items; age, history of falls, gait problems, and confusion were significantly associated with falls. Based on these results, we suggested a tailored falls CQI process with specific indexes. CONCLUSION: The fall-risk assessment tool was found to need considerable reviews for its validity and usage problems in practice. It is also necessary to develop protocols for use and identify strategies that reflect changes in patient conditions during hospital stay.

Bone Mineral Density, Body Mass Index, Stress, and Health Promotion Lifestyle of Female College Students

PURPOSE: The purpose of this study was to examine the bone mineral density (BMD), body mass index (BMI), stress, and health promotion lifestyle of female college students and to assess relations among them. METHODS: A total of 220 female college students were assessed through anthropometric measurements and bone mineral density test using quantitative ultrasound. In addition, the subjects were asked about stress and health promotion lifestyle with a self-rating questionnaire. Collected data were processed with the SPSS/WIN 12.0 program. RESULTS: 1) Of the students, 67.8% had weight control experience. The percentage of the osteoporosis, osteopenia and normal groups were 2.8%, 53.5% and 43.8%, respectively, and the percentage of the underweight, normal and overweight groups according to BMI were 27.9%, 57.2% and 14.9%, respectively. 2) The levels of stress and health promotion lifestyle were 2.9 and 2.3, respectively. 3) There was a positive correlation between BMD and BMI (r=.196, p<.01). There was a negative correlation between stress and health promotion lifestyle (r=-.35, p<.01). 4) Weight control experience made negative effects on BMD and BMI. CONCLUSION: The findings of this study suggest the necessity of new health promotion programs to increase bone density of female college students. Stress management programs are also needed.

Kidney Transplantation in Sensitized Recipients; A Single Center Experience

A successful transplantation, across a positive crossmatch barrier, is one of the most persistent long- standing problems in the field of kidney transplant medicine. The aim of this study was to describe seven consecutive living renal transplantations in recipients with positive crossmatch for donors or positive for donor specific antibodies (DSAs). A preconditioning regimen including plasmapheresis and intravenous immunoglobulin was delivered three times a week until the crossmatch and/ or DSAs became negative. Mycophenolate mofetil and tacrolimus were started two days before the plasmapheresis. The protocol was modified to include administration of anti-CD 20 antibody (rituximab, 375 mg/m(2)) from the patient number 3 through the patient number 7. All seven patients achieved negative conversion of the crossmatch or DSAs, and the kidney transplantations were successfully performed in all cases. Acute cellular rejection occurred in two patients, which were subclinical and controlled with high dose steroid treatment. Antibody-mediated rejection occurred in one patient, which was easily reversed with plasmapheresis. All recipients attained normal graft function during the 7-24 months of follow up. Our study suggests that sensitized patients can be transplanted successfully with desensitization pretreatment.

Establishment of Active Identification and Management System for Potential Brain Dead Donors in Life-link Center / 대한이식학회지

BACKGROUND: The purpose of this study was to promote organ donation by active identification and proper management of brain-dead donor with collaborating network system and to assume operating expenses in the setting of independent organ procurement organization (IOPO) in Korea. METHODS: Seoul National University Hospital and Gachon University Gill Hospital worked together as regional OPO during 8 months from April to December 2008. RESULTS: We constructed cooperative network system with five base-hospitals by MOU (memorandum of understanding). We visited 138 hospitals 223 times and built up brain-dead organ donation. Among total 265 dead patients in intensive care unit (ICU), 95 (36%) patients were considered as potential organ donors, but only 14 (14.7%) donated their organs actually. During the previous 8 months, there were 67 contacts for potential donor evaluation and total 100 solid organs were actually procured from 31 brain-dead donors except 4 cases. We also established and applied a flow chart and critical pathway of potential brain-dead donor. It was worthy of notice to manage 3 brain-dead donors and successfully procured their organs without donor transportation to HOPO. Apart from operating and depreciation expenses, we could estimate the expenses loss of mean 850,000 won per organ in the current system. CONCLUSIONS: Our results showed hope for success of IOPO in Korea which would be founded in the near future. Besides persistent active relationship with regional hospitals, a certain degree of financial support or other means such as increase of organ fee and medical insurance coverage should be considered.

A Structural Model on Quality of Life for Recipients of Liver Transplants / 기본간호학회지

PURPOSE: This study was done to construct a quality of life (QOL) model for recipients of a liver transplant. METHOD: In consideration of the main factors influencing QOL in recipient of liver transplants, a hypothetical model was constructed with 16 paths. A questionnaire was used to collect data from recipients of liver transplants who were being followed at one of 3 university hospitals. For the final analysis, there were 189 completed questionnaires and the hypothetical model was verified through covariance structure using LISREL program. RESULTS: Overall fitness indices of hypothetical model were GFI= .99, AGFI= .97, NNFI= .96 and RMR=.020. After considering modification indices and paths that proved not to be significant and to improve model fitness, the hypothetical model was modified. In the final model, 3 paths from the hypothetical model were excluded. Overall fitness indices of the final model were GFI= .99, AGFI= .98, NNFI= .98 and RMR= .020. Eleven of fifteen paths proved to be significant. QOL was influenced by duration after transplantation, perceived health status, self-esteem, uncertainty, social support, self efficacy and depression and these variables explained 65% of the variance. CONCLUSION: This study presents a theoretical model for QOL for recipients of a liver transplant. Based on the results of this study and to improve QOL for recipients of a liver transplant, it is suggested that interventions to re-enforce self efficacy and self-help are needed.

Experience of Simultaneous Pancreas and Kidney Transplantation in Seoul National University Hospital / 대한이식학회지

Purpose: Aim of this study is to review the simultaneous pancreas and kidney transplantation (SPK) cases performed in Seoul National University Hospital for DM nephropathy patients. Methods: Medical records of the SPK recipients from April 2002 to February 2006 were reviewed and analyzed retrospectively. Results: There were 10 cases of SPK transplantation in SNUH from April 2002 to February 2006, which were composed of 8 type II DM patients and 2 type I DM patients. We experienced 1 operative mortality case and 3 acute rejection cases. All the acute rejection cases were recovered by steroid pulse therapy. We performed two graft pancreatectomy operations due to CMV infection followed by duodenal perforation and severe graft pancreatitis with pancreatic leakage. With the exception of 1 mortality case and 2 graft loss cases, all 7 patients stopped insulin and oral hypoglycemic agent and are keeping blood glucose level within normal range. Conclusion: Although patient follow-up is limited up to four years, SPK recipients are free from insulin use and show good graft functions. SPK could be a good treatment modality for insulin dependent type II DM nephropathy patients.

Adjustment Experience of Liver Transplant Recipient / 재활간호학회지

The purpose of this phenomenological study was to understand and describe the essence and the structure of lived experience of liver transplant recipient. Five individual interviews were conducted to gather data regarding their subjective experiences. About 130 significant statements were extracted and these were clusterd into 9 themes. End stage liver disease patients chose their last treatment - liver transplantation. After liver transplantation. recipients experience vague anxiety and uneaseness related to much information and life style change that they had to accept. And they feared to lose their health again. But they felt free from medication and restriction of food. And they satisfied with regaining their physical status. Most of the recipients also had financial difficulties and social restrictions. And they experience uncertainty about their future. But they restored their previous social life. And they experience psychological wellbeing and hope. The results of this study might help nurses who work with liver transplant recipient in establishing and implementing an effective nursing intervention by understanding their lived experience.

Relations between Perceived Burden and Social Support of Stroke Patient's Family Caregiver / 간호학회지

The purpose of this study was to describe the perceived burden of the stroke patient's caregiver and related factors to analyze relationships between perceived burden and social supports. A convenient sample of 225 caregivers who take care for a stroke patient at home participated in this study. Caregiver's perceived burden was measured by the objective and subjective burden scale developed by Montgomery (1985). Related factors of burden were studied in terms of the patient's instrumental activties of daily living, cognitive function, caregiver's demographic variables and caregiver's illness intrusiveness. The results were as follows: (1) The mean of objective burden score was 4.5, and subjective burden score was 3.1. These scores show that caregivers perceive moderate level of burden. (2) Caregivers' objective burden was significantly related to caregivers's illness intrusiveness (r=.62), patient's IADL (r=-.33), and patient's cognitive function (r=-.15). The subjective burden was related to the caregiver's illness intrusiveness (r=.29), the patient's IADL (r=.24), and the caregiver's age(r=.23). (3) The percentage of stroke caregivers who perceived physical support was 49.1%. The percentage of those who perceived emotional support was 61.0%, and those who perceived financial support totaled 37.6%. (4) Caregivers who received any type of social supports perceived lower subjective burden, and caregivers who received physical or psychological support perceived lower objective burden. These results emphasized the necessity of a rehabilitation programs for stroke patients and support program for family caregivers.

Relations between Perceived Burden and Social Support of Stroke Patient's Family Caregiver / 간호학회지

The purpose of this study was to describe the perceived burden of the stroke patient's caregiver and related factors to analyze relationships between perceived burden and social supports. A convenient sample of 225 caregivers who take care for a stroke patient at home participated in this study. Caregiver's perceived burden was measured by the objective and subjective burden scale developed by Montgomery (1985). Related factors of burden were studied in terms of the patient's instrumental activties of daily living, cognitive function, caregiver's demographic variables and caregiver's illness intrusiveness. The results were as follows: (1) The mean of objective burden score was 4.5, and subjective burden score was 3.1. These scores show that caregivers perceive moderate level of burden. (2) Caregivers' objective burden was significantly related to caregivers's illness intrusiveness (r=.62), patient's IADL (r=-.33), and patient's cognitive function (r=-.15). The subjective burden was related to the caregiver's illness intrusiveness (r=.29), the patient's IADL (r=.24), and the caregiver's age(r=.23). (3) The percentage of stroke caregivers who perceived physical support was 49.1%. The percentage of those who perceived emotional support was 61.0%, and those who perceived financial support totaled 37.6%. (4) Caregivers who received any type of social supports perceived lower subjective burden, and caregivers who received physical or psychological support perceived lower objective burden. These results emphasized the necessity of a rehabilitation programs for stroke patients and support program for family caregivers.

A Study on the Relationship Between Learned Helplessness and Self-care Agency in Dialysis Patients / 재활간호학회지

The purpose of this study was to identify the degree of learned helplessness and self-care agency in dialysis patients and the relationship between learned helplessness and self-care agency. The subjects were 168 dialysis patients who were undergoing hemodialysis and peritoneal dialysis from 1 university hospital, 1 hospital, 1 hemodialysis center in Seoul, 1 hospital in Incheon, Korea. The data were collected with two interview questionnaires which were Learned Helplessness Scale (LHS) and Self-as-Carer Inventory (SCI). The collected data were analyzed by descriptive statistics and t-test, One-way ANOVA and Pearson Correlation with SPSSWIN program. Results were obtained as follows : 1) The mean scores of learned helplessness were 45.93(range 20-80). The mean learned helplessness scores of peritoneal dialysis patient and hemodialysis (HD) patient were not different significantly. However by the aging process, the mean scores of learned helplessness has a tendency to get higher and who had a job were likely to low score of learned helplessness. 2) The mean scores of self-care agency were 142.48 (range 33-198). The mean self-care agency scores of peritoneal dialysis (PD) patient much higher than the score of it with hemodialysis. The score of self-care agency were significantly different between peritoneal dialysis patient and hemodialysis patient. The patients who have job were likely to be higher score of self-care agency than other groups. 3) There was significant relationship between the score of learned helplessness and self-care agency. In conclusion, there was an inverse relationship between learned helplessness and self-care agency in dialysis patients. Considering this, the high level of learned helplessness of dialysis patients should be intervened by nurse with a well developed edicational program or cognitive behavioral therapy.

Related Factors of the Quality of Life in Stroke Patients / 재활간호학회지

The related factors of the quality of life (QOL) in stroke patients was identified empirically. The subjects were 254 stroke patients who were discharged and taken follow-up care at the outpatient department. In this model, the physical, psychological, and social status were assumed to affect the QOL. And the social support was assumed to moderate these effects. NIH stroke state, ADL, and IADL were used to measure the physical status. Using CES-D, the psychological status was measured. The social status was defined as the job change after stroke attack. The satisfaction with the care by primary caregivers, significant others, and health professionals was measured as the social support. To identify the effect of the physical, psychological, and social status on the QOL, multiple regression analysis was carried out. The psychological and social status were found to be the significant predictors of the QOL(R2=0.27, p=0.00). Next, to identify the moderating effect of the social support, the subjects were divided into two groups, that is, the low social support group and the high social support group. It is found that the predicting variance is different between these two groups. In the low social support group, the psychological, social, and physical status predicted as much as 42% of the QOL. On the contrary, the psychological status predicted only 8% of the QOL in the high social support group. So it is concluded that the social support moderates the effects of the physical, psychological, and social status on QOL. Finally, to identify the social support which moderates those effects, the social support was divided into three classes. Each social support class was divided into the low and high social support group again. In the every class of social support, the difference between two groups was also identified. So the model of the QOL is recommended for the framework of the care for the stroke patients. Also these results support the claim that the long-term facilities for stroke patients are necessary.