Development and Evaluation of Nursing Work Environment Scale of Clinical Nurses / 간호행정학회지

Purpose@#This study aimed to develop a nursing work environment scale for clinical nurses and to verify its validity and reliability. @*Methods@#The initial items comprised individual interviews with eleven clinical nurses. The content validity of the initial items was evaluated twice by nine experts, while 37 preliminary items were reviewed through pilot tests with 20 nurses and cognitive interviews with five nurses. The survey data were collected from 353 clinical nurses working at general hospitals. @*Results@#In the exploratory factor analysis, the number of factors was determined through parallel analysis, scree test, and cumulative variance ratio. Consequently, 23 items and three factors were thus composed, yielding a total cumulative variance ratio of 91.3%. The finalized 20 items of the final three factors were subjected to a confirmatory factor analysis, which led to the validation of the three subscales model. The three sub-factors were composed of nurse manager competency, nurse safety management system, and a nurse support system. @*Conclusion@#This scale is expected to be useful for evaluating the nursing work environment of clinical nurses by verifying its reliability and validity through various methods.

Influence of Self-care on Burnout in Primary Family Caregiver of Person with Dementia

Purpose@#The purpose of this study was to identify the influence of self-care on burnout experienced by primary family caregivers of persons with dementia. @*Methods@#The subjects of the study were 156 primary family caregivers of persons with dementia at home in Korea. Data were analyzed using descriptive statistics, independent t-test, one-way ANOVA, Pearson correlation coefficient, and hierarchical multiple regression using IBM SPSS Statistics ver. 24.0 for Windows. @*Results@#The mean scores for self-care and burnout were 42.35 and 61.60, respectively. Self-care, subjective health status, living with a person with dementia, and behavioral and psychological symptoms of dementia were significant factors affecting burnout in family caregivers. Self-care was identified as the strongest factor affecting burnout, explaining 13.9% of burnout with controlling factors in caregivers and care receivers. @*Conclusion@#To prevent burnout in primary family caregivers of persons with dementia, self-care of family caregivers should be emphasized. In nursing education, family caregivers should be recognized and approached as nursing clients who are responsible for taking care of their health. In nursing practice and research, digital self-care or self-care improvement intervention programs should be designed to help family caregivers, and further studies on self-care centered on health of family caregivers should be conducted.

Influence of Self-care on Burnout in Primary Family Caregiver of Person with Dementia

Purpose@#The purpose of this study was to identify the influence of self-care on burnout experienced by primary family caregivers of persons with dementia. @*Methods@#The subjects of the study were 156 primary family caregivers of persons with dementia at home in Korea. Data were analyzed using descriptive statistics, independent t-test, one-way ANOVA, Pearson correlation coefficient, and hierarchical multiple regression using IBM SPSS Statistics ver. 24.0 for Windows. @*Results@#The mean scores for self-care and burnout were 42.35 and 61.60, respectively. Self-care, subjective health status, living with a person with dementia, and behavioral and psychological symptoms of dementia were significant factors affecting burnout in family caregivers. Self-care was identified as the strongest factor affecting burnout, explaining 13.9% of burnout with controlling factors in caregivers and care receivers. @*Conclusion@#To prevent burnout in primary family caregivers of persons with dementia, self-care of family caregivers should be emphasized. In nursing education, family caregivers should be recognized and approached as nursing clients who are responsible for taking care of their health. In nursing practice and research, digital self-care or self-care improvement intervention programs should be designed to help family caregivers, and further studies on self-care centered on health of family caregivers should be conducted.

Predictors of Behavioral and Psychological Symptoms of Dementia: Based on the Model of Multi-Dimensional Behavior

PURPOSE: The purpose of this study was to identify factors predicting behavioral and psychological symptoms of dementia (BPSD) in persons with dementia. Factors including the patient, caregiver, and environment based on the multi-dimensional behavioral model were tested. METHODS: The subjects of the study were 139 pairs of persons with dementia and their caregivers selected from four geriatric long-term care facilities located in S city, G province, Korea. Data analysis included descriptive statistics, inverse normal transformations, Pearson correlation coefficients, Spearman's correlation coefficients and hierarchical multiple regression with the SPSS Statistics 22.0 for Windows program. RESULTS: Mean score for BPSD was 40.16. Depression (β=.42, p<.001), exposure to noise in the evening noise (β=−.20, p=.014), and gender (β=.17, p=.042) were factors predicting BPSD in long-term care facilities, which explained 25.2% of the variance in the model. CONCLUSION: To decrease BPSD in persons with dementia, integrated nursing interventions should consider factors of the patient, caregiver, and environment.

Lived Experiences toward Harmful Work Environment among Clinical Nurses: Phenomenological Approach / 간호행정학회지

PURPOSE: This study was conducted to expand nurse's experience of harmful work environments. METHODS: Data were collected through in-depth dividual interviews and analyzed using Colaizzi phenomenological analysis methodology. RESULTS: Harmful work environments experienced by nurses were categorized as followed: ‘Neglect concerning infections’, ‘Being thrown into a violent working environment’, ‘The hard times of being alone’, ‘Struggling with the harmful work environments’. CONCLUSION: The results of this study provide a deep understanding of the harmful work environments. It is necessary to create safe work environments and it is important to improve awareness in the system of organizations as well as individuals. Also, it is necessary to develop tools to measure work environment including risk factors.

Evolutionary Concept Analysis of Resilience in People with Mental Disabilities / 정신간호학회지

PURPOSE: This study was done to define and clarify the concept of resilience in people who are mentally disabled. METHODS: Rodgers' evolutionary approach to concept analysis was used to identify common attributes, antecedents, and consequences of the resilience of people who have mental disabilities. A literature search of the RISS, Kiss, CINAHL, PubMed, ProQuest, Scopus and PsycArticle databases from 1980 to 2016 was conducted, using the key words of ‘psychiatric disorder resilience’, and ‘mental illness resilience.’ Thirteen relevant articles and one book were finally selected and reviewed in depth. RESULTS: The concept analysis showed that, the attributes of resilience in people with mental disabilities were ‘flexibility’, ‘potentiality’, ‘strengthening’. The antecedents of resilience were psychiatric symptoms and perceived stigma. The consequences of resilience were understood to be recovery. CONCLUSION: The findings in this study indicate that it is important to provide preliminary knowledge necessary for mental health nurses to reinforce resilience in people with mental disabilities. There is also a need to develop a scale to measure resilience in this population.

Predictors of Chewing Discomfort among Community-dwelling Elderly

PURPOSE: The purpose of this study was to identify associated factors of chewing discomfort among community-dwelling elderly. METHODS: The study was cross-sectional design and secondary data analysis using the 6th Korea National Health and Nutrition Examination Survey. Among the total of 7,550 participants, data was analyzed with 1,126 adults aged 65 years and over. Chewing discomfort was assessed by the perceived chewing discomfort. Multivariate logistic regression analysis was used to find the associated factors of chewing discomfort. RESULTS: Along with 61.7% of the participants reported having chewing discomfort, 85.2% reported to perceive poor oral health and 35.0% had oral pain. In multivariate logistic regression, perceived oral health (OR 3.22, 95% CI 2.24~4.63), oral pain (OR 2.46, 95% CI 1.76~3.43), activity limitation (OR 1.71, 95% CI 1.05~2.80), teeth requiring treatment (OR 1.61, 95% CI 1.14~2.26), number of remaining teeth (OR 1.60, 95% CI 1.22~2.10) and educational level (OR 1.56, 95% CI 1.15~2.12) were the significant predictors of chewing discomfort. CONCLUSION: The prevalence in chewing discomfort was high in elderly Koreans and various factors were associated with chewing discomfort. To improve chewing ability, it is suggested that the national level of policies offer strategical oral health programs in this population.

The Evaluation of Feasibility and Predictive Validity of Comprehensive Korean Frailty Instrument: Using the 2008 and 2011 Living Profiles of Older People Survey in Korea

PURPOSE: This study aimed to verify the predictive validity of Comprehensive Korean Frailty Instrument (CKFI) among older adults. METHODS: A secondary analysis of data from a prospective cohort study was conducted. Frailty was determined in older adults (N=9,188) according to the data in 2008 and the effects of frailty on adverse outcomes (such as institutionalization and death) were evaluated according to the data in 2011. The Cardiovascular Health Study (CHS) index was used to compare with the predictive validity of CKFI. RESULTS: The prevalence of frailty was 26.3%. With the CKFI, the frail group had a higher risk of negative health outcomes compared to the robust and pre-frail groups after three years. The two of the highest risks identified using the CKFI and CHS index were institutionalization (5.522 times higher) and mortality (3.210 times higher). For both instruments, the survival analysis revealed that the risk of death increased as the degree of frailty increased. CONCLUSION: The CKFI consisting of self-report items and multidimensional aspects of frailty can be used as a simple instrument for assessing the frailty of older adults residing in a local community in Korea.

Development of the Meaning in Life Scale for Older Adults

PURPOSE: The purpose of this study was to develop and test the psychometric properties of the newly developed instrument, Meaning in Life, for elderly Korean people. METHODS: Ten older adults participated in the qualitative research used to develop the initial items. Participants for the psychometric testing were 371 community-dwelling older adults. Validity and reliability analyses included content, construct, and criterion-related validities, internal consistency, and test-retest reliability. RESULTS: The Meaning in Life Scale consisted of 12 items with three distinct factors; value of life, source of life, and will to live, which explained 86.7% of the total variance. A three-factor structure was validated by confirmatory factor analysis. Criterion-related validity was supported by comparison with the Purpose in Life Test (r=.74). Reliabilities were secured with test-retest reliability of Intra-class Correlation Coefficient (ICC) .85 and the Cronbach's alpha coefficient .90. CONCLUSION: The results of this study indicate that this instrument is useful to measure meaning in life in Korean elders.

Predictors of Suicidal Ideation in Community-dwelling Older Men: A Comparison between Young-old and Old-old / 정신간호학회지

PURPOSE: This study was done to examine the prevalence of suicidal ideation and predictors of suicidal ideation in community-dwelling older men, comparing young-old (65 to 74) and old-old (75 and over). METHODS: The 2014 National Elderly Survey was used with a sample of 2,790 elderly men. Multivariable logistic regression analysis was used to identify the predictive factors for suicidal ideation in elderly men. RESULTS: The proportions of participants with suicidal ideation were significantly different between young-old and old-old men (χ²=4.46, p=.035). The multivariable logistic regression analyses revealed that being a recipient of basic livelihood security, experiencing discrimination, conflicting with children, and being depressed were significantly associated with suicidal ideation in young-old men. In old-old men, living arrangements, conflicting with children, and being depressed were significantly associated with suicidal ideation. CONCLUSION: Results indicate that the development of suicide prevention programs requires different approaches young-old and old-old men.

Effect of an educational tooth-brushing program using priming in an elderly population with dementia residing in nursing homes / 대한구강보건학회지

OBJECTIVES: The purpose of this study was to examine the effect of an educational program using priming on oral health, and dental plaque, and gingival bleeding indices in an elderly population with dementia (EWD) residing in nursing homes. METHODS: A pretest and posttest were conducted with a nonequivalent control group. In total, 40 participants from an EWD had the following characteristics: 1) they were aged >65 years, 2) they scored <23 points on the MMSE-DS, 3) they were able to communicate, 4) they were able to hold a toothbrush and brush his or her teeth by themselves, and 5) they had no periodontal treatment for the last 3 months. Through random sampling, participants were assigned into either the experimental (n=20) or control group (n=20). The educational program consisted of twelve 30-minute sessions (twice per week for 6 weeks). The control group was demonstrated the standard tooth-brushing method by the facility during the study period. RESULTS: There were no significant differences in demographics or main variables at pretest. The experimental group showed significant differences in the subjective oral health condition, as compared to the control group. The experimental group showed an increase in the level of tooth-brushing effort (t=―8.816, P<.001) and higher scores of self-evaluative dental health status (P<.001) as compared to the control group. The experimental group showed a reduced plaque index (t=11.179, P<.001) and gingival bleeding index (t=5.812, P<.001) compared to the control group. Additionally, the experimental group showed significant differences in changes of plaque index and gingival bleeding index between the pretest and posttest. CONCLUSIONS: An interventional program on tooth brushing with priming effectively improved dental health, plaque index, and gingival bleeding index in EWDs residing in nursing homes. Direct care providers should understand the remaining abilities of EWDs and carry out priming when providing care to them.

Association of Functional Ability and Benign Prostatic Hyperplasia With Urinary Incontinence in Older Korean Men / 대한배뇨장애요실금학회지

PURPOSE: The purpose of this study was to determine the prevalence of urinary incontinence (UI) and analyze its association with instrumental activities of daily living (IADL) and benign prostatic hyperplasia (BPH) in community-dwelling older men in Korea. METHODS: This study was a secondary analysis of data from the Actual Living Condition of the Elderly and Welfare Need Survey conducted in the year 2008. Data was subjected to hierarchical logistic regression analysis to examine the association of IADL and BPH with UI in older men, entering IADL and BPH in model 1, and age, body mass index (BMI) and education in model 2, and then comorbidities and walking speed in model 3. RESULTS: Of 6,185 men, 243 (3.9%) had self-reported UI. The prevalence of UI was 1.8% in men aged 60-64 years and 11.7% in those aged 85 years and above, indicating an increase in the prevalence of UI with their age. IADL and BPH remained the only significant factors associated with UI in model 1 (odds ratio [OR], 1.54; 95% confidence interval [CI], 1.44-1.64 and OR, 2.73; 95% CI, 1.47-5.10, respectively), model 2 (OR, 1.50; 95% CI, 1.40-1.61 and OR, 2.68; 95% CI, 1.42-5.07), and model 3 (OR, 1.43; 95% CI, 1.32-1.54 and OR, 2.58; 95% CI, 1.36-4.90). CONCLUSIONS: IADL limitations and presence of BPH were associated with UI in older men after controlling for BMI, education, comorbidities, and walking speed. Thus, UI should be assessed in older Korean men with IADL decline and BPH. Gender-sensitive interventions to attenuate IADL limitations and manage BPH should be developed and applied to improve UI in older men.

Factors Associated With Self-reported and Medically Diagnosed Urinary Incontinence Among Community-Dwelling Older Women In Korea / 대한배뇨장애요실금학회지

PURPOSE: The purpose of this study was to examine the prevalence of urinary incontinence (UI) in community-dwelling Korean women 60 years or older, and to identify factors associated with self-reported and medically diagnosed UI. METHODS: This study was a secondary analysis of data from the 2008 Actual Living Condition of the Elderly and Welfare Need Survey, which used a stratified two-stage cluster sampling method to select a representative sample of 8,961 elderly Korean women. RESULTS: Of the 8,961 women in this study, 579 (6.5%) had self-reported UI, and 209 (2.3%) were medically diagnosed with UI. As patient age and exercise ability of the upper extremities increased, risk for self-reported UI decreased (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.96-0.99; OR, 0.99; 95% CI, 0.98-0.99, respectively). In contrast, as the number of limited instrumental activities of daily living (IADL) increased, the risk for self-reported UI increased (OR, 1.30; 95% CI, 1.24-1.35). Overweight women were 1.94 times more likely to have self-reported UI compared to underweight women. Women with a history of stroke or asthma were more likely to have self-reported UI compared to women with no history. Also, women who reported being in good health were less likely to have UI, compared to women who reported being in poor health (OR, 0.47; 95% CI, 0.31-0.70). Medically diagnosed UI was negatively associated with the number of limited IADL and exercise ability scores for the lower extremities (OR, 0.86; 95% CI, 0.80-0.92; OR, 0.98; 95% CI, 0.97-0.99, respectively). In contrast, as the exercise ability score for the upper extremities increased, so did the risk for medically diagnosed UI (OR, 1.02; 95% CI, 1.01-1.03). CONCLUSIONS: An interventional program for home visit health services is needed for incontinent women who are highly dependent on others for IADL.

Effect of Muscle Strength Training on Urinary Incontinence and Physical Function: A Randomized Controlled Trial in Long-term Care Facilities

PURPOSE: This study was done to determine whether muscle strength training programs have an impact on improving symptoms of urinary incontinence (UI) and physical function among elderly women with UI who reside in long-term care facilities. METHODS: A randomized controlled trial was conducted. Participants had to be over 65 years, score over 15 score on the mini-mental state examination, and be able to walk alone or with an assistant. Seventy residents were randomly allocated to either the training group (n=35) or control group (n=35). The program consisted of 50 minutes, twice a week for 8 weeks, and included Kegel's exercise, Thera-band training and indoor walking. Main outcomes were UI symptoms, peak vaginal pressure and physical functions measured with timed up and go test (TUG), one leg standing test (OLST), activities of daily living (ADL) and grip strength. Changes in outcome measurements were calculated from baseline to 4 weeks and to 8 weeks using repeated measures ANOVA. RESULTS: There were significant differences in peak vaginal pressure (p<.001), TUG (p<.001), OLST (p=.012) and grip strength (p<.001) in the interaction between groups and time. CONCLUSION: Future studies are suggested to confirm the effect of muscle strength training in long-term care facilities where elderly women with UI reside.

Predictors of Resilience in Adolescents with Cancer

PURPOSE: The purpose of this study was to identify the predictors influencing on resilience in adolescents with cancer. METHODS: The participants consisted of 107 parents and 107 adolescents who aged ten and eighteen diagnosed with cancer more than six months and currently receiving outpatient treatment or further management after off-therapy. Data was collected using self-report questionnaires and analyzed by descriptive statistics, t-test, ANOVA, Pearson's correlation, and multiple regression. RESULTS: Resilience was significantly different by religion (t=2.472, p=.045) and number of cancer treatment regimens (F=3.155, p=.047). Family problem-solving communication was also significant by number of cancer treatment regimens (F=3.582, p=.031). The higher social support showed the stronger family hardiness and the better family problem-solving communication. In addition, a positive relationship was found between Family Hardiness Index (FHI) (r=.193, p=.046), Family Problem Solving Communication (FPSC) (r=.226, p=.019) and resilience of adolescents with cancer. FPSC (beta=.356, p=.045) and religion (beta=.441, p=.002) were predictive factors at ages 10-12, FHI (beta=.509, p=.029) and FPSC (beta=.503, p=.037) were predictive factors at ages 13-15 on resilience of adolescents with cancer that explained 16.0% and 24.3% respectively. CONCLUSION: The findings suggest that nursing interventions should focus on enhancing family resilience and resilience of adolescents with cancer.

Effects of Multisensory Stimulation Using Familiarity: Persons with Dementia in Long-term Care Facility in Korea

PURPOSE: The purpose of the study was to examine the effects of multisensory stimulation (MSS) using familiarity on persons with dementia (PWDs) residing in nursing homes in Korea. METHODS: A nonequivalent control group with pre and posttests was used. Fifty one PWDs were included if they: 1) were over 65 yr old, 2) were diagnosed with dementia, 3) had no visual or speech impairments, 4) were able to communicate, and 5) had spent more than one month in a nursing home. The experimental group (n=25) received a 55 min MSS program twice a week for 10 weeks. The outcome variables included were cognition, activities of daily living, grip strength, depression, wandering, and aggressive behaviors. Repeated ANOVA was used for data analysis. RESULTS: There were no significant differences in demographics or the main variables at pretest. Cognition, depression, wandering, and aggressive behaviors were significant over time between the two groups. Grip strength was only significant when accounting for interaction between group and time. CONCLUSION: An intervention of MSS using familiarity was marginally effective in improving cognition, depression, wandering, and aggression. Future study is suggested with a larger sample and longer treatment to retest the effects of MSS.

Direction for Development of the Journal of Korean Academy of Adult Nursing through Analysis of Accepted and Rejected Papers (2007~2009) / 성인간호학회지

PURPOSE: The purpose of this study was to explore the direction for development of the Korean Journal of Adult Nursing toward becoming an international journal through analysing the accepted and rejected papers during the last three years (2007-2009). METHODS: Two hundred and ten accepted papers were analyzed focusing on research methodology and key words using descriptive statistics. In addition, rejected papers were reviewed to analyze their study designs and key words. RESULTS: The proportion of quantitative research was 86.4% while the proportion of qualitative research was 9.5%. The majority of the qualitative research design was survey (71.8%). Sixty percent of the research had verbal consent and 32.7% had written consent from the participants. The prevailing data collection settings were hospitals (52.1%), and community (22.7%). The most frequently used research domain was health. It was noted that theoretical framework was rarely presented. The paper rejection rate was 31.5% and among the rejected paper, 75.3% was survey. CONCLUSION: The results of this analysis suggest that published studies have been improved and diversified compared with the papers published before the year 2007. However, translation research, clinical trials by nurses, and more detailed evaluation process for ethics in research need to be facilitated.

Wandering Behavior in Korean Elders with Dementia Residing in Nursing Homes / 간호학회지

PURPOSE: This study investigated various factors relatied to wandering behavior of Korean elders with dementia (KED). METHODS: A sample of 160 ambulatory residents with dementia from 14 long term care facilities was used to examine demographic, individual, cognitive, physical health, and environmental characteristics by comparing wanderers (N=108) to nonwanders (N=52). Subjects were evaluated by Korean versions of the Mini-mental State Exam (K-MMSE), the Physical and Instrumental Activities of Daily Living (K-PIADL), and the Revised Algase Wandering Scale Nursing Home version (KRAWS-NH) along its six dimensions. Demographic and environmental data were also obtained. Independent sample ttests, Chi-square test, Fisher's Exact tests, and ANCOVAs were used to examine differences between wanderers and nonwanders. RESULTS: Wanderers were significantly (p<.05) older and had more limitations in K-PADL and K-IADL. The degree of overall wandering and certain features of wandering were significantly different (p<.05) by total number of residents in the facility, type of bedroom (i.e., "Ondol"), and color of bedroom and living-room walls (i.e., sky blue). CONCLUSIONS: Findings of this study may be useful in understanding wandering behavior of KEDs and thus developing more culturally specific management strategies.

Fatigue and Its Related Factors in Korean Patients on Hemodialysis / 간호학회지

PURPOSE: This study examined the characteristics of fatigue and the relationship between fatigue and its related factors in Korean patients on hemodialysis. METHODS: A cross-sectional correlational study was conducted with 104 patients on hemodialysis in Seoul, Korea. FINDING: Of a total of 104 subjects, eighty-one (77.9%) complained of fatigue. Fatigue severity was measured by the self-rating Visual Analogue Scale-Fatigue (VAS-F) with a mean score of 36.5 (SD=17.49, range 2 - 81). The mean duration of fatigue was 3.8 hours (SD=5.3, range 0 - 24). Depression was most significantly correlated with fatigue (beta=.43, p<.00), with interdialytic weight gain (beta=.25, p<.05) being the second most significant correlate. CONCLUSION: This study shows that nursing interventions for patients who experience fatigue while on hemodialysis should be focused on both psychological problems, such as depression, as well as on physiological problems, such as interdialytic weight gain.

Attitudes toward the Elderly among Nursing Students in Korea / 간호학회지

PURPOSE: The primary purpose of this study was to reexamine underlying dimensions of attitudes toward the elderly held by undergraduate nursing students. A secondary purpose was to investigate characteristics of nursing students associated with attitudes toward elders. METHODS: A survey was performed using self-report questionnaire completed by nursing students from a total of 10 nursing schools or departments each selected randomly from one province of Korea. Students' responses (N=366) were analyzed using factor analysis, correlation coefficients, t-test, and ANOVA. RESULTS: Three attitudinal dimensions explaining 35.29% of the variance were extracted: vitality, generosity and flexibility. From a neutral point of 4.0 in the range of 1 to 7, only generosity (4.47) was evaluated positively, whereas vitality (3.31) and flexibility (2.91) were evaluated negatively. The mean scores of the vitality and generosity dimensions were significantly different by students' level of communication with the elderly, experience living with the elderly, and interest in elders or in issues related to elders. Interest in elders/elder issues was the only characteristic affecting significant mean score difference in flexibility. CONCLUSION: Educational process should increase students' exposure to healthy elderly to modify negative attitudes toward the elderly among nursing students.