Development and Testing of a Mastery Learning Program of Nursing Skills for Undergraduate Nursing Students

PURPOSE: This study was undertaken to develop and test a mastery learning program of nursing skills for undergraduate nursing students. METHODS: In this methodological study, first, the preliminary draft of a mastery learning program to provide training for nursing skills was developed based on Bloom's framework for mastery learning. Second, to test the developed program, a single-blinded, nonequivalent control group nonsynchronized study was conducted on 50 senior nursing students in a University selected by convenient sampling. Thirteen students were assigned to a control group; 13, 12, and 13 of them were assigned to intravenous therapy, transfusion, and patient transfer groups, respectively. The achievement levels and performance scores of the selected nursing skills were measured before and after the completion of the program in all the groups. Lastly, the final program was confirmed based on the results of the program testing. RESULTS: Intravenous therapy, transfusion, and patient transfer were selected as essential nursing skills for the program based on the priorities rated by clinical instructors and staff nurses. The achievement levels of selected nursing skills were determined by Angoff scores. After participating in the program, the proportion of passers and performance scores of the nursing skills in the experimental groups were significantly higher than those in the control group. The final program was confirmed which included a diagnostic test, enrichment activities for the passers and three repetitions of corrective activities and formative assessments for non-passers. CONCLUSION: The results suggest that a mastery learning program for undergraduate students can lead to better improvement and performance of essential nursing skills.

Effects of an Education Program on Prevention of Malpractice using Precedent Cases related to Patient Safety in Safety Perception, Safety Control, Autonomy and Accountability in Clinical Nurses / 간호행정학회지

PURPOSE: The purpose of this study was to identify the effects of an education program on safety perception, safety control, autonomy and accountability in clinical nurses. Precedent cases related to patient safety were used in the education program. METHODS: A quasi-experimental design with pretest and posttest measures was used. Participants in the study, 72 nurses in the experimental group, 71 nurses in the control group, were enrolled for 3 months. The education program was composed of the 20 precedent cases related to patient safety from home and foreign countries. RESULTS: The major findings of this study were as follows: Safety perception (p=.000), Safety control (p=.000), attitude toward autonomy (p=.000), and attitude toward accountability (p=.000) improved after the education program. CONCLUSION: The findings from this study indicate that an education program using precedent cases is an efficient method to improve behavior and change attitudes towards protecting patients' safety and preventing malpractice claims against nurses.

Lifestyle Risk Factors and Awareness of Stroke among Adults in Urban Areas

BACKGROUND: Modifying risk factors and improving stroke awareness in the general community have been emphasized for preventing stroke. This study aimed to explore modifiable lifestyle risk factors and the awareness of stroke and to compare scores for stroke knowledge according to lifestyle risk factors and recognition of important indicators among adults in urban areas. METHODS: A cross-sectional study was conducted with a total of 196 participants aged 40 to 65 selected by a convenient sampling of community cultural centers, churches, and recreational groups. Participants completed a structured questionnaire including general characteristics, risk factors of stroke, and awareness of stroke including general knowledge, risk factors, reactions to warning symptoms, and knowledge on personal risk factors of stroke such as body weight, blood pressure, blood sugar, and cholesterol level. RESULTS: Less than 30% of the participants engaged in regular physical activity and low fat diet and 33% of the participants were classified as having 'higher' level of knowledge on stroke. Knowledge on their personal risk factors of stroke were generally poor. Scores for knowledge on stroke were not different for lifestyle risk factors and knowing whether their body weight and blood pressure level were within normal limits. Meanwhile, scores for knowledge on stroke were significantly higher among those knowing whether their blood sugar and cholesterol level were within normal limits. CONCLUSIONS: There is a need to improve stroke awareness among community adults by providing more targeted information on warning symptoms, risk factors of stroke, and important indicators of major conditions related to stroke and their contribution to stroke prevention.

Effects of Foot Massage and Supportive Communication by Hospice Volunteers on Depression, Anxiety, and Mood of Cancer Patients Who Undergo Intravenous Chemotherapy at Out-patient Department / 한국호스피스완화의료학회지

PURPOSE: This study was done to investigate effects of foot massage and supportive communication provided by hospice volunteers on depression, anxiety, and mood of cancer patients who are going under intravenous chemotherapy at out patient department (OPD). METHODS: A non-equivalent control group non-synchronized design was used. Sixty-four participants were recruited from out-patients setting in a university hospital by a convenient sampling. Two trained-hospice volunteers first provided regular hospice volunteer service to 34 patients in the control group. Subsequently, foot massage and supportive communication were provided to 30 participants in the experimental group. After the intervention, all participants answered the structured questionnaire with visual analog scales on depression, anxiety, and mood including general characteristics. Data were analyzed using descriptive statistics, two sample t-test, and paired t-test by PASW 17. RESULTS: After the intervention, changes in negative moods, i.e. strain and powerlessness in the experimental group were significantly different from those in control group; strain and powerlessness in the experimental group were significantly decreased by foot massage and supportive communication provided by hospice volunteers. CONCLUSION: The current findings provide an empirical evidence of a brief and efficacious intervention for cancer patients. Further studies are warranted with larger sample size to validate the effectiveness of foot massage and supportive communication as a solid intervention for cancer patients who are undergoing intravenous chemotherapy at OPD.

Women's Cancer Screening According to Body Mass Index in a Cohort of Rural Korean Women

PURPOSE: This study was done to examine the difference in cancer screening with mammography and Papanicolaou smear according to Body Mass Index (BMI). METHODS: The participants in this study were 5,912 women ages 40 to 69 yr, selected from the Korean Genomic Regional Cohort in Kangwon province. Mammography and Papanicolaou smear were assessed by questionnaire and body weight (kg) and height (m) measured to calculate BMI. RESULTS: The distribution of BMI was as follows: low weight (1.5%), normal weight (31.1%), over weight (24.6%), mildly obese (36.4%) and severely obese (6.3%). After adjusting for age, education and monthly income, compared with normal weight women, overweight women (odds ratio [OR]=1.283, 95% confidence interval [CI]=1.089-1.513) and mildly obese women (OR=1.214, 95% CI=1.048-1.406) were less likely to have had mammography. In contrast to mammography, cancer screening with Papanicolaou smear was not significantly different by BMI. CONCLUSION: Obese women in rural areas are less likely to screen for breast cancer by using mammography than non obese women. To ensure regular screening for breast cancer, health care providers need to give scrupulous care to obese women and remove barriers originated from obesity. Also, educational and clinical implications are considered to increase the Papanicolaou smear rate.

Development of an Integrated Breast Health Program for Prevention of Breast Cancer among Middle-aged Women / 여성건강간호학회지

PURPOSE: This study was done to develop an integrated breast health program for prevention and early detection of breast cancer, integrating primary and secondary prevention factors using cognitive-behavioral strategies. METHODS: This methodological study conducted as follows; Selection of components for the program through a literature review, survey to identify women's knowledge and risk perception of breast cancer and diet, and building prototype for the program using discussion based on findings. Using structured questionnaires, interviews were done with 130 women aged 40-59 who lived in a rural area. RESULTS: Primary prevention (diet pattern, knowledge about breast cancer, and risk perception) and secondary prevention (early detection behaviors) factors were identified through the literature review. The survey showed that women lack knowledge and awareness about the risks of breast cancer, and have a low compliance rate for early detection behavior. Based on these results, a program was developed utilizing counseling and models to provide education and practice related to diet, breast cancer, and early detection behaviors. CONCLUSION: Use of this integrated and tailored breast health program with women at risk will contribute to better breast health, but further study is needed to verify the effects.

The Effects of Somatosensory Stimulation on Cognitive Function and ADL of Patients after Stroke / 성인간호학회지

PURPOSE: The purpose of this study was to determine the effect of a 2-week somatosensory stimulation program on cognitive function and ADL of patients with brain damage. METHODS: The sample consisted of two groups of patients with stroke: 10 patients with a mean age of 59.0 years who were treated with somatosensory stimulation, and 9 patients with a mean age of 51.78 years, who were not treated with somatosensory intervention. A nonequivalent control group non-synchronized design was used to assess the functional recovery after stroke. Instruments used in this study were MMSE-K for cognitive function and FIM for ADL. RESULTS: The hypothesis 1 that "Patients with stroke who were treated with the somatosensory stimulation program will show higher MMSE-K score than that of the non-treatment group" was supported(Z = -2.390, p = .017). The hypothesis 2 that "Patients with stroke who were treated with the somatosensory stimulation program will show higher FIM score than that of the non-treatment group", however, was partially supported(social cognition: Z = -2.204, p = .045). CONCLUSION: Somatosensory stimulation was effective to patients with stroke in improving their cognitive function. These findings suggest that somatosensory input can be adopted to nursing intervention for functional recovery after stroke.

The Effects of Somatosensory Stimulation on Cognitive Function and ADL of Patients after Stroke / 성인간호학회지

PURPOSE: The purpose of this study was to determine the effect of a 2-week somatosensory stimulation program on cognitive function and ADL of patients with brain damage. METHODS: The sample consisted of two groups of patients with stroke: 10 patients with a mean age of 59.0 years who were treated with somatosensory stimulation, and 9 patients with a mean age of 51.78 years, who were not treated with somatosensory intervention. A nonequivalent control group non-synchronized design was used to assess the functional recovery after stroke. Instruments used in this study were MMSE-K for cognitive function and FIM for ADL. RESULTS: The hypothesis 1 that "Patients with stroke who were treated with the somatosensory stimulation program will show higher MMSE-K score than that of the non-treatment group" was supported(Z = -2.390, p = .017). The hypothesis 2 that "Patients with stroke who were treated with the somatosensory stimulation program will show higher FIM score than that of the non-treatment group", however, was partially supported(social cognition: Z = -2.204, p = .045). CONCLUSION: Somatosensory stimulation was effective to patients with stroke in improving their cognitive function. These findings suggest that somatosensory input can be adopted to nursing intervention for functional recovery after stroke.

A Descriptive Study for Developing a Program to Promote Compliance with Regular Breast Self-Examination(BSE) / 여성건강간호학회지

PURPOSE: The purpose of this study was to identify knowledge, facilitators, and barriers of breast self -examination(BSE) in Korean couples for developing a continuous regular BSE promotion program. METHOD: This descriptive study was undertaken with a focus group methodology including 27 couples of husbands and wives recruited by convenience-sampling. Data transcribed from audiotapes was analyzed to identify common themes. RESULTS: Knowledge of breast cancer and BSE included 'the risk factors of breast cancer', 'prevention of breast cancer', and 'how to do BSE'. Facilitators to BSE included 'self, health professional, and spouse-facilitating factors'. Barriers to BSE included 'cognitive, psychological, informational, and physical barriers'. CONCLUSION: To promote compliance with BSE among women, tailored programs according to the stage of change of BSE adoption are crucial, not only reflecting the specific needs of the individual by the stage of change, but also utilizing husbands as facilitators.

Effects of Action Oriented Breast Self-examination(BSE) Education on Knowledge, Self-efficacy, and Performance Competence in Nursing Students / 여성건강간호학회지

PURPOSE: This study was undertaken to test effects of action oriented BSE education on knowledge, self- efficacy, and performance competence in nursing students. METHODS: A non-equivalent pre-posttest of time serial quasi-experimental design was used to prevent diffusion of the experiment. Out of 53 nursing students selected by convenient sampling in the third grade at a nursing college, 27 students were randomly assigned to the control group and were first given a traditional lecture on BSE. For the experimental group of 26 students action oriented BSE education consisted of lectures, demonstrations with breast models, and BSE skill practice by micro teaching. RESULTS: There was no significant difference in general and BSE-related characteristics between the two groups. Scores of the experimental group in knowledge, self-efficacy, and performance after the intervention were significantly higher than those of the control group. CONCLUSIONS: Results showed that action-oriented BSE education was effective in increasing knowledge, self-efficacy and performance competence in nursing students. Education for students should incorporate strategies reinforcing confidence by practicing actual BSE skills as well as acquiring knowledge of BSE, so that students can become competent and practical cancer prevention educators.

The Effects of Psychosocial Interventions to Improve Stress and Coping in Patients with Breast Cancer / 간호학회지

PURPOSE: The purpose of this study was to examine stress, coping, and immune response effects of a psychosocial intervention program based on the PNI model and Stress-Appraisal-Coping for Korean patients with breast cancer. METHODS: A nonequivalent control group pretest-posttest design was used. The participants who had survived breast cancer and lived in Wonju city and the surrounding area were assigned to an intervention group (N=21) or a control group(N=18).We conducted a 12-week intervention, 2 hours a day weekly, and measured the variables at baseline, six and twelve weeks later. Dependent variables are: stress, anxiety-depression and anger, and immune response. RESULTS: Patients in the psychosocial intervention program reported significantly less stress perception (U=31.500, p=.023), more problem solving ability and less problem avoidance in coping (U=20.500, p= .013; U=29.500, p=.040), and less anxiety-depression (U=22.000, p=.023). No difference, however, was found in anger and immune responses between the two groups. Intervention effects were evident at week 6 and 12 for anxiety-depression, and at week 6 for problem avoidance in coping, the same time that NK cell counts and the T8 decreased. CONCLUSIONS: These results suggested positive effects of a psychosocial intervention program. However, the results are inconclusive due to the small sample.

Study of Cohort Construction for Development of Early Alarm System (EMS) for Breast Cancer: based on women living in a rural area / 성인간호학회지

PURPOSE: 1) to construct cohorts according to risk scores calculated with the Gail Breast Cancer Risk Assessment Tool (Gail et al., 1989) (Gail) and the Breast Cancer Risk Appraisal (Lee et al,. 2003) (Lee) 2) to identify the distribution of risk factors and preventive behavior stages between the cohorts 3) to identify abnormal breast conditions in risk cohort. METHOD: Using convenience sampling, 775 rural women were selected. Risk appraisal was scored using Gail and Lee. Preventive behavior stages for BSE (Breast self examination) and mammography were measured using 4 stages of the Transtheoretical Model (Prochaska & DiClemente, 1983). RESULTS: 1) The risk cohort according to Gail was 12.3% (n=95), and Lee, 3.1% (n=24). 2) There were significant differences in the distribution of risk factors (age, family history, age at 1st live birth, age at menarche, number of breast biopsy, history of breast disease, and breast-feeding) between cohorts. 3) There was a significant difference in the distribution of the stage of BSE according to Lee. 4) Six women in the risk group detected masses or nodules and physician consultation and ultrasonography were recommended. CONCLUSION: On the basis of the constructed cohorts, further longitudinal studies of cohorts are recommended with interventions according to characteristics of cohorts.

Perceived Benefits and Barriers According to the Stage of Mammography Adoption in Adult Women* / 성인간호학회지

PURPOSE: This descriptive study was undertaken to explore the distribution of stages of mammography adoption and identify benefits and barriers perceived by women according to the stage of mammography adoption. METHODS: A total of 227 women aged between 30-60 was selected by the convenient sampling in W city. The instrument developed by the researcher based on the scales of Champion(1993), Champion & Skinner(2003), and Rakowski et al (1992) was used. RESULTS: The distribution of stages of mammography adoption was as following; precontemplation 30.7%, contemplation 23.8%, relapse 20.2%, action 14.4%, and maintenance 10.8%. Women in maintenance and actors showed high scores in benefits and low scores in barriers. Those in relapse reported high scores in both benefits and barriers, while precontemplators and contemplators showed high score in barriers and low scores in benefits. CONCLUSION: Despite the rate of mammography participation has increased, the proportion of maintenance stage is still low and that of relapse is high. For those in relapse, strategies to eliminate barriers hindering regular and continuous mammography are necessary. For precontemplators and contemplators, detail information including purpose, procedure and benefits of mammography should be given primarily.

Risk Factors and Early Screening Behavior for Breast Cancer in Rural Women / 여성건강간호학회지

PURPOSE: The aim of this study was to identify risk factors for breast cancer and early screening behavior in women in the community. METHOD: The participants were 125 women residing in W city. Data was collected using an instrument developed by the researchers. Analysis was done using descriptive statistics, and the x2 test. RESULT: For risk based on the Gail Model, age (above 50 years) had a distribution of 24.8%, first degree family history, 4.9%, age at first full term pregnancy, 13.8%, and benign breast cancer history, 4.9%. For risk based on other common risk factors, menopause had a distribution of 20.7%, did not breast feed, 15.4%, history of HRT, 7.3%, meat preference, 35.0%, and history of smoking or drinking, 2.4% and 43.5%, respectively. There was a significant difference in BSE and mammography screening behavior (x2=22.5, p< .00), but no difference in distribution of risk factors and screening behavior. CONCLUSION: For effective prevention of breast cancer, it is necessary to develop an instrument for risk assessment and, through assessment, select women at high risk. It is also necessary to provide education and appropriate recommendations on screening behavior.

Predictors of Mammography Participation Among Rural Korean Women Age 40 and Over / 간호학회지

PURPOSE: The study was conducted to identify predictors of mammography screening for rural Korean women according to 'Stage of Change' from the Transtheoretical Model which, along with the Health Belief Model, formed the theoretical basis for this study. METHODS: A cross-sectional descriptive design was utilized. Through convenience sampling 432 women were selected from 2 rural areas. Data were collected by survey. Health beliefs constructs were measured with Champion's HBM Scale-Korea version. Mammography participation was measured using the Stage of Mammography Adoption Scale developed by Rakowski, et al. (1992). RESULTS: The most frequent stage of mammography adoption was 'contemplation' (40.5%). Predictors of stage of mammography adoption included 'mammogram recommended by health professional' (beta=0.59, t=16.12, p=.000), 'perceived benefits' (beta=0.09, t=2.21, p=.050), 'perceived susceptibility' (beta=0.09, t=1.98, p=.050), and 'perceived barriers' (beta= 0.07, t= -2.05, p=.041). 'Mammogram recommended by health professional' demonstrated the greatest association with having a mammogram. CONCLUSION: Health professionals play key roles in improving mammography participation and should recognize the importance of their role in cancer prevention and be more actively involved in education and counseling on prevention of breast cancer.

Perceived Importance and Performance Frequency of Nursing Interventions and Nursing Activities in the Physiological Domains of Nursing Intervention Classification(NIC) in Home Health Care Nursing / 성인간호학회지

PURPOSE: To identify perceived importance and performance frequency of nursing interventions with nursing activities of 5 nursing interventions from the physiological domains of NIC used in the home health care nursing. METHOD: Five nursing interventions in the physiological domain of NIC were selected based on the previous finding. Data were collected from 85 nurses working in 54 home health care centers between August and October, 2004 using mailing survey(return rates : 41.5%). The questionnaire consisted of 96 nursing activities in 5 interventions with definitions, asking perceived importance and performance frequency of them. RESULT: Skin surveillance was perceived as the most important(3.52+/-0.36) intervention and also performed most frequently(4.43+/-0.45). All the nursing activities in skin surveillance appeared to be used frequently, which was rated over 4 out of 5 point Likert, while only 4 nursing activities in exercise therapy: joint mobility did. Correlations between perceived importance and performance frequency of 5 interventions were all significant (r=0.591-0.718, p=0.000). CONCLUSION: Identifying the use of particular interventions and nursing activities will help nurses simplify documentations and to deliver better care to the patients in home health care nursing.

Validation of Quality of Life Index-Cancer among Korean Patients with Cancer / 간호학회지

PURPOSE: The purpose of this study was to validate Quality of Life Index-Cancer (Q.L.I.-C) developed by Ferrans (1990) among Korean cancer patients. METHOD: This study design was exploratory factor analysis methodology. Q.L.I.-C was translated into Korean and reverse-translated into English. The subjects were 357 Korean patients with various cancers. Data were collected by questionnaires from May to August, 2000 and was analyzed by descriptive statistics, Principal Component Analysis for construct validity and Cronbach's alpha coefficient for reliability. RESULT: The range of factor loadings was .446~.841. The explained variance from the 5 extracted factors was 63.7% of the total variance. The first factor 'family' was 35.5%, and 'health & physical functioning', 'psychological', 'spiritual', and 'economic' factors were 11.5%, 6.9%, 5.6%, and 4.2% respectively. Because of cultural difference between Americans and Koreans, certain items such as sexuality, job status, and education were deleted from the extraction of factors in this study. The Cronbach's alpha coefficient was .9253 among the 28 items. CONCLUSION: Q.L.I.-C could be applied in measuring quality of life of Korean cancer patients. It also recommend to do further studiesfor validation of Q.L.I.-C American and Korean versions relating to cultural differences.

Development and Application of a Web-Based Tailored Nutrition Management Program and Change in Knowledge of Nutrition and Eating Habits in Elementary Students / 대한의료정보학회지

OBJECTIVE: This study was undertaken to develop and apply a web-based tailored nutrition management program for elementary school students. METHODS: One group pretest, posttest design was used with a random sample of 5th and 6th grade students in two elementary schools out of the 20 elementary schools in W city. The web-based nutrition program was developed based on previous studies and existing web sites related to nutrition education and management. It consisted of a combination of web-based step-by-step self-checkups and web-based instructions on knowledge of nutrition, eating habits, and perception and satisfaction with body shape etc. Students completed web-based questionnaires on knowledge of nutrition and eating habits at baseline and three weeks later. Data were analyzed using descriptive statistics and paired t-test. RESULTS: Knowledge of nutrition and practice of correct eating habits increased significantly after the students completed the web-based program. CONCLUSION: These results suggest that a web-based nutrition management program is effective for nutrition education for children in terms of accessibility, compliance, and client-initiative.

Difference of Decisional Balance and Confidence in the Stage of Adoption for Breast Self Exam in Married Women / 성인간호학회지

PURPOSE: The purpose of this study was 1) to classify the stage of adoption 2) to compare the decisional balance and confidence by stage of adoption 3) to identify factors influenced the stage of adoption for breast self exam. METHOD: A comparative study using a survey method with convenience sample of 143 women was used. Decisional balance and confidence was measured using the CHBMS-K. Stage of adoption for BSE was measured by a single item modified by the researchers based on the Rakowski et al (1992). RESULT: 1) The number of women in each stage of adoption for BSE was as follows; maintenance phase, 7.7% (n=11), action phase, 49.0% (n=70), contemplation phase, 35.0% (n=50) and pre- contemplation phase, 8.4%(n=12). 2) The mean difference in the decisional balance (F=4.32, p=.006) and confidence (F=13.85, p=.000) according to the stage of BSE adoption was statistically significant. 3) Prevention education and confidence accounted for 32% of variance in BSE. CONCLUSION: Assessment of decisional balance and stage of adoption for BSE can guide planning for cancer prevention education. We must educate women to have confidence in BSE. Further, it is important to urge women to continually practice BSE.

Factors Related to the Stage of Mammography Screening in Married Korean Women / 성인간호학회지

PURPOSE: The purpose of this study was to examine factors related to different stages of mammography screening based on the transtheoretical model (TTM) and health belief model (HBM). METHOD: 143 women were recruited from community centers in W city. The mean age was 44.08 (SD=7.78) and 74 (51.7%) had experienced education on preventative behavior related to breast cancer. The Decisional Balance Scale (Pros and Cons of mammography) and Stages of Adoption of Mammography Scale by Rakowski et al. (1992) and the revised Health Belief Model Scale (Perceived Seriousness, Perceived Susceptibility and Health Motivation) by Champion (1993) were used. RESULTS: According to the stage of adoption of mammography, 17.4% of the women were in pre-contemplation, 45.5% in contemplation, 24.5% in action, and 12.6% in maintenance. The mean differences for pros, and the decisional balances between the stages of mammography adoption were significant (F=8.84, p=.000; F=7.20, p=.000). Education related to prevention of breast cancer was the most important variable. Prevention education, history of breast disease and pros of mammography explained the stages of mammography adoption (R2=26%). CONCLUSION: Findings support TTM as a useful tool for improving mammography adherence. Behavioral interventions that target decisional balance and health belief can effectively promote adherence to mammography.