Factors Related to Long-term Hospital Length of Stay and Opinions on Discharge-related Community-based Medical and Welfare Service on Elderly Patients with Chronic Diseases in Korean Veterans Hospitals

Purpose@#This study aims to investigate factors related to long-term length of stay (LOS) of patients with chronic diseases in Korean veterans hospitals. @*Methods@#The subjects were 196 elderly patients with chronic disease staying in the hospital for more than 10 days, Data were collected by the survey of patients with structured questionnaires and medical records review by nurses from July 15 to August 10, 2019. Collected data were analyzed using t-test, ANOVA, Pearson's correlation coefficient and stepwise multiple regression. @*Results@#The present and desired LOS were 37.78±32.66 days and 60.87±45.95 days, respectively. Factors affecting hospital LOS were found to be main disease (genitourinary) (p<.001), assistance in activities of daily living (p<.001), area of hospital (p<.001), payment of medical fees (p=.026), hospital satisfaction (p=.036) and the explanatory power of these variables was 26.4%. The most common health problems that need to be solved after discharge were symptom alleviation and health promotion.These problems can be solved using community-based facility services or visiting medical-welfare services (especially home care nursing). @*Conclusion@#In order to reduce hospital LOS, the following measures are required: personalized self-management education, provision of transportation services for dialysis therapy of inactive patients, linking patients with visiting medical-welfare services including home care nursing and mobile healthcare services, operation of the case management system including the notice of the discharge date at admission, interim check of patient status, and connecting the patient with community resources or transferring the patient to long-term care facilities at discharge.

Prediction of Suitable Site to Measure Abdominal Skin Fold Thickness and Correlation among Obesity Indicators in Patients with Type 2 Diabetes Mellitus

Purpose@#The purpose of this study was to predict measuring site suited for abdominal skin fold thickness (ASFT) by measuring the distribution of abdominal subcutaneous fat thickness (AScFT) and ascertain the correlations among obesity indicators. @*Methods@#The size of analysis materials was 124 secondary data measured by ultrasonic device, bioelectrical impedance analyzer and caliper. Data were analyzed using t-test, and Pearson’s correlation. @*Results@#The average of AScFT was 10.63± 6.79mm with its range 1.39-36.16 mm, and AScFT of female and of central parts were thicker than those of male and outer parts in the abdomen. The average of ASFT was 29.26± 12.59 mm. Site 5 on Figure 1 was most similar to the average of AScFT in both sexes. Body mass index (BMI) and waist hip ratio (WHR) were 23.65± 3.98 and 0.88± 0.05 respectively. The body weight, BMI, WHR, visceral fat, ASFT vs AScFT revealed in significant correlation (r= .29, r= .55, r= .39, r= .33. r= .29). @*Conclusion@#BMI and WHR seem more useful than other obesity indicators, when obesity control is necessary for Type 2 diabetes patients. Site 5 on Figure 1 is most suitable site to measure ASFT.

Difficulties and Coping Experienced by Advanced Practice Nurses in Home Health Nursing Field

Purpose@#This study aimed to explore the difficulties and coping that advanced practice nurses (APNs) experience in home health nursing field. @*Methods@#The participants were 12 APNs who had experience in home health nursing for over 5 years. Data were collected through two focus group interviews between August and September, 2017. The results were analyzed using a qualitative content analysis. @*Results@#Out of 10 sub-categories and 29 codes, 4 categories emerged: “crushed by the responsibilities as the only healthcare professional”, “worn out by family who interfere with work”, “anxiety about my safety being threatened” and “using self-learned know-hows”. @*Conclusion@#APNs face difficulties due to the environmental characteristics of the homes, the characteristics of chronically critically ill (CCI) patients and their families, and legal or systematical limitations when dealing with problems based on their personal competence. In order to ensure that professional nursing care is more readily provided to CCI patients through home health nursing services in local communities, it is imperative that support systems at the organizational and institutional levels be established in a systematic way to resolve the issues faced by APNs.

Impediment in Activity of Daily Living and Social Support for Rural Elderly Farmers Undergoing Nerve Block due to Low Back Pain

PURPOSE: This study is to investigate the low back pain, social support, impediment in daily living activities and to identify factors affecting impediment in elderly farmer' daily living activities. METHODS: The participants were 128 elderly farmers who had received nerve block. Data were collected using a structured questionnaire from February to March, 2018. They were analyzed using t-test, ANOVA, pearson's correlation coefficient, and linear multiple regression. RESULTS: The score of low back pain was 6.27±1.69 (10 points), that of social support 2.92±0.76 (1~5 points), and that of impediment in activity of daily living 2.01±0.82 (0~5 points). Factors affecting impediment in activity of daily living were found to include age (p=.017), daily hours of farm work (p<.001), fear for the nerve block (p<.001), low back pain (p<.001), and social support (p<.001); the explanatory power of these variables was 58.8%. CONCLUSION: This study has found the controllable factors affecting impediment in activity of daily living among the rural elderly engaging in farm work include low back pain, social support, and daily farming hours. Therefore, to reduce impediment in activity of daily living among them, it is necessary to develop nursing interventions that can improve impediment in activity of daily living through reduction of daily farming hours using local resources. It is also desirable to improve their health status by reducing low back pain, and develop and apply social supports with health education programs that fit the local resources and the needs of the rural elderly.

Goal Attainment Rate for Parameters of Metabolic Adjustment in Elderly Patients with Type 2 Diabetes Taking a Hypoglycemic Agent / 임상당뇨병

BACKGROUND: This study aimed to investigate the goal attainment rates for hemoglobin A1c (HbA1c), blood pressure (BP), and low-density lipoprotein cholesterol (LDL-C) in elderly patients with type 2 diabetes. METHODS: The subjects were 762 over 65 years old patients with type 2 diabetes taking a hypoglycemic agent. Data were collected by reviewing medical records and included general characteristics, biochemical tests, prescribed pharmacologic agents, and complications. RESULTS: The goal attainment rates (mean value) for HbA1c, BP, and LDL-C were 50.4% (7.3% ± 1.2%), 78.9% (126.0 ± 15.1/72.1 ± 10.0 mm Hg), and 60.6% (88.6 ± 29.9 mg/dL). Diabetes-related complications for retinopathy, nephropathy, neuropathy, and cardio-cerebral vascular disease were 36.3%, 37.2%, 23.6%, and 31.9%, respectively. Life habit-related variables positively associated with goal attainment were not drinking alcohol and exercise for HbA1c, not smoking for BP and not drinking alcohol for LDL-C. Metabolic adjustment indicator-related significant variables for complications were HbA1c in retinopathy, BP in nephropathy, and LDL-C in cardio-cerebral disease. CONCLUSION: We found that goal attainment rates for parameters of metabolic adjustment were not high in elderly patients with type 2 diabetes. Thus, diabetes educators should be concerned about metabolic adjustment indicators. Also, case management guidelines according to elderly patient health and functional status should be developed to help manage metabolic adjustment.

The Appropriateness of the Length of Insulin Needles Based on Determination of Skin and Subcutaneous Fat Thickness in the Abdomen and Upper Arm in Patients with Type 2 Diabetes

BACKGROUND: Longer needle and complicated insulin injection technique such as injecting at a 45-degree angle and making skinfolds may decrease patient compliance to insulin injection therapy. In this light, shorter insulin needles have been recently developed. However, it is necessary to ascertain that such shorter needles are appropriate for Korean patients with diabetes as well. METHODS: First, the diverse demographic and diabetic features of 156 Korean adults with diabetes were collected by a questionnaire and a device unit of body fat measurement. The skin and subcutaneous fat thicknesses of each subject were measured by Ultrasound device with a 7- to 12-MHz probe. Data were analyzed using analysis of variance and multiple linear regression. RESULTS: The mean skin thickness was 2.29+/-0.37 mm in the abdomen and 2.00+/-0.34 mm in the upper arms, and the mean subcutaneous fat thickness was to 10.15+/-6.54 mm in the abdomen and 5.50+/-2.68 mm in the upper arms. Our analysis showed that the factors affecting the skin thickness of the abdomen and upper arms were gender and body mass index (BMI), whereas the factors influencing the subcutaneous fat thickness in the abdomen were gender and BMI, and the factors influencing the subcutaneous fat thickness in the upper arms were gender, BMI, and age. Insulin fluids may not appear to be intradermally injected into the abdomen and upper arms at any needle lengths. The risk of intramuscular injection is likely to increase with longer insulin needles and lower BMI. CONCLUSION: It is recommended to fully inform the patients about the lengths of needles for insulin injections. As for the recommended needle length, the findings of this study indicate that needles as short as 4 mm are sufficient to deliver insulin for Korean patients with diabetes.

Erratum: Corrected Sentence. The Appropriateness of the Length of Insulin Needles Based on Determination of Skin and Subcutaneous Fat Thickness in the Abdomen and Upper Arm in Patients with Type 2 Diabetes

An error was found in the following published article.

A Comparison of the Rates of Hemolysis and Repeated Blood Sampling using Syringe needles versus Vacuum tube needles in the Emergency Department

PURPOSE: This study was done to compare the rates of hemolysis and repeated sampling in blood samples obtained by a syringe needle versus a vacuum tube needle. METHODS: A randomized, prospective study was used to evaluate the differences between the two blood sampling methods. The study group consisted of patients seen in the emergency department (ED) for blood sampling to determine electrolyte level. ED patients were randomly assigned to either the syringe group or the vacuum tube group. All blood samples were collected by experienced ED nurses and hemolysis was determined by experienced laboratory technologists. Data were analyzed using Fisher's exact test and binary logistic regression. RESULTS: One hundred forty-five valid samples were collected (74 in the syringe group versus 71 in the vacuum tube group). 5 of 74 (6.8%) blood samples in the syringe group and 8 of 71 (11.3%) in the vacuum tube group hemolyzed. Repeated blood sampling occurred for 2 of 74 (2.7%) and 3 of 71 (4.2%) in each group respectively. There were no significant differences in rates of hemolysis and repeated sampling between two groups (B=1.97, p=.204; B=2.36, p=.345). CONCLUSION: Venipuncture with syringe needles can be recommended for ED nurses to obtain blood samples.

Seoul Teacher's Satisfaction with and Needs for Health Examination and Health Promotion Programs

PURPOSE: The purpose of this study was to investigate Seoul teacher's satisfaction with and needs for health examination and health promotion programs. METHODS: The participants were 3,186 teachers in Seoul. Data were collected through an on-line survey system from November 16 to December 7, 2008. Collected data were analyzed by descriptive statistics, t-test, ANOVA, and Scheffe's test using PASW 18.0 program. RESULTS: Teacher's satisfaction with teacher health examination was low and needs for detailed tests of cancer and vocal cord disorders were high. Teacher's satisfaction with teacher health promotion programs was low and needs for stress management, exercise and vocal cord protection program were high. CONCLUSION: Vocal cord disorders should be included in teacher health examination and vocal cord protection program should be provided for teacher's health promotion. Stress management and exercise program should also be provided for teacher's health promotion.

The Effects of Foot Reflexology on Peripheral Neuropathy, Symptom Distress, Anxiety and Depression in Cancer Patients Treated with Oxaliplatin

PURPOSE: This study was done to clarify the effects of foot reflexology on peripheral neuropathy, symptom distress, anxiety and depression in cancer patients treated with oxaliplatin. METHODS: A quasi-experimental design was employed. Changes in the variables were evaluated to test the effects of foot reflexology. Participants were cancer patients treated with oxaliplatin (experimental group 14 and control group 17). Peripheral neuropathy, symptom distress, anxiety and depression were measured before and after reflexology. Data were collected from October, 2010 to April, 2011. chi2-test, Fisher's exact test, t-test, Wilcoxon signed rank test and the Mann-Whitney U test were used to analyze the data. RESULTS: The experimental group who received foot reflexology experienced less peripheral neuropathy and symptom distress than the control group. There was no difference in anxiety and depression between the experimental and control group. CONCLUSION: The foot reflexology program adopted in this study was found to be an effective method to reduce peripheral neuropathy and symptom distress. We recommend foot reflexology for patients with chemotherapy induced peripheral neuropathy.

Oncology Advanced Nurses' Use of Outcome Indicators and Perception of Outcome Evaluation / 간호행정학회지

PURPOSE: The purpose of this study was to explore the use of outcome indicators and perception of outcome evaluation of oncology advanced practice nurses (APNs). METHOD: A total of 111 oncology APNs from hospitals which have over 400 beds were surveyed. The participants' use of outcome indicators and perception of outcome evaluation were collected using a questionnaire including 84 outcome indicators for APNs developed by Sung et al. and 13 items on APNs' contribution to the hospitals developed by Kleinpell (2005). Data were analyzed using descriptive statistics, t-test, and chi2 test. RESULT: Twelve items out of 84 outcome indicators were used over 50% of the time and 57 items could be used in the future by the participants. Seven of the 10 top-ranking outcome indicators in use were education related and were also expected to be used frequently in the future. The score for participants' perception of outcome evaluation was average-high, 3.82 out of 5. CONCLUSIONS: The results of the study show that the main outcome indicator for oncology APNs is education related, and thus the use of education related outcome indicators is recommended to make oncology APNs' activities be more visible.

Effect of Music Therapy as Intervention on Peripheral Neuropathic Pain and Anxiety of Gynecologic Cancer Patients Undergoing Paclitaxel Chemotherapy / 여성건강간호학회지

PURPOSE: This study was to investigate the effect of music therapy as intervention on peripheral neuropathic pain and anxiety of gynecologic cancer patients who were undergoing paclitaxel chemotherapy. METHODS: Hospitalized 62 patients were assigned to an experimental group (n=30) and a control group (n=33) in this quasi-experimental study. The experimental group participated in music therapy that includes listening, singing and song writing during 1 hour. The peripheral neuropathic pain, anxiety and depression were examined as pre-intervention evaluation by using pain scale, anxiety scale (20 questions) and depression scale (20 questions) in both groups. There were no further treatments for the control group while the experimental group involved in music therapy. The peripheral neuropathic pain and anxiety were evaluated in both groups as post-intervention evaluation. RESULTS: Outcomes were verified through hypothesis testing. The level of peripheral neuropathic pain and anxiety in the experimental group was decreased, compared to the control group. CONCLUSION: According to the study, music therapy is a beneficial intervention that reduces peripheral neuropathic pain and anxiety in gynecologic cancer patients. These findings are encouraging and suggest that music therapy can be applied as an effective intervention for minimizing chemotherapy related symptoms.

Medication Status and Adherence of the Elderly under Home Care Nursing

PURPOSE: This study is a descriptive research intended to clarify the medication status of community-dwelling elders and to identify factors affecting their medication adherence. METHODS: Data were collected using questionnaires and interviews from 101 subjects who had taken prescribed drugs for at least 7 days sampled among elderly people using home care nursing at a general hospital in Seoul. RESULTS: According to the results of this study, medication adherence measured by pill counting was 88.3% and that measured by self-reporting was 94.6%. There were statistically significant differences in medication adherence according to major disease (p=.006), the number of admissions (p=.032), the number of drugs (p=.051), the frequency of medication (p=.026), and depression (r=-.205). In addition, depression was found to be a significant variable explaining the medication adherence with explanatory power 3.8% (p=.035). CONCLUSION: The presence of depression affected the elderly subjects' the medication adherence. Therefore, more concern and educational approaches are required to encourage elderly people to comply correctly with medication regimens particularly for elderly patients who have a malignant or long-lasting disease or who have to take multiple drugs or maintain a daily dosing frequency.

Characteristics and Quality of Life in Patients with Chemotherapy-Induced Peripheral Neuropathy / 종양간호학회지

PURPOSE: The purpose of study was to identify how patients experienced chemotherapy-induced peripheral neuropathy (CIPN) and quality of life related to CIPN. METHODS: This was a descriptive research. We collected data from 105 patients with chemotherapy-induced peripheral neuropathy. They completed a self-reported questionnaire including Eastern Cooperative Oncology Group (EORTC) CIPN20 and items related to their disease and peripheral neuropathy. The investigators filled in part of items about disease and treatment. RESULTS: In the study, duration of peripheral neuropathy was 9.4 month and 54.3% of patients used pharmacological or non-pharmacological interventions. Patients reported the highest score for sensory scale and it's score was 38.74+/-20.24. The scores for motor scale and autonomic scale were 21.95+/-19.19 and 26.61+/-21.0 respectively. This showed that patients more suffered from sensory neuropathy than any other domain of neuropathy. The most frequently selected two items were 'did you have tingling fingers or hands?' and 'did you have tingling toes or feet?'. CONCLUSION: The results of this study will provide useful information for chemotherapy-induced peripheral neuropathy.

Job Analysis of Korean Oncology Advanced Practice Nurses in Clinical Workplace: Using the DACUM Method / 종양간호학회지

PURPOSE: The purposes of this study were to identify job definition, duties and tasks of Korean oncology Advanced Practice Nurses (APNs) and assess frequency, importance, and difficulty for each of duty and task using the DACUM method. METHODS: The DACUM committee was organized with nine oncology APNs. The committee documented the job definition, duties and tasks based on their daily job descriptions. Validity of the elicited duties and tasks was tested by a study team and 6 oncology APNs. Data were collected using a questionnaire survey from 53 oncology APNs. RESULTS: The job description of oncology APNs was identified 12 duties and 66 tasks. Among the twelve duties, 'education for patients/ families' was the most frequently performed and was the most important duty. 'Case management' was the most difficult duty. Among 66 tasks, 'providing education for patients/families' was most frequently performed. 'Providing education for patients/families' and 'assessing patient condition comprehensively' were the most important tasks. 'Implementation research' as the principal investigator was perceived as the most difficult task. CONCLUSION: In this study, Korean oncology APNs' job performances were identified and analyzed. It is recommended that job description for oncology APNs needs to be standardized and reshaped in advanced way in future.

Influence of Clinical Nurse Specialists' Emotional Intelligence on Their Organizational Commitment and Turnover Intention / 간호행정학회지

PURPOSE: The purpose of this study was to identify the influence of clinical nurse specialists' emotional intelligence on their organizational commitment and turnover intention. METHODS: A descriptive study with second data analysis was conducted with permission. The original data was from the policy research on the status of clinical nurses with extended role hosted by the Hospital Nurses Association in 2007. RESULTS: The mean score of emotional intelligence, organizational commitment, turnover intention were 58.66 (+/-6.63), 46.71 (+/-3.54), 12.87 (+/-3.98) respectively. Emotional intelligence had 40% positive influence on organizational commitment (F=50.58, p<.01, adj.R2=.16) and 24% negative influence on turnover intention (F=16.68, p<.01, adj.R2=.06). CONCLUSION: The results recommend to develop a program that enhances clinical nurse specialists' emotional intelligence. The program could be utilized as an institutional retention strategy to increase clinical nurse specialists' organizational commitment and decrease their turnover intention.

Effects of a Palliative Care Program based on Home Care Nursing

PURPOSE: This study was done to develop and test a palliative care program based on home care nursing. METHODS: A quasi-experimental design was employed. Changes in the variables were evaluated to test effects of the developed program. Participants were patients with terminal cancer and their families receiving home care nursing from six hospitals (experimental group: 24 and control group: 22). Data collection was conducted from February to October, 2006. Chi-square test, Fisher's exact test, t-test, Mann-Whitney U test and repeated measures ANOVA were used to analyse the data. RESULTS: Hypothesis 1, the experimental group receiving this program will experience less pain (severe, average, weak pain) than the control group, was supported. Hypothesis 2, the experimental group will have less symptom experience than the control group, was supported. Hypothesis 3, the experimental group will have higher QOL than the control group, was supported and the last hypothesis 4, family burden in the experimental group will be less than the control group, was supported. CONCLUSION: The home care nursing based palliative program developed in this study was found to be an effective program to reduce patient pain and symptom experience, to improve patient QOL and to decrease family burden.

An Analysis of the Elderly Care and Management in Hospital-Based Home Care Agencies

PURPOSE: To analyze the home care services provided to the elderly aged 65 and older by a hospital-based home care agencies and to investigate the effects of long-term care insurance for the elderly. METHOD: The subjects were the home care service recipients aged 65 and older in 172 hospital-based, home care agencies registered in Health Insurance Review & Assessment Service in January, 2007. The data were collected using a questionnaire from March 16 to April 15, 2007. The questionnaire return rate was 43.8%. RESULT: The hospital-based home care agencies were able to visit 66.5% of the national administrative districts. Of the home care service recipients, over 50% were 65 years old and older. About 43% of the agencies reported that over 50% of their patients would be subject to the long-term care insurance. They expressed concern that home care services would be withdrawn once the insurance system is initiated. CONCLUSION: This study suggests that hospital-based home care agencies need to manage home care services with long-term care insurance. It also recommends developing guidelines for the use of services and referrals.