The Mediating Effects of Health Concern and Depression in the Relation between Self-quarantined People’s COVID-19 Stress and Fatigue

Purpose@#This study was to investigate the mediating effects of health concern and depression on the stress and fatigue of COVID-19 self-quarantine. @*Methods@#This was a cross-sectional study. A total of 227 people with COVID-19 self-quarantine experience were recruited during May 2021. Participants were invited to complete self-reported questionnaires that measure stress, health concern, depression, fatigue and demographic information. The data obtained were analyzed using multiple regression and dual mediation model applying the PROCESS macro with 95% bias-corrected bootstrap confidence interval. @*Results@#This study analyzed the direct effects of COVID-19 stress on the health concern, depression and fatigue. And COVID-19 stress had indirect effects on their fatigue via health concern and depression. Both health concern and depression had dual mediating effects in the influence of COVID-19 stress on fatigue. In the relationship between COVID-19 stress and fatigue, the mediating effect of depression was significant. @*Conclusion@#Fatigue due to prolonged COVID-19 can be alleviated by managing stress and mediating health concern and depression, and so therefore active nursing intervention is required.

Development and Validation of the Nurse Needs Satisfaction Scale Based on Maslow’s Hierarchy of Needs Theory

Purpose@#The purpose of this study was to develop an instrument to evaluate the needs satisfaction of nurses and examine its validity and reliability. @*Methods@#The initial items for the instrument were developed through a literature review and interviews, using the conceptual framework of Maslow’s hierarchy of needs theory. The initial items were evaluated for content validity by 14 experts. Four hundred and eighty-six clinical nurses participated in this study through offline and online surveys to test the reliability and validity of the instrument.The first evaluation (n = 256) was used for item analysis and exploratory factor analysis, and the second evaluation (n = 230) was used to conduct a confirmatory factor analysis and to assess the criterion-related validity and internal consistency of the instrument. Test-retest reliability was analyzed using data from 30 nurses. @*Results@#The final instrument consisted of 30 items with two sub-factors for five needs that were identified through the confirmatory factor analysis. The criterion-related validity was established using the five need satisfaction measures (r = .56). Cronbach’s a for total items was .90, and test-retest reliability was .89. @*Conclusion@#The findings from this study indicate that this instrument has sufficient validity and reliability. This instrument can be used for the development of nursing interventions to improve the needs satisfaction of clinical nurses.

Influence of Clinical Nurses’ Job Stress on Mental Health Problems:Mediating Effect of Appreciation Moderated by Health-Promoting Lifestyle / 간호행정학회지

Purpose@#The purpose of this study was to investigate the moderating mediation effect of health-promoting lifestyle in the relationships between clinical nurses’ job stress, appreciation and mental health problems. @*Methods@#The participations were 230 clinical nurses working in general hospitals in Seoul City and Gyeonggi Province. Data were collected in November 2019 via an online survey that covered job stress, appreciation, health-promoting lifestyles and mental health problems. The collected data were analyzed using SPSS 25.0, SPSS PROCESS Macro(Model 4, Model 7) and bootstrapping method. @*Results@#Appreciation had a significant mediation effect in the relationship between job stress and mental health problems. Health-promoting lifestyle had a significant moderation effect in the relationship between job stress and appreciation. Further, health-promoting lifestyle significantly moderated mediation effect of job stress on mental health problems through appreciation. @*Conclusion@#The results of this study suggest that it is necessary to effectively manage health-promoting lifestyle in the context of clinical nurses’ mental health problems due to job stress. In order to improve clinical nurses’ mental health, it is necessary to provide them with increased appreciation and lead health-promoting lifestyle.

Analysis of Subgroups with Lower Level of Patient Safety Perceptions Using Decision-Tree Analysis

Purpose@#This study was aimed to investigate experiences, perceptions, and educational needs related to patient safety and the factors affecting these perceptions. @*Methods@#Study design was a descriptive survey conducted in November 2019. A sample of 1,187 Koreans aged 20-80 years participated in the online survey. Based on previous research, the questionnaire used patient safety-related and educational requirement items, and the Patient Safety Perception Scale. Descriptive statistics and a decision tree analysis were performed using SPSS 25.0. @*Results@#The average patient safety perception was 71.71 (± 9.21). Approximately 95.9% of the participants reported a need for patient safety education, and 88.0% answered that they would participate in such education. The most influential factors in the group with low patient safety perceptions were the recognition of patient safety activities, age, preference of accredited hospitals, experience of patient safety problems, and willingness to participate in patient safety education. @*Conclusion@#It was confirmed that the vulnerable group for patient safety perception is not aware of patient safety activities and did not prefer an accredited hospital. To prevent patient safety accidents and establish a culture of patient safety, appropriate educational strategies must be provided to the general public.

Development and Validation of the Nurse Needs Satisfaction Scale Based on Maslow’s Hierarchy of Needs Theory

Purpose@#The purpose of this study was to develop an instrument to evaluate the needs satisfaction of nurses and examine its validity and reliability. @*Methods@#The initial items for the instrument were developed through a literature review and interviews, using the conceptual framework of Maslow’s hierarchy of needs theory. The initial items were evaluated for content validity by 14 experts. Four hundred and eighty-six clinical nurses participated in this study through offline and online surveys to test the reliability and validity of the instrument.The first evaluation (n = 256) was used for item analysis and exploratory factor analysis, and the second evaluation (n = 230) was used to conduct a confirmatory factor analysis and to assess the criterion-related validity and internal consistency of the instrument. Test-retest reliability was analyzed using data from 30 nurses. @*Results@#The final instrument consisted of 30 items with two sub-factors for five needs that were identified through the confirmatory factor analysis. The criterion-related validity was established using the five need satisfaction measures (r = .56). Cronbach’s a for total items was .90, and test-retest reliability was .89. @*Conclusion@#The findings from this study indicate that this instrument has sufficient validity and reliability. This instrument can be used for the development of nursing interventions to improve the needs satisfaction of clinical nurses.

Content Analysis of the Meaning of Spiritual Care as Perceived by Nursing Students / 한국호스피스완화의료학회지

Purpose@#This study aimed to describe the meaning of spiritual care as perceived by nursing students. @*Methods@#This study used a descriptive research design, and the participants were 126 fourth-year nursing students from three nursing colleges. Data were collected from August to September 2019, and were analyzed using the content analysis method. @*Results@#Four themes of spiritual care with 15 sub-themes were extracted from the content analysis: 1) “promoting spiritual well-being” (sub-themes: “providing religious help”, “caring for the patient as a spiritual being”, and “presupposing human dignity regardless of religion”); 2) “taking place in actual nursing practice” (representative sub-themes: “considering the perspective of the patient”, “reducing suffering”); 3) “caring for the multifaceted needs of human beings” (representative sub-themes: “providing physical, mental, and spiritual care”, “caring for both the mental and physical health of the patient”), and 4) “growing together”(sub-themes: “positively affecting patient well-being”, “beginning with the nurse’s self-transcendence”). @*Conclusion@#These results suggest that nursing students consider spiritual care to be a highly positive and practical form of nursing care. However, because few students have been exposed to religion and spirituality, more systematic training should be provided.

Operation Experiences of Women with Breast Cancer / 기본간호학회지

Purpose@#In order to implement effective nursing interventions in operative procedures, it is necessary to understand the patients' care requirements. The aim of this study was to investigate the operating room experiences of patients with breast cancer. @*Methods@#The study was conducted from November 15, to December 28, 2018. Participants were recruited through an objective sampling method and included eight women who had undergone breast cancer surgery within the last 10 years. Interviews were conducted with the participants until no new data were obtained. Qualitative data were analyzed using the 6-stage phenomenological analysis method of Colaizzi. @*Results@#Three categories were identified across 18 themes and 8 theme clusters. For the category “before entering the operating room”, participants experienced crossing the threshold of death, mixed feelings of regret and resentment, and discomfort due to the gaze of unfamiliar people. With regard to “when entering the operating room”, participants experienced uneasiness owing to the cold environment and the medical procedures. However, they felt comforted with the attentiveness of the medical staff. Finally, regarding the category “after leaving the operating room”, participants experienced a sense of relief that the cancer cells were removed but expressed distress concerning the obstacles in follow-up care. @*Conclusion@#The results indicate the necessity of understanding the experiences of breast cancer patients undergoing surgery and developing effective nursing interventions for these patients.

Mediating Effects of Hope and Therapeutic Relationship in the Relation between General Social Functions and Mental Health Recovery of Community People with Mental Illness

PURPOSE: This study tries to test mediating effects of hope and therapeutic relationship in the relation between general social functions and mental health recovery of community people with mental illness. METHODS: This study was carried out in a cross-sectional research design. The participants included 217 people with mental illnesses who were enrolled at eight Mental Health Welfare Centers in the Gyeonggi Province. Data were collected from February to May, 2018. The collected data were analyzed using a regression analysis, and SPSS PROCESS macro was used to test the mediating effects. RESULTS: This study analyzed the direct effects of general social functions on the hope, therapeutic relationship and mental health recovery. And general social functions had indirect effects on their mental health recovery via hope and therapeutic relationship. Both hope and therapeutic relationship had dual mediating effects in the influence of general social functions on mental health recovery. CONCLUSION: The role of hope and therapeutic relationship in the mental health recovery of community people with mental illness is important, and it is confirmed that hope is a powerful factor influencing mental health recovery.

Mediating Effect of Perceived Stress and Mental Health on Subjective Well-being in College Students / 정신간호학회지

PURPOSE: The purpose of this study was to examine subjective well-being in college students and the mediating effect of perceived stress and mental health on the influence of empowerment. METHODS: A descriptive correlational and cross-sectional research design was used. Participants were 275 students who were recruited from a university in Seoul, and completed the survey. Research tools were empowerment, perceived stress, subjective well-being and mental health (standardized MMPI-2 scale). Collected data were analyzed using SPSS and AMOS 23.0. Significance of the indirect effect was analyzed by the bootstrapping method. RESULTS: Fitness of the modified model was appropriate (χ²/df=2.68, TLI=.92, CFI=.94, RMSEA=.078, SRMR=.053). Empowerment had a significant direct effect on mental health and indirect effect through perceived stress. Perceived stress had a significant direct effect on subjective well-being and indirect effect through mental health. Empowerment had an indirect effect on subjective well-being through perceived stress and mental health. Empowerment, perceived stress and mental health explained 70.7% of the subjective well-being in the structural equation model. CONCLUSION: It is important to maintain good mental health in order to improve the well-being of college students. In addition, strategies to improve empowerment are required to reduce stress and promote mental health.

Effects of Academic Stress in Middle School Students on Smartphone Addiction: Moderating Effect of Self-esteem and Self-control / 정신간호학회지

PURPOSE: The purpose of this study was to analyze the effects of academic stress among middle school students to their smartphone addiction while exploring the moderating effect of self-esteem and self-control in the relationship between academic stress and smartphone addiction. METHODS: A descriptive research design was used. The participants were 398 middle school students from one middle school in Seoul. A self-administered questionnaire was used to measure academic stress, self-esteem, self-control, and smartphone addiction. Data were analyzed with the SPSS/WIN 21.0 program. RESULTS: Smartphone addiction significantly differed according to gender, duration of smartphone use and average monthly amount of use. The hierarchical regression analyses revealed significant positive relations between academic stress and smartphone addiction. On the other hand, self-esteem and self-control were negatively related to smartphone addiction. Self-control appeared to have moderating effects in the relationship between academic stress and smartphone addiction. CONCLUSION: It is important when developing smartphone addiction prevention programs to consider self-control that showed moderating effects.

Development and Validation of the Empowerment Scale for Woman with Breast Cancer

PURPOSE: The purpose of this study was to develop a scale to evaluate empowerment in woman with breast cancer and to examine the validity and reliability of the scale. METHODS: The development process for the initial items included a literature review, interviews, and construction of a conceptual framework. The identified items were evaluated for content validity by experts, resulting in 3 factors and 48 preliminary items. Participants were 319 women with breast cancer recruited to test reliability and validity of the preliminary scale. Data were analyzed using item analysis, confirmatory factor analysis, criterion related validity, internal consistency and test-retest reliability. RESULTS: The final scale consisted of 30 items and 3 factors. Factors, including 'intrapersonal factor' (14 items), 'interactional factor' (8 items), and 'behavioral factor' (8 items), were drawn up after confirmatory factor analysis. Goodness of fit of the final research model was very appropriate as shown by chi2/df=1.86, TLI=.90, CFI=.92, SRMR=.06, and RMSEA=.05. Criterion validity was evaluated by total correlation with the Cancer Empowerment Questionnaire .78. Cronbach's alpha for total items was .93 and test-retest reliability was .69. CONCLUSION: Findings from this study indicate that the scale can be used in the development of nursing interventions to promote the empowerment of women having breast cancer.

The Effect of the Infant Cardiopulmonary Resuscitation Immediate Remediation for Child Care Teachers / 한국간호교육학회지

PURPOSE: The purpose of this study was to evaluate the effectiveness and retention period of immediate remediation for infant cardiopulmonary resuscitation (CPR) in child care teachers. METHODS: This study used a nonequivalent comparison pre- and post-test design to measure knowledge about and confidence in infant CPR and an interrupted time-series design to determine skill performance. The experimental group (n=25) received both immediate remediation and video learning for infant CPR, and the comparison group (n=28) received video learning only. Knowledge and confidence were measured before and after 4 weeks. Their skill performance was tested immediately, and 4 weeks, 8 weeks, 12 weeks, and 24 weeks after intervention. Data analysis consisted of chi2 tests, t-tests, paired t-tests, and a generalized linear mixed model. RESULTS: There were significant increases in knowledge and confidence within the experimental group. Skill performance showed a significant difference according to the group factor (F=10.81, p=.002) and measurement time (F=146.80, p<.001). The experimental group maintained significantly higher skill performance than did the comparison group. CONCLUSION: These findings support the necessity of immediate remediation education for infant CPR to maintain skill performance. In addition, appropriate renewal time and the improvement of training programs for child care teachers are necessary.

Effect of School-based Peer Leader Centered Smoking Prevention Program

PURPOSE: The purpose of this study was to develop and evaluate a school-based peer leader centered smoking prevention program. METHODS: Non-equivalent control group with a pre/post-test design was used. Students (n=174) in two boys' junior high schools located in D city, Korea participated with 85 being selected for the experimental group and 89 for the control group. Five sessions were given to the experimental group and a 50 minute lecture to the control group. Knowledge, attitude, non-smoking intention, and non-smoking efficacy were measured for the both experimental and control group at two weeks before the program and one month after the program was completed. Data were analyzed using chi2-test, Fisher's exact test, independent t-test and paired t-test with the SPSS 21.0 program. RESULTS: The experimental group showed higher overall knowledge, negative attitude toward smoking, and higher non-smoking intention and efficacy. After receiving the school based peer leader centered smoking prevention program scores for attitude toward smoking and non-smoking efficacy increased in the experimental group were higher than in the control group. CONCLUSION: The school-based peer leader centered smoking prevention program needs longitudinal evaluation, but from this study, there is an indication that this program can be used with junior high school students and effectively change students' attitude toward smoking and promote non-smoking efficacy.

Influence of Experiences of Witnessing Tobacco Advertising and Preferences of Tobacco Companies' Social Responsibility on Current and Future Smoking Intentions in Adolescents

PURPOSE: To evaluate the influence of experiences of witnessing tobacco advertising and preferences of tobacco companies' social responsibility (CSR) on current and future smoking intentions in adolescents. METHODS: Data were collected from 700 adolescents living in Korea representing 7 metropolitan cities and 8 provinces in the method of proportional random sampling. The Gallup's data collection system was adopted using 1:1 face to face interviews. The witness of tobacco advertising was determined by 'yes', or 'no' responses to three survey items and to four survey items for preferences of tobacco CSR. For statistical analysis, chi2 test, Fisher's exact test and logistic regression were used. RESULTS: 98.4% of the adolescents had experiences of witnessing tobacco advertising. POP (OR=103.44, 95% CI: 8.22~1301.45) and magazine advertisement (OR=6.07, 95% CI: 1.34~22.58) had a significant effect on their current smoking. Also, POP (beta=.24, p<.001) and movie advertisement (beta=.42, p<.001) had a significant effect on their future smoking intentions. As for the preferences of tobacco CSR, cultural-art support activities (beta=.15, p=.025) and environmental purifying campaigns (beta=-.15, p=.034) had a significant effect on their future smoking intentions. CONCLUSION: Witness of tobacco advertising and positive responses to tobacco CSR are associated with current and future smoking intentions in adolescents.

Comparison of Three-Level Triage Versus Five-Level Emergency Severity Index for Prediction of Hospital Outcome of Emergency Patient

PURPOSE: This study compared the performance for the prediction of three-level versus five level triage tool (Emergency Severity Index version 4, ESI) on the hospital outcome of emergency patients. METHODS: This was an observational study that included all patients >15-year-of-age visiting an urban tertiary hospital emergency department (ED) in Korea from July 2007 to December 2008. We collected data from the electronic medical records, which included demographic factors, hospital outcome including admission to intensive care unit (ICU) and hospital mortality, and result of triage at arrival to ED. A three-level triage tool was used in the first year (July 2007 to June 2008), divided in four 3-month periods (threelevel phase). For 5 weeks, the three-level tool and ESI were used simultaneously (test phase). For the last 4 months, ESI was used for triage (five-level phase). We described the demographic findings of each study phase and compared the performance for the prediction of admission to ICU as well as hospital mortality, using the area under the receiver operating characteristic curve (AUC). RESULTS: A total of 34,342 patients during three-level phase, 3,371 during the test phase, and 11,048 during five-level phase were involved. Demographic findings about gender, age, week and time of visiting to ED, use of ambulance service, injury or illness, and results after ED management were similar without significant difference. Proportion of admission to ICU and hospital mortality at ED and on the ward was 6.1% in period 1, 6.1% in period 2, and 5.6% in period 3 of the three-level phase, 5.8% in the test phase, and 5.8% in the five-level phase. The calculated AUC of the three periods in the three-level phase was 0.747 (95% Confidence Interval, CI, 0.729~0.765), 0.786 (95% CI, 0.769~0.804), and 0.786 (95% CI, 0.769~0.804). During the test phase, the AUC of the three-level was 0.820 (95% CI, 0.786~0.854) and that of the five-level was 0.842 (95% CI, 0.809~0.874). During five-level phase using ESI, AUC of ESI was 0.826 (95% CI, 0.809~0.844). CONCLUSION: ESI showed greater ability to predict hospital mortality than the three-level triage tool of emergency patients in a Korean ED, where the emergency care system and insurance coverage differs from North America.

Epidemiology of Patients Using the Resuscitation Room in an Emergency Department

PURPOSE: The resuscitation room is the hub of intensive care and focused management within the emergency department (ED). For patients with life-threatening conditions, immediate triage and proper treatment using the resuscitation room is important. This study was conducted to assess the epidemiology of patients using the resuscitation room in an emergency department. METHODS:This was a retrospective observational study. Eligible subjects were enrolled through the National Emergency Department Information System from July 2007 to September 2008. All subjects came through a single regional emergency center that logs more than 45,000 patients annually. Pediatric patients less than 15 years of age and those who were dead on arrival at the ED were excluded. The Emergency Severity Index (ESI) version IV was used as a triage tool, and characteristics and ESI levels of patients using or not using resuscitation rooms were compared. RESULTS: The total number of eligible subjects was 40,926 and the male-female ratio was 1:0.92. The numbers of patients using the resuscitation room was 1,050 (2.99%). Patients using the resuscitation room were older than the patients not using the resuscitation room, were more likely to have used an ambulance to visit the ED, and had a higher mortality rate and a higher admission rate. A majority of staff members had the authority to put patients in the resuscitation room. Among them were professors 18.19%, emergency residents 11.43%, certified emergency nurses 40.57%, emergency nurses 19.43%, emergency medical technicians 2.86%, and paramedics 6.19%. Critical care was done in the resuscitation room for cardiopulmonary resuscitation 11.66%, intubation 26.33%, ventilation 1.71%, defibrillation 5.73%, and other 54.57%. The most frequent ESI levels of patients using the resuscitation room was 1 (57.89%); an ESI score of 3 (72.01%) was the most frequent value for patients not using the resuscitation room. CONCLUSION: Patient using the resuscitation room were older, more likely to have used an ambulance, and had a higher mortality rate, admission rate and ESI level.

A Survey on the Experience of Accident of Infant, Toddler and Preschooler, and the Education about Emergency Care for Parents / 아동간호학회지

The purpose of this study was to investigate the experiences of accident and visiting emergency center, and the experiences of education about emergency care for parents. The subjects of this study were 117 mothers whose children are attending 9 different nursery schools or kindergartens. The instrument used in this study was developed by researchers and validated by nursing professor, first aid doctor and the president of nursery school, and consisted of 'most important thing in child rearing' ,'experiences of accident and visiting emergency center', 'type of trauma' and 'need for parent education program' the result of this study were as followed ; 1.There were 70.09% of the experience of visiting emergency center among the subjects. The cause of visiting emergency center were high fever and convulsion (42.86%), and trauma by accident (28.04%) 2. The most common type of the indoor accident were fall down and slipping(76.92%), the common type of trauma were contusion (76.92%), abrasion (47.01%), laceration (29.06%), dislocation or fracture (12.82%), burn (10.26%), piercing (8.55%). 3.47.01% of subjects had the experience of education about emergency care for parents. They were educated by child rearing journals (32.72%), small books which were published by hospitals or community health center (25.45%), mass media(21.8%), parent seminar (12.72%), nursery school or kindergarten (5.45%). In conclusion, the need of emergency care for children was strongly found. Therefore, on the basis of above results, the parent education program which fits their cognitive level and their health care needs So, it must be directed on the further study of parents' knowledge about emergency care for children. To enhance the effectiveness of program and accomplish the children's health promotion, advanced instructional media and demonstration must be included.