Assessment of Risk Factors for Postoperative Delirium in Older Adults Who Underwent Spinal Surgery and Identifying Associated Biomarkers Using Exosomal Protein

Purpose@#With an increase in the aging population, the number of patients with degenerative spinal diseases undergoing surgery has risen, as has the incidence of postoperative delirium. This study aimed to investigate the risk factors affecting postoperative delirium in older adults who had undergone spine surgery and to identify the associated biomarkers. @*Methods@#This study is a prospective study. Data of 100 patients aged ≥ 70 years who underwent spinal surgery were analyzed. Demographic data, medical history, clinical characteristics, cognitive function, depression symptoms, functional status, frailty, and nutritional status were investigated to identify the risk factors for delirium. The Confusion Assessment Method, Delirium Rating Scale-R-98, and Nursing Delirium Scale were also used for diagnosing deliri-um. To discover the biomarkers, urine extracellular vesicles (EVs) were analyzed for tau, ubiquitin carboxy-terminal hydrolase L1 (UCH-L1),neurofilament light, and glial fibrillary acidic protein using digital immunoassay technology. @*Results@#Nine patients were excluded, and data obtained from the remaining 91 were analyzed. Among them, 18 (19.8%) developed delirium. Differences were observed between partici-pants with and without delirium in the contexts of a history of mental disorder and use of benzodiazepines (p = .005 and p = .026, respectively). Tau and UCH-L1—concentrations of urine EVs—were comparatively higher in participants with severe delirium than that in partici-pants without delirium (p = .002 and p = .001, respectively). @*Conclusion@#These findings can assist clinicians in accurately identifying the risk factors before surgery, classifying high-risk patients, and predicting and detecting delirium in older patients. Moreover, urine EV analysis revealed that postoperative delirium following spinal surgery is most likely associated with brain damage.

Status Quo and Innovative Directions for Inpatient Fall Interventions / 기본간호학회지

Purpose@#The purpose of this study was to explore nurses’ experience of falls, and their perception of the status quo of inpatient fall interventions. @*Methods@#The participants were 28 ward nurses in a university hospital, Seoul, Korea. Five focus group interviews and three individual interviews were conducted. The interviews were analyzed using thematic analysis. @*Results@#The findings from this study suggest that nurses face limitations in providing conventional fall interventions due to patient disease related characteristics, situations in hospital, and medical devices used in the hospital settings. Although nurses adopted their own strategies to prevent falls effectively, they expressed the need for innovative approaches to overcome these limitations. @*Conclusion@#Systematic, technology-based approaches are needed to create a safer physical environment and to improve current nursing interventions to prevent falls.

Factors Affecting the Patient Safety Management Activity of Nursing Students: A Quantile Regression Approach / 간호행정학회지

Purpose@#The purpose of this study was to identify factors affecting the Patient Safety Management Activity (PSMA) of nursing students according to levels of PSMA based on the Theory of Planned Behavior (TPB). @*Methods@#A descriptive study was used. The participants were 135 nursing students from universities in Korea. Data were collected with self-reported questionnaires through online survey. The questionnaire consisted of PSMA scale and modified version of the TBP-based questionnaire. Data were analyzed using multiple linear regression and quantile regression. @*Results@#The average score of PSMA was 4.09±0.44 out of 5 points. In the multiple linear regression, patient safety education, subjective norm, perceived behavioral control and intention were significant factors. In the quantile regression, place of clinical practice (in 75%), patient safety education (in 50% and 90%), subjective norm (in 75%), perceived behavioral control (in 50% and 75%) and intention (in 50%) were significant factors. @*Conclusion@#We confirmed the dynamic influences of all factors according to the levels of PSMA. It is proposed that the affecting factors according to the levels of PSMA should be considered in designing effective programs to enhance PSMA among nursing students.

Associations among Uncertainty, Depression, and Anxiety in Isolated Inpatients / 정신간호학회지

PURPOSE: The purpose of this study was to explore uncertainty, depression, and anxiety in isolated inpatients and to identify associations between them, with specific focus on state anxiety. METHODS: Data were collected using structured questionnaires and semi-structured interviews, administered to isolated inpatients at an acute care hospital (N=92). The structured questionnaires consisted of the State-Trait Anxiety Inventory, Mishel Uncertainty in Illness Scale, and the Center for Epidemiologic Studies Depression Scale. Multiple linear regression and content analysis were conducted. RESULTS: Isolated inpatients showed significant differences in uncertainty, depression, trait anxiety, and state anxiety according to gender, perception of sufficient information about isolation, and the type of isolation. State anxiety scores increased when sufficient information about isolation was not provided (β=.23, p=.005), with higher levels of depression (β=.24, p=.020) and trait anxiety (β=.49, p<.001). Through the content analysis, three themes were identified regarding patient's information needs about isolation specifically for disease, explanation, and environment. CONCLUSION: Based on the findings, it is crucial to improve the awareness of emotional responses of isolated patients experiencing uncertainty, depression, and anxiety. Our study findings are expected to support the development of nursing interventions to provide proper information and mental health support when caring for isolated inpatients.

Development of Strategic Plans for Advancing Nursing in Korea

PURPOSE: The aim of the study is to evaluate the current and prospective status of nursing in Korea and develop a strategic framework and plan to accommodate the increased demands on nurses in the changing health-care system. METHODS: This study used a mixed-methods approach including a literature review, an online survey with health-care consumers, expert panel interviews, and an analysis of strengths, weaknesses, opportunities, and threats to develop the strategic plans and framework. RESULTS: The vision of the strategic framework involved improving health and quality of life, and its mission was to elevate the status of Korea's nursing sector as a key health-care profession through high-quality and innovative nursing education, research, and practice. The five values in accordance with the mission and vision were innovation, creation, collaboration, excellence, and authenticity. Three strategic goals, namely, education, research, and practice, were identified, and 31 related strategic tasks were developed. CONCLUSION: In response to the rising social demand for a paradigm shift in nursing care services, there is a need for advancements in nursing education, research, and practice in Korea. This study provide some recommendations to achieve these aims.

Knowledge and Practice Behaviors Regarding Urinary Incontinence Among Korean Healthcare Providers in Long-term Care Hospitals / 대한배뇨장애요실금학회지

PURPOSE: The purpose of this study was to assess the current management status of patients with urological issues and to examine the level of knowledge and practice behaviors regarding urinary incontinence (UI) among Korean healthcare providers in long-term care hospitals. METHODS: This study used a cross-sectional descriptive design with a written questionnaire to assess knowledge and practice behaviors of 756 healthcare providers in 11 long-term care hospitals in Korean metropolitan areas. RESULTS: A total 42.6% of participants reported that more than 50% of patients had urologic issues, and that 68.1% of patients were regularly sent to urologists; no participants reported an on-site urologist in their facility. Participants identified collaboration with other hospitals and regular consultations by urologists as important factors in improving urologic care. Although the overall UI knowledge score was upper intermediate, a knowledge deficit was found for risk factors of UI. The knowledge level of physicians was significantly higher than that of other healthcare providers. Practice behaviors of nurses seemed to be better than those of other healthcare providers. CONCLUSIONS: Systematic collaboration between healthcare providers and urologic specialists, enhancing staff competence, and patient-tailored intervention should be recommended to improve quality of care for patients with urologic issues in long-term care hospitals.

Acculturation, Social Network, and Health-related Quality of Life in Korean-Chinese Immigrants

PURPOSE: The purpose of this study is to identify relationships between acculturation, social network, and health-related quality of life (HRQOL) among Korean-Chinese immigrants. METHODS: A cross-sectional descriptive study was conducted with 147 Korean-Chinese immigrants who were residing more than 1 year in Korea. Physical and mental dimensions of HRQOL were assessed by Short Form-12 Health Survey that consisted of a physical component summary (PCS) and a mental component summary (MCS). Data were analyzed with Pearson's correlation and multiple regression. RESULTS: The mean PCS score was 41.14+/-10.72 and the mean MCS score was 49.09+/-11.31 (possible range 10-70). Depression (beta=-6.43) and Social network frequency (beta=2.44) explained 28.4% of the variance in PCS while depression (beta=-11.54) and visiting clinic/hospital (beta=-4.00) explained 34.3% of the variance in MCS. Acculturation was not significantly associated with HRQOL. CONCLUSION: This study confirmed that the social network frequency influences HRQOL among Korean-Chinese Immigrants. The findings suggest that social network analysis should be considered in the process of developing health intervention strategies for Korean-Chinese immigrants.

The Content Evaluation of Tobacco Cessation Information on Internet Web-Sites in Korea / 대한의료정보학회지

In this study, quality of tobacco cessation information provided through Internet web sites was evaluated in terms of clarity of objectives, suitability, accuracy, reliability and usability. This study limited to those internet web sites developed and delivered by Korean public health service organizations or their related institutions or associations. This study analyzed 8 internet web sites and evaluation criteria developed by Chung, Yong Chul and Park, Hyeoun Ae (2000) were used. Study results indicated that objectives of those sites were not described or not clear; the types of audiences of those sites were not evident; Sources of the information were not clearly documented; sponsored institutions or organizations were not clearly identified; authors/editors credentials were not clearly stated. The development of guidelines for standardized health information on Internet web sites is necessary.