Effects of Education Program for Combined Management of Lymphedema with regard to Breast Cancer Patients with Axillary Lymph Node Dissection: A Quasi-Experimental Study

Purpose@#This study aimed to evaluate the effectiveness of a combined management of lymphedema education (CMLE) program which was designed for the prevention of breast cancer related lymphedema. @*Methods@#We applied a quasi-experimental study, pretest, and posttest design with a non-equivalent control group. Breast cancer survivors with partial or total mastectomy and axillary lymph node dissection were recruited and assigned to either an intervention or control group at S hospital in Seoul. The outcomes were measured using the Breast Cancer Lymphedema Symptom Experience Index, Lymphedema Risk Reduction Behavior Checklist, Patients Activation Measure 13, Functional assessment of cancer therapy-General, and Disabilities of the Arm, Shoulder and Hand. The circumferences of both arms were measured by a nurse. These measurements were conducted and compared at baseline and two weeks after completing the (CMLE) program. @*Results@#There were statistically significant changes in quality of life, physical wellbeing, and lymphedema risk behaviors in both groups after the CMLE program. There were significant differences in the circumference of right forearm, elbow, and upper arm between the two groups. @*Conclusion@#It can be concluded that the CMLE program is viable tool to prevent and manage breast cancer related lymphedema and is effective in improving the quality of life in breast cancer survivors with axillary lymph node dissection.

Effects of Symptoms and Patient Activation on Sleep Disturbance in Patients with Acute Leukemia Undergoing Chemotherapy

Purpose@#Sleep disturbance is among commonly reported symptoms associated with leukemia and its treatment. The purpose of this study was to identify the symptom experience, anxiety and depression, and sleep disturbance in patients with acute leukemia undergoing chemotherapy. @*Methods@#A total of 82 patients with acute leukemia who were undergoing chemotherapy were recruited. Data were collected using a self-reported questionnaire, which included the M. D. Anderson Symptom Inventory, the Hospital Anxiety Depression Scale, the Pittsburgh Sleep Quality Index, and the Patient Activation Measure 13. @*Results@#Sleep disturbance and symptom experience, and anxiety and depression were shown to be positively correlated, and patient activation was shown to be negatively correlated. Use of sleeping pills and symptom severity were significantly associated with sleep disturbance. @*Conclusion@#The psychological and physical symptoms patients experience during treatment should be accurately identified, and effective nursing interventions should be provided. In addition, patient activation in patients with acute leukemia under inpatient treatment was not correlated with symptoms. However, supportive care should be provided to develop and accurately measure patient activation tools suitable for disease characteristics to increase patient activation.

Moderating Effect of Inner Strength between Mood Status and Quality of Life in Female Patients with Lung Cancer

Purpose@#This study aimed to examine associations among inner strength, mood status, symptom experience, and quality of life in women with lung cancer and to investigate whether inner strength has a moderating effect on these relationships. @*Methods@#This study used a cross-sectional design to analyze 106 women with lung cancer in the National Cancer Center. A hierarchical regression analysis was conducted on the influence of quality of life. For the moderating effects, the Johnson–Neyman methods were applied using the SPSS PROCESS macro. @*Results@#The significant factors of quality of life were inner strength, symptom experiences, total mood disturbance, accounting for 70.7% of the variance. Inner strength had a moderating effect on the relationship between total mood disturbance and quality of life. This means that when women have higher inner strength, there is a significantly less negative effect of total mood disturbance on quality of life. @*Conclusion@#Female patients with lung cancer who experienced inner strength can improve the quality of life as well as reduce the negative impact of mood status on the quality of life. Therefore, these findings support the theory of inner strength and provide nurses with an opportunity to foster the development of this theory in female cancer survivors.

Effects of Symptoms and Patient Activation on Sleep Disturbance in Patients with Acute Leukemia Undergoing Chemotherapy

Purpose@#Sleep disturbance is among commonly reported symptoms associated with leukemia and its treatment. The purpose of this study was to identify the symptom experience, anxiety and depression, and sleep disturbance in patients with acute leukemia undergoing chemotherapy. @*Methods@#A total of 82 patients with acute leukemia who were undergoing chemotherapy were recruited. Data were collected using a self-reported questionnaire, which included the M. D. Anderson Symptom Inventory, the Hospital Anxiety Depression Scale, the Pittsburgh Sleep Quality Index, and the Patient Activation Measure 13. @*Results@#Sleep disturbance and symptom experience, and anxiety and depression were shown to be positively correlated, and patient activation was shown to be negatively correlated. Use of sleeping pills and symptom severity were significantly associated with sleep disturbance. @*Conclusion@#The psychological and physical symptoms patients experience during treatment should be accurately identified, and effective nursing interventions should be provided. In addition, patient activation in patients with acute leukemia under inpatient treatment was not correlated with symptoms. However, supportive care should be provided to develop and accurately measure patient activation tools suitable for disease characteristics to increase patient activation.

Moderating Effect of Inner Strength between Mood Status and Quality of Life in Female Patients with Lung Cancer

Purpose@#This study aimed to examine associations among inner strength, mood status, symptom experience, and quality of life in women with lung cancer and to investigate whether inner strength has a moderating effect on these relationships. @*Methods@#This study used a cross-sectional design to analyze 106 women with lung cancer in the National Cancer Center. A hierarchical regression analysis was conducted on the influence of quality of life. For the moderating effects, the Johnson–Neyman methods were applied using the SPSS PROCESS macro. @*Results@#The significant factors of quality of life were inner strength, symptom experiences, total mood disturbance, accounting for 70.7% of the variance. Inner strength had a moderating effect on the relationship between total mood disturbance and quality of life. This means that when women have higher inner strength, there is a significantly less negative effect of total mood disturbance on quality of life. @*Conclusion@#Female patients with lung cancer who experienced inner strength can improve the quality of life as well as reduce the negative impact of mood status on the quality of life. Therefore, these findings support the theory of inner strength and provide nurses with an opportunity to foster the development of this theory in female cancer survivors.

Awareness and Competency of Multi-Drug Resistant Organisms Infection Control in Nursing Students with Clinical Practice

PURPOSE: The aim of this study was to identify awareness and competency for Multi-Drug Resistant Organisms (MDRO) infection control in nursing students with experience of clinical practice.METHODS: This cross-sectional descriptive study was conducted from March 2019 to May 2019 by including 231 nursing students in four nursing schools located in Seoul, Gyeonggi-do and Chungcheongnam-do. The data were collected using self-report questionnaires.RESULTS: The awareness and the competency for Carbapenem-Resistant Enterobacteriaceae (CRE) infection control were lower than that of Methicillin-Resistant Staphylococcus aureus (MRSA). The agreement between the awareness and the competency of MDRO infection control in participants was low with regard to isolation, contact precautions, and disinfection for MRSA. Also, it was low with respect to disinfection, isolation, contact precautions, and carrier identification for CRE. The awareness and the competency of MDRO infection control exhibited significant positive correlation.CONCLUSION: The infection control competency is required to prevent MDRO infection. In order to enhance the infection control competency, it is important to raise awareness about MDRO infection control by providing education based on the guidelines and the principles of infection control.

Text Network Analysis of Oncology Nursing Studies Published in the Journal of Asian Oncology Nursing

PURPOSE: The purpose of this study was to identify the knowledge structure of Asian Oncology Nursing (AON) from 2002 to 2018.METHODS: Abstracts from 382 studies were reviewed and analyzed using the text network analysis program, NetMiner 4.3. Keywords network trends were compared before and after 2012 when the journal title changed from Journal of Korean Oncology Nursing to Journal of Asian Oncology Nursing.RESULTS: ‘Cancer,’ ‘patient,’ ‘quality of life,’ ‘breast,’ ‘nurse,’ ‘depression,’ ‘health,’ ‘nursing,’ ‘pain,’ ‘family’ were the top 10 most frequent keywords, and ‘cancer,’ ‘patient,’ ‘quality of life,’ ‘health,’ ‘nursing,’ ‘family,’ ‘intervention,’ ‘effect,’ ‘hospital,’ and ‘therapy’ were the dominant keywords that ranked highest in co-appearance frequency. Core keywords changed before and after 2012. After 2012, depression, health, symptom and pain were the keywords ranked that replaced nursing, education, family, and intervention from before 2012. Four subtopic groups were identified: 1) cancer treatment, education and information, 2) chemotherapy and psychological adjustment, 3) psychosocial adjustment of cancer survivors, and 4) process of cancer intervention and support.CONCLUSION: This study provides a general overview of research trends of the Asian Oncology Nursing Society. Findings of this study may guide future research directions in Asian Oncology Nursing research.

Does Holding Back Cancer-Related Concern Affect Couples' Marital Relationship and Quality of Life of Patients with Lung Cancer? An ActorePartner Interdependence Mediation Modeling Approach

PURPOSE: This study was designed to examine both actor and partner effects of perceived marital relationship on quality of life, as well as the mediating effect of holding back cancer-related concerns.METHODS: This was a cross-sectional study in an outpatient setting. Participants were 150 couples consisting of patients with lung cancer and their spouses. Perceived marital relationship, holding back cancer-related concerns, and quality of life were measured with self-report scales. Actor and partner effects on quality of life were analyzed using the actorepartner interdependence mediation model by using structural equation modeling.RESULTS: A couple's quality of life had a significant direct actor effect on the perceived marital relationship. However, the partner effect and the indirect effect of holding back cancer-related concerns on quality of life was not significant.CONCLUSION: When patients with lung cancer and their spouses perceived their marital relationship positively, they assessed their quality of life positively. They were also found to be less hesitant when talking about cancer-related concerns. However, holding back on talking concerns did not have a significant impact on the quality of life (of either oneself or the spouse). Therefore, nurses should first check how they perceive their marital relationship before encouraging communication between patients with lung cancer and their spouses. Nurses can assess these risk factors and intervene if needed, along their cancer trajectory.

Factors Affecting Cognitive Function in Patients with Stomach Cancer

PURPOSE: This study aimed to identify factors affecting cognitive function in stomach cancer patients. METHODS: This was a cross-sectional study designed to obtain data from stomach cancer patients. The Global Assessment of Recent Stress, Hospital Anxiety-Depression Scale, Distress Thermometer, Korean version of the Montreal Cognitive Assessment, and electronic medical records were used to assess stress, anxiety, depression, psychological distress, and cognitive function, respectively. RESULTS: Among 182 total participants, there were statistically significant differences in sex between the group of patients who received chemotherapy and those who did not (χ2=5.32, p=.029). There were statistically significant differences in stress and cognitive function between the two groups. The factors affecting cognitive function in stomach cancer patients included distress, stress, anxiety, and depression. CONCLUSION: Cognitive function should be examined with consideration of the psychological distress, stress, anxiety, and depression in patients with stomach cancer. Moreover, an improved program to manage cognitive function is needed, which includes mediation between psychological and physiological factors including stress, anxiety, and cognitive level.

Text Network Analysis Related to Disclosure of Cancer Diagnosis among Korea and other Countries

PURPOSE: This study aimed to identify and compare research topics related to disclosure of cancer diagnosis among Korea and other countries using text network analysis. METHODS: Abstracts from 119 studies for the period of 2000~2015 were analyzed. An integrative literature review and text network analysis were applied to examine the research. The keywords from each article's abstracts were extracted by using a program, KrKwic, and analyzed using network-related measures including degree centrality, and clustering using the NetMiner program. RESULTS: The most important core keywords; ‘patient’, ‘cancer’, ‘diagnosis’, ‘disclosure’, ‘truth’, ‘physician’, ‘family’, ‘telling’, ‘information’, ‘preference’, ‘member’, ‘age’, and ‘tell’ ranked highly. Asian countries as Korea, Japan, and China showed a similar high centrality of degree of connection in family, which appeared as a factor that influences cancer diagnosis disclosure. CONCLUSION: These findings showed knowledge structure of disclosure of cancer diagnosis and its research trends. The 11 topics identified in this comparative study can provide further starting points for research of communication with cancer patients and their family.

Control Effect of Illness Perception on Depression and Quality of Life in Patients with Hemodialysis: Using Structural Equation Modeling

PURPOSE: This study aimed to evaluate the effect of illness perception on depression and quality of life in patients with hemodialysis. METHODS: This is a cross-sectional study using structural equation modeling. Depression, quality of life and cognitive and emotional illness perceptions were measured by the Center for Epidemiologic Studies Depression-10 (CESD-10), Short Form-36 version 2 (SF-36v2), and Brief Illness Perception Questionnaire (BIPQ) in 272 hemodialysis patients. RESULTS: Prevalence of depression was 76.1%, and higher in female patients on hemodialysis. Cognitive illness perception had effect on depression and quality of life, while emotional illness perception had effect only on depression. Quality of life was explained 69.6% through depression (β=−.74, t=−8.17) and cognitive illness perceptions (β=.21, t=3.06), while depression was explained 40.5% through cognitive (β=−.34, t=−5.99) and emotional (β=.59, t=9.37) illness perceptions. CONCLUSION: In the inevitable choice of dialysis, illness perception could decrease depression and improve quality of life in hemodialysis patients.

Factors Influencing Health Related Quality of Life in Adult Survivors of Haematopoietic Stem Cell Transplantation

PURPOSE: The aim of the study is to evaluate the health-related quality of life, psychological symptoms, distress, and sense of coherence in adult haematopoietic stem cell transplantation survivors. METHODS: Fifty two survivors completed four questionnaires after the transplantation. The questionnaires were the Functional Assessment of Cancer Therapy-BMT Scale, the National Cancer Center Psychological Symptom Inventory, the Distress Thermometer, and the Sense of Coherence scale. RESULTS: Quality of life was positively correlated with sense of coherence, whereas sense of coherence was negatively correlated with all psychological symptoms and distress. Hierarchical regression analyses revealed that sense of coherence was the only significant predictor of quality of life after controlling for sex and age at transplantation. Model 2 explained 33.2% of the total variance of quality of life. CONCLUSION: Supporting patients towards improving comprehensibility, manageability and meaningfulness, the three components of sense of coherence, may be beneficial and improve outcomes. Individually pre-transplant and post-transplant assessments of sense of coherence may be of clinical importance, in order to identify patients with unmet needs and to provide rolonged support.

Association between Awareness of Nutrition Labels and Menstrual Cycle Irregularity in Korean Women: The Fifth Korea National Health and Nutrition Examination Survey (2010~2012)

PURPOSE: The aim of this study was to identify the relationship between awareness of nutrition labeling and menstrual cycle irregularity in women from a nationally representative sample of the Korean population. METHODS: A cross-sectional analysis was performed using hierarchical multivariable logistic regression analysis models. A total of 4,324 women aged 19~54 years from the 2010~2012 Korean National Health and Nutrition Examination Survey participated in the study. The participants were classified into three groups based on self-report responses to a questionnaire about their awareness of nutrition labels: Reading, Not-Reading, and Not-Knowing Groups. RESULTS: The Reading, Not-Reading, and Not-Knowing Groups comprised 46.4%, 44.9%, and 8.7% of the participants, respectively, and 53.6% of the participants had never used nutrition labels. In the Not-Knowing Group, irregular menstrual cycles for more than 3 months were significantly more common than women with irregular menstrual cycles for up to 3 months and women with regular menstrual cycles. Women in the Not-Knowing Group were more likely to exhibit menstrual cycle irregularity (adjusted odds ratio: 1.63, 95% confidence interval: 1.10~2.41) compared to women in the Reading Group after adjusting for age, body mass index, smoking status, alcohol intake, exercise regularity, stress, depression, suicidal ideation, metabolic syndrome, age at menarche, parity, and use of oral contraceptives. CONCLUSION: No awareness of nutrition labeling appears to be associated with a higher prevalence of menstrual cycle irregularity in a nationally representative group of Korean women.

Psychometric Properties of the Korean Version of the Inner Strength Questionnaire

PURPOSE: The purpose of this study is to verify the validity and reliability of the the Inner Strength Questionnaire-Korean version (ISQ-K). METHODS: The questionnaire was provided to breast cancer survivors in two Cancer centers in Gyeonggi, Korea and 167 surveys were analyzed. Data were analyzed by CVI for contents validity, confirmative factor analysis for construct validity and correlation for criteria validity. Test-retest analysis and Cronbach's α was calculated for reliability. RESULTS: Content validity was excellent. Confirmative factor analysis was performed on 4 factors based on the original structures and the goodness-of-fit was as followed: χ2=784.01, df=318, RMSEA=.09, TLI=.78, CFI=.72, GFI=.72. Standard errors of variance ranged from 0.06 to 0.15. Inner strength was correlated positively with resilience (r=.47, p<.001). Test-retest reliability was 0.90 and internal consistency was indicated by Cronbach alphas of 0.85 for inner strength. CONCLUSION: We conclude that the ISQ-K would be a valuable tool in evaluating inner strength among breast cancer survivors.

Trends of Studies Published in Asian Oncology Nursing, 2011~2014

PURPOSE: The purpose of this study was to analyze and identify recent trends of published research in Asian Oncology Nursing (AON). METHODS: A total of 140 studies were analyzed using a tool developed by the researchers, focusing on research design, research subject, research themes, and type of interventions and outcome variables of experimental studies. RESULTS: AON lacked studies which were supported by research funds (27.9%), or used an experimental study design (10.0%). In particular, there were only 2 studies (1.4%) conducted with randomized controlled trials (RCT). Research subjects were various, including patients with cancer, family care givers, healthy population, and oncology nurses. Based on a framework of cancer control continuum, most studies addressed issues of the treatment phase, whereas few studies addressed issues of diagnosis, survivorship, or the end-of-life (EOL) phase. Regarding research themes, psychosocial nursing including quality of life, anxiety, and depression was most frequently reported. In the experimental studies, an education program was most frequently applied and psycho-social-spiritual variables and symptoms were most frequently used to evaluate the effects of the intervention. CONCLUSION: The results suggest that further expansion of RCT and studies regarding diagnosis, survivorship, and EOL phases are needed. Also, our findings may contribute toward the development of a Korean oncology nursing research agenda.

Teaching Effectiveness and Adequacy of Practical Training in Nursing Students / 한국간호교육학회지

PURPOSE: The purpose of this study was to identify the teaching effectiveness and adequacy of practical training in nursing students. METHODS: This descriptive research was conducted using a convenience sampling. The sample consisted of 619 nursing students with experience in practical training among five colleges, located in four cities. The data collection was performed using self-reported questionnaires. Research tools, developed by Kim (1996), were used to measure the effectiveness of clinical instructors and the adequacy of practical training developed by researchers. The data was analyzed using SPSS 20.0. RESULTS: The average of teaching effectiveness was 3.43 (out of 5) and adequacy of practical training was 3.33 (out of 5). Teaching effectiveness and adequacy of practical training showed a significant positive correlation (r=.74, p<.001). Teaching effectiveness and each sub-area: adequacy of practical training, practical contents (r=.59, p<.001), practical attitude (r=.45, p<.001), practical instructor (r=.62, p<.001), practical environment (r=.46, p<.001), and practical evaluation (r=.64, p<.001), revealed a significant positive correlation. CONCLUSION: Nursing students prefer the actual training from professors who are more professional and clinical experienced. Professors presenting the theory lectures should also be aware of clinical practice so that education can be more professional and effective in terms of clinical practice.

Educational Needs for Sexual Health and Its Effect on Depression and the Quality of Life in Patients with Prostate Cancer

PURPOSE: The purpose of this study was to explore educational needs for sexual health, to identify relations among educational needs for sexual health, depression and quality of life, and to identify the factors affecting quality of life in patients with prostate cancer aged > 40 years. METHODS: A sample of 78 patients was recruited from a university hospital in Seoul. A cross-sectional design was used in which participants completed the questionnaires to assess educational needs for sexual health, depression and quality of life. The data were analyzed using the t-test, ANOVA, correlation analysis and stepwise regression analysis. RESULTS: The quality of life of participants differed significantly by occupation status before and after diagnosis, stage at diagnosis, underlying disease, performance status, and in the Gleason sum score. Stepwise regression analysis of the data showed that depression, sexual interaction, Gleason sum score, and occupation since diagnosis were the statistically significant factors associated with quality of life of patients with prostate cancer. This regression model explained 55.1% of the quality of life. CONCLUSION: These results indicate that depression and sexual interaction had the greatest impact on quality of life in prostate cancer patients. In clinical practice, we recommend that healthcare professionals take the initiative to provide adequate and accurate information about sexual health to prostate cancer survivors.

Structural Equation Modeling of Quality of Work Life in Clinical Nurses based on the Culture-Work-Health Model

PURPOSE: The purpose of this study was to construct and test a structural equation model of quality of work life for clinical nurses based on Peterson and Wilson's Culture-Work-Health model (CWHM). METHODS: A structured questionnaire was completed by 523 clinical nurses to analyze the relationships between concepts of CWHM-organizational culture, social support, employee health, organizational health, and quality of work life. Among these conceptual variables of CWHM, employee health was measured by perceived health status, and organizational health was measured by presenteeism. SPSS21.0 and AMOS 21.0 programs were used to analyze the efficiency of the hypothesized model and calculate the direct and indirect effects of factors affecting quality of work life among clinical nurses. RESULTS: The goodness-of-fit statistics of the final modified hypothetical model are as follows: chi2=586.03, chi2/df=4.19, GFI=.89, AGFI=.85, CFI=.91, TLI=.90, NFI=.89, and RMSEA=.08. The results revealed that organizational culture, social support, organizational health, and employee health accounted for 69% of clinical nurses' quality of work life. CONCLUSION: The major findings of this study indicate that it is essential to create a positive organizational culture and provide adequate organizational support to maintain a balance between the health of clinical nurses and the organization. Further repeated and expanded studies are needed to explore the multidimensional aspects of clinical nurses' quality of work life in Korea, including various factors, such as work environment, work stress, and burnout.

Predictors of Clinical Nurses' Presenteeism / 한국직업건강간호학회지

PURPOSE: The purpose of this study was to identify factors affecting clinical nurses' presenteeism. METHODS: A descriptive cross-sectional design was used in which participants completed self-report questionnaires that consisted of measures for nurses' job satisfaction, job stress, professionalism and presenteeism. 267 nurses working in general hospital participated in this study. Logistic regression analysis was used to estimate predictors of the presenteeism in clinical nurses. RESULTS: 250 nurses experienced one or more health problems last one month. The group who experienced presenteeism during the last one year had significant differences in professionalism and perceived productivity. Predictors of sickness presenteeism in clinical nurses included work experience, total health problem and last 1 year absenteeism. Last 1 year absenteeism and total health problem were strongly related to presenteeism in clinical nurses. CONCLUSION: Major findings of this study indicated that in dealing with nurses' presenteeism, not only managing nurses' job stress and job satisfaction but also providing flexible work schedule and increasing staffing level as an organizational approach are necessary to be considered. Further repeated and expanded research is needed to explore the multidimensional aspects of nurses' presenteeism including a broad range of work setting and the influence of Korean nurses' organizational culture on presenteeism.

Posttraumatic Growth, Dyadic Adjustment, and Quality of Life in Breast Cancer Survivors and Their Husbands

PURPOSE: The purpose of this study was to identify whether the couple perceived breast cancer as a traumatic event, to evaluate the association among posttraumatic growth, dyadic adjustment, and quality of life and to explore the predictors affecting quality of life of the couple. METHODS: A cross-sectional comparative survey design was utilized. Participants were 57 couples recruited from a national cancer center in Korea. Data were analyzed using paired t-test, McNemar test and independent t-test. On the basis of variables found to be significantly associated with quality of life, multiple regression was used to examine the simultaneous influence of multiple predictors. RESULTS: Breast cancers survivors and spouses perceived breast cancer as a traumatic event (43.9% and 24.6%, respectively). The global quality of life was explained by perception as trauma (beta= -19.79) and posttraumatic growth (beta=0.46) in survivors, and perception as trauma (beta= -18.81) and dyadic adjustment (beta=0.53) in spouses. CONCLUSION: Results suggest that future research should use qualitative methods to evaluate why contemplating reasons for cancer contributed to posttraumatic growth, examine other potential predictors of quality of life such as dyadic adjustment and intimacy, and identify links between posttraumatic growth and other psychological outcomes such as distress and well-being, using prospective analyses.