Development of the Developmental Support Competency Scale for Nurses Caring for Preterm Infants

PURPOSE: Developmental care has been recognized as a very important component for the development and health promotion of preterm infants. However, research on how to assess developmental nursing competency has not been studied as expected. This study was done to develop and evaluate a new scale to measure nursing competency for developmental support of preterm infants. METHODS: Concept analysis was done with using the Hybrid model of Schwartz-Barcott and Kim (2000), from which a preliminary new scale (30 items) was developed. To test the validity and reliability of the new scale being developed, data were collected from 122 NICU nurses at 4 hospitals in 3 cities in the Republic of Korea, from December, 2014 to March, 2015. RESULTS: The final version of the Developmental Support Competency Scale for Nurses (DSCS-N) caring for premature infants was a 4-point Likert type scale, consisting of 19 items, and categorized as 6 factors, explaining 62.5% of the total variance. Each of the factors were named as follows; ‘environmental support’ (4 items), ‘parental support’ (3 items), ‘interaction’ (3 items), ‘critical thinking’ (3 items), ‘professional development’ (3 items), and ‘partnership’ (3 items). The Cronbach's α coefficient for the scale was .83 and the reliability of the subscales ranged from .60~.76. CONCLUSION: The psychometric evaluation of the new scale demonstrated an acceptable validity and reliability. Findings indicate that the DSCS-N can be used as the tool to test the effect of educational programs for nurses and contribute to advance developmental care for preterm infants.

A Predictive Model of Behavioral Problems in Elementary School Children

PURPOSE: The purposes of the study were to develop and test a model which explains the relationship among factors affecting behavioral problems in elementary school children. METHODS: The participants for the study were 368 elementary school children and their mothers at 3 elementary schools in one city. Data analysis was done using the SPSS 17.0 program for t-test, -test, and ANOVA and the AMOS 17.0 program for theoretical model testing. RESULTS: The theoretical model showed a significant goodness of fit to the empirical data (Goodness of Fit Index: .96, Adjusted Goodness of Fit Index: .93 Comparative Fit Index: .95, Root Mean Square Error of Approximation: .06, Standardized Root Mean Square Residual: .02). Six paths were found to be statistically significant including from child rearing attitude to self-esteem, stress, stress coping and behavioral problems, and from self-esteem to stress and behavioral problems. Child rearing attitude showed a significant effect to behavioral problems by total effect. Self-esteem affected behavioral problems by total and direct effects. CONCLUSION: Child rearing attitude and self-esteem of children are important factors affecting behavioral problems in elementary school children.

Case Management for Medical Aid Beneficiaries in Korea: Findings from Case-control Study

PURPOSE: This study was to evaluate effects of case management provided for 7 months for medical aid in Korea. METHODS: This study was a retrospective comparative study using secondary data analysis. Data from two pre-existing survey were reanalyzed. The data were collected through door to-door interviews using the structured questionnaire. For the medical service use, claims data from the Korea National Health Insurance Corporation was used. Subjects were 73 in the intervention group and 118 in the control group. RESULTS: There was no significant change in the intervention group in self-care ability (p = .296), medication adherence (p = .194) or quality of life (p = .903) compared to those of the control group. For hospital visiting days, it appeared to decrease in the intervention group (p = .038) but with no significant difference from that of the control group (p = .157). Neither were there significant differences in medical expenditures (p = .605). CONCLUSION: Although the effect of case management in this study appeared extremely limited, the short intervention period and characteristics of the medical aid beneficiaries and the limit of controlling only the demand side were discussed as factors to be considered. Nurses have been carrying out professional roles in case management in Korea. However more efforts are needed to develop case management as an area for nursing specialization.

Effects of a Responsive Parenting Education Program on Child's Behavioral Problems and Pivotal Developmental Behaviors in Children at Risk for Attention Deficit Hyperactivity Disorder

PURPOSE: This study was done to determine whether a parenting education program using responsive teaching strategies is effective for parenting stress, maternal interactional behavior and behavioral problems in children at risk for Attention Deficit Hyperactivity Disorder (ADHD). METHODS: Participants in this study were 17 elementary school children and their parents. The ADHD risk group was determined by scores on the Korean-ADHD Rating Scale. The parenting education program was developed based on Dr. Mahoney's responsive teaching curriculum. Mothers participated in the program once a week for 8 sessions. Treatment outcome was evaluated using the Korean version of the Child Behavior CheckList (K-CBCL), parenting stress, maternal interactional behavior, and child pivotal developmental behavior. Data were analyzed using Wilcoxon signed rank test, Mann-Whitney test, and regression analysis. RESULTS: After the parenting education program, no significant difference in parenting stress (Z=-1.00, p=.320) was found, but there was a significant decrease in the child's internal behavior problems (Z=-2.05, p=.040), and also a significant improvement in maternal interactional behavior and a significant difference in child pivotal developmental behavior (Z=-2.67, p=.008). CONCLUSION: The results indicate that parenting education programs based on responsive teaching strategies are effective and that application of a program is recommended to prevent behavioral problems and improve maternal child interaction for children at risk for ADHD.

Analysis of Relationships between Parenting Stress, Maternal Depression, and Behavioral Problems in Children at Risk for Attention Deficit Hyperactive Disorder

PURPOSE: In this study differences in behavioral problems between children at risk for Attention Deficit Hyperactive Disorder (ADHD) and normally developing children were identified. Further, relationships between parental stress, depression, and child behavioral problems according to ADHD symptoms were explored. METHODS: Participants were 222 elementary school children and their parents. The ADHD risk group was determined by the Korean-ADHD Rating Scale. Data were collected using the Korean-ADHD Rating Scale, Korean version of Child Behavior CheckList (K-CBCL), Parenting Stress Index, and Beck Depression Inventory. Data were analyzed using t-test, Pearson correlation coefficients, and regression analysis. RESULTS: 1) The ADHD risk group showed higher levels of behavioral problems, parenting stress, and maternal depression than the normal group. 2) There were significant relationships between ADHD scores and parenting stress (r=.66), maternal depression (r=.35), internal behavioral problems (r=.47), and external problems (r=.55), but, ADHD risk scores were negatively correlated with social competence (r=-.40). 3) The regression analysis revealed that ADHD levels affected the child's internal behavioral problems, mediated by maternal depression (beta=.29, p<.001). CONCLUSION: The study results show that higher risk scores for ADHD indicate a significant effect for behavioral problems. Also, parenting stress and depression influence child's behavioral problems. These results suggest that identification of children at risk for ADHD and development of parental education programs would contribute to the prevention of behavioral problems and aggravation of the ADHD symptoms.

Maternal Identity in Mothers of Premature Infants admitted in NICU / 아동간호학회지

PURPOSE: The research was conducted to investigate the experience of maternal role attainment of mothers of premature infants admitted in NICU and to conceptualize the phenomena. METHOD: The grounded theory method was utilized for data collection and analysis. 8 mothers of premature infants were selected and in-depth interview was performed. Paradigm model was utilized for data analysis and presentation. RESULT: The central category was "unstable maternal identity". The properties of the core phenomena was "ambivalent feeling to baby" "negative emotion" "commitment to baby". The loss of control due to premature delivery was the causal condition. contextual condition was the "perceived threats" due to severity of the premature infant and uncerainty of the baby's life. The mother's health status, economic status, and familial and social support was recognized as intervening conditions during the process of maternal role attainment. The strategic action/interactions were emotion-focused coping, reappraisal of the situation, problem-focused coping, and information seeking. The consequence was the maternal role attainment with competence and expectation. CONCLUSION: The process of maternal role attainment was affected by threats due to severity of the baby and intervening factors and interaction strategy. Further research is recommended to develop adequate intervention method during the process of maternal role attainment.

Predicting and Understanding School-Age Children's Visual Health Behavior / 아동간호학회지

PURPOSE: The purpose of the study was to investigate the status of visual health behavior of school-age children and to identify the predicting variables of the school-age children's visual health behavior. METHOD: The subject was 764 children in grades 4 to 6, enrolled in 2 elementary schools located in urban area. The data were analyzed using t-test, ANOVA, correlation analysis, and stepwise multiple regression. RESULT: The findings were as follows: 1. The mean of the score of the visual health behavior of school-age children was 41.59(SD=7.22) and there was a significant difference according to grade. 2. There were significant correlations between visual health behavior and self-efficacy for visual health behavior (r=.51, p=.000), motivation for visual health(r=.45, p=.000), perceived benefits(r= .34, p=.000), self-concept(r=.32, p=.000), knowledge of visual health(r=.30, p=.000), health perception for vision(r=.16, p=.000), health locus of control(r=.11, p=.002), and perceived barriers(r=.-.12, p=.000). 3. Self-efficacy for visual health behaviors, knowledge of visual health, motivation for visual health, self-concept, health perception for vision, and perceived benefits were identified as predictor variables of the visual health behavior of the school-age children from the stepwise multiple regression analysis. The total percent of variance accounted by these 6 variables were 36.9%. CONCLUSION: From the result, it is suggested that the development of comprehensive visual health education program including the component of self-efficacy, health motivation and self-concept to promote the visual health of school-age children.

Nurses' Knowledge and Attitude to Pain Management in Children / 아동간호학회지

PURPOSE: The purpose of this study was to examine the nurses' knowledge and attitude to pain management in children and explore the status of pain management in clinical practice. METHOD: The subjects were 131 nurses enrolled in 3 university affiliated hospitals. Questionnaire method was utilized for data collection. Data was analyzed by SPSS statistical program. RESULT: The result was as follows: 1. The overall mean score of the pain knowledge was 16.88 (58.2%). The percentages of correct response in test subsections were pain assessment 45.5, choice of medication and drug action 48.7, and pain statement 79.6 respectively. 2. 70.3% of the nurses agreed or strongly agreed that the procedural pain should always be eliminated. And, 44.3% of the nurses agreed or strongly agreed that post-operative treatment of pain in children should always aim at eliminating the pain completely. 3. There was a significant relationship between pain attitude and knowledge related facts about pain(r=.217, p < .01). 4. When asked to identify the point of self-reported pain on a 0-10 scale at which the nurse would give medication, point 7 was mostly identified (29%). 5. Only 19.8% of the nurses utilized pain rating scale to assess children's pain. 6. The nonpharmacologic interventions nurses used most were position change, emotional support, and massage. 7. 68.7% of the nurses indicated that they learned about pain management from their current working environment. Also, Mostly helpful resource identified in increasing their pain management knowledge and skills was the continuing education program. CONCLUSION: The findings showed that there was a need to develop educational program for adequate pain management for children. Further research study is recommended to examine the effectiveness of the intervention methods for children's pain.

Factors Related to Vision Disturbances in the Elementary School-Age Children / 아동간호학회지

The vision disturbances of school-age children has been recognized as and important school health problem. The purpose of this study is to describe the current status of the visual health and to explore the related factors for the decrease in visual acuity in the elementary school age children. The study subjects were 697 children (Boys: 338, Girls: 359) of 4th to 6th grade in two school in urban area. The visual acuity data of the school health examination in 1999 and 2000 were utilized for analysis. The questionnaire for children and parents was used for survey. The findings were as follows. 1. The prevalance rate of the children with the visual acuity less than 0.7 on the left eye were 26.84% ( Grade 4), 31.30% (Grade 5), and 38.39% (Grade 6). The rate on the right eye were 28.31% (Grade4), 30.37% (Grade 5), and 37.92% (Grade 6). There was a significant difference in the rate of the visual acuity less than 0.7 according to grade (p < .01). 2.The rate of visual acuity decrease was 40.12%. 3. The factors related to the decrease in the visual acuity were grade, sex, genetic factor, posture, and the awareness of the visual acuity. There was more decrease in the visual acuity when the children were in higher grade (O.R= 1.06), girls (O.R=2.29). Children having parents with better vision (Father: O.R=1.26; Mother O.R= 1.25) showed better vision. On the other hand, when the children have siblings with glasses, there was more decrease in the visual acuity (O.R=2.31). Students with good posture during study (sitting on the chair) and watching TV to the lower direction showed less decrease in the visual acuity. Also, when the students know their visual acuity, the rate of decrease were lower. The variables which odds ratio were statistically significant were sex (p < .01), siblings with glasses (p < .01), and awareness of visual acuity (p < .01).

Effects of a Sensory Stimulation on Weight Gain, Behavioral State, and Physiological Responses in Premature Infants / 간호학회지

PURPOSE: The purpose of this study was to examine the effects of sensory stimulation on premature infants. METHOD: Thirty three premature infants admitted to NICU of D University Hospital in C city were randomly assigned in two groups (Experimental group: 16, Control group:17). For the experimental group, tactile and kinesthetic stimulation developed by Dr. Field was applied 2 times a day for 10 days. Behavioral state was measured using the Anderson Behavioral State Scale (ABSS). Heart rate, respiration, and oxygen saturation were obtained for each infant before and after sensory stimulation. Hypothesis testing was done using the X2- test, student t-test, and repeated measures of ANOVA. Result: Hypothesis 1: There was a significant difference in the daily body weight gain between experimental and control group (F= 40.77, p= .0001). Hypothesis 2: There was a significant difference in the frequency of 'inactive awake state' between two groups (X2= 39.778, p= .001). Hypothesis 3: There were significant differences in the mean of heart rate and O2 saturation between two groups (t= -2.174, p= .037; t= 3.080, p= .005). However, there was no significant difference in the mean of respiration rate between two groups (t= -1.966, p= .581). CONCLUSION: The effectiveness of a sensory stimulation on weight gain and behavioral state in premature infants was supported. Further study is recommended to develop a sensory stimulation method as an independent nursing intervention for premature infant.

A Study on the Preliminary Validation of a Postoperative Pain Measure for Parents for Children's Pain Assessment after Surgery / 간호학회지

Parents are primary care taker for the children and have an important role for the assessment and managent of children's pain following surgery. The purpose of the present study was to examine the validity and clinical utilization of the Postoperative Pain Measure for Parents (PPMP) developed by Chambers et al. Subjects were 52 children aged 4-12 years admitted for tonsillectomy and other minor surgery and their mothers. Faces Pain Scale, State Anxiety, and Postoperative Pain Measure for Parents were used. The data were collected by two research assistant on the operation day and 1st day after surgery at hospital during the period of July 20 to August 28, 1998. The results are as follows: 1. Eta correlation coefficient between 15 items of PPMP and child rated pain were calculated. Correlation coefficients were more than .2 for both day. 2. Internal consistency for PPMP were .82 and .83. 3. The scores of the PPMP were 10.73 (SD=3.71) and 9.27(SD=4.07) on the operation day and 1st day after surgery and there was no significant difference between two days(p=.056) On the other hand, there was a significant difference on the child rated pain by Faces Pain Scale between operation day and 1st day after surgery(p=.001). 4. The correlation(Spearman Rho) between PPMP and child rated pain were .40(p=.003) and .56(p=.000). The score of the PPMP and the children's state anxiety were highly correlated on the operation day and 1st day after surgery (.60, .52, p=.000). 5. Partial correlation between PPMP and child rated pain except state anxiety were .18(p=.23) and .48(p=.001) on the opration day and 1st day after surgery. 6. Using a cut-off score 10 out of 15, the measure showed excellent sensitivity (>80%) and moderate specificity (46.15%, 60% ). This study provides preliminary evidence for the use of the PPMP as a valid pain assessment tool with children between the ages of 4-12 years following surgery. It is suggested to explore the validity with a different subjects with other surgery and to examine the validity for infant and younger children.

Effects of Nonnutritive Sucking on Behavioral State in Preterm Infants / 아동간호학회지

The purpose of study was to examine the effect of nonnutritive sucking(NNS) on behavioral state in preterm infants. Fourteen infants(gestational age 28-35 weeks, M=31.86 ; birth weights 1095-2275g, M=1694g) admitted to NICU, serving as their controls were randomly administered 5 min of nonnutritive sucking and a control condition. Behavioral state was measured using the Anderson Behavioral State Scale(ABSS). Heart rates were obtained for each infant before and during NNS and bottle feeding. Data collection was done by 3 experienced nurses in NICU 2 times a day for consecutive 4 days for each subject. Interrater reliability were .80-.90. The findings were as follows : 1. Preterm infants averaged active restless states 58.93% in the preintervention phase and 27.32% in the NNS phase. Inactive awake states were 3.57% in the preintervention phase and 34.64% in the NNS phase. 2. There were significantly more positive changes to inactive awake states for the NNS intervention, Z=-2.35, p=.01. 3. There was no statistically significant difference in heart rate change between NNS intervention and control condition, z=-1.15, p=.24. 4. The rates of feeding success determined by finishing prescribed amount of milk by bottle feeding within 15 minutes were 83.94% in NNS intervention and 89.29% in control condition. The findings from this study confirmed that NNS is effective for behavioral state modulation and inducing optimal state for feeding in preterm infant. The NNS intervention in nursing practice may help the transition of preterm infants for nipple feeding.

Predicting and Understanding School-Age Children's Health Behavior / 간호학회지

The purpose of the study was to investigate the level of health behavior of school-age children and to identify the predicting variables of the school-age children's health behavior. The subject were 467 children in grades four to six, enrolled in two elementary schools located in two cities. The mean age of the subject was 10.03(SD=1.33). The data were analyzed using t-test, ANOVA, correlation analysis, and stepwise multiple regression. The result are as follows: 1. The mean of the score of health behavior of the school-age children was 154.6, showing thar they are practicing health behavior relatively well. 2. There were significant differences in the mean scores of health behavior according to grade(F=6.53, p=.001), sex(t=-3.70, p=.000), educational level of the parents(F=4.92, p=.002; F=4.47, p=.004), occupation of the patients(F=3.31, p=.003;F=4.76, p=.000), and socioeconomic status(F=11.87, p=.000). 3. There were significant correlations between health behavior and health motivation(r=.53, p=.000). self-concept(r=.32, p=.000), perceived health status(r=.16, p=.000), and health locus of control(r=.15, p=.001). 4. Health motivation, self-concept, grade, socioeconomic status, and health locus of control were identified as predictor variables of health behavior of the school-age children from the stepwise multiple regression analysis. The total percent of variance accounted for by these five variables was 35.0%. From the result, it is suggested that in the development of a school health education program, the effect of health motivation and self-concept to promote student's health behavior in school-age children should be considered.

An Analysis on Curriculum Content of Child Nursing in Korea / 아동간호학회지

The purpose of nursing education is to prepare the professional practitioner as nurse who will be interested in the health and the related aspects of community and will assume responsibility for contributing toward the improvement of the health for the all. This means that nursing education must provide opportunities for the development of knowledge, skills, and attitudes which make this possible. Consequently, this approach has relevance for nursing education. Faculty engaged in endless debates about what is to be included, and to what death, and what will be given short shrift as a result. Thus, it can be seen why there is so much confusion and lack of agreement between the emphasis and objectives in nursing. This study attempted to review and identify the curriculum content of child nursing in Korea to build and develop the standard curriculum contents for national board examination for nurses and child's health needs for the coming 21st century. The questionnaire was consisted of items for selection and organization of the knowledge components and type of unit with weigh to be attained in child nursing. Response of 34% of nursing program in university and junior college. Content analysis was done by using consensual validation of essential knowledge for curriculum content to identify what is obvious or trivial. This study pointed out that it is not yet apparent that demographic fact has greatly influenced child nursing curriculum content. In a similar vein the majority of content of child nursing devote little time and weigh to social and epidemically significant to child health. It seems to be needed that the content of child nursing may push the paradigm shift in nursing education such as health promotion and prevention for postretinal roles of child and family. In conclusion, it is time to convoke and content and standardization on job analysis for national board exam for nurses in Korea.

Psychometrics of Children's Health Locus of Control Scale for Korean Children / 아동간호학회지

The purpose of the study was to test the reliability and validity of the Korean version of Children's Health Locus of Control Scale(CHLC), an instrument designed to measure health locus of control in children aged 7 to 12. The scale was administered to 467 children in grades 4 to 6, enrolled in 2 elementary schools located in city. The mean age of the subject was 10.03(SD=1.33). The findings were as follows: 1. Cronbach alpha coefficient for internal consistency was .69 for the total, and .67, .65, and .56 on the respective subscales. 2. Construct validity was supported through factorial isolation of three theory consistent subscales: internal, chance, and powerful others. Two items did not fit well with the originally developed subscale. The total percent of variance explained by 3 factors was 34.5%. The result of the factor analysis according to Kaiser's criterion revealed that the scale was consisted of 5 factors. But, The items of the subscales were rather inconsistent with the dimensions of the locus of control concept. 3. There were significant differences according to parent's educational level and occupation, and birth order on the scores of the CHLC. There were no significant differences according to grade level and sex. 4. The score of the CHLC was significantly correlated with the self concept of the children(r=.14, p<.001). The result indicated that the Korean version of Children's Health Locus of Control Scale was valid and reliable in measuring health locus of control concept in children, even though further research is required to reconfirm and increase the reliability of the instrument. CHLC could be used for study explaining the health related behavior of the children and research project to health education program.