Differences in perceived parental stress between parents with very low birth weight infants and nurses in neonatal intensive care units, South Korea

Purpose@#This descriptive study compared the perceived parental stress levels between parents with very low birth weight infants (VLBWIs) and nurses in the neonatal intensive care unit (NICU). @*Methods@#In total, 83 parents of VLBWIs and 78 NICU nurses were enrolled. Data were collected with the Parental Stress Scale (PSS) and analyzed using the t-test and analysis of variance in SAS version 9.4. @*Results@#The average PSS score was 3.31 among parents and 3.45 among nurses. The stress score was significantly higher among nurses with children (t=2.46, p=.016) and senior nurses (t=2.12, p=.037). There was a significant difference in the stress score according to parents' education (t=3.29, p=.002) and occupation (F=3.14, p=.049) in the sights and sounds subscale. Mothers had significantly higher stress scores than fathers in the parental role alterations subscale (t=2.32, p=.023). Parental stress scores were higher than those perceived by nurses in the infant's appearance and behaviors subscale for breathing patterns (t=2.95, p=.004), followed by jerky/ restless behavior (t=2.70, p=.008). @*Conclusion@#Nurses should provide explanations to parents of VLBWIs in order to reduce parental stress about the appearances and behavior of VLBWIs. This is more important than aspect of the NICU environment and education about parental roles.

Posttraumatic Growth of Adolescents with Childhood Leukemia and their Parents

PURPOSE: Childhood leukemia is a serious trauma affecting both adolescents and their parents, who experience painful process. However, adolescents with leukemia and their parents also experience positive changes, which is referred to as posttraumatic growth. We examined posttraumatic growth, core beliefs, impact of event, and event-related rumination in adolescents within 5 years of a diagnosis of childhood leukemia and their parents. METHODS: The participants were 68 adolescents with childhood leukemia (aged 13~18 years) and their parents, who were recruited from C university hospital in Korea from May to September 2016. The Posttraumatic Growth Inventory, Core Belief Inventory, Impact of Event Scale-Revised, and Event-related Rumination Inventory were completed by the adolescents and their parents. The mean scores and correlations between variables were investigated for both set of participants. RESULTS: Parents showed significantly higher levels of posttraumatic growth, disruption of core beliefs, impact of event, and invasive rumination than adolescents. Disruption of core beliefs and deliberate rumination were positively correlated with posttraumatic growth in both groups. CONCLUSION: Nursing intervention programs that involve modifying core beliefs and inducing a positive thought can help adolescents with leukemia and their parents grow after traumatic events.

Development and Effect of Nurse-Centered Doula Support Program for Mothers with Natural Childbirth: PILOT TEST

PURPOSE@#The present study is to develop a Nurse-Centered Doula Support Program (NDSP) for the management of pain and childbirth support in natural births and to evaluate its effect.@*METHODS@#Sixty items were derived by 5 experts and the final contents of program were confirmed with the verification of 58 items with content validity index of 0.8 or more, by an expert group consisting of 2 obstetricians and 3 maternity nurses. Twenty-four pregnant women admitted for maternity care at Mediflower hospital in Seoul were included in the evaluation of NDSP efficacy. Pain, anxiety, postpartum hemorrhage, type of birth, and the birth satisfaction of the newborn were assessed for the evaluation.@*RESULTS@#This study showed that compared to non-NDSP-applied group, NDSP-applied group had lower pain scores during transitional phase and lower postpartum anxiety score. Also, postpartum hemorrhage was less frequently found in NDSP-applied group, with higher birth satisfaction, when compared to the non-NDSP-applied group.@*CONCLUSION@#These results suggest that the NDSP developed by the present researcher is effective in reducing maternal pain, anxiety, postpartum hemorrhage, and birth satisfaction in natural births, and thereby, is expected to be used as nursing intervention in maternal care.

Outcomes of Maternal and Newborn in Waterbirth; A Review of 3-Year Medical Records in a Natural Birth Center

PURPOSE: This study aims to investigate the effects of waterbirth on the maternal delivery process and its safety on the newborn babies. METHODS: This study is a retrospective study, analyzing the medical records of pregnant women who gave birth at a natural birthing center in Seoul, Republic of Korea. The study compared and analyzed a total of 1,907 medical records of pregnant women, composed of 539 women who used a birthing pool and 1,160 women who did not use a birthing pool from 2015 to 2017. The collected data were analyzed by the chi-square test, Mann-Whitney U-test and Fisher exact test using SPSS ver. 22.0. The results are shown in the table below. RESULTS: The cesarean section rate was lower in the birthing pool use group, compared to the non-birthing pool use group (p=0.038), with the significantly lower cesarean section rate in birthing pool use group among primigravida women in particular (p=0.002). The birthing pool use group also used oxytocin less frequently than the non-birthing pool use group (p=0.001) And especially in primigravida women, the second stage of delivery in birthing pool use group was found to be shorter than that of the non-birthing pool use group (p=0.045). There were no significant differences in the neonatal Apgar score and the neonatal intensive care unit admission rate between the 2 groups. CONCLUSION: This study has its meaning as the first report in Korea that analyzes the effects of waterbirth on the maternal delivery process and its safety on the newborn babies.

Structural Equation Model of Health-Related Quality of Life in School Age Children with Asthma / 간호학회지

PURPOSE: This study aimed to construct and test a hypothetical model of the quality of life of school-age children with asthma based on the health-related quality of life model by Wilson and Cleary. METHODS: Data were collected from 205 pairs of pediatric outpatients diagnosed with asthma and their parents in Seoul and Gyeonggi-do from July 2016 to April 2017. The exogenous variables were asthma knowledge, number of accompanying allergic diseases, and social support. The endogenous variables were asthma self-efficacy, asthma symptom control, perceived health status, parental quality of life, and children's quality of life. For data analysis, descriptive statistics, factor analysis, and structural equation modeling were performed. RESULTS: Eighteen of the twenty-four hypotheses selected for the hypothetical model were attentive and supported statistically. Quality of life was explained by asthma self-efficacy, asthma symptom control, perceived health, parental quality of life, and asthma knowledge with 83.5%. CONCLUSION: Strategies for promoting self-efficacy and enforcing asthma knowledge will be helpful for the improvement of health-related quality of life with school-aged asthmatic children.

Predictors of the Posttraumatic Growth in Parents of Children with Leukemia

PURPOSE: Parents caring for children with leukemia experience a tremendous challenge to get positive results in overcoming traumatic events with their children. The purpose of this study was to identify predictors of posttraumatic growth in parents of children with leukemia. METHODS: One hundred thirty seven parents (117 mothers and 20 fathers) of children with leukemia participated this study from May to August in 2016. Participants completed self-report measures of posttraumatic growth, core belief, deliberate rumination, resilience and social support. RESULTS: All the variables were positively correlated with posttraumatic growth. Core belief, resilience and social support were significant predictors related to posttraumatic growth in parents of children with leukemia and explained for 54% of the variance in posttraumatic growth. CONCLUSION: The results show that there are several factors affecting posttraumatic growth in parents of children with leukemia. Therefore, nursing intervention programs including strengthening resilience, revising core belief as well as utilizing social support systems should be provided for this population in order to enhance positive psychological change beyond parental traumatic events related to children with leukemia.

Nursing Frequency, Nursing Time, and Nursing Intervention Priorities depending on Neonatal Therapeutic Hypothermia Methods

PURPOSE: This study compared nursing frequency, nursing time, and nursing intervention priorities depending on the method of neonatal induced hypothermia. METHODS: We observed 15 neonatal subjects receiving therapeutic hypothermia for 3 days each. Forty-five nurses experienced with nursing neonatal patients under therapeutic hypothermia provided responses about nursing intervention priorities. Analyses with the chi-square, the Fisher exact test, the paired t-test, the Wilcoxon signed rank test, and the Wilcoxon rank-sum test were performed on the data using SAS version 9.4. RESULTS: The frequency of nursing activities was higher for selective head therapeutic hypothermia (SHTH) than for systemic therapeutic hypothermia (STH), and nursing time was also significantly longer. In terms of nursing intervention priorities, there were priority differences in “risk for ineffective thermoregulation” and “risks for impaired skin integrity” for SHTH compared to STH . CONCLUSION: Since SHTH for neonatal therapeutic hypothermia requires more nursing time and frequent nursing activities than STH, STH is therefore recommended if the therapeutic efficacy is similar. Appropriate nursing personnel should be allocated for neonatal SHTH nursing. Nurses should be aware of nursing interventions for therapeutic hypothermia as the priorities are different for different methods of neonatal therapeutic hypothermia.

Perception on Parental Coping on Unintentional Injury of Their Early Infants and Toddlers: Q Methodological Approach

PURPOSE: The purpose of this study was to identify parental coping strategies in the face of early infant and toddler injury, and to provide basic data for a parental education program and the most desirable directions it should take. METHODS: A Q-methodology to analyze the subjectivity of each item was used. Thirty-four Q-statements were derived from a literature review and interviews. Forty-seven parents were classified into a shape of normal distribution using a 9-point scale. Collected data were analyzed by the pc-QUANL program. RESULTS: Five types of parental coping in early infant and toddler injury were identified. Type I was “hospital treatment focused”, type II was “Improving the safety of the child's environment”, type III was “expression of negative emotion”, type IV was “taking the lead in problem solving”, and type V was “Interrogating the person in charge of the situation in which the injury occurred”. CONCLUSION: The results of this study indicate that different approaches to educational programs can be used for parents in early childhood injury.

Structural Equation Model of Health-Related Quality of Life in School Age Children with Asthma

PURPOSE@#This study aimed to construct and test a hypothetical model of the quality of life of school-age children with asthma based on the health-related quality of life model by Wilson and Cleary.@*METHODS@#Data were collected from 205 pairs of pediatric outpatients diagnosed with asthma and their parents in Seoul and Gyeonggi-do from July 2016 to April 2017. The exogenous variables were asthma knowledge, number of accompanying allergic diseases, and social support. The endogenous variables were asthma self-efficacy, asthma symptom control, perceived health status, parental quality of life, and children's quality of life. For data analysis, descriptive statistics, factor analysis, and structural equation modeling were performed.@*RESULTS@#Eighteen of the twenty-four hypotheses selected for the hypothetical model were attentive and supported statistically. Quality of life was explained by asthma self-efficacy, asthma symptom control, perceived health, parental quality of life, and asthma knowledge with 83.5%.@*CONCLUSION@#Strategies for promoting self-efficacy and enforcing asthma knowledge will be helpful for the improvement of health-related quality of life with school-aged asthmatic children.

Factors Affecting Post-Traumatic Stress of General Hospital Nurses after the Epidemic of Middle East Respiratory Syndrome Infection / 임상간호연구

PURPOSE: This study examined post-traumatic stress (PTS) and the factors affecting it among general hospital nurses after the MERS(Middle East Respiratory Syndrome) epidemic. METHODS: Data were collected from 170 nurses who worked at general hospitals since the first reported MERS outbreak. The IES-R-K assessed PTS. Data were analyzed using SPSS. RESULTS: The mean PTS level was 7.80 points (range: 0~88); 7.1% of the participants were at a high risk. Nurses who had been in contact with patients suspected or diagnosed with MERS had high post-traumatic levels; those who had been quarantined during the MERS outbreak had relatively higher PTS levels. Shift-work nurses had higher PTS levels than those with fixed working hours. Above charge' nurses stress levels were higher than staff nurses' stress levels. The results showed that factors including contact with an MERS-suspected or diagnosed patient, position at work, and working status of MERS-affected nurses explained 16% of the PTS. Among the main variables, nurses' above charge position was the greatest factor affecting PTS. DISCUSSION: It is necessary to develop intervention studies and programs considering these variables. Furthermore, development and implementation of differentiated programs should be done considering the position of above charge nurses.

The Knowledge & Attitude on Tuberculosis by Parents of North Korean Refugee Children

PURPOSE: The purpose of this study was to investigate the knowledge and attitude on tuberculosis by parents of North Korean refugees' children. METHODS: A descriptive study was conducted. Data were collected from July to November, 2014 in Hanawon and 74 North Korean refugee parents participated in the study. Data were analyzed using the SPSS 21.0. RESULTS: The score for knowledge was 17.72 out of 30 points, for awareness in attitude, 49.34 out of 60 points and for prevention behavior in attitude, 48.39 out of 60 points. There were positive significant correlations among knowledge, attitude and health interest. There was also a significant positive correlation between awareness and prevention behavior in attitude, and between prevention behavior and health interest. CONCLUSION: North Korean refugee parents showed a low level of knowledge and a negative attitude. The implication of these results is an awareness of the need for education on the causes, transmission and importance of treatment for tuberculosis. This kind of education can guide North Korean refugee parents to obtain correct information and positive attitudes and therefore, be able to effectively practice appropriate health behaviors in tuberculosis management for their children.

Predictors of Meaning in Life in Adolescents with Leukemia

PURPOSE: The purpose of this study was to identify predictors of spiritual well-being and meaning in life for adolescents with leukemia. METHODS: Participants were 102 adolescents (11-21 years) recruited at C university hospital from June to August in 2014. The eligible participants were diagnosed with leukemia and are on follow-up care at the outpatient clinic. Participants were assessed for spiritual well-being, meaning in life, self-esteem, and social support. RESULTS: Levels of spiritual well-being and meaning in life for these adolescents with leukemia were 3.69 out of 6 and 3.10 out of 4, respectively. Self-esteem and social support from family were factors affecting spiritual well-being. Self-esteem, existential well-being and social support from family and friends were predictive for meaning in life and accounted for 68% of total variance. CONCLUSION: The results show that there are several factors affecting spiritual well-being and meaning in life in adolescents with leukemia. Therefore, nursing intervention programs for adolescents with leukemia should include strengthening self-esteem and social support as well as considering the spiritual aspect of life in order to find meaning in life beyond leukemia.

Predictors of Resilience in Adolescents with Leukemia

PURPOSE: The purpose of this study was to identify the factors relating to resilience for adolescents with leukemia and examine the relationship between these factors. METHODS: From June to September in 2014, 199 adolescents aged 11 to 21 participated in the study as they visited the out-patient clinic at C university hospital for follow-up care. To verify the predictors and the effects of resilience, uncertainty, symptom distress, perceived social support, spiritual perspective, defensive coping, courageous coping, hope, and self-transcendence were measured. Collected data were analyzed using hierarchical regression analysis with the SAS statistics program. RESULTS: The final regression model showed that courageous coping, hope, and self-transcendence were significant predictors related to resilience in adolescents with leukemia and explained for 63% of the variance in resilience. CONCLUSION: The findings indicate that adolescent-oriented intervention programs enhancing courageous coping, hope, and self-transcendence should be provide for adolescents with leukemia in order to overcome illness-related stress and support physical, psychological and social adjustment.

Late Effects, Social Adjustment, and Quality of Life in Adolescent Survivors of Childhood Leukemia

PURPOSE: This study was conducted to examine the late effects, social adjustment, and quality of life in adolescents who had been completely treated for childhood leukemia and their parents. METHODS: Participants consisted of 41 pairs of adolescent survivors (13-18 years) and their parents. Parents checked for their child's physical late effects. The Korean Version of Post-Traumatic Symptoms for psychological late effects, social functioning questionnaire for social adjustment and the PedsQL 4.0 Generic Core Scales for quality of life were completed by adolescents and parents. Data were analyzed using SPSS. RESULTS: Twenty out of 41 adolescents had one or more physical late effects. Adolescents showed more serious psychological late effect than parents. Five children and seven parents had above cut-off scores and they were considered the high risk group for posttraumatic symptoms. Parent-reported scores were significantly higher than child-reported scores in terms of social adjustment and emotional functioning of quality of life. Low school functioning in adolescents was associated with physical late effects. CONCLUSION: The results indicate that long-term and systematic management for childhood leukemia survivors affect positive social adjustment and can further improve quality of life.

Effects of Topical Anesthetic Cream on Pain at Venipuncture in Children

PURPOSE: This study was done to evaluate the effectiveness of EMLA cream on pain related to venipuncture among children. METHODS: In this study, 48 children were evaluated using a sequential measurement for level of pain by Skin Conductance Level (SCL) based on Galvanic Skin Response (GSR), heart rate, and the Visual Analogue Scale (VAS) at four times. RESULTS: The maximum and mean of the SCL were each significantly different between the experimental and control groups and furthermore, the two were also significantly different among observed times. In addition there was a significant interaction between group and time. The children's perceived pain using VAS was not significantly different between the experimental and control groups. There was no significant difference in the heart rate between the experimental and control groups; however, the interaction between group and time was significant. CONCLUSION: In conclusion, applying topical anesthetic cream to the venipuncture site to reduce pain was effective among the children and therefore it is highly recommended that topical anesthetic cream be applied at the venipuncture site as a nursing intervention to reduce pain when a child has to undergo a venipuncture.

Development and Effects of a Health Education Program for North Korean Preschool Defectors

PURPOSE: This study was conducted to develop a health education program for preschoolers who have defected from North Korea with their mothers, and to evaluate the effects on health knowledge and behavior. METHODS: A non-equivalent control group pre-post test design was used with 58 preschoolers who were assigned to either the experimental or control group (29 for each group). The program was composed of five sessions in health education and contracts. To test the effectiveness of the intervention, health knowledge and behaviors, and total bacterial colony counts on hands were measured at one pretest and two post tests (1 week and 4 weeks after the intervention ended). Data were analyzed using the SAS program. RESULTS: Health knowledge and behavior in the experimental group increased significantly compared to the control group. The effects of the intervention were evident even at 4 weeks after the intervention ended. Total bacterial colony counts in the experimental group decreased significantly at the 1 and 4 week posttest intervention compared to the control group. CONCLUSION: Results indicate that this program is effective in improving health knowledge and behavior in these children and therefore can be utilized to ensure efficient management their health care.

Quality of Life in Children and Adolescents with Cancer

PURPOSE: This study was done to provide basic data for developing nursing interventions to enhance quality of life of pediatric patients with cancer (children and adolescents) by examining the quality of life and related factors. METHODS: Participants were 134; 67 pediatric patients and 67 parents. The PedsQL(TM) 3.0 Cancer Module was employed to measure quality of life in the participants. The related factors included general and clinical characteristics of the participants. RESULTS: Mean score for quality of life in the patients was 75.07, and mean score for patient quality of life as perceived by their parents was 64.40. Among the quality of life subscales, treatment anxiety had the highest score whereas nausea had the lowest score. Mean score in adolescent patients (13-18 years of age) was 71.62, lower than the 78.04 for child patients (8-12 years of age). Regarding general and clinical characteristics of the participants, there were no significant differences in the scores. CONCLUSION: The results indicate that there is difference in perception of quality of life between patients and their parents, and between children and adolescents and these differences should be taken into account when planning and providing nursing care.

Effects of Covering Newborn's Head after Bath on Body Temperature, Heart Rate and Arterial Oxygen Saturation

PURPOSE: In this study changes were observed in body temperature, heart rate and arterial oxygen saturation (SaO2) of newborns after bathing and to determine the effects of covering their heads with cotton hats after bathing. METHODS: Participants were 58 newborn infants, 31 in the experimental group had their heads covered with cotton hats after their bath while 27 in the control group did not. Body temperature, arterial oxygen saturation and heart rate were measured at 8 consecutive times after bathing. Data were analyzed using t-test and repeated measures ANOVA. RESULTS: Body temperature declined shortly after bathing. The experimental group showed faster recovery (p<.001). Heart rate increased after bathing in both groups. Heart rate in the experimental group decreased for 120 minutes and gradually increased to baseline (p<.001). In the control group, heart rate decreased for 180 minutes and then increased but did not reach the baseline (p<.001). Arterial oxygen saturation decreased shortly after bathing and recovery to the baseline was more rapid in the experimental group (30 minutes vs. 60 minutes) (p<.001). CONCLUSION: With significant changes observed in newborns' body temperature, arterial oxygen saturation and heart rate, covering the head right after bathing is effective in stabilizing infants' physiological system.

Sexual Knowledge and Perception and Current Status of Sex Education among Parents of First and Second Grade Elementary Schoolers

PURPOSE: This study was done to identify sexual knowledge and perception and current status of sex education among parents of first and second grade elementary school age children. METHODS: Participants in the study were recruited from parents with a child in the lower grades and who resided in Seoul. From January 1 to February 28, 2011, data were collected using a self-report questionnaire. Data were analyzed using McNemer test, paired t-test, ANONA, and Scheffe test. RESULTS: Mean sexual knowledge scores for fathers and mothers were 27.74+/-4.94, and 28.62+/-4.70 respectively. Parent's sexual knowledge correlated with their occupation, education level, and family's monthly income. CONCLUSION: Study results showed that both parents are aware of the need for sex education. However, at home, mothers have a more active attitude towards sex education and conduct the education more often than fathers.

Analysis of Research Trends in Papers Published in the Journal of Korean Academy of Child Health Nursing (2005-2009)

PURPOSE: The purpose of this study was to analyze papers published in the Journal of Korean Academy of Child Health Nursing (JKACHN) to identify the current state of child health nursing research and recommend directions for future research. METHODS: Using analysis criteria developed by the researchers, 233 papers published in JKACHN between 2005 and 2009 were reviewed. RESULTS: Both quantity and quality of these papers showed significant improvement compared to before 2005. The number of published papers, the proportion of intervention studies, and studies that involved children directly as participants had increased. However, published papers still leave much to be desired. Quantitative studies were dominant (91.4%) and many of these studies were survey designs (65.7%). Children, especially young children were still less likely to be direct participants. All experimental studies were quasi or pre-experimental studies. There were few qualitative research studies. CONCLUSION: Findings of this study indicate that strengthening peer review according to review guidelines will improve the quality of published papers and promote JKACHN as an international journal. Instead of proxy accounts from parents or nurses, research involving direct accounts by children is needed. Child-friendly data collection methods need to be developed and used by child health nurse researchers.