A Structural Equation Model on Social Re-Adjustment of Stroke Patients: Based on Roy’s Adaptation Model

Purpose@#This study aimed to develop and test a structural equation model on social re-adjustment of individuals with stroke based on a literature review and Roy’s adaptation model. @*Methods@#This study involved 321 participants who had a stroke and visited the outpatient department after discharge. The hypothetical model was developed based on Roy’s adaptation model and a comprehensive review of previous literature on the topic. The model comprised four exogenous variables (neurological damage, gender [man], age, and social support) and five endogenous variables (activities of daily living, acceptance of disability, depression, rehabilitation motivation, and social re-adjustment). The data were analyzed using SPSS Windows software version 22.0 and AMOS 23.0. @*Results@#Out of 28 research hypotheses, 18 were supported, and they indicated approximately 64% probability of social re-adjustment. Social re-adjustment is directly and significantly affected by age, social support, activities of daily living, and depression. Social re-adjustment is indirectly affected by neurological impairment, gender (men), age, social support, and rehabilitation motivation. @*Conclusion@#Continuous assistance and care should be provided for individuals with disabilities caused by sudden neurological damage to facilitate gradual improvement in their social re-adjustment. To enhance social re-adjustment, especially among older adults, newly developed interventions should focus on improving their activities of daily living, preventing depression, and enhancing support from family and healthcare personnel.

Factors Influencing the Quality of Life among Family Caregivers of the Elderly with Dementia / 기본간호학회지

Purpose@#The purpose of this study was to identify quality of life of family caregivers and to investigate factors positively and negatively affecting family caregivers’ quality of life. @*Methods@#Participants were 153 family caregivers taking care of dementia elderly. Collected data were general characteristics, quality of life, care burden, depression, social support, family relationship, and problematic behaviors. Data were analyzed using descriptive statistics, independent t-tests, Pearson correlation coefficient, and multiple regression. @*Results@#Mean age of participants was 58.70±13.88. The average scores of main variables for family relationship, social support, quality of life, care burden, problematic behaviors and depression were 3.99±1.08, 3.34±0.84, 3.00±0.63, 1.96±0.51, 1.48±1.06, 1.17±0.71 and 1.13±0.61, respectively. In regression analysis, depression (β=-.20), subjective health (β=.26), social support (β=.23), education level (β=-.20), and care burden (β=-.22) accounted for 59.1% of the variance in quality of life. @*Conclusion@#To increase quality of life for family caregivers, interventions should be focused on reducing depression and care burden, enhancing caregiver’s health and social support. especially for family caregivers who received lower education.

Effects of Low Intensity Exercise Training during Hemodialysis on Fatigue, Activity of Daily Living, Positive Psychological Capital, and Blood Pressure / 기본간호학회지

PURPOSE: The purpose of this study was to estimate the effects of a video low intensity exercise program provided during hemodialysis on fatigue, activity of daily living, positive psychological capital and blood pressure of patients being treated. METHODS: A non-equivalent control group pre-post test design was used. Participants were 85 hemodialysis patients assigned to either the experimental group (n=41) or the control group (n=44). The experimental group exercised for about 25 minutes 3 times a week for 8 weeks. Data analyses involved descriptive statistics, χ2 test, t-test, multiple regression and repeated measure ANOVA using SPSS/WIN 23.0. RESULTS: The exercise intervention significantly reduced post hemodialysis fatigue and significantly increased positive psychological capital. There was a significant interaction effect on time by group in blood pressure. Systolic blood pressure changes in the experimental group were stable but, changes in the control group tended to increase gradually. CONCLUSION: To reduce fatigue and increase positive psychological capital for hemodialysis patients, providing exercise during hemodialysis is recommended. Furthermore individualized exercise in terms of intensity, time, duration, etc should be developed and tested. Also, to reduce drastic blood pressure changes during hemodialysis, exercise should be provided.

Factors Influencing Quality of Life of Elderly People with Dementia / 기본간호학회지

PURPOSE: The purpose of this study was to identify the factors that affect quality of life in elderly people with dementia. METHODS: The participants for this descriptive correlational study were 97 elderly patients with dementia who were attending a daycare center or were being cared for at home. Data were collected from the participants using the Mini-Mental Status Examination-Dementia Scale, the Geriatric Depression Scale (Short Form), Activity of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) Scale. RESULTS: There were statistically significant differences in quality of life of elders with dementia according to mobility, using dementia day-care center, and cohabitation. In multiple regression analysis, depression, activity of daily of living, using dementia day-care centers and cohabitation were significant predictors of quality of life and the four variables explained 60% of the variance in quality of life. CONCLUSION: Findings indicate that to enhance the quality of life for elders with dementia, depression needs to be decreased and regular use of daycare service recommended. Further, various programs enhancing physical ability need to be developed and used with these elders.

Clinical Alarms in Intensive Care Units: Perceived Obstacles of Alarm Management and Alarm Fatigue in Nurses / 대한의료정보학회지

OBJECTIVES: The purpose of this descriptive study was to investigate the current situation of clinical alarms in intensive care unit (ICU), nurses' recognition of and fatigue in relation to clinical alarms, and obstacles in alarm management. METHODS: Subjects were ICU nurses and devices from 48 critically ill patient cases. Data were collected through direct observation of alarm occurrence and questionnaires that were completed by the ICU nurses. The observation time unit was one hour block. One bed out of 56 ICU beds was randomly assigned to each observation time unit. RESULTS: Overall 2,184 clinical alarms were counted for 48 hours of observation, and 45.5 clinical alarms occurred per hour per subject. Of these, 1,394 alarms (63.8%) were categorized as false alarms. The alarm fatigue score was 24.3 +/- 4.0 out of 35. The highest scoring item was "always get bothered due to clinical alarms". The highest scoring item in obstacles was "frequent false alarms, which lead to reduced attention or response to alarms". CONCLUSIONS: Nurses reported that they felt some fatigue due to clinical alarms, and false alarms were also obstacles to proper management. An appropriate hospital policy should be developed to reduce false alarms and nurses' alarm fatigue.

Cognitive Function, Physical Function, Problematic Behaviors of Elders using Dementia Daycare Service and Reasons for Stopping Daycare / 기본간호학회지

PURPOSE: Purpose of this retrospective study was to investigate cognitive function, physical function, and problematic behaviors of elders who attended dementia daycare centers, and to identify reasons why they stopped using the center. METHODS: Participants were 176 elders, 60 years or over, attending one of four dementia daycare centers in Incheon. Data were collected from center documents. RESULTS: Mean age was 80.5 years. When admitted to the centers mean scores for the mini-mental status examination, activity of daily living, and instrumental activity of daily living (IADL) were 12.31, 9.53, and 25.09 respectively. Participants received day care service for an average of 17.98 months. The reasons for leaving the center were worsening dementia and health (40.2%), and problematic behaviors (20.1%). CONCLUSION: Results show that elders began to use day care services when their cognitive function and IADL had declined considerably. As the ultimate goal of dementia daycare service is to delay the worsening of cognitive capability and decreases in activities daily living, the effect of the service can be maximized when the service is provided as early as possible in the course of progressively severe dementia. Active promotion should be exerted in the community to encourage early use of this service.

Prevention Effects of Graduated Compression Stockings and Intermittent Pneumatic Compression on Deep Vein Thrombosis in SICU Patients: Pilot Study / 기본간호학회지

PURPOSE: The purpose of this pilot study was to investigate the effects of mechanical interventions for deep vein thrombosis (DVT) prophylaxis in surgical intensive care unit (SICU) patients. METHODS: The participants were assigned to the intermittent pneumatic compression (IPC) and graduated compression stocking (GCS) intervention. Patients who met the criteria were selected for comparison from our previous study. Data for 140 patients were included in the final analysis. RESULTS: The mean age was 57.5 (+/-15.7) and 61.4% were men. About forty-seven percent of the participants were 61 years or over. In the second duplex scan, 3, 2 and 1 critically ill patients developed deep vein thrombosis in the control, GCS, and IPC groups, respectively. Incidences of DVT were 6.0%, 5.0%, and 2.0% for the control, GCS, and IPC groups, respectively. This difference was not significant. Relative risks of no intervention were 3.0 and 1.2 compared with IPC and GCS application. There were no significantly different variables among the three groups before the intervention except for diagnosis on admission. CONCLUSION: Although it may difficult to conclude that mechanical prophylaxis effectively prevents DVT among SICU patients because there was no statistical significance in this study, but incidence rates among the three groups differed greatly. The findings reveal that further study should be conducted with larger samples and randomized controlled trial for SICU patients.

Retraction: Risk Factors and Features of Critically Ill Patients with Deep Vein Thrombosis in Lower Extremities

This article is being retracted as a part of the manuscript was a 'duplicate publication' from an earlier publication.

Factors Influencing Compliance with Standard Precautions in Intensive Care Unit and Emergency Room Nurses / 기본간호학회지

PURPOSE: The purpose of this study was to investigate the level of knowledge, attitude and compliance with standard precautions and to identify predicting factors of compliance with standard precautions in ICU and ER nurses. METHODS: The participants were 228 ICU and ER nurses working in one of three university hospitals and one general hospital. Collected data included general characteristics, features related to infection risk, and knowledge, attitude and compliance with standard precautions. For the final analysis, 218 questionnaires were used. RESULTS: Within the previous one year, 103 (47.3%) nurses experienced pricking injury from syringe needles or other sharp materials, 111 (50.9%) nurses reported exposure to patients' blood and body fluid. In general, the scores for knowledge, attitude and compliance were all high. Compliance scores for nurses in intensive care units were significantly higher than those of nurses in emergency. There were significant correlations of knowledge, attitude, and compliance with standard precautions. Attitude and work place were significant factors predicting compliance with standard precautions. CONCLUSION: The results indicate that to increase nurse's compliance with standard precautions, continuous efforts to enhance positive attitudes and at the same time, improve work environments and use individualized approaches based on the work units are needed.

Trends in Research Studies Published in Journal of Korean Academy of Fundamentals of Nursing: 2009-2011 / 기본간호학회지

PURPOSE: The purpose of this study was to identify the trends in research studies published in Journal of Korean Academy of Fundamentals of Nursing from 2009 to 2011. METHODS: A total of 156 studies published between 2009 and 2011 were reviewed using analysis criteria developed by the researchers. RESULTS: Quantitative studies accounted for 90.4% and qualitative studies, 8.3%. The research designs for the quantitative studies were experimental, 28.0% and survey, 63.8%. IRB approval was received for only 25.6% of the studies and 61.0% of studies presented participant criteria. Questionnaires were used for data collection in 90.8% of studies. Individual or group education was the most frequent intervention in the experimental studies. CONCLUSION: The results indicate that more randomized controlled trials with a low risk of bias are needed to support greater evidence-based nursing practice. Considering the low rate of ethical consideration, it is important that stricter application of research methods needs to be encouraged to improve the quality of Journal of Korean Academy of Fundamentals of Nursing.

Comparison of Factors Affecting Nursing Professionalism Perceived by Nursing Students Anticipating Graduation According to Nursing Educational System / 기본간호학회지

PURPOSE: The purpose of this study was to compare nursing professionalism between diploma students and bachelor students and to identify differences in factors affecting nursing professionalism according to nursing educational system. METHODS: The participants were 462 nursing students who had completed all clinical practicum courses. Of these students, 255 were from one of 2 diploma degree colleges and 207 were from one of 3 bachelor degree universities. Collected data included general characteristics, professionalism, nursing image, self-efficacy, satisfaction with nursing as a major, and satisfaction with clinical practice. RESULTS: Age, religion, grade point average, motivation for admission, nursing professionalism and satisfaction with clinical practice were significantly different between diploma and bachelor students. Image of nurse, satisfaction with nursing as a major and satisfaction with clinical practice were common factors influencing nursing professionalism in both groups. Self-efficacy was a significant factor only for diploma degree students and religion was a significant factor only for bachelor degree students. CONCLUSION: For more positive nursing professionalism by students, more attention should be paid to enhancing positive nurse images, satisfaction with nursing as a major and satisfaction with clinical practice during the students' period of study.

Risk Factors and Features of Critically Ill Patients with Deep Vein Thrombosis in Lower Extremities

PURPOSE: The purpose of this study was to identify the features, risk scores and risk factors for deep vein thrombosis in critically ill patients who developed deep vein thrombosis in their lower extremities. METHODS: The participants in this prospective descriptive study were 175 adult patients who did not receive any prophylactic medication or mechanical therapy during their admission in the intensive care unit. RESULTS: The mean age was 62.24 (+/-17.28) years. Men made up 54.9% of the participating patients. There were significant differences in age, body mass index, and leg swelling between patients who developed deep vein thrombosis and those who did not have deep vein thrombosis. The mean risk score was 6.71(+/-2.94) and they had on average 4.01(+/-1.35) risk factors. In the multiple logistic regression, body mass index (odds ratio=1.14) and leg swelling (odds ratio=6.05) were significant predictors of deep vein thrombosis. CONCLUSION: Most critically ill patients are in the potentially high risk group for deep vein thrombosis. However, patients who are elderly, obese or have leg edema should be closely assessed and more than one type of active prophylactic intervention should be provided.

Content and Educational Needs for Fundamental Nursing Practice / 기본간호학회지

PURPOSE: The purpose of this study was to identify content of Fundamental Nursing Practice (FNP) and the educational needs for nursing practice items in schools of nursing. METHODS: Participants were 81 professors who were teaching FNP and 166 clinical nurses. The research questionnaire included 148 practice items, which were selected by content analysis of 7 FNP textbooks. Data were collected from May 20 to July 27, 2011 and analyzed using descriptive statistics and t-test with SPSS 17.0. RESULTS: The research findings showed that : 1) the seven items included in the education content of all schools of nursing were putting on sterile gloves, checking radial pulse, checking blood pressure in the arm, Foley catheterization, injection preparation with ampule, intramuscular injection in the buttocks, and mixing intravenous fluid. Fifty items were included in the content in more than 80% of the schools. 2) Educational domains needing emphasis were medication, infection control, health assessment, oxygenation, urinary elimination, activity/positioning, and nutrition. There were significant differences in reported educational needs between professors and clinical nurses for 62.8% of practice items. CONCLUSIONS: Results indicated that standardization of FNP education contents using the findings of this study should lead to improvement in quality of FNP education.

Effects of Aroma Hand Massage on the Stress Response and Sleep of Elderly Inpatients / 기본간호학회지

PURPOSE: This study was done to examine the effects of aroma hand massage on stress response and sleep in hospitalized elderly patients. METHODS: A non-equivalent pre-and post-test design was used. Sixty-six hospitalized patients were recruited using a convenience sampling method and assigned to the experimental (n=34) or the control group (n=32). For the experiment, bergamot, lavender, and roman camomile oil were mixed in 2:1:1 ratio to provide aroma hand massage to both hands of each patient in the experimental group for 5 minutes per hand, for 3 days. Post-test data collection was conducted three days after completion of the hand massage. RESULTS: The experimental group had significantly lower stress score (t=-2.648, p=.010, and anxiety scores (t=-4.166, p=.000), and higher sleep measurement scores (t=2.328, p=.023) than those in the control group. CONCLUSION: These results indicate that short-term application of aroma hand massage for hospitalized elderly patients has a positive effect on hospitalization stress, anxiety, and sleep. Therefore, aroma hand massage should be applied as a nursing intervention to reduce stress response and enhance sleep in elderly hospitalized patients.

Relationship between Intake and Output Balance and Body Weight Changes in Intensive Care Unit Patients / 기본간호학회지

PURPOSE: The purpose of this study was to identify differences between intake and output balance and body weight changes and to identify factors related to differences in critically ill patients. METHODS: The participants for this descriptive correlational study were 65 medical surgical ICU patients. The data were collected from patient medical records. RESULTS: Mean age of the patients was 63.80 years (+/-15.21). Body weight changes for 48 hours averaged 281.54g (+/-2210.48). I&O balance for 48 hours corrected for insensible loss averaged 398.1mL. Differences ranged from 45mL to 7,535mL. In the distribution of absolute difference between body weight change and intake and output balance, only 40% of the patients were within less than 1,000mL. Factors relating to accurate measure of intake and output were ventilation methods, respiration patterns, and edema status. CONCLUSION: Although mean values of weight change and I&O balance for all patients were very close, the range of differences was very wide indicating that, for many patients, intake and output is not an appropriate indicator of body fluid balance. Therefore, because of the frequency fever and/or hyperventilation, nurses need to use caution when using intake and output balance only to estimate current body fluid status for critically ill patients.

Adequacy of Nutritional Support and Reasons for Underfeeding in Neurosurgical Intensive Care Unit Patients

PURPOSE: The purpose of the study was to identify the adequacy of enteral feeding, and the reason and prevalence of under-nutrition, and to determine the relationships between caloric intake and resulting nutritional parameters among neurosurgical intensive care unit (ICU) patients. METHODS: The participants for this descriptive study were 47 neurosurgical ICU patients who had enteral feeding initiated after ICU admission. Data were collected from the initial day of enteral feeding for 7 days. Data related to enteral feeding, feeding interruptions or delay, prealbumin, and transferrin were collected. RESULTS: The mean age of the participants was 56.62 years. Twenty-six patients did not receive their feeding formula more than once during 7 days, and 11 had interruptions more than 6 times. The mean number of feeding interruptions was 3.23 (SD= 4.47). On the average, only 76.44% of the estimated energy requirement was provided by enteral feeding to the patients. The frequency of underfeeding was 52.17% with respect to enteral feeding. The most frequent reason for the feeding interruption was observation before and after intubation and extubation, which was unavoidable. The next most common reason was gastrointestinal bleeding, mostly due to old clots or trace, followed by residual volume less than 100 mL. Changes in prealbumin and transferrin levels for 7 days between the underfed and adequately fed groups were not statistically significant. CONCLUSION: The management of enteral feeding by nurses was overprotective because of the unpredictable nature of ICU patients in terms of their underlying disease process. The management of feeding intolerance needs to be evidence-based and nurses must consistently follow the protocol that has been supported as a useful measure.

Gender Differences in Factors Influencing Quality of Life among Patients with Coronary Artery Disease / 기본간호학회지

PURPOSE: The purpose of this study was to identify the level of quality of life and gender differences in predictors of quality of life among patients with coronary artery disease. METHODS: Participants for this descriptive survey were 67 men and 65 women who signed informed consents. They were patients who had undergone coronary artery bypass graft surgery or percutaneous transluminal coronary angioplasty, or were on medication therapy after a heart attack. The Short-Form Health Survey (SF-36), Personal Resource Questionnaire-part (II), and the Center for Epidemiologic Studies Depression Scale were used to measure quality of life, social support, and depression respectively. Gender and age were controlled because they were reported as influencing factors in previous studies. RESULTS: There were significant differences in depression and quality of life between men and women however, social support was not significantly different by gender. In multiple regression analysis, depression was a significant predictor and explained 51.9% of quality of life for men. In women, depression and social support were significant predictors and explained 50.9% of quality of life. CONCLUSION: Factors influencing quality of life for men and women were different, and therefore, nurses need to consider their patients' gender and use specific strategies to improve quality of life for patients with coronary artery disease.

Nutritional Status and Indicators of Intensive Care Unit Patients on Enteral Feeding / 기본간호학회지

PURPOSE: The purpose of this study was to identify the nutritional status and to compare nutritional indicators by caloric intake for intensive care unit patients. METHODS: The participants for this descriptive investigation were 62 patients who were admitted to medical and surgical ICUs and started on enteral feeding. Data were collected in a tertiary hospital and the patients were followed for 7 days after enteral feeding was initiated. For analysis, patients who received 80% less calories than their required level were categorized as the underfed group and patients who received more than 80% to their required level, as the adequately fed group. RESULTS: Compared to daily requirements, the prescribed calories and protein for patients overall were 77.39% and 64.75% respectively. The level of calories and protein given was less than their prescription. However, a comparison of the underfed group and the adequately fed group, showed that there was no significantly difference in albumin, prealbumin and transferrin. Only body weight was significantly different between the groups. C-reactive protein had a significant correlation with prealbumin and transferrin. CONCLUSION: Underfeeding is a common phenomenon among ICU patients. Nutritional indicators such as prealbumin, albumin and transferrin may not sensitive indicators to assess nutritional status of ICU patients.

Factors Influencing Care Burdens of Caregivers of Elders with Dementia who Request Dementia Domiciliary Welfare Services / 기본간호학회지

PURPOSE: The purpose of the study was to identify the factors, which predict care burden perceived by caregivers of elders with dementia. METHODS: The participants in this descriptive survey were 92 caregivers who used one of six daycare centers located in Incheon. The data were collected by questionnaires composed of items on general characteristics of the elders and caregivers, care burden, caregiver fatigue, and functional status of the elders. RESULTS: General characteristics of the elders associated with care burden were age, gender, religion, and the presence of a spouse. Features of caregivers related to care burden were education, relationship with elderly, amount of rest, intention to care, monthly family income, and perceived family economic status. There were significant correlations among care burden, fatigue of caregiver and functional status of the elders. In stepwised multiple regression analysis, significant influencing factors were identified as caregiver fatigue, functional status of the elders, intention to care, relationship with the elders, amount of rest and elder's gender. Those variables explained 46% of variance of care burden. CONCLUSION: Functional status of elders and amount of rest were significant predictors and are supported by other previous studies. Future interventions for caregivers need to be focused on the slowing down of functional status of elders and increasing of number and length of caregiver's rest periods.

A Study on the Use of Sedatives, Analgesics & Muscle relaxant for Mechanically Ventilated Patients

The purpose of this study was to investigate the administration pattern of sedatives, analgesics, and muscle relaxants for mechanically ventilated patients. The subjects of this descriptive study were 21 adult patients who received mechanical ventilation therapy more than 3 days in SICU. The results of this study are as follows: 1. The mean age of the subjects was 52 years old. Ten out of 21 subjects were female and 11 patients were male. 2. The 13 different drugs were prescribed for the patients. There were 325 total doses administered for 3 days to these patients. Most frequently used medication was midazolam. On average, the patients were received 2.5 different drugs. 3. The number of administered drug and the frequency of administration differed depending on the type of surgery which the patients had undergone. 4. Examination on the administration pattern of midazolam revealed that patients received midazolam by continuous intravenous infusion (19%), by intermittent intravenous injection (33%), and by both continuous and intermittent method (19%). 5. About 42% of patients received neuromuscular blocking agents with sedatives or analgesics. None of them was given paralytic agents without sedatives or analgesics. Future study should be focused on the evaluation of the adequacy of current practice for sedation and paralysis in terms of the patient's response.