The Development of a Tool for Assessment of Spiritual Distress in Cancer Patients

Purpose@#This study was conducted to develop a scale to measure spiritual distress in cancer patients. @*Methods@#A total of 69 preliminary items for the spiritaul distress assessment tool (SDAT) were compiled, based on a literature review, selection of empirically relevant items through concept analysis of hybrid models, confirmation of content validity by experts, cognitive interviews, and a pretest. Self-administered questionnaires were collected between April 1 and July 31, 2018, from 225 cancer patients at four medical institutions and one nursing home. The data were analyzed using item analysis, exploratory factor analysis, convergent and discriminant validity, and Pearson correlation for criterion validity. Reliability was tested by Cronbash’s α coefficient. @*Results@#The final version of the SDAT consisted of 20 items. Five-factors, loss of peace, burden of family, avoidance of confronting death, guilt and remorse, regret for not being able to apololgize and forgive were extracted, and showed 62.8% of total variance. The factors were confirmed through convergent and discriminant validity. Criterion validity was confirmed by functional assessment chronic illness therapy spiritual well-being scale 12 (FACIT-Sp12). The overall Cronbach’s α was .91, and the coefficients of each subscale ranged from .78~.83. @*Conclusion@#The SDAT for cancer patients is valid and reliable. It is suggested that the tool can be used to measure spiritual distress in cancer patients.

Concept Analysis of Illness Acceptance in Chronic Disease: Application of Hybrid Model Method / 기본간호학회지

Purpose@#This study was done clarify the concept of illness acceptance in patients with chronic disease. @*Methods@#This study was conducted using a hybrid model of concept analysis that consists of three phases. In the theoretical phase, a working definition was formulated through a systematic review. In the fieldwork phase, five participants who had diabetes or hypertension for at least one year were interviewed. In the third phase, the results were combined in the final analysis. @*Results@#There are three phases of accepting an illness: experiencing the limits, disease management, and designing new life. At the experience of the limits and disease management stages, the attributes of physical, psychological and social domains were derived, but at the stage of designing their new life, integrated attributes of these three domains were derived. @*Conclusion@#Illness acceptance of chronic disease was defined as a continuous and dynamic process in three phases. First, patients experience limitations due to the disease, such as physical illness, psychological instability, and difficulty performing social roles. Second, patients manage the disease by engaging in self-management, psychological coping strategies, and establishing social support. Third, patients design their new life by seeking better health-related quality of life and integrating the illness into their everyday life. However, patients experienced negative changes when disease management was not performed properly. The fact that illness acceptance could be cyclic means the difference between illness and loss/death acceptance. Nurse should develop and provide an integrated nursing intervention that is appropriate for phases of illness acceptance.

A Systematic Review of Measurement Properties of Spirituality related Assessment Tools Published in Korean Journals / 기본간호학회지

Purpose@#The purpose of this study was to evaluate the measurement properties of spirituality-related assessment tools published in Korean journals. @*Methods@#The databases used to search the literature reporting use of the spirituality-related assessment tools were RISS, NDSL, DBpia, KoreaMed, and KISS. The quality of the measurement properties was evaluated based on the reported internal consistency, content validity, criterion validity, construct validity, reproducibility, responsiveness, floor-ceiling effects and interpretability based on the tools review criteria suggested by Terwee et al. @*Results@#Twenty-five assessment tools (including 7 original Korean versions) were identified from the 208 Korean studies published up to November, 2016. All of the 25 tools reported internal consistency and content validity; construct validity was reported in 21 tools while only six tools had reported on criterion validity. None of the studies reported on the reproducibility, responsiveness, and floor-ceiling effects. Among 25 spirituality-related assessment tools, the spiritual well-being scale was identified as the most commonly used tool for spirituality assessment. @*Conclusion@#Among 25 spirituality-related assessment tools used in Korean studies, all of them satisfied only three criteria out of the eight criteria for measurement properties, internal consistency, content validity, and interpretability. The results of this study provide evidence to develop reliable and valid tools that will satisfy the criteria for measurement properties. In addition, standardized, reliable, and valid assessment tools must be chosen for spirituality-related study.

Development and Validation of the New Version of Spirituality Assessment Scale

PURPOSE@#The purpose of this study was to develop a new version of Spirituality Assessment Scale (N-SAS) and verify its reliability and validity.@*METHODS@#The total of 59 preliminary items for the N-SAS were selected through a literature review, two rounds of experts' content validation, cognitive interviews, and pre-tests. Verification of its reliability and validity was divided into two phases. In Phase I, questionnaires were collected from 219 adults. Reliability was tested using Cronbach's alpha, validity with item analysis, and exploratory factor analysis. In Phase II, questionnaires developed based on the results of Phase I were collected from 225 adults. Reliability was tested using Cronbach's alpha, validity with confirmatory factor analysis, and criterion validity.@*RESULTS@#The final version of the N-SAS comprised two dimensions (vertical and horizontal), four domains (relationship with God; meaning of life and self-integration; self-transcendence; and relationship with others, neighborhoods, and nature), and 44 items were identified. Total Cronbach's α was .97; those of each subscale ranged from .79 to .98. N-SAS scores were positively correlated with the scores of Howden's Spiritual Assessment Scale (r=.81, p<.001).@*CONCLUSION@#Findings suggest that the N-SAS can be used to measure spirituality in adults. The use of N-SAS is expected to facilitate perceiving patient's spiritual needs and providing spiritual care.

Development and Validation of the New Version of Spirituality Assessment Scale / 간호학회지

PURPOSE: The purpose of this study was to develop a new version of Spirituality Assessment Scale (N-SAS) and verify its reliability and validity.METHODS: The total of 59 preliminary items for the N-SAS were selected through a literature review, two rounds of experts' content validation, cognitive interviews, and pre-tests. Verification of its reliability and validity was divided into two phases. In Phase I, questionnaires were collected from 219 adults. Reliability was tested using Cronbach's alpha, validity with item analysis, and exploratory factor analysis. In Phase II, questionnaires developed based on the results of Phase I were collected from 225 adults. Reliability was tested using Cronbach's alpha, validity with confirmatory factor analysis, and criterion validity.RESULTS: The final version of the N-SAS comprised two dimensions (vertical and horizontal), four domains (relationship with God; meaning of life and self-integration; self-transcendence; and relationship with others, neighborhoods, and nature), and 44 items were identified. Total Cronbach's α was .97; those of each subscale ranged from .79 to .98. N-SAS scores were positively correlated with the scores of Howden's Spiritual Assessment Scale (r=.81, p<.001).CONCLUSION: Findings suggest that the N-SAS can be used to measure spirituality in adults. The use of N-SAS is expected to facilitate perceiving patient's spiritual needs and providing spiritual care.

Trends of Concept Development in Nursing Published in Korean Journals

Purpose@#The purpose of this study was to identify trends of nursing concept development in Korean journal papers to improve accurate understanding of nursing concepts. @*Methods@#A systematic review of 216 concept development articles published from 1970 to 2018 that met the inclusion criteria was conducted using Research Information Sharing Service (RISS) databases. @*Results@#The most common method of concept development was Walker and Avant’s concept analysis method, identified in 139 (64.3%) of the 216 studies, followed by 48 examples of hybrid models (22.2%) and 15 examples of evolutionary methods (6.9%). Chinn and Kramer’s method, Norris’s clarification, Wilson’s method, and others were also used. The concepts of “spirituality” and “fatigue” were most frequently analyzed. Among the 139 studies that used Walker and Avant’s concept analysis method, 127 studies (91.4%) applied all the recommended steps; the others applied the recommended steps partially, omitting description of model cases/additional cases, antecedents/consequences, and empirical indicators. Among the studies using the hybrid model, among two (5.7%) did not describe attributes, three (8.5%) did not provide definitions, and 16 (45.7%) did not present empirical indicators in the final stage. @*Conclusion@#Among concept development studies published in Korean journals, Walker and Avant’s concept analysis method is most commonly used. In case of most studies using Walker and Avant’s method a suitable concept analysis process is applied, but in case of other studies using the other concept development method, a suitable concept analysis process is not applied. Therefore, a suitable concept analysis process must be applied for concept development in nursing research.

Development and Validation of the New Version of Spirituality Assessment Scale

PURPOSE@#The purpose of this study was to develop a new version of Spirituality Assessment Scale (N-SAS) and verify its reliability and validity.@*METHODS@#The total of 59 preliminary items for the N-SAS were selected through a literature review, two rounds of experts' content validation, cognitive interviews, and pre-tests. Verification of its reliability and validity was divided into two phases. In Phase I, questionnaires were collected from 219 adults. Reliability was tested using Cronbach's alpha, validity with item analysis, and exploratory factor analysis. In Phase II, questionnaires developed based on the results of Phase I were collected from 225 adults. Reliability was tested using Cronbach's alpha, validity with confirmatory factor analysis, and criterion validity.@*RESULTS@#The final version of the N-SAS comprised two dimensions (vertical and horizontal), four domains (relationship with God; meaning of life and self-integration; self-transcendence; and relationship with others, neighborhoods, and nature), and 44 items were identified. Total Cronbach's α was .97; those of each subscale ranged from .79 to .98. N-SAS scores were positively correlated with the scores of Howden's Spiritual Assessment Scale (r=.81, p<.001).@*CONCLUSION@#Findings suggest that the N-SAS can be used to measure spirituality in adults. The use of N-SAS is expected to facilitate perceiving patient's spiritual needs and providing spiritual care.

Affecting Factors of Health Behavior Adherence depending on the Duration of the Hypertension Diagnosis / 재활간호학회지

PURPOSE: This study was to analyze health behavior adherence and identify affecting factors on the duration of the hypertension diagnosis. METHODS: A total of 154 patients of hypertension participated in this study. Data were collected from October to December, 2013 and analyzed using frequency, t-test, ANOVA, multiple linear regression. RESULTS: The scores of health behavior adherence and hypertension knowledge in incidental hypertension patients were 82.23±9.69, 17.86±4.33, respectively. In the treated hypertension patients, the scores of health behavior adherence were 89.30±10.17 and hypertension knowledge were 18.54±3.89. The selected independent variables explained 34% of the health behaviors in the incidental hypertension patients and 36% of the health behaviors in the treated hypertension patients. The regression models were statistically significant (F=4.37, p < .001, F=4.45, p < .001). Among selected potential influencing factors, age (β=.423, p < .001), smoking habit (β=−.227, p=.038), obesity (β=.369, p=.030), hypertension knowledge (β=.281, p=.007), coping strategies (β=.261, p=.015). affect health behavior adherence in the incidental hypertension. In the treated hypertension patients were age (β=.362, p=.007), sex (β=−.396, p=.004), smoking habit (β=−.245, p=.022), perceived health status (β=−.238, p=.035) affect health behavior adherence. CONCLUSION: There was difference about health behavior adherence between newly diagnosed and treated hypertension patients. So different approaches for incidental and treated hypertensive patient need to improve health behavior through tailored nursing intervention.

Corrigendum: Evolutionary Concept Analysis of Spirituality

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Concept Analysis of Female Sexual Subjectivity based on Walker and Avant's Method

PURPOSE: The purpose of this study was to clarify attributes, antecedents, and consequences of female sexual subjectivity. METHODS: Walker and Avant's concept analysis process was used to analyze 27 studies from the current literature that relates to female sexual subjectivity. A systematic literature review of women's study in sociology, psychology, theology, law, health science, and nursing was reviewed. RESULTS: The defining attributes of female sexual subjectivity were sexual self-awareness, sexual decision making, sexual desire, and good sexual communication with partner. The antecedents of female sexual subjectivity were social environment, sexual education, sexual experience, and interpersonal relationship. The consequences of female sexual subjectivity were safe sex, prevention of sexual victimization, and sexual satisfaction. CONCLUSION: Female sexual subjectivity is defined as sexual self-awareness, sexual decision making, sexual desire to seek sexual pleasure and safety, and effective communication with partner in terms of sexual behavior, sexual experience and sexual health. Based on these results, a scale measuring female sexual subjectivity is needed.

Evolutionary Concept Analysis of Spirituality

PURPOSE: This study was done to clarify attributes, antecedents, and consequences of spirituality. METHODS: Rodgers's evolutionary concept analysis was used to analyze fifty seven studies from the literature related to spirituality as it appears in systematic literature reviews of theology, medicine, counseling & psychology, social welfare, and nursing. RESULTS: Spirituality was found to consist of two dimensions and eight attributes: 1) vertical dimension: ‘intimacy and connectedness with God’ and ‘holy life and belief’, 2) horizontal dimension: ‘self-transcendence’, ‘meaning and purpose in life’, ‘self-integration’, and ‘self-creativity’ in relationship with self, ‘connectedness’ and ‘trust’ in relationship with others·neighbors·nature. Antecedents of spirituality were socio-demographic, religious, psychological, and health related characteristics. Consequences of spirituality were positive and negative. Being positive included ‘life centered on God’ in vertical dimension, and among horizontal dimension ‘joy’, ‘hope’, ‘wellness’, ‘inner peace’, and ‘self-actualization’ in relationship with self, ‘doing in love’ and ‘extended life toward neighbors and the world’ in relationship with others·neighbors·nature. Being negative was defined as having ‘guilt’, ‘inner conflict’, ‘loneliness’, and ‘spiritual distress’. Facilitators of spirituality were stressful life events and experiences. CONCLUSION: Spirituality is a multidimensional concept. Unchangeable attributes of spirituality are ‘connectedness with God’, ‘self-transcendence’, ‘meaning of life’ and ‘connectedness with others·nature’. Unchangeable consequences of spirituality are ‘joy’ and ‘hope’. The findings suggest that the dimensional framework of spirituality can be used to assess the current spiritual state of patients. Based on these results, the development of a Korean version of the scale measuring spirituality is recommended.

Factors Influencing Nursing Students' Performance of Infection Control / 기본간호학회지

PURPOSE: This study was done to investigate the level of nursing students' awareness, attitude, safety climate, and performance of infection control, and to identify factors influencing performance. METHODS: The sample consisted of 239 nursing students from 5 nursing schools. Data were collected from November 15 to December 11, 2013 and analyzed by frequency, t-test, ANOVA, Pearson correlation coefficients, and multiple stepwise regression with SPSS/WIN 21.0. RESULTS: Of the participants, 216 (90.4%) had experienced contact with infectious diseases. The performance of personal hygiene was scored the highest followed by standard precautions, transmission precautions, and vaccination. There were significant correlations between awareness, attitude, safety-climate and performance. Awareness, safety-climate, attitude, contents of infection control education, and direct exposure to infectious disease collectively explained 30% of the variance in performance, and awareness was the most influential factor. CONCLUSION: The results indicate that performance of infection control by nursing students can be increased if awareness, safety climate, attitude, and contents of infection control education are improved, and exposure to infectious disease is decreased. These findings can be utilized to improve performance by developing education programs for infection control.

Perception and Performance about Patients' Medical Information Protection in Allied Health College Students / 한국간호교육학회지

PURPOSE: This study aims to identify perception, performance, and the related factors of performance in regards to patients' medical information protection among allied health college students. METHODS: Four hundred twelve subjects from three colleges located in Jeonbuk and Kyungbuk province consented to participate. Data was collected from November 28 to December 15, 2012. To assess perception and performance in regards to patients' medical information protection, a self-reporting questionnaire was used. Data was analyzed via SPSS 18.0 program. RESULTS: The score of perception and performance about patients' medical information protection were 4.07 and 3.56, respectively. All item's scores of performance were significantly lower than those of perception. The perception score was significantly different according to recognition of hospital ethics code (t=1.95, p=.052), and recognition of association ethics code (t=2.88, p=.004). The performance score was significantly different according to gender (t=-3.32, p=001), major (F=14.41, p<.001), clinical practicum hospitals (F=8.22, p<.001), and method of electronic medical record access (F=3.23, p=.023). The factors influencing performance were perception(beta=.46, p<.001), duration of clinical practice(beta=-.36, p<.001), and gender(beta=.09, p=.033). CONCLUSION: In order to improve performance in regards to patients' medical information protection of allied health college students, we should develop ethical education programs and standardize them through multidisciplinary collaboration.

The Effects of Learning Styles and Nursing Professional Attitude on Problem-Solving Ability among Nursing Students / 한국간호교육학회지

PURPOSE: The effects of learning styles and nursing professional attitude on the problem-solving ability among nursing students were explained. METHODS: A cross-sectional descriptive study was performed with 245 nursing students who completed self-report questionnaires between April 14 and May 7, 2014. RESULTS: The dominant learning styles of the nursing students were assimilating (33.9%) and diverging (33.1%), with converging (11.4%) being the least dominant. Nursing professional attitude in the nursing students was high (mean 65 out of 80). Problem-solving ability in the nursing students was high (mean 159 out of 225), especially among seniors. The relationship between learning styles and problem-solving ability in nursing students was not statistically significant (F=2.44, p=.065), even though nursing students with converging learning style had higher problem-solving ability than nursing students with other learning styles. The problem-solving ability of nursing students was influenced by nursing professional attitude, being a senior and preference for discussion. These variables explained 16.9% of the variance in problem-solving ability. Nursing professional attitude with 12.3% was the most influential. CONCLUSION: The problem-solving ability of nursing students was more influenced by nursing professional attitude than by learning styles. Therefore, we suggest strategies to develop a positive nursing professional attitude that leads to promoting the problem-solving ability of nursing students.

The job analysis of Korean nurses as a strategy to improve the Korean Nursing Licensing Examination / 보건의료교육평가

PURPOSE: This study aimed at characterizing Korean nurses' occupational responsibilities to apply the results for improvement of the Korean Nursing Licensing Examination. METHODS: First, the contents of nursing job were defined based on a focus group interview of 15 nurses. Developing a Curriculum (DACOM) method was used to examine those results and produce the questionnaire by 13 experts. After that, the questionnaire survey to 5,065 hospital nurses was done. RESULTS: The occupational responsibilities of nurses were characterized as involving 8 duties, 49 tasks, and 303 task elements. Those 8 duties are nursing management and professional development, safety and infection control, the management of potential risk factors, basic nursing and caring, the maintenance of physiological integrity, medication and parenteral treatments, socio-psychological integrity, and the maintenance and improvement of health. CONCLUSION: The content of Korean Nursing Licensing Examination should be improved based on 8 duties and 49 tasks of the occupational responsibilities of Korean nurses.

Effect of Perception of Career Ladder System on Job Satisfaction, Intention to Leave among Perioperative Nurses / 간호행정학회지

PURPOSE: This was a correlational study to identify effects of perception of clinical ladder system on job satisfaction and intention to leave in perioperative nurses. METHODS: Participants were 154 of perioperative nurses from larger general hospitals in Seoul. Data were collected from April, 16 to 22, 2013 using self-report questionnaires which included items on perception of clinical ladder system, job satisfaction, and intention to leave. Data were analyzed using frequency, t-test, ANOVA, Scheffe? test, Pearson correlation coefficients, and multiple stepwise regression. RESULTS: The average mean score for perception of clinical ladder system was midline at 2.69 point out of 4 point. Perception of clinical ladder system correlated positively with job satisfaction (r=.38, p<.01) and negatively with intention to leave (r=-.88, p<.01). Perception of clinical ladder system was the factor which most influenced job satisfaction explaining 17.1% of the variance, also perception of clinical ladder system was the factor which most influenced intention to leave, explaining 12.7% of the variance. CONCLUSION: Results of this study suggest that there is a need to enhance the perception of the clinical ladder system and to find ways to fulfill the expected effects for improving perioperative nurses' job satisfaction and reducing the intention to leave.

Political Interest, Political Efficacy, and Media Usage as Factors Influencing Political Participation in Hospital Nurses / 간호행정학회지

PURPOSE: The purpose of this study was to identify how political interest, efficacy and media usage influence political participation in hospital nurses. METHODS: Participants were 286 nurses, who were informed of the study purpose and agreed to participate. Data were collected during November and December, 2012 using a questionnaire on political interest, political efficacy, media usage and political participation. Data were analyzed using t-test, ANOVA, Scheffe's test, Pearson Correlation Coefficients, and Multiple Stepwise Regression. RESULTS: Scores for political participation and political interest was average. The score for political efficacy was higher than average. Political participation was significantly different by education level, job career, position, and intention to vote in the election for the 18th President. Political participation had a moderate positive correlation with political interest (r=.50, p<.001), political efficacy (r=.32, p<.001) and media usage (r=.14, p=.022). Political interest (beta=.43) was the factor most influential on political participation, explaining 25% of the variance. A total of 32% of political participation was explained by political interest, political efficacy, and TV news or SNS for media use. CONCLUSION: The results suggest that it is necessary to develop strategies to promote political interest and political efficacy for hospital nurses to improve political participation.

Protocol for Physical Restraints of Patients in Nursing Homes / 기본간호학회지

PURPOSE: The purpose of this study was to develop a protocol that would help prevent accidents, apply physical restraints properly, and reduce the use of physical restraints in nursing homes. METHOD: A review of the literature and analysis of existing statutes and regulations were used to develop the preliminary protocol. To test the validity of this preliminary protocol, ten experts were selected from academia and clinical practice to review the protocol. The initial protocol was finalized after it had been reviewed by experts and tested for clinical validity in five different nursing homes. RESULT: The protocol consists of objectives, definitions and accident probability assessment, principle of using physical restraints, monitoring and documentation of physical restraints. CONCLUSION: The findings of this study can be used as guidelines to focus on preventing accidents arising out of use of physical restraints, assessing the probability of accidents, and reducing the use of physical restraints through preventive interventions. This will be helpful to prevent ethical, physical, or psychological problems arising from use of physical restraints and to protect the rights of elderly people in nursing homes.

Development of a Comprehensive Self-Management Program Promoting Self Efficacy for Type 2 Diabetic Patients / 기본간호학회지

PURPOSE: The purpose of this study was to develop a comprehensive self-management program promoting self efficacy for Type 2 diabetic patients. METHODS: The study was a methodological research design in which previous related research was reviewed to develop the comprehensive self-management program promoting self efficacy using self efficacy theory. RESULTS: Comprehensive self-management programs promoting self efficacy included the whole range of eight self-management domains: diet, exercise, medication, self-testing of blood glucose, complication or foot, stress, time, and general health, and consisted of four sources of self efficacy: enactive mastery experience, vicarious experience, verbal persuasion, and physiological and affective states, as strategies to promote self efficacy. Developmental methods included, in addition to large and small group education, individual education or counseling, and telephone counseling. CONCLUSION: Further studies are needed in community health centers or hospitals to establish the effects on self-management compliance and glycemic control of the comprehensive self-management program promoting self efficacy.

Bone Health Knowledge, Self-Efficacy, and Behaviors in Middle-Aged Korean Women

BACKGROUND: With the rapid growth of the elderly population, osteoporosis has become a major health problem worldwide. Although health knowledge and self-efficacy are important assets to facilitate healthy behaviors and disease prevention, such information as it relates to individuals and their bone health is limited. The purpose of this study was to assess the levels of knowledge, self-efficacy, and health behaviors on promoting bone health in middle-aged Korean women. METHODS: This is a cross-sectional survey study. A convenience sampling of middle-aged women (> or =40 years) was done at a community health center in Korea. Bone mineral density was measured by dual energy X-ray absorptiometry with the DEXXUM T. The level of knowledge was measured with the Knowledge of Osteoporosis Scale, and self-efficacy with the Osteoporosis Self-efficacy Scale. A questionnaire for bone health behaviors was developed for this study. Collected data were analyzed through descriptive methods, independent t-test, analysis of variance, and Pearson's correlation analysis. RESULTS: A total of 150 middle-aged women whose mean age was 59.8+/-11.5 years participated in the study. Most (74%) were menopausal. Less than one-quarter of participants (22.7%) had osteoporosis and less than half (42%) had osteopenia based on the T-score at the left femur neck site. Level of knowledge (mean score, 10.35) and self-efficacy (mean score, 47.67) ranged from low to moderate. Intake of calcium and vitamin D-rich foods was insufficient in our subjects. Bone health behaviors had significant positive relationships with knowledge (r=0.22, P=0.008) and self-efficacy (r=0.29, P<0.001) on promoting bone health. CONCLUSIONS: These results indicate that educational interventions are needed to enhance knowledge and confidence and to encourage middle-aged women to engage in bone health behaviors.