Effect of the Fever Education Program on Pediatric Nurses' Expert Knowledge, Attitudes and Nursing Practice

PURPOSE: This study was performed to develop the Fever Education Program (FEP) and evaluate its effects on the knowledge, attitudes, and nursing practice of pediatric nurses. METHODS: The quasi-experimental research strategy used a pretest-posttest nonequivalent control group design. Recruited participants were forty-seven nurses at two pediatric hospitals in G city. The research was conducted from September 1 to October 10, 2015. To test the effects of the FEP, the participants were divided into two groups, an experimental group (n=27) and a control group (n=20). Data were collected prior to and six weeks after the intervention using self-reported questionnaires. Data were analyzed using Fisher's exact test, the χ²-test, t–test, Mann-Whitney U test, and analysis of covariance (ANCOVA) with the SPSS/WIN 19.0 program. RESULTS: Following the FEP intervention, no significant differences were found in nursing practice, but significant differences were found in knowledge (t=3.62, p=0.001) and attitudes (t=4.26, p=0.000) between the experimental group and the control group. CONCLUSION: The results of this study indicate that the FEP could provide an effective nursing intervention to improve knowledge and attitudes toward fever care in pediatric nurses.

Factors Affecting the Life Quality in Mothers of Children with Disabilities

PURPOSE: The purpose of this study is to investigate factors affecting the quality of life in the mothers of children with disability and to identify the relationships between mother's quality of life, self-efficacy, social support and parenting-stress. METHODS: The subjects were 160 mothers of children with disabilities in G city. The data were collected using a structured questionnaire and analyzed with SPSS/PC+ 21.0. RESULTS: There was a significant relationship between mother's quality of life and self-efficacy (p<.001), and their quality of life and social support (p<.001). Mother's Quality of life was negatively correlated with parenting stress as well (p<.001). Variables affecting their quality of life were self-efficacy, social support, parenting-stress and the income of families with children with disability. The four factors accounted for 38.7% of the quality of life. CONCLUSION: The results of the study show that self-efficacy, social support and parenting-stress are the most significant factors affecting mother's quality of life. It is urgently needed to develop nursing intervention that will enhance mothers' quality of life, thereby helping them to lead a more decent life.

Factors Affecting Depression in Mothers of Children with Disabilities

PURPOSE: The purpose of this study was to investigate the factors affecting depression in mothers of children with disabilities and to identify the relationships between the depression, parenting-stress and self-esteem. METHODS: The participants were 100 mothers of children with disabilities lving in G city. Data were collected using a structured questionnaire and analyzed using descriptive statistics, t-test, ANOVA and Pearson Correlation Coefficients with SPSS/PC+ 21.0. RESULTS: There was a significant relationship between depression and parenting stress (p<.001). Depression was negatively correlated with self-esteem (p<.001). Variables affecting depression were parenting-stress, self-esteem and family income. The three factors accounted for 38.7% of the depression. CONCLUSION: The results of the study show that parenting-stress and selfesteem are the most significant factors affecting depression. There is an urgent need to develop nursing interventions to reduce levels of depression in mothers of children with disabilities and to help them lead a healthier life.

Current Status in Management of Children with Atopic Dermatitis and Knowledge and Practice of Preschool Teachers

PURPOSE: The purpose of this study was to describe current status in management of children with atopic dermatitis and to examine knowledge and care practices of preschool teachers. METHODS: A survey using a self-administered questionnaire was conducted. Knowledge and practice were measured with the questionnaire by Park (2011). Data were analysed using SPSS.WIN 20.0. RESULTS: Of the teachers, 81.3% managed children with atopic dermatitis depending on parents' needs and 58.9% reported difficulties due to limited knowledge and expressed a need for continuing education and provision of educational guidelines. Preschool teachers had a mean score for knowledge about atopic dermatitis of .75 out of 1 point. Among three domains of knowledge, signs & symptoms had the highest score and management, the lowest. The mean score for care practices for children with atopic dermatitis was 3.4 out of 4 points. Among the four domains of care practices, food had the highest score and dress & bedclothes, the lowest. Knowledge and practice of the teachers were different according to responsibility in management and educational need. The correlation between knowledge and practice was not significant. CONCLUSION: These results suggest that educational programs and strategies should be developed to increase preschool teachers' knowledge and improve care practice for children with atopic dermatitis.

Predictive Bayesian Network Model Using Electronic Patient Records for Prevention of Hospital-Acquired Pressure Ulcers

PURPOSE: The study was designed to determine the discriminating ability of a Bayesian network (BN) for predicting risk for pressure ulcers. METHODS: Analysis was done using a retrospective cohort, nursing records representing 21,114 hospital days, 3,348 patients at risk for ulcers, admitted to the intensive care unit of a tertiary teaching hospital between January 2004 and January 2007. A BN model and two logistic regression (LR) versions, model-I and -II, were compared, varying the nature, number and quality of input variables. Classification competence and case coverage of the models were tested and compared using a threefold cross validation method. RESULTS: Average incidence of ulcers was 6.12%. Of the two LR models, model-I demonstrated better indexes of statistical model fits. The BN model had a sensitivity of 81.95%, specificity of 75.63%, positive and negative predictive values of 35.62% and 96.22% respectively. The area under the receiver operating characteristic (AUROC) was 85.01% implying moderate to good overall performance, which was similar to LR model-I. However, regarding case coverage, the BN model was 100% compared to 15.88% of LR. CONCLUSION: Discriminating ability of the BN model was found to be acceptable and case coverage proved to be excellent for clinical use.

Student Experience and Satisfaction with Clinical Nursing Practice in Women's Health Nursing / 여성건강간호학회지

PURPOSE: The purpose of this study was to identify students' experiences of performance and their satisfaction with clinical nursing practice in Women's health nursing. METHODS: Data was collected using questionnaire consisting of 104; 89,; and 82 nursing activities with 12; 10; and 7 domains for delivery floor, obstetric, and gynecologic wards retrospectively. Five hundred ninety nursing students from 10 four year and one three year colleges, were recruited and selected for data collection. RESULTS: Site specific core nursing activities among top 15 items of performed experience were: interpreting fetal monitoring; massage for pain reduction; breathing technique; perineal pad change; non stress test; manual check for uterine contraction; and position change for the delivery floor. Experiences of clinical nursing practice for the obstetric ward and the gynecologic ward were identified and ranked as well. Observation of delivery, measurement & test during labor and observation of anesthesia and operation were the highest ranked activity domains of satisfaction for delivery floor, obstetric and gynecologic wards retrospectively. CONCLUSION: Discussions are needed to standardize curriculum for clinical practice in women's health nursing initiated at the level of Korean Society of Womens' Health Nursing by reflecting this result. Strategic approaches are emphasized in order to enhance a collaboration between clinical fields and colleges.

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.

Comparison of Perceived Health Status, Health Promoting Behaviors and Depression between Korean and Foreign Students at a Women's University

PURPOSE: This research was conducted to investigate perceived health status, health promoting behaviors and depression level in Korean and foreign students at women's university. METHODS: The sample group of this study consists of 100 Korean students at a women's university and 98 foreign students from China and Vietnam who were enrolled at the same university in G City. The research results were analyzed using the SAS program (Version 8.2) with Chi-square test, Fisher's exact test and t-test. RESULTS: 1) The Korean students showed a significantly higher score in drinking and smoking than foreign students. Also, age, religion, part time job, stress and allowance were significantly different between the two groups. 2) The foreign students showed a significantly higher score in perceived health status and health promoting behavior than the Korean students. 3) The foreign students showed a significantly higher score in depression than the Korean students. CONCLUSION: In the development of health programs for foreign students, it is necessary to focus on reducing depression and to consider the traditions of their own countries. It is desired to conduct further study about health promoting behavior and factors affecting health with respect to the countries where the foreign students originated.

Comparison in Care Burden, Fatigue, and Life Contentment of Caregivers by Gender Relationship with Demented Elders / 여성건강간호학회지

PURPOSE: This study was done in order to examine the differences in gender respect to care burden, fatigue, and life contentment of family caregivers of elderly with dementia. METHODS: The setting of the study was a community-based dementia care center providing daycare services. One hundred ninety four caregivers were recruited for the survey. A structured questionnaire was used which included demographic information, care burden, fatigue, and general contentment scales. Caregivers were classified into 4 groups by gender relationship with care recipients. RESULTS: The majority of the caregivers were middle-aged and elderly. More than twice as many were female rather than male caregivers. The results showed that women caregivers expressed more fatigue than men overall (p< .05). In the gender relationships, a different combination of man-woman appeared to have more burdens than that of a woman-woman group (p< .05). For fatigue, the man caregiver-woman elderly group showed a higher fatigue score than a woman-man group (p< .05). However, there was no significant difference in life contentment among groups. CONCLUSION: These results suggest that caregiver's gender and gender relationship with elders could be considerable factors when the nurses make a plan in the community for dementia nursing management services.

Evaluation of Knowledge Model for a Hypertension Management CDSS Using a Standard-based Knowledge Authoring Tool / 대한의료정보학회지

OBJECTIVE: For the development of interoperable and sharable knowledge-based clinical decision support systems, it is important to evaluate the appropriateness of knowledge in each phase. In this study, an evaluation of early phase's knowledge model for hypertension management was conducted to develop a more precise and useful knowledge model. METHODS: The knowledge model for hypertension management based on JNC7 was modeled using a knowledge representation tool based on SAGE. Two physicians were involved in evaluating the process of the knowledge model. They reviewed 36 scenarios and made recommendations based on the knowledge model. These recommendations were compared with those derived from the model. RESULTS: Eight algorithms and 223 evidence statements were included in the knowledge model. The concordance rate of the recommendations between the physicians and the model for the goal BP were 61% and 93% by the respective physicians. Six scenarios showed low proficiency and efficiency for drug recommendation. Two refinements of the knowledge model were made based on the results. CONCLUSION: The evaluation process of the knowledge model in the early phase provides more precise and useful knowledge model in the next.

Change of Stress and Nursing Needs after Hospitalization in Preterm Labor Women / 여성건강간호학회지

PURPOSE: This study was to examine the change of stress and nursing needs in preterm labor women after hospitalization. METHOD: Forty seven women with preterm labor who were admitted in two university hospitals participated in the survey and they were completed the questionnaires on admission day and 5thday after admission. Questionnaires included in modified Antepartum Hospital Stressor Inventory (AHSI) and Nursing Needs for Preterm Labor. The collected data were analyzed by paired t-test and Pearson correlation test. RESULT: The stress level was not decreased significantly after hospitalization. Among them, the stresses about fetus and medical staff were decreased significantly after hospitalization, but those about pregnant women, husband and environment were increased significantly after hospitalization. The difference in the level of nursing needs between the two different days was not significant except the physical needs. The total level of stress and nursing needs were correlated significantly on the 5th day after hospitalization. CONCLUSION: These results indicate that stress and nursing needs of preterm labor women undergo changes after hospitalization. Therefore, development of the program being followed by stressors which change from day to day and further studies are required in order to examine the decreasing of the stress.

Availability of nursing data in an electronic nursing record system for a development of a risk assessment tool for pressure ulcers / 대한의료정보학회지

OBJECTIVES: This study explored the reuse of data captured by nurses to support nursing decisions related to pressure-ulcer care. METHODS: To examine the existence of coded data in an electronic nursing record system for the identified concepts, we used the electronic nursing documents of a teaching hospital in Gyeonggi-Do, in Korea. A surgical intensive care unit (SICU) was selected as the test unit due to the high incidence of pressure ulcers. The concepts were identified from literature review and refined through the involvement of staff nurses. RESULTS: We found that 93.4% of the necessary concepts were matched semantically with data items at the input level of the electronic medical record system. Eighteen concepts (60%) were directly matched with the data variables of structured electronic nursing records. Five concepts (16.7%) were matched into more than two items. Including the standard nursing statements coded in Nurses' notes, five concepts were mapped more. CONCLUSIONS: More than 90% of the concepts were matched successfully, which suggests that the secondary use of the routine data collected in an EMR system could be used to develop an automated risk assessment tool for pressure ulcers.

A case of malignant Mixed Mullerian Tumor (MMMT) of the uterine cervix / 대한산부인과학회지

Malignant mixed mullerian tumors (MMMT) are rare biphasic malignant neoplasm with two components of carcinoma and sarcoma. The most common site of occurrence in female genital tract is the uterine corpus. MMMT of the cervix is extremely rare. MMMT of uterine corpus is highly malignant and the prognosis is poor. Surgery is treatment of choice of uterine cerivx MMMT. The clinicopathologic characteristics of tumor and treatment are uncertain because of lack of clinical data. We experienced one case of malignant mixed mullerian tumor of uterine cervix and report our experience with a brief review of literature.

A Survey of Urban Middle-aged Women's Sexual Function and Sexual Distress / 여성건강간호학회지

OBJECTIVE: This survey assessed the prevalence and type of sexual dysfunction in middle-aged women regarding sexually related personal distress and examined the prevalence of perceived sexual dysfunction and perceived partners' dysfunction by women. METHODS: One-hundred ten healthy community-based middle-aged women participated voluntarily, and validated question- naires of the Female Sexual Function Index(FSFI) and the Female Sexual Distress Score(FSDS) were used. RESULTS: The percentage of women having sexual dysfunction and sexual distress were 67% and 32% respectively according to the cut-off of FSFI and FSDS. The average score of FSFI was 23.5(s.d.=5.7), which was lower than the cut-off of FSFI, while the average score of FSDS was 13.2, which was in range of a normal score. When considering the two concepts simultaneously, the women were categorized into 4 groups: sexually stressed dysfunction group (24.8%), sexually depressed group(42.2%), sexually healthy group(25.7%), and sexually hyperactive group (7.3%). The percentage of women reporting sexual problems was 24.3%, while the percentage of women reporting sexual dysfunction in their partner was 29.9%. CONCLUSIONS: The results indicate a high rate of sexual dysfunction and sexual distress in middle-aged women. However, considering the relationships between sexual dysfunction and sexual distress, almost two thirds were in the sexually depressed group among the women having sexual dysfunction.

Strategic Approach for Standardization on Ubiqitous Healthcare System / 대한의료정보학회지

BACKGROUND: As ubiquitous computing is being introduced in the health care sector due to increase in elderly population and chronic patients, development in sensoring and wireless communication technologies, information technology infrastructure and computerization of health care facilities, the concept of ubiquitous health is also being introduced. In order to vitalize and spread the ubiqiutous health, standardization of related information technology must be preceded anything else. OBJECTIVE: The objective of this study is to review status of standaridization and standard adoption in domestic and international ubiquitous health care, and propose scope of standardization, a list of nessessary standards, and strategic approaches to develop standards based on the review. METHODS: We reviewed components of ubiquitous health care system, scope of standardization in technology, application cases, and status of standard aoption based on literature search. Status of standardization of related information technology in health care domain was reviewed by domestic and international activities of related standard development organizations. Based on these review results, scope of standardization and strategic approaches to develop standards for the domestic ubiquitous health were developed and modified after consultation of expert panel. RESULTS: Status of health care information standardization is in the early stage and information technology for ubiquitous health is in the exploratory stage in Korea. Accrodingly, it is proposed to develop standards for computerization of health care facilities, health information exchange, point-of-care bio-signal measurement, smart cards, and sensor technology in order by taking different approaches such as adopt or adapt international standards or develop domestic standards and introduce them as international standards according to possession of corresponding technology by domestic vendors and maturity of dometic vendors.

Approach to the Requirements of a Decision Support System for Hypertension Management in a Health Center / 대한의료정보학회지

BACKGROUND: Guidelines and protocols have gained support as vehicles for promulgating the best practices in clinical medicine, and many researchers have proposed frameworks for modeling them in a computer-interpretable format. However, for guidelines to be most useful for decision support, they need to be integrated into the patient care process and to be patient-specific. OBJECTIVE: To achieve this, as a part of the development of interoperable and sharable clinical decision support system in the context of electronic health records, we identified the system requirements on the CDS for integrating hypertension management into workflow of a health center. We also introduced our approach to the acquisition of medical knowledge. METHODS: A method combining the top-down and bottom-up approaches was used. For the top-down, the service scope and target group of patients were defined, and the knowledge sources, including JNC 7 and other guidelines from which decision logic was extracted, were identified. For the bottom-up approach, scenario-use cases were applied and an analysis of care data and a survey of the care providers were conducted. RESULTS: This bidirectional method revealed the opportunities of our approach and the means by which improvements can be suggested in practice. The content and functions expected by users were also identified. These results will be used for further encoding knowledge at the computable level and application development at the implemental level.

Physician Factors Associated with the Blood Pressure Control among Hypertensive Patients / 예방의학회지

OBJECTIVES: Little is known about the physician-related factors that are associated with the management of hypertension. The purpose of this study was to determine the physician-related factors associated with blood pressure control in hypertensive patients. METHODS: We surveyed 154 physicians at 117 public health (subhealth) centers in Gyeonggi-do. Forty-one physicians completed the survey (response rates: 26.6%) and 31 physicians were finally included as the study subjects. Using the information obtained from the selfreported survey, we measured the physician-related factors associated with hypertension control, including their perception of hypertension, prescription patterns (combination prescription rates, specific antihypertensives prescription rates among patients with diabetes mellitus), and sociodemographic factors. We then collected data on blood pressure and medication use in patients seen by these physicians from the health center's information system. We compared the physicians' perceived hypertension control rates with the actual rates, and then evaluated the rate of high overestimation (overestimation by more than 25% of the median degree of hypertension control rate overestimation) among the physicians. The physicians' antihypertensive prescription patterns were also evaluated. Multiple logistic regression analysis was used to evaluate the independent association between hypertension control and physicianrelated factors. RESULTS: The physicians tended to overestimate the proportion of their patients with controlled blood pressure (79.5% perceived vs. 57.8% actual). The percentage of physicians with high overestimation was 35.5% (11 physicians). The physicians with lower control rates were more likely to highly overestimate their patients' control rates. Physicians with below-median actual control rates tended to prescribe fewer combination treatments for patients with uncontrolled blood pressure and angiotensinconverting enzyme inhibitors or fewer angiotensin receptor blockers for patients with diabetes mellitus. The rate of high overestimation by physicians was 1.31 times higher in patients with uncontrolled blood pressure than in patients with other conditions (OR=1.31, 95% CI: 1.17-1.48). CONCLUSIONS: Physicians have a tendency to overestimate the rates of hypertension control in their patients. Because physicians have a direct role in treatment outcomes, physicians' overestimation about hypertension management contributes to inadequate blood pressure control. Thus, interventions for improving physician' awareness regarding the management of patients with hypertension are needed.

A new scoring system for differentiation between benign and malignant ovarian masses / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to design a new scoring system for differentiation between benign and malignant ovarian masses and to assess effectiveness of new scoring system comparing other scoring systems. METHODS: This study was based on 199 women who visited Soonchunhyang Hospital for surgery of ovarian mass. Ultrasonography and scoring system based on De Priest, Sassone, Ferrazi and Alcazar was performed the day before operation. Pathologic diagnosis after operation was directly compared with diagnosis of scoring system. The cut-off level of the new index is 11 points. This study was evaluated by sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). RESULTS: Parameters of new scoring system were wall thickness, number of septum, volume of mass, irregularity, vascularity and echogenicity. The new scoring system had sensitivity 73.9%, specificity 97.7% and negative and positive predictive values of 96.6% and 80.9% respectively. CONCLUSION: Sensitivity of new scoring system was similar to previous ones but specificity of that is higher. Our new scoring system shows better to differentiate benign from malignant ovarian mass than four other scoring systems.

Development of a Nursing Diagnostic Decision Support System for Inpatients with Type 2 Diabetes Mellitus Using Knowledge Engineering / 대한의료정보학회지

BACKGROUND: The development of decision support systems for nursing has been limited by difficulties in defining and representing the nursing knowledge base and by a lack of knowledge about how nurses make decisions. However, the current trends suggest that many of the formidable technological and conceptual challenges associated with representing nursing knowledge can be overcome, and that decision support systems developed using knowledge engineering can be used to significantly improve nursing practice. OBJECTIVE: The aim of this study was to develop a diagnostic nursing decision support system for inpatients with type 2 diabetes mellitus, and to elucidate the advantages and disadvantages of applying a knowledge engineering approach to its development. METHODS: To acquire the relevant knowledge, a literature review was used to iteratively establish nursing diagnoses and clinical assessment criteria. Twenty-five NANDA diagnoses and 145 clinical assessment variables were structured into a criteria table used as the knowledge base for a prototype system. To investigate the responses of nurses to knowledge presentation, 27 nurses from inpatient and ambulatory settings and the graduate course of nursing informatics were recruited and a scenario-based preliminary evaluation was performed. RESULTS: A prototype for inpatients with type 2 diabetes mellitus was developed as a Web-based stand-alone system. It automatically generated suggested nursing problem lists based on the input data, and also provided detailed explanatory information for each item on the list. We describe the advantages and disadvantages of the development approach used and discuss the users' impressions of the system.

Research and Development Efforts Aimed at Implementing Electronic Health Record Systems with Interoperability and Patient Safety / 대한의료정보학회지

Electronic health records (EHR) hold promise in improving the quality and efficiency of health care, yet the health care system remains years behind other industries with respect to the adoption of information technology (IT). Stakeholders in the medical community, including government and tertiary hospitals, have emphasized the urgent need to adopt IT systems. This paper reviews the current research and development efforts related to EHR in Korea, which have been supported by the government since December 2005, on the basis of the following core EHR components: EHR architectures that incorporate an external, implementation-independent view of a complete EHR; EHR functionality for defining tasks that an EHR system should perform; semantic ontology for developing standard vocabularies at the national level; EHR messaging standards for exchanging data; and clinical decision support systems for improving patient safety. Recent international work on EHR systems and the underlying trends are described, and suitable directions for research and development are suggested under relevant subtopics. Advances in the relevant areas will greatly facilitate our ability to achieve interoperability and promote patient safety. However, EHR systems will perform optimally only if we improve our understanding of the political, structural, and technical foundations for EHR, and reach consensus via collaborations between all the stakeholders in the health care system.