Development and Psychometric Evaluation of the Ischemic Stroke Distress Scale (ISDS)

Purpose@#This study aimed to develop a scale to measure distress in patients with ischemic stroke and verify its validity and reliability. @*Methods@#Preliminary items were developed from literature review and in-depth interviews. The final preliminary scale was confirmed through a content validity test of eight experts and a preliminary survey of 10 stroke patients. The participants for psychometric testing were 305 stroke patients in the outpatient clinic. Validity and reliability analyses included item analysis, exploratory and confirmatory factor analysis, convergent validity, known-group validity, and internal consistency of the scale. @*Results@#The final scale consisted of 17 items and 3 factors. The three distinct factors were ‘self-deprecation, worry about future health, and withdrawal from society’ and this structure was validated using a confirmatory factor analysis. Convergent validity was supported by comparison with the Center for Epidemiologic Studies Depression Scale (r = .54, p < .001) and Brief Illness Perception Questionnaire (r = .67, p < .001). Known-groups validity was verified by dividing groups according to ‘duration since diagnosis’ (t = 2.65, p = .009), ‘presence of sequela’ (t = 10.16, p < .001), and ‘awareness of distress’ (t = 12.09, p < .001). The internal consistency of the scale using Cronbach’s α for the total items was .93. @*Conclusion@#The Ischemic Stroke Distress Scale is a valid and reliable tool that reflects stroke distress effectively. It is expected to be used as a basic tool to develop various intervention strategies to reduce distress in ischemic stroke patients.

Analysis of ROX Index, ROX-HR Index, and SpO 2 /FIO 2 Ratio in Patients Who Received HighFlow Nasal Cannula Oxygen Therapy in Pediatric Intensive Care Unit

Purpose@#This study aimed to evaluate the use of the respiratory rate oxygenation (ROX) index, ROX-heart rate (ROX-HR) index, and saturation of percutaneous oxygen/fraction of inspired oxygen ratio (SF ratio) to predict weaning from high-flow nasal cannula (HFNC) in patients with respiratory distress in a pediatric intensive care unit. @*Methods@#A total of 107 children admitted to the pediatric intensive care unit were enrolled in the study between January 1, 2017, and December 31, 2021. Data on clinical and personal information, ROX index, ROX-HR index, and SF ratio were collected from nursing records. The data were analyzed using an independent t-test, χ2 test, Mann–Whitney U test, and area under the curve (AUC). @*Results@#Seventy-five (70.1%) patients were successfully weaned from HFNC, while 32 (29.9%) failed. Considering specificity and sensitivity, the optimal cut off points for predicting treatment success and failure of HFNC oxygen therapy were 6.88 and 10.16 (ROX index), 5.23 and 8.61 (ROX-HR index), and 198.75 and 353.15 (SF ratio), respectively. The measurement of time showed that the most significant AUC was 1 hour before HFNC interruption. @*Conclusion@#The ROX index, ROX-HR index, and SF ratio appear to be promising tools for the early prediction of treatment success or failure in patients initiated on HFNC for acute hypoxemic respiratory failure. Nurses caring for critically ill pediatric patients should closely observe and periodically check their breathing patterns. It is important to continuously monitor three indexes to ensure that ventilation assistance therapy is started at the right time.

Effects of the Advanced Practice Nurse-Led Psychoeducational Program for Colorectal Cancer Survivors

Purpose@#This study aimed to investigate the effects of an advanced practice nurse-led psychoeducational program on distress, anxiety, depression, coping with cancer (CWC), health promotion behavior (HPB), and quality of life (QOL) among colorectal cancer survivors. @*Methods@#This study was designed as a quasi-experimental study with a non-equivalent control group pretest-posttest. The participants were survivors of colorectal cancer who underwent follow-up care. There were 39 survivors: 19 in the experimental group and 20 in the control group. The experimental group performed a psychoeducational program for 120 minutes per session, once a week for a total of six weeks, while the control group received routine education and counseling. Distress, anxiety, depression, CWC, HPB, and QOL were investigated before, immediately after, and 4 weeks after the intervention. The data were analyzed with SPSS/WIN ver. 24.0, using repeated measures ANOVA. @*Results@#There were significant interactions between time and group for distress and anxiety. In addition, CWC interacted with the total of CWC and interpersonal coping, and QOL interacted with the total of QOL and functional status. However, there were no significant differences in the depression or HPB scores. @*Conclusion@#Based on the results of this study, we expect that this program can be used as an effective intervention for colorectal cancer survivors.

Factors Influencing Supportive Care Needs of Colorectal Cancer Survivors

Purpose@#There is an increasing number of colorectal cancer survivors in South Korea. However, no research has identified supportive care needs of survivors of colorectal cancer in South Korea. Thus, the purpose of this study was to determine the level of supportive care needs and effects of emotional state and quality of life (QoL) on supportive care needs of colorectal cancer survivors. @*Methods@#This cross-sectional study was conducted among 115 survivors of colorectal cancer in South Korean who had primary treatment of surgery for colorectal cancer. Data were collected from April to September 2016. Participants responded to self-reported questionnaires assessing supportive care needs, emotional state (Hospital Anxiety and Depression Scale), and QoL (Functional Assessment of Cancer Therapy-Colorectal scale). @*Results@#The overall score of supportive care needs for colorectal cancer survivors was 1.22 ± 0.61 (full score: 3 points), with health care staff and social support needs garnering highest scores. Approximately, 20.0% and 21.7% of patients had anxiety and depression, respectively. The mean QoL score was 2.90 ± 0.53, with social and family status having the lowest QoL score. Multiple regression analysis showed that both the period after treatment and anxiety significantly influenced supportive care needs. @*Conclusion@#Appropriate interventions should be used immediately after completion of treatment to help reduce anxiety and meet supportive care needs of colorectal cancer survivors.

Noise Experience Status and Response to Noise of Patients and Nursing Staff in the ICU / 기본간호학회지

Purpose@#The purpose of this study was to analyze noise experience and response to noise by patients and nursing staff in intensive care units (ICU). @*Methods@#This study was a cross-sectional survey based on questionnaires administered to patients and staff in ICU to analyze the perceived noise level in the ICU environment, frequency of noise experience and noise level emitted by different sources, noise induced discomfort, response to noise, and the quality of sleep. The data were analyzed using descriptive statistics, independent t-test, ANOVA, and Pearson's correlation coefficient. @*Results@#Regarding the frequency of experience and noise levels emitted by various sources, patients carried the maximum number of human factors, and staff carried the highest number of medical devices or medical supplies. The quality of sleep caused by noise in patients was lower. Based on the correlation between the various variables, the higher the perceived noise level in the ICU environment, the higher the response to the noise (positive correlation) and the lower the quality of sleep (negative correlation). @*Conclusion@#Based on the results of this study, a follow-up study is suggested to compare perceived noise levels of patients and staff. Practical strategies are needed to reduce noise based on noise levels and sources of noise experienced by ICU patients and staff.

Effects of the Anger Management Program for Nurses

Purpose@#The purpose of this study was to examine the effects of an anger management program on anger, job stress, psychological well-being, and heart rate variability in clinical nurses. @*Methods@#A quasi-experimental study was conducted using a nonequivalent control group, pre–post test design with repeated measures. The participants included 43 nurses assigned to the experimental and control groups. Anger, job stress, psychological well-being, and heart rate variability were evaluated before the intervention, immediately after the completion of the intervention, and four weeks after the end of the intervention. Chi-square test, t-test, Fisher’s exact test, and GEE (Generalized Estimating Equations) were used to analyze the data. @*Results@#There were significant differences in the level of anger, state anger, job stress, and psychological well-being between the two groups. The rate of change in the total power (TP) and the high-frequency band (HF) of the experimental group increased immediately after the intervention completion, but that of the control group decreased at the same time. @*Conclusion@#The above results demonstrate that an anger management program for nurses effectively attenuated anger and job stress, improved psychological well-being, and regulated heart rate variability.

Factors Influencing Supportive Care Needs of Colorectal Cancer Survivors

Purpose@#There is an increasing number of colorectal cancer survivors in South Korea. However, no research has identified supportive care needs of survivors of colorectal cancer in South Korea. Thus, the purpose of this study was to determine the level of supportive care needs and effects of emotional state and quality of life (QoL) on supportive care needs of colorectal cancer survivors. @*Methods@#This cross-sectional study was conducted among 115 survivors of colorectal cancer in South Korean who had primary treatment of surgery for colorectal cancer. Data were collected from April to September 2016. Participants responded to self-reported questionnaires assessing supportive care needs, emotional state (Hospital Anxiety and Depression Scale), and QoL (Functional Assessment of Cancer Therapy-Colorectal scale). @*Results@#The overall score of supportive care needs for colorectal cancer survivors was 1.22 ± 0.61 (full score: 3 points), with health care staff and social support needs garnering highest scores. Approximately, 20.0% and 21.7% of patients had anxiety and depression, respectively. The mean QoL score was 2.90 ± 0.53, with social and family status having the lowest QoL score. Multiple regression analysis showed that both the period after treatment and anxiety significantly influenced supportive care needs. @*Conclusion@#Appropriate interventions should be used immediately after completion of treatment to help reduce anxiety and meet supportive care needs of colorectal cancer survivors.

Health Literacy, Knowledge and Self-care Behaviors in Patients with Pulmonary Tuberculosis Living in Community / 기본간호학회지

Purpose@#This descriptive investigative study was done to identify health literacy, knowledge and self-care behavior of patients with pulmonary tuberculosis. @*Methods@#The patients were 206 adults over the age of 19 who were diagnosed with pulmonary tuberculosis, taking anti-tuberculosis drugs and receiving care at one of the following: health centers, health center branches, public or privately affiliated hospitals in six cities nationwide. Tools used for the study were health literacy, knowledge and self-care behavior scales regarding pulmonary tuberculosis. Data were analyzed using SPSS/WIN 21.0 to identify frequency and percentages, means and standard deviation using t-test, ANOVA, Scheffé test, Pearson correlation coefficient, and multiple-regression analysis. @*Results@#Health literacy in pulmonary tuberculosis patients was found to be lower for men, patients over 60, high school graduation or less, having no religion and no family members living together. For knowledge on tuberculosis, the tuberculosis symptom field was lowest, and self-care behavior was lowest for examinations and drug intake. Factors affecting self-care behavior were knowledge related to tuberculosis prevention examinations, education, health literacy, and living together with family members. @*Conclusion@#In order to completely cure pulmonary tuberculosis and prevent recurrence, customized education is needed according to the patient’s educational background or health literacy, and assertive countermeasures are needed to enhance self-care behavior for examinations and drug intake.

Palliative Care Competencies Required of Undergraduate Nursing Students in Korea / 한국호스피스완화의료학회지

A resolution adopted by the World Health Assembly in 2014 stated that all nurses should be equipped with palliative care skills in order to integrate palliative care into a day-to-day healthcare system. This article introduces the palliative nursing competency that was developed for the Korean environment by the Korean Hospice Palliative Nursing Research Network based on its study of overseas cases where this competency and competency-based training were developed. This is the first step towards the development of competency-based palliative nursing education, and active efforts should be made to integrate this competency into the undergraduate nursing curriculum.

Factors Influencing Lower Urinary Tract Symptoms in Advanced Cancer Patients With Chemotherapy-Induced Peripheral Neuropathy / 대한배뇨장애요실금학회지

PURPOSE: This study aimed to investigate the severity of lower urinary tract symptoms (LUTS) and to identify factors that influenced LUTS in advanced cancer patients with chemotherapy-induced peripheral neuropathy (CIPN). METHODS: This cross-sectional study included a total of 158 advanced cancer patients with CIPN. A structured questionnaire including the International Prostate Symptom Score and the Functional Assessment of Cancer Therapy/Gynecology Oncology Group/Neurotoxicity scale was used. Data were analyzed using the Pearson correlation coefficient and multiple regression analysis. RESULTS: Nocturia was the most prevalent LUTS. A positive relationship was found between CIPN symptoms and LUTS. The duration of cancer diagnosis and the severity of CIPN were key factors that influenced LUTS. CONCLUSIONS: The severity of CIPN symptoms was the most important predictor of LUTS. Nurses’ care for advanced cancer patients should incorporate a comprehensive health assessment, which includes a history of treatment and physical neuropathic symptoms, for any patient complaining of CIPN symptoms.

Disease-related Knowledge, Stress, and Quality of Life in Patients with Varicose Veins

PURPOSE: The purpose of this study was to investigate the disease-related knowledge, stress and quality of life for the patients with varicose veins. METHODS: Data were collected via questionnaire from 138 patients with varicose veins in C University Hospital in Korea from November in Korea 2012 to August 2013. RESULTS: Knowledge of the symptoms and diagnosis was the lowest. The scores from patients with disease-related knowledge tended to be low for both subjects over the age of 60 and subjects with low education (less than high school). The score for stress over complications was the highest. The level of stress is higher for women, subjects without spouses, subjects with higher severity of disease and patients who had been taking hormones in the past or are still taking hormones. The disease-related quality of life tended to be lower for women and subjects without spouses. 21% of the variance in quality of life was explained by the level of disease-related stress, disease severity and knowledge. CONCLUSION: Education and the management of nurses to improve disease-related knowledge for patients with varicose veins is highly recommended. Intervention, by reducing stress, is necessary to improve the quality of life for women, subjects without spouses, and subjects with higher severity of the disease.

Awareness and Attitudes Towards Violence and Abuse among Emergency Nurses

PURPOSE: This study identifies degree of awareness and legal knowledge about overall abuse and violence, and investigates attitudes towards domestic violence in emergency nurses. METHODS: The data collection period was between August and December 2012 for 131 nurses who worked in the emergency center of five hospitals in South Korea. This study surveyed emergency nurses about the recognition of abuse and violence, the legal knowledge of abuse and violence, and the attitudes towards domestic violence. RESULTS: This study showed that approximately 60.0% of participants experienced incidents of suspected abuse or violence, but the reporting rates were low. Of all the participants, 70.2% knew that they must report the discovery of abuse or violent incidents, but 45.0% did not know that if someone who had duty to report but did not report that he/she had a legal responsibility. Most emergency nurses agreed that "even if the domestic violence is severe it should not be suggested to victims that they run away, leaving children at home", and "perpetrators are patients who need treatment." CONCLUSIONS: Appropriate awareness about abuse and violence, and systematic education are required for emergency nurses so that they can provide appropriate interventions.

Relationship between Quality of Life and Nurse-led Bedside Symptom Evaluations in Patients with Chemotherapy-induced Peripheral Neuropathy

PURPOSE: This cross-sectional study aimed at determining the relationship between patient-reported quality of life (QOL) and nurse-led bedside evaluations of chemotherapy-induced peripheral neuropathy symptoms. METHODS: One hundred ninety-five patients treated at the oncology clinic at our institution were assessed using Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity and nurse-led bedside examinations. The relationship between self-reported QOL and bedside examinations was evaluated using Spearman rank correlations. RESULTS: Scores of upper and lower extremity muscle strength based on the bedside examinations showed a weak negative correlation with the emotional well-being subscale of Functional Assessment of Cancer Therapy-General. Further, weak negative relationships were present between QOL and the following nurse-reported parameters: vibration perception in the hand, upper extremity muscle strength, touch and vibration perception in the feet, and tendon reflexes. CONCLUSION: Collectively, our results indicate that nurse-led bedside evaluation is a noninvasive and useful method for detecting neurotoxicity and evaluating the patient's QOL both during and after treatment.

Analysis of Pain Records for Cancer Patients Complaining of Moderate or Severe Pain / 한국호스피스완화의료학회지

PURPOSE: This is a retrospective study that investigated cancer patients' complaints of moderate or severe pain to analyze pain characteristics, pain relief interventions and their effects. METHODS: This is a retrospective study that investigated cancer patients' complaints of moderate or severe pain to analyze pain characteristics, pain relief interventions and their effects. RESULTS: The most frequent region of pain was the abdomen. The most frequent factor that exacerbated pain was movement. The most frequent pain alleviating factor was administration of analgesics. The most frequent pain type was breakthrough pain, and the most frequent non-pharmaceutical intervention for pain control was heat therapy. Among all, analgesics were routinely prescribed for 52.2% of the participants. Morphine sulfate was the most frequently used analgesic while Gabapentin was the most frequently used non-narcotic analgesic. At the time of discharge, 82.5% of the participants marked their pain intensity as 3 points or lower. CONCLUSION: For cancer patients complaining of moderate or severe pain, it is important to actively control pain from the beginning of admission. Thus, it is necessary to educate not only cancer patients using narcotic analgesic for pain control and their families but nurses about the effects and side-effects of drugs. Moreover, patients and their families need to learn how to assess and record pain at home to collect data that can be referred for future treatment.

Factors Influencing Post-traumatic Stress in Korean Forensic Science Investigators

PURPOSE: The aim of this study was to understand factors that influence post-traumatic stress (PTS) in Korean forensic science investigators. METHODS: A total of 111 forensic science investigators were recruited in Korea. PTS was measured using the tool modified by Choi (2001) from the original developed by Foa, Riggs, Dancu, and Rothbaum (1993) based on DSM-IV. Factors influencing PTS included demographic and job-related characteristics, emotional intelligence, and death anxiety. RESULTS: PTS scores were positively correlated with personality type, fatigue from work, and death anxiety. PTS scores were negatively correlated with length of career as a forensic science investigator and emotional intelligence. The factors that had the greatest influence on PTS were death anxiety, years spent as a forensic science investigator, personality type, emotional intelligence, fatigue, and homicide experience. The explanatory power of these six factors was 44.0%. CONCLUSION: Therefore, it is necessary to regularly evaluate the mental health of those who are vulnerable to PTS. Based on these results, various interventions could be implemented for promoting overall health of the forensic science investigators.

Life Experience of Patients suffering from Crohn's Disease

PURPOSE: The purpose of this study was to describe and explore the experience process of life of patients with Crohn's disease. METHODS: Using a grounded theory methodology, 24 interviews were performed with 7 men and 5 women, 17-47 years of age, suffering from Crohn's disease. RESULTS: 'Tuning of two conflicting lives' was identified as the core category, and 5 subcategories were identified and they were integrated into the core category. The identified outcomes were 'Living a withdrawn life', 'coping flexibly', 'drifting with tangled emotions' and 'maintaining long-term remission'. CONCLUSION: When caring for these patients, it is important to identify needs, allow patients to express what they want at that moment and support them in maintaining a daily life that can be perceived as normal.

Parenting Stress and Information Needs at the End of Treatment after Complete Remission of Leukemia

PURPOSE: This study has attempted to comparatively analyze the parenting stress that parents of a child with leukemia and their information needs at the end of treatment after complete remission (CR) of leukemia. METHODS: For data collection, a structured questionnaire survey on parenting stress and information needs was conducted using parents of children with leukemia visiting the Blood & Marrow Transplantation Center at C University Hospital in Seoul from August to December 2011. A total of 100 parents were examined. RESULTS: The parents of children under treatment after CR had greater parenting stress than parents of children whose treatment was finished. The parents of children whose treatment was finished had greater information needs than the parents of children whose treatment was ongoing. The differences had no statistical significance. In both groups, information needs about patients' growth development and school adjustment was high. CONCLUSION: This study confirms that it is necessary to add information about daily life management, child's growth development, sociopsychological adaptation, school adjustment, and support of family, to the current symptom care-centered education program.

Nursing Students' Awareness of Biomedical Ethics and Attitudes toward Death of Terminal Patients / 한국호스피스완화의료학회지

PURPOSE: The aim of this study was to investigate nursing students' awareness of biomedical ethics and attitudes toward death of terminal patients. METHODS: A structured questionnaire was developed to examine nursing students' biomedical ethics. Their attitudes toward terminal patients' death were measured by using the Collett-Lester Fear of Death Scale. Surveys were conducted with 660 nursing students enrolled at a three-year college located in Daejeon, Korea. Data were analyzed using descriptive statistics, Wilcoxon rank sum test and Kruskall Waills test. RESULTS: Students who have experienced biomedical ethics conflicts, agreed to prohibition of cardiopulmonary resuscitation (CPR) and have no religion exhibited more negative attitudes toward death compared to students without the above characteristics. Of the participants, 81.2% answered that life sustaining treatment for terminal patients should be discontinued and 76.4% replied that CPR on terminal patients should be prohibited. The majority of the correspondents stated that the two measures above are necessary "for patients' peaceful and dignified death". CONCLUSION: Study results indicate the need to establish a firm biomedical ethics value to help nursing students form a positive attitude toward death. It also seems necessary to offer students related training before going into clinical practice, if possible. The training program should be developed by considering students' religion, school year, experience with biomedical ethics conflicts and opinion about CPR on terminal patients. The program should also include an opportunity for students to experience terminal patient care in advance via simulation practice on standardized patients.

Effects of Aromatherapy on Depression, Anxiety and the Autonomic Nervous System in Breast Cancer Patients Undergoing Adjuvant Radiotherapy / 한국호스피스완화의료학회지

PURPOSE: The study was designed to verify effects of aromatherapy on depression, anxiety and the autonomic nervous system in breast cancer patients who are undergoing adjuvant radiotherapy. METHODS: Data were collected from November 2006 through March 2007 at the C university hospital in Seoul. The study included 33 patients and they were assigned to three groups. Group I had aroma oil inhalation for 2 minutes per time, three times a day for six weeks whereas Group II and a control group inhaled aroma oil for 2 minutes per time, once a day for six weeks. For Groups I and II, a mixture of lemon, lavender, rosewood and rose essential oils were used while control group inhaled tea tree oil. RESULTS: Depression was significantly decreased in patients in the experimental groups only. In Groups I and II patients, anxiety level was lower than that in control patients. Patients in Groups I and II also showed stronger physical resistance to stress than control group patients. CONCLUSION: Aromatherapy should be considered as a method that can significantly decrease depression in breast cancer patients who are undergoing adjuvant radiotherapy.

Effects of a Short-term Life Review on Spiritual Well-being, Depression, and Anxiety in Terminally Ill Cancer Patients

PURPOSE: This study was done to evaluate the effects of a short-term life review on spiritual well-being, depression, and anxiety in patients with terminal cancer. METHODS: The study used a pre posttest quasi experimental design with a nonequivalent control group. Measurement instruments included the Functional Assessment of Chronic Illness Therapy-Spiritual scale (FACIT-Sp12) and the Hospital Anxiety and Depression Scale (HADS). Participants were 32 patients with terminal cancer who were receiving chemotherapy or palliative care at hospitals or at home. Eighteen patients were assigned to the experimental group and 14 to the control group. A sixty minute short-term life review session was held twice a week as the intervention with the experimental group. RESULTS: There was a statistically significant increase in spiritual well-being in the experimental group compared to the control group. There were also significant decreases in depression and anxiety in the experimental group compared to the control group. CONCLUSION: The results indicate that a short-term life review can be used as a nursing intervention for enhancing the spiritual well-being of patients with terminal cancer.