Factors Associated with Functional Decline in Older Adults After Discharge from an Acute-Care Hospital

PURPOSE: This study was conducted to investigate the trend in functional changes over time and factors associated with the number of areas showing functional decline in older adults who had been discharged from acute care hospitals. METHODS: This longitudinal study involved 156 patients aged ≥ 65 years who were admitted to one tertiary hospital in Seoul and discharged home. Authors investigated patient demographic and health-care characteristics and the number of areas showing functional decline at 1 and 3 months after discharge. The data were analyzed using univariate and multivariate Poisson regression models. RESULTS: The number of areas showing functional decline increased between admission and 1 month after discharge and had declined slightly at 3 months after discharge. The factors associated with the number of areas showing functional decline at 3 months after discharge were age, education level, and length of hospitalization (p < .05); the factors associated at 1 month after discharge were medical department and caregiver relationship (p < .05). CONCLUSION: The results indicate that older patients with no spouse or those with their elderly spouse as their caregiver are at risk of functional decline in a greater number of areas after discharge. Therefore, a comprehensive health-care policy to ensure care continuity is required for functional health maintenance for older adults after hospital discharge.

Clinical Practice Stress and Coping Experience of Men in Nursing as a Student / 정신간호학회지

PURPOSE: The purpose of this study was to understand the stress coping experience of men nursing students in clinical practice. METHODS: In-depth interview were done using semi-structured questionnaire with 25 men nursing students taking clinical practice. Data were analyzed using grounded theory. RESULTS: Core category of coping experience of these nursing students was ‘a rolling stone’. Students' coping strategies were ‘women centered environment’, ‘physical difficulty’, ‘lack of sufficient role models’, and ‘age related’. Helping components for their coping behaviors were ‘individual characteristics’, ‘attitude to men nursing student’, ‘one's vision of nursing’, and ‘gender equality in nursing culture’. The consequence of this phenomenon were ‘a sense of belonging’, ‘building gender free nursing identity’, ‘nursing pride acquisition’ and ‘dream of nursing expert’. CONCLUSION: Men nursing students emphasized ‘growing as a mature nursing student’ in clinical practice.

The Coping Experience of Nursing Students in Clinical Practice: Trying to be a Meaningful Presence / 한국간호교육학회지

PURPOSE: The purpose of this study was to understand the coping experience of nursing students in clinical practice. METHODS: In-depth interview was done with semi-structured questionnaire on 32 nursing students taking clinical practice. Data was analyzed through the grounded theory. RESULTS: Core category of coping experience of nursing students was ‘trying to be a meaningful presence’ while clinical practice. Students' coping strategies were ‘overcoming inexperience’, ‘receiving the recognition from the clinical instructors’, and ‘governing mind and body’. Helping components for their coping behaviors were ‘support from people’, ‘personal experience before clinical practice’, ‘dynamics with partners’. Through the coping experience during clinical practice, nursing students became mature and confirmed their identities as student nurses. CONCLUSION: Nursing students taking clinical practice tried to be a meaningful presence.

Dietary Nutrient and Food Intake and Their Relations with Serum Heavy Metals in Osteopenic and Osteoporotic Patients

Several studies have reported that heavy metals have a relation with osteoporosis and osteoporotic fractures. In this study, we investigated the association between heavy metal exposure status, as assessed by serum major heavy metals such as lead (Pb), cadmium (Cd), and mercury (Hg) and bone mineral density (BMD) status among Korean adults. A total of 64 adults participated in this study and were assigned to one of three study groups based on the T-score of spine BMD: a normal group (n = 21, T-score > -1), osteopenia group (n = 29, -2.5 < T-score < or = -1) and osteoporosis group (n = 14, T-score < or = -2.5). We also assessed serum levels of heavy metals (Pb, Cd and Hg) by using atomic absorption spectrometer (AAS) and daily nutrient and food intakes for 3 days by using 24-hr recall method in the subjects. The mean age was significantly higher in the osteoporosis group compared with the osteopenia and normal groups (p < 0.001). There was no significant difference in serum levels of Pb, Cd and Hg among the three groups after adjusting for age. Daily intakes of energy, nutrients were not significantly different among the three groups. The osteoporosis group consumed significantly higher fish and shellfish than the other groups (p < 0.05). In the correlation analysis controlling for age, sex, BMI, and BMD status, the serum Cd level was significantly negatively correlated with intake of cereals, milks and total food. In summary, we did not find a direct association between serum heavy metal levels and BMD status. However, negative relationships were found between serum heavy metal levels and intake of some foods.

Reliability and Validity of the Decision-Making-Competency Inventory (DMCI) in Korean Adolescents

PURPOSE: This study was done to verify the reliability and validity of the Korean version of DMCI in Korean adolescents. METHODS: A methodological study design was used with Cronbach's alpha for reliability, and an exploratory factor analysis and contrasted groups approach for construct validity. DMCI was translated into Korean and tested with a sample of 406 adolescents in Korea. The data were analyzed using Cronbach's alpha, item correlation with total, principal component factor analysis, and t-test. RESULTS: The translated content of the DMCI was validated by nursing faculty members and translation equivalency was obtained. The Cronbach's alpha of the DMCI simplified with 18 items was .78. The factor analysis revealed three factors explaining 41.5% of total variance and the corresponding factors were self-observation (21.6%), self-judgement (11.4%), and self-confidence (8.6%). The mean score for the DMCI in the aggression group was significantly lower than the non-aggression group. CONCLUSION: Results of this study suggest that the Korean version of DMCI can used as a reliable and valid measure to assess decision making competency in Korean adolescents.

Depression Health Literacy and Help-seeking Intention of the Aged Receiving Customized Home Visiting Health Care Services

PURPOSE: The purpose of this study was to understand levels of both mental health literacy of depression and intention of help-seeking, and then to identify the relationship of them in Korean older adults. METHODS: Participants in this cross-sectional survey were 395 persons over 65 years old receiving customized home visiting health care services at Chungnam province. Data were collected through interviews by visiting nurses in 2011. RESULTS: The proportion of participants with depression was 61.8% (6.7+/-3.6). 78.2% of subjects appeared to have help-seeking intention for solving depression. The proportions of participants with ability to recognize depression was 69.1%. Although the level about knowledge and belief in self-help interventions were varied according to questionnaires, subjects understood self-help intervention of smoking accurately (86.3%) and physical activity (85.5%). Ability to recognize depression, knowledge and belief about self-help managements, and opinion of medication for treatment among health literacy variables measured in this study were related to help-seeking intention. In addition, women, visual impairment, and lower depression scores were related to help-seeking intention. CONCLUSION: Results demonstrate that it is necessary to improve depression health literacy to manage effectively depression of vulnerable elderly in communities. These results could be used in developing mental health literacy programs.

Structural Equation Modeling on Successful Aging in Elders: Focused on Selection, Optimization, Compensation Strategy

PURPOSE: This study was designed to construct and test a structural equation modeling on specific domain health status and the Selection, Optimization, Compensation (SOC) strategy affecting successful aging in elderly people. METHODS: The model construction was based on the SOC model by Baltes and Baltes. Interviews were done with 201 elderly people aged 65 or older. Interview contents included demographics, functional health status, emotional health status, social health status, SOC strategies, and successful aging. Data were analyzed using SPSS 15.0 and AMOS 7.0. RESULTS: Model fit indices for the modified model were GFI=.93, CFI=.94, and RMSEA=.07. Three out of 7 paths were found to have a significant effect on successful aging in this final model. Functional health status had a direct and positive effect on successful aging. Emotional health status influenced successful aging through SOC strategies. CONCLUSION: This study suggests that interventions for improving functional health status and for strengthening SOC strategies are critical for successful aging. Continuous development of a variety of successful aging programs using SOC strategy is suggested.

The Analysis of Intervention Studies for Snoezelen / 재활간호학회지

PURPOSE: The purpose of this study was to analyze intervention studies related to Snoezelen (multisensory environment). METHODS: Studies related to Snoezelen (multisensory environment) published between 1995 and 2010 in both Korean and International journals were systematically reviewed, and analyzed following guidelines. Based on inclusion criteria, 23 studies including 5 Korean and 18 International articles were selected. RESULTS: Most studies were conducted in various area of research such as medicine, nursing, and occupational therapy. There was no publication related to Snoezelen (multisensory environment) in Korean nursing journals. In terms of target population, more than 65% of the study subjects were patients with dementia, mental retardation, and learning disability. Intervention was implemented mostly in less than 30 minutes, once a week for 2 to 4 weeks. The effects on behavior, physical, and psychological contexts were assessed as outcome indicators. There was more 'positive' than 'no effect' in self-stimulatory behaviors, problem behaviors, heart rate, pain, mood state, and anxiety, whereas more 'no effect' than 'positive' in blood pressure, respiration, enjoyment, and relaxation. CONCLUSION: Future studies are needed to develop the protocol and outcome indicators for effective use of this new intervention in Korea.

Comparison of Standardized Peristomal Skin Care and Crusting Technique in Prevention of Peristomal Skin Problems in Ostomy Patients

PURPOSE: This study was performed to compare the effects of standardized peristomal skin care (SPSC) and crusting technique (CT) on the peristomal skin of ostomates. SPSC was developed by a consensus among the expert group based on a comprehensive review of the relevant literature and hospital protocols. METHODS: A randomized controlled pilot trial with 2 parallel arms was used. A total of 81 ostomates, who were recruited from a tertiary hospital, completed the baseline, 1-month, 2-month, and 3-month follow-up (SPSC group, n=45; CT group, n=36). SPSC consisted of water cleansing and direct application of ostomy appliances. CT involved crusting hydrocolloid powder and patting with water sponge or protective barrier liquid film. The outcomes of the study were assessed by skin problems, such as discoloration, erosion and tissue overgrowth; the domains of the evaluation tool used in examining the peristomal skin. A generalized estimating equation model was used to examine the effects according to time and group. RESULTS: In both SPSC and CT groups, the likelihood of occurrence of discoloration (OR, 1.99; 95% CI, 1.61-2.46), erosion (OR, 1.87; 95% CI, 1.55-2.25) and tissue enlargement (OR, 1.94; 95% CI, 1.36-2.77) increased with time. There was no significant difference in discoloration between the groups, whereas the probability of erosion (OR, 0.38; 95% CI, 0.16-0.89) and tissue overgrowth (OR, 0.09; 95% CI, 0.02-0.55) was lower in the SPSC group than in CT group. CONCLUSION: SPSC was sufficient in preventing peristomal skin problems of ostomates compared to the CT.