Factors Affecting International Patient's Satisfaction with Korea Medical Services, Revisit and Recommendation Intention / 보건행정학회지

BACKGROUND: This study aims to analyze quality of and satisfaction with Korea medical services and identify factors affecting medical service satisfaction, revisit, and recommendation intention among international patients. METHODS: Secondary analysis of survey data conducted by Korea Health Industry Development Institute from June 10th to July 17th in 2013 was done using multiple regression and logistic regression analysis. The 191 international patients from 9 medical institutions in Seoul were enrolled. RESULTS: The results showed that international patients were satisfied with 85.6 points out of 100.0 points. International patients appraised higher in staff service rather than other services. Factors influencing medical service satisfaction were gender, religion, medical specialty, length of stay, and quality of medical services. Quality of medical service explained 29.8% of medical service satisfaction and especially, ‘doctor's care’ and ‘communication and patient respect‘ were significantly related to medical service satisfaction. Medical specialty had a significant influence on revisit intention. There were no statistically significant influencing factors of recommendation intention. Additionally, more satisfied patients were associated with higher revisit and recommendation intention. CONCLUSION: This study implies that quality of medical services is a critical factor for patient satisfaction and that satisfaction with medical services is an important factor for increasing revisit and recommendation intention among international patients. In addition, health care providers should consider cultural differences to enhance satisfaction with medical services for international patients. Therefore, multidimensional strategy is required to strengthen the cultural competency of healthcare providers.

A Comparison Study using Mixed Methods on Foreign Residents' Satisfaction with Korean Health Care Services

PURPOSE: This study was conducted to examine and compare satisfaction with Korean health care services for Americans, Chinese and Russians who resided in Korea. METHODS: A questionnaire was distributed to 252 participants (81 Americans, 89 Chinese, 82 Russians). Three focus group interviews were subsequently conducted in order to obtain a greater understanding of participants' experience and perspectives. RESULTS: The average satisfaction score was 3.09, with Americans and Russians showing significantly higher scores than Chinese. Overall, participants reported higher satisfaction in 'Facility', 'Quality of care' and 'Nursing services' as opposed to 'Information/education'. 'Care with cultural respect' as well as communication related services. Data from the focus group interviews were categorized into 12 sub-categories, 7 categories and 2 themes. The two themes were common experience and contrasting experience. Common experience included 4 categories, 'Quality of care', 'Hospital facility and health care system', 'Language barrier' and 'Information and education'. Contrasting experience included 3 categories, 'Medical cost', 'Health care personnel' and 'Accessibility'. CONCLUSION: Results of this study provide basic knowledge on foreign residents' satisfaction and experience with Korean health care services. Further research is needed with foreigners from different cultural backgrounds. Administrative and educational efforts are required to improve communication skills and cultural competency.

Structural Equation Modeling On Health-related Quality of Life in Patients with Obstructive Sleep Apnea

PURPOSE: This study was done to test structural equation modeling of health-related quality of life (QOL) of men with obstructive sleep apnea in order to identify parameters affecting QOL and provide guidelines for interventions and strategies to improve QOL in these patients. METHODS: Model construction was based on 'The conceptual model of patient outcome in health-related QOL' by Wilson and Cleary, using the variables; age, physiological factors, social support, cognitive appraisal, symptoms and QOL. Participants were 201 adult male patients recruited at a tertiary university hospital in Seoul. Data were collected via questionnaires, polysomnography, and clinical records. RESULTS: Age and symptoms directly influenced QOL. Social support and cognitive appraisal about sleep did not have a direct influence on QOL, but indirectly affected it via symptoms. QOL was lower in patients who were younger and had more severe symptoms. Symptoms were more severe for patients with lower social support and more dysfunctional cognitive appraisal. When social support was lower, cognitive appraisal was more dysfunctional. CONCLUSION: These results suggest it is necessary to not only manage symptoms, but also apply interventions to increase social support and cognitive appraisal about sleep in order to increase QOL in patients with obstructive sleep apnea.

Menopausal Symptoms and Quality of Life according to Hormone Replacement Therapy in Rural Postmenopausal Women / 재활간호학회지

PURPOSE: This study was conducted to identify menopausal symptoms and quality of life (QOL) according to hormone replacement therapy (HRT) in rural menopausal women. METHODS: Menopausal symptoms and QOL were measured by questionnaires. A total of 50 participants in HRT group had received hormone replacement therapy for 12 weeks and another 50 who had not received hormone therapy were assigned to non-HRT group. RESULTS: Vasomotor symptom score of non-HRT group was significantly higher than that of HRT group (p=.013). There were no statistically significant differences between two groups in all menopausal symptoms except for vasomotor symptom. There were no significant differences between two groups in the total scores and sub-scores of QOL. Total scores and sub-scores of QOL were very low in both group. Menopausal symptoms were significantly negatively correlated with QOL. CONCLUSION: These results showed that there were no statistically significant differences between HRT group and non-HRT group in menopausal symptoms except for vasomotor symptom and QOL. Menopausal symptoms were moderate and QOL was very low in menopausal women. It is necessary to develop nursing interventions to improve menopausal symptoms and QOL in menopausal women.

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

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

Influence of Hope, Core beliefs and Social support on Posttraumatic growth in Mothers of Chronically Ill Children / 기본간호학회지

PURPOSE: The purpose of this study was to identify the influence of hope, core beliefs, and social support on the posttraumatic growth of mothers with chronically ill children. METHODS: In this study, 94 mothers who gave written consent completed the questionnaires between July 21 and July 31, 2012 when they visited a university hospital in Seoul, Korea. Data were analyzed using t-test, ANOVA, Pearson correlation coefficient and stepwise multiple regression. RESULTS: Hope, core belief and social support had positive correlations with posttraumatic growth. Models including these variables explained 64.8% (F=55.276, p<.001) of the variance for posttraumatic growth. Hope (beta=.441, p<.001) was the most influential factor. CONCLUSION: The findings demonstrate that it is essential for nurses to mediate and facilitate posttraumatic growth of mothers caring for chronically ill children. Furthermore, there is an needto develop and implement new strategies in clinical practice that will result in improvements in posttraumatic growth.

Experiences of Family Caregivers of Patients with Terminal Cancer

PURPOSE: This study done to identify the experiences of families caring for patients with terminal cancer. The question was, "What is the caregiving experience of a family who has a member with terminal cancer?" METHODS: Grounded Theory was applied and in-depth interviews were done with 11 family members. Interviews were recorded with the interviewees' consent and were transcribed and analyzed. Participants' relationships to patients were 6 spouses, 4 daughters, and 1 mother. The ages of the participants were between 32 and 62, with an average of 47.5. RESULTS: The study showed "enduring with bonds" as the main category and the main factor affecting this category was the "patients' diagnosis of terminal cancer." The caregiving experience was divided into four stages: shock, confusion, struggle, and acceptance. Mediating factors were relationship with the patient, intimacy with the patient, social support, communication, and trust. Conclusively, participants underwent internal maturity, and changes occurred in family and social and personal life. CONCLUSION: The families took care of the patients with responsibility and love. The study results should help with the understanding of a family with a member with terminal cancer and should be used to develop nursing, mediating, and consulting programs for these caregivers.

Educational Needs Based on Analysis of Importance, Frequency and Difficulty of ICU Nursing Practice for ICU Nurses / 기본간호학회지

PURPOSE: The purpose of this study was to assess the educational needs of ICU nurses based on an analysis of importance, frequency, and difficulty for ICU nursing practice. METHOD: A cross-sectional survey was conducted using a questionnaire with 80 questions in 14 ICU nursing categories. Data were collected from August to October 2009. A total of 295 ICU nurses from five hospitals who had minimum of one year clinical experience participated. Data were analyzed with using descriptive statistics. RESULTS: For importance, emergency care had the highest score, followed by physical assessment, communication, cardiovascular care, and ICU basic nursing. Regarding the frequency, physical assessment had the highest score, followed by communication, medication, ICU basic nursing, and respiratory care. Cardiovascular care was the most difficult task, followed by neurological care, emergency care, other ICU related nursing care, diagnostic test, and communication. CONCLUSION: The findings indicate a high educational need in the areas of communication, medication, physical assessment, diagnostic test, emergency care, and cardiovascular care. Thus the development of educational programs on communication, medication, physical assessment, diagnostic test, emergency care, and cardiovascular care are needed for ICU nurses.

Content and Educational Needs for Fundamental Nursing Practice / 기본간호학회지

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

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.

The Relationships between Stigma, Distress, and Quality of Life in Patients with Lung Cancer / 종양간호학회지

PURPOSE: The aim of this study was to investigate the relationships between stigma, distress, and quality of life (QOL) in patients with lung cancer. METHODS: The subjects of the study were 123 lung cancer patients who visited the outpatient department of S hospital in Seoul from July 21st to August 29th, 2011. To measure stigma, distress, and QOL, Cataldo Lung Cancer Stigma Scale, Hospital Anxiety and Depression Scale (HADS), and EORTC QLQ-C30 (Quality of Life Questionnaire, Core 30) were used in this study. The collected data were analyzed using frequency, average, t-test, ANOVA, and Pearson correlation with SPSS WIN 19.0. RESULTS: Stigma showed positive correlations with anxiety, depression, and symptom (r=.37, p<.001; r=.44, p<.001; r=.23 p=.012), while it showed negative correlations with global QOL and function (r=-.26, p=.003; r=-.40, p<.001). Anxiety and depression also positively correlated with symptoms (r=.43, p<.001; r=.58, p<.001) while anxiety and depression negatively correlated with global QOL (r=-.40, p<.001; r=-.56, p<.001) and function (r=-.64, p<.001; r=-.66, p<.001). CONCLUSION: The findings of the study demonstrated that lung cancer patients experienced stigma and distress that had a negative influence on the subjects' QOL. Thus the study's findings can be useful in developing psychosocial nursing strategies to improve QOL of lung cancer patients in the future.

A Comparative Study on the Validity of Fall Risk Assessment Scales in Korean Hospitals

PURPOSE: The purpose of this study was to compare the validity of three fall risk assessment scales including the Morse Fall Scale (MFS), the Bobath Memorial Hospital Fall Risk Assessment Scale (BMFRAS), and the Johns Hopkins Hospital Fall Risk Assessment Tool (JHFRAT). METHODS: This study was a prospective validation cohort study in five acute care hospitals in Seoul and Gyeonggi-Do, Korea. In total, 356 patients over the age of 18 years admitted from December 2009 to February 2010 participated. The three fall risk assessment scales listed above were tested for sensitivity, specificity, positive predictive and negative predictive values. A receiver-operating characteristic (ROC) curve was generated to show sensitivities and specificities for predicting falls based on different threshold scores for considering patients at high risk. RESULTS: Based on the mean scores of each scale for falls, the MFS at a cut-off score of 50 had a sensitivity of 78.9%, specificity of 55.8%, positive predictive value of 30.8%, and negative predictive value of 91.4%, which were the highest values among the three fall assessment scales. Areas under the curve of the ROC curves were .761 for the MFS, .715 for the BMFRAS, and .708 for the JHFRAT. CONCLUSIONS: Accordingly, of the three fall risk assessment scales, the highest predictive validity for identifying patients at high risk for falls was achieved by the MFS.

Educational Needs Assessment on Research Ethics among Nursing Researchers

PURPOSE: This study aimed to investigate the educational needs of research ethics among nursing researchers. METHODS: Convenience sample of 161 nursing professors and 262 master or doctoral nursing students participated in the study. Data was collected with self-reported questionnaire from June to August 2009, and analyzed with descriptive statistics using SPSS WIN (version 14.0). RESULTS: Among 161 nursing professors, about 31.7% has educated nursing ethics in the postgraduate course. The most common course was nursing research or methodology (62.7%), and median education time was 2 hr. Areas that showed difficulty in understanding was the conflict of interest and plagiarism for professors and falsification and fabrication for graduate students. Average knowledge on the research ethics was 75.4 points for professors and 61.6 points for students based on the 100 points. CONCLUSION: Educational needs of research ethics among nursing professors and students in the postgraduate course was high. We recommend both basic and advanced research ethics educational programs for the nursing researchers. The basic course should be at least 6 hr and include various cases and something to discuss.

Application and Evaluation of a Web-based Education Program on Blood-borne Infection Control for Nurses

PURPOSE: To develop a web-based program on blood-borne infection control and to examine the effect of the newly developed program on perceived threat of diseases, knowledge, preventive health behaviors for blood-borne infections, and incidence rates of accidental needle sticks and other sharp object injuries in nurses. METHODS: The program was developed through the processes of analysis, design, development, implementation, and evaluation. The research design involved a nonequivalent control group for pretest and posttest experiments. The setting was a 745-bed general hospital located in Korea. RESULTS: The program was designed and developed after consulting previous studies. After development of the program was completed, it was evaluated and revised by a panel of experts. The total score for perceived threat of diseases, knowledge, preventive health behaviors in the experimental group was significantly higher compared to the control group (p<.05). The incidence rates for needle sticks and other sharp object injuries in the experimental group were significantly lower compared to the control group (p<.05). CONCLUSION: Application of a Web-based, blood-borne infection control program is effective, and can be expanded to other healthcare workers who also have a high risk of blood-borne infections.

Model Construction of Sexual Satisfaction in Patients with a Colostomy

PURPOSE: This study was designed to construct and test the structural equation model on sexual satisfaction in patients with a colostomy. METHODS: The model construction was based upon Roy's adaptation model. Stoma-related discomfort (SRD), age, frequency of sexual intercourse, treatment modality, and gender affect sexual satisfaction and are mediated by physical, psychosocial, and interdependence modes. Each mode was conceptualized as sexual function, body image/depression, and marital intimacy. The patients were 112 colostomates with colorectal cancer who were asked to complete a mail-back survey on their demographic data, SRD, body image, depression, marital intimacy, sexual function, and sexual satisfaction. Data were analyzed using SPSS WIN 15.0 and AMOS WIN 7.0. RESULTS: Significant variables for sexual satisfaction in the final model were body image affected by SRD, depression affected by body image and SRD, marital intimacy affected by depression, and sexual function affected by marital intimacy. CONCLUSION: The results of this study suggest that specific guidelines for SRD are necessary to improve sexual satisfaction among colostomates. Nurses should be vigilant in monitoring depression and body image disturbance, and providing appropriate interventions to increase marital intimacy. Treatment modality, gender, and age should be considered in developing education programs pertaining to sexuality.

Task Analysis of the Job Description of Gerontological Nurse Practitioners based on DACUM

PURPOSE: The aim of this study was to develop and to analyze the task of gerontological nurse practitioners (GNPs) in Korea. METHODS: The definition of GNP and job description was developed based on developing a curriculum (DACUM) by 7 panels who have experienced in DACUM analysis and gerontological nursing. One hundred sixty nurses who were working at long term care facilities were participated. The questionnaire included frequency, importance, and difficulty of duties, tasks, and task elements. The data were collected in November 2006, analyzed by descriptive statistics. RESULTS: The job description of GNPs in Korea revealed 5 duties, 23 tasks, and 86 task elements. On the all five duties, the highest duty in frequency and in importance was professional nursing care (3.25+/-0.35, 3.49+/-0.29). But the highest duty in difficulty was research (3.24+/-0.46). 'Prevent health problem (3.42+/-0.43, 3.56+/-0.33)', 'Teach other staffs (2.83+/-0.77, 3.39+/-0.43)', 'Develop the evidence-based standards (2.43+/-0.76, 3.22+/-0.43)', 'Develop the self (2.81+/-0.65, 3.26+/-0.42)', and 'Participate the team activities' were the highest score in frequency and in criticality of tasks. 'Provide emotional support to older adults and families (3.16+/-0.41)', 'Counsel older adults and their families (3.14+/-0.49)', 'Do clinical research (3.32+/-0.49)', 'Quality insurance (3.25+/-0.49)', and 'Build collaborative system (3.18+/-0.47)' were perceived the most difficult tasks. CONCLUSION: The political efforts for the legislation of role and task of GNPs were needed.

Cancer Survivors' Life Experience / 종양간호학회지

PURPOSE: The purpose of this study was to describe and understand the meaning of cancer survivors' life experience after being discharged from the primary cancer treatment. METHODS: Data were collected through a tape-recorded in-depth interview from six participants living in Gyeonggi province from September 2007 to January 2008. The analysis of the data was made through the phenomenological analytic method suggested by Colaizzi. RESULTS: Thirteen themes regarding the survivors' life experience were found. From these thirteen themes, six major theme were emerged. The six major theme included 'keeping his/her mind comfortable', 'going ahead with new hope', 'accepting for his/her existing burden', 'maintaining a good health for a new life', 'improving the strength and relationship among the family member', and 'being faithful to his/her religion'. CONCLUSIONS: The results of this study would help oncology nurses to understand the cancer survivors' life and to develop a quality of life improvement program for physical, psychosocial, and spiritual aspects of nursing.

A Study on Exercise Behavior, Exercise Environment and Social Support of Middle-Aged Women / 간호학회지

PURPOSE: The purpose of this study was to identify exercise environments and social support associated with exercise behaviors in middle-aged women. METHOD: Subjects were 207 women aged between 41 and 59 yr in an urban community. The research instruments utilized in this study were exercise stages, exercise environments, exercise partners and social support scale. Subjects were given a self-report questionnaire. Data was analyzed using the SPSS Win program. RESULT: The subjects were in the stages of precontemplation (3.4%), contemplation (25.1%), preparation (40.6%), action (5.8%), and maintenance (25.1%). Subjects who engaged in regular exercise were 30.9%. The mean score of the exercise environment was 6.34. The mean score of social support was 21.28, and 65.7% of subjects had exercise partners. The score of the exercise environment was significantly associated with the exercise stage (p=.01). The number of exercise partners of regular exercise groups was significantly greater than that of non-regular exercise groups (p=.00). The score of social support of regular exercise groups was significantly greater than that of non-regular exercise groups (p=.00). The score of social support was significantly associated with the exercise stage (p=.00). CONCLUSION: Exercise environments and social support need to be considered in planning exercise programs to improve exercise behavior among middle-aged women.

Educational Issues and Strategies to Improve APN Education / 간호학회지

PURPOSE: This study was aimed at exploring the current status of graduate programs for an advanced practice nurse(APN) to recommend future directions of APN education. METHODS: A total of 142 students enrolled in seven APN specialty programs, 67 professors who were involved in APN education, and nine nurse administrators participated in the study. Data was collected by questionnaires and focus group interviews. RESULTS: The current definition of APN was found not to be specific enough to represent expected roles of APN in regards to knowledge, attitudes, roles, and skills. Standard curricula employed regardless of the area of APN specialty, lack of qualified clinical practice settings, as well as prepared instructors were found to be problematic. CONCLUSION: The following needs to be addressed: 1. redefining of APN roles, 2. tailoring specialty areas of APN, 3. consolidating educational programs, and 4. ensuring APN role models and faculty. Suggesting a CNS role in Korean APN, areas of APN should be rearranged toclarify their roles and educational programs need to be further developed to meet the expectations and quality of APNs. It is necessary to ensure APN's employment in the health care system by laws and policies to perform advanced nursing roles.

Affecting Factors of End Colostomy-Related Complications / 성인간호학회지

PURPOSE: This study was performed to investigate the type and frequency of end colostomy-related complications and to identify the risk factors for those complications. METHODS: Retrospective analysis of medical records was made in 708 patients who underwent end colostomy in Samsung Medical Center between October 1994 and February 2005. The type was divided into stomal and peristomal complications: stomal complications included bleeding, necrosis, mucocutaneous separation, prolapsed stoma, retraced stoma, stenosis, and hyperplasia; peristomal complications did peristomal varix, peristomal hernia, irritant contact dermatitis, allergic contact dermatitis, maceration, folliculitis, hyperplasia, bacterial infection, candidal infection, malignancy in the peristomal area, mechanical damage and pyoderma gangrenosum. RESULTS: For stomal complications, hyperplasia was most common(9.0%). For peristomal complications, irritant contact dermatitis was developed in 17.4%. Sex and BMI were risk factors for irritant contact dermatitis, hyperplasia, peristomal hernia, flat stoma, and retracted stoma. CONCLUSION: Teaching for preventing irritant contact dermatitis such as proper pouching and peristomal skin protection, and for comprehensive weight control should be emphasized on self care program for ostomates, while ostomy care nurse should take a careful consideration of preoperative ostomy site marking in female obese patients.