Determinants of Problem Drinking by Regional Variation among Adult Males in Single-Person Households: Geographically Weighted Regression Model Analysis

Purpose@#This study aimed to identify regional differences in problem drinking among adult males in single-person households and predict the determinants. @*Methods@#This study used data from the 2019 Community Health Survey. Geographically weighted regression analysis was performed on 8,625 adult males in single-person households who had been consuming alcohol for the past year. The Si-Gun-Gu was selected as the spatial unit. @*Results@#The top 10 regions for problem drinking among adult males in single-person households were located in the Jeju-do and Jeollanam-do areas near the southern coast, whereas the bottom 10 regions were located in the Incheon and northern Gyeonggi-do areas. Smoking, economic activity, and educational level were common factors affecting problem drinking among this population. Among the determinants of regional disparities in problem drinking among adult males in single-person households, personal factors included age, smoking, depression level, economic activity, educational level, and leisure activity, while regional factors included population and karaoke venue ratio. @*Conclusion@#Problem drinking among adult males in single-person households varies by region, and the variables affecting each particular area differ. Therefore, it is necessary to develop interventions tailored to individuals and regions that reflect the characteristics of each region by prioritizing smoking, economic activity, and educational level as the common factors.

Influencing Factors for Sleep Quality among Firefighters: Based on Objective and Subjective Evaluation

Purpose@#The purpose of this study was to assess insomnia and the quality of sleep, investigate the concordance between objective and self-report sleep patterns, and identify physiological, psychological, and situational factors influencing insomnia and sleep quality among firefighters. @*Methods@#A descriptive, cross-sectional study was conducted with 103 firefighters in Korea. The collected data were analyzed using SPSS 23.0. Descriptive statistics, the independent t-test, and hierarchical logistic regression analysis were performed. @*Results@#Insomnia was found in 66 (64.1 %) of the total subjects, and the average quality of sleep (PSQI) was 5.65 (SD=2.57). Total sleep time (401.00 minutes) and sleep latency (21.60 minutes) measured using self-reported scales were longer than the ones measured using objective measurements by approximately 48.70 and 17.10 minutes, respectively. Factors related to insomnia included the role as a paramedic (OR=4.28, 95% CI: 1.02~17.92), anxiety (OR=1.12, 95% CI: 1.01~1.24), and sedentary lifestyle (OR=0.85, 95% CI: 0.78~0.94), and factors related to sleep quality were physical illness status (OR=5.17, 95% CI: 1.53~17.51) and social support (OR=0.86, 95% CI: 0.78~0.95). @*Conclusion@#The results show a high prevalence of insomnia, poor quality of sleep and the discrepancy between objective and subjective sleep patterns among firefighters. To promote sleep quality and health, early screening and treatment of anxiety and physical illness are required. It is necessary to conduct further studies examining the relationship between physical activity level and sleep.

Effects of Using Mobile Apps for Mental Health Care in Korea: A Systematic Review / 정신간호학회지

Purpose@#This study aimed to systematically evaluate the content and effect of using Korean mobile apps for mental health care as reported in previous studies. @*Methods@#We conducted a systematic review according to PRISMA guidelines. Randomized controlled trials published up to May 2021 were searched in the PubMed, Cochrane Library, EMBASE, CINAHL, PsycINFO, RISS, KISS, and KoreaMed databases. We used the Cochrane risk-of-bias tool version 2 for randomized trials to evaluate the selected studies. @*Results@#Out of 3,374 articles retrieved, 12 were selected. These studies included people with mental disorders (mood disorder, panic disorder, or obsessive-compulsive disorder), psychiatric symptoms (depression, anxiety, attention deficit, etc.), and people in specific groups (college students or nurses). The apps were based on cognitive-behavioral therapy, cognitive training, well-being cognition technique, or relaxation techniques. The apps were effective in reducing depression, anxiety, panic attacks, attention deficit, negative emotions, and dysfunctional attitudes, and boosting memory and positive emotions. @*Conclusion@#Mobile apps with well-established, theory-based content can serve as an effective intervention for managing several mental health symptoms. However, the scope of the research subjects and symptoms in Korea remains limited. Further studies with more varied populations and symptoms are required.

Nursing students’ confidence in clinical competency and job readiness during the COVID-19 pandemic era / 한국간호교육학회지

Purpose@#This study explored nursing students’ experiences of attending clinical practicum courses in 2020 during the COVID-19 pandemic era, focusing on their confidence in clinical competency and job readiness. @*Methods@#The data for this study were collected using online questionnaires that were uploaded to a free online survey website and distributed via a link to the survey to 334 nursing students attending four-year nursing colleges at four national universities. Data analysis was done with descriptive statistics, independent t-tests, and ANOVA. @*Results@#The participants were mostly female (83.2%) college seniors (78.1%). About 60% of the participants practiced between 40% to 100% of their clinical practicum hours in alternative ways. Almost a third of the participants reported that they were not ready for a job (30.2%). However, participants’ confidence in clinical competency and job readiness was not related to the rate of alternative practice, but rather to both achievement of educational outcomes and satisfaction in the nursing practicum. @*Conclusion@#Due to COVID-19, it is evident that effective and efficient materials and ways of delivering clinical courses are constantly to be sought and developed. In particular, recently graduated nurses who experienced abrupt and considerable alterations in their clinical practicum courses due to COVID-19 are in need of attention while they strive to make clinical adaptations.

Validation of the Korean Version of the Patient-Reported Outcomes Information System® Emotional Distress Measures / 정신간호학회지

Purpose@#This methodological study aimed to translate the Korean version of the Patient-Reported Outcomes Measurement Information System® item bank-emotional distress (i.e., depression, anxiety, and anger) for adults and evaluate its psychometric properties. @*Methods@#Translation involved forward translation, back translation, expert review, harmonization and quality assurance, and cognitive testing. Psychometric properties were evaluated with a community sample of 201 adults. To assess the unidimensionality of the measures, we used factor analysis to examine construct validity. @*Results@#All items of the Patient-Reported Outcomes Measurement Information System item bank-emotional distress measures were translated through a rigorous translation process, and semantic, conceptual, and normative equivalences between the original and Korean version were ensured. Exploratory factor analysis revealed that all items loaded on one dominant factor. The Korean Patient-Reported Outcomes Measurement Information System measures demonstrated acceptable psychometric properties and unidimensionality. @*Conclusion@#The Korean version of the Patient-Reported Outcomes Measurement Information System item bank-emotional distress (i.e., depression, anxiety, and anger) for adults is reliable and valid. Hence, it may be utilized extensively in clinical and research settings and contribute to patient-centered care.

Experiences of Community-based Case Management for Early Psychosis: Focusing on Social Treatment for Early Psychosis (STEP) Program / 정신간호학회지

Purpose@#The purpose of this study was to explore the experience of case management for early psychosis and identify factors influencing care management. @*Methods@#We conducted in-depth interviews with 10 mental health professionals who implemented the Social Treatment for Early Psychosis (STEP) program. The collected data were analyzed using qualitative content analysis. @*Results@#The findings consisted of 4 categories and 15 subcategories. Case management should develop expertise considering the desires of young adults, and grew as experts by promoting family cooperation and coping with mental crises. Administrator's support and peer support programs had a positive impact, while the absence of collaborative systems with psychiatric institution were identified as limitations in the operating system of the basic center. Consulting and monitoring of the metropolitan center provided a foundation for case management at the basic center, while the government's support policy is needed to improve of working environment and set up the youth-friendly early intervention system. @*Conclusion@#The results suggest that case management for early psychosis requires multilateral and cooperative efforts by strengthening the capabilities of case managers, establishing an integrated case management network of basic and metropolitan centers, and expanding the government's human and physical infrastructure.

Validation of the Korean Version of the Patient-Reported Outcomes Information System® Emotional Distress Measures / 정신간호학회지

Purpose@#This methodological study aimed to translate the Korean version of the Patient-Reported Outcomes Measurement Information System® item bank-emotional distress (i.e., depression, anxiety, and anger) for adults and evaluate its psychometric properties. @*Methods@#Translation involved forward translation, back translation, expert review, harmonization and quality assurance, and cognitive testing. Psychometric properties were evaluated with a community sample of 201 adults. To assess the unidimensionality of the measures, we used factor analysis to examine construct validity. @*Results@#All items of the Patient-Reported Outcomes Measurement Information System item bank-emotional distress measures were translated through a rigorous translation process, and semantic, conceptual, and normative equivalences between the original and Korean version were ensured. Exploratory factor analysis revealed that all items loaded on one dominant factor. The Korean Patient-Reported Outcomes Measurement Information System measures demonstrated acceptable psychometric properties and unidimensionality. @*Conclusion@#The Korean version of the Patient-Reported Outcomes Measurement Information System item bank-emotional distress (i.e., depression, anxiety, and anger) for adults is reliable and valid. Hence, it may be utilized extensively in clinical and research settings and contribute to patient-centered care.

Experiences of Community-based Case Management for Early Psychosis: Focusing on Social Treatment for Early Psychosis (STEP) Program / 정신간호학회지

Purpose@#The purpose of this study was to explore the experience of case management for early psychosis and identify factors influencing care management. @*Methods@#We conducted in-depth interviews with 10 mental health professionals who implemented the Social Treatment for Early Psychosis (STEP) program. The collected data were analyzed using qualitative content analysis. @*Results@#The findings consisted of 4 categories and 15 subcategories. Case management should develop expertise considering the desires of young adults, and grew as experts by promoting family cooperation and coping with mental crises. Administrator's support and peer support programs had a positive impact, while the absence of collaborative systems with psychiatric institution were identified as limitations in the operating system of the basic center. Consulting and monitoring of the metropolitan center provided a foundation for case management at the basic center, while the government's support policy is needed to improve of working environment and set up the youth-friendly early intervention system. @*Conclusion@#The results suggest that case management for early psychosis requires multilateral and cooperative efforts by strengthening the capabilities of case managers, establishing an integrated case management network of basic and metropolitan centers, and expanding the government's human and physical infrastructure.

A Systematic Review on Peer Support Services related to the Mental Health Services Utilization for People with Severe Mental Illness / 정신간호학회지

Purpose@#The purpose of this study was to systematically review peer support services related to mental health services utilization by people with severe mental illness and to identify core strategies essential for effective peer support services. @*Methods@#A systematic search was conducted using keywords in English, 4 electronic databases, including CINAHL, EMBASE, MEDLINE, and PubMed. Of the 1,305 publications identified, 14 studies were finally included in this systematic review. The Scottish Intercollegiate Guidelines Network (SIGN) was used for the quality assessment. @*Results@#The 14 studies consisted of 8 randomized controlled trials (RCTs), 4 cohort studies, and 2 quasi-experimental studies. Overall, peer support services were found to be effective in reducing hospitalization rates, hospitalization days, number of emergency room visits, and total medical costs. There was inconsistent evidence that the services were associated with positive effects on measures of psychiatric symptoms, quality of life, and social support. @*Conclusion@#Peer support services for people with severe mental illness can be a cost-effective way to increase crisis stabilization and continuity of treatment. The core strategies of the services is the development of structured programs to cultivate professional peer providers and the establishment of a cooperative system between mental health professionals and peer providers.

Development and Evaluation of the Life Respect Enhancement Program for Nursing Officers

Purpose@#The present study was conducted to develop the Life Respect Enhancement Program and test its effectiveness on suicide knowledge, suicide intervention skills, self-efficacy in suicide prevention, and gatekeeper behaviors among nursing officers. @*Methods@#The program was developed according to the ADDIE model and finalized after practical need analysis, expert verification, and a preliminary study.The present study used a concurrent embedded mixed-method research design. To compare the effects of the Program and the control group on the outcome variables, a quantitative study was conducted using a nonequivalent control group with a pretest-posttest design.Quantitative data were analyzed using c 2 -tests, t-tests, and RM-ANOVA. A qualitative study was conducted using FGI with six members of the experimental group 3 months after intervention completion. @*Results@#In total, 56 nursing officers participated in the 3-month follow-up test. Compared to the control group, the experimental group showed significant improvements in suicide knowledge, suicide intervention skills, and self-efficacy in suicide prevention scores at post-test. The significant group differences in suicide knowledge and suicide intervention skills were maintained at 3 months. The gatekeeper behavior scores of the experimental group were also significantly higher than those of the control group at 3 months. Qualitative analysis of the participants’ experiences with the Program yielded two themes and seven sub-themes. @*Conclusion@#The newly developed Life Respect Enhancement Program demonstrates significant effects on suicide knowledge, suicide intervention skills, and gatekeeper behaviors. Thus, this program is recommended to promote suicide prevention competencies among nursing officers in military clinical settings.

Associations of Acculturative Stress, Depression, and Quality of Life among Indonesian Migrant Workers in South Korea / 정신간호학회지

PURPOSE: The purpose of this cross-sectional, correlational study was to identify associations of acculturative stress, depression, and quality of life among Indonesian migrant workers living in South Korea. METHODS: A total of 91 migrant workers who were recruited in Korea completed paper-and-pencil self-administered questionnaire in September 2018. Acculturative Stress Scale, Patient Health Questionnaire-9, World Health Organization Quality of Life Instrument, Multidimensional Scale of Perceived Social Support (MSPSS), Perceived Organizational Support Scale, and demographic questionnaire were used to measure acculturative stress, depression, quality of life, social support, and organizational support, respectively. We applied descriptive statistics, Pearson's correlation coefficients, and multiple linear regression analyses with SPSS 22 program. RESULTS: A positive correlation was shown between acculturative stress and depression and a negative correlation was found between acculturative stress and quality of life. Significant factor associated with depression was acculturative stress. Significant factors associated with quality of life were acculturative stress and social support. CONCLUSION: Our study findings assist nurses to improve the quality of mental health services for Indonesian migrant workers by providing important information such as contact information for health services and counseling and to guide future studies on mental health issues among the population.

An Estimation of Supply and Demand for Primary Healthcare Nursing Workforce in the North Korean Region after Korean Reunification / 간호행정학회지

PURPOSE: This study was done to estimate supply and demand for nursing workforce to provide community-based primary healthcare in the North Korean region to cost-efficiently narrow the health gap between the two Koreas in case of a Korean reunification. METHODS: To understand the nursing education system and current state of nursing workforce in North Korea, the authors interviewed six North Korean defectors who had worked as nurses in North Korea. Based on the interview results and literature review, the supply and demand for the primary healthcare nursing workforce that would be needed after Korean reunification were estimated RESULTS: Currently, a total of 2,100 to 2,700 North Korean nurses were estimated to have graduated from nursing schools with a 2 year curriculum or completed 6-month military nurse training courses every year. The projected number of nurses in demand to provide primary health care ranged from 84,160 to 105,200 and the shortage would be between 31,586 and 52,626. CONCLUSION: An active utilization of the North Korean nursing workforce to improve the health of North Koreans after reunification will be the best way to reduce the reunification cost which will be inflicted mainly on South Korea.

Systematic Review of Mental Health Interventions Designed for Multicultural Children and Adolescents in South Korea / 정신간호학회지

PURPOSE: The purpose of this study was to review intervention programs designed to promote mental health in multicultural children and adolescents living in Korea. METHODS: A systematic search with key words in Korean and English was conducted using 9 electronic databases. Twelve studies were included in the sample for systematic review and the Methodological Index for Non-Randomized Study (MINORS) was used to assess methodological rigor and quality of scientific evidence. RESULTS: Randomized controlled trials (RCTs) were used in 3 and quasi-experimental designs in nine studies. Interventions utilizing art therapy were found to be effective in improving school adjustment in these children, and in decreasing levels of depression and anxiety. Learning activities and self-image were not found to be effective. In all 12 studies discussion of the theory guiding the intervention was not included and all 12 studies were rated as having a high risk of bias based on MINORS criteria. CONCLUSION: Findings provide a basis for developing intervention programs to improve mental health in multicultural children and adolescents. Core strategies for promoting mental health in these children and adolescents include access to age and situational characteristics. For intervention effects, development of programs to improve self-esteem and resilience is important.

Retention Esophagitis as a Significant Clinical Predictor of Progression to Esophageal Cancer in Achalasia

BACKGROUND/AIMS: Chronic liquid and/or food stasis caused by retention esophagitis (RE) in achalasia is a notable endoscopic finding because of the presence of a thickened or whitish esophageal mucosa and histologically altered squamous hyperplasia. We aimed to identify the clinical features of RE associated with achalasia and to clarify the clinical definition of RE in achalasia as a precancerous lesion identified by analyzing biomarker expressions. METHODS: From 2006 to 2015, we retrospectively reviewed 37 patients with achalasia without previous treatment. Among them, 21 patients had diagnostic findings of RE (RE+) and 16 patients had no diagnostic findings of RE (RE−). Immunohistochemical staining of p53, p16, and Ki-67 was performed on the endoscopic biopsy tissues from the patients with achalasia and 10 control patients with non-obstructive dysphagia. RESULTS: The symptom duration and transit delay were significantly longer in the RE+ group than in the RE− group. We found particularly high p53 positivity rates in the RE+ group (p<0.001). The rate of p16 expression was also significantly higher in the RE+ group than in the other two groups (p=0.003). CONCLUSIONS: A high p53 expression rate was more frequently found in the RE+ group than in the other two groups. RE could be a meaningful clinical feature of achalasia for predicting esophageal carcinogenesis.

A Phenomenological Study on the Lived Experience of Train Operators Exposed to Person under Train (PUT)

PURPOSE: To understand the meaning of the lived experience with Person under train (PUT) for train or subway operators. METHODS: The study was built on hermeneutic phenomenological themes from individual interviews of present-day train or subway operators in South Korea. Eight participants were selected to participate in the study. All qualitative data were analyzed using the heuristic guides of Van Manen. RESULTS: Four fundamental lifeworld themes and eight sub themes emerged in the findings. The first theme of spatiality had‘the place pressed by the darkness’ and ‘the train drags me there’. The second theme, corporeality had ‘a foreboding fear’, and ‘debris of death that gets stuck in the whole body’. The temporality theme had‘distorted time in chaos’, and ‘memory trapped in time’. Finally the last existential theme of relationality had ‘intrapersonal encounter’ and ‘resentment and guilt’. CONCLUSION: The four existential lifeworld themes provided a framework for in-depth investigation of the operator's “lived experience.” This leads to clear understanding of effects of PUT experience on related individuals. The findings imply that specific active nursing intervention strategies are necessary in order to treat affected train operators, and to prevent further issues in their work and private life.

A Systematic Review of Suicide Prevention Programs for Healthcare Personnel / 정신간호학회지

PURPOSE: The purpose of this study was to systematically review the suicide prevention programs for healthcare personnel to identify contents, formats, and strategies essential for effective suicide prevention programs. METHODS: A systematic search using key words in English and Korean was conducted using 10 electronic databases, including EMBASE, MEDLINE, and RISS. Of 794 publications identified, 9 studies were finally included in this systematic review. The Scottish Intercollegiate Guidelines Network (SIGN) was used for the quality assessment. RESULTS: Of the nine experimental studies, seven studies used randomized controlled trials (RCTs), and two used quasi-experimental designs. Overall, suicide prevention programs were found to be effective in improving competencies (e.g., knowledge, communication skills, and attitudes) of healthcare personnel working in diverse settings. Limitations of these studies included a lack of rigorous research designs and reliable and universal outcome measures. Paradoxically, none of the studies were conducted in South Korea, which consistently has the highest suicide rate of all OECD countries. CONCLUSION: Suicide prevention programs for health personnel can be an effective way to improve competency of healthcare personnel in preventing suicide. These findings will serve as a foundation for the development of suicide prevention programs by Korean healthcare personnel.

The Experience of Nursing Students' Moral Distress in Clinical Practice / 한국간호교육학회지

PURPOSE: This study explores the moral distress that nursing students experience during their clinical practice in Korea. METHODS: Data were collected using focus group interviews, and analyzed using qualitative content analysis. Participants were recruited from three nursing schools in three different cities; each focus group interview lasted between one to two hours. RESULTS: Twenty-two nursing students with more than one year of clinical practice experience participated. Three categories and ten themes were extracted. The following situational categories: "unprotected patients' right and dignity," "clinical settings in which standards of care are not upheld," "disrespectful hospital culture," and "inconsistent and unsystematic clinical education" caused moral distress. Types of responses to moral distress included: "shock and confusion over the gap between reality and moral standards," "powerlessness when cannot advocate patients," "fear and doubts about nursing career," and "moral desensitization and disappointment in oneself." "Expressions of moral distress and the need for advice" and "a search for meaning and hope" were identified as coping strategies. CONCLUSION: These results demonstrate the need for systematic clinical practicum and education programs to minimize moral distress. These programs may offer opportunities for students to turn moral distress into opportunities for learning and growth in the future.

The Effects of Emotion-focused Individual Intervention for Family Caregivers of People with Early Stages of Dementia / 정신간호학회지

PURPOSE: Many family caregivers of people with early stages of dementia experience difficulty in obtaining information on dementia. In addition, adjusting to this new caregiving role is emotionally demanding, thus many family caregivers go thorough a lot of emotional stress. This study tested emotion-focused individual intervention as a way to help family caregivers of early-stage dementia patients obtain necessary information and emotional support related to caregiving. METHODS: To achieve this goal, a quasi-experimental study with a non-equivalent control group design was conducted. Emotion-focused individual intervention was administered to the experimental group (n=15), and no treatment was administered to the control group (n=21). Both groups completed a demographic profile, and also took pre- and post-test measuring their dementia-related knowledge, self-efficacy of care, preparedness of care, and coping strategies of care. Descriptive statistics were calculated, and t-test, and ANCOVA were performed to SPSS program. RESULTS: It was found that there was a statistically significant improvement in dementia-related knowledge (p<.001), self-efficacy of care (p=.030), preparedness of care (p<.001), and coping strategies of care (p<.001) after the intervention. CONCLUSION: The findings suggest that emotion-focused individual intervention was effective for family caregivers of patients with early dementia to adjust to the new caregiving role.

Mental Health Literacy among Parents of Adolescents and Teachers in Korea / 정신간호학회지

PURPOSE: The purpose of this study was to investigate the level of mental health literacy (MHL) among parents of adolescents and middle and high school teachers in Korea. METHODS: A descriptive cross-sectional survey design was used for the present study. Participants were 120 parents and 103 middle and high school teachers in Korea. In 2014-2015 participants completed a survey about two case vignettes(adolescent schizophrenia and depression) and answered questions assessing recognition of these disorders and belief about the helpfulness of interventions and resources. Descriptive analysis, t-test and chi2 test were performed. RESULTS: Schizophrenia was recognized by only 11.6% of parents and 25.2% of teachers. Depression was recognized by 32.5% of parents and 59.2% of teachers. Both parents and teachers acknowledged individual and socio-environmental factors as causes for schizophrenia and depression. However, they were less likely to recognize biological factors as potential causes for mental illness. CONCLUSION: The findings demonstrate the need for education programs for parents of adolescents and teachers to improve their mental health literacy, particularly concerning biological causes of mental illness.

Applying the Flipped Learning Model to an English-Medium Nursing Course

PURPOSE: An emerging trend in Asian higher education is English-medium instruction (EMI), which uses English as the primary instructional language. EMI prepares domestic students for international leadership; however, students report difficulty in learning, and educators have raised questions concerning the effectiveness of EMI. The flipped learning model (FLM), in which lecture and homework activities for a course are reversed, was applied to an English-medium course offered by a college of nursing in Korea. The aims of this study were to: 1) revise an existing English-medium nursing course using the FLM; 2) explore students' learning experiences and their acceptance of the FLM; and 3) identify key factors in the success of FLM. METHODS: We used a descriptive, cross-sectional, mixed-methods design and the participants were students at one nursing school in Korea. A series of course development meetings with faculties from the nursing school and the center for teaching and learning were used to develop the course format and content. We conducted course evaluations using the Flipped Course Evaluation Questionnaire with open-ended questions and focus group interviews. RESULTS: Students (N=75) in a 15-week nursing course responded to a survey after completing the course. Among them, seven students participated in one of two focus groups. Overall, students accepted and favored the flipped learning strategy, and indicated that the method enhanced lecture content and their understanding of it. Factors associated with effective instruction included structured monitoring systems and motivational environments. CONCLUSION: The FLM requires sufficient preparation to facilitate student motivation and maximize learning outcomes.