Critical Thinking Disposition, Medication Error Risk Level of High-alert Medication and Medication Safety Competency among Intensive Care Unit Nurses / 중환자간호학회지

Purpose@#: The study aimed to identify relationship among intensive care unit (ICU) nurses’ critical thinking disposition, medication error risk level of high-alert medication, and medication safety competency, as well as the factors affecting medication safety competency. @*Methods@#: The participants were 266 ICU nurses of one higher-tier general hospital and one general hospital in Province. The data were collected using structured self-administered questionnaire from August 10 to August 31, 2021. Measurements included the critical thinking disposition questionnaire, nurses’s knowledge of high-alert medication questionnaire, the medication safety competency scale. Data were analyzed using hierarchical multiple regressions using SPSS/WIN 28.0. @*Results@#: In the multiple regression analysis, the medication safety competence has a statistically significant correlation with the working department, the critical thinking disposition, and medication error risk level of high-alert medication. @*Conclusion@#: Based on the results of this study, it is suggested to develop and apply an educational strategy that can strengthen the knowledge and skills of critical thinking disposition and medication error risk level of high-alert medication to improve the ICU nurse’s medication safety competency.

Post-traumatic Growth and it’s associations with Deliberate Rumination, Self-disclosure, and Social Support among Intensive Care Unit Nurses / 중환자간호학회지

Purpose@#: This study aimed to identify intensive care units (ICU) nurses’ experience of traumatic events, deliberate rumination, self-disclosure, social support, and post-traumatic growth (PTG), and to explore relationships among the variables. @*Methods@#: Participants were 157 nurses who have provided direct patient care for six months or more in ICUs at a university hospital. Collected data were analyzed using descriptive statistics, independent t-tests, one-way ANOVAs, Pearson correlations, and multiple linear regressions using the SPSS/WIN version 23.0. @*Results@#: The PTG was found to be significantly associated with deliberate rumination (r=0.36, p<.001), self-disclosure (r=0.39, p<.001), and social support (r=0.54, p<.001). Factors that affect PTG significantly were found in the order of social support (β=0.40, p<.001), self-disclosure (β=0.25, p<.001), and deliberate rumination (β=0.24, p<.001). The final regression model explained 40.1% of the variance of PTG (F=26.33, p<.001). @*Conclusion@#: The influencing factors identified in this study on PTG, including social support, self-disclosure, and deliberate rumination should be included in programs to promote PTG for ICU nurses who may experience traumatic events repeatedly.

Associations between job stress, social support, and nursing professionalism among nurses in postgraduate courses / 한국간호교육학회지

Purpose@#This study aimed to identify the associations between job stress, social support, and nursing professionalism among nurses taking postgraduate courses, and to explore the factors influencing their nursing professionalism. @*Methods@#The participants were 121 nurses who were enrolled in graduate school master's or doctoral programs in Korea. Data were collected from June 30 to August 31, 2021, using an internet-based self-report questionnaire. The data were analyzed by descriptive statistics, independent t-test, one-way ANOVA, Pearson's correlation coefficient, and multiple regression analysis using the IBM SPSS 23.0 program. @*Results@#The mean scores of job stress, social support, and nursing professionalism among the participants were 2.47 out of 4, 4.06 out of 5, and 3.47 out of 5, respectively. There were statistically significant differences in nursing professionalism among the participants according to the degree program (F=-2.76, p=.007) and the length of nursing career (F=4.35, p=.015). Their nursing professionalism showed a positive correlation with social support (r=.45, p<.001) and a negative correlation with job stress (r=-.43, p<.001). As a result of the multiple regression analysis, factors influencing nursing professionalism of the participants were found to be job stress (β=-.28, p=.003), social support (β=.23, p=.015), and the length of nursing career (β=.19, p=.018). The explanatory power of the model was 28.0% (F=12.62, p<.001). @*Conclusion@#The present study suggests that organized efforts are needed to alleviate job stress and to increase social support for nurses in postgraduate courses in order to ultimately improve their nursing professionalism.

Factors Influencing Compliance with Safe Handling of Antineoplastic Agents Among Clinical Nurses

Purpose@#This study aimed to investigate the levels of compliance with safe handling of antineoplastic agents, time pressure, knowledge of safe handling of antineoplastic agents, and workplace safety climate, and to identify factors influencing compliance with the safe handling of antineoplastic agents among clinical nurses. @*Methods@#For this cross-sectional study, anonymous written surveys were conducted on a convenience sample of 130 clinical nurses at a university-affiliated hospital between July 10 and 20, 2020. Data were analyzed through descriptive statistics, t-tests, analyses of variance, Pearson’s correlation, and hierarchical multiple regression analysis using SPSS. @*Results@#The average level of compliance with safe handling of antineoplastic agents was 120.81 out of 175. The significant correlates for compliance with safe handling of antineoplastic agents were clinical experience, knowledge of safe handling of antineoplastic agents, and workplace safety climate. These accounted for 38% of the total variance in compliance with the safe handling of antineoplastic agents. @*Conclusion@#The findings suggest that to increase compliance with safe handling of antineoplastic agents, workplace safety climate and knowledge of safe handling of antineoplastic agents should be improved. The development and application of an effective training program on the safe handling of antineoplastic agents would lead to improvements in this area.

Factors Influencing Patient Safety Nursing Activities of Intensive Care Unit Nurses / 중환자간호학회지

Purpose@#: The purposes of this study were to examine the levels of job stress, perceptions of the patient safety culture, and patient safety nursing activities, and to identify factors influencing patient safety nursing activities among intensive care unit (ICU) nurses. @*Methods@#: For this cross-sectional study, data were collected from 161ICU nurses working in two university-affiliated hospitals in Gyeonggi-do between June 30 and July 30, 2020.The data were analyzed with descriptive statistics, an independent t-test, a one-way ANOVA, the Pearsoncorrelation method, and multiple regression using the SPSS program. @*Results@#: The average levels of job stress, perception of patient safety culture, and patient safety nursing activities were 3.48, 3.44, and 4.45 out of 5, respectively. Multiple regression showed that perception of patient safety culture and career in current workplace were found to be statistically significant correlates of patient safety nursing activities. @*Conclusion@#: In order to promote patient safety nursing activities, patient safety culture needs to be incorporated into the education of ICU nurses. Perception of patient safety should be enhanced to improve patients safety nursing activity.

Factors Influencing Compliance with Safe Handling of Antineoplastic Agents Among Clinical Nurses

Purpose@#This study aimed to investigate the levels of compliance with safe handling of antineoplastic agents, time pressure, knowledge of safe handling of antineoplastic agents, and workplace safety climate, and to identify factors influencing compliance with the safe handling of antineoplastic agents among clinical nurses. @*Methods@#For this cross-sectional study, anonymous written surveys were conducted on a convenience sample of 130 clinical nurses at a university-affiliated hospital between July 10 and 20, 2020. Data were analyzed through descriptive statistics, t-tests, analyses of variance, Pearson’s correlation, and hierarchical multiple regression analysis using SPSS. @*Results@#The average level of compliance with safe handling of antineoplastic agents was 120.81 out of 175. The significant correlates for compliance with safe handling of antineoplastic agents were clinical experience, knowledge of safe handling of antineoplastic agents, and workplace safety climate. These accounted for 38% of the total variance in compliance with the safe handling of antineoplastic agents. @*Conclusion@#The findings suggest that to increase compliance with safe handling of antineoplastic agents, workplace safety climate and knowledge of safe handling of antineoplastic agents should be improved. The development and application of an effective training program on the safe handling of antineoplastic agents would lead to improvements in this area.

Differences in Associated Factors according to the Time of Occurrence of Pressure Ulcers in Intensive Care Unit Patients / 중환자간호학회지

Purpose@#: This study aimed to present the incidence of pressure ulcers and identify different associated factors according to the time of occurrence of pressure ulcers in intensive care unit (ICU) patients. @*Methods@#: The participants were 313 patients who reported pressure ulcers among 2,908 patients in ICUs at a large tertiary hospital in Gyeonggi-do. Among them, 220 patients (70.3%) had a pressure ulcer before admission, and 93 patients (29.7%) reported newly developed pressure ulcers after admission to the ICU. Data were collected between August 2018 and April 2019. Along with the time of occurrence and characteristics of pressure ulcers, diverse associated factors were gathered through electronic medical records. Data were analyzed using descriptive statistics, independent t-tests, and χ2-tests. @*Results@#: Different risk factors associated with pressure ulcers in ICU patients according to the time of occurrence were main diagnosis, score of acute physiology and chronic health evaluation, score of Richmond agitation sedation scale, level of consciousness, administered sedatives, use of a ventilator, insertion of a feeding tube, and the duration of fasting period. @*Conclusion@#: Based on the results of this study, healthcare providers, especially ICU nurses, should try to detect early signs and symptoms of pressure ulcers, taking into account the derived factors associated with pressure ulcers in ICU patients. Practical intervention programs and strategies considering the factors associated with pressure ulcers must be developed to prevent and alleviate such ulcers in ICU patients in the future.

Factors Influencing Patient Safety Nursing Activities of Intensive Care Unit Nurses / 중환자간호학회지

Purpose@#: The purposes of this study were to examine the levels of job stress, perceptions of the patient safety culture, and patient safety nursing activities, and to identify factors influencing patient safety nursing activities among intensive care unit (ICU) nurses. @*Methods@#: For this cross-sectional study, data were collected from 161ICU nurses working in two university-affiliated hospitals in Gyeonggi-do between June 30 and July 30, 2020.The data were analyzed with descriptive statistics, an independent t-test, a one-way ANOVA, the Pearsoncorrelation method, and multiple regression using the SPSS program. @*Results@#: The average levels of job stress, perception of patient safety culture, and patient safety nursing activities were 3.48, 3.44, and 4.45 out of 5, respectively. Multiple regression showed that perception of patient safety culture and career in current workplace were found to be statistically significant correlates of patient safety nursing activities. @*Conclusion@#: In order to promote patient safety nursing activities, patient safety culture needs to be incorporated into the education of ICU nurses. Perception of patient safety should be enhanced to improve patients safety nursing activity.

Effects of uncertainty and spousal support on infertility-related quality of life in women undergoing assisted reproductive technologies

Purpose@#The purpose of this study was to investigate the effects of uncertainty and spousal support on infertility-related quality of life in women undergoing assisted reproductive technologies. @*Methods@#In this correlational survey study, 172 infertile women undergoing assisted reproductive technologies for infertility treatment at M hospital in Suwon participated. Data collection took place at the outpatient department of M hospital using a self-report questionnaire from July to August 2019. Data were analyzed using SPSS for Windows version 28.0. @*Results@#The mean scores for uncertainty, spousal support, and infertility-related quality of life were 28.35 (out of 50), 86.67 (out of 115), and 57.98 (out of 100), respectively. Infertility-related quality of life was positively correlated with spousal support and negatively correlated with uncertainty. According to the regression analysis, infertility-related quality of life was significantly affected by uncertainty, total number of assisted reproductive technology treatments, marriage duration, subjective health status, the financial burden of infertility testing, and the presence of a burdensome person. These variables had an explanatory power of 35.0% for infertility-related quality of life. @*Conclusion@#Uncertainty was an important factor influencing infertility-related quality of life among women undergoing assisted reproductive technologies. It is necessary to develop and implement a nursing intervention program focused on reducing various forms of uncertainty during assisted reproductive procedures and to consider other factors affecting infertility-related quality of life in the clinical setting.

Effects of stress, depression, and spousal and familial support on maternal identity in pregnant women

Purpose@#The objective of this study was to identify the factors influencing maternal identity in pregnant women. @*Methods@#Using a descriptive research design, a cross-sectional survey was conducted. In total, 127 pregnant women were recruited from a tertiary hospital in Korea from January to April 2019. Measurements included maternal identity, stress, depression, spousal and familial support, and demographic and obstetric characteristics. Data were analyzed by descriptive statistics, the independent t-test, one-way ANOVA, Pearson correlation coefficients, and stepwise multiple regression using SPSS version 25.0. @*Results@#The mean score for maternal identity was 131.15 out of 160, and the mean scores for stress, depression, and spousal and familial support were 14.59 (out of 40), 6.82 (out of 30), and 109.04 (out of 132), respectively. Stress (r=–.38, p<.001), depression (r=–.37, p<.001), and spousal and familial support (r=.37, p<.001) were significantly correlated with maternal identity. In multiple regression analysis, stress (β=–0.27, p=.005) and spousal and familial support (β=0.23, p=.014) were found to be significant factors influencing maternal identity in pregnant women (F=14.17, p<.001). @*Conclusion@#It is necessary to develop effective strategies to mitigate stress and to encourage spousal and familial support in pregnant women. Such strategies could further enable pregnant women to enhance their maternal identity.

The Association Between Perceived Stress and Quality of Life in University Students: The Parallel Mediating Role of Depressive Symptoms and Health-Promoting Behaviors

PURPOSE: This study examined whether depressive symptoms and health-promoting lifestyle behaviors mediate the association between perceived stress and quality of life (QoL) in university students. METHODS: Using a cross-sectional survey, Korean university students (N = 187, Mage = 23.97 years; 54.0% Woman) completed structured questionnaires with psychometric adequacy. A parallel multiple mediation model was used to test the mediating effect of depressive symptoms and health-promoting lifestyle behaviors on the relationship between perceived stress and QoL. RESULTS: Total effect of perceived stress, depressive symptoms, and health-promoting lifestyle behaviors on QoL was −.55. Of these, total indirect mediating effect was −.50, whereas direct effect was only −.05 in the parallel mediation model. In particular, depressive symptoms (indirect effect = −.32) and healthpromoting lifestyle behaviors (indirect effect = −.18) completely mediated the relationship between perceived stress and QoL. CONCLUSION: The results suggest that effective strategies primarily focusing on improving depressive symptoms along with health behaviors are needed to decrease the negative effect of perceived stress on QoL.

Peer Attachment, Perceived Parenting Style, Self-concept, and School Adjustments in Adolescents with Chronic Illness

PURPOSE: The purpose of this study was to identify how peer attachment and parenting style differentially affect self-concept and school adjustment in adolescents with and without chronic illness. METHODS: A cross-sectional study using multiple group analysis on the Korean panel data was used. A nationwide stratified multistage cluster sampling method was used and the survey was conducted in 2013 on 2,092 first-year middle school students in Korea. We used standardized instruments by the National Youth Policy Institute to measure peer attachment, parenting style, self-concept, and school adjustment. Multiple-group structural equation modeling was used to evaluate the difference of relations for peer attachment, parenting style, self-concept, and school adjustment variable between adolescents with chronic illness and those without chronic illness. RESULTS: The model fit of a multiple-group structural equation modeling was good. The difference of the path from negative parenting style to self-concept between the two groups was significant, and a significant between-group difference in the overall path was found. This indicated that self-concept in adolescents with chronic illness was more negatively affected by negative parenting style than in adolescents without chronic illness. CONCLUSIONS: Healthcare providers can promote the process of school adjustment in several ways, such as discussing this issue directly with adolescent patients, along with their parents and peers, examining how the organization and content of the treatment can be modified according to the adolescents' school life.

Effect of Intervention Programs for Improving Maternal Adaptation in Korea: Systematic Review

PURPOSE: The purpose of this study was to determine the current state of nursing intervention for maternal adaptation and its' effectiveness in Korea by utilizing a systematic review. METHODS: The PICO(Population-Intervention-Compar ator-Outcome) strategy was established, and 1,720 pieces of literature published during the last ten-year period from four electronic databases were reviewed. Eighteen references that met inclusion and exclusion criteria were finally selected for systematic review. The quality of references using critical appraisal checklist for experimental studies were evaluated, and then systematic review and meta-analysis were conducted. RESULTS: All 18 references were quasi-experimental research design. Most interventions were provided at the hospital and postpartum care center. Maternal adaptation interventions appeared to be of many types, and particularly maternal role education programs were the most common. Confidence in maternal role was used as the most common variable for the maternal adaptati on. Various interventions for helping maternal adaptation in the postnatal period improved maternal confidence, moth er-infant attachment, maternal satisfaction and mother-infant interaction effectively. CONCLUSION: A diversity of nursin g interventions in postnatal period improved various aspects of maternal adaptation. Randomized controlled trials and longitudinal studies are needed in order to verify the effect of interventions for maternal adaptation more clearly.

Impact of Critical Thinking Disposition, General Self-Efficacy, and Leadership on Clinical Competence in Nursing Students / 한국의학교육

PURPOSE: The purpose of this study was to evaluate the relationships among critical thinking disposition, general self-efficacy, leadership and clinical competence, and identify the factors influencing clinical competence in nursing students. METHODS: In this descriptive study, 153 nursing students (from 2nd to 4th school year) of a university in South Korea were enrolled in December 2010. The instruments for this study were the Korean versions of the Critical Thinking Disposition Scale, General Self-Efficacy Scale, Leadership Inventory, and Clinical Competence Scale. Data were analyzed by descriptive statistics, t-test, MANOVA, Pearson correlation, and multiple linear regression with PASW 18.0 software. RESULTS: The mean scores (ranging from 1 to 5) in nursing students for critical thinking disposition, general self-efficacy, leadership, and clinical competence were 3.44, 3.51, 3.55, and 3.42, respectively. Positive correlations were found for clinical competence with critical thinking disposition, general self-efficacy, and leadership. The strongest predictor of clinical competence was leadership. In addition, leadership, nursing school year, and subjective academic achievement accounted for 34.5% of variance in clinical competence. CONCLUSION: This study revealed that developing leadership, critical thinking disposition, and self-efficacy in undergraduate nursing education is important to improve clinical competence of nursing students.

Impact of Life Style Characteristics on Prevalence Risk of Metabolic Syndrome

PURPOSE: The goal of this study was to evaluate the impact of life style characteristics on the prevalence risk of metabolic syndrome (MS). METHODS: A total of 581 adults were recruited from a cardiovascular outpatient clinic. A newly developed comprehensive life style evaluation tool for MS patients was used, and patient data related to the MS diagnosis were reviewed from the hospital records. RESULTS: The overall prevalence of MS was 53.2%, and the mean of MS score was 2.6 for patients at a cardiovascular outpatient clinic (78% of the patients had hypertension). Dietary habits among the life style characteristics had significant influence on the prevalence risk of MS and MS scores. And also interestingly, the classification and regression tree (CART) model suggested that the high prevalence risk groups for MS were older adults (61.5< or =age<79.4), and adults between 48.5 and 61.5 yr of age with bad dietary habits. CONCLUSION: This study indicates that nurses should focus on dietary habits of patients (especially patients classified as high prevalence risk for MS) for improvement and prevention of MS prevalence risk.

Evaluation of a Complementary Cyber Education Program for a Pathophysiology Class / 한국의학교육

PURPOSE: The goal of this study was to develop and evaluate a complementary cyber education program for a required pathophysiology class for nursing students. METHODS: The cyber education program comprised electronic bulletin boards, correspondence material storage, an announcement section, a report submission section, reference sites, and statistics on learning rates. Twelve online lectures complemented five lectures in the classroom. To evaluate the course's educational effectiveness, we performed an online objective questionnaire and an open questionnaire survey anonymously, and compared the complementary cyber education program with traditional classroom education. RESULTS: The complementary cyber education program effected significant improvements in scores for importance with regard to major, clarity of goals and education plans for courses, professor readiness, preciseness and description of lectures, amount and efficiency of assignments, and fairness in appraisal standards compared with the traditional classroom education group. CONCLUSION: This study indicates that a complementary cyber education program provides nursing students with the flexibility of time and space, the newest information through updated lectures, efficient motivational aids through intimacy between the lecturer and students, and concrete and meaningful tasks. The complementary cyber education course also increased student effort toward studying and student satisfaction with the class.

Noninvasively-determined Diastolic Stiffness is Abnormal during Exercise, but not at Rest, in Patients with Apical Hypertrophic Cardiomyopathy

BACKGROUDN: The ratio of mitral inflow (E) and annular velocity (E') to stroke volume (E/E'/SV) has been used as an index of diastolic elastance (Ed). However, its change during exercise has not been evaluated. We hypothesized that Ed values obtained during exercise would be abnormal in patients with apical hypertrophic cardiomyopathy (ApHCM). METHODS: Ed was measured at rest and during graded supine bicycle exercise (25 Watts, 3 minute increments) in 15 patients with ApHCM (12 male; mean age, 57 years) and in 15 age- and gender-matched control subjects. RESULTS: Ed was not significantly different at rest and during 25 W of exercise. However, Ed was significantly higher at 50 W of exercise in patients with ApHCM compared to control subjects (0.21+/-0.05 vs. 0.15+/-0.04 cm/s, p=0.0059). There was significant positive correlation between the magnitude of change in proBNP levels during exercise and the change of Ed from rest to 50 W of exercise (r2=0.69, p<0.0001). CONCLUSION: Noninvasively-determined Ed was similar at rest and during mild exercise between patients with ApHCM and control subjects. However, Ed was significantly higher during moderate exercise in ApHCM patients, suggesting a dynamic change in LV stiffness during exercise in these patients.

Noninvasively-determined Diastolic Stiffness is Abnormal during Exercise, but not at Rest, in Patients with Apical Hypertrophic Cardiomyopathy

BACKGROUDN: The ratio of mitral inflow (E) and annular velocity (E') to stroke volume (E/E'/SV) has been used as an index of diastolic elastance (Ed). However, its change during exercise has not been evaluated. We hypothesized that Ed values obtained during exercise would be abnormal in patients with apical hypertrophic cardiomyopathy (ApHCM). METHODS: Ed was measured at rest and during graded supine bicycle exercise (25 Watts, 3 minute increments) in 15 patients with ApHCM (12 male; mean age, 57 years) and in 15 age- and gender-matched control subjects. RESULTS: Ed was not significantly different at rest and during 25 W of exercise. However, Ed was significantly higher at 50 W of exercise in patients with ApHCM compared to control subjects (0.21+/-0.05 vs. 0.15+/-0.04 cm/s, p=0.0059). There was significant positive correlation between the magnitude of change in proBNP levels during exercise and the change of Ed from rest to 50 W of exercise (r2=0.69, p<0.0001). CONCLUSION: Noninvasively-determined Ed was similar at rest and during mild exercise between patients with ApHCM and control subjects. However, Ed was significantly higher during moderate exercise in ApHCM patients, suggesting a dynamic change in LV stiffness during exercise in these patients.

The Role of Myocardial Contrast Echocardiography in Acute Chest Pain without ST Elevation

BACKGROUND AND OBJECTIVES: We hypothesized that simultaneous assessment of myocardial perfusion and a regional wall motion abnormality, using real-time myocardial contrast echocardiography (MCE), provides more useful information than routine two-dimensional echocardiography (2DE) in the diagnosis of acute coronary syndrome in patients with a non-diagnostic ECG. SUBJECTS AND METHODS: We prospectively enrolled 101 patients (age:61+/-10 years, 57 men) who presented with acute chest pain. A routine 2DE was performed to evaluate the regional wall motion abnormality, and a MCE to assess the perfusion defect. Coronary angiography was performed in all patients. The cardiac events (myocardial infarction, revascularization and death) were analyzed. RESULTS: Of the 101 patients studied, 64 had significant coronary artery disease (diameter stenosis >0%). Cardiac events occurred in 58 patients;21 myocardial infarction, 48 revascularization. The sensitivities of 2DE and MCE for significant coronary artery stenosis were 57.8 and 73.4%, and the specificities were 83.8 and 81.1%, respectively. Of the 58 patients with cardiac events, a regional wall motion abnormality was observed in 34 (59%), and a perfusion defect in 44 (76%). The specificities of 2DE and MCE for cardiac events were 79 and 77%, respectively. Cardiac events were more frequent in males, smokers and in those with an abnormal ECG (p<.05), but only a perfusion defect independently predicted cardiac events (p<.001, odds ratio=8.37). CONCLUSION: Real time MCE, in patients with acute chest pain, reasonably predicts significant coronary artery stenosis, and identifies those who will have cardiac events.