Factors related to the intention of pre-clinical vaccination among nursing students / 한국간호교육학회지

Purpose@#The aim of this study was to identify factors related to the vaccination intentions of nursing students before clinical practice. @*Methods@#A descriptive correlational study design was used. The participants were 129 nursing students who were enrolled in one college of nursing in Seoul and were scheduled for clinical training. Data collection was conducted from February 28 to March 7, 2022. The data were analyzed using descriptive statistics, a t-test, ANOVA, Pearson’s correlation coefficient, and a latitudinal regression analysis using the IBM SPSS statistics version 26.0 program. @*Results@#The intention to vaccinate showed a significant correlation with vaccination attitude (r=.72, p<.001), subjective norms (r=.68, p<.001), and perceived behavioral control (r=.63, p<.001). The influencing factors on three intent to vaccinate were vaccination attitude (β=.36 p<.001), subjective norms (β=.31, p<.001), and perceived behavioral control (β=.36, p<.001). The explanatory power of these variables was 69.6%. @*Conclusion@#The vaccination rate before the clinical training of nursing students was related to economic burden, a lack of time, and transportation problems that nursing college students experienced during the vaccination process. Therefore, administrative and financial support is needed for improving the vaccination rates of nursing students.

Face Mask Usage, Knowledge and Behavior of Face Mask Usage in Older Adults Living Alone in the COVID-19 Era

Purpose@#This study analyzed the current status of face mask usage. It also identified factors related to the knowledge and behavior regarding the same among older adults living alone during the COVID-19 pandemic. @*Methods@#This descriptive study was conducted via a telephone survey involving 283 older adults living alone in S City from March to April 2020. Knowledge and behavior pertaining to face mask usage were measured using Hilda Ho’s Face Mask Use Scale; reliability of the measurement was Kuder-Richardson formula-20 = .62, Cronbach’s α = .92. Data were analyzed using descriptive analysis, independent t-test, Pearson’s correlation coefficient, and multiple linear regression. @*Results@#Older adults used one mask for 3.55 days on an average. The knowledge level was 9.97 (± 1.84) out of 12 and behavior level was 15.49 (± 1.55) out of 16. Level of education (β = - .31, p < .001), living region (β = .13, p = .017), personal income (β = .12, p = .041) significantly affected the face mask usage-related knowledge, and living region (β = .15, p = .010) significantly affected the face mask usage-related behavior. @*Conclusion@#Older adults living alone are aware of the effects of using face masks. However, their mask usage is inappropriate, for example, the prolonged use of the same mask. Considering the low level of face mask usage-related knowledge, it is necessary to develop customized education programs and infectious disease prevention strategies for older adults possessing low educational levels living alone in urban-rural complex areas.

Face Mask Usage, Knowledge and Behavior of Face Mask Usage in Older Adults Living Alone in the COVID-19 Era

Purpose@#This study analyzed the current status of face mask usage. It also identified factors related to the knowledge and behavior regarding the same among older adults living alone during the COVID-19 pandemic. @*Methods@#This descriptive study was conducted via a telephone survey involving 283 older adults living alone in S City from March to April 2020. Knowledge and behavior pertaining to face mask usage were measured using Hilda Ho’s Face Mask Use Scale; reliability of the measurement was Kuder-Richardson formula-20 = .62, Cronbach’s α = .92. Data were analyzed using descriptive analysis, independent t-test, Pearson’s correlation coefficient, and multiple linear regression. @*Results@#Older adults used one mask for 3.55 days on an average. The knowledge level was 9.97 (± 1.84) out of 12 and behavior level was 15.49 (± 1.55) out of 16. Level of education (β = - .31, p < .001), living region (β = .13, p = .017), personal income (β = .12, p = .041) significantly affected the face mask usage-related knowledge, and living region (β = .15, p = .010) significantly affected the face mask usage-related behavior. @*Conclusion@#Older adults living alone are aware of the effects of using face masks. However, their mask usage is inappropriate, for example, the prolonged use of the same mask. Considering the low level of face mask usage-related knowledge, it is necessary to develop customized education programs and infectious disease prevention strategies for older adults possessing low educational levels living alone in urban-rural complex areas.

Nurses’ Experience with Caring for COVID-19 Patients in a Negative Pressure Room Amid the Pandemic Situation

Purpose@#The purpose of this study was to explore nurses’ experience with caring for COVID-19 patients in a negative pressure room amid the spread of the pandemic. @*Methods@#This study was a qualitative research, and focus group interviews were used to collect data. Three focus groups comprising 19 nurses were interviewed from February 17 to 25, 2021. All interviews were recorded and transcribed verbatim with the consent of the participants. The verbatim transcripts were scrutinized using thematic analysis. @*Results@#Two main themes emerged from the analysis: ‘Struggling in an isolated space’ and ’Limitations of nursing infrastructure and system’. The nurses caring for COVID-19 patients experienced anxiety and fear about the infection, physical exhaustion, emotional burnout, and a sense of duty as a nurse. They also acknowledged the lack of guidelines, increased task and burden, limitations of nursing care, and the demand for improving the limitations of the nursing system. @*Conclusion@#The results of this study demonstrate that nurses caring for COVID-19 patients encounter physical and emotional problems within the limited healthcare system. The study suggests that comprehensive interventions are needed for nurses. Furthermore, detailed guidelines, strengthening of nursing personnel, and improvements to the nursing system are vital to effectively cope with the pandemic. The government and medical institutions should be aware of the needs of nurses and what they are going through, and make efforts to improve the quality of life of healthcare workers and create a safe healthcare environment.

Older Adults' Perceptions of Age-friendliness with an Emphasis on Community Supports and Health Services in a City in South Korea

PURPOSE: This study tries to comprehend older adults' perspectives of community supports and health services in a South Korean city and identify important sociodemographic and health characteristics that affect their perspectives. METHODS: 166 older adults were involved in this cross-sectional study. Questions on background characteristics and community supports and health services criteria (categorized as service accessibility, offer of services, voluntary support, or emergency care planning) based upon the WHO's Age-Friendly Cities Guide were used. The data were analyzed using paired and independent t-tests, one-way ANOVA, and hierarchical multiple regression analyses. RESULTS: Emergency care planning was rated as the most important by the participants (mean age=76.24 years, 22.9% male), while its current level of performance was lowly appraised (p<.001). The rated importance for each category differed based on individual characteristics. Depression (p=.016), older age (p=.012), and restricted network type (p=.039) were significantly related to ascribing a higher degree of importance to community services. CONCLUSION: Community initiatives are warranted to optimize emergency care for older adults. This planning must be based on the unique characteristics of older adults in coordination with supportive resources. In addition, comprehensive assessments are warranted before implementing action plans to ensure that the multi-dimensional problems of older adults are incorporated.

Validity and Reliability of the Korean Version of the Partners In Health Scale (PIH-K) / 중환자간호학회지

PURPOSE: The purpose of this study was to validate the Korean version of Partners In Health scale (PIH-K) which is used to measure the self-management of patients with chronic illnesses in Korea.METHODS: Translation of the 12-item PIH-K was conducted according to the World Health Organization guidelines. Data from 306 participants who took medicines over 3 months by doctor's prescription were collected from October to November 2017. Validity such as content validity, construct validity, and concurrent validity were conducted using content validity index (CVI), exploratory and confirmatory factor analyses (CFA). To evaluate concurrent validity, the correlation coefficients between the PIH-K and concurrent scales (Self-As-Carer Inventory) were calculated. The reliability of the PIH-K was examined using the internal consistency and test-retest reliability tests.RESULTS: The CVI of the PIH-K was 0.91. According to the CFA, factor loadings for four factors ranged from .64 to .97, which explained 67.5% of the total variance. The PIH-K was significantly correlated with concurrent variables such as those on the Self-As-Carer Inventory. The Cronbach's α was .86 and the intraclass correlation coefficient for the two-week test-retest reliability was .88.CONCLUSION: Findings show that the PIH-K is reliable and valid in measuring self-management of patients with chronic illnesses.

Compliance with Respiratory Infection Preventive Behaviors and Its related Factors in Older Adults using a Senior Center

PURPOSE: The purpose of this study is to identify factors related to compliance with respiratory infection preventive behaviors including hand washing, cough etiquette, and oral hygiene of older adults. METHODS: A cross-sectional study was conducted with a convenience sample of 100 older adults (mean age: 76.11±6.35 years, female: 86.0%). Data were collected from a community senior center through face to face interviews by using instruments including measuring knowledge, perceived threat, self-efficacy, compliance with respiratory infection preventive behaviors. RESULTS: The mean score of knowledge was 7.52 out of 13 in total. The compliance with hand washing with soap was 6.0% for 8 or more times per day. Among the participants, 12.0% adhered to the cough etiquette. Sixty-two older adults (62.0%) didn't use interdental brushes or floss at all. The stepwise linear regression indicated that age and self-efficacy for respiratory infection preventive behaviors were significant factors and explained 24.0% of the compliance with hand washing and the cough etiquette. Education level, cancer diagnosis, and self-efficacy for respiratory infection preventive behaviors were significant predictors of oral hygiene. The factor with the greatest effect was self-efficacy in the two models. CONCLUSION: The findings suggest that it is necessary to improve compliance with respiratory infection preventive behaviors among older adults using senior centers. In order to enhance the compliance, it is necessary to develop nursing programs based on the self-efficacy for respiratory infection preventive behaviors in the senior centers.

Interventions Using Technologies for Older Adults in Long-term Care Facilities: A Systematic Review

PURPOSE: Although innovative interventions using technologies have been introduced in long-term care settings, available evidence is still anecdotal. The purpose of this study is to investigate and synthesize the outcomes of interventions using technologies delivered to nursing home residents. METHODS: Published clinical trials were identified through PubMed, CINHAL, Cochrane and PsycINFO databases and manually hand-searching. Eligible studies were articles published between 1997–2016 in English or Korean with a randomized controlled trial or quasi-experimental design in which interventions using technologies were delivered to nursing home residents. RESULTS: A total of 20 studies were selected for this review. Types of interventions using technologies were classified into the electronic documentation technology (n=1), the clinical decision support system (n=1), the safety technology (n=1), the health and wellness technology (n=10), and the social connectedness technology (n=7). Overall resident outcomes indicated that interventions using technologies improved behavioral symptoms and psycho-social outcomes, but mixed results were shown in the aspects of physical function, cognitive function, social relationship and quality of service. CONCLUSION: This review demonstrates that incorporating technologies into nursing home care have positive effects on residents' psycho-social outcomes and behavioral symptoms. To disseminate the effectiveness of interventions using technologies, further research is needed to determine what mechanisms underlying such relationships exist.

Development of a Triage Competency Scale for Emergency Nurses

PURPOSE: This study aimed to develop a triage competency scale (TCS) for emergency nurses, and to evaluate its validity and reliability. METHODS: Preliminary items were derived based on the attributes and indicators elicited from a concept analysis study on triage competency. Ten experts assessed whether the preliminary items belonged to the construct factor and determined the appropriateness of each item. A revised questionnaire was administered to 250 nurses in 18 emergency departments to evaluate the reliability and validity of the scale. Data analysis comprised item analysis, confirmatory factor analysis, contrasted group validity, and criterion-related validity, including criterion-related validity of the problem solving method using video scenarios. RESULTS: The item analysis and confirmatory factor analysis yielded 5 factors with 30 items; the fit index of the derived model was good (χ2/df =2.46, Root Mean squared Residual=.04, Root Mean Squared Error of Approximation=.08). Additionally, contrasted group validity was assessed. Participants were classified as novice, advanced beginner, competent, and proficient, and significant differences were observed in the mean score for each group (F=6.02, p=.001). With reference to criterion-related validity, there was a positive correlation between scores on the TCS and the Clinical Decision Making in Nursing Scale (r=.48, p < .001). Further, the total score on the problem solving method using video scenarios was positively correlated with the TCS score (r=.13, p=.04). The Cronbach's α of the final model was .91. CONCLUSION: Our TCS is useful for the objective assessment of triage competency among emergency nurses and the evaluation of triage education programs.

Prevalence and Factors Related to Sarcopenic Obesity among Community-dwelling Elderly Women

PURPOSE: The aims of this study were to identify prevalence and identify factors related to sarcopenic obesity among community-dwelling elderly women. METHODS: This is a secondary analysis of the prospective cohort study. Our analysis included 338 elderly women (≥65 years old) in South Korea as a part of the Community-dwelling Older Adult Health Cohort (COHC) Study (2014-2015). Sarcopenic obesity was defined as the Asian Working Group of Sarcopenia recommendations and upper two quintiles for percentage body fat. Logistic regression analysis was used to determine the factors related to sarcopenic obesity including chronic diseases, medications, stress, fatigue, depression, exercise, level of proteins on body compositions, smoking, and alcohol use. RESULTS: The prevalence of sarcopenic obesity was 6.2%. A lower protein on body compositions (OR 0.017, 95% CI 0.003-0.081, p<.001), a larger number of medications (OR 2.104, 95% CI 1.404-3.152, p<.001), and a higher level of fatigue (OR 1.255, 95% CI 1.023-1.541, p=.030) were related factors of sarcopenic obesity. CONCLUSION: The findings suggest that nutritional interventions focusing on protein intakes should be needed to prevent sarcopenic obesity among the elderly women. Polypharmacy issue for preventing adverse outcomes and level of fatigue as indicator for early identification are also considered to develop community prevention programs.

Structural Equation Modeling of Self-Management of Liver Transplant Recipients

PURPOSE: The purpose of this study was to construct and test a structural equation model of self-management of liver transplant recipients based on self-determination theory. METHODS: Participants were 275 outpatients who received liver transplantation. A structured self-report questionnaire was used to assess health care providers' autonomy support, transplant-related characteristics, illness consequence perception, autonomy, competence, family relatedness, depression and self-management. Collected data were analyzed using SPSS/WIN 24.0 and AMOS 24.0 program. RESULTS: The modified model showed a good fitness with the data: GFI=.96, RMSEA=.06, CFI=.96, NFI=.93, TLI=.93, PGFI=.43, PNFI=.49. The health care providers' autonomy support, competence, family relatedness and depression were factors with a direct influence on the self-management of liver transplant recipients. The health care providers' autonomy support and illness consequence perception had an indirect influence through competence, family relatedness and depression. However, the transplant-related characteristics and autonomy did not have a significant effect on self-management. This model explained 59.4% of the variance in self-management. CONCLUSION: The result suggests that continuous education must be done to promote the competence of liver transplant recipients and to encourage the patient to positively perceive their current health condition with a view that enhances one's self-management. Additionally, the liver transplant recipients should be screened for depression, which would affect self-management. Most of all, health care providers, who have the most influence on self-management, should improve therapeutic communication and try to form a therapeutic relationship with the liver transplant recipients.

Concept Analysis of Triage Competency in Emergency Nursing / 중환자간호학회지

PURPOSE: This concept analysis identified attributes and defined triage competency among emergency nurses.METHOD: Walker and Avant's approach was used to guide the concept analysis. A literature review was completed including 26 studies, 5 reports of related associations, and 5 books.RESULTS: The concept of triage competency in emergency nurses was identified as five attributes: clinical judgment, expert assessment, management of medical resources, timely decision, and communication. Antecedents of the concept were triage education and emergency room experience. The consequences of the concept were efficiency of care, patient rating, and safety. Triage competency in emergency nurses was defined as the comprehensive ability to prioritize patients' urgency and allocate limited medical resources.CONCLUSION: This study is meaningful since it clarified triage competency among emergency nurses. The attributes and empirical indicators of this study will likely lay the foundation for development of triage competency metrics.

Lifestyle and Genetic Predictors of Stiffness Index in Community-dwelling Elderly Korean Men and Women

PURPOSE: Differing lifestyle, nutritional, and genetic factors may lead to a differing stiffness index (SI) determined by quantitative ultrasound in elderly men and women. The purpose of this study was to determine SI and the gender-specific factors associated with low SI in a Korean elderly cohort. METHODS: This was a cross-sectional descriptive study identifying the gender-specific factors related to SI in 252 men and women aged 65 years and greater from local senior centers in Seoul, Korea between January and February 2009. RESULTS: The mean SI of elderly men was significantly higher than that of the women's. A multiple regression analysis reveals that age, nutritional status, and physical activity were predictive factors of lower SI in men, whereas age, alcohol consumption, educational level, and genetic polymorphism were predictive factors for elderly women. CONCLUSIONS: Low SI was common in both elderly men and women. We found gender differences in factors linked to low SI. In multiple regression analysis, nutritional status and physical activity were more important factors in men, whereas alcohol consumption, educational level, and genetic polymorphism were significant factors predicting low SI in women. Gender-specific modifiable risk factors associated with low SI should be considered when developing osteoporosis prevention programs for the elderly.

Effects of a Multi-disciplinary Approached, Empowerment Theory Based Self-management Intervention in Older Adults with Chronic Illness

PURPOSE: The purpose of this study was to develop a multi-disciplinary self-management intervention based on empowerment theory and to evaluate the effectiveness of the intervention for older adults with chronic illness. METHODS: A randomized controlled trial design was used with 43 Korean older adults with chronic illness (Experimental group=22, Control group=21). The intervention consisted of two phases: (1) 8-week multi-disciplinary, team guided, group-based health education, exercise session, and individual empowerment counseling, (2) 16-week self-help group activities including weekly exercise and group discussion to maintain acquired self-management skills and problem-solving skills. Baseline, 8-week, and 24-week assessments measured health empowerment, exercise self-efficacy, physical activity, and physical function. RESULTS: Health empowerment, physical activity, and physical function in the experimental group increased significantly compared to the control group over time. Exercise self-efficacy significantly increased in experimental group over time but there was no significant difference between the two groups. CONCLUSION: The self-management program based on empowerment theory improved health empowerment, physical activity, and physical function in older adults. The study finding suggests that a health empowerment strategy may be an effective approach for older adults with multiple chronic illnesses in terms of achieving a sense of control over their chronic illness and actively engaging self-management.

Dysphagia Screening Measures for Use in Nursing Homes: A Systematic Review

PURPOSE: The purpose of this study was to evaluate the psychometric quality and feasibility of measurements for screening dysphagia in older adults to identify the 'right tool' for nurses to use in nursing homes. METHODS: A systematic review was done. Electronic databases were searched for studies related to dysphagia screening measurements. A checklist was used to evaluate the psychometric quality and applicability. Tools were evaluated for feasible incorporation into routine care by nurses. RESULTS: 29 tools from 31 studies were identified. Dysphagia screening tools with an acceptable validity and reliability had sensitivity between 68% and 100% and specificity between 52% and 100%. The Gugging Swallowing Screen (GUSS) and the Standardized Swallowing Assessment (SSA) were the tools with high psychometric quality, especially with high sensitivity, that nurses could perform feasibly to identify the risk and to grade the severity of dysphagia and aspiration of nursing home residents. CONCLUSION: Results show that GUSS and SSA are reliable and sensitive tools for screening dysphagia which nurses can use in nursing homes. Further research is needed to examine feasibility of screening with identified tools, and also, to establish effective and standardized protocols for these tools so they can be effectively incorporated into routine care.

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.

Nurses' Perception and Experiences at Nursing Home Residents with Dysphagia: Focus Group Interviews / 재활간호학회지

PURPOSE: This study aimed to describe Korean nursing home nurses' perceptions on dysphagia management and their working experiences of older adults with dysphagia. METHODS: Using a purposive sampling design, 23 eligible nurses were interviewed as four focus groups from 4 facilities out of nursing homes. The qualitative data from focus group interviews were analyzed using thematic analysis to classify common themes into larger categories. RESULTS: Two main themes on the attributes of caring nursing home residents with dysphagia were 'Need for nursing resources' and 'Need for support'. In addition, four subthemes emerged as a result of analysis: 'need for nursing protocols for assessing and managing dysphagia', 'need for emergency care skills of nurses and nurse assistants', 'need for prompt and accurate management by cooperation of physicians and therapists', and 'need for partnership upon comprehension of visiting family members concerning dysphagia'. CONCLUSION: Nursing home nurses fully recognized the importance of dysphagia management; however, they experienced substantial barriers due to lack of adequate nursing protocols or partnership with family caregivers, insufficient training for emergency care, and deficient support from medical staff. Development of nursing guidelines tailored to the nursing home context and based on partnership among medical experts and family caregivers is needed.

Validity and Reliability of Korean Version of Health Empowerment Scale (K-HES) for Older Adults

PURPOSE: The purpose of this study was to assess the validity and reliability of the Korean version of the Health Empowerment Scale (K-HES). METHODS: This was a methodological study, which included translation, pilot study, main study and expert verification. The K-HES was translated and modified based on the Diabetes Empowerment Scale-Short Form. Where diabetes was mentioned in the original tool, the K-HES expanded the items to cover all kinds of health conditions that affected health empowerment. Expert-verification, pilot-test and main study were conducted among 175 Korean elderly. RESULTS: The K-HES had an acceptable internal consistency with a Cronbach's alpha of .80. Construct validity was tested using item analysis and convergent validity. Item analysis demonstrated that all of the corrected item to total correlation coefficients possessed good internal consistency (alpha > .60) except for item 1 (.32) and item 6 (.19). Convergent validity was supported by significant correlations between the total scores of the K-HES and the Exercise Self-Efficacy Scale (Pearson's coefficient = .60). Content validity was supported by scale content validity index of .96 and item content validity index ranging from .96 to 1.0. CONCLUSION: The K-HES had acceptable validity and reliability. The brevity and ease of administration of the K-HES makes it a suitable tool for evaluating empowerment-based education programs targeted towards older populations.

Violent Experiences and Coping among Home Visiting Health Care Workers in Korea

PURPOSE: The purpose of this study was to explore violent experiences of home visiting health care workers in Korea. METHODS: This study was a cross-sectional survey. Data were collected using self-report questionnaires from 1,640 health care workers. Data collection was done between September 1, 2009 and June 30, 2010. RESULTS: Of the respondents, 70.6% had experienced work-related violence. Shouting (51.9%) was the most common verbal violence, followed by verbalizing sexual remarks to the health care workers (19.0%) and touching the hands (16.5%), the most common acts relating to sexual harassment. Of the respondents who had experienced violence, 50.9% told their peers about the incidents. However, the major reasons why they did not report these incidents was due to the fact that they felt it was useless to file reports and that they expected such incidents to occur as part of their job. The majority of the respondents (86.4%) wanted education on how to deal with such violence at work. CONCLUSION: The results of this study indicate that efforts should be made to increase awareness and to minimize violence in the workplace. Also, educational programs should be designed to improve knowledge and to prevent workplace violence.

Effects of an Empowerment Program on the Adjustment of Older Adults to Nursing Home Life

PURPOSE: This study aimed to evaluate the effectiveness of the empowerment intervention on the levels of self-esteem, interpersonal relationships and adjustment to nursing home life of the Korean nursing home residents. METHODS: Participants (n=47) whose period of stay was less than one year were purposefully selected from 3 nursing homes in Korea. The experimental group (n=21) attended 10 weekly hour-long empowerment sessions. The empowerment program comprised two components; group education and group discussion. The control group (n=26) received a two-hour education about health management. RESULTS: Compared with the control group, the experimental group showed significantly higher mean scores of self-esteem (t=5.51, p<.001), interpersonal relationships (t=2.73, p=.009) and adjustment to nursing home life (t=2.10, p=.041). CONCLUSION: Findings of this study suggest that empowerment interventions may be effective in enhancing nursing home residents' self-esteem, interpersonal relationships and adjustment to nursing home life. Future research is needed to determine if such an empowerment program could be used with newly institutionalized elders to speed as well as enhance their adjustment to nursing home life.