Eating Difficulties among Older Adults with Dementia in South Korean Long-Term Care Facilities: A Scoping Review / 기본간호학회지

Purpose@#This study synthesized the literature on eating difficulties among older adults with dementia in long-term care facilities. @*Methods@#A scoping review, using the framework proposed by Arksey & O'Malley (2005) and supplemented by Levac et al. (2010), was conducted. Literature was searched from RISS, KISS, DBpia, PubMed, and CINAHL. Two reviewers independently selected studies and extracted their characteristics, using pre-tested forms to determine final inclusion. In total, 1283 articles were identified, and 13 articles were used for the final analysis. @*Results@#The Eating Behavior Scale and the Edinburgh Feeding Evaluation in Dementia scale were the most widely utilized measurement tools. The most common factors related to eating behavior in older adults with dementia were cognitive and physical functions in the individual domain, the caregiver's attitude toward eating in the inter-individual domain, and meal type in the environmental domain. @*Conclusion@#Measurement tools reflecting the eating behavior of older adults with dementia must be developed to obtain a comprehensive understanding of this issue and create effective interventions for the specific context of long-term care facilities in Korea. The results of this study are intended to serve as a basis to develop meal support programs for older adults with dementia.

The Effects of Symptom Experiences and Depression on Falls Efficacy in Elderly Patients Undergoing Chemotherapy / 임상간호연구

PURPOSE: The purpose of this study was to identify the effects of symptom experience and depression on the falls efficacy of elderly patients who were undergoing chemotherapy. METHODS: The questionnaires were administered to 105 elderly patients over 65 years hospitalizing for chemotherapy from October 25 to December 30, 2018. The data were analyzed by descriptive statistics, t-test, ANOVA, Scheffé test, Pearson's correlations and Multiple Linear Regression, ursing an SPSS/WIN 22.0 program. RESULTS: Falls efficacy was negatively correlated with the symptom experience (r=−.58, p<.001), and depression (r=−.57, p<.001). Symptom experience and depression were positively correlated (r=.72, p<.001). The significantly influential factors of falls efficacy were age (β=−.34, p<.001), symptom experience (β=−.24, p=.022), and the history of falls (β=−.15, p=.040), explaining 57.0% of the variance in falls efficacy. CONCLUSION: The main findings of this study can be used as the foundation for developing programs to increase the falls efficacy of elderly patients undergoing chemotherapy.

Individual and School Factors Affecting Critical Thinking Ability among Nursing Students / 의학교육논단

The purpose of this study was to investigate factors associated with the critical thinking ability of nursing students at the individual and school levels. The study adopted a descriptive design and recruited 465 nursing students from four nursing schools from November 2014 to September 2015 through convenience sampling. The Clinical Critical Thinking Skill Test was used to measure critical thinking ability, and the data were analyzed with the SAS ver. 9.4 program (SAS Institute Inc., Cary, NC, USA) for descriptive statistics, t-test, analysis of variance, and multi-level model. The results showed that clinical practicum experience (β=−0.72, p=0.025), taking critical thinking courses (β=0.63, p=0.010), and taking simulation courses (β=0.56, p=0.035) improved critical thinking ability in the individual level model. In the school level model, the interaction effect between the years of clinical practice done by the student and the presence of full-time clinical instructors was significant (β=1.29, p=0.011). These results suggest that critical thinking ability improves with the more years of clinical practice individual nursing students have, and this improvement is greater with the presence of full-time clinical instructors in the school. Therefore, it is recommended that nursing students undergo critical thinking and simulation courses to develop their critical thinking ability, and dedicated clinical instructors in nursing schools should play a vital role.

A Concept Analysis of Fear of Dementia

PURPOSE: This study tries to identify and clarify the concept of fear of dementia. METHODS: The hybrid model method was used to perform a conceptual analysis of fear for dementia. Results from both the theoretical review of 35 studies and the field study with 8 community-dwelling older adults were included in the final stage. RESULTS: Fear for dementia had 4 dimensions with 14 attributes including cognitive factors (direct experience of precursor symptoms of dementia, indirect experience of dementia, preliminary knowledge of dementia, impossibility of cognitive control, and confidence in dementia), emotional factors (negative feelings and pessimistic thoughts), social factors (social isolation, economic instability, embarrassment), and behavioral factors (existing health problems, making efforts to maintain health, impossibility of body control, peripheral autonomic nervous system response) along with 34 indicators. CONCLUSION: This study is meaningful because it reveals the attributes of Korean elderly adults' fear for dementia. In addition, the results may serve as a basis for the early assessment and management of fear for dementia.

Current Status and Future Direction of Nursing Education for Clinical Practice / 의학교육논단

The quantitative expansion of nursing schools has necessitated the qualitative improvement of nursing education, which requires the development of nursing education for clinical practice. To identify strategies for strengthening the educational capacity of clinical fields and nursing schools, this study first examined the current status of nursing education for clinical practice, and then proposed several prospective directions for education. Nursing clinical practice-related studies from several Korean and international electronic databases were reviewed. Insufficient training hospitals and lack of qualified clinical training instructors were the main problems found within nursing educational resources for clinical practice, while the simple practice contents based on observation and inadequate evaluations were the main problems found in nursing educational management for clinical practice. This study suggests better standards and educational accountability for training hospitals and programs to nurture human resources for clinical practice, as well as a variety of training methods to integrate practical training courses and the expansion of formation evaluation. Based on these results, it is necessary to establish governance for nursing education for clinical practice and clarify the role and standards of each practitioner, strengthen the educational role of the hospital, and improve the system. In addition, introducing various types of education methods and strengthening evaluation standards are needed in order to enhance nursing education for clinical practice.

Development of Patient Transfer Techniques based on Postural-stability Principles for the Care Helpers in Nursing Homes and Evaluation of Effectiveness

PURPOSE: This study was done to develop a postural-stability patient transfer technique for care helpers in nursing homes and to evaluate its effectiveness. METHODS: Four types of patient transfer techniques (Lifting towards the head board of the bed, turning to the lateral position, sitting upright on the bed, transferring from wheel chair to bed) were practiced in accordance with the following three methods; Care helpers habitually used transfer methods (Method 1), patient transfer methods according to care helper standard textbooks (Method 2), and a method developed by the author ensuring postural-stability (Method 3). The care helpers' muscle activity and four joint angles were measured. The collected data were analyzed using the program SPSS Statistic 21.0. To differentiate the muscle activity and joint angle, the Friedman test was executed and the post-hoc analysis was conducted using the Wilcoxon Signed Rank test. RESULTS: Muscle activity was significantly lower during Method 3 compared to Methods 1 and 2. In addition, the joint angle was significantly lower for the knee and shoulder joint angle while performing Method 3 compared to Methods 1 and 2. DISCUSSION: Findings indicate that using postural-stability patient transfer techniques can contribute to the prevention of musculoskeletal disease which care helpers suffer from due to physically demanding patient care in nursing homes.

Effects of a Combined Exercise Program Using an iPad for Older Adults / 대한의료정보학회지

OBJECTIVES: The purpose of this study was to examine the function, health status, and efficacy effects of a combined exercise program using an iPad among older women in Korea, a tech-savvy country. METHODS: The study employed a pretest and posttest experimental design with a control group. The experimental group of subjects comprised 16 female older adults and the control group comprised 10 who were aged 65 years or older. The experimental group participated in a supervised group-based exercise program and an individualized home-based exercise program that involved the use of an iPad. The combined group and home-based exercise program consisted of group exercise, which took place in a senior center for 30 minutes weekly, and a home-based iPad exercise program, which the subjects followed at least 3 times a week. The collected data were analyzed using the Statistical Analysis System (SAS ver. 9.3 TS Level 1M0) program, which utilized a chi-square test, a Fisher exact test, a t-test, and a repeated-measures ANOVA. RESULTS: The results showed that cognitive status changed significantly over time, and there was an interaction between group and time. Further, self-efficacy for exercise and outcome expectations for exercise changed significantly over time. CONCLUSIONS: Exercise programs using iPad interventions may be useful for the management of cognitive functioning and the integration of functional physical abilities in older adults.

Effects of Simulation Education on the Communication Competence, Academic Self-efficacy, and Attitude About the Elderly for Nursing Students: A learning approach based on an elderly-with-cognition-disorder scenario / 한국간호교육학회지

PURPOSE: The purpose of this study was to investigate the effects of simulation in nursing education based on caring for elderly cognition disorder patients. The education consisted of a caring program for patients that included a process of assessment of a patient's mental status, diagnosis of the patient's health condition, and intervention to address the problems by using therapeutic communication. METHODS: A nonequivalent control group pretest-posttest design was used. A total of 69 subjects (undergraduate students) participated in the education and they were assigned to two groups: the experimental group (n=32) and the control group (n=37). Data-gathering structured questionnaires that included communication competence, academic self-efficacy, and attitudes about the elderly. The data were collected from October 2013 to December 2013, and statistical analyses were conducted with-test and t-test using the SPSS 21.0 program. RESULTS: With respect to education, there was significant improvement in communication competence in the experiment group (t=2.41, p=.022) compared with in the control group (t=.69, p=.494). However, there was no statistically significant difference in academic self-efficacy and attitude about the elderly. CONCLUSION: Simulation-based education should continue to be developed further for better elderly-patient care. Integrated education in particular using a high-fidelity simulator will contribute to improvements in nursing competence in this area.

Development of an Instrument to Measure the Quality of Care through Patients' Eyes for Hospitalized Child

PURPOSE: The purpose of this study was to develop an instrument that evaluated QUality Of care Through patients' Eyes for hospitalized child (QUOTE-Child), and examine the validity and reliability. METHODS: Preliminary items were reviewed through expert content validity and face validity. To test the validity and reliability of the instrument, the data were collected from 221 care givers of hospitalized children. Data were analyzed using exploratory factor analysis, Pearson correlation coefficient, Cronbach's alpha and Spearman-Brown coefficient. RESULTS: Factor analysis yielded 19 items in four factors including 1) respect, 2) explanation, 3) kindness, and 4) skillfulness, with a cumulative explanatory variance of 70.68%. For criterion-related validity, a significant positive relationship was found between quality of care and pediatric family satisfaction. For internal consistency reliability, the Cronbach's alpha was .93 (importance) and .95 (performance) for the overall instrument. The half split reliabilities were .86, .95 (importance) and .92, .97 (performance). The Cronbach's alpha of 110 data was .92 (importance) and .94 (performance). CONCLUSION: Researchers and practitioners can use this instrument to systematically assess quality of care for hospitalized children and identify areas of support for hospitalized children and their family.

Validation of a clinical critical thinking skills test in nursing / 보건의료교육평가

PURPOSE: The purpose of this study was to develop a revised version of the clinical critical thinking skills test (CCTS) and to subsequently validate its performance. METHODS: This study is a secondary analysis of the CCTS. Data were obtained from a convenience sample of 284 college students in June 2011. Thirty items were analyzed using item response theory and test reliability was assessed. Test-retest reliability was measured using the results of 20 nursing college and graduate school students in July 2013. The content validity of the revised items was analyzed by calculating the degree of agreement between instrument developer intention in item development and the judgments of six experts. To analyze response process validity, qualitative data related to the response processes of nine nursing college students obtained through cognitive interviews were analyzed. RESULTS: Out of initial 30 items, 11 items were excluded after the analysis of difficulty and discrimination parameter. When the 19 items of the revised version of the CCTS were analyzed, levels of item difficulty were found to be relatively low and levels of discrimination were found to be appropriate or high. The degree of agreement between item developer intention and expert judgments equaled or exceeded 50%. CONCLUSION: From above results, evidence of the response process validity was demonstrated, indicating that subjects respondeds as intended by the test developer. The revised 19-item CCTS was found to have sufficient reliability and validity and will therefore represents a more convenient measurement of critical thinking ability.

Computer and Internet Interventions for Loneliness and Depression in Older Adults: A Meta-Analysis / 대한의료정보학회지

OBJECTIVES: This study conducted a meta-analysis to examine the effectiveness of computer and Internet training interventions intended to reduce loneliness and depression in older adults. METHODS: Searches were performed to retrieve studies that had been published in peer-reviewed journals from January 2001 to July 2012 and written in English or Korean from PubMed, CINAHL, Scopus, the Cochrane Library, PsycINFO, KoreaMed, KMbase, KISS, MEDLIS, and RISS. We used combinations of the keywords for population, intervention, and psychosocial problems. A meta-analysis was employed to summarize the findings of studies on computer and Internet interventions for older adults. An overall mean weighted effect size for each outcome was calculated, and Q statistics were used to test the heterogeneity of variance in the effect sizes of the selected studies. RESULTS: As the Q statistics revealed heterogeneity, random effects models were chosen for the meta-analysis. The overall mean weighted effect size for loneliness from five studies was statistically significant for decreased loneliness (Z = 2.085, p = 0.037). However, the overall mean weighted effect size for depression from five studies was not statistically significant (Z = 1.528, p = 0.126). CONCLUSIONS: These results suggest that computer and Internet programs were effective in managing loneliness among older adults. Therefore, further computer-mediated social support should be considered to help manage loneliness in this population.

A Comparative Study on Physical Function Test between Faller Group and Nonfaller Group among Community-Dwelling Elderly

PURPOSE: This study aimed to identify the physical function test differences between the faller group and the nonfaller group in a sample of the community-dwelling elderly METHODS: This study used a nonexperimental two-group-comparative study design. The participants were 356 people aged 65 years and over living in an urban area. From May to December 2010, data were collected through personal interviews using questionnaires and measurements of muscle strength, physical endurance, flexibility, motor agility and dynamic balance, and static balance. The collected data were analyzed by descriptive statistics, Chi square analysis, and t test. RESULTS: Upper muscle strength was significantly weaker in the faller group (p < .05). Lower muscle strength was significantly weaker in the faller group; both hip flexion (p = .004), knee extension (Right: p = .004; Left: p = .031), left ankle plantar flexion (p = .045), and left ankle inversion (p = .036). Tandem standing with eyes opened and closed was significantly shorter, indicating decreased static balance in the faller group. CONCLUSION: Nurses should make efforts to implement exercise programs focused on physical fitness enhancement for community-dwelling elderly adults for fall prevention.

Reliability and Validity of the Korean Version of Belongingness Scale-Clinical Placement Experience

PURPOSE: The purpose of this cross-sectional survey was to determine the reliability and validity of the Korean version of the Belongingness Scale-Clinical Placement Experience (BS-CPE). METHODS: The study conducted a cross-sectional survey which used a self-report questionnaire. A convenient sampling method was utilized, and data on 335 students was gathered. We verified construct validity by performing confirmatory factor analysis. RESULTS: The overall Cronbach's alpha score was .90 (range: .71-.84). BS-CPE was correlated with self-respect (r = .47, p < .001) and self-directed learning (r = .50, p < .001). The original BS-CPE was modified based on the validity test. CONCLUSION: This modified Korean version of the BS-CPE is applicable for use with university undergraduates to measure belongingness in clinical practice.

Relationship between Critical Thinking Disposition, Clinical Decision Making and Job Satisfaction of Cancer Center Nurses / 간호행정학회지

PURPOSE: This study was a descriptive correlation study to increase understanding of, and relationships among critical thinking disposition, clinical decision making and job satisfaction of cancer center nurses. METHOD: The participants in this study were 150 nurses working in one cancer center located in Gyeonggi Province. The statistic program, SPSS WIN17.0 was used for data analysis and data were analyzed using t-test, ANOVA, and Pearson correlation. RESULTS: The critical thinking disposition of the participants showed statistically significant differences according to areas of practice (F=4.426, p=.005), and current position (F=9.346, p=.000). For clinical decision making of the participants, statistically significant differences were found according to current position (F=10.667, p=.000). Furthermore, for job satisfaction, there were statistically significant differences according to income (F=6.779, p=.002), length of career (F=2.701, p=.033) and current position (F=5.423, p=.005). There were significant positive correlations for critical thinking disposition with clinical decision making, and with job satisfaction. CONCLUSION: The results of the study indicate that to improve clinical decision making and job satisfaction of cancer center nurses, it is necessary to increase critical thinking disposition. To make this change, appropriate programs are needed to increase critical thinking and clinical decision making of general cancer center nurses.

Adherence to Physical Activity Among Older Adults Using a Geographic Information System: Korean National Health and Nutrition Examinations Survey IV

PURPOSE: The purpose of this study was to examine the adherence to physical activity (PA) among older adults in Korea using data from the Fourth Korean National Health and Nutrition Examination Survey (KNHANES IV), and to illustrate geographic variations in PA using Geographic Information Systems (GIS). METHODS: A secondary analysis of the KNHANES IV data from 2007 to 2008 was used for this study. Participants of the study included 2,241 older adults over the age of 65. Estimates on adherence to PA were obtained for vigorous, moderate, walking, strengthening, and stretching activities. All estimates were weighted to represent Korean population. The association between participants' characteristics and PA was analyzed using Wald chi-square test. Maps depicting regional variations in PA were created using GIS software. RESULTS: Adherence to PA among Korean older adults who met national recommendations during the period of year 2007-2008 was about 9% in vigorous activity, 10% in moderate activity, and 48% in walking. The most common type of PA was walking. A higher level of PA was associated with male gender, younger age, high level of income and education, and living with family. CONCLUSION: The majority of older adults did not meet the national PA recommendations, suggesting that consistent surveillance and intervention for PA in the geriatric population are needed in the future. Maps generated using GIS visually showed regional differences in PA among the study participants.

Development and Validation of a Scale for the End of Life Caregiving Appraisal

PURPOSE: End-of-life caregiving experiences can be complex. Family members experience physical and mental suffering as they anticipate their impending loss. Healthcare providers should be able to provide good quality of end-of-life (EOL) care and support for primary EOL caregivers. Studies have highlighted the role of healthcare providers providing information in the EOL situation to caregivers of chronic disease patients. This has resulted in the development of the End-of-life Caregiving Experience Appraisal Scale (EOLCAS) presented in this paper. The purposes of this study were to develop a scale that can evaluate the experiences of EOL caregivers, and to test the reliability and validity of this scale. METHODS: The scale domains were derived from systematic review of 35 relevant studies. We then examined its content validity with nurse scholars and clinicians using content validity index. To examine construct validity, a total of 175 caregivers from tertiary hospital setting in Korea participated in this study from December 2007 to May 2008. For the construct validity, factor analysis was utilized. RESULTS: The scale was composed of 32 items with four subscales: two negative appraisals (physical suffering and burden), one positive appraisal (maturation), and one neutral appraisal (social support pursuit). In this sample, the Cronbach's alpha for the entire scale was .84 indicating adequate reliability. However, Cronbach's alpha of subscales was varied. CONCLUSION: Nurses and other healthcare professionals could use the EOLCAS to assess the experiences of EOL caregivers to understand their experience in the EOL and enhance their quality of life although psychometrics of EOLCAS shows limited findings.

Critical Thinking in Nursing Science: A Literature Review / 성인간호학회지

PURPOSE: The purposes of this study were as follows; 1) To review the definitions of critical thinking from various perspectives, 2) To examine the critical thinking measurements throughout nursing research, and 3) To review the nursing studies with regard to critical thinking. METHODS: This study was a literature review with regard to the critical thinking in nursing in aspects of conceptual meaning, measurements, and research. RESULTS: The definition of critical thinking in nursing included decision making in clinical setting, inference with logical construct to increase nursing quality, interpretation in the context, and evaluation. The critical thinking was a core concept, which meant not only simple nursing process, but included decision making ability. The critical thinking has been conceptualized by both critical thinking disposition and skill. However, there was no nursing specified critical thinking measurement. Critical thinking research has been conducted to describe critical thinking disposition and critical thinking, to determine relationships between critical thinking and clinical competency, and to evaluate the effectiveness of educational programs. CONCLUSION: The instruments for measuring critical thinking disposition and skill that contain cultural difference and clinical specificity need to be developed to measure critical thinking and increase it.

A Study on Perceived Stress and Dietary Habits of Female College Students / 여성건강간호학회지

PURPOSE: The purpose of this study was to investigate perceived stress and dietary habits of female college students and define the relationships between them. METHOD: A convenient sampling method was used at a university based in Seoul. Finally, 412 students participated in the study from May 1 to June 10, 2008. The questionnaires administered consisted of a Stress Scale for college students and Dietary habit scale questionnaires. The students filled out the questionnaires by themselves. The collected data was analyzed with the SPSS Win 14.0 statistics program, which was used to calculate the frequencies, percentages, ANOVA, and Pearson's correlation of the variables. RESULT: The major findings of this study were as follows; In general, female students were mostly stressed by 'schooling.' Stress scores were significantly different in accordance with religion. Overall, dietary habits of study participants were normal. Significant differences were observed in the dietary habits between type of residence, major, and spending money per month. There was a significant relationship between perceived stress and dietary habits. CONCLUSION: Stress management for female college students should be developed and nutritional education programs should be reinforced.

The Effect of Stress, Social Support and Self-Efficacy on the Mental Health of Female Undergraduate Students / 기본간호학회지

PURPOSE: The purpose of this study was to investigate the effect of stress, social support and self-efficacy on the mental health of female undergraduate students. METHOD: Three hundred ninety-nine undergraduate students were conveniently selected from a university in Seoul. The instruments used in this study were stress, social support, self-efficacy, and mental health scales. ANOVA, t-test, Pearson correlation coefficients, and stepwise multiple regression with SPSS Win 16.0 Version were used to analyze the data. RESULTS: Mental health was significantly influenced by stress, social support, self-efficacy, and monthly expenditures. These variables accounted for 44.2% of the variance in mental health. CONCLUSION: The important factor that was found to affect the mental health of undergraduate female students was stress. Therefore, future studies need to be pursued to develop various strategies, such as stress relief programs, for mental health promotion of female undergraduate students.

A Study of Irritable Bowel Syndrome, Self-esteem, Depression, and Physical Health in Female University Students / 여성건강간호학회지

PURPOSE: The purpose of study was to explore the frequency of irritable bowel syndrome(IBS) among female university students and identify self-esteem, depression, and physical health. METHOD: The secondary analysis was performed. A total 401 university female students were recruited from 1 university in Korea. IBS was diagnosed based on the Rome III criteria. The questionnaires included Rosenberg's self-esteem scale, Center for Epidemiological Studies-Depression (CESD) scale, and physical health questionnaire developed by Lee. The collected data was analyzed with SPSS Win 15.0 statistics program using frequencies, percentages, ANOVA, and the Pearson's correlations of the variables. RESULT: The frequency of IBS was 26.7 % in students. All women had mixed constipation and diarrhea subtype of IBS. Compared to the women without IBS, those with IBS reported significantly lower scores on self-esteem and higher scores of CESD and on the physical health questionnaire. CONCLUSION: Nursing interventions targeting female students with IBS should be developed in order to reduce the depression and physical health problem and improve self-esteem.