Exercise Experience of Elderly Medicaid Beneficiaries with Osteoarthritis Based on Self-Determination Theory

Background@#Osteoarthritis is the most common chronic disease among elders, and it crucially requires self-management. This study aimed to qualitatively examine exercise experiences of elderly Medicaid beneficiaries with osteoarthritis receiving exercise intervention based on self-determination theory (SDT). @*Methods@#Eight elders who received a community-based exercise intervention were interviewed three times. Using the interview transcriptions and field notes, researchers conducted an interpretative phenomenological analysis based on SDT to explore the motivational process of exercise compliance. @*Results@#Three meaningful profiles (non-compliant, intermitter, and compliant) were identified along with satisfaction with needs (autonomy, competence, and relatedness) that motivate exercise compliance based on SDT. Compliance of exercise is primarily initiated by external regulation and followed by the internalization process of recognizing and accepting the value of the behavior. @*Conclusions@#The concepts of SDT could be used to explore factors associated with motivation and gradual behavior change among elderly Medicaid beneficiaries with osteoarthritis. Autonomy, competence, relatedness, external regulation, and identified regulation control may be applied to establish a strategy that promotes behavior change by satisfying the psychological needs and internalizing the behavior of these elders.

Exercise Experience of Elderly Medicaid Beneficiaries with Osteoarthritis Based on Self-Determination Theory

Background@#Osteoarthritis is the most common chronic disease among elders, and it crucially requires self-management. This study aimed to qualitatively examine exercise experiences of elderly Medicaid beneficiaries with osteoarthritis receiving exercise intervention based on self-determination theory (SDT). @*Methods@#Eight elders who received a community-based exercise intervention were interviewed three times. Using the interview transcriptions and field notes, researchers conducted an interpretative phenomenological analysis based on SDT to explore the motivational process of exercise compliance. @*Results@#Three meaningful profiles (non-compliant, intermitter, and compliant) were identified along with satisfaction with needs (autonomy, competence, and relatedness) that motivate exercise compliance based on SDT. Compliance of exercise is primarily initiated by external regulation and followed by the internalization process of recognizing and accepting the value of the behavior. @*Conclusions@#The concepts of SDT could be used to explore factors associated with motivation and gradual behavior change among elderly Medicaid beneficiaries with osteoarthritis. Autonomy, competence, relatedness, external regulation, and identified regulation control may be applied to establish a strategy that promotes behavior change by satisfying the psychological needs and internalizing the behavior of these elders.

Evaluation of a Community-based participatory professional periodontal care program for hypertension and diabetes patients / 대한구강보건학회지

OBJECTIVES: To evaluate the Community-Based Participatory Research (CBPR) professional periodontal care program model for patients with hypertension and diabetes. METHODS: This descriptive case study included 151 participants of the professional periodontal care program. The CBPR-based professional periodontal care program consists of 5-steps: ‘Issue identification and prioritization’ (Step 1), ‘Strategy development’ (Step 2), ‘Entry into community’ (Step 3), ‘Implementation’ (Step 4), and ‘Transition’ (Step 5). Quantitative data were analyzed using frequency analysis, and descriptive data with PASW 23.0 (SPSS Inc., Chicago, IL, USA). The results of the Focus group interview (FGI) were classified as ‘general opinions regarding the program planning and operation receptiveness’, ‘sustainability’, ‘potential spread of the program’, and ‘improvement of program’. The interviews were qualitative research involving seven people. RESULTS: 1. Participants increased their interest in health and oral health by managing their hypertension, diabetes, and periodontal disease using community resources. Through this, healthy practices and improved awareness helped to prevent complications and manage periodontal diseases. 2. Community organizations actively cooperated, resulting in positive changes in oral health practices (increased registration of patients in education centers for hypertension and diabetes, and increased number of patients visiting the local dental clinic). In the future, it was positive to participate in the program continuously. CONCLUSIONS: The most important step is ‘Entry into community’, which has led to active participation and cooperation of community organizations and participants. Therefore, community organizations and strategy development should be discussed, and the role of community leaders should be emphasized to build cooperative relationships. In addition, participation in and collaboration with health-based projects should be achieved through a search of various community organizations.

Comparing the Needs of Case Management between Medical Aid Beneficiaries with Simple and Multiple Chronic Diseases / 재활간호학회지

PURPOSE: The purpose of this study was to compare the needs of case management between Medical aid beneficiaries with simple and multiple chronic diseases (SCD vs MCD). METHODS: The study employed secondary analysis method using a cross-sectional data from 2009 case management service enrollees. Data on 35,862 beneficiaries who have chronic disease(s) were used in the description of chronic disease characteristics, and data on 20,392 beneficiaries, excluding those who have depression and/or disabilities, were used to compare the group differences. RESULTS: Mean age was 68.8+/-11.63 years, and 73.3% were females. MCD group showed an older age, had more women than SCD group. Self-care ability and appropriateness of health care utilization were significantly different between the groups, but there was no difference in health-related quality of life. In subscales, there were significant differences in general health status, depression, symptom management, healthy lifestyle, hygiene and vaccination, and appropriateness of health utilization. CONCLUSION: Different characteristics between patients with simple and multiple chronic diseases indicate that different case management approaches are required for these groups. The study results could be used as a basis for the development of case management model tailored to the characteristics and needs of medical-aid beneficiaries.

Factors associated with Patient Activation for Self-management among Community Residents with Osteoarthritis in Korea

PURPOSE: The purpose of this study was to survey patient activation for self-management and to identify factors associated with patient activation for self-management among community residents with osteoarthritis in Korea. METHODS: Cross-sectional study design was used. Survey data were collected from 270 community residents with osteoarthritis through direct interviews. Studied factors included patient activation, joint pain, physical function, depression, and general characteristics. Data were analyzed using chi-squared test, t-test and multivariate logistic regression analysis. RESULTS: The participants' mean score of patient activation was 56.0+/-16.61. The mean score of each factor was 10.6+/-5.89 for joint pain, 5.5+/-3.56 for physical function, and 19.3+/-10.01 for depression. The patient activation level was significantly associated with depression and general characteristics such as education, religion, comorbid hypertension, and use of medical clinics (p<.05). CONCLUSION: The findings suggest that depression, education, religion, comorbid hypertension, and use of medical clinics may be important factors to be considered when developing programs of patient activation for self-management. This is the first study that measured patient activation, and further studies are suggested to find factors associated with patient activation for self-management among community residents with other chronic diseases.

A Historical Trends of Doctoral Nursing Education in Korea / 한국간호교육학회지

PURPOSE: The aim of this study was to identify historical backdrop leading to the introduction of the doctorate degree of nursing in Korea, and to explore trends of doctoral nursing education program. METHODS: The research design was a descriptive study adopting a historical approach. Documentation data were collected through web sites and mail survey. The semi-structured interviews were conducted with 6 professors who were involved in the introduction of the doctorate degree of nursing. The outcomes of doctoral nursing education program were evaluated with a total of 1,153 dissertations' titles published from 1982 to 2007. RESULTS: First introduced in Korea in 1978, doctoral nursing education program had steadily increased totaling 21 doctoral program in 2007. This resulted in a rapid increase in the number of doctoral students, but the number of faculty and the quality were not as satisfactory as expected. Many doctoral program had the missions or goals that fostered nursing scholars, theorists, and researchers, a trend that seems set to continue. The majority of dissertations utilized the experimental design (39.9%), others were qualitative design (21.6%), and survey design (19.0%). CONCLUSION: Doctoral education that is the hallmark of nursing scholarship is further elaborated in terms of academic tradition of nursing school in Korea.

Validation of a Needs Assessment Tool for Case Management in Korean Medical Aid Beneficiaries

PURPOSE: The purpose of this study was to validate the Needs Assessment Tool for Case Management (NATCM) for use with Korean medical aid beneficiaries. METHODS: Psychometric testing was performed with a sample of 645 Korean medical aid beneficiaries, which included 41 beneficiaries who were selected using proportional sampling method, to examine intraclass correlation coefficients (ICC). Data were evaluated using item analyses, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), Cronbach's alpha, and ICC. RESULTS: Through psychometric testing the final version of NATCM was found to consist of two subscales: 1) Appropriateness of Health Care Utilization (5 items) and 2) Self Care Ability (6 items). The two subscale model was validated by CFA (RMSEA=.08, GFI=.97, and CFI=.93). Internal consistency measured by Cronbach's alpha was .82, and subscale reliability ranged from .79 to .84. The ICC of the NATCM between case managers was .73 and between case managers and health care professionals. .82. CONCLUSION: This study suggests that the final version of NATCM is a brief, reliable, and valid instrument to measure needs of Korean medical aid beneficiaries. Therefore, the NATCM can be effectively utilized as an important needs assessment as well as outcome evaluation tool for case management programs in Korea.

Multilevel Analysis of Health Care Service Utilization among Medical Aid Beneficiaries in Korea

PURPOSE: The current study was done to identify individual- and group-level factors associated with health care service utilization among Korean medical aid beneficiaries by applying multilevel modeling. METHODS: Secondary data analysis was performed using data on health care service reimbursement and medical aid case management progress from 15,948 beneficiaries, and data from 229 regions were included in the analysis. RESULTS: Results of multilevel analysis showed an estimated intraclass correlation coefficient (ICC) of 18.1%, indicating that the group level accounted for 18.1% of the total variance in health care service utilization, and that beneficiaries within the region are more likely to share common features with regard to health care service utilization. At the individual level, existence of disability and types of medical aid beneficiaries showed a significant association, while, at the group level, social deprivation index, and the number of beneficiaries and case managers within the region showed a significant association with health care service utilization. CONCLUSION: The significant influence of group level variables in health care service utilization found in this study indicate a need for group level approaches, such as policy change and/or promotion of community awareness.

A study on Korean nursing students' educational outcomes / 보건의료교육평가

The purpose of this study was to describe outcome indicators of nursing education including critical thinking, professionalism, leadership, and communication and to evaluate differences among nursing programs and academic years. A descriptive research design was employed. A total of 454 students from four year baccalaureate (BS) nursing programs and two three-year associate degree (AD) programs consented to complete self-administered questionnaires. The variables were critical thinking, professionalism, leadership and communication. Descriptive statistics, chi2-test, t-tests, ANOVA, and the Tukey test were utilized for the data analysis. All the mean scores of the variables were above average for the test instruments utilized. Among the BS students, those in the upper classes tended to attain higher scores, but this tendency was not identified in AD students. There were significant differences between BS students and AD students for the mean scores of leadership and communication. These findings suggested the need for further research to define properties of nursing educational outcomes, and to develop standardized instruments for research replication and verification.

The Effects of Tele-care Case Management Services for Medical Aid Beneficiaries

PURPOSE: This study was done to analyze the effects of tele-care case management services using secondary data. METHODS: A descriptive research design was utilized, and the participants were 134 medical aid beneficiaries who were in either the high-risk group or the preventive group. Case management services were delivered by 8 care managers. Data were analyzed using PAWS Statistics 17 through descriptive statistics and paired t-test. RESULTS: After the case management intervention, the participants' health quality of life, self-care competency, and reasonable medical care utilization increased significantly for the high-risk group. However there were no significant changes in the preventive group. CONCLUSION: The results showed that the tele-care case management services were effective for high-risk medical aid beneficiaries. Further studies with controls for constitutional variables and a comparison group are required to validate the robustness of the effectiveness of the case management program in the present study.

Effects on Nursing Students of Cognition-Behavior Integrated Breast Cancer Prevention Education Using an Interchangeable Nodule Model / 여성건강간호학회지

PURPOSE: The study was done to examine the effects of cognition-behavior integrated breast cancer prevention education, in which a breast model with interchangeable nodules was utilized, on the self-competency of nursing students in performing breast cancer education. METHODS: A nonequivalent control group non-synchronized design was used. A traditional lecture intervention was provided for 49 3rd year college of nursing students (control group) while the integrated breast cancer prevention education was given to 47 3rd year students in the same college one year later (experimental group). The integrated breast cancer prevention education was developed by the research team to strengthen the competency of cognitive and behavioral components in education on breast cancer. RESULTS: Effects of the intervention were found to be significant through all study variables: knowledge about breast cancer (t=7.79, p <.001), breast cancer risk awareness (t=2.05, p <.05), self-competency of breast self-exam (t=8.27, p <.001), and intention to teach breast self-exam (t=3.87, p <.001). CONCLUSION: The integrated breast cancer prevention education was useful to improve not only knowledge about breast cancer but competency in performing breast examination for nursing students who acquired technical skills from various simulation nodules. As the program helped the students to be prepared as confident educators, future application of the module is recommended for academic curricula.

Content Analysis of Experience of Nursing Students in Clinical Judgment during Nursing Practicum / 성인간호학회지

PURPOSE: To describe the lived experience of nursing students when faced with clinical judgment in a nursing practicum at the hospital. METHODS: A descriptive research design was utilized. Participants were 79 students in the clinical practicum. Participant consent was obtained for ethical protection. Data were collected from August to December 2007 using a semi-structured questionnaire. Content analysis was utilized for data analysis. RESULTS: Two categories and 5 themes were extracted from the data for 'difficult' and 'easy' clinical judgments. For the student category, the two themes were 'knowledge' and 'skill', while the three themes for the clinical education environment category were, 'judgment of clinical symptoms and signs', 'differences between theory and practice' and 'human relationships'. For coping, 2 categories and 5 themes were extracted for the difficult clinical judgment situation, while one category and one theme were found for the easy clinical judgment situation. CONCLUSION: To develop students' clinical judgment, there is need to develop the method of clinical skills using simulation in clinical teaching. For future research, a study on factors affecting clinical judgment of nursing students in hospitals is needed.

A Mentoring Program for Stress Management among Korean Adolescents

PURPOSE: The purpose of this study was to develop a mentoring program for stress management among Korean adolescents and to assess the effects of the program. METHODS: The nonequivalent control group (CG) pretest-posttest design was used in this study. The mentoring intervention was delivered to 18 middle school students (males and females) but nothing was done to the control group consisting of 18 students. The mentoring intervention was conducted by seven nursing students who participated in the program as mentors using various methods such as individual meetings and group activities. The dependent variable was stress level. RESULTS: The program consisted of group and individual mentoring. At follow-up, although the mentees's satisfaction was high and they stated qualitatively positive experience, the difference of stress level between the two groups was not significant. CONCLUSION: If future mentoring programs reflect the limitation of the current program, they may have potential as developmentally appropriate interventions for stress management of adolescents, and enable nursing students to gain confidence in their professional capability.

The Effect of Tele-Health Service on Knowledge and Family support of Hypertension patients / 대한의료정보학회지

OBJECTIVE: The purpose of this study was to evaluate the effect of tele-health service on knowledge and family support of hypertension patients. METHODS: The subjects were two hundred thirty seven primary hypertension patients who were enrolled at health care center located at the cities of Chunchon, Wonju, and Kangreung, Kwangwon-Do. Tele-health system were located health care center of each cities and the service had been provided for three months. Tele-health system called patients every morning to remind them of taking the prescribed medicine by a 12.5 second pre-recorded message. In addition, tele-health system informed the patients of knowledges on hypertension(medication, exercise, nutrition, regular examination) by 18.4 through 25.3 second pre-recorded message during weekend. Data were collected using a questionnaire before and after the service. RESULTS: The differences of knowledge on hypertension before and after tele-health service was significant(t=-7.908, p=.000). Family support before and after the service was statistically significant as well(t=-7.550, p=.000). CONCLUSION: Tele-health service was effective to manage hypertension.

Characteristics of Subgroups on Patients with Hypertension for Hypertension Management: Based on Knowledge, Attitudes, and Behavior Related to Medication and Health Lifestyle

PURPOSE: The purpose of this study was to identify and profile distinct subgroups of patients with hypertension based on knowledge, attitudes, and behavior regarding their medication and health lifestyle. METHOD: A descriptive-exploratory research design was employed. Two hundred and twenty-three patients with hypertension using W Public Health Center were randomly recruited on the basis of being over 30 of age. Upon the receipt of their written consents, direct interview with a structured questionnaire were conducted by a public health nurse. Descriptive statistics and chi2-test were utilized. RESULTS: Three subgroups were identified. Group I members had a low score on all three factors including knowledge, attitudes and behavior related to medication and health lifestyle. Group II members had a low score on one or two of the factors. Group III members had a high score on all three factors. The three subgroups were significantly associated with education level, economic status, non-smoking and non-drinking. CONCLUSIONS: Further research should be conducted to validate these findings and test tailored nursing intervention for patient compliance.

A Comparison of Stress Levels of Elementary Students by Geographical Regions / 간호학회지

PURPOSE: The purpose of this study was to compare stress levels of elementary students according to three regional levels: a large city, a medium-sized city, and a rural area. METHODS: This was a descriptive comparative survey using a convenience sample of 1,161 5th-and 6th-grade students. The stress level was measured by a stress scale that consisted of 65 items regarding personal characteristics, family, school, and peer factors. The data were analyzed by chi-square-test, t-test, ANOVA and multiple regression using the SPSS 10.0 statistical program. RESULTS: Overall, the mean stress scores reported by the participants were near the middle of a 5-point scale and the level of familyrelated stress was highest, followed by peer, school, and individual-related stress. Sixth-graders and female students showed higher stress levels than 5th-graders and male students, respectively. The participants reporting unsatisfaction with their lives and those living in large cities tended to have significantly higher stress levels. CONCLUSION: Grade, gender, life satisfaction, and regional levels were all significant factors associated with high stress levels among elementary students. Development of stress management programs for this specific population, especially targeting students who are female and living in large cities, is needed.

Development of Standards and Criteria for Accreditation of a Baccalaureate Nursing Education Program: Reflections on the Unique Characteristics of the Nursing Profession / 간호학회지

PURPOSE: The purpose of this study was to determine characteristics of nursing science and identify expected outcomes from baccalaureate graduates, and to develop accreditation standards and criteria reflecting the characteristics of the nursing profession. METHODS: A methodological research design was utilized in this study. Related literature reviews and the nursing education program goals and objectives of the 99 nursing schools in Korea were analyzed. A cross-sectional survey research design was utilized to test the validity of the developed characteristics of the nursing profession and their accreditation criteria and standards. The face validity was from the advisory committee and public committee hearing. RESULTS: The characteristics of nursing science were defined with five concepts including humanity, scientific knowledge, professionalism, therapeutic relationship, and facilitating well-being. The expected outcomes from graduates were identified as providing holistic nursing, critical thinking, establishing professionalism and leadership, construction of a therapeutic relationship, and skilled nursing practice. Finally6 standards and 14 criteria reflecting the unique characteristics of the nursing profession were developed for accreditation. These proposed accreditation standards and criteria are a challenge to promote the quality of nursing science.

Factors Predicting Condom Use for the Prevention of Sexually Transmitted Diseases among Sex Workers

PURPOSE: The purpose of this study was to identify factors to predict of condom use for the prevention of sexually transmitted diseases (STDs) among sex workers in a Korean community. The theoretical ground of this study was the Interaction Model of Client Health Behavior. METHOD: A descriptive, cross sectional and retrospective research design was employed in this study. A total of 100 sex workers who take a clinical check-up on STDs regularly at W Public Health Center were recruited by convenient sampling, and with consent to participate in this study. All of the measures were piloted, and the reliability of each scale ranged from 0.7 to 0.9. Data were analyzed using discriminating function analysis with SPSS-PC. RESULTS: Five independent measures (partner preference for using condoms, subjects desire to prevent STD, age, type of relationship and sexual self-determination) contributed significantly to the best discriminating function. The discriminating function analysis resulted in correct classification of 83.1% of the respondents into their corresponding groups. CONCLUSION: Condoms are a main means of STDs prevention. Risk-reduction interventions that enhance communication skills and intrinsic motivation will be effective in increasing condom use to prevent STDs among sex workers.

Development and Testing of a Sexually Transmitted Diseases Prevention Program in At-Risk Prostitutes / 간호학회지

PURPOSE: The purpose of the study was to test the effectiveness of an 8 session intervention program to prevent sexually transmitted diseases (STDs) among at-risk prostitutes. METHOD: An experimental research design was employed. Subjects were 59 prostitutes (29 in the control group and 30 in the experimental group) who agreed to participate in this study. An STD Prevention Framework derived from Cox's Interaction Model of Client Health Behavior guided the overall intervention and the components. The intervention had 8 sessions with STD-prevention strategies and was led by Public Health Nurses. Analysis included change scores, chi2-test, and t-test. RESULT: The results revealed significant increase in feelings and skills of condom use, peer belief on condom use, condom use practice, and satisfaction with service at public health centers (PHC) on STDs knowledge and skills in the experimental group. However, newly contracted STDs were not significant statistically between groups. CONCLUSION: The 8 session STDs prevention program showed a effect on emotions, skills and behaviors of condom use even withthe limitation of methodological rigors because of subject-specific conditions. In the future, a capacity-building model based on collaborating networks among community-based organizations will be needed to develop in effective STDs prevention.

Content Analysis of the Experience of Preceptors in Clinical Education for Senior Student Nurses / 간호학회지

PURPOSE: The purpose of this study was to identify experiences of nurses who served as preceptors in clinical education for senior student nurses in a college of medicine in Wonju city. METHOD: Data was collected from 20 preceptors instructing senior student nurses in 2001 using a self-completion questionnaire. To analyze data, content analysis was done using an analysis scheme developed by the investigators. RESULT: The analysis scheme consisted of 7 categories and 25 subcategories. 135 significant statements were analyzed and categorized. Preceptors indicated that they were role models, socialization facilitators and educators while instructing students in the clinical practicum. In performing the preceptors' role, preceptors reported that their most important change was self-enhancement,and positive experience was a constructive work atmosphere. The most important factor facilitating the preceptors' role performance was support from head nurses, and the most discouraging factor was work loads. CONCLUSION: This study suggests that interventions for encouragement and socialization of preceptors should be developed to promote clinical education for senior student nurses.