Relationship between super-leadership and self-directed learning ability in online nursing education: The mediating effects of self-leadership and self-efficacy perceptions.

Background: Self-directed learning ability is a core competence that enables students to enhance their academic achievement, clinical competence, and professional growth in nursing education. Super-leadership-as a strategy to develop the learning process-promotes students' self-leadership, which, in turn, enhances perceived self-efficacy perception and ultimately facilitates self-directed learning ability. Few studies have rigorously determined the influences of super-leadership, self-leadership, and academic self-efficacy perceptions on self-directed learning ability in online nursing education during the COVID-19 pandemic. Objectives: To determine the mediating effects of self-leadership and self-efficacy perceptions in the relationship between perceived super-leadership and self-directed learning ability. Design: This study was conducted using a quantitative mediation analysis design. Participants: One hundred and fifty nursing students were conveniently recruited from two nursing colleges offering the same four-year nursing degree program. Methods: Participants completed a super-leadership scale, a self-leadership scale, an academic self-efficacy scale, and a self-directed learning ability inventory. Data were analyzed with Pearson's correlations, regression analysis, Sobel's test, and Hayes's Process Macro using the bootstrap method. Results: Self-directed learning ability was correlated with perceived super-leadership (r = .47, p < .001), self-leadership (r = 0.69, p < .001), and academic self-efficacy (r = 0.29, p < .001). Super-leadership influenced self-leadership (ß = 0.42, p < .001), academic self-efficacy (ß = 0.22, p = .002), and self-directed learning ability (ß = 0.36, p < .001). Self-leadership and academic self-efficacy mediated the relationship between super-leadership and self-directed learning ability (ß = .42, p < .001; ß = 0.35, p < .001) (z = 1.936, p = .026 by Sobel test). Conclusion: Learning strategies to enhance self-directed learning ability are required for successful super-leadership to boost self-leadership and academic self-efficacy perceptions among nursing students in the online, asynchronous COVID-19 educational environment. Therefore, this study's empirical evidence on integrating super-leadership with self-leadership and academic self-efficacy has practical and future research implications in terms of attaining core academic goals for nursing students.

Type D personality, cognitive illness perception, depression, approach coping, and self-management among older adults in long-term care hospitals: Structural equation modeling.

This study aimed to construct a structural equation model to explore the relationship between Type D personality, cognitive illness perception, depression, approach-coping, and self-management. The study was conducted at two long-term care hospitals with 300 or more beds in Korea. Participants were 287 older patients from whom data were collected from February 17 to March 10, 2021, using a structured questionnaire comprising items on the following variables: Type D personality, cognitive illness perception, depression, approach coping, and self-management. Type D personality (ß=-.601, p=.001), cognitive illness perception (ß =.692, p <.001), depression (ß =-.204, p =.011), and approach-coping (ß =.326, p <.001) explained 78.8% of the total variance of self-management, highlighting their impact on how patients accept and manage a disease and their relevance to the self-management of older adults in long-term care hospitals.

An intradialytic aerobic exercise program ameliorates frailty and improves dialysis adequacy and quality of life among hemodialysis patients: a randomized controlled trial.

BACKGROUND: Hemodialysis patients with chronic kidney disease exhibit impaired exercise tolerance and functional decline. Despite the life-saving benefits of adequate dialysis, those declines translate into frailty and deteriorating quality of life (QoL). This study evaluated the effects of an intradialytic aerobic exercise program on frailty, dialysis adequacy, and QoL among hemodialysis patients. METHODS: Patients at an university hospital-affiliated hemodialysis center were randomly assigned to an exercise group (n = 18) or a control group (n = 21). The 12-week aerobic exercise program comprised 40 to 70 minutes of ergometer cycling 3 times/wk and a single education session. The control group completed only the education session. Outcomes were assessed at the time of enrollment, week 4, week 8, and week 12 using Fried's frailty phenotype measures (gait speed, grip strength, vitality, body mass index, and physical activity), the short physical performance battery (SPPB), Kt/V urea, and the Short Form-36 questionnaire. RESULTS: There were significant interactions between groups and follow-up times in the frailty score (p < 0.001), gait speed (p < 0.001), SPPB (p < 0.001), and mental QoL (p = 0.03). The intention-to-treat and per-protocol analyses revealed that the exercise group exhibited significant improvements in frailty score (p < 0.001), gait speed (p < 0.001), grip strength (p < 0.001), exhaustion (p = 0.02), SPPB (p = 0.01), dialysis adequacy (p = 0.01), and physical QoL (p = 0.003). CONCLUSION: An intradialytic aerobic exercise program could be a safe, feasible, and appropriate additional strategy to routine care among hemodialysis patients for improvements in frailty, dialysis adequacy, and QoL.

The role of clinical trial nurses: Transitioning from clinicians to clinical research coordinators.

AIMS: This study aimed to explore the role of clinical research coordinators (CRCs) and identify the importance and performance of the role as well as the factors that affect the professional recognition of their role. METHODS: A total of 102 CRCs from 10 hospitals were recruited for a survey. The Clinical Trial Nursing Questionnaire scale developed by Ehrenberger and Lillington was used to collect data for the importance-performance analysis. The importance and performance data were plotted on a two-dimensional grid, and multiple stepwise linear regression analysis was used to determine the influencing factors on the CRC role. RESULTS: The influencing factors on the importance of the CRC role were frequency of protocol assessment, implementation and evaluation and professional nursing role performance. The influencing factors on performance were formal education and training in clinical research, institutional career ladder system for professional development and identification as a principal investigator in research studies. The influencing factor on the professional nursing role perception was the lower component of the 'performance of professional nursing role'. CONCLUSION: Formal educational preparation, identification as a principal investigator in research studies and clear career progression are supportive factors to the professional recognition of CRC as a specialized nursing role.

Effects of a laughter programme with entrainment music on stress, depression, and health-related quality of life among gynaecological cancer patients.

OBJECTIVE: This study examined the effects of a laughter programme with entrainment music on stress, depression, and health-related quality of life (HRQoL) among gynaecological cancer patients. METHODS: This quasi-experimental study randomly assigned participants to either a laughter group (n = 17) or a control group (n = 19). The 8-week laughter programme included a weekly 60-min group session composed of laughter, deep breathing, stretching, meditation, and entrainment music-related activities (chorusing, body movement, and dancing). Values involving stress, depression, and HRQoL from before and after the programme were analysed using the Mann-Whitney U test and rank analysis of covariance. RESULTS: The laughter group exhibited improvements in relation with stress and depression, as well as improvement in the emotional and functional well-being of HRQoL domains. CONCLUSION: A laughter programme with entrainment music may be used as a stress-moderator and a positive emotion-enhancing strategy among gynaecological cancer patients.

Validation of a Questionnaire to Delineate the Clinical Trial Nursing Roles in Korea.

BACKGROUND: In clinical trials, research nurses play a particularly important role in promoting cancer care best practices. However, no Korean questionnaire has been developed to define the clinical trial nursing roles based on Good Clinical Practice standards. OBJECTIVE: The aim of this study was to cross-culturally evaluate the reliability and validity of a Korean version of the Clinical Trials Nursing Questionnaire (CTNQ) among Korean clinical research nurses. METHODS: Cross-cultural adaptation was performed, with forward and backward translation, a pilot test (linguistic validation), and a field test. Validation was performed by questioning 53 clinical research nurses who were working in clinical cancer centers at 5 tertiary university hospitals. The distribution of the item responses and internal consistency reliability were assessed using the ceiling and floor effects, Cronbach's α, and the item-total correlation. Construct validity was assessed using Spearman correlation analysis and principal-component factor analysis. RESULTS: The distributions of the item responses and the item-total correlation were generally appropriate. The Cronbach's α values for the frequency scale and the importance scale were 0.852 and 0.899, respectively. Eight sections of the Korean CTNQ were generally correlated with each other. The frequency subscale loaded on 1 factor, and the importance subscale loaded on 2 factors, with broadly similar factor loadings. CONCLUSION: The Korean version of the CTNQ is reliable, valid, and interchangeable with the original CTNQ. IMPLICATIONS FOR PRACTICE: The Korean version of the CTNQ can be used to validly and reliably assess the clinical trial nursing roles in Korea.

Effects of Korean hand acupressure on opioid-related nausea and vomiting, and pain after caesarean delivery using spinal anaesthesia.

OBJECTIVE: This study examined the effects of Korean hand acupressure on opioid-related nausea and vomiting, and pain after caesarean delivery. METHODS: Fifty participants were randomly assigned to an acupressure group or a control group. Korean hand acupressure discs were applied for 24 h onto 12 acupressure points (K-9, F-4 for nausea and vomiting; M-3, M-4, L-4, H-2, H-3, H-7 for abdominal pain; and I-38, J-2 for back pain). Nausea and vomiting incidences, the opioid-related symptom distress scale scores, and pain scores were analysed using chi-square test, Fisher's exact test, Mann-Whitney U test, or the repeated-measures analysis of variance. RESULTS: The acupressure group had lower incidences of nausea and vomiting, as well as significant improvements in the opioid-related symptom distress scores for nausea, vomiting, and pain. The acupressure group required fewer rescue antiemetics and analgesics. CONCLUSION: Korean hand acupressure can relieve nausea and vomiting, as well as pain after caesarean delivery.

Relationship among Emotional Clarity, Maternal Identity, and Fetal Attachment in Pregnant Women with Gestational Diabetes Mellitus.

PURPOSE: The purpose of this study was to examine the relationship among emotional clarity in emotional intelligence, maternal identity, and fetal attachment to measure how emotional clarity and maternal identity impact on fetal attachment and to determine mediating effects of maternal identity in pregnant women at the time of diagnosis with gestational diabetes mellitus (GDM). METHODS: This study used a correlational survey design. 88 pregnant women with GDM completed a study questionnaire of emotional clarity, maternal identity, and fetal attachment immediately after the diagnosis of GDM. Data were analyzed Mann-Whitney U test, and ANOVA with Duncan test, Pearson correlation, three-step regressions to test mediating effect, and Sobel test. RESULTS: The emotional clarity was positively related with maternal identity and fetal attachment. It affected maternal identity with 21.9% of explained variance. The emotional clarity and the maternal identity were significant predictors of fetal attachment by 57.7% of explained variance. The maternal identity mediated the relationship between emotional clarity and fetal attachment. CONCLUSION: The results suggest that a nursing program to enhance the emotional clarity and the maternal identity needs to be developed as an effective strategy to improve fetal attachment.

The effects of a simulated laughter programme on mood, cortisol levels, and health-related quality of life among haemodialysis patients.

OBJECTIVE: This study aimed to evaluate the effects of a simulated laughter programme on mood, cortisol levels, and health-related quality of life among haemodialysis patients. METHODS: Forty participants were randomly assigned to a laughter group (n = 20) or a control group (n = 20). Eleven participants completed the laughter programme after haemodialysis sessions and 18 control participants remained. The 4-week simulated laughter programme included weekly 60 min group sessions of simulated laughter, breathing, stretching exercises, and meditation, as well as daily 15 s individual laughter sessions administered via telephone. Mood, cortisol levels, and health-related quality of life were analysed using the rank analysis of covariance, and Wilcoxon's signed rank test. RESULTS: The laughter group exhibited improvements in mood, symptoms, social interaction quality, and role limitations due to physical health. CONCLUSION: The simulated laughter programme may help improve mood and health-related quality of life among haemodialysis patients.

Validation of the Korean version of the 39-Item Parkinson's Disease Questionnaire (PDQ-39).

PURPOSE: To evaluate the reliability and validity of the Korean version of the 39-item Parkinson's disease questionnaire (PDQ-39). METHODS: Cross-cultural adaptation was performed according to the international guidelines: forward and backward translation, focus group meeting, and a field test. With Korean consensus translation produced, validation was assessed by evaluating reliability and validity. Ninety-three outpatients with Parkinson's disease (PD) and 89 healthy aged controls were recruited. Internal consistency reliability was assessed by Cronbach's alpha. Validity was assessed by Spearman correlation analysis, t test, factor analysis, and analysis of variance with Duncan's multiple range tests. RESULTS: In the PD group, mean age was 65.13 ± 9.84 years, and mean duration of PD was 42.41 ± 37.01 months. Ceiling and floor effects ranged 1.1%-2.2% and 1.1%-15.1%, respectively. Cronbach's alpha of eight dimensions ranged from .70 to .97. All dimensions were correlated with each other, except for the stigma dimension. PD patients had significantly lower quality of life than healthy aged controls did, except for the bodily discomfort dimension. Eight dimensions of Korean PDQ-39 loaded on one factor. PD patients with a Modified Hoehn and Yarh Staging score of 4 had the worst quality of life. The relationships among the eight dimensions of Koran PDQ-39 and the Modified Hoehn and Yarh Staging is fair to good, except for the stigma and social support dimension. CONCLUSION: The Korean PDQ-39 was proved to be reliable and valid. Our results suggest that Korean PDQ-39 could be used in clinical research to assess and evaluate the disease process and its impacts on health-related quality of life in Korean PD patients.

Effects of a Case Management Program on Self-efficacy, Depression and Anxiety in Pregnant Women with Gestational Diabetes Mellitus.

PURPOSE: To examine the effects of a case management program on self-efficacy, depression and anxiety in pregnant women with gestational diabetes mellitus. METHODS: Thirty-seven patients who enrolled in a diabetes outpatient clinic were randomly assigned to either an experimental group (n=19) or a control group (n=18). The experimental group received a 2-week intervention composed of a series of one face-to-face interactive interview and five telephone interviews based on the National standards for diabetes self-management education and Bandura's self-efficacy resources of performance accomplishment, vicarious experience, verbal persuasion, and emotional arousal. The effects of the intervention were assessed by completion of a 9-item self-efficacy questionnaire, a 20-item depression questionnaire and a 20-item anxiety questionnaire prior to, and after the intervention. The statistical significances were examined using t-test. RESULTS: The change in self-efficacy was significantly greater in the experimental group than in the control group. Depression and anxiety changes in the experimental group were significantly greater compared to those in the control group. CONCLUSION: The results of study suggest that a case management program improves self-efficacy, and decreases depression and anxiety in pregnant women with gestational diabetes mellitus.

[Factors associated with lower urinary tract symptoms for patients with Parkinson's disease].

PURPOSE: The study was done to identify lower urinary tract symptoms (LUTS) and to evaluate the factors affecting LUTS for the people with Parkinson's disease. METHODS: The research design was a cross-sectional study with interviews using a structured questionnaire. The participants were 72 patients with Parkinson's disease who were seen in the Neurology clinic of a university hospital from September to November 2005. RESULTS: Mean score of LUTS for the participants was 10.11. In each symptom score of LUTS (range 0-5), weak stream was the highest 2.06, followed by nocturia 1.71, and urgency 1.61. The severity of LUTS was moderate to severe group for 51%. LUTS were significantly different by regular exercise. Positive correlations were observed between Hoehn and Yahr stage (stage of disease severity) and frequency and between Hoehn and Yahr stage and urgency (r=.280, p=.018; r=.328, p=.005). LUTS were significantly predicted by regular exercise (p=.001) which explained 15.0% of the variance in LUTS. CONCLUSION: Regular exercise was found to be a very important factor associated with LUTS for patients with Parkinson's disease.

The reliability and validity of a Korean translation of the BASDAI in Korean patients with ankylosing spondylitis.

OBJECTIVES: The objective of this study was to develop a Korean version of the original English version of BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) and to evaluate its reliability and validity in Korean patients with Ankylosing Spondylitis (AS). METHODS: A total of 50 outpatients diagnosed as AS by the modified New York criteria participated. To develop a Korean version of the BASDAI, we followed rigorous international translation steps and evaluated reliability and validity by calculating Cronbach's alpha and correlation coefficients between BASDAI score and clinical parameters (e.g., ESR, CRP, modified Schober test index, finger-to-ground index, and Bath Ankylosing Spondylitis Radiologic Index Score, and bone mineral density). RESULTS: Cronbach's alpha (= 0.75) was acceptable. The distribution of item responses evaluated by the ceiling and floor effects showed appropriate proportions and a good discrimination with the Korean version of the BASDAI. The correlations among the mean BASDAI score and five scales for the convergent validity was significantly correlated with each other (all P-values < 0.01). The correlations between the BASDAI score and both erythrocyte sedimentation rate and C-reactive protein for the criterion validity were positively correlated (all P-values < 0.05). The results of this study showed that the Korean translation of the BASDAI is an efficient tool in terms of its reliability and validity for the measurement of the disease activity in patients with AS. CONCLUSIONS: The Korean version of the BASDAI could be used in clinical research to assess and evaluate the course of disease activity in Korean AS patients.

[Validation of the Korean version of liver disease quality of life (LDQOL 1.0) instrument].

BACKGROUND AND AIMS: Assessment of Health-related quality of life (HRQOL) outcomes in treatment of chronic disease is increasingly important. The objective of this study was to validate a Korean translation of the Liver Disease Quality of Life instrument (LDQOL version 1.0) for use in patients with chronic liver disease. METHODS: Two native Korean speakers with fluent English translated LDQOL including instructions, items, and response choices. This Korean translation of the LDQOL was administered to 121 patients with chronic liver disease. Cronbach's alpha coefficients were applied to test an internal consistency reliability of disease-specific scales of the LDQOL. MELD and modified CTP scores were calculated for all patients. Associations of MELD and modified CTP scores with severity of liver disease were analyzed with LDQOL. RESULTS: Internal consistency reliability was good (Cronbach's Alpha=0.69-0.94) in liver disease specific scales, except for the quality of social interaction scale (Cronbach's Alpha= 0.56). Mean modified CTP score and MELD score were 6.2+/-1.9 and 9.3+/-5.3, respectively. Both MELD score and modified CTP score showed correlations with most of the scores of liver disease specific scales of LDQOL 1.0, except for the quality of social interaction and sleep scale. CONCLUSIONS: The Korean version of the liver disease specific scales of the LDQOL 1.0 is validated and useful for measuring HRQOL in Korean patients with chronic liver disease.

[Body fat distribution and blood pressure according to anthropometric change in Korean patients with non-insulin dependent diabetes mellitus (NIDDM)].

PURPOSE: This study was done to identify fat distribution and blood pressure according to anthropometric change patterns between NIDDM patients and control subjects. METHODS: Cross-sectionally 167 NIDDM patients and 87 controls were studied. Previous maximal body weight and acute weight loss was obtained. Current height, body weight, BMI, waist-hip ratio (WHR), skinfold thicknesses(abdomen, subscapular and triceps), and blood pressure was measured. Three anthropometric change patterns were categorized by BMI changes from the maximum lifetime's BMI to the current time (obese-obese, obese-nonobese and nonobese-nonobese: obese: BMI > or =25 kg/m2, nonobese: BMI<25 kg/m2). The data was analyzed by Chi2, t-test, age adjusted ANCOVA and Least Squares Means (LSM) for multiple comparison. RESULT: Acute body weight loss (p=0.01), anthropometric change types (p=0.001), WHR (P=0.05), and skinfold thickness (p=0.002) of NIDDM were significantly higher than those of the controls. The mean arterial pressure, WHR and skinfold thicknesses were greater in both obese-obese and obese-nonobese NIDDM and control subjects compared with both nonobese-nonobese NIDDM and control subjects. (all p's<0.05). CONCLUSION: NIDDM patients had more central and upper body adiposicity. Also both obese-obese and obese-nonobese NIDDM and control subjects had higher mean arterial pressures and central body obesity.

Validation of the Korean version of the McMaster Quality of Life Scale in terminal cancer patients.

The purpose of this study was to develop and validate a Korean version of McMaster Quality of Life Scale (K-MQLS) suitable for evaluating clinical hospice and palliative care. The McMaster Quality of Life Scale (MQLS) is a brief and comprehensive scale that is used to assess cancer patients receiving palliative care due to poor physical condition. To further develop the K-MQLS, we followed rigorous international translation steps and performed validity, reliability, and sensitivity analyses. The results of our study show that the K-MQLS is an efficient tool in terms of its validity, reliability, and sensitivity for the measurement of the health-related quality of life during the palliative phase. This developed tool could be used in research or clinical settings to assess health-related quality of life in Korean palliative care patients.