Korean women's perceptions of traumatic childbirth: a qualitative descriptive study.

BACKGROUND: Previous studies have established that negative or traumatic childbirth can create childbirth-related post-traumatic stress disorder (CB-PTSD). Because of the negative implications of CB-PTSD for mothers, children, and families, global qualitative research on traumatic or negative childbirth has risen in recent years. However, few studies have been conducted in South Korea. This study aims to explore women's various perceptions of traumatic childbirth in South Korea. METHODS: This qualitative descriptive study examined nine women who were at high risk of PTSD (IES-R-K > 24) at the time of the interview, between 1 and 11 years after childbirth. Semi-structured interviews were conducted. Interview transcripts were subjected to thematic analysis. RESULTS: The analysis identified two themes with six subthemes, as follows: (1) person-centred factors (pain, guilt, maternal identity conflict, and damaged femininity); (2) society-centred factors (threatened dignity and disrupted relationships). These findings may be attributed to Korean culture (excessive motherhood and lookism), as well as unbearable pain, disrespectful childbirth environments, lack of spouse's support, loss of their lifestyle, and unrealistic expectations. CONCLUSIONS: This study demonstrates various negative consequences, ranging from psychological damage to conflict in women's relationships with their spouses, and others. This highlights the various perceptions stemming from traumatic childbirth and emphasizes the significance of clinical intervention. Therefore, healthcare professionals' greater understanding of women's perceptions and increased concern about childbirth and respectful childbirth environments are required. In addition, based on our findings, there is a need to develop interventions that can alleviate CB-PTSD and further improve women's mental health, particularly through women-centred interventions.

Association of weight, smoking, and alcohol consumption with age at natural menopause.

In South Korea, rapid economic growth and modernization have led to changes in lifestyle factors that may affect age at natural menopause. Data from 4,793 women aged ≥55 years, who had a natural menopause, were analyzed from the Korea National Health and Nutrition Examination Survey (2013-2017). Multinomial logistic regression was used to examine the association between lifestyle factors and age at natural menopause after adjusting for birth cohort (Model 1) and sociodemographic and reproductive factors (Model 2). Overall, 3.1% of women experienced premature menopause (<40 years), 7.6% early menopause (40-44 years), and 12.8% late menopause (≥55 years). Women born in the 1940s or earlier among the birth cohorts had the highest prevalence of premature (70.0%), early (58.5%), and late (43.1%) menopause. In Model 2, current smoking (odds ratio = 3.99 and 95% confidence interval = 1.35-11.81) was associated with premature menopause. Low (<18.5 kg/m2) and high (≥25 kg/m2) body mass index were associated with early (odds ratio = 2.30 and 95% confidence interval = 1.01-5.22) and late (odds ratio = 1.38 and 95% confidence interval = 1.10-1.72) menopause respectively. Conversely, there was no association between age at natural menopause and alcohol consumption. The results suggest that healthy lifestyle factors, such as not smoking and proper weight maintenance, are significant factors affecting age at natural menopause. Our findings may help develop health policies and provide targeted care to improve women's health after midlife.

Social policies and breastfeeding duration in South Korea: A survival analysis of the national data.

OBJECTIVES: Parenting support policies increase the period that the mother and child spend together after childbirth, which is expected to facilitate breastfeeding. Additionally, the mother's attitudes towards parenting may influence her willingness to breastfeed. The objective of this study was to identify the association of breastfeeding duration with parenting support policies and mothers' attitudes towards parenting. DESIGN: This study employed a cross-sectional design. SETTING: The study was conducted using data from South Korea's 2018 National Survey on Fertility and Family Health and Welfare. PARTICIPANTS: Data of women with children born on or after January 2016 to September 2018 (N = 1,861) were analysed using Cox's proportional hazard regression model with the duration of breastfeeding as the outcome variable. MEASUREMENTS AND FINDINGS: The main predictors comprised social policy factors (hospital environment and parenting support) and individual factors (mothers' attitudes towards parenting). The median duration of breastfeeding was 5 months. Not initiating breastfeeding within 1 h of birth (hazard ratio = 1.215, 95% confidence interval 1.07-1.37, p = .002) and a negative attitude towards the necessity of having children (hazard ratio = 1.153, 95% confidence interval 1.02-1.30, p = .021) were associated with a shorter breastfeeding duration after controlling for age, occupation, number of pregnancies, number of births, and the infant's birth weight. However, social policy factors were not associated with breastfeeding duration. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: This study shows that breastfeeding within 1 h of birth as well as a positive attitude regarding the necessity of having children may increase the duration of breastfeeding. Therefore, the midwives and nurses in hospitals should encourage mothers to initiate breastfeeding within 1 h of birth. In addition, the government should improve positive attitudes towards parenthood amongst young adults.

Risk factors for unplanned extubation in ventilated neonates in South Korea.

PURPOSE: Although unplanned extubation (UE) is a common occurrence in neonatal intensive care units (NICUs), the factors influencing UE have not been clearly identified in South Korea. Therefore, we investigated the incidence of UE along with its risk factors among neonates in the NICU. DESIGN AND METHODS: This retrospective cohort study was conducted in a single NICU in B city. The electronic medical records of 137 ventilated neonates admitted between January 2017 and June 2018 were analyzed using an audit tool on extubation. Kaplan-Meier estimation and univariate and multivariate Cox proportional hazards models were used for statistical analyses. RESULTS: The rate of UE was 32.1%, with an incidence of 6.56 per 100 ventilation days during the 18-month study period. Risk factors for UE were the use of sedatives or analgesics; no re-fixation of the endotracheal tube (ETT); suction frequency; a high nurse-patient ratio; and working night shifts (weekdays 5 p.m. to 8 a.m.), weekends, or holidays. CONCLUSIONS: The rate of UE among neonates was found to be considerably higher than that of other countries. Among the various factors, nursing-related factors were most commonly associated with the risk of UE. APPLICATION TO PRACTICE: Various prevention strategies, including complete ETT fixation, maintaining ETT placement, a low nurse-patient ratio, and close observation of the ETT may help reduce UE in the NICU.

Association Between Timing of Sexual Initiation and Suicidal Ideation Among Adolescents in South Korea: A Cross-Sectional Study.

BACKGROUND: The age of adolescents' sexual initiation is decreasing worldwide. Early sexual initiation has been reported to affect social, physical, and mental health, but little is known about the relationship between the timing of sexual initiation and suicidal ideation. PURPOSE: This study was designed to identify the association between the timing of sexual initiation and suicidal ideation by gender. METHODS: This cross-sectional study used data from South Korea's Youth Health Behavior Online Survey for 2016. Data on first- to 12th-grade students (N = 10,810) were analyzed using descriptive statistics, χ2 tests, and hierarchical logistic regression. RESULTS: The results revealed a significant relationship between early sexual initiation and suicidal ideation among both boys and girls. This relationship remained significant after controlling for confounding variables that are known to affect suicidal ideation, including perceived stress, hopelessness, school grades, and sociodemographic characteristics. The risk of suicidal ideation was higher among students who first experienced sex in earlier grades (before the ninth grade) and was also higher in girls than in boys. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Health providers should be aware of the potentially higher risk of suicidal behavior among adolescents after early sexual initiation. Given the extreme sensitivity and vulnerability of this target population, a multidisciplinary school- or community-based intervention program to promote the mental health of affected individuals and the general student population is warranted.

Impact of Birth Cohorts in Breast Cancer Risk Among South Korean Women.

BACKGROUND: The incidence of breast cancer among South Korean women, a historically low-risk population, has increased over the past 3 decades, with marked changes in socioeconomic environment by birth cohort. OBJECTIVES: We investigated associations between breast cancer risk and reproductive factors as well as the impact of birth cohort in those associations. METHOD: This was a cross-sectional study of data from the Korea National Health and Nutrition Examination Survey for 2013-2016. Data from 10 012 parous women 30 years or older were analyzed using descriptive statistics and Cox multivariate regression after adjusting for socioeconomic status, educational level, occupation, and birth cohort. RESULTS: Of the reproductive factors considered-age at menarche, number of pregnancies, age at first birth, age at last birth, breastfeeding duration, and use of oral contraceptives-only age at menarche was associated with breast cancer risk. Higher educational level, not having an occupation, and younger birth cohort were also associated with increased risk of breast cancer, with birth cohort the strongest of these impact factors. CONCLUSION: Whereas the relationship between reproductive factors and breast cancer risk was relatively weak, birth cohort was the most important risk factor for breast cancer. IMPLICATIONS FOR PRACTICE: The results provide a basis and a rationale for developing birth cohort-based clinical guidelines for breast cancer prevention and early detection, treatment, and survivorship. These findings should also be useful to researchers in other countries experiencing rapid changes in breast cancer incidence.

Transition shock and job satisfaction changes among newly graduated nurses in their first year of work: A prospective longitudinal study.

AIMS: To identify the changes in transition shock and job satisfaction among newly graduated nurses during their first year and examine the factors affecting these changes. BACKGROUND: Newly graduated nurses' high turnover is related to transition shock and job satisfaction. However, insufficient information exists on changes in these variables among such nurses. METHODS: A prospective longitudinal design was used. Participants were nurses newly graduated from nursing schools and working in hospitals in South Korea. There were 312, 195 and 120 participants at 4, 8 and 12 months, respectively. RESULTS: Transition shock and job satisfaction decreased as working period increased; transition shock was lower, and job satisfaction was higher in positive work environments. Linear mixed models revealed work environment was the only factor significantly related to transition shock and job satisfaction changes. CONCLUSION: The nurses' transition shock and job satisfaction varied as per working period and work environment, which were the most important factors of these changes. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers can be aware of transition shock and job satisfaction changes, assess their severity and implement solutions in their hospitals. Thus, retention strategies should differ according to the changing needs of nurses at different stages of their career.

Factors Affecting Posttraumatic Stress Disorder in South Korean Trauma Nurses.

Trauma nurses are exposed to suffering, death and dying, and vicarious trauma, which may result in nurses experiencing posttraumatic stress disorder (PTSD). This study aims to investigate the extent of PTSD and the effect of the frequency of traumatic events, coping strategies, and social support on PTSD in South Korean trauma nurses. A cross-sectional study was conducted. Participants were 145 trauma nurses recruited from 6 regional trauma centers in Korea. The data were collected through convenience sampling using self-administered questionnaires, including the Korean version of Impact of Event Scale-Revised (IES-R-K), the frequency of traumatic events, coping strategies, and social support. The data were analyzed with descriptive statistics, t test, analysis of variance, Pearson's correlation coefficients, and multiple linear regression. The prevalence of IES-R-K score of 25 or more (indicating a high risk of PTSD) was detected in 57.2% of the trauma nurses. The frequency of traumatic events, work at traumatic emergency units, dysfunctional coping, emotion-focused coping, and social support were found to be significantly associated with PTSD. Therefore, it is necessary to develop PTSD management programs in order to provide effective coping strategies and social support for relieving PTSD symptoms. At the same time, efforts to improve the working environment are needed.

Effects of pre-graduation characteristics and working environments on transition shock of newly graduated nurses: A longitudinal study.

BACKGROUND: The transition of newly graduated nurses to nursing practice is a considerable challenge and can lead to transition shock, which is defined as the difficulty experienced by newly graduated nurses during the transition from student to nurse. However, there have only been a few studies on the transition shock of newly graduated nurses and its influencing factors. OBJECTIVES: The purpose of this study was to determine the effects of pre-graduation characteristics and working environments on the transition shock of newly graduated nurses. DESIGN: A prospective, longitudinal, and correlational design was used. SETTINGS: Data were collected from 5 nursing colleges in South Korea. PARTICIPANTS: Participants included 312 newly graduated nurses who had graduated from the 5 nursing colleges in February 2016 and were working in hospitals. METHODS: A convenience sample of 526 undergraduate nursing students completed questionnaires, capturing demographic data and measuring grade point average, self-efficacy, and professional nursing values. After graduation, 317 of the participants responded to the second survey, which included measures of transition shock and working environments. Of these, 312 were used for the final analysis, excluding 5 with incomplete responses. Data were analyzed using descriptive, bivariate, and multivariate analyses as appropriate. RESULTS: The mean transition shock perceived by newly graduated nurses was 2.81 points on a 4-point scale. The factors significantly influencing transition shock were age, self-efficacy, working unit, desired unit, and nurse work environment. CONCLUSIONS: In order to reduce transition shock of newly graduated nurses, it is necessary for undergraduate programs to enhance their self-efficacy. It is also optimal to assign nurses into their desired unit and to improve nurse work environments. These changes will not only mitigate the transition shock of newly graduated nurses but will also contribute to the provision of quality nursing services at a hospital level.

Predictors of the Timing of Sexual Intercourse Initiation among Adolescents in South Korea.

While the age of sexual intercourse initiation has decreased in South Korea, its correlates have not been identified using a nationally representative sample. This study investigated the predictors of the timing of sexual intercourse initiation among high school students in South Korea. A total of 10,810 students in the twelfth grade were selected from the Youth Health Behavior Online Survey (2016), and their data were analyzed using descriptive statistics and survival analysis. Approximately 11.6% of boys and 5.1% of girls reported having sexual intercourse. Significant predictors of the timing of sexual intercourse initiation among male students were the presence of parents, living with their family, socioeconomic status, grade of alcohol consumption initiation, grade of smoking initiation, and school type. Except for school type, the same results were found for girls. Sex education that targets high risk groups using the factors identified in this study may be effective in influencing positive changes in behavioral outcomes, such as delayed initiation of sex.

Psychometric evaluation of the Environmental Reality Shock-Related Issues and Concerns instrument for newly graduated nurses.

BACKGROUND: Reality shock is a critical representation of the gap between nursing education and clinical practice and it is important to explore the level of reality shock among nurses. However, there is no relevant instrument to assess the level of reality shock in South Korea. OBJECTIVES: The purpose of this is to determine the validity and reliability of the Korean version of the Environmental Reality Shock-Related Issues and Concerns instrument. DESIGN: A cross-sectional study design was used in this study. SETTINGS: The data collection was conducted in selected 15 hospitals in South Korea. PARTICIPANTS: A convenience sample of 216 newly graduated nurses participated in the study. METHODS: The Korean version of the Environmental Reality Shock-Related Issues and Concerns instrument was developed through the forward-backward translation technique, and revision based on feedback from expert groups. The internal consistency reliability was assessed using Cronbach's alpha, and the construct validity was determined via exploratory and confirmatory factor analysis. RESULTS: The Korean version of the Environmental Reality Shock-Related Issues and Concerns has reliable internal consistency (Cronbach's alpha=0.91). Exploratory factor analysis revealed five factors including job, relationships, expectations, private life, and performance, which explained 61.92% of variance. The factor loadings ranged from 0.451 to 0.832. The five-factor structure was validated by confirmatory factor analysis (RMR<0.05, CFI>0.9). CONCLUSION: It was concluded that the Korean version of the Environmental Reality Shock-Related Issues and Concerns instrument has satisfactory construct validity and reliability to measure the reality shock of newly graduated nurses in South Korea.

[Development of the Transition Shock Scale for Newly Graduated Nurses].

PURPOSE: The purpose of this study was to develop a scale to assess the transition shock experienced by newly graduated nurses, and test the validity and reliability of the scale. METHODS: The initial items were identified through a review of literature and in-depth interviews with nine newly graduated nurses. Content validation of the items was evaluated by five nurse professors and three nurses. Participants were 269 newly graduated nurses who worked at six acute care hospitals in Busan, Ulsan, and Yangsan, South Korea. Data were analyzed using item analysis, exploratory and confirmatory factor analysis, criterion related validity, and internal consistency. RESULTS: The final scale consisted of 18 items and six factors (conflict between theory and practice, overwhelming workload, loss of social support, shrinking relationship with co-workers, confusion in professional nursing values, and incongruity in work and personal life), which explained 71.3% of the total variance. The six subscale model was validated by confirmatory factor analysis. Cronbach's alpha for the total items was. 89. Convergent validity was evaluated by analyzing total correlation with burnout (r=.71, p<.001) and turnover intention (t=5.84, p<.001). CONCLUSION: This scale can be used in the development of nursing interventions to reduce the transition shock experienced by newly graduated nurses.

Effects of Irrational Parenthood Cognition, Post Traumatic Stress Disorder and Spousal Support on Quality of Life of Infertile Women.

PURPOSE: This study examined degrees of irrational parenthood cognition, post traumatic stress disorder (PTSD), spousal support, and quality of life and investigated factors that influence the quality of life of infertile women. METHODS: Research design was a cross sectional correlational survey with a total of 113 female patients receiving treatment for infertility. Data were collected from August 1 to November 30, 2015. The collected data were analyzed using t-test, ANOVA, Pearson's correlation, and multiple regression analysis. RESULTS: The mean score of the quality of life was 59.0±14.8. The quality of life was significantly associated with irrational parenthood cognition (r=-.70), post traumatic stress disorder (r=-.65), and spousal support (r=.56). The factors significantly affecting the quality of life in infertile women were irrational parenthood cognition (ß=-.45), post traumatic stress disorder (ß=-.34), and spousal support (ß=.32). The explained variance by these factors was 70.4%, and the regression model was valid (F=89.81, p<.001). CONCLUSION: This study may contribute to the development of nursing intervention program to improve the quality of life of infertile women.

Impact of Sexual Attitude and Marital Intimacy on Sexual Satisfaction in Pregnant Couples: An Application of the Actor-Partner Interdependence Model.

PURPOSE: The purpose of this study was to investigate actor and partner effects of sexual attitude and marital intimacy on sexual satisfaction in pregnant couples. METHODS: Data were collected from 176 pairs of the pregnant couples visiting for prenatal care at hospitals from June 18 to September 24, 2016. The collected data were analyzed by paired t-test and Pearson's correlation coefficients using SPSS 18.0 and interdependent effect (Actor-Partner Interdependence Model analysis) through AMOS 18.0. RESULTS: The sexual attitude and marital intimacy of the pregnant woman did not have a partner effect on the sexual satisfaction of her husband, respectively (ß=.12, p=.141), (ß=.01, p=.938). The sexual attitude of the husband had a partner effect on the sexual satisfaction of the pregnant woman (ß=.13, p=.021), but the marital intimacy of the husband did not show a partner effect (ß=.07, p=.202). CONCLUSION: Study suggests that the sexual attitude and marital intimacy of pregnant couples should be considered as factors when developing an intervention to improve sexual satisfaction in couples. Moreover, pregnant couples should participate in intervention together because the sexual satisfaction has conceptual view of interdependence in two-person relationships.

[Risk factors for deliberate self-extubation].

PURPOSE: This study was conducted to analyze intubation survival rates according to characteristics and to identify the risk factors affecting deliberate self-extubation. METHODS: Data were collected from patients' electronic medical reports from one hospital in B city. Participants were 450 patients with endotracheal intubation being treated in intensive care units. The collected data were analyzed using Kaplan-Meier estimation, Log rank test, and Cox's proportional hazards model. RESULTS: Over 15 months thirty-two (7.1%) of the 450 intubation patients intentionally extubated themselves. The patients who had experienced high level of consciousness, agitation. use of sedative, application of restraints, and day and night shift had significantly lower intubation survival rates. Risk factors for deliberate self-extubation were age (60 years and over), unit (neurological intensive care), level of consciousness (higher), agitation, application of restraints, shift (night), and nurse-to-patient ratio (one nurse caring for two or more patients). CONCLUSION: Appropriate use of sedative drugs, effective treatment to reduce agitation, sufficient nurse-to-patient ratio, and no restraints for patients should be the focus to diminish the number of deliberate self-extubations.

Factors Influencing Desired Postnatal Weight Loss in Women after Birth.

PURPOSE: The purpose of this study was to identify factors influencing desired postnatal weight loss in women after birth. METHODS: With correlational survey design, 191women of the study participants completed questionnaires on their desired postnatal weight loss and related factors, and body and health concerns during their hospitalization after birth. Data were collected from February to May, 2011. Data were analyzed using t-test, ANOVA, Pearson correlation coefficients, and multiple linear regression. RESULTS: The women's gestational weight gain, pre-pregnant BMI, body concerns, expected time to reach the desired weight after birth and health concerns were identified as factors influencing desired postnatal weight loss in women after birth. The model explained 68% of the variance. CONCLUSION: Results suggest that nurses in women's health care should consider women's gestational weight, pre-pregnant BMI and their body concerns, health concerns and expected time to reach the desired weight after birth when developing weight management program for women after birth.

[Influence of childbirth experience and postpartum depression on quality of life in women after birth].

PURPOSE: The purpose of this study was to identify influence of childbirth experience and postpartum depression on quality of life in women after birth. METHODS: Two hundred and eleven postpartum women were asked to complete the questionnaires on their childbirth experience during their admission and on their postpartum depression and quality of life between one to three weeks after birth. Initial data were collected from February 1 to May 30, 2011 at two obstetric hospitals in Busan, Korea. Data were analyzed using t-test, ANOVA, Pearson correlation coefficients, and hierarchical multiple regression. RESULTS: The women's childbirth experience and postpartum depression were identified as factors influencing quality of life after birth. The model explained 50% of the variables. CONCLUSION: Results suggest that childbirth educators should include strategies to increase a positive childbirth experience and to decrease postpartum depression in their education programs in order to improve women's quality of life.

Effects of Self-breast Pumping in Primiparous Women after Cesarean Delivery.

PURPOSE: This study was done to identify the effects of self-breast pumping on breastfeeding rates and, the degree of breast milk fullness among primiparous women giving birth by cesarean section. METHODS: The study design was a non-synchronized posttest control group experiment with repeated measures. The participants were 60 women, 31 in the experimental group who used a manual pump 5 times a day after exclusive breastfeeding and 29 in the control group who breastfed exclusively with no other interventions. RESULTS: While self-breast pumping did not improve breastfeeding rates or the degree of breast milk fullness at any of the time points studied, breastfeeding rates continued to remain high till 12 weeks postpartum in both groups. CONCLUSION: Although some modifications in research methods will be required to identify the effects of breast pumping and exclusive breastfeeding, both these approaches can be used as interventions to improve breastfeeding rates and breast milk quantity.

Childbirth Experience of Participants in Lamaze Childbirth Education.

PURPOSE: This study was intended to explore the essential structure and the meanings of childbirth experiences among Korean women participated in Lamaze childbirth education. METHODS: Giorgi's phenomenological method was used to analyze data collected by in-depth interviews with six primiparous women from March to July 2009. RESULTS: Five components identified in the meanings of experience: 'Simplicity', 'Self-control', 'Uncontrollable pain', 'Spiritual maturity', 'Physiologic event'. CONCLUSION: The study results revealed that the childbirth experience was positive generally, partially influenced by Lamaze childbirth education. But, meanings of childbirth experience with Lamaze childbirth education were mostly physiological respect related to labor pain or one's own efforts to endure labor pain. Therefore, nursing strategies for drawing emotional and socio-environmental experiences from childbirth experience with Lamaze childbirth education is needed.

Postpartum Depressive Score and Related Factors Pre- and Post-delivery.

PURPOSE: This study aimed to identify the scores of postpartum depression(PPD) on the first day, 1st week, and 6th week after the delivery and to explore their related factors before and after delivery in postpartum women. METHODS: With a survey design, 293 postpartum women were recruited from a postpartum unit, Ilsin Christian hospital in Pusan via convenience sampling and were followed at 1st week and 6th week in the outpatient clinic. RESULTS: Results showed that the scores of PPD(EPDS score) were low at postpartum 1st day, 1st week and 6th week but prevalence of PPD(EPDS > or =13) was 3.1% at 1st day, 8.2% at 1st week and 7.5% at 6th week, respectively. The pre-delivery factors were experience of depression, and the post-delivery factors were baby's sex(1st day), no caregiver for baby(1st week), and no help and concern for taking care of baby from husband and family(1st day and 6th week). The greater satisfaction with becoming a mother and her life, and greater maternal attachment were related to lower level of PPD at the three time points. CONCLUSION: Regular screening for postpartum depression and supportive and informative education is needed for postpartum women visiting the outpatient clinic for follow-up.