The validity and reliability of the Korean version of the Cancer-chemotherapy Concerns Rating Scale.

OBJECTIVE: The Cancer-chemotherapy Concerns Rating Scale was developed in Japan for outpatients undergoing chemotherapy, and its validity and reliability have been reported. The purpose of the study was to test the reliability and validity of the Korean version of the Cancer-chemotherapy Concerns Rating Scale. METHODS: The questionnaire was filled out by 199 cancer patients, who were currently undergoing outpatient chemotherapy. The data were analyzed using exploratory factor analysis with Promax Rotation to determine the factor construct validity. The reliability of the Cancer-chemotherapy Concerns Rating Scale was investigated by Cronbach's alpha and the Spearman Brown coefficient. RESULTS: Four factors were obtained and the overall structure was similar to that of the Japanese version; reorganization of daily life, self-existence, disease progress, and social and economic concerns. Cronbach's alpha for the total scale was 0.91 and the Spearman Brown coefficient was 0.85. CONCLUSIONS: We found that the Korean version of the Cancer-chemotherapy Concerns Rating Scale could be clinically useful. It could provide health-care providers with information useful to understand the psychological state of patients undergoing outpatient chemotherapy.

Evaluation of falls by inpatients in an acute care hospital in Korea using the Morse Fall Scale.

The purpose of this study was to determine the cut-off values of the Korean version of the Morse Fall Scale (MFS-K) that would be most useful in identifying hospitalized patients at risk of falls in an acute-care setting in Korea. This study was conducted using the medical records of 66 patients who fell and 100 patients who did not fall (no-fall patients) sampled from inpatients hospitalized at a tertiary acute-care hospital in Seoul during the period from 1 January to 30 November 2009. The optimal cut-off point for the MFS-K was found to be 45 points, which produced an acceptable sensitivity and a fairly good specificity, negative predictive value and accuracy. The highest peak on the receiver operating characteristic curve was a cut-off score of 45 points in the MFS-K. Further research needs to be performed to determine the optimal cut-off score according to subjects' conditions through daily measurement with the MFS in medical or surgical patients who are relatively homogeneous in terms of individual and disease-related factors.

Perception, attitudes, preparedness and experience of chemotherapy-induced alopecia among breast cancer patients: a qualitative study.

OBJECTIVES: Regardless of its negative impact on quality of life, little is known about the importance of alopecia from the patients' perspective. This study aimed to explore the whole experience of chemotherapy- induced alopecia among Korean breast cancer patients including perception, attitudes, preparedness, and changes after alopecia. METHODS: Patients expected to experience or had experienced alopecia were recruited at a tertiary hospital in Seoul, Korea. Semi-structured in-depth interviews were performed in 21 patients. Recurrent issues were identified and placed into thematic categories. RESULTS: All patients think that appearance is important and they pay attention to how they look like. They had negative perceptions about alopecia. Patients were not well prepared for alopecia, and experienced substantial physical, psychological and social distress. Lack of information and limited social support combined with negative images of cancer made it difficult for patients to overcome the trauma and deterred them from usual daily activities resulting in poor quality of life. CONCLUSIONS: Patients were not well prepared for alopecia and negative perceptions, lack of preparedness, and limited social support and resources increased alopecia- related distress. Educational programs for preparing patients to cope with alopecia distress and advocate activities to change people's negative perception about alopecia are needed to reduce the burden imposed by alopecia in cancer patients.

Health-related quality of life in cancer patients between baseline and a three-year follow-up.

PURPOSE: The aim of the study was to identify health-related quality of life (QOL) in persons diagnosed with cancer and to determine differences between the QOL over a 3-year period. METHODS: We investigated the QOL in cancer patients at baseline and 3 years later using the EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30) and the ECOG (Eastern Cooperative Oncology Group) Performance Status. Initially 216 participants (85 women, 131 men) were enrolled, and at the 3-year follow-up there were 126 (52 women, 74 men). RESULTS: Scores on the function and symptom scales changed significantly between the baseline and the 3-year follow-up. Physical, role, and social functions improved, whereas problems with constipation worsened. The global QOL of the participants at the 3-year follow-up was lower than that of baseline, but it was not statistically significant. The QOL in cancer patients improved from the baseline to the 3-year follow-up. CONCLUSION: The results could serve as a guideline for nurses interpreting the perspective of QOL in their own groups of patients, and improve the understanding of the significance of mean QOL scores and develop nursing interventions in the future.

Symptom clusters and quality of life in Korean patients with hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is the fifth most common malignancy worldwide, causing about 1 million deaths annually. Patients with HCC usually reported multiple concurrent symptoms. The purpose of this multivariate study was to explore whether multiple concurrent symptoms are clustered into groups of symptoms and to explore the effect of symptom clusters on the quality of life (QOL) in patients with HCC. A sample of 180 patients with HCC at a medical center in Korea was recruited. Patients completed a demographic questionnaire, a Symptom Checklist, the Hospital Anxiety and Depression Scale, and the Functional Assessment of Cancer Therapy-Hepatobiliary. Factor analysis was used to identify symptom clusters based on the severity of patients' symptom experiences. Four symptom clusters were identified: pain-appetite, fatigue related, gastrointestinal, and itching-constipation. Two patient subgroups were identified through cluster analysis: high- and low-symptom group. Patients in the high-symptom group had significantly poorer functional status and poorer QOL in all the domains, with the exception of social well-being. The differences between the 2 patient subgroups were not only statistically but also clinically significant. Patients in the high-symptom group were also statistically and clinically anxious and depressed. Further research is needed to explore whether compositions of symptom cluster phenotypes vary over time and whether the associations of symptom clusters with QOL and mood are changing along the disease and treatment trajectory as well as symptom status.

[Identification and validation of symptom clusters in patients with hepatocellular carcinoma].

PURPOSE: The purpose of this study was to identify cancer-related symptom clusters and to validate the conceptual meanings of the revealed symptom clusters in patients with hepatocellular carcinoma. METHODS: This study was a cross-sectional survey and methodological study. Patients with hepatocellular carcinoma (N=194) were recruited from a medical center in Seoul. The 20-item Symptom Checklist was used to assess patients' symptom severity. Selected symptoms were factored using principal-axis factoring with varimax rotation. To validate the revealed symptom clusters, the statistical differences were analyzed by status of patients' performance status, Child-Pugh classification, and mood state among symptom clusters. RESULTS: Fatigue was the most prevalent symptom (97.4%), followed by lack of energy and stomach discomfort. Patients' symptom severity ratings fit a four-factor solution that explained 61.04% of the variance. These four factors were named pain-appetite cluster, fatigue cluster, itching-constipation cluster, and gastrointestinal cluster. The revealed symptom clusters were significantly different for patient performance status (ECOG-PSR), Child-Pugh class, anxiety, and depression. CONCLUSION: Knowing these symptom clusters may help nurses to understand reasonable mechanisms for the aggregation of symptoms. Efficient symptom management of disease-related and treatment-related symptoms is critical in promoting physical and emotional status in patients with hepatocellular carcinoma.

Blended learning on medication administration for new nurses: integration of e-learning and face-to-face instruction in the classroom.

PURPOSE: This study analyzed the effects of a blended learning program on medication administration by new nurses using a non-equivalent groups design. METHOD: A medication education program using blended learning (including e-learning) was administered to 26 new nurses, while face-to-face instruction in the classroom was given to 24 new nurses. The following dependent variables were compared: degree of knowledge of medication, self-efficacy of medication administration, medication-administration ability, and satisfaction with the learning program. RESULTS: The experimental, blended learning group showed a significantly higher level of knowledge of medication and satisfaction with the comprehensiveness of their medication learning, but the self-efficacy of medication administration, medication-administration ability, and other items related to their learning satisfaction did not differ significantly from that in the control group. CONCLUSION: These results suggest that blended learning integrating e-learning and face-to-face instruction in the classroom is useful for enhancing medication knowledge. An e-learning program can reduce the lecturing time and cost of repeated topics such as medication, suggesting that it can be an effective component in nurse education programs.

[Hospital nurses' experience of do-not-resuscitate in Korea].

PURPOSE: The purpose of the study was to describe the experiences of do-not-resuscitate (DNR) among nurses. METHODS: Data were collected by in-depth interviews with 8 nurses in 8 different hospitals. Conventional qualitative content analysis was used to analyze the data. RESULTS: Eight major themes emerged from the analysis: DNR decision-making bypassing the patient, inefficiency in the decision-making process of DNR, negative connotation of DNR, predominance of verbal DNR over written DNR, doubts and confusion about DNR, least amount of intervention in the decision for DNR change of focus in the care of the patient after a DNR order, and care burden of patients with DNR. Decision-making of DNR occurred between physicians and family members, not the patients themselves. Often high medical expenses were involved in choosing DNR, thus if choosing DNR it was implied the family members and health professionals as well did not try their best to help the patient. Verbal DNR permission was more popular in clinical settings. Most nurses felt guilty and depressed about the dying/death of patients with DNR. CONCLUSION: Clearer guidelines on DNR, which reflect a family-oriented culture, need to be established to reduce confusion and to promote involvement in the decision-making process of DNR among nurses.

[Factors influencing nurses' clinical decision making--focusing on critical thinking disposition].

PURPOSE: The purpose of this study was to investigate the factors influencing nurses' clinical decision making focusing on critical thinking disposition. METHODS: The subjects of this study consisted of 505 nurses working at one of the general hospitals located in Seoul. Data was collected by a self-administered questionnaire between December 2006 and January 2007. Data was analyzed by one way ANOVA, Pearson correlation coefficients, and stepwise multiple regression using SPSS Win 14.0. RESULTS: The mean scores of critical thinking disposition and clinical decision making were 99.10 and 134.32 respectively. Clinical decision making scores were significantly higher in groups under continuing education, with a master or higher degree, with clinical experience more than 5 years, or with experts. Critical thinking disposition and its subscales have a significant correlation with clinical decision making. Intellectual eagerness/curiosity, prudence, clinical experience, intellectual honesty, self-confidence, and healthy skepticism were important factors influencing clinical decision making(adjusted R(2)=33%). CONCLUSION: Results of this study suggest that various strategies such as retaining experienced nurses, encouraging them to continue with education and enhancing critical thinking disposition are warranted for development of clinical decision making.

The roles of critical care advanced practice nurse.

PURPOSE: To determine and compare the perception among nurses and doctors of the roles and tasks of critical care advanced practice nurses (APNs) in order to establish standardized and formally agreed role criteria for such critical care APNs. METHOD: This study measured and analyzed the necessity of each of the roles and tasks of critical care APNs, as perceived by nurses and doctors, through a survey of 121 participants: 71 nurses in 7 intensive care units (ICUs) at a general hospital in Seoul, and 50 doctors who used ICUs. Data collection utilized a questionnaire of 128 questions in the following fields: direct practice (79), leadership and change agent (17), consultation and collaboration (15), education and counseling (11), and research (6). RESULTS: Both the nurses' and the doctors' groups confirmed the necessity of critical care APNs, with doctors who frequently used ICUs indicating a particularly strong need. As for the priority of each role of critical care APNs, the nurses considered direct practice to be the most critical, followed by education and counseling, research, consultation and collaboration, and leadership and change agent. The doctors also considered direct practice to be the most critical, followed by education and counseling, consultation and collaboration, research, and leadership and change agent. There was a statistically significant difference between how the two groups regarded all the roles, except for the consultation and collaboration roles. As for the necessity of each role of critical care APNs, the nurses considered research to be the most necessary, followed by education and counseling, consultation and collaboration, leadership and change agent, and direct practice. The doctors, on the other hand, considered education and counseling to be the most necessary, followed by research, consultation and collaboration, leadership and change agent, and direct practice. The responses of the two groups to all the roles, except for education and counseling roles, were significantly different. CONCLUSION: Nurses and doctors have different perceptions of the roles and tasks of critical care APNs. Thus, it is necessary for the combined nursing and medical fields to reach an official agreement on a set of criteria to standardize for the roles and tasks of critical care APNs.

[Development of an e-learning program about medication for new nurses].

PURPOSE: The purpose of this study was to develop an e-Learning program about medication for nurses to enhance nurses' medication performance ability and to analyze learners' responses after studying with this program. METHOD: For the development of the e-Learning program, the NBISD(Network Based Instructional Systems Design) model, suggested by Jung(1999) was applied as a basic model and the instruction design theory of Gagne & Briggs(1979) and ARCS theory of Keller(1983) were applied. After the operation of this program for one month to 34 new nurses, learners' responses were analyzed. RESULT: Learners' knowledge of medication was greatly improved after this program. In addition learners' satisfaction with the overall education program, help in field applicability, ease of screen shift and exploration, and tutor activities were high and the contents were regarded suitable for e-Learning. Many things were advantageous such as easy accessibility, easy understandability with pictures and flash animation, practical cases and feedback from a tutor. Provision of a supplementary handout and improvement of a tight time schedule were pointed out as things to be improved. CONCLUSION: This e-Learning program can be used effectively for medication education for registered nurses, student nurses, and new nurses.