Development of a mobile application based on the salutogenic model for self-management in adolescents with Moyamoya disease.

PURPOSE: Moyamoya disease (MMD) is a rare disease which has a high incidence of onset in adolescence. Disease self-management skills are imperative for adolescents with MMD. This study aimed to describe the systematic development, content, and usability of the Moyamoya Healthy Youth application (app), which was developed to enhance self-management skills for adolescents with MMD. DESIGN AND METHODS: The theoretical grounding for the app was salutogenic model and the development process of the app was guided by the intervention mapping (IM) protocol. Results of each IM step were applied to the next step leading to the design of the app. Additionally, a pilot test was conducted to determine the usability of the app. RESULTS: Following the salutogenic model, we identified the stressors, behaviors, and resources regarding managing symptoms of MMD by interviewing adolescents with MMD, their parents, and healthcare providers. Based on the findings of the interviews, we determined the program outcomes and performance objectives to improve the self-management of MMD in adolescents. The app was developed by translating the theoretical methods to achieve the performance objectives into practical strategies for delivering the program. A pilot test with eight participants showed satisfaction with the app in terms of its usefulness and ease of use. CONCLUSION: We delineated the development process of the Moyamoya Healthy Youth. Additionally, we presented the positive outcomes regarding the usability of the app. PRACTICE IMPLICATIONS: The Moyamoya Healthy Youth app could benefit adolescents with MMD, by improving their self-management skills which are crucial for their health.

Risk and protective factors for a salutogenic sense of health in adolescents with Moyamoya disease.

PURPOSE: To identify the risk and protective factors affecting a salutogenic sense of health in adolescents with Moyamoya disease based on Antonovsky's salutogenesis theory. METHODS: This study used a qualitative descriptive design. We interviewed adolescents diagnosed with Moyamoya disease and their parents and experts with experience in treating them from 4 July 2019 to 10 October 2019. Data analysis was performed according to the process of deductive content analysis based on Antonovsky's salutogenesis theory. RESULTS: This study identified risk and protective factors affecting a salutogenic sense of health in adolescents with Moyamoya disease. Risk factors were closely related to problems with friends, parent relationships and academic work. Protective factors were identified as emotional support through interpersonal relationships, positive attitudes to the disease situation, ability to understand and predict patterns of symptoms, increasing strength to resolve the state of tension and developing available resources. CONCLUSION: The factors affecting a salutogenic sense of health in adolescents were identified reflecting on the characteristics of the developmental stage of adolescents and the symptoms and situations that are unique to adolescents. It is important for adolescents with Moyamoya disease to recognize available resources and use them appropriately to successfully manage the state of tension caused by stress.

Effectiveness of mHealth-Safe Kids Hospital for the prevention of hospitalized children safety incidents: A randomized controlled trial.

BACKGROUND: Preschool-age children in hospitals are at a high risk of unexpected incidents. Safety incidents in hospitals can cause serious damage to the children. OBJECTIVE: To determine the effectiveness of the mobile-type mHealth Safe Kids Hospital (SKH) application (app) for the prevention of hospitalized child safety incidents. DESIGN: This study used a three-group, randomized controlled trial pre-post design. SETTING(S): This study was conducted in the pediatric ward of three general hospitals in Korea. PARTICIPANTS: A total of 124 eligible hospitalized children and their caregivers were enrolled in the study from June to December 2018. Of these, 116 finally participated in the study, and 8 were excluded because they were discharged before the intervention. METHODS: Hospitalized preschool-age children and their caregivers were randomly allocated into three groups: experimental group I (n = 39), experimental group II (n = 39), and the control group (n = 38). Experimental group I received the SKH app intervention, the experimental group II received a paper-based intervention, whereas the control group received the usual intervention. Participants' outcomes of awareness, knowledge, and behavior related to hospital safety, were assessed at two time points: baseline and 24 h after the intervention. RESULTS: Hospital safety awareness had a higher increase after intervention in experimental groups I and II than in the control group. Among the four subdomains of hospital safety awareness, there was a significant increase in the scores of experimental group I on three subdomains after the intervention: falls (F = 8.19, p < 0.001), burns (F = 6.73, p = 0.002), and medical devices (F = 6.81, p = 0.002). In hospital safety knowledge and safety behavior, experimental group I had the highest average score after the intervention compared with experimental group II and the control group; however, there was no statistically significant difference in the average score of the three groups. CONCLUSIONS: Using the SKH app is easy to attract the interest of preschool-age children and is also easy for nurses to use in clinical trials; thus, it is considered to be a useful educational intervention to prevent safety incidents in clinical fields in future. CLINICAL RELEVANCE: It is thought to contribute to the prevention of preschool-age children's safety incidents in pediatric wards.

Features and diversity of symptoms of moyamoya disease in adolescents: A cluster analysis.

AIMS: The purpose of this study is to explore the symptoms experienced by adolescents with moyamoya disease and to identify the characteristics of each symptom cluster associated with moyamoya disease. DESIGN: A retrospective and descriptive design, which is a secondary data analysis study based on electronic medical record data from hospitals. METHODS: To assess the symptoms associated with moyamoya disease, a qualitative study was conducted on 12 adolescents, 12 caregivers and 12 experts on moyamoya disease. According to a qualitative study, 12 main symptoms (limb weakness, numbness, pins and needles, difficulty in speech, blurred vision, facial paralysis, hand tremors, involuntary movements, convulsions, dizziness, nausea/vomiting and headaches) were selected. Data were collected around these symptoms. The data collection was carried out through the Electronic Medical Record (EMR) data of 303 adolescents aged 13-19 who were diagnosed with moyamoya disease (ICD 10 Code: I67.5) between January 2010-December 2019 in a hospital in Seoul, South Korea. Cluster analysis was applied to identify symptom clusters with the hierarchical cluster agglomerative approach. We used the log-likelihood distance to measure the similarity of variables. Proximity between groups of variables was measured using the two-step method. RESULTS: The physical symptoms experienced by adolescents with moyamoya disease were 'limb weakness' - the most common - followed by a 'headache,' 'difficulty in speech,' and 'nausea/vomiting.' A total of five symptom clusters were derived: cluster 1 was characterized by 'limb weakness'; cluster 2 participants were asymptomatic or experienced 'convulsions'; cluster 3 experienced 'difficulty in speech' and 'facial paralysis'; cluster 4 is prone to 'dizziness' and 'pins and needles'; and cluster 5 displays 'headaches' and 'nausea/vomiting'. CONCLUSION: This study offers a multidimensional approach for identifying differences in clinical symptoms of moyamoya disease among adolescents. IMPACT: These results will help provide interventions concerning the characteristics of the symptoms of moyamoya disease among adolescents.

The Hospital Safety Scale for Kids: Development of a new measurement tool for hospitalized children.

This study aimed to develop an instrument to assess the perception of hospital safety among hospitalized children for preschool age children. An initial 30 items of the preliminary Hospital Safety Scale for Kids (HSS-Kids) were generated based on literature reviews and focus-group interviews. The 30 items were developed as different types of hospital-based incidents, situation scenarios, and pictorial animation cards for describing them. The evaluation process was conducted with a sample of 150 hospitalized children and their caregivers. Construct, convergent, and discriminant validities were tested by exploratory and confirmatory factor analyses. For criterion validity, concurrent validity was confirmed, and reliability was established through Cronbach's α coefficients. The final 15 HSS-Kids hospital scenario picture cards were categorized into four subdomains, falls, general injuries, burns, and medical devices, which explained 62.92% of the total variance. The HSS-Kids demonstrated construct, convergent, discriminant, and concurrent validity, with Cronbach's αs ranging from .649 to .792. The HSS-Kids is a promising instrument to screen children at high risk of incidents by capturing their perception on hospital safety.

Pediatric nurses' grit and nursing intention during the COVID-19 pandemic: Mediating and moderating effects of mindset and psychological collectivism.

PURPOSE: This study aimed to identify the mediating and moderating effects of mindset and psychological collectivism, respectively, on the relationship between grit and nursing intention for children with emerging infectious diseases, including coronavirus disease 2019 (COVID-19), among pediatric nurses. METHODS: We conducted a crosssectional descriptive study with 230 pediatric nurses. RESULTS: Grit directly impacted mindset (ß=.27, p<.001) and nursing intention (ß=.20, p=.001). The direct effect of mindset on nursing intension (ß=.28, p<.001) and the indirect effect of grit on nursing intension via mindset (ß=.08, p<.001) were significant. Accordingly, mindset mediated the effect of grit on nursing intention. The effects of grit and psychological collectivism (ß=.19, p=.003), respectively, on nursing intention were significant. However, the interaction between grit and psychological collectivism was not significant. Thus, psychological collectivism did not moderate the effect of grit on nursing intention. CONCLUSION: The findings demonstrate the importance of pediatric nurses' grit and mindset on their intended care for patients in critical situations. Cultivating a gritty culture and developing interventions to enhance nurses' personality traits associated with their performance will be crucial, and such measures are especially salient for pediatric nurses to face the new adjustments required in the era of COVID-19.

Development and Effects of a Mobile Application for Safety Incident Prevention among Hospitalized Korean Children: A pilot Study of Feasibility and Acceptability.

PURPOSE: This study aimed to describe the development, feasibility, acceptability, and effectiveness of a safety incident prevention program using the Safe Kids Hospital (SKH) application (app) among hospitalized Korean children aged 3-6 years. DESIGN AND METHODS: Through a literature review of studies on the development of mobile apps for child safety education, reference to educational apps on YouTube, and discussions among the research team, the SKH, a 2D game-based learning app, was developed. The SKH makes use of hospital pictures from the Hospital Safe Scale-Kids (HSS-Kids) test, a structured pictorial questionnaire that measures hospitalized children's safety awareness. This study was a pilot test of the SKH app in an urban Korean medical center. A one-group pre-posttest design was used to evaluate the effect of the SKH app among 30 child-caregiver (parent or grandparent) pairs using the HSS-Kids. In addition, semi-structured interviews were conducted to explore participants' experiences related to using the app. Quantitative and qualitative data were analyzed with t-test and content analysis, respectively. RESULTS: The mean age of the children was 4.5 years. Their level of safety awareness increased after the safety incident prevention program using the SKH app (M = 17.80, 24.53; t = 6.275, p < 0.001). Participants considered the app easy to use and a fun way of learning, expressing overall satisfaction with the education program. CONCLUSIONS: The effectiveness, feasibility, and acceptability of the SKH app were established. PRACTICE IMPLICATIONS: The SKH app is a promising educational method in pediatric settings.

Changes in the Reciprocal Relationship Between Parenting and Self-Awareness During Adolescence: A Longitudinal Analysis of National Big Data.

PURPOSE: This study aimed to identify the reciprocal relationship between parenting and self-awareness during adolescence. DESIGN AND METHODS: This study analyzed longitudinal data from the Korea Children and Youth Panel Survey at three time points over a four-year period. Individuals (n = 2092; mean age 12.95 years) in their first year of middle school participated at the beginning of the survey. Repeated measurements were performed for the same participants in their third year of middle school and first year of high school between 2010 and 2016. Participants completed 18 self-awareness (self-esteem and self-identity) items and 21 parenting (positive and negative) items at three different time points. The autoregressive cross-lagged model was used to examine the causal relationship between parenting and adolescents' self-awareness. RESULTS: Positive parenting and adolescents' self-awareness influenced each other. In terms of the magnitude of the effects of the two variables, the impact of adolescents' self-awareness on positive parenting was greater than that of positive parenting on adolescents' self-awareness. Adolescents' self-awareness at the previous time points negatively predicted negative parenting at the later time points. However, negative parenting at the previous time points was not a significant predictor of adolescents' self-awareness at the later time points. CONCLUSIONS: In this study, the impact of adolescents' self-awareness on parenting was greater than was the case vice versa. This result could be regarded as reflecting adolescents' developmental characteristics. PRACTICE IMPLICATIONS: Intervention programs directly focusing on improving adolescents' self-awareness may be more effective than parenting interventions to improve self-awareness in adolescents.

[Mediating and Moderating Effects of Multicultural Efficacy in the Relationship between Cultural Empathy and Cultural Competence in Child Care Teachers]. / 보육교사의 ë¬¸í™”ì  공감과 ë¬¸í™”ì  역량에 대한 다문화 효능감의 매개효과와 ì¡°ì ˆíš¨ê³¼.

PURPOSE: This study examined the mediating and moderating effects of multicultural efficacy in the relationship between cultural empathy and cultural competence in child care teachers. METHODS: A cross-sectional descriptive survey design was used. The participants were 277 child care teachers at private and public daycare centers in G and S districts of Seoul. The survey instruments included a cultural empathy questionnaire, a multicultural efficacy scale, and a cultural competence scale. Data were analyzed using the SPSS and AMOS programs. For data analysis, descriptive statistics, correlation, and mediating and moderating effect analyses were performed. Bootstrapping was implemented to verify the mediating effect of the model developed herein. RESULTS: Positive correlations among cultural empathy, multicultural efficacy, and cultural competence were noted. Multicultural efficacy showed a significant mediating effect on the relationships between cultural empathy and cultural competence. However, there was no moderating effect. CONCLUSION: In order to enhance the cultural competence of child care teachers, it is necessary to develop a strategy that can promote their cultural empathy and multicultural efficacy. Furthermore, these results will ultimately enhance the role of child care teachers, thus contributing to the normal growth and development of multicultural children.